Genitourinary system is the second most common site of tuberculosis (TB) after pulmonary system. Tuberculosis of the prostate is a rare manifestation of genitourinary tuberculosis. It is even more uncommon if occurring in an immune-competent individual. Prostate TB is usually an incidental finding in transurethral resection of prostate (TURP). Here, we report a case of TB of the prostate in a 70-year-old man who had benign prostatic hyperplasia for two years. TB was diagnosed incidentally post-TURP. In this report, we also discuss additional tests which may help in establishing the diagnosis of genitourinary tuberculosis.
Palm oil tocotrienol-rich fraction (TRF) containing majorly of αα, β, γ and δ-tocotrienols and some αα-tocopherols, was reported to have anti-ageing effects in both human and non-human model organisms, but still remains unexplored in the yeast model. It was reported to have the ability to extend the lifespan of several organisms. Chronological lifespan is one of the means to measure ageing in yeasts. The effect of TRF on the viability of three strains of Saccharomyces cerevisiae (wild-type, CTT1ΔΔand GPx2Δ) was studied. Phenotypic growth analysis of all strains was carried out for 15 hours by measuring the absorbance at OD600nm and cell counting. The optimum dose of TRF was optimised by determining the number of colony-forming unit by the wild-type strain at the end of a 24-hour treatment with TRF (ranging from 0μg/ml to 300μg/ml). TRF at 300 μg/mL showed the best result, and selected as a working dose. Treatment of cells with 300 μg/mL of TRF improved the viability of the wild-type strain in the initial stationary phase, but not on the knockout strains. These finding suggests that TRF has a potential in prolonging the chronological lifespan of S. cerevisiae, and perhaps other organisms as well.
Thymomas comprise about 1% of all mediastinal tumours and are rare in children. Typically, these tumours are aggressive, with a poor outcome. The current treatment of invasive thymoma is often multidisciplinary. We report a 16-year-old boy with invasive thymoma who was successfully treated with systemic chemotherapy, surgical resection and irradiation. The patient has been in continuous remission for 6 years without radiographic evidence of tumour recurrence.
Door to needle (DTN) time for thrombolysis in the Emergency Department, Universiti Kebangsaan Malaysia Medical Centre (ED, UKMMC) is an indicator that can reduce mortality and morbidity of patients with ST Elevation Myocardial Infarction (STEMI). This study was conducted to determine factors that influence DTN time for acute ST Elevation Myocardial Infarction (STEMI) and whether it has achieved the recommended time of 30 minutes. A cross-sectional study was conducted among patients diagnosed with acute STEMI and thrombolysed in ED, UKMMC from June 2016 until March 2017. A data collection sheet was used to collect patient’s demographic data and clinical data which included time of arrival to ED, time of initial electrocardiogram (ECG), time of drug preparation and time of thrombolytic delivery to the patient. A total of 98 patients were included in this study. Majority of patients (77.6%) were thrombolysed more than 30 minutes following ED arrival. Mean DTN in ED, UKKMC was 59.28 + 36.01 minutes. The mean door to ECG time was 7.19 + 8.08 minutes and the mean drug preparation time was 9.86 + 7.51 minutes. Out of 76 (77.6%) patients that were thrombolysed after 30 minutes of ED arrival, 59.2% (n=45) were due to multiple disciplinary referral. Other factors were delay in performing initial ECG 19.8% (n=15), incorrect initial ECG interpretation 9.2% (n=7) and unavoidable need for prior resuscitation 9.2% (n=7). As a conclusion this study showed that there was an unacceptable delay in hospital thrombolysis for acute STEMI.
An increase in the number of residents in nursing homes has become a significant concern due to the rise in medication demand and subsequently medication-related issues, especially in frail elderly. Community pharmacists are the closest healthcare professionals available that can contribute to this population to allow optimal utilization of the prescribed drugs and to prevent drug-related problems. The present study aimed to investigate the awareness of community pharmacists on issues regarding frail elderly and to determine their willingness in collaborative care of frail elderly in nursing homes and the services they are willing to offer. This was a cross-sectional study utilising a set of questionnaire that was delivered to practicing community pharmacists in Peninsular Malaysia from June 2018 until December 2018. Majority of the participants agreed to the fact that aging is the primary cause of frailty (n=98, 88.3%), and that chronic disease is also a cause of frailty (n=96, 86.5%). Most of the community pharmacists were also keen to participate in the collaborative care of frail elderly, and were willing to provide their pharmacy service to the frail elderly. There was a positive correlation between the awareness of community pharmacists on issues regarding frail elderly and their willingness on collaborative care of frail elderly in nursing homes (r=0.374, n=111, p=0.01). Majority of the pharmacists were aware of the issues regarding the frail elderly, and were willing to participate in the collaborative care of frail elderly in nursing home.
