This study was conducted to asses the future physicians' habits, knowledge and attitude towards smoking. These factors influence the credibility of future Malaysian physicians as advocators and treatment providers. A cross sectional study was carried out among medical students at the Medical Faculty, University Malaya. Knowledge on smoking was evaluated on the total scores for knowledge questions, with one point and zero for each correct and incorrect answer respectively, to a maximum of six potential points. Attitude towards smoking was measured by summation of scores on attitude items; each item was scored from five points for "against smoking" and one point for "favourable to smoking". The possible score ranged from 10 to 50. The response rate was 79.4%. Prevalence of overall smokers was 4.4%. The mean knowledge score among smokers (4.30 +/- 2.17) was significantly lower than nonsmokers (5.19 +/- 1.28). The mean attitude score was higher among non-smokers (44.30 +/- 6.54) than smokers (39.86 +/- 10.93). The result from this study showed that smoking prevalence was lower compared to previous studies done in Malaysia.
This is a cross-sectional study design aimed to determine the prevalence of Chorda Tympani Nerve (CTN) injury and related symptoms following myringoplasty. Thirty patients were included in this study. The methods used were measuring taste thresholds using electrogustometer to map taste threshold on the anterior two-third of the tongue on the operated side with the non operated side as the control. Reading is taken when the subject experiences sour/metallic taste. All corresponding threshold values and findings were recorded and compared to control. Results showed 50% of patients had elevated threshold levels suggestive of CTN injury. However, none of the patients reported subjective taste loss. This study concludes that the prevelance rate of CTN injury in post myringoplasty patients is about 50% but this is not associated with altered taste sensation.
Arteriovenous malformation of the pregnant uterus is very rare, and may present with unexplained torrential bleeding. We report a patient with absence of the conventional risk factors, and was saved by quick recourse to hysterectomy to control the bleeding.
A 23 year old female with a past history of a lung abscess diagnosed at the age of 13 years presented with recurrent episodes of productive cough. Chest radiograph and a high resolution CT scan of the thorax led to the diagnosis of a left lower lobe lung abscess. She underwent a successful thoracotomy and a left lower lobe lobectomy. Histopathological examination revealed the diagnosis of an infected congenital bronchogenic cyst. The recent literature on this is reviewed.
The differential diagnoses of an abscess deep in the neck are retropharyngeal abscess and parapharyngeal abscess. We report a case each of these deep neck space abscesses to highlight their difference with emphasis on its anatomy and possible etiologies.
Atypical mycobacterium is rarely seen as a cause of chronic mastoiditis but has been increasingly recognized over the past few years. Mycobacterium abscessus is the most pathogenic and chemotherapy-resistant, rapid-growing mycobacterium of all the four groups. This paper presents a case of a 57-year-old woman who had chronic mastoiditis with recurrent exacerbations. The initial computed tomography (CT) findings showed the presence of an inflammatory process and she was treated with the appropriate antibiotics. The patient subsequently underwent a tissue biopsy when she presented with another exacerbation. At this time, the CT scan did not identify the ongoing exacerbation, but the Gallium-67 scintigraphy did.
