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Fulltext Functional outcome 6 months after severe traumatic brain injury following admission to intensive care unit: a follow-up study in two neuro-center hospitals

Norain Abdul Rashid

International Medical Journal Malaysia, 2017;16(11):45-45.
MyJurnal

Traumatic brain injury (TBI) is a major medical and socioeconomic
problem. Patients with severe TBI shows physical and functional improvement but
remain with cognitive and psycho-social problem throughout recovery. Despite all the
issues, the impact of TBI on long-term survivors in Malaysia is unknown. The aim of this
study is to measure the functional level of ICU survivors with severe TBI within 6 months
post injury. (Copied from article).

Matched MeSH terms: Brain Injuries, Traumatic
Fulltext A Case of Medialized Lateral Maxillary Sinus Wall: A Pillar of Support

Othman IA, Hashim ND, Nazimi AJ

Case Rep Med, 2018;2018:4053531.
PMID: 29861735 DOI: 10.1155/2018/4053531

The number of maxillofacial trauma (MFT) cases attended in the Emergency Department is progressively increasing in trend, owing to the rising statistics of motor-vehicle accidents (MVAs) and urban assaults in addition to occupational-related injuries. Prompt and thorough assessment is important for accurate diagnosis and paramount treatment plans. We will be discussing a case of unusual presentation of an orbital floor fracture post-MVA which was treated conservatively based on the clinical assessments during follow-ups, supported by radiological findings. We will also briefly discuss the different radiological modalities available in assessing MFT and late presentation of enophthalmos.

Matched MeSH terms: Maxillofacial Injuries
Fulltext Early management of head injury in adults in primary care

Liew BS, Zainab K, Cecilia A, Zarina Y, Clement T

Malays Fam Physician, 2017;12(1):22-25.
PMID: 28503270

Head injury is common and preventable. Assessment of the head injury patient includes airway, cervical spine protection, breathing, circulation, haemorrhage control and the Glasgow Coma Scale. Hypotension, hypoxia, hypocarbia and hypercarbia should be avoided by continuous monitoring of vital signs and hourly head chart to prevent secondary brain injury. This paper aims to assist primary healthcare providers to select the appropriate patient for transfer and imaging for further management of head injury.

Matched MeSH terms: Brain Injuries
Fulltext A case of missed thoracic fracture masquerading as intra-abdominal injury

Amin,O., Nik Azlan, N.M., Afliza, A.B.

Medicine & Health, 2017;12(1):127-130.
MyJurnal

Altered mental status in the setting of polytrauma poses a challenge to the emergency team managing the patient. The tendency to miss positive findings in these circumstances increases several folds due to multiple factors such as depressed mental status/intoxication, presence of distracting injuries and concurrent life-threatening injuries that require more urgent attention. In view of this, NEXUS (National Emergency X-Radiography Utilization Study) criteria of clearing the cervical spine was adopted and used worldwide. Consensus on clearance of the other parts of spine is still lacking. This case reports highlights the findings in a 18-yrs-old male who presented with altered mental status, facial pain and abrasion, following a motor vehicle accident. Facial bone fracture was diagnosed and he was discharged. Three days later, he came with severe epigastric pain. Tenderness on palpation was noted at the spine and Computed Tomography (CT) scan was done. Multiple thoracic vertebra fractures were seen. As a conclusion, thorough primary and secondary survey should be done in patients who have regained full consciousness prior to discharge in order to avoid overlooking other serious injuries.
Keywords: altered, CT scan, fracture, mental status, thoracic vertebra

Matched MeSH terms: Abdominal Injuries
Fulltext An 8-year retrospective review of microbial keratitis in a secondary referral centre in Malaysia

Nazri Omar, Maimunah Abdul Muna’aim, Rafidah Md. Saleh, Zaidah Mohd. Kasim, Muhammad Mohd. Isa

Malaysian Journal of Medicine and Health Sciences, 2017;13(2):47-57.
MyJurnal

Introduction: Microbial keratitis (MK) is an important cause for corneal blindness and understanding its risk factors enable us to improve management and minimise its complications. Methods: In this retrospective case review, medical records of all patients treated for MK from 2006 to 2013 was analysed to know the socio-demography, preceding risk factors, clinical characteristics, causative organisms and final visual outcome. Results: A total of 174 patients (180 eyes) were included in this study. Identifiable ocular risk factors included contact lens (CL) usage (85, 47.2%), ocular trauma (50, 27.8%), ocular surface disease (21, 11.6%), steroid use (6, 3.3%) and immuno-compromy (19, 10.5%). Association factors for presenting uncorrected visual acuity (UCVA) were age group (p=0.013), size (p

