IIUM Medical Journal Malaysia (IMJM)
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Influence of Creativity Stimulation on Brain Connectivity during Divergent Thinking Tasks
Get PDFINTRODUCTION: Different facets of divergent thinking (DT) are associated with connectivity between different cerebral areas. However, the causal interactions between the key DT nodes have yet to be explored. It is hypothesised that with creativity stimulation, changes in effective connectivity among regions will be observed. MATERIALS AND METHODS: By using control (n=26) and experimental (n=24) participants, this study aimed to investigate the effective connectivity between brain areas associated with divergent thinking that accentuate fluency, flexibility, and originality. The experimental participants attended a two-day creativity stimulation, followed by three task-based fMRI sessions for all participants, which included basic use (BU) identification, alternative use (AU) generation and unusual use (UU) determination tasks. Dynamic causal modelling (DCM) was used to determine the most optimal causal model representing the most possible modulatory influence on the connections between medial prefrontal cortices (mPFC), inferior frontal gyrus (IFG), and inferior parietal lobule (IPL). RESULTS: The experimental participants scored higher fluency and flexibility than the controls (p<0.05). At neuronal level, the control group showed similar intrinsic connections receiving modulatory influence for AU and UU tasks, while the experimental group preferred a different perturbation of connection between both tasks. These intergroup differences may be caused by different thinking strategies involving semantic and episodic memory retrieval, and integration of remotely associated ideas to construct new combination among the experimental participants. CONCLUSION: Different DT demands may influence the effective connectivity between mPFC, IFG and IPL especially among individuals with higher DT abilities, especially in fluency and flexibility versus originality
The Efficacy of Patient Controlled Analgesia for Acute Non Traumatic Abdominal Pain in Emergency Department
Get PDFINTRODUCTION: Patient-Controlled Analgesia (PCA) is an intravenous selfadministration of small doses of opioids (such as morphine) using a programmable pump, The goal of PCA is to efficiently reduce patients’ pain at patient's preferred dose and schedule. Thus, we conducted a study to compare patient PCA morphine with intravenous bolus morphine for acute abdominal pain of non-traumatic origin in the emergency department (ED). MATERIALS AND METHODS: A randomised, non-blinded clinical trial was conducted in patients presented with severe acute non traumatic abdominal pain of less than 24 hours requiring opioid analgesic based on numerical pain score of more than seven at triage. The primary outcome was visual analogue pain score (VAS) recorded at 0, 30th, 60th and 120th minutes during the management in the ED and after admission to wards, and the secondary outcomes were total dosage of morphine used and degree of patient satisfaction. RESULTS: A total of 62 participants who fulfilled study criteria were randomized into PCA morphine group or bolus morphine group. The average amount of analgesic used for bolus morphine group was lower compared to PCA morphine (4.23 mg)(s.d 1.89 vs 5.29 mg)(s.d 2.16) (p=0.027). Despite of significant VAS score changes within group analysis, between group repeated measure ANOVA (RMA) VAS score analysis was not statistically significant. [Bolus group (6.7+2.03) compared to PCA group (5.83 + 2.38)](p=0.089). Patient satisfaction was statistically significant for the PCA group [PCA (1.65+0.709) compared to bolus group (2.23+0.920)](p=0.007). CONCLUSIONS: There was no significant difference in pain score reduction between PCA and intravenous bolus of morphine for the management of severe acute non traumatic abdominal pain in ED. However, PCA provided more patient satisfaction and should be considered as an alternative modality of acute pain management in ED
Prevalence of Erectile Dysfunction and its Associated Factors among Men in Government Health Clinics in Kuantan, Pahang
Get PDFINTRODUCTION: Erectile dysfunction (ED) is a significant issue that should not be ignored in the clinical setting and can negatively affect the quality of life of patients and their partners. This study aims to determine the prevalence of ED and its associated factors among men who visited 12 government health clinics in Kuantan, Pahang, Malaysia. MATERIALS AND METHODS: Between July and October 2021, 300 males aged 18 to 60 participated in this cross-sectional study at 12 government health clinics in Kuantan. Information on demographic data, medical history, and lifestyle of the participants was obtained through a self-administered questionnaire that included a validated Malay version of the 21 item Depression Anxiety Stress Scale (DASS 21) and the International Index of Erectile Function (IIEF-5). RESULTS: The overall prevalence of self-reported ED was 69.3%. In terms of severity, 45.7% had mild, 20.7% mild-to-moderate, 2.3% moderate, and 1% severe ED. Multivariate analysis showed that ED associated with diabetes (OR 2.97, 95% CI 1.13–7.79); anxiety (OR 2.85, 95% CI 1.06 – 7.67) and household income (OR 0.41, 95% CI 0.18–0.95). CONCLUSION: ED was high in our study population. Diabetes mellitus, anxiety and household income were significantly associated with ED