Many of our chronic kidney disease (CKD) patients venture into complementary and alternative medicine (CAM) to seek a cure for the disease beyond conventional management. The objective of this study was to determine the prevalence and pattern of CAM usage; and its association with the progression of CKD in our population. This was a cross-sectional survey recruited CKD patients from Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Data was collected via interview using questionnaires which explore the demographics, type and pattern of CAM use. Patients’ comorbidities and serum creatinine were extracted from the medical notes to assess the association between progression of CKD and usage of CAM. Chi-square, Independent Samples t-test, Mann-Whitney U test and logistic regression were used to evaluate for an association. Three hundred and seventy two eligible patients were recruited. The prevalence of CAM use was 29% in the past year. Younger age, higher education and higher income level were associated with significantly more usage of CAM. Natural products were the commonest type of CAM used (86.1%). The belief in the effectiveness of CAM was the main reason for its uptake and about 57.8% revealed their practice to their physician. We found that the use of CAM in Malaysian CKD patients did not influence the progression of the disease.
Superior vena cava syndrome is a medical emergency. The morbidity and mortality of superior vena cava syndrome can be decreased by early recognition, early establishment of primary cause, early supportive and definitive treatment. We illustrate a case of 53-year-old male with underlying advanced Parkinsonism and ischemic stroke who presented with superior vena cava syndrome over 4 days period. Diagnostic challenge in this patient lies in the fact that patient had aphasia and his daily living activity was dependent. Most of the information was based on caretaker’s observations. A strong clinical suspicion based on clinical history is crucial for early diagnosis and treatment of superior vena cava syndrome.
The primary objective of the present study was to investigate the impact of sociodemographic factors on smoking and alcohol consumption among adults in Penang (Malaysia). A cross-sectional primary survey data with 398 respondents was used for analysis. The present study applied logistic regression models to examine the factors affecting the odds of smoking and alcohol consumption. The results showed that gender, ethnicity and education could significantly affect smoking. In particular, males (OR: 26.678) had a higher likelihood of smoking compared to the females, whereas Chinese (OR: 0.177), Indians/others (OR: 0.331) and individuals with tertiary education (OR: 0.258) had a lower likelihood of smoking than others. In terms of alcohol, gender, ethnicity and marital status were found to have a significant influence on the likelihood of alcohol consumption. Specifically, males (OR: 5.051), Chinese (OR: 37.796) and Indians/others (OR: 10.863) were more likely to consume alcohol than others, while married individuals (OR: 0.380) were less likely to consume alcohol than unmarried individuals. Based on the findings of the present study, numerous population-based intervention measures were suggested.
In this report we demonstrate the role of fluorescence in situ hybridisation (FISH) and conventional cytogenetic methods in clinically and cytogenetically confirmed cases of microdeletion syndromes. A total of nine cases were referred to the Cytopathology and Cytogenetic Unit, Hospital Universiti Kebangsaan Malaysia (HUKM) from 2002 to 2004. They include three Prader-Willi syndrome, three DiGeorge syndrome, one Williams syndrome, one Miller-Dieker syndrome and one Kallmann syndrome. Blood samples from the patients were cultured and harvested following standard procedures. Twenty metaphases were analysed for each of the cases. FISH analysis was carried out for all the cases using commercial probes (Vysis, USA): SNRPN and D15S10 for Prader-Willi syndrome, LIS1 for Miller Dieker syndrome, ELN for Williams syndrome, KAL for Kallmann syndrome, TUPLE 1 and D22S75 for DiGeorge syndrome. Conventional cytogenetic analysis revealed normal karyotypes in all but one case with structural abnormality involving chromosomes 9 and 22. FISH analysis showed microdeletions in all of the nine cases studied. This study has accomplished two important findings ie. while the FISH method is mandatory in ruling out microdeletion syndromes, conventional cytogenetics acts as a screening tool in revealing other chromosomal abnormalities that may be involved with the disease.
