Patients with Benign Prostatic Hyperplasia (BPH) commonly presents with lower urinary tract symptoms (LUTS), which can be of obstructive symptoms such as hesitancy, incomplete voiding, post void dribbling or of irritative symptoms such as urgency, frequency and nocturia. Various recent studies indicate that nocturia is a very important and bothersome lower urinary tract symptom especially among patients with Benign Prostatic Hyperplasia (BPH). The aims of the study was to determine the frequency of common urinary symptoms among patients with BPH in HUSM as well as to evaluate the extent of bothersomeness of each and every symptom to these patients. This study too was aimed at evaluating the success of TURP in resolving pre operative LUTS. This was a questionnaire-based survey using a validated ICSBPH model whereby patients with BPH were selected and quizzed personally by an investigator. A subset of patients who had undergone TURP were further questioned regarding their satisfaction with the procedure. When nocturia is defined as waking up at night once or more to pass urine, the prevalence of nocturia was about 90%, but only 1 in 6 patients considered this is a very serious symptom. Even if the definition was changed to waking up twice or more, the prevalence is still quite high at over 80%. Urgency were noted in half of the patients, but only a quarter of them consider it a serious problem. 1 in 5 patients experienced significant leak and almost all consider it serious. About one third of the studied population had to be catheterized due to urinary obstruction and interestingly only about half of them considered it as a very serious event. Overall, a great majority of these patients considered suffering from these urinary symptoms for the rest of their life as very devastating. This study conclude that although the prevalence of nocturia was high among BPH patients, but it was not considered serious by majority of them. In fact, LUTS in our BPH patients did not differ much from BPH patients elsewhere. On the whole, TURP resolved most of the LUTS effectively.
A 43 year-old man presented with pain on the right tooth for three days duration. Computed tomography showed left orbital cellulitis and right parapharyngeal abscess. There was also evidence suggestive of a dental abscess over right upper alveolar region. Magnetic resonance imaging revealed left superior ophthalmic vein thrombosis. Emergency drainage of the right parapharyngeal abscess was performed. Right maxillary molar extraction revealed periapical abscess. Left eye proptosis markedly reduced after initiating heparin.
Hand grenade explosion is a rare occasion in our local community. Most of us have seen or heard about the injuries only from the TV news or newspaper. We report two cases of bomb blast injury that occurred in an army camp in September 2000. These case studies illustrate the clinical presentations of hand grenade blast injures that present with multiple organ involvement. We would like to share our experience in managing such cases in a busy emergency department and highlight the outcome of those two cases. Certain issues pertaining to the complexity of the injuries and mass casualty management are also highlighted.
This case report describes a 35-year-old lady who presented with generalized weakness and lethargy of two weeks duration and jaundice of more than 20 years duration. Her initial workup was suggestive of haemolysis and blood film showed a leucoerythoblastic picture with moderate microspherocytes. She was finally diagnosed as a case of hereditary spherocytosis after ruling out other possible causes of chronic haemolysis and supported by an abnormal osmotic fragility test, although family members refused for screening. Hereditory spherocytosis is uncommon in Malay population and presentation with jaundice of 20 years duration with leucoerythroblastic picture on blood film were interesting features in this case. Patient is being followed closely for need of splenectomy in near future as per severity of haemolysis and currently being managed with folic acid supplement.
Klebsiella pneumoniae ranks high as a cause of adult pneumonia requiring hospitalization in Malaysia. To study whether extended-spectrum b-lactamase (ESBL) producing K. pneumoniae was linked to hospital outcomes, we retrospectively studied 441 cases of adult respiratory tract infections with microbial proven K. pneumoniae from an urban-based university teaching hospital between 2003 and 2004. 47 (10.6%) cases had ESBL. Requirement for ventilation and median length of hospital stay, were greater in 'ESBL' than in 'non-ESBL' group [34% vs. 7.4%, p<0.001; 14 days vs. 5 days, p<0.001 respectively] but not crude hospital mortality rate [21.3% vs. 12.4%, p=0.092]. There was a four-fold increased risk of requiring ventilation [4.61 (2.72-7.85)] when ESBL was present. Our findings support the association of ESBL producing K. pneumoniae with adversed hospital outcomes and reiterate the need for vigilance on the part of treating clinicians.
