Pyomyoma (suppurative leiomyoma) is a rare complication of uterine leiomyoma. It results from infarction and infection of a leiomyoma. It may lead to diagnostic and therapeutic difficulties with potential complications such as bacteraemia, uterine rupture, compressive effect to adjacent structures and even death. We report a case of pyomyoma based on the Ultrasound (US) and Computed Tomography (CT) findings and literature review on the subject.
The azygos system enlarges in cases of obstruction to the superior vena cava or inferior vena cava and result in increase blood flow through the system. Azygos continuation of the inferior vena cava is usually congenital and asymptomatic. The azygos vein is the sole drainage of the blood from the lower half of the body to the heart. It is crucial to identify the anomaly as it might involve in the surgical planning of tumours in the thorax or abdomen. Computed Tomography is a non-invasive technique and provide important information about the tumour and the vascular anomaly.
Introduction: The proto-oncogene c-kit is the cellular homologue of the oncogene v-kit of HZ4 feline sarcoma virus. It is located on chromosome 4 (4q11-12) in the human genome. Interaction between the c-kit receptor and its ligand, stem cell factor, is essential in the development of tissues. C-kit expression has been identified in a number of different neoplasms like seminoma/dysgerminoma, and gastrointestinal stromal tumors (GIST). Recently it has been reported that c-kit is also present in leiomyosarcomas. Tyrosine kinase inhibitors (TKIs) are a promising new therapy in the treatment of cancer. These agents target cellular proteins like kit and its related homologues decreasing cellular proliferation and survival. TKIs may be helpful in treating leiomyosarcomas expressing c-kit. Materials and Methods: In this study a total of 6 cases diagnosed as leiomyosarcomas at Department of Pathology, Universiti Sains Malaysia, Kubang Kerian, Malaysia, were investigated for reactivity for c-kit using immunohistochemical stain. Stain was considered positive if more than 10 percent of the cells showed membrane or cytoplasmic positivity. Results: Two leiomyosarcomas stained faintly with c-kit and in less than 10 percent of the cells. The other 4 cases showed no staining. The control showed good membrane and cytoplasmic positivity. Conclusion: Uterine leiomyosarcomas did not express c-kit. The reason for this could be that the tumors are inherently c-kit negative. More study using larger number of cases is required to validate these findings and further molecular characterization of these mesenchymal tumors is needed to identify the true nature of these sarcomas.
Introduction: Primary care management of knee osteoarthritis OA has received little attention in the scientific literature and the main reason of this survey is to study and explore the variations and patterns of primary care management and assess both conventional and complementary therapy usage in knee OA in the primary care setting. Materials and Methods: A cross sectional survey of 100 randomly selected general practitioners (GPs) in the northern states of Malaysia (Kedah, Perlis, Pulau Pinang) was undertaken using questionnaires. The GPs involved were asked about basic knowledge of OA in terms of diagnosis, investigation, and treatment of OA. They were also asked their usage of conventional and complementary medication. Results: 80 (80%) GPs responded to the questionnaires sent. 85% of GPs were in solo practice and 15% in group practice. Most of the GPs surveyed (69%) were in practice for more than 10 years, 21% in 5- 10 years and 10% were in practice for less than 5 years. 65% GPs surveyed see an average of more than 20 patients per week, 25% see about 10- 20 patients and 10% see less than 10 patients per week. 75% of GPs surveyed would arrange an X-ray. 65% of GPs surveyed will arrange a blood test, mostly serum uric acid, rheumatoid factor and ESR. Pharmacological management consists of first line treatment with analgesics (32%), NSAIDs (59%) or a combination of the two (4%). Non-pharmacological management consist of advise an exercise (37%), weight reduction (23%) and referral to physiotherapy (8%). 89% of GPs surveyed prescribed some form of complementary medications. 68% prescribed glucosamine sulphate, 29% chondroitin sulphate, 18% cod liver oil, 12% evening primrose oil. Only 5% of GPs surveyed perform intra- articular injection. Conclusion: The data suggest that in the primary care, majority of GP over investigate the diagnosis of OA. Pharmacological interventions largely concentrate on analgesic and NSAIDs. The use of physiotherapy and non drug approach were enormously under-utilized. There is a need to further educate GPs in the management of OA.
