Florencia Wirawan, Ronald E. Pakasi, Muthia Mukharoma, Andre Maharadja
Background and aim: Spinal tuberculosis (STB) is a hazardous type of bone tuberculosis that could affect the entire spine, with predilection towards the lower thoracic level. Upper cervical spondylitis occurred only at 0.3 – 1% of all STB cases, but this rare type leads to severe consequences, including tetraplegia, autonomic dysfunction, and respiratory impairment. This case reported long CTLSO rigid external stabilisation reasoning to boost protection whilst recovering tuberculosis despite stable internal stabilisation. Methods: A 34-year-old male came with one year of worsening low-back pain, unintentional weight loss, and gradual loss of power and sensation of both feet within a month. Physical examination showed kyphotic deformity, tenderness, key-muscle-strength 3, and sensory impairment for lower extremities, with no autonomic disturbances. Laboratory works showed chronic ongoing infection. Whole-spine MRI showed multiple spondylodiscitis with multi-focal paravertebral abscesses at C3 – C5, C7 – T3, T9 – T12, L1, severe canal stenosis and anterior segment destruction of T12. Results: The patient was diagnosed with SCI AIS D with a neurological level of L3 secondary to T12 vertebra destruction from STB. He underwent abscess evacuation, debridement, and posterior stabilisation at T10 – L3 and debridement of abscess at C3 – C5 without the need for stabilisation. After procedures, the spine was further stabilised by a CTSLO brace with flexion, extension, lateral flexion, rotation stop. Inward rehabilitation includes incremental mobilisation, upper-limb-extensor-group-strengthening-programme, balance-exercise with ambulation training. Patient discharged with status: ambulate independently with a walker. To date, the patient has returned to work with independent ambulation. Conclusion: Type-III STB was indicated for surgical procedures. Instability of upper cervical prevented patient to performed loadbearing activity thus lowering patient functional outcomes. CTLSO supplementation was given to compensate for 3 lesion sites, the upper cervical, mid-thoracic, and lower-thoracic. For the C3 – C5 lesion, there was no internal stabilisation, so a proper external mode of stabilisation should be given. However, for the thoracic level, CTLSO was given due to (1) incomplete SCI lesion in the absence of deteriorating neurological deficit,c(2) porous nature of STB, and (3) good prognostic recovery of STB with anti-TB medication leading to the reversible neurological deficit.
{"title":"Long Cervicothoracolumbal Rigid Bracing Stabilization on Incomplete Spinal Cord Injury of Post-Operated Multi-Focal Upper Cervical-Thoracic Spinal Tuberculosis: A Unique Case Report","authors":"Florencia Wirawan, Ronald E. Pakasi, Muthia Mukharoma, Andre Maharadja","doi":"10.51200/bjms.vi.3744","DOIUrl":"https://doi.org/10.51200/bjms.vi.3744","url":null,"abstract":"Background and aim: Spinal tuberculosis (STB) is a hazardous type of bone tuberculosis that could affect the entire spine, with predilection towards the lower thoracic level. Upper cervical spondylitis occurred only at 0.3 – 1% of all STB cases, but this rare type leads to severe consequences, including tetraplegia, autonomic dysfunction, and respiratory impairment. This case reported long CTLSO rigid external stabilisation reasoning to boost protection whilst recovering tuberculosis despite stable internal stabilisation. Methods: A 34-year-old male came with one year of worsening low-back pain, unintentional weight loss, and gradual loss of power and sensation of both feet within a month. Physical examination showed kyphotic deformity, tenderness, key-muscle-strength 3, and sensory impairment for lower extremities, with no autonomic disturbances. Laboratory works showed chronic ongoing infection. Whole-spine MRI showed multiple spondylodiscitis with multi-focal paravertebral abscesses at C3 – C5, C7 – T3, T9 – T12, L1, severe canal stenosis and anterior segment destruction of T12. Results: The patient was diagnosed with SCI AIS D with a neurological level of L3 secondary to T12 vertebra destruction from STB. He underwent abscess evacuation, debridement, and posterior stabilisation at T10 – L3 and debridement of abscess at C3 – C5 without the need for stabilisation. After procedures, the spine was further stabilised by a CTSLO brace with flexion, extension, lateral flexion, rotation stop. Inward rehabilitation includes incremental mobilisation, upper-limb-extensor-group-strengthening-programme, balance-exercise with ambulation training. Patient discharged with status: ambulate independently with a