MyMedR

Ocular malignant melanoma - a report of two cases

Reddy SC, Darnal HK

Nepal J Ophthalmol, 2014 Jan;6(11):113-8.

PMID: 25341837 DOI: 10.3126/nepjoph.v6i1.10783

INTRODUCTION: Melanoma is a rare malignant tumour in the eye.

OBJECTIVE: To report two cases of malignant melanoma in the eye, one in the conjunctiva and the other in the choroid.

CASES: The first case was in a 49-year-old lady who presented with a swelling on the inner side of left upper eyelid. The vision was 6/6. On everting the eyelid, multiple, pigmented, nodular swellings were noted on the tarsal conjunctiva. Excision biopsy confirmed the diagnosis of malignant melanoma of the conjunctiva. A pigmented nodular swelling occurred on the lower bulbar conjunctiva in the same eye one-and-a-half years after the first presentation. There were no secondary nodules in the body. Excision biopsy confirmed malignant melanoma of the conjunctiva. The second case was in a 72-year-old lady who presented with pain and bleeding in the right eye. There was no perception of light. The cornea was hazy and the details behind it could not be seen. There was micro perforation of the cornea with oozing of blood and secondary glaucoma. B-scan ultrasonography of the right eye revealed an intraocular tumour. The histopathology of the enucleated eyeball confirmed the diagnosis of malignant melanoma of the choroid.

CONCLUSION: In the case of conjunctival melanoma, the occurrence of tumour at multiple sites and absence of recurrence at the original site suggests the possibility of de novo origin of the tumour. Secondary glaucoma and bleeding may be the presenting features of melanoma in the choroid.

Matched MeSH terms: Pain

Fulltext Arthroscopic resection of the distal clavicle with concomitant subacromial decompression: a case series

Chan H, Ooi C, Lim M, Ong E, Zulkiflee O

Malays Orthop J, 2014 Jul;8(2):59-62.

PMID: 25279097 MyJurnal DOI: 10.5704/MOJ.1407.007

Shoulder impingement syndrome and acromioclavicular joint osteoarthritis often occur simultaneously and easily missed. Kay et al. reported excellent results with combined arthroscopic subacromial decompression and resection of the distal end of the clavicle in patients with both disorders(1). Arthroscopic treatment of these disorders produces more favourable results than open procedures. We report two patients who were not responding to conservative management and were treated with direct arthroscopic distal clavicle excision and subacromial decompression in single setting. Both patients gained good postoperative outcome in terms of pain score, function and strength improvement assessed objectively with visual analogue score (VAS) and University of California Los Angeles Score (UCLA).

Matched MeSH terms: Pain

Fulltext Psycho-behavioural risks of low back pain in railway workers

Ganasegeran K, Perianayagam W, Nagaraj P, Al-Dubai SA

Occup Med (Lond), 2014 Jul;64(5):372-5.

PMID: 24727561 DOI: 10.1093/occmed/kqu039

BACKGROUND:
Low back pain (LBP) is the most costly ailment in the work force. Risky work behaviour and psychological stress are established risk factors.

AIMS:
To explore the associations between workplace risk factors, psychological stress and LBP among Malaysian railway workers.

METHODS:
A cross-sectional study was carried out on railway workers in Malaysia. Socio-demographics, workplace risk factors for LBP, perceived psychological stress and history of LBP over the previous month were obtained by direct interviews using a structured closed-ended questionnaire. Descriptive, bivariate and logistic regression analyses were conducted.

RESULTS:
There were 513 study participants (70% response rate). The prevalence of LBP in the previous month was 69%. Multivariate analysis yielded four significant predictors of LBP: employment of ≥ 10 years, lifting and lowering heavy loads, prolonged standing posture and psychological stress.

CONCLUSIONS:
The high prevalence of LBP and its significant associations with physical and psychological stress factors in railway workers points to an urgent need for preventive measures, particularly among workers in high-risk occupations.

Matched MeSH terms: Low Back Pain/etiology*; Low Back Pain/epidemiology; Low Back Pain/psychology

Fulltext Case Report: A Patient with Acute Cardiac Tamponade Secondary to Complicated Stanford Type A Intramural Haematoma - the role of CT

Poh F, Chow MB

Med J Malaysia, 2014 Feb;69(1):37-9.

