Introduction: The goal of the present study was to examine the effect of alcohol consumption on sperm count and motility and the morphological changes in the seminiferous tubules of parent mice and their offspring. Methods: Animals were divided into two groups, Group 1 (alcohol group) of twelve male and twelve female mice, were given a daily dose of (3 g/kg body weight as 25%, v/v) ethanol by gastric gavage for four and eight weeks. Group 2 (control group) also of twelve male and twelve female mice; received normal access of food and water. After four weeks of treatment, the males and females in each group were allowed to mate, and ethanol treatment continued for up to another four weeks. Twelve male offspring from group 1 and twelve male offspring from group 2 were selected randomly and allowed to become mature. Male parent mice were killed at the 4th and 8th weeks of treatment, and their male offsprings were killed when they reached maturity age. Results: Physiological examination of the sperm solution showed that there was a significant decrease in sperm count and motility after 4 and 8 weeks of ethanol treatment in parent male mice, but this decrease was not significant in their adult offspring. Furthermore, histological investigations indicated testicular lesions in the parent male mice and their adult male offspring. Conclusion: Alcohol abuse has deleterious effects on the testes structure and on the sperm count and motility of the epididymal spermatozoa of both parent mice and their offspring.
Introduction: Obesity has been recognized as a major public health concern due to lack of physical activity and a sedentary lifestyle. Methods: This cross sectional study was carried out to determine the status of body mass index (BMI) and habitual physical activity level among staffs working in Military Hospital, Malacca using Habitual Physical Activity Questionnaire (HPAQ). Results: About 120 HPAQ were distributed and only 82 responded with 23(28%) of them males and 59 (72%) females, aged between 21 to 59 (40.52 ± 9.38) years old. Anthropometry analysis showed the mean weight of male respondents was 79.48 (± 16.33) and 70.95 (± 15.66) for the females. Body mass index (BMI) for males (33.61 ± 2.82) was almost similar to females ( 33.20± 2.95).The mean waist circumference of men was 93.26 (± 10.94)cm compared to 94.03 (± 11.98)cm in the females. Following categorization of BMI, 59% (n=48) are in the obese group, 24% (n=20) are overweight and only 17% (n=14) have an ideal body weight or normal BMI. Relationship between BMI and HPAQ demonstrated strong and significant correlation coefficient for habitual physical activity at work (r = 0.775, p < 0.001), sports (r = 0.735, p < 0.05) and leisure ( r = 0.713, p < 0.001). Conclusion: The staffs working in the Hospital demonstrated poor habitual physical activity which explains for the high incidence of obesity among the staffs. This requires measures to be taken to promote a healthier lifestyle among them.
Changes in tear protein concentrations may reflect ocular surface health. This study analyzes changes in tear protein concentrations of young Malays with dry eye (DE) and determines its association with the clinical findings. Methods: Subjects were screened using McMonnies questionnaire (MDEQ) and flourescein tear break up time (TBUT). Total tear protein concentration (TTPC) was determined using Bradford's technique and specific tear protein (sIgA, lysozyme, lactoferrin and human serum albumin (HSA)) concentrations were determined using SDS-PAGE. Parametric and nonparametric tests were used to compare means between groups. Spearman correlation was used to determine the association between variables measured. Results: A total of 42 subjects (21 DE and 21 NDE) were included. Mean MDEQ score for DE was 16.00±1.48 and NDE was 8.47±3.47. Mean TBUT for DE was 3.47±0.47s and NDE was 4.98±0.43s. Mean TTPC for DE and NDE was 9.84±2.40mg/ml and 8.96±1.84mg/ml respectively. Mean sIgA, lysozyme, lactoferrin and HSA for DE was 0.54±0.10mg/ml, 1.68±0.17mg/ml, 1.47±0.25mg/ml, 0.06±0.03mg/ml and for NDE was 0.57±0.09mg/ml, 2.04±0.19mg/ml, 1.75±0.23mg/ml, 0.06±0.03mg/ml accordingly. Significant differences were noted in MDEQ score (p=0.01), TBUT (p=0.01), lactoferrin (p=0.01) and lysozyme (p=0.01) but not in TTPC (p=0.19), HSA (p=0.74) and sIgA (p=0.24) between groups. Significant correlations were noted between TBUT with lactoferrin (r=0.02, p=0.02) and lysozyme (r=0.63, p=0.01) and between MDEQ score with lactoferrin (r=-0.34, p=0.02) and lysozyme (r=-0.64, p=0.01). Conclusions: There are changes in specific tear protein in dry eye patients, which correlate well with clinical results. Tear protein analysis may play an important role in the diagnosis of the dry eye.
