We report the case series of phacoemulsification-related Descemet membrane detachment (DMD) encountered at a tertiary hospital in Kuala Lumpur. Case 1 was an iatrogenic DMD which was detected intraoperatively and managed early with good outcome. Case 2 and case 3 described unusual presentation of DMD which was initially undiagnosed. This report highlights the use of anterior segment optical coherence tomography (ASOCT) in detecting and confirming the correct diagnosis for DMD. With the aid of an experienced corneal specialist, the higher threshold for suspicious occurrence of DMD was confirmed using ASOCT. Treatment was tailored accordingly, with successful clearance of corneal oedema and visual recovery. This case series highlighted the importance of proper operative documentation and high threshold for suspicion for DMD in focal corneal oedema following an otherwise uneventful cataract surgery. It is concluded that ASOCT is an excellent tool to confirm diagnosis of DMD and success of treatment.
The Hypoglycaemia Symptom Rating Questionnaire (HypoSRQ) is potentially
useful for local research on hypoglycaemia. However, it requires adaptation and
validation in local settings. This study reports the process and results of cross-cultural
adaptation and linguistic validation of HypoSRQ for Malay and English versions in
our local setting. The HypoSRQ underwent forward and backward translation and
adaptation with support from professional translators and a clinical psychologist.
Cognitive debriefing was done among patients with Type 1 and Type 2 diabetes
mellitus from varying sociodemographic backgrounds. Discussion was done
together with the original developers of the HypoSRQ to decide on the best version
for local use. The finalised versions were proofread and formatted with the help
of Health Psychology Research. Cognitive debriefing for Malay version involved 7
patients and for the English version5 patients. Direct literal translation into Malay
language was unsuitable due to technical terms which were difficult for laypersons
to understand. Amendments were made based on findings from the cognitive
debriefing process. Participants found the questionnaire fairly easy to understand.
The HypoSRQ-My (Malay) and HypoSRQ-EMy (English) is easily understood by
local participants. These tools may undergo psychometric evaluation for future
use in local settings.
Identification of causative organisms of clinically suspected microbial keratitis is very important so that appropriate targeted antimicrobial treatment can be offered to patients. The current routine method of corneal scraping specimens on to multiple agar culture plates for microbiological study is not really providing encouraging result. Our trial of modified technique of using BACTEC broth for three clinically suspected microbial keratitis cases worked 100% to identify the causative organisms in cases of microbial keratitis.
Keywords: culture media, cornea, keratitis
Hemoglobin S (HbS, α2β26GluVal) merupakan variasi hemoglobin yang terbentuk hasil daripada mutasi GAG GTG pada kodon 6 gen β-globin. Hemoglobinopati haemoglobin S (HbS) jarang ditemui di kalangan penduduk Malaysia tetapi selalunya dijumpai di kalangan pendatang asing dari Afrika. Walau bagaimanapun beberapa kes didapati dalam kaum India dan Melayu. Kajian ini meninjau keputusan makmal pesakit HbS dan penggunaan “multiplex ligation-dependent probe amplification” (MLPA) dan “flow-through hybridization” (FTH) dalam mengesan mutasi HbS. HbS dikenalpasti melalui kromatografi cecair prestasi tinggi (HPLC) dan/atau elektroforesis kapilari serta elektroforesis hemoglobin. Analisis molekul dijalankan menggunakan kaedah MLPA, FTH dan penjujukan Sanger. Dua warga Afrika, tiga Melayu dan dua India berusia antara 2-31 tahun telah dikenalpasti. Lima