The Medical Journal Of Malaysia[JOURNAL]
Sun
200 papers
A study on role of topical application of mitomycin c postoperatively in reducing adhesions/synechiae after FESS in patients with chronic rhinosinusitis: A Randomized controlled trial.
Vemula A, Anbarasan S, Anand KH … +1 more , Subramanian E
Med J Malaysia · 2025 Dec · PMID 41456147
INTRODUCTION: Synechiae formation is a common and undesired complication after functional endoscopic sinus surgery. Mitomycin-c, known for its anti-proliferative and anti-fibroblastic properties holds potential for reduc...
INTRODUCTION: Synechiae formation is a common and undesired complication after functional endoscopic sinus surgery. Mitomycin-c, known for its anti-proliferative and anti-fibroblastic properties holds potential for reducing synechiae and scar tissue formation following endoscopic sinus surgery. This study aims to evaluate the efficacy of topically applied mitomycin-c postoperatively in minimising adhesions and nasal obstruction symptoms using the Lund- Kennedy Endoscopic Scoring and Nasal Obstruction Symptom Evaluation (NOSE) scores. MATERIALS AND METHODS: This double-blind randomised study assessed topical mitomycin-c's efficacy in reducing adhesions post-FESS in 50 chronic rhino-sinusitis patients. Participants who were selected based on Lund-Mackay CT scores underwent functional endoscopic sinus surgery (FESS). The mitomycin-c and saline-soaked nasal packs were placed in middle meatuses either of one in each nasal cavity. Postoperative care included antibiotics, analgesics and saline douching. Outcomes were evaluated at 1, 4 and 12 weeks using the NOSE (nasal obstruction symptom evaluation) questionnaire and Lund-Kennedy scoring to determine mitomycin-c's impact on nasal obstruction and synechiae formation. RESULTS: The results indicated statistically significant variation between mitomycin-c and control sides in terms of symptoms and endoscopic findings in the first week postoperatively. By the fourth week, the clinical pictures of both sides were nearly identical. DISCUSSION: Data suggested that low-dose mitomycin-c significantly reduces adhesions and improves nasal symptoms in the early postoperative period for chronic rhinosinusitis patients. These results align with previous research, supporting mitomycin-c as a valuable adjunctive therapy in sinus surgery. Future studies are recommended to explore varying dosages and application methods for potential differences in outcomes.
Electrocardiographic changes in Chronic Obstructive Pulmonary Disease and its correlation with airflow limitation.
Dhanush B, Abinaya SR, Gopalakrishnan KV … +3 more , Raghunathan EG, Prasanna K, Selva B
Med J Malaysia · 2025 Dec · PMID 41456146
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is the third most prevalent cause of death in India. In 2012, over 3 million people succumbed to COPD, accounting for 6% of global deaths. COPD is the second mos...
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is the third most prevalent cause of death in India. In 2012, over 3 million people succumbed to COPD, accounting for 6% of global deaths. COPD is the second most common respiratory disease after pulmonary tuberculosis. Early identification of cardiac manifestations may guide clinicians in implementing timely interventions to manage both the respiratory and cardiac aspects of COPD. This study aims to analyse the ECG changes in COPD patients and their correlation with airflow restriction. MATERIALS AND METHODS: This cross-sectional observational prospective study was conducted on 50 patients with COPD at Kurnool Medical College for a period of two years from December 2019 to June 2021. The ECG was recorded using a spectrophotometer. RESULTS: The most frequent ECG abnormalities were RS in V6 (60%), Incomplete Right Bundle Branch Block (40%), and Right Axis Deviation of QRS (34%). The correlation analysis demonstrated significant associations between specific electrocardiographic changes and FEV1/FVC ratio. The P wave axis, QRS, P wave height, R V6 height, and RBBB showed statistically significant correlations with FEV1. DISCUSSION: Our findings highlight the prevalence of electrocardiography changes in chronic obstructive pulmonary disease patients, with specific ECG anomalies demonstrating a correlation with the severity of both COPD and pulmonary functional impairment. Further research is warranted to validate these associations and explore their implications for clinical management.
Role of foot length in predicting the gestational age of a neonate.
Tenali SLA, Shami KRP, Navin U
Med J Malaysia · 2025 Dec · PMID 41456145
INTRODUCTION: The aim was to study neonatal foot length as a simple method for quick gestational age assessment, which can be done by basic health care personnel, overcoming the technicality required by other assessment...
INTRODUCTION: The aim was to study neonatal foot length as a simple method for quick gestational age assessment, which can be done by basic health care personnel, overcoming the technicality required by other assessment methods. MATERIALS AND METHODS: A Prospective descriptive study was done. Live-born neonates at Saveetha Medical College and Hospital, Chennai, were enrolled. Gestational age was assessed by New Ballard's Scoring (NBS), and foot length (FL) was measured using the paddle blades of automated digital Vernier callipers within 24 hours, while birth weight was taken within 72 hours of birth. Based on gestational age, babies were grouped into preterm, term and post term and were sub-classified as small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) based on Lubchenco's intrauterine growth chart. Correlation and regression analysis with a Scatterplot was done. RESULTS: Out of 150 neonates, term, preterm and post-term were70.3%,28.4%and1.3% while SGA, AGA, and LGA babies were11%, 85% and 4%. respectively. Mean foot length was7.588±0.57. With a range of 5.2-8.4cm. Foot length strongly correlated with gestational age in Preterm AGA, preterm SGA and Term AGA babies (<0.05). The correlation coefficient between foot length and gestational age was higher in preterm babies (R2=0.56) and SGA babies (R2=0.66). Gestational age in 53% of the total study population could be predicted with a regression equation. CONCLUSIONS: Foot length may be useful for quick estimation of gestational age in preterm and term neonates for early referral of newborns requiring special care, and can even be done by basic healthcare personnel.
