Microbiology

CHAPTER 1 : Basic Microbiology
01) Introduction to Medical Microbiology

CHAPTER 2 : Genetic Microbiology
02) Introduction to Genetic Microbiology
03) DNA Functions in Microbiology
04) Genetic Variations and Gene Rearrangements
05) Extra Chromosomal Elements
06) Gene Transfer
07) Cloning Strategies
08) Molecular Techniques Used in Diagnosis Microbial Diseases

CHAPTER 3 : Basic Bacteriology
09) Bacterial Cell Structure
10) Bacterial Growth Requirement
11) Bacterial Products
12) Bacterial Reproduction
13) Bacterial Growth Curve
14) Bacterial Infection

CHAPTER 5 : Medical Bacteriology
15) Genus Staphylococci
16) Genus Streptococci
17) Genus Neisseria
18) Genus Bacillus
19) Corynebacterium
20) Genus Clostridium
21) Mycobacterium
22) Lactose Fermenters Enterobactericae
23) Non Lactose Fermenters Enterobactericae

CHAPTER 6 : Medical Mycology
00) Introduction to Medical Mycology
00) Classification and Diagnosis of Fungal Infections
00) Superficial Fungal Infections
00) Candidal Infection
00) Subcutaneous Mycosis
00) Systemic Mycosis
00) Mycotoxicosis

CHAPTER 7 : Medical Virology


CHAPTER 8 : Nosocomiology


CHAPTER 9 : Basic Anti-Microbial Agents
00) Antibiotic Agents
00) Drug (Antibiotic) Resistance
00) Antibiotic Drugs Used in Combination
00) Anti-Fungal Agents
00) Anti-Viral Agents

CHAPTER 10 : Clinical Microbiology
00) Normal Bacterial Flora in Man
00) Acute Diarrhea in Childhood
00) Food Poisoning
00) Endocarditis
00) Blood Stream Infections
00) Pneumonia
00) Meningitis
00) Otitis Media
00) Sore Throat
00) Conjunctivitis
00) Urinary Tract Infection
00) Surgical Site Infection
00) Genital Tract Infection
00) Encephalitis
00) Water-Borne Diseases
00) Milk-Borne Diseases
00) Osteomyelitis and Septic Arthritis
00) Infection in Pregnancy
00) Mother to Fetus/Newborn Transmitted Diseases
00) Pyrexia of Unknown Origin
00) Arthropods Transmitted Diseases
00) Opportunistic Infections
00) Zoonosis
00) Bacterial Toxigenic Diseases
00) Organisms Associated with Skin Ulcers
00) Skin Lesions Associated with Viral Infection
00) Organisms Associated with Skin Infection
00) Viral Hepatitis
00) Infection Causes of Jaundice

[Continue reading...]

Orthopedic

CHAPTER 1 : Traumatic Injuries
01) Classification of Open Fractures
02) Compartment Syndrome

CHAPTER 2 : Upper Limb Injuries
03) Lunate & Perilunate Dislocation
04) Distal Radius Fracture (Colles, Smith, Barton)
05) Ulnar Shaft Fracture (Nightstick)
06) Radial Shaft Fracture
07) Capitellar Fracture
08) Radial Head Fracture
09) Olecranon Fracture
10) Elbow Dislocation
11) Distal Humerus Fracture
12) Humeral Shaft Fracture
13) Proximal Humeral Fracture (Surgical Neck, Intra-articular)
14) Shoulder Dislocation
15) Clavicular Fracture

CHAPTER 3 : Lower Limb Injuries
16) Calcaneal Fracture
17) Talar Fracture
18) Ankle Dislocations & Fractures
19) Tibial Pilon Fracture (Plafond)
20) Tibial-Fibula Fracture
21) Tibial Plateau Fracture
22) Knee Ligamentous Injuries
23) Patellar Dislocation
24) Patellar Fracture
25) Tear of Quadriceps or Patellar Tendons
26) Distal Femur Fracture
27) Femoral Shaft Fracture
28) Subtrochanteric Femur Fracture
29) Femoral Neck Fracture
30) Trochanteric Hip Fracture
31) Traumatic Dislocation of Hip Joint
32) Pelvic Ring Injuries

Suggested Reading Resources:

Bernstein:	Musculoskeletal Medicine - For overviews of basic anatomy, pathoanatomy and physiology.
Hoppenfeld:	Physical Examination of the Musculo-Skeletal System - A thin green book. It has terrific pictures and explanations.
Rang:	Children’s Fractures - The best text of pediatric Orthopaedics, for the surgeon, pediatrician and primary care doctor alike.
Hoppenfeld:	Surgical Approaches in Orthopaedics - Terrific for OR preparation; most of the residents have this.
Rispoli:	Tarascon Pocket Orthopaedica. - Indispensable pocket reference.

