Colorectal cancer (CRC) constitutes one of the most aggressive malignancies worldwide and in Malaysia. Due to high recurrence rate and toxic side effects associated with radiation and chemotherapies, new agents are urgently needed. CARP-1 is a peri-nuclear phospho-protein which plays a dynamic role in regulating cell growth and apoptosis. CARP-1 functional mimetics (CFMs) are a class of compounds that stimulate CARP-1. CFM-4, a lead compound, was shown to suppress growth and metastasis of various cancers, other than CRC. We hypothesized that CFM-4 inhibits proliferation and metastasis in CRC. Materials and method: CFM-4 anti-cancer effects of on CRC cells were investigated using MTT assay, Annexin V/Propidium iodide (PI) apoptosis assay, cell cycle analysis, quantitative real-time PCR (qRT-PCR) and Western blotting. Antimetastatic activities were assessed by migration, colony formation and invasion assays. Results: CFM-4 inhibited CRC cell proliferation and was much more potent than the classical anti-CRC 5-fluorouracil. These effects were shown to be mediated at least in part by stimulating apoptosis, as indicated in our Annexin V/PI assay results. Cell cycle analysis showed that CFM-4 induced G2/M phase arrest. Molecularly, qRT-PCR results revealed that CFM-4 promoted intrinsic apoptosis by upregulating expression of caspase-8 and -9 , p53, PUMA and Noxa, and stimulated extrinsic apoptosis by enhancing expression of death receptors (DR4 and DR5). CFM-4 upregulated NF- k B signaling inhibitor A20-binding inhibitor protein and the PI3K negative regulator PTEN. Western blot analysis results revealed that CFM-4 enhanced expression of CARP1, caspase-8 and executioner caspase-3. Metastatic properties of the CRC cells were reduced by CFM-4 through blocking their capabilities to form colonies, migrate and invade through the matrix-coated membranes. Conclusion: The potent antitumor and anti-metastatic properties of CFM-4 against CRC are due to collective pro-apoptotic, anti-proliferative and anti-metastatic activities. Together our data warrants further investigations of CFM-4 as potential anti-tumor agent for CRC malignancy and metastasis.
Endoscopic retrograde cholangiogram pancreatography (ERCP) and biliary stenting is a minimally invasive procedure widely utilised to relieve biliary obstruction. Although not common, it is related with several possible complications. Stent migration causing duodenal perforation is 1 of its rare complications as being described in several previous case reports. However up to date there is no case report on migrated stent with subsequent duodenal and distal ileal perforation as will be discussed here. Importance of radiological examinations and its related findings in diagnosing this very rare complication will be described in this article.
The process of anaesthesia is one of the most important anxiety precipitating factors for both parent and child who is going for operation. Parental anxiety may adversely affect the children during perioperative period. Studies have shown that anxious parents would want to be provided with more information prior to their child’s surgery. We examined the effects of additional paediatric information leaflet on parents and children in reducing pre-operation anxiety. Materials and methods: This was a randomized controlled trial involving 70 parentchild dyads in Hospital Raja Perempuan Zainab II (HRPZ II), Kelantan. Inclusion criteria were child aged 3 to 12 years old who underwent elective surgery. Parents were assigned to intervention and control groups. The former received the information leaflet and the later received standard preparation.. Parents were compared on their anxiety level using Depression Anxiety Stress Scales 21 (DASS-21) (anxiety domain) in the holding area. Children were compared on their emotional state level before induction of anaesthesia using Children’s Emotional Manifestation Scale (CEMS). Results: The number of parents who were anxious was similar in both groups (11 (31%) vs. 7 (21%), p =.34). There were no differences in the children’s anxiety state between interventional and control groups as depicted by the CEMS score (7.5 (6.0-9.75) vs. 8.0 (7.0-15.0), p= .12). Conclusion: Parent-child dyads in HRPZ II did not show improvement in the anxiety level with the inclusion of paediatric anaesthesia information leaflet. Further study is needed with larger number of participants involving other selected tertiary hospitals in Malaysia.
