The Journal of Clinical and Health Sciences (JCHS) is an international, peer-reviewed, open-access scholarly journal established in 2016 and based in Malaysia. The journal is dedicated to advancing knowledge across the broad spectrum of clinical and health sciences by publishing high-quality, evidence-based research that contributes to scientific understanding, clinical practice, and health policy. JCHS publishes original research articles, systematic and narrative reviews, case reports, and clinical quizzes relevant to clinicians, researchers, educators, and healthcare professionals. The journal operates a rigorous double-blind peer-review process and adheres to internationally recognised standards of publication ethics, transparency, and editorial best practices. JCHS is committed to upholding research integrity, methodological rigor, and academic excellence in all manuscripts considered for publication. The journal is published biannually (March and September) by Penerbit UiTM (UiTM Press). It is a fully open-access journal with no publication fee. All published content is freely and permanently accessible online without subscription barriers, supporting equitable knowledge dissemination and wider global accessibility. JCHS is currently indexed in: • Malaysian Citation Centre (MyCite) • Directory of Open Access Journals (DOAJ) JCHS is also available at Google Scholar, Crossref, Copernicus, Publons, UiTM PTAR Repositories. CLICK HERE TO SUBMIT MANUSCRIPT
Emerging Trends in Medical Imaging: From Patients to Pixels Symposium, 19 June 2025
Copyright (c) 2026 https://creativecommons.org/licenses/by-nc-nd/4.0
Dual malignancies in Lynch Syndrome: A rare case of synchronous colorectal and ovarian cancer highlighting the potential role of immunotherapy
We report a 35-year-old woman with dual malignancies associated with Lynch Syndrome, diagnosed with Stage IIIC sigmoid colon adenocarcinoma and Stage IIA left ovarian serous papillary adenocarcinoma. Germline testing revealed MSH2 gene mutation, particularly exon 7 deletion. This case highlights the importance of early detection, germline testing and individualized management strategies for Lynch Syndrome patients. It also underscores the potential of immunotherapy as an effective therapy for recurrent Lynch-associated cancers, emphasizing the need for continuous research into novel therapeutic modalities.
Rapid postural improvement in mixed diagnosis of recurrent vestibulopathy and posterior BPPV: A Case Study
Benign paroxysmal positional vertigo (BPPV) is a condition caused by otoconia that cause spinning. Recurrent vestibulopathy is characterized by several episodes of vertigo lasting minutes to hours, which last longer than six months and are devoid of neurological or auditory symptoms. The triggering factors for mixed BPPV and recurrent vestibulopathy include head trauma, inner ear disease, and prolonged immobilization following cerebrovascular infarction. In this case, we evaluated the improvement of recurrent vestibulopathy and posterior BPPV case using BPPV manaeuvre and Intensive Balance Rehabilitation specifically looking at postural control. A 51-year-old female patient, with a history of asthma, allergic rhinitis, migraine, and vertigo for three years was diagnosed to have recurrent chronic vestibulopathy. Vestibular Rehabilitation using the Bal Ex exercise was applied to promote adaptation to and substitution for various aspects of deficits related to a wide variety of balance disorders.
An Abscess of Thyroid Remnant in a Positive Coronavirus Disease 2019 Patient
Thyroid abscess is rare due to the unique anatomy and physiological features of the thyroid gland. The underlying thyroid disorder, thyroidectomy, immunocompromised conditions, and congenital third or fourth branchial arch anomalies are among the known risk factors. The association of COVID-19 with thyroiditis is recently reported and the inflammation of the thyroid gland may predispose to the abscess formation, especially in combination with other risk factors. The principle of management is by broad-spectrum antibiotics and evacuation of the abscess, with careful monitoring of thyroid hormone status. Serial aspiration is preferred in localized or less extensive cases to avoid possible complications like thyroid storm. We present a unique case of thyroid abscess arising from the remnant of thyroid isthmus or pyramidal lobe in an immunocompetent patient with a history of total thyroidectomy and recently infected with COVID-19, successfully treated with serial aspiration and antibiotic.
