IIUM Medical Journal Malaysia

A Comparison of Wound Complications and Post-operative Factors Following the Use of Hydrodissection for Mastectomy in Breast Cancer Patients

Muhammad Aizat Tamlikha Ismail — 2022-07-01

Introduction: Mastectomy with axillary clearance remains the hallmark of breast cancer treatment. The conventional use of electrocautery has been associated with the risk of post-operative complications. Hydrodissection may reduce surgery time and produce fewer wound complications with less post-operative pain. The aim of this study was to compare these 2 modalities. Materials & Methods: This prospective randomised control trial was performed with breast cancer patients in Hospital Selayang, Malaysia, between 1 June 2019 to 1 September 2020. The patients were randomised into conventional and hydrodissection groups. The outcomes of interest were post-operative wound complications and other post-operative factors. A chi-square test and independent Student t-test were used to compare the 2 groups. Result: A total of 94 patients were recruited. There was a significant reduction in post-operative seroma in the hydrodissection group compared to the conventional group (40.4 vs 19.1, p<0.05). The surgery in the hydrodissection group was also shorter (114.09 vs 100.15, p<0.05), and there was less 24-hour post-operative pain (3.28 vs 2.13, p<0.05). However, no significant association was observed with other post-operative wound complications (i.e. flap necrosis, surgical site infection and hematoma) or other post-operative factors (i.e. estimated blood loss, mean volume of drain and duration of drain). It was also demonstrated that the hydrodissection technique lowers the risk of developing seroma 3-fold (odds ratio=0.349, p<0.05). Conclusion: The use of hydrodissection with liposuction cannula reduced the rate of post-operative seroma and provided a shorter operative duration and better post-operative pain control.

Pedobarography Study among Malay Population in Kuantan, Pahang: A Pilot Study

Haidar Nasuruddin — 2022-07-01

INTRODUCTION: Pedobarography has been widely used in developed countries for few decades. However, in Malaysia it is still in its infancy. Studies showed that the normal values of pedobarography vary between races. To the best our knowledge there is no standard value available for Malaysian or Southeast Asia. This study is designed to measure the pressure values in the normal foot of Malays in Pahang, Malaysia and its difference between different gender and body mass index (BMI). Materials and Methods: A total of 400 feet of adult Malay subjects with no existing diabetes mellitus, lower limb and spine pain or problem are measured using Emed-q100 pedobarography device. Results: 226 (56.5%) were females. 44.5% were with normal BMI followed by overweight (31.5%), and obese (24%). The mean-maximum-peak pressure (MPP) is 509kPa (SD 167) with no significant difference among gender and BMI. Most (38.5%, n=154) of the peak pressure area (PPA) are observed in 1^st metatarsal head and big toe region (1MH&T), followed by 2^nd metatarsal head (2MH) (34.3%, n=137). In the normal BMI group, 48.3% were in 1MH&T region while in the overweight and obese groups, 42.1% and 43.8%, respectively were in 2MH. This difference is significant (x2(df=8)=36.963, p<0.001). There was no significant difference between PPA and gender. ConClusion: The MPP among Malays in this study was 509kPa(SD 167) and it is not affected by different genders or BMI. The PPA are most commonly fall on 1MH&T. There is a significant shift in the overweight and obese groups to the 2MHT. This finding can be used as initial reference for further studies, in Malaysia particularly.

Effect of Acacia Honey Drink Consumed Pre and During Exercise on Glucose Metabolism, Total Antioxidant Status, and Running Performance in the Heat

Nursyuhada Mohd Sukri — 2022-07-01

Introduction: This study investigated the effects of Acacia honey drink on glucose metabolism, plasma total antioxidant status, selected physiological parameters and time trial running performance in the heat compared to a commercially-available sports drink. Materials and methods: Ten participants completed two endurance running trials in the heat with either honey drink (H) or sports drink (SPD) ingestion. Honey drink or sports drink was ingested one hour prior to the experimental trials. Participants warmed up for 5 min by running at 50% of their respective VO_2max, and subsequently ran at 60% of their respective VO_2max for 1hour. This was immediately followed by a 20 min time trial running performance. Participants drank 3 mL.kg body weight^-1 of cool honey or sports drink every 20 min during the trials. Blood samples were collected for subsequent biochemical analysis. Results: Plasma glucose, insulin, cortisol, total antioxidant status and running performance were not statistically different between H and SPD trials. These findings indicated that Acacia honey drink and sports drink ingested before and during exercise elicited similar effects on glucose metabolism and endurance running performance. Conclusion: Acacia honey has potential to be used as an alternative ergogenic aid for athletes who train and compete in a hot and humid environment.

