MASH Journal Volume 7 Issue I

March 2022
Dermatofibrosarcoma Protuberans With Fibrosarcomatous Transformation: A Case Report & An Overview
Eyrique G, Riham H and Arrazeen H

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma of the skin characterized by plaque like tumor derived from mesenchymal cell. Fibrosarcomatous transformation of DFSP (FS-DFSP) is an even rarer variant of which it is clinically indistinguishable from other DFSP variant – diagnosed by histopathological characteristics. As it is known to be more aggressive with higher risk of distant metastases, treatment should be carefully planned followed by strict post-op follow ups.


This is a case of a 57 years old man with a slow growing large tumor on his forearm following a minor trauma 10 years ago, presented to our institution for further management due sudden rapid enlargement and discomfort. The result of the lesion sent for histopathological examination is diagnosed as FS-DFSP without distant metastases (from a full body CT scan). On 3rd month of follow up, neither recurrence nor symptoms of distant metastases has been observed.


In conclusion DFSP needs a histopathological examination to distinguish its variant. This is important as FS-DFSP has higher risk of recurrence and metastasis. There are options of technique to ensure complete surgical resection of tumor. In cases of metastases and unresectable tumor, radiotherapy and pharmacological treatment is to be considered.  In our case, there is no signs of recurrent or distant metastases. However, long -term follow up is strictly recommended.

A 6 Step Approach In Initiating Essential Emergency Critical Care Services In A Resource Limited Emergency Department Setting.
Gurjeet Singh a/l Harvendhar Singh

The emergency departments of today no longer only cater for treatment of life threatening conditions as it also involves monitoring and lodging of critically ill patients pending admission to the wards in view of overcrowding and longer boarding times in the emergency. Application of critical care services will ensure that the patients who are critically ill and boarding in the emergency departments especially the red zones receive proper monitoring and ICU like care services. However, advanced emergency and critical care services require many resources which may not be possible in many resource limited facilities. This calls for the introduction of essential emergency critical care, a concept that provides the essentials of critical care in the emergency setting to ensure good monitoring and continuous critical care for lodging patients. In this article we introduce a 6 step method employed in a resource limited setting to implement essential emergency critical care services in the red zones of the emergency department.

A Brief on Exercises in Gym with Some Misconceptions
Ashraful Kabir


Ancient gymnasiums were the places for social interaction, recreation and leisure, but they were first and foremost educational institutions where the intellectual and athletic training of a military character was supposed to be accomplished. The Greek gymnasium was a popular recreational space for the members of the aristocratic class as it provided those with an opportunity to perform and enhance their outstanding persona and family [1]. Gyms are one of the most pursued leisure places in western societies and can be said to have established themselves as part of a white middle-class culture [2, 3, 4, 5, 6-8, 9]. Almost 13% of the UK population is registered as members of a private health and fitness gym or publicly-owned fitness facility, with London having the most registered users [10]. Depending on the size and target group, multi-purpose amenities encourage pre- or post-training activities, for example at their spas and beauty centers or they organize social activities at the weekend [11]. Indeed, gym membership usually starts with the diagnostic procedure of a health check where weight, height, body fat, blood pressure, body mass index, etc., are measured and compared to what has been established as a scientific norm so that goals for further training can be identified and changes noticed. Bodies can be sculpted and corrected by the right diet, exercise and cosmetic products. Advertisements suggest that individuals are personally responsible for monitoring and controlling their attractiveness and ambition [12]. Gym participants over 65 years old tend to come to the gym not only for physical training but also to form social bonds [13]. The medical condition might experience to come in a gym as a compulsory homework [14].

Mental Health Evaluation Of Students In A Private University In Malaysia During The Pandemic.
Ching Xiu Wei, Lee Wei Jun, Tan Zi Tien, Muhammad Syahmi bin Nadzri, Humas Nasir, Philip George, John Pinto


Mental health disorders in Malaysia have been on the rise, especially among youth. The data from the National Health and Morbidity Survey, 2015 conducted by the Ministry of Health Malaysia recorded an increasing trend of mental health problems among adults, of age 16 years and above in Malaysia from the year 1996 (10.7%) to 2015 (29.2%). Changes in the learning environment due to the COVID-19 pandemic cause an increased burden on their mental health. This survey evaluates 118 students from a local private university using several scales such as the- DASS-21, Satisfaction with Life Scale (SWLS), and Brief Resilience Scale (BRS) to screen for mental health wellbeing. The results showed the prevalence of moderate to extremely severe depression symptoms at 33.9%, anxiety symptoms at 30.51%, and stress at 19.49%. About 31.3% of students have poor satisfaction with life and 29.7% of students have poor resilience. There seemed to be no significant association between different ethnicity, course of study, family income, and relationship status. However, there is a significant relationship between the age group of 15-24 years compared to 25-34 years in stress scores. Younger students seemed to record more stress symptoms.