Monosodium methylarsonate (MSMA) is an organic arsenical pesticide widely used in agriculture. Humans are exposed to arsenic through drinking water and anthropogenic activities. Exposure to inorganic arsenic has been linked with multiple health problems. However, studies focusing on chronic organic arsenic exposure and its adverse effects on kidney were limited. The purpose of current study was to determine the effects of chronic organic arsenic exposure in rats kidney by light and electron microscopy. Materials and Method: Thirty-six male SpragueDawley rats were divided into six groups (n=6); three control and three treatment group respectively. All the control group was given distilled water via oral gavage. The treatment group was given oral gavage of MSMA at 42.10 mg/kg body weight (BW) which is equivalent 1/30 LD50 of MSMA. The control and treatment groups were sacrificed at two month, four month and six months interval. Both kidneys harvested for light microscopy and electron microscopy study. Results: Showed progressive changes. The changes initially focal and became diffused involving glomerular; such as glomerular hypercellularity, glomerular shrinkage and dilated Bowman's space. Meanwhile, in proximal tubules, showed diminished brush borders, detachment of nucleus and basement membrane thickening. Electron microscopy showed flattened cell bodies of podocytes, effacement and fusion of podocytes foot processes, thickening of glomerular basement membrane, and discontinuity of brush border. The control and two-months treated group appeared to be normal. Conclusion: Chronic organic arsenic (MSMA) exposure induced chronic kidney injury.
Pediculosis capitis among primary school children is a worldwide problem which carries significant consequences among the school children and caregivers. Despite causing significant health problem which needs to be intervened, only few studies were conducted in Malaysia and there is no previous study conducted in Pahang. Thus, this study aims to investigate the determinants of prevalence of Pediculosis capitis among primary school children in Kuantan, Pahang, Malaysia. Materials and method: An analytical cross-sectional study using cluster random sampling of primary schools was carried out in Kuantan. Selfadministered validated questionnaire was used followed by hair and scalp examination. Multivariate logistics was done to determine the predictors and to control for confounding effect. Results: The overall median age of the 1,365 respondents was 8.0 years. Majority of them were males (53.41%), Malays (60.29%), household income between RM1000-RM2999 (31.87%) and from urban school location (98.68%). The overall prevalence of Pediculosis capitis was 9.6% (n=131). Multivariate logistic regression analysis showed that female (Odds ratio (OR)=8.571, 95% Confidence interval (CI)=5.024-14.620), Indian (OR = 5.560, 95% CI=3.3849.136), those who had number of siblings more than five (OR = 2.644, 95% CI=1.0446.700), history of contact with infested person (OR=2.445, 95% CI=1.619-3.691) and urban school location (OR=0.030, 95% CI=0.284-0.091) were predictors for Pediculosis capitis. Conclusion: The prevalence of Pediculosis capitis among primary school children in Kuantan, Pahang is endemic(9.6%) and predictors are female, Indian, having siblings of more than 5 and contact with infested person. Hence, preventive measures are necessary to reduce the transmission of head lice among school children.
This study aimed to evaluate the short-term efficacy of artificial tears (AT) instillation on tear film quality and quantity utilising two dual polymer artificial tears; Systane Hydration preservative (SH) and non-preservative (SHUD) in 60 minutes observation period compared to normal saline. Materials and methods: One hundred eyes of 50 participants involved in this prospective, double-masked randomised study. Viscosity and pH of both AT were evaluated using Rheometer and digital pH-meter respectively prior to tear film characteristics assessment. Tear break-up time (TBUT) and tear meniscus height (TMH) were measured at baseline, 5, 15 and 60 minutes after instillation. Tear ferning pattern (TFP) were compared between baseline and 60 minutes after instillation. One-way analysis of variance (ANOVA) was used to evaluate the effects of both AT instillation. Independent T-test was employed to compare between the two groups (SH vs SHUD) for each specific time-interval. P-value of 0.05 was set as the level of significance. Results: The viscosity of SH and SHUD was 0.0267Pa.s and 0.03273Pa.s respectively with pH of 7.85 for SH and 7.74 for SHUD. Both AT showed significant increment in TBUT between baseline and 15 minutes (SH: 5.82 ± 1.063, p = 0.01; SHUD: 6.02 ± 0.979, p
Snapping scapula syndrome is a condition with audible and palpable grating localized to the superomedial angle of the scapula associated with pain. The etiology is likely secondary to anomalous tissue between scapula and chest wall (e.g. bursitis, hooked superomedial angle scapula, Luschka tubercle, malunited rib/scapula fracture and osteochondroma). Case report: We present a case of a 17year-old gentleman, with chronic pain over bilateral upper scapula associated with grating sound upon shoulders movement. Examination revealed significant audible crepitus on bilateral scapula without restriction of shoulders motion. MRI showed no abnormal finding. An attempt for conservative approach including physical therapy and steroid/local anaesthesia injection has been unsuccessful. We subsequently performed an arthroscopic bursectomy and superomedial angle scapula decompression on the right scapula. There were inflammed bursa with fibrotic tissue and prominent superomedial angle of scapula observed during the surgery. Postoperatively, the symptom over right scapula completely resolved with good patient satisfaction. At present, patient is scheduled for the similar surgery on the remaining symptomatic left scapula. In conclusion, arthroscopic scapulothoracic bursectomy with superomedial angle scapula decompression is a reliable treatment for snapping scapula syndrome with predictably high rates of pain relief, patient satisfaction as well as improvement in functional outcomes.
