IIUM Medical Journal Malaysia (IMJM)
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Adaptation and Validation of the Muslim Medical Students Questionnaire (MMSQ) in the Indonesian Language
Get PDFINTRODUCTION: The Muslim Medical Students Questionnaire (MMSQ) is a self-assessment tool that was designed to measure student’s Islamic competency in line with the implementation of the Islamic medical curriculum. For it to be applicable in Indonesia, this questionnaire needed to be translated and validated in the Indonesian language (Bahasa Indonesia). This study aimed to collect validity evidence of the Bahasa Indonesia version of MMSQ (BI-MMSQ). MATERIALS AND METHODS: The research process consisted of four stages: Forward and backward translation; Harmonization of the BI-MMSQ resulting from the initial stage; Pre-test of the BI-MMSQ among 30 clinical students, and finally construct validation among 225 clinical students. The completed questionnaires of 213 students were then analysed for their reliability and validity using exploratory factor analysis (EFA). RESULTS: The study showed that the scale had sufficient validity evidence; content, response process, and internal structure. The evidence of the internal structure of the tool is derived from the internal consistency (Cronbach’s Alpha is 0.85) and also from the factor analysis. Most of the items had a factor loading value of > 0.3, but it was suggested that some of those with a value of < 0.3 should be rephrased to increase their quality. The Practice domain was the most stable sub-scale since most of the items contained high factor loadings. CONCLUSION: The BI-MMSQ had sufficient validity evidence and the internal structure may be improved by alteration of a few items
Comparative Study of Microwave Oven-Assisted Tissue Processing with Isopropanol and Mineral Oil Mixture and Propylene Glycol Methyl Ether on Morphological Quality of Tissue Sections
Get PDFBackground:
Over several years, xylene has been traditionally utilised as the clearing agent of choice in tissue-processing due to effectiveness in rapidly clearing tissue, facilitating the paraffin infiltration process. However, xylene use adversely impacts the health of personnel with long term exposure due to toxicity. In order to overcome these effects and replace it with a safer alternative agent, the present study aims to compare quality of tissue sections processed using an isopropanol and mineral oil mixture and propylene glycol methyl ether (PGME) as xylene substitutes.
Methods:
Rat skeletal muscle tissue samples (n=20) were prepared for each processing protocol with xylene substitutes. Tissue specimens were processed according to the proposed microwave protocol. The clearing steps were performed using isopropanol and mineral oil mixture, and PGME, replacing xylene. From each paraffin-embedded block, one section of 4-5µm thickness tissue was obtained and conventionally-stained with Haematoxylin and Eosin (H&E). The histological sections were microscopically assessed and scored by a pathologist. A qualitative analysis was performed with the results obtained.
Results:
The overall score obtained for xylene processed tissue was 100% with a score of 2 for all the 3 parameters assessed. However, the outcome for tissue processed with isopropanol and mineral oil mixture was 28.6% unsatisfactory, 28.6% satisfactory and 42.8% good. In PGME-treated tissues, 14.3% were unsatisfactory sections, 71.4% were satisfactory and 14.3% produced good quality sections. Overall, tissues processed using both substitutes exhibited sufficient staining quality in terms of the aforementioned parameters as compared to xylene-processed tissues, though significant difference in scores were observed.
