The diagnostic value of core needle biopsy is increasingly being preferred because of its better characterization of benign and malignant lesions and lower frequency of insufficient samples. The aim of this study was to determine the diagnostic accuracy and complication rates with 2 different gauges of core biopsy needle in the preoperative diagnosis of palpable breast lumps. A total of 150 consecutive core biopsies were included in this prospective non-randomised study of palpable breast lump from May 2000 to May 2001. The tissue diagnosis made from the core biopsy specimen was compared with the final histopathology reports from the excised specimen. However, if the lump is not excised, a presumptive diagnosis of benign lesion was made only after at least 6 months follow up with no change in the breast lump. The data were analysed for sensitivity, specificity, predictive values, diagnostic accuracy and complications. The results from the 2 different sizes of core needle biopsies were compared accordingly and a statistical analysis was performed using Chi-squared test. Ninety-six core specimens were acquired with 14 G needle while the other 54 with 16 G needle. There was no significant statistical difference between the accuracy of both needle sizes. However, 4 complications occurred with the larger size 14 G needle while none with the 16 G needle, but this was not statistically significant. In conclusion the size 16 G core biopsy needle provided an accurate diagnostic reliability that is comparable to the larger size 14 G needle in the preoperative diagnosis of palpable breast lump.
Biopsy, Fine-Needle/*instrumentation ; Breast Diseases/*pathology ; Needles/*adverse effects ; *Palpation ; Preoperative Care/*instrumentation ; Reproducibility of Results

The safety of intravenous glycoprotein Ⅱb/Ⅲa inhibitors (GPI) in elderly patients admitted with acute coronary syndrome (ACS) has not yet been established. The purpose of this study was to evaluate the safety of GPI in elderly patients with ACS. Methods Ninety consecutive patients ≥70 years of age admitted to a county hospital between 1999-2004 were included. All patients had typical ACS symptoms along with high-risk markers. Results There was no difference in the TIMI risk score between patients who received GPI (n=47) and those who did not (n=43). Patients who received GPI had a lower creatinine clearance(40 cc/min vs. 47cc/min, p= 0.04). Patients who received GPI had a lower incidence of death, reinfarction or major bleeding (19% vs.4%, p=0.03). There was no significant difference in major bleeding between the 2 groups. None of the patients in either group developed thrombocytopenia. Conclusion This retrospective small study suggests that the use of GPI in a selected group of elderly patients with acute coronary syndrome may be safe.

Stridor in infants with subglottic cyst is rare. Mismanagement of such cases may lead to respiratory compromise with a potentially serious and fatal outcome. The diversity of the clinical presentations throws a great challenge in the diagnosis of subglottic cysts. Manifestations vary as they depend on the size and location of the cysts. We report the case of a 6-month-old girl who had a subglottic cyst but managed as moderate croup till she developed worsening respiratory acidosis which difficult intubation. Any case of premature infants with previous history of neonatal intubation presenting with stridor should prompt clinicians to look for possible cysts in the larynx. This is important because once the diagnosis is made,appropriate treatment may be given and unnecessary morbidity and mortality may be avoided.
Intubation, Intratracheal

Perianal mucinous adenocarcinoma is a rare tumor which may be associated with long-standing chronic perianal sepsis. Early diagnosis is challenging and is based on a high index of clinical suspicion and specific histological features. Definitive treatment is surgical, in the form of an abdomino-perineal resection. We hereby describe a case of a perianal mucinous adenocarcinoma arising from long-standing recurrent perianal fistula and complement this with a brief review of the literature pertaining in particular to the management of this condition.
Chronic ; Fistula ; Adenocarcinoma, Mucinous ; Adenocarcinoma ; Definitive

The study aims to evaluate students’ perceptions towards e-Learning Management System (e-LMS) in pharmacy education. A cross-sectional survey was conducted among all undergraduates enrolled at School of Pharmaceutical Sciences, Universiti Sains Malaysia. A pre-validated questionnaire consisting of two domains (demographic characteristics and students’ perception regarding the use of e-LMS) was used for data collection. Descriptive statistics were used to describe the demographic characteristics of the study respondents. Chi Square test was used to measure association between the study variables. All analysis was performed by using Predictive Analytical Software (PASW) v. 18. A total of 315 students completed the survey questionnaire with a response rate of 57.6%. Majority of the students (61.0%) accessed e-LMS to acquire lecture notes for their studies, followed by 53.3% have used e-LMS for the preparation of the assignments. Seventy eight percent of the respondents agreed that e-LMS is very useful and felt that e-LMS is making their studies easier. However, 50% of students claimed that poor network connection at the campus is a major barrier in accessing e-LMS. Moreover, 48% of the respondents disagreed that e-LMS should be taken into account as an assessment criterion for students’ grading. Students are found to be frequently engaged in using e-LMS and believed that online based learning is enhancing their academic performances. Nevertheless, students still prefer hybrid teaching methodologies than choosing traditional system or e-learning as an alone entity.