Theophylline toxicity is a life-threatening toxidrome that can present to an emergency department. To ascertain an immediate provisional diagnosis in toxicology at the emergency department is very challenging, especially when the patient presents with altered mental status, because the clinical features of several toxidromes overlap. We report a case of survival of undiagnosed theophylline toxicity that required intubation for two days in the intensive care unit. This was the first case to have been reported from our department. Accurate diagnosis of a toxidrome by gaining adequate history and conducting a thorough physical examination and early serum toxicology screening, coupled with good knowledge of toxicology, will lead to better patient outcomes.
Ongoing surveillance of Pseudomonas aeruginosa resistance against antimicrobial agents is fundamental to monitor trends in susceptibility patterns and to appropriately guide clinicians in choosing empirical or directed therapy. The in vitro activity level of eight antimicrobial drugs was assessed against 97 clinical isolates of P. aeruginosa collected consecutively for three months in 2007 from a Malaysian hospital. Antimicrobial susceptibility was determined using the E-test method in addition to the hospital's routine diagnostic testing by the disk diffusion method. Respiratory and wound swab isolates were the most frequently encountered isolates. The E-test and disk diffusion methods showed high concordance in determining the in vitro activity of the antimicrobial agents against the E isolates. Piperacillin-tazobactam was the most active antimicrobial agent with 91.8% susceptibility, followed by the aminoglycosides (amikacin, 86.6% and gentamicin, 84.5%), the quinolone (ciprofloxacin, 83.5%) and the beta-lactams (cefepime, 80.4%, ceftazidime, 80.4%, imipenem, 79.4% and meropenem, 77.3%). Incidence of multidrug resistance was 19.6% (19 out of 97 isolates). Periodic antibiotic resistance surveillance is fundamental to monitor changes in susceptibility patterns in a hospital setting.
A cross-sectional study was carried out in Kota Bharu on three groups of men with ages ranging from 18 to 44 years. The study groups included 83 athletes representing various types of sports and levels of participation (athlete group), 80 active men who exercised a minimum of 30 minutes per day at least 3 times per week (exercise group), and 80 inactive men (sedentary group). The objectives of the study were to compare the body mass indices (BMIs) and body fat statuses among the three groups with different physical activity levels. The height and weight of respondents were measured using the Seca weighing balance with height attachment. Skinfold thickness of biceps, triceps, subscapular regions, and suprailiac regions of each respondent were measured using Harpenden skinfold calipers. Percentage body fat was calculated as the sum of the four measurements of skinfold thickness. The results showed that the mean (± SD) BMIs in the athlete, exercise, and sedentary groups were 22.6 ± 2.9, 23.4 ± 3.5, and 24.3 ± 4.6 kg/m(2), respectively. The combined prevalence of pre-obese (BMI 25.029.9) and obese (BMI ³ 30.0) subjects was 21.7% in the athlete group, 29.9% in the exercise group, and 47.5% in the sedentary group. The mean (± SD) percentage of body fat in athletes was 15.7 ± 5.4%, which was lower than in the exercise (18.9 ± 5.5%) and sedentary (20.6 ± 5.8%) groups. The study revealed that individuals who are actively involved in physical activity, particularly in sport activities, have lower BMIs and percentage body fat values compared to sedentary people. Therefore, to prevent obesity, all individuals are encouraged to perform regular physical activity, particularly sports activities.
This study assessed several common oxidative indices in subjects infected with intestinal parasites, as well as in colorectal cancer (CRC) patients both with and without intestinal parasites.
Wallerian degeneration is a complicated process whereby axons and myelin sheaths undergo degeneration, and eventually are phagocytosed by macrophages and Schwann cells following nerve damage. Schwann cells proliferate and the endoneural tubes persist. In addition, neurotrophins, neural cell adhesion molecules, cytokines and other soluble factors are upregulated to facilitate regeneration. The important role of cellular components, neurotrophins, and extracellular matrix components, including cell surface molecules involved in this regenerative process, is highlighted and discussed in this review.
