Objectives: The objectives of this study were to ascertain the prevalence of Indonesians obstetrics immigrant and to assess the fetal maternal outcome. Methodology: A prospective cohort study design was used to analyse 54 consecutive Indonesians obstetrics immigrant compared to 56 Malay women. Chi square and student t test were used where appropriate, p < 0.05 was considered to be of statistical significance. Results: There was a reducing trend in the incidence admission of Indonesians from 10.5 in 1999 to 6.5 % in 2002. The maternal mortality ratio showed an increasing trend from 1999 (40.0/100000) to 2001 (162.9/100000) but decreased to 5.8/100000 in 2002. The majority was between 20-40 years old, multiparous and booked, which was similar to the Malay population. Most Malays were in occupational class 1 to 3 and the husband has secondary and tertiary education compared to the Indonesians who were in class 4 and 5 and the husband has primary and no formal education. Significantly more immigrants were housewives compared to Malays who were working women. There was no significant difference in the antenatal complications. There were no significant difference in terms of delivery and most delivered vaginally. The perinatal outcome in terms of gestation, birth weight, Apgar score and admission to neonatal ICU were similar in both populations and there was no perinatal mortality. In conclusion, the incidence admission of Indonesian immigrant was on the decreasing trend. The outcome of these patients managed in MHKL was similar to the Malay population. Further studies with enrollment of a larger number of patients should be carried out to ascertain the significance of these findings.
This is a prospective study on infection following fixation of closed fractures done in Hospital Tengku Ampuan Afzan ,Kuantan from May 2003 to May 2005. There were 23 cases in this study. The mean age of patient was 32.9 years (range 15 to 77). Twenty one were males and 2 females. Twenty (87%) infections occurred in the lower limb and only 3(13%) occurred in the upper limbs. Twenty two patients (91%) had plating done for the fracture. Infection following internal fixation is commonly a deep seated (96%) and florid (78%) infection in which 70% occur after the surgical wound has healed. Staphylococcus aureus is the commonest organism isolated in which 43% are Methicillin resistant (MRSA). Overall infection caused by gram negative organisms is more common than gram positive organisms.
Passive smoking among pregnant mothers has been associated with numerous maternal and fetal effects. The aim of this study was to determine the effects of passive smoking on the fetal outcome among women who delivered at the Maternity Hospital Kuala Lumpur. This cross sectional study was carried out at the Maternity Hospital Kuala Lumpur in July 2004. Universal sampling of the women who delivered at the hospital was used and data was collected by interview using pre-tested questionnaire and patients’ medical records. Analysis was done by SPSS version 11.5. More than 75% were Malays, between 21 to 35 years, married, received secondary education, housewives and family income between RM 1000 – RM 1999. Seventy-seven per cent of the women were exposed to environmental tobacco smoke and majority were exposed at home and for less than 1 hour a week. There were significant relationships between duration of exposure with exposure at workplace, exposure at home and exposure in the car. Most of the babies delivered were males, term, normal weight and normal. Health education of the adverse effects of smoking to the pregnant women, spouses and family members need to be intensified by the hospital and the Ministry of Health.
Objective To determine the prevalence of diseases and its association with the sociodemographic factors (age, sex and ethnicity) among elderly patients admitted to a tertiary hospital in Malaysia.