Post Vaginal Delivery with Impending Silent Abdominal Catastrophe: A Case of Vernix Caseosa Peritonitis
Get PDFVernix caseosa peritonitis (VCP) is a rare condition previously thought to be a complication of Caesarean section caused by the spillage of amniotic fluid and or meconium into the maternal peritoneal cavity during operation.1 This triggered an inflammatory reaction symptom such as an acute abdomen. A total of 34 cases has been reported since 1976.2 Nine of the 10 cases reported have been diagnosed in postpartum period after uneventful Caesarean section and only three reported cases of antenatal leakage since in 1998.3 VCP following vaginal delivery was first reported in 2013, involving a 28 year old with one previous scar who developed acute abdomen symptoms as early as 3 hours post vacuum delivery, with initial diagnosis of possible uterine scar rupture.4 Here we report a case of VCP in a post spontaneous vaginal delivery who presented with impending catastrophe and survived the ordeal
Evaluation of Learning Approaches among First-Year Medical and Dental Students of a Private University, in Malaysia
Get PDFINTRODUCTION: Every learner has a way of interacting with the knowledge they have acquired, and this interaction is called a learning approach. Knowing the student's favorite learning methods will facilitate them with directions tailored to their unique needs. This study aims to measure the differences in learning approaches among first-year medical and dental students of a private university, in Malaysia. MATERIALS AND METHODS: A three-month analytical cross-sectional study was undertaken among the interested students. The self-administered, validated ASSIST questionnaire was used to measure students’ preferred learning approaches. The Pearson correlation and independent sample t-test were used to analyze the data with SPSS software. The p-value was set at less than 0.05 to indsicate a significant level. RESULTS: A total of 225 students participated, out of which 150 (66.7%) respondents were medical students, and 75 (33.3%) were dental students. Medical students reported a favoured considerably deep learning approach over dental students (t=2.874, p=0.004), and preferred the strategic approach to learning (t=2.051, p=0.041). There was a weak and no significant correlation between the concept of learning (learning as reproducing knowledge [RK] p=0.377, learning involving personal understanding [PU] p=0.269), self-rating (p=0.824), and the surface learning approach. Both medical and dental students have no significant difference in surface learning approach with t =0.556 and p=0.579. CONCLUSION: Medical students favoured deep and strategic learning over dental students. While there was no significant difference in the surface learning approach, the deep and strategic learning approaches were substantially connected with the notion of learning, types of courses/teaching, and self-rating. The knowledge of learning approaches will assist educators in making efforts to address students through successful teaching strategies. Once teachers understand the need to accommodate individual strengths and needs, they will devise appropriate new teaching methods
An Orange Baby: Benign Carotenemia in an Infant: A Case Report
Get PDFCarotenemia is a clinical condition characterized by yellow skin pigmentation (xanthoderma) and increased blood beta-carotene levels due to various causes. Diet-related carotenemia is common but usually underreported. We report here a case of carotenemia in a male infant caused by over ingestion of the high-carotene diet by the infant and his mother. Recognizing this condition will avoid unnecessary referrals and investigations
Recurrent Hypoglycaemia in A Diabetic Patient: The Unexpected Diagnosis
Get PDFHypoglycaemia is a common complication seen in diabetic patients receiving insulin. However, insulin is not the risk factor for hypoglycaemia attack as patient with underlying liver problem is also at risk. Thus, as an attending physician, a high index of suspicion is required in dealing with hypoglycaemia patient. We report a 60-year-old woman with underlying diabetes mellitus who presented with recurrent hypoglycaemic episodes and noted to have multiple benign liver cysts that progressed into hepatic failure secondary to hepatocellular carcinoma
Construction of Sexual and Gender Minority Identity among Malay-Muslim Natal Females: A Meta-Synthesis
