To report a rare case of left orbital rhabdomyosarcoma(RMS) presented with severe proptosis and fungating mass in an elderly patient.A 66 year Malay lady presented with severe proptosis and fungating mass in the left eye preceded by epistaxis for eight months. Biopsy showed histological features of alveolar RMS.

Platinum based adjuvant chemotherapy is generally recommended for ovarian cancer to improve the survival rate. Intravenous route is commonly used, easily administered and less associated complications. However, intraperitoneal route is gaining its popularity as a single procedure or adjunctive to the intravenous route. Numerous questions on its eligibility and safety are still perplexed. A case review on a patient with non optimal debulking surgery of advanced ovarian cancer was studied. Intravenous platinum based chemotherapy combined with paclitaxel failed to bring her to clinical remission. Second line chemotherapy, gemcitabin rendered her to poor response with unresolved debilitating ascites needing recurrent drainage. Surprisingly, a trial of intraperitoneal chemotherapy with cisplatin revealed a great response with a complete clinical remission.

Job Satisfaction ; Motivation ; Primary Health Care ; Education, Graduate

A four-month cross-sectional study found five species of parasitoids parasitizing puparia of filth flies breeding at the Taman Beringin landfill in Kepong and a poultry farm in Sungai Pelek, Sepang, Selangor. Effect of monthly rainfalls towards density of flies and percentage of parasitoids emerging from collected puparia were also analyzed. Spalangia sp. was the most common, consisting of Spalangia endius Walker, S. cameroni Perkins and S. gemina Boucek. Other parasitoids collected were Pachycrepoideus vindemmiae Rondani and Exoristobia phillipinensis Ashmead. The parasitized fly hosts were Musca domestica Linn. and Chrysomya megacephala Fabricius. S. endius was the most common parasitoid attacking M. domestica at both locations. M. domestica was the most common fly found at the Sg. Pelek poultry farm whereas C. megacephala was the most numerous at the Taman Beringin landfill. During heavy rainfall month of November 2003, density of flies were high whereas the emerging parasitoids were low at both landfill and poultry farm. The present study revealed the endemic presence of parasitoids especially S. endius in both poultry farm and garbage landfill and the potential of the parasitoid species in fly control in Malaysia.

·AIM: To report an unusual presentation of a rapid increase in size of an orbital schwannoma secondary to intratumoural haemorrhage.·METHODS: A case report.·RESULTS: A 79-year-old male patient had a 2 year history of a slow-growing lump over the medial aspect of his left upper eyelid. The lump had further increased in size recently. An incision biopsy was undertaken. However, during the following 4 weeks, the mass rapidly grew in size and had reduced his vision in the left eye to 6/18. He was referred to the orbit service for further management. On examination, he had a large mass emerging from the supero-medial aspect of his orbit. He had mechanical ptosis and the globe was displaced infero-laterally. Eye movements were limited in the left eye, especially in upgaze. A CT scan demonstrated an extraconal mass in the medial aspect of the left orbit. A left anterior orbitotomy with excision biopsy of the mass showed a well encapsulated mass. Histological examination demonstrated a schwannoma with cystic changes and thrombosed blood vessels. The patient had an uneventful postoperative course. Postoperatively his vision improved to 6/6 and he no longer experienced diplopia. ·CONCLUSION: Our case emphasises the point that orbital schwannomas should be regarded as an important differential diagnosis for a slow growing tumour, but the rapid growth, of a previously presumed benign tumour, which can make it highly suspicious for malignancy or inflammation, could also represent intratumoural haemorrhage.

A fourteen years old Malay boy was involved in a motor vehicle accident and suffered multiple injuries. The patient was referred to ophthalmology for right periorbital haematoma, ocular examination was normal but proptosis of right eye was detected which was later associated with increase in the intraocular pressure (IOP). Direct carotid cavernous sinus fistula (CCF) was diagnosed by angiography and treated with embolization.

This is a prospective randomized clinical trial to compare use of a combination of periarticular drug injection with patientcontrolled analgesia (PCA) to PCA alone in post-total knee arthroplasty (TKA). Thirty patients who were admitted for unilateral total knee arthroplasty were selected randomly into an Injection group or a Standard group. The periarticular injection contained Ropivacaine, Ketorolac and Adrenaline, given intra-operatively. The mean amount of opioid used was 22.87 mmol/L in the Injection group as compared to 39.78 mmol/L in the Standard group (p = 0.026). The Injection group had lower pain score at rest and during exercise (p=0.021, p=0.041, respectively), as well as better return to function (p=0.026) and shorter hospital stay (6.1 days, Injection; 7.5 days, Standard, p=0.027). Overall, the group receiving periarticular drugs injection had less pain, less narcotic usage, earlier return to function, similar experience of adverse effects and shorter hospital stays.

