IIUM Medical Journal Malaysia

Prevalence of Erectile Dysfunction and its Associated Factors among Men in Government Health Clinics in Kuantan, Pahang

Wan Fatimah Suriyani Wan Mahmud — 2023-10-01

INTRODUCTION: Erectile dysfunction (ED) is a significant issue that should not be ignored in the clinical setting and can negatively affect the quality of life of patients and their partners. This study aims to determine the prevalence of ED and its associated factors among men who visited 12 government health clinics in Kuantan, Pahang, Malaysia. MATERIALS AND METHODS: Between July and October 2021, 300 males aged 18 to 60 participated in this cross-sectional study at 12 government health clinics in Kuantan. Information on demographic data, medical history, and lifestyle of the participants was obtained through a self-administered questionnaire that included a validated Malay version of the 21 item Depression Anxiety Stress Scale (DASS 21) and the International Index of Erectile Function (IIEF-5). RESULTS: The overall prevalence of self-reported ED was 69.3%. In terms of severity, 45.7% had mild, 20.7% mild-to-moderate, 2.3% moderate, and 1% severe ED. Multivariate analysis showed that ED associated with diabetes (OR 2.97, 95% CI 1.13–7.79); anxiety (OR 2.85, 95% CI 1.06 – 7.67) and household income (OR 0.41, 95% CI 0.18–0.95). CONCLUSION: ED was high in our study population. Diabetes mellitus, anxiety and household income were significantly associated with ED.

Clinical Characteristics and Outcomes of Klebsiella Pneumonia Bacteraemia in Adult

Tiong Chan Lee — 2023-10-01

INTRODUCTION: Klebsiella pneumonia (K. pneumonia) bacteremia is one of the leading causes of hospital morbidity and mortality. Our study aimed to evaluate the clinical characteristics, risk factors and outcomes of K. pneumonia bacteremia in a Malaysian public hospital. MATERIALS AND METHODS: A retrospective cross-sectional study of adults with K. pneumonia bacteremia was conducted in a hospital in Johor, Malaysia. Demographics, medical comorbidities, source of infections and the mortality rate was reviewed and analyzed. RESULTS: A total of 185 cases of K. pneumonia bacteremia were included for analysis. The mean age for this study was 54.9 (SD 15.4), with 56.8% males and 46.5% in-hospital mortality. Extended-spectrum Beta Lactamase (ESBL) producing and Carbapenem-resistant K. pneumonia contributed to 37.3% and 1.1 % of K. pneumonia bacteremia, respectively. Among those who contracted K. pneumonia bacteremia, two most frequent sources were primary bloodstream infections (n=75, 40.5%), pneumonia (n=44, 23.8%) and urinary tract infections (n=28, 15.1%). There was statistically significant associations found between diabetes mellitus (AOR 1.46, 95% CI 1.02-2.08), cancer (AOR 2.02, 95% CI 1.33-3.05) and alcohol use disorder (AOR 7.73,95% CI 1.38-43.21 ) with K. pneumonia bacteremia. In-hospital mortality was higher in older patients by 1.03 odds (p=0.003). CONCLUSION: Diabetes mellitus, cancer, and alcohol use disorder were independent risk factors associated with K. pneumonia bacteremia. Patients with advanced age had a higher mortality rate.

A Single Centre Case-Series of Covid-19 Infection in Kidney Transplant Recipients

