Osteomyelitis of the mandible, a serious complication of untreated odontogenic infection has been reported. This case report describes an interesting presentation of chronic suppurative osteomyelitis (CSO) of the mandible in a 13 years old anaemic male patient. Investigations revealed inversion of his permanent teeth leading to trans-cutaneous extra-oral eruption along with marked destruction of mandible on the affected side. The treatment included a pre surgical course of antibiotics followed by the removal of the retained second premolar tooth, surgical debridement of the affected bone, and resection of the cutaneous sinus tract. The post-operative healing was uneventful. A combination of antibiotic therapy and surgical debridement were effective in the treatment of chronic suppurative osteomyelitis.
The reconstruction of the upper eyelid with medial canthal involvement post extensive removal of malignant tumour remains a challenge. Proper eyelid reconstruction is necessary to reestablish anatomic integrity, restoration of its functions and to maintain the best cosmetic appearance. These case reports illustrate an alternative reconstructive technique for large upper eyelid full thickness defect with medial canthal involvement. Two cases of upper eyelid tumours involving medial canthal region underwent staged reconstruction by glabellar flap advancement and reconstruction of the posterior lamellar with autologous graft using buccal mucosa and ear cartilage. The posterior lamellar graft and flap survived without any complication except for mild eyelid margin notching in one of the two cases. The staged reconstruction with glabellar flap advancement provides adequate defect coverage, excellent blood supply, maintains eyebrow contour and function of the eyelid. The flap also perfectly matches the surrounding tissue with minimal donor site morbidity.
Abstract Water quality in the dental unit waterlines (DUWLs) is important to the patients and dental health care personnel as they are at risk of being infected with opportunistic pathogens such as Pseudomonas or Legionella species. In this study, a total of 86 samples were collected from DUWLs of 19 dental units in 11 Malaysian Armed Forces dental centres (MAFDC). 350 ml water sample was collected in sterile thiosulphite bags from the outlets of 3–way syringe, high speed handpiece, scaler, cup filler, independent water reservoir or the tap of the same surgery respectively. Samples were transported to the laboratory within 24 hours and kept in the refrigerator at 40C. 100ml of each sample was filtered through a 0.45 μm polycarbonate membrane filter. The filter was then inoculated onto plate count agar and incubated at 370 C for 24 hours, after which the formed colonies were enumerated. Another separate 100ml of water sample was poured onto buffered charcoal yeast extract agar and cetrimide agar to culture Legionnella and Pseudomonas respectively. Identification of these bacteria were confirmed by polymerase chain reaction and sequencing. Pseudomonas aeruginosa was detected in 9.5% of the samples but Legionnella was not detected in any of the samples. 77% of the samples met American Dental Association (ADA) recommendation of less than 200 cfu/ml. The result of this study showed that it is difficult if not impossible to eliminate biofilm from the DUWLs. Regular monitor of water quality from DUWL is required to maximise the health of the dental patients and dental health care personnel.
MeSH terms: Agar; American Dental Association; Bacteria; Cetrimonium Compounds; Charcoal; Culture Media; Humans; Legionella; Polycarboxylate Cement; Pseudomonas; Pseudomonas aeruginosa; Syringes; United States; Water; Polymerase Chain Reaction; Biofilms; Water Quality
Megakaryoblastic leukaemia is the commonest form of leukaemia occuring in Down syndrome infants. However, it’s subtype with translocation t(1;22)(p13;q13) is uncommon comprising
Levonorgestrel (LNG) is a well-known safe and efficacious emergency contraception (EC). However, ectopic pregnancy following the failure of LNG-only EC has been reported. The exact incidence of ectopic pregnancy has been hindered by lack of data due to the fact that LNG-only EC is accessible at pharmacies without a prescription. We describe a case of ectopic pregnancy in an 18 year-old single woman who took LNG-only EC within 48 hours of unprotected sexual intercourse. She presented to the emergency department at 8 weeks period of amenorrhoea with an acute abdomen and hypovolaemic shock. Laparotomy confirmed a ruptured right tubal pregnancy and salpingectomy was performed. The patient was discharged well after 2 days. We aim to highlight this potential adverse effect and to discuss the plausible causality of ectopic pregnancy following administration of LNG-only EC.