Using the Theory of Motivated Information Management to Understand Direct Information Seeking on COVID-19 from Close Contacts

Tengku Siti Aisha Tengku Mohd Azzman Shariffadeen — 2022-07-01

INTRODUCTION: As the COVID-19 pandemic spread like wildfire in 2020, initially, little was known about the pandemic. Various parties including local governments, health agencies, medical researchers, and frontliners made concerted efforts to ensure the accuracy, timeliness, and reliability of the information released to the public. Accordingly, a major focus of this study is to examine the factors influencing COVID-19 direction information seeking from close contacts as determined by the theory of motivated information management (TMIM). MATERIALS AND METHODS: A cross-sectional survey using Google form was distributed to undergraduate students pursuing communication courses at public universities in Malaysia. RESULTS: Out of six hypotheses, only two are not supported. Consistent with TMIM, outcome expectancy and target efficacy predict direct information seeking on COVID-19 from close contacts. Further, target efficacy mediates the relationship between outcome expectancy and direct information seeking. CONCLUSION: Overall, the study found empirical support for TMIM as a useful framework for understanding COVID-19 information management. The repercussions of these findings on TMIM as well as key factors that may influence decision-making on information seeking during a global health pandemic are also discussed.

Complementary Thyroid Elastography on Conventional Ultrasound in Diagnosis of Malignant Thyroid Nodules

Adi Syazni Muhammed — 2022-07-01

INTRODUCTION: Ultrasound has been widely used to assess thyroid nodules. Although ultrasound elastography has been developed to improve detection of thyroid malignancy, it has received mixed responses. This study aimed to determine the efficacy of ultrasound elastography in detecting malignant thyroid nodules. MATERIALS AND METHODS: Patients with thyroid nodules were assessed using conventional ultrasound and elastography followed by fine-needle aspiration and or hemithyroidectomy. The ultrasound findings were compared with the cytology or histopathology for statistical analysis. RESULTS: Out of 156 nodules from 92 patients included in the study, 12 (7.7%) were malignant and 144 (88.8%) were benign. The elastography was found to be an independent predictor of malignancy (OR 10.35, 95% CI [1.31, 81.6], p = 0.03). Other independent predictors were taller shape and central Doppler pattern obtained using conventional ultrasound. A combination of the three independent predictors was shown to improve the sensitivity of detecting malignant thyroid nodules up to 100%, 95% CI [73.5,100] with NPV of 100%. A new scoring system incorporating the three variables was developed and an algorithm using the scoring system was proposed. CONCLUSION: Thyroid elastography is an independent predictor of thyroid malignancy. Its performance is comparable to conventional ultrasound when used alone and improved when used in combination with conventional ultrasound. It is valuable as screening and risk-stratification tools for patients with thyroid nodules.

Comparison of Doses in Organs at Risk of Conventional and Three-Dimensional Treatment Planning in Hybrid Brachytherapy

Suk Chiang Chen — 2022-07-01

INTRODUCTION: This retrospective study aims to evaluate the doses of organs at risk (OARs) calculated by conventional two-dimensional (2-D) and three-dimensional (3-D) treatment planning techniques in hybrid high dose rate (HDR) brachytherapy for cervical cancer. MATERIALS AND METHODS: Data of five patients treated with combination of intracavitary and interstitial brachytherapy were used. For each implant, computed tomography (CT) images were obtained, and the clinical target volume and OARs were contoured on CT images. In 3-D planning, the volumes of OARs were derived from dose-volume histogram (DVH) on a dose volume of 2 cc for bladder, rectum, and sigmoid. The OARs defined in replanning for 2-D treatment were the ICRU-38 bladder (bICRU) and rectum (rICRU) points. Paired T-tests were used to analyse the radiation doses of bladder and rectum obtained from both techniques. RESULTS: The mean point doses evaluated via bICRU) and rICRU were 89.34 GyEQD2 and 75.92 GyEQD2, respectively. Meanwhile, the mean volumetric doses of D_2cc for bladder and rectum were 80.50 GyEQD2 and 69.08 GyEQD2, respectively. There is a significant difference in mean doses of ICRU point and D_2cc volume for bladder (p<0.05). However, there is no significant difference in mean doses of ICRU point and D_2cc for rectum (p>0.05). Overall, ICRU point doses overestimated volumetric D_2cc doses with a mean dose ratio of 1.110 for bladder and 1.099 for rectum respectively. CONCLUSION: The bICRU in 2-D planning could not represent the bladder 2 cc used in 3-D planning, thus resulting in different total dose; whereas rICRU of 2-D planning was discovered to be similar with rectum 2 cc of 3-D planning and deemed reliable in total dose estimation

