Introduction: The mental foramen is present on either side of the body of the mandible bone. This foramen
transmits mental vessels and nerves. In forensic anthropology, mental foramen may be important for
differentiating sex, estimating age and identifying various races based on morphology. The main aim of the
present study was to determine the position, shape and diameter of the mental foramen according to sex,
age and race by postmortem computed tomography in the Malaysian population.
Materials and Methods: A total of 79 dentulous patients (48 males, 31 females) from 3 age groups (18-30 years, 31– 50 years, 51-74
years) were selected for this study, and ten parameters were observed for each mandible. The parameters
were divided into two morphological and eight morphometric parameters. The morphometric parameters
were measured by using Osirix MD Software 3D Volume Rendering.
Results: Results showed that mandibular
body length and height were significantly greater in males than in females by independent t-test. (p< 0.05).
However, the mandibular body height was found to decrease significantly with age in both sexes by one-way
Anova. It was observed that the shape of mental foramen was 45.6% oval and 54.4% rounded. About 44.3% of
them were in line with the longitudinal axis of the second premolar tooth.
Conclusion: It was concluded that
mental foramen may be used for identification purposes, particularly for sex, age and race determination.
Introduction: The purpose of this study is to identify the incidence of clavicle fractures in newborn
associated with fetal, maternal and process of deliveries in Kuantan General Hospital from June 2012 until
January 2014. This study is to determine epidemiological data of clavicle fractures, maternal and baby risk
factors associated with clavicle fractures of newborn and its’ outcome.
Methods: This is a prospective
study. 13 patients were identified to fulfill the inclusion criteria of the study. The data of
sociodemographic, associated fetal and maternal risk factors and the outcomes were recorded using
proforma. The statistical data analysis was done using SPSS 12.0.
Results: Out of 20,257 live births at our
centre during the study period, 13 infants were diagnosed to have clavicle fractures, giving an incidence of
0.64 per 1000 live births. There were 5 (38.5%) left, 7 (53.8%) right and one (7.7%) bilateral fracture. All
fractures located at the mid shaft of the clavicle and none have associated brachial plexus injuries. All
infants were delivered through vaginal delivery (61.5%); five through assisted delivery (instrumental); 2
(15.4%) forcep and 3 (23.1%) vacuum. Two of the babies developed shoulder dystocia. The average birth
weight was 3371 grams (SD 0.269) and mean gestational age was 38.7 weeks (SD 1.16). Five of the mothers
(38.5%) were primigravida and eight (61.5%) were multigravida in which,7 (53.8%)were healthy without
other co-morbidty, 5 (38.5%) having gestational diabetis and one (7.7%) hypertension. The average maternal
weight was 62.0 kg and height 1.58 metres with average BMI of 24.16 (3.29SD). All eventually had a
complete recovery at 6 weeks with clinical and radiological evident of fracture union.
Conclusions: In
conclusion, all patients with clavicle fractures were found following vaginal delivery. There were no
associations between neonatal clavicle fractures with maternal or baby risk factors. All fractures healed
without any complications.
Introduction: A few studies investigated the numerous potential endodontic uses of CBCT, including the
examination of root canal morphology and presumed that CBCT was effective for the initial identification of
such morphology; moreover CBCT is a reliable method for the detection of the MB2 canal when compared
with the gold standard of physical sectioning of the specimen. The aim of this study was to identify the root
and canal morphology of the maxillary first molars among Malaysians analysed by cone-beam computed
tomography (CBCT) images.
Materials and Methods: Maxillary first (n = 421) molars from Malaysian patients
(n = 241) of Malay, Chinese and Indians inceptions were examined by two Endodontists using in vivo CBCT
methods. The number and configuration of roots, the number of root canals, and the canal configuration
according to Vertucci’s classification were determined.
