Acute appendicitis is the most common extra-uterine surgical emergency encountered during pregnancy, but an accurate diagnosis is still an enigma. Anatomical shifting of the appendix by the enlarging uterus makes the clinical and sonographic diagnosis difficult. Prompt diagnosis and treatment are essential to prevent perforation, which increases the risk of fetal and maternal death. Surgical intervention, either by an open laparotomy or laparoscopy is the most appropriate treatment for appendicitis. This article reviews the epidemiology, clinical diagnosis, investigation, complications and treatment of acute appendicitis in pregnancy.
Fogging activity has become one of the important methods in tackling dengue outbreaks nowadays. Despite this, it is an occupation that has known hazards namely noise and pesticides which can affect the body organs. Based on this knowledge, a cross sectional study was conducted to determine the association between hearing impairment and serum cholinesterase level among foggers from five randomly selected Health District Offices in Selangor. A total of 200 workers comprising of 100 workers exposed to fogging activity and another 100 workers not exposed were randomly selected for this study. Data was obtained through self administered questionnaire, audiometric testing and serum cholinesterase level measurement. The overall prevalence of hearing impairment was 16% with foggers having significant higher prevalence (24%) compared to the non foggers (8%) (χ2=9.52, p=0.002). Measurement of serum cholinesterase showed that exposed workers had lower level compared to the non exposed group. Similarly, those who have hearing impairment had also lower serum cholinesterase level although it was not statistically different. Among all studied factors, age and duration of exposure to fogging activities were statistically different with hearing impairment (p
Introduction : Mersing, a district in north-east Johore was also affected by the recent worst flood in 100 years that striked Johore. Orang Asli settlements were among the worst affected by the flood in Mersing due to their location along the river. For Kg. Peta, not only flooded, the communications as well as the access roads were also tarnished. This settlement situated very deep interior about 100 km from Mersing town and next to Endau- Rompin National Park. Besides the distance, the geography and the communication issues make the flood operation even more difficult. Even then, the welfare of this minority group was never been neglected. Our Medical and Health Teams made a move in but unfortunately were also been trapped in between the flood waves.
Methodology : It was a qualitative finding. The data for this report were collected from various means. Some data were collected through informal interview among the staffs that being trapped, head villager and the dwellers, local head departments of government and non-government organizations. Others were from the relevant photographs, formal flood returns as well as through the observation.
Finding : The existence of very good involvement, cooperation and coordination from various agencies was the main factor that ensures all the villagers of Kg. Peta received our services despite of many difficulties or challenges. During this disaster, no outbreak of infectious disease or death from the settlement was reported. The welfare and the needs of all who affected and those involved in the flood operation were taken care off. Therefore, we believed that without good support and cooperation from others, we will not be able to deliver our services and their welfare especially when health was concerned will be deprived. The objectives of this write up were to share our experience in managing flood in very remote area and to show the importance of good integration between agencies in disaster management.
The main source of E. coli 0157:H7 is cattle, but recent studies showed high percentage of outbreaks
contributed by contaminated water. The occurrence of E. coli O157:H7 in environmental water samples poses a potential threat to human health. The aim of this study was to establish a protocol for the detection of the pathogen E. coli O157:H7 and E. coli virulence genes (eaeA, rfbE, hly, stx1, and stx2) in a multiplex PCR protocol using six specific primer pairs. The target genes produced species-specific amplicons at 625 bp, 397 bp, 296 bp, 166 bp, 210 bp and 484 bp for E. coli O157:H7 (fliCh7 gene) and virulence genes (eaeA, rfbE, hly, stx1, and stx2) respectively. The results obtained show that the established PCR protocol is suitable for a rapid and specific analysis of the pathogenic E. coli O157:H7 in environmental water samples for the assessment of microbiological risks.
