Browse publications by year: 2020

  1. Sekaran VC, Kamath VG, Ashok L, Kamath A, Hegde AP, Devaramane V
    Asian J Psychiatr, 2020 Apr;50:101941.
    PMID: 32070886 DOI: 10.1016/j.ajp.2020.101941
    INTRODUCTION: Adolescent behavioural problems are a growing public health concern. The authors in this study investigated paternal and maternal reports of parenting attitudes and dimensions as predictors of adolescent behavioural problems in the Indian context.

    MATERIALS AND METHODS: Using stratified sampling at the community level, 640 parents including 419 mothers and 221 fathers participated in the study. Tools included a socio-demographic pro-forma; Parental attitude inventory (PAI) to assess parenting attitudes, Parent Global Report of the Alabama Parenting Questionnaire (APQ) to assess current parenting dimensions, and the parent version of the Strengths and Difficulties Questionnaire (SDQ) to assess behavioural problems among adolescents. We examined the prevalence and predictors of total difficulties, externalizing and internalizing behavioural problems among adolescents from paternal and maternal reports.

    RESULTS: Paternal and maternal reports of total difficulties (11.3 %, 13.6 %), externalizing (2.3 %, 1.9 %) and internalizing behaviours (8.6 %, 7.4 %) among adolescents are reported. Predictors of abnormal behaviours per paternal reports included lower social class and poor paternal control. Being a male adolescent increased the odds of total difficulties and externalizing problems. Favourable maternal attitude, good maternal warmth and control predicted the reduced likelihood of total difficulties and externalizing behaviours per maternal reports. Paternal control and maternal warmth and control were found to reduce the likelihood of internalizing behaviours among adolescents.

    CONCLUSION: Maternal attitude, paternal control and maternal warmth and control dimensions emerged as significant predictors of total difficulties, externalizing and internalizing behavioural problems among adolescents.

    MeSH terms: Adolescent; Adult; Attitude*; Mental Disorders/etiology; Mental Disorders/psychology*; Cross-Sectional Studies; Humans; India; Male; Middle Aged; Parents/psychology*; Surveys and Questionnaires; Parenting/psychology*
  2. Musa KI, Abdullah JM
    Malays J Med Sci, 2020 Dec;27(6):1-6.
    PMID: 33447129 DOI: 10.21315/mjms2020.27.6.1
    The recent spike of transmissibility of COVID-19 was evident by a large number of COVID-19 cases and apparent quick spread of SARS-CoV-2 in the state of Sabah, Selangor and Negeri Sembilan in Malaysia. The question remains as to what are the main contributory factors for the impending COVID-19 second wave in Malaysia and why the current surveillance system fails to show signs of the impending second - or the third - COVID-19 wave. In public health surveillance, data are the ultimate indicator, and in the era of big data and the Industrial Revolution 4.0, data has become a valuable commodity. The COVID-19 data keeper must fulfil some criteria to ensure COVID-19 data are useful. Researchers are obligated to share their COVID-19 data responsibly. The surveillance for COVID-19 is paramount, and the guidelines such as the one published by the World Health Organization 'Public health surveillance for COVID-19: interim guidance' must be referred to. Data must be taken seriously and shared to enable scientists, clinicians, epidemiologists and public health experts fight COVID-19.
  3. Abdul Karim AK, Abd Aziz NH, Md Zin RR, Mohd Mokhtar N, Shafiee MN
    Malays J Med Sci, 2020 Dec;27(6):7-14.
    PMID: 33447130 DOI: 10.21315/mjms2020.27.6.2
    Endometriosis is an inflammatory condition characterised by the presence of endometrial growth beyond the uterine cavity. It is a debilitating disease requiring multiple modalities of treatment. In considering surgery as the option of treatment, the benefits should outweigh the risk. Besides direct surgical risk, intervention may lead to a reduction of ovarian reserve, in addition to premature menopause and low fecundity. To date, there is an inconclusive evidence to support any specific parameters in monitoring disease progression following surgical intervention. Serum cancer antigen (CA)-125 is expressed by coelomic epithelium and has been extensively studied as a biomarker for endometriosis. Elevated expression of CA-125 has been shown in endometrial tissues and the marker increased indirectly from peritoneal irritation that accompanies an extensive form of endometriosis. Additionally, the visual analogue scale (VAS) scores have been used as an objective measurement for measuring pain, especially in a complex disease such as endometriosis. This review aims to consolidate a series of clinical trials that utilised CA-125 level and VAS score as tools for monitoring patients undergoing surgery for endometriosis.
    MeSH terms: Endometriosis; Endometrium; Epithelium; Female; Humans; Menopause, Premature; Neoplasms; Pain; Peritoneum; Uterus; CA-125 Antigen; Disease Progression; Visual Analog Scale; Ovarian Reserve
  4. Bhartiya NM, Husain AA, Daginawala HF, Singh L, Kashyap RS
    Malays J Med Sci, 2020 Dec;27(6):15-26.
    PMID: 33447131 DOI: 10.21315/mjms2020.27.6.3
    Background: Human brucellosis is an important zoonotic disease of public health and often remains neglected owing to lack of sensitive and efficient diagnostic methods. This study evaluates diagnostic utility of in-house designed enzyme-linked immunosorbent assay (ELISA) using whole-cell antigens of Brucella abortus (B. abortus) S19 against the commercially available kits.

