IIUM Medical Journal Malaysia (IMJM)
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The potential of Tamarindus indica seed extract as anti-snake venom against Ophiophagus hannah, Naja kaouthia and Daboia russelli in mice
Get PDFIntroduction: Globally, snakebite cases are estimated to be around 5 million annually affecting mainly the poorer countries like Africa and Asia, and in 2009 WHO has categorized it as a ‘neglected tropical disease’. Currently the standard treatment for snake envenomation is the anti-snake venom therapy, which is expensive, poor supply and species specific. This study was conducted to evaluate the potential of using Tamarindus indica seed extract (TSE) to inhibit the in-vitro and in-vivo effects of snake venom of three snakes; namely Ophiophagus hannah, Naja kaouthia and Daboia russelli. Methods: Methanolic extract of TSE was used. In-vitro enzymatic inhibition study i.e phospholipase A2, proteolytic and phosphomonoesterase were studied. In-vivo acute subcutaneous (SC) toxicity of TSE in ICR mice was conducted. Study on the SC TSE inhibition of lethality was also conducted. Results: Findings from enzymatic inhibition studies showed that, TSE was able to significantly reduce (p<0.05) all three enzymatic activities. SDS-PAGE experiment showed disruption of protein bands when venom reacted with TSE. No signs of toxicity were observed over 4 weeks when mice were exposed to SC TSE 60mg/20g except for superficial skin ulcers. Histological examination of the liver, both kidneys and skin showed no changes when compared to the control group. TSE was able to increase the mice survival rate. Conclusions: The study shows that SC TSE was safe to be injected up to 60mg/20g and has the potential to delay the effects of venoms from O. hannah, N. kaouthia and D. russelli
Determination of ultra-morphological changes of Trichophyton rubrum treated with hydroxychavicol
Get PDFIntroduction: Trichophyton rubrum is a common pathogenic fungal species that is responsible for causing infection of human skin, hair and nail. The antifungal-resistant strains however, complicate the treatment regime. Hydroxychavicol (HC) is one of the main compounds from the Piper betel leaf that have antifungal potential and its mechanism of action has yet to be studied. This study was carried out to determine the antifungal properties of HC against Trichophyton rubrum using transmission electron microscope (TEM) on gross and ultrastructure of Trichophyton rubrum hypha. Methods: Broth dilution method was used to determine the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of HC and miconazole (MI) against the Trichophyton rubrum (ATCC 28188). Trichophyton rubrum was treated with HC and MI at concentrations of 1.25, 2.5, 5 and 10 mg/mL for 1, 3, 5 and 7 days continuously. Results: The MIC results of the HC and MI against Trichophyton rubrum were 0.00048 mg/mL and 0.000061 mg/mL respectively. MFC results showed 0.0019 mg/mL for HC and 0.000061 mg/mL for MI. Microscopically, the fungi structures became more severely damaged at increasing treatment duration. The cell wall of the fungi treated with HC showed a rough surface, shrinkage and demolition similar to that of the MI treated group. The fungi organelles were also demolished and disorganized. Conclusions: This study reveals that HC has the ability to inhibit Trichophyton rubrum growth and it has the potential to be an antifungal agent especially in treating dermatitis
Extended reliability measures for the fast method of schroeder-phase masking
Get PDFIntroduction: Schroeder-phase masking test has been found to be highly useful in providing information on the cochlea phase response that was not previously discovered. Conventional Three Alternative Forced Choice (3AFC) method of conducting Schroeder phase masking takes a long testing time (around 45 minutes) and could possibly limit the valuable information that may be gathered from this test. A faster Schroeder-phase masking method which is able to cut down almost 80% of the testing time has been developed, and has been proven reliable for normal hearing population. This study aims to extend the reliability measures to hearing impaired population. Methods: This is an observational study involving 10 normal hearing and 6 sensorineural hearing loss subjects. Schroeder phase masking functions were measured at 500 Hz, 1 kHz and 2 kHz (75 dB A) using the conventional and fast methods to find the agreement between two methods. The fast method was measured in two sessions to find the test–retest reliability. Results: The fast method showed; i) good agreement with the conventional 3 AFC method-no significant difference of masked thresholds between two methods at majority of the tested conditions (p>0.05), ii) good test retest reliability- no significant difference of masked thresholds between two sessions (p>0.05). Conclusions: Proven to be a reliable method in both normal hearing and hearing impaired population, the faster method could potentially facilitate more Schroeder phase masking experiments in investigating the fundamental of sound processing and auditory perception
