A 65-year-old lady with cholelithiasis underwent an elective laparoscopic cholecystectomy (LC) and was discharged on post-operative day 2. She was re-admitted after five days with right hypochondriac pain and fever. Investigations revealed a drop in hemoglobin. Computed tomography showed a large intrahepatic subcapsular collection without intra-abdominal collection. She was treated with intravenous antibiotics. Percutaneous aspiration of intrahepatic subcapsular collection under ultrasound guidance revealed old blood. Hence diagnosis of intrahepatic subcapsular hematoma (ISH) was made. She improved and was discharged after a two weeks' hospital stay. Follow-up ultrasonography examination two months later revealed complete resolution of the hematoma. We report this case due to its rarity and review the previously documented cases of this complication.
The presenting signs of acute leukaemia occur as a result of bone marrow failure and organ infiltration. Increased bleeding tendencies are seen on the skin, gums and mucosal lining. Bleeding in the posterior segment of the eye, namely the retina and vitreous, may occur, but do not usually cause any visual disturbances. This case demonstrates visual loss as a result of premacular subhyaloid haemorrhage in acute leukaemia.
Malaysia is a country consisting of people of Malay, Chinese and Indian ethnic origin and also of some Indonesian and Thai population. In this study of acute pancreatitis, the age group, sex incidence, clinical
features, complications and treatment were compared between different ethnic groups. A total of fifty-four consecutive patients admitted in Sungai Petani Hospital, Kedah, Malaysia with acute pancreatitis from 2002 to 2004 were taken for this study. There were 29 males and 25 females. The 40–60 years age group was more commonly involved. The common factors associated with acute pancreatitis were alcohol intake in males and biliary disease in females. Two females suffered from acute pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). One of the 54 cases died due to multi-organ failure.
Intrapulmonary bronchogenic cyst is a rare congenital lesion originating from abnormal budding of the embryonic foregut. It is less common than mediastinal bronchogenic cyst. We describe a case of intrapulmonary bronchogenic cyst and discuss the treatment of this condition.
Male factor infertility which accounts for 30-50% of infertility is a major problem faced by married couples. Congenital absence of the vas deferens, though uncommon, remains the most common abnormality seen in extratesticular ductal and ejaculatory system, accounting for 1-2% of male infertility. It may be unilateral or bilateral. Association with renal abnormality has also been reported with congenital absence of vas deferens (1). The patients are asymptomatic and the congenital abnormality is usually detected when investigation for infertility is carried out. We present a case of an unusual presentation of congenital bilateral absence of vas deferens (CBAVD).
Substance abuse is one of the leading and most complicated health and social problems faced by our country. Unfortunately, after three decades of managing these problems, outcomes are unpromising and poor.(Copied from the article).
Recent innovations in the treatment of schizophrenia reflect a growing trend towards community-based care. Malaysia had in the past few years attempted to deinstitutionalise mental patients in the mental hospitals. Therefore it is important to conduct research to compare the two groups of schizophrenia patients (community-based patients against chronic hospitalised patients) to ascertain if deinstitutionalisation has been beneficial. The main objective of the study was to compare levels of depression and function in community-based patients against chronic hospitalised patients as depression is prevalent among schizophrenia patients. This study was cross sectional in nature where data was collected from 51 inpatients in Hospital Bahagia Ulu Kinta (HBUK) and 23 community-based patients. Calgary Depression Scale for Schizophrenia (CDSS) and Global Assessment of Functioning scale (GAF) were the assessment tools used. Community-based patients were found to have significantly lower scores in the CDSS scale (1.96) as compared to chronic hospitalised patients (4.04); p < 0.01). They also showed higher functional capability between community-based and hospitalised patients respectively (74.04 vs 57.92) respectively. (p < 0.001). Community services appeared to be more effective than long stay in-patient services in preventing depression and promoting better functional levels.
Rectal delivery of drugs has been proven to be effective in terms of drug absorption and distribution comparable with other routes such as oral, buccal, sublingual or even nasal. In this study, two new suppository bases were developed using combinations of locally sourced hydrogenated palm kernel oil, hydrogenated palm kernel stearin and hydrogenated palm kernel olein with mixtures of stearic acid and glyceryl monostearate. When formulated with aspirin, these bases produced suppositories with acceptable characteristics. These aspirin suppositories were tested on twelve healthy subjects after an approval from the Medical Ethics Committee, University of Malaya had been procured. We quantified aspirin from the urine samples of the subjects to determine the relative availability of the different suppository preparations relative to an oral dose. The excretion of salicylic acid, one of the metabolite of aspirin in human urine taking aspirin was quantified. The F value was found to range from 1.16 to 1.38. Hence, the excretion results showed that these palm kernel oil blends are suitable suppository bases.
