A 24-year-old Chinese gentleman presented with two weeks history of sudden floaters in his right temporal visual field associated with blurring of vision. This ex-smoker also reported chronic, bloody cough for two years and recent pleuritic chest pain. Examination revealed a thin patient with right eye visual acuity of 6/18 associated with optic nerve dysfunction, optic disc swelling and macula star, retinal vasculitis and retinitis. Despite anti-tuberculosis medication and corticosteroids, he developed neovascularisation. Subsequent vitreous haemorrhage necessitated trans pars plana vitrectomy, membrane peeling, endolaser and silicone oil injection. Final visual acuity was 6/9 with quiescent retinopathy.
A 50-year-old Chinese man presented with sudden onset of painful right eye, diplopia, and redness associated with headache and deteriorating vision. Examination revealed obvious proptosis with elevated intraocular pressure. Computed tomography (CT) scan showed presence of retrobulbar haemmorhage. Emergency lateral canthotomy and cantholysis was performed followed by medical orbital decompression, resulting in improvements in visual acuity, and other ocular symptoms. The diagnosis of thrombosed orbital varices involving inferior ophthalmic vein was confirmed on radiological- angiographic study. To date, he is symptoms-free with good visual acuity. Immediate surgical decompression with lateral cantholysis for retrobulbar haemorrhage was effective in the treatment of retrobulbar haemorrhage.
Fulminant haemorrhage in cervical cancer leads to severe anaemia and haemodynamic instability. Palliative management includes vaginal packing as temporary measure, radiotherapy and other invasive surgical procedures. High dose emergency chemotherapy is not commonly implemented particularly when complicated with anaemia and renal impairment. We discuss three case series on the usefulness of high dose chemotherapy to combat bleeding from cervical cancer as an emergency treatment. The first case was clinically staged as operable 2A disease with severe anaemia due to bleeding from the tumour mass. The haemoglobin was corrected by blood transfusion while the bleeding was being arrested by high dose chemotherapy. The second case was inoperable with invasion to the bladder mucosa. She had frank haematuria and bleeding from the tumour with severe anaemia. A course of chemotherapy and blood transfusion controlled the bleeding and anaemia was corrected. The third case presented late with obstructive uropathy and anaemia. She required dialysis, blood transfusion and high dose emergency chemotherapy to stop the bleeding before undergoing urinary diversion after an unsuccessful ureteric stenting. High dose chemotherapy consisting cisplatin, vincristine, bleomycin and mitomycin-C has a clinical value in arresting fulminant haemorrhage in cervical cancer.
Eccrine spiradenoma is a benign tumour of the sweat gland. Eccrine glands can be found almost everywhere but are mostly concentrated on the palms, soles and the axillae. Lesions involving the breast are rare. We present a case of a 13-years-old Malay girl with eccrine spiradenoma of the breast. The clinical presentation and histological features are being described.
This study aimed to review the risk factors and clinical outcomes of patients undergoing pars planar vitrectomy (PPV) for breakthrough bleeding (BTB) from age related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). We performed a retrospective review of medical records of 346 patients operated by the vitreoretinal unit at Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia from January 2008 - June 2011. We found eight eyes of 8 patients with AMD/IPCV-related BTB who underwent PPV. Mean age of patients was 64.4 years (range 41-80 years) with 5 males. Five were Chinese. Duration of symptoms ranged from days to months. Four patients were on anti-coagulants. Two had history of prior photodynamic therapy. There were five cases of PCV, of which three were macular in location. All three cases of AMD were macular. Intraoperative intravitreal ranibizumab injection was given in three cases and two had combined vitrectomy and cataract extraction. All cases reported improvement in visual acuity with four cases achieving 6/60 or better post operatively including two cases of extramacular PCV achieving 6/9 vision. Mean follow-up was 60 weeks. Postoperative complications included retinal tear and detachment in one case, reattached on reoperation. Six patients had a history of hypertension including one individual with stroke. Our small series indicates a predominance of Chinese individuals with BTB. Usage of anticoagulants and hypertension may be a predisposing factor. Better visual prognosis occurs with extramacular lesions which tend to be of PCV type.
