To assess the efficacy of the trans-septal approach to the mitral valve, 40 patients who underwent mitral valve surgery via this approach were compared to 37 patients who underwent surgery via the standard left atriotomy. Concomitant procedures included tricuspid annuloplasty, aortic valve replacement, closure of atrial septal defect, coronary artery bypass grafting and aortic valve repair. There was one (1.2%) operative mortality. No patients required pacemaker implantation. Follow-up of up to 18 months showed that all patients were in NYHA classes I and II. One third of the patients who had trans-septal approach to the mitral valve achieved conversion from atrial fibrillation to sinus rhythm while none of the patients who underwent conventional left atriotomy had conversion (p < 0.02). The trans-septal approach to the mitral valve is a useful approach in selective patients requiring mitral valve surgery.
Comment in: Lim KG. The trans-septal approach to the mitral valve. Med J Malaysia. 2001 Dec;56(4):513
Leukemic infiltration of the optic nerve is rare . [Camera, A., Piccirillo, G., Tranfa, F., Rosa, N., Frigeri, F., Martinelli, V., Rotoloi, B. (1993) "Optic nerve involvement in acute lymphoblastic leukemia", Leuk. Lymph. 11, 153-155]. Radiotherapy should be given urgently to all patients with optic nerve infiltrate to restore their vision . [Rosenthal, A. (1983) "Ocular manifestation of leukemia", Ophthalmology 90, 899-905]. We report a case of a unilateral optic nerve relapse 7 months after diagnosis of acute lymphoblastic leukemia (ALL) in a 17-year-old boy who had been off treatment for 6 weeks. The ocular symptoms was initially diagnosed as primary optic neuritis and treated with corticosteroids resulting in temporary clinical recovery. Radiation therapy for ocular leukemia that was commenced 2 months after the onset of symptoms failed to reverse the visual loss. The lack of a reliable and effective tool to diagnose ocular leukemia at an early stage has resulted in significant treatment delay and poor visual outcome.
It is essential to replace fluids lost so as to remain well hydrated during exercise. The intake of fluids is considered a physiological ergogenic aid to enhance exercise performance. There are currently several products in the market that are believed to have ergogenic properties which act as fluid replacement drinks during exercise. One such drink available in the Malaysian market is â€˜AgroMasÂ®â€™ herbal drink whose efficacy is yet to be proven. The purpose of this study was, therefore, to evaluate the effects of acute ingestion of this herbal drink (H) or a coloured water placebo (P) on cycling performance. Nine healthy and trained young male cyclists (age: 16.2 Â± 0.5 years) exercised on a cycle ergometer at 71.9 Â± 0.7% of maximal oxygen consumption (VO2max) until exhaustion on two occasions at 1-week intervals. During each exercise bout, subjects received 3ml kg-1 body weight of H or P every 20 min in a double-blind randomised study design. There was no significant difference between H and P trials in the total work time to exhaustion (83.7 Â± 4.6 and 81.5 Â± 5.0 min respectively). Changes in oxygen consumption, heart rate and perceived rate of exertion were similar for both types of drinks. These results demonstrate that the herbal drink and the placebo elicited similar physiological responses and exercise performance during endurance cycling. It is therefore concluded that AgroMasÂ® herbal drink and water ingestion resulted in a similar ergogenic response on cycling performance in young cyclists.
