Little is known about the association between actual and selfperceived oral health status among residents living in a care home. This study aimed to assess their oral health status and to determine its association with their selfperceived oral health satisfaction. Materials and method: A cross-sectional study was conducted from July to August 2018 among 75 residents of Rumah Ehsan, Terengganu (the largest care home in east coast Malaysia). The oral health status and oral hygiene of the participants were examined. Their sociodemographic profile and self-perceived oral health status were collected through structured interviews. Chi-square, Man-Whitney, and multiple logistic regression tests were used to test the factors associated with the self-perceived oral health satisfaction of the participants. Results: Unsurprisingly, the majority of the participants had poor oral health with high median DMF-T score of 29.0 (IQR=12) and majority (86.7%) had poor oral hygiene. It was intriguing to know that the majority of them (64%) perceived they have good oral health status with 68% satisfied with their current oral health status. There was no significant association between their actual oral health status and their perceived satisfaction. However, increasing age, Malay and those eating dependently were less likely to satisfy with their oral health status. Meanwhile, those who were dependent on the staff to brush their teeth were more likely satisfied with their oral health status. Conclusion: There was a wide discrepancy between the actual and self-perceived oral health status among residents in care homes. Hence, it is crucial to improving awareness and knowledge among them in order to improve their oral health. Factors contributed to their oral health satisfaction should be acknowledged by all dental practitioners.
Knowledge on under-five childhood immunization has been identified as a key factor in determining understanding and compliance to the schedule. Understanding the current levels of knowledge and introducing a health intervention to improve the level will benefit the population to be healthier and reduce morbidity. Materials and Method: A quasi-experimental study was conducted in nurseries in Putrajaya and Cyberjaya, Malaysia from January 2016 to January 2018. 98 respondents from Putrajaya were given the technology based intervention and 98 from Cyberjaya were the wait-listed control group. Respondents answered a validated, self-administered questionnaire at baseline, immediate post-intervention and 3 months post-intervention that were specifically targeted to examine their levels of knowledge on under five childhood intervention. Results: Data was analysed using Statistical Package for Social Science (SPSS) Version 23. The level of knowledge at baseline was 58.9% for the intervention group and 61.7% for the control group with no significant difference between both groups (p=0.651). Immediate post intervention showed a significant difference (p
The growing of mortality and morbidity that are related to orthopaedic cases have contributed to the development and innovation of technology which actively seeks for the best treatment options. In order to achieve the goal, animal models have been used as a bridge from in vitro to the clinical study to provide insights both as a precursor and beneficial to human-based research. Many animal models have been developed to investigate bone regeneration, pathological changes and reparation. Besides, animal models are used more commonly in orthopaedic innovation and development. Through the practical application of the 5Rs (reduction, refinement, replacement, reproducibility and responsibility) principles that correlate with the Islamic ethics in this research, this study aimed to provide an ultimate ethical standard on animal use in orthopaedic research. Besides the texts of the Qur’an and the prophetic narrations (hadith), both Muslim jurists (fuqaha) and ethicists’ relevant opinion on these matters would be unveiled. As from the Islamic viewpoints, the usage of animal is permittable for scientific research purposed within the permissible limits described by the Shari’ah and guided by ethical values derived from the Divine Revelations (al-wahy al-Ilahyi). By practising the guidelines, it is hoped that these ethical guidelines will help to educate the Muslim scholars and researchers to substantive improvements in terms of quality and the ethical standards of animal studies in orthopaedic research.
