IIUM Medical Journal Malaysia (IMJM)
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A qualitative study of factors affecting the compliance of hearing protective device usage among factory workers in Kuantan
Get PDFIntroduction: Occupational noise-induced hearing loss (NIHL) is an acquired cumulative and irreversible hearing impairment which is totally preventable. Literature review concluded that noise hazard control via administrative and engineering methods are difficult to implement for many reasons. Thus, hearing protection device (HPD) is the best compromise to protect workers from the excessive noise. The purpose of this study is to qualitatively explore the factors affecting the HPD compliance among factory workers in Kuantan. Methods: A purposive sampling of twenty four male workers exposed to occupational noise of 85 dB and more for 8 hour-period was recruited from 15th July to 31st August 2013 to participate in four focus group discussions. The open-ended guided questions were used during the discussions to explore the workers’ perspective, knowledge, attitude and behaviour regarding the use of HPD. The data were analyzed using the conventional content analysis and the key themes were elicited in relation to the study, either toward the positive hearing protective behaviours or the factors that act as the barriers against it. Results: From the findings, five themes have emerged with their respective subthemes including perception of noise in the workplace, use of HPD, barriers against the use of HPD, workplace influence and value of hearing. Our studies found that the three main reasons for workers not to wear HPD are discomfort, cumbersome and impediment of speech / other wanted sounds. Conclusions: Effective hearing conservation programme, particularly on the use of HPD should therefore address these factors to ensure good compliance among the workers
Procalcitonin and Interleukin-6 for predicting culturenegative and culture positive bacterial sepsis in critically ill patients with systemic inflammatory response syndrome
Get PDFIntroduction: Differentiation between culture-negative bacterial sepsis (BS), culturepositive BS and non-infectious systemic inflammatory response syndrome (SIRS) among critically ill patients remains a diagnostic challenge to the intensive care unit (ICU) physicians. This study aimed to evaluate the role of procalcitonin (PCT) and interleukin-6 (IL-6) in predicting non-infectious SIRS, culture-negative BS and culture-positive BS in the ICU. Methods: This prospective observational study was conducted in a tertiary ICU in Pahang. The patients were divided into sepsis and non-infectious SIRS based on clinical assessment with or without positive cultures. Patients with positive cultures were further divided into bacteraemia and positive other culture. The PCT and IL-6 were measured daily over the first 3 days. Results: Two hundred and thirty nine consecutive patients diagnosed with SIRS were recruited, of whom 164 (69%) had sepsis. Among sepsis patients, there were 62 (37.8%) culture positive and 102 (62.2%) culture negative. Of these, 27 (16.5%) develop bacteraemia. The most common site of infection was respiratory (34.4%). Post-LSD analyses showed significant difference in the PCT between culture negative sepsis and SIRS (p=0.01); and positive other culture and SIRS (p=0.04). On the other hand IL-6 cannot differentiate between SIRS and negative culture sepsis (p=0.06). Both PCT and IL-6 predicted bacteraemia with an AUC of 0.70 (0.57 to 0.82) and 0.68 (0.53 to 0.70). IL-6 is independently associated with bacteraemia and other culture after adjusting for age, sex, hypertension, SAPS II score and day 1 PCT. Conclusions: Procalcitonin but not Interleukin-6 is able to differentiate SIRS from culture-negative BS. However, IL-6 is independently associated with bacteraemia and other culture
Personal And Professional Characteristics Of A Good Muslim Doctor: Perception Of Newly Graduated Doctors
Get PDFIntroduction: The Medical Faculty of Universiti Sains Islam Malaysia (USIM) aims to produce good Muslim doctors (GMD) who are able to practise medicine that is integrated with Islamic values. Islamic courses and Medical Ethics are integrated into the curriculum in its effort to provide adequate Islamic knowledge and nurturing professionalism as a process of personal and professional development (PPD) within the framework of Islamic teaching. The objective of the study was to evaluate the perception of graduates and students of characteristics of a GMD. Method: A self-administered questionnaire was distributed to the participants. The respondents were asked to rate their level of agreement or disagreement on the statements that represent the characteristics of a GMD. Statistical analysis of the data was carried out using SPSS version 18.0. The mean, median and inter quartile ranges of the characteristics were determined and differences between the groups were analysed using Mann-Whitney U test. Results: Results showed significant difference between gender for the item “Conscious of professional ethics” (p=0.021). Significant differences were seen in the median scores between the graduates and the final year students in four out of six items for personal characteristic. Conclusion: Islamic input in the medical curriculum and the teaching of professionalism has an impact on graduate perception of characteristics of a GMD. Further improvement in the teaching of professionalism among undergraduates is necessary in order to promote greater impact on the understanding and internalization of characteristics of a GMD. The Islamic input in the medical curriculum can thus be regarded as the blueprint for PPD of medical undergraduates to become a GMD