MeSH terms: Central Nervous System Stimulants; Body Weight; Double-Blind Method; Physical Exertion; Heart Rate; Male; Oxygen Consumption; Water; Exercise; Ergometry
Food insecurity exists whenever people are not able to access sufficient food at all times for an active and healthy life. This study used the Radimer/Cornell hunger and food insecurity instrument to assess food insecurity and to determine the risk factors and consequences of food insecurity among low-income households in Kuala Lumpur. One hundred and thirty-seven Malay pre-school children (4-6 years old) from Taman Sang Kancil were measured for their weights and heights. Questionnaires were used to collect food security and socioeconomic information on the households. The findings indicated that 34.3% of the households were food secure, while 65.7% experienced some kind of food insecurity, (27.7% households were food insecure, 10.9% individuals were food insecure and 27.0% fell into the child hunger category). The prevalence of underweight, stunting and wasting were 44.5%, 36.5% and 30.7% respectively. The prevalence of high weight-for-height (overweight) was 13.1%. Based on multinomial logistic regression, larger household size (OR=1.418; p
Age has been suggested to modify systemic lupus erythematosus expression. In this study we have attempted to study 13 patients with late onset (40 years and above) and 90 with early onset disease (below 40 years) to determine whether agerelated differences in disease expression exist and whether the genetic make-up influences the age of disease onset. We found that patients with late onset disease initially presented with pericarditis (31% vs 3%, P
We have recently reported that a dipstick colloidal dye immunoassay (DIA) that detect parasite antigens in human serum is sensitive and specific for the diagnosis of active infection of lymphatic filariasis. Rabbit polyclonal antibodies (RbBmCAg) labelled with a commercial dye, palanil navy blue was used to detect filarial antigenemia among Indonesian and Bangladeshi immigrant workers (N= 630) at oil palm estates at Hulu Trengganu District, Peninsular Malaysia. Microfilaremia with Brugia malayi were detected in 51 (8.10%) individuals, of which 42 (6.67%) were among the Indonesians and 9 (1.98 %) among the Bangladeshis. Microfilaremia with Wuchereria bancrofti were detected in 33 (5.24 %) individuals of which 15 (2.38 %) were among the Indonesians and 18 (2.86 %) among the Bangladeshis workers. The DIA detected 96 (15.24 %) antigenemic cases which comprise of all the microfilaremic cases and 15 (2.38%) amicrofilaremic cases. The amicrofilaremic cases with filarial antigenemia consisted of 9 (1.43%) Indonesians and 6 (0.95%) Bangladeshis. We have used 6 ul of the RbBmCAg and diluted (1:10) patientsâ€™ sera per dipstick which make the DIA reagent conservative. The DIA is a rapid test and can be read in approximate 2 hours.. Additionally, coloured dots developed in the DIA can be qualitatively assessed visually for intensity. The DIA does not require sophisticated equipment or radioactivity, and therefore suitable for field application.
A young man was involved in a motor vehicle accident and sustained cerebral contusion in the right frontal and occipital lobes. Computed tomography (CT) scan done 2 weeks after the injury revealed multiple serpenginous structures which enhanced following intravenous contrast media administration. The possibility of arteriovenous malformation (AVM) was raised and angiography was suggested. However, he was managed conservatively and a repeat CT scan 4 months post trauma revealed encephalomalacia in the right frontal and occipital lobes with no more surrounding enhancement. The cause for the multiple serpenginous enhancement demonstrated previously confirmed those are areas of hyperperfusion in healing surface brain contusion. The aim of this case report is to discuss on the possible causes of focal enhancement following head injury versus the features of AVM on plain and post contrast CT scan with the effort to clear the doubt and to avoid future confusion.
Lactic Acid Bacteria (LAB) isolated from several traditional fermented foods such as â€œtempehâ€, â€œtempoyakâ€ and â€œtapaiâ€ were screened for the production of bacteriocin. One strain isolated from â€œtempehâ€ gives an inhibitory activity against several LAB. The strain was later identified as Lactobacillus plantarum BS2. Study shows that the inhibitory activity was not caused by hydrogen peroxide, organic acids or bacteriophage. The bacteriocin production was maximum after 10 hours of incubation with an activity of 200 AU/ml. The bacteriocin was found to be sensitive towards trypsin, a-chymotrypsin, b-chymotrypsin, a-amylase and lysozyme.
