1.Malaysia Stroke Council guide on acute stroke care service during COVID-19 Pandemic
Wan Asyraf Wan Zaidi ; Abdul Hanif Khan Yusof Khan
The Medical Journal of Malaysia 2020;75(3):313-
On the 18th of March 2020, the Malaysia government
declared a movement control order (MCO) due to the
unprecedented COVID-19 pandemic. Although the majority
of patients presented with respiratory-related symptoms,
COVID-19 patients may present atypically with neurological
manifestations and may even have an increased risk of
stroke. The Malaysia Stroke Council is concerned regarding
the level of care given to stroke patients during this
pandemic. During the recent National Stroke Workflow
Steering Committee meeting, a guide was made based on
the currently available evidences to assist Malaysian
physicians providing acute stroke care in the hospital
setting in order to provide the best stroke care while
maintaining their own safety. The guide comprises of prehospital stroke awareness, hyperacute stroke care, stroke
care unit and intensive care unit admission, post-stroke
rehabilitation and secondary prevention practice. We urge
continuous initiative to provide the best stroke care possible
and ensure adequate safety for both patients and the stroke
care team.
2.Glycemic patterns and factors associated with Post-Hemodialysis Hyperglycemia among end-stage Renal Disease patients undergoing, maintenance Hemodialysis
Abdul Hanif Khan Yusof Khan ; Nor Fadhlina Zakaria ; Muhammad Adil Zainal Abidin ; Christopher Tiam Seong Lim ; Nor Azmi Kamaruddin
Journal of the ASEAN Federation of Endocrine Societies 2020;35(1):68-76
Introduction:
Chronic and post-prandial hyperglycemia are independent risk factors for diabetic complications. Glycemic patterns among hemodialysis end-stage-renal-disease (ESRD) differ as glucose metabolism changes with declining kidney function with more pronounced glycemic fluctuations. The objectives of this study are to determine glycemic patterns on hemodialysis days, the magnitude of post-hemodialysis rebound hyperglycemia (PHH) and their associated factors.
Methodology:
148 patients on hemodialysis were analysed, 91 patients had end-stage-diabetic-renal disease (DM-ESRD), and 57 patients had end-stage-non-diabetic renal disease (NDM-ESRD). Glycemic patterns and PHH data were obtained from 11-point and 7-point self-monitoring blood glucose (SMBG) profiles on hemodialysis and non-hemodialysis days. PHH and its associated factors were analysed with logistic regression.
Results:
Mean blood glucose on hemodialysis days was 9.33 [SD 2.7] mmol/L in DM-ESRD patients compared to 6.07 [SD 0.85] mmol/L in those with NDM-ESRD (p<0.001). PHH occurred in 70% of patients and was more pronounced in DM-ESRD compared to NDM-ESRD patients (72.5% vs 27.5%; OR 4.5). Asymptomatic hypoglycemia was observed in 18% of patients. DM-ESRD, older age, previous IHD, obesity, high HbA1c, elevated highly-sensitive CRP and low albumin were associated with PHH.
Conclusion
DM-ESRD patients experienced significant PHH in our cohort. Other associated factors include older age, previous IHD, obesity, high HbA1c, elevated hs-CRP and low albumin.
Renal Dialysis
;
Diabetes Complications
;
Hyperglycemia
;
Risk Factors
;
Asian
3.Hypersexuality In A Rape Victim Child
Nur Amirah Shibraumalisi ; Mohd Hafidzudin Zainal Abidin ; Nabil Muhammad Al Kuddoos ; Abdul Hanif Khan Yusof Khan
Malaysian Journal of Medicine and Health Sciences 2021;17(No.4):422-424
Hypersexuality is rare in children. Our case describes a 14-year-old girl who presented with a history suggestive of
hypersexuality. She was repeatedly raped and exposed to video pornography at a very young age. Consequently,
she became addicted to pleasure during sexual intercourse and actively involved in multiple unprotected sexual
intercourses. Management, in this case, was challenging, where early intervention with contraceptive methods and
cognitive behavioural therapy were unsuccessful. Subsequently, alternative treatment with Islamic psycho-spiritual
therapy combined with conventional therapy resulted in an improvement in her sexual pre-occupation. This case
highlights the importance of recognition of hypersexuality, especially among children with a history of sexual abuse
as management proofs to be challenging, and requires a multimodal approach to prevent a potentially devastating
outcome.
