Displaying publications 1 - 20 of 268 in total

  1. Ong, S.F., Nik Azlan, N.M.
    Medicine & Health, 2017;12(1):90-93.
    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
  2. Rossman, H., Nik Azlan, N. M., Mahathar , A. W.
    Medicine & Health, 2017;12(2):179-192.
    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
  3. Mohd Yazid, B., Ayesyah, A., Mohd Rohaizat, H., Nurhanani, A. B.
    Medicine & Health, 2017;12(2):210-219.
    Hyperbaric oxygen therapy (HBOT) was established to increase oxygenation and antimicrobial effect that potentially improve the healing of chronic ulcer. Present study aim to assess the effects of HBOT in chronic diabetic foot ulcer (DFU). A total of sixty patients classified according to Wagner 1, 2 or 3 chronic diabetic foot ulcers, were recruited and subsequently divided randomly into two groups; HBOT and control group. All patients underwent the standard treatment for DFU, but for the HBOT group, underwent 20 HBOT sessions, each lasted 80 – 90 mins at 2.5 atmospheres absolute (ATA). White cell count (WCC) and C-reactive protein (CRP) levels were taken during inclusion, at second and fourth week of treatment. Wound sizes were documented at each follow up until six months follow up. SF-36 at one-month post hyperbaric oxygen therapy was used to measure the health-related quality of life. Reduction of WCC and CRP in HBOT group were significant throughout the treatment (p=0.046 and p=0.039, respectively). A total of 26 patients (86.7%) from the HBOT group achieved complete ulcer healing at six months’ follow-up, while 18 patients (60%) in the control group’s ulcer healed completely. Patients treated with HBOT had significantly better mental and physical health constituent of quality of life. It must be emphasised that HBOT is an adjunctive therapy to the standard management of chronic DFU in accelerating wound healing for a better quality of life.
    Keywords: oxygenation, quality of life, wound healing
  4. Nurasyikin, Y., Azma, R.Z., Suria, A.A., Chandramaya, S., Noraidah, M., Omayma, S.E.B
    Medicine & Health, 2017;12(1):66-82.
    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
  5. Mazliadiyana, M., Nazrun, A.S., Isa, N.M.
    Medicine & Health, 2017;12(1):83-89.
    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
  6. Lee, J.X., Ong, S.I., Lee, V.Y., Fairuz Nazri, A.R.
    Medicine & Health, 2017;12(1):42-55.

    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
  7. Gunasekaran, G., Muhamad Fitri C.A., Chandrashegkar, S., Hajar Amalnina A.B., Raishan, S., Nurul Faiznani, Z., et al.
    Medicine & Health, 2017;12(2):202-209.
    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
    ) mengikut kumpulan
    tertentu: kawalan, H2
    , madu gelam, H2
    + madu gelam. Selepas 24 jam
    rawatan, biopetanda tekanan oksidatif seperti malondialdehid (MDA) dan protein
    karbonil ditentukan. Aruhan tekanan oksidatif meningkatkan aras MDA (p
  8. Aimy Mastura, Z.Y., Norshamsiah, M.D., Hazlita, M.I., Othmaliza, O., Ropilah A.R.
    Medicine & Health, 2017;12(1):94-98.
    Selulitis orbital merupakan jangkitan tisu di sekitar mata di dalam ruangan orbit yang
    termasuk saraf mata. Ia boleh menyebabkan komplikasi yang membawa kematian
    sekiranya merebak melalui saraf mata dan ke otak. Penyebab utama jangkitan
    adalah termasuk perebakan jangkitan sinusitis dari ruangan paranasal atau melalui
    selulitis preseptal. Kes ini menggambarkan jangkitan di luar kebiasaan mengenai
    jangkitan orbital selulitis yang berlaku akibat luka torehan pada konjunktiva mata
    yang disebabkan oleh kemalangan. Rawatan antibiotik sistemik yang agresif
    mengurangkan risiko komplikasi penglihatan. Kesemua luka pada atau sekelililng
    mata haruslah dirawat dengan sebaiknya bagi mengelakkan berlakunya komplikasi
    yang membahayakan.
  9. Norshalizah, M., Zar Chi, T., Farihah, S.
    Medicine & Health, 2017;12(1):56-65.
    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.
