IIUM Medical Journal Malaysia (IMJM)
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Stage Protocol in the Management of Infection Following Plating of the Tibia
Get PDFIntroduction: Anterior border of the tibia is covered only by a thin layer of protective tissue. Plating of the tibia often results in wound complication and infection if the injury to this area is not recognized. We review our results of managing infection following plating of the tibia using a protocol base on the status of bone healing and the presence of bone or soft-tissue defect. Methods: Eight cases of infection following plating of the tibia were managed according to stage procedures protocols and classification, which is based on the state of bony union and the defect following wound debridement. The soft-tissue defects were managed with local flaps, and the bone defects were managed with Illizarov bone transport. Results: Three patients had more than one bacterium isolated. Gram negative organisms were isolated from seven patients. Methicillineresistant Staphylococcus aureus was isolated in two patients. All patients achieved union with a mean union time of seven months. The infections were controlled in seven patients. One patient had minimal sinus discharge but refused further treatment. Conclusions: The stage protocol for the management of infection following plating of the tibia is practical and produces excellent results
Euthanasia and Physician-Assisted Suicide: A Review from Islamic Point of View
Get PDFDue to globalizing trend of homogenisation of culture, changes in the health care delivery system and market economics infringing on the practice of medicine, there has been a gradual shift in the attitude of the medical community as well as the lay public towards greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As the subject has gained worldwide prominence, we want to review this topic from Islamic perspective due to its significance in medical ethics and clinical practice
Airway Y-stent Insertion in Tracheobronchomalacia: A New Experience
Get PDFThis case report describes a rigid bronchoscopy-assisted placement of a silicone airway Y-stent in a patient who developed tracheobronchomalacia following repeated dilatations for post-tuberculous airway stenosis. This is the first report of an airway Y-stent insertion in Malaysia
Isolated Metacarpal Bone Metastasis from Advanced Rectosigmoid Carcinoma
Get PDFDistant metastasis is a common sequelae of stage III colorectal adenocarcinoma. Liver and lungs are the most common sites for distant metastases, but, metastases to extremities are very rare. We report a case of rectosigmoid adenocarcinoma, which metastasizes to left first metacarpal bone, which is the first occurrence in our experience. The investigations and management of the patient are discussed
Pilot Study: A Review of Personnel Involved in School Vision Screening and the Training Module in Betong, Malaysia
Get PDFIntroduction: School vision screening program is a scheduled program under the Ministry of Health, Malaysia for 7, 12 and 15 years-old children in the government schools. The aim of this study was to review the school vision screening program from the perspective of the personnel involved as the screener. Methods: The evaluation of the performance of the screener was based upon the accurate referrals' outcome from the school health database of Betong Division in Sarawak, Malaysia in the year of 2008. Results: The total accuracy of the referrals was 50.7%. Lower accuracy of the referrals was found significantly associated with Grade 1 [χ2 (2.N=304) = 28.810, p<0.001, OR 4.472, CI.95= 0.843=2.335] and among Native Iban [χ2 (2.N=304) = 7.901, p<0.05, OR 1.502, CI.95= 0.935=2.414]. Conclusions: Further review on the training modules demanded improvement and enhancement to suggest that training module might be one of the contributing factors on the performance of the screener
Salivary and Serum Antioxidant Activity in Patients with Acute Coronary Syndrome
Get PDFIntroduction: Oxidative stress has been implicated in the pathogenesis of many diseases, including cardiovascular diseases. However, much less is understood about the redox status of patients with acute coronary syndrome (ACS). The present study was, therefore, designed to evaluate the redox status of patients with ACS prior to and following therapy as compared to age-matched healthy individuals by monitoring the antioxidant potential of serum and saliva as biomarkers of oxidative stress and evaluating their likely correlation with the clinical status of the patients. Methods: A total of 33 patients (29-78 year old, male) with the diagnosis of ACS and age-matched 16 healthy male (control) were included in the study. The diagnosis of ACS was based on the clinical presentation, ECG and serum cardiac biomarkers. These patients were grouped as acute myocardial infarction with ST-segment elevation subtype (STEMI, n=24) and