IIUM Medical Journal Malaysia (IMJM)
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Lower Urinary Tract Symptoms (LUTS) Among Women Attending Gynaecology Clinic And Its Effect On Their Social Life
Get PDFObjective: Lower Urinary Tract Symptoms (LUTS) is a highly prevalent disease which varies by geography and culture. It influences the quality of life and has social implication. The objectives of this study are to estimate the prevalence of LUTS among women attending our gynaecology clinic, the associated risk factors and their quality of life. Method: This is a cross sectional study on women attending gynaecology clinic in a tertiary centre. Participants were given 3 sets of validated self-answered questionnaire, UDI-6, IIQ-7 and OAB V8. Results: the prevalence of luts is 50.6% which is common among Malay women. Forty nine percent is due to stress urinary incontinence (SUI). The risk of LUTS is significantly associated with obesity (AOR = 12.14 95% CI = 1.21 to 121.99, p – value = 0.034), higher parity (AOR = 1.68 95% CI = 1.26 to 2.24, p – value = <0.001) and previous pelvic surgery (AOR = 5.38 95% CI = 1.41 to 20.62, p – value = 0.014). LUTS does not really affect our patient’s quality of life (QOL) except for travelling (1.2%) and emotion (1.6%). Conclusion: This study shows that LUTS is highly prevalent in our local population, but it has no serious effect on QOL. Further population-based study is needed for better understanding of severity and impact on quality of life
Effects of Serum Stored at Various Temperature and FreezeThaw Cycles on Selected Biochemical Parameters
Get PDFIntroduction: Preanalytical variation as a result of sample storage conditions are common issues in a large scale study since the sample has to be kept for an extended duration at ultra low temperature (-70ºC) before analysis. However, ultra low freezers may not be available in some laboratories. Sometimes, the laboratory test may need to be repeated on the previously frozen and thawed samples. The aim of this research was to study the effect of storage temperature and freeze-thaw cycles on some biochemical parameters in our laboratory. Methods: An experimental study was carried out on 50 volunteers. Serum were aliquoted and stored at 4ºC, -30ºC and -70ºC. The serum was analyzed for total cholesterol (TC), triglycerides (TG), high density-lipoprotein (HDL-C) and glucose after 3 months of storage. The effects of freeze-thaw cycles were also recorded. Results: No significant differences (p>0.05) were seen in the level of the biochemical parameters between the samples stored at -70ºC and at -30ºC. The levels of selected parameters were higher after second freeze-thaw cycles as compared to the first thaw. All parameters showed significant positive correlations between the samples stored at -70ºC and the samples stored at -30ºC and 4ºC as well as between the first and second freeze-thaw cycles in samples kept at both -70ºC and -30ºC. Conclusions: Our finding suggested that the level of TC, TG and glucose in sample stored for 3 months at -70ºC are comparable with the samples stored at -30ºC. Only one freeze-thaw cycle is acceptable
Epigenetic methylation status of P16, MGMT and SPOCK2 in diffuse Large B cell lymphoma
Get PDFIntroduction: Epigenetic methylation has been implicated in the pathogenesis of diffuse large B cell lymphoma (DLBCL). This study investigated the methylation status of p16, MGMT and SPOCK2. Aberrantly methylated p16 and MGMT have been linked to DLBCL, but not SPOCK2. p16 inhibits cyclin-dependent kinase, which results in retinoblastoma phosphorylation and blockage of cell cycle at G1 phase. MGMT removes alkyl adduct at O 6 - guanine, thus preventing lethal cross-links. SPOCK2, an extracellular chondroitin and heparin sulfate proteoglycans, abolishes the inhibition of membrane-type 1-matrix metalloproteinase which might enhance the angiogenesis. The absence of SPOCK2 methylation was therefore hypothesized in the majority of cases in this study. Methods: Extracted DNA from 88 formalin-fixed paraffin-embedded (FFPE) tissues of DLBCL were subjected to bisulfite conversion followed by methylation-specific PCR (MSP) analysis for p16, MGMT and SPOCK2 methylation. p16 methylation was also quantified in 16 samples through pyrosequencing assay. Results: p16 methylation was observed in 65/88 (74%) samples by MSP. Pyrosequencing detected p16 methylation in all 16 samples ranging from 18% to 81%. MGMT methylation was detected in all 88 (100%) cases. Methylated SPOCK2 was found in 83 (94.3%) samples. There was a significant association between p16 methylation status with patients above 50 years of age (p= 0.04). Conclusions: These preliminary discoveries may serve as a good platform in order to gain a comprehensive overview on the epigenetics contribution in the pathogenesis of DLBCL. Pyrosequencing is a robust tool in detecting and quantifying methylation
The functional outcome and quality of life following open diaphyseal tibial fractures