Variation in celiac trunk is common and has importance in preoperative planning to reduce the risk of accidental vascular injuries during surgical and radiological intervention. Our aim was to measure the prevalence of coeliac trunk types and describe its different variations using MDCT angiography among patients in Hospital Tengku Ampuan Afzan (HTAA), Kuantan. Materials and method: A retrospective cross sectional study was conducted. Computed Tomographic Angiography (CTA) images were retrieved from July till December 2017. Images were reconstructed in 3D Volume Rendering (VR) format using workstation and reviewed for the normal and anatomical variations of the celiac trunk. The variations were classified using Uflacker’s classification. The results were calculated using IBM SPSS statistic version 22. Results: A total of 140 cases were found, from which 23 were excluded. Mean age was 57.3 years and male/female percentage was 65.8/34.2. Anatomical variation of the CT was found in 54 (46.2%) cases. The most common variation was the origin of inferior phrenic artery (IPA) from the CT in 21 (17.9%) cases followed by celiac-colic trunk in 15 (12.8%) cases. However, 31 (26.5%) cases displayed variations not described in Uflacker’s classification. They include celiaco-phrenic trunk, coexistence of IPA with other Uflacker’s variations, Buhler arc, accessory hepatic artery from the CT and coexistence of celiac-colic trunk with gastro-splenic and hepato-splenic trunk in one case each. Conclusion: Accurate knowledge and identification of anatomical variations in CT is crucial before undergoing any surgical or invasive imaging procedure. This can help surgeons and interventional radiologists to prevent accidental vascular injuries and perform a safe procedure.
Traumatic diaphragmatic hernia (TDH) is uncommon and it can be a result from both blunt and penetrating trauma. About to 1% to 7% of patients with blunt trauma sustained TDH. Left sided traumatic diaphragmatic hernia are much common compared to right side.TDH can present acutely or delayed with signs of respiratory distress of intestinal obstruction. The diagnosis was made with the aid of chest radiograph and computed topography (CT) abdomen. A coiled nasogastric tube within the hemithorax is a pathognomonic for TDH.We are presenting a case of high impact injury resulting in a TDH in a 19-year-old, malay male with unsure mechanism injury. He presented with generalised abdominal pain and in respiratory distress with a clinical evidence of abdominal tenderness and type 1 respiratory failure. Subsequently, he underwent exploratory laparotomy and repair of left diaphragmatic hernia. Intraoperatively, noted large linear tear of left hemidiaphragm posterolaterally extending medially until the insertion of falciform ligament. Stomach, left lobe of liver, spleen and splenic flexure of colon were herniated into the left hemithorax. The left diaphragmatic tear was repaired in 2 layers using prolene. A left subdiaphgramatic drain and a chest tube were inserted. Post operatively, the patient was nursed in ICU and recovered well. Repeated chest x -ray showed left lung was fully expanded. With aggressive chest physiotherapy and incentive spirometry, he recovered well and was discharged home. In trauma, there should be a high index of suspicion in patients with both respiratory and abdominal symptoms.Conclusion:Prompt recognition and early definitive management can improve patient outcomes.
We are reporting a case of previously undiagnosed hepatoblastoma in a healthy child, who presented acutely in a post-traumatic setting.We reported a7-year-old boy, with no previous medical history, presented with gradual worsening abdominal pain following an episode of trivial trauma to the abdomen two weeks prior. He was anaemic at presentation, and had a distended abdomen with a tender enlarged liver. Computed tomography (CT) of the abdomen showed a grossly enlarged left lobe of the liver, within which was an organized hematoma. Serum alpha-fetoprotein (α-FP) was raised significantly. The liver injury was managed conservatively and the child recovered well. He is set to undergo staging scans and further workup, in anticipation of subsequent systemic therapy.Though exceedingly unlikely in older children, the diagnosis of hepatoblastoma should be entertained in those with an enlarged liver with a clinical presentation masquerading as a ‘straightforward’ liver injury.
Intra-abdominal injury is one of the leading causes of morbidity and mortality in all age groups in the world. Our aim is to review the demography, incidence rates and prevalence of intra-abdominal injury in Hospital PulauPinang in a tertiary hospital in Northern region of Malaysia.Materials andMethods: We retrospectively reviewed medical records of patients diagnosed with intra-abdominal injury from January 2016 until December 2017 using an in-house electronic database.Traumatic renal injury was excluded. Diagnosis was confirmed via contrast-enhanced CT scan or exploratory laparotomy. Results: A total of 82 patients were diagnosed with intra-abdominal injury over a period of 2 years. There is a male (75.61%) and of Chinese ethnicity (43.90%) predominance. Median age at presentation was 20 years old. The oldest patient was 94 years old and the youngest patient was 9 months old. Commonest etiology was motor vehicle accident (78.04%) followed by traumatic fall (12.19%). Thecommonest injury was splenic injury (50%) followed by liver injury (39.28%). The majority of patient (59.52%) was treated non-surgically, in which a grade 2 splenic injury patient underwent operation after failing a non-operative management. There were only 2 mortalities among the 34 patients in the operative group.Thereis a higher incidence among Chinese ethnicity due to skewed distribution of Chinese population in our studied area in relation to total Chinese population in Malaysia. We showed a reduction in negative laparotomy in stable patients with suspected intra-abdominal injury with the utilization of a CT scan. Decision for non-operative management should be tailored to individualized approach accompanied by serial assessment for optimal care.Conclusion: Blunt trauma was the most common type of intra-abdominal injury and the spleen was found to be the most common organ injured.
