1.A rare case of streptococcus mitis infective endocarditis complicated by heart failure in a lactating mother with recurrent breast engorgement
Inche Mat Liyana Najwa ; Hoo Fan Kee ; Sallehuddin Hakimah ; Zakariah Siti Zulaikha ; Wan Zukiman Wan Zul Haikal Hafiz ; Tan Wei Ming
Malaysian Family Physician 2019;14(2):36-38
Infective endocarditis during breastfeeding is rare. To the best of the authors’ knowledge, this is the second recorded case of infective endocarditis in a lactating mother. It is known that women of child-bearing age are susceptible to infective endocarditis during pregnancy when the immune system is compromised.1 Nevertheless, past cases were also exposed to a systemic infection via milk infected by their infant’s oral commensal. Streptococcus mitis (S.Mitis) endocarditis in pregnancy has also been reported, whereby a lady delivered via caesarean section and underwent mitral valve reconstruction and annuloplasty.1 S. mitis is considered a pioneer streptococci commensal in human oral mucosa, appearing as early as 1-3 days after delivery.2 As a child grows, their oral mucosa will be colonized by more viridans streptococci, including the teeth, oropharynx and nasopharynx. In a mother who breastfeeds, a crack in the nipple and breast engorgement can be predisposing factors for systemic infection stemming from an infant’s oral commensal. Both cases of breastfeeding-related infective endocarditis caused by pioneer streptococcus viridans, S.mitis in our report and S.salivarius3 in the previous report, affected the left-sided valves
2.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.
3.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.
4.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.
5.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.
6.Safety and Efficacy of Dabigatran Versus Warfarin in Asian Patients With Atrial Fibrillation
Liyana Najwa Inche Mat ; Ooi Qi Wen ; Nurul Natasha Ashikin Johari ; Rooban Raao Subramaniam ; Wan Aliaa Wan Sulaiman ; Hoo Fan Kee ; Chia Peck Kee ; Hamidon Basri
Malaysian Journal of Medicine and Health Sciences 2020;16(No.4):89-95
Introduction: Nonvalvular atrial fibrillation is a common cause of cardioembolic stroke which accounts around
50% of all cardioembolic emboli. Oral anticoagulants remain the main choice of stroke prevention in patients with
atrial fibrillation. Our study is aimed to determine the safety (absence or presence of bleeding events) and efficacy
(absence or presence of ischemic stroke occurrence) of dabigatran versus warfarin for stroke prevention in patients
with nonvalvular atrial fibrillation. Methods: A retrospective audit study was conducted based on past data obtained
from Electronic Hospital Information System (EHIS) records in Serdang Hospital. Our sample was 150 patients with
nonvalvular atrial fibrillation who were at risk of getting stroke and being prescribed with oral anticoagulants either
warfarin or dabigatran from the year 2013 until 2019. Results: Our study showed that there was lesser occurrence
of ischemic stroke in patients from dabigatran group (1.3%) as compared to those in warfarin group (2.7%). There
were also almost 2 times lesser bleeding events in dabigatran group (6.7%) as compared to those in warfarin group
(14.7%). The median of CHA2DS2-VASc Score in warfarin sampled patients (median=3+/-1) was lower than dabigatran sampled patients (median=4+/-1). Conclusion: Both warfarin and dabigatran are effective in preventing stroke
for patients with nonvalvular atrial fibrillation. However, dabigatran is associated with lesser bleeding events with
lower incidence of major bleeds compared to warfarin.
7.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.