Browse publications by year: 2018

  1. Dieng H, Satho T, Binti Arzemi NA, Aliasan NE, Abang F, Wydiamala E, et al.
    Acta Trop, 2018 Sep;185:230-238.
    PMID: 29856985 DOI: 10.1016/j.actatropica.2018.05.019
    Food location by mosquitoes is mediated by resource-derived olfactory and visual signals. Smell sensation is intermittent and dependent on the environment, whereas visual signals are continual and precede olfactory cues. Success of mosquito bait technology, where olfactory cues are used for attraction, is being impeded by reduced attractiveness. Despite proof that mosquitoes respond to colored objects, including those mimicking floral shape, and that they can discriminate among flowers, the impacts of artificial flowers on foraging remain unexplored. Using artificial flowers with sugar rewards, we examined the foraging responses of Aedes aegypti to various colors in equal choice bioassays. Starved adults were exposed to single flowers with petals of a given color (Single Blue Flowers [SBFs]; Single Red Flowers [SRFs]; Single Yellow Flowers [SYFs]; Single Pink Flowers [SPIFs]; and Single Purple Flowers [SPFs]) and two others with white petals (SWFs). Discrepancies in response time, visitation, feeding, and resting of both sexes were compared between colored flowers and SWFs. Ae. aegypti exhibited shorter response times to colored flowers compared to SWFs, but this behavior was mostly seen for SBFs or SYFs in females, and SRFs, SYFs, SPIFs, or SPFs in males. When provided an option to land on colored flowers and SWFs, female visitation occurred at high rates on SBFs, SRFs, SYFs, SPIFs, and SPFs; for males, this preference for colored flowers was seen to a lesser degree on SBF and SPIFs. Both sexes exhibited preference for colored flowers as sugar sources, but with different patterns: SPIFs, SRFs, SYFs, and SPFs for females; SYFs, SPFs, SPIFs and SRFs for males. Females preferentially rested on colored flowers when in competition with SWFs, but this preference was more pronounced for SPFs, SRFs, and SBFs. Males exhibited an increased preference for SRFs, SPFs, and SYFs as resting sites. Our results indicated the attraction of Ae. aegypti to rewarding artificial flowers, in some cases in ways similar to live flowering plants. The discovery that both male and female Ae. aegypti can feed on nectar mimics held by artificial flowers opens new avenues for improving sugar bait technology and for developing new attract-and-kill devices.
    MeSH terms: Aedes/physiology*; Animals; Feeding Behavior*; Female; Male; Smell; Flowers*; Plant Nectar; Mosquito Vectors/physiology*
  2. Kumar K, Arshad SS, Selvarajah GT, Abu J, Toung OP, Abba Y, et al.
    Acta Trop, 2018 Sep;185:219-229.
    PMID: 29856986 DOI: 10.1016/j.actatropica.2018.05.017
    Japanese encephalitis (JE) is a vector-borne zoonotic disease caused by the Japanese encephalitis virus (JEV). It causes encephalitis in human and horses, and may lead to reproductive failure in sows. The first human encephalitis case in Malaya (now Malaysia) was reported during World War II in a British prison in 1942. Later, encephalitis was observed among race horses in Singapore. In 1951, the first JEV was isolated from the brain of an encephalitis patient. The true storyline of JE exposure among humans and animals has not been documented in Malaysia. In some places such as Sarawak, JEV has been isolated from mosquitoes before an outbreak in 1992. JE is an epidemic in Malaysia except Sarawak. There are four major outbreaks reported in Pulau Langkawi (1974), Penang (1988), Perak and Negeri Sembilan (1998-1999), and Sarawak (1992). JE is considered endemic only in Sarawak. Initially, both adults and children were victims of JE in Malaysia, however, according to the current reports; JE infection is only lethal to children in Malaysia. This paper describes a timeline of JE cases (background of each case) from first detection to current status, vaccination programs against JE, diagnostic methods used in hospitals and factors which may contribute to the transmission of JE among humans and animals in Malaysia.
