MyMedR

Special tinted contact lens on colour-defects

Mutilab HA, Sharanjeet-Kaur, Keu LK, Choo PF

Clin Ter, 2012;163(3):199-204.

PURPOSE: The objective of this study was to determine the visual function of colour-deficient subjects when wearing special red tint contact lenses.
MATERIALS AND METHODS: A total of 17 subjects with congenital colour vision deficiency (14 deutans and 3 protans), voluntarily participated in this study. The average age for the subjects was 23.00 ± 4.06 years old. Visual functions tested were visual acuity (LogMAR), contrast sensitivity (FACT Chart) and stereopsis (TNO and Howard Dolman tests). Two types of special red tint lenses were used in this study; Type I (light red) and Type II (dark red).
RESULTS: The protans and deutans showed no significant changes in visual acuity and contrast sensitivity when wearing either type of contact lens. Stereopsis testing using the Horward-Dolman test gave no significant changes but significant differences were seen using the TNO test. Stereopsis using the TNO test was significantly poorer with the red tinted contact lenses compared to without for both protons and deutans. Testing binocularly with Ishihara plates showed that 88% (n=15) of patients passed the test with Type I and Type II contact lenses. When D15 test was done, 3 patients (17.6%) were 'normal' when using the Type I contact lenses and 2 patients (11.8%) were 'normal' when using the Type II contact lenses. However, with FM100Hue test, most patients showed deutan responses. Total error scores (TES) were found to be higher with Type I and Type II contact lenses compared to without.
CONCLUSIONS: The Type I and II special tinted contact lens used in this study did not cause a reduction of visual acuity and contrast sensitivity for the colour defects. Stereopsis was also not reduced with the Type I and Type II contact lenses for the colour defects except when tested with the TNO test. Colour vision defects became difficult to detect using the Ishihara plates but FM100Hue test did not show any improvement with the Type I and Type II contact lenses.

Fulltext Sonographically abnormal placenta: an association with an increased risk poor pregnancy outcomes

Wan Masliza WD, Bajuri MY, Hassan MR, Naim NM, Shuhaila A, Das S

Clin Ter, 2017 10 19;168(5):e283-e289.

PMID: 29044348 DOI: 10.7417/T.2017.2021

BACKGROUND: The placenta is a most interesting but unfortunately often ignored and misunderstood organ. Placental abnormalities, therefore, can be an "early warning system" for fetal problems. A complete prenatal sonographic examination of the placenta is an essential component as its abnormalities can have a direct effect on fetal or maternal outcomes, obstetrical management and future fertility.

OBJECTIVE: To determine whether any association exists between the finding of an increased thickness of placenta, abnormal placenta shape, placental calcification, placental lake and abnormal cord insertion site at 20-22 and 30-32 weeks gestation with an increased risk of uteroplacental complications or a poor pregnancy outcome.

METHODOLOGY: A real-time ultrasound was used at the time of detail scan (at 20-22 weeks gestation) and at 30-32 weeks gestation to look for placenta appearance, fetal growth and anomaly. The main outcome measures were risk of hypertension disease in pregnancy, fetal growth restriction and poor fetal outcomes such as low Apgar score and low cord pH.

RESULT: The majority of the participants were Malay (77.9%). Abnormal placenta found at both gestations were placental lakes and thickness, and only one case had marginal cord insertion. Approximately 6% of the cases were confirmed placenta previa. No abnormal shape or abnormal calcification found at both gestations. About 10% patient developed hypertensive disease in pregnancy, 15% of the fetus was found to have growth restriction and another 16% have low umbilical cord pH. Majority of them delivered at term (90%) and via vaginal delivery (81%). There was no significance between presence of abnormal placental lake and thickness at both gestations with the maternal and fetal outcome.

CONCLUSION: Presence of abnormal placental thickness and lakes at 30-32 weeks scan associated with maternal hypertensive disease, fetal growth restriction and low umbilical cord pH, however these were not statistically significant.

Single incision laparoscopic surgery (SILS) inguinal hernia repair - recent clinical experiences of this novel technique

Yussra Y, Sutton PA, Kosai NR, Razman J, Mishra RK, Harunarashid H, et al.