Haematological trends and associated congenital anomalies in children with cleft lip and palate.
Navin U, Radha K, Shamikumar R … +1 more , Vaanmathi AS
Med J Malaysia · 2025 Dec · PMID 41456144
INTRODUCTION: Cleft lip and palate are prevalent congenital craniofacial anomalies affecting approximately 1 in 400 live births. These conditions result from incomplete fusion of embryonic facial processes and can lead t...
INTRODUCTION: Cleft lip and palate are prevalent congenital craniofacial anomalies affecting approximately 1 in 400 live births. These conditions result from incomplete fusion of embryonic facial processes and can lead to significant aesthetic, functional, and psychological challenges. Recent studies have suggested a possible link between cleft anomalies and haematological abnormalities. This study aimed to investigate the haematological parameters and associated anomalies in children with cleft lip and/or palate admitted for surgical repair at a tertiary care hospital. MATERIALS AND METHODS: We conducted a prospective observational study involving 100 children with cleft lip and/or palate admitted between January and December 2023. Demographic data, haematological parameters (including haemoglobin, white blood cell count, and platelet count), and associated anomalies were recorded and analysed using JAMOVI software. RESULTS: The mean haemoglobin levels were 10.2 g/dL in cleft lip, 11.3 g/dL in cleft lip and palate, and 9.98 g/dL in cleft palate alone. Anaemia was observed in 12 children with cleft lip alone, 1 with both cleft lip and palate, and 12 with cleft palate alone. Elevated total leucocyte counts were noted in children with cleft lip and palate. Associated anomalies included Pierre Robin sequence (3%), ventricular septal defect (4%), and renal anomalies (4%). Malnutrition was detected in five children. CONCLUSION: Anaemia and leucocytosis are common in children with cleft lip and/or palate. Comprehensive nutritional support and regular monitoring of haematological parameters are crucial for improving surgical outcomes and overall health in these patients.
Comparing negative pressure wound therapy to conventional wound healing in post op fistulectomy patients.
Manish BUG, Samuthiram K, Shanmugam K … +1 more , Kamal VS
Med J Malaysia · 2025 Dec · PMID 41456143
INTRODUCTION: Fistulectomy, though effective for treating lower anal canal fistulas, is associated with longer operative times, larger incisions, delayed wound healing, and a higher risk of flatus incontinence. Negative...
INTRODUCTION: Fistulectomy, though effective for treating lower anal canal fistulas, is associated with longer operative times, larger incisions, delayed wound healing, and a higher risk of flatus incontinence. Negative Pressure Wound Therapy (NPWT), which applies controlled vacuum pressure to promote wound healing, may offer a solution to these challenges. This study evaluates the effectiveness of NPWT in enhancing postoperative recovery following fistulectomy. MATERIALS AND METHODS: This prospective study included 20 patients who underwent fistulectomy at Saveetha Medical College and Hospital. NPWT was applied postoperatively, and patient data-including wound characteristics, healing outcomes, and complications-were collected and analysed. The therapy aimed to accelerate granulation tissue formation, reduce tissue oedema, and minimise infection, thereby reducing hospital stay duration. RESULTS: Among the 20 patients, the majority were male (75%) and aged between 31 and 60 years. Intersphincteric fistulas were most common (60%), and Escherichia coli was the predominant organism cultured (80%). Laboratory analysis showed normal haemoglobin levels, variable leukocyte and platelet counts, and stable albumin. Thyroid hormone levels varied widely and appeared to influence recovery. The mean postoperative hospital stay was 7.45 days. Patients aged 20-40 years who received NPWT had a shorter hospital stay (6.7 days) compared to those receiving traditional dressings (8.2 days). CONCLUSION: NPWT appears to enhance wound healing and reduce hospital stay in post-fistulectomy patients. Although still an uncommon approach for anal fistulas, the promising outcomes observed in this study suggest NPWT may be a valuable addition to routine clinical practice and merit further investigation.
Use of ultrasound to confirm tracheal intubation and for supervising a trainee performing tracheal intubation in real time.
Ashok Kumar B
Med J Malaysia · 2025 Dec · PMID 41456142
INTRODUCTION: Accidental oesophageal intubation is a significant cause of death or neurological injury during anaesthesia in the perioperative period, making it crucial to confirm the correct placement of the tracheal tu...
