Shewanella spp is a facultatively anaerobic, motile, gramnegative bacillus and can be found throughout the world mainly in marine environments and soil. It is a rare pathogen in human and infection by it is usually associated with underlying severe morbidities. We report a case of a 69- years old woman who presented with Shewanella putrefaciens dysentery and who was subsequently found to have underlying malignancy.
CASE REPORT: Five cases of Kimura's disease had been treated in our centre from year 2003 to 2010. All cases were presented with head and neck mass with cervical lymphadenopathy. Surgical excision was performed for all cases. Definite diagnosis was made by histopathological examination of the resected specimens. One out of five cases developed tumour recurrence four years after resection.
CONCLUSION: Surgical excision is our choice of treatment because the outcome is immediate and definite tissue diagnosis is feasible after resection. Oral corticosteroid could be considered as an option in advanced disease. However, tumour recurrence is common after cessation of steroid therapy.
Spontaneous intracranial haemorrhage (ICH) is a rare complication of chronic immune thrombocytopenic purpura (ITP) in children. We report four patients with cITP who developed ICH. The latency between onset of ITP and ICH varied from 1-8 years. All our patients were profoundly thrombocytopenic (platelet count of <10 x 109/l) at the time of their intracranial bleed. The presenting features and management are discussed. All patients survived, three had complete neurological recovery while one had a minimal residual neurological deficit.
OBJECTIVE: To compare the clinical presentation, severity and progression of primary angle closure between Chinese and Malays residing in Malaysia.
METHODS: A comparative retrospective record review study was conducted involving one hundred (200 eyes) Malay and fifty eight (116 eyes) Chinese patients. They were selected from medical records of Hospital Universiti Sains Malaysia, Kelantan and Hospital Pulau Pinang, Penang, Malaysia. The selected patients were re-diagnosed based on the International Society of Geographical and Epidemiological classification. The clinical data on presentation including the presence of systemic diseases were documented. Progression of the disease was based on available reliable visual fields and optic disc changes of patients who have been on follow-up for at least five years.
RESULTS: Malay patients presented at older age (61.4 years SD 8.4) compared to Chinese (60.6 years SD 8.3). There was significant higher baseline Intraocular Pressure (IOP) among Malays (34.7 SD 18.5mmHg) compared to Chinese (30.3 SD 16.7mmHg) (p=0.032). The Chinese patients presented with significantly better visual acuity (p<0.001) and less advanced cup to disc changes (p=0.001) compared to Malays. Malay patients progressed faster than the Chinese. Majority progressed within 1 year of diagnosis. Malays without laser peripheral iridotomy (LPI) have a 4 fold (95% CI 1.4, 10.9) risk of progression. Higher baseline IOP, more advanced visual field defect and absence of LPI was identified as significant predictors associated with progression.
CONCLUSION: The Malays presented with more advanced angle closure glaucoma as compared to the Chinese in Malaysia. Aggressive disease progression was observed in Malays with the onset of optic neuropathy. Effective public awareness and aggressive management is important to prevent blindness in the Malaysian population.
We describe the clinical presentation, investigation and management of an eventually fatal case of hypercalcemic crisis due to primary hyperparathyridism (PHPT). A 60 year-old lady with history of urolithiasis presented with worsening generalized bone pain, spinal scoliosis and a limp. Laboratory data showed hypercalcemia and raised alkaline phosphatase. Left hip x-ray revealed a subcapital femoral neck fracture. Intact parathyroid hormone was elevated, 187.6 pmol/L (1.6 – 6.9) and ultrasound showed an enlarged right parathyroid gland. Despite initial reduction of serum calcium with saline infusion and multiple doses of intravenous pamidronate, her calcium increased to 4.14 mmol/L a week following application of Buck’s traction for persistent left hip pain. She succumbed eventually with serum calcium peaking at 6.28 mmol/L despite multiple therapeutic interventions.
KEY WORDS: Primary hyperparathyroidism, hypercalcemic crisis, pathological fracture, urolithiasis
This study is a review of the Acute Pain Service in Hospital Kuala Lumpur for the years 1998 to 2001. 5042 records from post-operative patients were analysed. The majority of patients (81.8%) had satisfactory pain control. Eighty-two percent of patients experienced only mild pain at rest on the first post-operative day. The highest pain score occurred on the first day in 68.3% of patients. Nausea or vomiting occurred in 23.2% of the patients. Eight patients had respiratory depression. The low pain scores recorded by most patients and the low incidence of side effects reflect the efficiency of the service provided.
Over a 2-week period, the management of upper respiratory tract infection by 24 medical officers and medical assistants in Seremban District was studied. Each practitioner recorded clinical data and prescription for twenty consecutive patients using a structured questionnaire. The extent to which the practitioners used "predictive features" (fever, absence of cough, cervical adenopathy, enlarged tonsils and exudates on tonsils) in clinical decision-making was analysed. The mean antibiotic prescription rate was 28.7% (95% CI: 24.6%, 33.0%). The antibiotic prescription rate of medical officers and medical assistants were similar. Five features were independently associated with antibiotic prescription (phlegm, fever, cervical adenopathy, red throat and tonsillar exudates). Antibiotics were prescribed for 22.1% of patients with 0-1 predictive features. High prescribers were 5 times more likely to prescribe antibiotics in this group of patients than low prescribers. To a large extent the clinical decision-making of practitioners in this study was evidence based. However, they were unduly influenced by purulent manifestation (phlegm) and redness of throat. The antibiotic prescription rate in these government health clinics is potentially reducible by means of educational intervention.