Noise exposure during orthopaedic surgery
Get PDFIntroduction: There is serious concern on noise hazard in the operating theatre, especially in the orthopaedics field that requires usage of many instruments. However, local data on this noise exposure is rather limited. This study was conducted as a pilot study to investigate the noise exposure in orthopaedics theatre in a hospital in Kuantan, Pahang in June 2011. Methods: Several different orthopaedics theatres involving procedures that use powered instruments were investigated. Time recorded noise exposures were taken using a noise dosimeter throughout the surgeries worn by the surgeons. The peak noise level and the average noise exposure within 8 hours were determined, and compared with available health guidelines, namely the Factories and Machinery (Noise Exposure) Regulations 1989. Results: Six out of seven surgeries which include interlocking nail and plating of femur, Ilizarof insertion, total knee replacement and dynamic hip screw insertion of the femoral head were found to exceed 140 dB(A) for peak sound levels. The average noise exposure within 8 hours was below 85 dB(A) in all cases. Although the average noise level did not surpass the health guidelines, the peak level exceeding 140 dB(A) still carries risk for hearing loss. Conclusions: In conclusion, healthcare personnel in operating theatre were exposed to noise hazard for certain orthopaedics surgical procedures. Hence, proper noise management should be implemented to protect them from noise-induced hearing loss while maintaining the success and efficiency of the surgeries
Functional outcome of anterior cruciate ligament (ACL) reconstruction: comparison of bone-patella tendon-bone (BPTB) vs. Hamstring graft
Get PDFIntroduction: This is a cross-sectional study to evaluate the functional outcome of ACL Reconstruction between BPTB and hamstring graft who underwent ACL Reconstruction between January to June 2012 at our institution. Methods: Functional IKDC scoring was done pre-operatively, at 6 months and one year. Arthrometric measurements were taken using KT2000. Lysholm score and SF-36 were assessed at one year. Resuts: All patients are male, mean age is 29 (21 to 37 years old). 21.4% patients from patella BPTB group and 13% of hamstring group had anterior knee pain. 50% of patients from both groups complained of numbness over operative site. Average time return to pre-injury sports activity for BPTB group was 7.9 months, whereas for hamstring group was 8.3 months. KT-2000 measurements revealed an average side to side laxity difference average of 6.6mm in BPTB group and 7.9mm in hamstring group. Pivot shift were negative at 6 months in all patients. IKDC knee scoring significantly improved from grade C or D to grade B in 82% of BPTB group and 63% in hamstring group one year post operatively. There were no difference between both groups in terms of SF-36, Lysholm score and knee range of motion. Conclusions: There are no difference in functional outcome and lysholm knee score between the two groups although there is a discrepancy of IKDC score and arthrometric measurement at one year. Although both groups have moderate anterior laxity after one year, but they are asymptomatic and able to go back to preinjury sports activities
Lifestyles and non-communicable diseases status among primary health care staff in Kuantan, Pahang
Get PDFIntroduction: Unhealthy lifestyle is one of the risks of non-communicable diseases (NCDs) in our population even among the healthcare provider. They should be as the role model for their NCDs patients in the clinics. Therefore, this study was to determine the lifestyle practice and lifestyle-related NCDs (LR-NCDs) status among primary health care staffs. Methods: A cross-sectional survey was done among 69 health-staff (20- physicians (PCPs), 16-nurses and 33-Para-Med) aged between 20-60 years from 3 selected governments primary health care clinics in Kuantan on April 2015. A pre-tested questionnaire is used to the collect history of LR-NCDs, smoking, exercise status and 24-hours- dietary recall. The BMI, systolic and diastolic blood pressure of the participants were also measured. The Nutritionist-Pro-(g) software was used to extract macronutrients (Carbohydrate, Protein and Total-Fat %) and balance-diet (within recommended %). Results: The most common LR-NCDs among health-staff were overweight (34.8%) and followed by obesity (24.6%), DM (8.7%) and hypertension (3.2%). The majority (95.7%) were non-smokers and 69.6% did not exercise regularly. Diet-recall analysis showed that only 8.9% (2-PCPs, 1-nurse & 3-ParaMed) had balanced-diet. The status of the DM, hypertension and smoking and practicing balance-diet were not significantly different (p>0.05) among the PCPs, registered-nurses and Para-Med except for the exercise. Most PCPs (90%) have inadequate exercise compared to registered-nurses (43.8%) and Para-Med (69.7%) (p<0.05). Conclusions: There is a high prevalence of overweight and obesity, inadequate exercise and having an unbalance-diet were noticed among all levels of health-staff
