Jehovah’s witness patient undergoing major surgery: Methods to minimize blood loss

Jehovah's Witnesses are a group of people who refuses to get blood transfusions and blood products due to their faith. Due to this, Jehovah's Witness patients who are planned for major surgical procedures are always a challenge for both surgeons and anaesthetist. Surgical and anaesthetic techniques must be aimed at minimising blood loss. We are reporting a peri-operative management for a Jehovah's Witness patient scheduled for a major surgery. This article emphasizes the techniques to minimize blood lose, in order to avoid blood transfusion

A to Z: Current Spinal Cord Injury Rehabilitation

Over the past century, the remarkable advances in health care have changed the outlook on Spinal Cord Injury (SCI). The “grim prognosis” has become a story of the past, and today, the life expectancy of the SCI survivors has been comparable to that of general population, and the health care providers are working harder to improve quality of life of SCI patients, whilst various ongoing research are promising for a better healing potentials. At this moment, resources, management strategies and policies are important factors that must be properly managed to further improve the SCI outcomes. As a newcomer, the telerehabilitation system promises to resolve issues on unmet medical needs, financial and manpower constraints, rehabilitation interventions and independence of activities of daily living

Progressive Enlarging Blind Spot in a Young Asian Lady: A Case Report on Acute Zonal Occult Outer Retinopathy

Acute Zonal Occult Outer Retinopathy (AZOOR) is a very rare retinal disease that predominantly affect the Caucasians. It is usually present in a young myopic woman with an acute onset of photopsia and enlarging blind spots. Here, we report a young Asian lady who presented with a typical presentation of AZOOR and later confirmed by electrophysiological test of the retina. She was wrongly diagnosed as retrobulbar optic neuritis due to low index of suspicion for AZOOR among the treating physicians in the hospital. Fortunately, she responded to systemic corticosteroid that was given as a treatment of optic neuritis. AZOOR was only diagnosed later by a visiting European neuro-ophthalmologist in a neighbouring country. The objective of this case report is to remind the reader that the condition exists in Asian population and should be kept as a differential diagnosis in a young lady who presented with progressive visual field defect

Sensory predominant Guillain-Barré syndrome concomitant with dengue infection: A case report

Guillain-Barre syndrome is an acute demyelinating polyneuropathy disease which is autoimmune in nature and usually follows gastrointestinal or respiratory infections. Dengue fever is however not a common trigger to the condition. Here, we report a patient who developed sensory predominant demyelinating polyradiculopathy during febrile phase of dengue fever. It was later confirmed with serology test and nerve conduction study. He was successfully treated with intravenous immunoglobulin and discharged home well. The purpose of this case report is to highlight that Guillain-Barré syndrome can occur as an uncommon neurological complication of dengue fever which can occur during any phase of the illness

SARS-CoV-2 infection of the nervous system: A review of the literature on neurological involvement in novel coronavirus disease-(COVID-19)

The novel coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is believed to have emerged from an animal source and has been spreading rapidly among humans. Recent evidence shows that SARS-CoV-2 exhibits neurotropic properties and causes neurological diseases. Here, we review the literature on neurological involvement in SARS-CoV-2 infections and the possible mechanisms of invasion of the nervous system by this virus, to provide a summary and critical analysis of the early reporting of neurological involvement in COVID-19. An exhaustive search of scientific articles on neurological involvement in COVID-19 was performed in the Web of Science, Scopus, Medline/PubMed, and several other databases. Nineteen relevant articles that had been published or were in preprint were carefully selected according to the inclusion and exclusion criteria. Based on our research, we found that patients with COVID-19 can present with neurological symptoms that can be broadly divided into central nervous system involvement, such as headache, dizziness, altered mental state, and disorientation, and peripheral nervous system involvement, such as anosmia and hypogeusia. Most of these patients are in the older age group and exhibit comorbidities, especially hypertension, and severe infection. In extreme presentations of COVID-19, some patients exhibit seizures, stroke, flaccid paraparesis, corticospinal weakness, and even coma. Moreover, the neurological man-ifestations can occur independently of the respiratory system. In conclusion, SARS-CoV-2 infection can cause multiple neurological syndromes in a more complex presentation. Therefore, this review elucidated the involvement of the nervous system in SARS-CoV-2 infection and will hopefully help improve the management of COVID-19

