A case of rapid stabilization using electroconvulsive therapy (ECT) for a major
depressive disordered (MDD) patient with life-threatening low body mass index
(BMI) is reported. This case report focuses on a 55-year-old Malay housewife with
underlying hyperthyroidism in a euthyroid state who presented with MDD with
mood congruent psychotic features, which were precipitated by the death of her
husband. Her BMI was only 11 kg/m2
due to severe anorexia, and she was highly
suicidal. Peripheral total parenteral nutrition was started and ECT was commenced
for rapid stabilization on top of tablet escitalopram 15 mg nocte. Full remission was achieved after nine ECTs and steady healthy weight gain was achieved throughout
admission. The patient was discharged at BMI of 13 kg/m2
with good appetite. ECT
was safe for very low BMI MDD patient.
Vaginismus is a sexual dysfunction which results from vaginal musculature spasm
and makes the penetration almost impossible. It is commonly associated with
significant emotional distress. On several occasions, fear of pain during sexual
intercourse may perpetuate the sexual dysfunction. We report a case of primary
vaginismus that was associated with psychiatric squeale of anxiety and depression
psychopathology. It suggests that psychological problems related to a mentalhealth
problem in vaginismus should be dealt adequately for a holistic approach.
A combination of behavioural, psychological and pharmacological treatment is
important to ensure a good prognosis outcome.
Patient-controlled analgesia (PCA) via an infusion pump enables patient to
administer their own analgesia. The aim of this study was to evaluate the effect
of an educational programme in managing post-operative pain and satisfaction
on PCA following orthopedic surgery. A pre-test and post-test interventional study
design with implementation of patient education programme on PCA was provided
to 54 respondents. The control group received conventional PCA briefing from
the Acute Pain Service protocol. Pain intensity was measured at 2 hrs, 6 hrs and
24 hrs following surgery and pre-test and post-test of the Revised American Pain
Society Patient Outcome Questionnaire (APS-POQ-R) was administered. There
was difference in respondents’ level of pain score among the study respondents’
medians for control group at 2 hrs, 6 hrs and 24 hrs following surgery and they were
7.00 (IQR=3.00), 5.00 (IQR=2.00) and 3.00 (IQR=2.00); intervention group at 2 hrs,
6 hrs and 24 hrs following surgery were 6.00 (IQR=2.00), 3.00 (IQR=1.00) and
1.00 (IQR=1.00) respectively. There were significant differences in median of pain
score between intervention and control group at 2 (U=142.0, p
The Hypoglycaemia Symptom Rating Questionnaire (HypoSRQ) is potentially
useful for local research on hypoglycaemia. However, it requires adaptation and
validation in local settings. This study reports the process and results of cross-cultural
adaptation and linguistic validation of HypoSRQ for Malay and English versions in
our local setting. The HypoSRQ underwent forward and backward translation and
adaptation with support from professional translators and a clinical psychologist.
Cognitive debriefing was done among patients with Type 1 and Type 2 diabetes
mellitus from varying sociodemographic backgrounds. Discussion was done
together with the original developers of the HypoSRQ to decide on the best version
for local use. The finalised versions were proofread and formatted with the help
of Health Psychology Research. Cognitive debriefing for Malay version involved 7
patients and for the English version5 patients. Direct literal translation into Malay
language was unsuitable due to technical terms which were difficult for laypersons
to understand. Amendments were made based on findings from the cognitive
debriefing process. Participants found the questionnaire fairly easy to understand.
The HypoSRQ-My (Malay) and HypoSRQ-EMy (English) is easily understood by
local participants. These tools may undergo psychometric evaluation for future
use in local settings.