Clin Ter, 2013;164(5):425-8.

PMID: 24217830 DOI: 10.7417/CT.2013.1608

Inguinal hernia remains the most commonly encountered surgical problem. Various methods of repair have been described, and the most suitable one debated. Single port access (SPA) surgery is a rapidly evolving field, and has the advantage of affording 'scarless' surgery. Single incision laparoscopic surgery (SILS) for inguinal hernia repair is seen to be feasible in both total extraperitoneal (TEP) and transabdominal pre-peritoneal (TAPP) approaches. Data and peri-operative information on both of these however are limited. We aimed to review the clinical experience, feasibility and short term complications related to laparoscopic inguinal hernia repair via single port access. A literature search was performed using Google Scholar, Springerlink Library, Highwire Press, Surgical Endoscopy Journal, World Journal of Surgery and Medscape. The following search terms were used: laparoscopic hernia repair, TAPP, TEP, single incision laparoscopic surgery (SILS). Fourteen articles in English language related to SILS inguinal hernia repair were identified. Nine articles were related to TEP repair and the remaining 5 to TAPP. A total of 340 patients were reported within these studies: 294 patients having a TEP repair and 46 a TAPP. Only two cases of recurrence were reported. Various ports have been utilized, including the SILS port, Tri-Port and a custom- made port using conventional laparoscopic instruments. The duration of surgery was 40-100 minutes and the average length of hospital stay was one day. Early outcomes of this novel technique show it to be feasible, safe and with potentially better cosmetic outcome.

Short-term functional outcomes of a delayed single-stage reconstruction of chronic posterior cruciate ligament and posterolateral corner deficiency

Rusdi A, Shahrulazua A, Siti HT, Nizlan NM

Clin Ter, 2014;165(1):e28-34.

PMID: 24589957 DOI: 10.7471/CT.2014.1668

AIMS: To evaluate the functional outcomes of a delayed (>6 months post-injury) and combined reconstruction of grade III posterior cruciate ligament (PCL) and grade III posterolateral corner (PLC) deficiencies.
PATIENTS AND METHODS: Between March 2006 and October 2009, a delayed surgery consisting of arthroscopically-assisted PCL reconstruction and open reconstruction of the PLC was performed on 19 men and 2 women (average age, 29 years). The mean time-to-surgery was 18 months (range, 7-51 months) and duration of follow-up was 22 months (range, 12-48 months). Postoperatively, patients were evaluated using Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) subjective and objective scores.
RESULTS: At the final follow-up, majority of the knees (61.9%) achieved either normal or nearly normal rating objective IKDC score. The means of IKDC subjective score, Lysholm score and Tegner activity level were 62.09, 74.35 and 5.14 respectively. One patient was able to participate in competitive sport, 5 patients were able to be involved in recreational sports for at least 5 times per week, 10 patients were able to perform heavy labour and recreational sports for at least twice weekly, 4 patients were able to engage in moderately heavy labour work and one patient was only able to perform light labour work. There was no significant statistical association found between the time-to-surgery and the final patients' outcomes.
CONCLUSIONS: A delayed simultaneous reconstruction of chronic grade III PCL and PLC deficiencies can restore sufficient function for standard daily and recreational sports activities to the patients.

Sexual dysfunction among postmenopausal women

Masliza W, Daud W, Yazid Bajuri M, Shuhaila A, Hatta S, Rohaizat Hassan M, et al.

Clin Ter, 2014;165(2):83-9.

PMID: 24770809 DOI: 10.7471/CT.2014.1681

Female sexual dysfunction (FSD) has a major impact on interpersonal relationships and quality of life. For many women it has been emotionally distressing, physically disconcerting, and socially disruptive. To determine the prevalence and factors that contribute to female sexual dysfunction (FSD) and to evaluate the different sexual domains that influence sexual function amongst post menopausal women.

Fulltext Sex estimation by femur in modern Thai population

Monum T, Prasitwattanseree S, Das S, Siriphimolwat P, Mahakkanukrauh P

Clin Ter, 2017 6 15;168(3):e203-e207.

