While socio-demographic, physical and other factors are associated with neck pain, there is scanty literature about how these factors are associated with disability in adults suffering from this condition. We aimed to determine the socio-demographic and physical (strength and range of motions) related factors of disability in adults with non-specific chronic neck pain. A total of 34 adults with neck pain, with mean age 55 (10.80) years from a physiotherapy clinic in a teaching hospital participated in this study. Socio-demographic details such as body mass index (BMI), current employment status, hours of exercise done a week were obtained. Severity of pain was evaluated using the Numerical Rating Scale (NRS). Disability level was assessed using Neck Disability Index. Cervical range of motion was measured using the Cervical Range of Motion device. A hand dynamometer was used to measure the dominant hand grip muscle strength. The data was analyzed using descriptive and stepwise linear regression analysis. More than half the participants were females, above 50 years, in the overweight group (BMI>25 kg/m2), currently unemployed and had severe neck pain (NRS >7). Handgrip strength was the only factor found to be significantly (p
Chair based exercise (CBE) is an exercise alternative for older adults in ensuring safety during exercise. Its evidence of effectiveness is currently limited to frail older adults or those with acute medical conditions or terminal illnesses. Given higher exercise difficulty level, CBE could benefit healthier older adults and can be an exercise option for this population. This study was designed to evaluate the outcome of a CBE on physical performance and quality of life in community-dwelling older women in Malaysia. A total of 18 older women (mean age 66.78 + 4.60 years) completed CBE at twice-per-week for eight weeks. Exercise outcomes were measured using six minutes’ walk test (6MWT), five times sit to stand test (FTSTS) and hand-held dynamometer for physical endurance, functional lower limb strength and grip strength, respectively. A Malay version of the World Health Organization quality of life scale (WHOQOL-BREFMalay) was used to measure the health status and QOL of the participants. All data were analysed with the use of inferential statistics, with significance level set at p
Orbital cellulitis is an infection of the orbital soft tissue that could possibly lead to serious complications if treatment is delayed. It is important to differentiate this condition from a less life-threatening condition like preseptal cellulitis as orbital cellulitis would require a more aggressive treatment than the former condition. The present case discusses about a patient who was diagnosed with orbital cellulitis and developed complications from the disease. The delayed administration of the appropriate antibiotic subsequently led to the patient’s death. The delay was because of the reason that the patient belonged to the immunocompromised group who harbour different causative organism than the normal population.
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.
Solitary fibrous tumour (SFT) is a fibrotic neoplasm, also previously designated as hemangiopericytoma. STAT6 is a protein for signal tranducers and activators of transcription (STAT) family which is involved in immune function and early cell growth. Oncogenic alteration of STAT6 plays an important role for specific driver for tumour genesis of solitary fibrous tumour via NAB2-STAT6 fusion gene. The aim of the study was to compare and evaluate STAT6 expression between SFT and other soft tissue histological mimics. We evaluated a total of 30 cases material formalin fixed paraffin embedded tissue block previously diagnosed SFT cases (n=14) and soft tissue tumours mimic cases (n=16) over period of 15 years. Fourteen SFT cases (100%) showed nuclear expression of STAT6, which was diffuse and intense. All other tumour types were negative for STAT6, except for one case of dedifferentiated liposarcoma, one gastrointestinal stromal tumour and one spindle cell lipoma, which showed weak non-specific cytoplasmic staining. Nuclear STAT6 expression is useful and reliable as adjunctive marker for solitary fibrous tumour when the diagnosis is inconclusive by conventional methods.
Gelatin has been frequently used in tissue engineering scaffold due to its favorable biological properties in wound healing enhancement. Genipin, a natural compound derived from Gardenia plants, was shown to be effective in improving physicochemical characteristics of the gelatin scaffold. This systematic review reported the utility of genipin as a crosslinker in gelatin scaffold fabrication. Two electronic databases, namely Scopus and MEDLINE via Ebcoshost were searched for publication between January 1999 and December 2018, using the keywords ‘gelatin’ and ‘genipin’. Articles published in English, reporting the utility of genipin in the fabrication of gelatin sponge were included. The keywords search yielded 830 articles, in which 14 articles were selected and examined in this review. The result of the search provided input in terms of the optimum concentration, crosslinking temperature, and fabrication method of genipin to be used. From the literature, it was found that 0.5% is the optimum genipin concentration and 25˚C is the optimum crosslinking temperature. The result also revealed a gap in the knowledge regarding genipin crosslinker and justifies the need to create awareness of the utility of genipin as a gelatin scaffold crosslinker. The current review provides an extensive overview on the current knowledge on genipin crosslinking and be a guide to an optimal fabrication of the genipin-crosslinked gelatin scaffold.
