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  1. Labao HC, Faller EM, Bacayo MFD
    Ann Glob Health, 2018 08 31;84(3):474-480.
    PMID: 30835403 DOI: 10.29024/aogh.2331
    BACKGROUND AND PURPOSE: Musculoskeletal disorders (MSDs) are alarmingly high among migrant workers in Malaysia. MSDs are the most prevalent occupational-related conditions in most parts of the world affecting function, productivity and overall health-related quality of life. Therefore, this study aims to determine the profile of Filipino migrant workers in Malaysia and their various musculoskeletal complaints.

    METHOD: This study utilized a quantitative, nonexperimental, cross-sectional research design. A total of 60 subjects were randomly selected after passing the study's sampling criteria. The Nordic Musculoskeletal Questionnaire (NMQ) was to used to determine common MSDs affecting the various regions in the body. The Demographic Pofile Sheet was provided to gather a subject's demographic characteristics.

    RESULTS: Filipino migrant workers mostly complain of pain in the low back area (60%) and shoulder pain (60%), followed by pain in the upper back (48.3%) and neck pain (45%) in the last 12 months. Household workers accounting for 73.3% of the subjects commonly complain of pain in the hips/thighs (78.9%), while workers in the service industry commonly complain of knee pain (39.1%).

    CONCLUSIONS: Results imply that Filipino migrant workers have a higher prevalence of shoulder and lower back pain in the last 12 months. Household workers are more susceptible to hip/thigh pain. Interventions focusing on ergonomics policy implementation, education on posture and lifting techniques and physical function is recommended. Further studies should consider the psychological and psychosocial aspects of migrant employment, which are known risk factors for MSDs.

    Matched MeSH terms: Low Back Pain; Neck Pain; Shoulder Pain
  2. Wan Ahmad Hazim, Nur Hidayah Aeshah Ng, Salleha Khalid
    MyJurnal
    Minimally invasive surgery results in faster recovery. The objective of this study is to identify criteria for the feasibility of 24-hour discharge post laparoscopic ovarian cystectomy. This is a prospective cross-sectional study that was carried out at the Obstetrics and Gynaecology Department in Putrajaya Hospital between 1 January and 31 December, 2016. The inclusion criteria were: age between 15 and 45, no comorbidities, no family history of malignancy, BMI of less than 30, mass size less than 18 weeks, single uninoculated simple cyst and no ascites. The exclusion criteria were post-menopause women, known medical illness, family history of malignancy, mass size more than 18 weeks, multiloculated or bilateral ovarian cyst, presence of solid area within the cyst and ascites. The sample size was calculated to be 14. A total of 16 participants were identified. Results showed that using the Visual Analogue Score (VAS), the mean pain score post operatively in the first six hours, 24 hours, 48 hours, two weeks and three months were 3.67, 2.57, 0.5, 0 and 0, respectively. Two of the subjects experienced post-operative nausea and vomiting, one had urinary tract infection and one had minor bleeding from the surgical site. All the participants were discharged within 24 hours post-operatively. There was no readmission. In conclusion, 24-hour discharge post laparoscopic cystectomy is safe and feasible. Factors determining the success must be adhered to closely to ensure a good and satisfactory outcome. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
    Matched MeSH terms: Pain, Postoperative
  3. Kang W, Singarayar C, Wahab NA, Sukor N, Kamaruddin NA
    J ASEAN Fed Endocr Soc, 2019;34(1):95-98.
    PMID: 33442143 DOI: 10.15605/jafes.034.01.15
    An adrenal mass can be a diagnostic challenge as it is not easy to differentiate the adrenal glands from other adrenal pseudotumours with only radio-imaging. We report a 28-year-old patient who was diagnosed radiologically as an adrenal cortical carcinoma after he presented with abdominal pain and fullness. Biochemically, he demonstrated secondary hyperaldosteronism. Intra-operatively there was a huge mass, inferior to a normal right adrenal, which was histopathologically proven to be a dedifferentiated liposarcoma.
    Matched MeSH terms: Abdominal Pain
  4. Thever Ramasamy V, Sivapatham L, Grover SR, Shanmugam SS, Ganesalingam M
    J Pediatr Adolesc Gynecol, 2021 Feb;34(1):61-64.
    PMID: 33010465 DOI: 10.1016/j.jpag.2020.09.003
    BACKGROUND: Uterine torsion is a rare event, which mostly reported in females with a gravid uterus and is exceptionally rare in children.

