Low vision and blindness are major health issues affecting ageing population. This cross-sectional study aims to determine the prevalence of visual impairment (VI) in Petaling Jaya North, Petaling Jaya South, and Lembah Pantai using data from the Malaysian Elders Longitudinal Research. There were 1322 participants aged ≥55 years selected by random sampling from parliamentary electoral rolls. Visual acuity was assessed using the logarithm of the minimum angle of resolution chart at 4 m distance. The overall population-adjusted prevalence of VI was 9.0%. The estimated prevalence of VI was highest in Malays followed by Indians and Chinese. Following adjustments for ethnic discrepancies in age, marital status, education level, gender and medical illness, the Malay ethnicity remained an independent association for VI. Education level was associated with Indian ethnicity. In conclusion, the Malay ethnicity and lower education level among Indian ethnicity were found to be associated with VI among the older population in Malaysia. The Malay ethnicity showed the highest prevalence of VI followed by Indians and Chinese.
Psychogenic polydipsia is prevalent among people with schizophrenia. Although its pathophysiology is relatively unknown, it causes life threatening complications due to acute or severe hyponatraemia.. This report illustrates a patient with schizophrenia who had unrecognized psychogenic polydipsia and developed severe complication. It also highlights the clinical salience of its management.
MeSH terms: Humans; Hyponatremia; Schizophrenia; Water Intoxication; Causality; Polydipsia, Psychogenic
Penetrating injury to the abdominal viscera is not uncommon unless when it is caused by marine life. We present a 39-year-old fisherman from a tropical country who had sustained a penetrating injury from a stab wound to the abdomen due to needlefish impalement. He sustained a small perforation of the sigmoid colon during exploratory laparotomy and primary repair was done. Although this incident is rare, there are cases involving seawater activities either for leisure, sport or diving for fishing. We highlight this rare incident and discuss the management plan.
Scimitar syndrome is a rare congenital heart defect occurring in 1 to 3 per 100,000 live births. This is a case of a 26 years old lady presenting with episodic fainting spells since the age of 18 years old. She was initially diagnosed with epilepsy until a referral to our centre found a soft splitting of the second heart sound and multiple premature ventricular complexes on ECG. The computed tomography of the pulmonary artery confirmed the diagnosis if Scim- itar syndrome in the presence of anomalous single right pulmonary vein draining into infra-diaphragmatic systemic venous circulation. A corrective open-heart surgery to re-implant the pulmonary vein was performed with excellent clinical outcomes. Therefore, it is crucial for clinicians to embody high index of suspicion of congenital anomaly even in adults presenting with indefinite clinical symptoms. This report also represents the first published case of adult Scimitar syndrome from Malaysia.
A 2-year-old girl who was under genetic follow up for developmental delay and dysmorphism was accidentally found to have bilateral optic disc swelling during screening examination. She showed response to optokinetic drum examination and the anterior segment examination was unremarkable. Optic disc swellings were seen in both eyes. Lumbar puncture shows high opening pressure of 50 cm H2O with unremarkable CSF analysis. MRI of brain was done and showed features in keeping with mild cerebral atrophy, with no evidence of hydrocephalus or space oc- cupying lesion. She was diagnosed with idiopathic intracranial hypertension and oral acetazolamide 125mg bd was commenced. However, papilloedema persist despite medical therapy. Ventriculoperitonel shunt was inserted to re- duce the csf pressure. This case report highlights the importance of considering idiopathic intracranial hypertension as a cause of optic disc swelling in pre-pubertal children because delay in diagnosis and treatment may permanently affect visual function especially in children.
A 42-year-old gentleman presented with left eye pain after accidental contact with Euphorbia lactea sap while gar- dening. At presentation, left eye best-corrected visual acuity (BCVA) was 20/30. Ocular examination revealed left eye conjunctiva congestion and cornea abrasion. Eye symptoms and BCVA deteriorated over 12 hours. Cornea showed diffuse stromal oedema with presence of anterior uveitis. A diagnosis of toxic keratouveitis was made. He was treat- ed with intensive topical steroids, cycloplegics, lubricants, prophylactic antibiotics and oral non-steroidal anti-in- flammatory analgesic. Patient achieved complete resolution two weeks later. We aim to raise awareness among the ophthalmologists to detect and manage these injuries.
