OBJECTIVES: This study aimed to determine the level and factors contributing to burnout among doctors in Sana'a City, Yemen and to determine the relationship between burnout and psychological morbidity.
METHODS: This was a cross-sectional study of 563 working doctors in the four main hospitals in Sana'a City, Yemen. The 12-item version of the General Health Questionnaire (GHQ12) was used as a measure of psychological morbidity and the 22-item Maslach Burnout Inventory (MBI) was used to measure emotional exhaustion, depersonalization, and personal accomplishment. Sources of job stress were determined using a 37-item scale questionnaire. The questionnaire elicited information about socio-demographic and work characteristics.
RESULTS: On the MBI, 356 doctors showed high emotional exhaustion (63.2%), 109 showed high depersonalization (19.4%) and 186 showed low personal accomplishment (33.0%). Sixty six doctors (11.7%) were identified as experiencing a high degree of burnout (high emotional exhaustion and depersonalization and low personal accomplishment). The prevalence of high degree of burnout was significantly higher in those with duration of work or=40 h/wk (OR=2.1, 95% CI 1.25-3.62) and in those who had psychological morbidity (OR=5.3, 95% CI 2.22-12.39). Thirteen out of 37 sources of stress were significantly associated with high degree of burnout. In multivariate analysis, the significant predictors of high burnout were: dealing with patient's psychosocial problems, feeling of isolation, disturbance of home/family life by work, not chewing khat, long working hours and psychological morbidity.
CONCLUSION: The prevalence of high degree of burnout as well as emotional exhaustion in Yemeni doctors was higher than those reported internationally and was associated with psychological morbidity and many important sources of job stress.
Effect of Tai Chi exercise on the level of DNA damage using the comet assay, lymphocyte viability and frequency of sister chromatid exchange (SCE) were determined in adults aged above 45. Tai Chi participants of 7 years (n=35), showed higher level of normal DNA and lower level of mild and severely damaged DNA as compared to the sedentary subjects (n=35). The former are suggested to have effective DNA repair mechanism as their frequency of SCE was markedly lower. Higher lymphocyte apoptosis and proliferation found in the Tai Chi participants also indicated that the exercise promotes renewal and regeneration of lymphocytes.
Penile reconstructive surgeries are performed mainly as radical treatment for conditions associated with congenital abnormalities of the urethra or penis, after penile trauma, penile cancer, short penis, corporal fibrosis and in cases of gender reassignment. We present here a method of penile reconstruction with a pre fabricated radial forearm free flap incorporating the segment of the radius for structural support.
Cancers and related treatments have devastating effects on psychosexual life of patients. This study helps us to understand the cultural perspectives of 50 Asian women diagnosed with cancer. Median age was 50+ years. Median duration of time from diagnosis to interview was 23 months. Thirty-eight per cent stopped sex before illness, 36% stopped sex completely whereas 18% stopped gradually after diagnosis; 8% continued to have sex till time of interview. Overall, 70% were living with spouse but not engaged in sexual intercourse; 31.4% slept in different room, 48.6% slept in the same room but without any form of sexual contact. Thirty-eight per cent believed sexual activity could cause cancer recurrence, and 30% believed cancer could be sexually transmitted. Eighty-two per cent reported acceptance of changes to physical appearance. Approximately 70-86% did not discuss sexuality with their doctor or spouse; 90% agreed doctors should ask about psychosexual issues on a routine basis. Approximately 74.4% reported good cooperation from spouse. Cultural beliefs of Asians pose as barriers to providing and receiving psychosexual affection between women diagnosed with cancer and their spouse. However, these beliefs also serve as protective factors in their mutual acceptance of change in psychosexual activities. Health-care professionals need to be sensitive to the vast cultural differences in psychosexual expressions and needs of women diagnosed with cancer.
Jenny, a nonsmoker, 54 years of age, presents with 3 years of dry cough, progressive breathlessness and reducing exercise tolerance. Two years ago she was diagnosed with asthma and treated with inhaled bronchodilators (which have been marginally effective). Jenny has worked in a tile factory for 22 years; 15 years in the grinding department, transferring to the chipping department 7 years ago. On examination she is tachypnoeic with a prolonged expiratory phase. There are bilateral rhonchi and a few fine crepitations at the left infrascapular region. Jenny's full blood count and electrocardiogram are normal. Arterial blood gas show mild hypoxia with respiratory alkalosis. Spirometry demonstrates mixed moderate obstructive and restrictive impairment. The diffusion capacity for carbon monoxide is reduced. Mantoux is negative and erythrocyte sedimentation rate is 10 mm/hour. A chest X-ray is taken.