    CASE: A 9-year-old girl presented with 3 days of intermittent lower abdominal pain. Ultrasound revealed an ovarian mass, but laparotomy revealed an ischemic enlarged ovary and uterus rotated 180°. No reperfusion occurred after 60 minutes. A subtotal hysterectomy and right salpingoophorectomy were thus performed.

    CONCLUSION: Uterine and adnexal torsion presents with symptoms similar to those of adnexal torsion. Delays in diagnosis and referral continue to be an issue, resulting in suboptimal outcomes. Uterine torsion, although exceedingly rare in childhood, appears to occur only in the setting of ovarian masses, which provide the impetus for the rotational force to the elongated cervix of the prepubertal uterus.

    Matched MeSH terms: Abdominal Pain/etiology
  5. Keah RSH, Ch'ng KS
    Malays Fam Physician, 2013;8(2):62-64.
    PMID: 25606287 MyJurnal
    A 28-year-old man presented with a chief complaint of rashes all over his body. He had a history of a trip to Langkawi Island, a famous island resort off the west coast of Malaysia, over the Chinese New Year’s weekend. According to him, he had a lot of fun with a group of friends at the sunny beach and the beautiful sea. There were no untoward incidents and they were perfectly well when they returned home after a 2-day trip. On the evening of the second day after his return, he noticed rashes appearing over his body, notably on shoulders and trunk. These rashes were little painful in nature.
    Matched MeSH terms: Pain
  6. Kamal A, Salman B, Razak NHA, Samsudin ABR
    Eur J Dent, 2020 Oct;14(4):613-620.
    PMID: 32777838 DOI: 10.1055/s-0040-1714765
    OBJECTIVE:  A dry socket is a well-recognized complication of wound healing following tooth extraction. Its etiology is poorly understood and commonly occur among healthy patients. As such, management strategies for dry socket has always been empirical rather than scientific with varying outcome. The aim of this study is to investigate the efficacy of concentrated growth factor (CGF) and low-level laser therapy (LLLT) and compared them to the conventional treatment in the management of dry socket.

    MATERIALS AND METHODS:  Sixty patients with one dry socket each, at University Dental Hospital Sharjah, were divided into three treatment groups based on their choice. In group I (n = 30), conventional treatment comprising of gentle socket curettage and saline irrigation was done. Group II (n = 15) dry sockets were treated with CGF and group III (n = 15) sockets were lased with LLLT. All dry socket patients were seen at day 0 for treatment and subsequently followed-up at 4, 7, 14, and 21 days. Pain score, perisocket inflammation, perisocket tenderness, and amount of granulation tissue formation were noted.

    STATISTICAL ANALYSIS:  Data were analyzed as mean values for each treatment group. Comparisons were made for statistical analysis within the group and among the three groups to rank the efficacy of treatment using one-way analysis of variance (ANOVA). Statistically significant difference is kept at p < 0.05.

    RESULTS:  Conventional treatment group I took more than 7 days to match the healing phase of group II CGF treated socket and group III LLLT irradiated socket (p = 0.001). When healing rate between CGF and LLLT are compared, LLLT group III showed a delay of 4 days compared with CGF in granulation tissue formation and pain control.

    CONCLUSION:  CGF treated socket was superior to LLLT in its ability to generate 75% granulation tissue and eliminate pain symptom by day 7 (p = 0.001).

    Matched MeSH terms: Pain; Pain Management
  7. Genesan P, Haspani MSM, Noor SRM
    Malays J Med Sci, 2018 Sep;25(5):59-67.
    PMID: 30914863 MyJurnal DOI: 10.21315/mjms2018.25.5.6
    Background: Many different conventional approaches such as the frontal and pterional approaches are used to access anterior circulation aneurysms. Recently, the supraorbital approach has been widely applied to the treatment of anterior circulation aneurysms. This study was done to evaluate which approach (pterional or supraorbital) has better outcomes in terms of residual neck post-clipping, cosmetic satisfaction, scar tenderness, complications and functional outcomes.

    Methodology: A total of 123 patients were recruited into this study, comprising 82 patients who underwent a pterional approach and 41 patients who underwent a supraorbital approach. Computed tomography angiograms, the modified Rankin Scale, and the visual analogue scale were administered at 6 months to look for residual aneurysm, functional outcomes, scar tenderness, and cosmetic satisfaction. Complication data were collected from patients' case notes.

