Tornwaldt's (Thornwaldt's) or nasopharyngeal cyst is an uncommon developmental
benign cyst located in the midline postero-superior wall of nasopharynx. Incidence reported in
general population is 0.06%. It occurred in the potential space due to outpouching of ectoderm into
the pharyngobasilar fascia at the site where notochord attached to pharyngeal ectoderm. (Copied from article).
We present a case of 80-year-old man with two-year history of hoarseness of voice secondary to left vocal cord paralysis. CT scanning revealed a saccular thoracic aneurysm compressing the left recurrent laryngeal nerve. A review of literature on Ortner's or cardiovocal syndrome is presented.
Introduction: The clinical evaluation of the three layers of tear film is still poorly described. The purpose of this study is to evaluate the value of aqueous assessment in diagnosing dry eye.
Materials and method: Schirmer test with anaesthesia (STA) and tear meniscus height (TMH) measurement were conducted on non-dry eye (NDE) and dry eye (DE) subjects in this cross-sectional study. The NDE and DE subjects were classified using two types of classification; classification 1 and classification 2.
Results: 321 subjects with 642 eyes were recruited in the study. STA was significantly correlated with TMH (r = 0.24, p < 0.001) in all 642 eyes. The comparison between nondry and dry eye subjects in STA and TMH were not significantly different (p > 0.05) if the Classification 1 was used to define dry eye. In Classification 2, there were significantly different between NDE (12.5 ± 8.2 mm) and DE (3.4 ± 0.8 mm) subjects in STA (p < 0.001). Similar trend was also depicted in TMH based on the definition of dry eye stated in Classification 2 (NDE = 0.45 ± 0.20 mm, DE = 0.39 ± 0.14 mm; p < 0.05).
Conclusion: The value of STA and TMH were lower significantly in dry eye subjects. However, the significant outcomes were only demonstrated if the clinical signs of dryness were used in the definition of dry eye.
Venom is a mixture of biologically active toxins that affect normal physiological functions. With the advance in technology, the complexity and functions of venom and its toxins are slowly being revealed. It has become important source for therapeutic, diagnostic and cosmetic agents. However, there is concern among the Muslim community pertaining to halal and safety issues on the venom and venom-derived product usage. There are few studies that discuss the Islamic views in the usage of venom and venom-based product in medicine and cosmetic applications. There is a need for Muslim scientists and scholars to seriously identify the potential ethical and safety issues in the usage of venom and venom-derived products in view of the widespread application in medicine and cosmetic, which subsequently forming the basis for relevant and reliable shariah ruling. This is an attempt to review the relevant articles based on the following keywords: venom and Islamic ruling, venom-based product, venom and medicine, venom and cosmetic, antivenom, venom toxin, snake poison and venom diagnostics. It will also attempt to clarify and elaborate the implication of the “halal” status for venom-based product. Finaly the current available shariah rulings on the usage of venom and venom-based product both in medical and cosmetic area and the related principle of fiqh involved will be analyzed. The findings from this review, particularly the current available ruling will allow various parties to be well informed on the current ruling and related issues on the usage of this products.
Cast removal procedures can be a daunting experience for children giving
rise to anxiety. The objective of this study is to measure the level of anxiety in children
during cast removal at Hospital Tengku Ampuan Afzan. (Copied from article).
Introduction: Febuxostat is a non-purine-selective oral xanthine oxidase inhibitor drug, and is an alternative to Allopurinol to lower serum uric acid in gout patients. It is probably more effective than Allopurinol, however, its use is limited because of its cost and availability. Allopurinol has been the mainstay treatment for gout for about 50 years. However, its use has been associated with allergic reactions especially in patients with renal impairment.The objective of this study was to describe HTAA Rheumatology Unit experiences with Febuxostat in the management of gout.
Materials and method: Case records belonging to 6 patients who had been started on Febuxostat between January 2012 and January 2017 were analysed.
Results: The majority of patients on Febuxostat were males (83.3%) as well as Malays (83.3%). About 66.7% of patients had already developed mild to moderate chronic kidney disease (GFR between 30-89 mL/min) due to multifactorial causes by the time they were started on Febuxostat. Also 33% of patients had mild liver impairment (ALT & AST < 1.5 ULN) due to fatty liver prior to Febuxostat. All patients had been started on Febuxostat due to allergic reactions to Allopurinol. All patients were on Febuxostat 40 mg once a day. Following Febuxostat, a significant decrease in the uric acid levels much closer to the target level i.e. less than 360 µmol/L were achieved in all patients. Only 1 patient (16.7%) developed a side effect i.e. ALT > 1.5 ULN while the rest tolerated the drug very well.