Giant Splenic Hydatid Cyst in Pediatric Age
Get PDFGiant hydatid cyst in spleen is rare in the pediatric age group. We came across two cases of giant splenic hydatid cysts in pediatric age group, out of which, one case had pulmonary, liver and splenic hydatid cyst which was managed with single stage approach. As a single stage approach is a novel method with less morbidity, it should be adopted as a preferred method for the management of pulmonary and abdominal hydatidosis. Hydatid cyst is described as a slow growing cyst in literature, but the presentation of giant size hydatid cyst in our 7 and 12 year old child is difficult to explain by this concept of slow growth
Survival analysis of surgically treated laryngeal cancer in Hospital Tengku Ampuan Afzan, Kuantan, Pahang from January 2002 to June 2013
Get PDFIntroduction: Laryngeal cancers are one of the most prevalent head and neck cancer in Malaysia. However, little information is available on survival rate for larynx cancer in Malaysia has been reported. The purpose of the present study was to evaluate the survival and the prognostic factors in surgically treated patient with laryngeal cancer in Hospital Tengku Ampuan Afzan, Kuantan, Pahang. Methods: Retrospective analysis of surgically treated patient of laryngeal cancer treated in Hospital Tengku Ampuan Afzan during January 2002 to June 2013 was analyzed. The overall survival rate was measured using the Kaplan Meier method. Prognostic factor was identified by log rank test taking p value <0.05 as statistical significance. Results: A total 36 cases were analyzed. Two-thirds (86.1%) of the cases were at an advanced stage (stage III & IV) at presentation. The 2, 5 and 10 year overall survivals for the laryngeal cancer were 62%, 34% and 22% respectively. The histopathological examination result was the strongest prognostic factors in laryngeal cancer. Conclusions: The results revealed remarkably poor outcomes of the patients in the series, indicating a strong need to increase the proportion of early stage presentations and maximize the treatment efficacy to improving outcomes
Oral health knowledge of periodontal disease among final year non-dental students of IIUM Kuantan Campus
Get PDFIntroduction: To determine the levels of oral health knowledge of periodontal disease and its determinants among final year non-dental students of IIUM Kuantan Campus. Methods: A cross-sectional study was conducted among 284 final year non-dental students from five different kulliyyah using a validated structured questionnaire. The questionnaire consisted of items to assess participants’ demographic and socioeconomic variables, dental health education, periodontal disease knowledge, and oral hygiene practice. The relationship between levels of knowledge with the socioeconomic background, oral hygiene practice, and dental health education were analyzed using Chi-square Test and One-way ANOVA. Statistical analysis was based on probability values of less than 0.05 (p<0.05). Results: 70.4% (200/284) of the participants were female and 29.6% (84/284) were male with mean age 23.5. Limited knowledge was seen more in non-medical students than medical students significantly (p<0.05) in periodontal disease factors (43.8% vs 21.8%), relationship with systemic disease (50.5% vs 29.6%), signs (28.6% vs 11.7%), symptoms (23.8% vs 10.1%), and prevention (26.7% vs 12.3%) whereas causes (34.3% vs 32.4%) and treatment (62.9% vs 58.1%) were not significantly different (p>0.05). Therefore, medical students had higher knowledge of periodontal disease (p<0.05) than those from non-medical students (26.8% vs 16.2%). There were no relationships between knowledge levels with other determinants. Conclusions: There were significant differences in level of periodontal disease knowledge except causes and treatment between medical and non-medical students. Thus, periodontal health knowledge education promotion should be emphasized among non-medical students. Further study should be carried out to improve oral hygiene practices among students
Adherence to guidelines: an audit of the endoscopic management of acute upper non-variceal gastrointestinal bleeding
