Two rare cases of intractable epilepsy caused by Dysembryoplastic Neuroepithelial Tumours (DNET) are reported and their different management discussed. The first case required vagal nerve stimulation and radiosurgery while the later was operated with the help of neuronavigation. Both had good outcome according to Engel classification after a one year follow up.
Tonsillectomy in children is performed on a regular basis in ENT. The indications are chronic tonsillitis, sleep apnea to deeper structures. The natural history of tonsillar hyperplasia is regression when a child is six years beyond. In children with bilateral tonsillar hyperplasia we studied the use of laser as an alternative procedure to reduce the bulk of the tonsillar mass. Children with symptoms of bilateral tonsillar hyperplasia underwent laser tonsillotomy. The tonsils were dissected using carbon dioxide (CO2) laser. The tonsillar bed was left untouched. Intraoperative and postoperative conditions were noted.
The incidence of wound related complication following total knee arthroplasty is as high as 10%-20%. To perform total knee arthroplasty in a knee with extensive scarring around the knee can be a challenging task. We report a case of 55-year-old diabetic woman, who had total knee arthroplasty, performed two years after she had recovered from necrotizing fasciitis around the right knee. Understanding the vascular anatomy around the knee is of paramount importance in the planning of skin incision to ensure fewer wound related complications.
Melioidosis is caused by the gram-negative bacillus, Burkholderia pseudomallei. It is endemic in tropical Australia and in Southeast Asian countries. The overall mortality from this infection remains extremely high despite recent advancement in its treatment. This review discuss about clinical manifestations, diagnosis and management of melioidosis.
The Malaysian Ministry of Health has undertaken various campaigns on healthy lifestyle and health promotion over the years. The impact of these campaigns has been mixed and not well documented. This cross-sectional study evaluated the knowledge level of patients with and without diabetes in a large urban polyclinic using a 41-item questionnaire. One hundred and forty-nine adults (83 with diabetes, 66 without diabetes) participated in this study. Patients with diabetes had higher overall knowledge scores than those without diabetes (81.8% vs 64.0%, p < 0.001). While the overall knowledge of patients without diabetes appeared to be acceptable, several areas of knowledge deficiency were identified in this group--areas that should be filled by the on-going health promotion activities.
Study site: Klinik Kesihatan Seremban, Seremban, Negeri Sembilan, Malaysia
MeSH terms: Adult; Ambulatory Care Facilities; China/ethnology; Cross-Sectional Studies; Diabetes Mellitus*; Female; Humans; India/ethnology; Health Knowledge, Attitudes, Practice*; Malaysia; Malaysia/ethnology; Male; Middle Aged; Patient Education as Topic*; Primary Health Care*; Surveys and Questionnaires; Self Care*; Case-Control Studies
This survey was intended to gauge the management of pain in palliative cancer patients by the doctors in Melaka Hospital. It also sought to identify possible barriers to adequate pain management among doctors and gauge their response to the adequacy of medical school teaching on cancer pain issues. A 39 item survey was used to cover the issues involved. Overall, the doctors displayed a lack of systematic approach to cancer pain management with inadequate knowledge of analgesia handling. Medical school exposure to cancer pain issues was lacking. Formulation of accepted clinical practice guidelines and new education strategies can improve cancer pain management.
MeSH terms: Analgesics/therapeutic use*; Clinical Competence*; Humans; Malaysia; Medical Staff, Hospital/education*; Neoplasms/complications*; Pain/drug therapy*; Pain/etiology; Pain Measurement; Palliative Care*; Patient Education as Topic; Practice Patterns, Physicians'*; Health Care Surveys
Aim of the study was to audit patients who had undergone parathyroidectomy in University of Malaya Medical Centre (UMMC), and compare surgical outcomes with that in the literature. Data on demography, aetiology, surgical indications, pre-operative localization, surgery and complications was obtained retrospectively from medical records of patients undergoing parathyroidectomy between 1st October 2000 to 31st October 2005. Twelve patients were identified. Mean age was 50.6 years. Sixty seven percent were females. The ratio of Chinese, Malays and Indians was 7:4:1. Most surgeries were performed in the last two years (91.7%). Aetiology was mainly tertiary hyperparathyroidism (83%). All patients had pre-operative ultrasound localization. Half underwent total parathyroidectomy without autotransplantation. There were no re-do operations. Mean duration of surgery was 1.96 hours. All patients had abnormal calcium levels at some point following surgery, but 90% were normocalcaemic at last follow up. Other complications were recurrent laryngeal nerve injury (one) and wound infection (one). There were no peri-operative mortalities. The mean duration of hospital stay was 7.75 days (range 3-17 days). The median duration of follow-up was 11 months. The outcome of parathyroidectomy in UMMC is satisfactory with few major complications. Despite this, intensive effort is needed to further improve these results to match those obtained in specialist endocrine centres.