    MeSH terms: Animals; Disease Outbreaks; Encephalitis, Japanese/epidemiology*; Encephalitis, Japanese/prevention & control; Encephalitis, Japanese/transmission; Humans; Malaysia/epidemiology; Vaccination; Japanese Encephalitis Vaccines/immunology
  3. Khor ES, Wong PF
    Int J Biochem Cell Biol, 2018 Aug;101:64-73.
    PMID: 29857052 DOI: 10.1016/j.biocel.2018.05.016
    Accumulation of senescent endothelial cells can contribute to endothelium dysfunction. Suppression of MTOR signaling has been shown to delay senescence but the mechanism that underpins this effect, particularly one that involves miRNAs, remains to be further defined. This study sought to identify miRNAs involved in MTORC1-mediated inhibition of replicative senescence in endothelial cells. Pre-senescent HUVECs were prolonged treated with low dose rapamycin (1 nM), an MTOR inhibitor. Rapamycin treatment down-regulated the phosphorylated MTOR, RPS6 and 4EBP1 expressions, which confirmed MTORC1 suppression. Prolonged low dose rapamycin treatment has significantly reduced the percentage of senescence-associated beta galactosidase (SA-β gal) positively stained senescent cells and P16INK4A expression in these cells. On the contrary, the percentage of BrdU-labelled proliferating cells has significantly increased. RPTOR, a positive regulator of MTORC1 was knockdown using RPTOR siRNA to inhibit MTORC1 activation. RPTOR knockdown was evidenced by significant suppressions of RPTOR mRNA and protein expression levels. In these cells, the expression of miR-107 was down-regulated whereas miR-145-5p and miR-217 were up-regulated. Target gene prediction revealed PTEN as the target of miR-107 and this was confirmed by biotin pull-down assay. Over-expression of miR-107 has decreased PTEN expression, increased MTORC1 activity, induced cell cycle arrest at G0/G1 phase and up-regulated P16INK4A expression but mitigated tube formation. Collectively, our findings revealed that delayed endothelial replicative senescence caused by the inhibition of MTORC1 activation could be modulated by miR-107 via its influence on PTEN.
    MeSH terms: Biotin; Bromodeoxyuridine; Phosphoproteins; RNA, Messenger; Down-Regulation; Sirolimus; RNA, Small Interfering; MicroRNAs; Endothelial Cells; Adaptor Proteins, Signal Transducing; PTEN Phosphohydrolase
  4. Nawaz A, Wong TW
    J Invest Dermatol, 2018 11;138(11):2412-2422.
    PMID: 29857069 DOI: 10.1016/j.jid.2018.04.037
    5-Fluorouracil delivery profiles in the form of chitosan-folate submicron particles through skin and melanoma cells in vitro were examined using microwaves as the penetration enhancer. The in vivo pharmacokinetic profile of 5-fluorouracil was also determined. Chitosan-carboxymethyl-5-fluorouracil-folate conjugate was synthesized and processed into submicron particles by spray-drying technique. The size, zeta potential, morphology, drug content, and drug release, as well as skin permeation and retention, pharmacokinetics, in vitro SKMEL-28 melanoma cell line cytotoxicity, and intracellular trafficking profiles of drug/particles, were examined as a function of skin/melanoma cell treatment by microwaves at 2,450 MHz for 5 + 5 minutes. The level of skin drug/particle retention in vitro and in vivo increased in skin treated by microwaves. This was facilitated by the drug conjugating to chitosan and microwaves fluidizing both the protein and lipid domains of epidermis and dermis. The uptake of chitosan-folate particles by melanoma cells was mediated via lipid raft route. It was promoted by microwaves, which fluidized the lipid and protein regimes of the cell membrane, and this increased drug cytotoxicity. In vivo pharmacokinetic study indicated skin treatment by microwave-enhanced drug retention but not permeation. The combination of microwaves and submicron particles synergized skin drug retention and intracellular drug delivery.
    MeSH terms: Administration, Cutaneous; Fluorouracil/therapeutic use*; Fluorouracil/chemistry; Folic Acid/therapeutic use*; Folic Acid/chemistry; Humans; Melanoma/drug therapy*; Microwaves; Skin/drug effects; Skin/pathology*; Skin Absorption; Skin Neoplasms/drug therapy*; Drug Delivery Systems; Membrane Microdomains; Cell Line, Tumor; Chitosan/analogs & derivatives*; Chitosan/therapeutic use; Chitosan/chemistry; Nanoparticles/therapeutic use*; Nanoparticles/chemistry