    Methods: A prospective cohort study involving different populations within the Vidarbha regions of Maharashtra, India was conducted through camps organised from May 2009 to October 2015. A total of 568 serum samples were collected from high-risk people recruited as study cohorts based on inclusion criteria, additional risk factors and clinical symptoms. Samples were evaluated by indirect ELISA using the whole-cell antigens of B. abortus. The results were compared with the commercially available IgG detection ELISA kit to ascertain the specificity and sensitivity of the developed test.

    Results: Fever, body ache, joint pain, lower back pain, loss of appetite and weight loss were major symptoms associated with the disease. With the cut-off of > 0.8, the positivity of brucellosis infection was at 12.32% (70/568) compared to 9.33% (53/568) as detected by the commercial kit. The in-house developed ELISA method yielded a sensitivity of 87.5% and specificity of 99.18% as compared to the commercial kits (sensitivity -80.30% and specificity -99.6%).

    Discussion: The B. abortus S19-derived whole-cell protein-based ELISA is rapid and cost-effective and can be used for screening brucellosis infection in lieu of the commercially available ELISA kits.

    MeSH terms: Animals; Appetite; Brucella abortus; Brucellosis; Cost-Benefit Analysis; Enzyme-Linked Immunosorbent Assay; Humans; Immunoglobulin G; India; Prospective Studies; Public Health; Risk Factors; Zoonoses; Cohort Studies; Weight Loss; Low Back Pain; Musculoskeletal Pain
  5. Fitriawan AS, Kartika AI, Chasanah SN, Aryandono T, Haryana SM
    Malays J Med Sci, 2020 Dec;27(6):27-38.
    PMID: 33447132 DOI: 10.21315/mjms2020.27.6.4
    BACKGROUND: Epithelial ovarian cancer (EOC) is a lethal disease due to late diagnosis and lack of effective screening methods. MicroRNA (miR/miRNA) plays an important role in ovarian carcinogenesis and may serve as a non-invasive biomarker for EOC. This study aimed to assess miR-141 expression in the blood plasma of patients with EOC and healthy subjects and determine its association with the clinical stage of EOC.

    METHODS: This cross-sectional study used blood plasma from 30 newly diagnosed untreated patients with EOC and 25 healthy subjects. The mean age was 47.73 (SD = 10.29) years for EOC and 44.48 (SD = 16.14) years for healthy subject. The total RNA was isolated from blood plasma and reversed transcribed to obtain cDNA. The expression of miR-141 was measured by real-time quantitative polymerase chain reaction (qRT-PCR), and calculated using 2-ΔΔCt methods. The data were analysed using Mann-Whitney test.

