Methods: A cross-sectional study was conducted at the haemodialysis (HD) unit of a tertiary hospital in Malaysia from January 2018 to February 2019. Dialysis-dependent ESRD patients were included and those with a recent history of ACS (within 30 days) were excluded. Pre-dialysed serum hs-cTnT levels were measured using Cobas e411. The upper limit of the 99th percentile value for troponin T was 14 ng/L.
Results: A total of 150 patients were recruited as study participants. The majority were female (62%) and of Malay ethnicity (94%), and the mean (SD) age was 45.19 (16.36) years old. The hs-cTnT range (min, max) was 11.39-738.30 ng/L and the median (interquartile range [IQR]) of hs-cTnT was 59.20 (83.41) ng/L. Elevated hs-cTnT levels were observed in 149/150 (99%) of the study participants (54/55 [98.2%] of the patients were on HD, and 95/95 [100.0%] of the patients were on continuous ambulatory peritoneal dialysis).
Conclusion: This study supports prior research showing that even without ACS, most ESRD patients have elevated concentrations of cardiac troponin. Furthermore, our study illustrates the need to revisit the use of absolute troponin values when making a diagnosis of ACS in ESRD patients.
Methods: Patients with third- and fourth-degree haemorrhoids were recruited from the clinic from January 2018 to December 2019. The procedure was performed as a day case under regional anaesthesia. Using a LigaSureTM device, excisional haemorrhoidectomies (Milligan-Morgan haemorrhoidectomy) were performed without sutures or an anal sponge. We evaluated wound bleeding, pain and urinary retention per daycare protocols.
Results: A total of 264 patients were enrolled. There were 153 males (57.9%) with a median age of 30 years old (range 16 years old-80 years old). A total of 142 patients (54%) had third-degree haemorrhoids, while the rest had fourth-degree haemorrhoids. The median operating time was 8 min (range 4 min-17 min) and minimal blood loss was observed. During follow-up, the complications were one case (0.3%) had anal stenosis, one case (0.3%) had minimal bleeding and one case (0.3%) had urine retention. Upon discharge, four patients (1.5%) required additional analgesia and another four (1.5%) developed post-spinal headaches. No incontinence was encountered.
Conclusion: LigaSure™ excisional haemorrhoidectomy is a safe and effective daycare procedure with acceptable re-admission and complication rates.
METHODS: A self-administered online questionnaire was distributed to undergraduate medical students at Universitas Indonesia. The study was conducted from September 2020 to February 2021. The questionnaire included a modified version of the Online Learning Environment Scale (OLES) and the Positive Emotion, Engagement, Relationships, Meaning and Accomplishment (PERMA) profiler. The OLES was used to evaluate students' perceptions of the online learning environment, whereas the PERMA Profiler was used to evaluate students' wellbeing. We validated the questionnaire before distribution. The content validity index was 1.0, with internal consistency coefficients of 0.87 and 0.89, respectively. Regression analyses were performed to evaluate the relationship between OLES and PERMA scores.
RESULTS: The questionnaire was completed by 274 undergraduate medical students. Students reported moderate to high degrees of positive perception towards online learning, high levels of positive emotions and moderate levels of negative emotions. Statistically significant differences were found across groups based on students' gender, year of study and academic programme. Almost all aspects of the online learning environment were significantly predictive of students' wellbeing, with personal relevance and evaluation and assessment being the two most important predictors (R 2 = 0.201; P < 0.001).
CONCLUSION: Medical students generally enjoyed online learning, although some challenges were presented. The online learning environment was positively associated with students' wellbeing; however, some students expressed negative emotions including loneliness, anxiety, anger and sadness.
Methods: A retrospective cross-sectional review was conducted on medical records of all cataract surgeries carried out in Hospital Keningau, Sabah. This study used all patients' medical records who had been assessed using immersion biometry pre-operatively, underwent phacoemulsification cataract surgery besides attending a post-operative refraction session within 90 days from the operation date. Clinical details were recorded in the form of standard proformas and analysed. The refractive outcome was evaluated using spherical equivalence (SE) and best-corrected visual acuity (BCVA). The percentage of cases with post-operative SE within ±1.00 diopter (D) and BCVA of '6/12 or better' were determined. The association between demographic factors and surgical-related factors with post-operative SE was evaluated using Fisher's exact test.