Matched MeSH terms: Eye Injuries
Fulltext Number of familiarisation sessions required for an Isokinetic Knee Strenght Assesment in Female varsity athletes

Yin, Jerusha Chan Poe, Ashril Yusof, Victor Selvarajah Selvanayagam

Jurnal Sains Sukan & Pendidikan Jasmani, 2016;5(2):1-8.
MyJurnal

Journal of Sports Science and Physical Education 5(2): 1-8, 2016 - The objective of this
study was to determine the number of familiarisation sessions required for isokinetic knee
extension and flexion in female varsity athletes. Thirty right footed dominance female varsity
athletes (n=30; age: 21.73 ±0.22 years, body mass index (BMI): 22.58 ±0.52 kg/m2), with no
history of knee injuries were recruited. The design started with either with the dominant or
non-dominant limb, followed by the opposite limb. Four sets of isokinetic maximal voluntary
contraction at 60 o/s were performed for each limb. The results showed that for knee
extension regardless of which limb starts first is 2 sessions, however for knee flexion, 3
sessions is required for dominant limb while 2 for non-dominant. In addition, the presence of
cross-education effect is observed for knee flexion from non-dominant to dominant limb,
where the number of session was reduced from three to two. In conclusion, we propose that
two sessions of familiarisation are required for female varsity athletes and should begin with the non-dominant limb followed by dominant limb.

Matched MeSH terms: Knee Injuries
Analysis of reactive astrocytes and NG2 proteoglycan in ex vivo rat models of spinal cord injury

Patar A, Dockery P, Howard L, McMahon S

J Neurosci Methods, 2019 01 01;311:418-425.
PMID: 30267723 DOI: 10.1016/j.jneumeth.2018.09.027

BACKGROUND: The use of animals to model spinal cord injury (SCI) requires extensive post-operative care and can be expensive, which makes an alternative model extremely attractive. The use ofex vivo slice cultures is an alternative way to study the pathophysiological changes that can mimic in vivo conditions and support the 3Rs (replacement, reduction and refinement) of animal use in SCI research models.
NEW METHOD: In this study the presence of reactive astrocytes and NG2 proteoglycans was investigated in two ex vivo models of SCI; stab injury and transection injury. Stereological analysis to measure immunohistochemical staining was performed on the scar and injury zones to detect astrocytes and the chondroitin sulphate proteoglycan NG2.
RESULTS: The volume fraction (Vv) of reactive astrocytes and NG2 proteoglycans increased significantly between day 3 and day 10 post injury in both ex vivo models. This data shows how ex vivo SCI models are a useful research tool allowing reduction of research cost and time involved in carrying out animal studies, as well as reducing the numbers of animals used.
COMPARISON WITH EXISTING METHOD: This is the first evidence of an ex vivo stab injury model of SCI and also the first comparison of immunohistochemical staining for injury markers within stab injured and transection injured ex vivo slice cultures.
CONCLUSIONS: The use of organotypic slice culture models provide a simple way to study the cellular consequences following SCI and they can also be used as a platform for potential therapeutics regimes for the treatment of SCI.

Matched MeSH terms: Spinal Cord Injuries
Bilateral xanthomas of tendoachilles in a slow learner adolescent - A rare case report of van bogaert scherer epstein disease

Jesslyn L, Ngah KC, Muhammad Zaidulkhair Mhd R, Ashwini S

Med J Malaysia, 2018 10;73(5):321-322.
PMID: 30350812 MyJurnal

Van Bogaert Scherer Epstein Disease is a rare autosomal recessive condition involving abnormal deposition of cholesterol and cholestanol in various parts of body, various clinical symptoms manifest on different age group, significantly neurological impairment in late presentation. We are reporting a slow learner young lady presented with bilateral painless ankle swelling, our initial clinical impression were torn Achilles tendon or Haglund's deformity. On further detail history taking, it leads us towards this disease and confirmed with biopsy. A proper history taking and assessment can easily diagnose this condition, early treatment can perhaps change the fate of these unfortunate patients.

