Branchial apparatus anomalies usually manifest in teenage or early adult life. Infection complicates second branchial pouch anomalies usually presented as a neck lump or discharging sinus. It is the most common form of anomalies compared to another branchial pouch aberrant. However, it is extremely rare to find a complete branchial fistula with both internal and external openings. Misdiagnosis usually occurs leading to inappropriate and suboptimal treatment. Here, we report of a case of complete second branchial pouch fistula and discuss the clinical presentation and surgical management of such lesion.

Diffusion Tensor Imaging (DTI) is an advanced magnetic resonance imaging (MRI) technique. DTI provides quantitative information at microstuructural level via its parameter indices e.g. mean diffusivity (MD) and fractional anisotropy (FA). It also allows for visualization of neuron fibres through a specific technique called fibre tractography. Leukoaraiosis is an asymptomatic pathological condition of the brain white matter which appears hyperintense on T2-weighted MRI images. Association of leukoaraiosis with age and ischemic heart disease have been previously reported. The objective of this study is to compare MD and FA values measured in various areas of the brain white matter (WM), grey matter (GM), and cerebrospinal fluid (CSF) in humans using DTI. 30 subjects with leukoaraiosis and 12 subjects without leukoaraiosis underwent brain scan using GE 1.5 Tesla MRI system. Region of interests were located in the CSF and various WM and GM areas. Comparison of MD and FA values was made between leukoaraiosis tissue (LA) and normal appearing brain tissue (NABT) measured within the same leukoaraiosis subjects, and with normal brain tissue (CONTROL) of healthy control subjects. LA demonstrated a significantly higher MD and lower FA compared to NABT and CONTROL in frontal and occipital WM areas. No differences were observed in MD in any brain region between NABT and CONTROL. Whereas no differences were observed in FA between NABT and CONTROL except in the occipital WM. Fibre tractography showed 31.7% to 56.1% lesser fibre tracts in LA subjects compared to CONTROL subjects. Significant differences were found between pathological tissue compared to normal appearing brain tissue and normal brain tissue. Fibre tractography exposed reduced number of neural fibres in leukoaraiosis subjects as compared to normal subjects.
Diffusion Tensor Imaging

Soluble HLA (sHLA) are potential tumour markers released in order to counter immune surveillance. sHLA-class II is less known especially in acute lymphoblastic leukaemia (ALL). This study aimed to investigate soluble, surface and allelic expression of HLA Class II (sHLA-DR) in B-cell ALL patients and compare with soluble expression in normal individuals. A sandwich enzyme-linked immunosorbent assay (ELISA) was developed to measure soluble HLA-DRB1 in plasma. Flow cytometric analysis was performed to determine median fluorescence intensity in HLA-DR surface expression. HLA-DNA typing by polymerase chain reaction, sequence specific oligonucleotides, PCRSSO was performed to determine HLA-DRB1 type in ALL samples. Results showed sHLA-DRB1 (mean+SEM) was significantly increased (p=0.001) in plasma of ALL patients (0.260±0.057 μg/mL; n=30) compared to healthy controls (0.051±0.007μg/mL; n=31) of Malay ethnicity. However, these levels did not correlate with percentage or median fluorescence intensity of HLA-DR expressed on leukemia blasts (CD19+CD34+/-CD45loHLA-DR+) or in the normal B cell population (CD19+CD34- CD45hiHLA-DR+) of patients. No significant difference was observed in gender (male/female) or age (paediatric/adult). Only a trend in reduced sHLA was observed in patients carrying HLA-DR04. These results have to be validated with a larger number of samples.

