Kanser nasofarinks atau Nasopharyngeal Carcinoma (NPC) adalah kanser yang tumbuh atau bermula di kawasan yang dipanggil nasopharynx atau belakang hidung  (Imej 1).


Imej 1: Kawasan nasopharynx atau belakang hidung


Kanser ini merupakan kanser kepala dan leher yang paling kerap berlaku dan antara 5 kanser paling kerap berlaku bagi kaum lelaki di Malaysia.

1. Apakah FAKTOR RISIKO kanser nasofarinks?

a)    Genetik - kanser ini paling kerap berlaku dalam kalangan mereka yang berketurunan Cina (49%), diikuti kaum Bidayuh di Sarawak dan lain-lain kaum pribumi Sabah dan Sarawak, dan orang Melayu juga direkodkan memiliki kekerapan yang tinggi. Kanser ini sangat jarang ditemui dalam kaum India. (Clinical Practice Guidelines, KKM).

b)    Jangkitan virus Ebstein Barr (EBV)

c)    Sejarah ahli keluarga pernah mengidap NPC atau kanser.

d)    Faktor gaya hidup dan persekitaran seperti merokok, pengambilan diet ikan masin, pendedahan kepada bahan kimia dan industri yang berpanjangan (melebihi 10 tahun) juga menjadi faktor risiko untuk kanser nasofarinks ini.


2. Apakah GEJALA (Symptoms) yang dikaitkan dengan kanser ini?

a)    Bengkak / benjolan di leher melebihi 2 minggu dan semakin membesar  (rujuk  imej 2)
 



Sumber imej: Muhamad Yusri Musa


b)    Hidung berdarah, tersumbat, mengeluarkan cecair berlendir bercampur darah.

c)    Kurang pendengaran, telinga berdengung (kebiasaannya sebelah).

d)    Sakit kepala, belakang mata atau muka.

e)    Pandangan kabur atau berganda (double vision).

f)    Lain-lain gejala umum seperti kurang sihat, demam berpanjangan, sukar menelan, kurang selera makan dan berat badan menurun.


3. Bagaimana DIAGNOSIS dilakukan jika mengalami gejala yang berkaitan?

a)    Pengesahan diagnosis boleh dilakukan dengan pemeriksaan endoskopi ke dalam rongga hidung dan tisu untuk pemeriksaan histopatologi diambil daripada kawasan nasofarinks yang disyaki ada ketumbuhan.

b)    Penyiasatan pengimejan seperti  Magnetic Resonance Imaging, MRI dan Computed Tomography, CT scan juga akan dilakukan untuk membantu diagnosis.


4. Apakah RAWATAN yang boleh dilakukan?

a)    Antara rawatan terkini yang boleh dilakukan adalah gabungan Radioterapi dan Kemoterapi (Concurrent Chemoradiothrapy, CCRT) dan menggunakan teknologi Intensity Modulated Radiotherapy (IMRT) untuk radioterapi. Pengalaman penulis di Institut Perubatan dan Pergigian Termaju (IPPT) USM Bertam  sejak memulakan perkhidmatan radioterapi pada 2015 telah merawat lebih 100 pesakit kanser nasofarinks dengan kadar penyembuhan dianggarkan melebihi 70 peratus (tertakluk kepada tahap). Namun begitu, terdapat pelbagai kaedah lain atau gabungan protokol rawatan yang pelbagai bergantung kepada keupayaan kepakaran dan teknologi yang ada di institusi perubatan tersebut, tahap penyakit dan pesakit.

b)    Kebanyakan pusat-pusat rawatan onkologi dan radioterapi di seluruh negara mampu memberikan rawatan yang tepat untuk kanser nasofarinks. Pesakit tidak perlu bimbang dan risau tentang kaedah rawatan dan komplikasi kerana rawatan dan sokongan yang berterusan akan diberikan kepada pesakit agar mereka dapat menyelesaikan rawatan dengan sempurna dan kembali pulih.