The effects of methanolic extract of Javanese turmeric (Curcuma xanthorrhiza Roxb.) at different level of concentrations on the inactivation of Bacillus cereus, Escherichia coli, Pseudomonas spp. and Staphylococcus aureus in oyster mushroom (Pleurotus sajor-caju) were investigated. This study was conducted principally for the achievement on the best combination between the
susceptibility of C. xanthorrhiza extract on natural microflora and foodborne pathogenic bacteria with the sensory acceptability of the soaked oyster mushroom. Three different concentrations (g/ml), 0.05%, 0.50% and 5.00%, of C. xanthorrhiza extract prepared with dilution method were designed as sanitizing agent in treating the oyster mushroom at 5 minutes and 10 minutes.
There was significance reduction in the survival of microbial load between the untreated fresh oyster mushroom and those soaked with 0.05%, 0.50% and 5.00% rhizome extract (P
Two hundred and sixty four samples of ready -to-eat foods (RTE) were obtained over a period of six months (April to September 2005) from 33 school hostel kitchens and canteens previously implicated in food poisoning outbreaks from 2000 to 2004. Sampling was done by food technologists and assistant environmental health ofhcers from various districts in Pahang while microbiological analysis was carried out at the Mentakab Food Quality Control Laboratory. The objective of the study was to obtain a comprehensive picture on the microbiological status of the foods that may have accounted for food poisoning outbreaks at school hostels and canteens in Pahang. Each food sample was analyzed for Total Plate Count (TPC), Salmonella, Coliform, Escheria coli, Staphylococcus aerus and Bacillus cereus. lt was found that none of the ready-to-eat foods sampled contained Salmonella although hve samples contained Bacillus cereus , four samples contained Staphylococcus aerus. High Coliform Counts were found in 15 food samples while Escheria coli was detected in two samples. Overall, it was found that 10.2 % of the samples had unsatisfactory counts.
A five-week-old infant presented with infantile acute lymphoblastic leukaemia. He devel-oped an early CNS and bone marrow relapse despite intensive treatment. This paper discusses infantile leukaemia and its treatment.
Irritable bowel syndrome (IBS), a common gastrointestinal disorder involving the gut-brain axis, and inflammatory bowel disease (IBD), a chronic relapsing inflammatory disorder, are both increasing in incidence and prevalence in Asia. Both have significant overlap in terms of symptoms, pathophysiology, and treatment, suggesting the possibility of IBS and IBD being a single disease entity albeit at opposite ends of the spectrum. We examined the similarities and differences in IBS and IBD, and offer new thoughts and approaches to the disease paradigm.
Depression is one of the leading causes of mortality and morbidity worldwide. In the year 2000 depression accounted for 4.4% of the global disability adjusted life years (DALYs). The Kingdom of Saudi Arabia (KSA) has a population of 28 million people and is one of the countries experiencing demographic transition in its population structure. Improvements in socioeconomic status have been shown to be associated with increased chronic diseases including chronic mental diseases like depression, but still there is no comprehensive review summarizing the various reports currently existing in the literature. Although individual studies within Saudi Arabia have reported prevalence rates and risks, the quality of such studies need to be subjected to rigorous assessment and their findings pooled to give combined weighted evidence that will provide basis for targeted intervention. Pooled risks have the advantage of adjusting inherent variations within sampled populations and therefore providing more reliable estimates even though there are concerns about possible magnification of smaller individual risks.
Vibrio parahaemolyticus is well known to be abundantly distributed in marine, coastal and
estuarine environments. Since 1951, V. parahaemolyticus had been the source of numerous
outbreaks related to contaminated or mishandled seafood. However, V. parahaemolyticus
had been detected on other types of food. This issue has prompted this study to investigate
on the prevalence of V. parahaemolyticus in various food samples and determine the risk
associated with it. The results of the MPN-plating technique of the study indicated that V.
