Tuberculosis (TB) is a major public health problem worldwide. It is estimated that 2 billion people, a third of
the world population, have TB infection, but are not down with the disease. Globally, incident cases of TB
showed a rising trend, with a 6.6 million reported in 1990, 8.3 million in 2000, 9.24 million in 2004, and an
estimated 9.27 million incident cases in 2007. The aim of this study was to evaluate the treatment outcome of
TB patients in Nigeria in the state of Jigawa. A cross sectional retrospective study was conducted to evaluate the
treatment outcome in directly observed treatment with a short course for tuberculosis (TB DOTS) in facilities
in the state between the years 2010 to 2014. The study population were all the patients with TB, who had
access to DOTS therapy. Data were collected from the various local governmental areas for tuberculosis control
(LGA TB) register. The LGA TB control registers contained basic information of the patients, and a statistical
software SPSS-V22.0 was used to analyse the data. A total of 963 TB patients were studied. More than half
(57.4%) of the patients were male, and nearly three- fourths (71.2%) of the patients accessed care from urban
local government areas in the state. The greater majority (96.3%) of the cases had pulmonary tuberculosis
(PTB). Among the patients, more than two-fifths (45%) were cured, and a little over one-fifth (20.6%) of them
were HIV positive. This study revealed that the treatment success rate (TSR) in the Jigawa State of Nigeria
was higher than the overall TSR of Nigeria, and the defaulter rate in this state was lower than the Nigerian
average. The aim of this study was to evaluate the treatment outcome of TB patients in Nigeria in the state
of Jigawa. A cross sectional retrospective study was conducted to evaluate the treatment outcome in directly
observed treatment with a short course for tuberculosis (TB DOTS) in facilities in the state between the years
2010 to 2014. The study population were all the patients with TB, who had access to DOTS therapy. Data were
collected from the various local governmental areas for tuberculosis control (LGA TB) register. The LGA TB
control registers contained basic information of the patients, and a statistical software SPSS-V22.0 was used
to analyse the data. A total of 963 TB patients were studied. More than half (57.4%) of the patients were
male, and nearly three- fourths (71.2%) of the patients accessed care from urban local government areas in
the state. The greater majority (96.3%) of the cases had pulmonary tuberculosis (PTB). Among the patients,
more than two-fifths (45%) were cured, and a little over one-fifth (20.6%) of them were HIV positive. This study
revealed that the treatment success rate (TSR) in the Jigawa State of Nigeria was higher than the overall TSR
of Nigeria, and the defaulter rate in this state was lower than the Nigerian average.
MeSH terms: Cross-Sectional Studies; Humans; Male; Local Government; Nigeria; Public Health; Retrospective Studies; Software; Tuberculosis; Tuberculosis, Pulmonary; HIV Infections; Treatment Outcome; Latent Tuberculosis
Phyllodes tumour is a rare entity, affecting mainly middle aged women. It consists of a spectrum of disease
from benign tumour to highly aggressive malignant form. We present a case of massive ruptured malignant
Phyllodes tumour, and its subsequent management.
Pulmonary embolism is the obstruction of the pulmonary artery or its branches, commonly by thrombus or
fat. We report an unusual case of double pathology - both pulmonary thromboembolism and fat embolism
syndrome in a patient with bilateral femur and bilateral tibia fractures. This highlights the importance of a high
index of suspicion of these conditions while managing patients with multiple long bone fractures. Morbidity
and mortality can be significantly reduced with prompt and appropriate prevention strategies.
The study aimed to assess whether sharing of health services improved service quality in health centers in Kampala Capital City Authority (KCCA). With multi-stage sampling, data was gathered by face to face interviews, via translators from residents in the five divisions of KCCA, using a questionnaire. Schedules were made with Local Council I chairmen, and support to fill in the questionnaire was given to the respondents. The statistical methods used for analysis included a Chi-square, Spearman correlations and hierarchical regression. The study found that regarding tangibility, sharing health services significantly determines the number of modern medical equipments (p=0.000) and the number of medical personnel that had a neat and professional appearance (p=0.000) but did not determine the number of visually appealing health facilities (p=0.386). Recentralizing health care changed the mode of delivery. Health workers were responsive, reliable and provide better care for patients. There was increased availability of basic medical equipment, and health workers were neater in appearance with increased confidence and hence were better able to provide for the safety of residents.