5. Apakah peluang untuk SEMBUH?

a)    Kanser ini merupakan antara kanser yang memiliki kadar kesembuhan yang tinggi berbanding kanser-kanser yang lain. Anggaran kadar penyembuhan yang dilaporkan oleh pelbagai jurnal dan badan antarabangsa adalah pada tahap melebihi 80 peratus untuk kanser tahap 1 dan 2.

Secara rumusannya kanser nasofarinks ini boleh dirawat dengan berkesan serta mempunyai peluang kesembuhan yang amat cerah jika dapat dikesan pada tahap awal (1 dan 2) dan melalui semua proses pemeriksaan dan rawatan yang disediakan. Malahan, pesakit tahap 3 dan 4 juga berpotensi untuk mendapat kesembuhan yang sepenuhnya jika berupaya melalui proses rawatan dengan sempurna.

Rujukan 

1. Clinical Practice Guidelines (CPG), Ministry of Health Malaysia.
2. Nasopharyngeal cancer: EHNS–ESMO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Oleh:
Dr.Muhamad Yusri Musa
Pakar Perunding Otorinolaringologi
IPPT, USM Kampus Bertam





Expert views : Lagi-lagi resdung


Opinions and Reviews on "Resdung".  'Consulting is more than giving advice'.  Biar betul? Ulat resdung keluar dari hidung?!

View at https://youtu.be/LJOcGuZwyuw and Subscribe Dr. Yusri MD channel to get more info.




Expert views: Primary Immunodeficiency Diseases: clinical and diagnostic services in IPPT


Primary immunodeficiency diseases (PID) is a disease caused by defective immune system leading to increased susceptibility to infection and maybe fatal. It involves diverse phenotype which may include susceptibility to infections, allergy, immune dysregulations and auto-inflammation. With the advent of exome and genome sequencing, more than 350 identified genetic defect causing monogenic PID worldwide. 

Each individual has his or her own blueprint, a map made up of millions of bits of information called genes. The gene-map of each individual is a unique mix of genes from the mother and father. This map instructs the body how to build and how to maintain itself. Sometimes there are malfunctions in this map. When it fails to produce a functioning immune system, the disease resulting is called a primary immune deficiency (PI). Sometimes there may be a history of such a malfunction in the family, but often there is not.  It all depends upon how the genes of the parents have come together to make up the blueprint for a unique and distinct individual.

In 2019, the Primary Immunodeficiency Disease Group officially launched a diagnostic and treatment service, catering for clinical referrals from Northern and Eastern Malaysia (Kelantan and Terengganu). The service comprises a clinical service and diagnostic lab which does some immunological tests like T, B and NK cells enumeration, serum immunoglobulin (Ig) and allergy tests. There are also tests for specific antibody production. These tests measure how well the immune system responds to vaccines. 

The team is headed by Dr Intan Juliana Abd Hamid, a Paediatric Immunologist, supported by two scientists (Dr Zarina Thasneem Zainudeen and Dr Ilie Fadzilah Hashim) working on functional and molecular/genetic aspects of PID and two staff nurses. This centre is also listed on Jeffrey Modell Foundation website. 


Our PID Clinic location : https://goo.gl/maps/11JXSKAzT69XaSQA7




Prepared by:
Dr. Zarina Thasneem Zainudeen
(University Lecturer (DS51))
Dr. Intan Juliana Abd Hamid
(Paediatric Immunology & Allergy)
Dr. Ilie Fadzilah Hashim
(University Lecturer (DS51))




Obsessive-compulsive disorder (OCD) and COVID-19 pandemic


COVID-19 caused by infection with the SARS CoV-2 virus has become a major infection pandemic since March 2020 which resulting in more than 25 million people infected worldwide and leads to more than 800,000 deaths. A few of the preventive measures to prevent the spread of infection and to break the chain of infection include frequent hand washing, social distancing, frequent use of hand sanitiser, and home quarantine. These precautionary and preventive measures to combat COVID-19 are not without negative impact on the mental health of the general population. One of the common symptoms of obsessive-compulsive disorder (OCD) is repetitive obsessive contamination and compulsive hand washing. Interview with Dr. Mohammad Farris Iman Leong Bin Abdullah, Consultant Psychiatrist, Institut Perubatan dan Pergigian Termaju, Universiti Sains Malaysia will get you informed regarding the risk of OCD during COVID-19:

(1) Following the standard operating procedure implemented during the Restricted Movement Control Order (RMCO), would it possible to make people contracting OCD as they are advised to keep washing their hands or use hand sanitiser?