Systemic lupus erythematosus (SLE) is one of the commonest systemic autoimmune diseases that can present with variable clinical manifestations. Intravenous Immunoglobulin (IVIG) has been used as a salvage therapy for severe lupus with encouraging results though there is yet randomised trial to support the usage. This report highlights the efficacy and safety of high dose IVIG in SLE patients with multi-organ involvement particularly lupus nephritis. We also reviewed the literature on the usage of IVIG for lupus nephritis. However, more studies are needed to further clarify the optimal therapeutic dosage and regime for IVIG and to identify the group of patients who might benefit the most from this expensive therapy.
Rhabdomyosarcoma of the genitourinary tract is rare and predominantly affects paediatric patients. We present an unusual case of such a lesion in an adult with extensive occupation of the bladder cavity by the lesion, resulting in bilateral ureteric obstruction, without evidence of ureteric outlet invasion. We outline the unusual CT and macroscopic appearance of this lesion. We also discuss the literature data and management strategies of rhabdomyosarcoma of the genitourinary tract.
Priapism is a urological emergency. The treatment for ischaemic priapism is usually cavernosal aspiration with or without cavernosal irrigation. Some patients may need surgical intervention -the various shunt procedures. We report a 21-year-old man with priapism secondary to chronic myeloid leukemia who needed a combined medical and surgical management. He underwent a spongiocavernosal shunt as well as cytoreductive chemotherapy to achieve complete detumescence. Therefore, cytoreductive chemotherapy is an adjunct in difficult cult to treat priapism associated with chronic myeloid leukemia.
Educational environment of an institution is the environment experienced or perceived by students and teachers. Individual students and teachers will respond differently to these subtle elements in their learning experience. Curriculum's most significant manifestation and conceptualisation is the environment. There is a proven connection between the environment and the valuable outcomes of students' achievement, satisfaction and success. If one wants to describe, assess or get a handle on the curriculum in a medical school, then the educational and organisational environment or total milieu associated with the curriculum and the medical school needs to be studied. Educational environment is one of the most important determinants of an effective curriculum. Educational environment fosters scholarly or intellectual activities; it encourages friendliness, co-operation and supportiveness. It also fosters the learning, growth and development of students. Students' perceptions of their educational environment are a useful basis for modifying and improving the quality of educational environment. Several research groups over the years have attempted to identify and quantify the presence and impact of rather intangible aspects of a learning environment. Each study has used different survey questionnaires to solicit student reactions.
Leadership and management in health organisations are essential and frequent topics of discussion among professionals and other staff, who are directly or indirectly involved with the operation of the said organisations. In a hospital setting for example, managers are appointed at different functional or unit levels. Though more often than not, we refer to them as the heads or managers or by any other names, the leadership component might be assumed to be just part but not the most important aspect of their roles.(Copied from article).
Prevalence and signs and symptoms of menopause have been extensively studied among Malaysian women but no one had investigated the level of knowledge and perception of menopause. This study aimed to examine the knowledge and perception of menopause among young to middle aged women (15 to 49 years old). A cross-sectional survey using 20-items questionnaire was conducted in three randomly chosen districts in Federal Territory, Kuala Lumpur. Women in this survey were aware of the meaning of the term menopause and its symptoms. However, the majority lacked comprehensive understanding about the health risks associated with menopause. Commonly cited sources of knowledge were magazines and family members. Lack of official sources for accurate information on menopause was reported. Communication with health care personnel regarding menopause was uncommon. An exploration into respondents' perceptions on menopause revealed that the majority displayed positive thinking towards menopause. Young respondents seemed to have better perception regarding menopause compared to middle aged women. Although the women had good knowledge about menopause, they expressed feelings of sadness and nervousness upon the approach of their own menopause. Our data provides insight on the knowledge and perception of menopause that will guide future public health initiatives for premenopausal women in order for them to cope better when approaching this stage of life cycle.
Oral cavity malignancy reconstructive surgery has advanced from pedicle flaps to microvascular free tissue transfer. Previously, reconstruction of these defects were done using radial forearm free flaps in this centre. We report our experience using anterolateral thigh free flap in a 49 year old lady with squamous cell carcinoma of the tongue. Excision of tumour left a defect which was later reconstructed using microvascular free tissue transfer using the right anterolateral thigh free flap. The flap was well taken up at the recepient site and no evidence of flap failure noted post operatively and on completion of radiotherapy. She was able to maintain comprehensible speech and swallowing ability.
What does this term medical education conjure up? Does it refer to the teaching and learning of medicine and therefore relates to students and the curriculum? Does it refer to the process of teaching and therefore relates to teachers? Perhaps it is both, since teaching and learning go hand in hand.(Copied from article).