Matched MeSH terms: Tendon Injuries
A child with elbow pain

Mat Yudin ZA, Wan Ahmed WA, Chanmekun SB

Malays Fam Physician, 2019;14(2):44-45.
PMID: 31827738

Elbow injuries are common in children. Supracondylar fractures occurred in 16% of all pediatric fractures. Supracondylar fractures can be classified into 4 types according to the Gartland classification, depending on the degree of the fracture present in the lateral radiograph. This case highlights the case of a child with a Gartland Type I fracture. A misdiagnosis of this fracture will compromise the management of the injury with regards to immobilization and subsequent care. As this injury can be managed on an outpatient basis, primary care frontliners need to be aware of the condition.

Matched MeSH terms: Arm Injuries
Fulltext Neuropsychological profile at three months post injury in patients with traumatic brain injury

Ali R, Wahab S, Abdul Rahman AH

Sains Malaysiana, 2013;42(3):403-408.

This study looked into the rate and pattern of neuropsychological impairment in patients with traumatic brain injury patients at three months post injury. Forty patients attending the neurosurgery outpatient clinic were included in the study. Benton visual retention test (BVRT), rey auditory verbal learning test (RAVLT), digit span test, trail making test (TMT) and mini mental state examination (MMSE) were used for assessment. Forty five percent (n=18) sustained moderate to severe head injury. Twenty five percent (n=10) have abnormal MMSE result. Forty two and a half percent (n=17) have abnormal BVRT result. Seventy five percent (n=30) have abnormal RAVLT result while 35% (n=14) have abnormal digit span test result. Seventy seven and a half percent (n=31) have at least one neurological deficit. There was significant association between severity of head injury (GCS score) and neuropsychological deficit. This study highlights the point that in post head injury patients, there are high occurrences of cognitive dysfunction. MMSE and GCS play a significant and important role in assessing cognitive dysfunction. Severity of head injury as determined by GCS scores also influence the outcome in patients with head injury

Matched MeSH terms: Brain Injuries, Traumatic
Fulltext Arthroscopic All-Inside Repair of Tear of the Anterior Horn of Discoid Lateral Meniscus

Muniandy M, Rajagopal S, Tahir SH

Surg J (N Y), 2019 Jan;5(1):e35-e37.
PMID: 31093532 DOI: 10.1055/s-0039-1688951

The anterior horn of lateral meniscus tear is usually repaired using outside-in technique. Although easy to perform, it was associated with several complications which may alter the outcome of the surgery. Here, we present a case of an adolescent girl presented with incomplete discoid lateral meniscus accompanied by tear of anterior horn. The tear was repaired using all-inside technique without any implants. We described the surgical technique and discussed the rationale.

Matched MeSH terms: Tibial Meniscus Injuries
Dimensional and structural stability of gamma irradiated stacked die quad flat no leads (QFN)

Siew PF, Wan Yusmawati Wan Yusoff, Azman Jalar

Sains Malaysiana, 2014;43:827-832.

The physical properties and structural stability of the Quad Flat No-Leads (QFN) package with different gamma radiation doses have been investigated. The packages were irradiated with Co-60 gamma radiation with varying doses of 5 Gy, 50 Gy, 500 Gy, 5 kGy and 50 kGy with operating dose of 2.54 kGylh at room temperature. The infinite focus microscope (IFM) was used to measure the dimensional change and slantinglwarpage behaviour, while the 3D CT Scan X-ray machine was used to determine the occurrence of deflection on a wire in package due to exposure. It is believed that radiation effect on ceramic filler in the epoxy mold compound (EMC) plays an important role to induce the defects and resulted in swelling of the package. The slantinglwarpage behaviour is believed to be caused by the swelling behaviour of ceramic filler and further induced structural stability. The induced stress on the EMC structural after the dimensional change and slantinglwarpage failure leads to the occurrence of wire sweep. The finding suggests that defect production in swelled ceramic filler leads to the occurrence of dimensional and structure instability.

Matched MeSH terms: Radiation Injuries
Fulltext Brachial Artery Injury in a Child following Closed Elbow Dislocation: Case Report of a Rare Injury

Vickash K, Amer A, Naeem A, Falak S

Malays Orthop J, 2016 Nov;10(3):36-38.
PMID: 28553446 DOI: 10.5704/MOJ.1611.001

Elbow dislocation, though a common orthopaedic emergency is rare with brachial artery injury and is even more uncommon in the paediatric age group. We present the case of a child who sustained trauma resulting in closed elbow dislocation with brachial artery injury. Elbow dislocation with brachial artery injury can present with palpable distal pulses and good capillary refill because of rich collaterals at the elbow. But this patient presented with signs of frank ischemia distally, and was managed with ipsilateral reverse cephalic vein graft. He had good volume pulses at one year follow-up. Patients with such presentation should have careful clinical and radiological assessment to exclude complicated elbow dislocation.

