Vitamin C deficiency in a picky eater child.

Vitamin C deficiency or scurvy is an uncommon condition that occurs in poorly developed countries or in refugee camps. Nonetheless, in countries where food is readily available, like Malaysia, occasionally there are cases of vitamin C deficiency reported. Although it was primarily reported in children with special needs or learning disability, scurvy is encountered in children with normal development, among the severe picky eaters. We present here case of a nine-year-old picky-eating boy with scurvy. The development of scurvy in this child took several years, especially after he became a very selective eater at the age of five. The child had displayed limping when walking with knee-joint pain before he came to a primary hospital. However, his condition was not diagnosed promptly and progressively worsened until he was unable to walk. Thus, it is crucial to recognize scurvy in children who limps and are severe picky eaters.

Computed Tomography (CT) of Blunt Abdominal Trauma: The Frequency of Incidental Findings, how it was Documented in Radiology Report and the Implication of These Findings to Acute Trauma Care.

The wide use of computed tomography (CT) scanning for patients with blunt abdominal trauma can reveal incidental findings that vary in their importance. We evaluated these findings, how it was reported by radiologists and its implication on the trauma care. In 30 out of 154 patients, 32 incidental findings were discovered (19.5%). Out of these 32 findings, only 3 cases (9.4%) were considered significant and required immediate attention from the managing team. In all these 3 cases, the findings were described in the body of the report and highlighted in the conclusion section at the end of the radiology report. However, similar reporting style was used in only 58.4% of cases with moderate clinical concern and 23.5% of cases with little clinical concern. In 41.2% of cases with little concern, the incidental findings were not mentioned in the radiology report. In conclusion, incidental findings in CT scan performed for blunt abdominal trauma were common but many were clinically insignificant. There is little consistency in radiology reporting of these findings especially those with moderate and little clinical concern.

Does long term supplementation of vitamin E cause detrimental effects on the central nervous system? Morphological and histological study in experimental male Wistar rats.

AIM: Aging is attributed to neuronal loss associated with increased oxidative stress. Vitamin E, and in particular, tocotrienol are potent antioxidants, which have been shown to be neuroprotective. The main aim of the present study was to observe the effect of long term intake of vitamin E in the form of tocotrienol rich fraction (TRF) and refined, bleached, deodorized palm olein (RBDPO) on the brain of experimental rats. MATERIALS AND METHODS: Thirty male Wistar rats aged 3 months were either supplemented with TRF (dose of 200 mg/kg body weight), RBDPO (dose of 1 ml/kg body weight) or distilled water, continuously for 8 months. The animals were then examined in vivo for clinical magnetic resonance imaging (MRI) studies before being sacrificed. The brain was extracted, measured and studied for histological changes. RESULTS: The magnetic resonance imaging (MRI) scan of the lateral ventricle, cortical thickness of cingulate gyrus and hippocampus size did not show any significant changes in all three groups. The brain weight, length and width as well as histological sections of the brain showed no significant changes between the groups. CONCLUSION: It is thereby concluded that chronic consumption of vitamin E was not detrimental to the central nervous system.

An atavastic belly of the flexor digitorum profundus with absence of tendon of flexor digitorum superficialis to the little finger: morphological and histological considerations.

In this case report, we report the absence of the fourth tendon of flexor digitorium superficialis (FDS) to the little finger with a concurrent anomalous muscular belly of flexor digitorum profundus (FDP) in the palm. The FDS originated from the medial epicondyle, divided into three tendons for the index, middle and ring fingers with the little finger devoid of any attachment. The FDP exhibited a muscular belly which passed deep to the flexor retinaculum (FR) and continued for another 4 cm thereby dividing into four slips for the index, middle, ring and little fingers. The presence of the muscular belly of the FDP lead us to think whether it was an adhesion between the tendons of the FDP, so we proceeded to histological analysis. The tissue was processed and stained with Hematoxylin and Eosin. Abundant longitudinal muscle fibers with peripherally situated nuclei confirmed it to be a skeletal muscle. Absence of the tendon of FDS to little finger may influence the flexion movement in the middle and proximal interphalangeal joints. Presence of anomalous muscle belly of FDP in the palm may mimic any soft tissue tumour, compress neurovascular structures or even pose difficulty while performing tendon transplant surgeries.

Acardius amorphus: magnetic resonance imaging (MRI) can be helpful in the diagnosis when ultrasound (US) is inconclusive.

An acardiac twin is rare and the diagnosis is commonly achieved from antenatal ultrasound (US) scans. However there have been cases where the appearances of the acardiac twin can be confusing and mimics a mass or tumour, for example, a teratoma. We experienced a case where the findings were unclear from the antenatal ultrasound scans and we had to resort to Magnetic Resonance Imaging (MRI), where we finally made the correct diagnosis based on the identification of two umbilical cords, supplying the normal fetus and the 'mass' (acardiac twin) respectively.

