This case report describes an unusual case of extrapulmonary tuberculosis of the ischial tuberosity presenting with chronic gluteal pain of 4 years duration. The patient presented when the pain became intolerable; at that time, the ischial tuberosity was debrided and curetted while incision and drainage were used to treat the gluteal abscess. Antituberculosis chemotherapy was administered (for a period of one year) following histopathological confirmation of tuberculosis. At four yearspostoperatively, the patient has no pain and is symptom free. Furthermore, radiographs shows that the right ischial tuberosity osteomyelitis has healed. Prompt diagnosis and treatment resulted in a good clinical outcome in this patient.
We report a case of a 21 years old female who presented with a history of anterior knee pain for previous 3 months. Pain was localized to the anteromedial aspect of the left knee and aggravated by flexion. Clinical examination revealed a 2x2cm painful lump on the anteromedial aspect of the left medial condyle with no effusion. Magnetic resonance imaging revealed an anterosuperior tear of the medial collateral ligament. The patient subsequently underwent left knee arthroscopic examination. Two yellowish pedunculated masses arising from the anteromedial portion of the synovium were discovered and completely excised. Histopathological examination of the excision biopsy revealed pigmented villonodular synovitis (PVNS) with marked central necrosis. One year post excision, she is well with no signs or symptoms of recurrence. This case highlights an uncommon cause of anterior knee pain. Localized PVNS typically presents with mechanical symptoms, however, pain could arise from pedicle torsion and necrosis.
Extensive peri-acetabular osteolysis caused by malignant disease process is a major surgical challenge as conventional hip arthroplasty is not adequate. We describe a modified use of the Harrington procedure for acetabular insufficiency secondary to metastatic disease in twelve patients. The procedures include application of multiple threaded pins to bridge the acetabular columns, anti-protrusio cage and cemented acetabular cup. Eleven patients were able to walk pain free and achieved a mean Musculoskeletal Tumour Society Functional Score of 80 (range, 68 to 86).
The aim of this descriotive study is to determine the incidence of injuries among recreational badminton players. We evaluated 86 recreational badminton players in the city of Malacca; 35 were excluded for fitting the exclusion criteria. The average recreational badminton player was 36.13 years old and had been playing badminton for the past 17.84 years at a frequency of 2.11 times per week. 39.21% of the recreational badminton players complained of recent injuries in relation to playing badminton. Our data showed that the most common injury sustained by recreational badminton players was pain and stiffness at the shoulder joint. None of the injuries sustained by the players in our data were serious enough to warrant any form of surgical intervention. We conclude that badminton is a sport of relatively low risk and that the majority of related injuries were chronic overuse injuries.
Synovial sarcoma of the extremities is an uncommon type of soft tissue sarcoma occuring predominantly in young adults at the para-articular regions. We present a series of 10 patients with an average age of 44 years and include a follow-up of 39 months. Eight patients had a surgical procedure for a mistaken benign lesion. In contrast to other soft tissue sarcomas, the swellings were associated with pain and most were fixed to the underlying structures. Five patients had a local reccurence after many years, stressing the necessity for close and long-term follow-up in these patients.
Sprengel’s shoulder and myositis ossificans (MO) are rarely seen concomitantly. This report is about a rare case in a 4 year-old girl who presented with right shoulder deformity and pain associated with right proximal arm swelling.
The incidence of ureteric calculus as a cause for severe abdominal pain in children is mounting, especiallyin the tropical country. The course of illness may be non-specific but a swift detection via non-invasiveimaging modalities singly or in combination may avert unnecessary radiation hazard and futile surgery ina young child. In this paper, we discussed a case of an 11 year-old boy who was presented with a suddenonset of the right side severe abdominal colic whose a bedside ultrasound was positive for hydronephrosisfor which localisation of stone was further confirmed via a low dose limited intravenous urography (IVU).It is important to note that data available on the value of a combined ultrasound and the limited IVU inan emergency setting when urolithiais is being suspected in children with abdominal pain are particularlyscarce. Hence, this case documented the potential value of a combined ultrasound and a limited IVUstudy as a unique combined armamentarium used in a suspected childhood urolithiasis in the tropics.
