Introduction: Smoking is prevalent among Muslims in this country despite public knowledge regarding smoking as haram (unlawful). This may be due to ignorance of the consensus of the ' mufti ' on the ' fatwa ' on smoking or a result of poor education and understanding of health-related risks of smoking.
Methods: A cross-sectional, questionnaire-based survey was carried out among the public who attended the IIUM Faculty of Medicine open day in Kuantan, Pahang on June 12th, 2004. Knowledge of smoking-related illnesses and the religious ' fatwa '(edict) on smoking was assessed.
Results: Seventy four muslims participated in the survey. 46(63%) were smokers (including ex-smokers) and 28(37%) were non–smokers. There was no statistically significant difference between the knowledge of smoking-related illnesses and their knowledge of the religious edict which regards smoking as haram between smokers and non-smokers. Only 6.7% of smokers perceive smoking as haram compared to 48% of non-smokers (p<0.001).
Conclusion: The conviction that smoking is haram among smokers is still poor among smokers. This could be one of the main reasons contributing to the high prevalence of smoking in our society. There was no difference between smokers and non-smokers concerning their knowledge on the religious edict on smoking and the health-related hazards of smoking.
Introduction: The objective was to evaluate the perceived risks, barriers and stages of change on smoking cessation among the Malay male security guards. Materials and Methods: In the year 2004, a cross sectional survey was conducted on a group of security guards working in the campus and the hospital of a public university in Kuala Lumpur. Universal sampling (n=210) was conducted with a response rate of 88.6%. A self-administered questionnaire was used to survey the participants on their smoking status, stages of change, perceived risks and barriers to smoking cessation. Results: There were 37% current smokers and 23.7% ex-smokers. The mean year of smoking was 19.2 + 8.1 and the number of cigarettes smoked was 16.4 + 8.0 per day among the current smokers. About two-third of the smokers perceived the amount smoked currently was bad for health. However, only 23.3% and 30.9% of the smokers perceived themselves to be at higher risk for lung cancer and heart disease respectively. The three main reasons to quit smoking were health reasons, doctorsâ€™ advice and cost. The main barriers were addiction (53.3%) and stress (28.3%). Most of the smokers (42%) were in the pre-contemplation stage with half of them not having thoughts of quitting. Conclusion: The smokers had misperception on smoking and majority was at the pre-contemplation stage of change in smoking cessation. The findings of this survey add on to the existing literature about the perception of risks, barriers and stages of change to smoking cessation. This will provide valuable information on the planning and delivering of smoking cessation programmes in the local context.
Introduction: The aim of treatment for hyperemesis gravidarum is to stop vomiting, correction of dehydration, starvation and electrolytes imbalance. The common types of fluid used for fluid replacement are isotonic solutions like normal saline and hartman's solutions. The absence of potassium in normal saline makes hartman's solution superior but there is a possibility that the lactate component in hartman's solution could worsen the starvation state of the patients. This study is to evaluate which of these two solutions is more effective for fluid replacement in hyperemesis gravidarum. The objectives are to compare which solution corrects dehydration, hypokalaemia and acetonuria faster and to evaluate whether the ketosis state is aggravated by lactate component in hartman's solution. Materials and Methods: Patients with hyperemesis gravidarum were randomised to receive either Hartman's solution or normal saline at the rate of 125mls/hour. Blood urea and serum electrolytes, haematocrit, lactate and urine acetone were taken during admission and repeated every 12 hours. The volume of fluid required to correct dehydration, hypokalaemia and acetonuria were compared. Comparison of the pre and post treatment level of serum lactate were also done. Results: Both hartman's solution and normal saline are both effective in correcting dehydration (11.52Â±3.28 pints versus 11.94 Â± 2.30pints respectively) and acetonuria (11.64 Â± 2.75 pints versus 11.64 Â± 2.54 pints respectively).
A lower volume of hartman's solution was needed to correct hypokalaemia (8.34 Â± 2.44 pints versus 8.88 Â± 2.63 pints) but was not statistically significant. Ketonaemia was not made worse after treatment with hartman's solution. Conclusion: Normal saline and hartman's solution are equally effective in treating complications of hyperemesis gravidarum.
