Objective: To audit the amount and complexity of case load and the waiting time for orthodontic treatment in Orthodontic Department of Universiti Kebangsaan Malaysia (UKM).
Materials and Methods: This study involved three waiting list records in Orthodontic department, UKM and 484 patients’ record were selected using Random Sampling technique. Demographic data of the patients were noted. Data on date of patient’s visit to ‘Klinik Rawatan Utama’ (KRU), Screening clinic and first orthodontic treatment (removable/fixed) clinics were also recorded. The severity of referred cases were graded using complexity scale (Russle et al, 1999).
Results: Patients were mostly female (76%) with age ranging from 10 to 52 years old. 75% of the referred cases were complex cases. From the year 2002-2007, 35% were referred for removable and 65% were referred for fixed clinic. In average, orthodontic screening waiting time was 6.9 ± 2.5 month. Patient would received removable and fixed appliance treatment after 4.4 ± 1.0 months and 14.5 ± 9.8 months respectively.
Conclusions: Most patients were referred to fixed waiting list. The waiting time from 2002 until 2007 for orthodontic treatment in UKM was longest for fixed followed by screening. The shortest waiting time was for the removable treatment.
Study site: Orthodontic Department of Universiti Kebangsaan Malaysia (UKM)
Congenital epulis is a fairly rare soft tissue tumour occurring exclusively on the alveolar ridge of newborns. The exact origin of congenital epulis is still debatable. The objective of the study is to determine the clinicopathological features and immunohistochemical findings of congenital epulis. A retrospective study was carried out to determine the clinicopathological features of congenital epulis, diagnosed histologically in the main oral histopathology laboratory in Malaysia from 1967 to 2014. Immunostaining using vimentin, muscle specific actin, smooth muscle antigen, desmin, S100, CD34, CD68 and CD1a was carried out. Twelve cases of congenital epulis were reviewed. All of the patients were females and the presentation age ranged from 2 to 90 days. The patients comprised of 6 Malays, 3 Chinese, 2 Indians and 1 Orang Asli. Most of the cases (n=7) involved the maxillary ridge and presented as pedunculated well-defined lumps (n=8). Excisional biopsy was performed in all cases. Via immunohistochemistry, vimentin expression was observed in all cases; but negative for CD34, muscle specific actin, smooth muscle antigen, and desmin. CD1a and S100 positivity was seen in five cases. The interstitial cells were highlighted by CD68. Although congenital epulis has been first described 130 years ago, the exact nature of its histogenesis remains a mystery.
Background: (13) C – urea breath test (UBT) is sensitive and specific for detection of Helicobacter pylori (H. pylori) infection. Gastric biopsy culture for H. pylori confirms the diagnosis. Here, we analyzed data of all patients who were investigated for H. pylori infection using both tests throughout the year 2005. Materials and Methods : Retrospective data of 377 patients between the ages of 17 – 88 were identified through endoscopy records from January to December 2005. Upper endoscopy, UBT and gastric biopsy culture were performed on all patients simultaneously during each endoscopy session. Patients who had positive UBT and biopsy culture for H. pylori were treated with triple therapy of PPI, amoxicillin and clarithromycin for one week. A repeat of UBT was done at one-month post therapy. Results and Analysis: Twenty-eight patients on the list had no available data on UBT and were omitted from the analysis. Ethnic group Chinese comprised of 45.4% (n=163), followed by Malay, 37.3% (n=134), Indian, 10.6% (n=38) and others, 3.9% (n=14). UBT was positive in 23.7% (n=85)(figure1). H. pylori culture was positive in 19.2% (n=69)(figure1). Sixteen patients with UBT positive had H. pylori culture negative, 18.8% (n=16/85)(figure2). Five patients with H. pylori culture positive had UBT negative, 7.2% (n=5/69)(figure3). Ethnic group Indian had the highest incidence of UBT positive, 47.4% (n=18/38), followed by Others (Sikhs and foreigners) 42.8% (n=6/14), the Chinese 27.6% (n=45/163) and the Malays 11.6% (n= 16/138). UBT positive was the highest in the age group of 50 and above, 64.7% (n=55/85), followed by the age group between 30 to 49, 21.2% (n=18/85) and the age group of 29 and below, 14.5% (n=12/85). Out of the 85 UBT positive patients 91.8% (n=78/85)(figure4) of them responded to the conventional one week of triple therapy (PPI, amoxicillin, clarithromycin) with negative UBT at one-month post therapy compared to only 8.2% (n=7/85)(figure4) who failed with positive UBT at one-month post therapy.
