IIUM Medical Journal Malaysia (IMJM)
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Wire-Induced Stent Crumpling Remedied By BailOut Crush Stenting; A Case Report
Get PDFWe report a-56-year old army pensioner who presented initially to a peripheral hospital with acute ST-elevation inferior myocardial infarction thrombolysed with streptokinase. He was subsequently referred to the National Heart Institute (Institut Jantung Negara, Malaysia) for coronary revascularization. Coronary angiogram revealed an ectatic right coronary artery with discrete lesions at the proximal and distal segments stented with bare metal stents (BMS). Post dilatation shots revealed a wire-induced, distal dissection at the posterior left ventricular artery remedied by balloon angioplasty but resulting in balloon-induced crumpling of the distal BMS. We discuss the importance of sequential, distal-to-proximal coronary intervention, stent crumpling and remedial strategies
Antiphospholipid Syndrome Presenting as Mesenteric Vein Thrombosis and Gangrenous Small Bowel
Get PDFA 35-year-old Jordanian gentleman presented with worsening right iliac fossa pain of three-day durations with vomiting, loose stool and intermittent fever. He later underwent laparoscopic surgery, which was subsequently converted to open laparotomy. Intraoperatively, there was thickened bowel with multiple mesenteric lymph nodes, and also thrombosis of the small bowel vein supplying the affected bowel lesion, the diagnosis which was later confirmed with the histopathological report. Resection with end-to-end anastomosis was done during the surgery. Within one-week post laparotomy, he developed another progressive abdominal pain and distension, vomiting and no bowel opening. He was sent for another exploratory laparotomy. Intraoperatively, there was a gangrenous small bowel segment measuring 130 cm, with an intact large bowel and previous anastomotic site. Resection of 150 cm of the small bowel was subsequently done
Screening for thalassaemia among group of students of a higher institution – our experience
Get PDFIntroduction: Thalassaemia is an inherited blood disorder and is a significant public health alarm in Malaysia with many not knowing they are carriers of this haemoglobin disorders. Materials and methods: This study conducted a one off collection of blood samples from 72 Malays students of International Islamic University Malaysia (IIUM) in Kuantan. Blood samples were subjected to conventional haemoglobin analyses that include full blood count and picture, HPLC, Haemoglobin electrophoresis and H-inclusion test. All samples were also genotyped for alpha thalassaemia–1 of Southeast Asia (a-Thal1SEA). Result: There were 17(23.6%) students who were diagnosed as thalassaemia carriers. Out of this, four (5.5 %) and six (8.3 %) students were presumptive β-thalassaemia trait and Haemoglobin-E trait as determined by the HPLC assay respectively. Nine (12.5%) students were genotyped a-Thal1SEA among whom two were also β-thalassaemia carriers. All thalassaemia cases had MCH of < 27pg. Nonetheless, two out of six Haemoglobin-E trait and three out of nine a-Thal1SEA carrier had MCV value of >80fL. Two out of four (50%) presumptive β -thalassaemia trait and one out of six (17%) students of presumptive Haemoglobin-E trait had family history of thalassaemia respectively. Conclusion: The high occurrence of the three common types of thalassaemia carrier (β, Hb-E and a-Thal1SEA thalassaemia) in our small group of subjects could be due to better participation of students who had family history of thalassaemia. The study reaffirmed the importance of molecular study for detection of alpha-thalassaemia and the use of MCH value of <27pg rather than MCV value of < 80fL for prediction of thalassaemia
Effects of holothuria extract on pain behaviour and Fos like immunoreactivity (FLI) in formalin pain
Get PDFIntroduction: The aim of this study was to determine the effects of gamat extract on pain behaviour and Fos like immunoreactivity (FLI) expression in the ventral posterolateral thalamus using the acute pain model. Materials & Methods: Fourteen Sprague-Dawley male rats (220-300 gram) were given intraplantar injection of 0.05ml formalin (1%) followed by intraperitoneal administration of either 4 mg/kg gamat extracts (Holothuria spp.) or saline (control). Behavioural changes were observed and rats were sacrificed 2 hours post-formalin injection. Immunohistochemistry testing was done on the brain sections. FLI was examined using a light microscope attached to an image analyser. The behaviour and FLI data were analysed using repeated measure analysis of variance and independent t-test respectively. Significance level was taken as p<0.05. Results: The control group has significantly higher pain scores compared to holothuria group (F (1) =13.635, p=0.003). There was significant reduction in the pain behaviour score in the holothuria group when compared to the control group in phase 1 (t (14) =2.9, p=0.012) and most of the time from 15 to 60 minutes post-formalin injection (t (12) =3.535, p=0.004). There was a significant reduction (P<0.05) in the number of FLI on the contralateral aspect of the ventral posterolateral thalamic nucleus in the group that received 4mg/kg of holothuria extract (63 3.18) compared to control group (84 6.36). Conclusion: This study showed that administration of holothuria extract significantly suppressed the pain behaviour and reduced the number of FLI in formalin injected rats compared to control