  5. Sahlabadi A, Chandren Muniyandi R, Sahlabadi M, Golshanbafghy H
    Adv Bioinformatics, 2018;2018:9391635.
    PMID: 29796018 DOI: 10.1155/2018/9391635
    Nowadays, microarray technology has become one of the popular ways to study gene expression and diagnosis of disease. National Center for Biology Information (NCBI) hosts public databases containing large volumes of biological data required to be preprocessed, since they carry high levels of noise and bias. Robust Multiarray Average (RMA) is one of the standard and popular methods that is utilized to preprocess the data and remove the noises. Most of the preprocessing algorithms are time-consuming and not able to handle a large number of datasets with thousands of experiments. Parallel processing can be used to address the above-mentioned issues. Hadoop is a well-known and ideal distributed file system framework that provides a parallel environment to run the experiment. In this research, for the first time, the capability of Hadoop and statistical power of R have been leveraged to parallelize the available preprocessing algorithm called RMA to efficiently process microarray data. The experiment has been run on cluster containing 5 nodes, while each node has 16 cores and 16 GB memory. It compares efficiency and the performance of parallelized RMA using Hadoop with parallelized RMA using affyPara package as well as sequential RMA. The result shows the speed-up rate of the proposed approach outperforms the sequential approach and affyPara approach.
  6. Zahari Z, Lee CS, Ibrahim MA, Musa N, Mohd Yasin MA, Lee YY, et al.
    Iran J Pharm Res, 2018;17(Suppl):8-16.
    PMID: 29796025
    Hyperalgesia is a common clinical phenomenon among opioid dependent patients on methadone maintenance therapy (MMT) and it may be associated with undertreated pain and/or therapeutic failure. This study aimed to investigate association between serum methadone concentration (SMC) and cold pressor pain responses. Cold pressor pain responses in 147 opioid dependent patients on MMT were assessed using cold pressor test (CPT) at 0 h and at 2, 4, 8, 12, and 24 h after the dose intake. Blood samples were collected at 24 h after the dose. Serum methadone concentrations were measured using the Methadone ELISA kit and classified into two categories: < 400 ng/mL and ≥ 400 ng/mL. Eighty-eight patients (59.9%) had trough concentrations of < 400 ng/mL and 40.1% had trough concentrations of ≥ 400 ng/mL. There were significant effects of SMC on the cold pressor pain threshold (p = 0.019). Patients with concentrations < 400 ng/mL had significantly higher (almost 60% higher) cold pressor pain threshold (adjusted mean (95% CI) = 30.15 (24.29, 36.01) s) compared to those with concentrations of ≥ 400 ng/mL (18.93 (11.77, 26.08) seconds). There was also a 20% difference in pain tolerance, and 6% difference in cold pressor pain intensity score, neither of which were significant statistically (p > 0.05). Our results suggest an association of trough methadone concentration with the cold pressor pain threshold among opioid dependent patients on MMT. It would be useful to study the mechanisms underlying this association to help managing pain in such a population.
    Study site: Psychiatric Clinic, Hospital Universiti Sains Malaysia (HUSM); Psychiatric Clinic, Hospital Raja Perempuan Zainab II; and eight other government MMT clinics in Kelantan, Malaysia
    MeSH terms: Adult; Ambulatory Care Facilities; Hospitals, General; Hospitals, University; Humans; Malaysia; Methadone; Outpatient Clinics, Hospital; Pain
  7. Yahaya SN, Wahab SFA, Yusoff MSB, Yasin MAM, Rahman MAA
    World J Emerg Med, 2018;9(3):178-186.
    PMID: 29796141 DOI: 10.5847/wjem.j.1920-8642.2018.03.003
    BACKGROUND: Demanding profession has been associated with poor psychological health due to multiple factors such as overworking hours and night shifts. This study is to determine prevalence and associated factors of depression, anxiety and stress among medical officers working at emergency department in Malaysian hospitals.