A 64-year-old Malay gentleman alleged occupational injury when a malfunctioned metal hydraulic door hit on his face while unloading sand from his tipper-truck. Post-trauma, he complained of right eye (RE) pain and total loss of vision. On examination, noted RE visual acuity was unable to be assessed and left eye (LE) was 6/24 with pinhole 6/9. No eyeball could be seen in the right socket with superior orbital rim step deformity and left periorbital haema- toma. Computed tomography scan of the brain and orbit confirmed displaced right eye globe into the right anterior cranial fossa with right and left multiple orbital wall fractures. He then underwent successful right eye globe reposi- tioning. Traumatic orbital roof fracture is a rare condition. Repositioning of the eye globe was done to salvage the eye globe for a cosmetic reason and to avoid localised inflammatory reaction at the anterior cranial fossa.
MeSH terms: Brain; Eye; Humans; Malaysia; Male; Middle Aged; Orbit; Orbital Diseases; Orbital Fractures; Pain; Tomography; Visual Acuity; Ocular Motility Disorders; Motor Vehicles; Cranial Fossa, Anterior; Drug Repositioning; Occupational Injuries
Iatrogenic diaphragmatic entry following thoracic surgery is rare with only two cases reported till date. This case reports on a 46-year-old male with persistent pleural sepsis due to right empyema thoracis despite best medical ef- forts. Following a right thoracotomy and decortication, the right diaphragm was inadvertently incised due to dense adhesions between the diaphragm and thickened cortex. To our knowledge, this is the third case reported of iatro- genic diaphragmatic entry following thoracic surgery for empyema thoracis. The pearls from this case report is that any evidence of empyema thoracis involving the lower lobe on imaging should warn the surgeons to be aware of inadvertent entry into the peritoneal cavity, as the diaphragm can be adherent to the cortex trapping the lower lobe.
Fat density lesions or masses arising from the mesentery are best imaged in Computed Tomography or Magnetic Res- onance Imaging scans. This a case of a 75 year old man who presented with intestinal obstructive symptoms. Urgent computed tomography scan was carried out which revealed a large mesenteric lipoma compressing the small bowel at the level of the jejunal loops. Small bowel obstruction can be due to intrinsic, extrinsic and intraluminal causes. Mesenteric lipomas are uncommon, thus torsion or twisting of the mesenteric lipoma causing intestinal obstruction is exceptionally rare.
Intramedullary nailing is the preferred method of closed shaft fracture fixation of long bones. One of the most dread- ed complications to occur following internal fixation of a lower limb fracture is pseudo- or false aneurysm which can lead to the loss of the limb due to acute ischemia. This diagnosis is made by contrast angiogram of the limb. Pointers to the diagnosis include absent distal limb pulsation as well as other signs of acute ischemia post trauma or surgery. We present a case of development of pseudo-aneurysm in an elderly patient following open reduction and internal fixation of a femoral fracture. This case report outlines a prompt multidisciplinary approach of management in a rare case of pseudoaneurysm post fixation of long bone.
Herein is a case report of a 70 years old man with a tenacious benign prostatic hyperplasia (BPH). The aim of this manuscript is to briefly discuss the usage and advantage of EmbozeneTM Microsphere in embolization of the pros- tate arteries in the treatment of failed medical and surgical therapy for BPH.
Combined latissimus dorsi transfer, subscapularis repair and Latarjet surgery is rare and has never been reported. A 35-year-old man with chronic shoulder pain had a long history of instability of his right shoulder. The first episode occurred during a game of touch rugby followed by multiple episodes of subluxation. MRI was done which showed complete tear of the subscapularis anteriorly which was retracted and atrophied indicating a longstanding tear. There was also significant mid substance supraspinatus tendon tear. Patient then underwent two surgeries. The initial sur- gery found the rotator cuff to be irreparable with glenoid bone loss and only acromioplasty with acromioclavicular joint resection were performed. He then had a single stage surgery consisting of latissimus dorsi transfer, Latarjet procedure and subscapularis repair. A two-stage surgery can be avoided, and good results can be obtained provided that the patient undergo correct rehabilitation regime after undergoing a single stage surgery.