Achilles tendon is the strongest tendon in the body . Achilles tendon rupture is a debilitating ankle injury especially among the athletes. We would like to highlight an unusual case of acute dual-level injuries of the Achilles tendon. Case report: A 30-year-old footballer presented with left ankle injury during a football tournament. Examination revealed tenderness at posterior left heel, palpable gap at Achilles tendon region and positive Thompson test. Radiological assessment showed dual-level injuries of the Achilles tendon-proximally was a rupture at musculotendinous junction and distally was an avulsion calcaneal fracture. We performed a mini-open approach Achilles tendon reconstruction for this patient. First, we reconstructed the distal avulsion calcaneal fracture using double row anchor sutures technique. Next, we repaired the proximal ruptured Achilles tendon using percutaneous Achilles reconstruction system (PARS) from Arthrex. Postoperatively, patient was put on functional rehabilitation protocol. At present, patient recovers well and regains back the Achilles tendon function. In conclusion, segmental Achilles tendon injury is rare and its surgical treatment can be challenging and must be well-planned.
From Quran, dogs were mentioned several times in different perspectives. Surah al-Maidah , informs that a hunting dog’s catch is lawful to be eaten. An authentic hadith about a prostitute who gave water to a dog and her sins were forgiven and was promised heaven. Case report: MrJ, 35 years old gentleman, sustained 3cm x 2cm over left leg following a dog bite. Patient underwent emergency operation and appropriate antibiotic given. After operation, the nurse had washed entire surgical instruments with taharah soap, washed it again six times with water and followed by enzymatic detergent before sending for autoclaving. Discussion: The status of dog impurities and how to clean it derived from hadith narrated by Abu Hurairah: ‘Rasulullah PBUH said: ‘Cleaning a utensil that has been licked by a dog is by washing it seven times and one of the washing cycle is mixed with soil”. Majority Muslims in Malaysia follow Shafi'i sect, where dog’s saliva and all its body are considered ritually mughallazah. Thus, if touched, they are required to cleanse the body part that came into contact with a specific Islamic ritual as mentioned. Up to date, there is no official guideline from KKM or JAKIM related to this. Surgical instruments used for the operation related to dog bite injury were not in direct contact with the dog. This practice imposes unnecessary steps for staffs. Apart from that, there are no study done on the effect of commercially manufactured soil-based soap to surgical instruments. The information regarding content also unclear. Surgical instruments are sensitive and expensive, thus improper handling can expedite damage to the instruments. Conclusion: KKM and JAKIM are recommended to produce SOP regarding this issue. Effort should be done to produce medical grade soil-based cleansing agent. Study should be done to evaluate the safety to surgical instruments.
