Showing papers in "The Malaysian journal of medical sciences in 2010"
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TL;DR: The prevalence of stress among medical students in USM is high and year of study was the factor most significantly associated with medical students' stress.
Abstract: Background: Being in medical school has always been regarded as highly
stressful. Excessive stress causes physical and mental health problems.
Persistent stress can impair students’ academic achievement and
personal or professional development. The aim of this study is to
explore the nature of stress among medical students by determining the
prevalence, sources and pattern of stress and the factors affecting it.
Methods: We chose a cross-sectional study design utilizing validated
questionnaires, the 12 items General Health Questionnaire (GHQ-12) and
Medical Student Stressor Questionnaire (MSSQ), to evaluate stress
levels and stressors. School and ethical committee clearance were
obtained prior to the study. Data were analysed using SPSS version 12.
Results: Of the medical students who were administered the
questionnaire, 761 (72%) respondents participated in this study. The
prevalence of stress among the medical students was 29.6%. The top 10
stressors were academic-related. Prevalence of stress for the first,
second, third, fourth and fifth year students was 26.3%, 36.5 %, 31.4%,
35.3% and 21.9%, respectively. Year of study was the only significant
factor affecting stress among medical students (P-value < 0.05).
Conclusions: The prevalence of stress among medical students in USM is
high. Academic related problems were the major stressor among medical
students. Year of study was the factor most significantly associated
with medical students’ stress. There was a bimodal pattern of the
stress level throughout the year of study.
242 citations
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TL;DR: This pilot study revealed that Big Sib students perceived a positive learning environment at the School of Medical Sciences, USM and identified some low-scored areas that require further exploration to pinpoint the exact problems.
Abstract: Background: A cross-sectional descriptive study was conducted among Big Sib students to explore their perceptions of the educational environment at the School of Medical Sciences, Universiti Sains Malaysia (USM) and its weak areas using the Dundee Ready Educational Environment Measure (DREEM) inventory. The DREEM inventory is a validated global instrument for measuring educational environments in undergraduate medical and health professional education. Method: The English version of the DREEM inventory was administered to all Year 2 Big Sib students (n = 67) at a regular Big Sib session. The purpose of the study as well as confidentiality and ethical issues were explained to the students before the questionnaire was administered. Results: The response rate was 62.7% (42 out of 67 students). The overall DREEM score was 117.9/200 (SD 14.6). The DREEM indicated that the Big Sib students’ perception of educational environment of the medical school was more positive than negative. Nevertheless, the study also revealed some problem areas within the educational environment. Conclusion: This pilot study revealed that Big Sib students perceived a positive learning environment at the School of Medical Sciences, USM. It also identified some low-scored areas that require further exploration to pinpoint the exact problems. The relatively small study population selected from a particular group of students was the major limitation of the study. This small sample size also means that the study findings cannot be generalised.
66 citations
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TL;DR: The results suggested that PDE exhibits antidiabetic and antilipaemic effects in alloxan-induced diabetic rats.
Abstract: Background: The antidiabetic and antilipaemic effects of Phoenix
dactylifera leaf extract (PDE) and its fractions were investigated in
various rat models. Methods: Diabetes was induced in male Wistar rats
by alloxan monohydrate. Diabetic animals were randomly divided into 8
groups (1 diabetic control and 7 treated groups). Diabetic control
animals received saline (5 mL/kg) orally, whereas the treatment groups
received different doses of PDE (100, 200, and 400 mg/kg), PDE
fractions (50, 100, and 200 mg/kg), or glibenclamide (4 mg/kg) orally
once a day for 14 days. Blood was withdrawn for glucose determination
on the 1st, 6th, 10th, and 14th days. The rats were fasted overnight
and then sacrificed on the 14th day; blood was collected for
biochemical evaluation, including the levels of blood glucose, plasma
insulin, serum triglyceride, and cholesterol. Results: Subacute
administration of PDE or its fractions in alloxan-induced diabetic rats
significantly reduced blood glucose (P < 0.01). Water intake, serum
triglyceride, and cholesterol also decreased in treated animals
compared with the control group (P < 0.01). Plasma insulin level
increased in the treated groups relative to the control group (P <
0.01). Conclusion: The results suggested that PDE exhibits antidiabetic
and antilipaemic effects in alloxan-induced diabetic rats.
51 citations
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TL;DR: The reliability and validity of a Malay version of a questionnaire assessing breastfeeding knowledge is determined and the breastfeeding knowledge level among respondents is described.