This study aimed to compare dexmedetomidine and propofol, in terms of haemodynamic parameters, respiratory rates and offset times, when used for sedation in patients undergoing elective orthopaedic and surgical procedures under regional anaesthesia. This was a prospective, randomised, single-blind study where 88 patients were recruited. Patients were randomised into two groups to receive either dexmedetomidine or propofol infusion. Central neuraxial blockade (spinal, epidural or combined spinal epidural) was performed. After ensuring an adequate block and stable haemodynamic parameters, dexmedetomidine was infused 15 minutes later at 0.4 μg/kg/hr, and propofol, at a target concentration of 2.5 μg/ml. Both drugs were titrated to achieve a bispectral index score of 70 before surgery commenced. Sedation level was monitored using the bispectral index score and assessed by the Observer Assessment of Alertness Scale score. Drug infusion was adjusted to maintain bispectral index scores ranging between 70-80 during surgery. Both groups showed reductions in mean arterial pressure and heart rate from baseline readings throughout the infusion time. However there was no significant reduction in the first 15 minutes from baseline (p > 0.05). Haemodynamic parameters and respiratory rate between both groups were not significantly different (p > 0.05). No patient demonstrated significant respiratory depression or SpO2 ≤ 95%. Offset times were also not significantly different between both groups (p = 0.594). There were no significant differences in haemodynamic parameters, respiratory rates and offset times between dexmedetomidine and propofol used for sedation in patients undergoing elective orthopaedic and surgical procedures under regional anaesthesia.
Inflammatory Pseudotumor (IP) of bladder is one of a variety of lesions which may arise from spindle cell lesions in the bladder. It is benign in nature compared to the other end of the spectrum of spindle cell lesions, such as sarcoma, sarcomatoid carcinoma and leiomyosarcoma. The diagnosis of IP and its differentiation from a malignant pathology is a diagnostic dilemma for Urologist and Pathologist as both entities share certain similar morphological and histo-pathological appearance as well as immuno-histo chemistry staining. It is however crucial to avoid misdiagnosis as the treatment option varies significantly between a radical or partial cystectomy with future surveillance cystoscopes. Hereby, we highlight a case of a benign variant of spindle cell tumour of bladder which needed second pathology review for confirmation and thus avoiding a radical cystectomy. We also review the literature on its presentation and emphasis characteristics differentiating a benign from a malignant pathology
Emphysematous pyelonephritis is a form of infection of the kidney. Chest physiotherapy was executed on a 15-year-old girl who had complications such as secretion retention and pleural effusion following percutaneous pigtail nephrostomy in addition to oxygen therapy and medical management to promote respiratory functions. The processes to increase chest wall mobility includes particular passive stretching and mobilization. Chest mobility exercises composed of an intercostal stretch on a determined intercostal space using index fingers, thoracic rotation and anterior compression with stretching in sitting position to improve respiratory functions. These exercises were suggested to the patient as a regular daily treatment along with low-level incentive spirometry breathing exercises. Following 9th sessions of treatment patient demonstrated satisfactory improvement by means of increasing in chest expansion and reduction in dyspnea level without using supplemental oxygen. The results expressed a substantial clinical improvement in reduction of dyspnea level and improvement in chest expansion
Traumatic knee crush injuries of degloving nature carries a greater risk for the multitude of complications rendering emergency surgical intervention the treatment of choice in the majority of such injuries. These types of injuries commonly result in a unique post- operative complication such as arthrofibrosis and it presents overly challenge for Physiotherapists managing it. In this retrospective single-case report, we describe the challenges of in – and out- patient physiotherapy treatment planning for a 16-year old boy throughout the continuum of care for his knee arthrofibrosis following a series of surgical procedures. As result of his complex medical situation, the time-specific physiotherapy intervention during the immediate post-operative period failed to improve our patient’s knee function. The knee function with regard to range of motion ( especially extension), muscle strength(quadriceps) improved considerably with the adoption of an aggressive physiotherapy intervention approach that included specific quadriceps muscle strengthening, joint mobilization (rotation/traction) in sitting position with legs over the edge of table and contract-relax quadriceps stretching in prone position using theraband.
