Schwannoma of the cervical sympathetic chain is an extremely rare nerve tumour. We report an unusual swelling in a 41-year-old female who presented with an asymptomatic solitary mass in the right parapharyngeal space. Clinical examination and computed tomography showed displaced carotid artery in an antero-medial direction. Surgical excision of the lesion was carried out and histological examination revealed an Ancient Schwannoma.
A 43-year old lady presented with progressive loss of vision in both eyes followed by rapid deterioration of consciousness within the next few days. This was preceded by a viral infection one week before her presentation. At presentation she had evidence of meningism and signs of bilateral upper motor neuron lesions and was managed initially as acute meningoencephalitis with antibiotics. The brain CT was within normal limits but subsequent MRI of the brain revealed multiple foci of hyperintense lesions on T2-weighted and FLAIR images. The cerebrospinal fluid examination revealed lymphocytosis, and normal protein and glucose levels. Cultures of the CSF were negative. She was managed as acute disseminated encephalomyelitis (ADEM) with high-dose of intravenous methlyprednisolone one gram/day for three consecutive days followed by oral prednisolone 60 mg/day. Despite the management she lapsed into coma and succumbed to her illness nine days after admission.
Hepatitis complicating typhoid fever has been previously reported widely. Occurrence of acute renal failure and hepatitis together is exremenly rare. A case report of complicated acute renal failure and hepatitis in a tyhoid patient is reported and discussed.
To determine the prevalence of goblet cell metaplasia in endocervical and endometrial adenocarcinomas by histochemial staining and to investigate the most sensitive histochemical staining method to detect this metaplasia, a total of 90 tissue blocks representing 30 non-neoplastic cervix, 30 non-neoplastic endometrium, 30 endocervical and endometrial adenocarcinoma cases were obtained for histochemical staining with Toluidine Blue (TB), Methylene Blue (MB), Mucicarmine (MUC), Periodic Acid Schiff before and after Diastase digestion (PAS, PAS-D), Alcian Blue pH 2.5 (AB), and Periodic Acid Schiff after Alcian Blue pH 2.5 (PAB). The cases were blinded and evaluated by a pathologist [NHO] for the presence of goblet cell metaplasia, the amount of goblet cells present and the histochemical differentiation of the goblet cells compared with its surrounding glandular epithelium. Goblet cell metaplasia was present in 2 out of 30 cases in non-neoplastic cervix, 0 out of 30 cases in non-neoplastic endometrium, 7 out of 15 cases in endocervical adenocarcinoma and in 2 out of 15 cases in endometrial adenocarcinoma. Relatively few goblet cells were seen in endometrial adenocarcinoma, few to moderate amounts were seen in endocervical adenocarcinoma and relatively more goblet cells were seen in non-neoplastic cervix. The differentiation of the goblet cells with its surrounding glandular epithelium was moderate to strong in non-neoplastic cervix and endocervical adenocarcinoma, while the differentiation in endometrial adenocarcinoma was weak to moderate. The various staining methods showed differences in presence, amount and differentiation of the goblet cells. Goblet cell metaplasia of the reproductive organs is not as rare as previously reported. There was no statistical difference in presence, amount and differentiation of goblet cells according to the various cases. The must optimum staining methods for staining goblet cells in non-neoplastic cervix, endocervical adenocarcinoma and endometrial adenocarcinoma were PAS, PASD and AB.
A 40-year-old man presented with floaters and painless progressive blurring of vision in the right eye for one month duration. Visual acuity in the right eye was 6/24. There was mild anterior chamber reaction and vitritis. The optic disc was swollen and elevated with presence of granulomatous lesion in the optic disc head. Blood investigations were unremarkable. Serum angiotensin converting enzyme (ACE) was normal and conjunctival biopsy showed presence of inflammatory cells. B-Scan ultrasound revealed an echo-dense lesion in the optic nerve head. There was increased uptake of the right lacrimal gland and presence of 'Panda sign' with Gallium scan. A diagnosis of right ocular sarcoidosis was made base on the clinical features and Gallium scan.
