Anomalies of the genitourinary tract occur in approximately 10% of the population and account for about one third of all congenital malformations in children (1). Congenital malformations involving the genitourinary system are major therapeutic challenges faced by the practising urologist.
MeSH terms: Child; Face; Humans; Physicians; Urinary Tract; Urogenital System
We report a case of an 86 year old Chinese man who presented with a painless right testicular swelling that had persisted for one year. There was no history of maldescend or cryptorchid testes. Clinical and ultrasound examination revealed testicular tumour with two round masses within the right scrotal sac, with minimal fluid seen within the sac. Tumour markers were normal. He subsequently underwent a right inguinal orchidectomy under local anaesthesia as he had an underlying cardiac insufficiency. Histopathological examination revealed malignant Sertoli cell tumour. True Sertoli cell mesenchyme tumours constitute less than 1% of all testicular cancers.Current literature on histopathological and clinical features and treatment options are reviewed.
Demographic, economic and social changes have had major impact on health and illness globally, including in Malaysia, and present significant challenges to the structure and delivery of health services. While these changes have influenced the epidemiology of disease, the diagnosis, experience and response to changes in health status for individuals and their families are influenced by additional environmental and personal factors. We describe these factors in relation to our ongoing research program on personal and social aspects of impairment and disability. The Resilience study aims to understand how people with impairments and their families live with chronic health conditions, how these conditions impact on self-esteem, social relationships and societal participation, and how structure, context and environment affect individual functioning, disability and well-being. We described our methodology and summarize the baseline data that will inform our future enquiries.
MeSH terms: Disabled Persons; Health Status; Humans; Malaysia; Self Concept; Social Change
Evidence suggests that breast cancer is taking the form of a chronic illness. This will add on to the present burden of managing chronic diseases in the healthcare delivery system. The burden of breast cancer being a chronic illness, calls for greater efforts to address the many neglected, physical-psycho-social and occupational functioning consequences. Timely efforts are needed to identify and implement interventions that are aim at improving the quality of life of women with breast cancer. At present, research evidence is highlighting that chronic diseases may best be managed using a self-management approach, and best treated by a balance of traditional medical care and the day-to-day practice of self-management skills. This paper presents the perspective of breast cancer as a chronic illness and its implication for rehabilitation and medical education. It is imperative that health professionals be made aware of these survivorship issues through medical education. The goals are to reduce the many disability risks, encourage patient-health provider communication and enhance partnership in care, within a timely, holistic therapeutic program to improve the quality of life of women with breast cancer.
MeSH terms: Breast Neoplasms; Chronic Disease; Education, Medical; Female; Goals; Health Personnel; Humans; Quality of Life; Research; Risk; Self Care; Survival Rate; Health Communication
Lymphangioleiomyomatosis (LAM) is a rare disease. The reported prevalence is around one per million in the West but the exact prevalence in Asia is unknown. It affects primarily young women of reproductive age, with a mean age of onset at 34 years. The disease is characterised by an abnormal proliferation of smooth muscle-like cells that grow over a course of time to obstruct airways, lymphatic and blood vessels. We report a case of LAM in a young woman who presented with a spontaneous pneumothorax. Computed tomography scan of the thorax and abdomen showed homogenous thin-walled cystic lesions with normal intervening lung parenchyma and multiple lesions in her kidneys with Hounsfield units similar to that of fat.
The year 2005 marked the rebirth of JUMMEC when the Editorial Board took over from its previous Editor with modest but realistic expectations. One year on, we have successfully achieved our initial expectation, that is, to encourage greater participation from our junior academics to write and publish in our very own journal, JUMMEC. As we head towards the end of 2006 and prepare to usher in 2007, we see JUMMEC consolidating and gaining in strength. Let us reflect on its past achievements and our expectations for the future.(Copied from article).
Squamous cell carcinoma of the tongue is a highly malignant condition and results in high mortality and morbidity in patients despite its early detection (1). Early surgical interventions have been found to reduce mortality but in many reports, tongue reconstructions using live grafts have been found to reduce normal tongue function of speech, swallow and taste. In contrast, our report using free radial forearm flap (FRFF) to reconstruct the defect left over after a radical tongue resection in a 38-year-old gentleman with oral cancer has shown promising results. This type of reconstruction has left the patient with a functional and cosmetically acceptable tongue with minimal alteration in recognizable speech.
