Isolated involvement of the clitoris by vascular malformation (VM) is very rare. Clinically, the lesion simulates female pseudohermaphroditism. A five-year-old girl presented with clitoromegaly and a clinical diagnosis of solitary VM of the clitoris was made. Magnetic resonance imaging showed characteristic features and confirmed the diagnosis and the extent of the VM. This is the first reported case of isolated involvement of the clitoris by VM to be diagnosed preoperatively.
Hysterectomy is performed for a wide range of benign and malignant conditions, such as fibroids, menorrhagia and pelvic pain, and gynaecological malignancies. One in four women has a chance of undergoing hysterectomy in her lifetime. Conventionally abdominal hysterectomy is done through the open approach. However, many patients assume that the modern laparoscopic hysterectomy is superior to the standard approach. Laparoscopic surgical centres are mushrooming in major cities. This article presents ethical considerations involved in the decision-making process of choosing from the surgical options available.
Acute puerperal uterine inversion is a life-threatening and unpredictable obstetric emergency. If overlooked, it could lead to a maternal death. Although the precise cause is unknown, it is postulated to be caused by the mismanagement of the third stage of labor with premature traction of the umbilical cord and fundal pressure before placental separation. At the Ipoh General Hospital in Malaysia there were 31 394 deliveries and four acute uterine inversions occurring from 1 January 2002 to 30 June 2005. The four patients were between 25 and 36 years of age and their parities were between two and three. When manual repositioning of the uterus failed, successful correction was accomplished by the O'Sullivan's hydrostatic method. One case had to undergo subtotal hysterectomy after repositioning because of massive hemorrhage secondary to placenta accreta. Early diagnosis, immediate treatment of shock, and replacement are essential.
Patient satisfaction is critical for the growth and prosperity of any oral health service or practice. The success of any oral health service can be assessed by an evaluation of the degree of satisfaction/dissatisfaction of its patients.
Chronic Obstructive Pulmonary Disease (COPD) is a growing health problem worldwide and in Malaysia. Until recently, research on COPD has been slow and difficult, partly due to the huge heterogeneity of this disease, and its variable and imprecise definitions. To perform a descriptive study on a convenient sample of local patients with COPD treated in a state hospital in Malaysia. Fifty-two patients [mean (95% CI) age: 67 (63-70) years; 86% male: 38% Malays, 36% Chinese, 25% Indians; mean (95% CI) PEFR: 45 (40-51) % predicted normal] were interviewed. Clinico-demographic data was collected using a structured questionnaire and health-related quality of life was scored using St George's Respiratory Questionnaire (SGRQ). For analysis, patients were also divided into moderate (n=17) [PEFR 50% to 80%] and severe (n=35) [PEFR < 50%] disease groups. Except for education and total family income, demographic and comorbidity variables were comparable between the two groups of COPD severity. All except 9% of patients were current or ex-smokers. Breathlessness, not chronic bronchitis (i.e. cough and sputum), was the first ranking respiratory symptom in over 70% of the patients, whether currently or at early disease manifestation. Between 5 and 15% of the patients denied any symptom of chronic bronchitis as current or early stage symptoms. Duration of symptoms prior to the diagnosis varied considerably with about 9% having symptoms for over 10 years. Over 80% of the patients smoked for over 15 years before the onset of symptoms. Quality of life in patients with COPI) was generally poor and similar between both COPD severity groups. About one fifth of the patients had exacerbations more than 12 times a year. While many features described in our local patients are well recognized in COPD, the finding that 'chronic bronchitis' is not a prominent symptom in the current or past history may have important implications in the diagnosis of at risk individuals and patients with early disease requiring attention. More research is required to confirm and to understand this.
To determine the immunisation status of hospitalised infants and to examine the potential risk factors associated with incomplete immunisation. Prospective study of infants admitted to a paediatric hospital in Kuala Lumpur, conducted by interviewing carers. Twenty-two percent of infants had incomplete immunisation. The most significant factor that was associated with incomplete immunisation was the carer's lack of knowledge on the timing of the next immunisation (p = 0.005). Other factors that had significant association were the presence of a previous admission to hospital (p = 0.03) and the infant's age of more than 6 months (p = 0.025). The rate of incomplete immunisation in the study population was 22%. An admission to hospital of an infant should be taken as an opportunity to update their immunisation in order to improve the rate of uptake.