INTRODUCTION: Accidental oesophageal intubation is a significant cause of death or neurological injury during anaesthesia in the perioperative period, making it crucial to confirm the correct placement of the tracheal tube immediately. In the operating room, anaesthesiologists typically use indirect methods to verify tracheal tube positioning. Ultrasonography (USG) can be employed to confirm whether the endotracheal tube (ETT) is correctly placed in the trachea. This study evaluates the use of USG in supervising a trainee during intubation and also examines the time it takes for USG to identify the tube's entry into the trachea or oesophagus in real-time. MATERIALS AND METHODS: The study included 90 patients with ASA physical status 1 and 2 who were scheduled for elective surgeries under general anaesthesia. Preoperative data were collected on patient characteristics, airway measurements, and baseline haemodynamic parameters. Anaesthetic management was kept consistent across all participants. The 90 patients were divided into three groups of 30 each, with intubation performed by either an intern, resident, or faculty member, assigned through computergenerated randomisation. A high-frequency linear ultrasound probe (9-14MHz) was placed at the suprasternal notch and slightly moved to the left. In this view, at the level of the suprasternal notch, the oesophagus appears posterolateral to the trachea. During laryngoscopy, the Cormack-Lehane grade was recorded. The anaesthesiologist performing the ultrasound simultaneously measured the time taken to confirm endotracheal intubation. In cases of oesophageal intubation, the "double track" sign was used for identification, and the time required to make this identification was recorded. The times for confirming intubation into the trachea and oesophagus were documented for all three groups. SPSS Version 20.0 software was used for statistical analysis. The study employed mean, standard deviation, chi-square test, ANOVA, and Duncan Multiple Range Test (DMRT) for data analysis. RESULTS: The patient characteristics and demographic data showed no significant statistical differences. Oesophageal intubation was detected as quickly as 2 seconds, and the average time in seconds to confirm endotracheal tube placement was recorded for each group as follows: Faculty < Resident < Intern (Mean time: 17.5 < 26.8 < 53.6 seconds). The ANOVA test indicated statistically significant differences in tracheal intubation times among the three groups. Further analysis with the Duncan Multiple Range Test (DMRT) confirmed that the timing differences between the groups were statistically significant. DISCUSSION: Ultrasound is a valuable tool in training scenarios where a physician supervises less experienced practitioners. It provides a fast and reliable method for confirming correct endotracheal intubation.
Alkaline phosphatase as an adjunct for Appendicitis Inflammatory Response score.
Abidah Tanweer AM, Rahul Raj CL, Evelyn EE … +3 more , Rahman K, Dakshay AC, Manish BUG
Med J Malaysia · 2025 Dec · PMID 41456141
INTRODUCTION: Appendicitis is a common acute surgical condition globally, primarily diagnosed through clinical assessment, imaging, and laboratory markers. The Appendicitis Inflammatory Response (AIR) score, which utilis...
INTRODUCTION: Appendicitis is a common acute surgical condition globally, primarily diagnosed through clinical assessment, imaging, and laboratory markers. The Appendicitis Inflammatory Response (AIR) score, which utilises various clinical and laboratory parameters, is often employed to predict appendicitis more accurately. However, diagnostic improvements, especially in ambiguous cases, are needed. Alkaline phosphatase (ALP), a marker linked to inflammation, may enhance the AIR score's diagnostic precision by reflecting the severity of inflammation more accurately. This study aims to assess the impact of integrating ALP levels into the AIR score. MATERIALS AND METHODS: This observational study was conducted at Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences. Patients suspected of acute appendicitis were evaluated over one year (2022-2023). Patients were assessed using the AIR score with and without the inclusion of ALP levels. ALP levels were measured along with standard laboratory markers. Statistical analyses were performed using SPSS, assessing the specificity, sensitivity, NPV, and PPV of the AIR score. RESULTS: A total of 112 patients enrolled: 64 males (57%) and 48 females (43%), most presented with right lower quadrant pain. The median ALP level was 215 IU/L. Initial analyses showed an AIR score sensitivity of 80% and specificity of 75%, which improved to 92% and 85%, respectively, with the inclusion of ALP. The ROC curve analysis indicated an AUC improvement from 0.78 to 0.92 with ALP. This established an optimal ALP cutoff at 90 IU/L. The p-value for AIR is 0.012, whereas the P-value for AIR+ALP is 0.001. DISCUSSION: Integrating ALP into the AIR score significantly enhances its diagnostic accuracy for appendicitis. This suggested ALP's potential as a valuable biomarker in appendicitis diagnosis. This integration could improve clinical decision-making and patient outcomes, reducing unnecessary surgeries and associated healthcare costs.
Multi-target prediction to Detect the Anti-cancerous Potential of Sida cordifolia in Treating Breast Cancer.
Aswathi KB, Nisha B, Rajeshkumar S
Med J Malaysia · 2025 Dec · PMID 41456140
INTRODUCTION: Breast cancer arises from the uncontrolled proliferation of breast cells, leading to tumour. Sida cordifolia, commonly known as Bala, an herbaceous plant widely used in traditional medicine, particularly in...
INTRODUCTION: Breast cancer arises from the uncontrolled proliferation of breast cells, leading to tumour. Sida cordifolia, commonly known as Bala, an herbaceous plant widely used in traditional medicine, particularly in Ayurveda, due to its numerous medicinal properties. This study investigates the multi-target therapeutic mechanisms of S. cordifolia against breast cancer using network pharmacology. MATERIALS AND METHODS: Phytochemicals of S. cordifolia were extracted from the IMPPAT database, and their ADME (Absorption, Distribution, Metabolism, and Excretion) properties were evaluated using SwissADME database. The web tool SwissTargetPrediction identified phytochemical targets, and breast cancer targets were retrieved from the database Open Targets Platform. Shared targets were identified using the web tool Venny 2.1.0, and a PPI (Protein- Protein Interaction) network was generated via STRING database. Hub genes were analysed in Cytoscape 3.10.2 software, with KEGG (Kyoto Encyclopaedia of Genes and Genomes) and GO (Gene Ontology) was performed using the tool ShinyGO 0.80. RESULTS: The KEGG pathway analysis revealed five genes: Epidermal growth factor receptor (EGFR), Estrogen receptor 1 (ESR1), mammalian target of rapamycin (mTOR), Progesterone receptor (PGR), and tumour protein p53 (TP53) that directly participate in the breast cancer pathway. These genes were identified as core targets and are targeted by the phytochemicals present in S. cordifolia, including quinazoline, abietaic acid, malvalic acid, linoleic acid, and 20-hydroxyecdysone. DISCUSSION: This study highlights S. cordifolia's potential as a multi-target therapeutic agent against breast cancer, with key phytochemicals targeting critical genes involved in cancer progression. These findings suggest that S. cordifolia could be a valuable candidate for further research in breast cancer treatment.
