IIUM Medical Journal Malaysia (IMJM)
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The Accuracy of Surgeon-Performed Preoperative Parathyroid Ultrasound Localization for Renal Hyperparathyroidism Patient
Get PDFIntroduction: Parathyroid surgery for renal hyperparathyroidism (RHPT) is indicated when patients have a progressive disease despite optimal medical therapy. The success of total parathyroidectomy in RHPT lies in accurate localization and excision of all PTGs. Recently, surgeon-performed ultrasound (SPU) has been increasingly used for the preoperative localization of PTGs in the intent of focused approach and reduce morbidity. Thus, we conducted a prospective observational single-center study to determine the accuracy of SPU for PTG localization in RHPT and the factors affecting its accuracy. Materials and Methods: This is a prospective, observational, single-center study conducted in University Kebangsaan Malaysia Medical Centre between March 2018 and March 2019. The patients’ preoperative demography, clinical data, and relevant blood laboratory results, including calcium, phosphate, alkaline phosphatase, and intact parathyroid hormone, were recorded. Preoperative USG and surgery were performed by the same endocrine surgery consultant. Results: SPU localization had an overall accuracy of 78.1%, sensitivity of 81.0%, and specificity of 30.0% with a positive predictive value of 94.8% and a negative predictive value of 10.5%. The SPU gland localization rate was significantly higher in patients without goiter (median=0.88, IQR=0.63–1.00) than in those with goiter (median=0.50, IQR=0.25–0.75) (p=0.028). Conclusions: SPU localization of the PTG in RHPT had an accuracy comparable with that in previous literature with the additional advantage of identifying concurrent unknown thyroid nodules. Considering the high prevalence of concomitant nodular thyroid disease in our RHPT population, we advocate the routine use of preoperative neck ultrasound for RHPT patients undergoing parathyroid surgery.
Vaginal Injury Due to Inflicted Self-Medication: A Rising Concern
Get PDFImproper self-treatment of vaginal discharge may result in various complications to the patient. We reported a case of a 24-year-old single and nulliparous lady with an oak gall stick lodged in her vagina during an attempt to treat her own vaginal discharge. During an examination under anaesthesia (EUA), her hymen was noted to be torn and a foreign body was identified and removed out from her vaginal. Her upper vaginal swab cultures negative for any pathogen. We concluded that this was a case of intravaginal foreign body complicated with vaginal injury secondary to a self-medication for vaginal discharge by using a herbal stick. Hence, the public should be educated to seek proper medical treatment rather than performing self-treatment
Malay Version of Acceptance and Action Questionnaire-II (AAQ-II): A Reliability and Validity Analysis in Non-Clinical Samples
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
The Effectiveness of the Islamic Input in Medical Practice (IIMP) in Improving the Knowledge, Attitude and Practice among Medical Students in Malaysia. A 5-year Prospective Study
No full textIntroduction; In order to produce well-rounded medical doctors in the future, Islamic-based Medical schools in Malaysia and other parts of the world are implementing a special approach in their curricula. The main vision of these medical schools is instillation of Islamic values in their curricula. In International Islamic University of Malaysia (IIUM), a special curriculum namely Islamic Input in Medical Practice (IIMP) was introduced for this purpose. The importance of this study is to measure the effectiveness of this program on the aspects of knowledge, attitude and practice among our students. Materials & Methods: We follow up a total of 142 students for 5 years duration. The first assessment was done right at the enrolment to the medical program and the second assessment by using the similar questionnaire was done after 5 years upon completion of their course. Results: From a total number of students 145 from initial assessment, only a total of 102 medical students completed second time. The remaining number were excluded due to either incomplete forms and delay the academic progress due to failure of subjects. The mean different between pre and post shows a significant improvement in all 3 measured aspects (p<0.001 to 0.022). Conclusion: The 5-year evidence shows our IIUM program is effective to improve the knowledge, attitude and practice
Development and validation of the Self-efficacy, Knowledge, Attitude and Practice towards Environmental Tobacco Smoke (SE-KAP-ETSQ) in the Malay language for mothers with children below 6 years old.
