Hyperdensity of basal ganglia in computed tomography (CT) of brain is always recognised as hemorrhagic stroke or calcification. Features of hyperglycemia include muscle weakness, hypotonia, pyramidal tract signs and hemichorea-hemiballismus (HC-HB), which mimic the symptoms of stroke. Hyperdensity of the basal ganglia was reported in patient with non-ketotic hyperglycemia (NKH). Inability to recognize the hyperdensity in CT brain as a feature of NKH may lead to failure of treatment. Early recognition and reversal of hyperglycemia will improve the outcome. This was a case of an atypical presentation of stroke-like symptoms with the neuroimaging finding showing asymmetric hyperdensity of basal ganglia. Neurological examination failed to elicit any sign of HC-HB. Laboratory test showed hyperglycemia with absence of acidosis and ketonaemia. The patient was diagnosed having basal ganglia hemorrhage and referred to the Neurosurgical team. However, the stroke-like symptoms completely resolved following the normalization of glucose level. This is the only other reported case of NKH with typical neuroimaging features not associated with HC-HB. One should be aware of the possibility of NKH in the absence of movement disorder with asymmetric basal ganglia hyperdensity in CT brain. Misinterpretation as acute intracranial bleeding may result in suboptimal management of the true underlying cause.
Diabetes requires dedicated self-management to be able to achieve good control and outcome as this is a lifelong condition. The internet offers an amazing wealth of health information which may influence diabetes self-management. The aim of this study was to determine the prevalence of online health information seeking among people with diabetes and its associated factors. About 380 participants answered the online health information seeking questionnaire developed from literature search and expert panel review. Diabetes Self-Management was assessed using the Diabetes Self-Management Questionnaire (DSMQ). The prevalence of online health information seeking among people with diabetes was 38.4%. Common information sought included diabetes treatment (82.9%) lifestyle modification (77.4%) and diabetes prevention (67.3%). A large majority (93.1%) felt that the online information on diabetes was useful. Doctors and printed reading materials were the most common sources of information for diabetes (94.2% & 65.3%). Lower median age (59 years, IQR = 11), having a family member with diabetes, (COR = 1.188) tertiary education (COR = 6.037) and those who are employed (COR = 3.880) have higher odds of seeking online diabetes related health information. However, there was no significant association between online health information seeking and diabetes self-management. Prevalence of online health information seeking among people with diabetes was at an acceptable level. However, it was not associated with optimal diabetic self-management. Doctors and printed information remain as popular sources of information and hence should be maintained.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Human Immunodeficiency Virus (HIV) epidemic remains a significant burden in Malaysia. Stigma related to HIV and its effect on the quality of life (QOL) of persons living with HIV (PLHIV) remains under-reported. The aim of the present study was to assess self-perceived stigma amongst PLHIV attending an urban community clinic and its influence on their QOL. Data was collected using HIV Stigma Scale and WHO-QOL HIV BREF Scale. The overall stigma experienced by PLHIV in this community was higher than previous studies (mean ± SD; 103.37 ±18.14). Majority participants had fear disclosing their disease status, while personalized stigma or the experience of prejudice and rejection was the least experienced. The overall QOL was low and was significantly impaired in social relationship domain (mean ± SD; 12.72 ± 3.59). However, their ability to perform daily activities was not affected by the illness (mean ± SD; 14.48 ± 2.91). PLHIV with higher spiritual values demonstrate lower perception of negative self-image and inferiority (r= -0.54). This finding was unique to PLHIV in this study and suggested the importance of spirituality and personal beliefs on their self-esteem. In conclusion, stigma remains as a significant problem among PLHIV in this community. Primary care offers the best platform to promote a holistic management of PLHIV, where the integration between counselors, religious experts, family and non-governmental associations could come together. The management of PLHIV is unique in every community, hence individualized approach based on cultural norms and beliefs could assist in the overall management of PLHIV.
