Introduction: The study was conducted to look for the effects of polycythaemia on Glycosylated Haemoglobin (GHb) levels and to the see the correlations between the levels of haemoglobin, GHb, blood glucose, and lipid profi les including Atherogenic Index of plasma (AIP), in type 2 diabetics living 5800ft above sea level at Gangtok in Sikkim, India. GHb is used to predict the risk of long term complications of Diabetes mellitus (DM) like coronary artery disease (CAD). Materials and Methods: The study group consisted of Group I (Type 2 DM male patients with PPG levels 200mg/dl) and age matched healthy males formed the control group. Results: In Group I, GHb levels correlated positively with AIP, but not with TC/HDL-C ratio. In Group II, both PPG and GHb levels correlated positively with Total cholesterol (TC), LDL Cholesterol, TC /HDL-C ratio and AIP. This shows that higher PPG levels are associated with more Atherogenic lipid profi les. Study also showed higher GHb levels in controls at 7.61%, and correlated positively with postprandial glucose (PPG) levels (r = 0.92). Conclusion: In predicting risk for future CAD, PPG levels and AIP can be used as an adjunct parameter.
A 43-year-old man presented with acute extensive anterior ST-segment elevation myocardial infarction. During coronary angiogram, a segment of myocardial bridging was noted in the mid-segment of left anterior descending artery. The association of myocardial bridging and an anterior ST segment elevation is rarely reported in the medical literature. Myocardial bridging is caused by systolic compression of a coronary artery by overlying myocardium tissue. It is a rare coronary artery anomaly, which usually has a benign prognosis despite some case reports of myocardial ischemia leading to myocardial infarction, lethal arrhythmias and sudden cardiac death. We report one such case of myocardial bridging that was complicated with acute extensive anterior myocardial infarction.
Hepatic adenomatosis is a rare, benign tumour of the liver. It was first described by Flejou et al as multiple adenomas in an otherwise normal liver parenchyma. Although benign, it can present as a diagnostic
challenge because the lesions can be diffi cult to distinguish from other hepatic tumours. Patients can be
asymptomatic and the diagnosis may only be made incidentally. We describe the case of 40-year-old Malay lady who was incidentally found to have hepatomegaly. Radiological examinations revealed a complex left ovarian cyst with multiple liver lesions. Biopsy of the liver lesion showed features of hepatic adenomatosis. Literature review was done and the dilemma in managing her was discussed.
Introduction: This study measured the health-related quality of life (HRQoL) among COPD patients attending outpatient clinic at Institute of Respiratory Medicine, Kuala Lumpur.
Materials and Methods: A cross sectional survey was conducted from November 2008 to January 2009 on 99 COPD patients. Subjects were interviewed through socio-demographic and health characteristics. The HRQoL was measured using the SF-36v2 questionnaires.
Results: Majority of the subjects were above 60 years (64.6%) with mean age of 64.10 ± 11.04 years, male (84.8%), Malays (49.5%), married (74.7%), primary educational level(57.6%), income level below RM1000 (39.4%), ex-smoker (64.6%), moderate COPD (40.4%), 1 to 5 years of illness (62.6%), presence of co-morbidities (65.7%) and satisfied with support from caregiver (48.5%). The total mean score for physical health component summary (PCS) was 41.64 ± 7.99 and mental health component summary (MCS) was 46.53 ± 13.21.
Conclusion: There were significant differences in PCS for different educational level (p<0.05) and socio-economic status (p<0.01). The MCS were signifi cantly different between ethnicity (p<0.05) and level of satisfaction with support from caregiver (p<0.01). This finding provides information that needed focus in
healthcare services.
KEYWORDS: COPD, health-related quality of life, Malaysia
Study site: outpatient clinic, Institute of Respiratory Medicine, Kuala Lumpur, Malaysia
Introduction: Diabetes Mellitus (DM) is a chronic metabolite disorder with high potential of multisystemic medical complications especially among poorly controlled patients. This study was conducted at Raja Perempuan Zainab II Hospital, Kota Bharu with objectives to explore the pattern of common diabetic mellitus type 2 complications and to compare between gender and races in relation to other risk factors during their hospitalization. Materials and Methods: This is a retrospective study based on patients’ record involving 215 patients (110 women and 105 men) who were admitted with diabetic complications in medical ward for a period of 6 months (January to June 2006) Results: Out of total 300 identifi ed subjects, 285 case notes were traceable. From 285, 84.6% (241 subjects) were diagnosed as DM type 2. 215 out of 241 subjects (89.2%) had one or more diabetic complications. In general the most common diabetic complication was diabetic nephropathy 34.9% (75 patients). When we compared between genders, diabetic foot ulcers was the most common diabetic complications among males (43.8%) and diabetic nephropathy for females (40.9%). A total of 199 patients (92.6%) had poor blood sugar control during their hospitalization and 103 patients (47.9%) had hypertension. Conclusion: Patients with DM type 2 had a high prevalence of complications. Common diabetic complications among genders were varied. Patients with diabetic complications had high prevalence of risk factors such as poor blood sugar control, concomitant hypertension and smoking habit.
