Open reduction and internal fixation using
conventional lateral distal femur locking plate is a
standard operative method for distal femur fracture.
This case series describes medial plating of distal
femur fracture using proximal tibia locking plate that
is anatomically fit to the medial aspect of distal femur,
by the minimally invasive plate osteosynthesis (MIPO)
technique which gives a stable construct with good
outcome.
Dengue is the most rapidly increasing arthropodborne
disease globally. The disease burden has increased
exponentially, doubling almost every decade from the
estimated 8.3 million cases in 2010 to about 58.4 million
cases in 2013.1
The number of countries reporting
dengue has also increased. Before 1970, less than 9
countries reported dengue but now it has been reported
in more than 100 countries worldwide. It is transmitted
by two species of Aedes mosquito, Aedes aegypti and Ae.
albopictus. (Copied from article).
Rheumatoid arthritis (RA) is a chronic inflammatory condition that can be associated with abnormal bone turnover and hence osteoporosis. Osteocalcin (OC) levels are increased in conditions with high bone turnover, including high RA disease activity. Thus, OC levels could possibly be used as a marker to assess bone health and disease activity in RA patients. As there have been no previous studies looking at serum OC levels in Malaysian RA patients, this study was performed to examine possible correlations between OC, bone mineral density (BMD) and disease activity in this population. A cross-sectional study of 75 female RA patients and 29 healthy controls was performed. Serum OC was measured using a Quantikine® ELISA kit. Dualenergy x-ray absorptiometry (DXA) was used to assess BMD. Serum OC levels were not significantly different between RA patients (median 14.44 ng/mL, interquartile range [IQR 12.99]) compared to healthy controls (median 11.04 ng/mL IQR 12.29) (p=0.198). Serum OC increased with age (Spearman’s rho r=0.230, p=0.047). There was no significant correlation between serum OC and body mass index (BMI), menopause status, BMD, DAS28, swollen or tender joint counts. Overall, there were 11 (14.7%) patients with osteoporosis and 27 (36.0%) with osteopenia. Menopause status was significantly associated with BMD at all sites (lumbar spine p=0.002, femoral neck p=0.004, total hip p=0.002). Serum OC were similar in RA patients compared to healthy controls. In RA patients, serum OC did not correlate with RA disease activity or BMD. Menopause status remains an important influence on BMD. Thus, measuring serum OC levels in Malaysian RA patients was not useful in identifying those at risk of low BMD.
Study site: Rheumatology clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, and Klinik Pakar Puchong, Kuala Lumpur, Malaysia
Introduction: It is still a challenge that the
dissecting room has a place in learning gross anatomy.
Understanding the students’ preference of learning
tools is important to devise alternative teaching aids
for improvement in learning anatomy. This study was
conducted to assess student’s preference of learning tools
available in the anatomy laboratory of an integrated
curriculum.
Methods: A cross-sectional comparative study was
carried out for 4 weeks among 741 medical and dental
students of International Islamic University Malaysia
(IIUM), Universiti Teknologi MARA (UiTM),
University Sabah Malaysia (UMS) and University
Malaysia Sarawak (UNIMAS). Pre-tested, semistructured,
self-administrated questionnaires including
open-ended questions were distributed. The data were
analyzed by using SPSS 17.
Results: Most of the participants were Malays (86%) and
female (67%). The students from IIUM, UiTM, UMS
and UNIMAS preferred the plastic model in terms of
handability and application in examination (OSPE). It was
statistically significant (p
Tumoral calcinosis is an uncommon condition which has been described to exist in primary and secondary forms. A lack of awareness of this entity can lead to unnecessary procedures and incorrect management. We report a case of a patient on peritoneal dialysis who presented with multiple painful joint swellings to the orthopaedic department. An initial diagnosis of septic arthritis was made, then revised to chronic tophaceous gout and referred to the rheumatology unit.
