Eosinophil-type nasal polyp (NP) is common in Western population. This aim of
this study was to determine the histology type of NP among different Malaysian
ethnic groups. A total of 122 chronic rhinosinusitis with nasal polyposis (CRSwNP)
patients were retrospectively enrolled and demographic data was recorded. The
histological slides were retrieved. The number of eosinophils and non-eosinophils
were counted and average number of inflammatory cells for each high power
field was calculated. Eosinophil-predominant was seen in 32.8% of patients and
67.2% was non-eosinophil-predominant. Phenotypes of NP significantly showed an association with ethnicity (x² = 8.322; p < 0.05). A total of 78.9% of Chinese
nasal polyps showed non-eosinophil predominant, while Malay and Indian nasal
polyps revealed 71.9% and 40.7% of non-eosinophilic phenotype, respectively.
Our study showed that Malaysian population had a non-eosinophilic phenotype
of nasal polyps. There was a significant association in Malaysian ethnicity with the
highest percentage in Chinese population.
Clostridium difficile infection (CDI) causes mild to severe diarrhoea and pseudomembranous colitis in patients who had prior antibiotic exposure. Despite CDI being prevalent worldwide, its epidemiological data is scanty in Malaysia. This study aimed to determine the prevalence and incidence of CDI at Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Stool specimens from 147-suspected CDI patients were obtained from 1 November 2011 until 31 October 2012. The presence of C. difficile toxin A and/or B were detected using a commercial immunochromatographic kit (Wampole™ Tox A/B Quik Chek). Surveillance data was collected from patients’ medical records to establish the demographic and clinical characteristics. The overall prevalence and incidence of CDI in UKMMC was 6.1% and 5.2 cases per 10 000 patient-days, respectively. Among nine CDI patients, 77.8% were males and 55.6% were Chinese. CDI was most common in medical wards (88.9%). The median age was 60 years and the median length of hospital stay was 13 days. Majority (88.9%) of CDI patients received antibiotics eight weeks prior to CDI. Penicillin-beta-lactamase inhibitors were the most common antecedent antibiotics. Five (55.6%) CDI patients received acid suppressant medications. The in-hospital mortality rate was 22.2%. In conclusion, the prevalence and incidence of CDI at UKMMC is relatively low and occurs sporadically.
The AIDS epidemic in Southeast Asia has led to a marked rise in the incidence of talaromycosis (penicilliosis) marneffei. The aim of this cross-sectional study was to determine the clinico-epidemiological features and outcome predictors of talaromycosis in Malaysia. We identified Talaromycosis marneffei cases from cultures of sterile specimens from 191 human immunodeficiency virus (HIV)- infected patients. Talaromycosis increased from 20-25 (2010-2011) to 45-50 cases per year (2012-2014). Talaromycosis was the HIV-presenting illness in 117 (61.3%) patients. The incidence of talaromycosis as HIV-presenting illness showed an increasing trend from 10.7 (2010) to 26.4 (2014) cases per 1000 new HIV patients. The patients were between 19 and 74 of age (mean 37.2+9.4 years) and the male to female ratio was 7.7:1. Malay (73, 38.2%) and Chinese (70, 36.3%) were the most prevalent ethnic groups. Common clinical manifestations included loss of weight (85.9%), fever (84.8%) and cough (67%), while skin lesions were only present in 42.9% cases. Common concurrent infections were oral candidiasis (79.6%), tuberculosis (36.1%) and hepatitis C infection (20.9%). Most patients (93.7%) were anaemic with mean haemoglobin level of 9.9+2.3 g/dL, 39% had impaired liver function, and 18.8% were neutropaenic. Median CD4 cell count was 16 cells/L. Most patients (70.4%) received intravenous amphotericin B followed by itraconazole. At 8-month follow up, 148 (81.8%) patients were alive while 33 (18.2%) had died. Intravenous drug abuse, concurrent toxoplasma encephalitis and concurrent Pneumocystis jiroveci pneumonia independently predicted death outcome in both univariate and multivariate logistic regression analyses.
