Curcumin adalah satu rempah tradisional yang mempunyai potensi untuk menyembuhkan pelbagai jenis penyakit inflamatori, termasuk artritis. Kajian ini dijalankan untuk memerhatikan kesan-kesan curcumin ke atas perubahan histopatologi dan aras interleukin-1β (IL-1β) di dalam artritis aruhan kolagen (CIA). Tiga puluh ekor tikus jantan Sprague-Dawley (150+50 g) dibahagikan kepada lima kumpulan secara rawak. Satu kumpulan dijadikan kumpulan kawalan normal (CTRL), manakala selebihnya disuntik dengan 150 μg emulsi kolagen secara subkutan pada hari 0. Kumpulan CTRL dan CIA-Curcumin-d0 masing-masing diberi suplimentasi harian minyak zaitun oil (1 ml/kg) dan curcumin (110 mg/ml/ kg) bermula pada hari 0. Kumpulan CIA-OV (kawalan negatif), CIA-Beta dan CIA-Curcumin-d14 pula, masing-masing diberi suplimentasi harian minyak zaitun (1 ml/kg), Betamethasone (0.5 mg/ml/kg), dan curcumin (110 mg/ml/kg) bermula pada hari 14. Suplimentasi harian tersebut diberi kepada tikus-tikus sehingga hari ke 42. Kajian ini menunjukkan bahawa kumpulan CIA-Beta (**P=0.00) dan CIA-Curcumin-d0 (**P=0.01) masing-masing mempamerkan purata skor histologi yang lebih rendah secara signifikan berbanding kumpulan CIA-OV. Aras IL-1β di dalam serum untuk kumpulan CIA-Beta dan CIA-Curcumin-d0 tidak meningkat secara signifikan pada hari ke 42 berbanding hari 0. Purata peningkatan aras IL-1β dari hari 0 ke hari 42 juga adalah rendah secara signifikan (**P≤0.01) untuk semua kumpulan CIA berbanding kumpulan CIA-OV. Tidak terdapat perbezaan yang signifikan dalan purata skor histologi dan aras IL-1β kumpulan of CIA-Curcumin-d0 berbanding kumpulan CIA-Beta. Kesimpulannya suplimentasi awal curcumin berpotensi untuk meminimakan perubahan yang disebabkan penyakit artritis aruhan kolagen pada tikus.
The occurrence of severe lead (Pb) poisoning has risen in certain countries.
There is increasing evidence that chronic lead exposure disturbs the prooxidant:
antioxidant balance in the brain tissue and alters brain histology. The present
study observed the antioxidant effect of tocotrienol-rich fraction (TRF) on brain
tissues of the experimental rats following lead poisoning. Eighteen (n=18) male
Sprague-Dawley rats, 6-weeks old, were randomly divided into control (CTRL)
group and experimental groups; fed with 0.2% w/v lead acetate, as PB2 group;
and fed with 0.2% w/v lead acetate and daily TRF supplementation (200 mg/kg
body weight) as PB2T group. The experiment was conducted for 30 days. At the
end of the study, the brain tissues were harvested and histopathological changes of
the hippocampal region were observed. Biochemical findings such as brain lead,
TRF and malondialdehyde (MDA) levels, and erythrocyte superoxide dismutase
(SOD) activity were determined. It was observed that atypical apoptotic-like and
disorganized neurons were present in the hippocampal region of the untreated
PB2 group compared to PB2T group. Biochemical parameters showed a significant
decrease (p < 0.05) in brain lead level in PB2T compared to PB. Even though no
significant difference (p > 0.05) was obtained for MDA level, there was a significant
increase (p < 0.05) in the erythrocyte SOD activity in PB2T compared to PB2 and
CTRL. Supplementation with TRF improved histopathological changes in the brain
tissues caused by lead exposure in drinking water by reducing lead accumulation
in the brain of experimental rats.
