IIUM Medical Journal Malaysia (IMJM)
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Plasma Cystatin C and Estimates of Glomerular Filtration Rate Using Cystatin C Independently Diagnose Acute Kidney Injury in Critically Ill Patients with Sepsis
Get PDFIntroduction: Plasma Cystatin C (CysC) is as an early functional marker for acute kidney injury. Estimates of glomerular filtration rate using CysC (eGFRCysC) has been used in some clinical setting. We evaluated the utility of CysC and eGFRCysC in diagnosing acute kidney injury (AKI) and predicting death in critically ill patients with sepsis. Materials and method: This is an interim analysis of single centre, prospective observational study of critically ill patients. Inclusion criteria were patients older than 18 years old with sepsis and procalcitonin > 0.5ng/ml. Plasma creatinine and CysC were measured on admission, and eGFRCysC. AKI was defined based on the plasma creatinine criteria of the KDIGO guideline. Results: Thirty one patients were recruited so far, of which 13 (41.9%) had AKI and six died. CysC were higher in patients with AKI versus No AKI (p<0.001), and corresponding eGFRCysC were lower (p=0.006). CysC and eGFRCysC on ICU admission diagnosed AKI with an AUC of 0.88(0.72 to 1.00), and 0.79 (0.62 to 0.96), respectively. Both did not predict death (AUC 0.59 (0.31 to 0.87) and 0.59 (0.31 to 0.86), respectively). After adjusting for age and SOFA score, both CysC and eGFRCysC independently diagnosed AKI (OR 13 (1.5 to 115) and 1.03 (1.01 to 1.06), respectively). The ideal cut-off point for diagnosing AKI for CysC is 1.5 mg/dl (84% sensitivity and 89% specificity) and for eGFRCysC as 77 ml/min (72% sensitivity and 84% specificity). Conclusion: Plasma CysC and its estimated GFR independently diagnosed AKI in critically ill patients with sepsis. We suggest the ideal cut-off points of 1.5 mg/dl and 77 ml/min which can be used in the clinical setting in this cohort of patients
Traumatic Pediatric Atlantoaxial Rotatory Dislocation Successfully Reduced with 1 Month Total of Halter Traction: A Case Report
Get PDFThe occurrence of atlantoaxial rotatory subluxation is fairly uncommon; however, it is more common to be encountered in the paediatric population, typically seen after a retropharyngeal inflammation or after a minor trauma. Ligamentous laxity, shallower and more horizontally oriented facet joints especially at the C1-2 joint making them prone to have atlantoaxial subluxation or dislocation. If recognized early it can be successfully managed non-surgically before chronic inflammatory changes affect the ligaments and joint structure of the C1-2 complex. However, there is no standard treatment protocol as some authors like Nael et al and Haliasos and Norris recommended more invasive Halo skull traction. Thus, we report this case managed with less invasive Halter traction with no risk of pin site infections. We present the case of a 12-year-old Malay boy with traumatic atlantoaxial dislocation who came to us after he slipped and fell, presented with neck pain and torticollis to the left side but without other neurological deficits. A computed-tomography (CT) scan revealed an atlantoaxial rotation of 47 to the left without any signs of osseous lesions. MRI was also done and all ligaments were intact. The neck was then reduced by cautious rotation with Halter traction with the cervical spine in the neutral position with slight flexion thus avoiding harm by potential posttraumatic disc lesions. The patient was put on Halter traction for a total of one month. Post-traction revealed full range of motion of the neck without any tenderness, head and neck alignment restored to neutral position. In the children population, atlantoaxial subluxation is a rare condition but is severe if left untreated. Early treatment implies a non-surgical approach and a good outcome is observed in our case as well as reported by other authors
Knowledge, Attitude and Practice towards Smoking among International Islamic University Malaysia Kuantan Communities
Get PDFSmoking is an issue that has spread around the world throughout the years. The majority of smokers have the intention to quit smoking, but due to some factors, it may prevent their intention. Research and interventions have been done in many countries to decrease the smoking prevalence. This cross-sectional study aimed to find out the associations of knowledge, attitude and practice (KAP) towards smoking and to identify the factors associated with knowledge and attitude towards smoking, in priority to sociodemographic factors among the International Islamic University Malaysia Kuantan (IIUMK) communities, including between students and workers. One hundred fifteen respondents of students and workers from IIUMK were investigated with a self-administered questionnaire starting from 10-01-2014 to 10-02-2014. The data were analysed using SPSS software. Respondents had good knowledge and practice, and moderate attitude towards smoking. There was weak positive correlation between knowledge with attitude (r=+0.193, p=0.038) and practice (r=+0.206, p=0.028), also moderate correlation between attitude and practice towards smoking (r=+0.626, p<0.001). There was no factor found to be associated with knowledge, but significant association was found between attitude towards smoking with gender (p<0.001), education level (p=0.016) and smoking status (p<0.001). Although, the mean values of KAP levels were higher for workers, but it was not statistically significant as compared to the students. These study findings suggested that the main obligation are more for students to improve their KAP level towards smoking as they are fresh generation who will educate and lead the upcoming generation of Malaysia