No full textIntroduction: Children under 6-years old are most susceptible to environmental tobacco smoke (ETS). Mothers spend more time with their children and need to be empowered to protect their children from ETS. The study aimed to develop and validate a Malay ETS questionnaire that measures the self-efficacy, knowledge, attitude, and avoidance practice (SE-KAP-ETSQ) among mothers with children below 6 years old. Materials and Methods: The SE-KAP-ETSQ was adapted from two questionnaires; 10-item EEQ and 29-item KAP-ETSQ. The two phases of the study are phase 1: development of the questionnaire and phase 2: validation of the questionnaire. Data were analysed using SPSS ver.26 and AMOS ver.24. Result: A total of 513 mothers; Exploratory factor analysis (EFA) was 186 and Confirmatory factor analysis (CFA) was 327 responded with a mean age of 31.44 years. EFA identified four domains with 26 items. Factor loadings ranged from 0.574 to 0.854 and Cronbach’s alpha ranged from 0.755 to 0.887. CFA generated four models before it achieved best-fit indices with root mean square error of approximation (RMSEA) of 0.053, goodness-of-fit index (GFI) was 0.932, comparative fit index (CFI) was 0.968, Tucker-Lewis index (TLI) was 0.960, Chi-squared/degree of freedom (ꭓ2/df) was 1.909, that left 17 items with factor loadings ranged from 0.614 to 0.948. Composite reliability and average variance extracted of the domains ranged from 0.778 to 0.858 and 0.534 to 0.689, respectively. Conclusion: This study produced a valid and reliable new Malay SE-KAP-ETSQ that can be used for further studies within a wider population
A Group-Randomized Study Comparing the Traditional Lecture and Informal Cooperative Learning For Undergraduate Radiology Training In A Malaysian University
Get PDFPurpose: Radiology teaching via the traditional lecture (TL) is susceptible to a decline in focus and engagement, leading to compromised training and competency. In this study, we investigated the teaching of radiology topics via informal cooperative learning (ICL). Materials and Methods: We randomly delivered teaching via the TL or the ICL to four clinical group of thirteen third-year undergraduate medical students. The study involved eleven radiology topics throughout one academic year. For each topic, two groups underwent the TL while the other two learned via the ICL. All students underwent a pre-test at the beginning of each class, consist of One Best Answer (OBA) and Objectively Structured Clinical Examination (OSCE) to assess knowledge and skills, respectively. They subsequently underwent post-tests with another OBA and OSCE assessments at the end of class and six weeks later. Results: Students who learned from the ICL classes scored significantly higher in the knowledge assessment immediately post-teaching, six weeks later, and the overall score regardless of time. Assessments of skills showed no statistically significant difference between the two teaching methods. However, for both the ICL and TL, post-teaching scores of knowledge and post-teaching scores of skills were significantly higher than the pre-test. Conclusion: Our study provides empirical evidence on the superior competency of undergraduate radiological skills through the ICL. The findings signify the need to engineer competent doctors via innovative clinical training. The novel experience from this study better-orientate radiology teaching and contribute to the broader field of medical education, clinical practice, and patient safety
The Obstetric Outcomes of Obese Primigravida with Spontaneous Onset of Labour at Term
Get PDFINTRODUCTION: Obesity has reached pandemic level with higher prevalence among women. Obese pregnant women have higher risk of comorbidities, maternal and fetal complications. This study aimed to determine the prevalence of vaginal delivery and pregnancy outcomes of obese primigravida presented with spontaneous labour at term. MATERIALS AND METHODS: This prospective cohort study was conducted in a tertiary hospital in Perak involving 250 obese primigravida (BMI ≥27.5kg/m2) and 250 non-obese primigravida. Data collected from August 2020 till January 2021 and analyzed using descriptive statistics, independent T-test and Mann-Whitney U test by SPSS version 23.0. RESULTS: Our study found that there were no significant differences in the proportion of vaginal delivery and caesarean delivery between obese and non-obese primigravida [72.0% vs. 78% (vaginal delivery) and 28% vs. 22% (caesarean delivery)] with spontaneous onset of labour at term. No difference in complications of labour such as PPH and OASIS (p=0.187), with high successful delivery without complications. Obese women presented with cervical dilatation of 4cm had longer delivery interval [5.82(2.97) vs. 4.75(2.71), p=0.013] but shorter delivery interval at 6cm [2.41(1.58) vs. 3.61(1.78), p=0.026] compared to non-obese. They also had higher caesarean rate indicated for abnormal labour progress [28(71.8) vs. 11(28.2), p=0.019] and higher comorbidities [149(72.3) vs. 57(27.7), p=<0.001]. There was no difference in the fetal outcome (p=0.311). CONCLUSION: After careful selection, obese women with spontaneous labour at term are safe for vaginal delivery as they have similar risk of labour augmentation, duration of active labour, caesarean delivery, PPH and OASIS despite higher comorbidities
