This paper presents a case report of a primary lymphoma of the appendix as the underlying cause of acute appendicitis. As in previous reported cases, diagnosis can only be made intraoperatively followed by a proven histopathological picture as they present with an acute surgical abdomen.
Acute nonspecific carditis with advanced heart block is rare. We observed nine cases with complete heart block and one with Mobitz type II block over an eight and a half year period. Temporary cardiac pacing was instituted in all while permanent pacing was required in six patients. No death was recorded.
In a prospective study of 300 infants with acute gastroenteritis 150 infants had enteropathogens in the stools, 58 being due to rotavirus, 130 to adenovirus, 32 to Sahnonella, 18 Shigella and 29 E. coli. Hypernatraemic dehydration was present in 11% and acquired carbohydrate intolerance in 30% of the infants. Protracted diarrhoea was observed in 8% of infants and was commoner in the bacterial than viral group. The study shows that clinical features and simple blood tests cannot be used as reliable indices of predicting the aetiology of AGE. Despite the diverse aetiology of acute gastroenteritis, rehydration by the oral or intravenous route remained the mainstay of therapy.
Keywords: Kuala Lumpur, university hospital,
The dynamics of the transmission of subperiodic Brugia malayi in a typical endemic area in Malaysia was studied over a period of 4 years. Mass chemotherapeutic control with diethylcarbamazine citrate was found to be inefficient, new cases being detected even after the fifth treatment cycle of 6 mg/kg X 6 days per cycle. This is in marked contrast to the situation in periodic b. malayi areas where mass treatment efficiently controlled the infection. The disparity in results in these two areas is attributed to zoonotic transmission of subperiodic B. malayi from non-human primates where a mean infection rate of 76.3% was found.
A prospective study of acute nephritis in children was conducted at the Universiti Sains Malaysia Hospital, Kubang Kerian between July 1987 and June 1988. One hundred and twenty four children were admitted with acute glomerulonephritis. The aim of the study was to determine the clinical pattern of the nephritis as well as its aetiology. The majority of our patients came from the lower socio-economic group and 54% of the families had incomes below the poverty line. Preceding skin infection was much more common than throat infection. The children showed a high incidence of complications: severe hypertension (43.6%), hypertensive encephalopathy (11.3%), clinical pulmonary oedema (36.3%), severe azotaemia (10.5%), and prolonged gross haematuria (13.7%). By using immunologic indices such as ASOT, anti-DNase B and complement 3, it was concluded that 121 of the 124 patients had post-streptococcal nephritis.
Structured epidemiological studies based on sentinel herds in Indonesia and Malaysia have provided much information regarding the bluetongue (BT) viruses (BTV) and their likely vectors in South-East Asia. Serotypes 1, 2, 3, 7, 9, 12, 16, 21 and 23 have been isolated. Molecular analyses show all group within the Australasian topotype, with four genotypic sub-groupings identified to date. There are relationships to isolates from both India and Australia. Strains of BTV in South-East Asia do not appear to be highly virulent, since BT disease is not seen in local sheep. Known vector species identified include Culicoides fulvus, C. actoni, C. wadai and C. brevitarsis. C. imicola has not been identified in Malaysian or Indonesian studies. Molecular analyses indicate movement of South-East Asian strains of BTV into northern Australia, and the gradation in observations between India and eastern Australia regarding serotype, genotype, virulence and vector species suggests movement along a conceptual gradient through South-East Asia.
The cause and effect relationship between acute pancreatitis and primary hyperparathyroidism (pHPT) still evokes controversy. Our paper reviews the debate in the medical literature. In this controversy we add a case of a 49-year old non-alcoholic man presenting with recurrent attacks of acute pancreatitis. His raised serum calcium was realized rather late. Eventually, high intact parathyroid hormone levels led to open neck exploration and finding of a solitary parathyroid adenoma. Post-surgery, serum calcium returned to normal and abdominal symptoms disappeared. The case report and the accompanying literature review support our belief, that acute pancreatitis is one of the symptoms of pHPT often caused by a parathyroid adenoma and curable by its excision.
AIMS: To examine the expression of the Bcl-2 family of proteins (Bcl-2, Bcl-x, Bcl-xL and Bax) in classical Hodgkin's lymphoma (cHL) and to correlate the expression of these proteins with proliferation, apoptosis and the presence of Epstein-Barr virus (EBV).
METHODS AND RESULTS: Expression of the Bcl-2 family of proteins was detected by immunohistochemistry, proliferation was determined by Ki67 labelling and apoptosis by TUNEL in-situ hybridization. EBV was detected by Epstein-Barr virus early RNA (EBER) in-situ hybridization. Expression of Bcl-2, Bcl-x, Bcl-xL and Bax was detected in the Hodgkin/Reed-Sternberg (H/RS) cells in 43.7% (27/62), 87.5% (56/64), 67.2% (41/61) and 74.6% (47/63) of the cHL cases, respectively. EBER was detected in 53% (35/66) of the cases, whereas Ki67 was observed in 86.7% (52/60) of the cases. Apoptotic H/RS cells were observed infrequently, and only 43.2% (11/26) of the cases showed an apoptotic index of > or = 10% in the H/RS cells. A statistically significant inverse relationship was observed between the expression of Bcl-2 and the presence of EBV (P = 0.003). Bcl-xL showed an inverse correlation with apoptosis in the H/RS cells (P = 0.004).