    RESULTS: The expression of miR-141 was upregulated 8.41 fold in the blood plasma of EOC patients compared to healthy controls (P < 0.001). Expression of miR-141 in the advanced stage was upregulated 4.2 fold compared to the early stage (P < 0.001).

    CONCLUSION: The miR-141 was upregulated in the blood plasma of EOC and associated with an advanced stage of disease, suggesting it has potential as a biomarker for EOC detection.

  6. Abbas MA, Oriquat GA, Abbas MM, Al-Najjar BO, Kandil YI
    Malays J Med Sci, 2020 Dec;27(6):39-52.
    PMID: 33447133 DOI: 10.21315/mjms2020.27.6.5
    BACKGROUND: Dyslipidaemias are common in patients with diabetes mellitus. A high prevalence of type 2 diabetes in hyperlipidaemic patients also exists. The aim of this study was to find a treatment that lowers both blood glucose and lipid levels simultaneously.

    METHODS: The hypolipidaemic effect of (R)-(-)-carvone was investigated in a tyloxapol-induced hyperlipidaemia mice model. Furthermore, its effect on insulin secretion and proliferation of 1.1E7 human pancreatic β-cells was studied. In addition, using molecular docking, the binding affinity of (R)-(-)-carvone against 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase was estimated.

    RESULTS: (R)-(-)-carvone (100 mg/kg) decreased plasma triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C) levels and atherogenic index by 90.6%, 49.3%, 56.6% and 70.3%, respectively, but it had no effect on high-density lipoprotein cholesterol (HDL-C). Furthermore, it increased hepatic triglyceride level and catalase activity by 79.6% and 59.6%, respectively. In-vitro, 500 μM (R)-(-)-carvone increased insulin secretion by 454.4% and proliferation of 1.1E7 cells with no cytotoxic effects up to a concentration of 100 μM. Molecular docking simulation demonstrated a good binding affinity with -5.03 Kcal/mol of (R)-(-)-carvone to HMG-CoA reductase.

    CONCLUSION: The hypolipidaemic effect of (R)-(-)-carvone is comparable to that of fenofibrate. (R)-(-)-carvone has the advantage over fenofibrate of not producing hypoglycaemia in animals. Furthermore, (R)-(-)-carvone increased proliferation and insulin secretion of human pancreatic β-cells.

  7. Appunni S, Rubens M, Ramamoorthy V, Sharma H, Singh AK, Swarup V, et al.
    Malays J Med Sci, 2020 Dec;27(6):53-67.
    PMID: 33447134 DOI: 10.21315/mjms2020.27.6.6
    Background: Ischaemic stroke (IS), a multifactorial neurological disorder, is mediated by interplay between genes and the environment and, thus, blood-based IS biomarkers are of significant clinical value. Therefore, this study aimed to find global differentially expressed genes (DEGs) in-silico, to identify key enriched genes via gene set enrichment analysis (GSEA) and to determine the clinical significance of these genes in IS.

    Methods: Microarray expression dataset GSE22255 was retrieved from the Gene Expression Omnibus (GEO) database. It includes messenger ribonucleic acid (mRNA) expression data for the peripheral blood mononuclear cells of 20 controls and 20 IS patients. The bioconductor-package 'affy' was used to calculate expression and a pairwise t-test was applied to screen DEGs (P < 0.01). Further, GSEA was used to determine the enrichment of DEGs specific to gene ontology (GO) annotations.

    Results: GSEA analysis revealed 21 genes to be significantly plausible gene markers, enriched in multiple pathways among all the DEGs (n = 881). Ten gene sets were found to be core enriched in specific GO annotations. JunD, NCX3 and fibroblast growth factor receptor 4 (FGFR4) were under-represented and glycoprotein M6-B (GPM6B) was persistently over-represented.