Peripheral Intravenous Catheters (PIC) are widely used. Nurses are required to possess appropriate knowledge and practice. The present study aimed to determine nurses' knowledge and practice towards care of PIC. A cross-sectional descriptive study was conducted and 84 respondents participated in the study. A 26-item questionnaire comprising 11 items on knowledge and 15 items related to nursing practice was adapted and modified. The findings reported higher mean score from specialty unit respondents, with knowledge (M = 49.19, SD = 3.44) and practice (M = 66.38, SD = 5.15), compared to medical surgical wards with knowledge (M = 46.25, SD = 4.68) and practice (M = 63.17, SD = 4.63) towards the care of PIC, which was significant (p value = 0.010 and p value = 0.009, respectively). The study indicated a higher mean score of charge nurse respondents as compared with registered nurse with knowledge (M = 49.68, SD = 3.23); (M = 46.20, SD = 4.62) and practice (M = 67.11, SD = 4.84); (M = 63.06, SD = 4.61), which was significant (p value = 0.003 and p value = 0.001, respectively). There were no significant differences between respondents’ education qualification towards care of PIC with p > 0.05. However, the findings reported that respondents who possessed Bachelor of Nursing were deemed to score slightly higher in their knowledge and practice towards the care of PIC. In conclusion, the specialty unit and charge nurse respondents were deemed to possess better knowledge and practice towards the care of PIC in the hospital.
Local anaesthesia systemic toxicity (LAST) is an uncommon and a potentially life-threatening event that develops after peripheral nerve block. The cause may be multifactorial and may include the choice of drug, technique of block and individual patient risk factors. We report a case of a 55-year-old female who developed slurring of speech and quadriplegia after receiving a mixture of lignocaine and hydrocortisone through an intra-articular injection to the right shoulder. Neurological examination revealed hypotonia and absence of power (0/5) in all limbs. These toxic events may have resulted from an accidental intra-arterial or dural cuff injection of local anaesthesia or absorption from surrounding tissues. This case report demonstrated that an intra-articular injection in the shoulder may cause LAST and may be under-recognized as it can mimic stroke.
Fractures may occur after an episode of seizures. Although rare, with a high index
of suspicion and proper physical examination, delay of diagnosis and treatment
can be avoided. We report a case of near missed bilateral proximal humerus
fracture after an episode of generalized tonic-clonic seizure. A 58-year-old lady
with a background history of epilepsy complained of generalized body ache after
a generalized tonic-clonic seizure which happened few hours before presentation to our Emergency Department. On assessment, she was in pain and unable to
move all four limbs. After given analgesia, patient was reassessed whereby she
complained of bilateral shoulder stiffness and pain. Examination of the upper limbs
revealed restricted range of movement in all directions with no shoulder squaring.
X-ray showed bilateral proximal humerus fracture. Proximal humeral fractures
rarely occur by itself following seizures; they are almost always associated with
dislocation of the glenohumeral joint.
Open tracheal injury is rare but can lead to disastrous consequences such as massive bleeding, airway obstruction or failure and aspiration of blood. We present a case of open tracheal injury of a man who tried to attempt suicide using a knife. In this case, the initial management was securing the airway by attempting orotracheal intubation. However, it was unsuccessful when the tube came out from the laceration wound. Intubation was then re-attempted through the distal cut-end of the trachea in the face of airway failure. A quick initial assessment and anticipation of a failed airway should always be the top priority in any emergency physician managing these cases. Direct intubation through the laceration wound might be the only option when all else fail and your patient is crashing.
Keywords: intubation, laceration, trachea
The Morel-Lavallee lesion is a rare soft tissue injury that occurs due to traumatic shearing force on skin surface causing separation of skin and subcutaneous tissue resulting in hematoma. This case report depicts a 22-year-old gentleman who was involved in a motor vehicle accident. He complained of pain and swelling over lower back. He was treated for soft tissue injury and admitted for pain control. One day post-trauma, he complained of increased swelling over the back. His hemoglobin dropped from 12.2g/dL to 10.7g/dL. Diagnosis of Morel-Lavallae lesion was made. Initially no surgical intervention was planned. However, in view of worsening of swelling, bedside aspiration was performed and subsequently a pigtail catheter was inserted to drain the hematoma. In total, 2.05 litre of liquefied hematoma was drained. Thus, Morel-Lavallee lesion is an uncommon soft tissue injury that can cause significant bleeding following trauma.
Keywords: degloving injuries, hematoma, trauma
Mild hyperkalaemia does not typically cause cardiac symptoms. However, for an elderly patient on atrio-ventricular (AV) nodal blocker, even mild hyperkalaemia may result in disastrous outcome. We report a case of persistent bradyarrythmia caused by iatrogenic hyperkalaemia in a patient who had concomitant use of AV nodal medication. An 81-year-old lady with multiple comorbidities and a long list of medications presented with symptomatic bradyarrhythmia. She, in fact, had two AV nodal blockers in her prescription, a beta-blocker and amiodarone. Her potassium level was found to be mildly elevated due to acute renal failure. She remained bradycardic despite initial treatment and was subsequently dependant on intravenous isoproterenol until her renal function improved. This case highlights the different threshold for manifestation of hyperkalaemic symptoms in a growing group of patients: elderly patients with multiple comorbidities and polypharmacy.