Comparing the immunogenicity of mRNA and non-mRNA COVID-19 vaccines: A scoping review
For the past five years, the Coronavirus disease (2019 COVID-19) has spread alarmingly, challenging the economy and public health. The COVID-19 mRNA vaccines, such as Pfizer-BioNTech’s BNT162 and Moderna’s mRNA-1273, were developed in a short space of time and were the first mRNA vaccines approved by the United States Food and Drug Administration (US FDA) for Emergency Use Authorization (EUA). In phase II trials, the BNT16b2 vaccine was reported to have 91.3% efficacy against COVID-19, while the mRNA-1273 vaccine showed a slightly higher (94.1%) efficacy against COVID-19 in phase III trials. Both mRNA vaccines are reported to be safe and effective against COVID-19 and have an acceptable adverse event profile. The analysis from this scoping review suggests that the efficacy of the mRNA vaccines was superior to non-mRNA vaccines, which is based on the vaccine efficacy (VE) and antibody response analysis. Further analysis of the mRNA vaccines showed that the Moderna (mRNA-1273) vaccine had higher efficacy compared to the BioNTech, Pfizer (BNT1262b) vaccine. However, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) appears to undergo frequent mutations in its spike protein gene, posing substantial public health concerns as even fully vaccinated individuals can succumb to the newer variants of the COVID-19 virus, warranting further investigation.
Paternal Peripartum Depression and its Risk Factors among Men transitioning into Fatherhood in Malaysia
Introduction: Fatherhood can be challenging, and men’s well-being during their partner’s perinatal period is often overlooked. This study assesses the prevalence of paternal perinatal depression (PPND) and associated factors among men in a Malaysian district during their partner’s perinatal period. Methods: This cross-sectional study used a self-administered questionnaire for men whose partners attended the maternal and child health clinic (MCHC) during perinatal period. Eligible participants received either a hard copy or a link to an online Google Form. The questionnaire covered sociodemographic, economic, and clinical details, as well as the Multidimensional Scale of Perceived Social Support (MSPSS) and the Edinburgh Postnatal Depression Scale (EPDS). Informed consent was obtained, and men with EPDS scores of 10 or higher were considered at risk for post-partum neural depression (PPND). Data were analyzed using SPSS version 26. Results: 400 men responded, but only 381 completed data were analyzed. The mean age of participants was 32.72 (±5.648). The prevalence of PPND in this sample was 12.4%. The two significant factors for PPND were low or moderate social support and the presence of existing chronic disease. Conclusion: The study concluded that men lacking social support are at an increased risk of PPND. It also emphasized that men with pre-existing chronic conditions face a higher risk of PPND. Therefore, it is crucial to screen for PPND in men, particularly those with chronic illnesses and limited social support. Additionally, the well-being of fathers should be considered during follow-up and care of their female partners during the perinatal period.
Development and validation of a nutrition education module on free sugar for individuals with metabolic syndrome: My 3S (Smart Sugar Study)
Introduction: Metabolic syndrome (MetS) is a measure of an individual’s risk of developing cardiovascular disease. This paper describes the development and validation of a nutrition education module, The My 3S (Smart Sugar Study) that focused on free sugar. Methodology: The My 3S have three phases: Phase 1 Needs assessment, Phase 2 Development and validation of nutrition education module, and Phase 3 Feasibility study. Phase 1 is a cross-sectional study conducted using surveys on dietary free sugar of general population (n=209) and individuals with MetS (n=39), and clinical observation of dietetic consultation (n=20). The inclusion criteria included Malaysian; 30-65 years old; able to communicate in Malay or English; presence with MetS. The module development involved five experts in nutrition, dietetics, and medicine. The content validity was conducted using a content validity index (CVI) among five expert panels who were health care experts. And the face validity involved 32 target audiences and five expert panels. Result: The free sugar of individuals with MetS was 18.6 (9.09) % of total energy intake and the dietetic consultation did not include daily free sugar allowance. The developed module showed good content validity (CVI = 1.0) and face validity (average score of 78.3% to 91.7% from the expert panels and 96.9% to 100.0% from the target audiences). Conclusion: Individuals with MetS consumed high free sugar and there is lack of nutrition education module on free sugar for them. The newly developed nutrition education module can be used to educate individuals with MetS and high free sugar.