    Conclusion: The identified genes are either associated with the pathophysiology of IS or they affect post-IS neuronal regeneration, thereby influencing clinical outcome. These genes should, therefore, be evaluated for their utility as suitable markers for predicting IS in clinical scenarios.

    MeSH terms: Brain Ischemia; Genetic Markers; Glycoproteins; Humans; Leukocytes, Mononuclear; Regeneration; RNA; RNA, Messenger; Gene Expression; Stroke; Receptor, Fibroblast Growth Factor, Type 4; Molecular Sequence Annotation; Gene Ontology
  8. Md Nizar ND, Hassan SK, Mohamad Zaini RH, Hassan MH, Wan Hassan WMN, Mazlan MZ
    Malays J Med Sci, 2020 Dec;27(6):68-78.
    PMID: 33447135 DOI: 10.21315/mjms2020.27.6.7
    BACKGROUND: Hypotension is a common complication following spinal anaesthesia. The administration of intravenous fluids prior to spinal anaesthesia, known as pre-loading, has been used to offset the hypotension effect; however, the ideal fluid for pre-loading is still a matter of debate. The objective of this study was to compare the effects of Gelaspan 4% and Volulyte 6% as pre-loading fluids.

    METHODS: A total of 93 patients with American Society of Anaesthesiologists (ASA) physical status I or II having lower limb orthopaedic surgery under spinal anaesthesia were randomised into two groups that received either Volulyte (n = 47) or Gelaspan (n = 46). Before the spinal anaesthesia, these patients were pre-loaded with 500 mL of the fluid of their respective group. Blood samples were taken before pre-loading and again after spinal anaesthesia and sent for venous blood gas and electrolyte level measurement. Baseline and intraoperative records of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and the requirement of ephedrine to treat hypotension were also recorded.

    RESULTS: Both fluids could not prevent significant reductions in SBP (P = 0.011), DBP (P = 0.002) and MAP (P = 0.001). There was also significant reduction in HR over time (P < 0.001). There was no significant difference in terms of ephedrine usage between both groups. Neither Volulyte 6% nor Gelaspan 4% caused significant changes in acid-base status.

    CONCLUSION: The use of 500 mL of either Gelaspan 4% or Volulyte 6% as pre-loading fluids did not significantly prevent the incidence of post-spinal anaesthesia hypotension following orthopaedic lower limb surgery; however, both were useful in the maintenance normal acid-base balance.

  9. Lourdesamy Anthony AI, Zam Z, Hussin N
    Malays J Med Sci, 2020 Dec;27(6):79-88.
    PMID: 33447136 DOI: 10.21315/mjms2020.27.6.8
    Background: In real-life practice, only 20% of hospitalised pneumonia cases have an identified etiology. The usage of Legionella urine antigen test (LUAT) in developed nations revolutionised case detection rates. Accordingly, our objectives were to study the microbiological etiology for hospitalised pneumonia patients and the diagnosis of Legionella pneumonia.

    Methods: A prospective, observational single-centre study was conducted where all 504 cases that were consecutively admitted for pneumonia were enrolled. Blood and sputum samples obtained were used to identify pathogens using standard microbiological culture methods. The urine samples collected were tested using the ImmunocatchTMLegionella immunochromatographic (ICT) urine antigen test.

    Results: A microbiological diagnosis was only achieved in 104 cases (20.6%) and a Gram-negative infection predominance was observed. Culture-positive cases required longer hospitalisation (8.46 days versus 5.53 days; P < 0.001) and the higher usage of antipseudomonal antibiotics (23.1% versus 8.3%; P < 0.001). Only 3 cases (0.6%) were diagnosed with Legionella pneumonia.

    Conclusion: The local pathogen distribution is diverse compared to other regions. Culture-negative pneumonia is common and significantly differs from culture-positive pneumonia. Legionella pneumophila serotype 1 is not a common cause of pneumonia and LUAT did not help demystify the cause of culture-negative pneumonia.

