Foreign body ingestion among children is common and most usually pass through the gastrointestinal tract without requiring any intervention. Magnets, however, pose a greater threat especially when more than one are ingested. We report a case of multiple bowel perforation secondary to ingestion of magnetic beads in a 3-year-old.
Pulmonary toxicity is a rare complication of Rituximab therapy. Although Rituximab is relatively safe and can be administered in an outpatient setting, Rituximab-associated lung disease has been reported and may cause mortality despite early detection. Typically the pulmonary toxicity occurs at around the fourth cycle of Rituximab. High index of suspicion is crucial and other concurrent pathology such as infective causes should be excluded. Radiological imaging and histological confirmation should be obtained and early treatment with corticosteroid should be initiated. Patients should receive counselling regarding respiratory symptoms and possible pulmonary toxicity.
Induction of anaesthesia with propofol is often associated with a significant decrease in arterial pressure, especially in the older population. The aim of this study is to determine the efficacy of phenylephrine in two different doses i.e. 100mcg and 200mcg, given during induction to counteract the anticipated hypotensive effect of propofol in older patients aged over 55 years.
Epithelioid sarcoma (ES) of the small bowel is a rare gastrointestinal tumour. We report a case of gastrointestinal bleeding secondary to small bowel ES in a 55-year-old gentleman. After gastroscopy and colonoscopy failed to identify the source of bleeding, we proceeded with computed tomography angiogram of the mesentery, which revealed intraluminal blood clot in the distal jejunum with features of obstruction. This is a rare cause of obscure gastrointestinal bleeding and emphasises the need for additional evaluation in the presence of negative endoscopic findings.
Coronary artery disease is the major cause of mortality and morbidity in Malaysia and worldwide. This paper reviews all research and publications on coronary artery disease in Malaysia published between 2000-2015. 508 papers were identified of which 146 papers were selected and reviewed on the basis of their relevance. The epidemiology, etiology, risk factors, prevention, assessment, treatment, and outcomes of coronary artery disease in the country are reviewed and summarized. The clinical relevance of the studies done in the country are discussed along with recommendations for future research.
Introduction: Little is known about how smokers respond cognitively and emotionally to the experience of "late" relapse after the acute withdrawal phase. This study assessed the kinds of thoughts and feelings that emerge in order to provide a basis for quantitative research assessing prevalence of different types of response and implications for future quit attempts. Methods: Face-to-face in-depth interviews were conducted among 14 people attending a quit smoking clinic in Malaysia who had relapsed after at least 6 weeks of abstinence. Transcripts were analyzed using thematic analysis to enable emergence of important aspects of the experience. Results: Following relapse, smokers often engaged in rationalizations and activities to minimize worry about the harmful effects of smoking by switching to a lower-tar cigarette, reducing the number of cigarette smoked, attempting to reduce cigarette smoke inhalation, comparing themselves with other smokers, and minimizing the health risks associated with smoking. In some cases, smokers retained a "non-smoker" identity despite having relapsed. Conclusion: Smoking relapsers rationalize their failure to quit and minimize their health risk in order to protect their image as non-smokers while it remains a source of identity conflict.
Study site: Quit Smoking Clinic, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia
CONTEXT: The Palliative Care Outcome Scale (POS) is an easy-to-use assessment tool to evaluate the effectiveness of palliative care. There is no published literature on the use of POS as an assessment tool in Malaysia.
AIM: To define the concordance in the assessment of quality of life between patients with advanced cancers and their palliative care nurses using a Malay version of the POS.
SETTINGS AND DESIGN: This study was conducted in the palliative care unit of the Hospital Tuanku Ja'afar Seremban, Malaysia, from February 2014 to June 2014.
SUBJECTS AND METHODS: We adapted and validated the English version of the 3-day recall POS into Malay and used it to define the concordance in the assessment of quality of life between patients and palliative care nurses. Forty patients with advanced stage cancers and forty palliative care nurses completed the Malay POS questionnaire.
STATISTICAL ANALYSIS USED: The kappa statistical test was used to assess the agreement between patients and their palliative care nurses.
