Objectives: The objectives of this study were to ascertain the prevalence of Indonesians obstetrics immigrant and to assess the fetal maternal outcome. Methodology: A prospective cohort study design was used to analyse 54 consecutive Indonesians obstetrics immigrant compared to 56 Malay women. Chi square and student t test were used where appropriate, p < 0.05 was considered to be of statistical significance. Results: There was a reducing trend in the incidence admission of Indonesians from 10.5 in 1999 to 6.5 % in 2002. The maternal mortality ratio showed an increasing trend from 1999 (40.0/100000) to 2001 (162.9/100000) but decreased to 5.8/100000 in 2002. The majority was between 20-40 years old, multiparous and booked, which was similar to the Malay population. Most Malays were in occupational class 1 to 3 and the husband has secondary and tertiary education compared to the Indonesians who were in class 4 and 5 and the husband has primary and no formal education. Significantly more immigrants were housewives compared to Malays who were working women. There was no significant difference in the antenatal complications. There were no significant difference in terms of delivery and most delivered vaginally. The perinatal outcome in terms of gestation, birth weight, Apgar score and admission to neonatal ICU were similar in both populations and there was no perinatal mortality. In conclusion, the incidence admission of Indonesian immigrant was on the decreasing trend. The outcome of these patients managed in MHKL was similar to the Malay population. Further studies with enrollment of a larger number of patients should be carried out to ascertain the significance of these findings.
This is a prospective study on infection following fixation of closed fractures done in Hospital Tengku Ampuan Afzan ,Kuantan from May 2003 to May 2005. There were 23 cases in this study. The mean age of patient was 32.9 years (range 15 to 77). Twenty one were males and 2 females. Twenty (87%) infections occurred in the lower limb and only 3(13%) occurred in the upper limbs. Twenty two patients (91%) had plating done for the fracture. Infection following internal fixation is commonly a deep seated (96%) and florid (78%) infection in which 70% occur after the surgical wound has healed. Staphylococcus aureus is the commonest organism isolated in which 43% are Methicillin resistant (MRSA). Overall infection caused by gram negative organisms is more common than gram positive organisms.
Passive smoking among pregnant mothers has been associated with numerous maternal and fetal effects. The aim of this study was to determine the effects of passive smoking on the fetal outcome among women who delivered at the Maternity Hospital Kuala Lumpur. This cross sectional study was carried out at the Maternity Hospital Kuala Lumpur in July 2004. Universal sampling of the women who delivered at the hospital was used and data was collected by interview using pre-tested questionnaire and patients’ medical records. Analysis was done by SPSS version 11.5. More than 75% were Malays, between 21 to 35 years, married, received secondary education, housewives and family income between RM 1000 – RM 1999. Seventy-seven per cent of the women were exposed to environmental tobacco smoke and majority were exposed at home and for less than 1 hour a week. There were significant relationships between duration of exposure with exposure at workplace, exposure at home and exposure in the car. Most of the babies delivered were males, term, normal weight and normal. Health education of the adverse effects of smoking to the pregnant women, spouses and family members need to be intensified by the hospital and the Ministry of Health.
Objective To determine the prevalence of diseases and its association with the sociodemographic factors (age, sex and ethnicity) among elderly patients admitted to a tertiary hospital in Malaysia.
Design A cross sectional study was conducted at various wards in the year of 2002. There were 9 333 respondents in this study selected by universal sampling. Setting A tertiary hospital in Malaysia. Main outcome measures Association between sociodemographic factors and prevalence of diseases. Results The mean age of the respondents was 68.9 + 6.8 years. Majority of the respondents were male (53.3%), Malays (43.7%) and married (73.2%). The prevalence of neoplasm was 15.5% followed by cataract (7.2%), diabetes mellitus (5.0%), hypertension (4.7%) and anemia (0.5%). There were significant association between gender and hypertension, diabetes mellitus, anemia and cataract (p
Objectives: To evaluate the cost-effectiveness of the new oxytocin regimes in the augmentation of labour and the effect on the maternal and fetal outcome. Design: Randomized controlled trial. Setting: Labour ward of Hospital Tengku Ampuan Afzan, Kuantan. Participants: 230 pregnant women in labour at term with obstetric indications for labour augmentation. Methods: The women were randomly assigned to receive new oxytocin regime of 5 units in 500 cc of D/Saline at titration of 5 dpm with increments of 5 dpm to a maximum of 60 dpm. Or, old oxytocin regime of 1/2/4 units with titration of 20/40/60 dpm for primips and half the dosage for multips.