walker. To date, the patient has returned to work with independent ambulation. Conclusion: Type-III STB was indicated for surgical procedures. Instability of upper cervical prevented patient to performed loadbearing activity thus lowering patient functional outcomes. CTLSO supplementation was given to compensate for 3 lesion sites, the upper cervical, mid-thoracic, and lower-thoracic. For the C3 – C5 lesion, there was no internal stabilisation, so a proper external mode of stabilisation should be given. However, for the thoracic level, CTLSO was given due to (1) incomplete SCI lesion in the absence of deteriorating neurological deficit,c(2) porous nature of STB, and (3) good prognostic recovery of STB with anti-TB medication leading to the reversible neurological deficit.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79422831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This special issue is dedicated to the Borneo International Spinal Cord Injury (SCI) Rehabilitation Conference (BISCIR) which was held on 30th July – 1st August 2021 through a virtual platform. It was co-organized by the Department of Rehabilitation Medicine, Queen Elizabeth Hospital, and Rehabilitation Medicine Unit, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah in partnership with Docquity and Kelab Perubatan Rehabilitasi Sabah. Attended by almost 500 delegates from Southeast Asian countries including the hosting country of Malaysia, the conference served its purpose as a global sharing platform by having invited local and international experts from Thailand, the Philippines, India, South Korea, and Australia. With the theme “SCI Rehabilitation: Basics and Beyond”, there was a great opportunity for participating delegates to submit their abstracts for oral and poster competition on spinal cord-related disorders and their rehabilitation. The covered areas include but are not exhaustive to the spinal cord pathophysiology, disease presentations, complications, and management, as well as rehabilitation interventions. Each submitted abstract was double-blinded peer-reviewed by two external reviewers. A total of 15 abstracts were accepted after rigorous review based on objective judging criteria, with seven and eight abstracts as oral and poster submissions respectively. Most of them were case reports with four cross-sectional studies and one review article. “Managing Tetraplegia with Blindness: Rehabilitation Approach” presented the improvement in mobility and daily living skills through orientation and mobility training with sensory education and repeated verbal instructions for compensating the loss of visual and sensory feedback. The “International Lower Urinary Tract Function Data Set: A Study in SCI Population in HRC” reviews the epidemiology of spinal cord injury patients with the neurogenic bladder in the largest rehabilitation hospital in Malaysia. “Navigating Neurological Recovery with NeuroAiD in Severe Spinal Cord Injury: A Noteworthy Novelty?” reported a case of complete tetraplegia who regained some neurological recovery following NeuroAiD supplementation. “A Case of Incomplete Spinal Cord Injury Associated with Brown Sequard Syndrome After Cervical Blunt Trauma with Atlanto-Axial Rotatory Subluxation in a Paediatric Patient” exhibited a case of a paediatric patient with high cervical spinal cord injury secondary to blunt trauma that has resulted in atlantoaxial rotatory subluxation. The “Long Cervicothoracolumbal Rigid Bracing Stabilization on Incomplete Spinal Cord Injury of Post-Operated Multi-Focal Upper Cervical-Thoracic Spinal Tuberculosis: A Unique Case Report” showed that the use of long CTLSO rigid external stabilization justifies the reason to boost protection while recovering from spinal tuberculosis despite receiving stable internal stabilization. “Orthotic Intervention for Ageing Individuals
{"title":"Spinal Cord Injury Rehabilitation: Basics and Beyond","authors":"Fatimah Ahmedy, Khin Nyein Yin, Sadia Choudury Shimmi","doi":"10.51200/bjms.vi.3708","DOIUrl":"https://doi.org/10.51200/bjms.vi.3708","url":null,"abstract":"This special issue is dedicated to the Borneo International Spinal Cord Injury (SCI) Rehabilitation Conference (BISCIR) which was held on 30th July – 1st August 2021 through a virtual platform. It was co-organized by the Department of Rehabilitation Medicine, Queen Elizabeth Hospital, and Rehabilitation Medicine Unit, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah in partnership with Docquity and Kelab Perubatan Rehabilitasi Sabah. Attended by almost 500 delegates from Southeast Asian countries including the hosting country of Malaysia, the conference served its