Browse publications by year: 2024

  1. Ben H, Kholinne E, Guo J, Ryu SM, Ling JL, Koh KH, et al.
    Arthroscopy, 2024 Aug 28.
    PMID: 39214427 DOI: 10.1016/j.arthro.2024.08.017
    PURPOSE: To identify independent factors responsible for the poor outcomes after a graft tear after arthroscopic superior capsular reconstruction (ASCR).

    METHODS: Patients who underwent ASCR for massive rotator cuff tears between January 2013 and July 2021were reviewed. Based on the achievement of the minimal clinically important differences for clinical outcome measures at the final follow up, patients were divided into the good outcome (GO) and poor outcome (PO) groups. The minimal clinically important differences were calculated as the values equal to one-half of the standard deviation of the changes in outcome scores between the preoperative baseline and the latest follow-up. Pre- and final follow-up variables included demographics, American Shoulder and Elbow Surgeons (ASES) score, Constant score, visual analog scale (VAS) score, range of motion, Preoperative and postoperative 1-year radiological variables were analyzed using MRIs, including anteroposterior (AP) and mediolateral (ML) tear sizes, subscapularis tear, acromiohumeral distance (AHD), and degree of fatty degeneration. Logistic regression analysis was performed to identify the significant predictors of poor outcomes.

    RESULTS: A total of 33 patients who underwent ASCR presented with graft tears, which were confirmed by postoperative 1-year magnetic resonance imaging (MRI), and had a minimum follow-up duration of 2 years after surgery were enrolled. The GO group demonstrated significantly greater improvements in functional outcomes compared with the PO group (ASES: 83.5 ± 11.8 vs. 64.0 ± 20.4, P = 0.004; Constant: 67.6 ± 5.7 vs. 57.1 ± 9.8, P <0.001; and VAS: 0.9 ± 1.2 vs. 2.4 ± 2.0, P = 0.026). The postoperative 1-year AHD showed significant improvement in the GO group (3.1 ± 1.2 vs. 6.1 ± 1.4, P <0.001) but no change in the PO group (3.4 ± 1.3 vs. 4.2 ± 0.9, P = 0.074) postoperatively. Multivariate logistic regression analysis indicated that a decreased postoperative 1-year AHD (OR, 0.145; P = 0.019) was associated with a poor outcome after a graft tear.

    CONCLUSION: A narrow postoperative 1-year AHD was identified as the most importantindependent risk factor indicating poor clinical outcomes after a graft tear post-ASCR, which was related to a larger tear and loss of integrity between the grafts and infraspinatus at 1 year postoperatively.

    LEVEL OF EVIDENCE: Level IV.

  2. Alamoodi AH, Zughoul O, David D, Garfan S, Pamucar D, Albahri OS, et al.
    J Med Syst, 2024 Aug 31;48(1):81.
    PMID: 39214943 DOI: 10.1007/s10916-024-02090-y
    Artificial intelligence (AI) has become a crucial element of modern technology, especially in the healthcare sector, which is apparent given the continuous development of large language models (LLMs), which are utilized in various domains, including medical beings. However, when it comes to using these LLMs for the medical domain, there's a need for an evaluation platform to determine their suitability and drive future development efforts. Towards that end, this study aims to address this concern by developing a comprehensive Multi-Criteria Decision Making (MCDM) approach that is specifically designed to evaluate medical LLMs. The success of AI, particularly LLMs, in the healthcare domain, depends on their efficacy, safety, and ethical compliance. Therefore, it is essential to have a robust evaluation framework for their integration into medical contexts. This study proposes using the Fuzzy-Weighted Zero-InConsistency (FWZIC) method extended to p, q-quasirung orthopair fuzzy set (p, q-QROFS) for weighing evaluation criteria. This extension enables the handling of uncertainties inherent in medical decision-making processes. The approach accommodates the imprecise and multifaceted nature of real-world medical data and criteria by incorporating fuzzy logic principles. The MultiAtributive Ideal-Real Comparative Analysis (MAIRCA) method is employed for the assessment of medical LLMs utilized in the case study of this research. The results of this research revealed that "Medical Relation Extraction" criteria with its sub-levels had more importance with (0.504) than "Clinical Concept Extraction" with (0.495). For the LLMs evaluated, out of 6 alternatives, ( A 4 ) "GatorTron S 10B" had the 1st rank as compared to ( A 1 ) "GatorTron 90B" had the 6th rank. The implications of this study extend beyond academic discourse, directly impacting healthcare practices and patient outcomes. The proposed framework can help healthcare professionals make more informed decisions regarding the adoption and utilization of LLMs in medical settings.
    MeSH terms: Artificial Intelligence*; Decision Making; Humans; Fuzzy Logic*
  3. Hao Y, Zhou X, Razman R, Peng S, Ahmad NS
    BMC Public Health, 2024 Aug 30;24(1):2357.
    PMID: 39215263 DOI: 10.1186/s12889-024-19842-7
    BACKGROUND: Compliance with the 24-Hour Movement Guidelines (24-HMG: physical activity (PA), screen time (ST), and sleep) has been associated with numerous beneficial health outcomes among children and adolescents. However, there is a lack of consensus on the overall compliance with the 24-HMG specifically among children and adolescents with disabilities. Therefore, this systematic review and meta-analysis aimed to examine the extent to which children and adolescents with disabilities adhere to the 24-HMG globally.