    MeSH terms: Anti-Bacterial Agents; Hospitalization; Humans; Legionella; Legionnaires' Disease; Microbiological Techniques; Pneumonia; Prospective Studies; Reference Standards; Sputum; Legionella pneumophila; Developed Countries; Serogroup
  10. Said Mogutham NN, Abdullah JM, Idris Z, Ghani ARI, Abdul Halim S, Naesarajoo JJJ, et al.
    Malays J Med Sci, 2020 Dec;27(6):89-101.
    PMID: 33447137 DOI: 10.21315/mjms2020.27.6.9
    Background: Dizziness is a common presenting complaint among patients in Malaysia. It is a vague term which could be associated with vertigo, imbalance, ataxia or syncope. In order to deal with this overwhelming complaint, a detailed history-taking is essential in confirming aetiology of disease and this should be followed by a meticulous clinical examination. The purpose of the video manuscript it to provide a step-by-step approach to a dizzy and swaying patient, specially catered for Malaysian medical students and trainees.

    Methods: A series of videos were shot, which involved the eye, ear, vestibular system, cerebellar, proprioceptive sense and gait examination. These videos, conducted in Universiti Sains Malaysia (USM) School of Medical Sciences, will be first in Malaysia and will highlight the proper technique and rapport with patients and essential points of each examination. There will be summary at the end of each examination on how to report findings which is a common weakness among students.

    Conclusion: We hope that students and junior doctors could be apply these methods in their daily assessment of dizzy patients and ultimately, reach an accurate diagnosis.

    MeSH terms: Ataxia; Dizziness; Education, Medical, Undergraduate; Gait; Humans; Malaysia; Schools; Students, Medical; Syncope; Vertigo
  11. Idris NA, Zakaria R, Muhamad R, Nik Husain NR, Ishak A, Wan Mohammad WMZ
    Malays J Med Sci, 2020 Dec;27(6):102-114.
    PMID: 33447138 DOI: 10.21315/mjms2020.27.6.10
    Background: Tuberculosis (TB) is contagious and the transmission risk is high in congregate settings like school. Incidence of TB among adolescents is significantly high hence an education programme was developed to improve knowledge, attitude, practice and stigma (KAPS) among them.

    Methods: This school-based, non-randomised controlled study was conducted among secondary school students with a total of 236 respondents. The KAPS score were assessed before and 1 month after using self-administered validated KAPS questionnaire on TB. Analysis was done using repeated measures ANOVA.

    Results: The mean percentage score (SD) for baseline knowledge, attitude, practice and stigma score for the respondents were 54.0 (4.48), 65.6 (1.74), 70.0 (1.43) and 66.0 (6.88), respectively. There was a significant difference (P < 0.001) in the knowledge and stigma score for intervention group compared to control group, adjusted for gender, ethnicity and smoking status 4 weeks post-TB educational programme. However, with regards to attitude and practice score, there was no significant difference (P = 0.210 and P = 0.243, respectively).

    Conclusion: TB education programme was effective in improving knowledge and stigma related to TB. This health education programme can be used as one of the strategies for the prevention and control of TB in schools.

    MeSH terms: Adolescent; Analysis of Variance; Ethnic Groups; Health Education; Humans; Surveys and Questionnaires; Schools; Smoking; Students; Tuberculosis; Incidence; Control Groups; Social Stigma
  12. Ab Latif R, Mat Nor MZ
    Malays J Med Sci, 2020 Dec;27(6):115-127.
    PMID: 33447139 DOI: 10.21315/mjms2020.27.6.11
    Background: Concept mapping has been established as a learning strategy that encourages critical thinking and creativity among students, leading to the development of a concept mapping guideline designed to guide nurse educators in using this teaching strategy.