Internet Sites:

The following sites may be good starting points for links and for other information:

• www.aaos.org -The American Academy of Orthopaedic Surgeons
• www.assh.org -The American Society for Surgery of the Hand
• www.wheeless.org -Duke University orthopaedics site
• www.ejbjs.org -Journal of Bone & Joint Surgery site

ORTHOPAEDIC TERMS:

Abduction:	motion in sagittal plane—extremity moved away from midline
Adduction:	motion in coronal plane—extremity moved toward midline
Arthrocentesis:	aspiration of fluid from a joint
Arthrodesis:	fusion of a joint surgically
Comminuted:	Term used in regards to fractures indicating that there are several fragments of bone (more than two) – also: multifragmentary
Coxa:	refers to hip and prox. femur
Cubitus:	refers to elbow
Diastasis:	separation of bones that are attached by fibrous tissue (i.e. symphysis pubis). This is a distinct form of dislocation, which refers to a disruption of a diarthrodial joint
Dislocation:	complete disruption of a joint—loss of articular congruity
Genu:	refers to knee
Subluxation:	disruption of a joint with partial loss of congruity of articular surfaces.
Valgus:	angulation in a coronal plane—used in conjunction with a joint. Indicate that the extremity distal to the joint in question goes away from the midline.Example: genu valgum—knock-knees
Varus:	angulation in a coronal plane—used in conjunction with a joint. Indicate that the extremity proximal to the joint in question goes towards the midline.Example: genu varum—bow-legged
Commonly Used Abbreviations:
AP:	anteroposterior (as in X-ray view)
BON:	brief operative note
CR:	closed reduction
DF:	dorsiflexion
DNVI:	distal neurovascular status intact. (Must be completely intact for you to write this.)
EBL:	estimated blood loss
EXFIX:	external fixation
F/U:	follow up
GET:	general endotracheal
HO:	House officer or doctor on call for particular service
IM:	intramuscular or intramedullary
IVF:	intravenous fluids
LE:	lower extremity
LAC:	long arm cast
LLC:	long leg cast
NPO:	nothing by mouth (no food or liquid)---used prior to surgery
NWB:	non weight bearing (strict, absolutely no weight on affected extremity)
OOB:	out of bed
ORIF:	open reduction internal fixation
OT:	occupational therapy
PF:	plantar flexion
POC:	post operative check
POD:	post operative day number
PP:	pin prick or percutaneous pinning
PT:	physical therapy
PWB:	partial weight bearing (need to note amount: for example 25%-50% -- this is a percentage of body weight)
SAC:	short arm cast
SLC:	short leg cast
TT:	tourniquet time (tourniquets are often used in surgery to decrease the amount of operative blood loss)
TTWB:	toe touch weight bearing (this is the least amount of weight bearing possible – it is just touch down of toe for balance)
UE:	upper extremity

[Continue reading...]

Parasitology

CHAPTER 1 : Introduction
1) Definition & Conception of Parasitology
2) Basic Transmission & Prevention of Parasitic Diseases
3) Classification of Parasites

CHAPTER 2 : Protozoa - Amoeboid
4) Introduction of Amoeboid Protozoans
5) Host Living Amoeba (Entamoeba Hystolytica - Amoebiasis)
6) Free Living Amoeba

CHAPTER 3: Protozoa - Flagellate
7) Introduction of Flagellated Protozoans
8) One Flagellate Protozoa (Tryponosome)
9) One Flagellate Protozoa (Leishmania - Leishmaniasis)
10) Two Flagellates Protozoa (Ceratium)
11) Four Flagellates Protozoa (Trichomonas)
12) Eight Flagellates Protozoa (Giardia)
13) Many Flagellates Protozoa (Trychonympha)

CHAPTER 4 : Protozoa - Ciliate
Introduction of Ciliated Protozoans
Paramecium

CHAPTER 5 : Protozoa - Sporozoa
Introduction of Sporozoans
Plasmodium

CHAPTER 6 : Helminthes - Nematodes

CHAPTER 7 : Helminthes - Trematodes

CHAPTER 8 : Helminthes - Cestodes

CHAPTER 9 : Arthropods

[Continue reading...]