Tushar Dighe — 2023-10-01

INTRODUCTION: Severe acute respiratory syndrome coronavirus (SARS-CoV) has mutated over time, affecting its virulence, pathogenicity and disease severity. In December 2019, a new coronavirus (SARS-CoV-2) has emerged causing a disease known as coronavirus disease (COVID-19). The COVID-19 has a broad spectrum of severity ranging from an asymptomatic to a severe acute respiratory syndrome requiring mechanical ventilation. COVID-19 is often more severe in people aged 60 years or more, or those with health conditions like lung or heart disease, diabetes, or conditions that affect the immune system including kidney transplant recipients. In this case series, we presented our experience with 17 kidney transplant recipients who had COVID-19 infection. In India, COVID-19 peaked twice: once between August and November 2020, and again between March and June 2021. Thus, there was paucity of COVID-19 data in kidney transplant recipients in India during these times. MATERIAL AND METHODS: Our case series constituted a retrospective observational study involving 17 kidney transplant recipients who experienced COVID-19 infection from November 2020 to September 2021 at a solitary tertiary care center in Pune. Within our institution, the nephrology team assessed kidney transplant recipients with COVID-19 for appropriate immunosuppression dosing, renal drug clearance when deemed necessary, and overall well-being. Treatment for COVID-19 adhered to institutional protocols. RESULTS: In our case series, majority of the patients (n=13) had COVID-19 in March 2021 to July 2021 and the commonest presenting symptoms were fever and cough. Out of 17 kidney transplant recipients included in this case series, 13 patients survived while 4 patients succumbed to infection. CONCLUSION: An individualized, case-based approach to managing transplant recipients with COVID-19 is crucial for achieving favorable clinical outcomes.

Improved Quality of Healed Wounds with Topical Application of Eurycoma Longifolia Jack Root Extract Hydrogel

Maryam Riyadh Yaseen Al-Bayati — 2023-10-01

INTRODUCTION: Collagen is the key component of the extracellular matrix that plays a critical role in the strength and quality of the healed wound. Eurycoma longifolia Jack root extract (TA) has been documented as an anti-inflammatory, antioxidant, and antimicrobial agent that may improve the quality of healed wounds. The objective of this study is to investigate the effect of topical application of TA hydrogel on the quality of the healed skin in rats. MATERIALS AND METHODS: Twenty male Sprague Dawley rats were grouped into 4 groups: Negative control, Hydrocyn® aqua gel positive control, vehicle (Xanthan) hydrogel, and Eurycoma longifolia Jack (TA) hydrogel. Treatments were applied twice daily starting on wounding day until day 21. An excisional wound was created on the back of 20 rats. Tissue samples of the healed skin were collected for histological examination by measuring the epidermal and dermal thicknesses and evaluating the collagen fibre quality by VVG stain. RESULTS: The TA hydrogel group had the thickest newly formed epidermis compared with the other experimental groups. For the dermal thickness, compared with the vehicle (xanthan) hydrogel group, TA hydrogel, and Hydrocyn aqua® gel positive control groups showed significantly increased thickness with p values 0.020 and 0.045, respectively. Histologically TA hydrogel group showed a significant increase in mixed-oriented collagen fibres, and fascicular collagen bundles and showed profound collagen density. CONCLUSION: TA hydrogel improved the quality of healed skin by increasing the epidermal/dermal thicknesses and enhancing the quality of newly produced collagen fibres. It can be considered a promising and effective wound-healing agent.

The Reliability of SketchAndCalcTM Area Calculator Software in Evaluating The Obturated Surface Area of Mandibular Premolars and Molars

Musliana Mustaffa — 2023-10-01

INTRODUCTION: The measurement consistency of an assessment tool in biomedical research is important for validation of data. This study aims to determine the reliability of SketchAndCalc^TM Area Calculator software in evaluating the obturated surface area of single rooted mandibular premolars and mandibular first molars between two examiners and to compare with the previous studies. MATERIALS AND METHODS: 30 scanning electron microscopy (SEM) images of extracted single rooted mandibular premolars and 30 SEM images of mandibular first molars were obtained from the previous studies. The extracted teeth were previously obturated with GuttaFlow Bioseal. Calibration between two examiners was done prior to start of the study. SketchAndCalc^TM Area Calculator software was used to evaluate the volumetric percentage of obturated surface area. Inter-examiner reliability was determined between two examiners and compared to the previous studies using Intraclass Correlation Coefficient (ICC) with the following categories; ICC<0.50: poor reliability, ICC 0.50-0.75: moderate reliability, ICC 0.75-0.90: good reliability, ICC>0.9: excellent reliability. The data was analysed with SPSS version 25.0. RESULTS: The ICC values between two examiners were 0.979 in mandibular premolars and 0.918 in mandibular molars. Meanwhile, the ICC values between two examiners and to the previous studies were 0.844 in mandibular premolars and 0.962 in mandibular molars. CONCLUSIONS: Excellent inter-examiner reliability was observed in premolars and molars, however when compared to the previous studies, good and excellent interexaminer reliability were observed in premolars and molars respectively.

