Aneusomy is an early genetic event and a characteristic feature of many solid tumors. It is often associated with poor prognosis in cancer patients. The involvement of PAX8-PPARγ rearrangement in tumorigenesis of follicular thyroid lesions has been widely assessed. However, there were few reports on aneusomy of the PPARγ gene at the 3p25 locus in follicular thyroid lesions. It remains undetermined whether these abnormalities can be translated into improved diagnosis, classification, or outcome prediction. Herein, we report three cases of follicular thyroid neoplasms [two follicular thyroid carcinomas (FTCs) and one Hurthle cell adenoma (HCA)] with 3p25 aneusomy detected by fluorescence in situ hybridization (FISH). 3p25 trisomy was observed in one FTC and one HCA while 3p25 tetrasomy was observed in one FTC. Furthermore, all three lesions did not show overexpression of PPARγ protein. Hurthle cell neoplasms (HCN) are distinct clinically and histologically from other follicular thyroid neoplasms (FTN). However, the presence of the aneusomy in HCA and FTC indicates that there could be a biological continuum between the two and chromosomal gains might play an important role in the pathogenesis of these two types of neoplasms. Despite their differences, HCN and FTN may share the same early genetic event in tumour development.
Myelofibrosis is a chronic myeloproliferative disorder characterised by splenomegaly, leukoerythroblastic anaemia, tear-drop poikilocytosis and marrow fibrosis. Splenectomy is indicated for patients requiring frequent transfusions or massive splenomegaly causing distressing symptoms and severe thrombocytopenia secondary to hypersplenism.A 56 year-old lady diagnosed to have primary myelofibrosis in year 2000 was referred to HUKM for further management of her increasing requirement of blood transfusion and massive splenomegaly. She has had two episodes of acute cholecytitis. Investigations done in our hospital showed that her hemoglobin level was 6.4g/dl, white cell count of 23.4x109/l, platelet count 163x109/l and peripheral blood showing leukoerythroblastic picture and tear-drop poikilocytosis. Leukocyte alkaline phosphatase score (NAP) was 184/100 neutrophils. Ultrasound of the abdomen showed massive splenomegaly with multiple gall stones. In view of the frequent transfusion requirements and symptomatic massive splenomegaly, splenectomy and cholecystectomy was performed. A review of her peripheral blood picture, post-splenectomy, showed marked reduction of the tear-drop poikilocytosis and leukoerythroblastosis. We believe that the spleen plays an important role in their formation, but the exact mechanism remains unclear.
Amitraz poisoning is rare and there has been no reported cases in the Malaysian literature. Ingestion of this compound carries many life threatening side effects. We describe a case of Amitraz poisoning in an 18 years old young adult. He developed hypotension, required ventilatory support and a day of intensive care unit stay. He had a quick recovery after he was treated symptomatically and was discharged well after 3 days.
Fractures may occur after an episode of seizures. Although rare, with a high index
of suspicion and proper physical examination, delay of diagnosis and treatment
can be avoided. We report a case of near missed bilateral proximal humerus
fracture after an episode of generalized tonic-clonic seizure. A 58-year-old lady
with a background history of epilepsy complained of generalized body ache after
a generalized tonic-clonic seizure which happened few hours before presentation to our Emergency Department. On assessment, she was in pain and unable to
move all four limbs. After given analgesia, patient was reassessed whereby she
complained of bilateral shoulder stiffness and pain. Examination of the upper limbs
revealed restricted range of movement in all directions with no shoulder squaring.
X-ray showed bilateral proximal humerus fracture. Proximal humeral fractures
rarely occur by itself following seizures; they are almost always associated with
dislocation of the glenohumeral joint.
