Globally, the prevalence of diabetes mellitus and the average life expectancy is on the rise. As diabetes mellitus is commonly associated with old age, it is very important to ensure good glucose control to reduce complications and improve quality of life. A cross sectional study was conducted among elderly diabetics in Kulim with the aim to determine the prevalence of glucose control and its associated factors. Three hundred and twenty nine respondents were chosen through stratified random sampling in all the seven health clinics in Kulim. Respondents were interviewed personally using a structured questionnaire. HbA1c level of 6.5% and below was considered as good glucose control. Prevalence of good glucose control was 22.5%. Being male (Adjusted prevalence odds ratio, APOR = 1.75, 95% CI: 1.02-3.00), age of 70 years and above (APOR = 2.48, 95% CI: 1.40-4.39) and duration of diabetes less than five years (APOR = 2.10, 95% CI:1.21-3.64 ) were found to have significant association with good glucose control. As a conclusion, this study showed that the low prevalence of good glucose control was determined by gender, age and duration of illness.
Menopause, a cessation of menstrual bleeding, is directly related to serious
illness confined to cardiovascular disease (CVD) such as hypertension and stroke. The oestrogen withdrawal and consumption of high cholesterol diet has
a detrimental effect on cardiovascular function and metabolism in menopausal
women. The present study was aimed to develop the hypertensive rat model in
the ovariectomised Sprague Dawley rats fed with 2% cholesterol diet following a
short term period. Eighteen Sprague-Dawley rats were randomly divided into three
groups; Sham control (sham), ovariectomized control fed with normal diet (Ovx
+N), ovariectomized rats fed with 2% cholesterol diet (Ovx + Cho) for four weeks.
At the end of the study, the food intake and body weight were measured. The
systolic, diastolic and mean blood pressure was determined. OVX+Cho showed
significant increase in physiological changes such as body weight and food intake
compared to Ovx+N group. The significant increase in systolic, diastolic and mean
blood pressure was observed in Ovx+Cho group. Based on the above findings,
it is believed that feeding cholesterol diet for four weeks (short term) results in
significant increase in the blood pressure, food intake and body weight in the
ovariectomised rats.
Dalam situasi wabak COVID-19 ketika ini, maklumat yang tidak disahkan telah membanjiri platform media sosial, lalu meningkatkan tahap kegelisahan dan gejala kemurungan di kalangan orang ramai. Penyelidikan ini bertujuan untuk menilai hubungan antara pengetahuan, sikap, dan amalan (KAP) yang berkaitan dengan COVID-19 dan kesan psikologinya, seperti kegelisahan dan gejala kemurungan pada rakyat Malaysia. Tinjauan dalam talian telah dilaksanakan dari 8-22 April 2020, yang melibatkan 227 responden. Set soal selidik tersebut merangkumi ciri-ciri sosiodemografi, soal selidik KAP - 11 soalan mengenai pengetahuan (K1-K11), 3 soalan mengenai sikap (A1-A3), 4 soalan mengenai amalan (P1-P4), bersama dengan Soal Selidik ‘Patient Health Questionnaire (PHQ-9)’ dan ‘Generalized Anxiety Disorder (GAD-7) Scale’. Untuk mentafsir hasil penyelidikan, analisis deskriptif, ujian chi-square dan analisis teori respons barang telah dilaksanakan. Peratusan responden yang menjawab soalan penyataan benar dari komponen Pengetahuan (K1-K3) dengan betul adalah hampir 100%. Walau bagaimanapun, item yang menguji maklumat palsu COVID-19 (K4-K11) berkisar dari 38.8% hingga 95.2%. Satu-satunya item dari komponen Sikap yang kurang dari 95% dijawab dengan betul adalah A1 (78.9%), mengenai penggunaan topeng muka. Dari komponen Latihan, lebih daripada 80% responden mengenal pasti bahawa mereka menggunakan media sosial untuk mendapatkan kemas kini mengenai COVID-19 sepanjang masa. Ini merupakan sesuatu yang membimbangkan kerana kebanyakan maklumat yang beredar di media sosial belum disahkan oleh pihak berwajib, yang mungkin menyebabkan, dan terus-menerus memperkuat maklumat palsu yang menimbulkan kegelisahan. Kajian ini menunjukkan bahawa skor KAP keseluruhan yang lebih rendah, terutamanya untuk item komponen Pengetahuan, berkaitan langsung dengan tahap kegelisahan dan kemurungan yang lebih tinggi.