Covid-19 Vaccination: The Prevalence And Influencing Factors For Vaccine Hesitancy Among Mbbs Students From International Medical University, Malaysia
Ganesha Grant, James Koh, Mariyam Nizha, Yap Cheng, Kwek Ser, Sheetel Kaur, Anis Ahmed


Vaccines have been the most effective and safe way to protect people from harmful diseases.  With the severity of the pandemic weighing on healthcare systems around the world, the development of COVID-19 vaccines has been prioritized by pharmaceutical companies around the world. Therefore, we decided to carry out research to determine the prevalence of vaccine-acceptance and vaccine-hesitancy attitudes among medical students, to identify factors influencing attitudes towards COVID-19vaccines among medical students, and to establish correlation among various variables toward COVID-19vaccination. This comparative cross-sectional study recruited medical students from semester 1 to 10, and data was collected by using a questionnaire adopted from a similar study in the local settings. A total of 397 students responded to this study. Overall, students of both phases had similar attitudes but the only significant difference regarding the trust in vaccines approved by the Ministry of Health with more agreeability in clinical phase students. This study is one of few studies that evaluate the vaccine hesitancy of medical students in Malaysia. Further studies should be carried out to compare these findings with undergraduates at various points of their education.

Outcome Of Reduction Of Subcondylar Fracture In Retromandibular Transparotid Approach
Mohammed Ayaz Ahmed


Among all mandibular fracture, 25 to 40% fractures are regarded as Condylar and Subcondylar fracture. Commonly, reduction of subcondylar fracture is done under general anaesthesia. Different approaches are found for the surgical treatment of condylar fractures besides intraoral approaches such as the pre-auricular, submandibular, rhytidectomy, retromandibular. To find out the outcome of retromandibular transparotid approach for subcondylar fracture treatment of mandible i.e to find out correction of occlusion and establishment of jaw function, infection, hematoma, salivary fistula, facial nerve damage, hematoma etc. complications. Surgical treatment of subcondylar fractures of 15 patients were done from January 2019 to December 2021 in retromandibular transparotid approach. The patients were evaluated for hematoma, infection, Frey’s syndrome, salivary fistula, facial nerve damage, occlusion, fracture site stability, chronic pain in the fracture site and temporomandibular joint movements in the postoperative period.  Facial nerve injury was not observed. Postoperative swelling of parotid region developed in first two patients. Single patient developed paresis in zygomatic branch of facial nerve causing left upper eyelid muscle weak and after two weeks of physiotherapy it became normal. Salivary fistula developed in three patients which were resolved spontaneously. Outcome of this approach like good anatomy and function was found in all cases. Good articular function was obtained in all the cases. By this retromandibular approach condylar fracture reduction, fixation and healing were managed comfortably. However, direct vision of facial nerve fibers has limited the risk of facial nerve injury.

Thoughts on Snake Species, Their Bites As Well As Management
Ashraful Kabir, Walid Fathy


Snakes are medically recognized creature all over the world. Snakebite is a much-neglected issue, but its management is urgent to the victims. Recently, Chittagong Medical College of Bangladesh has inaugurated a research section on the venom of snakes. This composition based on various reports, articles and books has been done for the multidisciplinary people. The review report suggested flood season is vulnerable to all sorts of people, and villagers are more prone to snakebite. The villagers do not get proper medications due to a lack of knowledge of first aid, and they are used to the treatment by traditional snake charmers.

