Antrochoanal polyps are rare lesions. We report a series of 40 consecutive cases of antrochoanal polyps treated in our tertiary centre over a period of ten years between May 1998 and April 2008. The median age of the patients was 37 years. The most common clinical symptom was nasal obstruction (92.5%) followed by rhinorrhoea (45%), postnasal drip (35%) and snoring (22.5 %). The median period of follow-up of these patients was 30 months. Various surgical approaches were used; the commonest was powered endoscopic polypectomy and middle meatal antrostomy in 28 patients (70%), followed by endoscopic polypectomy and middle meatal antrostomy in seven patients (17.5%). Five patients (12.5%) underwent powered endoscopic polypectomy without middle meatal antrostomy. In addition, two patients had septoplasty and one had a frontal sinustomy. There were six patients (15%) who had combined sublabial antrostomy. No major complications occurred; four patients relapsed; three patients had initial operation performed elsewhere and one patient developed recurrence after the first surgery. The median hospitalization period was three days. We conclude that, the use of powered instrumentation in the removal of antrochoanal polyps is safe, effective and associated with minimal morbidity.

Learning environment in the universities plays an important role in producing highly competent graduates especially in nursing profession. Thus, the most important as-pects are the teaching activities and as well as student – teacher interaction in daily environment in the university. To investigate the International Islamic University Malay-sia (IIUM) nursing students experience towards their teachers and to identify the rela-tionship between teaching and students learning perception in their learning environ-ment. This study used quantitative method and utilized two out of five subscales in Dundee Ready Educational Environment Measurement (DREEM). The subscales used were students’ perception of learning (SPoL) , students’ perception of teacher (SPoT) and total items in these both subscales are 12 and 11 items, respectively. The ques-tionnaire results revealed that IIUM nursing students scored 28.54/48.00 in (SPoL) and 28.13/44.00 in (SPoT). Both findings showed the IIUM nursing students’ experience their teachers and the learning environment are moving in towards positive directions. The regression finding was 51% of the total variation in students’ perception of teacher score was explained by students’ perception of learning. Although the overall sub-scales (SPoL) score in the current study falls in the category of a more positive per-ception, 2 out of 12 items were poorly scored by the IIUM nursing students. The re-searcher strongly agrees that listening to the expression of students is an important consideration for an educational institution. The overall mean score for (SPoT) showed that the students perceived their teachers as moving in the right direction. In this pre-sent IIUM study, one item showed a mean score of less then 2.00. As a result, these two subscales most probably should reflect the same outcome such as in their aca-demic performance and experience greatly during their student life on campus. The arising issues from this DREEM study at IIUM embrace the need for the creation of supportive environment as well as designing and implementing interventions to remedy unsatisfactorily elements of the learning environment for more effective and successful teaching and learning to be realised.

Langerhans cell histiocytosis of the spine frequently presents as a solitary lesion and rarely results in neurological deficit. Involvement of thyroid tissue is also rare, even in multifocal disease presentations. We present an unusual variant of Langerhans cell histiocytosis in a 37-year-old man presenting with profound quadriparesis and incidental thyroid involvement. MR imaging and skeletal radiographs revealed widespread involvement of the spine. The patient underwent surgical resection of the tumour and stabilization of the spine. Diagnosis was confirmed by histological and immunohistochemistry analysis. Langerhans cell histiocytosis should be included in the differential diagnosis of radiolucent lesions of the spine in adults.

The aim of the research is to compare the physical profile between Malaysian women basketball players and netball players. The physical profile measures were height, body mass, and body fat. The subjects were divided into two groups based on their playing performance and positions. The playing performance consisted of elite/senior, junior, and reserve players. Meanwhile, the playing positions consisted of forward/attack, centre, and guard/defence. The percentage of body fat was determined by means of skinfold measurement at seven different locations. Results showed that there were significant differences in body fat percentage between basketball player and netball players (p < 0.01). The elite/senior basketball players were reported to have the lowest body fat percentage as compared to other basketball or netball players. While for the playing position, guard/defence position basketball players were reported to be the shortest and have the lowest body fat percentage as compared to other playing positions. In conclusion, Malaysian basketball players were found to have better physical or bodily advantaged in terms of playing contact sports as compared to the Malaysian netball players.
Physical Fitness