Uncontrolled bleeding due to pelvic fractures contributes to trauma-related morbidity and mortality. Three main strategies that have been outlined to combat this condition which include reduction of pelvic volume that lead to tamponade-like effect, arresting haemorrhage through angioembolization of the major vessels, and stabilization of the pelvic bone with external fixation need to be initiated early. A prehospital device that allow these strategies will aid significantly in the management of the patient. At present most devices used to treat pelvic fractures in the pre-hospital setting do have its’ own advantages but also have some limitations. A characteristic ‘wish-list’ of a good pelvic and lower limb immobilization device was created and the research team from UKM takes the challenge to design and produce a device that concurs to it. A two phase development project that incorporate anthropometric, biomechanical, cadaveric and radiological study was carried out over a period of seven years. Finally, BRIMTM immobilizer, a new pelvic and lower limb immobilization device that is user friendly, tough, cost effective, radiolucent, light and reusable that answers most of the requirement of a good device was invented.
Intussusception is a common cause of gastrointestinal emergency in the paediatric population and it is usually diagnosed through Barium enema radiography or ultrasound. The skill of using an ultrasound by a minimally trained medical officer in diagnosing this cases in the Emergency Department are very helpful and expedite the management. We present the case of a 7-month-old girl who presented to Emergency Department (ED) with the chief complaint of passing blood in stool. Clinically she was dehydrated, irritable and in compensated shock. There was generalised tenderness per abdomen but it was soft and not distended. There was no palpable mass and bowel sound normal. Immmediate fluid resuscitated commenced. Bedside abdominal ultrasound performed by ED medical officer showed a 1.8 cm x 2.5 cm mass of alternating hypo-echoic and hyper-echoic rings at the right lower quadrant, consistent with the ‘target’ sign of intussusception. Supine plain abdominal X-ray did not reveal any abnormality. The ultrasound finding of intussusception was later confirmed by the radiologist. She underwent immediate hydrostatic reduction and was discharged well.
Keywords: diagnosis, Emergency Department, intussusception, paediatric, ultrasound
Identification of causative organisms of clinically suspected microbial keratitis is very important so that appropriate targeted antimicrobial treatment can be offered to patients. The current routine method of corneal scraping specimens on to multiple agar culture plates for microbiological study is not really providing encouraging result. Our trial of modified technique of using BACTEC broth for three clinically suspected microbial keratitis cases worked 100% to identify the causative organisms in cases of microbial keratitis.
