Background: An impairment of the left atrial function similar to that usually observed in atrial fibrillation (AF) has been observed also in patients with patent foramen ovale (PFO) and permanent right-to-left shunting (RLS).
Methods: We reconstructed the geometrical model of right atrium (RA), PFO, left atrium (LA) and left atrial appendage (LAA) of 65 patients with mild (36 patients mean age 45.5±6.8 years, 24 females) or permanent (29 patients, mean age 45.1±5.3 years, 21 females) RLS using anatomical data obtained by transoesophageal echocardiography (TEE) and cardiac MRI, performed as a part of our institutional screening protocol for paradoxical embolism. Using computational fluid dynamic analysis (CFD) we assessed the vorticity magnitude in both the LA and LAA to analyse a possible rheological relationship between PFO and AF.
Results: The anatomical models, in terms of dimensions, were comparable among the patients with mild and permanent RLS. A higher vorticity magnitude was observed in the mild shunt both in the LA (101.12±21.3 vs 88.3±22.6, p=0.02) and LAA (62±14.4 vs 32.4±12.3, p<0.01) when compared to the permanent R-L shunting.
Conclusion: The lower vorticity magnitude across the LA and LAA in patients with permanent RLS suggests a possible higher stagnation of the blood in these anatomical sites, similarly as previously observed in patients with AF.
Resistance to anti-HER2 targeted therapy imposes a crucial limitation to the successful treatment of HER2 positive breast cancer. The expression of HER4 and its prognostic value is controversial in breast cancer. The role of HER4 in trastuzumab treatment and resistance in HER2-positive breast cancer has been recently studied. HER4 activation, cleavage and nuclear translocation have been demonstrated mediate trastuzumab resistance in HER2 positive breast cancer. In addition, nuclear HER4 is suggested could be a novel predictive and prognostic biomarker in HER2 positive breast cancer patients. Understanding the role of HER4 may offer useful insights to cancer treatment in HER2-positive breast cancer and other cancers.
Patients with multiple sclerosis tend to report higher levels of work difficulties and negative outcomes, such as voluntary and involuntary work termination and reduced work participation. In this article, we discuss the complex interactions of disease, personal coping strategies, and social and structural factors that contribute to their work experiences and outcomes. An overview of the coping strategies and actions that leverage personal and context-level factors and dynamics is also provided to support the overall goal of continued work in patients with MS.
BACKGROUND: To compare health care utilization and cost by asthma severity and type of health insurance in Thailand.
METHODS: A retrospective cohort study using an electronic database was conducted in patients with asthma. Patients who were diagnosed with asthma from 2009 to 2011, had at least two subsequent health care encounters for asthma during the first six months after the first asthma diagnosis, and had at least 90 days of follow-up were included. The primary outcome was direct health care costs of inpatient and outpatient care. We compared outcomes between groups on the basis of a proxy of severity (mild/moderate severe asthma vs. high severe asthma) and type of health insurance using a multivariable generalized linear model. Covariates such as Patients' demographic characteristics, comorbidities, and concurrent medications were included in the model.
RESULTS: Among 1982 patients included, the average age was 40.3 ± 24.0 years, with 60.7% being males. A total of 1936 patients had mild/moderate severe asthma, whereas 46 patients had high severe asthma. There were 1293 patients under the Universal Coverage Scheme, 264 patients under Social Security Insurance, and 626 patients under the Civil Servant Medical Benefit Scheme (CSMBS). The average annual cost per patient was $598 ± $871. In adjusted analyses, the health care cost of patients with high severe asthma was $71 higher than that of patients with mild/moderate severe asthma (95% confidence interval $-131 to $274). The cost of patients under the CSMBS was $110 (95% confidence interval $29-$191) higher than that of patients under Universal Coverage Scheme.
CONCLUSIONS: Health care costs of patients with asthma were substantial and were higher in patients with high severe asthma and patients under the CSMBS.
This study aimed to test the effect of modality imagery training via video tapes and audio tapes to improve the performance of overhead service skills in volleyball. 45 subjects who followed the volleyball professional course in Sultan Idris University of Education (UPSI) were selected for this test and they were randomly divided into three groups: video, audio group and control group. Russel-Lange Volleyball Test was used to obtain data on the overhead service performance. The results showed significant differences in overhead service performance before and after participants were exposed to the methods of video and audio tapes. There were also significant differences in overhead service performance among the video, audio, and control group. The study should that the introduction of audio and video imagery method may helps improve the overhead service skills performance in volley ball.
The purpose of this study is to retrospectively report the results of scoliosis patients who underwent chiropractic therapy and to evaluate their outcome by looking at the potential to alter the natural progression of scoliosis after therapy.