Introduction: The study was done at the aim to assess the functionality and viability of the β cells of the streptozotocin-induced diabetic rats model following repetitive dosage of administration of ethanolic extracts of Andrographis paniculata. Materials and Methods: The diabetic rats were treated with the extracts for fourteen days and at the dose given was 500 mg/kg twice daily. The assessments were made on fasting blood glucose, insulin, and immunohistochemical aspect of β cells before and after treatment. Results: The results showed that there was a signifi cant reduction on fasting blood glucose levels in metformin, 95% and 50% ethanolic plant extracts-treated groups but on insulin level only 95% and 50% ethanolic extracts-treated groups gave a signifi cant reduction(p
A 29-year-old, smoker, diabetic, hypertensive and hypercholesterolemic man was diagnosed of having severe coronary artery disease with a critical left main stem stenosis. On-pump coronary artery bypass graft surgery (CABG) was performed using conduits from the left internal mammary artery as well as the left radial artery and right saphenous vein which were both harvested endoscopically. He was discharged after a week of uneventful recovery. This case emphasizes on the best possible management of conduits selection, intraoperative myocardial protection and the risk factors modifi cation in achieving a long term graft patency and avoiding premature cardiac related death.
Introduction: Maternal psychological well-being determines early mother-infant relationship and babys health. Paying attention on this aspect is essential particularly in early postpartum period. This study aimed to determine early psychological reactions toward socioeconomic profi les, delivery methods and delivery outcomes among postpartum mothers in Kuala Lumpur Hospital. Materials and Methods: A total of 150 two week-postpartum mothers participated in this cross sectional study and their psychological perspective was measured by using the Depressive, Anxiety and Stress Scale (DASS). Results: 4%, 16% and 4.7% of respondents had significant depressive, anxiety and stress levels respectively. Conclusion: Socioeconomic variables such household income, level of education and presence of medical illness were statistically signifi cant to determine early postpartum psychological reactions but not the modes or outcomes of delivery.
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
Introduction: Attention deficit hyperactivity disorder (ADHD) is a frequently encountered clinical condition in children. Based on DSM IV-TR criteria it can be sub-classified into three distinct types namely hyperactiveimpulsive, inattentive and combined. Materials and Methods: In the present study, salivary antioxidant activity (AOA) in children with ADHD was compared with age-matched normal control subjects, both as a whole and also with regard to the three subtypes. Additionally, the effect of therapy on the altered AOA levels was investigated following short term (
Introduction: The objective of this study was to investigate the effects of lead on concentration and motility of spermatozoa recovered from epididymis and testes in mature male offspring whose mothers were exposed to different doses and concentrations of lead acetate during gestation period. Materials and Methods: Seventy two healthy mature female mice were divided into three major groups according to the number of injections involving 1, 2 and 3 injections. Each major group was subdivided into four minor groups according to the concentration dose of (0, 25, 50 and 100) mg/Kg of lead acetate. Sperm concentration, percentage of motility and grade of activity were microscopically examined and statistically analyzed. Results: A significant reduction in the sperm functions were seen in relation to an increased in the number of injections and/or concentration of lead acetate dose as compared with the control groups. Conclusion: The toxic effects of lead acetate may interfere with spermatogenesis and metabolism of spermatozoa.
Introduction: Frequency of lower urinary tract symptoms (LUTS) in young age women is not well studied. It is said to be common among female elderly and multiparous population. The aim of this study is to obtain the prevalence of LUTS among nulliparous students in relation to their personal hygiene. Materials and methods: This is a prospective cross-sectional study conducted among 200 nulliparous medical and nursing students aged between 18-28 years using standardized questionnaires. Urine samples were also collected from students to detect urinary tract infections. Results: The complete data sets of 146 students were analyzed. All of them were nulliparous, single and not sexually active. The prevalence of LUTS was 52.7% consist of over-active bladder, urinary incontinence (UI) and voiding difficulty respectively (51.3%, 34.9% and 45.2%). The most common type of UI was stress urinary incontinence which was 21.9% followed by 11.6% of urgency incontinence. Conclusion: The prevalence of LUTS among young age population is high at 52.7%. Public awareness regarding LUTS and availability of treatment is needed.