    Results: The mean operating time for the pterional group was 226 min, compared to supraorbital group, which was 192 min (P = 0.07). Cosmetic satisfaction was significantly higher (P = 0.001) in the supraorbital group. There was no significant difference between the supraorbital and pterional groups' scar tenderness (P = 0.719), residual aneurysm (P = 0.719), or functional outcomes (P = 0.137), and there was no significant difference between the groups in terms of intra-operative and post-operative complications.

    Conclusions: The supraorbital group had better cosmetic outcomes and shorter operating times compared to the pterional group.

    Matched MeSH terms: Pain Measurement
  8. Azrina, M.R., Saedah Ali, Mohd Nikman Ahmad, Nik Abdullah, N.M., Ziyadi Mohd Ghazali
    MyJurnal
    Introduction and Objectives: The intensive care unit (ICU) is an uncomfortable and stressful environment for patients. The use of adequate sedation and analgesia is important to reduce stress to patients. The aim of this study was to compare a relatively new sedative agent, dexmedetomidine to current sedative agent used, propofol in the provision of sedation and analgesia, their effects on haemodynamic and respiratory parameters and cost involved on post open heart surgery patients. Materials and Methods: A prospective, randomized single-blinded trial was conducted on post open heart surgery patients in the ICU of the Hospital Universiti Sains Malaysia (HUSM). Thirty two patients were randomized to dexmedetomidine or propofol groups. Analgesic requirement, haemodynamic and respiratory parameters, and extubation time were measured and compared. Mean rate of infusion to achieve adequate sedation were used to calculate the cost involved in the use of these two agents. Results: Patients sedated with dexmedetomidine required significantly lower dose of morphine compared to propofol [mean (sd): 12.80 (2.61) versus 15.86 (1.87) mg/kg/min, p=0.00]. Mean heart rate was also significantly lower in dexmedetomidine group compared to propofol group [mean (CI): 74.48 (70.38,78.59) versus 83.85 (79.61,88.09) per minutes, p=0.00]. However there were no significant differences in the other parameters between the two groups. Cost involved the use of dexmedetomidine was slightly higher compared to propofol (RM 9.57 versus RM8.94 per hour). Discussion and Conclusions: Dexmedetomidine is comparable to propofol in the provision of sedation, and its effect on haemodynamic and respiratory parameters. However it has added advantages in the provision of analgesia, and caused a significant reduction in heart rate. This is beneficial in these patients by reducing myocardial oxygen demand, and hence subsequent ischaemia and infarction. However, further larger studies are needed to evaluate the effect of dexmedetomidine on perioperative cardiac morbidity and mortality.
    Matched MeSH terms: Pain Management
  9. Razak I, Chung TY, Ahmad TS
    J Altern Complement Med, 2019 Aug;25(8):861-867.
    PMID: 31211607 DOI: 10.1089/acm.2019.0052
    Objectives:
    The study aims to assess, evaluate, and compare the efficacy of acupressure and hypnotherapy in the management of pain in patients presenting with chronic brachial neuralgia (CBN).
    Design:
    Randomized controlled trial.
    Settings/location:
    Department of Orthopaedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
    Subjects:
    Forty patients with CBN following traumatic brachial plexus injury from 2012 to 2017.
    Intervention:
    Therapy for a duration of 1 month in two groups; subjects in the hypnotherapy group received a weekly session of clinical hypnotherapy (total of four times) using a standardized protocol, while subjects in the acupressure group were guided by an acupuncturist during the initial session, received 2 month take home supply of acupressure patches, and were reviewed fortnightly.
    Outcome measures:
    The Visual Analog Scale, the Brief Pain Inventory, and the SF-36v2® Health Survey were recorded at different time points; 1 month pretreatment (week 0), pretreatment (week 4), post-treatment (week 8), and 4 months post-treatment (week 20).
    Results:
    There was a statistically significant improvement in the average pain intensity from pretreatment to post-treatment score in both groups. The pain intensity increased 4 months later; however, the pain intensity was still significantly reduced in comparison with pretreatment scores. The study suggests that both treatment outcomes are effective in terms of alleviating pain and improving quality of life in subjects with CBN, to a different degree.
    Conclusion:
    Overall, both therapies were able to improve the pain intensity and quality of life significantly during the treatment period. Hypnotherapy was observed to have a better carryover effect compared to acupressure, especially in terms of improving quality of life and the mental component score.
    Matched MeSH terms: Pain Management/methods*
  10. Endarti D, Riewpaiboon A, Thavorncharoensap M, Praditsitthikorn N, Hutubessy R, Kristina SA
    Value Health Reg Issues, 2018 May;15:50-55.
    PMID: 29474178 DOI: 10.1016/j.vhri.2017.07.008
    OBJECTIVES: To gain insight into the most suitable foreign value set among Malaysian, Singaporean, Thai, and UK value sets for calculating the EuroQol five-dimensional questionnaire index score (utility) among patients with cervical cancer in Indonesia.

