Background: The optic nerve covering is elastic enough to allow a detectable enlargement in response to changes in intracranial pressure. The objective of the present study was to determine the optic nerve sheath diameter (ONSD) in normal Nigerian adults. Methods: This study was conducted on 400 healthy adults. The ONSD was measured at 3 mm posterior to the globe using a 7.5 MHz linear transducer. Results: The study population consisted of 192 males and 208 females with mean age of 36.94 years (SD 16.63). The range of values for ONSD was 3.36 to 5.1 mm. The median right ONSD was 4.110 with a range of 3.36–4.86 mm (mean: 4.18 mm (SD 0.49)), while the median left ONSD was 4.35 mm with a range of 3.77−5.10 mm (mean: 4.17 + mm (SD 0.44)). No statistically significant variation in ONSD was found between the right and left sides (P = 0.12) and also between male and female participants (P = 0.296 and 0.745 for the respective right and left ONSD). Conclusions: The normal reference values of ONSD measurements in adults were obtained. It showed no significant correlation with side (right and left), age, and sex. Furthermore, there is no significant correlation of ONSD with the body height and weight.

The first support for HIV/AIDS intervention for the PLHIV community in Malaysia was initiated by non-governmental organisations (NGOs) particularly to sustain positive living and to reduce the mental health and psychosocial impact of HIV/AIDS. While there may be several studies pertaining to mental health and HIV/AIDS carried out in Malaysia, there are limited studies on the role of the Malaysian HIV/AIDS NGOs in promoting mental health. The mental health conditions of the PLHIV community cannot be easily summarised as the side effects of the infectivity as the contributory factors affecting the PLHIV‟s mental health are varied according to their needs and groups of community particularly due to the stigmatisation of the pandemic in Malaysia. The HIV/AIDS NGOs which initially started as support groups are now challenged with more intensified and wide-ranging task particularly with the introduction of the Malaysian National Strategic Plan in 2006. However, the capability of the small number of HIV/AIDS NGOs to cater for the needs of over 90,000 cases of HIV/AIDS in Malaysia remains unrequited. These NGOs have played a crucial role in providing diverse services and have become the core intermediaries to the various groups of stakeholders. Yet, there is still a serious need to strengthen their effort in promoting mental health as a mission for the PLHIV community‟s well-being. Promoting mental health demands specific skills to enable the PLHIVs to accept cope and manage their condition: an expertise which HIV/AIDS NGO members need continuous training and guidance. With a majority of volunteers‟ involvement and limited professional workers, the NGOs face a great challenge in realising its aims of promoting mental health among the PLHIV community. This paper looks into some of the ways for mental health programme inclusion in HIV/AIDS NGOs and concludes with some future directions in identifying a collaborative agenda with various stakeholders as well as policy adjustment that will enable to sustain mental health promotion for the PLHIV community in Malaysia.

Introduction: Oxidative stress induced by excessive and unopposed levels of reactive oxygen species in male reproductive system results in impaired sperm quality, fertilization capacity and poor embryo development. Our goal is to assess the potential effects of Aquilaria malaccensis (AM) leaves, a plant with strong antioxidant property on early embryo development in vitro and embryo quality following fertilization with cyclophosphamide (CP) exposed rat sperm. Materials and Methods: Twenty four male Sprague Dawley rats were allocated into eight groups of three rats (n = 3): control, CP only (200 mg/kg), AM only (100 mg/kg, 300 mg/kg and 500 mg/kg) and CP + AM (100 mg/kg, 300 mg/kg and 500 mg/kg). Animals were sacrificed after 63 days of treatment and sperm from caudal epididymis were taken for in vitro fertilization (IVF) with oocytes from untreated female. Fertilization, embryo division and embryo morphology were examined at 8 and 48 hours post insemination and compared between groups. Statistical evaluations were performed using Chi-Square test and Fisher’s exact test and p-value<0.05 was considered significant. Results: Administration of AM leave extract at 100 mg/kg/day to normal rats and CP-exposed rats has significantly increased (p<0.05) the fertilization rate, early cleavage rate and embryo quality when compared to CP only treated group. However, other groups showed no significant differences. Conclusion: Overall, the present results indicate the potential of AM leave extract supplementation to improve the fertility and early embryo development in male rat exposed to CP by inhibiting the oxidative processes and scavenging free radicals.

