Nocardia infection is rare in bone marrow transplant (BMT) recipients with less than 30 cases reported in the literature [1-4]. The majority of the cases occurred late in the post-transplant period. Common clinical presentations included formation of widespread and multiple abscesses. Bone marrow hypoplasia is an uncommon finding. We describe the first case of nocardiosis, diagnosed at day 100 after non-myeloablative allogeneic peripheral blood stem cell transplantation, presenting as pancytopenia and hypocellular marrow. Eradication of the infection with antibiotics resulted in complete hematological recovery.
Anaemia is the most common haematological problem in the elderly population. Using WHO criteria for anaemia (Hb of <12 g/dL in women and <13 g/dL in men), the prevalence of anaemia in the elderly has been found to range from 8-44% with the highest prevalence in men 85 years and older. Anaemia must not be considered simply as part of ageing because in 80% of cases, there is an underlying cause for Hb
levels of <12 g/dL in the elderly. Anaemia has negative impacts on the quality of life for the elderly and there is evidence of improved morbidity and
mortality after correction of anaemia. Chronic disease and thalassaemia may also cause microcytic anaemia besides iron deficiency and not all vitamin B12 and folate deficiency present with macrocytic megaloblastic anaemia. Nutritional deficiency anaemias are common, easily diagnosed, treatments are simple, inexpensive and effective. Tests for nutritional anaemia have to be given priority in the assessment before a patient is subjected to invasive tests to look for less common causes of anaemia. Serum ferritin which is the best non-invasive test for the diagnosis of iron deficiency anaemia may be increased in the elderly while serum iron and transferrin decrease with ageing. Serum methylmalonic acid (MMA) and homocysteine (HC) levels are sensitive for detecting subclinical vitamin B12 and folate deficiency. Routine iron therapy in non-anaemic elderly or in those without iron deficiency anaemia is of no use and may be detrimental to their health. Folate therapy may improve anaemia but may mask the signs and symptoms of neurological damage due to concomitant
vitamin B12 deficiency. Blood transfusion offers prompt symptom relief of anaemia in patients with terminal malignancy irrespective of the causes for the anaemia.
Pregnancy is associated with increased risk of development and progression of diabetic retinopathy (DR). Although pregnancy does not have any long term effect on DR, progression of retinopathy changes occur in 50%-70% of cases. The greatest risk of worsening occurs during the second trimester and persists as long as 12 months postpartum. The other factors found to be associated with its progression include duration of the diabetes, severity of retinopathy at conception, hyperglycaemic control, anaemia and progression of coexisting hypertension. Because of the increased risk of progression of the disease in pregnancy, conception should be delayed till the ocular disease is treated and stabilized and laser photocoagulation should be promptly instituted in all cases of severe non-proliferative retinopathy and should not be delayed till the patient develops early proliferative changes. Good diabetic control before and during pregnancy can help prevent this increase in the progression and serious vision loss.
Introduction: Anemia in pregnancy is still a public health problem in developing countries including Malaysia. Early screening of pregnant mothers who have risk factors of anemia could help identifying these potential anemic mothers and hence targeted for intervention.
Methodology: A cross sectional study IN 2008 was conducted among pregnant women who attended government health clinics in Johor Bahru district to assess the prevalence of anemia in pregnancy and factors associated with it using a structured questionnaire.
Result: Prevalence of anemia in pregnancy (Hb<11.0 g/dl) was 36.6% and majority in mild category (Hb 9-<11 g/dl). The associated factors of anemia in pregnancy were birth spacing, dietary intake with high iron content and iron pill consumption. Multivariate analyses revealed that iron pill intake was the most important factor influencing anemia in pregnancy.
Discussion and conclusion: Even though Johor Bahru is a big town with good health facilities, the prevalence of anemia in pregnancy was quite high. Results were compared with previous studies. Emphasis on compliance to iron pills is very important in prevention and treating anemia in pregnancy
Key Words: anemia in pregnancy, birth spacing and iron pill intake
Study site: Four urban and two rural klinik kesihatan, Johor, Malaysia
Antithyroid drugs have been used for more than 50 years for the management of hyperthyroidism. Most patients tolerate treatment well, but some may develop rare life threatening side effects such as agranulocytosis and aplastic anaemia. Clinical experience with the latter condition is extremely limited. We report on a case of carbimazole-induced aplastic anaemia caused by hypocellular bone marrow and associated plasmacytosis in a thyrotoxic patient chronically treated with carbimazole. This resolved after substitution with propylthiouracil. The clinical course was complicated by neutropaenic septicaemia and atrial fibrillation.