MeSH terms: Ambulatory Care Facilities; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Cross-Sectional Studies; Glucosamine; Hematologic Tests; Humans; Knee Joint; Malaysia; Primary Health Care; Private Practice; Surveys and Questionnaires; Referral and Consultation; Rheumatoid Factor; Uric Acid; Osteoarthritis, Knee; Physical Therapy Modalities; General Practitioners; Private Facilities
Femoral fractures are one of the commonest fractures encountered in orthopaedic practice. Over the years, treatment of this injury has evolved tremendously. The initial non-operative methods of reduction and stabilization have largely been replaced by operative fixation. There are currently three basic modes of internal fixation of femoral diaphyseal fractures in the adult age group: plate and screws, intramedullary Kuntscher nailing, and interlocking nailing. The objective of this study is to determine whether the so-called more ‘technologically advanced’ interlocking nailing results in better outcome compared to the more ‘traditional’ plate and screws, and Kuntscher nailing. It is found that, in terms of time to union and final function after an average of just under 2 years post-operative period, the group of patients who had interlocking nailing fared poorer. A review of relevant literature will then be presented.
Introduction: The aim of treatment for hyperemesis gravidarum is to stop vomiting, correction of dehydration, starvation and electrolytes imbalance. The common types of fluid used for fluid replacement are isotonic solutions like normal saline and hartman's solutions. The absence of potassium in normal saline makes hartman's solution superior but there is a possibility that the lactate component in hartman's solution could worsen the starvation state of the patients. This study is to evaluate which of these two solutions is more effective for fluid replacement in hyperemesis gravidarum. The objectives are to compare which solution corrects dehydration, hypokalaemia and acetonuria faster and to evaluate whether the ketosis state is aggravated by lactate component in hartman's solution. Materials and Methods: Patients with hyperemesis gravidarum were randomised to receive either Hartman's solution or normal saline at the rate of 125mls/hour. Blood urea and serum electrolytes, haematocrit, lactate and urine acetone were taken during admission and repeated every 12 hours. The volume of fluid required to correct dehydration, hypokalaemia and acetonuria were compared. Comparison of the pre and post treatment level of serum lactate were also done. Results: Both hartman's solution and normal saline are both effective in correcting dehydration (11.52±3.28 pints versus 11.94 ± 2.30pints respectively) and acetonuria (11.64 ± 2.75 pints versus 11.64 ± 2.54 pints respectively).
A lower volume of hartman's solution was needed to correct hypokalaemia (8.34 ± 2.44 pints versus 8.88 ± 2.63 pints) but was not statistically significant. Ketonaemia was not made worse after treatment with hartman's solution. Conclusion: Normal saline and hartman's solution are equally effective in treating complications of hyperemesis gravidarum.
Introduction: The objective was to evaluate the perceived risks, barriers and stages of change on smoking cessation among the Malay male security guards. Materials and Methods: In the year 2004, a cross sectional survey was conducted on a group of security guards working in the campus and the hospital of a public university in Kuala Lumpur. Universal sampling (n=210) was conducted with a response rate of 88.6%. A self-administered questionnaire was used to survey the participants on their smoking status, stages of change, perceived risks and barriers to smoking cessation. Results: There were 37% current smokers and 23.7% ex-smokers. The mean year of smoking was 19.2 + 8.1 and the number of cigarettes smoked was 16.4 + 8.0 per day among the current smokers. About two-third of the smokers perceived the amount smoked currently was bad for health. However, only 23.3% and 30.9% of the smokers perceived themselves to be at higher risk for lung cancer and heart disease respectively. The three main reasons to quit smoking were health reasons, doctors’ advice and cost. The main barriers were addiction (53.3%) and stress (28.3%). Most of the smokers (42%) were in the pre-contemplation stage with half of them not having thoughts of quitting. Conclusion: The smokers had misperception on smoking and majority was at the pre-contemplation stage of change in smoking cessation. The findings of this survey add on to the existing literature about the perception of risks, barriers and stages of change to smoking cessation. This will provide valuable information on the planning and delivering of smoking cessation programmes in the local context.