Femoral fractures are one of the commonest fractures encountered in orthopaedic practice. Over the years, treatment of this injury has evolved tremendously. The initial non-operative methods of reduction and stabilization have largely been replaced by operative fixation. There are currently three basic modes of internal fixation of femoral diaphyseal fractures in the adult age group: plate and screws, intramedullary Kuntscher nailing, and interlocking nailing. The objective of this study is to determine whether the so-called more â€˜technologically advancedâ€™ interlocking nailing results in better outcome compared to the more â€˜traditionalâ€™ plate and screws, and Kuntscher nailing. It is found that, in terms of time to union and final function after an average of just under 2 years post-operative period, the group of patients who had interlocking nailing fared poorer. A review of relevant literature will then be presented.
Introduction: Primary care management of knee osteoarthritis OA has received little attention in the scientific literature and the main reason of this survey is to study and explore the variations and patterns of primary care management and assess both conventional and complementary therapy usage in knee OA in the primary care setting. Materials and Methods: A cross sectional survey of 100 randomly selected general practitioners (GPs) in the northern states of Malaysia (Kedah, Perlis, Pulau Pinang) was undertaken using questionnaires. The GPs involved were asked about basic knowledge of OA in terms of diagnosis, investigation, and treatment of OA. They were also asked their usage of conventional and complementary medication. Results: 80 (80%) GPs responded to the questionnaires sent. 85% of GPs were in solo practice and 15% in group practice. Most of the GPs surveyed (69%) were in practice for more than 10 years, 21% in 5- 10 years and 10% were in practice for less than 5 years. 65% GPs surveyed see an average of more than 20 patients per week, 25% see about 10- 20 patients and 10% see less than 10 patients per week. 75% of GPs surveyed would arrange an X-ray. 65% of GPs surveyed will arrange a blood test, mostly serum uric acid, rheumatoid factor and ESR. Pharmacological management consists of first line treatment with analgesics (32%), NSAIDs (59%) or a combination of the two (4%). Non-pharmacological management consist of advise an exercise (37%), weight reduction (23%) and referral to physiotherapy (8%). 89% of GPs surveyed prescribed some form of complementary medications. 68% prescribed glucosamine sulphate, 29% chondroitin sulphate, 18% cod liver oil, 12% evening primrose oil. Only 5% of GPs surveyed perform intra- articular injection. Conclusion: The data suggest that in the primary care, majority of GP over investigate the diagnosis of OA. Pharmacological interventions largely concentrate on analgesic and NSAIDs. The use of physiotherapy and non drug approach were enormously under-utilized. There is a need to further educate GPs in the management of OA.
Introduction: The proto-oncogene c-kit is the cellular homologue of the oncogene v-kit of HZ4 feline sarcoma virus. It is located on chromosome 4 (4q11-12) in the human genome. Interaction between the c-kit receptor and its ligand, stem cell factor, is essential in the development of tissues. C-kit expression has been identified in a number of different neoplasms like seminoma/dysgerminoma, and gastrointestinal stromal tumors (GIST). Recently it has been reported that c-kit is also present in leiomyosarcomas. Tyrosine kinase inhibitors (TKIs) are a promising new therapy in the treatment of cancer. These agents target cellular proteins like kit and its related homologues decreasing cellular proliferation and survival. TKIs may be helpful in treating leiomyosarcomas expressing c-kit. Materials and Methods: In this study a total of 6 cases diagnosed as leiomyosarcomas at Department of Pathology, Universiti Sains Malaysia, Kubang Kerian, Malaysia, were investigated for reactivity for c-kit using immunohistochemical stain. Stain was considered positive if more than 10 percent of the cells showed membrane or cytoplasmic positivity. Results: Two leiomyosarcomas stained faintly with c-kit and in less than 10 percent of the cells. The other 4 cases showed no staining. The control showed good membrane and cytoplasmic positivity. Conclusion: Uterine leiomyosarcomas did not express c-kit. The reason for this could be that the tumors are inherently c-kit negative. More study using larger number of cases is required to validate these findings and further molecular characterization of these mesenchymal tumors is needed to identify the true nature of these sarcomas.
The azygos system enlarges in cases of obstruction to the superior vena cava or inferior vena cava and result in increase blood flow through the system. Azygos continuation of the inferior vena cava is usually congenital and asymptomatic. The azygos vein is the sole drainage of the blood from the lower half of the body to the heart. It is crucial to identify the anomaly as it might involve in the surgical planning of tumours in the thorax or abdomen. Computed Tomography is a non-invasive technique and provide important information about the tumour and the vascular anomaly.
