MyMedR

Potential effect of herbs on diabetic hypertension: alternative medicine treatment modalities

Zar CT, Das S

Clin Ter, 2013;164(6):529-35.

PMID: 24424219 DOI: 10.7417/CT.2013.1633

BACKGROUND AND OBJECTIVE: Diabetes mellitus is commonly known to lead to life threatening complications. Among them, hypertension is one complication which may be highlighted. In modern medical society, several drugs and treatment regimen have developed to treat diabetes mellitus. Although they obtain positive impacts, yet there are certain limitations encountered in the management of the disease due to their adverse effects and non-compliance by the patients. Herbs have been valued as a supplement in treating chronic oxidative stress disorder like diabetes mellitus. In the present review, some of the herbs which possess both anti-hyperglycemic and anti-hypertensive properties are being highlighted. Potential herbs which include Andrographis Paniculata, Ammi Visnaga, Allium sativum, Phyllanthus amarus, Ginkgo biloba, Solanum tuberosum, Tuberosum L. Piper sarmentosum and Lamiaceae family are known to possess antihypertensive properties. Various researches have been conducted on these herbs and positive results have been obtained. Based on these results, the present review article discusses the alternative management of diabetic hypertension with the herbal medicine. In conclusion, the present review article stresses on the need to ensure global awareness about the traditional medicines while treating diabetic hypertension.

Position of document holder and work related risk factors for neck pain among computer users: a narrative review

Ambusam S, Baharudin O, Roslizawati N, Leonard J

Clin Ter, 2015 Nov-Dec;166(6):256-61.

PMID: 26794814 DOI: 10.7417/CT.2015.1898

Document holder is used as a remedy to address occupational neck pain among computer users. An understanding on the effects of the document holder along with other work related risk factors while working in computer workstation requires attention. A comprehensive knowledge on the optimal location of the document holder in computer use and associated work related factors that may contribute to neck pain reviewed in this article. A literature search has been conducted over the past 14 years based on the published articles from January 1990 to January 2014 in both Science Direct and PubMed databases. Medical Subject Headings (MeSH) keywords for search were neck muscle OR head posture OR muscle tension' OR muscle activity OR work related disorders OR neck pain AND/OR document location OR document holder OR source document OR copy screen holder.Document holder placed lateral to the screen was most preferred to reduce neck discomfort among occupational typists. Document without a holder was placed flat on the surface is least preferred. The head posture and muscle activity increases when the document is placed flat on the surface compared to when placed on the document holder. Work related factors such as static posture, repetitive movement, prolong sitting and awkward positions were the risk factors for chronic neck pain. This review highlights the optimal location for document holder for computer users to reduce neck pain. Together, the importance of work related risk factors for to neck pain on occupational typist is emphasized for the clinical management.

Plasma vitamin C and tocotrienols changes in response to dietary supplementation among young male adults

Zahara AM, Lee CC, Fatimah IS, Poh BK, Khairul O, Das S, et al.

Clin Ter, 2010;161(2):121-4.

PMID: 20499024

Intake of the antioxidant vitamins C and E lowers the oxidative stress. The study aimed to determine plasma concentrations of vitamin C and tocotrienols after supplementation of both vitamins in young male adults.

Pisa syndrome secondary to rivastigmine: a case report

Muthupalaniappen L, Rosdinom R, Suguna M

Clin Ter, 2012;163(1):31-2.

PMID: 22362231

Pisa syndrome or pleurothotonus is the persistent flexion of the body and head to one side giving the appearance of the leaning tower of Pisa. It is most commonly caused by typical and atypical antipsychotic drugs. We report a case of Pisa Syndrome caused by prolonged use of high dose cholinesterase inhibitor, rivastigmine. Symptoms subsided when rivastigmine was withdrawn and did not reappear when a different cholinesterase inhibitor, donepezil was introduced. Physicians should be aware of Pisa syndrome and should alert patient of this possibility when starting and stepping up medications. The purpose of reporting this case is to create awareness among general practitioners as it is a reversible condition which responds to removal of the offending drug.

