POST TRAUMATIC INTRACRANIAL ANEURYSM PC 29 MKA Jaffar1, R Mohamad1, Z Hatta1 1Radiology Department, Hospital Sultanah Nora Ismail, Batu Pahat, Johor CASE DESCRIPTION: Traumatic intracranial aneurysms are rare, approximately occurring in less than 1% of patients with cerebral aneurysm. A 11-year-old boy no known medical illness, presented with history of motor vehicle accident suffered a polytrauma. Initial computed tomography (CT) brain shows no intracranial bleed. He was discharged home after 10 days of initial hospitalisation. Subsequently, patient represented post trauma day-21 with raised intracranial pressure symptoms. Repeated CT brain showed large acute intracranial bleed with intraventricular and subdural extension, mass effect, cerebral oedema and hydrocephalus. Hence, patient was subjected for right frontal burrhole and external ventricular drain (EVD) insertion. Further evaluation with computed tomography angiography (CTA) brain showed small focal lobulated density at frontal region suspicious of aneurysm. Patient was underwent right craniotomy and aneurysm clipping, right ventriculo-subgaleal shunt (VSGS) and removal of EVD. DISCUSSION/CONCLUSION: Post traumatic intracranial aneurysms may result from varied causes such as penetrating, blunt, or iatrogenic trauma. The site of traumatic intracranial aneurysms varies. Most common location found in the anterior circulation. CT scan usually demonstrates acute intracranial bleed, which may be intraparenchymal, intraventricular, subarachnoid or subdural. The reported risk of haemorrhage in post-traumatic intracranial aneurysms is 19%. The definitive management to treat the intracranial aneurysms are by surgical clipping and/or endovascular occlusion.
COMMON CONDITION, UNCOMMON ORGANISM PC 30 NJ Tey1, O Nor Ilyani1 1.Hospital Pakar Sultanah Fatimah, Muar, Malaysia CASE DESCRIPTION: Breast abscess is a relatively common pyogenic disease that causes morbidity in at risk patients. Common organisms causing breast abscess include S.aureus, as well as polymicrobial that consist of anaerobe organism include Bacteroides fragilis. An uncommon gram-negative anaerobic organism, Dialister pneumosintes was isolated from the pus sample of this breast abscess case. Dialister pneumosintes isolate grew after 2 days of incubation in anaerobic condition as tiny shiny colony on blood agar. Bacterial identification with Biomerieux Vitek shows unidentified organism as the isolate is not inside system database. Successful species identification requires the use of mass spectrometry, matrix-assisted laser desorption/ionization (MALDI-ToF). DISCUSSION/CONCLUSION: This case expands our understanding of breast abscess microbiology, emphasizing the need for improved identification methods such as mass spectrometry to enhance diagnostic accuracy of uncommon organism. Knowledge of common organisms and antibiotic sensitivity patterns is essential for effective management across healthcare disciplines.
A CASE REPORT OF ARFID MANAGEMENT: ‘ROMA BISCUIT BOY’ AND HIS FOOD PLAY SESSIONS PC 31 FA Zakaria1, KL Gan2 1Department of Dietetic and Food Service, Hospital Sultanah Fatimah Muar 2Child Developmental Centre, Hospital Sultanah Fatimah Muar CASE DESCRIPTION: This is a case report of a 7-year-old boy, NA with ARFID (Avoidant/ Restrictive Food Intake Disorder) and Autism. At presentation, his diet consisted of only Roma Cream Cracker and he was malnourished. He attended regular sessions at the combined feeding clinic which provided parental education but there was no progress with regards to his food range and growth. He was subsequently commenced on nasogastric feeding. NA is currently attending weekly individualized food play sessions for graduated food exposure. His willingness to try new food since these sessions has been encouraging. DISCUSSION/CONCLUSION: ARFID is characterized by restricted diet due to either lack of interest in food, avoidance based on sensory quality of food or concern about aversive consequences of eating; with significant health and psychosocial consequences. A study in Malaysia showed that 4.8% of adults are at risk of ARFID. In our hospital, there has been no patient with diagnosis of ARFID before NA presented to us. ARFID is a complex condition that requires multi-disciplinary approach to address the nutritional requirements, sensory aversion and behavioural concerns. There were no prior service in our hospital hence a combined clinic was set up. Mainstay of management include optimizing patient’s nutrition (using supplementary formula and multivitamins) and parental training in food chaining techniques and graduated exposure. The impact our individualized food play sessions on NA has been encouraging. Further research is needed to develop a food exposure therapy module and evaluate this treatment among patients presenting with a variety of ARFID symptoms.
PALATAL MUCOEPIDERMOID CARCINOMA IN AN ADOLESCENT: AN INCIDENTAL FINDING PC 32 M Mohd Noor1, SN Samsee1, FA Mustapha1 1Department of Paediatric Dentistry, Hospital Segamat, Segamat, Johor, Malaysia, CASE DESCRIPTION: In Febuary 2023, a 14 years old girl, was referred to us for management of palatal swelling. Initially, she requested for orthodontics treatment due to crowded teeth. However, during screening, the dentist noted presence of swelling at upper right posterior palatal mucosa close to upper right first and second permanent molars. It was painless, solitary, well-circumscribed, red-bluish colour swelling, fluctuant in consistency, non-pulsatile, non-tender, fixed to underlying bone and sized approximately 2.0 cm x 1.5 cm. She was unsure the duration of the swelling and it was not associated with tooth ache, loss of appetite and weight. The differential diagnosis of dentigerous cyst and Arteriovenous Malformation (AVM) was made. Aspiration of swelling showed no content. Magnetic resonance Imaging (MRI) reported as enhancing soft tissue lesion may represent neoplasm, incisional biopsy interpreted as salivary gland neoplasm in favour of mucoepidermoid carcinoma. DISCUSSION/CONCLUSION: Mucoepidermoid carcinoma (MEC) is an epithelial salivary gland neoplasm of oral cavity. About two-third arise within parotid gland, one -third arise within minor salivary gland. It occurs most frequently in adults during fifth and sixth decades of life, rare in children and adolescent. We reported a case of MEC in 14 years old adolescent. Majority of palatal MEC appears firm, painless and mimic mucoceles or vascular lesions. Palatal MEC is rare, and uncommon in children. In the case of painless swelling, regular oral dental screening and self-examination play very important role for early detection of oral cancer.
