The use of thrombolytic agent e.g. streptokinase is indicated in patients with early acute ST elevation myocardial infarction (MI) (if there are no contraindications) is becoming increasingly routine. Its use is however significantly limited by bleeding complications. Spinal epidural haematoma (SEH) is haemorrhage in the spinal epidural space after spinal anaesthesia. SEH may be acute or chronic, spontaneous, posttraumatic, or iatrogenic but its occurrence appears to be particularly associated with acquired coagulopathy from medications and disease states. Patients usually present with acute axial spine pain and evolving focal neurological deficits. With increasing number of available anticoagulants and patient receiving them, anaesthesiologists today have to face the challenge of balancing between risks and benefits of regional anesthesia in patients under such medications. The treatment of this condition involves the principles of conservative follow-up directed by an improving examination and an understanding of the pathophysiology of coagulopathy-induced spontaneous epidural bleeds. When the diagnosis is accomplished rapidly, surgical decompression can result in full functional recovery.
Replacement therapy for toxoplasmosis was not a clear-cut choice since most of anti-parasitic agents available are also associated with Steven Johnson Syndrome. Further more the therapy has to be effective to control infection, which was previously achieved by oral Fansidar in this patient. Oral Azithromycin was seen as a drug of choice for these reasons. Corticosteroids were maintained since it was relatively indicated in both toxoplasmosis and SJS. Both conditions can results in visual impairment. SJS can be a life threathening condition and its ocular complications include conjunctivitis, ectropion or entropion, symblepharon, vascularization of the cornea, chronic dry eyes, and ankylosymblepharon. Proper management in dealing with both diseases is mandatory in order to prevent mortality and minimize the ocular complications. It has been shown in this case that the challenging part in managing patient with both diseases is to balance out between prevention of fatal consequences and the need control to the infection and preserving vision. Decisions on medical treatment for both conditions will remain controversial till reliable prospective randomized control trials are done to address the issues
The advancement in human stem cell research has promised a viable alternative treatment for a range of ‘incurable diseases’ such as neurological diseases. To date, several studies have documented substantial evidences on the therapeutic properties of stem cells in promoting repair in different diseases including common neurological disorders i.e. ischaemic stroke and spinal cord injury. However, the progress of stem cell research has been surrounded by ethical issues which largely due to the usage of human embryos as one of the sources. These embryonic stem cells which originally derived from human embryo of aborted foetus or already existing human embryonic stem cells (hESCs) lines, has sparked an intense moral and religious argument among people of various faith, including Muslim community. From the therapeutic point of view, amongst the currently available stem cells, hESCs show the greatest potential for the broadest range of cell replacement therapies and are regarded as the most commercially viable. This review focuses on the major ethical issues, particularly to Muslim community, related to human embryonic stem cells research with special emphasis on the moral status of the embryo and the beginning of life according to the Islamic ethics and rulings. In this paper, we also discuss some ethical positions towards embryonic stem cell research in the Islamic world, including official regulations existing in some Muslim countries. We examine the justification and the necessity on the usage of hESCs following the newly discovered Induced Pluripotent Stem Cells (IPSCs) in the laboratory. In addition, we supplement the discussions with the general views and positions from the other two Abrahamic religions i.e. Christianity and Judaism.
The growing demand for orthodontic braces among Malaysian community has led to
the development of "fake" and "real" braces. "Fake" braces refer to braces that are worn as costume
and are not bonded to teeth hence unable to produce movement of teeth. "Real" braces refer to
braces that are bonded to tooth structure and are able to produce tooth movement. The braces are
bonded by unqualified practitioners with no formal dental education and they provide braces
treatment in unlicensed premises such as hotel rooms or patients' own homes. (Copied from article).
Orthodontic fixed appliance is now considered as fashion accessory and a symbol of
wealth. Due to overwhelming demand, 'fake' and 'real' braces services have been offered through
social media by unqualified personnel using poor quality orthodontic brackets and cases of metal
toxicity from using these type of braces has been reported. (Copied from article).
