One of the commonest psychological problems that a clinician would encounter in primary care is depression. The prevalence of depression is high in women, the elderly and those with underlying physical problems or during the postpartum period. The spectrum of clinical presentations is wide and somatic complaints are more common in primary care clinics. Depression may present as a primary disorder and co-morbidity with other psychological problems or physical illnesses is high. A good clinical interview is an important form of assessment and a quick screening of depression can be done with the administration of proper rating scales, such as the Patient Health Questionnaire, Hamilton Depression Rating Scale or Geriatric Depression Scale. Repeated use of the same scale in a patient would help the clinician to monitor the progress objectively.
MeSH terms: Aged; Depression; Depressive Disorder; Female; Humans; Physical Examination; Primary Health Care; Surveys and Questionnaires; Comorbidity; Prevalence; Postpartum Period
The management of depression in the primary care setting should ideally take a biological, psychological, and sociological approach. Antidepressants are the most commonly used biological agents in the treatment of depression. Psychological therapies and psychosocial interventions improve the outcome of treatment when combined with pharmacotherapy. Clinical depression is treatable and thus efforts should be made to alleviate the suffering of patients with depression.
Mr S is a 38 year old Indian man who has type 2 diabetes mellitus for 3 years. He is currently on metformin 500mg BD. His BMI is 24.9 kg/m2 (weight 72 kg, height 170 cm). His blood glucose is well controlled (HbA1c 6%). His fasting lipid levels are as follow: Total cholesterol 5.0 mmol/L, HDL-C 1.60 mmol/L, LDL-C 2.6 mmol/L and triglyceride 0.9 mmol/L. He has no family history of acute myocardial infarction. He is a smoker (14 sticks/day, 12 years) but non-hypertensive. He asks if he should take atorvastatin, a lipid-lowering drug that his father is taking. Should statins be started in type 2 diabetic patients without pre-existing coronary artery disease whose lipid level is not elevated?
MeSH terms: Atorvastatin Calcium; Blood Glucose; Cholesterol; Coronary Artery Disease; Diabetes Mellitus, Type 2; Fasting; Fathers; Humans; Lipoproteins, HDL; Male; Metformin; Myocardial Infarction; Triglycerides; Body Mass Index; Hydroxymethylglutaryl-CoA Reductase Inhibitors
Stroke is the third leading cause of death, a major cause of disability in adults, and is frequently more disabling than fatal. With a decline in mortality from initial cerebral infarction and an increase in the life expectancy of the population, the number of patients with recurrent stroke and ensuing cardiovascular events will become greater. Thus it is important to find out those patients at high risk of stroke recurrence. This case report illustrates the process of recurrent stroke and the resulting disabilities and morbidities in a 42-year- old man. The role of integrated stroke rehabilitation programme is described.
Urinary tract infections frequently affect pregnant mothers. This problem causes significant morbidity and healthcare expenditure. Three common clinical manifestations of UTIs in pregnancy are: asymptomatic bacteriuria, acute cystitis and acute pyelonephritis. Escherichia coli remains the most frequent organism isolated in UTIs. All pregnant mothers should be screened for UTIs in pregnancy and antibiotics should be commenced without delay. Urine culture and sensitivity is the gold standard in diagnosing UTIs. Without treatment, asymptomatic bacteriuria in pregnancy is associated with preterm delivery, intrauterine growth retardation, low birth weight, maternal hypertension, pre-eclampsia and anaemia. Acute pyelonephritis can lead to maternal sepsis. Recurrent UTIs in pregnancy require prophylactic antibiotic treatment.
Questions on Key Features Problems (KFP) are an important component of the theory paper for Part 1 of the membership examination of the Academy of Family Physicians of Malaysia (MAFP) and the Fellowship for the Royal Australian College of General Practitioners (FRACGP).This paper will attempt to provide information on the format and marking scheme of KFP. Expected answers for some KFP cases will be discussed and common errors made by candidates highlighted with suggestions on how to avoid them.
MeSH terms: Education, Medical; Educational Measurement; Family Practice; Malaysia
Dyspepsia is a common yet poorly understood problem. In the majority of cases, no underlying structural abnormality can be identified and it then becomes a frustrating problem for both patients, who expect an explanation for their discomfort and doctors, who do not know what to do for these patients. Symptoms can be severe and occasionally incapacitating and it cannot be dismissed as a trivial problem. Taking into account the costs of doctor consultations, medications and utilization of healthcare services, impairment of work performance and absenteeism from work, dyspepsia is indeed a burden tosociety.
