IIUM Medical Journal Malaysia (IMJM)
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Common Iliac Artery Aneurysm: Management Issues In The Era Of Endovascular Treatment
Get PDFCommon iliac artery aneurysm (CIAA) is rare. It only constitutes about 2% of all abdominal aneurysms. CIAA develops silently with typical presentation of hemorrhagic shock after rupture, which carries a very high perioperative mortality. Atypical presentation includes unilateral lower limb weakness, pain and swelling. These symptoms should alert clinicians to the differential diagnosis of iliac artery aneurysm. Early detection and investigations are paramount since immediate intervention can considerably improve the outcome. We will highlight 3 cases of symptomatic common iliac artery aneurysm with different treatment modalities. The options of management, including literature review regarding open and endovascular treatment will be highlighted
Antilipase and antioxidant activity of Orthosiphon stamineus methanolic extract
Get PDFIntroduction: Antilipase from natural resources are a potential tool for the treatment of obesity while antioxidant-rich plants are essential in combating degenerative diseases. The aim of this study is to determine the antilipase and antioxidant activity of Orthosiphon stamineus methanolic extract. Methods: The inhibitory activity against pancreatic lipase was determined by measuring the hydrolysis of p-nitrophenyl butyrate to p-nitrophenol at 405 nm. Antioxidant activity of O. stamineus extract was measured by 2, 2, diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging activity assay. Results: The O. stamineus crude extract exhibited strong lipase inhibitory activity with an IC50 value of 34.7 µg/ml. The inhibition mode study disclosed that O. stamineus could act as uncompetitive inhibitor. O. stamineus showed high antioxidant activity with an EC50 value of 26.3 µg/ml. Conclusions: The results suggest that O. stamineus has shown potential as a source of natural antilipase and antioxidant
Evaluation of the phytochemical content and the use of the essential oil from the leaves of Malaysian Plectranthus amboinicus (lour) spreng as antimalarial in vivo
Get PDFIntroduction: This study was conducted to evaluate the phytochemical contents and antimalarial properties of the essential oils extracted from the leaves of Malaysian Plectranthus amboinicus in mice infected with Plasmodium berghei. Methods: The essential oils were extracted and prepared by using a steam distillation technique and subjected to phytochemical screening by using gas chromatography–mass spectrometry (GC-MS). The antimalarial activity of different extract doses of the essential oil was tested in vivo in ICR (Instritute of Cancer Research) mice infected with Plasmodium berghei (PZZ1/100) during early, established and residual infections. The control groups were treated with distilled water (containing 10% DMSO, the solvent of the test extracts) and 2 standard drugs: chloroquine and Fansidar. Results: In all, 5 compounds made up 88.34% of total oil and the major chemical compounds were carvacrol (85.14%), thymoquinone (1.65%), terpinen-4-ol (0.70%), octenol (0.62%) and thymol (0.23%). Antimalarial assay showed this essential oil as a potential prophylactic agent with the percentage chemosuppression of 45.23%, 18.28%, 45.38% and 58.26%, while treated with 50, 200, 400 and 1000 µL/kg respectively of essential oil. It also showed a potential as a curative agent with percentage of chemosuppression of 54.10%, 47.35%, 56.75% and 65.38% while treated with the above dose of essential oil. Statistically, no reduction of parasitemia was calculated for suppressive test. Conclusions: The extract has prophylactic and curative effects on P.berghei in mice
Post concussion syndrome after mild traumatic brain injury in a single neurosurgical center in East Coast, Malaysia - A preliminary report
Get PDFIntroduction: Mild traumatic brain injury is the most common form of traumatic brain injury. Individuals sustaining mild head injuries often complain of a cluster of symptoms termed post concussion syndrome. Post concussion syndrome can be profoundly disabling. Thus the aim of this study is to determine the prevalence of post concussion syndrome in an adult population with mild traumatic brain injury in a single neurosurgical center in East Coast, Malaysia. Methods: Cross Sectional study, in a single neurosurgical center in Kuantan, Pahang. The study period is from January 2016 – December 2016. Universal sampling method was used, all patients with mild traumatic brain injury presenting to HTAA, meeting the inclusion and exclusion criteria is included in this study. Patients are then subjected to the checklist for diagnosis of post concussion syndrome as per ICD 10 classification at 2 weeks interval. Results: Between February 2016 – June 2016, a total of 136 patients with mild traumatic injury have been recruited to this study. The leading cause of mild traumatic brain injury is road traffic accidents, 86 patients (63.2%), and the mean age of this patient with mild traumatic brain injury is 28.8. Out of this number, 11 patients (8.1%) have been diagnosed with post concussion syndrome. Conclusions: The majority of individuals who sustain mild traumatic brain injuries are young adults, and the most common cause is road traffic accidents. Less than 10% of recruited patients suffered from post concussion syndrome
