IIUM Medical Journal Malaysia (IMJM)
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The Immunologic Properties of Undifferentiated Stem Cells from Human Exfoliated Deciduous Teeth (SHED) and Its Potential Application in Bone Regeneration
Get PDFIntroduction: Stem cells from human exfoliated deciduous teeth (SHED) are highly proliferative, clonogenic cells capable of differentiating into osteoblasts and inducing bone formation. It is a potential alternative for stem cell bone regeneration therapy. However, stem cell therapy carries the risk of immune rejection mediated by inflammatory cytokines of the human defense system. Objective: This preliminary research studies the interaction between SHED and the immune system by determining the inflammatory cytokines profile and osteogenic potential of SHED. Methods: Human fetal osteoblasts (hFOb) cell line and isolated SHED were cultured and total RNA was extracted, followed by reverse transcription cDNA synthesis. Semi-quantitative reverse transcription PCR and Multiplex PCR were performed to detect the expression levels of OPG/RANKL and TNF-α, IL-1β, IL-6, IL-8 and TGF-β in both cell types. Results: Analysis showed that SHED expressed significantly lower amounts of IL-1β, IL-6, and IL-8 compared to hFOB. IL-1β is a potent bone-resorbing factor, while IL-6 and IL-8 induce osteoclastogenesis and osteolysis respectively. SHED did not express TNF-α which stimulates osteoclastic activity. SHED demonstrated high OPG/RANKL ratio, in contrast with that of marrow stem cells described in previous studies. Our findings suggest that SHED may have improved immunomodulatory profile in terms of promoting relatively lower inflammatory reaction during transplant and enhancing bone regeneration. Conclusion: SHED has a potential to be a good source of osteoblasts for bone regeneration therapy. Further studies on the immunomodulatory properties of SHED-derived osteoblasts are necessary to enable stem cell therapy in immunocompetent host
Gender Identity Disorder is Not Simply Two in One
Get PDFA Case Report on Gender Identity Disorder with Recurrent Depressive Disorder is presented. Individuals having this disorder often exhibit discomfort about their actual anatomic gender, and they may have wished to alter their bodies. Sex role-stereotypes adopted during childhood are the beliefs, characteristics and behaviors of individual cultures that are considered normal and appropriate for boys and girls to possess. These "norms" are influenced by one's family and friends, the mass-media, and their community. Since some cultures disapprove of cross-gender behavior, it often results in significant problems for affected individuals and those in close relationships with them. The importance of treatment is not only because of the high rate of mental-health problems, including Depression but with higher suicide rate among untreated transsexual people than in the general population. These problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-deviated individuals. An example which classically illustrates Gender Identity Disorder is the case of a young man from Brunei Darussalam, who was seen and treated. This contribution will highlight the cultural and religious perspective of this Disorder
Tear Proteomics in Young Malays with Dry Eyes
Get PDFIntroduction: Changes in tear protein concentrations may reflect ocular surface health. This study analyzes changes in tear protein concentrations of young Malays with dry eye (DE) and determines its association with the clinical findings. Methods: Subjects were screened using McMonnies questionnaire (MDEQ) and flourescein tear break up time (TBUT). Total tear protein concentration (TTPC) was determined using Bradford's technique and specific tear protein (sIgA, lysozyme, lactoferrin and human serum albumin (HSA)) concentrations were determined using SDS-PAGE. Parametric and nonparametric tests were used to compare means between groups. Spearman correlation was used to determine the association between variables measured. Results: A total of 42 subjects (21 DE and 21 NDE) were included. Mean MDEQ score for DE was 16.00±1.48 and NDE was 8.47±3.47. Mean TBUT for DE was 3.47±0.47s and NDE was 4.98±0.43s. Mean TTPC for DE and NDE was 9.84±2.40mg/ml and 8.96±1.84mg/ml respectively. Mean sIgA, lysozyme, lactoferrin and HSA for DE was 0.54±0.10mg/ml, 1.68±0.17mg/ml, 1.47±0.25mg/ml, 0.06±0.03mg/ml and for NDE was 0.57±0.09mg/ ml, 2.04±0.19mg/ml, 1.75±0.23mg/ml, 0.06±0.03mg/ml accordingly. Significant differences were noted in MDEQ score (p=0.01), TBUT (p=0.01), lactoferrin (p=0.01) and lysozyme (p=0.01) but not in TTPC (p=0.19), HSA (p=0.74) and sIgA (p=0.24) between groups. Significant correlations were noted between TBUT with lactoferrin (r=0.02, p=0.02) and lysozyme (r=0.63, p=0.01) and between MDEQ score with lactoferrin (r=-0.34, p=0.02) and lysozyme (r=-0.64, p=0.01). Conclusions: There are changes in specific tear protein in dry eye patients, which correlate well with clinical results. Tear protein analysis may play an important role in the diagnosis of the dry eye
Primary Squamous Cell Carcinoma of the Rectum: a Case Report