Glaucoma is a group of neurodegenerative disease linked with imbalance in the aqueous humor flow due to resistance in the aqueous drainage system. This increases the intraocular pressure (IOP), which causes damage to the optic nerve head and leads to irreversible blindness. As IOP is the only treatable risk factor for glaucoma, its 24 hours biorhythm need to be understood before managing it. Monitoring IOP is a critically important part in the management of glaucoma. Various approach and technology have been initiated and on-going for a frequent, round-the-clock IOP measurement to determine the IOP peaks and fluctuations. We review the current innovative approach and its importance as well as discussing the shortcomings of each method to obtain the 24 hour IOP profile.
Brain health deterioration is a worldwide health epidemic. Alzheimer’s disease and other dementias are among the most expensive diseases to treat, with direct care expenses exceeding those for cancer and heart disease. The consumption of overly processed food products over the time has contributed to the increasing number of health deterioration at an earlier age. Honey has been known worldwide through history to be one of the purest, and popular natural product to be consumed as a health booster notably due to its antioxidant and phenolic contents. In the recent decade, many studies were perfomed to understand the biological process of cellular insult to the brain and ways to halt or slow down the process using natural products. Honey was shown in some of these studies as having the potential that may reduce or slow down these neural degenerations. Based on recent studies conducted on the use of honey and its effects on the brain physiologically, and anatomically, the results showed that honey holds potential in halting or even treating brain health deteriorations.
Revascularisation and replant surgery occasionally produces sub-optimal results. We present two cases of near total amputation of the digits. The first patient was an 11-year-old boy with a middle finger avulsion injury sustained after the finger was caught in a washing machine with the flexor digitorum profundus still attached. The second patient was a 42-year-old male who sustained a machete attack and had near total amputation of his small and ring fingers with a 2 cm skin bridge still attached. All patients underwent revascularization with repair of only one digital artery for each finger as the opposite artery was non-viable. No digital veins were repaired. Relief of venous congestion was done by pin-prick six times a day up till one week. At one week post-surgery, the fingers were discoloured black but had good pulp turgor and full contour with arterial bleed on pin-prick. Inexperienced surgeons may view this as gangrene and amputate the fingers. However, we continued observation and at one month post-surgery, the black skin had desloughed and the underlying skin was pink.
A claw hand causes disability as kinematics are affected due to hyperextension at the metacarpophalangeal joints. Zancolli lasso procedure is a simple tenodesis procedure which effectively lessens clawing to allow better grip. We present a 56-year-old lady who had a history of trauma with progressive clawing of her left hand. She has been diagnosed with partially recovered incomplete lower trunk brachial plexus injury. She underwent successful Zancolli lasso procedures for all of her fingers but 8 months later, the patient developed triggering of the index and middle fingers. We experimented by releasing the adhesions in one finger and releasing the whole A1 pulley together with the lasso-ed flexor digitorum superficialis (FDS) in the other finger and the latter worked.We repeated the procedure in the index finger and the triggering resolved. Although both her index and middle fingers now have a flexor digitorum profundus (FDP) only (the FDS having retracted proximally), she did not have a recurrence of her clawing. We attributed the triggering due to increasing A1 pulley volume as well as contractures causing post-release functional positions.
Worldwide, there is an increasing number of people living with HIV and AIDS especially in the reproductive age group. This has a huge impact when they wish to start a family. Managing reproductive issues among serodiscordant HIV couples is complex and often presents as a challenge especially in minimizing the risk of transmission. We report a case of a HIV positive man and his seronegative wife who successfully achieve conception and deliver a healthy baby without disease transmission of HIV to mother or child. Both partners were managed with treatment where the HIV positive male partner was treated with HAART while the unaffected female partner was on PrEP and conception was achieved through intrauterine insemination (IUI). Planning of conception, the use of medications and options for conception methods will be discussed in detail.
