IIUM Medical Journal Malaysia (IMJM)
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Factors Contributing to Red Blood Cells Crossmatch and Transfusion among Obstetrics Patients in a Single Tertiary Hospital
Get PDFINTRODUCTION: Transfusion of blood and blood components among obstetrics patients is a common practice but they are not without risks. This study aims to determine crossmatch to transfusion ratio (C:T ratio) and to assess the factors that influence red blood cells (RBC) transfusion among obstetrics patients in a single tertiary hospital. MATERIAL AND METHODS: This was a retrospective cohort study of RBC crossmatch requests with data collected from 350 obstetrics patients. The patients were grouped into either received RBC transfusion or did not receive transfusion. Demographics and clinical characteristics were analyzed using descriptive and multivariate analysis. RESULTS: The mean C:T ratio was 3.1. Of 350 patients, 149 (42.6%) patients did receive RBC transfusion. Patients with underlying hemoglobinopathy (75.9%), history of postpartum hemorrhage (63.6%), underwent instrumental assisted delivery (64.3%), and with hemoglobin level of < 70 g/L upon crossmatch requests (90.5%) did receive RBC transfusion. Cesarean section (p=0.011), hemoglobin level < 99 g/L (p<0.001), estimated blood loss > 1000 mL (p<0.001), and symptomatic anemia (p=0.029) were the significant factors associated with RBC transfusion. CONCLUSION: The mean C:T ratio in our study was high. Identifying the factors contributing to RBC transfusion among obstetrics patients are important to reduce unnecessary crossmatch and subsequently improve blood inventory management, and thus further reduce the risks associated with allogeneic transfusion
Brain Wave Changes during Cognitive Task Performance in Uncomplicated Diabetic Adults: An Exploratory Study
Get PDFIntroduction: Diabetes mellitus (DM) is a chronic disease associated with cognitive decline and dementia in the elderly population. This exploratory study analysed the brain wave changes during cognitive task performance in working adults with and without type 2 diabetes mellitus (T2DM). Materials and Methods: The Mini-Mental State Examination was used to screen subject’s cognitive function and quantitative electroencephalography was used to analyse subject’s brain waves at rest and whilst performing the serial seven test. Results: When performing the serial seven test, the diabetic group showed a higher absolute power of theta waves in the left frontal (Fp1, 16.22 ± 3.81 vs 3.75 ± 1.69; p = 0.022) and temporal regions (T3, 24.27 ± 3.69 vs 7.92 ± 2.17; p = 0.045), but lower absolute power of beta waves in both the frontal regions (Fp1, 27.35 ± 3.67 vs 41.14 ± 5.67; p = 0.029; Fp2, 23.01 ± 3.31 vs 39.05 ± 2.64; p = 0.041) and left temporal region (T3, 37.93 ± 4.64 vs 50.94 ± 3.56; p = 0.046) when compared to those of the control group. The diabetic group took longer to complete the task (127.9 ± 8.3 s vs 95.6 ± 5.9 s; p = 0.032) than the control group, despite no statistically significant difference in correct response rates. Diabetes duration was positively correlated with the theta/alpha ratio in the left frontal (Fp1, r = 0.525; p = 0.041) and temporal (T3, r = 0.618; p = 0.037) regions. Conclusions: T2DM may affect cognitive function in patients before clinical manifestation.