Heart failure is a physically debilitating and psychologically distressing chronic condition. Although depressive disorder is a strong predictor of short-term deterioration of heart failure symptoms and mortality, only few studies have focused on habit and daily routines. The present study aimed to investigate the relationship between depression and anxiety and heart failure patients’ self-care behaviour. Interviews were completed with 161 patients at hospital outpatient clinics in Belfast and Dublin. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). Self-care behaviour was assessed using the European Heart Failure Self-Care Behaviour Scale (EHFSCBS). ‘Probable’ clinical depression was indicated in 18%, and ‘probable’ caseness of anxiety disorder in 16% of patients. Self-care behaviour adherence varied considerably across behaviours and was higher for taking medication as prescribed (93.1%), and taking it easy if breathless (75.1%) and lower for daily self-weighing (13.6%), regular exercise (33.6%) and limiting fluid intake (38.5%). No significant relationship was found between overall reported self-care adherence and anxiety or depression. However, significant association with depression were found for five of the 12 self-care items, and also with anxiety for two of these. Our results demonstrated that mental well-being in patients with heart failure plays a significant role in the patients’ ability to adhere to self-care regimens.
Low Grade Papillary Nasopharyngeal Adenocarcinoma (LGPAC) is a very rare tumour of mucosal origin compared to a higher incidence of well differentiated keratinized/non-keratinized nasopharyngeal carcinoma. It is an epithelial tumour with glandular differentiation. Its papillary figure seen histologically, is also seen in metastatic papillary thyroid carcinoma. This has caused a significant challenge to the Pathologist to differentiate primary papillary nasopharyngeal adenocarcinoma and metastatic tumour. Thyroid Transcription Factor-1 (TTF-1) is also expressed in subsets of papillary nasopharyngeal adenocarcinoma, which is valuable as a diagnostic tool. LGPAC is a benign-like malignant neoplasm. An early diagnosis with a complete tumour removal via conventional excision or endoscopic approach has offered a good prognosis with low risk of recurrence.
Sexual dysfunction is highly prevalent in gynaecological cancer patients. Most of the time, sexual dysfunction in gynaecological cancer is underdiagnosed as there is overlapping of symptoms with other psychological morbidities, interplaying of multiple risks, patients’ reluctance to complain or incompetence of health care provider to assess. Determining the risk factors of sexual dysfunction in cancer patients enables us to pay more attention to those who are vulnerable and to device strategies for early detection, prevention and treatment of sexual dysfunction in them. The main aim of the study was to determine the prevalence of sexual dysfunction and its risk factors in gynaecological cancer patients in Hospital Sultanah Bahiyah, Alor Star, Malaysia. Sexual function of eighty-three gynaecological cancer patients who were married were assessed with self-rated MVFSFI (Malay version Female Sexual Function Index). Self-rated WHOQOL-BREF (World Health Organization- Quality of Life- 26) which assessed the domains of quality of life was used while MINI (Mini International Neuropsychiatry Interview) was used for diagnosis of major depressive disorder. The prevalence of sexual dysfunction among the married gynaecological cancer patients was 65% (54/83). Sexual dysfunction was significantly associated with low education level (OR 3.055, CI 1.009-9.250), shorter duration of cancer (OR 0.966, CI 0.966- 0.998), ongoing chemotherapy (OR 3.045, CI 1.149-8.067), pain perception (OR 3.230, CI 1.257-8.303), absence of sexual intercourse for more than one month (OR 1.862) and three domains of quality of life such as physical health, psychological health and social relationship (OR 0.942, CI 0.908-0.978; OR 0.955, CI 0.916-0.995; OR 0.933, CI 0.894-0.973, respectively). However, sexual dysfunction was not associated with major depressive disorder (χ2 ² = 1.224, p = 0.268). The prevalence of sexual dysfunction in gynaecological cancer patients was comparable to other studies of similar population. Since, the risk factors of sexual dysfunction in gynaecological cancer patients are multidimensional, the process of assessment and management need to be holistic and patient-oriented.