Fifty years have elapsed since the discovery of the number of human chromosomes in 1956. Newer techniques have been developed since then, ranging from the initial conventional banding techniques to the currently used molecular array comparative genomic hybridisation. With a combination of these conventional and molecular techniques, cytogenetics has become an indispensable tool for the diagnosis of various genetic disorders, paving the way for possible treatment and management. This paper traces the history and evolution of cytogenetics leading up to the current state of technology.
Langerhans cell histiocytosis is a disease primarily affects the bone. More than 50 percent of the disease occurs between the age of 1 and 15. We reported a case of a 2 year old boy who presented with a gluteal mass. Radiographic imaging showed an osteolytic lesion suspicious of malignancy. However, the histological diagnosis was Langerhans cell histiocytosis.
We present our preliminary experience in neuropsychological testing in epilepsy surgery patients to demonstrate how these tests contributed to decide the laterality of epileptic focus, and to assess the effect of surgery on patient's cognitive function and quality of life. Preoperative neuropsychological tests consisting of Wechsler Adult Intelligence Scale-III (WAIS) for IQ, Wechsler Memory Scale-III (WMS) for memory and patients' quality of life (QOLIE 31) were administered to refractory epilepsy patients under evaluation for surgical treatment. These tests were repeated one year after surgery and we studied any changes in trends. A total of seven patients were recruited in this study between July 2004 and July 2006. The aetiologies of refractory epilepsy were pure mesial temporal sclerosis (MTS) in five patients, dysembryogenic neuroepithelial tumour (DNET) in one and dual lesion of cavernous angioma with ipsilateral MTS in one. The preoperative neuropsychological tests were all in concordance to MRI finding, and showed good contralateral function; five lateralises to the right and two to the left. The post-operative Engel seizure count (median 8.00, IQR 7.00-8.75), general IQ (88 vs. 79), performance IQ (94 vs. 79), verbal memory (89 vs. 71), non-verbal memory (88 vs. 75) and QOLIE (53.14 vs. 44.71) were better compared to preoperative values. The verbal IQ (84 vs. 84) was unchanged. Neuropsychological tests are useful as ancillary investigations to determine the laterality of seizure focus and integrity of function in the contralateral temporal lobe. Following successful surgical treatment, there is a trend towards improvement in memory, IQ and quality of life scores in this small group of patients.
Graves' disease is a common cause of hyperthyroidism. Treatment options for Graves' disease include antithyroid medication, surgery or radioactive iodine (I-31) or RAI. This review will focus on the approach to RAI therapy; discussing dose selection, patient preparation, and consideration before and after administering RAI, examining aspects of pre-treatment with antithyroid medication as well as discussing possible adverse events including hypothyroidism and possible worsening of thyroid-associated opthalmopathy. Follow-up is lifelong with the aim of ensuring the patient remains euthyroid or on replacement therapy if there is evidence of hypothyroidism. While there are controversies in treatment of thyrotoxicosis with RAI, with appropriate patient selection and regular follow-up, radioiodine is a safe and effective modality in achieving high cure rates.
Choana atresia is a congenital abnormality of the posterior nasal apertures affecting the newborn. The aetiology is considered to be a persistence of the embroyological bucconasal membrane which separates the nasal cavity from the stomatodeum until it breaks down at seventh week, allowing communication through the primitive posterior nares. Bilateral choanal atresia almost always present as a respiratory emergency because newborn babies are obligate nasal breathers. The definitive surgical treatment is repair under general anaesthesia. We report our experience in doing a new technique of transnasal endoscopic repair.
