IIUM Medical Journal Malaysia (IMJM)
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The Association between Religiosity and Hba1c Level in Patients with Type 2 Diabetes Mellitus: A Systematic Review
Get PDFGlycemic control poses a challenge in the management of type 2 diabetes mellitus (T2DM). Religiosity can influence a patient’s coping strategies with the disease. However, the relationship between patient religiosity and glycemic control has not been thoroughly explored. In this systematic review, we assessed the relationship between religiosity and glycemic control in patients with T2DM. Using PubMed and Google Scholar, we included articles published in English from 2011 onwards that quantitatively examined religiosity and its relationship with glycemic control based on the glycated hemoglobin (HbA1c) levels. Four studies from four different countries were included, employing varying measurement tools to assess religiosity. The HbA1c level was significantly related to the Diabetes Fatalism Index (p<0.05) and with general gratitude and gratitude to God, as assessed using the Multidimensional Measurement of Religiousness. Religiosity may alleviate stress-related diseases and enhance diabetes care. One study showed a relationship between the HbA1c levels and the Beliefs and Values score amongst Muslims only. Two studies reported a significant correlation between religiosity and HbA1c levels. Reducing fatalistic beliefs and improving gratitude to God could be a viable strategy for helping patients manage T2DM. Further studies are needed to promote such an approach in T2DM management
Experiences of Family Medicine Specialists in Providing Health Care for Lesbian, Gay, Bisexual and Transgender Patients: A Qualitative Study in East Coast Peninsular Malaysia
Get PDFINTRODUCTION: Lesbian, Gay, Bisexual and Transgender (LGBT) patients continue to report discrimination in healthcare setting despite the efforts of the primary healthcare offering community friendly services in Malaysia. This qualitative study aimed to provide understanding of this current issue and to explore the challenges that family medicine specialists (FMSs) from East Coast of Peninsular Malaysia face when dealing with LGBT patients. MATERIALS AND METHODS: 30 FMSs working in East Coast Peninsular Malaysia were interviewed through a phenomenological framework using semi-structured in-depth interviews of LGBT patients. The interviews were recorded in audio format, transcribed verbatim, and subjected to Braun and Clarke’s thematic analysis. We discerned common themes that can be elucidated through the lens of Leininger’s Theory of Culture Care (TCC) and the Sunrise Enabler Model (SEM). RESULTS: Three overlapping themes of the transcriptions were developed; (1) Multidimensional understanding of LGBT described how FMSs saw the LGBT community as diverging from societal norms, yet acknowledge their vulnerability as integral members of the society, (2) obstacles to providing culturally competent care stemmed from inadequate training, an unsupportive clinic environment, and the self-stigma experienced by patients, and (3) barriers to incorporating spiritual needs for holistic care arose in situations where there was insufficient spiritual health training or a preference to concentrate on physical and emotional well-being to uphold trust. CONCLUSION: The findings on this study reflect the need for proper training of healthcare personnel to deliver a holistic, culturally competent care for LGBT patients. A collaborative effort with relevant authorities is also needed to successfully overcome those challenges
The Management Outcome of Heart Failure Reduced Ejection Fraction with or without Angiotensin Receptor Neprilysin Inhibitor
Get PDFINTRODUCTION: Heart failure is associated with recurrent admission, higher mortality and low quality of life. Angiotensin receptor neprilysin inhibitor (ARNI) is a novel agent that has been used for treating heart failure reduced ejection fraction (HFrEF) patients. Thus, it is interesting to evaluate the effect of ARNI on the reverse cardiac remodelling, rehospitalization, cardiac biomarker and quality of life in HFrEF patients. MATERIALS AND METHODS: A case controlled study was conducted to assess the treatment outcome of HFrEF with or without ARNI. During the study, the patients’ basic demography, co-morbidities, baseline echocardiography (ECHO) findings, NYHA classification, NT-pro BNP levels and KCCQ score were evaluated. The patients’ admission history within 90 days from initiation of ARNI or non ARNI were obtained retrospectively. A follow up ECHO was obtained after at least 3 months of intervention. RESULTS: A total of 81 patients were recruited in which 54 patients were on ARNI and 27 were on non ARNI treatment. There was a statistically significant improvement of ejection fraction, left ventricular internal diameter end diastole and systole, and left ventricular end-systolic volume in ARNI group. The NYHA class was also noted to improve after ARNI treatment. The NT-proBNP value was lower whereas the KCCQ score was higher in ARNI group compared to non ARNI group. CONCLUSION: HFrEF patients with ARNI treatment had better reverse cardiac remodelling effect, cardiac biomarker and quality of life compared to non ARNI treatment. Furthermore, patient received ARNI demonstrated improved heart failure classification after treatmen
