The patella is an uncommon site for all primary and metastatic bone tumours and primary intra-osseous tumours of the patella are very rare. A majority of the patella tumours are benign. We report a patient with a sudden onset swelling and pain of the right knee following a staircase fall. The plain radiograph showed an expansile multiseptated patella lesion and it was further assessed with an MRI. The radiological findings and the initial histopathological features from a limited sample were suggestive of a primary aneurysmal bone cyst. However, the final histopathological diagnosis from a more adequate specimen was a giant cell tumour with a secondary aneurysmal bone cyst.
Enteroenteric intussusception is a condition in which the full-thickness bowel wall becomes telescoped into the lumen of distal bowel. Intussusception in adult occurs infrequently and varies from childhood intussusception, particularly in its presentation, aetiology and treatment. Duodenoduodenal intussusception is rare because the duodenum is fixed in the retroperitoneal position. It usually occurs secondary to tumour, lipoma, Brunner's gland hamartomatous polyp or adenoma. The diagnosis in adults is usually made at laparotomy, where presentation is with intestinal obstruction. In non-emergency presentation, it may be difficult to arrive at an accurate diagnosis as symptoms may be vague, self-limiting intermittent abdominal pain. Clinical examinations and investigations may not be conclusive and another working diagnosis such as irritable bowel syndrome would be made. We describe a case where a patient initially presented with symptoms mimicking pancreatitis but his symptoms persisted over the course of 2 weeks. When a laparotomy was performed, duodenoduodenal intussusception was discovered and confirmed with histopathology. In this case, a discernible leading point could not be identified.
In Islam, the person with somatic sex ambiguity due to a disorder of sex development (DSD), such as 46,XX congenital adrenal hyperplasia or 46,XY androgen insensitivity, is recognized as khunsa. Two types of khunsa are distinguished: wadhih (discernible) and musykil (intractable). A recent fatwa (religious edict) in Malaysia decreed that it is permissible for male-assigned patients from these two groups to have gender reassignment surgery to female following diagnosis; however, the religious authority has yet to rule on the reassignment from female to male, if requested. The different schools of law in Islam agree on some aspects of gender-related issues like the position of khunsa in prayer congregations, but differ in their opinions on others such as property inheritance and bathing rituals. For purposes of illustration, this article includes three case reports on Muslim patients with DSD in Malaysia, focusing on issues of gender assignment: (1) a patient with 46,XX CAH, assigned as female, requesting reassignment to male; (2) a patient with 46,XX CAH, assigned female, and gender dysphoric, but undecided on the gender to be; and (3) a patient with 46,XY complete gonadal dysgenesis, raised female due to her phenotype at birth, diagnosed late, at age 18 years, and content to remain female. Gender-related issues from the perspective of Islamic jurisprudence are highlighted and discussed. To ensure holistic care, health-service providers involved in the care of Muslim patients with DSDs need to be aware of the Islamic perspectives on gender-related issues and involve expert religious authorities.
A reading chart that resembles real reading conditions is important to evaluate the quality of life in terms of reading performance. The purpose of this study was to compare the reading speed of UiTM Malay related words (UiTM-Mrw) reading chart with MNread Acuity Chart and Colenbrander Reading Chart.
Tonsillectomy is a very common procedure in Otolaryngology practice. Common complications include
bleeding, which can be primary or secondary due to infection of the tonsillar bed. Subcutaneous emphysema
after a tonsillectomy is very rare. We report a 19-year-old girl who developed cervicofacial subcutaneous
emphysema several hours after tonsillectomy with successful conservative treatment outcome.
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
An analytical cross-sectional study was conducted in a public university in Kuala Lumpur among a random sample of 2665 undergraduates. The objective was to study the prevalence of breakfast skipping and its associated factors. Data collection was conducted via a self-administered pre-tested questionnaire. There were 43.5% male respondents, with Malays being the majority (58.3%). The prevalence of breakfast skipping was 29.2 (95% CI: 27.3 - 30.3)%. The factors significantly associated with breakfast skipping (p<0.05) were age, race, accommodation, faculty and skipping dinner. As the respondents' age increased, their risk of breakfast skipping was lower (OR: 0.95; 0.89 - 0.99). Malays (OR: 1.94; 1.48 - 2.54), Indians (OR: 1.70; 1.08 - 2.66), and students from the Sabah and Sarawak indigenous communities (OR: 2.13; 1.37 - 3.33) were more likely to skip breakfast compared to their Chinese counterparts. Respondents who stayed in their own houses were also less likely to skip breakfast compared to those staying in hostel with meals catered (OR: 2.32; 1.39 - 3.84), hostel with cafeteria (OR: 2.92; 1.74 - 4.91) or in rented houses (OR: 2.08; 1.25 - 3.46). Respondents majoring in Arts and Economics had 1.40 (1.07 - 1.82) times risk of breakfast skipping compared to those majoring in Life Sciences. Those who skipped dinner too had twice the odds (1.47 - 2.77) of breakfast skipping. In conclusion the prevalence of breakfast skipping among the undergraduates of this university was moderately high. Health awareness campaigns or introduction of healthy eating guidelines should be initiated for the undergraduates as well as food caterers in campus. The policy and pricing of catered food in campus should also be reviewed.