MeSH terms: Continuity of Patient Care; Humans; Knee Joint; Leg; Male; Retrospective Studies; Rotation; Traction; Range of Motion, Articular; Prone Position; Physical Therapy Modalities; Quadriceps Muscle; Muscle Strength; Physical Therapists
A 28-year-old G3P1+1 at 6 weeks period of amenorrhea with a previous Caesarean section presented with per vaginal bleeding. A cervical ectopic pregnancy was confirmed by a transvaginal scan. An intramuscular methotrexate was given followed by intracervical route due to poor decline of the serum βHCG. However, due to persistent increment of serum βHCG, an additional four doses of intramuscular methotrexate with folinic acid rescue were administered and she responded well to the regime. Unfortunately, following the last dose, she developed an episode of excessive per vaginal bleeding which required suction and curettage of the cervical canal. A Foley‘s catheter balloon was placed intracervically as a tamponade and the bleeding was successfully arrested.
This retrospective study is aimed at evaluating the role of CT scan in predicting parametrium involvement in early stage of cervical carcinoma. It was conducted in a Gynaecologic Oncology Centre, Hospital Alor Star from January 2004 till December 2008. All patients with operable stage I and II cervical cancer had pelvic CT scan for evaluation of parametrium involvement before undergoing radical hysterectomy and pelvic lymphadenectomy. Parametrial streakiness or presence of infiltration suggested local invasion. Following radical hysterectomy, the specimens sent for histological confirmation and the correlation between the CT scan finding and the histopathology result was studied. The result revealed a total of 104 patients with operable stage cervical carcinoma had pelvic CT scan. The sensitivity and the specificity of CT scan in assessing parametrial involvement was 33.3% and 84.8%, respectively. In conclusion, CT scan had high specificity but low sensitivity in determining parametrial involvement in early stage of cervical cancer. Hence, routine preoperative pelvic CT scan has a limited role in assessing parametrial involvement in early stage cervical carcinoma.
Supraglottic airway devices have been used as safe alternatives to endotracheal intubation in appropriate types of surgery. This was a prospective, randomised, single blind study comparing the use of LMA™ and SLIPA™ in terms of ease of insertion, haemodynamic changes and occurrence of adverse effects (e.g. blood stains on the device upon removal and sore throat). A total of 62 ASA I or II patients, aged between 18 to 70 years were recruited for this study. Patients were randomised into two groups; LMA™ and SLIPA™ group. Following induction of anaesthesia, an appropriate sized LMA™ or SLIPA™ was inserted after ensuring adequate depth of anaesthesia. Anaesthesia was maintained with oxygen, nitrous oxide and sevoflurane. The ease of insertion was graded and haemodynamic changes were recorded at 2 minute intervals up to 10 minutes after insertion of the airway devices. The presence of blood stains upon airway device removal at the end of surgery and incidence of sore throat was also recorded. No difficult insertion was experienced in either of these devices. Insertion was either easy [LMA™ 87.1% versus SLIPA™ 80.6% (p = 0.49)] or moderate [LMA™ 12.9% versus SLIPA™ 19.4% (p = 0.16)]. Throughout the study period, the haemodynamic changes that occurred in both groups were not statistically different. Traces of blood were noted on the surface of the device in 9.7% of patients in the SLIPA™ group versus 6.5% of patients in the LMA™ group. The incidence of sore throat was recorded in 12.9% versus 19.4% of patients in the SLIPA™ and the LMA™ groups respectively. These findings were not statistically significant. In conclusion, this study showed no significant differences between the use of LMA™ and SLIPA™ in terms of ease of insertion, haemodynamic changes and adverse effects in patients undergoing minor surgical procedures.