Salah satu dari strategi untuk memperkasakan petugas kesihatan di dalam menentang kesan pandemik COVID-19 ini adalah melalui latihan yang berkesan. Keselamatan dan ketidak laziman merupakan dua perkara pokok yang menyebabkan modul ini dihasilkan. Modul latihan ini dibentuk berdasarkan tiga strategi utama iaitu belajar dari pengalaman lalu, mereka-bentuk modul latihan yang khusus, dan mengenal kelemahan yang ada. Modul yang dihasilkan ialah pemakaian-penanggalan alat perlindungan kendiri (PPE), pengurusan salur pernafasan dan resusitasi kardiopulmonari bagi pesakit yang disyaki COVID-19. Seramai 178 Perawat Kesihatan Barisan Hadapan (PKBH) telah dilatih. Setiap modul disertakan dengan senarai-semak yang mana peserta merasakan ianya sangat membantu. Tiada peserta yang jatuh sakit atau mengalami simptom setelah lebih dua minggu tamat latihan dan ini berkemungkinan hasil dari pelaksanan senarai semak persediaan pra-latihan yang ketat. Senarai semak pra-latihan ini mempunyai tujuh perkara penting iaitu ruang latihan, bilangan peserta, saringan COVID-19, pemeriksaan suhu badan, sanitasi tangan, PPE, dan pensanitasi peralatan sebelum dan selepas latihan. Latihan menggunakan senarai semak yang terarah didapati sangat membantu para petugas di dalam menguruskan situasi COVID-19. Kesimpulannya semasa menghadapai keadaan yang di luar kelaziman serta masa dan sumber yang terhad, latihan praktikal bersama senarai semak merupakan satu kaedah yang dapat membantu. Mengikuti langkah keselamatan pra-latihan yang betul juga boleh mengurangkan penyebaran penyakit ini.
Hyperbaric oxygen therapy (HBOT) was established to increase oxygenation and antimicrobial effect that potentially improve the healing of chronic ulcer. Present study aim to assess the effects of HBOT in chronic diabetic foot ulcer (DFU). A total of sixty patients classified according to Wagner 1, 2 or 3 chronic diabetic foot ulcers, were recruited and subsequently divided randomly into two groups; HBOT and control group. All patients underwent the standard treatment for DFU, but for the HBOT group, underwent 20 HBOT sessions, each lasted 80 – 90 mins at 2.5 atmospheres absolute (ATA). White cell count (WCC) and C-reactive protein (CRP) levels were taken during inclusion, at second and fourth week of treatment. Wound sizes were documented at each follow up until six months follow up. SF-36 at one-month post hyperbaric oxygen therapy was used to measure the health-related quality of life. Reduction of WCC and CRP in HBOT group were significant throughout the treatment (p=0.046 and p=0.039, respectively). A total of 26 patients (86.7%) from the HBOT group achieved complete ulcer healing at six months’ follow-up, while 18 patients (60%) in the control group’s ulcer healed completely. Patients treated with HBOT had significantly better mental and physical health constituent of quality of life. It must be emphasised that HBOT is an adjunctive therapy to the standard management of chronic DFU in accelerating wound healing for a better quality of life.
Keywords: oxygenation, quality of life, wound healing
A proportion of patients with acute viral fever with thrombocytopaenia does not necessary have dengue infection. Managing them indiscriminately as dengue infection may not be appropriate. The prevalence of this problem is not exactly known. The objective of this study is to determine the prevalence of acute non-dengue febrile thrombocytopaenia among adult patients presenting with acute non-specific febrile illness in an outpatient setting. This was a clinic-based cross sectional study. Consecutive patients presenting with non-specific febrile illness of less than two weeks were selected from the Primary Care Centre of Hospital Universiti Kebangsaan Malaysia (HUKM) and the Batu 9 Cheras Health Clinic. Full blood count was done on the day of visit and dengue serology was done on day five of illness for all patients enrolled. Seventy three patients participated in this study from May to November 2003. Among the patients, 35 (47.9%) were noted to have thrombocytopaenia. Fourteen (40%) patients with thrombocytopaenia were serologically negative. The prevalence of non-dengue febrile thrombocytopaenia was 19.2%. A significant number of patients with acute non-specific febrile illness with thrombocytopaenia were negative for dengue serology. These patients should be differentiated from those with acute febrile thrombocytopaenia, as they might differ in their natural history from those with dengue infection, and hence require different management strategies.
Study site: Primary Care Centre of Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) and the Batu 9 Cheras Health Clinic.
Patient’s belief towards pain management may affect pain management outcomes and quality of life. The main aim of the present study was to determine the impact of a pre-operative pain education package towards pain belief among patients undergoing orthopaedic surgery in a tertiary hospital. A one-group pre-test post-test design study was conducted on orthopaedic surgery patients. Thirty respondents were recruited and pre-operative pain education was administered individually before surgery. Pre-operative and post-operative pain belief, management scores and side effects were measured using the Barrier Questionnaire (BQ-13). The results reported significant differences between pre-test scores (Mean = 41.87, Standard Deviation = 11.467) and post-test scores (Mean=34.80, Standard Deviation=13.026) of pain belief (t = 2.84, p = 0.004). There were also significant differences between pre-test scores (Mean = 37.10, Standard Deviation = 10.610) and post-test scores (Mean=30.80, Standard Deviation = 11.424) of pain management (t = 3.856, p = 0.0005). Respondent’s gender (t = -2.403, p = 0.023) and ethnicity (F = 5.038, p=0.014) reported significant differences with p value < 0.05, respectively. However, there were no significant differences between educational level, ethnicity, prior surgical history with pain belief (p> 0.05). There was positive impact of the pain education package towards pain belief and painmanagement among respondents who underwent orthopaedics surgery in a tertiary hospital. Reinforcement of pain educational program is pivotal in order to achieve optimal post-operative pain management.