Keywords: HIV, quality of life, social stigma
There are numerous studies over
the past few decades that reiterate
the positive points of Obesity and
Metabolic Surgery. It’s ability to
provide a relatively more sustainable
weight loss over a longer period of
time, improvement in quality of life
and weight-related comorbidities
namely Type 2 Diabetes Mellitus are
among a few to boast. However, as
with any invasive procedure, Obesity
and Metabolic Surgery is not free of
possible complication risks, the main
reason for which there has been a major
push for improvements in efficacy and
innovation for better and safer surgical
weight loss options. In the era of
“healthcare at your fingertips”, a simple
Google search will be able to enlighten
just anyone on the available options
making it possible for an individual
to “negotiate” or “bargain” with their
surgeon before making a final decision.
The four most well researched and
documented weight loss procedures
are Laparoscopic Sleeve Gastrectomy
(LSG), Laparoscopic Roux-En-Y gastric
Bypass (LRYGB), Biliopancreatic
Diversion (BPD) and Laparoscopic
Adjustable Gastric Banding (LAGB)
(Buchwald et al. 2004). Look a little
closer and you will not be able to turn
away from being a tad bit curious about
a few “new kids on the block” such
as Laparoscopic Mini Gastric Bypass,
Laparoscopic Sleeve Gastrectomy with
Proximal Jejunal Bypass, Laparoscopic
Banded Roux-En-Y Gastric Bypass and
some of the less invasive endoluminal
procedures including a recent FDA
approved percutaneous aspiration
device called Aspire Assist that has
garnered much interest as well as
criticism at the same time (Lee et
al. 2014; Kumar 2016; Forssell &
Norén 2015). Surgeons from all over
the world, their institutions, and the
supporting industry laud the excitement
surrounding innovation in Obesity and
Metabolic Surgery. A sentiment shared
by consumers who perceive “new” as
synonymous with improved.
Madu gelam telah didapati mempunyai kesan anti-oksidatif, anti-kanser dan antiinflamasi
terhadap banyak jenis kanser. Tujuan kajian ini adalah untuk menentukan
kesan madu gelam terhadap aras tekanan oksidatif sel kanser peparu manusia.
IC50 madu gelam ditentukan dengan merawat sel A549 dengan dos madu yang
berbeza (50-200 mg/ml). Sel dibahagikan kepada 4 kumpulan dan diaruh tekanan
oksidatif dengan menggunakan hidrogen peroksida (H2
O2
) mengikut kumpulan
tertentu: kawalan, H2
O2
, madu gelam, H2
O2
+ madu gelam. Selepas 24 jam
rawatan, biopetanda tekanan oksidatif seperti malondialdehid (MDA) dan protein
karbonil ditentukan. Aruhan tekanan oksidatif meningkatkan aras MDA (p
We report a case of a giant bullous emphysema misdiagnosed as a pneumothorax. A 18-year-old chronic smoker presented with right sided chest pain and dyspnoea. Initial respiratory rate was 35 /min, blood pressure was 136/90 mmHg, heart rate 80/min and SpO2 was 98% on room air. Clinical examination revealed reduced right air entry and left trachea deviation. Chest X-ray helped to arrive at a diagnosis of pneumothorax. Needle aspiration was then performed followed by a chest tube thoracostomy because of no improvement. Massive amount of blood was drained and patient deteriorated further. CT thorax revealed a right haemopneumothorax with multiple bullaes. Patient was rushed to OT for emergency thoracotomy for stapling of the ruptured bullae. Giant bullous emphysema can mimic pneumothorax and physician must be vigilant if draining a suspected pneumothorax.
Keywords: emphysema, haemopneumothorax, thoracostomy, thorax
Peningkatan ekspresi dan aktiviti enzim 11β-hidroksisteroid dehidrogenase jenis
1 (11β-HSD1) di dalam sel adiposit matang menyebabkan obesiti dan sindrom
metabolik. Fruktos dalam air minuman telah terbukti boleh menyebabkan sindrom
metabolik pada tikus Wistar jantan. Oleh itu, kajian ini dilakukan untuk melihat
kesan ke atas ekspresi dan aktiviti enzim 11β-HSD1 di dalam hati model tikus
sindrom metabolik yang dirangsang dengan air minuman fruktos. Sebanyak 12 ekor
tikus Wistar jantan dibahagikan secara rawak kepada dua kumpulan: kumpulan
kawalan, C (n=6) dan kumpulan yang diberi minuman fruktos 20%, F20 (n=6).
