1.Diagnostic challenge of Burkitt’s lymphoma at early age
Nor Fauziah Handar ; Faizah Mohd Zaki ; Loh C-Khai
The Medical Journal of Malaysia 2017;72(5):324-326
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. We would
also want to stress the importance of early diagnosis of BL
as it is known to be the most aggressive tumour within 24
hours yet to have good survival if early diagnosis was made.
Lymphoma
;
Child
2.The Value of Pre-Operative Embolisation in Primary Inferior Vena Cava Paraganglioma
Faizah Mohd Zaki ; Syazarina Sharis Osman ; Zaleha Abdul Manaf ; Jeyaledchumy Mahadevan ; Mazri Yahya
Malaysian Journal of Medical Sciences 2011;18(2):70-73
We report a case of a 13-year-old boy who complained of progressive abdominal distension and
symptoms of anaemia. Radiological investigations revealed that the child had a hypervascular tumour
of the inferior vena cava (IVC). Unfortunately, the child presented with acute lower gastrointestinal
bleed soon after the investigation. He underwent an urgent pre-operative embolisation, aimed to
reduce the tumour vascularity. A total resection of the tumour, right nephrectomy, and partial
duodenal resection were done within 24 hours post-embolisation. The child was stable postoperatively.
The histopathological examination revealed chromogranin-positive paraganglioma originating from the IVC. We highlight the radiological findings of rare primary IVC paraganglioma and the role of embolisation prior to surgical removal of the tumour.
3.Contrast enhanced Voiding Urosonography (ce-VUS) as a radiation-free technique in the diagnosis of vesicoureteric reflux: Our early experience
Faizah Mohd Zaki ; Hamzaini Abdul Hamid ; Kanaheswari Yoganathan ; Dayang Anita Abdul Aziz ; Zulfiqar Muhamed Annuar
The Medical Journal of Malaysia 2015;70(5):269-272
Objective: Contrast-enhanced ultrasound has become
increasingly utilised as an alternative imaging modality for
the diagnosis of vesicoureteric reflux (VUR) in paediatric
patients. The study objective is to evaluate the efficacy of
contrast enhanced Voiding Urosonography (ce-VUS)
compared with fluoroscopic micturating
cystourethrography (MCU) in the detection of VUR.
Methods: This prospective study was carried out between
July 2011 and January 2013 on paediatric patients who
underwent MCU. All consented patients would undergo ceVUS
prior to MCU. We documented the epidemiology details,
the number of Kidney-Ureter (K-U) unit studied, baseline
renal and bladder sonogram, as well as presence of VUR on
ce-VUR. The technique for ce-VUS was standardized using
normal saline to fill the bladder prior to administration of
SonoVue® (2.5 ml) to assess the kidney-ureter (K-U) unit.
Dedicated contrast detection software was used to discern
the presence of microbubbles in the pelvicaliceal system
(PCS). The findings were then compared with MCU.
Results: 27 paediatric patients were involved in the study [17
males (63%) and 10 females (37%)] involving 55 K-U units
(one patient had a complete duplex system). MCU detected
VUR in 10 K-U units while ce-VUS detected VUR in 8 out of
the 10 K-U units. There were 2 false negative cases (both
Grade 1) with ce-VUS. The sensitivity, specificity, accuracy,
positive predictive value, and negative predictive value of
ce-VUS were 80%, 98%, 95%, 89% and 96%, respectively.
Conclusion: ce-VUS is a sensitive and specific radiation-free
alternative for the detection of VUR in the paediatric
population.
Urinary Tract Infections
4.Renal doppler assessment in differentiating obstructive from non-obstructive hydronephrosis in children
Nadzri Misni ; Erica Yee Hing ; Hamzaini Abdul Hamid ; Faizah Mohd Zaki ; Aini AbAziz ; Kanaheswari Yoganathan ; Zulfiqar Mohd Annuar
The Medical Journal of Malaysia 2015;70(6):346-350
background: to determine the usefulness of Doppler
ultrasound measurement of resistive index (RI) in
differentiating obstructive from non-obstructive
hydronephrosis in children.
Methods: From August 2011 to November 2012, renal
Doppler assessments of the intra-renal renal arteries were
performed on 16 children (19 kidneys) with congenital
hydronephrosis. the independent t-test was used to
assess for significant difference in RI values between those
with obstructive hydronephrosis (6 kidneys) and those with
non-obstructive hydronephrosis (13 kidneys) as determined
by dynamic renal scintigraphy. the assessor was blinded to
the clinical findings and scintigraphy results.
Results: RI was significantly different between obstructive
and non-obstructive hydronephrosis. Obstructive
hydronephrosis returned higher RI values, with mean RI of
0.78. Mean RI in non-obstructive hydronephrosis was 0.70,
and the difference was significant (p <0.05). the sensitivity
and specificity of Doppler ultrasound were 100% and 53%
respectively.
conclusion: Doppler ultrasound measurement of resistive
index is useful in differentiating obstructive from nonobstructive
hydronephrosis and provides an alternative
non-ionizing investigation other than dynamic renal
scintigraphy.
5.Association of Cobb angle progression and neuraxial abnormality on MRI in asymptomatic Adolescent Idiopathic Scoliosis
Faizah Mohd Zaki ; Ng Kai Ling ; Te Boon Chin ; Mohd Hafizuddin Azman ; Nur Aifaa Liah ; Nurhanisah Mohd Razali ; Azmi Baharudin ; Hamzaini Abdul Hamid
The Medical Journal of Malaysia 2016;71(3):122-125
Background: Detection of neuraxial abnormality in
neurologically asymptomatic adolescent idiopathic
scoliosis (AIS) is crucial prior to surgery. It can only be
detected on magnetic resonance imaging (MRI), which was
not routinely done in this group of patient. On the other
hand, whole spine radiographs for measurement of Cobb
angle have been routinely included during clinic follow-up.