RESULTS: Slight to fair concordance was found in all items, except for one item (family anxiety) where there was no agreement.
CONCLUSIONS: The Malay version of the POS was well accepted and reliable as an assessment tool for evaluation of the effectiveness of palliative care in Malaysia. Slight to fair concordance was shown between the patients and their palliative care nurses, suggesting the needs for more training of the nurses.
INTRODUCTION: Gestational diabetes (GDM) has significant maternal and foetal implications. screening allows active interventions which significantly improves pregnancy outcomes. Despite World Health Organization (WHO), FIGO and National Institute of clinical Excellence (NIcE) recommendations for universal screening especially among high risk population; Malaysia currently adopts a selective risk based screening for GDM.
OBJECTIVE: the objective is to audit the effectiveness of the current practice of selective risk based screening in detection of GDM in Malaysia.
METHODOLOGY: this is a retrospective cohort study based on the National Obstetric Registry (NOR) which comprises of 14 major tertiary hospitals in Malaysia. the study period was from 1st January 2011 till 31st December 2012 and a total of 22,044 patients with GDM were analysed. Logistic regression analysis was used to calculate the crude odd ratio.
RESULTS: the incidence of GDM in Malaysia is 8.4%. Maternal age of ≥25, booking bMI ≥27kg/m2, booking weight ≥80kg and previous hypertension are non-significant risk of developing GDM in Malaysia. Parity 5 and more was only associated with an odds-ratio of 1.02 (95% confidence Interval: 0.90-1.17) as compared to parity below 5. the association of women with previous stillbirth with GDM was not significant.
CONCLUSION: current risk based screening for GDM based on maternal age, booking bMI, weight and hypertension is inappropriate. An ideal screening tool should precede disease complications, which is the novel objective of screening. Universal screening for GDM in Malaysia may be a more accurate measure, especially with regards to reducing maternal and foetal complications.
Intrapancreatic accessory spleen (IPAS) is a benign anomaly of splenic embryology and a rare cause of pancreatic pseudotumour. Here, we report a case of a 70-year-old Malay lady whose IPAS was discovered incidentally during her surveillance computed tomography for her underlying left lower lung fibrosis. Radiologically, the lesion mimicked a neuroendocrine pancreatic tumour and was only diagnosed pathologically as IPAS after surgery. In conclusion, recognising IPAS as a differential for enhancing pancreatic mass allows us to exhaust all non-invasive diagnostic means to diagnose this benign lesion. It will allow the patient to avoid unnecessary surgery and its accompanying complications.
The literature on adrenal gland tumour in HIV-infected patients is scarce. We report a 46-year-old Malay man with HIV and Hepatitis C infection presenting with a large nonfunctioning adrenal tumour. Computed tomography showed a large right adrenal tumour with heterogeneous enhancement and central necrosis. A high index of suspicion of a malignant tumour or pheochromocytoma led us to surgical removal of the adrenal gland. In this case report, we highlight important features to look for during pre-op evaluation of a large adrenal mass. Appropriate action should be taken when there is a suspicion of a pheochromocytoma or malignancy.
Anaemia is a common condition in Malaysia, and is mostly due to iron deficiency. In many cases, allogeneic blood transfusion (ABT) is administered unnecessarily to treat anaemia. Patient blood management (PBM) is a concept whereby a patient becomes his or her "own blood bank", instead of receiving ABT. The concept encompasses three pillars namely optimising erythropoiesis, minimising blood loss and harnessing human physiological reserve. We present a safe and fruitful outcome of managing severe anaemia without utilising any ABT, made possible with the PBM approach including administration of intravenous iron.
