Stroke is becoming a major public health issue in our country due to the fact that there isan increasing life span of our population. Due to advancement of acute management of stroke, three out of four people will survive beyond the acute phase of stroke. Stroke careproviders are still debating regarding the exact period of the terminology ‘longer-term stroke’; however many agreed that long-term of stroke refers to the period of one year and thereafter as this period is the determinant for longer-term survival. Management beyond the first year of stroke is complex, encompasses all aspects of patient’s life; physical, psychological and integration into community. Rehabilitation being the cornerstone of longer-term stroke management should now focused on more evidence-based approach as to be effective and relevant to the stroke patients.
This is a report of a patient on multiple antipsychotic medications for the treatment of schizophrenia. Often, polypharmacy is not encouraged, however, with the advent of newer atypical antipsychotic agents, this practice may need review. This case will be used to highlight the rare instances when polypharmacy may be useful prior to the commencement of clozapine for the treatment of schizophrenia.
The aim of this study is to evaluate the treatment outcome using fixed and removable appliances, in the Faculty of Dentistry, University of Malaya (U.M.). The study models of 25 fixed and 30 upper removable appliance cases, with complete written records were examined before and after orthodontic treatment using the PAR (Peer Assessment Rating) Index. All the data were analyzed using the Statistical Package for Social Sciences (SPSS) for Windows. Eighty five percent of the cases selected as sample were either 'improved' or 'greatly improved'. Among the 10 cases which were 'greatly improved', all had high pre-treatment PAR points (> 35 PAR points). Conversely, all the eight cases classified as 'worse or no different' were with low pretreatment PAR scores « 20 PAR points). The mean treatment duration in this study was 23. I months, ranging from 2 months to 78 months. The results of this study showed that the standard of treatment in this Faculty were fairly acceptable.
Renal arteriovenous malformation (AVM) is a rare congenital anomaly of the urinary system. We present a patient with bilateral renal AVMs who presented with back pain and microscopic hematuria. This case highlights the importance of careful diagnostic work-up in the evaluation of upper tract hematuria. Renal AVM was found to be the cause of mild back pain and persistent microscopic hematuria in a 45-year-old lady. This case highlights the importance of complete diagnostic work-up in the evaluation of microscopic hematuria in arriving at the correct diagnosis of an uncommon clinical entity.
INTRODUCTION AND OBJECTIVE:
Most of important variables measured in medicine are in numerical forms or continuous in nature. New instruments and tests are constantly being developed for the purpose of measuring various variables, with the aim of providing cheaper, non-invasive, more convenient and safe methods. When a new method of measurement or instrument is invented, the quality of the instrument has to be assessed. Agreement and reliability are both important parameters in determining the quality of an instrument. This article will discuss some issues related to methods comparison study in medicine for the benefit of medical professional and researcher.
METHOD:
This is a narrative review and this article review the most common statistical methods used to assess agreement and reliability of medical instruments that measure the same continuous outcome. The two methods discussed in detail were the Bland-Altman Limits of Agreement, and Intra-class Correlation Coefficient (ICC). This article also discussed some issues related to method comparison studies including the application of inappropriate statistical methods, multiple statistical methods, and the strengths and weaknesses of each method. The importance of appropriate statistical method in the analysis of agreement and reliability in medicine is also highlighted in this article.
CONCLUSION:
There is no single perfect method to assess agreement and reliability; however researchers should be aware of the inappropriate methods that they should avoid when analysing data in method comparison studies. Inappropriate analysis will lead to invalid conclusions and thus validated instrument might not be accurate or reliable. Consequently this will affect the quality of care given to a patient.
Autologous chondrocyte implantation (ACI) is a widely accepted procedure for the treatment of large, fullthickness chondral defects involving various joints, but its use in developing countries is limited because of high cost and failure rates due to limited resources and support systems. Five patients (age
To study the role of pulse oximetry in the assessment of acute asthma in children presenting to the A&E department, 360 children who presented themselves to the A&E department were enrolled into the study. Those admitted were found to have a lower mean Sa02 of 92% compared to those discharged with Sa02 of 94% (p < 0.001). After the initial treatment at the A&E, those admitted still have a lower mean Sa02 of 94% compared to those discharged with a mean Sa02 of 96% (p < 0.001). However taking Sa02 of 92% as a predictor of admission hada sensitivity of 39% and a specificity of 80% but it had a high negative predictive value of 92%. Hence pulse oximetry alone is not sensitive for predicting admission in acute asthma in children.
Candidacidal assay was used to assess the phagocytic and killing activities of polymorphonuclear leukocytes from paediatric patients diagnosed to manifest with characteristics of atopic dermatitis. From this group of patients evaluated, all the 11 cases exhibited lower candidacidal activity in comparison to the normal children. However, there were no abnormalities observed in the engulfing abilities and myeloperoxidase activities of these leukocytes. The result indicated that lower killing capacity of polymorphonuclear leukocytes in these patients may contribute to the frequent bacterial infections in atopic dermatitis children.
Accidental stab wounds caused by door handles are rare. A case is presented where a boy sustained a stab injury by a door handle with resultant impaction of the door handle into his forearm. The injury was possibly predisposed by the design of the door lock-and-handle complex and precipitated by his activity, both of which could have been avoided by a different design of the door lock and handle complex and perhaps closer supervision while at school.
Breast cancer is one of the most important diseases among females. According to the Malaysian Oncological Society (Wahid, 2007), about 4% of women who are 40 years old and above are suffering from breast cancer. Masses and microcalcifications are two important signs for breast cancer diagnosis on mammography. In this research, the effects of different image processing techniques which include enhancement, restoration, segmentation, and hybrid methods on phantom images were studied. Three different phantom images, which were obtained at 25kv (63.2 MAS), 28kv (29.8 MAS) and 35kv (9.5 MAS), were manipulated using image processing methods. The images were scored by two expert radiologists and the results were compared to explore any significant improvements. Meanwhile, the Wilcoxen Rank test was used to compare the quality of the manipulated images with the original one (alpha=0.05). Each image processing method was found to be effective on some particular criteria for image quality. Some methods were effective on just one criterion while some others were effective on a few criteria. The statistical test showed that there was an average improvement of 41 percent when the images were manipulated using the histogram modification methods. It could be concluded that different image processing methods have different effects on phantom images which generally improve radiologists’ visualization. The results confirm that the histogram stretching and histogram equation methods lead to higher improvement in image quality as compared to the original image (p < 0.05).
During recent years, extensive development has been made to improving vaccines for tuberculosis. This is due to the presence of genome sequences of diverse mycobacterial species and Mycobacteroum tuberculosis (M. tuberculosis) isolates which has led to advances in the characterization of genes and antigens of M. tb and better realization of protective immune responses to the disease in both animals and humans. This review summarizes vaccine types, reasons for variable efficacy of BCG, latest advances in tuberculosis vaccine development and major vaccine design strategies.