The influence of age on various histological types of breast cancer at both age <50 years and >50 years to simulate menopause was studied retrospective from 2002 to 2004 in Malaysia. One hundred and fifty five cases were reviewed. Ninety two cases recorded at age <50 years, 60 (65.2%, 95%CI: 54.6 - 74.8%) were infiltrating ductal carcinoma in 11(12.0%, 95% CI: 6.1-20.4%), ductal carcinoma in situ (DCIS) in 9 (9.8%, 95% CI: 4.6-17.8%), medullary carcinoma in 6 (6.5%, 85%CI: 2.4-13.6%), invasive lobular carcinoma in 4 (4.3%, 95%CI: 1.2-10.8%), mucinous carcinoma and poorly differentiated carcinoma in 2 cases (2.2%, 95%CI: 0.3-7.6%). At >50 years of age, 63 cases were recorded. Forty seven (74.6%, 95%CI: 62.0- 84.7%) cases were of infiltrating ductal carcinoma, ductal carcinoma in situ in 9 (14.3%, 95%CI: 6.7-25.4%), mucinous carcinoma in 5 (7.9%, 95%CI: 2.6-17.6%), medullary carcinoma (8.5%) and papillary carcinoma in 1 case each (1.6%, 95%CI: 0.0-8.5%). Infiltrating ductal carcinoma was the commonest histology at both age <50 years and >50 years.
High environmental temperature has detrimental effects on the gastrointestinal tract of poultry. An experiment was conducted to determine the effect of acute heat stress on endogenous amino acid (EAA) flow in broiler chickens. A total of 90, day-old broiler chicks were housed in battery cages in an environmentally controlled chamber. Chicks were fed a nitrogen-free diet on day 42 following either no heat exposure (no-heat) or 2 weeks exposure to 35 ± 1 °C for 3 h from days 28 to 42 (2-week heat) or 1 week exposure to 35 ± 1 °C for 3 h from days 35 to 42 (1 week heat). The most abundant amino acid in the ileal flow was glutamic acid, followed by aspartic acid, serine and threonine in non-heat stressed group. The EAA flow in 1-week heat and 2-week heat birds were significantly (p < 0.05) higher than those under no heat exposure (14682, 11161 and 9597 mg/kg of dry matter intake respectively). Moreover, the EAA flow of 2-week heat group was less than 1-week heat group by approximately 36%. These observations suggest that the effect of heat stress on EAA flow is mostly quantitative; however, heat stress may also alter the content of EAA flow qualitatively.
In Penang, Malaysia, the Oriental and Afrotropical Megaselia curtineura (Brues) and the Oriental and Japanese Megaselia spiracularis Schmitz are reported from human corpses, these being the first reports of these species in such forensic cases.
The role of alcohol in the causation of Fetal Alcohol Syndrome (FAS) has been firmly established. In most cases events leading to its occurrence have been set into motion prior to conception. Alcohol consumption during pregnancy, the sole causative agent of FAS, can therefore be prevented even prior to conception by implementation of preconception counseling (PCC). The present review examines the important issues involved in the implementation of PCC for the prevention of FAS which can be of immense help to the affected population.
A group of proboscis monkeys (Nasalis larvatus) consisting of an alpha-male, six adult females, and several immatures was observed from May 2005-2006. We collected over 1,968 hr of focal data on the adult male and 1,539 hr of focal data on the six females in a forest along the Menanggul River, Sabah, Malaysia. Availability and seasonal changes in plant species consumed by the focal monkeys were determined by vegetation surveys carried out across an area of 2.15 ha along 200-500 m trails in riverine forest. A total of 188 plant species were consumed by the focal monkeys. The activity budget of members of our study group was 76.5% resting, 19.5% feeding, and 3.5% moving. Young leaves (65.9%) and fruits (25.9%) accounted for the majority of feeding time. Over 90% of fruit feeding involved the consumption of unripe fruits and in the majority of case both the fruit flesh and seeds were eaten. Although fruit eating was rare in some months, during other times of the year time fruit feeding exceeded the time devoted to young leaves. We found that monthly fruit availability was positively related to monthly fruit eating and feeding activity, and seasonal fluctuations in dietary diversity were significantly affected by fruit eating. These results suggest that fruit availability and fruit-eating behaviors are key factors that influence the activity budget of proboscis monkeys. Earlier assumptions that colobine monkeys are obligate folivores do not apply well to proboscis monkeys and certain other colobines. Our findings may help contribute to a better understanding of the dietary adaptations and feeding ecology of Asian colobines.