A strain of streptomycin-resistant Listeria monocytogenes LM35 isolated from imported frozen beef was examined in this study. In conjugation studies, the L. monocytogenes LM35 strain harbouring two plasmids of 54, 3.0, 2.8 and 2.7 kilobase was used as the donor and streptomycin-sensitive and plasmidless L. monocytogenes LM65 and LM100 strains as the recipients. Streptomycin resistance was transferred to L. monocytogenes LM65 and LM100 strains at frequencies of 3.3 x 10-8 and 1.2 x 10-9 per input donor cells, respectively. In both occasions, we also observed the concomitant transfer of the donorâ€™s 54 kilobase plasmid. These results suggest that streptomycin resistance in L. monocytogenes LM35 was mediated by the 54 kilobase plasmid.
Twenty-eight isolates of E. faecalis and 5 isolates of E. hirae were isolated from chicken samples obtained from markets in Sri Serdang, Selangor. They were tested for susceptibility to vancomycin and other antimicrobial agents. All of the isolates showed multiple resistance to the antibiotic tested. All Enterococcus spp. were resistant (100%) to ceftaxidime, cephalothin, erythromycin, gentamicin, kanamycin, nalidixic acid and streptomycin. Resistance was also observed to norfloxacin (97%), tetracycline (91%), penicillin (85%), bacitracin (82%), chloramphenicol (61%) and the least resistance was to ampicillin (27%). High prevalence to vancomycin resistance was detected among the E. faecalis (27of 28) and E. hirae (4 of 5) isolates. The multiple antibiotic resistance index ranging between 0.64 to 1.0 showed that all strains tested originated from high-risk contamination. Plasmid profile analysis of Enterococcus spp. revealed plasmid DNA bands ranging in size from 1.3 to 35.8 megadalton but some isolates were plasmidless. No correlation could be made between plasmid patterns and antibiotic resistance.
Âµ-Lipoic acid (ALA) is a naturally occuring cofactor that serves as an acyl carrier in oxidative decarboxylation of _-keto acids in carbohydrate metabolism. Current findings suggest that _-lipoic acid and its reduced form, dihydrolipoic acid (DHLA) may act as antioxidants and are able to quench free radicals in vitro and in vivo. However, the mechanism underlying the process is still unknown. In this study, atherosclerotic lesions were induced in six groups of adult male NZW rabbits labelled as group K, A, B, C, D, E (n=6) by giving 100g/head/day of 2% cholesterolrich diet for ten weeks. While group K acted as a control, the rest were supplemented with ALA orally (1.4, 2.8, 4.2, 8.0 and 10mg/kg, respectively). In week ten, venous blood samples drawn from ear lobes were analysed for complete lipid profile and peroxidation index. The results showed a significant reduction of total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) levels in most of the treated groups as compared to the control whereas apo-A levels showed a significant increase in group C and D. However, microsomal lipid peroxidation index, malondialdehyde (MDA) was found to be not significantly different. These findings suggest that Âµ-lipoic acid may act as a lipid lowering agent in dose dependent manner in premature stage of atherosclerosis but was unable to inhibit lipid peroxidation processes in matured stage of atherosclerosis in rabbits fed a high cholesterol diet.
