Written Asthma Action Plan Improves Asthma Control and the Quality of Life among Pediatric Asthma Patients in Malaysia: A Randomized Control Trial / 가정의학회지

Background@#A written asthma action plan (WAAP) is one of the treatment strategies to achieve good asthma control in children. @*Methods@#This randomized controlled trial was conducted to observe the effect of WAAP on asthma control and quality of life using the Asthma Control Questionnaire and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) at baseline and after 3 months. A repeated measure analysis of variance was used to analyze the mean score difference between the two groups. @*Results@#There was no significant difference in mean score for asthma control at baseline between groups (F[degree of freedom (df)]=1.17 [1, 119], P=0.282). However, at 3 months, a significant difference in mean scores between groups was observed (F[df]=7.32 [1, 119], P=0.008). The mean±standard deviation (SD) scores in the intervention and control groups were 0.96±0.53 and 1.21±0.49, respectively. For the analysis of the PAQLQ, no significant difference was observed in the mean score for the quality of life baseline in both groups. There were significant mean score changes for the quality of life (F[df]=10.9 [1, 119], P=0.001) at 3 months follow-up, where those in the intervention group scored a mean±SD score of 6.19±0.45, and those in the control group scored 5.94±0.38. A time-group interaction analysis using repeated-measures analysis of variance showed significant differences in mean score changes (F[df]=5.03 [1, 116], P=0.027) and (F[df]=11.55 [1, 116], P=0.001) where a lower mean score was observed in the intervention group, indicating better asthma control and quality of life, respectively. A significant (P<0.001) negative Pearson correlation between asthma control and quality of life (-0.65) indicated a moderate correlation. @*Conclusion@#WAAP, along with standard asthma treatment, improves asthma care.

Risk Perception and Emergency Preparedness Against Flood Affected Participants From the Primary Health Care Centre, Malaysia: A Comparison Between Genders

@#Introduction: Flooding has become a major natural disaster in Malaysia in recent decades. There may be a gender difference in many aspects related to flood response and practice. This study aimed to examine the gender gap in knowledge, attitudes, and practice of flood preparedness in Malaysia. Method: This cross-sectional study was conducted among patients attending the primary care clinic at Universiti Sains Malaysia health campus, Kelantan. A validated questionnaire was used for data collection. Results: 328 subjects were recruited, 56.1% of them were females. The female respondents were younger than the males (36 vs. 41 years old). However, females have better knowledge, and practice on flood preparedness compared to male respondents. Among those, women were more aware of the local emergency plan than males (p=0.01). More female respondents kept their vaccination and personal medical records in a waterproof container or sealed plastic bag during past and future flood preparations (3-5 day supply of non-perishable food) than male respondents (p<0.05). In addition, with the practice of keeping a one-week supply of medication, and having their medical records in a waterproof container along with a first-aid kit (p=0.001). For future flood preparation, more women would filter the cloudy water through clean clothes for boiling (p=0.035). The determinants of good preparedness for future floods for female were older-age (p=0.001), blue-collar (p=0.043); whereas male were lower household income (p=0.014), being blue collar (0.014) and white collar (0.039) compared with student/retiree based on multivariate logistic regression. Conclusion: Our study reported that the determinants of good preparedness for future floods were older-age, blue-collar and having a lower-household income.

Coronavirus Disease 2019 Presenting as Conjunctivitis / 가정의학회지

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The world is currently challenged to handle this pandemic. The common symptoms of COVID-19 are fever, cough, fatigue, and shortness of breath. There are few reports on the association of SARS-CoV-2 with ocular abnormalities including conjunctivitis. We report a case of a 54-year-old woman who presented solely with conjunctivitis subsequently diagnosed with COVID-19. A lack of full history of her travel abroad was another issue leading to a delay in evaluating her COVID-19 status that increased the infection risk to her managing team. Thus, primary care practitioners should be suspicious of this atypical feature of COVID-19, thus enabling us to identify such patients at entry points. Maintaining safety measures while managing patients is also crucial.

