IIUM Medical Journal Malaysia (IMJM)
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Measurement of Inflammation-Related Biomarkers in Different Chronic Kidney Diseases in Humans: Role of Aging and Gender?
Get PDFINTRODUCTION: Chronic kidney disease (CKD) is a worldwide health problem which becomes a substantial emerging cause of morbidity. The inflammation can be resulted via different mechanisms in different kidney diseases including the imbalance of proinflammatory/anti-inflammatory biomarkers levels. This study aimed to measure the level of physiological bioactive substances as inflammation-related biomarkers in different CKD and to investigate whether gender or aging is critical in these measurements. MATERIALS AND METHODS: 84 persons (19 healthy, 29 chronic glomerulonephritis, 26 diabetic nephropathy, 6 benign nephrosclerosis, 4 lupus nephritis) were enrolled in this study. The inflammation progression degree in CKD was estimated by measuring the plasma level of neutrophil gelatinase-associated lipocalin (NGAL), monocyte chemoattractant protein 1 (MCP1), and clusterin (CLU) using ELISA. Serum total protein, urea and creatinine were measured using an automatic analyzer. RESULTS: Plasma level of urea and creatinine was increased while total protein level was decreased in all the patients compared to control participants. The level of NGAL, MCP1 and CLU was significantly increased in all the kidney diseases compared to controls. In addition, there were no differences in the level of inflammation-related markers between women and men. Moreover, the levels of inflammatory markers were increased in the kidney diseases regardless of the age difference. CONCLUSIONS: This study showed that the physiological bioactive substances NGAL, MCP1 and CLU can be increased in renal pathologies and considered as good indicators of progression of inflammation in chronic kidney diseases, with no role of gender and age in their increment plasma levels
The Three-Level Model (3LM): A Conceptual Framework for the Integration of Naqli and Aqli Knowledge In Medicine
Get PDFDoes Personality and Anxiety Symptomatology Matter in the Diabetes Mellitus Treatment Adherence? A Cross-Sectional Study Among Women with Diabetes Mellitus.
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Purpose: Anxiety is prevalent among women with diabetes mellitus. Women also tend to have higher levels of neuroticism and anxiety. These symptoms can have an impact on social functioning and diabetes care. The main aim of the present study was to determine the relationship between neuroticism and anxiety symptoms, and other clinical and psychosocial variables, among women with diabetes mellitus (DM).
Patients and methods: This was a cross-sectional study conducted on women with diabetes mellitus. Sociodemographic and clinical variables were acquired, including perceptions on religious practice, social support, and diabetic self-care. Study subjects completed the Generalized Anxiety Disorder 7-item (GAD-7) and the Big-Five Inventory (BFI). The neuroticism subscale of the BFI was used for analysis.
Results: The study included 141 subjects (Median age: 64.0 years, IQR: 52.5–71.0 years) with a median duration of diabetes of 12.0 years (IQR: 6.0–20.0 years). Neuroticism scores correlated positively with the GAD-7 scores (Spearman’s rho: 0.406; p<0.001). In the bivariate analysis, neuroticism also had significant association with employment status (p=0.023), religious practice (p=0.006), perceived social support (p=0.001), and perceived ability of diabetic self-management (p<0.001). In the regression analysis, after controlling for employment, religious practice, and social support, neuroticism remained associated with anxiety (p<0.001) and diabetic self-management (p=0.001).
Conclusions: Neuroticism was related to poorer subjective sense of diabetic management and a greater level of anxiety among women with DM. Improving self-efficacy in managing diabetes may help patients coping up with anxiety symptoms among those with neuroticism traits. This may also contribute to a better understanding of features and effective treatment of women with DM.