    METHOD: Quantitative studies published in English until May 2023 were sought by searching seven electronic databases: Web of Science, PubMed, SPORTDiscus, CINAHL, MEDLINE, Scopus, Psychology and Behavioural Sciences Collection. This review included studies that identified participants as individuals with disabilities and reported the overall (non) compliance with the 24-HMG among children and adolescents with disabilities.

    RESULTS: A total of 13 studies, involving 21,101 individuals (65.95% males), aged 6 to 21 years from 9 countries, were included in the analysis. In general, 7% (95%CI: 0.05-0.09, p 

    MeSH terms: Adolescent; Child; Female; Disabled Persons; Humans; Male; Exercise*; Guideline Adherence/statistics & numerical data; Disabled Children; Young Adult
  4. Goh Y, Sadikan MZ, Jaiprakash H, Nasir NAA, Agarwal R, Iezhitsa I, et al.
    BMC Complement Med Ther, 2024 Aug 30;24(1):322.
    PMID: 39215295 DOI: 10.1186/s12906-024-04614-y
    BACKGROUND: Tocotrienol is a vitamin E analogue that is known to exert anti-inflammatory and antioxidant effects. Hence, in the current study, the effects of TRF on the expression of pro- and anti-apoptotic proteins in the streptozotocin-induced diabetic rat retinas were investigated. The effect of TRF on the visual behaviour of rats was also studied.

    METHODS: Diabetes was induced in rats by intraperitoneal injection of streptozotocin and was confirmed by a blood sugar level of at least 20 mmol/L, 48 h, post-injection. Diabetic rats were divided into a group treated with vehicle (DV) and the other treated with TRF (100 mg/kg; DT). A group of non-diabetic rats treated with vehicle (N) served as the control group. All treatments were administered orally for 12 weeks. Rats were then subjected to an assessment of general behaviour in an open field arena and a two-chamber mirror test to assess their visual behaviour. At the end of the experimental period, rats were sacrificed, and their retinas were isolated to measure the expression of pro- (Casp3, Bax) and anti-apoptotic (Bcl2) markers using RT-qPCR and ELISA. TUNEL staining was used to detect the apoptotic retinal cells.

    RESULTS: Treatment with TRF lowered the retinal expression of Casp3 protein by 2.26-folds (p 

    MeSH terms: Animals; Male; Streptozocin; Rats, Sprague-Dawley; Rats, Wistar; bcl-2-Associated X Protein/metabolism; Rats; Caspase 3/metabolism
  5. Wardhani AK, Dwiantama K, Iskandar K, Yunus J, Gunadi
    Med J Malaysia, 2024 Aug;79(Suppl 4):1-5.
    PMID: 39215407
    INTRODUCTION: Hirschsprung disease (HSCR) is a congenital disorder caused by the absence of ganglion cells, which leads to a functional obstruction in infants. HSCR is divided into short, long and total colon aganglionosis (TCA). However, post-operative outcome assessment of patients with long-segment and TCA is scarce. We determined the functional outcomes, Hirschsprung-associated enterocolitis (HAEC) and complications of long-segment and TCA HSCR's children following pull-through surgery.

    MATERIALS AND METHODS: Descriptive analysis research was done for children with HSCR long-segment and TCA who underwent an operation at our institutionfrom 2013 to 2020. We assessed the functional outcome and HAEC by the Krickenbeck and the HAEC scoring, respectively.

    RESULTS: We ascertained 13 HSCR long-segment and six TCA. We performed the following surgical procedures: Duhamel (n=7), Martin (n=4), Kimura (n=1), transabdominal Yancey-Soave (n=3) and transanal endorectal pull-through (n=4). All long-segment patients revealed good functional outcomes, whereas two TCA children suffered soiling and failed to achieve voluntary bowel movement. HAEC was noted in three long-segment and four TCA patients. Furthermore, surgical site infection and diaper rash were noticed in 10 and two patients, respectively.

    CONCLUSION: Long-segment patients might have better functional outcomes TCA group, whereas the frequency of HAEC is compatible among arms. Long-term follow-up is important and necessary to identify complications early and define the proper treatment. Our study comprehensively analyzes functional outcomes, HAEC and complications of children with HSCR long-segment and TCA after definitive surgery in a developing country.

    MeSH terms: Child; Child, Preschool; Colon/surgery; Enterocolitis/etiology; Female; Humans; Infant; Male; Postoperative Complications/etiology; Retrospective Studies; Treatment Outcome
  6. Zakiyah AN, Prasetyo KR, Puspitawati I, Makhmudi A, Gunadi
    Med J Malaysia, 2024 Aug;79(Suppl 4):6-11.
    PMID: 39215408
    INTRODUCTION: Hirschsprung disease (HSCR) is a disorder caused by the failure of neural crest migration leading to an aganglionic colon and functional obstruction. Transabdominal Yancey-Soave pull-through is one of the definitive therapies for this condition. Prognostic factors, including sex, aganglionosis type, age at definitive surgery, nutritional status, eosinophilia and lymphocytosis, might influence the outcomes of the pull-through. We evaluated the functional outcomes of HSCR patients after Yancey- Soave surgery and associated them with the prognostic factors.

