Polypoidal choroidal vasculopathy (PCV) is a retinal disorder characterized
by aneurismal polypoidal lesions in choroidal vasculature. PCV appears to
preferentially affect pigmented individuals and is considerably high among Asians.
Most reports on patterns of PCV around Asia are based on a homogenous race
(e.g. Chinese, Japanese) and very few descriptions from a multiracial population
like those seen in Malaysia. The present study aimed to describe the demographic
features, clinical and investigative characteristics of PCV in a multiracial group at
Universiti Kebangsaaan Malaysia Medical Centre (UKMMC). Ninety one eyes of 86
PCV patients, comprising of Chinese (65.1%), Malays (31.4%), Indians (2.3%) and
Eurasian (1.2%) were retrospectively reviewed. All underwent complete ophthalmic
examination and investigations. Mean patient age was 70.4 years with a male
preponderance (59.3%), and mostly unilateral presentation (94.1%). The logMAR
mean presenting visual acuity was 0.78 ± 0.64. Polypoidal vascular lesions were
located generally within the macula area (86.8%), manifesting mainly as submacular
hemorrhage (59.3%). Interestingly a number of eyes (43.9%) had associated drusen.
Optical coherence tomography largely demonstrated exudative changes (75.9%)
and almost all patients (97.7%) had loss of external limiting membrane (ELM) and
IS/OS interface. On indocyanine green angiography, majority of eyes had multiple
polyps (82.4%) with ‘cluster’ (58.2%) being the commonest configuration. In
conclusion, although the patterns of PCV in UKMMC were mainly similar to other
Asian patients, a number of our patients had associated drusen. This indicates
that PCV in our population could be a variant of neovascular age related macular
degeneration and not solely idiopathic in nature.
The uses of Complementary and Alternative Medicine (CAM) among patients with chronic diseases are becoming increasingly popular. This was a descriptive cross-sectional study conducted in 45 government health clinics across Negeri Sembilan. Respondents at diabetes clinics were selected via systematic random sampling and interviewed using structured questionnaire. CAM usage was divided into three groups; CAM use for diabetes (CAM-DM), CAM use for general health (CAM-G) and Non CAM user. The prevalent use of CAM among type II diabetes mellitus patients in Negeri Sembilan was 58.5% (CAM-DM: 40.6% and CAM-G: 17.9%). For CAM-DM group, bitter gourd (Momordica charantia) was the most popular CAM consumed to help control diabetes, while supplement milk was the most popular choice for the CAM-G group. In conclusion, the use of CAM among type II diabetes mellitus patients in Negeri Sembilan was common. Natural products are the main choice of CAM modality used to help with the management of diabetes. Majority of CAM users never informed their healthcare providers about their CAM use.
The occurrence of severe lead (Pb) poisoning has risen in certain countries.
There is increasing evidence that chronic lead exposure disturbs the prooxidant:
antioxidant balance in the brain tissue and alters brain histology. The present
study observed the antioxidant effect of tocotrienol-rich fraction (TRF) on brain
tissues of the experimental rats following lead poisoning. Eighteen (n=18) male
Sprague-Dawley rats, 6-weeks old, were randomly divided into control (CTRL)
group and experimental groups; fed with 0.2% w/v lead acetate, as PB2 group;
and fed with 0.2% w/v lead acetate and daily TRF supplementation (200 mg/kg
body weight) as PB2T group. The experiment was conducted for 30 days. At the
end of the study, the brain tissues were harvested and histopathological changes of
the hippocampal region were observed. Biochemical findings such as brain lead,
TRF and malondialdehyde (MDA) levels, and erythrocyte superoxide dismutase
(SOD) activity were determined. It was observed that atypical apoptotic-like and
disorganized neurons were present in the hippocampal region of the untreated
PB2 group compared to PB2T group. Biochemical parameters showed a significant
decrease (p < 0.05) in brain lead level in PB2T compared to PB. Even though no
significant difference (p > 0.05) was obtained for MDA level, there was a significant
increase (p < 0.05) in the erythrocyte SOD activity in PB2T compared to PB2 and
CTRL. Supplementation with TRF improved histopathological changes in the brain
tissues caused by lead exposure in drinking water by reducing lead accumulation
in the brain of experimental rats.
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.
Bone histomorphometric measurements are required to understand the efficacy
of treatment on bone remodelling. Previous studies used the Weibel technique
as a quantitative stereological method to determine bone cellular and dynamic
changes. However, there was no description on how this technique was applied.
This studyaimed to provide a full picture about the utilization of the Weibel
technique to measure static and dynamic bone histomorphometric indices.