A prospective study comparing the efficacy of Budesonide nasal douching vs. Fluticasone nasal spray in Post FESS patients.
Prithviraj SM, Subagar AS, Shree NR … +1 more , Haritha S
Med J Malaysia · 2025 Dec · PMID 41456139
INTRODUCTION: The study assessed and compared the efficacy of Budesonide steroid nasal douching versus Fluticasone nasal spray in preventing recurrence of symptoms and nasal polyps post-FESS. MATERIALS AND METHODS: A pro...
INTRODUCTION: The study assessed and compared the efficacy of Budesonide steroid nasal douching versus Fluticasone nasal spray in preventing recurrence of symptoms and nasal polyps post-FESS. MATERIALS AND METHODS: A prospective cohort study conducted in the Department of ENT, Saveetha Medical College and Hospital, Thandalam from June 2022 to June 2023 involving 60 patients diagnosed as Chronic sinusitis with polyposis were scheduled for FESS. Inclusion criteria included adults aged 18 and above with a confirmed diagnosis based on clinical symptoms, endoscopic findings, and radiological imaging. The severity of CRS was evaluated with SNOT22 score and Lund-Kennedy Endoscopic grading system. Patients were randomly assigned to two groups: Group A which was started on Budesonide nasal irrigation twice a day, and Group B, which received Fluticasone nasal spray. RESULTS: The average age of participants were 33.23 years, with an even distribution between females and males. Preoperative SNOT-22 and Lund-Kennedy scores were similar between both groups. One month postoperatively, both the groups had similar SNOT22 scores, but the Budesonide group had significantly lower Lund-Kennedy scores. At three months, no significant differences were observed. However, at six months, the Budesonide group had significantly lower SNOT22 and Lund-Kennedy scores when compared to the patients receiving Fluticasone. DISCUSSION: While Budesonide and Fluticasone are both effective post-FESS treatments, Budesonide nasal irrigation may offer better long-term symptom control and endoscopic outcomes. The broader nasal coverage achieved through nasal douching could contribute to its enhanced therapeutic effect.
Evaluation of embryonic toxicology, antimicrobial, anti-inflammatory, and antioxidant activity of the Equisetum arvense mediated Magnesium oxide nanoparticles.
Sulochana G, Rajeshkumar S
Med J Malaysia · 2025 Dec · PMID 41456138
INTRODUCTION: Preparing and stabilising various types of nanoparticles using herbal extract has proven to be an intriguing prospective environmentally beneficial technology. Magnesium oxide nanoparticles (MgONPs) are fin...
INTRODUCTION: Preparing and stabilising various types of nanoparticles using herbal extract has proven to be an intriguing prospective environmentally beneficial technology. Magnesium oxide nanoparticles (MgONPs) are finding a broad range of applications in the environmental and medical sciences due to their impressive antioxidant, anticancer, and antibacterial activity. The traditional uses of Equisetum arvense included wound and ulcer healing, renal issues, tuberculosis treatment, and bleeding control. This work intended to synthesise magnesium oxide nanoparticles in an environmentally friendly manner utilising E. arvense, with potential uses in biomedicine. MATERIALS AND METHODS: Using a green fabrication technique, E. arvense extract was used to create magnesium oxide nanoparticles (MgONPs). The antibacterial activity of the resulting MgO NPs against wound infections was evaluated. The ABTS, Nitric Oxide, DPPH, FRAP, and H2O2 assays were used to measure antioxidant activity. Utilising zebrafish survivability during MgONPs treatment, cytotoxicity was evaluated. RESULTS: The green-produced MgONPs showed good antibacterial activities against wound infectious microbes, compared to the E. arvense control. It also demonstrated outstanding biocompatibility and antioxidant activity. DISCUSSION: The potential application of plants mediated NPs as antibacterial, and an antioxidant agent is the primary conclusion of the research.
Insights into necrotising fasciitis: A prospective pilot study in a Tertiary Care Hospital.
Touzeen H, Vishnu Priya M
Med J Malaysia · 2025 Dec · PMID 41456137
INTRODUCTION: Necrotising fasciitis, commonly referred to as "flesh-eating disease," is a rapidly spreading soft tissue infection characterised by extensive necrosis of the skin, subcutaneous tissue, and fascia while spa...