Influence Of Academic Strain, Remoteness From School, And Fear Of Infection In Medical Students’ Stress And Health During The Covid-19 Pandemic
AR Denisha Ravichandran, Shiv Eswar Adrian Anantha Raja, Syacynthia Lynn Ravindran, Seow Jiin Terng , Mila Nu Nu Htay, Sujata Khobragade, Soe Moe and Htoo Htoo Kyaw Soe


The emergence of the COVID-19 has greatly affected the world and caused many unprecedented changes in our lives. For many, it has generated a significant amount of stress, anxiety, worries about health, social isolation, unemployment as well as financial problems. Just like the rest, the pandemic has really taken a toll on students’ well-being all around the world. They have a lot on their plates, especially dealing with academic strains, remoteness from school and fear of infection during this time of crisis. Therefore, a cross-sectional study was conducted to explore how and if these three stressors have an impact on the medical students’ stress and health during the pandemic. The analysis included mean, frequency, correlation, unpaired T-test & ANOVA.  Out of 159 students, we have found that Hindu religion has a higher stress level (mean =24.4). Female gender (mean = 25.6) and those who have underlying mental health issues (mean=30.3) have a higher physical and psychological impairment. There is a positive significant association between academic strain (r= 0.245, p=0.001), remoteness from school (r=0.223, p=0.003) with perceived stress. There is also a positive significant correlation between academic strain (r=0.283, p=0.000), remoteness from school (r=0.387, p=0.000), perceived stress (r=0.583, p=0.000) with impairment of physical and psychological health. Thus, with this information we can conclude that we have found that there is a positive significant association between academic strain, remoteness from school with perceived stress, physical and psychological health.

What Are The Most Important Attributes Of A ‘Good’ Doctor Among Clinical Phase MBBS Students In Malaysia?
Andrew Jacob Solomon, Nor Rafidah Bt Ibrahim, Daniel Win, Goh Ju Huan , Sujata Khobragade, Mila Nu Nu Htay, Soe Moe, Htoo Htoo Kyaw Soe


Non-academic attributes are not taught in medical school and mostly learned from home and the upbringing of certain people. Theories and clinical learning are taught in medical schools by experienced professors. A survey and study were done in the United Kingdom with 10 specialists and asked the doctors to rank the most important attributes needed in a good doctor. A cross sectional study was conducted on medical students in a private medical university in Malaysia in April 2021 to study the relationship between demographic profile and the most important factor attributes of a ‘good’ doctor among clinical phase MBBS students. Purposive non-probability sampling method was used, and data was collected through a questionnaire via Google form. Epi info v7.2.4 was used to analyse the data and mean, standard deviation and range was calculated. Based on our results, certain demographic details such as gender, academic performance, race, academic performance, parent monthly income, parent highest education, family members work in medical field had significant association with certain attributes. In conclusion, we were able to understand that certain demographic details had an impact on how medical students in the clinical phase ranks the most important attributes needed in a good doctor.

Unusual Spontaneous Passing Of Large Renal Calculi
Jesper Leonard Vun Kien Fung , Kartik Saxena


Urolithiasis is among the most common urological diseases encountered in this modern time. This report recounts a case of a 65-year-old Chinese Malaysian gentleman, presenting with left sided flank pain and symptoms suggestive of benign prostatic hyperplasia and recurrent urinary tract infection for 2 years. His pain worsened over the last 2 weeks with a newly developed bladder outlet obstruction. On the 14th day, he passed a stone measuring 10mm x 6mm. Three days later, he passed a second stone measuring 14mm x 9mm x 5mm, followed by haematuria and transient urinary incontinence. Most surgical literature and guidelines draw the cut-off point for spontaneous passing of calculi at 5mm in diameter. This unusual case of spontaneous passage of large urinary calculi serves as another excellent reminder that there are no absolutes in medicine.

A Synopsis on the Kinds and Functions of Human Hormones
Ashraful Kabir


Based on the classification of human hormones, there is no solid idea in most books. In this view, this article could exemplify a concrete solution, especially for medical and university students. Hormones have many life-saving roles in the human body. With the deficiency of hormones, our body might fall into lots of severe problems. Data analyses of much information from books, articles, as well as online supplements provided different ideas on the total hormones. The result suggested that some hormones were secreted from the same glands. Out of 110 hormones (when the same hormone produced from different sources), different types of hormones were 88. Analyzed hormones consisted of four major groups- amine (4 hormones), eicosanoid (4), steroid (15), and peptide (65) out of 88 endocrine chemicals. The endocrine and reproductive system (56) jointly secreted most of the hormones, and secondly gastrointestinal tract (26 hormones). Besides the organ system or glands, some were secreted from the cell, tissue, tissue system, and placenta. This paper also mentioned that many sex hormones were found both in males and females. In future, it is needed to enhance more research on the classification of the hormones in human body.