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.
Objective: To evaluate the early results of patients in a single institution who underwent total knee arthroplasty using an implant system. Methods: We retrospectively reviewed 76 total knee replacements using the Genesis II prosthesis (Smith and Nephew, Memphis) in 60 patients (16 were bilateral cases) performed between February 2005 andFebruary 2008. Patient related outcomes and clinical evaluations were done by an independent observer. Knee function and patient satisfaction were evaluated using the American Knee Society (ASK) score and the Western Ontario and Mac Master University Osteoarthritis Index (WOMAC). Results: The mean age of the patients at the time of operation was 63.5years. The mean follow up period was 1 year 5 months. At the final follow up, the mean Knee Society Knee Score was 87.9 with 77.3% (58 knees) rated excellent, 21.3% (16 knees) rated good and1.3% (1 knee) rated fair; none were rated poor. The mean Function Score was 87.1 with 64% (48 knees) rated excellent, 29.3% (22 knees) rated good, 6.7% (5 knees) rated fair, no knee was rated poor. The mean WOMAC Score was 94.4 (standard deviation 6.59). Conclusion: Most patients treated for knee osteoarthritis with total knee replacement showed high rates of excellence and good early functional outcomes.
Intrarticular Hyaluronic Acid was administered to 45 patients with various grades of osteoarthritis in the knee. Following 3 fortnightly injections, these patients were reviewed at 6 weeks and 3 months with regard to their knee pain. We found the most patients (84.4%) has decreased knee pain following these injections. Patients who had severe grade osteoarthritis based on knee radiographs before the injections were less likely to have pain reduction compared to those with milder grade osteoarthritis. Only 4 (8.9%) patients showed no improvement and were subsequently considered for surgery. Many patients did not require any further treatment (24.4%) and the remaining were given analgesia (64.4%) to aid in their pain. One patient required another course of this injection. there were no complications recorded in this study. We concluded that Intrarticular Hyaluronic acid is an easy and safe method to treat osteoarthritis. The short-term outcome with regard to knee pain is good in patients with milder grades of osteoarthritis.
Study site: Private orthopaedic clinic, Johor, Malaysia
Parotid tumours represent one of many groups of tumours in the field of
Otorhinolaryngology. However, a local demographical evaluation of parotid tumours and its annual incidences has never been undertaken. This study intends to review local demography in relation to incidence of parotid tumour seen in Otorhinolaryngology (ORL) clinic, Hospital Tuanku Ja’afar Seremban, Negeri Sembilan from the year 2007 till 2012. Methods: A retrospective demographical study on parotid cases seen in ORL clinic, Hospital Tuanku Ja’afar Seremban between 2007 till 2012 involving 56 cases. Data that was collected include patient details, facial nerve involvement on presentation, type of surgery performed, site of tumour, facial nerve injury post operation and final histopathological diagnosis. Results: An average of 10 cases per year was noted from 2007 to 2012. Male to female ratio was found to be 1.4:1. Age range of sample population were 9 to 79 years old with a mean age of 47 at time of diagnosis. Superficial lobe was found to be the most common tumour site (63%). Majority of cases consists of benign tumours in 51 out of 56 cases with Warthin’s tumour and Pleomorphic Adenoma being the most common histopathological finding. Post operative facial nerve injury were noted in 17 cases in which 13 cases were temporary while 4 others were permanent.
