IIUM Medical Journal Malaysia (IMJM)
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Predictors of perioperative complications following single or combination nasal-palatopharyngeal surgery for severe obstructive sleep apnoea
Get PDFIntroduction: To assess the relationship between perioperative complications and upper airway surgeries for obstructive sleep apnoea (OSA). Methods: The records of 118 adult patients, diagnosed with obstructive sleep apnoea (apnoea-hypopnoea index (AHI) >5), who underwent upper airway surgery at a single tertiary referral hospital from 2007 to 2015 were reviewed. Pulmonary, surgical, and cardiovascular complications within the first 30 postoperative days were analyzed according to types of upper airway surgery. Upper airway surgery types were single surgery or combinations of surgeries to the tonsils, pharyngeal adenoids, soft palate, tongue base and nose. Logistic regression was used to assess the multivariable association of age, sex, BMI, OSA severity, medical comorbidity, and types of upper airway surgery with postoperative complications. Results: At least one perioperative complications occurred in 48 of 128 patients (37.5%). In a multivariable model, the overall complication rate was increased with age, obesity, smoking and underlying comorbid medical problems. Complication rates were not associated with AHI severity, types of procedures performed and whether the surgery was a single or combination surgery. Conclusions: In OSA patients undergoing upper airway surgery, the severity of OSA as assessed by the AHI, and the sites and numbers of concurrent surgery performed were not associated with the rate of perioperative complications
Outcome of NEXGEN® fixed bearing and posterior stabilising total knee replacement
Get PDFIntroduction: Total knee arthroplasty (TKA) represents a major advance in the treatment of degenerative joint disease, providing excellent restoration of joint function and pain relief. This study aim to evaluate the survival analysis of the implant, the functional and knee scores outcome and to identify a complication following Nexgen fixed bearing and posterior stabilizing total knee replacement. Methods: The present study was conducted to retrospectively review the results of all primary TKA performed at Hospital Tengku Ampuan Afzan over a period of 15 years from 2000 to 2015. The study sample consisted of 160 TKA. Oxford knee score and SF 36 were used and statistical analysis of both knee scores and functional scores were compared using SPSS software. Survivorship analysis was compared using the Kaplan-Meier method. Endpoints of implant defined as revision with removal of implant and addition or exchange of prosthetic components. Results: Functional and knee score post operatively was excellent and good. Mean range of movement of knee during the study period were left 107.50 degrees and right 106.49 degrees. Mean femoral flexion angle is 92.38 degrees and mean tibial angle is 89.48 degrees. The outcome categories for the Oxford knee score have 101 patients showed excellent result, 41 patients good, and 18 patients fair. In this study mean total SF 36 score is 80.99. Conclusions: The outcome shows that total knee replacement is a reproducible surgery for which a trained surgeon will be able to produce excellent and good results
Clinical and cytogenetic profiles of children with autism in Kuantan Pahang
Get PDFIntroduction: Autism spectrum disorder (ASD) is a group of neurodevelopmental disorder. The aetiology is not known in 75 to 80 percent of patients while in 20 to 25 percent a genetic cause is identified. There are very few studies on cytogenetic profile of ASD being carried out locally. This cross-sectional study was conducted to examine the clinical and cytogenetic profiles of paediatric ASD patients attending the Kuantan branch, National Autistic Society of Malaysia School. Methods: All paediatric patients (up to 18 years of age) attending the school in the year 2009/2010 were recruited. Clinical data was obtained by interviewing the guardians and assessment of the patients. Peripheral blood samples were collected for cytogenetic analysis. Results: Guardians of 14 out of 24 patients (58.3%) agreed for their children to be enrolled into the study. The age range was 5 to 12 years of age. The diagnostic subgroups were autistic disorder (13/14 patients) and Asperger syndrome (1/14). Approximately 80% had learning disability and history of allergy. Five patients had hyperactivity and none had history of seizures. There were family histories of developmental delay, mental retardation, epilepsy, psychiatric disorders and allergy. No structural or numerical chromosomal abnormality was detected. Conclusions: Although no cytogenetic abnormalities were identified, most probably due to the small sample size, it is crucial that genetic studies, including molecular genetic be explored as they would provide useful clinical insights and enhance understanding of the pathogenesis