Technical expertise, processing of bone samples, randomization of the trabecular
sections and an adequate number of analysed images for each section are required to achieve reliable results with a low possibility of errors.
Mutation is known to occur before the development of various types of cancers.
Mutation in p53 gene can be found in human breast cancer. The aim of the present
study was to determine the correlation between p53 protein expressions with women in premenopausal age. A total of 111 breast cancer tissues were examined for p53
protein expression by IHC. The results showed that majority (36.9%; n=41/111)
who were more than 41 yrs, overexpressed positive p53 (+) protein category and
2.7% (n=3/111) aged 41 yrs and less, showed less positive p53 (+) protein category.
However, the Fishers exact test, indicated that, there was no significant correlation
between participant’s age group with p53 protein category (χ2
(1) = 0.78; p =0.52)
and no correlation strength was indicated (Cramer’s V coefficient = 0.08; p
=0.37), respectively. The risk estimate showed probability of p53 (+) protein being
overexpressed in the age group < 41 yrs was 0.66 times less likely compared to the
age group > 41 yrs. In conclusion, with or without overexpression of p53 protein,
women above 41 yrs were found to have greater risk.
Conventional argon laser causes transient thickening of retinal nerve fibre layer (RNFL). The effect of pattern scanning laser (PASCAL) has not been well described. We compared the immediate changes in peripapillary RNFL thickness post-panretinal photocoagulation between conventional argon lasers and PASCAL in patients with diabetic retinopathy changes. A total of 32 subjects were recruited. There were 16 patients in the argon group and 16 patients in PASCAL group. Diabetic patients were recruited from Ophthalmology Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Complete eye examinations and fundus photographs were performed at baseline prior to laser treatment, and post-laser treatment at two and four months. RNFL thickness was measured using time domain optical coherence tomography. Both groups were comparable with respect to clinical characteristics and demographics. There was no significant difference in average RNFL thickness between the two groups prior to treatment (p= 0.323). RNFL post-laser treatment for patients receiving conventional argon laser remained unchanged with no significant differences in all quadrants at any time-point (two and four months). However, for the PASCAL group, significant thickening occurred at four months for average RNFL and the inferior quadrant (p <0.05). The other quadrants similarly demonstrated increasing thickness at four months but this did not reach statistical significance. Transient RNFL thickening occurs in both conventional and PASCAL laser patients. The PASCAL laser induces a greater increase in RNFL thickness than the argon laser group. Important events, such as laser eye treatments and even type of laser used, are worthy of consideration when evaluating RNFL.
Keywords: diabetic retinopathy, optical coherence, photocoagulation, retinal ganglion cells, tomography
Study site: Ophthalmology Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
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
Peripheral Intravenous Catheters (PIC) are widely used. Nurses are required to possess appropriate knowledge and practice. The present study aimed to determine nurses' knowledge and practice towards care of PIC. A cross-sectional descriptive study was conducted and 84 respondents participated in the study. A 26-item questionnaire comprising 11 items on knowledge and 15 items related to nursing practice was adapted and modified. The findings reported higher mean score from specialty unit respondents, with knowledge (M = 49.19, SD = 3.44) and practice (M = 66.38, SD = 5.15), compared to medical surgical wards with knowledge (M = 46.25, SD = 4.68) and practice (M = 63.17, SD = 4.63) towards the care of PIC, which was significant (p value = 0.010 and p value = 0.009, respectively). The study indicated a higher mean score of charge nurse respondents as compared with registered nurse with knowledge (M = 49.68, SD = 3.23); (M = 46.20, SD = 4.62) and practice (M = 67.11, SD = 4.84); (M = 63.06, SD = 4.61), which was significant (p value = 0.003 and p value = 0.001, respectively). There were no significant differences between respondents’ education qualification towards care of PIC with p > 0.05. However, the findings reported that respondents who possessed Bachelor of Nursing were deemed to score slightly higher in their knowledge and practice towards the care of PIC. In conclusion, the specialty unit and charge nurse respondents were deemed to possess better knowledge and practice towards the care of PIC in the hospital.
Fifth metatarsal bone fracture is one of the most commonest fractures of the foot.
The decision for surgical or conservative approach is still inconclusive. Scoring
system, decision analysis model and classification system are established to weigh
between surgical and conservation approaches. Its unique anatomy and surgical
complication influence decision on optimal surgical approach. Therefore, the
present review attempts to look at factors that might influence decision making in
management of fifth metatarsal fracture.
