This is a cross-sectional study to evaluate the outcome of posterior cruciate ligament reconstruction in chronic injuries using ipsilateral Bone-patella tendon-Bone graft in nine patients, between January 2000 and January 2003 at our institution. Methods: Eight male and one female patient; their ages ranged from 18 to 36 years old. The surgery was done at an average of 17.2 months (range from 3 and 40 months) post injury. All patients were followed up for a minimum of two years period. The assessment was done at twelve and twenty-four months using Lysholm knee score, IKDC knee examination evaluation score and arthrometric measurement with KT-2000. Results: The result showed only moderate success in restoration of ligament stability with 73.4% satisfactory objective results. However, the functional improvement and patient satisfaction is only 55%. The incidences of degenerative changes were 89% at the time of operation. Conclusion: Surgical reconstruction of chronic Posterior Cruciate Ligament restored satisfactory stability of the knee but the functional outcome was only moderate.

Choriostomas represent the most common epibulbar lesions in the pediatric age group. Generally, they are on the surface and do not involve the deeper layer of cornea or sclera. Epibulbar dermoids frequently cause amblyopia and cosmetic problems due to high astigmatism and the presence of the tumor. Surgery is the only option for epibulbar dermoids. Lamellar or penetrating keratoplasty has been advocated depending on the site and the depth of the epibulbar dermoids. However, the outcome is not always promising due to accompanying amblyopia and high incidence of vascularization of the grafts. In the present article we report a case of epibulbar choriostomas in the right eye of a 5-year-old, non-syndromic girl who underwent right limbal dermoid excision with lamellar keratoplasty.Postoperatively she was improved cosmetically, however the astigmatism and the vision remained the same. Therefore the amblyopic therapy should be emphasized postoperatively.

Pain, while salient, is highly subjective. A sensation perceived as painful by one person may be perceived as uncomfortable, not painful or even pleasant to others. Within the same person, pain may also be modulated according to its threat value and the context in which it is presented. Imaging techniques, such as functional magnetic resonance imaging and positron emission tomography, have identified a distributed network in the brain, the pain-relevant brain regions, that encode the sensory-discriminative aspect of pain, as well as its cognitive and affective/emotional factors. Current knowledge also implicates the prefrontal cortex as the modulatory area for pain, with its subdivisions forming the cortico-cortical pathway, an alternative pain modulatory pathway distinct from the descending modulatory pathway of pain. These findings from neuroimaging in human subjects have paved the way for the molecular mechanisms of pain modulation to be explored in animal studies.

Introduction: The purpose of this study is to identify the incidence of clavicle fractures in newborn associated with fetal, maternal and process of deliveries in Kuantan General Hospital from June 2012 until January 2014. This study is to determine epidemiological data of clavicle fractures, maternal and baby risk factors associated with clavicle fractures of newborn and its’ outcome. Methods: This is a prospective study. 13 patients were identified to fulfill the inclusion criteria of the study. The data of sociodemographic, associated fetal and maternal risk factors and the outcomes were recorded using proforma. The statistical data analysis was done using SPSS 12.0. Results: Out of 20,257 live births at our centre during the study period, 13 infants were diagnosed to have clavicle fractures, giving an incidence of 0.64 per 1000 live births. There were 5 (38.5%) left, 7 (53.8%) right and one (7.7%) bilateral fracture. All fractures located at the mid shaft of the clavicle and none have associated brachial plexus injuries. All infants were delivered through vaginal delivery (61.5%); five through assisted delivery (instrumental); 2 (15.4%) forcep and 3 (23.1%) vacuum. Two of the babies developed shoulder dystocia. The average birth weight was 3371 grams (SD 0.269) and mean gestational age was 38.7 weeks (SD 1.16). Five of the mothers (38.5%) were primigravida and eight (61.5%) were multigravida in which,7 (53.8%)were healthy without other co-morbidty, 5 (38.5%) having gestational diabetis and one (7.7%) hypertension. The average maternal weight was 62.0 kg and height 1.58 metres with average BMI of 24.16 (3.29SD). All eventually had a complete recovery at 6 weeks with clinical and radiological evident of fracture union. Conclusions: In conclusion, all patients with clavicle fractures were found following vaginal delivery. There were no associations between neonatal clavicle fractures with maternal or baby risk factors. All fractures healed without any complications.

Introduction: Accurate yet inexpensive methods for measuring free-living energy expenditure (EE) are much needed. The aim of this study was to determine the feasibility of heart-rate monitoring method (HRM) in measuring EE as compared to the established activity diary (AD) were used simultaneously in 34 young adults (18 females, 16 males, mean age 21.5 ± 1.5 years). Estimates of the EE from HRM were based on individually measured and published energy cost of various activities. Total daily energy expenditure (TDEE) and its components (EE during sleep, during rest and during physical activity) were compared using Student paired-t tests. Results: TDEE from HRM method averaged 8.17 ± 2.00 MJ/day compared to 8.50 ± 1.28 MJ/day from AD method. Although large intra-individual differences were found (ranging from -36.9% to 47.4%), there was no significant difference between the two methods (mean difference -3.6 ± 19.4%). The limits of agreement (mean ± 2SD) were -3.77 and 3.11 MJ/day. There were no significant differences for any of the TDEE components between the two methods, except for EE during sleep (p<0.05). Conclusion: HRM method was found to be a feasible method for assessment of EE, and was comparable to AD for group assessment of TDEE and its components

