Giant-cell arteritis is an infl ammatory disease of blood vessels most commonly involving large and medium arteries of the head, predominately the branches of the external carotid artery. It is a form of vasculitis. Giant-cell arteritis of the temporal artery is referred to as “temporal arteritis”. Giant cell arteritis is rare among Asians. Diagnosis is based on American College of Rheumatology (ACR) classifi cation criteria for giant-cell arteritis with gold standard temporal artery biopsy.1 Blindness is a feared complication, mostly caused by anterior ischaemic optic neuropathy. High-resolution magnetic resonance imaging (MRI) has started to play a role in the diagnosis of giant cell arteritis. Evidence of arteritis involving the superfi cial temporal arteries with mural thickening and even the ophthalmic arteries can be seen on MRI, which further increase the diagnostic confi dence prior to biopsy.2,3 Optic perineuritis is a rare association with giant cell arteritis. MRI is required for diagnosis especially for differentiation from optic neuritis.4 We report a case of giant cell arteritis with optic perineuritis to demonstrate the role of MRI in the diagnosis.

Food is closely related with emotion. It often provides comfort and satisfaction. Some individuals choose to turn to food to curb their negative emotion, resulting in disturbances in eating patterns, such as overeating which lead to obesity and severely controlling food intake, which culminate in eating disorders like anorexia nervosa, bulimia nervosa and binge eating. These disorders are not related to the eating problems per se but often due to underlying or complicated by psychological factors, namely depression, anxiety, impulse control problems and personality. The roles of psychological factors in eating disorders and obesity should therefore not be downplayed. These disorders should be managed comprehensively involving multiple approaches, including not only biological but also psychological interventions provided by a professional team comprising endocrinologists, psychiatrists, dietitians, exercise physicians and surgeons.

We aimed to report the first case of anorexia nervosa in a young Malaysian Malay homosexual man with underlying borderline personality disorder and major depression. Patient and parents were interviewed. The Structured Clinical Interview for DSM IV was used to generate Axis-I diagnosis. The Hamilton Depressive Rating Scale was used to assess the severity of depression. His parents had marital discord. His father was overinvolved. Regarding anorexia nervosa, he had 163 cm height, 46kg weight and a body mass index (BMI) of 17 kg/m2 . His four limbs had multiple scratch marks. Laboratory test results showed anemia, leukocytosis and hypoalbuminemia. Family pathology, borderline personality disorder and homosexuality could be the risk factors of anorexia nervosa in this patient.

We aimed to report the first case of anorexia nervosa in a young Malaysian Malay homosexual man with underlying borderline personality disorder and major depression. Patient and parents were interviewed. The Structured Clinical Interview for DSM IV was used to generate Axis-I diagnosis. The Hamilton Depressive Rating Scale was used to assess the severity of depression. His parents had marital discord. His father was overinvolved. Regarding anorexia nervosa, he had 163 cm height, 46kg weight and a body mass index (BMI) of 17 kg/m2. His four limbs had multiple scratch marks. Laboratory test results showed anemia, leukocytosis and hypoalbuminemia. Family pathology, borderline personality disorder and homosexuality could be the risk factors of anorexia nervosa in this patient.

Biomechanical Phenomena ; Child ; Exercise ; physiology ; Female ; Humans ; Leg ; Muscle, Skeletal ; injuries ; physiology ; Peripheral Nervous System Diseases ; Sciatic Neuropathy ; diagnosis ; etiology ; Thigh

Background: The modified Stoppa approach was first described in 1993 by Hirvensalo as an alternative to the ilioinguinal approach for treatment of pelvic ring fracture. Methods: This is a retrospective study of 5 patients with unstable pelvic fracture treated with internal fixation using the modified Stoppa approach. Residual displacement of the pelvic ring was measured and graded using the methods described by Matta and Lindahl. Functional outcomes were assessed using the modified Merle D Aubigne and Pos
Orthopaedic