purpose as a global sharing platform by having invited local and international experts from Thailand, the Philippines, India, South Korea, and Australia. With the theme “SCI Rehabilitation: Basics and Beyond”, there was a great opportunity for participating delegates to submit their abstracts for oral and poster competition on spinal cord-related disorders and their rehabilitation. The covered areas include but are not exhaustive to the spinal cord pathophysiology, disease presentations, complications, and management, as well as rehabilitation interventions. Each submitted abstract was double-blinded peer-reviewed by two external reviewers. A total of 15 abstracts were accepted after rigorous review based on objective judging criteria, with seven and eight abstracts as oral and poster submissions respectively. Most of them were case reports with four cross-sectional studies and one review article. “Managing Tetraplegia with Blindness: Rehabilitation Approach” presented the improvement in mobility and daily living skills through orientation and mobility training with sensory education and repeated verbal instructions for compensating the loss of visual and sensory feedback. The “International Lower Urinary Tract Function Data Set: A Study in SCI Population in HRC” reviews the epidemiology of spinal cord injury patients with the neurogenic bladder in the largest rehabilitation hospital in Malaysia. “Navigating Neurological Recovery with NeuroAiD in Severe Spinal Cord Injury: A Noteworthy Novelty?” reported a case of complete tetraplegia who regained some neurological recovery following NeuroAiD supplementation. “A Case of Incomplete Spinal Cord Injury Associated with Brown Sequard Syndrome After Cervical Blunt Trauma with Atlanto-Axial Rotatory Subluxation in a Paediatric Patient” exhibited a case of a paediatric patient with high cervical spinal cord injury secondary to blunt trauma that has resulted in atlantoaxial rotatory subluxation. The “Long Cervicothoracolumbal Rigid Bracing Stabilization on Incomplete Spinal Cord Injury of Post-Operated Multi-Focal Upper Cervical-Thoracic Spinal Tuberculosis: A Unique Case Report” showed that the use of long CTLSO rigid external stabilization justifies the reason to boost protection while recovering from spinal tuberculosis despite receiving stable internal stabilization. “Orthotic Intervention for Ageing Individuals","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"300 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76362580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and aim: Orthostatic hypotension is a known complication of spinal cord injury, especially in individuals with tetraplegia and thoracic paraplegia. It is triggered by tilting the patient upright and often easily reversed by removing the precipitating factors. The salt tablet is an old medical supplement that works as a blood volume expander by retaining water. We present a case of intractable orthostatic hypotension in incomplete tetraplegia, which resolved after the initiation of salt tablets. Methods: The patient was a 58-year-old gentleman with background hypertension who presented with neck pain following an aggressive neck massage, associated with progressive limb weakness, for six days duration. He developed urinary and bowel retention one day before the presentation. Urgent MRI scan revealed blunt injury at cervical spine with contusion of the cervical spinal cord, epidural haematoma, and contusion of prevertebral soft tissue from C4 till C6 spinal level. He was treated conservatively with steroids. In the rehabilitation ward, the patient developed multiple syncopal episodes during tilt table exercises. The perpetuating factors were antihypertensive medications, anaemia, and urinary tract infection, which resulted in polyuria and electrolyte imbalances. The orthostatic hypotension persisted, despite optimising fluid intake, treating underlying medical issues, removing triggers, and adopting additional measures such as abdominal binder and elastic stockings. Results: Following the initiation of salt tablets 1 gram TDS, the syncopal attacks gradually resolved. The patient tolerated the tilt table exercises until 90° elevation and subsequently progressed into sitting in the wheelchair for an extended period. The patient was completely free of syncope at discharge and required minimal assistance to perform stand transfer to the wheelchair. Conclusion: Orthostatic hypotension is a treatable barrier to progress in spinal cord injury rehabilitation. Therefore, simple, cheap, and easily accessible treatment options such as salt tablets should be considered in intractable cases.