pesakit adalah HbS homozigot, seorang kompaun heterozigot HbS/β-talasemia dan seorang lagi pembawa HbS. Tahap hemoglobin (Hb) kes HbS homozigot adalah antara 7.4-10.2 g/dL dengan aras HbS dan HbF diantara 58.3-94.7% dan 1.5-35.5%. Hb untuk kes kompaun heterozigot HbS/β-talasemia adalah 5.8 g/dL dan normal pada pembawa HbS. Aras HbS, HbF dan HbA2 untuk HbS/β-talasemia dan pembawa HbS adalah 67%, 27.2% dan 4.2%, dan 38.6%, 0.1% and 2.8% setiap satu. Kedua-dua kaedah MLPA dan FTH berjaya mengesan mutasi HbS dalam semua kes, manakala cuma FTH dapat menentukan zygositi mutasi HbS dan β-talasemia dalam satu ujian yang sama.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme deficiency worldwide including Malaysia. Screening of cord blood for partial G6PD deficiency is important as they are also prone to develop acute haemolysis. In this study, we determined the prevalence of partial G6PD deficient in paediatric population aged 1 month-12 years and normal term female neonates using OSMMR-D kit with haemoglobin (Hb) normalization and compare it with florescence spot test (FST). A total of 236 children, aged between between 1 month-12 years and 614 normal term female neonates were recruited for this study. Determination of normal means for G6PD activity and; cut-off points for partial and severe deficiency were determined according to WHO Working Group (1989). Determination of prevalence for partial deficiency for both groups (female patient) was done using this enzyme assay kit and findings were compared with FST. In this study, 15.7% (18/115) female children were classified as partial G6PD deficient by quantitative enzyme method (G6PD activity: 4.23-5.26U/gHb). However, FST only detected 0.9% (1/115) with minimal G6PD activity. The prevalence of partial G6PD deficiency in female neonate group was 3.42% (21/614) by enzyme assay versus 0.49% (3/614) by FST. This study concluded that our routine screening method using FST was unable to diagnose female heterozygotes. We recommend using this quantitative enzyme assay method by OSMMR-D kit since it was more sensitive in detecting G6PD deficiency in female neonates compared to FST.
Ovitrap autosidal berperanan penting dalam pemantauan dan kawalan vektor denggi, Aedes aegypti and Aedes albopictus. Beberapa jenis ovitrap ini telah digunakan di Malaysia termasuklah Mosquito Larvae Trapping Device (MLTD) yang diperkenalkan oleh Dewan Bandaraya Kuala Lumpur. Kajian ini bertujuan untuk menilai kepadatan larva Aedes dan pembolehubah meteorologi setempat di sebuah penempatan pelajar di Cheras, Kuala Lumpur. MLTD (n=30) dengan umpan larutan baja NPK (5:5:5) organik telah digunakan. Pengumpulan larva dan penyelenggaraan ovitrap telah dilakukan setiap minggu selama lapan minggu. Pemeliharaan larva dan penentuan spesies telah dijalankan di makmal. Daripada sejumlah 2,152 larva Aedes, 85% merupakan Ae. albopictus manakala selebihnya Ae. aegypti. Ae. albopictus lebih banyak dikumpulkan di luar berbanding di dalam bangunan (purata larva per ovitrap, 9.28 lawan 6.08). Sebaliknya, Ae. aegypti lebih banyak dikumpulkan di dalam berbanding di luar bangunan (1.72 lawan 0.86). Ovitrap indeks yang paling tinggi adalah semasa minggu kelima (90%) dan keenam (93%). Minggu pertama menunjukkan ovitrap indeks yang paling rendah (30%). Analisis mendapati korelasi positif antara kepadatan larva Aedes dan suhu maksimum (r=0.830, p=0.011), manakala kelembapan relatif minimum menunjukkan korelasi negatif (r=-0.778, p=0.023). Pemantauan rutin bagi peringkat pramatang vektor denggi boleh memberikan maklumat mengenai kepadatan dan naik turun populasi nyamuk setempat. Apabila digandingkan dengan faktor meteorologi sejajar, maklumat ini dapat memberi panduan bagi perlaksanaan kawalan vektor sebagai sebahagian strategi pencegahan denggi.