    METHODS: A cross-sectional study was conducted on 140 emergency department medical officers working at general hospitals from seven Malaysia regions. They were randomly selected and their depression, anxiety and stress level were measured by the 21-item Depression, Anxiety, Stress Scale.

    RESULTS: The highest prevalence was anxiety (28.6%) followed by depression (10.7%) and stress (7.9%). Depression, anxiety and stress between seven hospitals were not significantly different (P>0.05). Male medical officers significantly experienced more anxiety symptoms than female medical officers (P=0.0022), however depression and stress symptoms between male and female medical officers were not significantly different (P>0.05). Depression, anxiety and stress were not associated with age, working experience, ethnicity, marital status, number of shifts and type of system adopted in different hospitals (P>0.05).

    CONCLUSION: The prevalence of anxiety was high, whereas for depression and stress were considerably low. Gender was the only factor significantly associated with anxiety. Other factors were not associated with depression, anxiety and stress. Future research should aim to gain better understanding on unique factors that affect female and male medical officers' anxiety level in emergency setting, thus guide authorities to chart strategic plans to remedy this condition.

    MeSH terms: Anxiety; Anxiety Disorders; Cross-Sectional Studies; Depression; Depressive Disorder; Emergency Service, Hospital; Female; Hospitals, General; Malaysia; Male; Prevalence; Marital Status
  8. Cheah WL, Majorie Ensayan J, Helmy H, Chang CT
    Malays Fam Physician, 2018;13(1):2-9.
    PMID: 29796204 MyJurnal
    Introduction: The present study aimed to determine the prevalence of hypertension and its association with nutritional status (body mass index, body fat percentage, and visceral fat) among students in a public university in Sarawak, Malaysia.

    Methods: This was a cross-sectional study among undergraduate students aged 18 years old and above. Anthropometric measurements, such as weight, height, body composition, and blood pressure measurements, were collected. Hypertension was defined as equal or more than 140/90 mmHg. Statistical analyses were done using IBM SPSS version 20.

    Results: A total of 354 respondents participated in the study. Mean age for the respondents was 21 years (SD 1.18 years). About 40% of the respondents were overweight or obese. Prevalence of hypertension was 8.2%. Mean systolic blood pressure was 119.1mmHg (SD14.36mmHg), and the mean diastolic blood pressure was 72.6mmHg (SD 9.73mmHg). There is a significant association between male gender (odds ratio =3.519, 95% CI is 1.886-6.566), body fat percentage (odds ratio = 1.944, 95% CI is 1.050-3.601), visceral fat (odds ratio = 2.830, 95% CI is 1.346-5.951), and family history of hypertension (odds ratio= 2.366, 95% CI is 1.334-4.194) and hypertension.

    Conclusion: The prevalence of hypertension was less than 10% and is associated with male gender, body composition, and family history of hypertension.

    MeSH terms: Blood Pressure; Body Composition; Body Weight; Cross-Sectional Studies; Hypertension; Malaysia; Male; Nutritional Status; Obesity; Surveys and Questionnaires; Students; Universities; Body Mass Index; Prevalence; Odds Ratio; Intra-Abdominal Fat; Overweight
  9. Yunus NA, Mohamed Yusoff H, Draman N
    Malays Fam Physician, 2018;13(1):10-17.
    PMID: 29796205 MyJurnal
    Introduction: Cervical cancer ranks as the second most frequent cancer among women in Malaysia. Although a cervical screening program has been introduced since 1960s and is provided free of charge in all government health facilities, the coverage and adherence rate to recommendation among Malaysian women remains low.

    Objectives: To determine the proportion of non-adherence to Pap smear screening guidelines and its associated factors among women attending a health clinic in Malaysia.

    Method: A cross sectional study involving 316 women aged 20 to 65 years who had undergone a Pap smear. Universal sampling method was applied to select participants among women who attended the selected health clinic from January 2013 to May 2013. A self-administered questionnaire was used to obtain the socio-demographic characteristics, socio-health data and perceptions about cervical cancer and Pap smear screening. The data was analysed using descriptive statistics and multiple logistic regression.

    Result: The proportion of non-adherence to Pap smear screening was 90.5%. Age, marital status, duration of marriage, education level, employment, household income and number of children were not significantly associated with non-adherence. Perceived severity, perceived susceptibility, perceived benefit, perceived barrier and cues to action did not show significant association with non-adherence to Pap smear screening.

    Conclusion: Non-adherence to Pap smear screening was high among Malaysian women. Measures should be taken to increase Pap smear screening coverage in our country. Other factors beyond Health Belief Model that influence Pap smear screening practice among Malaysian women should be explored.
    MeSH terms: Ambulatory Care Facilities; Uterine Cervical Neoplasms; Cross-Sectional Studies; Female; Humans; Malaysia; Mass Screening; Surveys and Questionnaires; Vaginal Smears; Logistic Models; Marital Status; Papanicolaou Test
  10. Hani SS, Liew SM
    Malays Fam Physician, 2018;13(1):18-27.
    PMID: 29796206 MyJurnal
    BACKGROUND: Chronic low back pain (CLBP) is a common and often difficult to treat condition in the primary care setting. Research involving in-depth exploration on the views and experiences faced by primary care doctors in managing patients with CLBP in Malaysia is limited.

    OBJECTIVE: To explore the primary care practitioners' views and experiences in managing patients with CLBP.