Information technology use in healthcare education has become a popular
medium of instruction. One of the medium of instruction is video assisted learning
(VAL). The use of VAL as an instructional method in the teaching and learning of emergency skills is not new. However, there are lack of studies on the perception of
using this method in learning emergency skills. This qualitative study involved four
focused discussion groups following a VAL instruction on emergency skills. A total
of 20 paramedics were divided into four groups. They were involved in a focussed
discussion after a VAL instruction session. Findings reveal that the paramedics
perceived three major themes which were categorized as : i) advantages of video
as teaching tool, ii) barrier in using video as a teaching tool; and iii) suggestions on
using video as teaching tool. The findings indicate that the paramedics perceived
VAL as a potential tool for learning emergency skills. However, they suggested the
language of instruction should be in their mother tongue for better understanding.
This implies that using English language has disadvantage in technology enhanced
learning for better understanding.
Eosinophil-type nasal polyp (NP) is common in Western population. This aim of
this study was to determine the histology type of NP among different Malaysian
ethnic groups. A total of 122 chronic rhinosinusitis with nasal polyposis (CRSwNP)
patients were retrospectively enrolled and demographic data was recorded. The
histological slides were retrieved. The number of eosinophils and non-eosinophils
were counted and average number of inflammatory cells for each high power
field was calculated. Eosinophil-predominant was seen in 32.8% of patients and
67.2% was non-eosinophil-predominant. Phenotypes of NP significantly showed an association with ethnicity (x² = 8.322; p < 0.05). A total of 78.9% of Chinese
nasal polyps showed non-eosinophil predominant, while Malay and Indian nasal
polyps revealed 71.9% and 40.7% of non-eosinophilic phenotype, respectively.
Our study showed that Malaysian population had a non-eosinophilic phenotype
of nasal polyps. There was a significant association in Malaysian ethnicity with the
highest percentage in Chinese population.
Polypoidal choroidal vasculopathy (PCV) is a retinal disorder characterized
by aneurismal polypoidal lesions in choroidal vasculature. PCV appears to
preferentially affect pigmented individuals and is considerably high among Asians.
Most reports on patterns of PCV around Asia are based on a homogenous race
(e.g. Chinese, Japanese) and very few descriptions from a multiracial population
like those seen in Malaysia. The present study aimed to describe the demographic
features, clinical and investigative characteristics of PCV in a multiracial group at
Universiti Kebangsaaan Malaysia Medical Centre (UKMMC). Ninety one eyes of 86
PCV patients, comprising of Chinese (65.1%), Malays (31.4%), Indians (2.3%) and
Eurasian (1.2%) were retrospectively reviewed. All underwent complete ophthalmic
examination and investigations. Mean patient age was 70.4 years with a male
preponderance (59.3%), and mostly unilateral presentation (94.1%). The logMAR
mean presenting visual acuity was 0.78 ± 0.64. Polypoidal vascular lesions were
located generally within the macula area (86.8%), manifesting mainly as submacular
hemorrhage (59.3%). Interestingly a number of eyes (43.9%) had associated drusen.
Optical coherence tomography largely demonstrated exudative changes (75.9%)
and almost all patients (97.7%) had loss of external limiting membrane (ELM) and
IS/OS interface. On indocyanine green angiography, majority of eyes had multiple
polyps (82.4%) with ‘cluster’ (58.2%) being the commonest configuration. In
conclusion, although the patterns of PCV in UKMMC were mainly similar to other
Asian patients, a number of our patients had associated drusen. This indicates
that PCV in our population could be a variant of neovascular age related macular
degeneration and not solely idiopathic in nature.
The occurrence of severe lead (Pb) poisoning has risen in certain countries.