Study site: University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Serious protein-energy malnutrition and severe nutrient deficiencies affected children in poor rural communities and estates during the first half of the century until the 1960s or so. Since then, the nutritional status of children in Malaysia in general has imporved amidst active socioeconomic development and various intervention programmes that have been implemented. Nevertheless, results from studies undertaken in the 1990s indicate that certain old nutrition problems in children still persist. These include protein-energy malnutrition in the forms of underweight, stunting and wasting, as well as iron deficiency anaemia, worm infestation and iodine deficiency disorders. Meanwhile, there is an increase in the prevalence of overweight among urban children. This review discusses the prevalence of these issues in rural communities, estates, Orang Asli, and communities in Sarawak and Sabah.
Neonatal malaria may be overlooked likely due to its non-specific features and low prevalence in Malaysia. In this case report, we detail a case of neonatal malaria in an 18-day old baby girl of Myanmar origin who presented with 6 days of intermittent fever but was otherwise well. Initially, she was treated as neonatal sepsis. She then developed thrombocytopaenia and severe anaemia with persistent spikes of temperature. This prompted a series of investigations and multiple changes of antibiotics. The diagnosis of neonatal malaria surfaced when her peripheral blood film incidentally revealed the presence of Plasmodium vivax parasites. Peripheral blood smears are simple and inexpensive. Therefore practising especially in endemic areas for malaria, we need to consider this diagnosis when dealing with neonatal sepsis that does not respond to standard treatment.
A 6-year-old intact Persian cat was presented for the primary complaint of inappetence and weight loss. Irregular surface of
kidneys was palpated during physical examination. Abdominal radiograph findings were indicative of renomegaly. Ultrasonography
revealed multiple anaechoic structures within the renal parenchyma. The cortex, medulla and renal pelvis were unable to be
differentiated. Both radiographic and ultrasonographic findings were suggestive of polycystic kidney disease. Blood test revealed
normochromic, normocytic anaemia with azotaemia whereas urinalysis findings were hypostenuria and proteinuria, consistent of
chronic kidney disease due to polycystic kidney. Ultrasound is a useful antemortem diagnostic tool to diagnose polycystic kidney
disease in cats.
Scurvy resulting from dietary deficiency of vitamin C is characterized by anaemia, tender limbs swelling and hemorrhagic manifestations such as petechiae and bruises. We report a case of scurvy in a 13 years old boy with cerebral palsy who presented with history of limbs bruising and swelling for 2 months. On examination, he was cachexic and pale with poor dentition and swollen gum. There were extensive bruises and swollen limbs as well. His platelet count and coagulation profile were normal. Limbs X-ray revealed classical scorbutic changes in the long bones. Serum ascorbic acid level was low
A review of recent data available on the nutritional health of Indian children seems to suggest that malnutrition is a major problem among poor Indian preschool and school children. Examination of indirect indicators of malnutrition reveals that for Indians, the annual percentage decrease in TMR is the lowest and incidence of low birth weight and perinatal mortality rate the highest. While there is very little documentation in the extent and severity of protein-malnutrition among Indian children, hospital admission returns for severe PEM show a predominance of Indian preschool children. This suggest that moderate forms of malnutrition may even be more widely prevalent amongst this group of the population thus posing a great problem from the public health point of view. The prevalence of moderate PEM as represented by acute ("wasting") and chronic forms ("stunting") was found to be the highest among Indian urban and rural children. Biochemical studies indicate widespread prevalence of anemia, vitamin A and B deficiencies especially among Indian preschool children. The presence of high parasitic infections may exacerbate such deficiencies. The causes of malnutrition are multiple and complex. Low family income as a consequence of high unemployment rate (8%) and low wages, lack of basic sanitation and adequate housing, large family size, alcoholism and apathy among parents, ignorance of good nutrition and disturbed conditions in the home environment have been identified as some of the factors that may contribute towards malnutrition in this community. Thus the viscous cycle of malnutrition appears to have gained a foothold in the poor Indian community. As has been well documented, the social implications of malnutrition are many, the most important being its effect on education. It is now well known that malnutrition hinders intellectual development; it interferes with a child's motivation, ability to concentrate, and ability to learn and cope with the school situation. Malnutrition thus could be one of the contributory factors to the generally poor performance in studies, to the low aspiration for higher education and to the alarming drop-out rate (60%) found among Indian school children. While this review attempts to highlight some of the nutritional problems confronting the Indian poor, it is clearly essential from a national view-point that community level surveys should be further undertaken to assess the nutritional health of this group. The problem of malnutrition among poor Indian children is real and needs urgent recognition and remedial measures from both public and political sectors alike.
