Introduction: Safety helmets are one of the personal protective equipment (PPE) that to decrease the impact of any falling object to the skull and to avoid head and brain injury by many industries, including palm oil plantation. Nev- ertheless, the level on the usage of the current safety helmet is very low due to a few factors that lead to the discom- fort. Among the common issues for the non-compliance of safety helmets are their discomfort, ventilation, weight and safety. This study aims to determine subjective preference of the new prototypes’ safety helmets device among palm oil plantation harvesters. Methods: A cross-sectional study conducted among 124 harvesters in three palm oil plantations located in Sabah, Malaysia. A set of questionnaires used to collect data on their socio-demographic background, perceptions toward existing safety helmets and their subjective preference of new safety helmets pro- totypes. Apart from that, six harvesters were randomly choosing to attend an interview session for qualitative study. Results: The descriptive analysis indicate that among the emphasized issues regarding non-compliance of existing safety helmet were due to discomfort (66.1%), poor ventilation (97.6%), load of safety helmet (83.3%) and safety issues (68.5%). In terms of new safety helmets prototypes, 72.6% of the harvesters preferred Design C to be worn for work in the plantation. Conclusion: It can be suggested that the existing safety helmet is uncomfortable and was not design ergonomically namely loose size and discomfort. Design C was the most preferred to be worn for work in the palm oil plantation.
To evaluate the outcome of intravitreal bevacizumab in the treatment of radiation-induced cystoid macular oedema among patients who underwent external beam radiotherapy for nasopharyngeal carcinoma.
Trauma is thought to complicate 1 in 12 pregnancies. The management of trauma during pregnancy requires special consideration because pregnancy alters maternal physiology and the foetus is a potential collateral victim. The approach of these cases in the setting of the Emergency Department should not only be diagnostic for any foetal injuries but also prognostic for any future undue outcome. Antenatal traumatic brain injury is a rare but real complication of maternal blunt force trauma. Our case involves a 22-year-old primigravida who suffered a motor vehicle accident and on initial assessment revealed normal foetal assessment but subsequently after premature labour revealed a new born with traumatic brain injury. Early ultrasonographic evaluation and observational period with continuous electronic foetal monitoring may improve the detection and emergent treatment in these cases.
Cervical spinal cord injury (SCI) often causes debilitating loss of function of the upper limb. Upper extremity reconstruction surgery can restore some of the upper limb function in tetraplegic patients with SCI. The procedures are typically muscle-tendon unit transfer surgeries, which redistribute the remaining functional muscles to restore active elbow extension, key grip, and finger grasping. In addition to the tendon transfer surgeries, nerve transfers have emerged recently and are showing promising results. However, despite more than half of the tetraplegic patients can benefit from upper limb surgery, only a few of them receive the procedures. This missed opportunity may be due to the lack of communication between SCI specialists and hand surgeons, or the lack of awareness of such options among the specialists and patients. In this review, we provide a basic overview of upper limb reconstruction in tetraplegic patients with target audience of SCI specialists for their better understanding of the basic concept of surgery and information for patient consultation before referring to hand surgeons.
Introduction: Clinical and sharp bins are commonly found in clinical settings. The usage of these bins is vital to ensure that health care facilities remain hygienic, free from any microbial transmissions and incidences of needle stick injuries. ‘oQ-Ba’ is a Japanese phrase that means bin. In real clinical settings, it is difficult to gather all bins at once while performing procedure due to limitations of space, frequency and mobility of bins. Therefore, ‘oQ-Ba’ the Universal Bins Trolley is developed to improve the waste management practice and increase the efficiency and effectivity of care delivery. Methods: A total of 40 respondents comprised of staffs from Emergency and Trauma De- partment and Haemodialysis Unit at Serian District Hospital were selected to use “oQ-Ba” the Universal Bins Trolley. They were given self-administered questionnaires pre and post-trials whichcomposed of ‘yes’ or ‘no’ answers to ob- tain feedbacks on the effectiveness of this project. Descriptive statistics include frequencies, means and percentages were used to analyze the data using the SPSS version 22. Results: The staffs found that the prototype helps to ensure the availability of the three bins as the bins are all attached together under one compartment. The staffs also found that the prototype is more convenient compared to the existing waste bins because of its mobility and unique design which consumed little amount of space. Conclusion: ‘oQ-Ba’ the Universal Bins Trolley provides handful of benefits to medical practitioners as it can ensure the availability of the three bins during a procedure.