Design A cross sectional study was conducted at various wards in the year of 2002. There were 9 333 respondents in this study selected by universal sampling. Setting A tertiary hospital in Malaysia. Main outcome measures Association between sociodemographic factors and prevalence of diseases. Results The mean age of the respondents was 68.9 + 6.8 years. Majority of the respondents were male (53.3%), Malays (43.7%) and married (73.2%). The prevalence of neoplasm was 15.5% followed by cataract (7.2%), diabetes mellitus (5.0%), hypertension (4.7%) and anemia (0.5%). There were significant association between gender and hypertension, diabetes mellitus, anemia and cataract (p
Introduction: Mammography is commonly regarded as the single most important tool for screening and for early detection of breast cancer. However it is not generally recommended for women under 40 years of age and in those taking hormone replacement therapy as the increased density of the breast parenchyma may make mammography more difficult to read and interpret. The limitations of mammography have spurred attempts to find new techniques that can be used either separately or in conjunction with mammography. Purpose: The aim of this study was to quantify the clinical value of using electrical impedance scanning (EIS) or Trans Scan as an adjunct to mammography in order to identify cancerous tissue based upon its inherent altered local dielectric properties. Methods and Materials: The patients were examined using Trans Scan (Trans Scan Medical, Ltd., distributed by Siemens AG. The study population was derived from patients with suspicious breast lesions categorized as BIRADS 3 or 4 detected during mammography or ultrasound. Results: Fifty-three women with 53 mammographically and/or sonographically suspicious findings were examined using EIS. With respect to the histopathological findings (15 malignant and 38 benign lesions) 13 of 15 (86.6% sensitivity) malignant lesions were correctly identified using EIS whereas, 33 of 38 (81.5% specificity) benign lesions were correctly identified. Negative and positive predictive values of 93.9% and 65% were observed respectively. Two benign lesions were correctly identified in a dense breast. The smallest lesion detected in this study measured 20 x 14 mm, which was an infiltrating ductal carcinoma. Conclusion: Electrical impedance scanning as an adjunct to mammography or ultrasound in classifying suspicious lesions is promising because it increases the sensitivity for cancer detection and may reduce biopsy of equivocal lesions. The additional use of EIS with negative predictive value of 93.9% may be useful to exclude some benign lesions from further diagnostic or invasive procedures. Artifacts, such as signals from superficial skin lesions, poor contact and bubbles are currently a limitation
Subdermal etonogestrel implant (Implanon®) is the newest, long term contraceptive implant which has recently been made available to Malaysian women. This prospective study was conducted to determine the effects on selected health indices among 42 women who had consented to Implanon® as their choice of contraception. Health indices were checked prior to Implanon® insertion and six months post insertion. Findings indicate a significant reduction in total cholesterol with a significant increase in total haemoglobin and BMI. However there was no significant change noted in the fasting blood sugar, glycosylated haemoglobin, systolic blood pressure and diastolic blood pressure.
Objectives: To evaluate the cost-effectiveness of the new oxytocin regimes in the augmentation of labour and the effect on the maternal and fetal outcome. Design: Randomized controlled trial. Setting: Labour ward of Hospital Tengku Ampuan Afzan, Kuantan. Participants: 230 pregnant women in labour at term with obstetric indications for labour augmentation. Methods: The women were randomly assigned to receive new oxytocin regime of 5 units in 500 cc of D/Saline at titration of 5 dpm with increments of 5 dpm to a maximum of 60 dpm. Or, old oxytocin regime of 1/2/4 units with titration of 20/40/60 dpm for primips and half the dosage for multips.
Main outcome measures: Cost analysis, duration of labour, duration of augmentation, complication of labour, post partum hemorrhage (PPH), mode of delivery and perinatal outcome.
Results: There was no significant difference in the mean duration of labour (6.8 h vs 6.7 h ; p = 0.45) and mean augmentation time (3.86 h vs 4.0 h; p = 0.9) between the regimes studied There seemed to be higher incidence of caesarean section in the old oxytocin group (6.5% vs 24.7%; p = 0.001). There was no significant influence on the neonatal morbidity and mortality (p = 0.07). A moderate reduction of annual cost for augmentation of labour was noted (RM 962.34).
Conclusion: The results showed that the new oxytocin regime was more cost-effective without apparent increased in the maternal and fetal mortality and morbidity.
Replacement therapy for toxoplasmosis was not a clear-cut choice since most of anti-parasitic agents available are also associated with Steven Johnson Syndrome. Further more the therapy has to be effective to control infection, which was previously achieved by oral Fansidar in this patient. Oral Azithromycin was seen as a drug of choice for these reasons. Corticosteroids were maintained since it was relatively indicated in both toxoplasmosis and SJS. Both conditions can results in visual impairment. SJS can be a life threathening condition and its ocular complications include conjunctivitis, ectropion or entropion, symblepharon, vascularization of the cornea, chronic dry eyes, and ankylosymblepharon. Proper management in dealing with both diseases is mandatory in order to prevent mortality and minimize the ocular complications. It has been shown in this case that the challenging part in managing patient with both diseases is to balance out between prevention of fatal consequences and the need control to the infection and preserving vision. Decisions on medical treatment for both conditions will remain controversial till reliable prospective randomized control trials are done to address the issues
Patient understanding and perception of diabetes control is important if clinicians were to allow diabetes patients to play a central role in management of their illness. We conducted a survey to see what diabetic patients generally thought of their understanding of disease and glycemic control; if these perceptions were accurate and related to complications.
