Rawatan ortodontik boleh menjejaskan keseimbangan mikrobiota oral yang memainkan peranan utama dalam etiologi penyakit periodontium. Kajian klinikal prospektif ini bertujuan untuk menilai kesihatan periodontal dan profil mikrobiologi pesakit periodontal yang sihat (Kumpulan 1) dan yang telah stabil (Kumpulan 2) selama tiga bulan pertama semasa rawatan ortodontik. Aplian ortodontik atas dan bawah tetap dipasang. Kesihatan periodontium dinilai menggunakan skor plak (PS), pendarahan pada probing (BOP) dan kedalaman poket (PD). 29 tapak telah diambil untuk persampelan plak subgingival. Sampel plak diinokulasikan pada agar Trypticase Soya Darah (TSBA) dan agar Trypticase Soya Bacitracin Vancomycin (TSBV) untuk penilaian aerob, anaerob, bakteria berpigmen hitam (BPH) dan Aggregatibacter actinomycetemcomitans. Semua ukuran diambil sebelum pendakap gigi dipasang (T0), 1 minggu (T1), 1 bulan (T2) dan 3 bulan selepas dipasang pendakap gigi (T3). Secara umumnya, kesihatan periodontium dalam kedua-dua kumpulan hampir sama. Selepas 1 minggu, bilangan aerob adalah lebih tinggi dalam Kumpulan 1 (88%) manakala anaerob adalah lebih tinggi dalam Kumpulan 2 (45%). A. actinomycetemcomitans lebih tinggi dalam Kumpulan 1 pada T0 dan T1 tetapi jauh lebih tinggi dalam Kumpulan 2 di T3. BPH adalah minimal pada setiap masa dengan tiada perbezaan signifikan. Oleh itu, semasa 3 bulan pertama rawatan ortodontik dijalankan, terdapat perubahan ketara dalam bilangan aerob-anaerob pada kedua-dua pesakit periodontal yang sihat dan stabil. Bakteria patogenik akan meningkat semasa rawatan awal ortodontik.
Decision making in nursing is one of the most important skills nurses must apply and utilize in their nursing practice. The aim of this study was to determine the perception of clinical decision making ability among nursing students. A descriptive cross-sectional study was conducted in a tertiary hospital. A total of 54 nursing students were recruited using a modified version of Clinical Decision Making in Nursing Scale (CDMNS) adapted from Jenkins (1985). The findings showed good CDMNS score with mean and standard deviation of (124.24±12.713). The four sub-scales of CDMNS were: searching for alternative (33.24±4.821), canvassing (28.74±3.514), evaluation and re-evaluation (31.43±3.922), searching for information (30.83±4.765). Nineteen (35%) of the participants chose nursing as their first choice, whereas 35 participants (65%) did not. Thirthy seven (69%) participants were satisfied with their nursing competency, 17 (31%) were unsatisfied. There were significant differences between searching for alternatives, evaluation and re-evaluation, and nursing as their first choice (p=
Study site: Nursing students, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
The most common cause of hyperthyroidism is Graves disease (GD) which is characterised by the presence of autoantibodies which binds to the TSH receptor (TRAb). Recently, a rapid, fully automated electrochemiluminescent immunoassay ElecsysAnti-TSHR for detection of autoantibodies to TSH receptor was made available for routine clinical use. The objective of this study is to evaluate this assay and to determine the sensitivity, specificity and cut-off value. Interassay and total imprecision (CV) were determined at 3.78-7.02 IU/L and 13.5-21.2 IU/L respectively. A total of 124 samples which comprised of 46 GD, seven Hashimoto thyroiditis (HD), 11 non autoimmune nodular goitre (NAG), 2 thyroid cancers (Ca) and 58 normal controls were retrospectively analysed to determine the sensitivity, specificity and cut-off value. Inter-assay CV’s were 2.4% at a concentration of 3.90 IU/L (range: 3.78-7.02 IU/l) and 0.8% at 20.80 IU/L (range:13.5-21.2 IU/l). Total imprecision was 3.8% at a concentration of 3.80 IU/L (range:13.5-21.2 IU/l) and 1.0% at 20.8 IU/L (range:13.5-21.2 IU/l). The ROC analysis of patients with GD, other thyroid disorders and normal controls revealed that the highest sensitivity (94%) and specificity (98%) were seen at cut-off value of 1.69 IU/L. Positive predictive value (PPV) and negative predictive value (NPV) was 95% and 94% respectively. At this derived cut-off value of 1.69 IU/L, we found that the sensitivity of TRAb positivity within the group of 29 newly diagnosed GD patients was 94%. Our results demonstrate that this fully automated assay with testing time of 27 minutes has high sensitivity in detecting GD and high specificity for discriminating other thyroid disease and represent major improvement in the diagnosis and management of patients with thyroid diseases.
