Spontaneous partial rupture of upper renal tract is rare and is usually associated with urolithiasis. Other causes include instrumentations, trauma, pelvic cancer, retroperitoneal fibrosis, fluid overload, and pregnancy. We report two cases (46-year-old and 41-year-old men) of upper renal tract rupture. The first case had rupture of the ureter proximal to stone impaction and the second case had fornicial rupture secondary to stone impaction at the uretero-vesical junction. In contrast to ureteral rupture, fornicial extravasation is more common and the symptoms are always mild. The mechanism of ureteral rupture can be explained as either pressure around the ureteral wall due to stone impaction, or a tear caused by pressure during the passage of the stone. Fornicial rupture occurs when intra-pelvic pressure is greater than 35cm H2O. It is important to distinguish true rupture of the ureter from fornicial tear with extravasation, because both the outcome and treatment are different.

Most health advisories related to outdoor physical activity during haze are general in nature. The advisories normally advise everyone to reduce or limit prolonged exertion or heavy exertion without mentioning the acceptable duration for performing outdoor physical activity causing difficulty for public to decide to stop or cancel a particular outdoor or sport event. The aim of this paper is to determine the acceptable duration for performing outdoor physical activity pattern based on API level. Health risk assessment approach that comprises of hazard identification, exposure assessment, dose-response, and risk characterization steps were used to determine the potential inhaled dose and risk associated with performing the physical activity during haze. We have considered many factors that include time spent for physical activity patterns for Malaysian adult, age, physical intensity-specific inhalation rate (m3/min), and the indoor/outdoor ratio of PM10. A hypothetical exposure scenario of PM10 was created using the breakpoints of PM10 concentration for the calculation of respective API levels. The association between physical activity pattern, API level and risk quotient were presented in the form of risk radar diagram. In general, based on the average estimate, everyone should avoid high intensity physical activity and moderate exertion when API reach > 175 and > 200 respectively. Whereas, based on the high estimate, everyone should avoid high intensity physical activity and moderate exertion when API reach > 135 and > 150 respectively. Below the said API, the duration for performing prolonged exertion and heavy exertion should be adjusted according to the API level as stated in the recommended maximum duration for performing physical activity. Reducing the physical activity is an effective strategy to lower the dose of inhaled pollutants and reduce the health risk during poor air quality. Based on the assessment, the recommended maximum duration for performing the physical activity based on API level was established as a guide for the authority or public to plan their activity during poor air quality.​

Background: The prevalence of teenage smoking has decreased over the past decade following the implementation of the national tobacco control programme. However, the effect of the programme on smoking cessation in teenagers has not been determined. Methods: Twenty-eight participants (12 teenagers, 8 teachers, and 8 doctors) were interviewed using 5 in-depth interviews and 3 group discussions. Social cognitive theory (SCT) was applied as the theoretical framework. Semi-structured interview protocols were used, and thematic analysis and analytic generalisation utilising SCT were performed. Results: The current national tobacco control programme was found to be ineffective in promoting smoking cessation among teenagers. The participants attributed the ineffective campaign to the followings: inadequacy of message content, lack of exposure to the programme, and poor presentation and execution. In addition, the participants perceived the developed tobacco control policies to be a failure based on poor law enforcement, failure of retailers to comply with the law, social availability of cigarettes to teenagers, and easy availability of cheap, smuggled cigarettes. This study highlighted that the programme-related problems (environmental factors) were not the only factors contributing to its perceived ineffectiveness. The cunning behaviour of the teenagers (personal factor) and poor self-efficacy to overcome nicotine addiction (behavioural factor) were also found to hinder cessation. Conclusion: Tobacco control programmes should include strategies beyond educating teenagers about smoking and restricting their access to cigarettes. Strategies to manage the cunning behaviour of teenagers and strategies to improve their self-efficacy should also be implemented. These comprehensive programmes should have a foundation in SCT, as this theory demonstrates the complex interactions among the environmental, personal, and behavioural factors that influence teenage smoking.

