Inspite of the advent of newer antimanic drugs, lithium carbonate remains widely used in the treatment and prevention of manic-depressive illness. However care has to be exercised due to its low therapeutic index. The central nervous system and renal system are predominantly affected in acute lithium intoxication and is potentially lethal. The more common side effect involves the central nervous system. It occurs early and is preventable. We describe three cases of lithium toxicity admitted to Johor Bahru Hospital, with emphasis on its neurological preponderance.
Pancreatic sphincter hypertension (PSH) is one of the causes of recurrent pancreatitis. The diagnosis can be established by direct measurement of pancreatic sphincter pressures at pancreatic sphincter manometry. This procedure is not without risks, and in cases with PSH, it certainly carries a higher risk of post procedure pancreatitis. The treatment of this disorder is pancreatic sphincterotomy, which on its own carries risk of acute pancreatitis. Therefore it is important to establish the diagnosis reliably before undertaking this procedure. In order to overcome the false positive readings that are possible in sphincter manometry, we proposed to use secretin stimulated endoscopic ultrasound (SSEUS) to measure pancreatic ductal response as an adjunctive method to aid and supplement the diagnosis. Here we describe 3 cases in which this was carried out to optimal effect.
The effect of ambient temperature on the analytical and clinical performance of a glucose meter was examined. A total of 114 venous whole blood samples were analysed for glucose by a reference method, and by a glucose meter at 21-22 degrees C, room temperatures, 26-27 degrees C and 33-34 degrees C. Glucose meter readings at each temperature were compared with the reference values and evaluated by analysis of variance, Spearman's correlation, the percentage of glucose meter readings within +/- 10% of the reference value and error grid analysis. Analysis of covariance was used to determine the effect of temperature on glucose meter readings. There were no significant differences in the glucose meter readings and in accuracy of the meter readings between different temperatures. Temperature was not a significant independent determinant of the glucose meter readings. For each glucose concentration, the precision of the meter and clinical performance were comparable between the different temperatures. In conclusion, ambient temperature does not affect the accuracy, precision and clinical performance of the Omnitest Sensor.
There is presently no line of distinction between oral lichen planus and other oral lichenoid lesions. The aim of this study is to determine using histomorphometry, the differences between these lesions. Paraffin sections from 7 normal buccal epithelium, 19 oral lichen planus (LP), 14 oral lichenoid lesions (LL) and 7 discoid lupus erythematosus-like lesions (DLE-ll) were selected. The nuclear volume (V(N)) and cellular-volume (V(CELL)) of the epithelium were assessed using an image analyser. The V(N) and V(CELL), derived for both basal and spinal strata in LP and DLE-ll were 2.3 times more than that of normal tissues. There was a significant difference between LP and LL (P < 0.005) and between LL and DLE-ll (P < 0.001), but not between LP and DLE-ll. In conclusion, there appears to be a difference between LP, LL and DLE-ll and V(N) and V(CELL) may serve as potential discriminators between these groups of lesions.
Background: Sore throat is not an uncommon complaint following general anaesthesia (GA) with endotracheal intubation. It has been a source of considerable discomfort particularly in those patients who had thyroid surgery. Driven by the increased number of patients with post-intubation sore throat following thyroid surgery, the aim of the present study was to evaluate the contributing factors of sore throat in patients who had thyroid surgery under general anaesthesia.
Methods: A total of 57 consecutive patients who had thyroid surgery from November 1998 to April 1999 was included in this prospective study. Factors such as intubation time, number of intubation attempts, size and type of endotracheal tube (ETT) used, gender and age were recorded. The nature and extent of the surgical procedures were also studied. Postoperative symptoms were assessed by questionnaire on the day after surgery and the different parameters were compared and analysed.
Results: The incidence of post-intubation sore throat following thyroid surgery was documented in 39 (68.4%) patients. Twenty-seven (47.4%) patients had a mild complaint of sore throat, which resolved after the third day. The data from the present study show that the size of ETT and extent of surgical procedure were significant contributing factors affecting the postoperative recovery.
Conclusion: The outcome of the present study demonstrated a substantial increased incidence of sore throat after thyroid surgery under GA. Postoperative sore throat following thyroid surgery under GA may be caused by multiple contributing factors. Nonetheless effort and care should be taken during endotracheal intubation and surgery to reduce this unpleasant complaint arising mainly from pharyngeal irritation or trauma.
In the title compound, C25H19NO4, the indole moiety is not completely planar, the heterocyclic ring being distorted very slightly towards a half-chair conformation. The benzoyl and 4-methoxyphenyl substituents are individually almost planar and are in a bisecting and nearly perpendicular configuration, respectively, with respect to the plane of the indole moiety. The molecular and packing structures in the crystal are stabilized by intramolecular and intermolecular C-H...O interactions.
