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Fulltext Acute renal failure in the same hospital ten years apart

Chow YW, Lim BB, Hooi LS

Med J Malaysia, 2007 Mar;62(1):27-32.
PMID: 17682566 MyJurnal

A three month prospective study was carried out in 1994 (8/3/94 - 7/6/94) and late 2004/early 2005 (24/11/2004 - 15/2/2005) among patients with acute renal failure (ARF) (serum creatinine > 0.200 mmol/1). Incidence of ARF had increased from 0.48% (78/16,418) to 1.1% (211/18,697) of admissions between 1994 and 2004. Two thirds of patients were male. Mean age was 57.7 +/- 20.1 years in 1994 and 55.6 +/- 17.8 years in 2004. No difference was noted in causative factors, rate of oliguric ARF (about 10%) and mean peak urea and creatinine. The cause was pre-renal failure in 43.6% in 1994 and 53.5% in 2004. The second commonest cause was sepsis with 41% in 1994 and 37.9% in 2004. One in six patients needed dialysis and peritoneal dialysis was the main dialysis modality (69.2% and 74.3%). Mortality was 56.4% in 1994 and 44.5% in 2004. A quarter of deaths occurred within two days of admission due to severe underlying illness. Mortality among non-oliguric patients decreased from 52.9% in 1994 to 37.0% in 2004 (p = 0.04); for patients from intensive care units it was 78.3% in 1994 and 68.5% in 2004.

Matched MeSH terms: Adolescent
Fulltext Open septorhinoplasty: operative technique and grafts

Gendeh BS, Tan VE

Med J Malaysia, 2007 Mar;62(1):13-8.
PMID: 17682563 MyJurnal

In this case series, the senior author details his series of patients who had undergone open septorhinoplasty for functional and/or aesthetic purposes in the Otorhinolaryngology Department at the Hospital Universiti Kebangsaan Malaysia (HUKM), Kuala Lumpur between January 2003 and September 2005. There were 23 patients, consisting of 15 men and 8 women from different Malaysian ethnic groups. Discussion on open septorhinoplasty with regards to operative technique, grafts and implants is presented from an otorhinolaryngologist's point of view.

Matched MeSH terms: Adolescent
Pleomorphic adenoma in the palpebral lobe of the lacrimal gland misdiagnosed as chalazion

Ramlee N, Ramli N, Tajudin LS

Orbit, 2007 Jun;26(2):137-9.
PMID: 17613864

We reported a case of pleomorphic adenoma of the lacrimal gland involving the palpebral lobe in young teenage girl of Asian origin. The presentation at young age group is rare, which initially misdiagnosed as a large chalazion. The benign tumor with its intact pseudocapsule was removed through lateral orbitotomy together with the suspicious looking orbital lobe.

Matched MeSH terms: Adolescent
Impact of CYP2D6 genetic polymorphism on tramadol pharmacokinetics and pharmacodynamics

Gan SH, Ismail R, Wan Adnan WA, Zulmi W

Mol Diagn Ther, 2007;11(3):171-81.
PMID: 17570739

Tramadol is metabolized by the highly polymorphic enzyme cytochrome P450 (CYP)2D6. Patients with different CYP2D6 genotypes may respond differently to tramadol in terms of pain relief and adverse events. In this study, we compare the pharmacokinetics and effects of tramadol in Malaysian patients with different genotypes to establish the pharmacokinetic-pharmacodynamic relationship of tramadol.

Matched MeSH terms: Adolescent
Vitamin D status and its association with parathyroid hormone concentrations in women of child-bearing age living in Jakarta and Kuala Lumpur

Green TJ, Skeaff CM, Rockell JE, Venn BJ, Lambert A, Todd J, et al.