Computed tomography of blunt renal trauma.

Renal injury is observed in 10 percent of cases of abdominal trauma, and the majority (80 percent to 90 percent) of these are attributable to blunt trauma. Intravenous urography and ultrasonography of the abdomen were previously the modalities of choice in the imaging of renal injuries. However, computed tomography (CT) is currently the imaging modality of choice in the evaluation of blunt renal injury, since it provides the exact staging of renal injuries. The purpose of this article is to describe the CT staging of renal injuries observed in blunt abdominal trauma based on the Federle Classification and the American Association for the Surgery of Trauma renal injury severity scale.

Computed tomography (CT) in blunt liver injury: a pictorial essay.

Computed tomography (CT) is widely used in assessing clinically stable patients with blunt abdominal trauma. In these patients, liver is one of the commonest organs being injured and CT can accurately identify and assess the extent of the injury. The CT features of blunt liver trauma include laceration, subcapsular or parenchymal haematomas, active haemorrhage and vascular injuries. Widespread use of CT has notably influenced the management of blunt liver injury from routine surgical to nonsurgical management. We present pictorial illustrations of various liver injuries depicted on CT in patients with blunt trauma.

A rare case of alpha-thalassaemia intermedia in a Malay patient double heterozygous for alpha(+)-thalassaemia and a mutation in alpha1 globin gene CD59 (GGC --> GAC).

A rare case of thalassaemia-intermedia involving a non-deletion alpha thalassemia point mutation in the alpha1-globin gene CD59 (GGC --> GAC) and a deletion alpha+ (-alpha(3.7)) thalassaemia in which use of high performance liquid chromatography (HPLC) C-gram Hb subtype profile and DNA molecular analysis helped establish the diagnosis.

Accessory sulci of the liver. An anatomical study with clinical implications.

OBJECTIVE: To study the presence of accessory sulcus (AS) in the embalmed cadaveric livers, and compare it with the normal liver. METHODS: The present study was conducted on 40 embalmed cadaveric livers in the Department of Anatomy, National University of Malaysia, Kuala Lumpur, Malaysia, from September to October 2007, in order to observe the presence and pattern of anomalous AS. RESULTS: Out of the 40 liver specimens studied, we observed the presence of AS in only 2 specimens 5%. The AS was located in the inferior and posterior surfaces of the right lobes in 2 specimens. CONCLUSION: The AS of the liver is a rare anomaly. Research studies had mainly described the diaphragmatic sulci in the liver, however there are no research reports on the presence of AS in the inferior surface of the right lobe of the liver. The presence of the AS may represent the deep course of the hepatic veins superficially, thus proving to be more beneficial to the hepatobiliary surgeons. The AS may be due to a developmental defect, or may be acquired as a result of pressure by any superficial structure. The precise anatomical knowledge of the AS may also be important for radiologists interpreting CT images of injected veins. The gross anatomical findings of anomalous AS in 2 liver specimens, and its clinical implications are being highlighted in the present study.

Clinical evaluation of watermarked medical images.

Digital watermarking medical images provides security to the images. The purpose of this study was to see whether digitally watermarked images changed clinical diagnoses when assessed by radiologists. We embedded 256 bits watermark to various medical images in the region of non-interest (RONI) and 480K bits in both region of interest (ROI) and RONI. Our results showed that watermarking medical images did not alter clinical diagnoses. In addition, there was no difference in image quality when visually assessed by the medical radiologists. We therefore concluded that digital watermarking medical images were safe in terms of preserving image quality for clinical purposes.

Comparative effects of palm vitamin E and alpha-tocopherol on healing and wound tissue antioxidant enzyme levels in diabetic rats.

The effect of supplementing 200 mg/kg body weight palm vitamin E (PVE) and 200 mg/kg body weight alpha-tocopherol (alpha-Toc) on the healing of wounds in streptozotocin-induced diabetic rats was evaluated. The antioxidant potencies of these two preparations of vitamin E were also evaluated by determining the antioxidant enzyme activities, namely, glutathione peroxidase (GPx) and superoxide dismutase (SOD), and malondialdehyde (MDA) levels in the healing of dermal wounds. Healing was evaluated by measuring wound contractions and protein contents in the healing wounds. Cellular redistribution and collagen deposition were assessed morphologically using cross-sections of paraffin-embedded day-10 wounds stained according to the Van Gieson method. GPx and SOD activities as well as MDA levels were determined in homogenates of day-10 dermal wounds. Results showed that PVE had a greater potency to enhance wound repair and induce the increase in free radical-scavenging enzyme activities than alpha-Toc. Both PVE and alpha-Toc, however, were potent antioxidants and significantly reduced the lipid peroxidation levels in the wounds as measured by the reduction in MDA levels.