 
The “Fountain of Death”: A Case Series on Tracheo-innominate Artery Fistula
Get PDFTracheo-innominate artery fistula (TIF) is a very rare complication related to tracheostomy and has been reported in 0.7% of patients, but certainly is one of the most life-threatening conditions. It is of paramount importance to maintain a high index of suspicion in evaluating patients with TIF and to anticipate occurrence of massive haemorrhage even during simple procedures related to tracheostomy such as tube change. We report 3 cases of TIF, each with a unique and unsuspecting history of the condition and review the emergency protocol in arresting the bleeding. We’ve also highlighted the potential role of permissive hypotension with sedation in improving survival outcomes of patients with TIF
Sociodemographic Impact and Acquaintance on Antibiotic Resistance Among Outpatients in Specialist Hospital, Malaysia
Get PDFINTRODUCTION: Awareness on antibiotics resistance among outpatients in hospital settings is reasonably explored and this study aimed to investigate the sociodemographic impact and the level of acquaintance towards antibiotics practice and resistance. MATERIALS AND METHODS: This cross-sectional study was conducted on 270 patients from the outpatient department of KPJ Seremban Specialist Hospital (KPJSSH), Malaysia. A pre-validated questionnaire was used to collect the data on the demographics of the patients, their knowledge, attitude, and usage of antibiotics. The study was approved by the KPJUC ethics committee (KPJUC/RMC/BPH/EC/2017/104). RESULTS: The mean age of the respondents was 36 ± 11.07 years and 50.37% of them have moderate knowledge on antibiotics. The knowledge and attitude on antibiotics usage exhibited a significant difference (p=0.001) amongst these patients in association with literacy. The results showed that the literate respondents have significant knowledge on the identification of antibiotics (p=0.021), their roles, and adverse effects (p=0.004). The attitude of the respondents towards following the prescription was significantly associated with their literacy (p=0.004). CONCLUSION: This study reveals that respondents have the least knowledge on antibiotic course compliance and termination of therapy, which could lead to antimicrobial resistance. In conclusion, inculcating the knowledge of antimicrobial resistance, adverse effects, and course compliance among the patients may help overcome the national and global issues on multi-drug-resistant diseases
Patient Satisfaction with Doctor-Patient Interaction using SKIP-11 and Its Associated Factors among Type 2 Diabetics in Primary Care.
Get PDFABSTRACT
Introduction: The quality of diabetes care is widely suboptimal, and most of the interventions depend on the active involvement and participation of patients. Understanding and determining patient related factors can help primary care providers pay more attention and give greater care to those patients. This will improve patient satisfaction, which further enhances compliance with or adherence to diabetic treatment. Therefore, this study aims to determine patient satisfaction with doctor-patient interaction and its associated factors among patients with type 2 diabetes mellitus.
Materials and Methods: This cross-sectional study was performed among adults who had had diabetes for at least six months. Participants were selected by systemic random sampling in the outpatient clinic of the University Hospital. Patient satisfaction with doctor-patient interaction was measured using 11- items with a three-domain version of the “Skala Kepuasan Interaksi Perubatan-11” questionnaire. The total scores ranged from 11 to 55, and those who scored 44 and above (> 80%) were considered satisfied.
Results: A total of 417 patients were recruited in the study. 60% were satisfied with their doctor-patient interactions. Among the subtypes in the satisfied group, the domain of rapport had the highest percentage of satisfaction at 77.7%. HbA1c was found to be significant associated with patient satisfaction with doctor-patient interaction (95% CI: 0.81, 0.97; p = 0.008)
Conclusion: 60% of the participants clearly illustrated positive feedback and were more satisfied with their doctor-patient interactions. HbA1c was found to be significantly associated with patient satisfaction concerning doctor-patient interaction
 
Undergraduate Students’ Perception on Assessment Experience in a Malaysian Medical School: Comparison among Gender, Ethnicity and Phase of Study
Get PDFINTRODUCTION: It is a well-known fact that assessment influences learning and study behaviour. Assessment affects what and how students learn, either positive or negative learning behaviour. This study was aimed to determine students’ perceived assessment experience and the comparison among different gender, ethnicity, and phase of the study. MATERIALS AND METHODS: This is a cross-sectional study. Assessment Experience Questionnaire (AEQ) version 3.3 was distributed to 324 undergraduate medical students of Universiti Putra Malaysia. The AEQ score among different gender, ethnicity, and phase of the study was compared using independent t-test and one-way ANOVA. RESULTS: Female students were found to develop a surface approach to learning, learn new things from the assessment, and be satisfied more with the teaching compared to males. Chinese students tended to put higher effort into learning compared to Malay. Clinical students valued more the