Qur’anic verses recitations to ill patients are practiced by many Muslims as a form of healing and worship. The effectiveness has been observed in many medical institutions; however, it has never been objectively measured and documented. This pilot study was conducted to construct a methodological approach to evaluate the therapeutic effects of Yasiin recitation on the haemodynamics of critically ill patients. Methods: Ventilated Muslim patients in coronary care unit of a teaching hospital were evaluated. Yasiin was recited twice; by one of the researchers and then by the patients’ relatives. Mean arterial blood pressure, pulse rate, oxygen saturation level and electrocardiographic changes, were observed. The difference of the parameters before and during recitation was analysed. Results: Five patients fulfilling the selection criteria were selected; two acute myocardial infarctions, two congestive cardiac failures, and a third-degree atrioventricular block. Based on a non-parametric two-related-sample test, the haemodynamic parameters were not significantly affected by Yaasiin recitation. At the end of the study, two of the patients passed away, one patient was extubated and survived. Two patients were still on ventilators when the study had been completed. Limitations in the study were observed and highlighted in explaining the equivocal results. Conclusions: The effect of Yasiin recitation on heamodynamics of patients was not proven in this study. Further refinements might be needed based upon the observation on limitations encountered. It is hoped that this humble effort would pave the way for further studies to explore this field.
Advances in neonatal care now enable more infants to be kept alive despite clear clinical evidence of inevitable or imminent death on a life-support system. It is therefore no longer acceptable to the society that a patient is left to die in the hospital, without any form of treatment or intervention. We report a case of severe birth asphyxia, hypoxic-ischemic encephalopathy, neonatal seizures and left cephalohematoma. In spite of initial successful resuscitation, the infant could not survive until all possible methods of treatment were exhausted. This case illustrates one of many examples of the process involved in dealing with ending of life decision in a condition considered as futile.
Intracranial nail gun injury is a rare subset of penetrating head injury. Here we report a case of intracranial nail gun injury in a Vietnamese patient who attempted suicide with no neurological deficit. Three nails were launched. Because the nail head acted as a brake, the launched nail could make a hole into the skull but could not entirely pass it. A rational management strategy should permit these patients to be discharged with no additional injury. Some medical and surgical management in penetrating head injury are discussed. The use of antibiotics and antiepileptic drugs and the retraction of the nail aided by the performance of a craniotomy surrounding the entry point are recommended.
It is well known that ionizing radiation has an onco-genetic activity and has been implicated in the causation of brain tumors. However, when a new growth appears adjacent to the site of previous tumor, the diagnosis is more toward recurrence. In addition to that, the possible cause might be overlooked, when it occurs many years after radiation treatment. We report a case of radiation-induced meningioma developed 20 years after the patient received radiotherapy for pituitary adenoma.
We present a case of 80-year-old man with two-year history of hoarseness of voice secondary to left vocal cord paralysis. CT scanning revealed a saccular thoracic aneurysm compressing the left recurrent laryngeal nerve. A review of literature on Ortner's or cardiovocal syndrome is presented.
Introduction: To analyze the ART outcome and factors associated with successful ART treatment for infertile couples in a newly set up medical university IVF centre. Methods: A six-month cohort study of patients undergoing their first assisted reproductive technique cycle was conducted at IIUM fertility centre, Kuantan (from 15th June until 31st Dec 2009). Outcome measures include clinical pregnancy rate, ongoing pregnancy rate, take home baby rate and complications rate. Results: Fifty-five first cycles of IVF/ICSI were studied. Mean embryo per transfer was 2.1±0.8. Four patients were pregnant (23.5%) from a single embryo transfer (SET). Clinical pregnancy rate was 30.9% (17/55). Ongoing pregnancy rate was 23.6% (13/55) and take home baby rate was 21.8% (12/55). There was only one twin pregnancy. Nine patients (16.4%) had OHSS whereby 77.8% were mild and 22.2% were moderate. Conclusion: Take home baby rate at the IIUM fertility centre is comparable to most established ART centres in Malaysia considering that this is only the first year of operation.
Introduction: The aim of this study is to determine the most common organisms isolated in diabetic foot infection and the most utilised antibiotic regimes as the first line of treatment.
Methods: This is a retrospective record review of the National Orthopaedic Registry Malaysia among diabetes mellitus type 2 patients who had foot infections. All identified cases admitted to 18 government hospitals in Malaysia from the 1st January 2008 until the 31st December, 2009 were included in the study.