Abstract: Background: There is a need to identify the knowledge that mothers have
about breastfeeding to help promote it. Therefore, it is important to
develop a valid and reliable questionnaire to provide useful and
comparable data about breastfeeding knowledge. The objectives of this
study were to determine the reliability and validity of a Malay version
of a questionnaire assessing breastfeeding knowledge and describe the
breastfeeding knowledge level among respondents. Methods: A
cross-sectional study was conducted from 1 January to 31 May 2008 among
female staff working at the Universiti Sains Malaysia Health Campus. A
self-administered questionnaire containing 53 items assessing
breastfeeding knowledge was given to respondents. The questions were
adapted and modified from a breastfeeding questionnaire developed by a
team of Hospital Universiti Sains Malaysia paediatric nurses.
Exploratory factor analysis, internal consistency reliability, and
descriptive analysis of respondents’ knowledge were conducted.
Results: A total of 252 female staff participated in the study. Factor
analysis constructed 10 domains of knowledge and excluded 6 items,
leaving 47 items in the final questionnaire. Cronbach’s alpha of
the final questionnaire was 0.77. Respondents’ lowest knowledge
was on the practical aspects of breastfeeding. Conclusion: The
questionnaire is reliable and valid to assess the breastfeeding
knowledge of Malaysian women.
40 citations
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TL;DR: The observations suggest that Pio+Met combination reduced nuclear damage and sperm abnormalities by enhancing the antioxidant status in the diabetic animals.
Abstract: Background: Oxidative stress due to improper control of blood glucose
in chronic diabetes plays a major role in the development of secondary
complications including cancer and birth defect. the aim of this study
is to evaluate the protective effect of combination of pioglitazone
with metformin or glimepiride against the experimental type-2 diabetes
induced nuclear damage and reproductive toxicity in rats. Methods: The
combinations of Pioglitazone (Pio-1 mg/kg) with metformin (Met-50
mg/kg) or glimepiride (Gmp-0.2 mg/kg) given orally daily for 4 weeks
were tested against nicotinamide (nA- 230 mg/kg, ip)-streptozotocin
(StZ-65 mg/kg, ip)-induced micronuclei (Mn) formation and sperm
abnormalities in male Wistar rats. the antioxidant status was evaluated
by measuring the levels of serum lipid peroxidation (LPO), catalase
(CAt) and superoxide dismutase (SOD). Results: The administration of
Pio+Met significantly (P<0.01) reduced the number of micronucleated
erythrocytes, increased the polychromatic: normochromatic erythrocytes
(P/n ratio), reduced (P<0.001) sperm morphology defects and
increased (P<0.05) the caudal sperm count compared to the untreated
diabetic condition. Furthermore, the Pio+Met combination enhanced the
antioxidant status in diabetic animals. However, Pio+Gmp did not
attenuate the nuclear and sperm defects or oxidative stress.
Conclusions: The observations suggest that Pio+Met combination reduced
nuclear damage and sperm abnormalities by enhancing the antioxidant
status in the diabetic animals.
39 citations
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TL;DR: ABO incompatibility is twice as common as Rh incompatibility and the majority of kernicterus patients died in the acute phase, according to this study.
Abstract: Background: Kernicterus occurs in infants around the world. This study
examined the outcomes of various treatments for neonatal
hyperbilirubinemia (NH) used in the Khulna Medical College Hospital in
Bangladesh. Methods: All of the jaundiced newborns in the neonatal ward
between 2005 and 2008 were included in the study. Total serum bilirubin
and fractional levels were measured in all cases, regardless of the
degree of jaundice. NH was classified as mild, moderate or severe
depending on the bilirubin level; mild NH was treated with a sunbath,
moderate NH was treated with phototherapy, and severe NH was treated
with exchange transfusion. Results: Of 1981 neonates, 426 (22%) were
diagnosed with NH. Physiological jaundice (26.7%) was most common,
followed by the jaundice of prematurity (20.9%). Haemolytic jaundice
was primarily caused by ABO incompatibility (11.3%) and Rh
incompatibility (5.4%). Exchange transfusion (ET) was performed in 22
patients; four (18.2%) died as a result of hazards that could have been
avoided with skilled monitoring. Twelve (2.8%) individuals with
jaundice died. Kernicterus developed in nine (2.1%) children, four of
whom survived with neurological sequelae. Conclusion: ABO
incompatibility is twice as common as Rh incompatibility. The majority
of kernicterus patients died in the acute phase.
36 citations
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TL;DR: A 1-year-old boy with a history of exomphalos and hydrocephalus had surgeries to correct these pathologies and presented with protrusion of the distal VP shunt tip from the mouth due to perforation through the gastrointestinal tract.