Knowledge of Chronic Kidney Disease Management among Primary Healthcare Doctors: A Cross-Sectional Study
Introduction: The prevalence of chronic kidney disease (CKD) is increasing worldwide including in Malaysia. Primary healthcare professionals are required to have sufficient knowledge in all aspects of CKD management. The study determines the level of knowledge on chronic kidney disease and management, its associated factors, and to describe the practice of chronic kidney disease management among public primary healthcare providers in Kelantan. Methods: A cross-sectional study using an online self-administered questionnaire involving purposively sampled medical officers working at the health clinics in the Ministry of Health. The questionnaire assessed knowledge of CKD definition, risk factors, complications, investigations, and management. Descriptive statistics and multivariate analysis were used to determine factors associated with knowledge level. Results: One hundred seventy-nine primary healthcare providers in Kelantan participated in this study. The mean score for knowledge among primary healthcare providers was 71.6%. Most participants were able to identify the risk factors of CKD correctly. Previous exposure to CKD management training and use of clinical practice guidelines were significantly associated with knowledge. Some practices among the participants were discordant with the guidelines. More than three-quarters of participants used serum creatinine as the initial screening test for CKD, whereas only 47.5% screened for anaemia among CKD patients. Conclusion: Previous exposure to training and usage of guidelines were significant associated factors for the level of knowledge. Educational activities and the availability of guidelines in clinical practice are important to improve the quality of care among healthcare professionals.
Knowledge, risk perceptions, and preventive behaviours among undergraduate students in Selangor amidst the Covid-19 transition: An observational study
Introduction: The emergence of COVID-19 in 2019 marked one of the most devastating pandemics in recent history, leading to widespread infections and fatalities globally. In response to efforts to mitigate its impact, people were enlightened through various channels about the new disease and necessary preventive measures, prompting a significant lifestyle shift to scale down the transmission. This study determines the level of knowledge knowledge, risk perception, and preventive behaviors among undergraduate students at a public university in Selangor, Malaysia during the endemic transition phase, which began from 1st April 2022 until 5th May 2023. Method: Employing a cross-sectional design and stratified random sampling method across six medical and health sciences courses, questionnaires were distributed via email to selected participants. Statistical analysis was conducted with SPSS version 27.0. Results: The study revealed mean scores of 29.50 ± 2.2 for knowledge, 35.60 ± 0.2 for risk perception, and 31.55 ± 6.6 for preventive behavior. Gender showed significant associations with both risk perception and preventive behaviour , while educational background was significantly correlated with preventive behaviour. Risk perception was significantly associated with both knowledge (r: .124, p: .007) and preventive behaviour (r: .054, p: .241). Conclusions: There are significant associations between COVID-19 risk perception and both knowledge and preventive behaviour. Gender has a significant association with risk perception and preventive behaviour, and educational background has a significant association with preventive behaviour. Unfaltering awareness and proactiveengagement in preventive measures are essential to sustaining efforts against the ongoing threat of the pandemic.
Utilising pulse wave velocity in assessing arterial stiffness in patients with mild-to-moderate chronic kidney disease
Introduction: Arterial damage in patients with chronic kidney disease (CKD) is characterized by increased arterial stiffness, which is associated with increased cardiovascular risk, particularly seen in elderly patients with advanced CKD. However, arterial stiffness among the young early CKD is not clear. The study investigates the presence of arterial stiffness using pulse wave velocity (PWV) in the younger-age adults with stages 2 to 4 CKD. Methods: Eighty-seven patients with stages 2-4 CKD and eighty-seven control subjects with normal renal function participated in the study. Demographic details, comorbidities, risk factors, medications as well as blood samples were collected. Arterial stiffness was determined using carotid-femoral PWV Results: The mean age for CKD patients was 47+5.4 years. CKD patients had a higher mean PWV (7.8+1.7 m/s) compared to control subjects (5.6+1.0 m/s) (p<0.001, 95% CI -2.59-1.77). A significant difference in mean PWV was also found between patients with stage 2 CKD (7.6+1.5 m/s) and control subjects (5.6+1.0 m/s) (p<0.001, 95% CI -2.40, -1.49). A stepwise increase in PWV corresponding to CKD stages was observed (p<0.001). Furthermore, significant differences were seen in mean PWV in CKD patients with diabetes (8.2+1.8 m/s) compared to non-diabetic CKD patients (7.3 + 1.3 m/s) (p=0.022, 95% CI -1.50, -0.12). Multiple linear regression analysis revealed pulse pressure as an independent predictor of abnormal PWV (r2=0.249, p<0.001). Conclusion: In summary, arterial stiffness occurs early in younger CKD stage 2 patients. Increased arterial stiffness occurs in parallel with a decline in glomerular filtration rate in patients with mild-to-moderate CKD.