Results: Single roots were not found in maxillary
first molars. The incidence of fused roots was 1.995% in the first molars between mesiobuccal and
distobuccal roots. In (421) 3-rooted maxillary first molars, additional canals were found in 45.6% of the
mesiobuccal (MB) roots and 0% of the distobuccal (DB) roots. Bilateral symmetry of the MB roots was found
in 82.36% of the first molar. Only one tooth was found to have pulp stone inside the pulp chamber.
Conclusions: The root and canal configuration of a Malaysian population showed different features from
those of other populations. CBCT scans can enhance the understanding of root canal anatomy, with the
potential of improving the outcome of endodontic treatment.
Introduction: Obesity has been recognized as a major public health concern due to lack of physical activity and a sedentary lifestyle. Methods: This cross sectional study was carried out to determine the status of body mass index (BMI) and habitual physical activity level among staffs working in Military Hospital, Malacca using Habitual Physical Activity Questionnaire (HPAQ). Results: About 120 HPAQ were distributed and only 82 responded with 23(28%) of them males and 59 (72%) females, aged between 21 to 59 (40.52 ± 9.38) years old. Anthropometry analysis showed the mean weight of male respondents was 79.48 (± 16.33) and 70.95 (± 15.66) for the females. Body mass index (BMI) for males (33.61 ± 2.82) was almost similar to females ( 33.20± 2.95).The mean waist circumference of men was 93.26 (± 10.94)cm compared to 94.03 (± 11.98)cm in the females. Following categorization of BMI, 59% (n=48) are in the obese group, 24% (n=20) are overweight and only 17% (n=14) have an ideal body weight or normal BMI. Relationship between BMI and HPAQ demonstrated strong and significant correlation coefficient for habitual physical activity at work (r = 0.775, p < 0.001), sports (r = 0.735, p < 0.05) and leisure ( r = 0.713, p < 0.001). Conclusion: The staffs working in the Hospital demonstrated poor habitual physical activity which explains for the high incidence of obesity among the staffs. This requires measures to be taken to promote a healthier lifestyle among them.
We report a-56-year old army pensioner who presented initially to a peripheral hospital with acute ST-elevation inferior myocardial infarction thrombolysed with streptokinase. He was subsequently referred to the National Heart Institute (Institut Jantung Negara, Malaysia) for coronary revascularization. Coronary angiogram revealed an ectatic right coronary artery with discrete lesions at the proximal and distal segments stented with bare metal stents (BMS). Post dilatation shots revealed a wire-induced, distal dissection at the posterior left ventricular artery remedied by balloon angioplasty but resulting in balloon-induced crumpling of the distal BMS. We discuss the importance of sequential, distal-to-proximal coronary intervention, stent crumpling and remedial strategies.
Introduction: Hypertension is one of the most important risk factors for cardiovascular disease in Malaysia. The prevalence of hypertension nearly doubled over a ten-year period (1986 – 1996). This has resulted in a significant rise in its attendant cost. We aim to review the institutional anti-hypertensive use, the cost incurred and the implications on management in our local setting. Materials and Methods: A retrospective review of the annual cost (2006) of anti-hypertensive medications was undertaken at the Department of Pharmacy, Hospital Tengku Ampuan Afzan, a 600-bed major regional hospital on the east-coast of Malaysia. The total number of prescriptions given out and the total cost per drug is then factored to give the annual cost per drug per person in a percentage of the total annual expenditure.Results: The majority of patients were on either 2 (46.5%) or 3 (25.9%) anti-hypertensives. The most frequently prescribed medications were ACE Inhibitors (33.45%), Calcium channel blockers (29.63%), diuretics (16.67%) and β-blockers (13.64%). In terms of cost however, the Calcium channel blockers constituted the greatest percentage of the annual anti-hypertensive budget (63.67%) compared to ACE Inhibitors at just 20.04% of the annual expenditure. The least costly group of drugs is the diuretic making up 16.67% of the total annual prescriptions but only constituting 1.23% of the annual cost. Conclusion: The majority of patients were on ACE Inhibitors and/or Calcium channel blockers. This has huge monetary implications as they represent a large proportion of the annual antihypertensive allocation. There may be a need to reverse the trend in the developing world due to cost restrictions.
