We report a case of scapholunate dissociation which was initially missed and presented late. A modification of Blatt dorsal capsulodesis performed using dorsal intercarpal ligament (DICL) and extra tunnel appears not only to add to dorsal stability but also address the volar problem as well. This modification may be a better alternative to the current technique of using a single flap.
therapeutic aspects ; Assault by stabbing ; Unmarried ; Ligaments

A 27 year old patient with ameloblastoma of the mandible underwent anterior mandibulectomy and reconstruction with left fibula osteocutaneous flap. The bone was shaped at the lower limb before cutting the pedicle. Vascularised free fibula flap provides a good alternative to other bone grafts in mandible reconstruction as it is relatively easy to perform, carries a low complication rate, and mandibular shaping with intact pedicle cuts down on ischaemic as well as total operative time.

Glomus tumours (GT), neoplasms of the glomus body comprise 4.5% of upper limb tumours. Seventy-five per cent of these occur in the hand, and most are subungual (50%). We performed a literature review and retrospective search of histopathologically confirmed GT seen from 1995 to 2009. Fifteen patients were identified, with an average age of 49.6 years. Eight were in the hand, 2 in the upper limb, 2 lower limb and 3 in the ear. Eighty-six per cent presented with pain and 50% underwent radiological investigation. Most diagnoses followed biopsy findings. Surgical excision resulted in a recurrence rate of 13%. The average time to diagnosis was 3.3 years. The average duration of symptoms was 7 to 11 years with an average of 2 to 3 consultations prediagnosis. MRI remains the most useful imaging modality (82 to 90% sensitivity). Excision biopsy is the most common treatment. Greater awareness is needed for quicker diagnosis.

Objectives: This paper aims to report on a case in which re-challenging with clozapine in combination with lithium in a patient who developed neutropenia was carried out. Methods: The patient was treated with clozapine for treatmentresistant schizophrenia. After five weeks he showed much improvement but developed neutropenia. Withdrawal of clozapine brought on a relapse of psychotic symptoms. Subsequently, clozapine was reintroduced along with Lithium. The neutrophil count was monitored closely. Results: The neutrophil and white blood cell count were noted to return to normal upon re-challenging, and the patient’s clinical condition also improved. Conclusion: Simultaneous administration of lithium and clozapine to patients experiencing neutropenia on clozapine is a possible strategy. However, very close monitoring of the white count is needed.
Clozapine ; Lithium ; Neutropenia ; Schizophrenia

Pneumocephalus or collection of air in the intracranial cavity can occur after trauma or surgery. However, delayed pneumocephalus occurring months after the initial injury is not common. We would like to report a case of spontaneous traumatic pneumoencephalocele presenting with transient recurrent hemiparesis 14 months after the initial trauma.
month ; Deferred ; Wounds and Injuries ; Injury inflicted to the body by an external force ; Surgical aspects

Objective: A cross-sectional study was conducted in Malaysia with the objectives of determining the prevalence of smoking in Malaysia, reasons for starting to smoke, age first started to smoke, duration of smoking and to determine the relationship between smoking and age, sex,race, education level, peer influence and parental smoking status. Methods:All residents aged 18 years and above from selected households were included in this study. A standardised pre-tested structured questionnaire was used in this study. Results: The results showed that the overall mean age of the 17.246 respondents was 38.8 (95% CI=38.5-39.2) years with a range of 18-100 years. The majority were Malays (55.5%) followed by Chinese (21.2%) and Indians (11.2%). The age , sex and ethnicity adjusted prevalence of ever and current smokers were 32.0% and 24.9% respectively. The prevalence of ever and current smokers for males was 59.3% and 47.2% respectively. For the females,the prevalence of ever and current smokers was 4.8% and 2.7% respectively. The highest ethnicity adjusted prevalence of current smokers was in Malays (28.9%) followed by the Chinese (18.7%). The lowest prevalence was amongst the Indians (16.8%). The highest prevalence of current smokers was found in Kelantan (30.2%), Terengganu (29.7%), Pahang (28.7%) and Kedah (26.9%); the lowest prevalence was in Kuala Lumpur, Federal Territory (20.4%). The overall mean initiation age of current smokers was 19.2 years (95% CI=19.1. 19.4 years). The mean initiation age of male current smokers was significantly lower (18.9 years) compared to female current smokers(24.1 years). The mean duartion of smoking amongst the current smokers was 18.6 years .Males smoked significantly more cigarettes than the females (p<0.001). Discussion: Multivirate logistic regression analysis showed that smoking was significantly associated with age, sex, ethnicity, educational level and peer and family influence.

Adult ; Female ; Frontal Lobe ; physiopathology ; Frontotemporal Dementia ; diagnosis ; etiology ; physiopathology ; Humans ; Magnetic Resonance Imaging ; Treatment Outcome ; Tuberculoma, Intracranial ; complications

Cerebrovascular Circulation ; drug effects ; Computer Systems ; Fibrinolytic Agents ; administration & dosage ; pharmacology ; Humans ; Infarction, Middle Cerebral Artery ; drug therapy ; physiopathology ; Infusions, Intravenous ; Male ; Middle Aged ; Regional Blood Flow ; drug effects ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; administration & dosage ; pharmacology

OBJECTIVETo generate life table characteristics for the dengue vector Aedes albopictus (A. albopictus) under uncontrolled conditions, incorporating both the aquatic and the adult stages.

METHODSTen females derived from wild pupae were allowed to fully blood-feed on restrained mice. 774 eggs were hatched in seasoned water. F1 larvae were followed for development until their F2 counterparts emerged as adults. Some population parameters were monitored (F1) or estimated (F2).

RESULTSA. albopictus exhibited increased fecundity and egg hatch success. Immature development was quick. Immature survival was high, with lowest rate in the pupal stage. Adult emergence was about 81% and sex ratio was close to 1:1. Generational mortality (K) was about 28%. A high proportion of females completed a reproductive cycle and the obtained parity rate was predicted to lead to higher fecundity in the next generation.

CONCLUSIONSIt can be concluded that natural A. albopictus populations in Penang seem largely determined by quick development in combination with low immature loss and increased oviposition.

Aedes ; growth & development ; physiology ; Animals ; Female ; Insect Vectors ; Malaysia ; Male ; Mice ; Vital Statistics

Background: Same-day discharge, defined as discharge from the hospital within 24 h of surgery, has been shown to be safe for joint arthroplasty. We examined demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty in adult patients. Methods: Utilizing data from the American College of Surgeons National Surgical Quality Improvement Program database, we extracted information of all patients that underwent shoulder arthroplasty. The primary and secondary outcome of interest was same-day discharge and 30-day unplanned readmission, respectively. We utilized multivariable logistic regression to identify covariates associated with these outcomes. Results: There were 17,011 patients analyzed when identifying predictors for same-day discharge. There was an increase in same-day discharge from 2007 to 2016. The odds of same-day discharge were significantly better for males (P < 0.001). The odds of same-day discharge was significantly decreased for every 10-year increase in age and for patients with insulin dependent diabetes, poor functional status, chronic obstructive pulmonary disease, congestive heart failure, bleeding disorder, and comorbidity burden (all P < 0.001). There were 14,276 patients analyzed for hospital readmission. The odds of unplanned readmission were significantly higher for every 10-year increase in age and for patients with poor functional status, congestive heart failure, bleeding disorder, and higher comorbidity burden (all P < 0.001). Conclusions The results of this study show that preoperative comorbidities and advanced age reduce the odds of same-day discharge. Risk stratification, preoperative optimization, and coordinated care after surgery may be helpful to optimize patients for same-day discharge.