Acral melanoma involve the non-pigmented palmoplantar and subungual areas and are commonly seen among Asians. Patients commonly display advanced stage of disease at presentation. It may appear unnoticed and mimic benign lesions.
Sensorineural hearing loss is a common and important source of disability among the workers and often caused by occupational noise exposure. Aims of the study were to determine the prevalence and contributing factors of hearing loss among airport workers. A cross-sectional study was carried out at an airport in Malaysia. This study used stratified sampling method that involved 358 workers who were working in 3 different units between November 2008 and March 2009. Data for this study were collected by using questionnaires eliciting sociodemographic, occupational exposure history (previous and present), life-style including smoking habits and health-related data. Otoscopic and pure-tone audiometric tests were conducted for hearing assessment. Noise exposure status was categorize by using a noise logging dosimeter to obtain 8-hour Time-Weighted Average (TWA). Data was analyzed by using SPSS version 12.0.1 and EpiInfo 6.04. The prevalence of hearing loss was 33.5%. Age >40 years old (aOR 4.3, 95%CI 2.2-8.3) is the main risk factors for hearing loss followed by duration of noise exposure >5 years (aOR 2.5, 95%CI 1.4-4.7), smoking (aOR 2.1, 95%CI 1.2-3.4), duration of service >5 years (aOR 2.1, 95%CI 1.1-3.9), exposure to explosion (aOR 6.1, 95%CI 1.3-29.8), exposure to vibration (aOR 2.2, 95%CI 1.1-4.3) and working in engineering unit (aOR 5.9, 95%CI 1.1-30.9). The prevalence rate ratio of hearing loss for nonsmokers aged 40 years old and younger, smokers aged 40 years old and younger, non-smokers older than 40 years old and smokers older than 40 years old was 1.0, 1.7, 2.8 and 4.6 respectively. This result contributes towards better understanding of risk factors for hearing loss, which is relatively common among Malaysian workers.
Myelodysplastic syndromes (MDS) are a group of haematological malignancies categorized by ineffective hematopoiesis that result in dysplasia. Although morphological diagnosis is a traditional and standard technique that is used for the diagnosis of MDS, the heterogeneous blood and bone marrow characteristics of MDS patients can potentially obscure the right diagnosis. Thus, we have utilized flow cytometric immunophenotyping as a supportive mechanism to obtain a more accurate and faster method for detection of abnormal markers in MDS. Flow cytometry was used for analyzing bone marrow samples from newly diagnosed MDS patients to investigate the abnormal antigen expression patterns in granulocytic, monocytic, erythroid, lymphoid lineages and myeloid precursors. The results were compared with those obtained from cases that had Idiopathic Thrombocytopenic Purpura (ITP) as a control. The most common abnormality found in the granulocytic lineage was the decrease of CD10. Low expressions of CD13 were the most frequent abnormality in the monocytic lineage. The erythroid lineage was found to have low expression of CD235A+/CD71+, reduce of CD71 and decreased CD235a. In conclusion, this method is useful for confirming cases in which it is difficult to make a diagnosis by morphology.
High grade gliomas, frequently with their infiltrative nature, often make the outcome from neurosurgical intervention alone unsatisfactory. It is recognized that adjuvant radiochemotherapy approaches offer an improved prognosis. For these reasons, we opted for surgical debulking, intraoperative radiation therapy (IORT) in combination with whole brain irradiation therapy and chemotherapy (temozolamide cycles) in the management of a 42 year-old lady with Glioblastoma Multiforme (GBM). Her troublesome symptoms improved after 3 months of this polymodal therapy and remained independently functional for more than two years.
Congenital internal herniation is a rare condition presenting as recurrent abdominal pain or acute intestinal obstruction. In cases in which bowel incarceration or strangulation develop, rapid progression to bowel ischemia, necrosis or perforation is inevitable. Mortality in such cases has been reported to be as high as 50%. Despite advances in imaging modalities, arriving at a pre-operative diagnosis of a congenital internal herniation remains a challenge. We report such a case where imaging was unsuccessful in determining the cause of intestinal obstruction in a 3 year old child. Congenital internal herniation may result in disastrous consequences if not addressed in a timely fashion due to its rarity. Hence a high index of clinical suspicion is needed to avoid missing this diagnosis in a child presenting with recurrent abdominal pain or acute intestinal obstruction.
Latent Autoimmune Diabetes in Adults (LADA) is an autoimmune form of type 1 diabetes mellitus presenting in adulthood. It is often confused with other types of diabetes and therefore the management is frequently inadequate. Acute hyperglycemic crisis in the form of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS) are unusual findings. We report a clinical case of a 66-year-old female who presented for the first time with DKA and was subsequently diagnosed as a case of LADA. Presumptive diagnosis of LADA was confirmed with the presence of autoantibody to glutamic acid decarboxylase 65 (Anti-GAD65 antibody).
