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Hand Grip Strength and Myocardial Oxygen Consumption Index among Coronary Artery Bypass Grafting Patients

Sokran SN, Mohan V, Kamaruddin K, Sulaiman MD, Awang Y, Othman IR, et al.

Iran J Med Sci, 2015 Jul;40(4):335-40.
PMID: 26170520

Hand grip strength (HGS) is a reliable indicator of peripheral muscle strength. Although, numerous studies have investigated the strength of hand grip; little attention has been given to coronary artery disease (CAD) patients, exploring the relationship between HGS and myocardial oxygen consumption (MVO2) index. The current study aimed to evaluate the interaction between HGS and MVO2 index findings before and after cardiac surgery.
Tilt table practice improved ventilation in a patient with prolonged artificial ventilation support in intensive care unit

Hashim AM, Joseph LH, Embong J, Kasim Z, Mohan V

Iran J Med Sci, 2012 Mar;37(1):54-7.
PMID: 23115431

Patients who are on prolonged ventilator support in critical care unit present wide variety of complications, which range from reduction in oxygen uptake to various musculoskeletal impairments. Early mobilization and rehabilitation are encouraged to manage these complications effectively. Use of tilt table to motivate early mobilization in the intensive care unit for ventilator practices is not a usual practice. However, this new technique has attracted involvements of clinicians and therapists for its therapeutic benefits to the patient. Herein we describe a case of a seventy eight-year-old male patient who suffered Motor car accident, and was on ventilator support in intensive care unit for more than one month. He underwent treatment using a tilt table protocol with other routine treatment, which benefited him based on clinical as well as physiological variables. For practitioners in intensive care units, this report may offer perceptivity into the alternate practice of early mobilization using tilt table, and for investigators it may promote interest for further studies.
Fulltext Histological changes in the fracture callus following the administration of water extract of piper sarmentosum (daun kadok) in estrogen-deficient rats

Estai MA, Soelaiman IN, Shuid AN, Das S, Ali AM, Suhaimi FH

Iran J Med Sci, 2011 Dec;36(4):281-8.
PMID: 23115413

BACKGROUND: The fracture healing is impaired in osteoporosis. Piper sarmentosum is a plant, which contains potent antioxidant, naringenin that may enhance fracture healing. The present histological study aimed to determine the effects of water extract of Piper sarmentosum on the late phase of fracture healing in estrogen-deficient rats.
METHODS: Twenty four female Sprague-Dawley rats (200-250 gm) were obtained. Six rats underwent sham operation and the rest were ovariectomized. Six weeks post-ovariectomy all the rats were fractured at the mid-diaphysis of the right femur and a K-wire was inserted for internal fixation. The sham group was given vehicle (normal saline) and the ovariectomized group was randomly subdivided into three groups: (i) ovariectomized-control group supplemented with vehicle; (ii) ovariectomized+estrogen replacement therapy group treated with estrogen (100 µg/kg/day) and (iii) ovariectomized+Piper sarmentosum group treated with Piper sarmentosum water extract (125 mg/kg). Following six weeks of treatment, the rats were sacrificed and the right femora were harvested for histological assessment of fracture callus.
RESULTS: The ovariectomized-control group showed a significant delay in fracture healing compared to the sham, ovariectomized-estrogen replacement therapy and ovariectomized-Piper sarmentosum groups. The median callus score for the ovariectomized-Piper sarmentosum group was 4.50 (range, 4-5), which was significantly higher than the median callus score 3.50 (range, 3-4) for the ovariectomized-control group (P=0.019). However, there was no significant (P>0.05) difference in the callus score among the sham, ovariectomized-estrogen replacement therapy and ovariectomized-Piper sarmentosum groups groups.
CONCLUSION: Treatment with water extract of Piper sarmentosum proved beneficial in the fracture healing in estrogen-deficient rats.
KEYWORDS: Antioxidant; callus; fracture healing; histology; osteoporosis; ovariectomy
Fulltext Glycemic control among pregnant diabetic women on insulin who fasted during ramadan

