This retrospective study was undertaken to analyze perioperative parameters, functional outcomes and complications of cemented versus uncemented bipolar hemiarthroplasty in elderly patients presenting with displaced intracapsular femoral neck fracture. The authors reviewed 17 patients that underwent cemented bipolar hemiarthroplasty and 21 patients that underwent uncemented bipolar hemiarthroplasty. The mean follow-up duration in the cemented and uncemented group was 29.9 and 30.5 months respectively. Intraoperative and postoperative blood loss was higher in the cemented group. On the last follow-up the mean HHS was 74.7 in the cemented group and 84.2 in the uncemented group. No statistically significant difference was evident in the pain score. In summary, bipolar hemiarthroplasty was found to be a good option for displaced intracapsular femoral neck fractures, and overall outcome was marginally better in the uncemented group in terms of postoperative of blood loss and functional outcome at last follow up.
Many researchers studies have shown that stressful life events, from the death of a loved one to the loss of a job, are linked to an increase in certain health problems, particularly heart disease, diabetes, and hypertension. Many people assume that stress leads to cancer as well. Evidence for this, however, is not clear. However, the significance of mind-body interactions in medicine is now increasingly being recognised.(Copied from article.)
MeSH terms: Diabetes Mellitus; Heart Diseases; Hypertension; Life Change Events; Neoplasms; Research; Research Personnel
The current issue of JUMMEC touches on many diverse topics and in many ways reflects the evolution of modern medicine from the practice of acupuncture to epidemics facilitated by modern travel to the subject of ethics including controversies surrounding financial incentives given in promoting organ donation.(Copied from article).
MeSH terms: Humans; Motivation; Tissue and Organ Procurement; Acupuncture Therapy; Therapeutic Touch
As the debate on accepting financial incentives persists, more and more findings linked to its success as well as to its foreseeable backlash continue to unravel. Specifically out to enhance perceptions on financial incentives, this paper reviews important aspects of the financial incentives and provides a diverse range of empirical findings at a glance. Through a review of several empirical findings and literature, this paper argues that several basic practices of the financial incentives are indeed instrumental to enhancing organ donation. However, more experimentation is necessary to unearth the best mode that is best responsive to a society and subsequently, rejects the overly generalization that labels it as unethical.
MeSH terms: Humans; Motivation; Tissue and Organ Procurement; Perception; Dissent and Disputes
The liver is an important organ of the human body, playing a major role in the metabolism and storage of nutrients, synthesis of protein and other nutrients, as well as detoxifying many metabolic by-products. The response of the foetal and newborn liver to external insult and injury is limited. This is because the ability of the closely interdependent structures of a developing liver of expressing in the face of a variety of insults is limited as well. Thus most infants with insults to the liver present as cholestatic jaundice with variable degree of pale stools, enlarged liver and conjugated hyperbilirubinaemia. Biliary atresia, an idiopathic condition characterized by progressive fibrosing obliteration of both intra- and extrahepatic bile ducts, is the most important cause of neonatal cholestasis worldwide, including Malaysia. It is also the most important indication for childhood liver transplantation the world over. Challenges facing infants with biliary atresia include a delay in the diagnosis and late surgery, leading to a poor outcome. This often results from a failure to recognise the potential serious nature of an infant with prolonged cholestatic jaundice and pale stools among health care professionals.
Night work and rotating shift work are found to be detrimental to the health of workers. A cross sectional analytical study was conducted among the employees of a public medical centre in Kuala Lumpur. A total of 380 employees participated in the health screening and questionnaire survey. The majority of the respondents were Malays, females, and with mean age of 49 years old. The shift workers persistently had higher but non-significant proportions of being overweight/obesity and unhealthy clinical indicators such as systolic and diastolic blood pressure, fasting blood glucose and lipid profile except waist circumferences and HDL-cholesterol. There were also slightly more shift workers diagnosed with diabetes mellitus, hypertension or coronary heart disease (p>0.05). Although the present study could not provide established evidence for a relationship between shift work and cardiovascular risks, this could serve as a pilot study for future studies in this area.
Breast feeding has been actively encouraged in Malaysia in the last few years in all public hospitals. This study proposes to find out the prevalence of breast feeding in three villages in a rural community in Kedah, Malaysia. This was a cross sectional study on breastfeeding practices in Kubang Pasu, a district of Kedah. Majority of the mothers initiated breast feeding but exclusive breastfeeding was only 21% for four months and predominant breastfeeding was about 12.6%. The breastfeeding practice was more prevalent among women from the higher educational strata and higher income than those from the lower strata and lower income (p
MeSH terms: Breast Feeding; Cross-Sectional Studies; Female; Hospitals, Public; Humans; Income; Malaysia; Mothers; Poverty; Rural Population; Social Problems; Prevalence
As women with breast cancer are living longer, issues beyond survivorship like the much neglected sexual functioning and issue of quality of life have become increasingly important. Experiences of significant alterations in sexual functioning need to be addressed. However, these sexual issues are often not acknowledged in our traditional medical model of health care delivery. This paper briefly reviews the changes in sexual functioning after a diagnosis of breast cancer, with implication for clinical practice and medical curicula.