Carbapenem-Resistant Enterobacteriaceae Bacteraemia in Intensive Care Unit: A Descriptive Study on Risk Factors and Clinical Outcome

Sivasangari Nachamuthu — 2023-10-01

INTRODUCTION: Over the past 10 years, the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) has been increasing dramatically with numerous hospital outbreaks reported. Bacteraemia caused by CRE have limited treatment options and have been associated with high mortality rates. As a result, preventing both CRE transmission and CRE bloodstream infections have become important objectives in managing intensive care unit (ICU) patients. The study aims to determine the incidence and risk factors of CRE bacteraemia in intensive care settings, and its’ clinical outcome. MATERIALS AND METHODS: A retrospective, descriptive study was conducted, where data of the patients admitted to general ICU of Hospital Pulau Pinang from January 2017 till December 2018 were collected and assessed for incidence, presence of predisposing factors and clinical outcome for CRE bloodstream infection. RESULTS: Out of 2,585 total ICU admissions, there were 37 cases of CRE bacteraemia with an incidence rate of 1.43%. An analysis of risk factors revealed that the use of indwelling catheter has the highest association with CRE bacteraemia in which 95% of the patients were exposed. The commonest organisms of CRE bacteraemia were Klebsiella pneumoniae (97.3%) and Escherichia coli (2.7%). The 30-day mortality rate after CRE bacteraemia was 78.4%. CONCLUSION: CRE bacteraemia among ICU patients showed a high mortality rate. Most of the patients were exposed to multiple risk factors. A high index of suspicion and rapid identification of patients at risk for CRE infection are important for effective therapy and initiation of infection control measures to prevent further spread.

Influence of Creativity Stimulation on Brain Connectivity during Divergent Thinking Tasks

Khairiah Abdul Hamid — 2023-10-01

INTRODUCTION: Different facets of divergent thinking (DT) are associated with connectivity between different cerebral areas. However, the causal interactions between the key DT nodes have yet to be explored. It is hypothesised that with creativity stimulation, changes in effective connectivity among regions will be observed. MATERIALS AND METHODS: By using control (n=26) and experimental (n=24) participants, this study aimed to investigate the effective connectivity between brain areas associated with divergent thinking that accentuate fluency, flexibility, and originality. The experimental participants attended a two-day creativity stimulation, followed by three task-based fMRI sessions for all participants, which included basic use (BU) identification, alternative use (AU) generation and unusual use (UU) determination tasks. Dynamic causal modelling (DCM) was used to determine the most optimal causal model representing the most possible modulatory influence on the connections between medial prefrontal cortices (mPFC), inferior frontal gyrus (IFG), and inferior parietal lobule (IPL). RESULTS: The experimental participants scored higher fluency and flexibility than the controls (p<0.05). At neuronal level, the control group showed similar intrinsic connections receiving modulatory influence for AU and UU tasks, while the experimental group preferred a different perturbation of connection between both tasks. These intergroup differences may be caused by different thinking strategies involving semantic and episodic memory retrieval, and integration of remotely associated ideas to construct new combination among the experimental participants. CONCLUSION: Different DT demands may influence the effective connectivity between mPFC, IFG and IPL especially among individuals with higher DT abilities, especially in fluency and flexibility versus originality.