MeSH terms: Carcinoma, Squamous Cell; Forearm; Glossectomy; Humans; Mouth Neoplasms; Speech; Taste; Tongue; Early Detection of Cancer
A cross-sectional survey of commercial vehicle drivers who were renewing their own licences was conducted at the Selangor Road Transport Department office in Padang Jawa between 1 February 2002 and 28 February 2002, using questionnaire and medical examination. The objective was to determine the prevalence of myopia, colour vision deficiency and visual field defect among the commercial vehicle drivers. The respondents that reported visual defect at the time of interview was compared with those detected by the author through medical examination. Out of the 223 respondents, 21 (9.4%) reported to have myopia by the questionnaire survey. Through the visual examination there were 63 (28.3%) with myopia (visual acuity worse than 6/12),six (2.6%) had a visual field defect and 14 (6.3%) had red-green colour deficiency. The visual defect detected during the study among the commercial vehicle drivers, which were missed at the time of the routine medical examination were significant. The process of the statutory medical examination should be reviewed.
The aim of the study was to compare the body fat percentages between Malaysian national women basketball players and netball players. Both basketball and netball players were elite players who represented Malaysia in the 1997 Southeast Asia Games in Jakarta, Indonesia and the 1998 Commonwealth Games in Kuala Lumpur. The percentage of body fat was determined by means of skinfold measurement at seven different locations. Results of the findings showed that overall, the basketball players had higher percentages of body fat than netball players. The average percentages of body fat of basketball and netball players were 19.68 ± 4.93% and 18.93 ± 4.41%, respectively. Both Malaysian national basketball and netball players' average percentage of body fat were found to be higher than the ideal average percentage of body fat range between 10-16% for female athletes in elite team sports. The players in the defence position in basketball were found to have the highest percentage of body fat (23.00%), followed by centre position players (21.62%) and attack position players (15.10%). These results differed from netball players' in similar playing positions. Among the netball players, the defence position players had the highest percentage of body fat (21.00%), followed by attack position players (18.63%), and centre position players (16.57%).
MeSH terms: Adipose Tissue; Basketball; Female; Humans; Indonesia; Malaysia; Play and Playthings; Recreation; Athletes
Six groups of adult Sprague-Dawley rats were orally administered with a variety of treatments to elucidate their cytoprotective effects. Absolute ethanol combined with HCl was used to induce gastric lesions in rats. Aqueous and ethanol extracts of Chromolaena odorata, a famous folk herb for treating skin wounds were evaluated to determine their protective effect on gastric mucosa. In this study, aqueous extract and ethanol extract of C. odorata were combined with honey. In addition, honey alone and honey combined with cimetidine were also evaluated. Rat stomachs were examined grossly and histologically. Results were expressed as inhibition percentage. The honey and aqueous extract combination showed the highest inhibition percentage (72.67%) followed by honey and ethanol extract (58.92%), honey and cimetidine (56.55%) and the lowest was honey alone (46.74%). However, there were no significant differences between the effects of aqueous and ethanol extracts of C. odorata and honey in promoting cytoprotective effects and this may be due to the small sample size. Nevertheless, these results suggest that C. odorata and honey may be beneficial in treating induced gastric mucosal injury.
A cross-sectional study of 109 patients with Pseudomonas aeruginosa bacteremia from the University of Malaya Medical Centre (UMMC) in the years 2000 and 2001 was conducted to describe epidemiological features, underlying diseases, possible source of infection, early mortality among patients as well as the antibiotic susceptibility pattern of patients' isolates. Further analysis of the 87 patient records that were available revealed that the mean age was 48.5 years (SD ± 25.1). Fifty-two per cent of cases were male and 48% female. Seventy-nine per cent of infections were nosocomially acquired, 33% of bacteremias were polymicrobial, 47% of patients had a continuous bladder drainage catheter (CBD) in situ, 33% had a central venous catheter (CVL) present at the time of bacteremia and 30% were ventilated. Sixty-eight per cent of patients had an underlying immunosuppressed state and 26% had undergone surgery involving general anesthesia in the week prior to isolating P. aeruginosa. Among the 23 patients with early mortality, 61% were on inappropriate antimicrobials. Most of the patients' isolates were sensitive to imipenem (86%), ciprofloxacin (81%), ceftazidime (79%), gentamicin (78%) and cefoperazone (77%). Among the community acquired strains, however, there was 100% sensitivity to imipenem, ceftazidime, cefoperazone and ciprofloxacin.