Response: Yes, there is a possibility that people who are exposed to too much media coverage and information regarding the high mortality rate and the negative impact of COVID-19, having an intense fear of getting infected, and their strong belief that COVID-19 can be prevented by frequent hand washing, social distancing, and frequent use of hand sanitiser will lead to constant fear and anxiety which may aggravate some people to develop OCD, especially with symptoms like obsessive contamination (repeated thoughts of being dirty, the surrounding is full of germs and viruses, and having high risk of being infected) and compulsive hand washing or repeated taking bath or cleaning body (repeated hand washing which they are compelled to perform due to the anxiety develop from the obsessive thoughts of contamination). In addition, those who are at high risk of worsening of OCD symptoms due to COVID-19 are those who already have OCD before the start of COVID-19. Even OCD patients who have recovered from OCD symptoms due to treatment are also at high risk of recurrence of OCD due to COVID-19 and MCO.

(2) Parents put too much pressure on their children to study, especially when they cannot go out during the MCO period, and they still have to study and face their computer every day. Will that leads to increase risk of OCD in their children? How do we recognise the early symptoms of OCD?

Response: No. Restricting children to go out and force them to study during MCO will not increase the risk of OCD. As I have mentioned in response to question 1, the risk factors are those who focused too much onto information on COVID-19, intense fear of being infected, those who are obsessed with the needs of frequent hand washing, need for good hygiene, and the need for frequent use of sanitiser. However, if the child already suffering from OCD before COVID-19 started, then the child is at risk of worsening of OCD symptoms or having a recurrence of OCD if the child gets too stressful as a result of being forced by parents to stay at home to study and do nothing else.

OCD is characterised by (a) obsessive thoughts (like repeated thoughts of feeling dirty, himself/herself and the surrounding is full of germs or repeated doubts that doors are not closed, gas is not shut off, etc. or repeated thoughts that objects are not placed in the right position or repeated urges/mind images to do something bad) and (b) compulsion (repeated hand washing/taking bath or repeated checking for doors/gas or repeated praying/counting/saying some words silently to distract the bad urges/mind images). In the context of COVID-19, the common OCD symptoms will be repeated thoughts of feeling dirty, himself/herself and the surrounding is full of germs followed by repeated hand washing/taking a bath or rubbing hands with sanitisers.

(3) Because of COVID-19, working at home is stressful. Can this also cause OCD?  How do we know if we have OCD?

Response: Again the answer is the same as question 2. No risk for OCD for those who do not have OCD before in their life even if they are stress working at home. But those who already have OCD before COVID, yes, stress working at home will increase their risk of worsening of OCD symptoms or recurrence of OCD for those who have recovered. The risk factors for those who are normal to develop OCD during COVID are those who focus too much onto information on COVID-19, intense fear of being infected, those who are obsessed with the needs of frequent hand washing, need for good hygiene, and the need of frequent use of sanitizer. In the context of COVID-19, the common OCD symptoms will be repeated thoughts of feeling dirty, himself/herself and surrounding is full of germs followed by repeated hand washing/taking bath or rubbing hands with sanitisers. As a result of COVID-19, some people may also develop an intense fear of shortage of basic goods like food, water, medication, protective tools like mask and gloves may lead to hoarding disorder which is closely related to OCD in which the person will collect and accumulate all these basic goods in the house until there is no more space to put other things or belongings. This may be seen in some people who panicky to buy things and goods in the supermarket at the start of MCO.

