MASH Journal Volume 8 Issue I

March 2023
Tuberculoma In A Healthcare Worker
Teo Kye Vonn, Nur Adlina, Ng Tyng Sam

Tuberculosis (TB) is an endemic and a public health concern around the world. It commonly affects the lungs, however it can affect other organs, which known as extrapulmonary tuberculosis. Extrapulmonary TB occurs in around 10-15% of all TB cases. Central nervous system (CNS) TB is one of the severe types of extrapulmonary TB, accounts for around 1% of TB cases. It resulted from Mycobacterium tuberculosis (MTB) spread via hematogenous to intracranial. Tuberculoma is around 0.2% of all biopsies brain masses.

Keningau Weave Technique: A modification Of The Japanese “Himawari” Method For Comminuted Patella Fixation
Eyrique G, Jeremy SV, Vickneshan S, Amir R, Looi C

Severely comminuted patella fractures deemed unsalvageable have traditionally been treated with patellectomies. This procedure significantly reduces the mechanical advantage the patella provides to the quadriceps for knee extension resulting in significant morbidity. The ‘Himawari Method’ developed in Japan has significantly reduced the need to resort to patellectomies. However, this procedure requires the use of expensive locking sleeves to be successful. The modified technique illustrated here excluded the need for the locking sleeves by weaving cerclage wires around multiple longitudinal k-wires creating an anterior cage over the patella. With the addition of a tension relieving wire, the efficacy of the modified procedure as the patient achieved fracture union with full range of motion at 12 weeks can be demonstrated. Outcome evaluated utilizing the patellar-femoral instability scorings, Favourable Kujala patellar instability scores & Oxford knee score were noted a year post-intervention.

A Brief Review of the Evolutionary Thought and Etiology of the Stomach Disorders with Prevention
Ashraful Kabir

The stomach of animals plays a significant role throughout life. After taking food, the nutrients of those foods maintain all biological processes. The stomach is a reservoir for storing food for several hours. If digestion within the stomach hampers, the entire body will undergo many ailments. Evolutionary changes in the stomach of various animals (herbivores, carnivores, and omnivores) to understand the quality or nature of the stomach based on their food. Based on some articles, oral communication, and an effective questionnaire proved that in a northern region of Bangladesh (Saidpur town under Nilphamari District), out of 60 families, 85% of family members were affected by acidity problems where 37% of college students (17-19 years) due to their excess taking of oily and spicy foods. On the other hand, their regular food intake showed 80% acidic, 7.5% neutral, and 12.5% alkaline food.

A Review of the Genetic Link Between Overweight and Extreme Obesity
Ashraful Kabir

In the present context of the world, obesity is increasing and creating life-threatening diseases in the human body. Everybody whether they are children or adults needs to be more conscious of this issue. Obesity comes from being overweight is nothing but the imbalance of energy within the body. Lots of published articles on the internet prove that obesity either genetic or acquired possible to overcome through diet and exercise according to the guidelines of such experts. Since morbid obesity (obese III) is rare in the world and in few cases, they need to attach surgery. When we take improper food in our usual daily foods, our bodily metabolic functions could be hampered, and finally first overweight then obesity persists. Nutrients of healthy food and physical activities those will burn extra calories are a must for maintaining a healthy life.

Does Peer Pressure and Time Management Play a Role in Academic Stress Among Medical Students?
Lee Yun Shuang, Muhammad Azhar bin Suffian, Kenley Ong Khang Yee, Yogarooban a/l Sreethar, Khine Lynn Phyu, Mila Nu Nu Htay, Soe Moe, Htoo Htoo Kyaw Soe

Academic stress refers to the physical and mental responses of students to academic challenges that are beyond their ability to cope. It can result in significant stress levels and anxiety, especially during exams and other assessments. A study was conducted on undergraduate medical students at Manipal University College Malaysia to investigate the relationship between peer pressure, time management, and academic stress. A total of 130 responses were collected via questionnaires distributed through social media and the data was analysed using Epi Info software. The results showed medical students experienced slightly higher levels of academic stress due to factors such as study pressure, workload, worrying about grades, and self-expectation. However, they experienced slightly lower levels of academic stress due to despondency. Our study also revealed a significant association between peer pressure and academic stress caused by despondency but no significant difference between time management and academic stress. Among the demographic variables, family income is found to be significantly associated with academic stress due to self-expectation and worrying about grades. In conclusion, medical students experienced moderate level of academic stress across all sources of stress. Academic stress among medical students can be caused by factors such as peer pressure and poor time management skills. Effective time managementabilities can aid students in managing their academic responsibilities and decreasing academic stress.