Malay Version of Acceptance and Action Questionnaire-II (AAQ-II): A Reliability and Validity Analysis in Non-Clinical Samples

Farhana Harzila Mohd Bahar — 2022-07-01

INTRODUCTION: Majority of gestational diabetes mellitus (GDM) mothers resume normal glycaemic state after delivery. However, this hyperglycaemic condition may persist in some women. Postpartum GDM mothers have a higher risk of progression to diabetes and prediabetes than those with normal pregnancy. This study was aimed to determine the prevalence of prediabetes among postpartum GDM mothers and its associated factors during six weeks of postpartum glucose testing. MATERIALS AND METHOD: A cross-sectional secondary data review was conducted from January 2021 until May 2021 among postpartum mothers with history of GDM who performed postpartum glucose testing in all government health clinics in Besut, Terengganu from January 2018 until December 2019. A descriptive and multiple logistic regression analysis were performed using IBM SPSS Statistics version 26 software. RESULT: A total of 429 cases were included. Prevalence of diabetes and prediabetes was 2.3% (95% CI 1.6%, 3.0%) and 13.8% (95% CI 12.1%, 15.5%), respectively. There was significant associations found between previous history of GDM (Adj. OR 3.28; 95% CI 1.83, 5.87; p < 0.001) and insulin usage (Adj. OR 2.75; 95% CI 1.51, 4.99; p= 0.001) with development of prediabetes at postpartum period. CONCLUSION: The prevalence of diabetes and prediabetes among postpartum GDM mothers in Besut district was as high as other studies in Malaysia and globally. Women with a previous history of GDM and insulin usage should be focused on prevention strategies as they were at higher risk of developing prediabetes in the postpartum period.

Prevalence and Associated Factors of Prediabetes in Postpartum Gestational Diabetes Mellitus Mothers in the East Coast of Malaysia

Saidah Adilah Binti Mohamed Yusof — 2022-07-01

Introduction: Majority of gestational diabetes mellitus (GDM) mothers resume normal glycaemic state after delivery. However, this hyperglycaemic condition may persist in some women. Postpartum GDM mothers have a higher risk of progression to diabetes and prediabetes than those with normal pregnancy. This study was aimed to determine the prevalence of prediabetes among postpartum GDM mothers and its associated factors during six weeks of postpartum glucose testing. Materials and method: A cross-sectional secondary data review was conducted from January 2021 until May 2021 among postpartum mothers with history of GDM who performed postpartum glucose testing in all government health clinics in Besut, Terengganu from January 2018 until December 2019. A descriptive and multiple logistic regression analysis were performed using IBM SPSS Statistics version 26 software. Result: A total of 429 cases were included. Prevalence of diabetes and prediabetes was 2.3% (95% CI 1.6%, 3.0%) and 13.8% (95% CI 12.1%, 15.5%), respectively. There was significant associations found between previous history of GDM (Adj. OR 3.28; 95% CI 1.83, 5.87; p < 0.001) and insulin usage (Adj. OR 2.75; 95% CI 1.51, 4.99; p= 0.001) with development of prediabetes at postpartum period. Conclusion: The prevalence of diabetes and prediabetes among postpartum GDM mothers in Besut district was as high as other studies in Malaysia and globally. Women with a previous history of GDM and insulin usage should be focused on prevention strategies as they were at higher risk of developing prediabetes in the postpartum period.