One hundred and eight consecutive patients (mean age 52.7± 13 years, BMI 27±5.2 kg/m2, HbA1c 9.2±2.2 %) attending diabetes clinic participated including 63% women, 60% primary or no education, and 47% duration of diabetes >10 years. 54% claimed to have a good understanding although nearly half answered questions on diabetes management and targets wrongly. 32% perceived their glycemic control to be good and were found to have lower baseline HbA1c (p
Plasma total homocysteine levels (tHcy) is lowered by high insulin levels, and it can be elevated in insulin-resistant states. However, it is uncertain whether plasma tHcy and insulin or any components of the metabolic syndrome has any relationship among hypertensive individuals. In this study the tHcy and insulin concentrations were measured by enzyme immunoassay techniques in samples from 41 (27 male and 14 female) participants. Components of the metabolic syndrome (insulin resistance) profiles were also evaluated. The participants’ age ranged from 31 to 67 years (mean+SEM, 52.1±1.3 years), body mass index from 20.2 to 38.3 kg/m2 (27.2±0.7 kg/m2), plasma tHcy concentration from 6.9 to 16.2 μmol/L (11.0±0.4 μmol/L), and plasma insulin 3.0 to 16.6 μIU/mL (7.3±0.5 μIU/mL). A significant negative correlation was found between tHcy concentrations and insulin levels (r=-0.358, P=0.011), but not with other variables (P>0.05). In conclusion, the tHcy concentration is significantly related to plasma insulin in hypertensive subjects. tHcy concentrations were independent of the components of the metabolic syndrome and other risk factors of coronary heart disease in hypertensive subjects.
Extrapelvic endometriosis is fairly rare and may occur in numerous sites throughout the body. Unnecessary investigation may be performed before the diagnosis could be made. Here we present two cases where endometriotic nodules occurred on a caesarean section scar and in the vagina. Further management is discussed in the report.
We present a case of a 45-year-old female who presented with blurring of right vision associated with constitutional symptoms. Examinations revealed right optic disc swelling with inferior exudative retinal detachment and hepatomegaly. Gynaecological examination showed a fungating cervical mass. Histopathological reports of cone biopsy confirmed the presence of large B cell non-Hodgkin lymphoma. HIV screening was positive. A diagnosis of HIV related lymphoma was made. Chemotherapy and antiretroviral treatment were instituted. The ocular signs resolved. However, the patient could not tolerate the side effects of medical therapy and opted for palliative treatment.
Invasive Lobular Carcinoma of the breast is less common than Invasive Ductal Carcinoma and the presentation can be different from other types of breast carcinomas. It can present as diffuse swelling or thickening of breast rather than a mass. Sometimes, it can present as metastatic deposits from a very small primary breast lesion. These make the diagnosis of this type of breast carcinoma difficult and challenging for the radiologist and surgeon. We describe a case of Invasive Lobular Carcinoma of the breast, which presented with a left sterno-chondral metastasis and discuss the imaging findings and treatment of this condition.
Neck abscess is still common in developing countries. Often the presentation is late especially when the pain becomes intolerable or the airway is compromised. Intramuscular abscess in the neck is very rarely encountered. We report a case of an abscess of the right sternocleidomastoid. The culture grew Proteus mirabilis. The outline of management is discussed.
We present two cases of direct traumatic carotico-cavernous fistula following motor vehicle accident. Their main symptoms include loss of vision, progressive proptosis and recurrent epistaxis. Angiogram confirmed presence of carotico-cavernous fistula in both cases. One was successfully treated by open surgery and the other by embolization with Guglielmi detachable coils (GDC). In both cases, proptosis and epistaxis resolved completely.
