Haemoptysis is the clinical features of pulmonary tuberculosis (PTB) (32.5%) in Malaysia, in which if massive and left untreated it carries out a mortality risk of more than 50%. In the majority of cases, the main bleeder arises from the bronchial artery, with the pulmonary arterial circulation as a rare cause of bleeding, accounting for less than 10% of cases. Rasmussen aneurysm is a rare phenomenon following the weakening of the pulmonary artery wall resulting from adjacent cavitary tuberculosis. The sequelae which follow include pseudoaneurysm formation and subsequent rupture.
The aim of this study to assess the efficiency of flushing
method of Dental Unit Waterline (DUWL) system in reducing the
number of microorganism. Water samples were taken before and after
two minutes of flushing from air-water syringes system in ten randomly
selected dental units in a Dental Teaching Centre. These samples
were immediately transferred to the microbiology laboratory in the cool
box within 8 hours for the heterotrophic plate count (HPC) test. Paired
t-test was used to analyse number of microbe before and after flushing.
The numbers of colony forming unit (CFU) ranged from 13,000 to
120,000CFU/ml in unflushed samples, and 3,000 to 15,000CFU/ml in
flushed samples. The mean HPC post-flushing was lower than preflushing [8360.00 (4561.48) vs 63300.00 (44587.12) CFU/ml]. The
mean HPC between pre- and post-flushing was significantly different
(P=0.004, 95% CI 22039.52, 87840.48). The coliform count from the
control was 140 CFU/ml. In conclusion, flushing method of DUWL
system significantly reduces the number of microorganisms in the
dental unit. However, the level of microorganisms still does not meet
the standard guideline by Environmental Protection Agency for safe
drinking water, which should be below 500 CFU/ml. In our opinion, the
duration of flushing should be increased and additional chemical
treatments of the dental units should be implemented to ensure the
safety of patients and dental personnel.
We report a case of dural carotid cavernous fistula (CCF) pose a diagnostic dilemma with initial symptoms of the arteriovenous shunt. A 56 year-old man presented with right eye diplopia, thensubsequently developed ptosis, congestion of conjunctiva, dilated episcleral vessels, and gradual rise in intraocular pressure. Initial diagnosis of pseudotumour was made based on negative finding of CCF by computed tomography angiography (CTA). In view of persistent clinical manifestations in spite of steroid therapy, and with the presence of new ocular signs; cock-screw conjunctival vessels, dilated retinal veins, and proptosis, digital subtraction angiography (DSA) was performed and confirmed the diagnosis of dural CCF.The ocular symptoms resolved completely post embolization of the fistula.
Wounds are inevitable events that can occur daily due to many factors such as; physical, chemical and biological, which can cause tissue, cell and in some events bone damage. The process of wound healing is complicated as it involves many factors; therefore, an effective and safe agent is essential to ensure good healing process. Herbal medicine is considered safe and effective. Flaxseed (Linum usitatissimum) is an effective plant when it comes to wound healing and has been used for decades as a traditional healing agent. The bioactivities of flaxseed extract have been reported to demonstrate many beneficial effects such as antimicrobial, antioxidant and anti-inflammatory effects. It has been shown that flaxseed has positive effects on many types of wounds such as skin wound healing, burns and burn scar healing, bone healing and also has demonstrated positive results in the healing of oral ulceration besides exhibiting anti-bacterial effects in the oral cavity. This review describes the positive effects of flaxseed in multiple types of wound healing. Additionally, it is also aimed to introduce the potential applications of flaxseed in socket healing which involves series of complex changes to both soft and hard tissues in the oral cavity.
Thalassaemia is one of the most common autosomal recessive blood disorders in the world and its carrier status is prevalent in nearly 15% of Malaysian population. The global and economic burden for lifelong care of those affected increases every year. Currently, there is no policy on thalassaemia-carrier screening for couples prior to marriage besides HIV/AIDS screening in Malaysia. Other countries such as Iran, Iraq, Turkey, Bahrain and Saudi Arabia have established a policy for thalassaemia prevention by conducting premarital thalassaemia screening. Zero thalassaemia cases in new-born child in Cyprus have proven that thalassaemia can be prevented. This study aimed to investigate the willingness of premarital Malays on premarital thalassaemia screening.
A set of questionnaire was distributed to 57 persons at premarital course sites and wedding fairs and expositions held in Kuala Lumpur and Selangor. Components in the questionnaire included: 1) demographic 2) knowledge about thalassaemia, signs and screening method 3) attitudes towards thalassaemia premarital screening 4) practices of premarital thalassaemia screening. Analysis for the questionnaire was performed using IBM SPSS Statistics 23.0.
Oesophageal perforation is a rare clinical situation. However, it is associated with high morbidity and mortality rate. A 39-year-old lady with underlying epilepsy was admitted to hospital for alleged accidental ingestion of broken dentures while sleeping. She underwent emergency direct laryngoscopy, oesophagoscopy and oesophagogastroduodenoscopy. However, no foreign body was found. She was subsequently discharged home. Two days later, the patient presented again with dyspnoea, fever and chest discomfort. A chest radiograph showed bilateral pleural effusion, left pneumothorax and right mediastinal shift. A suspicion of oesophageal perforation was raised. Upper gastrointestinal study revealed an oesophageal perforation. Under conservative management, her condition was complicated with thoracic empyema. She subsequently underwent video assisted thoracoscopy and decortication. Fortunately, after one month of hospitalization, she regained full recovery. In conclusion, any chest symptoms which arise after oesophagogastroduodenoscopy should be dealt with extra caution. Patients outcome after oesophageal injury are time dependent, thus any delay in obtaining radiological assessment should be avoided.