Tyrosinase is a key enzyme that catalyzes melanogenesis in human skin. It oxidizes tyrosine to L-3,4-dihydroxyphenylalanine (L-DOPA) and subsequently to dopachrome, which further polymerizes to melanin pigments. Therefore finding an effective tyrosinase inhibitor, either from synthetic or natural sources, is not only useful as skin whitening agents in cosmetic application, but also beneficial in treating melanin-related disorders. The present study reports of the optimized and validated results of a cell-based tyrosinase assay using B16F10 murine melanoma cell line, which produces melanin pigments and has been used extensively in antimelanogenesis studies. The optimization studies involved 3 parameters (1) optimal seeding cell number per well for total protein extraction; (2) optimal dopachrome formation from enzymatic reaction between total protein (tyrosinase source) and L-DOPA (substrate); and (3) optimal incubation period after the addition of substrate. The present study demonstrates that using seeding cell number of 2 × 105 cells/well, total protein of 40 μg, L-Dopa of 5 mM,and at an incubation period of 1 hour at 37°C provided the optimal response on cultured melanoma cells. Kojic acid, a standard tyrosinase inhibitor, was used as a positive control in the optimized cell-based tyrosinase assay to validate the usefulness of the assay. CONCLUSION: The use of the mentioned protocol is sensitive to determine changes in melanoma cells as the result of tyrosine inhibitors.
INTRODUCTION: Health-risky behaviours among undergraduates are a course of concern both due to its tendency to be carried towards later adulthood and the emergence of non-communicable diseases at younger age group.
METHODS AND MATERIAL: A cross-sectional study involving 1622 respondents comprising of students undertaking tertiary education was carried out using self-administered questionnaires. (adapted and translated into Bahasa Malaysia from the CDC Health Risk Behaviour Survey)
RESULTS: It is found that 6.9% of the respondents have had sexual intercourse with the mean age of the first intercourse at 18.6 years. Of those who have had intercourse, 25.9% did not practice safe sex. The study showed that 7.2% of the undergraduates who drives have driven after taking alcohol and 19.3% of the respondents have travelled in a car driven by drunk driver. It is also found that 10.8% of the respondents tried smoking at a young age of 15 years. One point two percent (1.2%) of the studied population has also taken recreational drugs previously.
CONCLUSION: Health risk behaviours among undergraduates in Malaysia are presently existing issues which poses serious concerns.
The objective of the present study is to investigate the impact of socio-demographic factors on the acquisition of health information on Non-Communicable Diseases (NCDs) among Malaysian adults. A robust analysis was conducted on cross-sectional survey data obtained from 398 respondents in Penang (Malaysia) between August to October 2010. An ordered probit model was applied to examine the factors affecting the scale of health information. The results suggest that old individuals, rural dwellers, having chronic disease and history of serious family illnesses are 0.19%, 2.39%, 2.2% and 2.71% less likely to acquire poor health information on NCDs than others, whereas Malays, Chinese, males and those of low educated are 8.76%, 6.22%, 2.94% and 21.62% more likely to acquire poor health information on NCDs than others. Based on these findings, several intervention measures toward increasing the health knowledge among the population are recommended, which include the use of language-based mass media to advertise the information on diseases, designing health awareness campaigns in urban areas and introducing more basic health related subjects and courses into primary and secondary schools.
INTRODUCTION: Although the Feldenkrais method of rehabilitating chronic obstructive pulmonary disease (COPD) patients have been suggested, its use among practitioners is not widespread owing to preference of the more familiar standard program presently available. Several advantageous of the Feldenkrais Method have been suggested which includes improving the efficiency of movement, posture and, breathing. However how this compares to the standard rehabilitation protocol or pulmonary rehabilitation program (PRP) have not been previously demonstrated. The present study was thus conducted to compare the effectiveness of the Feldenkrais Method to the standard PRP using Borg score and 6 minute walked distance (6MWD) as outcome measurement tools.
RESULTS: There were 17 subjects in the Feldenkrais group (FG) and 19 subjects in the pulmonary group (PG), both of which received therapy for 8 weeks and assessed before and after receiving therapy. There were no improvements observed in the Borg score for the FG (after and before; 6.06+ 1.09 vs. 6.00+0.94). However, improvements in the PG group could be seen (after and before; 3.58+ 1.17 vs. 5.84 +1.01). Improvements in the 6MWD was observed in both groups with no significance differences noted (FG vs. PG; 379+129m vs. 374+80m).
CONCLUSION: The Feldenkrais method does not offer any advantage over the present PRP and in fact the latter offers better improvement in terms of the Borg score. However in view of the small study sample, further study would be needed before a final conclusion can be made.
Study site: Respiratory clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia