IIUM Medical Journal Malaysia (IMJM)
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Aggressive vertebral hemangioma in paediatric spine with cord compression
Get PDFVertebral body hemangiomas are benign primary vascular tumours and account for 4% of all spinal tumours. The majority of patients are asymptomatic. They affect male and female equally. The majority has seen in middle age group. An aggressive vertebral hemangioma presenting with neurological deficits are rare, accounting for less than 1% in the general population. A 10 year old girl with a two weeks history of unsteady gait, frequent falls and back pain which was preceded by a history of traumatic compression fracture of T10 vertebrae. Examination revealed upper motor lesion. MRI demonstrated a T10 body and posterior element lesion with cord compression. A CT scan with the typical picture of ‘polka dot’ can be seen on axial cut. Biopsy confirmed the diagnosis of vertebral hemangioma. Preop embollization, decompression, vertebroplasty and posterior stabilization was done. One week post-op, her condition improved significantly. At six weeks post-op her condition was back to normal. Spinal hemangioma may affect all levels of the vertebrae with a predilection towards the thoracic region. MRI plays an important role, especially in looking at the extension of cord compression and presence of extraosseus lesion. An inactive lesion consist mainly of fatty tissue which give a hyperintense signal on both T1 and T2 weighted images. Treatment options range from radiotherapy, embolisation and surgery. Our goal of treatment in this patient was to decompress the spinal cord and achieved a stable spine. Persistent chronic back pain months after a compression fracture should raise our suspicion to pathological cause. Further investigation must be carried out to confirm the diagnosis
Conus Medullary Syndrome secondary to Spinal Schwannoma : A report of 3 cases
Get PDFSpinal Schwannoma originates from the Schwann cells, hence it is called Schwannoma. The tumor localization is in various parts of the spinal cord, but prevails in cervical and thoracic. In the literature 70 to 80% of spinal schwannomas are reported to be intradural in location, and 15% with both intradural and extradural components. All 3 cases were female in their 4th-5th decade, presented with either low back pain, radiculopathy, weakness of both lower limbs associated with urinary incontinence. MRI revealed a well defined mass adjacent to conus medullary area located intradural, extramedullary. All three patients underwent microscopic assisted excision of the tumour. All patients had Good Early Outcome. Spinal schwannoma causing Conus Medullary Syndrome is rare. Back pain and radicular pain were most common early presenting symptoms while urinary symptoms occur later. Schwannomas typically arise from a single nerve root originating from the schwann cells. To obtain total resection, the affected nerve root is commonly sacrificed in order to prevent recurrence. Intradural Extramedullary Schwannoma, even presented at a later stage with significant neurological deficit, has a Good Outcome post operatively owing to its Benign nature, Extramedullary location, and a Meticulous Microscopic assisted Complete Surgical Excision
Post Herpetic Neuralgia After Acyclovir Treatment
Get PDFPost Herpetic Neuralgia (PHN) is often diagnosed when pain persists in a dermatomal pattern weeks after the herpes zoster vesicular eruption has healed. There is a definite tendency for PHN to improve with time. There is no way of predicting who will recover. However, some reported that as many as 40% of patients with PHN will continue to have long-term problems because of incomplete or no pain despite the best treatments given. This retrospective series discussed the outcome of treatment of 3 patients with PHN, using acyclovir, Gabapentin and analgesics. Patients were treated by a single pain specialist in a conventional community pain practice. Therapies were given twice-monthly for 1-2 months, then less frequently until pain relief was optimized. Patients received a median of 7 treatments (range 4 - 11). Median baseline allodynia levels were reduced from 9 /10 (range 8 to 10) to 0/10 (range 0 to 6), intermittent shooting pain from 9/10 (range 8 to 10) to 0/10 (range 0 to 6). 1 of 3 patients (30%) was able to be weaned off pain medications. These data showed that there is variation in the response to treatment in patients suffering from PHN. The response ranged from a complete cure to unresponsive at all to the treatment given. There is no way of predicting who will fully recover
Histological effects of Tamarind seed extract against muscle, liver and renal alterations induced envenomation with King Cobra venom in mice
