Clinical submission of supernumerary head of adducter brevis muscle

Adductor brevis is an important member of the adductor family occupying the medial compartment of the thigh executing the function of adduction and medial rotation. Deviations from normal anatomy are unusual and rarely reported. A survey of anatomical archives revealed occasional mention of additional bellies of adductor brevis muscle. The present study reports a double belly of adductor brevis muscle (AB) found during a cadaveric dissection class for medical students. The left sided AB displayed two bellies disposed in the same plane. This case report attempts to present the clinical applications of supernumerary bellies of this important adductor muscle of the thigh. It is feasible to categorize these muscular variations upon specialized radiological procedures such as CT and MRI scans only if the radiologist possesses satisfactory understanding of variant anatomy of this region. It is thereafter inferred that upon recognition these muscles present a fair chance of being of utilitised in reconstructions. A biomechanical overview of the present anomaly is also attempte

Solid waste management by considering composting potential in Malaysia toward a green country

Solid waste disposal has become a serious issue for country and municipal governments throughout the nation. As available landfill space decreases and the cost of siting and building new landfill increases, local authorities are struggling to develop alternative means of meeting the waste disposal challenge. Landfilling is the most widely used method for solid waste disposal in countries with tropical settlement. Landfills have created various environmental problems such as emissions and leachate. The public has become more aware concerning landfill issues such as increasing concern on the groundwater contamination, potential release of toxic gases and odor. A big part of these problems come from organic waste into the solid waste. Municipal solid waste in Malaysia has a large percent of food waste (around 50-60 percent) that makes a lot of problems in disposal methods. It has emerged as a potentially viable means by which local governments can reduce the volume of waste entering landfills by diverting the organic fraction. Composting is a biological process, in which the organic matter is biodegraded by microorganisms under controlled conditions of temperature, moisture content, oxygen, PH and the retention time that can be initiated by mixing biodegradable organic matter with bulking agents to enhance the porosity of the mixture. In this study, a composting plant in Malaysia is considered that uses organic waste from the market (market waste). Five tons organic waste per day is received in the plant, and it is treated by the wind raw composting method. After calculating costs and benefits of this method result shows that total quantitative benefit of this plant is not much higher than a total quantitative cost but this result is just for quantitative parameter. This method has a lot of qualitative benefits such as: reducing the amount of municipal solid waste, transportation cost of carrying municipal solid waste to land fill, emissions and leachate of landfill, increasing life span of landfill and reducing land use. Composting organic materials that have been diverted from landfills ultimately avoids the production of methane and leachate formulation in the landfills regarding to 50 percent of organic waste in municipal solid waste of Malaysia. With removing this amount of waste from MSW with using composting method, not only the environmental problems of land filling can be reduced but also the costs of transportation and other costs of disposal can be reduced by 50%. Because of one of the most important problems in tropical settlement is to find proper methods to dispose of municipal solid waste toward decreasing pollution, producing compost can be a suitable way but expanding of this treatment method in Malaysia closely related to economic governmental support

Infantile acute megakaryoblastic leukaemia with T(1:22) in a non-down syndrome child.

Megakaryoblastic leukaemia is the commonest form of leukaemia occuring in Down syndrome infants. However, it’s subtype with translocation t(1;22)(p13;q13)is uncommon comprising <1% of all cases and reported to exclusively occur in infant without Down syndrome. It has a female predominance and carries apoor prognosis. We described this rare form of leukaemia in a 9-month-old girl who presented with bruises, massive hepatosplenomegaly and multiple cervical and inguinal lymphadenopathy. The blood film showed severe anaemia with ovalostomatocytosis, thrombocytopenia and mild leucocytosis. The bone marrow aspirate showed numerous blasts showing high nuclear-cytoplasmic ratio and agranular cytoplasm with cytoplasmic blebs. Peroxidase staining was negative. The immunophenotyping of the blasts showed positive expression of CD117, CD13, CD33 and CD61 which confirmed the diagnosis of acute megakaryoblastic leukaemia. Interestingly, the cytogenetic finding of translocation t(1;22) which is most common in acute megaloblastic leukaemia in infants without Down syndrome was found in this case. She received the AML trial 15 ADE protocol chemotherapy regime and developed severe neutropenic sepsis and respiratory distress requiring ventilatory support and granulocyte colony stimulating factor (G-CSF). She recovered wellmafter the first course of chemotherapy and was discharged. Unfortunately, she was not brought in for follow-up chemotherapy and presented a few months later with relapsed AML. She was re-started on ADE protocol and currently is on oral thioguanine for maintenance therapy

Concomitant t(8;21) and trisomy 4 in a patient with Acute Myeloid Leukemia (AML)

The t(8;21)(q22;q22) is a frequently occurring aberration in acute myeloid leukemia (AML) (18-20%) and usually correlate with French-America-British (FAB) M2 subtype. Several studies showed that patients carrying this abnormality demonstrated good response to standard chemotherapy but also have a high incidence of disease relapse. Trisomy 4 is a rare and specific chromosomal abnormality occurring in AML M2 or M4 of the FAB subtypes. We report a case of a 33-year-old female with an apparently clinical and hematologic diagnosis of acute promyelocytic leukemia (APL) in whom cytogenetic analysis revealed an abnormal karyotype with trisomy 4, in addition to t(8;21). Trisomy 4 and t(8;21) in a patient with AML is rare. The significance of t(8;21) with trisomy 4 in AML are unclear but patients bearing this abnormality are associated with a poor prognosis

