Although more Malaysians are taking part in International Multisport Games, these athletes well-being at such events have not been fully explored. The purpose of this study was to examine the pattern of injury and illness among Malaysian athletes during the XVII Asian Games 2014. Clinical and socio-demographic information of athletes diagnosed with injury or illness during the centralised training camp and at the Games were recorded in a standardised report form. Throughout the study period, 83 injuries and 64 illnesses were recorded from 276 athletes. Muscle strains and tears were the most common injury followed by ligamentous injury and soft tissues contusion. The number of injuries was highest among badminton players followed by hockey and rugby. Significantly higher incidence of injuries was observed among men than women hockey players. Athletes in individual events had higher proportion of more severe injury than those in team events. Respiratory tract infection was the most frequent illness diagnosed among athletes. Most injuries and illnesses diagnosed among athletes were minor and did not result in time away from participation. The incidence of injuries and illnesses among Malaysian athletes at the XVII Asian Games were comparable with those reported by previous authors. Injury and illness rate were influenced by gender and sports. Fortunately, majority of injuries and illnesses were minor and did not prevent athletes from participation.
We hereby present a case of planned complex suicide. In this case study, we report a teen-aged girl who committed suicide by strangulating herself, and subsequently fell from the 13th floor of a housing apartment. The planned complex suicide was substantiated by the presence of a suicide note and a photograph captured in a mobile handset. To the best of our knowledge, it is the first case involving self-strangulation and fall from height, in which the photograph was stored in the handset. This is to further emphasize that objects like mobile handsets can be important in determining the cause and manner of death. The available evidence at the site of incident should be explored meticulously in order to arrive at a proper conclusion.
Thirty one patients were investigated for the main complaint of easy bruising. These patients had normal platelet count with no past history of immune thrombocytopenia or systemic disorders known to predispose to bruising and a negative drug history. The evaluation of these patients included clinical review (history and physical examination) plus coagulation tests consisting of bleeding time, prothrombin time, partial thromboplastin time, thrombin time, fibrinogen level, FXIII screen and platelet functions test. Seven of the paediatric patients had acquired platelet dysfunction with eosinophilia (APDE). In 17 (94.4%) of the 18 adult patients no abnormality was demonstrated. Hence APDE was the commonest cause of easy bruising in children while the haemostatic defect contributing to easy bruising in adults remained unknown.
Kerokan is a traditional Indonesian treatment involving abrading the skin over various parts of the body with a blunt object such as a coin or a piece of ginger which may create suspicious injuries. Here, the case of a 30-year-old woman who had undergone kerokan therapy is reported. She was complaining of retro-sternal pain and epigastric discomfort and subsequently became markedly short of breath and died. The observation of injuries predominantly located around the neck initiated a police investigation and forensic autopsy. Scattered abrasions, blisters and bruises were present on the forehead, the bridge of the nose extending to the ala, the upper and anterior aspect of the chin and the sternal notch, with discrete fresh and scabbed abrasions around the neck, over the sternum and on the backs of both hands. There were, however, no facial or conjunctival petechiae and no bruising of the underlying strap muscles, or fractures of the hyoid bone or thyroid cartilage. Histology revealed that myocarditis was the cause of death. Traditional practices may cause unusual bruises, abrasions, blisters and burns that may raise suspicion of inflicted injury from an assault. Knowledge of the manifestations of socio-ethnic practices such as kerokan is important in the evaluation of trauma in specific cultural groups.
The clinical diagnosis of snakebite is critical, particularly in Southeast Asia where venomous snakebites are a public health concern. Additionally, cases involving unwitnessed snakebite with no species identification, especially in non-verbal children posed a challenge in the emergency setting. A 2-year-2-month-old boy presented to our emergency department with signs of neurotoxicity. He was restless and mildly bradypnoeic with the respiratory rate of 24 to 28 breaths per minute. He also had bilateral ptosis with absent gag reflex. There were faint fang marks noted over the medial aspect of his left ankle with local swelling and bruises, despite no history of animal bite and no eyewitness. A high index of suspicion of neurotoxic envenomation was prompted and a total of 6 vials of neuro-polyvalent anti-venom were administered in scheduled batches. Progressive clinical recovery was subsequently observed after the first batch of anti-venom administration. The case illustrated the importance of clinical recognition of neurotoxic envenomation in the absence of snake bite history or species identification. Early administration of anti-venom may potentially reverse the neurotoxic effects of systemic envenomation and saves lives.