INTRODUCTION: Necrotising fasciitis, commonly referred to as "flesh-eating disease," is a rapidly spreading soft tissue infection characterised by extensive necrosis of the skin, subcutaneous tissue, and fascia while sparing the underlying muscle. Despite its low overall incidence, it is a significant soft tissue infection due to its rapid spread and associated high mortality risk. MATERIALS AND METHODS: This prospective pilot study aims to analyse 25 consecutive cases of necrotising fasciitis to assess various aspects, including age and sex incidence, microbial flora, role of co-morbidities in prognosis, and overall outcome. We conducted a descriptive study involving 25 patients aged 18-84 years diagnosed with necrotising fasciitis over a 6-month period (January 2022 to June 2022) at Saveetha Medical College. RESULTS: Of the 25 patients treated, 21 (84%) were male and 4 (21%) were female, resulting in a male-to-female ratio of 5.25. The age ranged from 18 to 84 years (Mean age: 50.24 ± Standard deviation, SD=14.175). Trauma was identified as the main precipitating factor in approximately 40% of cases, while Diabetes Mellitus (40%) emerged as the most common co-morbidity. Lower limb involvement was predominant in both male and female patients. The infection was monomicrobial in 32% of cases (Enterococci 16% + Bacteroides 16%) and poly-microbial in 68% with Streptococcus pyogenes + Escherichia coli being the most common organism combination. Wound debridement followed by split skin graft was the most common treatment modality (84%), with the number of debridement sessions varying based on infection severity (corresponding with higher LRINEC scores). Prolonged hospital stay was the most common complication, observed in 52% of cases. DISCUSSION: Our analysis revealed that necrotising fasciitis is more prevalent in individuals aged over 50 years with a male predominance. Streptococcus pyogenes with Escherichia coli was the predominant microflora, and Diabetes Mellitus emerged as the most common comorbidity. Early recognition, prompt control of diabetes mellitus, aggressive surgical treatment, and supportive therapy are essential steps in managing necrotising fasciitis.
Haematological indices as screening tool in distinguishing beta thalassemia trait and iron deficiency anaemia: Insights from a tertiary hospital study.
Yogalakshmi E, Chander RV, Sulochana S … +1 more , Kavitha K
Med J Malaysia · 2025 Dec · PMID 41456136
INTRODUCTION: Beta thalassemia trait (BTT) or heterozygous, is an inherited haematological disease characterised by more than 100 different mutations that lead to reduced beta chain formation. Distinguishing BTT from Iro...
INTRODUCTION: Beta thalassemia trait (BTT) or heterozygous, is an inherited haematological disease characterised by more than 100 different mutations that lead to reduced beta chain formation. Distinguishing BTT from Iron deficiency anaemia (IDA) is challenging since both conditions are characterised by microcytic anaemia, have distinct underlying causes, and thus require different approaches in treating the condition. The aim of our study is to determine the utility of haematological indices as a screening marker in detecting cases of beta thalassemia carriers and differentiating it from IDA in our tertiary care hospital. MATERIALS AND METHODS: A retrospective analysis of the data at the Department of Pathology from January 2020 to December 2023 (4 years duration) was conducted. The analysis included a comparison of haematological parameters and RBC (Red Blood Cell) indices between the 78 cases of BTT and the 60 cases of IDA. Complete blood count (CBC) samples were collected in 2 ml of K2 EDTA (Di potassium Ethylene Diamine Tetra Acetic acid) vacutainer tube and processed in the automated haematology analyser, Sysmex XN 1000. Haematological parameters were analysed, and RBC indices were calculated. HPLC (High Performance Liquid Chromatography) analysis was done to detect HbA2/F levels. HbA2 levels more than 4% were diagnosed as BTT in our study. Various discriminating formulas, such as Srivastav index(SI), Red blood cell Distribution Width Index (RDWI), Shine and Lal index (SLI), Ricera index (RI), Green and King index (GKI), Mentzer index (MI), Sirdah Index (SI), Mean density of Haemoglobin/litre of blood (MDHL), England and Fraser index (EFI), Mean Cell Haemoglobin Density (MCHD), and Ehsani Index (EI), were applied to differentiate BTT cases from IDA Cases. RESULTS: The mean haemoglobin in BTT was 10.8 g/dl, while in IDA, the mean Hb was 7.4 g/dl. The mean RBC count in BTT was 5.6 million/mm3, while in IDA it was 3.8 million/mm3. The values of haemoglobin (HB), Red blood cell Distribution Width - Coefficient of Variation (RDW-CV), Mean Corpuscular Haemoglobin Concentration (MCHC) and Mean Corpuscular Volume (MCV), between BTT cases and IDA cases showed statistical significance of p<0.05. Among the 11 discriminator formulas applied in our study, maximum accuracy was observed with the Ehsani index (84.06%), followed by the MI (82.61%). Maximum sensitivity was observed with RDWI (97.44%), followed by SLI (96.15%), EI (83.3%), and MI (79.45%). Youdens' score was highest in Ehsani index (68.33%), followed by MI (66.16 %), and the Green and King index (59.87%). DISCUSSION: Among the various discriminator formulas applied, two indices, such as EI and MI showed the highest accuracy, and maximum score in Youdens' formula. Hence, in mass screening or in cases suspected to have IDA, either MI <13 or Ehsani index <17 with normal serum ferritin levels can be subjected to HPLC evaluation for the diagnosis of beta thalassemia carrier cases.
Comparison of motor and haemodynamic profiles of epidural 0.5% Levobupivacaine with 0.75% Ropivacaine in patients undergoing elective below umbilical surgery.
