Introduction: Hanging is one of the most common methods of suicide in Malaysia, and to date, there is a rise in the number of deaths by hanging among adults. The purpose of this study was to determine the pattern of hanging in Malaysia from the year 2000 till 2009. Methods: The sample comprised 108 cases received at the Universiti Kebangsaan Malaysia Medical Centre, and five parameters, namely, age, sex, racial affiliation, marital status, and medical history were studied. Results: Of the 108 cases, 56% was reported to be Chinese. Suicide by hanging was more predominant in males (81%), and a high number of cases were seen in age groups of 21 to 30, 31 to 40 and 41 to 50 years. Of the cases studied, half of them were married, and previous history of physical and mental illness and alcohol intoxication were reported. Conclusions: In brief, this data would help the higher authorities in detecting the causes of suicide by hanging, as well as detecting the high risk groups with suicidal tendencies. In this way, suicide can be prevented and thus, the rate of suicide by hanging could be reduced in Malaysian.
Introduction: Internet addiction is becoming a global problem and has been associated with mental health issues such as depression and anxiety. There is a strong need for local research, given the recent rise of mental health issues amongst children and adolescents in Malaysia, as well as lack of research in this field locally. Methods: This study assessed the prevalence of internet addiction, and its association with internetrelated factors, depressive symptoms, anxiety symptoms, and self-esteem, amongst selected secondary school students in the Klang Valley, Malaysia. In a cross-sectional study, 199 adolescents were conveniently chosen from six randomly selected secondary schools within Klang Valley. Subjects completed a demographic questionnaire, as well as Malay versions of the Internet Addiction Test (MVIAT), Children’s Depression Inventory (CDI), Depression Anxiety Stress Scales-21 anxiety subscale (DASS-21) and Rosenberg Self-Esteem Scale (RSES). Multiple logistic regression analysis was carried out. Results: This study found that 49.2% of students were addicted to the internet. Significant factors associated with internet addiction were spending longer hours online during the holidays (OR 1.20, CI 1.01-1.35), easy access to a computer (OR 4.01, CI 1.50 - 10.76), confiding on the internet (OR 4.07, CI 1.49-11.13), severe level of anxiety (OR 3.63, CI 1.04-12.73) and high depression scores (OR 1.10, CI 1.01-1.20). Contrary to previous studies, self-esteem was not found to be significantly associated with internet addiction. Conclusion: This study has important implications in relation to clinical practice, research, and policy-making in Malaysia.
Introduction: Diabetic retinopathy (DR) is one of the commonest complications of diabetes mellitus. This study was to determine the prevalence of DR and its association with chronic kidney disease (CKD), high HbA1c and dyslipidemia among diabetic patients in government primary care clinics.
Materials and Methods: A cross sectional study was carried out. The respondents were selected from diabetic registry at two government primary care clinics in Kuantan, Pahang via stratified random sampling method during the study period from May 2010 to April 2011. The respondents were interviewed and assessed clinically using a structured questionnaire. Retinal examination was performed by accredited staff using non-mydratic retinal imaging and DR was classified according to the International Clinical Diabetic Retinopathy Disease Severity Scale.
Results: Out of 400 respondents, 58.8% were diagnosed with diabetes less than 5 years and 51.0% had uncontrolled blood pressure (>130/80 mmHg). The prevalence of DR and maculopathy were 33.5% and of 17.8% respectively. Most of these patients (22.3%) had mild non-proliferative DR. DR patients had higher percentages CKD (17.9% vs. 6.8%; p<0.001) and a higher mean of HbA1C (8.69 vs. 8.11; p=0.015) compared to non-DR patients. The study revealed that DR was independently associated with CKD {OR: 3.46, 95% CI (1.76, 6.80)} and high HbA1c {OR: 1.12, 95% CI (1.02, 1.23)}. Those with dyslipidemia however, has 39% less risk of DR {OR: 0.61, 95% CI (0.39, 0.94)}.
Conclusion: This study showed that diabetic patients with CKD and high HbA1c have greater risks to develop DR but has protective risk with dyslipidemia.