Numerous specimens of Ancyrocephaloides triacanthi Yamaguti, 1938 and A. chauhani Bychowsky & Nagibina, 1975 were collected from two triacanthid fishes, Triacanthus biaculeatus and Tripodichthys blochii, off Peninsular Malaysia. The two monogenean species are redescribed and considered to be the only valid species of Ancyrocephaloides Yamaguti, 1938. Examinations of these worms revealed new features, e.g. the presence of exudates (both net-like and bundle-like) and superficial grooves in the anchors in both species, which necessitated re-descriptions of the two species and amendments to the generic diagnosis. Both species have relatively small anchors with two lateral superficial grooves along the shaft and point, peduncular glands and four large, pyriform secretory reservoirs in the peduncular-haptoral region, each with a single tubular extension to an associated anchor, and net-like structures (exudate) attached to the anchors. The net-like structures are one of the external manifestations of the secretion produced in the peduncular glands and stored in the pyriform secretory reservoirs. When released within the gill-tissue of the host, the exudate is in the form of bundles which extend within the gill-filament. The small anchors convey secretions from the secretory reservoirs via lateral superficial grooves into the gills as the anchors pierce the host tissue for attachment. The secretion coagulates as left and right thread-like bundles of exudate within the gill tissues and is only apparent as nets when it is released into the surrounding water. The recurved point of the anchor and position of the point of exudation allow the nets to remain attached to the anchor point, even after the detachment of the anchors from the gill tissue. This exudate possibly acts somewhat like a 'belay device' or 'safety belt', preventing the parasite from being washed away by the respiratory current during the onset of its leech-like locomotion, as well as assist the relatively small anchors in attachment.
The progesterone (P(4)) profiles and macroscopic vulvar changes of female Malayan tapirs were investigated in order to understand their fundamental reproductive physiology and to search for visual indicators of estrus. Blood was collected once or twice a week from seven female Malayan tapirs kept at four zoos. Serum or plasma P(4) concentrations were determined by radioimmunoassay. The P(4) concentrations changed cyclically throughout the years, and a total of 56 cycles was confirmed in the seven females. The length of the estrous cycle based on the P(4) profiles was 43.6+/-2.0 days; however, this mean includes great variation in length, from 21 to 84 days. Mucous discharge from the vulva and vulvar swelling were seen when the P(4) concentrations were low before the beginning of a rise in most cases. In conclusion, captive female Malayan tapirs have variations of approximately 1 to 3 months in estrous cycle length, and visual changes in the vulva are helpful in estimating estrus in female Malayan tapirs.
This study was carried out to determine the association between body mass index and age related cataract among patients attending eye clinic. We conducted a case control study. The outcome of clinical eye assessment determined the patient's status. Mean body mass index among the cases was shown to be higher (25.4 +/- 4.5) than the control group (24.4 +/- 3.9) (p < 0.01). Crude analysis showed that only obese respondents were 2.4 times more likely to develop age related cataract, however this association was not seen in the multivariate analysis after adjusting for other determinants (aOR 1.81; 95% CI 0.91 - 3.62). We conclude that there is no association between body mass index and age related cataract.
Study site: Eye clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
An open biopsy has minimal sampling error, but is a major procedure, with its inherent complications and morbidity. The complications of paraspinal needle biopsy of vertebral lesions are well known. Needle biopsies have a high incidence of false negatives, especially for tumors. Percutaneous transpedicular bopsy is efficacious, safe, and cost effective, and mostly performed under local anesthesia. Fluoroscopic monitoring enables real time positioning of the needle. Serious needle complications from percutaneous needle biopsy are uncommon. More than 50% of vertebral body tissue, including the disc is accessible via a unilateral transpedicular approach and amenable for biopsy.
A descriptive study was conducted on premarital HIV screening programme in Johor over a three year period. HIV screenings were done at government clinics and confirmed by accredited laboratories. As a result, 123 new HIV cases were detected (0.17%) from 74,210 respondents. In 2004, 24 cases (64.9%) advanced to marriage (n = 37) after they underwent counselling and six of them married among themselves. Positivity rate from this programme (0.17%) is higher than antenatal screening (0.05%). Despite the implementation of the premarital HIV screening programme, marriage application in Johor rose 2.8% in 2004 compared with 2002. This programme had partly contributed to public awareness against HIV and provides another option in early detection of the disease.
To ascertain any differences in knowledge and perceptions of generic medicines between senior (final year) medical students and pharmacy pre-registrants in Australia.
