Arthroscopic sub acromial debridement surgery with acromioplasty is one of the shoulder surgeries performed to treat chronic shoulder pain. This surgical procedure is usually indicated in sub acromial impingement syndrome of shoulder, degenerative rotator cuff tears, severe functional limitation of shoulder joint and often surgery was performed in cases where all the conservative management had failed in the treatment of chronic shoulder pain. Even though the patient would be referred for early rehabilitation, post operative management of this surgical condition is highly challenging. Movement of the shoulder joint is often related with scapulo-thoracic joint, acromio-clavicular joint and sternoclavicular joint and the shoulder movements are governed by various different muscular forces from these joints. Failure to understand this biomechanical complexity of shoulder joint during post operative rehabilitation results in failure of the surgical outcome and might cause severe functional limitation with recurrent shoulder pain. Often in clinical practice, greater emphasis is given to achieve and regain movements in shoulder joint at the expense of the joint stability. However, inadequate scapular stability might further predispose the shoulder joint to excessive loading and results in repetitive injuries leading to chronic shoulder pain. This might affect the surgical and clinical outcome of the acromioplasty and result in surgical failure. Hence, surgeons and clinicians need to understand the biomechanical contributions in the post operative rehabilitation of the shoulder joint. The present case report emphasises the biomechanical model of post operative rehabilitation of a patient who had arthroscopic sub acromial debridement with acromioplasty.
Pseudohyperkalemia is a spuriously high serum potassium measurement in a patient with no clinical evidence of hyperkalemia. It has been reported to occur in patients with leukocytosis and thrombocytosis. Only a few cases of pseudohyperkalemia have been reported in patients after splenectomy. Two cases of pseudohyperkalemia occurring after emergency splenectomy for abdominal trauma are presented to highlight their clinical presentation and sequalae. Consecutive patients who underwent emergency splenectomy for trauma and subsequently developed pseudohyperkalemia were monitored in Universiti Kebangsaan Malaysia Medical Centre for their clinical sequalae. Both the patients developed leukocytosis, thrombocytosis and high serum potassium level within 2-weeks of their splenectomies. They did not demonstrate any symptoms and signs of hyperkalemia. Their conditions resolved spontaneously without any specific treatment. Pseudohyperkalemia should be suspected in a similar clinical scenario to avoid unnecessary treatment that could lead to severe hypokalemia.
Popliteal artery entrapment syndrome is an important infrequent cause of serious disability among young adults and athletes. We hereby describe a case of popliteal artery syndrome and its clinical implications. Physicians should be aware of the possibility of popliteal artery entrapment in young patients presenting with progressive arterial insufficiency.
Acute appendicitis is one of the most common differential diagnoses for acute abdominal pain made by emergency doctors. Suspected cases require surgical referral for observation or definitive intervention to prevent complications. A high index of suspicion and good clinical skills with the aid of scoring systems allows early decision making, which includes optimal pain control. The objective of this study was to identify the pain score and is relationship to the cut-off points of the Alvarado scoring system so that justifies early surgical referral or discharge for suspected acute appendicitis from the Emergency Department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a cross sectional study of acute abdominal pain from June 2007 to September 2008. All patients who fulfilled the criteria and consented to the study were assessed for Alvarado score, verbal numerical pain score (VNRS) and their subsequent management. Patients with an Alvarado score of ≥7 were likely to have acute appendicitis (80.1% sensitivity and 52.63% specificity) and those with the score of ≤3 were unlikely to have acute appendicitis. The median pain score was 7.00 (IQR: 5.00-8.50) but 72.5% did not receive any analgesia. There was no direct relationship between the pain score with Alvarado score. Oligoanalgesia in patients with acute appendicitis still exist in Emergency Department of UKMMC.
Morbidly adherent placenta with spontaneous rupture of membrane at extreme prematurity poses poor pregnancy outcome. Various issues on different management modalities still remain perplexed and individual consideration is vital. Two cases of morbidly adherent placenta with symptomatic per vaginal bleeding and spontaneous rupture of membrane at severe prematurity were reviewed and discussed. We found that, active intervention by termination of pregnancy and methotrexate therapy at early gestation can prevent the need of hysterectomy following major obstetrics haemorrhage.