{"title":"A Pinch of Salt Won’t Kill: The Role of Salt Tablets in Reversing Intractable Orthostatic Hypotension in an Incomplete Tetraplegic Patient","authors":"Muhamad Faizal Zainudin, Alicia Dixie Abraham, Mohd Razali Hasim, Nurul Diyanah Zenian","doi":"10.51200/bjms.vi.3748","DOIUrl":"https://doi.org/10.51200/bjms.vi.3748","url":null,"abstract":"Background and aim: Orthostatic hypotension is a known complication of spinal cord injury, especially in individuals with tetraplegia and thoracic paraplegia. It is triggered by tilting the patient upright and often easily reversed by removing the precipitating factors. The salt tablet is an old medical supplement that works as a blood volume expander by retaining water. We present a case of intractable orthostatic hypotension in incomplete tetraplegia, which resolved after the initiation of salt tablets. Methods: The patient was a 58-year-old gentleman with background hypertension who presented with neck pain following an aggressive neck massage, associated with progressive limb weakness, for six days duration. He developed urinary and bowel retention one day before the presentation. Urgent MRI scan revealed blunt injury at cervical spine with contusion of the cervical spinal cord, epidural haematoma, and contusion of prevertebral soft tissue from C4 till C6 spinal level. He was treated conservatively with steroids. In the rehabilitation ward, the patient developed multiple syncopal episodes during tilt table exercises. The perpetuating factors were antihypertensive medications, anaemia, and urinary tract infection, which resulted in polyuria and electrolyte imbalances. The orthostatic hypotension persisted, despite optimising fluid intake, treating underlying medical issues, removing triggers, and adopting additional measures such as abdominal binder and elastic stockings. Results: Following the initiation of salt tablets 1 gram TDS, the syncopal attacks gradually resolved. The patient tolerated the tilt table exercises until 90° elevation and subsequently progressed into sitting in the wheelchair for an extended period. The patient was completely free of syncope at discharge and required minimal assistance to perform stand transfer to the wheelchair. Conclusion: Orthostatic hypotension is a treatable barrier to progress in spinal cord injury rehabilitation. Therefore, simple, cheap, and easily accessible treatment options such as salt tablets should be considered in intractable cases.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72754162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anis Afikah Ismail, Muhammad Hafiz Hanafi, Al Hafiz Ibrahim
Background and aim: Autonomic dysreflexia (AD) is an uncommon yet life-threatening and preventable condition. AD classically presents with hypertension, headache, bradycardia, flushing of the face, diaphoresis, malaise, nausea, and blurring of vision. One of the trigger factors is the neurogenic bowel. This clinical report highlights the use of fleet enema in spinal cord injured patients that can cause autonomic response and lead to severe complications. Methods: A 33-year-old man with 3 months post-traumatic Cervical 5 AIS (American Spinal Injury Association) B was admitted for active rehabilitation. Despite the use of tablet Bisacodyl, his neurogenic bowel remains unregulated. Consequently, he was given a fleet enema for bowel programme management and successfully been regulated. On the next bowel day, he presented with sudden onset of blurring of vision and light-headedness after given fleet enema, accompanied by marked elevation of blood pressure, ranging from 130 – 140/ 90 – 100 mmHg (baseline during admission 80 – 90/ 50 – 60 mmHg) with a heart rate 50 – 60 bpm. The condition worsened as 20 minutes later, he developed a sudden generalised tonic-clonic seizure for 10 seconds, which aborted spontaneously. Results: Pre-ictal blood pressure significantly showed a more significant rise in the SBP, up to 40 mmHg. Computed tomography (CT) brain revealed no abnormality. A series of infection markers pre- and post-event showed normal value. However, the result of metabolic level post-event appeared to be higher in phosphate level 1.80 mmol/L, low calcium level 2.0 mmol/L, and borderline high level of sodium 146 mmol/L. Conclusion: This case illustrates the usage of fleet enema can cause AD, as it has been reported that it may irritate the bowel. Hence, a seizure is also a part of AD complications. On top of that, it also led to an electrolytes imbalance which triggered the seizure. Fleet enema, which contains monobasic sodium phosphate, may result in electrolytes imbalances such as hyperphosphataemia, hypernatraemia, and hypocalcaemia. This needs to be highlighted the proper use of fleet enema in neurogenic bowel management.