Piper sarmentosum prevents glucocorticoid-induced osteoporotic bone resorption by increasing 11β-hydroxysteroid dehydrogenase type 1 activity

Suhana MR, Farihah HS, Faizah O, Nazrun SA, Norazlina M, Norliza M, et al.

Clin Ter, 2011;162(4):313-8.

PMID: 21912818

Osteoporosis is a proven complication of long-term glucocorticoid therapy. Concern on glucocorticoid induced osteoporosis has increased dramatically in recent years with the widespread use of synthetic glucocorticoids. Glucocorticoid action in bone depends upon the activity of 11βhydroxysteroid dehydrogenase type 1 enzyme (11βHSD1). This enzyme plays an important role in regulating corticosteroids by locally interconverting cortisone into active cortisol. This has been demonstrated in primary cultures of human, mouse or rat osteoblasts. Therefore, inhibition of this enzyme may reduce bone resorption markers. Piper sarmentosum (Ps) is a potent inhibitor of 11βHSD1 in liver and adipose tissue. In this study we determined the effect of Ps on 11βHSD1 activity in bones of glucocorticoid-induced osteoporotic rats.

Piper sarmentosum is comparable to glycyrrhizic acid in reducing visceral fat deposition in adrenalectomised rats given dexamethasone

Fairus A, Ima Nirwana S, Elvy Suhana MR, Tan MH, Santhana R, Farihah HS

Clin Ter, 2013;164(1):5-10.

PMID: 23455734 DOI: 10.7417/CT.2013.1502

Visceral obesity may be due to the dysregulation of cortisol production or metabolism that lead to metabolic disease. In adipose tissue, the enzyme 11beta-hydroxysteroid dehydrogenase type 1 regulates cortisol metabolism (11beta-HSD1). A previous study showed an increase in the visceral fat deposition in adrenalectomised rats given intramuscular dexamethasone. Glycyrrhizic acid (GCA) has been shown to reduce fat deposition because it is a known potent inhibitor of the 11beta-HSD1 enzyme. Piper sarmentosum (PS) is an edible medicinal plant commonly used in Asia as traditional medicine for treating diabetes, hypertension and joint pains. In this study, we determined the effects of PS extract on the disposition and morphology of perirenal adipocytes of adrenalectomised rats given intramuscular dexamethasone.

Perianchor radiolucency following PEEK suture anchor application associated with recurrent shoulder dislocation: a case report

Shahrulazua A, Duckworth D, Bokor DJ

Clin Ter, 2014;165(1):31-4.

PMID: 24589948 DOI: 10.7471/CT.2014.1658

The authors describe a case of a 25 year old male who suffered recurrent shoulder dislocations after a symptom-free period following an initial arthroscopic shoulder stabilisation using PEEK suture anchors to repair the Bankart and SLAP lesions. The MRI and CT scans showed perianchor radiolucency around all of the previously placed PEEK suture anchors. It is believed that his recurrent shoulder instability was related to this radiological finding although the exact pathomechanism of the osteolysis is not clear. To our knowledge, this is the first reported case of perianchor radiolucency after the use of a PEEK suture anchor.

Perception of quality of life amongst end stage renal failure patients undergoing haemodialysis

Ho SE, Ho CC, Norshazwani N, Teoh KH, Ismail MS, Jaafar MZ, et al.

Clin Ter, 2013;164(6):499-505.

PMID: 24424213 DOI: 10.7417/CT.2013.1627

AIMS: The objective of the study was to examine the quality of life amongst the end stage renal disease (ESRD) haemodialysis patients in Malaysia.

MATERIALS AND METHODS: A cross sectional descriptive study was conducted on 72 ESRD patients at a Dialysis Centre in Malaysia. The modified KDQOL-SF™ subscales, kidney disease-targeted scale and 36 item health survey scale questionnaires were used.

