Frontal mucocele is not commonly masked as upper lid abscess.A 72-year-old Chinese man with underlying hyperthyroidism complained of left upper eyelid swelling of 6 months duration. The swelling had persisted and worsen when intravenous antibiotic was changed oral type. Visual acuity on presentation was hand motion and reverse relative afferent pupillary defect was present. Because the swelling was large and resulted in mechanical ptosis and ophthalmoplegia, a CT imaging was performed, which showed huge left frontal mucocele eroding the supereromedial orbital rim. The left globe was displaced inferolaterally but there was no extension into brain parenchyma. Fundus examination showed pale optic disc with dull macula. Old laser marks were seen at peripheral fundus. Referral to ortholaryngologist was made and endoscopic sinus surgery and evacuation of mucopyocoele was done. Culture and sensitivity of the fluid showed no organism. He recovered well postoperatively with additional two weeks of antibiotics. We highlight the necessity of surgical drainage of mucocele, following a course of antibiotic.
Introduction: In Malaysia, medical specialisation training is mainly carried out by the public universities. Methods: A survey was carried out to explore the views of medical specialists in the country on issues such as structure of medical specialty training, availability of human resource, public/private sector competition, competency and apprenticeship, and its impact on assurance and quality of medical specialty training. Results: Altogether 238 medical specialists from 30 hospitals and medical institutions in the country participated in the survey. Conclusion: Among the findings, competition for human resource between public and private sector and lack of uniformity on medical specialty training across universities in the country are among the issues found to be of concern. There is also a need to address governance issue which necessitates to clearly delineating what constitutes medical specialty and what constitutes a subspecialty so that an agreed uniformed nomenclature is exercised across all stakeholders. The respondents also strongly agreed on the need to ensure competence in medical specialist training.
Objective: This case report highlights the clinical dilemmas encountered in deciding the diagnostic status of persons with unipolar depression who develop hypomania during antidepressant/electroconvulsive therapy.
Methods: We report a case of a 52 year-old Chinese lady, diagnosed with unipolar depression, which developed hypomania after she was started on T. Fluvoxamine 100mg daily and completed 8 sessions of Electroconvulsive therapy.
Results: Her diagnosis was revised to Bipolar Disorder and she was treated with T. Sodium Valproate 400mg twice daily after which she improved.
Conclusion: Treatment-emergent hypomania is likely a subtype of bipolar spectrum disorder and patients with Treatment - emergent Hypomania should be treated as Bipolar Disorder.
Objective: This case report highlights psychosis post craniopharyngioma surgery.
Methods: We report a case of a young Malay lady who presented with psychotic symptoms after she underwent craniotomy for craniopharyngioma.
Results: Presence of prominent hallucinations and delusions after removal of the tumour and the symptoms lasted more than a month. The psychosis subsided with antipsychotic.
Conclusion: Psychosis post craniopharyngioma surgery is still possible whether possibly due to the residual tumour or as a result of treatment sequealae.
Objectives: This paper aims to report on a case in which re-challenging with clozapine in combination with lithium in a patient who developed neutropenia was carried out. Methods: The patient was treated with clozapine for treatment- resistant schizophrenia. After five weeks he showed much improvement but developed neutropenia. Withdrawal of clozapine brought on a relapse of psychotic symptoms. Subsequently, clozapine was reintroduced along with Lithium. The neutrophil count was monitored closely. Results: The neutrophil and white blood cell count were noted to return to normal upon re-challenging, and the patient’s clinical condition also improved. Conclusion: Simultaneous administration of lithium and clozapine to patients experiencing neutropenia on clozapine is a possible strategy. However, very close monitoring of the white count is needed. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 90-92.
The working environment of intensive care unit (ICU) nurses is a constant source of stress. Researchers have described ICU as a stressful environment because of the complex nature of patients’ health problems requiring an extensive use of very sophisticated technology. This study aimed to identify the prevalence of stress among staff nurses working in ICU, Hospital Universiti Kebangsaan Malaysia (HUKM), factors influencing stress and to explore the symptoms of stress experienced. This descriptive study was conducted on 67 staff nurses working in ICU, HUKM. Data was collected using self-administered questionnaires. The questionnaires included sections on socio-demographic data, factors influencing stress and symptoms of stress experienced. Data was analyzed using frequency and percentage. The Chi square test was used to examine the relationship between socio-demographic data and factors influencing stress. Findings indicated that stress symptoms were experienced by 100 per cent (n =67) of staff nurses Knowledge, working experience, critically ill patients, and environmental factors were one of the many factors contributing to the stress experienced by the ICU nurses in HUKM. Nurses working in ICU, HUKM are found to have a high level of stress. Recommendations like encouraging ICU nurses to take up post basic ICU courses and increasing the nurses quota can reduce the prevalence of stress among ICU nurses. Hospital management has an important role to play in reducing the stress levels of nurses working in ICU as stress has an effect on job performance and quality of nursing care.