KEYWORDS: diabetic retinopathy (DR), non-mydratic retinal camera, primary care clinic
MeSH terms: Ambulatory Care Facilities; Blood Pressure; Cross-Sectional Studies; Diabetic Retinopathy; Hemoglobin A, Glycosylated; Humans; Malaysia; Primary Health Care; Surveys and Questionnaires; Registries; Retina; Retinal Diseases; Prevalence; Dyslipidemias; Renal Insufficiency, Chronic
Introduction: Astrocytic gliomas are the most common and lethal intracranial brain tumours and rely on angiogenesis for the tumour development. Endothelial progenitor cells (EPCs) contribute to the angiogenesis of glioma tumour. Objectives: The study aimed to investigate the matured circulating endothelial cells population in the peripheral blood mononuclear cells (PBMCs) and its associations with tissue resident angiogenic cells in astrocytic glioma patients. Methods: A total of 22 astrocytic glioma patients were recruited from Hospital Universiti Sains Malaysia. Tumour were sliced and stained with CD133+ and VEGFA+ for angiogenic cells (n=22). The circulating (CD133-/VEGFR2+) matured endothelial cells in PBMCs (n=22) were quantified using FACS. The paired t-test and Pearson correlation test were used for the data analysis. Results: The angiogenic cells in brain tumour tissue were significantly higher compared to adjacent normal brain tissue (median 1.07±0.96% vs. median 0.69±0.68%; Wilcoxon signed rank test Z=-3.100; p=0.002). Positive correlation was found between the angiogenic cells of brain tumour tissue and adjacent normal brain tissue (Spearman’s rho correlation test, r=0.56; p=0.007). Significant positive correlation was found between matured endothelial cells in peripheral circulating systems and angiogenic cells in tumour of astrocytic glioma patients (Pearson correlation test, r=0.60, p=0.003).Conclusion:The findings of the study give support to the possible roles of EPCs in astrocytic glioma patients. Thus targeting tissue resident angiogenic cells and matured circulating endothelial cells by antiangiogenic treatment might be useful to prevent the tumour growth.
Over the last decade, Malaysia has witnessed a steady rise in obesity rate. The overweight and obese now comprise of half its 30 million population. This figure is broken down into 30 percent in the overweight category and 17.7 percent in the obese category, according to the 2015 National Health and Morbidity Survey.1 This is an increase of four times from what was reported in 1996, at 4.4 percent.2 World Health Organization (WHO) definition of obesity is body mass index (BMI) of 30 or more, calculated as weight in kilograms divided by height in metres squared.3 As the general population get heavier, the average BMI of ICU admissions have also increased. From the International Nutrition Survey (INS) 2014, the average BMI of critically ill patients admitted to Serdang Hospital was 26 kg/m2 higher than the Asian average at 23.6 kg/m2 . 4 Being obese puts the patients at a greater risk of heart disease, hypertension, stroke, diabetes, sleep apnoea, fatty liver disease, osteoarthritis, and many other serious medical conditions.
MeSH terms: Body Weight; Diabetes Mellitus; Heart Diseases; Humans; Hypertension; Intensive Care Units; Liver Diseases; Malaysia; Nutrition Surveys; Obesity; Osteoarthritis; Surveys and Questionnaires; Sleep Apnea Syndromes; World Health Organization; Body Mass Index; Critical Illness; Stroke; Overweight
Sleep disorder including insomnia is one of the complications of general anaesthesia. It is not uncommon and it is temporary but majority remains unnoticed and untreated. The effect of insomnia ranges from mild to severe, influencing both physical and mental health. Surgeon and anaesthetist need to identify this complication so that an appropriate treatment can be delivered. In complicated case, psychiatrist involvement is crucial. The treatment is symptomatic and temporary. We reported a case of distressful sleep disorder as a sequelae of general anaesthesia for mastoidectomy surgery. Subsequently after symptomatic treatment, he recovered completely and regained his normal sleep pattern.
MeSH terms: Anesthesia, General; Sleep Initiation and Maintenance Disorders; Male; Mental Health; Psychiatry; Sleep Wake Disorders; Surgeons; Anesthetists
Catheter-related bloodstream infections caused by Kodamaea ohmeri are generally not considered due to the relative scarcity of reported cases. This is a case of an 85-year-old man with poorly controlled diabetes mellitus who was initially admitted to our hospital for diabetic ketoacidosis. An internal jugular catheter was inserted as part of the initial management. A week later the patient developed a temperature spike and a yeast identified as Kodamaea ohmeri by ID 32 C (bioMérieux, France) was isolated from both his central and peripheral blood cultures. The catheter was removed and the patient was treated with fluconazole despite the organism’s relatively high minimum inhibitory concentration (2 μg/mL) to this antifungal. The fungemia resolved following a 2-weeks course of fluconazole.
