A fish bone (foreign body) in the throat is a common presentation in an otolaryngology practice. Commonly the fish bone can be visualized and removed in a clinic setting. More distal foreign body impaction such as at the cricopharyngeus level will need direct laryngoscopy and removal under general anesthesia. It is not uncommon to have patient presented with residual symptom of post foreign body ingestion. Findings such as traumatized mucosa and embedded bone with slough on the mucosal surface are commonly encountered. We report a case of post foreign body ingestion presented with odynophagia and laryngoscopy showed a partially swollen epiglottis. The symptom recovered with conservative management.
We reported a young patient with myelodysplastic syndrome (MDS) with eosinophilia, in which her chromosomal analysis revealed the presence of trisomy X and a marker chromosome at chromosome 11. The technique used to detect the chromosomal abnormalities is a multicoloured –fluorescent in situ hybridization technique (M-FISH). Our observation suggested that these underlying chromosomal abnormalities were probably responsible for her development of MDS with eosinophilia.
Myelodysplastic syndrome (MDS) is a condition whereby there is ineffective production of haematopoietic stem cells and poor quality of cells produced. The cause can either be a primary bone marrow problem, de novo or therapy related. Most MDS cases are secondary rather than primary. Many chromosomal abnormalities have been found in cases of myelodysplastic syndrome. We described a case of MDS with eosinophilia in association with presence of trisomy X and a marker chromosome in chromosome 11.
MeSH terms: Bone Marrow; Chromosome Aberrations; Chromosomes, Human, Pair 11; Eosinophilia; Female; Hematopoietic Stem Cells; Humans; Myelodysplastic Syndromes; Sex Chromosome Aberrations; Trisomy; In Situ Hybridization, Fluorescence; Chromosomes, Human, X; Sex Chromosome Disorders of Sex Development
Human herpesvirus-6 (HHV-6) levels have been considered as markers for various diseases. The aim of this study was to evaluate the prevalence of HHV-6 infection in healthy adults in Malaysia. Methods: The level of HHV-6 in saliva was investigated in 36 healthy adults, age 19 to 23 years, at Kuala Lumpur, Malaysia using variant-specific TaqmanTM quantitative real-time PCR (qPCR). Results: The amount of HHV-6 DNA in the saliva of healthy adults ranged from negative to 10,000 HHV-6 genomes/ml of saliva (median, 360 genomes/ml of saliva). Of the 36 samples tested, 30 (83%) contained HHV-6 DNA. HHV-6B was the only variant detected in the saliva of all the positive cases. Conclusions: The detection of HHV-6 DNA in saliva by real-time PCR assay provides a sensitive and specific quantitation of HHV-6. Our pilot study suggests the wide prevalence of HHV-6 in saliva from
healthy adults.
Acanthamoeba is a free-living protozoa which causes serious ocular problem. Acanthamoeba keratitis is becoming more prevalent amongst contact lens wearers and it can cause loss of vision and blindness if not treated properly. The objective of this research is to determine the effectiveness of gentamicin against six Acanthamoeba spp. isolates, of which three were clinical isolates (HS 6, HKL 95, HTH 73) and three environmental isolates (SMAL 7, SMAL 8, TTT 9). Cyst suspension from the chosen isolates were exposed to gentamicin. After 48 hours of incubation at temperature of 30°C and 37oC, each mixture was filtered and filtration membrane was put onto non-nutrient agar laid with Escherichia coli. The agar plates were incubated for three days at 30oC and 37oC and the plates were examined daily until day 14 to look for the presence of Acanthamoeba trophozoites under inverted microscope. The presence of trophozoites indicated the ineffectiveness of gentamicin. Gentamicin was found to be effective against Acanthamoeba cysts from all the test strains at both incubation temperatures. The minimum cysticidal concentration (MCC) mean value of gentamicin was 0.193 mg/mL at 30oC and 0.229 mg/mL at 37oC. So, we concluded that gentamicin has cysticidal potential towards Acanthamoeba.
