Percutaneous pinning after closed reduction is commonly used to treat supracondylar fractures of the humerus in children. Minor pin tract infections frequently occur. The aim of this study was to prevent pin tract infections using a rubber stopper to reduce irritation of the skin against the Kirschner (K) wire following percutaneous pinning. Between July 2011 and June 2012, seventeen children with closed supracondylar fracture of the humerus of Gartland types 2 and 3 were treated with this technique. All patients were treated with closed reduction and percutaneous pinning and followed up prospectively. Only one patient, who was a hyperactive child, developed pin tract infection due to softening of the plaster slab. We found using the rubber stopper to be a simple and inexpensive method to reduce pin tract infections following percutaneous pinning.
Bone Wires

The determination of HIV drug resistance mutations (DRMs) towards antiretroviral (ARV) drugs among HIV-1 treated patients with virological failure is crucial for further management of the patient. This study aimed to assess the most common genomic mutation and to analyse subtypes among the HIV-1 patients with viral load level > 1,000 copies/mL. A total of 101 virological failure HIV-1 patients from four different regions of Peninsular Malaysia with a viral load measurement facility were included in the study. Majority of patients (89.1%) have at least 1 mutation associated with clinical resistance to either protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) or nonnucleoside reverse transcriptase inhibitors (NNRTIs). Major resistance mutations among the patients towards NRTIs and NNRTIs were 70.3% and 18.8%, respectively. The most common mutation for NRTIs was M184V while K103N mutation was detected in the majority of patients who were treated with NNRTIs. The most commonly observed mutations for major PI and minor PI seen among the study population were V82A/T and L10V, respectively. In HIV-1 subtype analysis, CRF33_01B was the most predominant HIV-1 subtype in this study group. The vast detection of DRMs in this study emphasized the importance of genotypic resistance test in the management of HIV patients as DRMs can alter patient’s susceptibility towards ARV drugs. Further study on larger number of samples is essential for the development of a database on HIV-1 DRMs among patients that experience virological failure in Malaysia.

Dengue infection is endemic in South East Asia and parts of the Americas. Dengue hemorrhagic fever is characterized by vascular permeability, coagulation-disorders and thrombocytopenia, which can culminate in hypotension i.e. dengue shock syndrome. Hypopituitarism arising as a complication of dengue is extremely rare. Hemorrhagic pituitary apoplexy of pre-existing pituitary adenomas has been rarely reported in dengue. We describe an uncommon case of hypopituitarism in a dengue shock syndrome survivor without known pituitary adenoma. A 49 years old nulliparous lady (from Kuala Lumpur, Malaysia) presented with typical symptoms of hypocortisolism. Postural hypotension was evident with normal secondary sexual characteristics. Further history revealed that she survived an episode of dengue shock syndrome 6 years ago where premature menopause developed immediately after discharge, and subsequently insidious onset of multiple hormonal deficiencies indicative of panhypopituitarism. There were no neuro-ophthalmological symptoms suggestive of pituitary apoplexy during hospitalization for severe dengue. Magnetic resonance imaging of the pituitary 6 years later revealed an empty sella. Autoimmune screen and anti-thyroid peroxidase antibodies were negative. We describe a rare possible causative association of severe dengue with panhypopituitarism without known pituitary adenoma, postulating pituitary infarction secondary to hypotension (mimicking Sheehan’s syndrome), or a direct viral cytopathic effect. Subclinical pituitary apoplexy secondary to asymptomatic pituitary hemorrhage however cannot be excluded. Future research is required to determine the need for and timing of pituitary axis assessment among dengue shock syndrome survivors.