Predictors of knowledge, attitude and practice among seropositive leptospirosis cattle farmers in northeastern Malaysia
Introduction: Leptospirosis is a neglected re-emerging disease, with Kelantan being the leading state in Malaysia for its annual incidence. Among agricultural workers, cattle farmers significantly contribute to the high incidence in Kelantan. In 2018, a high seroprevalence of leptospirosis (72.5%) was reported among these farmers. Despite various studies on leptospirosis in Kelantan, none have focused on cattle farmers. This study aims to assess knowledge, attitudes, and practices (KAP) levels and identify associated factors among seropositive leptospirosis cattle farmers in Kelantan. Methodology: This cross- sectional study utilized an interviewer-guided validated questionnaire to collect data from all seropositive leptospirosis cattle farmers in Kelantan. A Likert scale was used to score KAP, with total scores converted to percentages. Descriptive analysis was performed using IBM SPSS version 24.0. Result: Most respondents (64.4%) demonstrated good knowledge of leptospirosis, yet only 38.4% had a satisfactory attitude, and a mere 16.4% practised satisfactory preventive measures. Not eating or drinking at the workplace was associated with good knowledge, satisfactory attitudes, and practices. Wearing rubber boots and experiencing rat infestation at the workplace were linked to good knowledge. Living more than 200 meters from a river correlated with satisfactory attitudes while increasing age was associated with better practices. Additionally, wearing rubber gloves was linked to satisfactory practices. Conclusion: Despite their good knowledge, respondents exhibited unsatisfactory attitudes and practices toward leptospirosis prevention. Future efforts should focus on improving attitudes and practices to enhance preventive measures against leptospirosis.
Cattle farmers, leptospirosis, knowledge, attitude, practice, KAP
Obesity as a Disease: The Malaysian Perspective
Obesity is increasingly recognised as a chronic, relapsing, and progressive disease driven by complex interactions between biological, environmental, and societal determinants. Malaysia faces one of the highest obesity burdens in Southeast Asia, with more than two-thirds of adults classified as overweight or obese when local diagnostic thresholds are applied. This editorial examines obesity through a disease-based lens, highlighting Malaysian epidemiological trends, underlying physiological mechanisms, and the rapidly evolving therapeutic landscape. It further discusses policy and health-economic implications, underscoring the urgent need for a comprehensive, system-wide response that integrates prevention, evidence-based treatment, and stigma-free care. Recognising obesity as a disease is fundamental to reversing current trajectories, preventing long-term complications and collapse of the healthcare economy, as well as to ensure sustainable health outcomes for Malaysians.
Obesity, chronic disease, Malaysia, GLP-1 receptor agonists, dual incretin therapy, health policy, health economics
Abstracts from Gynaecological & Breast Imaging Online Symposium
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Unexpected High International Normalised Ratio
45-year-old man who was suspected to have the antiphospholipid syndrome, presented with persistently high international normalised ratio despite not being on any oral anticoagulant. He was previously put on Rivaroxaban at another institution after multiple episodes of thromboembolic events, but was stopped prior to his admission at our clinic. No bleeding episodes were recorded. Subsequent measurements of prothrombin time (PT) were performed using Sysmex CS-2500, Sysmex CA-104 and Instrumentation Laboratory (IL) ACL Top analysers. PT results by both Sysmex analysers were prolonged at 34s and 30s, respectively. Conversely, the PT result using IL ACL Top analyser was within normal range. Both Sysmex analysers used a PT reagent, which incorporated a recombinant thromboplastin. When PT was repeated using a tissue derived PT reagent, PT result was within the reference range. The patient was later found to have antiphospholipid antibodies with triple positivity.