Since humans evolutionally adapt to a bipedal gait, the foot is important to allow humans to stand up, walk, run, and to jump. Without the soft tissues and bones at the foot and ankle, our lower limbs could not support the weight of the body. Crush injury of the foot and ankle is a consequence of high energy trauma leading to combined bone and soft tissue loss or destruction. The treatment of crush injury of the foot and ankle remains a challenge as it is associated with high morbidity. We report two cases of traumatic injury of footand ankle to highlight the paramount importance of soft tissue coverage in limb salvaging and reconstructive surgery of foot and ankle.
Isolated blunt pancreatic injury with ductal involvement is rare following a motor vehicle collision, but correlates with significant morbidity and mortality. We reported a15-year-old male who presented to emergency department after sustained motor vehicle collision. Post trauma, he appeared drowsy but hemodynamically stable. Abdominal examination was unremarkable but FAST scan was positive and he was subjected for CECT abdomen and showed pancreatic laceration at the body with suspicious of pancreatic ductinjury. He was planned for emergency exploratory laparotomy and intra-operatively noted pancreatic head laceration with transected pancreatic duct. The case proceeded with ligation of pancreatic duct cephalic stump, and distal pancreaticogastrostomy. Postoperatively, the patient recovered well and he was discharged home on day 6 post operatively. Upon follow up visit, he was asymptomatic with repeated ultrasonography of abdomen showed no evidence of intra-abdominal collection. Discussion: Pancreatic injuries with ductal disruption are of special significance. Apart from bleeding, the leak of enzyme rich of pancreatic juice incites vigorous inflammatory cascade that lead to catastrophic changes in patient metabolism and its sequelae including pancreatic necrosis, peripancreatic abscess, pseudocyst, enteric fistulae and organ failures. In a hemodynamically stable patient, CECT abdomen is the investigation of choice to detect pancreatic duct involvement. Pancreatic injury with ductal involvement require surgical management to prevent the complication of pancreatic enzyme leak. Non operative measure is found to be useful in selected patient. The criteria for non-operative group are stable hemodynamically, a controlled leak wall off like pseudocyst, absent associated injury or pancreatic necrosis. Non-operative strategy requires multidisciplinary involvement with excellent nutritional support, expert endoscopist and interventional radiologist.
Meckel’s diverticulum occurs in 2-3% of general population and can presents as Littre’s hernia.We are reporting an 88-year-old female referred to our surgical unit with a painful right groin hernia2 weeks, associated with vomiting, fever and diarrhoea. Physical examination showed an irreducible tender lump in the right groin with overlying erythematous skin. Plain radiograph showed dilated small bowel with a loop of bowel seen within the right groin region. A diagnosis of strangulated right femoral hernia was made preoperatively.Right inguinal incision initially employed, however, after a grossly inflamed Meckel's diverticulum with adjacent bowel perforation was found, a midline laparotomy ensues. Meckel's diverticulum was resected together with the perforated segment of small bowel. A primary anastomosis was then performed.In managing Meckel’s diverticulum the proposed treatment for is wedge resectionand primary repair of the ileum. If there is oedema or inflammation at the base of the diverticulum, resection and anastomosis of a segment of the ileum may be necessary.Meckel’s diverticulum may be found in any type of abdominal hernia and thus an incarcerated hernia should not be attempted to manually reduce.