Abstract: A 1-year-old boy with a history of exomphalos and hydrocephalus had surgeries to correct these pathologies the ventriculopleural (VP L ) shunt inserted for hydrocephalus was complicated by pleural effusion, for which a ventriculoperitoneal (VP) shunt was inserted on the contralateral side He subsequently presented with protrusion of the distal VP shunt tip from the mouth due to perforation through the gastrointestinal tract the child also had a history of peritonitis post-exomphalos repair, which may have predisposed him to this relatively uncommon shunt complication Probable causes and risk factors of the perforation are discussed
29 citations
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TL;DR: The technique of subgaleal tunnelling of more than 5cm and the duration of the ventricular catheterisation of 10 days and less should be implemented as standardised protocol at health institutions to reduce the risk of EVD-related infections.
Abstract: Background: External ventricular drainage (EVD) has been widely used
for the purpose of cerebrospinal fluid (CSF) diversion at Hospital
Kuala Lumpur (HKL). Methods: This prospective observational study was
conducted in HKL from December 2006 to December 2008 among patients who
were subjected for EVD, following strict inclusion and exclusion
criteria. Results: The frequency of EVD-related infection was as high
as 32.2% (95% CI 23.3% to 42.57%) among 87 patients studied. This study
clearly demonstrates that tunnelling the catheter for more than 5 cm
under the scalp, from the burr hole to the exit site of the skin,
carried a significantly lower risk of infection compared with
tunnelling the catheter for 5 cm or less (OR = 0.184, 95% CI 0.083 to
0.406, P < 0.001). The majority of cases (19 out of 28) with
EVD-related infection occurred among patients catheterised for more
than 10 days (OR = 0.334, 95% CI 0.171 to 0.652, P < 0.001).
Conclusion: The technique of subgaleal tunnelling of more than 5cm and
the duration of the ventricular catheterisation of 10 days and less
should be implemented as standardised protocol at health institutions
to reduce the risk of EVD-related infections.
29 citations
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TL;DR: A case that is encountered of ketamine-associated ulcerative cystitis is reported and the diagnosis and disease management are discussed, in addition to a review of the literature.
Abstract: Ketamine can be abused as a recreational drug, and there has been a
recent surge in its usage. The effects of ketamine on the urinary
system were unknown until the recent publication of a few case reports.
Many doctors are still unaware of this new clinical entity, termed
ketamine-associated ulcerative cystitis. We report a case that we
encountered and discuss the diagnosis and disease management in
addition to a review of the literature.
28 citations
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TL;DR: The ocular manifestations of HIV and AIDS-related patients who had been admitted to TM Jafferji Hospital, Dar-es-Salaam, Tanzania were described to describe the late stages of HIV.
Abstract: Background: Although around 70% of HIV+ cases used to have ocular
manifestations, the late reporting of cases often results in severe
forms of ocular morbidity that would otherwise have been prevented. The
objective of this study was to describe the ocular manifestations of
HIV and AIDS-related patients who had been admitted to TM Jafferji
Hospital, Dar-es-Salaam, Tanzania. Methods: Proven cases of HIV were
recruited in this study. Detailed slit lamp examination and fundoscopy
using a +90D lens were carried out in all cases after thoroughly
dilating the pupil with 1% tropicamide eye drops. Results: Around 90%
of the recruited cases were in clinical stage III and IV HIV. The
notable ocular manifestations included micro-vasculopathy of the retina
in 25%, uveitis in 8%, CMV retinitis in 7%, neuro-ophthalmic
manifestation in 6%, Herpes zoster ophthalmicus in 5%, Kaposi’s
sarcoma in 3% and conjunctival carcinoma in 2% of cases. Fifty-three
percent of the cases had other anterior segment disorders like
conjunctivitis, blepharitis and corneal ulcers. Conclusion: Most of the
cases recruited in our study were in the late stages of HIV. A
significantly high number of cases (70%) had ocular manifestations.
Around 53% had additional anterior segment disorders like
conjunctivitis, blepharitis and corneal ulcers.
24 citations
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TL;DR: There were significant differences in mean patient pain scores on arrival, compared to those of doctors and triagers, and asking for pain scores is a very important step towards comprehensive pain management in emergency medicine.
Abstract: Background: Pain management in the Emergency Department is challenging.