Work-Related Hand Injuries (WRHIs) may result in disability and diminished productivity and cause economic impacts not only to the individual, worker’s families and industries, but to the local community as well.
Objectives: To determine the prevalence of severe Work-Related Hand Injuries (WRHIs) and factors associated at a tertiary hospital.
Methods: A pre-tested validated questionnaire was used to obtain data. All patients 18 years and above with WRHIs seen at a tertiary hospital between January 2010 and June 2010 were included in the study. Data was analysed using SPSS version 18.
Results: Out of the 297 industrial accidents, 74 (24.9%) were WRHIs. Among those with WRHIs, (47.3%) of them had severe hand injuries. The overall mean age of the respondents was 30.36 (± 9.54 SD) years. Majority (82.5%) of the injuries occurred between Mondays to Friday. Majority (70.1%) of hand injuries were caused by machine and 48.6% of the hand injuries occurred when the hand was caught in the operating part of the machine. Majority (62.1%) of the respondents had fingers’ injuries and 32.4% had open fracture. Bivariate analysis showed that there was significant association between severity of WRHIs and locations of injury, mechanisms of injury, sources of injury and sectors of industry (p < 0.05). Logistic regression analysis showed that WRHIs was significantly associated with source of injury and sector of industry. Respondents with hand injury resulted while operating on mechanical machine was 26 times more likely to report severe WRHIs than those with other sources of their hand injury like (sharp tool, heavy door, and wet floor). Respondents working in metal-machinery industries were eight times more likely to report severe WRHIs than those who working in other sectors of industry like (wood-furniture, constriction, food preparing, service and automotive).
Conclusions: WRHIs contributed to 24.9% of all industrial accidents seen at the emergency department and orthopaedic clinic and 47.3% of the respondents with WRHIs had severe hand injuries. Severity of WRHIs was significantly associated with sources of injury and sectors of industry.
Study site: emergency room, orthopaedic ward, general surgery ward and the orthopaedic outpatient clinic of a tertiary hospital
MeSH terms: Accidents, Occupational; Emergency Service, Hospital; Finger Injuries; Fractures, Open; Hand Injuries; Hospitals; Humans; Interior Design and Furnishings; Malaysia; Orthopedics; Outpatient Clinics, Hospital; Prospective Studies; Surveys and Questionnaires; Prevalence; Logistic Models; Tertiary Care Centers
The Clitoria ternatea (Fabaceae) root, seed, and leaf are commonly used in Ayurvedic medicine in Malaysia and Indonesia. The methanol leaf extracts of C. ternatea was tested for toxicity by means of brine shrimp lethality test and acute oral toxicity assay. In the brine shrimp lethality test, the leaf extract were non-toxic or showed weak lethality (LC50 > 1 mg/ml) at the 6 h, 12 h and 24 h incubation period. Nevertheless, at the 48 h incubation time, the leaf extract exhibited moderate toxicity activity with LC50 values of 0.49 mg/ml. In the acute toxicity study using mice, the median lethal dose (LD50) of the extract was found greater than 2000 mg/kg, and we found no pathological changes by means of macroscopic examination of tissues of mice treated with the extract. We conclude that the C. ternatea leaf extract is not toxic in mice and brine shrimp.