    MATERIALS AND METHODS: The study included Hirschsprung patients aged ≥3 and <18 years who underwent Yancey- Soave surgery at our hospital. The functional outcomes were evaluated using the Krickenbeck classification to determine voluntary bowel movement (VBM), constipation and soiling.

    RESULTS: Most (82.6%) patients showed VBM, 26.1% had constipation and 4.3% suffered from soiling. Among 23 patients who received Yancey-Soave surgery, 8 (34.8%) had eosinophilia and 5 (21.7%) had lymphocytosis. However, no significant differences were observed between eosinophilia and non-eosinophilia groups for VBM (p=1.0), constipation (p= 0.621) or soiling (p=0.738). Similarly, no significant differences were found between lymphocytosis and nonlymphocytosis groups for VBM (p=1.0), constipation (p=0.545) or soiling (p=0.973). Moreover, no other prognostic factors affected the functional outcomes after Yancey- Soave surgery (p>0.05).

    CONCLUSION: Our study shows that eosinophilia and lymphocytosis might not affect the functional outcome of patients with HSCR following Yancey-Soave surgery. In addition, sex, aganglionosis type, age at definitive surgery and nutritional status might not influence the functional outcome after definitive surgery. Further, a more extensive study is essential to clarify our findings.

    MeSH terms: Adolescent; Child; Child, Preschool; Eosinophilia*; Female; Humans; Male; Prognosis; Retrospective Studies; Treatment Outcome
  7. Lestiono A, Fauzi AR, Agustriani N, Wibowo T, Gunadi
    Med J Malaysia, 2024 Aug;79(Suppl 4):12-16.
    PMID: 39215409
    INTRODUCTION: Oesophageal atresia (EA) is a life-threatening congenital oesophageal deformity that causes considerable newborn morbidity and death. Many prognostic variables have been linked to the survival of infants with EA, although the results of the studies are still conflicting. Furthermore, studies on EA effects in developing countries still need to be included. Here, we aimed to determine the survival of children with EA and link it to prognostic variables in a particular developing country.

    MATERIALS AND METHODS: A cross-sectional observational retrospective study was conducted using medical records of paediatric patients with EA at our institution from January 2014 to December 2020.

    RESULTS: A total of 53 children with EA were included in the study. Log-rank analysis showed that definitive surgery and thrombocytopenia were significantly associated with the survival of children with EA, with a p-value of 0.007 and 0.002, respectively, whereas, sex, EA type, pneumonia and sepsis were not (p = 0.898, 0.919, 0.255, and 0.499, respectively). Multivariate analysis revealed that thrombocytopenia and definitive surgery were strongly associated with the survival of children with EA with a pvalue of 0.014 (hazard ratio (HR) = 2.67 [95% confidence interval (CI) = 1.22-5.85]) and 0.022 (HR =0.39 [95% CI = 0.17- 0.87]), respectively.

    CONCLUSION: Our study shows that thrombocytopenia might increase mortality, while definitive surgery might be beneficial for the survival of paediatric patients with EA. It implies that definitive surgery should be performed as early as necessary to prevent further morbidity and mortality. Our study comprehensively provides the survival of children with EA and links it to prognostic variables in a particular developing country. It serves as a potential research project that can be applied to the clinical setting to help clinicians manage EA better.

    MeSH terms: Cross-Sectional Studies; Female; Humans; Infant; Infant, Newborn; Malaysia/epidemiology; Male; Prognosis; Retrospective Studies; Thrombocytopenia/etiology; Thrombocytopenia/mortality
  8. Kusmayadi DD, Emiliana L, Trifosa SC
    Med J Malaysia, 2024 Aug;79(Suppl 4):17-22.
    PMID: 39215410
    INTRODUCTION: Conjoined twins (CT) is a rare congenital disorder characterised by the presence of malformations associated with secondary abnormal conjoined organ changes and abnormal hemodynamic superimposed effects about 1 in every 200 identical twin pregnancies, between 1 in 50,000 to 1 in 100,000 live births. The aim of this study is to describe the characteristics of conjoined twins.

    MATERIALS AND METHODS: This was a retrospective descriptive study. All medical records of conjoined twins who were admitted to Hasan Sadikin Bandung General Hospital from January 1st, 2015, to June 30th, 2023, were reviewed for gender, conjoined type, birth order, risk factor and treatment.