Eur J Clin Nutr, 2008 Mar;62(3):373-8.
PMID: 17342165

OBJECTIVE: To describe the vitamin D status of women living in two Asian cities,--Jakarta (6 degrees S) and Kuala-Lumpur (2 degrees N), to examine the association between plasma 25-hydroxyvitamin D and parathyroid hormone (PTH) concentrations, and to determine a threshold for plasma 25-hydroxyvitamin D above which there is no further suppression of PTH. Also, to determine whether dietary calcium intake influences the relationship between PTH and 25-hydroxyvitamin D.
DESIGN: Cross-sectional.
SETTING: Jakarta, Indonesia and Kuala Lumpur, Malaysia.
PARTICIPANTS: A convenience sample of 504 non-pregnant women 18-40 years.
MAIN MEASURES: Plasma 25-hydroxyvitamin D and PTH.
RESULTS: The mean 25-hydroxyvitamin D concentration was 48 nmol/l. Less than 1% of women had a 25-hydroxyvitamin D concentration indicative of vitamin D deficiency (<17.5 nmol/l); whereas, over 60% of women had a 25-hydroxyvitamin D concentration indicative of insufficiency (<50 nmol/l). We estimate that 52 nmol/l was the threshold concentration for plasma 25-hydroxyvitamin D above which no further suppression of PTH occurred. Below and above this concentration the slopes of the regression lines were -0.18 (different from 0; P=0.003) and -0.01 (P=0.775), respectively. The relation between vitamin D status and parathyroid hormone concentration did not differ between women with low, medium or high calcium intakes (P=0.611); however, even in the highest tertile of calcium intake, mean calcium intake was only 657 mg/d.
CONCLUSION: On the basis of maximal suppression of PTH we estimate an optimal 25-hydroxyvitamin D concentration of approximately 50 nmol/l. Many women had a 25-hydroxyvitamin D below this concentration and may benefit from improved vitamin D status.

Matched MeSH terms: Adolescent
Role of impacted cerumen in hearing loss

Subha ST, Raman R

Ear Nose Throat J, 2006 Oct;85(10):650, 652-3.
PMID: 17124935

We performed a study to determine if cerumen in the ear canal causes significant hearing loss and to ascertain if there is any correlation between the amount of cerumen and the degree of hearing loss. Our study was conducted on 109 ears in 80 patients. The results indicated that impacted cerumen does cause a significant degree of conductive hearing loss. We found no significant correlation between the length of the cerumen plug and the severity of hearing loss. Nor did we find any significant correlation between the presence of impacted cerumen and variables such as age, sex, ethnicity, or affected side.

Matched MeSH terms: Adolescent
Differential osteogenic activity of osteoprogenitor cells on HA and TCP/HA scaffold of tissue engineered bone

Ng AM, Tan KK, Phang MY, Aziyati O, Tan GH, Isa MR, et al.

J Biomed Mater Res A, 2008 May;85(2):301-12.
PMID: 17688285

Biomaterial, an essential component of tissue engineering, serves as a scaffold for cell attachment, proliferation, and differentiation; provides the three dimensional (3D) structure and, in some applications, the mechanical strength required for the engineered tissue. Both synthetic and naturally occurring calcium phosphate based biomaterial have been used as bone fillers or bone extenders in orthopedic and reconstructive surgeries. This study aims to evaluate two popular calcium phosphate based biomaterial i.e., hydroxyapatite (HA) and tricalcium phosphate/hydroxyapatite (TCP/HA) granules as scaffold materials in bone tissue engineering. In our strategy for constructing tissue engineered bone, human osteoprogenitor cells derived from periosteum were incorporated with human plasma-derived fibrin and seeded onto HA or TCP/HA forming 3D tissue constructs and further maintained in osteogenic medium for 4 weeks to induce osteogenic differentiation. Constructs were subsequently implanted intramuscularly in nude mice for 8 weeks after which mice were euthanized and constructs harvested for evaluation. The differential cell response to the biomaterial (HA or TCP/HA) adopted as scaffold was illustrated by the histology of undecalcified constructs and evaluation using SEM and TEM. Both HA and TCP/HA constructs showed evidence of cell proliferation, calcium deposition, and collagen bundle formation albeit lesser in the former. Our findings demonstrated that TCP/HA is superior between the two in early bone formation and hence is the scaffold material of choice in bone tissue engineering.

Matched MeSH terms: Adolescent
The prevalence of domestic violence against pregnant women in Perak, Malaysia

Jahanfar S, Kamarudin EB, Sarpin MA, Zakaria NB, Abdul Rahman RB, Samsuddin RD

Arch Iran Med, 2007 Jul;10(3):376-278.
PMID: 17604477

Domestic violence during pregnancy is a key issue in maternal and fetal mortality and morbidity. This cross-sectional study aimed at obtaining the prevalence of domestic violence amongst pregnant women who attended Ipoh General Hospital in Perak, Malaysia and to determine the risk factors associated with domestic violence during pregnancy. The prevalence of domestic violence was low (4.5%). Comparison between the two groups of subjects with or without domestic violence did not show any significant difference in terms of risk factors. The effect of domestic violence on pregnancy should be investigated comprehensively in a multicentral or community-based study using a culturally sensitive questionnaire. With the estimated low prevalence of domestic violence in this study, the need for screening it in health-care services in Malaysia is yet to be determined.