Tuberculosis, an ancient disease, still thrives today as the leading infection caused by Mycobacterium tuberculosis. Diagnosis of ocular tuberculosis poses a great challenge due to the varied clinical presentations. We report 3 cases of primary ocular tuberculosis with varied presentations: conjunctival abscess, sclera-uveitis and occlusive vasculitis. There were no symptoms suggestive of pulmonary tuberculosis in all cases. All patients presented with acute, unilateral painful red eye. The first case had good visual acuity (VA) OD (6/9) with a swollen upper lid, localized perilimbal-hemorrhagic conjunctival swelling superiorly, keratic precipitates and mild anterior chamber reaction. The posterior segment was normal. The second case had a VA of 6/60 OD. There was presence of conjunctival injection, keratic precipitates, posterior synechiae and anterior chamber reaction of 1+. A few days later, there was a progression to vitritis OU and hyperemic optic disc OD with choroidal folds, cystoid macula edema and a positive T sign on B scan ultrasonography. The third case had VA of 6/6 OU, AC reaction of 2+ OD. There was multiple peripheral choroiditis with peripheral vasculitis seen in the posterior segment OU. Fundus fluorescein angiography (FFA) showed peripheral periphlebitis in all 4 quadrants OU. All 3 cases had positive Tuberculin Skin Test (Mantoux test) results which were more than 20mm. Anti-tuberculous treatment was promptly started and all patients showed significant clinical improvement. This case series highlights the diverse clinical presentations of ocular tuberculosis. A high clinical index of suspicion led to prompt initiation of anti-tuberculous therapy which resulted in good clinical outcomes for all cases.
Sino-nasal osteoma is a common benign tumour of paranasal
sinuses and usually asymptomatic. Here, we presented a case of a huge sinonasal osteoma. Despite the large size of the tumour, the only presentation
was epiphora. There were no headache, facial pain or diplopia. Nasal
obstruction only occurred after involvement of the nasal cavity. In diagnosing
aetiology of the epiphora, sino-nasal pathology needed to be ruled out after
excluding ocular causes. Multidisciplinary approach between otolaryngology
(ORL) team and ophthalmology team was essential in managing the case.
The tumour was successfully removed surgically via endoscopic approach;
and dacryocystorhinostomy (DCR) was performed to alleviate the epiphora.
Cornea bee sting is a rare condition with mild to severe complications. We report a case series of three patients with cornea bee sting presented to a tertiary center. All patients sustained embedded stingers in the cornea stroma and presented within a few hours of injuries. All patients received topical antibiotics, topical steroids and removal of stingers. However, techniques of stinger removal and administration of the medications are among factors that contributed to different outcomes in these patients
Orbital cellulitis is a clinical diagnosis. Once the diagnosis is made, an empirical antibiotic is started, and in most cases, the clinical improvement can be observed within 24-48 hours. We discuss treatment options in managing orbital cellulitis in a 34-year-old male in which no improvement was seen despite being started on empirical broad-spectrum antibiotic. Patient had a prior history of being bitten by an insect in the left upper eyelid while doing gardening about 5 days prior to admission. The patient developed left orbital cellulitis a few days following the insect bite. Patient was started empirical broad-spectrum antibiotic immediately, but no improvement observed. Culture and sensitivity taken from the upper eyelid grew methicillin-resistance Staphylococcus aureus (MRSA) which was sensitive to vancomycin. Patient was treated with intensive fourteen days of intravenous vancomycin. The infection resolved as evidenced by clinical improvement and reduction of white blood cells count.
We describe the first clinical case of contact lens related corneal ulcer caused by Elizabethkingia meningosepticaregistered in Southeast Asia. A 20-year-old female student who wasa regular soft contact lens wearer, presented with pain, photophobia and blurring of vision of the right eye for 3 days. On slit lamp examination, there was a small paracentral anterior stromal infiltrate with an overlying epithelial defect. Microbiological cultures from corneal scrapings, contact lens and its casing were positive for E.meningoseptica. Due to high likelihood of contact lens contamination causing keratitis, topical fortified gentamicin0.9% and ceftazidime 5% were administered empirically. Topical vancomycin 5% was later added tailoring to the culture and sensitivity of the organism. After 8 weeks of treatment, the keratitis subsided and corneal epithelial defect completely healed with residual corneal opacity. Even though uncommon, contact lens related E.meningosepticakeratitis can occur in healthy immunocompetent individuals with no ocular comorbidities.
The quality of pap smear determined by the specimen adequacy of cervical smears. It plays an important role to detect changes in the cervix particularly the transformation zone (TZ). This study aimed to determine factors associated with poor pap smear quality in Barat Daya District, Penang. This is a cross-sectional study of 276 randomly selected specimens of woman who underwent pap smear test in all government health clinics in Barat Daya District, Penang between January until June 2019. Study proforma was based on cytological report issued by Pathology Department, Penang Hospital and staff records in Nursing Unit, Barat Daya District Health Office. 30.1% has poor smear quality. Women who are menopause are twice the risk to have poor smear quality [Adjusted OR (95% CI): 2.34(1.14, 4.84), p