Introduction: Violence Against Women has increasingly been recognized in the international areas as an obstacle to women’s development and it may have a myriad of devastating consequences on women’s long or short- term health and wellbeing. The study explored the highlight the prevalence and health effects of Violence Against Women which might reflect the probable causes, the types of injuries, leading factors and consequences of the violence. Methods:Hospital based case study, which was referred to forensic department, Mandalay General Hospital from 1st Jan 2000 to 30th Sept 2000. Personal interview and medical examination of 50-100 victims, girls & women, who were phys-ically and sexually violated was done. Results: Total 92 patients were interviewed and examined, prevalence of dif-ferent age ranging from 5 to 56, were physically and sexually violated during the study period, 62 patients were phys-ically assaulted, and 30 victims were sexually violated. 20-40 age group is more commonly conflicted by physical violence 69.3%) while 10-20 age group were commonly conflicted by sexual violence (56.6%). Pattern of different types of injury and locations are also recorded as a consequence of physical assault and commonest injury is bruise (47%). Commonest location is injury over head & neck (61.8%). Relationship to perpetrator were recorded, physical assaults were commonly by spouse (39%) while sexual assaults were acquaintance (58%). Events leading to violence at home are recorded as nuclear family and alcohol consumption is more common, fights were most common events in community setting. Conclusion: Violence Against Women is neither prevalent nor uncommon in Myanmar. In this study, all forms of injuries were recorded and among them the commonest injuries were bruises, the event leading to violence recorded as fights, alcohol consumption, nuclear family was most common. Violence has a psychological impact on other members of the family, particularly children. However, a multi-sectoral approach has become a necessity to create a happy family, society and nation. It could be achieved by uplifting the socio-economic status of the family, practising the religious teachings and abiding within the framework of the laws. The Trans-National Committed should be formed to effectively minimize trafficking in women and children in the Region.
An 11-year-old Malay boy was allegedly involved in motor vehicle accident. He sustained left lung contusion and pneumothorax which necessitate chest tube insertion at a district hospital. On arrival at Accident & Emergency Unit, general physical examination was performed. Neck examination revealed multiple jagged lacerations wound on the left side of the neck (Panel 1). (Copied from article).
Scurvy resulting from dietary deficiency of vitamin C is characterized by anaemia, tender limbs swelling and hemorrhagic manifestations such as petechiae and bruises. We report a case of scurvy in a 13 years old boy with cerebral palsy who presented with history of limbs bruising and swelling for 2 months. On examination, he was cachexic and pale with poor dentition and swollen gum. There were extensive bruises and swollen limbs as well. His platelet count and coagulation profile were normal. Limbs X-ray revealed classical scorbutic changes in the long bones. Serum ascorbic acid level was low
A teenager college student was fatally injured by burst tyre air pressure while waiting on a public bus stand to catch a bus to reach her college at Kuala Lumpur. She accidentally came near the wheel while boarding when tube and tyre got burst .The air pressure had blown the girl in the air and she subsequently fell on a rough surface. The iron-locking rim of the wheel acted as a missile and hit the girl. She died on her way to the hospital. A medico-legal autopsy was performed which showed extensive injuries in the cranial and chest cavity. Head had large scalp laceration with diffuse separation and gaping from in the vault region; skull bones were fractured. Chest cavity had extensive rib fractures, lacerated lungs and haemo-thorax while externally there was no obvious injury. It requires intensive care management and screening of the victims. Tyre-blast injuries are not so common. This case exposes the hazard due to burst tyre.
A seven years retrospective study was performed in 45 consecutive vascular injuries in the extremities to investigate the pattern of injuries, managements and outcomes. Motor-vehicle accidents were the leading cause of injuries (80%), followed by industrial injuries (11.1%) and iatrogenic injuries (4.4%). Popliteal and brachial artery injuries were commonly involved (20%). Fifteen (33.3%) patients had fractures, dislocation or fracture dislocation around the knee joint and 6 (13.3%) patients had soft tissue injuries without fracture. Traumatic arterial transection accounted for 34 (75.6%) cases, followed by laceration in 7 (15.6%) and 9 (6.7%) contusions. Associated nerve injuries were seen in 8 (17.8 %) patients using intra-operative findings as the gold standard, both conventional angiogram (CA) and computerized tomography angiogram (CTA) had 100% specificity and 100% sensitivity in determining the site of arterial injuries. The mean ischemic time was 25.31 hours (4 - 278 hours). Thirty-three (73.3 %) patients were treated more than 6 hours after injury and 6 patients underwent revascularization after 24 hours; all had good collateral circulation without distal pulses or evidence of ischemic neurological deficit. The mean ischemic time in 39 patients who underwent revascularization within 24 hours was 13.2 hours. Delayed amputation was performed in 5 patients (11.1%). Of the 6 patients who underwent delayed revascularization, one patient had early amputation, one -had delayed amputation following infection and multiple flap procedures while the rest of the patients' limbs survived. Joint stiffness was noted in 10 patients (22.2%) involving the knee joint, elbow and shoulder in two patients each. Infection was also noted in 5 patients (11.1%) with two of them were due to infected implants. Other complications encountered included nonunion (2 patients, 4.4%), delayed union (1 patient, 2.2%),limb length discrepancy (1 patient, 2.2%), hematoma (1 patient, 2.2%) and leaking anastomosis in one patient (2.2%). Volkmann's ischemic contracture occurred in 3 (6.7%) patients. There was no complication noted in 8 (17.8%) patients Three patients (6.7%) died of whom two were not due to vascular causes. We conclude that early detection and revascularization of traumatic vascular injuries is important but delayed revascularization also produced acceptable results.