Introduction: Anterior border of the tibia is covered only by a thin layer of protective tissue. Plating of the tibia often results in wound complication and infection if the injury to this area is not recognized. We review our results of managing infection following plating of the tibia using a protocol base on the status of bone healing and the presence of bone or soft-tissue defect. Methods: Eight cases of infection following plating of the tibia were managed according to stage procedures protocols and classification, which is based on the state of bony union and the defect following wound debridement. The soft-tissue defects were managed with local flaps, and the bone defects were managed with Illizarov bone transport. Results: Three patients had more than one bacterium isolated. Gram negative organisms were isolated from seven patients. Methicillineresistant Staphylococcus aureus was isolated in two patients. All patients achieved union with a mean union
time of seven months. The infections were controlled in seven patients. One patient had minimal sinus discharge but refused further treatment. Conclusions: The stage protocol for the management of infection following plating of the tibia is practical and produces excellent results.
Dural arteriovenous malformation (DAVM) is relatively rare and defined as abnormal connections or shunts between the arterial and the venous side of vascular tree located within the dura mater. Spontaneous closures of DAVM are rare and have been scarcely reported. This case report will describe the neuroimaging findings and classification of DAVM. A 50 year old lady presented with headache. Neuroimaging showed prominent serpinginous flow-void structures, cerebral angiogram confirmed the presence of DAVM at the occipital region. She had defaulted treatment and follow-up for 3 years. On second admission, she had a cerebral angiogram which showed normal findings with no evidence of fistulas or malformation. She was discharged well. Causes of spontaneous closure of DAVM are discussed.
Introduction: Substance abuse is both a social and public health problem with a substantial burden to society. Opioid dependence results in unemployment, crimes, family disruption, and transmission of diseases. In Malaysia, methadone maintenance therapy (MMT) has been introduced as a harm reduction method. However, relapse during treatment remains an issue to be resolved that hinders successful outcome in the therapy. Spirituality in the treatment of substance abuse disorders has yet to be fully explored. This study aims to examine how MMT clients who relapsed perceive spiritual deficits as an influence and association of spiritual practice with relapse. Methods: This is a cross-sectional study done from June-July 2016. All MMT clients undergoing therapy at 3 treatment centers in Terengganu, Malaysia who fulfilled the inclusion and exclusion criteria and consented were included in the study. A semi-structured questionnaire was filled via face to face interview and spiritual practice was assessed using Hatta Islamic Religiosity Scale. 121 questionnaires were assessed and data was analyzed using SPSS version 22 for quantitative data. Results: All respondents were males of Malay race and Islamic religion. Current relapse, defined as any episode of intake of opioid for the past one month after a period of abstinence was 34%. Only three out of 42 clients who relapsed had some spirituality theme in their perceived cause of their relapse. However, a significant majority of those relapsed had a spiritual practice score of less than the mean practice score. Conclusion: Relapse in opioid addiction remains high in those receiving MMT in Terengganu, Malaysia. Spirituality may have a subconscious influence towards relapse in addiction in MMT clients. Further effort should be taken to inculcate spirituality intervention effective to prevent relapse which may contribute towards achieving a more successful therapy outcomes.
Metastatic spread of tumors to the skull is quite unusual and often represents diagnostic and therapeutic issues. Skull involvement can be observed in various neoplasms of epithelial origin and are most often due to lung, breast, thyroid, kidney and prostate cancers. However, skull metastases from hepatocellular carcinoma (HCC) have been rarely reported. The prognosis for patients with hepatocellular carcinoma is so poor that treatment of such distant metastatic lesion cannot be achieved before death occurs due to the primary malignancy. Therefore, the clinical manifestations of cranial metastasis prior to that of primary hepatocellular carcinoma have rarely been reported. This case illustrates a rare case of skull metastasis as an initial manifestation of hepatocellular carcinoma. Although a solitary skull metastasis prior to the diagnosis of HCC demonstrates rare metastatic behavior for HCC, especially in Asia, skull metastases from HCC should be included in the differential diagnosis of skull tumors, even if the patient is asymptomatic of liver cirrhosis.