CLOZAPINE-INDUCED AKATHISIA: A CASE REPORT PC 33 NA Osman1, S Mohd Som1 1Hospital Permai, Johor Bahru, Johor CASE DESCRIPTION: Akathisia, a component of extrapyramidal syndrome (EPS), is frequently observed in individuals taking antipsychotics. Severe cases can induce profound distress and increase the likelihood of suicidal ideation. Clozapine, often chosen for schizophrenia treatment due to its lower propensity for causing EPS, stands out in this regard. Mrs. HHY, a 43-year-old woman with a history of treatment-resistant schizophrenia, was discharged with clozapine from the hospital following a psychotic episode in November 2023. Following subsequent followup, her clozapine regimen was optimized for residual psychotic symptoms. In December 2023, she was readmitted with restlessness and poor sleep. Reports indicated inappropriate hugging of family members, leading to her confinement to a room. Despite denying psychotic symptoms typical of her previous presentation, Mrs. HHY exhibited worsening symptoms, including restlessness, involuntary hugging, sleep disturbances, and neglect of personal hygiene. Initially treated for clozapineinduced obsessive-compulsive symptoms (OCS) with fluoxetine, her symptoms worsened with escalating clozapine dosage. Suspecting clozapine-induced akathisia, her clozapine was reduced, and fluoxetine discontinued, resulting in significant symptom improvement. Following discharge, the clozapine dose was maintained, preventing further psychotic episodes, with mirtazapine added to manage residual akathisia during follow-up. She experienced another brief admission for residual akathisia in February 2024. DISCUSSION/CONCLUSION: Delayed diagnosis of clozapine-induced akathisia led to extreme distress and prolonged hospitalization, with symptoms potentially mistaken for another psychotic episode or clozapine-induced OCS. Clozapine-induced akathisia should be considered in individuals undergoing clozapine treatment for schizophrenia.
WIDE-AWAKE ORTHOPAEDIC SURGERY: HOSPITAL SULTAN ISMAIL 3-YEAR EXPERIENCE OF WALANT TECHNIQUE PC 34 AS Noor Hisham1, NF Jaafar1, MH Mohd Hamid1, MS Mustapah1, MS Mohd Shif1 1Department of Orthopaedics, Hospital Sultan Ismail, Johor Bahru, Johor CASE DESCRIPTION: “Wide Awake Local Anaesthesia No Tourniquet” (WALANT) technique of surgical anaesthesia that combine the effect of lignocaine as local anaesthesia and adrenaline as vasoconstrictor to provide a painless and bloodless surgical field eliminating the usage and risk pertaining to tourniquet. The tumescent solution can be given in a larger volume allowing bigger working area while within safe dose limit. It was initially used for soft tissue procedure of the hand. WALANT technique has advanced to include fracture fixation. In January 2022, Department of Orthopaedic Hospital Sultan Ismail established an elective WALANT OT as an initiative to clear up the back-logged of elective cases post COVID-19 pandemic. At present, we have expanded our WALANT OT service to accommodate elective fracture fixation to reduce general anaesthesia OT waiting time. There are increasing number of cases for both soft tissue procedures and fracture fixation from January 2022 till present. 46% and 31% of total cases in 2022 and 2023 respectively were fracture fixation. Remainder of the cases were combinations of implant removal and soft tissue procedures. Most of the fracture fixation done were upper limb fractures i.e. metacarpal fractures and distal end radius fracture. Bimalleolar and patella were the most common lower limb fracture treated. DISCUSSION/CONCLUSION: This is the first hospital in southern peninsula Malaysia to offer elective WALANT services. It is beneficial in reducing waiting time for surgery with no major complication encountered. Observational study or audits are needed to assess patient’s satisfaction and monitor complications as the service continues.
UNDIFFERENTIATED SARCOMA MIMICKING AS RETROPHARYNGEAL ABSCESS AN UNEXPECTED TWIST. PC 35 1Sherman Tay 1Department Otorhinolaryngology-Head and Neck Surgery, Hospital Pakar Sultanah Fatimah CASE DESCRIPTION: Paediatric undiffentiated sarcoma is an extremely rare and highly aggressive tumour which represent a major challenge for clinicians and pathologist. There are limited research and case reports about undifferentiated sarcoma of nasopharynx in paediatric population. We report a case of undifferentiated sarcoma initially displaying as retropharyngeal abscess. A 1 year 7 month old boy who presented to our department with respiratory distress due to retropharyngeal mass in which then confirmed as abscess by cect neck. Patient underwent direct laryngoscopy+transoral incison and drainage twice with minimal pus drain. Incidental findings of undifferentiated sarcoma on histopathological examination abscess wall was reported. Hence patient was started on chemotherapy. DISCUSSION/CONCLUSION: The case report is to highlight rarity of disease and atypical presentation. One has to be mindful risk of malignancy in cases presented as refractory retropharyngeal abscess.
WIDE-AWAKE ORTHOPAEDIC SURGERY: COMMINUTED HUMERUS FRACTURE FIXATION UNDER WALANT PC 36 AS Noor Hisham1, NF Jaafar1, MH Mohd Hamid1, MS Mustapah1, MS Mohd Shif1 1Department of Orthopaedics, Hospital Sultan Ismail, Johor Bahru CASE DESCRIPTION: Mr A, 20 year old gentleman sustained closed comminuted left midshaft humerus fracture. Patient was given an option for definitive fixation under elective WALANT (wide awake local anaesthesia no tourniquet) due to limited slot under general trauma. He consented and underwent open reduction and plating of left humerus nine days after his injury. Anterolateral approach of the left arm was planned and 110cc 0.5% WALANT solution was infiltrated over the planned surgical site. Intraoperative, comminuted midshaft humerus fracture with abundant callous resulting difficult reduction requiring stronger tractional forces to relax the muscles causing discomfort to the patient. IV Morphine10 mg stat and IV Midazolam 5 mg stat was served to aids in fracture reduction. There were intramedullary serous discharge noted at the fracture site. The surgery was completed and successful without the need for conversion to general anaesthesia. Patient remains awake throughout the surgery allowing immediate range of movement and neurological assessment. Post-op 3 months, wound healed without any complication. Serial x-rays showed no evidence of callous. Formal sample of the intramedullary fluid sent showed no culture growth. DISCUSSION/CONCLUSION: WALANT technique for fracture usage has been reported mainly for subcutaneous bone fracture fixation. Humerus bone are anatomically deeper hence more challenging without general anaesthesia. To our best knowledge, this is the first case fracture fixation of humerus using WALANT technique. Despite requiring sedation and additional analgesia intra-operatively due to the discomfort from traction applied for fracture reduction, we successfully completed the surgery without conversion to general anaesthesia.