Clostridium difficile infection (CDI) causes mild to severe diarrhoea and pseudomembranous colitis in patients who had prior antibiotic exposure. Despite CDI being prevalent worldwide, its epidemiological data is scanty in Malaysia. This study aimed to determine the prevalence and incidence of CDI at Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Stool specimens from 147-suspected CDI patients were obtained from 1 November 2011 until 31 October 2012. The presence of C. difficile toxin A and/or B were detected using a commercial immunochromatographic kit (Wampole™ Tox A/B Quik Chek). Surveillance data was collected from patients’ medical records to establish the demographic and clinical characteristics. The overall prevalence and incidence of CDI in UKMMC was 6.1% and 5.2 cases per 10 000 patient-days, respectively. Among nine CDI patients, 77.8% were males and 55.6% were Chinese. CDI was most common in medical wards (88.9%). The median age was 60 years and the median length of hospital stay was 13 days. Majority (88.9%) of CDI patients received antibiotics eight weeks prior to CDI. Penicillin-beta-lactamase inhibitors were the most common antecedent antibiotics. Five (55.6%) CDI patients received acid suppressant medications. The in-hospital mortality rate was 22.2%. In conclusion, the prevalence and incidence of CDI at UKMMC is relatively low and occurs sporadically.
Evidence of ossification was previously considered a relative contraindication to cochlear implantation. It was considered difficult or impossible to achieve safe electrode insertion because of bony obstruction. Either the electrodes or the inner ear structures could be damaged. Moreover, obstructed scala tympani could limit the number of electrodes that can be inserted. The efficacy of the electrical stimulation was also questioned, as a higher current would be needed on an ossified cochlea. Finally, the neural survival in ossified cochlea is unknown. This may complicate the surgical procedure and affect the long-term outcome. However, depending on the experience of the surgeon, cochlear implantation has been attempted even in grossly ossified cochlea. Here we illustrate that cochlear implantation is safe in labyrinthitis ossificans.
Hyperlipidemia is a condition of high lipid levels in the plasma and often linked with the deposition of lipid droplets in the aorta which initiate the progression of atherosclerosis. Atherosclerosis is a common cardiovascular disorder initiated by the formation of foams cells in the vascular wall which leads to turbulent blood flow, injury to the endothelial layer and subsequent vascular thrombosis. Since the early 1980’s, Golden-Syrian hamsters have been widely used as an animal model in the research of hyperlipidemia and atherosclerosis. The use of hamsters in the hyperlipidemic and atherosclerotic model is due to their lipoprotein profile that is closer to human setting, sensitive to high-fat high-cholesterol (HFHC) diet and a suitable rodent model. Atherosclerosis can be induced in hamsters through dietary challenge with HFHC diet. Over the decades, coconut oil (CNO) was commonly used as the source of fat in the diet design of high saturated fatty acids (SFA) composition. In this review, we summarized published literature with designs involving CNO plus cholesterol-induced hyperlipidemia, atherosclerosis or both. The factors that may influence the ability of CNO and cholesterol combination to induce hyperlipidemia such as the period of dietary intervention, hamster strains and the dietary amount were evaluated and summarized.