Do we need to ask patients specifically about their pain scores, or
does our observational scoring suffice? The objective of this study was
to determine the inter-rater differences in pain scores between
patients and emergency healthcare (EHC) providers. Pain scores upon
discharge or prior to ward admission were also determined. Methods: A
prospective study was conducted in which patients independently rated
their pain scores at primary triage; EHC providers (triagers and
doctors) separately rated the patients’ pain scores, based on
their observations. Results: The mean patient pain score on arrival was
6.8 ± 1.6, whereas those estimated by doctors and triagers were
5.6 ± 1.8 and 4.3 ± 1.9, respectively. There were significant
differences among patients, triagers and doctors (P < 0.001). There
were five conditions (soft tissue injury, headache, abdominal pain,
fracture and abscess/cellulites) that were significantly different in
pain scores between patients and EHC providers (P < 0.005). The mean
pain score of patients upon discharge or admission to the ward was 3.3
± 1.9. Conclusions: There were significant differences in mean
patient pain scores on arrival, compared to those of doctors and
triagers. Thus, asking for pain scores is a very important step towards
comprehensive pain management in emergency medicine.
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TL;DR: This paper presents examples of various injuries in trauma patients depicted in abdominal CT images and hopes these images provide a resource for radiologists, surgeons and medical officers, as well as a learning tool for medical students.
Abstract: Blunt abdominal trauma can cause multiple internal injuries. However, these injuries are often difficult to accurately evaluate, particularly in the presence of more obvious external injuries. Computed tomography (CT) imaging is currently used to assess clinically stable patients with blunt abdominal trauma. CT can provide a rapid and accurate appraisal of the abdominal viscera, retroperitoneum and abdominal wall, as well as a limited assessment of the lower thoracic region and bony pelvis. This paper presents examples of various injuries in trauma patients depicted in abdominal CT images. We hope these images provide a resource for radiologists, surgeons and medical officers, as well as a learning tool for medical students.
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TL;DR: A case report is presented to highlight the distinguishing features of both hyperacusis and phonophobia and discuss the steps of management in these conditions.
Abstract: Phonophobia and hyperacusis are two separate but closely related symptoms that are often mistakenly used in clinical practice as the same entity. Here we present a case report to highlight the distinguishing features of both and discuss the steps of management in these conditions. It is vital for the attending doctors to recognise hyperacusis and phonophobia as different entities to manage them successfully.
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TL;DR: Urinary incontinence among the elderly was significantly associated with age, gender, depression, functional dependence, and diabetes mellitus (P < 0.05).
Abstract: Background: Urinary incontinence is a common but poorly understood problem in the elderly population. The aim of this study was to determine the prevalence of urinary incontinence and its associated factors among the elderly in a community setting. Methods: A cross-sectional study design was used. Stratified cluster sampling was used in this study. All elderly residents aged 60 years old and above who fulfilled the selection criteria were included as respondents. The translated Malay version of the Barthel's Index (BI) was used to identify the presence of urinary incontinence. Results: The prevalence of urinary incontinence was 9.9% among the elderly respondents. Urinary incontinence among the elderly was significantly associated with age, gender, depression, functional dependence, and diabetes mellitus (P < 0.05).
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TL;DR: Dear Editor, expression, enhancement of phagosome-Tuberculosis is one of the leading causes of mortality produced by a single infectious agent.
Abstract: Dear Editor, expression, enhancement of phagosome-Tuberculosis is one of the leading causes of mortality produced by a single infectious agent. Each year 8 million new cases and between 2 to 3 million deaths are reported. One-third of the human population is already infected with
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TL;DR: The results from the present study show that a change in the enzyme antioxidant systems in patients after chemotherapy and mastectomy causes an overall decrease in antioxidant levels.
Abstract: Background: Breast cancer is the most common cancer in Indian women.
The aim of this study was to assess the levels of red blood cell (RBC)
superoxide dismutase (r-SOD), RBC catalase (r-CAT), RBC glutathione
peroxidase (r-GPx) and the ferric reducing ability of plasma (FRAP) in
advanced breast cancer patients post mastectomy before and after
chemotherapy. Methods: Female breast cancer patients between 27 and 65
years of age who were admitted to the Department of Surgery of the All
India Institute of Medical Sciences in New Delhi were enrolled in the
study. This study included two arms: a control group of healthy
age-matched females (n = 20) and patients undergoing treatment with a
combination of the anticancer drugs cyclophosphamide, doxorubicin, and
5-fluorouracil (CAF) (n = 55), No treatment was given to the control
group. The CAF group received CAF treatment at weeks 0, 3, and 6, then
surgery at week 9 followed by CAF treatment at weeks 12, 15, and 18. A
three-week drug-free interval was included between each cycle of drug
treatment. Blood samples were collected from control subjects and from
patients in the CAF group before administration of drugs at week zero
to establish a baseline, again weeks 12 and 18, and once more at the
end of the 26-week treatment. Blood samples collected from the control
subjects and CAF patients were analysed to determine levels of the
endogenous antioxidants, r-SOD, r-CAT, r-GPx, and FRAP. Results: Levels
of r-SOD, r-CAT, r-GPx, and FRAP in CAF-treated patients at 12, 18, and
26 weeks were significantly decreased (P < 0.001) in comparison to
the baseline levels observed at week zero. Conclusion: The results from
the present study show that a change in the enzyme antioxidant systems
in patients after chemotherapy and mastectomy causes an overall
decrease in antioxidant levels. Chemotherapeutic agents induce
oxidative stress that damages many cellular targets.