A CASE REPORT OF DENGUE FEVER WITH ATYPICAL PRESENTATION AN UNUSUAL PRESENTATION OF DENGUE FEVER WITHOUT HISTORY OF FEVER PC 37 1NN Tinakaran 1Klinik Kesihatan Mahmoodiah Johor Bahru CASE DESCRIPTION: This is a case of a 43 year old Malay gentleman with underlying type 2 diabetes mellitus, dyslipidaemia, essential hypertension and bronchial asthma presented with a history of diarrhoea past 3 days with 3-4 episodes each day with abdominal pain and myalgia. Patient denies having fever prior to this no vomiting, no abdominal pain, no bleeding tendency, and no shortness of breath. Patient denies any history of recent travel or history of outside food intake On examination, patient was alert and conscious, pulse volume was good, capillary refill time was less than 2 seconds. Sitting blood pressure was documented as 116/73, heart rate was 80 beats per minute and temperature was documented as 36 degrees Celsius. Other systemic examination was unremarkable. Laboratory investigations was taken such as full blood count which revealed wcc 9.3/HB:14.8/HCT:44.7/platelet 190.Patient was further preceded with dengue rapid test which revealed a positive IG M and IG G; NS1 was negative. Random capillary blood glucose was 24mmol, hence urine FEME was taken and there was no evidence of ketosis, was positive only for glucose. On the basis of clinical manifestations and laboratory results, patient was diagnosed of dengue fever day 3 of illness in critical phase with warning signs with uncontrolled diabetes mellitus. DISCUSSION/CONCLUSION: Dengue fever infection can present to at primary care with atypical presentation such as absence of fever however patient may manifest other warning signs such as diarrhoea. The clinical presentation and management of each patient was described for the purpose sharing the experiences. As the incidence of dengue fever is increasing, not all dengue fever presents with fever. High index suspicion has to be implemented at primary care level if patient comes with symptoms of gastrointestinal losses such as vomiting and diarrhoea Dengue is an extremely challenging infection to treat in the globe today. Above unusual presentation and complications could be fatal, if not detected early where therapeutic window period is very short. Clinicians need awareness of these problems which are not uncommon, but underreported and often overlooked.
BORDERLINE PERSONALITY DISORDER (BPD) AND BIPOLAR MOOD DISORDER: DILEMMA IN PRIMARY CARE; A CASE REPORT PC 38 CLC Alvin1, H Suriati1 1Endau Health Centre, Mersing, Johor CASE DESCRIPTION: Borderline personality disorder (BPD) typically presents to outpatient clinic with depressive symptoms and impulsivity. The overlapping of impulsivity and manic symptoms pose a dilemma in diagnosis and hinders with the treatment of the patient. We are reporting 2 different cases of BPD whereby the first case was 19 years old, lady who was initially treated for Major Depressive Disorder (MDD) with BPD. She showed poor response to antidepressants and typical antipsychotics. After re-exploration of the history, patient manifested hypomanic symptom that could be overlooked as an act of impulsivity. She was started on Quetiapine and showed marked improvement. Her current symptoms may have improved on Quetiapine however, the diagnosis of Bipolar Mood Disorder (BMD) remains a question. Case 2 was 29 years old, lady diagnosed with MDD and BPD. However, she was initiated with Quetiapine earlier and showed marked improvement especially on her mood lability and impulsivity. She scores 9/10 on Zanarini score. The dilemma in the aspect of diagnosis of case 1 leads to poor quality of life. In both cases, it is proven that Quetiapine helps with patient suffering from BPD. DISCUSSION/CONCLUSION: History taking is important when dealing with psychiatry illness. This will help to prevent delay treatment for patients, improved the quality of life of patient and adherence to treatment. Quetiapine shows better response in patient with BPD and Zanarini Scale rating may be useful in aiding of diagnosis of BPD but unsure regarding BMD.
DOCTOR, IS MY BACK PAIN SERIOUS? PC 39 WH Puam1, SM Liau1, A Ibrahim1, CR Ng1 1Rheumatology Unit, Department of Medicine, Hospital Pakar Sultanah Fatimah CASE DESCRIPTION: 32-year-old lab assistant, Para 2 gave birth in May 2022. She has no previous medical illness. She presented with inflammatory low back pain ever since she had a fall in July 2023. Her pain was only partially relieved by Celecoxib 200mg BD. Otherwise, she did not have unexplained red eyes, altered bowel habit, skin rashes, fever, constitutional symptoms or red flag signs. She has no family history of similar back pain nor autoimmune diseases. Clinically, she was well-built, tender over left sacroiliac joint (SIJ). Spinal mobility examination was restricted as evidenced by modified Shober test of + 2 cm. Her raised inflammatory markers (ESR: 78; CRP: 26.4mh/L) and BASDAI score of 7.5 indicated a high disease activity. Further investigations revealed a negative HLA B27 despite squaring of lumbar vertebrae and positive MRI SIJ namely subchondral marrow edema with enhancement along the tendon and ligament suggestive of enthesitis. T1/T2 hyperintensity predominantly along iliac aspect of SIJ suggestive of sclerosis. However, her pelvis x-ray demonstrated bilateral symmetrical triangular shaped sclerosis especially on iliac sides of SIJ which is against the diagnosis of spondyloarthritis but osteitis condensas ilii (OCI). DISCUSSION/CONCLUSION: In conclusion, our case portrayed a combination scenario of seronegative spondyloarthritis with concomitant OCI which happens commonly in a postpartum lady.