    METHODS: Data from 87 patients with cervical cancer recruited from a referral hospital in Yogyakarta province, Indonesia, from an earlier study of health-related quality of life were used in this study. The differences among the utility scores derived from the four value sets were determined using the Friedman test. Performance of the psychometric properties of the four value sets versus visual analogue scale (VAS) was assessed. Intraclass correlation coefficients and Bland-Altman plots were used to test the agreement among the utility scores. Spearman ρ correlation coefficients were used to assess convergent validity between utility scores and patients' sociodemographic and clinical characteristics. With respect to known-group validity, the Kruskal-Wallis test was used to examine the differences in utility according to the stages of cancer.

    RESULTS: There was significant difference among utility scores derived from the four value sets, among which the Malaysian value set yielded higher utility than the other three value sets. Utility obtained from the Malaysian value set had more agreements with VAS than the other value sets versus VAS (intraclass correlation coefficients and Bland-Altman plot tests results). As for the validity, the four value sets showed equivalent psychometric properties as those that resulted from convergent and known-group validity tests.

    CONCLUSIONS: In the absence of an Indonesian value set, the Malaysian value set was more preferable to be used compared with the other value sets. Further studies on the development of an Indonesian value set need to be conducted.

    Matched MeSH terms: Pain Measurement
  11. Loh JW, Taib NA, Cheong YT, Tin TS
    World J Surg, 2020 08;44(8):2656-2666.
    PMID: 32193622 DOI: 10.1007/s00268-020-05458-6
    BACKGROUND: Pre-incision wound infiltration using NSAID is an alternative method to manage post-operative pain in surgery. It is postulated that NSAID delivered peripherally exerts efficient analgesic and anti-inflammatory effect with minimal systemic complication. This study explored the efficacy of using diclofenac for wound infiltration in open thyroidectomy and parathyroidectomy as compared to conventional agent, bupivacaine.

    METHODOLOGY: The study was designed as a double-blind, randomized controlled trial involving 94 patients who underwent open thyroidectomy or parathyroidectomy in Hospital Pulau Pinang, Malaysia, from November 2015 to November 2016. The study compared the efficacy of pre-incision wound infiltration of diclofenac (n = 47) versus bupivacaine (n = 47) in post-operative pain relief. Wound infiltration is given prior to skin incision. Mean pain score at designated time interval within the 24-h post-operative period, time to first analgesia, total analgesic usage and total analgesic cost were assessed.

    RESULTS: Ninety-four patients were recruited with no dropouts. Mean age was 49.3 (SD = 14.2) with majority being female (74.5%). Ethnic distribution recorded 42.6% Chinese, 38.3% Malay, followed by 19.1% Indian. Mean duration of surgery was 123.8 min (SD = 56.5), and mean length of hospital stay was 4.7 days (SD = 1.8). The characteristics of patient in both groups were generally comparable except that there were more cases of total thyroidectomy in the diclofenac group (n = 31) as compared to the bupivacaine group (n = 16). Mean pain score peaked at immediate post-operative period (post-operative 0.5 h) with a score of 3.5 out of 10 and the level decreased steadily over the next 20 h starting from 4 h post-operatively. Pre-incision wound infiltration using diclofenac had better pain control as compared to bupivacaine at all time interval assessed. In the resting state, the mean post-operative pain score difference was statistically significant at 2 h [2.1 (SD = 1.5) vs. 2.8 (SD = 1.8), p = 0.04]. During neck movement, the dynamic pain score difference was statistically significant at post-operative 1 h [2.7 (SD = 1.9) vs. 3.7 (SD = 2.1), p = 0.02]; 2 h [2.7 (SD = 1.6) vs. 3.7 (SD = 2.0), p = 0.01]; 4 h [2.2 (SD = 1.5) vs. 2.9 (SD = 1.7), p = 0.04], 6 h [1.9 (SD = 1.4) vs. 2.5 (SD = 1.6), p = 0.04] and 12 h [1.5 (SD = 1.5) vs. 2.2 (SD = 1.4), p = 0.03]. Mean dose of tramadol used as rescue analgesia in 24 h duration was lower in the diclofenac group as compared to bupivacaine group [13.8 mg (SD = 24.9) vs. 36.2 mg (SD = 45.1), p = 0.01]. The total cost of analgesia used was significantly cheaper in diclofenac group as compared to bupivacaine group [RM 3.47 (SD = 1.51) vs. RM 13.43 (SD = 1.68), p pain relief compared to bupivacaine for patient who had underwent open thyroidectomy or parathyroidectomy. Diclofenac is cheap and easily available in the limited resource setting. This approach offers a superior alternative for post-operative pain relief as compared to bupivacaine.