Conclusion:
Despite several challenges faced in the study, isopropanol and mineral oil mixture and PGME can be suggested as alternative clearing agents to xylene, provided having access to a more sophisticated microwave oven with precise temperature control for complete tissue-processing
Voices of Young Mothers on Relational Issues Leading to Out-of-Wedlock Pregnancy and its Protective Measures: A Qualitative Exploration
Get PDFINTRODUCTION: Adolescents learn through experimenting and interactions with others. Experimenting romance and sexuality issues if not properly guided, can result in an out-of-wedlock unplanned pregnancy. This study aims to explore factors leading to out-of-wedlock pregnancy among pregnant teenagers and factors that may prevent such occurrence. MATERIALS AND METHODS: Two in-depth interviews (IDI) and two focus group discussions (FGD) were conducted in this qualitative study. The study involved 22 participants from a local governmental body shelter home in Peninsular Malaysia. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was used for data analysis. RESULTS: Three salient relationship themes that led to teenage pregnancy were i) an enjoyable relationship with peers, ii) poor family relationship, and iii) intimate relationship with boyfriends. Some of the proposed ways that may protect teenagers from pregnancy include i) careful selection of friends, ii) controlling the desire in risky experimentation, and iii) wiser use of smartphones or/and social media. CONCLUSION: Relational issues with parents, peers and boyfriends are important factors as it could lead to out-of -wedlock pregnancy among adolescents and youths. It is also necessary for the current educational system to emphasize on building positive relationships with peers, being more assertive, and the safe use of social media among youths
Histopathological Changes in Chronic Low Dose Organic Arsenic Exposure in Rats Kidney
Get PDFINTRODUCTION: Exposure to environmental arsenic remains a major public health challenge. Human is exposed to arsenic from groundwater as a result of anthropogenic activities. Chronic exposure to inorganic arsenic has been linked with multiple medical conditions. Therefore, many agricultural countries have shifted the use of inorganic to the organic-based herbicide, monosodium methylarsonate (MSMA). However, with increasing numbers of chronic kidney disease of unknown etiology (CKDu), chronic exposure to herbicide is believed as one of the potential explanations. To date, studies on chronic effects of organic arsenic on the kidney are limited. Therefore, this study aimed to investigate the effect of chronic oral organic arsenic exposure on the rat’s kidney. MATERIALS AND METHOD: Thirty-six Sprague Dawley rats were randomly divided into treatment and its corresponding control groups according to the duration of observations either 2, 4 or 6 months. Both groups were subdivided into three subgroups, each with six animals per subgroup. The treatment groups were given oral MSMA at 63.20 mg/kg body weight, while control groups received distilled water. At the end of each duration, blood was collected for the renal profile, urine for neutrophil gelatinase-associated lipocalin (NGAL) marker, and kidney tissues were harvested for arsenic level measurement and histological analysis. RESULTS:Arsenic level and urinary NGAL were higher in all treatment groups than its corresponding control groups. Histological findings showed progressive pathological changes in the glomeruli and proximal tubules. CONCLUSIONS:Chronic oral exposure to low dose organic arsenic has demonstrated evidence of kidney injury in rats.
A Review on the Relationship between Matrix Metalloproteinases (Mmps) and their Natural Inhibitors (Tissue Inhibitors Of Matrix Metalloproteinases [Timps]) and the Success of an Autologous Arteriovenous Fistula (Avf)
Get PDFSince its introduction by Brescia and Cimino in 1966, arteriovenous fistula has been regarded as the best vascular access for haemodialysis purpose. However, it’s not without any drawbacks which has cost over USD1 billion in the United States alone to rectify them. Intimal hyperplasia has been shown to be a major contributory factor to this development. Intimal hyperplasia is a complex molecular process resulting in unwarranted accumulation of contractile smooth muscle cells, myofibroblasts, fibroblasts, and macrophages. There is an increasing amount of evidence suggesting that matrix metalloproteinases (MMPs) and its natural inhibitors (tissue inhibitors of matrix metalloproteinases ([TIMPs]) play a pivotal role in the development of intimal hyperplasia. Our purpose of writing this review article is to examine these evidences and to suggest of what future research questions need to be answered to further strengthen and clarify this relationship
Mutational Analysis of Quinolone-Resistant Determining Region gyrA and parC Genes in Quinolone-Resistant ESBL-Producing E. Coli