Sources of Perceived Social Support and Associated Factors for Depression amongst Malay Primary School Adolescents in Kelantan, Malaysia

Azriani Rahman — 2023-10-01

INTRODUCTION: Adolescent depression is a substantial health concern nowadays, and perceived social support determines the outcome. Lack of research on depression amongst Malaysian younger group of adolescents, puts them at risk of being under diagnosed and under treated. Furthermore, the function of various social supports for depression in early adolescents is less explored. The primary objective of this study was to determine the level of support for adolescent depression from five different sources: i) parents, ii) teachers, iii) close friends, iv) classmates, and v) others in school. The secondary objective is to study the prevalence of depression amongst primary school adolescents and establish their association and the other factors that influence depression. MATERIALS AND METHODS: A cross-sectional study involving 576 adolescents between the ages of 10-11 year olds were conducted from August 2020 till September 2020 using the Malay Children Depression Inventory (M-CDI) and Malay Child and Adolescent Social Support Scale (M-CASSS). RESULTS: The respondents reported that teachers were the most supportive. Approximately 131 (22.7%) of them had depressive symptoms. Only parental support significantly reduced their risk of developing depression. Having a single parent household, being bullied, emotional abuse, and performing poorly in school increased the likelihood of developing depression. CONCLUSION: Findings from this study, demonstrated the necessity for early depression screening amongst primary school adolescents and the need for stakeholders to continue supporting parents in their efforts to deal with adolescent concerns.

Urinary Apolipoprotein A1 and its Potential as a Biomarker for Coronary Artery Disease in Young Adults

Norbaiyah Mohamed Bakrim — 2023-10-01

INTRODUCTION: Very few studies have focused on exploring the utilisation of urinary protein biomarkers to improve the risk stratification of coronary artery disease (CAD) in young adults. Apolipoprotein A1 (ApoA1) as a primary constituent protein of Highdensity Lipoprotein (HDL) known to modulate cholesterol metabolism exhibits promising properties to be used as a protein biomarker, specifically for CAD in young adults. Thus, this study is aimed to evaluate the potential of urinary ApoA1 as a urinary biomarker of CAD in young patients with acute myocardial infarction (AMI). MATERIALS AND METHOD: This case-control study recruited 40 newly diagnosed AMI patients and 40 healthy control subjects aged 18–45. Urine samples were collected from all subjects. Once centrifuged, the supernatant was collected and stored at -80 °C until further analysis. The urinary concentration of ApoA1 was quantified using the ApoA1 Enzyme-linked Immunosorbent Assay (ELISA) kit according to the manufacturer's protocol. All subjects' risk factors were determined and documented, such as smoking status, Body Mass Index (BMI), blood pressure, plasma total cholesterol, and glucose levels. RESULTS: The mean age of AMI patients was higher than the controls; 37.1 1 ± 5.2 and 31.6 ± 8.1 years respectively. The mean urinary concentration of ApoA1 of AMI patients was significantly higher than the controls (12. 442 ± 3.571 vs. 10.067 ± 5.606 ng/ mL (p<0.05). Following an adjustment to other conventional CAD risk factors, there was an insignificant association between urinary excretion of ApoA1 and AMI in young adults (Odd Ratio (OR)=3.123, 95% CI: 0.756–1.015, p>0.05). CONCLUSION: A significant elevation of urinary excretion of ApoA1 in AMI young adults demonstrated its potential use as a urinary protein biomarker for CAD in young adults.

Exploratory Study on the Compensation Practices in Private Hospitals for Clinical Specialists in Malaysia