Ascariasis is a common helminthic infestation in Malaysia, particularly in rural settings. Ascariasis lumbricoides normally lives in the upper small bowel without causing symptoms. Complications arise when these worms migrate into the bile duct (biliary ascariasis). A case of biliary ascariasis presenting as biliary colic is described. Patient presented with 2 days duration of right upper quandrant pain at the district hospital. Initial investigations were suggestive of acute cholecystitis and patient was treated with empirical antibiotics. However, due to worsening symptoms, she was transferred to the nearest tertiary setting. The diagnosis of helminthic biliary infestation was established using both ultrasound of the hepato-biliary system (HBS), CT-Scan abdomen and endoscopic retrograde cholangio-pancreatography (ERCP). Endoscopic removal of the worm led to rapid resolution of symptoms and patient was discharged home well.
A 17-year-old male student of Indonesian parentage presented with two weeks history of progressive painless bilateral visual deterioration. There was no contact with tuberculosis (TB)-infected patients and parents claimed that all immunization including BCG was completed. However, BCG scar was not apparent. Visual acuity was 6/36 and 6/60 in the right and left eyes respectively. The anterior and vitreous chambers were quiet. Funduscopic examination revealed retinal vasculitis with perivascular exudates, branch vein occlusion, neovascularization and macular oedema. Fluorescein angiography confirmed large areas of capillary non-perfusion and leaking new vessels. Mantoux test was positive and full regime anti-TB therapy was instituted. HIV screening was negative. Three days later, an immunosuppressive dose of oral steroid was started. Both eyes received intensive laser photocoagulation.Interestingly, there was no development of vitritis throughout.
The Malaysian skincare industry is growing rapidly with a vast number of new sunscreens being produced annually. Inadequate skincare regulations and lack of enforcement have resulted in the overrating of sunscreens’ quality. The objectives of this study were to evaluate the efficacy and safety of the local and international sunscreens and to determine the effects of adding concentrated antioxidants into them. Three local and three internationally manufactured sunscreens were tested for the in vitro Ultraviolet A protection factor (UVAPF), Sun Protection Factor (SPF) and photostability. The creams were spread onto roughened polymethylmethacrylate plates where the absorbance was measured using a spectrophotometer before and after two hours of sunlight irradiation. The procedure was repeated combining available concentrated vitamin C and E creams. International sunscreens were found to have more accurate SPF labels (p=0.009) while local sunscreens were found to be more photostable (p=0.003). However, both sunscreens had inadequate UVAPF (p=0.471). Vitamin C enhanced the SPF values (p= 0.04) of both groups of sunscreens while vitamin E enhanced their photostability (p=0.000). Interestingly, combining vitamins C and E rich creams with the sunscreens had no effect on the SPF and UVAPF values as compared to the use of a single vitamin. More importantly, the combination of vitamins decreased the photostability (p=0.002) of sunscreens as compared to the addition of vitamin E alone. In conclusion, photoprotection is best achieved when sunscreens are used together with creams containing either vitamin C or E alone.