Get PDFIntroduction: The clinical outcome of open tibia fracture been extensively studied in many institutions. However, the functional outcome and quality of life has not been widely studied. The aim of this study is to evaluate the functional outcome and quality of life for patients with open tibia fracture that were treated in Hospital Tengku Ampuan Afzan. Methods: Between 2009 and 2010, we treated 33 patients with open diaphyseal tibial fractures with a minimum period of one year follow up. There were 31 males and 2 females; the mean age of 29 years old (range: 10 to 60). Four patients sustained open fracture grade I, 13 grade II, 12 grade IIIA and 4 with grade IIIB. All patients who fulfill the inclusion criteria were called for interview in the clinic by the investigator. The outcome that were analyzed include health related quality of life (SF36) and Lower Extremity Functional Score (LEFS). Results: All except one fracture achieve union. One patient with grade IIIB open fracture developed infected non union. Quality of life is satisfactory in all domains. The functional outcome score was significantly reduced in grade IIIB (48.5) as compare to other grade (grade I 74.2, grade II 70.4, grade IIIA 74.1). Conclusions: The quality of life and the functional outcome worsened with increasing severity of fracture
Co-expression of MYC and BCL2 in diffuse large B-cell lymphoma
Get PDFIntroduction: Diffuse large B-cell lymphoma (DLBCL) is the most common type of nonHodgkin lymphoma. The pathogenesis of DLBCL is complex because it involves at least two different pathways, a de novo pathway and a transformation pathway. MYC and BCL2 oncogenes are 2 key regulators implicated in the pathogenesis. DLBCL with concurrent expression of MYC and BCL2 has been shown to be clinically aggressive and confers a worse prognosis. MYC detection by immunohistochemistry is however not performed in a routine diagnostic work up of DLBCL cases. This study examined the presence of MYC and BCL2 proteins by immunohistochemistry in patients diagnosed to have DLBCL. Methods: This retrospective study involved patients diagnosed to have DLBCL at Tengku Ampuan Afzan Hospital, Kuantan, Pahang (Year 2009-2011) and Queen Elizabeth Hospital, Kota Kinabalu, Sabah Malaysia (Year 2012-2014). Immunohistochemistry for MCY and BCL2 were performed on sections of formalin fixed paraffin embedded tissue blocks. Results: There were 91 cases analyzed. Forty-nine cases (53.8%) exhibited concurrent expression of MYC and BCL2 proteins. In about one third of the cases, positivity was confined to BCL2. In 4 cases (4.4%) only MYC was expressed while in 9 cases (9.9%) both markers were negative. Overall about 60% and 85% of the cases were positive for MYC and BCL2 respectively. Conclusions: Approximately half of DLBCL case studied co-express MYC and BCL2. Prospective studies to look at the clinical significance and prognostic impact of this finding are advocated
Assessment on the bioavailability of rare earth elements in rocky shore organisms and their potential effects on human health
Get PDFIntroduction: This study focuses on the distribution of rare earth elements in rocky shore ecosystem along east coast of Peninsular Malaysia coastal waters using the soft tissue of Saccostrea cucullata, Thais clavigera and Nerita chameleon as bioindicator, and deliberating on interspecies variability. The results were examined in relation to human health as well. Methods: Samples were treated using Teflon Bomb technique and concentrations of 14 naturally occurring REEs were measured using ICP-MS technique, along with selected trace metals for added data. Results:The results were certified using standard reference material BCR 668 with quality control practices. Constant REEs abundance patterns were found in all samples, with enrichment of LREEs over HREEs, which suggests that REEs are transported as a coherent group through aquatic ecosystems. There are variations in the REEs abundance for every site, however, they reveal connections in their REEs distribution patterns, which suggest that they are of parallel origins. As no data on the permissible limits of REEs in biota reported, assessment with permissible limits are quantified by comparing with Hg, Pb and Cd data as REEs concentrations seems to be lower compared with these metal values. Conclusions: Results showed that the values are considerably below the safety limit, with the exception of Ce and Nd in the soft tissue of S. cucullata
Traditional postpartum dietary practices and maternal nutritional status
Get PDFIntroduction: In Malaysia, new mothers commonly practice traditional postpartum dietary restrictions, which generally involve food proscriptions and prescriptions. These practices may affect the success of breastfeeding as it may impact the ability to meet the increased nutritional requirements during lactation period. This review examines the postpartum dietary practices of different cultures. It also intends to assess maternal nutritional status during the confinement period. Methods: A literature search was conducted through Mendeley software and PubMed (from year 2001 to 2016) by the keywords postpartum, practices, dietary, beliefs, culture, and nutritional status. Search by bibliography was also done. Results: A total of 30 literatures were examined in this review, which included quantitative and qualitative studies. Typically, mothers in Eastern cultures avoid intake of particular foods perceived to have properties of “cold”, “gassy”, “itchy”, etc. A study found that women in confinement have 19% lower mean energy intake as compared to Malaysian Recommended Nutrients Intake (RNI) and more than 90% of mothers did not meet nutritional requirements for some micronutrients and minerals. As lactating mother needs higher energy and nutrients intake, food restrictions practiced during this period may impact their ability to meet these nutritional requirements. Consequently, the lactation process may be affected. Conclusions: More investigations are needed to determine the potential effects of dietary postnatal restrictions on maternal nutritional status and lactation practices. This is necessary to optimize the effectiveness of breastfeeding, which would enhance the intermediate as well as the future health of the country’s next generations