Diffuse large B-cell lymphoma (DLBCL) is a heterogenous entity. The pattern of CD15, CD30 and Bcl-2 expression is not well documented, especially in local population. We investigated 67 consecutive cases of DLBCL by immunohistochemistry on paraffin-embedded tissue. The male to female ratio was 1.2:1 with median age of 55 years, and more common nodal than extranodal in presentation. Only 3 of 67 cases expressed CD15. In addition, three cases showed weak membrane staining for CD30. Only one of these three cases was noted to have co-expression of CD15 and with occasional tumour cells showing weak CD30 expression. Bcl-2 protein was expressed in 43 of 67 (64%), more frequently in nodal than in extranodal tumours. In conclusion, CD15 and CD30 expressions are infrequent in DLBCL, and co-expression is rare. Bcl-2 protein expression is common in DLBCL.
MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Immunohistochemistry; Male; Middle Aged; Prospective Studies; Biomarkers, Tumor/metabolism; Antigens, CD15/biosynthesis*; Antigens, CD15/genetics; Lymphoma, B-Cell/genetics*; Lymphoma, B-Cell/metabolism; Lymphoma, Large B-Cell, Diffuse/genetics*; Lymphoma, Large B-Cell, Diffuse/metabolism; Antigens, CD30/biosynthesis*; Antigens, CD30/genetics; Genes, bcl-2/genetics*; bcl-2-Associated X Protein/biosynthesis*; bcl-2-Associated X Protein/genetics
A cross sectional survey on pattern and perception of herbal use among medical patients in Penang Hospital was conducted. Among 250 patients surveyed, 67.9% were using herbal medicine and conventional medicine concomitantly. A majority of the patients used herbs for health maintenance (51.3%) purpose. More than 90% of herbal users did not disclose herbal use to their physician and "Doctor never asked" was the major reason given (54.2%). The Chinese reported the highest rate of herbal use but was least likely to disclose. These findings are important for health professionals to ensure medication safety and recognise potential drug herb interaction.
MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Pharmaceutical Preparations; Female; Humans; Health Knowledge, Attitudes, Practice*; Malaysia; Male; Phytotherapy/utilization*; Middle Aged; Patient Acceptance of Health Care/ethnology; Patient Acceptance of Health Care/statistics & numerical data*; Plants, Medicinal*; Surveys and Questionnaires; Health Care Surveys; Plant Preparations/therapeutic use*; Herbal Medicine*; Herb-Drug Interactions
Significant hypertension in adolescence is defined according to Blood Pressure (BP) distribution among general population. The present study was conducted to determine the BP distribution in Iranian adolescents. In a population-based study held in Tehran, BP data for 2560 participants aged 10-17 years (1247 boys and 1313 girls) were collected. The 90th and 95th percentiles of systolic (SBP) and diastolic BP (DBP) were obtained for different age and height subgroups of boys and girls. While the 90th and 95th percentiles of SBP obtained in our study were generally lower than international guidelines, the corresponding percentiles of DBP were higher. Significant associations were found between BP and age, height, weight and BMI. According to our findings, it is necessary to prepare BP reference tables according to regional surveys.
The aim of this paper is to describe the impact of oral conditions on the quality of life of the adult population of Malaysia. The adapted Malaysian Oral Health Impact Profile (L-OHIP-M) questionnaire was used. A total of two hundred and twenty respondents completed the L-OHIP(M). Overall, slightly more than 50% of the sample had at least one impact reported as either "very often" or "often". The younger age group, Indian ethnic and those who had tertiary education reported more impacts. The preliminary results revealed that a substantial proportion of the sample included in this study experienced frequent psychosocial impacts associated with oral conditions.