Study site: clinic, Kampala, Uganda
MeSH terms: Ambulatory Care Facilities; Cross-Sectional Studies; Delivery of Health Care; Health Facilities; Health Personnel; Health Services; Humans; Surveys and Questionnaires; Uganda
The anterior cruciate ligament (ACL) deficient knee has been subjected to various research and many conclusions
have been drawn to the loss of function in relation to it. ACL reconstruction is also very commonly done as
this ligament damage is the most common injury in sports. Muscle strength and proprioception have been
postulated to be affected alongside this injury. We conducted a cross sectional study in 19 patients who have
ruptured their ACL. We measured their muscle strength, thigh muscle bulk and proprioception in comparison
to their contralateral normal knee. The Biodex Isokinetic machine was used to measure the muscle strength
and proprioception. The thigh circumference was measured manually using a measuring tape. There was
significant reduction of muscle strength and thigh circumference in the ACL deficient limb as compared to the
normal side, p
Antibacterial activity of different types of P. odorata leaf extracts was evaluated in combination with
standard antibiotics. Persicaria. odorata leaves were extracted with n-hexane (n-hex), dichloromethane
(DCM) and methanol (MeOH). Each extract was applied on vancomycin (30µg), erythromycin (15µg) and
gentamicin (10µg) discs, respectively. Disk diffusion method was used to evaluate the synergistic activity of
each combination on Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes,
Streptococcus pneumoniae, Pseudomonas aeruginosa, Salmonella typhi, and Escherichia coli. Minimum
inhibitory concentration (MIC) and gas chromatography mass spectrometry (GCMS) analysis was performed on
the active extract. Synergistic effects seen were mainly from the n-hex+antibiotics combinations, mainly on
the Gram-positive bacteria (7 additive, 5 antagonistic), with MIC range from 50 µg/ml to 100 µg/ml, as well
as Gram-negative bacteria (2 additive, 2 indifferent, 5 antagonistic). In particular, synergism showed by the
combination of n-hex+van were all additive against the susceptible bacteria. DCM extract combination
showed synergistic effects on three Gram-positive species (S. aureus, S. epidermidis, S. pyogenes).
Meanwhile, MeOH+antibiotics combination showed significant additive synergistic effects (p
Introduction: Marital satisfaction is vital to the wellbeing and functioning of the individual and family. Marital dissatisfaction can lead to detrimental effects on mental, physical and family health. The study aimed to determine the proportion of marital dissatisfaction in outpatient setting and its association with sexual functioning and psychiatric morbidity in Kuala Lumpur, Malaysia.
Materials & Methods: A cross-sectional study was conducted in selected primary care using purposive sampling. Data collection was done using socio-demographic questionnaire and several validated Malay version of self-administered questionnaires. Marital satisfaction was measured by the Malay version of Golombok–Rust Inventory of Marital State (Mal-GRIMS).
Results: The prevalence of marriage dissatisfaction in sample population was about 37.3% with almost equal prevalence in both, 36.5% (male) and 37.8% (female). Using a regression analysis, the significant factors that affect marital dissatisfaction were respondent’s age group between 31-40 years old (Adjusted Odds Ratio, AOR. =11.4, 95% Confidence Interval, CI. =1.2-110.9), spouse’s salary of RM1000-RM2000 (lower income category) (AOR=7.3, 95% CI= 1.9-28.1), anxiety case (AOR= 4.8, 95% CI=1.1-21.5), depression case (AOR= 4.8, 95% CI=1.0-22.8), female sexual dysfunction in term of arousal function (AOR= 0.01, 95% CI=0.0-0.7), satisfaction dysfunction (AOR= 9.4, 95% CI= 1.5-58) and pain function (AOR=43.7, 95% CI=1.28 - 1489.2).
Conclusion: Marital dissatisfaction can be influenced by financial factor, sexual dysfunction and presence of psychiatric morbidity. Hence, in management of marital discord, thorough screening of these factors should be prioritized in clinical setting.