A spring is a result of karsts topography where surface water has infiltrated the earth's surface recharge area, becoming part of groundwater and emerges from below to become natural spring water. From few observations, local people tend to consume this water directly for many health reasons. The objective of the study was to determine the concentration of lead (Pb) and cadmium (Cd) in natural water resources and bottled drinking water sources, and compared with the existing standard. This field assessment was carried out in 2014 as part of the educational module for public health master student. About 13 water samples were collected directly from the tubing into the pre-washed sample bottle and rinse with the sampling water in the field. Sample preservation was achieved by acidifying to pH less 4.0 with nitric acid (HNO3). Samples were stored in a cooler with temperature between 0 to 4oC. Heavy metals were analysed by standard method for graphite furnace atomic absorption spectrophotometer (GFAAS) with Zeeman’s correction. Pb and Cd content were analysed from 13 samples which consists of eight natural spring water and five flavoured bottled drinking water. The result showed that Pb content in spring water ranges between 1.8 and 37.3ppb, while the Cd content in spring water ranges between 3.0 and 23.0ppb. In the commercialised drinking water, the amount of Pb ranges between 0.4 and 2.6 ppb, while the content of Cd ranges between 0.8 and 7.0 ppb. This study indicates that there are high content of Pb and Cd in most of the natural spring water points and some bottled drinking water that are available within Klang Valley. In the absence of any specific point sources, the possibility of urban area and high traffic source leading to run off as well as rock types may result in variations observed. Hence, very worrying, especially that these sources of water were consumed directly as drinking water or eye drops without knowing its content. Further tests, coupled with supportive soil and conductivity studies, are required to test all possible similar natural sources to safeguard the health of people.

·AIM: To assess the biocompatibility of bovine bone as orbital implants in rabbits.·METHODS: Bovine bone graft was used as an ocular implant in rabbits to determine whether it could be successfully used in the anophthalmic socket as an alternative to the expensive synthetic alloplastics. Evisceration of eyes with and without bovine bone orbital implantation was performed in the right eyes of 12 New Zealand white rabbits.Group Y (n =6) was eviscerated without implant, meanwhile Group X (n =6) was eviscerated with insertion of an orbital implant using bovine bone. Observation was carried out on day 1, day 7, day 14, day 28 and day 42. Serial clinical examination was carried out based on a few fixed criteria,which included rate of infection, implant migration, evidence of wound breakdown and any restriction of intraocular movements. The implanted eyes were then enucleated on day 42. The enucleated eyes were sent for histopathological evaluation to record the type of inflammatory reaction and rate of fibrovascular ingrowth.·RESULTS: Serial clinical examination showed presence of minimal infection in all eyes, both in Group X implanted) and Group Y (control) on first postoperative day, which responded well with antibiotics. Infection occurred in the implanted group after first postoperative day, but there was no evidence of orbital migration or extrusion of implant, wound breakdown, restriction of extraocular movement, severe infection or any physical abnormality. Histopathological examination revealed good fibrovascular ingrowth in the implanted group, with minimal rejecting reaction of rabbit eye towards bovine bone implant.·CONCLUSION: This study shows that bovine orbital implant has a good biocompatibility in rabbit eyes and its cost is acceptable.

Spinal neurofibromas occur sporadically and typically occur in association with neurofibromatosis 1. Patients afflicted with neurofibromatosis 1 usually present with involvement of several nerve roots. This report describes the case of a 14-year-old child with a large intraspinal, but extradural tumour with paraspinal extension, dumbbell neurofibroma of the cervical region extending from the C2 to C4 vertebrae. The lesions were readily detected by MR imaging and were successfully resected in a two-stage surgery. The time interval between the first and second surgery was one month. We provide a brief review of the literature regarding various surgical approaches, emphasising the utility of anterior and posterior approaches.

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.

This study determined the association between nutritional status and the use of protease inhibitors (PI) containing regimen among HIV-infected children receiving treatment at the referral centres in Klang Valley. A total of 95 children currently on antiretroviral (ARV) therapy, aged one to eighteen years, were recruited using purposive sampling. Demographic data, anthropometric measurements, medical history, were collected using a structured questionnaire. Serum micronutrients levels and lipid profile were also examined using blood samples. Mean age was 8.8 3.9 years and 44.2% were on PI. Age ( 2 = 10.351, p = .006), weight-for-age ( 2 = 6.567, p = .010), serum selenium ( 2 = 4.225, p = .040) and HDL-C ( 2 = 7.539, p = .006) were significantly associated with the use of PI. Fewer children on PI were deficient in selenium as compared to those not on PI. On the contrary, more children on PI were underweight and had low HDL-C. The use of PI was found to have both positive and negative effects with better selenium level but poorer HDL-C level and weight status.