A retrospective study of ranula in two centres in Malaysia

Introduction: Ranula is a mucous extravasation cyst which occurs as a result of trauma or obstruction of the sublingual or minor salivary gland or the duct itself. Patients and results: 14 patients were seen at Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur and Hospital Tunku Ampuan Afzan, Kuantan, Malaysia between 2000 to 2006. There were six cases of intra-oral ranula and eight plunging ranula. Twelve patients underwent surgical intervention while two refused surgery. Four patients (33.3%) from those who had surgical intervention returned with recurrence; two (16.7%) had marsupialization and the other two (16.7%) had excision of the pseudocyst intraorally. Conclusion: Excision and marsupialization remain as the treatment of choice in our centres

Cost analysis of facial injury treatment in two university hospitals in Malaysia: a prospective study

Objective: Facial injury (FI) may occur in isolation or in association with injuries to other parts of the body (facial and other injury [FOI]). The objective of this study was to determine the direct treatment costs incurred during the management of facial trauma. Materials and methods: A prospective cohort study on treatment cost for FIs and FOIs due to road-traffic crashes in two university hospitals in Malaysia was conducted from July 2010 to June 2011. The patients were recruited from emergency departments and reviewed after 6 months from the date of initial treatment. Direct cost analysis, comparison of cost and length of hospital stay, and Injury Severity Score (ISS) were performed. Results: A total of 190 patients were enrolled in the study, of whom 83 (43.7%) had FI only, and 107 (56.3%) had FOI. The mean ISS was 5.4. The mean length of stay and costs for patients with FI only were 5.8 days with a total cost of US$1,261.96, whereas patients with FOI were admitted for 7.8 days with a total cost of US$1,716.47. Costs doubled if the treatment was performed under general anesthesia compared to local anesthesia. Conclusion: Treatment of FI and FOI imposes a financial burden on the health care system in Malaysia

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Susuk: di antara penemuan klinikal dan amalan tradisional

Susuk, atau dikenali sebagai ‘jarum pesona’ dipakai di muka dan bahagian badan yang lain kerana ia dipercayai dapat meningkatkan kecantikan dan keremajaan serta untuk kelihatan ‘garang’ atau tujuan merawat kesakitan tubuh badan, adalah merupakan amalan yang berdasarkan kepercayaan tradisional. Kebiasaannya, penemuan susuk secara klinikal adalah dengan tidak sengaja dalam pengimejan diagnostik, diagnostik iaitu x-ray atau computed tomography scan (CT scan), prosedur yang dijalankan untuk membantu mendiagnos sesuatu penyakit. Penemuan susuk secara kebetulan ini menimbulkan isu yang perlu dijelaskan. Dalam konteks ini, kami ingin menyelidik penggunaan susuk dan aspek-aspek lain yang berkaitan termasuk membincangkan pandangan Islam mengenai praktis ini. Pencarian sistematik telah dijalankan melalui empat pangkalan data elektronik: Ovid, Scopus, PubMed dan Embase, berdasarkan garis panduan PRISMA-ScR sehingga Jun 2023 menggunakan kata kekunci susuk di mana kriteria pemilihan adalah mana-mana artikel yang menerangkan susuk sebagai jarum lurus tanpa menghadkan masa penerbitan. Sejumlah 31 artikel telah dimasukkan dalam kajian skop ini. Kajian ini memberikan maklumat yang relevan dan berpotensi untuk memperkayakan pemahaman tentang susuk dan pengetahuan dalam pelbagai bidang seperti antropologi budaya, sains perubatan dan agama, serta mempromosikan dialog antara bidang ini