{"title":"Fleet Enema-Induced Autonomic Dysreflexia in a Spinal Cord Injured Patient","authors":"Anis Afikah Ismail, Muhammad Hafiz Hanafi, Al Hafiz Ibrahim","doi":"10.51200/bjms.vi.3753","DOIUrl":"https://doi.org/10.51200/bjms.vi.3753","url":null,"abstract":"Background and aim: Autonomic dysreflexia (AD) is an uncommon yet life-threatening and preventable condition. AD classically presents with hypertension, headache, bradycardia, flushing of the face, diaphoresis, malaise, nausea, and blurring of vision. One of the trigger factors is the neurogenic bowel. This clinical report highlights the use of fleet enema in spinal cord injured patients that can cause autonomic response and lead to severe complications. Methods: A 33-year-old man with 3 months post-traumatic Cervical 5 AIS (American Spinal Injury Association) B was admitted for active rehabilitation. Despite the use of tablet Bisacodyl, his neurogenic bowel remains unregulated. Consequently, he was given a fleet enema for bowel programme management and successfully been regulated. On the next bowel day, he presented with sudden onset of blurring of vision and light-headedness after given fleet enema, accompanied by marked elevation of blood pressure, ranging from 130 – 140/ 90 – 100 mmHg (baseline during admission 80 – 90/ 50 – 60 mmHg) with a heart rate 50 – 60 bpm. The condition worsened as 20 minutes later, he developed a sudden generalised tonic-clonic seizure for 10 seconds, which aborted spontaneously. Results: Pre-ictal blood pressure significantly showed a more significant rise in the SBP, up to 40 mmHg. Computed tomography (CT) brain revealed no abnormality. A series of infection markers pre- and post-event showed normal value. However, the result of metabolic level post-event appeared to be higher in phosphate level 1.80 mmol/L, low calcium level 2.0 mmol/L, and borderline high level of sodium 146 mmol/L. Conclusion: This case illustrates the usage of fleet enema can cause AD, as it has been reported that it may irritate the bowel. Hence, a seizure is also a part of AD complications. On top of that, it also led to an electrolytes imbalance which triggered the seizure. Fleet enema, which contains monobasic sodium phosphate, may result in electrolytes imbalances such as hyperphosphataemia, hypernatraemia, and hypocalcaemia. This needs to be highlighted the proper use of fleet enema in neurogenic bowel management.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"116 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74269814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Subcutaneous emphysema (SE) occurs when there is a trapping of air under the skin due to leakage either from the gastrointestinal or respiratory tract. SE is commonly associated with procedural complications such as chest tube insertion, cardiothoracic surgery; as well as barotrauma, infection and malignancy. The majority of SE resolve spontaneously without any active intervention. However, it is a medical emergency as SE may spread and compromise the airway. Various interventions had been described in other literature. We would like to illustrate a case of extensive SE one day after chest tube insertion for secondary spontaneous pneumothorax, successfully relieved by usage of cannulas and low-grade pressure suction.