Stress tends to worsen the prognosis of patients with coronary heart disease. The aim of the study is to determine the relationship between stress related psychosocial factors like anxiety, depression and life events and temporally cardiac events specified as acute myocardial infarction and unstable angina 65 subjects with confirmed myocardial infarction or unstable angina were interviewed using 2 sets of questionnaire, the Hospital Anxiety and Depression Scale (HADS) and Life Changes Stress Test, a segment of the Rahe's Stress and Coping Inventory first at time of occurrence of their cardiac event and the second time was 6 months later. Anxiety, depression and life events scores were calculated for both and recurrence of cardiac event for the 6 month duration was also recorded. Patients who had significant levels of depression and or life events were ten times more likely to have recurrence of cardiac events as compared to those without risk for either of these psychological symptoms. Anxiety, depression and stress levels are significantly increased after the onset of ischemic heart disease and could be contributing or predisposing factors for the recurrence of cardiac events for these patients.
Even though extensive studies have been conducted on the effect of noise exposure on hearing apparatus / auditory system, information on the effect of noise on the other body functions is sparse. The present study examined the effect of exposure of albino rats to acute and chronic noise stress on two important interlaced endocrine levels. In acute experiments the animals were exposed to 120 dB noise for a duration of 1, 2, 3 hrs. In chronic experiments the animals were exposed to noise for one hour daily for 30, 60 and 90 days. Plasma corticosterone and leptin levels were measured in these animals. There was significant elevation in the levels of corticosterone and leptin after exposure to noise stress. The elevation in corticosterone level after noise stress is in agreement with earlier reports. So noise acts like a stressor and elevates the secretion of the corticosterone, the stress hormone and leptin, the product of the ob gene there is an elevation in leptin levels after noise stress.
Cardiovascular disease (CVD) has been the number one cause of death since the last three decades in Malaysia and diabetes mellitus and hypertension are considered as major risk factors. A study to reduce risk factors for cardiovascular diseases in the community (PIKOM) through education and lifestyle changes was undertaken. The study population was from four different areas in Peninsular Malaysia - Kota Bharu and Bachok in Kelantan ; Raub in Pahang; Gunung Besout in Perak and Felda Palong in Negri Sembilan. The subjects invited to participate in this study ware aged between 30 - 65 years, did not have any debilitating illnesses and no known history of diabetes mellitus, hypertension or cardiovascular disease. Subjects were asked to come to the local clinic in a fasting state and after physical examination, blood was taken for plasma glucose and lipids. Oral glucose tolerance test (OGTT) was then performed. A total of 4,121 subjects participated in the study. The proportion of subjects with diabetes mellitus was highest in Felda Palong area (20.3%) and lowest in Raub area (7.1%). The proportion of subjects with hypertension was also highest in Felda Palong area (38.6%) and lowest in Raub area (29.1%). This could be attributable to the subjects in Felda Palong having the highest mean Body Mass Index (BMI) and Waist-to-Hip Ratio (WHR). There were significant associations between diabetes and hypertension with age and obesity. Subjects with diabetes mellitus and hypertension also had the highest mean age, BMI, WHR and plasma cholesterol.In conclusion, the proportion of patients with risk factors for CVD was high and intervention studies through education and lifestyle changes were being carried out to see their effectiveness.
The present study, analyzes data from 1991 to 2000 for rotavirus infection among children with diarrhoea and acute gastroenteritis admitted to the Hospital Universiti Sains Malaysia (HUSM). The Latex Slide Agglutination Test was used for the detection of rotavirus antigens. Out of 1097 stool samples tested, 207 samples or 18.8 % were found to be positive for rotavirus. The infection occurred most frequently in infants and young children from 6 months to 2 years of age. The infection was recorded highest in the year of 2000 - 48 cases (34.1%) and the lowest in 1999 - 5 cases (6.6%). Stool examination and cultures from the rotavirus positive samples revealed no parasites and enteropathogenic bacteria. These observations suggested that rotavirus could still remain as an important agent causing diarrhoea and gastroenteritis in young children admitted to HUSM.
There is a particular importance of determining a basic minimum required 'n' size of the sample to recognize a particular measurement of a particular population. This article has highlighted the determination of an appropriate size to estimate population parameters.
