The healing of wound is a complex process which requires the interactions of different cells and extracellular molecules. The normal wound healing process can be divided into four overlapping phases i.e. haemostasis, inflammation, proliferation and remodeling. In diseased condition like diabetes mellitus, the wound healing process is grossly impaired, resulting in chronic wounds which fail to heal. In the past decades, several researchers have tested various traditional medicines obtained from the plants for their wound healing properties. Such traditional plants are Aloe vera, Calotropis procera, Portulaca oleracea, Acalypha langiana, Plagiochasma appendiculatum and Momordica charantia. Perhaps one of the most popular and easily available plant is Momordica charantia (bitter gourd). The present article presents an extensive review on the impaired wound healing process in diabetes mellitus and highlights the use of traditional medicines in diabetic wounds.
The development of induced pluripotent stem cells (iPSCs) has been met with much enthusiasm and hailed as a breakthrough discovery by the scientific and research communities amidst the divisive and ongoing debates surrounding human embryonic stem cells (hESC) research. The discovery reveals the fact that embryonic pluripotency can be generated from adult somatic cells by the induction of appropriate transcriptional factor genes essential for maintaining the pluripotency. They provide an alternative source for pluripotent stem cells, thus representing a powerful new research tool besides their potential application in the field of regenerative medicine. In this review, the historical background of iPSCs generation will be discussed together with their properties and characteristics as well as their potential therapeutic applications.
Non-secretory multiple myeloma (NSMM) is a rare variant of the classic form of multiple myeloma (MM). In NSMM, no monoclonal gammopathy can be detected in serum or urine by conventional techniques, making the diagnosis more difficult. We describe a 71-year-old man who had been diagnosed and treated for granulocytic sarcoma one year prior to his recent problems of progressive low-back pain of two months duration. Skeletal X-rays showed diffuse osteolytic lesions with multiple pathological fractures but there was no monoclonal gammopathy in the serum or urine. The biopsy of the lytic lesion on the upper part of the femur showed infiltration by abnormal plasma cells. A diagnosis of NSMM was made and he was treated with chemotherapy. The early diagnostic difficulty and the challenges faced regarding the case are discussed.
A systematic approach to death registration and reporting is essential for studies and comparison within or between countries. One of the accepted methods in the system is to have medically certified death. The objective of this study was to improve the proportion of medically certified death (MCD) in the state of Malacca. Structured questionnaires were used by Medical Assistants (MAs) in the investigation of the cause of death for non-medically certified deaths. Data on certification of death by MAs in Malacca was analysed and compared with the total deaths obtained from the Department of Statistics. Possible determinants of deaths were investigated. Total deaths in the state of Malacca during the study period from 2000 - 2001 were 5941. About 35% (883/2493) of the total deaths in year 2000 and 45% (1550/3448) in 2001 certified by MAs were examined. By districts, 50.6% were certified in the district of Malacca Tengah, 13.4% Jasin and 36.0% Alor Gajah in 2000; 65.9% occurred in Malacca Tengah, 11.0% Jasin and 23.2% Alor Gajah in 2001. This project helped to increase the percentage of the medically certified deaths in Malacca from 49.8% in year 1998, 49% in 1999 to 73% in 2000 and 85% in 2001. The proportion of MCD in Malacca in 2000 (73%) may be increased to 93% if all MCDs done by MAs were accepted by the Department of Statistics. There is still a high proportion (23.6%) of ill-defined conditions such as old age and sudden death being diagnosed by MAs. The study shows that the quality of mortality data particularly in the percentage of medically certified deaths can be improved.
Opportunistic pneumonias are major causes of morbidity and mortality in HIV infected individuals. The majority of new HIV infections in Malaysia are adults aged 20 to 39 years old and many are unaware of their HIV status until they present with an opportunistic infection. HIV associated opportunistic pneumonias can progress rapidly without appropriate therapy. Therefore a proper diagnostic evaluation is vital and prompt empiric treatment of the suspected diagnosis should be commenced while waiting for the results of the diagnostic studies. Tuberculosis, Pneumocystis pneumonia (PCP) and recurrent bacterial pneumonias are common causes of AIDS-defining diseases and are discussed in this article.
Hyperkalaemia is a life threatening acute medical emergency. Patients with end stage renal failure are more prone to get hyperkalaemia as potassium is normally excreted via the kidneys. Therefore, patients with end stage renal failure should avoid food with high potassium contents. Bananas are well known to have high potassium content. However, the 'king of fruits' the durian, has higher potassium content compared to bananas. We describe a case of life threatening hyperkalaemia in a lady with end stage renal failure who ate durians prior to her presentation.