Sexual Assault: A Descriptive Study of Victims Attending a Public Hospital in Ipoh

@#Introduction: Sexual assault continues to be a significant issue globally. It has a profound effect on the physical and emotional wellbeing of the victims. Methods: This is a retrospective study based on data collected from the ‘‘OneStop Crisis Centre’’ at Hospital Raja Permaisuri Bainun for the duration of 4 years from January 2011 to December 2014 aiming to highlight the pattern and prevalence of sexual assault in the city of Ipoh, Malaysia. Results: Ninety-six cases were reported with the age of the victims ranging from 4 to 63 years old. All the victims were female except for one. Forty-six of the victims were in the young adults category (19-30 years old) and six were above 30 years old. The mean (SD) age of the victims was 19.8 (7.9) years. Sixty-seven cases involved rape (69.8%) and 12 cases involved gang rape. Twelve cases were allegedly committed by relatives of the victim, 57 cases involved persons known to the victim and 27 cases (28.1%) were allegedly perpetrated by strangers. Most cases were reportedly committed at the victim’s’ own house (n=32). Conclusion: This study highlights the salient fact that most perpetrators were known by the victim. Rape was the commonest type of sexual assault and most victims were between the age of 19-30. The comprehensive recommendations for prevention of sexual violence put forward by the United States Centers for Disease Control and Prevention should be implemented by all relevant parties.

Intravitreal dexamethasone as an adjunct for the treatment of dengue virus related maculopathy: a case report

Dengue infection related ocular pathology whether as a direct manifestation of coagulopathy or as a sequale of immunological reaction is being increasingly recognized in endemic regions and has expanded out into a spectrum with pan ocular presentation. Authors present a case of a young female from an endemic region who developed visual field abnormality and loss of vision several days after onset of fever. She was diagnosed with dengue virus infection and subsequently went on to develop thrombocytopenia requiring transfusion. Detailed ophthalmological evaluation revealed maculae edema, and changes consistent with neuroretinitis and posterior segment vasculitis. She was treated with a combination of pulse steroid therapy and intravitreal dexamethasone injection. Patient went on to have excellent visual recovery on follow up with no persisting visual field deficit.

Analysis of orbital malignancies presenting in a tertiary care hospital in Pakistan

Objective: To determine the frequencies of various orbital malignancies amongst orbital lesions in patients presenting in a tertiary care hospital in Pakistan

Methods: A retrospective analysis of 666 orbital cases with an established histopathological diagnosis of malignant tumors treated in Mayo Hospital Lahore from 1996 to 2015 [20 years]

Results: About 66% of the malignant tumors were primary, 25% secondary, 8% haematopoietic and 1% metastatic. Almost 50% of the cases were children. Retinoblastoma is the commonest tumor [43% overall and 87% among children]. Squamous cell carcinoma is the second commonest [15.6% overall and 31% among adults]. These are then followed by Adenoid cystic carcinoma of Lacrimal Gland [9%], Lymphoma/Leukaemia [8%] and Rhabdomyosarcoma [6.3%]

Conclusion: Frequencies of various orbital malignancies show geographical variation in both paediatric and adult population

Female sexual dysfunction among overweight and obese women in Kota Bharu, Malaysia

Objectives: Overweight and obesity have been identified as risk factors for sexual dysfunction. However, this relationship has not been well documented in women, and the results have been conflicting, perhaps because of the complexity of female sexuality. The aim of our study was to determine the prevalence of and factors associated with female sexual dysfunction [FSD] and its subtypes among overweight and obese women

Methods: This cross-sectional study was conducted from January to June 2012 at Klinik Rawatan Keluarga Hospital Universiti Sains Malaysia. A validated Malay version of the Female Sexual Function Index was administered to 204 overweight and obese women. The socio-demographics and physical and biochemical parameters were obtained. Multiple logistic regression was used to evaluate the confounding factors toi sexua/ dysfunction

Results: The prevalence of FSD among overweight and obese women was reported to be 12.3% [95% CI:7.79, 16.81]. Sexual desire disorder was the most prevalent dysfunction [23%], followed by arousal disorder [8.3%], lubrication disorder [9 3%], orgasm disorder [4.9%], satisfaction disorder [9.3%] and pain disorder [6.9%]. Parity 1.08 [1.01, 1.15] and duration of marriage 0.70 [0.50, 0.96] were significantly associated with FSD in the study cohort

Conclusions: Sexual dysfunction among overweight and obese women was low. Parity showed a significant positive correlation with FSD, while the duration of marriage appeared to be a protective factor against FSD

Dermatological evaluation of counter irritant potential of human urine in rabbits