Gene manipulation tools have transformed biomedical research and improved the possibilities of their uses for therapeutic purposes. These tools have aided effective genomic modification in many organisms and have been successfully applied in biomedical engineering, biotechnology and biomedicine. They also shown a potential for therapeutic applications to alleviate genetic and non-genetic diseases. Small interfering RNA (siRNA) and clustered regularly inter-spaced short-palindromic repeat/associated-protein system (CRISPR/Cas) are two of the tools applied in genetic manipulation. This review aims to evaluate the molecular influence of siRNA and CRISPR/Cas as novel tools for genetic manipulations. This review discusses the molecular mechanism of siRNA and CRISPR/Cas, and the advantages and disadvantages of siRNA and CRISPR/Cas. This review also presents comparison between siRNA and CRISPR/Cas as potential tools for gene therapy. siRNA therapeutic applications occur through protein knockout with- out causing damage to cells. siRNA knocks down gene expression at the mRNA level, whereas CRISPR/Cas knocks out gene permanently at the DNA level. Inconclusion, gene manipulation tools have potential for applications that improve therapeutic strategies and plant-derived products, but ethical standards must be established before the clin- ical application of gene editing.
The purpose of this study was to integrate the available data published to date on susuk or charm needles into a com- prehensive analysis of their clinical/radiological features. An electronic search was undertaken in September 2019. Eligibility criteria included publications having enough clinical and radiological to confirm a definite diagnosis. The initial literature search resulted in 48 publications. Ten publications were excluded for duplicates, and another 17 excluded after a screening of the abstract. Besides, the screening of the abstract shows that five publications were not meeting the inclusion criteria, resulting in a total of 14 publications of susuk that were included in the systematic review. Bias analysis was conducted according to Oxford Center for Evidence-Based Medicine. The resulting total of 78 cases from the selected publications were analysed, showing a wide age range with different distribution among gender and ethnicity. Three cases reported in the literature having symptoms related to susuk. Susuk can be seen as an incidental finding during a routine radiographic assessment, and clinicians should be able to differentiate it from other radiopaque foreign bodies. The practice is not limited to South East Asian population and can be seen in wide racial profiles.
MeSH terms: Electronics; Ethnic Groups; Foreign Bodies; Humans; Mass Screening; Needles; Radiography; Radiology; Evidence-Based Medicine; Continental Population Groups
Treatment effectiveness depends on the knowledge, attitude, and practice (KAP) of osteoarthritis (OA) patients to- wards their assigned treatment. This study aimed to explore the KAP towards non-surgical intervention among OA patients. A methodological framework proposed by Arksey and O’Malley (2005) was implemented. An electronic database search of English-language academic articles was conducted using PubMed and ScienceDirect databases encompassing 1998 to 2018 period of time, resulting in a total of 26 studies. OA patients were knowledgeable about the disease and exercise management. However, they were lack of knowledge on drug therapy and complementary strategies. The attitude towards non-surgical interventions was ambivalence. Lastly, the practice section mainly fo- cused on patients’ compliance and behaviour towards different conservative managements, namely physiotherapy, medications, and complementary and alternative medicines (CAMs) which influenced by both knowledge level and attitudes. In conclusion, a higher knowledge level and positive attitude will result in good practice.
Presently, there is no specific federal legislation governing articular cartilage tissue engineering (ACTE) experimenta- tion practices in Malaysia. However, there are related regulations and guidelines provided by government agencies to oversee and guide such practices. The rules and regulations provided in the documents have the essential aim of safeguarding public health through ensuring that non-clinical studies reach a certain quality, efficient and safe for hu- man use. There are themes identified when scrutinising relevant documents which includes, the need for authorised personnel and the establishment of facilities in conducting such experiments, the aspect of cell-scaffold construct development, the use of human materials, the aspect of biosafety, animal care and use during the experiments, and considerations on the impact on the environment. The individual laboratory or facility shall adopt and adapt these standards as deemed appropriate by the ACTE researchers to ensure that non-clinical studies are conducted in a proper and ethical manner.
MeSH terms: Animals; Animal Husbandry; Cartilage, Articular; Containment of Biohazards; Government; Government Agencies; Humans; Laboratories; Malaysia; Public Health; Reference Standards; Tissue Engineering
Most orthopaedic cases that involved with bone fracture are normally treated with medical implants. To be noticed that some precautions in terms of biomechanical and biomaterial properties are necessary for a successful post-sur- gery process. The biomechanical evaluation of implants could be carried out using computing and engineering technologies. However, in the computer simulation, some assumptions are needed as the limitations on computer resources and data input. This review focuses on the current method of developing the finite element model for patients with specific values of material properties for lower limb part such as hip, knee and ankle joint. Previous literature was reviewed from which keywords and search engines were identified. In this review, inclusion and exclusion criteria were used to limit the literature search. We reviewed the state-of-the-art in this area and provide recommendations for future research. In conclusion, the previous published reports illustrated different methods to develop numerical models.