Basic Transmission & Prevention of Parasitic Diseases

A) Basic factors of transmission of parasitic diseases:
1) The source of the infection
2) The routes of transmission
3) The susceptible host

         Parasitic disease → Infectious disease → Transmission

The combined effect of those factors, helps in:
1. Determine the spread and the prevalence of the parasites at a given time and place
2. Regulate the incidence of the parasitic diseases in certain local population

The source of the infection
1. Patient (Case): Persons who have parasites in their body and show clinical symptoms
2. Carrier: Persons who have parasites in their body but not show clinical symptoms
3. Reservoir host: Animals that harbors the same species of parasites as man. Sometimes, the parasites in the animals can be transmitted to human

The routes of transmission 
1. Congenital transmission: From mother to infant, toxoplasmosis
2. Contact transmission: 
    - Direct contact - Trichomonas vaginalis
    - Indirect contact - Ascaris lumbricodes
3. Food transmission: The infectious stage of parasites contaminated food/The meat of intermediate host containing infectious stage of parasites
4. Water transmission: Drink or contact the water contaminated the infectious stage of parasites
5. Soil transmission: Contamination of the soil by feces containing the certain stage of parasites and this stage can develop into another stage
6. Arthropod transmission: vectors of certain parasitic diseases

The susceptible host
In general, most people is the susceptible host. The parasite reaching the susceptible host must gain entrance and set up a favorable residence in order to complete its life cycle and cause the transmission of parasitic diseases

______________________________________________________________________

B) The avenue of invasion:
1) Digestive tract: Most common avenue of entrance
    (food/water transmission)
2) Skin: Infective larvae perforate skin and reach to body and establish infection
    (soil/water transmission)
3) Blood: Bloodsucking insects containing infective parasites bite the skin and inject parasites into human blood
    (Arthropod transmission → Malaria)

______________________________________________________________________

C) The prevention measures of the parasitic diseases:
1) Controlling the source of infection:
    - Treatment of the patients, carriers and reservoir hosts
2) Intervention at the routes of transmission:
    - Managing feces and water resource
    - Controlling or eliminating vectors and intermediate hosts
3) Protecting the susceptible hosts:
    - Paying attention to personal hygiene
    - Changing bad eating habit
    - Taking medicine

______________________________________________________________________

Previous → Definition & Conception of Parasitology

[Continue reading...]

Definition & Conception of Parasitology

A) Definition of parasitology: 
1) Parasitology -
The study of parasites, their hosts and the relationship between them
2) Clinical parasitology -
The study of parasites and the parasitic diseases that may affects the hosts

The relevance of studies parasites and parasitic disease

Parasites	Morphology Life Cycle
	Pathogenesis
Parasitic Diseases
	Transmission Diagnosis Treatment Prevention

______________________________________________________________________

B) Conceptions related to clinical parasitology:

1) Symbiosis
2) Parasites and type of parasites
3) Host and common type of hosts
4) Life cycle and common type of life cycles

Symbiosis
The relationship between two living things (animals). Two living things live together and involve protection or other advantages to one or both partners:
1. Commensalism
2. Mutualism
3. Parasitism

Commensalism	Both partners are able to lead independent lives, but one may gain advantage from the association when they are together and least not damage to the other
Mutualism	An association which is beneficial to both living things
Parasitism	An association which beneficial to one partner and harmful to the other partner. The former that is beneficial to is called parasite, the latter that is harmful to is called host

Parasites and type of parasites
Parasites, is an animals that is dependent on another animal (host) for it survivals. Types of parasites:
1. Protozoa
2. Helminthes
3. Arthropods

Protozoa
Helminthes	- Nematodes	→	Endoparasites	A parasites which lives in the body of the host
	- Trematodes
	- Cestodes
Arthropods		→	Ectoparasites	A parasite which lives on the body of the host

Host and common type of hosts
Host, is an organisms that harbors the parasites usually larger than the parasite. Type of hosts:
1. Intermediate host
2. Final host
3. Reservoir host

Intermediate host	The host harboring the larvae or asexual stage of parasite
Final host	The host harboring adult or sexual stage of parasite
Reservoir host	Animals harboring the same species of parasites as man. Potential sources of human infection

Life cycle and common type of life cycles
life cycle is the whole process of parasite growing and developing. Type of life cycles:
1. Direct life cycle
2. Indirect life cycle

Direct life cycle	Life cycle with only one host (no intermediate host)
Indirect life cycle	Life cycle with more than one host (intermediate host and final host)

______________________________________________________________________

C) Relationship (effect) between parasites and host:

1) Effect of parasites on the host

2) Effect of host on the parasites

↗produce mechanical injuries to the host ↘

Parasite →             harbor in the            → Host

↖Produce immune response to the parasite↙

Effect of parasites on the host

1. Depriving the host of essential substance

(e.g. Hookworm → suck blood → anemia)

2. Mechanical effect of parasites on the host

(e.g. Ascaris → perforated/obstruction)

3. Toxic and allergy effect

(e.g. E. Hystolitica → proteolytic enzyme → necrosis)

(e.g. parasite antigen → immune system → anaphylaxis)