Matched MeSH terms: Arm Injuries
The treatment of wounds

Cameron JAP

Journal of the Malaya Branch of the British Medical Association, 1939;3:297-304.

Matched MeSH terms: Wounds and Injuries
Fulltext Medical problems in an oil palm estate

Chua WT, Lim CH

Family Practitioner, 1982;5(3):49-53.

Oil palm estates and associated industries employ a fair proportion of workers. Good medical care benefits both the employers and the employees. The pattern of illness is not very different from that found in general practice. However, certain environmental factors, the nature of occupation and the water supply can influence the increased incidence of certain diseases. Upper respiratory tract infection, acute gastroenteritis, contact dermatitis (eczemas & rashes) eye, and ear diseases, injuries and musculoskeletal diseases are the commonest causes of morbidity. The resident doctor, who has a good knowledge of the environment of his patients is in the best position to practise preventive medicine or early intervention, thereby reducing illnesses and improving productivity of the workers.

Matched MeSH terms: Wounds and Injuries
Fulltext Activation of the kynurenine pathway and increased production of the excitotoxin quinolinic acid following traumatic brain injury in humans

Yan EB, Frugier T, Lim CK, Heng B, Sundaram G, Tan M, et al.

J Neuroinflammation, 2015 May 30;12:110.
PMID: 26025142 DOI: 10.1186/s12974-015-0328-2

During inflammation, the kynurenine pathway (KP) metabolises the essential amino acid tryptophan (TRP) potentially contributing to excitotoxicity via the release of quinolinic acid (QUIN) and 3-hydroxykynurenine (3HK). Despite the importance of excitotoxicity in the development of secondary brain damage, investigations on the KP in TBI are scarce. In this study, we comprehensively characterised changes in KP activation by measuring numerous metabolites in cerebrospinal fluid (CSF) from TBI patients and assessing the expression of key KP enzymes in brain tissue from TBI victims. Acute QUIN levels were further correlated with outcome scores to explore its prognostic value in TBI recovery.
METHODS: Twenty-eight patients with severe TBI (GCS ≤ 8, three patients had initial GCS = 9-10, but rapidly deteriorated to ≤8) were recruited. CSF was collected from admission to day 5 post-injury. TRP, kynurenine (KYN), kynurenic acid (KYNA), QUIN, anthranilic acid (AA) and 3-hydroxyanthranilic acid (3HAA) were measured in CSF. The Glasgow Outcome Scale Extended (GOSE) score was assessed at 6 months post-TBI. Post-mortem brains were obtained from the Australian Neurotrauma Tissue and Fluid Bank and used in qPCR for quantitating expression of KP enzymes (indoleamine 2,3-dioxygenase-1 (IDO1), kynurenase (KYNase), kynurenine amino transferase-II (KAT-II), kynurenine 3-monooxygenase (KMO), 3-hydroxyanthranilic acid oxygenase (3HAO) and quinolinic acid phosphoribosyl transferase (QPRTase) and IDO1 immunohistochemistry.
RESULTS: In CSF, KYN, KYNA and QUIN were elevated whereas TRP, AA and 3HAA remained unchanged. The ratios of QUIN:KYN, QUIN:KYNA, KYNA:KYN and 3HAA:AA revealed that QUIN levels were significantly higher than KYN and KYNA, supporting increased neurotoxicity. Amplified IDO1 and KYNase mRNA expression was demonstrated on post-mortem brains, and enhanced IDO1 protein coincided with overt tissue damage. QUIN levels in CSF were significantly higher in patients with unfavourable outcome and inversely correlated with GOSE scores.
CONCLUSION: TBI induced a striking activation of the KP pathway with sustained increase of QUIN. The exceeding production of QUIN together with increased IDO1 activation and mRNA expression in brain-injured areas suggests that TBI selectively induces a robust stimulation of the neurotoxic branch of the KP pathway. QUIN's detrimental roles are supported by its association to adverse outcome potentially becoming an early prognostic factor post-TBI.