    RESULTS: Of the 28 conjoined twins, 21 were girls (75%), and 7 were boys (25%); 19 (67,85%) were of the thoracoomphalopagus type; 11 (39,28%) were born as first children; 18 (64,28%) were born at 37 weeks of gestational age; and 22 twins' (78,57%) parents were aged between 21 and 35 years. None of the mothers had used medication, 13 (46,42%) took folic acid on occasion, five (17,85%) used traditional herbs, nine (32,14%) smoked and none drank alcohol. Parents who live in industrial areas were 18 (64.28%). There was no history of conjoined twins in previous pregnancies or deliveries or in the parent's family. Liver separation had been done in four (14.28%). Emergency separation in one twin. Nine (21.42%) patients died before surgery due to a worsening condition.

    CONCLUSION: The conjoined twins were more common in girls, predominantly of the thoracoomphalopagus type. Risk factors that were commonly found were the first child, a gestational age of less than 37 weeks, and living in an industrial area.

    MeSH terms: Adult; Female; Humans; Infant, Newborn; Male; Pregnancy; Retrospective Studies; Risk Factors; Twins, Conjoined*; Young Adult
  9. Siwi K, Tejosukmono A, Anggorowati N, Arfian N, Yunus J
    Med J Malaysia, 2024 Aug;79(Suppl 4):23-30.
    PMID: 39215411
    INTRODUCTION: Muscle health in diabetes mellitus (DM) is often neglected, which leads to muscle wasting. Increased reactive oxygen species in DM could decrease antioxidant enzymes such as superoxide dismutase-1 (SOD-1) and -2 (SOD-2) and inhibit calcineurin (CN) and PGC-1α signalling pathways. Chlorogenic acid (CGA) is known as a potent antioxidant and activators of CN and PGC-1α. This study aimed to determine the effect of CGA on mRNA expressions of SOD-1, SOD-2, CN and PGC-1α in inhibiting the progression of DM to muscle wasting.

    MATERIALS AND METHODS: This study was conducted at Department of Anatomy, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada starting on July 20th, 2020. A total of 24 male Wistar rats were randomly divided into six groups (four rats per group), i.e., control, DM 1.5 months (DM1.5), and DM 2 months (DM2); and DM groups treated with CGA in three different doses, namely CGA1 (12.5 mg/kg BW), CGA2 (25 mg/kg BW), and CGA3 (50 mg/kg BW). Control group was only injected with normal saline, while diabetic model was induced by intraperitoneal injection of streptozotocin. Blood glucose levels were measured twice (one week after diabetic induction and before termination). The soleus muscle tissue was harvested to analyse the mRNA expressions of SOD-1, SOD- 2, CN and PGC-1α using RT-PCR. In addition, the tissue samples were stained with immunohistochemistry for CN and haematoxylin-eosin (HE) for morphologic analysis under light microscopy.

    RESULTS: The mRNA expressions of SOD-1 and SOD-2 in the CGA1 group were relatively higher compared to the DM2 groups. The mRNA expression of CN in the CGA1 group was significantly higher compared to the DM2 group (p = 0.008). The mRNA expression of PGC-1α in the CGA1 group was significantly higher compared to the DM2 group (p = 0.025). Immunohistochemical staining showed that CNimmunopositive expression in the CGA1 group was more evident compared to the other groups. Haematoxylin-eosin staining showed that muscle tissue morphology in the CGA1 group was similar to that in the control group.

    CONCLUSION: Chlorogenic acid at a dose of 12.5 mg/kg BW shows lower blood glucose level, good skeletal muscle tissue morphology and higher mRNA expressions of SOD-1, SOD-2, CN and PGC-1α compared to the DM groups.

    MeSH terms: Animals; Male; Muscular Atrophy/drug therapy; Muscular Atrophy/metabolism; Superoxide Dismutase/metabolism; Up-Regulation/drug effects; Rats, Wistar; Muscle, Skeletal/drug effects; Muscle, Skeletal/metabolism; Rats; Superoxide Dismutase-1/genetics; Superoxide Dismutase-1/metabolism
  10. Zahra F, Sari DCR, Yuniartha R, Alex, Thamrin MM, Melindah T, et al.
    Med J Malaysia, 2024 Aug;79(Suppl 4):31-37.
    PMID: 39215412
    INTRODUCTION: Ischaemic stroke induces oxidative stress with SOD2 downregulation, and BAX upregulation producing apoptosis. Vitamin D is a fat-soluble hormone that has a neuroprotective effect. The aim of this study is to elucidate the role of vitamin D in memory function, oxidative stress and apoptosis in transient global brain schaemic injury (TGBII) model.

    MATERIALS AND METHODS: TGBII was performed in male Wistar rats (3 to 5 months, 150 to 300 g) which underwent bilateral common carotid artery occlusion (BCCAO) for 20 minutes, then reperfused for 10 days (BCCAO group, n = 6). Two groups of BCCAO were treated with intraperitoneal injection of calcitriol 0.125 μg/kgBW (VD1 group) and 0.5 μg/kgBW (VD2 group). The spatial memory function was tested using a probe test with Morris water maze (MWM). mRNA expression of BAX and SOD2 were assessed by the RT-PCR method. Meanwhile, immunohistochemical staining was used for identification of SOD2 protein. Statistical analysis is tested using one-way ANOVA followed by post-hoc LSD.