This is a retrospective descriptive study done to look at common presentation and method of detection of breast cancer. A total of 366 case records of patients attending the Breast and Endocrine Clinic at Hospital Kuala Lumpur were reviewed. The peak age of breast cancer presentation was 40 to 49 years (39.6%). Most (81.4%) patients presented with a lump in the breast and the lump was mainly self-detected (97.3%). The mean tumour diameter on presentation was 4.7± 3 cm. Medical staff detected the disease in 1.6% cases and 1.1% of cases were detected by mammogram. Most women detected the lump themselves, suggesting that Breast Self Examination (BSE) can be used for detection of the disease in places where there is cost and availability constrains for mammogram. Early detection with BSE can possibly offer better treatment options and quality of life despite the evidence that it does not reduce the mortality due to breast cancer.
Study site: Breast and Endocrine Clinic at Hospital Kuala Lumpur
Introduction: Laparoscopic fundoplication is performed for the management of symptomatic hiatus hernias and gastro-oesophageal reflux disease (GORD) refractory to medical therapy. We adopted the use of Gore Bio-A® for selected laparoscopic hiatus hernia repairs in 2011 and with this case series aimed to establish whether mesh augmentation affects symptomatic outcomes. Methods: A retrospective review of prospectively collected data from all laparoscopic fundoplications performed by a single surgeon between October 2011 and January 2013 was performed. Patient specific data were entered into a proforma and analysed using Microsoft ExcelTM. Patient reported outcomes were assessed with a system specific quality of life questionnaire (GORD-HRQL) both pre and post-operatively. Results: Twenty-three patients underwent laparoscopic fundoplication during the study period. Gore Bio-A® re-enforcement of the hiatal repair was used in 14 patients and was the preferred option for those with pre-operative evidence of a large hiatus hernia. Whilst overall there was a statistically significant difference between pre and post-operative scores (21 vs 0, p=
There are many inherent challenges in the evaluation and management of children with laryngotracheal disorders, and it differs widely from one institution to another. The main challenges include access to suitable equipment, fully trained surgeon and, cooperation with the anesthetist and pediatrician. Material & Methods: The aim of the study was to analyze the pediatric laryngotracheal cases undergoing endoscopic examination in Hospital Universiti Sains Malaysia. A retrospective review of 73 cases undergoing microlaryngoscopy and bronchoscopy from 2004 to 2008 was done. Results: Laryngomalacia was the commonest diagnosis. The majority of the cases (45.2 %) were referred because of noisy respiration. Other reasons for referral were foreign body inhalation, unresolved lung disease, failed extubation, examination prior to decannulation and hoarseness. Conclusion: Management of pediatric laryngotracheal cases were varied and tailored to each problem. The endoscopic examination must be meticulous. The management include observation, medical treatment, closed (endoscopic)
techniques and open surgery.
Objectives: 1) To establish the incidence of rotavirus infection in paediatric patients admitted to a private hospital in Malaysia with a diagnosis of community-acquired acute gastroenteritis. 2) To determine whether patients with rotaviral acute gastroenteritis have greater disease severity. Design Retrospective cross-sectional study. Setting An urban private hospital in Malaysia. Participants All paediatric patients with a discharge diagnosis of acute gastroenteritis (AGE) admitted to the hospital between September 2005 and March 2006. A total of 261 patients were included in the study. Results Rotavirus infection contributed to 54% of paediatric hospital admissions with discharge diagnoses of acute gastroenteritis. 74% of children with rotavirus infection were aged 5 years and below. This study demonstrated that patients with rotaviral gastroenteritis had greater disease severity, as measured by two indicators. Firstly, the average length of hospital stay was longer in patients who were rotavirus positive (5.14 days) compared to those who were rotavirus negative (4.81 days). These results were statistically significant (p
Background: Kawasaki Disease (KD) and acute rheumatic fever are the two leading causes of acquired heart disease in children in the developing countries. Objectives: To determine the epidemiology of KD and its short-term outcome in Malaysian children. Materials & Methods: A retrospective study of patients with a diagnosis of KD at the Kuala Lumpur Hospital from January 1999 to December 2003. Results: 84 patients with KD were seen over the 5 year period. Of these, 52 (61.90%) were male and 32 (38.10%) female. Malays comprised 51 (60.71%), Chinese 30 (35.71%) and Indian 3 (3.57%). Their ages ranged from 2 months to 11 years 1 month old. There were 25 (29.76%) patients less than one year old, 50 (59.52%) aged 1-4 years, 4 (4.76%) aged 5-7 years and 5 (5.95%) were more than 7 years old. Echocardiographic examination during the acute phase showed that 24 patients (28.57%) had coronary artery dilatation; 23 had mild dilatation and one had giant aneurysm involving both coronary arteries. Echocardiographic examination at 8 weeks showed that 5 (21.74%) of the 23 patients with mildly dilated coronary arteries had resolved; the bilateral giant coronary aneurysms remained the same. There was no death due to KD over the 5 year period. Conclusion: KD occurred most commonly in children aged 1-4 years old with a peak at 17 months. There was male preponderance with a male to female ratio of 1.6:1. Despite immunoglobulin therapy, 29% of patients had coronary artery involvementduring the acute phase; 22% of those with mild coronary artery dilatation resolved at 8 weeks after disease onset.