Acute aortic dissection (AAD) is rare in the paediatric and young adult population. We present a fatal case of acute aortic dissection Stanford B in a young male diagnosed with hypertension. He presented with severe acute abdominal pain with malignant hypertension. He did not have any trauma to the chest or did not have history of an illicit drug abuse. He had no features suggestive of connective tissue disease as well as other typical signs of aortic dissection. The complain of acute, severe abdominal pain which was out of proportion and required multiple doses of intravenous opioid, raised the suspicion of aortic dissection in this case. Point of care sonography (POC) was done in Emergency Department (ED). However, due to its highly operator dependability, the intimal flap was missed. Computed tomography (CT) scan of abdomen was done and confirmed the diagnosis of AAD. Unfortunately, his clinical condition rapidly deteriorated few hours later with no response to surgical intervention and succumbed within 36 hours of admission. We highlighted the importance of the early recognition of this disease as well as the point of care sonography in ED as a diagnostic tool to tackle this time-sensitive disease.
Keupayaan Centella asiatica (CA) untuk bertindak sebagai antioksidan dan agen anti-radang telah banyak dilaporkan. Namun begitu, kaedah pengekstrakan CA untuk memperoleh hasil yang terbaik masih dipersoalkan. Dalam kajian ini, kami menilai tiga kaedah pengekstrakan CA dan membuat perbandingan ekstrak dari segi aktiviti antioksidan dan anti-radang, dan juga kandungan sebatian bioaktif, asiaticoside dan madecassoside. Centella asiatica diekstrak menggunakan pelarut etanol, metanol dan juga air. Kandungan sebatian fenolik ekstrak diukur menggunakan kaedah reagen Folin-Ciocalteu. Kandungan asiaticoside dan madecassoside ditentukan dengan kaedah HPLC. Aktiviti antioksidan diukur dengan asai 2,2-diphenyl-1-picrylhydrazyl (DPPH) dan asai penurunan kuasa Ferric Reducing Antioxidant Power (FRAP). Aktiviti anti-radang ditentukan dengan kebolehan ekstrak untuk merencatkan enzim tapakjalan keradangan, COX-1 dan COX-2, serta kebolehan ekstrak melindungi sel fibroblas aruhan 12-O-tetradecanoylphorbol-13-acetate (TPA) daripada menghasilkan prostaglandin E2 (PGE2 ). Hasil kajian menunjukkan aras sebatian fenolik, asiaticoside dan madecassoside tertinggi dalam ekstrak etanol, diikuti metanol dan esktrak akues (masing-masing 17.76 g/100g, 15.52 g/100g, 13.16 g/100g untuk sebatian fenolik, 42.86 mg/g, 36.37 mg/g, 2.82 mg/g untuk asiaticoside and 18.66 mg/g, 15.87 mg/g, 3.75 mg/g untuk madecassoside). Ketiga-tiga ekstrak menunjukkan aktiviti antioksidan sederhana berbanding kawalan positif. Kesemua ekstrak, asiaticoside dan madecassoside merencat COX-1 dan COX-2 dan menyekat penghasilan PGE2 -aruhan TPA. Ekstrak etanol dan metanol merupakan perencat COX yang lebih kuat dan lebih poten daripada ekstrak akues. Oleh itu, walaupun ekstrak akues menunjukkan kebolehan antioksidan yang lebih tinggi, dari segi aktiviti anti-radang, pelarut hidrofobik iaitu etanol dan metanol ternyata lebih baik untuk mengekstrak Centella asiatica.