Medication wastage poses a financial burden on the nation’s economy, as well as, environmental implications associated with wastage disposal. This study was conducted in a public hospital in Brunei and aimed to measure the extent of medication wastage and its disposal. This cross-sectional study used a self-designed questionnaire for patients attending outpatient pharmacy at the Suri Seri Begawan (SSB) hospital in which 253 patients participated over a period of two weeks. Exclusion criteria were: i) patients below 18 yrs, ii) patients visiting the Accident and Emergency Department and iii) patients admitted to the hospital. Majority of the participants were reported to have unused medication at home (75.1%, n=189). Nearly half (54.2%) had unused medicines and this was due to improvements in their medical conditions. Most of the participants (70.8%) were not given necessary advice on how to dispose their medicines in a proper manner. Majority disposed their unused medicines in the household garbage (70%), despite 50.2% (n=189) knowing that disposing of medicines in the garbage can cause detrimental effects on the environment. It was found that 47.7% of the participants would return their unused medicines back to the pharmacy, but in practice, only 18.6% did such. There was no significant association between knowing detrimental effects of medicine on
the environment and returning their medicines to the pharmacy (p=0.065). Results showed that medication wastage exists in SSB hospital and patients’ knowledge and
practices on its proper disposal was relatively poor. Health policy makers should be informed to implement wastage reduction strategies.
The Hypoglycaemia Symptom Rating Questionnaire (HypoSRQ) is potentially
useful for local research on hypoglycaemia. However, it requires adaptation and
validation in local settings. This study reports the process and results of cross-cultural
adaptation and linguistic validation of HypoSRQ for Malay and English versions in
our local setting. The HypoSRQ underwent forward and backward translation and
adaptation with support from professional translators and a clinical psychologist.
Cognitive debriefing was done among patients with Type 1 and Type 2 diabetes
mellitus from varying sociodemographic backgrounds. Discussion was done
together with the original developers of the HypoSRQ to decide on the best version
for local use. The finalised versions were proofread and formatted with the help
of Health Psychology Research. Cognitive debriefing for Malay version involved 7
patients and for the English version5 patients. Direct literal translation into Malay
language was unsuitable due to technical terms which were difficult for laypersons
to understand. Amendments were made based on findings from the cognitive
debriefing process. Participants found the questionnaire fairly easy to understand.
The HypoSRQ-My (Malay) and HypoSRQ-EMy (English) is easily understood by
local participants. These tools may undergo psychometric evaluation for future
use in local settings.
A case of rapid stabilization using electroconvulsive therapy (ECT) for a major
depressive disordered (MDD) patient with life-threatening low body mass index
(BMI) is reported. This case report focuses on a 55-year-old Malay housewife with
underlying hyperthyroidism in a euthyroid state who presented with MDD with
mood congruent psychotic features, which were precipitated by the death of her
husband. Her BMI was only 11 kg/m2
due to severe anorexia, and she was highly
suicidal. Peripheral total parenteral nutrition was started and ECT was commenced
for rapid stabilization on top of tablet escitalopram 15 mg nocte. Full remission was achieved after nine ECTs and steady healthy weight gain was achieved throughout
admission. The patient was discharged at BMI of 13 kg/m2
with good appetite. ECT
was safe for very low BMI MDD patient.
Out-of-hospital cardiac arrest (OHCA) patients require immediate cardiopulmonary
resuscitation (CPR). Early initiation of CPR and defibrillation before arrival at
Emergency Department (ED) increases the chance of survival from sudden cardiac
arrest. The main objective of this study was to identify the factors that influenced
the outcome of early cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac
arrest (OHCA) patients managed at the ED of Universiti Kebangsaan Malaysia
Medical Centre (UKMMC). The second objective was to determine the incidence
of CPR initiated by the public prior to ambulance arrival. The present study was a
one-year cross-sectional study. The OHCA patients were identified from the ED
resuscitation logbook. Patients’ medical records were used to obtain details of the
resuscitation. Factors recorded included: aetiology of arrest, initiation of on-scene
CPR, use of automated external defibrillators (AEDs), mode of transportation and
the incidence of return of spontaneous circulation (ROSC) in the ED. Categorical
data was analysed using chi-square and Fisher exact tests. Nine patients out of 98
had early CPR. Three patients achieved ROSC. Gender was significantly associated
with ROSC (p-value=0.015). More patients who received early CPR achieved ROSC
compared to those who received late CPR. The provision of early CPR and usage
of AEDs by the public is still low. Female gender had a positive influence on ROSC.
Efforts are required to increase the awareness and involvement of the public in
initiating early CPR prior to the arrival of ambulance service.