Faiz Daud — 2023-10-01

INTRODUCTION: Fee-for-service (FFS) has been the main payment method for clinical specialists around the world. However, until most recently, several payment methods for doctors, particularly clinical specialists, such as salary, pay for performance and blended remuneration of the above models have been researched. This mechanism is being used to increase the level of quality and value of healthcare services in the health sector. Despite increasing interest in these alternative payment methods, there is limited research about the payment method offered to clinical specialists in Malaysia. MATERIALS AND METHODS: Using qualitative interview with 15 private clinical specialists and 4 hospital administrators working in private hospitals in Malaysia, we explored the existing payment methods offered to private clinical specialists by private hospitals. RESULTS: Our study found that four payment methods were used which were FFS, salary-based, salary-based plus incentives and pool system. Majority of the clinical specialists interviewed were under the FFS payment method. New emerging payment methods which include salary-based and salary-based plus incentives were implemented in recent years, while the pool system was confined to certain specialities. CONCLUSION: The private hospitals in Malaysia provides different payment methods to the private clinical specialists which includes FFS, salary-based, salary-based plus incentives and pool system. These findings can help policymakers to explore the potential of various payment methods in the near future.

Perception Towards COVID-19 Vaccination-A Cross-Sectional Study in Iraq

Miami Yousif — 2023-10-01

INTRODUCTION: The current COVID-19 pandemic has urged the scientific community globally to find answers in terms of therapeutics including vaccination to control the disease. Various COVID-19 vaccines have been distributed in many countries, including Iraq. Vaccination program will only be successful when there are high rates of acceptance and coverage. Thus, to accomplish this program, it is critical to understand the perceptions of the COVID-19 vaccine and its acceptance. Therefore, our study was performed to investigate community perceptions towards COVID-19 vaccinations in Iraq. METHODS: A cross-sectional study was conducted in Iraq from March 2021 to June 2021. We enrolled a total of 9,620 participants (3,160 men and 6,460 women). The participants responded to an online survey on COVID-19 vaccination which consisted of three sections of questionnaires. The first section (Section A) was on demographic characteristics of respondents including age, gender, occupation, level of education, and residency whereas the second section (Section B) was on the respondent’s perception toward COVID-19 vaccine, with nine inquiries about reasons for fearing COVID-19 vaccine. The final section (Section C) was questions on the type of vaccine they prefer to receive, once it is made available. RESULTS: Of the total respondents, 70.68% were not keen for a COVID-19 vaccination. Some of the respondents’ concerns were that the vaccines are not safe and may cause infection with COVID-19, infertility, congenital infection, and fetal anomalies. Majority of respondents who accepted to be vaccinated trusted the Pfizer vaccine followed by Sinopharm vaccine. CONCLUSION: Hesitancy for COVID-19 vaccination among participants were mainly due to lack of trust in the safety and efficacy of the vaccine and also feared of being infected and death. Thus, the healthcare providers and community leaders should come out with strategies to decrease the hesitancy and increase the acceptability of the vaccines.

Factors Associated with Risk Exposure to Human Rabies among Mammal Bite Cases in Mukah Division, Sarawak, East Malaysia

Nik Nairan Abdullah — 2023-10-01

INTRODUCTION: Rabies is a neglected disease. Before the epidemic of rabies in Sarawak in July 2017, surveillance of mammal bites was not well implemented throughout the state. Our objective was to determine the prevalence of mammal bites in the Mukah Division and the factors that are associated with the risk of exposure to human rabies. MATERIALS AND METHODS: This is a cross-sectional study that used data from reported cases of mammal bites in Mukah Division, Sarawak, from 2018–2019. A universal sampling method was used, and 457 cases of mammal bites were included in the analysis. Data was analysed using single logistic regression and multiple logistic regression. RESULTS: The prevalence of mammal bites in Mukah Division was 0.35% with a cumulative incidence of 354 per 100 000 population. Age group 0-14 years old (AOR 6.49, 95%CI 1.26-33.53), free-roaming pet (AOR 2.93, 95% 1.36-6.28) and stray mammals (AOR 10.88, 95% CI 5.05-23.48) were found to be significantly associated with risk exposure to human rabies in Mukah Division in the final model. CONCLUSION: Health awareness and education should be emphasized to the community and medical personnel on the identified risk factors so that rabies infection can be prevented.