    Matched MeSH terms: Pain Measurement; Pain, Postoperative/prevention & control*
  12. Hanifah J, Joehaimey J, Yusof MI
    Malays Orthop J, 2017 Jul;11(2):85-88.
    PMID: 29021888 MyJurnal DOI: 10.5704/MOJ.1707.018
    Spinal epidural abscess is a severe, generally pyogenic, infection of the epidural space of spinal cord or cauda equina. The swelling caused by the abscess leads to compression or vascular disruption of neurological structures that requires urgent surgical decompression to avoid significant permanent disability. We share a rare case of Klebsiella pneumoniae spinal epidural abscess secondary to haematogenous spread of previous lung infection that presented late at our centre with cauda equina syndrome that showed good short-term outcome in delayed decompression. A 50-year old female presented with one-week history of persistent low back pain with progressively worsening bilateral lower limb weakness for seven days and urinary retention associated with saddle anesthesia of 2-day duration. Magnetic resonance imaging with contrast of the lumbo-sacral region showed an intramuscular collection of abscess at left gluteus maximus and left multifidus muscle with a L3-L5 posteriorly placed extradural lesion enhancing peripherally on contrast, suggestive of epidural abscess that compressed the cauda equina. The pus was drained using the posterior lumbar approach. Tissue and pus culture revealed Klebsiella pneumoniae, suggestive of bacterial infection. The patient made immediate improvement of muscle power over bilateral lower limbs postoperative followed by ability to control micturition and defecation the 4th post-operative day. A good short-term outcome in delayed decompression of cauda equine syndrome is extremely rare. Aggressive surgical decompression combined with antibiotic therapy led to good short-term outcome in this patient despite delayed decompression of more than 48 hours.
    Matched MeSH terms: Low Back Pain
  13. Memon MA, Yunus RM, Memon B, Awaiz A, Khan S
    Surg Laparosc Endosc Percutan Tech, 2018 Dec;28(6):337-348.
    PMID: 30358650 DOI: 10.1097/SLE.0000000000000589
    AIMS AND OBJECTIVES: The aim was to conduct a systematic review and meta-analysis of the randomized evidence to determine the relative merits of perioperative outcomes of laparoscopic-assisted (LARR) versus open rectal resection (ORR) for proven rectal cancer.

    MATERIALS AND METHODS: A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified English-language randomized clinical trials comparing LARR and ORR. The meta-analysis was prepared in accordance with the PRISMA statement. Thirteen outcome variables were analyzed. Random effects meta-analyses were performed due to heterogeneity.

    RESULTS: A total of 14 randomized clinical trials that included 3843 rectal resections (LARR 2096, ORR 1747) were analyzed. The summary point estimates favored LARR for the intraoperative blood loss, commencement of oral intake, first bowel movement, and length of hospital stay. There was significantly longer duration of operating time of 38.29 minutes for the LARR group. Other outcome variables such as total complications, postoperative pain, postoperative ileus, abdominal abscesses, postoperative anastomotic leak, reintervention and postoperative mortality rates were found to have comparable outcomes for both cohorts.

    CONCLUSIONS: LARR was associated with significantly reduced blood loss, quicker resumption of oral intake, earlier return of gastrointestinal function, and shorter length of hospital stay at the expense of significantly longer operating time. Postoperative morbidity and mortality and analgesia requirement for both these groups were comparable. LARR seems to be a safe and effective alternative to ORR; however, it needs to be performed in established colorectal units with experienced laparoscopic surgeons.