The Effect of Doxycycline on Matrix Metalloproteinase-9 Levels in the Colon of Wistar Rats with Obstructive Ileus
Get PDFINTRODUCTION: Obstructive ileus after colonic anastomosis resection can increase leakage up to 2.5-fold. One possibility could be the extracellular matrix degradation, where matrix metalloproteinase-9 (MMP-9) negatively influences anastomotic healing. This study aimed to determine the effect of doxycycline on MMP-9 levels in the colon of experimental rats with obstructive ileus. MATERIALS AND METHODS: In this study, 28 male Wistar rats were selected randomly in a post-test control-group design comprising: Group A - control group, Group B - group without obstructive ileus given doxycycline, Group C - group with obstructive ileus not given doxycycline, and Group D - group with obstructive ileus given doxycycline. Doxycycline was given at a dose of 30 mg/kg. Groups C and D underwent anastomotic resection 24 hours following obstructive ileus procedure. Groups A and B underwent anastomotic resection at the same time as Groups C and D. Colonic tissue was collected to examine MMP-9 levels using an enzyme-linked immunosorbent assay (ELISA). Data were compared using Shapiro–Wilk tests, ANOVA, and Mann–Whitney U tests, and p<0.05 was considered significant. RESULTS: The results showed that the average MMP-9 levels increased with doxycycline treatment, [Group C (4.294 ± 0.226)], with significantly higher MMP-9 levels than Group A (1.017 ± 1.569, p<0.001). Group B did not differ significantly from Group A (p=0.848). MMP-9 levels differed significantly between Groups B and D (p<0.001), and between Groups C and D (p<0.001). CONCLUSION: Oral administration of doxycycline can attenuate increasing MMP-9 levels in Wistar rats with obstructive ileu
Effectiveness of Hypertonic Saline, Polidocanol, and Glycerol as Sclerosing Agent: An Experimental Study in Javan Rabbits (Lepus nigricollis)
Get PDFINTRODUCTION: Therapeutic approaches to varicose veins include sclerotherapy, laser ablation, and surgery. Using sclerosing agents such as hypertonic saline, polidocanol, and glycerol can be an option in cases of recurrent varicose veins. This study aimed to assess the effectiveness of hypertonic saline, polidocanol, and glycerol as sclerosant agents in an in vivo study. MATERIAL AND METHODS: This was an experimental study on 24 Javan rabbits, divided into three treatment groups: hypertonic saline (group I, n=8), polidocanol (group II, n=8), and glycerol (group III, n=8). All animals received treatment by injection into the vein behind the ear, then vein damming 10 minutes later. Punch tissue samples for standard histopathological examination were taken from blood vessels at 1 hour, 24 hours, 7 days, and 45 days post-treatment across all groups. The histopathology changes were scored based on inflammation, proliferation, luminal narrowing, and fibrosis. RESULT: No differences were observed in the degrees of inflammation, proliferation, luminal narrowing, or fibrosis at different observation intervals. However, a significant and positive correlation was found between inflammation, vascular proliferation, and fibrosis with all sclerosing agents (p<0.005). No significant correlation exists in the scoring of luminal narrowing among any sclerosing agent (p>0.005). CONCLUSION: Hypertonic saline, polidocanol, and glycerol demonstrated comparable efficacy as sclerosing agents in vivo concerning fibrosis, vascular proliferation, and inflammation
The Impact of Symptomatic Chronic Venous Insufficiency (CVI) on Health-Related Quality of Life (HR Qol) in A Multi-Ethnics Society in a Developing Nation
Get PDFINTRODUCTION: Chronic venous insufficiency (CVI) is a common condition especially among those of advance age that is often neglected. As the disease severity progresses, it increases the healthcare cost and resources required, while diminishing the quality of life of the persons. Health-related Quality of Life (HRQoL) among CVI patients begins to decline once the symptom starts to appear, and reduces it further as the symptoms worsens. MATERIALS AND METHODS: This is a prospective, multi-centred, cross-sectional study on consenting symptomatic CVI patients who presented to the International Islamic University of Malaysia (IIUM) teaching hospital in Pahang, Malaysia. The diagnosis of CVI was confirmed on duplex imaging. Clinical grading was performed using Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification. Patients completed generic validated Malay language Short Form 36 (SF36) HRQoL instrument. RESULTS: One hundred and ten patients (62% male) with a mean age of 57 years, Malays (60%), Chinese (25%) and Indian (15%) were recruited. The most frequent CVD symptoms reported were pain (42%). The clinical, aetiological, anatomical, and pathophysiological (CEAP) classification placed most patients in the C2 class (34%). Apart from partaking in social functions, all other elements of mental and physical health component of SF 36 showed a marked deterioration as the disease progressed. CONCLUSIONS: We found a significant decline in the HRQoL among symptomatic CVI patients presenting to IIUM hospital in a multi-ethnic developing country
Understanding the Motives and Intention of Blood Donation during the Pandemic