Translation, adaptation and psychometric properties of Bahasa Malaysia version of the hearing handicap inventory for adult (HHIA): A preliminary study
Get PDF Introduction: Patient self-perceived handicap inventory is an important tool for modern health care including hearing loss. The HHIA is a self-reporting outcome measurement invented to verify the hearing-impaired patients’ complaint and carry out for appropriate client-centered rehabilitation program. To the author’s knowledge, none of the self-reported questionnaire for hearing loss is available in Malay language, therefore, further research is required. The aim of this study was to translate the English version of HHIA into Bahasa Malaysia and to psychometrically validate the questionnaire. Methods: The questionnaire was initially translated using forward-backward translation techniques by four-panelists (2 panels for each level). The translated questionnaire was then reconciled and harmonized for cultural and content by the researchers and two expert panels before being piloted among 10 hearing impaired patients. At the present stage, psychometric evaluations have been conducted among 30 adults hearing-impaired participants using Cronbach’s α (for internal reliability) and Pearson’s correlation for (inter-item correlation). All participants were recruited from IIUM Hearing and Speech Clinic. Results: Cronbach’s α value was 0.96 for combined items. There were a strong correlation between the total score of the combined items with each of the sub-scale scores (social and emotional) and between each of the sub-scale scores (r=0.92-0.98, ρ<0.01). Conclusions: The preliminary finding suggests the translated version of HHIA has the potential to be a reliable and valid tool to evaluate the hearing handicaps among hearing-impaired patients in Malaysia. A large sample of subjects is needed for further evaluation to support this notion
Extraction optimization and properties of collagen from chicken (Gallus gallus domesticus) feet
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Introduction: The collagen can be basically extracted by chemical and enzymatic hydrolysis. In industry, the chemical hydrolysis method is more commonly used. However, the enzymatic hydrolysis is more effective when the high nutritional value product will be produces based on the extracted material. Chicken (Gallus gallus domesticus) feet are used as a source of bird collagen. Methods: Optimization of collagen extraction was investigated by using three different methods which were soaked in 5% lactic acid for 36 hours, 0.5 mol/L acetic acid with 0.1% papain and 0.5 mol/L acetic acid with 0.1% bromelain. Various properties such as percentage of end yield, concentration of protein, pH, swelling percentage and SDS-PAGE patterns of collagen from chicken feet were evaluated in order to determine the best method of extraction. Results: Type I collagen was considered as a major component of chicken feet collagen, which indicated by β chain and two distinct α-chains which are α1 and α2 that observed from the electrophoresis pattern of collagen extracted from all three methods. The lactic acid method showed the highest percentage of end yield and concentration of protein compared to the other two methods. However, lactic acid method showed the lowest swelling percentage and higher pH value. Conclusions: According to these results, soaked in 5% lactic acid for 36 hours is possible as the best collagen extraction method from chicken feet
Gore-Tex Medialisation Thyroplasty for Unilateral Vocal Cord Palsy: A Tertiary Centre 7 Years Experience
Get PDFBackground: The resultant dysphonia and aspiration in unilateral vocal cord palsy can be overcome with medialisation thyroplasty. With this background, we aim to determine the aetiology of the unilateral vocal cord palsy and effectiveness of the phonosurgical procedure with Gore-Tex as a sole treatment. Methods: Within a seven year period, 37 Gore-Tex medialisation thyroplasty were performed for unilateral vocal cord palsy at our institution and medical records were retrospectively reviewed. Results: There were 18 males and 19 females with mean age of 48.7 years (range 19–81 years). The predominant aetiology was thyroidectomy (43.2%) with benign thyroid disease predominates (n=13) over thyroid malignancy (n=3). Voice outcome was evaluated subjectively using visual analogue scoring system, results indicating that Gore-Tex medialisation thyroplasty was effective in addressing dysphonia in 62.5% (n=15) patients. However it alone cannot address aspiration seen in those with high vagal nerve lesion. Airway compromise occurred in two cases postoperatively (5.4%) presenting as acute stridor. Conclusion: In unilateral vocal cord palsy, Gore-Tex medialisation thyroplasty can effectively improve the resultant dysphonia and often accompanying aspiration which would otherwise be disabling for the patients