Peripheral, predominantly motor polyneuropathy is associated with a plethora of possible aetiologies and the investigative procedures to rule them out are extensive. A 31 year old lady presented with progressive lower limb weakness over a period of 2 years. Examination revealed symmetrical weakness (3+/5) of all distal muscle groups in the lower limbs with absent ankle jerk. There was no sensory loss. The nerve conduction study revealed a predominantly axonal motor neuropathy. Cerebrospinal fluid examination and other investigations to rule out potential causes of predominantly motor peripheral neuropathy were normal. The only positive findings were multiple qualitative assays for porphobilinogen in her urine.
Introduction: Internet addiction is becoming a global problem and has been associated with mental health issues such as depression and anxiety. There is a strong need for local research, given the recent rise of mental health issues amongst children and adolescents in Malaysia, as well as lack of research in this field locally. Methods: This study assessed the prevalence of internet addiction, and its association with internetrelated factors, depressive symptoms, anxiety symptoms, and self-esteem, amongst selected secondary school students in the Klang Valley, Malaysia. In a cross-sectional study, 199 adolescents were conveniently chosen from six randomly selected secondary schools within Klang Valley. Subjects completed a demographic questionnaire, as well as Malay versions of the Internet Addiction Test (MVIAT), Children’s Depression Inventory (CDI), Depression Anxiety Stress Scales-21 anxiety subscale (DASS-21) and Rosenberg Self-Esteem Scale (RSES). Multiple logistic regression analysis was carried out. Results: This study found that 49.2% of students were addicted to the internet. Significant factors associated with internet addiction were spending longer hours online during the holidays (OR 1.20, CI 1.01-1.35), easy access to a computer (OR 4.01, CI 1.50 - 10.76), confiding on the internet (OR 4.07, CI 1.49-11.13), severe level of anxiety (OR 3.63, CI 1.04-12.73) and high depression scores (OR 1.10, CI 1.01-1.20). Contrary to previous studies, self-esteem was not found to be significantly associated with internet addiction. Conclusion: This study has important implications in relation to clinical practice, research, and policy-making in Malaysia.
Dentigerous cyst is the most common odontogenic cysts that are associated with the
crowns of permanent teeth. Treatment modalities normally include enucleation or marsupialization
of the cyst. However, currently there are no standard assessment criteria to dictate which kind of
treatment for certain cases. (Copied from article).
Introduction: Epidemiology of fungal infections in an infectious disease reference centre is different from other institutions. This study aimed to look at the scenario of fungal infections at an infectious disease reference centre in Malaysia. Methods: All positive fungal cultures from an infectious disease reference centre were identified by routine mycology laboratory methods. Patient demographic, laboratory and clinical data were collected and analyzed. Duplicate data were excluded. Results: Middle-aged Malay males were the most common group. However, increased proportions of Chinese, Myanmar and Indonesians reduced the Malay predominance in HIV-positive group. In all patients, Candida species represented 64.1% isolates, followed by Cryptococcus neoformans (14.7%) and Penicillium marneffei (14.7%). Among HIVpositive individuals, C. neoformans (37.9%) was the most common species, followed by P. marneffei (35.6%) and all Candida species (17.2%). In contrast to other non-infectious disease reference centres, common causes of fungaemia included P. marneffei (43.5%), Candida species (25.8%), C. neoformans (24.2%) and H. capsulatum (6.5%). Conclusion: The prevalence of fungal infection at an infectious disease reference centre is different from other non-infectious disease reference centres. This may have an impact on current antifungal practice especially empiric antifungal therapy, patient morbidity and mortality.
Spinal epidural angiolipomas are rare benign tumors. The tumors contain both vascular and mature adipose components. Typically, they present with a progressive clinical course. Acute presentation is rare. We present a case of a fifteen-year-old girl who presented with a sudden onset of backpain followed by paraparesis with bladder and bowel incontinence. Neurological examination showed sensory loss below T10 with Grade 2 motor power. Spinal MRI showed long segment extradural lesion at T6-T9 level. Multiple laminectomy and excision of the tumor containing areas of hemorrhage was performed. Histopathology report revealed angiolipoma.
Nasopharyngeal carcinoma (NPC) is a malignant neoplasm arising from the mucosal epithelium of the
nasopharynx, mainly within the lateral nasopharyngeal recess or Fossa of Rosenmuller. Distant metastasis to the cervical spine is the least common site in the vertebral system. This is a case of a 37-year-old lady with stage IV C nasopharyngeal carcinoma with local extension to the cervical spine who presented with right upper limb weakness.
Introduction: Auditory hallucination (AH) is often unexplored in depth in clinical practice. This study sought
to ascertain the relationship between AH, depressive symptoms and quality of life (QOL) and its association
with socio-demographic and clinical variables.