Matched MeSH terms: Adolescent
Fulltext Distraction osteogenesis over intramedullary nail: a report of two cases

Sulaiman AR, Munajat I, Liau KM, Salehuddin AY, Shukrimi A

Med J Malaysia, 2006 Dec;61 Suppl B:48-50.
PMID: 17600992

Distraction osteogeneis over intramedullary nail has a benefit of decreasing the time for external fixation thus reducing the rate of associated complications. However, risk of panosteomyelitis is still the major worry. We are reporting two patients who underwent the procedure. The first case was a 13-year-old girl requiring 6 cm of femoral lengthening and the second case was a 17-year-old girl who required 5 cm of tibial lengthening. The healing index was 19.5 days/cm and 14.8 days/cm respectively, compared favorably to 30 days/cm with traditional method of distraction osteogenesis. There were mild pin tract infections and joint stiffness which responded to non-operative treatment.

Matched MeSH terms: Adolescent
Culture, gender, and the self: variations and impact of social comparison processes

Guimond S, Branscombe NR, Brunot S, Buunk AP, Chatard A, Désert M, et al.

J Pers Soc Psychol, 2007 Jun;92(6):1118-34.
PMID: 17547492

Psychological differences between women and men, far from being invariant as a biological explanation would suggest, fluctuate in magnitude across cultures. Moreover, contrary to the implications of some theoretical perspectives, gender differences in personality, values, and emotions are not smaller, but larger, in American and European cultures, in which greater progress has been made toward gender equality. This research on gender differences in self-construals involving 950 participants from 5 nations/cultures (France, Belgium, the Netherlands, the United States, and Malaysia) illustrates how variations in social comparison processes across cultures can explain why gender differences are stronger in Western cultures. Gender differences in the self are a product of self-stereotyping, which occurs when between-gender social comparisons are made. These social comparisons are more likely, and exert a greater impact, in Western nations. Both correlational and experimental evidence supports this explanation.

Matched MeSH terms: Adolescent
Intraoperative small-dose ketamine does not reduce pain or analgesic consumption during perioperative opioid analgesia in children after tonsillectomy

Batra YK, Shamsah M, Al-Khasti MJ, Rawdhan HJ, Al-Qattan AR, Belani KG

Int J Clin Pharmacol Ther, 2007 Mar;45(3):155-60.
PMID: 17416110

OBJECTIVE: Ketamine inhibits the NMDA receptors via non-competitive antagonism, resulting in an antihyperalgesic effect achieved by doses of ketamine much smaller than are required for analgesia. The aim of this study was to determine the extent to which small-dose ketamine, when used in conjunction with remifentanil, has a morphine-sparing effect in the perioperative period.
MATERIALS AND METHODS: In this randomized, double-blind, placebo-controlled prospective study, we enrolled 40 children undergoing tonsillectomy. Anesthetic care was standardized. Intraoperative analgesia was provided with remifentanil 0.5 microg x kg(-1) followed by an infusion of 0.25 microg x kg(-1) x min(-1). Group I (ketamine, n = 20) received a bolus dose of ketamine 0.5 mg x kg(-1) followed by a continuous infusion of 2 microg x kg(-1) x min(-1) before start of surgery. The infusion was stopped when surgery ended. Group II (placebo, n=20) received normal saline in the same manner. Pain was assessed postoperatively using the Children's Hospital Eastern Ontario Pain Scale (CHEOPS; range of scores 4 13), and total morphine consumption was recorded in the postanesthesia care unit (PACU). Patients were transferred to the ward and morphine was administered via a patient-controlled analgesia (PCA) device and analgesia was recorded using a visual analogue scale (VAS) (0 - 10).
RESULTS: Intraoperative remifentanil consumption was not different between the ketamine group (0.29+/-0.09 microg x kg x min(-1) ) and the control group (0.24+/-0.07 microg x kg x min(-1)). There were no significant differences between CHEOPS scores and VAS score between the two groups. The total mean morphine consumption in the ward was not significantly different between the two groups: 376.5 +/-91.6 microg x kg(-1) with ketamine and 384.4+/-97.3 microg x kg(-1) with placebo. The time-to-first analgesic requirement was also similar in both groups.
CONCLUSIONS: Small-dose ketamine did not decrease postoperative pain after tonsillectomy in children when added to a continuous intraoperative remifentanil infusion.

Matched MeSH terms: Adolescent
Aspiration of breast abscess under ultrasound guidance: outcome obtained and factors affecting success

Elagili F, Abdullah N, Fong L, Pei T

Asian J Surg, 2007 Jan;30(1):40-4.
PMID: 17337370

To assess ultrasonographically (US) guided needle aspiration of breast abscesses as an alternative to surgical incision and drainage.