Obesity is a well-established risk factor for coronary heart disease, ischemic stroke, type 2 diabetes, cancers of the breast, colon, prostate and other organs. Objectives: To determine the prevalence of obesity and associated factors among university staffs. Methods: A cross sectional study was carried out among university staffs of University Putra Malaysia using a self-administered validated pre-tested questionnaire. Weight was measured using a digital bathroom scale (TANITA Model HD 319) and height was measured using a SECA Body Meter Model 206. Body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters (kg/m2). A p value of
MeSH terms: Body Weight; Colon; Coronary Artery Disease; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Humans; Malaysia; Male; Neoplasms; Obesity; Prostate; Surveys and Questionnaires; Risk Factors; Universities; Body Mass Index; Prevalence; Stroke
Saccular aneurysms associated with moyamoya disease are commonly located in the vertebrobasilar circulation. Anterior circulation aneurysm associated with moyamoya disease is uncommon and is usually treated by neurosurgical clipping. Objective: We report a succesful treatment using the endovascular approach in a case of ruptured anterior communicating artery aneurysm in unilateral moyamoya disease. Clinical Presentation: A 23 year old man presented with a 5 day history of headache, diplopia and fever. Computed Tomography (CT) scan and cerebral angiogram showed a bilobed anterior comunicating artery aneurysm. There was also severe M1 segment stenosis of the left middle cerebral artery with multiple collaterals, representing moyamoya vessels. Intervention: Treatment was done under general anesthesia and followed the standard practice for endovascular treatment. The aneurysm was occluded with three detachable platinum microcoils (Microplex®, Microvention®). Conclusion: Endovascular treatment can be a treatment option for ruptured anterior circulation saccular aneurysms associated with moyamoya disease.
We report a case of factitious dermatitis in a 17 year female student who presented with recurrent pain .swelling and subcutaneous crepitations of the forearm. A thorough investigation was done. Full blood count, erythrocyte sedimentation rate was normal. Plain radiographs revealed the presence of subcutaneous emphysema. MRI showed similar findings and revealed normal muscles. Colonoscopy and OGDS were normal. except for a small polyp at the gastro-esophageal junction. Based on the clinical findings and lack of correlation with the investigations a diagnosis of factitious subcutaneous emphysema was made.
The pandemic of obesity is of great concern as its associated co-morbidities are devastating; causing lifelong burden to individual’s health and is economically costly to a country. Factors that lead to obesity are a combination of environmental and genetic factors. The Pro-opiomelanocortin (POMC) gene resides in chromosome 2p23.3, and its protein is composed of 241 amino acids which is responsible for the production of polyhormones that regulate appetite and food intake. The study aimed to investigate the prevalence of the RsaI single nucleotide polymorphism (SNP) site in the 5’-untranslated region (UTR) of POMC and its possible association with obesity among 302 multi-ethnic Malaysian subjects (142 obese, 160 non-obese; 120 males, 182 females) from the Kampar Health Clinic. Subjects were recruited by convenience sampling with informed consent and socio-demographic data as well as anthropometric measurements were taken. Subjects were genotyped by polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) analysis using DNA extracted from blood. The distribution of the RsaI genotypes was significantly different among the different ethnicities, but the mutated RsaI (- / -) genotype was rare as it only occurred in 8.9% of the subjects. With the frequency of the RsaI (-) allele of 0.31, it was associated with the percentage of skeletal muscles (p
There are many inherent challenges in the evaluation and management of children with laryngotracheal disorders, and it differs widely from one institution to another. The main challenges include access to suitable equipment, fully trained surgeon and, cooperation with the anesthetist and pediatrician. Material & Methods: The aim of the study was to analyze the pediatric laryngotracheal cases undergoing endoscopic examination in Hospital Universiti Sains Malaysia. A retrospective review of 73 cases undergoing microlaryngoscopy and bronchoscopy from 2004 to 2008 was done. Results: Laryngomalacia was the commonest diagnosis. The majority of the cases (45.2 %) were referred because of noisy respiration. Other reasons for referral were foreign body inhalation, unresolved lung disease, failed extubation, examination prior to decannulation and hoarseness. Conclusion: Management of pediatric laryngotracheal cases were varied and tailored to each problem. The endoscopic examination must be meticulous. The management include observation, medical treatment, closed (endoscopic)
techniques and open surgery.