Get PDFIntroduction: For patients with acute upper non-variceal gastrointestinal bleeding (AUNVB), various guidelines and meta-analysis have shown that combination endoscopic treatment is superior to a single treatment modality (injection or thermal coagulation) as an endoscopic haemostatic technique. This study aim to assess the adherence to ‘best practice’ standards (an emphasis on endoscopic treatment modalities) for patients with non-variceal upper gastrointestinal bleeding with high risk stigmata on endoscopic findings. Methods: Between January 2015 and March 2016, consecutive charts of patients hospitalized for acute upper gastrointestinal bleeding in Hospital Tengku Ampuan Afzan, Kuantan were reviewed. Data regarding initial presentation, endoscopic findings and management were collected. The inclusion criteria were patients with peptic ulcer disease and high risk stigmata on endoscopic findings. Results: Eighty one patients were included in the final analysis. There were 62 males and 19 females patients with mean age of 62.5 ± 1.5. Although the statistical analysis was not significant, more than half of the patients (60.5%) were given a single treatment modality to achieve haemostasis. Only 33.3% and 6.2% patients received a combination of two and three treatment modalities respectively. Conclusions: There was marked variability between the process of care and ‘best practice’ in AUNVB. Certain patient and situational characteristics may influence guideline adherence. Further studies are needed to delineate the underlying causes
Recontruction of coronoid process using autologous tricortical iliac bone graft after persistent traumatic elbow dislocation- case report
Get PDFCoronoid fractures are challenging to manage and rarely isolated. It’s always associated with three instability patterns of the elbow, which is the terrible triads, varus posteromedial rotatory instability and transolecranon fracture- dislocation. We have performed an open reduction and reconstruction of the coronoid process using autologous tricortical iliac bone graft for one patient after persistent elbow dislocation in malunited type III coronoid fracture. The main goal of management of coronoid fracture with elbow dislocation is to maintain the joint stability and acceptable elbow functions. Through understanding the pattern of injuries, proper investigation and approach could improve the outcome of surgery. We believe that reconstructing coronoid process using tricortical iliac bone graft provides acceptable stable elbow joint and good functional flexion arc of motion
A study on burden among caregivers of stroke patients
Get PDFIntroduction: Studies have shown that caregiving is associated with high burden that could affect caregivers’ mental and physical well-being. Unfortunately, caregivers are often overlooked even by healthcare professionals. With the rise of our elderly population and morbidity from stroke, there is a need to assess the burden among family caregivers in our society. This study was carried out to determine the level of burden among caregivers of stroke patients attending Hospital Universiti Sains Malaysia in Kelantan and to evaluate the possible risk factors associated with those with a burden. Methods: A total of 116 caregivers of stroke patients were interviewed. The participants were recruited from the Klinik Rawatan Keluarga in Hospital Universiti Sains Malaysia. Caregivers were assessed for the level of burden using the Zarit Burden Interview. Results: The mean burden score among the caregivers was 25.42 (SD 6.45). The minimum burden score is 11 and the maximum score is 49. This study significantly found that caregivers who look after bedbound patients have higher levels of burden. While the caregiver burden is lower with higher household income and among caregivers who have secondary or tertiary education level. Conclusions: Factors that affect caregiver burden such as the condition of the patient, caregiver’s education level and household income should be taken into account in the evaluation of caregivers of stroke patients
Vasorelaxation effect of Syzygium polyanthum (wight) walp. Leaves extract on isolated thoracic aorta rings of normal and hypertensive rats
Get PDFIntroduction: Syzygium polyanthum (Wight) Walp. leaves are traditionally consumed by the Malays as an alternative treatment for hypertension. Until now, effect of S. polyanthum leaves extract on blood vessel is not yet disclosed. Methods: This study investigated the effect of S. polyanthum leaves aqueous extract (AESP) (0.01, 0.1, 1 & 10 mg/ml) on isolated thoracic aorta rings of normotensive Wistar-Kyoto rats (WKY) and Spontaneously Hypertensive rats (SHR). Both rings were pre-contracted using phenylephrine (1 µM). Distilled water that dissolved AESP served as negative control. Results: As compared to negative control, AESP at 0.1, 1, and 10 mg/ml significantly relaxed aorta rings of WKY by 39.81 ± 2.99 % (P<0.001), 59.55 ± 7.60 % (P<0.001), and 72.58 ± 5.57 % (P<0.001), respectively. In SHR, AESP at 1 and 10 mg/ml significantly relaxed the aorta rings of SHR by 40.53 ± 3.66 % (P<0.001) and 65.73 ± 8.24 % (P<0.001), respectively. There was a significant difference between AESP-induced vasorelaxation in WKY and in SHR at a concentration of 0.1 mg/ml (P<0.001). The IC50 value for AESPinduced vasorelaxation on aorta rings of WKY (94.67 ± 1.41 µg/ml) was lower than of SHR (799.80 ± 1.69 µg/ml). Conclusions: The S. polyanthum leaves extract was able to cause significant relaxation on aorta rings of both normal and hypertensive rats. Thus, this finding is well-corroborated with the use of this plant as a traditional remedy for hypertension. It is suggested that an in-depth investigation of the mechanism of vasorelaxation of this plant is carried-out in the future