Effect of host on the parasites
The host can produce certain degree resistance to parasites in human body or re-infection. the resistance (immunity) is not very strong. In general, it don't wipe out parasites completely, but may limit the number of parasites and establish balance with parasites. Type of immunities:
1. Innate immunity
2. Acquired immunity

Innate immunity	1. Barrier: prevent parasites to invade in certain degree from skin / mucous membrane / placenta 2. Acid in skin or stomach: can cause damage of the parasites 3. Phagocytosis of phagocyte: non-specific / effective against a wide range of parasitic infection / controlled by genetic factors → BUT NOT VERY STRONG
Acquired immunity	Mechanism: Cellular and humoral immunity - Sterilizing immunity: wipe out the parasites completely, meanwhile get a long-term specific resistance to re-infection → RARE - Non-sterilizing immunity: wipe out most of the parasites, but not completely → COMMON → NO PARASITE, NO IMMUNITY

______________________________________________________________________

Next → Basic Transmission & Prevention of Parasitic Disease

[Continue reading...]

Kematian Akibat Tibi Meningkat 13 Peratus Tahun Lalu

KUALA LUMPUR: Tibi atau Tuberculosis menjadi punca utama kematian bagi kategori penyakit berjangkit dengan mencatatkan peningkatan kes kematian sebanyak 13 peratus pada tahun lalu.

Menteri Kesihatan, Datuk Seri S Subramaniam, berkata sebanyak 1,597 kes kematian disebabkan Tibi dilaporkan di Malaysia pada tahun lalu iaitu sebanyak 183 kes berbanding 1,414 kes kematian pada 2012.

"Kes Tibi juga meningkat pada tahun lepas iaitu sejumlah 24,071 kes dilaporkan dan ia meningkat sebanyak enam peratus atau 1,361 kes berbanding 22,710 pada tahun 2012," katanya pada sidang media selepas merasmikan sambutan Hari Tibi Sedunia 2014 peringkat kebangsaan yang bertemakan 'Mantapkan Prestasi: Ke Arah Mengesan, Merawat dan Menyambuhkan Pesakit Tibi' di sini hari ini.

Beliau berkata, secara nisbah seorang pesakit Tibi yang aktif boleh memberi jangkitan kepada 10 orang lain sekiranya tidak mendapatkan rawatan lanjut dan tidak menghiraukan langkah pencegahan awal bagi menghapuskan kuman Tibi.

"Sebanyak 14 peratus pesakit Tibi merebak disebabkan oleh warga asing manakala 86 peratus lagi disebabkan oleh penduduk tempatan. Setakat ini Sabah adalah negeri yang mencatatkan kes Tibi paling banyak iaitu 4,526 kes," katanya.

Dr Subramaniam berkata, ujian sarinagn kesihatan mengesan penyakit itu pada peringkat awal adalah amat penting bagi masyarakat untuk ambil berat supaya individu yang disahkan menghidapi Tibi boleh mendapatkan rawatan lanjut bagi memutuskan rantaian jangkitan.

"Kenal pasti penyakit Tibi yang mustahak, kalau ada batuk berterusan, tidak ada selera makan dan demam yang berterusan tanpa sebab, individu itu perlu berjumpa doktor dengan kadar segera. "Ada keperluan untuk mendapat rawatan lanjut dan ubatan khusus untuk penyakit ini agar kuman yang boleh menjangkiti orang lain akan berkurangan dan tidak akan merebak," katanya.

Terdahulu dalam ucapan perasmiannya, Dr Subramaniam berkata kementerian itu begitu komited terhadap usaha menangani masalah penularan penyakit Tibi dalam kalangan rakyat dengan merangka beberapa pelan strategik kebangsaan seperti Program Kawalan Tibi Kebangsaan.

"Bagi memperkukuh Program Kawalan Tibi Kebangsaan ini, Kementerian Kesihatan telah menyediakan beberapa strategi untuk mendekati pesakit Tibi yang masih tidak mendapatkan perkhidmatan rawatan yang disediakan dalam proses penyembuhan penyakit ini.

"Antaranya ialah memperluaskan perkhidmatan rawatan Tibi kepada klinik-klinik swasta bagi memastikan rakyat mendapat rawatan Tibi yang cepat, tepat dan efisien," katanya.

-BERNAMA-

[Continue reading...]

Malaysia-Rusia Bakal Menghasilkan Vaksin Denggi

SYARIKAT dari Malaysia dan Rusia akan menjalin kerjasama untuk membangunkan vaksin denggi pertama di dunia dalam tempoh lima tahun akan datang.

Kerjasama itu antara Pahang Technology Resources Sdn Bhd dan NT Pharma, syarikat berpangkalan di Moscow yang separuh daripada sahamnya dimiliki oleh kerajaan Rusia.