PMID: 24814629

Chest pain is a common presenting complaint in the emergency room of which acute aortic syndrome is a sinister cause associated with high morbidity. A contrastenhanced CT aortogram is often performed for initial evaluation at the first instance of suspicion. We present a patient with Stanford Type A intramural haematoma complicated by haemopericardium and acute cardiac tamponade and highlight the relevant CT signs that would alert the managing physician to urgent echocardiogram correlation and emergent cardiothoracic intervention.

Matched MeSH terms: Chest Pain

Fulltext The Effects of Pre-emptive Administration of Ketamine and norBNI on Pain Behavior, c-Fos, and Prodynorphin Protein Expression in the Rat Spinal Cord after Formalin-induced Pain Is Modulated by the DREAM Protein

Long I, Suppian R, Ismail Z

Korean J Pain, 2013 Jul;26(3):255-64.

PMID: 23861999 DOI: 10.3344/kjp.2013.26.3.255

We investigated the effects of pre-emptive administration of ketamine and norBNI on pain behavior and the expression of DREAM, c-Fos, and prodynorphin proteins on the ipsilateral side of the rat spinal cord at 2 and 4 hours after formalin injection.

Matched MeSH terms: Pain

Fulltext Radiofrequency-induced intradiscal nucleoplasty chronic low back pain secondary to lumbar disc herniation

Lee D, Loh E, Kueh C, Poi J, Francis T, Koh KC, et al.

Malays Orthop J, 2013 Jul;7(2):18-20.

PMID: 25722820 MyJurnal DOI: 10.5704/MOJ.1307.009

We set out to assess the efficacy of radiofrequency-induced intradiscal nucleoplasty in reducing pain in symptomatic patients with MRI-defined lumbar disc herniation and their satisfaction with the procedure. We compared the patients' pain intensity and severity of disability scores before and after undergoing the procedure in a retrospective questionnaire. These patients reported statistically significant reduction of pain intensity and disability level after the procedure. We conclude that radiofrequencyinduced intradiscal nucleoplasty is an acceptable alternative minimally invasive procedure in relieving the symptoms of patients with lumbar disc herniation.

Matched MeSH terms: Pain

Fulltext Femoral Shaft Cortical Pathology associated with longterm Alendronate Therapy: A New Classification

Kwan M, Chan C, Ng W, Merican A, Chung W, Chan S

Malays Orthop J, 2013 Jul;7(2):12-7.

PMID: 25722819 MyJurnal DOI: 10.5704/MOJ.1307.008

There are reported cases of cortical reaction over the tension side of the normal femoral shafts in patients on long term treatment with alendronate, leading to subsequent femoral shaft fractures. We performed a retrospective review of patients with low-energy femoral shaft fracture on alendronate, admitted to our institution during the period 2004 to May 2009. The presence of radiological changes of cortical hypertrophy with or without Looser's zone over the tension side of the femoral bone (normal limb) was determined and correlated with clinical symptoms. Thirteen patients were identified. Average duration of alendronate use was 6.5 ± 3.3 years (ranges, two to 10 years). These radiological changes were noted in four patients. Average duration of alendronate usage in these four patients was 6.5 ± 2.4 years (ranges, 5 to10 years). Prodromal thigh pain was present in a patient, who had cortical hypertrophy with the presence of a Looser's zone traversing the cortex on the femoral shaft. One patient had Looser's zone limited at the lateral hypertrophied cortex without prodromal pain. The interobserver kappa coefficient was 0.96. A femoral radiograph should be performed in all patients who are on long-term alendronate therapy who present with thigh pain. We propose a new grading system based on our observation of the radiological features in these four cases. This new grading of the radiological spectrum of femoral shaft cortical pathology has the potential to stratify the risk of low energy femoral fracture for patients treated with long-term alendronate therapy.

Matched MeSH terms: Pain

Fulltext Cardiovascular effects of common analgesics

Ong HT, Ong LM, Tan TE, Chean KY

Med J Malaysia, 2013 Apr;68(2):189-94.