Matched MeSH terms: Adolescent
Fulltext The transcolumellar transsphenoidal approach to pituitary tumours: advantanges and limitations

Gendeh BS, Sakina MS, Selladurai BM, Jegan T, Misiran K

Med J Malaysia, 2006 Aug;61(3):349-54.
PMID: 17240588

A retrospective review was performed on 11 patients who had undergone the transcolumellar transsphenoidal hypophysectomy in our center. There were eight females and three males with age ranging from 17 to 72 years (mean 50 years). Ten patients had pituitary macroadenomas and one had suprasellar cyst. The mean follow up duration for these 11 patients post surgery was 7.2 months. Complications included two cerebrospinal leaks, one postoperative sphenopalatine bleed, one septal perforation and one patient developed numbness of the tip of the nose. We found that this approach is a preferred alternative technique especially in smaller Oriental noses with lower complication rate and better aesthetic result.

Matched MeSH terms: Adolescent
Fulltext The role of endoscopic endonasal approach to pituitary tumours: HUKM experience

Gendeh BS, Doi M, Selladurai BM, Khalid BA, Jegan T, Misiran K

Med J Malaysia, 2006 Aug;61(3):343-8.
PMID: 17240587

Surgery for pituitary tumours at our institution was performed by rhinosurgical route by combined procedure by otolaryngologist and neurosurgeons. A retrospective review of case records of patients who had endonasal endoscopic transphenoidal approach for pituitary tumours from September 1998 to December 2004 was performed. A total of 81 trans-sphenoidal surgeries were performed during this study period. Only 68 case records with adequate information were available for review, 56 patients were included in the study and 12 were excluded. There were 24 males (42%) and 32 females (58%). The ethnic distribution, were 29 Malays, 24 Chinese, 2 Indian and 1 others. The age ranged from 16 years to 76 years, with a mean of 46 years. The majority of our patients presented with visual symptoms (38), headache (28), menstrual cycle disturbance or impotence (14) and acromegalic features (16). Forty patients had macroadenoma (71%) and 16 had microadenomas (29%). Thirty-six patients out of 40 macro-adenomas had suprasellar extensions (90%). Only eleven patients had lumbar drain inserted prior to commencement of the surgery and the majority of these were macroadenomas. The common complications encountered were diabetes insipidus (4), cerebrospinal fluid leak (2), meningitis (3), epistaxis (2), septal perforation (2), intercavernous sinus haemorrhage (3) and anterior pituitary insufficiency (2). Our study reveals that endonasal trans-sphenoidal approach is a safe and effective method of management of pituitary adenomas.

Matched MeSH terms: Adolescent
Fulltext Epilepsy surgery on dysembryoplastic neuroepithelial tumours

Sayuthi S, Tharakan J, George J, Pieter MS, Salmah WM, Madhavan M, et al.

Med J Malaysia, 2006 Aug;61(3):374-6.
PMID: 17240596 MyJurnal

Two rare cases of intractable epilepsy caused by Dysembryoplastic Neuroepithelial Tumours (DNET) are reported and their different management discussed. The first case required vagal nerve stimulation and radiosurgery while the later was operated with the help of neuronavigation. Both had good outcome according to Engel classification after a one year follow up.

Matched MeSH terms: Adolescent
Cranial base and airway morphology in adult malays with obstructive sleep apnoea

Banabilh SM, Suzina AH, Dinsuhaimi S, Singh GD

Aust Orthod J, 2007 Nov;23(2):89-95.
PMID: 18200785

Obstructive sleep apnoea (OSA) has been described as a public health problem comparable to smoking in its impacts upon society.

Matched MeSH terms: Adolescent
Fulltext Linkage and association studies in a Malaysian family with autosomal recessive non-syndromic hearing loss