Milk is a physiological fluid which has high nutritional value and soybean has strong antioxidant characteristics which is believed to inhibit carcinogenesis. The objective of this study was to investigate the effects of administration of soybean and goatâ€™s milk on hepatocarcinogenesis in rats (fed with diethylnitrosamine; DEN and acetylaminofluorene; AAF) by determining the activities of plasma gammaglutamyl transpeptidase (GGT) and alkaline phosphatase (ALP). Thirty-six rats from the species Sprague-Dawley were divided into 6 groups: control, DEN/AAF, soybean, DEN/AAF with soybean treatment, goatâ€™s milk and DEN/AAF with goatâ€™s milk treatment. Soybean and goatâ€™s milk administrations were given 5 ml/day. The rats were sacrificed after 8 weeks and the blood was collected. Treatment with DEN/AAF caused an increase in ALP and GGT levels and a decrease in weight significantly (p
Pulmonary tuberculosis (TB) in the AIDS population has a variable chest radiographic presentation. The association between the chest radiographic presentation of pulmonary TB and CD4 T-lymphocyte count in the HIV-infected patient was investigated in order to provide an empirical approach for early diagnosis, treatment, and isolation of these patients. A retrospective analysis of chest radiographs, CD4 T-lymphocyte counts, and clinical history of 80 patients from Hospital Kota Bharu, was performed. All patients were HIV-seropositive and had culture and /or cytology-proven pulmonary tuberculosis. Radiographs were evaluated for the presence of atypical or typical patterns of pulmonary TB. Thirteen (16.2%) patients had typical postprimary pattern, where opacities were distributed at the upper zones, with or without cavitation. Sixty-seven (83.8%)patients had atypical patterns, consisting of normal chest radiograph, middle and/or lower zones parenchymal opacities, mediastinal lymphadenopathy, pleural effusion and miliary TB. Of these, 18 (22.5%) patients demonstrated normal chest radiographs, 36 (45%) patients showed parenchymal opacities at the middle and/or lower zones of the lungs, 30 (37.5%) had mediastinal lymphadenopathy, 18 (22.5%) revealed pleural effusion and 6 (7.5%) presented with miliary TB. Sixtytwo (77.5%) patients had CD4 T-lymphocytes count less than 200 cells/ul. Of these patients, only 1 (1.6%) had typical pattern. Eighteen (22.5%) patients had CD4 Tlymphocyte count more than 200 cells/ul, where 12 (66.7%) of them showed typical pattern. Patients with CD4 T-lymphocytes count of less than 200 cells/ul, were more likely to produce normal chest radiographs, middle and /or lower zones parenchymal opacities and mediastinal lymphadenopathy. The mean CD4 Tlymphocytes count were also found significantly lower. AIDS patients with pulmonary TB can present with both typical and atypical chest radiograph patterns. An AIDS patient who had CD4 T-lymphocytes count less than 200 cells/ul were more likely to present with atypical radiographic appearance of pulmonary TB. They required appropriate treatment and isolation until the diagnosis of pulmonary TB was confirmed.
MeSH terms: Acquired Immunodeficiency Syndrome; HIV Seropositivity; Humans; Lymphatic Diseases; Lymphocytes; Pleural Effusion; Retrospective Studies; Tuberculosis, Miliary; Tuberculosis, Pulmonary; HIV Infections; Lymphocyte Count; Early Diagnosis
A total of 190 secondary four male school students from three schools in Kota Bharu were surveyed on their smoking habits and their attitudes towards the health warning messages on cigarette packs. There were 57 (30.0%) students who were current smokers, 45 (23.7%) students who were ex-smokers and 88 (46.3%) students who have never smoked cigarettes. Nearly all current and ex-smokers (95.1%) as well as non-smokers (94.3%) knew the wording of the health warning message currently displayed on cigarette packs. Almost all the students (95.3%) also knew where the warning message was placed. There were more ex-smokers and nonsmokers (70.5%) compared to current smokers (50.0%) who felt that there should be different health warning messages and each should be displayed concurrently on different cigarette packs. The students felt that the current health message was not effective to motivate smokers to quit (score=2.25). Alternative messages which the students felt may be more effective were â€˜Smoking is dangerous for pregnancyâ€™ (score = 3.3), â€˜Cigarette smoke is dangerous for your childâ€™ (score=3.11) and â€˜Smoking can kill youâ€™ (score=3.08). The current health message â€œ Smoking is dangerous for your healthâ€™ is eighth with a score of only 2.64. The students felt that the least effective message was â€˜Cigarettes are drugsâ€™ (score=2.22). Most of the students (80.0%) felt that the health warning message should be placed at the front instead of on the side of the cigarette pack to be more effective.
