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Keratoacanthoma: an unusual nasal mass

Sazafi MS, Salina H, Asma A, Masir N, Primuharsa Putra SH

Acta Otorhinolaryngol Ital, 2013 Dec;33(6):428-30.
PMID: 24376301

We report a case of keratoacanthoma in a non-sun-exposed nasal vestibule of an 84-year-old man. He presented with a progressively growing left nasal mass that had been present for 8 months. Examination showed a non-tender protruding mass arising from medial vestibular wall of the left nostril. Histopathology indicated it was a keratoacanthoma. In an elderly patient with a history of a progressively growing mass in the nose, a differential diagnosis of malignancy should be ruled out, and histological conformation is essential. To our knowledge, only a very small number of cases of nasal vestibular keratoacanthoma have been reported.

Matched MeSH terms: Aged, 80 and over
Fulltext Theories and measures of elder abuse

Abolfathi Momtaz Y, Hamid TA, Ibrahim R

Psychogeriatrics, 2013 Sep;13(3):182-8.
PMID: 25913768 DOI: 10.1111/psyg.12009

Elder abuse is a pervasive phenomenon around the world with devastating effects on the victims. Although it is not a new phenomenon, interest in examining elder abuse is relatively new. This paper aims to provide an overview of the aetiological theories and measures of elder abuse. The paper briefly reviews theories to explain causes of elder abuse and then discusses the most commonly used measures of elder abuse. Based on the reviewed theories, it can be concluded that elder abuse is a multifactorial problem that may affect elderly people from different backgrounds and involve a wide variety of potential perpetrators, including caregivers, adult children, and partners. The review of existing measurement instruments notes that many different screening and assessment instruments have been developed to identify elders who are at risk for or are victims of abuse. However, there is a real need for more measurements of elder abuse, as the current instruments are limited in scope.

Matched MeSH terms: Aged, 80 and over
Mental Health Correlates Among Older Persons Residing in Malaysian Nursing Homes During the COVID-19 Pandemic

Nair P, Gill JS, Sulaiman AH, Koh OH, Francis B

Asia Pac J Public Health, 2021 11;33(8):940-944.
PMID: 34243684 DOI: 10.1177/10105395211032094
Matched MeSH terms: Aged, 80 and over
Successful En Bloc Resection of Complicated Giant Stomach Gastrointestinal Stromal Tumor in an Elderly Patient

Yeoh BZY, Chuan Hoe V, Kong SN, Ooi WK, Chiew KY, Hayati F

Am J Case Rep, 2022 Jan 07;23:e934492.
PMID: 34992206 DOI: 10.12659/AJCR.934492

BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and mostly affect the stomach. The size of the tumors vary, ranging from 0.6 cm to 25.5 cm, with a median size of 6.8 cm. CASE REPORT We report a case of a giant GIST (25×18×8.5 cm) in an 83-year-old woman, which we believe is the largest reported GIST, in Borneo, Malaysia. She presented with gradually increasing abdominal distension with occasional discomfort on movement for 1 month. Computed tomography revealed a large multilobulated enhancing mass measuring 10×20×22 cm with no clear plane with the posterior gastric wall, duodenum, and pancreas. We performed a distal gastrectomy and transverse colon segmentectomy, as the tumor was plastered to the mesentery of the transverse colon. Despite extensive surgery, she recovered well after surgery. Due to her advanced age and the tumor size, a tyrosine kinase inhibitor was not given owing to the possibility of adverse effects. CONCLUSIONS The management of GIST is complicated, especially for a huge GIST with local invasion. Despite the benefits of a tyrosine kinase inhibitor, the role of surgery in managing GIST is crucial, especially for patients with huge tumor size, advanced age, and local complications from the tumor.