Hyperdensity of basal ganglia in computed tomography (CT) of brain is always recognised as hemorrhagic stroke or calcification. Features of hyperglycemia include muscle weakness, hypotonia, pyramidal tract signs and hemichorea-hemiballismus (HC-HB), which mimic the symptoms of stroke. Hyperdensity of the basal ganglia was reported in patient with non-ketotic hyperglycemia (NKH). Inability to recognize the hyperdensity in CT brain as a feature of NKH may lead to failure of treatment. Early recognition and reversal of hyperglycemia will improve the outcome. This was a case of an atypical presentation of stroke-like symptoms with the neuroimaging finding showing asymmetric hyperdensity of basal ganglia. Neurological examination failed to elicit any sign of HC-HB. Laboratory test showed hyperglycemia with absence of acidosis and ketonaemia. The patient was diagnosed having basal ganglia hemorrhage and referred to the Neurosurgical team. However, the stroke-like symptoms completely resolved following the normalization of glucose level. This is the only other reported case of NKH with typical neuroimaging features not associated with HC-HB. One should be aware of the possibility of NKH in the absence of movement disorder with asymmetric basal ganglia hyperdensity in CT brain. Misinterpretation as acute intracranial bleeding may result in suboptimal management of the true underlying cause.
Sharps injury among health care workers in HUKM has received serious attention lately due to the possible transmission of diseases like HIV, Hepatits B and Hepatitis C, which can cause serious consequences for the victim. The aim of the study was to gain a deeper understanding of the emotional problems experienced by health care workers who had incurred a sharps injury and the coping strategies adopted by them to overcome the problem. A 28 item semi-structured questionnaire was designed by the supervisors and the researcher as there was no existing questionnaire to be adopted, as no research had been carried out in this area prior to this. The target group consisted of 64 health care workers of different categories working in HUKM. Data was collected over a period of five months from November 2000 to March 2001. The results of the study revealed that the most frequently injured were the staff nurses, nearly 90% of whom were emotionally upset and were worried that they might contract a disease. There was no significant difference in the emotional stress experienced by the different categories of the health care workers, all were equally upset about the injury but each category of staff adopted different methods to overcome the tragedy. Open comments and opinions about prevention and the management of the sharps injury in HUKM as given by the respondents here are taken into account. Several views given by the participants were explored and discussed. Finally, several implications for nursing and recommendations have been presented.
Study site: Wards and the general operating theatres in Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Kemahiran pemikiran kritikal adalah satu kemahiran yang penting bagi para jururawat membuat keputusan klinikal yang lebih baik untuk memberi jagarawatan yang selamat. Seseorang mesti mempunyai kecenderungan awal untuk berfikir kritis bagi pembangunan kemahiran pemikiran kritikal. Pembentukan kecenderungan pemikiran kritis disokong oleh harga diri yang mencukupi. Kajian ini bertujuan untuk mengukur tahap kecenderungan pemikiran kritis dan harga diri di kalangan pelajar ijazah sarjana muda kejururawatan di sebuah universiti awam Malaysia. Kajian keratan rentas ini telah dijalankan di universiti melibatkan 99 orang pelajar. Data dikumpul dengan responden menjawab sendiri borang soal selidik. Data yang diperolehi kemudiannya dianalisa secara kuantitatif. Sejumlah 97% pelajar kejururawatan mempunyai tahap yang tinggi untuk mempunyai kecenderungan pemikiran kritis. Hampir 3/4 daripada pelajar kejururawatan mempunyai tahap sederhana bagi tanggapan harga diri (74.7%). Kecenderungan pemikiran kritis didapati signifikan berkait dengan tanggapan harga diri (rho = 0.203, p