JOHOR RESEARCH DAY 2024: STUDENT POSTER PRESENTATION ABSTRACT
ID PRESENTATION TIME TITLE PRESENTER STUDENT ORIGINAL RESEARCH 01 Health literacy of the Deaf Community: A Scoping review. Goh Kang Suen STUDENT ORIGINAL RESEARCH 02 Postmenopausal Breast Cancer Recurrence Rates after Adjuvant Tamoxifen - 5 versus 10 years Chittima Phakdee A/P Som Bat STUDENT ORIGINAL RESEARCH 03 Density of breast: An independent risk factor for developing breast cancer, a prospective study at two premium breast centres Bamunusinghe Arachchige Devni Yasara Perera STUDENT ORIGINAL RESEARCH 04 Trends in Facial Reanimation Surgery - A Bibliometric Analysis Raed Alderhali STUDENT ORIGINAL RESEARCH 05 Bibliometric Analysis of Patient Satisfaction and Psychological Well-being in Implant-based Breast Reconstruction Raed Alderhali STUDENT ORIGINAL RESEARCH 06 Investigating the relationship between Food Glycaemic Index (GI) and Insulinaemic Index (II) in Diabetic patients: A Comparative Analysis Tee Xin Yi STUDENT ORIGINAL RESEARCH 07 Framework of An Electromechanical Cardiac – Coronary Flow Coupling Model Laila Fadhillah Binti Ulta Delestri STUDENT ORIGINAL RESEARCH 08 Developing Marmoset and Macaque Translational Model to Understand Autism and Social Prediction Yousr A Elebessy STUDENT ORIGINAL RESEARCH 09 Deep Analysis of Motor unit and Fasciculation Activity using Motor Unit MRI Abdelrahman Ghonaim STUDENT ORIGINAL RESEARCH 10 Drug Rash with Eosinophilia and Systemic Symptoms (DRESS): Case-Fatality Rate and Clinical Characteristics Lai Yong Sheng STUDENT ORIGINAL RESEARCH 11 Management of Osteoporosis in Thalassemia Patients: A Systematic Review Samran Shahid STUDENT ORIGINAL RESEARCH 12 MEDAIRO WALKMATE – Medical AI Robot Assistive Smart walker Hoo Yann Torng PROGRAMME : POSTER PRESENTATION ABSTRACT
HEALTH LITERACY OF THE DEAF COMMUNITY: A SCOPING REVIEW SO 01 KS Goh1, RCC Yau1, JR Appalasamy1, U Palanisamy1, SA Jacob1 1Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia INTRODUCTION: It is essential to gain an insight into the health literacy of Deaf individuals, as they face many challenges when accessing health information. This scoping review aims to provide an overview and identify gaps in the health literacy of the Deaf community. METHODS: A systematic search was conducted across the following databases, including EMBASE, PUBMED, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. The search was limited to studies with abstract and full-text available, in English and from database inception to 30th November 2023. RESULTS: Fifty-four studies were included in this scoping review. Deaf individuals had poor health literacy in Human Immunodeficiency Virus (HIV), cancer and non-communicable diseases. The Deaf also had a lower health literacy compared to their hearing counterparts. Factors that were positively associated with the health literacy of the Deaf include education level, income, and family economic status. In contrast, the Deaf with worse hearing impairment had poorer health literacy. The primary sources of information reported by The Deaf were family members, friends, and school. DISCUSSION/CONCLUSION: This review provided a comprehensive understanding of the health literacy level within the Deaf community. Further initiatives to bridge the gap between the Deaf and hearing community should be explored. Educational and interventional programmes tailored for the Deaf community should be developed and implemented to improve the health literacy of the community.
POSTMENOPAUSAL BREAST CANCER RECURRENCE RATES AFTER ADJUVANT TAMOXIFEN - 5 VERSUS 10 YEARS SO 02 A Gandhi1, XY Liew1, SWS Au Young1, RK Chandran1, CSB Phakdee1, XL Chin2 1Jeffrey Cheah School of Medicine and Health Sciences, Clinical School Johor Bahru, Monash University Malaysia 2 Griffith University, Brisbane, Australia INTRODUCTION: Breast cancer is a significant global health concern, affecting around 1-in-5 women. Adjuvant tamoxifen has proven effective in reducing breast cancer mortality rates for up to 15 years’ postdiagnosis. Extended therapy of 10 years may provide additional benefits but concerns regarding potential adverse effects associated with prolonged treatment duration remain. This literature review aims to analyse the most feasible duration of adjuvant therapy for estrogen receptor (ER)-positive breast cancers. METHODS: Eligible studies (randomised control trials from 2010 to 2022, English language) focused on postmenopausal females with ER+ early breast cancer, excluding those on aromatase inhibitors or with Tamoxifen contraindications. The search strategy covered databases Medline, PubMed, Embase, etc., with duplicates removed. Data from 1998-2022 were analysed, including study characteristics, participant demographics, treatment regimens, and outcome measures. RESULTS: The literature search identified 42 papers for screening with 22 papers excluded and 20 selected for full assessment. These studies compare efficacy of Tamoxifen for 5 and 10 years in postmenopausal ER+ breast cancer patients, ranging from level 1 to 4 evidence. DISCUSSION/CONCLUSION: Current guidelines advocate for a 5-year course of Tamoxifen in postmenopausal women with ER+ breast cancer, reducing recurrence and mortality. While extended therapy may offer additional benefits, it also increases endometrial cancer risk Therefore, personalized regimens, considering factors like age, menopausal status, and disease characteristics, is warranted. This study is limited by the variable follow-up durations and patient selection biases. In conclusion, with considerations of patients’ profiles, a 5-year Tamoxifen course is preferred, given its substantial therapeutic benefits outweighing potential risks.
DENSITY OF BREAST: AN INDEPENDENT RISK FACTOR FOR DEVELOPING BREAST CANCER, A PROSPECTIVE STUDY AT TWO PREMIUM BREAST CENTRES SO 03 CH Lo1, XY Chai1, SSW Ting1, SC Ang1, X Chin1, LT Tan1, P Saania1, TNAT Mat2, SM Sikin3, A Gandhi1, B Perera1 1 Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia 2Department of Surgery, Hospital Sultanah Aminah (HSA), Johor Bahru, Johor 3Department of Surgery, Hospital Sultan Ismail (HSI), Johor Bahru, Johor INTRODUCTION: Breast cancer is the leading cause of death worldwide, and recent studies have identified breast density as a controversial risk factor. This is one of the first Malaysian studies to investigate the association between breast density and breast cancer. If breast density is proven to be a risk factor, intervention could be implemented to reduce breast cancer risk. METHODS: A prospective cohort study is carried out in two hospitals targeting adult female patients. Breast density assessed from mammograms was correlated with tissue biopsy results and final diagnosis of benign or malignant breast disease. RESULTS: Participants with dense breasts showed 29% increased risk of breast cancer when compared to those with almost entirely fatty breasts (odds ratio [OR] 1.29, 95% CI 0.38-4.44, P = .683). Among the postmenopausal women, those with dense breasts were 3.1 times more likely to develop breast cancer compared with those with fatty breasts (OR 3.125, 95% CI 0.72-13.64, P = .13). Moreover, the chance of developing breast cancer increases with age (OR 1.046, 95% CI 1.003-1.090, P < .05). In contrast, the density of breast decreases with increasing age (P < .05) and body mass index (P = .051). DISCUSSION/CONCLUSION: Although results were not statistically significant, the association between breast density and risk of breast cancer cannot be ruled out. The study is limited by a small sample size and subjective assessment of breast density. More studies are required to reconcile the differences between studies of contrasting evidence.