    STUDY DESIGN: A qualitative approach was employed using focus group discussions (FGD) at an academic primary care clinic in Kuala Lumpur, Malaysia. Twenty-three primary care doctors were purposively selected. Data were collected through audio-recorded interviews, which were transcribed verbatim and checked for accuracy. Data saturation was reached by the third FGD. An additional FGD was included to ensure completeness. A thematic approach using the one sheet of paper (OSOP) method was used to analyse the data.

    RESULTS: Participants view managing patients with CLBP as challenging. This is mainly due to the difficulty in balancing the doctors' expectations with the patients' perceived expectations during consultation. Barriers identified include lack of awareness and conflicting views regarding the usefulness of the local clinical practice guideline (CPG) in clinical practice. Other barriers include time constraints and perceived lack of support from multidisciplinary teams in managing these patients.

    CONCLUSION: Managing patients with CLBP is still a challenge for Malaysian primary care doctors. Any intervention should target identified barriers to improve the management of patients with CLBP.

  11. Husain S, Amilia HH, Rosli MN, Zahedi FD, Sachlin IS, Development Group Clinical Practice Guidelines Management of Rhinosinusitis in Adolescents & Adults
    Malays Fam Physician, 2018;13(1):28-33.
    PMID: 29796207 MyJurnal
    Rhinosinusitis is a common health problem encountered in primary care. It is due to mucosal inflammation of the nose and paranasal sinuses. Less than 2% of the cases are associated with bacterial infections. Diagnosis is based on clinical symptoms and supported by nasal endoscopy and imaging studies. Intranasal corticosteroids and normal saline irrigation are important treatments. Antibiotics are seldom indicated.
    MeSH terms: Administration, Intranasal; Adrenal Cortex Hormones; Anti-Bacterial Agents; Bacterial Infections; Endoscopy; Inflammation; Nose; Paranasal Sinuses; Primary Health Care; Sinusitis
  12. Vong KS, Mohamad I, Salim R
    Malays Fam Physician, 2018;13(1):34-36.
    PMID: 29796208
    Introduction: A foreign body (FB) in the upper aerodigestive tract is a fairly common encounter. Fish bones are the commonest FB seen in adults. The commonest presentation is odynophagia. Usually, the patient will point at the level of FB on the neck to indicate the location.

    Methods: Clinical report.

    Results: This case report describes a large FB in an adult with underlying infantile cerebral palsy. Besides dysphagia, it was associated with drooling of saliva and pain in the throat region.