Effectiveness of motorcycle helmets for preventing head and facial injuries

SUMMARY Background Malaysia has the highest road traffic crash death rate per 100,000 people in South East Asia. Motorcycle crashes contribute 58% of the total road crash fatalities in the country. The high death rate from motorcycle crashes is often associated with helmet non-use. However, this is not the situation in Malaysia. Helmet wearing rate was shown to be 90% among the riders and 70% with the pillions. Various types of helmets were worn by motorcyclists in this hot climate country. The overall aim of this PhD research was to quantify the association between helmet type, helmet use and helmet components and the distribution and severity of head and facial injuries in riders and pillions in Klang Valley, Malaysia. Methods Three studies were conducted: a case series study, a case control study and a laboratory analysis of crash-involved helmets. Participants in the case series study were people who presented to hospital for treatment of injury or who died from injury, following motorcycle crash in the study area. Cases were recruited from four selected hospitals and a police department. The case control study used data from the head and facial injuries of participants from case series sample together with new data relating to demographic, motorcycle-related and helmet-related factors collected from controls observed at selected roadsides within the same geographical area. Association between helmet use and helmet type and head and facial injuries was determined using logistic regression for both studies. The third study was a laboratory-based biomechanical study, which involved measurement of physical properties of each helmet component; namely the outer shell, the inner liner, the retentive system and the visor. In addition, Fourier Transform Infrared spectroscopy was carried out on the outer shell and visor to determine the type of material and presence of material degradation. Associations between each component and the presence of head and facial injuries in the helmet wearer were assessed using chi square statistics. Logistic regression was carried out to determine the effect of visor type and visor damage on facial injuries. Findings 755 subjects were recruited from the selected centres for the case series. Among all the subjects, 520 sustained head and facial injuries. Of these 520 subjects, 404 sustained head injuries while 391 with facial injuries. There were 391 cases diagnosed with brain injuries. The potential confounders for the relationship between helmet type and helmet fixation and the outcomes of head, brain and facial injuries in the case series study were age, alcohol and illicit substance use, type of colliding vehicle, type of collision and pre-crash speed. Helmet fixation was shown to have a greater effect on the outcomes of head, brain and facial injuries. Adjusted logistic regression showed the following increased risk of adverse outcome for the non-fixed helmet compared to the fixed helmet: i) 5.73 (95% CI 3.38-9.73) for head injury ii) 5.80 (95% CI 3.41-9.89) for brain injury iii) 4.59 (95% CI 2.68-7.85) for facial injury Adjusted logistic regression results for various helmet types are shown below (compared to the full-face helmets): Head injury i) Half head and open-face helmet users: 1.86 (95% CI 0.57-6.09) ii) Tropical helmet users: 2.67 (95% CI 0.65-11.01) iii) Unhelmeted motorcyclists: 4.88 (95% CI 1.23-19.33) Brain injury i) Half head and open-face helmet users: 1.74 (95% CI 0.53-5.75) ii) Tropical helmet users: 2.38 (95% CI 0.57-9.96) iii) Unhelmeted motorcyclists: 4.68 (95% CI 1.17-18.71) Facial injury i) Half head and open-face helmet users: 2.05 (95% CI 0.67-6.24) ii) Tropical helmet users: 3.01 (95% CI 0.75-12.07) iii) Unhelmeted motorcyclists: 13.79 (95% CI 3.28-57.98) Apart from the helmet type, the effect of the visor type on facial injury was assessed (compared to the integrated type). The results are: Facial injury i) Added-on visor users: 0.80 (95% CI 0.45-1.30) ii) Visor-less helmet users: 1.26 (95% CI 0.51-3.11) For the case control study, the same cases as the above were employed and 1510 population controls were observed at the selected roadsides. The potential confounders were found to be the same as for the case series’. The effect of helmet use or fastening status was analysed together with the helmet type. Adjusted logistic regression showed the following results for the non-fixed helmet compared to the fixed helmet: i) 3.32 (95% CI 2.39-4.62) for head injury ii) 3.41 (95% CI 2.44-4.76) for brain injury iii) 2.21 (95% CI 1.54-3.18) for facial injury Adjusted logistic regression results for various helmet types are shown below (compared to the full-face helmets): Head injury i) Half head and open-face helmet users : 2.10 (95% CI 0.74-5.99) ii) Tropical helmet users: 1.22 (95% CI 0.37-3.96) iii) Unhelmeted motorcyclists: 6.91 (95% CI 2.14-22.33) Brain injury i) Half head and open-face helmet users : 2.04 (95% CI 0.72-5.82) ii) Tropical helmet users: 1.10 (95% CI 0.34-3.63) iii) Unhelmeted motorcyclists: 6.53 (95% CI 2.01-21.26) Facial injury i) Half head and open-face helmet users : 1.50 (95% CI 0.57-3.92) ii) Tropical helmet users: 0.78 (95% CI 0.25-2.41) iii) Unhelmeted motorcyclists: 8.12 (95% CI 2.81-23.45) Apart from the helmet type, the effect of the visor type on facial injury was assessed (compared to the integrated type). The results are: Facial injury i) Added-on visor users: 1.57 (95% CI 1.08-2.30) ii) Visor-less helmet users: 1.51 (95% CI 0.79-2.90) The final study, the laboratory analysis did not reveal any significant association between the helmet components and head and brain injuries. However, the adjusted logistic regression on visor damage and facial injuries revealed the following results: i) 5.48 (95% CI 1.46-20.57) for facial injury ii) 4.51 (95% CI 1.08-18.86) for middle face injury Interpretation Helmet use, helmet type and helmet fixation are associated with head, brain and facial injuries. Visor damage is associated with facial injury. This PhD research used the biomechanical epidemiology approach to assess the effectiveness of helmet type and use in reducing head and facial injury. The results provide strong evidence to suggest that proper use is more important than helmet type in providing protection. A population attributable risk (PAR) reduction of 33% in head injury and 50% in death can be expected if all helmets were properly secured. Conclusion and recommendation The effect of improper use and fixation status showed a stronger effect than helmet type in relation to the risk of head, brain and facial injuries. These results provide a new insight into motorcycle injury prevention in Malaysia. Several recommendations for future studies were proposed such as determinants of failure of helmet fixation, helmet biomechanics studies and a helmet type effectiveness study