Proximal stability consists of core and hip stability play a significant role in supporting the body weight in stationary and in motion. Thus, proximal stability could contribute to knee osteoarthritis (OA). Therefore, this study was carried out to determine the core stability and hip stability of knee OA patients. A total of thirty-two women aged between 45 to 60 years had volunteered to participate in this study, comprised of 16 knee OA patients and 16 normal. Hip stability was assessed using hip crossover test and core stability was assessed using core muscle endurance, core muscle strength and core muscle flexibility. Data of hip stability, core muscle strength and flexibility were analyzed using chi-square; and core muscle endurance data were analyzed using independent sample t-test. Compared to normal subjects, knee OA patients have poor hip stability [Hip Crossover Test (λ=0.500, p=0.033)] and core stability. Core stability was assessed based on core muscle strength [abdominal muscles (χ=12.157, p
Cardiopulmonary capacity should be evaluated accurately to determine exercise intolerance and training intensity of stroke survivors before an exercise rehabilitation programme is prescribed. However, no cardiopulmonary exercise test (CPET) is suitable because of the stroke victims’ physical impairment. The aim of this study was to develop and validate a new rowing-ramp protocol as a CPET for stroke survivors. Eleven stroke patients (6 male; 5 female; age, 45 + 16.01 years, performed two incremental exercise tests on a Concept II rowing ergometer to determine the peak oxygen consumption (VO2 peak). Test-retest reliability for VO2 peak, measured 1-week apart, resulted in an intra-class correlation of 0.97 and 0.95, respectively. A linear regression equation was developed to predict the VO2 peak from final stage stroke power. Validity and reliability of the prediction equation were established. The regression equation for predicted VO2 peak was VO2 peak=11.429±+ 0.232 (Final Stage Stroke Power) + 12.63 (F=25.326, p
The aim of this study was to investigate the prevalence of postnatal urinary incontinence (PNUI), the risk factors associated with it and postnatal women’s (PN) level of engagement in practicing traditional Malay confinement care (TMCC) in Kelantan, Malaysia. A cross-sectional survey was conducted among 362 postnatal women aged between 18 – 45 years and who were between three to five months post-delivery. Participants were selected through convenience sampling at six Maternal and Child Health Clinics located in comparatively similar districts. Descriptive and inferential analyses including, factor analysis, Pearson chi-square, Mann-Whitney U test and logistic regressions analysis were used for data analysis. Overall, PNUI was reported by 80 women (22.1%). Vaginal delivery was associated with PNUI. All PN women within the study context practiced TMCC. The findings revealed that women who had PNUI were more likely to engage in a higher level of the ‘Body care’ component of TMCC. UI is prevalent among PN women in Kelantan, Malaysia. Further research into the impact of the ‘body care’ component of TMCC on PNUI is required.
Kateter Vena Cenral boleh tercabut dengan senang daripada tubuh badan.
Artikel ini membincang tiga teknik terperinci yang berinovasi untuk mengelakkan
berlakunya insiden kateter tercabut. Penempatan leher kateter kira-kira 1cm dari
tempat kateter keluar pada bahagian kulit dengan jahitan tambahan di bahagian
leher kateter membantu mencegah insiden kateter tercabut.
Basal cell carcinoma (BCC) of the scrotum is uncommon and its pathogenesis is not well understood. The clinical behaviour of scrotal BCC is thought to be more aggressive and has a higher metastatic potential than BCC of other regions. The mainstay of treatment for localized scrotal BCC is wide local excision, while metastatic disease may need systemic chemotherapy for palliative control. A rare clinical scenario of scrotal BCC presenting concurrently with another metastatic cancer has never been reported. The present case illustrates the diagnostic challenge and management dilemma due to simultaneous presentation of scrotal BCC and metastatic squamous cell carcinoma (SCC). A 70-year-old man complained of a non-healing scrotal ulcer while he was being investigated for metastatic squamous cell carcinoma (SCC) of the external auditory meatus. The scrotal lesion was initially thought to be metastatic SCC. It was later confirmed to be BCC with biopsy and histopathological examination. He underwent surgical resection of the scrotal BCC for local control followed by palliative chemotherapy with cisplatin and radiotherapy for lymph node metastases. He remained well and did not have any local recurrence following 6 months after palliative treatment. Surgery coupled with palliative chemoradiation can offer good quality of life for patients with scrotal BCC and concurrent metastatic SCC.
