Obturator internus pyomyositis is a rare disease that is more commonly found in tropical countries. Due to its infrequent occurrence, it is a differential of hip pain that has not been sufficiently considered, which often results in delayed diagnosis. We present a case report of a 4 year old boy with pyomyositis of obturator internus as well as externus. He was treated successfully with intravenous antibiotics. A comparison is made with other case reviews to identify symptoms and signs that could help in diagnosing the condition early and accurately so as to initiate intravenous antibiotics, the mainstay treatment in a timely fashion, eventually avoiding surgical drainage of the sequelae when it becomes an abscess.
Pyomyositis

Since the initial outbreak of Nipah encephalitis in Malaysia in 1998, the virus has reemerged in Bangladesh and the adjacent Indian state of West Bengal since 2001. To date more than 470 patients have been affected with over 250 fatalities in total. Although the source of the virus is believed to be the Pteropus fruit bats both in Malaysia and Bangladesh, there are also significant epidemiological and clinical differences in the outbreaks occurring in these two regions. Epidemiologically, in the Bangladesh and India outbreaks, bat-to-human transmission through food and animal and human-tohuman transmissions were the predominant modes, the outbreaks were on a smaller scale and they have recurred every year except 2002 and 2006. Clinically, the mortality was higher and respiratory manifestation was more prominent in the Bangladeshi and Indian patients compared with their Malaysian counterparts, which might reflect differences in care and medical practices. There remain however, important differences in clinical manifestations which are likely to be due to some genetic variations in the virus.

Individuals deal with dying and death differently and may not experience the same journey. We investigated Kübler-Ross’ Five Stages of Grief on terminally ill patients to review the current applicability of the model among this population. The aims of this paper is to share information regarding the Five Stages of Grief, the emotions associated with the stages, and the challenges that terminally ill patients, namely those diagnosed with cancer, experience. Methods: Non-structured interviews were conducted among terminally ill patients located at the palliative ward for two years. Results: We found that terminally ill patients at the palliative ward were undergoing the Five Stages of Grief, and that the emotions associated with the stages were reported to be similar to the emotions proposed in the model and among the patients. Conclusion: Kübler-Ross’ Five Stages of Grief is still applicable among terminally ill patients. The thoughts regarding dying and death still remain negative, therefore, the change in the myths of dying and death are required to help improve the journey towards death.

Pattern ; Malaysia ; Lupus Nephritis

Objective: To compare the results of auditory steady-state response (ASSR) and click auditory brainstem response (click ABR) among infants and young children tested at the Ear Unit of a Tertiary General Hospital. Methods: Design: Cross-sectional Study Setting: Tertiary General Hospital Population: Within-subject comparisons of click auditory brainstem response (click ABR) thresholds and auditory steady-state response (ASSR) thresholds among 55 infants and young children, 2 months to 35 months of age referred to the Ear Unit for electrophysiologic hearing assessment. Results: Click ABR showed strong positive correlation to all frequencies and averages of ASSR. Highest correlation was noted with the average of 1-4 kHz ASSR results with Pearson r = 0.89 (Spearman r=0.80), the average of 2-4 kHz had strong positive correlation r = 0.88 (0.79). Correlation was consistently strong through all ASSR frequencies (0.5 kHz at r=0.86 (0.74), 1 kHz at r=0.88 (0.78), 2 kHz at r=0. 87 (0.79), 4 kHz at r=0.85 (0.76)). Average differences of click ABR and ASSR thresholds were 8.2±12.9dB at 0.5 kHz, 8.6±12.6dB at 1 kHz, 5.3±11.8dB at 2 kHz and 7.8±13.4dB at 4 kHz. Among patients with no demonstrable waveforms by click ABR with maximal click stimulus, a large percentage presented with ASSR thresholds. Of these, 80.5% (33 of 41) had measurable results at 0.5 kHz with an average of 107.3±11.1dB, 85.4% (35 of 41) at 1 kHz with an average of 110.5±11.8dB, 73.2% (30 of 41) at 2 kHz with an average of 111.2±11.1dB and 63.4% (26 of 41) at 4 kHz with average of 112.2±8.21dB. Auditory steady-state response results were comparable to auditory brainstem response results in normal to severe hearing loss and provided additional information necessary for complete audiologic assessment especially among patients with severe to profound hearing loss wherein click ABR showed no responses. Up to 85.4% of patients that would have been noted to have no waveforms by click ABR still demonstrated measurable thresholds by ASSR. Conclusion: Our study suggests that ASSR may be the best available tool for assessing children with severe to profound hearing loss, and is a comparably effective tool in overall hearing assessment for patients requiring electrophysiological testing. The advantages of ASSR over click ABR include: 1) detection of frequency-specific thresholds and; 2) the detection of hearing loss thresholds beyond the limits of click ABR.