Mammal diversity assessments based on DNA derived from invertebrates have been suggested as alternatives to assessments based on traditional methods; however, no study has field-tested both approaches simultaneously. In Peninsular Malaysia, we calibrated the performance of mammal DNA derived from blowflies (Diptera: Calliphoridae) against traditional methods used to detect species. We first compared five methods (cage trapping, mist netting, hair trapping, scat collection, and blowfly-derived DNA) in a forest reserve with no recent reports of megafauna. Blowfly-derived DNA and mist netting detected the joint highest number of species (n = 6). Only one species was detected by multiple methods. Compared to the other methods, blowfly-derived DNA detected both volant and non-volant species. In another forest reserve, rich in megafauna, we calibrated blowfly-derived DNA against camera traps. Blowfly-derived DNA detected more species (n = 11) than camera traps (n = 9), with only one species detected by both methods. The rarefaction curve indicated that blowfly-derived DNA would continue to detect more species with greater sampling effort. With further calibration, blowfly-derived DNA may join the list of traditional field methods. Areas for further investigation include blowfly feeding and dispersal biology, primer biases, and the assembly of a comprehensive and taxonomically-consistent DNA barcode reference library.
A study was carried out on the distribution and enrichment of trace elements in the core marine sediments of East Malaysia from three stations at South China Sea and one station each at Sulu Sea and Sulawesi Sea. Five stations of sediment cores were recovered and the vertical concentration profiles of six elements namely Br, Cs, Hf, Rb, Ta, and V were determined using the instrumental neutron activation analysis. The enrichment factor, geoaccumulation index and the modified degree of contamination were used to calculate the anthropogenic and pollution status of the elements in the samples. Except for Cs and Hf, which by the enrichment factor are categorized from minimum enrichment to moderate enrichment in all stations and for V and Rb in Sulu Sea and Sulawesi Sea, which are categorized minimum enrichment, other elements are found to be no enrichment at all stations. The geoaccumulation index of Hf in one station shows moderately polluted and for other elements are unpolluted. However, the modified degree values of all samples are less than 1, suggesting very low contamination of elements found in all the stations.
Breast cancer (BC) is a major life-threatening problem and a global concern including Malaysia. BC is an equal threat for both developing and developed countries. The aim of this study was to determine the relationship between sociodemographic factors with knowledge, attitude, and perception on BC screening among the females of University Kuala Lumpur, Royal College of Medicine Perak (UniKL RCMP).
BACKGROUND: The outcomes of the physician-patient discussion intervene in the satisfaction of cardiovascular disease risk patients. Adherence to treatment, provision of continuous care, clinical management of the illness and patients' adjustment are influenced by satisfaction with physician-patient interaction. This study aims to determine the patient satisfaction with doctor-patient interaction and over six months after following prevention counselling, its associations with modifiable cardiovascular risk factors amongst moderately-high risk patients in a primary healthcare clinic in Kelantan, Malaysia.
METHODS: A prospective survey was conducted amongst patients with moderately-high cardiovascular risk. A total of 104 moderately-high risk patients were recruited and underwent structured prevention counselling based on the World Health Organization guideline, and their satisfaction with the doctor-patient interaction was assessed using 'Skala Kepuasan Interaksi Perubatan-11,' the Malay version of the Medical Interview Satisfaction Scale-21. Systolic blood pressure, total cholesterol and high-density lipoprotein cholesterol were measured at baseline and at a follow-up visit at six months. Descriptive analysis, paired t test and linear regression analyses were performed.
RESULTS: A total of 102 patients responded, giving a response rate of 98.1%. At baseline, 76.5% of the respondents were satisfied with the relation with their doctor, with the favourable domain of distress relief (85.3%) and rapport/confidence (91.2%). The unfavourable domain was interaction outcome, with satisfaction in only 67.6% of the respondents. Between the two visits, changes had occurred in total cholesterol (P = 0.022) and in systolic blood pressure (P
Oil palm (Elaeis guineensis Jacq.) is one of the most planted trees in Malaysia for the palm oil production. Thus, solid biomass had been generated from this industry such as empty fruit bunch, shell, mesocarp fibre, frond and trunk produced that causes problematic to the nation and expected to escalate up to 85-110 million tonnes by 2020. Besides that, palm oil mill effluent and excessive steam also generated from the production of palm oil. In situ hydrothermal pretreatment means the utilisation of excessive steam produced by the oil palm mill and at the same time, generating value added product as well as reducing the biomass. Oil palm biomass is rich in lignocellulosic materials which comprised of lignin, hemicellulose and cellulose. Refinement of lignocellulosic from oil palm biomass can be utilised to form fermentable sugar, bioethanol and other potential chemicals. Recalcitrant property of lignocellulosic reduces the ability of enzymes to penetrate, thus pretreatment is required prior to hydrolysis process. Pretreatment can be either physical, chemical, biological or combined. In this review paper, three types of hydrothermal pretreatment were discussed as suitable in situ pretreatment process for oil palm biomass; in palm oil mill. The suitability was measured based on the availability of excess steam and energy in the mill. Furthermore, physicochemical pretreatment also facilitate the saccharification process, whereby it loosened the lignocellulose structure and increase the surface area. The effects and factors in choosing right pretreatment are highlighted in this paper.
