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Medical Journal of Malaysia

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https://www.readbyqxmd.com/read/29308782/septic-miscarriage-with-toxic-shock-syndrome-and-disseminated-intravascular-coagulation-dic-the-role-of-surgery-recombinant-activated-factor-vii-and-intravenous-immunoglobulin-ivig
#1
L N Tan, G Mariappa, H Y Voon, H Suharjono
Severe sepsis with multi-organ failure is associated with a high mortality rate. This case report highlights the challenges and modalities available in the management of a lady with refractory shock and disseminated intravascular coagulation (DIC) due to toxic shock syndrome (TSS) from genital tract sepsis. Early surgical intervention to remove the source of infection, the use of recombinant activated factor VII to treat intractable disseminated intravascular coagulation and intravenous immunoglobulin to neutralise the circulating exotoxins, have been employed and shown to drastically improve outcomes...
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29308781/community-acquired-necrotising-pneumonia-caused-by-panton-valentine-leucocidin-producing-methicillin-resistant-staphylococcus-aureus
#2
C L Leong, A Norazah, A Azureen, R Lingam
A 61-year-old male presented with community-onset pneumonia not responding to treatment despite given appropriate antibiotics. Computed tomography scan of the thorax showed large multiloculated pleural effusion with multiple cavitating foci within collapsed segments; lesions which were suggestive of necrotising pneumonia. Drainage of the effusion and culture revealed methicillin-resistant Staphylococcus aureus, which had the same antibiotic profile with the blood isolate and PVL gene positive.
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29308780/multiple-myeloma-masquerading-as-panuveitis-in-a-middle-aged-woman
#3
Y C Yew, F S Nurul-Fatin, A T Norazita
Panuveitis secondary to masquerade syndrome is uncommon. A middle-aged woman presented to the ophthalmology clinic with panuveitis associated with anaemia, joint pain, and renal impairment. An incidental finding of a lytic lesion over her left scapula following a chest x-ray prompted further skeletal survey and revealed further lytic lesions over the skull and pelvic bone. Bone marrow aspiration was performed and this confirmed the diagnosis of multiple myeloma. Her left eye vision and intraocular inflammation improved after commencement of chemotherapy...
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29308779/a-frequently-missed-entity-in-systemic-lupus-erythematosus-sle-intestinal-pseudo-obstruction-ipso
#4
L Shirley, R J Thundyil
Intestinal pseudo-obstruction (IpsO) is defined as presence of clinical features of intestinal obstruction without identifiable mechanical obstructive lesion. IpsO is an uncommon gastrointestinal manifestation of systemic lupus erythematosus (SLE) and is largely under-recognised. There are only over 30 published cases in English literature on SLE-related IpsO. Herein, we report two cases of SLE-related IpsO to illustrate the importance of early recognition to avoid unnecessary surgical intervention, as SLE-related IpsO responds well to systemic high dose corticosteroids...
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29308778/adult-human-metapneumovirus-encephalitis-a-case-report-highlighting-challenges-in-clinical-management-and-functional-outcome
#5
Y L Tan, T C Wee
We report a rare case of adult human metapneumovirus (HMPV) in a healthy 32-year-old man. There was dramatic deterioration in his condition developing pneumonia with Type-I respiratory failure and encephalitis. He needed mechanical ventilation in the intensive care setting and was treated with intravenous ribavirin. Post-extubation he remained severely physically and cognitively impaired despite rehabilitation. Treatment of HMPV pneumonia is at present, still without specific antiviral therapy. Managing HMPV-encephalitis remained supportive and challenging...
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29308777/rare-complication-of-appendix-small-bowel-gangrene-caused-by-the-appendicular-knot
#6
R T Mohana, A A Zainal
Intestinal knot formation was first described by Riverius in 16th century and later by Rokitansky in 1836. We report a very rare cause of small bowel gangrene caused by appendiceal knotting on to the ileum in a previously healthy mid aged lady. Patient underwent laparatomy and right hemicolectomy and primary anastomosis. The intra operative findings were the appendix was twisting (knotting) the small bowel about 40cm from the terminal ileum and causing gangrene to the segment of small bowel. Appendicitis is a common condition and management is usually straightforward...
