Chronic progressive liver diseases, such as liver cirrhosis, eventually cause portal hypertension & hepatic coma, and among the cause of death from UGI bleeding variceal bleeding secondary to portal hypertension is the most common, over 50%. Clinical management for variceal bleeding includes IV vasopressin injection, insertion of Balloon tamponade administration of somatosatin or propranolol, and shunt operation, but the effect has not been promising. (continue...)
Balloon Occlusion ; Cause of Death ; Esophageal and Gastric Varices* ; Hemorrhage* ; Hepatic Encephalopathy ; Hypertension, Portal ; Liver Cirrhosis ; Liver Diseases ; Propranolol ; Sclerotherapy* ; Vasopressins

There is a strong correlation between stress and the quality of care provided by informal carers. In this regard, an accurate understanding about factors contributing to stress among informal carers is crucial in order to find appropriate interventions to solve their problems. A pilot study was conducted in October 2009 in the Klang Valley area, to test the instrument liability in the local context. In-depth interviews were conducted with two informal caregivers who are providing full-time care for their chronically-ill family members. Informal caregivers face multiple types of stress. A variety of factors such as financial problems, an unsupportive community, fatigue, the unavailability of social services to assist them and their inability to accept the fact that their loved ones are terminally ill, contribute to their stress. Differences in factors contribute to stress, and lead to the adoption of different styles of coping strategies: emotion and problem focused coping.
Patient Care ; Adaptation, Psychological

Introduction: Peripheral arterial disease(PAD) and abdominal aortic aneurysm(AAA) are two important underdiagnosed vascular pathologies. As they share common risk factors with coronary arterial disease, we conducted a study to look at their prevalence among patients with acute coronary syndrome(ACS). Materials and Methods: Patients with ACS admitted to Queen Elizabeth Hospital, Malaysia, from February 2009 till August 2009 were screened prospectively for PVD and AAA. Patients’ data and clinical findings were gathered and analyzed. Measurements of ankle brachial index (ABI) and abdominal aortic diameter were performed by a single assessor. PAD was defined as ABI ≤ 0.9 or diabetic patients with signs and symptoms of PAD and absence of pedal pulses. AAA was defined as abdominal aortic diameter ≥ 3cm. Results: 102 patients were recruited with mean age of 59.5 years old. Male: female ratio was 6:1. 40.2% of patients had NSTEMI; 45.1%, STEMI and 14.7%, unstable angina. Risk factors profile is as follows: hypertension- 68.6%, smoking-56.9%, hypercholesterolemia- 52.9%, diabetes mellitus-35.3% and history of stroke- 5.9%. Median ABI was 1.1 with lowest reading of 0.4. Mean abdominal aortic size was 2.0cm with largest diameter of 3.3cm. PAD was present in 24.5% of patients and AAA in 2.0%. 68.0% of patients with PAD were asymptomatic. Smoking and age more than 60 years were independent predictors for PAD among ACS patients. Conclusions: PAD is strongly correlated with CAD with old age and smoker as independent predictors. However, association between AAA and ACS could not be established.

Human ; INTRAOCULAR PRESSURE ; GLAUCOMA, ANGLE-CLOSURE ;

Indonesia is an island country in Southeast Asia. In 2014, Indonesia established the National Health Insurance System (NHIS), and until 2019, the NHIS hadcovered 82% residents. The leading causes of death in Indonesia were stroke, ischemic heart disease, diabetes, tuberculosis and cirrhosis. In 1996, the Indonesian Ministry of Health allowed acupuncturists to enter Indonesian medical institutions to practice acupuncture. After that acupuncture was included in college education as a major course. However, there are still some problems, such as insufficient policy and legislation support of Traditional Chinese Medicine (TCM), imperfect education and talent training system of TCM, and low acceptance of TCM theories. Therefore, it is recommended that the local societies and organizations could actively promote the government’s legislation on TCM; local TCM schools could build a team of excellent teachers, improve teaching quality, and cultivate local TCM talents; strengthen the cooperation and exchanges of traditional medicine between the two countries to promote the spread and development of TCM in Indonesia.

Restoring acetabular bone loss in revision hip arthroplasty is a major challenge for the orthopaedic surgeon. This paper discusses the traditional cemented technique of impaction bone grafting as applied to the acetabulum, as well as the evolution of the technique to employ uncemented implants. Some of the recent published literature regarding these techniques is reviewed and the personal experiences of the senior author with these techniques are also reported.