Methods: Retrospective data collection was conducted at a private chiropractic centre in Kuala Lumpur. The data was collected from patients between the ages of 16 to 19 years old. A total of eight patients with 14 scoliotic curvatures (six thoracic, six lumbar and two thoracolumbar), who met the inclusion criteria, were selected as subjects for this study. All subjects received the same chiropractic therapy program. The outcome of the therapy was assessed by measuring the Cobb’s angle on the erect spine as captured on an x-ray. The Cobb’s angle was measured at the first presentation (to establish a baseline) after 6 and 24 months of therapy.
Results: The mean baseline Cobb’s angle for thoracic, lumbar and thoracolumbar scoliosis were 30.70 ± 19.40, 31.70 ± 12.30 and 25.00 ± 18.40 respectively. After 24 months of chiropractic therapy, there was no discernible effect on the magnitude of the Cobb’s angles on the subjects overall.
Conclusion: Our study showed no significant reduction in spine curvature in patients with scoliosis using chiropractic therapy after 24 months.
HbE/β-thalassemia is the most common severe form of thalassemia particularly in SEA region including Malaysia and globally, it comprised of a significant severe form of β-thalassemia disorder. It has various clinical manifestations ranging from very mild anemia to severe manifestation similar to beta thalassemia major. Many different syndromes are observed in HbE/β-thalassemia. Several genetic modifiers have been reported to play important role in contributing to phenotypic variability. The true reasons underlying this phenotypic variability remain unknown. The most reliable predictive factor of the disease phenotype is the nature of the beta globin gene mutation itself. However, the degree of severity is also believed to be affected by other genetic modifiers. For instance, high HbF level ameliorates the clinical severity of β thalassemia patients. Therefore, identification of these genetic modifiers is very important. The association of severe clinical manifestation and the specific β-globin gene mutation has been known. But the wide scope and other potential predictors have been only recently appreciated. This review therefore aimed to reveal the potential genetic modifiers of HbE/βthalassemia patients based on the previous reported studies. A better understanding on the mechanisms underlying the variety of phenotypes of this disease may lead to the direction for a better future management plans. This also promotes “personalized medicine” in patient care.
A substantial percentage of patients will have an inadequate response to
clozapine in treatment resistance schizophrenia. Therefore, different
approaches need to be considered for managing this group of patients. We
present a case of a treatment resistant schizophrenia patient who shows poor
response toward clozapine. Later, he was started with haloperidol. Even
though antipsychotic superiority of clozapine in relation to haloperidol is
significant, this patient demonstrated otherwise.
Obsessive Compulsive Disorder (OCD) may present in the prodromal phase
of schizophrenia. However at times it is difficult to distinguish between the
pure obsession and psychotic obsessions that exist in patients. We present a
case of a patient initially diagnosed as Schizophrenia due to the disorganized
aspect of her behaviour, only to discover an extreme form of obsessions that
explained her demeanor throughout.
Henoch – Schonlein purpura (HSP) is a vasculitis of small sized blood vessels. It is the most common acute systemic vasculitis in childhood. It mainly affects skin, gastrointestinal tract, joints and kidney. It results from Immunoglobulin A mediated inflammation. The characteristic skin findings are palpable purpuric lesions over the lower limbs and buttocks. The occurance of haemorrhagic bullae in children with HSP is rarely encountered. This case report describes a 12 year old boy with bullous haemorrhagic HSP treated at Institute Paediatric, Hospital Kuala Lumpur.
Hepatopulmonary syndrome (HPS) is characterized by the triad of liver disease, pulmonary vascular dilatation and arterial oxygenation abnormality. It occurs in 4% to 47% in patient with liver cirrhosis [1]. We describe 2 cases of HPS with recovery from hypoxaemia after liver transplantation.(Copied from article)
The incidence of envenoming from king cobra, Ophiophagus hannah in human is relatively rare. Its venom acts on the postsynaptic region of the neuromuscular junction causing descending flaccid paralysis. Locked-in syndrome is a clinical state of inability to provide motor response in a conscious patient. Many reported cases of locked-in syndrome following neurotoxic snake-bite mimics brain death. We report a case of a middle aged man who presented with progressive neurological deficit following a king cobra bite over his right arm. He had local and systemic neurotoxic envenoming. His condition deteriorated, and was intubated and ventilated in the emergency department. He received a total of 33 vials of the Ophiophagus hannah monospecific antivenom and subsequently recovered well with no neurological deficit. Retrospectively, he was able to recall the events and while he was lying paralysed and intubated under minimal sedation in the intensive care unit. He described it as a terrifying and painful experience. This case highlights the rare presentation of locked-in syndrome following a systemic envenoming from a king cobra bite. It is important to differentiate neurotoxic snake envenoming lock-in syndrome from brain dead. Patients are unable to respond to physical pain and require adequate analgesia. A patient suffering this highly distressing experience may require psychological support.