There has been a significant decline in maternal mortality in Malaysia since independence. The issue of measuring maternal mortality accurately is a problem in all countries. Another major problem is whether we can reduce the mortality further. The definition of maternal mortality includes two major components, which are causation of death and the time of death. To improve data collection on maternal deaths, we need to collect all data on maternal deaths, which are omitted or misclassified. Deaths from accidental causes that are not normally used in the calculations of maternal mortality need to be carefully reexamined to be excluded. The time of death means that in maternal mortality calculations, it includes up to six weeks after delivery, but recent World Health Organization (WHO) publication (ICD-10) suggests that the collection of maternal deaths even after six weeks should be reviewed because there are many maternal deaths which occur after six weeks. Measuring maternal mortality rate should be encouraged rather than maternal mortality ratio. Another measurement of maternal mortality is the lifetime risk of the women. The lifetime risk is the measure of maternal mortality that takes into account the probability of becoming pregnant and the probability of dying as a result of pregnancy. Many countries have started reporting the lifetime risk, which is considered to be better indicator to measure maternal health.
MeSH terms: Maternal Health; Data Collection; Death; Female; Humans; Malaysia; Maternal Mortality; Pregnancy; Probability; Publications; World Health Organization; International Classification of Diseases; Maternal Death
The objective of this study was to compare in-patient drug use patterns, costs, and outcomes associated with risperidone or olanzapine in a naturalistic clinical setting. Retrospective chart reviews of 92 patients with psychotic disorders were conducted at the University of Malaya Medical Centre (UMMC). Data was collected from patients who were hospitalized and for whom risperidone or olanzapine was the drug of first choice for long-term pharmacologic treatment. Proportion of patients for whom efficacy of the studied treatment could be established (as rated by the treating physician) was higher, but not significantly, with risperidone compared to olanzapine (p = 0.46). The average dose of the studied medication was 2.9 ± 1.0 mg/day for risperidone and 9.7 ± 2.4 mg/day for olanzapine. The total cost was significantly higher (p
Steroids remain an important component of maintenance immunosuppression after renal transplantation. Their anti-inflammatory action is partly due to the sequestration of CD4+ lymphocytes in the reticuloendothelial system. Steroids bind to intracellular receptors and the resulting steroid-receptor complex alters the transcription of cytokines by binding to glucocorticoid response elements on DNA. Transcription factors whose actions are altered by glucocorticoids include activating protein-1 (AP-1) and nuclear factor-B (NF-B). The main cytokines whose production by antigen-presenting cells is inhibited by steroids are interleukin-1 (IL-1), required for helper T-cell activation, and IL-6, required for B-cell activation. Other pro-inflammatory cytokines such as interferon gamma and tumour necrosis factor are also inhibited. This multiplicity of immunosuppressive actions is not fully replicated by other immunosuppressants. However, there are concerns about the long-term side effects of steroids. This review will examine the attempts at steroid withdrawal or steroid avoidance in renal transplant patients.
The aim of the study was to research the use of a simple neural network in diagnosing angina in patients complaining of chest pain. A total of 887 records were extracted from the electronic medical record system (EMR) in Selayang Hospital, Malaysia. Simple neural networks (simple perceptrons) were built and trained using a subset of 470 records with and without pre-processing using principal components analysis (PCA). These were subsequently tested on another subset of 417 records. Average sensitivity of 80.75% (95% CI 79.54%, 81.96%), specificity of 41.64% (95% CI 40.13%, 43.15%), PPV of 46.73% (95% CI 45.20%, 48.26%) and NPV of 77.39% (95% CI 76.11%, 78.67%) were achieved with the simple perceptron. When PCA pre-processing was used, the perceptrons had a sensitivity of 1.43% (95% CI 1.06%, 1.80%), specificity of 98.32% (95% CI 97.92%, 98.72%), PPV of 32.95% (95% CI 31.51%, 34.39%) and NPV of 61.33% (95% CI 59.84%, 62.82%). These results show that it is possible for a simple neural network to have respectable sensitivity and specificity levels for angina.