From November 1997 to June 2002, percutaneous transcatheter closure of muscular ventricular septal defects was attempted in seven patients. Four patients had single and three had multiple defects. Surgical closure was performed in two patients in an attempt to close a perimembranous defect, leaving behind a large apical muscular defect, which was successfully closed using a device in one patient, whilst the second patient succumbed to septicemia/endocarditis 3 weeks after failure of device implantation. One patient had previous pulmonary artery banding and in another intraoperative placement of two Clamshell devices followed by additional transcatheter closure using Gianturco coils in two different sessions was performed.
Double dislocations of joints of the thumb are uncommon injuries. We report an unusual case of simultaneous dislocation of the metacarpophalangeal (MCP) and subluxation of the carpometacarpal (CMC) joints of the thumb in a child to illustrate problems related to their treatment.
A study was undertaken to 1) determine the effects of tobacco smoke exposure on maternal and neonatal weight and body mass index (BMI) and placental weight, volume and surface area and 2) establish any correlations between the placental surface area, volume and weight with maternal and neonatal body weight and BMI in mothers exposed to cigarette smoke. A total of 154 full-term placentae, 65 from mothers exposed to tobacco smoke and 89 from non-exposed mothers were collected from Kuala Lumpur Maternity Hospital. The placental surface area was determined using a stereological grid, the volume by Scherle's method and the weight by using an electronic weighing machine. In general there were no differences in maternal, placental and neonatal parameters between the exposed and non-exposed groups. However, there were significant correlations between placental weight with maternal weight and maternal BMI in both exposed (r = 0.315; p = 0.013) and (r = 0.265; p = 0.038), and non-exposed (r = 0.224; p = 0.035) and (r = 0.241; p = 0.023) mothers. It was also found that the maternal weight on admission correlated significantly with placental weight in both Malay (r = 0.405; p = 0.020) and Indian (r = 0.553; p = 0.050) passive smokers. Correcting the placental parameters for the maternal weight had no effect on the results.
Twenty percent of all childhood deafness is due to mutations in the GJB2 gene (Connexin 26). The aim of our study was to determine the prevalence and spectrum of GJB2 mutations in childhood deafness in Malaysia. We analyzed the GJB2 gene in 51 deaf students from Sekolah Pendidikan Khas Alor Setar, Kedah. Bidirectional sequencing indicates that 25% of our childhood deafness has mutation in their GJB2 gene. Sixty two percent of these children demonstrate V37I missense mutation. Interestingly, V37I mutation in the GJB2 gene have been reported as polymorphism in Western countries, however in our country it behaved as a potentially disease-causing missense mutation, causing childhood deafness as it was not found in the normal control.
The global statistics reveal that at least one in every five women experiences rape or attempted rape during her lifetime. Rape myths encompass a set of (false) beliefs. Adolescents have high rates of rape victimization than other age groups. Rape myths among health care providers may have a negative influence on proper care of the victims. A total of 422 medical undergraduates of both sexes, studying at two Malaysian Institutes took part in the study. A validated questionnaire used in an earlier study was used for the present study, with a slight modification of scoring system. The age range of medical students was 17 to 34 years: mean +/- SD of men and women, were 20.6 +/- 2.1 and 20.3 +/- 2 respectively. Only about 19% of women and 11% of men had a very good positive attitude. Nearly 1/3 of women and 1/2 of men had a more negative attitude. On the whole the average total score of women was significantly higher (p=0.0004) than men. Nearly 50% of candidates with a village background carried more negative attitude. Violence against women is a significant public health problem. The major revelation of the present study is that only less than 20% of the medical undergraduates had a more positive attitude towards rape. Introduction of courses on 'sexual violence' in medical curriculum is likely to increase a) awareness, b) skills in management, c) in providing support and care for the victims and d) in implementing preventive actions.
A dobsonfly species group, the Protohermes dichrous group, endemic to Borneo, is characterized by the straight directed male ninth gonostylus with a narrow base and the elongate male ectoproct. Protohermes goodgeri sp. nov. and P. karubei sp. nov. from northern Borneo (eastern Malaysia) are herein described as new species placed in the P. dichrous group.
