IIUM Medical Journal Malaysia (IMJM)
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An Updated Review of Type 1 Diabetes in Malaysia
Get PDFThe emerging phenomenon of early-onset type 2 diabetes mellitus (T2D) among Malaysians and misclassification of diabetes types may impact the estimates of prevalence and incidence of type 1 diabetes mellitus (T1D). From previous studies, the prevalence of T1D among the major ethnic groups in Malaysia was seen highest among Chinese, followed by Malays and Indians. More than half of the patients had diabetes ketoacidosis (DKA). This corresponded with the overall poor glycaemic control seen. However, the incidence of chronic complications, such as nephropathy, was lower. The prevalence of autoantibodies was reported highest for anti-islet cell antibody (ICA). As part of treatment, most Malaysian children had one or two daily insulin injections. Generally, older patients responded better to insulin therapy and yielded better glycaemic control than younger patients. While significant advances have been made in understanding T1D in the Malaysian population, more research is warranted to improve the clinical assessment and outcome of the disease. The present narrative review aims to summarise the overall status of T1D in Malaysia, which includes epidemiology, clinical presentation, diagnosis, complications, and management
Effects of Time Delay in Processing Common Clinical Biochemical Parameters in an Accredited Laboratory
Get PDFINTRODUCTION: Analyte stability time is challenging to employ in clinical settings. The diversity of processing time may affect the accuracy of results. This study evaluates the maximum time delay permissible before sample centrifugation and analysis. MATERIALS AND METHODS: We evaluated 15 serum electrolytes in 40 samples centrifuged and analysed using an automated analyser. The time was divided into 1, 2, 6, and 24 hours. RESULTS: Most analytes studied remained stable for up to 24 hours before centrifugation. However, delayed processing affected the value of potassium, magnesium, LDH, and calcium after 2 hours up to a maximum of 6 hours at room temperature for total protein, phosphate, and sodium. CONCLUSIONS: Most analytes were unaffected by a delay in centrifugation at room temperatures, but several critical analytes were severely affected
Model-Based Insulin Sensitivity as a New Biomarker of Sepsis Diagnosis in the Intensive Care Unit
Get PDFINTRODUCTION: Currently, there is a lack of real-time biomarker to diagnose sepsis. Insulin sensitivity (SI) may be determined in real-time using mathematical glucose-insulin models, but its effectiveness as a diagnostic test of sepsis remains unexplored. We aimed to explore the diagnostic value of model-based SI as a new biomarker of sepsis in a mixed cohort of diabetic and non-diabetic patients newly admitted to the intensive care unit (ICU). MATERIALS AND METHODS: In this cross-sectional study, we analysed SI levels derived from the Intensive[1]Control-of-Insulin-Nutrition-Glucose model in septic (n=45) and non-septic (n = 41) patients upon their ICU admission. The diagnostic value of model-based SI for sepsis was determined through analysis of the area under the curve (AUC) of the receiver operating characteristic curve. RESULTS: Baseline SI levels were significantly lower in patients with sepsis than those without sepsis (0.560 (SD=0.676) vs. 1.097 (SD=1.473) x 10-4 L/mU/min, P = 0.037). However, the AUC of 0.588 revealed that model-based SI was a poor diagnostic test of sepsis in the mixed cohort of diabetics and non-diabetics. In a separate analysis among the non-diabetics (n=19), model-based SI predicted sepsis with clinically valid performance (AUC 0.911). CONCLUSION: Presence of sepsis significantly reduced SI in the critically ill patients but a low SI could predict sepsis only in the non-diabetic cohort
Religiosity and its Relationship with Smoking Cessation: A Systematic Review.