Menetrier's disease is a rare disease characterized by the presence of large rugal folds involving part or all of the stomach. Patients with hypertrophic gastropathy often have distressing abdominal symptoms, weight loss and edema due to gastric protein loss. The 48-year-old male patient was admitted to the Hangang Sacred Heart Hospital with cheif complaints of indigestion and epigastric pain. The diagnosis of Menetriers disease is established by radiologic, endoscopic, and pathologic examination. He was treated with soft diet, antacid, H2- receptor antagonist, and IV albumin. We report a case of Menetriers disease with brief review of literatures.
Diagnosis ; Diet ; Dyspepsia ; Edema ; Gastritis, Hypertrophic* ; Heart ; Humans ; Male ; Middle Aged ; Rare Diseases ; Stomach ; Weight Loss

Aims: Palm oil mill effluent (POME) is a major agricultural waste product of Malaysia. The aim of this study was to identify endophytic fungi capable of producing biofuel feedstock utilizing POME. Methodology and results: Endophytes were isolated from the Nipah palm tree, Nypa fruticans, and exposed to different POME concentrations (25%, 50% and 75%), with and without the addition of nutrients. The utilization of glucose was measured using the Dinitrosalicylic Acid assay whereas the lipid content in the fungal cells was extracted using the Bligh and Dyer method with slight modifications. Three endophytic fungi that displayed the highest growth on POME were identified using ITS 1 and 4 primers and found to be related to Pestalotiopsis sp., Lasiodiplodia theobromae and Rhizoctonia bataticola. Nutrient addition caused an average increase of 8 times in biomass, indicating nitrogen requirement for cell proliferation. The highest POME concentration (75%) resulted in lower biomass yield. Furthermore, all fungal samples in high POME concentration and nutrient conditions showed a decrease in lipids accumulated per milligram of biomass whereby lipid synthesis was enhanced under nitrogen limitation (25% without nutrients). Conclusion, significance and impact of study: In conclusion, all fungal samples can be classified as oleaginous microorganisms with Pestalotipsis sp. being the most efficient (up to 70% of its biomass). This is to our knowledge the first study that shows the potential use of Pestalotiopsis sp., L. theobromae and R. bataticola for the utilisation of POME as biofuel feedstock and could in the future potentially provide an alternative approach to the treatment of POME with value-added effect.

BACKGROUND: The Duromedics valve has been used in Korea since 1982, however, but there were no long term clinical results that have been reported. This paper presents the long term clinical results of Duromedics valve implanted in Seoul National University Hospital. MATERIAL AND METHOD: Between 1987 and 1988, 23 patients underwent cardiac valve replacement with Duromedics mechanical valve. There were 8 mitral valve replacements, 5 aortic valve replacements, one tricuspid valve replacement, 6 aortic and mitral valve replacements, and one mitral and tricuspid valve replacement. There were 12 men and 11 women. The mean age was 35+/-10(15~52) years. We evaluated the clinical performance of Duromedics cardiac prosthesis. RESULT: The early operative mortality was 4.3%(1/23) and the late morlatity was 4.3%(1/23). Causes of death were low cardiac output syndrome and structural valvular failure. The mean follow-up duration was 133+/-43(8~157) months. There were 3 reoperations. The causes of reoperations were thrombosis and structural failure and nonstructural valvular failure. The actuarial survival rate at 10 years was 90.9%. CONCLUSION: Although the number of patients was not sufficient for effective clinical study, the long term clinical results of Duromedics valve was relatively good and there was no structural defect in this mechanical valve. However, more research is needed in the future.
Aortic Valve ; Cardiac Output, Low ; Cause of Death ; Female ; Follow-Up Studies ; Heart Valve Prosthesis ; Heart Valves ; Humans ; Korea ; Male ; Mitral Valve ; Mortality ; Prostheses and Implants ; Seoul ; Survival Rate ; Thrombosis ; Tricuspid Valve

Background: Patients with severe psoriasis, namely those requiring phototherapy or systemic treatment, have an increased risk of death. The aim of this study was to determine the prevalence, aetiology and risk factors for mortality among adult patients aged 18 years and above with psoriasis in Malaysia. Methods: This was a retrospective study involving adult patients notified by dermatologists to the Malaysian Psoriasis Registry between July 2007 and December 2013. Data were cross-checked against the National Death Registry. Patients certified dead were identified and the cause of death was analysed. Multivariate analysis using multiple logistic regression were conducted on potential factors associated with higher risk of mortality. Results: A total of 419 deaths were identified among the 9775 patients notified. There were four significant risk factors for higher mortality: age>40 years (age 41-60 years old, Odds Ratio (OR) 2.70, 95%CI 1.75, 4.18; age>60 years OR 7.46, 95%CI 4.62, 12.02), male gender (OR 1.72, 95%CI 1.33,2.22), severe psoriasis with body surface area (BSA) >10% (OR 1.52, 95%CI 1.19, 1.96) and presence of at least one cardiovascular co-morbidity (OR 1.67, 95% CI 1.30, 2.14). Among the 301 patients with verifiable causes of death, the leading causes were infection (33.9%), cardiovascular disease (33.6%) and malignancy (15.9%). Conclusion: Infection was the leading cause of death among psoriasis patients in Malaysia. Although cardiovascular diseases are well-known to cause significant morbidity and mortality among psoriasis patients, the role of infections and malignancy should not be overlooked.
Psoriasis