Background: Set-up errors are errors which are inevitable in radiotherapy. However, they should be kept to a minimum to achieve the maximum radiation dose to a tumour as to maximise treatment efficacy. This study aims to quantify those errors and assess if they remain within the tolerance limit of 5 mm in all directions. This study will also determine the adequacy of the margins for set up error for 3DCRT of rectal cancers at University of Malaya Medical Centre (UMMC).
Methods: A total of 20 rectal cancer patients (July 2018 to May 2019) who were treated with radiotherapy amounting to a total of 119 CBCT images were included in the study. Population systematic errors and random setup errors were calculated.
Results: Population systematic errors and random setup errors in the vertical, longitudinal and lateral direction were tabulated in Table 1. There is a large deviation (>5 mm) noted in some patients’ setup between the first 3 days and the next successive day of imaging. Clinical target volume (CTV) to planning target volume (PTV) margin were calculated using Van Herk’s margin recipe (M=2.5Σ+0.7σ). The margins were 5.0 mm, 6.2 mm, and 4.0 mm for vertical, longitudinal and lateral directions, respectively. The systematic error for the population was 1.1 mm, 0.9 mm, 0.9 mm in the vertical, longitudinal and lateral directions respectively, while the random error is 3.2 mm, 5.7 mm and 2.5 mm in the vertical, longitudinal and lateral directions respectively.
Conclusion: All of the patients involved in the study were within tolerance limits at some point in their treatment. The results demonstrated that a larger margin is needed in the longitudinal direction. Weekly CBCT is also necessary after the initial 3-day imaging to ensure that patients are kept within the tolerance limits.
This paper attempts to examine the socio-demographic profile of the respondents in Migrant Health studies. It was based on questionnaire survey among 820 respondents from the Klang Valley and the State of Kelantan from 6th January 1998 to 14th January 1999. Majority of the respondents (47.9%) were from Bangladesh, followed by Indonesia (14.8%), Thailand (13.7%), Myanmar (20.4%), Pakistan (9.9%) and Others (1.3%). The male to female ratio is 7:1. He age of respondents ranged from 18 to 69 years with a mean of 30.5 years. More than 70% of them are adults (25-44 years). Females were older than males (mean age of 33.8 years and 30.5 years respectively). Majority of the respondents were married (females 75.8% and males 52.6%), 93.7 were Muslims. About 87.4% of them had some formal education. Majority of the foreign workers were employed as factory workers (35.7%), followed by construction workers (18.3%), agricultural workers (33.6%), service workers (13.3%) and self-employed (11%). Nevertheless, the profile of these responding do not conform to the national profile.
INTRODUCTION: Although the Feldenkrais method of rehabilitating chronic obstructive pulmonary disease (COPD) patients have been suggested, its use among practitioners is not widespread owing to preference of the more familiar standard program presently available. Several advantageous of the Feldenkrais Method have been suggested which includes improving the efficiency of movement, posture and, breathing. However how this compares to the standard rehabilitation protocol or pulmonary rehabilitation program (PRP) have not been previously demonstrated. The present study was thus conducted to compare the effectiveness of the Feldenkrais Method to the standard PRP using Borg score and 6 minute walked distance (6MWD) as outcome measurement tools.
RESULTS: There were 17 subjects in the Feldenkrais group (FG) and 19 subjects in the pulmonary group (PG), both of which received therapy for 8 weeks and assessed before and after receiving therapy. There were no improvements observed in the Borg score for the FG (after and before; 6.06+ 1.09 vs. 6.00+0.94). However, improvements in the PG group could be seen (after and before; 3.58+ 1.17 vs. 5.84 +1.01). Improvements in the 6MWD was observed in both groups with no significance differences noted (FG vs. PG; 379+129m vs. 374+80m).
CONCLUSION: The Feldenkrais method does not offer any advantage over the present PRP and in fact the latter offers better improvement in terms of the Borg score. However in view of the small study sample, further study would be needed before a final conclusion can be made.
Study site: Respiratory clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
A survey was done to assess the chest radiographs of a selected group of immigrants. The objective is to ascertain the rpesence of abnormalities especially the presence of tuberculosis. Five hundred and eleven (511) chest radiographs (PA view) were evaluated. majority of the chest radiographs were normal, except for 2 cases of hilar lymphadenopathy, 4 cases of scoliosis and cervical rib, an old case of fracture of the clavicle and a case of cardiomegaly. Only 2 cases of TB were detected.
Prevalence and signs and symptoms of menopause have been extensively studied among Malaysian women but no one had investigated the level of knowledge and perception of menopause. This study aimed to examine the knowledge and perception of menopause among young to middle aged women (15 to 49 years old). A cross-sectional survey using 20-items questionnaire was conducted in three randomly chosen districts in Federal Territory, Kuala Lumpur. Women in this survey were aware of the meaning of the term menopause and its symptoms. However, the majority lacked comprehensive understanding about the health risks associated with menopause. Commonly cited sources of knowledge were magazines and family members. Lack of official sources for accurate information on menopause was reported. Communication with health care personnel regarding menopause was uncommon. An exploration into respondents' perceptions on menopause revealed that the majority displayed positive thinking towards menopause. Young respondents seemed to have better perception regarding menopause compared to middle aged women. Although the women had good knowledge about menopause, they expressed feelings of sadness and nervousness upon the approach of their own menopause. Our data provides insight on the knowledge and perception of menopause that will guide future public health initiatives for premenopausal women in order for them to cope better when approaching this stage of life cycle.
Inferior vena cava agenesis (IVCA) is an uncommon congenital anomaly which was first described in the seventeenth century. The detection of such an anomaly is often incidental and patients are asymptomatic until the third to fourth decade of life. Due to the scarcity of these cases, there is no consensus on the subsequent treatment and surveillance of incidental asymptomatic IVC anomalies. Herein, we report on a young male with incidental findings of suprarenal IVC agenesis identified on contrast enhanced computed tomography (CT) scan of the abdomen in the course of treatment for acute appendicitis.
Human adipose tissue has been recognized as an alternative source of adult stem cells. The abundance and ease of harvest of adipose tissue has made it suitable for use in regenerative medicine and tissue engineering. Adipose-derived stem cells isolated from human adipose tissue are able to differentiate into several mesenchymal lineages and secrete growth factors that exhibit therapeutic potential. Protein profiles have been established using various isolation methods, which has expanded researchers’ understanding of adipose-derived stem cells in clinical applications. This review highlights the properties, isolation methods, immunophenotype and clinical applications of adipose-derived stem cells.
Senescent-decliue in the nervous-system functions is very frequently atbibuted to age-related neurone-loss. Processes and mechanisms involved in neuro- degeneration form part of the structural frame-work for interpreting the functional consequences. The literature concerning this matter are confusing and contradicting. The behaviour of cranial nerve ganglia was studied using neuro-histological techniques. On the evidence available in the present study, the dark cells are considered as active ones; the light cells are considered as those which have failed to establish functional projections, inactive, dying, dead or degenerating ones. Probably it is during the me- dium-sized stage of cell growth, the peripheral and central processes (of axons) begin to grow from the cell body and attempt to get established in their projection fields. The light cells have appeared among the very-small cells just on the day of hatching. This probably signifies the possible attempt to elinlinate the growing cells since they are no longer needed to replace larger categories of cells which have already well- developed neuronat connections at this stage. It is assumed that the time of appear- ance of light cells might be indirectly related to the onset of establishment of active functional connections of neurones and to the functional importance of the organs which it supplies. KEYWORDS: Neurone-Loss and Ageing, Dark and Light Neurones, Sensory and Autonomic Ganglia
The positive response to tamoxifen in ERa-positive breast cancer patients is usually of a short duration as many
of the patients eventually develop resistance. Our preliminary results show that aloe emodin extracted from
the leaves of the Aloe barbadensis Miller demonstrated a cytotoxicity that is selective to ERa-positive breast
cancer cells (MCF-7), but not to ERa-negative breast cancer cells (MDA-MB-231) and to the control cells (MCF-
10A). The objective of this study was to test the hypothesis that aloe emodin may enhance the response of
MCF-7 cells to treatment with tamoxifen. MCF-7 cells were treated with aloe emodin alone, tamoxifen alone
or a combination of emodin and tamoxifen, at their respective IC50 concentrations and at different time points
of 24 hours, 48 hours and 72 hours. The respective IC50s were the concentrations of aloe emodin and tamoxifen
required to achieve 50% inhibition of the cells in the study. Cell viability and apoptosis were determined using
trypan blue exclusion and DNA fragmentation assays, respectively. The involvement of RAS/MEKs/ERKs genes
of MAPK signalling pathways with aloe emodin was determined using QuantiGene 2.0 Plex assay. Data was
evaluated using the one-way ANOVA test. Our findings showed that aloe emodin enhanced the cytotoxicity of
tamoxifen on MCF-7 cells through apoptosis by downregulation of MEK1/2 genes. Our research may provide a
rational basis for further in vivo studies to verify the efficacy of a combination of aloe emodin and tamoxifen
on the viability of ERa-positive-breast cancer cells.
The Pabon Lasso Model is one of the most important and suitable techniques applied in evaluating the performance of hospitals. The visual representation standardizes the comparative accomplishments of hospitals which information is used by planners in effort to improve productivity of the health care system by use of three pointers namely: (i) Average Length of Stay (ALS); (ii) Bed Occupancy Rate (BOR); (iii) Bed Turnover (BTO). The purpose of this study is to evaluate performance of wards in health centers affiliated to Kampala Capital City Authority (KCCA) and Ministry of Health (MOH) during the financial year 2012-2013 constructed on Pabon Lasso Model. Data for the nine health centers and two referral hospitals was taken by the nursing sisters who were in charge. To ensure accuracy, a weekly standard report was submitted to head office and the data included: a list of wards, number of beds, admissions, deaths, discharges and inpatient days. For all government health centers and hospitals, overall, the average indicators ALS=3.63 days, BTO= 74.0 times per year and BOR=49.3% were obtained. Based on the Pabon Lasso graph, two wards are in Zone 3, two wards in Zone 4, one ward in Zone 2 and five wards in Zone 1. The performance of health centers and hospitals in Kampala were somehow poor. This represented unacceptable levels of technical deficiency.
Tuberculosis (TB) is a major public health problem worldwide. It is estimated that 2 billion people, a third of
the world population, have TB infection, but are not down with the disease. Globally, incident cases of TB
showed a rising trend, with a 6.6 million reported in 1990, 8.3 million in 2000, 9.24 million in 2004, and an
estimated 9.27 million incident cases in 2007. The aim of this study was to evaluate the treatment outcome of
TB patients in Nigeria in the state of Jigawa. A cross sectional retrospective study was conducted to evaluate the
treatment outcome in directly observed treatment with a short course for tuberculosis (TB DOTS) in facilities
in the state between the years 2010 to 2014. The study population were all the patients with TB, who had
access to DOTS therapy. Data were collected from the various local governmental areas for tuberculosis control
(LGA TB) register. The LGA TB control registers contained basic information of the patients, and a statistical
software SPSS-V22.0 was used to analyse the data. A total of 963 TB patients were studied. More than half
(57.4%) of the patients were male, and nearly three- fourths (71.2%) of the patients accessed care from urban
local government areas in the state. The greater majority (96.3%) of the cases had pulmonary tuberculosis
(PTB). Among the patients, more than two-fifths (45%) were cured, and a little over one-fifth (20.6%) of them
were HIV positive. This study revealed that the treatment success rate (TSR) in the Jigawa State of Nigeria
was higher than the overall TSR of Nigeria, and the defaulter rate in this state was lower than the Nigerian
average. The aim of this study was to evaluate the treatment outcome of TB patients in Nigeria in the state
of Jigawa. A cross sectional retrospective study was conducted to evaluate the treatment outcome in directly
observed treatment with a short course for tuberculosis (TB DOTS) in facilities in the state between the years
2010 to 2014. The study population were all the patients with TB, who had access to DOTS therapy. Data were
collected from the various local governmental areas for tuberculosis control (LGA TB) register. The LGA TB
control registers contained basic information of the patients, and a statistical software SPSS-V22.0 was used
to analyse the data. A total of 963 TB patients were studied. More than half (57.4%) of the patients were
male, and nearly three- fourths (71.2%) of the patients accessed care from urban local government areas in
the state. The greater majority (96.3%) of the cases had pulmonary tuberculosis (PTB). Among the patients,
more than two-fifths (45%) were cured, and a little over one-fifth (20.6%) of them were HIV positive. This study
revealed that the treatment success rate (TSR) in the Jigawa State of Nigeria was higher than the overall TSR
of Nigeria, and the defaulter rate in this state was lower than the Nigerian average.
Leadership style has been shown to be an important determinant of organisational success. The aim of this preliminary study was to develop an understanding of leadership style of three employees with leadership responsibility in a hospital. All the participants were interviewed using a structured questionnaire around a framework on leadership behaviours followed by self administered T-P leadership questionnaire and voluntary completion of a leadership perception survey by each of the participant’s colleagues. The results suggest that whilst individuals are aspiring to be transformational in style, key barriers such as organisational culture, inter-professional dynamics and lack of leadership development meant responses more characteristic of a transactional style were encountered. There is a need to have joint responsibility between developing the individual leadership style and the organisation that facilitates such development for their leaders. The author concludes that a more analytical approach to leadership and mentorship opportunities for developments is required.
Porto-spleno-mesenteric vein thrombosis is a rare, life-threatening condition of extrahepatic portal venous
system thrombosis. We report a rare case of a 49-year-old lady with late presentation of acute portal vein
thrombosis in a non-cirrhotic liver with an incidental finding of left adnexal teratoma. She presented with a
one-week history of severe abdominal pain associated with vomiting and diarrhea. She gave no history of prior
risk for venous thromboembolism or liver diseases. Physical examination revealed a tender mass extending from
suprapubic to left iliac fossa. Abdominal computed tomography scans showed a well-defined fat-containing left
adnexal mass, likely a benign teratoma, with no involvement of surrounding structures or calcification. There
was evidence of porto-splenic-mesenteric vein thrombosis with liver infarction, bowel and splenic ischemia.
Management of the extensive thrombosis causing multi-organ failure includes resuscitation, supportive care
and treatment of thrombosis. Treatment options include early anticoagulation and if feasible, thrombolysis.
Compression of the common bile duct by a stone impacted in the cystic duct is an uncommon cause of obstructive jaundice. We present a case study and review of the literature pertaining to the presentation, diagnosis, and surgical treatment of Mirizzi syndrome.
Rhabdomyosarcoma of the genitourinary tract is rare and predominantly affects paediatric patients. We present an unusual case of such a lesion in an adult with extensive occupation of the bladder cavity by the lesion, resulting in bilateral ureteric obstruction, without evidence of ureteric outlet invasion. We outline the unusual CT and macroscopic appearance of this lesion. We also discuss the literature data and management strategies of rhabdomyosarcoma of the genitourinary tract.
The incidence of road traffic injuries has increased over the last two decades. Of greater concern is the prediction that the problem is likely to increase further, given present trends in transportation. Injuries and not "accidents" need to be the focus of the health sector. Passive strategies, which are independent of human behaviour, are more likely to succeed in the prevention of injuries compared to "active" strategies. The health sector needs to play a bigger role in prevention through advocacy, research and education of target groups.
The COVID-19 pandemic resulted in 5 consecutive Movement Control Orders (MCOs) in Malaysia in an attempt to flatten the epidemiological curve, with a reduction of cases. This study aims to use statistical analysis to assess whether the decisive public health interventions in the MCO were efficacious. Three statistical tests were employed: Mann-Kendall trend analysis; one way between groups ANOVA; and Pearson correlation test. Results demonstrated significant differences between the second block, MCO 3-5, compared to MCO 1-2. Johor and Selangor states experienced significant increase in early MCO, whereas Sarawak and Selangor states experienced significant decrease by MCO 3-5. The northern border states of Kedah, Perlis and Kelantan, had caseloads stabilised to zero by MCO 4/MCO 5. This study demonstrates that the MCO was effective within the target of twice the two-week incubation period of COVID-19, with cases from community transmission and importation through the air and southern land borders. Selangor and Sarawak had higher cases in early MCO due to situational factors. In conclusion, MCO has been efficacious, with different states attaining different levels of case reduction due to individualised reasons.
Angioedema due to whatever cause is potelltially life threatening, especially if it involves the head and neck region. Patients at risk need to be identified and precautionary measures are necessary. The use of Angiotensin Converting Enzyme Inhibitors (ACEIs) has been associated with angioedenia of the face and tongue. Its widespread use has resulted in an increased awareness of this rare but important camplication. We report liere a case of angioedenla secondary to ACEls developing a few months after initiation of therapy and discuss its clinical importance. KEYWORDS: Angioedema, Angiotensin Converting Enzyme Inhibitor.
Oral cavity malignancy reconstructive surgery has advanced from pedicle flaps to microvascular free tissue transfer. Previously, reconstruction of these defects were done using radial forearm free flaps in this centre. We report our experience using anterolateral thigh free flap in a 49 year old lady with squamous cell carcinoma of the tongue. Excision of tumour left a defect which was later reconstructed using microvascular free tissue transfer using the right anterolateral thigh free flap. The flap was well taken up at the recepient site and no evidence of flap failure noted post operatively and on completion of radiotherapy. She was able to maintain comprehensible speech and swallowing ability.