IIUM Medical Journal Malaysia (IMJM)
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Serial Evaluation of Sequential Organ Failure Assessment Score in Predicting 1-Year Mortality in Critically Ill Patients
Get PDFIntroduction: Prediction of long-term prognosis or outcome in the intensive care unit (ICU) is important for prognostication and administration purposes. Sequential Organ Failure Assessment (SOFA) score was developed to estimate organ failure in sepsis patients. However, organ failures have been associated with mortality, and hence SOFA score has been validated as an outcome measure. To the best of our knowledge, the association of SOFA, and serial SOFA score with 1-year mortality was not well established. Materials and method: This was a retrospective observational cross sectional study using the existing record of patients admitted to general ICU Sultan Ahmad Shah Medical Centre from the 1st June 2017 to the 30thMay 2018. Data was collected from patients’ daily clinical charts and medical records. SOFA score on day-1 until day-3 and on discharge were recorded and subsequently delta SOFA was calculated. Results: A total of 120 patients’ data were collected. SOFA score within 3 days of admission predicted 1-year mortality, with the highest prediction for on SOFA score on discharge from ICU. Serial SOFA score measured within 24 hours (day 1 to day 2) and 48 hours (day 1 to day 3) did not predict mortality, but delta SOFA involving SOFA on discharged did. Cardiovascular and renal were the most significant individual component of SOFA score that contributed to 1-year mortality. Conclusions: SOFA score measured on discharge from ICU plays the key important factor in contributing to the prediction of 1-year mortality. Cardiovascular and renal were the most significant component that warrant risk stratification measures using the parameters
Prevalence and Associated Factors of Prediabetes in Postpartum Gestational Diabetes Mellitus Mothers in the East Coast of Malaysia
Get PDFIntroduction: Majority of gestational diabetes mellitus (GDM) mothers resume normal glycaemic state after delivery. However, this hyperglycaemic condition may persist in some women. Postpartum GDM mothers have a higher risk of progression to diabetes and prediabetes than those with normal pregnancy. This study was aimed to determine the prevalence of prediabetes among postpartum GDM mothers and its associated factors during six weeks of postpartum glucose testing. Materials and method: A cross-sectional secondary data review was conducted from January 2021 until May 2021 among postpartum mothers with history of GDM who performed postpartum glucose testing in all government health clinics in Besut, Terengganu from January 2018 until December 2019. A descriptive and multiple logistic regression analysis were performed using IBM SPSS Statistics version 26 software. Result: A total of 429 cases were included. Prevalence of diabetes and prediabetes was 2.3% (95% CI 1.6%, 3.0%) and 13.8% (95% CI 12.1%, 15.5%), respectively. There was significant associations found between previous history of GDM (Adj. OR 3.28; 95% CI 1.83, 5.87; p < 0.001) and insulin usage (Adj. OR 2.75; 95% CI 1.51, 4.99; p= 0.001) with development of prediabetes at postpartum period. Conclusion: The prevalence of diabetes and prediabetes among postpartum GDM mothers in Besut district was as high as other studies in Malaysia and globally. Women with a previous history of GDM and insulin usage should be focused on prevention strategies as they were at higher risk of developing prediabetes in the postpartum period.
Post-COVID-19 Symptoms, an Online Survey in Malaysia
Get PDFINTRODUCTION: Prolonged COVID-19 symptoms is one of the major challenges in the management of the disease. As the number of COVID-19 cases increased drastically, the number of those with prolonged symptoms are also accumulating, either diagnosed or undiagnosed. This study aimed to identify the long-term clinical symptoms of COVID-19 and the associated risk factors among Malaysian populations. MATERIALS AND METHODS: A cross-sectional survey using Google Form link for distribution of a self-administered questionnaire was shared and disseminated via online platforms such as Facebook, WhatsApp, and Telegram. The inclusion criteria included those with a history of positive COVID-19 from 1st March 2020 until one month prior to the survey, and age above 18 years old. RESULTS: A total of 215 Malaysians participated, with 74% female respondents and a mean age of 36.4 years. Twenty-seven (12.6%) were asymptomatic when diagnosed with COVID-19. More than half (56%) still had symptoms at one-month of diagnosis, while 39% and 18% still had symptoms at the second and third months respectively. The most reported symptoms were lethargy (45.1%), difficult concentrating (22.3%) and cough (21.9%). Female, chronic lung disease and hypertension are significantly associated with prolonged symptoms at one month of COVID-19 infection. CONCLUSIONS: Lethargy, difficulty to concentrate and cough were the most common symptoms reported months after COVID-19 diagnosis. Apart from treating acute conditions, physicians should also be able to recognize and manage those symptoms. The findings of this study will help policymakers better grasp the social and economic consequences of long-term post-COVID-19 symptoms.