During a forensic entomological study conducted at an oil palm plantation in Tanjung
Sepat, Kuala Langat, Selangor, a Bengalia emarginata Malloch, 1927 (Diptera: Calliphoridae:
Calliphorinae: Bengalini) was collected for the first time. Two adults were collected nearby the
pig carcass by the first author and identified by the second. Prior to this finding, nine species of
Bengalia were recorded from peninsular Malaysia or Borneo. Male of B. emarginata are different
from Bengalia varicolor Fabricious by the following characters: Sternite 5 projection rounded
with small identation and mid tibia double-fringed in ventral surface.
Legionella pneumophila are intracellular pathogens, associated with human disease,
attributed to the presence and absence of certain virulent genes. In this study, virulent gene loci
(lvh and rtxA regions) associated with human disease were determined. Thirty-three cooling
tower water isolates, isolated between 2004 to 2006, were analyzed for the presence of these
genes by PCR method. Results showed that 19 of 33 (57.5%) of the L. pneumophila serogroup 1
isolates have both the genes. Six (18.2%) of the isolates have only the lvh gene and 2 (6.1%) of the isolates have only the rtxA gene. However, both genes were absent in 6 (18.2%) of the L.
pneumophila isolates. The result of our study provides some insight into the presence of the
disease causing L. pneumophila serogroup 1 in the environment. Molecular epidemiological studies
will provide better understanding of the prevalence of the disease in Malaysia.
Antibodies to the protozoan parasite, Toxoplasma gondii were assayed in sera of 200
goats, 100 pigs, 126 cattle from various states of Malaysia, and 135 dogs and 55 cats around Ipoh
region using an indirect fluorescence antibody test (IFAT, cut-off titer 1:200); antibodies were
found in 35.5% of goats, 14.5% cats, 9.6% dogs, 7.9% local cattle and 4% yellow cattle but not in
pigs. Results indicate that infection is most prevalent in goats
Fannia prisca Stein, 1918 is newly recorded from peninsular Malaysia. This record is
based on 4 male specimens from Mount Berembun, Brinchang, Cameron Highland, Pahang state,
peninsular Malaysia. It is previously recorded from China, Mongolia, Korea, Japan, Taiwan, Bonin
Island, Thailand and oriental region. The male of Fannia prisca can be differentiated from male
Fannia scalaris by the following features: for F. prisca, mid-coxa without spine; mid-tibia normal
or without stout triangular ventral projection; and hind tibia usually with 2 av, while F. scalaris
has several stout hook-like spines on the anterior margin; mid-tibia with stout triangular ventral
projection and hind tibia usually with 3 av. Both F. prisca and F. scalaris can be differentiated
from Fannia leucosticta by looking at its hind tibia, which only has 1 av.
A forensic entomological study conducted in an oil palm plantation in Tanjung Sepat,
Selangor, Malaysia on 3 August 2007 revealed that a housefly, Musca domestica Linnaeus oviposited
its eggs on a freshly dead pig. This finding indicated that housefly might play an important role in
forensic investigation in determining post-mortem interval (PMI), although it was not yet found
in human corpses or any animal carrion. This preliminary paper presented a first record of Musca
domestica eggs found on animal carcass in the country.