A Review of Gastrointestinal Stromal Tumours- A Single Centre Experience
Get PDFIntroduction: Gastrointestinal stromal tumour (GIST) is relatively rare. The clinical behaviour of GIST ranges from benign to frank sarcoma. The diagnosis is established through histopathological examination and immunohistochemistry profile. In Malaysia, the number of publications related to GIST is relatively rare. This study was therefore conducted to examine the demographic, histopathological and immunohistochemical features of GIST cases diagnosed in the Department of Pathology, Hospital Tengku Ampuan Afzan, Kuantan, Pahang from 2009 until 2014. Methods: Past histopathological records were reviewed. Demographic and histopathological and immunohistochemical data of patients diagnosed were collected. Results: There were 28 cases (14 males and 14 females) diagnosed as GIST. Mean age was 56.4 years, and the majority were above 40 years of age (85.7%). Stomach was the most common location (42.9%), followed by small intestine (28.6%). In 23 cases (82%), the tumours exhibited spindle cell morphology, while epithelioid cell and mixed cell types were seen in 3 cases (11%) and 2 cases (7%), respectively. Five cases were categorised as very low risk to low risk behaviour, while 18 cases were intermediate to high. None of the histological parameters analysed which include tumour morphology, necrosis, haemorrhage, nuclear atypia and mean number of mitoses showed significance difference between the different risk behaviour groups. Positivity with KIT (CD117), considered to be the defining immunohistochemistry feature, was negative in 2 cases. Conclusion: Although this study is a retrospective study, the findings contribute to the knowledge on GISTS in Malaysia. Future research related to GISTs in Malaysia should focus on molecular analyses for KIT and PDGFRA mutations for diagnostic confirmation especially in KIT-negative cases and also for the purpose of therapeutic response correlations
Dysphagia Lusoria: A Case Report
Get PDFAberrant right subclavian artery is a rare cause of dysphagia. This is a congenital anomaly with the right subclavian artery originating from the dorsal part of the aortic arch and coursing through the mediastinum between the esophagus and the vertebral column. We report a case of a patient with chronic dysphagia caused by this condition. We further discuss the case with regards to its clinical features and options of management
Development of the malay digit triplet test via headphones and telephones as a national hearing screening tool in Malaysia
Get PDFIntroduction: This study aimed to develop a self-administered hearing screening test using digit triplets in Malay (MDTT) to be used as a national hearing screening tool via internet and telephone landlines in Malaysia. Methods: Recordings of disyllabic Malay digits by a female Malay native speaker were used together with a speech shaped stationary noise (TSN). The test stimuli were normalized using responses from twenty normal hearing native Malay speakers. The data were used to produce eight equivalent test lists. An additional twenty normal hearing native Malay speakers were recruited to test the lists equivalency. Forty six listeners with varying levels of hearing were recruited to validate the tests. ROC analysis was done to identify the pass and refer cut-off limits. Results: No statistical differences were found between lists for both test conditions. The evaluation in fixed SNRs resulted in a mean speech reception threshold (SRT) of -11.3 ± 0.34 dB SNR for headphone and -10.24 ± 0.1 dB SNR for telephone applications. A significant main effect of type of transducer was observed in both normal and hearing impaired groups. The cut off for refer, sensitivity and specificity for the tests using telephones are (-5.8dB, 80.8%, 95%) and headphones (-9.8dB, 80.8%, 100%). Conclusions: The MDTT was successfully developed and the normative values are comparable to other versions of the digit triplet tests. The MDTT showed high sensitivity and specificity and can be made available to any Malay speaking public via telephone and internet
Distribution of Hepatitis C virus genotypes among chronic Hepatitis C patients in Kuantan Pahang
Get PDFIntroduction: Hepatitis C virus (HCV) has been classified into seven genotypes with more than 80 subtypes isolated worldwide. HCV genotypes are an important parameter in determining the right antiviral dosage, duration and monitoring the response of that treatment. The main aim of this study was to determine the distribution of HCV genotypes, their association with demographic variables and to investigate the presence of uncommon mixed-genotype infection case. Methods: This cross sectional study was performed in Hospital Tengku Ampuan Afzan, Kuantan, Pahang from January to July 2014. The sera samples from 40 HCV seropositive patients were analyzed using reversetranscription PCR (RT-PCR) and direct DNA sequencing assays. Results: More than half of study patients were from male patients (32/40; 80%), below the age of 45 (27/40; 67.5%) and Malays (34/40; 77.5%). Thirty one out 40 (77.5%) samples were successfully sequenced for genotyping with genotype 3 (24/31; 77.4%) predominate the study, followed by genotype 1 (6/31; 19.3%). There is no significant association established between the demographic factors and HCV genotypes. Majority of the HCV RNA positive samples were identified as mono genotype HCV infection. There was one isolate with mixed-genotype infection. Conclusions: The findings of the study showed that genotype 3 and 1 are still the commonest genotypes found among the study population. No association can be established from HCV genotypes and basic demographic factors. The finding of mixed HCV genotype infection from this study requires further investigation to evaluate the clinical role of this type of infection in treatment outcome