Matched MeSH terms: Aged, 80 and over
An alternative approach for lumbar transforaminal epidural steroid injection-Far lateral approach

Liu JH, Soo CW, Lin YC, Lin CS

Pain Pract, 2021 Nov;21(8):978-983.
PMID: 34275177 DOI: 10.1111/papr.13060

INTRODUCTION: Transforaminal epidural steroid injection (TFESI) is one of the nonoperative interventions for lower back pain. In this study, we presented an alternative approach for TFESI, far lateral lateral recess TFESI (FLLR TFESI), which is targeted on lateral recess and anterior epidural space in patients with degenerative lumbar spondylosis-related radiculopathy.
TECHNIQUE: Under fluoroscopy, needle entry site and pathway are drawn according to the spinal anatomy. The needle is advanced toward the lateral recess and the needle tip is placed medially to the medial border of the pedicle under anteroposterior view and posteriorly to the posterior border of the upper endplate under lateral view. After checking optimal contrast spread, steroids and local anesthetics are injected.
CASE ILLUSTRATION: An 86-year-old woman who suffered from lower back pain with radiculopathy received interventional treatment. Comparing the "traditional" supraneural approach with the FLLR approach, the difference in contrast enhancement to lateral recess is clearly shown.
DISCUSSION: Compared to the pre-existing approaches, the FLLR approach may provide better ventral epidural and lateral recess enhancement. Furthermore, with the advanced needle tip, the injectate may enhance not only the at-level nerve root but also the nerve root of adjacent level during their existence in a single injection. With blunt needle usage, no nerve root injury or dura puncture was noted so far.
CONCLUSION: FLLR TFESI is a modified fluoroscopic technique targeted on lateral recess and anterior epidural space. However, subsequent trials are needed to confirm its efficacy in pain reduction and the rate of complications.

Matched MeSH terms: Aged, 80 and over
Implicit satiety goals and food-related expectations predict portion size in older adults: Findings from the BAMMBE cohort

Pink AE, Lee LL, Low DY, Yang Y, Fong LZ, Kang AYH, et al.

Appetite, 2023 Jan 01;180:106361.
PMID: 36332849 DOI: 10.1016/j.appet.2022.106361

Portion size selection is an indicator of appetite and within younger adults, is predicted by factors such as expected satiety, liking and motivations to achieve an ideal sensation of fullness (i.e., implicit satiety goals). Currently, there is limited research available on the determinants of portion size selection within older adults. Therefore, the current study aimed to examine the relationship between individual differences in implicit satiety goals, food-related expectations, and portion size selection in older adults. Free-living older adult Singaporeans (N = 115; Nmales = 62; age: M = 66.21 years, SD = 4.78, range = 60-83 years) participated as part of the Brain, Ageing, Microbiome, Muscle, Bone, and Exercise Study (BAMMBE). Participants completed questionnaires on their subjective requirements for experiencing different states of satiety and food-related expectations (i.e., liking, how filling) as well as a computerised portion size selection task. Using a multiple regression, we found that goals to feel comfortably full (B = 3.08, SE = 1.04, t = 2.96, p = .004) and to stop hunger (B = -2.25, SE = 0.82, t = -2.75, p = .007) significantly predicted larger portion size selection (R2 = 0.24, F(4,87) = 6.74, p

Matched MeSH terms: Aged, 80 and over
Vesicles and erosions in a patient with chronic eczema: is it just eczema?

Jamil A, Muthupalaniappen L

Ann Acad Med Singap, 2014 Feb;43(2):130-1.
PMID: 24652437
Matched MeSH terms: Aged, 80 and over
Aging: physical difficulties and safety in cooking tasks

Ibrahim NI, Davies S

Work, 2012;41 Suppl 1:5152-9.
PMID: 22317518 DOI: 10.3233/WOR-2012-0804-5152

It is known that many older people have difficulties in performing daily living activities such as cooking. These are due to the demands of the tasks and the changes in functional capabilities of the older people. This study examines cooking tasks performed by the aged that includes preparing and cooking meals, and storing kitchen tools in the kitchen. The objectives are to investigate the cooking difficulties encounter by older people and the safety concerning cooking tasks. This study focuses on individuals of age 65 years and above who can cook for themselves and/or family. Data were collected through observation, interviews, questionnaires and role play methods. The findings revealed that the common problems were due to the awkward body position where subjects had to bend down to take things from lower shelves, taking/storing things on higher shelves and cleaning the cooker. Moreover, the safety concerns were the layout of work centres (storage, cooker and sink), the use of cooker and opening packaging. It can be concluded that cooking difficulties are caused by inappropriate kitchen design and the decline of functional capabilities in older people.