Universal reliance on LAL/TAL in bacterial endotoxin detection in drugs and parenteral - An ecological and economic perspective
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Introduction: Endotoxin detection and quantification in biological drugs and parenteral is a crucial step in helping us to be confident in process control (IPC) and product release decisions. Food and Drug Administration (FDA) approves either Limulus Amebocyte Lysate (LAL) /Tachypleus Amebocyte Lysate (TAL) derived from blue blood of horseshoe crabs to detect and quantify endotoxin. This in turn increases harvest pressure on wild crabs for biomedical bleeding practice which eventually leads to post bleeding mortality up to 30%. In economic perspective, the LAL/TAL industry worth more than 50 million USD annually. Methods: Numbers of methods were adopted to enhance the accuracy of endotoxin detection, including gel clot, turbidimetric and chromogenic method. Results: However, all these methods require crabs either from wild or from captive for bleeding purpose. Though, various conservative measures are being taken, the habitat degradation and anthropogenic pressures on wild crab population is still beyond control and leads to unsustainable utilization of natural stock. Conclusions: Due to an increased demand of LAL/TAL, the present review paper addresses the issues related to Eco-economical viewpoint on sustainable utilization of wild stock for future LAL/TAL industry. It also addresses pros and cons of recent advanced sensor technology in rapid and low cost detection of endotoxin
Antibacterial property of crude extract from stem-bark and leaves of Rhizophora apiculata against selected bacterial fish pathogens
Get PDFIntroduction: Recently the wide range of commercial antibiotics in fish feed for aquaculture practices has led to antibacterial resistance, environmental pollution and residue build-up in fish tissue. Therefore new sources of antibiotics from natural sources need to be investigated to circumvent these problems. Rhizophora apiculata has been reported to have high antimicrobial activity due to the high concentration of tannin in the bark of the tree. Methods: Based on these contexts, this study was conducted to measure the antimicrobial activity of ethanol, ethyl acetate and distill water extracts from the stem-bark and the leaves of R. apiculata. 9 species of bacteria consist of B. subtilis, S. aureus, S. epidermidis, P.aeruginosa, P. mirabilis, H. alvei, V. alginolyticus, V. paraheamolyticus and E. coli were tested to measure their susceptibility to the extracts. The extracts were dissolved into 2 different concentrations which were 10 mg/mL and 50 mg/mL or 10 ug/disc and 50 ug/disc respectably, to determine the inhibitory effect of the extract upon the bacterial fish pathogen. Results: 2 species of Gram-positive bacteria which were B. subtilis and S. epidermidis have shown positive results with 9.0 mm to 16.0 mm of inhibition zone respectably while the other bacteria were resistant to the extract concentration administered. Conclusions: A continuous monitoring need to be carried out to comprehend the potential of Rhizophora apiculataas and other mangrove plants, which can be applied as an alternative source for environmental friendly antibacterial drug in pharmaceutical and aquaculture industries
Extraction of omega 3 fatty acids from sardine byproducts using supercritical carbon dioxide (SC-CO2)
Get PDFIntroduction: Sardine generally processed as canned fish, and in consequence of a lot of solid waste are generated as byproducts which could be good sources of fish oil. Omega-3 fatty acid compositions of total lipids extracted by supercritical carbon dioxide (SC-CO2) from sardine fish by-product (head, skin and viscera) were determined and the results were compared with Soxhlet extraction. Methods: SC-CO2 extraction was performed at the optimized condition at a temperature of 60 0 C, the pressure of 35 Mpa and flow rate of 3 ml min-1 . Results: Highest yield was obtained from the skin (42.5%) followed by the head (22.4%) and the viscera (9.6%) which is closer to that of the yield of Soxhlet extraction method where 44%, 23% and 11% (on dry basis) oil were yielded from skin, head and viscera, respectively. Saturated fatty acid was dominant incorporate with monounsaturated and polyunsaturated fatty acid in all organs and the difference of extracted fatty acids between SC-CO2 and Soxhlet methods were insignificant. Docosahexaenoic acid (DHA) was characteristically major PUFA accounting 19.8% in head, 15.4% in skin and 13.6% in viscera of the total fatty acids. Conclusions: Total oil extracted by SC-CO2 had lower free fatty acid content than the oil extracted by Soxhlet method. Thus, SC-CO2 could be the effective method for extracting omega-3 PUFA rich fish oil from sardine by-products