Parenting stress is the stress level experienced within the role of a parent (Hoekstra-Weebers et al. 1998). The source of stressors is variable and dependent on the phase of disease and chemotherapy (Sawyer et al. 2000). Failure to cope with these stressors may in turn affect the child’s emotional and social adjustment towards the diagnosis of cancer in addition to poor medical treatment adherence behaviour (Sawyer et al. 1993). The objectives of this study are to determine the level of parenting stress, the risk factors contributing to high parenting stress, and the coping mechanisms used to handle the stress. This single centred, cross-sectional study was done amongst 117 parents at the Paediatric Haematology and Oncology Unit, Universiti Kebangsaan Malaysia Medical Centre (UKMMC) over two years duration. Self-administered questionnaires comprising the Parenting Stress Index/Short Form (PSI/SF) and Coping Inventory for Stressful Situation (CISS) were distributed to parents of children who were 12 years old and below. The mean total parenting stress score amongst parents of children diagnosed with acute leukaemia was 91.5±21.1(95% CI). A total of 27.3% of parents experienced a high total parenting stress score (defined as total PSI score ≥ 75th centile, ie ≥ 103). Task-oriented coping mechanism was used by the majority of parents. Emotion-oriented coping mechanism was the only identifiable risk factor for high parenting stress score following multiple logistic regression analysis. A parent who used emotion-oriented coping mechanism was 7.1 times (95% Confidence Interval 1.2 to 41.4) more likely to have a high parenting stress score compared to a parent who used other coping mechanisms. By identifying these at-risk parents, appropriate counselling and psychological support may be offered early to alleviate the stress as well as assist in the coping and adjustment mechanisms of these parents.
Uncontrolled bleeding due to pelvic fractures contributes to trauma-related morbidity and mortality. Three main strategies that have been outlined to combat this condition which include reduction of pelvic volume that lead to tamponade-like effect, arresting haemorrhage through angioembolization of the major vessels, and stabilization of the pelvic bone with external fixation need to be initiated early. A prehospital device that allow these strategies will aid significantly in the management of the patient. At present most devices used to treat pelvic fractures in the pre-hospital setting do have its’ own advantages but also have some limitations. A characteristic ‘wish-list’ of a good pelvic and lower limb immobilization device was created and the research team from UKM takes the challenge to design and produce a device that concurs to it. A two phase development project that incorporate anthropometric, biomechanical, cadaveric and radiological study was carried out over a period of seven years. Finally, BRIMTM immobilizer, a new pelvic and lower limb immobilization device that is user friendly, tough, cost effective, radiolucent, light and reusable that answers most of the requirement of a good device was invented.
Dengue fever is a common pyrexial-viral infection in the Asian region and the incidence is increasing yearly. There are various ocular manifestations of dengue fever such as maculopathy, retinal hemorrhages, retinal lesions and vasculitis. Reduction in visual acuity and other visual disturbances such as metamorphopsia is the most common presentation of dengue-associated maculopathy. We report an interesting case of a young lady with bilateral maculopathy secondary to dengue fever who was managed conservatively with dramatic visual improvements. This case highlights the possibility of bilateral and simultaneous ocular involvements in patients infected with dengue fever. Both ophthalmologists and physicians need to be aware of ocular complications following dengue fever and advice patients regarding the symptoms.
Aneusomy is an early genetic event and a characteristic feature of many solid tumors. It is often associated with poor prognosis in cancer patients. The involvement of PAX8-PPARγ rearrangement in tumorigenesis of follicular thyroid lesions has been widely assessed. However, there were few reports on aneusomy of the PPARγ gene at the 3p25 locus in follicular thyroid lesions. It remains undetermined whether these abnormalities can be translated into improved diagnosis, classification, or outcome prediction. Herein, we report three cases of follicular thyroid neoplasms [two follicular thyroid carcinomas (FTCs) and one Hurthle cell adenoma (HCA)] with 3p25 aneusomy detected by fluorescence in situ hybridization (FISH). 3p25 trisomy was observed in one FTC and one HCA while 3p25 tetrasomy was observed in one FTC. Furthermore, all three lesions did not show overexpression of PPARγ protein. Hurthle cell neoplasms (HCN) are distinct clinically and histologically from other follicular thyroid neoplasms (FTN). However, the presence of the aneusomy in HCA and FTC indicates that there could be a biological continuum between the two and chromosomal gains might play an important role in the pathogenesis of these two types of neoplasms. Despite their differences, HCN and FTN may share the same early genetic event in tumour development.