To confirm the effect of human urine in the treatment of wounds, burns and irritation. The study was conducted at Bahauddin Zakariya University, Multan, in November 2013 and comprised 15 rabbits of either gender. Irritation was induced by clockwise frictional movement of fine sandpaper to the ear of the rabbits. The counter-irritant activity was determined by calculating the mean decrease in redness and erythema. A group of 3 rabbits each was used while experimenting with the main assay every time the concentration of irritants was increased. The ear treated with distilled water was used as a control. Sodium lauryl sulfate irritation model was also applied and the counter-irritant activity was evaluated. One-way analysis of variance followed by Bonferroni test were used for statistical analysis. The mean weight of the 15 rabbits was 1.5 +/- SD kg. Urine [50 and 100microl] showed excellent counter-irritant activity when compared with control and standard dexamethasone. Both the doses showed counter-irritant activity, ranging between 76.84% and 95.68% in the sandpaper model, and 68.90% and 93.68% in the sodium lauryl sulfate model. Human urine countered the effect of irritation in experimental animals and can be an alternative way of countering irritation

Effect of topical dexamethasone on intra-ocular pressure when used after phacoemulsification with intra-ocular lens implantation

Objective: To determine the effect of topical Dexamethasone on intra-ocular pressure when used after phacoemulsification and intra-ocular lens implantation

Study Design: A Cross Sectional Study

Place and Duration: At Eye [B] Unit Khyber Teaching Hospital Peshawar from 1st March 2009 to 1st March 2010

Methodology:The study was carried out on patients who underwent phacoemulsification with intraocular lens implantation by same surgeon. Goldmann applanation tonometer was used to measure the intra-ocular pressure on 1st post-operative day. Patients were started on topical Dexamethasone [0.1%] along with Tobramycin [0.3 %] eye drops for control of postoperative inflammation. Follow up was at 7th and 30th postoperative days and at each visit intra-ocular pressure [IOP] was measured

Results: Among 59 patients the mean age was 61.45 +/- 6.22 years with male to female ratio of 1.56: 1. Intra -ocular pressure measured on 1st post-operative day, ranged between 15.00 mmHg to 17.00 mmHg with a mean of 15.93 +/- 0.583. On 7th post operative day IOP ranged between 15.00 mmHg to 18.00 mmHg with mean of 15.89 +/- 0.824. On 30th post operative day in about 6 patients a clinically significant rise in IOP was noted. In about 6 patients IOP got increased above normal limit of 21 mmHg with a range between 15.00 mmHg to 24.00 mmHg with a mean of 17.08 +/- 2.68

Conclusion: Use of topical Dexamethasone after cataract surgery is associated with a risk of raised intra-ocular pressure [IOP]. We recommend further studies to compare other corticosteroids and NSAIDs to find out most safe drug

Modified T-Plate Interpositional Arthroplasty for Temporomandibular Joint Ankylosis: A New and Versatile Option

BACKGROUND: This study has been conducted with the aim of evaluating modified T-plate interpositional arthroplasty. METHODS: A prospective comparative study in patients admitted with temporomandibular joint ankylosis. Ankylotic temporomandibular joint arthroplasty included condylectomy gap arthroplasty in 7, temporalis muscle flap interpositional arthroplasty in 8, and modified T-plate interpositional arthroplasty in 13 cases. The patients were followed for three years. Collected data were tabulated and subjected to Fisher's exact test, chi-square test and probability estimation. RESULTS: A significant increase in interincisal distance of 32 mm was seen in 12 (92.31%) patients in the T-plate interposition group, in 2 (25%) cases of the temporalis muscle flap interposition group, and in 1 case (14.28%) of the condylectomy group at 12, 24, and 36 months. Re-ankylosis was observed in 1 case (9.69%) of the T-plate interposition group, while as it was observed in 4 (50%) cases in the temporalis muscle flap interposition group and 4 (57.14%) cases in the condylectomy group, and these differences were statistically significant. CONCLUSIONS: Our clinical experience with the use of the T-plate over the past 5 years has been encouraging, and our physiotherapy technique is quite simple. Even illiterate parents can assess it easily. Hence, we recommend this easy technique that does not damage the temporalis muscle for the management of temporomandibular joint ankylosis.