Chitosan was chemically modified with bulky structure, cis-5-norbornene-2, 3-dicarboxylic anhydride and the characteristic of this modified chitosan was studied. The resulting material was analyzed by FTIR, TGA, DSC, XRD and SEM to study the effect of N-acylation to the polysaccharide structure. FTIR results show that the anhydride monomer was successfully bound to amine group of chitosan. Thermal analysis of the modified structure provides the chitosan fibers with thermal stability while XRD and SEM show the lost of crystallinity of modified chitosan. XRD of modified chitosan shows broader peak pattern and a considerable increase in a dimension while SEM of chitosan presented the single particle morphology while norbornene-chitosan shows aggromolarate behaviour due to the hydrophobic nature of norbornene pendant group which induced aggromolaration of the particles in modified structure.
Nutrition has been widely recognized to have certain levels of influence on the risk of kidney stone formation. Thus,
this case-control study was conducted to determine the association of dietary intake and lifestyles factors with kidney
stone disease. Sociodemographic data, dietary intake, supplements intake, smoking and alcohol habit, medical history,
physical activity and anthropometric data were obtained using interviewer-administered pre-tested questionnaires
among 81 patients who had been diagnosed with kidney stone disease and 81 patients without kidney stone disease at
Universiti Kebangsaan Malaysia Medical Centre. The results indicated that body mass index and hip circumference
were higher among cases as compared to controls in both men and women (p < 0.05). Energy, macronutrients and
micronutrients intake were higher for case subjects compared to control subjects for all significant parameters (p < 0.05).
Results showed positive association of kidney stone with consumption of nuts (≥1 time/week) for men and women while
consumption of eggs (1-3 times/month) and beans (1-6 times/week) showed positive association for women. Analysis
of multivariate found the risk factor among women was diabetes mellitus [Adjusted OR = 27.6 (95% CI = 1.43-53.3)]
(p < 0.05). Whilst, plain water intake of at least 6 glasses [Adjusted OR = 0.001 (95% CI = 0.000-0.08)] (p < 0.05) and
8 glasses per day [Adjusted OR = 0.001 (95% CI = 0.000-0.02)] (p < 0.05) reduced the risk among women. The risk
factors for men were smoking habits [Adjusted OR = 16.2 (95% CI = 1.29-203)] (p < 0.05), consumption of carbonated
drink 1-3 times per month [Adjusted OR = 6.25 (95% CI = 1.04-40.7)] (p < 0.05) and 1-6 times per week [Adjusted OR =
12.5 (95% CI = 1.41-111)] (p < 0.05). Unhealthy dietary and lifestyles factors increased the risk of kidney stone disease
and various risk factors were found for different sexes.
A 23-year-old lady presented with both eye progressive painless blurring of vision for two weeks in 2011. Prior to that she had malar rash, hair loss, photosensitivity and bilateral leg swelling. Ocular examination showed that visual acuity on the right was 6/60 and on the left was 6/24. Both optic disc were swollen with extensive peripapillary cotton wool spot (CWS), flame shape haemorrhages, dilated and tortuous vessels with macular oedema. Systemic examination revealed blood pressure of 176/111 mmHg, malar rash and alopecia. Diagnosis of grade 4 hypertensive retinopathy secondary to SLE was made. The diagnosis was confirmed by positive ANA/ dsDNA, low C3/ C4 and renal biopsy showed lupus nephritis. She was treated with oral prednisolone, hydroxychloroquine and cyclosporin A. Throughout the monitoring for hydroxychloroquine toxicity, vision over both eyes were 6/9, but serial visual fields showed non-progressive left superior and inferior scotoma while right eye showed inferior scotoma. The intraocular pressure was normal with pink optic disc and cup disc ratio of 0.3. Optical coherence tomography (OCT) showed temporal and nasal retinal nerve fiber layer thinning bilaterally. However, macula OCT, fundus fluorescein angiography and autofluorescence were normal. The visual field defect was concluded secondary to CWS indicating microinfarction of the retinal nerve fiber secondary to previous hypertensive retinopathy. Non-progressive visual field defects may occur after the appearance of CWS in hypertensive retinopathy and it should not be overlooked when diagnosing glaucoma or hydroxychloroquine toxicity.
Introduction: Smoking is a well-known cause of oral disease and oral cancer. Several dysplastic cytological changes occur before the appearance of the clinical lesion. This study aimed to investigate the cytopathological effects of smoking in clinically normal oral mucosa of cigarette smokers.