Timbalan Menteri Pembangunan Ekonomi Persekutuan Rusia, Alexey Likhachev berkata, kerjasama itu akan melibatkan penggunaan teknologi tinggi dari Rusia yang dilakukan di Pahang.

“Di negara kami tidak ada denggi tetapi kami mempunyai teknologi yang dapat membantu menghasilkan vaksin itu dan dapat memberi manfaat kepada Malaysia.

“Ia adalah teknologi yang tidak pernah digunakan oleh negara lain sebelum ini,” katanya selepas forum perniagaan Malaysia-Rusia di Kuala Lumpur, semalam.

Menurutnya, aktiviti pembangunan dan penyelidikan dijangka mengambil masa dua tahun bagi menghasilkan vaksin itu.

Sementara itu, Timbalan Menteri Perdagangan Antarabangsa dan Industri, Datuk Ir Hamim Samuri berkata, pihaknya yakin akan meningkatkan jumlah dagangan dua hala antara Rusia dan Malaysia.

Pada 2013, jumlah dagangan kedua-dua negara meningkat 66.6 peratus kepada RM5.7 bilion berbanding RM3.4 bilion pada 2012.

Antara sektor yang diberi tumpuan adalah aeroangkasa, elektrik dan elektronik, automotif dan alat ganti serta perabot.

- Sinar Harian - 

- Astro Awani -

[Continue reading...]

Konvensyen Perubatan Dan Sains Kesihatan Ke-IV I-Medik Nasional 2014

HEBAHAN | Konvensyen Perubatan dan Sains Kesihatan, 

Tarikh: 12 April 2014 
Tempat: Pusat Sains Negara.
Anjuran: Ikatan Pengamal Perubatan dan Kesihatan Muslim Malaysia (I-Medik).

Layari: www.imedik.org

Jemput hadir untuk menghadiri program dan jangan lepaskan peluang mendaftar sebagai ahli I-Medik. 
Peserta yang mendaftar akan juga berpeluang untuk melihat pameran-pameran di PSN dan kini sedang berlangsung pameran 1001 Inventions from Muslim Civilisation secara PERCUMA!

Daftar program secara online pada link berikut:
https://docs.google.com/forms/d/1DY59FgBPou-r3RpOz5QDoil22dIGbfFrd_PL8KBL4fA/viewform

[Continue reading...]

History And Examination Of The Breast

(1) Benign Breast Disease:

• Most women who present with breast pain, nipple discharge or breast masses are primarily concerned about the possibility of breast cancer
• A careful, through history and physical examination are essential to evaluate these condition

(2) Breast Cancer:

• Breast cancer is the commonest cancer among women
• one in every 12 women develop breast cancer at some time in her life
• Moreover, breast cancer is the most common single cause of death in women at the age of 35-54 years

History:

• It should include:

1. Age of the patient, age at menarche; parity, including age at first delivery; occurence of breastfeeding after each delivery and for how long
2. Method of birth control and duration of use
3. personal and family history of cancer, particularly breast, ovarian and colon
4. the types and duration of medications and procedures used in women with a history of infertility
5. The use of postmenopausal hormone replacement therapy (HRT)

Physical Examination:

• Particular attention should be paid to:

1. Palpable breast lumps
2. Skin changes (such as dimpling)
3. Nipple direction, which may be altered due to retraction from an underlying carcinoma
4. women with breast implants should be reffered to a breast surgeon

• Women with benign breast conditions generally present with one of three signs or symptoms: breast, nipple discharge or breast mass.

(1) Breast Pain (Mastalgia or Mastodynia)

• Of the three clinical findings, breast pain is the least likely to be associated with breast cancer
• Types of breast pain:

1. Cyclic mastalgia - Breast pain varies with the menstrual cycle
2. Non cyclic mastalgia - This breast pain does not vary with the menstrual cycle
3. Breast pain associated with cancer - This type of breast pain is uncommon and it is more likely to be unilateral, localized, unremitting and constant

(2) Nipple Discharge

• Approxiamtely 3 to 10% of breast complaints involve nipple discharge
• Types of discharge:

Benign nipple discharge	Malignancy nipple discharge
- It is generally bilateral - It is more likely to be milky - It may be yellow or green in color - It is apparent at several ducts and can be elicited with breast manipulation	- It is more likely to be unilateral - It is usualy pink, bloody and non milky - It is frequently associated with breast mass

• Ductal papilloma is characterized by bloodstained secretion from the nipple

• Evaluation:

1. Hormonal essay: prolactin and Thyroid-stimulating hormone (TSH) levels should be evaluated
2. CT scan and MRI

(3) Breast Mass

• These may be:

Benign breast masses	Malignancy breast masses
- It is more likely to be soft or cystic - It have regular borders - It is freely mobile	- It is asymptomatic early in the course of breast

• Types of benign breast masses:

1. Fibrocystic disease or fibrocystic change
2. Cyst
3. Fibroadenoma
4. Sclerosing adenitis
5. Fat necrosis
6. Duct ectasia

[Continue reading...]