Correlation Between Health Beliefs And Lifestyle Among Medical Students In Malaysia: A Cross-Sectional Study
Bhargavi a/p Visualingam, Chong Guang Wen, Tharani R Mohan, Abhiraami Sathasivam, Hansika Gamage, Htoo Htoo Kyaw Soe, Soe Moe, Khatijah Taharah Mohamed Shah, Mila Nu Nu Htay

In student population, physical activity, dietary pattern, stress, screen time are intertwined to achieve a healthy lifestyle. Therefore, this study aimed to investigate the health beliefs, lifestyle, and dietary habits among the medical student population. This cross-sectional study was conducted by recruiting medical students from a private medical university with purposive sampling. Demographic characteristics, health belief model and lifestyle information were collected by using Google form. Data was analyzed by descriptive statistics, unpaired t-test, one-way ANOVA by using Epi info software (Version 7). A total of 160 students responded to this study.  Age of the respondents was significantly associated with nutritional confidence (P=0.033) and barrier (P=0.032) domains of health belief. While gender was significantly associated with barriers (P=0.041) and behavioral intention to do physical activity (P=0.018). Academic year was found to be associated with susceptibility domain (P=0.013) of health belief. Gender was significantly associated with the physical health and exercise (P<0.001) and psychological health (P=0.012) domains. Age was significantly associated with accident prevention domain (P=0.013). While BMI was significantly associated with physical health and exercises (P=0.001). Academic year was significantly associated with social concern (P=0.028) and sense of purpose (P=0.009) domains. Health beliefs among respondents were correlated with the nutritional and physical activity in their daily lifestyle. Especially having nutritional confidence, knowing the benefits of a healthy diet, behavioral intention to eat healthy food and to do physical activity were significantly correlated with the respondent’s nutrition intake and physical activities. Educational interventions and activities such as talks, trainings related to adopting healthy and active lifestyles could help the medical students in attaining a better lifestyle habit.


Trauma is one of the leading cause of death in the world among young and middle aged people1. Currently in the damage control resuscitation suite of emergency department Selayang Hospital, a CT Selayang Trauma Alert Diagnostic (STAD) protocol was introduced as the gold standard Whole Body CT scan diagnostic work-up to identify hidden injuries, grade injuries and recognize the source of bleed being arterial or venous in origin in major trauma patients. Early and accurate detection of organ injuries, grading the injuries and recognizing its origin in patients presenting with poly trauma to the Emergency Department can change the direction of care from operative to conservative3.

Encounter With An Obstructed Duodeno-Jejunal Flexure Tumour In An Emergency Setting, A Surgeons Dilemma: A Case Report
Chiew Junloong, Sekkapan Thannimalai Sambanthan, Nik Ritza Kosai & Soma Bala Ganapathy

The anatomy of the duodenum is complex, and tumours arising from it are rare even among small bowel tumours, with DJ flexure tumours being very uncommon in the entire gastrointestinal system. They usually present with vague symptoms and is of a unique challenge to surgeons for resection. We present a case report of a 41-year-old gentleman with an obstructed DJ flexure tumour encountered in an emergency setting and its challenges to the operative surgeon.