Quantification of pterygium fibroconnective components utilizing freeze-dried method
Get PDFIntroduction: To propose an objective method of quantifying pterygium fibroconnective components utilizing freeze-dried method. Methods: 60 primary pterygium were excised using controlled partial avulsion technique performed by a single surgeon (KMK), and divided into two groups: formalin-fixed (n=30) and fresh (n=30). Initially, each sterile container weight was measured and 5ml of 5% buffered formaldehyde were filled and stored for 1 week for formalin-fixed group while, 5ml distilled water were filled for fresh pterygium group. Each container was pre-frozen for 12 hours prior to freeze-dried (-80ºC for 24 hours). The final product known as fibroconnective tissue, then weighted as dry weight. Comparative analysis of wet and dry weight, and percentage of fibroconnective components between groups were performed via an independent t-test. Results: The overall mean and SD for formalin-fixed and fresh pterygium wet weight were 253.33 ± 82.17 μg and 255.17 ± 63.52 μg, and dry weight were 184.92 ± 84.31 μg and 179.54 ± 72.85 μg respectively. In terms of percentage of fibroconnective components, formalin-fixed group revealed slightly higher percentage compared to fresh pterygium tissue with 69.39 ± 13.29 % and 67.75 ± 13.27 % respectively. The difference in pterygium dry weight, between formalin-fixed and fresh pterygium tissue was statistically insignificant (p=0.792). Conclusions: The freeze-dried method can be used to quantify the fibroconnective component (dry weight) of pterygium fibro vascular tissue. Both methods (formalin-fixed and freeze-dried) are reliable in producing results. This is proven as there is no statistical significance between the two methods
Intertrochanteric fracture fixation with Dynamic Hip Screw: Is tip-apex distance measurement useful for predicting fixation failure?
Get PDFIntroduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable intertrochanteric fractures continues to raise concern related to risk of lag screw cut-out with or without subsequent damage to the acetabulum. Measurement of tip-apex distances (TAD) has been recommended to guide the optimal placement of lag screw and to predict subsequent risk of screw cut-out. In this study, the value of TAD was evaluated to verify its usefulness. Methods: This is a retrospective study of 33 consecutive patients with intertrochanteric fracture treated with DHS. Demographic data of the patients were traced from their case notes. Post-operative radiographs were reviewed by focusing on measurement of TAD on anteroposterior and lateral radiographs. Radiographs at one year follow-up were reviewed to depict any fixation-related failure or complication. Results: Fifty two percent of patients did not achieved the recommended TAD of ≤ 25mm. The mean post-operative TAD was 25.9mm and elderly patients were likely to achieve TAD of ≤ 25mm. The overall complication rate of 6% was attributed to screw cut-out in two cases. The unstable left-sided fracture was identified to be a potential risk for screw cut-out or migration. Conclusion: TAD is a valuable measurement to guide optimal placement of lag screw during DHS fixation of intertrochanteric fracture
New Modified Equation of Contact Lens Method in Determining Post Myopic Laser Refractive Surgery Corneal Power
Get PDFIntroduction: The purpose of this study was to derive a modified equation for contact lens method (CLM) in calculating post myopic laser refractive surgery corneal power. Methods: A total of 93 subjects who underwent myopic laser refractive surgery at IIUM Eye Specialist Clinic were recruited. The accuracy of postoperative corneal power using the standard CLM and newly-derived contact lens modified method (CLMmod) were compared to the standard comparison method ; the historical method (HM). The CLMmod equation was derived by adjusting postoperative corneal power of CLM according to amount of refractive change. Results: The mean postoperative corneal power using standard CLM was significantly higher than HM (mean difference: -0.24 D, p < 0.001). Fifty seven percent (n = 53 eyes) of the standard CLM results were within ±0.50 D of HM results. The difference between postoperative corneal power using standard CLM and HM increased significantly with the amount of refractive change (r = 0.835; p < 0.001). The mean postoperative corneal power of CLMmod showed that there was no statistical significant difference compared to the HM results (mean difference: 0.00 D, p= 0.964). Eighty eight percent (n = 82 eyes) of the CLMmod results were within ±0.50 D of HM results with improvement of 31% from the standard CLM results. Conclusion: The CLMmod equation provides more accurate calculation in determining post myopic laser refractive surgery corneal power. In near future, this modified equation can be used as an alternative equation to calculate postoperative corneal power when the preoperative data is unavailable
