Mycobacterium tuberculosis (MTB) is a rare cause of prosthetic joint infection. The diagnosis is challenging especially in cases of latent tuberculosis. QuantiFERON-TB Gold (QFT®) is an interferon-gamma relative assay (IGRA) which is highly specific and sensitive for detection of MTB infection. We report a case of 76-year-old lady diagnosed with tuberculous prosthetic joint infection following total knee replacement. Histological examination of abnormal synovial tissue taken intraoperatively reveals chronic granulomatous lesion and raised suspicion of tuberculous infection in otherwise asymptomatic patient. The tuberculin skin test, MTB acid-fast stain and tuberculosis polymerase chain reaction were negative. The diagnosis dilemma was solved with positive result of QuantiFERON TB Gold Test. The patient was treated with anti-tuberculous drug without any surgical intervention. At five months follow-up, patient was clinically well with no symptoms and signs of infection
Interferon-gamma ; latent tuberculosis ; mycobacterium tuberculosis ; total knee replacement ; tuberculosis

Glutamate is one of the most prominent neurotransmitters in mammalian brains, which plays an important role in neuronal excitation. High levels of neurotransmitter cause numerous alterations, such as calcium overload and the dysfunction of mitochondrial and oxidative stress. These alterations may lead to excitotoxicity and may trigger multiple neuronal diseases, such as Alzheimer’s disease, stroke, and epilepsy. Excitotoxicity is a pathological process that damages nerve cells and kills cells via excessive stimulation by neurotransmitters. Monitoring the concentration level of brain glutamate via an implantable microbiosensor is a promising alternative approach to closely investigate in the function of glutamate as a neurotransmitter. This review outlines glutamate microbiosensor designs to enhance the sensitivity of glutamate detection with less biofouling occurrence and minimal detection of interference species. There are many challenges in the development of a reproducible and stable implantable microbiosensor because many factors and limitations may affect the detection performance. However, the incorporation of multiple scales is needed to address the basic issues and combinations across the various disciplines needed to achieve the success of the system to overcome the challenges in the development of an implantable glutamate biosensor.

Complementary Alternative Medicine (CAM) is broadly used as an adjunct treatment for patients to treat various kinds of disease, prevent disease and to sustain and enhance quality of life of the users. The study is aimed to investigate the association between CAM uses, Health-Related Quality of Life (HRQoL) and anthropometric indices among workers or staffs in Universiti Sultan Zainal Abidin (UniSZA) Gong Badak Campus, Kuala Terengganu. A total of 300 subjects participated in this study and completed the malay version of modified HRQol (SF-12) questionnaires. Anthropometric measurements among the subjects were done. Independent t-test, One-way ANOVA and Pearson correlation were used to test the association and the hypotheses. The prevalence of CAM users was 37.3%. The results showed that bodily pain score domain was significantly higher among non-CAM users. Overall, male had higher Mental Health Composite Score (MCS) score than female. Physical Health Composite Score (PCS) was only correlated negatively with BMI among non-CAM users but negative correlated with body fat percentage in both CAM and non-CAM users. As conclusion, HRQoL had significant negative correlation with body fat percentage among CAM users. No association was found between CAM use and HRQoL scores.
CAM use ; HRQoL ; MCS ; PCS ; body fat percentage

Complementary Alternative Medicine (CAM) is broadly used as an adjunct treatment for patients to treat various kinds of disease, prevent disease and to sustain and enhance quality of life of the users. The study is aimed to investigate the association between CAM uses, Health-Related Quality of Life (HRQoL) and anthropometric indices among workers or staffs in Universiti Sultan Zainal Abidin (UniSZA) Gong Badak Campus, Kuala Terengganu. A total of 300 subjects participated in this study and completed the malay version of modified HRQol (SF-12) questionnaires. Anthropometric measurements among the subjects were done. Independent t-test, One-way ANOVA and Pearson correlation were used to test the association and the hypotheses. The prevalence of CAM users was 37.3%. The results showed that bodily pain score domain was significantly higher among non-CAM users. Overall, male had higher Mental Health Composite Score (MCS) score than female. Physical Health Composite Score (PCS) was only correlated negatively with BMI among non-CAM users but negative correlated with body fat percentage in both CAM and non-CAM users. As conclusion, HRQoL had significant negative correlation with body fat percentage among CAM users. No association was found between CAM use and HRQoL scores.

Myxoid neurofibroma is benign tumours of perineural cell origin that arise from elements in the peripheral nervous system. We report a case of a 60-year-old female patient presented with history of right ear mass which was slowly growing. Her primary complaint was cosmetic deformity but hearing loss was also present. The mass was excised and histologically revealed a myxoid neurofibroma. To the authors’ knowledge, this is the first time that a myxoid neurofibroma arising from external auditory canal is reported. It should be included in the differential diagnosis of a mass originating from this location.
Neurofibroma

Extracorporeal membrane oxygenation (ECMO) is a useful but less commonly used technique in right ventricular failure post cardiac surgery in our region. We report a case of successful use of ECMO for right ventricular failure post cardiac surgery. Our patient is a 27-year-old male presented with constrictive pericarditis post completion of treatment for disseminated Tuberculosis. He underwent pericardiectomy that was complicated with acute right ventricular failure. He was placed on extracorporeal membrane oxygenation after few hours post op that lasted for five days. The patient survived to hospital discharge and remained well on follow-up. From our experience, this aggressive management approach is beneficial in right ventricular failure and can be safely utilised in all cardiothoracic centres.