Get PDFSquamous cell carcinoma of the rectum is a very rare malignancy. In the literature, the incidence has been reported as 0.25 to 0.1 per 10000 colorectal carcinomas. Due to its rarity, the treatment and behavior of this tumor have only been discussed in case reports. As a result, several theories regarding their pathogenesis have been proposed. We will describe our experience in managing this rare malignancy in a 69-year-old man who presented with altered bowel habit. Surgery remains the mainstay of treatment. Issues regarding additional treatment have been presented in the literature. The rarity of this tumour also raises issues regarding criteria for diagnosis which we will try to highlight and discuss
First Year Experience in Assisted Reproductive Technology (ART) Services at IIUM Kuantan
Get PDFIntroduction: To analyze the ART outcome and factors associated with successful ART treatment for infertilecouples in a newly set up medical university IVF centre. Methods: A six-month cohort study of patients undergoing their first assisted reproductive technique cycle was conducted at IIUM fertility centre, Kuantan (from 15th June until 31st Dec 2009). Outcome measures include clinical pregnancy rate, ongoing pregnancy rate, take home baby rate and complications rate. Results: Fifty-five first cycles of IVF/ICSI were studied. Mean embryo per transfer was 2.1±0.8. Four patients were pregnant (23.5%) from a single embryo transfer (SET). Clinical pregnancy rate was 30.9% (17/55). Ongoing pregnancy rate was 23.6% (13/55) and take home baby rate was 21.8% (12/55). There was only one twin pregnancy. Nine patients (16.4%) had OHSS whereby 77.8% were mild and 22.2% were moderate. Conclusion: Take home baby rate at the IIUM fertility centre is comparable to most established ART centres in Malaysia considering that this is only the first year of operation
Prevalence of Overall and Abdominal Obesity among Adolescent High School Girls in Tabriz, Iran
Get PDFIntroduction: Obesity is a growing public health problem in both developed and developing societies. The aim of this cross-sectional study was to estimate the prevalence of overall obesity determined by body mass index (BMI) and abdominal obesity identified by waist circumference(WC) percentiles, waist to hip ratio(WHR) and waist to height ratio (WHtR), in adolescent girls attending high school in Tabriz, Iran. Methods: A sample of 985 girls was selected by stepwise random sampling from five districts of Tabriz. Weight, height, WC and hip circumferences ( HiC) of the subjects were measured and BMI, WHR and WHtR were calculated. Overweight and obesity were defined according to International BMI Cut-Off Points for adolescents. WC >90th percentile, WHR>0.80 and WHtR≥0.50 were categorized as abdominal obesity. Results: The prevalence rates of obesity and overweight were 2.8% and 16.4%, respectively. Abdominal obesity defined by WC percentiles, WHR, and WHtR were seen in 3.2%, 4.0%, and 18.2% of subjects, respectively. WHtR determined the highest prevalence of abdominal obesity in subjects compared to WC and WHR. WC, WHR, and WHtR were significantly related to BMI. Conclusions: Overall obesity and abdominal obesity are substantially prevalent in the studied adolescent girls. Further studies are needed to identify risk factors for the obesity in our studied population. Findings emphasize the importance of establishing community–based interventions in order to prevent the development of adolescent obesity and its complications in adulthood
Perceptions and Barriers of Hands Hygiene Practice among Medical Science Students in a Medical School in Malaysia
Get PDFIntroduction: Hand hygiene is the single, most critical measure for reducing the risk of transmitting organisms to patients and health care providers. To our knowledge, none of such study on Malaysian university student exists in the literature. Therefore, the objective was to explore the perceptions and barriers of hand's hygiene practice among university students. Methods: Focus group discussion conducted in January-2010 among 40 medical science students from Management and Science University (MSU). Simple random sampling was used, and the ethics were obtained from participants. The students were divided into five focus groups; the number of each group ranged between 8-10 members. The data obtained were classified into various categories, and the data was analyzed manually. Results: The majority of the participants mentioned that they frequently washed their hands using soap. Some of the participants washed the hands only with plain water. However, the majority of the participants mentioned that the laziness was their main barrier of frequent hand washing, followed by lack of nearby water supply and then the feeling that their hands are not dirty enough to be infected. The majority of the participants agreed that hand washing is clinically significant in reducing the spread of infectious diseases; some of them disagreed. The Majority of the participants knew the hand washing technique in the university. Conclusion: Medical science students still have some misconception and negative attitude towards hand hygiene practice. Multidisciplinary strategies needed to improve hand hygiene among students
Patient-Reported Outcomes of Retropubic versus Trans-Obturator Mid-Urethral Slings for Urinary Stress Incontinence: The Malaysian Experience
