Dengue Viral Infection (DVI) imperils an estimated 2.5 billion people living in tropical and subtropical regions. World Health Organization (2011) guidelines also classified dengue as 'Expanded Dengue Syndrome' to incorporate wide spectrum of unusual manifestations of dengue infection affecting various organ systems - including liver, kidney, heart and brain. Renal involvements are least appreciated area of dengue infection, therefore, we systematically reviewed studies describing renal disorders in dengue infection, with emphasis on Acute Kidney Injury (AKI). The purpose of current review is to underscore clinicians’attention to this neglected intricacy of DVI. It suggests that dengue induced renal involvements vary from glomerulonephritis, nephrotic range proteinuria and AKI. We observed great disparity in incidence of AKI among dengue patients, based upon criteria used to define AKI. AKI among dengue patients was found to be associated with significant morbidity, mortality and longer hospitalization, adding financial burden to patients and healthcare system. Additionally, we identified several predictors of AKI in dengue patients including old age, obesity, severe dengue infection and concurrent bacterial or viral infection. Direct viral injury and deposition of antigen-antibody complex in glomerulus were found to be possible causes of renal disorders in dengue infection. Prior knowledge of clinico-laboratory characteristics and risk factors with early detection of AKI by using appropriate criteria would not only reduce morbidity and mortality but also decrease burden to patients and healthcare system.
Hot flushes during menopause are distressing for women and result in poor quality of life. Purpose of the current review was to evaluate the available treatment modalities that should be utilised for the management of hot flushes. Menopause refers to last menses of women life and can be declared after amenorrhea of 12 months. Vasomotor symptoms including hot flushes and night sweats are common after menopause, affecting almost 50 - 85% women older than 45 years. The mean increment in core body and skin temperature is 0.5°C and 0.25 - 3°C during a hot flush attack. Low level of estrogen during menopause and its association in triggering episodes of hot flushes, is still under debate. The most accepted hypothesis is a narrowing of the thermoneutral zone (TNZ) triggered by estrogen fluctuations. Although, hormone replacement therapy (HRT) remains the standard treatment for the alleviation of such symptoms, incidence of life threatening side effects restrained medical professionals from its use. Complications associated with the use of HRT can be avoided by appropriate evaluation of patients before initiating therapy. Several guidelines have also recommended HRT (estrogen and progesterone) to be safe for up to a period of seven years. Both hormonal and non-hormonal treatments are used for the management of hot flushes. Since hot flushes are the least appreciated and neglected complication of menopause, current review provides detailed information on its background, pathophysiology and management, and emphasises the need of its treatment.
This is a retrospective audit of all patients admitted to the surgical unit for urosepsis from June 2014 to June 2015 at the General Surgery Unit of Hospital Sultan Ismail, Malaysia. Demographics, comorbidities, presenting symptoms, length of stay (LOS), mortality, and associated risk factors were recorded. There were 35 patients treated for urosepsis with a male preponderance of 21/35 patients. Hypertension (n=18) and diabetes (n=10) were the two most common comorbidities. There were five deaths (mortality rate=14.3%) and the main bacterium cultured was Escherichia coli. Age >65, presence of underlying comorbid disease, presence of cancer, urine and blood culture positivity had higher incidence of death but were not statistically significant for urosepsis mortality. However, this result is limited by the small sample size and single centre retrospective data.
Superior vena caval syndrome (SVCS) is a debilitating condition attributed to malignancy in more than 70% of cases. However, solitary head and neck metastases arising from renal cell carcinomas without evidence of disease elsewhere are rare. We report a case of renal cell carcinoma presenting as a rapidly growing right cervical lymph node with compression on the subclavian vein causing superior vena caval syndrome (SVCS). There was pulmonary embolism as well. Biopsy of the neck mass confirmed metastatic clear cell carcinoma with primary found in the (L) kidney. The patient had partial response to focussed radiotherapy to neck mass and Sunitinib (tyrosine kinase inhibitor) before succumbing to the disease.
Chronic kidney disease (CKD) is an asymptomatic disease associated with high morbidity and life-threatening complications that lead to decreased life expectancy. Worldwide prevalence of CKD is escalating at an alarming rate. Large population-based representative surveys have been reported in Western countries to estimate the prevalence of the disease. However, there is paucity of data as far as developing nations are concerned. Asia is the world's largest continent accommodating maximum number of under-developed and developing countries with an unclear picture of prevalence of CKD. Current review attempts to give an insight to the prevalence of CKD in this region by combining population-based surveys. This review will assist in estimating the burden of CKD in Asia, so that appropriate control measures could be designed.