{"title":"Management of Bilateral Extensive Subcutaneous Emphysema","authors":"Kee Nam Tan, Yon Lek Yap, Qin Jian Low","doi":"10.51200/bjms.vi.3301","DOIUrl":"https://doi.org/10.51200/bjms.vi.3301","url":null,"abstract":"Subcutaneous emphysema (SE) occurs when there is a trapping of air under the skin due to leakage either from the gastrointestinal or respiratory tract. SE is commonly associated with procedural complications such as chest tube insertion, cardiothoracic surgery; as well as barotrauma, infection and malignancy. The majority of SE resolve spontaneously without any active intervention. However, it is a medical emergency as SE may spread and compromise the airway. Various interventions had been described in other literature. We would like to illustrate a case of extensive SE one day after chest tube insertion for secondary spontaneous pneumothorax, successfully relieved by usage of cannulas and low-grade pressure suction.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88553918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic spontaneous urticaria is characterized by recurrent urticaria with or without angioedema for more than six weeks with no apparent external triggers. It affects up to one per cent of the general population and it is common in primary care settings or emergency services. Chronic spontaneous urticaria can be debilitating, difficult to treat, and frustrating for patients and doctors. Here, we described our experience of treating five patients with recalcitrant chronic spontaneous urticaria. Through this short communication, we would like to increase awareness of the general treatment approach to chronic spontaneous urticaria in primary care and specialist services.
{"title":"A Disease That Can Be Debilitating: Chronic Spontaneous Urticaria","authors":"Lim Tzyy Huei, Low Qin Jian, Cheo Seng Wee, Mak Woh Wei, Evelyn Yap Wen Yee","doi":"10.51200/bjms.vi.2923","DOIUrl":"https://doi.org/10.51200/bjms.vi.2923","url":null,"abstract":"Chronic spontaneous urticaria is characterized by recurrent urticaria with or without angioedema for more than six weeks with no apparent external triggers. It affects up to one per cent of the general population and it is common in primary care settings or emergency services. Chronic spontaneous urticaria can be debilitating, difficult to treat, and frustrating for patients and doctors. Here, we described our experience of treating five patients with recalcitrant chronic spontaneous urticaria. Through this short communication, we would like to increase awareness of the general treatment approach to chronic spontaneous urticaria in primary care and specialist services.\u0000 ","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85837888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is spreading worldwide and becomes a major cause of mortality. In addition to major pathology in lungs such as pneumonia or respiratory failure, multiorgan failure and frequently haematological disorders such as thromboembolic manifestations are leading causes of mortality. This study reviews the interaction of the immune system with target cells, the role of cytokines and other components such as complements encountered in the pathophysiology of major disease processes and possible post-recovery complications. Although there are some clinical effects induced by strong immune reactions, long term immunity against the virus is found in the majority.
{"title":"Immune System in COVID-19: Is It Temporarily Defeated While Conquering?","authors":"Aye Aye Wynn, Nang Khin Mya, T. Thein","doi":"10.51200/bjms.vi.3210","DOIUrl":"https://doi.org/10.51200/bjms.vi.3210","url":null,"abstract":"Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is spreading worldwide and becomes a major cause of mortality. In addition to major pathology in lungs such as pneumonia or respiratory failure, multiorgan failure and frequently haematological disorders such as thromboembolic manifestations are leading causes of mortality. This study reviews the interaction of the immune system with target cells, the role of cytokines and other components such as complements encountered in the pathophysiology of major disease processes and possible post-recovery complications. Although there are some clinical effects induced by strong immune reactions, long term immunity against the virus is found in the majority.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86180085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohd Nazri Shafei, Mohamad Azfar Zainuddin, Nor Azwany Yaacob, Zahiruddin Wan Mohammad, Nabilah Awang, Siti Asma’ Hassan, Fairuz Amran, Aziah Daud
