Dietary and Lifestyle Factors and its Risk to Kidney Stone Disease: A Case Control Study at UKM Medical Centre

Nutrition has been widely recognized to have certain levels of influence on the risk of kidney stone formation. Thus, this case-control study was conducted to determine the association of dietary intake and lifestyles factors with kidney stone disease. Sociodemographic data, dietary intake, supplements intake, smoking and alcohol habit, medical history, physical activity and anthropometric data were obtained using interviewer-administered pre-tested questionnaires among 81 patients who had been diagnosed with kidney stone disease and 81 patients without kidney stone disease at Universiti Kebangsaan Malaysia Medical Centre. The results indicated that body mass index and hip circumference were higher among cases as compared to controls in both men and women (p < 0.05). Energy, macronutrients and micronutrients intake were higher for case subjects compared to control subjects for all significant parameters (p < 0.05). Results showed positive association of kidney stone with consumption of nuts (≥1 time/week) for men and women while consumption of eggs (1-3 times/month) and beans (1-6 times/week) showed positive association for women. Analysis of multivariate found the risk factor among women was diabetes mellitus [Adjusted OR = 27.6 (95% CI = 1.43-53.3)] (p < 0.05). Whilst, plain water intake of at least 6 glasses [Adjusted OR = 0.001 (95% CI = 0.000-0.08)] (p < 0.05) and 8 glasses per day [Adjusted OR = 0.001 (95% CI = 0.000-0.02)] (p < 0.05) reduced the risk among women. The risk factors for men were smoking habits [Adjusted OR = 16.2 (95% CI = 1.29-203)] (p < 0.05), consumption of carbonated drink 1-3 times per month [Adjusted OR = 6.25 (95% CI = 1.04-40.7)] (p < 0.05) and 1-6 times per week [Adjusted OR = 12.5 (95% CI = 1.41-111)] (p < 0.05). Unhealthy dietary and lifestyles factors increased the risk of kidney stone disease and various risk factors were found for different sexes

Dietary and lifestyle factors and its risk to kidney stone disease: a case control study at UKM Medical Centre

Nutrition has been widely recognized to have certain levels of influence on the risk of kidney stone formation. Thus, this case-control study was conducted to determine the association of dietary intake and lifestyles factors with kidney stone disease. Sociodemographic data, dietary intake, supplements intake, smoking and alcohol habit, medical history, physical activity and anthropometric data were obtained using interviewer-administered pre-tested questionnaires among 81 patients who had been diagnosed with kidney stone disease and 81 patients without kidney stone disease at Universiti Kebangsaan Malaysia Medical Centre. The results indicated that body mass index and hip circumference were higher among cases as compared to controls in both men and women (p < 0.05). Energy, macronutrients and micronutrients intake were higher for case subjects compared to control subjects for all significant parameters (p < 0.05). Results showed positive association of kidney stone with consumption of nuts (≥1 time/week) for men and women while consumption of eggs (1-3 times/month) and beans (1-6 times/week) showed positive association for women. Analysis of multivariate found the risk factor among women was diabetes mellitus [Adjusted OR = 27.6 (95% CI = 1.43-53.3)] (p < 0.05). Whilst, plain water intake of at least 6 glasses [Adjusted OR = 0.001 (95% CI = 0.000-0.08)] (p < 0.05) and 8 glasses per day [Adjusted OR = 0.001 (95% CI = 0.000-0.02)] (p < 0.05) reduced the risk among women. The risk factors for men were smoking habits [Adjusted OR = 16.2 (95% CI = 1.29-203)] (p < 0.05), consumption of carbonated drink 1-3 times per month [Adjusted OR = 6.25 (95% CI = 1.04-40.7)] (p < 0.05) and 1-6 times per week [Adjusted OR = 12.5 (95% CI = 1.41-111)] (p < 0.05). Unhealthy dietary and lifestyles factors increased the risk of kidney stone disease and various risk factors were found for different sexes

Lesión vesical iatrogénica: experiencia de diez años, tratamiento y resultados entre 1999-2009, Kuala Lumpur, Malasia