The research on radiation induced mutation has been conducted as one of the promising method of plant breeding in Malaysia since 1980s. Nuclear Malaysia is leading research institute inMalaysia conducting plant mutationbreeding research. Gamma Greenhousefacility located in Nuclear Malaysiais one of the irradiation facilitiesto serve as a chronic irradiation facility for inducing mutation in various organisms including plants, fungi and microbes.Chronic irradiation refers to the exposure of materials at a lower dose rate over a long period of time. Previous studies have shown that this type of irradiation can minimize radiation damages to living materials and produces a wider mutation spectrum, therefore is very useful for trait improvements in irradiated organisms. Experiments on induce mutation using Gamma Greenhouse facility for crop improvement program have been conducted since its first operation in 2009. Various plant species including ornamental and herbal plants, food crops and industrial crops have been irradiated to improve their traits such as higher yield and biomass, pest and disease tolerance, higher bioactive compounds, longer bloom time and many others. Most of these crop improvement programs were done through collaborations with other agencies in Malaysia such as universities, research institutes and government departments. A number of publications on crop improvement using Gamma Greenhouse have been published inlocal and international journals as well as seminar presentations at national and international levels. The outputs from induced mutation via chronic radiation using Gamma Greenhouse could be of great interest for plant breeders dealing with improvement and development of new cultivars. This paper discusses the activities and achievement in plant breeding and improvement using Gamma Greenhouse Facility in Malaysia.
Lomanius annae sp. nov. is described from southern Vietnam. The species is characterized by the greatly developed dorso-basal process on cheliceral hand of males and by the partial effacement of all mesotergal grooves. The genus Lomanius contains four generic synonyms and currently comprises eight valid species distributed in China, Java, peninsular Malaysia, the Philippines, and Taiwan. The new species displays a general morphology similar to the former genus Paralomanius, with a combination of sexually dimorphic interocular mound (which is very large and strongly leaned back in males) and pedipalpus (which is extremely elongate in males). This morphological suite of features is herein called facies reclinobunoides. The replacement name Metibalonius triceratops nom. nov. is proposed for Trispinibunus abnormis Roewer, 1915, which is a junior secondary homonym of Ibalonius abnormis Strand, 1911. Finally, numerous morphological structures found in Podoctidae are recognized and named: (1) the cheliceral comb, present on cheliceral fingers, (2) the chained tubercular ridges, present on dorsal scutum and (3) several others related to the ocular region. The distribution of these two structures among podoctid species is not fully known, but both are absent in the former Ibaloniinae. We suggest that both structures may be useful to define supra-generic groups in the clade composed of the former Podoctinae and Erecananinae.
Fourteen sediment samples were collected along Linggi River, Malaysia. Neutron activation analysis (NAA) and inductively coupled plasma-mass spectrometry (ICP-MS) techniques were used in the determination of toxic element contents. The results showed that As, Cd and Sb concentrations were higher at all sampling stations, with enrichment factor values ranging from 17.7 to 75.0, 2.1 to 19.5 and 6.6 to 28.4, respectively. Elements of Pb and Zn) were also enriched at most of the sampling stations whilst Cu, Cr and Ni were shown as background levels. The sediment of Linggi River can be categorised as low (<8.0) to very high degree of contamination (>32.0). The mean concentrations of elements viz. Cd, Cr, Ni, Pb, Sb and Zn were lower than the threshold effect level (TEL) of FSQGs values except for As. The concentration of As (arsenic) was higher than PEL and PEC of FSQGs values.