Data on lung cancer survival are lacking in developing countries. Our objectives were to describe the survival of our lung cancer patients and to determine independent prognostic factors affecting survival.
Monitoring treatment response to anti-tuberculous therapy remains unsatisfactory in resource-limited countries where sophisticated and expensive tests are not readily available. Sputum culture for mycobacterium is desirable, but not obtainable in many developing countries. Sputum acid-fast bacilli (AFB) smear alone can be misinterpreted in the presence of unviable bacilli or non-tuberculous mycobacteria. Hence the search for a cheaper but reliable monitoring tool, or a combination of several tools, continues. Interesting reports from studies in third world nations have considered weight gain/loss as one such monitoring tool. Since pulmonary tuberculosis is endemic in this country, we take the opportunity to evaluate weight gain and chest radiograph, compared to sputum AFB smear in monitoring patient's response.
Selective Alzheimer Disease Indicator-1 (or Seladin-1) is a multifunctional protein first discovered by downregulation of its expression in Alzheimer's disease. Interestingly, the expression of this protein is upregulated in several cancers, including primary bladder cancer. However, its role in cancer formation has yet to be discovered. Goniothalamin is a natural product that has been demonstrated to induce apoptosis in various cancer cell lines. In this study, we have elucidated the role of Seladin-1 in goniothalamin-induced cytotoxicity towards human urinary bladder cancer cell line RT4.
Fasting during the month of Ramadan is one of the five pillars of Islam, a recurring annual ritual, which is passionately practiced by most Muslims across the world. It is obligatory on every healthy Muslim; however, the Qur’an and Islamic teachings specifically exempt people with acute or chronic illnesses from this duty, especially if it might have harmful consequences. Muslims with diabetes are exempted from fasting, but many of them still fast during Ramadan, for their personal convictions as revealed by EPIDIAR study which showed that 43% of patients with type 1 diabetes and 79% with type 2 diabetes fasted during Ramadan. Muslims constitute about a quarter of the world’s population who are spread all over the globe. It is inevitable that health care issues peculiar to them will be encountered worldwide and health care providers will have to counsel them regarding medications and whether it is safe to undertake the fast. This paper is an update on the management of Ramadan fasting based on current evidence from published literature and expert opinions.
Prolonged use of oral corticosteroids is a risk factor for osteoporosis. However, the effect of inhaled corticosteroids (ICS) on bone mineral density (BMD) of asthmatic patients remains controversial.
This study was carried out to determine the prevalence, patient's characteristic and reasons for defaulting follow-up and treatment among patients with lung cancer.
We describe a patient with empyema thoracis that had eroded through the apical chest wall to the supraclavicular fossa and lung parenchyma, ultimately leading to a bronchopleural fistula manifesting as lobulated, localized subcutaneous emphysematous swellings over the chest wall and supraclavicular fossa. This is a rarely reported phenomenon and the reason why the lobulated subcutaneous emphysematous swellings remained localized is unknown.
A 35-year-old multiparous woman was found unresponsive, tachypnoeic, hypoxic and in shock 4 h postpartum. The ECG revealed S1 Q3 T3, a right bundle branch block pattern and right-axis deviation. The computed tomography of her pulmonary arteries revealed bilateral pulmonary artery thrombosis with dilated right ventricle. She was fibrinolyzed with intravenous Tenecteplase 30 mg bolus. Her saturation and tachypnoea improved and her ECG reverted to sinus rhythm subsequently. We discuss our use of off-label Tenecteplase in postpartum pulmonary embolism and review the literature.
Melioidosis is known to cause abscesses in various organs, including the cranium, though less commonly. We present a patient with scalp abscess and subdural empyema that was visible on computed tomography of the brain. The neurosurgical drainage grew Burkholderia pseudomallei. Despite our best effort to treat the patient using parenteral antibiotics and surgical drainage, the patient did not survive.
