IIUM Medical Journal Malaysia (IMJM)
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Kappa antagonist to prevent drug relapse: Does stage in addiction cycle matter?
Get PDFIntroduction: An upregulation of the kappa opioid receptor (KOR) system during drug preoccupation stage in addiction cycle will cause dysphoria among addicts which can lead to relapse. Therefore, KOR antagonism treatment might hold the key to prevent relapse. In this study, we aim to identify the exact addiction’s stage in which KOR antagonist can be given. Methods: Using a conditioned place preference (CPP) model, adult male Swiss albino mice were divided into two major groups. The first group received treatment at the initial stage of morphine withdrawal (7.5 mg/kg, i.p) while the second group received treatment after complete abstinence was achieved. Each major groups were further divided into two treatment groups (n=8-12), either received a functional KOR antagonist (0.3 mg/kg buprenorphine/ 1 mg/kg naltrexone combination, i.p) or a selective KOR antagonist (10 mg/kg nor-BNI, i.p) prior to morphine priming (2.5 mg/kg, i.p). All data were analyzed using paired sample t-test. Results: The results showed that relapse was successfully attenuated in the groups that received KOR antagonists only after complete abstinence was successfully achieved (not significantly different from their baseline). However, the mice developed unusual sign of behavior sensitization (intermittent freezing, licking) when buprenorphine/naltrexone combination was given at initial stage of withdrawal. Conclusions: Our initial findings suggest that KOR antagonism might be beneficial only after the addicts achieved complete abstinence to prevent future druginduced relapse. Brain study should be conducted to explain the unusual behavior seen when the drug intervention is given at an earlier stage of withdrawal
Effects of Aromatherapy on Anxiety and Vital Signs of Myocardial Infarction Patients in Intensive Care Units
Get PDFIntroduction: Patients with myocardial infarction (MI) who were admitted to CCU experience anxiety. Anxiety increases the risk of ischemia and worsens the prognosis of MI. The aim of this study was to determine the effects of inhaling lavender oil on anxiety levels and vital signs in MI patients. Methods: A randomized controlled trial was performed. Sixty patients with MI were randomly assigned to the intervention and control group. The intervention group inhaled the essential oil of Lavender for three days (20-30 min/day, 3times/day) using a non absorbent paper which was stained with three drops of lavender oil. In control group steriled water was used. Each patient was assessed before and after intervention for the following clinical parameters: anxiety by state-trait anxiety inventory (STAI) and vital sign by Vista monitoring. The data were analyzed using Chi-square, paired t-test and Analysis of Covariance. Results: Results showed statistically significant decrease in state and trait anxiety at the end of study from 60.26±9.29 to 41.56±7.57 (P<0.001) and 55.73±10.22 to 44.53±7.28 (P<0.001) respectively, but in the control group were observed statistically significant increase in state and trait anxiety (P<0.001). Also statistically significant decrease were observed in blood pressure at the end of the intervention (p<0.05). The values for state and trait anxiety and blood pressure decrease in the intervention group in comparison with the control group (P<0.001 and p<0.05, respectively). Conclusion: This study showed that inhalation of lavender oil can reduce state and trait anxiety level and blood pressure in patients with MI
The Impact of Fluid Balances in the First 48 Hours on Mortality in the Critically Ill Patients
Get PDFIntroduction: There has been increasing evidence of detrimental effects of cumulative positive fluid balance in critically ill patients. The postulated mechanism of harm is the development of interstitial oedema, with resultant increase morbidity and mortality. We aim to assess the impact of positive fluid balance within the first 48 hours on mortality in our local ICU population. Methods: This was a secondary analysis of a single centre, prospective observational study. All ICU patients more than 18 years were screened for inclusion in the study. Admission of less than 48 hours, post-elective surgery and ICU readmission were excluded. Cumulative fluid balance either as volume or percentage of body weight from admission was calculated over 6, 24 and 48 hour period from ICU admission. Results: A total of 143 patients were recruited, of these 33 died. There were higher cumulative fluid balances at 6, 24 and 48 hours in nonsurvivors compared to survivors. However, after adjusted for severity of illness, APACHE II Score, they were not predictive of mortality. Sensitivity analysis on sub-cohort of patients with acute kidney injury (AKI) showed only an actual 48-hour cumulative fluid balance was independently predictive of mortality (1.21 (1.03 to 1.42)). Conclusions: Cumulative fluid balance was not independently predictive of mortality in a heterogenous group of critically ill patients. However, in subcohort of patients with AKI, a 48-hour cumulative fluid balance was independently predictive of mortality. An additional tile is thus added to the mosaic of findings on the impact of fluid balance in a hetergenous group of critically ill patients, and in subcohort of AKI patients