Keywords: bradyarrythmia, bradycardia, elderly, hyperkalaemia, polypharmacy
Revascularisation and replant surgery occasionally produces sub-optimal results. We present two cases of near total amputation of the digits. The first patient was an 11-year-old boy with a middle finger avulsion injury sustained after the finger was caught in a washing machine with the flexor digitorum profundus still attached. The second patient was a 42-year-old male who sustained a machete attack and had near total amputation of his small and ring fingers with a 2 cm skin bridge still attached. All patients underwent revascularization with repair of only one digital artery for each finger as the opposite artery was non-viable. No digital veins were repaired. Relief of venous congestion was done by pin-prick six times a day up till one week. At one week post-surgery, the fingers were discoloured black but had good pulp turgor and full contour with arterial bleed on pin-prick. Inexperienced surgeons may view this as gangrene and amputate the fingers. However, we continued observation and at one month post-surgery, the black skin had desloughed and the underlying skin was pink.
Basal cell carcinoma (BCC) of the scrotum is uncommon and its pathogenesis is not well understood. The clinical behaviour of scrotal BCC is thought to be more aggressive and has a higher metastatic potential than BCC of other regions. The mainstay of treatment for localized scrotal BCC is wide local excision, while metastatic disease may need systemic chemotherapy for palliative control. A rare clinical scenario of scrotal BCC presenting concurrently with another metastatic cancer has never been reported. The present case illustrates the diagnostic challenge and management dilemma due to simultaneous presentation of scrotal BCC and metastatic squamous cell carcinoma (SCC). A 70-year-old man complained of a non-healing scrotal ulcer while he was being investigated for metastatic squamous cell carcinoma (SCC) of the external auditory meatus. The scrotal lesion was initially thought to be metastatic SCC. It was later confirmed to be BCC with biopsy and histopathological examination. He underwent surgical resection of the scrotal BCC for local control followed by palliative chemotherapy with cisplatin and radiotherapy for lymph node metastases. He remained well and did not have any local recurrence following 6 months after palliative treatment. Surgery coupled with palliative chemoradiation can offer good quality of life for patients with scrotal BCC and concurrent metastatic SCC.
Keywords: basal cell carcinoma, squamous cell carcinoma, scrotum
Mature cystic teratoma is the commonest ovarian germ cell tumour which accounts for 70% of all benign ovarian neoplasms in the reproductive age groups. Being a pluripotent germ cell tumour, mature cystic teratoma has at least two out of three mature embryonic germ cell components: ectoderm, mesoderm and endoderm. The presence of multiple cystic spaces within the tumour wall, also known as pneumatosis cystoides-like appearance is rarely described but a characteristic feature in cystic teratoma of the ovary. Currently, there is little information concerning the mechanism of its formation. Herein, we described an unusual case of ovarian mature cystic teratoma in a 31-year-old pregnant female with multiple sieve-like areas resembling pneumatosis cystoides of the intestine. Macroscopic and histological examination of the ovary revealed features diagnostic of mature cystic teratoma. Intriguingly, multiple cystic spaces of variable sizes were found within the cyst wall histologically. They were lined partially or completely by foamy histiocytes and foreign body type multinucleated giant cells, exhibiting strong CD68 immunoreactivity. Vascular endothelial markers (CD31 and CD34) and epithelial marker (cytokeratin AE1/AE3) were negative. A diagnosis of mature cystic teratoma with pneumatosis cystoides-like feature was rendered. The patient was discharged well with no signs and symptoms of early labour. The etiopathogenesis of this intriguing histological feature is briefly discussed in this article.
Genitourinary system is the second most common site of tuberculosis (TB) after pulmonary system. Tuberculosis of the prostate is a rare manifestation of genitourinary tuberculosis. It is even more uncommon if occurring in an immune-competent individual. Prostate TB is usually an incidental finding in transurethral resection of prostate (TURP). Here, we report a case of TB of the prostate in a 70-year-old man who had benign prostatic hyperplasia for two years. TB was diagnosed incidentally post-TURP. In this report, we also discuss additional tests which may help in establishing the diagnosis of genitourinary tuberculosis.