  10. Faizah, M. H., Anisah, N., Yusof, S., Noraina, A. R., Adibah, M. R.
    Medicine & Health, 2017;12(2):286-292.
    Acanthamoeba spp. merupakan ameba hidup bebas yang biasa ditemui
    di persekitaran. Ia merupakan agen penyebab keratitis Acanthamoeba (AK)
    dan ensefalitis ameba bergranuloma (GAE). Ameba ini juga mampu menjadi
    perumah kepada pelbagai bakteria termasuklah yang bersifat patogenik seperti
    Mycobacterium, Legionella dan Staphylococcus aureus rintang metisilin (MRSA).
    Berdasarkan maklumat ini, satu kajian dijalankan untuk mengesan kehadiran tiga
    bakteria endosimbion berkepentingan perubatan di dalam Acanthamoeba spp. yang
    telah dipencilkan dari bolong penghawa dingin yang terdapat di wad and dewan
    bedah di Pusat Perubatan Universiti Kebangsaan Malaysia. Kehadiran bakteria
    endosimbion ini disaring menggunakan pasangan primer khusus bagi setiap genus
    menggunakan reaksi rantai polimerase (PCR) konvensional dan disahkan dengan
    analisis penjujukan. Dua puluh sembilan (80.56%) pencilan Acanthamoeba spp.
    didapati mengandungi bakteria endosimbion patogenik yang disasarkan dengan
    sekurang-kurangnya satu genus bakteria bagi setiap pencilan. Mycobacterium
    (82.76 %) adalah bakteria yang paling banyak dikesan, diikuti dengan Legionella sp.
    (65.52 %) dan Pseudomonas spp. (62.07 %). Tiada bakteria MRSA dikesan daripada
    mana-mana pencilan dalam kajian ini. Dua endosimbion Mycobacterium yang
    dikenalpasti telah dikelompokkan ke dalam strain Mycobacterium tuberculosis.
    Kami membuat kesimpulan bahawa, kebanyakan Acanthamoeba berpotensi untuk
    menjadi perumah bagi pelbagai bakteria patogenik, namun implikasi interaksi ini
    terhadap patogenisiti kedua-dua organisma masih kurang jelas dan memerlukan
    penyelidikan yang lebih lanjut.
  11. Ng, B. K., Chuah, J. N., Lim, P. S., Shuhaila, A., Marhani, M., Nor Azlin, M. I.
    Medicine & Health, 2017;12(2):244-258.
    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
  12. Wong, L. K. S., Muthupalaniappen, L., Tie, S. T.
    Medicine & Health, 2017;12(2):275-285.
    Adult influenza and pneumococcal vaccinations are grossly underutilized although there is clear benefit in reducing mortality and morbidity among those at risk. The aim of the study was to assess primary care physician’s knowledge on adult influenza and pneumococcal vaccinations, their beliefs and barriers to vaccination. A cross-sectional study using self-administered questionnaires was conducted at eight primary care centres in Kuching, Sarawak. A total of 108 primary care physicians participated in this study. Median age of participants was 29 years (IQR 4.0). The median knowledge score for influenza vaccine was 9 (IQR 3) and for pneumococcal vaccine was 8 (IQR 4). Female participants scored higher compared to their male counterparts for influenza and pneumococcal vaccines (P = 0.005 & 0.007). The highest percentage of correct responses for influenza vaccination was for side effects (75.3%) while the lowest was for contraindications (9.3%). The highest percentage of correct responses for pneumococcal vaccination was for side effects (69.1%) while the lowest was for advocated target groups (6.2%). Most participants believed that pneumococcal and influenza vaccines were safe (92.8 & 99%) and beneficial for patients (89.7 & 93.8%). Cost of influenza and pneumococcal vaccines (94.8% & 96.9%) and their availability (86.6% & 89.7%) were the main barriers to prescribing them. Primary care physicians in the public sector have moderate knowledge of both adult vaccinations. Areas of knowledge paucity and barriers need to be addressed to ensure a more comprehensive health care delivery to the aging Malaysian population.
    Keywords: adult, belief, influenza vaccines, knowledge, pneumococcal vaccines
  13. Nadia, A. B., Leelavathi, M., Narul Aida, S., Diana, M.
    Medicine & Health, 2017;12(2):230-243.