Jehovah’s Witness followers pose a clinical dilemma to the medical practitioners due to their religious belief of an absolute prohibition of blood transfusion under any circumstances. We present a case of Jehovah’s Witness follower who underwent an ultra-low anterior resection for rectal cancer after neo-adjuvant chemo-radiotherapy. The challenges in the perioperative management are highlighted and managed accordingly.
Inflammatory pseudotumour (IPT) is a rare benign solid tumor in adults and children. The prevalence, etiology and pathogenesis of this condition are still uncertain. Despite the use of modern laboratory techniques and imaging, it is often difficult to make the diagnosis of IPT. Besides, occasionally the nonspecific morphological appearance and clinical presentation of the mass may mimic other more common primary or secondary neoplasms. IPT is commonly encountered in the lung and mediastinum. Other sites include abdomen (liver, pancreas, stomach, omentum), retroperitoneum, pelvis (bladder) and extremities in children. We report a rare case of gastric inflammatory pseudotumour in a 65-year-old female patient. Clinical presentations and its management along with review of literatures are presented.
Plasma total homocysteine levels (tHcy) is lowered by high insulin levels, and it can be elevated in insulin-resistant states. However, it is uncertain whether plasma tHcy and insulin or any components of the metabolic syndrome has any relationship among hypertensive individuals. In this study the tHcy and insulin concentrations were measured by enzyme immunoassay techniques in samples from 41 (27 male and 14 female) participants. Components of the metabolic syndrome (insulin resistance) profiles were also evaluated. The participants’ age ranged from 31 to 67 years (mean+SEM, 52.1±1.3 years), body mass index from 20.2 to 38.3 kg/m2 (27.2±0.7 kg/m2), plasma tHcy concentration from 6.9 to 16.2 μmol/L (11.0±0.4 μmol/L), and plasma insulin 3.0 to 16.6 μIU/mL (7.3±0.5 μIU/mL). A significant negative correlation was found between tHcy concentrations and insulin levels (r=-0.358, P=0.011), but not with other variables (P>0.05). In conclusion, the tHcy concentration is significantly related to plasma insulin in hypertensive subjects. tHcy concentrations were independent of the components of the metabolic syndrome and other risk factors of coronary heart disease in hypertensive subjects.
Introduction: This cross-sectional study aimed to determine association of age and gender with dental treatment need among first-visit patients at Dental Outpatient Clinic, IIUM Kuantan in 2016.
Materials and Methods: Ethical approval (IREC 762) was obtained from IIUM Human Ethics Committee. List of first-visit patients who attended clinic from 1st January to 31st December 2016 was retrieved to assess patient's age and gender. Dental treatment need was determined according to the normative need which was professionally defined by dental-officer-in-charge. All first-visit patients were included, except those attended Orthodontic department or with old Malaysian identification card or foreign passport. Included patients were classified into six age groups (≤14, 15-19, 20-34, 35-44, 45-64 and ≥ 65). Pearson's chi square test was used for statistical analysis using SPSS Version 20 software.
Results: From a total number of 2,713 patients (age range of 2 to 87), 1,210 (44.6%) were males and 1,503 (55.4%) were females. Age (p<0.001) and gender (p<0.001) were significantly associated with dental treatment need. Paediatric patients (≤14) majorly received paedodontic care (97.5%). Young-age patients (15-19, 20-34 and 35-44) mostly required conservative care (39.5%, 31.2% & 30.6%, respectively) while elder-age patients (45-64 and ≥ 65) have major need for prosthodontics (30.0% & 40.2%, respectively). Females outnumbered males in all age groups, except for the age group of ≥ 65 whereby the situation was the opposite. Females also outnumbered males in all types of treatment need, except for periodontics which was predominated by males.
Conclusion(s): Age and gender have significant associations with treatment need for dental care.