    Matched MeSH terms: Pain, Postoperative/etiology
  14. Lee CY, Osman SS, Noor HM, Isa NSA
    Sultan Qaboos Univ Med J, 2018 Nov;18(4):e541-e544.
    PMID: 30988978 DOI: 10.18295/squmj.2018.18.04.020
    A congenital pulmonary airway malformation (CPAM) is a rare cystic anomaly that may occur during development of the fetal airways. The vast majority of CPAMs are detected in neonates; as such, it is unusual for diagnosis to occur in adulthood. We report a 21-year-old male patient who presented to the emergency department of the Hospital Ampang, Kuala Lumpur, Malaysia, in 2015 with chest pain, breathlessness and tachypnoea. Based on an initial chest X-ray, the patient was misdiagnosed with pneumothorax and underwent urgent chest tube insertion; however, his condition deteriorated over the course of the next three days. Further imaging was suggestive of infected bullae or an undiagnosed CPAM. The patient therefore underwent video-assisted thoracoscopic surgery, during which a large infected bulla was resected. A diagnosis of an infected CPAM was confirmed by histopathological examination. Following the surgery, the patient recovered quickly and no bullae remnants were found at a one-month follow-up.
    Matched MeSH terms: Chest Pain/etiology
  15. Deori A, Gupta N, Gupta AK, Yelamanchi R, Agrawal H, Durga CK
    Malays J Med Sci, 2021 Feb;28(1):97-104.
    PMID: 33679225 DOI: 10.21315/mjms2021.28.1.12
    Background: Axillary dissection is one of the important components of modified radical mastectomy (MRM). The present study was conducted to compare surgical outcomes by using monopolar electrocautery and ultrasonic dissector for axillary dissection in MRM.

    Methods: A parallel randomised controlled single blinded study was conducted with a sample size of 70 patients who were randomised into two groups. One group underwent MRM using ultrasonic dissector (Group A) and the other one using electrocautery (Group B). Intra- and post-operative outcomes were compared.

    Results: Group A had an average operating time of 30.86 min, which was statistically less than that of Group B. The mean mop count and the daily drain output in Group A were less as compared to Group B and the differences were statistically significant. Drain was removed early in Group A as compared to Group B. However, post-operative pain scores and seroma formation were not statistically significant among the two groups.

    Conclusion: Ultrasonic dissector group had significantly lesser intra-operative bleeding, operating time and post-operative drain output when compared to electrocautery group. However, the two groups had no significant difference in post-operative pain scores and seroma formation.

    Matched MeSH terms: Pain, Postoperative
  16. Hui CK, Hui NK
    Gut Liver, 2018 May 15;12(3):288-296.
    PMID: 29212311 DOI: 10.5009/gnl17056
    Background/Aims: The epidemiology of eosinophilic gastroenteritis remains unclear. We aim to determine the prevalence of eosinophilic gastroenteritis in patients with lower abdominal symptoms.

    Methods: In a prospective study, colonoscopy was performed on 2,469 consecutive patients. Biopsies were taken from the terminal ileum and ascending, transverse, descending and sigmoid colon in all patients.

    Results: Sixty-four of the 2,469 patients (2.6%) had eosinophilic gastroenteritis. Only five of the 64 patients (7.8%) with eosinophilic gastroenteritis had endoscopic mucosal abnormalities during colonoscopy. Six of these 64 patients (9.4%) had severe disease at presentation, and seven of these 64 patients (10.9%) required systemic steroid treatment. An elevated absolute peripheral eosinophil count was independently associated with severe disease at presentation (4/6 [66.7%] vs 3/58 [5.2%], p=0.005; odds ratio [OR], 25.320; 95% confidence interval [CI], 2.628 to 243.910), and severe disease at the time of presentation was independently associated with the use of systemic steroid treatment (6/7 [85.7%] vs 0/57 [0%], p=0.008; OR, 18.021; 95% CI, 2.163 to 150.152).

    Conclusions: The prevalence of eosinophilic gastroenteritis is common, and patients usually present normal-appearing mucosa on colonoscopy. Those with severe disease at presentation usually have a raised absolute peripheral eosinophil count and should be commenced on systemic steroids as an initial therapy.

