The most common cause of the chronic liver disease is non-alcoholic fatty liver disease (NAFLD). This study was designed to compare a mean subcutaneous tissue thickness (SCTT) and hepatic echo-intensity attenuation rate (HEIAR) among NAFLD grades. Sonography was carried out on 628 consecutive subjects. The distance between the skin surface and the liver capsule was measured and was labelled the SCTT. Also, the ultrasound of HEIAR was retrospectively quantified on an image archiving. HEIAR was calculated as the difference between mean intensity of echo for two regions of interest (ROIs) in near- and far-fields divided by the distance between these two ROIs multiply by frequency of the probe. Of the 628, 235 subjects were diagnosed with NAFLD. The age range was 45 – 75 years with mean 54.5 ± 6.7 years. There was a significant difference of mean SCTT among NAFLD grades (p
Post-operative complications are well known to impair the functional outcomes of total knee arthroplasty (TKA). Patella subluxations post-TKA is a grim complication rendering patients disable post-surgery. Howbeit, medial patella subluxation is a rarely recorded incident altogether. This case report describes a patient post successful TKA two years ago, who was incidentally diagnosed with a medial patellofemoral subluxation during a recent routine yearly follow up. This gentleman, however, had no complaints and the only evident clinical sign was anterior knee skin puckering. A radiograph of the knee confirmed our clinical suspicion of medial patella subluxation. The patient’s symptoms, his expectations, radiological findings, what went wrong during surgery and management of this rare entity were analysed. This rarely reported entity requires a high degree of suspicion especially if the patient complains of instability and peculiar anterior knee pain. Diagnosis is customarily clinical and revision surgery is almost invariably necessary.
Trauma is a major health problem in Malaysia. An understanding of the trauma epidemiology is important in developing a reliable trauma service. The aim of this study is to understand the pattern of trauma in our institution and to highlight the need for a dedicated trauma service. In this database, 142 cases were included. Majority were males (127, 89.4%). Most common injury types are motor vehicle accidents (87.3%) followed by falls (7.7%) and stabs (3.5%). Most Injury Severity Score (ISS) falls under moderate score with 38.7%. Mean Abbreviated Injury Score (AIS) was 3 with most involving the chest and 90% of the patients have injuries involving at least 2 regions. Average hospital length of stay (LOS) was 11.4 days ±11.5 SD; with most patients (71.8%) were discharged without permanent disability. The mortality rate was 9.2% with all having ISS>16. ISS found to be strongly related to longer hospital stay and worse outcome (0.59, p < 0.0001, 0.4, p < 0.0001). This data is equivalent to the compared registries from 4 different trauma centres. However, steps need to be taken to improve this database. In conclusion, this university hospital receives a reasonable load of trauma cases yearly which is equivalent with other trauma centres. The increasing trauma cases will benefit from an implementation of a dedicated trauma service. This trauma database needs more depth in its elements and better data handling to ensure a quality and complete registry.
Complete or partial restriction of the vocal cords usually occurs due to cancer, neurologic causes or mechanical causes like huge neck mass, trauma to the neck, viral infection, and sometimes iatrogenic during surgery. Bilateral vocal cord palsy is a severe condition that can lead to significant problems in breathing, speaking, and swallowing. If any patient presents with stridor, it requires urgent surgical airway management followed by specific treatment. A case of viral bilateral abductor vocal cord palsy in a 41-year-old female is reported here. The patient presented with stridor, and immediate tracheostomy was done. The stridor developed first 3 months earlier followed by cold and fever for a week. The stridor worsened gradually and leads to a state of commencing immediate tracheostomy. There was no history of trauma to the neck or any neck surgery. All basic laboratory blood test was within the normal limit. The laryngoscopic examination showed both vocal cords were immobile and almost median position with a small gap at the posterior commissure. Chest and neck plain X-ray along with computed tomography scan of neck was normal which ruled out the other causes of bilateral vocal cord palsy. The patient subsequently underwent successful left posterior cordectomy by laser, and decannulation of tracheostomy was done, known as Kashima operation.