A hospital based cross-sectional retrospective study was conducted to determine the frequency of hand foot syndrome (HFS) with Capecitabine as a single agent and in combination with Oxaliplatin. The study included 43 consecutive cases of colorectal carcinoma and conducted from June till December 2008. Patients on palliative care were excluded. SPSS was used for the application of chi-square test, by keeping the level of significance as p < 0.05. Fifteen (34.9%) patients developed HFS, 10 in the single-agent and 5 in the combination group. No significant association of HFS with either regimens was noted (p=0.876).
To determine the association between histological grade of tumour and estrogen progesterone receptors (ER/PR) expression in unselected invasive carcinoma of breast in Malaysian patients.
The aim of the review was to critically appraise the various pros and cons of the synthetic and herbal agents used in mouthwashes against halitosis and facilitate users to choose appropriate mouthwashes according to their need. Oral Malodour (OMO) or halitosis is a global epidemic with social and psychological impact. Use of mouthwash has been adopted worldwide to control halitosis within a past few decades. Alcohol and Chlorhexidine are common agents in synthetic mouthwashes, while Tannins and Eugenol are derived traditional herbal extracts. Each agent signifies some unique properties distinguishing them from others. Herbal ingredients are gaining the attention of the profession due to its mild side effects and competitive results. Herbal mouthwashes can be a safer choice in combating OMO, as an alternate to synthetic mouthwashes.
A bezoar is a concretion of foreign or indigestible matter in the alimentary canal and is usual cause of gastric obstruction. Bezoars can become fragmented and migrate downward leading to intestinal obstruction. Diagnosis of phytobezoar has become challenging in clinical practice due to lack of patient history and inability of patient to correlate preceding events with the episode of bowel obstruction. Bezoar associated small bowel obstruction rarely occurs and is usually found in patients with history of gastrointestinal surgery. Very few cases are reported of small bowel obstruction due to bezoar in healthy population without prior illness or surgery. We present a case of small bowel obstruction due to mushroom bezoar in a 62-year patient with no past history of medical illness or gastric surgery. Enterotomy was performed and a whole piece of undigested mushroom measuring 5 x 3 cm was successfully removed.
Multiple small bowel atresia is a relatively uncommon cause of intestinal obstruction in neonates. About one-third of the neonatal intestinal obstruction is caused by intestinal atresia. As suggested by Louw and Barnard, the vascular accident in utero is the principal reason, resulting in bowel atresia.1 The condition presents soon after birth, with bilious vomiting and abdominal distension, requiring emergency surgical intervention. A subtype of small bowel atresia (type IV), which presents with involvement of multiple segments, is unique due to the difficulties in management, accompanied by a variety of postoperative morbidities, which are highlighted in this case. The choice lies between resection of all the atretic segments with resultant single anastomosis and conservation with anastomoses of multiple small bowel segments involving meticulous repair by fine sutures, taking care to maintain luminal patency. The dilemma of whether to conserve the atretic segments of bowel, which is a time consuming procedure but preserves the bowel length or to proceed with excision of the atretic bowel segments, accepting the likelihood of short bowel, in order to provide a quick, safe and stable single anastomosis in a timely manner, is a valid challenge. The background of limited resource setting also need to be taken into consideration. Key Words: Atresia, Neonates, Bowel segments, Anastomosis.
Ingested foreign bodies (Fb) in children usually pass out in stools without any sequels. However, Fbs like open safety pins, button batteries, and super absorbent polymer (SAP) / jelly toys are associated with complications such as intestinal obstruction, and bowel perforation. Intestinal obstruction in children of uncertain nature should raise a suspicion of foreign body ingestion such as SAP, which may not be obvious at the initial presentation. The study reports two such children, outlining the presentation and management. Key Words: Children, Intestinal obstruction, Foreign body, Health hazard, Bilious vomit, Super absorbent polymer beads.
Oral mucosal melanoma is rare and more aggressive than cutaneous melanoma. Hard palate and maxillary alveolar crest are most commonly involved. Multidisciplinary team approach is necessary for successful management of this tumor. The main treatment modality is surgical resection, which usually results in impaired mastication, deglutition, speech, oral competence and significant cosmetic deformity. Here, a rare case of oral mucosal melanoma of mandibular gingiva in a 44-year man is reported, who was treated by en-block mandibular resection followed by adjuvant therapy with high dose interferons (IFN) - 2b. Following two weeks of healing period, prosthetic rehabilitation of the patient was done with an interim removable denture prosthesis, which effectively limited the unfavourable effects of surgery and helped him in resocialisation.
Oral rehabilitation in medically compromised patients like chronic kidney disease (CKD) needs special dental care. Many papers have been published on dental considerations for such individuals. However, literature citing oral care for patients with risk factors of CKD are scarce. Resistant hypertension, one such risk factor, is closely related to CKD. Furthermore, the associated increased prevalence and adverse renal/cardiac outcomes motivated the author to report its unexplored association/impact during dental care. The importance of assessing glomerular filtration rate is highlighted to better understand patients' medical conditions.