Penetrating injuries to bladder occur in 20 % of cases. Synchronous bladder and rectal perforation occur in 30-64 % of cases. The management of rectal and bladder injuries depend on whether it is an extra-peritoneal or intra-peritoneal injury. We hereby, report a case of penetrating trauma in a 13 year old boy who fell off a tropical fruit (Rambutan - Nephelium lappaceum) tree. He sustained an extra-peritoneal rectal injury with intra-peritoneal bladder injury. The rectal injury was repaired primarily via per anal route while the bladder injury needed an open repair following laparotomy. Upon removal of bladder clots, a leaf of the ‘Rambutan’ tree was found intra-vesically. It was removed and bladder repaired as per standard method. We review the literature on rare intra-vesicle foreign bodies and discuss the treatment of synchronous rectal and bladder injuries.
Suatu kajian mengenai pemencilan dan pengenalpastian mikroflora bakteria dari kolam air panas telah dilakukan di kolam air panas Bentong, Pahang. Kebanyakan bakteria yang dipencil dari kolam air panas adalah dari Bacillus sp. kerana ia mempunyai ciri adaptasi yang membolehkannya hidup di kawasan suhu yang tinggi dengan pembentukan endospora. Objektif kajian adalah untuk mengenal pasti spesies bakteria selain daripada spesies Bacillus sp. yang boleh dipencilkan dari kolam air panas. Tiga buah kolam air panas (A, B dan C) dikenal pasti dengan julat suhunya antara 36°C-52°C dan nilai pH antara 7.88-8.65. Kajian ini telah berjaya memencilkan dua pencilan bakteria kokus Gram positif dan tiga spesies basilus Gram negatif. Spesies Gram positif tersebut adalah dari genus Streptococcus dan Staphylococcus, manakala bagi Gram negatif pula terdapat masalah dalam pengenalpastian dan hanya dikenali sebagai X, XI and XII.
In forensic entomology practice, it is more common to use raw animal tissue to breed dipteran larvae and it often brings unpleasant odour in the laboratory. Few studies suggested the use of synthetic diets, mainly agar-based media, as alternatives to animal tissue but it is rarely being practiced in forensic entomology laboratory. The present study observed the growth of a forensically important fly, Megaselia scalaris (Loew) on raw cow’s liver, nutrient agar, casein agar and cow’s liver agar. A total of 100 M. scalaris eggs were transferred each into the different media and placed in an incubator at 30°C in a continuous dark condition. Data on length and developmental period were collected by randomly sampling three of the largest larvae from each rearing media, twice a day at 0900 and 1500 hours until pupariation. M. scalaris larvae reared on raw cow’s liver recorded the highest mean length (4.23 ± 1.96 mm) followed by cow’s liver agar (3.79 ± 1.62 mm), casein agar (3.14 ± 1.16 mm) and nutrient agar (3.09 ± 1.11 mm). Larval length in raw liver and liver agar were significantly different from those in nutrient and casein agar (p < 0.05). Larvae bred in liver agar and raw liver recorded the shortest larval duration before entering the post-feeding stage (89 hours), followed by nutrient agar (119 hours) and casein agar (184 hours). Total developmental time from oviposition until adult emergence for M. scalaris in liver agar and raw liver was approximately 163 hours. All puparia in nutrient agar and casein agar failed to hatch. This research highlighted the potential use of cow’s liver agar as an alternative diet of raw liver to culture M. scalaris in laboratory.
This study aimed to identify the foot sensory status of Malay women with type 2 diabetes mellitus and to determine its relation with: demographic factors, glycated haemoglobin level in plasma, and body mass index. A cross-sectional study was conducted on 71 Malay women with type 2 diabetes mellitus who attend three health clinics in Hulu Langat District, Selangor. Foot sensation was assessed using the Semmes-Weinstein Monofilament 5.07 in nine locations on the plantar and dorsal of the feet. Loss of protective sensation was defined as inability to sense the monofilament in one or more sites of either foot. This study found that 56.3% of women had loss of protective sensation, with common sites being the heel, fifth metatarsal head, lateral mid-foot and little toe. Duration of diabetes mellitus were significantly related to foot sensation. The age, HbA1C level and body mass index did not show any significant correlation. Loss of protective sensation may lead to serious foot complication and therefore early screening involving multidisciplinary team is essential for prevention.