Synovial Sarcoma is a rare malignancy. It presents in adolescents and young adults. It occurs in soft tissue
of extremities usually near to the large joints, heart, lung, mediastinum, head and neck. A 23-year-old
female presented with a big hard fixed swelling in right supraclavicular region for 15 years. X-Ray chest
posterior-anterior view presented Homogenous opacity in upper lobe of right lung. USG of neck showed
large heterogeneous lobulated almost avascular solid mass in right side of root of neck and anterior upper
mediastinum may be associated with Schwannoma/ paraganglioma/soft tissue sarcoma. Spindle cell
lesion was reported by FNAC. MRI showed large slightly lobulated mass along right side of root of neck
and right side of superior mediastinum. A large soft tissue density mass along right side of neck and
superior mediastinum was found in CT scan. Surgical excision was done successfully. Histopathological
examination revealed spindle cell tumor favoring synovial sarcoma in the neck tissue and metastatic
spindle cell tumor in the lung lesion.
Swallowing involves 55 muscles, five cranial nerves and two cervical nerve roots. When the coordination of this reflex is disturbed, dysphagia occurs. Dysphagia refers either to the difficulty someone may have with the initial phases of a swallow or to the sensation that the foods or the liquids are being obstructed in their passage from the mouth to the stomach. The objective of the study was to identify the diagnosis of patients attending Speech Therapy clinic, in Queen Elizabeth Hospital, Kota Kinabalu, Sabah, and to identify the demography of dysphagic patients. From the 406 patients that came during the study period, 139 patients (34.2%) were diagnosed with dysphagia, followed by developmental language disorders (33.3%). Of the 139 patients diagnosed with dysphagia, most of them are within the 41 to 60 (43.2%) and above 60 (42.2%) age groups. The majority were males (66.2%). A total of 81 (58.3%) patients with dysphagia had a history of cerebrovascular accident. Dysphagia is a common disorder among patients attending Speech Therapy Clinics at Queen Elizabeth Hospital, Kota Kinabalu. Training of Speech Therapists and early dysphagia intervention leads to a better outcome.
Lung cancer is by far the most lethal cancer, causing approximately 1.4 million deaths in 2008. Meanwhile, tuberculosis (TB) presents a global threat. Various research and studies had been reported in correlation of pulmonary tuberculosis and lung carcinoma. These cause diagnostic challenges from the multi-faceted presentations and lesions in radiograph mimicking each other.
Oxidative stress is an imbalance in redox coupling
in the body. Lack of antioxidants to scavenge the
reactive oxygen species produces adverse effects
on health. The causes for an imbalance in redox
coupling are multi-factorial. Though, reactive
oxygen species are beneficial in the body, excessive
generation and lack of proper scavenging may
pose a threat. Both internal and external factors
may elevate the level. Environmental pollution is
a major contributor. Man-made chemicals such as
pesticides, heavy metals, and carbon combustion
products are blamed. Chronic exposures lead to
disease processes through oxidative stress. They
mediate pro-inflammatory cytokines and produce
free radicals. Pro-oxidant to antioxidant mismatch
leads to the adverse effects. Nrf2 activates a number
of genes that encode the antioxidants. Glutamate
cysteine ligase is activated in response to Nrf2
and it is a key enzyme for GSH production. Nrf2
functionality protects the cells from environmental
pollutants. Nrf2 mediates the antioxidant response
due to chemical insults, translocated in the cell
nucleus. Oxidative stress is known to induce a
number of diseases such as genetic abnormalities,
carcinogenesis, cardiovascular and respiratory
diseases, neuro-degeneration - Parkinson’s and
Alzheimer’s diseases. Pesticides are the major
pollutants. Studies confirm oxidative stress and
environmental pollution need to be addressed for
public welfare.
Alcohol consumption has consequences for the health and quality of life of individuals and communities. It is a problem among some of the Indigenous groups of Sabah and Sarawak with some of the highest prevalence of risky drinking in Malaysia. Alcohol is considered to be part of the culture of some of these Indigenous groups and a way to maintain the connection to their culture and traditions. However, drinking too much on a single occasion and drinking regularly over time is not a part of the culture. Therefore, this study aimed to investigate the positive and negative effects of alcohol on quality of life (QoL) of an Indigenous community of Sabah. A total of 56 villagers from the West Coast Division of Sabah were interviewed in focus group discussions using the diamond dialogue tool. Data were analysed using thematic analysis and revealed that alcohol consumption has both beneficial and adverse effects on health, behavioural, social, economic and psychological factors, depending on the drinking patterns. These harmful results suggest that awareness and harm-reduction programmes may help to empower the Indigenous groups of Sabah to reduce alcohol-related harm
Escherichia coli (E. coli) is one of the most frequent causes of many bacterial infections especially
gastroenteritis in developing countries. It is also used as an indicator for faecal pollution in the
surveillance of bacteriological quality of drinking water. This study was conducted to determine the
survival of E. coli in water at room temperature (27oC). E. coli which is cultured in Lactose Peptone Broth
was inoculated into 8 bottles each containing 10 millilitres of distilled water. They were kept at 27oC.