Introduction: To describe the sociodemographic profile, contraceptive practice, and awareness of HIV infection among unmarried post partum women in the biggest government hospital in Pahang.
Methods: A cross sectional questionnaire-proforma-based study was conducted for one year duration from August 2010 until July 2011 by identifying and recruiting all the unmarried women upon admission for delivery. Basic information were obtained from the use of patients’ case notes, and further related and necessary information were obtained from a direct face-to-face interview based on a proforma.
Results: A total of 121 unmarried women were identified and recruited. The age ranged from 13 to 36 years with a mean age of 21.6 years. 31.4% were teenagers. Only 16% of patients have tertiary education, and 2.5% never had any formal education. About one third of the women were smokers or ex-smokers, 7.5% had consumed alcohol, but none denied ever use of any recreational drugs. Almost 9% has prior history of being sexually assaulted. About three quarter of the women never used any contraceptive method. Majority of the patients (85.1%) were aware of HIV transmission risk; 75% never had any antenatal checkup or booked at late gestation (> 20 weeks); and 45.8% were not aware of any support groups for single mothers. Conclusion: Single unmarried women are associated with disadvantaged sociodemographic profile.
Contraceptive practice was also very low despite significant awareness towards risk of HIV infection. Further follow up, support and care should be offered to these women.
We report a case of sudden hypoxaemia after intubation in a patient who had smoked a few hours prior to a surgical procedure. The cause of his desaturation was not related to bronchial secretions, bronchospasm or obstruction of the upper airways but most likely due to reduced oxygen saturation in the body prior to surgery. We managed to secure the airway and prevent prolonged desaturation by instituting remedial measures. Our conclusion is that cessation of smoking is very important and need to be emphasized in all patients having surgery under general anaesthesia. This applies to emergency cases as well.
Clinical scoring methods such as the Sequential Organ Failure Assessment
(SOFA) score are frequently used to predict outcome in sepsis, with limited capacity.
Further tools for risk assessment of septic critically ill patients would thus be useful.
Our purpose was to derive a scoring method i.e. Sepsis Mortality Score using multimarker
approach for the prediction of 30-day mortality in septic critically ill patients,
and compare its performance to the SOFA score (Copied from article).
Introduction: Epilepsy remains a stigmatised disease across geographical and temporal boundaries. Very little is known about epileptic stigma (ES) in cross-cultural settings. The aim of this study was to assess the prevalence of perceived stigma and factors associated with it, among patients with epilepsy (PWE) at a tertiary care referral hospital in East Coast of Malaysia. Methods: A cross sectional survey among 132 consenting PWE using pre-tested, semi-structured questionnaire in Malay/English language to assess their knowledge, attitude and practices (KAPs). Results: Among 132 respondents, 51.5% were male and 48.5 % were female. Their age ranged from 14 to 70 years (mean=31.6±13.41). Majority (53.8%) of them were aged 30 years or younger. The median number of years they had epilepsy was 8.0 (IQR 4.0-18.8) years and average duration of seizure prior to seeking medical attention was 1.0 (IQR 0.3 - 4.5) year. Most of them (90.9%) did not know the cause of epilepsy; however nearly all (91.7%) believed that it was a disease of the
brain. Higher education level respondents possessed significantly higher KAP scores compared to lower education level respondents (p
Dental caries is the most common yet preventable disease. Study found that seaweed
exhibits anti-cariogenic properties. However, little attention have been given to the study on anticariogenic properties of seaweed and the bioactive compound that responsible for the anticariogenic activities have not adequately investigated. This study was conducted to evaluate the
best extraction methods for S. polycystum and to determine the fatty acid compounds of S.
polycystum that have anti-cariogenic potential against oral cariogenic bacteria. (Copied from article).