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TL;DR: The study showed that antiepileptic drug was not beneficial in preventing late post-traumatic seizures, but may have a role in preventing early seizures, and younger as well as intubated patients were at a higher risk of developing this condition.
Abstract: Background: Post-traumatic seizure is a well-known and serious
complication of traumatic brain injury (TBI). The incidence and risk
factors vary among study populations. Very little data have been
published concerning this in the Malaysian population. The aim of this
study was to ascertain the risk factors for the development of early
post-traumatic seizures among patients with TBI. Methods: This was a
prospective observational study, carried out in Hospital Universiti
Sains Malaysia, Kubang Kerian, Kelantan, under the Department of
Neurosciences. A total of 157 patients, from all age groups, who were
diagnosed with TBI were enrolled from June 2007 to December 2007. They
were followed-up for 12 months until death or their first
post-traumatic seizure. Survival analysis with Kaplan–Meier
curves and Cox proportional hazards regression was performed. Results:
A total of 11 (7.0%) of the patients developed early post-traumatic
seizures. The risk factors for early post-traumatic seizures were young
age (P = 0.021, 95% CI 0.806 to 0.982) and intubated patients (P =
0.029, 95% CI 1.194 to 25.913). The incidence of early post-traumatic
seizures in the local population was 7.0%. Conclusion: The incidence of
early post-traumatic seizures in the local population of Kelantan and
Terengganu is comparable to the incidences reported elsewhere. Younger
as well as intubated patients were at a higher risk of developing this
condition. It may be necessary to give antiepileptic prophylaxis
because any seizure could adversely affect morbidity and mortality.
However, the study showed that antiepileptic drug was not beneficial in
preventing late post-traumatic seizures, but may have a role in
preventing early seizures.
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TL;DR: Patients who had undergone craniotomy and excision of abscess showed a significantly earlier improvement in neurological function, better radiological clearance and lower rate of re-surgery as compared to the burr hole aspiration group, but with respect to neurological improvement at 3 months, morbidity and mortality, there is no significant difference between the two surgical methods.
Abstract: Background: The purpose of the study is to compare the two surgical
methods (burr hole and craniotomy) used as treatment for superficial
cerebral abscess and its outcome in terms of radiological clearance on
brain CT, improvement of neurological status, the need for repeated
surgery, and survival and morbidity at three months after surgery. This
report is a retrospective case review of the patients who were treated
surgically for superficial cerebral abscess in Hospital Kuala Lumpur
(HKL) and Hospital Sultanah Aminah (HSA) over a period of four years
(2004 to 2007). Methods: Fifty-one cases were included in this study:
64.7% of patients were male and 35.5% were female. Most of the patients
were Malay (70.6%); 28 patients (54.9%) had undergone craniotomy and
excision of abscess, and the rest had undergone burr hole aspiration as
their first surgical treatment. Results: This study reveals that
patients who had undergone craniotomy and excision of abscess showed a
significantly earlier improvement in neurological function, better
radiological clearance and lower rate of re-surgery as compared to the
burr hole aspiration group (P-value < 0.05). However, with respect
to neurological improvement at 3 months, morbidity and mortality, there
is no significant difference between the two surgical methods.
Conclusion: The significance of these findings can only be confirmed by
a prospective randomised series. Further study will be required to
assess the cost effectiveness, intensive care needs, and possibility of
shorter antibiotic usage as compared to burr hole aspiration.
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TL;DR: A 28-year-old male with a painful parotid tumour, which grew slowly for 4 years, is reported, which cannot be easily distinguished from salivary malignant masses.
Abstract: Chronic sclerosing sialadenitis is a chronic inflammatory salivary gland disease. Kuttner reported 4 cases of submandibular gland lesions for the first time in 1896. Chronic sclerosing sialadenitis is a very rare inflammatory lesion of the parotid gland and cannot be easily distinguished from salivary malignant masses. We reported a 28-year-old male with a painful parotid tumour, which grew slowly for 4 years.
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TL;DR: As economists and business people always strive for better, faster, cheaper means of production, and demand higher productivity from their employees through effective leadership and supervision, neuroscience is relied upon to provide answers to questions like: • How can the authors leverage their brain in business?