Background: Hippocampal volume is affected by several psychiatric illnesses of old age, as well as by normal aging. It is important to have a normal data in a population to assist in diagnosis. The aim of this study is to determine hippocampal volume in normal Malay people aged 50 years old and older. Methods: This was a cross-sectional study of the normal Malay population aged 50 to 77 years. We included 43 participants, representing 19 men and 24 women. Magnetic resonance imaging (MRI) was performed using a GE Signa Horizon LX 1.0 Tesla. Oblique coronal images of temporal lobes were obtained and hippocampal volumetry was done manually and normalised with intracranial volume. Results: Mean right and left hippocampal volumes (HCVs) were 3.43 cm3 (SD 0.32) and 3.26 cm3 (SD 0.34), with a significant difference between them (P < 0.001). Total mean HCVs exhibited no significant difference between men and women (P = 0.234). The means of the normalised right and left HCVs were 3.42 cm3 (SD 0.31) and 3.26 cm3 (SD 0.32). Conclusion: The mean right and left hippocampal volumes were significantly different in this study. Men had slightly larger mean HCVs but the difference was not statistically significant. It was found that normalisation further reduces the mean volume difference between the genders.
Magnetic Resonance Imaging ; Hippocampus ; Adult ; Reference Values

Background: Magnetic resonance imaging (MRI) is a noninvasive method for determining brain morphology and volumetry. Hippocampal volume changes are observed in conjunction with several diseases. This study aimed to determine the normalised volume of the hippocampus in normal Malay children and adolescents. Methods: This was a cross-sectional study performed from January 2009 to June 2010. Brain and temporal lobe MRI was performed for 81 healthy normal Malay individuals aged 7–18 years. Manual volumetry was performed. The hippocampal volumes were normalised with the total intracranial volume. Results: The original right, left, and total hippocampal volumes (mean and standard deviation) were 3.05 (0.48) cm3, 2.89 (0.44) cm3, and 5.94 (0.90) cm3, respectively. Normalised hippocampal volumes for the right, left, and total volume were 3.05 (0.41) cm3, 2.89 (0.41) cm3, and 5.94 (0.79) cm3, respectively. Pearson’s correlation coefficient for the right and left hippocampal volumes with intracranial volume were 0.514 and 0.413, respectively (P < 0.001). Both the original and normalised hippocampal volumes of the right hippocampus were significantly larger than those of the left (P < 0.001). Conclusion: This is a data set for the local Malay paediatric population. There was no significant difference between the actual and normalised values of hippocampal volume in our study.

Introduction: Coated archwires improve aesthetics because of the tooth-coloured appearance. However, colour change of the coated archwires have been reported in vitro. Nonetheless, little is known to what extent this colour change occurs clinically. This second part of the multi-centre, double-blind, randomised controlled trial evaluated the colour change (∆E*) of three coated archwires with their controls and patient perception. Methods: 84 patients who received treatment with upper and lower fixed appliance treatment were invited. Consented patients were randomised to receive one of four treatment interventions using 0.014” superelastic nickel-titanium archwires from (1) Orthocare (2) RMO (3) G&H, and (4) 3M Unitek® uncoated. These archwires were ligated during bonding and collected after 8th week. After removal, the digital images of the archwires were assessed for colour change using Adobe® Photoshop® software, and the CIE L*a*b* system was used to calculate the ΔE* values. Patient perception was measured using oral aesthetic subjective impact scale (OASIS) questionnaire. Results: For colour change and patient perception assessment, 132 archwires from 66 participants who had been treated with aesthetic archwires were collected. Two fractured archwires were excluded. Initial analysis revealed all three aesthetic archwires groups showed significant mean of ∆E* with the highest was found in Orthocare (23.9), and the lowest is G&H (16.8). Post hoc comparison revealed statistically significant mean of ∆E* in Orthocare when compared with other groups (p <0.001). There was no statistically significant difference for patient perception between archwire groups. Conclusion: Preliminary results revealed that significant ∆E* in Orthocare group and patients showed positive perception following clinical use
Craniofacial & ; Biomaterial Sciences Cluster, Advanced Medical & ; Dental Institute, Universiti Sains Malaysia, 13200 Kepala Batas, Penang, Malaysia. 2 School of Dental Sciences, Universiti Sains Malaysia (Health Campus), 16150 Kubang Kerian, Kelantan, Malaysia

