IIUM Medical Journal Malaysia (IMJM)
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Molecular Pathogenesis of Atherosclerosis and Implication for Therapy
Get PDFA growing body of evidence supports the role of infl ammation in the pathogenesis of atherosclerosis. However, the supposed initiation factors of atherogenesis are infection and change in shear stress on certain location, leading to attachment of LDL and subsequent oxidation. The pathway activated are the NFkB and TGFβ leading to endothelial dysfunction and production of infl ammatory cytokines and adhesion factors followed by recruitment of infl ammatory cells to the site, oxLDL internalization and foam cell formation in the fatty streak that later develop into atherosclerotic plaque. Further, p53signaling causes apoptosis leading to plaque rupture, platelet activation and aggregation ending in clinical manifestations. Moreover, numerous individual risk factors might aggravate the condition, and the progress might take decades depending on the balance of pro and anti atherogenic factors. Therefore, management of atherosclerosis addressing the individual risk factors using drugs with various properties coping with the molecular basis especially infl ammation is beneficial
Anterior Myocardial Infarction Associated with Myocardial Bridging in a Young Man
Get PDFA 43-year-old man presented with acute extensive anterior ST-segment elevation myocardial infarction. During coronary angiogram, a segment of myocardial bridging was noted in the mid-segment of left anterior descending artery. The association of myocardial bridging and an anterior ST segment elevation is rarely reported in the medical literature. Myocardial bridging is caused by systolic compression of a coronary artery by overlying myocardium tissue. It is a rare coronary artery anomaly, which usually has a benign prognosis despite some case reports of myocardial ischemia leading to myocardial infarction, lethal arrhythmias and sudden cardiac death. We report one such case of myocardial bridging that was complicated with acute extensive anterior myocardial infarction
The Malay Version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ C30): Reliability and Validity Study
Get PDFIntroduction: The Malay Version of EORTC-QLQ C30 was validated among Malaysian women who had undergone breast cancer surgery. Materials and Methods: Test-retest evaluation (i.e. three weeks and ten weeks following surgery) was carried out to examine the validity and reliability of the scale. The Cronbach’s alpha value was used to determine the internal consistency, meanwhile, test-retest Intraclass Correlation Coefficients (ICC) indicates the reliability of the scale. Effect Size Index and Mean Differences interpret the sensitivity of the scale. Discriminant validity was evaluated by comparing two groups i.e. women who had mastectomy and women who had lumpectomy. Results: Internal consistencies are acceptable for Global Health Status (0.91), Functional domains (ranging from 0.50-0.89) and Symptomatology domains (ranging from 0.75-0.99). Intraclass Correlation Coefficient (ICC) ranged from 0.05 to 0.99 for Global Health Status and Functional domains, and ranged from 0.13 to 1.00 for Symptomatology domains. Sensitivity of the scale was observed in nearly all of the domains. Conclusion: The Malay Version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ C30) is a suitable tool to measure the quality of life of women with breast cancer
Medical Complications Among Type 2 Diabetes Mellitus Patients at a General Hospital in East Coast Malaysia
Get PDFIntroduction: Diabetes Mellitus (DM) is a chronic metabolite disorder with high potential of multisystemic medical complications especially among poorly controlled patients. This study was conducted at Raja Perempuan Zainab II Hospital, Kota Bharu with objectives to explore the pattern of common diabetic mellitus type 2 complications and to compare between gender and races in relation to other risk factors during their hospitalization. Materials and Methods: This is a retrospective study based on patients’ record involving 215 patients (110 women and 105 men) who were admitted with diabetic complications in medical ward for a period of 6 months (January to June 2006) Results: Out of total 300 identifi ed subjects, 285 case notes were traceable. From 285, 84.6% (241 subjects) were diagnosed as DM type 2. 215 out of 241 subjects (89.2%) had one or more diabetic complications. In general the most common diabetic complication was diabetic nephropathy 34.9% (75 patients). When we compared between genders, diabetic foot ulcers was the most common diabetic complications among males (43.8%) and diabetic nephropathy for females (40.9%). A total of 199 patients (92.6%) had poor blood sugar control during their hospitalization and 103 patients (47.9%) had hypertension. Conclusion: Patients with DM type 2 had a high prevalence of complications. Common diabetic complications among genders were varied. Patients with diabetic complications had high prevalence of risk factors such as poor blood sugar control, concomitant hypertension and smoking habit
Influence of Interferon-γ on Salmonella Typhi Induced Macrophage Apoptosis
