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Fulltext Dengue control during flood disaster in Johore,Malaysia

Shaharom, N.A., Nyamah, M.A., Norashikin, M., Zaharah, M.S., Zuhaida, A.J., Norb, H., et al.

Malaysian Journal of Community Health, 2009;15(3):104-110.
MyJurnal

The state of Johore suffered a massive flood disaster from 19th December 2006 to 1st January and from 12th January to 19th February 2007. The possible upsurge of dengue was of foremost concern and led to efforts in increasing control activities. Anyone with history of high fever with at least two symptoms of severe headache, pain behind the eyes, muscles and joint paint, rashes and petechiae were notified as dengue. Active and passive case finding was initiated at all 371 evacuation centres as well through health facilities and hospitals through an active surveillance system. Presumptive larval survey was also carried together with control activities by 46 health teams. Data were collected using the format ‘Aktiviti harian kawalan denggi di kawasan pos banjir- Lampiran E‘ and ‘Laporan aktiviti harian kawalan denggi di pusat pemindahan banjir – Lampiran D2’. Dengue serology and blood film for malaria was sent for as well as vector species identification. A total of 594 dengue cases were reported for the period of 19th December 2006 till 19th February 2007, which was an increase in comparison to the 5-year median but less than that reported in year 2006. However only 14 (2.3%) cases were from flood affected areas. During the flood phase, a total of 5,929 inspections were carried out at the evacuation centres with Aedes Index (AI) of 1.86%, while the post flood period showed a lower index. However Breteau Index (BI) and Container Index (CI) were higher. Preventive fogging were carried out at the evacuation centres using adulticides, thermal fogging was carried out at 21,959 premises (40.04% of inspected premises) and 350.6 L adulticides (malathion, fenitrothion and permethrin) were used. Dengue was expected to increase during flood as a result of increase Aedes potential breeding sites. However with intensive and integrated control activities, Johore was able to minimize the impact of flood for vector-borne diseases as seen from the low cases reported in flood related areas. A special guidelines for surveillance and control was developed during this flood as a reference for future occurrences.

Matched MeSH terms: Headache
Fulltext Patterns of health ailments and other health problems among children at a relief camp, Aceh, Indonesia; a two months post tsunami study

Adlina, S., Soe, Soe Aye, Narimah, A.H.H., Nuraliza, A.S.

Malaysian Journal of Public Health Medicine, 2005;5(1):31-37.
MyJurnal

On December 26, 2004, an earthquake triggered a devastating tsunami that caused death and destruction in twelve countries including India, Indonesia, Malaysia, Maldives, Seychelles, Somalia, Sri Lanka and Thailand. One of the authors was a volunteer with FELDA WAJA AMAN MALAYSIA medical relief team that served the Aceh victims from 16th February to 24th February 2005 (8 weeks post tsunami). A study to determine the pattern of health ailments was conducted among children aged 18 years and below based at Seuneubok Camp, 30 km from Banda Aceh. All respondents were from Pulau Aceh and the total number of children seen and examined was 60. About 18% had lost their fathers, 10 % had lost their mothers and 27% had lost one or more of their siblings. 77% suffered some form of health ailments. The common health ailments were diarrhea (61%), respiratory complaints (59%) and fever (20%). About 38 % of preschoolers had loss of appetite and 28% had sleep disturbances. About 35% of the elementary school children suffered from sleep disturbances, 29% of the young adolescents suffered from headaches and 24% had sleep disturbances. Nearly a quarter (24%) of all the children felt fearful and anxious about the disaster. Nevertheless, 56% of the respondents wanted to return back to Pulau Aceh, although 14 % did not want to go back. Interestingly, 73% of the children voiced their gratitude to God for having been saved from death.

