Osteolytic disease of the bones have a myriad range of aetiology. One rare cause is Gorham’s disease
or disappearing bone disease. This disease is a diagnosis by exclusion using correlation made with
clinical presentation, radiological findings and histopathological confirmation. Although many different
therapies have been advocated, none have been successful in fully controlling this disease. We present a
case that was detected in a Chinese lady using diagnostic imaging, confirmed with computed tomography
guided biopsy and successfully treated with joint reconstruction using endoprosthesis.
Azadirachta indica (neem) has been used for a long time in agricultural and alternative medicine. Neem
had been proved effective against certain fungi that could infect human body. This pilot study aims to
demonstrate the antifungal effect of Malaysian neem leaf extracts on the pathogenic fungi in otomycosis,
Aspergillus niger and Candida albicans. This is a laboratory-controlled prospective study conducted at
Universiti Sains Malaysia. The powder form of Malaysian neem leaf was prepared. Ethanol and aqueous
extracts of the neem leaf was diluted with sterile water to establish five different concentrations of 50 g/
ml, 25 g/ml, 12.5 g/ml, 6.25 g/ml and 3.125g/ml. The extract was tested on Sabouraud Dextrose Agar
suspended with Candida albicans and Aspergillus niger respectively. Well diffusion method was used
and zone of inhibition was measured. Growth of the fungi was inhibited in both alcohol and aqueous
extract concentrations. The minimum inhibitory concentration (MIC) of Malaysian neem aqueous extract
against Candida albicans was 11.91 g/ml, neem ethanol extract against Candida albicans was 5.16 g/
ml, neem aqueous extract against Aspergillus niger was 7.73 g/ml and neem ethanol extract against
Aspergillus niger was 9.25 g/ml. Statistical analysis showed that the antifungal activity of Candida
albicans is better in alcohol neem than aqueous extract (p
With advancement in genetic studies, familial phaeochromocytoma (PCC) and paraganglioma (PGL)
are increasingly being recognized. Characteristically, correlations exist between genotypes and clinical
and biochemical phenotypes. We report a phaeochromocytoma in a young patient with intriguing family
histories, raising the possibility of his being a familial case.
Extracranial aneurysms are a rare presentation accounting for only less than 5% of all peripheral artery
aneurysms. The left common carotid artery aneurysm is considered even rarer. We present a case of a 46-year-old gentleman who presented to casualty unit with a neck mass, stridor and acute respiratory distress. Prior to this admission patient was being investigated for Takayasu arteritis (TA). Patient was subsequently intubated due to respiratory compromise. A CT angiography of the thorax was done
showed a proximal left common carotid artery aneurysm with contained leakage of aneurysm with
severe compression of the trachea. Patient was subsequently transferred to the vascular team in National Heart Institute for further management.
Defatted dabai peel contains a high amount of anthocyanin. Anthocyanins are known to prevent several
types of disease, including cardiovascular-related complications. This study aimed to describe the
effects of different doses of defatted dabai peel extract by histopathological analyses on lesions in the
liver, kidney, heart and aorta. Histopathology methods were applied to determine the protective effects
of defatted dabai peel extracts against hypercholesterolemia-induced oxidative damages to animal
organs. Haematoxylin and eosin staining was applied for histopathology examination for liver, kidney,
heart and aorta. Data showed that a high dose of defatted dabai extract (3000 mg per day) applied to
hypercholesterolemic rabbits for eight weeks had mild protective effect, especially reducing the severity
of hepatic fibrosis and steatosis of the renal medulla. The high dose of extract supplementation also
reduced inflammation of aorta and formation of atherosclerosis plaque in the cell wall of right ventricle
of the heart. The high dose of defatted dabai peel extract could be a protective agent against oxidative
Toxoplasmosis, caused by an intracellular protozoan parasite, Toxoplasma gondii, is widespread throughout the world. The disease is of major medical and veterinary importance, being a cause of congenital disease and abortion in humans and in domestic animals. In addition, it has gained importance recently due to toxoplasma encephalitis in AIDS patients. T. gondii was discovered 100 years ago. Its identification was rapidly followed by the recognition that it was a human pathogen. During the past 100 years, the spectrum of diseases caused by this ubiquitous pathogen has expanded to include both congenital and acute infections as well as the recognition of diseases caused by this pathogen in the immune-compromised host. Recent data on behavioural changes in animals due to chronic toxoplasmosis is leading to research on the effect of this pathogen on the behaviour of humans. Experimental studies on T. gondii have resulted in it becoming a model organism for studies on host pathogen interactions. Integration of clinical and experimental data on T. gondii should continue to lead to important insights into improvements in diagnosis for clinical management and vaccine development for control of toxoplasmosis.