MeSH terms: Ambulatory Care Facilities; Cross-Sectional Studies; Diabetes Mellitus, Type 2*; Female; Foot; Hemoglobin A, Glycosylated; Humans; Malaysia/ethnology; Patient Care Team; Body Mass Index; Prevalence; Diabetic Foot
Thyroid and gonads are radiosensitive organs which requires radiation shield to reduce the dose received. However,
radiation shielding is not widely used in radionuclide imaging because it is heavy, uncomfortable and can cause pain
in the spine. Therefore, a research was carried out to determine the ability of thyroid and gonad radiation shield
which is thinner and lighter in reducing radiation dose. A study was conducted in Hospital Putrajaya to determine
the radiation dose received by the thyroid and gonads during a complete Positron Emission Tomography-Computed
Tomography (PET-CT) procedure with and without radiation shield. A total of six male staffs have been chosen as subject
and data from 33 complete PET-CT procedures have been collected. For every PET-CT procedure, the subject’s thyroid
and gonad were shielded using 0.5-mm thick radiation shielded, model Mavig 615 (USA) and Shielding International
(USA) respectively. Thermal luminescent dosimeter (TLD) chips were used as radiation dose detector. The average 18FFDG radioactivity administered to the patient was 387 MBq and the average scan time is 9.224 ± 1.797 minutes. The
results showed that the mean equivalent dose received by the thyroid with and without shielding were 0.080 ± 0.033
mSv and 0.078 ± 0.039 mSv respectively. The mean equivalent dose received by gonad with and without shielding
were 0.059 ± 0.040 mSv and 0.061 ± 0.030 mSv respectively. Radiation shield with 0.5 mm thickness is unable to
reduce radiation dose received by the thyroid (p = 0.76) and gonads (p = 0.79) because it is too thin to resist the
high-energy radiation during PET-CT procedures. Thyroid receive higher radiation dose of 0.016 m Sv compared to
the gonads (p < 0.05) because the thyroid’s position is more exposed to radiation sources which are 18F-FDG during
radiopharmaceutical preparation and patients after administered with 18F-FDG during PET-CT procedure.
Keywords: equivalent dose, radiation shield, TLD
Elektroretinogram paten (pERG) adalah pengrekodan respons retina terhadap stimulus paten yang dipancarkan bersilih ganti. Ia memberi maklumat mengenai integriti sel dalaman retina khasnya sel ganglion. Pengrekodan pERG dalam sesebuah makmal boleh dipengaruhi oleh beberapa faktor, maka piawai makmal perlu ada untuk memastikan bacaan pERG yang diperolehi boleh diulang dan dihasilkan semula. Objektif kajian ini ialah untuk menentusahkan faktor yang mungkin mempengaruhi pengukuran pERG untuk paiwaian Makmal Elektrofisiologi Jabatan Optometri, Fakulti Sains Kesihatan (FSK), Universiti Kebangsaan Malaysia (UKM). Kajian ini melibatkan 45 orang subjek yang berumur di antara 20 hingga 25 tahun yang dibahagikan kepada 3 kumpulan. Faktor yang dikaji adalah 1) kesan penggunaan anestetik Alcaine 0.5%, 2) variasi pengukuran pada waktu pagi dan petang dan 3) saiz dan bentuk target fiksasi yang berbeza terhadap bacaan pERG (amplitud dan tempoh pendam). Ujian-t berpasangan mendapati tiada perbezaan yang signifikan antara pengukuran sebelum dan selepas penggunaan Alcaine 0.5% bagi amplitud (p = 0.116) dan tempoh pendam
(p = 0.557). Pengukuran pada waktu pagi dan petang juga menunjukkan tiada perbezaan signifikan bagi amplitud (p = 0.864) dan tempoh pendam (p = 0.174). Untuk bentuk dan saiz target yang berbeza, didapati tiada perbezaan yang signifikan untuk parameter amplitud (p = 0.125) dan tempoh pendam (p = 0.404). Kesimpulannya, penggunaan Alcaine 0.5%, pengukuran pada waktu pagi dan petang dan target fiksasi yang berbeza tidak mempengaruhi bacaan pERG di Makmal Elektrofisiologi, FSK, UKM. Hasil kajian boleh diguna pakai untuk perbandingan dalam penyelidikan ataupun tujuan pendiagnosan penyakit retina di masa hadapan.