Prevalence of Ascaridia galli in white leghorn layers and Fayoumi-Rhode Island red crossbred flock at government poultry farm Dina, Punjab, Pakistan

Poultry farming not only provides high nutritious food but also creates employment opportunity for rural masses. Documented evidences elaborates that helminth parasitism is most deciduous problem of chickens especially in developing world. Ascaridia (A.) galli, a nematode of small intestine, has been considered as the most common and important parasite of chicken. The present study was carried out to investigate prevalence and severity of A. galli in White Leghorn layers (housing type: battery cage and deep litter, 50 each) and Fayoumi-Rhode Island Red crossbred (male and female: 50 each) flock rearing at Government Poultry Farm, Dina, Punjab, Pakistan. Two hundred faecal samples were examined by using standard parasitological and McMaster egg counting technique. The overall prevalence was 24.5% at farm, 13% in White leghorn layer (battery cage=2%, deep litter=24%) and 36% in Fayoumi-Rhode Island Red (male=34%, female=38%). It was also observed that White leghorn layer rearing in deep litter had more severe infection (EPG=1920) of A. galli compare with battery cages birds (EPG=500). Parasite prevalence was significantly related with sex (P<0.05) in Fayoumi-Rhode Island Red and male birds had less number of average parasites (0.34±0.47) as compared to females (0.38±0.490). Additionally, female birds were under serious threat of infection (EPG=2270) compared with its counterpart (EPG=1250). Given the high infection rates, particular attention should be paid to management and provision of feed supplement to White leghorn layer housing in deep litter and female bird of Fayoumi-Rhode Island Red crossbred.

Antinociceptive and anti-inflammatory activity of the extract of lycopus europaeus on laboratory animals.

Aims: To evaluate the analgesic and anti-inflammatory effects of methanolic extract of Lycopus europaeus on experimental animal models. Methodology: The analgesic activity was evaluated by hot plate, acetic acid induced writhing and formalin induced writhing method in Swiss Albino mice divided into 4 different groups (control, standard diclofenac sodium and extract at two different doses of 250 and 500 mg/kg BW). The extract was also investigated for the anti-inflammatory effect on Long Evans rats using carrageenan induced rat paw edema method. For anti-inflammatory study, 24 rats were divided into 4 different groups each receiving either distilled water, standard drug or the extract at the doses of 250 and 500 mg/kg BW. Results: Phytochemical analysis of the extract revealed the presence of tannins, flavonoids and terpenoids. The extract elicited a highly significant (p<0.001) analgesic activity in a dose dependent manner on hot plate method, acetic acid induced writhing test and also on both the early and late phases of formalin test at the doses employed. In the hot plate method, the extract increased the reaction time of heat sensation to 60.81% and 66.52% at the doses of 250 and 500 mg/kg BW respectively while that of the standard drug was 57.40% at the 3rd hour of study. In acetic acid induced writhing test, the percent inhibition of writhing response by the extract was 62.87% and 70.66% at 250 and 500 mg/kg doses respectively (p<0.001) which were even better than the standard drug diclofenac sodium (50.30%). The extract also significantly inhibited the licking response at the dose of 500 mg/kg in both the early phase (55.11%, p<0.01) and the late phase (66.43%, p<0.01) of formalin test while the standard drug inhibited by 52.27% and 72.03%, respectively. The oral administration of the extract significantly (p<0.001) inhibited inflammatory response induced by carrageenan in a dose dependent fashion. The most prominent inhibition of 61.68% (250 mg/kg) and 73.65% (500 mg/kg) were observed at the 4th hour of study. Conclusion: The central and peripheral analgesic as well as anti-inflammatory effect of the methanolic extract of Lycopus europaeus may be due to the presence of various chemical constituents specially flavonoids, tannins, alkaloids or terpenoids. These experimental findings would further establish the scientific basis of the traditional uses of the plant in the management and/or control of pain as well as inflammatory conditions.Keywords: Basic needs, biodiversity conservation, women’s basic understanding.