Pemberian makanan dan air minuman selama lapan minggu secara ad libitum. Di
akhir kajian, pengukuran ekspresi enzim 11β-HSD1 di dalam hati dilakukan dengan
menggunakan teknik pewarnaan imunohistokimia. Skor diberikan berdasarkan
intensiti pewarnaan granul di dalam sitoplasma hepatosit menggunakan teknik
‘double-blinded’. Manakala, aktiviti enzim 11β-HSD1 diukur menggunakan teknik
ELISA. Selepas lapan minggu pengambilan air minuman fruktos, kumpulan F20
menunjukkan peningkatan dalam ekspresi dan aktiviti enzim 11β-HSD1 di dalam
hati. Data yang diperolehi menunjukkan bahawa enzim 11β-HSD1 di dalam
hati mungkin memainkan peranan dalam pembentukan sindrom metabolik dan
komplikasinya pada tikus Wistar jantan.
Fluid replacement is the mainstay treatment for diabetic ketoacidosis (DKA). Currently, the best choice of fluids is still debatable. An amount of 0.9% sodium chloride is commonly used. Sterofundin® is an alternative crystalloid that is assumed to expedite resolution of acidosis. Advantages in sterofundin content being smaller significant ion difference (SID) to plasma and lower chloride content. The main objective of the study was to compare rate of acidosis resolution in DKA patients between treatment with 0.9% normal saline and Sterofundin over 12 hrs. Other objectives were to compare significant ion difference (SID), 12-hr blood ketone clearance and electrolyte balance between the two groups. The study was a prospective open labelled randomized control trial. This study was conducted over 6 months. Sample size of 18 was obtained with 9 for each arm. Main difference between two groups was initial median 2-hr pH level improvement (NS = +0.006 vs. Sterofundin = +0.05, P=0.063), however not being significant. Ketone, anion gap reduction, bicarbonate normalisation, sodium, chloride, urea and creatinine levels failed to show any significant differences between both groups. Twelve-hour median chloride levels increments were higher in the NS group (+11) compared to the sterofundin group (+6). There was no difference between mortality and morbidity. Comparing the two fluid groups, there was no significant biochemical differences during treatment of DKA. This was a pilot study that can initiate further clinical trials.
Keywords: anion gap, diabetic ketoacidosis, ketone, ph, saline, sterofundin
Acute myeloid leukaemia (AML) is the most common subtype of acute leukaemias with a poor outcome. Msi2 protein is a newly discovered prognostic marker and it has been considered as a new target for therapy in AML. The study of Msi2
protein expression in AML cases has not been performed in Malaysia, to date. The main aim of the present study was to observe the expression of Msi2 protein in AML patients by immunohistochemistry (IHC) and to correlate its expression
with the well-established prognostic and clinical parameters in AML as well as the overall survival (OS). Sixty four bone marrow trephine biopsy sections were immunostained for Msi2 protein. The percentage of blasts with positive reaction
and the intensity of the cytoplasmic and nuclear staining were evaluated. The expression of Msi2 protein was found in 95.3% cases with Msi2 pattern varying between the cases. In 71.9% of cases, the blasts showed total cellular positivity and 23.4% cases showed only cytoplasmic positivity. Majority showed high expression of Msi2 for cytoplasmic staining. Interestingly, there was significant correlation between total cellular staining and the intermediate cytogenetic subgroup (P=0.04). In conclusion, the results showed that the majority of the patients had high expression of Msi2 but this did not correlate to OS. However, the Msi2 expression correlated to the cytogenetic findings. The results suggest future extensive research to be conducted in order to ascertain the exact role of Msi2 positive blast cells in AML in our population and their association with prognosis and outcome.