Background: The COVID-19 pandemic has brought about mental anguish to the general population. This pandemic has changed the way we deliver healthcare. The enhanced community quarantine measures have caused the institution to close the outpatient department, leading to apprehensions among patients. Shifting to telemedicine to reach out to the patients as an alternative to face-to-face prenatal services is the current practice. Objectives: This study was conducted to assess the level of depression, anxiety, and stress in pregnant women enrolled under obstetric (OB) service who now have no access to regular antenatal services, as well as to determine the acceptance of telemedicine as a satisfactory alternative to regular prenatal visits. Materials and Methods: This is a descriptive study among patients currently enrolled under OB service in a tertiary hospital in Cebu City and Mandaue City. Respondents have been provided the social media page and given prenatal checks by phone calls from the OB resident doctors since March 2020. A data collection form was filled up online consisting of three parts: (1) the mother's sociodemographic and obstetrical information, (2) a validated tool, the depression, anxiety, and stress-21 scale to assess depression, anxiety, and stress, and (3) query on whether telemedicine has helped alleviate depression, anxiety, and stress. Results: Among the 196 patients surveyed, 21.94% were found to be moderately to severely depressed, 35.2% were moderately to severely anxious, and 8.61% were moderately to severely stressed. About 96.43% of the patients felt that telemedicine alleviated depression, anxiety, and stress during this crucial time. Conclusion The level of depression, anxiety, and stress among the patients was generally normal or low. However, 21.93%, 35.2%, and 8.61% were found to be moderately to severely depressed, anxious, and stressed, respectively. Telemedicine was found to be a satisfactory alternative to regular prenatal visits. Respondents accepted telemedicine for the following reasons: unwilling to go to the hospital for fear of contracting the virus, fear of certain lockdown measures such as no available public transportation and no crossing of borders were allowed.
Depression ; Anxiety ; Pregnancy ; Telemedicine

INTRODUCTIONGrade 4 cystoceles are among the most challenging to achieve a successful repair for gynaecologists. The high rate of recurrence of severe prolapse encouraged surgeons to use meshes. Only recently have meshes been used transvaginally for pelvic organ prolapse. The aim of our pilot study was therefore to determine the effectiveness of transvaginal anterior colporrhaphy reinforced with prolene mesh in the treatment of severe or recurrent cystoceles by looking at their primary surgical outcomes as well as their complications.

MATERIALS AND METHODSThis was a retrospective study conducted by the urogynaecology unit at KK Women's and Children's Hospital (KKWCH) in Singapore based on operations performed from April 2002 to December 2003. The inclusion criterion was that women had to have at least a grade 4 or recurrent grade 3 cystocele and had undergone a vaginal anterior colporrhaphy reinforced with prolene mesh. The women were further subdivided into 3 groups depending on whether vaginal hysterectomies were performed or not as well as the absence or presence of the uterus.

RESULTSThirty-seven patients with severe cystoceles underwent this procedure. The 3 mean follow-up times for the 3 groups ranged from 14.4 to 19.2 months (range, 2 to 32). Overall for the 3 groups, 75.7% were cured with no or grade 1 cystocele, 18.9% had asymptomatic grade 2 cystocele while 5.4% developed grade 3 or 4 cystocele. There were no mesh erosions.

CONCLUSIONTransvaginal anterior colporrhaphy reinforced with a tension-free prolene mesh in the treatment of severe or recurrent cystoceles is simple, safe, easily performed and is associated with a low failure rate and morbidity.