Introduction: There are many factors that determine the survival of patients with VSD. Among these include size of VSD, position, pulmonary hypertension, bacterial sepsis, valvular involvement, associated anomalies with VSD, associated syndromes and age at first diagnosis. There has been no published local data as far as we know and this information will be useful especially for consultation with parents. Even though VSD in general has a good prognosis, whenever they have added risks for example pulmonary hypertension then they are at risk of further morbidity and mortality. Objective: To determine the factors that are associated with survival of patients with VSD. Design: Retrospective cohort. Materials and methods: All cases of isolated VSDs admitted to HUSM from 1996 to 2003 were reviewed. Results: Univariate Cox regression of survival time of patients with VSDs revealed that 4 factors had prognostic significance namely bacterial sepsis (HR= 287.7, 95% CI 51.1, 1618.5, P < 0.001), Down syndrome (HR = 14.89, 95% CI 3.00, 73.92, P = 0.001), pulmonary hypertension (HR=14.58, 95% CI 1.69, 125.7, P=0.015) and large VSDs (HR=8.23, 95% CI 1.5, 45, P=0.015). Bacterial sepsis was the only significant prognostic factors for the survival of patients with VSDs using the multivariate Cox proportional hazard model. Conclusion: Bacterial sepsis, pulmonary hypertension, large VSD and Down syndrome were the significant prognostic factors from Univariate Cox analysis, however bacterial sepsis was the only significant prognostic factor from Multivariate Cox analysis.
This retrospective study was conducted at the audiology clinic of UKM in the year 2000. It was intended to detect the effect of walkman on the hearing system of its users and to investigate whether distortion product otoacoustic emission test can provide an early and reliable sign of cochlear damage or not. Distortion product otoacoustic emission test helps to determine the function of outer hair cell. Outer hair cells get damaged with exposure to loud sound, drugs and aging. Thirty subjects (20 in the study group and 10 in the control group), between the ages of 19-25 years, who fulfilled all the criteria of selection, were investigated. There were two sets of criteria (general and specific). Anyone, in the control or study group, failing in any of these criteria was excluded from the study. According to the general criteria, it was essential for all the subjects to have clean ear canals, normal hearing at all the frequencies (250Hz- 8000Hz), normal middle ear function (Type A tympanogram), no middle ear problem, not used/using any ototoxic medicine, no family history of hearing loss, no history of ear surgery, not exposed to any form of loud noise like disco, concert, F1 racing or gun shooting. According to the special criteria it was essential for the subjects in the control group to have never used a walkman and those in the study group must have been using a walkman for at least 6 months. Comparison of distortion product emission levels between control and study groups revealed that emissions were significantly lower in the study group, across all the frequencies, suggesting outer hair cell damage in the walkman users. These differences reached level of statistical significance (p<0.05) at 2, 4, 6 and 8kHz. Using walkman at an intensity unsafe for hearing and a duration longer than recommended is suspected for the outer hair cell damage in our study group. Those using walkman for longer duration and higher intensity manifested much lower emission levels. Our study supports the literature that distortion product emission test is a much sensitive test than pure-tone audiometry, as it can detect cochlear damage long before it appears in an audiogram. It is recommended that people who are exposed to loud noise regularly should be monitored with distortion product emission test. It is suggested that the use of walkman.