In the title compound, C20H20FNO5S, the pyrrolidine ring adopts an envelope conformation. The fluorophenyl and thiophene rings are individually planar. The molecular and crystal structures are stabilized by intra- and intermolecular C-H...O interactions.
The title compound, 3,5,7-triaza-1-azoniatricyclo[3.3.1.1(3,7)]decane 2,4-dinitrophenolate monohydrate, C6H13N4+*C6H3N2O5-*H2O, the 1:1 hydrate adduct of hexamethylenetetramine (HMT) and 2,4-dinitrophenol, undergoes a temperature phase transition. In the room-temperature phase, the adduct crystallizes in the monoclinic P2(1)/m space group, whereas in the low-temperature phase, the adduct crystallizes in the triclinic P1 space group. This phase transition is reversible, with the transition temperature at 273 K, and the phase transition is governed by hydrogen bonds and weak interactions. In both these temperature-dependent polymorphs, the crystal structure is alternately layered with sheets of hexamethylenetetramine and sheets of dinitrophenol stacked along the c axis. The hexamethylenetetramine and dinitrophenol moieties are linked by intermolecular hydrogen bonds. The water molecule in the adduct plays an important role, forming O-H...O hydrogen bonds which, together with C-H...O hydrogen bonds, bridge the adducts into molecular ribbons. Extra hydrogen bonds and weak interactions exist for the low-temperature polymorph and these interconnect the molecular ribbons into a three-dimensional packing structure. Also in these two temperature-dependent polymorphs, dinitrophenol acts as a hydrogen-bond acceptor and HMT acts as a hydrogen-bond donor.
The objective of this study was to compare the rates of bacterial contamination of expressed breast milk (EBM) obtained by manual expression and breast pumps in mothers of very low birthweight (VLBW) infants (<1501 g). This was a randomized, controlled study carried out on 28 mothers of such babies and 92 specimens of EBM were collected: 41 specimens from 13 mothers assigned to the manual group and 51 specimens from 15 mothers in the breast-pump group. EBM was cultured quantitatively by the Miles and Misra method. Breast milk expressed by breast pumps (86.3% or 44/51 specimens) had a significantly higher rate of bacterial contamination than milk expressed by the manual method (61.0% or 25/41 specimens) (P= 0.005). When breast milk was expressed in the hospital, there was no significant difference in contamination rates between the two methods. When breast milk was expressed at home, the rates of bacterial contamination by staphylococci (P= 0.003) and Gram-negative bacilli (P= 0.002) were significantly higher in the breast-pump group than the manual group. In conclusion, the rate of bacterial contamination of EBM of mothers of VLBW infants was high, especially when EBM was obtained by the breast pump or when expression was carried out at home.
In the search for agents effective against immune-mediated disorders and inflammation, we have screened Malaysian medicinal plants for the ability to inhibit the expression of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) on the surface of murine endothelial cells (F-2), and mouse myeloid leukaemia cells (M1), respectively. Of 41 kinds (29 species, 24 genera, 16 families) of Malaysian plants tested, 10 and 19 plant samples significantly downregulated the expression of ICAM-1 and VCAM-1, respectively. Bioassay-directed fractionation of an extract prepared from the bark of Goniothalamus andersonii showed that its ingredients, goniothalamin (1) and goniodiol (2) inhibited the cell surface expression of both ICAM-1 and VCAM-1. The present results suggest that Malaysian medicinal plants may be abundant natural resources for immunosuppressive and antiinflammatory substances.
Malaysia is a developing country with a range of parasitic infections. Indeed, soil-transmitted helminths and malaria parasites continue to have a significant impact on public health in Malaysia. In this article, the prevalence and distribution of these parasites, the problems associated with parasitic infections, the control measures taken to deal with these parasites and implications for the future will be discussed.