Culture expanded chondrocytes isolated from non-load bearing region of osteoarthritic (OA) joint has been used to construct tissue engineered cartilage for treatment purposes. The aim of the study was to compare the histological properties of the cartilage tissue and morphological properties of the chondrocytes isolated from less and severely affected OA knee. Human articular cartilage was obtained as redundant tissue from consented patients with late-stage OA undergoing total knee replacement surgery at Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Articular cartilage was graded according to Dougados and Osteoarthritis Research Society International (OARSI) classification. Articular cartilage was classified into less affected (LA; Grade 0-1) and severely affected (SA; Grade 2-3). Cartilage tissue from less and severely affected region was stained with Safranin O staining. Isolated chondrocytes from each group were cultured until passage 4 (P4). Their growth patterns, cell areas, and circularity were compared. LA-cartilage tissue shows uniform spread of safranin O staining indicating intact extracellular matrix (ECM) component. However, SA-cartilage shows significant reduction and unstable staining due to its degraded ECM. LA-chondrocytes showed an aggregated growth compared to SA-chondrocyte that remains monolayer. Moreover, LA-chondrocytes have significantly higher cell area with wider spreading at passage 0 and 4 compared to SA-chondrocytes. It was also found that chondrocyte circularity increased with passage, and circularity of LAchondrocytes was significantly higher than that of the SA-chondrocytes at passage 3. This study demonstrated the considerable difference in the cellular properties for less and severely affected chondrocytes and implication of these differences in cell-based therapy needed to be explored.
Fluid replacement is the mainstay treatment for diabetic ketoacidosis (DKA). Currently, the best choice of fluids is still debatable. An amount of 0.9% sodium chloride is commonly used. Sterofundin® is an alternative crystalloid that is assumed to expedite resolution of acidosis. Advantages in sterofundin content being smaller significant ion difference (SID) to plasma and lower chloride content. The main objective of the study was to compare rate of acidosis resolution in DKA patients between treatment with 0.9% normal saline and Sterofundin over 12 hrs. Other objectives were to compare significant ion difference (SID), 12-hr blood ketone clearance and electrolyte balance between the two groups. The study was a prospective open labelled randomized control trial. This study was conducted over 6 months. Sample size of 18 was obtained with 9 for each arm. Main difference between two groups was initial median 2-hr pH level improvement (NS = +0.006 vs. Sterofundin = +0.05, P=0.063), however not being significant. Ketone, anion gap reduction, bicarbonate normalisation, sodium, chloride, urea and creatinine levels failed to show any significant differences between both groups. Twelve-hour median chloride levels increments were higher in the NS group (+11) compared to the sterofundin group (+6). There was no difference between mortality and morbidity. Comparing the two fluid groups, there was no significant biochemical differences during treatment of DKA. This was a pilot study that can initiate further clinical trials.
Keywords: anion gap, diabetic ketoacidosis, ketone, ph, saline, sterofundin
Bystander rate of cardiopulmonary resuscitation (CPR) is still low worldwide because of inadequate skills and knowledge. Training the public on CPR is one of the methods to increase the bystander CPR rate. This study aimed to compare the efficacy in acquiring and retaining CPR skills and knowledge among secondary school students in Klang Valley trained by school teachers and medical students. We recruited five school teachers and five medical students as trainers. They were trained in several sessions by American Heart Association (AHA)-certified instructors using the video-assisted CPR training module. The recipients were 44 secondary school students divided between the teacher’s group and the medical student’s group. We compared knowledge and psychomotor skills between these two groups prior, immediately after and at three months after CPR training. Students in the teacher’s group showed a higher increase in knowledge comparable to the medical student’s group (median score difference 3 vs 2, p>0.05) and in psychomotor skill (median score difference 5 vs. 7, p