Matched MeSH terms: Headache
Fulltext A cross sectional study of chronic pain relief after bekam (traditional malay "cupping") therapy

Lim KG, Chuah SW, Ee MST, Wong ZG, Murugesan A, Syed Azman SA

International e-Journal of Science, Medicine & Education, 2015;9(2):32-36.
MyJurnal

Introduction: Bekam, an Islamic variant of cupping, is an ancient form of traditional medicine still practised today in Malaysia. There are published findings indicating that cupping benefits patients with low back pain, other musculoskeletal pain and even pain from cancer, herpes zoster and trigeminal neuralgia when pain is measured on an analogue scale. We proposed to investigate whether in addition to pain improvement on an analogue scale we could show if pain relief might be demonstrated in terms of reduction of analgesic use.

Methods: We carried out a retrospective cross sectional study on subjects who had been for outpatient clinic treatment with chronic pain of at least one month and who completed at least two bekam therapy sessions. In addition to documenting a pain score before and after therapy we documented their analgesic consumption.

Results: A total of 77 respondents, with overlapping symptoms of headache, backache and joint pains were included. The mean pain score before bekam therapy was 6.74±1.78, and was 2.66±1.64 after two sessions of therapy. Twenty eight respondents completed six sessions of bekam therapy and had a mean pain score of 2.25±1.32 after. Thirty-four patients consumed analgesic medication before starting bekam therapy and only twelve did so after. The consumption of analgesics was significantly lower after bekam therapy.

Conclusions: Bekam therapy appears to help patients experience less pain and reduce the amount of analgesic medication they consume. Nevertheless only a randomised prospective study will eliminate the biases a retrospective study is encumbered with and we believe would be worth doing.

Matched MeSH terms: Headache
Fulltext Otogenic Brain Abscess: A Retrospective Study of 10 Patients and Review of The iterature

Asma, A., Hazim, M.Y.S., Marina, M.B., Azizi, A.B., Suraya, A., Norlaili, M.T., et al.

Medicine & Health, 2007;2(2):133-138.
MyJurnal

Proper management of chronic otitis media may reduce the incidence of otogenic brain abscess. The aim of this study was to describe the clinical profile, treatment and surgical outcome of patients presenting with otogenic brain abscess. The medical record of patients in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) with otogenic brain abscess were retrospectively analyzed from January 1997-January 2006. Within this eriod we had approximately 10,800 of follow up cases of chronic otitis media (COM) in our clinic. Ten patients (2 females, 8 males) with an average age of 42 (age range 11 to 69 years) were identified with otogenic brain abscess and included in this study. The mean follow-up period was 14 months. All patients had cholesteatoma. All patients had a history of chronic ear discharge, headache, otalgia and fever. Six of the 10 patients had cerebellar abscess and 4 had temporal lobe abscess. Cerebellar signs were present in 3 patients All the patients were treated with broad-spectrum antibiotics. In 5 patients, mastoid exploration was the primary surgical treatment and the brain abscesses were treated conservatively. In the other 5 patients, craniotomy and drainage were performed followed by mastoid exploration when their neurological conditions had stabilized. All our patients had uneventful recovery. There were no permanent cerebellar signs during the follow up and no mortality reported in our series. In this series we demonstrated that early diagnosis and proper treatment of otogenic abscess leads to good neurological outcome.

Matched MeSH terms: Headache
Fulltext Management of upper respiratory tract infections in Kinta District, Perak

Hairul lzwan AR, Hazlee AH, Noridah O

Malaysian Journal of Public Health Medicine, 2003;3(2):10-13.
MyJurnal

Upper respiratory tract infections (URTI) are the most common diseases treated in the primary health care centres in Kinta District, Perak. Thus, aretrospectiire study was undertaken to examine the documentation of the presentation of patients diagnosed with URTI and their antibiotic treatment at two health care centres in Kinta district, The randomly selected case notes of 700 patients documented the following symptoms, fever (43 .29%) , cough (68.14%) , no cough (24.43%), nasal symptoms (35 .29%) , sore throat (46.00%), headache (13 .57%) , bodyache (3 .57%) , earache (1 .86%) and gastrointestinal symptom (0, 14%) . Analysis of results using 'sore throat score' and isuggested appropriate management’ adopted from a study by Wawen et al. revealed poor correlation between diagnosis of URTI and the need for antibiotic therapy. Therefore, a clinical score for patients with sore throat can be introduced to overcome inappropriate prescription of antibiotics.
Klinik Kesihatan Gopeng, Klinik Kesihatan Malim Nawar, Kinta district, Perak, Malaysia

Matched MeSH terms: Headache
Fulltext Recurrent optic neuritis as early presentation of idiopathic hypertrophic cranial pachymeningitis

Norhayaty Samsudin, Tai, Evelyn Li Min, Chui, Yain Chen, Kumar, Lakana, Azhany Yaakub, Adil Hussein, et al.

