Blunt abdominal trauma can cause multiple internal injuries. However, these injuries are often difficult to accurately evaluate, particularly in the presence of more obvious external injuries. Computed tomography (CT) imaging is currently used to assess clinically stable patients with blunt abdominal trauma. CT can provide a rapid and accurate appraisal of the abdominal viscera, retroperitoneum and abdominal wall, as well as a limited assessment of the lower thoracic region and bony pelvis. This paper presents examples of various injuries in trauma patients depicted in abdominal CT images. We hope these images provide a resource for radiologists, surgeons and medical officers, as well as a learning tool for medical students.
Urinary incontinence is a common but poorly understood problem in the elderly population. The aim of this study was to determine the prevalence of urinary incontinence and its associated factors among the elderly in a community setting.
Scalene myofascial pain syndrome is a regional pain syndrome wherein pain originates over the neck area and radiates down to the arm. This condition may present as primary or secondary to underlying cervical pathology. Although scalene myofascial pain syndrome is a well known medical entity, it is often misdiagnosed as being some other neck pain associated with radiculopathy, such as cervical disc prolapse, cervical spinal stenosis and thoracic outlet syndrome. Because scalene myofascial pain syndrome mimics cervical radiculopathy, this condition often leads to mismanagement, which can, in turn, result in persistent pain and suffering. In the worst-case scenarios, patients may be subjected to unjustifiable surgical intervention. Because the clinical findings in scalene myofascial pain syndrome are "pathognomonic", clinicians should be aware of ways to recognize this disorder and be able to differentiate it from other conditions that present with neck pain and rediculopathy. We present two cases of unilateral scalene myofascial pain syndrome that significantly impaired the patients' functioning and quality of life. This case report serves to create awareness about the existence of the syndrome and to highlight the potential morbidity due to clinical misdiagnosis.
The standard management for the majority of benign jaw cysts is enucleation, marsupialisation, curettage and decompression. Enucleation has the advantage that the whole specimen is sent for microscopic evaluation so that more sinister pathological processes (i.e. squamous cell carcinoma) may not be missed. In a large cystic lesion, enucleation is still possible, but technical difficulties might be encountered. In such instances, inevitable damage can occur to the surrounding structures. We report a case of a large radicular cyst of the maxilla that was enucleated via endoscopic assistance through the Caldwell Luc approach.
Laryngeal amyloidosis is a rare cause of stridor in a healthy young adult. We report a case of localised laryngeal amyloidosis, including our MRI findings, which included a necrotic centre that has not previously been described. This case also highlights the need for a high index of clinical suspicion to achieve the correct histopathological interpretation.
Orthodontic elastic bands are an important iatrogenic etiologic factor in the causation of periodontal attachment apparatus breakdown. Appropriate diagnosis and a well constructed treatment plan tailor-made to suit the requirements of the particular patient is imperative for management of periodontal lesions induced by subgingival retention of rubber band. There are conflicting reports regarding the reattachment and regeneration of lost periodontal supporting tissues in such cases. The present case report highlights the spontaneous reversal and correction of periodontal destruction due to iatrogenic orthodontic elastic band displacement deep into the subgingival tissues.
The shoulder and axillary regions contain various complex anatomical structures in close proximity, many of which can give rise to neoplasms. Determining the origin and hence the exact diagnosis of advanced (diffuse) tumours in this region may become problematic. In view of the tumour morphology and the affected location in this case, we highlighted the importance of Hodgkin lymphoma immunohistochemistry interpretation in a tumour which was initially suspected to be a soft tissue sarcoma.
Ribosomal proteins are traditionally associated with protein biosynthesis until recent studies that implicated their extraribosomal functions in human diseases and cancers. Our previous studies using GeneFishing™ DEG method and microarray revealed underexpression of three ribosomal protein genes, RPS26, RPS27, and RPL32 in cancer of the nasopharynx. Herein, we investigated the expression pattern and nucleotide sequence integrity of these genes in nasopharyngeal carcinoma to further delineate their involvement in tumourigenesis. The relationship of expression level with clinicopathologic factors was also statistically studied.
BACKGROUND: The objective of this study was to determine the effectiveness of MMT program among injecting drug users (IDUs) in Kota Bharu, Kelantan.
METHODS: The study was a retrospective study based on the records of injecting drug users (IDUs) involved in the MMT program from November 2005 to 31st Jan 2008, registered at the Psychiatric Clinic of Hospital Raja Perempuan Zainab II. Opiate Treatment Index (OTI) was used as the research instrument. Repeated measures ANCOVA was used to compare the mean scores during the entry period and after completing twelve months of MMT program after adjusted for age, marital status, and level of education.
RESULTS: A total of 117 file records were reviewed. There was significant reduction in the mean scores after 12 months of heroin Q score, HIV Risk-taking Behavior Scale and health scale after adjusted for age, marital status, and level of education. For Heroin Q score, mean difference was 2.01 (95% CI: 1.45, 2.56), for HIV Risk-taking Behavior Scale, mean difference was 7.64 (95% CI: 6.03, 9.26), and for health scale, mean difference was 5.35(95% CI: 3.90, 6.79).