    Objectives: This paper illustrates the development of a guideline to build a concept mapping based-learning strategy. Called the Rusnani concept mapping (RCM) protocol guideline, it was adapted from the Mohd Afifi learning model (MoAFF) and the analysis, design, development, implementation and evaluation (ADDIE) model, integrated with the Kemp model.

    Methods: This model uses the five phases of analysis, design, development, implementation and evaluation. The validity of the guideline was determined by using content and face validity and the Delphi technique. Content validity for this RCM guideline was established using expert review. This formula suggested that if the content validity is greater than 70%, it shows good content validity, and if it is less than 70%, the content validity is low and it is advisable to recheck the content according to the objective of the study.

    Results: The reliability of the RCM was 0.816, showing that the RCM guideline has high reliability and validity.

    Conclusion: It is practical and acceptable for nurse educators to apply RCM as an effective and innovative teaching method to enhance the academic performance of their nursing students.

    MeSH terms: Delphi Technique; Faculty, Nursing; Humans; Learning; Students, Nursing; Thinking; Reproducibility of Results
  13. Ahmad NFD, Ren Jye AK, Zulkifli Z, Bujang MA
    Malays J Med Sci, 2020 Dec;27(6):128-143.
    PMID: 33447140 DOI: 10.21315/mjms2020.27.6.12
    Background: This study aims to develop and validate a job satisfaction questionnaire (JS-Q) for health workforce who are employed by a healthcare institution.

    Methods: The study consists of six phases which begins with eliciting a conceptual understanding of the subject matter which is then followed by questions development, designing the overall structure and format of the questionnaire, assessing both its content validity and face validity, conducting a pilot study and finally a field test. A sample of study respondents who were permanent hospital staff above 18 years of age had been recruited from three government hospitals in Kuching, Sarawak, Malaysia.

    Results: The finalised JS-Q consists of a total of 34 questions that were based on 8 domains. For all these 8 domains, the minimum loading of each item on the factors was calculated to be at least 0.500, its coefficient of Cronbach's alpha was calculated to be at least 0.750 and its corrected item-total correlation was calculated to be at least 0.500. The goodness of fit of the model was determined to be satisfactory with a value of Chi-square/df < 3.0, and a value of root mean square error approximation (RMSEA) < 0.8 and finally with both Tucker Lewis index (TLI) and comparative fit index (CFI) > 0.9.

    Conclusion: This newly developed and validated questionnaire (JS-Q) is found to be a valid and reliable study instrument for assessing job satisfaction among health workforce.