Results: A total of 416 patients were included in the study. The most common organisms cultured were Proteus species (17.5%), Klebsiella species (17.1%) and Staphylococcus aureus (17.9%), while the most commonly used antibiotic was ampicillin/sulbactam (67.5%). None of the patients was appropriately treated with metronidazole, cefoperazone or fucidic acid. All patients were given appropriate antibiotics to treat Serratia infection.
Conclusion: Significant number of patients with diabetic foot infections were not treated using appropriate antibiotics as the first line treatment.
Introduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable intertrochanteric fractures continues to raise concern related to risk of lag screw cut-out with or without subsequent damage to the acetabulum. Measurement of tip-apex distances (TAD) has been recommended to guide the optimal placement of lag screw and to predict subsequent risk of screw cut-out. In this study, the value of TAD was evaluated to verify its usefulness.
Methods: This is a retrospective study of 33 consecutive patients with intertrochanteric fracture treated with DHS. Demographic data of the patients were traced from their case notes. Post-operative radiographs were reviewed by focusing on measurement of TAD on anteroposterior and lateral radiographs. Radiographs at one year follow-up were reviewed to depict any fixation-related failure or complication.
Results: Fifty two percent of patients did not achieved the recommended TAD of ≤ 25mm. The mean post-operative TAD was 25.9mm and elderly patients were likely to achieve TAD of ≤ 25mm. The overall complication rate of 6% was attributed to screw cut-out in two cases. The unstable left-sided fracture was identified to be a potential risk for screw cut-out or migration.
Conclusion: TAD is a valuable measurement to guide optimal placement of lag screw during DHS fixation of intertrochanteric fracture.
KEYWORDS: Intertrochanteric fracture, dynamic hip screw, tip-apex distance, screw cut-out
Introduction: The goal of palliative care is the provision of the best quality of life (QOL) for terminally ill
and dying patients. Advances in medical treatment has seen an increase in overall survival of all stages of
malignant diseases. This includes advanced and/or inoperable malignancies where management is mainly
palliative involving different modalities. Methods: We designed a cross-sectional descriptive study of
surgical patients in a palliative care unit in a 1000-bedded teaching hospital in Kuantan, Malaysia.
Objectives of this study are: to study the demographic characteristics and indications for admission of
surgical patients in palliative care unit, to study the options of treatment modalities and their
complications, to identify the barriers in decision making in surgical treatment and finally to objectively
assess the quality of life of these patients by utilizing QUALITY OF LIFE (WHOQOL) –BREF –questionnaire.
Results: One hundred and one eligible patients (53%) male, (47%) female of mean age of 54yrs, majority
Malay and Chinese patients were included in the study. All patients had malignancies and they were Breast
(30%), Lower gastrointestinal (GI) (24%), (18%) upper GI, (15%) hepato-biliary, and (7%) pancreatic cancers.
Thirty two percents of patients had emergency treatment while the rest had supportive treatment. Barriers
to decision making were mainly due to patient factors in 71%, while 12% was due to the disease presenting
at an advanced stage and 15% due to limitation of care. The final results of overall quality of life rating
were shown as poor (1%), neither poor nor good (42%), good (52%) and very good (2%). Conclusions:
Palliative care and end of life decision making from surgical point of view is a delicate issue. Like all other
fields in medicine, palliative care must be evidence-based with specific goal directed therapy. Our study
shows that we are able to positively impact the quality of life in more than two thirds of our patients. Our
aim is to achieve 100% success. As such, it is imperative to inculcate the goal of palliative care to all grades
of health care personnel. ‘To cure sometimes, To relieve often, To comfort always’ should not be mere
words.
Introduction: There has been increasing evidence of detrimental effects of cumulative positive fluid
balance in critically ill patients. The postulated mechanism of harm is the development of interstitial
oedema, with resultant increase morbidity and mortality. We aim to assess the impact of positive fluid
balance within the first 48 hours on mortality in our local ICU population. Methods: This was a secondary
analysis of a single centre, prospective observational study. All ICU patients more than 18 years were
screened for inclusion in the study. Admission of less than 48 hours, post-elective surgery and ICU
readmission were excluded. Cumulative fluid balance either as volume or percentage of body weight from
admission was calculated over 6, 24 and 48 hour period from ICU admission. Results: A total of 143 patients
were recruited, of these 33 died. There were higher cumulative fluid balances at 6, 24 and 48 hours in nonsurvivors
compared to survivors. However, after adjusted for severity of illness, APACHE II Score, they were
not predictive of mortality. Sensitivity analysis on sub-cohort of patients with acute kidney injury (AKI)
showed only an actual 48-hour cumulative fluid balance was independently predictive of mortality (1.21
(1.03 to 1.42)). Conclusions: Cumulative fluid balance was not independently predictive of mortality in a
heterogenous group of critically ill patients. However, in subcohort of patients with AKI, a 48-hour
cumulative fluid balance was independently predictive of mortality. An additional tile is thus added to the
mosaic of findings on the impact of fluid balance in a hetergenous group of critically ill patients, and in subcohort
of AKI patients.