Tualang Honey Supplementation Alleviates Obesity and Dyslipidaemia in High Cholesterol Diet Induced Non-Alcoholic Steatohepatitis Animal Model
Get PDFINTRODUCTION: Dyslipidaemia and obesity are two main features of non-alcoholic steatohepatitis (NASH). This study aimed to investigate the effects of Tualang honey (TH) supplementation on bodyweight, liver weight, and lipid profiles in high cholesterol diet (HCD) induced NASH animal model. MATERIALS AND METHODS: Sixteen Sprague-Dawley rats were given 12% HCD for 16 weeks to induce NASH. These animals were divided into 4 groups; Group 1 (continued HCD), Group 2 (changed to normal diet), Group 3 (normal diet and TH 1.2g/kg) and Group 4 (normal diet and TH 3.0g/kg) for the following 4 weeks. Bodyweight was measured daily. At the end of the study, blood was collected via retro-orbital bleeding and the rats were sacrificed to harvest their liver. RESULTS: The group 4 rats had significantly lower mean final bodyweight than rats in group 1, 2 and 3 (478.0±24.4 vs. 641.5±25.1, 593.8 ±29.3, 552.0±72.9 g, p<0.05). Animals in group 4 were also found to have a significantly lower mean liver weight compared to groups 1 and 2 (12.9±0.9 vs 20.1±2.2, 15.7±1.2 g, p<0.05). In comparison to controls, the mean concentration of total cholesterol was significantly lower in all the other groups and the lowest mean concentration of triglycerides was recorded in group 4 with significant difference when compared to the controls (0.9±0.4 vs 3.6±0.4 mmol/L, p<0.05). CONCLUSION: The change from HCD to a normal diet coupled with TH supplementation has been shown to reduce bodyweight, liver weight, total cholesterol and triglyceride levels in the 12% HCD NASH induced animal models.
Prevalence of Breast Cancer and its Associated Factors for Recurrence in Hospital Tengku Ampuan Afzan from 2008 to 2012
Get PDFINTRODUCTION: Breast cancer is the commonest malignancy in Malaysian women. Cancer recurrence commonly seen in the first 2 years can be detrimental. Thus, identifying its prognostic factors is important. MATERIALS AND METHODS: We have retrospectively analyzed 179 women with breast cancer based on 5 years single center database with minimum follow up of 2 years. The demographic and clinico[1]pathological characteristics were determined using descriptive statistics. Survival was calculated based on Kaplan-Meier method. Multivariate analysis by Cox proportional hazards was performed to evaluate the potential factors affecting breast cancer recurrence. RESULTS: Mean follow up was 42 months, with mean age 52 years and 60.9% presented in Stage II disease. Overall recurrence was 41.9% with local recurrence 2.1%, regional recurrence 12.3% and distant recurrence 27.4%. 50% of our patients developed recurrence at 25 months. On univariate analysis, time to first presentation was significantly correlated with recurrence. In multivariate analysis, the tumor size, lymph node positivity and lympho-vascular invasion were independently associated with recurrence. Discussion: To date, local studies on prognostic factors in breast cancer recurrence remained sparse. Based on this study, factors associated with breast cancer recurrence identified and coincides with the previous evidence. Furthermore, this would provide evidence to improve the survival for patients with breast cancer in local settings. CONCLUSION: Further studies also need to be done on the non-compliant patients with advanced disease at presentation to determine factors towards their perception of surgical care in breast oncology
Classical Enteropathy-Associated T-cell Lymphoma (EATL) Complicating A Crohn’s Disease Patient on Thiopurine Monotherapy: A Case Report
Get PDFThiopurine exposure from inflammatory bowel disease (IBD) treatment had been associated with a higher risk of lymphoproliferative disorders namely peripheral T-cell lymphoma, as early as 2 years after its initiation. We report a rare case of classical or type 1 enteropathy-associated T-cell lymphoma (EATL) with liver metastasis in a long-standing Crohn’s disease 61-year-old patient treated with azathioprine monotherapy. He presented with acute, severe abdominal pain with cholestatic jaundice and pancytopenia. Colonoscopy showed multiple small, superficial ulcers at the terminal ileum and the biopsy taken was reported as classical EATL, an uncommon gastrointestinal non-Hodgkin’s lymphoma with CD2, CD 3, CD 30, and CD 56 positivity and more than 90% Ki67 proliferative index. Computed tomography (CT) 3-phase liver scan suggested liver metastasis. This case highlights the unusual presentation of classical EATL in non-celiac disease patients and its risk association with thiopurine therapy in IBD.