Herein, we report our experience in treating extensive traumatic submacular hemorrhage with a single dose of intravitreal ranibizumab. A 23-year-old healthy Malay man presented with a progressive reduction of central vision in the left eye of 2 days' duration following a history of blunt trauma. Visual acuity was reduced to counting fingers. Examination revealed infero-temporal subconjunctival hemorrhage, traumatic anterior uveitis, and an extensive sub-macular hemorrhage with suspicion of a choroidal rupture in the affected eye. He was initially treated conservatively with topical prednisolone acetate 1%. The subconjunctival hemorrhage and anterior uveitis resolved but his vision remained poor with minimal resolution of the submacular hemorrhage at 1 week follow-up (day 12 post-trauma). In view of the poor resolution of submacular hemorrhage, he was treated with a single dose of 0.5 mg intravitreal ranibizumab at day 20 post-trauma. At 4 weeks post-intravitreal ranibizumab, there was an improvement in visual acuity (from counting fingers to 6/45) and complete resolution of the submacular hemorrhage with presence of a choroidal rupture scar temporal to the fovea, which was not seen clearly at presentation due to obscuration by blood. His visual acuity further improved to 6/18 at 3 months post-trauma. Although this single case had a favorable outcome, a large population cohort study is needed to establish the effectiveness of intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage.
Work-related Musculoskeletal Disorders (WMSDs) are common occupational injuries among workers in the construction industry. Epidemiological studies indicated that WMSDs include neck pain, lower back pain, knee pain, leg fatigue as well as ankle and feet discomfort. The objectives of this study are to identify the WMSDs experienced by the workers during construction works and discuss the causes of those WMSDs. Subjective approach associated with modified Nordic Musculoskeletal Questionnaire (NMQ) was applied to identify the symptoms of WMSDs. A case study was conducted in several construction sites situated at the southern region of Peninsular Malaysia. During the study, 37 construction workers with different age and scope of works were interviewed to determine the WMSDs that they have experienced. Based on distributed questionnaire, almost all workers experienced pain in the region of lower back, upper back and biceps. These pains were contributed by manipulation of heavy load and high force exertion. Based on discussed causations, control measures via engineering controls method and administrative controls method were proposed to alleviate the risk of WMSDs among construction workers.
The management of pink pulseless limbs in supracondylar fractures has remained controversial, especially with regards to the indication for exploration in a clinically well-perfused hand. We reviewed a series of seven patients who underwent surgical exploration of the brachial artery following supracondylar fracture. All patients had a non-palpable radial artery, which was confirmed by Doppler ultrasound. CT angiography revealed complete blockage of the artery with good collateral and distal run-off. Two patients were more complicated with peripheral nerve injuries, one median nerve and one ulnar nerve. Only one patient had persistent arterial constriction which required reverse saphenous graft. The brachial arteries were found to be compressed by fracture fragments, but were in continuity. The vessels were patent after the release of obstruction and the stabilization of the fracture. There was no transection of major nerves. The radial pulse was persistently present after 12 weeks, and the nerve activity returned to full function.
We are all aware that there has been a dramatic increase in the number of anterior cruciate ligament (ACL) reconstructions that are carried out here in Malaysia as well as around the world. The numbers of ACL injuries have undoubtedly increased over the years with greater participation of young adults in sporting activities. However it is not certain whether the increase in the numbers of reconstructions can be accounted for by the increasing numbers of ACL injuries. Without doubt commercial interests as well the influence of the biomedical companies have a role to play. In the past the rational for surgical treatment of an ACL tear was that the ACL is vital for knee function and that in the long term ACL deficiency will lead to more injuries of the meniscus and more degeneration of the joint. This belief was prevalent because the natural history of an ACL deficient knee was not known although the ultimate outcome of reconstruction of the ACL was not known either. However in past few years a substantial amount research has been published, which has elucidated the natural history of ACL deficient knees as well as the long term outcome of reconstruction of the ACL.
Accidental needle-stick injuries (NSIs) are a hazard for health-care workers and general public health. Orthopaedic surgeons may be more prone to NSIs due to the prevalence of bone spikes in the operative field and the use of sharp orthopaedic instruments such as drills, saws and wires. A hospital-based cross sectional study was conducted in the orthopedic wards of Melaka General Hospital. The prevalence of NSIs was 32 (20.9%) and majority of it occurred during assisting in operation theatre 13(37.4%). Among them six (18.8%) were specialist, 12(37.5%) medical officer, 10 (31.2%) house officer and four staff nurses (12.5%). Among the respondents 142 (92.8%) had been immunized against Hepatitis B and 148 (96.7%) participants had knowledge regarding universal precaution. The incidence of NSI among health care workers at orthopaedics ward was not any higher in comparison with the similar studies and it was found out that the prevalence was more in junior doctors compared with specialist and staff nurses and it was statistically significant.