Lasers have been identified as one of the preventive tools that can be utilised to prevent white spot lesion in orthodontic practice. The aim of this scoping review was to evaluate the current scientific literature on the use of lasers specifically to prevent white spot lesion in orthodontic cases. Search was performed in PubMed, Web of Science, Scopus and EBSCO databases from the past ten years. The records obtained were peruse considering specific inclusion and exclusion criteria. From the total of 1123 studies that were evaluated, 68 papers were included for this review. A variety of laser types has been reported including Er;YAG, Er,Cr:YSGG, Argon and CO2 lasers. CO2 laser has a good number of evidence of it’s positive result and can be suggested to be use in clinical practise. However, since most data for the other type of lasers were derived from in vitro studies, they must be interpreted with care. Randomised clinical trials would be beneficial to give more meaningful evidence for clinicians to adopt lasers in their practice.

Introduction: This study aimed to evaluate the correlation between Quality of Life Impact of Refractive Correction (QIRC) score with visual disturbances and contrast sensitivity in spectacle wearers. Methods: A total of 21 spectacle-corrected moderate myopes was recruited. Subjects completed the QIRC questionnaire for quality of life assessment. The functional and emotional QIRC scores were analysed separately. Visual disturbances were evaluated using the Halo and Glare Simulator, and contrast sensitivity was measured by the M&S Smart System II. All measurements were taken binocularly in 1 lux illumination. Spearman’s test was employed to evaluate the correlations. Results: The most common visual disturbance was diffuse glare. The functional QIRC score was significantly correlated with glare intensity (r = -0.54, P = 0.01). Whereas, the emotional QIRC score was significantly correlated with contrast sensitivity (r = 0.45, P = 0.04). Conclusion: The functional QIRC score is lower when the glare intensity is greater, and the emotional QIRC score is higher in person with greater contrast sensitivity. Hence, glare intensity and contrast sensitivity measurements are suggested to predetermine spectacle wearers’ functional vision and well-being, respectively

Lysosomal dysfunction plays an important role in neurodegenerative diseases, including Parkinson’s disease (PD) and possibly Parkinson-plus syndromes such as progressive supranuclear palsy (PSP). This role is exemplified by the involvement of variants in the GBA1 gene, which results in a deficiency of the lysosomal enzyme glucocerebrosidase and is the most frequently identified genetic factor underlying PD worldwide. Pathogenic variants in the SMPD1 gene are a recessive cause of Niemann–Pick disease types A and B. Here, we provide the first report on an association between a loss-of-function variant in the SMPD1 gene present in a heterozygous state (p.Pro332Arg/p.P332R, which is known to result in reduced lysosomal acid sphingomyelinase activity), with PSP-Richardson syndrome in three unrelated patients of Chinese ancestry.

Full thickness skin graft is a simple and reliable method for closure of small facial wound defect. A thorough understanding of how a skin graft heals and how to perform the procedure is essential for successful outcome. We report the use of full thickness skin graft in a wound closure of a facial skin defect caused by Paederus fuscipes, locally known as charlie. An 8-year old boy developed blister and painful swelling over his right cheek following skin contact with charlie. This lesion gradually became extensive, eventually leading to tissue loss and facial wound defect. A full thickness skin grafting was performed with satisfactory functional and excellent aesthetic result.