What Are The Attributes Among Malaysian Medical Students Towards Migrating Abroad? A Cross-Sectional Study
Fathima Nashfa, Ruhashini Chanla, Saranya Saghadevan, Udila Helitha Attygalle, Mila Nu Nu Htay, Soe Moe, Htoo Htoo Kyaw Soe

Brain drain of healthcare professionals is a global pandemic that equally affects Malaysia. Due to multiple ‘push factors’ in Malaysia and multiple ‘pull factors’ in the source country Malaysia is losing qualified doctors at an increasing rate. The study aims to determine the intention and attributes of Malaysian medical students towards migrating abroad. A cross sectional analytical study was carried out from August 2021 to October 2021 involving the medical students of Manipal University College Malaysia (MUCM), Malaysia. Purposeful sampling was applied in the selection of eligible participants. The total number of participants recruited was 168, majority form the clinical batches. Among the participants, 45.24% had a positive intention to migrate abroad, 19.64% did not want to migrate, while 35.41% were undecided. The significant ‘pull factors’ for migration were better quality of health care system and better quality of postgraduate education abroad. The significant ‘push factors’ were peer and family pressure and an unsatisfactory political system at home country. Females were significantly more interested in migrating abroad than males. As brain drain can bring about a negative impact on home country in all spheres, it is vital that the country takes active efforts to minimize the contributory causes and provide incentives that ensure satisfactory work environment for the medical doctors.

EUS-guided Gastrojejunostomy - A Novel Approach
Nicholas Heng Ee Zhing, Tan Sze Hao, Andre Ng Wen Hao and Glenn George Koleth

Endoscopic ultrasound-guided (EUS) gastrointestinal procedures have now been a novel approach to manage complications arising from gastrointestinal malignancy owing to its lower morbidity and mortality rate compared to surgical approach. We present a case of EUS-guided gastrojejunostomy for a patient with advanced pancreatic carcinoma with duodenal obstruction with distant metastasis.

MASH Journal Volume 8 Issue 2

September 2023
Effectiveness of Video-Based Learning on Students’ Memory: A Randomized Controlled Trial
Hathush Nehan Robert, Yaashiyni a/p Vejanthern, Samindi Navanchana Fernando, Kishanthini a/p Viswanaathan, Erick Tan Yan Jin, Soe Moe , Mila Nu Nu Htay, Htoo Htoo Kyaw Soe

In 1993 Rauscher et al. discovered that after listening to Mozart’s sonata for a short period of time, participants showed significantly better spatial reasoning skills. Since then, the Mozart effect has become widely used especially among students. The purpose of this study was to determine the impact of Mozart effect on short term emotional intelligence among undergraduate medical students. This study was a pilot randomized controlled trial conducted among batch 45 undergraduate medical students in a private medical university in Malaysia. Participants were divided into control (n=20) and intervention (n=20) group by block stratified randomization. A piece from Mozart Sonata for two Pianos in D, K.448 was played for 15 minutes and was given a content validated, self-developed questionnaire for the intervention group whereas only the self-developed questionnaire was given to the control group (no preceding music was played). The data analyzed by using unpaired t-test, mean, standard deviation and mean difference was calculated. The level of significance was set at P<0.05. Our research was divided to four main domains under emotional intelligence. First domain; emotionality was assessed using four questions and a mean (SD) of 13.90 (4.13) for intervention group and 11.35 (2.76) for control group was obtained (p= 0.027). The second domain; self- control was assessed by two questions and a mean (SD) of 8.00 (1.81) for the intervention group and 6.55 (1.79) for the control group (p= 0.016). The third domain; sociability was assessed by four questions and a mean (SD) of 14.80 (3.93) for the intervention group and 13.05 (2.99) for the control group (p= 0.121). The fourth domain; wellbeing was assessed by five questions and a mean (SD) of 19,9 (4.35) for the intervention group and 17.6 (3.68) for the control group (p= 0.079). The result of our study is in alignment with prior research that had been done in South Africa whereby the outlook, emotionality, and self -discipline of high school students were improved due to music involvement.

The Mozart Effect On The Short-Term Emotional Intelligence Status Among Medical Students In Manipal University College Malaysia: A Pilot Randomized Controlled Trial
Sindhiya Devi Anbananthan, Rheanogha Subramaniam, Shantinni Devi Subramaniam, Magalle Hewa Jayasundara Samadhi Divyangana, Kaleswar Mogan, Htoo Htoo Kyaw Soe , Soe Moe, Htay Lwin, Mila Nu Nu Htay