Abstract: As a business educator, I am enthralled with the recent advancements by scientists who integrated neuroscience (the study of the anatomy and physiology of the brain) and psychology (the study of the human mind and human behaviour). Such convergence has given birth to a plethora of new interdisciplinary business fields with neuroprefix such as neuroeconomics, neuromarketing, neuroaccounting, neurogovernance, neuroethics, and neuroleadership. Such an exotic union of science and the arts may provide better understanding of human nature and behaviour change. Imaging technologies such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) reveal unseen neural connections in the living human brain along with brain wave analysis technologies such as quantitative electroencephalography (QEEG). We can even theoretically link the brain (the physical organ) with the mind (the human consciousness that thinks, feels, acts, and perceives) through an advanced computer to analyse these connections. As economists and business people always strive for better, faster, cheaper means of production, and demand higher productivity from their employees through effective leadership and supervision, neuroscience is relied upon to provide answers to questions like: • How can we leverage our brain in business? • Capitalise/invest on the brain? • Make the best decision? • Find the productivity “hot buttons” in the brain? • Encourage creative and ethical brain?
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TL;DR: A rare case of a patient who had a nephrectomy 10 years earlier for RCC and presented with tumours in the frontal sinus and posterior pharyngeal wall is reported, confirming metastatic RCC at both sites.
Abstract: Metastatic renal cell carcinoma (RCC) presenting with multiple deposits in the head and neck region is unusual. It is not uncommon for a RCC to metastasise to a distant site after years of a tumour-free period, but most of it would be expected to have a single site of deposit. We report a rare case of a patient who had a nephrectomy 10 years earlier for RCC and presented with tumours in the frontal sinus and posterior pharyngeal wall. Radiological imaging and histology confirmed metastatic RCC at both sites.
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TL;DR: 2 cases of vallecular cysts in infants admitted to the hospital where timely diagnoses led to appropriate treatment are described.
Abstract: Vallecular cyst, a benign yet rare laryngeal lesion, may cause stridor and even life-threatening upper airway obstruction in infants. It can cause apnoea and poor feeding habits, thus reducing the chance of survival. Although laryngomalacia remains the most common cause of stridor in this age group, awareness and a high level of suspicion for this condition can help lead to early management and intervention. Direct laryngoscopy is accepted as the gold standard for diagnostic purposes, and
marsupialisation of the cyst is the preferred treatment. We describe 2 cases of vallecular cysts in infants admitted to our hospital where timely diagnoses led to appropriate treatment.
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TL;DR: It is revealed that efforts by Nigerian dentists to prevent HIV transmission are presently less than optimal, and there is a need for sensitisation and motivation through seminars, workshops and lectures.
Abstract: Background: As healthcare providers, dentists are in a unique position
to foster behavioural changes that are needed to stem the spread of HIV
infection. This study was conducted to assess the role of dentists in
the prevention of HIV transmission in Nigeria. Methods: This
descriptive cross-sectional survey was conducted from June 2006 to
January 2007. A multi-stage sampling technique was used to select 300
practising dentists from all parts of Nigeria. Data were collected
through a self-administered questionnaire that focused on dentist
demographic details, attitudes towards treating HIV-infected persons,
involvement in public or clinic-based patient education on HIV and
infection control. Results: Two hundred and fifty-seven questionnaires
were returned completed, constituting an 86% response rate. The
majority of respondents (77.8%) had their dental practice in the
southern part of Nigeria, and 89% were in the age bracket of 21-40
years. HIV education by dentists was ranked as poor, as less than a
quarter of respondents routinely educated patients on HIV in the
clinic. Only a few dentists (33.3%) were involved in public
enlightenment programme on HIV in the previous 12 months. Most of the
respondents (93%) reported a willingness to treat HIV-infected patients
while observing universal precautions. Good infection barrier practices
were adopted by 89.9% of dentists, and disposable cartridges for local
anaesthetic agents and dental needles were not reused by 93.4% of the
respondents. Autoclaving was the most widely used sterilization method
(73.2%), but less than half of the respondents knew how to ascertain
whether sterilization was effective. Conclusion: This study revealed
that efforts by Nigerian dentists to prevent HIV transmission are
presently less than optimal. Therefore, there is a need for
sensitisation and motivation through seminars, workshops and lectures.
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TL;DR: Magnetic resonance imaging revealed communication of the cyst with the subarachnoid space through a calvarial defect, with concomitant findings of vertically positioned straight venous sinus and subependymal grey matter heterotopia, and a diagnosis of atretic cephalocele was made.