Ashok Kumar B, Rathna A
Med J Malaysia · 2025 Dec · PMID 41456135
INTRODUCTION: Our study focuses on comparing the motor and haemodynamic effects of levobupivacaine 0.5% and ropivacaine 0.75% when administered as epidural anaesthesia for surgeries below the umbilicus. This comparison i...
INTRODUCTION: Our study focuses on comparing the motor and haemodynamic effects of levobupivacaine 0.5% and ropivacaine 0.75% when administered as epidural anaesthesia for surgeries below the umbilicus. This comparison is particularly important given that the racemic mixture of bupivacaine, which includes the dextro (D-(+)) and levo (L-(-)) isomers in equal proportion, is associated with significant cardiovascular and central nervous system complications, particularly due to the R-(+)-isomer. In contrast, the levorotatory isomers like our study drug levobupivacaine and ropivacaine are noted for their more reliable and stable pharmacological profiles. MATERIALS AND METHODS: Fifty-six patients with the American Society of Anaesthesiologists (ASA) classification 1 and 2 classifications were randomly assigned to one of two study groups.(17 ml of 0.5% levobupivacaine was given epidurally in Group L, while Group R received 17 ml of 0.75% ropivacaine).The prospective randomised double blinded study was carried out at Saveetha Medical College Hospital, S.I.M.A.T.S., from 2022 to 2024. RESULTS: The duration, onset, and regression of motor block were comparable in both groups. The motor block grade as per MBS in the two groups showed significant differences. (p<0.001) Group R achieved maximum motor blockage in 40.18 minutes, whereas group L achieved it in 17.86 minutes (p=0.043). In group R, the average duration of motor block was 146.25±48.58 minutes, while in group L it was 160.71±46.64 minutes (p>0.05). Heart rate (HR), mean arterial pressure (MAP), and oxygen saturation (SpO2) exhibited no significant differences between the two groups at various time intervals. DISCUSSION: Both levobupivacaine 0.5% and ropivacaine 0.75% effectively provide epidural anaesthesia for surgeries below the umbilicus. Levobupivacaine achieved maximum motor block more quickly than ropivacaine, but overall motor block duration was similar. Haemodynamic parameters were stable with no significant differences between the two groups.
The migration of atrial septal occluder device, is it fatal?
Ambarsari YA, Aribowo H, Kurnia Y … +4 more , Amal I, Susantya DP, Novenanto TT, Satriotomo I
Med J Malaysia · 2025 Dec · PMID 41451730
Atrial septal defect (ASD) is a defect between right and left atrium. Nowadays, percutaneous closure using an atrial septal occluder (ASO) device is the preferred treatment for secundum ASDs due to its minimal invasivene...
Atrial septal defect (ASD) is a defect between right and left atrium. Nowadays, percutaneous closure using an atrial septal occluder (ASO) device is the preferred treatment for secundum ASDs due to its minimal invasiveness and high success rates. Although rare, device dislodgement can occur and may require surgical retrieval. This retrospective case series from RSUP Dr. Sardjito Hospital (January 2022- July 2024) reports three paediatric cases of failed ASD closure due to ASO dislodgement. The patients were aged 9, 12, and 13 years. Dislodgement occurred three years postimplantation in one patient, two months post-implantation in another, and intraoperatively in the third. Migration sites included the left atrium and right ventricle. Surgical removal and patch closure were performed in all cases. Cross-clamp times ranged from 20-24 minutes and cardiopulmonary bypass times from 34-46 minutes. All patients successfully recovered and were discharged without residual defects or further complications. Possible causes of ASO dislodgement include undersized devices, large defects, poor rim support, and procedural factors. Despite the children's relatively normal body weights, improper anchoring or anatomical limitations may have contributed to the device failure. While percutaneous retrieval is possible, chronic dislodgements are best managed surgically. No major complications, such as rupture or embolism, occurred postoperatively. In conclusion, although ASO dislodgement is rare, timely surgical intervention is essential. Since asymptomatic cases may remain undiagnosed, regular follow-up is crucial to detect delayed dislodgement.
One-step surgery for cyanotic heart disease with pectus excavatum: Should it be done?
Ambarsari YA, Kurnia Y, Aribowo H … +5 more , Amal I, Supomo I, Trianingsih T, Novenanto TT, Susantya DP
Med J Malaysia · 2025 Dec · PMID 41451729
Congenital heart disease accompanied with pectus excavatum is very rare, we present our experienced in one step surgery of pectus and cardiac repair and staged procedure at our institution. We retrospectively reviewed me...
Congenital heart disease accompanied with pectus excavatum is very rare, we present our experienced in one step surgery of pectus and cardiac repair and staged procedure at our institution. We retrospectively reviewed medical records for patients who underwent a hybrid repair of both pectus and CHD between 2022 and 2023 in RSUP dr. Sardjito, Indonesia. Of these patients, 2 patients had both pectus and CHD. The first patient was using one-staged produce operation began with ASD repair than the patient proceeded with pectus repair. During pectus repair, the patient experienced worsening hemodynamics, the total operation took time seven hours. During those seven hours, there was 1400 cc of bleeding. The patient's condition was stationary and worsened within 72 hours. The patient died three days after surgery due to sepsis, MODS, and hyperlactatemia. Meanwhile the second patient underwent two-staged produce showed good result. The total duration of the operation is half shorter than the one-step operation experience, bleeding during the operation also appears to be at least 300 cc. After surgery, the patient's condition was stable and the vital sign was satisfactory. The patient currently has no complaints, including no concerns about unstable hemodynamics caused by the pectus condition. The timing and approach to surgical correction of pectus excavatum in patients with congenital heart disease must be individualized. Factors such as age, anatomical development, cardiopulmonary status, and the complexity of the cardiac defect should guide the decision between single-stage and two-stage procedures. While early intervention carries the risk of recurrence due to ongoing growth, delayed or staged surgery may offer better longterm stability and outcomes, particularly in complex or adult cases.