Get PDFINTRODUCTION: In every country, an adequate and reliable blood supply can be assured by a stable base of regular, voluntary, and unpaid blood donors. However, with the strike of COVID-19 around the world, fewer donors have come forward to donate blood since the government's movement control order. Therefore, to ensure the blood supply is always sufficient, this study discussed the Malaysians' motivation and intention to donate blood during the COVID-19. MATERIALS AND METHODS: The structural focus group discussion was conducted among nine informants. The informants are classified into four groups, which are non, first-time, regular, and lapsed (repeated/occasional) blood donors. RESULTS: It indicated that the regular and lapsed group of blood donors were motivated by the satisfaction of donating blood. Meanwhile, first-time donors are motivated to donate blood because of extrinsic rewards. However, the donors attested that the movement control order restricted their movement to go to the blood transfusion center. On the other hand, the non-donor group admitted that they do intend to donate blood. Still, several factors such as work commitment, location, and fear of being infected by COVID-19, hold them from doing so. CONCLUSIONS: These findings will serve as insights for future blood donation disruption remediation, especially during unexpected situations, as well as the success of the Malaysian blood campaign
Radiological and Clinical Outcome of Thoracolumbar Burst Fracture Following Short Segment and Long Segment Pedicle Screw Fixation
Get PDFINTRODUCTION: The indications for operative treatment and type of stabilization procedures for the treatment of thoracolumbar fracture remains controversial. Long-segment pedicle screw fixation permits correction of kyphotic deformity while short-segment pedicle screw fixation preserves motion segments, reduces costs and time of surgery. Our aim is to study the correlation and comparison between clinical and radiological outcome of both fixations and identify factors that might contribute to the outcome. MATERIALS AND METHODS: 60 patients with thoracolumbar spine fracture from 2017 to 2022 were identified. Age, gender, mechanism of injury, classification of fracture, duration of hospital stays and one-year post-operative outcome of Visual Analogue (VAS) pain score, and Oswestry Disability Index (ODI) score were documented. Pre- and post-operative AP/Lateral radiographs measurements of local kyphotic angle, Cobb angle were measured. Signs of fixation failure were examined at follow-up. RESULTS: Subjects mean age is 42.4, male predominance (85%) and work-related. The highest incidence was at level of L1 (56.7 %) in the long-segment and 46.7 % in short-segment. Most common injury was burst fracture (AO classification A3 A4 group) due to fall from height. There is shorter hospital stay documented in the short-segment fixation. Radiological outcome measured in both groups were comparable with no signs of fixation failure. Short-segment fixation group also resulted in better clinical and functional outcome at one-year follow-up. CONCLUSION: There is no significant difference in radiologic outcome of Cobb and kyphotic angle in both fixation groups. Short-segment fixation has significantly better clinical and functional outcome post-operative and at 1-year follow up
Association of Serum Programmed Cell Death Protein 1 (PD-1) and Gene Polymorphism with Some Valid Predictors for Systemic Lupus Erythematosus (SLE) Patients in Basra Province, Iraq
Get PDFINTRODUCTION: Systemic Lupus Erythematosus (SLE) is a systematic autoimmune disorder characterized by the production of autoantibodies against nuclear antigens and inflammation initiation. We aimed to examine the correlation between IL-18, IL-37, and PD-1, and the potential link between polymorphisms in the PD-1 gene located in intron-4 and the susceptibility to SLE. MATERIALS AND METHODS: This cross-sectional study included 43 SLE and 53 healthy individuals. Blood samples were obtained and underwent biochemical examination. The polymorphisms were screened by amplifying the intron-4 of the PD-1 gene using particular primers and then verified through sequencing. RESULTS: Our findings demonstrated statistically significant positive correlations between IL-18, IL-37, and PD-1, while the AUC of the ROC curve is 0.985, 0.968, and 0.940, and cut-off concentration is ≥132.87, ≥62.98, and ≥169.02, respectively. Moreover, two separate SNPs (rs6705653 and rs41386349) were discovered within intron-4 of the PD-1 gene. The genotype AA of the +7499 (G/A) SNP was significantly related with an increased risk of SLE (OR=3.11, 95%CI=1.52–5.94, p-value=0.031). Additionally, the A allele was identified as a risk allele (OR=1.59, 95%CI=1.09–2.31, p-value=0.043). Nevertheless, our study didn’t find any noteworthy connection between the allele and genotype of the +7209 (C/T) polymorphism region of the PD-1 gene frequencies and the susceptibility to SLE. CONCLUSION: IL-18, IL-37, and PD-1 may play significant roles in SLE immune responses and processes. Furthermore, the sequencing examination of intron-4 within the PD-1 gene demonstrated a noteworthy correlation between the A allele and the AA genotypes of PD-1 +7499 (G/A) SNP presence with the increased SLE susceptibility