Materials and Methods: A total of 40 cigarette smokers and 40 nonsmokers (control group) were included in this study. All participants had clinically normal oral mucosa. Oral smears were obtained from the side of the tongue and floor of the mouth using a Cytobrush. The smears were stained by Papanicolaou stain and examined under light microscope for inflammation, hyperkeratinization and dysplasia.
Results: There was a significantly higher rate(p<0.005) of inflammation 63%, hyperkeratiniztion 62% and mild dysplasia 26% among smokers than non-smokers where the rates were 35%, 12% and 2% respectively.
Conclusion: Smoking causes significant cytopathological changes in normal oral mucosa, the detection of which is important to prevent progression into carcinoma. The procedure is fast, painless and inexpensive.
KEYWORDS: Papanicolaou stain, brush biopsy, cigarette smokers, dysplasia, oral mucosa
Prolonged drought conditions have adverse environmental and socio-economic impacts due to unmet water demands. Defining drought is difficult because of its onset and ending time. Therefore, characterisation of drought is essential for drought management operations. Thus, drought indices come in handy and are a practical approach to assimilate large amounts of data into quantitative information which can then be applied for drought forecasting, declaring drought levels, contingency planning and impact assessments. This study analyses drought events using indices, namely SPI and Deciles Index, computed with DrinC software program but are not popular in Malaysia. It is observed that both indices are identical and suitable for drought occurrences.
Sawdust is considered a waste material and a number of innovative ways are being taken to mitigate its effects on the environment. The use of sawdust as additional admixture in cement-sand brick production is an alternative option to mitigate the problem. In this study, three different types of cement-sand brick mixture in proportion of 1%, 2% and 3% of sawdust added to the normal mixture are prepared. Compression test was conducted on the brick mixture and results indicated 1% sawdust satisfy the Class 1 loadbearing brick whilst the 2% sawdust is slightly above the minimum required strength of 5.2 MN/ m2 for an ordinary quality brick set by the Standards MS 76:1972. Thus, the use of sawdust as admixture in cement-sand brick should not exceed 3%.
Despite the proven benefit of cryotherapy in the management of
threshold retinopathy of prematurity (ROP), it was shown
leading to ocular adverse effects. A male infant was born at 28
week of gestation with a birth weight of 1200 g. Serial
examinations revealed worsening ROP in both eyes until he
reached a high risk pre-threshold ROP in his right eye and
threshold ROP in his left eye. Cryotherapy was performed for
the threshold ROP in the left eye while the right eye was
subjected to further observation. Subsequently, ROP in both
eyes regressed without cicatrisation. The patient was followedup
over 8 years and refractions showed that the treated eye
developed steadily increasing myopia while the untreated eye
remained emmetropic. This case demonstrated the detrimental
effect of cryotherapy to the treated eye leading to the progressive
myopia as the child grew.
Leech infestation in otolaryngology is sporadically seen in
remote area of tropical countries, but the cases are usually not
scientifically reported. We are reporting an unusual case of a
land leech removal from external auditory canal (EAC).
This study aims to investigate a visual status and prevalence of visual problems in relation to eye safety and health amongst
visual display terminal (VDT) users in industries. A visual profile questionnaire (VPQ) and visual tests were conducted on workers
from 9 type of industries aged 20 to 60 years old in between October 2015 and June 2016. Workers with a history of exposure to VDT
more than 2 hours a day were used as a baseline for recruitment. Respondents who did not complete the visual profile questionnaires
(VPQ) and visual tests were excluded from the study. A total of 1214 respondents with mean aged of 39.33 ± 9.80 years have completed
the study. Most respondents show moderate to high in vision problems in related to VDT, low knowledge on visual hazards and policy
in relation to eye safety and health at the workplace and high percentage of not getting proper eye tests while serving their industries.
Visual Profile (VP) is needed as a key indicator to profile eye safety measures and the need for policy to help prevent eye problems and
improve employees’ productivity at workplace.
Brake pad apparatus is designed for help student and instructor in teaching and learning application. The objective
of this research is to differentiate the pressure effect and braking temperature condition of different pad. This apparatus
also aimed for learning the safety car and motorcycle braking system. This apparatus can to compare with theoretical
calculation in order to approve that this apparatus is useful. The main concept in this apparatus is thermocouple use
to detect the temperature gain while braking process. Speed motor controller used for set the angular velocity of the
motor in braking process. Pressure applied at brake pedal detected by pressure gauge and data logger function as a
connector. This apparatus also designed based on valid data for average of teenager in Malaysia which made on a
sample university student. Result show that the apparatus can function effectively by defines the different temperature
when applied the different pressure and different pad. Pad C shows the 880C for thermocouple 1 and 790C for
thermocouple 2 at the 20 psi and infrared thermometer show 1130C for pad C. Graph from calculation shows that the
pad A have 216.480C at 1000 rpm which have low temperature than pad B, C and D. high efficiency of friction and
pressure applied will cause more heat generate than low coefficient of friction and pressure applied.