Dermoid cyst in a kidney is rarely seen. We report a case of intrarenal dermoid cyst which mimics malignant renal tumour and discuss the dilemma in managing this disease.
Extra-gonadal germ cell tumours (EGGCT) are rare. Therefore further investigations of the testis is aimed at sourcing a possible primary origin of gonadal tumour. Over the years, various case series on EGGCT have been reported questioning its true nature as in a majority of them, a primary source is found in the testis, thus representing a metastatic gonadal tumour. The testis pathology could be either a true germ cell foci, an intra-tubular epithelial neoplasia or an area of fibrosis, indicating a ‘burnt out tumour’. We report a 39-year-old male who underwent laparotomy and excision of a retroperitoneal tumour. Histopathological examination revealed retroperitoneal lymph node of mixed germ cell tumour origin. Clinical and ultrasound examination of bilateral testis was normal. The patient refused orchidectomy or a testicular biopsy. He underwent four cycles of bleomycin, cisplatin, and etoposide with no evidence of tumour recurrence on follow up and remains disease free after 12 months of diagnosis. A literature review of EGGCT, its relation and factors relating with future testicular tumour is presented.
A 37-year-old Malay woman presented with progressive deterioration in vision and was diagnosed with advanced proliferative diabetic retinopathy with neovascular glaucoma. Intravitreal ranibizumab injection (an anti-vascular endothelial growth factor) was administered prior to vitrectomy. Slit lamp assessment 2 days post-injection revealed significant regression of both iris and retinal neovascularisation. This resulted in adequate reduction of intra-ocular pressure prior to surgery. In addition, the regression of retinal vessels reduced the risk of intra-operative haemorrhage, thus aiding the surgical excision of the fibrovascular membranes. Periodic post-operative assessment in the first 3 weeks showed minimal inflammation and no recurrence of vitreous haemorrhage. This case illustrates that intravitreal ranibizumab has a role as an adjunct therapy prior to diabetic vitrectomy to significantly reduce the risk of intra-ocular haemorrhage.
We report the case of a 34-year-old Malay, admitted for constipation and abdominal pain at 35 weeks of gestation. Initially, she was diagnosed to have paralytic ileus and was managed conservatively. As her condition did not improve, emergency laparotomy was performed for suspected intestinal obstruction. She delivered a baby boy weighing 2.84kg with good Apgar score through a caesarean section. Intra-operatively, she was noted to have sigmoid volvulus and sigmoidopexy was performed. Post-partum, colonoscopy and bowel decompression was performed. She recovered well and was discharged on day 5. This case illustrates the need to diagnose or suspect volvulus in pregnant woman presenting with severe constipation as early surgical intervention can reduce morbidity to both mother and fetus.
Vulvo-vaginal haematomas are not an uncommon obstetric complication. Despite advances in obstetric care, practice and technique, vulvo-vaginal haematomas do occur especially in complicated vaginal deliveries. Various management options are available for vulvo-vaginal haematomas. We describe three cases of vulvo-vaginal haematomas with different severity and presentations which were managed in different manners i.e. local haemostasis control, laparotomy with hysterectomy, and transarterial embolisation. The choice of treatment options would mainly depend on the clinical presentations, availability of expertise as well as facilities. Early identification is crucial.
Colonic diverticula is observed in over 60% of the western population aged over 80 where up to 30% will eventually be symptomatic and may develop complications. The natural history and etiology of colonic diverticula have been well described. However, predictive indicators of complicated diverticular disease are not known thus preventing the prophylactic treatment of this subset of patients,. The aim of this study was to observe patients with complicated diverticular disease in order to identify common factors associated with recurrent complications. All hospital admissions from January 2005 to December 2008 for complications of diverticular disease were recruited. Using logistic regression, demographic data and factors such as clinical presentation, nature of complication, lifestyle, concomitant medical illness and medications that may be associated with recurrent episodes of complications were analyzed. A total of 121 patients were diagnosed with complicated diverticular disease during the study period with 24 patients having recurrent complications. Logistic regression analysis performed after controlling for confounders found active smoking (p=0.006) and alcohol consumption (p=0.036) along with underlying diabetes (p=0.031) and dyslipidemia (p=0.039) significantly associated with an increased risk of recurrent complications. We therefore concluded that smoking, alcohol consumption, diabetes mellitus and dyslipidemia are associated with recurrent complicated colonic diverticular disease. As these are modifiable risk factors, they should be sought for during the presentation of the first attack. Aggressive control of these factors will help in reducing the risk of recurrent complications.