Extensive Necrotizing Fasciitis of the Neck: A Rare Case Report
Necrotizing fasciitis of the neck and chest wall is a very rare, aggressive infection with high morbidity and mortality. It caused a severe soft tissue infection involving subcutaneous tissue and fascial planes. This infection is more prone in patients with impaired immune systems. Its aggressiveness can also be rapidly fatal, thus requiring aggressive medical and surgical therapy to improve the prognosis. We present a case of a young man with no comorbidities who had an extensive submandibular abscess with necrotizing fasciitis of the neck, anterior chest wall, and descending mediastinitis. Computed tomography of the neck and thorax showed evidence of the initial diagnosis. He was treated with broad-spectrum intravenous antibiotics and surgical debridement of the neck and anterior chest wound. After the surgery, his condition rapidly improved, and he was discharged after a week. The wound was healed after a month of daily dressing.
Thyroglossal Duct Carcinoma: A Rare Entity
Thyroglossal dust cysts are commonly located over the neck centrally along the path of migration of the thyroid gland. The occurrence of malignancy within thyroglossal dust cysts is extremely rare with papillary carcinoma as the most common subtype. We highlight a case of a 30-year-old gentleman who presented with anterior neck swelling for a month which gradually increased in size. Subsequently post Sistrunk procedure with thyroid gland preservation, he was diagnosed with papillary carcinoma within a thyroglossal dust cyst. He recovered well with no evidence of recurrence with normal blood parameters after one year of follow-up. Although thyroglossal dust cysts malignancy is rare, every patient should be examined thoroughly for risk stratification for malignancy. Any swellings over neck region is warranted for a proper evaluation by the attending clinician.
Validation and Reliability of Reflux Symptoms Score-12 in Bahasa Malaysia
Introduction: Laryngopharyngeal reflux is a prevalent disease. The combined multichannel intraluminal impedance and pH monitoring device is the “gold standard” to diagnose LPR but only available in certain centres. Primary care givers should be equipped with tools applicable everywhere to diagnose and monitor LPR efficiently such as the Reflux Symptoms Score 12 (RSS-12).This study was conducted to develop a Malay version of RSS-12 and to evaluate validity, consistency and reliability of this tool to be applied to the Malaysian population Methods: The English RSS-12 was adapted into Bahasa Malaysia Reflux Symptom Score 12 (M-RSS 12) translated to Bahasa Malaysia by an authorized translator. Content validation was done by 3 expert panels. Face validation performed using the questionnaire rated by 10 respondents from our clinic. A pilot study involving 30 patients was then conducted to determine the feasibility of the study Results: The item- level content validity index (I-CVI) for all items was 1.0, the scale-level content validity index (S-CVI/Ave) was 1. The item-level face validity index (I-FVI) for all items was 0.95 -1.00 and scale-level face validity index based on the average method (S-FVI/Ave) was 0.99. Both indices of content validity and face validity achieved satisfactory level. For internal consistency, the Cronbach alpha for 3 domains in the MRSS-12 ranged between 0.891-0.928 which showed high reliability Conclusion: M RSS-12 is practical, valid and reliable to be used among Malaysian population.
