Introduction: Many tasks seem daunting for a new medical graduate who is starting houseman
posting; as educators, we must ask ourselves whether our graduates are ready to face emergency
situations as the first responders during a crisis. Exploration of undergraduate students’ perceptions
highlights needs in some areas, including acute care, practical skills and prescribing. Armed with basic
resuscitation skills, students could face emergencies with more confidence and skill. Method: Seven
cohorts of final-year students completed a one-and-a-half day cardiac life support course and were
assessed using megacode and pre- and post-course multiple choice questions. Results: The pre- and
post-test analysis using paired sample T-test demonstrated significant performance improvement
(p
Extrinsic pulmonary artery stenosis caused by anterior mediastinum teratoma presenting with an ejection systolic murmur is a rare phenomenon. Till date, 15 cases have been reported (inclusive of this case) in the English literatures. Herein we report a 20 year old female with extrinsic pulmonary artery stenosis because of compression by an anterior mediastinal teratoma with a loud ejection systolic murmur. The case report aims to highlight the awareness of such rare presentation of anterior mediastinal teratomas that may mimic congenital valvular heart diseases among clinicians.
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.
This paper looks at electrical power generation from solar concentrator using thermoelectric generator. An experiment was conducted on a concentrator thermoelectric generator (CTEG) utilising solar thermal energy. The CTEG used a parabolic dish as concentrator with thermoelectric device installed at the focal point to convert thermal energy to generate electricity. The investigation covered the cooling effect of the cold side of the thermoelectric generator using natural and forced convection cooling for optimum output. Forced convection cooling with a fan provided 69% more power output from the CTEG system as the temperature difference across the TEG was greater than the system cooled by natural convection. The outcome of this project showed maximum power output was obtained for the CTEG system cooled by forced convection cooling.
Schwannomas are benign tumours arising from neurilemmal cells which forms the myelin sheath of peripheral nerves. It usually occurs in the head, but may be found in the brachial plexus and sciatic nerve. Common peroneal nerve schwannoma are rare. We report a case of a middle age gentleman who presented with pain and swelling over the right popliteal fossa with associated right radicular pain of the anterolateral leg and weakness of ankle dorsiflexion. Examination revealed a 3x2 cm lump behind the posterolateral aspect of the right knee with positiveTinel’s sign upon tapping of the lump, sensory deficit over the anterolateral aspect of the leg and the ankle dorsiflexors had a muscle power of grade 3. Magnetic resonance imaging (MRI) of the right leg revealed a well circumscribed, oval lesion located along the pathway of the common peroneal nerve homogenously hypointense on T1-weighted images and heterogeneously hyperintense on T2 weighted images compared to the muscles. The lesion was not surpressed on fat suppression sequences. Intra-operatively, we noted that the schwannoma was in continuity with the common peroneal nerve. The patient underwent excision of the schwannoma. Post operatively, the pain reduced remarkably but patient suffers from numbness and right foot drop as a complication of the tumour. This case highlights the rarity of common peroneal nerve schwannoma which presents with neuropathic symptoms complicated with right foot drop.
Open tracheal injury is rare but can lead to disastrous consequences such as massive bleeding, airway obstruction or failure and aspiration of blood. We present a case of open tracheal injury of a man who tried to attempt suicide using a knife. In this case, the initial management was securing the airway by attempting orotracheal intubation. However, it was unsuccessful when the tube came out from the laceration wound. Intubation was then re-attempted through the distal cut-end of the trachea in the face of airway failure. A quick initial assessment and anticipation of a failed airway should always be the top priority in any emergency physician managing these cases. Direct intubation through the laceration wound might be the only option when all else fail and your patient is crashing.
Keywords: intubation, laceration, trachea
Minimal Change Disease (MCD) and Focal Segmental Glomerulosclerosis (FSGS) are common causes of nephrotic syndrome. These two conditions are similar in their presentations but differentiated via their histopathological features and responsiveness to corticosteroids. There are ongoing debates whether MCD and FSGS are at the same spectrum of disease rather than separate entities. FSGS has been postulated to be the severe end of the spectrum of MCD. We have reported a case that has primary FSGS after years of poorly controlled MCD, which supports both conditions are the same spectrum of disease.
