Borneo Journal of Medical Sciences (BJMS)

A Unique Ear Foreign Body: A Thorny Issue

2025-09-28T08:51:19+08:00

Foreign body in the external auditory canal is one of the most common problems encountered in otorhinolaryngology clinics. It could become a medical emergency based on the type of the foreign body and its removal requires skillful expertise and specific instruments. We report 3 cases of thorny rattan shoots lodged in the ear canal. The unique arrangement of the thorns made the removal procedure complicated. Apart from mastering the manoeuver, knowledge about the nature of the foreign body itself is essential to avoid further harm.

Beyond the Usual Suspects: A Diagnostic Challenge of Kikuchi-Fujimoto Disease in a Young Male

2025-09-28T14:53:52+08:00

Kikuchi Fujimoto Disease (KFD) is a rare disorder characterized by histiocytic necrotizing lymphadenitis with clinical presentation mimicking other diseases. We present a 15-year-old young boy presented with unremitting fever, erythematous rash and inguinal lymphadenopathy. On physical examination, he also had splenomegaly. On further history, the patient did not have any infective or autoimmune symptoms with no positive family history of cancer. His travel, medication and drug histories were also non-significant making a diagnostic conundrum. The initial investigations done narrows it on either lymphoma or an occult sepsis since hyperleukocytosis and increased inflammatory markers were noted. However, after an extensive workup and multidisciplinary input, with the help of histopathological examination of the inguinal lymph node tissue, the diagnosis of KFD was able to achieve. Here, we present a case with this condition highlighting the challenges faced throughout the process of diagnosis and the importance of recognizing this rare disease as well as the detailed diagnostic approach.

Cardiac Tamponade: A Rare Initial Presentation of Thymoma

2025-06-24T13:47:38+08:00

Thymomas represent the predominant type of neoplasm of the anterior mediastinum, constituting approximately a quarter of all tumours found within the mediastinal region. They can present in various ways, including as asymptomatic incidental findings, paraneoplastic syndromes, or symptoms due to the tumour’s spread within the thorax. In advanced cases, pericardial and pleural effusions may develop. Nevertheless, it is extremely rare for a thymoma to initially manifest as a spontaneous bleeding into the pericardial space, resulting in cardiac tamponade. This report illustrates a case of an elderly woman who presented with shortness of breath, reduced effort tolerance, cough, appetite loss, and weight loss. Examination revealed tachycardia, hypotension, distended jugular veins, and muffled heart sounds. Investigations showed anaemia, transaminitis, elevated inflammatory markers, and cardiomegaly with pleural effusions. Echocardiography confirmed cardiac tamponade, and pericardiocentesis drained 1000 ml of haemorrhagic pericardial fluid. CT imaging revealed a large anterior mediastinal mass compressing major vessels. Histopathology confirmed WHO type B2 thymoma. Due to unresectability of the tumour, the patient received palliative chemotherapy but showed disease progression. This case highlights cardiac tamponade as a rare initial presentation of thymoma and emphasises the importance of considering mediastinal malignancy in unexplained pericardial effusions.

Overcalling Rifampicin Resistance by Rapid Molecular Xpert MTB/RIF Ultra - A Diagnostic Pitfall and Treatment Dilemma

2025-03-13T10:22:14+08:00

Tuberculosis (TB) is a worldwide pandemic and Sarawak constitutes the top three most TB prevalent state in Malaysia. Molecular WHO-recommended rapid diagnostic tests for TB (mWRDs) such as Cepheid GeneXpert’s Xpert MTB/RIF Ultra has been a game-changer in early detection of Mycobacterium tuberculosis (MTB), with additional rifampicin resistance information, enabling prompt and effective treatment of possible multidrug-resistant TB (MDR-TB). However, improved test sensitivity comes at the expense of specificity, causing higher risk of false positivity. We report a false-positive rifampicin resistance detected by Xpert MTB/RIF Ultra in a newly-diagnosed pulmonary TB patient without MDR-TB risk factors. A 39-year-old healthy gentleman was admitted to the hospital for productive cough, increasing breathlessness, and constitutional symptoms for three months. Following his sputum acid-fast bacilli (AFB) smear positivity, first-line anti-TB treatment was started. The initial sputum culture was tested susceptible to first-line antibiotics. He completed the intensive phase, but during his maintenance phase, on the third day his sputum sample was positive for AFB, alerting of MDR-TB possibility. Sputum Xpert MTB/RIF Ultra showed MTB detection with rifampicin resistance. Repeated Xpert a week later revealed absence of rifampicin resistance. Additional testing using line probe assay and cultures no longer detected MTB complex, however, the incidental AFB-positive sputum was identified by culture to be a non-tuberculous mycobacterium. The patient responded with first line anti-TB re-treatment regime, and was discharged well. False-positive rifampicin resistance in Xpert MTB/RIF Ultra is uncommonly reported but may lead to overcalling and complicate MTB treatment. Patient clinical evaluation and careful MDR-TB risk assessment should be performed prior to treatment escalation.