4.Longitudinal Extensive Transverse Myelitis as a Neurological Sequelae post-Sea Urchin Stings: A Case Report
Anas Aminin W M Izzuddin ; Abdul Hanif Khan Yusof Khan ; Liyana Najwa Inche Mat ; Laila Mastura Ahmad Apandi ; Peck Kee Chia ; Hamidon Basri
Malaysian Journal of Medicine and Health Sciences 2021;17(No.1):187-190
Puncture injury from sea-urchin stings may lead to a local and systemic inflammatory reaction. We are reporting a
case of longitudinal extensive transverse myelitis (LETM), which occurred ten days post-sea-urchin stings, where the
patient presented with bilateral lower limb weakness. MRI showed multilevel segment spinal cord T2-weighted hyperintensity. Prompt intravenous methylprednisolone was administered, and the patient had a full recovery. To date,
there is no case report of LETM associated with sea-urchin stings. Possible mechanism due to delayed immunological
hypersensitivity to sea-urchin venom. This case demonstrates the potential serious neurological sequelae that may be
associated with post-sea-urchin sting and the importance of prompt recognition and management in aiding recovery.
5.Acute Mycoplasma Pneumoniae Encephalitis in an Adult
Leong Wan Yi ; Abdul Hanif Khan Yusof Khan ; Janudin Baharin ; Wei Chao Loh ; Anna Misya&rsquo ; il Abdul Rashid ; Wan Aliaa Wan Sulaiman ; Fan Kee Hoo ; Hamidon Basri ; Laila Mastura Ahmad Apandi ; Liyana Najwa Inche Mat
Malaysian Journal of Medicine and Health Sciences 2022;18(No.5):222-224
Mycoplasma pneumonia is an atypical bacterium that causes mild respiratory tract infections, especially in the upper
respiratory system. Mycoplasma pneumoniae infection is infrequently associated with various CNS manifestations
such as encephalitis, meningoencephalitis, myelitis, Guillain-Barre syndrome and acute disseminated encephalomyelitis (ADEM). Here we report a rare case of mycoplasma encephalitis in an adult who presented with a first episode
of seizure following fever and neck stiffness for one week. Mycoplasma pneumoniae antibody titer was markedly
elevated at >1:320 and MRI brain revealed encephalitic changes with a lesion in the splenium. Interestingly, there
was no associated respiratory infection and his stay in the hospital was also complicated by SIADH. The patient improved after treatment with a macrolide antibiotic.
6.Regional Emergency Stroke Quick-Response (RESQ) Network: A Proposed Paradigm of Malaysia Stroke Care Services
Peck Kee Chia ; Nur Afiqah Mohamad ; Liyana Najwa Inche Mat ; Iskasymar Itam@Ismail ; Abdul Hanif Khan Yusof Khan ; Wei Chao Loh ; Wan Aliaa Wan Sulaiman ; Fan Kee Hoo ; Ezamin Abdul Rahim ; Ahmad Sobri Muda ; Hamidon Basri
Malaysian Journal of Medicine and Health Sciences 2020;16(No.4):353-361
Stroke care service in Malaysia is suboptimal despite the fact that it is one of the commonest cause of death. This
is due to several limitations, including lack of resources and funding for the stroke care establishment and the management itself. Alternatively, other regions have come up with numerous ways to combat the difficulties in order
to provide better stroke care services. We have identified the overwhelming benefits of creating stroke care units,
thrombolysis services, and endovascular thrombectomy. For this reason, we designed a Regional Emergency Stroke
Quick Response Network (RESQ) based on the needs of the current situation in Malaysia. With a standardised RESQ
training, we hope to achieve close-knitted cooperation in between the emergency medical services, emergency department team and the RESQ, which subsequently will create an ideal improvised stroke care units.
7.Tissue Window versus Time Window? A Review of Patients Receiving Extended Hours Thrombolysis Guided By DWI-FLAIR Mismatch : Case Series
Anna Misya&rsquo ; il Abdul Rashid ; Mohamad Syafeeq Faeez Md Noh ; Abdul Hanif Khan Yusof Khan ; Wei Chao Loh ; Janudin Baharin ; Azliza Ibrahim ; Liyana Najwa Inche Mat ; Wan Aliaa Wan Sulaiman ; Fan Kee Hoo ; Hamidon Basri
Malaysian Journal of Medicine and Health Sciences 2022;18(No.3):182-187
Introduction: Intravenous thrombolysis (IVT) is the gold standard for the treatment of patients with acute ischemic
stroke (AIS) presenting within four and a half hours of onset. However, development of new thrombolytic agents and
advanced imaging has led to extended time for thrombolysis based on advanced imaging. Here we describe four
patients who presented in the extended hours; that benefitted from thrombolysis. Case series: We advocate magnetic resonance imaging (MRI) for AIS, that includes diffusion weighted imaging (DWI), apparent diffusion coefficient
(ADC), fluid attenuated inversion recovery (FLAIR), susceptibility weighted imaging (SWI), and magnetic resonance
angiography (MRA). We included four patients who were more than 18 years old, with National Institute of Health
Stroke Scale (NIHSS) of six or more, presenting between four and a half to nine hours after stroke onset with no contraindications for intravenous thrombolysis. The imaging criteria used to determine eligibility for IVT is evidence of
DWI-FLAIR mismatch on MRI. If FLAIR detects no signal change in the area of stroke on DWI, it is then termed DWIFLAIR mismatch, or FLAIR-negative – indicating high probability that the brain tissue is still viable, and that patients
are good candidates for IVT. Conclusion: For patients with AIS who present within nine hours, DWI-FLAIR mismatch
serves as an excellent surrogate marker of salvageable brain tissue, allowing a greater proportion of patients benefiting from this life-saving therapy. Our experience also shows that with careful patient selection, treatment with IVT
can safely be given without an increased risk of bleeding or mortality.