Dietry and lifestyle changes of Malaysia breast cancer survivors: a qualitative study

Objective : This study was performed to determine changes in diet and lifestyle among breast cancer survivors in Malaysia. Methods : This was a qualitative study done on fifteen survivors (8 Malays and 7 non-Malays) obtained from the Oncology and Surgery Department, National University of Malaysia Hospital. The study was conducted using a semi-structured interview format. The data obtained were sorted into various categories via content analysis. Results : Majority of breast cancer survivors increased their fruit and vegetable intake following diagnosis. Some non-Malays changed to vegetarian whereas all the Malays remained on the same dietary pattern. As far as exercise was concerned, all Malays did not exercise before diagnosis, but did so after diagnosis, whereas most of non-Malays did not exercise either before or after diagnosis. Conclusion : Some changes were noticed in dietary and lifestyle behaviors after diagnosis among some survivors. The differences were due to their different cultural and religious backgrounds

Chest wall stretching exercise as an adjunct modality in post operative pulmonary management.

Emphysematous pyelonephritis is a form of infection of the kidney. Chest physiotherapy was executed on a 15-year-old girl who had complications such as secretion retention and pleural effusion following percutaneous pigtail nephrostomy in addition to oxygen therapy and medical management to promote respiratory functions. The processes to increase chest wall mobility includes particular passive stretching and mobilization. Chest mobility exercises composed of an intercostal stretch on a determined intercostal space using index fingers, thoracic rotation and anterior compression with stretching in sitting position to improve respiratory functions. These exercises were suggested to the patient as a regular daily treatment along with low-level incentive spirometry breathing exercises. Following 9th sessions of treatment patient demonstrated satisfactory improvement by means of increasing in chest expansion and reduction in dyspnea level without using supplemental oxygen. The results expressed a substantial clinical improvement in reduction of dyspnea level and improvement in chest expansion

Lower Erythrocyte GST activity in Autism Spectrum Disorder (ASD) patients compared to normal controls

Glutathione S-transferases (GST) are antioxidant enzymes that play an important role in the cellular detoxification and excretion of environmental pollutants including heavy metals. GST mu (GSTM1) and G theta (GSTT1) are known to be highly polymorphic and homozygous deletions of these genes result in the lack of enzyme activity and when combined with decreased levels of antioxidants, they have been associated with the Autism Spectrum Disorder (ASD). This preliminary study was performed to investigate the role of GSTM1 and GSTT1 polymorphisms as risk factors of ASD associated with GST activity and phenotype expression. Fifty one ASD patients and 45 controls were recruited for GSTM1 and GSTT1 genotyping while 6 ASD patients and 8 controls were assessed for GST activity. The results showed no significant differences in frequencies of GSTM1 null, GSTT1 null and combination both genotype between ASD patients and controls. However the mean erythrocyte GST activity in ASD is significantly decreased compared with controls (p = 0.043). The mean erythrocyte GST activity is lower in the severely autistic group compare to the mild to moderately autistic group, although it was not statistically significant. Further investigations are needed with a bigger sample size, analyzing multiple GST genes and GST activity determination to find out the gene susceptibility of ASD and factors that contribute to the phenotype expression of ASD

Unusual formation and sub-omohyoid course of external jugular vein.

Variations in the origin and termination of external jugular vein are common and are reported in the past. However, variations in the course of external jugular vein are uncommon. During routine dissection classes for medical undergraduates, we came across the unusual formation and course of right external jugular vein and absence of common facial vein, in an approximately 60-year-old male cadaver of Indian origin. External jugular vein was formed by the continuation of undivided trunk of retromandibular vein. Following its formation, it passed vertically superficial to sternocleidomastoid muscle to the lower part of occipital triangle. In the occipital triangle it pierced the investing layer of deep cervical fascia and passed deep to the inferior belly of omohyoid muscle and coursed through the subclavian triangle. Then, it terminated at the junction of subclavian vein with internal jugular vein. Facial vein joined with submental vein and finally drained into internal jugular vein. Further, the posterior auricular vein and anterior jugular veins were absent. Knowledge about the variations of the retromandibular vein, common facial vein and external jugular vein observed in this study, may be important for the surgeons, to prevent inadvertent injury and excessive bleeding during diagnostic and therapeutic procedures

The impact of socio-economic factors on small business success

Small enterprises play a vital role in economic development as they can provide the economy with efficiency, innovation, competition and employment. Entrepreneurs are responsible for the success of their businesses and have to face up with definite challenges in doing so. To know what constitute critical determinants of small business success data were collected from 60 randomly selected respondents in the Dera Ismail Khan district, Khyber Pakhtunkhawa, Pakistan, who were administered with structured questionnaires. Regression analyses of the findings showed the positive and significant impact factors of investment, entrepreneurial experience, business profile and culture with R2=0.638 and F= 11.222. The provision of ample opportunities to develop skills for business enhancement is suggested as the rational way forward