Curcumin adalah satu rempah tradisional yang mempunyai potensi untuk menyembuhkan pelbagai jenis penyakit inflamatori, termasuk artritis. Kajian ini dijalankan untuk memerhatikan kesan-kesan curcumin ke atas perubahan histopatologi dan aras interleukin-1β (IL-1β) di dalam artritis aruhan kolagen (CIA). Tiga puluh ekor tikus jantan Sprague-Dawley (150+50 g) dibahagikan kepada lima kumpulan secara rawak. Satu kumpulan dijadikan kumpulan kawalan normal (CTRL), manakala selebihnya disuntik dengan 150 μg emulsi kolagen secara subkutan pada hari 0. Kumpulan CTRL dan CIA-Curcumin-d0 masing-masing diberi suplimentasi harian minyak zaitun oil (1 ml/kg) dan curcumin (110 mg/ml/ kg) bermula pada hari 0. Kumpulan CIA-OV (kawalan negatif), CIA-Beta dan CIA-Curcumin-d14 pula, masing-masing diberi suplimentasi harian minyak zaitun (1 ml/kg), Betamethasone (0.5 mg/ml/kg), dan curcumin (110 mg/ml/kg) bermula pada hari 14. Suplimentasi harian tersebut diberi kepada tikus-tikus sehingga hari ke 42. Kajian ini menunjukkan bahawa kumpulan CIA-Beta (**P=0.00) dan CIA-Curcumin-d0 (**P=0.01) masing-masing mempamerkan purata skor histologi yang lebih rendah secara signifikan berbanding kumpulan CIA-OV. Aras IL-1β di dalam serum untuk kumpulan CIA-Beta dan CIA-Curcumin-d0 tidak meningkat secara signifikan pada hari ke 42 berbanding hari 0. Purata peningkatan aras IL-1β dari hari 0 ke hari 42 juga adalah rendah secara signifikan (**P≤0.01) untuk semua kumpulan CIA berbanding kumpulan CIA-OV. Tidak terdapat perbezaan yang signifikan dalan purata skor histologi dan aras IL-1β kumpulan of CIA-Curcumin-d0 berbanding kumpulan CIA-Beta. Kesimpulannya suplimentasi awal curcumin berpotensi untuk meminimakan perubahan yang disebabkan penyakit artritis aruhan kolagen pada tikus.
Obesiti semakin meningkat di seluruh dunia dan secara umumnya ramai wanita mempunyai persepsi yang tidak tepat mengenai berat badan mereka. Tujuan kajian ini dijalankan adalah untuk mengenal pasti kadar obesiti di kalangan wanita mengandung dan dan persepsi mereka tentang berat badan sendiri. Seramai 315 wanita mengandung telah mengambil bahagian dalam kajian ini. Indeks jisim badan (BMI) mereka direkod dan persepsi tentang berat badan mereka dinilai dengan menggunakan soal selidik. Lebih dari separuh peserta (60.6%, n=191) dalam kajian ini didapati mempunyai berat badan yang melebihi paras normal dimana peratusan obes adalah 29.8% (n=94) manakala 30.8% (n=97) mempunyai berat badan yang berlebihan. Analisa kappa (kappa = 0.185 (95% CI, 0.119 hingga 0.258, p
'Carotid-cavernous fistula' (CCF) boleh berlaku secara spontan atau akibat kecederaan. Disebabkan komplikasi pada mata, proses mengenalpasti penyakit dan rawatan tidak harus ditangguhkan. Kami ingin melaporkan satu kes di mana seorang wanita tua yang mengalami kemerahan mata dan kemudiannya mata menjadi semakin bengkak. Beliau disyaki menghidapi penyakit CCF tetapi pemeriksaan imbasan tomografi berkomputer pada otak dilaporkan normal. Pesakit kemudiannya dijadualkan untuk cerebral angiografi dan beliau dikenalpasti menghidap penyakit CCF. Malangnya, pesakit tersebut mengalami komplikasi seperti retinopati stasis vena dan glaukoma neovascular disebabkan rawatan tergendala. Penglihatan beliau tidak dapat disembuhkan walaupun rawatan agresif telah diberikan. Kes ini bertujuan untuk menekankan kepentingan mengesyaki sesuatu penyakit melalui pemeriksaan klinikal walaupun dengan imbasan imej yang normal. Ini adalah untuk mengelakkan komplikasi seperti kebutaan yang tidak dapat disembuhkan.