A revision of the genus Leopoldamys is presented, and both the species composition and distribution in Indochina and Sundaic regions is reinvestigated. The phylogeny of the genus is recovered based on Cyt b, COI, and IRBP gene analyses. Five basal and 16 secondary monophyletic phylogenetic lineages were identified. A taxonomic reassessment of the continental and Sundaic populations is performed based on morphological verification of the genetically defined clades. Six clades were recovered in the phylogenetic analyses and correspond to morphologically defined species: L. revertens (distributed in lowlands of eastern and central Indochina), L. herberti (western and central Indochina, northward to northern Vietnam), L. edwardsi (China and northern Vietnam, northward of 21 degrees N), L. milleti (endemic of Dalat Plateau, southern Vietnam), L. sabanus (Borneo), and L. vociferans (lowlands of the Malacca Peninsula, northward to southwestern Thailand). The absence of proper L. sabanus in continental Indochina is revealed. The substitute name for the species known from the majority of Indochina under the name of L. sabanus should be L. revertens. The name L. neilli, which has been ascribed to populations from Thailand and Vietnam, is a junior synonym of L. herberti. Two related but rather divergent clades are found in Sumatra and the Malacca Peninsula. Based on their considerable genetic distances, these forms should be regarded as separate species from the L. sabanus type-bearing populations of Borneo, or as the members of L. sabanus polytypic superspecies. The substitute name for the lineage-bearing taxon from Malacca should be L. vociferans. The continental populations of Leopoldamys can be distinguished from each other by external and cranial characters and may be subdivided into four species. Two of these species (L. revertens and L. milleti) are well distinguished by external and cranial morphology, whereas the other two species (L. herberti and L. edwardsi) may be treated as sibling species that are difficult to distinguish based on morphological characters.
The Oriental genus Stigmothrips Ananthakrishnan is synonymised with A draneothrips Hood, a genus in which most species have been described from the Neotropics. Problems with descriptions by T.N. Ananthakrishnan of species from India are discussed, but cannot be fully resolved without access to the holotypes. A key is provided to 23 species of Adraneothrips from Asia and Australia, including four new species: darwini sp. n. from Northern Territory, Australia; hani sp. n. from Taiwan, China; yunnanensis sp. n. from Yunnan, China as well as Java, Indonesia; and waui sp. n. from Papua New Guinea. One species from the Philippines, Adraneothrips makilingensis (Reyes) comb. n., is transferred from Apelaunothrips, and the male of Adraneothrips russatus (Haga) is described and illustrated for the first time, from Yunnan, China. Two species are newly recorded from Australia: coloratus (Mound) previously known only from the Solomon Islands, and russatus (Haga) previously known from southern Japan and southern China but with one female recorded here from Fiji. Further new records are, coloratus from Java, and chinensis (Zhang & Tong) from Malaysia. Colonies of species in this genus are commonly found living on dead leaves, as fungus-feeders, and many species are brightly coloured or bicoloured in patterns of yellow and brown.