Abstract: A 6 year-old girl presented with a midline parietal scalp swelling that had been gradually enlarging since birth. Magnetic resonance imaging revealed communication of the cyst with the subarachnoid space through a calvarial defect, with concomitant findings of vertically positioned straight venous sinus and subependymal grey matter heterotopia. A diagnosis of atretic cephalocele was thus made based on these classical imaging findings.
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TL;DR: The angioarchitecture of BAVM like nidal size, deep location and deep venous drainage can predict the risk of intracranial bleeding and can help in the management of high risk patients without any delay.
Abstract: Background: Central nervous system arteriovenous malformation (AVM) is
a vascular malformation of the brain and involves entanglement of veins
and arteries without an intervening capillary bed. Affecting
predominantly young male patients, AVM presents with different clinical
manifestations namely headache, seizures, neurological deficit and
intracranial haemorrhage. The patients who present acutely with
intracranial bleeding have a significant morbidity and mortality. The
aim is to study the angioarchitecture of brain AVM (BAVM) and determine
the risk factors for intracranial bleeding. Ultimately, the goal of the
study is to look for the association between volume of haematoma and
architecture of BAVM. Methods: A cross-sectional study of 58 patients
was conducted at the Hospital Universiti Sains Malaysia. Data were
collected over a period of seven years (2000 to 2007) to look for the
association between the angioarchitecture of brain arteriovenous
malformations (BAVM), haemodynamics and the natural history and risk of
intracranial haemorrhage. Results: BAVM was predominantly found in
young male patients in 65.5%. Small nidal size (P-value 0.004), deep
location (P-value 0.003) and deep venous drainage (P-value 0.006) were
found to be significant factors contributing to intracranial
haemorrhage. All patients with coexisting intranidal or prenidal
aneurysms presented with intracranial haematoma. Conclusion: The
angioarchitecture of BAVM like nidal size, deep location and deep
venous drainage can predict the risk of intracranial bleeding and can
help in the management of high risk patients without any delay. Small
sized and deep seated lesions have a diffuse type of intracranial bleed
which eventually need more attention to the managing team as diffuse
haematoma indicates more insult to brain.
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TL;DR: In this article, the authors compared craniofacial morphology in Malaysian infants with unoperated cleft lip and palate (CLP) with a control sample of unaffected Malaysian infants, and found that CLP affects the size and orientation of the nasal bones and is associated with an altered morphology of some facial bones at positions distant from the region of the cleft.
Abstract: Background: The application of three-dimensional computed tomography
(3D CT) to analyse craniofacial morphology in individuals with cleft
lip and palate (CLP) enables detailed assessments to be made of
asymmetry in the region of the cleft and in regions distant from the
cleft. The aim of this study was to compare craniofacial morphology in
a sample of Malaysian infants with unoperated CLP with a control sample
of unaffected Malaysian infants. Methods: The study sample comprised 29
individuals: 10 with unilateral CLP (UCLP), 5 with bilateral CLP
(BCLP), 7 with cleft lip and primary palate (CLPP), and 7 with isolated
cleft palate (ICP). The control sample consisted of 12 non-cleft (NC)
infants. All subjects were between 0.4 and 12.2 months of age. Nine
mid-facial and 4 nasal bone landmarks were located on 3D CT scans and
compared to a midline reference plane, which was created using the
landmarks basion, sella, and nasion. Unpaired t tests and F tests were
used to compare means and variances between sample groups, whereas
paired t tests were used for comparisons within the UCLP and NC groups.
Results: Differences in variances of some mid-facial breadths and nasal
bone dimensions were found in both male and female cleft groups when
compared to the NC sample. In the UCLP group, some nasal bone and
facial breadth dimensions were larger than in the NC sample and the
nasal bone tended to deviate to the contralateral side of the cleft.
Conclusion: CLP affects the size and orientation of the nasal bones and
is associated with an altered morphology of some facial bones at
positions distant from the region of the cleft.
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TL;DR: The oral administration of TP prevents the adverse effects of lead on blood constituents, and lead caused a significant increase in the percentage of neutrophils and the plasma malondialdehyde concentration, while TP, however, significantly prevented the adverse effect of LA.