TRENDS IN FACIAL REANIMATION SURGERY - A BIBLIOMETRIC ANALYSIS SO 04 A Gentile1, A Ceccaroni1, R Alderhali2, M Alzaid3, R Singh4, BE Fink5 1Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University Of Salerno, Baronissi, Salerno Italy 2Department of Medicine, Newcastle University Medicine Malaysia, Johor Malaysia 3School of Medical Sciences, University of Manchester, United Kingdom 4Department of Surgery, James Paget University Hospital NHS Foundation Trust, Great Yarmouth, United Kingdom 5Plastic Surgery Bristol Southmead Hospital, United Kingdom INTRODUCTION: Facial paralysis is a debilitating condition, with physical, psychological and social sequelae. Facial reanimation surgery (FRS) aims to restore form and function, employing a range of dynamic and static procedures. We performed a bibliometric analysis focused on the 100 most-cited FRS articles to understand emerging trends and assess methodological quality of the highest impact studies. METHODS: The 100 most-cited articles in FRS were identified on Web of Science, across all available journal years (from 1976 to 2019). Study details, including the citation count, main subject, and outcome measures were extracted from each article. Oxford Centre for Evidence Based Medicine (OCEBM) Levels of Evidence (LOE) of each study were assessed. RESULTS: The 100 most-cited articles in facial reanimation surgery were cited by a total of 6841 articles. Citation per article ranged significantly from 31 to 535 (mean 68.41). Overall, most of the top-cited articles were LOE 3 (n = 43), representing the large number of cohort studies. The remaining number of articles for LOE 5, 4, 2 and 1 were 25, 15, 3 and 3, respectively. Most articles focused on ‘surgical technique’ (n = 64), followed by ‘outcomes’ (n = 22). Patient reported outcome measures (PROMs) were used in 8 articles, and 52 articles reported cosmetic outcome measures. CONCLUSION: This analysis highlights the need for improved study designs in FRS research, with a profound lack of high-quality studies. Improved research methodologies and adoption of validated PROMs would promote high-quality evidence-based patient care in FRS.
BIBLIOMETRIC ANALYSIS OF PATIENT, SATISFACTION AND PSYCHOLOGICAL WELL-BEING IN IMPLANT BASED BREAST RECONSTRUCTION SO 05 K Daneshi1, F Ruccia2, R Merh3, T Barlattani4, R Alderhali5, A Khajuria6 1School of Medicine and Population Health, The University of Sheffield, Sheffield, UK 2Department of Plastic and Reconstructive Surgery, The Royal Marsden NHS Foundation Trust, London, UK 3Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, London, UK 4Department of Biotechnological and Applied Clinical Sciences, Aquila, Italy 5Department of Medicine, Newcastle University Medicine Malaysia, Johor, Malaysia 6Kellogg College, University of Oxford, Oxford, UK; Department of Surgery & Cancer, Imperial College London, UK INTRODUCTION: Implant-based breast reconstruction (IBR) is a procedure that aims to rebuild the shape and volume of the breast following a mastectomy. Quality of life can be significantly altered post operatively. This bibliometric analysis aims to identify trends within literature and highlight the importance of measuring and ensuring procedures improve the patient’s quality of life. METHODS: The 100 most cited publications in IBR were identified on Web of Science, across all available journal years (1977 to 2024). Study details (the citation count, main content focus, outcome measures and usage of psychological questionnaires) were extracted and tabulated from each publication. Oxford Centre for Evidence Based Medicine (OCEBM) Levels of Evidence (LOE) of each study were assessed. RESULTS: The 100 most cited publications on patient satisfaction and psychological well-being in implantbased reconstruction. Citations per publication ranged from 63 to 457 (mean 126.96 ± 72.1). Most publications were LOE II (n = 50), representative of prospective cohort studies and systematic reviews of non-randomized studies. The number of publications for LOE V, IV, III and I was 0, 7,43 and 0, respectively. Most articles focused on ‘quality of life’ in 81 publications, BREAST Q and short form health survey 36 questionnaire were also sometimes utilized. 62 publications used validated questionnaires with psychometric development. DISCUSSION/CONCLUSIONS: This analysis demonstrates the need for improved research methodologies within IBR, as there is a lack of LOE1 studies. Improved research methodologies centered around quality of life should be the main aim for future endeavors within the field.
INVESTIGATING THE RELATIONSHIP BETWEEN FOOD GLYCAEMIC INDEX (GI) AND INSULINAEMIC INDEX (II) IN DIABETIC PATIENTS: A COMPARATIVE ANALYSIS SO 06 XY Tee1, KK Teo1, SP Lau1, JW Wong1, MMFIM Albasal1, B Vijayam1,2,3 1Newcastle University Medicine Malaysia (NUMed), Johor. 2Department of Clinical Medicine, Newcastle University Medicine Malaysia (NUMed), Johor. 3Regenerative Medicine Working Group, Newcastle University Medicine Malaysia (NUMed), Johor INTRODUCTION: Diet therapy with Glycaemic Index (GI) is advocated as one of many managements for insulin resistance in diabetes. Insulinaemic Index (II), mimics GI but studies on endogenous serum insulin responses to food. Recent meta-analysis showed the implementation of GI to be less successful among diabetics. We aim to compile II data for diabetics to investigate the GI-II relationship. METHODS: Our systematic approach included (1) literature search, (2) data extraction, and compilation (3) testing data normality, and (4) correlation analysis.We screened around 1300 scholarly articles published up to March 2024. II values in articles that were derived from incremental area under the curve (iAUC) were extracted directly. When II were not reported, data were calculated from provided iAUC, bar images or insulin concentration points over time. II and GI data normalities were evaluated prior to Pearson or Spearman’s correlation test. All data were represented to three decimal points and a significance of p < 0.05. RESULTS: Among 42 foods from 16 studies, the highest II was 175 for western breakfast. The lowest II was 18.2 for fructose. Pearson’s test showed no significant correlation between II and GI with r(40) = 0.103, p = 0.515. We found a low GI – hyperinsulinaemia paradox in which 66.67% and 20% of the food II were over 50 and 100 respectively. DISCUSSION/CONCLUSION: There is no significant correlation between II and GI. Low GI does not assure low insulin excretion. We recommend against advocating low GI food to diabetics without II values.
