Introduction: Presentation of Dermatomyositis with Interstitial Lung Disease (ILD) is not uncommon. Case descrip-tion: A 50 years old lady with dyspnoea of 1 month. On examination patient had heliotrope rash around face with gottron papules and fine crepitations bibasally over lung auscultation with proximal weakness of the limbs. High Resolution Computer Tomography of Chest(HRCT of Chest) revealed ground glass appearance with fibrotic changes in both lungs. Blood test serum ANA 1:160, Anti MDA5 strong positive, Anti Ro 52 positive with Serum dsDNA nega-tive. Skin Biopsy-compatible with cutaneous manifestation of dermatomyositis. EMG revealed there is electrophysio-logical cause of myopathy. Lung function test was unable to perform due to severe pain. Investigate for the possibility of underlying malignancy were taken with Serum Tumour Markers, Nasoscopy, ultrasound of pelvis, OGDS and colonoscopy. Did not reveal lesions suspicious of malignancy. Patient treated by using tablet prednisolone 50mg once daily with tapering done and tablet azathioprine 100mg once daily. Planned for IV Methylprednisolone if wors-ening of disease. Patient passed away due to rapidly worsening ILD. Conclusion: Amyotrophic Dermatomyositis with interstitial lung disease(ILD) diagnosis can be confidently diagnosed with clinical correlation and Serum AntiMDA5.
Introduction: Microbial keratitis (MK) is an important cause for corneal blindness and understanding its risk factors enable us to improve management and minimise its complications. Methods: In this retrospective case review, medical records of all patients treated for MK from 2006 to 2013 was analysed to know the socio-demography, preceding risk factors, clinical characteristics, causative organisms and final visual outcome. Results: A total of 174 patients (180 eyes) were included in this study. Identifiable ocular risk factors included contact lens (CL) usage (85, 47.2%), ocular trauma (50, 27.8%), ocular surface disease (21, 11.6%), steroid use (6, 3.3%) and immuno-compromy (19, 10.5%). Association factors for presenting uncorrected visual acuity (UCVA) were age group (p=0.013), size (p
Introduction: Rotary wing aircraft (RWA) or the helicopter has been used in Primary Health Care and Medical Emergency Services in the state of Sabah since the seventies. The use of RWA has distinct advantages in terms of speed, ability to access remote areas and in the transportation of patients to tertiary care. Single engine RWA was used for the last forty years which has now been replaced with twin engine RWA. The objective of this study is to compare the different type of RWA which was used and the suitability of
these machines for health services in Sabah. Methods: A detailed analysis and comparison of manufacturers’ specifications which include the performance, size, the number of power plant, passenger capacity,
safety track record, aircraft manufacturer’ s support, maintenance and operational costs of different types of RWA available in Sabah taking into account current and future demands as well as functional requirements and
the capability of the aircraft service providers were considered. Results: The choice of aircrafts depends on the type of service and its suitability. From the assessment, a single engine RWA would be adequate to support the
current and future need in Sabah. Conclusion: Adequate technical knowledge in choosing the type of aircraft to provide an effective health service is vital. These also contribute to the cost effectiveness of the program and significantly determine efficiency of the service and the interest of the rural people with poor accessibility to health care.
Introduction: IImmersive Virtual Reality (IVR) is a computer-generated world where users can immerse using
Head-mounted devices (HMD), but different spatial ability groups show different performance when engaged
virtual reality. The VR application of the solar system roller-coaster tour develop by DrashVR LLC downloaded from
Google Play used for the study. It aims to study spatial ability group’s viewing techniques related to emotional engagement toward IVR. Methods: The study employed a qualitative research design with triangulation method to administer a spatial ability test before IVR sessions to determine low spatial (0-15 score) and high spatial (16-30 score)
groups. Observations of 30 participants were made and conduct semi-structured interviews after each IVR session.