Get PDFIntroduction: Studies reported that trans-obturator mid-urethral sling (TOT) is superior in safety and efficacy when compared with retro-pubic trans-vaginal tape (TVT) with regard to bladder, vascular and urethral injury. The purpose of this study is to determine if the TOT is equivalent to the TVT by using patient-reported outcomes for the treatment of urodynamic stress urinary incontinence (USI) at Ipoh Hospital. Methods: It is a cross-sectional study on all consecutive patients who underwent TVT procedure between Jan 2005 and Jan 2006 and TOT procedure from Jan 2006 to Jun 2008. Post operatively; all women were followed up at one month, three months, 12 months and annually, thereafter. Data was retrieved from the patients’ records based on the standard pre-operative assessment sheet and follow up record. Then, interviews were made via a telecommunication to assess the patients’ symptoms and satisfaction using a validated questionnaire. Data analysis were performed using IBM SPSS Statistics for Windows version 19 (SPSS Inc., Chicago, Illinois) considering a significant level of P < 0.05. Results: Total of 51 subjects in TVT group and 52 in TOT group were available for analysis. At 12 months, the stress urinary incontinence (SUI) cure rate is higher in the TVT (90.2%) compared to TOT (80.8%) group; however, it was not statistically significant (p=0.279). The lower urinary tract symptoms (LUT) were improved post-operatively in both groups with urgency and urgency incontinence being significantly better in the TVT group. Four (7.4%) subjects in the TVT group had a bladder perforation (p=0.992) and one case of vaginal erosion reported in the TOT group. Conclusion: TVT had a higher successful rate in the treatment of SUI; however, it increases the risk of bladder perforation. Over active bladder symptom (OAB) were significantly improved in the TVT compared to TOT group
Comparative Study of Serum Gamma Glutamyltransferase, 5’ Nucleotidase and Alkaline Phosphatase in Icteric and an-Icteric Biliary Disease Patients
Get PDFIntroduction: Diagnostic enzymology plays a useful role in evaluation of various hepatobiliary diseases and numerous enzymes have been compared in different disorders. Among these, significance of Gamma Glutamyl Transferase and 5’ Nucleotidase over Alkaline Phosphatase has been stressed repeatedly, but mainly in the icteric obstructive biliary disease patients. In this study, these three enzymes were compared not only in the icteric but also the an-icteric biliary disease patients, particularly to look for elevation and significance of these enzymes in the latter group.Methods: The study was conducted on 50 biliary disease patients, who were further divided into an-icteric (32 patients) and icteric (18 patients) subgroups depending on their bilirubin levels. 50 subjects matched for age and sex with the study group were enrolled for the control group. Gamma Glutamyl Transferase, 5’Nucleotidase, Alkaline Phosphatase and bilirubin levels were evaluated in all the patients as well as the control subjects. Results: All three enzymes showed a significant rise in the icteric subgroup (p value < 0.001). However, in the an-icteric subgroup, only Gamma Glutamyl Transferase and 5’Nucleotidase showed a significant rise. The rise was more for Gamma Glutamyl Transferse (1.60 times normal, p < 0.001) as compared to 5’Nucleotidase (1.39 times normal, p < 0.01). Conclusion: Gamma Glutamyl Transferase and 5’Nucleotidase are useful for evaluation of not only obstructive biliary disease patients but also for the patients with biliary disease who are an-icteric, and out of these two, the former is a more valuable diagnostic indicator in such disease
The Association between Helicobacter Pylori Infection and Insulin Resistance
Get PDFIntroduction: Helicobacter pylori are associated with severe gastrointestinal pathologies. Moreover, it is associated with other conditions such as atherosclerosis, insulin resistance, diabetes mellitus and some autoimmune diseases. The purpose of this study is to search the relation between Helicobacter pylori infection and Insulin Resistance. Methods: Ninety patients complaining of dyspepsia was selected from Gastroenterology, Hepatology and Infectious Diseases Department, Benha University Hospital. The patients were divided into two groups with matching age, sex and the basic laboratory investigations results. Group (A) patients were Helicobacter pylori-positive. Group (B) patients were Helicobacter pylori negative based on endoscopic findings and confirmed by histopathological diagnosis and exclusion of other causes of dyspepsia. Insulin resistance was compared between the two groups. Results: In the present study, there was statistically significant association between Helicobacter pylori positive patients (51/90; 56.7%) and insulin resistance (IR) compared to Helicobacter pylori negative patients (39/90; 43.3%) (P value <0.001). The mean value of IR was 3.6 ± 0.58, 2.2 ± 0.36 respectively for Helicobacter pylori positive and Helicobacter pylori negative patients. There was no statistical significant difference between Helicobacter pylori positive and Helicobacter Pylori negative patients as regard to other investigations (P value >0.05). Conclusion: Insulin resistance has a role in the chronicity of H. pylori infection and the reduction of IR will lead to a better response of therapy in these patients