MeSH terms: Adult; Ambulatory Care Facilities; Anxiety; Cross-Sectional Studies; Depression; Humans; Erectile Dysfunction*; Malaysia
In the perspective of recent bauxite mining in Malaysia, this review aims to identify the potential
environmental and health impacts on miners and surrounding communities. The environmental issues of
bauxite mining include, air, water and soil pollution due to bauxite dust; leaching of bauxite into water
sources resulting in reduced soil fertility as well as affecting agricultural food products and aquatic life.
Bauxite occupational exposure affects the health of miners, and has negative consequences on the health of
surrounding communities, such as increased respiratory symptoms, contamination of drinking water, other
potential health risks from ingestion of bauxite and heavy metals, including noise-induced hearing loss and
mental stress. This review discusses the processes of bauxite mining, its constituents and residual trace
elements, and their impact on the environment and health of exposed workers and communities. It also
explores the Malaysian legal requirements and standards of occupational exposure to bauxite.
In children, most cases of optic neuritis are immune-related. Less frequently, it may also be due to
demyelinating disorders. Other secondary causes such as infection of adjacent structures or infiltration are
even rarer. The occurrence of optic neuritis in children on chemotherapy also has not being extensively
reported. We report a case of bilateral optic neuritis in a young girl with subacute visual loss after receiving
systemic chemotherapy for embryonal ovarian carcinoma.
We report a 26-year old lady who presented with chronic cough and breathlessness associated with subtle
TB symptoms for 1 year. Her CT thorax showed multiple cavitating pulmonary nodules with mediastinal and
cervical lymphadenopathy. Cervical lymph node biopsy and CT-guided pulmonary biopsy at our centre
confirmed the diagnosis of Hodgkin’s lymphoma with pulmonary infiltrations. She was successfully treated
with ABVD regime but later developed life-threatening bleomycin-induced pulmonary fibrosis. Sadly, she
succumbed to respiratory failure due to severe pneumonia with possibility of bleomycin-induced pulmonary
fibrosis. Multiple cavitating pulmonary nodules secondary to lymphoma is rare and in TB endemic area, it
may result in delayed diagnosis and treatment.
Left ventricular non-compaction cardiomyopathy (LVNC) is a rare congenital cardiomyopathy, which is
characterized by hypertrabeculations and deep recesses of the left ventricle. A patient could be
asymptomatic or presented with common manifestations, including reduced systolic function, arrhythmia,
thromboembolic events and heart failure. The rarity of the condition as well as lack of proper assessment
has probably led to this condition to be largely underdiagnosed or unrecognized. A 23-year-old lady had
collapsed at home thirty one days after delivering her first child. She had a history of goitre diagnosed a
year ago and noted to be fairly well throughout the pregnancy. Post mortem findings showed increased
trabeculations of the left ventricle. Further history was obtained after the procedure, revealing symptoms
such as syncopal attacks and bilateral lower limb weakness dated back as far as five years prior to her
sudden demise. These features were in keeping with hypotension hypoperfusion effects resulted from
reduced systolic function and decreased ejection fraction, as a result of left ventricular dysfunction. While
LVNC remains a rare type of disease, we would like to highlight the importance of a good anamnesis. It may
help to uncover some uncommon pathology such as this heart disease, thus warranting an appropriate
cardiac imaging to be engaged to clinch the primary diagnosis.
Tonsillectomy is a very common procedure in Otolaryngology practice. Common complications include
bleeding, which can be primary or secondary due to infection of the tonsillar bed. Subcutaneous emphysema
after a tonsillectomy is very rare. We report a 19-year-old girl who developed cervicofacial subcutaneous
emphysema several hours after tonsillectomy with successful conservative treatment outcome.
Thyroglossal duct cyst is the most common upper neck midline lesion in children. Approximately 1% of
thyroglossal duct cyst undergoes malignant transformation. Calcification which is a marker of malignancy
almost always points out to papillary thyroid carcinoma. Benign case of calcified thyroglossal cyst maybe
undiagnosed or under reported. We report a case of a 5 year old girl with a benign calcified thyroglossal
duct cyst, a fourth case in world literature. Here the differences between a benign and malignant
thyroglossal duct cyst are discussed.