Hyperlipidemia is a condition of high lipid levels in the plasma and often linked with the deposition of lipid droplets in the aorta which initiate the progression of atherosclerosis. Atherosclerosis is a common cardiovascular disorder initiated by the formation of foams cells in the vascular wall which leads to turbulent blood flow, injury to the endothelial layer and subsequent vascular thrombosis. Since the early 1980’s, Golden-Syrian hamsters have been widely used as an animal model in the research of hyperlipidemia and atherosclerosis. The use of hamsters in the hyperlipidemic and atherosclerotic model is due to their lipoprotein profile that is closer to human setting, sensitive to high-fat high-cholesterol (HFHC) diet and a suitable rodent model. Atherosclerosis can be induced in hamsters through dietary challenge with HFHC diet. Over the decades, coconut oil (CNO) was commonly used as the source of fat in the diet design of high saturated fatty acids (SFA) composition. In this review, we summarized published literature with designs involving CNO plus cholesterol-induced hyperlipidemia, atherosclerosis or both. The factors that may influence the ability of CNO and cholesterol combination to induce hyperlipidemia such as the period of dietary intervention, hamster strains and the dietary amount were evaluated and summarized.
Ankle injuries are commonly seen in various sports. The main aim of the present
review was to highlight the normal anatomy of the ankle, mechanism of injuries
related to sports, congenital abnormalities or anatomical variations related to
ankle injury and discuss its effective management. A review of literature was done
to determine the ankle injuries which occur as a result of various sports related
activities. We documented all sports which involved injury to the ankle joint. The
anatomy of various structures in the sole of foot and their involvement in injuries
were discussed at length. The anatomical knowledge of ankle injury may be
beneficial for future diagnosis and treatment purpose.
A cross sectional study on work stress prevalence was carried out among 185 executives and managers in the head quarter of an international tobacco company. The aim of the study was to identify work stress prevalence in this company and work stressors that were associated with stress experienced by the workers. A questionnaire based on the Personal Stress Inventory by O'Donell (1984) was used. Data collected from participants included sociodemography factors, symptoms of stress and work stressors related to organizational policy, organizational structure, organizational process, and work environment. The study showed that the prevalence of stress among executives was 68.1% and managers were 67.9%. There was no significant difference in the level of stress between the executives and the managers in the company. The sociodemographic factors that were significantly associated with stress were salary, number of children and personal factors. The significant stressors in the workplace were lack of job recognition, over focusing on quality of work, heavy workload and long working hours.
Idiopathic hypereosinophilic syndrome (HES) is an uncommon disorder which usually presents with prolonged and significant primary eosinophilia with end-organ dysfunction. Damaging proteins released by the eosinophilic granules are responsible for the tissues and organ system damage. Here we report two cases of idiopathic HES. Both the patients were young lady presented with high grade fever and concomitant symptoms. Laboratory findings showed leucocytosis with predominant neutrophilia and marked eosinophilia. A diagnosis of idiopathic HES was made after excluding secondary causes of eosinophilia. However, the first patient was complicated with multiple venous thrombosis and intravenous heparin was started which was later changed to subcutaneous low molecular weight heparin (LMWH). The patient developed pleural effusion and consolidation. Intravenous Tazoscin, tablet Prednisolone and tablet Hydroxyurea was started and the patient responded well. Despite treatment, two weeks later, suddenly the patient collapsed and unfortunately succumbed. On the other hand, the second patient was complicated with fever, thrombocytopenia, haemolytic anaemia, acute renal failure and neurological deficit which were part and parcel of thrombotic thrombocytopenic purpura (TTP). Plasma exchange was commenced and patient’s condition had slowly improved. Nevertheless, the hypoxia which she sustained during the multiple episodes of fits had resulted in permanent brain injury and thus requiring a tracheostomy for prolonged ventilatory support. Currently, there is no cure for HES. The main aim of treatment is to minimise the tissue damage caused by the hypereosinophilia. Early diagnosis and intervention are therefore crucial in preventing the spread of the disease and the end-organ damage.