non-ST-segment elevation myocardial infarction subtype (NSTEMI, n=9). Serum and salivary antioxidant activity (AOA) were determined spectrophotometrically. Results: Antioxidant defense, as reflected by lower total AOA in saliva and serum, was found to be significantly attenuated in patients with ACS as compared to control subjects, indicating an increased oxidative stress. The decrease in AOA was more conspicuous in patients with STEMI as compared to non-NSTEMI suggesting more oxidative stress in the former is associated with the severity of the disease, including tissue necrosis in STEMI patients. Drug treatment to ACS patients for a short-term period (4-6 days) elicited no significant improvement in their AOA. However, ACS patients receiving longterm drug treatment (4-5 weeks) exhibited a significant increase in AOA as well as an improvement in the clinical status. Conclusion: This preliminary study supports the role of oxidative stress in the pathogenesis of ACS and the use of salivary and serum AOA as a potential marker of the redox status and disease severity
Surgery for Massive Paediatric Head and Neck Neurofibroma: Two Case Reports
Get PDFWe report two paediatric patients with massive head and neck plexiform neurofibromas who underwent surgical excision. We wish to highlight issues and implications pertaining to the surgery, in particular, the management of intraoperative bleeding often encountered in these cases
Nasopharyngeal Carcinoma Presented with Right Upper Limb Weakness: A Case Report
Get PDFNasopharyngeal carcinoma (NPC) is a malignant neoplasm arising from the mucosal epithelium of the nasopharynx, mainly within the lateral nasopharyngeal recess or Fossa of Rosenmuller. Distant metastasis to the cervical spine is the least common site in the vertebral system. This is a case of a 37-year-old lady with stage IV C nasopharyngeal carcinoma with local extension to the cervical spine who presented with right upper limb weakness
Nutritional Antioxidants and Lipid Profile in Newly Diagnosed Rheumatoid Arthritis Patients
Get PDFIntroduction: Rheumatoid arthritis (RA) is a chronic progressive autoimmune disorder characterized by symmetric erosive synovitis. The pathogenesis of bone erosion and joint deformities are not fully understood. The aim of this study was to find out vitamin C and E levels along with the lipid profile in newly diagnosed cases of RA. Materials and Methods: The patients for the study were selected from individuals attending the routine checkup in an Outpatient Department. Based on the criteria led by the American Rheumatism Association (ARA), the newly diagnosed patients were taken as cases and other normal individuals were taken as control group in the study. A total of 50 subjects were included in the study with the age group of 48 ± six years for both genders. Serum Vitamin-E was determined by the colorimetric method and serum Vitamin-C was estimated by the dinitro phenyl hydrazine method. Serum total cholesterol, HDL-cholesterol, triglycerides, and VLDL levels were estimated by the enzymatic method. LDL- cholesterol was calculated by the Friedewald's formula. Results: The levels of nutritional antioxidants vitamin E and C were different significantly in RA patients compared to control group. The lipid profile parameters were also different significantly in RA patients compared to the controls. Conclusion: Patients with RA presented with an imbalance in the oxidant-antioxidant system that markedly increased lipid peroxidation products and significantly decreased lipid soluble antioxidant vitamin E. These changes might play a role in the tissue damage and inflammation process in this disease
Factors Influencing Childhood Immunization Defaulters in Sabah, Malaysia
Get PDFIntroduction: The purpose of this study was to determine the prevalence of defaulters of immunization, and their associated risk factors among children age 12 to 24 months. Materials and Methods: A cross-sectional study was conducted in all government's maternal child health clinics in District of Kota Kinabalu, Sabah. Data was collected using a standardised questionnaire from July to November 2006. Results: The prevalence rate for defaulting immunization was 16.8% from the 315 respondents. Bivariable analysis showed various significant factors associated with defaulters such as mother’s employment status, family mobility, transportation and cost. Nonetheless, multivariable analysis showed only mother’s age, mother employment status and family size were the significant predictors for defaulting immunization. Immunization that had the highest rate of defaulters was DPT–OPV booster dose (56.6%), followed by MMR immunization (43.4 %) and DPT-Hib/OPV and Hep B third dose (37.7%).Conclusion: Employed mothers with bigger family size should be more closely monitored and advised to reduce the chance of defaulting on the immunization. Health promotion activities also should focus to these groups of mothers