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XANTHOGRANULOMATOUS CHOLECYSTITIS: A DIAGNOSTIC DILEMMA

Summaya S ; Aun A ; Shamaila A ; Muhammad Rauf S ; Amjad Siraj M

Journal of University of Malaya Medical Centre.2018;21(2):1-3.

Xanthogranulomatous cholecystitis is a rare histopathological finding and accounts for 1.3% to 5.2% of cases. It closely resembles gallbladder cancer because of its extensive inflammation and involvement of the surrounding organs. We are reporting a case where it presents as an extensive inflammatory mass mimicking gallbladder cancer.

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RISK OF ACUTE KIDNEY INJURY AND HYPONATREMIA IN LONG-DISTANCE RUNNERS

Wan Md Adnan WAH ; Abdullah R

Journal of University of Malaya Medical Centre.2018;21(2):4-9.

Long-distance running has gathered some momentum among health-conscious participants. However, some studies have revealed association between long-distance running and development of acute kidney injury. Although the impact usually lasts only for a few days after the event, some participants have been admitted for severe acute kidney injury, the minority of which require dialysis treatment. The mechanisms underlying the injury may include dehydration, development of rhabdomyolysis, heat stroke and concomitant use of NSAIDS. Unfortunately, there is no long-term follow-up study to determine the long-term effect on kidney function. Acute hyponatremia may develop in a significant proportion of long-distance runners. Majority of them were asymptomatic but a few fatal cases which were supposedly due to cerebral oedema have been reported. Excessive intake of hypotonic drinks, excessive sweating and secretion of non-osmotic antidiuretic hormone have been postulated to be the causes of hyponatremia. This mini review will discuss the pathophysiology of the development of acute kidney injury and hyponatremia. It will also discuss the prevention and treatment of both conditions

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PRESENCE OF BOTH DENGUE SPECIFIC NS1 ANTIGEN AND IMMUNOGLOBULIN M ANTIBODY IN CONFIRMED DENGUE PATIENTS IN KOLKATA

Poddar S ; Mukim Y ; Pal D ; Bhattacharya N ; Hati AK

Journal of University of Malaya Medical Centre.2018;21(2):10-14.

The object of this study was to identify patients with diagnosed dengue infection, who were positive for both dengue-specific NS1 antigen and IgM antibody.

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BARRIERS AFFECTING CLUBFOOT TREATMENT IN SARAWAK

Nur Alyana BA ; Sahdi H ; Rasit AH ; Zabidah P

Journal of University of Malaya Medical Centre.2018;21(2):15-22.

Congenital talipes equinovarus (CTEV), also known as clubfoot is the most common lower limb congenital deformity among paediatric patients. The outcome of starting clubfoot treatment early is very promising. Patient retention throughout the treatment programme is challenging in Sarawak. In this study, we explored the barriers that parents/caregivers face when seeking clubfoot treatment in Sarawak, Northwest Borneo. A better understanding of the barriers will provide us with the information to formulate effective programmes for clubfoot treatment in this region.Methods: We conducted a questionnaire-based quantitative cross-sectional descriptive survey. We adapted a set of closed-ended questionnaires originally designed by Kazibwe and Struthers in a study done in Uganda in the year 2006.Results: A total of 53 parents/caregivers of children with idiopathic clubfoot were recruited in this study, with 16 defaulter cases and 37 non-defaulter cases. We found 2 statistically significant barriers to clubfoot treatment in Sarawak, with p-value < 0.05, namely the geographical factor (p = 0.019) and logistic factor (p = 0.017).Conclusion: Barriers to clubfoot treatment that influence the compliance to treatment identified in this study are long distance travel, logistics limitations, uncooperative patients during treatment, parents/caregivers having other commitments, unsupportive family members, lack of understanding regarding clubfoot and its treatment, inadequate specialists in clubfoot, traditional socio-cultural beliefs and practices and economic constraints. Enhanced understanding in this matter will guide us in devising culturally admissible ways to increase awareness in parents/caregivers regarding clubfoot and its treatment. A sustainable national clubfoot program will be very beneficial in providing a holistic approach to tackle barriers to treatment in our country