CONCLUSIONS: The higher Bcl-xL expression (67.2%) compared with Bcl-2 expression (43.5%) observed in cHL as well as the statistically significant inverse relationship between Bcl-xL and apoptosis suggests that Bcl-xL plays an important role in the survival of H/RS cells. Expression of Bax may be neutralized by other anti-apoptotic members of the family such as Bcl-2 and/or Bcl-xL.
Increasing concern about the antibiotic resistance in acute otitis media (AOM) has led to debate over use of antibiotic in AOM and duration of therapy. Many studies have proved that watchful waiting should be used more often for acute otitis media. In children over two years, the most appropriate treatment was found to be initial observation followed by 5 days of an antibiotic if the child failed to improve spontaneously. In children less than 2 years or one with severe symptoms antibiotic can be started after 24 hours if there is no improvement with symptomatic treatment. Physician should be more selective in the prescription of antibiotics early in AOM.
Central nervous system melioidosis is an unusual infection in humans. This article reports a case of melioidosis presenting as an acute spinal epidural abscess. A discussion of this case and its management together with a brief review of melioidosis of the central nervous system is presented.
Salmonella weltevreden has been found to be one of the commonest Salmonella serotypes isolated from diverse sources in India and has also been isolated in a number of other countries. A phage typing scheme was developed for this serotype using a set of six typing phages. These phages had been selected out of 146 phage strains isolated and purified from stool samples of man, laboratory animals and other animals, sewage and surface water sources, and the lytic mutants of temperate phages form S. weltevreden. The phage typing scheme was applied systematically to type the 946 strains from India isolated during 1958-1974 and 148 strains originating from Australia, Burma, England, Gan Island, Holland, Hong Kong, Malaysia, New Zealand, Papua New Guinea, The Philippines, Thailand, The United States and Vietnam during 1953-1971. The scheme was particularly studied to evaluate its utility in mapping the epidemiologically related strains from various sources. The S. weltevreden strains could be classified into ten phage types. Phage types 2 and 7 were found exclusively amongst Indian strains, type 6 from Vietnam and type 8 from Burma, Thailand and Vietnam. Phage types were found to be stable and consistent with the independent epidemiological data available.
Curcuma longa L. uses widely as a traditional medicine especially in India and China for the treatment of diabetic wounds, inflammatory, hepatic, and digestive disorders. These effects lead to the research of this plant for the treatment of chronic diseases. To assess the tumour inhibition effect of curcumin in animal models by integrating various studies into a systematic literature review (SLR) and meta-analysis. Studies of curcumin treatment in tumor-induced animal models were searched in electronic databases. The assessment of the quality of the studies included and the tumor inhibition effect used SYRCLE’s Risk of Bias tool and Review Manager (The Cochrane Collaboration) software. From the 732 articles identified, only 11 studies met the selection criteria and included in the analysis. Curcumin significantly inhibited the tumor volume in the animal models in overall, and the subgroup analyses revealed that high dose, long-duration curcumin treatment, and intervention by injection have a more significant effect compared to the opposite group. Curcumin was effective in inhibiting tumor volume in animal models. The study quality and heterogeneity of the meta-analysis can probably be improved if a larger-scale bases of animal models and a well-designed study were available
Introduction: While sharing a common causal link, both rheumatoid arthritis (RA) and periodontitis (PD) manifest similar inflammatory responses. With the progression of severity, both diseases result in bone loss. Hence, Ca and Zn, as structural components of the bones, are expected to be altered in saliva and serum in PD and RA respectively. Zinc and calcium concentrations have been studied previously in patients with PD or RA, with PD patients exhibiting increased salivary Ca and decreased Zn concentrations in serum, while RA patients have been reported to express low plasma concentrations of both Zn and Ca. The aim of this study is to evaluate the saliva and serum levels of Ca and Zn in PD patients with or without RA. Methods: Serum and saliva samples were collected from 82 patients from the Faculty of Dentistry, University of Malaya and the University Malaya Medical Centre rheumatoid clinic. Patients were grouped according to their periodontal health and RA status (healthy n=21; PD n=21; RA n=21; RAPD n=19). Results: Zinc concentration in serum was significantly higher (p
Introduction:Increasing number and the complexity of dengue cases pose a great challenge. The dengue outbreak preparedness and contingency plan is a series of collective intervention or polices put into place via collective agreement between administrative, Medical, Emergency Department and Intensive Care Unit (ICU). The aim of this paper is to evaluate the impact implementation of a dengue contingency plan on the clinical outcome of dengue cases. Methods: Implementation of the dengue outbreak preparedness and contingency plan was commenced in 2017. A pre-intervention (2017) and post-intervention (2018) retrospective review of mortality cases and referral to ICU were undertaken. The interventions included mandatory fast review by Emergency Physician, Medical Physi-cian and Anaesthesist in Emergency Department for ill patients (Dengue Care Pathway), cohorting dengue patient to one ward with mandatory monitoring and review system, clinical management adhering to the Clinical Practice Guideline of Management of Dengue Infection in Adults (2015), referring ill patients to ICU, deployment of nurses and experienced doctors to the dengue ward based on ratio of staff to patients, increasing number of doctors on-call at the dengue ward and a dengue bed manager system led by the Matron and Sisters. The plan was activated by mutual agreement between the Head of Medical Department and the Hospital Director. Results: There was a marked increment of admission of dengue cases into intensive care unit by 59% either directly from emergency department or the dengue wards in 2018 compared to 2017. The mortality rates reduced significantly from 5.4 deaths for every 1000 admission in 2017 to 3.3 in 2018. This is a reduction 2.1 death for every 1000 dengue admission. Conclusion:The implementation of the dengue outbreak preparedness and contingency plan aided the team to provide best care and practice in dengue management especially in the severely ill.