Islam, Iman, and Ihsan: The Role of Religiosity on Quality of Life and Mental Health of Muslim Undergraduate Students in Islamic University

Jamilah Hanum Abdul Khaiyom — 2022-07-01

INTRODUCTION: The current study examines the relationships between religiosity, quality of life, and positive mental health among Muslim students in an Islamic university in Malaysia. This study uses the operational definition of religiosity based on Hadith Jibril, which defined Islam into three elements: Islam, Iman, and Ihsan. Materials and Methods: One hundred and seventy-nine students participated in this cross-sectional study. Three measures were used to measure religiosity (IIUM Religiosity Scale), quality of life (WHO Quality of Life-BREF Scale), and positive mental health (Positive Mental Health Scale). Results: Significant relationships between religiosity, quality of life, and positive mental health were found. Further analysis found that i) Ihsan highly predicts the physical and psychological domains of quality of life and mental health; ii) Islam shows the highest prediction on social-based quality of life, and iii) Iman highly predicts the environmental-based quality of life. Conclusion: Religiosity plays a vital role in predicting an individual’s quality of life and mental health. These findings provide hope for future research and utilisation of Islamic elements as an intervention for psychological wellbeing among students.

Serial Evaluation of Sequential Organ Failure Assessment Score in Predicting 1-Year Mortality in Critically Ill Patients

Azrina Md Ralib — 2022-07-01

Introduction: Prediction of long-term prognosis or outcome in the intensive care unit (ICU) is important for prognostication and administration purposes. Sequential Organ Failure Assessment (SOFA) score was developed to estimate organ failure in sepsis patients. However, organ failures have been associated with mortality, and hence SOFA score has been validated as an outcome measure. To the best of our knowledge, the association of SOFA, and serial SOFA score with 1-year mortality was not well established. Materials and method: This was a retrospective observational cross sectional study using the existing record of patients admitted to general ICU Sultan Ahmad Shah Medical Centre from the 1^st June 2017 to the 30^thMay 2018. Data was collected from patients’ daily clinical charts and medical records. SOFA score on day-1 until day-3 and on discharge were recorded and subsequently delta SOFA was calculated. Results: A total of 120 patients’ data were collected. SOFA score within 3 days of admission predicted 1-year mortality, with the highest prediction for on SOFA score on discharge from ICU. Serial SOFA score measured within 24 hours (day 1 to day 2) and 48 hours (day 1 to day 3) did not predict mortality, but delta SOFA involving SOFA on discharged did. Cardiovascular and renal were the most significant individual component of SOFA score that contributed to 1-year mortality. Conclusions: SOFA score measured on discharge from ICU plays the key important factor in contributing to the prediction of 1-year mortality. Cardiovascular and renal were the most significant component that warrant risk stratification measures using the parameters.

A Group-Randomized Study Comparing the Traditional Lecture and Informal Cooperative Learning For Undergraduate Radiology Training In A Malaysian University

Mohd Salami Ibrahim — 2022-07-01

Purpose: Radiology teaching via the traditional lecture (TL) is susceptible to a decline in focus and engagement, leading to compromised training and competency. In this study, we investigated the teaching of radiology topics via informal cooperative learning (ICL). Materials and Methods: We randomly delivered teaching via the TL or the ICL to four clinical group of thirteen third-year undergraduate medical students. The study involved eleven radiology topics throughout one academic year. For each topic, two groups underwent the TL while the other two learned via the ICL. All students underwent a pre-test at the beginning of each class, consist of One Best Answer (OBA) and Objectively Structured Clinical Examination (OSCE) to assess knowledge and skills, respectively. They subsequently underwent post-tests with another OBA and OSCE assessments at the end of class and six weeks later. Results: Students who learned from the ICL classes scored significantly higher in the knowledge assessment immediately post-teaching, six weeks later, and the overall score regardless of time. Assessments of skills showed no statistically significant difference between the two teaching methods. However, for both the ICL and TL, post-teaching scores of knowledge and post-teaching scores of skills were significantly higher than the pre-test. Conclusion: Our study provides empirical evidence on the superior competency of undergraduate radiological skills through the ICL. The findings signify the need to engineer competent doctors via innovative clinical training. The novel experience from this study better-orientate radiology teaching and contribute to the broader field of medical education, clinical practice, and patient safety.

Development and validation of the Self-efficacy, Knowledge, Attitude and Practice towards Environmental Tobacco Smoke (SE-KAP-ETSQ) in the Malay language for mothers with children below 6 years old.