The mechanistic role of catalytic residues in non-stereo dehalogenase (DehE)
Get PDFIntroduction: DehE or non-stereospecific dehalogenase from Rhizobium sp. RC1 catalyzes the hydrolytic dehalogenation of both isomers of D,L-2-haloacids to produce an inverted configuration of 2-hydroxyl acid. The enzymatic degradation for the removal of halides from haloacid substance has been highlighted since the enzyme itself is a potential candidate as bio-remediation agent. However, the mechanistic role of active site residues for dehalogenase is still unclear, especially for non-stereospecific ones. Method: In this study, using computational analysis, the complex structure of DehE docked with catalytic water (DehE-H2O) was subjected to MD simulation to study the mechanistic role of catalytic residues, especially Asn114 and Asp189 towards catalytic water. Results: Our findings confirmed that Asn114 hold the catalytic water at distance of ~4 Å while Asp189 was appropriately oriented towards catalytic water for catalysis reaction throughout the simulation process. Conclusions: The results attained here will play important role in elucidating the direct attack mechanism of halogenated compound by non-stereospecific haloacid dehalogenase. Moreover, this research could suggest different solvent that can be used in dehalogenation to produce a beneficial product other than hydroxyl acid
The reliability of an error classification system developed for use by the International Islamic University Malaysia Primary Care Clinic
Get PDFIntroduction: Primary care is often the entry point for patients in a healthcare system. The literature, however suggests that primary care is not as safe as it should be due to medical errors. Because no error classification has been developed for preventing medical errors in Malaysian primary care clinics. Thus, this study aimed to develop an error classification system for use in the International Islamic University Malaysia Primary Care Clinic (IIUMPC) before assessing its reliability and acceptability to potential users. Methods: An error classification system for primary care was developed by merging four existing error classification systems. This cross-sectional study, then recruited 107 healthcare students as participants. Each student had to read 3 case studies on medical errors in primary care before classifying each case using the newly developed error classification system. The students then had to fill in a questionnaire to provide feedback about the classification system. The interrater reliability was then compared using Krippendorff's alpha. Results: Krippendorff’s alpha coefficient computed for Case I was 0.358, Case II was 0.369, while Case III was 0.314. The mean Krippendorff’s alpha coefficient for all three cases was 0.347. 72% of participants indicated their willingness to use the classification system in the future, citing ease of use (48%) among others. Conclusions: Although a new error classification system was successfully developed for use in the IIUMPC, the level of agreement between classifiers was considered low. Nevertheless, the positive responses by the participants warrant the classifications system's improvement
Production of monoclonal antibodies to immunogenic peptides of ω-glaidin/c-hordein and rye-secalin for gluten free food screening
Get PDFIntroduction: The ω-glaidin/c-hordein (QPFPQPEQPFPW) and rye-secalin (QPFPQPQQPIPQ) peptides have previously demonstrated immunogenicity in sensitised coeliac T cell lines. The development of monoclonal antibody to those immunogenic peptides is presented with a view of developing an improved enzyme linked immunosorbent assay (ELISA) as a reliable tool to screen the safety of foods specialised for coeliac disease (CD) patients. Methods: Balb/C mice were fed with gluten free food. The immunogens were conjugated to purified tuberculin protein derivative (PPD) with glutaraldehyde and emulsified in Freund’s adjuvant. The employed immunization schedule included 3-5 weeks intervals, followed by a final intravenous injection without adjuvant, 3-4 days prior to fusion. Results: The antibody produced was IgM rather than IgG, although the hybridoma was successfully generated. The IgM class antibody is known to be relatively unstable, so could not be used in kits designed for food screening. Conclusions: The immunogenic peptides could possibly be used to raise monoclonal antibodies for gluten screening. However, a single booster injection might be insufficient to stimulate the spleen directly or the mice should be immunized with higher concentration of immunogen. This could be improved by including multiple booster administrations and increasing the dose