A massive goiter may constrict the trachea resulting in shortness of breath. Recurrent laryngeal nerve compression may cause vocal cord paralysis. We highlight a case of a 62- year-old female with a 30 year history of an anterior neck swelling gradually increasing in size. She presented with acute symptoms of upper airway obstruction and voice changes. Emergency thyroidectomy was performed by dividing the middle part of the gland using ultrasonic scissors. The recovery was uneventful and the patient regained normal vocal cord function post operatively.

· AIM: To evaluate the optic disc parameters in the three main ethnic groups of Malaysia (Malay, Chinese and Indian). Possible relationships between optic disc parameters and gender, intraocular pressure and axial length of eye were also studied. · METHODS: The study included 244 eyes of 122 subjects (61 cases with open angle glaucoma and 61 non- glaucomatous individuals) with clear ocular media. Magnification corrected measurements of optic disc diameters and area were done using Zeiss FF450 Plus fundus camera. Differences between the three ethnic groups were tested by using ANOVA. The association between factors such as gender, intraocular pressure and axial length of the eye, and the optic disc size was tested through Pearson's bivariate correlation analysis. · RESULTS: The overall mean vertical optic disc diameter as (1.96 ± 0.20) mm, horizontal optic disc diameter was (1.84±0.20)mm and optic disc area was (2.84±0.56)mm2. Indians had larger optic disc area compared to Malay and Chinese. However, the difference was not statistically significant. · CONCLUSION: Optic disc size is larger in Malaysian population than Caucasians, Among the three ethnic groups, Indians have the largest optic disc size without any statistical difference.

AIM: To report the usefulness of a new parameter (maximum cross sectional area) in the measurements of B-scan ultrasonography to evaluate the progress of choroidal metastatic tumour size during the follow-up of patient.METHODS: Case report-the B-scan ultrasonographic measurements of height, base and maximum cross sectional area during the follow-up of the patient are presented.RESULTS: A 62-year-old Chinese lady, known case of non-small cell lung carcinoma, presented with painless blurring of vision in the right eye. She was diagnosed to have bilateral choroidal metastasis (advanced in the right eye and early in the left eye) with good vision in both eyes. The tumour size in the right eye reduced significantly after the first chemotherapy; but increased again 6 weeks after the end of last cycle of chemotherapy. She was given radiotherapy and another course of chemotherapy. The tumour size in the right eye did not respond much later on. However, the tumour size in the left eye was static through out the follow up period of 2years. The patient maintained best corrected visual acuity in both eyes (6/9 in right eye and 6/6 in left eye). The progress of tumour size in right eye was evaluated with serial B-scan ultrasonographic measurements.CONCLUSION: The ultrasonographic measurements were reproducible all through the follow up period and coincided well with clinical appearance of the tumour in right eye. We suggest the use of B-scan ultrasonography in the follow up of patients with elevated choroidal masses for quantitative assessment of progression/regression in their size during the treatment period.

Patients who self-discharge against medical advice (DAMA) are susceptible to life-threatening consequences. By understanding the factors associated with DAMA, healthcare centres can build strategies to assist patients to receive optimal medical care and prevent unfavourable outcome. The objective of this study was to determine the factors associated with DAMA from the Emergency Department (ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a prospective unmatched case control study conducted over a 4-month period. For every DAMA episode, two patients who were admitted on the same day were randomly selected as control. Following patient consent, data was collected using a standardized questionnaire. Patients were contacted by the investigator for information regarding hospitalization within two weeks of DAMA. Ninety three patients were recruited; 31 DAMA patients and 62 admitted patients. Payment method was significantly associated with DAMA (OR 3.17 95% CI 1.29-7.98; p=0.01). The likelihood of self-paying patients to take DAMA was three times higher than those who had a guarantor letter from their employer or insurance provider. Other factors which influence DAMA were family obligations (OR 4.08 95% CI 1.09- 15.26; p = 0.03) and work problems (OR 3.83 95% CI 1.13-12.94; p=0.03). A total of 19.4% of DAMA patients left following symptomatic pain relief. A total of 80.6% DAMA patients were admitted to hospital within two weeks of the DAMA episode. Payment method significantly influences DAMA. Payment planning, social welfare services, non-governmental organization funds and the introduction of a national health policy scheme may aid hospital payment, alleviate financial limitation of patients and reduce DAMA episodes.
Patient Discharge

