IIUM Medical Journal Malaysia (IMJM)
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Misconceptions about disease among parents of thalassaemic patients: A qualitative study
Get PDFIntroduction: Poor understanding and knowledge about thalassaemia has been associated with a poor attitude towards the disease as a whole. Thus, it is the aim of this study to explore the poor attitude and misconceptions about thalassaemia among the parents of thalassaemic patients. Methods: This study was conducted over a six-month period. Five focus group sessions (5-6 per group) involving different sets of parents of thalassaemia patients attending the Paediatric Clinic of Tengku Ampuan Afzan Hospital, Kuantan, Pahang, Malaysia was carried out. Results: The study reveals that misconceptions associated with thalassaemia are still prevalent as shown in our study. Misconceptions that we encountered were related to the underlying cause, sign and symptoms, blood transfusion therapy and iron chelation therapy. Such incorrect knowledge was observed among parents coming from different educational backgrounds and socioeconomic status. As a result of misconceptions parents opt for alternative medicine or to seek treatment from traditional healers for thalassaemia. Conclusions: Several misconceptions still continue despite the nationwide campaign on screening programme to increase awareness about the disease. More effort is needed to improve the knowledge of the parents of thalassaemic patients as they have direct influence on the supervision of the management of thalassaemia patients
Proximate composition of Malaysian Trigona and Tualang Bee Honey
Get PDFIntroduction: Honey is widely known as a natural product which is collected from various plants by bees. The aim of this study was conducted to determine the proximate composition (moisture, ash, crude protein, total fat, dietary fiber and total carbohydrate) of four Malaysian honey samples. Methods: TB1 (Trigona bee honey from Kedah), TB2 (Trigona bee honey from Kelantan), TU1 (Wild Tualang bee honey from Pahang) and TU2 (Tualang bee honey was collected from a farm from Pahang) were examined for their proximate compositions. Proximate composition was determined using the methods of AOAC (1990; 1995; 2003). Results: Moisture content was significantly the highest (p<0.05) in TB2 with a value of 30.586± 0.109 g/100g and the lowest in TU2 with a value of 18.914± 0.264 g/100g. TB2 had significantly (p < 0,05) higher ash content than other examined samples with a value of 0.766±0.010 g/100g. Protein content of TU1was significantly higher than the other analyzed honey samples with a value of 1.776±0.04 g/100g. The total fat content of TB2 was significantly lower than the other honey samples. Dietary fiber of TB1 was found to be significantly higher compared to the others with a value of 0.612±0.027. Total carbohydrate content was significantly (p<0,05) the highest in TU2 compared to other samples with a value of 79.980±0.280 g/100g. Conclusions: All honey samples are good sources of nutrients for human consumption. Moreover, the differences in the components of the different honey samples were probably connected with the variances in the floral source
Technical Considerations in the Surgical Management of External Laryngotracheal Trauma: Surgical Outcomes
Get PDFIntroduction: External laryngotracheal (ELT) trauma is rarely encountered in clinical practice. In most circumstances, this injury is overlooked by the primary attending team. Surgical management of ELT trauma is complicated, because there is no established management approach for this potentially life-altering, high morbidity injury. It is important for this injury to be identified early, as any delay in surgical intervention may result in poor airway and phonatory outcomes. The aim of surgical reconstruction is to minimise the above debilitating morbidities by restoring the main laryngeal functions as much as possible. Methods: We reviewed the outcomes of six surgical interventions for ELT trauma at Tengku Ampuan Afzan Hospital from June 2007 to June 2014. Clinical presentations, computed tomography (CT) scans features, intraoperative findings, and postoperative outcomes were evaluated. Results: All patients made a good recovery in terms of phonation except for one patient who had reduced speech function. After one year, one patient was still dependent on a fenestrated tracheostomy. This article describes the surgical reconstruction techniques used to achieve these positive outcomes. Stenting is helpful to aid healing and re-epithelialisation. Conclusion: Prompt recognition and non-traumatised airway control are essential for addressing laryngotracheal trauma. Subcutaneous emphysema is an important hallmark that should alert the attending physician to the possibility of ELT trauma. Immediate surgical intervention using appropriate techniques can produce favorable patient outcomes