Pain management of pemphigus vulgaris

Pemphigus is a rare autoimmune bullous disease which affects the mucous membranes and skin. Pemphigus vulgaris (PV) is the most prevalent type of pemphigus. PV presents with extremely painful, non- healing oral erosions. However, there are only a handful of reports addressing the pain management of PV. We would like to present a case of a painful PV, which was successfully managed

Unusual presentation of Cerebral lupus: A case report of Parkinsonism in Cerebral lupus

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multisystem involvement that follows a relapsing and remitting course. It is characterized by an immune-mediated response to own body defense mechanism and mistakenly attacked healthy cells of the skin, joints, kidneys, blood cells, and nervous system. Cerebral lupus refers to a constellation of neurological and/or behavioral clinical syndromes in patients with SLE. The spectrum of presentation can vary widely ranging from mild symptoms such as headaches, slight cognitive dysfunction, and mood disorders to more serious conditions like seizures, stroke, or coma. This case report is about a case of cerebral lupus manifested with symptoms of Parkinsonism. The purpose of this case report is to share an uncommon occurrence of cerebral lupus which manifested as Parkinsonism and to highlight the importance of early diagnosis of the condition which is potentially reversibility with prompt

Cranial Diabetes Insipidus in Neuropsychiatric Systemic Lupus Erythematosus, a Rare but Treatable Association: A Case Report

Systemic lupus erythematosus has been rarely reported to be associated with cranial diabetes insipidus. It is a condition clinically manifest as severe polyuria and reactive polydipsia that may lead to electrolyte imbalance or acute kidney injury as a result of arginine vasopressin insufficiency. Here, we report a patient with systemic lupus erythematosus and lupus nephritis previously under control with medication presented with neuropsychiatric symptoms which responded to pulsed methylprednisolone, developed severe polyuria, polydipsia and hypernatremia which persisted after pulsed therapy. Serum and urine osmolarity were suggestive of diabetes insipidus and the polyuria resolved dramatically after trial of oral desmopressin which in keeping with the diagnosis of central cause. The objective of this case report is to share the uncommon occurrence of diabetes insipidus in neuropsychiatric systemic lupus erythematosus

Turban Pin Inhalation Syndrome with Unusually Mobile Pin from Series of Radiographs

Foreign Bodies (FB) dislodges are common in the ear, nose and throat especially among infants and children. Occasionally, they can accidentally be ended up in the bronchus as well. We describe a 13-year-old girl with accidental ingestion of a scarf needle pin after she was slapped on the back while biting the pin. Chest radiograph had confirmed the diagnosis of pin ingestion which is consistent with turban pin inhalation syndrome. In view of logistic and specialty issues, she was transferred to another tertiary hospital for further intervention. A series of chest radiograph showed a migratory metallic FB in different locations in the airway, which was considered as an extreme rarity. We discuss this rare entity with literature review of FB aspiration in general

Children’s eating behaviour: A comparison between normal, overweight and obese children

Background: Childhood obesity has become a major global health concern and has been increasing dramatically over the years. Previous study has shown that specific eating behaviours may have been associated with obesity especially under-responsiveness to internal satiety cues and over-responsiveness to external food cues such as the taste, smell, availability and emotions. However, there is still inadequate number of studies present to describe the association between the children’s body mass index (BMI) and their eating behaviours, especially in Sabah, Malaysia. Therefore, the objective of this study is to established the association between the children’s eating behaviours with their nutritional status based on their body mass index. Materials and methods: A cross-sectional study involving 484 children aged 6–12 years old was conducted in Kota Kinabalu, which is a developing urban area in Sabah. The children were recruited from five primary schools that were selected based on multistage stratified and convenience sampling method. Sociodemographic details and anthropometric measures both parents and children, and eating behaviours of children were assessed using Children Eating Behaviour Questionnaires (CEBQ). Age-adjusted BMI z-scores were then calculated according to the World Health Organization recommendations to assess nutritional status. Results: The prevalence of childhood obesity among children aged 6–12 years old is 13.2%. The mean scores of ‘Food Approach’ subscales from the CEBQ showed higher mean score in overweight and obese groups as compared to the mean score in normal weight group. The mean scores of ‘Food Avoidance’ subscales showed lower mean score in overweight and obese groups as compared to mean score in normal weight group. Conclusion: This study provides evidence that childhood obesity is yet to be a prevalent health problem in a developing urban area considering the “Food approach” subscales were positively associated with the excess weight in children