Red cell alloimmunisation is defined as the development of antibodies in response to foreign red cell antigens through transfusion or pregnancy. In pregnant women even without the history of previous blood transfusion, this is possible through previous or current pregnancy with the presence of paternal red cell antigen inherited by the fetus. This study was aimed to determine the prevalence of red cell alloimmunisation among pregnant women without previous history of blood transfusion and the association with number of pregnancy and history of obstetric complications. This was a cross-sectional study in which 150 pregnant women were randomly selected from the antenatal clinic. Ten mls of peripheral blood was obtained for antibody screening using indirect antiglobulin test besides the routine antenatal screening. In this study, the majority (37.3%) of the women were primigravidae. Red cell alloantibodies were detected in two out of 150 (1.3%) patients which were subsequently identified as anti-C and anti-D. However none of the primigravida was alloimmunised. One woman of gravida 2 (2.9%) and gravida 3 (3.6%) each were positive for alloimmunisation. One of them also had a bad obstetric history. This study showed that the prevalence of red cell alloimmunisation among pregnant women was low in this centre. Nevertheless, red cell alloantibody screening test should be made available to reduce possible complications of alloimmunisation in mothers and fetuses.
Study site: Antenatal clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
The tumour suppressor gene p53 and the proto-oncogene Bcl-2 encode respectively, for a nuclear phosphoprotein and for a mitochondrial membrane protein involved in multiple cellular functions. Both proteins are linked to programmed cell death pathways and provide prognostic information on breast carcinoma. Our aim is to study the expression of p53 and Bcl-2 oncoproteins in breast carcinoma and correlate with patients’ age, tumour size, disease stage and histological grade. Fifty nine cases of breast carcinomas from Universiti Kebangsaan Malaysia Medical Centre (UKMMC) were studied with the immunohistochemical method. Our results showed 45.8% (27 of 59) and 40.7% (24 of 59) of the breast carcinomas were immunopositive for p53 and Bcl-2 respectively. There was significant correlation between Bcl-2 expression with early tumour stage (p=0.01). No significant relationship was seen with other variables. Results also showed an inverse relationship between p53 and Bcl-2 expression (p=0.001). These findings indicate a down regulation of Bcl-2 by p53 in breast carcinogenesis.
The most common cause of hyperthyroidism is Graves disease (GD) which is characterised by the presence of autoantibodies which binds to the TSH receptor (TRAb). Recently, a rapid, fully automated electrochemiluminescent immunoassay ElecsysAnti-TSHR for detection of autoantibodies to TSH receptor was made available for routine clinical use. The objective of this study is to evaluate this assay and to determine the sensitivity, specificity and cut-off value. Interassay and total imprecision (CV) were determined at 3.78-7.02 IU/L and 13.5-21.2 IU/L respectively. A total of 124 samples which comprised of 46 GD, seven Hashimoto thyroiditis (HD), 11 non autoimmune nodular goitre (NAG), 2 thyroid cancers (Ca) and 58 normal controls were retrospectively analysed to determine the sensitivity, specificity and cut-off value. Inter-assay CV’s were 2.4% at a concentration of 3.90 IU/L (range: 3.78-7.02 IU/l) and 0.8% at 20.80 IU/L (range:13.5-21.2 IU/l). Total imprecision was 3.8% at a concentration of 3.80 IU/L (range:13.5-21.2 IU/l) and 1.0% at 20.8 IU/L (range:13.5-21.2 IU/l). The ROC analysis of patients with GD, other thyroid disorders and normal controls revealed that the highest sensitivity (94%) and specificity (98%) were seen at cut-off value of 1.69 IU/L. Positive predictive value (PPV) and negative predictive value (NPV) was 95% and 94% respectively. At this derived cut-off value of 1.69 IU/L, we found that the sensitivity of TRAb positivity within the group of 29 newly diagnosed GD patients was 94%. Our results demonstrate that this fully automated assay with testing time of 27 minutes has high sensitivity in detecting GD and high specificity for discriminating other thyroid disease and represent major improvement in the diagnosis and management of patients with thyroid diseases.