There is increasing evidence that chronic lead exposure disturbs the prooxidant:
antioxidant balance in the brain tissue and alters brain histology. The present
study observed the antioxidant effect of tocotrienol-rich fraction (TRF) on brain
tissues of the experimental rats following lead poisoning. Eighteen (n=18) male
Sprague-Dawley rats, 6-weeks old, were randomly divided into control (CTRL)
group and experimental groups; fed with 0.2% w/v lead acetate, as PB2 group;
and fed with 0.2% w/v lead acetate and daily TRF supplementation (200 mg/kg
body weight) as PB2T group. The experiment was conducted for 30 days. At the
end of the study, the brain tissues were harvested and histopathological changes of
the hippocampal region were observed. Biochemical findings such as brain lead,
TRF and malondialdehyde (MDA) levels, and erythrocyte superoxide dismutase
(SOD) activity were determined. It was observed that atypical apoptotic-like and
disorganized neurons were present in the hippocampal region of the untreated
PB2 group compared to PB2T group. Biochemical parameters showed a significant
decrease (p < 0.05) in brain lead level in PB2T compared to PB. Even though no
significant difference (p > 0.05) was obtained for MDA level, there was a significant
increase (p < 0.05) in the erythrocyte SOD activity in PB2T compared to PB2 and
CTRL. Supplementation with TRF improved histopathological changes in the brain
tissues caused by lead exposure in drinking water by reducing lead accumulation
in the brain of experimental rats.
Micro computed tomography (micro-CT) imaging is a useful tool to monitor fracture
healing in osteoporosis model. It creates a 3-D image of the fracture callus which can
be analysed to assess bone parameters quantitatively. In this study, micro-CT was
used to assess the fracture healing of orchidectomised rats, an androgen-deficient
osteoporosis model. The effects of Eurycoma longifolia, a medicinal plant with proandrogenic
effects, on fracture healing were assessed. The rats were grouped into
orchidectomised-control (ORX), sham-operated (SHAM), orchidectomised and
injected with testosterone intramuscularly once weekly (TEN) and orchidectomised
and daily oral gavage of Eurycoma longifolia (EL). Treatment duration was six
weeks following bone fracture. Fracture was induced in the right tibia of all the
rats. A total of 100 axial slices above and below fracture line were scanned with
a micro-CT. The micro-CT analysis was able to detect significant difference in the
fracture healing rate of ORX and TEN groups. The bridging cortices and fraction
of mineralized tissue of the bridging cortices of the callous of ORX group was
significantly lower than TEN group. No significant micro-CT changes were seen
in the fracture healing of the EL group. The effect of EL on fracture healing was not
demonstrable in orchidectomised rat model.
Bone histomorphometric measurements are required to understand the efficacy
of treatment on bone remodelling. Previous studies used the Weibel technique
as a quantitative stereological method to determine bone cellular and dynamic
changes. However, there was no description on how this technique was applied.
This studyaimed to provide a full picture about the utilization of the Weibel
technique to measure static and dynamic bone histomorphometric indices.
Technical expertise, processing of bone samples, randomization of the trabecular
sections and an adequate number of analysed images for each section are required to achieve reliable results with a low possibility of errors.
Madu gelam telah didapati mempunyai kesan anti-oksidatif, anti-kanser dan antiinflamasi
terhadap banyak jenis kanser. Tujuan kajian ini adalah untuk menentukan
kesan madu gelam terhadap aras tekanan oksidatif sel kanser peparu manusia.
IC50 madu gelam ditentukan dengan merawat sel A549 dengan dos madu yang
berbeza (50-200 mg/ml). Sel dibahagikan kepada 4 kumpulan dan diaruh tekanan
oksidatif dengan menggunakan hidrogen peroksida (H2
O2
) mengikut kumpulan
tertentu: kawalan, H2
O2
, madu gelam, H2
O2
+ madu gelam. Selepas 24 jam
rawatan, biopetanda tekanan oksidatif seperti malondialdehid (MDA) dan protein
karbonil ditentukan. Aruhan tekanan oksidatif meningkatkan aras MDA (p
We report a case of a giant bullous emphysema misdiagnosed as a pneumothorax. A 18-year-old chronic smoker presented with right sided chest pain and dyspnoea. Initial respiratory rate was 35 /min, blood pressure was 136/90 mmHg, heart rate 80/min and SpO2 was 98% on room air. Clinical examination revealed reduced right air entry and left trachea deviation. Chest X-ray helped to arrive at a diagnosis of pneumothorax. Needle aspiration was then performed followed by a chest tube thoracostomy because of no improvement. Massive amount of blood was drained and patient deteriorated further. CT thorax revealed a right haemopneumothorax with multiple bullaes. Patient was rushed to OT for emergency thoracotomy for stapling of the ruptured bullae. Giant bullous emphysema can mimic pneumothorax and physician must be vigilant if draining a suspected pneumothorax.