Background: Benzene is primarily routed by inhalation which highly sensitive to blood parameters as bone marrow is their target organ. The ability of benzene even in low exposure levels may induce human bone marrow suppression resulting in blood diseases such as leukopenia, anemia, thrombocytopenia, aplastic anemia, and pancytopenia. In the occupational setting, the most common benzene-exposed workers are from the petrochemical industries and petrol distribution such as gasoline pumps. Benzene also generated primarily by mobile exhaust and some from various of anthropogenic sources at environmental atmosphere and occupationally exposed in the policemen traffic, taxi and bus drivers, and street vendors in long-length time with low concentration exposure. Methodology: This paper reviewed published articles on biomarkers exposure, effects and susceptibility as the useful tools for benzene exposure assessment in the occupational and environmental setting. Data from previous epidemiological studies relevant to benzene exposure in various occupational and environmental setting is also summarized. Results: Based on these analyses, the findings agreed that these biomarkers are could suggest in linking the benzene exposure with possible adverse health effects. The biological monitoring used in epidemiological studies is useful in providing an understanding of activation and detoxification of benzene in both the occupational and general population as they are exposed to wide range of benzene concentration. Conclusion. The biomarkers of exposure, effects, and susceptibility utilized for benzene exposure assessment are valid tools in determining the greatest potential risk as well as an early biological effect which then caused a related specific disease.
Introduction: Diabetic foot infection, a complication which can lead to lower limb amputation, is a major source of morbidity and mortality in Malaysia. The objective of this study was to determine the predictive factors of major lower limb amputation among patients with diabetes mellitus in a cluster of three district hospitals in Pahang, Malaysia. Materials and Methods: This cross-sectional study involved 170 patients who had undergone surgical interventions for diabetic foot infections at three district hospitals from 1st of September 2014 to 31st December 2015. The predictors for major amputation of lower limb were determined using simple logistic regression (LR) and forward LR multiple logistic regression. Results: A total of 21 patients had undergone major amputations of lower limb (15 transtibial and 6 transfemoral). The following factors were associated with major amputation of lower limb; longer duration of disease, age ≥ 60 years, patients from Bentong Hospital, presence of hypertension, presence of fever, history of multiple limb-salvaging surgeries, monomicrobial culture, necrotising fasciitis, anemia and leukocytosis. Upon forward LR multiple logistic regression, only duration of disease, history of more than three previous limb-salvaging surgeries and total white blood cell count ≥15X109/L were found to be significant as predictive factors of major amputation of lower limb. Conclusion: Among the factors analysed in this study, a longer duration of disease, raised total white blood cell count and history of more than three limb-salvaging surgeries were identified as predictors for major amputation of lower limb in diabetic foot infections using stepwise logistic regression analysis.
Purpose Selective internal radiation therapy or radioembolization (RE) shows efficacy in unresectable hepatocellular carcinoma (HCC) limited to the liver. This study compared the safety and efficacy of RE and sorafenib in patients with locally advanced HCC. Patients and Methods SIRveNIB (selective internal radiation therapy v sorafenib), an open-label, investigator-initiated, phase III trial, compared yttrium-90 (90Y) resin microspheres RE with sorafenib 800 mg/d in patients with locally advanced HCC in a two-tailed study designed for superiority/detriment. Patients were randomly assigned 1:1 and stratified by center and presence of portal vein thrombosis. Primary end point was overall survival (OS). Efficacy analyses were performed in the intention-to-treat population and safety analyses in the treated population. Results A total of 360 patients were randomly assigned (RE, 182; sorafenib, 178) from 11 countries in the Asia-Pacific region. In the RE and sorafenib groups, 28.6% and 9.0%, respectively, failed to receive assigned therapy without significant cross-over to either group. Median OS was 8.8 and 10.0 months with RE and sorafenib, respectively (hazard ratio, 1.1; 95% CI, 0.9 to 1.4; P = .36). A total of 1,468 treatment-emergent adverse events (AEs) were reported (RE, 437; sorafenib, 1,031). Significantly fewer patients in the RE than sorafenib group had grade ≥ 3 AEs (36 of 130 [27.7%]) v 82 of 162 [50.6%]; P < .001). The most common grade ≥ 3 AEs were ascites (five of 130 [3.8%] v four of 162 [2.5%] patients), abdominal pain (three [2.3%] v two [1.2%] patients), anemia (zero v four [2.5%] patients), and radiation hepatitis (two [1.5%] v zero [0%] patients). Fewer patients in the RE group (27 of 130 [20.8%]) than in the sorafenib group (57 of 162 [35.2%]) had serious AEs. Conclusion In patients with locally advanced HCC, OS did not differ significantly between RE and sorafenib. The improved toxicity profile of RE may inform treatment choice in selected patients.