Ticks and mites are second only to mosquitos in importance as vectors of human infectious diseases. This paper reviews recorded information on zoonotic infections based primarily on studies conducted in Malaysia since 1948, but with some attempt at a global perspective. The tropical rain forest ecosystem is reviewed. The paper summarizes some 35 years of studies on the involvement of ticks and mites in human health and welfare in Malaysia. This is also an attempt to introduce the field to those who may be interested, in view of our limited knowledge relative to the importance of these vectors, and their potential of transmitting newly emerging diseases that may be introduced to the country. Tropical rain forest is a stable environment. Though Acari-borne zoonotic diseases evolved in the forest, infections are manifested through the alterations mostly by man-made activities. The parasitic Acari have preferred environmental conditions and biotopes that determine their distribution in nature, particularly within the tropical rain forest and consequently the environmentally altered areas that are the source of greatest risk for diseases. Acarines also vary in their vector potential. This article reviews the biology and ecology of all those species known to have zoonotic importance. Zoonosis in this paper refers not only to diseases that are transmitted from animals to man, but also those parasites of animals that cause dermatitis and other skin conditions in humans. This paper documents all Acari-borne zoonoses and distinguishes between those caused by viruses and those caused by rickettsiae. Emphasis is placed on Langat Virus, a tick-borne virus discovered and documented in Malaysia, with notes on the life-history and ecology of the vector
Ixodes granulatus from which Langat virus was first isolated. Another tick-borne virus, the Lanjan virus was also isolated from Dermacentor “auratus” at the IMR. The paper mentions three other viral infections that have been isolated in Malaysia from ticks, vertebrate reservoirs or both. The tick-borne rickettsial infection, boutonneuse fever is reviewed. The distribution is given for Q-fever, a disease caused by a pathogenic agent that is rickettsia-like. Information to clarify the status of Dermacentor ticks, human tick bites, and the presence of questing ticks on vegetation are also given. Tick-caused human otoacariasis in Malaysia and elsewhere is discussed, with notes on terminology. Based on a report by Induharan et al., tick paralysis is believed to occur in Malaysia. The potential importance and introduction of Lyme disease to Malaysia is discussed. The epidemiology and ecology of scrub typhus and its vectors is reviewed, including the colourful history of its study at the Institute for Medical Research (IMR). Scabies is now recognized as a zoonosis and the condition is described. Sarcoptid mites are suspected to represent more than one species. Scrub-itch and dermatitis caused by chigger mites, macronyssid mites and astigmatid mites are discussed. The importance of birds and bats in the dispersal of parasites is discussed. As examples of classical Acari-borne zoonoses, a viral disease from India and a rickettsial disease from America are briefly described. The elucidations of the natural history of these tick-borne diseases are described as epics of biomedical history. Though the essence of this paper is on environmental effects of zoonoses caused by ticks and mites, the environment in relation to human welfare and diseases is also discussed.
. The inhibitory activity of diflubenzuron, a chitin synthesis inhibitor, on the ecdysis of
Aedes sp. larvae was evaluated in earthen jars and automobile tires. Two formulations of
diflubenzuron were used in this study: Dimilin® WP (wettable powder), 25% and Dimilin® GR
(granular), 2%. The equivalent rate of 25 g/ha, 50 g/ha and 100 g/ha active ingredients for both WP
and GR formulations were used in this study. Generally, at the higher dosage of 100 g/ha, both
formulations were more effective against Aedes mosquitoes. On the whole, the WP formulation
appeared to perform better than the GR formulation in terms of residual activity.
Vegetative proteins from Malaysian strains of Bacillus thuringiensis israelensis strains
(Bt 11, Bt 12, Bt 15, Bt 16, Bt 17, Bt 21 and Bt 22) and Bacillus sphaericus H-25 strains (Bs 1 and
Bs 2) were screened for haemolytic, cytotoxic and larvicidal activity. SDS-PAGE profiles of the
Bacillus thuringiensis strains studied consistently showed major bands of 33-37 kDa and 47
kDa. Bt 16 also showed two bands of 66 kDa and 45 kDa similar to the previously reported binary
vegetative protein, Vip1Ac (66 kDa) and Vip 2Ac (45 kDa). Both the Bacillus sphaericus strains
showed a 35 kDa band that was similiar to a previously reported vegetative protein, the Mtx2
protein. Bs 2 also contains a 37 kDa band, similar to another vegetative protein, the Mtx 3 protein.