Keywords: AML, cytogenetics, immunohistochemistry, Msi2 protein
Di Malaysia, timun laut lebih dikenali sebagai Gamat. Di kalangan kaum Melayu,
gamat sering digunakan sebagai ubat tradisional untuk melegakan kesakitan,
merawat luka dan kesan terbakar. Ianya juga digunakan sebagai tonik untuk
memberi sumber tenaga tambahan. Stichopus chloronotus merupakan salah satu
spesies timun laut yang boleh didapati di Malaysia. Kajian ini bertujuan untuk
menentukan dos optimum ekstrak akues Stichopus chloronotus emulsi salap ke
atas luka pada model tikus. Beberapa siri kepekatan iaitu 0.1%, 0.5% dan 1%
ekstrak akues Stichopus chloronotus emulsi salap diberikan ke atas luka eksisi sekali
sehari selama 10 hari. Perubahan pada kawasan luka diukur dengan menggunakan
angkup dan gambar luka diambil pada hari pertama, ke-3, ke-6, ke-8 dan ke-10
selepas pembentukan luka. Keputusan daripada peratusan pengurangan luka dan
pemerhatian makroskopik akan menentukan dos optimum Stichopus chloronotus.
Hasil kajian menunjukkan, kumpulan tikus kajian yang menerima rawatan
Stichopus chloronotus 0.5% mempunyai peratusan pengurangan luka yang lebih
tinggi dan pemerhatian makroskopik yang lebih baik bermula dari hari ke-6 selepas
pembentukan luka berbanding kumpulan yang lain. Kesimpulannya, dos 0.5%
merupakan kepekatan optimum bagi Stichopus chloronotus memberikan kesan
kepada penyembuhan luka dan akan digunakan pada kajian sebenar
Euphorbia tirucalli dilaporkan mempunyai aktiviti antibakteria terhadap pelbagai
mikroorganisma. Kajian in vitro ini bertujuan untuk menilai ciri-ciri antibakteria
ekstrak (metanol, etanol dan ekstrak akueus) batang Euphorbia tirucalli terhadap
bakteria yang berkaitan dengan karies gigi, iaitu Streptococcus mutans (S. mutans)
dan Streptococcus sobrinus (S. sobrinus). Sifat-sifat antibakteria telah ditentukan
menggunakan ujian resapan agar berlubang pada kepekatan ekstrak yang berbeza
(10, 20 dan 30 mg/ml). Komersial amoxicillin (10 µg) telah digunakan sebagai
kawalan positif manakala pelarut yang sesuai telah digunakan sebagai kawalan
negatif. Ekstrak metanol dan ethanol daripada batang Euphorbia tirucalli didapati
berkesan terhadap S. mutans dan S. sobrinus. Walau bagaimanapun, ekstrak akueus
batang Euphorbia tirucalli tidak menunjukkan aktiviti terhadap kedua-dua strain
bakteria. Perbezaan dalam ciri-ciri antibakteria dalam perbezaan ekstrak Euphorbia
tirucalli mungkin disebabkan oleh perbezaan dalam juzuk fitokimia.