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29308776/necrotising-pneumonia-a-pneumonia-that-may-need-surgical-intervention
#7
S Y Ooi, S W Lee
Pneumonia is primarily a disease that is usually managed medically with antibiotics. However, in rare cases it may progress to necrotising pneumonia, which is an uncommon but severe complication of bacterial pneumonia. This case illustrates a typical case of necrotising pneumonia complicated with parenchymal and pleural complication such as empyema, pneumothorax with possible bronchopleural fistula. Early consultation with thoracic surgeon can be life-saving.
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29308775/a-case-of-immune-thrombocytopenic-purpura-with-prolonged-aptt-time-a-clotter-hidden-in-a-bleeder
#8
M H Lee, P J Khoo, L T Gew, C F Ng
We report the case of a 23-year-old woman who presented with prolonged menstruation and multiple bruises on the limbs and trunk. Investigations revealed severe thrombocytopenia and deranged coagulation profile with markedly prolonged activated partial thromboplastin time (aPTT). Lupus anticoagulant, anti-cardiolipin antibody and anti-beta-2-glycoprotein 1 antibody were positive. She was diagnosed with Immune Thrombocytopenic Purpura (ITP) with positive antiphospholipid antibody serology and given a course of intravenous methylprednisolone and tapering doses of oral prednisolone...
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29308774/a-comparison-of-dabigatran-and-warfarin-for-stroke-prevention-in-elderly-asian-population-with-nonvalvular-atrial-fibrillation-an-audit-of-current-practice-in-malaysia
#9
S H Yap, Y P Ng, A Roslan, J Kolanthaivelu, K W Koh, H S P'ng, Y L Boo, F K Hoo, L B Yap
INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia with significant morbidity and mortality in relation to thromboembolic stroke. Our study aimed to evaluate the safety and efficacy of dabigatran in stroke prevention in elderly patient with nonvalvular AF with regard to the risk of ischemic stroke and intracranial haemorrhage (ICH) in real-world setting. METHODS: A retrospective cohort study of 200 patients on dabigatran and warfarin from January 2009 till September 2016 was carried out...
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29308773/evaluation-of-visual-outcomes-after-toric-intraocular-lens-implantation
#10
H R Ng, C H Goh, Y S Ngim, J Juliana
PURPOSE: To evaluate postoperative visual acuity, refractive status and rotational stability of toric intraocular lens (IOL) in correcting pre-existing corneal astigmatism. METHODS: A total of 69 patients with topographic corneal astigmatism of 1.0 Diopter (D) and above who underwent cataract surgery between June 2015 and December 2016 were included in this retrospective observational study. All preoperative toric IOL calculations were performed using immersion biometry...
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29308772/psychometric-properties-of-the-malay-translated-general-practice-physical-activity-questionnaire-among-shipyard-workers
#11
N Arma, I Rosnah, I Noor Hassim
BACKGROUND: The General Practice Physical Activity Questionnaire (GPPAQ) is a validated and reliable screening tool to measure the level of physical activity in adults. However, it has never been translated and validated in Malaysian population. This study aimed to translate the GPPAQ into Malay language and to evaluate the psychometric properties of the Malay-translated GPPAQ among shipyard workers. METHODS: The original English version of GPPAQ was translated forward and backward into Malay version by experts...
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29308771/clinical-features-and-prognostic-factors-of-cutaneous-vasculitis-among-dermatology-patients-in-johor-bahru-malaysia
#12
S Latha, S E Choon, K E Tey, Y N Chee
BACKGROUND: Cutaneous vasculitis is common, yet the risk factors for its chronicity have not been established. OBJECTIVE: To describe the clinical spectrum and identify risk factors for chronicity of cutaneous vasculitis. METHODS: Retrospective data analysis of 275 patients diagnosed with cutaneous vasculitis from January 2008 to December 2013. RESULTS: The mean age was 33.7 (±17.89) years, with female predominance...
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29308770/assessment-of-the-level-of-knowledge-of-colorectal-cancer-among-public-at-outpatient-clinics-in-serdang-hospital-a-survey-based-study
#13
Y Pan, C Y Chieng, A A H Haris, S Y Ang
OBJECTIVES: Colorectal cancer (CRC) is one of the most common gastrointestinal cancers in the world. In the Asia- Pacific region, it is the fastest emerging gastrointestinal cancer. Level of awareness on CRC warning signs and risk factors in the rural population of Malaysia is reported of very low. The aim of this study was to assess the level of knowledge of CRC among the public at medical outpatient clinics in Serdang Hospital. The association between sociodemographic factors with level of knowledge among the respondents was further studied...