Get PDFObjective: This study aims to systematically review the literature regarding the relationship between religiosity and smoking behaviour. Methods: Four electronic databases were used to identify the literatures including Scopus, Science Direct, ProQuest and PubMed. The search was limited to full text articles and in English or Malay only. Articles on smoking prevention and other nicotine delivering devices such as vape or electronic cigarette were excluded from the study. Results: Initially, 10,154 articles were retrieved and 12 met the inclusion criteria. Out of the 12 studies, five studies revealed a significant relationship between religious activities and cessation while the others showed inverse associations between religiosity and smoking. Conclusion: Religiosity played an important role in influencing smoking behaviour, making it an important vehicle to complement other existing tobacco control efforts. Limited studies were focusing on the Islamic religion despite the growing number of Muslim populations worldwide. Thus, further research on the integration of Islamic religion in smoking cessation program is highly recommended especially in a Muslim country like Malaysia
Postnatal Depression in Malaysia: Perspectives of Stakeholder on Awareness Medium
Get PDFINTRODUCTION: Postnatal depression is a highly prevailing illness, yet underdiagnosed. Untreated, it carries a transgenerational impact, and therefore promoting awareness for it has to be of high priority. This research explored the elements of an educational tool to develop awareness for postnatal depression as preferred by stakeholders. MATERIALS AND METHOD: A descriptive qualitative approach using semi-structured face-to-face interviews were conducted, where nine participants were recruited via purposive sampling from a university hospital in Malaysia. Interviews with each participant were audio-recorded and transcribed to verbatims. Emergent themes were identified during the analysis. RESULTS: Four consistent themes regarding elements for an educational tool were derived as follows: Foundations of the tool, Illness circumstances, Support bases, and Matters of perspective. CONCLUSION: An educational video within the local setting should involve the usage of a short emotionally driven video, highlighting illness- and treatment-related content, and addressing the preference and concerns of women within the religious and cultural context. The use of edutainment as an educational tool is replicable and has a high outreach even to those who are illiterate. The findings can be used in the tailored development of an educational video on postnatal depression which will benefit local women by creating awareness and encouraging early help-seeking
Atypical Optic Neuritis in an Immunocompetent Patient with Orbital
Get PDFAspergillosis infection in immunocompetent individuals is an uncommon entity. Non-specific presentation could delay in the diagnosis and management. We describe a case of orbital aspergillosis with cavernous sinus extension in a healthy lady. A 67-year-old lady presented with left eye decreased vision, preceded by non-specific headache for three weeks. Visual acuity deteriorated followed by ptosis and left ocular restrictions after corticosteroids therapy. Examination revealed poor left eye visual acuity with ptosis, anisocoria and total ophthalmoplegia. MRI orbit and brain demonstrated a heterogenous left orbital apex lesion extending to cavernous sinus. Transsphenoidal endoscopic biopsy revealed Aspergillus infection at the left retro-orbital space and the sphenoid sinus. Patient was treated with long duration of oral voriconazole. Ptosis and ophthalmoplegia resolved but left optic atrophy remained. In conclusion, orbital aspergillosis may carry a poor visual prognosis and intracranial spread does easily occur. Early treatment may lead to a better outcome in immunocompetent patients
Sentinel Lymph Node Biopsy in Early Breast Cancer Using the Indocyanine Green Fluorescence Technique: A Validation Study
Get PDFINTRODUCTION: Introduction: Sentinel lymph node biopsy (SLNB) is now recognized as the standard of care for early breast cancer patients with negative axillary lymph nodes. Various approaches for Sentinel Lymph Node (SLN) identification using either the blue dye method or scintigraphy alone or their combination have been proposed. However, this method is costly and may not be applicable in certain developing countries. SLNB involving the use of indocyanine green (ICG) offers several advantages, and it is valid and safe when in direct comparison with the blue dye method and scintigraphy. Hence, we performed SLNB using this method in early breast cancer as the first center that involves the use of ICG in Malaysia. We performed validation study on this method with the aims to determine its sensitivity and safety profile. MATERIALS AND METHODS: This is a validation and non-randomised prospective observational study involving 20 patients underwent SLNB wherein ICG is used for localisation. The patients were recruited according to the recommendations stipulated in the Malaysia Clinical Practice Guideline. RESULT: The average number of SLNs removed per patient was 4.0 (range, 3–6) with sentinel lymph nodes detection rate at 98.75% (79/80). The false negative rate is at 5%. No adverse events were observed in all cases. CONCLUSION: The ICG fluorescence method is simple, reliable and safe. Moreover, it demonstrates a high SLN detection rate with a low false-negative rate, and it does not require a special instrument for radioisotope use
Expression of Survivin in Basal-Like and Triple Negative Breast Carcinoma and Associations with Clinicopathological Parameters