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FACTORIAL VALIDATION OF THE CHINESE GENERAL FUNCTIONING SUBSCALE (GF-12) OF THE FAMILY ASSESSMENT DEVICE IN MALAYSIA

Wo SW ; Lai PSM ; Ong LC ; Low WY ; Wu DBC ; Nathan AM ; Wong CP

Journal of University of Malaya Medical Centre.2018;21(2):23-30.

The objective of this study wasto determine the factorial validity of the Chinese version of the General Family Functioning subscale (GF-12) and to assess parents’ perceived family functioning of children with or without chronic respiratory disease in Malaysia. Thirty two parents of children with chronic respiratory disease and 30 parents of healthy children were recruited. The GF-12 was administered at baseline and 2 weeks later. Confirmatory factor analysis showed that our instrument was a 1-factor model assessing general family functioning. Cronbach’s α value was 0.950. Test-retest reliability coefficient ranged from 0.490-0.790. The overall mean (standard deviation) score was not significantly different between parent’s perceived family functioning of children with or without respiratory disease [1.83(0.63) versus 1.65(0.46), p=0.385]. The Chinese version of the GF-12 was found to be a valid and reliable instrument to assess family functioning in Malaysia. Parents in the present study showed healthy perceived family functioning (total score >2.00)

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PHENYTOIN-INDUCED SEVERE THROMBOCYTOPAENIA POST DEXAMETHASONE CO-ADMINISTRATION IN A PATIENT WITH INTRACEREBRAL HAEMORRHAGE

Lau EF ; Shanmugam H ; Mazlan M

Journal of University of Malaya Medical Centre.2018;21(2):31-34.

Phenytoin is commonly prescribed for the prophylaxis of seizures in neurosurgical patients. A phenytoin-induced serious adverse effect of thrombocytopenia has been reported in the literature. The concurrent use of dexamethasone, another commonly prescribed drug in neurosurgical patients, has been reported to aggravate this adverse haematological effect. We present a report of phenytoin-induced thrombocytopenia in a patient concurrently prescribed with dexamethasone, after an intracerebral haemorrhage secondary to a rupture of an arteriovenous malformation. The thrombocytopenia was noted after two weeks of phenytoin medication. Phenytoin was immediately withheld, and seven units of random donor platelets were transfused. A gradual resolution of thrombocytopenia was observed within a week

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RIGHT SIDED CONGENITAL DIAPHRAGMATIC HERNIA OF MORGAGNI TYPE IN ADULTS: A RARE ENTITY

Kumar D ; Aun A ; Summaya S ; Ahmed N ; Samo K ; Rehman SU

Journal of University of Malaya Medical Centre.2018;21(2):35-37.

Congenital diaphragmatic hernia (CDH) is an anomaly of infants. It is associated with other anomalies, including pulmonary hypoplasia, malrotation of the gut and patent ductus arteriosus (PDA). Hence it is essential that it is diagnosed early. Sometimes, it can remain unrecognized till adulthood, if no other associated developmental anomalies, like pulmonary hypoplasia, occur. In adults, it is diagnosed when intestinal contents herniate into the thorax causing pulmonary and intestinal complications. It is mostly present on the left side because of late fusion of the pleuro-peritoneal membranes, and the absence of the liver on the left side. Moreover, it is commonly due to trauma in adults. A case report of a right sided diaphragmatic hernia of Morgagni type in an adult was discussed

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RISK PERCEPTION OF CHILDHOOD IMMUNISATION AMONG THE PUBLIC IN KOTA KINABALU, SABAH

Zaki RA ; Hazwan AE ; Musa N ; Roffeei SN

Journal of University of Malaya Medical Centre.2018;21(2):38-44.