A case of a 53-year old-single, Kelantanese lady with a diagnosis of paranoid schizophrenia for 28 years is reported with aims to illustrate the influence of life experiences particularly based on education and intelligent on delusion illustrate the evolving nature of the complexity of delusions as well as to show the importance of documentation in psychiatric practice. We concluded that this patient had used defense mechanism of suppression, reaction formation and persecution throughout her delusion. The final persecutory delusion evolved through series of transformation via object of admirations. We postulated that in-depth emotional insight about effects of schizophrenia might have contributed to her self-reflection that have made her frustrated with her poor achievement in life.
The incidence of deep vein thrombosis is believed to be rare in Asians. During recent years, a few reports have appeared with high incidence in orthopaedic patients comparable to Western studies. This study was carried out to find out the incidence of post-operative deep vein thrombosis (DVT) after major surgical procedures in general surgical patients in an Asian population. In a prospective study of 45 consecutive Asian patients after major general surgery, colour-flow duplex scan of the legs as an initial screening was done twice within two weeks. Mean age of the patients was 54 years 5 months and 87% of patients were included in the moderate and high risk group for deep vein thrombosis. Ascending venography was used to confirm deep vein thrombosis on patients with equivocal or positive results from colour flow duplex scan. One patient showed positive evidence of post-operative deep vein thrombosis on colour flow duplex scan which was further confirmed by ascending venography; giving an incidence of 2.2%. The incidence of post-operative deep vein thrombosis in general surgical patients is lower than the Western studies.
Tonsillectomy is performed for several indications, the two commonest in practice are infective (chronic tonsillitis) and obstructive symptoms such as sleep apnea. The objective of this study is to determine the necessity of routinely performed histopathological examination of fonsillectomy specimens. In this paper, a retrospective evaluation of 480 specimens from 241 patient who had undergone tonsillectomies in Hospital Universiti Sains Malaysia between January 2004 and October 2005 was done. It was found that 462 (96.25 %) were reactive lymphoid hyperplasia and 18 (3.75 %) were follicular hyperplasia. None of them were found to be malignant. The result of this study indicates that routine histopathological examination of tonsillectomy specimens are unnecessary and results only in added cost and a loss of man hours.
An indigenous contraceptive herbal formulation consisting of a mixture of Lepidagathis longifolia, Palaquium sp and Phyllagathis rotundifolia is being used by the Temuan Aborigins of Malaysia. Although the previous studies demonstrated that this contraceptive herbal formulation causes anovulatory estrous cycle, altered circulating hormone levels and fetal resorption in rats, but the effects of this formulation on the gonadotrphs of the pituitary gland are yet to be evaluated. The present study was designed to observe the morphometric changes of the gonadotrophs and the plasma concentrations of follicle stimulating hormone and leutinizing hormone. Thirty five Sprague-Dawley adult female rats were randomly divided into 5 groups. Experimental animals were given a combined herbal extract or individual herbal extract at a dose of 540 mg/kg/day subcutaneously for 7 days. Immunostained gonadotrophs were studied by using image analyzer. FSH and LH serum concentrations were determined using RIA. The FSH and LH concentrations were low in animals that received combined herbal extract (p<0.01). FSH concentration was noted to be significantly low in animals that received P. rotundifolia (p<0.05). The mean cell area and cell density of gonadotrophs of animals that received combined herbal extract were significantly low compared to control group (p<0.05). It was concluded that the herbal extracts do suppress the production of gonaotrophins along with the demonstrable suppresive effect on the FSH cells.
Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally invasive tumour. Patients are usually in their adolescent age and present with epistaxis and nasal blockage. Diagnosis is based on clinical evaluation and the C.T. scan findings. Pre-operative superselective embolisation (SSE) and surgical excision is the treatment of choice. The out patient clinic of ORL-HNS hospital of University Science Malaysia received 25 referrals, all male, majority between 9-13 years of age and few adolescents. Clinically the patients were consistent with symptoms of recurrent epistaxis and nasal blockage. They reported from October 1998 to October 2001 from with in the state of Kelantan and the nearby states of Pahang, Kedah and Terenganu. Diagnosis was mostly made on typical radiological findings and the tumours were classified accordingly into four stages. SSE and surgical excision was carried out in all cases. Regular follow-up helped us to identify early recurrences which were treated with salvage surgery or radiotherapy in one case with extensive intracranial extension. A retrospective review of presenting features, diagnostic difficulties, surgical approaches and its outcome is presented. Maxillary swing procedure performed in three cases as a new surgical option in the management of JNA is also discussed.
Study site: ENT clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Malaysia is endemic for both these diseases and one should not be too surprised when faced with a diagnosis of co-infection of typhoid and malaria, as have been described in India and Canada. Here we describe one such case of Salmonella typhi and Plasmodium vivax infection.
Insulin insensitivity is a common finding in several metabolic disorders including glucose intolerance, dyslipidemia, hyperuricemia and hypertension. Most of the previous studies on insulin sensitivity were performed on diabetic or obese population. So our knowledge about insulin sensitivity of healthy population remains limited. Rising prevalence of obesity, diabetes and metabolic syndrome is a serious issue in Malaysia and some other rapidly developing countries. So it is important to look at the insulin sensitivity status of healthy Malaysian subjects and to compare it in future with those of diabetic, obese or metabolic syndrome patients. In this study we sampled subjects who were independent of confounding factors such as obesity (including abdominal obesity), hypertension and glucose intolerance (diabetes, IGT or IFG) which may influence insulin sensitivity. Fasting plasma glucose, fasting insulin and lipid profile were determined. Insulin sensitivity and secretory status were calculated using the homeostasis model assessment (HOMA) software (HOMA%S, HOMA%B and HOMA-IR). The insulin sensitivity (HOMA%S) of healthy Malay subjects aged between 30-60 years was 155.17%, HOMA-IR was 1.05 and HOMA%B was 116.65% (values adjusted for age, sex, BMI and waist circumference). It was seen that non-obese Malaysians can prevent age related lowering of insulin sensitivity if they can retain their BMI within limit.
Study site: 7 schools and 2 public offices in Kota Bharu, Kelantan, Malaysia
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 use of headphone has been thought to cause infection in the ear canal and contribute to hearing loss. In this study, we examined 136 Customer Service Representative from Celcom (Malaysia) Sdn. Bhd. who use headphone throughout their working hours. The purpose of this study was to determine the prevalence of ear canal infection and other related diseases of the ear, nose and throat. Their hearing thresholds were also determined using the Amplaid 309 Clinical Audiometer. We found no incidence of infection of the external ear canal amongst the subjects. There were 4 cases of chronic middle ear infection and 4 cases of impacted wax. Hearing impairment was found in 25 subjects (21.2%). However, there was no significant association between hearing loss and the exposure to sound from headphone usage because the high frequencies were not predominantly affected. There was also no association between hearing loss and duration of service.
Adaptations in the structural and/or functional properties of cells, tissues and organ systems in the human body occurs when exposed to various stimuli. While there is unanimous agreement that regular physical activity is essential for optimal function of the human body, it is evident that extrinsic factors, such as diet, smoking, exercise habits, are reflected in the morbidity and mortality statistics of the population. Ageing is obligatorily associated with reduced maximal aerobic power and reduced muscle strength, i.e. with reduced physical fitness. As a consequence of diminished exercise tolerance, a large and increasing number of the aged population will be living below, at or just above 'threshold' of physical ability, needing only a minor illness to render them completely dependent. Physical training can readily produce a profound improvement of functions essential for physical fitness in old age. Adaptation to regular physical activity causes less disruption of the cells' internal environment and minimises fatigue which enhances performances and the economy of energy output during daily physical activity. Regular physical exercise reduces the risk of premature mortality in general, and of coronary heart disease, hypertension and diabetes mellitus. Physical activity also improves mental health and is important for health and optimal function of muscles, bones and joints. The most recent recommendations advice the people of all ages to include a minimum of 30 minutes of physical activity of moderate intensity, such as brisk walking, on most, if not all, days of the week.