Results: 23% of high spatial and 10% low spatial group used an aggressive viewing technique. While 33% of
high spatial and 34% of low spatial using less aggressive and static viewing techniques restricted view less than
180 degrees to avoid unpleasant feeling. Both groups reported cybersickness after an average time of 5 minutes
for low spatial and 7 minutes for high spatial. High spatial counter cybersickness by focus on visual elements
to immersed and sustain attention while low spatial focus on the negative feeling that rip out enjoyment. 70% of
high and low spatial with positive emotion engagement could sustain enjoyment due to motivated to continue
VR tour despite having cybersickness. Conclusion: : Different spatial abilities displayed unique viewing techniques
and emotional engagement to counter the unpleasant effects. The result significant when these groups of spatial using
IVR as treatment.
Acute epiglottitis though relatively common in pediatric patients as compared to adults, present with almost similar clinical presentations. They include voice change, difficulty or painful swallowing and sometimes with upper airway obstruction. Physical finding of swollen epiglottis is difficult to be obtained owing to the danger of introducing laryngeal mirror into the oropharynx as to avoid contact spasm. The diagnostic thumb sign appearance on lateral neck radiograph is considered pathognomonic of epiglottitis. We report a case of an adult with clinical features and radiological finding of an acute epiglottitis, which did not resolve with antibiotic treatment. Subsequent imaging confirmed the presence of an abscess in the epiglottic mucosa.
Introduction: Melatonin (MEL) loaded alginate-chitosan/beta-tricalcium phosphate (Alg-CH/β-TCP) composite hy- drogel has been formulated as a scaffold for bone regeneration. MEL in the scaffold was anticipated to accelerate bone regeneration. The objective of this study is to observe signs of systemic toxicity and physical changes on surface defected bone for bone regenerative performance of the composite. Methods: The proximal-medial metaphyseal cortex of the left tibia of New Zealand white rabbit was the surgical site of the defect. A total of nine rabbits were randomly allocated to three groups; Group I; implanted with MEL loaded Alg-CH/β-TCP, Group II; Alg-CH/β-TCP and Group III defects were sham control. The rabbits were daily observed to determine systemic toxicity effects by composites. The physical changes to implanted site were observed using digital x-ray radiography and computerized tomography at weeks 0, 2, 4, 6 and 8 of post-implantation. Results: There were no clinical signs of systemic toxicity for all groups of rabbits. Digital radiography did not show adverse effects to the bone. Computerized tomography showed reduction in the area size and depth volume of the implantation site, but accelerated regeneration within the 8 weeks was not significantly different (P
Introduction: The advancement of technology and an ecological shift in the creative media industry requires manag- ers and TV production workers to adapt to changes to ensure their well-being. Recent development shows a growing concern for the mental, physical and social health of creative media workers that demands a more in-depth inves- tigation. Studies have found that those working in television production are facing long hours of work, poor pay, isolation and insecurity. However, there is little empirical research undertaken on those who work in the Malaysian creative media industry, especially Malay Muslims. Studies of media workers in Malaysia are mostly concerned with news production and the impact of reporting and journalistic challenges. The purpose of this study is to explore how Malay Muslim creative media workers manage and negotiate their mental health and well-being issues. Methods: By employing a phenomenological approach, interviews were conducted with seven participants, exploring their experience in the creative media industry. Results: The study found four emergent themes: (a) passion and commit- ment for creative endeavours, (b) work culture, (c) issue on work-life balance, and (d) role of religion. Discussion: This study is an attempt towards understanding the mental health of those working in the creative and entertainment realms in Malaysia. Based on the findings, implication for practitioners and future studies are discussed.
Antiphospholipid syndrome is a hypercoagulable autoimmune condition that predominantly affect the female and commonly manifest as arterio-venous thrombosis and recurrent miscarriage. Here, we present a unique case of a healthy young man who developed sudden onset of right leg swelling after exercise which was then found to be due to deep vein thrombosis via Doppler ultrasound. His blood investigations showed thrombocytopenia and prolonged coagulation profile. Therefore, antiphospholipid syndrome was suspected and later confirmed by positive autoim- mune antibodies. He was treated with long term moderate intensity oral warfarin. The objective of this case report is to share the uncommon occurrence of an unprovoked deep vein thrombosis secondary to antiphospholipid syn- drome in a healthy young man so that the possibility of deep vein thrombosis should be suspected in selected cases of non-resolving leg swelling after exercise as it can lead to fatal pulmonary embolism.