Beta (β)- thalassaemia is a public health problem in Malaysia. The carrier rate is estimated to be 4.5% by micro-mapping studies particularly among Malays who comprise 53.5% of the population in Malaysia. The common diagnostic method in Malaysia for mutation detection is by amplification refractory mutation system (ARMS). It allows single mutation detection in each reaction but is labour intensive and time consuming when many mutations need to be identified. The purpose of this study was to develop a diagnostic tool for effective mutation detection of beta thalassaemia in Malay patients and compare its efficacy with ARMS-PCR, the current method in use. Methods: Reverse dot blot hybridization (RDBH) technique was incorporated in the development of two strip assays [RDBH-Strip M(6) and RDBH-Strip C(6)] to identify common beta thalassaemia mutations in the Malays. The panels of selected mutations were based on the mutation frequencies in Malaysia reported in previous studies. RDBH-Strip M(6) was applied as step 1 and RDBH-Strip C(6) was applied as step 2 for unidentified mutations. The strips were validated with the gold standard method, ARMS- PCR. Results: One hundred and thirty seven Malay patients with 274 alleles were studied. In Step 1 mutation detection, 238 alleles (86.9%) were identified in 119 of patients by RDBH-Strip M(6). Step 2 resulted in a further detection of 20 alleles in another 10 patients by RDBH-Strip C(6). The combination of both strips resulted in the identification of 258 alleles in 129 (94.6%) of 137 Malay patients. The strip assays were 100% sensitive and specific when compared with ARMS-PCR method. Conclusion: Two strip assays utilising the RDBH technique were developed to identify common β-thalassaemia mutations in Malays. The RDBH Strip M(6) identified 86.9% of the mutations and the RDBH-Strip C (6) detected further 7.3% alleles. This two step strategy was found to be rapid and cost effective for the direct diagnosis of β-thalassaemia mutations in the Malays. The remaining unidentified mutations would require DNA sequencing. It can serve as a specific molecular diagnostic tool for effective diagnosis of
β-thalassaemia mutations in this ethnic group.
Pneumonia is one of the most common complications of stroke with significant impact on patients’ outcome. The aim of this study is to look for the predictors of stroke-associated pneumonia (SAP) and its 30-day mortality and to analyse the survival of ischaemic stroke patients with pneumonia. Methodology: This is a prospective observational study, involving all acute first time ischaemic stroke patients admitted to a tertiary hospital that fulfilled the inclusion and exclusion criteria over a 6-month period. Demographic data were obtained on admission. Patients were reassessed for SAP, on day 5 and day 30. Assessment was done using the National Institutes of Health Stroke Scale (NIHSS) score, Barthel index and modified Rankin scale (MRS). All patients with pneumonia were assessed with the pneumonia severity index (PSI) for SAP. Results: One hundred and twenty patients were enrolled consecutively within the 6-month study period. 15.8% developed SAP. Independent predictors of SAP were clinical dysphagia (OR 76.32; 95%CI 4.46 to 1307.05), random blood glucose (RBS) on admission (OR 1.34; 95%CI 1.06 to 1.68) and NIHSS score on admission (OR 1.15; 95%CI 1.02 to 1.30). Independent predictors for 30-day mortality were NIHSS score on day 5 (OR 1.20; 95%CI 1.08 to 1.33) and occurrence of pneumonia (OR 14.90; 95% CI 3.34 to 66.42). There was a significant difference in mean survival between SAP and non-SAP patients. Conclusions: Clinical dysphagia, RBS on admission and NIHSS score on admission were independent predictors of SAP. NIHSS score on day 5 and pneumonia were independent predictors of 30-day mortality. SAP patients had shorter survival
time compared to non-SAP patients.
MeSH terms: Blood Glucose; Brain Ischemia; Deglutition Disorders; Demography; Hospitalization; Humans; National Institutes of Health (U.S.); Pneumonia; Prospective Studies; United States; Stroke; Tertiary Care Centers
Sexual dysfunction is common but not often assessed in the routine clinical care among males on opiate substitute treatment.
Objective: To determine the association between clinical variables and erectile dysfunction (ED) among men on methadone maintenance therapy (MMT).
