Telemedicine in neurosurgery or teleneurosurgery has been widely used for transmission of clinical data and images throughout the country since its implementation in 2006. The impact is a reduction of patient number that need to be reviewed in the level III hospitals and an increment in the number of patients that are kept in level II hospitals for observation by the primary team. This translates to reduction of unnecessary transfer of patients and subsequently cost benefits for patients and medical providers. The main aim is to determine the amount of reduction in unnecessary transfer by the implementation of teleneurosurgery in the management of referrals to neurosurgical department in Hospital Sultanah Amninah Johor Bahru (HSAJB). Other factors associated with transfer decision are also evaluated.
Brain ischaemia and infarction are the leading factors in morbidity and mortality of traumatic brain injury. This study aimed to determine the perfusion status of pericontusional hypodense areas in traumatic cerebral contusion
Blunt abdominal trauma can cause multiple internal injuries. However, these injuries are often difficult to accurately evaluate, particularly in the presence of more obvious external injuries. Computed tomography (CT) imaging is currently used to assess clinically stable patients with blunt abdominal trauma. CT can provide a rapid and accurate appraisal of the abdominal viscera, retroperitoneum and abdominal wall, as well as a limited assessment of the lower thoracic region and bony pelvis. This paper presents examples of various injuries in trauma patients depicted in abdominal CT images. We hope these images provide a resource for radiologists, surgeons and medical officers, as well as a learning tool for medical students.
When performing a radiological assessment for a trauma case with associated head injury, a fragment of dense tissue detected near the craniovertebral junction would rapidly be assessed as a fractured bone fragment. However, if further imaging and evaluation of the cervical spine with computerised tomography (CT) did not demonstrate an obvious fracture, then the possibility of ligament calcification would be considered. We present a case involving a previously healthy 44-yearold man who was admitted following a severe head injury from a road traffic accident. CT scans of the head showed multiple intracranial haemorrhages, while scans of the cervical spine revealed a small, well-defined, ovoid calcification in the right alar ligament. This was initially thought to be a fracture fragment. Although such calcification is uncommon, accident and emergency physicians and radiologists may find this useful as a differential diagnosis in patients presenting with neck pain or traumatic head injury.
Monostotic fibrous dysplasia of the vertebra is a rare entity. A case of a 53-year-old lady who presented with an 8 months history of pain in the thoracic spine region with paraparesis is discussed. She had a history of papillary thyroid carcinoma and had undergone total thyroidectomy one year prior to her current problem. Magnetic resonance imaging revealed isolated osteolytic lesion over the posterior element of the T12 vertebra with narrowing of the spinal canal causing compression of the cord. The diagnosis of fibrous dysplasia was made histologically. Fibrous dysplasia rarely occurs in axial bones compared with peripheral bones. This case illustrates that osteolytic lesion of the vertebrae should be evaluated with detailed radiological and histopathological examination before an empirical diagnosis of spinal metastasis is made in an adult with a background history of primary malignancy well-known to spread to the bone.
Emergency Medicine and Disaster Medicine are two specialties which are similar in the multidisciplinary involvement during the acute phase of the disaster. Recently, there was an increase in the number of disasters in the world but not many physicians are familiar with the principles for dealing with such situations, the unique organizational demands, coordination and the urgent need for medical assistance and relief. This case report delineates our experiences at a tsunami disaster area and the approach to setting up a medical relief team in the affected area. A medical reconnaissance team comprising of an emergency doctor from Hospital Universiti Sains Malaysia (H.U.S.M) and two MERCY Malaysia members was assembled. The team flew to Colombo on day 5 after the tsunami with medical supplies and related materials. The mission started from December 31(st) 2004 until January 8(th) 2005. Our surveillance area covered the Southern and Eastern Province with a total distance of 1700 km along the coast. The strategies employed during this medical reconnaissance included risk analysis, devising a resources matrix, developing lines of communication and rapport with other relief teams, Sri Lankan government agencies, and local and international non-government organizations. As a result, our team was able to set up a medical relief camp and distribute the relief items to the tsunami victims. In conclusion, the Disaster Emergency Medical Assistant Team (DEMAT) from H.U.S.M and MERCY Malaysia were able to set up and provide medical relief with our limited resources to a large scale disaster situation.
Myiasis occurs when living tissues of mammals are invaded by eggs or larvae of flies, mainly from the order of Diptera. Most of the previousty reported cases are in the tropics and they were usually associated with inadequate personal hygiene, sometimes with poor manual dexterity. This report describes two cases of oral myiasis in cerebral palsy patients in Seremban General Hospital, Malaysia. This article also discusses the therapeutic property of maggots and highlights the importance of oral health care in the special needs patients.
This special editorial for the month of January 2009 is "THE" interview with Professor Tan Sri Dato' Dzulkifli Abdul Razak, Vice Chancellor of the Universiti Sains Malaysia (USM). He talked to us about the Apex University status that was conferred on 3rd September 2008. While most newspapers and the rest of the media were in frenzy interviewing him that month, MJMS decided to catch up with him on Monday 15th December 2008 just before the celebration at the Dewan Utama, Universiti Sains Malaysia Health Sciences Campus to commemorate the 25th anniversary of the establishment of the Hospital University Sains Malaysia by Yang Berhormat, Minister of Higher Education Datuk Seri Mohamed Khaled Nordin. References to USM as an APEX University are included at the end of this editorial especially for non-USM readers.