    RESULTS: MWM showed a shorter duration in target quadrant of BCCAO group than the SO group, which is associated with BAX upregulation and SOD2 downregulation. The VDtreated groups had longer duration probe test compared to BCCAO. Furthermore, VD-treated groups had a longer duration in probe test with lower mRNA expression of BAX and higher expression of SOD2. However, there was no significant difference in VD1 and VD2. Immunostaining showed a reduced SOD2 signal in pyramidal cell of CA1 area in BCCAO group and ameliorated in VD1 and VD2 groups.

    CONCLUSION: Vitamin D ameliorates memory function and attenuates oxidative stress and apoptosis in the TGBII model.

    MeSH terms: Animals; Disease Models, Animal; Male; Memory/drug effects; RNA, Messenger/metabolism; Vitamin D/pharmacology; Up-Regulation/drug effects; Rats, Wistar; Apoptosis/drug effects; Oxidative Stress/drug effects; Rats
  11. Purnomo E, Gibran K, Makhmudi A, Andi D, Gunadi
    Med J Malaysia, 2024 Aug;79(Suppl 4):38-43.
    PMID: 39215413
    INTRODUCTION: Intussusception is a prevalent paediatric emergency condition. The standard of care involves the reduction using air or fluid enema is considered a safe procedure. Sedation-induced muscle relaxation thus optimising the treatment. We present a comprehensive 6- year study involving non sedative reduction (NSR) versus sedative reduction (SR) utilising ketamine and midazolam.

    MATERIALS AND METHODS: A retrospective cohort study was conducted between January 2017 and July 2023 in Yogyakarta, Indonesia. A total of 85 children diagnosed with intussusception underwent hydrostatic reduction, which employed water-soluble contrast administered into the rectum. Cases that were unsuccessful in reduction underwent immediate surgical intervention.

    RESULTS: Among the 85 children with intussusception underwent reduction, 22 children underwent the SR procedure and 63 underwent NSR procedure. We found a successful outcome in 17 cases (77%) of SR procedure with one recurrent and the other five (23%) got surgical reduction such as anastomosis resection (3 cases) due to Meckel- Diverticula. On the other hand, we found 24 successful cases (38.0%) in NSR procedure with one recurrent after case. 39 others who failed with NSR continued to surgical reduction. Manual reduction was done for 31 patients with one case mortality due to pulmonary bleeding. Anastomosis resection (4 cases) and, stoma (4 cases) were decided for others surgical reduction. The relative risk (RR) on this study was 2.02 (p value < 0.05, CI 95%).

    CONCLUSION: Implementation of the SR procedure may reduce surgery rates in paediatric intussusception, thereby enhancing patient management. Furthermore, the success rate of hydrostatic reduction higher in under sedation procedure. We contribute to evolve insight of non-operative approaches of paediatric intussusception management, particularly in the Yogyakarta.

    MeSH terms: Child; Child, Preschool; Female; Humans; Hypnotics and Sedatives/administration & dosage; Indonesia; Infant; Ketamine/administration & dosage; Male; Midazolam/administration & dosage; Midazolam/therapeutic use; Retrospective Studies; Treatment Outcome
  12. Faradiani AR, Mayangsari Y, Sirinupong N, Saputra WD, Firdausyah PY
    Med J Malaysia, 2024 Aug;79(Suppl 4):44-50.
    PMID: 39215414
    INTRODUCTION: The number of inflammatory bowel diseases cases has increased throughout the years. Since, the current therapeutic methods have their adverse effects, this is leading to the development of alternative therapy derived from natural products.

    MATERIALS AND METHODS: In the present study, our objective was to explore the potential of Citrus aurantifolia peel extract (CAPE) on 2, 4, 6-trinitrobenzene sulfonic acid (TNBS) induced colitis in mice. Twenty-eight male Balb/c mice were divided into four groups: (1) normal group, (2) TNBS group, (3) 125 mg/kg CAPE group and (4) 250 mg/kg CAPE group. Colitis was induced through rectal administration of TNBS. The anti-inflammatory effects of CAPE against colitis were assessed by body weight, DAI score, colonic length, weight-to-length ratio, haematology profile and histopathological examinations.

    RESULTS: Our results showed that CAPE maintained the body weight of mice, repressed the increase of DAI score, maintained mice colonic length and weight, improved blood profile and suppressed the excessive production of TNF-α, IL-6 and IL-1β. Furthermore, CAPE improved the histopathological score of colitis mice.

    CONCLUSION: All the findings of this study suggested that Citrus aurantifolia peel extract may be a potential natural agent for protecting mice against TNBS-induced colitis.

    MeSH terms: Animals; Disease Models, Animal*; Male; Mice, Inbred BALB C*; Trinitrobenzenesulfonic Acid*; Mice
  13. Melindah T, Sari DCR, Setiawan J, Alex, Thamrin MM, Zahra F, et al.
    Med J Malaysia, 2024 Aug;79(Suppl 4):51-57.
    PMID: 39215415
    INTRODUCTION: Ischaemic stroke induces oxidative stress, mitochondrial damage, inflammation and senescence and the decrease of cognitive function. Vitamin D is a fat-soluble vitamin that has a neuroprotective effect to repair the function of the nervous system. The aim of this study is to investigate the effect of vitamin D on memory function, p16, p21 (senescence), and nerve growth factor (NGF) mRNA expression on the hippocampus after transient global cerebral ischemic.

