Introduction: Transposition is a rare dental anomaly in positional interchange between two adjacent teeth. Studies indicated that tooth transpositions are more frequent unilateral than bilateral (12:1). It is a very rare phenomenon when the anomaly is bilateral and affects same teeth on both sides. The case of a 17 year old girl, with class I incisor relationship on class 1 skeletal base with bilateral transposition of maxillary canines-first premolars, severe crowding and posterior crossbite, is presented. This case report demonstrates the orthodontic management of bilateral transposition of maxillary canines-first premolars and by the end of treatment, the transpositions were maintained while achieving a good functional and aesthetic result.
KEYWORDS: transposition, maxillary canine, malocclusion
Introduction: HCV infection is frequent in patients undergoing maintenance haemodialysis, with prevalence between 8 and 10%. Hepatitis C has an adverse effect on both patient and graft survival in those who get renal transplants. There are relatively scarce reports on the natural fluctuation in viral load level in patients on chronic haemodialysis. Materials and Methods: This is a longitudinal short-term three months study, where 27 chronic haemodialysis patients infected with known HCV genotypes were recruited from seven haemodialysis centres in Pahang. Serum samples were collected monthly, both pre- and post-haemodialysis sessions, over a period of three months. Viral RNA was extracted from serum using QIAamp Viral RNA Extraction kit (Qiagen). The HCV viral load was measured using one-step reverse transcriptase qPCR (Applied Biosystems) targeting the 5`HCV non-coding region (5’UTR). The serum α-IFN level was measured using commercial ELISA kit (Amersham, UK). Six biochemical liver function tests (AST, ALP, TP, albumin, ALT and TB) were also done for all pre-haemodialysis samples. Results: All patients showed persistent low level viral load that varied significantly over the study period (p = 0.001). HCV genotype 1 viral load was significantly higher than that of genotype 3. Conclusion: No apparent correlation could be recognized between the viral loads and the corresponding interferon-alpha levels which were detectable in only a few patients during the period of study.
Introduction: Breast cancer is the most common cancer among women worldwide and in Malaysia. It has better cure rate if detected early. However, the practice of breast cancer screening in Malaysia is still low. The objective of this study is to determine the knowledge and its associated factors as well as sources of information on breast cancer and breast cancer screening among female staff in a public university in Malaysia. Materials and Methods: This was a cross sectional study conducted in 2005 involving 394 female staff including academic and non-academic staff, which was selected by cluster sampling. A self-administered questionnaire on socioeconomic characteristics and family history of breast cancer was used for data collection. Chi-square Test and Fisher’s Exact Test was used for testing an association using SPSS 12.0. Results: The response rate was 84.3%. Only 50.9% had high knowledge on breast cancer and breast cancer screening and this was significantly associated with occupational status, monthly family income and educational level (p
The Malaysian Breastfeeding Peer Counsellors (MBFPC) is the pioneer of non-governmental organization (NGO) of trained breastfeeding peer counsellors in Malaysia initiated in 2010. The training was done in a systematic way using a developed syllabus that was adapted from and endorsed by the La Leche League International (LLLI) to suit our local population. Training materials used throughout the program were presentation slides, demonstration tools, mantas and role-plays. Materials and methods: In 2015, MBFPC partnered with Global Health Media Project (GHMP) to incorporate breastfeeding videos as training tool to further enhance the delivery of current breastfeeding peer counsellor trainings to the participants, emphasizing on helping breastfeeding mothers. The new training tool was evaluated in 38 participants, who underwent 21 hours of training. Participants were required to do pre and post-assessments to complete the MBFPC Modules, view 8 videos and do practical sessions within a 2 month period post training. Participants’ field experience survey and focus group discussions were conducted among the participants and the trainers to look at the practicality of the videos in our training. Results: All participants felt that the videos made the training more effective and helped change their understanding and approach. The trainers agreed that the videos had covered all key topics need to be delivered in the training modules and helped them to deliver most important topics in helping breastfeeding mothers in a more practical way. Conclusion: GHMP Breastfeeding Videos are suitable as educational and training tools in helping breastfeeding mothers in our training.