Ismail NA, Olaide Raji H, Abd Wahab N, Mustafa N, Kamaruddin NA, Abdul Jamil M

Iran J Med Sci, 2011 Dec;36(4):254-9.
PMID: 23115409

BACKGROUND: Ramadan fasting for pregnant women with diabetes remains controversial and underreported. The objective of this study was to determine the glycemic control in pregnant diabetic women on insulin who fasted during Ramadan.
METHODS: This was a retrospective study carried out over a period of three years including pregnant diabetic women, who were on short-acting, intermediate-acting, or a combination of them, and opted to carry out Ramadan fasting. Glycemic control was assessed before, middle and after Ramadan fasting.
RESULTS: Thirty seven women opted to fast with 24 (64.9%) of them had type 2 diabetes mellitus and 83.8% of them required combined insulin (short- acting, intermediate-acting) therapy. The age of the participants was 32.13±4.68 years, and the age of their pregnancies was 25.60±7.12 weeks when the study was performed. The median number of days fasted was 25 days, and most of the women were able to fast for more than 15 days. There was no difference between glycemic control of type 2 diabetes mellitus and gestational diabetes mellitus women prior to fasting. In the middle of Ramadan, serum fructosamine decreased in both groups. However, only serum HbA1c reduced in gestational diabetes mellitus after Ramadan.
CONCLUSION: the findings indicate that pregnant diabetic women on insulin were able to fast during Ramadan and that their glycemic control was improved during fasting period. They may also suggest that instead of absolute ban on fasting for pregnant diabetic women more practical approach and close consultation with health care providers might be more helpful.
KEYWORDS: Fasting; diabetes; gestational diabetes; insulin; pregnancy
Bedside teaching in undergraduate medical education: issues, strategies, and new models for better preparation of new generation doctors

Salam A, Siraj HH, Mohamad N, Das S, Rabeya Y

Iran J Med Sci, 2011 Mar;36(1):1-6.
PMID: 23365470

Bedside teaching is a vital component of medical education. It is applicable to any situation where teaching is imparted in the presence of patients. In teaching in the patients' presence, learners have the opportunities to use all of their senses and learn the humanistic aspect of medicine such as role modeling, which is vital but difficult to communicate in words. Unfortunately, bedside teaching has been on the decline. To investigate the reasons for the decline in bedside teaching, its importance and its revival, a review of literature was carried out using PubMed and other data bases. The review revealed that the major concerns of bedside teaching were time constraint, false preceptors' concern about patients' comfort, short stay of patients in hospitals, learner distraction by technology, lack of experience and unrealistic faculty expectation. Whatsoever the reasons, bedside teaching cannot be replaced with anything else. There are newer approaches of effective bedside teaching, and the core focus of all such approaches is educational process. A bedside teacher must learn how to involve patients and learners in the educational processes. Moreover, bedside teaching is the process through which learners acquire the skills of communication by asking patients' permission, establishing ground rules, setting time limit, introducing the team, diagnosing learner, diagnosing patient, conducting focused teaching, using simple language, asking patient if there is any question, closing with encouraging thanks, and giving feedback privately. It is most important to ensure a comfortable environment for all participants, the learner, the patient and the bedside teacher. Ongoing faculty development programs on educational processes and realistic faculty expectations may overcome the problems.
Optimization of the Static Human Osteoblast/Osteoclast Co-culture System

Jolly JJ, Chin KY, Farhana MFN, Alias E, Chua KH, Hasan WNW, et al.

Iran J Med Sci, 2018 Mar;43(2):208-213.
PMID: 29749990

Osteoblasts (OBs) and osteoclasts (OCs) are 2 major groups of bone cells. Their cell-to-cell interactions are important to ensure the continuity of the bone-remodeling process. Therefore, the present study was carried out to optimize an OB/OC co-culture system utilizing the human OB cell line hFOB 1.19 and OCs extracted from peripheral blood mononuclear cells (PBMNCs). It was a 2-step procedure, involving the optimization of the OB culture and the co-culture of the OBs with PBMNCs at an optimum ratio. Firstly, pre-OBs were cultured to 90% confluency and the time required for differentiation was determined. OB differentiation was determined using the van Gieson staining to detect the presence of collagen and Alizarin Red for calcium. Secondly, OBs and OCs were co-cultured at the ratios of 1 OC: 1 OB, 1 OC: 4 OBs, 2 OCs: 1 OB, and 1 OC: 2 OBs. Tartrate-resistant acid phosphatase (TRAP) staining was used to detect the differentiation of the OCs. The results showed that collagen was present on day 1, whereas calcium was detected as early as day 3. Based on the result of TRAP staining, 1 OC: 2 OBs was taken as the most appropriate ratio. No macrophage colony-stimulating factor and receptor activator of the nuclear factor-κB ligand were added because they were provided by the OBs. In conclusion, these optimization processes are vital as they ensure the exact time point and ratio of the OB/OC co-culture in order to produce a reliable and reproducible co-culture system.
Anxiety and depression in patients with coronary heart disease: a study in a tertiary hospital

Eng HS, Yean LC, Das S, Letchmi S, Yee KS, Bakar RA, et al.

