IIUM Medical Journal Malaysia (IMJM)
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Disseminated Cutaneous Mycobacterium Fortuitum-Chelonae Complex Infection in a Young, Immunocompetent Patient: A Case Report: A Case Report
Get PDFMycobacteria fortuitum and chelonae are a group of Rapidly Growing Mycobacteria (RGM) that can cause skin infections, most commonly in immunocompromised patients. RGM can also infect immunocompetent patients, but the disease is usually localized. Immunocompetent patients infected by RGM usually had a predisposing condition leading to the skin infection. We present a case of an immunocompetent patient with no predisposing factors, who presented with a chronic lesion on his neck that disseminated to his axilla. Culture and species identification from the skin biopsy revealed Mycobacterium fortuitum-chelonae complex. The patient was treated with a combination of surgery and multi-drug therapy. This case report highlights the rarity of cutaneous RGM infections encountered in ENT setting and the diagnostic dilemma due to the non-typical characteristics of skin lesion in RGM infections
Validation of a Malay Version of the Patient-Rated Wrist Hand Evaluation (PRWHE-MV)
Get PDFINTRODUCTION: The Patient-Rated Wrist Hand Evaluation (PRWHE) is a widely used measure of patient[1]reported disability, pain and appearance related to both hand and wrist disorders. It has been adapted cross[1]culturally worldwide but not in Malaysia. We performed a translation and cross-cultural adaptation of the PRWHE into a Malay version (PRWHE-MV) with assessed reliability and validity in patients presented with hand and/or wrist disorders. MATERIAL AND METHODS: PRWHE-MV was developed via translation and resolution of cultural discrepancies. A total of 83 patients (38 men, 45 women) with the mean age of 38 (SD 14) years and hand and/or wrist disorders completed both PRWHE-MV and the Malay version of Quick DASH during their first orthopaedic hand clinic follow up, and a second PRWHE-MV at 48 hours later. Intraclass Correlation Coefficient (ICC) was used to assess test-retest reliability of the PRWHE-MV while Cronbach’s alpha was calculated to assess the internal consistency. We tested the validity of PRWHE-MV against the Malay version of Quick DASH by calculating the nonparametric Spearman’s correlation coefficient between these two measures. RESULTS: There was no major cultural problems during the forward and backward translation of PRWHE, except for a minor change owing to cultural discrepancy in toilet hygiene. The Cronbach alpha PRWHE-MV was 0.978 (SEM = 5.5) at baseline and 0.979 (SEM = 5.35) at the second assessment. For the test-retest reliability, ICC was 0.99. There was a strong direct correlation between the scores for the PRWHE-MV and the Quick DASH (r = 0.916, p< 0.001). A majority of patients considered hand appearance somewhat important and were bothered in the past week. Their main concerns were gaining back normal hand function and subsequently returning to work. CONCLUSION: The PRWHE-MV showed high internal consistency, test-retest reliability and good validity in patients with hand and/or wrist disorders
Vagus Nerve Injury during Continuous Intraoperative Neuromonitoring (cIONM) for Thyroid Surgery: Assessment of Severity
Get PDFIntroduction: Vocal cord palsy is one of the biggest concern in thyroid surgery especially among the professional voice user. Continuous intra-operative nerve monitoring allows real time of the nerve function during surgery that will reduce risk of injury. The procedure involve is not without complication but meticulous usage and following standard operating procedure is utmost important. This study was aimed looking at the potential morbidity of the procedure.
Methodology: A prospective observational study was conducted on 20 patients who underwent routine thyroid surgery using c-IONM. The procedure of c-IONM follows the standard guidelines. Measurements of vagal stimulation were taken proximal(V3) and distal(V2) to APS electrode to document any injury to the vagus nerve. The blood pressure and pulse rate were also documented through-out surgery, looking at the physiological effect of the stimulation. The function of the vocal cord was assessed by pre and post-operative laryngoscopy
Result: 18 patients with 29 nerves at risk were included as in two patients, the vagal stimulation did not achieve the acceptable amplitude (400 µV). There were drops of amplitude between V3 and V2 in 14 nerve at risks but there was clinical evidence of palsy on laryngoscopy. There were also fluctuation of mean arterial pressure and pulse rate but not significant enough to warrant intervention.