Index Admission Percutaneous Coronary Intervention versus Pharmaco-invasive Strategy for Patients with Acute ST-Elevation Myocardial Infarction: A Tertiary Centre-based Study
No full textIntroduction: Pharmaco-invasive strategy is a standard of care in patients with ST -elevation myocardial infarction (STEMI), but the optimal timing may not be achieved due to limitations. Thus, a large number of patients underwent percutaneous coronary intervention (PCI) at a later timing during their index hospitalisation. However, small evidence is available on the outcome of this strategy. This study aimed to compare the clinical outcomes of PCI during index admission with a pharmaco-invasive strategy for patients with STEMI. Material&Methods: This retrospective cohort study was conducted at a tertiary centre. Medical records of all STEMI patients who were treated by PCI from January 2013 to March 2018 were retrieved. The clinical outcomes of the study were the rate of major adverse cardiac event (MACE) and major bleeding at 30 days and 6 months post PCI. Results: A total of 91 STEMI patients were analysed. Twenty-nine (31.9%) patients were treated by pharmaco-invasive strategy, and 62 (68.1%) patients underwent PCI during their index admission. At 30 days post PCI, the rates of MACE in the pharmaco-invasive and PCI during index admission group were 10.7% and 10.3%, respectively (p = 0.958). The rates at 6 months were 8.3% and 7.8% (p = 0.942). The rates of major bleeding at 30 days were one (3.6%) and none (p = 0.151). By contrast, the rate at six months was only one (2.0%) for the PCI during index admission group. Conclusions: PCI during index admission may had similar clinical outcomes to pharmaco-invasive strategy
Hypertension among Diabetes Population in Malaysia and its Associated Risk Factors; Findings from National Health and Morbidity Survey 2015
Get PDFThe prevalence of hypertension and diabetes continue to rise globally. This study aims to examine the national prevalence of hypertension among diabetes population in Malaysia and its associated risk factors. A sub-analysis of data from National Health Morbidity Survey (NHMS) 2015 was conducted among 4229 respondents with diabetes. This data was obtained from respondents aged 18 years and above. Diabetes was defined as those who self-reported to have diabetes or who had fasting capillary blood glucose of ≥6.1 mmol/L or non-fasting blood glucose of >11.1 mmol/L. Hypertension was defined as one who has systolic and diastolic blood pressure of ≥140 and ≥ 90, respectively. The prevalence of hypertension among respondents with diabetes was 57.9% (95%CI: 55.8,60.0). The prevalence of hypertension among diabetes was higher among females (58.7%), ≥60 years old (80.1 %), Chinese (61.1%), those with primary education (69.6%), widow/widower/divorce (75.4%), not working (67.7%), rural residents (60.6%), non-smokers (60.1%), non-drinkers (58.1%), those who were obese (66.0%) and with abnormal cholesterol level (63.5%). Multiple logistic regression analyses revealed that age group, working status, obesity and cholesterol were associated with hypertension among respondents with diabetes. Early detection of hypertension should be an integral part of diabetes management
Knowledge in Dealing with the COVID-19 Based on the Guidance of Al-Quran and Al-Sunnah: A Cross-Sectional Survey among the Pharmacy and Health Sciences Diploma Students in Malaysia
Get PDFINTRODUCTION: Medicine and communicable disease control are embedded in many Islamic teachings as conveyed by the Prophet Muhammad (PBUH) through the Al-Quran, Al-sunnah, and Al-hadith more than 1400 years ago. Therefore, when the COVID-19 outbreak hits Malaysia, with the majority of the population being Muslims, the society should be equipped with knowledge in dealing with this pandemic. This study investigates the knowledge towards dealing with COVID-19 based on the guidance of Al-Quran and Al-Sunnah of Prophet Muhammad (PBUH) among undergraduate students in Malaysia. MATERIALS AND METHODS: A cross-sectional study using self-constructed questionnaires was performed. The questionnaires were pre-validated and distributed to pharmacy and health sciences students via an online survey platform. One of the selection criteria was that the respondent must be a Muslim. RESULTS: The students scored a median of 26 (IQR 4) in the knowledge test. Students’ percentage knowledge levels were divided into three categories: poor (n = 42, 15%); moderate (n = 207, 73%) and good (n = 33, 12%). The lowest scored knowledge item was observed on the Islamic terminology, Maqasid Shariah (4.3%), and differences between hadith and sunnah (20.9%). No significant differences in knowledge scores were observed in the pre-determined independent variables such as age, year of study, accommodation, and previous religious school admission. CONCLUSION: The study findings suggest that the students have a good understanding of scientific aspects of COVID-19 but lack knowledge in handling the pandemic as recommended by Al-Quran and Al-Sunnah
Relationship between Alveolar Ridge Resorption in Mandible and Masticatory Performance Based on Gender in Complete Denture Wearers at Dental and Oral Hospital University Sumatera Utara