MeSH terms: Attitude; Dangerous Behavior; Habits; Male; Motivation; Smoking; Students
Hepatoblastoma is the most common primary liver tumour of childhood. This is a case report of a one-year-old boy who presented with a one-month history of progressive abdominal distension and weight loss. He was cachexic, anaemic, had gross hepatomegaly and ascites. He had been born prematurely with a birth weight of 1.23 kg, and his developmental milestones were delayed. Ultrasound and CT scan demonstrated a large solid tumour in the left lobe of the liver with a smaller superficial nodule in the right lobe. Serum alpha fetoprotein was significantly raised. A left lobe hepatectomy and complete excision of the right sided nodule was performed. There was no evidence of metastatic disease. Histopathological examination confirmed hepatoblastoma of the fetal type. The patient developed features of intestinal obstruction a few days after surgery and he succumbed ten days after re-aparotomy. The clinical presentation and investigation results in this case are characteristic. Recent reports have suggested a strong relationship between very low birth weight (< 1500gm)/prematurity and hepatoblastoma as is present in this case. Surgery is the mainstay of therapy in hepatoblastoma. A brief review of the literature on this tumour is presented.
Osteoporosis is recognised as a public health problem the world over. There is increasing awareness about this problem in Malaysia and this is particularly important, as our population gets older. This brief review aims to highlight the important aspects of history taking as well as the investigative approach to the diagnosis of osteoporosis. The modalities of bone mineral density measurements particularly with regards to the diagnosis and the monitoring of the disease are also discussed.
MeSH terms: Awareness; Malaysia; Medical History Taking; Osteoporosis; Public Health; Absorptiometry, Photon; Bone Density
The forearm fracture is a fracture of the upper limb between the elbow and the wrist. It is a common injury in children, accounting for more than half of all childrenâ€™s fractures, and mostly occur when a child falls on the outstretched arm. A difficult clinical problem that often arises is how much angulation can be accepted in the child and how much remodeling will occur. One hundred consecutive cases of forearm fractures that were admitted at Childrens Orthopaedic Ward, Institute of Paediatrics at Hospital Kuala Lumpur between 1st January 1997 to 31st December 1998 were studied. We found that all fractures united 3 to 6 weeks, with a remodeling rate of about 2.5 degrees/month; the proximal fractures having the most potential to remodel. We conclude that the early remodeling potential of forearm fractures in children is 1.5 degrees/month in midshaft fractures and 2.5 degrees/month in distal and proximal fractures. We recommend accepting a 10 - 20 degree angulation in midshaft fractures, and a 20 - 30 degree angulation in metaphyseal fractures; based on our study of early remodeling potential.
Ewingâ€™s sarcoma is a rare malignant tumor of the foot in children. We report a case of Ewingâ€™s sarcoma of the talus in a four-year-old Chinese girl to highlight the initial difficulty in diagnosis and the clinical course of the disease. She was initially diagnosed as osteomyelitis of the talus and died eight months after presentation with pleural and spinal metastases. To the best of our knowledge, Ewingâ€™s sarcoma of the talus in a young child has never been reported in Malaysia.
We studied the curve progression of untreated curves presenting to the Scoliosis Service of Hospital Kuala Lumpur. One hundred and fifty-two (152) patients were included in this study. The median rate of curve progression of idiopathic scoliosis curves was 7.03 degrees per year, for neuromuscular scoliosis curves as 17.39 degrees per year; and congenital scoliosis curves were 3.67 degrees per year. These rates are similar to the reported rates in the literature. Data for sixty-one (61) surgically treated patients were reviewed to determine the early curve correction of the curves of different aetiology. The mean age of surgery was 14.15 years old, the mean preoperative curve size was 71.61 degrees; and the mean postoperative curve size was 43.78 degrees. The mean duration of follow up after surgery was 2.44 years. The revision and removal of instrumentation rate was 8.3%.
Over a seven-year period, 170 cases of humerus fractures were plated in Hospital Melaka. Of these, 131 cases were successfully traced for this study. Besides looking at fracture epidemiology, its relationship with radial nerve injury was examined. The incidence of post-traumatic wrist drop in closed and compound fractures were 14.9% and 35.3% respectively. In relation to the site of fracture, lower third fracture had the highest incidence of wrist drop (29%). The recovery from post-traumatic wrist drop was 83%. The average duration taken for recovery was 11.8 weeks. The incidence of post-operative wrist drop was high at 17.6% but all recovered during follow-up.