There are numerous studies over
the past few decades that reiterate
the positive points of Obesity and
Metabolic Surgery. It’s ability to
provide a relatively more sustainable
weight loss over a longer period of
time, improvement in quality of life
and weight-related comorbidities
namely Type 2 Diabetes Mellitus are
among a few to boast. However, as
with any invasive procedure, Obesity
and Metabolic Surgery is not free of
possible complication risks, the main
reason for which there has been a major
push for improvements in efficacy and
innovation for better and safer surgical
weight loss options. In the era of
“healthcare at your fingertips”, a simple
Google search will be able to enlighten
just anyone on the available options
making it possible for an individual
to “negotiate” or “bargain” with their
surgeon before making a final decision.
The four most well researched and
documented weight loss procedures
are Laparoscopic Sleeve Gastrectomy
(LSG), Laparoscopic Roux-En-Y gastric
Bypass (LRYGB), Biliopancreatic
Diversion (BPD) and Laparoscopic
Adjustable Gastric Banding (LAGB)
(Buchwald et al. 2004). Look a little
closer and you will not be able to turn
away from being a tad bit curious about
a few “new kids on the block” such
as Laparoscopic Mini Gastric Bypass,
Laparoscopic Sleeve Gastrectomy with
Proximal Jejunal Bypass, Laparoscopic
Banded Roux-En-Y Gastric Bypass and
some of the less invasive endoluminal
procedures including a recent FDA
approved percutaneous aspiration
device called Aspire Assist that has
garnered much interest as well as
criticism at the same time (Lee et
al. 2014; Kumar 2016; Forssell &
Norén 2015). Surgeons from all over
the world, their institutions, and the
supporting industry laud the excitement
surrounding innovation in Obesity and
Metabolic Surgery. A sentiment shared
by consumers who perceive “new” as
synonymous with improved.
Solar retinopathy is an injury of the retinal photoreceptors due to excessive
exposure to the solar radiation. Diagnosis of the disease is challenging and requires
combination of a detailed history and imaging modalities. This case report focuses
on a 55-year-old fruit picker with an irreversible central scotoma of the right eye.
A diagnosis of solar retinopathy was made based on history but mainly by several
imaging modalities, such as optical coherence tomography (OCT), infrared (IF)
imaging of the fundus and fundus autofluorescence (FAF). Electroretinogram (ERG) showed flattened and reduced waves in both scotopic and photopic response.
Fundus angiography (FA) revealed no obvious telangectatic vessels. In conclusion,
solar retinopathy is a disease where multimodal imaging may play an important
role in the diagnosis. The condition may be irreversible thus advocating protective
eyewear is mandatory in patients who are chronically exposed to the sun.
The search for novel biomarkers has taken centre stage in the past decades of research in Rheumatoid Arthritis (RA). The purpose of the present study was to determine the correlation of serum matrix metalloproteinase-3 (MMP-3) with disease activity, joint damage and functional disability in patients with RA. We consecutively recruited RA patients who were under follow-up at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Information on the RA disease characteristics were obtained from the medical records and all RA patients were
assessed for DAS28 (disease activity score based on 28 joints) and Stanford Health Assessment Questionnaire (HAQ) 8-item Disability Index (HAQ-DI). The hand radiographs of the RA patients were assessed for joint damage using the Modified Sharp Score (MSS). Serum MMP-3 levels from RA patients and healthy controls were measured using the ELISA method. We recruited a total of 77 RA patients and 18 healthy controls. The serum MMP-3 levels were significantly higher among the RA patients (p<0.05). There were significant correlations between the serum MMP3 levels and MSS (r =0.327) and HAQ-DI (r=0.256), both p<0.05. The mean serum MMP levels in RA patients with radiographic joint erosions was significantly higher than in patients without erosions (p<0.05). Likewise, the subjects with significant functional impairment i.e HAQ-DI ≥1; had significantly higher mean MMP-3 levels compared to RA patients without significant disability (p<0.05). Using multivariate analysis, HAQ-DI remained the independent predictor of serum MMP-3 in RA patients. Serum MMP-3 is a potential biomarker and predictor of radiographic joint damage and functional disability in RA.
