A 7-year-old boy presented with both of his thumbs flexed (Figure 1), the inability to perform the ‘thumbs-up’ gesture, and difficulties in opposing thumbs and fingers in activities such as holding a pencil during writing, pincer movements, and picking up small objects. His mother only observed the deformity for one month after the boy complained of difficulty in writing during class. He had no prior history of trauma to the thumbs or pain and swelling in other joints. There were no other birth anomalies noticed by his parents. Upon examination, the boy had flexion deformities of the interphalangeal joint (IPJ) on both of the thumbs. Passive range of motion of the IPJ was not possible and both were fixed at 60° of flexion. Power of both thumbs could not be assessed as there was no motion of the joint. The range of motion of the metacarpophalengeal joints (MCPJ) of both thumbs and all other finger joints was normal. A 0.5cm x 0.5cm subcutaneous nodule was palpable at the volar crease of the MCPJ bilaterally. The nodule was tender on palpation; however, no overlying skin changes were evident.

A pure ovarian choriocarcinoma is a very rare disease which can be either pregnancy related (gestational), may not be related (non-gestational), or commonly correlated with different type of germ cell; teratocarcinoma, dysgerminoma or undifferentiated carcinoma. A pure non-gestational primary ovarian choriocarcinoma is astronomically uncommon and we recorded such condition in 14-year-old teenage girl’s ovary. An abdominal operative procedure with the help of a careful histopathology examination revealed choriocarcinoma in absence of other type of germ cell element. Multiple courses of Etoposide/Methotrexate/Actinomycin-D (EMA) regime of chemotherapy were shown to be effective in this case.
Choriocarcinoma

Stroke is a causal factor that commonly caused physical impairments and activity limitations among patients to perform daily activities until at certain level stroke patients will experience disability. The aim of this study is to examine the relationship of each demographic and clinical factors that is believed to associate with physical functioning of patients those who experienced stroke. This present study also try to compare physical functioning of patients with associated factors and then examine the correlation between those factors with physical functioning. A total of 147 respondents that pass for cognitive screening test involved in this study. Barthel Index (ADL) was administered to the respondents after 6 weeks of stroke attack in order to measure their physical functioning status. Results found that there was a significant difference [F(3, 143) = 4.06; p < 0.01] between level of educations with physical functioning of patients. With respect to clinical factors also showed a significant difference (p < 0.01) was higher in physical functioning when stroke attack occurred at right hemisphere of brain. There was a significant difference (p < 0.01) in physical functioning with respect to belief of recovery. Furthermore, number of stroke attack also showed a significant difference [F(1, 145) = 11.19; [p < 0.01] in physical functioning of patients. Correlation test that was carried out found a positive significant correlation (r = 0.24; p < 0.01) between physical functioning with respect to the affected lesion side. In conclusion, demographic and clinical factors also played the roles to determine level of physical functioning among stroke patients and thus these factors should be considered in any studies that intended to enhance physical functioning of patients in future.
Stroke

Background: The aim of this study was to address the ability of the recovery locus of control scale (RLOC) and post-traumatic stress symptoms (PTSS) to predict physical functioning among stroke patients. In addition, the best predictors within the subdomains of the RLOC and PTSS were also investigated. Methods: A total of 147 stroke patients aged 33–85 years who had intact cognitive functioning were involved in the study. The Recovery Locus of Control Scale (RLOC), the Impact of Event Scale- Revised (IES-R), and the Barthel Index (ADL) were administered to respondents six weeks after stroke. Results: The results showed that the RLOC and PTSS were significant predictors and were capable of predicting 31% of the physical functioning of stroke patients (adjusted R2 = 0.31; P < 0.001). Furthermore, with respect to clinical factors, the affected lesion side contributed to predicting 7% of the physical functioning (R2 = 0.07; P < 0.001). A hierarchical regression analysis found that the internal recovery locus of control (IRLOC) was a predictor capable of explaining 18% of the predicted physical functioning (adjusted R2 = 0.18; P < 0.001). Meanwhile, avoidance was the most influential significant predictor among PTSS, contributing to 24% of the predicting physical functioning (adjusted R2 = 0.24; P < 0.001). Conclusion: In conclusion, the RLOC and PTSS were capable of predicting physical functioning among stroke patients.

Objective: Several cases of suicide attempt by charcoal burning producing CO have been reported in Malaysia. This case report highlights a case of delayed delayed neuropsychiatry sequelae (DNS) in CO poisoning. Method: We report a young Chinese homemaker who presented with DNS who was detained in a Malaysian forensic psychiatric ward. Results: After approximately two weeks of admission, in a familicide attempt, she had started to exhibit subtle changes in her behaviour, including social withdrawal, impaired memory, and there was lack of emotional distress. Conclusion: We report an interesting DNS as one of the two forms of chronic sequelae of CO poisoning, whereas the other type of neuropsychiatric sequelae is the persistently progressive type.