Evaluating single incision laparoscopy-assisted extracorporeal biopsy as an alternative to frozen sections in the management of Hirschsprung disease.
Perdana RSY, Pratama Y, Gabriela GC … +1 more , Purnomo E
Med J Malaysia · 2025 Dec · PMID 41451728
Hirschsprung disease (HD) is a congenital condition characterized by the absence of ganglion cells in the distal intestine, leading to bowel obstruction. While the use of frozen sections during biopsy is common practice,...
Hirschsprung disease (HD) is a congenital condition characterized by the absence of ganglion cells in the distal intestine, leading to bowel obstruction. While the use of frozen sections during biopsy is common practice, discrepancies with immunohistochemistry results and the unavailability of frozen section technology in certain pediatric surgical facilities in Indonesia highlight the need for alternative diagnostic approaches. This study evaluates the effectiveness of Single Incision Laparoscopy-Assisted Extracorporeal (SI-ECo) leveling biopsy with immunohistochemistry as a reliable alternative to frozen sections in the preoperative management of Hirschsprung disease, especially in facilities lacking frozen section capabilities. We present three cases of pediatric patients diagnosed with HD confirmed through rectal biopsy. Each patient underwent an SI-ECo leveling biopsy, successfully identifying the ganglionic zone by locating ganglion cells in the distal sigmoid. Based on these findings, subsequent transanal endorectal pull-through (TEPT) procedures were performed. The results demonstrated that SI-ECo leveling biopsy effectively identifies the ganglionic zone, providing a less invasive and precise method for preoperative planning. Leveling biopsy with SILS offers an effective method for identifying the ganglionic zone in Hirschsprung disease. SIECo reduces diagnostic discrepancies and provides higher specificity for detecting ganglion cells compared to frozen sections before the pull-through procedure. SI-ECo leveling biopsy with immunohistochemistry offers a practical, accurate, and less invasive alternative for diagnosing and managing Hirschsprung disease. It reduces the risk of discrepancies observed with frozen sections, making it a viable option for facilities without access to frozen section technology.
Gut Microbiome profile on hirschsprung diseases with hirschsprung associated enterocolitis and non-hirschsprung associated enterocolitis: A systematic review.
Barmadisatrio, Hakim ZFE, Akbar MI … +1 more , Sofyan IAA
Med J Malaysia · 2025 Dec · PMID 41451727
INTRODUCTION: Hirschsprung's disease (HSCR), commonly known as aganglionic megacolon, is a rare congenital intestinal illness. Hirschsprung-associated enterocolitis (HAEC), an HSCR complication, is the major cause of mor...
INTRODUCTION: Hirschsprung's disease (HSCR), commonly known as aganglionic megacolon, is a rare congenital intestinal illness. Hirschsprung-associated enterocolitis (HAEC), an HSCR complication, is the major cause of morbidity and mortality in patients. Many research has highlighted specific microbiomes that promote HAEC, although there is still controversy on microbiome management. The aim of this study is to profile the gut microbiome of paediatric patients on HSCR with or without HAEC. MATERIALS AND METHODS: We conducted an analytical descriptive systematic review of relevant case reports from inception research articles between January 2014 to October 2024 using 3 databases following PRISMA guidelines. We extracted data of gut microbiomes in humans with HSCR with or without HAEC. Data about microbiome's effects on gut physiology were also extracted. RESULTS: This study identified 244 citations; 17 articles were included and analyzed. Proteobacteria were the most common bacteria in HSCR patients developing HAEC and Bacteroidetes were the most common bacteria found in HSCR patients without HAEC. CONCLUSION: Proteobacteria were associated in HSCR patient developing HAEC. Therefore, gut microbiome dysbiosis may also be the key point to prevent HAEC.
Anesthetic management for enhanced recovery after major surgery in children.
Widyastuti Y
Med J Malaysia · 2025 Dec · PMID 41451726
INTRODUCTION: Perioperative Enhanced Recovery After Surgery (ERAS) protocols, though originally created in adult surgery, are increasingly gaining applications in pediatric practice. This application addresses the unique...
INTRODUCTION: Perioperative Enhanced Recovery After Surgery (ERAS) protocols, though originally created in adult surgery, are increasingly gaining applications in pediatric practice. This application addresses the unique challenge in children, who possess more complex surgical stress responses. The main goal of ERAS is to maximize postoperative recovery and improve clinical outcomes through a standardized multimodal perioperative care approach. MATERIALS AND METHODS: This review article integrates current literature and expert consensus regarding the use of ERAS principles in pediatric anesthetic care in the preoperative, intraoperative, and postoperative phases in children undergoing major surgery, also explores the implementation, benefits, and challenges of ERAS in pediatric patients, highlighting recent advancements and the impact of these protocols on recovery. RESULTS: The key pillars of pediatric ERAS include preoperative education and dietary optimization, multimodal opioid-sparing analgesia (e.g., regional anesthesia, nonopioid systemic analgesics), minimally invasive surgery, and goal-directed fluid resuscitation. Postoperative care includes early enteral nutrition, early mobilization, and planned discharge. Existing evidence, although further emerging, indicates that adherence to these protocols is associated with significant benefits, including shorter hospital length of stay, reduced opioid consumption, reduced intraoperative fluid administration, and faster return to normal diet. CONCLUSION: ERAS protocols implemented in pediatric anesthesia are successful in optimizing recovery by reducing complications, improving pain control, and reducing length of stay. Implementation is case-specific anesthetic planning and multidisciplinary collaboration, finally maximizing outcomes and improving satisfaction for parents and children.