Keywords: acquired joint deformity, matrix metalloproteinases, rheumatoid arthritis
Two new vascular health markers which are derived from finger
photoplethysmography (PPG) waveform have been introduced based on Malaysian
population, namely PPG fitness index (PPGF) and vascular risk prediction index
(VRPI). The objectives of this study were to investigate the associations between
PPGF and other cardiovascular disease (CVD) markers such as carotid femoral pulse
wave velocity (PWVCF), to compare PPGF between those with and without CVD risk
factors and to determine the sensitivity of VRPI in identifying young subjects with
CVD risk factors. A total of 114 men age 20 to 40 yrs with and without CVD risk
factors were recruited. Risk factors included hypertension, smoking, dyslipidemia,
abdominal obesity and family history of premature CVD. Subjects were divided
into healthy, those with one risk factor and those with at least two risk factors. Their
weight, height, peripheral and central blood pressure (BP), PWVCF and PPGF were
measured and the sensitivity of VRPI in predicting subjects with CVD risk factor was
calculated. Data was analyzed via SPSS version 15 and p < 0.05 was considered
significant. The mean age of the subjects was 28.94 ± 4.86 yrs. No differences in
PPGF was observed between groups (p > 0.05). The independent variables for
PPGF were forward pressure (Beta = 0.35, p < 0.01), PWVCF (Beta = -0.26, p < 0.01),
systolic BP (Beta = -0.26, p = 0.04) and height (Beta = 0.24, p < 0.01). The sensitivity
of VRPI was 82.02%. In conclusion, PPGF was correlated to PWVCF and may be a
potential marker of arterial stiffness. In addition, VRPI is sensitive to be used as an
early screening of CVD risk factors.
Mutation is known to occur before the development of various types of cancers.
Mutation in p53 gene can be found in human breast cancer. The aim of the present
study was to determine the correlation between p53 protein expressions with women in premenopausal age. A total of 111 breast cancer tissues were examined for p53
protein expression by IHC. The results showed that majority (36.9%; n=41/111)
who were more than 41 yrs, overexpressed positive p53 (+) protein category and
2.7% (n=3/111) aged 41 yrs and less, showed less positive p53 (+) protein category.
However, the Fishers exact test, indicated that, there was no significant correlation
between participant’s age group with p53 protein category (χ2
(1) = 0.78; p =0.52)
and no correlation strength was indicated (Cramer’s V coefficient = 0.08; p
=0.37), respectively. The risk estimate showed probability of p53 (+) protein being
overexpressed in the age group < 41 yrs was 0.66 times less likely compared to the
age group > 41 yrs. In conclusion, with or without overexpression of p53 protein,
women above 41 yrs were found to have greater risk.
Conventional argon laser causes transient thickening of retinal nerve fibre layer (RNFL). The effect of pattern scanning laser (PASCAL) has not been well described. We compared the immediate changes in peripapillary RNFL thickness post-panretinal photocoagulation between conventional argon lasers and PASCAL in patients with diabetic retinopathy changes. A total of 32 subjects were recruited. There were 16 patients in the argon group and 16 patients in PASCAL group. Diabetic patients were recruited from Ophthalmology Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Complete eye examinations and fundus photographs were performed at baseline prior to laser treatment, and post-laser treatment at two and four months. RNFL thickness was measured using time domain optical coherence tomography. Both groups were comparable with respect to clinical characteristics and demographics. There was no significant difference in average RNFL thickness between the two groups prior to treatment (p= 0.323). RNFL post-laser treatment for patients receiving conventional argon laser remained unchanged with no significant differences in all quadrants at any time-point (two and four months). However, for the PASCAL group, significant thickening occurred at four months for average RNFL and the inferior quadrant (p <0.05). The other quadrants similarly demonstrated increasing thickness at four months but this did not reach statistical significance. Transient RNFL thickening occurs in both conventional and PASCAL laser patients. The PASCAL laser induces a greater increase in RNFL thickness than the argon laser group. Important events, such as laser eye treatments and even type of laser used, are worthy of consideration when evaluating RNFL.
Keywords: diabetic retinopathy, optical coherence, photocoagulation, retinal ganglion cells, tomography
Study site: Ophthalmology Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
The objectives were to identify factors associated with early revisit of adult patients with acute asthma exarcebation discharged from the Emergency Department (ED). It was a retrospective cohort study with patients aged 12 years or more within a period of 1 month and who were treated for acute asthma and discharged from the ED of Sarawak General Hospital. A total of 397 patients fulfilled sampling criteria and out of this number, 13.9% had revisit to the ED within 2 weeks. In all of these revisit cases, 9.1% were actually admitted. Prescription rate of oral corticosteroid was found to be low (24.9%) and abscond rate was high (25.1%). Patients who absconded from the ED and their concurrent infection were associated with early ED revisit.