Get PDFIntroduction: The objective of the present study is to investigate protective effects of the tamarind seed extract on the adverse histological reaction of venoms of the King Cobra. Methods: Twenty healthy, mature male mice were randomly divided into 4 groups with 5 mice in each. The control group (C) was injected with 1 ml of normal saline. The second group (V) was injected subcutaneously with a single dose of 24.96µg/20g King Cobra venom (KCV) solution. The third group (TV1) was injected with the same dose of KCV solution and 10mg/20g of Tamarind seed extract (TSE). The fourth group (TV2) was injected with the same dose of KCV solution and 15mg/20g TSE solution. The animals were sacrificed after 24 hours of injection of the solution. Fragments of muscle, kidney and liver were fixed in 10% buffered formalin, and processed for light microscopical studies. Results: Mice of group V, treated with KCV solution showed severe degeneration, disorganization and myonecrosis in the muscle fibers. The liver revealed degenerative changes in most of the hepatic lobules and dilatation in the central veins and the sinusoids. The kidney revealed shrunken glomeruli, dilatation of Bowman capsule and degenerative changes in the renal tubules. Treatment with TSE reduced the histopathological changes induced by the King Cobra venom in the muscles, livers and kidneys and the improvement were proportional to the applied dose of the TSE. Conclusions: The observation is indicating that tamarind seed extract prevents adverse histological changes in the muscle, liver and kidney
Anatomical variations of the anterior communicating artery complex: a multidetector CT angiographic study
Get PDFIntroduction: The anterior communicating artery (ACoA) complex of the cerebral circulation, an area with great anatomical diversity, forms part of the communicating arterial supply to the brain. As brain tissues are susceptible to ischemic death, knowledge of this variability is important in diagnosis and management of diseases affecting brain circulation. The aim of the study is to measure the prevalence and to describe these variations. Methods: All patients who underwent CT angiography (CTA) scanning in HTAA from January 2009 to August 2015 were selected. A cross-sectional study was done to study these variations in 81 reconstructed CTA images. Results: Eleven types of variations were described (typical pattern; hypoplasia, aplasia, and duplication of ACoA; hypoplasia, and aplasia of A1 segment of the anterior cerebral artery (ACA); hypoplasia, and aplasia of A2 segment of ACA; A2 segments of ACA arising from a common trunk; the third A2 segment; bihemispheric ACA). A1 segment is the part of ACA from the internal carotid artery to ACoA, and A2 segment is the part of ACA from ACoA to the junction between the rostrum and genu of the corpus callosum. The typical pattern was seen in 35.8%, and the cases with other variation types constituted 64.2%, which is higher compared to previous studies. The variations in ACoA alone were 43.2%, and the most common variation was the ACoA aplasia, accounting for 28.4%. Conclusions: This study shows the high prevalence of anatomical variations in the ACoA complex, and the probable difference of this figure in different populations
Charateristics and reasons for diabetic-defaulters between primary care clinics and diabetic specialist clinic: A prospective cohort study in Kuantan, Malaysia
Get PDFIntroduction: Defaulted appointment in diabetic clinics is a great concern as it affects disease controlled and complications. Geographical location, clinic-types and quality of health services provided are known determinant reasons for defaulting. Thus, this study aimed to identify characteristics and reasons for default between diabetic-patients at public-primary-care-clinics (PPCCs) and public-hospital-diabetic-specialist-clinic (DS-OPD). Methods: A prospective one-year-cohort study was conducted among 405 diabetic patients from two PPCCs and DS-OPD in Kuantan (2015-2016). There were 2-point visits (at 6-month and 12-month) assessing follow-up appointments within one year. Defaulter is defined by at least one-time defaulted either at 6-month or 12-month. Regular-attendees were included as control. Type-1-DM-patients, missing-records, known-deceased and transferout cases were excluded. Background socio-demographic data of diabetic-defaulters were collected from DM-records and reasons for defaulting were traced via 3-times-telephone contacts which 51.6% diabetic-defaulters responded. A stratified cross-analysis was done to compare the prevalence and characteristics between defaulters and regular attendees. Reasons for defaults were analyzed using open-ended-questions analysis method. Results: Prevalence of defaulters was 18% (73/405); higher prevalence was found in DS-OPD than PPCCs (32.4% vs 10.3%). Gender, race, age, education, occupation and the duration of DM were not significantly different between defaulters and regular-attendees at DS-OPD. However, self-employment (25.9%), housewives (25.9%), aged less than 45-years (33.3%) and≥ 55 years-old (44.4%) were significant defaulters in PPCCs. Significant different of reasons for default found at DS-OPD compare to PPCCs for postponing the date (54.5% vs 12.5%), while refusing treatment/used alternative medicine (18.2% vs 43.8%); and movedout/transferred/referred cases (27.3% vs 31.2%) were more in PPCCs. Conclusions: Distinctive characteristics and diverse reasons for default between DS-OPD and PPCCs among diabetic-patients fortified to set tailored remedial to reduce defaulter-rate in different clinic
Infected nonunion proximal humerus fracture: two-stage oncologic approach solution with reverse total shoulder reconstruction