Farnaza Ariffin — 2022-07-01

Introduction: Children under 6-years old are most susceptible to environmental tobacco smoke (ETS). Mothers spend more time with their children and need to be empowered to protect their children from ETS. The study aimed to develop and validate a Malay ETS questionnaire that measures the self-efficacy, knowledge, attitude, and avoidance practice (SE-KAP-ETSQ) among mothers with children below 6 years old. Materials and Methods: The SE-KAP-ETSQ was adapted from two questionnaires; 10-item EEQ and 29-item KAP-ETSQ. The two phases of the study are phase 1: development of the questionnaire and phase 2: validation of the questionnaire. Data were analysed using SPSS ver.26 and AMOS ver.24. Result: A total of 513 mothers; Exploratory factor analysis (EFA) was 186 and Confirmatory factor analysis (CFA) was 327 responded with a mean age of 31.44 years. EFA identified four domains with 26 items. Factor loadings ranged from 0.574 to 0.854 and Cronbach’s alpha ranged from 0.755 to 0.887. CFA generated four models before it achieved best-fit indices with root mean square error of approximation (RMSEA) of 0.053, goodness-of-fit index (GFI) was 0.932, comparative fit index (CFI) was 0.968, Tucker-Lewis index (TLI) was 0.960, Chi-squared/degree of freedom (ꭓ2/df) was 1.909, that left 17 items with factor loadings ranged from 0.614 to 0.948. Composite reliability and average variance extracted of the domains ranged from 0.778 to 0.858 and 0.534 to 0.689, respectively. Conclusion: This study produced a valid and reliable new Malay SE-KAP-ETSQ that can be used for further studies within a wider population.

Prevalence of Problematic Internet Use and its Association with Psychological Distress and Coping Strategies among Universiti Teknologi Mara Students during the COVID-19 Pandemic

Azlina Wati Nikmat — 2022-07-01

Introduction: The COVID-19 pandemic is affecting our day-to-day life and brings a serious impact on public mental health. Due to the practice of physical distancing, the Internet technology is being used to accommodate our daily interactions. In view of the increasing dependency towards this technology, its impact on our mental health well-being is indeterminate. This study aimed to examine the association between problematic Internet use, psychological distress, and the type of coping strategies used among Universiti Teknologi MARA students during this pandemic. Materials and Methods: A cross-sectional online survey was conducted using Internet Addiction Test, Kessler Psychological Distress Scale, and Brief Coping Orientation to Problems Experienced (COPE) Inventory. Data was analysed using SPSS version 26. Results: Of the 444 respondents, 32.2% were noted to have problematic Internet use with 61.3% reported psychological distress. Problematic Internet use was associated with higher level of psychological distress (OR = 1.04, 95% CI: 1.01 – 1.08), and the coping strategies of self-distraction (OR = 1.24, 95% CI: 1.04 – 1.47) and behavioural disengagement (OR = 1.29, 95% CI: 1.07 – 1.55). Conclusion: A high prevalence of psychological distress and its association with problematic Internet use and maladaptive coping among students during this pandemic was evident in this study. Hence, the findings from this study could help to provide insight on the state of the psychological well-being of students in higher education institutions as well as to assist the stakeholders in taking measures to help the students dealing with the pandemic.

Attitudes and Practices on Covid-19 amongst Residents of Two States in Northern Peninsular Malaysia

Kim Tat Tan — 2022-07-01

INTRODUCTION: With the global evolution of Covid-19, and Malaysia’s efforts in containment, the onus of curtailing spread lies in the efforts of the residents to comply and adapt to the new social norms. Our aim was to study the attitudes and practices of the residents in two states in Northern Peninsula. MATERIALS AND METHODS: An analytical cross-sectional study conducted late October 2020. A pre-validated questionnaire via Google forms used. Sample size determined to be 385 for each state. Five-point Likert scale was used to cover 12 questions on attitude and 10 required practices. Data scored and converted into categorical data based on median value of good and bad attitude and practices respectively and analysed with SPSSv23. Statistically significant was p<0.05. With the scored data, Spearmans correlation was used to determine difference in attitude and practice and between the two states. RESULTS: Total of 834 respondents with 50.2% from Penang, mostly aged 20 to 30 years, green zone (40.9%), Chinese (52.6%), Malaysians (97.6%). Overall, 55.6% had good practice with 50.6% good attitude against Covid-19 prevention. Females, those aged 20 to 30 years, married and full-time workers, scored better in preventive actions. Attitude was not associated with any of the factors. Overall, 94.8% agreed to strict enforcement of social distancing and masking. A weak but positive, significant correlation between attitude and practice. CONCLUSION: Level of compliance to new norms is good with no difference between the two states. We need to ensure the social norms are sustained by the community.