Dandy-Walker syndrome is a rare congenital malformation of the brain that involves the cerebellum and the fourth ventricle. It is characterised by a classical triad of hydrocephalus, cystic dilatation of the fourth ventricle and complete or partial agenesis of the vermis. Majority of cases are diagnosed during neonatal or early infantile period. In this case report, a seven-year-old boy complained of recurrent headaches for the past one year. Physical examination was unremarkable. Examination of the fundus on the same day revealed bilateral papilloedema. His subsequent computed tomography scan of the brain done at a major district hospital demonstrated features in keeping with Dandy-Walker malformation. Our case highlighted the importance of embarking on a detailed and thorough approach when dealing with a child with chronic headache, especially in rural settings where advanced medical equipment is not readily available.
Myasthenia gravis (MG) is a rare autoimmune disorder
characterised by fluctuating and variable combination
of muscle weakness and fatigue. Most cases are due to
T-cell mediated autoantibodies against post-synaptic
acetylcholine receptors (AChR-Ab), thus preventing
acetylcholine from binding and signalling skeletal
muscle to contract.1
The annual incidence is 7-23 new cases per million.1
It can occur at any age but with two peaks; an earlyonset
(20-40 years) female-predominant and a late-onset
(60-80 years) male-predominant peak. MG is classified
into ocular and generalised (80%). More than half the
patients initially present with ptosis and diplopia but half
will progress to generalised disease with involvement of
bulbar, limb and respiratory weakness. Those presenting
as generalised MG can also develop eye signs later.1
It is important to recognise MG early because it is
highly treatable. Untreated disease leads to permanent
weakness.2 Treatment reduces mortality from lifethreatening
myasthenic crisis.1,3 Misdiagnosis leads to
potentially harmful interventions and inappropriate
management.4,5 Diagnosis in late-onset MG is easily
missed2,3,4,5 because of overlapping symptoms with
other diseases common in the elderly. We report a case
of delay and misdiagnosis in an elderly patient with
co-morbidities. (Copied from article).
Leptospirosis has a wide range of presentation which ranges from mild flu-like symptoms, to severe form including renal failure, liver failure, and hemorrhage. Pulmonary involvement can progress from subtle clinical features to life threatening pulmonary hemorrhage and acute respiratory distress syndrome. Although benefits of corticosteroids in adult respiratory distress syndrome have been proven and accepted, evidence for use of corticosteroids in pulmonary leptospirosis is still limited. Given the vasculitic nature of severe leptospirosis, it has been proposed that addition of intravenous corticosteroid therapy, particularly in cases of pulmonary involvement is beneficial. We report a case of leptospirosis with suspected pulmonary hemorrhage which deteriorates after a few days of admission in our tertiary hospital. We have demonstrated that the prescription of a lower dose of corticosteroid than what was widely reported in the literature can equally led to a satisfactory recovery of the pulmonary hemorrhage.
Objective: This study evaluates the feasibility of diffusion tensor imaging(DTI) in assessing median
nerve by measuring diffusion parameters such as fractional anisotropy (FA), mean diffusivity (MD),
axial diffusivity (AD) and radial diffusivity (RD) at different sites of median nerve and evaluating
their differences in patients with and without carpal tunnel syndrome (CTS) in local setting. Methods:
A prospective cross sectional study was performed with 9 female patients diagnosed with CTS by
clinical evaluation and nerve conduction study and 8 age and sex matched normal patients. Magnetic
resonance imaging (MRI) wrist was performed with pre-set axial PD and DTI protocol on a 3T
MRI, images post-processed using 3D SLICER software to generate median nerve tract and measure
diffusion parameters FA, MD, AD and RD in segments and focal points. Results: The FA values were
significantly lower in CTS patients, 0.454 (± 0.065), p< 0.002 and demonstrates negative correlation
with disease severity, r = - 0.510, p = 0.002.The mean MD, 1.090 (± 0.178) and mean RD, 0.834
(± 0.128) is higher in CTS patients, p = 0.041 and p = 0.014 respectively. They show an increasing
trend with increasing disease severity. Negative correlation was noted between the FA values and
age groups. FA cut of value of ≤ 0.487 with sensitivity 70.6 % and specificity 76.5%, is suggested
for diagnosing CTS.
Conclusion: MR neurography using DTI can be utilised to detect CTS. Patients with CTS demonstrate
lower FA and higher MD and RD values.
