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.
Emergence of multidrug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB) is one of the reasons why tuberculosis (TB) continues to cause great mortality and morbidity in less-developed countries. The development of rapid diagnostic methods targeting genetic mutations associated with resistance to the anti-tuberculous drugs is essential to fight this deadly pathogen. Isoniazid (INH) has been included in the multidrug regimens for the treatment of drug-susceptible TB for the decades. In the worldwide setting, isoniazid resistance was highly prevalent and was observed in one of every seven TB cases. Since katG315 mutation is highly prevalent, the common mutation in the enzyme essential for the activation of the INH concerned with the mechanism of drug resistance and associated with high level resistance to INH, katG315 mutation was necessary to be identified by molecular method as a molecular determinant of INH resistant Mycobacterium tuberculosis. The prevalence of katG315 mutation in various countries was discussed in this report and a new molecular method for the detection of the mutation was proposed.
Toxigenic strains of Vibrio cholerae serogroup O1 and O139 are causative agents of deadly
diarrheal disease named cholera. Vibrio cholerae O1 is traditionally divided into two
biotypes, classical and El Tor, which are different in phenotypic as well as genotypic traits.
Since 1961, classical strains of Vibrio cholerae O1 serogroup has become obsolete as the
cause of epidemic and pandemic cholera and replaced by El Tor strains. Since 2002, atypical
O1 El Tor strains possessing the traits of classical strains have been increasingly recognized
as the cause of cholera in many countries across the world. This article focuses on the genetic
traits of O1 classical and El Tor strains. Furthermore, an overview of emergence of atypical
O1 El Tor strains and their genetic traits is presented.
Synovial osteochondromatosis is an unusual, rare and benign tumour. This disease is characteristically monoarticular, most commonly found in knee joint, however it is rarely found in the elbow. A 49-year-old Indian man presented to hospital with a 6-month history of pain, swelling, intermittent locking, loss of range of motion of right elbow and a considerable size of elbow with no recollection of associated trauma. Plain radiographs of right elbow showed numerous radiopaque round and oval loose bodies within the right elbow joints. Computer Tomographic (CT) scan showed multiple bony mass within the right elbow joint. Arthroscopic synovectomy, debridement, excisional biopsy and loose body removal combined with miniarthrotomy of the right elbow was performed due to limited exposure for removal of larger loose bodies. Histopathological examination of the tissue sample is consistent with the diagnosis of synovial osteochondromatosis. The clinical and radiological evaluation at 6th month postoperatively showed marked reduction in the volume of the elbow, further improvement of elbow range of motion of this patient and the Mayo elbow performance score before surgery and at 6 months postoperative, with an increase from 50 to 80 points. Synovial osteochondromatosis of the joints is a rare condition. The signs and symptoms are not specific and may be suggestive of other pathology conditions. Arthroscopic synovectomy and removal of loose body is the standard operative procedure till today. However, combination of arthroscopy and miniarthrotomy in cases of large loose bodies may provide a good clinical and functional outcome.
Milk discharge from neonatal breast commonly occurs bilaterally. Majority of them are benign in nature. Those cases usually require conservative management and will resolve with time. It typically occurs within one month of age in which late-onset of galactorrhoea in toddlers is indeed a rare occasion. Thus, an abnormal cause needs to be ruled out. An 18-months-old child had persistent milky discharge from the left nipple for several days without underlying specific identified causes. This case highlights the occurrence of physiological milk discharge can still possibly occur at the age beyond one-year-old despite its absence in the initial months of life. The principle observation at primary care is still adequate in managing such cases unless high suspicion of alarming disease arises. This case proved a late onset of physiological galactorrhoea can still occur in the early toddler age group.
Prenatal exposure to chronic stress during critical periods of foetal development produces depression, attention and learning deficits, hormonal imbalances and affects the brain. The effect of prenatal restraint-stress on the postnatal developmental milestones, anthropometric measurements, and the body, brain and adrenal gland weights of the pups were examined and compared with the unrestrained control and the restrained group under the pyramid at postnatal day 10 and 21. Pregnant rats were restrained (9h/day) from gestation day 7 until parturition. Results showed significant delay in the milestones by one day in the restraint control (RC) compared to the unrestrained normal control (NC), while pups of the restrained pyramid (RP) group did not show the delay. Significant decreases in the anthropometric measurements, body and brain weights in RC group were observed at both postnatal days, while the RP group results matched with the NC group. Significant increase in the adrenal weights was found in the RC group compared to NC group and not the RP group. Results suggest prenatal restraint-stress definitely hampers the developmental milestones, anthropometric measurements, and body and brain weights of the young offspring. Results suggest, pyramid environment counteracts and protects the deleterious effects of chronic prenatal stress.
Since the 1970s, people’s understanding of life has gradually deepened into the basic material nucleic acid and protein levels of life. The life sciences have entered the era of “molecules†and produced a large number of new and interdisciplinary subjects. An important direction has had a major and profound impact on the development of epidemiology itself and on disease control.
