Attention Deficit Disorder with Hyperactivity ; diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans

Riley Day Syndrome, also known as familial dysautonomia, is a rare reported entity characterised by disturbance of pain and temperature perceptions, inability to produce tears, labile blood pressure and poor growth due to disorder of the autonomic and sensory nervous system. It is an autosomal recessive condition with the genetic locus mapped to chromosome 9q31-q33. Traumatic fractures are common and due to lack of pain, may go unrecognised for prolonged periods of time, resulting in nonunion or pseudoarthrosis. Scoliosis is seen in up to 90% of the patients. Complications of are common in these patients and range from infection to wound breakdown to failure of fixation. We report a case (nineyear-old girl) of Riley Day Syndrome with general absence of pain and damage to the extremities to highlight this rare syndrome
Pseudoarthrosis ; Dysautonomia, Familial

Diabetes is a leading cause of morbidity and mortality in the world. There is currently an active search for antidiabetic drugs with greater effectiveness with fewer and less adverse side effects. Although numerous individual herbs have been experimentally or clinically reported to possess antidiabetic effects, considerably less research has been conducted on polyherbal compounds. It is believed that herbal compounds containing multiple plant products have synergistic antidiabetic effects and could enhance the desired actions. Several polyherbal formulations have been studied as therapeutic agents in diabetes management. To describe the current state of research on polyherbal compounds in the treatment of diabetes, an extensive review of literature was undertaken on several major databases. This paper presents what is known about the efficacy of these polyherbal formulations and compare their antidiabetic effects with those of current oral hypoglycemic drugs as reference. The percent decrease in blood glucose, lipids and other biochemical parameters achieved by each product in diabetic animals and patients is reported. Also, the possible mechanisms responsible for hypoglycemic action of polyherbal formulations are discussed.

Attention Deficit Disorder with Hyperactivity ; complications ; Case-Control Studies ; Child ; Data Interpretation, Statistical ; Female ; Humans ; Male ; Sleep Disorders, Intrinsic ; complications

Introduction: Factory and Machinery Act (Noise Exposure) Regulation 1989 (FMA [Noise] 1989) has been implemented in Malaysia for nearly 30 years, but noise-induced hearing loss (NIHL) cases is still rising. Fault tree analysis is a top-down approach to analyzing incidences of 'failures', starting with establishing the single top event that will eventually cause NIHL, followed by identification of the contributing factors to the top event which are the immediate or basic events. Through its visual, structural and deductive approach; FTA is able to depict the temporal sequence of events and their interactions in a formal and logical hierarchy. Materials and Methods: Employees with permanent standard threshold shifts (PSTS) underwent further assessment confirming the presence of NIHL. A single common fault tree was constructed based on six cases of PSTS. The top event is the PSTS. Intermediate and basic events were identified and mapped with relevance to the provisions in the FMA (noise) 1989 indicating how failed control measures have resulted in the PSTS cases. Results: The constructed fault tree with its branches illustrated how breach or noncompliance of FMA (Noise) 1989 resulted in the eventual top event (NIHL). Conclusion: FTA provides a standardized perspective of errors within the system in preventing NIHL.

Vallecular cyst, a benign yet rare laryngeal lesion, may cause stridor and even life-threatening upper airway obstruction in infants. It can cause apnoea and poor feeding habits, thus reducing the chance of survival. Although laryngomalacia remains the most common cause of stridor in this age group, awareness and a high level of suspicion for this condition can help lead to early management and intervention. Direct laryngoscopy is accepted as the gold standard for diagnostic purposes, and marsupialisation of the cyst is the preferred treatment. We describe 2 cases of vallecular cysts in infants admitted to our hospital where timely diagnoses led to appropriate treatment.

A young gentleman of Indian descent with oculacutaneous albinism (OCA) was found to have severe pulmonary fibrosis at first presentation. Following investigations, he was diagnosed with Hermansky-Pudlak Syndrome (HPS). It is a genetic condition characterised by albinism, bleeding diathesis and multisystem disorder observed in individuals of particular descents. Although there is no curative treatment apart from lung transplantation, preventive measures to minimise pulmonary insult may change the natural history of the disease. Therefore HPS should be actively sought, monitored and risk factors addressed in individuals with OCA and bleeding diathesis particularly those of Indian descent as they may develop serious complications such as pulmonary fibrosis in the future.

Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Femoral Artery ; surgery ; Humans ; Limb Salvage ; Peripheral Vascular Diseases ; surgery ; Stents