Lecuran tar, walaupun dikelaskan sebagai kecederaan kimia, disebabkan oleh perbezaan mekanisma kecederaan dan kesukaran untuk mengeluarkan agen daripada kulit tanpa menyebabkan kerosakan kulit dengan lebih lanjutnya, merupakan satu masalah yang sukar untuk diselesaikan. Terutamanya, apabila pesakit pediatrik terlibat. Lecuran tar biasanya merupakan kecederaan pekerjaan dan kebanyakannya berlaku kepada lelaki dewasa. Dua kes dibentangkan di sini, seorang budak lelaki berusia enam tahun dan seorang gadis berusia 15 tahun yang mengalami luka lecuhan tar dan berjaya dirawat dengan menggunakan enema minyak mineral Fleet® dan paraffin tulle Bactigras®, yang mudah didapati di kebanyakan hospital.
Sesi praktikal konvensional sebelum ini telah dilaporkan kurang berkesan dalam mencapai objektif pembelajaran. Oleh itu “Speedy Biochemistry” diperkenalkan untuk membantu pelajar mengaplikasikan pengetahuan yang telah mereka pelajari di dalam kelas. Teknik ini memupuk semangat kerja berpasukan dan penerapan pengetahuan dalam penyelesaian masalah yang dapat dicapai melalui pembelajaran aktif. Pendekatan pembelajaran aktif telah kian diminati oleh para akademik kerana memberikan lebih banyak faedah kepada pelajar. Sesi “Speedy Biochemistry” telah dijalankan di kalangan pelajar perubatan Tahun 1 di Universiti Kebangsaan Malaysia dan maklum balas mereka telah direkodkan. “Speedy Biochemistry” boleh menjadi contoh sesi pembelajaran aktif yang baik dalam meningkatkan minat pelajar perubatan di dalam mata pelajaran Biokimia.
Psychophysiological effect associated to an event is inseparable with regard to the human’s mental health (Celik 2010; Cannon 1987; Roxo et al. 2011; Laird & Lacasse 2014). The manifestation of psychophysiological phenomenon in relation to an event has been observed during pre-modern era and inspired physician like Avicenna from the influence of the great thinker of Aristotle and Plato. Avicenna or IbnuSina, the Persian-born philosopher and physician from the Greco-Islamic era, has made his standpoint on the clinical importance of pulsology (Celik 2010). In his earlier concepts on pulse patterns, it was found that pulse would rise when he or she is anticipating an event, especially if an event is meaningful and related to him or her. Avicenna documented in dealing with such events, the psychophysiological changes that were observed, i.e. increased pulse from normal pulse. For example, a man who is approaching a house with a lady that he loved, started to experience tachycardia and palpitation. Sphygmology, a study of pulses is based on the contribution by Ibnu-Sina (Zarshenas et al. 2013). It is a relatively simple, practical and inexpensive means, having a significant diagnosis yield (Zarshenas et al. 2013). It has been recognised through the history of medicine, over the centuries, that we have a better understanding on the fundamental concept of coping with stress by observing our own pulses. Using this modest physiological approach, it has contributed to the modern way in dealing with distressed situation-the psychophysiology of biofeedback therapy and instilling the Buddhist teaching of mindfulness. For example in the former, biofeedback is a simple way of overcoming stress. Biofeedback therapy is a method that trains people to enhance their health by regulating certain bodily processes that normally happen involuntarily (Abgrall-Barbry & Consoli 2006). Once we are in a stressful state, our pulse and blood pressure will increase. Meditating, or self-dialogueand telling our brain that, “I am in control and can dictate my pulse from the highest to lowest possible beat,” can be helpful in dealing with our stress level via higher mental function coordination. Indeed, regulation of basic physiological phenomena and psychological input-“calming the mind” has both anatomical and neurophysiological explanation via the reticular activating system and thalamic integration. Understanding a simple way in managing with stress, especially during the difficult and stressful time can be gratifying and rewarding. This is especially true when it comes to inconveniences, hassle and problems due to coronavirus disease 2019 (COVID-19) pandemic, and during the movement control order (MCO).