Results: Of 140 cataract surgeries, 113 fulfilled the inclusion criteria. The average patient age was 66.3 (SD = 10.9) years old. The technique was proven to replicate a good outcome of 84.1% of cases with post-operative SE within ±1.00 D while 90.3% of the cases achieved BCVA of '6/12 or better'. Age and ethnicity were found to be associated with post-operative SE.
Conclusion: The study proves the reproducibility of good refractive outcome in a rural facility using immersion biometry. The findings provide a benchmark for performance surveillance in rural facilities.
Methods: A cross-sectional study was conducted on 500 people who donated blood at hospitals located in Sana'a between August and October 2016. The volunteers were aged 18-65 years old and were recruited using convenience sampling. A set of questionnaires was administered through face-to-face interviews. Blood samples from each donor were tested for hepatitis B surface antigens using enzyme-linked immunosorbent assay.
Results: The overall seroprevalence of HBV infection in the blood donors was 2.6%. Participants with a history of dental treatment had 7.80 higher odds (95% confidence interval [CI]: 2.26, 26.71; P = 0.002) for HBV infection. Respectively, blood donors who had history of malaria infection or cupping therapy had 7.48 (95% CI: 1.75, 31.82; P = 0.010) and 7.32 (95% CI: 1.72, 30.83; P = 0.010) greater odds of HBV infection.
Conclusion: The seroprevalence of HBV infection in Sana'a is lower than in other governorates in Yemen. Stakeholders could focus on a history of dental procedure, malaria infection and cupping treatment when strategising about HBV infection prevention and control among blood donors.
Methods: This study is a retrospective study reviewing the medical records of DFI patients admitted to the Dr Hi Abdul Moeloek Regional General Hospital in 2017-2019. DFI patients with complete medical record data were included in this study. Demographic, clinical, laboratory, wound culture and antibiotic susceptibility data were collected from the medical records using a short structural chart. The data obtained then reviewed.
Results: In this study, 131 DFI patients met the study criteria and were included. Based on the wound culture results, Gram-negative bacteria were obtained in 112 (85.5%) subjects with Enterobacter spp. as the predominant bacteria. Gram-positive bacteria were found in 19 (14.5%) subjects with Staphylococcus spp. as the predominant bacteria. Gram-negative bacteria found in this study showed high susceptibility to amikacin, meropenem and sulbactam/cefoperazone. Meanwhile, the Gram-positive bacteria showed high susceptibility to meropenem, sulbactam/cefoperazone and amikacin.
Conclusion: The findings of the study revealed Enterobacter spp. as the most predominant bacteria causing DFI in the studied population. The highest antibiotic susceptibility was seen for amikacin, meropenem and sulbactam/cefoperazone.
Methods: This study was a randomised, double-blind clinical trial conducted on 162 children undergoing adenotonsillectomy surgery. The participants were randomly divided into three groups of receiving ketamine (0.5 mg/kg) (N = 54), ketamine (0.5 mg/kg) + propofol (1 mg/kg) (N = 54) and ketamine (0.5 mg/kg) + midazolam (0.01 mg/kg) (N = 54) 10 min before the end of the operation. At the time of the patients' entry into the post-anaesthesia care unit (PACU) and at intervals of 5 min, 10 min and 20 min after that, consciousness, mobility, breathing, circulation and SpO2 were recorded. Modified Aldrete recovery score (MARS), the objective pain score (OPS) and Richmond agitation-sedation scale (RASS) were also evaluated.
Results: At the time of entrance to the PACU and 5 min later, the ketamine-midazolam and ketamine-propofol groups had lower RASS scores than the ketamine group (P < 0.001); after 10 min and 20 min, the ketamine-propofol group showed the lowest RASS score (P < 0.001). Ketamine-propofol group had a significantly lower MARS score at all-time points (P < 0.001). Recovery time was the longest for the ketamine-propofol group (P = 0.008).