Methods: A cross-sectional study involving 108 participants who attended the Drug Clinic, Hospital Kuala Lumpur. The instruments used include the Structured Clinical Interview for DSM-IV Axis-I Disorder (SCID-I), Beck Depression Inventory (BDI) and International Index of Erectile Function-15 (IIEF-15).
Results: Concurrent heroin abuse was significantly associated with presence of ED (p=0.024). Treatment factors including methadone dose and duration of methadone treatment were not significantly associated with ED.
Conclusion: Education on sexual dysfunction as a potential adverse effect and its association with illicit heroin use should be considered in the doctor-patient consultation to encourage treatment adherence and abstinence from heroin.
Study site: Drug Clinic, Hospital Kuala Lumpur, Malaysia
MeSH terms: Analgesics, Opioid; Cross-Sectional Studies; Depression; Heroin; Heroin Dependence; Hospitals, General; Humans; Erectile Dysfunction; Malaysia; Male; Methadone; Outpatient Clinics, Hospital; Psychiatric Status Rating Scales; Referral and Consultation; Diagnostic and Statistical Manual of Mental Disorders; Opiate Substitution Treatment
The health related quality of life (HRQoL) of chronic obstructive pulmonary disease (COPD) patients is greatly influenced by their health status. The Health Index Questionnaire - Short Form 36 (SF-36) and St George Respiratory Questionnaire (SGRQ) are commonly used to assess the HRQoL of COPD patients. Objective: This study investigates differences in HRQoL following sessions of pulmonary rehabilitation program (PRP) with a control group (CG) that had no intervention. Method: This quasi-experimental study involving 17 subjects assigned to the CG and 16 subjects in the intervention group (IG). Ethical approval was obtained from the relevant authority. Both groups were given the health index questionnaires- SF-36 and SGRQ prior and 5 weeks after the intervention. The CG only had medication while the IG performed exercises (cycling, treadmill walking, upper limb strengthening exercise and stair climbing exercise). Results: Data analysis using SPANOVA demonstrated significant improvement in HRQoL measured from SF-36 in domains of bodily pain (p=0.005), vitality (p=0.021) and mental health (p=0.002) in IG unlike the CG. Similarly, SGRQ, also shows improvement in symptom (p=0.028), activity (p=0.004) and total score (p=0.012. Conclusion: The 5 weeks pulmonary rehabilitation program demonstrated improvement in HRQoL among COPD
patients.
MeSH terms: Exercise Therapy; Health Status; Humans; Mental Health; Pain; Quality of Life; Surveys and Questionnaires; Exercise; Walking; Pulmonary Disease, Chronic Obstructive; Control Groups
Heart failure is chiefly the end stage of primary hypertension and a major public health problem in Malaysia. The aim of this work is to investigate the level of BNP that may discriminate between primary hypertension patients without heart failure and primary hypertensive patients with heart failure. This study was conducted on 60 hypertensive patients without any clinical symptoms of heart failure referred for echocardiography to evaluate the ventricular function. Patients with metabolic diseases and terminal diseases were excluded from the study. The BNP levels were assessed using the Triage Meter from Biosite Diagnostics. Results showed that BNP level display a negative correlation with ejection fraction (Pearson correlation test). The significant result (paired t test, p < 0.05) proves that both predictors are very important and relates to each other. Low ejection fraction is significantly marked with raised BNP level suggesting that BNP may play potential role as screening tool for early detection of heart failure in primary hypertensive patients.