Introduction: This case series is a retrospective review of iatrogenic bladder injuries treated at our institution Universiti Kebangsaan Malaysia, Medical Centre, over a ten-year period, from 1999 to 2009. Materials and methods: A retrospective review of the operating theater database yielded the names and registration numbers of patients who underwent operative repair of bladder injuries. Patients who sustained bladder injuries due to nonsurgical reasons (such as traumatic bladder injuries due to pelvic fractures, blunt trauma or penetrating injuries to the pelvis) were excluded. Results: There were 12 cases of iatrogenic bladder injury treated during this time. A total of eight injuries occurred during gynaecological surgery. Five injuries occurred during lower segment caesarean section, two injuries during total abdominal hysterectomy and bilateral salpingo-oopherectomy, and a single injury during Burch colposuspension. Four out of the five injuries during caesarian section had a history of previous caesarian section. Of the four remaining non-gynaecological related injuries, two injuries occurred during hernioplasty, one during exploration of an enterocutaneous fistula and the other was during laparoscopic appendicectomy. Conclusion: Iatrogenic bladder injury should be anticipated in patients undergoing caesarean section who have had multiple previous caesarean sections. Iatrogenic injuries should be identified intra-operatively to enable early repair and the best outcome. These injuries were adequately assessed by ascending cystography. Continuous repair with absorbable sutures together with perivesicle drainage and bladder catheterization produces good outcome. Introducción: Esta serie del casos es una revisión retrospectiva de heridas iatrogénicas de vejiga tratadas en la Universidad Nacional de Malasia entre 1999 y 2009. Métodos: Se hizo una revisión retrospectiva de la base de datos de la sala de cirugía del Centro Médico de la Universidad Nacional de Malasia, en individuos a quienes se les realizó cirugía de heridas de vejiga. Se excluyeron los pacientes que presentaron heridas de vejiga sin cirugía como heridas traumáticas debido a fracturas pélvicas, trauma cerrado o heridas penetrantes en la pelvis. Resultados: Se encontraron 12 casos de herida de vejiga iatrogénica tratados entre 1999 y 2009. Ocho heridas ocurrieron durante cirugía ginecológica, 5 durante cesárea segmentaria baja, 2 durante histerectomía abdominal total y salpingo-ooforectomía bilateral y 1 herida durante colposuspensión de Burch. Las 4 heridas restantes no ginecológicas fueron: 2 heridas por iatrogenia ocurrida durante una hernioplastia, una durante exploración de una fístula entero-cutánea y la otra se presentó durante una apendectomía laparoscópica. Conclusión: La herida iatrogénica de la vejiga debe ser anticipada en pacientes que experimentan cesárea que han tenido múltiples cesáreas previas. Las heridas iatrogénicas deben ser identificadas intra-operatoriamente para permitir reparación temprana y obtener el mejor resultado. Obtuvo mejores resultados la reparación continua con suturas absorbibles junto con drenaje vesical mediante catéter. La cistografía ascendente con 300 ml de contraste es la mejor opción para el diagnóstico de herida iatrogénica de vejiga y también para la evaluación de la reparación total

A rare case of scrotal basal cell carcinoma in the presence of metastatic squamous cell carcinoma of the external auditory meatus and its management strategy

Basal cell carcinoma (BCC) of the scrotum is uncommon and its pathogenesis is not well understood. The clinical behaviour of scrotal BCC is thought to be more aggressive and has a higher metastatic potential than BCC of other regions. The mainstay of treatment for localized scrotal BCC is wide local excision, while metastatic disease may need systemic chemotherapy for palliative control. A rare clinical scenario of scrotal BCC presenting concurrently with another metastatic cancer has never been reported. The present case illustrates the diagnostic challenge and management dilemma due to simultaneous presentation of scrotal BCC and metastatic squamous cell carcinoma (SCC). A 70-year-old man complained of a non-healing scrotal ulcer while he was being investigated for metastatic squamous cell carcinoma (SCC) of the external auditory meatus. The scrotal lesion was initially thought to be metastatic SCC. It was later confirmed to be BCC with biopsy and histopathological examination. He underwent surgical resection of the scrotal BCC for local control followed by palliative chemotherapy with cisplatin and radiotherapy for lymph node metastases. He remained well and did not have any local recurrence following 6 months after palliative treatment. Surgery coupled with palliative chemoradiation can offer good quality of life for patients with scrotal BCC and concurrent metastatic SCC

Small Cell Neuroendocrine Tumour of Bladder: A Rare Entity and Review of the Literature

Small cell neuroendocrine cancer of the bladder (SCNCB) is a rare tumor with highly aggressive characteristics and poor differentiation. It comprises less than 1% of bladder malignancy and usually diagnosed at an advanced stage. It is challenging to differentiate between SCNCB with other bladder tumors as they had a similar presentation. We presented a case of a 60-year-old gentleman who presented with painless hematuria and ultrasound and cystoscopy examination show mass on the right urinary bladder wall. Computed tomography revealed urinary bladder mass with invasion to the prostate. Histopathological examination after transurethral resection of bladder tumor display features consistent with small cell neuroendocrine carcinoma with muscularis propria invasion, positive for synaptophysin, chromogranin A and p53 in immunohistochemistry. The patient currently underwent neoadjuvant chemotherapy with Etoposide and cisplatin for 4-cycles. We, with this, presented a rare case of SCNCB, along with a discussion on the clinical presentation, histological characteristics, management, and prognosis

Alum Irrigation for the Treatment of Intractable Haematuria

Managing intractable haematuria is a daunting task. One cause of this condition is radiationinduced haemorrhagic cystitis. Several treatments for the condition have been proposed and one non-invasive option is alum irrigation. Here, we report on a 65-year-old woman with intractable haematuria secondary to radiation cystitis who was successfully treated with alum irrigation. Alum irrigation is safe, well tolerated and relatively cheap. A review of the literature and a comprehensive discussion on alum irrigation as treatment for haematuria is discussed here to create an awareness regarding this treatment option

Relationship Between Serum Testosterone and Severity of Lower Urinary Tract Symptoms Among Malaysian Men