Adult ; Aged ; Aged, 80 and over ; Biocompatible Materials ; Cystocele ; surgery ; Female ; Humans ; Middle Aged ; Pilot Projects ; Polypropylenes ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Surgical Mesh ; Treatment Outcome ; Urologic Surgical Procedures ; adverse effects ; methods ; Vagina ; surgery

One of the main factors for virulence of fungus such as Candida albicans is the ability to change its morphology from yeast to hyphae. Allicin, one of the volatile sulfur-oil compounds from freshly crushed garlic, has a variety of antifungal activities. In this study, the effect of allicin on growth and hyphae production in C. albicans as compared to fluconazole, an antifungal drug was investigated using survival time in vitro and microscopic image at different time intervals. Additionally, the expression of selected genes involved in hyphae formation and development such as SIR2 and SAP1-4 was evaluated by semi-quantitative RTPCR and relative real time RT-PCR. Allicin was shown to down-regulate the expression of SIR2 (5.54 fold), similar to fluconazole (3.48 fold) at 2x MIC concentrations. Interestingly, allicin had no effect on SAPs1-4 expression, whereas fluconazole was able to suppress SAP4 expression. Our findings showed that allicin was effective in suppressing hyphae development of C. albicans to an extent that is sometimes equal or more than fluconazole. Moreover, allicin and fluconazole seemed to share a common anti-Candida mechanism through inhibition of SIR2 gene, while fluconazole appeared to also exert its fungistatic effect through another pathway that involved SAP4 suppression.

Introduction: Little is known about the sero-prevalence of diphtheria anti-toxoid antibody levels among medical students in Malaysia. They too, just like other health care workers (HCWs) are at risk of contracting and transmitting diphtheria. Fortunately, this can be prevented by giving a specific vaccine: the diphtheria, tetanus and pertussis (DTP) vaccine. Nonetheless, data from local or regional surveys are needed before any decision is made by the respective authorities. General objective: We studied the epidemiology of diphtheria anti-toxoid antibody levels and vaccination history amongst medical students and staff in Faculty of Medicine and Health Sciences, Universiti Putra Malaysia. Specific objectives: We determined the level of diphtheria anti-toxoid antibodies amongst pre-clinical students and staff. Methodology: A total of 152 sera were collected from subjects aged 19 to 63, and diphtheria anti-toxoid levels were measured by an enzyme-linked immunosorbent assay. Results: One hundred and fifty-two (94.4%) blood samples out of 161 participants were successfully withdrawn, which comprised 105 (69.1%) and 47 (30.9%) medical students and staff, respectively. A total of 77.6% and the other 22.4% of the subjects had full and basic protection, respectively. Higher levels were predominant amongst males and they were 1.3 times more protected than females in 20-29 year-old group (85.1% vs 66.2%; odd ratios 1.25 [95% CI 1.03-1.50]; P=0.03). No significant difference in the levels of immunity among subjects for ethnicity and academic position (P>0.05). Recommendations: Level of full protection against diphtheria toxin should be clearly defined by broad population based studies using several comparable detection methods. Medical students and staff with basic protection should be closely monitored or should be given a booster dose for those who are at high risk of acquiring the disease. Thus, a standard degree of coverage should be clearly determined for health workers to prevent a potential outbreak. Conclusion: Students and staff possess immunity towards diptheria toxin however the level of full protective antibody is yet to be determined in future.

Interleukin-27 (IL-27) has a pleiotropic role either as a pro-inflammatory or anti-inflammatory cytokine in inflammatory related diseases. The role and involvement of IL-27 during malaria was investigated and the effects of modulating its release on the production of major inflammatory cytokines and the histopathological consequences in major affected organs during the infection were evaluated. Results showed that IL-27 concentration was significantly elevated throughout the infection but no positive correlation with the parasitaemia development observed. Augmentation of IL-27 significantly elevated the release of anti-inflammatory cytokine, IL-10 whereas antagonising and neutralising IL-27 produced the opposite. A significant elevation of pro-inflammatory cytokines (IFN-γ and IL-6) was also observed, both during augmentation and inhibition of IL-27. Thus, it is suggested that IL-27 exerts an anti-inflammatory activity in the Th1 type response by signalling the production of IL-10 during malaria. Histopathological examination showed sequestration of PRBC in the microvasculature of major organs in malarial mice. Other significant histopathological changes include hyperplasia and hypertrophy of the Kupffer cells in the liver, hyaline membrane formation in lung tissue, enlargement of the white and red pulp followed by the disappearance of germinal centre of the spleen, and tubular vacuolation of the kidney tissues. In conclusion, it is suggested that IL-27 may possibly acts as an anti-inflammatory cytokine during the infection. Modulation of its release produced a positive impact on inflammatory cytokine production during the infection, suggesting its potential in malaria immunotherapy, in which the host may benefit from its inhibition.