Starting from the day 1, ten-fold dilutions were made from each bottle number and E. coli count was
done from each dilutions by using pour plate method. The colony forming unit/ millilitre (CFU/ml) was
calculated. The same procedure was carried out from bottles number 2 to 8 from day 2 to day 8
consecutively. CFU/ml of E. coli in dilution 10-5was markedly decreased from 3.9 x 106
in day 1to 0 in
day 8. The findings suggest that if the water is contaminated with low number of E. coli, it can be
eliminated by keeping water at room temperature for only few days.
Telomeres are specialized DNA complexes found at the end of all chromosomes. Human, as a member of eukaryotic cells, requires telomeres to maintain the length and the stability of chromosomes. Telomeres lose their non-coding DNA sequence to protect the genetic information on the chromosomes. Shortening of telomeres occurs in most somatic cells after sufficient cell division in a human lifetime. Normal haemopoietic cells or stem cells possess telomerase enzyme to restore telomeres and allow further replication. Telomere dysfunction is the origin of several degenerative disorders and also predispose to cancer. Roles of telomere in carcinogenesis and ageing related disorders are reviewed.
Hepatic involvement in extra-pulmonary tuberculosis (TB) is rare, even in the endemic area. It has a high mortality rate as it can easily be misdiagnosed due to its rarity and non-specific presentations, and the treatment can be challenging for its hepatotoxic side-effect. A 55-year old man who was newly diagnosed with AIDS and pulmonary TB which complicated with anti-TB-induced transaminitis, presented with a few weeks history of fever and persistent diarrhoea. It was initially treated as microsporidia infection but the symptoms persisted despite given antiparasitic agent for more than a week. He was subjected to computed tomography (CT) scan of the abdomen and noted multiple hypoechoic lesion at multiple segments of the liver, which later confirmed to be liver TB by liver biopsy. As he could not tolerate Akurit-4 (Rifampicin 150 mg, Isoniazid 75 mg, Pyrazinamide 400 mg and Ethambutol 275 mg), the second-line treatment was given instead. He is currently well on regular clinic appointment. The objective of this case report is to share the rare occurrence of hepatic TB and the difficulty to treat it as the hepatotoxic effect of anti-TB medications complicate the liver damage due to the infection.
Introduction: Good visual acuity (VA) coupled with the ability to discriminate colours and having a sufficiently wide field of view are factors needed for safe driving. This study aimed to determine the types of colour vision deficiency (CVD) among failed candidates for driving license and to identify the accuracy of the Road transport Department (RTD) screening tests in detecting those who have poor VA and CVD in Sabah.
Methods: A cross-sectional study on the patient’s records of all failed candidates for the driving license that were referred for further assessment by an optometrist. This study was conducted at eight hospitals in Sabah from March to June 2019. Basic demographic data, distance VA, Ishihara test and Farnsworth-Munsell D15 test were collected. Descriptive statistics were used to summarise the results. All subjects referred with best-corrected visual acuity (BCVA) 0.3 LogMAR were included.
Results: A total of 73 subjects (79% males and 21% females), age range from 16 to 61 years (mean 29±13 years) were recruited. Bajau, Dusun, Bugis and Kadazan were the major ethnic among the subjects. Mean VA on attendance was 0.1 ± 0.19 LogMAR, while BCVA was 0.0 ± 0.07 LogMAR. Thirty-six subjects (49%) were found to have CVD. The prevalence of CVD was more in males than females (45% vs 4%). Most of the CVD were deutans (25%) followed by protans (22%), no findings of tritan CVD In this study, 37 subjects (51%) passed the Ishihara test. These were the false-positive error of the RTD screening tests.