The upper airway is a crucial structure. It becomes a grave problem should it be narrowed. Several methods
of treatment were rendered for patients with laryngotracheal stenosis. We share our experience with the
combination total intravenous anaesthesia and apneic pause technique with or without steroid injection.
Four cases of laryngotracheal stenosis were observed in Hospital Ampang: two adult and two paediatric
cases. Age, gender, causative factor, stenosis segment length, grade or severity were observed before and
after dilatation, number of dilatation were observed and compared. The outcome measures are
decannulation and avoidance of tracheostomy. All cases had improvement of symptoms. Half or 50% of the
patient required repeated balloon dilatations. The paediatric cases successfully avoided tracheostomy while
the adult cases successfully decannulated with no complication from the procedure. Balloon dilatation by
total intravenous anaesthesia coupled with apneic method is a safe and effective method of treatment for
the narrowed airway.
Introduction: Dyslipidaemia is one of the risk factors contributing to the pathogenesis of cardiovascular
diseases (CVDs). This study was conducted to investigate the effect of wet cupping on lipid profile.
Methods: This randomized controlled trial was conducted in 2012 at the School of Medical Sciences,
Universiti Sains Malaysia, Malaysia. Sixty-two healthy volunteers ranging from 30 to 60 years old were
randomized into control and intervention groups. Subjects in the intervention group were assigned to two
sessions of wet cupping at the beginning of the study and at the third month; individuals in the control group
did not undergo any cupping procedure. Venous blood sample was collected for serum lipid profile: Total
Cholesterol (TC), High Density Lipoprotein Cholesterol (HDL-C), Low Density Lipoprotein Cholesterol (LDL-C),
and triglycerides; measured at baseline, first, third and fourth month.
Results: Subjects in the cupping
group had significant improvements from baseline to third and fourth month for TC (MD=-0.56, P=0.004),
HDL-C (MD=-0.22, P
Introduction: Malocclusion is one of the most common dental problems observed. Limited data is currently
available regarding the demographics of malocclusion observed locally.
Materials And Methods: This is a
retrospective study where 770 patients were recruited from May 2009 till December 2014. 560 orthodontic
study models that met the inclusion criteria were examined and the malocclusions were classified according
to the British Standard Institute (BSI) incisor classification. Demographic pattern and their relationship were
analysed by structural equation modelling using SPSS (version 23.0).
Results: From 560 study models
analysed, 72% were female. The age of the patients ranges from 7-12 years old (17.1%), 13-17 years old
(55.9%) and >18 years old (27.0%). Majority of the patients were Malay followed by Chinese (5.7%), Indian
(1.8%) and other races (1.8%) Treatments received were fixed appliances (FA) (60.0%), removable appliances
(RA) (12.5%), functional appliances (FnA) (1.1%), combination of RA and FA (16.1%), combination of FnA and
FA (2.1%) and consultation (8.2%). Types of malocclusions observed were Class I (25.7%), Class II/1(32.7%),
Class II/2 (7.5%) and Class III (34.1%). There was significant association (p
MeSH terms: Ethnic Groups; Female; Humans; Incisor; Malaysia; Malocclusion; Referral and Consultation; Retrospective Studies; Continental Population Groups
The increasing awareness amongst the society on medico-legal issues as well as the growth of consumerist
attitude towards the provision of medical services has caused the medical profession to be subjected to
vociferous criticism if they do not meet rising expectations of the society. Substandard services have not
been well tolerated and paternalistic approaches in medical treatment are considered to be outmoded and
inappropriate. Any dissatisfaction on the part of the patient towards medical services provided nowadays
may easily trigger claims in the court of law. This changing trend has also fundamentally changed the
behaviour of the courts towards the medical profession. Judicial and legislative interventions in medical
practice have created more and more rights for the patients and consequently, corresponding legal duties
for the medical profession to uphold. In the present healthcare setting, the medical profession will not be
able to provide infallible services without knowledge of the legal standards which they have to adhere.