CONCLUSION: This study supports the evidence that MMT program is effective in treating heroin and opiate dependence.
KEYWORDS: Kelantan; intravenous drug users; methadone; opiate treatment index
Study site: Psychiatric Clinic, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
Telemetric EEG in the rat's brain has been used for experiments which tests the effects of an antiepileptic compound on it's antiseizures activity. A simple classification correlating epileptiform discharge and Racine's behavioral activity is discussed.
Fournier's gangrene is a severe life-threatening infection involving the perianal area, perineum, and external genitalia. It demands prompt recognition, critical care therapy, surgical therapy, and a combination of antibiotics. The infection commonly spreads via the fascial planes and causes superficial vascular thrombosis within the Colles' fascia around the external genitalia. It can extend cephalad to involve the Scarpa's fascia and Camper's fascia in the abdominal wall. The treatment would include multiple debridements, which would result in disfiguring scars of the perineum and might lead to significant physical and psychological complications. We describe a case of a 58-years-old man presenting with Fournier's gangrene resulting from an infection of an impacted urethral stone. The patient previously had obstructive voiding symptoms for 1 month but chose to neglect them. The resultant infection was severe and caused penile and right testicular gangrene. He underwent multiple wound debridements, which included a total penectomy and right orchiectomy. Psychological and rehabilitative support was necessary for him to overcome his loss and disfigurement.
The study objective was to determine the diagnostic value of physical examinations for positive computer tomography (CT) scans in children with mild head injuries. Retrospective data of patients evaluated for mild head injuries with loss of consciousness (LOC) or amnesia were reviewed. Estimations of prevalence, sensitivity, specificity and predictive values were calculated. Agreement between the physical examinations and CT brain scans was calculated using the Kappa test. 225 patients were included in the study. Of this group, 19.56% of patients had positive CT scans and 7.56% had normal physical examinations. 15 underwent neurosurgical intervention. For positive CT scans, sensitivity and specificity were 61.36% and 60.22%, respectively. Agreement between physical examinations and CT scans was Kappa = 0.147 (P < 0.05), 95% CI (0.035, 0.259). The present study demonstrated that physical examinations were significantly associated with positive CT scans (P = 0.01). However, the calculated Kappa value showed only slight agreement between these 2 variables and the low sensitivity and specificity of the physical examinations suggest that intracranial pathology in children with mild head injuries and LOC or amnesia cannot be excluded based on physical examinations alone.
This study aimed to determine the perception and level of safety satisfaction of staff nurses with regards to Occupational Safety and Health (OSH) management practice in the Sabah Health Department, and to associate the OSH management dimensions, to Safety Satisfaction and Safety Feedback.
This study aimed to determine the perceptions and expectations of bone cancer patients with respect to their doctors and the breaking of bad news as well as the environment in which the news was delivered.
Medical training is often regarded as a stressful period. Studies have previously found that 21.6%-50% of medical students experience significant psychological distress. The present study compared the prevalence and levels of psychological distress between 2 cohorts of first-year medical students that underwent different admission selection processes.
Different computational methods have been used for the prediction of X-ray spectra and beam quality in diagnostic radiology. The purpose of this study was to compare X-ray beam qualities based on half-value layers (HVLs) determined through measurements and computational model estimations.
Traditionally, the most common diagnostic approach used for diagnosing leptospirosis was the demonstration of immune-seroconversion in acute and convalescent patient serum samples. Recently, a variety of molecular techniques, including conventional and real-time polymerase chain reaction (PCR), have been developed for the specific detection of pathogenic bacteria from the genus Leptospira. PCR is a sensitive, specific, and rapid technique that has been successfully used to detect several microorganisms; including those of clinical significance.
The prevalence of atrial fibrillation (AF) is high in both community- and hospital-based studies in the Far East and South East Asia. Hypertension is the most common risk factor, but coronary heart disease and diabetes mellitus are other important co-morbidities in these countries. Anticoagulant therapy use was low, being 0.5%-28% in Malaysia, Singapore, and China. The reported rate of stroke related to AF was 13.0%-15.4% based on community studies in those countries, and was 3.1%-24.2% of stroke rate in hospital-based cohorts. Better assessment of thromboembolic and bleeding risks is important. International guidelines now recommend the use of the CHA2DS2-VASc score to identify the ''truly low-risk'' AF patients, who do not need antithrombotic therapy, whilst those with ≥ 1 stroke risk factors can be offered oral anticoagulation. Aspirin is ineffective and may not be any safer than oral anticoagulants, especially in the elderly. It is anticipated that the availability of the new oral anticoagulant drugs would improve our efforts for stroke prevention in the Far East and South East Asia, especially where anticoagulation monitoring for warfarin is suboptimal.
In an infant presenting with a mass in the abdomen and non-bilious vomiting, duplication cyst needs to be considered in the list of differential diagnoses. Gastric duplication cyst is an uncommon occurrence in children. Diagnosis is based on clinical findings and imaging features. Surgical excision is safe and offers a complete cure. The literature recommends excision even in asymptomatic cases due to isolated reports of malignancy arising in the duplication cyst in later life.