Conclusion: The ketamine-midazolam group had lower RASS, greater haemodynamic stability and MARS values without delayed awakening.
METHODS: The algorithm utilises the weighted support vector machine method for efficient classification of heart disease based on a binary response that indicates the presence or absence of heart disease as the result of an angiographic test. The optimal values of the support vector machine and the Radial Basis Function kernel parameters for the heart disease classification were determined via a 10-fold cross-validation method. The heart disease data was partitioned into training and testing sets using different percentages of the splitting ratio. Each of the training sets was used in training the classification method while the predictive power of the method was evaluated on each of the test sets using the Monte-Carlo cross-validation resampling technique. The effect of different percentages of the splitting ratio on the method was also observed.
RESULTS: The misclassification error rate was used to compare the performance of the method with three selected machine learning methods and was observed that the proposed method performs best over others in all cases considered.
CONCLUSION: Finally, the results illustrate that the classification algorithm presented can effectively predict the heart disease status of an individual based on the results of an angiographic test.
METHODS: A retrospective cross-sectional study was performed on patients who received IVIG in Hospital Kuala Lumpur. Data were extracted from the request forms for IVIG recorded in the Pharmacy Department from January 2018 until December 2019. Chi-squared test and t-test analysis were used for statistical analysis, and a P-value of < 0.05 was considered significant.
RESULTS: A total of 482 patients received IVIG in Hospital Kuala Lumpur. There were 243 (50.4%) females and 228 (47.3%) males with median age of the patients was 27 years old. The highest indications for IVIG among all patients were hypogammaglobulinemia and other deficiency states in 127 patients (26.3%). The most common indication for one-off treatment in adults was hypogammaglobulinemia and other deficiency states, 35%; whereas in paediatrics, it was Kawasaki disease, 20.3%. The highest indication for regular therapy among adult patients was chronic inflammatory demyelinating polyneuropathy (23.4%), while in paediatrics it was sepsis (31.1%). The clinical category was associated with the frequency status of IVIG usage in both adult and paediatric cohorts with P = 0.004 and P = 0.017, respectively.
CONCLUSION: There were significant differences between the indication of one-off treatment and regular therapy among adult and paediatric patients. A national guideline on the prescription of IVIG for patients is instantly needed to help clinicians in prescribing IVIG appropriately.
METHODS: Systematic sampling was used to recruit working mothers who attended Kuching's maternal and child health clinics. They were interviewed with a validated translated questionnaire to obtain data on sociodemographics, health profiles, and Edinburgh Postnatal Depression Scale (EPDS) and postpartum symptoms. Data were analysed using IBM SPSS version 21.0.
RESULTS: Out of the total 281 respondents, 15.3% of respondents had depression symptoms. Fatigue (42.7%), back or neck pain (36.3%), breast discomfort (16.4%), dizziness (13.5%) and nipple irritation (11.0%) were the most common physical symptoms experienced by the mothers. Regression analysis showed that working mothers who exhibited higher scores of physical symptoms were 1.26 times more likely to develop PD (adjusted odd ratio 1.26, P < 0.01; 95% CI: 1.071, 1.487).
CONCLUSION: Physical symptoms were the predictors of PD among working mothers.
METHODS: This retrospective study was conducted at Hospital Sultanah Aminah Johor Bahru from 1 January 2019 to 31 December 2019. All patients with TBI requiring urgent craniotomy were identified from the operating theatre registry, and the required data were extracted from their clinical notes, including the Glasgow Outcome Score (GCS) at discharge and 6 months later. Logistic regression was performed to identify the factors associated with poor outcomes.
RESULTS: A total of 154 patients were included in this study. The median door-to-skin time was 605 (interquartile range = 494-766) min. At discharge, 105 patients (68.2%) had poor outcomes. At the 6-month follow-up, only 58 patients (37.7%) remained to have poor outcomes. Simple logistic regression showed that polytrauma, hypotensive episode, ventilation, severe TBI, and the door-to-skin time were significantly associated with poor outcomes. After adjustments for the clinical characteristics in the analysis, the likelihood of having poor outcomes for every minute delay in the door-to-skin time increased at discharge (adjusted odds ratio [AOR] = 1.005; 95% confidence interval [CI] = 1.002-1.008) and the 6-month follow-up (AOR = 1.008; 95% CI = 1.005-1.011).