BackgroundLower urinary tract symptoms (LUTS) are commonly experienced among ageing males. The increasing prevalence of late-onset hypogonadism suggests a possible relationship between serum testosterone and severity of LUTS. This study examines the association between serum testosterone and severity of lower urinary tract symptoms among Malaysian men, as reflected by the International Prostate Symptom Score (IPSS). MethodA total of 163 men with LUTS were enrolled in a cross-sectional study in Hospital Canselor Tuanku Mukhriz, Malaysia. Full examination, IPSS, and serum total testosterone (TT) levels were evaluated. Categorical and continuous correlations were analyzed using chi-square test and age-adjusted Pearson’s partial correlation, respec t ively. ResultMean age was 66.25 (SD = 7.05), with mean serum TT of 16.74 nmol/L (SD = 6.32). Twenty eight percent (n = 46) had low testosterone levels. Severity of LUTS (mild, moderate, severe) was not found to be dependent on TT status (normal, low, severely low), (χ2 [4, N = 163] = 4.24, P = 0.37). Weak negative correlations between total IPSS and IPSS storage sub-score with serum TT levels were exhibited respectively (r = −0.17, P < 0.05; r = −0.17, P < 0.05). ConclusionAmong elderly Malaysian men, severity of LUTS and TT status were not found to be associated, despite a weak negative correlation between IPSS and serum testosterone levels. Nonetheless, with a high prevalence of hypogonadal ageing men, further research regarding serum testosterone measurement among this population may be valuable as part of a multimodal approach to treatment

Predicting Outcome of Trial of Voiding Without Catheter in Acute Urinary Retention with Intravesical Prostatic Protrusion

Background: Acute urinary retention (AUR) is one of the most serious complications of benign prostatic hypertrophy. This study was done to predict the outcome of trial of voiding without catheter (TWOC) in patients with AUR with intravesical prostatic protrusion (IPP) detected on transabdominal ultrasound. Other factors such as prostatic volume and patient’s age were also assessed. Method: Patients with a first episode of AUR secondary to benign prostatic hypertrophy were assessed with ultrasound following bladder catheterization. The IPP was measured and graded (grade 1 is 5 mm or less, grade 2 is 5–10 mm and grade 3 is more than 10 mm). Success of TWOC was then correlated with the degree of IPP. Results: A total of 32 patients with AUR were included in the study. Patients with grade 3 IPP were found to have a significant failure rate compared to grade 1 (P = 0.022) and grade 2 (P = 0.041). Conclusion: Intravesical prostatic protrusion is a useful predictor of success of TWOC in patients with AUR. Patients with grade 3 IPP on ultrasound would benefit from TWOC and warrant earlier definitive surgical treatment

Array comparative genomic hybridization analysis identified the chromosomal aberrations and putative genes involved in prostate tumorigenesis of Malaysian men

The identification of chromosomal aberrations in prostate cancer has been widely studied with several known oncogenes and tumor suppressor genes have successfully been discovered. The most frequent aberrations detected in western population were losses in chromosome 5q, 6q, 8p, 13q, 16q, 17p, 18q and gains of 7p/q and 8q. The purpose of this study was to determine the chromosomal aberrations among Malaysian men of Southeast Asia population and discover those potential genes within that chromosomal aberrant region. Thirty-six formalin-fixed paraffin embedded specimens consist of eight organ-confined prostate cancer cases, five with capsular invasion, 14 showed metastasis and nine cases had no tumor stage recorded, were analyzed by array CGH technique. Chromosomal losses were frequently detected at 4q, 6q, 8p, 13q, 18q while gains at 7q, 11q, 12p, 16q and 17q. Gain of 16q24.3 was statistically significant with tumor size. Gains of 6q25.1 and Xq12 as well as losses of 3p13-p1.2 and 13q33.1-q33.3 were significantly correlated with Gleason grade whereas 12p13.31 gain was associated with bone metastasis. Several potential genes have also been found within that aberrant region which is myopodin (4q26-q27), ROBO1 (3p13-p11.2), ERCC5 (13q33.1-q33.3) and CD9 (12p13.31), suggesting that these genes may play a role in prostate cancer progression. The chromosomal aberrations identified by array CGH analysis could provide important clues to discover potential genes associated with prostate tumorigenesis of Malaysian men

UKM medical graduates’ perception of their communication skills during housemanship

The art of talking to patients and their relatives does not come naturally to most of us and the ability to put oneself in the patients’ predicament is difficult particularly for the young doctors. To identify the communication abilities of the young doctors, a cross sectional study was carried out on 32 house officers who graduated from UKM in 2004 during their house jobs at different hospitals in Malaysia. A standardized questionnaire was used to collect the data. Fifty nine percent respondents claimed that they had communicated very well with patients while 69% with support staff and 88% with peers. On the other hand 38% and 41% of the respondents claimed they communicated very well with their superiors and families of patients. Only 22% of the graduates’ skills of communication in breaking bad news were very well, while 50% and 81% were very well in counselling patients and taking consent for procedures. Curriculum planners need to emphasize the importance of developing good communication skills in all aspects for the future doctor