Objective: The purpose of this study was to evaluate the clinical behaviour, pathological findings, survival and prognostic factors in young women in comparison to menopausal women with epithelial ovarian malignancy. Methods: A retrospective analysis of 141 patients (67 for age below 40 years and 74 menopausal) treated between 1980 and 2000 was conducted. Results: Irrespective of the stage, the most common clinical presentation was abdominal distension in both young (78%) and menopausal women (66%). In young women, 52% presented at an early stage of the disease and in menopausal women this was seen in 22% (p-value
Introduction: HIV/AIDS is one of the leading health problems worldwide. There is an increasing rate among the ages between 13 to 49 years old. School based intervention is an important component of community-based interventions for HIV/AIDS and is the best stage to promote abstinence which is best maintained among those not sexually experienced. Objectives: This study was carried out to determine attitude towards sex among secondary school children in Selangor state. Methods: A cross-sectional study design was used. Four out of nine districts in Selangor state were selected at random. Students were divided according to gender, academic performance (good or poor) with no behavioural problems
and students with evidence of behaviour problems (at risk). Results: Out of 149 students, the majority (56.4%) were females. The majority of students did not think sex should be discussed in depth and do not speak to parents, teachers, religious teachers, counselors, relatives, doctors or nurses but speak to friends regarding sex. More than half watch pornography. A significantly higher percentage of male students in the weak and at-risk group admit to thinking of intimacy (hugging and kissing) with the opposite gender. A higher number of these students would try sex out of curiosity, for fun, because it was difficult to say ‘no’ to and that they would like it. A significantly higher percentage will try sex because they did not want to hurt their girlfriends’ feeling by saying ‘no’. While the majority of students think intimacy will end in sex, a significantly higher percentage of male at-risk students think just talking with the opposite gender will end in sex. The majority of male students responded feeling attracted to the picture of a girl in sexy clothing but a significantly higher percentage of at-risk students also felt attracted to the picture of a girl properly attired. A significantly higher percentage of male at-risk students say parents do not say sex before marriage is wrong and a significantly higher percentage of
male students of weak and at-risk groups say girlfriends say sex before marriage is okay. A significantly higher percentage of weak and at-risk students speak to doctors regarding sex and think sex should be discussed in depth. Conclusion: Weak and at-risk male students appeared to have a more vulnerable attitude towards sex. This may predispose them to risky sexual behaviours leading to HIV/AIDS. Poor academic performance and behaviour problems may not be different as potential sexual risk predictors. The information obtained will be useful in designing intervention programmes in the prevention of HIV/AIDS.
Introduction: The incidence of diabetes mellitus (DM) is increasing globally and it is associated with significant morbidity and mortality. The importance of a better quality of diabetes care is increasingly acknowledged. Objective: This clinical audit was conducted to assess the quality of care given to type 2 DM patients in public primary care clinics. Methods: A clinical audit was conducted in two selected urban public primary care clinics, between April and June of 2005. The indicators and criteria of quality care were based on the current Malaysian clinical practice guidelines for type 2 DM. A structured pro forma was used to collect data. Results: A total of 396 medical records of patients with type 2 DM were included in this audit. Most of the patients had measurements of fasting blood glucose and blood pressure recorded in more than 90% of the visits over the previous one year. Twenty-seven percent of the patients had glycosylated haemoglobin (HbA1c) done every 6 months with a mean of 8.3%. Only 15.6% had HbA1c values less than 6.5 %. Fifty percent had blood pressure controlled at 130/80 mmHg and below; and 13.0% had low density lipoprotein cholesterol values of 2.6 mmol/L or less. The majority of the patients were overweight or obese. Conclusions: The quality of diabetes care in this study was
found to be suboptimal. There is a gap between guidelines and clinical practice. Certain measures to improve the quality of diabetes care need to be implemented with more rigour.
