Journal of Clinical and Health Sciences

Pathogenesis and pathophysiological mechanism of obstructive sleep apnea: A review of anatomical, cytoskeletal, muscular, and neurological abnormalities

Siti Nuraidatul Amira Anas — 2025-03-01

Obstructive sleep apnea (OSA) is associated with abnormality of the upper airway, which affects about 1 billion people globally, leading to significant morbidity and mortality causing a burden on the healthcare system. The collapse of the upper airway during sleep has been the main pathogenesis of OSA. A thorough understanding of the upper airway's anatomy, muscular, cytoskeletal, and neurological properties is crucial to developing the most updated and latest treatment strategies for this condition.

A Cross-Sectional Study on Pain Prevalence, Management and Interference among University Students in a Malaysian Public University

Nurin Jazlina Mohd Jamsari — 2025-03-01

Introduction: Pain is common among university students, and if left unmanaged, it can greatly hinder productivity, academic, mood, and social life. Identifying the prevalence of pain and evaluating the effectiveness of pain management methods among university students are crucial steps in assessing the need for a pain management program. This study aims to assess pain prevalence among university students, analyse the pain management methods, and evaluate the impact of pain on different aspects of students' lives.
Methods: This cross-sectional study was conducted through an online questionnaire consisting of five sections and involved a convenience sampling of 380 Universiti Malaya students. The statistical tests used were descriptive and inferential analysis (i.e. chi-squared test, Kruskal-Wallis test).
Results: The overall pain prevalence in the last 30 days was 82.1%, with 1.3% of the cases being chronic pain lasting more than three months. Females are more likely to experience pain (p<0.001). Headache, musculoskeletal pain and period pain were the most commonly experienced pain by the students. About 72% of the participants who reported pain used pharmacological methods, and about 88% used non-pharmacological methods. However, 23.1% of the pain sufferers did not take any action to address their pain. Mood and daily functioning were the aspects of life that are most affected when in pain.
Conclusions: The high prevalence of pain and the presence of unmanaged pain among a proportion of the students suggest that the introduction of a pain management program would be highly advantageous for university students.

Clinical Profiles of Cancer-Associated Thrombosis among Newly Diagnosed Patient with Solid Cancer

Faiza Naimat — 2025-03-01

Background and objectives: Cancer-associated thrombosis (CAT) is a clinically significant complication that is linked to cancer patients. However, evidence regarding epidemiology of CAT and clinical characteristics in Malaysian cancer patients is very limited. The objective of this study is to investigate baseline characteristics of cancer patient with VTE and clinical profile of the VTE event. Methods: There were 462 cancer patients who were in anticoagulant recipient list from Radiology and Oncology Pharmacy Department, Hospital Kuala Lumpur between 2018 and 2021. A total of 208 patients met the inclusion and exclusion criteria of our study. We analysed retrospectively with respect to underlying diseases or predisposing factors. Results: Mean age of CAT patient was 50.51 years old and body mass index was normal (24.01kg/m² ). Patients were mostly having good performance status (0-1). The prevalence rates of CAT were higher in breast, gynaecology and lung. About 63% of the cases experienced DVT, 27.3% had pulmonary embolism and 9.6% of the cases experienced both DVT and PE. Lower extremities DVT was prevalence (28.4%) and followed by upper extremities DVT. Slightly more than 50% of the cases developed VTE within 3 months of cancer diagnosis. Conclusion: The clinical profiles of CAT in our study were different with patients in the West. Nevertheless, risk factors for cancer-related thrombosis found in our study were much consistent with current literature from Asia. The findings in this study may gave an insight on the direction of management of CAT and improve thromboprophylaxis strategies among newly diagnosed cancer patient.

The Survey of Clinical Fundal Height Assessment among The Obstetric Practitioners

Nadzratulaiman Wan Nordin — 2025-03-01

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.

Efficacy of Prophylactic Dexamethasone on Postoperative Nausea and Vomiting in Laparoscopic Appendicectomy: A Randomized Controlled Trial

Shin Ann Ng — 2025-03-01

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, 12^th hour and 24^th 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 24^th 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 12^th 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.

Evaluation of Antinuclear Antibodies of SLE Panel in COVID-19 Patients: A Cross-Sectional study in a Tertiary Care Hospital

K Usha Krishnan — 2025-03-01

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.

Dystrophia Myotonica with Hypercapnic Respiratory Failure – Local Challenges and Ethical Dilemmas

Muhammad Amin Ibrahim — 2025-03-01

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.

Plunging Ranula Causing Airway Compromise in a Child: A Rare Case

Farhana Kamaruzaman — 2025-03-01

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.

Fibromatosis Colli, A Forgotten Entity

Muhammad Raziin Zainal Abidin — 2025-03-01

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.

Retroperitoneal Ewing Sarcoma among Asian Patients: A Case Report and Review of Literature

Kamarul Aryffin Baharuddin — 2025-03-01

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.

Breaking Barriers and Building Bridges - The Influence of Ethics in Advancing Medical Practice

Mark Kiak Min Tan — 2025-03-01