Study site: (Universiti Kebangsaan
Malaysia Medical Center and International Medical University cardiology clinic, Seremban
Prevalence of diabetes is escalating both globally as well as in Malaysia. With the epidemic of diabetes and its related morbidities and mortalities, health care professionals are facing an unprecedented challenges in controlling the disease. Objective: To determine the metabolic control and the cardiovascular risk factors among type 2 diabetic patients in a primary care setting. Method: This was a cross sectional study conducted in a primary care clinic in Selangor, Malaysia. Inclusion criteria were all type 2 diabetic patients aged 18 and above and were being followed-up for more than six months prior to the recruiting period in May 2009. The demographic data were obtained through face- to-face interview. Height, weight and blood pressure of the patients were taken during the day of data collection. The co-morbidities and laboratory results were obtained from the medical records. Results: Two-hundred patients were recruited. The mean age was 58.6 (SD=10.5) with 79.0% of the patients aged more than 50 years old. The majority of the patients were female (62.5%). One-tenth (11.5%) were smokers. More than half of the patients (64.0%) had co-morbid of hypertension and half of them (50.5%) had dyslipidaemia. A total of 72.5% of the patients had 3 or more cardiovascular risk factors. Less than one fifth of the patients had achieved the target of control for glycaemia, blood pressure, LDL and BMI. Those age 60 and above had significantly higher proportion of patients achieving fasting blood glucose control (p=0.033). Conclusion: The majority of type 2 diabetic patients had multiple cardiovascular risk factors (3 or more risk factors) and had not achieved the recommended goals in
metabolic control.
MeSH terms: Adult; Aged; Ambulatory Care Facilities; Blood Glucose; Blood Pressure; Blood Pressure Determination; Cardiovascular Diseases; China/ethnology; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Fasting; Female; Humans; Hypertension; India/ethnology; Malaysia; Malaysia/ethnology; Primary Health Care; Risk Factors; Body Mass Index; Prevalence; Dyslipidemias
This prospective randomised study was undertaken to compare surgical parameters as well as clinical and radiological outcomes of subvastus (SV) to midvastus (MV) approaches in staged bilateral total knee arthroplasty (TKA). Twenty-three patients, aged 55–76 years, who underwent staged bilateral TKAs, were followed up for 6 months. The SV approach was used on one knee and MV approach on the other. We found similar lateral retinacular release rates and patellar resurfacing rates between the two approaches .The SV approached knees had a more significant blood loss and increased operative time compared to the MV approached knees but they achieved significantly earlier active straightleg raises (SLR) postoperatively (p
BACKGROUND:
Laparoscopic cholecystectomy, although is less invasive than open surgery, is not completely pain free. The use of local anaesthesia to relieve pain following this procedure is a common practice. However, it remains debatable whether a pre- or post-operative drug administration is more effective. Here, we investigated the role of preemptive local anaesthetic infiltration given pre- or post-incisional, in relieving the pain during laparoscopic surgery.
METHODOLOGY:
A randomized controlled trial was conducted with 96 patients receiving 0.5% Bupivacaine 100mg. Group A (n=48) received post-incisional skin infiltration whilst Group B (n=48) received pre-incisional infiltration. Incisional (somatic) and intra-abdominal (visceral) pain was assessed using Visual Analog Scale (VAS) at day 0, day 1 and day 7 post-operative days.
RESULT:
Baseline characteristics between the two groups were similar. Incisional pain was lower in Group B as compared to Group A at day 0 (P=0.03) and day 1 (P0.05).
CONCLUSION:
Administration of pre-incisional local anaesthesia offers better pre-emptive pain relief measure than post-incisional administration by reducing somatic and visceral pain in laparoscopic gall bladder surgery.
The story of clinical genetics is a relatively new one, first spearheaded by paediatrics but increasingly, has taken root in all branches of medicine leading to ‘personalised medicine’. There are expectations that this revolution in genetics will pave the way to genomic medicine and a cure for all inherited disorders. The development of the field of Clinical Genetics and genetic counselling in Malaysia is still in its infancy. Using evidence-based data on genetic disorders such as birth defects, inborn errors of metabolism, genetic syndromes, neurological disorders and hereditary cancers, that hitherto have not been well documented in Malaysia, this review article will focus on findings and issues that will present a unique insight and opportunity to understanding the complex genetic counselling issues related to clinical genetics in Malaysia.
MeSH terms: Child; Genetic Counseling; Humans; Malaysia; Metabolism, Inborn Errors; Neoplasms; Nervous System Diseases; Pediatrics; Syndrome; Genomics; Precision Medicine