Patients who self-discharge against medical advice (DAMA) are susceptible to life-threatening consequences. By understanding the factors associated with DAMA, healthcare centres can build strategies to assist patients to receive optimal medical care and prevent unfavourable outcome. The objective of this study was to determine the factors associated with DAMA from the Emergency Department (ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a prospective unmatched case control study conducted over a 4-month period. For every DAMA episode, two patients who were admitted on the same day were randomly selected as control. Following patient consent, data was collected using a standardized questionnaire. Patients were contacted by the investigator for information regarding hospitalization within two weeks of DAMA. Ninety three patients were recruited; 31 DAMA patients and 62 admitted patients. Payment method was significantly associated with DAMA (OR 3.17 95% CI 1.29-7.98; p=0.01). The likelihood of self-paying patients to take DAMA was three times higher than those who had a guarantor letter from their employer or insurance provider. Other factors which influence DAMA were family obligations (OR 4.08 95% CI 1.09-15.26; p = 0.03) and work problems (OR 3.83 95% CI 1.13-12.94; p=0.03). A total of 19.4% of DAMA patients left following symptomatic pain relief. A total of 80.6% DAMA patients were admitted to hospital within two weeks of the DAMA episode. Payment method significantly influences DAMA. Payment planning, social welfare services, non-governmental organization funds and the introduction of a national health policy scheme may aid hospital payment, alleviate financial limitation of patients and reduce DAMA episodes.
Out-of-hospital cardiac arrest (OHCA) patients require immediate cardiopulmonary
resuscitation (CPR). Early initiation of CPR and defibrillation before arrival at
Emergency Department (ED) increases the chance of survival from sudden cardiac
arrest. The main objective of this study was to identify the factors that influenced
the outcome of early cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac
arrest (OHCA) patients managed at the ED of Universiti Kebangsaan Malaysia
Medical Centre (UKMMC). The second objective was to determine the incidence
of CPR initiated by the public prior to ambulance arrival. The present study was a
one-year cross-sectional study. The OHCA patients were identified from the ED
resuscitation logbook. Patients’ medical records were used to obtain details of the
resuscitation. Factors recorded included: aetiology of arrest, initiation of on-scene
CPR, use of automated external defibrillators (AEDs), mode of transportation and
the incidence of return of spontaneous circulation (ROSC) in the ED. Categorical
data was analysed using chi-square and Fisher exact tests. Nine patients out of 98
had early CPR. Three patients achieved ROSC. Gender was significantly associated
with ROSC (p-value=0.015). More patients who received early CPR achieved ROSC
compared to those who received late CPR. The provision of early CPR and usage
of AEDs by the public is still low. Female gender had a positive influence on ROSC.
Efforts are required to increase the awareness and involvement of the public in
initiating early CPR prior to the arrival of ambulance service.
Midazolam is one of the most commonly used drugs for sedation in Emergency Department (ED). This was a retrospective study conducted on 380 patients from December 2012 to May 2014 in ED of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The objective was to elicit the frequency of side effects and correlation to various factors i.e. socio-demography, co-morbidities, age groups and underlying illnesses. Out of 380 patients, 35 patients experienced side effects (20 patients with midazolam alone, 15 patients with combination of drugs). The average age was 42 years and the average dose of midazolam was 3.5mg. The most common other drug combined was fentanyl. The overall complication rate for midazolam was 5.3%. The most common side effect recorded was excessive somnolence (1.6%). Other side effects included local skin reactions (1.1%), vomiting (0.8%), headache (0.8%) and hypotension (0.5%). There was no significant association between the socio-demographic factors and drugs combination with the side effects of midazolam on patients. It was concluded that midazolam was a safe drug due to absence of any life-threatening side effects. There are possibilities that most side effects recorded could be caused by other comfounding factors e.g. underlying injuries or disease and combination with other drugs.
Fulfillment of the family needs for the critically ill patient in Critical Care Unit
should be met by healthcare providers to improve patient’s quality of life. The
purpose of this study was to identify the needs of family members of critically ill
patients in a Critical Care Unit. A cross-sectional study was conducted on 109
family members of patient hospitalized at the Intensive Care Unit and Coronary
Care Units of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The
modified Critical Care Family Needs Inventory (CCFNI) comprised of 5 domains of
family member’s needs: Information, Proximity, Assurance, Comfort and Support.