Children with Autism Spectrum Disorder (ASD) have significant challenges in their daily life including social communication and interaction, emotional awareness and management, as well as behavioural issues. Many interventions are conducted based on theoretical backgrounds and past literature. There is lack of research study that interview and explore the real psychological needs of children with ASD in Malaysia. It is a significant component as their needs may vary depending on the cultural background, lifestyle, and social norms. Besides, there is a need to develop standardised intervention module to enhance intervention fidelity and replication of future study. The current study aims to scrutinise the psychological needs of children with ASD in Malaysia, develop a standardised group intervention module based on the identified needs, and then examine the feasibility of the developed module. Nine children with moderate to high functioning of ASD (7 to 12 years old) and their parents from Kuala Lumpur and Sarawak participated in the study. Result from the focus group interview suggests that children with ASD have three major psychological needs which are sociocommunication, awareness of danger, and emotions. The group intervention module was designed to fulfil these needs. The feasibility result shows that the designed module is practical, useful, and understandable for the participants. In view of this, future study may explore the effectiveness of the module. Once the module is proven effective, it can be patented and utilised to improve the psychological functioning of children with ASD in Malaysia.
Autism Spectrum Disorder ; children ; group intervention ; feasibility ; psychological needs.

The integration of human knowledge between the medical and health care sciences with revealedknowledge was established since the era of Al-Razi (Rhazes), Ibn Sina (Avicenna), Ibn Rushd (Averroes), Al-Zahrawi (Albucasis) and others. However, the glorious period of Islamic medicine gradually declined afterthe period of 'Abbasiyyah and 'Uthmaniyyah. At present, many scholars tend to separate the modernmedicine and the revealed knowledge, resulting in the disconnection between these two fields. There islittle to suggest the presence of reference collections that integrate the Qur’an and Hadith with medicine.This review aimed to fill that gap. Relevant Qur’anic verses and authentic Hadith of the Prophet Muhammad(peace be upon him; henceforth PBUH) in relation to a specific field in medicine i.e. the anatomy of humanmusculoskeletal system was extracted. The musculoskeletal system is unique in which it forms the‘backbone’ of normal human posture. The system plays a vital role in maintaining human daily activities.From this review, it is noted that many Qur’anic verses and Hadith relate to the musculoskeletal system. Afew examples include the number human joints and its relationship with the daily prayers (Salah), the dailycharitable act recommended to all Muslim, the coccyx bone that is indestructible and shall be the source forhuman resurrection during the hereafter, and others. These examples necessitate for a more in-depthanalysis to enlighten the revealed knowledge from the medical perspective.

Objective: To delineate and differentiate between late subacute hemorrhage and intracranial lipomas in clinically available conventional and advanced MR sequences. Methods: Two cases of late subacute hemorrhage and two cases of intracranial lipoma were reviewed with CT scans and 3.0T scanner MRI. The sequences evaluated in MRI were T1-weighted (T1W) fast spin echo (FSE), T2-weighted (T2W) FSE, gradient echo T2*-weighted (GRE T2*W) images, diffusion weighted (DWI), apparent diffusion coefficient (ADC) and multivoxel spectroscopy. Results: Late subacute hemorrhage and intracranial lipoma have similar imaging features on T1W, T2W FSE with blooming artefact at the margins on GRE T2*W. However on GRE T2*W sequence, the central area of lipoma demonstrates low signal; while hemorrhage demonstrates high signal. In DWI, late subacute hemorrhage shows hyperintensity; while in lipoma there is loss of signal. Conclusion: Awareness of the potential pitfalls in standard sequence are important, as these entities appear to have similar T1W/ T2W characteristic with blooming artefact on T2*W. Knowing the distinctive central signal intensity pattern on GRE T2W* and DWI is therefore essential to differentiate between these lesions as there are differences to their clinical management.
Magnetic Resonance Imaging

Introduction: Child malnutrition continues to be a major public health problem in developing countries. This study aims to determine the current nutritional status of Malaysian school children using the anthropometric indicators of weight for age (WAZ), height for age (HAZ), and body mass index for age (BAZ). Methods: A nationwide school-based survey was undertaken in all Malaysian states and territories, which included 18,078 children aged 8-10 years attending 445 primary schools. The software WHO AnthroPlus was used to calculate zscores for the nutritional status (WAZ, HAZ and BAZ) of the target population relative to the World Health Organization (WHO) 2007 reference. Results: The national prevalence of underweight among school children was 13.6% and in rural areas, this rate was nearly double that of urban areas. The national prevalence rate for stunting was 10.9%, double among rural school children compared to their urban counterparts. As for thinness, the national prevalence was 6.5%. Using the WAZ indicator, we found that the national prevalence of overweight children was 7.6%. Additionally, we found that urban areas showed a higher prevalence of overweight children (8.8%) than rural areas (5.9%). Conclusion: The findings of this study indicate that Malaysian school children face the burden of malnutrition, suffering from both undernourishment and overweight. Malaysia must make a concerted effort to overcome the problems of malnutrition among children.

Postpartum depression is a depressive episode that can start at any point during the first year after childbirth. There are several tools that can be used for PPD screening. The need to define a predictive tool that is clinically useful and has acceptable sensitivity and sensitivity is important especially to be used in the primary care setting. This systematic review investigates the evidence of the sensitivity and specificity of screening tools used for PPD screening. The Standard for Reporting of Diagnostic Accuracies (STARD) guidelines were used to conduct the review as a basis for our methodology. PubMed, ScienceDirect and Springerlink databases between 2007 until 2017 were comprehensively searched EPDS and BDI instrument has sensitivity of more than 80% but findings for specificity was inconclusive. The heterogeneity across studies could be the result of methodological differences in validation of the instruments. In addition, these studies were conducted across continents and settings with different cultures, languages and resources. We have identified 5 different instruments used to screen for postpartum depression. The EPDS was the most validated instrument in the review and we found that EPDS and BDI have higher accuracy to screen postpartum depression because the sensitivity reported were more than 80%.