Conclusion: The use of c-IONM during thyroidectomy do exert minimal effect on the vagus nerve and its function but not significant enough to abandoned the procedure. It is safe and able to help the surgeon to identify and preserve the nerve function especially in difficult thyroidectom
Serum Vitamin D and Cardiometabolic Markers: A Comparative Study in Adult Men Based on Body Mass Index
Get PDFINTRODUCTION: Deficiency of vitamin D has been implicated in several disorders, including skeletal, immune, neural, metabolic, and cardiovascular diseases (CVDs). The impact of vitamin D deficiency on CVDs is potentially through derangement of cardiometabolic profile. The present work assessed the relationship between serum vitamin D levels and cardiometabolic markers in adult men. MATERIALS AND METHODS: A cross-sectional analytical study (n=160) was conducted on adult men between the ages 35-50 years without a history of CVDs and/or diabetes, liver, or kidney disorders. Serum vitamin D, lipid profile (cholesterol, triacylglycerol; TAG, low[1]density lipoprotein; LDL, high-density lipoprotein; HDL), and renal function tests (urea, creatinine) were measured using enzyme‑linked immunosorbent assays (ELISA). Pearson’s correlation was used for assessing correlations between the studied parameters. Participants were further grouped as underweight, normal weight, overweight, and obese based on their BMI values, and one-way ANOVA and post-hoc Tukey’s tests were done to observe group mean differences. RESULTS: Vitamin D and HDL were positively correlated (r=0.395, p=0.000) while negative correlation of serum vitamin D levels was seen with TAG (r=-0.539, p=0.000), cholesterol (r=-0.325, p=0.000), LDL (r=-0.541, p=0.000) and urea (r=-0.514, p=0.000). Levels of serum vitamin D (p=0.000) and HDL (p=0.000) were lower while levels of TAG (p=0.000), cholesterol (p=0.000), LDL (p=0.000) and urea (p=0.000) were higher in the overweight and obese groups. CONCLUSION: Inadequate serum vitamin D status is associated with dyslipidaemia in adult men. Moreover, obese and overweight men have lower serum vitamin D levels with pronounced dyslipidaemia, thus highlighting vitamin D as a potential cardiometabolic risk factor
Using Mathematical and Statistical Model to Forecast the Path of Infection by Covid-19 in the Kingdom of Saudi Arabia
Get PDFSaudi Arabia, like any other part of the earthly globe, has been exposed to the Covid-19 pandemic. The first case appeared on March 3, 2020, followed by an increase in the number of infections until it reached thousands with the numbers on the rise. Therefore, adopting clear strategies to deal with the pandemic according to specific data on its size is necessary. In this study, the time series of the number of infections and deaths were analyzed to study the behavior of the pandemic over time. The cumulative curve of the phenomenon was analyzed to show the extent of the pandemic's decline or spread. On the other hand, the time curve of the number of cases of the pandemic was fitted based on a set of mathematical and statistical models, which were divided into three sections [nonlinear growth model, Susceptible, Exposed, Infectious, Recovered (SEIR) model, regression model] to attain the best possible fitting of the relationship curve. The results show that the Weibull model and Polynomial model at (n = 4) are the best models for fitting the relationship at short run and the SEIR model gives better relationship fitting at long run. In conclusion, there is a tendency for the disease to decline during the short period, while expecting other waves of the epidemic that will recede in the long term with the emergence of a suitable vaccine
Endoscopic Management of Branchial Fistula: Diagnostic and Therapeutic.
Get PDFRecurrent neck abscess is a typical feature of branchial anomaly. Open surgical excision has been the primary treatment modality for past decades however several alternative treatment modalities such as endoscopic electrocauterization has recently gained popularity and acceptance universally. This series aims to introduce endoscopic assessment as the first line diagnostic and therapeutic management for branchial fistula.
5 patients underwent examination under general anesthesia via direct laryngoscopy, endoscopic assessment and cauterization in our centre from 2016 to 2019. They were then followed up at our clinic to assess disease progression.
Comparison between open neck surgery and endoscopic cauterization of internal sinus tract opening as the primary treatment has reported similar recurrence rate.