The main purpose of this study was to establish the comfort zone for bus drivers in a seated position. In addition, this study is to investigate the seated pressure distribution among Malaysian bus drivers. The study consists of 10 bus drivers randomly selected to be a part of this study. The FSA pressure mat was utilized in order to investigate the force distribution of buttock to the seat pan of the drivers’ seat. This device is placed on the driver seat and backrest. Later, the subject would sit on for several minute. The finding reveals that most of the bus drivers feel discomfort by having low back pain and musculoskeletal disorder. The seat pressure distribution of Malaysian busses indicated that the seat not able to absorb high pressure generated from buttock that later may cause the discomfort and restricted the performance of drivers.
An assessment on the use of acetaminophen (paracetamol) among consumers would
provide guidance for implementing strategies to overcome the misuse of acetaminophencontaining
products. This study aims to evaluate Malaysian consumers’ practices,
perceptions and understanding regarding the use of acetaminophen. A semi-structured
qualitative study utilising face-to-face interviews was conducted among 14 consumers
aged 24 to 82 years old who live in Pulau Pinang, Malaysia. Transcripts of all the
interviews were generated from audio tapes and were analysed for the issues and themes
emerging from the text; the transcripts were independently coded and verified by experts.
The consumers had a positive attitude towards the popularity, safety and efficacy of
acetaminophen. The consumers predominantly used acetaminophen for pain and fever.
Some consumers tended to increase the frequency and dosage of acetaminophen
consumption if their condition persisted. Consumers had difficulty recognising the generic
acetaminophen-containing products available in the market. Health literacy investigations
have found that consumers have a lack of knowledge regarding the correct dosing
regimen for acetaminophen in adults and children. The consumers were not aware of the
precautions and toxicities of acetaminophen. To increase awareness of acetaminophen
poisoning in Malaysia, the consumers suggested that educational tools regarding the
proper use of acetaminophen are needed from the Ministry of Health and policy-makers.
The information gained from this study emphasises the importance of educational
interventions to educate the public on the proper use of acetaminophen in Malaysia.
The most prevalent oral mucosal lesions are aphthous ulcerations commonly referred to as canker sores. The clinical characteristic of oral recurrent aphthous ulceration/stomatitis(ORAS) is well defined and can be partly described as an oval or rounded ulcer covered by a grey-white or yellowish fibrinous exudate and surrounded by an erythematous halo. There is intense or moderate pain and the ulcers heal in about 10 - 14 days for the more common type and more than 2 weeks for the severe type. Recurrence of the ulcers occurs at intervals within a year or over several years. Variations of ORAS described above have made studies on aetiology and treatment difficult to interpret due to differing descriptions of differing diseases with similar clinical signs and symptoms and possibly differing aetiologies. A classification that was considered useful as a working model for ORAS was formulated in 1978. While the classification of ORAS had been widely accepted since 1978, the cause for ORAS is still unknown and its aetiology in general remains unclear. However, its immunopathogenesis is now becoming more clearly defined.
The aim of this review was to systematically explore the underlying musculoskeletal biomechanical mechanisms of carrying and to describe its potential relationship with low back pain. This literature review was carried out using AMED, CINAHL, Compendex and MEDLINE electronic databases. Articles published from 2004 to 2012 were selected for consideration. Articles were considered if at least one measurement of kinetics, kinematics or other related musculoskeletal parameters related to biomechanics were included within the study. After combining the main keywords, 677 papers were identified. However, only 10 studies met all the inclusion criteria. Age, body mass index, gender and level of physical activity were identified as the factors that may influence the biomechanics of carrying activity. Carrying a loaded backpack was reported leading to posterior pelvic tilt, reduced lumbar lordosis, but increased cervical lordosis, thoracic kyphosis and trunk forward lean. Furthermore, while carrying bilaterally, lumbo-pelvic coordination was also reported to be more in-phase, as well as reduced coordination variability in transverse plane. Future studies investigating the biomechanics of a standardized carrying activity for clinical test are recommended.