Situasi Terkini Demam Denggi Di Malaysia

Pada minggu ke 7 tahun 2014, sebanyak 2,265 kes telah dilaporkan iaitu meningkat 68 kes (3.1%) berbanding dengan minggu sebelumnya 2,197 kes. Jumlah kumulatif kes Denggi yang dilaporkan di seluruh negara adalah 13,915 kes berlaku peningkatan sebanyak 302.2% (10,455 kes) berbanding dengan hanya 3,460 kes dilaporkan bagi tempoh yang sama tahun 2013. Terdapat sepuluh (10) negeri yang menunjukkan peningkatan kes berbanding minggu sebelumnya iaitu Pahang 24 kes (150%), Kelantan 20 kes (20%), Johor 20 kes (18%), Pulau Pinang 17 kes (46%), Perak 16 kes (12%), Terengganu 11 kes (110%), Melaka 10 kes (14%), Kedah 4 kes (24%), Sabah 4 kes (24%) dan Sarawak 3 kes (11%).

Pada minggu lepas, terdapat enam (6) kematian denggi dilaporkan menjadikan jumlah kumulatif kematian Denggi sehingga kini adalah sebanyak 25 kematian, meningkat sebanyak 17 kematian (213%) berbanding hanya lapan (8) kematian direkodkan bagi tempoh yang sama tahun 2013.

Berikutan situasi denggi yang masih melaporkan kes dan kematian yang tinggi, Kementerian Kesihatan meneruskan pemantauan rapi dan tindakan proaktif dalam mengawal situasi denggi diseluruh negara. Disamping perlaksanaan kaedah kawalan baharu, peringkat tertinggi Kementerian Kesihatan mengadakan mesyuarat setiap minggu bersama negeri – negeri yang bermasalah denggi termasuk bersama pakar penyelidik, pakar klinikal dan agensi lain yang berkaitan. Antara perkara yang akan dilaksanakan hasil keputusan mesyuarat tersebut adalah:

1. Bagi kawasan hotspots semburan kabus secara kombinasi iaitu menggunakan racun serangga (insecticide) dan temephos bagi membunuh nyamuk dewasa dan larva secara serentak bagi memastikan aktiviti kawalan lebih berkesan.
2. Pemantauan rapi di kawasan berwabak akan diteruskan termasuk mempastikan pegawai pegawai dari setiap daerah dan negeri “turun padang” dan membuat pemantauan di lapangan.
3. Setiap Pejabat Kesihatan Daerah dan Jabatan Kesihatan Negeri mengenal pasti punca punca pembiakan utama termasuk di tapak tapak binaan dan memfokus intervensi mengikut masalah setempat.
4. Meningkatkan aktiviti penguatkuasaan agar kesedaran masyarakat terhadap menghapuskan tempat tempat pembiakan di praktikkan dalam amalan harian mereka.
5. Kementerian Kesihatan akan mengadakan gotong-royong secara serentak di sepuluh lokaliti hotspots pada awal bulan Mac. Penyertaaan agensi lain termasuk Badan Bukan Kerajaan di alu alukan.
6. Meningkatkan kesedaran masyarakat bagi melindungi diri gigitan nyamuk melalui penggunaan repellen dan penggunaan aerosol.
7. Mempertingkatkan aktiviti kawalan melalui pengurangan sumber pembiakan Aedes yang lebih menyeluruh dilokaliti melalui penglibatan semua agensi. Ianya berkesan dalam kawalan denggi untuk tempoh yang lebih lama.

Diharapkan dengan perlaksanaan perkara-perkara ini, ianya dapat mengekang peningkatan kes dan kematian denggi yang berlaku pada ketika ini. Cara paling berkesan mencegah denggi adalah mempastikan tiada nyamuk Aedes di persekitaran kita. Oleh itu, saya ingin menyeru semua masyarakat meningkatkan aktiviti mencari dan menghapuskan tempat pembiakan Aedes setiap minggu dan menjaga kebersihaan dalam rumah serta persekitaran mereka.

YB DATUK SERI DR. S.SUBRAMANIAM MENTERI KESIHATAN MALAYSIA

Kenyataan akhbar ini diambil daripada Portal Rasmi Kementerian Kesihatan Malaysia dengan izin Ketua Pengarah Kesihatan.

[Continue reading...]