This revision completes a taxonomic survey of fireflies (Coleoptera: Lampyridae) in the area encompassed by Australia, the Republic of Palau, Federated States of Micronesia, Papua New Guinea, Indonesia (West Irian/Papua), Solomon Islands, New Caledonia, Vanuatu and Fiji. It finalises the taxonomic issues arising from the 1969–70 voyage of the scientific vessel Alpha Helix to New Guinea. The firefly fauna of this area is exclusively Luciolinae. The scope of the revision was extended to include all known Luciolinae genera and certain species from SE Asia, and a phylogenetic analysis of 436 morphological characters of males, females, and associated larvae includes 142 Luciolinae species (Ballantyne & Lambkin 2009, and Fu et al. 2012a). The phylogenetic analyses infer four major groups within the Luciolinae. The monotypic Missimia Ballantyne is sister to all remaining Luciolinae and forms a grade to Aquatica Fu etBallantyne. The large clade of Curtos Motschulsky, Photuroluciola Pic, Colophotia Motschulsky, Poluninius gen. nov., Pyrophanes Olivier, Pteroptyx s. str. Olivier, Medeopteryx gen. nov., Trisinuata gen. nov., and Australoluciola gen. nov.forms a grade to the clade of Luciola s. str. Laporte (including Bourgeoisia Olivier). The monotypic Emeia Fu et al.forms a grade with a clade of Luciola and Pygoluciola Wittmer, sister to a large clade of Convexa Ballantyne, Pacifica gen. nov., Magnalata Ballantyne, Lloydiella Ballantyne, Asymmetricata Ballantyne, Pygatyphella s. str. Ballantyne, Atyphella Olliff, Aquilonia Ballantyne, and Gilvainsula Ballantyne. Luciola is paraphyletic, found in up to six clades across the tree. Together with Luciola, Magnalata, Aquilonia, and Gilvainsula render Atyphella paraphyletic. The new genera described here are all monophyletic and supported in the phylogenetic analyses that also provide evidence for the inclusion of taxa within them. Twenty-three genera including five new ones, and ten new species, are recognised and keys are presented for the males and females. Certain females are characterised by the nature of their bursa plates. Australoluciola gen. nov. is proposed for ten species from Australia and New Guinea, seven transferred from Luciola and three new, with species keyed from males, all of which have an entire light organ in ventrite 7. Aus. anthracina (Olivier), Aus. aspera (Olivier), Aus. australis (F.), Aus. flavicollis (MacLeay), Aus. foveicollis (Olivier), Aus. nigra (Olivier) and Aus. orapallida (Ballantyne) are transferred from Luciola with males assigned to Aus. aspera(Olivier), and a lectotype designated for Luciola foveicollis Olivier; Aus. baduria sp. nov., Aus. fuscamagna sp. nov.,Aus. fuscaparva sp. nov., Aus. japenensis sp. nov. and Aus. pharusaurea sp. nov. are described. Females of Aus. australis and Aus. flavicollis have two pairs of wide bursa plates. The bent-winged fireflies of New Guinea and Australia are removed from Pteroptyx Olivier and assigned to Medeopteryx gen. nov. and Trisinuata gen. nov. Medeopteryx gen. nov. is erected for 17 species including two new; all have ventrite 7 with an entire light organ, trisinuate posterior margin and short posterolateral projections; the following 14 species in which males have deflexed elytral apices are transferred from Pteroptyx Olivier: M. amilae (Satô), M. antennata (Olivier), M. corusca (Ballantyne), M. cribellata (Olivier), M. effulgens (Ballantyne), M. elucens (Ballantyne), M. flagrans (Ballantyne), M. fulminea (Ballantyne), M. hanedai (Ballantyne), M. platygaster (Lea), M. similisantennata(Ballantyne), M. sublustris (Ballantyne), M. tarsalis (Olivier), and M. torricelliensis (Ballantyne). M. clipeata sp. nov. is described. Two species without deflexed elytral apices include M. pupilla (Olivier) which is transferred from Luciola, and M. similispupillae sp. nov. A Lectotype is designated for Luciola pupilla (Olivier). Females of M. corusca(Ballantyne), M. cribellata (Olivier), M. effulgens (Ballantyne), and M. similispupillae sp. nov. have two pairs of wide bursa plates. The second genus including species in which the males have deflexed elytral apices is Trisinuata gen. nov., where all males have light organ in ventrite 7 bipartite and posterolateral projections expanded; it is proposed for eight New Guinean species: T. microthorax (Olivier), T. minor (Ballantyne), T. papuae (McDermott) and T. similispapuae(Ballantyne) are transferred from Pteroptyx Olivier, T. papuana (Olivier) previously known only from a female, has males associated and is transferred from Luciola, and T. caudabifurca sp. nov., T. dimidiata sp. nov. and T. apicula sp. nov. are described. Females of T. similispapuae (Ballantyne) have two pairs of wide bursa plates. Luciola s. str. is defined by scoring the type species L. italica (L), Bourgeoisia Olivier and Lampyroidea (based on its type species syriaca Costa) both of which are submerged into