1.Comparison of morphine with fentanyl added to intrathecal 0.5% hyperbaric bupivacaine for analgesia after caesarean section.
The Medical journal of Malaysia 2009;64(1):71-4
This was a prospective randomised, controlled, single-blind study done to determine the effect of intrathecal morphine 0.1 mg as compared with intrathecal fentanyl 25 microg in terms of analgesia and duration for postoperative pain relief after Caesarean section. Sixty ASA I or II parturients were randomised into two groups. Group 1 (n=33) received 1.8 ml of 0.5% hyperbaric bupivacaine combined with 0.1 mg morphine while Group 2 (n=27) received 1.8 ml of 0.5% hyperbaric bupivacaine combined with 25 microg fentanyl for spinal anaesthesia. Postoperatively, all patients were provided with patient controlled analgesia (PCA) morphine. Pain was assessed using visual analogue score (VAS) at 6, 12, 18 and 24 hours. Time to first demand of PCA morphine, cumulative PCA morphine requirement and opioid side effects were documented. The VAS for pain and the cumulative PCA morphine requirement were both significantly lower in Group 1 (p < 0.05) during the 24 hours study period. The time to first demand was also significantly longer in Group 1 (p < 0.05). Overall, there were no significant difference between the two groups in side effects, except for a high incidence of nausea and vomiting requiring treatment in Group B in the first six hours. In conclusion the addition of 0.1 mg morphine for spinal anaesthesia provided superior and longer postoperative analgesia after Caesarean section.
Morphine
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Pain management
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intrathecal
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Passive Cutaneous Anaphylaxis
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Fentanyl
2.Spontaneous twin pregnancy in premature ovarian failure.
R Anna Liza ; R Z Alik ; Z Ahmad Murad ; I Ghazali
The Medical journal of Malaysia 2008;63(3):263-4
Premature Ovarian Failure (POF) is associated with subfertility. Despite efforts to induce ovulation, success rates are low. We report a case of POF spontaneously conceiving twins while on hormone replacement therapy.
Ovarian Failure, Premature
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Spontaneous
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Twin Multiple Birth
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Pregnancy
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success
3.Compliance towards methadone maintenance therapy and its associated factors in Selangor primary care centers and Kuala Lumpur hospital.
W P Sharifa Ezat ; H Noor Azimah ; R Rushidi ; K Raminder ; I Ruhani
The Medical journal of Malaysia 2009;64(1):65-70
This paper seeks to determine the client's compliance level towards Methadone Maintenance Therapy (MMT) and identify its associated factors. A cross sectional study was conducted from June to September 2007 where 288 samples were interviewed. The outcomes were divided into good compliance and partial compliance categories. Overall client's compliance level is good at 86.1%. There are significant difference between mean age of groups (t = -2.041, p = 0.04); and significant associations of job's status (chi2 = 9.54, p = 0.008); client's confident score (t = -3.12, p = 0.023), client'ssocial function score (t = -2.308, p = 0.002) and client's social function level (chi2 = 5.43, p = 0.02) with compliance toward program. With multivariate analysis, only client's age, client's confidence score and client's job status were related to compliance status. It was concluded that there is high compliance rate among client's who received the program. Younger clients, low scores on client's confident and social function, and clients with unsteady jobs are at risk not to comply with treatment.
seconds
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Clients
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lower case pea
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Drug addiction therapy - methadone
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Lower case tea
4.Cerebrospinal fluid rhinorrhoea secondary to amyloidosis of the sphenoid sinus.
Elmuntser A Ali ; R Philip ; N Prepageran ; S C Peh
The Medical journal of Malaysia 2008;63(4):341-2
Amyloidosis of the skull base is a rare entity. A patient with localized amyloidosis of the sphenoid sinus presented at our institution with cerebrospinal fluid rhinorrhoea. Endoscopic excision of the lesion and multilayered obliteration of the sphenoid sinus resolved the symptoms.
Amyloidosis
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Metastatic to
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Cerebrospinal Fluid Rhinorrhea
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symptoms <1>
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Endoscopic approach
5.Neonatal Clavicle Fracture: A Review of Fourteen Cases in East Coast Peninsular Malaysia
Awang MS ; Abdul Razak AH ; Che Ahmad A
The International Medical Journal Malaysia 2017;16(2):79-83
Introduction: The purpose of this study is to identify the incidence of clavicle fractures in newborn
associated with fetal, maternal and process of deliveries in Kuantan General Hospital from June 2012 until
January 2014. This study is to determine epidemiological data of clavicle fractures, maternal and baby risk
factors associated with clavicle fractures of newborn and its’ outcome. Methods: This is a prospective
study. 13 patients were identified to fulfill the inclusion criteria of the study. The data of
sociodemographic, associated fetal and maternal risk factors and the outcomes were recorded using
proforma. The statistical data analysis was done using SPSS 12.0. Results: Out of 20,257 live births at our
centre during the study period, 13 infants were diagnosed to have clavicle fractures, giving an incidence of
0.64 per 1000 live births. There were 5 (38.5%) left, 7 (53.8%) right and one (7.7%) bilateral fracture. All
fractures located at the mid shaft of the clavicle and none have associated brachial plexus injuries. All
infants were delivered through vaginal delivery (61.5%); five through assisted delivery (instrumental); 2
(15.4%) forcep and 3 (23.1%) vacuum. Two of the babies developed shoulder dystocia. The average birth
weight was 3371 grams (SD 0.269) and mean gestational age was 38.7 weeks (SD 1.16). Five of the mothers
(38.5%) were primigravida and eight (61.5%) were multigravida in which,7 (53.8%)were healthy without
other co-morbidty, 5 (38.5%) having gestational diabetis and one (7.7%) hypertension. The average maternal
weight was 62.0 kg and height 1.58 metres with average BMI of 24.16 (3.29SD). All eventually had a
complete recovery at 6 weeks with clinical and radiological evident of fracture union. Conclusions: In
conclusion, all patients with clavicle fractures were found following vaginal delivery. There were no
associations between neonatal clavicle fractures with maternal or baby risk factors. All fractures healed
without any complications.
