Introduction: The purpose of this study is to identify the incidence of clavicle fractures in newborn associated with fetal, maternal and process of deliveries in Kuantan General Hospital from June 2012 until January 2014. This study is to determine epidemiological data of clavicle fractures, maternal and baby risk factors associated with clavicle fractures of newborn and its’ outcome. Methods: This is a prospective study. 13 patients were identified to fulfill the inclusion criteria of the study. The data of sociodemographic, associated fetal and maternal risk factors and the outcomes were recorded using proforma. The statistical data analysis was done using SPSS 12.0. Results: Out of 20,257 live births at our centre during the study period, 13 infants were diagnosed to have clavicle fractures, giving an incidence of 0.64 per 1000 live births. There were 5 (38.5%) left, 7 (53.8%) right and one (7.7%) bilateral fracture. All fractures located at the mid shaft of the clavicle and none have associated brachial plexus injuries. All infants were delivered through vaginal delivery (61.5%); five through assisted delivery (instrumental); 2 (15.4%) forcep and 3 (23.1%) vacuum. Two of the babies developed shoulder dystocia. The average birth weight was 3371 grams (SD 0.269) and mean gestational age was 38.7 weeks (SD 1.16). Five of the mothers (38.5%) were primigravida and eight (61.5%) were multigravida in which,7 (53.8%)were healthy without other co-morbidty, 5 (38.5%) having gestational diabetis and one (7.7%) hypertension. The average maternal weight was 62.0 kg and height 1.58 metres with average BMI of 24.16 (3.29SD). All eventually had a complete recovery at 6 weeks with clinical and radiological evident of fracture union. Conclusions: In conclusion, all patients with clavicle fractures were found following vaginal delivery. There were no associations between neonatal clavicle fractures with maternal or baby risk factors. All fractures healed without any complications.

This study is aimed to examine the predominant inflammatory cells in nasal polyps (NP) in the local community and its correlation to the clinical presentations. Materials and Methods: The study was done retrospectively looking at patients who had undergone functional endoscopic sinus surgery (FESS) in Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia with a histopathological diagnosis of nasal polyposis (NP), between the years 2004 to 2008. Sixty two patients between the ages of 18 years to 60 years old were selected and data relevant to the study were collected from the patient’s folders using a specially created form prepared for the study. The NP histopathology report from each patient underwent FESS were analysed and the patients were divided into eosinophilic and non eosinophilic dominant group. Clinical presentations from each patient were also gathered and analysed according to the NP group. Results: In HUSM, there were a higher number of eosinophilic types NP as compared to the neutrophilic type NP which is contrary to other study conducted on Asian populations. The clinical symptom correlations between either eosinophilic or non-eosinophilic type of NP have not shown any significant associations. Conclusion: The study showed that the incidence of histological subtypes of nasal polyp in HUSM is almost the same as that found in other parts of the world (Europe and North America) which will reduce the possibility of racial or geographical influence on the pathogenesis of the nasal polyp. Clinical symptoms and presentation alone are not enough to differentiate the type of the nasal polyp without the histological study.

The increasing awareness amongst the society on medico-legal issues as well as the growth of consumerist attitude towards the provision of medical services has caused the medical profession to be subjected to vociferous criticism if they do not meet rising expectations of the society. Substandard services have not been well tolerated and paternalistic approaches in medical treatment are considered to be outmoded and inappropriate. Any dissatisfaction on the part of the patient towards medical services provided nowadays may easily trigger claims in the court of law. This changing trend has also fundamentally changed the behaviour of the courts towards the medical profession. Judicial and legislative interventions in medical practice have created more and more rights for the patients and consequently, corresponding legal duties for the medical profession to uphold. In the present healthcare setting, the medical profession will not be able to provide infallible services without knowledge of the legal standards which they have to adhere. Thus, educating future medical professionals with the fundamentals of law and ethics would ensure greater accountability, knowledge and personal commitment in providing medical services to the society as the ideals of professionalism not only require them to have the necessary expertise, dedication, respect, compassion, empathy, honesty, altruism, responsibility, integrity, self-improvement and accountability but also adherence to the demands of law and highest ethical standards.

The upper airway is a crucial structure. It becomes a grave problem should it be narrowed. Several methods of treatment were rendered for patients with laryngotracheal stenosis. We share our experience with the combination total intravenous anaesthesia and apneic pause technique with or without steroid injection. Four cases of laryngotracheal stenosis were observed in Hospital Ampang: two adult and two paediatric cases. Age, gender, causative factor, stenosis segment length, grade or severity were observed before and after dilatation, number of dilatation were observed and compared. The outcome measures are decannulation and avoidance of tracheostomy. All cases had improvement of symptoms. Half or 50% of the patient required repeated balloon dilatations. The paediatric cases successfully avoided tracheostomy while the adult cases successfully decannulated with no complication from the procedure. Balloon dilatation by total intravenous anaesthesia coupled with apneic method is a safe and effective method of treatment for the narrowed airway.

Thyroglossal duct cyst is the most common upper neck midline lesion in children. Approximately 1% of thyroglossal duct cyst undergoes malignant transformation. Calcification which is a marker of malignancy almost always points out to papillary thyroid carcinoma. Benign case of calcified thyroglossal cyst maybe undiagnosed or under reported. We report a case of a 5 year old girl with a benign calcified thyroglossal duct cyst, a fourth case in world literature. Here the differences between a benign and malignant thyroglossal duct cyst are discussed.

Tonsillectomy is a very common procedure in Otolaryngology practice. Common complications include bleeding, which can be primary or secondary due to infection of the tonsillar bed. Subcutaneous emphysema after a tonsillectomy is very rare. We report a 19-year-old girl who developed cervicofacial subcutaneous emphysema several hours after tonsillectomy with successful conservative treatment outcome.

Thyrotoxicosis results in alteration in functioning of nervous system in some patients. However, these mental disturbances may be severe in rare cases in the form of manic-depressive, schizoid or paranoid reaction. The pathophysiological basis of these nervous system findings is not well understood.

Distant metastasis is a common sequelae of stage III colorectal adenocarcinoma. Liver and lungs are the most common sites for distant metastases, but, metastases to extremities are very rare. We report a case of rectosigmoid adenocarcinoma, which metastasizes to left first metacarpal bone, which is the first occurrence in our experience. The investigations and management of the patient are discussed.

Due to globalizing trend of homogenisation of culture, changes in the health care delivery system and market economics infringing on the practice of medicine, there has been a gradual shift in the attitude of the medical community as well as the lay public towards greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As the subject has gained worldwide prominence, we want to review this topic from Islamic perspective due to its significance in medical ethics and clinical practice.

We report a 26-year old lady who presented with chronic cough and breathlessness associated with subtle TB symptoms for 1 year. Her CT thorax showed multiple cavitating pulmonary nodules with mediastinal and cervical lymphadenopathy. Cervical lymph node biopsy and CT-guided pulmonary biopsy at our centre confirmed the diagnosis of Hodgkin’s lymphoma with pulmonary infiltrations. She was successfully treated with ABVD regime but later developed life-threatening bleomycin-induced pulmonary fibrosis. Sadly, she succumbed to respiratory failure due to severe pneumonia with possibility of bleomycin-induced pulmonary fibrosis. Multiple cavitating pulmonary nodules secondary to lymphoma is rare and in TB endemic area, it may result in delayed diagnosis and treatment.