IIUM Medical Journal Malaysia (IMJM)
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Scleral Tunnel Fixated Intraocular Lens in Complicated Cataract: A Case Series
Get PDFWhen capsular support is inadequate in complicated cataract, scleral fixated IOL (SFIOL) has its advantage whereby it is nearer to physiological nodal point when compared to other types of IOL implantation. Scleral tunnel fixated intraocular lens (STFIOL) technique is gaining popularity due to its simplicity and ease of placement compared to sutured IOL. We report our experience with eight cases of STFIOL implantation from September 2016 to May 2018 in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). All patients had improvement of vision except one case who had unchanged vision. Mean post-operative BCVA was logMAR 0.57±1.13 (which is almost equivalent to 6/21) and improved to logMAR 0.37±0.43 (which is almost equivalent to 6/12) excluding one patient with chronic RRD with band keratopathy. Post-op complications include raised intraocular pressure, cystoid macular oedema, hyphaema, and wound leak. However, all complications were not severe and responded to topical eyedrops. In conclusion, STFIOL insertion technique is safe and works well to restore vision in majority of patients operated with this technique.
Risk Factors for Sexual Dysfunction among Postpartum Women in Kuantan, Pahang
Get PDFINTRODUCTION: Sexual dysfunction after childbirth is reported to be prevalent worldwide. The risk factors for sexual dysfunction is still underexplored. Thus, this study aims to determine the possible risk factors associated with sexual dysfunction among post-partum women. MATERIALS AND METHODS: This cross-sectional study was conducted in nine primary care clinics in Kuantan involving 420 women within six months postpartum. The respondents were conveniently sampled and completed the data collection forms comprising of their socio[1]demographic data, the Malay version Female Sexual Function Index (MVFSFI) Questionnaire to measure the sexual dysfunction score. Descriptive analysis, Chi-square test, and binary logistic regression were used for data analysis. RESULTS: Among the women sampled, those with higher education had a 72% increased risk of developing postpartum sexual dysfunction (aOR=1.72, 95%CI=1.01,2.81). Women who practised non-hormonal contraception were a 42% lower risk of getting postpartum sexual dysfunction as compared to those who consumed hormonal contraception (OR=0.58, 95%CI=0.35,0.95). CONCLUSION: Education level is associated with a higher risk of developing postpartum sexual dysfunction. Non-hormonal contraceptive methods were found as a protective factor for developing postpartum sexual dysfunction. Therefore, doctors can advise those postpartum women with sexual dysfunction and on hormonal contraception to change to non-hormonal methods
Trajectory of Change in Erectile Dysfunction Symptoms Following Coronary Artery Bypass Surgery in Malaysian Population
Get PDFINTRODUCTION: Despite the advantages of Coronary artery bypass surgery (CABG), this procedure has been reported to have a significant impact on sexual activity. The study aims to assess the trajectory of change in erectile dysfunction (ED) symptoms following CABG.METHODS: 73 adult male participants were recruited. Participant primary data was measured using the International Index of Erectile Dysfunction (IIEF-5) at three-time points. RESULTS: Severe ED was most prevalent during 6 weeks following-operation (86.3%); however, the proportion of severe ED symptoms reduced after 4 months following-operatively (42.5%). There was a statistically significant difference in ED symptoms between pre-operatively and 6 weeks post- operatively (p< 0.001). At 4 months, there was a marginally significant improvement in ED symptoms compared to baseline pre-operatively post CABG (p = 0.064). Age significantly increases the chance in odds of having abnormal ED symptoms by 22% at 4 months postoperatively (aOR=1.22, 95% CI=1.06, 1.41, p<0.05). Other risk factors for abnormal ED symptoms following CABG, which include normal creatinine clearance, being a smoker, and having moderate to good LV function was not statistically significant. CONCLUSION: The present study has demonstrated a high prevalence of ED following CABG and the procedure caused a negative impact on the ED symptoms. However, there was a significant improvement in ED symptoms as the time from surgery increases and patients recovered. Further studies with larger sample size and longer recovery time are needed to assess the trajectory of recovery in ED symptoms in this population.>< 0.05). Other risk factors for abnormal ED symptoms following CABG, which include normal creatinine clearance, being a smoker, and having moderate to good LV function was not statistically significant. CONCLUSION: The present study has demonstrated a high prevalence of ED following CABG and the procedure caused a negative impact on the ED symptoms.