parahaemolyticus was detected in seafood (33.3%, 95% Confidence Interval [CI] 31.9 – 34.8 ,
94 – 290 MPN/g) and vegetables (10.0%, 95% CI 9.7 – 10.3 , 9.2 – 23 MPN/g) while negative
V. parahaemolyticus was detected in fruits (0.0%, 95% CI 0 – 1,
Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA+-M2BP) has been suggested to be useful for the assessment of disease severity in non-alcoholic fatty liver disease (NAFLD). Consecutive adult NAFLD patients who had a liver biopsy were included. Serum WFA+-M2BP level was measured using a lectin-antibody sandwich immunoassay using a chemiluminescence enzyme immunoassay machine (HISCL-5000, Sysmex, Kobe, Japan). The measured levels were indexed using the following equation: Cut-off index (COI) = ([WFA+-M2BP]sample-[WFA+-M2BP]NC) / ([WFA+-M2BP]PC-[WFA+-M2BP]NC), where PC = positive control and NC = negative control. Histopathological examination of liver biopsy specimen was reported according to Non-Alcoholic Steatohepatitis (NASH) Clinical Research Network Scoring System. Data for 220 cases were analyzed. The AUROC of the COI for the diagnosis of NASH was 0.65. The AUROC of the COI for the diagnosis of steatosis grade ≥2 and 3 was 0.64 and 0.53, respectively. The AUROC of the COI for the diagnosis of lobular inflammation grade ≥1, ≥2 and 3 was 0.57, 0.68 and 0.59, respectively. The AUROC of the COI for the diagnosis of hepatocyte ballooning grade ≥1 and 2 was 0.64 and 0.65, respectively. The AUROC of the COI for the diagnosis of fibrosis stage ≥1, ≥2, ≥3 and 4 was 0.61, 0.71, 0.74 and 0.84, respectively. Out of the 220 cases, 152 cases were the same 76 patients who had a repeat liver biopsy after 48 weeks of intervention. The AUROC of the change in the COI to detect improvement in steatosis, lobular inflammation, hepatocyte ballooning and fibrosis was 0.57, 0.54, 0.59 and 0.52, respectively. In conclusion, serum WFA+-M2BP was most useful for the diagnosis of significant fibrosis, advanced fibrosis and cirrhosis in NAFLD patients. However, it was less useful for differentiating NASH from non-NASH, and for diagnosis and follow-up of the individual histopathological components of NASH.
The mosquito Anopheles balabacensis balabacensis has been identified as a natural vector of at least two species of simian malaria in the monsoon forests of the northern Malay States. This mosquito is also a serious vector of human malaria from Viet Nam to northern Malaya. This is the first report of a mosquito which transmits both human and simian malaria in nature.
Primary thyroid lymphoma is a rare disorder accounting for about 2% of all malignant lymphomas and less than 5% of thyroid malignancies. It is an aggressive disease with poor outcome. The majority of thyroid lymphomas are non-Hodgkin lymphomas of Bcell origin. Majority of cases occur in women in the sixth decade. We report two cases of primary thyroid lymphoma and highlight the clinical issues and challenges posed by this rare disease. Both cases presented with respiratory obstructive symptoms that required surgical intervention. The optimal management for a primary thyroid lymphoma be it chemotherapy, radiotherapy, surgery or monoclonal antibodies is still debatable. The role for surgery has evolved through the years but its importance in emergency situations should not be overlooked. Both our patients had to undergo surgery but only one patient received additional chemotherapy and radiotherapy. These two case reports illustrated the difficulties in managing this rare disorder.