The global prevalence of chronic kidney disease (CKD) is between 11 to 13%. Renal replacement therapies (RRT) – which include dialysis and renal transplantation – consume a significant portion of a country’s health resources even though only 0.1% of all CKD patients are at stage 5, also known as end-stage renal disease (ESRD). The aim of this review was to compare the magnitude of the economic burden of ESRD on national healthcare systems of selected countries with high prevalence of ESRD including Malaysia. The quantity of interest in this review were total ESRD expenditures and its proportions to the national health systems' expenditure. It was identified that total ESRD expenditure contributes between 0.91% to 7.1% of national health system expenditure in countries selected for this review. In Malaysia, the public sector - through its various agencies at the federal and state levels, accounted for almost 70% of dialysis funding; the remaining 30% came from the private sector and out-of-pocket payments. The ESRD expenditures in Malaysia constitutes 4.2% of total health expenditure by the public sector, relatively high compared to other countries. This review will summarise findings of the currently available economic evaluations of RRT in Malaysia. Based on available evidence, estimated weighted cost of treating ESRD patient in Malaysia is MYR39,346 per patient per year (USD26,648, PPP 2016).

Colonic diverticula is observed in over 60% of the western population aged over 80 where up to 30% will eventually be symptomatic and may develop complications. The natural history and etiology of colonic diverticula have been well described. However, predictive indicators of complicated diverticular disease are not known thus preventing the prophylactic treatment of this subset of patients,. The aim of this study was to observe patients with complicated diverticular disease in order to identify common factors associated with recurrent complications. All hospital admissions from January 2005 to December 2008 for complications of diverticular disease were recruited. Using logistic regression, demographic data and factors such as clinical presentation, nature of complication, lifestyle, concomitant medical illness and medications that may be associated with recurrent episodes of complications were analyzed. A total of 121 patients were diagnosed with complicated diverticular disease during the study period with 24 patients having recurrent complications. Logistic regression analysis performed after controlling for confounders found active smoking (p=0.006) and alcohol consumption (p=0.036) along with underlying diabetes (p=0.031) and dyslipidemia (p=0.039) significantly associated with an increased risk of recurrent complications. We therefore concluded that smoking, alcohol consumption, diabetes mellitus and dyslipidemia are associated with recurrent complicated colonic diverticular disease. As these are modifiable risk factors, they should be sought for during the presentation of the first attack. Aggressive control of these factors will help in reducing the risk of recurrent complications.

Abstract: Malignant melanoma is a rare malignancy of the external auditory canal. The vast majority of them occur in the areas of the body that are exposed to the sun. Early histological examination may possibly favor better prognosis. We report a case of a 38-year-old female who presented with a small mass in right ear canal, earache and minimum discharge since 4 months. Initially scraping was done in the ENT clinic. Subsequently she had a wide excision done by the end aural approach at a different hospital. A year later the patient presented with a swelling involving the ear canal which extended to the helix and supratemporal region with the histology report as malignant melanoma. A literature review of the disease, radiological findings, immunohistochemical features and treatment options are discussed.
Melanoma

Opportunistic pneumonias are major causes of morbidity and mortality in HIV infected individuals. The majority of new HIV infections in Malaysia are adults aged 20 to 39 years old and many are unaware of their HIV status until they present with an opportunistic infection. HIV associated opportunistic pneumonias can progress rapidly without appropriate therapy. Therefore a proper diagnostic evaluation is vital and prompt empiric treatment of the suspected diagnosis should be commenced while waiting for the results of the diagnostic studies. Tuberculosis, Pneumocystis pneumonia (PCP) and recurrent bacterial pneumonias are common causes of AIDS-defining diseases and are discussed in this article.

This study explores the experience of both learners and a teacher during a team-based learning (TBL) session. TBL involves active learning that allows medical students to utilise their visual, auditory, writing and kinetic learning styles in order to strengthen their knowledge and retain it for longer, which is important with regard to applying basic sciences in clinical settings. This pilot study explored the effectiveness of TBL in learning medical genetics, and its potential to replace conventional lectures. First-year medical students (n = 194) studying at Universiti Kebangsaan, Malaysia, during 2014/2015 were selected to participate in this study. The topic of ‘Mutation and Mutation Analysis’ was selected, and the principles of TBL were adhered to during the study. It was found that the students' performance in a group readiness test was better than in individual readiness tests. The effectiveness of TBL was further shown in the examination, during which the marks obtained were tremendously improved. Collective commentaries from both the learners and the teacher recommended TBL as another useful tool in learning medical genetics. Implementation strategies should be advanced for the benefit of future learners and teachers.

Obstructive sleep apnoea hypopnoea syndrome (OSAHS) is a common cause of breathing-related sleep disorder, causing excessive daytime sleepiness. Common clinical features of OSAHS include snoring, fragmented sleep, daytime somnolence and fatigue. This article aims to provide a comprehensive review of the condition, including its management.