PMID: 23629578 MyJurnal

The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing inflammation and pain. Classical non-steroidal anti-inflammatory drugs (NSAID) inhibit the COX-2 enzyme that produces inflammatory prostaglandins as well as the COX-1 enzyme that produces gastric mucosa protecting prostaglandins. By specifically inhibiting only the COX-2 enzyme, coxibs thus reduce pain but do not damage the gastric mucosa. However, COX-2 at the vascular endothelium produces antithrombotic prostaglandins, and so by inhibiting COX-2 enzyme, the coxibs promote thrombosis. Rofecoxib and valdecoxib have been withdrawn because of the adverse cardiovascular events they induce. Amongst presently available coxibs cardiovascular risk is highest with enterocoxib and lowest with celecoxib. NSAIDS also increase cardiovascular events, the risk is highest with diclofenac and lowest with naproxen. Paracetamol and corticosteroids induce hypertension, while steroids also adversely affect the heart from metabolic change as well as fluid retention. Aspirin is an anti-thrombotic agent because of its ability to inhibit the COX-1 enzyme that produces the pro-aggregatory thromboxane. However, it increases gastrointestinal bleeding, can promote fluid retention and is nephrotoxic, all of which may lead to adverse cardiovascular outcomes. Patients at especially high risk of cardiovascular events from analgesic use include the elderly, and those with heart failure, hypertension, rheumatoid arthritis, chronic renal disease, chronic obstructive airway disease and previous myocardial infarction, cerebrovascular disease or peripheral vascular disease. Adverse cardiovascular events can occur within a week of initiation of analgesic treatment.

Matched MeSH terms: Pain

Fulltext Retained intraspinal bullet: a rare case in a visitor to malaysia - a case report

Ariffin M, Noreen F, Nor Hamdan Y, Shaharuddin AR, Azmi B

Malays Orthop J, 2012 Nov;6(3):45-7.

PMID: 25279057 MyJurnal DOI: 10.5704/MOJ.1207.005

Firearm injuries to the spine commonly present with acute neurology caused by direct penetration or indirectly from concussive effects of bullet impact on the vertebral column. We report a case of delayed neurologic presentation of retained intra-spinal bullet in a 42 year-old African who had chronic low back pain and sciatica with a past history of gunshot injury to the spine and radiograph revealed a bullet at the L4-5 disc level. Intra-operative exploration showed a fibrous mass around the bullet compressing on the L4 existing nerve root and L5 traversing nerve root. Removal of the retained bullet resulted in a good clinical outcome with complete resolution of symptoms.

Matched MeSH terms: Low Back Pain

Screening of stepping forces in an arthritic rat model using a novel analgesic meter and data acquisition system

Yam MF, Ahmad M, Por LY, Ang LF, Basir R, Asmawi MZ

Sensors (Basel), 2012;12(7):9603-12.

PMID: 23012561

The stepping forces of normal and Freund Complete Adjuvant (FCA)-induced arthritic rats were studied in vivo using a proposed novel analgesic meter. An infrared charge-coupled device (CCD) camera and a data acquisition system were incorporated into the analgesic meter to determine and measure the weight of loads on the right hind paw before and after induction of arthritis by FCA injection into the paw cavity. FCA injection resulted in a significant reduction in the stepping force of the affected hind paw. The stepping force decreased to the minimum level on day 4 after the injection and then gradually increased up to day 25. Oral administration of prednisolone significantly increased the stepping forces of FCA-induced arthritic rats on days 14 and 21. These results suggest that the novel device is an effective tool for measuring the arthritic pain in in vivo studies even though walking is a dynamic condition.

Matched MeSH terms: Pain

Fulltext Vaginismus and subfertility: case reports on the association observed in clinical practice

Ramli M, Nora M, Roszaman R, Hatta S

Malays Fam Physician, 2012;7(1):24-7.

PMID: 25606241 MyJurnal

OBJECTIVE: To analyse the features of patients with vaginismus first presented to a gynaecologist for infertility before being referred for psychiatric evaluation and management. The case series aim to provide some insight on features and presentations of Asian women with vaginismus. Vaginismus is characterised by persistent or recurrent difficulties in vaginal penetration despite the woman's wish for coitus. Avoidance, phobia, anticipatory fear of pain and involuntary pelvic muscle contraction are the most common symptoms.