RESULTS: The overall health rating was 66.73 ± 11.670 indicating good quality of life. There was no significant difference between quality of life for the different domains according to gender (p >0.05). However, there were significant differences between quality of life in the domain of burden of kidney disease. Physical functioning deteriorated significantly with age (p=0.012) while social functioning was lowest in the 50-65 years age group (p=0.037). Those who had no morbidities had significantly better scores on the effects of kidney (p=0.036), burden of kidney disease (p=0.011) and physical functioning (p=0.025).

CONCLUSIONS: Patients undergoing haemodialysis have been found to have good quality of life despite having ESRD. It is therefore of paramount importance to constantly monitor the standard of care for these patients to enable them to live their life to the fullest.

Off-pump Coronary artery bypass graft surgery in patients with left main stem disease

Ishamuddin IM, Zamrin DM, Joanna OS, Ramzisham AR, Hairolfaizi H

Clin Ter, 2011;162(6):527-31.

PMID: 22262322

The safety, feasibility and post-operative outcome are the main concern in Off-pump Coronary artery bypass graft (OPCAB) surgery as compared to conventional technique especially in multi-vessels coronary artery disease.

Occupational radiation exposure to anesthetists from fluoroscopic projections during orthopedic operative procedures

Abas AA, Rahman RA, Yahya N, Kamaruzaman E, Zainuddin K, Manap NA

Clin Ter, 2014;165(4):e253-7.

PMID: 25203339 DOI: 10.7417/CT.2014.1739

The role of anesthetists during orthopedic fluoroscopic procedures exposes them to radiation. We conducted a prospective, descriptive study to estimate the radiation exposure to anesthetists during procedures over a six-month period in the orthopedic trauma operating theatres which had the most fluoroscopic usage.

Nurses compliance to hand hygiene practice and knowledge at Klang Valley hospital

Ho SE, Ho CC, Hng SH, Liu CY, Jaafar MZ, Lim B

Clin Ter, 2013;164(5):407-11.

PMID: 24217826 DOI: 10.7417/CT.2013.1604

Hand hygiene is the most important measure in the prevention of healthcare-associated infections (HCAI). Adherence to hand hygiene protocols in hospital by nurses enables in prevention and control the HCAI. The main aim of the present study was to assess nurses' compliance to hand hygiene practice and knowledge in a hospital.

Novel usage of fresh frozen plasma in hereditary angioedema

Hanizah N, Affirul CA, Farah NA, Shamila MA, Ridzuan MI

Clin Ter, 2016 Nov-Dec;167(6):182-184.

PMID: 28051822 DOI: 10.7417/CT.2016.1969

Hereditary angioedema (HAE) is a rare and potentially life threatening autosomal dominant disease characterized by recurrent episodes of cutaneous and mucosal oedema. It results from reduced expression or loss of function of CI-esterase inhibitors (C1-INH). As opposed to the more common histamine-mediated angioedema, HAE does not respond well to conventional treatments with anti-histamines, steroids and adrenaline. Early recognition and timely intervention with the correct treatment are crucial particularly preventing airway obstruction. New disease specific treatment including plasma derived or recombinant C1-INH, ecallantide and icatibant have recently emerged and its appropriate use can reduce HAE-associated mortality and morbidity. However due to its costs, these disease specific treatments have yet to reach Malaysia. Despite that no randomized clinical trial on FFP has been performed, its efficacy in treating acute attacks of HAE is only demonstrated in case studies. This case report illustrates the successful treatment of acute HAE episode with FFP in a Malaysian government hospital setting.

Non-secretory multiple myeloma with diagnostic challenges

Hamidah NH, Azma RZ, Ezalia E, Das S, Umar NA, Swaminathan M, et al.

Clin Ter, 2010;161(5):445-8.

PMID: 20949241

Non-secretory multiple myeloma (NSMM) is a rare variant of the classic form of multiple myeloma (MM). In NSMM, no monoclonal gammopathy can be detected in serum or urine by conventional techniques, making the diagnosis more difficult. We describe a 71-year-old man who had been diagnosed and treated for granulocytic sarcoma one year prior to his recent problems of progressive low-back pain of two months duration. Skeletal X-rays showed diffuse osteolytic lesions with multiple pathological fractures but there was no monoclonal gammopathy in the serum or urine. The biopsy of the lytic lesion on the upper part of the femur showed infiltration by abnormal plasma cells. A diagnosis of NSMM was made and he was treated with chemotherapy. The early diagnostic difficulty and the challenges faced regarding the case are discussed.

New Method of Age Estimation from Maxillary Sutures Closure in a Thai Population

Sinthubua A, Theera-Umpon N, Auephanwiriyakul S, Ruengdit S, Das S, Mahakkanukrauh P

Clin Ter, 2016 Mar-Apr;167(2):33-7.

PMID: 27212570 DOI: 10.7417/CT.2016.1918

Age estimation is one of the major components of forensic identification. Cranial suture closure has long been used as indicator for age estimation. Maxillary sutures have been less studied for estimation of age at death because they vary in their timing of closure with age. The purpose of this study was to estimate age by examining 190 Thai skulls with age ranging between 15-93 years from Forensic Osteology Research Center, Faculty of Medicine, and Chiang Mai University. Four parts of maxillary suture (incisive, anterior, transverse, and posterior sutures) were investigated the suture obliteration of each suture by computerizing from photograph. The suture were measured by pixel counting.The prediction model which based on the support vector machine (SVM) for regression or support vector regression (SVR) was utilized for data analysis. The results showed high correlation (R2 = 0.9086) between the predicted age and actual age. Plot between actual age group and predicted age in seven groups also revealed high correlation (R2 = 0.9434). These can be implied that we are able to use this SVR model to predict age at death using maxillary suture information.The interesting issue is to further apply this model in more cases to ensure the generalization of the finding. This study is the first attempt to estimate age at death using a new method based on novel analysis which considers a characteristic of relationship between maxillary suture closures with age that are not in linear form. The present study may contribute as a basis knowledge and method for further study of age estimation in archaeological and forensic anthropological contexts, especially when only skull or base of skull are found.

Nasal type NK/T-cell lymphoma - diagnosis and treatment difficulties

Hamidah NH, Shahrom S, Siti Aishah MA, Das S, Gendeh BS, Fadilah SA

Clin Ter, 2014;165(3):139-42.

PMID: 24999566 DOI: 10.7417/CT.2014.1711

Primary nasal lymphomas are rare. One of the most common cellular subtypes in the Asian population is natural killer (NK)/T-cell lymphoma (NKTL) with a high association of EBV. We report a case of a 42-year-old female, who presented with a worsening sore throat, odynophagia, dysphagia to solid food due to oropharyngeal ulcers and bilateral nasal blockage and recurrent fever for the past two weeks prior to admission. Physical examination revealed ulcers over the soft palate with nasopharyngeal slough. Computerized Tomography (CT) scan of the neck showed nasopharyngeal abscess with bilateral maxillary ethnoidal sinusitis. The diagnostic and management challenge is discussed.

Myocardial ischaemic time and its relation with left ventricular ejection fraction after single valve replacement

Izham IN, Zamrin DM, Joanna OS, Ramzisham AR, Hairolfaizi H, Ishamuddin IM, et al.

Clin Ter, 2011;162(6):521-5.

PMID: 22262321

The effect of the duration of ischaemic myocardial time to left ventricular ejection fraction (LVEF) after valve replacement surgery has been attributed. This study aims to look at the correlation between myocardial ischaemic time and changes LVEF post valve replacement surgery up to 6 months period.