Keywords: emergency, envenoming, neurotoxicity, snakebite
Objective: This case reported highlighted psychotic disorder due to dengue fever
is rare. Hence we describe a case which clearly presented with psychotic
symptoms during the illness.
Methods: We reported a case of psychotic disorder
due to dengue fever who presented with psychotic symptoms of auditory and
visual hallucination, and persecutory delusion, which had significant temporal
correlation with dengue fever symptoms. There were no neurological deficits
noted, no altered sensorium and cognitive impairment during the episode. He
has no past and family history of mental illness and there was no evidence of
encephalitis and metabolic disturbances.
Results: Our case suggests that
prominent psychotic symptoms can occur during an episode of dengue fever,
which remitted when one recovering from dengue fever.
Conclusion: We
demonstrated that patients who presented with the acute onset of psychosis
accompanied by symptoms of viral fever should be screened for dengue fever,
particularly if the person lived in or visited the area where dengue fever is
endemic.
Arabic script is highly sensitive to changes in meaning with respect to the accurate arrangement of diacritics and other related symbols. The most sensitive Arabic text available online is the Digital Qur'an, the sacred book of Revelation in Islam that all Muslims including non-Arabs recite as part of their worship. Due to the different characteristics of the Arabic letters like diacritics (punctuation symbols), kashida (extended letters) and other symbols, it is written and available in different styles like Kufi, Naskh, Thuluth, Uthmani, etc. As social media has become part of our daily life, posting downloaded Qur'anic verses from the web is common. This leads to the problem of authenticating the selected Qur'anic passages available in different styles. This paper presents a residual approach for authenticating Uthmani and plain Qur'an verses using one common database. Residual (difference) is obtained by analyzing the differences between Uthmani and plain Quranic styles using XOR operation. Based on predefined data, the proposed approach converts Uthmani text into plain text. Furthermore, we propose to use the Tuned BM algorithm (BMT) exact pattern matching algorithm to verify the substituted Uthmani verse with a given database of plain Qur'anic style. Experimental results show that the proposed approach is useful and effective in authenticating multi-style texts of the Qur'an with 87.1% accuracy.
Despite improvements in operative strategies for esophageal resection, anastomotic leaks, fistula, postoperative pulmonary complications, and chylothorax can occur. Our review seeks to identify potential risk factors, modalities for early diagnosis, and novel interventions that may ameliorate the potential adverse effects of these surgical complications following esophagectomy.
Intussusception is a common cause of gastrointestinal emergency in the paediatric population and it is usually diagnosed through Barium enema radiography or ultrasound. The skill of using an ultrasound by a minimally trained medical officer in diagnosing this cases in the Emergency Department are very helpful and expedite the management. We present the case of a 7-month-old girl who presented to Emergency Department (ED) with the chief complaint of passing blood in stool. Clinically she was dehydrated, irritable and in compensated shock. There was generalised tenderness per abdomen but it was soft and not distended. There was no palpable mass and bowel sound normal. Immmediate fluid resuscitated commenced. Bedside abdominal ultrasound performed by ED medical officer showed a 1.8 cm x 2.5 cm mass of alternating hypo-echoic and hyper-echoic rings at the right lower quadrant, consistent with the ‘target’ sign of intussusception. Supine plain abdominal X-ray did not reveal any abnormality. The ultrasound finding of intussusception was later confirmed by the radiologist. She underwent immediate hydrostatic reduction and was discharged well.
Keywords: diagnosis, Emergency Department, intussusception, paediatric, ultrasound
Plasma cell myeloma is known to cause expansion of a single clone of munoglobulin (Ig) which results in the secretion of a unique homogeneous monoclonal protein (M component). However, there are cases which reported that it can also cause production of two different clones of these monoclonal proteins. Although it is relatively very rare as the prevalence is only 2% of all plasma cell myeloma cases, the clinical features are said to be similar to monoclonal gammopathy. It is suggested that these biclonal gammopathy results from either one monoclonal cell clone in monoclonal gammopathy or two different monoclonal cell clones. Whichever the mechanism of the disease be, the response to treatment seems to be similar as compared to the monoclonal cases although some reports shows chemoresistant. Here, we report a rare case of plasma cell myeloma with IgG (lambda) and IgA (lambda) type of biclonal gammopathy, the clinical presentation, the haematological and biochemical markers as well as the response to the treatment.