Introduction: Acanthamoeba is an ubiquitous free-living protozoa which causes serious ocular problems. Acanthamoeba keratitis is becoming more prevalent amongst contact lens wearers. The disease can cause loss of vision and blindness if not treated properly. The objective of this research is to study the sensitivity of six Acanthamoeba spp. isolates, of which three were from the clinical isolates (HKL 95, HTH 40 and HS 6) and the remaining three from environmental isolates (TTT 9, TL 3 and SMAL 8) to antimicrobial agents. Methods: The antimicrobial agents chosen for this purpose were polyhexamethylene biguanide (PHMB) and chlorhexidine. Serial dilutions were perfomed for polyhexamethylene biguanide and chlorhexidine. Cyst suspensions from the chosen isolates were exposed to PHMB and chlorhexidine respectively. After 48 hours incubation time at 30°C, each mixture was filtered and filtration membrane was put onto non-nutrient agar laid with Escherichia coli. The agar plates were incubated for three days at 30°C and examined daily until day 14 to detect the presence of Acanthamoeba trophozoites under the inverted microscope. The presence of trophozoites indicated the ineffectiveness of the antimicrobial agents. Results: Both of the antimicrobial agents tested were found to be effective against Acanthamoeba cysts from all the test strains. Polyhexamethylene biguanide gave a minimum cysticidal concentration (MCC) mean value of 2.848 μg/mL while chlorhexidine showed
MCC mean value at a concentration of 3.988 μg/mL. Conlusion: It can be concluded that the Acanthamoeba cysts were sensitive to polyhexamethylene biguanide and chlorhexidine.
Objective: A baseline functional magnetic resonance imaging (fMRI) study was carried out on a healthy right-handed male subject to attain further insights into the basic neuronal control mechanisms of bimanual and unimanual movements of hand fingers, an area that is still not fully understood. Methods : The study used the basic unimanual and bimanual movements of the left- and right-hand fingers to stimulate neuronal activity in the cerebral cortices. The subject was instructed to sequentially press his fingers either unimanually (UNI) or bimanually (BIM), against the thumb in a consistent alternative manner during the functional scans. The data were analysed using the MATLAB and SPM2 software packages. Results : Brain activations obtained via the F-test indicate a larger activation area as compared to that obtained from the T-test. The results showed that, the activated brain regions due to the self-paced finger movements are the precentral and postcentral gyrii covering the primary motor, premotor and somatosensory primer areas. The activestate signal intensity was found to be significantly (p < 0.05) higher than that of the resting-state. For UNI, brain activation showed contra-laterality with a larger activation area and a higher signal intensity at the point of maximum intensity for the left-hand finger
movement (UNIleft) compared to the right-hand finger movement (UNIright). Small ipsilateral activations were observed during UNIright and UNIleft. For BIM, the activation was observed in both hemispheres with the right hemisphere showing a higher signal intensity and coverage. The results support the fact that for a right-handed person performing either UNI or BIM type of movement, the activated motor area on the right hemisphere of the brain (movement of the left hand fingers) experience a higher intensity and larger coverage of hemodynamic response compared to the left hemisphere of the brain (movement of the right hand fingers). Analyses performed on the activated regions of interest (ROI) by
comparing the unimanual and bimanual types of activations revealed that during BIM, there are voxels in the left hemisphere controlling the movement of the left hand fingers (BIMleft) and voxels in the right hemisphere controlling the movement of the right hand fingers (BIMright). The interactions observed in this study resemble the existence of interhemispheric connection between both hemispheres during BIM. Conclusion : Although this is a single subject study, the hemodynamic response and the neuronal control mechanism in the cerebral cortices based on the BOLD mechanism can be studied and evaluated using fMRI and SPM.
Introduction: It is estimated that 4.9 million people worldwide died in 2000 as a result of their addiction to nicotine, about half of them prematurely. This huge death toll is rising rapidly, especially in low and middle income countries where most of the world’s 1.2 billion tobacco users live.
