Most breast cancer recurrences occur in the surgical scars or within other quadrants of the same breast. Isolated tumour recurrence occurring in the nipple after breast-conserving surgery and radiotherapy is extremely unusual. The reason for this is unknown, but is speculated to be due to involved surgical margins or an occult involvement of the nipple–areolar complex in a breast cancer of the same breast. We present a case of a 44-year-old Indian woman who had recurrent tumour over her right nipple after an ipsilateral breast-conserving surgery that was followed by adjuvant chemotherapy and radiotherapy. There was no typical malignancy features from the mammogram. However, histopathological study confirmed a malignant growth that infiltrated into the dermis and the underneath breast tissue. Completion mastectomy was then performed and the patient was later treated with Taxane-based chemotherapy. Nipple recurrence after breast-conserving surgery and adjuvant radiotherapy may be confused with other nipple conditions such as Paget’s disease of the breast. Comprehensive assessments, which include mammogram and biopsy, have proved that such recurrence do occur, as presented in this case. This warrants a specific management strategy.

In experienced hands, ultrasonic shears had been found to be a useful tool in total thyroidectomy surgery as long as the safety precautions are adhered to closely. It has the advantage of minimising operating time and will eventually reduce the cost of surgery. A randomised controlled trial is thus suggested to further evaluate its efficacy.

Introduction: The escalated demand for protective rubber glove in the healthcare industries has resulted in increased prevalence of glove related skin problem, irritant and allergic contact dermatitis and latex sensitivity. The industry has recently introduced a new nitrile glove product using a novel patented non-sulphur system to effect co-valent bond crosslinking to provide the desired elasticity of the gloves. This glove also has ionic crosslinking provided by the zinc oxide used in the formulation and the carboxylic group of the nitrile latex. The main objective of this study is to prove that residual chemical additives at a level that may induce Type IV allergy in the unsensitized general user population are not present in this rubber glove and to compare it with a powder free latex examination glove. Methods: In collaboration with the Islamic University of Gaza, we conduct modified test on a specially formulated and powder free, accelerator free LOW DERMA™ enhanced nitrile rubber glove that has physical properties and barrier integrity similar to that of NRL gloves. This glove does not contain sulphur or sulphur related compound. Two sets of Powder free, accelerator free LOW DERMA™ Nitrile Patient Examination Gloves*, white and blue colour were tested using the modified draize-95’ test. Filter paper soaked in normal saline and powder free latex examination glove were used as control. Results: A total of 209 subjects, 149 subjects, Caucasian (71.29%), 30 subjects, Afro Caribbean (14.35%) and 30 subjects, Asiatic (14.35%) were recruited. All 209 subjects had a final patch testing scoring of not more than 1.5 during both the induction phase and the challenge phase for both types of Powder Free Nitrile Patient Examination Gloves (white and blue) and to the negative control, normal filter paper and the powder free NRL control glove. Conclusion: The skin sensitization test (‘Modified Draize-95’ Test) of Powder Free Nitrile Patient Examination Gloves (white and blue) and the powder free NRL examination glove were negative. There was no clinical evidence on the presence of residual chemical additives at the level that may induce Type IV allergy in unsensitized general user population for both Powder Free Nitrile Patient Examination Gloves, blue and white colored, non-sterile. Both gloves qualify for “Low dermatitis Claim”.

The incidence of lower limb amputation is high across the globe and continues to be a major threat to morbidity and mortality. Consequently, the provision of high quality and effective prosthetics services have been known as an essential component for a successful rehabilitation outcome. In Malaysia, amputation prevalence has been increasing in which several main components of service delivering aspects (such as service intervention, prosthetic personnel) should be anticipated to accommodate for the increasing demand. This article highlights the hurdles experienced in providing prosthetic services in Malaysia from multiple aspects such as financial burden to acquire the prosthesis and lack of expertise to produce quality prosthesis. This paramount issues consequently justify for the urgency to carry out national level survey on the current statistics of lower limb amputation and to ascertain the available workforce to provide a quality prosthetics services. Only with accurate and current information from the national survey, strategies and policies aimed at enhancing the outcome from prosthetics services can be achieved.

Childhood obesity is an established problem in many countries and emerging in others. Epidemiological data on obesity in children is essential in order to plan public health policy and services. A study was conducted to determine the prevalence of obesity in schoolchildren in the fifth grade of elementary school (10-12 years old) in the district of Kuala Selangor. Ten schools of which five are in urban and five in rural areas were selected consisting of 699 eleven year old schoolchildren from the three major ethnic groups. Using international cut-off points for obesity, we report an overall prevalence of obesity of 7.2%. Prevalence of obesity in urban children is 7.2% whereas in rural children it is 7.0 %. Analysed by gender, there were 8.9% obese boys and 5.3% obese girls. Among the 3 major ethnic groups, the Malays had the highest prevalence of obesity at 9.3% followed by the Chinese with 6.6% while among Indians 3.0%. The data obtained from this study suggests that obesity in Kuala Selangor children is a cause for concern in urban and rural areas.
Obesity ; seconds ; Child ; Prevalence aspects ; rural area

Introduction: Chronic kidney disease (CKD) is associated with periodontal disease due to its hyperinflammatory state. Limited studies have explored the prevalence of periodontal disease among CKD patients in Malaysia. Objective: To assess the periodontal status of pre-dialysis CKD patients in Hospital Universiti Sains Malaysia. Methods: A total of 46 pre-dialysis CKD patients who attended the nephrology clinic at Hospital Universiti Sains Malaysia were enrolled in this study. Periodontal examination was performed using the periodontal probing depth (PPD), clinical attachment loss (CAL) and plaque index. Results: The majority of the CKD patients were Malay (95.7%) and 80.4% were males. The mean age of the patients was 58.5 years. Using PPD measurement, 37 (74.0%) of the patients had mild periodontitis, 9 (20.0%) had moderate periodontitis and 3 (6.0%) had no periodontitis. Based on CAL measurement, 12 (26%) patients had mild periodontitis, 29 (63.0%) had moderate periodontitis and 5 (11%) had severe periodontitis. The mean (standard deviation [SD]) value of mild and moderate-to-severe periodontitis by PPD measurement were 4.26 (0.26) and 5.24 (0.36), respectively. The mean of mild and moderate-to-severe periodontitis by CAL measurement were 2.66 (0.62) and 4.98 (0.73), respectively. There was no correlation between the periodontal parameters and estimated glomerular filtration rate (PPD: r = −0.160, P = 0.914; CAL: r = −0.135, P = 0.372; plaque index: r = 0.005, P = 0.974). Conclusion: This study revealed a greater prevalence and severity of chronic periodontitis among CKD patients. Thus, the periodontal health of CKD patients’ needs to be screened and monitored.

Toxoplasma gondii consists of three genotypes, namely genotype I, II and III. Based on its virulence, T. gondii can be divided into virulent and avirulent strains. This study intends to evaluate an alternative method for predicting T. gondii virulence using hierarchical cluster analysis based on complete coding sequences (CDS) of sag1, gra7 and rop18 genes. Dendrogram was constructed using UPGMA with a Kimura 80 nucleotide distance measurement. The results showed that the prediction errors of T. gondii virulence using sag1, gra7 and rop18 were 7.41%, 6.89% and 9.1%, respectively. Analysis based on CDS of gra7 and rop18 was able to differentiate avirulent strains into genotypes II and III, whereas sag1 failed to differentiate.

Introduction: This study aimed to determine the relationship of maternal dietary intake with human milk nutritional composition, among Malay mothers during the postpartum period of exclusive breastfeeding. Methods: Human milk samples (20- 30ml) were collected from mothers (n=32) at least once monthly for six months postpartum. Macronutrients and fatty acids contents were determined using proximate analysis and gas chromatography methods, respectively. Maternal dietary intakes were recorded using the multiple-pass diet recall method prior to each milk sampling and were analysed using the Nutritionist ProTM software. Associations between the milk composition and maternal diet were tested using Spearman correlation. Results: The energy content ranged between 49.6-59.2 kcal/100ml, protein 1.3-1.4 g/100ml, carbohydrate 6.5-9.7 g/100ml and total fat 6.5-9.7 g/100ml. The polyunsaturated, monounsaturated, and saturated fatty acids concentrations were 10.5-19.1 %, 40.6-43.5 %, and 38.0-49.7 %, respectively. During confinement (first month postpartum), total energy and total fat content of human milk were the highest whereas total carbohydrate was the lowest, compared to the rest of the exclusive breastfeeding period. In contrast, intakes of total calorie and total fat were the lowest, whereas protein was the highest during this period. However, no associations were detected between human milk nutritional contents and maternal dietary intake. Conclusion: In our study population, the composition of maternal diet and nutritional content of human milk differed between confinement and post-confinement periods. However, the association between maternal diet and human milk composition itself warrants further investigation.

Aims:Campylobacter infection is one of the leading bacterial food-borne illness and most frequently reported in humans in developed countries. This study was designed to determine the prevalence of multidrug resistant (MDR) Campylobacterand the risk factors associated with their occurrence in broiler chicken meat retailed in markets. Methodology and results:A total of 210 samples consisting of 140 chicken meat and 70 swabs from weighing scales and cutting boards were collected. Isolates were cultured by passive filtration method, identified by biochemical tests and confirmed using PCR assay.Thirty-two(32/210) 15.2% were positive for Campylobacterof which (25/210) 11.9%, (6/210) 2.9% and (1/210) 0.5% were Campylobacter jejuni, C.coli andC.upsaliensis respectively. The isolates showed high resistance to ampicillin (62.5%), enrofloxacin (56.3%) and nalidixic acid (50.0%), while only 3.1% were resistant to streptomycin. Multidrug resistant isolates (resistance to at least one antibiotics in three classes or more) was high at 71.9%. The risk factors significantly (p<0.05) associated with Campylobactercontamination on chicken’smeat included poor workers hygiene {OR: 5.250 (95% CI: 0.988-27.895)}, wearing improper work attire {OR: 2.700 (95% CI: 1.144-6.374)}, poor protective equipment {OR 38.50 (95% CI: 2.915-508.463)}, poor environment/stall hygiene {OR 44.00 (95% CI: 2.193-882.66)}, and using tiled counter top surface {OR 6.667 (95% CI: 0.597-74.506). Conclusion, significance and impact of study:The finding of this study affirmed that lack or poor work hygiene, unclean environmental stall and protective equipment are associated with high occurrence of multidrug resistant Campylobacterspecies isolated from chicken meat

Aims:The ever-revolving fungi strains and environmental and health concerns due to current practice of synthetic pesticide in agricultural fields have encourages more ventures into bio-pesticides research. Mimusops elengi, a widely available endogenous plant intropical countries and most parts of this plant have been proven to possess medicinal and antimicrobial potential. In this study, M.elengiseeds crude extracts are tested for their antifungal activities on paddy seed-borne and pathogenic fungi.Methodology and results:The dried and grinded M.elengiseeds are macerated separately using water, methanol, ethyl acetate, dichloromethane and petroleum ether as extraction medium. Crude extract of each solvent wasused on paddy seed surface treatment to determine their antifungal inhibition potential on seed-borne fungi and paddy grain germination. Synthetic fungicide mancozeb and thiram are also tested as comparisons to the performance of plant extracts. Water andmethanol extracts exerted the best fungal inhibiting and grain germination results from the five crude extracts tested and qualitative phytochemical screening reveals both extracts contained the most number of phytoconstituents including saponin, flavonoids, alkaloids, tannins and phenolic. Water extract, methanol extracts and synthetic fungicides are then subjected to in-vitro bioassay to observe their effect on mycelial growth of several fungi strains pathogenic to paddy namely, Fusarium fujikuroi,Curvularia aeria,C.lunata andC.eragrostidis.Water and methanol extracts showed a very similar trend of inhibition on all four fungi strains tested with best percentage of inhibition on mycelia growth of C.eragrostidisfollowed by C. aeria, C. lunataand least effective on F.fujikuroi. Further separation of crude extract need to be done to isolate the specific acting compounds contributing to fungal growth inhibition.Conclusion, significance and impact of study:Both water and methanol extracts of the seeds contain promising antifungal properties on seed borne fungi which is as good as the synthetic fungicides compared in this study. A broad range of active phytochemical properties it possesses may be the contributing factor for the fungal growth inhibition. This preliminary screening could narrow down the potential of this seed extracts as natural antifungal agents and the acting active compounds.