While the prevalence of visually impaired children constitutes a small portion of the visually impaired population, it is important to determine whether the Jurnal Sains Kesihatan Malaysia 5 (1) 2007: 37-45 38 low vision services available are utilised by these children. This is important as previous studies have shown that children have a very high rate of successful low vision device use compared to adults. This was a cross sectional retrospective study. Fifty nine low vision clinic children records were evaluated. The results showed that 25.4% of the children were categorised as with moderate low vision, 30.5% with severe low vision and 40.7% were categorised as blind. The major causes of low vision were congenital cataract, congenital nystagmus, congenital glaucoma, macular degeneration and retinitis pigmentosa. Low vision rehabilitation for near work using magnifiers improved the vision of 30.5% of the low vision children. This finding suggests that 1/3 of low vision children could benefit from low vision rehabilitation. The low vision devices most commonly prescribed to the children in this study were stand magnifiers, hand-held magnifiers and spectacles. This study illustrates the key role of optometrists in the management of visual impairment in Malaysian children. It would appear that the establishment of low vision services in government hospitals using trained optometrists is a cost effective method of service delivery. Therefore more low vision children would have access to proper low vision rehabilitation and through that rehabilitation, their quality of life can be improved.

The large population of human congestion in Makkah during Hajj would promote contagious diseases. Thus, the pilgrims require health care services that are efficient, effective, and high quality. The aim of this study is to determine the type of health-related problems among Malaysian pilgrims and to identify the health care services required by them during Hajj in Makkah. A cross-sectional study was conducted in which involved 379 Malaysian pilgrims in 2013/14234H. The survey was conducted after the pilgrims completed their Hajj ritual. A total of 400 sets of questionnaires were distributed at Abraj Janadriyah Hotel, which was occupied by more than 3000 Malaysian pilgrims. The response rate for this survey was 93%. Male respondents were constituted of 49.6% and female respondents were 50.4% with the mean age 52 years old. The underlying disease among Malaysian pilgrims during Hajj was respiratory disease (77.5%). The demands for health personnel (36.1%) and quality medication (34.7%) are among the important healthcare services required by the Malaysian pilgrims in Makkah. Respiratory disease is a common disease experienced by Malaysian pilgrims in Makkah. A certain types of services such as health personnel and quality medicine are strongly demanded by the Malaysian pilgrims to overcome their health problem during Hajj. This research provides a fundamental input to the health care providers, and also benefited the Hajj management authority to improve the quality of hajj management in future

Hajj and ‘Umrah pilgrimage are a huge congregation performed by Muslims in Makkah, Saudi Arabia. The pilgrimage causes overcrowding and congestion that can lead to a high risk of health problems, especially when pilgrims have health problems. The purpose of this study is to assess the reliability of EQ-5D as a measuring tool to capture the health status of the pilgrims. Data collection was done during Ramadhan’s ‘Umrah in 2014. In this cross-sectional study, a total of 300 self-administered questionnaires attached with the EQ-5D-5L questions were distributed to Malaysian ‘Umrah pilgrims in Makkah and willing to participate in the study. The outcomes from the questionnaires and EQ-5D-5L were systematically analysed by using the SPSS software. The response rate was 64%, involved female (53%) and male (47%) respondents with the mean age of 55 years old. Hypertension (21.5%) and diabetes (16.2%) were the commonest underlying health problems suffered by the respondents in this study. Based on the EQ-5D outcomes, 53.3% of the respondents had no problem in their movement. However, the mean of EQ-VAS (visual analogue scale) presented 83 out of 100 scaling point, which means they might have problems in their health status. In addition, this study revealed, respondents with underlying illnesses had difficulty in some dimensions in EQ-5D. Hypertension was identified as the commonest underlying disease amongst the pilgrims. A contradicted outcome from the objective and subjective measuring scales of EQ-5D and EQ-VAS respectively; presented its sensitivity of EuroQol as a measuring tool for the quality of life among pilgrims living within such congestion