Hereditary Hemorrhagic Telangiectasia, also known as Osler-Weber-Rendu Syndrome is an autosomal
dominant disorder causing systemic abnormalities of the vascular structure. There are multiple arteriovenous malformations present in the skin and mucosal surface of the nail beds, nose, gastrointestinal tract, lungs and brain. Epistaxis is the common presentation symptom, which may require multiple hospital admissions and blood transfusions. It is extremely rare disease in our population. We report 4 cases of HHT who presented to us with moderate to severe epistaxis and how we managed these patients.
We report a child with Proboscis Lateralis with nasal aplasia and complete agenesis of maxillary and
ethmoidal sinuses. This is a rare congenital malformation. Embryological basis has not been proven, and it is often associated with facial malformation. However, no such abnormality was noted in our patient. This condition is diagnosed clinically and confirmed radiologically of which CT scan plays a pivotal role. Reconstructive surgery is planned at the age of fifteen years.
The presence of nurses and junior doctors in the ward environment are crucial, especially in detecting
deteriorating patients. However, there is consistent evidence that warning signs may not always be
identified or acted upon. This paper aimed to analyse the incidence of deteriorating patients, and the
concept of risk assessment of these patients by nurses and junior doctors in general ward, through a review
on relevant literature. An extensive literature search was conducted through online research databases, i.e. CINAHL, MEDLINE (Ovid), Science Direct and ProQuest. Professional journals were hand searched for relevant literature based on reference lists and citations made in key publications, and attempts were also made to obtain any relevant grey literature (unpublished materials). A total of eleven papers which focused on patient’s assessment, response to deteriorating patients and knowledge in medication, and a guideline were reviewed. Most of the studies were carried out in the United Kingdom (n=4), followed by Australia (n=2), Sweden (n=2), the Netherlands (n=1) and Taiwan (n=1). Meanwhile, among these studies, the chosen research designs include, qualitative (n=6), quantitative (n=3) and systematic review (n=1). This review concluded that nurses and junior doctors in general ward have a lack of knowledge in risk assessment of deteriorating patients.
Tinnitus is not a disease per se but it is a symptom. It can be either subjective or objective type and the
underlying cause varies such as tumour, infection, vascular abnormality or Meniere’s disease. Foreign body in the external ear is a common presentation especially in children. However, foreign body in the middle ear manifested with only symptom of tinnitus is a rare and unexpected presentation. Foreign body in the middle ear are commonly due to iatrogenic cause such as complication of myringotomy and ventilation tube insertion surgery. There are reported cases of complications of myringotomy and ventilation tube insertion, and they typically presented with the ear infection manifestation, myringosclerosis or permanent perforation of tympanic membrane. Currently, there are only few reported cases in literatures of foreign body in the middle ear following complication of medial migration of ventilation tube into a middle ear with intact tympanic membrane.
We report a 55-year old lady with the presentation of stridor and type II respiratory failure requiring tracheal intubation. She had right Horner’s syndrome associated with pleural effusion. Her chest radiograph revealed right upper zone lobulated opacities and therefore right Pancoast tumor was the initial diagnosis. However, her CECT thorax revealed a huge right subclavian artery pseudoaneurysm with severe tracheal compression. This rare condition imposed a significant diagnostic as well as therapeutic challenge. Vascular surgery is the definitive treatment but it is associated with high risks. The exact role of rigid bronchoscopy for airway stenting is unknown due to limited evidence available. Indeed, this form of central airway obstruction may benefit from temporary tracheal stenting whilst the surgical repair of the lesion is planned. It may facilitate early weaning and allows less complicated airway control.
Cervical vagal schwannoma is an uncommon, benign neoplasm. It is usually asymptomatic and
presents as a painless, palpable mass in the neck. However, large schwannomas can cause dysphagia,
dysphonia or dyspnea as a result of compression. We report a case of an extremely rare complication
of vagal schwannoma in which neck palpation induced the patient to cough. As the patient refused
any surgical intervention, conservative management was used.