Infectious agents and immune responses in schizophrenia: A case control study
Get PDFIntroduction: Exact causal mechanism of schizophrenia is still unknown; however, genetic and environmental factors are implicated in disease aetiology. The aim of the study is to determine the association of infectious agents cytomegalovirus and T.gondii along with immune cytokines IL-2, IL-6 and IFN-γ with schizophrenia. Methods: Ninety subjects participated in the study, 45 were patients diagnosed with schizophrenia, and the other 45 were a healthy control group. Qualitative and quantitative enzyme immunoassays were used for detection of antibodies and quantitation of cytokines respectively in subjects’ sera. Results: Both patients and control groups had similar CMV seroprevalence of 93.3% (42/45). Prevalence of anti T. gondii IgG antibodies were 53.3% and 64.4% among schizophrenic patients and controls respectively. No statistically significant difference was observed between patients and controls (p > 0.05). A significant difference (p<0.005) between mean serum Interleukin-2 levels in patients (14.7 pg/mL) and controls (33.5 pg/mL) was observed. No statistically significant difference (p>0.05) was found between the median IQR serum Interleukin-6 levels of patients (4.3 pg/mL) and controls (3.1 pg/mL). There was a significant difference (p< 0.001) in median IQR serum IFN – γ levels between patients (0.8 pg/mL) and the control group (4.9 pg/mL). Conclusions: No significant differences between schizophrenic patients and healthy controls with regard to previous infections with cytomegalovirus or T.gondii were observed. While significantly higher levels of proinflammatory cytokines IL-6 and IFN – γ among controls than patients might be an indication of weaker than normal immune responses in schizophrenic patients
Contraception use and its associated factors among grand multipara mothers in Kuantan
Get PDFIntroduction: Pregnancy and childbirth bring health risks for women, and it is magnified in grand multipara mothers. Effective practice of contraceptive is important in spacing out childbirth to ensure both mother and child acquire optimum quality of life. Thus, with increasing number of grand multipara mothers who would face a greater reproductive risk, it is crucial to have a better understanding of their reproductive health. This study aimed to determine the contraceptive use and to identify associated factors influencing contraceptive use among grand multipara mothers in Kuantan. Methods: A descriptive cross sectional study was carried out in Klinik Kesihatan Ibu dan Anak Jaya Gading using purposive sampling. 49 respondents had been selected. The data of this study were analyzed and transformed by using statistical software. Results: The prevalence of contraceptive use among grand multipara mothers was 51%. Grand multipara mothers who had high level of knowledge (p=0.030) regarding contraceptive, positive attitude (p=0.017) toward contraceptive use and having discussions with the spouse on contraception (p = 0.008) were more likely to use contraception. There was no statistically significant difference between the practice of contraceptive use and occupation (p=0.175) or number of living children (p=0.250). However, in this study, we found a statistically significant association between the contraceptive use and educational level (p=0.036). Conclusions: The prevalence of contraceptive use in this study compared relatively low to other studies. Effective health promotion programs need to be done to encourage the practices of contraceptive
Norms for Eating Disorder Examination Questionnaire (EDE-Q) among Secondary School Students in Kuala Lumpur, Malaysia
Get PDFIntroduction: The Eating Disorder Examination Questionnaire (EDE-Q) has been widely used as a tool to detect eating disorders. We aimed to identify the EDE-Q normative data among secondary school students in Kuala Lumpur, Malaysia. Methods: This is a cross-sectional study involving four secondary schools in an urban area. The respondents of secondary school students were selected using stratified sampling. Results: There were 298 teenagers 12 to 17 years of age who participated in the study. The EDE-Q mean scores ± standard deviation was 1.27 ± 1.08 for the total score (Global Score), 0.78 ± 0.95 for Restraint Domain, 1.02 ± 1.03 for Eating Concern, 1.76 ± 1.55 for Shape Concern and 1.54 ± 1.43 for Weight Concern. Conclusion: Mean values obtained from this study were relatively lower when compared to western populations. Shape Concern and Weight Concern had higher scores compared to the other domains. These values are useful for EDE-Q interpretation in Malaysia