With the exception of Bt 17 and Bt 21, vegetative proteins from all Bacillus thuringiensis and
Bacillus sphaericus strains were highly haemolytic to human erythrocytes, causing more than
75% haemolysis at the highest concentration of 200 µg/ml. High haemolytic activity was associated
with high cytotoxic activity with most of the haemolytic strains being indiscriminately cytotoxic
to both CEM-SS (human T lymphoblastoid) and HeLa (human uterus cervical cancer) cell lines.
Interestingly, the less haemolytic vegetative proteins from Bt 17 and Bt 21 demonstrated cytotoxic
activity comparable to that of the highly haemolytic vegetative proteins. Bt 21 displayed toxicity
towards both cell lines while Bt 17 was more toxic towards CEM-SS cells. Bioassay against Aedes
aegypti and Culex quinquefasciatus larvae revealed that vegetative proteins from the Bacillus
thuringiensis strains had activity against both species of larvae but vegetative proteins from
Bacillus sphaericus were weakly larvicidal towards Cx. quinquefasciatus only.
This entomological study was conducted in a man-made freshwater pond in a palm oil
plantation in Tanjung Sepat, Selangor from 23 July 2007 by using pig (Sus scrofa) as a carcass
model. A 1.5 month old piglet (5 kg), which died of asphyxia after being accidentally crushed by
its mother, was thrown into a pond. Observation was made for ten days; one visit per day and
climatological data were recorded. On the first two days, the piglet carcass sunk to the bottom of
the pond. The carcass floated to the surface on the third day but no fly activities were seen. The
blow fly, Chrysomya megacephala and Chrysomya rufifacies started to oviposit on the fourth
day. Other than adult flies, a spider (Arachnida) was also observed on the carcass. Bubbles
accumulated at the mouthpart, and the abdomen was greenish black. A lot of blow fly eggs were
seen on the body surface on the fifth day (floating decay), along with first and second instars C.
megacephala crawling under the piglet’s skin. On the sixth day, adult blow fly, C. megacephala,and
C. rufifacies,and muscid flies, Ophyra spinigera and Musca domestica were observed on to the
carcass. High numbers of first and second instars of flies were observed wandering around the
body surface with C. megacephala larvae being the predominant species. Two prominent maggot
masses occurred on seventh and eighth days. Bloated deterioration stage began on day eighth
exposing rib bones, humerus bones and intestines. Carcass was partially sinking and the maggot
masses were at the water level. On day ninth, the carcass was partially sinking and three maggot
masses were observed on the exposed surface. There were very few adult flies, including a scarab
beetle was sighted on the carcass at this stage. The carcass along with the maggots sunk on day
tenth, leaving an oily layer on the water surface.
Analysis on fly artifacts produced by forensically important blowfly, Chrysomya
megacephala (Fabricius) (Diptera:Calliphoridae), revealed several unique patterns. They can be
divided into fecal spots, regurgitation spots and swiping stains. The characteristics of fecal spots
are round with three distinct levels of pigmentation; creamy, brownish and darkly pigmented.
Matrix of the spots appears cloudy. The round spots are symmetrical and non-symmetrical,
delineated by irregular and darker perimeter which only visible in fairly colored fecal spots.
Diameter of these artifacts ranged from 0.5 mm to 4 mm. Vomit or regurgitation spots are
determined by the presence of craters due to sucking activity of blowflies and surrounded by
thickly raised and darker colored perimeter. The size of these specks ranged from 1 mm to 2 mm.
Matrix of the spots displays irregular surface and reflective under auxiliary microscope light.