Iran J Med Sci, 2011 Sep;36(3):201-6.
PMID: 23358115

Anxiety and depression could reduce the quality of life, and exacerbate physical symptoms and even mortality amongst patients with coronary heart disease (CHD). The aim of this study was to investigate the incidence of anxiety and depression in patients with acute CHD. In a period from March to December 2008, the views of 108 CHD patients, hospitalized in a tertiary hospital, were solicited using Hospital Anxiety and Depression Scale (HADS) and sociodemographic questionnaires. Patients with CHD had a low level anxiety and depression scores. There was significant differences in the total HADS score of participants stratified for marital status (P=0.027) or co-morbidity of diseases (P=0.012). Also, there were significant differences in the scores of depression subscale stratified for marital status (P=0.021) or co-morbidity of disease (P=0.007). However, there was no significant difference between the total HADS score or depression subscale score of the participants stratified based on age, gender, race, education, or income. Moreover, unmarried CHD respondents possessed higher depression level compared to the married respondents, and CHD respondents with co-morbid diseases showed a high level of depression. The findings might be taken as evidence to suggest that CHD patients should be evaluated early for the detection of anxiety and depression for appropriate referral and support.
The effects of piper sarmentosum water extract on the expression and activity of 11β-hydroxysteroid dehydrogenase type 1 in the bones with excessive glucocorticoids

Suhana Mohd Ramli E, Nirwana Soelaiman I, Othman F, Ahmad F, Nazrun Shuib A, Mohamed N, et al.

Iran J Med Sci, 2012 Mar;37(1):39-46.
PMID: 23115429

BACKGROUND: Long-term glucocorticoid therapy causes secondary osteoporosis leading to pathological fractures. Glucocorticoid action in bone is dependant upon the activity of 11β-hydroxysteroid dehydrogenase type 1 enzyme (11β-HSD1). Piper sarmentosum is a local herb that possesses the ability to inhibit 11-βHSD1 enzyme activity. We aimed to determine the effects of Piper sarmentosum water extract on 11-βHSD1 expressions and activity in the bones of glucocorticoid-treated adrenalectomized rats.
METHODS: Forty male Sprague-Dawley rats (200-250 g) were used. Twenty-four animals were adrenalectomized and received intramuscular injection of dexamethasone (120 μg/kg/day). They were simultaneously administered with either Piper sarmentosum water extract (125 mg/kg/day), GCA (120 mg/kg/day) or distilled water as vehicle by oral gavage for two months. Eight animals were sham-operated and given vehicle daily, i.e. intramuscular olive oil and oral distilled water.
RESULTS: Following two months treatment, dexamethasone-treated adrenalectomized rats had significantly lower 11β-HSD1 dehydrogenase activity and higher 11β-HSD1 expression in the femoral bones compared to the sham-operated and baseline group. The rats supplemented with Piper sarmentosum water extract had significantly higher 11β-HSD1 dehydrogenase activity and lower 11β-HSD1 expression in the bones.
CONCLUSION: The results showed that Piper sarmentosum water extract had the ability to prevent glucocorcoticoid excess in the bones of glucocorticoid-treated adrenalectomized rats through the local modulation of 11β-HSD1 expression and activity, and may be used as prophylaxis for osteoporosis in patients on long-term glucocorticoid treatment.
Parapharyngeal Schwannoma Masquerading as Lymphangioma

Kai Jun T, Suhana AR, Avatar Singh MS, Kadar Shiraz Qamil MA, Mawaddah A

Iran J Med Sci, 2020 Jul;45(4):316-317.
PMID: 32801423 DOI: 10.30476/ijms.2020.81956.0
Fulltext Disappearance of Imported Cases of Omicron Lineage BA.2.40 in West Kalimantan, Indonesia

Liana DF, Novianry V, Andriani A, Mahyarudin M, Astuti P

Iran J Med Sci, 2024 Mar;49(3):176-185.
PMID: 38584647 DOI: 10.30476/ijms.2023.97513.2935

BACKGROUND: The World Health Organization has declared Omicron as the fifth variant of concern with more than 50 mutations, particularly in the spike protein. Given increased viral infectivity due to mutations, worldwide genomic surveillance and detection of severe acute respiratory syndrome 2 (SARS-CoV-2) is essential. The present study aimed to track Omicron lineage BA.2.40 in West Kalimantan, Indonesia.
METHODS: In May-August 2022, nasopharyngeal swab samples (n=3,642) were collected from international travelers to West Kalimantan (active surveillance), and patients hospitalized due to SARS-CoV-2 infection (baseline surveillance). The samples were tested for Omicron lineages based on ORF1ab, N, and HV69-70del genes, followed by whole-genome sequencing. The sequences were then identified using two genomic databases, aligned against the reference genome (Wuhan/Hu-1/2019), and then compared with BA.2.40 lineage detected across the world. Phylogenetic analysis between the samples and other SARS-CoV-2 isolates was performed using molecular evolutionary genetics analysis software.
RESULTS: Based on the genomic databases, 10 isolates were identified as BA.2.40. All samples tested positive for the ORF1ab and N genes, but negative for the HV69-70del gene, which is a marker to detect the Omicron variant. Phylogenetic analysis showed the isolates were closely related to an isolate from Malaysia, an area dominated by BA.2.40.
CONCLUSION: Omicron lineage BA.2.40 has no HV69-70 deletion in the spike protein, a marker used to screen for the Omicron variant. BA.2.40 showed a high similarity to an isolate from Malaysia and was detected only during certain periods, indicating the effect of internationally imported cases.