This study is to examine the use of a Rapid Troponin T test in patients attending the Emergency Room with complaints of chest pain. The results show a strong correlation between time to positive developmentaf the Rapid Trapanin T lest to ELISA Trapanin T. These results indicate the use of a simple to perform bedside assay of Rapid Trapanin T may be used in early risk stratification of patients presenting wilh acute coronary syndromes. KEYWORDS: Rapid Trapanin T, acule coronary syndromes, risk stratification.
Osteoarthritis is the most common joint disorder in the human population. It is characterized by the destruction of articular cartilage and the overgrowth of marginal and subchondral bone. The commonest weight bearing joint affected is that of the knee, affecting over one third of people over Ihe age of 65 years. This article reviews the recent principles of non surgical management of osteoarthritis. This is divided into non drug management such as primary prevention, physiotherapy, occupational therapy and patient education. Drug management will include the use of different types of analgesics. viscosupplementation as well as joint injection. KEY WORDS: Osteoarthritis, management
Scrub typhus is an acute febrile illness caused by the bacteria Orientia tsutsugamushi, which can be transmitted to humans through the bite of infected trombiculid chigger mites. Besides the typical clinical features of fever and eschar formation, the central nervous system has been reported to be involved as evidenced of reported cases ranging from meningitis to meningoencephalitis. Here, we describe an atypical presentation of scrub typhus case that occurred in a 34-year-old Malay male who presented with quadriplegia following an insect bite at the back of his neck. Our case displayed unusual findings of this rare condition in a non-aboriginal Malaysian population. Based on previous literature, we emphasized the importance of prompt diagnosis of scrub typhus in order to reduce the mortality and morbidity and to improve the quality of life for patients with complications of this disease.
Evidence-based recommendations on intrapartum care are important to ensure the safety of mothers and neonates. The objective of this study was to compare two established guidelines for intrapartum care to provide clinicians with more comprehensive recommendations on intrapartum management. We carried out a descriptive analysis of guidelines from the Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines published by the World Health Organization, and the Perinatal Care Manual published by the Ministry of Health Malaysia, on intrapartum care to determine differences, if any, with regards to management. Latent, active and the second phase of labour are defined differently in both guidelines. Both guidelines showed high similarity in the steps of clinical management for all phases of labour but differed in foetal monitoring methods, indications for episiotomy, mood and behavior assessment, universal precautions, pain management, and placental disposal. Both guidelines had similar managements for most of the problems encountered during the intrapartum period except for preterm labour and multiple births which have substantial differences. Malaysian guidelines highlight additional systems such as the red alert system, and referral and retrieval system, which would enhance the quality of intrapartum management. The IMPAC guidelines emphasize supportive care, birth companionship, maternal care and monitoring up to one hour after placental delivery; and home birth management; these are inadequately explained or lacking in Malaysian guidelines. From the comparison, it was seen that substantial variation exists in intrapartum management between both guidelines that indicates the need for better evidences to synthesize a more comprehensive set of guidelines for the improvement in intrapartum care.
Human adipose tissue has been recognized as an alternative source of adult stem cells. The abundance and ease of harvest of adipose tissue has made it suitable for use in regenerative medicine and tissue engineering. Adipose-derived stem cells isolated from human adipose tissue are able to differentiate into several mesenchymal lineages and secrete growth factors that exhibit therapeutic potential. Protein profiles have been established using various isolation methods, which has expanded researchers’ understanding of adipose-derived stem cells in clinical applications. This review highlights the properties, isolation methods, immunophenotype and clinical applications of adipose-derived stem cells.
Background: Most postpartum women are prescribed at least one medication; so the safety of the medication
is a major concern. In 2017, 11% of 815 questions received by the Pharmacy Drug Information Services at seven
clinics in Dungun is related to medication use in breastfeeding. Thus, this study was carried out to evaluate
the attitudes of healthcare providers (HCPs) and to investigate the effect of knowledge about medication use
in breastfeeding among HCPs; pre- and post-educational intervention.