OBJECTIVE: To evaluate thyroid function and hormonal profile in women with polycystic ovary syndrome (PCOS). METHODS: A case-control study was conducted at Saad Abualila Center, Khartoum, Sudan. The cases were women with confirmed PCOS based on Rotterdam criteria. The controls were infertile women with no evidence of PCOS. The socio-demographic characteristics and medical history were gathered using a questionnaire. Thyroid hormones (thyroid-stimulating hormone, free tri-iodothyronine, and free thyroxine), anti-thyroid peroxidase, and anti-thyroglobulin antibodies were measured. RESULTS: While there were no significant differences in the age and haemoglobin levels of the two studied groups (55 women in each arm), body mass index was significantly higher in women with PCOS. There were no significant differences in the levels of thyroid-stimulating hormone, luteinizing hormone, follicle stimulating hormone, luteinizing hormone/follicle stimulating hormone, anti-thyroid peroxidase, anti-thyroglobulin antibodies, cholesterol, triglycerides and low-density lipoprotein cholesterol between the cases and the controls. The mean±standard deviation of free tri-iodothyronine (3.50±0.2 vs. 3.38±0.3 pg/mL, P=0.040) and median (interquartile) high-density lipoprotein cholesterol (37.0 [34.0 to 42.0] vs. 35.80 [29.0 to 41.0] mg/dL, P=0.015) were significantly higher in PCOS patients compared with the control group. In linear regression, PCOS (0.151 pg/mL, P=0.023) and anti-thyroid peroxidase levels (-0.078 pg/mL, P=0.031) were significantly associated with free tri-iodothyronine. CONCLUSION: Free tri-iodothyronine was a significantly higher among PCOS patients compared with the control group.
Antibodies ; Body Mass Index ; Case-Control Studies ; Cholesterol ; Female ; Follicle Stimulating Hormone ; Humans ; Infertility ; Linear Models ; Lipoproteins ; Lutein ; Luteinizing Hormone ; Ovarian Diseases* ; Peroxidase ; Polycystic Ovary Syndrome ; Sudan ; Thyroid Gland* ; Thyroid Hormones ; Thyrotropin ; Triglycerides

The rapid increase in the ageing population and health conditions are imposing a higher challenge to the health care system that requires multidisciplinary teamwork utilizing coordinated care approach. This study examined the effects of integrated care model on quality of care received by older hospitalized patients in West Bank. A quantitative interrupted time series design (pretest and posttest multiple time series, quasi-experiment design) was used. The study examined the effects of integrated care model on admitted older patients (n=32) in the West Bank measuring ten dimensions of quality of care and four health indicators. There was a significant improvement in the dimensions of quality of care: dimensions: nurses’ communications with patients, physicians’ communications with patients, staff response to patients’ needs, pain management, explanations on medications, amount of information given on discharge plan, patients' area cleanliness, patients' area quietness, rating of the hospital, and willingness to recommend the hospital. Incidence of falls and incidence of pressure ulcer improved after implementing the model, while readmission rate and average length of stay did not improve. This study contributed to the limited body of knowledge related to the effect of integrated care model on hospitalized older patients’ quality of care in Palestine/ West Bank. Integrated care has the potential to improve care outcomes among hospitalized older patients.

Objective: To determine abundance, distribution and diversity of potential breeding container habitats of the dengue vectors in public places including schools, restaurants, mosques and parks in southwest areas of Penang Island, Malaysia. Methods: Premises at restaurants, schools, parks and mosques were surveyed simulta-neously and inspected visually for container habitats and production of immature mosquitoes from March 2015 to March 2016. Abundance (mean ± SE) of breeding containers between sites was compared using One-way ANOVA. Independent sample t-test was used to compare total number of Aedes albopictus (Ae. albopictus) and Aedes aegypti (Ae. aegypti) surveyed. Results: The surveyed locations yielded a total of 3741 breeding containers and 19537 immature mosquitoes from four areas. Concurrent artificial and natural containers pro-duced 78.4%immature Ae. albopictus and 6.3%Ae. aegypti mosquitoes in wet season, with 14.2% Ae. albopictus and 1.1% Ae. aegypti mosquitoes in dry season. Artificial containers accounted for 98.1% of the total containers recorded, with restaurants being the most productive locations (8012) and schools being the least productive (2234). Conclusions: It was concluded that public places are good sources of potential container habitats of Aedes mosquitoes in Penang Island, Malaysia and Ae. albopictus has exclu-sively replaced the home-grown Ae. aegypti even in urban areas. Therefore, treatment of artificial containers in such locations is critical in Aedes mosquito control campaigns during dengue outbreaks.

Firearm injuries to the spine commonly present with acute neurology caused by direct penetration or indirectly from concussive effects of bullet impact on the vertebral column. We report a case of delayed neurologic presentation of retained intra-spinal bullet in a 42 year-old African who had chronic low back pain and sciatica with a past history of gunshot injury to the spine and radiograph revealed a bullet at the L4-5 disc level. Intra-operative exploration showed a fibrous mass around the bullet compressing on the L4 existing nerve root and L5 traversing nerve root. Removal of the retained bullet resulted in a good clinical outcome with complete resolution of symptoms.