Luciola; Luciola s. str is addressed here from four Pacific Island species: L. hypocrita Olivier, L. antipodum Bourgeois both transferred from Bourgeoisia; L. aquilaclarasp. nov. and L. oculofissa sp. nov. are described. L. oculofissa sp. nov. is the only Luciolinae male known to lack light organs. Females of L. italica and L. hypocrita lack bursa plates.Pacifica gen. nov. is proposed for five species from the Solomon Islands transferred from Pygatyphella(Ballantyne), and which the phylogenetic analysis shows to be distinctive viz. P. limbatifusca (Ballantyne), P. limbatipennis (Pic), P. plagiata (Blanchard), P. russellia (Ballantyne), and P. salomonis (Olivier). A monotypic genus Poluninius gen. nov. is proposed for Pol. selangoriensis sp. nov. from Selangor, Malaysia. The genera Colophotia, Pteroptyx, Pyrophanes, and Pygoluciola are treated in an abbreviated fashion with generic diagnoses, lists of, and keys to, species. Pteroptyx bearni Olivier and P. tener Olivier are characterised from type specimens and female bursae and P. similis Ballantyne is synonymised with P. bearni. Luciola semilimbata Olivier is transferred to Pyrophanes, and Luciola cowleyi Blackburn to Pygoluciola. The following species are treated as species incertae sedis: L. melancholica Olivier, L. ruficollis Guérin-Ménéville. The New Guinean records of Luciola tenuicornis Olivier, L. timida Olivier and Photinus cinctellus Motschulsky are suspect. Fifteen of the species treated here are recognised by flashing patterns. The functions of the terminal abdominal modifications, origins of the Australopacific firefly fauna, and use of female and larval characters in interpretations of relationships are considered.
The eagle ray Aetobatus flagellum (Bloch & Schneider, 1801) is redescribed based on new material from the Persian Gulf (Kuwait), Indonesia and Malaysia. A related but distinct species of Aetobatus from the western North Pacific, previously referred to as A. flagellum, is reported. Aetobatus flagellum is a medium-sized eagle ray which attains about 900 mm DW; males mature at approximately 500 mm DW. Aetobatus flagellum appears to be uncommon and restricted to estuary-influenced waters of the Indo-West Pacific. It is caught as gillnet bycatch where its habit of schooling, combined with probable small litter size, may make it particularly vulnerable to impacts from fisheries.
A new species of karst-adapted gekkonid lizard of the genus Cnemaspis Strauch is described from Gua Gunting and Gua Goyang in a karst region of Merapoh, Pahang, Peninsular Malaysia whose unique limestone formations are in immediate danger of being quarried. The new species differs from all other species of Cnemaspis based on its unique suite of morphological and color pattern characters. Its discovery underscores the unique biodiversity endemic to karst regions and adds to a growing list of karst-adapted reptiles from Peninsular Malaysia. We posit that new karst-adapted species endemic to limestone forests will continue to be discovered and these regions will harbor a significant percentage of Peninsular Malaysia's biodiversity and thusly should be conserved rather than quarried.
Species of Apelaunothrips are fungus-feeders on dead leaves, particularly in leaf-litter, and they are recorded across the Old World tropics from Africa to northern Australia and southern Japan. All species in this genus have the maxillary stylets 4-6 microns in diameter, considerably broader than the 2-3 micron diameter that is typical among Phlaeothripinae. The species are largely uniform in structure, but in four species the larger males have fore femora enlarged with a conspicuous tubercle on the inner margin at the base. In one of these species, the males are dimorphic, with no intermediates between large and small individuals, in contrast to the continuous variation in structure found in many polymorphic Phlaeothripidae. A key is provided to the 37 recognised species of Apelaunothrips, including the following: A. desleyae sp.n. from northern Australia; A. bogor sp.n. from Java; A. gombak sp.n. from Peninsular Malaysia.
Paragaleus tengi was previously considered to be the only member of this genus occurring in the Western Pacific, with Paragaleus randalli occurring in the Indian Ocean and allopatric in distribution. Recent molecular and morphological studies showed that P. randalli also occurs in the Western Pacific with records from Thailand, Malaysia and Indonesia previously mostly incorrectly attributed to P. tengi. This paper provides a redescription of P. tengi and confirms the presence of P. randalli from off Taiwan in the western North Pacific. These two species are morphologically very similar in appearance but differ in meristics, dentition, some coloration attributes and minor morphological characters. The conservation status of these two species needs to be reassessed based on this new information.