In face-to-face communications, to avoid sanctions and disapproval from others, people are more likely to hide negative aspects of their true self (such as socially undesirable personalities, minds, beliefs and consciousness) to avoid conflict with social norms and laws. The anonymity of cyberspace provides people a unique environment to behave more freely and openly with less restraint from the real word. Existing research related to online true self expression has mainly explored true self as an independent aspect of self. Regarding true self as a two-dimensional concept, this study investigates true self from the perspective of individuals' self-guide and identity reconstruction in both online and offline world. Using qualitative research methods, the current study investigates 57 participants through interviews and questionnaires. Content analysis reveals four factors that motivate people to express more true self (especially negative true self) when reconstructing their online identity and involve true self as a part of their self-guide in anonymous environment. By incorporating true self as an important part of individuals' self-guide and identity online, the current study advances self-discrepancy theory, making it more comprehensive for cyberspace. The results are also interpreted based on self-determination theory. The theoretical contributions of this study are discussed and practical implications are also presented.
Haemothorax is one of the less common presentations that requires hospital admission. Most cases are associated with underlying causes, but there is such an entity called spontaneous haemothorax. Spontaneous haemothorax is commonly associated with adhesions within the pleural cavity. Here, we reported two cases of young adults who presented with massive spontaneous haemothorax and required emergency thoracotomy for haemostasis purpose.
BACKGROUND AND AIMS: Acne is a common skin disorder which can cause physical scaring and impact the quality of life. The aim of this study is to determine the prevalence, severity and the risk factors for developing acne among medical students in Universiti Kebangsaan Malaysia (UKM).
MATERIALS AND METHODS: A cross sectional study among UKM medical students from academic year 1 to 5 was conducted from July 2011 to May 2012. A total of 361 students were selected by stratified cluster sampling method. Baseline data of the students, risk factors, height and weight were recorded. Acne severity was graded using the Comprehensive Acne Severity Scale (CASS).
RESULTS: The prevalence of acne among medical students is 68.1% (n=246). Males and females were almost equally affected (1:1.1). Majority students with acne were graded as almost clear (55.7%, n=137), mild (35.0%, n=86), moderate (7.7%, n=19), and severe (1.6%, n=4). More than half of them had developed acne scars (59.0%, n= 213). Males were found to be at higher risk of developing acne compared to females (p<0.05, OR=4.734; 95%CL=2.726-8.222). They are also at higher risk of developing moderate and severe grades of acne compared to females (p=0.001). The odds for developing acne was higher when mother (p=0.029; OR=1.752; 95%CL=1.058-2.902) or father (p=0.027; OR=1.852; 95%CL=1.072-3.201) had acne. When both parents were affected by acne the odds of developing acne was 3 times. (p=0.025; OR=3.056; 95%CL=1.153-8.094).
CONCLUSIONS: This study shows that the prevalence of acne among medical students is high. Hence, it is important to identify those at risk and provide optimal treatment to prevent scarring and possible low self esteem among these future doctors.
KEYWORDS: acne vulgaris; medical; prevalence; risk factors; severity; students
Memory performance is usually impaired when participants have to encode information while performing a concurrent task. Recent studies using recall tasks have found that emotional items are more resistant to such cognitive depletion effects than non-emotional items. However, when recognition tasks are used, the same effect is more elusive as recent recognition studies have obtained contradictory results. In two experiments, we provide evidence that negative emotional content can reliably reduce the effects of cognitive depletion on recognition memory only if stimuli with high levels of emotional intensity are used. In particular, we found that recognition performance for realistic pictures was impaired by a secondary 3-back working memory task during encoding if stimuli were emotionally neutral or had moderate levels of negative emotionality. In contrast, when negative pictures with high levels of emotional intensity were used, the detrimental effects of the secondary task were significantly attenuated.
The present article reports two experiments examining the impact of recollecting emotionally valenced autobiographical memories on subsequent working memory (WM) task performance. Experiment 1 found that negatively valenced recollection significantly disrupted performance on a supra-span spatial WM task. Experiment 2 replicated and extended these findings to a verbal WM task (digit recall), and found that both negative and positive autobiographical recollections had a detrimental effect on verbal WM. In addition, we observed that these disruptive effects were more apparent on early trials, immediately following autobiographical recollection. Overall, these findings show that both positive and negative affect can disrupt WM when the mood-eliciting context is based on autobiographical memories. Furthermore, these results indicate that the emotional disruption of WM can take place across different modalities of WM (verbal and visuo-spatial).
Reduced fetal movement is a worrisome common complaint, not only for mothers but also for the attending medical personnel. The aim of this study was to analyse the pregnancy outcomes of women who presented primarily with reduced fetal movements (RFM). A retrospective study was performed based on patients' perception alone. Obstetric, past medical history, current presentation and outcomes of pregnancy were analysed. A total of 230 case notes were reviewed, with the majority being primigravidae. Less than half (48.7%) of the women had spontaneous labour, 45.7% had induction and 5.6% had elective caesarean section. There were no maternal complications in 97.4% (n = 224) of them. About 0.9% (n = 2) and 1.7% (n = 4) had primary postpartum haemorrhage and extended perineal tear, respectively. Although there was no major neonatal mortality and morbidity, until a randomised trial with a significant sample is conducted in the management of RFM, careful selections for elective delivery or conservative management would prevent untoward complications.
Prosthesis suspension systems can alter the distribution of pressure within the prosthetic socket. This study evaluates a new suspension system for lower limb prostheses, and aims to compare the interface pressure and amputees' satisfaction with the new system compared with a common prosthetic suspension system (pin/lock).
An increase in the consumption of smokeless tobacco has been noticed among high school, college students, and adults. Despite the antiquity and popularity of chewing tobacco in India, its effects have not been investigated systematically in humans. The aim of this study was to investigate acute effects of gutkha chewing on heart rate variability (HRV) among healthy young adults.