Kecelaruan spektrum Autisme (ASD) merupakan sejenis ketidakseimbangan
perkembangan neuro kanak-kanak yang dikaitkan dengan kecacatan kognitif
dan bahasa. Penyelidikan sebelum ini mendapati bahawa kanak-kanak yang
mempunyai ketidakseimbangan perkembangan meningkatkan tahap tekanan
ibu bapa. Namun, ibu bapa yang mempunyai anak ASD mengalami tahap
tekanan yang lebih tinggi berbanding ibu bapa yang mempunyai kanak-kanak
ketidakseimbangan perkembangan yang lain. Justeru, kajian ini bertujuan untuk
mengkaji perbezaan tahap tekanan antara ibu bapa yang mempunyai kanak-kanak
ASD dan ibu bapa yang mempunyai kanak-kanak perkembangan tipikal (TD) yang
dikategorikan dalam kumpulan kontrol. Borang indeks tekanan ibu bapa, terbitan
ketiga digunakan untuk menilai tahap tekanan dalam kalangan 30 ibu bapa yang
mempunyai kanak-kanak ASD dan 36 ibu bapa yang mempunyai kanak-kanak
TD. Sampel ibu bapa yang mempunyai kanak-kanak autisme dikumpul dari Pusat
Perubatan Universiti Kebangsaan Malaysia (PPUKM), Hospital Tangkak, dan Pusat
Autisme (NASOM) di Muar dan Segamat. Ibu bapa yang mempunyai kanak-kanak
ASD mempunyai tahap tekanan yang signifikan lebih tinggi berbanding ibu bapa
mempunyai kanak-kanak TD (p
Iron deficiency anemia is the most common form of anemia in pregnancy. The present study was carried out to determine the prevalence of antenatal anemia and iron deficiency in the Malaysian population and its correlation with sociodemographic and obstetric profile. It was a cross-sectional study conducted at an urban health clinic over a period of six months. A single blood sample was drawn from apparently healthy pregnant mothers at antenatal booking and sent for laboratory assessment of full blood count and serum ferritin as screening tools for anemia and iron status. SPSS version 19.0 was used for statistical analyses. The results showed that out of 250 subjects, 43.6% had anemia and 31.6% had iron deficiency. Whilst 47.7% of subjects with anemia were iron deficient, 19.1% of subjects without anemia were also iron deficient. Serum ferritin correlated negatively with period of gestation at booking (p<0.001), with 77.6% of these women not having prior iron supplements. Serum ferritin was also significantly lower among grandmultiparae (p=0.01). Iron deficiency was significantly (p=0.024) more common among Indians (42.5%) compared to Malays (33.5%) and Chinese (13.0%). In conclusion, continuation of the current practice of routine antenatal iron supplementation is still warranted and justifiable in Malaysia as there is high prevalence of iron deficiency in pregnancy not only in the presence of anemia but also in the presence of normal hemoglobin values. Keywords: anaemia, ferritn, pregnancy
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
Sickle cell disease (SCD) in pregnancy is uncommon in Malaysia. We present a case of sickle cell disease in pregnancy with maternal and fetal complications. The patient presented with acute pain crisis and hemolysis in the third trimester. Despite thromboprophylaxis, she developed deep vein thrombosis. The pregnancy was further complicated by severe pre-eclampsia and intrauterine growth restriction which require preterm caesarean section. The baby was admitted to Neonatal Intensive Care Unit due to prematurity and low birth weight. Multidisciplinary
approach in managing pregnant patient with SCD is essential in achieving good obstetrics outcome.
Keywords: anemia, sickle cell disease, pregnancy outcomes
The incidence of envenoming from king cobra, Ophiophagus hannah in human is relatively rare. Its venom acts on the postsynaptic region of the neuromuscular junction causing descending flaccid paralysis. Locked-in syndrome is a clinical state of inability to provide motor response in a conscious patient. Many reported cases of locked-in syndrome following neurotoxic snake-bite mimics brain death. We report a case of a middle aged man who presented with progressive neurological deficit following a king cobra bite over his right arm. He had local and systemic neurotoxic envenoming. His condition deteriorated, and was intubated and ventilated in the emergency department. He received a total of 33 vials of the Ophiophagus hannah monospecific antivenom and subsequently recovered well with no neurological deficit. Retrospectively, he was able to recall the events and while he was lying paralysed and intubated under minimal sedation in the intensive care unit. He described it as a terrifying and painful experience. This case highlights the rare presentation of locked-in syndrome following a systemic envenoming from a king cobra bite. It is important to differentiate neurotoxic snake envenoming lock-in syndrome from brain dead. Patients are unable to respond to physical pain and require adequate analgesia. A patient suffering this highly distressing experience may require psychological support.