Medical students in Malaysia and globally were considered among the most exposure groups in the community to stress due to several sources. The most significant and severe sources of stress in medical students is an academic sources, includes a lot of exams/tests, lack of time and facilities for entertainment, stay in a hostel, high parental expectations and vastness of syllabus, in addition to emotional problems and others personal sources. Stress is a very important issue that leads to a worsening of health problems. Stress develops in the body and leads to oxidative stress which in turn leads to a disorder in the whole body. Oxidative stress may lead to abnormal haematological indices elevated white blood cells (WBCs) count. Oxidative stress can lead to massive destruction of red blood cells (RBCs). The brain and the gastrointestinal system (GI) are intimately connected as one system. The brain has a direct impact on the GI tract. A stressful brain can send signals to the gut, just as a troubled intestine can send signals to the brain. Therefore, stress can be the cause of block the breakdown and assimilation of food for energy and nutriment. This malabsorption can then lead to a reciprocal negative effect to the stress and can be another cause of anaemia through malabsorption minerals and vitamins that are to erythropoiesis. So, stress can be one of the leading causes of anaemia among medical students. Stress is a chronic epidemic in the most medical students and can directly affect how well body works. This review article discovers the effect of stress in medical students that can be effect on their studies and further create researcher's interest to generate database that help to reduce stress response and bring about the empowerment of balanced life among Malaysian medical students besides the increasing level of health and academic performance.
A 26-year-old female patient with Type 1 Gaucher's disease (GD) was admitted to our clinic with complaints of stomachache and signs of anemia. The patient underwent ultrasonography (US), computerised tomography (CT), and magnetic resonance imaging (MRI) scan. Imaging studies revealed massive hepatosplenomegaly, choledocolithiasis, and six nodules in the spleen with a mean size of 14 mm. The nodules appeared hyperechoic, hypoechoic, and of mixed echogenicity on the US and hypodense on the CT. While the nodules were observed to be iso-hypointense in T1-weighted (T1WI) images, they appeared to be hyperintense in the T2-weighted (T2WI) images. There were no diffusion restrictions in these nodules that appeared on the diffusion-weighted magnetic resonance imaging (DWI). A nodule located at the lower pole was observed to be hypointense in the T2WI images. The nodule located at the lower pole, which appeared hypointense in T2WI series, had restricted diffusion upon DWI. In this study, we aimed to present the properties of splenic GD nodules using US, CT, and conventional MRI, together with DWI. This case report is the first to apply US, CT, and conventional MRI, together with DWI, to the splenic nodules associated with Gaucher's disease.
The association between pure red cell aplasia (PRCA) and autoimmune haemolytic anaemia (AIHA) has rarely been reported. PRCA represents an isolated process, characterized by normochromic, normocytic anaemia, reticulocytopenia and erythroid hypoplasia in the bone marrow, and may be attributable to infection with Parvo virus B19. AIHA is a condition in which peripheral red blood cell destruction is induced by the presence of autoantibodies. However, the co-existence of these conditions is very rare, since only few cases of PRCA and AIHA associated with malignant lymphoma (ML) were reported. A case of PRCA and AIHA was detected and described, for the first time in Malaysia, in a 10-year-old child suffering from non-Hodgkin lymphoma from the Department of Haematology, Universiti Sains Malaysia. Following the induction course of chemotherapy, the patient turned anaemic, with tendency for red cell clumping, reticulocytopenia and anisocytosis. AIHA was suspected in spite of the weak Coomb reaction obtained. The bone marrow aspirate revealed the presence of giant pronormoblasts, suggesting PRCA. Serological tests for Parvo virus and other viruses were negative.