Validity and reliability of the SF-36: the Malaysian context.

Results of construct validity and reliability of the SF-36 are described, based on data from a multi-centre study on asthmatics and a population based survey. Questionnaire refinement was carried out between the two studies. Quality of data was good, with all items having less than 0.5% missing values. Floor and/or ceiling effects were observed for REE, REP, PF and SF. For scaling assumptions, correlations between each items and its hypothesized scale were all above 0.50, except for one item in PF. and for both items in SF. Item discriminant validity was an issue for items in VT, SF and MH scales. Cronbach's as for all scales exceeded the recommended 0.70 level, except for SF. Only one latent dimension was identified in principal component analysis, and only 52-53% of variance accounted for. As expected, PF shows high correlations with the physical component while MH was highly correlated with the mental component. Contrasting findings in the loadings of other scales were observed in the asthma data. Age, disease severity and presence of self-reported handicap/disability significantly affect PF, while MH demonstrates no obvious pattern with declining age. In essence, the Malay version of SF-36 could be used in Malaysia, with its generally acceptable internal consistency and validity. The caveat is in the call for additional domains of importance to Malaysians that is not covered by the instrument, and in the caution to be employed when using and construing the instrument.

Quality of life of the Malaysian general population: results from a postal survey using the SF-36.

Population norms for Health Related Quality of Life using SF-36 are described. A national sample was canvassed in 2000 using a self-administered SF-36 in Bahasa Malaysia and English. Response rate was 30.6%, with 3072 usable data. Male: Female ratio was 1.04 and mean age was 39.8 years. Quality of life was affected by age and sex. Older population and women had a poorer quality of life. Population norms for Malaysia differed from those of US, Canada and Australia. The malaysian general population norm described is useful as reference point for studies in Malaysia. Variability in scores by age and sex emphasize the need to use appropriate age- or sex-specific normative data.

Computed tomography of the brain in predicting outcome of traumatic intracranial haemorrhage in Malaysian patients.

UNLABELLED: Head injury is a significant economic, social and medical problem all over the world. Road accidents are the most frequent cause of head injury in Malaysia with highest risk in the young (15 to 24 years old). The associated outcomes include good recovery, possibility of death for the severely injured, which may cause disruption of the lives of their family members. It is important to predict the outcome as it will provide sound information to assist clinicians in Malaysia in providing prognostic information to patients and their families, to assess the effectiveness of different modes of treatment in promoting recovery and to document the significance of head injury as a public health problem. RESULTS: A total of 103 cases with intracranial haemorrhage i.e. intracerebral haemorrhage, extradural haemorrhage, subdural haemorrhage, intraventricular haemorrhage, haemorrhagic contusion and subarachnoid haemorrhage, following motor vehicle accidents was undertaken to study factors contributing to either good or poor outcome according to the Glasgow Outcome Scale. Patients below 12 years of age were excluded. The end point of the study was taken at 24 months post injury. The selected variables were incorporated into models generated by logistic regression techniques of multivariate analysis to see the significant predictors of outcome as well as the correlation between the CT findings with GCS. CONCLUSION: Significant predictors of outcome were GCS on arrival in the accident emergency department, pupillary reflex and the CT scan findings. The CT predictors of outcome include ICH, EDH, IVH, present of SAH, site of ICH, volumes of EDH and SDH as well as midline shift.

The clinical significance of the branching pattern of the facial nerve in Malaysian subjects.

Fine dissection was carried out in 79 facial halves from formalin fixed Malaysian adult cadavers of various races, to trace the extracranial part of the facial nerve and its peripheral branches. The facial nerve trunk, after leaving the stylomastoid foramen was located at a depth of 1 to 2 cm from the skin in the vagino-mastoid angle. It bifurcates at the posterior border of the ramus of the mandible and in 3.8% trifurcation was found. Mean distance of bifurcation from the angle of the mandible was 28.06 mm and 81.0% were within the range of 21 to 35 mm. The branching patterns were classified into six types, and the frequency of occurrence was type I 11.39%, type II 15.9%, type III 34.18%, type IV 18.98%, type V 7.59% and type VI 12.67%. Type I, a classical text book pattern was found to be one of the least common patterns. There is no significant difference in percentage of each type between the present study and that of Koreans, though some differences with Caucasians were noted in three uncommon types. The frontal branch could be outlined between the two diverging lines from the earlobe to the lateral ends of the eyebrow and the highest frontal crease. Posterior to the facial artery, the mandibular branch was seen passing below the inferior border of the mandible in 20%; anterior to the artery, this nerve divides into one to four branches. In almost all the cases, branches to the mentalis and the depressor labii inferioris muscles and infrequently branches to the depressor angular oris were seen below the inferior border of the mandible.(ABSTRACT TRUNCATED AT 250 WORDS)