Computed tomography pulmonary angiogram (CTPA) is widely used in the investigation of suspected pulmonary embolism. CTPA is not without adverse effects as it involves intravenous contrast injection and radiation exposure. The annual incidence of pulmonary embolism is 60 – 70 per 100,000 populations and CTPA remains the commonest imaging modality1. This study aims to audit all CTPA performed at Hospital Sultanah Nora Ismail, Batu Pahat, Johor for the entire year of 2018 to illustrate the demographic data, symptoms, risk factors, clinical scoring system applied and patients’ outcome. A retrospective study was conducted to audit all CTPA performed between 1st January to 31st December 2018 via the radiology department electronic records and patients’ records. There were a total of 60 CTPA performed in the entire year of 2018 with 16 positive and 44 negative scans. Among the 16 positive scans, 7 (44%) had a Wells score above 6, 6 (38%) had a Wells score between 2 – 6 and 3 (18%) had a Wells score less than 2. Out of the 16 positive scans, 4 (25%) were known malignancy and 1 was a known case of anti-phospholipid syndrome. All 60 patients had electrographs and arterial blood gases performed prior to CTPA. D dimer was performed in 15 cases (5%). Among the 16 positive scan patients, 4 (25%) passed away during the same admission directly or indirectly related to pulmonary embolism. This annual computed tomography audit report will assist clinicians in making better diagnostic decision when dealing with patients with suspected pulmonary embolism.
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.
In this era, most of us are suffering some level of respiratory problem. Respiratory system of our children is even more sensitive compare to adults. As our children spending an average of 8 hours in school, indoor air quality of the classroom become an important element. Many studies have shown that indoor air quality not only affecting the respiratory system of schoolchildren but their performance in academy as well.
Vaccination is considered to be one of the most successful achievements of public health intervention either in developed or developing countries. “Vaccine hesitancy†is described as anyone who is suspected of vaccination or who chooses to delay or refuse vaccination. Nowadays, parental refusal or delay of childhood vaccines is increasing. The studies show that 77% of parents polled are reported of having concerns about one or more childhood vaccinations. It became a concern for the increased occurrence of vaccine preventable diseases in children.
Silicosis is a fibronodular lung disease secondary to the inhalation of crystalline silica dust. It had continued to cause significant morbidity and mortality worldwide. Here is a case of a 63-year-old woman, a lifelong non-smoker who complained of intermittent wheezing since retired 8 years ago. She had worked in the clay and piping industry for more than a decade. She wore only a simple 3-ply face mask at work without other protective devices. She had multiple hospital admissions for acute exacerbation of chronic lung disease for the past several years. Respiratory examinations revealed bilateral fine crepitations and occasional rhonchi on auscultation. Chest radiograph revealed ground glass changes. Pulmonary function testing showed an irreversible severe obstruction picture with an FEV1 of 45%. High resolution computed tomography thorax demonstrated hyperinflated lungs with emphysematous changes and multiple nodules over subpleural region, conglomerate mass with calcifications over bilateral lungs. Her imaging findings combined with a significant occupational history were suggestive of progressive massive fibrosis (PMF) due to silicosis. She is currently being treated with several inhalers and does not require home oxygen therapy. She is suffering from accelerated silicosis which may potentially progress to radiological deterioration, altered respiratory function and premature death. Therefore, it is essential to avoid any potential hazards that may predispose to silicosis.
Calcineurin inhibitors, cyclosporine and tacrolimus are increasingly becoming part of the standard immunosuppresant therapies for renaltransplanted patients in Malaysia. In this study, the clinical safety and efficacy of cyclosporine and tacrolimus in a Malaysian renal-transplanted population is compared. A fourteen-year retrospective review on all renal-transplanted patients (from September 1991 to September 2015) or patients being followed up at University Malaya Medical Centre (UMMC) on cyclosporine or tacrolimus regime was conducted. We collected the clinical and laboratory parameters at 3-month, 6-month, 7-month, 8-month, 9-month, 10-month, 11-month, 12- months, 2-year and 3-year following from transplantation for each drug. The mean cyclosporine and tacrolimus trough levels were within the recommended therapeutic ranges (189.16 ± 69.10 ng/ml and 7.84 ± 2.18 mg/day respectively). The mean low-density lipoprotein (LDL) was significantly higher at eleven months for tacrolimus compared to cyclosporine. Similarly, the mean total bilirubin level was significantly higher with cyclosporine as compared to tacrolimus between 3 – 9 months post transplantation but did not show any significant difference (p = 0.49). The overall monthly means of serum uric acid levels in patients were also similar, 380 ± 87 mg/dL (cyclosporine) and 390.96 ± 95.97 mg/dL (tacrolimus) (p = 0.49). The Kaplan-Meier survival rate is significantly longer (p = 0.03) with cyclosporine-based treatment as compared to tacrolimus. Overall, cyclosporine and tacrolimus did not show any significant difference in terms of safety and efficacy parameters among Malaysian renal-transplanted patients indicating that they may be used interchangeably.