Red cell alloimmunisation is defined as the development of antibodies in response to foreign red cell antigens through transfusion or pregnancy. In pregnant women even without the history of previous blood transfusion, this is possible through previous or current pregnancy with the presence of paternal red cell antigen inherited by the fetus. This study was aimed to determine the prevalence of red cell alloimmunisation among pregnant women without previous history of blood transfusion and the association with number of pregnancy and history of obstetric complications. This was a cross-sectional study in which 150 pregnant women were randomly selected from the antenatal clinic. Ten mls of peripheral blood was obtained for antibody screening using indirect antiglobulin test besides the routine antenatal screening. In this study, the majority (37.3%) of the women were primigravidae. Red cell alloantibodies were detected in two out of 150 (1.3%) patients which were subsequently identified as anti-C and anti-D. However none of the primigravida was alloimmunised. One woman of gravida 2 (2.9%) and gravida 3 (3.6%) each were positive for alloimmunisation. One of them also had a bad obstetric history. This study showed that the prevalence of red cell alloimmunisation among pregnant women was low in this centre. Nevertheless, red cell alloantibody screening test should be made available to reduce possible complications of alloimmunisation in mothers and fetuses.
Study site: Antenatal clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Objektif kajian ialah untuk menentukan kesan program latihan papan Wobble ke atas daya keseimbangan para atlet yang mengalami ketakstabilan fungsi pergelangan kaki (FAI). Sebanyak 30 subjek (n=30) yang mengalami FAI direkrut berdasarkan kriteria rangkuman dan eksklusi. Kesemua subjek dinilai daya keseimbangan menggunakan ujian dirian anggota tunggal (single limb stance) dan ujian jangkauan fungsi dan didedahkan kepada program latihan papan Wobble sebanyak lima sesi seminggu selama empat minggu. Ujian t berpasangan digunakan untuk membandingkan min data pra dan post-ujian dan aras signifikan ditetapkan pada nilai 0.05. Pada ujian dirian anggota tunggal, para atlet mendapat min skor postlatihan yang tinggi [26.4] berbanding pra-latihan. Perbezaan disahkan dengan nilai ‘t’ yang diperolehi [16.00]. Bagi ujian jangkauan fungsi, para atlet memperolehi min skor post-latihan yang tinggi [15.88] berbanding pra-latihan [1.26]. Perbezaan disahkan dengan nilai ‘t’ yang diperolehi [12.54]. Ini menunjukkan bahawa latihan papan Wobble meningkatkan keseimbangan dinamik dan statik para atlet yang mengalami FAI. Secara kesimpulannya, latihan papan Wobble mungkin efektif dalam meningkatkan keseimbangan para atlet yang mengalami FAI.
Fifty Non Insulin Dependent Diabetes Mellitus (NIDDM) patients undergoing surgery under epidural anaesthesia were studied. All patients received dextrose 5% infusion at 100 ml/hr from the period of fasting until upon arrival to the operation room. Patients were randomly divided into two groups. Patients in Group 1 (n=25) received normal saline while patients in Group 2 (n=25) were given Ringer’s lactate. Both groups received their infusion throughout the operative period up to four hours postoperatively. Blood glucose level was measured at baseline, 45 minutes intra operatively and postoperatively at 30 minutes and four hours by using a glucometer. Patients in Group 2 has a larger mean increase in blood glucose level of 1.5 mmol/L between 4 hours postoperatively and baseline compared to 0.96 mmol/L in Group 1. However, this was not statistically significant. There was no difference in the increase of mean glucose level at 30 minutes when compared to baseline. There was a significant increase in mean blood glucose level in both groups in the postoperative period when compared to baseline. This study demonstrated that patients with NIDDM receiving Ringer’s lactate has a larger increase in mean blood glucose level compared to those receiving normal saline, but the magnitude is not statistically significant.