Phytosterols are plant sterols with a chemical structure similar to cholesterol. It has anti-cholesterol, anti-cancer and anti-oxidant properties which are probably mediated by suppression of lipid peroxidation. However, there are limited studies on the effects of phytosterols on lipid peroxidation. The aim of this study is to determine the effects of phytosterols on plasma and tissue malondialdehyde (MDA) of rats exposed to carbon tetrachloride. The rats were divided into four groups of normal control (NC), carbon tetrachloride (CCl4), phytosterol (P) and phytosterol+carbon tetrachloride (P+CCl4).
The P and P+CCl4 groups were pretreated with subcutaneous phytosterol at 140 mg/kg once weekly for 5 weeks while the NC and CCl4 groups only received olive oil (vehicle). A single oral dose of carbon tetrachloride was then given to rats in the CCl4and P+CCl4 groups to induce lipid peroxidation. After 24 hours, all the rats were sacrificed and the plasma and tissue MDA were measured. Our results showed carbon tetrachloride had caused significant elevations of the plasma and hepatic MDA of the CCl4 group compared to the NC group. Phytosterol pretreatment (P+CCl4 group) were able to prevent the MDA elevations. Phytosterols treatments in normal rats (P group) were found to reduce the hepatic MDA level. The conclusion of this study was that phytosterols are effective suppressor of plasma and hepatic lipid peroxidation. They have potential as supplements to further reduce lipid peroxidation in healthy individuals.
The increasing health care cost and public awareness on the delivery of high quality services has forced healthcare service providers to look into the healthcare delivery system. Clinical Pathway (CP) has been introduced in many hospitals and has been accepted as a beneficial tool in assisting healthcare organizations worldwide. Further, the CP also provides consistently high quality and coordinates services with minimum resources. It is proven to be a beneficial tool in other countries. CP is recently being introduced into the Malaysian healthcare system. The aim of this article was to high-light the benefits of CP in improving healthcare quality and controlling the medical cost. The relevant articles have been reviewed. The majority of literature reviewed con-cluded that there were positive effects in implementing CP. The CP was found to be significant in reducing length of stay and medical cost. The introduction of evidence based medicine, clinical outcomes, clinical audit, multidisciplinary communication, teamwork and care planning were also improved by CP. The challenges for healthcare providers and healthcare managers are to participate and be fully committed in path-way development and implementation in order to improve healthcare quality and cost control.
This is a report of a patient on multiple antipsychotic medications for the treatment of schizophrenia. Often, polypharmacy is not encouraged, however, with the advent of newer atypical antipsychotic agents, this practice may need review. This case will be used to highlight the rare instances when polypharmacy may be useful prior to the commencement of clozapine for the treatment of schizophrenia.
Kejuruteraan tisu merupakan satu bidang perubatan baru yang membolehkan tisu
manusia dibentuk secara in vitro sebelum pemindahan tisu dilakukan. Sel stem
mesenkima daripada sum sum tulang (BMSCs) adalah sumber sel yang sesuai
dalam kejuruteraan tisu tulang rawan, ekoran kebolehannya untuk membentuk
rawan hialin. Kajian ini telah dijalankan untuk mengkaji potensi BMSCs untuk
membentuk sel rawan secara in vitro dan in vivo. BMSCs dipencilkan daripada
kambing dan dibahagikan kepada dua kumpulan; iaitu kumpulan kajian dan
kumpulan kawalan. Sel di dalam kumpulan kawalan disemai di dalam medium
yang mengandungi 10% serum anak lembu (FBS). Manakala, sel di dalam kumpulan
kajian telah dikultur di dalam medium yang diperkaya dengan 1% FBS, 1% ITS, 5
ng/mL TGF-ß3, 50 ng/mL IGF-1, 40 ng/mL L-proline, 100 nM dexamethasone dan