Ficus deltoidea leaves were widely used as a tea beverages in Malaysia with no information of its mineral content. Hence the mineral content of two species of Ficus deltoidea leaves were investigated. The dried leaves of F. deltoidea var. angustifolia and F. deltoidea var. deltoidea were acid digested and mineral elements of Na, Mg, K, Ca, Mn, Cr, Fe and Zn were determined using ICP–MS. Magnesium, potassium, sodium, manganese, iron and zinc were found to be present in the leaves of F. deltoidea var. angustifolia and F. deltoidea var. deltoidea. Concentration of magnesium (1934 mg/L), manganese (58.37 mg/L), iron (6.89 mg/L) and zinc (1.77 mg/L) in F. deltoidea var. deltoidea species were significantly (P < 0.05) higher than in F. deltoidea var. angustifolia species with concentration of 317 mg/L, 29.62 mg/L, 4.55 mg/L and 1.26 mg/L for magnesium, manganese, iron and zinc respectively. Meanwhile, concentration of sodium in F. deltoidea var. deltoidea species (3.13 mg/L) was found to be significantly (P < 0.05) lower than the concentration in F. deltoidea var. angustifolia species (9.11 mg/L). The finding showed that the leaves of F. deltoidea var. deltoidea has higher nutritional value than the leaves of F. deltoidea var. angustifolia. Leaves of Ficus deltoidea especially the F. deltoidea var. deltoidea species contain high amount of magnesium, manganese and potassium. Therefore, tea made of this leaves can be served as a good source of minerals for human consumption.
Penentuan kumpulan bangsa dalam analisis rambut pada kepala adalah satu cabaran yang dihadapi dalam analisis forensik untuk mengenal pasti mangsa, suspek dan tempat kejadian jenayah. Kajian ini bertujuan untuk mengenal pasti perbezaan antara dua kaum terbesar di Malaysia iaitu Melayu dan Cina melalui penelitian ciri-ciri rambut. Ini termasuklah ciri umum rambut, corak kutikel, warna, taburan pigmen kortek dan ciri medula – jenis, ketebalan dan indeks medula. Kajian ini telah dijalankan dengan menggunakan mikroskop cahaya dan terdiri daripada lima langkah iaitu penyediaan sampel, penelitian ciri umum rambut, penyediaan dan penelitian slaid acuan corak sisik kutikel, slaid kortek serta medula. Hasil daripada kajian in mendapati bahawa kebanyakan Melayu mempunyai warna pigmen yang bercoklat gelap manakala Cina mempunyai pigmen coklat cerah. Kami juga mendapati bahawa ketebalan medula boleh juga digunakan untuk membezakan antara Melayu dan Cina di mana nilai purata bagi Melayu dan Cina masing-masing adalah 7.59 ± 1.45 μm dan 9.12 ± 1.85 μm. Nilai purata indeks medula bagi Melayu dan Cina pula adalah 0.17 ± 0.02 μm dan 0.18 ± 0.02 μm masing-masing. Walaupun begitu, ciri-ciri seperti tekstur, ketebalan rambut, corak sisik kutikel, taburan pigmen dan jenis medula pula menunjukkan perbezaan yang tidak ketara antara Melayu dan Cina. Kesimpulannya, kajian ini telah menunjukkan bahawa warna pigmen, ketebalan medula dan indeks medula adalah ciri-ciri penting yang boleh digunakan untuk menentukan bangsa.