Saudi oncology society and Saudi urology association combined clinical management guidelines for urothelial urinary bladder cancer

In this report, updated guidelines for the evaluation, medical, and surgical management of transitional cell carcinoma of the urinary bladder are resented. They are categorized according the stage of the disease using the TNM staging system 7[th] edition. The recommendations are presented with supporting level of evidence

Saudi oncology society and Saudi urology association combined clinical management guidelines for prostate cancer

In this report, updated guidelines for the evaluation, medical, and surgical management of prostate cancer are presented. They are categorized according the stage of the disease using the tumor node metastasis staging system 7[th] edition. The recommendations are presented with supporting evidence level

Saudi oncology society and Saudi urology association combined clinical management guidelines for renal cell carcinoma

In this report, updated guidelines for the evaluation, medical and surgical management of renal cell carcinoma are presented. They are categorized according the stage of the disease using the tumor node metastasis staging system 7[th] edition. The recommendations are presented with supporting evidence level

Saudi oncology society and Saudi urology association combined clinical management guidelines for testicular germ cell tumors

In this report, updated guidelines for the evaluation, medical, and surgical management of germ cell tumor of testes are resented. They are categorized according the stage of the disease using the tumor-node-metastasis staging system 7[th] edition. The recommendations are presented with supporting level of evidence

Antipyretic study of methanolic bark extract of plumeriarubra, linn. in various pyrexia induced models.

To provide pharmacological evidence of plumeria rubra as antipyretic agent in practice many parts of Pakistan. Antipyretic effect of methanolic extract of the bark of plumeria rubra was investigated.on yeast , dinitrophenol and E-coli induced model. Intraperitoneal administration of yeast, dinitrophenol and E-coli in albino rabbits leads to pyrexia. Intraperitoneal administration of methanolic extract of the bark of plumeria rubra at a dose 100mg/kg body weight were shown significantly reduce the elevated body temperature of rabbit in yeast induced model which was compared with aspirin (Standard Drug) and solvent used. In dinitrophenol induced pyrexia, mixture of verapamil (2mg/kg) and Plumeria rubra (50mg/kg), while in In E-coli induced pyrexia, mixture of Ciproflaxacin (10mg/kg) and Plumeria rubra (50mg/kg), significantly reduced the elevated temperature in all models as compared to the standard drug Aspirin.

Frequency of headache with stress in adolescent and young adults

Objective of this study was to establish a link between stress as a cause of headache in young adults. Cross sectional study. Department of Neurology Military Hospital [MH] Rawalpindi from September 2009 to March 2010. Thirty young patients, referred for the complaints of headache to the Neurology out patient department, were included in this study. A detailed especially designed, pre tested headache questionnaire was devised which was filled for every patient individually included in the study. Twenty One [70%] of the patients in the study group did have the feeling of stress preceding the headache which sometimes persisted during the episode. Nine [30%] did not report any such feeling of stress before or during the episode. Out of the patients reporting stress 71% [15] were female patients and 29% [6] were males. These key findings suggest that stress and headaches may be related for adolescents and young adults and that this relationship may be reinforced over time. Moreover female patients were far more susceptible to this stressful stimulus as compared to the males

Optic nerve astrocytosis [astrogliosis], induced by ethambutol

Purpose: To determine astrogliosis in optic nerve of rabbit induced by ethambutol

Materials and Methods: Ten, New Zealand white, albino rabbits of either sex, 6-12 months old; weighing 1- 2 kg were randomly divided into two group comprising five animals in each. Group A served as control, while Group B was given ethambutol 100 mg/kg/day for four weeks. At the end of experimental period, each animal was sacrificed by using chloroform and both optic nerves were dissected out, preserved and processed; in this way, twenty optic nerve specimens Maximum stone size included in our study was 3 cm. All patients included in our study were treated by rigid URS and stone fragmentation with Pneumatic Lithoclast. [ten for each group] were collected from ten albino rabbits

Results: Mean number of astrocytes, calculated in group B was 27.94 +/- 2.94, that was significantly increased from those in group A, showing mean number of astrocytes as 09.66 +/- 2.16 [p value = 0.001]

Conclusion: Ethambutol, in toxic doses, induces the proliferation of astrocytes in optic nerve, a part of astrogliosis, indicating the repair process in damaged optic nerve

Giant dedifferentiated retroperitoneal liposarcoma

A 72 years old lady presented with a gradually increasing abdominal mass for the last 25 years, with more rapid increase in the last 05 years. Examination revealed a large mass spanning the whole abdomen. CAT scan revealed a huge retroperitoneal tumour, with tortuous ureters passing through the tumour and three tiny nodules in the right lung field. A subtotal piecemeal excision of the tumour was done after stenting the ureters with single J stents. The excised tumour mass weighed 46 Kg. The patient had a prolonged ileus that recovered in 5 days. Histopathology revealed the mass to be dedifferentiated liposarcoma. The patient and the family were satisfied with the short-term outcome of the surgery. She was ambulating with little support and was able to manage her daily affairs