Pyomyoma (suppurative leiomyoma) is a rare complication of uterine leiomyoma. It results from infarction and infection of a leiomyoma. It may lead to diagnostic and therapeutic difficulties with potential complications such as bacteraemia, uterine rupture, compressive effect to adjacent structures and even death. We report a case of pyomyoma based on the Ultrasound (US) and Computed Tomography (CT) findings and literature review on the subject.
Peripheral, predominantly motor polyneuropathy is associated with a plethora of possible aetiologies and the investigative procedures to rule them out are extensive. A 31 year old lady presented with progressive lower limb weakness over a period of 2 years. Examination revealed symmetrical weakness (3+/5) of all distal muscle groups in the lower limbs with absent ankle jerk. There was no sensory loss. The nerve conduction study revealed a predominantly axonal motor neuropathy. Cerebrospinal fluid examination and other investigations to rule out potential causes of predominantly motor peripheral neuropathy were normal. The only positive findings were multiple qualitative assays for porphobilinogen in her urine.
Pterygium is a common external eye problem. It is more frequently seen in tropical areas regions where exposure to ultraviolet sunlight is high. Clinically, a pterygium is a wing shaped fibrovascular growth arising from the bulbar conjunctiva onto the superficial cornea. Complications of pterygium include decreased in visual acuity, dryness, foreign body sensation and persistent redness. Surgical management is the mainstay of treatment for this condition. Numerous surgical techniques have been described in the treatment of pterygium. They include the bare sclera technique, simple direct conjunctival closure, rotational conjunctival graft and conjunctival autograft. Additional treatment to some of these techniques may include the use of beta particle therapy and antimetabolite therapy. Despite the wide range of surgical procedures described for its treatment, the main concern from these procedures has been the recurrence, which could be as high as 30% to 70%. Recurrent pterygium is often accompanied by increased conjunctival inflammation and accelerated corneal involvement. Repeated surgical procedures often only worsen the situation, as loss of conjunctival tissue and scarring can result in obliteration of the fornices and mechanical restriction of extraocular movements, with clinically significant diplopia. In Hospital Tengku Ampuan Afzan, pterygium excision is the most common surgical procedure after cataract extraction. We reviewed patients who had undergone pterygium surgery in HTAA in order to determine the most effective surgical method that could minimize recurrence. PURPOSE: To compare success rates of various excision techniques performed for primary and recurrent pterygium in Hospital Tengku Ampuan Afzan, Kuantan, Pahang.
METHODS: The outcome of 47 cases of pterygia (44 primary and 3 recurrent) excised with various techniques between January 2004 to September 2004 was retrospectively reviewed. Six clinical specialists and four trainees performed the surgical procedures. Outcome was evaluated in terms of recurrence of pterygia onto the cornea. RESULTS: The mean follow up was 3.04 months (range, 1-7 months). All pterygia were morphologically graded as intermediate or fleshy type except one. Four types of pterygium excision techniques were performed. Twenty-four cases had bare sclera, seventeen cases had conjunctival autograft transplantation, six cases had direct conjunctival closure and one had amniotic membrane transplantation done. Recurrence of pterygia occurred in thirteen eyes. Twelve cases from primary pterygia group and one case from recurrent group recurred. Recurrence rate was noted to be higher in direct conjunctival closure (4 out of 6 cases) and lowest in conjunctival autograft transplantation (2 out of 17 cases). Recurrence rate for bare sclera technique was noted to rank second in this study (6 out of 24 cases). In five cases of recurrence, subconjunctival tissue invasions were more than 1 mm but further surgical interventions were not needed at the time of this review was done. CONCLUSIONS: Conjunctival autografting was found to have less recurrent rate when compared with other techniques. The bare sclera technique was quoted to be associated with higher recurrence rate in other literatures. Interestingly in our series, recurrence rate for direct conjunctival closure technique was higher when compared to the former technique. This may be related to inadequate excision of pterygia tissue, which led to direct apposition of abnormal tissue to the cornea in the direct conjunctival closure technique. Even though the bare sclera technique is associated with a higher recurrence rate, it is still the preferred excision technique. This could be because it is less time consuming and technically easier to perform. Based on this study, conjunctival autografting should be the surgical procedure of choice for pteryigum in order to minimise the risk of recurrence.