Methods: An interventional study was carried out among medical officers, assistant medical officers,
pharmacists and pharmacist assistants from seven clinics in the district of Dungun, Malaysia. The questionnaires
were distributed during pre- and post-intervention period. The interventions in this study included continuous
medical education (CME) and the use of a booklet regarding medication use for breastfeeding women. The
data collected were analyzed using Statistical Package for Social Studies (SPSS) and presented as frequencies,
means, and standard deviations.
Results: Fifty HCPs were enrolled in this study and over 20% of them advised mothers to discontinue
breastfeeding whenever they are prescribed any medication. The knowledge of HCPs about medication use in
breastfeeding women was significantly improved (Z= -5.917, p
Child abuse is a part of violence and maltreatment towards a child. It has led to many immediate and longterm
consequences. The factors pertaining to the perpetrators of physical and emotional abuse were least
explored in the literature. The aim of this systematic review is to comprehend the factors of vulnerability
among the perpetrators of child abuse, and to identify the most common reported characteristics of child
abuse perpetrators in the literature globally. A systematic search of articles published between 2013 and
2018 was conducted in several databases (Scopus, Ovid Medline, EBSCOhost and Google Scholar). Fourteen
studies met the inclusion criteria and were included in the review. The risk factors and characteristics of
child abuse perpetrators are classified into three different levels; individual, relationship and community.
The most common reported characteristics are at the individual level. Family background plays an important
role in determining the risk of being a child abuse perpetrator. Low socioeconomic status of the family is the
prominent contributing risk factor for abusing own children.
The objective of this study was to compare in-patient drug use patterns, costs, and outcomes associated with risperidone or olanzapine in a naturalistic clinical setting. Retrospective chart reviews of 92 patients with psychotic disorders were conducted at the University of Malaya Medical Centre (UMMC). Data was collected from patients who were hospitalized and for whom risperidone or olanzapine was the drug of first choice for long-term pharmacologic treatment. Proportion of patients for whom efficacy of the studied treatment could be established (as rated by the treating physician) was higher, but not significantly, with risperidone compared to olanzapine (p = 0.46). The average dose of the studied medication was 2.9 ± 1.0 mg/day for risperidone and 9.7 ± 2.4 mg/day for olanzapine. The total cost was significantly higher (p
There has been a significant decline in maternal mortality in Malaysia since independence. The issue of measuring maternal mortality accurately is a problem in all countries. Another major problem is whether we can reduce the mortality further. The definition of maternal mortality includes two major components, which are causation of death and the time of death. To improve data collection on maternal deaths, we need to collect all data on maternal deaths, which are omitted or misclassified. Deaths from accidental causes that are not normally used in the calculations of maternal mortality need to be carefully reexamined to be excluded. The time of death means that in maternal mortality calculations, it includes up to six weeks after delivery, but recent World Health Organization (WHO) publication (ICD-10) suggests that the collection of maternal deaths even after six weeks should be reviewed because there are many maternal deaths which occur after six weeks. Measuring maternal mortality rate should be encouraged rather than maternal mortality ratio. Another measurement of maternal mortality is the lifetime risk of the women. The lifetime risk is the measure of maternal mortality that takes into account the probability of becoming pregnant and the probability of dying as a result of pregnancy. Many countries have started reporting the lifetime risk, which is considered to be better indicator to measure maternal health.
Adults with Growth hormone (GH) deficiency is now being recognised to display many distinct clinical, metabolic and psychological abnormalities. It has been demonstrated that GH deficient (GHD) adults display features of multiple insulin resistant syndrome (MIRS) which predispose the GHD adults to increased cardiovascular morbidity and mortality. These features include central obesity, insulin resistance and glucose intolerance, hypertension, dyslipidaemia that includes a reduced level of high density lipoprotein cholesterol, an elevated triglyceride level and sniall low density lipoprotein cholesterol size. Furthermore, GHD adults are found to have a lower bone mass and a reduced sense of well-being. Replacement of G H in these GHD adults has brought about a major itnproveliient in psychological well-being and central obesity. The improvement of some of the lipid abnornialities is however more modest. Insulin resistance, the corner stone of MIRS, is however not altered by G H replacement. Long term data is as yet unavailable to assess if GH replacement reduces cardiovascular mortality and morbidity in these subjects. KEYWORDS: Growth hormone, Horlnoiie deficiency, Diabetes niellitus, Central obesity, Hyperlipidaemia, Hypertension.