Penilaian status visual kanak-kanak prasekolah adalah penting kerana ia adalah salah satu faktor yang menentukan ketersediaan mereka untuk bersekolah. Walau bagaimanapun, tidak semua kanak-kanak prasekolah mendapat peluang untuk mengikuti program saringan penglihatan. Dalam kajian ini, akuiti visual jauh dan dekat serta tahap stereoakuiti diukur di kalangan kanak-kanak berumur enam tahun (n=385). Parameter tersebut kemudiannya dibandingkan di antara kanak-kanak prasekolah swasta bandar dan prasekolah KEMAS daripada keluarga berpendapatan rendah di luar bandar. Tujuh peratus kanak-kanak prasekolah KEMAS adalah gagal dalam ujian saringan penglihatan jauh berbanding dengan 6% kanak-kanak prasekolah swasta. Untuk ujian penglihatan dekat, kadar kegagalan adalah masing-masing 8.7% dan 4.9% bagi kanak-kanak prasekolah swasta dan KEMAS masing-masing. Untuk ujian stereoakuiti, seramai 3.3% kanak-kanak prasekolah swasta dan 2.5% kanak-kanak prasekolah KEMAS dikategorikan sebagai lemah stereopsis. Semua perbezaan tersebut adalah tidak signifikan secara statistik (semua p>0.05). Peratusan kanak-kanak yang gagal ujian saringan penglihatan adalah serupa untuk kedua-dua jenis prasekolah. Oleh itu, program saringan penglihatan perlu dijalankan di semua jenis prasekolah untuk memastikan sebarang masalah penglihatan dapat dikesan, didiagnos, dirawat dan dicegah.
Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) immunohistochemistry are important markers in the management of patient with breast carcinoma. In this study, we determine the concordance rate of ER, PR and HER2 immunohistochemistry markers between core needle biopsy (CNB) and excisional biopsy (EB) of breast carcinoma in patients of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from January 2002 until December 2012. A total of 93 female patients with CNB and subsequent EB were included in this retrospective descriptive study. Immunohistochemistry is used to determine ER, PR and HER2. ER and PR was graded using Allred score (0 to 8) while HER2 was scored from 0 to 3+. The markers between these two biopsies were compared to determine the concordance rate. In ER and PR, 93 samples were compared. ER was concordant in 80 cases (86.0%) and 13 cases (14.0%) was discordant. PR was concordant in 82 cases (88.2%) and discordant in 11 cases (11.8%). In HER2, 87 samples were compared and 62 cases (71.3%) were concordant while 25 cases (28.7%) were discordant. Concordance between CNB and EB was high for ER and PR. However, concordance rate for HER2 immunohistochemistry was less consistent. Overall, immunohistochemical analyses of CNB reflect the tumour marker status of the excised specimen.
Keywords: breast carcinoma, core needle biopsy, estrogen receptor, progesterone receptor, HER2
Infective endocarditis (IE) is a potentially life-threatening disease which carries high risk of morbidity and mortality. The variability of clinical presentation of infective IE remains a diagnostic challenge for the Emergency Physicians. The clinical manifestation may present as an acute, rapidly progressive infection with the absence of classical immunological vascular phenomenon or as subacute or chronic disease with vague constitutional symptoms that may mislead initial assessment and mimic other conditions. Symptoms may also manifest as a result of systemic embolization which can be catastrophic and life-threatening especially if it ends up in the cerebral circulation. IE complicated by cerebral mycotic aneurysm (CMA) is the worst neurological sequalae and can be misdiagnosed as a primary intracranial infection such as meningoencephalitis. Here, we report a case of neurological emergency secondary to systemic embolization of IE with a devastating diagnosis of CMA. History of prolonged fever associated with headache and focal neurological deficit led to the initial diagnosis of meningoencephalitis due to a low clinical suspicion of the disease in the Emergency Department. In emergency setting, a combination of high degree of clinical suspicion together with thorough history, physical examination and diagnostic imaging are crucial in order to guide and establish the diagnosis of this potentially devastating disease. Early recognition and initiation of aggressive treatment is crucial to provide better prognosis and higher survival rate for patients with CMA.