Coronary Artery Bypass Graft in a Young Adult, An Emerging Phenomenon: A Case Report
Get PDFA 29-year-old, smoker, diabetic, hypertensive and hypercholesterolemic man was diagnosed of having severe coronary artery disease with a critical left main stem stenosis. On-pump coronary artery bypass graft surgery (CABG) was performed using conduits from the left internal mammary artery as well as the left radial artery and right saphenous vein which were both harvested endoscopically. He was discharged after a week of uneventful recovery. This case emphasizes on the best possible management of conduits selection, intraoperative myocardial protection and the risk factors modification in achieving a long term graft patency and avoiding premature cardiac related death
Knowledge, Attitude and Practice Towards Road Traffic Regulations Among University Students, Malaysia
Get PDFIntroduction: Each year, more than 20 million people are injured and 1.17 million are killed due to road traffic accidents. Developing countries account for over 85% of the deaths, and close to 90% of the disability caused by road traffic crashes worldwide. The objectives of this study were to determine the knowledge, attitudes and practice and the factors influencing university students in Malaysia concerning road traffic accident. Materials and Methods: This study was conducted among the students of Management and Science University, Malaysia. The questionnaire was distributed randomly to the students of the Faculty of Health and Life Sciences. Data was analyzed using SPSS version 13, T-test and ANOVA. Results: The total number of 109 students with the mean age of 20.94±1.89 years participated in this study. Approximately 39 (35.7%) of the participant had been involved in one or more than one road traffic accident. About 93.6% of them were very strongly/strongly convinced of seat belts importance. Multivariate analysis using the multiple linear regression method showed that age and attitude were significantly associated with the exposure to the accident. Conclusion: The study participants had moderate knowledge about road traffic regulations and most of them mentioned that high speed, drivers’ lack of awareness about traffic regulation and laws, and drivers’ non-compliance with traffic rules and regulation were the most important cause of road traffic accidents. Almost all students were very strongly/strongly convinced of seatbelts importance. Age and attitude were significantly associated with the exposure to the accident
Assessment on Functionality and Viability of β cells Following Repetitive Dosage Administration of Ethanolic Extracts of Andrographis paniculata on Streptozotocin-induced Diabetic Rats
Get PDFIntroduction: The study was done at the aim to assess the functionality and viability of the β cells of the streptozotocin-induced diabetic rats model following repetitive dosage of administration of ethanolic extracts of Andrographis paniculata. Materials and Methods: The diabetic rats were treated with the extracts for fourteen days and at the dose given was 500 mg/kg twice daily. The assessments were made on fasting blood glucose, insulin, and immunohistochemical aspect of β cells before and after treatment. Results: The results showed that there was a significant reduction on fasting blood glucose levels in metformin, 95% and 50% ethanolic plant extracts-treated groups but on insulin level only 95% and 50% ethanolic extracts-treated groups gave a significant reduction (p<0.05). Immunohistochemical assessments revealed that all extract groups and metformin-treated were significantly increased in the population of β cells (p<0.01). Conclusion: This study revealed that the plant extracts showed an ability to promote the growth or rejuvenate the STZdestructed β cells and in turn lower the blood glucose level
Non-Verbal Pain Assessment: A Literature Review
Get PDFPain is influenced by multiple factors including personal experience, psychological, sociocultural and situational factors. Failure to recognise pain will lead to poor patient management and deleterious effect on the patients’ wellbeing. Assessing pain in paediatric and cognitively compromised patients remains a challenge. Pain assessment in these groups of patients depends on the observers’ assessment and studies have shown the discrepancy between the observers’ assessment and patients’ verbal report. A specific and accurate tool is required to assist in the pain assessment. Although there are assessment tools available using behaviour scoring system and physiological indicators, none of the tool demonstrates its superiority than the others. Biochemical indicators such as stress hormones are frequently measured and used in con-junction with verbal reports; however they are non specific to pain and are increased in inflammation, haemodynamic and emotional changes. The association between immunological indicators e.g. IL-1 , IL-6, IL- 8 and clinical pain has been shown, however; the definite correlation of the changes in the indicators and the level of pain is still unclear and may require further investigation