Adequate pain relief is a requisite for a successful closed manipulative reduction (CMR) of fractures and dislocations. This prospective study was undertaken to assess the mode and adequacy of pain relief given to patients undergoing such procedures at Seremban Hospital from the 1st April to the 31st May 2001. All patients with fractures and dislocations scheduled to undergo CMR were included in this study. The type of sedative agents and analgesia administered were recorded. Demographic data and the type of fracture or dislocation of the selected patients were documented. A visual analogue scale (VAS) for pain perception was given to both to the patients and the medical personnel who performed the procedure. All data were collected manually before entered into computerized database for analysis. Of 72 patients included in this study, 47% were Malay, 26% Indian, 21% Chinese and 6% others. There was male predominance and the patients' age ranged between 9 to 79 years (average 27.4 years). Upper limb injuries (79%) were mainly fractures of the radius and ulna (29%) and isolated fracture radius (21%). For the lower limb injuries (21%), combined tibia and fibula fractures constituted 10% of the total cases followed by isolated tibia fractures (10%) and hip dislocation (1%). The most common pain relieving agents given during the CMR were intravenous pethidine alone (43%) followed by combination of intravenous pethidine and valium (36%), intramuscular pethidine (17%) and intramuscular tramal (4%). The Visual Analogue Score (VAS) for pain perception revealed that 61% of the patients had moderate pain while 21% had severe pain during the course of the procedures. Suboptimal pain relief administered during CMR should prompt positive actions to ensure that the patient is not subjected to undue pain just for the sake of an acceptable fracture reduction.
Pain ; Reduction (chemical) ; Meperidine ; pain perception ; Intravenous

We report a case of 74-year-old lady, presented with recurrent jargon aphasia as simple partial status epilepticus (SPSE) which lasted for a few days to a few weeks, following a brain abscess removal from the left temporo-parieto-occipital region at the age of 71 years. The ictal activity on electroencephalogram was documented at left posterior quadrant, where marked hyperperfusion was clearly visualized by perfusion image acquired with magnetic resonance imaging (MRI) using pulsed arterial spin-labeling (PASL). Jargon aphasia as a primary feature of simple partial status epilepticus is so uncommon that only few cases have been reported. Furthermore, this report suggests that MRI using PASL is a promising method not only to localize the seizure foci but also to follow up the corresponding regional cerebral blood flow changes noninvasively.

Myasthenia gravis (MG) is an immune mediated neuromuscular disease causing fatiguability, which can influence quality of life (QOL). MG disease status can be established with Myasthenia Gravis Quality of Life (MGQOL) 15 and Myasthenia Gravis Activities of Daily Living (MGADL) questionnaires to measure patients’ perception of MG-related dysfunction. This study aims to validate the translated Malay versions of the MGQOL15 and MGADL for use in Malay-speaking MG patients. By using the cross cultural adaptation process, both questionnaires were translated into Malay language. Two sets of MGQOL15 Malay version and MGADL Malay version were distributed to MG patients during their routine follow-up to be filled up one week apart. A total of 38 patients were recruited during this study comprising predominantly females compared to males (71% vs 29%) and Malays compared to non-Malays (60% vs 40%). The mean age was 52.5 years; with most of the patients in the 60-69 years old category (37%).The Spearman’s correlation coefficient was 0.987 for MGQOL-15 Malay version and 0.976 for MGADL Malay version, while the internal consistency for MGQOL15 Malay version was 0.952-0.957, and 0.677-0.694 for MGADL Malay version. The MGQOL15 Malay version and MGADL Malay version are reliable and valid instruments for the measurement of quality of life in MG patients in the local setting.
Myasthenia Gravis ; Quality of Life

Introduction: The world has been badly affected by the spread of a novel virus known as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) that was first reported in Wuhan, China back in December 2019. As the virus is transmitted through aerosol, respiratory droplets and close contact, hand hygiene and wearing mask are the most important preventive measures for COVID-19. Studies showed hand hygiene intervention improved compliances. This paper discussed the development of a hand hygiene intervention module, validation, usability and effectiveness reports. Methods: This study involved 5 stages; need analysis, module development, validation, usability and effectiveness studies. Need analysis and module development were carried out through brainstorming and literature search. The content was evaluated by three experts, whereas the usability was screened by four preschool teachers. The effectiveness of knowledge transfer was evaluated via pre and post intervention surveys. Results: The hand hygiene educational module received valuable comments from the content expert and the end-users (teachers). Knowledge score related to COVID-19 transmission, prevention and hand hygiene moments among pre-school children were significantly increased after the intervention. Conclusion: This module can be used to improve teaching method related to COVID-19 and hand hygiene. The ‘learn and play’ approach may increase excitement, thus make learning process enjoyable and memorable.

Introduction: Maintaining high levels of vaccinations is important for public health success in any vaccination planning. Success requires a better understanding of the public’s perceptions of diseases and consequent decisions about vaccinations. This study aims to gather exploratory qualitative data on public opinion on the Malaysian Government’s COVID-19 immunization campaigns. Methods: Open-ended question on Google Form was advertised online between 2 to 17 December 2020. The questionnaire form was deactivated when saturation has been reached. The free text questions were analysed by qualitative thematic analysis by all authors on a Microsoft Excel spreadsheet. Results: Six hundred and sixty-one participants replied to the online questionnaire. Four themes emerged from the thematic analysis on suggestions for future National COVID-19 Immunisation Program. First, COVID-19 vaccine administration policy; secondly, knowledge dissemination and plan to address obstacles of public acceptances towards the vaccine proactively; thirdly, better implementation programs by the government and fourthly, using local research expertise for vaccine development and alternative medicines. Participants believe all this are essential in increasing their trust and uptake for the government’s future national COVID-19 Immunisation Program. Conclusion: This study highlights the suggestions made by the public for the Malaysian Government. These findings will help develop education and intervention strategies for new vaccine introduction to combat the COVID-19 pandemic in Malaysia.

Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) is one of the fatal conditions that most commonly causes pregnancy-associated myocardial infarction. We herein report a case of P-SCAD in a 26-year-old multigravida woman, who complained of angina postpartum with raised cardiac biomarkers and transient ST-segment elevation on electrocardiograms. We emphasize the importance of a high degree of suspicion in the diagnosis of P-SCAD, together with the common presentation, the management approach, and its psychological impacts on the patients.