We report a rare case of left axillary artery injury associated with anterior dislocation of the left shoulder in a 25 yrs old male as a result of a road traffic accident. The shoulder dislocation was reduced. A left upper limb angiogram showed an obstructed left axillary artery. The obstructed segment was surgically reconstructed with a Dacron graft. Six months post operation in follow up, he was found to have good left shoulder function and no neurovascular deficit. This is an injury that could have been easily missed without a simple clinical examination.
Skin closure using simple interrupted nylon sutures was compared with closure using subcuticular nylon sutures in 80 consecutive patients undergoing semiemergency surgery, involving open reduction and internal fixation of either the forearm bones or femur. The simple interrupted technique was shown to be slower than the subcuticular technique with higher early postoperative wound complication rate. It may use an extra packet of sutures particularly if the average wound length is 19.8 cm. There is, however, no statistical difference demonstrated for the late scar complaints or subjective and objective scoring of cosmetic outcomes six months after the surgery. KEYWORDS: Simple interrupted, subcuticular, skin closure, nylon, cosmetic outcome
To compile and analyse existing scientific evidence regarding the association of dietary patterns with adiponectin and
leptin. Medline and PubMed electronic databases were searched for articles related to the association of dietary patterns
with adiponectin and leptin from 2005 to 2015. Only full text articles using English as a language of publication were
included. Studies were limited to the use of food frequency questionnaires in assessing dietary intake, factor analysis
using principal component analysis, cluster analysis or reduced rank regression method in determining dietary pattern.
A total of six relevant studies involving a total of 6467 subjects (47% men and 53% women) met the inclusion criteria
from 1407 reviewed articles Twelve dietary patterns were extracted i.e. healthy pattern, meat and fat, sweet pattern,
potatoes and refined grains, Japanese pattern, westernized pattern, mixed pattern, traditional pattern, vegetables, fruits
and lean meat pattern, high alcohol, ‘Izakaya’ pattern and dieting. Two studies showed association with leptin which
serum leptin concentration showed significantly higher in vegetables, fruits and lean meat compared to western pattern
and lower circulating levels of leptin in westernized breakfast dietary pattern. Adiponectin concentration resulting
significant positive relationship with fruits and vegetables, dieting, Japanese and healthy dietary pattern. Adherence
to healthy dietary patterns plays an important role on serum adiponectin and leptin concentration. However, in most
studies that resulted in a significant relationship, adiponectin, leptin and diet components were evaluated separately.
Therefore, further well-designed studies were required to clarify the mechanism mediating relationship between dietary
patterns and adipokines.
A 2 year-old Malay girl was admitted to our institution with a chesty cough and breathlessness but later found to have a chronic C1/C2 subluxation for one and half year with tetraplegia. Her cervical cord was decompressed and occipito-cervical fusion performed. Her neurological status improved significantly post-operatively and is able to care for her personal hygiene. The authors believe that the ability of the cervical cord to recover in the paediatric age group is remarkable that surgical option should be considered even when all seen lost. We believe that this is the first report in the literature to support this potential.
Objective measurement of physical activity (PA) and sedentary behavior (SB) associated with metabolic syndrome (MetS) has gained more attention among researchers in recent years. Although almost similar trends of results have been reported worldwide, they were not always statistically significant. This systematic review summarizes the evidence of observational studies reporting the associations between objectively measured PA, SB, and MetS in adults. Registration in PROSPERO was made (CRD42017078929). Literature search was conducted in the PubMed database for observational studies associating objectively measured PA and SB with MetS among adults. Secondary manual search was also conducted to find more related studies. A total of 44 studies were included in this systematic review. The quality score of studies obtained using National Institutes of Health Quality Assessment Tool ranged between 4 and 11. For total PA, most studies showed negative association with MetS. Similar association with MetS was reported in most studies assessing moderate-to-vigorous PA (MVPA) (total, bouts, sporadic), vigorous-intensity PA (VPA) (total, bouts), moderate-intensity PA (MPA) (total, bouts), and light-intensity PA (LIPA) bouts. However, more studies assessing LIPA total and LIPA sporadic found no significant association with MetS, with only a few studies reporting negative association. Meanwhile, all studies assessing step counts reported negative association with MetS. In contrast, MetS was positively associated in all studies investigating physical inactivity. MetS was also positively associated in most studies reporting sedentary (SED) time and bouts, while SED breaks showed no significant association with MetS. Further studies are required to ascertain the interaction and independent contribution of objectively measured PA and SB to the overall risk of MetS.