The trend of using nonprescription substances for weight-loss management is common. There are several factors associated with the use of nonprescription substances. This study aimed to determine prevalence and factors associated with the use of nonprescription substances for weight-loss management among university students. A cross sectional study was conducted from August until October 2013 among 358 postgraduate students aged 22 - 45 years in Universiti Kebangsaan Malaysia (UKM). A validated self-administered questionnaire was distributed by multistage sampling to the students. The prevalence of using nonprescription substances among university students was 27.9% (n=100). There were significant association between use of nonprescription substances with age (t=2.41, p=0.017), peer influence (t=7.06, p
The earliest report of a dengue epidemic in the Malaysian Peninsula was from Singapore in 1901 (More, 1904). S. Kae' in 1902 described the next epidemic in Penang. In March 1954, an outbreak of febrile illness was reported at the Methodist Girls' School, Kuala Lumpur, from which dengue viruses were first isolated in Malaysia and identified as dengue type 1.2 However, the first report of the sinister dengue fever with haemorrhagic manifestations was made only in 1962 from Penang Island (Rudnick et al, 1965).3Parameswaran4 in 1965 described the clinical features seen in 41 cases admitted into the children's ward in the Penang General Hospital. Several of the early isolates were of dengue type 2. (Copied from article).
The paper discusses on the complexity of the issues surrounding a patient with subluxation of cervical spine in a Down syndrome child. Several relevant issues are discussed including consent in a minor, conflicting decision making between parents and doctors, end-of-life issues, supporting handicapped child with minimal co-morbidities, community ethics, neglect of care by the caregiver and decision making after allowing zonal of parental discretion. Despite the difficulties surrounding parental actions, there are still ethical priorities which have to be considered individually to alleviate the suffering of the patients and the family members. Dealing with patients with chronic illnesses is a challenge for any medical doctors. The case warrants sensitive approach to allow appropriate respect for parental decision despite in disagreement with the clinical team. The term ‘zone of parental discretion’ refers to a controversial area of decision making; and has still many potential conflicts on day to day clinical cases, especially among the conservative society in the East Coast of Peninsular Malaysia.
The unsustainable harvesting of sea cucumbers in the Straits of Malacca poses a danger of collapsing population of this marine resource. Recent survey revealed the absence of commercially important sea cucumber species like Stichopus horrens was alarming since there were a lot of taxonomical complications in identifying species from this genus. The knowledge of taxonomy and ecology is an integral part in determining resource management strategies and conservation of marine resources like sea cucumber.
Molecular markers have been intensively used in assisting breeding to reduce the time taken by conventional breeding as well as helping introgression of specific traits. Baseline analysis of known markers is crucial in developing a genetic database on disease and pest resistance for local rice germplasm which does not yet
exist. In this study seven local rice varieties, including the popular MR219 and MRQ 74 and MRQ 76 (newly developed aromatic rice varieties), together with a foreign variety, Intani-2, were screened for genetic markers related to pest and disease resistance. One hundred and twenty-two type-related markers (SSR, STS, InDel and Allele-specific) for genes resistant to bacterial leaf blight, blast and brown planthopper were screened using PCR amplification and validated by sequencing. It was found that each variety had its own pattern of resistance. Using allele-specific markers namely pBPH9, pTA248 and Pisbdom were found to be the most efficient way to screen for the targeted genes. Of the seven varieties, MR219 and MR232 were found to have the highest distribution of markers for resistance genes against pest and diseases studied.
In August 2000, the Disease Control Unit of T erengganu noted an increase in the number of serologically confirmed cases of hepatitis A virus (HAH in Kuala Terengganu Hospital. Preliminary investigation revealed that there were an outbreak of hepatitis A in districts of Kuala Terengganu and Marang. Eventually, a total of 334 associated cases were reported among Kuala Terengganu residents and 59 cases among residents of Marang. The age of the patients range j9·om 2 years to 71 years old (median 16 years). Males accounted for ( 69.5% of cases and had a higher sex specyic attack rate (96.35/100,000) than females (42. 70/100,000). The highest attack rate (128.3/100,000} occurred among patients aged 10 — 14 years. The health staff of Kuala Terengganu and Marang District Health Ojice had investigated a total of 229 case. Most cases (62.4%) occurred amongst school children. A case control study was carried out amongst 35 cases that were matched with 71 controls by age group, class and sex, to identyy the potential source of injection. The results indicated that eating fried noodle with shelh‘ish significantly increased the risk of being infected during the outbreak (OR 16.38[4.2l-74.53]).