    MATERIALS AND METHODS: The study was designed as quasiexperimental with a control group that only received posttests. We performed in vivo study with an induction bilateral common carotid artery occlusion (BCCAO) model and vitamin D injection for 10 days. A total of 24 rats were divided into four groups (n = 6): Sham operation (SO [control]), BCCAO (transient global cerebral ischemic model not given vitamin D), VD1 (BCCAO + vitamin D 0.125 μg/kgBW), and VD2 (BCCAO + vitamin D 0.5 μg/kgBW). The spatial memory function was tested with the Morris water maze. We performed immunohistochemistry to localise p16 expression. p16, p21 and NGF mRNA expression were assessed by reverse transcriptase (RT-PCR) method.

    RESULTS: The vitamin D treatment group required shorter mileage to find the platform and probe test. The total time spent was longer in the target quadrant than in non-target. The Vitamin D-treated group had lower p16 and p21 mRNA expression and higher NGF mRNA expression than the BCCAO group. Immunostaining showed p16 signal in the pyramidal cell of CA1 area in the BCCAO group.

    CONCLUSION: Vitamin D repairs memory function, senescence expression was lower and NGF was higher in the BCCAO model.

    MeSH terms: Animals; Ischemic Attack, Transient/drug therapy; Ischemic Attack, Transient/metabolism; Disease Models, Animal*; Hippocampus/drug effects; Hippocampus/metabolism; Male; Memory/drug effects; Nerve Growth Factors/genetics; Nerve Growth Factors/metabolism; Up-Regulation/drug effects; Rats, Sprague-Dawley; Nerve Growth Factor/genetics; Nerve Growth Factor/metabolism; Rats
  14. Hendrawan F, Nugrahningsih DAA, Purnomo E, Azdy NA
    Med J Malaysia, 2024 Aug;79(Suppl 4):58-62.
    PMID: 39215416
    INTRODUCTION: There are some complications that can arise after surgery, like surgical site infection (SSI). In hernia repair, SSI incidence is low. Hence, the clinical practice guideline (CPG) published by the HerniaSurge Group (THG) does not recommend prophylactic antibiotics for hernia repair. Despite the unnecessary use of prophylactic antibiotics, regarding patient safety, prophylactic antibiotics can be used. However, each hospital has its own CPG and recommended antimicrobials based on the infection cases in its site. Regarding antimicrobial resistances, evaluating prophylactic antibiotics is essential to prevent increasing incidence of antimicrobial resistance cases. The aim of this study is to evaluate the use of prophylactic antibiotics in hernia inguinal cases.

    MATERIALS AND METHODS: This cross-sectional analytic study used patients' medical records between 2015 to 2020. Demographic data, surgery data and the used antimicrobial data were extracted and written in case report form. Identification of risk factors for inappropriate use of prophylactic antibiotics was done using logistic regression.

    RESULTS: We identified 55 inappropriate times of preoperative prophylactic antibiotic therapy cases out of 80 cases and 63 cases in post-operative antibiotics were different from the guideline. Statistical analysis did not find any factor related to inappropriate therapy time.

    CONCLUSION: The misuse of prophylactic antibiotics was frequently found regarding the duration of prophylactic antibiotics in both pre- and post-surgery setting. Nonetheless, no risk factor was identified with the inappropriate use of prophylactic antibiotics.

    MeSH terms: Adult; Aged; Anti-Bacterial Agents/administration & dosage; Anti-Bacterial Agents/therapeutic use; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Risk Factors; Antibiotic Prophylaxis*; Inappropriate Prescribing/prevention & control; Inappropriate Prescribing/statistics & numerical data
  15. Prasetyo AA, Rachmawati B, Riwanto I
    Med J Malaysia, 2024 Aug;79(Suppl 4):63-67.
    PMID: 39215417
    INTRODUCTION: Cholestasis is bile flow disruption that leads to bile accumulation, which could lead to liver fibrosis. Ursodeoxycholic acid (UDCA) has a hepatoprotective effect. Glutathione (GSH) is an endogenous antioxidant that plays a role in maintaining the function and structure of liver cells. This study aimed to examine the effect of UDCA-GSH combination therapy in multiple doses on liver function in the Sprague-Dawley rats' liver fibrosis model.

    MATERIALS AND METHODS: This was a randomised post-testonly study. A total of 28 rats were assigned into four groups: Group 1 is control group (C), samples had bile duct ligation and UDCA monotherapy 20 mg; Group 2, bile duct ligation + UDCA 10 mg + glutathione 10 mg (P1); Group 3, bile duct ligation + UDCA 20 mg + glutathione 15 mg (P2); Group 4, bile duct ligation + UDCA 30 mg + glutathione 20 mg (P3). Serum AST, ALT, ALP activity, total, direct and indirect bilirubin were collected. Shapiro-Wilk test was used for the normality test. All groups' data were compared using Kruskall-Wallis and Mann-Whitney tests.