Keywords: basal cell carcinoma, squamous cell carcinoma, scrotum
Long term glucocorticoids administration induces oxidative stress which leads to alteration of bone structure and strength. Palm oil is rich in tocotrienol, an antioxidant. It can be used for the prevention of oxidative stress related diseases. The main objective of this study was to determine the mechanism of palm tocotrienol in maintaining the bone structure and strength in glucocorticoidinduced osteoporosis. Thirty two adult male Sprague-Dawley rats, aged 3 months, weighing 300-320 g rats were used in this study. Sixteen rats undergone adrenalectomy and were administered with 120µg/kg/day intramuscular injection of dexamethasone. Eight rats were supplemented with oral palm tocotrienol 60 mg/kg/day (Adrx+Dex+PTT) and the other eight rats were given oral vehicle palm olein 0.1 ml/kg/day (Adrx+Dex). Eight rats underwent sham procedure and were given vehicle palm olein 0.05 ml/kg/day by intramuscularly and oral 0.1 ml/kg/day (Sham). The rats were euthanized after two months of treatments. Eight rats were euthanized after acclimatic action without receiving any treatment (Baseline). The right femurs were used for bone biomechanical strength and histomorphometry analysis while the left for gene expression and oxidative stress enzymes activities. The results indicated that long-term glucocorticoid treatment significantly increased bone resorption marker, CTX (6060.7 ± 410 pg/ml) and decreased bone structure and strength. Osteoblast and osteoclast related genes expressions indicated an increase in bone turnover. Supplementation of palm tocotrienol had maintained serum resorption (2619.4 + 209 pg/ml) marker level and preserved bone structure and strength. Gene expression analysis showed decrease in bone resorption. The findings suggested that palm tocotrienol has potential benefits against glucocorticoid-induced osteoporosis by regulating osteoblast and osteoclast related gene expressions.
Ovitrap autosidal berperanan penting dalam pemantauan dan kawalan vektor denggi, Aedes aegypti and Aedes albopictus. Beberapa jenis ovitrap ini telah digunakan di Malaysia termasuklah Mosquito Larvae Trapping Device (MLTD) yang diperkenalkan oleh Dewan Bandaraya Kuala Lumpur. Kajian ini bertujuan untuk menilai kepadatan larva Aedes dan pembolehubah meteorologi setempat di sebuah penempatan pelajar di Cheras, Kuala Lumpur. MLTD (n=30) dengan umpan larutan baja NPK (5:5:5) organik telah digunakan. Pengumpulan larva dan penyelenggaraan ovitrap telah dilakukan setiap minggu selama lapan minggu. Pemeliharaan larva dan penentuan spesies telah dijalankan di makmal. Daripada sejumlah 2,152 larva Aedes, 85% merupakan Ae. albopictus manakala selebihnya Ae. aegypti. Ae. albopictus lebih banyak dikumpulkan di luar berbanding di dalam bangunan (purata larva per ovitrap, 9.28 lawan 6.08). Sebaliknya, Ae. aegypti lebih banyak dikumpulkan di dalam berbanding di luar bangunan (1.72 lawan 0.86). Ovitrap indeks yang paling tinggi adalah semasa minggu kelima (90%) dan keenam (93%). Minggu pertama menunjukkan ovitrap indeks yang paling rendah (30%). Analisis mendapati korelasi positif antara kepadatan larva Aedes dan suhu maksimum (r=0.830, p=0.011), manakala kelembapan relatif minimum menunjukkan korelasi negatif (r=-0.778, p=0.023). Pemantauan rutin bagi peringkat pramatang vektor denggi boleh memberikan maklumat mengenai kepadatan dan naik turun populasi nyamuk setempat. Apabila digandingkan dengan faktor meteorologi sejajar, maklumat ini dapat memberi panduan bagi perlaksanaan kawalan vektor sebagai sebahagian strategi pencegahan denggi.
Sindrom distensi beg kapsul ialah salah satu komplikasi yang jarang berlaku selepas fakoemulsifikasi dengan implan kanta intraokular dimasukkan ke dalam bag kanta dalam mata. Kami menerangkan satu kes sindrom distensi beg kapsul yang berlaku pada seorang lelaki berusia pertengahan yang menjalani fakoemulsifikasi dengan ‘plat haptic’ implan kanta intraokular (Zeiss CT ASPHINA 509MP) ke dalam mata kanan. Penglihatan mata kanan semasa pemeriksaan susulan 1 minggu and susulan 5 minggu selepas pembedahan tidak menunjukan penambahbaikan dengan refraksi kuasa mata bertukar menjadi minus 2.5 diopter. Tekanan intraokular hanya meningkat pada 2 jam selepas pembedahan dan normal semasa pemeriksaan susulan berikutnya. Beg kapsul distensi telah disahkan dengan menggunakan IOL Master 700. IOL Master 700 menunjukkan pengasingan abnormal beg kapsul dari implan kanta intraokular. Diagnosis sindrom distensi beg kapsul yang disebabkan oleh pengekalan viskoelastik dibuat. Pengeluaran viskoelastik yang tertinggal di dalam mata kanan telah dilakukan dan sindrom distensi beg kapsul berjaya diselesaikan dengan penglihatan mata kanan kembali ke 6/6. Oleh itu, pengeluaran viskoelastik dengan sepenuhnya semasa fakoemulsifikasi dengan ‘plat haptic’ implan kanta intrakular adalah penting untuk mengelakkan sindrom distensi beg kapsul.