Journal of Biomedical and Clinical Sciences, 2017;2(1):23-26.
MyJurnal

44-year-old Malay lady presented with drooping of the right eyelid and worsening of left eye vision for one week duration. There was associated headache, periorbital discomfort and diplopia on left gaze. She previously had a history of recurrent optic neuritis affecting both eyes over a period of 12 years. On examination, there was right-sided partial ptosis and left exotropia. The adduction, abduction, elevation and depression of the right eye was limited. Left eye extraocular movements were full. The right eye visual acuity was 6/9, while the left eye visual acuity was perception to light, with a positive relative afferent papillary defect and a pale optic disc. The right optic disc was normal. There was reduced sensation in the trigeminal nerve distribution over the right side of the face. Neurological examination was otherwise normal. Magnetic resonance imaging of the brain and orbit revealed meningeal thickening with involvement of the right orbital apex and cavernous sinus. Blood investigations for infectious and autoimmune causes were unremarkable. She was diagnosed to have idiopathic hypertrophic cranial pachymeningitis and treated with systemic corticosteroids. The right eye extraocular motility improved, while the left eye visual acuity improved to counting finger. This case demonstrates that idiopathic hypertrophic cranial pachymeningitis may present as recurrent optic neuritis in the early phase, before radiological evidence of the disease is present. A high index of suspicion for the underlying cause is essential to prevent irreversible optic nerve damage due to recurrent optic neuritis.

Matched MeSH terms: Headache
Fulltext Cerebral venous thrombosis in evan’s syndrome: an unusual presentation

Cheng, M.H., Norzila, T.A.B.

International Medical Journal Malaysia, 2016;15(2):85-87.
MyJurnal

Cerebral Venous Thrombosis in patients with Evan’s Syndrome of autoimmune hemolytic anemia is rare. The
common neurological symptoms are headaches, vision loss, dyslexia without agraphia, motor aphasia,
unilateral upper limb weakness and papilloedema. We present a case report of a lady with a known case of
Evan’s Syndrome whom presented with severe anemia and unilateral right sided hemiparesis with right facial
weakness. Plain and Contrast enhanced CT brain showed bilateral high parietal white matter edema with
venous thrombosis in the right transverse and superior sagittal venous sinuses. At the time of the diagnosis,
she was in hematological remission.

Matched MeSH terms: Headache
Fulltext Post dental extraction basal skull osteomyelitis with cranial nerve palsy

Tan, Ciang Sang, Haiza Hani Hamidon, Zainah Shaikh Hedra

Malaysian Journal of Paediatrics and Child Health, 2016;22(101):0-0.
MyJurnal

Background: A 9 year old boy presented with history of persistent headache and recurrent vomiting for 1 month post dental extraction. CT brain was performed for the possibility of space occupying lesion but it was normal. Subsequently, he was treated as migraine after exclusion of meningitis and intracranial lesion. Unfortunately, he developed 3rd, 4th and 6th cranial nerve palsy two weeks later. Repeated CT brain showed subtle finding and inconclusive. MRI brain performed at the time showed features suggestive of basal skull osteomyelitis with congestion of right orbit and optic nerve swelling. Case was referred to Paediatric Neurologist and he was diagnosed to have cranial nerve palsy secondary to basal skull osteomyelitis, post dental extraction.

Conclusion: Dental procedure is common among children, however basal skull osteomyelitis with cranial nerve palsy is a rare complication. Adequate treatment of dental infection post dental procedure is important to prevent this complication.