Klebsiella ozaenae is a Gram negative bacillus. It has been described as a colonizer of oral and nasopharyngeal mucosa and is a cause of atrophic rhinitis. Klebsiella ozaenae has seldom been isolated from serious infections. However, several reports have stated that Klebsiella ozaenae may cause invasive infections and even mortality. We report a 55-year-old man with Klebsiella ozaenae infection causing abscesses involving the right eye and left kidney and possibly also in the brain, lungs and prostate. The isolates were sensitive to ceftazidime, ciprofloxacin, chloramphenicol, gentamicin and sulfamethoxazole-trimethoprim but resistant to ampicillin. He responded well to 4 weeks of i.v. ceftazidime and i.v. amoxycillin-clavulanic acid. To our knowledge, such a multiorgan infection has not been reported previously for this organism.
Optimal patient care varies considerably from place to place and is influenced by scientific as well as social developments. The purpose of this study was to investigate awareness and pertinent issues regarding informed consent among hospitalised patients and to determine lapses, in order to improve the standard of care.
Rhinocerebral mucormycosis is an invasive fungal sinusitis with a high mortality rate, especially in immunocompromised patients. A 70-year-old woman, with uncontrolled type 2 diabetes mellitus, presented with a one-month history of non-specific headaches associated with progressive swelling of her left eye. Computed tomography of the brain and orbits showed the extensive involvement of bilateral intranasal sinuses, orbits, extraocular muscle and soft tissues. The diagnosis of invasive mucormycosis was confirmed from a tissue biopsy taken from the internasal septum. Despite the extensive mucormycosis invasion, she was successfully treated with intranasal and systemic amphotericin B and minimal adjunctive intranasal sphenoidotomy.
The aim of this study was to assess the bone mineral density (BMD) of premenopausal patients with systemic lupus erythematosus (SLE) on corticosteroids (CS) and to determine the influence of CS and other risk factors on BMD. A total of 98 premenopausal patients with SLE were recruited from outpatient clinics in two teaching hospitals. Risk factors for osteoporosis were determined, and BMD was measured using dual-energy x-ray absorptiometry. The mean age of the patients was 30.05 +/- 7.54 years. The mean dose of prednisolone at time of BMD measurement was 18.38 +/- 10.85 mg daily. Median duration of CS use was 2.5 years (range 0-20). Median cumulative dose of CS was 9.04 g (range 0.28-890.0). Six patients (6.1%) had osteoporosis, 41 (41.9%) had osteopenia and 51 (52.0%) had normal BMD. Lumbar spine T score correlated with cumulative CS dose (P = 0.019). Duration of CS intake correlated with femoral neck T score (P = 0.04) and trochanter T score (P = 0.008). There was no correlation between BMD and race, SLE Disease Activity Index score, smoking and self-reported calcium intake or exercise. Only 52% of these patients had normal BMD. The duration and cumulative dose of CS intake was significantly correlated to BMD, but not the other commonly assessed risk factors. These findings suggest that premenopausal patients with SLE on CS should have their BMD measured at regular intervals to fully assess their osteoporosis risk.
Study site: outpatient clinics in two teaching hospitals
Pulmonary cryptococcosis can be clinically silent in non-HIV infected patients but can also present as nodules and masses on the chest radiograph, which can be mistaken for tuberculosis or lung cancer. Common symptoms include fever and cough, and uncommonly haemoptysis. This report illustrates a non-HIV infected patient whose main complaint was haemoptysis and headache. He was diagnosed with pulmonary cryptococcosis from biopsy of an endobronchial mass found on flexible bronchoscopy. Disseminated cryptoccoccal infection should be considered as a differential diagnosis in non-HIV infected patients presenting with haemoptysis and headache. Early recognition and administration of appropriate therapy will improve clinical outcome in these patients.
OBJECTIVE: To assess bone mineral density (BMD) changes in patients with systemic lupus erythematosus (SLE) undergoing longterm therapy with corticosteroids (CS) while taking calcium, calcitriol, or alendronate. The primary endpoint was BMD changes at 2 years.
METHODS: Premenopausal SLE patients were randomized into 3 groups according to medication: calcium carbonate 500 mg bd (calcium alone), calcitriol 0.25 microg bd plus calcium carbonate 500 mg bd (calcitriol + calcium), and alendronate 70 mg/week plus calcium carbonate 500 mg bd (alendronate + calcium). BMD was measured at baseline and at the end of the first and second years.