Study site: Audiology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
Following the suggestion that it was possible that cases of melioidosis amongst those who had been exposed abroad in the past, might be escaping notice, 487 Royal Marines were examined by indirect haemagglutination studies. Four hundred and eleven of these subjects had served for variable times in areas where melioidosis has been known to occur in Indonesia and Malaya, between 1960 and 1974, occupied in activities in the jungle and paddy fields during which exposure to the disease was to be expected. No evidence of residual subclinical melioidosis was found and it seems unlikely that recrudescent disease will prove to be a problem in the future for English servicemen who have been in South East Asia.
This is a retrospective study to determine the distribution site, associated fracture and causes of mandibular fractures at HUSM, over a 5 year period, from 1st January 2002 - 31st December 2006. Records of patients who had mandibular fracture were reviewed. Data of age, sex, site of fracture, causes and associated fracture were recorded and analyzed using SPSS version 15.0. There were 113 (84.3%) males and 21 (15.7%) females. The mean age for male was 84.3% and female was 15.7%. The fracture occurs mostly at the age of 11-20 years (45.5%), followed by 21-30 years (30.6%). Motor vehicle accidents (MVA) were the commonest causes of mandibular fracture (92.5%), followed by fight and assault (3.7%), industrial accidents (3.0%), fall (0.7%). There were no cases recorded due to sport injury. The commonest site of mandibular fracture occurs at angle and para-symphysis (23%), followed by body (20.1%), symphysis (16.7%), condyle (15.5%) and ramus (1.7%). The most common associated fractures were head injury (23.5%), followed by clavicle fracture (17.2%) and fracture of radius (10.7%). Mandibular fracture was common in males with the mean age 24.63 years and mostly due to MVA. Angle and para-symphysis is the commonest site of mandibular fracture with most of the patient suffered from concomitant head injury.
Reflex epilepsy is usually induced by external stimulation, photosensitive epilepsy being the most common. Epilepsy induced by auditory stimulation is rarely studied. There are no currently published magnetoencephalographic (MEG) studies demonstrating the initiation of epileptic neuronal discharges by repeated auditory stimulations in temporal lobe epilepsy (TLE) patients. We retrospectively studied one TLE patient who underwent a MEG study to localize her epileptic focus. Auditory, somatosensory, visual and motor evoked potential studies were performed during the MEG recording. A single dipole method calculated equivalent current dipoles to localize the epileptic source. The least-squares minimization method was used to obtain the optimal solution with goodness-of-fit of greater than 80%. Periodic lateralized epileptiform discharges (PLEDs) were recorded in the temporal region when repeated auditory stimulations were done. We postulated that neuronal cortical suppression occurred during repeated stimulations which provoked epileptiform discharges (PLEDs) without any physical symptoms or aura. It was concluded that repeated stimulations could facilitate epileptiform discharges in focal area/areas in certain subjects.
The aim of this study is to describe the epidemiological features of HFMD outbreak in the Hulu Langat District in 2000. Until November 2000, a total of 60 cases were reported and the worst ever reported to the previous years. The mean age of patients was 3.9; 5.8 years with majority of the cases aged between 1 to 4 years old (53.8 per 100,000 of population), male gender (8.3 per 100,000 of populations), and were of Chinese (12.2 per 11 100,000 of populations) and Malay ethnicity (7.2 per 100.000 of populations). All cases were uncomplicated cases and were diagnosed clinically. Most of the notified cases were front the government facilities, which are 44 cases (73.3%). Thirty-five (35) cases (58.4%) were treated as outpatient and 25 cases (41.6%) as in patients (p>0,05). Only 7 cases (11.7%) have history of contact with HFMD patients. The notified cases were mainly from the densely populated areas which were Cheras, Kajang and Ampang. No differences were noted between HFMD cases which have been breasfed for less than 6 month or more, and twenty nine (29) cases (48.3 %) had completed the immunization schedule. In conclusion, the recent emergence of HFMD brings a new challenge, which have to be faced in the prevention and surveillance activities of public health problems in the district.
Study site: Notified cases from Klinik Kesihatan, hospital, private clinics, Ulu Langat, Selangor, Malaysia
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.