Epididymo-orchitis is a medical condition characterised by inflammation of epididymis and testis which is a common urological diagnosis encountered by healthcare professionals. Misdiagnosis and under treatment can lead to poor outcome such as infarction and abscess formation.We presented a33-year-old man, with no known medical illness, presented with one-week history of left testicular pain, swelling and fever. He was commenced on Amoxicillin by his general practitioner. Physical examination showed left swollen and tender testis and normal right testis. Investigations showed an elevated white cell count (WCC) 41.3x103 /L and colour doppler ultrasound (USG) testes showed left epididymo-orhitis.He was admitted and treated with IV Unasyn®(Ampicillin+Sulbactam) for 5 days. His symptoms improved, and he discharged home well with one week oral Unasyn®. He represented 2 weeks later with worsening left scrotal swelling and pain. Clinical examination found a swollen, tender and erythematous scrotum with 1x1cm defect in the left scrotum with purulent discharge.He underwent operation incision and drainage of left scrotum and left orchidectomy. Post-operatively he recovered well. Histopathology reported as epididimo-orchitis with abscess, necrosis and perforation.As a conclusion, testicular rupture and abscess formation secondary to epididymo-orchitis is an uncommon reported complication. Immediate recognition and treatment is crucial as a delayed diagnosis can lead to sepsis and infertility.
Detailed knowledge of the vascular anatomy of hepatobiliary system is important for a safe cholecystectomy. We are reporting a case of aberrant type of right hepatic artery originating from superior mesenteric artery and encircles the gallbladder that has been found during laparoscopic cholecystectomy operation.We presented a39-year-old Malay lady came to International Islamic University Malaysia Medical Centre with features of obstructive jaundice. Ultrasound of hepatobiliary system showed cholelithiasiswith choledocholithiasis causing dilatation of the common bile duct. ERCP had been performed and sphincterotomy was done. Patient was planned for laparoscopic cholecystectomy. Intraoperatively, the Calot’s trianglewasidentified in usual manner. However,the right hepatic artery was identified encircling the gallbladder body anteriorly before entering the liver. The procedure was converted to open cholecystectomy due to anatomical variation via Kocher’s incision. Further identification upon open cholecystectomy revealed right hepatic artery originates from superior mesenteric artery runs anterior to cystic duct and encircles the gallbladder before further branches into right and left lobe of the liver. Right hepatic artery was dissected from the gallbladder and the gallbladder removed after cystic duct ligation and separation from the liver bed. On table cholangiogram showed distal CBD stone which was pushed down to duodenum with forceps?Post-operative was uneventful and patient liver functions improved.Knowledge regarding anatomical structure and variant of hepatic artery as well as cystic artery and cystic duct is important to ensure the inadvertent ligation of right hepatic artery which would leads to hepatic ischemia and necrosis.
Liver abscess can present in various manners and in some cases causes delays and misdiagnoses. We are reporting 2 cases of rare presentation of liver abscess.The first case isa64-year-old gentleman presented with right hypochondriac pain since August 2017 and diagnosed to have liver abscess. He was treated with antibiotics and serial imaging for reassessment. However, he presented again this year with right sided anterior abdominal wall swelling. Abdominal computed tomography (CT) showed anterior abdominal wall collection with extension into right internal and external oblique muscles with communication with liver collection at segment VII. An open incision and drainage was performed with drain inserted over the anterior abdominal wall collection. He was then referred to hepatobiliary center for further management. Second case is a30-year-old gentleman underlying Beta thalassemia major-post splenectomy with Klebsiella pneumoniabacteremia noted to have left multiseptated collection with posterobasal consolidation and left parapneumonic effusion which was initially misdiagnosed as splenic abscess. However, with further imaging was confirmed to be a left liver abscess with focal discontinuity in left hemidiaphragm, which communicates between liver abscess and enlarging left lower loculated pleural effusion. Radiological guided pigtail catheter was inserted and serial imaging showed collection decreasing in size. Extra-abdominal manifestation of a liver abscess is a rare clinical entity and is not well documented. The advent of ultrasound and CT scan, there has been improvement in the rate of early diagnosis even with these uncommon presentations. Percutaneous drainage with antimicrobial therapy remains gold standard for a non-ruptured abscess. Surgical intervention should be considered for large, complex, multi-septated abscesses or in whom percutaneous drainage has failed.