To highlight the first reported case of necrobiotic xanthogranuloma of the parotid gland. We also review the clinical presentations and treatments for this rare condition.
Lucio's phenomenon is a rare and aggressive necrotising variant of erythema nodosum leprosum that classically occur in patients with undiagnosed, diffuse non-nodular lepromatous leprosy. It is a potentially fatal leprosy reaction characterised by extensive, bizarrely-shaped, painful purpuric skin lesions and ulcerations. Lucio's phenomenon is very rarely reported outside of Mexico and Costa Rica.
INTRODUCTION: Endemic goitre is a major concern in many nations including Malaysia. Seven states in the country have been identified by Ministry of Health of Malaysia to have high incidence of goitre and one of these is Kelantan.
METHODS: This is a retrospective study over an 11-year period from 1994 to 2004 on all thyroid specimens submitted to the Pathology Department, Hospital Universiti Sains Malaysia (HUSM), in Kelantan. Epidemiological data were retrieved from the patients' records and pathology findings from the pathology reports.
RESULTS: During this period, Department of Pathology HUSM received a total of 1,486 thyroid specimens. The female to male ratio was 6:1 and the median age was 40.0 years. The duration of goitre ranged from one to 15 years. Histopathological examination showed 71.9 percent were non-neoplastic and 28.1 percent neoplastic lesions. The hospital-based incidence of nodular hyperplasia was 9.9 per 100,000 admitted patients per year. The hospital-based incidence of all types of malignant thyroid cancers was 3.5 per 100,000. The most common malignancy was papillary carcinoma 76.6 percent. The majority of the cancers (59.5 percent) occurred in a background of nodular hyperplasia. Thyroid cancers made up 4.9 percent of all cancers seen in HUSM.
CONCLUSION: This study suggests that malignant thyroid lesions arising from multi-nodular goitre are high in a population living in an iodine-deficiency area.
A middle-aged lady presented with a three-month history of chronic cough. After a long and extensive investigation, CT thorax revealed collapse consolidation of the right lower lung lobe and bronchoscopy showed a polypoidal tumour within the involved bronchus. Thoracotomy and segmental lung resection revealed a peanut in the airways of the fibrotic and infected lung tissue. In view of the rarity of the food particle aspiration in a healthy adult, the delay in presentation and diagnosis in our patient, we would like to highlight this particular case. A high index of suspicion of FBA is necessary to avoid unnecessary anxiety, extensive investigations and overzealous treatment as well as to promote lung conservation.
Inverted papillomas (IPs), although histologically benign, are aggressive lesions that may recur after excision. They usually present as unilateral firm, bulky, red and vascular masses. The objective of this case series is to discuss the surgical treatment options for IPs and to review the literature with a special emphasis on our experience with endoscopic medial maxillectomy. A retrospective review of the data of patients with IP treated by endoscopic medial maxillectomy was performed. This report describes the surgical experience with five patients with IP arising from various sites on the lateral nasal wall. Data points collected included age, sex, location(s) and histopathological diagnosis (benign IP vs IP with dysplasia or carcinoma). The surgical treatment strategy, need for adjunct approaches, complications, recurrence rates and length of follow-up were determined. The average age was 51.2 years (range, 35-62 years), with four males and one female. All cases were managed with endoscopic medial maxillectomy as the primary surgical modality. Adjunctive approaches included endoscopic dacryocystorhinostomy (EDCR) in two patients who presented with epiphora post-operatively. Intra-operative frozen section was performed in all cases to ensure complete tumor removal. No intra-operative complications were encountered. No recurrences were noted in these patients, with a mean follow-up period of 23 months.
Pyoderma gangrenosum (PG) is an uncommon, chronic, painful, ulcerative skin disease of unknown origin, often associated with systemic diseases including inflammatory bowel disease, rheumatoid arthritis; monoclonal gammopathy, hepatitis and myeloproliferative disorders. The mainstay of therapy for PG has been high-dose corticosteroids but not all patients have a favourable outcome. Other systemic agents have also been used such as cyclosporine, azathioprine, cyclophosphamide and tacrolimus. However, all these systemic therapies can be complicated by serious side effects. In this paper, we report a series of four patients with pyoderma gangrenosum treated successfully with topical cyclosporine. No side-effects were observed in any of the patients and there was minimal systemic absorption of the topical cyclosporine.
We report a case of umbilical necrosis after a unilateral pedicled transverse rectus abdominis myocutaneous flap in a patient post mastectomy. This uncommon complication of breast reconstruction is highlighted.