To highlight the first reported case of necrobiotic xanthogranuloma of the parotid gland. We also review the clinical presentations and treatments for this rare condition.
We report a case of a non-pulsatile groin swelling in a 38 years old male drug addict without the typical clinical signs of an aneurysm. Ultrasound revealed a left femoral artery pseudo-aneurysm. He was surgically treated and the vessels were ligated without revascularisation.
The significance of metastastic disease in the cervical lymph nodes has long been appreciated. The rich lymphatics of the upper aerodigestive tract explained the high incidence of cervical metastasis, occasional bilaterally spread. Even with appropriate treatment, cervical recurrences do occur. Nonetheless, with the resurgence of tuberculosis, the differential of tuberculous cervical lymphadenitis should be excluded. Appropriate modalities should be employed in making the appropriate diagnosis possible.
Despite being effective in promoting healthy dietary behaviour, smartphone apps are scarcely available for our local communities and the majority of nutritional-related information is based on western food selections. Our new innovation aims to provide specific educational advice about recommended food intake, types, nutritional qualities and weight issues for cancer patients and survivors who suffer appetite problems and nutritional deficits. The Cancer Dietary (CanDiTM) app was developed as a convenient, flexible and attractively engaging smartphone app containing healthy tips which are uniquely tailored to the local food choices, preferences and ingredients. This helps customise users’ dietary needs besides permitting constant information up-dating. Features are broadly categorised into Healthy Eating Guide (advice from healthy eating to eating problems, weight loss prevention and increasing proteins and calories intake) and Malaysian Recipes For Cancer Patients (focusing on common Malaysian dishes, ingredients, treatment-based recipes and special diets). An additional Symptom Diary allows user’s personal profile to be recorded and stored virtually online. Its feasibility and acceptability were further tested among 30 cancer patients, family caregivers and dieticians recruited from a public hospital in Terengganu, Malaysia. Very good feasibility (> 80%) and excellent acceptability (> 90%) were reported regarding its ease of operation, suitability of language used, attractiveness, knowledge enhancement and perceived usefulness. With this scientific yet creative innovation, routine dietary habits related to cancer conditions could be easily facilitated for both patients/survivors as well as family caregivers for their independent and healthy living.
International students usually experience a change in body weight and eating behaviour after
migrating to a host country. The aim of this study is to determine the factors associated with body
weight changes among Nigerian postgraduate students at Unversiti Sultan Zainal Abidin (UniSZA),
Malaysia. A prospective study was conducted for six months to determine the association between
body weight changes and socio-demographic, eating behavior, physical activity, dietary intake and
quality of life. A total of 82 students (76 male and six females) completed a set of self-administered
questionnaires, and their weight and height were measured. Descriptive statistic and paired t-test were
carried out to analyze the data (IBM SPSS Version 20.0). Multiple linear regression analysis was
conducted to determine the factors. Body weight significantly increased by 2.3 ± 0.5 kg after 6 months.