BACKGROUND: Plasmodium vivax is one of the major species of malaria infecting humans. Although emphasis on P. falciparum is appropriate, the burden of vivax malaria should be given due attention. This study aimed to synthesize the evidence on severe malaria in P. vivax infection compared with that in P. falciparum infection.
METHODS/PRINCIPAL FINDINGS: We searched relevant studies in electronic databases. The main outcomes required for inclusion in the review were mortality, severe malaria (SM) and severe anaemia (SA). The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Overall, 26 studies were included. The main meta-analysis was restricted to the high quality studies. Eight studies (n = 27490) compared the incidence of SM between P. vivax infection and P. falciparum mono-infection; a comparable incidence was found in infants (OR: 0.45, 95% CI:0.04-5.68, I2:98%), under 5 year age group (OR: 2.06, 95% CI: 0.83-5.1, I2:83%), the 5-15 year-age group (OR: 0.6, 95% CI: 0.31-1.16, I2:81%) and adults (OR: 0.83, 95% CI: 0.67-1.03, I2:25%). Six studies reported the incidences of SA in P. vivax infection and P. falciparum mono-infection; a comparable incidence of SA was found among infants (OR: 3.47, 95%:0.64-18.94, I2: 92%), the 5-15 year-age group (OR:0.71, 95% CI: 0.06-8.57, I2:82%). This was significantly lower in adults (OR:0.75, 95% CI: 0.62-0.92, I2:0%). Five studies (n = 71079) compared the mortality rate between vivax malaria and falciparum malaria. A lower rate of mortality was found in infants with vivax malaria (OR:0.61, 95% CI:0.5-0.76, I2:0%), while this was comparable in the 5-15 year- age group (OR: 0.43, 95% CI:0.06-2.91, I2:84%) and the children of unspecified-age group (OR: 0.77, 95% CI:0.59-1.01, I2:0%).
CONCLUSION: Overall, the present analysis identified that the incidence of SM in patients infected with P. vivax was considerable, indicating that P. vivax is a major cause of SM. Awareness of the clinical manifestations of vivax malaria should prompt early detection. Subsequent treatment and monitoring of complications can be life-saving.
BACKGROUND:
Prostate cancer often co-exists with other diseases. It accounts for 11% of all cancers in Nigerian men, and it is the commonest cause of mortality due to cancer in elderly males in Nigeria.
OBJECTIVE:
To present co-morbid medical conditions and medical complications of prostate cancer in patients with the disease in Southern Nigeria.
PATIENTS AND METHODS:
The study was carried out prospectively (2002 to 2003) at University of Port Harcourt Teaching Hospital (UPTH), and Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi- both in Southern Nigeria. Using common proforma, patients who presented to the urology units of the two teaching hospitals were evaluated clinically and with relevant investigations for prostate cancer and other diseases. Those with histologically confirmed prostate cancer were included in this study. Data was also collected retrospectively by using the same proforma to obtain information from case files of 37 patients diagnosed with prostate cancer at UPTH. Data from the two institutions were collated and analysed.
RESULTS:
Of 189 cases analysed, 73.4% had significant medical co-morbid diseases/complications. These included anaemia (69.8%), urinary tract infection (56.1%), chronic renal failure (33.9%), hypertension (41.8%), diabetes mellitus (9.5%), paraplegia (9.5%), congestive cardiac failure (9.0%) and cerebrovascular disease (5.3%).
CONCLUSION/RECOMMENDATIONS:
These patients had high disease burden. Improved health education and well coordinated interdisciplinary team work are suggested in managing this malignancy.
Domestic maid violence is an assault and coercive behaviour, which mainly includes physical, psychological and at times sexual too, by employer or household members of employer against a person hired as a domestic help. Maid abuse is well known but poorly documented in scientific literature. This is an important global issue. In this article, two illustrated cases of maid abuse are discussed. Their employers allegedly subjected both the victims to physical and psychological trauma. The physical examination of the victims showed poor state of clothing, nutrition, and presence of injuries of different duration. The bruises were irregular to patterned, and were inflicted by beating. Both cases had eczematous contact dermatitis over palms and soles, paronechia, and sub-ungal fungal infection due to unprotected working in wet conditions. In both cases, external ears were deformed like cauliflowers due to repeated trauma. All cases had multiple injuries of varying duration. In this paper, medico-legal and social issues related to maid abuse are also discussed in detail. A possible solution to minimise maid abuse is also suggested. This paper highlights and document maid abuse.