Farah WI, Aminuddin BS, Ruszymah BH

Malays J Pathol, 2006 Jun;28(1):23-33.
PMID: 17694956 MyJurnal

Hearing loss is a common sensory deficit in humans. The hearing loss may be conductive, sensorineural, or mixed, syndromic or nonsyndromic, prelingual or postlingual. Due to the complexity of the hearing mechanism, it is not surprising that several hundred genes might be involved in causing hereditary hearing loss. There are at least 82 chromosomal loci that have been identified so far which are associated with the most common type of deafness--non-syndromic deafness. However, there are still many more which remained to be discovered. Here, we report the mapping of a locus for autosomal recessive, non-syndromic deafness in a family in Malaysia. The investigated family (AC) consists of three generations--parents who are deceased, nine affected and seven unaffected children and grandchildren. The deafness was deduced to be inherited in an autosomal recessive manner with 70% penetrance. Recombination frequencies were assumed to be equal for both males and females. Using two-point lod score analysis (MLINK), a maximum lod score of 2.48 at 0% recombinant (Z = 2.48, theta = 0%) was obtained for the interval D14S63-D14S74. The haplotype analysis defined a 14.38 centiMorgan critical region around marker D14S258 on chromosome 14q23.2-q24.3. There are 16 candidate genes identified with positive expression in human cochlear and each has great potential of being the deaf gene responsible in causing non-syndromic hereditary hearing loss in this particular family. Hopefully, by understanding the role of genetics in deafness, early interventional strategies can be undertaken to improve the life of the deaf community.

Matched MeSH terms: Adolescent
Prognostic study of using different monitoring modalities in treating severe traumatic brain injury

Idris Z, Ghani RI, Musa KI, Ibrahim MI, Abdullah M, Nyi NN, et al.

Asian J Surg, 2007 Jul;30(3):200-8.
PMID: 17638640

To determine whether or not multimodality monitoring technique would result in a better outcome score than single modality monitoring in severely head injured patients.

Matched MeSH terms: Adolescent
The association between HLA genes and radiological erosions in Malaysian patients with rheumatoid arthritis

Yeap SS, Mohd A, Kumar G, Kong KF, Chow SK, Goh EM, et al.

Autoimmunity, 2007 May;40(3):187-90.
PMID: 17453717 DOI: 10.1080/08916930701233755

OBJECTIVE:
To assess the relationship between the HLA-DRB1 genes with disease severity as assessed by radiological erosions in Malaysian patients with rheumatoid arthritis (RA).

METHODS:
In this cross-sectional study, we studied 61 RA patients who fulfilled the ACR criteria for the diagnosis of RA. HLA-DRB1 genotyping was performed by sequence specific primer (SSP) - PCR. Radiological grading and erosive score of the hands and wrists was calculated according to the Larsen-Dale method. Demographic data and treatment given to the patients were obtained from their case records.

RESULTS:
Fifty-six females and five males were studied from three ethnic groups. In 57 patients with erosions, rheumatoid factor was detected in 80%, HLA-DR4 in 40%, HLA-DRB1*0405 in 24% and shared epitope (SE) in 31%. The median delay in starting DMARDs was 24 months. The presence of rheumatoid factor, HLA-DR4 and HLA-DRB1*0405 were not significantly associated with a worse erosive score. Patients who possessed the SE had a higher erosive scores, compared to those who did not (p = 0.05). Concurrently, a delay in starting DMARD was associated with a high erosive score (p = 0.023, r = 0.348). However, after adjustment for the delay in starting DMARD, SE was no longer significantly associated with the erosive score.

CONCLUSIONS:
In these patients, the delay in starting DMARDs had a greater influence on the erosive score than SE alone. Whilst we cannot discount the contribution of the SE presence, we would advocate early usage of DMARDs in every RA patient to reduce joint erosions and future disability.

Matched MeSH terms: Adolescent
Reconstruction of living bilayer human skin equivalent utilizing human fibrin as a scaffold

Mazlyzam AL, Aminuddin BS, Fuzina NH, Norhayati MM, Fauziah O, Isa MR, et al.

Burns, 2007 May;33(3):355-63.
PMID: 17321690

Our aim of this study was to develop a new methodology for constructing a bilayer human skin equivalent to create a more clinical compliance skin graft composite for the treatment of various skin defects. We utilized human plasma derived fibrin as the scaffold for the development of a living bilayer human skin equivalent: fibrin-fibroblast and fibrin-keratinocyte (B-FF/FK SE). Skin cells from six consented patients were culture-expanded to passage 1. For B-FF/FK SE formation, human fibroblasts were embedded in human fibrin matrix and subsequently another layer of human keratinocytes in human fibrin matrix was stacked on top. The B-FF/FK SE was then transplanted to athymic mice model for 4 weeks to evaluate its regeneration and clinical performance. The in vivo B-FF/FK SE has similar properties as native human skin by histological analysis and expression of basal Keratin 14 gene in the epidermal layer and Collagen type I gene in the dermal layer. Electron microscopy analysis of in vivo B-FF/FK SE showed well-formed and continuous epidermal-dermal junction. We have successfully developed a technique to engineer living bilayer human skin equivalent using human fibrin matrix. The utilization of culture-expanded human skin cells and fibrin matrix from human blood will allow a fully autologous human skin equivalent construction.

Matched MeSH terms: Adolescent

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