Introduction: Hypertension is a public health concern that is associated with heart disease. This study aims to investigate the prevalence of undiagnosed hypertension and its associated factors among the staff in a private uni- versity in Selangor, Malaysia. Methods: 100 respondents participated in this cross-sectional study. Blood pressure, Body Mass Index (BMI), percentage body fat (%BF), visceral fat rating (VFR), and waist circumference (WC) were measured. Questionnaires regarding knowledge, attitude, and practice (KAP) of salt diet validated from WHO/PAHO and Food Frequency Questionnaires regarding sodium intake validated from IPH Malaysia were administered. Sta- tistical data was analysed using SPSS. Results: The prevalence of undiagnosed hypertension was 24%. About 66% of the participants had excessive sodium intake. The mean sodium intake was 2869.43±930.75mg/d. Simple linear regression showed that BMI. %BF, VFR, and WC were significantly correlated with systolic blood pressure (SBP). Age and sodium intake were not correlated with SBP. After controlling all the variables in multiple linear regression, VFR remained as a significant contributor to SBP (adjusted R2=0.419, F=18.833, p=2400mg/d). Conclusion: Our study found a high prevalence of undiagnosed hypertension among the private university staff. The association between VFR and SBP is an important finding for community study. Increased awareness on the excessive salt consumed and its association with health is needed to reduce the sodium intake.
MeSH terms: Blood Pressure; Blood Pressure Determination; Cross-Sectional Studies; Diet; Heart Diseases; Humans; Hypertension; Malaysia; Pan American Health Organization; Public Health; Surveys and Questionnaires; Universities; Body Mass Index; Prevalence; Linear Models; Sodium Chloride, Dietary; Intra-Abdominal Fat; Waist Circumference
Introduction: Rac1 and STIM1 genes are emerging therapeutic targets for cancers. However, their roles in acute my- eloid leukaemia (AML) are not well understood. The goal of this study was to evaluate the effects of dose and time on Rac1 and STIM1 knockdown in the AML cell line model (THP-1 cells). Methods: THP-1 cells were transfected with siRac1 at doses of 50, 100, and 200 nM or dsiSTIM1 at doses of 2, 5, and 10 nM. Expression level of Rac1 and STIM1 then were assessed at time points between 12 and 72 h post-transfection using real-time reverse transcription poly- merase chain reaction. Results: Compared to the control, 87% Rac1 knockdown was attained with 50 nM siRac1 at 24 h post-transfection, and 70% STIM1 knockdown was achieved with 10 nM dsiSTIM1 at 48 h post-transfection. Conclusion: These results show that effective knockdown of Rac1 and STIM1 is possible, and therapy that includes Rac1 and STIM1 inhibitors eventually could provide a new and highly effective strategy for AML treatment.
Introduction: A parallel design randomized clinical trial was conducted to compare dentoalveolar and skeletal changes in two groups of patients who had completed twin block therapy; one group had a three-month night-time retention period whereas the other group had no retention period, after twin block therapy but before fixed applianc- es. Methods: 26 participants of Malay ethnicity aged 10 to 15 years were included in the trial and had an overjet of 5mm or greater, molar relationship greater than half cusp Class II on a skeletal Class II base which had been corrected to a Class I molar relationship following twin block therapy. Following randomization, the 26 were divided into two groups of 13. Group A had fixed appliances bonded immediately whereas group B continued wearing twin block at night for three months, after which fixed appliances were bonded. Lateral cephalograms assessed were those taken before randomization, upon twin block therapy completion (T1) and six months after bond-up of fixed appliances (T2). Results: Paired t-test showed several statistically significant dentoalveolar and skeletal changes in group A. In contrast, only condylar head position exhibited a statistically significant change in group B. Despite a statistical sig- nificance, changes measured in both groups were minimal at less than 2mm and therefore clinically insignificant. Independent t-test showed no statistically significant difference between the changes recorded in both groups. Con- clusion: The results suggest that a three-month night-time retention period after twin block therapy does not lead to any changes that may be considered clinically beneficial.