We report a case of open fracture of the clavicle with subclavian artery and vein laceration and perforation of the parietal pleural below the first rib that caused massive haemothorax. Emergency thoracotomy and exploration followed by repair of both vessels were able to salvage the patient and the extremity.

A 10-year-old well and asymptomatic female was referred for screening of acute right ventricular dilatation (ARVD) as she had an elder brother diagnosed with ARVD whom died of sudden cardiac death. Electrocardiography (ECG), transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR) were performed. Results of these investigations were suggestive of ARVD. Despite being a rare cardiac disease and largely unrecognised in children and young adult population, ARVD is an important cause of ventricular arrhythmias in this group of patients and is one of the causes of sudden cardiac death (SCD) in this population.

Aging is associated with increased risk of frailty and malnutrition. However, food insecurity has rarely been highlighted in the elderly population, especially among the low income group. Thus, a cross-sectional study was conducted to determine the association between nutritional status, food insecurity and frailty among elderly in low income residences in Klang Valley. A total of 72 elderly individuals aged 60 years and above was selected (mean age 66 ± 6 years) through convenient sampling. Participants were interviewed to obtain information on socio-demographic, health status, food insecurity and cognitive status. Anthropometrics parameters and frailty assessments was measured using standard criteria. Results showed that 75.0% of the participants had abdominal obesity. Nearly half of the participants were overweight (41.7%), followed by normal (43.0%) and underweight (15.3%). With respect to food insecurity, most of them reported that they had enough food (93.1%). There were significant correlation (p < 0.05) between food insecurity with height (r = -0.263, p = 0.026). Most of the participants were pre-frail (58.3%), frail (27.8%) and followed by non-frail (13.9%). Calcium intake is inversely associated with frailty (t = -2.62, p = 0.011). In conclusion, food insecurity was not a problem, however, half of the subjects were overweight and pre-frail. Three out four subjects had abdominal obesity. There is a need to investigate further the pathogenesis of fat frail in this low income elderly population and formulate effective intervention strategies.
Aged ; Income

BACKGROUND: This study aimed to observe the cartilaginous matrix production in SRY (sex determining region Y)-box 9 (SOX9)- and/or telomerase reverse transcriptase (TERT)-transfected chondrocytes from monolayer to three-dimensional (3D) culture.
Alcian Blue ; Cartilage ; Chondrocytes ; Clothing ; Coloring Agents ; Eosine Yellowish-(YS) ; In Vitro Techniques ; Proteoglycans ; Real-Time Polymerase Chain Reaction ; Regeneration ; Telomerase ; Tissue Engineering ; Transfection

Introduction: Oral health status among visually impaired (VI) children have shown to be poorer when compared with their normal peers. This preliminary study aimed to determine the oral health status of VI children and knowledge, attitudes and practices of their caregivers. Methods: A preliminary, cross sectional study were conducted on VI children and their caregivers attending Ophthalmology clinic Hospital USM. The assessment of oral hygiene was done using Sillness-Loe plaque index and dental caries using DMFT/dft index. Self-administered, validated questionnaires on knowledge, attitudes and practice towards a child’s oral health was distributed to the caregivers. Results: A total of 27 VI children along with their caregivers participated in this study. The mean age of VI children and their caregivers was 11.4(3.05) and 41.7(7.10) respectively. The children showed a fair oral hygiene status. The median(IQR) for caries experience for deciduous teeth (dft) and permanent teeth (DMFT) was 0.0(5.00) and 1.0(4.00) respectively. Caries prevalence among VI children was high at 85.2% (95% CI:70.86% - 99.51%). The caregivers showed a relatively good attitude and practice towards their child’s oral health with mean(SD) score of 23.2(2.95) out of 28 and 12.8(2.15) out of 19 respectively in comparison to low oral health knowledge of 5.5(1.50) out of 11. Conclusion: The oral hygiene status was fair with high prevalence of dental caries. Based on the score, although the caregivers showed to have minimal understanding on children’s oral health, their attitude and practice towards children’s oral health are relatively high.

We reported a case of recurrent subcutaneous swelling on the left foot of a diabetic patient. Two different organisms, Cladosporium spp. and Phaeoacremonium krajdenii were isolated, both of which are associated with phaeohyphomycosis and eumycetoma. The cure was achieved through surgical excision of the lesion and a course of antifungal therapy. The diagnosis was uncertain since clinical manifestations and laboratory results were insufficient to distinguish the two diseases.

A delayed wound healing process can lead to detrimental complications in chronic wound patients such as tissue necrosis and systemic infections. Application of immunonutrition (IN) in experimental animal models and chronic wound patients has shown promising and improved wound healing processes. IN restores the supply of essential nutrients that are critical for cell growth and tissue repair in the wounded subjects. Several commonly found nutrients in IN formulations include polyunsaturated fatty acids (PUFAs), essential amino acids, trace elements such as zinc and vitamins. Recently, some studies suggested the use of traditionally used herbs like curcumin in IN recipes due to its efficient wound healing properties. The roles and functions of IN in wound healing encompass recruitment of white blood cells, platelets and fibroblasts into the wounded area during the coagulation and inflammation phases, enhancement of fibroblast proliferation, collagen synthesis and neovascularization in the proliferation phase; and lastly, regulation of tissue re-epithelization for wound closure and recovery. In this review, the roles and functions of individual nutrients were deliberately discussed alongside their mechanisms of action in wound healing. This aims to provide a more holistic insight into the potentials of those nutrients when used as part of IN for major wound patients. Despite its remarkable effects in wound healing, several criteria should be considered in an IN formulation: the type and severity of wounds, administration timing and mode of administration, and concoction of immune-boosting nutrients in order to ensure the optimal wound healing effects.