FRAMEWORK OF AN ELECTROMECHANICAL CARDIAC – CORONARY FLOW COUPLING MODEL SO 07 LF Ulta Delestri1, A Ahmad Bakir1, NK Foo1, BG Sengers1, NW Bressloff1 1University of Southampton Malaysia INTRODUCTION: Myocardium requires an adequate supply of nutrients to function optimally, and this supply comes primarily from the coronary arteries embedded around the heart. The contracting myocardium in a cardiac cycle exerts extravascular forces to the coronaries which can compromise the coronary arterial blood flow, potentially affecting the cardiac perfusion rate. This study aims to investigate the behaviour of coronary arterial flow and myocardial motion, crucial aspects in understanding cardiovascular function and pathology. METHODS: In this work, we propose a comprehensive electromechanical cardiac-coronary model that couples a realistic human geometry of cardiac model and its coronary circulation. The model includes the (i) acquisition of realistic biventricular myocardial geometry and coronary arterial tree (ii) generation of myocardial fiber microstructure; (iii) a detailed formulation of the electrophysiology and myocardial active force generation including the properties of myocardial hyperelastic formulation; (iv) Windkessel openloop circulation model; (v) one-way coupling of the cardiac electromechanics with the coronaries boundary interface and (vi) the modelling of a lumped parameter model of coronary circulation. RESULTS: We are able to develop a cardiac electromechanical model coupled to its coronary lumped parameter model by showing the plots of the myocardial action potential, pressure-volume loop, left ventricular volume, torsional rate and apicobasal displacement. We also present the coronary pressure and flow waveforms in each artery to prove the existence of coupling between these two models. DISCUSSION/CONCLUSION: Our proposed model serves as a foundation of future detailed works on cardiac-coronary computational model using a realistic electromechanical cardiac and coronary circulation model to investigate coronary-myocardium physiology.
DEVELOPING MARMOSET AND MACAQUE TRANSLATIONAL MODEL TO UNDERSTAND AUTISM AND SOCIAL PREDICTION SO 08 S Shahid1, Y Elebessy1, Y Elebessy1 1Newcastle University Medicine Malaysia (NUMed), Johor INTRODUCTION: ASD, a widespread neurodevelopmental condition, has a complex, largely unknown cause, with rising global incidence. Understanding its intricacies is crucial. Non-Human Primates (NHPs) like marmoset and macaque monkeys offer valuable insights into such diseases. METHODS: The study aimed to explore ASD behavioural traits in marmoset monkeys using a social prediction task via a touchscreen interface and conducting cross species analysis between Marmoset and Macaque monkeys. Data collection was followed by computational analysis using MATLAB. RESULTS: Step 1 involved three marmosets, two favoring the right button and one the left. Each completed around 496.6 trials. In Step 2, all marmosets initially showed biases but adapted after a week. Step 3 and Cross-Species Analysis revealed one marmoset consistently providing usable data. Alvar, the macaque, showed varying accuracy over 2160 trials, with notably high accuracy at the start. DISCUSSION/CONCLUSION: In conclusion, our study on marmosets' spatial bias and adaptation offers insights into behaviour. Cross-species analysis suggests undisclosed biases, with Alvar's accuracy declining over 2160 trials, nearing marmoset levels. These findings underscore the importance of primate models for understanding conditions like autism spectrum disorder (ASD). Considering species-specific traits in research is crucial for advancing our understanding of neurodevelopmental disorders in clinical contexts.
DEEP ANALYSIS OF MOTOR UNIT AND FASCICULATION ACTIVITY USING MOTOR UNIT MRI SO 09 A. Ghonaim Campus of Aging and Vitality, Newcastle University, United Kingdom INTRODUCTION: Motor Unit MRI (MUMRI) is a novel MRI technology that observes muscle activity through diffusion-weighted imaging, it captures water movement induced by muscular contractions and depict it in the images. MUMRI aims to improve understanding of neuromuscular alterations associated with aging, sarcopenia, and various neuromuscular disorders (NMD) (1) METHODS: 1st part: Two timeframes, each comprising 180 images of fasciculation movements in MND (Motor Neuron Disease) patients' legs, were examined to highlight muscle movement. subsequently these areas were evaluated for overlap to determine the smallest identifiable units. 2nd Part: Five healthy patients underwent controlled muscular stimulation. Using current regulation researchers identified the smallest muscle unit that consistently operated in unison. Subsequently, correlation studies were conducted, correlating all pixels within these regions. Further comparison with a control sample from the same patients (of equivalent pixel count) was made. RESULTS: 1stpart: Analysis showed that fasciculations in MND patients exhibit varying morphologies at different times but overlap within the same area, suggesting involvement of multiple motor units that act independently. This random distribution and overlap imply a potential higher-level neural influence triggering mass random stimulation affecting multiple motor units simultaneously, leading to their sporadic contractions. 2ndpart: Strong correlations among pixels within highlighted regions were found suggesting a close functional relationship, indicating their probable inclusion within the same motor unit. Correlations diminished towards the borders of these regions, likely due to activation area limitations and challenges in precisely delineating borders with low resolution. This correlation diminishes when compared to the controls obtained. DISCUSSION/CONCLUSION: Fasciculation analysis in MND patients suggested that fasciculations are made of multiple motor units that can act independently. Furthermore, healthy patients’ analysis portrayed high correlation between different areas of a motor unit
DRUG RASH WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS): CASE-FATALITY RATE AND CLINICAL CHARACTERISTICS SO 10 YS Lai1, XZ Hon1, AKM Wong1, SE Choon1,2, KW Wong2, ME Tay2, PSK Tok3 1Clinical School Johor Bahru, Monash University Malaysia, Malaysia 2Department of Dermatology, Hospital Sultanah Aminah, Johor Bahru, Malaysia 3Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia INTRODUCTION: Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) is a severe cutaneous adverse reaction (SCAR), with an estimated overall population risk between 1 in 1,000 and 1 in 10,000 drug exposure. Despite its high mortality risk, estimated around 5-10% globally, current evidence on DRESS remains scarce in Southeast Asia, particularly on the association of drug exposure. METHODS: This is a longitudinal study involving all patients with a confirmed diagnosis of DRESS from HSAJB between January 2001 to December 2022. DRESS diagnosis was based on the Registry of Severe Cutaneous Adverse Reactions (Regi-SCAR) scoring system. Patients’ characteristics, clinical data, and variables of interest during hospitalisation were extracted from Tele-Primary Care (TPC) information systems. The study was registered and ethically approved by the MREC and MUHREC. RESULTS: From the study cohort of 287 patients, the male-to-female ratio was 1.7:1. Almost one-fifth of patients were between 51 and 60 years old, with a median age of 49 (IQR: 34.5-62.0). The top five drugs implicated in DRESS were allopurinol (21.6%), clotrimazole (18.8%), phenytoin (15.0%), dapsone (7.3%) and carbamazepine (5.9%). The commonly presented features were lymphadenopathy (71.8%), fever (53.6%) and mucosa involvement (32.1%). Case fatality rate (CFR) was reported as 12.9% (up to 30.3% in patients required ICU admission). DISCUSSION/CONCLUSION: DRESS requires early recognition and aggressive treatment. However, it is underdiagnosed, due to low awareness of possible drug reactions, lack of a careful review on the medication history, and poor recognition with clinical characteristics. Therefore, such insights would be offered with our regional data based on this study.