Swiping stains due to defecation by flies consists of two distinguishable segments, the body and
tail. It can be seen as a tear drop-like, sperm-like, snake-like and irregular tadpole-like stain. The
direction of body and tail is inconsistent and length ranged between 4.8 mm to 9.2 mm. A finding
that should be highlighted in this observation is the presence of crater on tadpole-like swiping
stain which is apparent by its raised border characteristic and reflective under auxiliary microscope
light. The directionality of this darkly brown stain is random. This unique mix of regurgitation
and swiping stain has never been reported before. Highlighting the features of artifacts produced
by flies would hopefully add our understanding in differentiating them from blood spatters
produced from victims at crime scenes.
Orthosiphon stamineus Benth (Family: Lamiaceae) or locally known as Misai Kucing
has been widely used in Malaysia for treating kidney problems, gout, and diabetes. This study
aims to evaluate the possible toxic effect after following fourteen days oral administration of
methanol extract of O. stamineus in female Sprague Dawley (SD) rats. Control groups were
treated orally with distilled water (vehicle) while the four test groups were treated up to fourteen
days with 0.5 g/kg, 1 g/kg, 3 g/kg and 5 g/kg body weight of methanol extract of O. stamineus
respectively. Toxicity of the methanol extract of O. stamineus was evaluated by the incident of
lethality, side-cage observation and blood serum biochemical parameters. No lethality or adverse
toxic signs were seen during the experimental period. A significant decrease in several serum
biochemical parameters i.e. AST and ALT and increase in liver weight was observed in young
female SD rat after being fed fourteen days with methanol extract of O. stamineus. No delayed
toxic effect and lethality was observed in all rats during fourteen days of recovery period. In
conclusion, methanol extract of O. stamineus within these range and treatment duration would
not cause any severe toxic effects and organ damages in rats.
The importance of house fly (Musca domestica L) wings in mechanical transmission
of bacteria was studied. A droplet of phosphate-buffered saline containing Vibrio cholerae was
rolled along one wing of each house fly. None adhered to the wings but small proportions of the
bacterium were isolated from about half the wings. Vibrio cholerae was spread onto the ventral
wing surfaces of each unconscious house fly which then was placed inside a bottle. When it
regained consciousness, the types of activity it performed over five minutes were noted before
the house fly was killed and the bacteria on its wings numerated. Control were house flies killed
before inoculation. The proportion of house flies with bacteria on their wings and the mean number
of bacteria remaining were significantly less on live house flies than killed controls. Among the
live house flies, bacteria were detected on fewer house flies which flew (25%) than those which
did not fly (81%). In addition, the mean number of bacteria on the former was significantly less
than the latter (5 against 780 colonies). However, both these parameters were not significantly
different between the group which performed and the group which did not perform wing grooming;
takeoff and alighting over short distances, and somersaulting. Wings of unconscious house flies
tethered by their thoraxes were inoculated with V. cholerae. After regaining consciousness, the
house flies were allowed to move their wings in flight motions for up to 30 seconds. Small
proportions of bacteria remained on all the house flies. House flies were placed in a chamber
containing a liquid bait spiked with V. cholerae. After two hours, 10 were removed sequentially
and cultured for V. cholerae. The bacterium was isolated from four house flies: two from the legs,
and two others from their bodies minus legs and wings. In conclusion, house fly wings do not
play an important role in mechanical transmission of bacteria suspended in a non-adhering liquid
medium because of the low transfer rate of the bacteria to the wings and poor retention of bacteria
on the wings during normal house fly activities.
Piophila casei (Linnaeus) (Diptera: Piophilidae) is reported from human cadavers in
two separate forensic cases for the first time in Malaysia. Both bodies were found indoors. The
first case, was that of a male of unknown nationality and age and also contained maggots of the
muscid Ophyra spinigera (Stein). The second case was a female Chinese whose body also
contained other species of maggots but these were not identifiable.