Learning through game scene is considered a game-based learning approach. Teaching and learning process using game scene is deemed interesting and effective due to the nature for this approach which seems alive with asserted activities. Students experience their own game via narration through the virtual world they undertook. This investigation is targeted towards conceptual change and explanation for basic programming theorem through navigated game scene by evaluating motivation and student experience. 55 respondents consisted of semester three students from computer software application certification a program from a community college is selected for the undertaken study. Motivation and experience surveys are reference based on intrinsic motivation inventory instrument (IMI). Findings were tabulated based on t-test statistics and descriptive to get the frequency, mean, standard deviation and percentage. Initial results reflected student acknowledgement on utilizing game scenes in terms of elaborating basic game programming key points in providing elevated learning experience.
This is a retrospective audit of all patients admitted to the surgical unit for urosepsis from June 2014 to June 2015 at the General Surgery Unit of Hospital Sultan Ismail, Malaysia. Demographics, comorbidities, presenting symptoms, length of stay (LOS), mortality, and associated risk factors were recorded. There were 35 patients treated for urosepsis with a male preponderance of 21/35 patients. Hypertension (n=18) and diabetes (n=10) were the two most common comorbidities. There were five deaths (mortality rate=14.3%) and the main bacterium cultured was Escherichia coli. Age >65, presence of underlying comorbid disease, presence of cancer, urine and blood culture positivity had higher incidence of death but were not statistically significant for urosepsis mortality. However, this result is limited by the small sample size and single centre retrospective data.
Aim: To investigate the association between smoking status and body-mass-index (BMI) categories.
Subject and methods: Data are obtained from 2,340 observations from the Malaysia Non-Communicable Disease Surveillance-1. An ordered probability model for BMI categories with ordinal smoking treatment categories is developed and estimated. Marginal and treatment effects are calculated.
Results: Socio-demographic and health-lifestyle factors play significant roles in body weight categories, conditional upon smoking status. Education levels are inversely correlated with BMI categories amongst non-smokers only. Age and income levels are associated with BMI within non-smokers and compulsive smokers. Gender (female), family history of serious illnesses, individual health conditions (hypercholesterolemic, hypertensive), ethnicity (Malays and Indians) and regional locations (metropolitan) are associated with higher BMI levels, irrespective of smoking status. Additionally, BMI categories and levels are closely associated with smoking habits. As individuals switch from non-smoking to casual smoking, the probability of being overweight or obese increases, with an upsurge of 1.89 BMI units. As the casual smoking habit evolves into compulsive smoking, overweight or obese likelihoods are lowered as individuals are more likely to be in the underweight, normal weight or at-risk weight BMI ranges instead, while experiencing a decline of 1.75 BMI units.
Conclusions: There exists close association between BMI categories and levels with smoking habits. As smoking tendencies develop from being a non-smoker to a casual (compulsive) smoker, overweight or obese likelihoods increase (decrease), as individuals realize an upsurge (reduction) in BMI levels.
Study name: Malaysia Non-Communicable Disease Surveillance-1 (MyNCDS-1) survey
Terdapat dua jenis permineralan bijih besi di kawasan Ladang Toh Pawang, Kedah iaitu bijih besi primer dan sekunder. Kepekatan Pb dan Cr yang amat rendah ditemui dalam bijih besi primer (bdl) manakala Cu ditemui sebagai bendasing (60-93 μg/g). Kepekatan Cr dan Cu meningkat di persentuhan antara jasad rejahan bijih besi dengan batuan sekitar. Kepekatannya masing-masing ialah sebanyak 27-30 μg/g and 242-294 μg/g. Pengayaan logam-logam tersebut disebabkan oleh penggantian metasomatik apabila magma likat yang panas berinteraksi dengan batuan syal Formasi Mahang yang kaya besi. Secara umum, kepekatan Pb dan Cr dalam bijih besi sekunder lebih tinggi berbanding dengan pemineralan bijih besi primer yang mana masing-masing berjulat 3-7 μg/g and 121-151 μg/g. Kepekatan Cu di dalam bijih besi primer dan sekunder hampir sama. Taburan Pb, Cr dan Cu di dalam bijih besi sekunder berpunca daripada luluhawa batuan syal Formasi Mahang yang kaya besi. Ketika proses permukaan berlaku, logam-logam berat tersebut telah dijerap daripada air bawah tanah lalu turut terenap bersama-sama dengan bijih besi sekunder.
