Kuantan, Malaysia
Kuantan, Malaysia

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Tee H.-P.,Hospital Tengku Ampuan Afzan | James M.W.,Wolfson Digestive Disease Biomedical Research Unit | Kaffes A.J.,Royal Prince Alfred Hospital
World Journal of Gastroenterology | Year: 2010

Postoperative biliary strictures are the most common cause of benign biliary stricture in Western countries, secondary to either operative injury or bile duct anastomotic stricture following orthotopic liver transplantation (OLT). Surgery or endoscopic interventions are the mainstay of treatment for benign biliary strictures. We aim to report the outcome of 2 patients with refractory anastomotic biliary stricture post-OLT, who had successful temporary placement of a prototype removable covered self-expandable metal stent (RCSEMS). These 2 patients (both men, aged 44 and 53 years) were given temporary placement of a prototype RCSEMS (8.5 Fr gauge delivery system, 8 mm × 40 mm stent dimensions) in the common bile duct across the biliary stricture. There was no morbidity associated with stent placement and removal in these 2 cases. Clinical parameters improved after the RCSEMS placement. Longterm biliary patency was achieved in both the patients. No further biliary intervention was required within 14 and 18 mo follow-up after stent removal. © 2010 Baishideng.


Islah M.B.A.R.,International Islamic University Malaysia | Jiffre D.,Hospital Tengku Ampuan Afzan
Medical Journal of Malaysia | Year: 2010

The occurrence of congenital diaphragmatic hernia in a pregnant adult is rare. In contrast to neonatal diaphragmatic hernias, most of the adult patients present with vague gastrointestinal symptoms mimicking other diseases hence the importance of high index of suspicion. We report a case of a young pregnant lady with congenital diaphragmatic hernia presenting with symptoms and clinical signs suggestive of acute pancreatitis. The patient had a laparotomy performed to reduce the hernial content and the diaphragmatic defect was successfully repaired.


Musa R.,International Islamic University Malaysia | Abu Bakar A.Z.,Hospital Tengku Ampuan Afzan | Ali Khan U.,International Islamic University Malaysia
Asia-Pacific Journal of Public Health | Year: 2012

Background. The commencement of methadone maintenance therapy (MMT) in 2005 represents a quantum leap in the management of heroin dependence in Malaysia. Objective. To examine the 2-year outcomes of this modality in the treatment of heroin dependence with respect to the quality of life (QOL), heroin abstinence, and rate of employment among heroin dependants attending the Tengku Ampuan Afzan Hospital (HTAA) MMT clinic. Method. This was an experimental study in which the second QOL assessment was conducted 2 years after treatment initiation. Results. A total of 172 patients enrolled at the point of entry to the MMT program. The authors examined 107 patients who remained in the program 2 years later (62.6% retention rate). A paired t test demonstrated sigsnificant improvements in all 4 domains of QOL (physical, psychological, social relationships, and environment; P <.001). The most marked improvement was noted in the psychological domain. Conclusion. The MMT program at HTAA is effective in improving the QOL among heroin dependants. © 2012 APJPH.


Ngow H.A.,International Islamic University Malaysia | Wan Khairina W.M.N.,Hospital Tengku Ampuan Afzan
Pathology and Oncology Research | Year: 2011

A 15 year-old adolescent was referred with 2 month history of worsening of breathlessness and haemoptysis. He also reported constitutional symptoms of fever, poor appetite and weight loss. The chest roentgenogram showed a massive right pleural effusion with apparent cardiomegaly. The cardiac silhouette over the right heart border was obliterated and the mediastinum was widened. Computed tomogram of the thorax showed a bulky heterogeneous mass in the right lung with extension to the heart. Subsequent CT guided lung biopsy revealed Primitive Neuroectodermal tumour (PNET). Here, we illustrate the clinical course of an aggressive pulmonary PNET with lethal cardiac metastasis. © 2011 Arányi Lajos Foundation.


Ngow H.A.,International Islamic University Malaysia | Wan Khairina W.W.N.,Hospital Tengku Ampuan Afzan
Cardiology Journal | Year: 2011

Solitary intra-cardiac cavity tuberculoma is extremely rare and often only diagnosed during a post-mortem. We report a case of right atrial tuberculoma causing right atrial outflow tract obstruction in an immune-compromised man. The diagnosis of cardiac tuberculoma was made through the detection of mycobacterium tuberculosis DNA by tuberculosis-polymerase chain reaction in the pericardial fluid. The patient succumbed five days after admission but an autopsy was refused by his family. © 2011 Via Medica.