(4) During the RMCO, patients with OCD worry about being infected and difficult to feel relaxed. Will the symptoms of repeated hand washing be more serious?

Response: Yes, OCD patients can have worsening of symptoms like worsening of repeated hand washing if their fear of getting infected and difficulty to feel relaxed become worsened during MCO. Even those OCD patients who had different OCD symptoms (like obsessive doubts and compulsive checking) before COVID-19, can also develop obsessive contamination and compulsive hand washing during MCO due to fear of getting infected.

(5) Nowadays, because people are worried about their safety wherever they go to and expose to strangers, will it cause many people to have an increased risk of OCD? Will this cause them to pay attention to disinfection, wash their hands, and wipe alcohol wipes all the time?

Response: Again, the risk factors to develop OCD during COVID-19 are those who focus too much onto information on COVID-19, intense fear of being infected, those who are obsessed with the needs of frequent hand washing, need for good hygiene, and the need of frequent use of sanitiser. In addition, patient with pre-existing OCD also have a high risk of recurrence or worsening of OCD symptoms. If anyone has these risk factors, then their chances of acquiring OCD during the COVID-19 pandemic will increase.

(6) Most celebrities suffer from OCD, depression, and eventually suicidal or anorexia symptoms. Are celebrities prone to develop OCD, depression and eventually suicide and anorexia?

Response: OCD and depression are associated with environmental factors, such as if people experience tremendous stress and unable to cope with it effectively, if they allowed the uncontrolled stress to be prolonged without asking for expert help to curb this, they will be prone for OCD and depression. In fact, OCD with co-morbid depression is common in many patients. Celebrities, on the other hand, are at constant stress due to the nature of their work and prolonged uncontrolled stress will lead to depression and OCD. Of course, if depression gets more severe and if untreated, will result in suicidal behaviour, which is the most severe symptom of depression. In fact, OCD with co-morbid depression is also a risk to develop suicidal behaviour. While for anorexia, be it anorexia nervosa or anorexia bulimia, for celebrities due to the nature of their work which needs to be good-looking and have a beautiful body are prone to and at risk of anorexia.



The role of Computed Tomography Calcium Scoring in early screening of Coronary Artery Disease


What is Coronary Artery Disease?

Coronary Artery Disease or Coronary  Arterial Disease (CAD) is caused by damage to the main blood vessels that supply oxygen and nutrients to the heart. The formation of cholesterol plaques on the walls of the arteries will eventually reduce the size of the arterial diameter and in turn results in a reduction in blood flow to the heart.

Decreased blood supply to the heart can lead to chest pain (angina), shortness of breath as well as other symptoms of coronary heart disease. If the coronary artery is completely blocked, then the individual with affected vessel can get a heart attack. As the narrowing of the arteries takes a long time, usually an individual will only realise it when a heart attack occurs.

 Risk Factors

There are various factors that contribute to this coronary artery damage. These include age, gender, family history, smoking habit, high blood pressure, dyslipidaemia, diabetes mellitus, overweight, lack of exercise, stress and consuming unhealthy diet.

Role of Computed Tomography Calcium Scoring

Usually a physician will recommend a calcium scoring examination to patients at risk of getting CAD. Calcium scoring is a non-invasive examination that uses a computed tomography (CT) scan. In this examination, information related to the presence, position and burden of plaques in the coronary arteries can be identified to determine the level and risk a person is likely to have CAD. The CT scanning process only takes less than 5 minutes without the need to administer contrast agent. In this examination, the level of calcium in the heart's blood vessels will be measured and the percentage of plaque will be calculated electronically.


Calcium in each heart blood vessel and its  location is identified using different colors

In general, the results of calcium scoring will be classified as below:

Calcium Score

Diagnosis

Description

0

No identifiable atherosclerotic plaque. Very low cardiovascular disease risk.

A ‘negative’ test.

Greater than 95% chance for absence of CAD.

1-10

Minimal plaque burden.

‘Significant’ CAD very unlikely.

11-100

Mild plaque burden.

Likely mild or minimal coronary stenosis.