Soluble HLA (sHLA) are potential tumour markers released in order to counter immune surveillance. sHLA-class II is less known especially in acute lymphoblastic leukaemia (ALL). This study aimed to investigate soluble, surface and allelic expression of HLA Class II (sHLA-DR) in B-cell ALL patients and compare with soluble expression in normal individuals. A sandwich enzyme-linked immunosorbent assay (ELISA) was developed to measure soluble HLA-DRB1 in plasma. Flow cytometric analysis was performed to determine median fluorescence intensity in HLA-DR surface expression. HLA-DNA typing by polymerase chain reaction, sequence specific oligonucleotides, PCRSSO was performed to determine HLA-DRB1 type in ALL samples. Results showed sHLA-DRB1 (mean±SEM) was significantly increased (p=0.001) in plasma of ALL patients (0.260 ±0.057 μg/mL; n=30) compared to healthy controls (0.051 ± 0.007µg/mL; n=31) of Malay ethnicity. However, these levels did not correlate with percentage or median fluorescence intensity of HLA-DR expressed on leukemia blasts (CD19+CD34 ± CD45(lo)HLA-DR+) or in the normal B cell population (CD19+CD34- CD45(hi)HLA-DR+) of patients. No significant difference was observed in gender (male/female) or age (paediatric/adult). Only a trend in reduced sHLA was observed in patients carrying HLA-DR04. These results have to be validated with a larger number of samples.

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.​

Dengue Fever is a major public health issue in Malaysia. This study aimed to assess knowledge, attitude and practice regarding dengue fever and effectiveness of health education programme among 204 students of Alam Shah Science School, Cheras/Kuala Lumpur. Study design was a cross sectional study followed by an interventional (pre-post) Study. The self-administered questionnaire included questions on sociodemographic factors, knowledge, attitude and practice regarding dengue fever. Majority of respondents were Malays (96.6%), monthly family income more than RM 3000 (64.6%) and lives in urban area (64.6%). There was no significant association between knowledge status and socio-demographic factors (p-value>0.05). Most of the respondents had good knowledge (63.2%) good attitudes (79.9%) regarding dengue fever. However, practices to prevent dengue was poor (74.0%). Only about one-fifth of the respondents (18.2%) believed that dengue fever is a flu-like illness. Knowledge score was significantly increased after health education programme (p value <0.001). There is a need to increase health education activities through campaigns and mass media to increase knowledge regarding dengue fever. This would help to inculcate positive attitudes and cultivate better preventive practices among the public to eliminate dengue fever in the country.

Adult ; Classification ; Diagnosis ; Humans ; Malaysia ; Malocclusion ; Passive Cutaneous Anaphylaxis ; Retrospective Studies

In the article, two co-authors were missing in the author list.

Purpose::Malnutrition is a common problem among hospitalized patients, especially among traumatic brain injury (TBI) patients. It is developed from hypermetabolism and the condition may worsen under the circumstance of underfeeding or incompatible dietary management. However, the data of nutrient intake especially calorie and protein among TBI patients were scarce. Hence, this study aimed to determine the calorie and protein intake among acute and sub-acute TBI patients receiving medical nutrition therapy in hospital Sultanah Nur Zahirah, Terengganu.Methods::This observational study involved 50 patients recruited from the neurosurgical ward. Method of 24 h dietary recall was utilized and combined with self-administered food diaries for 2-8 days. Food consumptions including calorie intake and protein intake were analyzed using Nutritionist PRO? (Woodinville, USA) and manual calculation based on the Malaysian food composition database (2015).Results::Patients consisted of 56% males and 44% females with the median age of 28.0 (IQR = 22.8-36.5) years, of which 92% were diagnosed as mild TBI and the remaining (8%) as moderate TBI. The Glasgow coma scale (GCS) was adopted to classify TBI severity with the score 13-15 being mild and 9-12 being moderate. The median length of hospital stay was 2 (IQR = 2.0-3.3) days. Calorie and protein intake improved significantly from day 1 to discharge day. However, the intake during discharge day was still considered as suboptimal, i.e. 75% of calorie requirement, whilst the median protein intake was only 61.3% relative to protein requirement. Moreover, the average percentages of calorie and protein intakes throughout hospitalization were remarkably lower, i.e. 52.2% and 41.0%, respectively.Conclusion::Although the calorie and protein intakes had increased from baseline, hospitalized TBI patients were still at a risk to develop malnutrition as the average intakes were considerably low as compared to their requirements. Optimum nutrient intakes especially calorie and protein are crucial to ensure optimum recovery process as well as to minimize risks of infection and complications.