MANAGEMENT OF OSTEOPOROSIS IN THALASSEMIA PATIENTS; A SYSTEMATIC REVIEW SO 11 S Shahid1, O Eldeeb1, M Ata1 Ahmad Moolla1 1Newcastle University Medicine Malaysia (NUMed), Johor INTRODUCTION: Osteoporosis is a complication that arises in patients with thalassemia. The pathophysiology of the complication is complex and not fully understood. We undertook a systematic review of studies conducted in the past 25 years assessing management options for osteoporosis in people suffering from thalassemia. METHODS: This literature review investigated treatments for thalassemia-induced osteoporosis/osteopenia. MEDLINE indexed papers with the following words keywords osteoporosis OR bone density OR bone disease, metabolic” AND “beta-thalassemia OR alpha-thalassemia OR deltathalassemia OR Thalassemia” AND “Diphosphonates OR Denosumab OR Teriparatide OR Osteoporotic Fractures OR Parathyroid Hormone-Related Protein.”. Following this, papers were reviewed manually by 3 investigators independently. RESULTS: Various methodologies and drug classes were employed. Zoledronic acid, in (n=9) studies, consistently boosted BMD. Pamidronate (n=6) and alendronate (n=4) also increased BMD. In one study (n=1), alendronate outperformed clodronate, and in another (n=1), pamidronate showed superior results to alendronate. Supplements, in (n=4) studies, showed varying effects based on their usage. Strontium ranelate enhanced BMD in women in a single (n=1) study. Additionally, a study (n=1) revealed that neondronate/etidronate, alongside calcium and vitamin D, yielded superior results compared to Vitamin D and Calcium alone. DISCUSSION/CONCLUSION: Diverse drug classes and supplements showed varying effects on bone mineral density (BMD). Zoledronic acid consistently boosted BMD in nine studies. Pamidronate and alendronate also increased BMD, with some studies favoring their efficacy over others. However, further studies are required to validate any findings.
MEDAIRO WALKMATE – MEDICAL AI ROBOT ASSISTIVE SMART WALKER SO 12 YT Hoo1, AN Mohd Arman1, A Anaz1, A Abdul Azmil1, G Chai1, WW Heng2, A Ahmad Bakir2, AS Idris1 1Department of Electrical and Electronic Engineering, University of Southampton Malaysia, Johor, Malaysia 2Department of Mechanical Engineering, University of Southampton Malaysia, Johor, Malaysia INTRODUCTION: MEDAIRO WALKMATE is a Medical AI Robot envisioned to assist patients with mobility issues to walk independently in a healthcare environment be it either in hospitals or elderly care facilities. MEDAIRO WALKMATE will assist patients to walk unaided whilst avoiding obstacles and hazards so that the patients can reach destinations such as toilets and other facilities safely. METHODS: MEDAIRO WALKMATE integrates the SCUTTLE Intel AMR Kit and a smart walker frame hardware with AI software for object recognition and obstacle hazard avoidance. Furthermore, sensors such as LIDAR will assist in manoeuvrability through SLAM which will integrate cameras and other sensors to detect the patient’s condition and to avoid falls. RESULTS: Recent issues in the healthcare industry have revolved around nursing staff shortage where recent publications have described the critical situation as at the breaking point. Thus, MEDAIRO WALKMATE not only aims to assist with patient mobility, but also aims to help alleviate the shortage of healthcare manpower and overloading of tasks that healthcare practitioners face by providing an autonomous assistive smart walker which will reduce the burden on healthcare providers. DISCUSSION/CONCLUSION: We expect that the healthcare industry and elderly care practitioners will greatly benefit from MEDAIRO WALKMATE and in particular, the patients will also gain independence to assist in their mobility needs.
JOHOR RESEARCH DAY 2024: STUDENT CASE REPORT PRESENTATION ABSTRACT
ID PRESENTATION TIME TITLE PRESENTER STUDENT CASE REPORT OR CASE SERIES 1 Diagnostic Challenge: A Case Report on Atypical Presentation of Multiple Sclerosis in Adolescence Omar Mohamed Shahat Mohamed Eldeeb STUDENT CASE REPORT OR CASE SERIES 2 Bilateral Congenital Femoral Deficiency Suggestive of an Underlying ESCO2 Spectrum Disorder – Diagnostic Challenges: A Case Report Karim Ayman Ghazi Khaled STUDENT CASE REPORT OR CASE SERIES 3 Understanding Pediatric Spinal Lesions: A Case Report of Neuroenteric Cyst Samran Shahid STUDENT CASE REPORT OR CASE SERIES 4 Managing Advanced Chronic Kidney Disease Complicated by Metabolic Acidosis and Uremia in the Setting of Polycystic Kidney Disease: A Case Study Yasmin A Elebessy PROGRAMME : CASE REPORT PRESENTATION ABSTRACT
DIAGNOSTIC CHALLENGE: A CASE REPORT ON ATYPICAL PRESENTATION OF MULTIPLE SCLEROSIS IN ADOLESCENCE SC 01 O Eldeeb1, Y T Chin2, K Khaled1, S Shahid1 1Newcastle University Medicine Malaysia (NUMed), Johor 2Hospital Sultanah Aminah, Johor Bahru, Johor CASE DESCRIPTION: A 16-year-old Indian-Malay male presented with multiple falls and progressive ataxia that started 1 year ago. He also reported generalised numbness, weakness, fatigue and dyscalculia, which affected his school attendance and performance. He has a family history of learning disability and a personal history of consuming approximately 15 units of alcohol weekly. On investigations, MRI revealed extensive cerebral and intramedullary cord T2W hyperintense non-enhancing lesions suggesting a demyelinating disease disseminated in space, though without dissemination in time. Lumbar puncture showed oligoclonal bands, fulfilling the diagnostic criteria. A thorough antibodies panel excluded other conditions, and the diagnosis of primary progressive multiple sclerosis (PPMS) was suggested. Management comprised a pulse dose of IV Methylprednisolone, Vitamin D, initiation of physiotherapy, and a pending approval for Ocrelizumab. DISCUSSION/CONCLUSION: This case highlights the variability of multiple sclerosis presentations and how a ‘great imitator’ it is and serves as a reminder to avoid tunnel vision when encountering new cases. This constellation of symptoms initially put multiple differentials in mind such as Guillain-Barré syndrome (GBS). With the MRI results, Neuromyelitis optica spectrum disorder (NMOSD) would be another differential, hence the extensive investigations. Moreover, the cognitive impairment, early disease onset and family history of learning disability raised a possibility for inherited conditions such as Friedreich ataxia. Finally, the extensive nature of the disease and its impact on the patient’s life raises the need for a holistic approach when managing MS and the necessity of novel effective therapies.