CONCLUSION: The door-to-skin time is directly proportional to poor outcomes in patients with TBI. Concerted efforts from all parties involved in trauma care are essential in eliminating delays in surgical interventions and improving outcomes.
METHODS: Forty-eight young female college students were assigned into four groups: i) 16S (16 weeks of sedentary activity); ii) 8E×8S (8 weeks of exercise followed by 8 weeks of sedentary activity); iii) 8H8S (8 weeks of honey supplementation followed by 8 weeks of sedentary activity) and iv) 8E×H8S (8 weeks of combined exercise and honey supplementation followed by 8 weeks of sedentary activity). Blood samples were collected from the participants prior to the intervention, at week 8 and at week 16 for the analysis of bone metabolism markers and antioxidant status.
RESULTS: At the mid test, bone speed of sound (SOS) (P < 0.01), serum alkaline phosphatase (ALP) (P < 0.001) and serum osteocalcin (P < 0.01) were significantly higher in the 8E×H8S group as compared to 16S group. After 8 weeks of cessation of exercise and honey supplementation, bone SOS was also significantly higher (P < 0.001) in the 8E×H8S group as compared to 16S group. In addition, the serum total calcium (P < 0.001), serum ALP (P < 0.01), total antioxidant status (TAS) (P < 0.01) and glutathione (GSH) (P < 0.01) in the 8E×H8S group were significantly higher at the post-test as compared to their respective pre-test values.
CONCLUSION: These findings demonstrate that there was improved maintenance of the beneficial effects induced by 8 weeks of combined exercise and honey supplementation on bone properties and the antioxidant status after 8 weeks of cessation of exercise and honey supplementation as compared to exercise and honey supplementation alone.
OBJECTIVE: The aim of this study was to microbiologically examine the stethoscopes used by clinicians at the University of Benin Teaching Hospital (UBTH) in Benin, Nigeria.
METHODS: A total of 106 clinicians' stethoscopes were cleaned using cotton-tipped swabs dampened with normal saline. This included both earpieces along with the diaphragm (three samples per stethoscope). The samples were then sent to the Medical Microbiology Laboratory of UBTH and processed immediately as per the standard guidelines. The emergent colonies were subsequently identified, and antimicrobial susceptibility tests were performed.
RESULTS: A total of 114 (35.8%) bacterial isolates were recovered, including Staphylococcus aureus (S. aureus) (33.3%), coagulase-negative staphylococci (CoNS) (33.3%), Bacillus spp. (22.8%), Acinetobacter spp. (5.3%), Escherichia coli (E. coli) (1.8%) and Klebsiella spp. (3.5%). Diaphragms had the highest yield of methicillin-resistant S. aureus (MRSA) (46.2%) and CoNS (17.9%). Age (P = 0.0387) and cadre of clinician (P = 0.0043) were risk factors for contamination, whereas clinicians who never cleaned their stethoscopes (P = 0.0044) or cleaned only the earpieces (P = 0.0001) had more contaminated stethoscopes.
CONCLUSION: The contamination rate of stethoscopes used by clinicians in Benin City was 56.6%. There is a need to establish proper stethoscope cleaning practices for all cadres of personnel in clinical practice to minimise health risks to patients and healthcare workers (HCW).
METHODS: In a cross-sectional study (2010 to 2012), clinical, economic, and social factors associated with the recurrence of tuberculosis were evaluated. The data were collected by a questionnaire and survey of medical records. Simple and multiple logistic regression analyses were performed using SPSS V.18.
RESULTS: A total of 300 patients with an average age of 51.9 years (SD 24.2) were randomly selected. Overall, 7.2% of the patients were diagnosed with a recurrence of tuberculosis. Sixty-four percent (n = 151) of the patients were in a low-income class. The migration from a village to a city (OR = 8.4) and weight loss (OR = 1.5) were significantly associated with an increased chance of recurrence.
