MyMedR

Fulltext Update on the management of diabetes during Ramadan fast for healthcare practitioners

Rathor MY, Mohammad Fauzi AR, Omar AM

International Medical Journal Malaysia, 2014;13(2):67-72.

MyJurnal

Fasting during the month of Ramadan is one of the five pillars of Islam, a recurring annual ritual, which is passionately practiced by most Muslims across the world. It is obligatory on every healthy Muslim; however, the Qur’an and Islamic teachings specifically exempt people with acute or chronic illnesses from this duty, especially if it might have harmful consequences. Muslims with diabetes are exempted from fasting, but many of them still fast during Ramadan, for their personal convictions as revealed by EPIDIAR study which showed that 43% of patients with type 1 diabetes and 79% with type 2 diabetes fasted during Ramadan. Muslims constitute about a quarter of the world’s population who are spread all over the globe. It is inevitable that health care issues peculiar to them will be encountered worldwide and health care providers will have to counsel them regarding medications and whether it is safe to undertake the fast. This paper is an update on the management of Ramadan fasting based on current evidence from published literature and expert opinions.

Evaluation of medical image watermarking with tamper detection and recovery (AW-TDR)

Zain JM, Fauzi AR

Annu Int Conf IEEE Eng Med Biol Soc, 2007;2007:5662-5.

PMID: 18003297

This paper will study and evaluate watermarking technique by Zain and Fauzi [1]. Recommendations will then be made to enhance the technique especially in the aspect of recovery or reconstruction rate for medical images. A proposal will also be made for a better distribution of watermark to minimize the distortion of the Region of Interest (ROI). The final proposal will enhance AW-TDR in three aspects; firstly the image quality in the ROI will be improved as the maximum change is only 2 bits in every 4 pixels, or embedding rate of 0.5 bits/pixel. Secondly the recovery rate will also be better since the recovery bits are located outside the region of interest. The disadvantage in this is that, only manipulation done in the ROI will be detected. Thirdly the quality of the reconstructed image will be enhanced since the average of 2 x 2 pixels would be used to reconstruct the tampered image.

Fulltext Usefulness of cytological specimens from bronchial brushings and bronchial washings in addition to endobronchial biopsies during bronchoscopy for lung cancer: 3 years data from a chest clinic in a general hospital

Fauzi AR, Balakrishnan L, Rathor MY

Med J Malaysia, 2003 Dec;58(5):729-34.

PMID: 15190660

A retrospective review of all bronchoscopy cases for investigation of lung cancer between January 1997 and December 1999 was done. The cases were included if endobronchial mass was visible (Group A) or when there was an abnormal mucosa and/or bronchial narrowing in the absence of a mass (Group B). All patients in Group A (n = 177) underwent endobronchial biopsy (EB) bronchial brushings (BB) and bronchial washings (BW). All cases in Group B underwent transbronchial biopsy (TBB), BB and BW. Only a small increase in the positive results for cancer was seen when cytology specimens (BB and BW) were added to EB (85.3% vs 88.1%, McNemar's P = 0.06) in Group A but there was a significant increase in Group B (37.3% vs 54.2%. McNemar's, P = 0.001). Therefore although cytology specimens did not significantly add to overall yield of positive results when endobronchial lesions were visible, when mass lesions were not visible, cytology specimens increased the yield by 16.9%.
Study site: Chest clinic, Hospital Sultanah Aminah (HSA), Johor Bahru, Johor, Malaysia

Outcomes and prognostic factors for survival of children with oesophageal atresia

Lestiono A, Fauzi AR, Agustriani N, Wibowo T, Gunadi

Med J Malaysia, 2024 Aug;79(Suppl 4):12-16.

PMID: 39215409

INTRODUCTION: Oesophageal atresia (EA) is a life-threatening congenital oesophageal deformity that causes considerable newborn morbidity and death. Many prognostic variables have been linked to the survival of infants with EA, although the results of the studies are still conflicting. Furthermore, studies on EA effects in developing countries still need to be included. Here, we aimed to determine the survival of children with EA and link it to prognostic variables in a particular developing country.

MATERIALS AND METHODS: A cross-sectional observational retrospective study was conducted using medical records of paediatric patients with EA at our institution from January 2014 to December 2020.

RESULTS: A total of 53 children with EA were included in the study. Log-rank analysis showed that definitive surgery and thrombocytopenia were significantly associated with the survival of children with EA, with a p-value of 0.007 and 0.002, respectively, whereas, sex, EA type, pneumonia and sepsis were not (p = 0.898, 0.919, 0.255, and 0.499, respectively). Multivariate analysis revealed that thrombocytopenia and definitive surgery were strongly associated with the survival of children with EA with a pvalue of 0.014 (hazard ratio (HR) = 2.67 [95% confidence interval (CI) = 1.22-5.85]) and 0.022 (HR =0.39 [95% CI = 0.17- 0.87]), respectively.