Conclusion: Although the number of patients analysed was small, Febuxostat was shown to be very effective and safe for use in patients with gout even with concomitant mild to moderate renal impairment. Serum uric acid levels reduced significantly while on the lowest dose of 40 mg once a day.
Introduction: Praying represents a fundamental activity of daily living in Muslim community. Muslims need to adopt several postures that require deep flexion of the knee and hip to perform this daily obligation. This is a preliminary report of the study on hip and knee range of motion conducted to obtain normative passive and functional range of flexion data during Muslim prayers in both weight-bearing joints of normal Muslim adults. Methods: A cohort of Malay men aged between 20 to 30 years was recruited in this cross-sectional study. Passive range of motion and flexion angles of the joints in various postures during prayer were measured using a standard goniometer. The difference against existing normative range of motion database available and the influence of various factors were analysed. Factors analysed include body mass index and other anthropometric measurements. Results: Sixty participants recruited for the preliminary phase of this study. The mean (SD) of passive hip and knee flexions were higher compared to other existing normative range of motion database. A unit increase in body mass index will have 0.782 units lower of knee range of motion. The hip and knee flexion arc were from 74.1° to 119.0° and from 3.3° to 119.7° respectively. Conclusion: The range of motion involved for prayers was more for the knee but less for the hip as compared to the measured passive range of motion. Body mass index has a significant linear negative relationship with the passive range of motion of the knee, but not the hip.
Following the announcement of Traditional and Complementary Medicine Act 2013, Muslim faith healers are slowly gaining grounds to make their practice mainstream. One of the major characteristics of Muslim faith healers is the strong inclination to attribute mental illnesses to Jinn possession (demonic possession). Unlike other traditional healers, Muslim faith healers’ primary mode of treatment is Ruqyah, an incantation or generally considered as ‘Du’a or prayers. This article is a sharing by a psychiatrist who has been actively engaging with faith healers in order to understand the world of faith healing including the attitude and knowledge of both the healers and clients while attempting to educate them on modern psychiatry based on bio-psycho-socio-spiritual paradigm. The methodology: 1) Involvement in symposium, seminar and focused group discussion, either as participant or as speaker. 2) Collaborating with local spiritual leader to conduct workshop on mental illness in mosques. 3) Writing articles in scientific and popular publications with and without faith healers as the collaborators. 4) Appearing in radio advocating and discussing about the dilemma of mental illness issue from the religious perspectives, and 5) Participate in workshop conducted by Muslim faith healers. As a result, several issues come to the author’s attention. The divisions of Muslim faith healers are rather complicated, for example Malay traditional healers or bomoh should not be categorized in the same group as Muslim faith healers. The oft-quoted ‘Islamic Medicine’ is problematic in view that it is laced with elements of local cultural value and practice which are not necessarily authentically Islamic. Since Malays make up the biggest community in Malaysia, one has to differentiate between Islam and Muslim. Majority of Muslims misunderstood the term Ruqyah as a form of healing exclusively done by the Muslim faith healers. In conclusion, psychiatrists should engage more proactively with faith and spiritual healers in order to curb stigmatization and delay in seeking psychiatric care and treatment.
Introduction: Psoriasis is a chronic, immune mediated, hyperproliferative skin disease that has substantial impact on the sexual functions. This study aimed to determine the prevalence and associated factors of female sexual dysfunction (FSD) in patients with psoriasis.
Methods: A cross-sectional study involving 79 women with psoriasis attending two Dermatology Outpatient Clinics were interviewed and assessed for female sexual dysfunction and severity of psoriasis. The socio-demographic and clinical characteristics of the subjects were compared between the women with and without sexual dysfunction. The subjects were interviewed using Mini International Neuropsychiatric Interview (M.I.N.I.) to exclude any existing psychiatric illness. Sexual dysfunction was assessed using a validated questionnaire on sexual function and the severity of psoriasis was assessed using Psoriasis Area and Severity Index (PASI).
Results: The prevalence of FSD in the patients with psoriasis was 20.3%, with hypoactive sexual desire being the most prevalent problem (44.3%). Sexual dysfunction was associated with older age, menopause, low body mass index, longer duration of marriage and presence of psoriasis in the genital area. Female sexual dysfunction was highly prevalent in patients with psoriasis.
Conclusion: Management of psoriasis should include assessment in patients’ sexual health. Genital area involvement with psoriasis should not be overlooked as it can cause significant psychosexual distress.
Keywords: Psoriasis, female, sexual dysfunction, prevalence, risk factor, Malaysia
Study site: Dermatology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Introduction: There was no previous study to assess relationship between dry eye symptoms and signs in the local population. The purpose of this study is to evaluate the relationship of symptomatic assessment and clinical signs of dryness in dry eye subjects.
Materials and method: A Cross-sectional study with convenient sampling involving 321 subjects with 642 eyes was done. Subjects were divided into non-dry eye (NDE) and dry eye (DE) groups. The division of NDE and DE groups were done using two types of classification. In Classification 1(symptoms-based), DE was defined if the score of Ocular Surface Disease Index (OSDI) score was more than 33. The value of tear film break-up time (TFBUT) less than 5 seconds and Schirmer test with anaesthesia (STA) less than 5mm/5 minutes were considered as DE for Classification 2 (signs based).
Results: There were poor correlations between OSDI and clinical signs of dryness in all subjects involved (p > 0.05). Similar findings were also noted within NDE subjects in Classification 1 and Classification 2. OSDI score was also not significantly correlated with the signs of dryness within DE subjects except with ocular protection index (OPI) (r = - 0.14, p = 0.047) in Classification 1 and with conjunctival lissamine green staining (CLGS) (r = 0.23, p = 0.040) in Classification 2.
Conclusion: There were no significant correlation between the symptoms of dry eye and the clinical signs of dry eye. Therefore, the clinical diagnosis of dry eye can be made based on either just on the symptoms or the signs.
Limb problem is a common complication for patients with diabetes. While the impact of diabetic limb problems
on physical health is well known, the psychological impact of the condition is still largely unknown. People with
diabetes with or without foot ulcers frequently suffer from major depressive disorder, and this is made worse
by the presence of limb complications. Furthermore, depression itself can have negative consequences on the
person’s diabetes. Hence, in caring for people with diabetic foot problem, the psychological sequelae must not
be overlooked but managed accordingly
The Community Health Posting teaching module is incorporated in the fourth year medical curriculum at Universiti Sains Islam Malaysia (USIM). The integration of Islamic principles and values in the medical curriculum is emphasized during the Community Health Posting. The Community Health curriculum allow students to appreciate and understand the medical and fiqh aspects of health and disease, the social issues in medical practice and research and to inculcate the practice of Islamic professional etiquettes. The teaching module illustrates the relevance of humanities in understanding illness and medical care within the community. Teaching and learning activities include components that enable the students to explore a wide range of influencing factors and how these affect the patients and their families. Issues pertaining to psychosocial and ecological perspectives of the community are also discussed. This posting utilizes various teaching and learning techniques such as lectures, tutorials, seminars, group discussions, educational visits, practical sessions and patient bedside teaching. In addition, the students are equipped with Islamic knowledge through the integration of Naqli and Aqli components in the Community Health Posting curriculum.
Total knee arthroplasty represents a major advance in the treatment of
degenerative joint disease. It provides excellent restoration of joint function and pain
relief. The primary indication for total knee arthroplasty is to relieve pain caused by
severe arthritis, with or without significant deformity. This study is to assess
psychological impact pre and post arthroplasty. (Copied from article).
Having children with congenital anomalies, particularly congenital talipes
equinovarus (CTEV) may impact the psychological wellbeing of the parents. This study
is to assess the psychological impact of CTEV, the related factors, and the coping
strategies used by the parents in Hospital Tengku Ampuan Afzan (HTAA), Kuantan,
Pahang. (Copied from article).
Copy denture technique is a classic technique for construction of a new denture
based on the favourable aspects of the original denture using a replica. This technique helps in
adaptation of new denture in elderly population. The aim of this paper was to assess the knowledge
and practice of copy denture technique among dentists and dental technologists. (Copied from article).
The aim of this study was to determine the incidence of torus palatinus and torus
mandibularis in Malaysians. The objectives are to evaluate the incidence of tori according to
ethnicity, to assess the incidence of tori according to gender and to determine the incidence of
torus palatinus vs torus mandibularis. (Copied from article).