Study of Public Approach Towards COVID-19 Vaccine Doses
Introduction: Vaccine hesitancy was one of India's problems after the COVID-19 vaccine roll-out. Earlier studies carried out to understand people's perception of the vaccine were mainly based on online or offline community-based surveys. These studies do not help to understand the actions taken by people towards vaccination. Hence, this study has been designed to understand the exact behaviour of people toward the vaccine Methods: Age-wise, the population was sub-grouped into three groups, above 18 years, 12-14 years, and 15-18 years. The data analysis has been done using cumulative coverage of vaccines in the said age groups Results: The study shows a substantial population has missed second and booster doses of vaccine at the state, regional, and national levels in all three age groups. Even for the states that have shown the smallest number of people who missed their dose, their number is in the thousands Conclusion: Further research is needed to know, in total population, how many people have not even taken a single dose of vaccine. Policy-level efforts are needed to cover the country's entire population for at least a single dose and vulnerable populations, for additional booster doses after primary doses
Promoting Community Health During Covid-19: A Service-Learning Experience in Selangor
Introduction: Given the prolonged movement restrictions that have led to sudden lifestyle changes and rising mental health concerns, innovative health promotion approaches are inevitable. ‘Health Fest UiTM’ was a virtual health promotion program conducted to address some of the overarching issues facing our communities during the COVID-19 pandemic. This paper aims to describe the implementation of ‘Health Fest UiTM’ as a public health service-learning tool with a community- based teaching and learning approach Methods: The ‘Health Fest UiTM’ project was organized by the Department of Public Health Medicine from the end of July to early August 2021. Four key themes were identified based on a community health needs assessment. They included: i) COVID-19 immunization, ii) mental health awareness, iii) physical activity and healthy diet during the pandemic, and iv) domestic violence awareness. Various activities were conducted using different social networking sites (SNSs) and anonymity was ensured to encourage greater participation and minimize stigmatization Results: In total, 214 fourth-year undergraduate medical students were involved in this service-learning program. Five virtual live events displayed favorable SNSs engagement metrics that ranged from 200 to 1000 participants and the total number of views and shares for the educational materials posted on SNSs exceeded 35,000. Conclusion: The COVID-19 pandemic has accelerated the integration of digital technology into the performance and delivery of service-learning in providing access to health information and education as well as facilitating community engagement through virtual platforms.
A Comparison Between Video-Assisted Teaching (VAT) and Traditional Teaching (TT) Methods on Knowledge and Confidence Level on Performing Focus Assessment with Sonography for Trauma (FAST) Among Final Year Medical Students in Emergency Department Teaching
Introduction: In response to the COVID-19 pandemic in 2020, many universities switched from face-to-face teaching to alternative forms of delivery without jeopardizing the quality of teaching and learning due to lockdown. Our study aims to discover the alternative way of teaching ultrasound among medical students and uses Focused Assessment with Sonography in Trauma (FAST) as an example of training. Methods: A prospective interventional study was conducted involving 100 final-year medical students. The study’s primary endpoint was to compare the level of knowledge and confidence pre- and post-workshop of FAST scan among medical students who received Video-Assessed Teaching (VAT) versus those who received Traditional Teaching (TT). Results: Our study showed a significant improvement in knowledge and confidence after the workshop. There was a significant mean difference between pre- and post-workshop for both knowledge and confidence among both groups (VAT and TT) (P <0.001). However, the two groups had no significant mean difference in knowledge and confidence levels (P >0.050). It was noticed from students’ responses that 31% preferred the hands-on session, 28% preferred bedside teaching, while few preferred lectures and videos, with 20% and 18%, respectively. Conclusion: VAT is non-inferior compared to TT in terms of knowledge and confidence in training ultrasound among undergraduate students. Thus, VAT can be considered an alternative method of teaching during a pandemic outbreak, with certain limitations.
A Randomized Controlled Study Comparing Incision and Drainage with Deroofing Versus Saucerization for the Treatment of Carbuncle
Saucerization is a common treatment for carbuncle is associated with excessive bleeding and prolonged healing. Incisional and drainage (I&D) is recommended internationally, however it is not widely practiced locally due to lesion severity at presentation. We compared I&D with deroofing against saucerization to treat carbuncle. We prospectively analyzed 59 patients in a single center for two years duration. All analysis was done based on intention to treat. Forty-four patients were eligible and randomized to I&D with deroofing arm (n=21) or saucerization arm (n=23). I&D with deroofing was associated with shorter healing time (median 28 days vs 72 days, p=0.003) and less days requiring dressing change (median 28 days vs 77.5 days, p=0.002). Saucerization was observed to have higher complications (17.4%; 3 patients required de-sloughing under local and general anesthesia, 1 required blood transfusion), while I&D with deroofing was observed to have less complications (14.3%; 3 patients required further de-sloughing under local anesthesia) with shorter operating times although these were not statistically significant. Staphylococcus aureus was the commonest organism grown from swab cultures from both arms. I&D with deroofing should be the treatment of choice in carbuncle due to significant improvement in healing time and less days required for dressing change. Future studies on cost effectiveness and effects of age, diabetes, incisional approach and lesion size on wound healing and sepsis resolution will provide a better insight on the holistic management of carbuncle.