Primary thyroid lymphoma is a rare tumour of the thyroid gland, accounting for 1-2 % of all thyroid malignancies. Diagnosis by fine needle aspiration cytology occasionally inconclusive, needing bigger biopsy or even thyroidectomy. This study reviews our experience with primary thyroid lymphoma.
Clinically, it is sometimes diffi cult to distinguish an infection of the spine from a metastasis. Spinal tuberculosis is common according to its endemic region and adenocarcinoma of the lung is also rising in the incidence worldwide. Similar presentations, with unknown primary, clinical fi ndings and hematological investigations rarely conclude a true diagnosis. Radiologically, the hallmark of spinal infection is erosion of adjacent vertebral endplates and narrowing of the disc space with or without a paravertebral shadow. Metastasis typically does not involve the disc space with erosion of the adjacent vertebral endplates. It usually presents as a lytic/sclerotic lesion in the vertebral body or “winkle owl” sign. These distinguishing features of infection versus metastasis are not certainties. Biopsy is mandatory whenever in doubt or patient is not responded with provisional treatment. The author presents a case with so-called radiological features of spinal tuberculosis infection, which turns out to be a metastatic adenocarcinoma of the lung.
A 35-year-old Jordanian gentleman presented with worsening right iliac fossa pain of three-day durations with vomiting, loose stool and intermittent fever. He later underwent laparoscopic surgery, which was subsequently converted to open laparotomy. Intraoperatively, there was thickened bowel with multiple mesenteric lymph nodes, and also thrombosis of the small bowel vein supplying the affected bowel lesion, the diagnosis which was later confi rmed with the histopathological report. Resection with end-to-end anastomosis was done during the surgery. Within one-week post laparotomy, he developed another progressive abdominal pain and distension, vomiting and no bowel opening. He was sent for another exploratory laparotomy. Intraoperatively, there was a gangrenous small bowel segment measuring 130 cm, with an intact large bowel and previous anastomotic site. Resection of 150 cm of the small bowel was subsequently done.
Introduction: Dengue is one of the commonest infections in Malaysia and it is a notifi able disease. Even
though the diagnosis of classical dengue fever and dengue haemorrhagic fever can be recognized clinically, the diagnosis remains a challenge in areas where it could not be differentiated with other febrile illnesses. The aim of this study was to focus on the specifi c and consistent morphological features observed in blood fi lms of dengue infection. Materials and Methods: In all 400 cases of dengue infection serologically diagnosed in the Tengku Ampuan Afzan Hospital (HTAA) during May to October 2007, only a total of 27 cases had blood fi lms examined, and thus were included in this study. These blood fi lms were re-examined by two pathologists from HTAA. The full blood count parameters were also retrieved and studied. Results: We consistently found typical reactive lymphocytes [n= 23 (85%)] and thrombocytopenia [n=21, (77.8%)] in the cases. However, leucopenia was present only in 9 cases (33%). Conclusion: The presence of typical reactive lymphocyte is a consistent fi nding in dengue fever and thus could have a signifi cant role in supporting the diagnosis of dengue infection.
Introduction: The Malay Version of EORTC-QLQ C30 was validated among Malaysian women who had undergone breast cancer surgery. Materials and Methods: Test-retest evaluation (i.e. three weeks and ten weeks following surgery) was carried out to examine the validity and reliability of the scale. The Cronbach’s alpha value was used to determine the internal consistency, meanwhile, test-retest Intraclass Correlation Coeffi cients (ICC) indicates the reliability of the scale. Effect Size Index and Mean Differences interpret the sensitivity of the scale. Discriminant validity was evaluated by comparing two groups i.e. women who had mastectomy and women who had lumpectomy. Results: Internal consistencies are acceptable for Global Health Status (0.91), Functional domains (ranging from 0.50-0.89) and Symptomatology domains (ranging from 0.75-0.99). Intraclass Correlation Coeffi cient (ICC) ranged from 0.05 to 0.99 for Global Health Status and Functional domains, and ranged from 0.13 to 1.00 for Symptomatology domains. Sensitivity of the scale was observed in nearly all of the domains. Conclusion: The Malay Version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ C30) is a suitable tool to measure the quality of life of women with breast cancer.