Knowledge, Attitudes And Practices Towards COVID-19 among Medical Students in International Islamic University Malaysia: An Online Cross-Sectional Study
Get PDFINTRODUCTION: COVID-19 pandemic has caused a major impact to global public health including one of the high risk groups which is the medical students. This study was intended to assess knowledge, attitudes and practices (KAP) towards COVID-19 among medical students in International Islamic University Malaysia (IIUM). MATERIAL AND METHOD: An online cross-sectional study was conducted among 438 medical students of IIUM from 6th July 2020 to 9th July 2020. KAP towards COVID-19 was measured using a structured Malay and English version questionnaire consisting of 13 items on knowledge, 3 items on attitudes and 3 items on practices. RESULTS: The average correct response rate on knowledge was 85.4%. Only 12.1% of the students had correct knowledge on all items, and 1 in every 4 and 5 students had misconceptions on the clinical features and transmission of COVID-19. In term of attitudes towards COVID-19, majority of the respondents believed that COVID-19 would be effectively controlled (85%) and had faith that Malaysia could overcome the war against COVID-19 (99%). Most of the respondents practiced good towards COVID-19 in avoiding crowded places (90%), wearing face masks (95%) and practicing hand hygiene (91.6%). CONCLUSION: Although the results are positive towards KAP, only 1 in every 10 students responded correctly to all knowledge questions, and few proportions had misconceptions on the disease and did not maintain adequate practices. Policies aimed at appropriate health promotion activities may ensure empowering the medical students with adequate knowledge on all aspects of COVID-19, and practice properly following the standard operating procedure implemented by the government
End-Of-Life Care in Dementia among Asian, A Scoping Review
Get PDFINTRODUCTION: Dementia is a neurocognitive disease characterised by a progressive deterioration of brain cognitive function. Dementia in the advanced stage should be treated as other terminal diseases. However, there is still a lack of acknowledgement regarding the end-of-life (EOL) care of people with dementia in Asian populations. This study aims to elucidate the components of EOL care in advanced dementia from the Asian perspective. MATERIAL AND METHODS: Arksey and O’Malley’s scoping review methodology framework was used to guide and conduct this scoping review. Databases of Pubmed, EBSCOhost, and Ovid Scholars were systematically searched using MeSH heading of end-of-life, palliative, dementia, and individual name of Asian countries. RESULT: Fourteen articles met the inclusion criteria. The majority of the studies involved interviews or questionnaires to the caregivers, the patients, and the healthcare professionals. The studies were done mostly in Taiwan and Japan and one from Indonesia. The studies reported themes that were categorised into life sustenance treatments and medications, advanced directives, the burden of the caretakers, and the knowledge, attitude, and practice of the healthcare providers or the family members. CONCLUSION: Major barriers in delivering EOL care to advanced dementia patients include knowledge, skills, communication, attitude, and beliefs, especially among developing countries in Asia. More education and awareness are needed amongst the healthcare providers and the public regarding this matter to ensure proper EOL care in advanced dementia patients
Acute Abdomen caused by Perforated Jejunal Diverticulitis
Get PDFJejunal diverticulum accounts for only 25% of small bowel diverticula, and approximately 7% of these will present as complicated jejunal diverticulitis or perforation. Here, we described a case of jejunal diverticular perforation presented as acute abdominal peritonitis. The computed tomography of the abdomen suggested small bowel perforation and therefore, emergency surgical exploration was performed. Intraoperatively, multiple jejunal diverticulae were found with one forming a localised diverticular abscess. Segmental resection of the diseased segment with primary anastomosis was performed. The patient made an uneventful post-operative recovery. Although complicated jejunal diverticulitis is rare, emergency surgery is often warranted if perforation occurs. Computed tomography is valuable in the diagnosis and preoperative planning especially in an emergency surgical conundrum when there is equivocal clinical peritonitis or perforation
Patients’ Perception towards General and Pelvic Examination by Male Medical Students: A Cross-sectional Study in a Multi-ethnic Population
Get PDFIntroduction
Male medical students globally have difficulty in obtaining consent to perform pelvic examination. We sought to identify independent factors influencing women consenting to male medical students performing general and pelvic examination under supervision.
Methods
This cross-sectional study conducted at a tertiary hospital and a public health care centre in Johor Bahru, Malaysia recruited 369 women above 18 years old who have had sexual intercourse before and no prior hysterectomy. A validated self-administered bilingual questionnaire was used to collect data on factors that influence them consenting to male medical students examining them and performing pelvic examination when indicated.
Results
The respondents were largely below 30 years old (52.9%), Malays (73.4%) and Muslims (75.3%). The consent rates for general and pelvic examination were 27.4% and 18.9%, respectively. Being a Muslim, having an occupation and being introduced by a male medical specialist increased the likelihood of women consenting to general examination. However, a history of being examined by male students decreased the likelihood by 64%. Believing that male doctors should have the skills to treat patients in women's health was the only independent factor that increased the likelihood for women to consent for pelvic examination to be conducted by male medical students.