Multifaceted profile of an unusual paramedian occipital condyle-anatomical and computerised tomographic evaluation

Arora J, Mehta V, Abhishek K, Nisha S, Suri RK, Rath G, et al.

Clin Ter, 2014;165(2):111-4.

PMID: 24770815 DOI: 10.7471/CT.2014.1687

During extensive osteological study of 150 dry skulls in the Department of Anatomy, Vardhman Mahavir Medical college, an unusual Paramedian Occipital (POC) condyle was detected in the occipital bone of a cadaveric skull. The anatomical details of this unusual occipital condyle were carefully studied and its morphometric measurements taken. A coronal multiplanner reformatted image and a volume rendered image were taken to study radiological details and establish significant clinical correlation. Precise understanding of anatomy of craniovertebral junction and its anomalies have become immensely important for the present day surgeon during orthopaedic and neurosurgical procedures of this region . Technical advancements in imaging modalities such as CT and MRI scans further signify the importance of these anatomical variations ,which are often missed in routine examination. Osteological study combined with radiological details of the paramedian occipital condyle in the present case aims to emphasize the importance of bony anomalies in the craniovertebral region and their role in diagnosis and appropriate treatment of neurovascular compression syndromes of craniovertebral junction. The present study highlights anatomical details, clinical relevance and embryological basis of such a rare unusual paramedian occipital condyle.

Mismanagement of cat bite wound: lessons to learn

Muthupalaniappen L, Siti Aishah MA, Wong YP, Jamil A

Clin Ter, 2013 May-Jun;164(3):225-7.

PMID: 23868624 DOI: 10.7417/CT.2013.1553

Animal inflicted wounds, left untreated may result in chronic bacterial or fungal infection. Clinical features of these infections may overlap leading to a delay in diagnosis and treatment. We report a case of chronic non-healing cat bite wound treated with several antibiotics without improvement. Later patient developed the classical "sporotrichoid spread" and a presumptive diagnosis of sporotrichosis was made. Laboratory investigation for fungal culture and skin biopsy failed to identify the underlying pathogen. A trial of oral antifungal agent resulted in complete recovery of the lesions implicating fungus as the causative pathogen. Physicians should have a high index of suspicion for fungal infections when managing animal inflicted wounds.

Misdiagnosed infected aneurysm presenting as pyrexia of unknown origin (PUO)

Abdikarim M, Shahari S, Idris MA, Hanafiah H, Kosai NR, Das S

Clin Ter, 2014;165(4):199-201.

PMID: 25203333 DOI: 10.7417/CT.2014.1733

Infected aneurysm is a life threatening clinical condition that is associated with significant morbidity and mortality. Early detection is essential for a rapid and efficacious initial treatment for better prognosis. Since the introduction of antibiotic therapy and concomitant decline of endocarditis, true mycotic aneurysms are rarely seen. The usual treatment consists of antibiotics along with aggressive surgical debridement of the infected tissue and vascular reconstruction, if needed. We here describe an infected aneurysm presenting as pyrexia of unknown origin and discuss the clinical features and challenges encountered in the treatment.

Fulltext Mechanical thrombolysis as an adjunct therapy to management of portal vein thrombosis following Radio Frequency Ablation

Hairol AO, Affirul CA, Azlanudin A, Zamri Z, Razman J, Choi SY

Clin Ter, 2017 Jan-Feb;168(1):e5-e7.

PMID: 28240755 DOI: 10.7417/CT.2017.1974

Radiofrequency ablation (RFA) has evolved to become the treatment of choice for non-resectable recurrent colorectal liver metastasis. It is however, not without complications. Portal vein thrombosis following RFA is rare but can be fatal to the outcome of the patient. Here, we present a case of a 66-year-old man who developed portal vein thrombosis following RFA. CT scan revealed a left portal vein thrombosis. This case report highlights the challenges and multimodal treatment of portal vein thrombosis following Radiofrequency ablation (RFA) in a cirrhotic patient.

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