feedback received and had clearer goals and expectations for their work than preclinical students. However, preclinical students tended to put a higher quantity of effort, learn wider coverage of syllabus and develop a surface approach of learning than clinical students. The respondents commented that feedback is lacking and suggested having more feedback sessions with their teachers after assessment. CONCLUSION: There were different assessment experiences and learning found among different gender, race, and phase of the study. These may affect their academic performance and are probably due to the curriculum setting. Understanding student assessment experience and its impact helps the faculty to improve the assessment structure for a conducive assessment environment and meaningful learning experience for the students
Correlates of Attempts to Quit Smoking: A Hierarchical Multiple Linear Regression Analysis
Get PDFBackground: Smoking is a public health concern that contributes to non-communicable disease fatalities. Nearly five million Malaysians aged 15 years and above are estimated to be smokers. Quitting smoking is complicated and challenging for most smokers to attempt and succeed. Not everyone enjoys it, but some have decided and/or tried to stop smoking completely. This study aimed at identifying predictors of quit smoking attempts. Methods: The researchers designed a cross-sectional study conducted in Samarahan Division, Sarawak, Malaysia. Data from 777 smokers were collected via face-to-face interview using a validated structured questionnaire. A hierarchical multiple regression analysis was performed to determine the factors associated with quit smoking attempts by IBM SPSS version 22.0. A p-value of ≤.05 was considered statistically significant. Results: The average age of the smokers was 43.46 years old, with the male to female ratio of 8.96:1. The median age of starting and being regular smoking were 20 and 23 years, respectively. The hierarchical multiple linear regression analysis revealed that motivation (β=.220, p<.001), intention to quit (β=.148, p><.001), age at regular smoking (β=.131, p><.01), gender (β=.088, p><.01) appeared to be significant predictors of quit smoking attempt. Self-efficacy (β=-.101, p><.05) had a negative effect on quit smoking. However, nicotine dependency and the age of respondents did not affect smoking cessation. Conclusion: Smoking cessation motivation, intention, and age of regular smokers were associated with quit attempts.Conclusion: Smoking cessation motivation, intention, and age of regular smokers were associated with quit attempts. Therefore, the aim of a future campaign should be to reinforce motivation, increase the level of intention and self-esteem for successful smoking cessation
Mesenteric Adenitis Caused by Salmonella Typhi: A Case Report
Get PDFBoth mesenteric adenitis and acute appendicitis may present with fever and right lower quadrant pain. This presentation makes it challenging to provide a timely and accurate diagnosis to avoid unnecessary surgery. We report a case of an 8-year-old who was admitted with fever and right lower quadrant pain, loss of appetite, and diarrhoea. There were tenderness and rigidity in the right lower quadrant of the abdomen. Hepatomegaly was present. Full blood count showed pancytopenia, and serum transaminases were mildly elevated. The clinical features in typhoid fever are not specific, making it difficult to differentiate from other infectious causes such as malaria, dengue, or leptospirosis, common in the region. This report illustrates a rare case of mesenteric adenitis caused by Salmonella serotype Typhi. It also shows the benefit of doing an abdominal ultrasound to help the surgeon decide whether surgery is necessary
Surgeon Performed Ultrasound in Assessing Thyroid Nodule Using American College of Radiology Tirads and Total Malignancy Score (TMS): A Validation Cross Sectional Study
Get PDFINTRODUCTION: This study aims to evaluate the diagnostic reliability of the American College of Radiology Thyroid Imaging Report and Data System (ACR-TIRADS) and Total Malignancy Score (TMS) scoring system, in differentiating benign and malignant thyroid nodules. MATERIALS AND METHODS: This is a cross-sectional study involving patients with thyroid nodules treated at Hospital Canselor Tuanku Muhriz from October 2017 until October 2019. Ultrasound findings were scored according to the ACR[1]TIRADS and TMS scoring system. They were then correlated with the FNAC or histopathology report. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of both scoring system were calculated for analysis. RESULTS: A total of 150 patients with 223 thyroid nodules were included. 17% or 38 nodules were found to be malignant. The sensitivity, specificity, PPV, NPV and accuracy of ACR-TIRADS and TMS were 97.37% vs. 84.21 % , 52.97% vs. 62.70%, 29.84% vs. 31.68%, 98.99% vs. 95.08% and 61% vs. 66% respectively. According to the ACR-TIRADS, only hypoechoic nodules was a strong predictor of malignancy. Comparatively, in the TMS, strong predictors of malignancy include single nodule, hypoechogenicity, irregular margin, and nodules with peri and intranodular vascularity. CONCLUSION: Both ACR-TIRADS and TMS score had good diagnostic accuracy in predicting malignant thyroid nodule. TMS is comparable and not inferior to ACR[1]TIRADS however, the latter is more practical for use as growth and Doppler characteristic are not included in the assessment