Conclusion
Believing that male doctors should be skilled in treating women positively influences decision to consent. Explaining earnestly to women on how they aid in developing the skills of future doctors should be prioritised.
Keywords: patients’ perception; male medical students; pelvic examinatio
Correlation of E-cadherin Expression in Endometrial Carcinoma with Tumour Grade and Stage
Get PDFINTRODUCTION: Endometrial carcinoma (EC) is among the common malignancy in the female with adverse prognosis in the advanced stage. Prediction of its prognosis is important in stratifying EC patients to achieve optimum treatment and improve clinical outcomes. This study is aimed to evaluate the prognostic significance of E-cadherin expression in patients with EC. The present study also investigated the correlation of E-cadherin expression in EC with its tumour grade and stage. MATERIALS AND METHODS: A total of 70 cases of EC were included in the study within eleven years comprising 56 cases of endometrioid carcinoma, 2 cases of mucinous carcinoma, 10 cases of serous carcinoma and 2 cases of clear cell carcinoma. E-cadherin expression was immunohistochemically analysed and compared with clinicopathological parameters. RESULTS: E-cadherin loss of expression shows significant association with non endometrioid EC (p=0.003), high tumour grade (p<0.001) and tumour with distant metastasis (p=0.028). Tumour grade is the main predictor of down-regulation of E-cadherin expression (Grade 3: aOR 8.400, 95%CI 2.534-27.842). There was no significant association found between E-cadherin expression with myometrial invasion, FIGO stage, lymph node status and lymphovascular invasion. CONCLUSION: E-cadherin loss of expression correlates with poor prognostic factors namely high grade and high stage (metastasis) EC. This may serve as a potential prognostic marker for EC>< 0.001) and tumour with distant metastasis (p=0.028). Tumour grade is the main predictor of down-regulation of E-cadherin expression (Grade 3: aOR 8.400, 95%CI 2.534-27.842). There was no significant association found between E-cadherin expression with myometrial invasion, FIGO stage, lymph node status and lymphovascular invasion
Quality Characteristics, Antioxidant and Anticancer Potential of Stingless Bee Honey and Honeybee Honey from Similar Environmental Conditions
Get PDFIntroduction: The composition of the honey depends on the intrinsic and extrinsic factors, including place of origin, the floral types, the season and the storage conditions. This study compared the anticancer potential, quality, antioxidant and phytochemical between unprocessed stingless bee honey (SBH) and honeybee honey (HBH) from the same environmental factors including place of nest, floral type (Acacia), harvesting month (August) and storage conditions (<5°C). Materials and methods: To measure quality, 5-hydroxymethylfurfural (HMF) and diastase activity were determined, followed by total phenolic content (TPC) and total flavonoid content (TFC) for phytochemicals. Antioxidant activity was assessed via 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay. Cytotoxicity towards cervical cancer cell line (HeLa) was measured using a 2-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay (IC50). Results: The results indicated that HBH exhibited significantly higher diastase activity (2.17 ± 0.07 DN), TPC (338.95 ± 3.49 mg GAE/kg), DPPH scavenging activity EC50 (80.06 mg/ml) and MTT activity IC50 (64.80 mg/ml) towards HeLa as compared to SBH with absence of diastase activity, TPC (250.60 ± 3.98 mg GAE/kg), DPPH scavenging activity EC50 (165.80 mg/ml) and MTT activity IC50 (75.76 mg/ml). However, there were no significant differences in HMF and TFC between HBH and SBH. Conclusion: Therefore, the present study found that HBH demonstrates better antioxidant capacity, anticancer potential and phenolic content as compared to SBH
Fusobacterium Nucleatum : An Atypical Cause of Pyogenic Liver Abscess in an Apparently Immunocompetent Patient
Get PDFPyogenic liver abscess is an uncommon but potentially lethal infection if left untreated. Enteric bacteria and anaerobes are the most common causative organisms of pyogenic liver abscess. Although most infections are of a polymicrobial nature, monomicrobial infections are possible. An immunocompromised status and the presence of periodontal disease are the risk factors for liver abscess caused by these rare, monomicrobial anaerobic infections. Here, we report on a successful non-operative management of a case of multiloculated pyogenic liver abscess caused by Fusobacterium nucleatum in a young, healthy, immunocompetent male patient. The diagnosis was established by radiological imaging and was based on a positive aspirate culture, whereas the mainstay of treatment comprised percutaneous drainage and a prolonged course of antibiotics. Thus, the patient was successfully treated with a 2-week course of intravenous imipenem/cilastatin while he was on percutaneous drainage, and he is now doing well