Benign Breast Disease

Introduction:

• Benign breast condition are practically a universal phenomena among women.
• It is more common than breast cancer but difficult to differentiate it from cancer although it accounts for about 90% of clinical presentation related to the breast
• In any women presenting with a breast lump it is important to try to differentiate those that are benign from those that may be malignant.
• Incorrect diagnosis and inappropriate treatment is associated with significant morbidity
• Triple assessment approach (history & clinical examination, imaging and pathological studies) are important to reach the final diagnosis

Different between Benign & Malignant:

1. By physical examination: 

• Generally:

	Benign	Malignant
Consistency	Soft or rubbery	Hard or firm
Skin manifestation	Absent	Present (advance stage)

• Exception:

Benign lesion that mimic cancer	Cancer lesion that mimic benign
- Radial scar - Traumatic fat necrosis - Diabetic fibrous mastopathy - Granulomatous mastitis	- Lobular carcinoma in situ - Medullary carcinoma - Tubular carcinoma - Phylloid tumour

Clinical Picture:

1. Painless breast lump (36%)
2. Painful lump or lumpiness (33%)
3. Breast pain alone (17.5%)
4. Nipple discharge (5%)
5. Nipple retraction (3%)
6. Swelling or inflammation (1%)

Evaluation:

• The triple assessment approach in benign breast disease are:

1. History taking and clinical examination (see gynecology chapter)
2. Imaging→ ❶ Ultrasound ❷ Mammography
3. Pathological studies→ ❶ Fine needle aspiration cytology (FNAC) ❷ Core biopsy ❸ Open biopsy

Etiology:

• Most benign conditions arise on the basis of dynamic changes which occur in the breast through the 3 main periods of reproductive life
• These changes are known as Abberation of Normal Development and Involution (ANDI)

1. Breast Development→ Disorder of breat development in early reproductive life
2. Cyclic Activity→ Disorder of breast condition in mature reproductive life, regular changes in relation to menstrual cycle, pregnancy doubling the breast weight at term
3. Involution→ Disorder of breast condition in late reproductive life, the breast stroma is replaced by fat, focal change of normal epithelium to sweat gland epithelium (apocrine metaplasia), increase number of gland (adenosis) and increase number of cell lining (hyperplasia)

• Abberation of Normal Development and Involution (ANDI):

Age	Normal Process	Aberration
< 25	Breast Development -Lobular -Stromal -Nipple evertion	Fibroadenoma (Giant fibroadenoma) Juvenile hypertrophy (Giagantomastia) Nipple inversion (subareolar abcess/ Mammary duct fistula)
25 – 40	Cyclic Activity ( regular changes in relation to menstrual cycle) Epithelial hyperplasia of pregnancy	Cyclic mastalgia (incapacitating mastalgia) Cyclic nodularity (diffuse or focal) Bloody nipple discharge
35 – 55	Involution -Lobular -Stromal -Ductal (dilatation) -Ductal (sclerosis) -Epithelial turnover	Macrocysts Sclerosing lesions Duct ectasia (periductal mastitis) Nipple retraction Epithelial hyperplasia (with atypia)

(1) Disorder of Breast Development in Early Reproductive Life
Juvenile Hypertrophy	Fibroadenoma
- Excessive breast enlargement during puberty - Overgrowth of periductal connective tissue, increase number of ducts, no lobule formation - No endocrine abnormality - Treatment: Reduction mammaoplasty	- Most common benign tumours - Occur at any time of puberty, but occur most frequent in the third decade - Painless, well circumscribed, freely movable tumours with a rounded lobulated or discoid configuration - Multiple in 10 – 15% and can become quite large - No increased risk in relation to breast cancer - Treatment: Remove fibroadenomas if >3 cm

(2) Disorder of Breast Condition in Mature Reproductive Life
Mastalgia	Nodularity
a) Cyclical Mastalgia - Heightened awareness or pain - Related to menstrual cycle - Etiology: Hormonal, water retention, neurosis, essential fatty acids - Treatment: 1. Exclude cancer 2. Reassure (proper fitting bra, reduce caffeine intake, drink soy milk) 3. Drugs (1st:Gamolenic acid-GLA, 2nd:Danazol, 3rd:Bromocriptine, 4th:Tamoxifen/LHRH) b) Non-Cyclical Mastalgia - Breast pain not related to menstrual cycle -Classification: Chest wall, true breast, non breast -Treatment: 1. Exclude specific cause 2. Simple Analgesic or NSAIDS 3. Steroid or Local Anaesthesia	a) Generalised Nodularity - Breast are normally nodular b) Focal Nodularity - Most common cause of breast lump - Up to the age of 50 -Etiology: Localised fibrosis, adenosis, microcyst or apocrine change. It also may be due to normal breast involution - Management: 1. Clinical examination 2. Mammography for patient > 40 years 3. Biopsy if suspicious 4. Reassured and discharged if no abnormality is found