Spinal Brucellosis Masquerading as Pyogenic Spondylodiscitis: A Rare Case
Get PDFBrucellosis is a zoonotic infection secondary to Brucella spp. Musculoskeletal system is the most affinity site to been affected by this disease and lumbar vertebrae the most favourite site of involvement. The disease can manifest as focal or diffuse. The dietary history is a main and good clinical clue towards the definite diagnosis. Plain radiograph may benefit in terms of focal disease, however MRI is the most sensitive and appropriate imaging to look for extension of the disease and spinal complications. We are reporting a case of spinal Brucellosis in a lady who was initially diagnosed as pyogenic and tuberculous spondylodiscitis. Patient’s initial presentation as well as the radiological investigation led towards the diagnosis of pyogenic spondylodiscitis, however the blood culture revealed Brucella melitensis. We would like to highlight the importance of clinical history and challenges in diagnosing spinal Brucellosis as radiographic manifestation is non-specific and the organism are almost forgotten nowadays
Correlation between Fasting Lipid, Total Body Fat, Body Mass Index and Thyroid Status Among Patients with Thyroid Disorders
Get PDFINTRODUCTION: Thyroid dysfunction affects lipid metabolism via lipoprotein transport. In this study, we compared the fasting lipid profile, body mass index and percentage of total body fat among patients with different thyroid status and its correlation with thyroid function test. MATERIALS AND METHODS: We conducted a cross sectional study over 28 months among patients with different thyroid status from Oncology Clinic and Endocrine Clinic at Hospital Universiti Sains Malaysia. Adult patients age 18 years to 80 years, hyperthyroid at least 6 months or hypothyroid at least 6 months or euthyroid at least 1 year were eligible. The total percentage of body fat was measured using DEXA scan. The thyroid function test and fasting lipid profiles were documented. Comparison of fasting lipid profile, BMI and percentage of total body fat among different thyroid status was performed using one-way ANOVA. Pearson correlation was used to analyse the aforementioned variables with the thyroid function test (TSH and free T4). RESULTS: A total of 159 patients were recruited. The majority were Malays (93.1%), female (68.6%) and hyperthyroid (42.8%). There was no significant mean difference of triglyceride (TG), total cholesterol (T-Chol), LDL, HDL, BMI and percentage of total body fat among patients with different thyroid status (p>0.050). Among hypothyroid patients, T-Chol and HDL were positively correlated with TSH (r=0.43, r=0.36) but inversely correlated with free T4 (r=-0.42, r=-0.39). The free T4 was inversely correlated with the percentage of total body fat among patients with euthyroid status (r=-0.50). The TSH was negatively correlated with the percentage of total body fat among patients with hyperthyroid status (r=-0.28). CONCLUSION: A positive correlation between TSH with T-Chol and negative correlation between T4 with T-Chol among hypothyroidism status suggests a potential reduction of risk in the cardiovascular event among this group.
 
Elevated CA 125 in A Male Patient with Lung Carcinoma: A Laboratory Perspective
Get PDFCA 125 is a tumour marker that is widely used for the management of patients with ovarian malignancy. However, elevated CA 125 has been reported in various non-ovarian cancer patients, including males. This report describes a case of an elevated CA 125 level in a 49-year-old male patient who presented with chronic cough associated with constitutional symptoms. The patient was diagnosed with lung carcinoma based on radiological investigations and tissue histopathological examination. According to recent studies, CA 125 has a potential role as a marker for lung malignancies. However, questions arise about the effectiveness of its measurement for such patients due to its poor specificity and improper utilization of the test. This report focuses on the clinical role of CA 125, the appropriateness of the test request for this patient, the significance of the result, and its implications for the patient and laboratory management