The study was conducted to create specific formulae for stature estimation of adult male population in Malaysia based on measurements of femur, tibia and fibula lengths using radiographic method. A number of thirty two Malaysians from hospitals involved as subjects in this study. The subjects were Malays (14), Chinese (8) and Indians (10) from 25-45 years old. The standing height of the subject was recorded before femur, tibia and fibula were scanned with an x-ray
machine. The bones length was measured on the x-ray film in centimetres (cm) and analysed using Statistical Package for Social Sciences (SPSS) version 19.0 for Windows. The results showed a significant relationship (p < 0.05) between stature and measurements of length of femur, tibia and fibula. Stature of Malays and Indians were significant (p < 0.05) with measurements of length of femur, tibia and fibula but insignificant in Chinese. Simple Linear Regression Analysis was used to derive regression equation for single bone and Multiple Linear Regression Analysis was used to derive regression equation for combination of femur, tibia and fibula. Six formulae for stature estimation of adult male population in Malaysia were derived. The formulae consist of three formulae for single bone, a formulae for combination bones with unknown race, a formulae for combination bones of Malays population and a formulae for combination bones of Indians population. Formulae for combination bones had the highest correlation coefficient compared to the formula using a single bone. Standard error was found to be high in all the formulae due to small sample size. Extension for this study is essential to provide Malaysia with accurate formulae.
MeSH terms: Adult; Body Height; Femur; Fibula; Humans; Malaysia; Male; Regression Analysis; Social Sciences; Tibia; X-Ray Film; X-Rays; Sample Size; Bones of Lower Extremity
This study was carried out to observe thermotolerance ability of Acanthamoeba spp. A total of 32 Acanthamoeba spp. isolates obtained from water taps, sinks, swimming pools and sea water were used. Trophozoites of Acanthamoeba spp. were inoculated onto non-nutrient agar (NNA) seeded with heat-killed Escherichia coli using aseptic technique and incubated for 14 days at 30°C to obtain the cyst. The cysts were subcultured onto new agar plates for thermotolerance test at 37°C and 42°C. The plates were observed until 96 hours after incubation for excystation of Acanthamoeba before being declared negative. Overall, 81.25% of samples were able to excyst at 37°C while 37.5% were able to excyst at 42°C. Thermotolerant Acanthamoeba is associated with high pathogenicity potential.
Kajian terdahulu banyak menunjukkan perbezaan dalam dimensi okular mengikut kaum. Walau bagaimanapun hanya terdapat sedikit data mengenai dimensi okular bangsa Melayu di Malaysia yang dilaporkan. Kajian ini bertujuan untuk menetapkan nilai normal dimensi okular bangsa Melayu muda di Malaysia. Seramai 584 orang telah diundang untuk menjadi subjek untuk kajian secara sukarela. Pengukuran yang dilakukan meliputi kelengkungan dan ketebalan tengah kornea, nilai esentrisiti kornea (e), diameter iris horizontal dan vertikal yang kelihatan, saiz pupil dan bukaan palpebral. Subjek dibahagikan kepada 3 kumpulan berikut mengikut umur dan dipadankan mengikut jantina dan umur: Kumpulan 1 (7-12 tahun, n = 188), Kumpulan 2 (13 to 18 tahun, n = 196) and Kumpulan 3 (19 to 24 tahun, n = 200). Pengukuran dilakukan menggunakan topografer kornea (CTK 922 dari Haag Streit, Jerman), pakometer ultrasonik (Corneo-Gage Plus 2 dari Sonogage Incorporated) dan auto refraktometer (Auto-Ref R1 dari Canon, Jepun). Dimensi okular bangsa Melayu yang diukur didapati lebih kecil dari bangsa lain di seluruh dunia. Perbezaan yang signifikan juga didapati untuk semua pengukuran dengan peningkatan umur (p < 0.05). Keputusan kajian ini boleh dijadikan rujukan untuk nilai dimensi okular populasi Melayu muda Malaysia di masa hadapan.