Get PDFMalay-Muslim identity is the regular norm among Malays in Malaysia; however, this identity has been challenged with the emergence of sexual-and-gender minority (SGM). Even though Malay cultural values and Islamic teachings prohibit same-sex orientation and cross-gender, a SGM group has evolved among Malay-Muslim natal females. This meta-synthesis was conducted to explore the psychosocial factors involved in the construction of SGM and its consequences among Malay natal females in Malaysia using the Sandelowski-Barroso approach. A systematic search of articles was done in the selected databases by using identified keywords between October to December 2020. Twelve full articles were included after proper screening and in-depth reviews. The quality of these articles was assessed independently by two researchers. The articles were then analysed using ATLAS.ti 8 software to group the data into subthemes and themes. Lastly, the effect sizes of each subtheme were calculated. Three main themes were identified: affection seeking, hurtful experience and nurturing influences. Malay natal females also shared consequences following construction of SGM identity which include acceptance from community, continuous conflicts in life and mental health consequences. This meta-synthesis revealed the influences that shape the construction of Malay SGM women. Thus, interventions shall be planned to aid them according to cultural and psychosocial factors
Childhood Vaccine Hesitancy in selected Islamic and Muslim-majority Countries : Result Synthesis from a Scoping Review
Get PDFVaccine hesitancy and refusal were linked to various religious beliefs, including Islam. Regardless, there were limited studies which offer insights into the role of religious affiliations and related misconceptions in childhood vaccination refusal and hesitancy in Islamic and Muslim Majority countries (MMC). Therefore, this review identifies the prevalence of childhood vaccine hesitancy and its contributory factors while determining the role of religious beliefs in childhood vaccine hesitancy in Islamic states and MMC. We examined four electronic databases for published studies related to childhood vaccine hesitancy and refusal in Islamic countries or MMC from 2011 to 2021. Results revealed that the prevalence of vaccine hesitancy and vaccine refusal range from 8.0% to 21.0% and 1.0% to 58%, respectively, which was comparable to other countries. Parental reasons contributing towards vaccine hesitancy and refusal include concerns related to vaccine safety, side effects and effectiveness, preference for alternative measure to prevent disease, prior bad experiences, and healthcare system distrust. Religious reasons instigating vaccine hesitancy include concerns that vaccine consists of haram ingredients, beliefs that vaccine is against God’s will, perceptions of vaccine being harmful, influences from religious leaders, and distrust towards religious authorities supporting vaccination. In brief, various factors induce vaccine hesitancy and refusal in Islamic states and MMC. Further studies could provide better insights into the role of religious factors in childhood vaccine hesitancy within local contexts in order to formulate effective interventions to address this issue
Effects of Combined L-Carnitine Supplementation and Moderate-Intensity Exercises on Oxidative Stress, Antioxidant, and Anti-Inflammatory Responses in Overweight and Obese Individuals: A Randomized Controlled Trial
Get PDFINTRODUCTION: Obesity has been associated to persistent oxidative stress and inflammation that could lead to chronic diseases. MATERIALS AND METHODS: Sixty[1]eight overweight and obese participants aged 29.03 ± 6.02 years old were randomly assigned, with 17 participants per group, into sedentary control (C), L-carnitine supplement alone (S), exercise alone (E), and combined L-carnitine supplementation and exercise (SE) groups. The participants in S and SE groups took one tablet of 1000 mg of L-carnitine every day. The E and SE groups performed brisk walking exercise for 30 minutes at 50% HRmax followed by Tabata exercise for 10 to 20 minutes per session, 3 sessions per week. During pre- and post-tests, blood markers of participants were assessed to determine their reactive oxygen species (ROS), malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), and interleukin-6 (IL-6) levels. All the observed parameters were analysed using two-way mixed ANOVA for repeated measures to determine significant differences within and between the groups and comparisons of mean differences were performed using one way ANOVA. RESULTS: Results showed that there were significant decreases in ROS and MDA in the S, E, and SE groups at post-test after 12 weeks of intervention. The greatest reduction of these parameters were observed in SE group among all groups. At the post-test, both CAT and SOD levels increased in the S, E, and SE groups. Regarding IL-6, it was found to be increased in C and E groups. In contrast, there were significant decreases in S and SE groups following the intervention. CONCLUSION: Twelve weeks of L-carnitine supplementation and engagement in brisk walking and Tabata exercise had significant improvement on oxidative stress, antioxidant, and anti-inflammatory responses in overweight and obese individuals