Matched MeSH terms: Aged, 80 and over
Fulltext Hyponatraemia in hospitalised elderly patients

Lim JKH, Yap KB

Med J Malaysia, 2001 Jun;56(2):232-5.
PMID: 11771085

This study aims to investigate the incidence and causes of hyponatraemia in hospitalised elderly patients. There was a total of 407 new patients. 55 (13.5%) patients were found to have at least one episode of hyponatraemia during their hospitalization. There were 58 deaths. Fifteen out of 55 (27.3%) patients who had hyponatraemia died compared to 43 out of 352 (12.2%) normonatraemic patients (chi-square significant, p < 0.01). The three most common causes of hyponatraemia were syndrome of inappropriate antidiuretic hormone secretion (SIADH), poor oral intake and diuretics. The two most common causes of SIADH were lower respiratory tract infection and stroke.

Matched MeSH terms: Aged, 80 and over
Fulltext Two cases of spontaneous pneumoperitoneum without peritonitis

Shahrudin MD

Med J Malaysia, 1993 Dec;48(4):449-52.
PMID: 8183172

Spontaneous pneumoperitoneum without peritonitis is a rare phenomenon which poses a dilemma to the surgeons faced with this problem. Two such cases and their outcome are presented. The first case was caused by tracheal rupture during emergency intubation and was treated by observation until complete resolution. The second case was caused by barotrauma during positive pressure ventilation and was treated by laparotomy. Both patients died for reasons unrelated to the pneumoperitoneum. The passage of air from the chest cavity into the abdominal cavity was along the great vessels in the first case and through the diaphragm in the second. A compilation of other aetiologies of pneumoperitoneum without peritonitis as extracted from the literature is presented. In the presence of pneumoperitoneum without peritonitis and when the clinical history does not suggest visceral perforation, an abdominal tap or lavage should be attempted. If negative, continued observation is advised.

Matched MeSH terms: Aged, 80 and over
Fulltext Postural behaviour of intraocular pressure

Singh M, Chin SSH

Med J Malaysia, 1986 Mar;41(1):38-43.
PMID: 3796346

Raised intraocular pressure (lOP) is generally held responsible for causing visual loss in chronic simple glaucoma. It is therefore desirable that a safe level of lOP be maintained all the time. Elevation of lOP with change of body position has been suggested as one of the factors which result in tissue damage in low tension as well as in primary wide open angle glaucoma. Postural behaviour of lOP was therefore studied in 58 normal and 30 glaucomatous Malaysian eyes. Clinical significance and possible pathogenesis of abnormal postural response of lOP has been discussed. More application of this simple procedure is advocated.

Matched MeSH terms: Aged, 80 and over
Fulltext Choledocholithiasis: diagnosis by ultrasound

Sakijan AS, Atan M

Med J Malaysia, 1987 Jun;42(2):115-8.
PMID: 3332300

The ultrasound findings of 100 patients with chloedocholithiasis documented by cholangiography and/or surgery were reviewed retrospectively. Common duct stones were detected in 45% of patients. This detection rate which is comparable with most series confirmed the lack of reliability of ultrasound in the diagnosis of choledocholithiasis. All the stones detected were in dilated common ducts. The main limiting factor was overlying bowel gas which impair visualisation of the lower part of the common duct. Despite the apparent insensitivity of ultrasound to detect common duct stones, the modality is still a valuable non-invasive screening diagnostic tool, because in positive cases, patients may be spared from invasive cholangiographic procedures.

Matched MeSH terms: Aged, 80 and over
A review of patients with deep vein thrombosis diagnosed at University Hospital, Kuala Lumpur

Liam CK, Ng SC

Ann Acad Med Singap, 1990 Nov;19(6):837-40.
PMID: 2130750

In this retrospective study, 81 patients were diagnosed to have deep vein thrombosis (DVT) at the University Hospital, Kuala Lumpur over a ten year period from 1977 to 1986. Fifty-six patients had their DVT confirmed by venograms. The left side was affected in 79.5% of venographically proven cases of DVT of the lower limbs above the popliteal vein. The incidence of clinically apparent DVT following surgery was 0.21 per 1,000 operations. The incidence of pregnancy-related DVT was 0.039%. DVT was 3 times more frequent in the puerperium than in the antenatal period. The overall incidence of symptomatic pulmonary embolism was 13.6% of the cases of DVT.