Changes in nitrate and nitrite contents (leaves and stem) of Amaranthus gangeticus (AG) and Amaranthus paniculatus (AP), resulting from blanching, storage time (0-4 days), storage temperature (0 and 4ºC), and reheating were analysed. Results showed that fresh AG (1859 ± 7.07 mg/kg) had higher nitrite content than AP (1262 ± 2.12 mg/kg). Nitrites content was 506 ± 2 and 825 ± 3.5 mg/kg for AG and AP, respectively. Reheating and storage times significantly increased the conversion of nitrate to nitrite in AG and AP. Storage at 0 and 4oC exhibited a significant change (P < 0.05) in nitrate and nitrite contents for both samples. Higher nitrite content was found in AP when stored at 4oC and 0oC. The present study indicated that storage time and temperature affected the nitrite contents in blanched AG and AP when stored in low temperatures. Apart from that reheating was also found to increase the formation of nitrite.
Fungsi penglihatan dipengaruhi oleh proses penuaan dan tanpa intervensi yang bersesuaian boleh mengakibatkan kemerosotan tahap penglihatan. Keadaan ini jika berterusan akan mengakibatkan kesukaran melakukan aktiviti kehidupan seharian dan memberi kesan kepada kualiti hidup kepada warga emas. Kajian ini mengkaji kesan gangguan penglihatan terhadap aktiviti harian dan kualiti hidup warga emas. Ukuran yang dilakukan ialah tahap penglihatan jauh menggunakan carta LogMAR untuk menilai gangguan penglihatan. Ujian kualiti hidup dilaksanakan menggunakan soalan kualiti hidup penglihatan terhad (LVQOL) dan ujian keupayaan melakukan aktiviti harian menggunakan indeks Barthel (BI). Dapatan kajian menunjukkan bahawa gangguan fungsi penglihatan bertambah teruk dengan peningkatan umur, begitu juga didapati bahawa BI berkurangan apabila fungsi penglihatan merosot. Skor kualiti hidup LVQOL pula berkurangan bersama-sama kemerosotan tahap penglihatan. Tiga puluh lima peratus warga emas dalam kajian ini memerlukan intervensi optometri dan penglihatan terhad, Kesimpulannya, kemerosotan tahap fungsi penglihatan di kalangan warga emas boleh menyebabkan penurunan keupayaan dalam melakukan aktiviti harian. Di samping itu, akuiti visual yang tidak dibetulkan akan menyebabkan penurunan kualiti hidup warga emas.
Perkembangan industri permotoran telah menyebabkan pencemaran udara yang menjadi faktor kepada peningkatan simptom masalah respiratori dalam kalangan kanak-kanak sekolah rendah. Kajian ini mengkaji perkaitan antara peningkatan simptom masalah kesihatan respiratori dalam kalangan kanak-kanak sekolah rendah dengan pendedahan terhadap pencemaran udara akibat lalu lintas. Kajian school-based jenis keratan lintang telah dilakukan di dua buah sekolah di daerah Kota Bharu, Kelantan iaitu Sekolah Kebangsaan Langgar dan Sekolah Kebangsaan Demit dengan melibatkan pelajar berumur 10, 11 dan 12 tahun. Saiz sampel seramai 124 orang (n = 124) dipilih menggunakan corak persampelan kebarangkalian iaitu persampelan rawak mudah. Responden disoal menggunakan instrumen yang telah disahihkan dan diadaptasi dari International Study of Asthma and Allergies in Childhood (ISAAC). Analisis data dilakukan dengan menggunakan Statistical Package For Social Sciences (SPSS). Hasil kajian menunjukkan peningkatan simptom masalah respiratori yang dihadapi oleh pelajar di dua buah sekolah rendah di Kota Bharu adalah berkait rapat dengan pencemaran udara yang berpunca dari lalu lintas dengan p < 0.05. Kajian mendapati pendedahan kepada bahan pencemar udara yang berpunca dari lalu lintas telah meningkatkan simptom masalah respiratori dalam kalangan kanak-kanak sekolah di rendah lokasi kajian.