Introduction: To review the gestational age at diagnosis, method of diagnosis, pregnancy outcome and
maternal complications of prenatally diagnosed lethal foetal anomalies. Methods: Retrospective review of 25
women who had aborted or delivered foetuses with lethal anomalies in a tertiary hospital in 2011 based on
patient medical records. Results: There were a total of 10,088 deliveries, in which 25 (0.24%) women were
found to have conceived foetuses with lethal anomalies. All of them were diagnosed by prenatal ultrasound
and only 7 (28.0%) had both prenatal ultrasound and genetic study done. The women’s mean age was 29.9
years old. The mean gestational age at diagnosis of lethal foetal anomalies was 25.5 weeks (SD=12.5) and
mean gestational age at termination of pregnancy (TOP) or delivery was 28.5 weeks (SD=12.5). Seven (28%)
women had early counseling and TOP at the gestation of < 22 weeks. Beyond 22 weeks of gestation, eight
(32%) women had TOP and ten (40%) women had spontaneous delivery. Twenty (80%) women delivered or
aborted vaginally, three (12%) women with assisted breech delivery and two (8%) women with abdominal
delivery which were performed due to transverse foetal lie in labour and a failed induction, leading to
emergency hysterotomy complicated by hysterectomy due to intraoperative finding of ruptured uterus.
Overall, the associated post-partum adverse events included post-partum haemorrhage (12%), retained
placenta (12%), blood transfusion (8%), uterine rupture (4%) and endometritis (4%). Mean duration of hospital
stay was 6.6 days (SD 3.7 days). Conclusion: Late diagnosis of lethal foetal anomalies leads to various
maternal morbidities, in this case series , which could have been prevented if they were diagnosed and
terminated at early trimester. A new direction is needed in our local practice.
Introduction: Lack of knowledge and negative attitude towards HIV/AIDS may be the risk factors for HIV infection among transsexuals. Research on knowledge and attitude towards HIV infection in transsexual communities is very limited at both local and international levels. This study aimed to assess the knowledge and attitude towards HIV infection among the male-to-female transsexual community in Kuantan, Pahang.
Methods: A cross-sectional study was carried out from July to August 2014 among 33 male-to-female transsexuals in Kuantan, Pahang. Convenience sampling was used. Participants who gave consent answered a self-administered questionnaire. Data obtained was analyzed with descriptive statistics, χ2-test, and independent sample t test.
Results: The majority of the subjects in this study were 29 years and below (48.5%), Muslims (93.9%), and had completed up to secondary education (60.6%). Most of them were sex workers (60.6%), and had relatively low income (no income to RM 3000, mean of RM1528). A total of 87.9% of the subjects demonstrated good knowledge and also positive attitude towards HIV/AIDS. Level of education was significantly associated with scores in knowledge (p=0.01).
Conclusions: Despite the positive outcome from this study, misconceptions towards HIV/AIDS still exist among transsexuals. Education and interventions from multiple directions on HIV/AIDS are essential to deliver the correct information to this population, so as to emphasize prevention, early detection, and holistic medical care. Transsexuals also require attention from religious bodies and non-governmental organizations to help them in employment, financial, spiritual, and psycho-social issues.
Introduction: Despite general acknowledgement of the importance in assessing family needs in critical care
patients, there is no psychometric instrument to measure the family needs within Malaysian settings. This
study aimed to perform factorial validation and establish psychometric properties of Malay translated
Critical Care Family Need Inventory (CCFNI-M) for Malaysians. Methods: This study consisted of four
protocols: Forward-Backward translation, validity, internal reliability and inter domain correlations phases.
The factorial validation of the CCFNI-M was based on its administration to 109 family members of critical
care patients admitted to the Intensive Care Unit of Hospital Universiti Sains Malaysia, Kelantan, Malaysia.