Objectives: This study aimed to determine (i) the prevalence of smoking among the community aged 18 and above in Terengganu state, and (ii) the relationship between smoking and age, sex, educational level, family and peer influence.
Methods: A cross-sectional study design was used in this study and data was collected using a standardised pre-tested structured questionnaire.
Results: The overall mean age of the respondents was 38.9 (95% CI= 37.7 – 40.2) years. The majority of the respondents were Malays (99.1%). Of the 653 respondents, 32.2% and 23.6% were ever and current smokers respectively. Of this, 211 ever smokers, 199 (94.3%) were males and only 12 (5.7%) were females. The prevalence of ever and current smokers for males was 73.2% and 53.7% respectively compared to the females (3.1% and 2.1% respectively). There was a significant association between smoking status and sex (p<0.001). The prevalence of ever smokers was lowest amongst respondents with college or university educational level. However, for current smokers, those with college or university education had the highest prevalence. The overall mean initiation age of ever smokers was 19.7 years (95% CI = 18.8 – 20.7). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001). The mean duration of smoking for the current smokers was 21.6 (95% CI= 19.1 – 24) years. There was also no significant difference in the mean duration of current smoking for males compared to the females (p = 0.5). The majority (93.4%) of the ever smokers started either because their friends asked them to try or they were trying for fun. The quit ratio was 27%.
Conclusion : The prevalence of ever and current smokers in males is very high (73.2% and 53.7% respectively) compared with the females (3.1% and 2.1% respectively). The mean initiation age for the males (19.1 years) was significantly lower compared to 29.8 years for the females (p<0.001). Key words: Smoking, prevalence, initiation age, duration, Terengganu state
Objectives: This study was carried out to determine the nutritional status of primary
school children aged 6 to 11 years in Sepang District and to compare the results with a
similar study carried out in 1999. Methods: This cross-sectional study was carried out in
Sepang District using stratified random cluster sampling technique. A pre-tested, structured
questionnaire was used to collect the data. Weight was recorded using a digital bathroom
scale TANITA model HD-309 and height was measured by using a SECA Body meter
Model 208. Body mass index (BMI) was calculated as weight in kilograms divided by the
square of height in meters. Classifications of the nutritional status of respondents was
based on WHO classification 1983 and 1995. Data were analysed using SPSS. Results:
The overall mean BMI for the 1,910 respondents was 16.8 (95% CI= 16.67 - 16.99;
SE=0.08). The median BMI was 15 .7 ranging from 9.51 to 36.75 kg/m2. The majority
(84.4%) had normal weight-for-age status, 7.6% respondents had weight-for-age status
below -2 SD of the NCHS-WHO median and 8.0% had weight-for-age status above +2 SD
of the NCHS-WHO median. The prevalence of underweight and overweight was significantly
higher in the males compared to the females (p< 0.05). There was a significant association
between underweight and ethnicity (p< 0.05). The majority (90.3%) had normal heightfor-
age status, 8.8% had height-for-age below - 2 SD of the NCHS-WHO standard median
and 0.9% had height-for-age above 2 SD from the NCHS median. The prevalence of
stunting was significantly higher in the male (10.3%) as compared to 7.4% in the females
(X2 = 5.11, P = 0.02). The majority (81.4%) of the respondents were within the normal
weight-for-height, 3.4% were wasted (weight-for-height was below - 2 SD of the NCHSWHO
median) and 15.2% of the respondents were obese (weight-for-height that is more
than +2 SD of the NCHS-WHO median). The prevalence of wasting was higher in the
females (4.1 %) compared to males (2.8%). The prevalence of obesity was slightly higher
in the males (15.4%) compared to females (14.9%). Conclusion: The overall nutritional
status of primary schools children is good. However, there still exists pockets of population
in Sepang where chronic and acute forms of undernutrition persist in these children.