In trauma, a systematic approach has been developed to assist physician and surgeon in identifying immediate life-threatening injuries so that prompt intervention can save lives and reduce mortality. This approach also called for a head-to-toe examination so that other injuries are not missed out. Sacral fracture, although rare, but could have serious complications. The present case discusses about a trauma patient who presented with complain of genitalia pain with normal genitalia examination. Sacral fracture was not suspected and was only detected when a pelvic radiograph was ordered as part of the trauma survey. Fortunately, the patient had no complications resulting from the injury itself. The aim of the present case is to discuss the importance of investigating beyond patient’s complaint, as in this case the patient only complained of genitalia pain which ended up as a sacral fracture.
Orbital cellulitis is an infection of the orbital soft tissue that could possibly lead to serious complications if treatment is delayed. It is important to differentiate this condition from a less life-threatening condition like preseptal cellulitis as orbital cellulitis would require a more aggressive treatment than the former condition. The present case discusses about a patient who was diagnosed with orbital cellulitis and developed complications from the disease. The delayed administration of the appropriate antibiotic subsequently led to the patient’s death. The delay was because of the reason that the patient belonged to the immunocompromised group who harbour different causative organism than the normal population.
Kimura’s disease (KD) is a rare, benign chronic inflammatory disease of unknown aetiology, typically presents in the Orientals as subcutaneous masses in the head and neck region that could be easily misdiagnosed as a malignant tumour, leading to unnecessary radical surgery or intensive cytotoxic therapy. It has been mainly reported in the Chinese and Japanese literature. It is difficult to diagnose before tissue biopsy and fine needle aspiration cytology (FNAC) has limited value. Hence, unless the pathologists are aware of this entity, it might be mistaken as a malignant lesion. We encountered a case of KD in a Malay patient presenting as a parotid mass that was initially diagnosed as Hodgkin’s lymphoma (HL). This disorder should be suspected in young male Asian patients presenting with a painless unilateral mass in the head and neck region with associated hypereosinophilia.
Local anaesthesia systemic toxicity (LAST) is an uncommon and a potentially life-threatening event that develops after peripheral nerve block. The cause may be multifactorial and may include the choice of drug, technique of block and individual patient risk factors. We report a case of a 55-year-old female who developed slurring of speech and quadriplegia after receiving a mixture of lignocaine and hydrocortisone through an intra-articular injection to the right shoulder. Neurological examination revealed hypotonia and absence of power (0/5) in all limbs. These toxic events may have resulted from an accidental intra-arterial or dural cuff injection of local anaesthesia or absorption from surrounding tissues. This case report demonstrated that an intra-articular injection in the shoulder may cause LAST and may be under-recognized as it can mimic stroke.