Get PDFINTRODUCTION: Triple negative breast carcinoma (TNBC) molecular subtype and its variant; basal-like triple negative (BLTN) carcinoma is an established poor prognostic indicator. The aim of this study is to analyse the survivin expression in TNBC and BLTN, and relating the results with clinicopathological parameters. MATERIALS AND METHODS: We conducted a cross sectional study using 94 archived formalin-fixed paraffin embedded tissue blocks of invasive breast carcinoma, no special type (NST). Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth receptor 2 (HER2) were used as surrogate markers to classify the cases into molecular subtypes. Samples with triple negative phenotype (ER, PR and HER2 negative) were stained with CK 5/6 to identify the BLTN subtype. All the samples were also immunostained for survivin. RESULT: Out of 94 cases, 41.5% (39 cases) were TNBC. Among the TNBC cases, only 41.0% (16 cases) were BLTN subtype when they found to be positive for CK 5/6. Among 94 cases of invasive breast carcinoma, 28.7% (27 cases) were survivin positive with (53.8%) 21 cases were TNBC and (11%) 6 cases were non-TNBC (p< 0.001). Among 16 cases of BLTN subtype, only 8 cases were survivin positive (p = 0.752). Survivin expression was also statistically significant with tubule formation (p=0.029), nuclear pleomorphism (p=0.008), tumour grade (p=0.010), ER status (p< 0.001) and PR status (p=0.001). CONCLUSION: Survivin expression was statistically significant in invasive breast carcinoma. Even though the expression was significantly high in TNBC, it is not related to whether it is a basal-like or non-basal-like variant
Prevalence of High Risk for Obstructive Sleep Apnoea and Its Risk Factors Among Adults Attending Government Primary Health Clinics in Kuantan
Get PDFINTRODUCTION: Obstructive sleep apnoea (OSA) is a sleep-related breathing disorder with recurrent episodes of apnoea or hypopnoea occurring during sleep. It is associated with an increased risk of cardiovascular disease. However, there is no applicable study that assesses the risk for OSA at the primary care level. This study aims to assess the prevalence of risk for OSA and its associated risk factors among adults attending primary care clinics. MATERIALS AND METHOD: This cross-sectional study was conducted among 252 adults attending four Klinik Kesihatan in Kuantan, Pahang. A self-administered validated Malay version of the Berlin Questionnaire was used to screen for the High Risk of OSA. The statistical analyses were done using t-statistics and chi-squared test then proceeded with binary logistic regression. RESULTS: The mean age of respondents was 53.3. Most of the respondents were male (54%), Malay (87.7%), and married (79.4%). The prevalence of High Risk for OSA was 32.9%. Among these, 94% of them presented with snoring and 16.9% presented with excessive daytime sleepiness. The risk factors that were significantly associated with High Risk of OSA includes younger age (AOR=0.951 CI=0.923-0.980); higher Body Mass Index (BMI) classification with obese type 1 (AOR=2.604 CI=1.278-5.308), obese type 2 (AOR=3.882 CI=1.078-13.975) and obese type 3 (AOR=6.800 CI=1.164-39.717); higher neck circumference (AOR=1.109 CI=1.007-1.221); hypertension (AOR=2.297 CI=1.122-4.702); and hypercholesterolaemia (AOR=2.040 CI=1.050-3.965). CONCLUSIONS: Nearly one-third of the adults attending primary health clinics were at High Risk for OSA. Screening for OSA was recommended particularly among those of younger age, higher BMI classification, and with co-morbidities
A Study of the Clinico-Bacteriological Profile of Infants Aged 29-59 Days Suffering from Very Severe Disease According to WHO IMCI Guideline
Get PDFINTRODUCTION: According to the IMCI guidelines young infants below 2 months are considered a special group because these infants have special characteristics, that they can become sick and die very quickly from serious bacterial infections. This descriptive cross-sectional study was carried out to assess clinical characteristics of very severe disease according to WHO IMCI guideline among young infants of 29-59 days age and to determine whether clinically severe infections are associated with culture-positive bacteremia as well as to find out common etiological factors including organisms involved. The rationale behind conducting such research was that, although young infants of 29-59 days were equally vulnerable to severe infections as are the neonates; similar research addressing the condition in the young infants of the mentioned age is generally lacking. METHODS AND MATERIALS: This was a descriptive cross-sectional study conducted in the Department of Pediatrics, Chittagong Medical College Hospital, from March 2016 to September 2016. Young infants aged between 29-59 days presenting with signs of very severe disease were enrolled. Exclusion criteria were young infants with a congenital anomaly and very sick infants. RESULTS: In this study, it was observed that the majority (43.8%) of patients belonged to age 31-40 days and the mean age was 42.2 ± 7.4 days, ranged from 30 to 57 days. Regarding the sign of severe infection, the majority (97.7%) of patients had a fever, followed by 81.6% fast breathing, 65.5% history of unable to feed, 29.9% convulsion, 27.6% movement when stimulated, 18.4% grunting, and 2.3% had low body temperature. Eleven patients were found in blood culture positive. Klebsiella spp. was the most prevalent pathogens, comprising 6(54.5%) of the isolates, followed by coliform 2(18.2%), staphylococcus aureus 2(18.2%), and coagulase -ve staphylococcus was 1 (9.1%). CONCLUSION: Fever, fast breathing, and unable to feed were more common signs of very severe disease in the patients and positive blood culture was found in 12.6% of the cases. Klebsiella was found to be the commonest pathogen.