Keywords: culture media, cornea, keratitis
Chlorella vulgaris, a unicellular microalgae, produces many intracellular phytochemicals namely carotenoids, tocopherols, ubiquinone and protein. Skin ageing which is induced by oxidative stress involves decreased extracellular matrix synthesis and increased expression of enzymes that degrade the collagenous matrix. The objective of this study was to determine the effect of C. vulgaris on the expression of genes encoded for collagen (COL) and matrix metalloproteinases (MMPs) which are involved in skin ageing. Human diploid fibroblasts (HDFs) were obtained from circumcision foreskin of 8-12 year-old boys. HDFs were cultured into 3 groups: untreated control cells, cells with stress-induced premature senescence (SIPS; cells were induced with H2O2 at passage 6 for 2 weeks) and SIPS treated with C. vulgaris (prolonged C. vulgaris treatment started at passage 4 and combined treatment with H2O2 at passage 6 for 2 weeks). Senescence-associated ß-galactosidase (SA ß-gal) was determined using senescent cells histochemical staining kit (Sigma, USA). Expression of COLI, COLIII, COLIV, MMPI, MMPII and MMPIII genes was quantitatively analysed with real-time RT-PCR method (iScript™ One Step real-time PCR with SYBR® Green; Biorad). HDFs treated with H2O2 (SIPS) exhibited senescent morphological features of flattening and enlarged with increased expression of SA ß-gal (p
Damage control resuscitation, characterized by hemostatic resuscitation with blood products, rapid arrest of bleeding and when possible, permissive hypotension with restricted fluid load form a structured approach in managing a polytrauma patient. When complicated with traumatic rhabdomyolysis however, permissive hypotension strategy may cause more harm resulting in subsequent ischaemicreperfusion injury and acute kidney injury. We present a case involving a 20-yearold man who was rolled over by a lorry and sustained an open unstable pelvic fracture with vascular injury and left lower limb ischaemia. Permissive hypotension strategy was pursued for 4 hours prior to bleeding control in OT. This was followed by protracted surgery of 6 hours. Coagulopathy, acute kidney injury and rhabdomyolysis ensued in the post-operative period and patient succumbed to his injury on Day 3 post-trauma. Challenges and pitfalls in managing a complex polytrauma patient and recent evidences on damage control resuscitation is discussed.
The objective of this study is to determine the prevalence of dysmenorrhoea, its associated factors and its effects on school activities among adolescent girls in a secondary school in a rural district of Selangor, Malaysia. This is a cross-sectional study conducted in a public secondary school. A stratified random sampling of 300 female students (12 to 17 years old) from Form one to Form five classes were selected. A self-administered questionnaire consisting of 20-items was used to collect sociodemographic and menstrual data. Pain intensity for dysmenorrhoea was measured by numerical rating scale. The prevalence of dysmenorrhoea was 62.3%. It was significantly higher in the middle adolescence (15 to 17 years old) age group (p=0.003), girls with regular menstrual cycle (p=0.007) and a positive family history (p
E-cigarettes have rapidly gained worldwide popularity. Since its use still poses a health risk to the users, it is important to assess their intention to quit this habit. This study aimed to determine the characteristics of e-cigarette use, its effect on cigarette smoking and users’ intention to quit vaping and smoking. A total of 377 e-cigarette users were recruited from three vape retail stores in Bandar Baru Bangi, Selangor. E-cigarette usage pattern, tobacco cigarette consumption and their intention to quit were assessed using a self-administered questionnaire. Most (70%) participants were e-cigarettes only users while 30% were dual users. The median duration of e-cigarette use was 2 (IQR 2) years. Almost all (98.4%) participants used third-generation devices and majority (63.7%) preferred liquid containing 6mg nicotine. About 92% participants, especially heavy smokers, smoked fewer tobacco cigarettes after initiating e-cigarette. Majority (79.6%) of dual users also had reduction in tobacco cigarette consumption with a median current consumption of 5 (IQR 5.0) cigarettes per day. Most (87%) e-cigarette users intend to quit the habit someday. However, many (63.1%) were in the pre-contemplation stage. E-cigarette users of less than 2 years duration tend to have the intention to quit compared to users of more than 2 years (p=0.005). In conclusion, there was more e-cigarette only users than the dual users. E-cigarette use could significantly reduce tobacco smoking, especially among heavy smokers. Most e-cigarette users had the intention to quit vaping but not in the near future and longer e-cigarette use may deter their intention to quit.