A cross-sectional survey of commercial vehicle drivers who were renewing their own licences was conducted at the Selangor Road Transport Department office in Padang Jawa between 1 February 2002 and 28 February 2002, using questionnaire and medical examination. The objective was to determine the prevalence of myopia, colour vision deficiency and visual field defect among the commercial vehicle drivers. The respondents that reported visual defect at the time of interview was compared with those detected by the author through medical examination. Out of the 223 respondents, 21 (9.4%) reported to have myopia by the questionnaire survey. Through the visual examination there were 63 (28.3%) with myopia (visual acuity worse than 6/12),six (2.6%) had a visual field defect and 14 (6.3%) had red-green colour deficiency. The visual defect detected during the study among the commercial vehicle drivers, which were missed at the time of the routine medical examination were significant. The process of the statutory medical examination should be reviewed.
Lymphangioleiomyomatosis (LAM) is a rare disease. The reported prevalence is around one per million in the West but the exact prevalence in Asia is unknown. It affects primarily young women of reproductive age, with a mean age of onset at 34 years. The disease is characterised by an abnormal proliferation of smooth muscle-like cells that grow over a course of time to obstruct airways, lymphatic and blood vessels. We report a case of LAM in a young woman who presented with a spontaneous pneumothorax. Computed tomography scan of the thorax and abdomen showed homogenous thin-walled cystic lesions with normal intervening lung parenchyma and multiple lesions in her kidneys with Hounsfield units similar to that of fat.
Intrapulmonary bronchogenic cyst is a rare congenital lesion originating from abnormal budding of the embryonic foregut. It is less common than mediastinal bronchogenic cyst. We describe a case of intrapulmonary bronchogenic cyst and discuss the treatment of this condition.
Priapism is a urological emergency. The treatment for ischaemic priapism is usually cavernosal aspiration with or without cavernosal irrigation. Some patients may need surgical intervention -the various shunt procedures. We report a 21-year-old man with priapism secondary to chronic myeloid leukemia who needed a combined medical and surgical management. He underwent a spongiocavernosal shunt as well as cytoreductive chemotherapy to achieve complete detumescence. Therefore, cytoreductive chemotherapy is an adjunct in difficult cult to treat priapism associated with chronic myeloid leukemia.
One (1) anti-Blastocystis serum from a monkey naturally infected with isolate M12 and four (4) hyperimmune sera raised in inbred Balb/c mice against crude antigens of two Blastocystis isolates (C and KPI). one each of Entamoeba histolytica (HK9) and Giardia lamblia (7404) were used to react with several homologous and heterologous Blastocystis isolates, E. histofytica, G. lambfia, Endolimax nana and Bac-4 (Escherichia coli isolated from culture medium of a B. hominis isolate KPl). All anti-Blastocystis sera did not show cross-reactivity with E. histolytica and G. lamblia by western blotting. Similarly, anti-E. histolytica and anti-G. lamblia sera also did not react against all Blastocystis isolates tested, even though these three protozoa are known to produce diarrhoea in humans. Polyclonal sera raised against antigen prepared from xenic culture of Blastocystis produced a smear reaction on the immunoblot, while antibodies raised against antigens prepared from axenic culture (isolate C) gave prominent reaction bands. This may be due to the purity of the immunogen used in inducing the immune response. The cross-reactions of sera from mice immunised with the xenic B. hominis isolates may also due to antibodies against E. coli. Anti-Blastocystis serum from monkey's with natural infection showed several prominent reaction bands together with a smear at above 40 kD were most probably induced by the excretory-secretory antigens of the parasite. A variety of reaction patterns were obtained with these anti-sera and the antigens from different Blastocystis isolates. These may be reflects from differences in antigenic components from various strains of this parasite. KEYWORDS: lJIastocysfis, polycional antibodies, immunoblot, experimental animals