A baby girl with prenatal diagnosis of complex cardiac anomalies and diaphragmatic hernia was born at 36 weeks of gestation. At 4 hr of life, the baby developed respiratory distress and was intubated. She was found to have right hetetrotaxy with total anomalous pulmonary venous drainage into the portal vein, five hepatic veins draining the liver and intrathoracic herniation of the stomach. The child also developed abdominal distension on the second day of life with passage of scanty meconium. The diagnosis of Hirschsprung's disease (HD) was confirmed by histology. HD in association with right heterotaxy has not been reported earlier. The association of heterotaxy with HD in our patient raises a possible genetic link between the two anomalies that needs further research.
BACKGROUND: Industrial hand injuries are a common occurrence and contributes to a large segment of workers' morbidity. The main aim of this study was to look into the day pattern, types and location of upper limbs injures, identify the types of machines involved and highlight the treatment received.
MATERIALS AND METHODS: The present study was performed on 57 industrial workers admitted and treated by the Orthopaedic team of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for acute injuries sustained whilst working.
RESULTS: The majority of the workers were male (93%). The commonest age group involved was between 25-35 years (48%). The right hand was injured more then the left with majority of injuries involving the fingers. Interestingly, we also observed that injuries occurred more on Saturdays. Laceration was the most common injury followed by fractures and crush injuries. Treatment depends on the type and severity of injuries. For most lacerated wounds, treatment was debridement, primary suturing and antibiotic therapy. Injuries on Saturdays indicated that workers needed a longer time break especially during weekends after a long hectic week.
CONCLUSIONS: Injuries sustained by workers may be prevented by proper working techniques and conditions together with wearing of protective gadgets.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
The fingerprints are very typical for a human being. The present study was undertaken to study the gender differences in fingerprint ridge density in Chinese and Malaysian population. The study done on 200 subjects (100 males and 100 females) of Chinese origin and 100 subjects (50 males and 50 females) of Malaysian origin revealed that significant gender differences occur in the finger ridge density. Fingerprint mean ridge density of 12 ridges/25 mm(2) or less is found to be more likely to be of males and a mean ridge count of more the 13 ridges/25 mm(2) is more likely of female origin in Chinese subjects. Fingerprint mean ridge density of 11 ridges/25 mm(2) or less is found to be more likely to be of males and a mean ridge count of more the 13 ridges/25 mm(2) is more likely of female origin in Malaysian subjects.
Treatment for chronic respiratory failure has advanced since the introduction of domiciliary non-invasive ventilatory devices. This has given a new light of hope for patients with chronic respiratory failure secondary to various causes. We report a series of patients with respiratory failure of different origins and types of management that they received. Four patients received bilevel positive airway pressure (BiPAP) and one patient received continuous positive airway pressure (CPAP).
A five-month-old Indian girl, product of consanguineous marriage, presented with diarrhoea with an onset within two days after birth, severe malnutrition and metabolic acidosis. The diarrhoea persisted even with lactose-free formula, amino acid-based formula and glucose-containing oral rehydration solution, but stopped when fasted. She required prolonged parenteral nutrition. Fructose and glucose tolerance tests were performed, confirming the child was able to absorb and metabolize fructose but not glucose, indicating a diagnosis of glucose-galactose malabsorption. This case illustrate how simple and pertinent clinical observations and laboratory investigations is sufficient to allow a firm diagnosis to be made.
This study aims to study the demographics, clinical presentation, treatment and outcome of neonatal tetanus patients managed at Hospital Duchess of Kent from January 1st 2006 to December 31st 2006. Five neonates were studied. All presented with fever, poor sucking and limb stiffness, with a history of unsterile delivery and uncertain maternal tetanus immunity status. All were nursed in a minimal-stimuli environment and were given IV penicillin G, IM tetanus immunoglobulin and sedatives to control spasms. Nutrition and chest physiotherapy were rendered. Three patients required artificial ventilation. Duration of treatment ranged from 25 to 44 days. All survived. Inadequate maternal immunization, unsterile delivery and inappropriate umbilical cord care are major contributing factors of neonatal tetanus in our study. Supportive measures are the mainstay of treatment in our setting with very limited resources.
The Malaysian National Cancer Registry (NCR) report for the period 2003-2005 shows an incidence of stomach cancer of 2.2 for Malay, 11.3 for Chinese and 11.9 for Indian males per 100,000 population. Malay (1.3), Chinese (7.2) and Indian (7.2) women have rates lower than men. Malays in Peninsular Malaysia have five times less stomach cancer than Chinese and Indians. This racial difference is more marked than that noted in the Singapore cancer registry. Regional data from Kelantan has an even lower rate for Malays there (1.5 for males and 0.9 for females per 100,000 population). The incidence of Helicobacter pylori infection, a known risk factor for stomach cancer, is low among Malays.