    Conclusion: FB ingestion with complete obstruction of the oesophagus is an emergency. It may cause total dysphagia as the passage of food is completely blocked.
    MeSH terms: Adult; Cerebral Palsy; Deglutition Disorders; Foreign Bodies; Humans; Neck; Pain; Pharynx; Saliva; Sialorrhea
  13. Vincent Ngu CY, Rohaizam J, Jong YH
    Malays Fam Physician, 2018;13(1):37-40.
    PMID: 29796209
    Lemierre's syndrome is a systemic complication commonly caused by oropharyngeal infection by Fusobacterium species, which manifests itself as an internal jugular vein thrombosis formation. It is a rare occurrence nowadays with the availability of broad spectrum antibiotics for treatment. Most cases in the literature presented with a life-threatening condition. We are reporting a case of Lemierre's syndrome that presented with persistent neck pain and swelling, initially diagnosed as cervical lymphadenitis.
  14. Boon C, Wan Mohamad WE, Mohamad I
    Malays Fam Physician, 2018;13(1):41-44.
    PMID: 29796210 MyJurnal
    Peritonsillar abscess, or quinsy, is a rare complication of acute tonsillitis. It usually presents with odynophagia, trismus, and muffled voice, reflecting the space-occupying lesion in the oral cavity. Examination reveals a unilateral swelling on either side of the soft palate, which drains thick pus after an incision is made. It is regarded as an emergency as an upper airway obstruction can develop. Bilateral peritonsillar abscess is a rare presentation and results in catastrophic sequelae. We present a case of bilateral peritonsillar abscess that was initially referred by a primary care centre facing a dilemma in diagnosis. Prompt diagnosis and fast drainage are warranted to avoid unwanted morbidity, and, also, mortality.
    MeSH terms: Peritonsillar Abscess; Airway Obstruction; Drainage; Edema; Malaysia; Mouth; Palate, Soft; Primary Health Care; Trismus
  15. Appannan VR, Md Daud MK
    Malays Fam Physician, 2018;13(1):45-48.
    PMID: 29796211
    Glomus tympanicum is a tumour classified under the group glomus tumours, and is also known as paragangliomas. It is thought to commonly occur in women in the fifth to sixth decades of life. Here, we report a case of a 77-year-old lady with multiple co-morbids and a diagnosis of glomus tympanicum presenting to us. Her symptoms included pulsatile tinnitus, and reduced hearing, and the management of the case was done with consideration for her underlying multiple co-morbidities. This paper also describes the best modality of treatment for this patient with regard to her background history. The treatment goal was to improve her quality of life and control the disease.
    MeSH terms: Female; Glomus Tumor; Glomus Jugulare; Goals; Humans; Paraganglioma; Quality of Life; Tinnitus; Hearing Loss; Glomus Tympanicum
  16. Malek KA, Kamal WW
    Malays Fam Physician, 2018;13(1):49-51.
    PMID: 29796212 MyJurnal
    An 8-year-old boy presents with asymptomatic hypopigmented patches on his bilateral cheeks which
    have been worsening for two weeks. The patches are oval in shape and have spared other parts of the
    body. There is no preceding erythematous rash. Similar lesions appeared two years ago which took
    several months to resolve. There are no recent triggers, such as personal care products. He has no history
    of atopy, but his mother has a recent history of atopic eczema. There is no known history of thyroid
    problems in the family. He was prescribed a topical cream from a general practitioner, but the patches
    persisted, and new patches appeared. He is otherwise well and actively participating in outdoor physical
    activities with frequent sun exposure. (Copied from article).
    MeSH terms: Cheek; Child; Dermatitis, Atopic; Exanthema; Female; Humans; Male; Mothers; Thyroid Gland; Precipitating Factors; Hypopigmentation; General Practitioners
  17. Jamani NA, Puteri Shanaz JK, Azwanis AH
    Malays Fam Physician, 2018;13(1):52-54.
    PMID: 29796213 MyJurnal
    A 21-year-old male college student presented with excessive severe bilateral sweating of his palms and
    soles for the past 3 years, which has progressively worsened. His symptoms occur throughout the day
    but worsened during exams or whenever he felt anxious. The condition has caused him difficulty in
    holding objects and writing assignments, and has resulted in public embarrassment on several occasions.
    He has to wipe his hands with a handkerchief each time they sweat. He also needs to change his socks
    frequently. No other area of his body is similarly affected. He denied any associated symptoms, such as
    pungent body odour, changes in weight, fever, heat intolerance, or changes in bowel habits. He has no
    known medical illness and is not on any medication. (Copied from article).
    MeSH terms: Humans; Hyperhidrosis*; Malaysia/ethnology; Male; Young Adult
  18. Appannan VR, Mohamad I, Ramli RR, Johan KB
    Malays Fam Physician, 2018;13(1):55-56.
    PMID: 29796214 MyJurnal
    A 5-year-old girl presented with a history of
    fever for four days associated with odynophagia.
    She was treated with amoxycillin prescribed
    by a general practitioner for 3 days prior to
    presentation. However, the symptoms were
    worsening and associated with drooling of
    saliva and poor oral intake. There was history
    of recurrent acute tonsillitis in the past two
    years, with 5 to 6 episodes per year. The child
    had completed regular immunizations up to her
    current age. There was no similar presentation
    amongst family members and friends. (Copied from article).
    MeSH terms: Peritonsillar Abscess; Amoxicillin; Child; Child, Preschool; Female; Fever; Humans; Immunization; Pain; Saliva; Sialorrhea; Friends; General Practitioners
  19. Mohamad I, Mohamad IS, Nik Hassan N
    Malays Fam Physician, 2018;13(1):57-58.
    PMID: 29796215 MyJurnal
    An elderly gentleman with a known history of
    well-controlled hypertension presented with
    a three-week history of hoarseness associated
    with mild breathlessness. There was no episode
    of cyanosis, no noisy breathing, and no
    reduction in effort tolerance. There was also no
    history of chest pain or orthopnea. He denied
    any feeling of food stuck in his throat or chest,
    and he had no history of choking sensations
    during meals. He, however, was unable to
    count from 1 to 10 in one breath, and lung
    auscultation revealed reduced air entry on both
    sides. A chest radiograph was then obtained. (Copied from article).
    MeSH terms: Aged; Airway Obstruction; Auscultation; Chest Pain; Cyanosis; Dyspnea; Hoarseness; Humans; Hypertension; Lung; Male; Pharynx; Sensation; Thorax
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