Being an art student (β=1.67, p=0.006), being a female (β=-2.68, p=0.009), consuming breakfast once
a week (β=5.10, P=
Treatment effectiveness depends on the knowledge, attitude, and practice (KAP) of osteoarthritis (OA) patients to- wards their assigned treatment. This study aimed to explore the KAP towards non-surgical intervention among OA patients. A methodological framework proposed by Arksey and O’Malley (2005) was implemented. An electronic database search of English-language academic articles was conducted using PubMed and ScienceDirect databases encompassing 1998 to 2018 period of time, resulting in a total of 26 studies. OA patients were knowledgeable about the disease and exercise management. However, they were lack of knowledge on drug therapy and complementary strategies. The attitude towards non-surgical interventions was ambivalence. Lastly, the practice section mainly fo- cused on patients’ compliance and behaviour towards different conservative managements, namely physiotherapy, medications, and complementary and alternative medicines (CAMs) which influenced by both knowledge level and attitudes. In conclusion, a higher knowledge level and positive attitude will result in good practice.
This study intended to investigate the level on airborne microbe in indoor air for new constructed building. It was divided by three different phase of building commissioning in Bandar Baru Bangi, Selangor. The first phase of the sampling was carried out after the building fully handed over from the main contractor to the building owner. Second phase of the sampling take place after the building is equipped with furniture. Phase three sampling is conducted after one month of building occupancy. Airborne microbes’ concentrations were determined by using a single stage impactor (Biosampler) as per requirement of National Institute of Occupational Safety and Health (NIOSH) method, NIOSH Manual Analytical Method MAM 0800. The total concentration of airborne bacteria and fungi were average to 641 and 38 CFU/m³ in the first phase, 133 and 117 CFU/m³ in the second phase, and 389 and 52 CFU/m³ in the third phase. These findings indicate that although a new constructed building should be having a significant background level of airborne microbe (total bacteria and total fungi). The building owner should be aware to their indoor air status to protect the occupant from the safety and health problem (risk) especially for ventilated building.
A preliminary study has been conducted in a new constructed 8 stories building (2 level of Hostels facility, 3 level of Training Room, 2 Level of Offices and 1 level of Exhibition Halls and Rooms) in Bandar Baru Bangi, Selangor. The Hostels facility is a floor tile and furnished with build in locker and use split air conditioning system while the Training Room and Exhibition Rooms used floor tile. The Offices and Exhibition Hall are carpeted furnished. All these spaces were using centralized air conditioning systems. A pre-commissioning assessment on 5 chemical parameters of indoor air pollutants such Total Volatile Organic Compounds (TVOC), Formaldehyde, Respirable Particulates (PM!
This study was done to investigate the background level on microbiological indoor air pollutants in new constructed 8 stories buildings (2 level of Hostel facilities, 3 level of Training Room level, 2 level of Offices and 1 Exhibition Halls and Rooms) in Bandar Baru Bangi, Selangor. The offices and exhibition hall are carpeted furnished. All these spaces were using centralized air conditioning system. Airborne microbes’ concentrations were determined by using a single stage impactor (Biosampler) as per requirement of National Institute of Occupational Safety and Health NIOSH method NIOSH Manual Analytical Method MAM 0800. Mean concentration of total bacteria detected is 1351 CFU/m3 and it was found significantly higher compared to maximum exposure limit 500 CFU/m3 in office room. The mean concentration of total fungi in the office rooms is 479 CFU/m3 and it was found slightly lower compared to maximum exposure limit 500 CFU/m3. The airborne microbe levels were found slightly lower in the accommodation, training and exhibition rooms compared to office room. These findings indicate that although a new constructed building should be having a significant background level of airborne microbe (total bacteria and total fungi).