Sarcoma is an aggressive, malignant condition of a breast. It is a rare condition, which makes it difficult to diagnose at clinicopathological study. We are reporting a case of a primary breast sarcoma in a 54-year-old menopausal lady that came with painless fast growing right breast lump within 6 months of duration. Clinically, there was a huge mobile painless right breast lump without discoloration of skin noted. Both axilla and supraclavicular lymph node were not palpable. A mammogram showed large lobulated dense mass 8.3cm x 10.0cm in size occupying right upper outer quadrantcorrespond to BIRADS 4 lesion. A trucut biopsy reported as a papillary lesion. Repeated trucut biopsy reported as mesenchymal lesion with smooth muscle differentiation. With this histopathology report, she was diagnosed with mesenchymal tumor of right breast. She underwent an uneventful mastectomy. Histopathological examination of the surgical specimen reported as tumor with mesenchymal differentiation which requiring further confirmation by breast-endocrine pathologist as primary breast sarcoma. She was subjected to post op radiotherapy to the chest wall followed by adjuvant chemotherapy.
Peripheral Occlusive Arterial Disease (POAD) is an important cardiovascular morbidity especially among diabetics. The goal of the treatment is to improve patients’ quality of life (QoL) starting by quantifying the disease burden in our population especially among high risk group such as diabetics.Materials and Methods:This cross-sectional study aims to provide a data on the prevalence of POAD among diabetic population in a primary health care in Kuantan and its’ effects on the patient’s QoL. Additionally, we examined for any other stipulated associated factors that may have contributed towards the development of POAD. We applied a universal sampling for the purpose of patient selection. POAD is universally defined as ankle-brachial index (ABI) of lower than 0.9. Individuals were assessed on validated Malay version of WHOQOL BREF to assess their QoL parameters. P value of
Traumatic extradural haematoma (EDH) is a common surgical emergency with huge socio-economic impact. Prompt diagnosis and management are key for patient survival and good outcome. Considering that neurosurgical units are mostly only available in tertiary centres, it is a challenge for non-neurosurgical centres to transport patient to the nearest neurosurgical unit for emergency surgery, which may be of significant distance away, hence, a delay in surgery. General surgery units are more widely available and general surgeons are trained to competently manage patients with EDH. Referring to the nearest general surgery unit for emergency surgery for EDH can be life-saving and avoid delay in surgery. There is a lack of study regarding outcome of patients with EDHoperated by general surgeons, hence the aim of this study to investigate in this regard. To determine the post-operative functional outcome of patients with extradural haematoma in a non-neurosurgical centre, and compare the outcome with other centres. Materials andMethods: This study was a retrospective review of records of all post-operative patients operated in HOSHAS for traumatic EDH in year 2017. Sample were obtained from 2017 General Surgery Department operative census in HOSHAS. Data were obtained from patient admission records using a proforma. Documented patient post-operative functional status was classified as per Glasgow Outcome Scale (GOS). Data were analysed using SPSS version 22. Results: A total of 11 patient data were collected. Mean age of the study population is 27. All samples were male patients. Road traffic accident was the main mode of injury (82%). Seven patients had GCS on arrival of 9 to 12 (64%), while 4 patients had severe brain injury on arrival (36%). All except 1 patient with moderate brain injury (GCS on arrival 9-12) recovered well post-operatively. As for patients with severe brain injury on arrival (GCS 3-8), only half of the patients had complete recovery post operatively. Most of the patients (73%) had good post-operative recovery (GOS 4-5). One patient died (GOS 1) and another ended up in vegetative state (GOS 2). The post-operative outcome in this study is comparable to other studies done in neurosurgical unit. Conclusion: The functional outcomes of traumatic EDH patients operated by general surgeons in HOSHAS are similar to those in neurosurgical centre.