    MeSH terms: Adolescent; Government; Hospitals; Humans; Job Satisfaction; Malaysia; Personnel, Hospital; Pilot Projects; Surveys and Questionnaires; Reproducibility of Results
  14. Zolkefli Y
    Malays J Med Sci, 2020 Dec;27(6):144-147.
    PMID: 33447141 DOI: 10.21315/mjms2020.27.6.13
    We recognise that people lie to health professionals for several reasons. However, these incidents endanger the well-being of the professionals and bring us to the question of whether people have an exclusive moral duty to always profess the truth about their health and other facts, particularly in a pandemic crisis. This review argues that an honest patient is a key to undertaking their roles as health professionals and delivering the best services possible to meet the needs of the patient. Greater awareness and comprehension of the potential ramifications of dishonesty, not only helps establish the moral obligation, to tell the truth, particularly in a pandemic situation, but also translates into a better relationship with health professionals. It also enforces an ethical solidarity on every single of us to show tangible moral response to ensure that those most vulnerable to risks from the pandemic illness such as health professionals are protected as far as possible.
  15. Noorsham AH, Abdullah MM, Abdul Halim S, Ghani ARI, Idris Z, Abdullah JM
    Malays J Med Sci, 2020 Dec;27(6):148-182.
    PMID: 33447142 DOI: 10.21315/mjms2020.27.6.14
    There are four classification levels for speech disorders namely dysphonia, dysarthria, dysprosody and dysphasia. In general, speech examination mainly focuses on three main components that are spontaneous speech, auditory comprehension, and oral motor examination. Quick bedside assessment on speech in Bahasa Malaysia is essential to assist the speech language therapist (SLT) and other physicians to determine the disorders. Speech therapy is also essential in monitoring and continuous assessment for patients with speech and language disorders such as dysphasia and dysarthria. Speech clinicians in Hospital Universiti Sains Malaysia (HUSM) have been adapting two most widely used batteries of speech assessment tools namely Western aphasia battery-revised (WAB-R) by Andrew Kertesz and Boston diagnostic aphasia examination (BDAE). These tools have been modified into simple and validated speech assessments in Bahasa Malaysia. This video manuscript will demonstrate the use of both tools in performing bedside speech assessment for patients with speech disorders. The Bahasa Malaysia speech examination should not be difficult when WAB-R and BDAE speech assessment tools are applied. The aim of this simple approach using the adapted version of BDAE and WAB-R is to assist the clinician to achieve quick and accurate diagnosis with a validated scoring system.
    MeSH terms: Aphasia; Communication Disorders; Dysarthria; Hospitals; Humans; Language Disorders; Language Tests; Malaysia; Physicians; Speech; Speech Disorders; Speech Therapy; Comprehension; Dysphonia
  16. Ganeson M, Amirthalingam SD, Kim KS
    Malays J Med Sci, 2020 Dec;27(6):183-186.
    PMID: 33447143 DOI: 10.21315/mjms2020.27.6.15
    The Malaysian government's ongoing movement control order (MCO) to prevent coronavirus disease 2019 (COVID-19) spread, has disrupted the teaching and learning (T&L) activities of higher education institutions in the country. This paper seeks to outline the steps taken by the Department of Family Medicine of the International Medical University (IMU), Malaysia, to adapt its online teaching and learning activities. The five tips are: i) understand how to use online T&L platforms; ii) teachers should create multiple communication channels; iii) ensure attendance is captured; iv) enhance the online T&L experience and v) conduct online formative assessments.
  17. Yelamanchi R, Agrawal H, Durga CK
    Malays J Med Sci, 2020 Dec;27(6):187-189.
    PMID: 33447144 DOI: 10.21315/mjms2020.27.6.16
    Breast complaints are a very common cause of healthcare visits in the female population. They range in severity from benign to malignant, and treatment options vary from simple observation to mastectomy. As healthcare facilities are overburdened with coronavirus disease 2019 (COVID-19) patients, properly triaging patients diagnosed with breast disorders is necessary for the optimal use of limited resources in developing countries. We are proposing a concise triage system for timely intervention among patients with breast disorders during the havoc of the COVID-19 pandemic.
    MeSH terms: Breast; Breast Diseases; Breast Neoplasms; Delivery of Health Care; Developing Countries; Female; Health Resources; Humans; Mastectomy; Triage; Coronavirus; Pandemics
  18. Hamid FA, Hasbullah AHH, Ban AY
    Breathe (Sheff), 2020 Dec;16(4):200065.
    PMID: 33447285 DOI: 10.1183/20734735.0065-2020
    Can you diagnose this patient with recurrent pneumonia and myasthenia gravis? https://bit.ly/2IBaxC1.
    MeSH terms: Humans; Myasthenia Gravis; Pneumonia; Receptors, Cholinergic
  19. Khoo KS, Koh PS, Ng KL
    Gland Surg, 2020 Dec;9(6):2198-2203.
    PMID: 33447571 DOI: 10.21037/gs-20-474
    Acute suppurative thyroiditis account for <1% of thyroid diseases and is uncommon because of the gland's encapsulation, iodine-rich environment, good vascular supply and extensive lymphatic drainage. It has been reported in patients with underlying goiters, thyroid cancers and in immuno-compromised patients. The usual causative organisms are Staphylococci spp. and Streptococci spp. Rarer organisms include Klebsiella spp. and Salmonella spp. Due to its rarity (as there have been only 28 cases of Salmonella thyroid abscess being reported in the literature till 2020), only case reports are available to guide management. We report two cases of thyroid abscess due to Salmonella enteritidis in our institution that may herald the re-emergence of this uncommon infection of the thyroid gland and to raise awareness for all clinicians. Both patients presented with neck swelling, dysphagia and sepsis. Surgical intervention was warranted in both patients due to the severity of the disease and failed medical therapy. Recovery was uneventful following adequate surgical intervention and antibiotic therapy according to the culture and sensitivity report of the pathogen. This case report highlights that both patients were immunocompromised, and they contracted Salmonella thyroid abscess without any gastrointestinal involvement. Thus, a high index of suspicion for Salmonella thyroid abscess in immunocompromised patients can expedite the diagnosis and appropriate management can be commenced such as antibiotic therapy, percutaneous aspiration and surgical drainage in the event of failed medical therapy.
    MeSH terms: Abscess; Anti-Bacterial Agents; Deglutition Disorders; Drainage; Goiter; Humans; Iodine; Klebsiella; Salmonella enteritidis; Staphylococcus; Thyroid Diseases; Thyroid Neoplasms; Thyroiditis, Suppurative; Immunocompromised Host; Sepsis
  20. Manshor NM, Razali N, Jusoh RR, Asmawi MZ, Mohamed N, Zainol S, et al.
    Int J Cardiol Hypertens, 2020 Mar;4:100024.
    PMID: 33447753 DOI: 10.1016/j.ijchy.2020.100024
    Introduction: Labisia pumila has been reported to possess activities including antioxidant, anti-aging and anti-cancer but there is no report on its vasorelaxant effects.