Along with the technological development, the use of video-based learning has increased rapidly in the higher education sector. This study aimed to assess the effectiveness of video-based learning on medical students’ memory while comparing with the effectiveness of text-based learning. A randomized controlled trial was performed in a private medical university in Malaysia by recruiting 40 medical students. The sample was randomized as block randomization. The intervention group was shown a video on DNA Fingerprinting and were given a questionnaire to assess the memory, concentration, satisfaction, and performance. The control group was given a text on the same topic which was followed by a questionnaire to assess the memory, concentration, satisfaction, and performance. All statistical tests were seen at two-tailed level of level of significance (p<0.05). The mean score percentage of the video-based learning was 74.5 whereas the text-based learning had a mean score percentage of 78.0. The text-based group scored more than the video-based group (mean score difference = 3.5±16.45, 95% CI = -7.93, 14.93, p= 0.538). The concentration was measured using a Likert scale and both the intervention and control group gave a score of 4. The study showed that the participants preferred video-based learning for future use. In conclusion, the video-based intervention learning was more preferred method than text-based learning although the mean score percentage was lower in the intervention group.

Case Report Of Secondary Nasopharyngeal Tuberculosis
Lyon Ian Bing Huong, Strahan Zhi Hui Teoh

Nasopharyngeal tuberculosis is a rare entity among the extrapulmonary manifestation of tuberculosis infection. It can be challenging to diagnose as it can mimics malignancy it when endoscopic examination shows left fossa of Rosenmuller mass. It presents as nasopharyngeal mass mimicking nasopharyngeal carcinoma.

Here we report a case of secondary nasopharyngeal tuberculosis with laryngeal, trachea-bronchial tree, pulmonary and cervical nodal involvement is reported.

Prompt diagnosis can bewas achieved with combination of endoscopic, bacteriological and imaging investigations.

Good treatment outcome wasis achieved with following 9 months of anti-tubercular medications.

Effect of Blackcurrant Juice on Perceived Stress and Mood among Medical Students - A Randomized Controlled Trial
Chean Ker Xin, Deveshwar a/l Raja Mohan, Dharishini a/p Parameswaren, Lithma Thamadhi De Silva, Mila Nu Nu Htay , Soe Moe, Htoo Htoo Kyaw Soe, Kazi Majidur Rahaman,

The high polyphenol content in blackcurrants is the most important component which makes it favorable for better mood enhancement and reduce perceived stress among medical students. There are a few randomized trials indicating that blackcurrant juice has a positive effect on mood. However, there are limited evidence showing that blackcurrant juice plays a role in reducing perceived stress. This pilot study utilized a randomized, single blind and placebo-controlled design to find out the effect of blackcurrant juice on mood and perceived stress. A total of 65 medical students were randomized into the intervention group (n=32) where they received blackcurrant juice for three consecutive days and into the control group (n=33) where they received placebo for three consecutive days as well. Evaluation of mood and perceived stress was done after three days by using Bond-Lader visual Analogue Scale, Positive and Negative Affect Schedule (PANAS), and Perceived Stress Scale (PSS). Results show the blackcurrant group had a higher score in terms of calmness in subjective mood, as measured by the Bond-Lader Visual Analogue Scale at post-intervention [mean difference 8.60; 95% CI 0.25 to 16.95; P=0.044]. However, there was no significant difference between the groups with regards to positive and negative affect of mood, alertness and contentment of subjective mood, and perceived stress, as measured by the PANAS and perceived stress scale at post-intervention. When comparing the baseline and post-intervention, participants in the group receiving blackcurrant juice showed significant difference in mood based on the Bond-Lader Visual Analogue Scale and perceived stress. Around 15.6% of blackcurrant juice group had the side effects such as gas/bleaching. In a nutshell, blackcurrant juice poses a good effect on the overall mood and perceived stress.