Main outcome measures: Cost analysis, duration of labour, duration of augmentation, complication of labour, post partum hemorrhage (PPH), mode of delivery and perinatal outcome.
Results: There was no significant difference in the mean duration of labour (6.8 h vs 6.7 h ; p = 0.45) and mean augmentation time (3.86 h vs 4.0 h; p = 0.9) between the regimes studied There seemed to be higher incidence of caesarean section in the old oxytocin group (6.5% vs 24.7%; p = 0.001). There was no significant influence on the neonatal morbidity and mortality (p = 0.07). A moderate reduction of annual cost for augmentation of labour was noted (RM 962.34).
Conclusion: The results showed that the new oxytocin regime was more cost-effective without apparent increased in the maternal and fetal mortality and morbidity.
Replacement therapy for toxoplasmosis was not a clear-cut choice since most of anti-parasitic agents available are also associated with Steven Johnson Syndrome. Further more the therapy has to be effective to control infection, which was previously achieved by oral Fansidar in this patient. Oral Azithromycin was seen as a drug of choice for these reasons. Corticosteroids were maintained since it was relatively indicated in both toxoplasmosis and SJS. Both conditions can results in visual impairment. SJS can be a life threathening condition and its ocular complications include conjunctivitis, ectropion or entropion, symblepharon, vascularization of the cornea, chronic dry eyes, and ankylosymblepharon. Proper management in dealing with both diseases is mandatory in order to prevent mortality and minimize the ocular complications. It has been shown in this case that the challenging part in managing patient with both diseases is to balance out between prevention of fatal consequences and the need control to the infection and preserving vision. Decisions on medical treatment for both conditions will remain controversial till reliable prospective randomized control trials are done to address the issues
Patient understanding and perception of diabetes control is important if clinicians were to allow diabetes patients to play a central role in management of their illness. We conducted a survey to see what diabetic patients generally thought of their understanding of disease and glycemic control; if these perceptions were accurate and related to complications.
One hundred and eight consecutive patients (mean age 52.7± 13 years, BMI 27±5.2 kg/m2, HbA1c 9.2±2.2 %) attending diabetes clinic participated including 63% women, 60% primary or no education, and 47% duration of diabetes >10 years. 54% claimed to have a good understanding although nearly half answered questions on diabetes management and targets wrongly. 32% perceived their glycemic control to be good and were found to have lower baseline HbA1c (p
Plasma total homocysteine levels (tHcy) is lowered by high insulin levels, and it can be elevated in insulin-resistant states. However, it is uncertain whether plasma tHcy and insulin or any components of the metabolic syndrome has any relationship among hypertensive individuals. In this study the tHcy and insulin concentrations were measured by enzyme immunoassay techniques in samples from 41 (27 male and 14 female) participants. Components of the metabolic syndrome (insulin resistance) profiles were also evaluated. The participants’ age ranged from 31 to 67 years (mean+SEM, 52.1±1.3 years), body mass index from 20.2 to 38.3 kg/m2 (27.2±0.7 kg/m2), plasma tHcy concentration from 6.9 to 16.2 μmol/L (11.0±0.4 μmol/L), and plasma insulin 3.0 to 16.6 μIU/mL (7.3±0.5 μIU/mL). A significant negative correlation was found between tHcy concentrations and insulin levels (r=-0.358, P=0.011), but not with other variables (P>0.05). In conclusion, the tHcy concentration is significantly related to plasma insulin in hypertensive subjects. tHcy concentrations were independent of the components of the metabolic syndrome and other risk factors of coronary heart disease in hypertensive subjects.
Extrapelvic endometriosis is fairly rare and may occur in numerous sites throughout the body. Unnecessary investigation may be performed before the diagnosis could be made. Here we present two cases where endometriotic nodules occurred on a caesarean section scar and in the vagina. Further management is discussed in the report.