Introduction: The aim of this study was to determine the effects of gamat extract on pain behaviour and Fos like immunoreactivity (FLI) expression in the ventral posterolateral thalamus using the acute pain model. Materials & Methods: Fourteen Sprague-Dawley male rats (220-300 gram) were given intraplantar injection of 0.05ml formalin (1%) followed by intraperitoneal administration of either 4 mg/kg gamat extracts (Holothuria spp.) or saline (control). Behavioural changes were observed and rats were sacrificed 2 hours post-formalin injection. Immunohistochemistry testing was done on the brain sections. FLI was examined using a light microscope attached to an image analyser. The behaviour and FLI data were analysed using repeated measure analysis of variance and independent t-test respectively. Significance level was taken as p
A 15-year–old Malay male with congenital insensitivity to pain presented with recurrent septic arthritis of the left knee complicated by osteomylitis. Repeated arthrotomy and wound debridement was done, however, the condition was not resolved. Amputation was suggested as the best method of treatment to eradicate the infection.
Coronary artery spasm can result in acute coronary syndrome. This vasospastic syndrome can cause profound morbidity and mortality as a significant proportion of patients continue to have angina despite optimal medical therapy. We illustrate the dilemma in managing a young woman who presented with non ST-segment myocardial infarction as a result of it. She did not have the conventional risks for coronary artery disease except the family history of myocardial infarction. Vasospasm was demonstrated at the mid right coronary artery which resolved with intracoronary nitroglycerine during angiogram. Most women with no significant heart disease following demonstration of normal or “near normal” coronary arteries after angiography are offered no treatment beyond reassurance each year. New data suggest that this approach may no longer be appropriate and the prognosis in such patient is not as benign as previously thought. We discuss the management dilemma of such patient with associated mild atherosclerotic plaque.
Education and training in disaster medicine is an ongoing process to all categories of personnel involved.
In addition to the collaborative inter-professional table top exercises, regularly conducted field exercise drills offers the best form of training. Currently in most countries there is no standardized curriculum
for the training of disaster management from the medical perspective. It is imperative that the concept of disaster medicine and its principles should be a component in the undergraduate and postgraduate
curriculum of Medical and Allied health related programmes.
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
An aberrant right subclavian artery is the commonest aortic arch anomaly. Majority of them were asymptomatic. An aberrant subclavian artery is a rare cause of dysphagia in adults. This condition is also known as dysphagia lusoria. We report a case of dysphagia in a 49-year-old woman from an aberrant right subclavian artery. Diagnosis of her condition was made with barium swallow and MDCT (multidetector computed tomography) scan. She was managed conservatively.
A Mondor’s disease is a rare, benign and self-limiting condition. It is due to thrombophlebitis of the superficial veins of the breast and chest wall. It usually occurs in middle-aged women who present with a palpable cordlike structure, often painful in the acute phase. The aetiology is unknown, and may be related to trauma, surgery, infection or tight clothing. The finding of a superficial vessel seen as a linear opacity on mammography and a tubular structure on ultrasound is typical. An intra-luminal thrombus may be seen on ultrasound, and there may be absent flow on Doppler imaging. Conservative treatment is usually instituted, although surgery may be indicated in certain circumstances.
Clinically, it is sometimes diffi cult to distinguish an infection of the spine from a metastasis. Spinal tuberculosis is common according to its endemic region and adenocarcinoma of the lung is also rising in the incidence worldwide. Similar presentations, with unknown primary, clinical fi ndings and hematological investigations rarely conclude a true diagnosis. Radiologically, the hallmark of spinal infection is erosion of adjacent vertebral endplates and narrowing of the disc space with or without a paravertebral shadow. Metastasis typically does not involve the disc space with erosion of the adjacent vertebral endplates. It usually presents as a lytic/sclerotic lesion in the vertebral body or “winkle owl” sign. These distinguishing features of infection versus metastasis are not certainties. Biopsy is mandatory whenever in doubt or patient is not responded with provisional treatment. The author presents a case with so-called radiological features of spinal tuberculosis infection, which turns out to be a metastatic adenocarcinoma of the lung.