A clinical appraisal of patients with psoriasis treated in Seremban General Hospital, Malaysia

A prospective clinical study of 181 patients with psoriasis seen in Seremban General Hospital showed the incidence of psoriasis among dermatology outpatients was 2.15%. A significantly higher proportion of male patients were affected, with a male to female ratio of 1.7:1. Within the racial groups; 63 were Malays, 37 Chinese, and 81 Indians. There was a significantly higher proportion of Indians affected as compared with the races. The mean age of patients in this study was 43.7 years old but the mean age of onset of psoriasis in these patients was 33.1 years old. Thirty-one (17.1%) patients gave a positive family history of psoriasis and the mean age of onset of psoriasis was lower (29.3 years old) for patients with a positive family history. Plaque psoriasis was the commonest type of clinical presentation with the scalp being the commonest site affected. Psoriatic arthropathy was seen in 35 (19.3%) patients. Ninety-five (52.5%) patients gave a positive history of factors exacerbating their pre-existing disease and stress was singled out as the most common exacerbating factor.     

Primary esophageal tuberculosis

A case of primary esophageal tuberculosis in a young male is hereby reported who presented with epigastric pain and dysphagia. An esophageal ulcer was seen at 29 cm level, and tuberculosis was confirmed by the presence of caseating granulomas and Langhan's giant cells. He responded well to antituberculous treatment.     

Childhood obesity and Pakistan

Obesity and overweight have become a problem of public health magnitude associated with substantial economic burden not only in the developed countries but also in the developing countries. The number of overweight children and adolescents has doubled in the last two decades in the United States and worldwide, including developing countries. No study on childhood obesity and overweight is available in Pakistan. Obesity in children impacts on their health in both short and long-term and obesity and its preventive strategies are poorly understood. Increasing number of these children and adolescents all over the world demand not only a substantial political will but also an investment for primary and secondary preventive measures and novel approaches in the treatment modalities.     

Malignant hyperthermia

Malignant hyperthermia refers to covert myopathies, which do not affect the individual during daily life activities, but may lead to life-threatening tachycardia, rigor, labile blood pressure and most importantly high-grade temperature when exposed to general anaesthesia. This conditions is mimicked by thyroid storm, neuroleptic malignant syndrome, phaeochromocytoma and sepsis. We present a presumptive case of malignant hyperthermia.     

Meckel's diverticulum causing exsanguinating haemorrhage

A seven month old male baby presented to emergency room in shock. Patient had 3 hours history of massive fresh bleeding per rectum. Emergency laparotomy revealed Meckel's diverticulum (MD) with large vitello-intestinal artery responsible for massive bleeding. Diverticulectomy was performed.     

The absence of factor V Leiden mutation in Malays with recurrent spontaneous abortions

OBJECTIVES: The objectives of this study were to investigate the prevalence of factor V Leiden mutation in Malay women with recurrent spontaneous abortion and to clarify the contribution of the factor V Leiden mutation to recurrent miscarriages in these women. DESIGN: A prospective case control study between June 1999 and April 2000. SETTING: Hospital University Science of Malaysia, Kubang Kerian, Kelantan, and Maternal and Child Health Clinic, Pasir Mas, Kelantan, Malaysia. SAMPLES: A total of 46 Malay women with a history of three or more first or second trimester miscarriages were studied. The control group consisted of 46 parous women without obstetric complications. METHODS: Diagnosis of factor V Leiden mutation was made by examination of factor V Leiden allele product following Mnl I digestion of factor V Leiden alleles amplified by polymerase chain reaction. RESULTS: None of the 46 women with recurrent spontaneous abortion carried the mutation. Also, we found no subject carrying the factor V Leiden alleles in the control group. CONCLUSION: These results suggest that that there is no association between the factor V Leiden mutation and recurrent spontaneous abortion in the Malay population.     

Risk factors for hemorrhage in severe dengue infections

The purpose of this study was to identify the early indicators of hemorrhage in severe dengue infections in 114 patients; 24 patients had severe hemorrhage and 92 had no hemorrhage. The platelet counts were not predictive of bleeding. The duration of shock (OR, 2.11; 95% CI, 1.13 to 3.92; P =.019) and low-normal hematocrit at the time of shock (OR, 0.72; 95% CI, 0.55 to 0.95; P =.020) were risk factors of severe hemorrhage.     

Psychological implications of hepatitis C virus diagnosis

BACKGROUND AND AIMS: Hepatitis C virus (HCV) diagnosis causes significant psychological stress and anxiety. We thought it would be important to illustrate the anxiety caused by HCV diagnosis in patients from the developing world. METHODS: This study was conducted at the Shifa International Hospital, Islamabad, between February 2004 and April 2004. All patients who were recently diagnosed with HCV (those who tested positive to anti-HCV and HCV polymerase chain reaction) were given a questionnaire that compared stress due to HCV infection with four other variables, including death of a close family member, divorce, loss of source of income and move to another city. We also analyzed the anxiety level among these patients using the Beck Anxiety Inventory (BAI). RESULTS: We studied 98 patients and 100 healthy controls. Thirty-one (31.63%) patients who were diagnosed with HCV presented only with fatigue. Sixty-three (64.28%) patients admitted that diagnosis of HCV interfered with their daily life in some way. Among the newly diagnosed cases, 48 (48.97%) patients had moderate to severe anxiety (BAI Class B and C). Multi-logistic regression analysis showed that anxiety was related to HCV-related stress (P < 0.002) and self-perceived severity of disease (P < 0.001). HCV diagnosis was significantly more stressful than divorce (59.87 vs 70.95; P < 0.013), loss of source of income (50.52 vs 70.80; P < 0.001), and a move to another city (28.32 vs 70.80; P < 0.001). CONCLUSIONS: Diagnosis with HCV is reported to be more stressful than divorce, loss of source of income and a move to another city.     

Extradural spinal cord and intraabdominal ganglioneuroblastoma

We report a rare case of a giant extradural and intraabdominal ganglioneuroblastoma in a young Malay girl who presented to a paediatrician initially at 5 days of life with a palpable abdominal mass. Unfortunately, the parents refused any form of surgical intervention until the child was 3 years old. She subsequently underwent vascular embolisation followed by the removal of this large tumour both via the abdomen and through a laminectomy approach and subsequently refused chemotherapy. The c-myc amplication in this patient was absent and there were no chromosomal aberrations, During the 2 year folow-up the patient remained well, and ambulatory with no tumour recurrence.