    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
  14. Azahsyahrina, A., Moonyza, A., Lee, B.R., Fazarina, M.
    Medicine & Health, 2017;12(1):109-112.
    Epidermal naevus is a congenital cutaneous hamartoma with a benign course. We highlight a rare case of epidermal naevus with concurrent basal cell carcinoma. A 79-year-old male had a skin biopsy at our centre for an enlarging skin nodule within a linear papular lesion measuring 2 x 4 cm at the left side of his neck, which was later diagnosed as basal cell carcinoma arising from an epidermal naevus. PIK3CA mutation is attributed to basal cell carcinoma which suggests the basal cell carcinoma component is independent of the epidermal naevus component. Clinicians and pathologists must be aware of possible malignant changes that might arise in an epidermal naevus.
    Keywords: basal cell carcinoma, BCC, epidermal naevus
  15. Mardziah, M., Nurasyikin, Y., Rafeah, T., Dian, N., Yousuf, R., Suria, A.A.
    Medicine & Health, 2017;12(1):103-108.
    Plasma cell myeloma is known to cause expansion of a single clone of munoglobulin (Ig) which results in the secretion of a unique homogeneous monoclonal protein (M component). However, there are cases which reported that it can also cause production of two different clones of these monoclonal proteins. Although it is relatively very rare as the prevalence is only 2% of all plasma cell myeloma cases, the clinical features are said to be similar to monoclonal gammopathy. It is suggested that these biclonal gammopathy results from either one monoclonal cell clone in monoclonal gammopathy or two different monoclonal cell clones. Whichever the mechanism of the disease be, the response to treatment seems to be similar as compared to the monoclonal cases although some reports shows chemoresistant. Here, we report a rare case of plasma cell myeloma with IgG (lambda) and IgA (lambda) type of biclonal gammopathy, the clinical presentation, the haematological and biochemical markers as well as the response to the treatment.
    Keywords: biclonal gammopathy, M protein, plasma cell myeloma
  16. Siti, N. I., Kavireshna, K., Zafirah, M. R., Foo, Y. I. W., Rabiatul Adawiyah, R., Salina, H., et al.
    Medicine & Health, 2017;12(2):259-274.
    Model tiga dimensi (3D) menyerupai ciri-ciri persekitaran tisu asli, justeru
    morfologi dan isyarat-isyarat sel daripada kultur 3D selalunya lebih menyerupai
    fisiologi asal berbanding sel kultur dua dimensi (2D). Diketahui juga, rembesan
    sel mempunyai kesan parakrin kepada pertumbuhan sel-sel lain. Dalam kajian
    ini, pengkulturan fibroblast hidung menggunakan system kultur sel 3D telah
    dioptimumkan dan kesan bahan rembesan (BR) daripada kultur 3D terhadap kadar
    pertumbuhan dan perlindungan sel telah dikaji. Fibroblas hidung dipencilkan
    daripada turbinate hidung manusia. Mikrosfera yang sesuai telah dipilih melalui
    pengkulturan fibroblast pemindahan ke-3 pada pelbagai jenis mikro sferapolisterin
    PolyGEM™. Kemudian, sel-sel telah dikulturkan pada mikrosfera yang terpilih
    menggunakan system kultur 3D dan media terkondisi (MT) telah dikumpulkan.
    Media terkondisi tiga dimensi (MT3D) telah ditambah kepada fibroblast untuk
    mengkaji kadar perlekatan sel, kadar proliferasi, dan perlindungan sel terhadap
    kesitotoksikan Centella asiatica. Asai protein asid bicinchonic dijalankan untuk
    mengetahui kuantiti protein di dalam BR. Elektroforesis gel poliakrilamida-Sodium
    Dodesil Sulfat (SDS-PAGE) telah dilakukan untuk memperoleh profil awal protein
    dan membandingkan profil MT3D dengan protein media terkondisi dua dimensi
    (MT2D). Kajian ini menunujukkan MT3D tidak menggalakkan perlekatan dan
    proliferasi sel secara signifikan. BR didapati memberikan perlindungan sel yang
    signifikan pada fibroblast hidung terhadap kesitotoksikan Centella asiatica. MT3D
    mempunyai kepekatan protein yang lebih tinggi berbanding MT2D. SDS-PAGE
    menunjukkan MT3D mempunyai 3 jalur ekslusif manakala MT2D mempunyai 4 jalur eksklusif. Kajian masa depan harus dijalankan keatas penggunaan BR
    fibroblast hidung untuk perlindungan sel terhadap agen-agen yang memudaratkan
    di alam sekitar dan produk herba yang sitotoksik.