The occurrence of axillary artery injury following proximal humerus fracture dislocation in elderly patient with low velocity fall is uncommon. The patient could have diverse clinical presentations in spite of intact peripheral pulses. We report the case of an 85-year-old lady who presented to our emergency department with greater tuberosity fracture of the humerus with dislocation of the right shoulder. After closed manipulative reduction of the dislocation, it was observed that the patient had brachial plexus palsy with intact radial pulse. An expanding swelling and bruise around the shoulder was noted and a steady drop in haemoglobin level. CT angiogram revealed avulsion of the posterior circumflex artery which was then treated successfully with stenting.
OBJECTIVE: The objective of this prospective cohort study was to analyse the characteristics of severe Traumatic Brain Injury (TBI) in a regional trauma centre Hospital Kuala Lumpur (HKL) along with its impact of various prognostic factors post Decompressive Craniectomy (DC).
MATERIALS AND METHODS: Duration of the study was of 13 months in HKL. 110 consecutive patients undergoing DC and remained in our centre were recruited. They were then analysed categorically with standard analytical software.
RESULTS: Age group have highest range between 12-30 category with male preponderance. Common mechanism of injury was motor vehicle accident involving motorcyclist. Univariate analysis showed statistically significant in referral area (P = 0.006). In clinical evaluation statistically significant was the motor score (P = 0.040), pupillary state (P = 0.010), blood pressure stability (P = 0.013) and evidence of Diabetes Insipidus (P < 0.001). In biochemical status the significant statistics included evidence of coagulopathy (P < 0.001), evidence of acidosis (P = 0.003) and evidence of hypoxia (P = 0.030). In Radiological sector, significant univariate analysis proved in location of the subdural clot (P < 0.010), location of the contusion (P = 0.045), site of existence of both type of clots (P = 0.031) and the evidence of edema (P = 0.041). The timing of injury was noted to be significant as well (P = 0.061). In the post operative care was, there were significance in the overall stability in intensive care (P < 0.001), the stability of blood pressure, cerebral perfusion pressure, pulse rates and oxygen saturation (all P < 0.001)seen individually, post operative ICP monitoring in the immediate (P = 0.002), within 24 hours (P < 0.001) and within 24-48 hours (P < 0.001) period, along with post operative pupillary size (P < 0.001) and motor score (P < 0.001). Post operatively, radiologically significant statistics included evidence of midline shift post operatively in the CT scan (P < 0.001). Multivariate logistic regression with stepwise likelihood ratio (LR) method concluded that hypoxia post operatively (P = 0.152), the unmaintained Cerebral Perfusion Pressure (CPP) (P = 0.007) and unstable blood pressure (BP) (P = <0.001). Poor outcome noted 10.2 times higher in post operative hypoxia [OR10.184; 95% CI: 0.424, 244.495]. Odds of having poor outcome if CPP unmaintained was 13.8 times higher [OR: 13.754; CI: 2.050, 92.301]. Highest predictor of poor outcome was the unstable BP, 32 times higher [OR 31.600; CI: 4.530, 220440].
CONCLUSION: Our series represent both urban and rural population, noted to be the largest series in severe TBI in this region. Severe head injury accounts for significant proportion of neurosurgical admissions, resources with its impact on socio-economic concerns to a growing population like Malaysia. This study concludes that the predictors of outcome in severe TBI post DC were postoperative hypoxia, unmaintained cerebral perfusion pressure and unstable blood pressure as independent predictors of poor outcome. Key words: Decompressive craniectomy, prognostication of decompressive craniectomy, prognostication of severe head injury, prognostication of traumatic brain injury, severe head injury, severe traumatic brain injury, traumatic brain injury.
KEYWORDS: Decompressive craniectomy; prognostication of decompressive craniectomy; prognostication of severe head injury; prognostication of traumatic brain injury; severe head injury; severe traumatic brain injury; traumatic brain injury