50 μg / fosfat. Analisis pembentukan sel rawan telah dijalankan secara in vivo pada
model mencit gondol atimus. Sel didapati beragregasi di dalam kumpulan kajian
dan menunjukkan permulaannya kondrogenesis telah berlaku dalam pengkulturan
sel. Kerangka fibrin yang telah disemai bersama sel yang telah atau tidak diaruh
disediakan dan ditanamkan di dalam lapisan subkutaneus mencik gondol atimus
selama 5 minggu. Eksplan tersebut kemudiannya dikeluarkan daripada lokasi
penempelan untuk pemeriksaan histologi. Berdasarkan pewarnaan Safranin O dan
pengekspresan GAG, eksplan daripada kumpulan kajian didapati menghasilkan
matriks rawan pada kadar yang tinggi berbanding eksplan di dalam kumpulan
kawalan. Hasil kajian ini menunjukkan keberkesanan medium rendah serum yang mengandungi TGF-ß3 merangsang pembezaan sel stem mesenkima daripada
sum-sum tulang untuk menjadi sel rawa
This is a cross sectional study examining quality of life in relation to coping styles among patients with Schizophrenia (N=92) in remission, from June 2002 to December 2002.Remission state is determined by Brief Psychiatric Rating Scale (BPRS). The psychiatric diagnosis was made by treating psychiatrist using the Clinical Interview Schedule for the DSM-IV Diagnosis. They are subsequently asked to complete demographic and clinical data questionnaire and followed by 36-item short-form health survey (SF-36) of the Medical Outcome Study (MOS) for the assessment of quality of life and the Coping Inventory for Stressful Situation (CISS). The QOL in term of overall mental health among patients with schizophrenia was significantly and positively associated with ethnic group (p
Penilaian anestetik pra-operasi adalah penting semasa penjagaan perioperatif. Matlamat utama kajian ini adalah untuk menilai tahap kepuasaan pesakit dan faktor-faktor yang mempengaruhi kepuasaan pesakit terhadap klinik pra-anestetik. Sejumlah 304 orang pesakit yang menghadiri klinik pra-anestetik telah terlibat dalam kajian ini. Kajian kepuasaan selidik dwibahasa (Bahasa Inggeris dan Bahasa Melayu) dengan berjumlah 18 soalan menguji faktor-faktor bukan penyedia (kemudahan klinik, kesesuaian masa menunggu) dan faktor-faktor penyedia (perkhidmatan doktor, pegawai kaunter, jururawat dan kakitangan sokongan) telah dikaji. Kajian kepuasaan selidik menggunakan format skala Likert lima mata skor sangat setuju/tidak setuju telah digunakan untuk menilai tahap kepuasaan pesakit. Secara keseluruhan, peratusan kepuasaan pesakit terhadap penilaian pra-anestetik dilaporkan sebagai 98.7% dengan skor purata untuk perkhidmatan doktor (4.49 + 0.60), pegawai kaunter (4.48 + 0.61), kakitangan sokongan (4.47 + 0.62), kemudahan klinik dan kesesuaian masa menunggu (4.40 + 0.62). Semua faktor-faktor yang dikaji menunjukkan hubungan yang signifikan (p
Most spider species in Malaysia are considered harmless and spider bites are rarely reported. This is partly due to the mild effects from the bite and victims do not seek medical treatment in the hospital. To date, there are few well-documented cases of medically significant bites from indigenous spider species in Malaysia. Here, we report the presentation, clinical management and outcome of two patients following a bite by the yet to be described ‘Black & Gold’ Huntsman spider from the genus Thelcticopis in Malaysia. The first case involved a 42-year-old man who was bitten on the tip of the distal phalanx of his right middle finger and presented with severe pain and local swelling. He was treated symptomatically and was discharged well. The second case involved a 57-year-old woman, who was bitten on the proximal phalanx of her right little finger and presented with severe throbbing pain and progressive swelling. She was treated symptomatically and was discharged after 24 hours observation in the medical ward. However, she noted moderate neck and generalized joints pains especially affecting the hips and knees, one day prior to discharge. She was treated with oral analgesia and symptoms resolved within two days.