Application of Gagne’s Theory of Instructional Design in Training Statistics to Medical Students
Mila Nu Nu Htay, Htay Lwin, Htoo Htoo Kyaw Soe, Soe Moe, Adinegara Lutfi Abas


Research methodology and statistical training are relevant to both undergraduate and postgraduate healthcare students. Medical educators play a crucial role to provide well-planned, effective training on statistics, which should be student-centered to equip the skill in data analysis and interpretation. In order to deliver effective teaching or training, educators use the instructional design models and integrate them into the curriculum. In this article, Gagne’s theory of nine-step instructional model design is applied to the biostatistics training of undergraduate medical students. It will provide a sample framework for future statistical training programmes.

Emergency Medicine Department Continuous Medical Education (CME) 6-step Transformation
Gurjeet Singh a/l Harvendhar Singh, Nur Hayat binti Khairul Shamsudin, Kogilanivashini Sevarash, Syed Jamal Fikri bin syed yusoff fadzil


Continuous medical education (CME) is an effort by a medical department to implement teachings of a particular specialty to improve the knowledge of the staffs within a department that will translate to better clinical practice. Traditional CME modules have always involved gathering of medical officers with a preset of topics that are rotate at a regular basis with or without supervision by a specialist sees many rooms for improvements. A more flexible CME module with emphasis placed on newer topics, without constant rotations, supervision from even before the beginning of the CME and inter departmental or hospital involvement can be fostered to ensure a continuous and longer lasting seasonal CME module. In this article we introduce a 6 step transformation that was done to improve the CME module.

Cross-sectional Study of Perception on Mobile Phone Health Hazard and Behavioral Risk among Undergraduate Medical Students
Ting Pei Erl, Lok Ren Hao, Vinod Iswaran a/l Vivekananda M, Tashmeetadev Kaur Thind a/p Sukhdeve Singh, Mila Nu Nu Htay, Sujata Khobragade, Soe Moe, Htoo Htoo Kyaw Soe


There is major concern about the hazards that electromagnetic waves emitted by mobile phones may pose to human health. We aimed to assess the perception of undergraduate medical students regarding mobile phone health hazards and behavioral risk, side effects that mobile phone hazards cause, behaviors affected due to mobile phone hazards, and whether mobile phone hazards may affect classroom habits. A cross-sectional study was conducted among pre-clinical and clinical year MBBS students in a private medical university in Malaysia. An online questionnaire was distributed and a total of 120 responses were collected. Epi info V7.0 was used to analyze the data. Findings revealed our participants perceived mobile phone usage could contribute to occurrence of fatigue, sleep disturbances, headache, and loss of mental attention. As for behavior risk associated with mobile phone usage, our participants thought that there were high behavioral risks such as to sleep all night with a turned-on mobile phone resting on the bedside and to stop a conversation to answer the mobile phone. With regards to side effects, the result reveals sleep disturbances as the side effects after mobile phone usage, concentration problems and blurred vision are experienced by the most. The results of how mobile phone hazards affect classroom habits shows that participants use mobile phone internet less than 7 hours a day, receive or send text messages during class but do not play games nor make or receive calls in class. In summary, the perceived mobile phone hazards among MBBS students were 62%. This study reveals the presence of a higher percentage of perceived mobile phone hazards among undergraduate medical students.

Pulmonary Complications and Peri-Operative Outcomes of Open Renal Surgery in HSAJB During COVID-19 Pandemic
Jin Rong Tan, Shamsuddin Bin Omar


Perioperative Covid-19 infection is associated with high risk of pulmonary complications and death. This study aimed to describe the pulmonary complications and peri-operative outcomes of open renal surgery done and to identify the possible associated factors for development of postoperative pulmonary complications. This is a clinical audit of all non COVID-19 patients underwent open renal surgery in Hospital Sultanah Aminah, Johor Bahru from January 2020 to January 2022. Socio-demographic data and factors associated with development of pulmonary complication were collected. Intraoperative outcome and post-operative pulmonary complications and outcomes were described. Bivariate analysis was performed to determine the association of the factors with the development of pulmonary complications. A total of 30 patients were included. 22 open radical nephrectomies, 7 open radical nephro-ureterectomies with bladder cuff excision and 1 open pyeloplasty were done. The mean operation time was 200±58.5 min (100-335 min) and blood loss was 1578±1930ml (200-8000 ml). The pulmonary complication rate was 10%. The mean hospital stay was 13±8.8days (6-45days). Thirty days mortality rate was 3.3%. ASA grades were found to be significant association with the development of pulmonary complications. Open renal surgery is safe to be done in Covid-19 treating hospital during COVID-19 pandemic.