Differentiated thyroid carcinoma (DTC) is the commonest thyroid malignancy. Several studies had shown that the outcome of DTC depend on the patient’s age at time of diagnosis, tumor characteristics and initial treatment. The aim of this study was to describe the outcome of DTC and its associated factors among patients diagnosed at Hospital Tengku Ampuan Afzan (HTAA) and International Islamic University Malaysia Medical Center (IIUMMC) Kuantan, Pahang. Materials and method: A retrospective cohort study was carried out among all DTC patients in HTAA and IIUMMC from July 2018 to September 2018. Case report form was used for data collection and it consists of four sections that include sociodemography, disease characteristics, treatment modalities and outcome. Descriptive statistics was used to describe the types of DTC, sociodemographic characteristics, disease characteristics, treatment modalities and the outcome, while chi-square test was used to explore the factors that were associated with the outcome. Result: In DTC, majority were diagnosed with papillary carcinoma (93.5%) than medullary carcinoma (6.5%). Three-quarter of the patients had residual disease at 6 months and the disease persistent in more than half of the patients at 12 months. At two-years follow-up, most of the patients (56.5%) were in disease-free state followed by persistent (26.1%) and residual disease (17.4%). However, there were no significant factors that affect the outcome of the patients. Conclusion: The two-year outcome post-treatment in this study revealed most of the patients were in remission.
Aeromonas Salmonicida is a rare type of the causative agent for splenic pseudocyst. We are reporting a case of splenic pseudocyst treated with deroofing of the cyst wall. An adolescent presented to us with a history of abdominal pain, fever, and loose stool for 3 days and was investigated. Computed tomography showed huge cystic mass arising from the inferior pole of the spleen. The adolescent underwent laparotomy, drainage of splenic cyst, and deroofing of cyst wall. The culture of Aeromonas Salmonicida was growth in the cyst content. To the best of our knowledge, this is the first case of such nature.
Intestinal malrotation is a consequent of deviation from the normal 270 degrees counter-clockwise rotation of the midgut during embryogenesis. It is a typically paediatric disease that manifest itself in the first month of life, usually as midgut volvulus. However adult manifestation of intestinal malrotation is not unheard of, albeit rare. Case report: his is a case report of 46 year old man with chronic abdominal pain who was subsequently diagnosed with intestinal malrotation. He was initially referred for barium enema following an incomplete colonoscopy. The suspicion of intestinal malrotation arose during barium enema, as the large bowel loops were all located on the left side. He subsequently had a plain CT following the barium enema, which confirmed the suspicion. In view of this finding, the patient was offered Ladd’s procedure by the surgical team. The patient duly declined and opted for conservative watchful waiting instead.
Transgender is an umbrella term for persons whose gender identity, gender expression or behaviour does not conform to that typically associated with the sex to which they were assigned at birth. Transgender individuals are particularly vulnerable to mental health concerns and psychological distress. Objective: This study aims to assess the prevalence of depression and associated risk factors among transgender male to female in Kuantan, Pahang. Material and method: This was a cross-sectional study conducted among 96 transgender male to female in Kuantan, Pahang. A convenient type of sampling was used as a mean of data collection. A selfadministered validated Malay version of Beck Depression Inventory(BDI) was used to screen for depression. Result: Majority of the respondent were Malay (82.3%), Muslim (99%), unmarried (93.8%) and monthly income <RM2300 (91.7%). Prevalence of depression among transgender male to female in Kuantan is 37.5%. There is no significant association between sociodemographic data of participants and depression. Conclusion: This study shows that almost one third of transgender male to female are at risk of depression. Therefore, screening for mental health assessment is recommended so that important measures can be taken to prevent depression among this high-risk group.
Family satisfaction has been identified as a quality indicator in critical care area. The impact of family satisfaction level was also found to be associated with symptoms of psychological distress such as anxiety, depression and stress among family members. We evaluated the satisfaction level and prevalence, risk factor and correlation of psychological distress symptoms with the satisfaction level among family members in Malaysian Intensive Care Unit (ICU). Materials and Method: This is a cross-sectional, multicentre study conducted in ICU at Hospital Sultanah Aminah Johor Bahru and International Islamic University Medical Centre. Family members were enrolled 3 days after ICU admission, and they completed a modified version of Critical Care Family Needs Inventory (CCFNI) and the Depression, Anxiety and Stress Scales (DASS). Results: A total of 176 family members were enrolled in this study. We found 116 (66%) of the family members scores ≥ 3 denoting satisfaction with the mean CCFNI score was 3.11 (SD=0.3). Prevalence of depression, anxiety and stress were of 30.1%, 41.4% and 28.9% respectively. Risk factor for psychological distress symptoms were female sex, spousal relationship, lower education, median income less than RM 4000, staying with patient and younger patient age. Negative correlation between depression, anxiety and stress with CCFNI score were found (p< 0.05) but with low correlation coefficient (r=-0.178 to -0.209). Family members without symptoms of psychological distress were more satisfied (higher CCFNI score) with ICU care compared to those with symptoms of psychological distress (p< 0.05). Conclusion: Family members of ICU patient were satisfied with the care provided in the ICU. High rates of psychological distress symptoms in this study and its correlation with the satisfaction level highlight the need to identify and implement preventive and management strategies for family members to improve the overall ICU care.