Prospective outlook on negative pressure wound therapy (NPWT) for gastroschisis and ruptured omphalocele: A scoping review.
Kloping NA, Barmadisatrio
Med J Malaysia · 2025 Dec · PMID 41451725
INTRODUCTION: In cases of gastroschisis and ruptured omphalocele where primary closure is not feasible, physicians must employ alternative strategies to gradually reduce the herniated contents and promote epithelializati...
INTRODUCTION: In cases of gastroschisis and ruptured omphalocele where primary closure is not feasible, physicians must employ alternative strategies to gradually reduce the herniated contents and promote epithelialization, either through non-surgical methods or with surgical intervention. Negative pressure wound therapy (NPWT) is a device specifically designed to promote wound healing by controlling sub atmospheric pressure. Despite the benefits of NPWT, its use in paediatric patients, particularly congenital abdominal wall defect, remains unclear. This study aimed to assess the benefits of NPWT as part of the treatment strategy for gastroschisis and ruptured omphalocele. MATERIALS AND METHODS: A literature search was conducted through electronic databases including Pubmed, ScienceDirect and JSTOR from inception through January 2025. The outcomes identified included NPWT application details (pressure, timing, duration), outcomes related to length of stay, initial feeding, complications, wound progression, and follow-up results. Quality assessment was not conducted as the review aimed to provide a broad overview of the topic. RESULTS: Sixteen studies were included in the final analysis. Subjects consisted of 41 patients (32 gastroschisis, and 9 ruptured omphalocele), with a mean gestational age of 36.9 weeks and a mean birth weight of 2,216 g. The most common herniated contents were small bowel and liver, with an average defect size of 6 cm. The initial NPWT pressure ranged from -25 mmHg to -100 mmHg, with -40 mmHg being the most common starting pressure. At 10-12 months followup, most subjects demonstrated no fascial defects and intact epithelialized skin. NPWT was found to be an effective alternative, particularly as part of immediate primary closure, facilitating wound healing during staged closure, or managing infection. Although most evidence came from case reports or series, and there is a lack of standardized protocols for NPWT, its benefits over conventional care were evident. CONCLUSION: NPWT shows its benefit in adjunct to delayed closure, primary suture less closure, and in the management of gastroschisis and ruptured omphalocele. Future research should further investigate the optimal use of NPWT in a larger larger prospective or randomized controlled trials to refine protocols and better understand its long-term benefits and risks.
Motor response in monogenic LRRK2 parkinson's disease after deep brain stimulation: A systematic review and meta-analysis.
Ar Rochmah M, Subagya S, Wibowo S … +4 more , Gofir A, Setyopranoto I, Wibisono DP, Nugroho DB
Med J Malaysia · 2025 Dec · PMID 41451724
INTRODUCTION: Genetic factors are increasingly recognized as crucial contributors to both familial and sporadic forms of Parkinson's disease (PD), including mutations in LRRK2 (Leucine-rich Repeat Kinase 2). Previous stu...
INTRODUCTION: Genetic factors are increasingly recognized as crucial contributors to both familial and sporadic forms of Parkinson's disease (PD), including mutations in LRRK2 (Leucine-rich Repeat Kinase 2). Previous studies have indicated that the G2019S variant results in more favorable motor outcomes post-deep brain stimulation (DBS) compared to the R1441G variant. This study was aimed at investigating whether different LRRK2 variants in Parkinson's disease patients with LRRK2 mutations (LRRK2 PD) produce distinct motor responses following DBS. MATERIALS AND METHODS: A literature search was conducted across three databases using keywords related to Parkinson's disease, deep brain stimulation, and LRRK2. The inclusion criteria involved studies focusing on LRRK2 PD with DBS intervention, specifically comparing LRRK2 variants, and measuring motor responses pre- and post- DBS using the UPDRS III. A meta-analysis was performed to compare motor responses using a random effects model. RESULTS: Out of 325 search results, eleven articles were included in the review. Three LRRK2 PD variants-G2019S, R1441G, and G2385R-were associated with DBS intervention. The overall effect of DBS in LRRK2 PD compared to idiopathic PD was not statistically significant, with a mean difference (MD) of -3.00 (-8.52; 2.52). High overall heterogeneity was observed (I = 63.1%; P < 0.05). Subgroup analysis revealed significant differences (P < 0.05), suggesting that different LRRK2 variants may result in varying motor outcomes post-DBS. CONCLUSION: LRRK2 PD exhibited diverse motor outcomes depending on the specific mutation variant when subjected to DBS. Patients with LRRK2 variants G2019S and G2385R demonstrated clinically significant improvements in motor responses, while those with the R1441G variant showed inadequate motor response.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe