Systematic review is a comprehensive review of research findings in which all of the primary studies are systematically identified, appraised and summarised using an explicit and reproducible methodology. Meta-analysis is the statistical component of a systematic review in which combinable studies are drawn together via a statistical process. Systematic reviews and meta-analyses are routinely being used in the evidence-based approach to medicine. These short notes intend to highlight important terms in systematic-review and meta-analysis. It is a beginner’s guide for health care professional of any discipline involved in research or practice who seeks to gain more comprehensive understanding of important terms used in systematic review and meta-analysis.
We report a case of an 86 year old Chinese man who presented with a painless right testicular swelling that had persisted for one year. There was no history of maldescend or cryptorchid testes. Clinical and ultrasound examination revealed testicular tumour with two round masses within the right scrotal sac, with minimal fluid seen within the sac. Tumour markers were normal. He subsequently underwent a right inguinal orchidectomy under local anaesthesia as he had an underlying cardiac insufficiency. Histopathological examination revealed malignant Sertoli cell tumour. True Sertoli cell mesenchyme tumours constitute less than 1% of all testicular cancers.Current literature on histopathological and clinical features and treatment options are reviewed.
The objective of this study was to determine the factorial validity of the Chinese version of the General Family
Functioning subscale (GF-12) and to assess parents’ perceived family functioning of children with or without
chronic respiratory disease in Malaysia. Thirty two parents of children with chronic respiratory disease and
30 parents of healthy children were recruited. The GF-12 was administered at baseline and 2 weeks later.
Confirmatory factor analysis showed that our instrument was a 1-factor model assessing general family
functioning. Cronbach’s α value was 0.950. Test-retest reliability coefficient ranged from 0.490-0.790. The overall
mean (standard deviation) score was not significantly different between parent’s perceived family functioning
of children with or without respiratory disease [1.83(0.63) versus 1.65(0.46), p=0.385]. The Chinese version
of the GF-12 was found to be a valid and reliable instrument to assess family functioning in Malaysia. Parents
in the present study showed healthy perceived family functioning (total score >2.00).
The majority of migrant workers studied in this survey were males Muslims from Bangladesh. The mean age was 30 and the majority were aged between 21-30 years. Although almost all of them had 7-13 years of schooling, the majority were working in the service industry. More than two thrids of the migrant workers were provided with various forms of housing by their employers. Majority of them stated that they had better amenities, such as piped drinking water and sanitary toilets, in Malaysia compared to those in their home countries. From their reports, it appears that the majority did not engage in risk behaviours such as, smoking, alcohol and drug abuse.
The records of 141 consecutive patients with proven tuberculosis (TB) were reviewed to examine for changes in their serum proteins, erythrocyte sedimentation rate (ESR) and tuberculin skin test reactivity. Hypoalbuminaemia was present in 73% of patients and hyperglobulinaemia was seen in 92% of patients. ESR showed a negative correlation with the serum albumin level but a positive correlation with the serum globulin level. In the case of pulmonary TB, ESR was higher in patients with radiologically more extensive disease. Tuberculin reactivity was reduced in patients who were older, those with more severe hypoalbuminaemia and those with disseminated TB. KEYWORDS: Albumin, erythrocyte sedimentation rate, globulin, tuberculin reactivity, tuberculosis
Pulmonary embolism is the obstruction of the pulmonary artery or its branches, commonly by thrombus or
fat. We report an unusual case of double pathology - both pulmonary thromboembolism and fat embolism
syndrome in a patient with bilateral femur and bilateral tibia fractures. This highlights the importance of a high
index of suspicion of these conditions while managing patients with multiple long bone fractures. Morbidity
and mortality can be significantly reduced with prompt and appropriate prevention strategies.
Background: Hepatitis C Virus (HCV) is a major public health problem worldwide. About 130- 200 million people
are infected with HCV worldwide leading to 500,000 deaths annually (WHO 2014). Healthcare workers (HCWs)
have played an important role in the transmission of HCV infection, either as victims or as sources of infection.
Objectives: To determine the prevalence of HCV, antibodies (Abs) RNA and genotypes among the female HCWs
in Baghdad and to identify whether HCWs were infective or only infected.
Subjects and Methods: A cross-sectional study involving 1001 women attending 17 health care centres in
Baghdad, Iraq, was carried out. Information on type and duration of their occupation was obtained. HCV Abs
(anti-HCV) were tested using a third generation enzyme immunoassay (EIA-3) and immunoblot assay (Lia
Tek-111). Molecular analysis using RT-PCR and DNA enzyme immunoassay (DEIA) for HCV-RNA and genotype
detections were carried out for 63 serum samples.
Results: Only 160/1001 (15.98%) were HCWs. Anti-HCV and HCV- RNA seroprevalence were significantly higher
(6.37%, p=0.0057, 88.83%, p= 0.011 respectively) among HCWs than non HCWs. HCWs were at a significantly
higher risk of exposure to HCV infection (OR=2.75, 95% C.I. =1.31-5.79). There was no significant association
between HCV genotypes and the HCWs. HCV-4 showed higher expression (62.5%) among HCWs.
Conclusion: Female HCWs were infective and infected with HCV, thus there is a need for medical equipment
to be sterilized and cleaned thoroughly.
We evaluated the use of Desflurane anaesthesia in this prospective observational audit in the University of Malaya Medical Centre Day Surgery Unit. Fifty ASA I-II unpremedicated day surgery patients received fentanyl and propofol induction after preoxygenation. Desflurane was introduced initially at 2% and the concentration was increased gradually to 4%, then 6%, 8% and 10% in nitrous oxide and oxygen. Patients breathed spontaneously throughout the surgery. Desflurane was switched off at the end of surgery and patients breathed 100% oxygen. The haemodynamic effect, perioperative complications and recovery profiles were recorded. Systolic arterial pressure and heart rate decreased after induction of anaesthesia but returned to baseline value at discharge. Adverse airway event such as coughing and postoperative nausea and vomiting are two unwanted complications. KEYWORDS: Desflurane, day surgery, propofol induction
Preliminary work was carried out f o r the development of a rapid method for the detection and enumeration of enterococcal phages in natural water. Eight enterococcal phages were isolated after amplification from water obtained from 2 local ponds. These were plaque-purified and used to test the phage susceptibility of 34 strains of enterococci isolated from pristine and polluted waters. Eight strains with the widest phage susceptibility were used as hosts in a double agar layer (DAL) and a single agar layer (SAL) assay for phage enumeration without pre-assay amplification. N o phages were obtained with the DAL method with all 8 hosts. Usingthe SALmethod, 2 phages were obtained with 1 of the 2 hosts used. Phage isolation was not improved by incubation at 44.5°C. For rapid quantitative testing, the sensitivity of the assays has to be increased to enable phage isolation without the need for prior amplification. KEYWORDS: Enterococci, phage, enumeration
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.
Long-distance running has gathered some momentum among health-conscious participants. However, some
studies have revealed association between long-distance running and development of acute kidney injury.
Although the impact usually lasts only for a few days after the event, some participants have been admitted for
severe acute kidney injury, the minority of which require dialysis treatment. The mechanisms underlying the
injury may include dehydration, development of rhabdomyolysis, heat stroke and concomitant use of NSAIDS.
Unfortunately, there is no long-term follow-up study to determine the long-term effect on kidney function.
Acute hyponatremia may develop in a significant proportion of long-distance runners. Majority of them were
asymptomatic but a few fatal cases which were supposedly due to cerebral oedema have been reported.
Excessive intake of hypotonic drinks, excessive sweating and secretion of non-osmotic antidiuretic hormone
have been postulated to be the causes of hyponatremia. This mini review will discuss the pathophysiology of
the development of acute kidney injury and hyponatremia. It will also discuss the prevention and treatment
of both conditions.
Current selection guideline for CRT uses broad QRS duration (>120 ms) as a marker for ventricular dyssynchrony. However, more recent data supports mechanical marker specifically measured by Tissue Doppler Imaging (TDI) as a better criterion to predict response to CRT. Sixty seven patients with significant left ventricular dysfunction (EF less than 40%) and narrow QRS complex were prospectively enrolled. They underwent Tissue Doppler Imaging (TDI) study to evaluate intraventricular mechanical dyssynchrony. Dyssynchrony index which is defined as standard deviation of time to peak systolic velocity in twelve ventricular segments was measured. A value greater than 32.6 is taken to reflect significant ventricular dyssynchrony. Overall 38 patients (56.7%) demonstrated significant dyssynchrony. There was no significant correlation between QRS duration and the Ts-SD-12 (r = 0.14, p = 0.11). Ventricular mechanical dyssynchrony is common in patients with normal QRS duration. Therefore, QRS duration alone will miss a substantial proportion of suitable patients for CRT and therefore deny them this adjunct therapy. We propose echocardiographic parameters, specifically TDI, to be included in patient selection criteria for CRT.
Introduction:
Living donation is an important source for organs transplantation in Malaysia. This study aims to investigate
the Malaysian living donors’ follow-up attendance, their preferences on medical-institutional facilities, and
the financial circumstances pertaining to the follow-up costs
Materials and Methods:
Primary data were collected through a survey of 80 living donors who made their donation at the University
of Malaya Medical Center (UMMC) between 1991 and 2012.
Results:
Out total of 178 donors, only 111 were reachable and 80 of them participated in the survey (72%). The findings
revealed that most of the donors (71.2%) attend the follow-up regularly. Nevertheless, donors seem to neglect
the importance of follow-up as they consider themselves healthy (28.9%) or consider the follow-up as being
troublesome (28.9%). Most donors (67.5%) are not in favour of being treated as patients, but prefer to be
monitored under donor registry (88.8%) and getting their health service in special clinics for donors (80%).
The majority of the donors fund the follow-up costs themselves (32.4%), while 25% of the donors’ follow-up
costs were funded by family members. Among those donors without income and those of low-income (84.8%
of respondents), 60.3% believe that the follow-up costs should be borne by the government.
Conclusions:
Based on the findings, it is therefore suggested that the government provides all living donors with proper
free health service through donor registry and donor clinics. Adequate care has to be given to the donors to
pre-empt any unforeseen health complications due to the organ donation surgical procedures.
The study was taken to assess the feasibility of diffusion-weighted imaging (DWI) and apparent diffusion
coefficient (ADC) mapping using different b-values for magnetic resonance-guided focused ultrasound (MRgFUS)
treatment of uterine fibroid and adenomyoma.
The contrast-enhanced T1-weighted image (cT1WI) as well as DWIs and ADC maps of different b-values (i.e.
200, 600 and 800 s/mm²) were obtained from nine fibroid and five adenomyoma patients, immediately after,
and 12 months after MRgFUS treatment. The image contrast score, non-perfused volume (NPV) and NPV
ratio obtained were compared to determine the feasibility of DWI and ADC mapping for MRgFUS treatment
outcome evaluation.
Our finding showed that immediately after MRgFUS treatment, the DWI acquired using 200 s/mm² b-value
gave the highest image contrast score among all other b-values. The NPV calculated from DWI of 200 s/
mm² showed the best correlation (R² = 0.938) with post-contrast NPV. At 12 months follow-up, there was no
specific b-value considered as significantly superior to others in terms of image contrast. However, the NPVs
and NPV ratios obtained from all DWIs and ADC maps of different b-values were in good agreement with the
post-contrast NPV and NPV ratio.
We observed that the DWI, particularly obtained with a low b-value (i.e. 200 s/mm²), is feasible for delineation
and quantitative volumetric evaluation of the ablated region immediately after the MRgFUS treatment. At 12
months follow-up, both DWIs and ADC maps are feasible for NPV and NPV ratio calculation.
In Malaysia, incidence of Wilms’ Tumor (WT) is rare, with only 8 cases reported over four years according to the Malaysia Cancer Registry Report (2012-2016). Reports of spontaneous rupture of WT are scarce and the commonest presentation of this entity is a palpable mass in the abdomen. Herein, we report on the unusual presentation of an 11-year-old boy with typical symptoms of acute appendicitis. The child was subjected to an initial open appendicectomy and diagnosed intra-operatively with a right sided ruptured renal mass. Subsequent investigation leading to the diagnosis of a ruptured Wilms’ tumor and its treatment is discussed in this case presentation.
Comparison and evaluation of physicochemical properties of the six betamethasone·17-valerate creams available locally were studied. Tests that were conducted include stiffness/hardness, grittiness. colour, odour, homogeneity (phase separation), pH, weight of loss, tackiness (stickiness) and microscopic examination. A point grading system was used 10 assess and compare the products. Results revealed that BetnovateT and CamnovaleT to be the most superior followed by BeavateT, SetrosoneT, BetasoneT and UniflexT
The sudden surge in the number of healthcare utilizations compels the hospital to plan for its future needs. Several time-series projections of Covid-19 were conducted to forecast the disease burden and resources utilization through simple predictive analytics. The projections revealed a rapid increase in the number of cases and patient in care at the hospital. It was estimated that the number of patients in care to range from 62 to 81 and 89 to 121 patients daily in the second and third phase of movement control order respectively. It was estimated that more than 100,000 plastic aprons, 80,000 sterile and non-sterile isolation gowns, 40,000 masks N95 and face shields, 30,000 gloves and nearly 17,000 bottles of hand sanitizers are needed until late May. Hence, a simple mathematical algorithm is a helpful tool to manage hospital resources during the pandemic.
The beginning of this year, 2020, has been a very challenging one as all over the world, we were caught right in the midst of the Coronavirus (COVID-19) pandemic. This pandemic is a serious global health threat, and its devastating effects are felt in all aspects of life. The World Health Organization (WHO) reported that as of 17th May 2020, we have 4,534,731 confirmed cases of COVID-19, and 307,537 deaths in total, throughout the world. In the WHO Western Pacific region, there were 167,546 confirmed cases, and 6,730 deaths while in the WHO Southeast Region, the COVID-19 accounted for a total of 136,314 confirmed cases, and 4,425 deaths (1). In Malaysia, the figure stood, thus far, at 6,872 confirmed cases, and 114 deaths while in Indonesia, there were 17,514 confirmed cases, and 1,148 deaths (2). Different countries are at different phases of this pandemic. While the curve may have flattened in some countries, there might still be spikes here and there. The COVID-19 pandemic has not disappeared; it is here to stay!
There had been increased and strong public interests in rare diseases and orphan drugs as well as the issue of
compulsory licencing for expensive medications in Malaysia in the mass-media and social media. We reviewed
the issues of orphan drugs and the challenges faced in many countries in developing appropriate health financial
modelling as well as getting accurate data on rare diseases. We also reviewed the old off-patent medications
and the developments on how policy-makers can intervene to make expensive treatment affordable and
sustainable for patients and the country.