METHOD: We report a series of cases of Malaysian women who had been suffering from vaginismus and 'infertility'. All the cases had never been attended to medically and there were long delays in seeking intervention. There was no history of traumatic sexual experience or any major psychiatric illness in these patients. Majority of the patients had prominent symptoms of anxiety.

CONCLUSION: The cases illustrate that it is important to rule out the possibility of vaginismus among patients with infertility. The former have unique psychological features which require psychological interventions.

Matched MeSH terms: Pain

In vivo antinociceptive and anti-inflammatory activities of dried and fermented processed virgin coconut oil

Zakaria ZA, Somchit MN, Mat Jais AM, Teh LK, Salleh MZ, Long K

Med Princ Pract, 2011;20(3):231-6.

PMID: 21454992 DOI: 10.1159/000323756

The present study was carried out to investigate the antinociceptive and anti-inflammatory activities of virgin coconut oil (VCO) produced by the Malaysian Agriculture Research and Development Institute (MARDI) using various in vivo models.

Matched MeSH terms: Pain/drug therapy*; Pain Measurement/methods

Fulltext Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation and analgesia in the emergency department

Jamal SM, Fathil SM, Nidzwani MM, Ismail AK, Yatim FM

Med J Malaysia, 2011 Aug;66(3):231-3.

PMID: 22111446

The study compared the effectiveness of ketamine and midazolam/fentanyl as procedural sedation and analgesia agents for reduction of fractures and dislocated joints. Forty-one adult patients were enrolled by convenience sampling. They were randomized to receive ketamine or midazolam/fentanyl. Depth of sedation, pain score, procedural outcome and memory of the procedure were documented. The ketamine group had deeper sedation, but there was no statistical difference in other variables between the two groups. Three patients in the midazolam/fentanyl group had oxygen desaturation. More adverse effects were associated with ketamine. Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation.

Matched MeSH terms: Pain/diagnosis; Pain/etiology; Pain/prevention & control*

Cytochrome P450 3A4 genetic polymorphisms and post-operative fentanyl requirements

Tan PC, Hassan SK, Mohamad NA, Gan SH

J Clin Pharm Ther, 2012 Feb;37(1):100-4.

PMID: 21128989 DOI: 10.1111/j.1365-2710.2010.01232.x

WHAT IS KNOWN AND OBJECTIVE: Interindividual variability in drug responses may be attributable to genetically determined alteration in enzyme activity. In this study, we investigated the association between cytochrome P450 3A4 (CYP3A4) genetic polymorphisms and post-operative fentanyl requirements.

METHODS: Patients (n = 94) scheduled for gynaecological laparotomy received i.v. fentanyl infusion (3 μg/kg/h) after induction of general anaesthesia. Post-operative fentanyl requirements were quantified by using a patient-controlled analgesia and the number of i.v. fentanyl rescue analgesia required were recorded. Pain control was assessed using visual analogue scores (VAS) and fentanyl's adverse effects were documented. CYP3A4*4, CYP3A4*5 and CYP3A4*18 alleles of cytochrome P450 3A4 were identified by polymerase chain reaction-restriction fragment length polymorphism. Differences in fentanyl requirements, VAS scores and adverse effects among the various genotypes were compared.

RESULTS AND DISCUSSION: No CYP3A4*4 and CYP3A4*5 alleles were detected. Eighty-nine patients (94·7%) were wild-type, five (5·3%) were heterozygous and none was homozygous. No significant difference was demonstrated between the genotype groups in terms of fentanyl consumption, pain control and adverse effects.

WHAT IS NEW AND CONCLUSION: CYP3A4*4 and CYP3A4*5 are rare in the Malaysian Malay population. Genetic polymorphism of CYP3A4*18 may not play an important role in influencing postoperative fentanyl requirements.

Matched MeSH terms: Pain Measurement; Pain, Postoperative/drug therapy*; Pain, Postoperative/enzymology

Fulltext Drug reaction with herbal supplement: a possible case of drug induced lupus erythematosus

Muthupalaniappen L, Jamani N, Muhammad M, Adawiyah J, Aziz N

Malays Fam Physician, 2010;5(2):99-100.