A case of a 21 year old gentleman is described, with no history of preceding trauma, presenting with intermittent dysphagia to solids and fluids for 4 years. Neck examination at rest was normal. However on deep inspiration, the right thyroid lamina protrudes or becomes more prominent. The patient is able to return the larynx to its normal position with manual manipulation. Laryngeal examination with fibreoptic scope during rest and deep breath shows gross rotation of the laryngeal structures for more than 60 degrees on deep breath, with the vocal cords axis rotated to the left side. Management was conservative.
A 68 year old man with significant cardiorespiratory risks factors presented with a ruptured thoracic aortic aneurysm (TAA). This was treated by emergency thoracic endovascular aneurysm repair (TEVAR) under general anaesthesia (GA). An incidental abdominal aortic aneurysm (AAA) was not treated. Eight months later, he presented with ruptured AAA. Due to the patient's compromised respiratory system, he underwent endovascular aneurysm repair (EVAR) under local anaesthesia (LA). He had a smoother post-operation recovery compared to the first repair under GA.
Coronary arteries vasospasm (CAS) is commonly seen in invasive cardiology laboratory during diagnostic catheterization or coronary intervention. Though the incidence of Printzmetal angina is uncommon, coronary vasospasm resulting in acute myocardial infarct is rare, especially if there is no significant atherosclerotic plaque within the coronary vasculature.
Hepatic angiosarcoma is a rare primary mesenchymal malignancy. Prognosis is poor and mortality occurs early. The diagnosis is challenging. Our case was an asymptomatic 70 year-old man referred, with incidental ultrasonography finding of multiple liver nodules. Diagnostic laparoscopic liver biopsy and the histopathological examination reported a haemangioma. Six months later, he became symptomatic and his health condition deteriorated rapidly.
Consumption of repeatedly heated oil can be detrimental to health. The objective of this study was to determine the level of knowledge, attitude and practice of night market food outlet operators in Kuala Lumpur regarding the usage of repeatedly heated cooking oil. The quality of cooking oil was also investigated. A cross-sectional study involving pretested questionnaire was undertaken in April 2009. The questionnaire was designed as a tool to collect data from the respondents (n=100) by face-to-face interview. The results showed that majority of respondents had only moderate (53.0%) or low (18.0%) level of knowledge regarding this issue. Most respondents (67.0%) agreed that it is not a good practice. The majority (69.0%) agreed that the usage of repeatedly heated cooking oil is detrimental to health. Despite that, most respondents (63.0%) admitted that they had used cooking oil repeatedly. Most (62.0%) of the cooking oil samples taken from the night market food outlets were considered fit for human consumption. In conclusion, the level of knowledge of night market food outlet operators in Kuala Lumpur regarding this issue needs to be improved in order to ensure the safety of fried food purchased from such establishments.
To assess uptake of perinatal postmortems (PM) among mothers experiencing perinatal deaths. Subjective assessment of factors influencing uptake was studied. Analysis of perinatal PM outcomes and its impact on cause analyses of intrauterine fetal demise was made.
Dapsone syndrome is a potentially fatal hypersensitivity reaction to sulphone. We report a 12-year-old girl who developed high grade fever associated with intense jaundice, exfoliative skin rash and hepatomegaly after five weeks of starting the multidrug regimen for the treatment of Hansen's disease. Laboratory investigations revealed presence of leucocytosis with eosinophilia, deranged liver enzymes and an abnormal coagulation profile. Immediate cessation of the offending drug and administration of steroid proved successful. A high level of clinical awareness is fundamental for early diagnosis of dapsone syndrome as initiation of a prompt treatment may lead to rapid recovery.
Isolated optic neuritis as a presenting sign of tuberculosis in children is uncommon. We report a case of an immunocompetent child who displayed features of bilateral optic neuritis secondary to presumed tuberculosis. It is essential to highlight this alarming presentation in a child, as the presence of tuberculosis has re-emerged as a serious public health problem especially in developing countries.
Urate lowering therapy in this country has mainly been achieved by the use of allopurinol and probenecid. A new xanthine oxidase inhibitor called febuxostat has been approved in 2009 for treatment of hyperuricaemia in gout. In this report, we describe the management of a patient with chronic tophaceous gout using febuxostat. The reduction in serum uric acid to target levels was rapid, and the tophi size had also reduced significantly while on therapy. There was no unwanted side effect observed during the therapy. Therefore, febuxostat would be a useful alternative drug in the treatment of hyperuricaemia in gout patients who have contraindications to allopurinol and probenecid.
Study site: Rheumatology clinic, Selayang Hospital, Kuala Lumpur, Malaysia
Wasp stings can present in various ways, ranging from mild self-limiting illness to severe multi organ failure with a potentially fatal outcome. We report a case of multiple wasp stings leading to acute renal failure needing prolonged dialysis support and posterior reversible encephalopathy syndrome.