Killian-Jamieson (K-J) diverticulum is a rare cervical oesophageal diverticulum, less commonly encountered compared with Zenker's diverticulum (ZD). We report a case of K-J diverticulum in a 52-year-old lady who presented with sensation of lump in the neck and food stuck in the throat of 5 years duration. Esophagogram showed a large rightsided pharyngoesophageal diverticulum which was confirmed on endoscopy. The patient underwent a diverticulopexy and recovered without complications. Her symptoms had improved. In this report, we review the literature and describe our surgical technique.
This paper deals with the interface-relevant activity of a vehicle integrated intelligent safety system (ISS) that includes an airbag deployment decision system (ADDS) and a tire pressure monitoring system (TPMS). A program is developed in LabWindows/CVI, using C for prototype implementation. The prototype is primarily concerned with the interconnection between hardware objects such as a load cell, web camera, accelerometer, TPM tire module and receiver module, DAQ card, CPU card and a touch screen. Several safety subsystems, including image processing, weight sensing and crash detection systems, are integrated, and their outputs are combined to yield intelligent decisions regarding airbag deployment. The integrated safety system also monitors tire pressure and temperature. Testing and experimentation with this ISS suggests that the system is unique, robust, intelligent, and appropriate for in-vehicle applications.
Chikungunya virus (CHIKV) is transmitted by Aedes mosquitoes and causes an acute symptomatic illness with fever, skin rash, and incapacitating arthralgia, which can evolve into chronic rheumatoid arthritis in elderly patients. This is a tropical disease originally described in central/east Africa in the 1960s, but its 2004 re-emergence in Africa and rapid spread in lands in and around the Indian Ocean (Reunion island, India, Malaysia) as well as Europe (Italy) led to almost 6 million cases worldwide. The risk of importation and spreading diseases with long-term sequelae is even greater today given the global distribution of the vectors (including in the Americas), increased tourism and the apparent capacity of CHIKV to produce high levels of viremia (10(9)-10(12) virus/ml of blood) and new mutants. CHIKV-associated neuropathology was described early in the 1960s, but it is the unprecedented incidence rate in Indian Ocean areas with efficient clinical facilities that allowed a better description of cases with severe encephalitis, meningoencephalitis, peripheral neuropathies and deaths among newborns (mother-to-child infection), infants and elderly patients. Death rates following CHIKV infection were estimated at 1:1000 cases in la Reunion's outbreak. These clinical observations have been corroborated by experimental infection in several mouse models, leading to CNS pathologies. We further describe in this review the capacity of CHIKV to infect neurons and glial cells, delineate the fundamental innate (intrinsic) immune defence mechanisms to protect from infection and argue about the possible mechanisms involved in the encephalopathy.
Autonomic dysreflexia (AD) is not an uncommon clinical condition and it is usually detected in patients with complete spinal injuries at or above thoracic 6th vertebral level (T 6). This condition is reported to occur in 48- 60% of cases of spinal cord injury at or above the level of T6. But AD due to injury below T6 is rare. The basic mechanism is thought to be due to excessive, uncontrolled activation of sympathetic system. In the present case, we discuss a persistent AD in 55-yr-old tetraplegic patient with C5 American Spinal Injury Association (ASIA) grade A lesion due to a fall from 10 metre height. MRI examination showed C5 and C6 bi-facets fracture and dislocation with canal compromise. Wiring and fusion was performed but recurrent mucous plugging and aspiration pneumonia and urinary tract infection happened during the hospital stay. Three months later, he was re-admitted with multiple pressure sores, pneumonia, sepsis and high blood pressure. He was administered with nifedepine but the blood pressure kept fluctuating. The present study highlights how the precipitating factors like concomitant urinary tract infection, decubitus ulcers, spasticity triggered the AD attack. The knowledge of the AD and its proper diagnosis and management may be beneficial to all clinicians and the present article attempts to highlight such.
A university student, 20 years of age, noticed a mass on her palate one morning while looking in the mirror. She has not experienced any symptoms such as pain or discomfort.
OBJECTIVE: The aim of this study was to validate the Malay version of the Multidimensional Scale of Perceived Social Support (MSPSS-M) among a group of medical students in Faculty of Medicine, University Malaya.
METHODS: 237 students participated in the study. They were given the Malay version of MSPSS, medical outcome study (MOS) social support survey, Malay version of General Health Questionnaire (GHQ), Malay version of Beck Depression Inventory (BDI) and English version of MSPSS. A week later, these students were again given the Malay version of MSPSS.
RESULTS: The instrument displayed good internal consistency (Cronbach's alpha=0.89), parallel form reliability (0.94) and test-retest reliability (0.77) (Spearman's rho, p<0.01). The negative correlation of the total and subscales of the instrument with the Malay version of GHQ and BDI confirmed its validity. Extraction method of the 12 items MSPSS using principle axis factoring with direct oblimin rotation converged into three factors of perceived social support (Family, Friends and Significant Others) with reliability coefficients of 0.88, 0.82 and 0.94, respectively.