Get PDFIntroduction: Salmonella Typhi (S.Typhi), which causes typhoid fever, is a widespread pathogen in developing countries. Interferon-gamma (IFN-γ) is a critical cytokine in host defense against Salmonella infection. IFN-γ provides protection against Salmonella infection by inducing macrophage activation. This study was designed to determine the effect of recombinant IFN-γ (rIFN-γ) on S.Typhi induced macrophage apoptosis and to examine the effect of rIFN-g on caspase-1 expression during apoptosis. Materials and Methods: After isolation of macrophages, apoptotic cells were analyzed using both annexin V-FITC detection kit by fl ow cytometry and TUNEL technique. Caspase-1 expression was determined by RT-PCR. Results: The rIFN-γ concentrations of 100 IU/ml ve 1000 IU/ml decreased macrophage apoptosis caused by S.Typhi, 13.1 % and 6.3 % respectively. Conclusion: Consequently, we observed that rIFN-g decreased Salmonella-induced apoptosis and inhibited caspase-1 expression during apoptosis. It is considered that the modulatory effect of IFN-γ on macrophage apoptosis may impact a protective effect during Salmonella infection and this may help to abort invasive S.Typhi infections
Multiplex Polymerase Chain Reaction Based Typing of Staphylococcal Chromosomal Cassette mec of Methicillin Resistant Staphylococcus aureus from Selected Hospitals in Lahore
Get PDFIntroduction: Staphylococcus aureus is one of the leading causes of nosocomial infections. Prevalence of methicillin resistant Staphylococcus aureus (MRSA) has been reported in up to 42% of isolates in Pakistan. Methicillin resistance is encoded by the mecA gene and it is transferred by a unique genetic vector called staphylococcal chromosomal cassette (SCCmec). Depending upon the selection pressures of antibiotics, different types of SCCmec elements may prevail in different parts of the world. Materials and Methods: Therefore, this study was designed to fi nd out the major SCCmec types present in selected hospitals of Lahore. For this purpose thirty fi ve MRSA isolates were collected. These strains were reconfi rmed and SCCmec types were determined by multiplex PCR. Results: It was found that 21 (60%) isolates possess SCCmec type IA while 14 (40%) isolates possess SCCmec type IIC. Conclusion: These cassettes are shown to be multiresistant and have not been reported in other Asian countries so far
A Descriptive Study of Blood Films of Patients Serologically Positive for Dengue in Hospital Tengku Ampuan Afzan, Kuantan
Get PDFIntroduction: Dengue is one of the commonest infections in Malaysia and it is a notifiable disease. Even though the diagnosis of classical dengue fever and dengue haemorrhagic fever can be recognized clinically, the diagnosis remains a challenge in areas where it could not be differentiated with other febrile illnesses. The aim of this study was to focus on the specific and consistent morphological features observed in blood films of dengue infection. Materials and Methods: In all 400 cases of dengue infection serologically diagnosed in the Tengku Ampuan Afzan Hospital (HTAA) during May to October 2007, only a total of 27 cases had blood films examined, and thus were included in this study. These blood films were re-examined by two pathologists from HTAA. The full blood count parameters were also retrieved and studied. Results: We consistently found typical reactive lymphocytes [n= 23 (85%)] and thrombocytopenia [n=21, (77.8%)] in the cases. However, leucopenia was present only in 9 cases (33%). Conclusion: The presence of typical reactive lymphocyte is a consistent finding in dengue fever and thus could have a significant role in supporting the diagnosis of dengue infection
Monoamniotic Twin Pregnancy; is There a Need for Frequent Fetal-Doppler Surveillance?
Get PDFMonoamniotic twin pregnancy is a rare type of twin pregnancy which poses risk of cord entanglement and sudden death of either one or both fetuses. The role of antenatal surveillance by Ultrasound Doppler for umbilical cord and ultrasonic evidence of cord entanglement or knotting may predict the pregnancy outcome but yet unavoidable. The discussion will include antenatal surveillance in this rare type of pregnancy
Determinants of Early Postpartum Psychological Reaction among Mothers in Kuala Lumpur Hospital
Get PDFIntroduction: Maternal psychological well-being determines early mother-infant relationship and baby’s health. Paying attention on this aspect is essential particularly in early postpartum period. This study aimed to determine early psychological reactions toward socioeconomic profiles, delivery methods and delivery outcomes among postpartum mothers in Kuala Lumpur Hospital. Materials and Methods: A total of 150 twoweek-postpartum mothers participated in this cross sectional study and their psychological perspective was measured by using the Depressive, Anxiety and Stress Scale (DASS). Results: 4%, 16% and 4.7% of respondents had significant depressive, anxiety and stress levels respectively. Conclusion: Socioeconomic variables such household income, level of education and presence of medical illness were statistically significant to determine early postpartum psychological reactions but not the modes or outcomes of delivery
High Frequency Oscillating Ventilation (HFOV) in Severe Acute Respiratory Distress Syndrome (ARDS): A Case Report
Get PDFHigh frequency oscillating ventilation (HFOV) provides a rescue therapy for patients with refractory hypoxaemia in severe acute respiratory distress syndrome (ARDS). HFOV utilizes high mean airway pressures to maintain an open lung and low tidal volumes at a high frequency that allows for adequate ventilation while at the same time preventing alveolar overdistension. This seems to be an ideal lung protective ventilation strategies to prevent ventilator-induced lung injury (VILI)2. We reported a case of severe extrapulmonary ARDS secondary to acute lymphoblastic leukaemia responding to the use of HFOV