Get PDFIntroduction: Co-resistance to quinolones among extended spectrum β[1]lactamase (ESBL)-producing E. coli commonly occurs in clinical settings. Quinolones act on DNA gyrase and DNA topoisomerase enzymes, which are coded by gyrA and parC genes, thus any mutation to the genes may affect the drug effectiveness. The objective of the study was to characterize gyrA and parC genes in quinolone-resistant E. coli isolates and correlated the mutations with their phenotypic resistance. Materials and Methods: Thirty-two quinolone-resistant (QR) and six quinolone-sensitive (QS) ESBL-E. coli isolates were identified by antibiotic susceptibility and minimum inhibitory concentration tests. Bioinformatics analysis were conducted to study any mutations occurred in the genes and generate their codon compositions. Results: All the QR ESBL-E. coli isolates were identified as multidrug-resistant bacteria. A single point mutation in the quinolone resistance-determining region (QRDR) of gyrA, at codon 83, caused the substitution amino acid Ser83Leu. It is associated with a high level of resistance to nalidixic acid. However, double mutations Ser83Leu and Asp87Asn in the same region were significantly linked to higher levels of resistance to ciprofloxacin. Cumulative point mutations in gyrA and/or in parC were also correlated significantly (p<0.05) to increased resistance to ciprofloxacin. Conclusion: Together, the findings showed that the mutations in gyrA and parC genes handled the institution of intrinsic quinolone resistance in the ESBL-E. coli isolates. Thus, vigilant monitoring for emergence of new mutation in resistance genes may give an insight into dissemination of QR ESBL-E. coli in a particular region
Positive Correlation between Monocyte-to-Lymphocyte Ratio and C-Reactive Protein in Vitamin D Deficient Preterm Infants with Respiratory Distress Syndrome
Get PDFINTRODUCTION: Respiratory distress syndrome (RDS) is one of the leading causes of preterm infant mortality. Vitamin D deficiency is known as a risk factor for RDS related to infants with immature lungs leading to inflammatory exacerbations. Therefore, early diagnosis is needed to prevent RDS. This study evaluated white blood cells (WBC) ratios and C-reactive protein (CRP) among vitamin D deficient preterm infants with RDS to identify simple and prompted inflammatory markers. MATERIALS AND METHODS: A cross-sectional study involving forty preterm infants (28 to 34-weeks gestational age) with low vitamin D levels (25(OH)D<20 ng/dL) was conducted in a neonatal ward of a hospital in Bandung, Indonesia, from February to October 2018. Two consecutive blood collections (cord blood at birth and venous blood at first week) were performed to measure cord blood vitamin D (25(OH)D) levels, complete blood count (CBC), and CRP levels. White blood cell ratios (Monocyte-to-Lymphocyte ratio: MLR, Neutrophil-to-Lymphocyte ratio: NLR, and Platelet-to-Lymphocyte ratio: PLR) were calculated and analyzed. Association analysis was performed using Student’s t-test, Mann-Whitney U and Spearman correlation tests. RESULTS: The median of 25(OH)D levels were 9.96 (7.58-15.81) ng/dL. A significant positive correlation between MLR and CRP was found in the RDS group (r=0.576, p=0.004) and all the subjects (r=0.491, p=0.002); the WBC ratio and CRP levels showed insignificant higher trends when compared to the non[1]RDS group. CONCLUSION: There was a positive correlation between MLR and CRP among vitamin D deficient preterm infants with RDS
Revisiting the Pedicled Gastrocnemius Flap for Orthoplastic Limb Reconstruction
Get PDFINTRODUCTION: Gastrocnemius muscle flap is performed in a combined approach of the orthopaedic and plastic team for limb reconstruction in the developed countries. However, this practice is not readily available in Malaysia because of the smaller numbers of plastic surgery services in government hospitals. This study reviews the outcome of the gastrocnemius flap performed by the orthopaedic team. MATERIALS AND METHODS: Thirty-two patients underwent gastrocnemius flap surgery with a mean age of 35.3 years (range 13-82). The flaps were done to cover the upper third (22), upper half (4), knee (2), distal femur (2) and the popliteal fossa (1). The initial problems were open fracture (21), infection following plating (5), necrotising fasciitis (3), degloving injury (1), pin site infection (1) and melioidosis (1). Five patients were having underlying Diabetes mellitus, 3 Hepatitis B, 2 HIV and 1 Hepatitis C infections. RESULTS: There was no flap necrosis. Complications include persistence infection in 3 patients which required advancement of the flap (1) and additional fasciocutaneous flap (2) to cover the wound breakdown. All fractures achieved union but one patient with infection following double plating for tibial plateau fracture developed chronic osteomyelitis. One patient develops transient peroneal nerve palsy following the lateral gastrocnemius transfer. Both patients who had patella ligament reconstruction with gastrocnemius flap develop knee stiffness. CONCLUSIONS: Gastrocnemius flap is a reliable and safe procedure in salvaging the leg from amputation related to open fractures and infections in orthopaedic surgery. It should be one of the options for the operative procedure taught during the orthopaedic training
A Mini Review: Visual and Auditory Perception in Dyslexia
Get PDFDyslexia is a reading disorder defined as the consequences of sensory impairment which can be quite tricky in diagnosis, as many symptoms of dyslexia tend to overlap with learning disabilities such as specific language Impairment (SLI), dysgraphia, dyscalculia, and a few others. However, as research keeps on progressing, a consensus has been made suggesting that dyslexia is commonly attributed to the impairment of auditory and visual perception. This review paper intends to discuss the detailed progression of research focusing on auditory and visual perception among dyslexics
Serum Magnesium: A Forgotten Electrolyte after Total Thyroidectomy
Get PDFHypocalcemia is a common complication after total thyroidectomy; however, hypomagnesemia is also frequently detected, and its role is often disregarded. We report a 72-year-old woman who underwent total thyroidectomy with neck dissection and subsequently developed atrial fibrillation due to hypocalcemia and hypomagnesemia. The pathophysiology of hypomagnesemia after total thyroidectomy and its significance in calcium homeostasis is described