MeSH terms: Asthma; Drug Packaging; Hypersensitivity; Schools; Social Sciences
The present study was carried out to determine the concentrations of selected metal elements (lead, copper, manganese, zinc and iron) in 51 samples of commercial drinking water and tap water available in Malaysia. The results indicated that low metal elements were found in the studied water samples. Lead, manganese, zinc and iron were not detected in some of the studied samples, except copper. The concentrations of the metal elements in the studied samples were well below the maximum permitted concentrations as recommended. Therefore these drinking water are safe for consumption and do not pose adverse effect to the health of consumers due to metal toxicity.
Acanthamoeba is a free living protozoa that can cause keratitis and granulomatous amoebic encephalitis. Physiological characteristics of this amoeba are found to have a medical importance in which it can be related to the pathogenicity potential of the organism. This study was carried out to investigate the physiological characteristics of survivability during axenization. Six Acanthamoeba strains from three clinical isolates (HSB 1, HKL 48 and HKL 95) and three environmental isolates (PHS 2, PHS 11 and PHS 15) were used in this study. Axenization test was done by treating cysts with hydrochloric acid (3%) and Page saline containing Gentamicin (100 µg/ml). Cysts were then cultured into PYG enrich media, incubated at 30oC and the presence and proliferation of trophozoites of Acanthamoeba were observed. This study showed that PHS 15, HSB 1, HKL 48 and HKL 95 could be axenized but they have poor proliferation rate in PYG enrich media. The result showed that the difference between both clinical and environmental isolates was observed in two strains; PHS 2 and PHS 11. This indicates that there is a possibility that the physiological traits of strains from both isolates are the same and strains from the environment are able to show the pathogenic potential and capable of causing infection to human.
Bunga rafflesia cantleyi Solms-Laubach merupakan salah satu jenis tumbuhan liar boleh ditemui di hutan tanah rendah di Semenanjung Malaysia dan digunakan secara meluas dalam ubatan tradisional. Objektif utama dalam kajian ini adalah untuk menguji keberkesanan ekstrak tumbuhan ini sebagai agen aktiviti antibakteria. rafflesia cantleyi Solms-Laubach diesktrak dengan menggunakan tiga kaedah pengekstrakkan berperingkat iaitu petroleum eter (PE) diikuti dengan etil asetat (EA) dan berakhir dengan etanol. Kesemua ekstrak ini kemudiannya diuji terhadap beberapa bakteria ujian iaitu Staphylococcus aureus ATCC 25923, Staphylococcus epidermidis, Escherichia coli ATCC 25922 dan Salmonella typhimurium dengan menggunakan kaedah resapan telaga. Hasil keputusan menunjukkan ekstrak etil asetat dan etanol mempunyai kesan perencatan bakteria yang baik, manakala ekstrak petroleum eter langsung tidak menunjukkan sebarang aktiviti antibakteria. Hasil kajian juga mendapati bahawa ekstrak etil asetat lebih ketara merencat kesemua bakteria yang diuji berbanding dengan ekstrak ethanol. Dua ujian lain yang dijalankan iaitu ujian penentuan nilai kepekatan perencatan minimum (MIC) dan nilai kepekatan minimum bakterisidal (MBC) didapati menyokong keputusan ujian kaedah resapan telaga di mana nilai MIC yang diperoleh bagi ekstrak etil asetat adalah lebih rendah iaitu dalam julat 6.25 hingga 12.5 mg/ml dan nilai MBC pula dalam julat 25.0 hingga 50.0 mg/ml berbanding ekstrak etanol dengan nilai MIC yang lebih besar iaitu dalam julat 25.0 hingga 50.0 mg/ml dan nilai MBCnya adalah 100.0 mg/ml.