Introduction: The aim of this study is to determine the prevalence of otitis media with effusion (OME) in Malaysian children between three months to twelve years of age and to identify the risk factors associated with it.
Materials and methods: This is a cross-sectional study consists of 153 children selected by stratified random sampling method. Parents of these children were interviewed with a structured questionnaire. Clinical examination, including otoscopic examination and tympanometry was performed for each child.
Results: The prevalence of OME was 18.3%. There was no statistical significant relationship between OME and gender, race, household size, attendance to daycare center, breast feeding, and exposure to passive smoking, allergy, and asthma.
Conclusion: The prevalence of OME is 18.3% in Malaysian children between three months to twelve years of age. Frequency of AOM is a statistically significant factor to the development of OME later in life. The different risk factors associated with OME are still controversial.
This case report describes a rigid bronchoscopy-assisted placement of a silicone airway Y-stent in a patient who developed tracheobronchomalacia following repeated dilatations for post-tuberculous airway stenosis. This is the first report of an airway Y-stent insertion in Malaysia.
Introduction: HCV infection is frequent in patients undergoing maintenance haemodialysis, with prevalence between 8 and 10%. Hepatitis C has an adverse effect on both patient and graft survival in those who get renal transplants. There are relatively scarce reports on the natural fluctuation in viral load level in patients on chronic haemodialysis. Materials and Methods: This is a longitudinal short-term three months study, where 27 chronic haemodialysis patients infected with known HCV genotypes were recruited from seven haemodialysis centres in Pahang. Serum samples were collected monthly, both pre- and post-haemodialysis sessions, over a period of three months. Viral RNA was extracted from serum using QIAamp Viral RNA Extraction kit (Qiagen). The HCV viral load was measured using one-step reverse transcriptase qPCR (Applied Biosystems) targeting the 5`HCV non-coding region (5’UTR). The serum α-IFN level was measured using commercial ELISA kit (Amersham, UK). Six biochemical liver function tests (AST, ALP, TP, albumin, ALT and TB) were also done for all pre-haemodialysis samples. Results: All patients showed persistent low level viral load that varied significantly over the study period (p = 0.001). HCV genotype 1 viral load was significantly higher than that of genotype 3. Conclusion: No apparent correlation could be recognized between the viral loads and the corresponding interferon-alpha levels which were detectable in only a few patients during the period of study.
Introduction: Anterior border of the tibia is covered only by a thin layer of protective tissue. Plating of the tibia often results in wound complication and infection if the injury to this area is not recognized. We review our results of managing infection following plating of the tibia using a protocol base on the status of bone healing and the presence of bone or soft-tissue defect. Methods: Eight cases of infection following plating of the tibia were managed according to stage procedures protocols and classification, which is based on the state of bony union and the defect following wound debridement. The soft-tissue defects were managed with local flaps, and the bone defects were managed with Illizarov bone transport. Results: Three patients had more than one bacterium isolated. Gram negative organisms were isolated from seven patients. Methicillineresistant Staphylococcus aureus was isolated in two patients. All patients achieved union with a mean union
time of seven months. The infections were controlled in seven patients. One patient had minimal sinus discharge but refused further treatment. Conclusions: The stage protocol for the management of infection following plating of the tibia is practical and produces excellent results.
Due to globalizing trend of homogenisation of culture, changes in the health care delivery system and market economics infringing on the practice of medicine, there has been a gradual shift in the attitude of the medical community as well as the lay public towards greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As the subject has gained worldwide prominence, we want to review this topic from Islamic perspective due to its significance in medical ethics and clinical practice.
Ewing's sarcoma is a rare tumor first discovered by James Ewing in 1921. It is more common in bone or skeletal component compared to soft tissue or extraosseous Ewing's sarcoma. Among soft tissue Ewing’s, spinal cord involvement is rarer with only nine cases reported. We report a case of nine-year-old Malay girl who presented with low back pain for two months following a fall with progressive neurological deficits of bilateral lower limb. Magnetic resonance imaging was suggestive of a well-defined margin of intradural extramedullary tumor. With nerve sheath tumor in mind, surgical excision with laminectomy L2-S1 was performed. Intraoperative finding was an extradural mass from L3-L5 with extension to bilateral neuroforamen. Histopathology report defined a round cell tumour of Ewing’s sarcoma from the mass.