Superior mesenteric artery syndrome (SMAS) is a rare complication following correction of scoliosis with either nonoperative or operative methods. If the patient diagnosed with this syndrome is not managed timely and adequately, mortality may result. We report two cases of SMAS complicating staged corrective surgery for scoliosis using modern segmental derotation instrumentation system. The aim of this report is to highlight the clinical presentations, laboratory findings, radiologic features, and management of the syndrome. The first patient had the syndrome after two-staged scoliosis surgery with halo traction between two stages, and the second patient after three-staged scoliosis surgery with halo traction between the first and second surgeries. The first patient responded well to conservative treatment. However, the second patient failed to respond to conservative treatment and needed a gastrojejunostomy operation to bypass the duodenal obstruction. Clinicians treating post scoliosis surgery patients should always have a high index of suspicion for this potential life-threatening condition. Early diagnosis will enable a multidisciplinary team approach to be initiated early to provide optimal care for the patient. Nutritional and fluid supplementation is mandatory during conservative treatment. The duration for trial of conservative treatment should not exceed 1 week.
Chondrosarcomas are malignant tumours of cartilaginous origin. They range from a well-differentiated growth resembling a benign cartilage tumour to a high-grade malignancy with aggressive local behaviour and the potential to metastasize. Only 5% to 10% of chondrosarcomas are known to occur in the head and neck region. A case of chondrosarcoma of the anterior region of the mandible is presented, along with a review of the relevant literature.
Eight patients with pituitary tumors were operated via the transseptal transsphenoidal approach from April to November 2004 at Hospital Ipoh. Seven patients presented with visual disturbances while three also had endocrine abnormalities. The post-operative follow-up period was between six months to a year. There was no mortality in this series. There were no complications related to the approach i.e. nasal or septal related. All patients with visual impairment showed improvement. Only one patient had hormonal irregularities. The endoscopic assisted transseptal approach to the sphenoid sinus for pituitary surgery was found to be easy and without sinonasal or labial complications often found with the sublabial approach.
Aseptic non-union is a major problem following complicated fracture tibia, which carries significant morbidity and prolonged course of treatment. Plate fixation and autogenous bone grafting has been established as a method of treatment. However the risk of infection, implant failure and donor site morbidity are high. We reviewed twelve consecutive cases of established non-union tibia treated by closed reamed interlocking nail in our centre. All patients had clinical and radiological union at three months. Three patients were complicated with infection and one required removal of implant and re-reaming to eradicate infection. Reamed interlocking nailing is an alternative treatment for selected non-union of fracture tibia with promising results.
Dengue fever is major public health problem especially among the highly urbanized states of Malaysia, such as, Selangor and Kuala Lumpur Federal Territory. We report an epidemiological cluster pattern of dengue outbreak in the district of Gombak, Selangor that may mimic other acute febrile illnesses in which the transmission mode is via close contact. This dengue outbreak consisted of two waves; an initial cluster of three cases (including the first deceased, JI) which occurred between 20th and 21st of July, followed by a later larger cluster of 11 cases that occurred between 1st and 8th of August 2005. This epidemiological clustering pattern of acute dengue virus infection among close contacts suggests an intense rate of dengue virus transmission within the vicinity of the first deceased's house.
Pregnancy-related deaths in four published perioperative mortality review reports were analysed. The aim is to look at the quality of surgical and anaesthetic services along with the perioperative care provided. The audit identified shortfalls in the logistic and support services and recommended remedial strategies. The review was conducted by a committee consisting of practising anaesthetists, surgeons and obstetricians who analysed the questionnaires collectively. A consensus was reached to categorise the death. There were 280 pregnancy-related deaths. Post-partum haemorrhage accounted for 31.8%, followed by hypertensive disorders of pregnancy (20.0% obstetric embolism (16.1%), sepsis (10.7%) and associated medical conditions (21.4%). In brief, there were comings in preoperative, intra-operative and post-operative care in some of the cases. Increased consultant input, clinical audit, improvements in monitoring and expansion of critical care facilities were the integral issues recommended.