Leptospirosis is speculated to be one of the most prevalent re-emerging zoonotic diseases to date, and town service workers are continuously exposed to occupational hazards that may increase their risk of infection. This study aimed to determine the occupational risk factors for leptospirosis among town service workers in northeastern Malaysia. A cross-sectional study was conducted among town service workers from four municipal councils. All sera samples were tested for the presence of anti-leptospiral antibodies using an enzyme-linked immunosorbent assay (ELISA) followed by a microscopic agglutination test (MAT). We found that 82 serum samples from 321 respondents were positive in the MAT (seroprevalence rate of 25.5%). Multiple logistic regression analysis identified overtime work (adj. OR 2.13; 95% CI 1.19, 3.84), contact with animals while working (adj. OR 2.09; 95% CI 1.06, 4.11), sighting of rats at the worksite (adj. OR 2.17; 95% CI 1.11, 4.25) and living less than 200 m from a river (adj. OR 1.84; 95% CI 1.03, 3.28) as risk factors for leptospiral infection. Whereas age (adj. OR 0.95; 95% CI 0.93, 0.98), wearing boots while working (adj. OR 0.44; 95% CI 0.25, 0.80) and washing hands with soap after work (adj. OR 0.20; 95% CI 0.10, 0.42) were recognised as protective factors. In conclusion, an association was observed between leptospirosis seropositivity among town service workers and the occupational factors. Prevention and control strategies for leptospirosis will require more focus on curbing the possible sources of leptospirosis transmission and maintaining safe work practices in high-risk working environments.
据推测，钩端螺旋体病是迄今为止最普遍的再次出现的人畜共患疾病之一，城镇服务工作者持续暴露于可能增加其感染风险的职业危害中。本研究旨在确定马来西亚东北部城镇服务人员钩端螺旋体病的职业危险因素。对来自四个市议会的城市服务人员进行了一项横断面研究。采用酶联免疫吸附试验(ELISA)和显微凝集试验(MAT)检测所有血清样本是否存在抗钩端螺旋体抗体。我们发现321名应答者的82份血清样本MAT阳性(血清阳性率为25.5%)。多元逻辑回归分析发现加班(adj. OR 2.13;95% CI 1.19, 3.84)，工作时接触动物(OR 2.09;95% CI 1.06, 4.11)，在工作场所发现大鼠(OR 2.17;95%可信区间1.11,4.25)，居住在距离河流不到200米的地方(形容词OR 1.84;95% CI 1.03, 3.28)为钩端螺旋体感染的危险因素。而年龄(adj. OR 0.95;95% CI 0.93, 0.98)，工作时穿靴子(形容词OR 0.44;95%置信区间为0.25,0.80)和下班后用肥皂洗手(相对值或比值为0.20;95% CI 0.10, 0.42)被认为是保护因素。综上所述，城镇服务人员钩端螺旋体病血清阳性率与职业因素存在相关性。钩端螺旋体病的预防和控制战略将需要更加注重遏制钩端螺旋体病可能的传播来源，并在高风险工作环境中保持安全的工作做法。
{"title":"Occupational Risk Factors for Seropositive Leptospirosis among Town Service Workers in Northeastern Malaysia","authors":"Mohd Nazri Shafei, Mohamad Azfar Zainuddin, Nor Azwany Yaacob, Zahiruddin Wan Mohammad, Nabilah Awang, Siti Asma’ Hassan, Fairuz Amran, Aziah Daud","doi":"10.51200/bjms.vi.3139","DOIUrl":"https://doi.org/10.51200/bjms.vi.3139","url":null,"abstract":"Leptospirosis is speculated to be one of the most prevalent re-emerging zoonotic diseases to date, and town service workers are continuously exposed to occupational hazards that may increase their risk of infection. This study aimed to determine the occupational risk factors for leptospirosis among town service workers in northeastern Malaysia. A cross-sectional study was conducted among town service workers from four municipal councils. All sera samples were tested for the presence of anti-leptospiral antibodies using an enzyme-linked immunosorbent assay (ELISA) followed by a microscopic agglutination test (MAT). We found that 82 serum samples from 321 respondents were positive in the MAT (seroprevalence rate of 25.5%). Multiple logistic regression analysis identified overtime work (adj. OR 2.13; 95% CI 1.19, 3.84), contact with animals while working (adj. OR 2.09; 95% CI 1.06, 4.11), sighting of rats at the worksite (adj. OR 2.17; 95% CI 1.11, 4.25) and living less than 200 m from a river (adj. OR 1.84; 95% CI 1.03, 3.28) as risk factors for leptospiral infection. Whereas age (adj. OR 0.95; 95% CI 0.93, 0.98), wearing boots while working (adj. OR 0.44; 95% CI 0.25, 0.80) and washing hands with soap after work (adj. OR 0.20; 95% CI 0.10, 0.42) were recognised as protective factors. In conclusion, an association was observed between leptospirosis seropositivity among town service workers and the occupational factors. Prevention and control strategies for leptospirosis will require more focus on curbing the possible sources of leptospirosis transmission and maintaining safe work practices in high-risk working environments.