Premature Ejaculation in Urban Malaysian Population: The Associations between Erectile Dysfunction(ED), Anxiety and Depression
Get PDFIntroduction: Both premature ejaculation(PE) and erectile dysfunction(ED) are prevalent sexual health disorders that have been inadequately investigated in Malaysia, a multiethnic and conservative nation.The objective of the study was to study the relationship between PE and ED, and other common mental health issues, i.e. anxiety and depression in Malaysian urban population. Methods: The diagnosis for PE was established by clinical diagnosis using DSM-5 and ISSM definition criteria for PE, whereas a diagnosis of ED was established by the International Index of Erectile Function (IIEF) questionnaire. Anxiety and depression levels were detected from the Hospital Anxiety and Depression Scale (HADS). Results: Based on DSM-V and ISSM clinical diagnosis for PE, the prevalence of PE was found to be 25%. Erectile dysfunction (p = 0.035, OR = 3.315, 95% CI 1.088, 10.103) and severe anxiety (p = 0.020, OR = 7.656, 95% CI 1.383, 42.396) significantly predicted presence of PE. Conclusion: There was a strong association between PE and ED and between PE and anxiety. Routine examination for PE in male patients should address the issue and the management of both ED and anxiety among PE patients, especially in an urban Malaysian clinical and medical care setting
Knowledge, Attitude and Practice towards Religious Obligations among Healthcare Workers in Hospital Langkawi, Malaysia
Get PDFIntroduction: Islamic prayers involve certain physical movements and positions. These positions may be difficult to achieve in Muslim patients who suffer from any illness that limit their physical movements. Therefore, Islam introduced the concept of Rukhsah or exemptions. The objective of this study was to assess the knowledge, attitudes and practices of healthcare workers related to performing prayers during illness. Materials and Methods: A cross sectional study was conducted among 121 healthcare workers in Hospital Langkawi, between 22nd to 24th April 2014. Simple random sampling method was used to select the participants among healthcare workers in Hospital Langkawi to attend a workshop on Rukhsah Ibadah. The participants were given a set of questionnaire to answer and all the data were collected just before the talk began. Results: The majority of the participants 108 (89.3%) were female and more than half of them 74 (61.2%) were staff nurses. The mean age for the participants was 32.4 (SD: 9.42) years. About 73 (60.3%) of the participants have good knowledge, 62 (51.2%) have good attitude and 73 (60.3%) have good practice towards religious obligations and Rukhsah. Bivariate analysis shows no correlation between age and knowledge, attitude and practice score. There was also no correlation seen between knowledge, attitude and practice score. Conclusion: Almost half of the participants have good knowledge, attitude and practice on performing prayers during illness. By conducting proper training and coaching, it is hoped that their level of understanding towards Rukhsah can be improved
Factorial Validation and Psychometric Properties Establishment of Malay Version Critical Care Family Need Inventory
Get PDFIntroduction: Despite general acknowledgement of the importance in assessing family needs in critical care patients, there is no psychometric instrument to measure the family needs within Malaysian settings. This study aimed to perform factorial validation and establish psychometric properties of Malay translated Critical Care Family Need Inventory (CCFNI-M) for Malaysians. Methods: This study consisted of four protocols: Forward-Backward translation, validity, internal reliability and inter domain correlations phases. The factorial validation of the CCFNI-M was based on its administration to 109 family members of critical care patients admitted to the Intensive Care Unit of Hospital Universiti Sains Malaysia, Kelantan, Malaysia. At validity phase, factorial validation was performed using Exploratory Factor Analysis using Principal Component Analysis with Varimax rotation. The internal consistency and inter domain correlations were calculated using Cronbach’s alpha and Pearson correlation coefficient respectively. Results: Preliminary analyses reported the suitability of data for factorial validation. With reference to the original CCFNI, five factors were extracted which explained 49.4% of the total variance. After removal of several items for different reasons, the final items in CCFNI-M were 42. The internal consistency values for five dimensions ranged from 0.72 to 0.87 with inter domain correlation values (r) among the dimensions ranged between 0.36 and 0.61. Conclusion: The high measures of factorial validity, internal consistency and inter domain correlations values of the CCFNI-M make it suitable measure for assessing the family needs of critical care patients
Radionuclide study in gastroparesis: Is it still relevant?