Occupational Related Chronic Low Back Pain (OCLBP) is a globally recognized illness that causes reduction in productivity and substantial economic burden to the countries. It requires a multidisclipinary approach involving employer, healthcare provider, compensatory and enforcement agencies. However there is no specific guideline or pathway that has integrated the roles of each responsible agency. The objective of this article is to highlight the need and to propose a coordinated approach through the concept of Integrated Care Pathway (ICP). Therefore, we reviewed international and local guidelines as well as published articles on chronic low back pain and care pathway. We believed that development of a pathway will be able to organize the role of management at every level, reducing the variations in the management, addressing issues of communicating the findings between the responsible stakeholders, fulfilling the requirements as the laws, allows effective and feasible approaches to take place in terms of cost and practicality, and increase the awareness on occupational diseases. Expected challenges such as limitation of resources, unawareness and lack of understanding on OCLBP from every level are issue that we agreed can be bridged through ICP.
An outbreak of pneumonia occurred among 1,491 recruits undergoing training at the Army Recruit Training Center, Port Dickson, Negeri Sembihxn, between july to August 2000. They had reported for training 2 weeks before and were placed in new modern concrete 4 floors buiMing with well ventilated dorm. A total of 70 recruits were ajjfected and one died. The attack rate was 4.7% and the case fatality rate was 1.4%. The outbreak ajfected recruits from all the jive companies; J (21/299,
30.0%) , G (19/298, 27.1 %), I (14/298, 20.0%), H (13/298, 18.6%) and F (3/298, 4.3%) . The main presenting symptoms were fever (68/70, 97.1%), cough (62/70, 88.6%), and chest pain (35/70, 50 .0%) . This was a common site outbreak with the mode of spread from person to person through infected droplet. The outbreak has three peaks, which was at lst, 4th and 6th week respectively and lasted for eight weeks. The organisms isobted through blood culture were Streptococcal pneumoniae and Klebsiella pneumoniae. All the cases were managed and treated as in-patients at four dijjferent hospitals depending on the severity of the illness. The main control activities carried out were separation of ill recruits from the healthy, reducing the number of recruits in the dormitories and encourage recruits to drink a lot of water while in training.
Pain and anxiety management is of paramount importance in dentistry especially for child patients. The term “Medicated Oxygen” or “Magic Air” refers to a mixture of nitrous oxide and oxygen gases that is commonly used for partial sedation in pediatric dental populations. The gas is colorless and virtually odorless with a faint, sweet smell. Nitrous oxide sedation is administered by inhalation, absorbed by diffusion through the lungs, and eliminated via respiration. In children, sedation may accelerate the delivery of dental treatment that requires patient serenity and may allow the patient to tolerate unpleasant procedures by reducing anxiety, discomfort, or pain.
BACKGROUND: Pain is the most troubling issue to patients with osteoarthritis (OA), yet current pharmacological treatments offer only small-to-moderate pain reduction. Current guidelines therefore emphasise the need to identify predictors of treatment response. In line with these recommendations, an individual patient data (IPD) meta-analysis will be conducted. The study aims to investigate the relative treatment effects of topical non-steroidal anti-inflammatory drugs (NSAIDs) and topical capsaicin in OA and to identify patient-level predictors of treatment response.
METHODS: IPD will be collected from randomised controlled trials (RCTs) of topical NSAIDs and capsaicin in OA. Multilevel regression modelling will be conducted to determine predictors for the specific and the overall treatment effect.
DISCUSSION: Through the identification of treatment responders, this IPD meta-analysis may improve the current understanding of the pain mechanisms in OA and guide clinical decision-making. Identifying and prescribing the treatment most likely to be beneficial for an individual with OA will improve the efficiency of patient management.
SYSTEMATIC REVIEW REGISTRATION:
CRD42016035254.
