Borneo Journal of Medical Sciences (BJMS)

A 20-Year Autopsy Study of Myocardial Bridging Among Sudden Deaths

Ahmad Shafiie Ahmad Amran — 2024-05-01

Myocardial bridging (MB) is a condition, where the cardiac muscle overlies the intramyocardial segment of the major epicardial coronary artery. This study aims to analyse the demographics and anatomical characteristics of MB within a pool of 2093 sudden cardiac-related death cases examined at the Forensic Unit of Universiti Kebangsaan Malaysia Medical Centre between 2000 and 2019. In this cross-sectional study, postmortem data collected were gender, racial affiliations, MB anatomical properties, and association with cardiac pathologies entered into the statistical software SPSS version 25 for analysis. The prevalence of MB was 12.9%. It was commoner in males (91.5%). MB was predominant between age 21-40 years old (50.2%). Chinese race showed the highest number of recorded MB cases (24.3%) among local races. MB was mostly found in left anterior descending (LAD) artery (98.2%), with the commonest length of 11-20mm (44.6%), depth of 1-5mm (49.8%), and distance from the ostium of 21-40mm (54.0%). The prevalence of isolated MB (43.2%) was nearly comparable to that of MB with cardiac pathologies (56.8%). MB was mostly associated with atherosclerosis (50.1%) and atheroma formation was mostly proximal to MB (78.3%). MB is a common occurrence and commonly found in the LAD as a single entity. It has a higher preponderance in the male gender among the adult population. In conclusion, the findings not only contribute to a deeper understanding of MB but also hold potential implications for identifying and managing risks related to sudden cardiac-related deaths. It is a pathological condition at a certain length and depth whether it exists as an isolated entity or associated with cardiac pathologies. Atherosclerosis tends to form proximal to MB and might pose a risk for myocardial infarction.

A Cross-Sectional Descriptive Study: Proportion of Authenticity and Complete Product Information of FarmaTag Hologram on Registered Pharmaceutical Products among Selected Mainstream Medicines’ Sellers in the State of Sabah (ProvoS)

Ahmad Firdaus Shahari — 2024-05-01

FarmaTag Hologram is a two-dimensional QR code sticker that is required on all registered pharmaceutical products (RPP) in Malaysia. By scanning the QR code, the authenticity and product information of the hologram are displayed. However, FarmaTag holograms with incomplete product information may be susceptible to being misused by manufacturers/distributors/suppliers (MDS) for different pharmaceutical products, unregistered pharmaceutical products, or counterfeit products. In addition to misusing, these callous acts may lead to consumer distrust, doubt, and a lack of confidence in the authenticity of RPP. A cross-sectional descriptive study was conducted among Selected Mainstream Medicines’ Sellers in the State of Sabah between January 2022 and September 2022 to evaluate the proportion of authenticity and complete product information of FarmaTag Hologram on registered pharmaceutical products (RPP) available among selected Mainstream Medicines’ Sellers (MMS) in the state of Sabah. The total sample size was 5048 registered pharmaceutical products. There was no formal sample size calculation performed because this was the first study to explore this topic. All samples being selected from MMS were authentic (100%), which included 31.7% (n = 1600) from private medical clinics, 18.8% (n = 948), from retail pharmacies, and 49.5% (n = 2500) from Non-Pharmacy Drug Stores (NPDS). However, only 268 (5.3%) samples were found to have complete product information. The findings of this study provide preliminary information to relevant authorities on the authenticity and complete product information of FarmaTag Hologram on registered pharmaceutical products among selected MMS in the state of Sabah.

Emergency Haemorrhoidectomy in Acute Haemorrhoidal Crisis: A Tertiary Centre Experience

Muhd Yusairi Kamarulzaman — 2024-05-01

Acute haemorrhoidal crisis refers to painful, irreducible prolapsed haemorrhoids. On the best of hand, surgical treatment of acute haemorrhoidal crisis could still risk complications of bleeding and worse, incontinence. Our study aimed to look at the short-term outcomes of emergency excisional haemorrhoidectomy for acute haemorrhoidal crisis at a colorectal centre. This is a retrospective study conducted at a tertiary centre in the northern state of Malaysia from January 2015 to December 2020. The medical record was traced from the medical record unit and the operation theatre list for all patients with surgical treatment for an acute haemorrhoidal crisis. Sociodemographic data and complications rate were collected with 12 months follow-up. There were 51 patients identified from the registry and 29 out of those were male. The median age was 41 (20-82) years old. In addition, 26% (n=13) of the females were pregnant at presentation. Five patients had previous haemorrhoidal procedures performed. The median operating time was 35 (15-143) minutes with the length of hospital stays of 4 (2-10) days. The early complications were seen in 17 patients with bleeding (5.9%) and urinary retention (27%). The 12-month recurrence rate was 7.8% with median Wexner incontinence scores of 0 (0-3). The emergency excisional haemorrhoidectomy in acute haemorrhoidal crisis is safe and effective for immediate symptomatic relief with an acceptable low self-limiting complication rate.

Metformin Preserves Function and Histology of Liver in Type 2 Diabetic Rat Model

Wan Amir Nizam Wan Ahmad — 2024-05-01

Diabetes mellitus (DM) causes significant morbidity and mortality worldwide. Metformin is considered

first-line oral therapy for type 2 DM, together with lifestyle modification. The objective of this study was to evaluate the protective effects of metformin on the liver in the type 2 DM rat (T2DR) model. The rats were fed a high-fat diet (HFD) to become obese, followed by a single low dose of streptozotocin (STZ) at 35 mg/kg intraperitoneally to induce T2DR. Twenty-eight male Sprague Dawley (SD) rats were divided into four groups equally (n=7): Control, Obese (obese rats), T2DR (Untreated T2DR), or Met-T2DR (T2DR on oral metformin at 250 mg/kg/day for six weeks). Weekly levels of fasting blood glucose (FBG) were measured. Rats were euthanised, and liver function tests and lipid profiles were measured. The histology of the liver was examined using haematoxylin and eosin staining. The met-T2DR group demonstrated a significant decrease in FBG levels beginning in week 3 and preserved liver function and histology, and lipid profile comparable to control. The effect of metformin in lowering blood glucose was demonstrated, thus controlling diabetes and preventing liver complications. The mechanism of the hepatoprotective effect could be linked to glycaemic control and lipid metabolism.

Factors Affecting Health Care Services Utilisation among Rural Population in Sabah, Malaysia

Adilius Manual — 2024-05-01

Malaysia has made significant strides in achieving universal health coverage since gaining independence. However, rural areas in Sabah still confront challenges in accessing adequate healthcare compared to Peninsula Malaysia. This study explores healthcare utilisation patterns among Sabah's rural populace, with a focus on identifying access determinants. Over four months, a household cross-sectional study interviewed 438 respondents, employing geographical units for random sample selection. The questionnaire used was adopted and pre-tested from the National Health and Morbidity Survey 2011 (Healthcare Demand Module). Descriptive statistics and logistic regression were utilised to analyse demographic characteristics and determinants of health utilisation among those reporting one or more diseases (n = 99). The findings underscored age and health limitations as significant predictors of healthcare usage. Despite commendable national health outcomes, resource allocation tends to favour secondary care over primary care in rural regions. Prioritising preventive care at the primary level could enhance overall health outcomes. Understanding healthcare utilisation in rural areas, especially those with heightened poverty rates, is crucial for refining tailored healthcare policies. This study fills a crucial gap in the literature, offering insights to shape effective healthcare interventions for underserved rural populations.

HTLV-1: Neglected Virus in Southeast Asia for Decades

Hidekatsu Iha — 2024-05-19

There are more than 100 types of human pathogenic viruses, with seven currently known oncogenic viruses (Hulo et al., 2011). Hepatitis B (HBV)/C (HCV) viruses (Mohamed et al., 2023) and human papillomavirus (Wee et al., 2024) are pathogens of public health concern not only in Malaysia but also in many other countries, while Burkitt's lymphoma (Epstein-Barr virus) and Kaposi's sarcoma (Kaposi's sarcoma-associated herpesvirus) pose serious complications for AIDS patients (Carbone et al., 2022).

Urgency or Emergency – A Report on Hypertensive Crisis with Severe Retinopathy

Mohd Shaiful Ehsan Shalihin — 2024-05-01

Hypertensive crisis is a common condition encountered in primary care clinics. It may result from uncontrolled hypertension or a known cardiovascular risk disease but may also be the first occurrence of undiagnosed secondary hypertension. However, there is confusion on the classification of whether certain atypical presentations, particularly in young patients without acute symptoms and exact duration of symptoms, are to be considered as hypertensive urgency or emergency. Some abnormal signs, such as proteinuria or retinopathy, could be signs of an existing progression of underlying chronic disease rather than a manifestation of acute hypertensive crisis. Nonetheless, in any situation where the findings have occurred recently without prior follow-up, they should be treated as if they are signs of an acute hypertensive crisis. Bedside clues, such as concomitant anaemia and proteinuria, are valid evidence for the presence of end-stage renal disease (ESRD) causing the hypertensive crisis, even without the features of fluid overload or failure symptoms. We report the case of a young man presented with an acute hypertensive crisis with an isolated one-month history of blurred vision. Despite the initial dilemma, the case was treated as a hypertensive emergency due to the presence of retinopathy and overt proteinuria. The renal profile later confirmed that the patient had ESRD. This case proves that ESRD is still possible even in a young patient without a long medical history or other supporting signs. Making the right decision on the first visit saved the patient’s life.

Sodium Hypochlorite Irrigation Extrusion in Root Canal Treatment: An Updated Overview

Nur Farhana Wan — 2024-05-01

Effective endodontic treatment requires the proper choice of instruments and irrigation techniques in chemo-mechanical preparation. Sodium hypochlorite (NaOCl) is the most employed irrigant in endodontic practice, known for its efficiency in disinfecting the root canal system and dissolving organic debris. However, its cytotoxicity poses a drawback, potentially causing acute harm when extruded beyond the apex, a situation referred to as a NaOCl accident. While this occurrence is rare globally, NaOCl extrusion during root canal therapy can lead to severe aftereffects in addition to acute symptoms like pain and swelling. This review paper aims to guide dental clinicians in the early detection and diagnosis of NaOCl accidents, providing appropriate management strategies. The discussion encompasses the prevalence, risk factors, management, complications, and prognosis of NaOCl extrusion beyond the root apex. Recommendations and preventive measures for safely using sodium hypochlorite irrigation during endodontic therapy are also highlighted to ensure better management of hypochlorite accident symptomatology.