Gurayat General Hospital is a 350 bed secondary referral hospital of Kingdom of Saudi Arabia. This is one of the busiest hospitals in Al-Jouf region. Trauma is very common in this city and the ER department is mostly overwhelmed by Neurosurgical emergency patients. The aim the study was to evaluate the age sex,
types of injuries and causes of injuries of the neurosurgical emergency patients. This was a cross-sectional descriptive observational study. Ethical approval was achieved from proper authority. Good Clinical Practice (GCP) ICH E6 protocol was followed in order to ensure safety and efficacy. Data was collected from the log book of the ER department. Data were transferred to a spreadsheet to make a master sheet. Valuables of individual columns were analyzed and tabulated. Comparison was performed between the result of this study and other international studies. About 7.3% of all ER admissions were for the Neurosurgical cases. Among the Neurosurgical cases (n=3588) there was clear predominance of male
gender (81%). Majority (45%) of the Neurosurgical patients were from children and teen age group. Nearly 50% of the patients reported to ER with the history of Road Traffic Accident (RTA). Head injury was the commonest (61%) type of injury. Approximately 45% patients were admitted in to general ward whereas 42% patients were discharged from ER after providing primary treatment. When the results of this study were compared to the results of the other international studies fair similarities were observed.
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.
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.
Both metformin and gliclazide have been used extensively in the management of type II diabetes mellitus. Metformin and gliclazide overdose can lead to severe hypoglycaemia refractory to intravenous (IV) dextrose rescue therapy. A 21-year-old man complained of vomiting and felt dizzy after four hours of taking 70 tablets of Metformin 500 mg and 40 tablets of Gliclazide 80 mg. He had major depressive disorder and wanted to commit suicide. He was given IV Dextrose 50% 50 cc immediately. Octreotide had been used successfully to reverse the refractory hypoglycaemia caused by gliclazide overdose. Unfortunately, he developed severe lactic acidosis with acute kidney injury. Dialysis had been done by continuous venovenous haemodiafiltrationa and intravenous sodium bicarbonate 8.4% infusion was given. However, the patient succumbed due to the severe lactic acidosis and kidney failure despite of urgent dialysis. Octreotide infusion helps in preventing refractory hypoglycaemia secondary to sulfonylurea overdose by inhibit calcium-mediated insulin release. Metformin overdose causes severe lactic acidosis due to conversion of glucose to lactate. Sodium bicarbonate therapy in metformin induced lactic acidosis is also controversial. Though sulfonylurea and metformin are the most commonly-prescribed anti-hypoglycaemic agents, thus during prescribing everyone has to be careful about the overdoses and side effects of these drugs.
Rapid rural appraisal (RRA) is a systematic but semi-structured study used to gain new insight into rural life in a quick manner. The current article describes the RRA conducted in a remote village in Lahad Datu, Sabah. The RRA aimed to address the background of the rural community and identify public health issues. Collection of secondary data, key informants’ interview, field observation and a structured interview with the villagers selected via convenience sampling were applied to obtain necessary data. Findings from informal approaches were summarised. Descriptive analysis was carried out for data collected from structured interview. Water sanitation, sanitation facility, food safety, air pollution, zoonosis and non-communicable diseases were among the potential public health issues identified within the village. A total of 188 villagers participated in the structured interview. The median age was 28.0 (IQR 30.8). The percentage for manual workers were 21.3% while 13.8% were white collars. The illiteracy rate was 12.2% and the poverty rate at 48.9%. A total of 22.3% of respondents reported overcrowded households. The household environment and take-up rate of basic amenities were suboptimal. The highest self-reported chronic disease was hypertension, recording 13 cases. The foremost priority is to fill up the flaws in the public health needs of the villagers. Those challenges require participation from relevant authorities as well as individual empowerment
Diabetic amyotrophy also known as Bruns-Garland syndrome is diabetic neuropathy subtype affecting the lumbosacral nerve roots and peripheral nerves. There is an ongoing debate on the pathophysiology behind this condition whether is it ischaemic, metabolic (hyperglycaemia) or inflammatory. A 36-year-old man with uncontrolled diabetes mellitus complained of unprovoked weight lost and right proximal thigh discomfort with weakness for one week duration. In neurological examination, his right hip flexion was at medical research council (MRC) grade 3, right hip extension MRC grade 4, his knee and ankle flexion and extension are normal (MRC grade 5). The muscle tones and reflexes were normal. Sensation and proprioception were intact bilaterally. Nerve conduction study (NCS) showed markedly reduced amplitude of the compound muscle action potentials and sensory nerve action potentials, while conduction velocities show only mild slowing. He was started on a course of oral prednisolone 10 mg daily and improved gradually. At three months follow-up, his right lower limb power has recovered fully and he can walk without any assistance. Diabetic amyotrophy was confirmed by suggestive clinical features supported by electrophysiological findings of the affected nerves. This condition is due to metabolic derangement and vasculopathy or immune mediated nerve injury. So, the healthcare providers should be aware about this rare complication of diabetes.