Pengukuran ketumpatan mineral tulang oleh 'Dual-energy X-ray Absorptiometry' (DXA) adalah penting untuk mengenalpasti osteoporosis. Ralat ketepatan DXA adalah ukuran yang penting untuk menentukan perubahan sebenar dalam nilai ketumpatan mineral tulang. Kajian ini bertujuan untuk mengkaji pekali variasi jangka pendek mesin QDR Wi DXA Discovery Hologic. Ketumpatan mineral tulang pinggul dan tulang belakang untuk lima belas sukarelawan (purata umur: 30.67 + 10.41 tahun) dan ketumpatan tulang keseluruhan badan untuk lima belas ekor tikus Sprague-Dawley betina (berusia tiga bulan) diimbas menggunakan mesin HDR Discover QDR Wi DXA. Setiap sukarelawan dan tikus menjalani imbasan sebanyak tiga kali untuk menilai kebolehulangan nilai ketumpatan tulang. Imbasan untuk subjek manusia dilakukan dalam tempoh 1 hingga 12 minggu. Untuk sampel haiwan, imbasan diulang pada hari yang sama selepas posisi semula. Ralat kepersisan dinyatakan sebagai peratusan pekali variasi (%CV). %CV diperolehi untuk tulang belakang lumbar adalah 1.8% dan 1.2% untuk tulang pinggul. %CV untuk keseluruhan BMD tikus adalah 1.4%. %CV jangka pendek yang ditunjukkan untuk kedua-dua manusia dan haiwan dalam kajian ini adalah setanding. Ralat kepersisan DXA mesti dipantau untuk memastikan prestasi yang optimum.
Anaplastic large cell lymphoma (ALCL) is a rare tumour, accounting for approximately 3% of adult non-Hodgkin lymphomas.1 Primary systemic ALCL frequently involves both lymph nodes and extranodal sites. A 44-year-old woman presented with a firm, mobile mass in the left iliac fossa region. Ultrasound findings showed a well defined inhomogenous soft tissue mass, measuring 4x4x2.6cm in the deep subcutaneous region. Histopathological examination revealed that the mass was infiltrated by large lymphoid cells with marked nuclear atypia including kidney-shaped nuclei. These neoplastic cells expressed anaplastic lymphoma kinase (ALK) (both nuclear & cytoplasmic staining), CD30 and EMA but not for T-cell (CD45RO and CD3), and B-cell (CD20 & CD79α) markers. Fluorescence in situ hybridization (FISH) analysis showed a t(2;5)(p23;q35) chromosomal translocation. Subsequently the patient developed shortness of the breath and a thoracic computed tomography (CT) scan showed a mass encasing the right upper lobe bronchus. She also had bilateral axillary lymph nodes, measuring 1 cm in diameter (biopsy was not done). The mediastinum and endobronchial region did not show any abnormalities. She received 6 cycles of CHOP chemotherapy and remained disease free 2 years after diagnosis. ALCL, rarely present as a soft tissue tumour and this disease should be included as a differential diagnosis of any soft tissue mass.
Model tiga dimensi (3D) menyerupai ciri-ciri persekitaran tisu asli, justeru
morfologi dan isyarat-isyarat sel daripada kultur 3D selalunya lebih menyerupai
fisiologi asal berbanding sel kultur dua dimensi (2D). Diketahui juga, rembesan
sel mempunyai kesan parakrin kepada pertumbuhan sel-sel lain. Dalam kajian
ini, pengkulturan fibroblast hidung menggunakan system kultur sel 3D telah
dioptimumkan dan kesan bahan rembesan (BR) daripada kultur 3D terhadap kadar
pertumbuhan dan perlindungan sel telah dikaji. Fibroblas hidung dipencilkan
daripada turbinate hidung manusia. Mikrosfera yang sesuai telah dipilih melalui
pengkulturan fibroblast pemindahan ke-3 pada pelbagai jenis mikro sferapolisterin
PolyGEM™. Kemudian, sel-sel telah dikulturkan pada mikrosfera yang terpilih
menggunakan system kultur 3D dan media terkondisi (MT) telah dikumpulkan.