Cognitive Behavioural Therapy for Chronic Pain Management: A Narrative Review

Carolyn Liang — 2022-07-01

Chronic pain is disabling and impacts an individual’s psychosocial and functioning in multiple areas. Cognitive Behavioural Therapy (CBT) appears to be one of the psychotherapies that has good potential of prominent efficacy in managing chronic pain. This narrative review aims to provide the necessary information and latest development on the delivery, results efficacy and barriers of CBT in chronic pain management. A search was conducted at Pubmed and Web of Science in April 2021 yielding a total of 251 articles. After careful screening and filtration, a total of 21 articles was selected for this review. Of these 21 articles, CBT was observed to be commonly delivered through online, which helped to preserving cost, promoting adherence, having good efficacy and also safer during the time of the Covid-19 pandemic. Most of the articles showed significant efficacy of CBT in chronic pain management. In order to improve CBT for better efficacy, understanding and consideration towards mediators that affect pain outcome and barriers in implementation are crucial in developing modules in CBT for chronic pain management. As such, CBT can be improved by integrating customised components in the modules to target mediators specifically, and training can be provided for psychotherapist to combat the barrier of online communication and time management. For future research, direction can be focused on development of CBT modules that are specific to chronic pain management.

An Updated Review of Type 1 Diabetes in Malaysia

Ahmad Mahfuz Gazali — 2022-07-01

The emerging phenomenon of early-onset type 2 diabetes mellitus (T2D) among Malaysians and misclassification of diabetes types may impact the estimates of prevalence and incidence of type 1 diabetes mellitus (T1D). From previous studies, the prevalence of T1D among the major ethnic groups in Malaysia was seen highest among Chinese, followed by Malays and Indians. More than half of the patients had diabetes ketoacidosis (DKA). This corresponded with the overall poor glycaemic control seen. However, the incidence of chronic complications, such as nephropathy, was lower. The prevalence of autoantibodies was reported highest for anti-islet cell antibody (ICA). As part of treatment, most Malaysian children had one or two daily insulin injections. Generally, older patients responded better to insulin therapy and yielded better glycaemic control than younger patients. While significant advances have been made in understanding T1D in the Malaysian population, more research is warranted to improve the clinical assessment and outcome of the disease. The present narrative review aims to summarise the overall status of T1D in Malaysia, which includes epidemiology, clinical presentation, diagnosis, complications, and management.

Constraints Related To Smoke-Free Policy Implementation: A Review

Halimatus Minhat — 2022-07-01

Introduction: Smoke-free policies have been enacted and enforced either by law or voluntarily adapted by countries in order to protect its people from the harms of second-hand smoke. However, the mere adoption of smoke-free policies does not guarantee success in fully achieving smoke-free environments due to the many issues and challenges in implementing the policies. The objective of this review is to identify the issues and challenges in the implementation of smoke free policies worldwide. Materials and Methods: A scoping review on observational study designs was conducted. English published journal articles between 1999 and 2019 were searched in four databases (Ovid Medline, PubMed, Scopus and ScienceDirect) and general search engine from September until December 2019. Relevant articles gathered systematically using PICO elements and combination of suggested Medical Subject headings (MeSH) keywords. Results: Twenty articles were included in this review after the filtering and screening process. The smoke-free policy implementation issues were discussed according to the health-policy framework (Content, Context, Actors and Process). Most of the barriers identified were related to the actor construct reflecting the important role played by smokers specifically and the community in general to support the implementation of the policy. Conclusion: The review highlights the important role played by the author contruct of the health-policy framework in order to successfully implement the smoke-free policy especially involving smokers’ awareness and commitment and also public perception towards the capacity of the authority to enforce the policy.

PTEN as A Candidate Molecular Target That Links MVA Pathway and Anti-HER2 Therapy Resistance

Rosmaizan Drahman — 2022-07-01

Drug resistance remains a major problem hampering the success of targeted treatment in cancer therapy. Despite the promising future of targeted therapy, the occurrence of drug resistance leading to poor therapeutic response has been recorded in a large number of patients. The underlying mechanism however is not conclusive. Cholesterol has been associated with the development of breast cancer and its link to drug resistance in this type of cancer could be a new branch of study. Targeting cholesterol biosynthesis for cancer therapy via mevalonate (MVA) pathway is currently demonstrated as an attractive approach for overcoming treatment resistance in HER2+ breast cancer. Here, we discuss the overview of MVA pathway components in breast cancer treatment and resistance as well as the potential use of MVA pathway inhibitors in breast cancer therapy as a new approach to the problem. We also highlight the role of PTEN deficiency, a well-known resistance mechanism in HER2+ breast cancer cells, as a possible new target of the HMGCR inhibition that could be exploited to reverse anti-HER2 resistance.