Leukaemic stem cells have heterogenous differentiation potential. The immunophenotypes of blast cells are usually consistent throughout the disease course even at relapse. Rarely, blast cells may undergo a ‘lineage switch’ during the course of disease especially during relapse. We would like to highlight such a case in a 10- year old boy who presented with a two weeks history of lethargy, poor appetite, low grade fever, respiratory distress, cardiac failure, generalized oedema and hepatosplenomegaly. Full blood count showed a leucocyte count of 41.5x10 9 /L and platelet count of 37x10 9 /L. The peripheral blood film showed presence of numerous blast cells. Bone marrow aspiration revealed a hypercellular marrow, which consisted of mainly blast cells with high nuclear to cytoplasmic ratio and inconspicuous nucleoli. Immunophenotyping and cytochemistry results were consistent with the diagnosis of Tcell acute lymphoblastic leukaemia. The patient achieved remission after treatment with UK ALL 97 protocol, regime B chemotherapy. However, he relapsed seven months after the initial diagnosis with 26% blast cells in the bone marrow aspirate. The majority was L1 blast cells admixed with some L2 blast cells. Immunophenotyping was consistent with common precursor B acute lymphoblastic leukaemia. The treatment was changed to a more lineage specific chemotherapy. Nonetheless, the patient never achieved remission and was planned for palliative management. This case illustrated a unique and rare case of rapid lineage switch from T-cell acute lymphoblastic leukaemia to common precursor B-cell acute lymphoblastic leukaemia.
Pregnancy induced hypertension (PIH) is commonly encountered in hypertensive disease in pregnancy (HDP) and important cause of feto-maternal morbidity and mortality. Abnormal changes of placenta development in PIH leads to abnormal elevation of second trimester maternal hCG level. Thus, it may have a role in prediction of PIH. The objective of this study was to evaluate the ability of serum hCG levels during early second trimester to predict PIH and obstetric outcome at later gestation. We conducted a cohort study which comprised 34 pregnant women varying from 14–20 weeks of gestation with serum hCG level taken at points of recruitment. Serum hCG was measured by a chemiluminescent immunoassay. Three (8.8%) pregnant women developed late onset PIH while the remainder were normotensive. The diagnostic performance of second trimester hCG in predicting PIH as assessed by receiver operator characteristic curve was poor (AUC = 0.398). Multiple of median (MoM) were used to improve the hCG performance and MoM of >2 MoM were considered as elevated hCG level. All pregnancies with PIH had 0.655). There was no significant association of hCG level and pregnancy outcome. In conclusion, estimation of second trimester hCG is a poor predictive marker for PIH. These findings are limited by the less number of hypertensive cases
Overweight and obesity have become a global concern and estimated with more than 1.9 billion adults worldwide were overweight and more than 650 million were obese in 2016. Nurses in Malaysia were no exception to overweight and obesity. This research was conducted with the aim to identify the prevalence of overweight among nurses on shift duty in a teaching hospital and to understand the relationship between abnormal eating behavior and body mass index. A total of 280 respondents participated in this research and Dutch Eating Behavior Questionnaire was used. Body Mass Index (BMI) score was categorized according to Clinical Practice Guidelines 2004. Results showed that 68.5% of the nurses were either overweight (37.1%) or obese (31.4%). The nurses’ BMI does not showed any association with socio-demographic data except age (r=0.156). As age increases, the nurses’ BMI also increase. This research also showed that there was no association between emotional and external eating behavior to BMI. However, there was a statistically significant differences in BMI for restraint eating (F=6.056, p=0.003). In conclusion, restraint eating behavior was the most practiced form of eating behavior in an attempt to achieve the ideal body weight but unfortunately lead to overweight among the nurses. Overweight or obese nurses will have a negative impression to the society and even reduce their confidence towards nurses’ health education. Overweight or obesity also ruined the nurses’ working performance and quality of care for patients. This issue requires immediate action and interventions to promote healthy lifestyles and eating habits among nurses should be conducted in the hospital.
Levonorgestrel (LNG) is a well-known safe and efficacious emergency contraception (EC). However, ectopic pregnancy following the failure of LNG-only EC has been reported. The exact incidence of ectopic pregnancy has been hindered by lack of data due to the fact that LNG-only EC is accessible at pharmacies without a prescription. We describe a case of ectopic pregnancy in an 18 year-old single woman who took LNG-only EC within 48 hours of unprotected sexual intercourse. She presented to the emergency department at 8 weeks period of amenorrhoea with an acute abdomen and hypovolaemic shock. Laparotomy confirmed a ruptured right tubal pregnancy and salpingectomy was performed. The patient was discharged well after 2 days. We aim to highlight this potential adverse effect and to discuss the plausible causality of ectopic pregnancy following administration of LNG-only EC.