Media terkondisi tiga dimensi (MT3D) telah ditambah kepada fibroblast untuk
mengkaji kadar perlekatan sel, kadar proliferasi, dan perlindungan sel terhadap
kesitotoksikan Centella asiatica. Asai protein asid bicinchonic dijalankan untuk
mengetahui kuantiti protein di dalam BR. Elektroforesis gel poliakrilamida-Sodium
Dodesil Sulfat (SDS-PAGE) telah dilakukan untuk memperoleh profil awal protein
dan membandingkan profil MT3D dengan protein media terkondisi dua dimensi
(MT2D). Kajian ini menunujukkan MT3D tidak menggalakkan perlekatan dan
proliferasi sel secara signifikan. BR didapati memberikan perlindungan sel yang
signifikan pada fibroblast hidung terhadap kesitotoksikan Centella asiatica. MT3D
mempunyai kepekatan protein yang lebih tinggi berbanding MT2D. SDS-PAGE
menunjukkan MT3D mempunyai 3 jalur ekslusif manakala MT2D mempunyai 4 jalur eksklusif. Kajian masa depan harus dijalankan keatas penggunaan BR
fibroblast hidung untuk perlindungan sel terhadap agen-agen yang memudaratkan
di alam sekitar dan produk herba yang sitotoksik.
Eradication of tuberculosis seems to be a long way off especially with the growing of drug resistance tuberculosis and HIV co-infection tuberculosis. The gaps in our knowledge and the limited sensitive and specific biomarkers especially for latent tuberculosis infection make it defensive. The fate of tuberculosis treatment ranged from cured to failure and there are many risk factors involved apart from the immune state and age. Therefore, this review focuses on the understanding of tuberculosis disease progression and the associated risk factors of the events in the disease progression. This article also highlights the diagnostic and predictive marker that may predict the disease progression. In addition, this review highlights the potential use of rifabutin in tuberculosis treatment regimen. It is hoped that this review could give an overview on future directions of research in tuberculosis.
Ludwig angina is a fulminant condition that is potentially lethal. If left unrecognized or untreated, this condition carries a mortality rate of up to 50%. We illustrate a case of 43-year-old male who presented with signs and symptoms of Ludwig angina over a period of two days. The patient had history of tooth extraction prior to the onset of symptoms. Despite typical clinical presentation, Ludwig angina was not considered during the first visit to medical. Ludwig angina is a clinical diagnosis that requires high index of suspicion. Delay in the diagnosis increase the risk of airway obstruction due to its rapidly spreading oedema of the upper airway.
Aneurysm and pseudoaneurysm of the dorsalis pedis artery remains to be rare vascular entities with a reported incidence of 0.5% of peripheral arterial aneurysms. Only, few cases were reported. The formation of pseudoaneurysm is commonly associated with fracture, laceration wound or iatrogenic arterial injury. An arterial injury that coincides with pseudoaneurysm can initially be missed due to lack of clinical findings. Prompt recognition remains paramount to reduce morbidity and mortality. Here, we present a rare complication of a commonly performed orthopaedic procedure in a young male who presented with painful swelling over left foot after he was involved in an industrial injury. He presented again with a pulsating mass over his left foot after 2 months post fixation surgery of a Lisfranc injury. He was treated conservatively with compression bandage and able to regain to his normal activity after the treatment initiated.
The association of human papillomavirus (HPV) with juvenile laryngeal papillomatosis has been well documented. We report two cases of juvenile laryngeal papillomatosis and correlated these cases with presence of HPV, p53 and c-erbB-2 proteins. The first case was a one-year-old male patient and the second a six-year-old female patient. Formalin-fixed paraffin-embedded biopsy specimens were tested for the presence of HPV genome by the technique of in situ hybridisation using wide spectrum and type specific biotinylated probes while the immunohistochemical expression of p53 (D07, 1:50) and c-erbB-2 (DAKO A0485, 1:300) proteins were evaluated with commercially available antibodies. Histologically the tumours in both cases showed papillary configuration of squamous papilloma. The first case detected HPV type 6, HPV type 11 and p53 protein expression while the second case showed only HPV type 6. Both cases of HPV showed positive signals confined to the nuclei in the superficial squamous epithelium. The first case showed p53 positivity seen from the basal region up to one third of the epithelium of laryngeal papillomas and the subsequent recent repeat biopsy showed the positivity of p53 had extended throughout the upper layers of the epithelium. Expression of c-erbB-2 protein was not detected in both cases. These findings were similar as in other studies where follow-up of the cases was recommended since they tend to recur.