CONCLUSION: Our study shows that thrombocytopenia might increase mortality, while definitive surgery might be beneficial for the survival of paediatric patients with EA. It implies that definitive surgery should be performed as early as necessary to prevent further morbidity and mortality. Our study comprehensively provides the survival of children with EA and links it to prognostic variables in a particular developing country. It serves as a potential research project that can be applied to the clinical setting to help clinicians manage EA better.

Fulltext An unusual cause of haemoptysis and headache: cryptococcosis

How SH, Kuan YC, Ng TH, Ramachandram K, Fauzi AR

Malays J Pathol, 2008 Dec;30(2):129-32.

PMID: 19291924 MyJurnal

Pulmonary cryptococcosis can be clinically silent in non-HIV infected patients but can also present as nodules and masses on the chest radiograph, which can be mistaken for tuberculosis or lung cancer. Common symptoms include fever and cough, and uncommonly haemoptysis. This report illustrates a non-HIV infected patient whose main complaint was haemoptysis and headache. He was diagnosed with pulmonary cryptococcosis from biopsy of an endobronchial mass found on flexible bronchoscopy. Disseminated cryptoccoccal infection should be considered as a differential diagnosis in non-HIV infected patients presenting with haemoptysis and headache. Early recognition and administration of appropriate therapy will improve clinical outcome in these patients.

Brachiocephalic vein stenosis in a patient with end-stage renal disease without prior central vein cannulation

Fauzi AR, Jeyabalan V, Kong NC, Selvam T

Saudi J Kidney Dis Transpl, 2003 Apr-Jun;14(2):194-6.

PMID: 18209446

Central vein stenosis is usually associated with previous cannulation or trauma to the affected vein. This pathology may present as ipsilateral arm swelling in patients in whom a recent arteriovenous fistula has been prepared for chronic hemodialysis. The presence of central vein stenosis without prior trauma or cannulation is not hitherto reported to the best of our knowledge. We herewith report a patient with end-stage renal disease who was initiated on chronic dialysis using an arteriovenous fistula, who was noted to have central vein stenosis. This was despite her never having had any central vein cannulation or previous known trauma. Venogram confirmed the presence of brachiocephalic vein stenosis. The patient underwent venographic stenting of the involved vein with good success.

Fulltext Hospitalised patients' awareness of their rights: a cross-sectional survey from a tertiary care hospital on the east coast of Peninsular Malaysia

Yousuf RM, Fauzi AR, How SH, Akter SF, Shah A

Singapore Med J, 2009 May;50(5):494-9.

PMID: 19495519

Optimal patient care varies considerably from place to place and is influenced by scientific as well as social developments. The purpose of this study was to investigate awareness and pertinent issues regarding informed consent among hospitalised patients and to determine lapses, in order to improve the standard of care.

Fulltext Invasive rhinocerebral mucormycosis with orbital extension in poorly- controlled diabetes mellitus

Hadzri MH, Azarisman SM, Fauzi AR, Kahairi A

Singapore Med J, 2009 Mar;50(3):e107-9.

PMID: 19352553

Rhinocerebral mucormycosis is an invasive fungal sinusitis with a high mortality rate, especially in immunocompromised patients. A 70-year-old woman, with uncontrolled type 2 diabetes mellitus, presented with a one-month history of non-specific headaches associated with progressive swelling of her left eye. Computed tomography of the brain and orbits showed the extensive involvement of bilateral intranasal sinuses, orbits, extraocular muscle and soft tissues. The diagnosis of invasive mucormycosis was confirmed from a tissue biopsy taken from the internasal septum. Despite the extensive mucormycosis invasion, she was successfully treated with intranasal and systemic amphotericin B and minimal adjunctive intranasal sphenoidotomy.

Fulltext The man with the boggy head: cranial melioidosis

Kuan YC, How SH, Ng TH, Fauzi AR

Singapore Med J, 2010 Feb;51(2):e43-5.

PMID: 20358143

Melioidosis is known to cause abscesses in various organs, including the cranium, though less commonly. We present a patient with scalp abscess and subdural empyema that was visible on computed tomography of the brain. The neurosurgical drainage grew Burkholderia pseudomallei. Despite our best effort to treat the patient using parenteral antibiotics and surgical drainage, the patient did not survive.

Fulltext Prevalence and risk factors of anti-tuberculosis drug-induced hepatitis in Malaysia

Marzuki OA, Fauzi AR, Ayoub S, Kamarul Imran M

Singapore Med J, 2008 Sep;49(9):688-93.