We present a case of a 45-year-old female who presented with blurring of right vision associated with constitutional symptoms. Examinations revealed right optic disc swelling with inferior exudative retinal detachment and hepatomegaly. Gynaecological examination showed a fungating cervical mass. Histopathological reports of cone biopsy confirmed the presence of large B cell non-Hodgkin lymphoma. HIV screening was positive. A diagnosis of HIV related lymphoma was made. Chemotherapy and antiretroviral treatment were instituted. The ocular signs resolved. However, the patient could not tolerate the side effects of medical therapy and opted for palliative treatment.
Introduction: Smoking is prevalent among Muslims in this country despite public knowledge regarding smoking as haram (unlawful). This may be due to ignorance of the consensus of the ' mufti ' on the ' fatwa ' on smoking or a result of poor education and understanding of health-related risks of smoking.
Methods: A cross-sectional, questionnaire-based survey was carried out among the public who attended the IIUM Faculty of Medicine open day in Kuantan, Pahang on June 12th, 2004. Knowledge of smoking-related illnesses and the religious ' fatwa '(edict) on smoking was assessed.
Results: Seventy four muslims participated in the survey. 46(63%) were smokers (including ex-smokers) and 28(37%) were non–smokers. There was no statistically significant difference between the knowledge of smoking-related illnesses and their knowledge of the religious edict which regards smoking as haram between smokers and non-smokers. Only 6.7% of smokers perceive smoking as haram compared to 48% of non-smokers (p<0.001).
Conclusion: The conviction that smoking is haram among smokers is still poor among smokers. This could be one of the main reasons contributing to the high prevalence of smoking in our society. There was no difference between smokers and non-smokers concerning their knowledge on the religious edict on smoking and the health-related hazards of smoking.
Peripheral, predominantly motor polyneuropathy is associated with a plethora of possible aetiologies and the investigative procedures to rule them out are extensive. A 31 year old lady presented with progressive lower limb weakness over a period of 2 years. Examination revealed symmetrical weakness (3+/5) of all distal muscle groups in the lower limbs with absent ankle jerk. There was no sensory loss. The nerve conduction study revealed a predominantly axonal motor neuropathy. Cerebrospinal fluid examination and other investigations to rule out potential causes of predominantly motor peripheral neuropathy were normal. The only positive findings were multiple qualitative assays for porphobilinogen in her urine.
Primary hyperparathyroidism with severe bone disease as a result of excessive parathyroid hormone ( PTH ) release and severe hypercalcaemia can lead to 'hungry bone syndrome' (HBS) post operatively. This is due to sudden cessation of PTH and drop in serum calcium. We reported a case a young man with primary hyperparathyriodism due to a single parathyroid adenoma with severe bone disease and post operatively developed hungry bone syndrome.
Varicella or chickenpox is an infectious disease caused by Varicella Zoster Virus (VZV), which commonly affects the children. It is a mild, self-limiting disease and rarely complicate to serious conditions except in adults. Decreasing incidence of chickenpox among children, probably owing to improved living conditions ,prevention and health care, is worrisome as growing number of adults are being infected. This creates disturbing concerns in many parties as women at childbearing age might get infected and not only are them at a great risk of serious complications, but also their unborn fetus or their newborn babies.
The number of people worldwide living with human immunodeficiency virus/ acquired immunodeficiency virus (HIV/AIDS) is more than 40 million, among them 17.7 millions are women (UNAIDS/WHO, 2006) The latest report from the Eastern Mediterranean Region shows that at least one million people are infected with HIV; among them 30% are women. The great majority of reported cases in the Region are men. However, the ratio of men to women cases varies in different countries. It ranges between “9:1 (as for example in Egypt), to 2:1” (as in Morocco and some parts of Yemen). Due to religious, social and cultural values regarding female purity, women and girls living with HIV and AIDS are subjected to greater discrimination than men. WHO reports show that a large percentage of the infected women in Arab countries have contacted the infection from their husbands especially migrants and drug abusers. In Arab countries, studies conducted show that 86% of women choose not to disclose their status of infection for the fear of abandonment, rejection, discrimination, violence, upsetting family members, and accusations of infidelity from their partners, families, and communities. As a result, many women only seek help at the last minute when they are already been terminally ill. Violence against women and girls in its different forms increases women's vulnerability to HIV infection and undermines AIDS control efforts. The fear of violence prevents many women from accessing HIV information, from getting testing and seeking treatment. Stigma and discrimination may also prevent them from carrying out their normal life activities. When women are blamed, this can lead to heightened levels of sexual and domestic violence, abandonment by families and communities, forced abortion or sterilization, dismissal from employment and loss of livelihood opportunities. A study of AIDS-related discrimination in Arab region found that over ten percent of women had lost financial support from family members since being diagnosed as HIV positive. There is a great deal of evidence to establish the significant link between gender-based violence and rising rates of HIV infection among women and girls throughout the world. HIV-positive women must be supported to make their own reproductive choices about whether and/or when to have children. Promote male involvement in sexual and reproductive health programmes. Finally the stigma, discrimination and violations must be stopped.