Rethinking Blood Pressure: A Marker of Overall Health, Not Just a Disease Threshold

2025-05-09T13:25:50+08:00

For many years, blood pressure (BP) has been considered a primary risk factor for cardiovascular disease, with management strategies focused heavily on pharmacological interventions, to ensure BP remain within a defined range. However, closer look at emerging research suggests that BP is not just a determinant of cardiovascular risk but serves as a broader indicator of metabolic and lifestyle health. This paradigm shift emphasizes the necessity to address underlying lifestyle factors such as diet, physical activity, stress and sleep, instead of solely aiming to lower BP values through medication. Epidemiological studies indicate that even individuals with BP within the "normal" range may face increased health risks, strengthening the need for early intervention and comprehensive lifestyle modifications. The traditional approaches mainly categorize hypertension based on numeric thresholds and often neglect the root causes of BP elevation. In contrast, a holistic approach views BP as an "indicator light"—a signal for underlying metabolic dysfunction, insulin resistance, chronic inflammation and suboptimal lifestyle habits. This perspective aligns with the principles of lifestyle medicine, advocating for proactive interventions that emphasize behavioural modifications, rather than pharmacological treatment. By redefining BP as a reflection of overall health rather than an isolated parameter, healthcare strategies can evolve towards a more preventive and patient-cantered model. This shift promotes long-term health improvements and instead of reliance on medication, ultimately enhancing quality of life. Addressing BP through comprehensive lifestyle modifications provides a potential to transform public health approach and outcomes by preventing cardiovascular diseases before they manifest clinically.

Health-Related Quality of Life in Colorectal Cancer Patients Undergoing Faecal Occult Blood Test and Genetic Testing

2025-07-15T12:01:28+08:00

Early detection of Colorectal Cancer (CRC) is becoming increasingly important in maintaining quality of life. Therefore, understanding the quality of life is a must in health system planning. Hence, this study aimed to determine the health-related quality of life (HRQoL) of CRC patients and its associated factors. This is a cross-sectional study was conducted among CRC patients between September 2018 and November 2019 at three tertiary hospitals in Malaysia. Health-related quality of life in CRC patients was measured using a validated EuroQol instrument, the EQ-5D-5L scale. For inferential statistic, non-parametric Mann Whitney U, Kruskal-Wallis, and chi-square tests were conducted. Statistical significance was set at p<0.05. A total of 222 patients were involved as respondents in this study, of which 164 (73.9%) were colorectal cancer patients undergoing Faecal Occult Blood Test (FOBT) and 58 (26.1%) were colorectal cancer patients undergoing genetic testing. The highest problem rate was reported in the pain/discomfort dimension with 51.4% of the total problems reported by patients. Significant factors related to the EQ-5D-5L utility score were ethnicity, employment status, monthly income, education level and cancer level. While the significant factors related to VAS score are monthly income, education level and cancer level. The model for utility scores confirmed that an important predictor of lower EQ-5D-5L scores was low level of education (p <0.05). Health-related quality of life measurements among patients found that significant differences in pain / discomfort dimension problems were identified between the two colorectal cancer screening methods. Those with low education were important predictor factors in the EQ-5D-5L score model and VAS score.Quality of life,

Implementation of an Enhanced Recovery After Surgery (ERAS) Protocol in a General Surgical Unit: A Prospective Cohort Study on Outcomes in Colorectal Surgery

2025-12-03T17:05:39+08:00

Background: Enhanced Recovery After Surgery (ERAS) protocols improve outcomes in elective colorectal surgery, but their efficacy in general surgical units, as opposed to specialized high-volume centres, is less established. This study evaluated the impact of a standardized ERAS protocol in a general surgical unit in Malaysia. Methods: A prospective observational study was conducted comparing 60 patients managed under a 24-element ERAS protocol to a historical cohort of 56 patients managed with traditional care. All patients underwent elective colorectal resection for malignancy. The primary outcomes were length of hospital stay (LOS), postoperative complication rates (Clavien-Dindo classification), 30-day readmission, and 30-day mortality. Adherence rate to the ERAS protocol was evaluated as the secondary outcome. Results: Baseline demographics were comparable between groups. The ERAS group demonstrated a significant reduction in median LOS (5 days [IQR: 2] vs. 8 days [IQR: 5], p<0.001) and a significantly higher rate of patients with no postoperative complications (58.3% vs. 44.6%, p=0.006). The rate of major complications (Clavien-Dindo ≥III) was nearly halved (10.0% vs. 17.9%). There were non-significant trends toward reduction in 30-day readmission (11.7% vs. 17.9%) and mortality (1.7% vs. 7.1%). Overall, ERAS protocol compliance was high (>70% for most elements). Conclusion: The implementation of a multidisciplinary ERAS protocol in a general surgical unit is feasible and effective. It significantly reduces length of stay and postoperative morbidity for patients undergoing elective colorectal surgery, demonstrating that the benefits of ERAS can be successfully translated beyond specialized centres into a broader surgical setting.

The Effect of Time and Holding Media on Cell Derivation of Balb/C Mouse at Room Temperature

2025-08-21T12:15:17+08:00

Efficient cell derivation from post-mortem tissues is critical for biomedical research, yet its success is often compromised by delayed processing and inadequate preservation. This study aimed to assess the impact of post-mortem time intervals and the use of holding media on the success rate of cell derivation from Balb/C mice tissues at room temperature. Tissue samples were divided into four groups based on time (0 hours, 6 hours, 12 hours, and 24 hours post-mortem) and whether they were retained in media or not. Then, the samples were processed by washing, mincing, neutralising, centrifuging at 1000 rpm for 5 minutes, and resuspending before plating in 12-well plates in triplicates. The data were analysed using RStudio. Tissues retained in media maintained viable cell morphology and a gradual decline in plating efficiency up to 24 hours (75%), whereas tissues without media showed loss of viability as early as 6 hours, with plating efficiency dropping to 8.33% and declining further over time. Statistical analysis revealed a p-value of 0.283 for tissues retained in media, indicating no significant difference in viability over time, whereas tissues without media had a p-value <0.001, indicating a significant time-dependent decline. The time factor alone showed no significant impact on derivation success for tissues in media, maintaining tissue hydration prior to derivation is crucial for ensuring higher viability and successful outcomes. It is hoped that this study could serve as a foundation for future research, further advancing efforts and activities related to planetary health.