Matched MeSH terms: Aged, 80 and over
Orthopantomographic survey of edentulous patients of different age groups in Malaysia

Dias AP, Jiffry MT

Aust Dent J, 1988 Feb;33(1):23-6.
PMID: 3165617
Matched MeSH terms: Aged, 80 and over
Fulltext Percutaneous transluminal coronary angioplasty in the treatment of coronary artery disease--the local experience: a review of 100 cases

Ng SC, Hitam O, Sawat

Med J Malaysia, 1991 Mar;46(1):59-65.
PMID: 1836039

This paper reviews our first 100 consecutive PTCAs done between December 1988 and May 1990. There were 31 females and 69 males and their ages ranged from 37 years to 80 years. The mean age was 57.7 years. We achieved a follow-up rate of 66%. The restenosis rate was 22% of those that we could follow-up. There were 35 simple and 65 complex PTCAs. An average of 1.39 arteries were entered per PTCA. Of the 100 PTCAs done there was a primary success rate of 83%. On closer examination most of the failures were in the total occlusion group. There were 30 total occlusions done and 17 were successfully dilated. The primary success rate for acute total occlusions was 77% and the primary success rate for chronic total occlusions was 41%. Of the 100 PTCAs there were two deaths and only one patient had to go for emergency bypass surgery. The other complications were relatively minor including hypotension, groin bleeding, chills and rigors. This paper documents our initial 100 cases of PTCAs. It shows that our figures are compatible with other centres in this region and those around the world.

Matched MeSH terms: Aged, 80 and over
Fulltext The Current and Future Challenges of Hip Fracture Management in Malaysia

Ong T, Khor HM, Kumar CS, Singh S, Chong E, Ganthel K, et al.

Malays Orthop J, 2020 Nov;14(3):16-21.
PMID: 33403058 DOI: 10.5704/MOJ.2011.004

By 2050, it is predicted that six million hip fractures will occur each year of which the majority will happen in Asia. Malaysia is not spared from this predicted rise and its rate of increase will be one of the highest in this region. Much of this is driven by our unprecedented growth in the number of older people. Characteristics of individuals with hip fractures in Malaysia mirror what has been reported in other countries. They will be older multimorbid people who were already at risk of falls and fractures. Outcomes were poor with at least a quarter do not survive beyond 12 months and in those that do survive have limitation in their mobility and activities of daily living. Reviewing how these fractures are managed and incorporating new models of care, such as orthogeriatric care, could address these poor outcomes. Experts have warned of the devastating impact of hip fracture in Malaysia and that prompt action is urgently required. Despite that, there remains no national agenda to highlight the need to improve musculoskeletal health in the country.

Matched MeSH terms: Aged, 80 and over
Conservative Treatment for Right Ventricular Free Wall Rupture in a Patient with Acute Myocardial Infarction

Firdaus MAM, Rahim NSA, Rusdi N, Idris NS, Mohd Said MR, Abidin IZ

Case Rep Cardiol, 2020;2020:8836627.
PMID: 32774930 DOI: 10.1155/2020/8836627

Ventricular wall rupture possesses a high mortality rate in patients with acute myocardial infarction. We presented a case of a ninety-year-old gentleman who presented with acute inferolateral myocardial infarction in cardiogenic shock and right ventricular free wall rupture. He was treated conservatively and survived.

Matched MeSH terms: Aged, 80 and over
Fulltext The Association of Falls with Instability: An Analysis of Perceptions and Expectations toward the Use of Fall Detection Devices Among Older Adults in Malaysia

Abdul Rahman K, Ahmad SA, Che Soh A, Ashari A, Wada C, Gopalai AA

Front Public Health, 2021;9:612538.
PMID: 33681130 DOI: 10.3389/fpubh.2021.612538