PMID: 18830542

Tuberculosis (TB) affects one-third of the world's population. Anti-TB drugs with isoniazid, rifampicin and pyrazinamide are very effective but they can cause hepatotoxicity. Many risk factors have been recognised. Data on prevalence of anti-TB drug-induced hepatitis as well as the contributing risk factors are scarce in Malaysia. This observational case control study was designed to look at the prevalence and the risk factors of drug-induced hepatitis in our population.

Fulltext Defaulters among lung cancer patients in a suburban district in a developing country

Ng TH, How SH, Kuan YC, Fauzi AR

Ann Thorac Med, 2012 Jan;7(1):12-5.

PMID: 22347344 DOI: 10.4103/1817-1737.91556

This study was carried out to determine the prevalence, patient's characteristic and reasons for defaulting follow-up and treatment among patients with lung cancer.

Fulltext Monitoring treatment response in sputum smear positive pulmonary tuberculosis patients: comparison of weight gain, sputum conversion and chest radiograph

How SH, Kuan YC, Ng TH, Razali MR, Fauzi AR

Malays J Pathol, 2014 Aug;36(2):91-6.

PMID: 25194531 MyJurnal

Monitoring treatment response to anti-tuberculous therapy remains unsatisfactory in resource-limited countries where sophisticated and expensive tests are not readily available. Sputum culture for mycobacterium is desirable, but not obtainable in many developing countries. Sputum acid-fast bacilli (AFB) smear alone can be misinterpreted in the presence of unviable bacilli or non-tuberculous mycobacteria. Hence the search for a cheaper but reliable monitoring tool, or a combination of several tools, continues. Interesting reports from studies in third world nations have considered weight gain/loss as one such monitoring tool. Since pulmonary tuberculosis is endemic in this country, we take the opportunity to evaluate weight gain and chest radiograph, compared to sputum AFB smear in monitoring patient's response.

Survival of lung cancer patients in a resource-limited country

How SH, Ng TH, Kuan YC, Jamalludin AR, Fauzi AR

Asia Pac J Clin Oncol, 2015 Sep;11(3):221-7.

PMID: 24575820 DOI: 10.1111/ajco.12179

Data on lung cancer survival are lacking in developing countries. Our objectives were to describe the survival of our lung cancer patients and to determine independent prognostic factors affecting survival.

Empyema thoracis complicated by pneumothorax necessitans manifesting as lobulated, localized subcutaneous emphysematous swellings

Kuan YC, How SH, Yeen WC, Ng TH, Fauzi AR

Ann Thorac Surg, 2011 Jun;91(6):1969-71.

PMID: 21619994 DOI: 10.1016/j.athoracsur.2010.11.075

We describe a patient with empyema thoracis that had eroded through the apical chest wall to the supraclavicular fossa and lung parenchyma, ultimately leading to a bronchopleural fistula manifesting as lobulated, localized subcutaneous emphysematous swellings over the chest wall and supraclavicular fossa. This is a rarely reported phenomenon and the reason why the lobulated subcutaneous emphysematous swellings remained localized is unknown.

Fulltext A mimicry of melioidosis by Klebsiella ozaenae infection

Ng TH, How SH, Kuan YC, Adzura, Aziz AA, Fauzi AR

Malays J Pathol, 2009 Dec;31(2):147-50.

PMID: 20514860 MyJurnal

Klebsiella ozaenae is a Gram negative bacillus. It has been described as a colonizer of oral and nasopharyngeal mucosa and is a cause of atrophic rhinitis. Klebsiella ozaenae has seldom been isolated from serious infections. However, several reports have stated that Klebsiella ozaenae may cause invasive infections and even mortality. We report a 55-year-old man with Klebsiella ozaenae infection causing abscesses involving the right eye and left kidney and possibly also in the brain, lungs and prostate. The isolates were sensitive to ceftazidime, ciprofloxacin, chloramphenicol, gentamicin and sulfamethoxazole-trimethoprim but resistant to ampicillin. He responded well to 4 weeks of i.v. ceftazidime and i.v. amoxycillin-clavulanic acid. To our knowledge, such a multiorgan infection has not been reported previously for this organism.

Fulltext Medical thoracoscopy: Pahang experience

Ng TH, How SH, Kuan YC, Hasmah H, Norra H, Fauzi AR

Med J Malaysia, 2008 Oct;63(4):298-301.