101-400

Moderate plaque burden.

Moderate non-obstructive CAD highly likely.

Over 400

High (extensive plaque burden).

Higher likelihood of at least one ‘significant’ coronary stenosis (>50% diameter).


For negative readings and those with minimal calcium score, the probability of getting CAD is very low over the next 2 to 5 years. Patients with mild and moderate calcium scores are usually advised to adopt a healthy lifestyle in terms of food intake as well as daily activities to reduce the risk of getting CAD. For patients with high plaque burden, further treatment and examination such as coronary angiography are usually required as the likelihood of coronary artery stenosis and the risk of heart attack is very high. At this point, the doctor will prescribe the medications that need to be taken as well as the preventive measures that the patient needs to take such as eating healthy diet and performing regular exercise. Regular visits to the doctor, especially for patients with high risk are very important to ensure the effectiveness of medications, intervention or procedures taken.

References

Greenland P, Blaha M, Budoff M, et al. (2018). Coronary Calcium Score and Cardiovascular Risk. J Am Coll Cardiol. Jul, 72 (4) 434–447.









10 fakta tentang katarak anda perlu tahu


 

Apabila penglihatan anda menjadi kabur dan silau, salah satu penyebabnya mungkin adalah katarak. Katarak adalah kekeruhan lensa mata yang terjadi secara semula jadi akibat beberapa faktor, terutamanya disebabkan usia lanjut. Lensa mata terletak di belakang kornea dan fungsinya serupa dengan lensa kamera. 


Kedudukan dan fungsi lensa kamera (A) adalah lebih kurang seperti lensa manusia (B). Cahaya yang masuk melalui apertur kamera boleh di ‘zoom’ atau difokus oleh lensa, dan imej akan terbentuk pada filem. Di dalam mata, cahaya masuk melalui kornea, anak mata dan lensa, seterusnya membentuk imej pada retina. Maklumat ini dihantar melalui saraf optik ke otak untuk ditafsir.

Pembedahan katarak adalah antara jenis pembedahan yang sangat lazim dilakukan. Di Malaysia, sebanyak 60,000 pembedahan katarak dilakukan dalam setahun di hospital kerajaan di bawah Kementerian Kesihatan Malaysia (KKM). Jumlah yang sama juga dianggarkan dilakukan di fasiliti swasta dan hospital universiti. Berikut adalah 10 fakta tentang katarak yang anda perlu tahu:

1) Adakah katarak hanya terdapat pada orang tua?

Sebilangan besar katarak terjadi secara perlahan-lahan dan mula terjadi pada usia lebih dari 50 tahun. Kadang-kadang bayi juga boleh mendapat katarak sejak lahir. Ini biasanya terjadi akibat komplikasi jangkitan semasa mengandung atau penyakit keturunan.

2) Bolehkah katarak dielakkan?

Katarak adalah proses penuaan semulajadi dan secara beransur-ansur membuat penglihatan makin kabur. Diet yang kaya dengan vitamin E dan C, lemak omega-3, lutein, dan zeaxanthin, boleh membantu kesihatan mata. Selain itu, penyakit diabetis dan beberapa penyakit kronik dan keradangan boleh menyebabkan katarak terjadi lebih awal. Tabiat merokok dan pengambilan alkohol yang berlebihan juga boleh mempengaruhi kejadian katarak. 

3) Bagaimana katarak dirawat?

Rawatan katarak adalah secara pembedahan. Teknik moden iaitu ‘phacoemulsification’ adalah pembedahan mikro dengan incision yang kecil tanpa jahitan. Lensa asal dikeluarkan dan kemudian diganti dengan implan lensa intraokular (IOL) untuk memulihkan penglihatan. Dalam kebanyakan kes, mata sembuh dengan cepat selepas pembedahan tanpa jahitan.

4) Adakah pembedahan satu-satunya rawatan katarak?