Rapid Stroke is a common clinical problem. Stroke can be broadly divided into ischaemic and haemorrhagic stroke. Ischaemic stroke can be further classified by TOAST classification into large-artery atherosclerosis, cardioembolism, small vessel occlusion, the stroke of other determined aetiology and stroke of undetermined aetiology. Importantly, we need to be wary of important stroke mimics such as brain tumour, demyelination, intoxication as they can lead to changes in clinical management. Here, we would like to illustrate a case of meningioma which clinically mimics a stroke. This patient is a 78-year-old lady who initially presented with sudden onset right-sided body weakness associated with slurred speech and facial asymmetry. An urgent plain computed tomography (CT) of the brain showed hypodensities at the left middle cerebral artery territory. However, re-evaluation noted her to have a normal Glasgow Coma Scale without any cortical signs, cerebellar sign or dysphasia. In view of these, stroke mimics was suspected. A contrasted CT brain was done which confirmed the diagnosis of meningioma. She was offered surgical intervention for meningioma but she was not keen on it. In conclusion, this case highlighted the importance of clinical evaluation in recognising stroke mimics
In this modern and fast-moving world, elderly’s safety and security have become an important issue. According to the World Population Prospects of the United Nations 2015, there is 12.3 per cent population aged 60 and above globally and it is the fastest growing population at a rate of 3.26 per cent per year. In order to reduce the worries about the elderly living alone at home, Elderly Monitoring System is required for continuous monitoring. “Fall†is one of the critical incidents for the elderly living alone as it causes serious injuries. A fall detection system using global system for mobile communication can help to reduce the time of unaware of their next of kin.
Honey dressing has been used to treat wounds since thousand years ago, however, it has been vanished of it usage on wounds management. Lately, it resurfaces again and has been used widely by clinicians in managing hard-to-heal ulcers. With the extensive study and research been carried out by scientists, a better understanding on the usage in managing non-healing ulcers has been widely accepted nowadays.
Pain management with analgaesics employs a multidisciplinary approach of clinicians towards patients. Nevertheless, preventing drug abuse and misuse in pain management is also an important goal. Understanding patients’ behaviour in the usage of painkillers may facilitate more effective communication and to educate them on the appropriate choice of painkillers. This study aimed to assess patients’ knowledge, attitude and practice towards painkillers. This was a questionnaire-based cross-sectional study conducted from February to May 2016 among patients in Tawau Hospital. Respondents were selected via convenience sampling and interviewed based on a questionnaire to assess their knowledge, attitude and practice towards painkillers. A total of 193 questionnaires with complete responses were analysed. Most of the respondents
(60.1%) obtained their painkillers from public facilities. Generally, they were very satisfied with the painkillers that they had used (36.7%). However, most of them (75.0%) did not know the name of the ingredient of the painkillers that they had taken before. They were also not aware of the side effects (73.1%) and allergic reactions (64.8%) caused by painkillers. Most of the respondents (58.5%) had not been informed regarding the side effects of the painkillers by healthcare professionals. Only 25.0% of the respondents had been asked regarding their past medical history, past medication history and allergic history by healthcare professionals before a painkiller was recommended to them. This study highlights the need of continuous efforts by healthcare professionals to inform patients of the proper use and risks associated with painkillers to improve the quality use of painkillers.
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.
High anion gap metabolic acidosis (HAGMA) is a hallmark of Diabetic Ketoacidosis (DKA). Occasionally, a Normal Anion Gap Metabolic Acidosis (NAGMA) can be seen, especially during the treatment phase. In this case report, a 55-year-old lady with diabetes mellitus who presented with a 2-day history of fever, lethargy and multiple episodes of vomiting and diarrhoea. Initial laboratory investigations revealed: capillary blood glucose as 27 mmol/L, urine ketone as 3+, blood ketone as 3.5 mmol/L, serum bicarbonate as 14 mmol/L, and serum chloride as 95 mmol/L. She was treated with intravenous normal saline fluid resuscitation and constant rate insulin infusion which was fortunately accompanied by stabilization of blood glucose and normalization of blood ketone to 0.2 mmol/L. However, despite normalization of her anion gap (25 to 14), she remained unwell with acidotic breathing due to refractory hyperchloraemic NAGMA with bicarbonate at 11 mol/L and chloride of 112 mmol/L. It was then decided to administer 100 mL of 8.4% Sodium Bicarbonate solution. The next day, she was no longer tachypneic as her bicarbonate and carbon dioxide improved to 21 mmol/L and 32 mmHg respectively. The presence of NAGMA in DKA should prompt clinicians to conduct a thorough search for possible underlying causes, such as gastrointestinal fluid loss, sepsis and chloride load from aggressive fluid resuscitation with normal saline. Sodium bicarbonate should only be considered in intractable cases to correct a NAGMA and not routinely used in the treatment of DKA.