Oral Myiasis: CASE REPORT

Myiasis occurs when living tissues of mammals are invaded by eggs or larvae of flies, mainly from the order of Diptera. Most of the previousty reported cases are in the tropics and they were usually associated with inadequate personal hygiene, sometimes with poor manual dexterity. This report describes two cases of oral myiasis in cerebral palsy patients in Seremban General Hospital, Malaysia. This article also discusses the therapeutic property of maggots and highlights the importance of oral health care in the special needs patients

Kimura’s Disease in Malaysian patients : three case reports

Kimura’s disease is a chronic inflammatory disorder which affects the subcutaneous tissues of the head and neck, axilla and upper limb as well as the groin region. In the head and neck region, major salivary glands and regional lymph nodes are mainly involved with associated eosinophilia and an elevated IgE concentration. Three cases of Kimura’s disease involving the parotid glands, lymph nodes and cheek are presented with a brief review of the literature

Malaysian Child Restraint Issues: A Brief Narrative Review

The child restraint legislation in Malaysia becomes mandatory from 1 January 2020. Prior to commencement of the rule, a survey showed that only 36% of Malaysian parents were aware of the importance of a child restraint system (CRS) and only 27% usage was reported during travel. The Malaysian Institute of Road Safety report showed that children transported in private vehicles were the leading groups of casualties among children aged 1 to 4 years old (43.8%) and 5 to 9 years old (30.2%), respectively. We performed a narrative review using the PubMed, ScienceDirect and Google Scholar databases using keywords such as child restraint system, unrestrained injuries, Malaysia and epidemiology. The objectives of this review were: (1) to determine the prevalence on the use of CRS in Malaysia, (2) to evaluate the injuries related to unrestrained children and (3) to show the nation’s preparation towards implementation of the child restraint law. Six papers on prevalence, one paper on injury and six mainstream newspaper were included in this study. The prevalence of a CRS use was shown between 5% to 41.8%. In relation to injury, the only publication from this country showed that among 19 children involved in a car crash, five (26.3%) children had non-craniomaxillofacial (CMF) injuries, ten (52.6%) with CMF injuries only, two (10.5%) with both CMF and non-CMF injuries and two (10.5%) without any injury. Overall, the Injury Severity Score (ISS) range was between 0 to 13 (median, 1.00; interquartile range, 1). Preparation to comply with the best practice of the child restraint law is still ongoing, especially those addressing the issues related to the low-income parents in the country. Due to scarcity of publication and data on the CRS use and injuries related to its non-usage, it is advocated that parallel with the implementation legislation, vigorous forms of public education as well as good data management must be performed and monitored regularly by the road safety authority in this country

Predictors of enophthalmos among adult patients with pure orbital blowout fractures.

The aim of this study was to determine the predictors of post-traumatic enophthalmos (PE) in relation to the internal orbital changes following pure orbital blowout fractures. The design was a 10-year retrospective cross-sectional study analysing 629 medical records and computed tomography (CT) data of patients with orbital fractures from January 2008 to January 2017. Demographic, etiology, co-morbidity and clinical characteristics were obtained from the medical records. Assessment of the PE, fracture site and size, intraorbital structures and muscle change were performed using the Digital Imaging and Communications in Medicine (DICOM) viewer software, OsiriX v5.8.2. Of the 629 patients with orbital fractures, 87 were pure orbital blowout fractures. Demographic pattern showed that males outnumbered females in the series, with male: female ratio of 5.7:1. The mean age was 37.2 ± 14.7 and the main etiology was motor vehicle accident. Orbital floor fracture was the most common fracture location (67.8%). The involvement of the posterior ledge and inferior orbital fissure showed statistical significant difference with PE (Fisher's exact test, p = 0.03). Binary logistic regression showed that after controlling for age, patients with fracture size of more than 150 mm2 had three times the odds of sustaining a PE, (adjusted odds ratio (AOR) = 3.01 (95% CI 1.17-7.92). Fracture size larger than 150 mm2 was a radiological predictor of PE. Additional research investigating further on the role of concurrent fracture of the posterior ledge and inferior orbital fissure is advocated

Actinomyces sp. Presence in the Bone Specimens of Patients with Osteonecrosis of the Jaw: The Histopathological Analysis and Clinical Implication

Medication-related osteonecrosis of the jaw (MRONJ) and osteoradionecrosis (ORN) are two similar bone pathologies in the jaw with different aetiologies. Actinomycosis is a relatively rare oral infection caused by the Gram-positive anaerobe Actinomyces sp. that normally colonizes the oral cavity. Actinomycosis is associated with the pathogenesis of both the MRONJ and ORN, as evident in our cases, and not just as a superficial contaminant. The clinical and histopathological aspects of the cases treated in our centre were also reported with a review of the literature. Clinical implication on the treatment of the cases was highlighted in view of the presence of this microorganism