Conclusions: Hereditary red-green perceptive disorder was the commonest CVD in Sabah. The severity of CVD was not been evaluated in this study because it is best evaluated using Hardy Rand and Rittler (HRR) test. The false-positive results might be because of technical error or unfamiliar of using computerized colour vision test, especially among elderly candidates. Visual field screening might be considered in the future to ensure safe driving.
Keywords:visual acuity (VA), colour vision deficiency (CVD), driving license
NMRR Research ID: NMRR-19-1785-48811
The CECT scan of the abdomen at axial and coronal views show gas bubbles tracking along the inner wall of the ascending colon and hepatic flexure, which is separated from the intraluminal gas within the bowel. These intramural gas bubbles appear to be outlining the bowel wall circumferentially. The bowel wall appears to be thickened however the inner mucosa is not enhanced. There are no ascites in the images provided. The colon of the hepatic flexure and transverse colon appears dilated. No significant atherosclerotic plaque in the visualised arteries. Based on the clinical presentations and CECT features in Figure 1 and Figure 2, the best diagnosis for him is benign pneumatosis intestinalis (PI) secondary to obstructed low rectal cancer. He was subjected for a trephine transverse colostomy to relieve the obstruction with simultaneous transanal rectal mass biopsy. Once the histology is available, he subsequently will be referred for concurrent chemo-radiotherapy as neoadjuvant treatment and later for a low anterior resection, provided that it is a localized disease.
Osteochondromyxoma is a rare bone tumour. Bone tumours of the talus are also uncommon, and accounts to be between 8% to 23% in tumours of the foot. A 28-year-old man presented with chronic right ankle pain. He had underlying left knee ligament and meniscal injury. Special examination tests for ligament injury were negative. Magnetic Resonance Imaging (MRI) revealed a benign bone lesion of talus with reactive oedema of sinus tarsi. Excision of lesion was done and subsequent histopathological examination confirmed the diagnosis of ostechondromyxoma.
Introduction: Hepatitis C virus (HCV) is a worrying public health issue worldwide. The introduction of direct-acting antiviral agents (DAAs) brings revolution to HCV treatment. Pharmacists’ role in Malaysia is significant since the implementation of Medication Therapy Adherence Clinic (MTAC). This study aims to determine the sustained virological response (SVR12) for HCV patients treated with Sofosbuvir and Daclatasvir and/or Ribavirin. Besides, it evaluates adherence rate, types of pharmaceutical intervention and physicians’ acceptance rate.
Phasic ECG voltage changes or electrical alternans is a well-described ECG changes seen in the pericardial effusion and cardiac tamponade. Popular as once believed, this ECG features are no longer considered pathognomonic for pericardial effusion and cardiac tamponade. Electric alternans is observed in pneumothorax especially left-sided pneumothorax. This is a case of a 41-year-old man who presented with chest pain and breathlessness to the emergency department. Assessment in the emergency unit revealed an obvious distress man with a respiratory rate of 60 breaths/min with cyanosis There were generalised rhonchi and prolonged expiratory breath sound appreciated. Chest X-ray (CXR) was done and diagnosed to have left tension pneumothorax. Initial electrocardiogram (ECG) showed electrical alternans in all leads. He was intubated for respiratory distress followed by chest tube insertion. His initial ECG findings resolved after treatment of the tension pneumothorax. Doctors need to evaluate the cardiac findings along with respiratory findings.
Trigeminal schwannoma is a rare cause of
cerebellopontine angle tumour. This case report
of a 65-year-old lady presented with ipsilateral
facial numbness and instability. She was finally
diagnosed to have trigeminal schwannoma after
seeking multiple medical consultations with her
doctors. This case report highlights a rare cause
of cerebellopontine angle tumour.
Myasthenia gravis, the most common autoimmune
neuromuscular disorder, is characterised by
muscle weakness and fatigability. A 23-yearold-lady
with background history of breathing
and swallowing difficulty for six months was
presented with respiratory distress to the hospital
which is without an in-house neurology service.
Her diagnosis remained a challenge as patient
presented as an emergency without detailed
medical history. She was subjected to bedside ice
pack testing and subsequently managed along the
diagnosis of myasthenia crisis. She responded to
the treatment and survived the critical period. So,
diagnosis of myasthenia gravis by ice pack test
and managing a case of myasthenic crisis would
be possible in limited heath care setting.