Get PDFINTRODUCTION: The aim of the study was to observe the relationship between alveolar ridge resorption in mandible and masticatory performance based on gender in complete denture wearers. MATERIALS AND METHODS: The subjects included were those wearing complete denture between the ages of 45-69 years-old, treated at the Dental and Oral Hospital of University Sumatera Utara. Alveolar ridge resorption in mandible was analysed using the panoramic radiograph and masticatory performance was evaluated clinically using the colour-changeable chewing gum. RESULT: 40 patients were included in this study. 50% were women in which 15 women (37.5%) had mild alveolar ridge resorption whilst 5 (12.5%) had severe alveolar ridge resorption. For masticatory performance, 14 women (35%) had good masticatory performance and 6 (15%) had poor masticatory performance. For the men; 17 (42.5%) had mild alveolar ridge resorption whilst 3 (7.5%) had severe alveolar ridge resorption. For masticatory performance, 16 men (40%) had a good masticatory performance and 4 (10%) had a poor masticatory performance. There was a significant correlation between alveolar ridge resorption in mandible and masticatory performance amongst women (p=0.014). However, there was no significant correlation found between gender and alveolar ridge resorption in mandible (p=0.695), between gender and masticatory performance (p=0.716), and between alveolar ridge resorption in mandible and masticatory performance amongst men (p=0.088). CONCLUSION: The alveolar ridge resorption in mandible is associated with masticatory performance amongst women
Constraints Related To Smoke-Free Policy Implementation: A Review
Get PDFIntroduction: Smoke-free policies have been enacted and enforced either by law or voluntarily adapted by countries in order to protect its people from the harms of second-hand smoke. However, the mere adoption of smoke-free policies does not guarantee success in fully achieving smoke-free environments due to the many issues and challenges in implementing the policies. The objective of this review is to identify the issues and challenges in the implementation of smoke free policies worldwide. Materials and Methods: A scoping review on observational study designs was conducted. English published journal articles between 1999 and 2019 were searched in four databases (Ovid Medline, PubMed, Scopus and ScienceDirect) and general search engine from September until December 2019. Relevant articles gathered systematically using PICO elements and combination of suggested Medical Subject headings (MeSH) keywords. Results: Twenty articles were included in this review after the filtering and screening process. The smoke-free policy implementation issues were discussed according to the health-policy framework (Content, Context, Actors and Process). Most of the barriers identified were related to the actor construct reflecting the important role played by smokers specifically and the community in general to support the implementation of the policy. Conclusion: The review highlights the important role played by the author contruct of the health-policy framework in order to successfully implement the smoke-free policy especially involving smokers’ awareness and commitment and also public perception towards the capacity of the authority to enforce the policy
A Rare Case of Klippel-Feil Syndrome with Cholesteatoma, Thrice Operated with Final Outcome of Cochlear Implant
Get PDFKlippel-Feil syndrome (KF) is defined as the congenital fusion of two or more vertebrae. Due to skeletal abnormalities, patients with KF syndrome may potentially present with hearing loss. To the best of our knowledge, this is a rare case of an adolescent patient with underlying KF syndrome and cholesteatoma. Our patient underwent three successive mastoid operations, primarily due to middle ear disease, with cochlear implantation for hearing rehabilitation.
Case Report: Lymphoepithelial Carcinoma of the Parotid Gland with EBV Association
Get PDFPrimary Lymphoepithelial Carcinoma (LEC) of the salivary gland is a rarely encountered malignant tumour by Otorhinolaryngology surgeons especially in Malaysia. It accounts for an estimated 0.4% of all malignant tumours of head and neck with a racial predilection towards Eskimos, people of Southern Costal of China and Japanese. Histologically it exhibits a poorly differentiated neoplasm and a strong association with Epstein-Barr virus that could be similar to an undifferentiated nasopharyngeal carcinoma (NPC). The parotid gland is the most common location a Primary LEC of the salivary gland develops, with patients mostly presenting with a painless parotid swelling and cervical lymphadenopathy. Herein, the authors report a rare case of Primary LEC of the parotid in an unfortunate Malay female. In this case report we further highlight the pathological and radiological features including management of Primary LEC of the parotid as this tumour should be considered in all patients presenting with a painless parotid mass to an Otorhinolaryngology clinic.