Matched MeSH terms: Headache
Fulltext Occipital Falcine Anaplastic Hemangiopericytoma Mimicking Meningioma

Kanesen D, Kandasamy R, Idris Z

J Neurosci Rural Pract, 2016 Dec;7(Suppl 1):S95-S98.
PMID: 28163517 DOI: 10.4103/0976-3147.196463

The rarity of hemangiopericytoma (HPC) and its controversial histological classification result in its frequent misdiagnosis and thus make the treatment quite challenging. It is often difficult to distinguish these tumors from meningiomas based on clinical features and radiological findings. This is a case report of a man, diagnosed clinically and radiologically as meningioma, which turned out to be anaplastic HPC on histological examination. A 30-year-old man presented with 3 months of progressively worsening of headache and blurring of vision. Clinical examination revealed the right homonymous hemianopia with reduced visual acuity and papilledema bilaterally. Magnetic resonance imaging revealed a multilobulated and heterogenous extraaxial lesion attached to the occipital falx. It measured 9.0 cm (AP) × 5.5 cm (W) × 5.8 cm (CC) and expands bilaterally with major bulk on the left. An occipital craniotomy followed by a subtotal tumor excision was only achieved due to profuse bleeding intraoperatively. Histopathology confirmed an anaplastic HPC (WHO Grade 3). The importance of differentiation between HPCs and meningiomas cannot be overemphasized. A preoperative correct diagnosis is difficult, but it is important that it should be made. Multilobulated (mushroom appearance), prominent internal signal voids, relatively narrow dural attachment, and lytic destruction without calcifications are useful findings to distinguish HPCs from meningiomas.

Matched MeSH terms: Headache
Fulltext Isolation and characterization of a 2,4-dinitrophenol-degrading bacterium

Noor Suffiah Md. Zin, Siti Nadzirah Padrilah, Mohd Fadhil Abd. Rahman, Koh, Sim Han, Ariff Khalid, Mohd. Yunus Shukor

Bioremediation Science and Technology Research, 2016;4(2):28-33.
MyJurnal

2,4-dinitrophenol (2,4-DNP) is utilized in the production of wood preservatives, dyes, and also
as a pesticide. Human acute (short-term) exposure to 2,4-DNP in humans by means of oral
exposure are nausea or vomiting, sweating, headaches, dizziness, and weight reduction. Thus, the
removal of this compound is highly sought. A 2,4-DNP-degrading bacterium (isolate 1) was
isolated from a sample soil from Terengganu. This bacterium (isolate 1) was characterized as a
rod Gram positive, non-sporulated, and non-motile bacterium. The bacterium is oxidase negative
and had catalase positive activity and was able to grow aerobically on 2,4-dinitrophenol as the
sole carbon source. This bacterium showed maximal growth on 2,4-DNP at the temperature
optimum of 30 oC, pH 5.0 and was tolerant to 2,4-DNP concentration of up to 0.5 mM (0.092
g/L). This bacterium prefers to use urea as the nitrogen source in addition to yeast extract for
mineral source and vitamin precursors.

Matched MeSH terms: Headache
Fulltext Health beliefs, concerns and expectations of patients presenting with non-acute pain: A preliminary study from a government health clinic in Malaysia

Teng CL, Mohd Jamin Z, Mohd Kamaruddin NI, Idris SA

Asia Pac Fam Med, 2003;2(1):23-26.

Aim: This study explored the health beliefs, concerns and expectations of primary care patients presenting with abdominal pain, headache and chest pain. Methods: Over a 6-week period, 107 adult patients with symptoms of pain were interviewed using a semistructured questionnaire. Results: The presenting symptoms of these patients were: abdominal pain, 41; headache, 35; and chest pain, 31. Females made up 53.3%; the ethnic groups were Malay (35.5%), Chinese (18.7%) and Indian (45.8%); and 71.8% of the patients had primary or secondary education. The patients' attributions of their symptoms were predominantly non-medical in all three ethnic groups. The non-medical causes mentioned include food, trauma, stress, weather changes and winds ('angin'). Only two fifths of the patients mentioned disease-specific concerns. Three quarters of these patients expected either medications or wanted the doctor to look for serious causes. Very few patients specifically wanted referral or special tests. Conclusions: The patients in the study had health beliefs and concerns, in view of their non-medical focus, that was at variance with those of the health care providers. However, having decided to consult the health clinic, they were mainly looking for symptomatic relief or evaluation for serious pathology.