Introduction: The proto-oncogene c-kit is the cellular homologue of the oncogene v-kit of HZ4 feline sarcoma virus. It is located on chromosome 4 (4q11-12) in the human genome. Interaction between the c-kit receptor and its ligand, stem cell factor, is essential in the development of tissues. C-kit expression has been identified in a number of different neoplasms like seminoma/dysgerminoma, and gastrointestinal stromal tumors (GIST). Recently it has been reported that c-kit is also present in leiomyosarcomas. Tyrosine kinase inhibitors (TKIs) are a promising new therapy in the treatment of cancer. These agents target cellular proteins like kit and its related homologues decreasing cellular proliferation and survival. TKIs may be helpful in treating leiomyosarcomas expressing c-kit. Materials and Methods: In this study a total of 6 cases diagnosed as leiomyosarcomas at Department of Pathology, Universiti Sains Malaysia, Kubang Kerian, Malaysia, were investigated for reactivity for c-kit using immunohistochemical stain. Stain was considered positive if more than 10 percent of the cells showed membrane or cytoplasmic positivity. Results: Two leiomyosarcomas stained faintly with c-kit and in less than 10 percent of the cells. The other 4 cases showed no staining. The control showed good membrane and cytoplasmic positivity. Conclusion: Uterine leiomyosarcomas did not express c-kit. The reason for this could be that the tumors are inherently c-kit negative. More study using larger number of cases is required to validate these findings and further molecular characterization of these mesenchymal tumors is needed to identify the true nature of these sarcomas.
Cervical vertebral osteomyelitis is rare. While an early and correct diagnosis is critical to prevent catastrophic neurological injury, the diagnosis of cervical vertebral osteomyelitis is often difficult because of its rarity and variable symptoms. We present a case of C1 and C2 vertebrae osteomyelitis with a misleading presentation and its fatal outcome.
Introduction: Caring for those with dementia affects the quality of life for both the caregivers and the patients themselves, particularly in the informal care system here in Malaysia. To date, only a few studies have explored from the family caregivers’ perspectives in the communities of different cultural background. The purpose of this study is to describe the Malaysian family caregivers’ perspectives of their experiences in providing care to for their family members suffering from moderate to severe dementia in Kuala Lumpur, Malaysia. Methods: This qualitative study involved in-depth individual interviews with twelve caregivers to patients with moderate to severe dementia. Participants were recruited via purposive sampling from the outpatient psycho-geriatric clinic at UKM Medical Centre, Kuala Lumpur. All interviews were audio-recorded and transcribed verbatim. Transcribed data was later analysed using a thematic approach. Results: Four themes identified in this study were; i) the feeling that ‘it is like caring for a baby’, ii) the caregivers’ perception of inadequate knowledge and skills, iii) the need for caregivers’ support system and iv) the importance of spirituality in enhancing care giving experiences. Conclusions: The framework of care shared by the caregivers in this study demonstrated strong cultural and spirituality influences in addition to the common issues of the challenges in managing the behavioural and psychological symptoms in people with dementia. Hence, culture and spirituality aspects should be addressed in the development of appropriate intervention to manage the needs of informal caregivers in this community.
Dentigerous cyst is the most common odontogenic cysts that are associated with the
crowns of permanent teeth. Treatment modalities normally include enucleation or marsupialization
of the cyst. However, currently there are no standard assessment criteria to dictate which kind of
treatment for certain cases. (Copied from article).
Cerebral Venous Thrombosis in patients with Evan’s Syndrome of autoimmune hemolytic anemia is rare. The
common neurological symptoms are headaches, vision loss, dyslexia without agraphia, motor aphasia,
unilateral upper limb weakness and papilloedema. We present a case report of a lady with a known case of
Evan’s Syndrome whom presented with severe anemia and unilateral right sided hemiparesis with right facial
weakness. Plain and Contrast enhanced CT brain showed bilateral high parietal white matter edema with
venous thrombosis in the right transverse and superior sagittal venous sinuses. At the time of the diagnosis,
she was in hematological remission.
Introduction: The corneal endothelium is made up of an extremely thin layer of non -regenerating cells essential in keeping the cornea clear. The purpose of this study was to quantify the corneal endothelial cells morphology, visual acuity (VA) and refractive error in patients having femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS). Methods: Clinical data from 56 eyes were included in this study. 28 eyes had FLACS surgery and another 28 eyes had CPS. Distance VA, refractive error, corneal thickness and endothelial cells morphology were evaluated pre-operatively and at 1 month follow up. Refractive error was determined subjectively and VA was taken using Snellen chart. Specular microscope was used to measure endothelial cells morphology and central corneal thickness. Mann Whitney test and Spearman correlation analysis were used to analyse the results. Results: There were no statistically significant difference in the mean endothelial cell density (p=0.24), mean central corneal thickness (p=0.68), mean coefficient of variance (p=0.19), mean hexagonality (p=0.44), VA (p=0.72) and postoperative refractive outcome (p=0.66) between both groups. The duration of surgery was noted to have no statistically significant difference between both groups (p=0.08), while the cumulative dissipated energy and torsional time showed a significant difference between groups (p=0.01 and p
The existence of new entity called occult hepatitis C virus (HCV) has
become a raising and escalating concern among healthcare professionals worldwide. It
is defined by the presence of viral RNA in liver and/or peripheral blood mononuclear
cells (PBMCs) within non HCV-infected patients. Previous study had shown the occult
HCV is infectious and capable of transmitting the virus to another host. Till today, HCV
infection remains common among hemodialysis patients despite having the best
preventive plans. Because of this, there is a significant concern about the source of viral
transmission. The aim of the study was to identify and characterize occult HCV infection
in PBMC sample of hemodialysis patients. This was an observational and cross sectional
study. (Copied from article).
In children, most cases of optic neuritis are immune-related. Less frequently, it may also be due to
demyelinating disorders. Other secondary causes such as infection of adjacent structures or infiltration are
even rarer. The occurrence of optic neuritis in children on chemotherapy also has not being extensively
reported. We report a case of bilateral optic neuritis in a young girl with subacute visual loss after receiving
systemic chemotherapy for embryonal ovarian carcinoma.
Varicella or chickenpox is an infectious disease caused by Varicella Zoster Virus (VZV), which commonly affects the children. It is a mild, self-limiting disease and rarely complicate to serious conditions except in adults. Decreasing incidence of chickenpox among children, probably owing to improved living conditions ,prevention and health care, is worrisome as growing number of adults are being infected. This creates disturbing concerns in many parties as women at childbearing age might get infected and not only are them at a great risk of serious complications, but also their unborn fetus or their newborn babies.
Choriocarcinoma is a malignant proliferation of syncytial trophoblast cells that do not form placental villi. It is a relatively rare and highly malignant variant of gestational trophoblastic disease. Although choriocarcinoma is mostly observed after a molar pregnancy, it may be preceded by any gestational event. It has been shown that even a partial mole can transform into choricarcinoma. Incidence rates of choriocarcinoma differ widely throughout the world. In Europe and North America, choriocarcinoma is reported to affect one in every 30,000 to 40,000 pregnancies, and one in 40 molar pregnancies. In South East Asia, choriocarcinoma is reported to affect one in every 500-3000 pregnancies. Following livebirth, choriocarcinoma with metastatic disease are important sequele (31%)(Tidy et al 1995). In the same study the reported median interval between antecedent pregnancy and choriocarcinoma is five months. Multi agent chemotherapy is required in the majority of patients (82%) for the high risk group. The prognosis for choriocarcinoma after a normal gestation is poorer. The mortality rate is also significantly higher than non-molar abortion (21%). Effective treatment with oral Methotrexate in metastatic choriocarcinoma to the lung confirmed the highly sensitive nature of this tumour to chemotherapy agent.
Lactiferous or milk fistula is a tract between the skin and lactiferous duct. Chronic lactiferous duct is uncommon and generally formed during lactating period. It commonly result from complication of the surgical intervention, such as excision biopsy of breast mass or incision and drainage (I&D) for breast abscess. We reported a case of chronic lactiferous fistula secondary to previous I&D for breast abscess in 31 year old lactating woman.
Introduction: Ambulatory blood pressure accurately reflects a patient's actual blood pressure than casual or office blood pressure. This study aims to describe the circadian blood pressure profile of hypertensive patients and to identify the associated cardiovascular risk factors in non-dippers.
Methods: A cross-sectional study was conducted from 1st January 2008 to 30th June 2008 among hypertensive patients attending Family Medicine Clinic HUSM. Schiller BR-102 plus was used to get 24 hours blood pressure (BP) reading. Mean of two offices BP were also taken. Non-dippers are defined as a systolic or diastolic nocturnal drop of less than 10%. Analysis was done using SPSS Version 12.
Results: 105 patients were recruited with mean (SD) age of 51.8 (9.34) year old. The mean (SD) 24-hour systolic and diastolic BP was 128.4 (12.7) mmHg and 79.7 (8.74) mmHg respectively. Mean (SD) daytime systolic and diastolic BP was 132.1 (11.72) mmHg and 82.4 (9.41) mmHg while for the night time were 123.3 (12.78) mmHg and 76.2 (9.01) mmHg. Mean (SD) systolic and diastolic office BP was 144.2(15.16) mmHg and 90.2(9.71) mmHg. Percentage of non dippers were 68.6% for systolic and 61.9% for diastolic.
Conclusion: Mean 24 hours and daytime ambulatory BP was normal but the mean night time diastolic and office BP was above-normal value. Majority of the patients were categorized as non dippers. Therefore, using ambulatory BP is clinically important to get a better understanding of blood pressure fluctuations over 24-hour periods compared to simple clinical measurements.