Sustainability Of Otorhinolaryngology Knowledge Among Undergraduate Medical Students In Malaysia.
Rafiq Vasiwala, Lee Wei Lek, Sherreen Elhariri

Adequate knowledge of otolaryngology (Ear, Nose & Throat, ENT) for undergraduate medical students and primary care providers (PCP) is vital for diagnosis and management as well as proper referral to the specialist for further management, as ENT problems are a major workload in primary care practice. In undergraduate medical study, it is vital to acquire ENT knowledge in the fourth-year and sustain it in the final-year and after graduation, to deliver efficient, realistic healthcare services to the population. This study was carried out to find out the sustainability of ENT knowledge in final-year International Medical University (IMU), Malaysia medical students with ENT posting in the fourth-year. We also aimed to assess the adequacy of undergraduate ENT posting for the duration of two weeks. A cross-sectional study was carried out among 156 medical students from a population of 560 IMU undergraduate students. Structured knowledge-based otolaryngology (ENT) 20 multiple-choice question (MCQ) questionnaires were developed based on curriculum and validated by a panel of family medicine specialists and ENT specialists. Assessment and grading were decided by a panel of specialists using the Nedelsky method. We concluded that there was a statistical significance between the ENT knowledge of students before and after their ENT posting [t (114): -7.463, p: 0.000]. However, there was no statistically significant difference in the ENT knowledge of students who had recent ENT training and final-year students who completed their ENT training more than 6 months before.gas/bleaching. In a nutshell, blackcurrant juice poses a good effect on the overall mood and perceived stress.

Minimally Invasive Total Esophagectomy For Giant Epiphrenic Diverticulum With Megaesophagus
Chiew Junloong, Sekkapan Thannimalai, Hans Alexander Mahendran, Ahmad Tarmizi Mohammad & and Nik Ritza Kosai

Background: Esophageal diverticulum is a rare condition, and its pathophysiology varies according to its anatomical location in the esophagus (i.e., Zenker’s, Rokitansky, and Epiphrenic). Among the three, epiphrenic diverticulum is the rarest and is also known as pulsion diverticulum. It is caused by the herniation of mucosa and submucosa through the esophageal muscular layers as a result of increased intraluminal pressure, involving the distal third of the esophagus within 10cm of the esophagogastric junction.


A case of a 62-year-old lady with an obstructive esophageal diverticulum secondary to achalasia and megaesophagus that underwent minimally invasive total esophagectomy due to a dysfunctional esophagus.


Case Presentation: A 62-year-old lady presented with a history of progressively worsening solid food dysphagia associated with a significant loss of weight. On examination, the patient was malnourished ( SGA B ). No remarkable findings were noted on abdominal, systemic, or laboratory investigations. Following a series of imaging examinations with manometry showing raised lower esophageal sphincter pressure and absence of peristalsis, the patient was diagnosed with a giant epiphrenic diverticulum with megaesophagus. After a length of nutritional built-up, the patient underwent minimally invasive total esophagectomy and gastric pull-up. Post-operatively, the patient was cared for in the intensive care unit and was discharged well on day 10 of post-operation. The patient was reviewed back again two weeks upon discharge and was noted to be well.


Discussion and Conclusions: Patients with epiphrenic diverticulum are mostly asymptomatic, and surgical interventions are reserved for progressively worsening symptomatic patients. It is mainly diagnosed by gastroscopy, contrasted studies, and manometry. Traditionally, diverticulectomy with myotomy is the treatment of choice for isolated esophageal diverticulum. Esophagectomy is an alternative approach and is the preferred surgical in this case when diverticulectomy with myotomy is not suitable. The surgical approach includes open or minimally invasive, with minimally invasive preferred. We proceeded with oesophagectomy since she was diagnosed with a giant epiphrenic diverticulum secondary to achalasia and megaesophagus

The Level of Comprehension of Medical Information Presented in Flowchart versus Standardised Text: A Randomised Controlled Trial
Shaamila Ramesh, Akila Vinudha Goonesinghe, Amelia Azalea binti Muhammad Ihsan, Daniel Yap Choon Liang, Soe Moe, Thin Mon Kyaw, Mila Nu Nu Htay