Matched MeSH terms: Headache
Spectrum of opportunistic infections related to the central nervous system among AIDS patients in Hospital Kuala Lumpur

Nissapatorn V, Lee C, Khairul Anuar A

JUMMEC, 2000;5:89-92.

A relTospective study was conducted in Hospital Kuala Lumpur, May, 2001.49 (12.1%) of 406 AIDS patients were diagnosed as opportunistic infections related to the central nervous system. The sex ratio (M:F) was 7.2. The median age was 34 years. The predominant age group for male as same as female was 25-34 years.The majority of the study subjects were Chinese (79.6%), married (49%), unemployed (42.9%) and heterosexuals (95.9%) as the risk behavior related to HlV infection. The most frequent clinical manifestations was headache (71.4%). At the time of diagnosis, the greater number of patients 39 (79.6%) had CD4 count < 200 celVcumm. Outcome of acute therapy the patients had a complete (85.7%), treatment continued (10.3%), and transfer to other hospital (2.00/0). Toxoplasmic encephalitis (7.6%) and cryptococcosis (3.9%) were the frequent cause of focal intracerebral lesions and meningitis in these patients respectively. Oral candidiasis (32.7%) was the most common among other opportunistic infections in this study. KEYWORDS: AIDS, Opportunistic infections. central nervous system, clinical manifestations, outcome.

Matched MeSH terms: Headache
Fulltext Dampness and mold exposure in buildings as a risk factor for health effects

Pei Zam H, Emilia Z, Karmegam K, Mohd Sapuan S

Malaysian Journal of Public Health Medicine, 2017;17 Special(1):28-40.

This study aims to review existing studies on the relations between indoor dampness and mould in different public occupied buildings with the risk of adverse health effects among both children and adults. This study specifically focused on the dampness-related problems from countries with tropical climate. A systematic literature search of ScienceDirect, PubMed, Google Scholar and Wiley Online Library from 2000 through December 2015 was conducted. Furthermore, the reference lists of recent reviews and of relevant articles were identified in our search. Crosssectional, case-control, and cohort studies in children or adults were selected according to a priori criteria. The search yielded a total of 18 studies on damp buildings, dampness and mould in buildings and indoor mould. Dampness and mould exposure in buildings is a risk factors for respiratory symptoms, wheeze, cough, bronchitis, rhinitis, eczema and upper respiratory tract infection as well as general symptoms such as headache and tiredness. Evident strongly suggested increased asthma development and exacerbation of current or ever diagnosis of asthma in children. Based on the results of the review, indoor dampness and mould problems in buildings are associated with substantial and increases in prevalence of a variety of respiratory and asthma-related health outcomes.

Matched MeSH terms: Headache
Fulltext Fatal Intracranial Hemorrhage in a Patient with Severe Dengue Fever

Sam JE, Gee TS, Wahab NA

Asian J Neurosurg, 2018 3 2;13(1):56-58.
PMID: 29492121 DOI: 10.4103/1793-5482.185056

Dengue fever has been a major cause of morbidity and mortality in subtropical and tropical countries. We report a rare case of severe dengue with spontaneous intracranial hemorrhage. A search of literature through PubMed revealed that the largest series analyzed so far only included five cases. A 47-year-old man presented with 7 days history of fever, headache, myalgia, and vomiting with hematemesis. On the day of presentation, he had reduced consciousness and an episode of generalized tonic-clonic seizure. His Glasgow Coma Scale was E1V1M3 with anisocoria. Postresuscitation computed tomography of the brain revealed a right subdural and left thalamic hemorrhage. His blood investigations revealed thrombocytopenia, dengue virus type 1 nonstructural protein antigen test was positive, dengue IgM negative, and dengue IgG positive. A right decompressive craniectomy was done. Unfortunately, the patient died soon after. Spontaneous intracranial hemorrhage in patients with dengue fever is an uncommon entity but usually carry a grave prognosis. To date, there has been no clear management guideline for such cases, as both operative and nonoperative approaches have their own inherent risks.