Increasing physical activity level during and after treatment is recommended by the American Cancer Society because of the many benefits namely reducing fatigue and improves psychological distress which leads to an improvement in the quality of life. This study is aimed to compare physical activity level and body composition between oncology patients who are still undergoing treatment and those on medical follow-up. Patients were recruited based on convenience sampling from the Oncology Outpatient Clinics of Universiti Kebangsaan Malaysia Medical Center (UKMMC). Anthropometric measurements and body compositions were measured using calibrated tools while physical activity level were assessed using Global Physical Activity Questionnaire (GPAQ). Medical treatment history was obtained from patients medical records. A total of 53 patients (n=38 were undergoing treatment and n=15 was on follow-up) consisting of Malays (54.7%) and Chinese (45.3%) and with mean age of 55.3 ± 9.3 years. Most patients were previously diagnosed with ovarian cancer (39.6%) and colon cancer (18.9%) patients and they were at cancer stage III (18.8%). Body mass index (BMI) and percent fat mass were significantly different (p<0.05) between patients undergoing treatment (22.8 ± 2.7 kg/m2, 28.7 ± 7.2%) and on follow-up (26.2 ± 5.5 kg/m2, 37.1 ± 11.9%). Majority of the patients undergoing treatment were categorized under low physical activity compared to those on follow-up (p<0.05). Physical activity level measured as METS-minutes/week is also found to be significantly different (p<0.05) between patients on treatment and follow-up. As a conclusion, cancer patients undergoing treatment have low physical activity, with lower BMI and fat mass compared to those on follow-up. This is consistent with their nature of living where during treatment the patients will resting while coping with side effects of treatments.
Histopathologically adult extracardiac rhabdomyoma is a benign tumour of mature striated muscle. It is a slow- growing tumour with predilection to occur in head and neck region. They appear mainly as a solitary lesion, and about 15% of them can be multicentric. A 56-year-old man presented to us with the floor of mouth swelling persisted for one year and the right neck swelling for three years mimicking a plunging ranula. Radiological imaging revealed enhancing mass at the floor of mouth and submandibular region. The mass represented a nonvascular benign tumour. Subsequently, the patient underwent excision of the mass via transcervical and transoral method. Histopathological examination revealed adult type of extracardiac rhabdomyoma. Adult type of extracardiac rhabdomyoma should be considered in the differential diagnosis for the head and neck masses. A complete excision will reduce the risk of recurrence.
The hepatitis C virus (HCV) consists of eight genotypes and 90 subtypes, with genotype (GT) 3 being the second most common globally and is linked to higher incidences of steatosis and rapid development of fibrosis and cirrhosis. The NS3/4A serine protease, a heterodimer complex of two HCV non-structural proteins, is an effective target for pharmaceutical intervention due to its essential roles in processing HCV polyproteins and inhibiting innate immunity. This study combines structure-based virtual screening (SBVS) of predefined compound libraries, pharmacokinetic prediction (ADME/T) and in vitro evaluation to identify potential low molecular weight (<500 Dalton) inhibitors of the NS3/4A serine protease (GT3). In silico screening of ZINC and PubChem libraries yielded five selected compounds as potential candidates. Dose-dependent inhibition of the NS3/4A serine protease and HCV replication in HuH-7.5 cells revealed that compound A (PubChem ID No. 16672637) exhibited inhibition towards HCV GT3 with an IC50 of 106.7µM and EC50 of 25.8µM, respectively. Thus, compound A may be developed as a potent, low molecular weight drug against the HCV NS3/4A serine protease of GT3.
Performing tracheostomy on COVID-19 patients poses a significant risk to the procedural team. Such procedures should be evaluated individually via close communication between the otorhinolaryngology-head and neck surgeon and the intensivist. Comprehensive examination and preparation should be well-planned before tracheostomy, optimal technique during tracheostomy and special care following the surgery. We would like to highlight our revised guidelines at Hospital Kuala Lumpur, Malaysia on the timing of tracheostomy, management of anticoagulant and the surgical planning in COVID-19 patients during these challenging times.
An acquired persistent tracheopharyngeal fistula secondary to an infected tracheopharyngeal voice prosthesis is a common cause of recurrent aspiration pneumonia in a postlaryngectomy patient. We report a case of a successfully treated tracheopharyngeal fistula whereby both the sternocleidomastoid muscles were used as muscular flaps to close the defect and its outcome.