Introduction: Our objectives are to identify the incidence of hypophosphatemia and the associated risk factors. We also want to establish intravenous replacement therapy that is effective for ICU patients. Methods: A prospective observational study assessing adults admitted to ICU in between March and May 2009. All patients without baseline phosphate level and renal failure were excluded. They were evaluated for the occurrence of common risk factors. Association with independent variables that includes age, gender and BMI were verified. Evaluation of IV replacement therapy was done in the treated patients. Results: From 50 patients that were reviewed, nine were excluded. There were 66% male and 34% female with mean age 46.88±17.89. The mean ICU stay was 8.00±6.41 days. The incidence of hypophosphatemia was 29% (n=12/41). Gender and
creatinine clearance was found to be significantly different between normophosphatemia and
hypophosphatemia patients. There was no significant association for each potential risk factor and the number of risk factors (≥3) with the incidence of hypophosphatemia. Multi-linear regression analysis showed that lactate, creatinine clearance and pH were significant predictors to the serum levels. A significant difference of mean serum phosphate was seen after repletion by total dose of 10, 20 and 40 mmols in the treatment subgroups. Conclusions: The incidence of hypophosphatemia in our ICU was high and comparable to previous studies. None of the commonly reported risk factors is associated with hypophosphatemia in this studied population. Among all significant correlated variables, only pH was found to be a significant predictor for serum phosphate. Baseline phosphate level may guide the initial replacement dose to prevent delay in normalization of serum levels.
Distant metastasis is a common sequelae of stage III colorectal adenocarcinoma. Liver and lungs are the
most common sites for distant metastases, but, metastases to extremities are very rare. We report a case of rectosigmoid adenocarcinoma, which metastasizes to left first metacarpal bone, which is the first occurrence in our experience. The investigations and management of the patient are discussed.
Introduction: The New Zealand White (NZW) rabbit model is commonly used for the research of
posterolateral intertransverse lumbar arthrodesis. The standard approach reported by many
researchers are a muscle splitting approach through the intermuscular plane between multifidus and longissimus muscles. Methods: In this research the fusion bed was exposed by retracting the three groups of paraspinal muscles (multifidus, longissimus and iliocostalis) medially. Results: This alternative method showed good exposure of the transverse processes and intertransverse membrane with less bleeding from the muscles observed. No death due to surgical complication was observed out of twenty-four rabbits operated. Conclusion: An easy and safe method for performing posterolateral intertransverse lumbar arthrodesis was demonstrated and recommended as an alternative approach for surgery on New Zealand White rabbits.
Introduction: School vision screening program is a scheduled program under the Ministry of Health, Malaysia for 7, 12 and 15 years-old children in the government schools. The aim of this study was to review the school vision screening program from the perspective of the personnel involved as the screener. Methods: The evaluation of the performance of the screener was based upon the accurate referrals' outcome from the school health database of Betong Division in Sarawak, Malaysia in the year of 2008. Results: The total accuracy of the referrals was 50.7%. Lower accuracy of the referrals was found significantly associated with Grade 1 [χ2 (2.N=304) = 28.810, p
Introduction: The New Zealand White (NZW) rabbit model is commonly used for the research of
posterolateral intertransverse lumbar arthrodesis. The standard approach reported by many researchers are a muscle splitting approach through the intermuscular plane between multifidus and longissimus muscles. Methods: In this research the fusion bed was exposed by retracting the three groups of paraspinal muscles (multifidus, longissimus and iliocostalis) medially. Results: This alternative method showed good exposure of the transverse processes and intertransverse membrane with less bleeding from the muscles observed. No death due to surgical complication was observed out of twenty-four rabbits operated. Conclusion: An easy and safe method for performing posterolateral intertransverse lumbar arthrodesis was demonstrated and recommended as an alternative approach for surgery on New Zealand White rabbits.
Introduction: We aim to investigate the effect of vasectomy on the histology of the testis as well as to evaluate DNA fragmentation in testicular tissue of male mice. Methods: Bilateral vasectomy was performed on 20 mature male mice; 10 control mice underwent sham-operation. After 6 weeks, the testes were evaluated for histological changes and DNA fragmentation by single cell gel electrophoresis (comet assay). Results: Marked alterations were observed in the testes of vasectomized mice, including degeneration of spermatids, thickened basement membrane, dilatation of the seminiferous tubules, exfoliation of germ cells, reduction in the seminiferous cell population, vacuolated appearance of the epithelium in the tubules and marked interstitial fibrosis. Single cell gel electrophoresis showed a highly significant (P
Traumatic bilateral sixth cranial nerve palsy is a rare condition which is typically associated with additional intracranial, skull, and cervical spine injuries. We describe a case of complete bilateral sixth nerve palsy in a 28-year-old female patient after an alleged motor vehicle accident. She had altered level of consciousness but no intracranial lesion or associated skull or cervical spine fracture was detected. In this case, we discussed the differential diagnoses, initial workup, and possible treatment options in cases of traumatic 6th nerve palsy.
We report two paediatric patients with massive head and neck plexiform neurofibromas who underwent surgical excision. We wish to highlight issues and implications pertaining to the surgery, in particular, the management of intraoperative bleeding often encountered in these cases.
Nasopharyngeal carcinoma (NPC) is a malignant neoplasm arising from the mucosal epithelium of the
nasopharynx, mainly within the lateral nasopharyngeal recess or Fossa of Rosenmuller. Distant metastasis to the cervical spine is the least common site in the vertebral system. This is a case of a 37-year-old lady with stage IV C nasopharyngeal carcinoma with local extension to the cervical spine who presented with right upper limb weakness.