Introduction: The content of polar compounds (PC) and polymeric triglycerides build up in fried and recycled/reused oils and therefore, these undesirable components are often used as markers of deterioration in edible oil quality. Expert and authoritative agencies have recommended an upper limit of 25% for PC in fried/reused edible oils; beyond this level the oil is considered unsuitable for human consumption. The safety of recycled or repeatedly-heated oils is still very much a concern of both the health authorities and the general public.
Objective: The present study evaluates the safety of long-tern consumption of heated vegetable oils containing 25% of PC on growth, effect on major body organs and reproduction outcome, using the Sprague-Dawley rat model.
Methods: Refined, bleached and deodorised palm olein (PO) and partially hydrogenated soybean oil (HSBO) were repeatedly heated for 5 hours daily with no topping-up at Isoac until a polar compound (PC) content of25% was attained. Refined soybean oil was similarly heated up to 50% PC and used in the positive control diet. All five experimental oils, namely unheated PO (No PC), heated PO (25% PC), unheated HSBO (No PC), heated HSBO (25% PC), and positive control oil (50% PC) were separately incorporated at 30% energy (15% w/w) as the sole dietary fat into nutritionally-adequate purified diets. Each experimental diet was provided ad libitum to a different dietary group comprising 14 male and 20 female Swiss albino rats. After 13 weeks (90 days), 10 males were selected from each group and each male was paired with two females from the same dietary group for the reproductive study. After 4 weeks into the reproductive study (total of 17 weeks on the experimental diets), all 10 males in each group were sacrificed and the usual toxicity tests consisting of blood cell type counts, liver and kidney function tests, and examination (organ-to-body weight ratios and histology) of the liver, kidney, heart and spleen were performed.
Results: The heated PO and HSBO diets were well-tolerated by the animals. However, these heated test oils inhibited growth marginally (p>0.05), enlarged the liver, kidney and heart, and markedly raised serum alkaline phosphatase (liver function test) compared to the unheated oils (p
Objective: To assess the prevalence of iron deficiency, anaemia and iron deficiency anaemia (IDA) in women aged 20-40 years and its association with iron intake. Methods: A total of 388 women were recruited from universities and work sites in Kuala Lumpur and its suburbs. The subjects comprised 135 Malays, 130 Chinese and 123 Indians. Dietary intake was estimated using a single 24-hour food recall and a semi-quantitative food frequency questionnaire. Haemoglobin (Hb), haematocrit (hct), mean corpuscular volume (MCV) and serum ferritin were determined. Results: The prevalence of anaemia (Hb
Introduction: Nasopharyngeal Carcinoma (NPC) is the second most common cancer among men in Malaysia. Establishing local data will help to improve the treatment strategies and lower the anxiety and depression level among NPC patients. Our aim was to compare the level of symptoms of anxiety and depression and the coping strategies employed between NPC and cancer-free patients. Methods: A comparative cross-sectional study with universal sampling was conducted on 22 NPC patients and 30 cancer-free patients from the Oncology and Radiotherapy Department and Ear, Nose and Throat clinic of Hospital Kuala Lumpur (HKL) between 12 to 29 May 2008. In this study, the symptoms of depression and anxiety were obtained by using the Hospital Anxiety and Depression Scale (HADS) while Brief COPE questionnaire was used to understand patients’ coping strategies. Results: The prevalence of NPC was higher in the Chinese, men, aged between 40 and 59 years, and those from the lower income group. The levels of anxiety and depression symptoms were found to be higher in the NPC group as compared to the cancer-free group. However, only the level of depression was found significantly related to the NPC group (p=0.002). This study also found that the two comparison groups were
using different types of coping strategies. The NPC patients mainly used ‘acceptance’ as their coping strategy while the comparative group most often used ‘religion’. Among the types of coping strategies reported by the patients, ‘use of instrumental support’ type was found to be associated with a lower level of anxiety (p = 0.035) and ‘humour’ type was associated with lower depressive symptoms (p = 0.269). On the contrary, ‘selfblame’ type was associated with both anxiety (p =0.0001) and depression (p = 0.001) symptoms. In addition, patients with different gender, ethnicity, educational levels, and
monthly income were also found to have significant differences in their levels of anxiety and depression as well as type of coping strategies. Conclusions: NPC patients had higher anxiety and depression levels as compared to the comparative group. Different socio-demographic backgrounds and different types of coping strategies had an influence on patients resulting in different levels of anxiety and depression.