Pyrodinium bahamense (var. compressum) has been the only dinoflagellate species that has caused major public health and economic problems in the Southeast Asian region for more than 2 decades now. It produces saxitoxin, a suite of toxins that cause Paralytic Shellfish Poisoning (PSP). A serious toxicological problem affecting many countries of the world, mild cases of this poisoning can occur within 30 minutes while in extreme cases, death through respiratory paralysis may occur within 2-24 hrs of ingestion of intoxicated shellfish. Blooms of the organism have been reported in Malaysia, Brunei Darussalam, the Philippines and Indonesia. The ASEAN-Canada Red Tide Network has recorded 31 blooms of the organism in 26 areas since 1976 when it first occurred in Sabah, Malaysia. As of 1999, the most hard hit country has been the Philippines which has the greatest number of areas affected (18) and highest number of Paralytic Shellfish Poisoning (PSP) cases (about 1995). Malaysia has reported a total of 609 PSP cases and 44 deaths while Brunei has recorded 14 PSP cases and no fatalities. Indonesia, on the other hand has a record of 427 PSP cases and 17 deaths. Studies on ecological/environmental impacts of these blooms have not been done in the region. Estimates of economic impacts have shown that the loss could be up to USD 300,000 day-1. Most of the data and information useful for understanding Pyrodinium bloom dynamics have come from harmful/toxic algal monitoring and research that have developed to different degrees in the various countries in the region affected by the organism's bloom. Regional collaborative research and monitoring efforts can help harmonize local data sets and ensure their quality and availability for comparative analysis and modeling. Temporal patterns of the blooms at local and regional scales and possible signals and trends in the occurrence/recurrence and spread of Pyrodinium blooms could be investigated. Existing descriptive and simple predictive models of Pyrodinium blooms can be improved and refined to help in the management of the wild harvest and aquaculture of shellfish in a region where the people are dependent on these resources for their daily food sustainance and livelihood.
MeSH terms: Animals; Asia, Southeastern; Data Collection; Dinoflagellida*; Economics; Environmental Monitoring; Eutrophication*; Models, Theoretical*; Population Dynamics; Shellfish; Water Pollutants; Aquaculture
OBJECTIVE: To find out the incidence and type of external laryngeal nerves during operations on the thyroid, and to assess the role of a nerve stimulator in detecting them.
DESIGN: Prospective, non-randomised study.
SETTING: Teaching hospital, Malaysia.
SUBJECTS: 317 patients who had 447 dissections between early January 1998 and late November 1999.
MAIN OUTCOME MEASURES:
Number and type of nerves crossing the cricothyroid space, and the usefulness of the nerve stimulator in finding them.
RESULTS: The nerve stimulator was used in 206/447 dissections (46%). 392 external laryngeal nerves were seen (88%), of which 196/206 (95%) were detected with the stimulator. However, without the stimulator 196 nerves were detected out of 241 dissections (81%). The stimulator detected 47 (23%) Type I nerves (nerve > 1 cm from the upper edge of superior pole); 86 (42%) Type IIa nerves (nerve < 1 cm from the upper edge of superior pole); and 63 (31%) Type IIb nerves (nerve below upper edge of superior pole). 10 nerves were not detected. When the stimulator was not used the corresponding figures were 32 (13%), 113 (47%), and 51 (21%), and 45 nerves were not seen. If the nerve cannot be found we recommend dissection of capsule close to the medial border of the upper pole of the thyroid to avoid injury to the nerve.
CONCLUSION: Although the use of the nerve stimulator seems desirable, it confers no added advantage in finding the nerve. In the event of uncertainty about whether a structure is the nerve, the stimulator may help to confirm it. However, exposure of the cricothyroid space is most important for good exposure in searching for the external laryngeal nerve.
The aim of this study was to determine the effects of surgical treatment of lower urinary tract symptoms (LUTS) in a Malaysian population by evaluating the quality of life before and after treatment.
MeSH terms: Aged; Aged, 80 and over; Follow-Up Studies; Health Status; Humans; Malaysia; Male; Middle Aged; Pain Measurement; Prostate/surgery; Quality of Life*; Severity of Illness Index; Time Factors; Urologic Diseases/surgery*; Treatment Outcome; Patient Satisfaction; Transurethral Resection of Prostate*
To compare the neonatal course of small for gestational age (SGA) and appropriate for gestational age (AGA) preterm infants 1500 g or less birthweight.
MeSH terms: Cause of Death; Female; Humans; Infant Mortality*; Infant, Newborn; Infant, Small for Gestational Age*; Malaysia/epidemiology; Male; Morbidity*; Respiratory Distress Syndrome, Newborn/mortality; Respiratory Distress Syndrome, Newborn/epidemiology; Infant, Very Low Birth Weight*
Drug induced myopathy has been reported with the use of fibric acid derivatives, hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors and nicotinic acid. Over the last three decades, hypolipemiants like fibric acid derivatives and statins have been increasingly recognised as causes of rhabdomyolysis and acute renal failure especially during combination therapy and in the presence of underlying renal impairment. We report two cases of bezafibrate-induced rhabdomyolysis in patients with underlying coronary artery disease and pre-existing renal impairment. Both patients developed rhabdomyolysis leading to acute renal failure soon after their hyperlipidaemia treatment was changed from gemfibrozil to bezafibrate. There were no intercurrent illnesses or co-administration of other lipid lowering drugs in both patients. Even though both drugs belong to the same fibric acid derivatives group, these patients developed the complication only after a switchover of therapy.