The main objective of this paper is to explore the varying volatility dynamic of inflation rate in Malaysia for the period from January 1980 to December 2004. The GARCH, GARCH-Mean, EGARCH and EGARCH-Mean models are used to capture the stochastic variation and asymmetries in the economic instruments. Results show that the EGARCH model gives better estimates of sub-periods volatility. Further analysis using Granger causality test show that there is sufficient empirical evidence that higher inflation rate level will result in higher future inflation uncertainty and higher level of inflation uncertainty will lead to lower future inflation rate.
During fermentation cells are subjected to various kinds of stress. One of the stresses concerned is high osmotic environment, which cells need to encounter in order to continue growing. To understand how cells adapt to this stress condition, information from genome, proteome and metabolome levels are crucial. In yeast cells, it was report that they produce glycerol to avoid depletion of water in the cell that could lead to cell shrinkage and eventually death. Thus, investigation of physiological responses were executed by shake flask method using three different Saccharomyces cerevisiae strains namely s288c, IFO2347 and FY834 which were grown in yeast potato dextrose (YPD) medium under the treatment of sodium chloride (NaCl) and sorbitol at 1M concentration to create the osmotic condition. These agents were added into the medium after 5 hours of fermentation when the cells reached exponential phase and carbon source is still available. The results proved that addition of both NaCl and sorbitol created the osmotic condition during growth resulted in higher accumulation of glycerol and trehalose when compared to the control in all strains. Among these strains, production of glycerol (g glycerol/g cell dry weight) was found highest in IFO2347, followed by s288c and FY834.
Restoration of anterior teeth requires high precision in the shade selection of the restorative material due to its aesthetic appearance. Incorrect selection of shade for the restoration may result in patient’s dissatisfaction due to unaesthetic appearance. This study was conducted to determine the optimum lighting condition and preferable patient’s position that may influence the anterior tooth shade selection at the Faculty of Dentistry, Universiti Kebangsaan Malaysia. One hundred dental students from the 4th and 5th year were randomly selected to perform the shade selection procedure on the maxillary central incisor of two selected subjects. The shade of the tooth was predetermined using an intraoral spectrophotometer machine and the result was used as reference for the visual shade selection procedure done by the students. Four different clinical situations were selected and the shade selected by the students’ was compared with the predetermined shade. The result showed that the shade selection for anterior composite resin restoration is more reliable using the first reading taken (46%) when the patient is in the upright position (35.5%) with dental chair light off (56%). As a conclusion, the patient’s position, lighting condition and number of readings taken does influence the result of the shade selection for the anterior tooth.
Recently we have reported on standard MAP and generalized Jacobi Elliptic monopole-antimonopole pair (MAP) solutions of the SU(2) Yang-Mills-Higgs model. Here we apply Cho Abelian decomposition to the gauge potential of these MAP solutions. It is shown that the point singularities at the locations of the monopole (antimonopole), that comes from the restricted part, are removed by the unrestricted valence potential. We also consider the effect of decomposition upon energy and magnetic charge density for the cases of standard MAP and generalized Jacobi elliptic MAP solutions, under the conditions of vanishing (λ = 0) and non vanishing (λ = 1) Higgs potential.
In this study, the Hg levels in eight parts of Asystasia gangetica (L.) T. Anderson collected from 14 sites were determined using a Mercury Atomizer MA-1S and a Mercury Detector MD-1. It was found that the ranges for all the parts were 3.21-18.2 μg/kg dry weight for flowers, 1.29-11.2 μg/kg dry weight for stalks, 0.32- 29.4 μg/kg dry weight for seeds, 0.87-10.2 μg/kg dry weight for pericarps, 1.45-18.1 μg/kg dry weight for remainders, 11.8-68.2 μg/kg dry weight for leaves, 0.73-20.9 μg/kg dry weight for stems, and 3.40-33.1 μg/kg dry weight for roots. The overall Hg accumulation pattern in decreasing concentrations was leaf > root > flower > flower remains > stalk > stem > pericarp > seed. This study provided the background levels of Hg in this non-native invasive weed species in Malaysia. However, further studies are needed to confirm it as a biomonitors of Hg in this region.