Study site: ENT clinic, Hospital Kuala Lumpur, Malaysia
Introduction: Splenic pseudo-aneurysm is an uncommon complication following splenic injury caused by blunt abdominal trauma. Pseudo-aneurysm is usually treated with splenic arterial embolisation. Spontaneous thrombosis of a splenic pseudo-aneurysm can occur but it is rare. Method: We report a case of spontaneous thrombosis in a post-traumatic splenic pseudo-aneurysm. The patient was managed conservatively as he was haemodynamically stable with a repeat CT scan on the 7th day showing a tubular enhancing structure in the upper pole of the spleen demonstrating the same attenuation value .
Conclusion: This case illustrates a spontaneous resolution of splenic pseudo-aneurysm, which is a rare outcome of the condition.
Cancer immunotherapy is a form of treatment protocol for cancer patients that has been studied intensively over the last two decades. The undesirable side effects during the course of conventional treatment has lead to the development of immunotherapy as an alternative treatment modality. This approach encompasses the use of three different strategies with various immunotherapeutic modalities including (i) cytokines and monoclonal antibodies; (ii) activation of antigen presentation cells (APC) by using antigen-specific peptides or sources of antigens such as tumour lysate; and finally (iii) adoptive transfer of ex vivo activated autologous cytotoxic T-cells. Due to specific-targeting by antigen-specific monoclonal antibodies, dendritic cells and activated CD8+ T-cells, immunotherapy can eliminate tumour
cells efficiently but the normal tissues are unaffected. Despite years of investigation, the outcome of immunotherapy-based clinical trials are inconsistent with very low response rates from patients. Several mechanisms have been proposed to contribute to this failure including the presence of regulatory T-cells (Treg), immunomodulatory cytokines, and aberrant gene expression in tumour cells. This review summarises information from about 140 articles and review papers. In addition, it also provides an update on recent trends in combinational immunotherapy with conventional therapy and encouraging results have been obtained. Reevaluation of previous studies is necessary to fine-tune the design and approach of immunotherapy to ensure better treatment outcomes.
Malaria remains one of the most important infectious diseases worldwide considering that 40% of the world’s population live in health risk areas and millions of febrile episodes due to malaria infection occur annually in children under the age of five in Africa alone and almost 3 million patients, primarily children, die each year. Among the various measures envisaged, to contain the disease, the concept of a vaccine to protect humans against malaria appears particularly attractive. The development of an effective malaria vaccine represents one of the most important approaches to provide cost-effective intervention, in addition to currently available malaria control strategies. Here, we review malaria as a public health problem and the status and promise in malaria vaccine development.
Objective: This study was conducted to determine prevalence and factors associated with obesity in Selangor, Malaysia. Methods: A population-based cross-sectional study was conducted in all districts of Selangor State. All individuals, 15 years and above in the selected households, were included. A pre-tested structured questionnaire was used to collect the data. Weight was recorded using TANITA model HD-309 and height was measured using SECA Body meter Model 208. Statistical analysis was performed using Stata 8.2 taking into account the complex survey design. Results: The overall mean age of the 2219 respondents was 36.6(95% CI 35.7 – 37.6) years. There was no significant difference in the mean age of the males and females (p=0.697). The majority of the respondents were Malays (52.9%), followed by Chinese (30.9%), Indians (15.4%) and
other races (0.9%). The overall mean BMI was 24.1 kg/m2 (95% CI=23.8- 24.4). The overall prevalence of obesity was 12.2% (95% CI 10.6%, 14.0%). There was no significant difference in the prevalence of obesity in the males compared to females (p>0.05). The prevalence of obesity increased with age up to the ages of 40-59 years and then decreased after 60 years. The highest prevalence of obesity was in the 40-59 years age groups in both sexes. The overall prevalence of obesity was significantly higher amongst the Malays (15.2%) compared to the Indians (11.6%) and Chinese (7.3%). Multivariate logistic regression analysis showed that only age and ethnicity were associated with obesity. Sex and educational level were not associated with obesity.