CONCLUSION: The Malay version of the MSPSS demonstrated good psychometric properties in measuring social support among a group of medical students from Faculty of Medicine, University Malaya and it could be used as a simple instrument on young educated Malaysian adolescents.
Umbilical Cord Blood Transplant (UCBT) is a type of allogenic haematopoetic stem cell transplant. Stem cell transplantation as a mode of treatment of diseases was first successfully done by the pioneering work of a Nobel Prize Winner in Physiology or Medicine, E. Donnall Thomas in 1957. Throughout the past 50 years, numerous other researchers have improved the techniques of this previously highly risky procedure. Among the notable landmark in haematopoetic stem cell transplant include: advancement in immunogenetics of HLA, better immunosuppressive preparative regimen, improved control of infections, appearance of donor registries throughout the world and successful transplantation stories using haematopoetic stem cells from peripheral blood and the cord blood. These developments lead to a change in terminology from marrow transplantation to haematopoetic stem cell transplantation .
OBJECTIVE: The purpose of this study was to determine the feasibility of a chiropractic practice-based research network to investigate the treatment of acute neck pain (ANP) and to report resulting findings.
METHODS: Participating chiropractors recruited sequentially presenting ANP patients on their initial visit to the office. Patients were treated by the chiropractors using their usual methods. Data were prospectively collected by having patients complete the Neck Disability Index, Characteristic Pain Intensity score, and a patient satisfaction questionnaire. Questionnaires were completed during routine office visits at baseline and then at weeks 1, 2, 4, 8, and 26, either in the office or by mail.
RESULTS: Ten chiropractors supplied data on 99 patients. The number of cases contributed by each of the participating chiropractors ranged from 1 to 54, with a mean (SD) of 9.2 (10.5). Mean (SD) Neck Disability Index scores were 36 (17.9) at baseline and 9.8 (12.2) at the final evaluation; the Characteristic Pain Intensity scores were initially 55.3 (20.4) and were 24.5 (21.5) at the final evaluation. Transient minimal adverse effects were reported by chiropractors for only 7 (7.8%) patients. No serious adverse reactions were reported.
CONCLUSION: The practice-based research methodology used in this study appears to be a feasible way to investigate chiropractic care for ANP, and its methodologies could be used to plan future research.
The sphenoid bone is known to have several foramina and the foramen ovale is one amongst them. The foramen ovale transmits the mandibular nerve, accessory meningeal artery, lesser petrosal nerve and the emissary veins. There have been past reports on the variations of the different foramina present in the skull but there are no reports on the variations of the skull foramina from any of the South-East Asian countries. The present study aims to highlight the presence of an accessory foramen ovale in the skull in Malaysian population. Both sides of fifteen adult skulls (n = 30) were taken for observation of any variations in the foramen ovale. We observed the presence of accessory foramen ovale on the left side of a single skull (3.33%). The minute accessory foramen ovale was located 0.1 cm medial to the normal foramen ovale. The anomalous accessory foramen ovale was circular in shape and measured 0.1 cm in diameter. Anatomical knowledge of the foramen ovale is important for all neurosurgical procedures involving the trigeminal nerve and administration of anaesthesia in the mandibular nerve. Interestingly, the percutaneous biopsy of the cavernous sinus is also performed through the foramen ovale. Prior knowledge of the presence of an accessory foramen ovale may be important for academic, anthropological, forensic and clinical purpose and the present study aims to highlight such.
Chronic Heart Failure (CHF) is a debilitating illness commonly encountered in primary care. Its prevalence in developing countries is rising as a result of an ageing population, and an escalating epidemic of hypertension, type 2 diabetes and coronary heart disease. CHF can be specifically diagnosed as Heart Failure with Reduced Systolic Function (HF-RSF) or Heart Failure with Preserved Systolic Function (HF-PSF). This paper illustrates a common presentation of HF-PSF in primary care; and critically appraises the evidence in support of its diagnosis, prognosis and management. Regardless of the specific diagnosis, long term management of CHF is intricate as it involves a complex interplay between medical, psychosocial, and behavioural factors. Hence, there is a pressing need for a multidisciplinary team management of CHF in primary care, and this usually takes place within the broader context of an integrated chronic disease management programme. Primary care physicians are ideally suited to lead multidisciplinary teams to ensure better co-ordination, continuity and quality of care is delivered for patients with chronic conditions across time and settings. Given the rising epidemic of cardiovascular risk factors in the Malaysian population, preventive strategies at the primary care level are likely to offer the greatest promise for reducing the growing burden of CHF.
This survey set out to describe patient registries available in the country, to determine their security features, data confidentiality, extent of outputs produced and data quality of the registries.