Human Milk Expression Practices, Experiences and Perceptions among Mothers: A Systematic Literature Review

Nor Kamariah Mohamad Alwi — 2023-10-01

Human milk expression is commonly practiced among breastfeeding mothers. Their practices, experiences, and perceptions varies due to many underlying environments and issues. This review describes practices, experiences, and perceptions of mothers in expressing milk. Literature search was conducted for peer-reviewed articles on milk expression using Scopus, Krisalis Discovery, CINAHL, and PubMed from 2010 to 2020 for qualitative and mixed studies. This review and reporting was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Screening and selection of articles were conducted using Distiller Systematic Review (DSR). Twenty-two qualitative studies were identified focusing on the milk expression practices, experiences, and perceptions of mothers. Their practices indicated time, duration and method of milk expression. The experiences found were on the reasons, challenges, coping strategies and motivations. The perceptions on milk expression were found to influence the experience and practices of milk expression. Human milk expression practices, experiences and perceptions have been highlighted in many studies; however, there is no clear association between practices, experiences and perception.

The Association of Sugar and Sugar Substitutes to Breast, Lung, and Oral Cancer Cell Lines: A Scoping Review

Mukarramah Zainal — 2023-10-01

Cancer which synonymously known as neoplasia is a genetic disorder of cell growth that is triggered by acquired or less commonly inherited mutations affecting a single cell and its clonal progeny. The aims of this scoping review was to investigate the role of sugar and sugar substitutes in breast, lung, and oral cancers with a hypothesis that sugar promoted carcinogenesis. Three databases (EBSCO, PubMed, and Scopus) were searched from January 2010 to December 2021 to identify the preclinical studies eligible for this scoping review. The review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. A total of 361 articles were reviewed and the qualitative synthesis used 12 of these articles. Based on the qualitative synthesis, four studies reported dietary sugar (glucose- and/or sucrose) induced cancer progression, one study revealed sugar substitute (aspartame) induced cancer proliferation, seven studies reported that sugar substitutes inhibit cancer proliferation, and one study reported that sucrose promotes cancer while xylitol inhibits cancer. In addition., it was reported that D-allose and cisplatin have a synergistic effect in treating cancer. In conclusion, simple sugar intake is associated with an increased risk of carcinogenesis. In contrast, sugar substitutes inhibit cancer cell line progression, subsequently acting as a potential cancer therapy, thus supporting the study's hypothesis.

A Scoping Review of Female Genital Mutilation and its Effects on Sexual Function and Sexual Satisfaction

Zalina Nusee — 2023-10-01

The practice of female circumcision (FC), particularly female genital mutilation/cutting (FGM/C), has been controversial as it is regarded as physically and mentally harmful and violates human rights. The purpose of this study is to perform a scoping review aiming to evaluate and compare the effects of FC and FGM/C on the sexual function of the affected women, including the Google Scholar, EBSCO Discovery Service, PubMed, ProQuest Health & Medical Complete, and Wiley Online Library between the year 1999 to 2020. The following keywords were used: ‘Female Circumcision’, ‘Female Genital Mutilation, ‘Female Genital Cutting’, ‘Female Circumcision and Sexual Function’, and ‘Female Circumcision and Sexual Satisfaction. A total of 72 articles related to FC and sexual function or satisfaction were retrieved, and 30 articles met the inclusion criteria. Based on the analysis of the final 30 articles, most of the articles described the detrimental effects of FGM/C on sexual function and sexual satisfaction. However, future studiesMaround the less invasive types of FGM/C are required to better reflect on FGM/C on female health. FGM is detrimental to female sexual satisfaction. However, a different method of FC that is less invasive may provide different outcomes. Therefore, a comprehensive guideline on proper FC techniques is needed for education among medical practitioners to prevent any adverse effects on sexuality.