Keywords: emphysema, haemopneumothorax, thoracostomy, thorax
Peningkatan ekspresi dan aktiviti enzim 11β-hidroksisteroid dehidrogenase jenis
1 (11β-HSD1) di dalam sel adiposit matang menyebabkan obesiti dan sindrom
metabolik. Fruktos dalam air minuman telah terbukti boleh menyebabkan sindrom
metabolik pada tikus Wistar jantan. Oleh itu, kajian ini dilakukan untuk melihat
kesan ke atas ekspresi dan aktiviti enzim 11β-HSD1 di dalam hati model tikus
sindrom metabolik yang dirangsang dengan air minuman fruktos. Sebanyak 12 ekor
tikus Wistar jantan dibahagikan secara rawak kepada dua kumpulan: kumpulan
kawalan, C (n=6) dan kumpulan yang diberi minuman fruktos 20%, F20 (n=6).
Pemberian makanan dan air minuman selama lapan minggu secara ad libitum. Di
akhir kajian, pengukuran ekspresi enzim 11β-HSD1 di dalam hati dilakukan dengan
menggunakan teknik pewarnaan imunohistokimia. Skor diberikan berdasarkan
intensiti pewarnaan granul di dalam sitoplasma hepatosit menggunakan teknik
‘double-blinded’. Manakala, aktiviti enzim 11β-HSD1 diukur menggunakan teknik
ELISA. Selepas lapan minggu pengambilan air minuman fruktos, kumpulan F20
menunjukkan peningkatan dalam ekspresi dan aktiviti enzim 11β-HSD1 di dalam
hati. Data yang diperolehi menunjukkan bahawa enzim 11β-HSD1 di dalam
hati mungkin memainkan peranan dalam pembentukan sindrom metabolik dan
komplikasinya pada tikus Wistar jantan.
Fluid replacement is the mainstay treatment for diabetic ketoacidosis (DKA). Currently, the best choice of fluids is still debatable. An amount of 0.9% sodium chloride is commonly used. Sterofundin® is an alternative crystalloid that is assumed to expedite resolution of acidosis. Advantages in sterofundin content being smaller significant ion difference (SID) to plasma and lower chloride content. The main objective of the study was to compare rate of acidosis resolution in DKA patients between treatment with 0.9% normal saline and Sterofundin over 12 hrs. Other objectives were to compare significant ion difference (SID), 12-hr blood ketone clearance and electrolyte balance between the two groups. The study was a prospective open labelled randomized control trial. This study was conducted over 6 months. Sample size of 18 was obtained with 9 for each arm. Main difference between two groups was initial median 2-hr pH level improvement (NS = +0.006 vs. Sterofundin = +0.05, P=0.063), however not being significant. Ketone, anion gap reduction, bicarbonate normalisation, sodium, chloride, urea and creatinine levels failed to show any significant differences between both groups. Twelve-hour median chloride levels increments were higher in the NS group (+11) compared to the sterofundin group (+6). There was no difference between mortality and morbidity. Comparing the two fluid groups, there was no significant biochemical differences during treatment of DKA. This was a pilot study that can initiate further clinical trials.