Renal injury occurs in 1%–5% of all trauma cases. The objective of this retrospective study is to register a clinical audit on renal injury management of a single center.Materials and Methods: All renal–related trauma cases presented to Penang Hospital between August 2015 and July 2017 were included in this audit. These injuries were classified using American Association for the Surgery of Trauma (AAST) renal injury scale.Results: A total of 145 cases of renal trauma were audited; of which 40 cases of Grade I injury, 30 cases of Grade II, 45 cases of Grade III and 30 cases constituting Grade IV and V injury. Broadly, these patients were managed via two main approaches; 138 (95.27%) via conservative approach and 7 (4.83%) via surgical intervention. Among those who underwent surgical intervention, 3 had emergency nephrectomy performed while the other 4 had ureteric stenting.Conclusion: Literature review had shown up to 95% of renal injuries can be successfully managed conservatively, especiallyin cases of blunt trauma. The clinical audit of our center demonstrates that the perspective of renal injury management is in par with internationally acclaimed general consensus; hence affirms the feasibility of conservative management in a vast number of cases, with a prudential role for surgical intervention in severe injuries.
An 11-year-old boy tried to jump over a metal rod but landed on it presented with perianal pain and rectal bleeding. On examination, there is a 1.5cm perineal laceration. His blood results showed a normal TWC with a normal abdominal and chest radiographs. His vital signs were within normal limits. He was planned for bedside T&S by ED team but deferred as persistent blood oozing from rectal, thus referred to Paediatric Surgery. Upon review, there was 2x1cm perianal laceration at 7 o’clock, abrasion wound at 10 & 12 o’clock. Ultrasound showed no free fluid. He was taken to emergency OT for EUA, intraoperative findings were a perianal laceration, on table sigmoidoscopy showed posterior rectal wall irregularities with slow oozing blood from it, however, no obvious perforation seen. The patient developed fever with lower abdominal tenderness on the following day. Urgent CECT abdomen pelvis performed and showed features of extraperitoneal rectal perforation. He was treated conservatively with antibiotics and NBM with parenteral nutrition support. He made a good recovery and was discharged home on day 9.Pediatric perineal impalement injuries often caused by falls on an offending object. These children are prone to severe injuries as compared to adults and the lesions in the pediatric perineum may appear innocuous, but can be potentially life-threatening and surgically challenging. Perineal impalement injuries in children are classified as transanal or perineal and further subdivided as extraperitoneal or intraperitoneal. This classification method is used to predict potential injuries and develop treatment guidelines. Evaluation of perineal impalement injuries in children needs to be thorough even in the presence of minimal or no symptoms.
Degloving injury is severe and commonly results from a huge rotational force which avulses the skin and subcutaneous tissue from its underlying fascia. This injury is associated with high morbidity and mortality if mismanaged. Perineal degloving injury commonly associated with urethral injury which can be further classified into anterior and posterior urethral injury. This study retrospectively evaluated management of traumatic perineal degloving injury compared to standard approach.A total of 3 cases of open perineal degloving injuries been identified and was managed at our centre at the year 2017. 2 cases of degloving wound of scrotum and one case of crush perineal injury with transected posterior urethral were included. We reviewed methods of management and clinical outcomes of these patients. All patients promptly underwent wound debridement and surgical repair after immediate diagnosis and resuscitation. Suprapubic insertion of catheter is crucial in managing the urethral injury. The case of crush perineal injury with transected urethral treated with operation primary urethral anastomosis, de-functioning of stoma and external fixation of pelvis. Unfortunately, this case was complicated with rupture at anastomotic urethral site after a traumatic CBD insertion during his hospitalization and he was treated conservatively with CBD. All patients did well clinically with their wounds healed well.We showed a multidisciplinary team approach consisting of colorectal surgeon, urologist, orthopaedics surgeon and plastic surgeon, together with prompt diagnosis provides the best outcome were for the treatment of open perineal degloving injury.
Electrical burns are one of the important health burdens throughout the world with incidences varying between 4–18% of all burns. We are presenting a case of 45-year-old gentleman whom sustained a high voltage electrical injury (railway voltage) with 25% total body surface area (TBSA) of mixed partial burns over the path of current. He was managed primarily by general surgical team in a district hospital. Subsequently, he was discharged home well after 23 days of hospitalization. In this article, we discuss about management of electrocuted burns in district hospital setting without burn unit.