Centrifugation of blood samples to produce platelet-poor plasma is one of the important steps for coagulation testing. Reduction of the time required for specimen processing without affecting quality of results should be ideal for tests which require immediate results. Centrifugation of platelet-poor plasma (3580 rpm) for 15 minutes performed for routine coagulation tests would prolong the turn-around time for an urgent test (30 minutes). This study was done to determine the effect of reducing centrifugation time for routine coagulation tests in order to meet the turn-around time (TAT) for urgent tests. Seventy-nine blood samples sent for routine coagulation tests, were assayed for prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen level and platelet counts, using two different centrifugation speed for plasma preparation: centrifugation at 3580 rpm for 15 minutes and rapid centrifugation at 4000 rpm for five minutes. Paired sample t-test showed that there was a significant
difference in the platelet count between the two groups (p=0.001). However, there was no significant difference in the normal APTT (p=0.16), abnormal APTT (p=0.80), abnormal PT (p=0.43) and the results of fibrinogen levels (p=0.36). In conclusion, rapid centrifugation at 4000 rpm for five minutes does not modify results of routine coagulation tests (PT, APTT and fibrinogen). It would be beneficial in providing rapid results for urgent coagulation tests.
Objektif kajian ialah untuk menentukan kesan program latihan papan Wobble ke atas daya keseimbangan para atlet yang mengalami ketakstabilan fungsi pergelangan kaki (FAI). Sebanyak 30 subjek (n=30) yang mengalami FAI direkrut berdasarkan kriteria rangkuman dan eksklusi. Kesemua subjek dinilai daya keseimbangan menggunakan ujian dirian anggota tunggal (single limb stance) dan ujian jangkauan fungsi dan didedahkan kepada program latihan papan Wobble sebanyak lima sesi seminggu selama empat minggu. Ujian t berpasangan digunakan untuk membandingkan min data pra dan post-ujian dan aras signifikan ditetapkan pada nilai 0.05. Pada ujian dirian anggota tunggal, para atlet mendapat min skor postlatihan yang tinggi [26.4] berbanding pra-latihan. Perbezaan disahkan dengan nilai ‘t’ yang diperolehi [16.00]. Bagi ujian jangkauan fungsi, para atlet memperolehi min skor post-latihan yang tinggi [15.88] berbanding pra-latihan [1.26]. Perbezaan disahkan dengan nilai ‘t’ yang diperolehi [12.54]. Ini menunjukkan bahawa latihan papan Wobble meningkatkan keseimbangan dinamik dan statik para atlet yang mengalami FAI. Secara kesimpulannya, latihan papan Wobble mungkin efektif dalam meningkatkan keseimbangan para atlet yang mengalami FAI.
Home Care Nursing Program (HCNP) at HUKM was started in 1998 and evaluation of the program was required. The objective of this study is to evaluate the effectiveness of HCNP on stroke rehabilitation at HUKM. A retrospective study using a matched pair design involving 69 stroke patients admitted to HUKM from August 1998 to December 2000 was carried out. The participants of this study were the HCNP group (n=35), and Non- HCNP (n=34). The matching was based on five criteria; age, sex, race, data of admission and severity of disability. The HCNP group was identified through data at the HCNP unit and their medical reports were traced. For the Non-HCNP group, the participants were identified based on criteria which were similar to that of the HCNP group. Based on the criteria identified, there was no significant difference between the two groups. The Activities of Daily Living was measured using the Modified Barthel Index twice; once on admission (based on record) and one post stroke. The t-test was applied to parametric data and non-parametric data; Chi-square was used to detect any significant relationships between the scores of the two groups. Results showed no significant difference (p=0.1990) in ADL on admission and ADL post stroke patients between the two groups. However, there were significant difference (HCNP p=0.000 and Non-HCNP p=0.000) in ADL on admission and post stroke for stroke patients who sought alternative treatment compared to those who had not.