At validity phase, factorial validation was performed using Exploratory Factor Analysis using Principal
Component Analysis with Varimax rotation. The internal consistency and inter domain correlations were
calculated using Cronbach’s alpha and Pearson correlation coefficient respectively. Results: Preliminary
analyses reported the suitability of data for factorial validation. With reference to the original CCFNI, five
factors were extracted which explained 49.4% of the total variance. After removal of several items for
different reasons, the final items in CCFNI-M were 42. The internal consistency values for five dimensions
ranged from 0.72 to 0.87 with inter domain correlation values (r) among the dimensions ranged between
0.36 and 0.61. Conclusion: The high measures of factorial validity, internal consistency and inter domain
correlations values of the CCFNI-M make it suitable measure for assessing the family needs of critical care
patients.
Introduction: The purpose of this study was to derive a modified equation for contact lens method (CLM) in
calculating post myopic laser refractive surgery corneal power. Methods: A total of 93 subjects who
underwent myopic laser refractive surgery at IIUM Eye Specialist Clinic were recruited. The accuracy of
postoperative corneal power using the standard CLM and newly-derived contact lens modified method
(CLMmod) were compared to the standard comparison method ; the historical method (HM). The CLMmod
equation was derived by adjusting postoperative corneal power of CLM according to amount of refractive
change. Results: The mean postoperative corneal power using standard CLM was significantly higher than
HM (mean difference: -0.24 D, p < 0.001). Fifty seven percent (n = 53 eyes) of the standard CLM results were
within ±0.50 D of HM results. The difference between postoperative corneal power using standard CLM and
HM increased significantly with the amount of refractive change (r = 0.835; p < 0.001). The mean
postoperative corneal power of CLMmod showed that there was no statistical significant difference compared
to the HM results (mean difference: 0.00 D, p= 0.964). Eighty eight percent (n = 82 eyes) of the CLMmod
results were within ±0.50 D of HM results with improvement of 31% from the standard CLM results.
Conclusion: The CLMmod equation provides more accurate calculation in determining post myopic laser
refractive surgery corneal power. In near future, this modified equation can be used as an alternative
equation to calculate postoperative corneal power when the preoperative data is unavailable.
Primary hyperparathyroidism with severe bone disease as a result of excessive parathyroid hormone ( PTH ) release and severe hypercalcaemia can lead to 'hungry bone syndrome' (HBS) post operatively. This is due to sudden cessation of PTH and drop in serum calcium. We reported a case a young man with primary hyperparathyriodism due to a single parathyroid adenoma with severe bone disease and post operatively developed hungry bone syndrome.
Varicella or chickenpox is an infectious disease caused by Varicella Zoster Virus (VZV), which commonly affects the children. It is a mild, self-limiting disease and rarely complicate to serious conditions except in adults. Decreasing incidence of chickenpox among children, probably owing to improved living conditions ,prevention and health care, is worrisome as growing number of adults are being infected. This creates disturbing concerns in many parties as women at childbearing age might get infected and not only are them at a great risk of serious complications, but also their unborn fetus or their newborn babies.
The number of people worldwide living with human immunodeficiency virus/ acquired immunodeficiency virus (HIV/AIDS) is more than 40 million, among them 17.7 millions are women (UNAIDS/WHO, 2006) The latest report from the Eastern Mediterranean Region shows that at least one million people are infected with HIV; among them 30% are women. The great majority of reported cases in the Region are men. However, the ratio of men to women cases varies in different countries. It ranges between “9:1 (as for example in Egypt), to 2:1” (as in Morocco and some parts of Yemen). Due to religious, social and cultural values regarding female purity, women and girls living with HIV and AIDS are subjected to greater discrimination than men. WHO reports show that a large percentage of the infected women in Arab countries have contacted the infection from their husbands especially migrants and drug abusers. In Arab countries, studies conducted show that 86% of women choose not to disclose their status of infection for the fear of abandonment, rejection, discrimination, violence, upsetting family members, and accusations of infidelity from their partners, families, and communities. As a result, many women only seek help at the last minute when they are already been terminally ill. Violence against women and girls in its different forms increases women's vulnerability to HIV infection and undermines AIDS control efforts. The fear of violence prevents many women from accessing HIV information, from getting testing and seeking treatment. Stigma and discrimination may also prevent them from carrying out their normal life activities. When women are blamed, this can lead to heightened levels of sexual and domestic violence, abandonment by families and communities, forced abortion or sterilization, dismissal from employment and loss of livelihood opportunities. A study of AIDS-related discrimination in Arab region found that over ten percent of women had lost financial support from family members since being diagnosed as HIV positive. There is a great deal of evidence to establish the significant link between gender-based violence and rising rates of HIV infection among women and girls throughout the world. HIV-positive women must be supported to make their own reproductive choices about whether and/or when to have children. Promote male involvement in sexual and reproductive health programmes. Finally the stigma, discrimination and violations must be stopped.