Methods: This was a cross sectional study done in a
psychiatry unit involving 60 schizophrenic patients between 18 to 60 years old. Psychotic Symptom Rating
Scale – Auditory Hallucination subscale (PSYRATS-AH), Calgary Depression Scale for Schizophrenia (CDSS)
and World Health Organization Quality of Life-Brief scale (WHOQOL-BREF) were used as instruments.
Results: Alcohol intake was found to be significantly associated with the severity of AH. A significant
moderate positive correlation was found between AH total score and CDSS (r=0.53, p
Symptomatic arterial pseudoaneurysm is not an uncommon emergent
vascular case presenting to a tertiary hospital. These are mainly associated with
infection, iatrogenic puncture or trauma. The resultant morbidity, limb loss and
mortality present a challenge to the surgeons managing these cases. (Copied from article).
Acute appendicitis is the most common extra-uterine surgical emergency encountered during pregnancy, but an accurate diagnosis is still an enigma. Anatomical shifting of the appendix by the enlarging uterus makes the clinical and sonographic diagnosis difficult. Prompt diagnosis and treatment are essential to prevent perforation, which increases the risk of fetal and maternal death. Surgical intervention, either by an open laparotomy or laparoscopy is the most appropriate treatment for appendicitis. This article reviews the epidemiology, clinical diagnosis, investigation, complications and treatment of acute appendicitis in pregnancy.
Epidermoid cysts are rare, benign congenital tumours of ectodermal origin which typically present between
the third to fifth decade. These tumours comprise approximately 0.2-1.8% of all intracranial tumours. Though
these pearly tumours are potentially curable, subtotal resection may lead to catastrophic complications such as
recurrence, granulomatous meningitis and carcinomatous degeneration of cyst wall. We herein report the case
of a 36-year-old man who presented with an unusual mixed density posterior fossa epidermoid cyst on imaging
studies. Total removal not only cures both tumour and seizure attack in this case but also preserves patient’s
neurological function.
Introduction: There has been increasing evidence of detrimental effects of cumulative positive fluid
balance in critically ill patients. The postulated mechanism of harm is the development of interstitial
oedema, with resultant increase morbidity and mortality. We aim to assess the impact of positive fluid
balance within the first 48 hours on mortality in our local ICU population. Methods: This was a secondary
analysis of a single centre, prospective observational study. All ICU patients more than 18 years were
screened for inclusion in the study. Admission of less than 48 hours, post-elective surgery and ICU
readmission were excluded. Cumulative fluid balance either as volume or percentage of body weight from
admission was calculated over 6, 24 and 48 hour period from ICU admission. Results: A total of 143 patients
were recruited, of these 33 died. There were higher cumulative fluid balances at 6, 24 and 48 hours in nonsurvivors
compared to survivors. However, after adjusted for severity of illness, APACHE II Score, they were
not predictive of mortality. Sensitivity analysis on sub-cohort of patients with acute kidney injury (AKI)
showed only an actual 48-hour cumulative fluid balance was independently predictive of mortality (1.21
(1.03 to 1.42)). Conclusions: Cumulative fluid balance was not independently predictive of mortality in a
heterogenous group of critically ill patients. However, in subcohort of patients with AKI, a 48-hour
cumulative fluid balance was independently predictive of mortality. An additional tile is thus added to the
mosaic of findings on the impact of fluid balance in a hetergenous group of critically ill patients, and in subcohort
of AKI patients.
Runt-related transcription factor 2 (RUNX2) plays important roles in osteoblast
differentiation, tooth development and chondrocyte maturation; hence its involvement in
craniofacial development is paramount. Mutation in RUNX2 is implicated with cleidocranial
dysplasia; a bone development disorder, while single nucleotide polymorphism (SNP) in RUNX2 is
associated with Class II/2 malocclusion. This study aimed to determine RUNX2 SNP of DNA marker
(rs6930053) in malocclusion patients from local population. (Copied from article).
PAX9 (Paired box 9) gene is one of the genes which play significant role during
craniofacial development. Single nucleotide polymorphism (SNP) in PAX9 has been associated with
Class II/Division 2 malocclusion (with or without hypodontia). However, the relationship between
PAX9 SNP marker (rs8004560) with mandibular prognathism (MP) has not been analysed, at least in
our local population. This study aimed to detect the presence of PAX9 (rs8004560) SNP in Class III
malocclusion patients (with MP) in the local population. (Copied from article).
Evidence suggests that several genes; including MYO1H, play an important role in the
etiology of Class III malocclusion. Single nucleotide polymorphism (SNP) in marker rs10850110 (locus
12q24.11) within MYO1H gene has been associated with the incidence of mandibular prognathism
(MP). MYO is a class 1 myosin that is responsible for the synthesis of Matrilin-1; an important
protein involved in the formation of cartilage's extracellular matrix, hence is implicated in the
formation of mandibular condyle cartilage. This study aimed to detect the presence of MYO1H
(rs10850110) SNP and to determine its genotype and allele distribution in MP patient in the local
population. (Copied from article).