PMID: 25606196 MyJurnal

A 24-year-old lady presented with four days history of fever, non-pruritic rash, ankle pain and swelling. She had consumed herbal supplement five days before the onset of symptoms. Examinations revealed erythematous maculo-papular lesions of varying sizes on sun exposed areas. Patient was suspected to have Drug Induced Lupus Erythematosus (DILE) and subsequently symptoms subsided rapidly on withholding the herbal medication.

Matched MeSH terms: Pain

Transvaginal sonographic measurement of cervical length vs. Bishop score in labor induction at term: tolerability and prediction of Cesarean delivery

Tan PC, Vallikkannu N, Suguna S, Quek KF, Hassan J

Ultrasound Obstet Gynecol, 2007 May;29(5):568-73.

PMID: 17444553

To compare transvaginal sonography for cervical length measurement and digital examination for Bishop score assessment in women undergoing labor induction at term, to assess their tolerability (in terms of pain) and ability to predict need for Cesarean delivery.

Matched MeSH terms: Pain/etiology; Pain Measurement/methods*

Fulltext An elderly man with acute anterior neck pain and odynophagia after a meal

Mohamad I, Jaafar R

Malays Fam Physician, 2013;8(3):37-9.

PMID: 25893057 MyJurnal

The upper aerodigestive tract, specifically the cricopharyngeal area, is the most common site of foreign body impaction. Anatomically, this area is the first constriction of the oesophagus. Fish bones, one of the most common foreign bodies encountered in the throat, tend to get stuck in this area. The movement of this sharp-edged foreign body upon swallowing will induce odynophagia and an acute onset of neck pain. We report a case of a healthy elderly man who complained of sudden anterior neck pain and odynophagia after eating yellowtail scad fish.

Matched MeSH terms: Neck Pain

Fulltext Transoral surgical resection of bilateral styloid processes elongation (eagle's syndrome)

Baharudin A, Rohaida I, Khairudin A

Acta Inform Med, 2012 Jun;20(2):133-5.

PMID: 23322967 DOI: 10.5455/aim.2012.20.133-135

Eagle's syndrome represents a symptomatic styloid process elongation or calcification of stylohyoid or stylomandibular ligament. The symptoms include the throat pain radiating to ipsilateral ear or foreign body sensation in the pharynx causing odynophagia and dysphagia. It is commonly unilateral and bilateral cases are rare. We report a case of bilateral elongation of styloid processes treated surgically by transoral approach.

Matched MeSH terms: Pain

The utility of a 'non-significant' coronary angiogram

Wang TK, Oh TH, Samaranayake CB, Webster MW, Stewart JT, Watson T, et al.

Int J Clin Pract, 2015 Dec;69(12):1465-72.

PMID: 26304046 DOI: 10.1111/ijcp.12723

Coronary angiography is the gold standard for assessing coronary artery disease (CAD). In many patients with chest pain, no or mild CAD (< 50% stenosis) is found. It is uncertain whether this 'non-significant' result influences management and outcomes. We reviewed characteristics and outcomes in a contemporary cohort of chest pain referrals who had mild or absent CAD on coronary angiography.

Matched MeSH terms: Chest Pain

Fulltext A case series of acquired haemophilia in a Malaysian hospital: unpredictably rare medical emergency

Lee CP, Khalid BB

Oxf Med Case Reports, 2015 Oct;2015(10):330-2.

PMID: 26568837 DOI: 10.1093/omcr/omv055

Acquired haemophilia (AH) is a rare bleeding disorder characterized by the presence of acquired inhibitors against Factor VIII causing disruption of coagulation cascade. It has no known genetic inheritance, and diagnosis remains a challenge. The peculiar presentations are later age of onset as acute pain in weight-bearing joints and spontaneous muscle haematoma with isolated prolonged activated partial thrombin time (APTT). Prevalence is 1 per million per year affecting both genders equally where blood product transfusion is seen in almost 87% of cases. The direct cause of AH is still unknown, and autoimmune dysregulation has been postulated, which predisposes to the development of the factor inhibitors. Being extremely rare, we are reporting two consecutive patients diagnosed by unusual bleeding episodes with isolated prolonged APTT due to Factor VIII inhibitors. AH deserves a special mention as high index of suspicion is required. More studies are required to provide better guidance in diagnosis and management of this condition.

Matched MeSH terms: Acute Pain

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