We report a 21-year old female patient who presented with an 18-month history of a swelling in the distal phalanx of her right little finger. Although the history, clinical features and MRI were suggestive of a benign tumour or a tuberculous lesion, the histo-pathological examination of the swelling was reported as a conventional osteosarcoma. Osteosarcoma of the hand is very rare. This article highlights the possibility of a seemingly benign lesion seen in a routine clinic could well turn out to be malignant, and the need to maintain a high index of suspicion
Osteosarcoma

Amyloidosis of the skull base is a rare entity. A patient with localized amyloidosis of the sphenoid sinus presented at our institution with cerebrospinal fluid rhinorrhoea. Endoscopic excision of the lesion and multilayered obliteration of the sphenoid sinus resolved the symptoms.
Amyloidosis ; Metastatic to ; Cerebrospinal Fluid Rhinorrhea ; symptoms <1> ; Endoscopic approach

Functional recovery in the immediate post stroke period predicts the long-term prognosis of post stroke patients. Despite the advancement in stroke rehabilitation in improving the physical function of survivors, there are other factors that may influence functional recovery. We aimed to assess the functional recovery of ischaemic stroke patients attending a tertiary hospital and its associated factors in order to make recommendations for post stroke care after hospital admission. A three months prospective observational study looking at functional recovery using the Modified Barthel’s Index (MBI) and depression (Patient Heath Questionnaire-9)score of post stroke patients. There were 46 ischaemic stroke patients who were recruited for the study. At three months, only 37 patients were eligible for analysis. The mean age was 67.2 (SD 11) years with the Malays (50%) making up the majority of the patients, followed by Chinese (41.3%) and Indians (8.7%). There was a total of seven (15.2%) deaths. Hypertension was the most common risk factor (89.1%) followed by dyslipidaemia (65.2%) and diabetes mellitus(63.0%). The mean MBI difference was 45.2 (SD 27.0) with a median MBI of 17.0(IQR 33.0) at baseline compared to 85.0(IQR 42.0) at three months (p < 0.001, CI 35.98,55.45). The prevalence of depression (PHQ-9≥10) was 21.6%. Lower functional recovery was found among depressed patients (p <0.026) and among patients with recurrent stroke (p< 0.035). Significant functional recovery can be seen as early as threemonths post stroke. Factors such as recurrent stroke and depression may affect functional recovery post stroke; hence should be routinely screened.

Microgravity, hypergravity, vibration, ionizing radiation and temperature fluctuations are major factors of outer space flight affecting human organs and tissues. There are several reports on the effect of space flight on different human cell types of mesenchymal origin while information regarding changes to vascular endothelial cells is scarce. Ultrastructural and cytophysiological features of macrovascular endothelial cells in outer space flight and their persistence during subsequent culturing were demonstrated in the present investigation. At the end of the space flight, endothelial cells displayed profound changes indicating cytoskeletal lesions and increased cell membrane permeability. Readapted cells of subsequent passages exhibited persisting cytoskeletal changes, decreased metabolism and cell growth indicating cellular senescence.

No abstract available.

Schistosomiasis, also known as bilharzia, is a parasitic disease caused by trematodes from the genus Schistosoma that can infect humans and animals. S. mansoni, S. japonicum, and S. mekongi all causes intestinal schistosomiasis except S. haematobium that causes urinary schistosomiasis. It is only specie which effects urinary system, it can affect liver, heart, lungs also but very rarely. Schistosoma haematobium is endemic to over 50 countries in Africa and the Middle East and Western Asia and may be fatal in HIV positive people. A number of reports from the African countries like Nigeria have been reported. A few cases are reported 9but in Pakistan it has never been reported before in native people. It is first time reported in Pakistan in the intestine of Rahu (Labeo rohita). The purpose of this study is to elaborate the approach of zoonotic agent by various other routes including the commonly available fish