    RESULTS: There was a significant difference in the ALP level in all rats and between the C and P2 groups. ALP level of all groups decreased significantly compared to the control group. Combination therapy group showed lower bilirubin levels. ALT levels significantly differed between the C-P1, P1-P2, and P1-P3 groups.

    CONCLUSION: UDCA-GSH therapy improves liver function in BDL rats' models compared to UDCA monotherapy.

    MeSH terms: Animals; Cholagogues and Choleretics/administration & dosage; Disease Models, Animal; Drug Therapy, Combination*; Liver/drug effects; Liver Function Tests; Male; Random Allocation; Rats, Sprague-Dawley*; Rats
  16. Ramadhani AT, Setiawan A
    Med J Malaysia, 2024 Aug;79(Suppl 4):68-71.
    PMID: 39215418
    INTRODUCTION: Gastric perforation is a rare occurrence, particularly in neonates. This is an emergency case in this population. The incidence of spontaneous gastric perforation in neonates is 1:2900 live births, with high mortality and morbidity rates. The primary treatment is surgical debridement and repair of the perforation, which has a high incidence of anastomotic leakage. At present, there is a plethora of studies investigating the efficacy of human dried amniotic membrane (H-DAM) technology in promoting wound healing. Consequently, researchers sought to ascertain whether there were differences in the number of adhesion and abscess classifications for the macroscopic evaluation of gastric perforation repair with HDAM as a biomaterial in New Zealand white rabbits.

    MATERIAL AND METHODS: A total of 30 male New Zealand rabbits underwent laparotomy and gastric perforation. These animals were then divided into three groups, with each group comprising 10 rabbits. Group 1 underwent primary repair, group 2 underwent omental patch repair, and group 3 underwent H-DAM patch repair. The rabbits were euthanised on the 7th day and the adhesion score and abscess classification were evaluated.

    RESULT: A total of 30 samples of rabbits were homogeneous. On macroscopic evaluation, it was found that the H-DAM had the lowest mean adhesion score and the lowest incidence of abscess formation compared to all other groups.

    CONCLUSIONS: It can be concluded that the utilisation of HDAM as a biomaterial patch in the treatment of gastric perforation in the rabbit model did not result in any instances of leakage, adhesion or infection.

    MeSH terms: Animals; Biocompatible Materials; Humans; Male; Rabbits; Wound Healing*
  17. Arfian N, Nugraha GC, Kencana SMS, Alexandra G, Eliyani ND, Dewi KC, et al.
    Med J Malaysia, 2024 Aug;79(Suppl 4):72-76.
    PMID: 39215419
    INTRODUCTION: Inflammation caused by diabetes can damage multiple organs, including the lungs. Vitamin D (VD) has been shown to potentially reduce inflammation and boost the immune system. VD might play a role in diabetes' inflammatory response. This study aims to elucidate the evidence regarding the lung as the target organ for DM and the possible role of VD in preventing pulmonary damage progression in the diabetes rat model.

    MATERIAL AND METHODS: Thirty Sprague Dawley rats (3-monthold, 200 to 300 gm) were randomly divided into six groups, namely control (C), 4 weeks diabetes mellitus (DM1), 8 weeks DM (DM2) and three DM1 groups (VD1, VD2, and VD3) who received Vitamin D doses of 0.125, 0.25 and 0.50 μg/kg BW, respectively. After 4 weeks, daily VD was administered intraperitoneally for 30 days. Lung tissues were taken for IL- 6, MCP-1, NFKB and CD68 mRNA expression analysis and paraffin embedding. Immunohistochemical staining against CD68 and MCP-1 was conducted. Data were analysed using one-way ANOVA. p < 0.05 was considered statistically significant.

    RESULTS: DM2 group represented significantly higher IL6, MCP1, NFKB and CD68 mRNA expression than Control group (p < 0.05). Meanwhile, VD2 and VD3 groups revealed significantly lower mRNA expression of IL-6, MCP1, NFKB and CD68 than DM2 (p < 0.05). Immunostaining revealed the spreading of MCP1 protein expression in lung tissue along with macrophage infiltration in the DM2 group, which was reduced in the VD2 and the VD3 groups.

    CONCLUSION: VD shows a protective effect on diabetesinduced lung damage by regulating inflammation factors.

    MeSH terms: Animals; Disease Models, Animal; Inflammation/drug therapy; Lung/drug effects; Lung/metabolism; Lung/pathology; Male; Interleukin-6/metabolism; Rats, Sprague-Dawley*; Chemokine CCL2/metabolism; Rats
  18. Poerwosusanta H, Aditia D, Gunadi, Halim PG, Yuliana M
    Med J Malaysia, 2024 Aug;79(Suppl 4):77-82.
    PMID: 39215420
    INTRODUCTION: Congenital diaphragmatic hernia (CDH) is a failure of closure of the pleuro-peritoneal canal due to faulty embryogenesis caused herniation of intra-abdominal contents into the chest. There needs to be more clarity about the optimal surgical timing for CDH. The aim of this study is to determine the optimal surgical timing for CDH using a systematic review analysis.