Introduction: Mammography is commonly regarded as the single most important tool for screening and for early detection of breast cancer. However it is not generally recommended for women under 40 years of age and in those taking hormone replacement therapy as the increased density of the breast parenchyma may make mammography more difficult to read and interpret. The limitations of mammography have spurred attempts to find new techniques that can be used either separately or in conjunction with mammography. Purpose: The aim of this study was to quantify the clinical value of using electrical impedance scanning (EIS) or Trans Scan as an adjunct to mammography in order to identify cancerous tissue based upon its inherent altered local dielectric properties. Methods and Materials: The patients were examined using Trans Scan (Trans Scan Medical, Ltd., distributed by Siemens AG. The study population was derived from patients with suspicious breast lesions categorized as BIRADS 3 or 4 detected during mammography or ultrasound. Results: Fifty-three women with 53 mammographically and/or sonographically suspicious findings were examined using EIS. With respect to the histopathological findings (15 malignant and 38 benign lesions) 13 of 15 (86.6% sensitivity) malignant lesions were correctly identified using EIS whereas, 33 of 38 (81.5% specificity) benign lesions were correctly identified. Negative and positive predictive values of 93.9% and 65% were observed respectively. Two benign lesions were correctly identified in a dense breast. The smallest lesion detected in this study measured 20 x 14 mm, which was an infiltrating ductal carcinoma. Conclusion: Electrical impedance scanning as an adjunct to mammography or ultrasound in classifying suspicious lesions is promising because it increases the sensitivity for cancer detection and may reduce biopsy of equivocal lesions. The additional use of EIS with negative predictive value of 93.9% may be useful to exclude some benign lesions from further diagnostic or invasive procedures. Artifacts, such as signals from superficial skin lesions, poor contact and bubbles are currently a limitation
Subdermal etonogestrel implant (Implanon®) is the newest, long term contraceptive implant which has recently been made available to Malaysian women. This prospective study was conducted to determine the effects on selected health indices among 42 women who had consented to Implanon® as their choice of contraception. Health indices were checked prior to Implanon® insertion and six months post insertion. Findings indicate a significant reduction in total cholesterol with a significant increase in total haemoglobin and BMI. However there was no significant change noted in the fasting blood sugar, glycosylated haemoglobin, systolic blood pressure and diastolic blood pressure.
Invasive Lobular Carcinoma of the breast is less common than Invasive Ductal Carcinoma and the presentation can be different from other types of breast carcinomas. It can present as diffuse swelling or thickening of breast rather than a mass. Sometimes, it can present as metastatic deposits from a very small primary breast lesion. These make the diagnosis of this type of breast carcinoma difficult and challenging for the radiologist and surgeon. We describe a case of Invasive Lobular Carcinoma of the breast, which presented with a left sterno-chondral metastasis and discuss the imaging findings and treatment of this condition.
Neck abscess is still common in developing countries. Often the presentation is late especially when the pain becomes intolerable or the airway is compromised. Intramuscular abscess in the neck is very rarely encountered. We report a case of an abscess of the right sternocleidomastoid. The culture grew Proteus mirabilis. The outline of management is discussed.
We present two cases of direct traumatic carotico-cavernous fistula following motor vehicle accident. Their main symptoms include loss of vision, progressive proptosis and recurrent epistaxis. Angiogram confirmed presence of carotico-cavernous fistula in both cases. One was successfully treated by open surgery and the other by embolization with Guglielmi detachable coils (GDC). In both cases, proptosis and epistaxis resolved completely.