MeSH terms: Absenteeism; Work Performance; Costs and Cost Analysis; Dyspepsia; Frustration; Health Services; Humans; Referral and Consultation; Work
The gold standard treatment for choledocal cysts is total cyst excision and cholecystectomy. Associated malignancy warrants more extensive surgery such as Whipple’s operation for lower common bile duct cancer or hepatectomy for proximal bile duct cancer or gallbladder cancer. Roux-en-Y hepaticojejunostomy or, less commonly, hepaticoduodenostomy is indicated to restore biliary drainage. For patients with symptoms of pain and jaundice, effective drainage of the common bile duct and pancreatic duct can be achieved by endoscopic sphincterotomy or operative laporotomy. For long-term prophylaxis and to treat cholangitis, antibiotics are helpful. [extracted from the text]
MeSH terms: Anti-Bacterial Agents; Bile Duct Neoplasms; Biliary Tract Surgical Procedures; Cholangitis; Cholecystectomy; Common Bile Duct; Cysts; Drainage; Gallbladder Neoplasms; Hepatectomy; Humans; Jaundice; Pain; Pancreatic Ducts; Sphincterotomy, Endoscopic
BMD is a popular method used to diagnose osteoporosis. It is a screening test, which is not without its limitations. The decision to subject a patient to a DEXA scan is based upon a set of criteria while the decision to treat osteoporosis is based on a careful study of the patient’s BMD. The risk factor for a new osteoporotic fracture is a previous fragility fracture. It is important to note that falls need to be prevented in the first place. Untreated fractures can lead to significant immobility in the elderly which predispose them to the need for long-term care. Bisphosphonates such as alendronate and risedronate have shown good efficacy in reducing vertebral and non-vertebral fracture risk. Other drugs such as teriparatide (daily injections of synthetic parathyroid hormone) have also been similarly effective.[extracted from the text]
Radiosynovectomy is a novel method of treatment for several acute and chronic inflammatory joint disorders. A small amount of a beta-emitting radionuclide is injected into the affected joint delivering a radiation dose of 70 to 100 Gy to the synovia. The proliferative tissue is destroyed, secretion of fluid and accumulation of inflammation causing cellular compounds stops and the joint surfaces become fibrosed, providing long term symptom relief. The radionuclides are injected in colloidal form so that they remain in the synovium and are not transported by lymphatic vessels causing radiation exposure to other organs. Complete reduction of knee joint swelling has been seen in above 40% and pain relief in 88% of patients. Wrist, elbow, shoulder, ankle and hip joints showed significant improvement in 50-60% and restoration of normal function and long term pain relief has been achieved in about 70% of small finger joints. In hemophilic arthropathies complete cessation of bleeding in about 60% and improved mobility in 75% of patients has been reported.
On the provider side of imaging services, challenges arise when images are accessible to any physician as they are to radiologists. Consequently, referring specialists are increasingly reading imaging exams especially when the images provided are so exquisitely detailed and/or are of textbook quality. This threatens to make radiology, as we know it and as it is being practised, obsolete for certain specialties. The future of radiology will hinge upon building value in the role of the radiologists as a synthesizer of patient information, including images, history, pathology and molecular diagnostics, in an effective bidirectional communication. This must be done in the most cost-effective manner that helps control health care costs. In addition, there are also issues with relation to workstation and what must be done to enhance productivity.
MeSH terms: Diagnostic Imaging; Humans; Physicians; Radiology; Reading; Specialization; Health Care Costs; Pathology, Molecular
MatLab® has often been considered an excellent environment for fast algorithm development but is generally perceived as slow and hence not fit for routine medical image processing, where large data sets are now available e.g., highresolution CT image sets with typically hundreds of 512x512 slices. Yet, with proper programming practices – vectorization, pre-allocation and specialization – applications in MatLab® can run as fast as in C language. In this article, this point is illustrated with fast implementations of bilinear interpolation, watershed segmentation and volume rendering.
Tonsillectomy is performed for several indications, the two commonest in practice are infective (chronic tonsillitis) and obstructive symptoms such as sleep apnea. The objective of this study is to determine the necessity of routinely performed histopathological examination of fonsillectomy specimens. In this paper, a retrospective evaluation of 480 specimens from 241 patient who had undergone tonsillectomies in Hospital Universiti Sains Malaysia between January 2004 and October 2005 was done. It was found that 462 (96.25 %) were reactive lymphoid hyperplasia and 18 (3.75 %) were follicular hyperplasia. None of them were found to be malignant. The result of this study indicates that routine histopathological examination of tonsillectomy specimens are unnecessary and results only in added cost and a loss of man hours.