MeSH terms: Breast Neoplasms; Female; Humans; Quality of Life; Sexual Behavior; Survival; Survival Rate; Biological Processes
The clinical experience of the novel drug temsirolimus on eight patients with metastatic renal cell carcinoma and who were refractory to other forms of treatment is reported. Although none of the patients showed complete or partial response, three patients had stable disease. One patient was prematurely withdrawn due to pneumonitis. Five patients died during the period of observation of twenty months and the median survival time from start of treatment was ten months. Three patients showed no evidence of adverse events (AE). Five patients showed dyslipidemia and two had pneumonitis for which, the drug had to be withdrawn in one of them. None had significant leucopenia. We conclude that temsirolimus has activity even in heavily pretreated patients in advanced renal cell carcinoma and in addition, has the benefits of ease of administration and good tolerability.
Distress has become a major issue in cancer population. Patients may suffer from either physical,psychological distress or both. Cancer patients who are undergoing chemotherapy are more likely to experience psychological distress. This could be due to the negative effects of chemotherapy agents, the uncertainty of post-treatment, and the occurrence of psychosocial problems. As a result, the patient may experience a normal reaction such as sadness or may develop common psychiatric disorders such as depression and anxiety.
Tumour-induced or oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome characterized by bone pain and muscle weakness. A biochemical profile consisting of normocalcaemia, hypophosphataemia, phosphaturia, increased serum alkaline phosphatase and inappropriately low serum levels of 1, 25-dihydroxyvitamin-D is diagnostic. OOM is usually caused by an osseous or soft-tissue tumour of mesenchymal origin that secretes phosphaturic substances leading to increased urinary phosphate wasting. These tumours are small and slow growing. The diagnosis continues to be easily missed and when eventually made, localization of the tumour can be difficult. We describe the case of a young man who presented with severe generalized pain associated with muscle weakness. He was extensively investigated and eventually diagnosed to have OOM 3 years after initial presentation. Specialized investigations were necessary to localize the offending tumour.
Malignant tumours of the scrotum are very rare. Several type of occupations have been identified as high risk for the development of SCC of scrotum e.g paraffin and shale oil workers (1), textile workers (2) etc. We report a rare case of SCC of scrotum. Search of our records in the Urology and Pathology departments of our Centre showed that this is the only case of SCC of the scrotum in the last 10 years.
Prescribing medication is not without its adverse effects. Complications due to drug therapy are on the rise in Malaysia, especially when antibiotics are used indiscriminately. We reviewed cases admitted to the Acute Medical Ward of University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia, over a two-month period from March to April 2009. The authors found that Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) were the most common severe adverse cutaneous reactions due to ingestion or parenteral use of drugs. In this report, is a brief description of the two conditions and ways to manage them. The authors have come to a conclusion that judicious use of medications with adequate patient education is important in order to avoid these adverse effects.
Despite being the major cause of cancer-related death in Malaysian women,local data on patterns of breast cancer relapse and their long term outcomes are still scarce. We conducted a retrospective study on all patients treated for non-metastatic invasive breast cancer in 1999-2000 at the University of Malaya Medical Centre (UMMC), who subsequently developed relapse. We sought to analyse the patterns of relapse, their associated clinicopathological features and the overall survival ratefollowing the relapses. Univariate and multivariate analyses were used to analyse demographics and clinicopathological factors. Survival was analysed using the Kaplan and Meier method and compared by the log rank test. A total of 268 patients with a mean age of 50, were identified for the study. At a median follow-up of 50 months, 73 patients (27.2%) had relapsed. Local, regional and distant relapse rates were 5.5%, 1.9% and 19.8% respectively, whereas, the 5-year survival rates were 61%, 40% and 21% respectively (p < 0.01). Most relapses occurred within the first five years of diagnosis. Patients with long disease-free interval had better survival. The most common distant relapse site was the lungs while bone was the distant relapse site with the best prognosis. Disease stage, nodal status and oestrogen receptor status were found to have correlation with the risk of relapse. We concluded that the survival of patients with relapsed breast cancer was associated with the site(s) of first relapse and the disease free interval and clinicopathological factors can be used to predict the risk of relapse.
In the last three centuries, medicine has focused predominantly on the physical body as the source of disease, placing very little importance on the mind. However, the significance of mind-body interactions in medicine is now increasingly being recognised. True health must include both the physical body and the mind. This article traces our concepts of the relationship between mind and body since primitive times and explores its relevance to the maintenance of health.