Differentiated thyroid cancer ( DTC ) is usually not very common ( incidence is about 1 % of all cancers and women are more often affected than men ). However, higher incidences has been reported in many parts of South East Asia particularly in iodine deficient areas. Unlike other solid tumors, DTC is potentially curable with documented survival rate of > 90 %. Even if the disease is not totally cured, through repeated high dose radio iodine therapy the progress of the disease can be controlled with significant improvement in quality of life for many years. This is possible if a proper and state of the art therapeutic approach is made. Since the incidence is relatively low, individual experience of treating physicians or centers is mostly inadequate leading to improper management with subsequent increase in morbidity and mortality. The purpose of this review is to evolve a rational management protocol for the treatment of thyroid cancer. Centers which do not have all facilities like high dose radio iodine therapy etc. may still follow the protocol by referring the patient for a particular step to another centre. What is needed is the awareness of the treating physician about the appropriate management of DTC. In recent years, there have been some important developments in the management of differentiated thyroid cancer like use of recombinant human thyrotropin (rhTSH), use of retinoic acid for redifferentiation etc. Some of these developments having practical relevance have been briefly mentioned.
The emergence of severe acute respiratory syndrome (SARS) had caused fear and anxiety of unprecedented proportion. To examine the impact of SARS on the medical students in a private medical university, a self-reporting questionnaire study was carried out to assess the factual knowledge, anxiety level and perception of the crisis, among the students. The two-week study (between 12 and 23 May, 2003) was carried out three weeks after the first reported SARS-related death in Malaysia. Ninety-one Phase I (junior) and 113 Phase II (senior) students completed the questionnaires. A large majority of students of Phase I and II were correct in their factual knowledge and were sensible in their perception of the future and the handling of the crisis by government(s). However, phase 1 students expressed significantly greater degree of anxiety compared to Phase II in relation to attendance and personal protection in hospital, and in meeting people coughing in public places. The lesser degree of anxiety expressed by phase II senior students may be due in part, to a more realistic assessment of SARS risk brought about by maturity, time spent in hospital and interaction with clinical lecturers and medical staff.
The clinicopathological conference, popularly known as CPC primarily relies on case method of teaching medicine. It is a teaching tool that illustrates the logical, measured consideration of a differential diagnosis used to evaluate patients. The process involves case presentation, diagnostic data, discussion of differential diagnosis, logically narrowing the list to few selected probable diagnoses and eventually reaching a final diagnosis and its brief discussion. The idea was first practiced in Boston, back in 1900 by a Harvard internist, Dr. Richard C. Cabot who practiced this as an informal discussion session in his private office. Dr. Cabot incepted this from a resident, who in turn had received the idea from a roommate, primarily a law student.
Disaster is a sudden event that associated with ecological changes, disruption of normal daily activities, destruction of infrastructures, loss of properties, and medical disabilities. In disaster, there is a mismatch between available resources and patients need for healthcare service. During flood disaster, the victims were predisposed to different type of illnesses for various reasons such as inadequate supply of clean water, poor sanitation or drainage system, unhealthy foods, and over-crowded relief centers. Mobile clinic is an option for delivering medical care for the disaster victims who often have a difficulty to access to the medical facilities. In this article we would like to share our experiences during the provision of humanitarian services for flood victims at District of Muar Johor. Common illnesses among the flood victims at visited relief centers and advantages of Mobile Medical Relief Team were also highlighted and discussed.
Involvement of oral health educators among non-health professionals in oral health promotion is important in the prevention of oral diseases. This study was carried out to compare the level of oral health knowledge among pre-school teachers before and after oral health seminar. Pre-test data was collected by distributing questionnaire to pre-school teachers in Pasir Mas, who attended the seminar on "Oral Health" (n=33) and they were required to fill anonymously before the seminar started. The questions consisted of information on general background, perceived oral health status, oral health knowledge and the environment where they work. After two weeks, post-test data was collected using the same structured questionnaire and identification code was used to match the pre and post data. SPSS 11.5 was use for statistical analysis. Two out of 33 eligible preschool teachers were considered non-respondents due to absenteeism during the post-test data collection. The response rate was 94.0% (n = 31). The study shows a significant improvement in oral health knowledge among pre-school teachers in Pasir Mas, after seminar (p < 0.001) as compared to controls. Thus, we can conclude that the oral health programme (seminar) appeared effective at influencing oral health educator's knowledge towards oral health.