Keywords: biclonal gammopathy, M protein, plasma cell myeloma
Intravascular papillary endothelial hyperplasia (IPEH) or Masson’s tumour is a benign vascular proliferation that mimics other malignant vascular tumour. To date, this is the fourth case of Masson’s tumour at urethra being reported in the literature. A 65-year-old female Para 2, presented with post-menopausal bleeding. Examination revealed a 4x3x3 cm growth surrounding the urethral meatus. She underwent examination under anaesthesia and excision of the periurethral mass. Histopathological examination confirmed Masson’s tumour. Diagnosis and management of this uncommon tumour at a rare location was discussed.
Keywords: angiosarcoma, endothelial hyperplasia, Masson’s tumour, urethral neoplasm, vascular neoplasm
Introduction: Osteoarthritis (OA) is the main cause of knee pain. It also affects individual’s physical functioning. Anti- inflammatory drugs and knee replacement are the mainstay methods in the management of knee OA in Malaysia. However, patients with knee OA often suffer pain. The general objective of the study is to evaluate the effectiveness of a cognitive behavioural intervention module on knee pain, functional disability and psychological outcomes among knee OA patients attending Orthopedics Clinics in Hospital Putrajaya and Hospital Serdang, Malaysia. This study aims to determine the baseline level of knee pain and functional disability among knee OA patients.
Methods: Baseline results on the knee pain and functional disability were obtained from a two arm parallel- group randomized controlled study. Three hundred patients aged 35 to 75 years diagnosed with knee OA were recruited. A set of pre tested and validated Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire was used in this study.
Results: Mean baseline of KOOS pain was 56.09 (SD=21.75) and 52.26 (SD=22.08) for the intervention and control groups respectively. Participants in the intervention and control groups had a mean KOOS function in daily living of 61.11 (SD=21.20) and 56.72 (SD=22.13) respectively. Overall mean baseline of KOOS function in sport and recreation was 35.30 (SD=27.38).
Conclusions: Majority of participants had moderate level of knee pain and functional disability in daily living. However, participants had more extreme symptoms of functional disability in sport and recreation. Therefore, interventions to reduce knee pain and functional disability symptoms in knee OA are needed.
Study site: Orthopedics Clinics in Hospital Putrajaya and Hospital Serdang, Malaysia
Objective: To examine the clinical utility of tumor markers in dermatomyositis/polymyositis patients in Taiwan.
Method: Data were collected retrospectively from the database of Taichung Veterans General Hospital in Taiwan from 1998 to 2014. Patients who fulfilled Bohan and Peter criteria of dermatomyositis/polymyositis were recruited. Serum level of tumor markers including carcinoembryonic antigen, alpha-fetoprotein, carbohydrate antigen 125, carbohydrate antigen 19-9 and carbohydrate antigen 15-3 were measured. The occurrence of malignancies and interstitial lung disease was identified. The association of tumor markers with malignancies and interstitial lung disease was examined using Chi-square test or Fisher's exact test.
Results: Among the enrolled 151 patients, 98 (64.9%) dermatomyositis and 53 (35.1%) polymyositis, a total of 15 malignancies were detected: breast ductal carcinoma (n = 4), bladder transitional cell carcinoma (n = 2), lung adenocarcinoma (n = 2), cervical intraepithelial neoplasia 3 and papillary squamous cell carcinoma (n = 2), colorectal (colon and rectal adenocarcinoma) (n = 2), uterine adenocarcinoma (n = 1), nasopharyngeal carcinoma (n = 1) and hematological malignancy (myelodysplastic with excess blast cells) (n = 1). Among the patients with malignancies, 13 (86.7%) had dermatomyositis, 2 (13.3%) polymyositis and 3 (20%) interstitial lung disease. The mean duration from dermatomyositis/polymyositis diagnosis to the occurrence of malignancies was 6.05 ± 5.69 years. There was no significant association of raised tumor markers with the occurrence of malignancies (p > 0.085), while a significant association was observed between the elevated levels of carbohydrate antigen 15-3 and the presence of interstitial lung disease (p = 0.006).
Conclusion: Tumor markers were not useful in malignancy screening or dermatomyositis/polymyositis patients in this tertiary center. The evaluation of the occurrence of malignancy in dermatomyositis/polymyositis patient should include a multidimensional approach. A raised level of carbohydrate antigen 15-3 may be a potential indicator of the presence of interstitial lung disease in dermatomyositis/polymyositis patients.