KEYWORDS: Capsaicin; Individual patient data meta-analysis; NSAIDs; Osteoarthritis; Topical
Introduction: Phlebitis may localise to the insertion site or travel along the vein. The risk of phlebitis is higher in children as they have thin and weak blood vessels and move continuously due to the pain associated with insertion. Therefore, regular assessment of the risk of developing phlebitis is crucial. This review aimed to identify infusion phlebitis assessment tool used in the paediatric setting. Methods: Electronic databases used were Scopus, ProQuest, ScienceDirect, and Google Scholar. A total of ten studies which assess the development of infusion phlebitis on hos- pitalised children included in this reviewed. Study findings were discussed and concluded with a recommendation for clinical practice and future studies. Results: Phlebitis development rate was the primary outcome measures in ten studies. Of ten studies, six provided no actual definition of phlebitis. Eight reported phlebitis incidence and/or severity, eight used a scale and two used a definition alone in assessing the development of phlebitis. This review identified five different phlebitis assessment scales. Conclusion: Although there are applicable phlebitis scales can be used for paediatric setting, Limited studies have been conducted on infusion phlebitis assessment method in chil- dren. Therefore, it is suggested that more studies and vigorous test needed to identify applicable assessment tools in paediatric setting.
Fibromyalgia is a highly heterogeneous condition, but the most common symptoms are widespread pain, fatigue, poor sleep, and low mood. Nonpharmacological interventions are recommended as first-line treatment of fibromyalgia. However which interventions are effective for the different symptoms is not well understood. The objective of this study was to assess the efficacy of nonpharmacological interventions on symptoms and disease-specific quality of life. Seven databases were searched from their inception until June 1, 2020. Randomised controlled trials comparing any nonpharmacological intervention to usual care, waiting list, or placebo in people with fibromyalgia aged >16 years were included without language restriction. Fibromyalgia Impact Questionnaire (FIQ) was the primary outcome measure. Standardised mean difference and 95% confidence interval were calculated using random effects model. The risk of bias was evaluated using the modified Cochrane tool. Of the 16,251 studies identified, 167 randomised controlled trials (n = 11,012) assessing 22 nonpharmacological interventions were included. Exercise, psychological treatments, multidisciplinary modality, balneotherapy, and massage improved FIQ. Subgroup analysis of different exercise interventions found that all forms of exercise improved pain (effect size [ES] -0.72 to -0.96) and depression (ES -0.35 to -1.22) except for flexibility exercise. Mind-body and strengthening exercises improved fatigue (ES -0.77 to -1.00), whereas aerobic and strengthening exercises improved sleep (ES -0.74 to -1.33). Psychological treatments including cognitive behavioural therapy and mindfulness improved FIQ, pain, sleep, and depression (ES -0.35 to -0.55) but not fatigue. The findings of this study suggest that nonpharmacological interventions for fibromyalgia should be individualised according to the predominant symptom.
To discuss the pathophysiology of atlanto-axial subluxation as a rare complication of tonsillectomy, and to discuss the important radiological findings for diagnosis and treatment planning.
Agarwood is a priceless non-timber forest product from Aquilaria species belonging to the Thymelaeaceae family. As a result of a defence mechanism to fend off pathogens, Aquilaria species develop agarwood or resin which can be used for incense, perfumery, and traditional medicines. Evidences from ethnopharmacological practices showed that Aquilaria spp. have been traditionally used in the Ayurvedic practice and Chinese medicine to treat various diseases particularly the inflammatory-associated diseases. There have been no reports on traditional use of agarwood towards cancer treatment. However, this is most probably due to the fact that cancer nomenclature is used in modern medicine to describe the diseases associated with unregulated cell growth in which inflammation and body pain are involved.
Erdheim-Chester disease (ECD) was first reported by J. Erdheim and W. Chester, in 1930. There are less than 250 reported cases till date. We report a case of ECD in a 16- year-old Malay male, who initially presented with elusive anemic symptoms with more specific symptoms of bony pain, cardiorespiratory and hepatic involvement evolving as the disease progressed.