    MATERIALS AND METHODS: Our study used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020. The literature search approach used publications between 2013 and 2023 using Pubmed and SagePub databases. Studies were included if they contained reports of the best timing for emergency surgery for CHD repair. We did not include review articles and unpublished data.

    RESULTS: Five articles met the criteria. The overall result, the first pre-operative 24-hour oxygenation index mean, was temporally reliable and representative (intraclass correlation coefficient = 0.70, 95% CI = 0.61-0.77). Within any severity level, there were no differences in 90-day survival or mortality rate between delayed repair and early repair (p = 0.002). As a result, there is no optimal timing for surgery in severe cases of CDH. A delay in repair did not predict an increased risk of death, nor did it suggest an increased need for post-operative extracorporeal membrane oxygen therapy.

    CONCLUSION: Regardless of the severity of the illness, the timing of CDH repair does not affect the mortality rate.Surgery is done after the physiology index achievement.

    MeSH terms: Humans; Infant, Newborn; Time Factors; Time-to-Treatment
  19. Choridah L, Pangastuti N
    Med J Malaysia, 2024 Aug;79(Suppl 4):83-86.
    PMID: 39215421
    Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) is a rare congenital malformation of the female urogenital tract characterized by a triad of uterine didelphys, obstructed hemivagina, and ipsilateral renal anomaly. It was formerly known as Herlyn Werner Wunderlich Syndrome (HWWS). The syndrome usually presents with cyclic pelvic pain following menarche. Endometriosis is a prevalent complication. Magnetic resonance imaging (MRI) helps in diagnosing OHVIRA syndrome and endometriosis due to its high contrast resolution and objectivity. We reported a 13- year-old girl who was evaluated for cyclic pelvic pain after her menarche at 12 years of age. Magnetic resonance imaging (MRI) revealed two separate uterine cavities, services and vaginae, indicating didelphys. The left uterine cavity is filled with fluid, and the left hemivagina is dilated and filled with hyperintense and hypointense fluid on T1 and T2, respectively, indicating blood products. Left hemivagina dilatation implicated the presence of an obstructing vaginal septum. A single left adnexal cyst lesion with blood products was suggestive of an endometriotic cyst. Additionally, the left kidney was absent. A uterine didelphys with left hemivagina obstruction, hematometra, hematocolpos, and the ipsilateral ovarian endometriotic cyst was diagnosed. A final diagnosis of OHVIRA syndrome or HWWS was made, considering that she had no left kidney.MRI is a suitable diagnostic tool for precise anatomical delineation of the uterus, cervix, and vagina in uterovaginal disorders such as OHVIRA syndrome. MRI can also properly evaluate endometriosis and adhesion.
    MeSH terms: Adolescent; Female; Humans; Magnetic Resonance Imaging*; Syndrome; Urogenital Abnormalities/complications; Urogenital Abnormalities/diagnosis
  20. Kurniawan T, Dwidanarti SR, Dhamiyati W, Ekaputra E, Meidania L, Yanuarta SE, et al.
    Med J Malaysia, 2024 Aug;79(Suppl 4):87-90.
    PMID: 39215422
    Diffuse intrinsic pontine glioma (DIPG) is a highly aggressive paediatric brain tumour and nowadays has not had satisfactory result, with most patients do not survive within 1 year of diagnosis. Due to its proximity to critical organs, surgery is avoided, and radiation is the mainstay of treatment. In this case report, we present a case of DIPG treated with radiation and concurrent temozolomide. A 7- year-old child was admitted with complaints of weakness in the eyelid, upper and lower limbs 2 months ago. Physical examination showed tetra paresis and bilateral cranial nerve palsy. Magnetic resonance imaging (MRI) scan showed intracranial tumour consistent with DIPG. Diagnosis was made based on imaging as surgery or biopsy can lead to further morbidity. The patient underwent radiotherapy with concurrent chemotherapy of temozolomide. Radiation was given by dose of 54 Gy/30 fractions (30 × 1.8 Gy) with volumetric arc therapy (VMAT). Due to technical issue after the first five irradiations resulting in 2 weeks delay, boosting of dose by 5 × 1.8 Gy was then given, hence, the total dose was 63 Gy. The booster only targeted the gross tumour volume. Following radiation, the patient felt clinical improvement. Eyelid and limb movement improved since the 15th fraction. At the last fraction, the patient's condition improved symptomatically, but experienced complaints related to post radiation oedema including dizziness and nausea. These complaints were improved upon steroids administration. The MRI evaluation will be done after 8 to 12 weeks of radiation, considering the effects of acute radiation could still occur at this period. In conclusion, a combination of radiotherapy and temozolomide could be an option for DIPG management, with tolerable acute toxicity and possible clinical improvements.
    MeSH terms: Child; Dacarbazine/analogs & derivatives; Dacarbazine/therapeutic use; Humans; Magnetic Resonance Imaging; Male; Antineoplastic Agents, Alkylating/administration & dosage; Antineoplastic Agents, Alkylating/therapeutic use; Chemoradiotherapy
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