Keywords: pain, education, orthopaedics, patient, surgery
Mature cystic teratoma is the commonest ovarian germ cell tumour which accounts for 70% of all benign ovarian neoplasms in the reproductive age groups. Being a pluripotent germ cell tumour, mature cystic teratoma has at least two out of three mature embryonic germ cell components: ectoderm, mesoderm and endoderm. The presence of multiple cystic spaces within the tumour wall, also known as pneumatosis cystoides-like appearance is rarely described but a characteristic feature in cystic teratoma of the ovary. Currently, there is little information concerning the mechanism of its formation. Herein, we described an unusual case of ovarian mature cystic teratoma in a 31-year-old pregnant female with multiple sieve-like areas resembling pneumatosis cystoides of the intestine. Macroscopic and histological examination of the ovary revealed features diagnostic of mature cystic teratoma. Intriguingly, multiple cystic spaces of variable sizes were found within the cyst wall histologically. They were lined partially or completely by foamy histiocytes and foreign body type multinucleated giant cells, exhibiting strong CD68 immunoreactivity. Vascular endothelial markers (CD31 and CD34) and epithelial marker (cytokeratin AE1/AE3) were negative. A diagnosis of mature cystic teratoma with pneumatosis cystoides-like feature was rendered. The patient was discharged well with no signs and symptoms of early labour. The etiopathogenesis of this intriguing histological feature is briefly discussed in this article.
Fetomaternal haemorrhage (FMH) may occur following a sensitizing event, during pregnancy or at delivery. In cases of rhesus (Rh) incompatibility between mother and the fetus, it can thus subject to the haemolytic disease of the newborn. The Kleihauer test for quantification of FMH lacks standardization and results are less accurate. Furthermore, it cannot differentiate the foetal cell from the adult HbF. Flowcytometry analysis using monoclonal antibodies, is a new technique for the quantification of FMH and it allows larger number of cells to be analysed. It is also able to differentiate the foetal cell from maternal HbF, and thus is more sensitive and accurate. The objective of our study was to determine the FMH using the flowcytometric analysis of anti-HbF antibody and to correlate the FMH using flow cytometry and the standard Kleihauer test. Ninety eight peripheral blood samples from pregnant women at more than 20 weeks of pregnancy and post delivery were analyzed by both methods. The percentage of the foetal cells were recorded and the FMH were calculated. We found a fair correlation between the two methods with the correlation coefficient r = 0.633 (p
Kateter Vena Cenral boleh tercabut dengan senang daripada tubuh badan.
Artikel ini membincang tiga teknik terperinci yang berinovasi untuk mengelakkan
berlakunya insiden kateter tercabut. Penempatan leher kateter kira-kira 1cm dari
tempat kateter keluar pada bahagian kulit dengan jahitan tambahan di bahagian
leher kateter membantu mencegah insiden kateter tercabut.
Delayed wound healing is one of the major complications of diabetes mellitus where it often leads to amputation. Virgin coconut oil (VCO) is a natural oil widely used to treat wounds and burns traditionally. It possesses potent antioxidant and antibacterial activities. This study aimed to determine the effect of VCO on the fibroblast population in diabetic wound healing. Full thickness cutaneous wound tissues were collected from non-treated, VCO-treated, and silver sulfadiazine (SS)- treated diabetic rats. The tissues were then subjected to Verhoeff eosin staining and immunohistology of fibroblast and myofibroblast. Histological analysis showed increased collagen deposition with intact epidermis in the VCO treated group compared to decreased collagen deposition with damaged epidermis in both non-treated and SS-treated groups. Interestingly, more fibroblasts and myofibroblasts were observed in the non-treated group compared to the VCO- and SS-treated groups. VCO significantly promoted wound healing process in diabetic rats via promoting re-epithelialization, and increasing collagen fibres deposition and wound contraction. The results suggested VCO can be used to treat diabetic wounds.