Ngow H.A.,International Islamic University Malaysia | Wan Khairina W.M.N.,Hospital Tengku Ampuan Afzan
Acta Cardiologica Sinica | Year: 2011

Tenecteplase is a recognized thrombolytic therapy for myocardial infarction. It is also increasingly used in massive and submassive pulmonary embolism. Thus far, there had been 22 patients with pulmonary embolism treated with tenecteplase. However, none of the patients was treated during peripartum period. We report its use in a 35-year-old multiparous woman who was referred at 4 hours post partum with cardiogenic shock. She was clinically suspected to have acute pulmonary embolism, and this was confirmed by computed tomography of the pulmonary artery. She was successfully thrombolysed with tenecteplase but suffered bleeding complication. She was resuscitated and remained stable until discharge 1 week later. A repeat computed tomography of the pulmonary artery at day 4 post-thrombolysis showed a significant reduction in the thrombus load. This case illustrates the potential benefit and efficacy of tenecteplase in acute pulmonary embolism in peri-partum women.


Chong J.L.,Hospital Tengku Ampuan Afzan | Sapari S.,Hospital Tengku Ampuan Afzan | Kuan Y.C.,International Islamic University Malaysia
Journal of Microbiology, Immunology and Infection | Year: 2011

Influenza A "novel H1N1" with severe acute respiratory distress syndrome (ARDS) is a serious illness that poses a challenge to clinicians managing such cases. This case report reveals a patient with ARDS secondary to influenza A with deteriorating clinical status, who improved tremendously after intravenous immunoglobulin G (IV IgG). Patients with H1N1 associated with ARDS may be given a trial of IV IgG. More case reports and trials are required to ascertain the efficacy of IV IgG and the best dosage and timing of starting IV IgG in relation to antiviral therapy. © 2011.


Lee Y.Y.,Universiti Sains Malaysia | Tee H.-P.,Hospital Tengku Ampuan Afzan | Mahadeva S.,University of Malaya
World Journal of Gastroenterology | Year: 2014

Bacterial infections are common in cirrhotic patients with acute variceal bleeding, occurring in 20% within 48 h. Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial infection. However, mortality from variceal bleeding is largely determined by the severity of liver disease. Besides a higher Child-Pugh score, patients with hepatocellular carcinoma are particularly susceptible to infections. Despite several hypotheses that include increased use of instruments, greater risk of aspiration pneumonia and higher bacterial translocation, it remains debatable whether variceal bleeding results in infection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peritonitis. Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures, but more recently, gram positives and quinolone-resistant organisms are increasingly seen, even though their clinical significance is unclear. Fluoroquinolones (including ciprofloxacin and norfloxacin) used for short term (7 d) have the most robust evidence and are recommended in most expert guidelines. Short term intravenous cephalosporin (especially ceftriaxone), given in a hospital setting with prevalent quinolone-resistant organisms, has been shown in studies to be beneficial, particularly in high risk patients with advanced cirrhosis. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved.


Govindarajan K.K.,Hospital Tengku Ampuan Afzan | Chai F.Y.,Hospital Tengku Ampuan Afzan
Malaysian Journal of Medical Sciences | Year: 2011

Bacille Calmette-Guerin (BCG) vaccination for protection against tuberculosis has been in use for long. Although the vaccine is safe, its administration can result in complications such as BCG adenitis. We report here a series of children with BCG adenitis with a view to recognise and manage this condition. It is hoped that this case series would encourage the increased identification of this condition. © Penerbit Universiti Sains Malaysia, 2011.


Krishna Kumar G.,Hospital Tengku Ampuan Afzan
Malaysian Journal of Medical Sciences | Year: 2012

In an infant presenting with a mass in the abdomen and non-bilious vomiting, duplication cyst needs to be considered in the list of differential diagnoses. Gastric duplication cyst is an uncommon occurrence in children. Diagnosis is based on clinical fndings and imaging features. Surgical excision is safe and offers a complete cure. The literature recommends excision even in asymptomatic cases due to isolated reports of malignancy arising in the duplication cyst in later life. © Penerbit Universiti Sains Malaysia.

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