Proposal of endoscopic assessment as the first line investigation and diagnostic tool with the aim of therapeutic cauterization at the same setting. MRI may be needed in scenarios such as failed endoscopic treatment or when open surgery is required
Serum Vitamin D and Immunoglobulin E Levels In Patients With Seasonal Allergic Conjunctivitis
Get PDFINTRODUCTION: Seasonal allergic conjunctivitis (SAC) is a mild but common immunoglobulin E (IgE) mediated ocular allergy. Low serum vitamin D levels have been related to some allergic disorders but such data in the clinical context of SAC are missing. Our study investigated serum IgE and vitamin D levels in SAC patients. MATERIALS AND METHODS: A cross-sectional case-controlled study was conducted at University of Hafr Al-Batin, Saudi Arabia involving patients with established diagnosis of SAC and age[1]matched healthy control subjects. Standard patient evaluation of eye dryness (SPEED) questionnaire was scored for the frequency and severity of symptoms. Blood samples were taken to quantify serum IgE and vitamin D levels. Mean +- SD were calculated and independent sample t-test was applied for comparison between groups. RESULT: A total of 52 subjects were recruited into the study in which 26 subjects were patients aged between 20-60 years with an established diagnosis of SAC and another 26 subjects were age-matched healthy controls without any allergy. Mean serum IgE, vitamin D level and SPEED scores were significantly higher in SAC patients than in healthy control (2181.09 IU/ml +- 1062.33 vs 54.83 IU/ml +- 26.67; 38.96 ng/ml +- 11.37 vs. 29.47 ng/ml+- 11.73; 19.42 +- 4.81 vs. 2.19 +- 1.49) with p-value 0.001, 0.005, and 0.001 respectively. Mean vitamin D levels in both groups were within normal range. CONCLUSION: Higher serum vitamin D levels may be linked with SAC, but further research is needed to eliminate irregularities in the existing evidence on the influence of vitamin D in SAC
A Systematic Review of Immersive Social Media Activities and Risk Factors for Sexual Boundary Violations among Adolescents
Get PDFSocial media is appealing to the general public, especially the teenagers. This has brought about changes as the role of social media has penetrated our daily activities which directly affects the adolescence. This review looked at the usage of social media amongst adolescents and its impact on their sexual behaviour. Four databases were used in the literature search ie Web of Science, PubMed, EBSCOhost, and Ovid Medline. The search terms used revolved around social media, adolescent and social behaviour. Only English literature published from 2015 to 2020 were included. A total of 244 potentially relevant articles were identified in the initial search. 16 were excluded due to duplicates. A further 199 articles were excluded due to irrelevant population, intervention or outcome. Only 29 articles were suitable for narrative synthesis. The selected articles were analysed for risk factors and impact on the usage of social media on sexual behaviour. Sexual abuse, same-sex sexual activity, pornography, multiple online sexual partner, and sexual dissatisfaction were found to be negative impact. Positive impact included understanding of sexual role and consequences, safe sex practices and improved psychological well-being. This systematic review proved social media usage amongst adolescents have great impact on their sexual behaviour. Sexting was the main social media online sexual activity amongst adolescents which brings about negative sexual behaviours. This must be curb from earlier on which demands parental supervision in monitoring adolescence online activities
A Survey Of Perceived Barriers And Motivators Towards Exercise Among People With Parkinson’s Disease In Malaysia
Get PDFINTRODUCTION: Considerable amount of evidence supports that exercise plays a vital role in maintaining and slowing Parkinson's disease (PD) progression. However, some people with PD have remained sedentary for undefined reasons. Therefore, the perceived barriers and motivators towards exercise among people with PD among Malaysian were investigated. METHODS: A cross-sectional survey was conducted using a self-developed and validated questionnaire distributed to forty-seven people with PD in a non[1]governmental organisation to determine exercise barriers and motivators. RESULTS: The exercise motivators in the study were having an exercise instructor (83.0%), exercise makes them feel healthier and more energetic (83.0%), and constant encouragement from family and friends (80.9%). The exercise barriers reported in this study were fatigue (40.4%) fear of falling (34%), bad weather (38.2%), and lack of transportation (31.9%). CONCLUSION: The study concluded that people with PD exercised because it makes them feel healthier and more energetic. Besides that, having an exercise instructor and being encouraged by family and friends reported being exercise motivators among the people in this study. The exercise barriers reported in this study were fatigue, bad weather, fear of falling, and lack of transportation. These findings should be taken into consideration when developing strategies and health interventions to improve exercise participation for people with PD