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.
Introduction: Multiply transfused patients are frequently subjected to platelet alloimmunization. These platelet alloantibodies produced can result in refractoriness to platelet transfusion. Material and Methods: Ninety five thrombocytopenic (platelet count
Background: (13) C – urea breath test (UBT) is sensitive and specific for detection of Helicobacter pylori (H. pylori) infection. Gastric biopsy culture for H. pylori confirms the diagnosis. Here, we analyzed data of all patients who were investigated for H. pylori infection using both tests throughout the year 2005. Materials and Methods : Retrospective data of 377 patients between the ages of 17 – 88 were identified through endoscopy records from January to December 2005. Upper endoscopy, UBT and gastric biopsy culture were performed on all patients simultaneously during each endoscopy session. Patients who had positive UBT and biopsy culture for H. pylori were treated with triple therapy of PPI, amoxicillin and clarithromycin for one week. A repeat of UBT was done at one-month post therapy. Results and Analysis: Twenty-eight patients on the list had no available data on UBT and were omitted from the analysis. Ethnic group Chinese comprised of 45.4% (n=163), followed by Malay, 37.3% (n=134), Indian, 10.6% (n=38) and others, 3.9% (n=14). UBT was positive in 23.7% (n=85)(figure1). H. pylori culture was positive in 19.2% (n=69)(figure1). Sixteen patients with UBT positive had H. pylori culture negative, 18.8% (n=16/85)(figure2). Five patients with H. pylori culture positive had UBT negative, 7.2% (n=5/69)(figure3). Ethnic group Indian had the highest incidence of UBT positive, 47.4% (n=18/38), followed by Others (Sikhs and foreigners) 42.8% (n=6/14), the Chinese 27.6% (n=45/163) and the Malays 11.6% (n= 16/138). UBT positive was the highest in the age group of 50 and above, 64.7% (n=55/85), followed by the age group between 30 to 49, 21.2% (n=18/85) and the age group of 29 and below, 14.5% (n=12/85). Out of the 85 UBT positive patients 91.8% (n=78/85)(figure4) of them responded to the conventional one week of triple therapy (PPI, amoxicillin, clarithromycin) with negative UBT at one-month post therapy compared to only 8.2% (n=7/85)(figure4) who failed with positive UBT at one-month post therapy.
The road safety campaign among car drivers is an ongoing program of the road safety campaigns which is aimed at decreasing the number of accidents involving car drivers and lowering the risks that they might face on the road. It is also aimed at creating good manners among car drivers and at discarding bad habits during driving to avoid accidents. A pre-test was carried out in the early stage of this campaign to assist in the identification of the most effective messages to be advertised in the media. It was carried out in Selangor on 493 respondents randomly chosen to answer the questionnaire provided. Only car drivers were chosen as respondents. The results show that the majority of respondents understood the messages given in the advertisements and fulfilled the requirements of the targeted group. In addition, the respondents said that these advertisements are sufficiently effective to create awareness on road safety through right driving behaviour.
PURPOSE: This review was performed to determine the association between demographic characteristics and the histopathological findings of colorectal cancer (CRC) patients operated in Hospital Tengku Ampuan Afzan (HTAA) Kuantan Pahang Malaysia. METHODS: We retrospectively reviewed the histopathological reports of 119 CRC cases operated in HTAA from January 2001 to December 2005 which met the inclusion criteria of histologically proven adenocarcinoma. The following demographic characteristics which include age, gender, and ethnicity were assessed. The histopathological related variables which include the site of primary tumor, Astler and Coller stage, tumor differentiation and lymph node metastasis were analyzed. Chi square test was used for categorical variables. Data with low expected counts were assessed using Fisher’s exact tests. RESULTS: There were 59 males and 60 females with age ranging from 23 to 93 years. 81.5% of the patients were older than 50 years (p=0.038). Malays accounted for 58.8% of the total cases, followed by Chinese (36.1%) and Indian (5%). Rectosigmoid region and rectum were the most common sites for primary tumor (55.6%). Cancer in male predominantly occurred in the rectum (p=0.023). Malays were commonly diagnosed with stage C2 (54.3%) while Chinese were diagnosed with stage B2 (58.1%) (p=0.011). Fifty percent of the patients who are less than 50 years old were diagnosed with stage C2 (p=0.024). There was significant change from well to moderately differentiated adenocarcinoma (p=0.000). Sixty percent of female patients diagnosed to have cancer with lymph node metastasis (p=0.044). Significant lymph node metastasis was also observed among Malay patients (p=0.022). CONCLUSION: The findings from the present review suggest that there are several associations between demographic distribution and histopathological characteristics of CRC. More than fifty per cent of CRC are found in the rectosigmoid region and the rectum. CRC are more common in Malay race and rectal cancer is predominantly affecting the male. About forty five percent of patients harbor metastases in the lymph nodes and fifty percent of the younger age group were presenting with nodal metastases.