Objective: The study was designed to determine the risk perception of the public population in Kota Kinabalu towards childhood immunisation. Methodology: This was a cross-sectional study where self-administered questionnaires were distributed to the public in Kota Kinabalu. The respondents who consented were 18 years old and older. The illiterate persons and the foreigners were excluded. The calculated sample size was 400. Only 313 samples collected were suitable for analysis using SPSS21.0. Results: Fever, pain swelling and allergic reaction were correctly identified as risks of immunisation. Autism, mental retardation and even death could also result from vaccination. Of the total respondents, 76.7% agreed with the practice of childhood vaccination, 70.0% thought that childhood vaccinations were safe and effective and 58.1% felt that its benefit outweighed the risk. Other than that, 32.0% refused childhood vaccination from fear of its risks, and this fear was the main reason for the refusal of childhood vaccination. Age, marital status, race and income were the factors which influenced parental willingness to vaccinate their children (p<0.05). Conclusions: Most participants understood the risks of childhood vaccination, but few agreed to the practice of childhood immunisation for herd immunity. Public health campaigns are needed, to increase the understanding and acceptance of childhood vaccination especially in the rural community.

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IMPACT OF CTLA-4 AND NOD2/CARD15 GENE VARIATIONS ON GRAFT- VERSUS-HOST DISEASE AFTER ALLOGENEIC HSCT: A STRUCTURED REVIEW

AL-Battawi S ; Hameed S ; Ng ESC ; Amini F

Journal of University of Malaya Medical Centre.2018;21(2):45-52.

Graft-versus-host Disease (GVHD) is the main cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (alloHSCT). In spite of immune-suppressive prophylaxis, most survivors suffer from acute and chronic GVHD (aGVHD and cGVHD). The outcome of alloHSCT may be affected by the presence of single nucleotide polymorphism (SNP) in non-HLA genes including those involved in innate immune responses. This study aimed to evaluate the impact of cytotoxic T-lymphocyte antigen-4 (CTLA-4) and caspase recruitment domain 15 (NOD2/CARD15) gene polymorphisms on the incidence and severity of aGVHD and cGVHD following alloHSCT. A structured literature review was carried out using various keywords and MESH terms such as stem cell transplantation, allogenic haematopoietic stem cell transplantation, GVHD, and non-HLA gene polymorphism, in PubMed, Google Scholar and Cochrane Database. A total of 8 studies that met inclusion criteria (English publications from 2006 to 2017) were included. Ten SNPs in CTLA-4 gene and three SNPs in NOD2/CARD15 gene were tested in patients with underlying haematological malignancies. Four studies tested the SNPs of CTLA-4 gene and two were found to have an association with CTLA-4 SNPs (rs3087243, rs231775) and increased incidence of aGVHD. The other four studies tested the SNPs of NOD2/CARD15 gene and one found an association between SNP13 and increased incidence of aGVHD. None of these eight studies found any effect on severity of GVHD. In conclusion, two SNPs in CTLA-4 and one SNP in NOD2/CARD15 increased the incidence of aGVHD but not its severity. The higher incidence of aGVHD in studies with larger sample size could support the impact of SNPs in the outcome of alloHSCT. However, due to the heterogeneity of studies in regard to the age of patients and donor, and conditioning regimen, it is difficult to draw a definite conclusion

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ORPHAN DRUGS AND HIGH COST MEDICATIONS: CHALLENGES AND SOLUTIONS

Chuah SY ; Thong MK

Journal of University of Malaya Medical Centre.2018;21(2):53-58.

There had been increased and strong public interests in rare diseases and orphan drugs as well as the issue of compulsory licencing for expensive medications in Malaysia in the mass-media and social media. We reviewed the issues of orphan drugs and the challenges faced in many countries in developing appropriate health financial modelling as well as getting accurate data on rare diseases. We also reviewed the old off-patent medications and the developments on how policy-makers can intervene to make expensive treatment affordable and sustainable for patients and the country

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