BILATERAL CONGENITAL FEMORAL DEFICIENCY SUGGESTIVE OF AN UNDERLYING ESCO2 SPECTRUM DISORDER – DIAGNOSTIC CHALLENGES: A CASE REPORT (ABSTRACT) SC 02 K Khaled1, SA Khor2, O Eldeeb1, S Shahid1 1Newcastle University Medicine Malaysia (NUMED Malaysia), Johor 2Hospital Sultan Ismail, Johor Bahru, Johor CASE DESCRIPTION: A 16-year-old Indian-Malay male presented with multiple falls and progressive ataxia that started 1 year ago. He also reported generalised numbness, weakness, fatigue and dyscalculia, which affected his school attendance and performance. He has a family history of learning disability and a personal history of consuming approximately 15 units of alcohol weekly. On investigations, MRI revealed extensive cerebral and intramedullary cord T2W hyperintense non-enhancing lesions suggesting a demyelinating disease disseminated in space, though without dissemination in time. Lumbar puncture showed oligoclonal bands, fulfilling the diagnostic criteria. A thorough antibodies panel excluded other conditions, and the diagnosis of primary progressive multiple sclerosis (PPMS) was suggested. Management comprised a pulse dose of IV Methylprednisolone, Vitamin D, initiation of physiotherapy, and a pending approval for Ocrelizumab. DISCUSSION/CONCLUSION: This case highlights the variability of multiple sclerosis presentations and how a ‘great imitator’ it is and serves as a reminder to avoid tunnel vision when encountering new cases. This constellation of symptoms initially put multiple differentials in mind such as Guillain-Barré syndrome (GBS). With the MRI results, Neuromyelitis optica spectrum disorder (NMOSD) would be another differential, hence the extensive investigations. Moreover, the cognitive impairment, early disease onset and family history of learning disability raised a possibility for inherited conditions such as Friedreich ataxia. Finally, the extensive nature of the disease and its impact on the patient’s life raises the need for a holistic approach when managing MS and the necessity of novel effective therapies.
UNDERSTANDING PEDIATRIC SPINAL LESIONS: A CASE REPORT OF NEUROENTERIC CYST SC 03 S Shahid1, K Khaled 1, O Eldeeb1, Asma', Afifi2 1Newcastle University Medicine Malaysia (NUMed), Johor 2Hospital Sultanah Aminah, Johor CASE DESCRIPTION: This case report is about a 4-year-old boy with acute-onset limb weakness and torticollis. Initially experiencing headache and neck pain intermittently, he developed left torticollis, followed by bilateral upper limb weakness and subsequent bilateral lower limb weakness with urinary incontinence within 3 days of presentation. Neurological examination revealed hypotonia, hyporeflexia in the upper limbs, and asymmetric power in the lower limbs. MRI identified a spinal cyst at the C2 level compressing the cervical cord, leading to cord edema at C3 level. However, no intracerebral lesions or abnormalities were found. Differential diagnosis of Arachnoid cyst was considered however, histopathological analysis revealed the cyst to be of neuroenteric/endodermal (enterogenous) origin. DISCUSSION/CONCLUSION: The diagnosis of a neuroenteric cyst, distinct from arachnoid cyst, underscores the complexity of diagnosing spinal lesions in pediatric patients. While arachnoid cysts are often asymptomatic and arise from the arachnoid membrane, neuroenteric cysts originate from endodermal remnants and can lead to neurological deficits due to spinal cord compression. The preferred treatment for symptomatic patients is thorough complete surgical removal as incomplete resection carries the risk of recurrence or potential malignancy. However, there are instances where subtotal resection is considered such as severe adhesion to adjacent structure where total resection increases risk of cord injury. This case highlights the importance of accurate diagnosis and tailored management approaches for rare spinal lesions in pediatric patients.
MANAGING ADVANCED CHRONIC KIDNEY DISEASE COMPLICATED BY METABOLIC ACIDOSIS AND UREMIA IN THE SETTING OF POLYCYSTIC KIDNEY DISEASE: A CASE STUDY SC 04 Y Elebessy1, S Shahid1, SY Ng2 1Newcastle University Medicine Malaysia (NUMed), Johor 2Hospital Sultan Ismail, Johor CASE DESCRIPTION: This case study focuses on a 41-year-old Malay female presenting with advanced chronic kidney disease (CKD) complicated by metabolic acidosis and uremia. The patient exhibited symptoms of vomiting, abdominal pain, and hematuria, with a medical history notable for type II diabetes mellitus, hypertension, and autosomal dominant polycystic kidney disease (ADPKD). Diagnostic imaging confirmed the presence of multiple cysts in both kidneys consistent with ADPKD five years ago. Laboratory investigations revealed severe renal impairment, metabolic acidosis, and non-compensatory normochromic normocytic anemia. Treatment involved a combination of hemodialysis sessions, blood transfusions, and pharmacological interventions to address electrolyte imbalances, manage anemia, and alleviate fluid overload. Concurrently, preparations for renal replacement therapy (RRT) were initiated, including the creation of an arteriovenous fistula (AVF) and education on continuous ambulatory peritoneal dialysis (CAPD). DISCUSSION/CONCLUSION: This case underscores the complexity of managing CKD complications such as metabolic acidosis and uremia, particularly in the context of comorbidities like ADPKD. Multidisciplinary collaboration between medical and surgical teams is essential for optimizing patient outcomes. Early initiation of RRT and meticulous monitoring of electrolyte balance and fluid status are crucial aspects of managing advanced CKD. Long-term management strategies should focus on slowing disease progression, controlling symptoms, and improving overall quality of life for patients with advanced CKD.
JOHOR RESEARCH DAY 2024: ACKNOWLEDGEMENT
ACKNOWLEDGEMENT The organising Committee of the JOHOR SCIENTIFIC CONFERENCE wished to express its apppriciation to the following for their contribution and support for the conference Right Honourable Chief Minister of Johor Johor State Goverment Johor State Health Department Invited Speaker Members of the various Committees
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