6.Prevalence of Eosinophilic/Non Eosinophillic Nasal Polyps and Analysis of Their Presentation in Hospital Universiti Sains Malaysia Kelantan, Malaysia.
Ramiza Ramza Ramli ; Irfan Mohamad
The International Medical Journal Malaysia 2017;16(2):89-92
This study is aimed to examine the predominant inflammatory cells in nasal polyps (NP) in the
local community and its correlation to the clinical presentations. Materials and Methods: The study was
done retrospectively looking at patients who had undergone functional endoscopic sinus surgery (FESS) in
Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia with a histopathological diagnosis of nasal
polyposis (NP), between the years 2004 to 2008. Sixty two patients between the ages of 18 years to 60 years
old were selected and data relevant to the study were collected from the patient’s folders using a specially
created form prepared for the study. The NP histopathology report from each patient underwent FESS were
analysed and the patients were divided into eosinophilic and non eosinophilic dominant group. Clinical
presentations from each patient were also gathered and analysed according to the NP group. Results: In
HUSM, there were a higher number of eosinophilic types NP as compared to the neutrophilic type NP which
is contrary to other study conducted on Asian populations. The clinical symptom correlations between either
eosinophilic or non-eosinophilic type of NP have not shown any significant associations. Conclusion: The
study showed that the incidence of histological subtypes of nasal polyp in HUSM is almost the same as that
found in other parts of the world (Europe and North America) which will reduce the possibility of racial or
geographical influence on the pathogenesis of the nasal polyp. Clinical symptoms and presentation alone are
not enough to differentiate the type of the nasal polyp without the histological study.
7.Educating Future Medical Professionals with the Fundamentals of Law and Ethics
The International Medical Journal Malaysia 2017;16(2):101-105
The increasing awareness amongst the society on medico-legal issues as well as the growth of consumerist
attitude towards the provision of medical services has caused the medical profession to be subjected to
vociferous criticism if they do not meet rising expectations of the society. Substandard services have not
been well tolerated and paternalistic approaches in medical treatment are considered to be outmoded and
inappropriate. Any dissatisfaction on the part of the patient towards medical services provided nowadays
may easily trigger claims in the court of law. This changing trend has also fundamentally changed the
behaviour of the courts towards the medical profession. Judicial and legislative interventions in medical
practice have created more and more rights for the patients and consequently, corresponding legal duties
for the medical profession to uphold. In the present healthcare setting, the medical profession will not be
able to provide infallible services without knowledge of the legal standards which they have to adhere.
Thus, educating future medical professionals with the fundamentals of law and ethics would ensure greater
accountability, knowledge and personal commitment in providing medical services to the society as the
ideals of professionalism not only require them to have the necessary expertise, dedication, respect,
compassion, empathy, honesty, altruism, responsibility, integrity, self-improvement and accountability but
also adherence to the demands of law and highest ethical standards.
8.Balloon Dilatation of Laryngotracheal Stenosis: Hospital Ampang Experience
The International Medical Journal Malaysia 2017;16(2):113-116
The upper airway is a crucial structure. It becomes a grave problem should it be narrowed. Several methods of treatment were rendered for patients with laryngotracheal stenosis. We share our experience with the combination total intravenous anaesthesia and apneic pause technique with or without steroid injection. Four cases of laryngotracheal stenosis were observed in Hospital Ampang: two adult and two paediatric cases. Age, gender, causative factor, stenosis segment length, grade or severity were observed before and after dilatation, number of dilatation were observed and compared. The outcome measures are decannulation and avoidance of tracheostomy. All cases had improvement of symptoms. Half or 50% of the patient required repeated balloon dilatations. The paediatric cases successfully avoided tracheostomy while the adult cases successfully decannulated with no complication from the procedure. Balloon dilatation by total intravenous anaesthesia coupled with apneic method is a safe and effective method of treatment for the narrowed airway.
9.Benign Calcified Thyroglossal Duct Cyst, – Defying The Hallmark of Papillary Carcinoma, 4th Case Reported In Literature
The International Medical Journal Malaysia 2017;16(2):117-120
Thyroglossal duct cyst is the most common upper neck midline lesion in children. Approximately 1% of
thyroglossal duct cyst undergoes malignant transformation. Calcification which is a marker of malignancy
almost always points out to papillary thyroid carcinoma. Benign case of calcified thyroglossal cyst maybe
undiagnosed or under reported. We report a case of a 5 year old girl with a benign calcified thyroglossal
duct cyst, a fourth case in world literature. Here the differences between a benign and malignant
thyroglossal duct cyst are discussed.
10.Facial Subcutaneous Emphysema As A Rare Complication Of Tonsillectomy
Mark Paul ; Najihah Hanim Asmi ; Rohaida Ibrahim ; Eshamsol Kamar
The International Medical Journal Malaysia 2017;16(2):121-124
Tonsillectomy is a very common procedure in Otolaryngology practice. Common complications include
bleeding, which can be primary or secondary due to infection of the tonsillar bed. Subcutaneous emphysema
after a tonsillectomy is very rare. We report a 19-year-old girl who developed cervicofacial subcutaneous
emphysema several hours after tonsillectomy with successful conservative treatment outcome.