Correlation between schroeder-phase effect and electrocochleography findings
Get PDFIntroduction: In Schroeder-phase masking test, different auditory perception ability towards different phases of Schroeder masker is known as ‘phase effect’. Previously, the phase effect mechanism was proposed to be dominantly contributed by peripheral auditory function, mainly by outer hair cells. This study aims to investigate the possible involvement of central auditory function (i.e. auditory nerve) in the phase effect mechanism. Methods: Four normal hearing and four sensorineural hearing loss subjects were recruited. Schroeder-phase masking test was conducted at 500 Hz, 1 kHz, and 2 kHz (75 dB A), and phase effect was recorded. Electrocochleography (ECochG) test via tip-trode recording using 90 dBnHL tone burst at 500 Hz, 1 kHz, and 2 kHz was also conducted on the same subjects. The amplitude of three ECochG components; i) cochlear microphonic (CM) - arises from outer hair cells, ii) summating potential (SP) - arises from inner hair cells, and iii) action potential (AP)- arises from auditory nerve; were recorded. Pearson and Spearman analysis were performed to find correlation between phase effect and individual ECochG components’ amplitude. Results: Result showed no significant correlation between phase effect and all ECochG components’ amplitude at all tested frequencies with exception at 2 kHz. A significant strong correlation (p: 0.02; r: 0.81) between phase effect and action potential’s amplitude at 2 kHz was observed. Conclusions: This finding suggests that central auditory function (i.e. auditory nerve) is possibly involved in the phase effect mechanism. This finding gives new insight towards better understanding of auditory perception
Quantitative evaluation of medium filth (najs mutawassitah) in halalan toyyibah food
Get PDFIntroduction: This study was conducted to evaluate the quantity of medium filth (najs mutawassitah) and the growth rate of faecal borne bacteria in self prepared fried rice toward the standardization of ‘halalan toyyibah’ food. Methods: The samples of fried rice were cooked with the application of hygienic practices. A specific quantity of human stools were then purposely inoculated into the samples. The growth curves of the bacteria were determined using NanoDrop 1000 UV-VIS Spectrophotometer at 630nm where the initial and end of lag times for each of the bacterial growth were determined. Results: The results showed that if the contamination of human stools in the food is in small quantity (1-2 drops), it may have no health risk at all (within lag time). If the human stools are in higher volume (more than 2 drops, or about 1 ml) then it may start to contaminate the food and could then lead to health risks. If foods are contaminated with small amounts (about 0.1 ml) of human stools and left at ambient temperature (about 37o C) for about 4 hours, the same thing will happen. Conclusions: If the level of health risk is translated according to Shariah law, foods which are contaminated with higher amount (more than 2 drops, or about 1 ml) of human stools or contaminated with small amounts (1-2 drops) of human stools, but are left (about 4 hours) at ambient temperature can be considered as shubhah/makhrooh to be eaten
DNA methylation of DISC1 gene in schizophrenia using methylight Taqman assay
Get PDFIntroduction: Significant evidences from functional studies have shown that DISC1 gene has a role in the pathogenesis of schizophrenia, although the basis of the genetic defect has yet to be established. There has been a shift of emphasis from DISC1 gene variations to other types of genetic defects namely copy number and epigenetic, both of which have not been well investigated. Thus, the aim of this study is to examine the DNA methylation status of DISC1 gene in patients with schizophrenia. Methods: In this study, 239 subjects were included, 117 schizophrenia patients and 122 healthy controls. Genomic DNA was derived from peripheral blood and bisulfite converted. The DNA methylation level was quantitatively measured by Methylight Taqman analysis. Sociodemographic and the clinical parameters were noted. The severity of the clinical symptoms was assessed using Positive and Negative Syndrome Scale (PANSS). Results: The mean age and gender distribution between the study groups were similar. There was no significant difference in the methylation level of DISC1 between the patients and control group. When patients were compared by age, duration of illness, age at diagnosis, body mass index, smoking status, PANSS score and types of antipsychotic treatment, the DNA methylation level of DISC1, did not show any significant difference (p>0.05). Conclusions: This study found no significant difference in methylation level of DISC1 gene between schizophrenia patients and healthy control. Therefore, it is suggested that aberrant DNA methylation of DISC1 most probably does not contribute to the pathogenesis of schizophrenia