The findings showed that assurance and information needs were the highest with
(3.77 ± 0.306); (3.62 ± 0.379), proximity need (3.60 ± 0.415), support need (3.57
± 0.477) and comfort need (3.55 ± 0.586), respectively. There was significant
relationship between respondent’s relationship with family needs of proximity
(p = 0.013). This study indicated that there were significant association between
respondent’s monthly income and family needs of comfort and support, (p = 0.033)
and (p = 0.004). There was also significant association between the gender with
comfort need (p = 0.013). In this study, it was observed that information, proximity,
assurance, comfort and support were opinioned as their requirements during
hospitalization. Hence, it assists in coping while being admitted to Intensive Care
Unit and Coronary Care Unit of UKMMC. An educational package and updating
patient’s information should be emphasized to enhance the family needs of critically
ill patient in the critical care settings.
Menopause, a cessation of menstrual bleeding, is directly related to serious
illness confined to cardiovascular disease (CVD) such as hypertension and stroke. The oestrogen withdrawal and consumption of high cholesterol diet has
a detrimental effect on cardiovascular function and metabolism in menopausal
women. The present study was aimed to develop the hypertensive rat model in
the ovariectomised Sprague Dawley rats fed with 2% cholesterol diet following a
short term period. Eighteen Sprague-Dawley rats were randomly divided into three
groups; Sham control (sham), ovariectomized control fed with normal diet (Ovx
+N), ovariectomized rats fed with 2% cholesterol diet (Ovx + Cho) for four weeks.
At the end of the study, the food intake and body weight were measured. The
systolic, diastolic and mean blood pressure was determined. OVX+Cho showed
significant increase in physiological changes such as body weight and food intake
compared to Ovx+N group. The significant increase in systolic, diastolic and mean
blood pressure was observed in Ovx+Cho group. Based on the above findings,
it is believed that feeding cholesterol diet for four weeks (short term) results in
significant increase in the blood pressure, food intake and body weight in the
ovariectomised rats.
Peripheral Intravenous Catheters (PIC) are widely used. Nurses are required to possess appropriate knowledge and practice. The present study aimed to determine nurses' knowledge and practice towards care of PIC. A cross-sectional descriptive study was conducted and 84 respondents participated in the study. A 26-item questionnaire comprising 11 items on knowledge and 15 items related to nursing practice was adapted and modified. The findings reported higher mean score from specialty unit respondents, with knowledge (M = 49.19, SD = 3.44) and practice (M = 66.38, SD = 5.15), compared to medical surgical wards with knowledge (M = 46.25, SD = 4.68) and practice (M = 63.17, SD = 4.63) towards the care of PIC, which was significant (p value = 0.010 and p value = 0.009, respectively). The study indicated a higher mean score of charge nurse respondents as compared with registered nurse with knowledge (M = 49.68, SD = 3.23); (M = 46.20, SD = 4.62) and practice (M = 67.11, SD = 4.84); (M = 63.06, SD = 4.61), which was significant (p value = 0.003 and p value = 0.001, respectively). There were no significant differences between respondents’ education qualification towards care of PIC with p > 0.05. However, the findings reported that respondents who possessed Bachelor of Nursing were deemed to score slightly higher in their knowledge and practice towards the care of PIC. In conclusion, the specialty unit and charge nurse respondents were deemed to possess better knowledge and practice towards the care of PIC in the hospital.
Stridor in infants with subglottic cyst is rare. Mismanagement of such cases may
lead to respiratory compromise with a potentially serious and fatal outcome. The
diversity of the clinical presentations throws a great challenge in the diagnosis of
subglottic cysts. Manifestations vary as they depend on the size and location of
the cysts. We report the case of a 6-month-old girl who had a subglottic cyst
but managed as moderate croup till she developed worsening respiratory acidosis
which difficult intubation. Any case of premature infants with previous history of
neonatal intubation presenting with stridor should prompt clinicians to look for
possible cysts in the larynx. This is important because once the diagnosis is made, appropriate treatment may be given and unnecessary morbidity and mortality may
be avoided.