PMID: 19385488 MyJurnal

Medical thoracoscopy has gain its popularity in Malaysia recently. This paper presents our early experience in thoracoscopy using semi-rigid fiberoptic thoracoscope. All thoracoscopy records since October 2006 were retrieved. The patients' records, thoracocentesis investigations results, thoracoscopic findings and all pleural biopsy results were reviewed. Twenty-four thoracoscopic procedures on 22 patients in whom two patients had repeated thoracoscopy. Ten patients were confirmed carcinoma. Eight patients had inconclusive thoracoscopic pleural biopsy results. Three patients underwent pleurodesis for malignant effusion. One patient had adhesiolysis for empyema. There was no procedure-related deaths or intraoperative accidents. Thoracoscopy is a relatively safe procedure.

Fulltext Transbronchial needle aspiration of mediastinal lymph node

How SH, Kuan YC, Ng TH, Norra H, Ramachandram K, Fauzi AR

Med J Malaysia, 2008 Jun;63(2):178-81.

PMID: 18942315 MyJurnal

In Malaysia, transbronchial needle aspiration (TBNA) is a relatively new procedure performed only in a handful of respiratory centres. We reviewed TBNA of mediastinal lymph node performed in Hospital Tengku Ampuan Afzan (HTAA) to determine the yield and its complications. Data was retrieved from endoscopy databases and patients' records, CT thorax images and all cytological and histological slides were reviewed. Twenty-five patients had TBNA performed. TBNA was positive in 15 patients (60%). Overall, 80% had confirmed malignancy after bronchoscopy. Only four patients had documented bleeding after TBNA and in two of them, bleeding stopped spontaneously and another two patients required diluted adrenaline to stop the bleed. No mortality was reported from this procedure. Hence, TBNA is a safe procedure.

Fulltext Molar pregnancy and glomerulonephritis

Teh HS, Halim AG, Soehardy Z, Fauzi AR, Kong CT

Med J Malaysia, 2006 Aug;61(3):361-2.

PMID: 17240591 MyJurnal

A 17-year-old, sexually active, single, nulliparous young woman presented to us with one week history suggestive of nephrotic syndrome. She was found to have a benign hydatidiform mole confirmed by histopathological examination after suction and curettage. Renal biopsy revealed focal segmental glomerulosclerosis. The renal pathology was most probably due to molar pregnancy due to the close temporal relationship. To our knowledge, this is the first case of focal segmental glomerulosclerosis associated with a gestation trophoblastic disease described in the literature.

Fulltext AMSAN variant of Guillain Barre syndrome progressing to chronic inflammatory demyelinating polyneuropathy in a patient with Marfan's syndrome and pulmonary tuberculosis

Soehardy Z, Yuhanisa A, Thein SS, Rohana AG, Fauzi AR, Norlinah MI, et al.

Med J Malaysia, 2005 Dec;60(5):655-6.

PMID: 16515122

We report a 40-year-old man who has Marfan's syndrome and was recently diagnosed to have pulmonary tuberculosis when he presented with chronic cough. He was admitted with bilateral lower limb weakness which was ascending in nature. He eventually required ventilation. It was initially thought to be isoniazid-neuropathy. However, stopping the drug did not improve the condition and the patient developed bilateral lower motor neuron 7th cranial nerve palsy. Nerve conduction, MRI and CSF studies were done to confirm a first case report of AMSAN variant progressing to CIDP in a patient with Marfan's syndrome and pulmonary tuberculosis.

Fulltext Antibodies in systemic lupus antineutrophil cytoplasmic erythematosus: prevalence, disease activity correlations and organ system associations

Fauzi AR, Kong NCT, Chua MK, Jeyabalan V, Idris MN, Azizah R

Med J Malaysia, 2004 Aug;59(3):372-7.

PMID: 15727383

Systemic Lupus Erythematosus (SLE) is a disease with multiorgan involvement and multiple autoantibody production including antineutrophil cytoplasmic antibodies (ANCA). Despite its reported prevalence in more than one third of SLE patients, the role of ANCA in the pathogenesis or otherwise in SLE remains unresolved. 131 SLE patients had been previously studied for various serologic parameters of disease activity. Their cumulative organ involvement in the course of their disease had also been determined and the Lupus Activity Index (LAI) calculated. Their stored sera were then screened for the presence of ANCA by two methods viz Indirect immunofluorescence (IIF) and also enzyme-linked immunosorbent assay (ELISA). ANCA was present in 24.8% of these SLE patients. The atypical ANCA pattern was predominant and accounted for an overall of 20.6%. Anti-MPO and anti-PR3 were detected in 1.5% of patients respectively. No association was found between ANCA positivity and disease activity. There was also no association of ANCA with specific organ involvement. Despite the high prevalence of ANCA especially the atypical variant in SLE, they probably represent only one of the wide repertoire of autoantibodies found in this disease. Routine testing for ANCA in lupus patients is therefore not recommended.

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