Unlocking the Power of Calcium Sulfate: Paving the Way for Periodontal Regeneration Across Time
Various type of bone substitutes was introduced including autograft, allograft, and xenograft to replace the missing bone. However, each has its drawbacks which prompts the use of other alternatives such as alloplastic materials. Calcium sulfate (CS) is one of the oldest alloplastic materials that has a long history in regenerative medicine. This narrative review aimed to address several key questions: 1) Which regenerative material is preferable for use; xenograft or alloplastic material? 2) What is the versatility of calcium sulfate in periodontal regeneration? 3) How can calcium sulfate and stem cell technology shape the future of periodontal regeneration?
From Connection to Crisis: Emerging Mental Health Challenges in the Digital Age
Retroperitoneal Ewing Sarcoma among Asian Patients: A Case Report and Review of Literature
Retroperitoneal Extraosseous Ewing Sarcoma (EES) is a rare malignancy and poses diagnostic and management challenges. We present a case report of a 32-year-old Malay male who experienced persistent abdominal distension with constitutional symptoms. Imaging studies revealed an aggressive retroperitoneal mass with lymphadenopathy and local invasion. The diagnosis of retroperitoneal EES was confirmed through histopathological examination. The patient's condition persisted, but he refused surgical intervention. To address the persistent pain, the patient underwent coeliac plexus block and neurolysis. We also reviewed case reports regarding retroperitoneal EES for better insight into the management of this rare sarcoma.
Fibromatosis colli or congenital muscle torticollis of infancy is a rare cause of neck swelling that originates from the sternocleidomastoid muscle (SCM). It typically presents as an incidental finding of a firm and painless neck swelling by concerned parents. The cause of this pathology is unknown. Ultrasonography (US) is the modality of choice to confirm diagnosis and treatment is mainly by physiotherapy. However, in inexperienced doctors’ hands, this pathology may be over investigated with unnecessary minimally invasive techniques such as fine needle aspiration or biopsy to obtain diagnosis. We report a case of a one-month-old boy presented with a painless right neck swelling, management, and literature review with the objective to remind the fraternity of this forgotten diagnosis and to prevent over investigation of this benign entity.
Plunging Ranula Causing Airway Compromise in a Child: A Rare Case
A plunging ranula is a rare cause of neck swelling. Typically, ranula presents with a gradual course and rarely causes acute respiratory impairment. We report the case of a 10-year-old Malay girl who presented with a rapidly enlarging right-sided neck swelling with symptom of upper airway obstruction for one day. Examination revealed submandibular and submental swelling on the right side and elevation of the floor of the mouth with medialization of the right pharyngeal wall. Computed tomography scan of the neck revealed a ranula lesion. The patient underwent marsupialization followed by external excision of the ranula. A plunging ranula is rare in children and is always misdiagnosed. Surgical excision is a treatment of choice with a low recurrence rate.
Dystrophia Myotonica with Hypercapnic Respiratory Failure – Local Challenges and Ethical Dilemmas
Dystrophia myotonica type 1 (DM1) is an adult-onset progressive form of muscular dystrophy which eventually lead to respiratory failure. Non-invasive home mechanical ventilation (HMV) for these patients could result in a reduced risk of morbidity and mortality. The following case report describes the management of respiratory failure in a patient with DM, and the challenges that come with it especially in our Malaysian settings.