Cervical spine injury is commonly associated with
road-traffic accidents. The true incidence of cervical
spine injuries is unknown due to under-reporting of
such injuries. Cervical spine injury is associated with
high morbidity and mortality if it is missed. With the
advancement of imaging modalities, the number of
missed cervical injuries has reduced. Nevertheless, some
clinicians are dependent solely on imaging tools to rule
out cervical spine injury in a trauma victim. We report
two cases of “near miss” C6 fracture to highlight the
importance of a detailed clinical history and clinical
examination with imaging as an adjunct to rule out
cervical injury.
Amoebiasis is a parasitic infection caused by the
intestinal protozoan Entamoeba histolytica, most
prevalent in developing countries. It results in 40,000 to
100,000 deaths each year from amoebic colitis and extra
intestinal infections. Amoebic liver abscess (ALA)
is the most common extra intestinal site of infection
with an incidence of between 3% and 9% of all cases of
amoebiasis. Ultrasound which has a sensitivity of more
than 90% for detecting ALA is highly recommended
as an initial investigation followed by serological
demonstration of circulating antibodies specific to
Entamoeba histolytica.
Introduction: The prevalence of cataract surgeries
ranges from 7 to 12 million cases in 2000, 20 million
in 2010 and an estimation of 32 million cataract
surgeries annually by the year 2020 worldwide (WHO,
2015). Traditionally, the healthcare providers were
only able to give health education before the patient
is discharged from the healthcare setting while followup
can only be done when the patient comes for their
follow-up. But most of the patients will remain confused
or had forgotten about the post-operative care even
after receiving a comprehensive discharge preparation.
However, with the advancement of technologies in
this modern era, nurse-led telephone follow-up can be
considered as a tool to assist healthcare providers in the
follow-up care in Malaysia. On the same note, a private
eye specialist organisation with centres throughout
Malaysia, had taken the initiative to provide telephone
follow-up service for their patients with three main
objectives namely, to provide pre- and post-education
on cataract surgery, to detect early post cataract surgery
complications as well as to minimise anxiety among
their patients. However, till date no patient feedback
regarding the service was conducted.
Objective: The research objective for this study was to
determine patient’s level of satisfaction with the nurseled
telephone follow-up after cataract surgery at a private
eye specialist centre in Penang.
Method: A cross sectional quantitative descriptive study
design was used to study ninety post cataract patients in
a private hospital, Penang through universal sampling
method. A validated self-developed questionnaire based
on the three main objectives of the telephone follow-up
service was used for this study.
Results: Overall, the level of patient’s satisfaction with
nurse-led telephone follow-up after cataract surgery at
a private eye specialist centre in Penang was high (49.9
±4.85) especially for the health education provided
(4.18 ±0.21) followed by the effort to detect early
complications (4.16 ±0.12) and to minimise patients’
anxiety level (4.16 ±0.12).
Limb length discrepancy (LLD) is quite common.
Lower limb shortening is one of the causes of limb
length discrepancy. The common treatment that is
used is the llizarov technique for bone lengthening.
The new technique uses an intramedullary nail with
a monoplanar external fixator. Using this technique,
bone lengthening duration in patients can be reduced
and knee joint mobility can be improved without
jeopardizing bone regeneration. We report a case of a
27-year-old gentleman who had right femur shortening
from childhood and was referred to us for corrective
deformity. He underwent bone lengthening on the nail
which lenghthens and equalizes the leg while avoiding
stiffness and reduces joint mobility which leads to good
patient satisfaction outcome. The use of the external
fixator with intramedullary nailing to lengthen the
femur is one method that can reduce patient burden
mentally and physically. However although it has many
advantages we must watch out for the complications
during the regular visits to ensure good outcome.
The human foot serves as an important part to support
the body weight and accounts for the majority of our
movements. A mangled limb involves injury to at least
three out of four systems, namely the soft tissues, nerves,
blood supply and bone. While amputation is indicated in
some cases of mangled limb, with proper planning, limb
salvaging surgical management is also a viable option.