Introduction: Thalassaemia is an inherited blood disorder and is a significant public health alarm in Malaysia with many not knowing they are carriers of this haemoglobin disorders. Materials and methods: This study conducted a one off collection of blood samples from 72 Malays students of International Islamic University Malaysia (IIUM) in Kuantan. Blood samples were subjected to conventional haemoglobin analyses that include full blood count and picture, HPLC, Haemoglobin electrophoresis and H-inclusion test. All samples were also genotyped for alpha thalassaemia–1 of Southeast Asia (a-Thal1SEA). Result: There were 17(23.6%) students who were diagnosed as thalassaemia carriers. Out of this, four (5.5 %) and six (8.3 %) students were presumptive β-thalassaemia trait and Haemoglobin-E trait as determined by the HPLC assay respectively. Nine (12.5%) students were genotyped a-Thal1SEA among whom two were also β-thalassaemia carriers. All thalassaemia cases had MCH of < 27pg. Nonetheless, two out of six Haemoglobin-E trait and three out of nine a-Thal1SEA carrier had MCV value of >80fL. Two out of four (50%) presumptive β -thalassaemia trait and one out of six (17%) students of presumptive Haemoglobin-E trait had family history of thalassaemia respectively. Conclusion: The high occurrence of the three common types of thalassaemia carrier (β, Hb-E and a-Thal1SEA thalassaemia) in our small group of subjects could be due to better participation of students who had family history of thalassaemia. The study reaffirmed the importance of molecular study for detection of alpha-thalassaemia and the use of MCH value of
Salvadora percisa (popularly known as miswak) has been widely used as an aid for
oral hygiene in dentate patient. There is no side effect of using miswak stick. A new approach
introduced the role of miswak stick in edentulous patient. It may prevent the incidence of denture
stomatitis among denture wearer. This study assessed the effectiveness of the miswak stick as an
oral aid in edentulous patients as an alternative treatment for denture stomatitis. (Copied from article).
Orthodontic tooth movement is a complex process involving tooth and periodontal
tissue, which release enzymes and biomarkers. The aim of this study was to investigate enzymes
activities of salivary fluid during orthodontic treatment, (Copied from article).
Enamel demineralization is associated with decrease in saliva pH due to fermentation of sugar by oral commensal. Thus, exploring the changing pattern of saliva pH is meaningful in dental caries prevention. The aim of this study was to compare the changing pattern of saliva pH after consuming different types of sweeteners (sucrose and maltitol). Methods: It was a case-control study involving 14 male patients attending IIUM dental clinic who were selected with the intention of getting seven patients with high caries risk ( DMFT ≥6) and seven patients with low caries risk (DMFT ≤3) with initial saliva pH interval of 6.5 to7.5. Patients were asked to consume snacks containing 8 gram sucrose and 8 gram maltitol as sweeteners. The changing pH values of the saliva were measured by Waterproof pHTestr 10BNC (Oakton, Vernon Hills, USA) seven times consecutively at 0 (before snack consumption), and at 5, 10, 15, 20, 30 and 60 minutes after snack consumption. The pH values of saliva of patients with low and high caries risk after consuming sucrose and maltitol were statistically analized by using Anova and Tukey-HSD tests at α = 0.05. Result: There were significant differences in saliva pH changes between low-risk group and high-risk group after consuming sucrose and maltitol. Conclusion: The changing patterns of saliva pH in high-risk patients were lower than those of low-risk patients after consuming two types of snacks containing sucrose and maltitol.
Extrahepatic bile ducts constitute a significant anatomic site for surgeons when performing hepatobiliary
operations from minor procedure such as cholecystectomy to major operation such as hepatectomy. The
challenges for surgeon in performing such cases increase when congenital variance of biliary tree occurs which
may lead to unintentional bile duct injuries. We reported a case of a lady who presented with obstructive
jaundice secondary to huge distal common bile duct stone. The presence of right posterior segmental hepatic
duct, which rarely occurs, was discovered during intraoperative cholangiogram before common bile duct
exploration. The operation was successful without incidence of biliary duct injury.
The present concepts in Total Hip Arthroplasty advocate mechanical cement interlock
with trabecular bone utilising the third-generation cementing technique. However, the
force generated can easily reach peak pressure of 122 kPa to 1500 kPa, leading to
extrusion of cement through nutrient foramina into femoral cortex into nutrient vessels,
henceforth the retrograde arteriovenogram. (Copied from article).