PMID: 28612898 DOI: 10.7417/T.2017.2007

Sex estimation is an important step of postmortem investigation and the femur is a useful bone for sex estimation by using metric analysis method. Even though there have been a reported sex estimation method by using femur in Thais, the temporal change related to time and anthropological data need to be renewed. Thus the aim of this study is to re-evaluate sex estimation by femur in Thais. 97 adult male and 103 female femora were random chosen from Forensic osteology research center and 6 measurements were applied tend to. To compare with previous Thai data, mid shaft diameter to increase but femoral head and epicondylar breadth to stabilize and when tested previous discriminant function by vertical head diameter and epicondalar breadth, the accuracy of prediction was lower than previous report. From the new data, epicondalar breadth is the best variable for distinguishing male and female at 88.7 percent of accuracy, following by transverse and vertical head diameter at 86.7 percent and femoral neck diameter at 81.7 percent of accuracy. Multivariate discriminant analysis indicated transverse head diameter and epicondylar breadth performed highest rate of accuracy at 89.7 percent. The percent of accuracy of femur was close to previous reported sex estimation by talus and calcaneus in Thai population. Thus, for especially in case of lower limb remain, which absence of pelvis.

Scrotal lump: do not forget tuberculosis!

Ho CC, Rusdi AR

Clin Ter, 2014;165(2):107-9.

PMID: 24770814 DOI: 10.7471/CT.2014.1686

Scrotal tuberculosis (TB) is rare. Lack of awareness may lead to a misdiagnosis and/or delayed diagnosis of scrotal TB. Clinicians should have a high suspicion index for scrotal TB when facing a patient with a chronic scrotal lump. Since scrotal TB can be medically cured, biopsy of the scrotal lump for pathology study and/or urine polymerase chain reaction (PCR) analysis for M. tuberculosis should be performed first for rapid diagnostic purposes, and therefore unnecessary surgery may thereby be circumvented.

Role of blood bag temperature indicators in maintaining patent temperature of the returned unused blood bags in blood bank

Nurasyikin Y, Leong CF, Fadhlullah TM, Hafiz WM, Nadiah Z, Atieqah AN, et al.

Clin Ter, 2011;162(1):19-22.

PMID: 21448541

The main objective of the present study was to evaluate the temperature chain of red blood cells (RBC) returned unused blood bags using blood temperature indicator and ascertain the factors like transportation time, type, size of coolant box and number of bags per box.

Risk of mental health disorders among farmers involved in palm plantation occupation

Leonard JH, Ali JE, Vikram M, Saraswathy V, Hanif FM, Nihayah M, et al.

Clin Ter, 2013;164(5):403-6.

PMID: 24217825 DOI: 10.7417/CT.2013.1603

The aim of this study was to define mental health status of palm plantation farmers in Muar, Johor, Malaysia.

Resolution of Acanthosis Nigricans Following Curative Gastric Carcinoma Resection

Jagwani AV, Reynu R, Affirul CA, Mustafa MT, Kosai NR

Clin Ter, 2016;167(4):99-100.

PMID: 27598021 DOI: 10.7417/CT.2016.1937

We discuss a 48-year old, who presented with upper epigastrium pain associated with early satiety and significant weight loss. Physical examination revealed a thickening and darkening of skins around the skin folds, scalp, back and front of abdomen. A diagnosis of gastro-esophageal junction adenocarcinoma was confirmed by oesophagogastroduodenoscopy (OGDS) and biopsy. The biopsy of the skin lesion revealed a diagnosis of acanthosis nigricans, He underwent a total gastrectomy followed by adjuvant chemo-radiotherapy. Recovery is unremarkable. Interestingly, the skin lesions disappear following our therapy. We believe this may be attributed to the treatment of the malignancy. We highlight the interesting association, pathophysiology and therapy.

Refractive status of children under the age of three years born premature without retinopathy of prematurity

Sharanjeet-Kaur, Norlaila MD, Chung KM, Azrin EA, Boo NY, Ong LC

Clin Ter, 2011;162(6):517-9.

PMID: 22262320

A cross-sectional study was undertaken to determine and compare the refractive status of premature children without retinopathy of prematurity (ROP) and full term children below the age of three years.