Traditional or herbal medications are generally perceived as safe since it is derived
from natural or plant sources. A rise in number of adverse reactions are being
reported with the use of traditional medications including localized cutaneous
reactions. The diagnosis of contact dermatitis is often quite straight forward
based on its appearance, pattern, site and distribution of the lesion which usually
corresponds to the area of contact. We report the case of a 65-year-old woman who
presented with redness, burning sensation and swelling of her hand after applying
topical Chinese traditional medication. This report aims to outline simple measures
to identify and manage contact dermatitis secondary to topical medication. The
present case creates awareness that topical traditional medications are not as harmless as previously thought to be. Precautions regarding adverse reactions are
required, as those with conventional medications.
Patient positioning is a vital in ensuring patient comfort, dignity and good access to
the operative site. Accurate positioning helps in minimising the risk of injury to the
patient. An in-house airbag made from recyclable medical supplies can be used
to replace the conventional sandbag for head and neck surgeries. It involves the
use of an empty irrigation bottle, a valve and suction tubing. Its shape and volume
is readily adjustable by altering the volume of inflated air. Moreover, compressible
air moulds the bag to the curvature of the patient’s external surface reducing the
risk of pressure sores in prolonged surgery. Ultimately this serves as an innovative technique which is financially savvy with the use of recyclable items.
Fifth metatarsal bone fracture is one of the most commonest fractures of the foot.
The decision for surgical or conservative approach is still inconclusive. Scoring
system, decision analysis model and classification system are established to weigh
between surgical and conservation approaches. Its unique anatomy and surgical
complication influence decision on optimal surgical approach. Therefore, the
present review attempts to look at factors that might influence decision making in
management of fifth metatarsal fracture.
Medication wastage poses a financial burden on the nation’s economy, as well as, environmental implications associated with wastage disposal. This study was conducted in a public hospital in Brunei and aimed to measure the extent of medication wastage and its disposal. This cross-sectional study used a self-designed questionnaire for patients attending outpatient pharmacy at the Suri Seri Begawan (SSB) hospital in which 253 patients participated over a period of two weeks. Exclusion criteria were: i) patients below 18 yrs, ii) patients visiting the Accident and Emergency Department and iii) patients admitted to the hospital. Majority of the participants were reported to have unused medication at home (75.1%, n=189). Nearly half (54.2%) had unused medicines and this was due to improvements in their medical conditions. Most of the participants (70.8%) were not given necessary advice on how to dispose their medicines in a proper manner. Majority disposed their unused medicines in the household garbage (70%), despite 50.2% (n=189) knowing that disposing of medicines in the garbage can cause detrimental effects on the environment. It was found that 47.7% of the participants would return their unused medicines back to the pharmacy, but in practice, only 18.6% did such. There was no significant association between knowing detrimental effects of medicine on
the environment and returning their medicines to the pharmacy (p=0.065). Results showed that medication wastage exists in SSB hospital and patients’ knowledge and
practices on its proper disposal was relatively poor. Health policy makers should be informed to implement wastage reduction strategies.
In recent years, there is a growing enthusiasm in honey which has potential health benefits, disease prevention and serves as substitution of modern medicine. Honey is a natural sweet product which is produced by honey bees from floral nectar and has been traditionally used to treat several diseases such as cardiovascular disease, diabetes mellitus, cancer and Alzheimer’s disease since ancient times. Gelam honey (GH) is one of the Malaysian wild monofloral honey which is widely used as traditional medicine by the local population. GH is enriched with several therapeutic properties namely, antioxidative, antiinflammatory, anticancer and accelerated wound healing activities. However, there is lack of literature focusing on the overall effects of GH and its medicinal value. This review paper summarises the phytochemistry characteristics of GH along with its therapeutic values which lead to a broad spectrum idea on several diseases. A concise clarification on the therapeutic properties of GH is expected to provide new knowledge to the scientific society in the era of modern globalization.
Ankle injuries are commonly seen in various sports. The main aim of the present
review was to highlight the normal anatomy of the ankle, mechanism of injuries
related to sports, congenital abnormalities or anatomical variations related to
ankle injury and discuss its effective management. A review of literature was done
to determine the ankle injuries which occur as a result of various sports related
activities. We documented all sports which involved injury to the ankle joint. The
anatomy of various structures in the sole of foot and their involvement in injuries
were discussed at length. The anatomical knowledge of ankle injury may be
beneficial for future diagnosis and treatment purpose.