The purpose of this study was to evaluate the anaesthetic technique for Caesarean section which was appropriate for the clinical situation. This retrospective study was conducted on 240 patients undergoing Caesarean section with indications of foetal distress during a 3-year period (2002-2004). The data were reviewed from the patient’s medical record of the Department of Anesthesiology, Dr. Soetomo Hospital, Surabaya. The patients were divided into three groups, according to the criteria of foetal heart rates. The success of the anaesthesia methods was determined by assessing the Apgar scores of the newborn baby. The results were analyse using Kruskal-Wallis and Chi-Square test. P0.05 was considered as statistically significant. 1- and 5-minute Apgar score of the normal range group was significantly higher than that of the bradycardia group (p0.05). One and five-minute Apgar scores of the sub-arachnoid block group were significantly higher than those of the general anesthesia group (p
Sebaceous cell carcinoma of the skin is a rare malignancy of the skin appendages. Most commonly noticed in the orbital region. Extra orbital sebaceous cell carcinoma is extremely rare. The aggressive behavior of this tumor is still a matter of controversy. We present a case of sebaceous cell carcinoma in scalp region in young women.
AVM in the mandible is rare. It may present with recurrent episodes of unexplained gingival haemorrhage, bony swelling, tooth mobility or facial asymmetry. We reported our experience in managing a case of a 15 year old Malay girl who presented with a life threatening bleeding from her mandible.
The maintenance of pure primary lymphocytes culture for long periods may be difficult because of its inability to divide continuously. In addition, lymphocytes separation methods such as Ficoll-Paque, RBC lysis and immunomagnetic microbeads separation may have some affect on cell viability. The objective of this study is to determine various types of lymphocytes purification methods, in order to prolong primary lymphocytes culture to 72 hours. The second objective is to use these primary lymphocytes as targets for quantitative and qualitative cell viability assays when analysing the action of toxins isolated from natural products. Human blood was drawn and purified by using Ficoll-Paque, RBC lysis or immunomagnetic separation column method in various combinations. The purified lymphocytes were also grown with and without the growth enhancement factor, concanavalin-A. Cell viability assays were carried out for 72 hours at 24 hours interval. The lymphocytes purified using RBC lysis method, with or without concanavalin-A can prolong 100% cell viability for 72 hours whilst lymphocytes purified using Ficoll-Paque and supplemented with concanavalin-A showed an increase in cell viability of over 250% at 72 hours incubation. It was observed only lymphocytes purified using Ficoll-Paque followed by the immunomagnetic microbeads separation method and supplemented with concanavalin A showed overall cell viability increase, reaching 300% at 72 hours incubation. This method was a reliable model to test the cytotoxicity of the Bacillus thuringiensis parasporal inclusion, suggesting that the method achieves the objectives of the study.
An indigenous contraceptive herbal formulation consisting of a mixture of Lepidagathis longifolia, Palaquium sp and Phyllagathis rotundifolia is being used by the Temuan Aborigins of Malaysia. Although the previous studies demonstrated that this contraceptive herbal formulation causes anovulatory estrous cycle, altered circulating hormone levels and fetal resorption in rats, but the effects of this formulation on the gonadotrphs of the pituitary gland are yet to be evaluated. The present study was designed to observe the morphometric changes of the
gonadotrophs and the plasma concentrations of follicle stimulating hormone and leutinizing hormone. Thirty five Sprague-Dawley adult female rats were randomly divided into 5 groups. Experimental animals were given a combined herbal extract or individual herbal extract at a dose of 540 mg/kg/day subcutaneously for 7 days. Immunostained gonadotrophs were studied by using image analyzer. FSH and
LH serum concentrations were determined using RIA. The FSH and LH concentrations were low in animals that received combined herbal extract (p
Orofacial clefts, particularly non-syndromic cleft lip with or without cleft palate (CL/P) are the most common craniofacial deformities, affecting one in every 700 to 1000 newborns worldwide. Numerous efforts have been made to understand the etiology of CL/P so as to predict its occurrence and to prevent it from occurring in the future. In the recent years, advances in genetics and molecular biology have begun to reveal the basis of craniofacial development. Various genetic approaches, including genome-wide and candidate gene association studies as well as linkage analysis, have been undertaken to identify aetiologic factors, but results have often been inconclusive or contradictory. These results may support the presence of aetiologic heterogeneity among populations and the presence of multiple genes involved in the aetiology of CL/P. Despite these difficulties, several different genes have been implicated in harbouring genes that contribute to the aetiology of CL/P. In conclusion, the genetic basis of CL/P is still controversial because of genetic complexity of clefting.