Haemangiopericytoma (HPC) is a rare vascular tumor arising from the pericytes of Zimmermann and is characterized by its unpredictable and variable biological behavior. These tumors are common in the trunk and the extremities and less than 16% of the cases occur in the head & neck region. Its occurrence in the oral cavity and pharynx is uncommon. We report an extremely rare case of haemangiopericytoma of the oropharynx arising from the tonsillo-lingual sulcus as a pedunculated mass, which was successfully excised perorally after a preliminary tracheostomy. No recurrence has been noted on a follow-up of more than six years.
Laryngeal hemangiomas are relatively rare. Laryngeal hemangiomas occur in two main forms--infantile and adult laryngeal hemangiomas. While infantile hemangiomas are usually found to occur in the subglottis, adult hemangiomas occur commonly in the supraglottic regions of the larynx. Laryngeal hemangioma with cavernous features isolated to the free edge of the vocal fold is a very rare clinical finding. We present a case of hemangioma of the right vocal cord in an adult, which was managed successfully in our center.
The status of thrombophilia in Asian women with recurrent pregnancy loss (RPL) is obscure and poorly understood. Numerous studies suggest the non-existence or extreme rarity of the two important thrombophilia markers, factor V Leiden (FVL) and prothrombin G20210A (PTG) mutations, in patients of Asian ancestries. Thus, the consensus that thrombophilia is rare among Asians and laboratory investigations is irrelevant. We therefore investigated Malaysian women with RPL for thrombophilia abnormalities.
Tetrodotoxin poisoning has been commonly reported in Japan due to consumption of contaminated fugu (puffer fish). Poisoning is possible when the fish is not cleansed and dressed properly. Puffer fish is considered a delicacy by the Japanese as the fish meat is very tender and tasty. A certified chef trained in ways of preparing this poisonous fish should only be allowed to serve this fish. Despite careful preparation, this fish remains a deadly meal for many as 50 deaths are reported annually1 . An outbreak of 34 cases of tetrodotoxin occurred in Johor in May 2008. Here, we would like to report three cases of tetrodotoxin poisoning in a family who consumed this deadly fish and was admitted to Hospital Sultanah Aminah Johor Bahru (HSAJB).
Traditional open approaches to the nasopharynx either provide limited access and risk significant morbidity. Here we describe our experience with endoscopic resection of nasopharyngeal tumours. Retrospective chart review was performed for all patients who underwent endoscopic nasopharyngeal resection from September 1993 to January 2007 at a tertiary rhinology centre. Six patients underwent endoscopic nasopharyngectomy for tumours arising from or involving the nasopharynx. The mean age was 49.8 years (range 23 - 70). The sex distribution was five males and one female. Four tumours were malignant and two were benign. The mean disease-free and overall survival for malignant tumors was 90.75 months (range 66 - 120 months). None of the benign tumors recurred. The endoscopic nasopharyngectomy technique may be successfully used for resection of tumors arising from or involving the nasopharynx with good efficacy and a decrease in morbidity when compared to open approaches.
OBJECTIVES: This study aimed to determine the level and factors contributing to burnout among doctors in Sana'a City, Yemen and to determine the relationship between burnout and psychological morbidity.
METHODS: This was a cross-sectional study of 563 working doctors in the four main hospitals in Sana'a City, Yemen. The 12-item version of the General Health Questionnaire (GHQ12) was used as a measure of psychological morbidity and the 22-item Maslach Burnout Inventory (MBI) was used to measure emotional exhaustion, depersonalization, and personal accomplishment. Sources of job stress were determined using a 37-item scale questionnaire. The questionnaire elicited information about socio-demographic and work characteristics.
RESULTS: On the MBI, 356 doctors showed high emotional exhaustion (63.2%), 109 showed high depersonalization (19.4%) and 186 showed low personal accomplishment (33.0%). Sixty six doctors (11.7%) were identified as experiencing a high degree of burnout (high emotional exhaustion and depersonalization and low personal accomplishment). The prevalence of high degree of burnout was significantly higher in those with duration of work or=40 h/wk (OR=2.1, 95% CI 1.25-3.62) and in those who had psychological morbidity (OR=5.3, 95% CI 2.22-12.39). Thirteen out of 37 sources of stress were significantly associated with high degree of burnout. In multivariate analysis, the significant predictors of high burnout were: dealing with patient's psychosocial problems, feeling of isolation, disturbance of home/family life by work, not chewing khat, long working hours and psychological morbidity.
CONCLUSION: The prevalence of high degree of burnout as well as emotional exhaustion in Yemeni doctors was higher than those reported internationally and was associated with psychological morbidity and many important sources of job stress.