Get PDFIntroduction: Infected non-union of proximal humerus after fixation is devastating consequence and remains challenging. Methods: The staged oncologic approach consists of wide resection and reconstruction ensures remissions of the infection. Results: We report a case of two-stage oncologic approach in a patient with infected non-union proximal humerus after fixation. In the first stage we have performed a wide resection and antibiotic cement spacer insertion. After complete eradication of infection, subsequent reconstruction of the shoulder using reverse shoulder replacement with modular humeral stem had been performed on purpose of restoring the acceptable joint functions. Conclusions: Reconstruction of the infected non-union of the proximal humerus is a challenging task, costly procedure that requires the use of the sophisticated limb reconstruction system. Staged approach incorporating the use oncologic wide resection to eradicate the infection with subsequent bony reconstruction ensure the optimum restoration of upper limb functions
Incidence of chronic Hepatitis B among Orang Asli in Pahang
Get PDFIntroduction: The rate of Hepatitis B infection in Malaysia is 4.7% and the prevalence of Hepatitis B infection varies among ethnic group in Malaysia. The estimated prevalence of chronic Hepatitis B among Orang Asli in Malaysia is 8.3%. Methods: 232 Orang Asli participated in this study on a voluntary basis during two health screening in two Orang Asli Villages. Subjects serum HBsAg and HBsAb titres were taken and analyzed. Results: From 232 participants, there are 24 subjects who are HBsAg positive (10.3%) and only 15.9% of the population study has immunity to Hepatitis B. Conclusions: The incidence of chronic Hepatitis B among Orang Asli in Pahang is higher than the general population, and the rate of immunity to Hepatitis B are low compared to the general population
Biotechnological potential of Kuantan mangrove actinomycete, Micromonospora K3-13
Get PDFIntroduction: Mangrove is a complex and unique ecosystem which experiences periodical tidal flooding inundated with low, moderate and high salinity water. Its muddy soil is rich in organic matter derived from the efficient nutrient cycling system and decomposition of mangrove leaves. An adaptation of mangrove microorganisms towards these environmental factors could promote the production of interesting bioactive compounds and enzymes. Methods: This study determines to unravel the identity and biotechnological potential of a Kuantan mangrove actinomycete, strain K3-13, through morphology observation, molecular identification, antimicrobial test and xylan degradation test. Results: The orange-colored mycelium-forming isolates produced spores after a long incubation period, and showed characteristics that resembled Micromonaspora colonies. Phylogenetic analysis of the 16S rRNA gene sequence of strain K3-13 indicated that the highest similarity was to Micromonospora carbonacea DSM43168 (99%). It was observed that K3-13 produced blue diffusible pigment upon cultivation on agar media. Cross streak assay conducted to detect antimicrobial activity indicated that K1-13 has strong antibacterial activity against Bacillus subtilis and Staphylococcus aureus. K3-13 also showed positive xylanase activity by exhibiting decolourization zone in the agar-based assay using azo-xylan as substrate. Conclusions: On the basis of its ability to produce blue pigment, antimicrobial activity against at least two test organisms and positive xylan degrading activity, Micromonaspora K3-13 is concluded as strain worth exploring for its potential biotechnological application as a natural dye, antibacterial drugs and Xylan biodegraders
Balance disorders among walk-in patients in the International Islamic University Malaysia (IIUM) Ear, Nose And Throat (ENT) clinic: An exploratory study
Get PDFIntroduction: The epidemiological studies of balance disorder symptoms in Malaysia are still understudied, therefore this research sought to explore this issue among the walk-in patients at the International Islamic University Malaysia (IIUM) Ear, Nose and Throat (ENT) clinic in Kuantan, Pahang. Methods: The study aimed to 1) observe the association of common balance disorder symptoms with factors like gender, ethnicity and age groups; 2) reveal the patterns of cases with each of the balance disorder symptom according to factors in 1); and 3) determine the pattern of balance disorders in this clinic. This study took place between February and April of 2016. The medical records of these patients were examined after services by ENT doctors. To extract the data, these documents were reviewed using a medical record review checklist. Results: A total of 92 medical records were reviewed. They consisted of 45.6% male and 54.4% female; Malay (60.8%), Chinese (27.2%), Indian (10.9%) and others (1.1%); these patients were from 3 months to 69 years old. Only 13 (14.1%) out of these cases presented with balance disorders. The findings indicated no association (p > 0.05) between each of the balance symptom and the demographic factors. Out of the 13 cases; the most frequent symptoms observed were headache (76.9%), imbalance (53.8%) and vertigo (46.2%). The peripheral vestibular disorder was found as the most common diagnosis of balance disorder; benign paroxysmal positional vertigo (BPPV) (4) and Meniere’s disease (1). Both of the disorders showed vertigo, vomiting, headache and blur vision. Conclusions: It is crucial to understand the symptoms of balance disorders, particularly for a Malaysian population as it can enhance the clinical services and its quality of treatment or rehabilitation