Sabah is a high tuberculosis (TB) burden area with incidence rate of 120 – 138 per 100,000 population. Until now, TB is still unable to control due to high loss to follow up rates. Loss to follow up TB treatment can cause to increase notification rate, prolonged infection, recurrent TB infections, increase multiple drug-resistance, and increase morbidity and mortality rates. To know the factors that contribute towards loss to follow up will better understand the epidemiology of treatment outcome and guide for appropriate strategies planning to improve the situation. Previous study by Liew et al. indicated that, incidence rate for loss to follow up in 2012 in Malaysia was 10.5%.
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.
Since the COVID-19 pandemic, Taiwan reported a total of 776 cases of COVID-19 (Dong et al., 2020) in comparison with its neighbouring countries, Japan and the Philippines which reported 210,769 and 465,724 cases of COVID-19 respectively, until 24 December 2020. Looking at the curve of the COVID-19 pandemic among various countries, Taiwan had indeed distinguished herself and stood out considering her well-contained COVID-19 infection despite it being a widespread infection in other countries.
Approximately 50% patients with psychotic illnesses on antipsychotic drugs have an increased risk of obesity. This study aimed to determine changes in body weight, body fat percentage and lipid profiles and to stress the importance of early nutrition intervention in the management of psychotic illness patient treated with antipsychotic drugs. This is a prospective longitudinal study conducted for 3 months in Hospital Mesra Bukit Padang, Kota Kinabalu, Sabah. A total of 150 patients with Diagnostic and Statistical Manual IV (DSM-IV) diagnosis of psychotic illness (either Olanzapine or Risperidone only at any dosage) first started or restarted after a treatment gap of at least 6 months were recruited. Weight, height and body fat percentage were measured using Bioelectrical Impedance Analysis (BIA) (Model Omron HBF-375) and blood fasting lipid test were taken from the point of starting medication for 12 weeks. Data were analysed using repeated measures of ANOVA for statistical method. All variables showed significant mean differences (p < 0.05) in increasing pattern throughout the 12 weeks of treatment. However, the total cholesterol of risperidone patients had no significant mean difference from initial to week 6 (p = 0.282). It was proven that there was increase in body weight, body fat percentage and lipid profiles among patients on olanzapine and risperidone. The limitation of this study might relate to the drugs’ dosage and method used in assessing the body composition. It is suggested that early nutrition intervention is needed to control unnecessary gain of weight, body fat and lipid profiles in the management of patient with psychotic illnesses.
Dandy-Walker syndrome is a rare congenital malformation of the brain that involves the cerebellum and the fourth ventricle. It is characterised by a classical triad of hydrocephalus, cystic dilatation of the fourth ventricle and complete or partial agenesis of the vermis. Majority of cases are diagnosed during neonatal or early infantile period. In this case report, a seven-year-old boy complained of recurrent headaches for the past one year. Physical examination was unremarkable. Examination of the fundus on the same day revealed bilateral papilloedema. His subsequent computed tomography scan of the brain done at a major district hospital demonstrated features in keeping with Dandy-Walker malformation. Our case highlighted the importance of embarking on a detailed and thorough approach when dealing with a child with chronic headache, especially in rural settings where advanced medical equipment is not readily available.
Purple urine bag syndrome (PUBS) is a rare presentation of urinary tract infections (UTIs). It is commonly seen in constipated patients. There is a deep purple discoloration of contents of urine bag due to presence of indigo and indirubin pigments which are metabolites of tryptophan. We would like to describe an interesting case of purple urine bag syndrome of 88-year-old woman who presented with catheter-related urinary tract infection. She had low-grade fever and suprapubic discomfort for three days duration. She had increased white cell count and C-reactive peptide (CRP). Urinalysis showed protein 2+, nitrite and leucocyte esterase positive. Urine culture grew Escherichia coli and Klebsiella pneumoniae. She was treated with oral cefuroxime and recovered. This case report may be the first case of PUBS reported in this region.
There is a strong need to reduce costs of hospital and advocating health economics in countries like the United States of America. The rising cost of healthcare globally especially in the United States of America has interestingly outraged the temper of many citizens about the Obamacare and Trumpcare. The issue about high cost in healthcare is the failure for people globally to recognize that healthcare facility is a 24-hour round-the-clock service. It therefore involves doubling of the utility bills, tripling the manpower due to shifts and rest, wear-and-tear of basic electrical devices is short-lived, breakdown period of huge machine is consistently due to overloaded usages in the government hospitals and poor knowledge of the maintenance programme. Low birth weights (LBW) is a public health concern because it has a well-known predisposition to increased risk for perinatal infections, respiratory distress and ultimately mortality. There is also a higher risk of poor health outcomes throughout the life course of the LBW newborns that includes Type 2 diabetes, high blood pressure, neurodevelopmental disabilities and cardiovascular diseases. The World Health Organization and United Nations Child’s Fund estimate the prevalence of low birth weights in the world ranges from 3% to 32%. Albania in the year 2000 recorded prevalence of low birth weight of 3% whereas Yemen recorded a low birth weight of 32% in 1997. In 2015, the US national vital statistics pointed out that 83.9% of preterm birth (PTB) are LBW. This indicates that prevention of PTB will lead to a decrease in the incidence of LBW.