Get PDFThe incidence of gastroparesis in Malaysia is not well documented. Gastroparesis may present with various combinations of debilitating sign and symptoms that decrease quality of life and increases morbidity. It is diagnosed based on clinical symptoms and exclusion of the obstruction. There should be a high index of suspicion in patients who present with symptoms to avoid missing the diagnosis. There are various approaches to study the gastric motility. Here’s a case of a young adult woman with type 1 diabetes mellitus suffering severe gastrointestinal symptoms. In this case, radionuclide scintigraphy is used as one of the investigation to confirm the diagnosis of gastroparesis. Radionuclide scintigraphy remains a hallmark in the diagnosis of gastroparesis after excluding mechanical obstruction
Oral hygiene practices and periodontal disease status assessment among diabetic patients from three selected public medical primary care clinics in Kuantan, Malaysia
Get PDFIntroduction: Evidences on the bilateral relationship between diabetes mellitus (DM) and periodontal diseases (PD) have been growing. Oral hygiene practice (OHP) is one of major determinants for PD. Thus, the aim of this study was to assess periodontal disease status and oral hygiene practices of DM-patients from public medical primary care clinics (PMPCCs). Methods: A medical-dental research team conducted an active PD-screening among 193 DMpatients using both self-reported questions (SRQs) and basic periodontal examination (BPE) by professionals at 3-PMPCCs in Kuantan in 2015. OHP was categorized into two groups; acceptable OHP (two/three-time tooth-brushing/day using with/without mouthwash/flossing) and need to improve OHP (one-time tooth brushing/day using with/without mouth-wash/flossing). HbA1C ≤ 6.5% was used as cut-off for glycaemic control achievement. A cross- analysis was done to infer the influences of demographic-background and OHP on PD- status and relationship between PD- status and glycaemic control achievement. Results: Out of 193 DM-patients, 72.5% (140/193) were PD-screening positive in self-reporting while 54.9% (106/193) had PD in professional screening. OHP of majority (86%) were acceptable. Only 14% (27/193) achieved glycaemic-control status. Influence of demographic and OHP on PD-status ( by BPE) and relationship between PD and glycaemic control achievement did not found out. There were no age and race difference in OHP; however, acceptable OHP was significantly higher (p<0.05) in female than male DM-patients (94% vs 77.4%). Conclusions: High prevalence of PD indicated to promote oral health education/care among DM-patients from PMPCCs. In-detailed OHP/PD assessment and other influencing factors on glycaemic-control achievement should be considered to get more valid results in further study
Antibiotics prescribing patterns in medical wards of Yangon General Hospital, Myanmar
Get PDFIntroduction: Irrational and inappropriate prescribing of antimicrobial is common in hospitals and contributes to the development of antibiotic resistance in clinical practice. In Myanmar, there is insufficient information concerning antibiotics prescribing patterns in some hospitals. Therefore, the aim of this study was to determine the prescribing patterns of antibiotics in various infections. Methods: A descriptive cross-sectional study was carried out over a 3- month period in the medical wards of Yangon General Hospital. A total 1054 patients who were prescribed with antibiotics for post-admission day were selected. Relevant demographic data, discharge diagnosis, antibiotic prescribing patterns and outcomes of the patients were collected through pro-forma. Results: The result revealed that the antibiotics prescribing rate in Yangon General Hospital was 49%. Amongst the major indications included acute gastroenteritis (10%), chest infections (6.8%), skin and soft tissue infections (6.5%), pneumonia (6.1%) and spontaneous bacterial peritonitis (6.0%). The most frequently prescribed antibiotics were combination of aminopenicillin with beta lactamase inhibitors (29.4%), metronidazole (28.2%), ceftriaxone (24.4%), azithromycin (15.2%) and cefixime (12.8%). The majority of the patients were discharged from hospital (73.7%) whereas the expired population was 8.6%. Conclusions: This study offers useful information in developing antibiogram for medical wards of Yangon General Hospital, Myanmar. The findings of this study could contribute to improvement in the treatment outcomes
The adsorption behaviour of lysozyme as a potential antibiofouling agent
Get PDFIntroduction: Biofilms can be problematic or beneficial. Reports on the underlying adsorption in such context-dependent fouling phenomena have been extensive. However, the mechanisms involved is scarce and appears adsorbate or foulant-specific. Methods: In this study, attenuated total reflection infrared spectroscopy was used to probe the solid-liquid interfacial phenomena involving lysozyme for assessing its surface antibacterial actions. Results: Lysozyme preferentially adsorbed more on to the hydrophilic coated ZnSe IR prism than to an uncoated ZnSe IR prism. Data on discrete adsorption rates suggested that lysozyme was adsorbing as multi-layer aggregates on to the ZnSe prism, and showed faster adsorptiondesorption patterns on an uncoated compared to a TiO2-coated ZnSe IR prism. A novel phosphate-modified TiO2 coating material for ZnSe IR prism was prepared as adsorbate which increased the negative charge on the TiO2 surface via P-O-Ti coordinated linkages, increasing the initial rate of lysozyme adsorption. Enhanced adsorption of lysozyme was achieved by increasing both the solution pH and NaCl concentration. Maximum adsorption occurred at pH 11 which corresponded to the protein’s isoelectric pH. Conclusions: ATR-IR spectroscopy has proved to be a useful method to study surface adsorption of antibacterial agents such as lysozyme for further explorations into approaches to control biofouled surfaces