Keywords: anion gap, diabetic ketoacidosis, ketone, ph, saline, sterofundin
Acute myeloid leukaemia (AML) is the most common subtype of acute leukaemias with a poor outcome. Msi2 protein is a newly discovered prognostic marker and it has been considered as a new target for therapy in AML. The study of Msi2
protein expression in AML cases has not been performed in Malaysia, to date. The main aim of the present study was to observe the expression of Msi2 protein in AML patients by immunohistochemistry (IHC) and to correlate its expression
with the well-established prognostic and clinical parameters in AML as well as the overall survival (OS). Sixty four bone marrow trephine biopsy sections were immunostained for Msi2 protein. The percentage of blasts with positive reaction
and the intensity of the cytoplasmic and nuclear staining were evaluated. The expression of Msi2 protein was found in 95.3% cases with Msi2 pattern varying between the cases. In 71.9% of cases, the blasts showed total cellular positivity and 23.4% cases showed only cytoplasmic positivity. Majority showed high expression of Msi2 for cytoplasmic staining. Interestingly, there was significant correlation between total cellular staining and the intermediate cytogenetic subgroup (P=0.04). In conclusion, the results showed that the majority of the patients had high expression of Msi2 but this did not correlate to OS. However, the Msi2 expression correlated to the cytogenetic findings. The results suggest future extensive research to be conducted in order to ascertain the exact role of Msi2 positive blast cells in AML in our population and their association with prognosis and outcome.
Keywords: AML, cytogenetics, immunohistochemistry, Msi2 protein
Di Malaysia, timun laut lebih dikenali sebagai Gamat. Di kalangan kaum Melayu,
gamat sering digunakan sebagai ubat tradisional untuk melegakan kesakitan,
merawat luka dan kesan terbakar. Ianya juga digunakan sebagai tonik untuk
memberi sumber tenaga tambahan. Stichopus chloronotus merupakan salah satu
spesies timun laut yang boleh didapati di Malaysia. Kajian ini bertujuan untuk
menentukan dos optimum ekstrak akues Stichopus chloronotus emulsi salap ke
atas luka pada model tikus. Beberapa siri kepekatan iaitu 0.1%, 0.5% dan 1%
ekstrak akues Stichopus chloronotus emulsi salap diberikan ke atas luka eksisi sekali
sehari selama 10 hari. Perubahan pada kawasan luka diukur dengan menggunakan
angkup dan gambar luka diambil pada hari pertama, ke-3, ke-6, ke-8 dan ke-10
selepas pembentukan luka. Keputusan daripada peratusan pengurangan luka dan
pemerhatian makroskopik akan menentukan dos optimum Stichopus chloronotus.
Hasil kajian menunjukkan, kumpulan tikus kajian yang menerima rawatan
Stichopus chloronotus 0.5% mempunyai peratusan pengurangan luka yang lebih
tinggi dan pemerhatian makroskopik yang lebih baik bermula dari hari ke-6 selepas
pembentukan luka berbanding kumpulan yang lain. Kesimpulannya, dos 0.5%
merupakan kepekatan optimum bagi Stichopus chloronotus memberikan kesan
kepada penyembuhan luka dan akan digunakan pada kajian sebenar
Euphorbia tirucalli dilaporkan mempunyai aktiviti antibakteria terhadap pelbagai
mikroorganisma. Kajian in vitro ini bertujuan untuk menilai ciri-ciri antibakteria
ekstrak (metanol, etanol dan ekstrak akueus) batang Euphorbia tirucalli terhadap
bakteria yang berkaitan dengan karies gigi, iaitu Streptococcus mutans (S. mutans)
dan Streptococcus sobrinus (S. sobrinus). Sifat-sifat antibakteria telah ditentukan
menggunakan ujian resapan agar berlubang pada kepekatan ekstrak yang berbeza
(10, 20 dan 30 mg/ml). Komersial amoxicillin (10 µg) telah digunakan sebagai
kawalan positif manakala pelarut yang sesuai telah digunakan sebagai kawalan
negatif. Ekstrak metanol dan ethanol daripada batang Euphorbia tirucalli didapati
berkesan terhadap S. mutans dan S. sobrinus. Walau bagaimanapun, ekstrak akueus
batang Euphorbia tirucalli tidak menunjukkan aktiviti terhadap kedua-dua strain
bakteria. Perbezaan dalam ciri-ciri antibakteria dalam perbezaan ekstrak Euphorbia
tirucalli mungkin disebabkan oleh perbezaan dalam juzuk fitokimia.