This is a cross sectional study examining quality of life in relation to coping styles among patients with Schizophrenia (N=92) in remission, from June 2002 to December 2002. Remission state is determined by Brief Psychiatric Rating Scale (BPRS). The psychiatric diagnosis was made by treating psychiatrist using the Clinical Interview Schedule for the DSM-IV Diagnosis. They are subsequently asked to complete demographic and clinical data questionnaire and followed by 36-item short-form health survey (SF-36) of the Medical Outcome Study (MOS) for the assessment of quality of life and the Coping Inventory for Stressful Situation (CISS). The QOL in term of overall mental health among patients with schizophrenia was significantly and positively associated with ethnic group (p<0.05), employment status, type of antipsychotic (p<0.05) and number of admission (p<0.05). Being Chinese and employed are associated with better QOL in term of overall mental health. The commonly used coping style among patients with Schizophrenia is the distraction component of avoidance-oriented coping. The task-oriented coping was significantly and positively correlated with quality of life in term of mental component. There was a negative correlation between the emotion-oriented coping and all the domain of the quality of life. In conclusion, better quality of life is positively correlated with taskoriented coping and inversely related with emotion-oriented coping.

The cross-sectional study was conducted among ESRD patients required haemodialysis in Ipoh aimed at determining their level of knowledge, attitude, and practice (KAP) towards drug phosphate binders. A total of 105 patients on phosphate binders’ medication participated in the study. The questionnaires on sociodemographic characteristics and KAP towards phosphate binder medication were used to obtain the data. In this study, most patients were aged 40 to 60 and slightly more women. Patients were generally highly knowledgeable about phosphate binders. Over 90% of respondents were aware of the importance of the medication and the need to follow the regimen. More 70% of the patients have a positive attitude toward medication. In terms of practice, most of patients take the medication daily (90.5%) and always taking it with meals (93.3%). The older patients aged more than 45 years old, married and not working patients had significantly better compliance to medication. In conclusion, most patients in this study have a good knowledge of phosphate binder medications, a high positive attitude and good adherence to a medication. There is still a need for a structured health education method and counselling session to improve the knowledge of patients, change an attitude of a specific group of patients and increase the treatment compliance focusing on a specific ethnic group, young, unmarried, and employed patients.
Dialysis

Background: Acute urinary retention (AUR) is one of the most serious complications of benign prostatic hypertrophy. This study was done to predict the outcome of trial of voiding without catheter (TWOC) in patients with AUR with intravesical prostatic protrusion (IPP) detected on transabdominal ultrasound. Other factors such as prostatic volume and patient’s age were also assessed. Method: Patients with a first episode of AUR secondary to benign prostatic hypertrophy were assessed with ultrasound following bladder catheterization. The IPP was measured and graded (grade 1 is 5 mm or less, grade 2 is 5–10 mm and grade 3 is more than 10 mm). Success of TWOC was then correlated with the degree of IPP. Results: A total of 32 patients with AUR were included in the study. Patients with grade 3 IPP were found to have a significant failure rate compared to grade 1 (P = 0.022) and grade 2 (P = 0.041). Conclusion: Intravesical prostatic protrusion is a useful predictor of success of TWOC in patients with AUR. Patients with grade 3 IPP on ultrasound would benefit from TWOC and warrant earlier definitive surgical treatment.

Cerebral amyloid angiopathy (CAA) accounts for approximately 10–20% of spontaneous intracerebral haemorrhage (ICH). This figure is thought to be higher in the elderly population. With the increasing life expectancy of our population, we anticipate that the prevalence of CAA- related ICH will increase in tandem. Although CAA-related ICH and hypertension-related ICH are distinct entities based on histopathology and imaging, the clinical presentation of the two conditions is similar. The use of brain computed tomography (CT) scans remain the ICH imaging modality of choice in Malaysia due to its availability, cost, and sensitivity in detecting acute bleeds. On the other hand, the use of brain magnetic resonance imaging (MRI) with susceptibility-weighted imaging (SWI) sequencing enables the clinician to determine the presence of chronic blood products in the brain, especially clinically silent microbleeds associated with CAA. However, the use of brain MRI scans in our country is limited and leads to a blurring of lines when differentiating between hypertension-related ICH and CAA-related ICH. How this misrepresentation affects the management of these conditions is unclear. In this study, we present two cases of ICH to illustrate this point and to serve as a springboard to question current practice and promote discussion.