KEYWORDS: treatment need, dental, association, age, gender
Introduction: Breast cancer is the most common cancer among women. Psychosocial distress, in the forms of depression and anxiety, regularly accompanies breast cancer diagnosis and throughout its treatment. Hence, it is important to objectively assess the therapy options that may help this distress. One of the most flexible psychotherapy modalities is the art therapy as it may be incorporated in many settings. The purpose of this systematic review is to determine the efficacy of art therapy (via creative paintings) on the mental health outcomes of female breast cancer patients. Material and Methods: Related articles were identified from Medline (OvidSP), ScienceDirect, Pubmed, EbscoHost-Academic Search Premier and Wiley Online Library. Screenings were performed based on the criteria that the study must be a randomised control trial (RCT) that investigated the effect of art therapy in breast cancer. Data were extracted using standardised forms, followed by evaluation of quality of reporting using CONSORT Guidelines. Results: Six RCTs were identified. Based on the heuristic synthesis of data extraction results, none of the studies can be considered as studies with acceptable quality, although four of them showed promising results. Conclusion: There is inconclusive evidence of the efficacy of art therapy (via creative paintings) for the improvement of mental health outcomes among female breast cancer patients.
Introduction: The Medical Faculty of Universiti Sains Islam Malaysia (USIM) aims to produce good Muslim
doctors (GMD) who are able to practise medicine that is integrated with Islamic values. Islamic courses and
Medical Ethics are integrated into the curriculum in its effort to provide adequate Islamic knowledge and
nurturing professionalism as a process of personal and professional development (PPD) within the framework
of Islamic teaching. The objective of the study was to evaluate the perception of graduates and students of
characteristics of a GMD. Method: A self-administered questionnaire was distributed to the participants. The
respondents were asked to rate their level of agreement or disagreement on the statements that represent
the characteristics of a GMD. Statistical analysis of the data was carried out using SPSS version 18.0. The
mean, median and inter quartile ranges of the characteristics were determined and differences between the
groups were analysed using Mann-Whitney U test. Results: Results showed significant difference between
gender for the item “Conscious of professional ethics” (p=0.021). Significant differences were seen in the
median scores between the graduates and the final year students in four out of six items for personal
characteristic. Conclusion: Islamic input in the medical curriculum and the teaching of professionalism has
an impact on graduate perception of characteristics of a GMD. Further improvement in the teaching of
professionalism among undergraduates is necessary in order to promote greater impact on the understanding
and internalization of characteristics of a GMD. The Islamic input in the medical curriculum can thus be
regarded as the blueprint for PPD of medical undergraduates to become a GMD.
PURPOSE: This review was performed to determine the association between demographic characteristics and the histopathological findings of colorectal cancer (CRC) patients operated in Hospital Tengku Ampuan Afzan (HTAA) Kuantan Pahang Malaysia. METHODS: We retrospectively reviewed the histopathological reports of 119 CRC cases operated in HTAA from January 2001 to December 2005 which met the inclusion criteria of histologically proven adenocarcinoma. The following demographic characteristics which include age, gender, and ethnicity were assessed. The histopathological related variables which include the site of primary tumor, Astler and Coller stage, tumor differentiation and lymph node metastasis were analyzed. Chi square test was used for categorical variables. Data with low expected counts were assessed using Fisher’s exact tests. RESULTS: There were 59 males and 60 females with age ranging from 23 to 93 years. 81.5% of the patients were older than 50 years (p=0.038). Malays accounted for 58.8% of the total cases, followed by Chinese (36.1%) and Indian (5%). Rectosigmoid region and rectum were the most common sites for primary tumor (55.6%). Cancer in male predominantly occurred in the rectum (p=0.023). Malays were commonly diagnosed with stage C2 (54.3%) while Chinese were diagnosed with stage B2 (58.1%) (p=0.011). Fifty percent of the patients who are less than 50 years old were diagnosed with stage C2 (p=0.024). There was significant change from well to moderately differentiated adenocarcinoma (p=0.000). Sixty percent of female patients diagnosed to have cancer with lymph node metastasis (p=0.044). Significant lymph node metastasis was also observed among Malay patients (p=0.022). CONCLUSION: The findings from the present review suggest that there are several associations between demographic distribution and histopathological characteristics of CRC. More than fifty per cent of CRC are found in the rectosigmoid region and the rectum. CRC are more common in Malay race and rectal cancer is predominantly affecting the male. About forty five percent of patients harbor metastases in the lymph nodes and fifty percent of the younger age group were presenting with nodal metastases.
Plasma Cystatin C (CysC) is as an early functional marker for acute kidney
injury. Estimates of glomerular filtration rate using CysC (eGFRCysC) has been used in
some clinical setting. We evaluated the utility of CysC and eGFRCysC in diagnosing acute
kidney injury (AKI) and predicting death in critically ill patients with sepsis. (Copied from article).
Kinetic estimate of GFR (keGFR) is a more accurate estimate of GFR in the
acute settings with rapidly changing kidney functions. It takes into account the changes
of creatinine over time, creatinine production rate, and the volume of distribution,
however needs serial measurement of creatinine. We evaluated which methods of the
conventional eGFR measurement best correlates with keGFR. This could assist clinicians
in using a simpler method of calculation and is useful in the absence of serial plasma
creatinine. (Copied from article).
Urine output provides a rapid estimate for kidney function, and its use has been incorporated in the diagnosis of acute kidney injury. However, not many studies had validated its use compared to the plasma creatinine. It has been showed that the ideal urine output threshold for prediction of death or the need for dialysis was 0.3 ml/kg/h. We aim to assess this threshold in our local ICU population.
High frequency oscillating ventilation (HFOV) provides a rescue therapy for patients with refractory hypoxaemia in severe acute respiratory distress syndrome (ARDS). HFOV utilizes high mean airway pressures to maintain an open lung and low tidal volumes at a high frequency that allows for adequate ventilation while at the same time preventing alveolar overdistension. This seems to be an ideal lung protective ventilation strategies to prevent ventilator-induced lung injury (VILI)2. We reported a case of severe extrapulmonary ARDS secondary to acute lymphoblastic leukaemia responding to the use of HFOV.
Introduction and Objectives: The intensive care unit (ICU) is an uncomfortable and stressful environment for patients. The use of adequate sedation and analgesia is important to reduce stress to patients. The aim of this study was to compare a relatively new sedative agent, dexmedetomidine to current sedative agent used, propofol in the provision of sedation and analgesia, their effects on haemodynamic and respiratory parameters and cost involved on post open heart surgery patients. Materials and Methods: A prospective, randomized single-blinded trial was conducted on post open heart surgery patients in the ICU of the Hospital Universiti Sains Malaysia (HUSM). Thirty two patients were randomized to dexmedetomidine or propofol groups. Analgesic requirement, haemodynamic and respiratory parameters, and extubation time were measured and compared. Mean rate of infusion to achieve adequate sedation were used to calculate the cost involved in the use of these two agents. Results: Patients sedated with dexmedetomidine required significantly lower dose of morphine compared to propofol [mean (sd): 12.80 (2.61) versus 15.86 (1.87) mg/kg/min, p=0.00]. Mean heart rate was also significantly lower in dexmedetomidine group compared to propofol group [mean (CI): 74.48 (70.38,78.59) versus 83.85 (79.61,88.09) per minutes, p=0.00]. However there were no significant differences in the other parameters between the two groups. Cost involved the use of dexmedetomidine was slightly higher compared to propofol (RM 9.57 versus RM8.94 per hour). Discussion and Conclusions: Dexmedetomidine is comparable to propofol in the provision of sedation, and its effect on haemodynamic and respiratory parameters. However it has added advantages in the provision of analgesia, and caused a significant reduction in heart rate. This is beneficial in these patients by reducing myocardial oxygen demand, and hence subsequent ischaemia and infarction. However, further larger studies are needed to evaluate the effect of dexmedetomidine on perioperative cardiac morbidity and mortality.