The complex pathophysiology of traumatic brain injury, its cascading effects and a varied outcome suggest that factors such as genetics may permeate and modulate the neurocognitive outcomes in patients with mild traumatic brain injury (mTBI). This study was conducted to determine the relationship between genetic polymorphism of apolipoprotein E, and neurocognitive and functional outcomes in mTBI. Twenty-one patients with mTBI were recruited prospectively. The severity of the injury was established with the Glasgow Coma Score (GCS). Other assessments included the CT Scan of the head on admission, Disability Rating Scale, Chessington Occupational Therapy Neurological Assessment (COTNAB) and Glasgow Outcome Scale (GOS). The Spearmen correlation analysis of ApoE allele status and the cognitive and functional assessments saw some association with the Sensory Motor Ability - Coordination (-0.526, p
To assess their awareness and usage of mouthguard and occurrence of sports-related oral injuries in athletes who involve in various sports activities in Kota Bharu. A cross-sectional study was carried out among 180 athletes aged 12 to 27 years. A structured interviewer-guided questionnaire was used to determine the prevalence of oral injuries sustained during sport activities, the use of mouthguard as well as the athletes' awareness of mouthguard use. The respondents consisted of 107 males (59.5%) and 73 females (40.5%) with a mean age of 16.7 years (SD 5.53). There were 60 (22.2%) athletes who had one or more types of sports-related oral injuries sustained. Laceration of lips, tongue and gums were the most frequent injuries (57.5%) while loosening of teeth and fracture of teeth sustained in 12.5% and 10.0% of athletes respectively. Malay traditional martial arts silat athletes, 17(68.0%) experienced the highest oral injuries among athletes. The prevalence of oral injuries was significantly different between ball sports, martial arts and other non-contact sports (p=0.002). Sixty-one athletes (33.9%) reported that they were aware of mouthguard; however none of the athletes used the mouthguards during their sports activities. Malay traditional martial arts silat was the most common susceptible to sustain oral injuries. None of the athletes were wearing mouthguard. Education on prevention of orofacial trauma should be given to the coaches and athletes. Wearing of mouthguard during sport activities should be compulsory during practice and competition events.
Traumatic bilateral sixth cranial nerve palsy is a rare condition which is typically associated with additional intracranial, skull, and cervical spine injuries. We describe a case of complete bilateral sixth nerve palsy in a 28-year-old female patient after an alleged motor vehicle accident. She had altered level of consciousness but no intracranial lesion or associated skull or cervical spine fracture was detected. In this case, we discussed the differential diagnoses, initial workup, and possible treatment options in cases of traumatic 6th nerve palsy.
Childhood brain injury is an important and complicated public health issue worldwide. Extensive work has been done in this field. This review highlights issues that are frequently misinterpreted or overlooked in the management of childhood brain injury. The incidence of traumatic brain injury is higher than non-traumatic brain injury. However it is frequently over-reported due to various confounding factors. In ascertaining the severity of injury, assessment of brainstem functions is important and should be included in routine clinical assessment. Most rehabilitative efforts are usually aimed at improving the physical outcome. However, non-physical sequelae are also common and may be more disabling with significant impact on the learning and functioning of the child. These areas, which include depression, cognitive functioning and health-related quality of life of children, should not be overlooked in the management of childhood brain injury. In addition to caregiver’s stress, family dynamic and siblings’ well-being also play a crucial role in the recovery process of the child. By highlighting the frequently missed issues in the management of childhood brain injury, it is hoped that clinicians and professionals could pay more attention to these issues and provide a comprehensive medical care for the patients and their families.
Traumatic brain injury (TBI) is known to inflict significant morbidity and mortality worldwide. In severe TBI cases, the resulting physical and cognitive impairments incur high management and rehabilitation costs that crucially involve monitoring intracranial pressure (ICP) and improving brain oxygenation. Normobaric Hyperoxia Treatment (NBOT) is a therapeutic strategy to improve brain oxygen metabolism and to decrease ICP by reducing tissue swelling and deactivating toxin. NBOT is administered by increasing the inspired oxygen concentration to 100% in normal atmospheric pressure. Previous studies involving NBOT had explored its effectiveness to salvage the TBI-related cognitive and motor deficits. However, the focus of these studies has frequently been on the cortical lesions despite the known facts that TBI often inflicts tissue damage to the subcortical areas such as the basal ganglia. There are growing evidence to support recent functional theories that implicate a pivotal role of the basal ganglia in regulating normal movements and cognition through dopamine (DA) and glutamate interaction. Thus, tissue damages leading to TBI-related motor and cognitive deficits may involve the different affected brain regions. This minireview attempts to highlight the key processes involved in the pathophysiology of severe TBI and offers insights into the role of NBOT by exploring its potential effects on the cerebral energy metabolism and gene expression patterns of dopamine receptor in a mouse model.