Attitudes and Practices on Covid-19 amongst Residents of Two States in Northern Peninsular Malaysia
Get PDFINTRODUCTION: With the global evolution of Covid-19, and Malaysia’s efforts in containment, the onus of curtailing spread lies in the efforts of the residents to comply and adapt to the new social norms. Our aim was to study the attitudes and practices of the residents in two states in Northern Peninsula. MATERIALS AND METHODS: An analytical cross-sectional study conducted late October 2020. A pre-validated questionnaire via Google forms used. Sample size determined to be 385 for each state. Five-point Likert scale was used to cover 12 questions on attitude and 10 required practices. Data scored and converted into categorical data based on median value of good and bad attitude and practices respectively and analysed with SPSSv23. Statistically significant was p<0.05. With the scored data, Spearmans correlation was used to determine difference in attitude and practice and between the two states. RESULTS: Total of 834 respondents with 50.2% from Penang, mostly aged 20 to 30 years, green zone (40.9%), Chinese (52.6%), Malaysians (97.6%). Overall, 55.6% had good practice with 50.6% good attitude against Covid-19 prevention. Females, those aged 20 to 30 years, married and full-time workers, scored better in preventive actions. Attitude was not associated with any of the factors. Overall, 94.8% agreed to strict enforcement of social distancing and masking. A weak but positive, significant correlation between attitude and practice. CONCLUSION: Level of compliance to new norms is good with no difference between the two states. We need to ensure the social norms are sustained by the community
Comparison of Doses in Organs at Risk of Conventional and Three-Dimensional Treatment Planning in Hybrid Brachytherapy
Get PDFINTRODUCTION: This retrospective study aims to evaluate the doses of organs at risk (OARs) calculated by conventional two-dimensional (2-D) and three-dimensional (3-D) treatment planning techniques in hybrid high dose rate (HDR) brachytherapy for cervical cancer. MATERIALS AND METHODS: Data of five patients treated with combination of intracavitary and interstitial brachytherapy were used. For each implant, computed tomography (CT) images were obtained, and the clinical target volume and OARs were contoured on CT images. In 3-D planning, the volumes of OARs were derived from dose-volume histogram (DVH) on a dose volume of 2 cc for bladder, rectum, and sigmoid. The OARs defined in replanning for 2-D treatment were the ICRU-38 bladder (bICRU) and rectum (rICRU) points. Paired T-tests were used to analyse the radiation doses of bladder and rectum obtained from both techniques. RESULTS: The mean point doses evaluated via bICRU) and rICRU were 89.34 GyEQD2 and 75.92 GyEQD2, respectively. Meanwhile, the mean volumetric doses of D2cc for bladder and rectum were 80.50 GyEQD2 and 69.08 GyEQD2, respectively. There is a significant difference in mean doses of ICRU point and D2cc volume for bladder (p<0.05). However, there is no significant difference in mean doses of ICRU point and D2cc for rectum (p>0.05). Overall, ICRU point doses overestimated volumetric D2cc doses with a mean dose ratio of 1.110 for bladder and 1.099 for rectum respectively. CONCLUSION: The bICRU in 2-D planning could not represent the bladder 2 cc used in 3-D planning, thus resulting in different total dose; whereas rICRU of 2-D planning was discovered to be similar with rectum 2 cc of 3-D planning and deemed reliable in total dose estimation
Estimates Of Glomerular Filtration Rate in Critically Ill Patients With Sepsis: Comparisons of Different Equations
Get PDFIntroduction: Accurate assessment of glomerular filtration rate (GFR) is important in the critically ill. Kinetic estimate of GFR (keGFR) considers the changes of creatinine, creatinine production rate, and volume of distribution, hence postulated to be a more accurate estimate of GFR, where there are rapidly changing kidney functions. We evaluated the association of the estimated GFR by established equations and keGFR with creatinine clearance (CrCl) measurement. Materials and Methods: This is a prospective observational study of critically ill patients. Inclusion criteria were patients older than 18 years old with sepsis (clinical infection and increase in SOFA score>2), and plasma procalcitonin>0.5ng/ml. Plasma creatinine and Cystatin C (CysC) were measured on admission and 4 hours later, and the eGFR were calculated by the Cockcroft Gault (CG), MDRD, CKD-EPI and keGFR equations, and compared to the CrCl measurement. Results: A total of 70 patients were recruited. eGFR by all 4 equations strongly correlates with CrCl. keGFR had the least bias depicted by the mean differences nearest to zero (-18ml/min). Similarly, keGFRCysC had less bias than eGFRCysC, with mean difference of -21ml/min. eGFRCG had the greatest precision depicted by the narrower SD lines, however the precision of both keGFR were not much difference compared to those of eGFRCG. Conclusions: In critically ill patients with sepsis, keGFRCr and keGFRCysC had the least bias and fair precision when compared to creatinine clearance measurement. In the absence of creatinine clearance measurement, keGFR calculations is useful as surrogate for kidney function
Challenging the Journalistic Ideal of Objectivity in Reporting Vaccination
Get PDFINTRODUCTION: The resurgence of vaccine-preventable diseases such as polio, diphtheria, measles, mumps, among others demonstrate the anti-vaccine movement's growing popularity and efficacy in spreading its views. To overcome the vaccine fallacies that are now prevalent, effective news media coverage on vaccination that emphasises the urgency and necessity of vaccination to the public is required. To determine whether such emphasis is made in the mainstream media, this study analysed vaccine coverage in two English newspapers in Malaysia, The Star and the New Straits Times (NST). MATERIALS AND METHODS: Framing analysis was performed on a total of 308 vaccine-related news items gathered over 14 months, from January 2019 to March 2020. RESULTS: Both publications used almost similar patterns in reporting vaccine-related issues. They relied heavily on official or government institutions as sources of information with high emphasis given on creating awareness and providing information about vaccines. In broad, vaccination is primarily covered as news to be reported, rather than a problem to be highlighted and further explored in-depth. CONCLUSION: Considering contemporary health realities, newspapers must play a persuasive and consistent role in publicising the necessity of immunisation.