Refeeding syndrome: the danger of feeding a starving man

Anitha H, Lam YF, Sutton PA, Kosai NR, Srijit D

Clin Ter, 2014;165(4):203-5.

PMID: 25203334 DOI: 10.7417/CT.2014.1734

Refeeding syndrome is a potentially fatal clinical condition characterized by severe electrolyte and fluid shifts associated with metabolic abnormalities in severely malnourished or starved patients undergoing oral, enteral or parenteral refeeding. We here present a case of a 50-year-old Indian male with a background of depression and alcoholic liver disease presented with alleged ingestion of a detergent. He subsequently developed an oesophageal stricture resulting in severe malnutrition. He developed refeeding syndrome following commencement of TPN associated with clear biochemical alteration. This was immediately identified and rectified. This case report highlights the prevalence of refeeding syndrome in a typical hospital setting that can easily be overlooked and stresses the importance of early recognition as this is a preventable disorder.

Rare atypical vascular pattern of subscapular artery: Anatomico-clinical insight

Kumar A, Goel S, Arora J, Mehta V, Pakhiddey R, Suri RK, et al.

Clin Ter, 2015;166(3):118-20.

PMID: 26152619 DOI: 10.7417/CT.2015.1841

The use of muscles of scapular region in transposition and reparative surgery has made the anatomical knowledge of axillary artery and its branches imperative. The subscapular arterial tree is frequently used as a source of microvascular grafts to replace damaged or diseased portion of arteries especially in upper and lower limbs. This investigation is aimed to study the variation in branching pattern of the third part of axillary artery.

Randomized Controlled Trial Comparing Daycare and Overnight Stay Laparoscopic Cholecystectomy

Salleh AA, Affirul CA, Hairol O, Zamri Z, Azlanudin A, Hilmi MA, et al.

Clin Ter, 2015;166(3):e165-8.

PMID: 26152626 DOI: 10.7417/CT.2015.1848

BACKGROUND: This present study sought to review the feasibility and patients' satisfaction of laparoscopic cholecystectomy to be perform as daycare procedure.

MATERIAL AND METHODS: Sixty-two patients with symptomatic gallstones were recruited within a year. They were randomized into overnight stay and daycare groups. The outcomes and post-operative complications were analyzed.

RESULTS: Fifty-eight patients were eligible for analysis and four patients were excluded because of conversion to open cholecystectomy. All patients in daycare group reported no fever but two patients in the overnight stay group complaint of post-operative fever (p=0.150). The mean pain score using Visual Analogue Score (VAS) in daycare group was 2.93 but in the overnight stay was recorded as 3.59 (p=0.98). Five patients had post-operative nausea and vomiting (PONV) in daycare group compared to 2 patients in the overnight stay group (p=0.227). Patient's satisfaction were higher in the daycare group (p=0.160). All patients in daycare group were back at work within a week but in overnight stay, 11 patients had to stay off work for more than one week (p=0.01).

CONCLUSIONS: Daycare laparoscopic cholecystectomy is safe and feasible. The satisfaction of daycare surgery is higher than overnight stay group. Patients' selection is an important aspect of its success.

Pulmonary embolism following histoacryl glue embolization for a large thigh arteriovenous malformation

Harunarashid H, Lily S, Rozman Z, Azim MI, Das S

Clin Ter, 2012;163(5):393-5.

PMID: 23099967

Arteriovenous malformation (AVM) are commonly congenital in origin. We hereby describe the case of a 24-year-old male who was diagnosed of left thigh intramuscular AVM at the time of 14 years old. The computerized tomography (CT) scan confirmed a large deep seated intramuscular AVM with the size of 20 x 15 cm, with dilated and distended feeding vessel from profunda femoris artery (PFA) and superficial femoral artery (SFA). He also had another AVM near the left supracondylar region adherent to the sciatic nerve. The main AVM lesion was earlier treated with surgical resection and it remained for asymptomatic for next seven years. Following this, the patient presented again to the clinic with recurring swelling, pain and occasional paraesthesia on the same site. He was then managed with a series of embolization (total of 6 attempts) with histoacryl glue. These attempts of embolization were successful. The interesting case of pulmonary embolism due histoacryl glue following embolization of an AVM is described.