Introduction: There has been increasing evidence of detrimental effects of cumulative positive fluid
balance in critically ill patients. The postulated mechanism of harm is the development of interstitial
oedema, with resultant increase morbidity and mortality. We aim to assess the impact of positive fluid
balance within the first 48 hours on mortality in our local ICU population. Methods: This was a secondary
analysis of a single centre, prospective observational study. All ICU patients more than 18 years were
screened for inclusion in the study. Admission of less than 48 hours, post-elective surgery and ICU
readmission were excluded. Cumulative fluid balance either as volume or percentage of body weight from
admission was calculated over 6, 24 and 48 hour period from ICU admission. Results: A total of 143 patients
were recruited, of these 33 died. There were higher cumulative fluid balances at 6, 24 and 48 hours in nonsurvivors
compared to survivors. However, after adjusted for severity of illness, APACHE II Score, they were
not predictive of mortality. Sensitivity analysis on sub-cohort of patients with acute kidney injury (AKI)
showed only an actual 48-hour cumulative fluid balance was independently predictive of mortality (1.21
(1.03 to 1.42)). Conclusions: Cumulative fluid balance was not independently predictive of mortality in a
heterogenous group of critically ill patients. However, in subcohort of patients with AKI, a 48-hour
cumulative fluid balance was independently predictive of mortality. An additional tile is thus added to the
mosaic of findings on the impact of fluid balance in a hetergenous group of critically ill patients, and in subcohort
of AKI patients.
Introduction: Stem cells from human exfoliated deciduous teeth (SHED) are highly proliferative, clonogenic cells capable of differentiating into osteoblasts and inducing bone formation. It is a potential alternative for stem cell bone regeneration therapy. However, stem cell therapy carries the risk of immune rejection mediated by inflammatory cytokines of the human defense system. Objective: This preliminary research studies the interaction between SHED and the immune system by determining the inflammatory cytokines profile and osteogenic potential of SHED. Methods: Human fetal osteoblasts (hFOb) cell line and isolated SHED were cultured and total RNA was extracted, followed by reverse transcription cDNA synthesis. Semi-quantitative reverse transcription PCR and Multiplex PCR were performed to detect the expression levels of OPG/RANKL and TNF-α, IL-1β, IL-6, IL-8 and TGF-β in both cell types. Results: Analysis showed that SHED expressed significantly lower amounts of IL-1β, IL-6, and IL-8 compared to hFOB. IL-1β is a potent bone-resorbing factor, while IL-6 and IL-8 induce osteoclastogenesis and osteolysis respectively. SHED did not express TNF-α which stimulates osteoclastic activity. SHED demonstrated high OPG/RANKL ratio, in contrast with that of marrow stem cells described in previous studies. Our findings suggest that SHED may have improved immunomodulatory profile in terms of promoting relatively lower inflammatory reaction during transplant and enhancing bone regeneration. Conclusion: SHED has a potential to be a good source of osteoblasts for bone regeneration therapy. Further studies on the immunomodulatory properties of SHED-derived osteoblasts are necessary to enable stem cell therapy in immunocompetent hosts.
Rat large intestine is an established model to study the effect of
carcinogens. There are several distinctive features among mammalian gastrointestinal
tracts in gross anatomy but they share some basic similar structures. The variety in
digestive system relies on its physiology. Rats rarely eat high fatty diets, thus the
function of gall bladder become less significant in their digestive system and this is
justified by the fact that rats have none. Rats have large caecum designated for their
fermentation chamber to digest cellulose. Another notable difference is the size and
length of colon itself, in which human colon is significantly bigger and longer. We aimed
to demonstrate the gross anatomy and histology of rat digestive system particularly the
large intestine. (Copied from article).
Introduction: Hypertension related morbidities and mortalities around the world show a gradual increase and early detection and prevention are advocated. The Database of Genomic Variants (DGV) has associated variation in DNA sequences called copy number variation (CNV) with susceptibility to common diseases. However, little is known about CNV role in essential hypertension. Thus, this study aimed to characterize the CNV esv27061 among prehypertensive and hypertensive young adults in Malaysia. Materials and method: In this comparative cross-sectional study, 104 subjects living in Kuantan who gave voluntary consent to participate are recruited and divided into three groups; control (43 subjects), prehypertensive (38 subjects) and mild hypertensive (23 subjects). An optimized droplet digital polymerase chain reaction (ddPCR) was used in the determination of CNV esv27061 in this study. Results: All subjects in the control (n=38; 88.4% gain), prehypertensive (n=33; 86.8% gain) and mild hypertensive (n=21; 91.3% gain) groups had CNV gain (copy number > 2) while 11.6% of control, 13.2% of prehypertensive and 8.7% of mild hypertensive subjects exhibited normal copies (copy number = 2). Conclusion: The present preliminary finding was consistent with the Database of Genomic Variants (DGV) which stated that CNV esv27061 showed more gain than loss.