Study site: Family Medicine Clinic, Hospital Universiti Sains Malysia (HUSM), Kelantan, Malaysia
Introduction: H. pylori BabA is an outer membrane protein that mediates bacterial adherence to the gastric
epithelium, triggers several pathways during the course of infection, and thus contributes to the disease
development. Considering the variability in the presence of BabA coding gene (babA2) among H. pylori
clinical strains, the aim of this study was to assess the relationship between the genotype status of H. pylori
babA2 and the severity of clinical and histopathological outcomes. Methods: Gastric mucosal biopsy
specimens were collected from 30 CLO test-positive patients, 16 with gastritis and 14 with peptic ulcer
disease. Polymerase chain reaction was carried out to detect the presence of H. pylori-specific glmM gene
and BabA coding gene (babA2). Histopathological examination was performed to evaluate the severity of H.
pylori-associated gastric disease according to the Updated Sydney Classification System. Results: The glmM
and babA2 genes were present in 100% and 86.7% of the tested H. pylori strains, respectively. Although
higher degrees of inflammatory activity and H. pylori density were noted in babA2-positive biopsy
specimens, there was no statistically significant association between babA2 genotype status and the severity
of gastric disease. Conclusion: The babA2 genotype status of H. pylori may not be considered as a sole
marker for determining the infection outcomes.
Intraoral periapical radiographic film is essential and aids in diagnosis, treatment
planning, monitoring treatment and monitoring lesion development. A poor image quality of
radiographic film and poor record keeping of these radiographs can affect the clinician's decision
making. This first audit was to evaluate the quality of radiographic images and the compliance in
following the standard of recording and labeling of radiographic films. The objectives of this audit
were; firstly to highlight any potential problems involving quality of radiographic films within the
department. Second, to assess the compliance of record keeping and labeling of intraoral
radiographs. Materials and Methods: The study was conducted in a retrospective manner in the
year 2017 with a sample of 100 intraoral periapical radiographic films from the year 2015 to 2016 in
Hospital Sultanah Bahiyah. Results: This first audit cycle demonstrated: Good quality of
radiographic films: 13% (n= 13/100), Good compliance of record keeping and labeling of radiograph: 32% (n= 32/100).
Jehovah’s Witness followers pose a clinical dilemma to the medical practitioners due to their religious belief of an absolute prohibition of blood transfusion under any circumstances. We present a case of Jehovah’s Witness follower who underwent an ultra-low anterior resection for rectal cancer after neo-adjuvant chemo-radiotherapy. The challenges in the perioperative management are highlighted and managed accordingly.
Introduction: Clinical resolution of periodontitis (CRP) of type-2 diabetic patients with chronic periodontitis (T2DM-PD) after receiving non-surgical periodontal treatment (NSPT) has been reported in the previous studies. This study aimed to evaluate CRP of T2DM-PD under medicaldental coordinated care (M-DCC). Materials and Methods: A 6-months follow-up quasi-experimental study was conducted among 20 subjects who received M-DCC in 2016. M-DCC included standard diabetic care provided by medical professional from 3 health clinics and NSPT provided by periodontal specialists from two periodontal specialist clinics. Target glycemic control achievement (TGCA) HbA1c 6.5% was assessed at baseline and 6 months after NSPT. Clinical resolution of PD was measured in terms of BPE, BOP %, CAL(mm), PPD(mm), PPD 4mm, PPD =4 mm and PPD 6mm at baseline, 3 and 6 months. Paired simple t test and ANOVA F test were applied to infer clinical resolution of periodontitis and its relation to TGCA.
Results: Mean (SD) of average BPE at baseline, 3- and 6-months were 3.52(0.34), 3.12(0.33) and 3(0.45) with (p<0.05); average PPD(mm) were 3.33(0.5), 3.23(0.75) and 2.73(0.57) with (p<0.05); PPD(%) 4mm were 71.03(12.33), 82.77(9.9) and 85.85 (8.9) with (p<0.05); PPD(%) =4 mm were 27.94(11.9), 16.97(10.01) and 13.71(9.1) with (p<0.05); PPD(%) 6mm were 8.04(4.32), 2.66(2.3) and 1.87(2.32) with (p<0.05). Significant resolution of BPE, CAL(mm) and PPD(mm) was noticed among two subjects who has changed from uncontrolled TGCA to controlled TGCA.
Conclusion(s): CRP and TGCA results have verified the effectiveness of M-DCC. A further clinical control trial with adequate sample size needs to confirm the results of the present study.
KEYWORDS: clinical resolution, chronic periodontitis, periodontal therapy, target HbA1C%, Type-2 Diabetic Patients with chronic periodontitis