Steroid-induced glaucoma is the most serious complication of the injudicious use of steroids,
particularly among children affected by allergic conjunctivitis. This condition is steroid-dependent,
and children are commonly being prescribed topical anti-inflammatories, including topical steroids,
by general practitioners. Furthermore, topical steroids are also available over the counter, and this
availability contributes to overuse without proper monitoring by an ophthalmologist. We present
a series of five cases illustrating the devastating effect of unmonitored, long-term use of steroids
among children for vernal keratoconjunctivitis. The medications were prescribed initially by general
ophthalmologists and were continually bought over the counter by parents. At the presentation to
our center, these patients were already compromised visually, exhibiting glaucomatous optic disc
changes and high intraocular pressure. The series highlights the optic nerve damage resulting in
irreversible visual compromises among children on long-term, topical steroids and the importance
of regular monitoring with a low threshold for ophthalmologist referral.
We report a case of acute gonococcal conjunctivitis in a 36-year-old woman who presented with
eye redness and a history of discharge for one month. Prior to presenting to us, she was treated for
bacterial conjunctivitis with three courses of local antibiotics by three different clinics after brief
assessments and without improvement. The final diagnosis of gonococcal conjunctivitis was made
after a complete history was elicited and supported by the presence of Neisseria Gonorrhoeae in
the eye swab culture test. She and her sexual partner were treated successfully with intramuscular
Ceftriaxone and oral Azithromycin. This case highlights the importance of complete history taking,
including sexual history, which translates into early recognition and treatment, thus preventing
complications. (Copied from article).
MeSH terms: Adult; Anti-Bacterial Agents; Ceftriaxone; Conjunctivitis; Conjunctivitis, Bacterial; Female; Gonorrhea; Humans; Infant, Newborn; Medical History Taking; Neisseria gonorrhoeae; Ophthalmia Neonatorum; Sexual Partners; Azithromycin
A 7-year-old boy presented with both of his thumbs flexed (Figure 1), the inability to perform the
‘thumbs-up’ gesture, and difficulties in opposing thumbs and fingers in activities such as holding a
pencil during writing, pincer movements, and picking up small objects. His mother only observed
the deformity for one month after the boy complained of difficulty in writing during class. He
had no prior history of trauma to the thumbs or pain and swelling in other joints. There were no
other birth anomalies noticed by his parents. Upon examination, the boy had flexion deformities
of the interphalangeal joint (IPJ) on both of the thumbs. Passive range of motion of the IPJ was
not possible and both were fixed at 60° of flexion. Power of both thumbs could not be assessed as
there was no motion of the joint. The range of motion of the metacarpophalengeal joints (MCPJ)
of both thumbs and all other finger joints was normal. A 0.5cm x 0.5cm subcutaneous nodule was
palpable at the volar crease of the MCPJ bilaterally. The nodule was tender on palpation; however,
no overlying skin changes were evident. (Copied from article).
Purple urine bag syndrome (PUBs) is a rare and startling phenomenon of purple discolouration
in the urine or urinary catheter and bag. It is reported in chronically debilitated elderly patients,
mostly in women on long-term urinary catheters. Its prevalence is strikingly more common in
nursing home residents. Several factors contribute to the formation of indigo (blue) and indirubin
(red) pigments from a breakdown of dietary tryptophan, which stains the urine purple. These
factors include constipation, dysmotility of the bowel, bowel bacterial overgrowth, dehydration, and
urinary tract infection. The presence of purple urine may cause undue alarm to both the patient and
the doctor. Thus, we present this case report on an 86-year-old woman, a nursing home resident
on a long-term urinary catheter, who presented to the primary care clinic. Her urine cleared
after antibiotic therapy, replacement of her urinary catheter, and supportive management, which
included hydration and nutrition. In addition to these measures, reducing the time between urinary
catheter changes was recommended to prevent recurrence of this condition.
Foreign body aspiration is commonly described in infants and children. However, recently, a new
high-risk group was identified among young women, especially those from the Muslim population
who wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between the
lips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing the
scarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present a
case of scarf pin inhalation and the challenges encountered in managing this patient during the
successful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particular
case was technically challenging for us as the sharp tip of the needle was pointing upward and
piercing the bronchial mucosa.
Kimura disease presents as benign lesion and is commonly present among the Asian population. It
is a disease with a favourable prognosis and a peak age of onset in the third decade. It is a chronic
inflammatory disorder of unknown etiology that involves the lymph nodes and subcutaneous
tissues of the head and neck region. We report a case of a 15-year-old boy with multiple Kimura
lymphadenopathies involving the left posterior auricular region as well as the anterior and posterior
triangles of the neck.
Cardiovascular symptoms presenting in a patient with dengue fever may post a diagnostic
dilemma. We describe a case of dengue myocarditis mimicking an acute myocardial infarction in a
56-year-old woman.