Evaluation of Antinuclear Antibodies of SLE Panel in COVID-19 Patients: A Cross-Sectional study in a Tertiary Care Hospital
Introduction COVID-19, caused by SARS-CoV-2, has raised concerns about its potential to trigger autoimmune phenomena and post-infection autoimmune diseases. This study aimed to assess the prevalence and patterns of antinuclear antibodies (ANA) in post COVID-19 patients. Methods A cross-sectional study was conducted from August to October 2021, involving 108 adult post COVID-19 patients with articular and musculoskeletal symptoms. ANA screening was performed using the Indirect Immunofluorescent Test (IIFT) with HEp-2 cell substrate, and positive samples were further analyzed using Line ImmunoAssay (LIA) for specific ANA detection. Demographic data and disease severity information were collected. Results Among the participants, 29% tested positive for ANA by IIFT, and 17% of those with 3 months post COVID-19 and 37% with >6 months post COVID-19 were ANA-positive. LIA confirmed ANA positivity in 18 patients. The most common ANA pattern was nuclear speckled (52%), followed by homogenous (21%), DFS 70, and Nucleolar (10% each), and Cytoplasmic (7%). The prevalence of ANA increased significantly with longer post COVID-19 duration (>6 months vs. 3 months, p = 0.017) U1 snRNP-related speckled pattern was most frequent. However, the study found no correlation between ANA patterns and post COVID-19 duration. Conclusion The findings suggest that COVID-19 may trigger the development of ANA autoantibodies, especially in patients with a longer post-infection duration. Long-term follow-up studies are essential to understand the role of ANA in infection-triggered autoimmune conditions, enabling early diagnosis and treatment.
Efficacy of Prophylactic Dexamethasone on Postoperative Nausea and Vomiting in Laparoscopic Appendicectomy: A Randomized Controlled Trial
Background: Dexamethasone has been established as an effective prophylactic antiemetic in various studies done in elective surgery. However, its efficacy in emergency surgery specifically, laparoscopic appendicectomy is not well documented. This study was conducted to compare the efficacy of prophylactic intravenous (IV) dexamethasone 8mg in preventing postoperative nausea and vomiting (PONV) in this surgical population. Methods: A total of 84 participants were recruited for the study in Hospital Universiti Sains Malaysia and were randomly assigned in equal numbers to treatment group with prophylactic IV dexamethasone 8mg or placebo. The outcomes of both groups were taken at three time intervals; first hour, 12th hour and 24th hour postoperatively which were proportion of PONV, PONV scores, pain scores and the need for rescue antiemetic. Results: The group receiving dexamethasone had significantly lower proportion of PONV compared to control group in the first hour postoperatively (dexamethasone vs Control; 16.7% vs 42.9%, P = 0.009) and at 24th hour postoperatively (0% vs 14.3%, P = 0.011). The dexamethasone group also required less rescue antiemetic at the first hour (14.3% vs 35.7%, P = 0.023) and 12th hour postoperatively (0% vs 11.9%, P = 0.021). No significant differences in pain scores or PONV scores were found in both groups. Conclusion: Prophylactic dexamethasone reduced postoperative nausea and vomiting (PONV) incidence in the first hour and 24 hours post-surgery, decreased the need for rescue antiemetics in the first hour and 12th hour, but did not significantly affect analgesia or PONV severity between groups.
The Survey of Clinical Fundal Height Assessment among The Obstetric Practitioners
Introduction: Clinical fundal height assessment (symphysis-fundal height (SFH), landmark method and finger method) is a common practice among obstetric practitioners despite a lack of evidence on its use. This study aims to determine the attitude and practice of the three methods of clinical estimation of fundal height among obstetric practitioners. Methods: This was a cross-sectional study involving 258 doctors who were practising obstetrics in Malaysia, who were recruited through convenience sampling. A validated self-administered questionnaire consisting of background details, and questions on attitude and practice on clinical estimation of fundal height was used. Results: From the total of 258 respondents, 237 (91.8%) agreed that estimating fundal height clinically is important and 230 (89.1%) respondents agreed this should be taught to medical students. In addition, 189 (73.3%) and 155 (60.1%) participants felt that SFH should be supplemented with the landmark method and finger method respectively. There were 230 (89.1 %) respondents practising clinical fundal height assessment, with 167/230 (72.6%) practising SFH measurement, 123/230 (53.5%) practising landmark method, and 116/230 (50.4%) practising finger method. This study also found that 96/230 (41.7%) practitioners use a single method for their practice and 134/230 (48.3%) practitioners use a combination of methods. The clinical fundal height assessment also was demonstrated to be associated with gender (p=0.01), highest degree obtained (p=0.00), current place of practice (p=0.00), and current post (p=0.00). Conclusion: The majority of obstetrics practitioners agree that clinical fundal height assessment is important and perform it in their daily practice, however, the methods used vary.