We report a neonate with anorectal atresia in whom preoperative evaluation prior to definitive operation revealed a short gap atresia. However, bidigital evaluation at operation revealed a septal atresia that was easily perforated from below through the anus. Unnecessary division of the anorectal sphincter complex was thus avoided.
A cross sectional descriptive study on breast feeding practices in an urban clinic was conducted among 136 mothers aged between 21-49 years who were interviewed using a questionnaire. Malays constituted 61% of the respondents, Chinese 22.8% and Indians 16.2%. Mojority of these were working mothers and although the initiation of breastfeeding was high (99.3%), exclusive breastfeeding was only 12.5%. A large proportion (33.8%) dtopped prior to 3 months. Majority of the Chinese mothers (61.3%) stipped before 3 months as compared to the Indian (40.9%) and Malay (21.7%) mothers (p<0.001). Mean age of introducing complementary foods at 3 months is below the accepted age of 4 to 6 months for weaning. Ever-breast feeding rate is high in this urban setting but more efforts are needed to effect a higher rate of exclusive breastfeeding and longer duration of breastfeeding.
(1) To describe the progesterone profiles following pituitary down regulation in stimulated IVF cycles with the use of GnRH-a (2) To assess the impact of progesterone supplement and pregnancy on the subsequent luteal phase.
The aim of the study was to validate the Malay version of the General Quentionnaire (GHQ-12) in patients with psychiatric morbidity secondary to urological disorder. Validity and reliability were studied in patients with lower urinary tract symptoms (LUTS) and patients without LUTS. Internal consistency was excellent. A high degree of internal consistency was observed for each of the 12 items and total scores (Cronbach's alpha value = 0.50 and higher and 0.65 respectively. Test-retest correlation coefficient for the 12 items scores was highly significant. Intraclass correlation coefficient was high (ICC=0.47 and above). A significant level between baseline and post-treatment scores were observed across 3 items in the surgical group. The Mal-GHQ-12 is a suitable, reliable, valid and sensitive to clinical change in the Malaysian population.
Eosinophilic inflammation in the airways is important in the pathogenesis of childhood asthma. Serum eosinophilic cationic protein (ECP), a marker of eosinophil activation was measured in 20 asthmatic children and 19 non-asthmatic controls. There was no difference in the socio-demography, passive smoke exposure, urinary cotinine levels and family history of asthma between the 2 groups. The median serum ECP in asthmatic children was 27.0 mcg/L (IQ1 8.8, IQ3 59.0); which was higher than in non-asthmatic controls [5.9 mcg/L (IQ1 3.0, IQ3 11.9), p=0.002]. An elevated serum ECP level can be helpful as supportive evidence in the diagnosis of bronchial asthma in Malaysia children.
We examined the prevalence of diabetes among inpatients in our hospital, the relationship of the diagnoses on admission to diabetes, and the frequency of testing for HbA1c as a marker of long-term glycaemic control, proteinuria, and hypercholesterolaemia. In addition, patients with raised laboratory plasma glucose without a know history of diabetes mellitus, were studied to see if these had been further evaluation. The overall prevalence of diabetes in our hospital was 25.% with the highest prevalence found (37.8%) on medical wards. 10.5% of admissions were due directly to diabetes and a further 58.9% of patients were admitted with illness which were significant related to diabetes. Overall testing rates for HbA31c, proteinuria, and hypercholesterolaemia were less than ideal (51.6, 73.4 and 45.% respectively). Less than 50% of patients without previously diagnosed diabetes but with high plasma glucose values had further evaluation for diabetes. In conclusion, this study has detected a high overall prevalence of diabetes among inpatients in an urban Malaysian hospital. Rates of testing for HbA51c, proteinuria, and hypercholesterolaemia, are disappointingly low, as is further evaluation of patients without known diabetes, but with elevated glucose values. More effective measures to improve the delivery of inpatient diabetes care are needed.
Schwannomas are rare tumours arising from peripheral nerve linings. A case of a schwannoma arising from cervical sympathetic chain is presented. The clinical presentation was that of a right solitary thyroid nodule. Intra-operatively, a 3 x 3 cm encapsulated lesion was seen arising posterior to the vagas nerve and attached to the cervical sympathetic trunk. The lesion was excised together with part of the nerve. Post-operatively, the patient developed Horner's syndrome that persisted. Unitil 2000, less that 50 cased of cervical sympathetic schwannoma have been described in the Englidh literature. A brief description of the pathology, presentation, diagnosis and treatment of this condition is presented.
Clomiphene is a widely prescribed drug for the treatment of infertility. Visual symptoms that occur as a side effect of this drug are uncommon. Some doctors may neglect to mention this side effect when prescribing clomiphene. Thus these visual disturbances can be very alarming to the patient and may also pose a hazard if the patient is doing activities such as driving or operating machinery. The patient should be told to stop taking clomiphene and ophthalmologic evaluation should be performed. Although visual disturbances generally cease on stopping clomiphene, some women may experience persistent visual disturbances.
Patients (particularly elderly) undergoing evaluation for peripheral neuropathy of unknown cause should be screened for the presence of a monoclonal protein (M protein). The association of a neuropathy and a paraproteinaemia such as Waldenstrom's Macroglobulinaemia (WM) is not uncommon with the former antedating the haematologic symptoms by several years. Response to treatment has varied from good to very poor. We describe a case of WM presenting as a subacute demyelinating peripheral neuropathy. There was prompt resolution of the neuropathy with intravenous immunoglobulin therapy. Subsequent treatment with cyclophosphamide and plasmapheresis resulted in complete clinical remission with no further neurological relapses.