Patients with diabetes have an earlier onset and increased severity of anaemia compared to those with similar degree of renal impairment from other causes. Anaemia is associated with an increased risk of vascular complications. In this study, we determined the prevalence of anaemia in T2DM patients and its association with sociodemographic, clinical and laboratory parameters in an endocrine tertiary hospital in Malaysia. This was a cross-sectional study using retrospective electronic data from January 2011 to December 2013 of 165 T2DM patients in Hospital Putrajaya. Data was analysed using IBM SPSS Statistics version 21.0 for Windows. The prevalence of anaemia was 39.4% and majority had normocytic normochromic (80%), mild (58.5%) anaemia. Majority were Malays (73.9%), aged below 60 with comparable gender percentage and long-standing, poorly-controlled DM [median fasting blood sugar (FBS) 8mmol/L; glycated haemoglobin (HbA1c) 7.9%]. Using the KDIGO chronic kidney disease (CKD) staging system, 86% of these patients were in stages 3-5. Anaemic patients had a significantly higher serum urea, creatinine and a lower FBS, estimated glomerular filtration rate (eGFR) compared to non-anaemic patients. Anaemic patients with diabetic nephropathy had a significantly lower haemoglobin (Hb) compared to those without this complication (p=0.022). The sensitivity and specificity at a cut-off eGFR value of 38.3 ml/min/1.73 m2 (maximum Youden index = 0.462) was 66.7% and 79.5%, respectively to discriminate mild from moderate anaemia. This study shows that anaemia is already present in T2DM patients in Hospital Putrajaya at initial presentation to the specialist outpatient clinic and is significantly associated with CKD. Hence, it emphasises the obligatory need for routine and follow-up full blood count monitoring in T2DM patients in primary care as well as tertiary settings in Malaysia to enable early detection and aggressive correction of anaemia in preventing further complications.
Introduction: Patients with Nasopharyngeal carcinoma (NPC) usually diagnosed at advanced cancer stage and re- current case. Rac1 have become an emerging therapeutic target for metastasis cancer. This gene is critically involved in cell polarization and reactive oxygen species-mediated cell killing. This study aims to investigate the Rac1 activ- ities in NPC/HK1 cell line using siRNA approach and evaluate the calcium deposition profile. Methods: The NPC/ HK1cells were transfected with Rac1-siRNA (siRac1) at concentrations of 50nM, 100nM and 200nM for 24 hours and stained with alizarin red s for calcium mineralization profile. Levels of Rac1 gene expression were measured via qRT-PCR followed by the time dependent assessment for 24, 48 and 72 hours. Results: Findings revealed that siRac1 concentrations of 200nM (p-value
Introduction:Diabetes is high in the agenda of public health issues with significant prevalence of diabetic-related amputations. Prosthetic restoration post-amputation is imperative to reduce disability, but its success is influenced by several factors. This study analysed the practice, and the determining factors affecting prosthetic restoration among major lower limb amputees with diabetes in Sabah. Methods: Retrospective cross-sectional study among 65 major lower limb amputees with diabetes referred for rehabilitation medicine services at Queen Elizabeth Hospital from 1st January 2015 to 31st December 2017. Demographics data, pre-morbid diseases, levels of amputation and prac-tice on prosthetic restoration (suitability for restoration, duration from prosthetic application to restoration, funding issue) are primary evaluated factors. Results: Forty-nine, fifteen and one amputees had below knee amputation, above knee amputation and hip disarticulation respectively. Forty-three amputees (66.2%) were deemed suitable for prosthetic restoration but only 27 were prosthetically restored, with mean duration from prosthetic application to res-toration of 5.92±2.189 months. Having additional pre-morbid diseases did not reduced the likelihood of suitability for prosthetic restoration compared to those only with diabetes (p=0.082). Funding issue is the key factor affecting prosthetic restoration with higher likelihood for restoration among those eligible through governmental agencies funding (p=0.027). Conclusion: In Sabah, low rate of suitability for prosthetic restoration is observed among major lower limb amputees with diabetes. A larger study is warranted to investigate causes of such low rate of suitability for prosthetic restoration among this specific population in the effort to reduce public health burden from major lower limb amputation-related disability.