    Matched MeSH terms: Abdominal Pain/etiology
  17. Abd Hamid MH, Abdullah S, Ahmad AA, Narin Singh PSG, Soh EZF, Liu CY, et al.
    Cureus, 2021 Jan 23;13(1):e12876.
    PMID: 33633905 DOI: 10.7759/cureus.12876
    INTRODUCTION: Distal end radius fractures are common fractures commonly treated with an option of open reduction and plating. Traditionally, plating is performed under general anesthesia (GA) or regional block. Recently, a new technique of plating under wide-awake local anesthesia with no tourniquet (WALANT) has been introduced. We aim to compare the preoperative anxiety level, intraoperative pain scores, post-operative pain scores, operating time, blood loss and clinical outcome of distal end radius plating with WALANT versus GA with tourniquet.

    METHODS: We conducted a randomized controlled study on patients with closed fracture of the distal end of the radius requiring open reduction and plating from January 2019 till April 2020. We recruited 65 patients (33 patients in the WALANT group and 32 patients in the GA group). Randomization was done via block randomization. Data were collected to evaluate preoperative anxiety using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) score, intraoperative pain score during injection (baseline) (V1), 10 minutes after injection (V2), during incision (V3), during gentle manipulation (V4), during aggressive manipulation (V5) and during first drilling of screw (V6), blood loss, duration of surgery and post-operative pain score. Additionally, intraoperative visual analog scale (VAS) score was obtained in the WALANT group. At three weeks, six weeks, three months and six months after operation, the Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) scores and range of motion (ROM) of the wrists were obtained.

    RESULTS: The average age in the WALANT group was 47.19 (range, 36-64) years and GA group was 49.48 (range, 38-60) years. The mean APAIS score obtained was 7.78 (WALANT group) and 7.36 (GA group) with no statistical difference. For intraoperative VAS, only during V4 and V5 were the scores 1/10; otherwise at all other phases, the VAS score was 0. The average time for surgery was statistically longer in the WALANT group (61.22 minutes) compared to the GA group (55.33 minutes) (p = 0.003). There was no statistical difference in mean blood loss in both groups. The average post-operative VAS showed statistical significance only at 1 hour and 12 hours post-operation with no statistical difference at 2 and 24 hours post-operation. There was no difference in the post-operative ROM including wrist flexion, extension, supination and pronation for both groups up to six months' follow-up.

    CONCLUSION: There was no statistically significant difference in terms of preoperative anxiety level, intraoperative and post-operative VAS score, amount of blood loss and clinical outcome in both groups for plating of the distal end radius. However, the operating time was slightly longer in the WALANT group. We conclude that distal radius plating under WALANT has similar outcomes to GA. In centres with limited resources, WALANT offers a safe, reliable and cheaper option, reserving GA time for head, abdominal and thoracic surgery.

    Matched MeSH terms: Pain, Postoperative
  18. Sharifudin MA, Zakaria Z, Awang MS, Mohamed Amin MA, Abd Aziz A
    Malays J Med Sci, 2016 Jan;23(1):82-6.
    PMID: 27540330 MyJurnal
    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.
    Matched MeSH terms: Pain
  19. Loh, Li Loong, Wong, Kai Ann, Zamzuri Zakaria@Mohamad
    MyJurnal
    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.
    Matched MeSH terms: Pain
  20. Khan ESKBM, Thean CAP, Zakaria ZB, Awang MSB, Karupiah RK, Awang MB
    J Orthop Case Rep, 2020;10(2):101-105.
    PMID: 32953668 DOI: 10.13107/jocr.2020.v10.i02.1718
    Introduction: Spinal schwannoma can occur anywhere along the spinal cord but is predominantly seen in the cervical and thoracic region.It composes mainly of well-differentiated schwann cell and is benign in nature. It is typically seen in the peripheral nerves and is commonly associated with neurofibromatosis. Up to 80% of cases, spinal schwannoma is reported to be intradural in location and 15% of cases have both intradural and extradural components. Spinal schwannoma rarely causes conus medullaris syndrome.

    Case Report: In this case series, all three female patients in their 4th and 5th decades of life presented with conus medullaris syndrome. Lower back pain, radiculopathy, lower limb weakness, and urinary incontinence are their main clinical presentation. Magnetic resonance imaging shows a well-defined intradural, extramedullary mass compressing onto the conus medullary region. These patients undergone microscopic assisted excision of the tumor and had remarkably good early outcome despite the advanced presentation of neurological deficit.

    Conclusion: Despite the late presentation with significant neurological deficit, surgical excision of spinal schwannomas carries a good prognosis postoperatively due to their benign nature and extramedullary location.

    Matched MeSH terms: Low Back Pain
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