8.Survival Analysis and Prognostic Factors for Peri-ocular Malignancies in Malaysia
Dhashani Sivaratnam ; Radzlian Othman ; Navin Kumar Devaraj ; Yap Ming Teck ; Vincent Ng Teng Fung ; Ew Shao Chen ; Ramizah Md Rozi ; Nur Najlaa Baharudin ; Kirbashini Kanasan ; Abdul Hanif Khan Yusof Khan ; Vasudevan Ramachandran ; Siew Moi Ching
Malaysian Journal of Medicine and Health Sciences 2024;20(No.1):60-69
Introduction: This study aims to determine the prognostic factors and survival outcomes of patients that underwent
this surgery. Method: A retrospective review of 43 patients who underwent exenteration for periocular malignancies
over a 14-year period was carried out. Patient demographics, tumour histology, treatment details, surgical margins’
status and post-operative survival were recorded. The survival outcome examined was the overall survival (OS)
rate. Cox regression and Kaplan-Meier analysis were used to evaluate post-exenteration survival. Results: In total,
20 females and 23 males with a median age of 62 ± 17.3 years were identified. The most common indication for
exenteration was basal cell carcinoma (20.9%), followed by squamous cell carcinoma (18.6%), adenocystic carcinoma (14%), malignant melanoma (14%) and sebaceous gland carcinoma (11.6%). The independent predictors for
worse OS on multivariate analysis were Chinese ethnicity (adjusted hazard ratio [aHR] 4.95, p =0.017), sebaceous
gland carcinoma (aHR 57.61 p=0.006), adenocystic carcinoma (aHR 45.87, p=0.008), clear surgical margins (aHR
5.41, p=0.025), receiving only chemotherapy (aHR 169.13, p=0.004), and receiving both adjuvant chemotherapy
and radiotherapy (aHR 41.51, p=0.010). Conclusion: We recommend targeted public health initiatives for Chinese
patients due to their increased mortality risk from peri-ocular malignancies. In addition, we advise comprehensive
adjuvant therapy for all patients regardless of whether a clear surgical margin is achieved. Basal cell carcinoma and
adenocystic carcinoma may also benefit from genetic research. We advocate more training for ophthalmologists to
identify periocular malignancies earlier for better treatment options and increased chances of survival.
9.Coronavirus Disease-2019: Knowledge and Practices Behaviour of Healthcare Workers at a University Teaching Hospital in Malaysia
Kai Wei Lee ; Abdul Hanif Khan Yusof Khan ; Siew Mooi Ching ; Navin Kumar Devaraj ; Janudin Baharin ; Peck Kee Chia ; Wei Chao Loh ; Anna Misya' ; il Abdul Rashid ; Liyana Najwa Inche Mat ; Wan Aliaa Wan Sulaiman ; Mohd Tawfeq Mohd Noor ; Dhashani Sivaratnam ; Fan Kee Hoo ; Hamidon Basri
Malaysian Journal of Medicine and Health Sciences 2021;17(No.3):149-158
Introduction: Coronavirus disease-2019 (COVID-19) was declared a global pandemic in March 2020, with 15 million people have been infected worldwide, and this number is increasing. Our study sought to assess the knowledge
and practice of healthcare workers (HCWs) in a teaching hospital in Malaysia. Methods: This cross-sectional study
was undertaken using online Google form links among HCWs. Knowledge and practice were assessed using a validated questionnaire. The analysis was performed with SPSS version 26. Factors associated with poor knowledge
were analysed using multivariate analysis. Results: A total of 193 HCW responded to our online survey. Majority of
our HCWs were female (74.1%) with a mean age of 32.5 years. We found 53 (27.5%) and 134 (69.4%) of our HCWs
had good knowledge and good practice on COVID-19, respectively. Knowledge gap was identified in the symptomatology, investigation methods and management. Based on multiple logistic regression, determinants of poor knowledge scores were those work as medical attendants (aOR = 3.626; 95% CI = 1.489, 8.834) and nurses (aOR = 4.107;
95% CI = 1.175, 14.358). Conclusion: Around one-third and 70% of our HCWs have good knowledge and practice
of COVID-19 infection respectively. Continuous, specifically targeted and updated medical education, need to be
carried out to improve the knowledge and practice among our HCWs in order to keep abreast of the fast-moving
pace of COVID-19 knowledge development.