Introduction: Exposure to excessive noise is the major avoidable cause of permanent hearing impairment. Sawmill is one of the workplaces where workers are exposed to hazardous noise level. This study was conducted to determine the reliability and validity of noise-induced hearing loss questionnaire among sawmill workers. Materials and Methods: This cross sectional study was conducted in March 2007 among 35 consented sawmill workers. A total of 40 items; 10 items for knowledge (8 areas), 20 items for attitude (7 areas) and 10 items for practice (2 areas) were assessed. Statistical analysis for reliability analysis was test by internal consistency and construct validity by exploratory factor analysis using principal components and Varimax rotation method. Results: Cronbach’s alpha coeffi cients were acceptable for attitude (0.90) and practice
(0.75). However, it was low for knowledge (0.67). Exploratory factor analysis showed three meaningful exploratory factors that could explain the three dimensions in the questionnaire. Conclusion: The results of the validation study suggested that the noise-induced hearing loss questionnaire is reliable and valid tool for assessing knowledge, attitude and practice among sawmill workers.
Introduction: The Malay Version of EORTC-QLQ C30 was validated among Malaysian women who had undergone breast cancer surgery. Materials and Methods: Test-retest evaluation (i.e. three weeks and ten weeks following surgery) was carried out to examine the validity and reliability of the scale. The Cronbach’s alpha value was used to determine the internal consistency, meanwhile, test-retest Intraclass Correlation Coeffi cients (ICC) indicates the reliability of the scale. Effect Size Index and Mean Differences interpret the sensitivity of the scale. Discriminant validity was evaluated by comparing two groups i.e. women who had mastectomy and women who had lumpectomy. Results: Internal consistencies are acceptable for Global Health Status (0.91), Functional domains (ranging from 0.50-0.89) and Symptomatology domains (ranging from 0.75-0.99). Intraclass Correlation Coeffi cient (ICC) ranged from 0.05 to 0.99 for Global Health Status and Functional domains, and ranged from 0.13 to 1.00 for Symptomatology domains. Sensitivity of the scale was observed in nearly all of the domains. Conclusion: The Malay Version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ C30) is a suitable tool to measure the quality of life of women with breast cancer.
MeSH terms: Breast; Breast Neoplasms; Female; Health Status; Humans; Malaysia; Mastectomy; Quality of Life; Surveys and Questionnaires; Global Health; Reproducibility of Results; Mastectomy, Segmental
Introduction: The study was conducted to look for the effects of polycythaemia on Glycosylated Haemoglobin (GHb) levels and to the see the correlations between the levels of haemoglobin, GHb, blood glucose, and lipid profi les including Atherogenic Index of plasma (AIP), in type 2 diabetics living 5800ft above sea level at Gangtok in Sikkim, India. GHb is used to predict the risk of long term complications of Diabetes mellitus (DM) like coronary artery disease (CAD). Materials and Methods: The study group consisted of Group I (Type 2 DM male patients with PPG levels 200mg/dl) and age matched healthy males formed the control group. Results: In Group I, GHb levels correlated positively with AIP, but not with TC/HDL-C ratio. In Group II, both PPG and GHb levels correlated positively with Total cholesterol (TC), LDL Cholesterol, TC /HDL-C ratio and AIP. This shows that higher PPG levels are associated with more Atherogenic lipid profi les. Study also showed higher GHb levels in controls at 7.61%, and correlated positively with postprandial glucose (PPG) levels (r = 0.92). Conclusion: In predicting risk for future CAD, PPG levels and AIP can be used as an adjunct parameter.
MeSH terms: Blood Glucose; Cholesterol; Coronary Artery Disease; Diabetes Mellitus, Type 2; Hemoglobin A, Glycosylated; Humans; India; Cholesterol, LDL; Male; Polycythemia; Sikkim; Control Groups; Diabetes Complications; Atherosclerosis
Monoamniotic twin pregnancy is a rare type of twin pregnancy which poses risk of cord entanglement and
sudden death of either one or both fetuses. The role of antenatal surveillance by Ultrasound Doppler for
umbilical cord and ultrasonic evidence of cord entanglement or knotting may predict the pregnancy outcome
but yet unavoidable. The discussion will include antenatal surveillance in this rare type of pregnancy.
Hepatic adenomatosis is a rare, benign tumour of the liver. It was first described by Flejou et al as multiple adenomas in an otherwise normal liver parenchyma. Although benign, it can present as a diagnostic
challenge because the lesions can be diffi cult to distinguish from other hepatic tumours. Patients can be
asymptomatic and the diagnosis may only be made incidentally. We describe the case of 40-year-old Malay lady who was incidentally found to have hepatomegaly. Radiological examinations revealed a complex left ovarian cyst with multiple liver lesions. Biopsy of the liver lesion showed features of hepatic adenomatosis. Literature review was done and the dilemma in managing her was discussed.