Matched MeSH terms: Headache
Solitary Extramedullary Plasmacytoma of the Sphenoid Sinus: A Case Report

Loong SP, Afandi AN, Lum CL, Ong CA

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 3):1692-1694.
PMID: 31763226 DOI: 10.1007/s12070-015-0945-1

Solitary extramedullary plasmacytomas are rare, discrete mass of neoplastic monoclonal plasma cells in the soft tissue with no evidence of multiple myeloma. They constitute 3 % of all plasma cell tumors and less than 1 % of head and neck malignancies. A 43 year old lady presented to our clinic with complains of diplopia and headache for 4 weeks. Computed Tomography scan showed a mass lesion in the sphenoid sinus eroding the sinus floor, right wall, basisphenoid and parasellar area. A biopsy of the mass reported as plasmacytoma. Systemic examination revealed no evidence of dissemination of the disease confirming the diagnosis of a solitary extramedullary plasmacytoma. The patient was subjected to 25 fractions of radiotherapy. Here, we report a rare case of solitary extramedullary plasmacytoma of the sphenoid sinus.

Matched MeSH terms: Headache
Fulltext Successful Primary Medical Therapy with Somatostatin Receptor Ligand in Acromegaly with Thyroid Cancer

Dharan SS, Kamaruddin NA

J ASEAN Fed Endocr Soc, 2017;32(2):169-172.
PMID: 33442102 DOI: 10.15605/jafes.032.02.12

Acromegaly is a rare disease with an annual incidence of 3 to 4 cases in a million.1 Diagnosis is often delayed due to the slow progression of the disease. Persistent elevation of growth hormone (GH) in acromegaly causes a reduction in life expectancy by 10 years. Aside from multiple cardiovascular, respiratory and metabolic co-morbidities, it has also been proven to cause an increased incidence of cancer. The main treatment of acromegaly is surgical excision of the functioning pituitary adenoma. Multiple comorbidities, including obstructive sleep apnea (OSA), left ventricular hypertrophy (LVH) and soft tissue swelling, make surgery complicated, if not impossible. Medical therapy to reduce comorbidities may be indicated in certain situations. Somatostatin receptor ligands (SRL) are able to reduce, and possibly normalize, IGF-1 levels.2 Reduction of insulin-like growth factor-1 (IGF-1), the main mediator of GH, is able to resolve headache, sweating, fatigue and soft tissue swelling, and also reduce ventricular hypertrophy. This case report illustrates the successful use of the SRL octreotide LAR in treating acromegaly. It also confirms the observation from several case series that thyroid cancer is the most common malignancy in acromegaly.

Matched MeSH terms: Headache
Fulltext Arteriovenous malformation in temporal lobe presenting as contralateral ocular symptoms mimicking carotid-cavernous fistula

Mohd-Tahir F, Siti-Raihan I, Wan Hazabbah WH

Case Rep Ophthalmol Med, 2013;2013:158961.
PMID: 23533876 DOI: 10.1155/2013/158961

Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.

Matched MeSH terms: Headache
Fulltext Correlations between subdural empyema and paraclinical as well as clinical parameters amongst urban malay paediatric patients