Abstract: BACKGROUND Lead is known for its adverse effects on various organs and systems. In this study, the ability of lead to adversely affect blood parameters was investigated, and Lycopersicon esculentum, or commonly known as tomato (a source of antioxidants), was administered orally in the form of tomato paste (TP) to reduce the adverse effects of lead. METHODS The study involved 56 Wistar rats divided equally into 4 groups of 14 rats each: Control, LA(G), TP(G), and LA+TP(G). Control and TP(G) rats were given distilled water ad libitum, while LA(G) and LA+TP(G) rats were given 1% lead (II) acetate (LA) per day. TP(G) and LA+TP(G) rats were additionally treated with 1.5 ml of TP per day. All treatments lasted for 10 weeks, after which the rats were weighed and sacrificed, and haematological and biochemical parameters were measured. The independent samples t test was used to analyse the results. RESULTS LEAD CAUSED SIGNIFICANT REDUCTIONS IN THE FOLLOWING PARAMETERS: weight; packed cell volume; red blood cell and white blood cell counts; the percentages of lymphocytes and monocytes; total serum protein, albumin, and globulin levels; and plasma superoxide dismutase and catalase activities. In contrast, lead caused a significant increase in the percentage of neutrophils and the plasma malondialdehyde concentration. TP, however, significantly prevented the adverse effects of LA. CONCLUSION The oral administration of TP prevents the adverse effects of lead on blood constituents.
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TL;DR: The importance of eradicating the source of infection followed by frequent, meticulous wound dressing and strict blood sugar control to obtain better outcomes in managing necrotizing fasciitis of the head and neck is advocated.
Abstract: Necrotizing fasciitis of the head and neck is a rare, rapidly progressive infection involving the skin, subcutaneous tissue and fascia. We report three cases of necrotizing fasciitis that differ in their presentation and outcome. The first case involves a patient who presented with progressively enlarging anterior neck swelling that was later complicated by dehydration and reduced consciousness. The second case is a patient with neck swelling and ipsilateral otorrhea. The third case concerns a patient with a buccal ulcer complicated by ipsilateral facial swelling. All of them underwent a fasciotomy with wound debridement with the addition of a cortical mastoidectomy in the second case. Two of these patients recovered well. Unfortunately, the third case succumbed to death due to airway compromise and septicaemia. We advocate the importance of eradicating the source of infection followed by frequent, meticulous wound dressing and strict blood sugar control to obtain better outcomes in managing necrotizing fasciitis of the head and neck. However, involvement of the airway carries a grave prognosis despite aggressive treatment.
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TL;DR: Post-operative histopathological findings showed a fascicular arrangement of neoplastic spindle cells with pallisading nuclei that showed intense positivity for S-100 protein, and were negative for CD117 and desmin in immunohistochemistry studies, which confirmed the final diagnosis of a gastric schwannoma.
Abstract: Schwannomas, or neurinomas, are generally benign, slow-growing, asymptomatic neoplasms originating from the Schwann cells of a nerve sheath. As a part of spindle cell mesenchymal tumours, schwannomas arising from the gastrointestinal tract (GIT) are unusual; however, when they occur, the most common site involved is the stomach, which represents 0.2% of all gastric tumours. We report the case of a 35-year-old female patient with a history of pulmonary tuberculosis presenting with a large palpable abdominal mass reaching up to the peritoneal cavity. The initial clinical impression was a tuberculous abdominal mass, a cyst, or a teratoma. However, intra-operative findings during a subtotal gastrectomy revealed an exophytic gastric serosal mass, which suggested a gastrointestinal stromal tumour (GIST). Post-operative histopathological findings showed a fascicular arrangement of neoplastic spindle cells with pallisading nuclei that showed intense positivity for S-100 protein, and were negative for CD117 and desmin in immunohistochemistry studies. These results confirmed the final diagnosis of a gastric schwannoma.
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TL;DR: This case report presents two cases of unilateral scalene myofascial pain syndrome that significantly impaired the patients' functioning and quality of life and highlights the potential morbidity due to clinical misdiagnosis.
Abstract: Scalene myofascial pain syndrome is a regional pain syndrome wherein pain originates over the neck area and radiates down to the arm. This condition may present as primary or secondary to underlying cervical pathology. Although scalene myofascial pain syndrome is a well known medical entity, it is often misdiagnosed as being some other neck pain associated with radiculopathy, such as cervical disc prolapse, cervical spinal stenosis and thoracic outlet syndrome. Because scalene myofascial pain syndrome mimics cervical radiculopathy, this condition often leads to mismanagement, which can, in turn, result in persistent pain and suffering. In the worst-case scenarios, patients may be subjected to unjustifiable surgical intervention. Because the clinical findings in scalene myofascial pain syndrome are "pathognomonic", clinicians should be aware of ways to recognize this disorder and be able to differentiate it from other conditions that present with neck pain and rediculopathy. We present two cases of unilateral scalene myofascial pain syndrome that significantly impaired the patients' functioning and quality of life. This case report serves to create awareness about the existence of the syndrome and to highlight the potential morbidity due to clinical misdiagnosis.