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76485230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Benjamin Ng Han Sim, Tay Shun Qian, Wong Sheau Ning
QUESTIONA 58-year-old man, known case of diabetes mellitus, hypertension presented with sudden onset of bilateral lower limb weakness while resting, to the nearby medical centre. The weakness later progressed to involve bilateral upper limbs, leaving him tetraplegic, 3 hours from symptom onset. He denied chest or back pain. His electrocardiogram (ECG) revealed sinus rhythm, without any acute ischemic changes. There was no preceding febrile illness or injury. His case was referred to our centre with the impression of Guillain-Barre Syndrome (GBS).
{"title":"Sudden Onset of Paraplegia With Rapid Progression to Tetraplegia in a Middle-Aged Man: What is the Diagnosis?","authors":"Benjamin Ng Han Sim, Tay Shun Qian, Wong Sheau Ning","doi":"10.51200/bjms.vi.3141","DOIUrl":"https://doi.org/10.51200/bjms.vi.3141","url":null,"abstract":"QUESTIONA 58-year-old man, known case of diabetes mellitus, hypertension presented with sudden onset of bilateral lower limb weakness while resting, to the nearby medical centre. The weakness later progressed to involve bilateral upper limbs, leaving him tetraplegic, 3 hours from symptom onset. He denied chest or back pain. His electrocardiogram (ECG) revealed sinus rhythm, without any acute ischemic changes. There was no preceding febrile illness or injury. His case was referred to our centre with the impression of Guillain-Barre Syndrome (GBS).","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74802881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Hayati, N. A. S. Nik Lah, A. Zakaria, S. S. Syed Abdul Rahim, N. Azizan
Globally, everyone has gone through an unusual and remarkable period during the COVID-19 pandemic. The pandemic has affected various sectors in the country and implicated society. Important services including the health care system, particularly in surgery, have raised challenges and issues that need to be sorted out. This action is prudent to justify the balance in between care on preventing the spread of COVID-19 infection and at the same time providing surgical services. In this article are the perspectives on how we elicit the issues and the solutions in providing surgical services during the COVID-19 pandemic in our state, Sabah.
{"title":"Issues and Impact of COVID-19 on Surgical Services in Northern Borneo, Sabah","authors":"F. Hayati, N. A. S. Nik Lah, A. Zakaria, S. S. Syed Abdul Rahim, N. Azizan","doi":"10.51200/bjms.vi.3538","DOIUrl":"https://doi.org/10.51200/bjms.vi.3538","url":null,"abstract":"Globally, everyone has gone through an unusual and remarkable period during the COVID-19 pandemic. The pandemic has affected various sectors in the country and implicated society. Important services including the health care system, particularly in surgery, have raised challenges and issues that need to be sorted out. This action is prudent to justify the balance in between care on preventing the spread of COVID-19 infection and at the same time providing surgical services. In this article are the perspectives on how we elicit the issues and the solutions in providing surgical services during the COVID-19 pandemic in our state, Sabah.","PeriodicalId":9287,"journal":{"name":"Borneo Journal of Medical Sciences (BJMS)","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84729808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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