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29308769/health-seeking-behaviour-among-patients-with-faecal-incontinence-in-a-malaysian-academic-setting
#14
A C Roslani, R Ramakrishnan, S Azmi
BACKGROUND: Faecal incontinence (FI) is not a common presenting complaint in Malaysia, and little has been published on this topic. Since it is a treatable condition, a greater understanding of factors contributing to healthseeking behaviour is needed in order to plan effective provision of services. METHODS: A survey of 1000 patients and accompanying relatives, visiting general surgical and obstetrics and gynaecology clinics for matters unrelated to FI, was conducted at University Malaya Medical Centre between January 2009 and February 2010...
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29308768/factors-influencing-outcome-after-hepatic-portoenterostomy-among-extrahepatic-bile-duct-atresia-patients-in-hospital-sultanah-bahiyah-alor-setar
#15
D Namasemayam, M Nallusamy
INTRODUCTION: Biliary atresia implies high risk of mortality if not diagnosed and treated early. We undertook this study to assess the prognostic factors affecting the outcome of Kasai surgery. METHODS: A retrospective clinical study was conducted among 58 patients from Hospital Sultanah Bahiyah Alor Setar. Data were analysed with logistic regression analysis using SPSS. Factors studied included age during surgery, bile duct diameter at the porta hepatic, race of patient, preoperative total bilirubin level and cholangitis...
December 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29197894/diagnostic-challenge-of-burkitt-s-lymphoma-at-early-age
#16
M H Nor Fauziah, M Z Faizah, C K Loh
A four-year-old Ibanese boy presented with subacute abdominal distension for two months duration. Ultrasound and computed tomography (CT) scan showed solid liver masses as well as bowel and intraperitoneal lesions. Initial diagnosis of intraperitoneal inflammatory process as in tuberculosis with non-liquefied liver abscess with differential diagnosis of neoplastic process was made. Liver biopsy and peritoneal fluid analysis revealed Burkitt's lymphoma (BL). We aim to highlight the diagnostic challenge of BL in this young age group emphasizing on the ultrasound and CT features of intraabdominal BL...
October 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29197893/management-of-concurrent-thoracic-and-abdominal-aortic-aneurysms
#17
S T Saw, S J Feona, B D K Leong
Concurrent thoracic and abdominal aortic aneurysm is uncommon. It remains a formidable surgical challenge to vascular surgeons, as decision to treat in staged or simultaneous setting still debatable. We present, here, a case of a 62-year-old-man with asymptomatic concurrent thoracic and abdominal aortic aneurysms, which was successfully treated with two-stage hybrid endovascular repair. The aim of this case report is to discuss the treatment options available, possible associated complications and measures to prevent them...
October 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29197892/relapse-of-b-cell-acute-lymphoblastic-leukaemia-presenting-as-right-aural-polyp-with-facial-and-mandibular-nerves-palsy
#18
C Shiun Chuen, M K Md Daud, N A Che Jalil, H Hazmi
A patient presenting with an ear polyp is a common finding in otorhinolaryngology practice. The common causes include chronic otitis media and cholesteatoma. We report an adult female patient with a history of acute leukaemia presenting with chronic otitis media symptoms and right ear polyp. She was subsequently diagnosed as relapse of B-cell acute lymphoblastic leukaemia based on histopathological examination. The presentation may be similar to an inflammatory pathology of the middle ear, making it misleading...
October 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29197891/management-of-malodour-fungating-wound-with-nanocrystalline-silver-coated-dressing
#19
W Steffi, B Zaliana, A Amreen, N Nasirudin
Chronic exudative malodorous fungating wound of four years at the right arm due to diffuse large B cell lymphoma managed with silver dressings. In two months of application with nanocrystalline silver coated dressings, there was significant improvement in wound.
October 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/29197890/siphoning-diesel-a-fatal-mistake
#20
W C Leong, B M Cheong
Diesel is commonly used as fuel for engines and is distilled from petroleum. Diesel has toxic potential and can affect multiple organs. Exposure can occur after ingestion, inhalation or through the dermal route. The practice of siphoning diesel using a rubber tubing and the mouth is common in rural communities. This can lead to accidental ingestion and aspiration. Here we report a case of a patient who accidentally ingested diesel during siphoning, which caused extensive erosion of the oral cavity and oesophagus leading to pneumomediastinum and severe chemical lung injury...
October 2017: Medical Journal of Malaysia
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