Pada masa ini dan untuk masa yang akan datang pembedahan adalah satu-satunya rawatan untuk katarak. Walaupun diet yang sihat dan perubahan gaya hidup dapat membantu mencegah katarak, namun ia tidak dapat membalikkan katarak setelah ia terjadi. Para penyelidik sedang mengkaji sama ada kemungkinan terdapat ubat titis mata yang dapat mencegah atau menyembuhkan katarak, tetapi kajian ini berada pada tahap awal. Sukar untuk meramalkan bila rawatan tersebut boleh dipraktis atau adakah ia akan berkesan seperti pembedahan katarak.

5) Adakah pembedahan katarak serius?

Semua pembedahan melibatkan beberapa risiko, jadi ya, memang serius. Walau bagaimanapun, pembedahan katarak adalah jenis pembedahan yang paling kerap dilakukan. Ramai pakar bedah katarak adalah sangat berpengalaman dan ini akan mengurangkan risiko komplikasi terjadi.

6) Doktor mengatakan saya ada katarak, tetapi dia mahu saya menunggu dahulu sebelum membuat pembedahan. Kenapa?

Katarak peringkat awal menyebabkan sedikit gangguan penglihatan. Doktor anda mungkin mahu mengawasi perkembangan katarak adakah menjadi semakin matang dan lebih menjejaskan penglihatan dan gaya hidup anda sebelum mengesyorkan pembedahan.

Sebilangan katarak tidak sampai ke tahap di mana ia perlu dikeluarkan. Tetapi jika katarak anda bertambah buruk dan anda mula menghadapi masalah untuk melihat dengan jelas semasa memandu dan melakukan tugas seharian yang lain, mungkin sudah tiba masanya untuk pembedahan katarak.

7) Adakah saya terjaga semasa pembedahan katarak?

Ya, biasanya pesakit dalam keadaan terjaga (sedar) semasa pembedahan katarak kerana menggunakan bius setempat sahaja. Ini bagi mengurangkan risiko yang berkaitan dengan bius am (general anaesthesia). Di bawah bius setempat, pakar bedah katarak boleh berkomunikasi dengan pesakit semasa pembedahan berjalan.

8) Adakah saya perlu cermin mata selepas pembedahan katarak?

Bergantung kepada jenis implan IOL - sekiranya anda memilih implan biasa, kemungkinan anda memerlukan cermin membaca, atau ‘power’ yang rendah untuk jarak jauh, ini bergantung kepada keperluan visual anda. Ramai juga pesakit yang tidak memerlukan cermin mata. Pembedahan katarak dengan lensa premium seperti IOL multifokal dapat memberikan hasil yang sangat baik dan membolehkan ramai pesakit bebas tanpa cermin mata.

9) Berapakah kos pembedahan katarak?

Kos pembedahan katarak berbeza bergantung kepada jenis prosedur, jenis lensa intraokular dan fasiliti kerajaan atau swasta yang dipilih. Pada masa kini, pembedahan katarak (untuk satu mata) di hospital kerajaan di bawah Kementerian Kesihatan Malaysia menelan belanja lebih kurang RM900.00 bagi jenis IOL biasa. Kos IOL jenis khas boleh menelan kos tambahan RM1,000 ke RM3,000. Pembedahan  di hospital swasta adalah bergantung kepada pusat rawatan yang dipilih.

10) Apa yang berlaku sekiranya katarak dibiarkan tanpa rawatan?

Dalam kebanyakan kes, katarak akan semakin menebal dari masa ke masa, menyebabkan penglihatan semakin berkurang secara berterusan. Ini boleh menjejaskan gaya hidup seperti tidak boleh memandu atau melakukan tugas harian. Katarak yang terlalu masak atau terlalu tebal menyukarkan prosedur pembedahan, bahkan boleh menyebabkan kebutaan total jika dibiarkan lama. Walaubagaimana pun, agak mustahil untuk meramalkan dengan tepat bila katarak akan bertambah teruk dalam setiap individu.

Jika anda mempunyai masalah penglihatan sila berjumpa doktor untuk pemeriksaan lanjut dan mendapatkan rawatan.




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