Introduction: The number of inpatient visiting the Bhayangkara Level III Hospital in Kendari City in 2016 was 2322 people, in 2017 there were 3611 people, in 2018 there were 3488 people and from January to November 2019 there were 4243 people. Methods: This research uses descriptive analysis method with a quantitative approach. This research is a case study of the service quality of the Bhayangkara Level III Kendari Hospital. In this study, the sample was taken using simple random sampling technique, in which each element was selected randomly. Results: There are 25 customer requirements for services in the Inpatient Installation of Bhayangkara Hospital, Kendari City which can be categorized into 8 dimensions of service quality according to Brown with priority order based on the level of importance (Tke), namely: 1) Safety Dimensions (98.6%); 2) Dimensions of Interpersonal Relations (98.6%);
3) Dimensions of Continuity (97.1%); 4) Dimension of Effectiveness (97.1%); 5) Efficiency Dimension (97.1%); 6) Dimension of Convenience (97.1%); 7) Dimensions of Access to Services (92.9%) and 8) Dimensions of Officer Competence (92.9%). Conclusion: According to the results of this research it is found that nurses did not take special time to communicate with patients. The officers were warm to patients, doctors always heard complaints and stories of patients, pharmacy officers always prayed for patients to get well soon.
Introduction: The need for ARV (Anti Retro Viral) for the population aged 15-49 years increased from 145,706 in 2011 to 248,903 in 2016. People with HIV/AIDS who received ARVs were estimated at 16.60% in 2011 increased to 18% in 2016. In Indonesia up to September 2014, there were 108,060 people with HIV/AIDS who received ARV therapy from 33 provinces and 300 districts / cities. There were 19,670 people with HIV/AIDS who stopped ARV, 15,046 were not followed up due to various causes and as many as 14,547 died. Methods: This research used a quasi-experimental methods with non equivalent control group design and used a pretest, posttest 1 and posttest 2. There was two groups, the first group was treated using SMS (Short Message Service) reminder and leaflets and the second group was treated with the usual method (counselling). Results: Research with the Mann-Whitney statistical test shows that after 1 month of treatment, there was differences in the average score of knowledge (p value = 0.001), attitude (p value = 0.008), and adherence of Antiretroviral Consumption (p value = 0.010) between the intervention group and the control group. After 2 months of treatment, there was differences in the average knowledge score (p value = 0.001), attitude (p value = 0.001), and adherence of Antiretroviral Consume (p value = 0.001) between the intervention group and the control group. Conclusion: There is the interventions that able to improve the knowledge, attitudes and adherence of taking antiretroviral at PLWHA.
Introduction: Broken glass exhibits unique fracture patterns depend upon the nature of the impact. The fracture patterns provide information like point and angle of impact, direction of force and sequence of firing. Recent studies have shown that the use of shotgun in Malaysia is increasing, yet, the relationship existing among the fracture pattern and the projectile impact factors are not well documented. The objective was to analyse the fracture characteristics on different glass types of variable thickness and distance made by shotgun ammunition. Methods: Soda lime and tempered glass panel with dimension of 12’x 12’ with 3 or 4 mm thickness were shot from various distances of 4, 6 and 8 m from the muzzle end of the shotgun. Samples were analysed under fixed parameters and observations were recorded. Results: It is found that the bullet hole diameter of 4 mm tempered glass were larger compared to 4 mm soda lime glass ranged from 14.33 to 24.17 cm as distance increased. Tempered glass surface also exhibited dicing fragments unlike soda lime glass where only radial fracture patterns are evident. This can be attributed to high inherent strength and ductility that makes the tempered glass remarkably resistant to external force. Conclusion: The findings from this study can lead to distinguish the type of glass through examination of fracture patterns, whether it is soda lime silica or tempered glass. The type of glass and the source of impact can be determined using the fragments, no reconstruction necessary.