Acupuncture is a form of complementary medicine that has been practiced in China for thousands of years. Adverse effect of acupuncture is rarely reported in local literature. This is a case of a patient who developed bilateral pneumothorax following an acupuncture session. A 63-year-old lady with no significant medical illness presented with sudden onset of shortness of breath half an hour following acupuncture and massage session by traditional medicine practitioner. On examination, she was tachypnoiec and there was reduced air entry bilaterally on lung auscultation. Urgent portable chest X-ray was done and it showed bilateral pneumothorax. Bilateral chest tubes were inserted. Patient was discharged well following five days of hospitalization. As acupuncture is gaining popularity among Malaysian population, medical practitioners need to increase their awareness and knowledge regarding the adverse effect of such alternative practice.
Tuberkulosis (TB) paru-paru dan penyakit “Chronic Obstructive Pulmonary Disease” (COPD) adalah punca utama kematian dan morbiditi di Malaysia. Di Malaysia, jumlah kes TB semakin meningkat dan terdapat 500,000 rakyat Malaysia yang didiagnosa dengan COPD pada tahun 2016. Sejumlah besar pesakit TB mendapat “COPD” pada jangka panjang. Jangkitan TB yang lepas telah terbukti menyumbang kepada etiologi COPD. Kami menjalankan kajian keratan rentas selama satu tahun yang melibatkan pesakit dewasa di klinik pesakit luar di Pusat Perubatan Universiti Kebangsaan Malaysia (UKMMC) yang mempunyai sejarah TB paru-paru 3 tahun sebelum kajian. Pesakit yang dikecualikan adalah pesakit asma, COPD, penyakit paru-paru interstitial dan bronchiectasis. Obstruksi aliran udara ditakrifkan sebagai nisbah FEV1: FVC
Pregnancy is perceived by many pregnant mothers as a period of happiness in anticipation of motherhood. Not all pregnant mothers experience cheerfulness as some may experience a high anxiety and depression level for unknown reasons. The purpose of this study was to determine the level of anxiety and depression among high risk pregnant women and the factors that contribute to their level of anxiety and depression. A descriptive cross-sectional study was conducted on 38 high risk mothers whose stay in hospital exceeded more than three days in the obstetric ward of Hospital Universiti Kebangsaan Malaysia. A self assessment questionnaire “Hospital Anxiety Depression scale” was used to measure the level of anxiety and depression among high risk pregnant women. Of the 38 participants, 16 (42.1%) women experienced a mild level of anxiety and 22 (57.9%) experienced a severe level of anxiety. Seventeen (44.7%) women was classified as having mild depression and 21 (55.3%) severe depression. The factors contributing to the level of anxiety and depression, include those related with “lack of information on disease”, “family matters” and “finance”. High risk pregnant women in this study experienced a significant level of anxiety and depression during their stay in hospital. It is therefore important for nurses and doctors to be aware and sensitive to the influencing factors that cause anxiety and depression as to enable high risk pregnant mothers to enjoy their pregnancy and childbirth.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Ventilated patients who require intensive care unit (ICU) treatment may encounter unpleasant experiences. These experiences may include factual incidents and delusional memories of ICU such as dreams, hallucinations and frightening experiences. A cross sectional study using “Intensive Care Experience Questionnaire” consisted of four domains: awareness of surrounding, frightening experiences, recall of experience and satisfaction with nursing care. Forty five participants who fulfilled the inclusion criteria were recruited in this study. This study was conducted in ICU of HUKM from January to March 2006. Results showed that 20 respondents (44%) were aware of their surrounding and 31 respondents (69%) reported frightening experiences. Majority of respondents (43 respondents, 96%) reported satisfaction with the delivery of nursing care. There was positive correlation between awareness of surrounding and their abilities to recall their experiences (p
A cross sectional study was done to determine the prevalence and distribution of human papillomavirus (HPV) genotypes in pre-invasive (cervical intraepithelial neoplasia, grade 3 or CIN 3) and invasive cervical cancer (ICC), in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A total of 80 paraffin-embedded tumour tissue blocks (20 CIN 3, 60 invasive cancers) between 1999 to 2007 were retrieved from the archives of the Department of Pathology. Patient’s medical records were obtained from the Medical Records Office. Among invasive cancers (n=60), squamous cell carcinoma (SCC) account for 75% and adenocarcinoma 25%. The mean age of cases studied was 52.0 ± 12.2 years and Chinese was the predominant ethnicity (66.3%). Twelve HPV genotypes were identified, namely, HPV 16, 33, 18, 39,52, 45, 58, 59, 31, 35, 6 and 11. The prevalence of HPV was 92.5% with types 16 being the most common (73.8%), followed by types 33 (30%) and 18 (22.5%). A total of 31 cases (38.8%) showed single HPV genotype, while 43 (53.8%) had multiple HPV (two genotypes or more) genotypes. In ICC, HPV 16, followed by types 33, 18, 52 and 39 were the top five common HPV genotypes detected. High prevalence of HPV and multiple HPV infections were major findings among patients with pre-invasive and invasive cervical cancer.
