Neuroendocrine neoplasm is an epithelial neoplasm with predominant neuroendocrine differentiation that can arise from many organs in the body. We reported a rare case of gastric neuroendocrine carcinoma which accounts for less than 1% of all gastric tumours that is associated with poor prognosis. The recognition of this rare tumour in early stage is challenging and high suspicious into it might bring to early detection and so forth might improve the prognostication.

The increasing prevalence of penicillin-resistant Streptococuus pneumoniae urges for fast and accurate susceptibility testing methods. This study evaluated the comparability of three commonly used techniques; disk diffusion, E-test and agar dilution, to detect penicillin susceptibility in clinical isolates of S. pneumoniae. Fifty pneumococcal isolates, obtained from patients at the University of Malaya Medical Centre, were selected to include both penicillin-susceptible strains and those that had decreased susceptibility (resistant and intermediate) to penicillin. The minimum inhibitory concentration (MIC) values of penicillin to serve as the reference was determined by the agar dilution method in which, based on the MIC breakpoints recommended by the National Committee for Clinical Laboratory Standards (NCCLS), 27 strains had decreased susceptibility to penicillin with 17 strains resistant and 10 intermediate. Comparing to the agar dilution method, oxacillin disk diffusion test detected all strains with decreased penicillin susceptibility as such while E-test showed a close agreement of susceptibility (92%) of the isolates to penicillin. This confirmed that oxacillin is a good screening test for S. pneumoniae isolates with decreased susceptibility to penicillin while E-test is very reliable for rapid and accurate detection of penicillin susceptibility.
Penicillin ; Streptococcus pneumoniae ; Dilution ; Upper case ee ; Clinical

Anthropometric Test Devices (ATDs) of different nominal percentile values have long been used as human surrogates in automotive crash testing. The Hybrid III family, which is one of the widely used ATDs in frontal crash test, was designed based on the anthropometry dimensions of US adults. Thus, this paper aims to assess the anthropometric differences between Malaysian adults and Hybrid III dummies in terms of 5th percentile (small female), 50th percentile (midsize male) and 95th percentile (large male). A series of anthropometric parameters of Malaysian adults was obtained from a database of 1321 subjects with 708 males and 613 females. The results revealed that the current midsize male population differs from the ATD’s statures and body weights by about 35 and 40 percentile points, respectively. This demonstrates that the current ATDs are not truly representative of the current Malaysian adults, which may potentially lead to different injury responses in road traffic crashes. Thus, car manufacturers may as well consider this discrepancy issue in developing their future models especially with regards to safety.

The study objective was to determine the diagnostic value of physical examinations for positive computer tomography (CT) scans in children with mild head injuries. Retrospective data of patients evaluated for mild head injuries with loss of consciousness (LOC) or amnesia were reviewed. Estimations of prevalence, sensitivity, specificity, and predictive values were calculated. Agreement between the physical examinations and CT brain scans was calculated using the Kappa test. 225 patients were included in the study. Of this group, 19.56% of patients had positive CT scans, and 7.56% had normal physical examinations. 15 underwent neurosurgical intervention. For positive CT scans, sensitivity and specificity were 61.36% and 60.22%, respectively. Agreement between physical examinations and CT scans was Kappa = 0.147 (P < 0.05), 95% CI (0.035, 0.259). The present study demonstrated that physical examinations were significantly associated with positive CT scans (P = 0.01). However, the calculated Kappa value showed only slight agreement between these 2 variables, and the low sensitivity and specificity of the physical examinations suggest that intracranial pathology in children with mild head injuries and LOC or amnesia cannot be excluded based on physical examinations alone.

Background: External ventricular drainage (EVD) has been widely used for the purpose of cerebrospinal fluid (CSF) diversion at Hospital Kuala Lumpur (HKL). Method: This prospective observational study was conducted in HKL from December 2006 to December 2008 among patients who were subjected for EVD, following strict inclusion and exclusion criteria. Results: The frequency of EVD-related infection was as high as 32.2% (95% CI 23.3% to 42.57%) among 87 patients studied. This study clearly demonstrates that tunnelling the catheter for more than 5 cm under the scalp, from the burr hole to the exit site of the skin, carried a significantly lower risk of infection compared with tunnelling the catheter for 5 cm or less (OR = 0.184, 95% CI 0.083 to 0.406, P < 0.001). The majority of cases (19 out of 28) with EVD-related infection occurred among patients catheterised for more than 10 days (OR = 0.334, 95% CI 0.171 to 0.652, P < 0.001). Conclusion: The technique of subgaleal tunnelling of more than 5cm and the duration of the ventricular catheterisation of 10 days and less should be implemented as standardised protocol at health institutions to reduce the risk of EVD-related infections.