Prevalence of cardiometabolic risk factors among Malaysian obese adults
Get PDFIntroduction: Obese adults are associated with increased cardiometabolic risk (CMR). The study aims to investigate the prevalence of CMR factor abnormalities in obese adults in Kuantan. Methods: Seventy-six obese adults with a mean (standard deviation) age of 33.7 years (9.8 years) participated in this study. All participants had a waist circumference (WC) measured, blood pressure (BP) taken, and assessment of fasting blood glucose (FBG), lipid profile (LP) and high-sensitivity C-reactive protein (hs-CRP) level. Results: For CMR factors, the mean values for WC was 97.2 ± 9.6 cm, mean overall BP was 119 ± 15/76 ± 11 mmHg, mean FBG level was 4.8 ± 0.5 mmol/L and the mean of total cholesterol (TC) and triglyceride (TG) was 5.4 ± 1.0 mmol/L and 1.4 ± 0.7 mmol/L, respectively. Lastly, the mean of hs-CRP was 6.0 ± 6.1 mg/L. The CMR factors with the highest prevalence of abnormal values included WC (male 100%; female 98%) and TC (male 73.1%; female 52%) for both genders, systolic BP (50%) and TG level (61.5%) for male, and hs-CRP level (68%) for female. Out of the nine CMR factors measured, five CMR risk factors were shown to have a high prevalence of abnormalities. Conclusions: The present study suggests that obese adults in Kuantan have multiple CMR factor abnormalities. A larger trial, sensibly informed of this trial, can now build upon and confirm these results
Osteochondral defect repair via autologous implantation of three dimensional construct engineered from poly (lacticco-glycolic acid) / fibrin hybrid scaffold seeded with bone marrow mesenchymal stem cells
Get PDFIntroduction: Treating damaged articular cartilage is a predicament in the orthopaedic field due to its limited capacity for regeneration. Efforts to find the best available treatment for articular cartilage injuries are still actively ongoing. This study investigates the ability of the autologous implantation approach using three dimensional (3D) constructs engineered from bone marrow mesenchymal stem cells (BMSCs) seeded on poly(lactic-co-glycolic acid) (PLGA) with or without fibrin as cells carrier for the repair of full-thickness osteochondral defect in rabbit model. Methods: 3D PLGA was fabricated via solvent casting-salt leaching technique using salt as porogen. The BMSCs obtained from the New Zealand white rabbits were cultured and mixed with (1) autologous plasma-derived fibrin or, (2) culture media which served as the control, prior to ‘cells seeding’ procedure into the PLGA. After three weeks of in vitro culture, the engineered 3D constructs - PLGA/Fibrin/BMSCs (PFB) and PLGA/BMSCs (PB) - were implanted autologously to the osteochondral defect created in the rabbit’s knee. The in vivo constructs were harvested en bloc and evaluated by gross inspection and histology, gene expression, sulphated glycosaminoglycan (sGAG) production and biomechanical defect property at 6 and 12 weeks post implantation (n=6 for each group). Results: The results showed that the osteochondral defects treated with the PFB constructs exhibited better repairment, more cartilaginous extracellular matrix, higher sGAG content, significantly stronger compressive strength and greater expression of chondrogenic marker genes than the PB group. Conclusions: The findings suggest that PFB with optimal induction are feasible to treat osteochondral and may become a potential treatment modality aiming to treat articular cartilage disease in human
Nigella sativa oil extracts improves dyslipidaemia in high fat diet (HFD) animal model
Get PDFIntroduction: Nigella sativa has been reported to have anti-inflammatory and antioxidative properties. We aimed to investigate the effects of Nigella sativa oil extract on the high fat diet (HFD) fed animal model. Methods: Thirty male Sprague-Dawley rats were used. Four groups (n=7) were fed with high fat diet (HFD) rat pellet orally for 10 weeks. The rats with HFD groups were subsequently randomly divided again into 4 groups. One group was continued with HFD while the other 3 groups were continued with the HFD in addition to Nigella sativa oil extract treatment at three different concentrations (0.5, 1 and 1.5 ml/kg/day) for another 4 weeks. Blood biochemical analysis and histological assessment of liver were subsequently performed. Results: Animals fed with HFD had increased aspartate aminotransferase (AST), alkaline phosphatase (ALP), albumin, cholesterol/HDL ratio, triglyceride (TG) levels, but decreased globulin, albumin/globulin ratio and high density lipoprotein (HDL) levels. Meanwhile, HFD animals treated with Nigella sativa oil extract showed a significant increase in the globulin and HDL levels, but reduced ALP, albumin, cholesterol/HDL ratio and TG levels. Nigella sativa oil extract at the higher doses displayed much better effect. Histologically the liver in all groups exhibited micro vesicular steatosis. Conclusions: Nigella sativa oil extracts improve the dyslipidaemia in animal models with HFD