Information technology use in healthcare education has become a popular
medium of instruction. One of the medium of instruction is video assisted learning
(VAL). The use of VAL as an instructional method in the teaching and learning of emergency skills is not new. However, there are lack of studies on the perception of
using this method in learning emergency skills. This qualitative study involved four
focused discussion groups following a VAL instruction on emergency skills. A total
of 20 paramedics were divided into four groups. They were involved in a focussed
discussion after a VAL instruction session. Findings reveal that the paramedics
perceived three major themes which were categorized as : i) advantages of video
as teaching tool, ii) barrier in using video as a teaching tool; and iii) suggestions on
using video as teaching tool. The findings indicate that the paramedics perceived
VAL as a potential tool for learning emergency skills. However, they suggested the
language of instruction should be in their mother tongue for better understanding.
This implies that using English language has disadvantage in technology enhanced
learning for better understanding.
In recent years, there is a growing enthusiasm in honey which has potential health benefits, disease prevention and serves as substitution of modern medicine. Honey is a natural sweet product which is produced by honey bees from floral nectar and has been traditionally used to treat several diseases such as cardiovascular disease, diabetes mellitus, cancer and Alzheimer’s disease since ancient times. Gelam honey (GH) is one of the Malaysian wild monofloral honey which is widely used as traditional medicine by the local population. GH is enriched with several therapeutic properties namely, antioxidative, antiinflammatory, anticancer and accelerated wound healing activities. However, there is lack of literature focusing on the overall effects of GH and its medicinal value. This review paper summarises the phytochemistry characteristics of GH along with its therapeutic values which lead to a broad spectrum idea on several diseases. A concise clarification on the therapeutic properties of GH is expected to provide new knowledge to the scientific society in the era of modern globalization.
Ankle injuries are commonly seen in various sports. The main aim of the present
review was to highlight the normal anatomy of the ankle, mechanism of injuries
related to sports, congenital abnormalities or anatomical variations related to
ankle injury and discuss its effective management. A review of literature was done
to determine the ankle injuries which occur as a result of various sports related
activities. We documented all sports which involved injury to the ankle joint. The
anatomy of various structures in the sole of foot and their involvement in injuries
were discussed at length. The anatomical knowledge of ankle injury may be
beneficial for future diagnosis and treatment purpose.
Traditional or herbal medications are generally perceived as safe since it is derived
from natural or plant sources. A rise in number of adverse reactions are being
reported with the use of traditional medications including localized cutaneous
reactions. The diagnosis of contact dermatitis is often quite straight forward
based on its appearance, pattern, site and distribution of the lesion which usually
corresponds to the area of contact. We report the case of a 65-year-old woman who
presented with redness, burning sensation and swelling of her hand after applying
topical Chinese traditional medication. This report aims to outline simple measures
to identify and manage contact dermatitis secondary to topical medication. The
present case creates awareness that topical traditional medications are not as harmless as previously thought to be. Precautions regarding adverse reactions are
required, as those with conventional medications.
Patient positioning is a vital in ensuring patient comfort, dignity and good access to
the operative site. Accurate positioning helps in minimising the risk of injury to the
patient. An in-house airbag made from recyclable medical supplies can be used
to replace the conventional sandbag for head and neck surgeries. It involves the
use of an empty irrigation bottle, a valve and suction tubing. Its shape and volume
is readily adjustable by altering the volume of inflated air. Moreover, compressible
air moulds the bag to the curvature of the patient’s external surface reducing the
risk of pressure sores in prolonged surgery. Ultimately this serves as an innovative technique which is financially savvy with the use of recyclable items.
Eosinophil-type nasal polyp (NP) is common in Western population. This aim of
this study was to determine the histology type of NP among different Malaysian
ethnic groups. A total of 122 chronic rhinosinusitis with nasal polyposis (CRSwNP)
patients were retrospectively enrolled and demographic data was recorded. The
histological slides were retrieved. The number of eosinophils and non-eosinophils
were counted and average number of inflammatory cells for each high power
field was calculated. Eosinophil-predominant was seen in 32.8% of patients and
67.2% was non-eosinophil-predominant. Phenotypes of NP significantly showed an association with ethnicity (x² = 8.322; p < 0.05). A total of 78.9% of Chinese
nasal polyps showed non-eosinophil predominant, while Malay and Indian nasal
polyps revealed 71.9% and 40.7% of non-eosinophilic phenotype, respectively.
Our study showed that Malaysian population had a non-eosinophilic phenotype
of nasal polyps. There was a significant association in Malaysian ethnicity with the
highest percentage in Chinese population.