An Unusual Cause of Lobulated Lung Mass
Get PDFEventration of the diaphragm is caused by weakened musculature of the diaphragm. This can occur in one or both hemidiaphragms. Symptoms may be minimal and it is usually detected incidentally on chest radiograph which would show an elevation of the diaphragm. We report and discuss a case of eventration of right diaphragm in a patient presented with a lobulated lung mass on chest radiograph
Cerebral Venous Thrombosis in Evan’s Syndrome: An Unusual Presentation
Get PDFCerebral Venous Thrombosis in patients with Evan’s Syndrome of autoimmune hemolytic anemia is rare. The common neurological symptoms are headaches, vision loss, dyslexia without agraphia, motor aphasia, unilateral upper limb weakness and papilloedema. We present a case report of a lady with a known case of Evan’s Syndrome whom presented with severe anemia and unilateral right sided hemiparesis with right facial weakness. Plain and Contrast enhanced CT brain showed bilateral high parietal white matter edema with venous thrombosis in the right transverse and superior sagittal venous sinuses. At the time of the diagnosis, she was in hematological remission
Systematic Review on the Functional Status of Elderly Hip Fracture Patients using Katz Index of Activity of Daily Living (Katz ADL) Score
Get PDFHip fractures cases are common in elderly population. After a hip fracture, around 80% of patients were unable to carry out at least one independent activity of daily living (ADL). This review attempted to provide an evidence-based literature on ADL of elderly hip fracture patients. A computerised literature search using Medline (OVID) and Scopus databases were conducted to identify relevant studies on ADL of elderly hip fracture patients that was assessed with Katz ADL score. Only articles that fulfilled the inclusion criteria were included in this review. Initial search identified 314 potentially relevant articles but after careful screening, only 5 full-text articles were selected for the present review. Three studies showed an increase dependent level of the patients’ ADL after hip fractures. Two studies showed not more than half of the patients were unable to regain their pre-fracture ADL level after one year of hip fracture incidence. Feeding/eating showed the highest independent activity while bathing was the lowest independent activity among patients. In conclusion, elderly hip fracture patients have declined ADL with the risk that they may never regain their pre-fracture ADL level
Pattern of Organisms and Antibiotics Used in Treating Diabetes Foot Infection
Get PDFIntroduction: The aim of this study is to determine the most common organisms isolated in diabetic foot infection and the most utilised antibiotic regimes as the first line of treatment. Methods: This is a retrospective record review of the National Orthopaedic Registry Malaysia among diabetes mellitus type 2 patients who had foot infections. All identified cases admitted to 18 government hospitals in Malaysia from the 1st January 2008 until the 31st December, 2009 were included in the study. Results: A total of 416 patients were included in the study. The most common organisms cultured were Proteus species (17.5%), Klebsiella species (17.1%) and Staphylococcus aureus (17.9%), while the most commonly used antibiotic was ampicillin/sulbactam (67.5%). None of the patients was appropriately treated with metronidazole, cefoperazone or fucidic acid. All patients were given appropriate antibiotics to treat Serratia infection. Conclusion: Significant number of patients with diabetic foot infections were not treated using appropriate antibiotics as the first line treatment
Investigation of an antidiabetic potential of a phenolic compound isolated from the leaves of mempelas paya