It has often been assumed that the translation of Greek medical books into Arabic was the main determinant in establishing Islamic medicine. This assumption must be put into proper perspective. Because, it is certainly true that the Prophet Muhammad (s.a.w) inspired love and passion for learning and called upon mankind to develop their faculties and intellects. His teaching on medicine indicates that no student of history of Islamic medicine can ignore the importance of the Prophet’s sayings and practices in this regard. This leads us to accept the fact that the principles of medicine in Islam, as a whole, are deeply rooted in the Qur’an and Ahadith of the Prophet (s.a.w), although this Islamic medicine itself came into being, especially during the Abbasid period, as a result of the integration by Muslims of several older traditions of medicine, most importantly Greek.
Introduction: Operative laparoscopy is the gold standard approach for treatment of tubal pregnancy. Although benefits of this approach are well established, data on its uptake trend in Malaysia is largely unknown. Objective: This study aims to determine the operative laparoscopy uptake in management of tubal pregnancy at a busy tertiary hospital and whether the benefits associated with laparoscopic surgery was achieved. Materials and Methods: This prospective observational study was conducted on all women admitted for tubal pregnancy at Hospital Sultanah Aminah, Johor Bahru, a public tertiary hospital over a period of 12 months. The on-call team was responsible for the surgical approach. Patient’s clinical presentation, operative laparoscopic uptake, factors affecting the choice of approach and duration of hospitalization were analyzed. Results: The tubal pregnancy rate was 7.6 per 1000 deliveries. Twenty- seven of the 138 cases (20%) had hypovolemic shock, requiring urgent laparotomy and were excluded from study. The operative laparoscopy rate for stable tubal pregnancy was only 42.3% (47 of 111 cases). Women managed laparoscopically were associated with a significantly higher pre-operative hemoglobin level, mostly nullipara and had surgery performed during office hours. They waited longer for their surgery but were discharged earlier compared to the laparotomy group. There was no difference in the duration of hospitalization. Conclusions: Less than half of all hemodynamically stable tubal pregnancies in our hospital had operative laparoscopy. The current laparoscopy uptake rate can be further improved.
We report a case of a 14-year-old Malay male who fell at school and sustained bilateral olecranon fractures. He had undergone an open reduction and tension band wiring to stabilize the fracture. Three months after the surgery, the movement of both his elbows was satisfactory.
Paragangliomas are slow growing hypervascular tumour arising from neural crest cell derivatives throughout the body. In the head and neck region, the major paraganglial cells are located at the carotid bifurcation (carotid body), along the ganglia of the vagus nerve and along the nerves supplying the middle ear and jugular bulb. Less common locations include the larynx, orbit, nose and the aortic arch. Carotid body tumours are very rare neoplasms constituting less than 0.5% of all tumours. The true nature of the tumour is established at the time of attempted biopsy or surgical resection, sometimes with disastrous consequences. Only a few of the more than 500 cases reported in the literature have been studied and diagnosed preoperatively. These tumours must be considered in the evaluation of any lateral neck mass, even one located far from the carotid bifurcation. We report a case of bilateral carotid body tumours detected using 16-slice MDHCT in a patient who presented with pulsatile neck swelling for two years. This tumour is rarely malignant; however it produces serious problems by its progressive enlargement and impairment of adjacent structures in the neck. The treatment of choice is surgical resection; preferably to excise this lesion when it is small, because large, very vascular tumours are intimately attached to the carotid vessels and make surgical resection more hazardous. Pre-operative embolization can be performed in large tumours, as to facilitates surgery and reduce complication. In most of the cases, there is strong attachment of the tumour to the carotid arteries. When this is the situation, removal of the tumour means complete excision of both great arteries as well, and the mortality rate is 40 to 45 %. When surgical removal is not feasible, radiotherapy may help to control the tumour growth, although the results have not been encouraging. As it is very slow growing tumour with the growth rate of less than 5 mm per year tumours in old patients with significant risk factors for surgical intervention can be managed by observation alone.