Thus, educating future medical professionals with the fundamentals of law and ethics would ensure greater
accountability, knowledge and personal commitment in providing medical services to the society as the
ideals of professionalism not only require them to have the necessary expertise, dedication, respect,
compassion, empathy, honesty, altruism, responsibility, integrity, self-improvement and accountability but
also adherence to the demands of law and highest ethical standards.
MeSH terms: Professionalism; Altruism; Anniversaries and Special Events; Emotions; Empathy; Humans; Social Responsibility; Societies; Moral Obligations
Background: With increasing number of dengue cases in Malaysia, it’s of utmost importance that immediate
action be taken to limit the epidemic. Since dengue control is a behavioral problem, the knowledge,
attitude and practice in population needs to be studied in order to control the disease. Hence, the aim of
this study is to assess knowledge, attitude and practice regarding dengue and its associated factors among
adult residents of Felda Sungai Panching Timur (SPT), Kuantan, Pahang, 2014.
Method: A cross sectional
study was carried out involving 265 adult respondents. A face to face interview questionnaire which was
divided into 2 parts (Part A: Sociodemoghraphic; Part B: Knowledge, Attitude and Practice) was used. Data
was analyzed using descriptive statistics, simple and multiple logistic regression.
Results: 53.2% of the
respondents had good knowledge about dengue and it was found that the main source of information from
mass media (76.6%). However, only 43.4% were found to have good attitude towards dengue. Multiple
Logistic Regression analysis showed there was no association between sociodemographic characteristics with
the level of knowledge and attitude towards dengue. There was also no association found between
knowledge of dengue and the attitude of the respondents towards dengue. Descriptive analysis on the
practice of dengue showed majority of the respondents who had possible breeding site for Aedes mosquitos
(water container, drains/gutter roof/flower pots/tires) in their compound practiced good habit in
preventing the Aedes mosquitoes from breed.
Conclusion: Although knowledge and practice towards dengue
is good, their attitude require improvement.
MeSH terms: Problem Behavior; Aedes; Animals; Breeding; Cross-Sectional Studies; Dengue; Habits; Malaysia; Mass Media; Surveys and Questionnaires; Water; Logistic Models; Flowers; Epidemics
We report a case of cavernous sinus thrombosis in a post-splenectomy male with underlying Haemoglobin E Thalassemia major. A 35-year-old man presented with a first episode of sudden onset of diplopia on lateral gaze for 1 week. He had no other ocular and systemic symptoms. There was no history of trauma or recent infection. However, he admitted that he was not compliant to his oral penicillin V and aspirin, which was prescribed to all post splenectomy patients. Unaided visual acuity in both eyes was 6/6. On examination, there was limited abduction over the left eye, suggestive of left lateral rectus palsy. Full blood count revealed leucocytosis with thrombocytosis. Magnetic resonance imaging, magnetic resonance angiography and magnetic resonance venography of the brain showed bulging of the left cavernous sinus, with a persistent focal filling defect, in keeping with left cavernous sinus thrombosis (CST). He was diagnosed with left isolated sixth nerve palsy secondary to aseptic cavernous sinus thrombosis with pro-thrombotic state post-splenectomy. He was started on subcutaneous fondaparinux and oral warfarin. His diplopia fully resolved after 1 month of treatment with complete resolution of CST on computed tomography venogram.
Medicinal plants have healing properties and are able to synthesize various chemical compounds. These chemicals (also known as phytochemical compounds) play vital roles in determining the pharmacological properties existing in certain plants. The phytochemical compounds present in plants are associated with primary and secondary constituents. Most of the time, the secondary constituents exhibit the bioactivities in plants such as antimicrobial, antioxidant, antidiabetic, antibacterial and anti-inflammatory properties. Some common medicinal plants that have been used in curing various diseases by traditional practitioners in Malaysia are Ficus deltoidea Jack, Andrographis paniculata, Curcuma longa, Clinacanthus nutans and Eurycoma longifolia Jack. This review discusses the morphology, phytochemical compounds and phytochemical properties of selected medicinal plants in Malaysia. The plants of focus have been found to possess anti-cancer and anti-diabetic effects. This review, it is hoped will enable Malaysian researchers to explore further on the potential of these plants in investigating new and novel drugs in the future.