CONCLUSION: In this study, the selected provinces of Iran had moderate rates of tuberculosis recurrence in comparison to global reports. Further studies on the relationship of both weight loss and the immigration from a village to a city with tuberculosis recurrence are necessary.
METHODS: Data were obtained from angiographic and medical records of patients treated at Shahid-Rajai, Taleghani, and Loghman Hospitals during the above-mentioned time period. The criteria for definitions and findings were those proposed by the American College of Rheumatology.
RESULTS: A total of 15 patients were identified. The median age at presentation was 36 years and 73.3% of patients were females. Fever was the most common presentation. According to "modified" National Institute of Health criteria, 44.7% of patients were in the acute phase of disease with systemic symptoms such as fever, weight loss, and elevated C-reactive protein (CRP) levels. Immunological markers such as antinuclear antibodies (ANA) and antineutrophil cytoplasmic antibodies (C-ANCA) were absent. The tuberculin test result was positive in 40% of the patients. Vascular bruit was present in 86.7% and hypertension was detected in 53.3% with 13.3% having associated renal artery stenosis. The angiographic manifestations were classified as; type I, cervicobrachial type (26.6%); type II, thoracoabdominal type (20.0%); type III, peripheral type (6.6%); and type IV, generalised type (46.7%). Coronary arteries were involved in three cases, pulmonary in two and renal in two.
CONCLUSION: Based on our findings, the most common clinical, laboratory and angiographic findings were fever, increased erythrocyte sedimentation rate (ESR) and stenosis, respectively. Because of dangerous consequences of this disease, attention to fever and increased ESR, especially in young women may be helpful for physicians to prevent diagnosis delay.
METHODS: A cross-sectional study was conducted in 338 children and adolescents aged 10-18 years old who were selected by a multistage cluster random sampling method. We performed standardised measurements of variables including waist circumference (WC), blood pressure, plasma glucose level, total cholesterol, high-density lipoprotein cholesterol (HDL), triglycerides, and insulin. MetSyn was defined according to the International Diabetes Federation criteria. IR was estimated by the homeostatic model assessment.
RESULTS: Of the 338 total subjects, 172 were female. The overall prevalence of MetSyn and IR were 3.4% and 18.2%, respectively. There was no sex difference for the prevalence of MetSyn. A total of 185 subjects (56.4%) had one or two components of MetSyn. The most common component was low HDL levels in both sexes, which was followed by high WC in females and high fasting plasma glucose levels in males.
CONCLUSION: The lack of a standard definition of MetSyn in children and adolescents combined with the geographical and socioeconomic differences make it difficult to compare the results from different studies. Modification of lifestyle habits is an important strategy in preventing MetSyn and IR.
METHODS: This prospective study was carried out in Khulna Medical College Hospital from 2007 to 2009. All of the admitted children between 1 month and 12 years of age were enrolled over a 2-year period if they met the inclusion criteria of having an acute onset of fever (≤ 14 days) and any of the following 3 signs: neck stiffness, convulsion, or altered mental status. Cerebrospinal fluid (CSF) was collected within hours and sent to the laboratory for cytological and biochemical analyses. CSF was examined by Gram staining and a latex agglutination test to detect common bacteria. Serum and CSF were also tested for Japanese encephalitis virus antibodies.
RESULTS: A total of 140 children were included in the study, which accounted for 2.5% of admissions between 2007 and 2009. The number of acute meningoencephalitis cases was relatively higher (37.9%) during the monsoon season. The CSF report revealed a pyogenic form in 24 (18.5%) and a viral form in 13 (10.0%) cases. Altered mental status was significantly less frequent (P < 0.001) in cases of pyogenic meningoencephalitis (62.5%) than in cases of non-pyogenic meningoencephalitis (93.4%). Bacterial causes were identified in 11 (8.5%) children; the causative agents included Streptococcus pneumoniae (n = 8), Neisseria meningitides (n = 2), and Haemophilus influenzae (n = 1). Three (2.3%) patients were positive for Japanese encephalitis virus.
CONCLUSION: S. pneumoniae was the most common bacteria causing acute meningoencephalitis among the study subjects, and Japanese encephalitis virus was present in few patients.