MeSH terms: Angina Pectoris; Chest Pain; Humans; Malaysia; Sensitivity and Specificity; Neural Networks (Computer); Principal Component Analysis; Electronic Health Records
Restrictive dietetic practices, rather than helping the patient, reduce his food intake and thereby impair recovery. This is a cruelty born-of erroneous notion passed on to us as a legacy from hakims and vaids (quakes), rather than having any scientific justification. Even if some doctors do not entertain such restrictions, the so called well-wishers of patients will definitely offer free advice and impose food restrictions upon their patients. Everybody has his own share of bitter experiences, horrific memories, and heart-rending stories of the past. The chain of death and destruction remains unbroken. The gloomy, dark sky is waiting for break of a new dawn gone into eclipse years before. The ongoing Indo- Pak peace process has already resulted in a number of confidence- building measures, but in spite of all that an average of five persons each day are being killed in terror-related incidents across the State. A tricky situation prevails in which militants and security forces are pitted against each other, converting the streets, the lanes and by-lanes, and human settlements in to a well-entrenched battle ground. Innocent Kashmir’s are dying, getting maimed, and suffering mental agony and the world is watching with a nonchalant indifference.
Pelvic inflammatory disease (PID) is a common cause of morbidity and accounts for 1 in 60 GP consultations by women under the age of 45 in the UK. Pelvic inflammatory disease encompases a broad category of disease including endometritis, salphingitis, salphingo-oopheritis, tuboovarian abscess and pelvic peritonitis. It most commonly occurs as a result of Chlamydia trachomatis or Nesseria gonorrhea 1,2 infection of the endocervix that eventually spread into the upper genital tract. Direct spread from a nearby infection such as appendicitis and diverticulitis is not that common. Hematogenous spread is rare except in cases of tuberculous pelvic inflammatory disease. This case illustrates atypical presentation of pelvic inflammatory disease in a previously healthy single unmarried lady. The presence of ascites, bilateral ovarian mass and constitutional symptoms closely mimics that of malignant ovarian tumour. This was preceded by empyema which grew E coli.
Thanatophoric dysplasia (TD) was reported earlier in the previous publication. It is one of the most common lethal human skletal dysplasia characterized by severe dwarfism. It occurs in 3 to 4 per 100,000 live births1 and is due to autosomal dominant sporadic de novo mutations in the fibroblast growth factor receptor 3 (FGFR3) gene3 which codes for the FGFR3 transmembrane receptor expressed largely by skeletal and brain tissues in the developing fetus where it is involved with growth regulation. The FGFR3 mutation in TD leads to generalized defects and lack of endochondral ossification, with membranous ossification being less impaired1. Male and female fetuses are equally affected. Two thanatophoric case of this extremely rare occurance are reported and discussed.
Vaginal agenesis is a rare event occurring at a frequency of 1 case per 4000-10 000 female lives born. The most common etiology of vaginal agenesis is congenital absence of the uterus and vagina called mullerian agenesis (Mayer-Rokitansky-Hauser Syndrome). Although most patients with mullerian agenesis have small rudimentary 2 ‘mullerian bulbs’ without any endometrial activity, 7-8% of these cases possibly have a functioning uterus 3. In vaginal agenesis, genetic females are thought to have persistence of mullerian inhibiting factor MIF, resulting in failure of the vagina and uterus to develop 4. The ovaries, given their separate embryonic source, are normal in structure and function. This condition usually goes undetected until these patients reach puberty, when they start to experience cyclic pelvic pain due to the accumulation of menstrual blood.
Transient abnormal myelopoiesis (TAM) occurs in approximately 10% of neonates with Down syndrome. In most cases it resolves spontaneously. Life threatening complications such as cardiopulmonary and liver diseases have been described. We present here two cases which suggest that management of TAM in selected cases will have to be more aggressive.