Kecelaruan spektrum Autisme (ASD) merupakan sejenis ketidakseimbangan
perkembangan neuro kanak-kanak yang dikaitkan dengan kecacatan kognitif
dan bahasa. Penyelidikan sebelum ini mendapati bahawa kanak-kanak yang
mempunyai ketidakseimbangan perkembangan meningkatkan tahap tekanan
ibu bapa. Namun, ibu bapa yang mempunyai anak ASD mengalami tahap
tekanan yang lebih tinggi berbanding ibu bapa yang mempunyai kanak-kanak
ketidakseimbangan perkembangan yang lain. Justeru, kajian ini bertujuan untuk
mengkaji perbezaan tahap tekanan antara ibu bapa yang mempunyai kanak-kanak
ASD dan ibu bapa yang mempunyai kanak-kanak perkembangan tipikal (TD) yang
dikategorikan dalam kumpulan kontrol. Borang indeks tekanan ibu bapa, terbitan
ketiga digunakan untuk menilai tahap tekanan dalam kalangan 30 ibu bapa yang
mempunyai kanak-kanak ASD dan 36 ibu bapa yang mempunyai kanak-kanak
TD. Sampel ibu bapa yang mempunyai kanak-kanak autisme dikumpul dari Pusat
Perubatan Universiti Kebangsaan Malaysia (PPUKM), Hospital Tangkak, dan Pusat
Autisme (NASOM) di Muar dan Segamat. Ibu bapa yang mempunyai kanak-kanak
ASD mempunyai tahap tekanan yang signifikan lebih tinggi berbanding ibu bapa
mempunyai kanak-kanak TD (p
Iron deficiency anemia is the most common form of anemia in pregnancy. The present study was carried out to determine the prevalence of antenatal anemia and iron deficiency in the Malaysian population and its correlation with sociodemographic and obstetric profile. It was a cross-sectional study conducted at an urban health clinic over a period of six months. A single blood sample was drawn from apparently healthy pregnant mothers at antenatal booking and sent for laboratory assessment of full blood count and serum ferritin as screening tools for anemia and iron status. SPSS version 19.0 was used for statistical analyses. The results showed that out of 250 subjects, 43.6% had anemia and 31.6% had iron deficiency. Whilst 47.7% of subjects with anemia were iron deficient, 19.1% of subjects without anemia were also iron deficient. Serum ferritin correlated negatively with period of gestation at booking (p<0.001), with 77.6% of these women not having prior iron supplements. Serum ferritin was also significantly lower among grandmultiparae (p=0.01). Iron deficiency was significantly (p=0.024) more common among Indians (42.5%) compared to Malays (33.5%) and Chinese (13.0%). In conclusion, continuation of the current practice of routine antenatal iron supplementation is still warranted and justifiable in Malaysia as there is high prevalence of iron deficiency in pregnancy not only in the presence of anemia but also in the presence of normal hemoglobin values. Keywords: anaemia, ferritn, pregnancy
Open tracheal injury is rare but can lead to disastrous consequences such as massive bleeding, airway obstruction or failure and aspiration of blood. We present a case of open tracheal injury of a man who tried to attempt suicide using a knife. In this case, the initial management was securing the airway by attempting orotracheal intubation. However, it was unsuccessful when the tube came out from the laceration wound. Intubation was then re-attempted through the distal cut-end of the trachea in the face of airway failure. A quick initial assessment and anticipation of a failed airway should always be the top priority in any emergency physician managing these cases. Direct intubation through the laceration wound might be the only option when all else fail and your patient is crashing.
Keywords: intubation, laceration, trachea