A Rare Case of Klippel-Feil Syndrome with Cholesteatoma, Thrice Operated with Final Outcome of Cochlear Implant

Siti Sarah Jasmin Abdul Aziz — 2022-07-01

Klippel-Feil syndrome (KF) is defined as the congenital fusion of two or more vertebrae. Due to skeletal abnormalities, patients with KF syndrome may potentially present with hearing loss. To the best of our knowledge, this is a rare case of an adolescent patient with underlying KF syndrome and cholesteatoma. Our patient underwent three successive mastoid operations, primarily due to middle ear disease, with cochlear implantation for hearing rehabilitation.

Case Report: Lymphoepithelial Carcinoma of the Parotid Gland with EBV Association

S Darmma Subramaniam — 2022-07-01

Primary Lymphoepithelial Carcinoma (LEC) of the salivary gland is a rarely encountered malignant tumour by Otorhinolaryngology surgeons especially in Malaysia. It accounts for an estimated 0.4% of all malignant tumours of head and neck with a racial predilection towards Eskimos, people of Southern Costal of China and Japanese. Histologically it exhibits a poorly differentiated neoplasm and a strong association with Epstein-Barr virus that could be similar to an undifferentiated nasopharyngeal carcinoma (NPC). The parotid gland is the most common location a Primary LEC of the salivary gland develops, with patients mostly presenting with a painless parotid swelling and cervical lymphadenopathy. Herein, the authors report a rare case of Primary LEC of the parotid in an unfortunate Malay female. In this case report we further highlight the pathological and radiological features including management of Primary LEC of the parotid as this tumour should be considered in all patients presenting with a painless parotid mass to an Otorhinolaryngology clinic.

Community-acquired Covid-19 Cluster among Non-Clinical Staff in a Teaching Hospital, Malaysia

Azimatun Noor Aizuddin — 2022-07-01

A novel coronavirus, COVID-19 is responsible for the current outbreak of pneumonia. As of 16 September 2021, a total of 2,049,750 COVID-19 cases were recorded in Malaysia. In this study, we aimed to describe a cluster of COVID-19 cases among non-clinical staff in a teaching hospital in Kuala Lumpur Malaysia. We obtained epidemiological and clinical data from patients with confirmed COVID-19, via phone interviews and patient medical records. We performed chronological mapping of the cases to identify the possible period, mode of transmission, and cluster pattern. Three laboratory-confirmed COVID-19 cases were identified from the teaching hospital cluster. These three cases were linked epidemiologically to the religious gathering cluster in Malaysia. Seventy-four close contacts consisting of teaching hospital staff were quarantined. The median incubation period was four days (IQR 1-7). The need for intensified surveillance and a high level of alertness is vital to minimise the risk of widespread transmission in Malaysia.

Classical Enteropathy-Associated T-cell Lymphoma (EATL) Complicating A Crohn’s Disease Patient on Thiopurine Monotherapy: A Case Report

Nur Raziana Rozi — 2022-07-01

Thiopurine exposure from inflammatory bowel disease (IBD) treatment had been associated with a higher risk of lymphoproliferative disorders namely peripheral T-cell lymphoma, as early as 2 years after its initiation. We report a rare case of classical or type 1 enteropathy-associated T-cell lymphoma (EATL) with liver metastasis in a long-standing Crohn’s disease 61-year-old patient treated with azathioprine monotherapy. He presented with acute, severe abdominal pain with cholestatic jaundice and pancytopenia. Colonoscopy showed multiple small, superficial ulcers at the terminal ileum and the biopsy taken was reported as classical EATL, an uncommon gastrointestinal non-Hodgkin’s lymphoma with CD2, CD 3, CD 30, and CD 56 positivity and more than 90% Ki67 proliferative index. Computed tomography (CT) 3-phase liver scan suggested liver metastasis. This case highlights the unusual presentation of classical EATL in non-celiac disease patients and its risk association with thiopurine therapy in IBD.

Sleep and Wellbeing – Interdependent Entities

Dato' Dr. Ahmad Fadzil Abdullah — 2022-07-01