This systematic review was aimed to evaluate the effectiveness of technology-enhanced learning (TEL) used in medical teaching for undergraduate medical students. The objectives are to (a) identify various teaching modalities which are used to enhance TEL; (b) evaluate whether TEL is more effective than traditional learning (TL) in cognitive and affective learning domain outcome. The empirical studies were searched in the following databases: Google Scholar, MEDLINE, ERIC, ProQuest, Cochrane Library and Scopus. All papers published from 2008 to 2018 were included. From eligible studies, the study design, study field, study population, intervention methods, type of assessment and learning achievement were abstracted and summarized the information. The search results were independently reviewed by two authors. From a pool of 1384 articles, 43 eligible articles were identified, enrolling 7292 undergraduate medical students examining comparative study between TEL and traditional learning. The results showed that there was a high degree of heterogeneity seen amongst the included studies in terms of TEL modalities used. The majority of intervention studies favoured online resources, while the rest used various offline multimedia electronic devices, virtual simulations and blended modes. Overall findings showed promising data that TEL is better than TL with regards to knowledge gain and skill acquisition, as well as providing higher student satisfaction. In all, the findings present blended learning in a positive and promising light in time, particularly where systematic reviews on technology-enhanced learning in the field of the undergraduate medical programme have produced mixed result.REVIEW ARTICLEA Systematic Literature Review on Technology-Enhanced Learning in Medical EducationMay Honey Ohn1*, Bareth Ravindran2, Chan Zhi Wei3, Khin Maung Ohn4, Ng Pey Luen5Borneo Journal of Medical Sciences 14 (1) January, 2020: 3 – 171 Emergency Department, Sandwell & West Birmingham NHS Trust, United Kingdom2 Surgical Department, Hospital Tuanku Ja’afar Seremban, Kuala Lumpur, Malaysia3 Orthopaedics Department, Hospital Sungai Buloh, Kuala Lumpur, Malaysia4 Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia5 Radiology Department, Hospital Queen Elizabeth II, Sabah, Malaysia* Corresponding author’s email: mayhoney.ohn@gmail.com Received: 14 July 2019 Accepted: 5 November 2019Borneo Journal of Medical SciencesBJMSKeywords: blended learning, technology-enhanced learning, medical education, hybrid learning, undergraduate medical students
Ludwig’s angina is a grave, fatal cellulitis usually occurs in adults. If it is diagnosed early along with
immediate treatment planning can save a life. In this case, it is a widespread dental infection which
extends to the neck and chest, therefore elevation of floor of mouth which causes respiratory
obstruction. Airway protection techniques along with proper parenteral antibiotics and meticulous
surgical drainage are the mainstay of treatment in a case of advanced staged Ludwig’s angina.
Ovarian cancer is the fourth most common cancer among women in Peninsular Malaysia. Epithelial ovarian cancer accounts for 90% of all ovarian tumours. Herein, we present a rapidly growing ovarian tumour in a young female patient, following an uneventful vaginal delivery at home. We discuss on the challenges of making said diagnosis in a post-partum patient who presented with abdomen distension. A 19-yearold lady presented to the Emergency Department three days after spontaneous vaginal delivery at home. Her chief complaint was that of a rapidly progressive abdominal distension. Diagnostic and therapeutic emergency laparotomy were done, revealing a huge cystic ovarian mass. Histopathology reported a high grade, serous ovarian carcinoma. There are multiple causes for abdominal distension in post-partum women, however priority should be given into looking for gynaecological origin, given the changes in hormone. Sudden abdominal distension during post-partum period is rare and a systemic approach in its management is vital. There is, inarguably, a role of diagnostic and therapeutic laparotomy in this.