Objectives: To assess the occlusal features, tongue habits, lip competence and their gender dimorphism in 12 years old Malaysian Malay school-children.
Materials and methods: The method involved cl inical examination of 208 subjects from public schools in Shah Alam, Selangor, Malaysia. Occlusal status was assessed according to Angle classification. The following features were also assessed and recorded: overjet, overbite, traumatic overbite, crowding, spacing, midline diastema, cross bite, scissors bite, dental midline shifts, canine displacement, missing teeth, traumatically fractured teeth, tongue thrust and lip competence. Descriptive statistics were used for all measurements; Chi-square was used to assess gender differences.
Results: Class I malocclusion is most prevalent in boys and girls (44.0% and 43.8% respectively), followed by Class Ill malocclusion (31% in boys and 30 .4% in girls). Anterior crowding was found in 69.7% of the sample while anterior spacing was found in 30.8%. Incompetent lips were more common in boys than gir1s.
Conclusions: The prevalence of malocclusion in this age group may warrant the need for more preventive and interceptive measures in dental and oral health planning.
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.
Building on two decades as a private health professional university, the International Medical University prepares for the third decade, taking stock of the challenges in changing epidemiology and pattern of disease, changing demography and healthcare, as well as explosion in knowledge and information technology. The Global Independent Commission1 provided a framework for instructional and institutional reforms, and the IMU will use its 3 I’s (insight, imagination & innovation) in adopting these measures. Some of the instructional reforms are already in place, others need to be further nurtured and promoted. In its third decade, competency based curriculum, inter-professional learning, IT, global collaboration, educational resources, new professionalism and emphasis on quality improvement will help ensure IMU train and produce competent, caring and ethical health professionals fit to tackle 21st century challenges.
Brush cutting is a commonly performed activity occupationally as well as recreationally in Malaysia. There are various occupational injuries reported related to brush cutting, for example foreign body penetration. There were 11 reported cases of foreign body penetrated in leg of brush cutting workers admitted to orthopaedic ward in Hospital Raja Permaisuri Bainun from the period of January till October 2009. Among the cases, 4 were surgically removed under local anaesthesia and 7 cases performed under general anesthesia. 2 cases reported foreign body penetrated into tibia bone. There were many contributing factors to the injury, which include lack of protective measures for workers, engineering property of brush cutting machine and education on handling of equipment. It is vital to study the factors separately in order to determine and recommend useful preventive measures. However, the actual numbers of cases are under reported and awareness of the problem is undermined.
Introduction: Various treatment modalities are available but no consensus has been reached for optimal treatment of lateral third clavicle fractures. Precontoured locking plates with broad lateral end for multiple screws fixation is a newly designed plate for lateral third clavicle fractures. The objective of our study was to analyse the functional outcomes as well as complications of this technique in a significant number of cases with long follow-up duration. Materials and Methods: Forty-six patients with distal third clavicle fractures were treated by precontoured clavicular locking plate with broad lateral end. Functional outcomes were assessed on the basis of Constant-Murley Shoulder Outcome Score and University of California, Los Angeles (UCLA) Shoulder Rating Score, active shoulder range of motion, time for fracture union and coraco-clavicular distance. Results: The mean Constant-Murley score was 92.56±4.47 (range: 79-98) for injured side and 96.22±2.23 (range: 90-100) for normal side with p-Value 0.56. Mean coraco-clavicular distance at final follow-up was 10.52±1.13 mm (range 9.7 to 11.7 mm) in injured side and 10.25±0.98 mm (range 9.6 to 11.2 mm) in normal side. Mean UCLA Shoulder Rating Score was 32.55±2.12 (range: 27-34) for injured side and 33.46±1.88 (range: 31- 35) on normal side with p value 0.58. No major complications that necessitated revision of surgery occurred in our study. Conclusion: This newly designed plate seemed extremely useful in successful union of lateral third clavicle fractures, with reduced rate of complications like fixation failures, iatrogenic rotator cuff injury, AC joint osteoarthritis and sub-acromial bursitis, with good functional outcomes.