Total knee replacement (TKR) is one of the most common surgeries in orthopedic field. Up to 1/3 of the patients require blood transfusion postoperative. Allogenic transfusion has many side effects. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent. We explore the usage of TXA in reducing blood loss and transfusion rate by injecting it into the knee joint during surgery. Materials and method: This is a retrospective study done in Hospital Tengku Ampuan Rahimah, Klang. Medical records of patient undergoing TKR between 1 January 2018 till 31 December 2018 were reviewed. Study sample was calculated as 90 patients and divided into 2 groups, one receiving TXA (study) and the other not receiving TXA (control). Post-operative hemoglobin levels and transfusion rate was recorded. Results: 45 patients in study group (17 male, 28 female) had a mean age of 65.4 years old and 45 patients in control group (24 male, 21 female) had a mean age of 64.2 years old. Mean post-operative hemoglobin drop in study group was 1.08 g/dL vs 1.86 g/dL in control group. Repeated measure ANOVA determined a p value of 0.001 which shows a significant correlation. Total transfusion rate in study group was 1 vs 9 in the control group. Using chi-square test, the p-value was 0.007 which again shows a statistically significant result. Conclusion: Intra-articular injection of TXA following TKR reduces blood loss and the need for blood transfusion without increasing any complication. This prevents many patients from undergoing a potentially hazardous blood transfusion. A routine usage of intra-articular TXA in patients undergoing TKR is recommended. However a large and well designed RCT is required to investigate the risk and benefits of TXA.
Pediculosis capitis among primary school children is always known as the problem of the lower socio-economic class and rural communities. It carries significant consequences to the school children and caregivers. Limited studies have been conducted among the urban populations. Thus, this study aims to investigate the prevalence and predictors of Pediculosis capitis among Urban primary school children in Kuantan. Materials and method: An analytical cross-sectional study using cluster random sampling was carried out in Kuantan, Pahang, Malaysia. A selfadministered validated questionnaire was issued to the participants with purpose to collect socio-demographic data related to age, gender and factors that associated with head lice infestations among primary school children from standard one to six. It was then followed by hair and scalp examination by a well-trained examiners to check the infestation status. The results were analyzed using the chi-squared test and logistic regression analysis. Results: A total of 1347 students from 5 schools were included in this study. Majority of them were males (53.6%), Malays (61.0%), household income between RM1000-RM2999 (32.1%). The overall prevalence was 9.1% (n=122). Multivariate analysis showed that predictors for pediculosis capitis were female gender (OR= 6.02, 95% CI= 2.97-12.21), Indian ethnicity (OR= 5.55 , 95% CI=3.26-9.45), sibling of more than 5 (OR= 2.72 , 95% CI=1.04-7.12) and contact with infested person (OR=2.42, 95% CI=1.58-3.71). Conclusion: The prevalence of Pediculosis capitis among urban primary school children in Kuantan, Pahang is endemic (9.1%) and predictors are female genders, Indian ethnicity, having siblings of more than 5 and contact with infested person. Hence, preventive measures are necessary to reduce the transmission of head lice among school children.