Introduction: Open globe injury may lead to devastating visual outcome. Urgent management and subsequent follow-up is important to maximise recovery. More data on open globe injury in Malaysia is needed to identify risk groups and prognostic factors. This study was carried out to investigate open globe injury, the socio-epidemic profile, clinical characteristics and outcome of the open globe injury in the Hospital Serdang, Malaysia. Methods: All patients managed for open globe injury to Hospital Serdang from January 2006 to December 2013 were included in this retrospective case review. Student’s T-test was used to determine difference between means and chi-square for categorical data. P value of less than 0.05 was regarded as statistically significant. Results: There were 155 patients managed for open globe injury with three of them had bilateral involvement. As such, there were 158 cases eligible for analysis in this study. The average age was 32.2 ± 16.5 years (mean ± standard deviation, SD). Male was at higher risk for open globe injury. Predictors for poor visual outcome were foreign nationality (p=0.047), lid laceration (0.008), type of injury (p=0.001), site of injury (p=0.008), RAPD (p
Microwave breast imaging has been reported as having the most potential to become an alternative or additional tool to the existing X-ray mammography technique for detecting breast tumors. Microwave antenna sensor performance plays a significant role in microwave imaging system applications because the image quality is mostly affected by the microwave antenna sensor array properties like the number of antenna sensors in the array and the size of the antenna sensors. In this paper, a new system for successful early detection of a breast tumor using a balanced slotted antipodal Vivaldi Antenna (BSAVA) sensor is presented. The designed antenna sensor has an overall dimension of 0.401λ × 0.401λ × 0.016λ at the first resonant frequency and operates between 3.01 to 11 GHz under 10 dB. The radiating fins are modified by etching three slots on both fins which increases the operating bandwidth, directionality of radiation pattern, gain and efficiency. The antenna sensor performance of both the frequency domain and time domain scenarios and high-fidelity factor with NFD is also investigated. The antenna sensor can send and receive short electromagnetic pulses in the near field with low loss, little distortion and highly directionality. A realistic homogenous breast phantom is fabricated, and a breast phantom measurement system is developed where a two antennas sensor is placed on the breast model rotated by a mechanical scanner. The tumor response was investigated by analyzing the backscattering signals and successful image construction proves that the proposed microwave antenna sensor can be a suitable candidate for a high-resolution microwave breast imaging system.
Neurocomputing has been adjusted effectively in time series forecasting activities, yet the vicinity of exceptions that frequently happens in time arrangement information might contaminate the system preparing information. This is because of its capacity to naturally realise any example without earlier suspicions and loss of sweeping statement. In principle, the most widely recognised calculation for preparing the system is the backpropagation (BP) calculation, which inclines toward minimisation of standard slightest squares (OLS) estimator, particularly the mean squared mistake (MSE). Regardless, this calculation is not by any stretch of the imagination strong when the exceptions are available, and it might prompt bogus expectation of future qualities. In this paper, we exhibit another calculation which controls the firefly algorithm of least median squares (FFA-LMedS) estimator for neural system nonlinear autoregressive moving average (ANN-NARMA) model enhancement to provide betterment for the peripheral issue in time arrangement information. Moreover, execution of the solidified model in correlation with another hearty ANN-NARMA models, utilising M-estimators, Iterative LMedS and Particle Swarm Optimisation on LMedS (PSO-LMedS) with root mean squared blunder (RMSE) qualities, is highlighted in this paper. In the interim, the actual monthly information of Malaysian Aggregate, Sand and Roof Materials value was taken from January 1980 to December 2012 (base year 1980=100) with various levels of anomaly issues. It was found that the robustified ANN-NARMA model utilising FFA-LMedS delivered the best results, with the RMSE values having almost no mistakes at all in all the preparation, testing and acceptance sets for every single distinctive variable. Findings of the studies are hoped to assist the regarded powers including the PFI development tasks to overcome cost overwhelms.
This paper is an attempt to perceive and order guns using a two-layer neural system model taking into account a feedforward backpropagation calculation. Numerical properties from the joined pictures were utilised for enhanced gun characterisation execution. Inputs of the system model were 747 pictures blackmailed from the discharging pin impression of five differing guns model, Parabellum Vector SPI 9mm. Components created from the dataset were further grouped into preparation set (523 components), testing set (112 components) and acceptance set (112 components). Under managed learning, exact results exhibited that a two-layer BPNN of 11-11-5 arrangement, with tansig/purelin exchange capacities and a “trainlm” preparing calculation, had productively delivered 87% right aftereffect of grouping. The order result serves to be progressed and contrasted with the previous works. Finally, the joined picture districts can offer some accommodating data on the grouping of gun.