Keywords: emergency, envenoming, neurotoxicity, snakebite
The Morel-Lavallee lesion is a rare soft tissue injury that occurs due to traumatic shearing force on skin surface causing separation of skin and subcutaneous tissue resulting in hematoma. This case report depicts a 22-year-old gentleman who was involved in a motor vehicle accident. He complained of pain and swelling over lower back. He was treated for soft tissue injury and admitted for pain control. One day post-trauma, he complained of increased swelling over the back. His hemoglobin dropped from 12.2g/dL to 10.7g/dL. Diagnosis of Morel-Lavallae lesion was made. Initially no surgical intervention was planned. However, in view of worsening of swelling, bedside aspiration was performed and subsequently a pigtail catheter was inserted to drain the hematoma. In total, 2.05 litre of liquefied hematoma was drained. Thus, Morel-Lavallee lesion is an uncommon soft tissue injury that can cause significant bleeding following trauma.
Keywords: degloving injuries, hematoma, trauma
Bisep brachii (BB) adalah salah satu otot yang mempunyai pelbagai variasi.
Terkini, kebanyakan maklumat adalah berkenaan variasi asal otot, namun terdapat
beberapa kes yang melaporkan variasi dalam sisipan BB. Dibentangkan di sini
kes BB otot yang mempunyai kedua-dua varian asal dan sisipan dalam otot yang
sama. Varian asal BB adalah panjang dan besar di kepala ketiga (10.2 cm lebar
dan 4.9 cm tebal) yang timbul dari pertengahan badan humerus. Lebih signifikan
lagi, bahagian tengah kepala meliputi dan menyembunyikan bahagian bawah
saraf median dan arteri brachial sebagai gerbang yang berterusan medially untuk
disisipkan ke epicondyle medial humerus. Dalam laporan ini, kami membincangkan
mekanisma yang mungkin untuk pemampatan neurovaskular oleh kepala ketiga
otot BB yang tidak normal dan perubahan BB dari asal dan sisipan. Memahami
perubahan ini adalah sangat penting dalam prosedur pembedahan di sekeliling
sendi siku dan lengan atas dan ia juga memberi ruang untuk diagnosis pembezaan
sindrom perangkap saraf
Kateter Vena Cenral boleh tercabut dengan senang daripada tubuh badan.
Artikel ini membincang tiga teknik terperinci yang berinovasi untuk mengelakkan
berlakunya insiden kateter tercabut. Penempatan leher kateter kira-kira 1cm dari
tempat kateter keluar pada bahagian kulit dengan jahitan tambahan di bahagian
leher kateter membantu mencegah insiden kateter tercabut.
Miscarriage is one of the most common complications in pregnancy. There is emerging evidence that psychological impact following miscarriage is not unusual. Understanding the magnitude of psychological morbidity is important in the management of miscarriage. The main objective of this study was to compare the mean Hospital Anxiety and Depression Scale (HADS) score between women with miscarriage and women with successful pregnancy and to determine the sociodemographic factor and clinical characteristic that are associated with anxiety and depression. A descriptive case control study was conducted in a teaching hospital, over a period of 12-months (from October 2014 till September 2015). A total of 65 women were recruited with 32 women as the study group (miscarriage) and another 33 women as the control group (women with successful pregnancy). Mean HADS-anxiety score was higher in the study group compared to control group although it was not statistically significant (6.53 ± 3.427 vs 5.73 ± 2.875, p=0.309). Mean HADS-depression score was higher in the control group (4.34 ± 2.695 vs 4.45 ± 3.073, p=0.878). Women with maternal age more than 35 years and history of previous miscarriage had a higher tendency of anxiety and depression with higher mean HADS score. There was no association between other sociodemographic data and clinical characteristic with risk of anxiety and depression. As conclusion, there was no significant difference in women with miscarriage as compared to those with successful pregnancies, although older women with history of miscarriage had a preponderance to both disorders.
Keywords: anxiety, depression, miscarriage, morbidity, psychological