The t(8;21)(q22;q22) is a frequently occurring aberration in acute myeloid leukemia (AML) (18-20%) and usually correlate with French-America-British (FAB) M2 subtype. Several studies showed that patients carrying this abnormality demonstrated good response to standard chemotherapy but also have a high incidence of disease relapse. Trisomy 4 is a rare and specific chromosomal abnormality occurring in AML M2 or M4 of the FAB subtypes. We report a case of a 33-year-old female with an apparently clinical and hematologic diagnosis of acute promyelocytic leukemia (APL) in whom cytogenetic analysis revealed an abnormal karyotype with trisomy 4, in addition to t(8;21). Trisomy 4 and t(8;21) in a patient with AML is rare. The significance of t(8;21) with trisomy 4 in AML are unclear but patients bearing this abnormality are associated with a poor prognosis.
Data on knowledge, attitude and ST Elevation Myocardial Infarction (STEMI) electrocardiography (ECG) detection among pre-hospital paramedics in Malaysia is still scarce. It is imperative to gain this information as a pre-requisite in initiating pre-hospital thrombolysis. This was a descriptive study conducted from May 2016 until November 2017 on paramedics from Universiti Kebangsaan Malaysia Medical Center (UKMMC) and Kuala Lumpur Hospital (HKL). It was to assess knowledge on pre-hospital thrombolytic therapy and ECG detection of STEMI. One hundred and six questionnaires were answered and analyzed. More than 60% of the candidates were unable to detect STEMI ECG changes and lacked of confidence in handling and administering thrombolytic treatment at the level of pre-hospital phase. Only 20.8% candidates managed to detect more than 8/10 of the correct ECG pattern in STEMI. Less than 40% of the candidates achieved more than 80% marks in answering questions regarding STEMI and treatment. It is concluded that the overall performance and knowledge of paramedic regarding pre-hospital thrombolytic therapy is generally poor. Further training need to be done prior to implementing pre-hospital STEMI thrombolytic therapy in Malaysia.
Congenital Nasal Pyriform Aperture Stenosis (CNPAS) is an extremely rare cause of
nasal airway obstruction. Clinically, it mimics choanal atresia in neonate. It needs
to be differentiated because management differs from each. Pyriform aperture is
located at the most anterior part of the nose and is always the narrowest region
of the nasal cavity. Therefore, nasal obstruction can easily occur if there is slight
decrease in its cross sectional area. CNPAS rarely presents alone. Usually, it arises
together with a midline developmental defect such as holoprosencephaly or
pituitary defect. We present the first ever reported case of CNPAS, in association
with Trisomy 8 Mosaicsm (T8M).
Congenital cholesteatoma (CC) is rare clinical condition and It is known as a pearly white mass medial to an intact tympanic membrane. In this case report, we describe a 6-year-old boy who presented with a one year history of left ear discomfort, reduced hearing, followed by ear discharge two months prior to admission. Otoscopic examination revealed a large attic perforation. Radiological investigation showed extensive cholesteatoma in the mastoid, mesotympanum and epitympanum with destruction of the ossicles including the stapes footplate. He underwent radical mastoidectomy in view of extensive cholesteatoma with tympanoplasty type V. In this case report, the classification, treatment and theories related to CC are discussed.
Diagnosis of ocular leptospirosis is challenging and requires a high index of suspicion of previous leptospiral infection and good laboratory support. This case series focuses on two young females with unilateral conjunctiva granuloma. To the best of our knowledge, these are the first two cases of ocular leptospirosis with conjunctiva granuloma. The definitive diagnosis of ocular leptospirosis was based on laboratory studies in which conjunctival biopsies in these two cases showed positive leptospira DNA. Retrospectively, the history was suggestive as both patients had exposure to leptospira organism. In conclusion, a diagnosis of ocular leptospirosis requires a high clinical suspicion index supported by mandatory laboratory investigations.
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.