MeSH terms: Adolescent; Adult; Cross-Sectional Studies; Female; Health Surveys; Humans; Interviews as Topic; Malaysia; Male; Middle Aged; Oral Health*; Quality of Life*; Surveys and Questionnaires; Sickness Impact Profile
Systemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disease with renal involvement being one of the most frequent and serious manifestations of the disease. The aim of the study is to analyze the treatment and renal outcome of patients with lupus nephritis (LN) WHO class III and IV on cyclophosphamide (CYC). We retrospectively identified 41 patients with biopsy proven LN who was given either oral or intravenous CYC. The male: female ratio was 4:37; with a mean age of 31.7 +/- 9.8 years at presentation. 36 patients (87.8%) had LN class IV and only five patients (12.2%) with LN class III. The mean serum creatinine at presentation was 87.4 +/- 37.2 micromol/L with mean follow-up of 84 +/- 78 months. A total of 30 patients (73.2%) completed 12 courses of IV CYC and one patient (2.4%) completed three months of oral CYC. 71.0% (n = 22) had complete response (CR), 25.8% (n = 8) had partial response and 3.2% (n = 1) had no response (NR). Of the remaining 11 patients, two patients (4.9%) died during the treatment, three patients (7.3%) defaulted treatment and five patients (12.2%) are still receiving ongoing treatment. Presence of hypertension (p < 0.003) and evidence of chronicity on renal biopsy (p < 0.016) were significantly correlated with the progressive deterioration of renal function in our population. In conclusion, hypertension and evidence of chronicity on renal biopsy, proved to be risk factors for progressive renal impairment in our study population. The achieved global outcome can be considered good.
Study site: Hospital Ipoh, Ipoh, Perak, Malaysia
Two hundred and seventeen diabetic patients attending the eye clinic were examined to determine the prevalence of retinal changes, and the association between diabetic retinopathy and risk factors. A detailed fundus examination was done, after dilating the pupils, using 90 D lens and slitlamp biomicroscope. Diabetic retinopathy was detected in 112 patients (51.6%). Background retinopathy was seen in 40 out of 217 (18.4%), pre-proliferative retinopathy in 11 (5.1%), proliferative retinopathy in 61 (28.1%) and maculopathy in 58 (26.7%) patients. Factors significantly associated with occurrence of retinopathy were duration of diabetes, presence of hypertension and presence of systemic complications (diabetic foot ulcer, lower limb amputation, nephropathy, and peripheral neuropathy).
Study site: Eye clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Microalbuminuria is the earliest indicator of diabetic kidney disease and generalised vascular endothelial dysfunction. The Microalbuminuria Prevalence (MAP) Study was carried out to assess the prevalence of macroalbuminuria, microalbuminuria and normoalbuminuria in Asian hypertensive patients with type 2 diabetes on usual care. This paper presents a subanalysis of data from patients in Malaysia. In 733 analysed patients, the prevalence of macroalbuminuria and microalbuminuria was 15.7% and 39.7%, respectively. The high prevalence of diabetic nephropathy in these high-risk patients is a cause for concern, and the Malaysian Health Care system should be prepared for a pandemic of end-stage renal disease due to diabetic nephropathy.
Study site: six medical centres in Kuala Lumpur, Kota Bharu,
Kuching and Kota Kinabalu
A total of 31 adult patients with moderate and severe head injury were assessed clinically on admission for Glasgow Coma Scale (GCS) and short test of mental status (STMS) on follow-up and compared to their initial and follow up CT scan. Good predictors were admission GCS, midline shift, volume of subdural haemorrhage in the initial CT scan of the brain as well as the presence of post-traumatic hydrocephalus, gliosis and site of gliosis in the follow-up CT scan. There was no direct correlation between the significant predictors on the first CT scan and the follow-up CT scan of the brain.
Day-case surgery is preferred for adults, allowing post-operative fast recovery in family environment and support. Myringoplasty using the traditional method of underlay temporalis fascia or tragal perichondrium is usually performed as an in-patient. From 2003 to 2004, 22 myringoplasty procedures were performed in a dedicated day surgery unit at the Hospital Melaka. We report the retrospectively review of the outcome results of these procedures. None of the patients need admission overnight. There were no surgical or anesthetic complications noted and this series suggests that day-case surgery is a safe and desirable practice for patients undergoing myringoplasty. However, there should be the facility for admission if required.
MeSH terms: Adolescent; Adult; Ambulatory Surgical Procedures*; Female; Humans; Male; Medical Audit*; Middle Aged; Myringoplasty*; Retrospective Studies; Surgery Department, Hospital; Otologic Surgical Procedures; Time Factors; Treatment Outcome*; Tympanic Membrane Perforation/surgery*