Get PDFIntroduction: Leaves of mempelas paya (Tetracera indica) (family: Dilleniaceae) is traditionally used in diabetes management in Malaysia. However, no attempt has ever been made to discover an active principle responsible for its blood glucose lowering effect. Hence, this research deals with the isolation, in vivo antidiabetic and toxicological evaluation of an active principle. Methods: Chemical investigation of methanol extract derived from the powdered leaves resulted in the isolation of a phenolic compound through repeated silica gel column chromatography. The structure was elucidated by spectroscopic (1H-NMR, 13C-NMR, MS, IR and UV) analysis. In vivo antidiabetic and toxicological studies were carried out using Sprague-Dawley rats (diabetic and normal) at three different concentrations (1, 5 and 25 mg/kg b.w.). Results: 5,7-dihydroxy-8methoxyflavone was found to exhibit significant anti-hyperglycaemic activity (p<0.05) in diabetic rats at 5 and 25 mg/kg b.w. without showing hypoglycaemic effect in normal rats. The anti-hyperglycaemic activity was found to be comparable with glibenclamide (GLBC) (p<0.05). In vivo toxicological study for continuous 21 days showed no abnormal activity and mortality. Histopathology of kidney, liver and pancreas of both normal and diabetic treated rats demonstrated normal and improved condition when compared to diabetic control group. There were no significant changes seen in the kidney (serum urea and creatinine) and lipid (TC, TG, LDL-C and HDL-C) functional parameters tested. Conclusions: 5,7-dihydroxy-8-methoxyflavone isolated from the leaves of mempelas paya coud be a safe antidiabetic agent
Model of a critical size defect in the New Zealand White rabbit’s tibia
Get PDFIntroduction: Critical size defects (CSD) in the long bones of New Zealand White rabbit (Oryctolagus cuniculus) have been used for years as an experimental model for investigation of the effectiveness of a new bone substitute materials. There are varieties of protocols available in the literature. This technical note attempts to present an alternative surgical technique of a CSD in the New Zealand white rabbit tibia. Methods: Thirty-nine New Zealand White rabbits were used in this study. A CSD of approximately 4.5 mm (width) X 9.0 mm (length) was surgically drilled at the proximal tibial metaphysis, approximately 1 cm from the knee joint. The surrounding of soft tissue was repositioned and sutured layer by layer with bio absorbable surgical suture. Povidone soaked gauze and bandage were used as a dressing. There is no control group used in this study. Results: This alternative method created good CSD with less bleeding from the muscle observed. No mortality on other surgical complications were observed within 6 weeks, 12 weeks and 24 weeks following surgery. Conclusions: A simple and safe method for performing critical size defect was demonstrated and recommended as an approach for surgery on New Zealand White rabbits
The mid term functional outcomes of NexGen legacy posterior stabilized flex fixed bearing total knee replacement in primary osteoarthritis
Get PDFIntroduction: To evaluate the midterm functional outcomes of patients who had undergone total knee replacement (TKR) using posterior stabilized (PS) fixed bearing system from January 2005 until April 2006 for primary osteoarthritis of the knees. Methods: A retrospective study was done on forty-six patients, 87% female (n= 40) and 13% male (n=6), aged 54 to 81 years old (mean 69 ± 5.69) who had undergone primary TKR using the NexGen LPS-Flex Zimmer Warsaw. The patients were followed up for at least five years. A medial parapatellar approach and cemented posterior stabilized fixed bearing TKR system were used performed by one of two arthroplasty surgeons. All patients followed the same rehabilitation protocol post-operatively. Assessments were done using Oxford-12 knee scoring questionnaire to evaluate knee function and SF-36 to assess quality of life outcomes. Results: Oxford knee score revealed patients had lower (better) than average scores in terms of function (score 14.35 ± 4.21 out of 35) and pain (score 9.28 ± 3.01 out of 25). Analysis on the quality of life outcome score with SF-36 revealed a higher (better) score for mental component summary (MCS) relative to physical component summary (PCS). Patients had the highest score for role emotional (RE), followed by mental health (MH), and social functioning (SF). Conclusions: The NexGen LPS-Flex TKR produced a good functional outcome with minimal pain in the operated knee with better mental compared to physical health of patients in the midterm period post-total knee replacement