Presented herein is a case of one different morphological anomaly of pronator quadratus (PQ) muscle. Here, the shape of PQ was not similar to the normal morphology of the muscle. The PQ muscle appeared to be in distinct triangular-shaped instead of quadrangular-shaped. In addition, this triangular-shaped was found in two sites i.e. proximal and distal. Significantly, the PQ muscle consisted of two fleshy red fibres and white aponeurosis. Proximally placed portion had a wide base and a narrower apex. The larger base was attached to the ulna and formed of fleshy red fibres which converged laterally to be continuous with aponeurosis ending on the radius. In contrast, the distal triangular portion had the fleshy fibres attached to the radius and converged medially to be continuous with aponeurotic portions on the ulna. Each portion were referred as pronator triangularis proximalis and pronator triangularis distalis. These variations might affect atypically in cases of forearm pronation. Information of these variations is important in hand surgeries and provide an additional knowledge on the relationship between morphology of PQ muscle and the limitation or the strength in the action of it.
Bisep brachii (BB) adalah salah satu otot yang mempunyai pelbagai variasi.
Terkini, kebanyakan maklumat adalah berkenaan variasi asal otot, namun terdapat
beberapa kes yang melaporkan variasi dalam sisipan BB. Dibentangkan di sini
kes BB otot yang mempunyai kedua-dua varian asal dan sisipan dalam otot yang
sama. Varian asal BB adalah panjang dan besar di kepala ketiga (10.2 cm lebar
dan 4.9 cm tebal) yang timbul dari pertengahan badan humerus. Lebih signifikan
lagi, bahagian tengah kepala meliputi dan menyembunyikan bahagian bawah
saraf median dan arteri brachial sebagai gerbang yang berterusan medially untuk
disisipkan ke epicondyle medial humerus. Dalam laporan ini, kami membincangkan
mekanisma yang mungkin untuk pemampatan neurovaskular oleh kepala ketiga
otot BB yang tidak normal dan perubahan BB dari asal dan sisipan. Memahami
perubahan ini adalah sangat penting dalam prosedur pembedahan di sekeliling
sendi siku dan lengan atas dan ia juga memberi ruang untuk diagnosis pembezaan
sindrom perangkap saraf
Chlorella vulgaris, a unicellular microalgae, produces many intracellular phytochemicals namely carotenoids, tocopherols, ubiquinone and protein. Skin ageing which is induced by oxidative stress involves decreased extracellular matrix synthesis and increased expression of enzymes that degrade the collagenous matrix. The objective of this study was to determine the effect of C. vulgaris on the expression of genes encoded for collagen (COL) and matrix metalloproteinases (MMPs) which are involved in skin ageing. Human diploid fibroblasts (HDFs) were obtained from circumcision foreskin of 8-12 year-old boys. HDFs were cultured into 3 groups: untreated control cells, cells with stress-induced premature senescence (SIPS; cells were induced with H2O2 at passage 6 for 2 weeks) and SIPS treated with C. vulgaris (prolonged C. vulgaris treatment started at passage 4 and combined treatment with H2O2 at passage 6 for 2 weeks). Senescence-associated ß-galactosidase (SA ß-gal) was determined using senescent cells histochemical staining kit (Sigma, USA). Expression of COLI, COLIII, COLIV, MMPI, MMPII and MMPIII genes was quantitatively analysed with real-time RT-PCR method (iScript™ One Step real-time PCR with SYBR® Green; Biorad). HDFs treated with H2O2 (SIPS) exhibited senescent morphological features of flattening and enlarged with increased expression of SA ß-gal (p