    Objective: This study aims to fractionate water extract of Labisia pumila, identify the compound(s) involved and elucidate the possible mechanism(s) of its vasorelaxant effects.

    Methods: Water extract of Labisia pumila was subjected to liquid-liquid extraction to obtain ethyl acetate, n-butanol and water fractions. In SHR aortic ring preparations, water fraction (WF-LPWE) was established as the most potent fraction for vasorelaxation. The pharmacological mechanisms of the vasorelaxant effect of WF-LPWE were investigated with and without the presence of various inhibitors. The cumulative dose-response curves of potassium chloride (KCl)-induced contractions were conducted to study the possible mechanisms of WF-LPWE in reducing vasoconstriction.

    Results: WF-LPWE produced dose-dependent vasorelaxant effect in endothelium-denuded aortic ring and showed non-competitive inhibition of dose-response curves of PE-induced contraction, and at its higher concentrations reduced KCl-induced contraction. 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) significantly inhibited vasorelaxant effect of WF-LPWE. WF-LPWE significantly reduced the release of intracellular calcium ion (Ca2+) from the intracellular stores and suppressed the calcium chloride (CaCal2)-induced contraction. Nω-nitro-L-arginine methyl ester (L-NAME), methylene blue, indomethacin and atropine did not influence the vasorelaxant effects of WF-LPWE.

    Conclusion: WF-LPWE exerts its vasorelaxant effect independently of endothelium and possibly by inhibiting the release of calcium from intracellular calcium stores, receptor-operated calcium channels and formation of inositol 1,4,5- triphosphate. WF-LPWE vasorelaxant effect may also mediated via nitric oxide-independent direct involvement of soluble guanylate cyclase (sGC)/ cyclic guanosine monophosphate (cGMP) pathways.

    MeSH terms: Antioxidants; Atropine; Calcium Chloride; Endothelium; Guanosine Monophosphate; Indomethacin; Inositol; Methylene Blue; Nitric Oxide; Potassium Chloride; Quinoxalines; Vasoconstriction; Vasodilation; Vasodilator Agents; Water; Calcium Channels; NG-Nitroarginine Methyl Ester; 1-Butanol; Liquid-Liquid Extraction; Soluble Guanylyl Cyclase
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