  17. Maszaidi, Z., Nurul Hazwani, H., Hatta, S.
    Medicine & Health, 2017;12(1):99-102.
    Kebimbangan dan gangguan emosi amat biasa di dalam Penyakit Kecelaruan
    Defisit Perhatian. Laporan kes ini mengetengahkan kes lelaki Melayu berusia
    23 tahun yang menunjukkan masalah memberi perhatian dan kemerosotan
    pencapaian akademiknya secara ketara. Kemerosotan pengajiannya disedari
    oleh ahli keluarganya 2-3 tahun sebelum beliau mendapatkan rawatan psikiatri.
    Beliau juga mengalami masalah kemurungan tetapi tidak mengalami gejala
    biologi kemurungan. Beliau telah dirawat dengan ubat-ubatan Buproprion 150 mg
    setiap hari dan juga ubat Ritalin 10 mg. Kebiasaannya ubat peransang digunakan
    untuk rawatan penyakit kecelaruan deficit perhatian tetapi dalam kes ini ubat
    anti kemurungan telah digunakan. Beliau telah menunjukkan penambahbaikan
    selepas memakan ubat dan seterusnya dapat memberi fokus kepada pembelajaran
  18. Nuur Ezzatyhusna, M. K., Nurul Izzati, H., Siti Suraiya M. N., Suharni, M.
    Medicine & Health, 2017;12(2):220-229.
    Amplikasi isoterma berpengantara gelung (LAMP) merupakan teknik amplifikasi gen
    yang menghasilkan produk akhir iaitu mendapan keruh magnesium pirofosfat yang
    boleh dianalisis dengan hanya menggunakan mata kasar. Penggunaan pewarna
    interkalat yang sesuai adalah penting kerana ia boleh meningkatkan sensitiviti dan
    mengurangkan keputusan positif palsu dan negatif palsu untuk pengesanan. Kajian
    ini bertujuan untuk membandingkan prestasi tiga pewarna interkalat yang berbeza;
    SYBR Green I, SYBR Safe dan pewarna berasaskan calcein di dalam asai LAMP
    HPV-16 melalui visualisasi oleh mata kasar, elektroforesis gel dan mesin masanyata
    turbidimeter. Reaksi LAMP dilakukan menggunakan amplifikasi kit Loopamp
    DNA berisipadu sebanyak 25 μl. Campuran reaksi dieram pada suhu 60�C selama
    60 minit dan ditamatkan menggunakan suhu 80�C selama 5 minit dalam mesin
    masa-nyata turbidimeter. Untuk pengesanan menggunakan mata kasar, SYBR
    Green I dan SYBR Safe telah dicairkan dalam 1:10 DMSO dan telah ditambah ke
    dalam tiub yang mengandungi campuran reaksi selepas proses amplifikasi berlaku
    manakala calcein ditambah sebelum proses amplifikasi. Sensitiviti asai telah disiasat
    menggunakan pencairan DNA HPV-16 yang berkepekatan bermula dari 101
    μl to 108
    salinan/μl. Ketiga-tiga pewarna mempamerkan keputusan yang sama
    dari segi sensitiviti dengan had pengesanan adalah 103
    salinan/μl. Penambahan
    calcein di dalam asai menunjukkan masa pengesanan bertambah selama 10 minit
    dengan menggunakan mesin nyata-masa turbidimeter. Prestasi ketiga-tiga pewarna
    interkalat untuk pengesanan mata kasar adalah setanding dan boleh digunakan
    untuk aplikasi pemeriksaan titik akhir dalam asai HPV-16, manakala dengan mesin nyata-masa turb
  19. Ahmad Khaldun, I., Mohd Fyzal, B., Soo, C. I., Yeap, B. T., Mohamed Faisal, A. H.
    Medicine & Health, 2017;12(2):357-362.
    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
  20. Khor, C. C., Tan, T. L.
    Medicine & Health, 2017;12(2):363-367.
    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
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