Throughout history, a proportion of men appear to correlate penis size and dimensions directly with physical fitness and sexual prowess. Foreign materials, such as paraffin oil, paraffin balm, mineral oils, and silicone, have been used to promise an improvement in penile shaft contour and dimensions. These materials are injected directly into the penis; inducing granuloma formation to achieve increased penis length and girth. However, the result is a severely disfigured and swollen penis, which cannot achieve erection. Local complications of penile lipogranuloma include infection, ulceration, local migration, and cavernosal invasion; leading to functional impairment. Meanwhile, systemic complications include foreign body embolization, organ infarct, and death. Penile lipogranuloma is best treated surgically. Granulomatous skin needs to be completely excised; wound closure with a scrotal skin flap, Cecil’s inlay operation and split thickness skin graft commonly used options. Our case series has shown that penile lipogranuloma, induced by subcutaneous foreign body injections into the penile shaft, and its subsequent adverse outcomes to patients and their partners.

Paratesticular liposarcoma is a rare entity. Compared to other genitourinary sarcoma, it is usually detected earlier and is easily resectable, resulting in an excellent prognosis. The recurrence of well-differentiated paratesticular liposarcoma after complete resection is extremely rare. Optimal management of the tumour recurrence includes complete re-excision and radiotherapy to the area of recurrence. Here, we describe a 48-year-old man with a recurrent left paratesticular well-differentiated liposarcoma, six years after its complete excision. Our discussion focused on the therapeutic strategy to prevent tumour recurrence. It is hoped that this case discussion can increase the awareness of this condition and assist in its management.
Liposarcoma ; Adult ; Sarcoma

The EXIT (Ex utero intrapartum treatment) procedures have been, with a high degree of success, employed to treat a myriad types of fetal airway obstruction most commonly neck masses such as cystic hygroma and lymphangioma with ample plan including prenatal diagnosis by ultrasound scan or MRI. Before the advent of EXIT, formal documentations had been published with descriptions of intubation during intrapartum period and fetal airway protection either during normal or operative delivery. We report a 28-year-old gravida 2 para 1 who was referred to our Maternal Fetal Medicine (MFM) unit at 26 weeks and 3 days gestation with a foetal neck mass. We present a case of an successful EXIT procedure performed in the Lloyd Davies position with the hips abducted and flexed at 15 degrees as is employed during gynecologic laparoscopy surgery minus the Trendelenburg tilt. Both mother and baby are well. The benefits of this position are discussed.

Introduction: Dengue virus is one of the emerging agents that can be transmitted via blood transfusion from infected blood donors to recipients. In Malaysia, the increase in dengue infection may contribute to the existence of asymptomatic blood donors and increase the risk of blood supply contaminated with this virus. The aims of this study were to investigate the prevalence of NS1 dengue antigen among blood donors and to ascertain the demographic data of blood donors in Penang and and Perak. Methods: A total of 374 voluntary blood donors were recruited from two blood donation campaigns organised by Hospital Pulau Pinang, Penang and Hospital Raja Permaisuri Bainun, Ipoh, Perak from April to May 2016. From each centre, 187 voluntary blood donors were enrolled, blood was collected and Dengue NS1 Ag was screened on all the samples using Platelia dengue antigen test kit from Bio-Rad Laboratories, France. Results: All 374 samples were found to be negative for the Dengue NS1 antigen. Demographic data of these blood donors showed that the most common blood group was O Rh positive, men donated more than women and Chinese blood donors were the biggest group of donors. Conclusion: Even though dengue is endemic in Malaysia, none of the blood donors was screened positive for dengue NS1 antigen in the areas studied. This indicates that none of the blood donor at the time of donation was in viraemia stage. The established donor screening program ensures that the dengue transmission through transfusion is minimal in the areas studied
Dengue Antigen

Healthcare workers typically work in shift to ensure smooth operation of healthcare industries around the clock. However, working in shift put them at risk of developing occupational fatigue and sleepiness during and after work, with multiple adverse effects to themselves and patients under their care. This review aims to identify available evidence-based intervention for fatigue and sleepiness among healthcare workers working in shift. We searched PubMed, Scopus and CENTRAL database from January 2013 to December 2017. Selection criteria included randomised controlled trials (RCTs) that investigated the effect of any interventions on fatigue and/or sleepiness among shift workers. Two authors independently screened titles and abstracts for relevant studies, extracted data, and assessed risk of bias. We included 8 relevant trials with 7 review-relevant participants. Given the methodological diversity of the included studies in terms of interventions and assessment tools, it is not possible to determine the effectiveness of these interventions to reduce occupational fatigue or sleepiness among healthcare workers working in shift. More good quality RCTs with comparable assessment tools is needed.