The reciprocal translocation t(9;22)(q34;q11) which gives rise to the Philadelphia (Ph1) chromosome and BCR/ABL fusion gene, plays a pivotal role in the diagnosis and pathogenesis of chronic myeloid leukemia (CML). In this study, we evaluated the role of fluorescence in situ hybridisation (FISH) in detecting the BCR/ABL rearrangement in CML patients. The sensitivity, specificity and detection rate of BCR/ABL gene using FISH, PCR and conventional cytogenetics (karyotyping) methods were also compared. 18 bone marrow samples of patients with clinically diagnosed CML and suspected of CML were collected. The sensitivity, specificity and positive predictive values of FISH were altogether 100% while the sensitivity, specificity and positive predictive values for conventional cytogenetics (karyotyping) were 85%, 100% and 100% respectively. Convetional cytogenetics (karyotyping) detected an additional chromosomal aberration in addition to the Ph1 chromosome. In conclusion, FISH is a highly sensitive method in detecting the BCR/ABL gene. Conventional cytogenetics (karyotyping) remains an important investigation in the work up of suspected CML patients since there is a possibility of detecting chromosomal aberrations in addition to the Ph1 translocation. Therefore, conventional cytogenetics (karyotyping) and FISH are complementary techniques and their results should be interpreted together with clinical information.
The aim of the study was to compare sexual functioning among Malaysian women in a primary care setting between those with a low and high frequency sexual intercourse. Across-sectional study on 230 married Malaysian women in a primary-care setting was conducted at the Bandar Tun Razak Clinic, Cheras. A validated Malay version of Female Sexual Function Index questionnaire (MVFSFI) was used to assess the sexual functioning profiles among women with low and high sexual activity. The percentage of women who had sexual intercourse 3-4 times a week, 1-2 times a week and < 1-2 times a month were 13.4%, 44.3 % and 42.4 % respectively. Women with a low frequency of sexual intercourse (Low SI) tended to suffer from more sexual dysfunction, (χ²=28.98, p < 0.001) compared to those with a high frequency of sexual intercourse (High SI) group. Women who were less sexually active (having low frequency intercourse, ie. ≤ 1 – 2 times per week) were found to be less sexually aroused (χ²= 25.9, p< 0.001), less orgasmic (χ²=19.8, p< 0.001), less lubricated during sexual activity (χ²=11.1, p< 0.001), complain of sexual pain (χ²=4.3, p = 0.033) and feels less satisfied sexually (χ²=12.6, p< 0.001).The problem of female sexual dysfunction (FSD) in the Malaysian primary care population with low sexual activity needs to be addressed.
Acute retinal necrosis (ARN) is a rare, blinding disease that typically affects adults. However, in this case report, we highlight the diagnosis, management and outcome of herpes simplex acute retinal necrosis in a 13-year-old healthy girl, who presented with painful right eye, redness and blurring of vision for one week. Examination of the right eye showed features of granulomatous panuveitis. Optic disc was swollen and retina appeared pale. There were multiple patches of retinitis and haemorrhages at mid-periphery of the fundus with inferior serous detachment observed. Rapidly progressive inflammation in just four days along with secondary cataract that obscured fundus view, imposed greater challenge to the diagnosis and management. Intravenous acyclovir 300mg, 3 times a day was initiated promptly while vitreous fluid was sent for polymerase chain reaction, which identified Herpes Simplex Virus-1. Inflammation improved, but she developed vitreous haemorrhage secondary to proliferative retinopathy, which required panretinal photocoagulation. ARN is therefore, principally a clinical diagnosis and high index of suspicion is crucial particularly, in children for prompt diagnosis and treatment. Complications should also be addressed timely to improve the chances of preserving vision.