Introduction: Detailed information of structural and functional anatomy of thenar muscle is very significant in order to improve diagnostic and various conditions of hand surgeries so that the function of hand movement can be re-stored and to prevent further iatrogenic injuries. Methods: In this study, fifty hands were dissected to determine the variation in each of the thenar muscle. Results: Only the abductor pollicis brevis showed significant findings. Normal formation of one belly in abductor pollicis brevis represented 72.0% (18) and 84.0% (21) for the left and right hands, respectively. Variations according to the number of belly of the abductor pollicis brevis were also observed. One of the variations is the absence of the abductor pollicis brevis, 4.0% (1) in the right hand. Two belly formations of abductor pollicis brevis were observed, 28.0% (7) and 12.0% (3) for left and right sides of hand respectively. Thus, more variations were observed to occur on the left hand (7) compared to the right hand (4). Many studies describe about the variations of each thenar muscle, but few literatures were found discussing on the association of thenar muscle variation with the sides of hand. Using the Fisher Exact Test, it showed that there was no significant associa-tion of variations in the thenar muscle in relation to the sides of hand. Conclusion: This study conclude that there is no consistency between variations of the thenar muscle in relation to the sides of hand. However, clinical awareness of these variations is important in the context of compartment syndrome, use of the aberrant structures as grafting material in reconstructive surgery and proper interpretation of imaging modalities.
CD4+CD25+ Foxp3+ T regulatory cell (Tregs) represents approximately 8-10% of the total CD4+ T cell population and are important for immune homeostasis and preventing autoimmune development. Thus, harnessing their functions as immune modulator may be coupled with the rapid advancement of nanotechnology development. Plant-mediated biosynthesis of silver nanoparticle (AgNP) is noteworthy due to simplicity, rapid rate and potentially render more biocompatibility with biomolecules. This study identified the effect of biosynthesized-AgNPs from Garcinia atroviridis (GA) in modulating inflammatory properties of Treg cells in Non-Obese Resistant (NOR). GA extract was used to biosynthesized AgNPs and was tested on the effect of inducing inflammatory properties in CD4+IL17Rhigh cells following 72hr in vitro treatment. Methods: Conventional CD4+CD25-Foxp3- cells from female NOR mice were sorted using magnetic separation and cultured in RPMI in the presence of anti-CD3/CD28 antibodies, TGF-β and IL-2 cytokines. Cells were then treated with or without GA-AgNPs for 48hr of iTreg cell induction and then re-cultured with new media treated with respective treatments received. After 72hr in vitro culture, cells were stained with fluorochrome-conjugated antibodies for flow cytometry. Results: Current result showed that AgNPs suppress CD4 expression in CD4+IL17Rhigh population. MAPK pathway proteins remain unchanged in both control and AgNP-treated groups. Conclusions: The preliminary findings may suggest the properties of GA-AgNPs in modulating CD4+ T cell population in normal condition. Further studies are necessary to elucidate the molecular mechanisms involve in such interaction. Current findings serve as basis in further identifying the immunomodulatory profile of nanoparticle for potential therapeutic use.