Neonates refers to the first 28 days of life, they are vulnerable to physiological changes. About 15% of neonates get admitted to NICU and a significant number of them end up in ventilation. This study assessed the beneficial role of non- pharmacological modalities on recovery with a better outcome of ventilated babies in NICU. Material and Methods: The study is a quantitative cross-sectional study for 9 months of NICU at IIUMMC. The study will include top conditions warranting neonatal intensive care unit (NICU) admissions and ventilation as preterm, respiratory distress, neonatal sepsis, HIE, and others. They are divided into two (2) groups; the first group will keep the standard practice and assigned as a control group. The second group will afford all or most of a package of non-pharmacological and sensory stimuli like a kangaroo, feeding, non-nutritive sucking, swaddling, skinto-skin contact, sensory saturation, soft massage, away irritant odour, Normal visual experience during daytime and dime light at night-time. decrease sound pollution, and voice stimulation assessing soft music or recitation of the Qur’an according to family preference. We will assess stabilizing vital signs, behavioural assessment, extubating timing, Short term outcome. Results: Adding non-pharmacological modalities could reduce the dose requirements for sedation and analgesics and has a positive effect on the neurodevelopmental outcome. Conclusion: nonpharmacological strategies besides other modalities improved short-term outcomes and the recovery of ventilated babies. The importance of coming back to nature, the effect of special senses and sensory stimulation on neonatal recovery, and ease extubation.
Productivity in medical field has inherent value in terms of improving our lives, which can expand our economies. Productivity in medicine has many aspects including improving clinical diagnostic skills, safety, and quality and quantity care. This study will assess whether early exposure to structured clinical reasoning coaching tools would improve their clinical decision making and productivity. Research question: Does clinical reasoning coaching tools Increase neonatal healthcare productivity? Materials and method: Medical practitioners recently joined neonatal units will participate over 2 years in an innovative series of clinical reasoning coaching sessions blended with virtual patients. Practitioners will be exposed to many teaching methods during the neonatal training that includes lectures, bedside teaching sessions and small group discussions beside website continuous contact for learning and chairing skills. Teaching series scope should cover resuscitating sick neonates, handling ventilators either conventional or high frequency, practicing common neonatal procedures, dealing with common neonatal scenarios, infection control policy and, effective communication skills The evaluation sessions will be introduced at the beginning of their training, during the course and at the end of the clerkship to assess their improving productivity, using diagnostic thinking inventory(DTI). Selection of the medical practitioners will be based on either on stratified random sampling or cohort control depending on the funding and logistic. All items will be analysed advanced statistical analysis methods. Results: The coaching tool may yield dramatic impact, allowing the innovators to be more productive. Suggesting widely utilize it for nurses, undergraduate and postgraduate medical Subspecialty. Conclusion: The research hypothesis is assuming that DTI scores and productivity will be higher after the coaching sessions as rated by the candidate’s performance.
Depression is a curable debilitating illness that becomes a leading cause of morbidity and mortality globally. The prevalence of depression is underrecognized among adolescents. The study is conducted to determine the prevalence of depression among secondary school students of Kuantan Malaysia. Materials and method: We conduct a quantitative cross-sectional study. A population of 414 students from two urban schools, two rural schools, and one international school will participate in the study. The assessment tool used is the Malaysian version of Depression, Anxiety and Stress Scale 21 (DASS 21). Data will be analyzed using SPSS version 21 (SPSS IBM, New York, USA). Factors associated with depressive symptoms will be analyzed using multi Variate logistic regression analysis. Results: Prevalence of depression in Kuantan, Malaysia will be compared to the same international trends. Conclusion: Our study can determine and compare the prevalence of depression in different categories. Education and early interventions of depressed adolescents will add extra value of the project.
Non Hodgkin lymphoma (NHL) is a malignant neoplasm affecting multiple systems in which extranodal NHL represents 10-20% of all NHL. Case report: This is a case of 45-year-old female with no known medical illness who presented with progressive numbness of bilateral lower limbs since March 2016 which subsequently progress to loss of motor power since November 2016. She initially was diagnosed as tuberculous (TB) spondylitis which then turned out to be B cell lymphoma of the thoracic vertebra. The diagnosis was confirmed on histopatological examination (HPE) after patient underwent laminectomy of T3-T7 vertebra bodies and excision biopsy with removal of the casseous material. Due to a lack of specific findings, the diagnosis of vertebral NHL is often missed or delayed. It warrants attention that NHL of thoracic vertebra may be misdiagnosed as TB spondylitis due to their similarities and sometimes the imaging features may simulate and overlap each other. The main treatment for vertebral NHL is chemotherapy, radiotherapy or both. Surgery maybe necessary if patient has story of neurological deficits. However patient was treated conservatively as she refused chemotherapy.