Prolonged writing task: comparison of electromyographic analysis of upper trapezius muscle in subjects with or without neck pain

Leonard JH, Kok KS, Ayiesha R, Das S, Roslizawati N, Vikram M, et al.

Clin Ter, 2010;161(1):29-33.

PMID: 20393675

Work related musculoskeletal disorders represent a serious public health problem as it is a leading cause for disability and absenteeism in workers. The main purpose of the present quasi-experimental study was to compare the muscle activity of the upper trapezius in subjects with neck pain and compare it to those of normal subjects.

Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)

Primary biliary cirrhosis and auto immune hepatitis overlap syndrome mimicking cholangiocarcinoma

Adel A, Zamri Z, Azlanuddin A, Bong JJ

Clin Ter, 2013;164(6):e493-5.

PMID: 24424229 DOI: 10.7417/CT.2013.1643

Primary Biliary Cirrhosis (PBC) and Auto Immune Hepatitis (AIH) are autoimmune diseases of the liver which highlighted with slow destructive process of intra hepatic small bile ducts. As a result of these damages cholestasis and over the time tissue damage will happen, which leads to scarring, fibrosis and finally cirrhosis. Some patients may present with clinical and biochemical features of both conditions, which is called "Overlap syndrome". Here we are reporting a case of PBC-AIH overlap syndrome that primarily diagnosed as gallbladder carcinoma and went under operation and finally histological examination revealed to be PBC.

Prevalence of iron deficiency anaemia and thalassaemia trait among undergraduate medical students

Azma RZ, Ainoon O, Azlin I, Hamenuddin H, Hadi NA, Tatt WK, et al.

Clin Ter, 2012 Jul;163(4):287-91.

PMID: 23007811

Anaemia is a global health problem including Malaysia. In adults, anaemia may affect work productivity. Iron deficiency anaemia and thalassaemia are common causes of anaemia in Malaysia. However, there is scarcity of data on national prevalence of iron deficiency anaemia and thalassaemia, especially in young adults. This cross sectional study was performed to determine the prevalence of iron deficiency anaemia and thalassaemia among medical students of Universiti Kebangsaan Malaysia Medical Centre (UKMMC).

Pregnant and severe acute abdominal pain: A surgical diagnostic dilemma

Kosai NR, Amin-Tai H, Gendeh HS, Salleh S, Reynu R, Taher MM, et al.

Clin Ter, 2015;166(3):110-3.

PMID: 26152617 DOI: 10.7417/CT.2015.1839

Acute abdominal pain in pregnancy remains a surgical conundrum. A 25-year-old primigravid at 29 weeks gestation presented with a two-week history of epigastric pain, nausea and vomiting. She had a distended abdomen consistent with a full term gravid uterus; tender at the epigastric and right hypochondrium suggestive of small bowel obstruction or acute appendicitis. Abdominal ultrasound was inconclusive but abdominal Computed Tomography (CT) suggested small bowel volvulus. An exploratory laparotomy revealed a segmental jejunal volvulus and small bowel diverticulum contributing to the volvulus. A short segmental bowel resection was performed. Histopathology confirmed a Meckel's Diverticulum. The patient recovered well but underwent premature labour 10 days later. Small bowel obstruction secondary to Meckel's diverticulum is rare in pregnancy. In an acute gestational abdomen, clinical examination is key. Radiological imaging may be helpful, whilst surgical intervention is confirmatory and therapeutic in the event of an obstructive volvulus.

Preconception counseling in the prevention of fetal alcohol syndrome: a unique window of opportunity

Das S, Rao V, Chaudhuri JD

Clin Ter, 2009;160(4):315-22.

PMID: 19795087

The role of alcohol in the causation of Fetal Alcohol Syndrome (FAS) has been firmly established. In most cases events leading to its occurrence have been set into motion prior to conception. Alcohol consumption during pregnancy, the sole causative agent of FAS, can therefore be prevented even prior to conception by implementation of preconception counseling (PCC). The present review examines the important issues involved in the implementation of PCC for the prevention of FAS which can be of immense help to the affected population.

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