No abstract available.
Ganglion Cysts ; Organic Chemicals

Tong Nibong is a Bidayuh village located at Sarawak Kalimantan border. Since the year 2004 to 2009, a total of 537 cases of malaria were recorded in Serian District of which 14 cases were reported from Kampung Tong Nibong. Community empowerment programme for malaria infection prevention showed tremendous improvement in implementation. This intervention study aims to gauge the effectiveness of community empowerment approach in malaria elimination programme in Kampung Tong Nibong Serian. An intervention study was conducted with pre and post data collection. Data was collected using validated questionnaire by face to face interview. Universal sampling method was used to select respondents from head of household and post data was collected after intervention activities were carried out within a year of study period. The study showed significant difference on level of knowledge of respondents on vector of malaria between pre and post data with a P < 0.05. There was significant difference between pre and post data on practices on control and prevention of malaria with a P < 0.05. The same goes to level of positive attitude of respondents towards malaria control. In conclusion, the study can be considered successful because there is significant difference in knowledge, attitude and practice among the respondents between pre and post data. This indicates that community empowerment (voluntary participation) measures can be implemented in high risk or endemic areas where malaria is a persistent problem to the community and health institutions faces many limiting factors.​

No abstract available.
Diffusion Tensor Imaging ; Diffusion ; Hemiplegia ; Humans

The Malaysian government implemented an excise tax of MYR 0.40 per L on sugar-sweetened beverages in July 2019. Excise tax is imposed on sweetened drinks containing more than 5 g of sugar per 100 ml, flavoured Ultra High Temperature milk-based drinks, and fruit juices with more than 7 g and 12 g of sugar per 100 ml, respectively. We analysed the impact of excise tax on the consumption of SSBs by developing a demand model for SSBs to estimate the elasticity of demand using a two-way fixed-effect model. The tax increased the price of 1 L SSBs by 8.33%, and we estimated it to decrease the consumption of SSBs by 9.25%. The estimated own-price elasticity of demand for SSBs was −1.11 (95% CI: −1.97 to −0.25). Price of SSB is a determinant for SSB demand, but income or the price of milk are not. The estimated excise revenue calculated was MYR 357.61 million. However, industry responses via product reformulation and pass-through rates could reduce revenue and enhance or reduce health impacts.

Introduction: This study aimed to investigate the prevalence, risk factors, and clinical outcomes of Inflammatory Bowel Disease (IBD) in Mosul Hospital, Iraq, in 2022. Methods: A cross-sectional study design was used to collect data from patients diagnosed with IBD in Mosul Hospital. A questionnaire was used to collect demographic and clinical data, including risk factors, symptoms, and treatment outcomes. Data were analyzed using descriptive statistics and logistic regression. Results: The study included 150 participants, with a mean age of (42.5. ± years and 56% being male. Women were found to be less likely to know the type of Crohn’s disease compared to men. 58.7% of participants did not have any other diseases, while 41.3% had multiple diseases. The CH type was known for 56.8% of participants, and the average disease duration was 70.41 months, ranging from 2 to 360 months. Most participants (72.1%) did not have involvement in a particular place, while 27.9% did. All participants had known involvement. 81.8% of participants did not use drugs, while 18.2% did, with partial or unknown drug usage reported in 39 individuals. Only 7.8% of participants had IBD in their family, while 92.2% did not. Most participants (95.2%) were smokers. Conclusion: The study highlights the need for increased awareness and early detection of IBD in Mosul Hospital. The identification of risk factors and symptoms can aid in the diagnosis and management of the disease. Further research is necessary to understand the underlying causes of IBD and to develop effective prevention and treatment strategies.

Objective To assess the knowledge on Zika virus infection among healthcare providers (doctors) in Aceh province, Indonesia. Methods A self-administered internet based survey was conducted from 3 May to 3 June 2016 among the members of doctor organizations in Aceh province. A set of validated, pre-tested questionnaire was used to measure knowledge regarding Zika infection and to collect a range of explanatory variables. A two-steps logistic regression analysis was employed to assess the association of participants' demographic, workplace characteristics and other explanatory variables with the knowledge. Results A total of 442 participants included in the final analysis and 35.9% of them (159) had a good knowledge on Zika infection. Multivariate model revealed that type of occupation, type of workplace, availability of access to medical journals and experience made Zika disease as differential diagnose were associated with knowledge on Zika infection. In addition, three significant source of information regarding Zika were online media (60%), medical article or medical news (16.2%) and television (13.2%). Conclusion The knowledge of the doctors in Aceh regarding Zika infection is relatively low. Doctors who have a good knowledge on Zika infection are more confident to established Zika disease as differential diagnosis in their clinical setting. Therefore, such program to increase healthcare providers' knowledge regarding Zika infection is needed to screen potential carriers of Zika infection.