Emergency medical guidelines allow rapid assessment and decision-making during emergency medical scenarios. Therefore, the presentation of medical management protocols should be concise, illustrative, and user-friendly using flowcharts. This study aimed to determine the level of comprehension of medical information and the time taken to make accurate decisions during medical emergency scenarios when presented in a flowchart compared to standardised text format among undergraduate medical students. A randomised controlled trial was conducted among medical students at a private medical university in Malaysia. A total of 60 students were recruited by purposive sampling and randomised equally into control and intervention groups. Flowchart and standardised text versions of “Immediate Management of Diabetic Ketoacidosis (DKA)” were given, followed by a validated case-based scenario questionnaire. The data was analysed using Epi Info Software version and SPSS software. The statistical tests used were Chi-square test, independent sample T-test and Fischer exact test. Based on the grading system, the level of comprehension was statistically significant (p = 0.043) among the groups. There was no significant difference in the time taken for correct answers among the two groups (p = 0.145). Based on the feedback form, medical students chose the flowchart as their preferred mode of medical information presentation (strongly agree) as it is a fast decision (p = 0.002) and agreement on understandability (p = 0.006 for agree, p = 0.001 for strongly agree). Using flowchart to analyse medical information enhanced the level of comprehension of students. The level of comprehension of medical information was significantly higher when using flowcharts compared to standardised text. Therefore, we recommend using flowcharts for future medical instruction, guidelines, and publications.

Influence of Physical Activity Intensity on Daily Energy Level Among General Adult Population in Malaysia
Sophia Lim Ka Man, Sangetha A/P Vesuvanathan, Nathan Bay Zhen Yi, Phoebe Giovanna Kunan, Soe Moe, Htay Lwin, Mila Nu Nu Htay

Improving the quality of life, encompassing physical and mental well-being is always the ultimate goal throughout all stages of life. However, the association between physical activity intensity and daily energy level remains relatively unexplored. This study investigated the factors associated with physical activity intensity and daily energy level. This cross-sectional study was conducted by recruiting the general adult population in Malaysia. The online questionnaire, including demographics, Global Physical Activity Questionnaire (GPAQ), World Health Organization Quality of Life (WHOQOL-BREF), and opinion-based questions were used for the data collection. The data was analyzed using Epi Info software version 7.2.5. A total of 205 respondents were included in our study. It was suggested that a higher proportion of the male population (80%) meets the WHO Recommended Physical Activity compared to females (62.2%). Notably, individuals taking medication or nutritional supplements demonstrated a significantly higher adherence percentage to the recommended physical activity (74.1%) than those not taking (61.3%). Underlying medical conditions emerged as a major influencing factor on physical health with a mean difference of 5.89, while caffeine intake had a significant impact on psychological health accounting for a mean difference of 4.48. Time constraint was identified as the primary barrier, constituting 26.34% of the total, whereas motivation, encouragement, and awareness were recognized as the main enabler facilitating regular physical activity, accounting for 43.9%. Overall, the majority of the respondents have positive thoughts and experiences on physical activity which allows them to improve or maintain physical health (22.93%), increase energy level (20.98%) and achieve satisfaction in daily life (20%). This study provides valuable insights into factors that influence adherence to recommended physical activity guidelines among the adult population in Malaysia. Further research and target interventions could be developed to improve this population's well-being and quality of life.

Trevor - Fairbanks Disease: Dysplasia Epiphysealis Hemimelica of the Knee – A Case Report and Review
Wee Liam H., Eyrique G., Suryasmi D.

Dysplasia Epiphysealis Hemimelica (DEH) is a rare skeletal developmental disorder involving epiphyses of long bones. It primarily emerges during childhood and is characterised by an osteocartilaginous overgrowth involving epiphyses of long bones. Although the exact aetiology of DEH remains elusive, it can be treated conservatively or surgically via excision or corrective osteotomies, depending on the patient's clinical presentation. Radiological imaging must be carried out before surgery to prevent expected intraoperative complications if the patient is planned for surgical intervention. We are reporting a case of an 8-year-old child who presented with left knee pain with imaging demonstrating a DEH. The patient then underwent surgery. The patient had a rapid recovery following several rehabilitation sessions, and no recurrence was reported at the follow-up. The surgical outcome of DEH is unpredictable and largely dependent on several factors. Surgical options should be offered only to those with impacted symptoms.