RESULTS: Ninety-eight patients were recruited. There were 33 patients taking calcium alone, 33 calcitriol + calcium, and 32 alendronate + calcium. On randomization, median duration of CS use was 2.5 years (range 0-20 yrs). Seventy-seven patients (78.6%) completed the study (23 taking calcium alone, 27 calcitriol + calcium, 27 alendronate + calcium). There were no significant differences in mean CS dosages among the 3 groups at the time of BMD measurements. After 2 years, there were no significant changes in BMD in the calcium-alone and calcitriol + calcium groups, apart from a 0.93% (p < 0.001) reduction in total hip BMD in the calcium-alone group. In contrast, the alendronate + calcium group showed significant increases in BMD of 2.69% (p < 0.001) in the lumbar spine and 1.41% (p < 0.001) in total hip.
CONCLUSION: Both calcium alone and calcitriol + calcium preserved lumbar spine BMD in premenopausal patients with SLE taking longterm CS at 2 years, whereas alendronate + calcium led to increases in BMD in lumbar spine and total hip. Premenopausal women taking CS should be considered for osteoporosis prophylaxis.
Study site: Outpatient clinics in 2 teaching hospitals in Kuala Lumpur, Malaysia
Medical thoracoscopy has gain its popularity in Malaysia recently. This paper presents our early experience in thoracoscopy using semi-rigid fiberoptic thoracoscope. All thoracoscopy records since October 2006 were retrieved. The patients' records, thoracocentesis investigations results, thoracoscopic findings and all pleural biopsy results were reviewed. Twenty-four thoracoscopic procedures on 22 patients in whom two patients had repeated thoracoscopy. Ten patients were confirmed carcinoma. Eight patients had inconclusive thoracoscopic pleural biopsy results. Three patients underwent pleurodesis for malignant effusion. One patient had adhesiolysis for empyema. There was no procedure-related deaths or intraoperative accidents. Thoracoscopy is a relatively safe procedure.
Tuberculosis (TB) affects one-third of the world's population. Anti-TB drugs with isoniazid, rifampicin and pyrazinamide are very effective but they can cause hepatotoxicity. Many risk factors have been recognised. Data on prevalence of anti-TB drug-induced hepatitis as well as the contributing risk factors are scarce in Malaysia. This observational case control study was designed to look at the prevalence and the risk factors of drug-induced hepatitis in our population.
In Malaysia, transbronchial needle aspiration (TBNA) is a relatively new procedure performed only in a handful of respiratory centres. We reviewed TBNA of mediastinal lymph node performed in Hospital Tengku Ampuan Afzan (HTAA) to determine the yield and its complications. Data was retrieved from endoscopy databases and patients' records, CT thorax images and all cytological and histological slides were reviewed. Twenty-five patients had TBNA performed. TBNA was positive in 15 patients (60%). Overall, 80% had confirmed malignancy after bronchoscopy. Only four patients had documented bleeding after TBNA and in two of them, bleeding stopped spontaneously and another two patients required diluted adrenaline to stop the bleed. No mortality was reported from this procedure. Hence, TBNA is a safe procedure.
Informed consent is now accepted as the cornerstone of medical practice, with reasonable patient standards typically considered to be appropriate in the developed countries; however it is still challenged in many developing countries. The objective of this descriptive study was to evaluate the perceptions and practices among attending medical professionals in matters relating to informed consent in selected hospitals.
This paper will study and evaluate watermarking technique by Zain and Fauzi [1]. Recommendations will then be made to enhance the technique especially in the aspect of recovery or reconstruction rate for medical images. A proposal will also be made for a better distribution of watermark to minimize the distortion of the Region of Interest (ROI). The final proposal will enhance AW-TDR in three aspects; firstly the image quality in the ROI will be improved as the maximum change is only 2 bits in every 4 pixels, or embedding rate of 0.5 bits/pixel. Secondly the recovery rate will also be better since the recovery bits are located outside the region of interest. The disadvantage in this is that, only manipulation done in the ROI will be detected. Thirdly the quality of the reconstructed image will be enhanced since the average of 2 x 2 pixels would be used to reconstruct the tampered image.