Chondrosarcomas are uncommon tumors which originates in the head and neck and accounts for approximately 10 to 15% of all cases. Most chondrosarcomas exhibit an indolent growth pattern. Nasoseptal tumors may mimic common sinonasal conditions, making early diagnosis difficult. We report a case of nasoseptal metastatic chondrosarcoma which was atypical, characterized by an aggressive growth pattern and widely disseminated.
This study examined the number and nature of spatiotemporal channels in the region where the frequency-doubling (FD) illusion would be expected to occur at eight locations spanning the central 30 degrees of the visual field.
Since its isolation in Tanzania in 1953, chikungunya virus has caused periodic outbreaks in both tropical Africa and Asia. In the last decade, the virus has shown not only increased activity but has expanded its geographical locations, thus classical delineation of various genotypes of chikungunya virus to specific geographic locales no longer holds true. Rapid mass movement of people and the constant presence of the right vectors in this region could have contributed to the change in virus ecology. This paper documents the first detection of chikungunya virus of Central/East genotype in Malaysia from a patient who was most likely infected with the virus during her visit to India. Without good Aedes vector measures, only time will tell whether this genotype rather than the existing endemic genotype will subsequently cause the next chikungunya outbreak in Malaysia.
Cystic spinal or ancient schwannoma is a rare form of intradural tumour especially in the conus medullaris region. Due to its indolent behavior and benign course, the diagnosis of schwannoma is always a challenge and the imaging findings can be misleading. Our patient presented with chronic mild sciatica pain without any other neurological symptom. MRI of the spine showed intradural tumour located at the conus medullaris region with nerves compression and was reported as ependymoma. L3-L5 laminectomy and total excision of tumour was performed without any neurological complication. We concluded that ancient schwannoma of the conus medullaris is a rare benign tumour that can present with minimal non-specific neurological symptom that lead to misdiagnosis. Radical tumour excision is safe with an excellent outcome.
Health and disease can only be distinguished by accurate and reliable reference values of a particular laboratory test. It is now a proven fact that there is considerable variation in hematology reference intervals depending on the demographic and preanalytical variables. There are evidences that values provided by manufacturers do not have appropriate application for all populations. Moreover, reference ranges provided by different laboratory manuals and books also do not solve this problem. We are presenting here normal reference ranges of Malaysian population. These values were determined by using Sysmex XE-2100 and ACL 9000 hematology and coagulation analyzers. Results from this study showed that there were considerable differences in the reference values from manufacturers, western population or laboratory manuals compared with those from the local population.
The objective of this study was to determine the proportion of patients with atherosclerotic peripheral vascular disease (PVD) who had elevated lipoprotein(a) [Lp(a)] levels, as well as to determine the latter's significance as a risk factor for PVD in the local population.
First discovered in the early 1950s, reoviruses (respiratory enteric orphan viruses) were not associated with any known disease, and hence named orphan viruses. Recently, our group reported the isolation of the Melaka virus from a patient with acute respiratory disease and provided data suggesting that this new orthoreovirus is capable of human-to-human transmission and is probably of bat origin. Here we report yet another Melaka-like reovirus (named Kampar virus) isolated from the throat swab of a 54 year old male patient in Kampar, Perak, Malaysia who was suffering from high fever, acute respiratory disease and vomiting at the time of virus isolation. Serological studies indicated that Kampar virus was transmitted from the index case to at least one other individual and caused respiratory disease in the contact case. Sequence analysis of the four small class genome segments indicated that Kampar and Melaka viruses are closely related. This was confirmed by virus neutralization assay, showing an effective two-way cross neutralization, i.e., the serum against one virus was able to neutralize the other. Although the exact origin of Kampar virus is unknown, epidemiological tracing revealed that the house of the index case is surrounded by fruit trees frequently visited by fruit bats. There is a high probability that Kampar virus originated from bats and was transmitted to humans via bat droppings or contaminated fruits. The discovery of Kampar virus highlights the increasing trend of emergence of bat zoonotic viruses and the need to expand our understanding of bats as a source of many unknown viruses.
Accidental swallowing of fish bone, which arrested in esophagus, is fairly common. However the incidence of esophageal perforation due to fish bone swallowing is low. Delayed posterior mediastinal abscess as a result of the esophageal perforation is a rare manifestation and may lead to fatal outcome. Two cases of delayed formation of posterior mediastinal abscess following esophageal perforation due to accidental fish bone ingestion are described here. In these cases patients presented with interscapular back pain. In one of the cases the patient died because of the presentation was misdiagnosed hence leading to delay in the intervention. Radiological findings and surgical management namely esophagoscopy and neck exploration are briefly described.