Patient satisfaction plays a crucial role in ensuring utilization of healthcare services, continuity of care, and compliance towards treatment. Thus, this study aimed at determining the level of patient satisfaction with the services provided by the UKMMC primary care clinic. A descriptive cross-sectional study involving 317 patients attending the clinic from February to March 2011 was carried out. They were selected through systematic random sampling. Using a validated self-administered Patient Satisfaction Questionnaire-46 (PSQ-46) in English and Malay versions, general satisfaction and satisfactions with five different subscales (doctors, nurses, accessibility, facilities and appointment) were assessed. A majority of the patients (93.1%) were generally satisfied with the overall services. Among the five subscales, patients were most satisfied with the doctors (96.5%), but only 35.6% of the patients were satisfied with the facilities. The proportions of patients who were satisfied with other subscales were: 86.1% (appointment), 82.0% (nurses) and 68.1% (accessibility). There was a significant association between each of the subscales and the general satisfaction (p
MeSH terms: Ambulatory Care Facilities; Continuity of Patient Care; Cross-Sectional Studies; Humans; Malaysia; Nurses; Patient Compliance; Personal Satisfaction; Physicians; Primary Health Care; Surveys and Questionnaires; Patient Satisfaction
Keupayaan Centella asiatica (CA) untuk bertindak sebagai antioksidan dan agen anti-radang telah banyak dilaporkan. Namun begitu, kaedah pengekstrakan CA untuk memperoleh hasil yang terbaik masih dipersoalkan. Dalam kajian ini, kami menilai tiga kaedah pengekstrakan CA dan membuat perbandingan ekstrak dari segi aktiviti antioksidan dan anti-radang, dan juga kandungan sebatian bioaktif, asiaticoside dan madecassoside. Centella asiatica diekstrak menggunakan pelarut etanol, metanol dan juga air. Kandungan sebatian fenolik ekstrak diukur menggunakan kaedah reagen Folin-Ciocalteu. Kandungan asiaticoside dan madecassoside ditentukan dengan kaedah HPLC. Aktiviti antioksidan diukur dengan asai 2,2-diphenyl-1-picrylhydrazyl (DPPH) dan asai penurunan kuasa Ferric Reducing Antioxidant Power (FRAP). Aktiviti anti-radang ditentukan dengan kebolehan ekstrak untuk merencatkan enzim tapakjalan keradangan, COX-1 dan COX-2, serta kebolehan ekstrak melindungi sel fibroblas aruhan 12-O-tetradecanoylphorbol-13-acetate (TPA) daripada menghasilkan prostaglandin E2 (PGE2 ). Hasil kajian menunjukkan aras sebatian fenolik, asiaticoside dan madecassoside tertinggi dalam ekstrak etanol, diikuti metanol dan esktrak akues (masing-masing 17.76 g/100g, 15.52 g/100g, 13.16 g/100g untuk sebatian fenolik, 42.86 mg/g, 36.37 mg/g, 2.82 mg/g untuk asiaticoside and 18.66 mg/g, 15.87 mg/g, 3.75 mg/g untuk madecassoside). Ketiga-tiga ekstrak menunjukkan aktiviti antioksidan sederhana berbanding kawalan positif. Kesemua ekstrak, asiaticoside dan madecassoside merencat COX-1 dan COX-2 dan menyekat penghasilan PGE2 -aruhan TPA. Ekstrak etanol dan metanol merupakan perencat COX yang lebih kuat dan lebih poten daripada ekstrak akues. Oleh itu, walaupun ekstrak akues menunjukkan kebolehan antioksidan yang lebih tinggi, dari segi aktiviti anti-radang, pelarut hidrofobik iaitu etanol dan metanol ternyata lebih baik untuk mengekstrak Centella asiatica.