This study aimed to determine the correlation between Cobb
angle progression and neuraxial abnormality finding on MRI
in asymptomatic AIS.
Methods: A retrospective study was conducted in the
Orthopaedic department of a tertiary hospital. Patients with
asymptomatic AIS aged 10-20 years who attended scoliosis
clinic from year 2007 to 2010 was reviewed. Patients who
had whole spine MRI and two vertebral radiographs at least
one year apart were further selected. Statistical analysis was
done to see the association between Cobb angle
progression and neuraxial abnormality on MRI.
Results: The mean age at first presentation was 14.4 years
old. Female (n=249) to male (n=50) ratio was 5:1. Only 19
patients fulfilled the selection criteria. There were 5 patients
(26.3%) who had neuraxial abnormalities. The mean curve
progression was 7.05° (range from -5° to 28°). Patients with
and without neuroaxial abnormality showed mean curve
progression of 0.6º and 9.36° respectively. There was no
significant association between Cobb angle progression
and neuroaxial abnormality (p=1.000).
Conclusion: Cobb angle progression is not a reliable
indicator for predicting neuroaxial abnormality in patients
with asymptomatic AIS. However, this study stressed the
need to perform MRI prior to operation to document any
associated neuraxial abnormality in clinically asymptomatic
AIS patients.
6.Five cases of iatrogenic cerebrospinal fluid (CSF) rhinorrhoea: Early management is crucial
Aidayanti DAUD ; Salina HUSAIN ; Balwant Singh GENDEH ; Farah Dayana ZAHEDI ; Faizah Mohd ZAKI
The Medical Journal of Malaysia 2018;73(4):249-252
Endoscopic sinus surgery (ESS) is a standard treatment forrhinosinusitis, which failed optimum medical therapy.Iatrogenic cerebrospinal fluid (CSF) rhinorrhoea can occurduring ESS warrants early repair of the leakage. Thecommon sites for CSF leakage are cribriform plate, foveaethmoidalis, and anterior ethmoid sinuses. We present fivecases of iatrogenic CSF rhinorrhoea due to ESS and itsmanagement.
7.Split Tummy Exercise Program for Reducing Diastasis Recti in Postpartum Primigravidae: A Randomized Controlled Trial
Suhaila SHOHAIMI ; Nik Rosmawati Nik HUSAIN ; Faizah Mohd. ZAKI ; Ixora Kamisan ATAN
Korean Journal of Family Medicine 2023;44(2):102-108
Background:
Diastasis rectus abdominis (DRA) involves the separation of the midline abdominal muscles and linea alba and affects more than half of postpartum women. This study aimed to assess the effect of a split tummy exercise program (STEP) on DRA closure in postpartum mothers.
Methods:
A randomized controlled trial was conducted from 2008 to 2020 at the Obstetrics and Gynaecology Clinic of the Universiti Kebangsaan Malaysia Medical Centre. Primigravida mothers diagnosed with DRA were selected and randomly assigned to the intervention (n=21) or control (n=20) group. The intervention group underwent a home-based STEP consisting of three phases of nine abdominal exercises. DRA size was assessed at baseline and at 8 weeks postpartum using two-dimensional ultrasound.
Results:
The mean age of the participants was 28 years (standard deviation, 3.6), with the majority of Malay ethnicity (87.8%) and working mothers (78%). After 8 weeks, the intervention group showed a significant reduction in DRA size of up to 27% (mean difference, 6.17 mm; 95% confidence interval, 3.7–8.7; P<0.001). No significant intergroup DRA changes were observed after 8 weeks of follow-up.
Conclusion
Early postpartum screening for DRA should be advocated to allow early STEP intervention to ensure favorable outcomes. STEP intervention is an effective postnatal training program for managing DRA.
8.Sonographic nomogram of paediatric renal size in Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Leong Yuh Yang ; Kanaheswari Yoganathan ; Faizah Mohd Zaki ; Erica Yee Hing ; Nik Azuan Nik Ismail ; Nik Farhan Nik Fuad ; Hamzaini Abdul Hamid
The Medical Journal of Malaysia 2020;75(2):130-135
Introduction: A person’s childhood is an important period of
growth, and also one’s most vulnerable, as one can be
exposed to various pathologies, for example those that
could affect the growth of one’s kidney. Asians are
physiologically different from Caucasians, and the
nomogram renal size obtained from a Western population
(mostly of Caucasians) is not be suitable for representing
Asian children. As such a nomogram on paediatric renal size
derived from Malaysia is needed.
Methods: A total of 109 (64 males and 45 females) aged 0-12
in Pusat Perubatan Universiti Kebangsaan Malaysia
(PPUKM) took part in this study. They underwent
ultrasonography of both kidneys, and their demographic
and anthropometric data were collected. The mean and
standard deviations of the renal length and renal volume
according to their age groups was calculated, and the final
data was compared to the ones reported by Rosenbaum et
al. (1984).
Result: Body weight and Body Surface Area (BSA) of the
children reported the strongest correlation with renal size.
Significant differences were found between local and the
data from Rosenbaum et al (1984). A nomogram on
paediatric renal size based on children in PPUKM was then
created.
Discussion: Ultrasonography is regarded as the standard
method for determining renal size. Body weight and BSA
were both strongly correlated with renal size. It was shown
that the widely used nomograms derived from data obtained
from Caucasian was not suitable to represent the population
of Malaysian children.