Introduction: According to the Youth Behaviour Risk Factor Surveillance (YBRFSS, 2011) in Malaysia, the prevalence of smokers nationally among Form 1, 2 and 4 students government secondary school students was 9.1% (ever smokers) and 8.7% (current smokers). However, there is limited information on the prevalence of smoking among religious secondary school students and self-esteem as risk factor. Thus, this study was conducted to determine the prevalence and factors associated with smoking among the religious secondary school students in Petaling district, Selangor.
Methods: A cross-sectional study was conducted among 899 students. The schools were selected using cluster sampling and self-administered questionnaire was used. Data was analyzed using chi-square test and multivariate logistic regression to identify the independent factors for smoking.
Results: The response rate was 94%. The prevalence of ever smoking was 10.1%; 3.9% among female and 18.6% among male. The median age (interquartile range) of smoking initiation was 12.00 (4.01) years. The results showed that independent factors for smoking were: males (OR= 5.47); age group 14-15 years (OR=2.82) and 16-17 years (OR=3.63) and having low self -esteem (OR=6.24).
Conclusion: prevalence of ever smokers is higher when compared to YBRFSS, (2011) and it was revealed that most of the smokers started smoking even before secondary school. The results also revealed the importance of promoting self-esteem. Efforts in smoking prevention should therefore be focused on curbing the initiation of the acts and improving students’ self-worth.
Medicinal plants become very important in our days for their therapeutic benefits to humankind. It sustains human health, and it is commonly known as herbal medicines since ancient times. Annona muricata is a heart-shaped fruit that is consumed raw or as the fruit juice in the tropical area. A. muricata is used in traditional and alternative medicine to treat different ailments such as diabetes, hypertension, respiratory and skin illness, inflammation and cancer. A. muricata contains essential anticancer agents named acetogenins that play the significant role in various cancer types. Acetogenins are strong nicotinamide adenine dinucleotide oxidase inhibitors of the cancer cell's mitochondrial membrane but showed neurotoxic effects in rats. Therefore, acetogenins need to be further investigated to determine the exact mechanisms of action, long-term safety, optimal dosage, and potential side effects. Given the extensive studies on A. muricata, this review focuses on the phytochemistry, medicinal uses, biological activities and the mechanisms of action for the fruit extracts and acetogenins, to stimulate further studies on the fruit pulp used for human consumption.
Introduction: In Malaysia, medical specialisation training is mainly carried out by the public universities. Methods: A survey was carried out to explore the views of medical specialists in the country on issues such as structure of medical specialty training, availability of human resource, public/private sector competition, competency and apprenticeship, and its impact on assurance and quality of medical specialty training. Results: Altogether 238 medical specialists from 30 hospitals and medical institutions in the country participated in the survey. Conclusion: Among the findings, competition for human resource between public and private sector and lack of uniformity on medical specialty training across universities in the country are among the issues found to be of concern. There is also a need to address governance issue which necessitates to clearly delineating what constitutes medical specialty and what constitutes a subspecialty so that an agreed uniformed nomenclature is exercised across all stakeholders. The respondents also strongly agreed on the need to ensure competence in medical specialist training.
Reproductive and Maternal health are an important components of public health and medicine which are concerned with the complete state of physical, mental and social wellbeing in all matters regarding reproductive system and health of mother especially during pregnancy.It implies ensuring that all women receive the care they need to be safe and healthy throughout pregnancy, childbirth and beyond. However, according to World Health Organization, millions of women all over the world do not have access to good quality health services during pregnancy and childbirth resulting in mortalities. Islam is a complete way of life. The Qur’an and Hadith consider pregnancy and child bearing as signs among other signs of the divine existence of Allah.The importance of maternal and reproductive is thus not unexplained in the Islamic perspectives. The study look at what role Muslim religious leaders can play in the prevention of maternal deaths and morbidities in developing countries. A qualitative study was conducted through in-depth interviews and focus groups discussion with a purposive sample of some Muslim religious leaders from Gusau local government area of Zamfara state northwest Nigeria in order to elicit information about the Islamic perspectives of reproductive and maternal health and the roles they can play in the prevention of maternal deaths among the Muslim communities. Muslim Religious leaders have a crucial role and contribution for the attainment and maintenance of good heath of women and children among Muslim communities through public enlightenment in the context of ‘ilm’, providing guidance through ‘Fatwah’ and community mobilization in the spirit brotherhood ‘ukhuwah’.Islam does not accept the “preventable death of a woman” due to childbirth or pregnancy. Thus, Islam encourages attendance of antenatal care visits and health care seeking.
Limb problem is a common complication for patients with diabetes. While the impact of diabetic limb problems
on physical health is well known, the psychological impact of the condition is still largely unknown. People with
diabetes with or without foot ulcers frequently suffer from major depressive disorder, and this is made worse
by the presence of limb complications. Furthermore, depression itself can have negative consequences on the
person’s diabetes. Hence, in caring for people with diabetic foot problem, the psychological sequelae must not
be overlooked but managed accordingly