This article aimed to review the available anthropometry measurements used in the assessment of nutritional sta- tus among Cerebral Palsy (CP) children. Searched journals were from Medline, PubMed and Ovid published from 2015 to 2018. The search identified 443 articles, and eight studies met the criteria. Anthropometric measurements included weight, height, recumbent length, knee height, tibia length, Dual-energy X-ray absorptiometry (DXA), Bio- electrical impedance (BIA), Mid arm circumference (MUAC) subscapular skinfold (SFT), Triceps skinfold (TSF) and prediction equations. Body fat composition can be obtained by DXA, BIA, skinfold measurement, and also prediction equation. The predictive equation is the most reported method to determine nutritional status among CP. This review found that TSF and SFT are more accurate to determine body fat percentage when using together with the predictive equation. Besides, predictive equations using segmental length are reliable in estimating the height and can be used to evaluate the nutritional status using the specific CP growth chart.
Introduction: Hypercholesterolemia has been proven as a main pathogenic trigger for pathogenesis of atherosclerosis. Atherosclerosis characterised by chronic inflammatory process and increased expression of inflammatory markers. In this study; Trihoney (a combination of three types of natural honey namely: Trigona, mellifera, and Dorsata)
was investigated for its anti-inflammatory effect in hypercholesterolemic atherosclerotic rabbits. Methods: Thirty
male New Zealand white rabbits (NZW) were grouped into: normal diet (C), normal diet with 0.6g/kg/day of Trihoney (C+H), 1% cholesterol diet (HCD), 1% cholesterol diet with 0.6g/kg/day of Trihoney (HCD+H), and 1%
cholesterol diet with 2mg/kg/day of atorvastatin (HCD+At.). After 12 weeks of starting the experiment, animals were
sacrificed and serum analysed for homocysteine and pro-atherogenic inflammatory markers such as: interleukin-1β
(IL-1β), interleukin-6 (IL-6), and tumour necrosis factor-α (TNF-α). Fasting serum glucose was analysed to assess glycaemic status. Results: Trihoney treated group showed significantly lower (p
Bacteria and their metabolites are shown to be a potential therapeutic agent for cancer treatment. Much attention has been directed to Lactic acid bacteria (LAB) which exhibits several killing mechanisms via invasion and coloni- zation of solid tumors. Discovery of the characteristics of postbiotic metabolites that exert the same probiotic effects has attracted immense attention towards anti-cancer effect. It is known that LAB improves health and composition of microbiota in the gut. Supplementation of LAB is proven to enhance the host immunity and modulation of the immune system to fight diseases including cancers. Lactobacillus plantarum I-UL4 is the LAB species isolated from Malaysian fermented food, Tapai Ubi which capable of producing bioactive metabolic products. In this review, the properties of UL4-PPM will be discussed including anti-microbial, anti-cancer and immunomodulatory effects. Overall, it would be beneficial to discover the potential effects of UL4-PPM to possibly serve as an alternative treat- ment for cancer.
Introduction: Benzimidazole analogues are bicyclic compounds that had been synthesized comprising the fusion of benzene and imidazole. It gains interest in research as it poses numerous therapeutic potential such as anti-ulcer, anti-malarial, anti-helminthic, anti-fungal, anti-inflammatory, and anti-cancer. Hence, this work aims to screen novel benzimidazole analogues using MTT assay for potential anti-proliferation activities on gastric cancer, which is the second cause of cancer-related death. Methods: MTT assay was conducted following standard protocol on HGT-1 gastric cancer cells. Cells were seeded and allowed to attach overnight before being introduced with various con-centration of benzimidazole analogues up to 72 hours and the optical density of the MTT was recorded using 560 nm wavelength. Two-Way ANOVA was used to analyse all data, followed by post-hoc Tukey test and the structure analysis relationship was analysed using MTT result. Results: From five analogues, only compound 4 showed an-ti-proliferation activity with IC50 8.212 ± 0.813 μM at 72 hours. Compound 4 had hydroxyl group at ortho- and para- position and remarkably, compound 2 which contained the hydroxyl group at ortho- and meta- position together with compound 5 which contained the combination of meta- and para- induced proliferation on gastric cancer. Conclusion: Different position of hydroxyl group on the benzene ring gives different activities on gastric cancer and from the experiment, only compound 4 had the anti-proliferative activity.