Background: Falls are a significant incident among older adults affecting one in every three individuals aged 65 and over. Fall risk increases with age and other factors, namely instability. Recent studies on the use of fall detection devices in the Malaysian community are scarce, despite the necessity to use them. Therefore, this study aimed to investigate the association between the prevalence of falls with instability. This study also presents a survey that explores older adults' perceptions and expectations toward fall detection devices. Methods: A cross-sectional survey was conducted involving 336 community-dwelling older adults aged 50 years and older; based on randomly selected participants. Data were analyzed using quantitative descriptive analysis. Chi-square test was conducted to investigate the associations between self-reported falls with instability, demographic and walking characteristics. Additionally, older adults' perceptions and expectations concerning the use of fall detection devices in their daily lives were explored. Results: The prevalence of falls was 28.9%, where one-quarter of older adults fell at least once in the past 6 months. Participants aged 70 years and older have a higher fall percentage than other groups. The prevalence of falls was significantly associated with instability, age, and walking characteristics. Around 70% of the participants reported having instability issues, of which over half of them fell at least once within 6 months. Almost 65% of the participants have a definite interest in using a fall detection device. Survey results revealed that the most expected features for a fall detection device include: user-friendly, followed by affordably priced, and accurate. Conclusions: The prevalence of falls in community-dwelling older adults is significantly associated with instability. Positive perceptions and informative expectations will be used to develop an enhanced fall detection incorporating balance monitoring system. Our findings demonstrate the need to extend the fall detection device features aiming for fall prevention intervention.

Matched MeSH terms: Aged, 80 and over
Common combinations of medications used among oldest-old women: a population-based study over 15 years

Thiruchelvam K, Byles J, Hasan SS, Egan N, Cavenagh D, Kairuz T

Aging Clin Exp Res, 2021 Jul;33(7):1919-1928.
PMID: 32909246 DOI: 10.1007/s40520-020-01693-y

BACKGROUND: Older people use many medications, but combinations of medications used among the oldest old (≥ 80 years) are not commonly reported.
AIMS: This study aimed to determine common combinations of medications used among women aged 77-96 years and to describe characteristics associated with these combinations.
METHODS: A cohort study of older women enroled in the Australian Longitudinal Study on Women's Health over a 15-year period was used to determine combinations of medications using latent class analysis. Multinomial logistic regression was used to determine characteristics associated with these combinations.
RESULTS: The highest medication users during the study were for the cardiovascular (2003: 80.28%; 2017: 85.63%) and nervous (2003: 66.03%; 2017: 75.41%) systems. A 3-class latent model described medication use combinations: class 1: 'Cardiovascular & neurology anatomical group' (27.25%) included participants using medications of the cardiovascular and nervous systems in their later years; class 2: 'Multiple anatomical group' (16.49%) and class 3: 'Antiinfectives & multiple anatomical group' (56.27%). When compared to the reference class (class 1), the risk of participants being in class 3 was slightly higher than being in class 2 if they had > 4 general practitioner visits (RRR 2.37; 95% CI 2.08, 2.71), Department of Veterans Affairs' coverage (RRR 1.59; 95% CI 1.36, 1.86), ≥ 4 chronic diseases (RRR 3.16; 95% CI 2.56, 3.90) and were frail (RRR 1.47; 95% CI 1.27, 1.69).
CONCLUSION: Identification of combinations of medication use may provide opportunities to develop multimorbidity guidelines and target medication reviews, and may help reduce medication load for older individuals.

Matched MeSH terms: Aged, 80 and over
Bullous pemphigoid with neurofibroma-like histopathological change in two patients without neurofibromatosis type 1: Coincidence or association?

Shiomi T

Malays J Pathol, 2020 Dec;42(3):445-448.
PMID: 33361727

The author reports two cases of Bullous pemphigoid (BP) with neurofibroma (NF)-like histopathological change. The two patients without neurofibromatosis type 1 (NF1) presented with several bullae on their trunk. Based on the results of positivity for anti-BP180 antibody, direct immunofluorescence, and histopathological findings, they were diagnosed with BP. Histologically, another lesion in the dermis, which was composed of spindle cells with wavy nuclei, collagen fibers, and mast cells, was located close to the bulla. Immunohistochemically, the spindle cells were diffusely positive for S-100 protein and CD34, and weakly positive for epithelial membrane antigen in certain foci. These findings were considered to be "NF-like" histopathological change. This is the first two cases of BP with NF-like histopathological change in patients without NF1.

Matched MeSH terms: Aged, 80 and over

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