Matched MeSH terms: Brain Injuries/diagnosis*; Brain Injuries/metabolism*; Brain Injuries/physiopathology
Fulltext Massive subcutaneous emphysema after a blunt neck injury

Mohamad, I., Md Shukri, N., Fauzi, M.H., Abdul Karim, A.H., Nik Hassan, N.F.H.

Malaysian Journal of Emergency Medicine, 2017;2(1):16-20.
MyJurnal

Subcutaneous emphysema can occur after a breach to the air-containing space. The classical condition will be ruptured alveolus in chronic lung disease. A disruption of the upper airway such as trauma to the laryngotracheal framework may lead to similar presentation. The amount of air leak varies depending on site and size of the breach. We report a case of blunt neck trauma after a fall from bicycle, which ended with massive subcutaneous emphysema, pneumothorax and pneumomediastinum requiring intubation.

Matched MeSH terms: Neck Injuries
Fulltext The prevalence of injuries among participants during the 16th National Silat Championships 2012

Hassan, N.H., Nik Muhamad, N.A.

Malaysian Journal of Emergency Medicine, 2017;2(1):11-15.
MyJurnal

This study is a descriptive epidemiology on the frequency of injuries, characteristics, and type of injuries incurred during the 16th National SilatChampionships 2012 competitions. This was a retrospective study by using a Pre Hospital Care Emergency Medicine PPUKM Form. All injuries sustained during the competition days were documented. The total number of participants involved in this tournament was 158 (114 males and 44 females). 51.6% participants sustained various injuries during the competition. The common sites of injuries involved the upper and lower extremities. The injuries sustained consist of swelling, fracture, dislocation, muscle sprain, strain and others. Most of the injuries were minor and did not require hospitalization. This study identified that soft tissue injuries due to blunt trauma were common among the silatparticipants. Strict observation of the tournament regulations, vigorous training and protective measures or equipments may contribute to the absence of severe or serious injury.

Matched MeSH terms: Soft Tissue Injuries
Fulltext Managing Subacute Subperiosteal Hematoma with High Intraocular Pressure: A case report

Hashim SE, Fatisha A, Nazri MN

International Medical Journal Malaysia, 2017;16(1):135-138.
MyJurnal

Subperiosteal haematoma of the orbit is an uncommon complication of maxillofacial trauma, hence easily missed. It usually presents subacutely with proptosis and diplopia. In our case, the subperiosteal haematoma is complicated with high intraocular pressure, necessisating measures to reduce the intraocular pressure. Unresponsive to only medical treatment, surgical evacuation was carried out in this patient. Removal of the clot finally relieved the intraocular pressure and simultaneously improved the proptosis and the cumbersome diplopia.

Matched MeSH terms: Maxillofacial Injuries
Fulltext Potential dermal wound healing agent in Blechnum orientale Linn

Lai HY, Lim YY, Kim KH

BMC Complement Altern Med, 2011 Aug 12;11:62.
PMID: 21835039 DOI: 10.1186/1472-6882-11-62

BACKGROUND: Blechnum orientale Linn. (Blechnaceae) is used ethnomedicinally to treat wounds, boils, blisters or abscesses and sores, stomach pain and urinary bladder complaints. The aim of the study was to validate the ethnotherapeutic claim and to evaluate the effects of B. orientale water extract on wound healing activity.
METHODS: Water extract of B. orientale was used. Excision wound healing activity was examined on Sprague-Dawley rats, dressed with 1% and 2% of the water extract. Control groups were dressed with the base cream (vehicle group, negative control) and 10% povidone-iodine (positive control) respectively. Healing was assessed based on contraction of wound size, mean epithelisation time, hydroxyproline content and histopathological examinations. Statistical analyses were performed using one way ANOVA followed by Tukey HSD test.
RESULTS: Wound healing study revealed significant reduction in wound size and mean epithelisation time, and higher collagen synthesis in the 2% extract-treated group compared to the vehicle group. These findings were supported by histolopathological examinations of healed wound sections which showed greater tissue regeneration, more fibroblasts and angiogenesis in the 2% extract-treated group.
CONCLUSIONS: The ethnotherapeutic use of this fern is validated. The water extract of B. orientale is a potential candidate for the treatment of dermal wounds. Synergistic effects of both strong antioxidant and antibacterial activities in the extract are deduced to have accelerated the wound repair at the proliferative phase of the healing process.

Matched MeSH terms: Wounds and Injuries/drug therapy*; Wounds and Injuries/metabolism; Wounds and Injuries/pathology

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