Special consideration to the skeletal stabilization, control
of infection, vascular status and soft tissue coverage is
paramount to the success of limb salvaging surgery. We
present a case of mangled limb which was successfully
treated with limb salvaging surgical management. Initial
debridement, Kirschner wires insertion and cross ankle
external fixation were used for skeletal stabilization. An
antibiotic spacer was inserted for local antibiotic and to
maintain the length left due to the loss of medial and
intermediate cuneiform bones. The anterior tibialis
artery and its venae comitantes were utilized for free
vascularized fibular graft to provide bony reconstruction
as well as soft tissue coverage for the mangled foot.
Bone transport using the Ilizarov technique has been
one of the most popular techniques in treating fracture
with significant bone defect. However, pain and joint
stiffness following Ilizarov fixation are few of the wellknown
complications. We report a case of a 23-year-old
gentleman with a closed left humeral diaphyseal fracture
following a traffic accident who underwent plating of the
left humerus which was later complicated with infected
nonunion. He was then treated with corticotomy and
bone lengthening using the semicircular Ilizarov ring
fixator. Good clinical and functional outcomes were
observed during transportation period (elbow flexion
10̊ to 90̊) with minimal complications.
Introduction: Nurses are obligated to respond
competently in the event of cardiac arrest. Nurses could
be hesitant to intervene due to low self-efficacy in their
ability to manage cardiac arrest patients.
Objective: The objective of this study was to
determine the level of nurses' perceived self-efficacy
in cardiopulmonary resuscitation (CPR) at a private
hospital in Kuala Lumpur.
Method: A cross-sectional descriptive study was
conducted with 112 respondents who fulfilled the
inclusion criteria. A 19 item questionnaire on
Resuscitation Self-Efficacy Scale (RSES) was adapted
and scored using a 5-point Likert scale.
Results: The total mean score and standard deviation
of perceived self-efficacy score in resuscitation was (M
= 77.68; SD ± 11.77) which indicated a high degree
of self-efficacy among nurses. There were significant
differences between respondents’ age groups with (t
= -2.520; p = 0.013), unit of working (t = -4.086; p =
0.001), real experiences in resuscitation (t = 2.532; p =
0.013), and the number of participations in resuscitation
(t=-6.668; p=0.001) and nurses perceived self-efficacy
in CPR. There were also significant differences between
respondents' years of working experience with (F
= 7.286; p =0.001) and types of last resuscitation
training (F= 7.088; p = 0.001). However, there was no
significant difference between the nurses' time of their
last resuscitation training (F = 1.225; p = 0.298) and the
nurses perceived self-efficacy in CPR.
Conclusion: In conclusion, nurses were deemed to possess
a high sense of self-efficacy in CPR. This study concluded
that nurses' age groups, years of working experience,
unit of working, real experiences in resuscitation and
the number of participations in resuscitation and types
of last resuscitation training are factors contributing
towards self-efficacy in CPR performances. However, the
time of last resuscitation training reported no significant
difference towards nurses' perceived self-efficacy in
CPR. Therefore, repetitive CPR and ACLS certification
training are pivotal in order to strengthen nurse’s self-efficacy in resuscitation and team collaboration through
training in this private hospital.
Primary sinonasal Non-Hodgkin’s Lymphoma’s
(NHLs) are quite rare and emulate the presentation
of benign inflammatory diseases. It is challenging to
distinguish them morphologically and radiologically
from other malignant neoplasms.
We report a 37-year-old male patient who presented
with obstruction of the nasal passages, rhinorrhoea,
epistaxis, post nasal drip, facial swelling, orbital
symptoms and pyrexia. The mass was a nasal diffuse large
B-cell lymphoma confirmed by immunohistochemistry.
After the first cycle of chemotherapy was started, the
patient improved with resolution of the facial swelling,
pain and visual defects.
A high index of suspicion is required to differentiate
sinonasal lymphomas from other lesions.