Introduction Onychomyosis is a common infection of the nails, caused by dermatophytes, nondermatophyte moulds or yeasts. There are four main types of onychomycosis which include lateral and distal onychomycosis, proximal onychomycosis, superficial white and total dystrophic onychomycosis. We performed a retrospective analysis looking into the recent trends of onychomycosis in a University Hospital in Malaysia. Materials and methods Data was collected from all patients who had their nail clippings cultured for fungal infection from January 2004 to December 2008, and were analysed. Results There were 272 nail specimens in total. The majority of specimens were from adults (65.8%), followed by the elderly (23.9%) and children and adolescents made up 10.3%. The mean age of the study population was 49.9 ± 19SD years. Of the 189 specimens with positive fungal culture, 110 (40.4%) were non-dermatophyte moulds, followed by yeasts predominantly Candida species (17.6%), 3 (1.1%) were dermatophytes, and 28 (10.3%) were a mixed infection of dermatophytes, non-dermatophyte moulds and yeasts. Conclusion From this study, it was found that onychomycosis in our hospital from 2004 to 2008 were mainly caused by non-dermatophyte moulds. Treatment may be challenging as nondermatophyte onychomycosis are more resistant to treatment.

Ectoderrmal dysplasias are a heterogenous group of disorders, in which more than 150 different syndromes have been identified. It is defined by primary defects in the development of two or more tissues derived from embryonic ectoderm, characterized by abnormalities in the skin, sweat glands, hair, teeth and nails. Other parts, including the lens of the eye, parts of the inner ear, or nerves, may also fail to develop normally.

Introduction Skin cancer is ranked the ninth commonest cancer among males and tenth among females in Malaysia. Objectives To review the pattern of skin cancers at University Malaya Medical Centre (UMMC). Methods This is a retrospective review of all histo-pathological confirmed skin cancers at UMMC from 2004 till 2010. Results Among the 155 patients reviewed, basal cell carcinoma (BCC) was the commonest skin cancer (44.5%), followed by squamous cell carcinoma (SCC) (27.1%) and malignant melanoma (MM) (11.6%). The nodulo-ulcerative subtype made up 46% of all BCC while 50% of MM was of acral lentiginous subtype. Patients with BCC were significantly older (>60 years old), (p=0.003). A majority of skin cancers were found on the head and neck. Conclusion BCC was the commonest skin cancer, with significantly older patients and located mainly on head and neck. MM was the least common skin cancer but associated with the highest mortality.

Background: Skin cancer is ranked the ninth commonest cancer among male and tenth among female in Malaysia. Objective: To determine the pattern of skin cancers and demography of skin cancer sufferers in University Malaya Medical Centre (UMMC). Methods: This is a retrospective review of all histo-pathologically confirmed skin cancers in UMMC from 2004 to 2010. Patients with incomplete or missing data were excluded. Results: A total of 155 patient records were reviewed. The commonest skin cancer was basal cell carcinoma (BCC) (44.5%), followed by squamous cell carcinoma (SCC) (27.1%) and malignant melanoma (MM) (11.6%). The other skin cancers included dermatofibrosarcoma protuberans and cutaneous lymphoma (5.2% each), extramammary Paget’s disease 3.2% and Kaposi sarcoma 2.6%. A majority (78%) of BCC was of nodulo-ulcerative subtype while 50% of MM was of acral lentiginous melanoma subtype. BCC had a significantly higher number of patients from the older age group (>60 years old) compared to other skin cancers (p=0.003). SCC had significantly more male patients than other skin cancers (p=0.006). With the exception of MM, a majority of skin cancers were found on the head and neck. Conclusions: BCC was the commonest skin cancer followed by SCC and MM. Patients with BCC were older with a female preponderance and mainly located on the head and neck. MM was the least common of the three major skin cancers, but has the highest risk of metastasis and mortality.

Objective To study the bovine coronary artery endothelial cells(BCAEC)damage induced by cigarette abstracts and further clarify the relationship between smoking and cardiovascular diseases.Methods BCAEC were treated with nicotine, mainstream smoke extract(MSW)and sidestream smoke extract(SSW)which had the normal concentration(1.0?10~(-5),0.8?10~(-5), 0.9?10~(-5)mol/L)of nicotine in smoker.The morphological changes of BCAEC were recorded by microscope digital image system. The quantification of apoptotic BCAEC cells was performed by visualization of nuclei stained with 4,6'-diamidino-2-phenylindole and trypan blue exclusion assay was used to examine the percentage of necrotic BCAEC.The caspase activity assay was employed to discuss the mechanism of BCAEC apoptosis.Results BCAEC exposed to nicotine and MSW appeared the typical morphological alteration of apoptosis and necrotic morphological alteration were observed after BCAWC were treated with SSW. 5.89% and 11.94% apoptotic ceils were found after BCAEC were exposed to nicotine and MSW for 24 hours.The level of BCAEC necrosis after treated with SSW was 62.84%.Caspase-3 activity was induced by nicotine and MSW.Conclusion Cigarette smoke extract can induce the cell death of BCAEC.Nicotine and MSW can induce caspase-3 activity increase.Even in the presence of a non-cytotoxic concentration of nicotine and mainstream smoke solution,protease-induced apoptosis of BCAEC can be significantly increased.Sidestream smoke solution may cause BCAEC necrosis instead of apoptosis.Caspase-3 activation is probably the mechanism of BCAEC apoptosis.