Insiden penyakit paru-paru obstruktif kronik (COPD) di Malaysia semakin meningkat. Tiada kajian yang dilaporkan tentang obstruksi aliran udara spirometrik, termasuk corak restriktif dan obstruksif pada populasi di Malaysia. Kajian ini dilakukan untuk mengira prevalens dan meramal obstruksi aliran udara dan menjalankan pemeriksaan gejala COPD menggunakan peralatan baru AirSmart® Spirometry dan COPD Population Screener (COPD-PS). Kajian keratan rentas dilakukan di dua hospital tertiari menggunakan COPD-PS dan AirSmart® Spirometry. Terdapat 265 subjek yang direkrut dengan 11% dan 16% populasi yang masing-masing disaring mempunyai corak yang restriktif dan obstruksif. Dua puluh peratus subjek mempunyai skor COPD-PS lebih daripada lima. Tujuh puluh empat peratus subjek dengan corak obstruktif aktif atau bekas perokok (p=0,03, p
Laporan prestasi kerja adalah laporan penilaian yang sistematik dan komprehensif secara kuantitatif bagi menilai tahap prestasi penjawat awam di Malaysia. Objektif kajian ini adalah untuk menentukan sama ada prestasi kerja kakitangan sokongan di Hospital Mersing setanding dengan prestasi kakitangan awam lain di Malaysia. Objektif lain adalah untuk mengenal pasti anggota yang berprestasi tinggi dan rendah dalam organisasi dan menentukan faktor yang mempengaruhi prestasi kerja. Kajian ini adalah pensampelan rentas, retrospektif, mudah digunakan dengan menggunakan data sekunder dari buku perkhidmatan pekerja, Sistem Maklumat Pengurusan Sumber Manusia (HRMIS) dan rekod perubatan kakitangan pada tahun 2016 digunapakai. Hasil kajian menunjukkan terdapat hubungan yang signifikan antara faktor sosio-demografi dengan prestasi kerja yang jantina, pendapatan bulanan dan tahap pendidikan. Bagaimanapun, tiada hubungan yang signifikan antara etnik, umur, status perkahwinan dan tempoh perkhidmatan. Tiada hubungan yang signifikan antara faktor kesihatan dan faktor pekerjaan dengan prestasi kerja. Dapatan yang diperolehi dari kajian ini boleh digunakan oleh pentadbiran hospital dan penyelia untuk mengambil langkah-langkah bagi memperbaiki tahap prestasi kerja kakitangan dengan sewajarnya di mana ia dapat memberi manfaat kepada individu dan organisasi secara keseluruhan.
There are three types of papilloma which arises from the Schneiderian membrane namely inverted, fungiform and oncocytic. Oncocytic papilloma is the rarest type and occurs predominantly in the older age group. Clinically, its behaviour is similar to inverted papilloma in having both local recurrence and associated malignancy. We report a rare case of oncocytic papilloma arising from the maxillary sinus, extending into the nasal cavity and nasopharynx, in a 78-year-old lady. Despite the longstanding history there was no evidence of associated malignancy in this lesion. An endoscopic medial maxillectomy was successfully utilized for approach and complete tumour excision. In conclusion, oncocytic papilloma should be considered as a differential diagnosis in patients presenting with unilateral polypoid nasal lesions especially in the elderly. In addition, endoscopic medial maxillectomy can provide an adequate approach for complete tumour removal.
Acanthamoeba spp. merupakan ameba hidup bebas yang biasa ditemui
di persekitaran. Ia merupakan agen penyebab keratitis Acanthamoeba (AK)
dan ensefalitis ameba bergranuloma (GAE). Ameba ini juga mampu menjadi
perumah kepada pelbagai bakteria termasuklah yang bersifat patogenik seperti
Mycobacterium, Legionella dan Staphylococcus aureus rintang metisilin (MRSA).
Berdasarkan maklumat ini, satu kajian dijalankan untuk mengesan kehadiran tiga
bakteria endosimbion berkepentingan perubatan di dalam Acanthamoeba spp. yang
telah dipencilkan dari bolong penghawa dingin yang terdapat di wad and dewan
bedah di Pusat Perubatan Universiti Kebangsaan Malaysia. Kehadiran bakteria
endosimbion ini disaring menggunakan pasangan primer khusus bagi setiap genus
menggunakan reaksi rantai polimerase (PCR) konvensional dan disahkan dengan
analisis penjujukan. Dua puluh sembilan (80.56%) pencilan Acanthamoeba spp.
didapati mengandungi bakteria endosimbion patogenik yang disasarkan dengan
sekurang-kurangnya satu genus bakteria bagi setiap pencilan. Mycobacterium
(82.76 %) adalah bakteria yang paling banyak dikesan, diikuti dengan Legionella sp.
(65.52 %) dan Pseudomonas spp. (62.07 %). Tiada bakteria MRSA dikesan daripada
mana-mana pencilan dalam kajian ini. Dua endosimbion Mycobacterium yang
dikenalpasti telah dikelompokkan ke dalam strain Mycobacterium tuberculosis.
Kami membuat kesimpulan bahawa, kebanyakan Acanthamoeba berpotensi untuk
menjadi perumah bagi pelbagai bakteria patogenik, namun implikasi interaksi ini
terhadap patogenisiti kedua-dua organisma masih kurang jelas dan memerlukan
penyelidikan yang lebih lanjut.