Reconstruction of hand injury is the challenge for the surgeon especially in rural settings. This case report is about a 10-year-old boy, who sustained large degloving wound of dorsum of right hand with extensor tendon injury following a road traffic accident. We performed a staged abdominal flap with tensor fascia lata graft for tendon reconstruction as microsurgery facilities was not available. Post-operatively he was subjected to physiotherapy and he has a functional right hand. This case report aimed to highlight abdominal flap as reconstructive option as compared to skin grafting which is reproducible with limited resources. Besides that, overall exposure to all surgical options is of paramount importance in the training of trainees to equip them with skills to serve in rural setting.
Xylazine is an alpha-2agonist often used as a sedative, analgesic and muscle relaxant agent
in animals. Xylazine was not accepted by Food and Drug Administration (FDA) for human use
due to hazardous side effect such as hypotension, bradycardia, respiratory depression and coma.
This is a rare case report of a 64-year-old farmer who accidentally injected himself with Xylazine
which was supposed to be given to a fractious cow. He developed altered conscious level, hypotension, bradycardia and respiratory failure requiring mechanical ventilation. Fortunately, he
recovered and was discharged home after three days. This occurred due to improper handling of
Xylazine without standard operating procedures. Xylazine is regulated for animal use only. Therefore, effects of Xylazine toxicity in human must be emphasized for awareness on proper handling as well as for right management of its poisoning incident in future.
Age Under Five Mortality Rate is one of the important child mortality indicators that could reflect a child’s population well-being in a society. It is defined as the probability per 1000 live births that a newborn baby will die before reaching the age of five.
Alcohol misuse compromises the quality of life of individuals, families, communities and whole societies in a variety of ways. Malaysia acknowledges the problems, implementing policies and health promotion activities in line with the World Health Organization Global Strategy to reduce the harmful use of alcohol by 10% between 2010 and 2025. Sabah, one of two Malaysian states on the island of Borneo, has more than 30 different indigenous ethnic groups. Alcohol production and consumption have traditional and unique roles in the cultural practices of many of these groups, making one common programme difficult to implement. Preliminary research suggests that alcohol is a serious problem in indigenous communities in Sabah. It also shows lack of knowledge on recommended limits for alcohol consumption and understanding of alcohol-related harm. The objective of this action-research is to produce a toolkit that will transfer knowledge and empower communities to adopt safer drinking and reduce alcohol-related harm. It must be attractive, appropriate, easily understood and be able to be tailored to suit different communities. The alcohol tool-kit was developed by a group of academicians using evidence-based information. Qualitative research methods were used to evaluate the initial alcohol tool-kit. A purposive sample of 45 village representatives was selected and divided into 5 groups for focus group discussion. Their feedback was recorded and transcribed verbatim. The alcohol tool-kit was edited accordingly. All participants agreed the alcohol tool-kit was important and can empower communities to reduce alcohol-related harm directly improving their quality of life. The amended alcohol tool-kit will be recommended for health promotion material and evaluated from time to time.
New techniques based on digital analysis and more precise visualisation in monitoring of individual health status can improve the accessibility and reliability of healthcare services. An innovation in capturing human biofield energy level using Electrophotonic Imaging (EPI) is seen as a breakthrough approach to healthcare service. This non-invasive imaging approach produces an image, i.e. the Kirlian image in digital form to aid visualization and probe for disease identification. The diagnosis and treatment process are fast, reproducible and cost-effective. EPI technique works using computational models of human health state, commonly before and after a course of treatment or meditation. The reliability and efficacy of EPI are validated by the physician’s perceptions using biomedical measurements. At the same time, the algorithms developed by engineers embedded in the imaging system have advanced gradually with the help of clinical data from physicians. To close the gap between engineering and medicine, the field of research known as ‘Biomedical Engineering’ (BME) has been established to merge engineering principles with medicine in order to advance = diagnosis, treatment, and monitoring, which will in turn improves quality of life of mankind. Engineering approach is used to study on how the captured image indicates the energy level of human biofield. This elementary analysis introduces a pre-processing procedure to extract the effects texture. The image indicates the radiation energy level based on its most significant glow (digitallyimaged isolines) and is used for medical biometrics and health analysis.