Kejatuhan adalah isu kesihatan yang sering dikaitkan dengan warga emas di seluruh dunia. Kejatuhan boleh menyebabkan kesan negatif pada individu dan juga menyebabkan kematian dalam kes tertentu. Kajian semasa kejatuhan adalah amat terhad di Malaysia. Tujuan kajian ini adalah untuk merumuskan kajian semasa yang dijalankan di Malaysia yang mengenai prevalens dan ciri-cirinya. Artikel telah dikenalpasti melalui menggunakan pangkalan data elektronik berikut: EBSCOhost, ClinicalKey, ScienceDirect, Wiley Online Library, SpringerLink dan Google Scholar. Pemilihan artikel adalah terhad kepada artikel bahasa Inggeris yang diterbitkan antara tahun 2013 hingga 2019. Kajian ini menilai golongan warga emas yang berumur 60 tahun ke atas; sama ada di kediaman, komuniti atau institut perubatan. Sembilan artikel yang berkaitan telah dikenalpasti dan disiasat. Hasil kajian menunjukkan variasi yang ketara dengan julat 4-74 % dalam prevalens kejatuhan di kalangan warga emas di Malaysia. Salah satu kajian yang dijalankan dalam komuniti menunjukkan prevalens kejatuhan yang lebih rendah. Majoriti peristiwa kejatuhan berlaku pada waktu pagi seperti yang dilaporkan oleh tiga kajian iaitu sebanyak 49%-64.7%. Kejatuhan dalam kawasan bangunan adalah jumlah tertinggi lokasi jatuh dengan 50-87% manakala di luar bangunan adalah 13-49.3%. Lokasi di bilik mandi / tandas mempunyai peratusan kejatuhan tertinggi dalam bangunan. Kejatuhan yang menyebabkan kecederaan adalah antara 47% -82%. Perubahan pada prevalens kejatuhan dalam warga emas ditentukan oleh faktor-faktor seperti lokasi dan keadaan kesihatan. Maklumat yang dikumpulkan dalam kajian ini menunjukkan terdapat kekurangan alat ukur piawai bagi mengkaji ciri-ciri kejatuhan di Malaysia. Kajian prospektif diperlukan untuk menubuhkan prevalens dan hubungan faktor-kesan kejatuhan di Malaysia.
Acute mastoid abscess is common in daily practice. In children, it is usually caused by unsuccessful treatment or partially treated acute otitis media (AOM). Some authors had reported that chronic suppurative otitis media (CSOM) can be the source of infection but it is usually associated with the presence of cholesteatoma. A case of an acute mastoid abscess in a 7 year old girl is presented. She had a history of severe otalgia with left post auricular swelling for 3 days. Clinically she was febrile, the left otoscopy showed diffuse post auricular swelling and sagging of the posterior wall of the external canal. She underwent an emergency cortical mastoidectomy for the left mastoid abscess and had an uneventful recovery. In conclusion, this patient was partially treated with antibiotics which increased the risk for ‘masked mastoiditis’, and she later developed a mastoid abscess. Therefore we advocate that all AOM patients should be treated with antibiotics at least for a duration of one week.
Facial nerve schwannoma is a rare slow growing benign tumour which arises from the Schwann cell of the neurilemma. A retrospective review of 6 patients who had been diagnosed with facial nerve schwannoma between 1998 and 2008 was conducted. There was equal distribution of male and female patients. The mean age was 42 years (range 19 to 66 years). The tumour originated in the internal auditory canal (2 patients), intra-temporal (3 patients) and intraparotid (1 patient) segments of the facial nerve. All tumours were successfully removed and facial nerve continuity was pre-served in 2 cases. The presenting symptoms of facial nerve schwannoma are non specific and dependent on the site of tumour origin. It is a great mimicker of other lesions that can present at the same location. The surgeon should have a high index of suspicion when patients present with progressive facial nerve palsy. Patients should always be counselled regarding risk of facial paralysis because the diagnosis of facial nerve schwannoma is often confirmed intra-operatively.