(3) Disorder of Breast Condition in Late Reproductive Life
Macrocyst	Epithelial Hyperplasia
- Most common dominant lump in patient age 35- 50 years - Clinical presentation: May be silent or painful, may be palpable or only seen on ultrasound or mammography, may be single(often) or multiple and may be associated with nipple discharge - Management: 1. Mammography for patient > 40 years 2. Aspirate the fluid with 21g needle 3. Cystology study if evenly bloodstained or mass persists 4. Review after 3 – 6 weeks 5. Cyst which rapidly or persistently refill should be excised	- An increase in the number of epithelial cell layers lining the terminal duct lobular unit - Previously known as epitheliosis or papilomatous Pathology: Mild→ No increased risk, Moderate/florid changes without atypia→ (1.5 -2), Atypical hyperplasia→ moderate risk (4-5). Strong interaction between atypia and family history -Clinical presentation: Lumps, nipple discharge, screen detected -Investigation: FNAC→ atypical cells, mammogram→ architectural distortion, microcalcification - Treatment: 1. Moderate and florid hyperplasia→ no follow-up 2. Atypical hyperplasia→ clinical and mammographic surveillance, mastectomy with reconstruction
Sclerosis	Duct Ectasia
- Sclerosis adenosis and radial scars are associated with distortion of the terminal duct lobular unit - Complex sclerosing lesions are associated with a significant amount of epithelial hyperplasia -Some debate about radial scars as precursors of invasive tubular necrosis Management: 1. Excision biopsy if often required to make a definitive diagnosis 2. No follow-up required unless associated with significant degree of epithelial hyperplasia	-Ducts dilate and shorten -Contain inspissated (thick) material -Minimal inflammation -Clinical presentation: Presents with nipple discharge, slit-like nipple retraction or a mass -Treatment: Troublesome discharge→ total duct excision

Classification:

• There are now two different classifications that are used:

Clinical Classification:

Pathological Classification:

(1) Physiological swelling and tenderness→ it may be mammary dysplasia/cystic mastopathy (normally occur during premenstrual phase and resolve during menstrual phase) and premature thelarche  (2) Nodularity→ hormonally-mediated change with lumpiness of the breast, bilateral symmetrical change are rarely pathology, asymmetrical change need to be review after 1 or 2 menstrual cycle (3) Mastalgia (Breast pain)→ not usually associated with malignancy, it may be cyclic or non-cyclic pain (4) Dominant or palpable breast lumps→ most benign lumps are either cyst or fibroadenoma (5) Nipple discharge→ it may be physiological, duct papilloma, duct ectasia, periductal mastitis, cancer and galactorrhoea (hormonal imbalance) (6) Breast infection and inflammation→ usually associated with lactation (Puerperal Mastitis) or without lactation (often associated with diabetes and immune compromise)

(1) Non-proliferative disorders→ no increased risk, the specific lesions: ❶ Fibrocytic changes, ❷ Fibrocystic disease, ❸ Duct ectasia, ❹ Solitary papillomas, ❺ Simple fibroadenomas, ❻ Mastitis or breast disease, ❼ Galactocele and ❽ Fat necrosis (2) Proliferative disorders without atypia→ mild to moderate increase risk:   (3) Atypical hyperplasia→ substantial increase in risk, the specific lesions: ❶ Ductal hyperplasia, ❷ Atypical hyperplasia, ❸ Complex Fibroadenomas, ❹ Sclerosing adenosis, ❺ Radial scars

Pathology:

Fibrocystic Breast Disease:	Fibrocystic breast change:
- Most benign breast condition - Incidence-varying, related to age: ❶Menstruating year- 20% ❷30 - 50% in premenopausal years - Synonyms: ❶Mammary dysplasia  ❷Cystic disease ❸Cyclic mastopathy ❹Cystic hyperplasia	- > 20% of premenopausal women - Discomfort, cysts - Treatment rarely required - More likely to not detect a developing cancer

Pathophysiology of Fibrocystic Disease:

• Hormonal basis and Methylexanthiones 

Hormonal Basis		Methylexanthiones
(1) Estrogen & progesterone	(2) Prolactin	- Increased intake of coffee, tea, cold drinks chocolate is associated with development of FDP
- Estrogen predominant over progesterone - Corpus luteum deficiency/anovulation in 70% - Patients with Pre Menstrual Tension Syndrome more likely to develop FBD - Luteal phase is shortened - Progesterone level decreased to 1/3 of normal	- Levels are increased in 1/3 of women with FDB - Probably due to estrogen dominance on pituitary
	(3) Thyroid
	- Suboptimal levels sensitize mammary epithelium to prolactin stimulation

[Continue reading...]