A Brief Review on the Reproductive Hormones which Cover Many Major Events in Human Body
Ashraful Kabir

Based on the classification of hormones, the enough ideas are scanty in most books. In this view, this article could exemplify a concrete solution, especially for Medical Science and Biology students. Hormones have many life-saving roles in the human body. With the deficiency of hormones, our body might fall huge problems. Information from books, articles, online supplements gave ideas on total hormones. The result suggested that endocrine and reproductive system jointly secreted 71 hormones (types were 56 in number). The highest number of hormones secreted from the ovary (10), then the kidney and testis (9). Out of 56 different hormones, the peptide hormones were 41(73.21%), steroid 27(48.21%), and amine 3(5.36%).

Overview of Vaccines and Their Characteristics
Ashraful Kabir

To boost up our active immunity there is no shortcut without vaccine. At the present context, vaccines are administering a lot like coronavirus vaccine. From the very beginning vaccines were used for preventing many diseases. With our correct food and exercise additionally, we need to take many vaccines especially for children. After reviewing some articles on vaccine this is clear that vaccines are very effective in our body.

A Rapid Review On Violence Of Man And Animals In History
Ashraful Kabir

To eradicate the violence from a nation, this type of article could help. After reviewing information, we could say that violence was common in our ancestry, but this is possible to overcome through understanding the human and animal behaviour.

Persistent Chyle Leak Post Nipple Sparing Mastectomy With Axillary Clearance: An Experience With Conservative Treatment
Ashvirni Gilbeth, Lavannya Rangas Paran, Yee Ling Tan, Anita Baghawi

Chylous fistula, a complication related to thoracic duct injury or its branches, may develop following neck or thoracic abdominal surgery. However, chyle leak after mastectomy with axillary clearance is an unusual phenomenon. Seroma formation and chronic lymphoedema of the upper limb are far more common. The reported incidence of chylous fistula after breast cancer surgery is less than 0.5%. It may delay wound healing, extend hospitalization, impair the immune system, and affect the initiation of adjuvant therapy. Therefore, I present a case of chyle leakage following a left -side nipple sparing mastectomy with axillary dissection in a patient with invasive carcinoma. Although rare, it is important that all breast surgeons should be aware that a chylous fistula can develop after axillary dissection and its available treatment options.

Chylous Ascites In Colorectal Surgery And Its Risk Factor: A Rare Situation
Ashvirni Gilbeth, Yee Ling Tan, Anita Baghawi

Chylous leakage is an unusual event after abdominal surgery and even more during colorectal procedures. Chylous leakage is a type of postoperative lymphatic leakage that occurs when chyle fluid drains from the drainage tube without evidence of lymphocele, lymphorrhea or chylous ascites. In this case, I present a 47-year-old male with an extended right hemicolectomy done for palliative measures. Based on literature search, this is the first reported case of its kind with rewarding conservative management.

Therapeutic Lymphangiography Following Infective Chyloma: An Unconventional Approach
Ashvirni Gilbeth, Lavannya Rangas Paran, Yee Ling Tan, Sadhana Mahamad, Anita Baghawi

Chyle leak post neck dissection is a rare but serious complication that poses a challenge to the surgeon. Its incidence ranges between 1-5% in neck dissections and more commonly occurs with dissection of the left side in the proximity of the thoracic duct. This is a first reported case of infected chyloma, following a Left Modified Radical Neck Dissection (MRND) with Central Lymph Node Dissection (CLND) which failed to be controlled with surgical exploration but was successfully treated with lymph angioembolization using ethiodised oil (Lipiodol).

Venomous Terrestrial Snakes In The Tropics Of Malaysia: A Review On Management, Envenomation And Surgical Interventions
Eyrique G.

Snake bites accounts for a less common yet significant morbidity and mortality among farmers, plantation workers and those outdoor labour workers, especially in those countries with heavy greeneries and forestry – Malaysia is one example (1). Statistically about 5 million people per year are bitten by snakes and approximately 0.02% - approximately 100,000 develops complication or sequelae from the bites (1). Bites from these venomous snakes can cause local and systemic envenomation that can lead to a life-threatening medical crisis (2). These snakes are prevalent in many tropical and subtropical countries. Malaysian data and literature on the snakebites and epidemiology is scarce. Snake bite incidences are not notifiable diseases in Malaysia however a quantitative data is available in the Malaysian Health Informative Centre (2).