This study investigated the relationship between leisure-time physical activity and physical fitness (cardiovascular fitness, body fat percentage, flexibility, muscle strength, and endurance) of 10th-grade male students in Oman. Data were collected from 330 students. All participants completed a descriptive questionnaire, a 1 mile walk/run test; a skinfold analysis of the chest, abdomen, and thigh; a sit and reach test; a hand grip test; and a 1-minute sit-up test. Students spent an average of 19.20 ± 6.77 hours on sedentary activities, 3.46 ± 2.11 hours on sports activities, and 11.22 ± 9.24 hours working per week. The students had an average body fat percentage of 6.38% ± 4.67%, muscle strength 38.04 ± 7.55 kg, flexibility 38.01 ± 7.41 cm, abdominal muscle endurance 38.85 ± 8.15 times/min, and cardiovascular endurance 8.10 ± 1.65 minutes.
The peroxisome proliferator-activated receptors (PPARs) have been implicated in regulating the immune response. We determined the relative changes in the transcriptional expression of PPAR isoforms (α, γ1 and γ2) and cytokines involved in the pathogenesis of type 1 diabetes (T1D) in the immune cells of 5 weeks, 10 weeks and diabetic male non-obese diabetic (NOD) mice compared to those of female NOD mice from our previous studies, "normalized" against their respective non-obese diabetic resistant (NOR) mice controls. Overall PPARα was significantly more elevated in the macrophages of female NOD mice of all age groups whereas PPARγ, particularly the PPARγ2 isoform was more depressed in the macrophages and CD4(+) lymphocytes of female NOD mice compared to their male counterparts. The pro-inflammatory cytokines, IL-1 and TNFα, as well as the Th1 cytokines, IL-2 and IFNγ were more elevated in female NOD mice whereas the Th2 cytokine, IL-4, was more depressed in these mice compared to their male counterparts. These findings suggest that the preponderance of T1D in female NOD mice may be influenced by the more pronounced changes in the expression of PPAR isoforms and pathogenic cytokines compared to those in male NOD mice.
MeSH terms: Animals; Diabetes Mellitus, Type 1/genetics; Diabetes Mellitus, Type 1/immunology*; Female; Male; Sex Characteristics*; Spleen/cytology; Spleen/immunology; Transcription, Genetic*; Cytokines/genetics*; Cytokines/immunology; Mice, Inbred NOD; Macrophages, Peritoneal/immunology; Protein Isoforms; Peroxisome Proliferator-Activated Receptors/genetics*; Peroxisome Proliferator-Activated Receptors/immunology; Mice; Real-Time Polymerase Chain Reaction
With the dramatic increase of the worldwide threat of dengue disease, it has been very crucial to correctly diagnose the dengue patients in order to decrease the disease severity. However, it has been a great challenge for the physicians to identify the level of risk in dengue patients due to overlapping of the medical classification criteria. Therefore, this study aims to construct a noninvasive diagnostic system to assist the physicians for classifying the risk in dengue patients. Systematic producers have been followed to develop the system. Firstly, the assessment of the significant predictors associated with the level of risk in dengue patients was carried out utilizing the statistical analyses technique. Secondly, Multilayer perceptron neural network models trained via Levenberg-Marquardt and Scaled Conjugate Gradient algorithms was employed for constructing the diagnostic system. Finally, precise tuning for the models' parameters was conducted in order to achieve the optimal performance. As a result, 9 noninvasive predictors were found to be significantly associated with the level of risk in dengue patients. By employing those predictors, 75% prediction accuracy has been achieved for classifying the risk in dengue patients using Scaled Conjugate Gradient algorithm while 70.7% prediction accuracy were achieved by using Levenberg-Marquardt algorithm.
MeSH terms: Algorithms; Aspartate Aminotransferases/blood; Dengue/classification*; Dengue/diagnosis*; Dengue/epidemiology; Hematocrit; Humans; Models, Biological; Platelet Count; Risk Factors; Sex Factors; Body Mass Index; Neural Networks (Computer)*; Risk Assessment; Severe Dengue/classification; Severe Dengue/diagnosis; Severe Dengue/epidemiology; Decision Support Systems, Clinical/organization & administration*