Nayan SA, Abdullah MS, Naing NN, Haspani MS, Md Ralib AR

Malays J Med Sci, 2008 Oct;15(4):19-27.
PMID: 22589634 MyJurnal

Paediatric subdural empyema is frequently seen in developing Asean countries secondary to rinosinusogenic origins. A cross-sectional analysis on the surgical treatment of intracranial subdural empyema in Hospital Kuala Lumpur (HKL), a major referral center, was done in 2004. A total number of 44 children who fulfilled the inclusion criteria were included into this study. The methods of first surgery, volume of empyema on contrasted CT brain, improvement of neurological status, re-surgery, mortality and morbidity, as well as the demographic data such as age, gender, sex, duration of illness, clinical presentation, probable origin of empyema, cultures and follow-up were studied. Chi-square test was performed to determine the association between surgical methods and the survival of the patients, neurological improvement, clearance of empyema on CT brain, re-surgery and long morbidity among the survivors. If the 20% or more of the cells were having expected frequency less than five, then Fisher's Exact test was applied. The level of significance was set at 0.05. SPSS version 12.0 was used for data entry and data analysis. There were 44 patients who were less than 18 years. Their mean age was 5.90 ± 6.01 years. There were 30 males (68.2%) and 14 females (31.8%) involved in the study. Malays were majority with 28 (63.6%) followed by Indian 8 (18.2%), Chinese 5 (11.4%) and others 3 (6.8%). The variables which were under interest were gender, race, headache, vomiting, seizures, sign of meningism, cranial nerve palsy, thickness site of abscess, first surgical treatment, improvement in neurological deficit, clearance of CT and whether re-surgery was necessary. All variables were found not to be associated with Henk W Mauser Score for PISDE grading. Comparison between this urban study and a rural setting study by the same corresponding author in the same period on subdural empyema was done. Common parameters were compared and it was found out that seizures were more prevalent in urban study where the patients are more than one year old (p=0.005). Mortality was much higher in urban study than the rural one (p=0.040). The larger proportion of urban group had volume of abscess less than or equal to 50 ml (p=< 0.001).

Matched MeSH terms: Headache
Fulltext Factors Affecting Visual Field Outcome Post-Surgery in Sellar Region Tumors: Retrospective Study

Sriram PR, Sellamuthu P, Ghani ARI

Malays J Med Sci, 2017 Dec;24(6):58-67.
PMID: 29379387 DOI: 10.21315/mjms2017.24.6.7

Background: Despite the broad category of differentials for sellar region, most of them present with similar clinical signs and symptoms. Headache and visual disturbance are among the frequently seen as presenting symptom. Visual field (VF) assessment is one of the crucial component of neuroophtalmologic assessment and mean deviation (MD) value from automated perimetry allows quantification of the visual field defect. We formulated a study to look into the factors that affect the visual field outcome after surgery.
Methods: All patients with sellar region tumor who has underwent surgery in Queen Elizabeth Hospital from July 2010 to July 2016 were retrospectively analysed through hospital notes. VF assessment via Humphrey visual assessment for these patient pre and post-surgery were reviewed for MD value.
Results: Eighty four patients were recruited and out of them, 151 eyes were taken into analysis after excluding eyes with missing data. Mean age of patients were 45.4 years with 70.2% of them were male. Visual disturbance is the commonest presenting symptom with mean duration of symptom prior to surgery is 9.7 months. Majority of them were pituitary adenomas (75%) followed by sellar meningioma (19%), craniopharyngioma (4.8%), and rathke cleft cyst (1.2%). 70.9% of patients showed improvement in VF based on MD outcome. Mean MD for pre surgery and post-surgery were -14.0 dB and -12.4 dB, respectively. Univariate analysis reveals younger age, female sex, shorter duration of symptom, pituitary adenoma, transsphenoidal approach, and transcranial approach favours improvement in VF. Multivariate analysis shows only shorter symptom duration, transphenoidal approach, and transcranial approach are significant for favourable VF outcome when other factors adjusted.
Conclusion: Symptom duration and surgical approach were independent factors that affects the visual field after surgery in patients with sellar region tumors.

Matched MeSH terms: Headache
Fulltext Problem based review: The patient with a pyrexia of unknown origin

Woolley AK, Hedger NA, Veettil RP

Acute Med, 2013;12(2):107-10.
PMID: 23732136

Pyrexia of unknown origin (PUO) is a frequent presentation to the Acute Medical Unit, and is a source of significant morbidity, both the psychological burden of an uncertain diagnosis and prognosis and untreated complications of the underlying pathology. We present a problem based review of the management of PUO, illustrated by a patient who recently presented to our unit with fever and systemic malaise after returning from abroad and in whom no cause could be found for more than two months. We describe a structured approach making use of complex modern techniques such as Positron Emission Tomography-Computed Tomography (PET-CT) which ultimately provided the diagnosis for our patient.

Matched MeSH terms: Headache/etiology

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