The injection of a local anesthetic in combination with a corticosteroid is an accepted choice in the treatment of plantar fasciitis with recalcitrant heel pain. When the injection is performed properly, post-injection infection is extremely rare. We are reporting a rare case of chronic calcaneal osteomyelitis that developed secondary to a local corticosteroid injection. A 56-year-old lady diagnosed with right plantar fasciitis presented with a 6-month history of pain and a persistent sinus with serous discharge of her right heel following a local infiltration of a corticosteroid. A Magnetic Resonance Imaging demonstrated right calcaneal osteomyelitis with intramuscular abscess. Surgical drainage and debridement were done, followed by antibiotic therapy. A recurrence of infection was not detected throughout the duration of follow-up. It is suggested that a plantar heel injection be done in a more controlled environment, such as in operating theatre, to reduce the risk of infection and to avoid injecting a steroid as compared to platelet-rich plasma (PRP) in view of their safety profiles. However, such an injection should only be offered after conservative treatment has failed, as 80% of patients recover well after initial conservative management.

Transmigration of a foreign body across the neck following accidental ingestion is a rare complication. We report a case of a 52-year-old female who presented with a right-sided sharp neck lump a few days following ingestion of fish bone. An anterior posterior view of neck radiography revealed a horizontal radio-opaque object consistent with a migrated fish bone. She underwent an emergency neck exploration and foreign body removal which was later identified as the fish bone. Awareness of all possible complications due to foreign body migration is essential to avoid misdiagnosis.

Involvement of informal carer in post-stroke care is important to prevent development of secondary complications particularly among stroke survivors with severe disability. However, to date, evidence on the benefit of stroke care training and involving carer to assist in the care for this group of stroke survivors is still limited. In this study, we evaluated the outcome of a carer-assisted care program for stroke survivors with severe disability who live at home. Sixteen stroke survivors with severe disability and 16 primary carers participated in this pre-test post-test intervention study. Carers were trained using a stroke care module which was developed by a group of multidisciplinary researchers from Universiti Kebangsaan Malaysia, prior to implementing the daily care for 8 weeks. Outcome of care on stroke survivors was assessed in term of change in disability level and quality of life using Modified Barthel Index (MBI) and EuroQol health-state measure (EQ-5D and EQ-VAS), respectively. While outcome of stroke care training on carer was determined using Modified Caregiver Strain Index (MCSI). Significant improvement is shown in the stroke survivors’ EQ-VAS component of EuroQol health state measure (average increase by 12%, t = 2.86, p = 0.01) following the care. Although not statistically significant (t = 0.97; p = 0.35), the mean score of MCSI reduced by 14%. No significant change was found in the MBI of the stroke survivors at completion of the program. Carer-assisted care is useful in improving quality of life of stroke survivors and can potentially reduce stress level among carers. Larger study may assist in establishing these preliminary findings.

Histological observation has always been important in the study of sentinels. In this research, histological differences in the liver and kidney of two wild populations of Fejervarya limnocharis exposed to different environmental cadmium levels were observed. Liver and kidney samples from 30 rice frogs caught from reference site (Mae Pa) and contaminated site (Mae Tao) were sectioned and stained with Haemotoxylin and Eosin and then observed under light microscope. It was found that liver sections from frogs caught from Mae Tao had higher hepatic macro-melanophage count (MMC) (0.949 ± 0.267 cells/1000 µm2) as compared to those from Mae Pa (0.672 ± 0.299 cells/1000 µm2 ). Other observable histological features found in frog’s liver from Mae Tao include possible necrotic areas, cellular swellings and chromatin margination. The kidney sections from frogs caught from Mae Tao showed the presence of tumor-like cell aggregation and hemorrhage. However, the proportion of tumor-like cell aggregation and hemorrhage were not significantly different than were expected from random occurrences. The result of the histological study revealed that F. limnocharis caught from Mae Tao had higher hepatic MMC and higher prevalence of renal tumor-like aggregation and renal hemorrhage than the rice frogs caught from Mae Pa. Cellular swelling, possible necrotic area and possible apoptotic cell could also be observed in the liver of contaminated frogs.

Cognitive Behavioral Therapy (CBT) is a critical rehabilitation component for teens who involved in sexual offences. CBT restructures their reasoning capacity to control their anti-social behaviour. An in-depth qualitative study was conducted in one of the state's institutions for girls to investigate the practice of CBT. Ten pregnant out of wedlock teens who were participate in the therapeutic rehabilitation programme were interviewed thoroughly about the practice of CBT. The study found that the practice of CBT in the programme focused only on the religious activities, tend to focus on the vocational programme, the absence of knowledge enhancement programme, no therapy expert to conduct the CBT procedure, and the absence of any set of protocol treatment for therapy. The findings then encourages the study to recommend few interventions that can enhance the implementation of the CBT practice for teens who involved with sex offence.