Background: Atopic Dermatitis (AD) is a chronic relapsing, pruritic inflammation of the skin which is often colonized by Staphylococcus aureus. Antibiotic resistance of S. aureus is a constant challenge for clinicians who manages atopic dermatitis. Aim: To determine S. aureus antibiotic resistance pattern among patients with non-infected atopic dermatitis and its association with disease severity. Methods: One hundred and seventy eight participants (89 AD patients and 89 controls) were recruited from Universiti Malaya Medical Centre (UMMC). Participants were subjected to a questionnaire on demographics, personal and family medical conditions as well as antibiotic administration. AD severity were determined using Scoring Atopic Dermatitis (SCORAD). Skin swab was taken from eczematous lesion in patients and from left forearm in controls. Antibiotic susceptibility towards methicillin, vancomycin, rifampicin, fusidic acid, erythromycin, gentamicin, clindamycin, sulphamethoxazole, cefuroxime and penicillin were determined using disk diffusion method. Results for antibiotic resistance were categorized as none, sensitive and resistant. Results: Colonization of S. aureus in AD were significantly higher than control (p<0.001). Highest antibiotic resistance was reported for Penicillin (32/39, 82.1%), followed by Fusidic Acid (7/39, 17.9%) as well as Clindamycin and Erythromycin (3/39, 7.7% respectively). Two AD patient (5.1%) were resistant to Gentamicin. In addition, 1 AD patient (2.6%) was resistant towards Methicillin, Sulfamethoxazole and Cefuroxime respectively. No antibiotic resistance was reported for Vancomycin and Rifampicin among the AD patients. Conclusion: High resistance were found for Penicillin and Fusidic acid. Their usage and prescription should be reduced to preserve its sensitivity.

Background: The incidence of diabetes mellitus is ever increasing. Individuals with diabetes mellitus may have concurrent mental health disorders and are shown to have poorer disease outcomes. The objectives of this study were to determine the prevalence of depression, anxiety and stress (DAS) in diabetes patients aged 20 years or more in the primary care setting. Methods: This was a cross-sectional study involving the use of self-administered questionnaire conducted in eight primary care private and government clinics in Pulau Pinang and Melaka, Malaysia. The validated DASS-21 questionnaire was used as a screening tool for the symptoms of DAS. Prior permission was obtained from the patients and, clearance from ethical committee was obtained before the start of the study. Data analysis was done using SPSS statistical software. Results: A total of 320 patients with diabetes from eight centres were enrolled via convenience sampling. Sample size was calculated using the Kish’s formula. The prevalence of DAS among patients with diabetes from our study was 26.6%, 40% and 19.4%, respectively. Depression was found to be significantly associated with marital status and family history of DAS; anxiety was significantly associated with monthly household income, presence of co-morbidities and family history of DAS; and stress was significantly associated with occupation and family history of DAS. Conclusions: The prevalence of DAS was higher in patients with diabetes compared with the general community. We recommend to routinely screen all patients with diabetes using the DASS-21 questionnaire because it is easy to perform and inexpensive.

Fracture-dislocations of the hip is the result of high-energy trauma which necessitates urgent reduction. Closed reduction is usually attempted first and if failed, open reduction is indicated and may require more than one surgical approach. However, there is also the option of managing it with vector traction. This case report details the treatment of a middle-aged gentleman who sustained a left hip central dislocation which was gradually reduced with vector traction prior to surgery and in doing so, diminished the risk of him developing several potentially debilitating complications known to be associated with surgical fixation of such injuries.

INTRODUCTION: Evidence supporting non-invasive ventilation (NIV) in paediatric acute respiratory distress syndrome (PARDS) remains sparse. We aimed to describe characteristics of patients with PARDS supported with NIV and risk factors for NIV failure. MATERIALS AND METHODS: This is a multicentre retrospective study. Only patients supported on NIV with PARDS were included. Data on epidemiology and clinical outcomes were collected. Primary outcome was NIV failure which was defined as escalation to invasive mechanical ventilation within the first 7 days of PARDS. Patients in the NIV success and failure groups were compared. RESULTS: There were 303 patients with PARDS; 53/303 (17.5%) patients were supported with NIV. The median age was 50.7 (interquartile range: 15.7-111.9) months. The Paediatric Logistic Organ Dysfunction score and oxygen saturation/fraction of inspired oxygen (SF) ratio were 2.0 (1.0-10.0) and 155.0 (119.4- 187.3), respectively. Indications for NIV use were increased work of breathing (26/53 [49.1%]) and hypoxia (22/53 [41.5%]). Overall NIV failure rate was 77.4% (41/53). All patients with sepsis who developed PARDS experienced NIV failure. NIV failure was associated with an increased median paediatric intensive care unit stay (15.0 [9.5-26.5] vs 4.5 [3.0-6.8] days; <0.001) and hospital length of stay (26.0 [17.0-39.0] days vs 10.5 [5.5-22.3] days; = 0.004). Overall mortality rate was 32.1% (17/53). CONCLUSION The use of NIV in children with PARDS was associated with high failure rate. As such, future studies should examine the optimal selection criteria for NIV use in these children.