Appendicitis within an Amyand's hernia is rare; when it occurs it is often misdiagnosed as a strangulated inguinal hernia. Management of these cases needs to be individualized according to the presentation. In uncomplicated cases, we recommend concurrent appendectomy and darning repair of the hernia. We present such a case and review the related literature.
Choriocarcinoma is a malignant proliferation of syncytial trophoblast cells that do not form placental villi. It is a relatively rare and highly malignant variant of gestational trophoblastic disease. Although choriocarcinoma is mostly observed after a molar pregnancy, it may be preceded by any gestational event. It has been shown that even a partial mole can transform into choricarcinoma. Incidence rates of choriocarcinoma differ widely throughout the world. In Europe and North America, choriocarcinoma is reported to affect one in every 30,000 to 40,000 pregnancies, and one in 40 molar pregnancies. In South East Asia, choriocarcinoma is reported to affect one in every 500-3000 pregnancies. Following livebirth, choriocarcinoma with metastatic disease are important sequele (31%)(Tidy et al 1995). In the same study the reported median interval between antecedent pregnancy and choriocarcinoma is five months. Multi agent chemotherapy is required in the majority of patients (82%) for the high risk group. The prognosis for choriocarcinoma after a normal gestation is poorer. The mortality rate is also significantly higher than non-molar abortion (21%). Effective treatment with oral Methotrexate in metastatic choriocarcinoma to the lung confirmed the highly sensitive nature of this tumour to chemotherapy agent.
The use of thrombolytic agent e.g. streptokinase is indicated in patients with early acute ST elevation myocardial infarction (MI) (if there are no contraindications) is becoming increasingly routine. Its use is however significantly limited by bleeding complications. Spinal epidural haematoma (SEH) is haemorrhage in the spinal epidural space after spinal anaesthesia. SEH may be acute or chronic, spontaneous, posttraumatic, or iatrogenic but its occurrence appears to be particularly associated with acquired coagulopathy from medications and disease states. Patients usually present with acute axial spine pain and evolving focal neurological deficits. With increasing number of available anticoagulants and patient receiving them, anaesthesiologists today have to face the challenge of balancing between risks and benefits of regional anesthesia in patients under such medications. The treatment of this condition involves the principles of conservative follow-up directed by an improving examination and an understanding of the pathophysiology of coagulopathy-induced spontaneous epidural bleeds. When the diagnosis is accomplished rapidly, surgical decompression can result in full functional recovery.
Pelvic inflammatory disease (PID) is a common cause of morbidity and accounts for 1 in 60 GP consultations by women under the age of 45 in the UK. Pelvic inflammatory disease encompases a broad category of disease including endometritis, salphingitis, salphingo-oopheritis, tuboovarian abscess and pelvic peritonitis. It most commonly occurs as a result of Chlamydia trachomatis or Nesseria gonorrhea 1,2 infection of the endocervix that eventually spread into the upper genital tract. Direct spread from a nearby infection such as appendicitis and diverticulitis is not that common. Hematogenous spread is rare except in cases of tuberculous pelvic inflammatory disease. This case illustrates atypical presentation of pelvic inflammatory disease in a previously healthy single unmarried lady. The presence of ascites, bilateral ovarian mass and constitutional symptoms closely mimics that of malignant ovarian tumour. This was preceded by empyema which grew E coli.
Restrictive dietetic practices, rather than helping the patient, reduce his food intake and thereby impair recovery. This is a cruelty born-of erroneous notion passed on to us as a legacy from hakims and vaids (quakes), rather than having any scientific justification. Even if some doctors do not entertain such restrictions, the so called well-wishers of patients will definitely offer free advice and impose food restrictions upon their patients. Everybody has his own share of bitter experiences, horrific memories, and heart-rending stories of the past. The chain of death and destruction remains unbroken. The gloomy, dark sky is waiting for break of a new dawn gone into eclipse years before. The ongoing Indo- Pak peace process has already resulted in a number of confidence- building measures, but in spite of all that an average of five persons each day are being killed in terror-related incidents across the State. A tricky situation prevails in which militants and security forces are pitted against each other, converting the streets, the lanes and by-lanes, and human settlements in to a well-entrenched battle ground. Innocent Kashmir’s are dying, getting maimed, and suffering mental agony and the world is watching with a nonchalant indifference.