AIM: To assess the effect of a single dose of Sildenafil citrate on the visual function in men with early-stage age-related macular degeneration(AMD).METHODS: Forty men (mean age 71, range from 55-86 years)with early-stage AMD were prospectively randomized to receive either placebo or Sildenafil citrate (Viagra; Pfizer Inc, New York, NY) 100mg as a single oral dose. Subjects underwent visual acuity, Amsler grid and color discrimination in each eye before and at specific intervals within 9 hours after dosing.RESULTS: Compared with placebo, no pattern of errors were evident in any visual function test following Sildenafil administration. No statistically or clinically relevant changes from baseline were observed in visual acuity or color discrimination. No clinically relevant changes were observed in the Amsler grid. Sildenafil treatment was associated with transient mild or moderate headache and flushing. CONCLUSION: A single 100mg dose of Sildenafil was well tolerated and produced no significant acute visual effects in a sample of men with early-stage AMD.

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.

Tissue engineering aims to restore lost, damaged, diseased or defective tissues in the human body using engineered or regenerated products. The advancement of tissue engineering has given a promising opportunity for better clinical practice in treating dental patients especially in the fields of endodontic, bone and periodontal tissue as well as whole tooth regeneration. In this review, we briefly summarise the possible selection criteria of scaffolds for potential tissue engineering applications in dentistry. Biochemical and physical properties, as well as scaffolding approaches involved in the selection of an ideal scaffold for dental tissue engineering, are also discussed in this review. This review also discussed major applications of tissue engineering in the dentistry field, which can create a paradigm for future studies of tissue regeneration by using selected cells and scaffolds as an alternative treatment in dentistry.

Objective The management of hypertrophic obstructive cardiomyopathy is not well-defined in the elderly.Medical therapy with 3-blockers and calcium-channel blockers are the mainstay therapy for symptomatic patients.Myomectomy is usually reserved for patients who fail medical therapy. Alcohol septal ablation has been recently introduced as an alternative therapy. Patients and Methods Ninety-five patients older than 65 years of age were included. All patients have completed one year of follow-up. The mean age was 72 ± 5 years, 47 patients were females, 10 patients with history of hypertension. Results The mean rise in CK post alcohol ablation was 1052 ± 430IU. The mean NYHA class decreased from 2.9 ± 0.6 to 1.2 ± 0.5 ( P ＜ 0.001 ). The exercise duration on treadmill testing increased from 328 ± 260 s to 349 ± 39 s. The mean resting left ventricular outflow tract gradient decreased from 65 ± 37 mmHg to 16 ± 29 mmHg at one year. One patient died in the hospital after coronary artery bypass grafting that was done subsequent to spiral dissection of the left anterior descending artery during ablation. Thirteen patients developed complete heart block immediately after ablation requiring pacing therapy. Conclusions Alcohol septal ablation seems to be an effective alternative therapeutic option for elderly patients with hypertrophic obstructive cardiomyopathy. Larger studies with longer follow-up are needed.

Seaweed contains various nutrients that has the potential to be a source of nutritious food, but only a few studies done on the red seaweeds in Malaysia. Therefore, this study was conducted to determine the macronutrients content, amino acid profile and fatty acid component in Kappaphycus alvarezii and Kappaphycus striatum. The study found that the range of moisture, fat, ash, protein, fiber and carbohydrates content for both red seaweeds were 6.9% - 7.3%, 0.5% - 2.6%, 29.4% - 30.9%, 2.5% - 5.7% , 5.3% - 5.5% and 50.1% - 53.3% respectively. A total of 16 amino acids were identified in which the essential amino acid for K. alvarezii and K. striatum were 41.11% and 36.15% respectively. A total of 34 fatty acids were identified in which the content of saturated fatty acids (SFA) was the highest (42.7% - 72.8%), followed by mono-unsaturated fatty acid (MUFA) (13.8% - 36.2%) and polyunsaturated fatty acids (PUFAs) was the lowest (13.5% - 21.2%). In conclusion, this study suggest that K. alvarezii and K. striatum are potentially be used as raw materials or food ingredients to improve the nutritional value of the human diet.