Bisecting-angle-technique is a method used to improve patient comfort during periapical radiography. This technique is usually performed without X-ray beam aiming device and has been commonly associated with dental radiographic error. The use of external marker as a beam aiming device in bisecting-angle-technique is potentially effective to reduce the number of errors occurring during periapical radiography. In this study, 240 periapical radiographs were taken by undergraduate dental students. Periapical radiographs were taken using traditional method of bisecting-angle-technique (BAT), bisecting-angle-technique with the use of external marker (BAT-M) and the standard method in periapical radiography; paralleling technique (PT). All radiographic images were evaluated and errors were classified and tabled according to the type and number of errors. Chi-square test was used to compare the total number of radiographic errors made using these three techniques. One of the most common errors with BAT was cone cut error (13.8%). This error had been markedly reduced to 1.3% and 2.5% by implementation of BAT-M and PT, respectively. The total number of errors was also found to be significantly lesser for BAT-M compared to BAT, p< 0.05.
Keywords: errors, dental, radiography
Hypertension has been recognised as an important public health issue, affecting paediatric population. This study aimed to determine the prevalence of hypertension and its relationship with obesity among different ethnic, gender primary school children in Kuching division, Sarawak. It was a cross-sectional study using multistage sampling. Data was collected using anthropometric equipment and digital blood pressure monitor. Data was analysed using SPSS version 20. A total of 1314 respondents participated. 36.9% of the respondents were overweight and obese, 31% were overfat and obese, 29% had abnormal waist circumference and 32.8% had abnormal waist-height ratio (WHtR). About 22.1% of the respondents were found to be in pre-hypertension and hypertension stage. There were significant differences in overweight and obese, overfat and obese, WHtR between males and females. Indigenous Sarawak reported to have the highest number of hypertensive at risk, overweight and obese, overfat and obese, abnormal waist circumference and WHtR. Those respondents who were hypertensive were found to be overweight and obese, overfat and obese, with abnormal waist circumference and WHtR. Screening of potential risk factors at a young age would help to reduce the incidents of chronic disease in the adulthood. Blood pressure measurement should be included in the routine physical examination, to identify high risk children for further investigation.
Diagnosis of ocular leptospirosis is challenging and requires a high index of suspicion of previous leptospiral infection and good laboratory support. This case series focuses on two young females with unilateral conjunctiva granuloma. To the best of our knowledge, these are the first two cases of ocular leptospirosis with conjunctiva granuloma. The definitive diagnosis of ocular leptospirosis was based on laboratory studies in which conjunctival biopsies in these two cases showed positive leptospira DNA. Retrospectively, the history was suggestive as both patients had exposure to leptospira organism. In conclusion, a diagnosis of ocular leptospirosis requires a high clinical suspicion index supported by mandatory laboratory investigations.
Transgender adalah satu keadaan biopsikososial yang kompleks dan merupakan sebahagian daripada dimensi seksualiti manusia. Ia merangkumi komponen kognitif-emosi dan tingkah-laku yang membuatkan seseorang insan itu unik di dalam ekspresi seksualitinya. Kaum transgender cenderung untuk menggunakan hormon-silang-seks untuk mengubah keadaan dirinya menyerupai gender bertentangan yang diingini dengan cara menutupi ciri sekunder seksnya. Seks hormon yang biasa digunakan ialah: ““Female to Male Treatment Options (FMTO)” iaitu testosterone and hormon wanita pada “Male to Female Treatment Options (MFTO)”, di mana kombinasi estrogen dan anti-androgen digunakan. Hormonsilang-seks iaitu FMTO, atau MFTO mempengaruhi sifat biologi dan psikologi individu transgender. Namun begitu, hormon-silang-seks mempunyai profil kesan sampingan tertentu yang juga memberi impak biologi dan psikologi. Impak psikologi menjurus kepada masalah kesihatan mental dan bunuh-diri. Pelbagai tahap pengaruh biopsikososial kesan hormon-silang-seks diterangkan dan ulasan ini memberi ruang membincangkan kepelbagaian pilihan rawatan. Di dalam psikiatri, perubahan biologi memberi pengaruh yang besar ke atas individu transgender, terutamnaya dari aspek psikososial dan budaya.