Previous studies have shown that stress on the vergence and accommodation systems, either artificially induced or naturally occurring, results in small misalignment of the visual axes, reduces binocular visual acuity and produces symptoms of ocular discomfort. This study examines the effect of artificially induced visual stress using ophthalmic prisms on three dimensional perception on 30 optometry students ages ranging from 19 to 29 years old. 6D base-in prisms, equally divided between the eyes (3D base-in each) was used to induce stress on the visual system producing misalignment of visual axes known as fixation disparity. The fixation disparity is quantified using near vision Mallett Unit and an enlarged scaled diagram. Stereoscopic perception was measured with the TNO test, with and without the presence of stress and the results was compared. Wilcoxon's matched pair ranked tests show statistically significant difference in the stereo thresholds of both conditions, p = 0.01 for advancing stereopsis and p = 0.01 for receding stereopsis, respectively. The study concludes that visual stress induced by prisms, produce misalignment of the visual axes and thus reduces three dimensional performance.
Pain, while salient, is highly subjective. A sensation perceived as painful by one person may be perceived as uncomfortable, not painful or even pleasant to others. Within the same person, pain may also be modulated according to its threat value and the context in which it is presented. Imaging techniques, such as functional magnetic resonance imaging and positron emission tomography, have identified a distributed network in the brain, the pain-relevant brain regions, that encode the sensory-discriminative aspect of pain, as well as its cognitive and affective/emotional factors. Current knowledge also implicates the prefrontal cortex as the modulatory area for pain, with its subdivisions forming the cortico-cortical pathway, an alternative pain modulatory pathway distinct from the descending modulatory pathway of pain. These findings from neuroimaging in human subjects have paved the way for the molecular mechanisms of pain modulation to be explored in animal studies.
Embolisation has long been used as an adjunct to surgical resection in the treatment of brain arteriovenous malformation (bAVM). The most commonly used embolic material, n-butylcyanoacrylate glue, requires experience and skill to handle its quick and unpredictable flow and polymerisation. A new liquid embolic agent, ethylene vinyl alcohol copolymer (Onyx), is less adhesive and polymerises slowly, which provides better control for radiologists performing embolisation.
The detection rate of thyroid incidentalomas is increasing; in fact, as many as 2.3% of patients undergoing FDG PET-CT for other indications have been found to have thyroid incidentalomas. The risk of malignancy in these thyroid incidentalomas can be as high as 47%. The increased uptake and the focal uptake pattern of F-18 fluorodeoxyglucose (FDG) in the thyroid during positron emission tomography (PET)-computed tomography (CT), and the calcification of the thyroid incidentaloma, are associated with even higher risk of malignancy. We report a case of a lady undergoing FDG PET-CT for breast cancer staging but noted to have a calcified thyroid incidentaloma, which was proven to be follicular thyroid carcinoma.
Floods are considered an annual natural disaster in Kelantan. However, the record-setting flood of 2014 was a 'tsunami-like disaster'. Hospital Universiti Sains Malaysia was the only fully functioning hospital in the state and had to receive and manage cases from the hospitals and clinics throughout Kelantan. The experiences, challenges, and recommendations resulting from this disaster are highlighted from an emergency medicine perspective so that future disaster preparedness is truly a preparation. The history of how the health campus was constructed with the collaboration of Perunding Alam Bina and Perkins and Willis of Chicago is elaborated.
Schwannoma of the cervical sympathetic chain is an extremely rare nerve tumour. We report an unusual swelling in a 41-year-old female who presented with an asymptomatic solitary mass in the right parapharyngeal space. Clinical examination and computed tomography showed displaced carotid artery in an antero-medial direction. Surgical excision of the lesion was carried out and histological examination revealed an Ancient Schwannoma.
Muslim consumers have special needs in medical treatment that differ from non-Muslim consumers. In particular, there is a growing demand among Muslim consumers for Halal medications. This descriptive exploratory study aims to determine the Halal status of selected cardiovascular, endocrine, and respiratory medications stored in an out-patient pharmacy in a Malaysian governmental hospital. Sources of active ingredients and excipients for each product were assessed for Halal status based on available information obtained from product leaflets, the Medical Information Management System (MIMS) website, or manufacturers. Halal status was based on the products' sources and categorized into Halal, Mushbooh, or Haram. The proportions of Halal, Mushbooh, and Haram products were at 19.1%, 57.1%, and 23.8%, respectively. The percentage of active ingredients for cardiovascular/endocrine products that were assessed as Haram was 5.3%; for respiratory medications, it was only 1.1%. For excipients, 1.7% and 4.8% fall under the category of Haram for cardiovascular/endocrine products and respiratory products, respectively. Ethanol and magnesium stearate were found to be the common substances that were categorized as Haram and Mushbooh.
Benign parotid neoplasm and inflammatory processes of the parotid resulting in facial paralysis are extremely rare. We report a 72-year-old Malay female with poorly-controlled diabetes mellitus who presented with a painful right parotid swelling associated with right facial nerve palsy. The paralysis (Grade VI, House and Brackmann classification) remained after six months.
Bilateral abductor vocal cord palsy is comparatively a rare vocal cord lesion, especially in a patient with no history of neck mass, previous surgery or trauma. Many patients are not stridulous. A patient presenting with stridor may need emergency airway management before the other treatment is commenced. We report a case of bilateral abductor palsy which required an emergency tracheostomy and subsequently a laser posterior cordectomy.
Magnetoencephalography (MEG) has been extensively used to measure small-scale neuronal brain activity. Although it is widely acknowledged as a sensitive tool for deciphering brain activity and source localisation, the accuracy of the MEG system must be critically evaluated. Typically, on-site calibration with the provided phantom (Local phantom) is used. However, this method is still questionable due to the uncertainty that may originate from the phantom itself. Ideally, the validation of MEG data measurements would require cross-site comparability.