The popularity of ultrasound for acute diagnosis of fractures in the Emergency Department (ED) has increased over the recent years. This present study aimed to determine the sensitivity and specificity of ultrasound use for detection of fractures in a different environment, which is at the triage area of the ED. We compared the results of bedside ultrasound in detecting non-critical fractures to the current gold standard of X-rays in the triage area. The design was a single centered crosssectional study. From August 2014 till November 2014, a total of 46 patients were recruited, creating 75 image pairs. Following consent, a bedside ultrasound was performed and subsequently compared with X-ray reporting regarding the presence or absence of fractures. SPSS analysis was used to determine the sensitivity and specificity of ultrasound in diagnosing fracture as compared to X-rays. Ultrasound had a sensitivity of 72% (95% CI, 50.6% - 87.9%) and a specificity of 80% (95%CI: 66.3 - 90%) when compared to X-rays in fracture diagnosis. The kappa analyses showed moderate inter observer agreement (0.5) between ultrasound and X-rays in diagnosing fractures. This study suggests that the use of ultrasound as a triage tool yet has unacceptable sensitivity and needs further evaluation and consideration.
Peningkatan ekspresi dan aktiviti enzim 11β-hidroksisteroid dehidrogenase jenis
1 (11β-HSD1) di dalam sel adiposit matang menyebabkan obesiti dan sindrom
metabolik. Fruktos dalam air minuman telah terbukti boleh menyebabkan sindrom
metabolik pada tikus Wistar jantan. Oleh itu, kajian ini dilakukan untuk melihat
kesan ke atas ekspresi dan aktiviti enzim 11β-HSD1 di dalam hati model tikus
sindrom metabolik yang dirangsang dengan air minuman fruktos. Sebanyak 12 ekor
tikus Wistar jantan dibahagikan secara rawak kepada dua kumpulan: kumpulan
kawalan, C (n=6) dan kumpulan yang diberi minuman fruktos 20%, F20 (n=6).
Pemberian makanan dan air minuman selama lapan minggu secara ad libitum. Di
akhir kajian, pengukuran ekspresi enzim 11β-HSD1 di dalam hati dilakukan dengan
menggunakan teknik pewarnaan imunohistokimia. Skor diberikan berdasarkan
intensiti pewarnaan granul di dalam sitoplasma hepatosit menggunakan teknik
‘double-blinded’. Manakala, aktiviti enzim 11β-HSD1 diukur menggunakan teknik
ELISA. Selepas lapan minggu pengambilan air minuman fruktos, kumpulan F20
menunjukkan peningkatan dalam ekspresi dan aktiviti enzim 11β-HSD1 di dalam
hati. Data yang diperolehi menunjukkan bahawa enzim 11β-HSD1 di dalam
hati mungkin memainkan peranan dalam pembentukan sindrom metabolik dan
komplikasinya pada tikus Wistar jantan.
Micro computed tomography (micro-CT) imaging is a useful tool to monitor fracture
healing in osteoporosis model. It creates a 3-D image of the fracture callus which can
be analysed to assess bone parameters quantitatively. In this study, micro-CT was
used to assess the fracture healing of orchidectomised rats, an androgen-deficient
osteoporosis model. The effects of Eurycoma longifolia, a medicinal plant with proandrogenic
effects, on fracture healing were assessed. The rats were grouped into
orchidectomised-control (ORX), sham-operated (SHAM), orchidectomised and
injected with testosterone intramuscularly once weekly (TEN) and orchidectomised
and daily oral gavage of Eurycoma longifolia (EL). Treatment duration was six
weeks following bone fracture. Fracture was induced in the right tibia of all the
rats. A total of 100 axial slices above and below fracture line were scanned with
a micro-CT. The micro-CT analysis was able to detect significant difference in the
fracture healing rate of ORX and TEN groups. The bridging cortices and fraction
of mineralized tissue of the bridging cortices of the callous of ORX group was
significantly lower than TEN group. No significant micro-CT changes were seen
in the fracture healing of the EL group. The effect of EL on fracture healing was not
demonstrable in orchidectomised rat model.