Anticoagulant Activity in Medicinal Plants: A Systematic and Bibliometric Review Over 10 Years (2011-2021)

Auni Nur Sabrina Kamaru Azman — 2023-10-01

Anticoagulants are helpful as treatment for coagulation disorders. Medicinal plants have been demonstrated to be part of history as a traditional treatment for this disorder, and these plants have anticoagulant properties. Hence, the goal of this study is to review the available publications on anticoagulant activity in medicinal plants from the year 2011 until 2021 using Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and bibliometric analysis. This review was performed based on the PRISMA guidelines and VOSviewer as a bibliometric analysis tool, using three search databases which were PubMed, MyMedR, and ScienceDirect. The findings of this study revealed that 27 articles met the inclusion criteria and focused on anticoagulant activity in medicinal plants. In each study, anticoagulant properties in medicinal plants were addressed. Meanwhile, the results of the bibliometric analysis demonstrated that China has the most publication for anticoagulant activity in medicinal plants and had the most
collaboration among institutes in their country. For the most used keywords used by the author, the word "anticoagulant activity" came on top of the results. To conclude, this study can contribute to the field of study as it helps combine the data related to anticoagulant activities in medicinal plants.

An Orange Baby: Benign Carotenemia in an Infant: A Case Report

Erinna Mohamad Zon — 2023-10-01

Carotenemia is a clinical condition characterized by yellow skin pigmentation (xanthoderma) and increased blood beta-carotene levels due to various causes. Dietrelated carotenemia is common but usually underreported. We report here a case of carotenemia in a male infant caused by over ingestion of the high-carotene diet by the infant and his mother. Recognizing this condition will avoid unnecessary referrals and investigations.

Post Vaginal Delivery with Impending Silent Abdominal Catastrophe: A Case of Vernix Caseosa Peritonitis

Nur Nadia Mohd Yusof — 2023-10-01

Vernix caseosa peritonitis (VCP) is a rare condition previously thought to be a complication of Caesarean section caused by the spillage of amniotic fluid and or meconium into the maternal peritoneal cavity during operation.¹ This triggered an inflammatory reaction symptom such as an acute abdomen. A total of 34 cases has been reported since 1976.² Nine of the 10 cases reported have been diagnosed in postpartum period after uneventful Caesarean section and only three reported cases of antenatal leakage since in 1998.³ VCP following vaginal delivery was first reported in 2013, involving a 28 year old with one previous scar who developed acute abdomen symptoms as early as 3 hours post vacuum delivery, with initial diagnosis of possible uterine scar rupture.⁴ Here we report a case of VCP in a post spontaneous vaginal delivery who presented with impending catastrophe and survived the ordeal.

A Multidimensional Strategy: Ways to Combat Cyclic Vomiting Syndrome with Hiatus Hernia and Gastroesophageal Reflux Disease in A Young Adult Female

Nazri Mustaffa — 2023-10-01

Cyclical vomiting syndrome (CVS) is a chronic idiopathic functional gastrointestinal disorder characterised by intermittent episodes of severe nausea and vomiting with symptoms-free intervals in between. CVS is seen in various age groups with a prevalence of 1.9%. Numerous psychosocial, physical and infectious stressors have been attributed as a trigger of CVS. Often, a co-existing organic and psychiatric comorbidities mask the disorder, and an absence of diagnostic investigation causes a delay in diagnosis and makes it challenging to treat.

Recurrent Hypoglycaemia in A Diabetic Patient: The Unexpected Diagnosis

Poh Siang Ooi — 2023-10-01

Hypoglycaemia is a common complication seen in diabetic patients receiving insulin. However, insulin is not the risk factor for hypoglycaemia attack as patient with underlying liver problem is also at risk. Thus, as an attending physician, a high index of suspicion is required in dealing with hypoglycaemia patient. We report a 60-year-old woman with underlying diabetes mellitus who presented with recurrent hypoglycaemic episodes and noted to have multiple benign liver cysts that progressed into hepatic failure secondary to hepatocellular carcinoma.

Confronting Global Obesity Epidemic: Art of Simplicity, Puzzle of Complexity

Assoc. Prof. Dr. Nik Nur Fatnoon Nik Ahmad — 2023-10-01