IIUM Medical Journal Malaysia (IMJM)
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The Role of Apolipoproteins in Dengue Infection: A Review
Get PDFThe re-emergence of the dengue virus in recent decades has significantly increased with almost 40%-50% of the world’s population being at risk. Meanwhile, cholesterol and its components, apolipoproteins, were found to play a vital role in dengue infectivity and the development of severe dengue. This review attempts to address the functional importance of cholesterol and related apolipoproteins in dengue virus pathogenesis and to identify the potential utilisation of this relationship in future diagnosis and management of dengue. The literature search was conducted using a computer-based electronic search on dengue infection with cholesterol and human lipoproteins from September 2017 to June 2019 through three main search engines: MEDLINE (OVID), PubMed, and Science Direct using the keywords including Flaviviruses, characteristics of dengue virus, the pathogenesis of dengue, enhancement of dengue, metabolism of cholesterol, cholesterol pathway and human lipoproteins in association with dengue. Dengue virus manipulates lipid raft integrity and utilizes cholesterol components and apolipoproteins for virus internalisation through LDLr and SR-BI receptors. Infectivity of the dengue virus correlated with a decrease in the cholesterol content of the virions. High cholesterol levels in the endoplasmic reticulum promote replication complexes formation of dengue virus. Cholesterol is needed for NS1 secretion which is essential in viral replication, dengue pathogenesis, and host immune evasion. Levels of cholesterol and its related components contributed to the development of severe dengue. The interplay between cholesterol and cellular proteins lead to significant effect in all aspects of the dengue virus replication cycle from viral entry to release
Utilisation and Perception of Complementary and Alternative Therapies (CATs) among Obese and Overweight Individuals in a Malaysian Public University
Get PDFIntroduction: Obesity and overweight are among the most serious public health issues that can threaten the well-being of individuals. Its increasing prevalence in Malaysia has inevitably caused many to additionally seek complementary and alternative therapies (CATs) to lose weight. This study intends to 1) assess the utilization and perception toward CATs among obese and overweight participants and 2) assess applicability, practicality, reliability and validity of the UPCATs-Malay. Materials and methods: It was conducted cross-sectionally on 30 students and staff. Responses were analyzed using SPSS (v21). Results: Among the participants (age = 26.17±8.23 years; female = 66.7%; students = 63.3%), 40.0% were overweight and 60.0% were obese. Overall, 23.3% of the participants had previously used some types of CATs to lose weight, with herbal or dietary supplements (20.0%) being the most common. Participants’ attitudes towards CATs were mostly influenced by the internet (93.3%). Most believed that CATs modalities were safe (53.3%) and not a threat to public health (70.0%). The majority of participants (53.3%) were also considering joining any CATs-based weight management programmes. Additionally, the questionnaire was considered clear, comprehensive and not difficult to complete (< 5 minutes). The overall reliability was 0.711 (domain range = 0.641-0.881). Majority of individual items in UPCATs-Malay correlated better with their domains compared to other domains supporting validity. Conclusion: Overall, positive perceptions towards CATs were apparent and the questionnaire was reliable and valid. Further approaches should be taken especially on the identification of safe, viable CATs modalities and their role in weight management
Unilateral Adrenal Hyperplasia: A Rare Cause of Primary Aldosteronism
Get PDFA 73-year-old gentleman with a background history of long-standing hypertension and hyperlipidaemia presented with one-year history of persistent asymptomatic hypokalaemia associated with metabolic alkalosis. Within a few months, the hypertension worsened, needing increasing dose of anti-hypertensive agents. Biochemical test showed an elevated aldosterone-renin ratio but the computerized tomography (CT) scan of adrenal did not show any adrenal mass. Arterial stimulation venous sampling (ASVS) lateralized the lesion to the left side. A left retroperitoneal adrenalectomy was performed with immediate reversal of hypokalaemia and improvement of blood pressure control to only single anti-hypertensive agent
Parental Experiences in the Management of Children with Syndromic Craniofacial Diagnoses in Malaysia
Get PDFINTRODUCTION: Patients with syndromic craniofacial diagnoses (SCD) require coordinated overall management and remain a parental challenge. This study assessed the parental experience and psychological outcome, as well as the evaluation of professional and community support, received in Malaysia. MATERIAL AND METHODS: The Craniofacial Experiences Questionnaire (CFEQ) was used to assess parents of SCD children registered with the Combined Oro-Craniomaxillofacial Clinic in University Malaya Medical Centre, Kuala Lumpur. RESULTS: Thirty parents participated in this study with their children’s age ranged from 2 months to 14 years old diagnosed with Apert, Crouzon, and Pfeiffer syndromes, as well as other SCD such as Goldenhar, Pierre Robin, and Nager. The majority of parents felt anxious whenever their child underwent an operation despite having positive perceptions of the outcome. Most respondents did not see the condition as handicap although 6.7% of parents were embarrassed by their child’s appearance. The majority of the respondents were worried about the financial implication, had to be occasionally absent from work due to their child’s regular appointments, and felt depressed while only a quarter of respondents socialised less and struggled to meet parenting needs. Most respondents received positive comments, were treated with respect, and obtained adequate support from both health professionals and the community with regards to their childcare. CONCLUSIONS: Although most parents were concerned about their children’s condition, only minimal social stigmatisation was noted. Parents were satisfied with the emotional and physical support received from healthcare professionals and the community. Understanding parental experience may contribute to the improvement of multidisciplinary syndromic craniofacial management
Effects of Brisk Walking on Plasma Lipoprotein(a), Total Antioxidant Status, Aerobic Fitness, Percent Body Fat, Waist Circumference and Resting Blood Pressure in Overweight and Obese Females
Get PDFINTRODUCTION: Obesity is a major public health challenge in many nations including Malaysia. Physical activity has been shown to be a modifiable determinant of obesity and non-communicable diseases. The objective of this study is to investigate the effects of 6 weeks of brisk walking on plasma lipoprotein(a), total antioxidant status, percent body fat, aerobic fitness, waist circumference and resting blood pressure in overweight and obese females. MATERIALS AND METHODS: Thirty-eight females (Age: 23.2 ± 3.9 years BMI: 28.8 ± 4.5 kg.m-2) were randomly assigned into 2 groups: control (C) and brisk walking (BW) groups. Pre- and post-tests were carried out to measure participants’ anthropometric measurements, aerobic fitness, resting blood pressure and blood sample for lipoprotein(a) and total antioxidant levels. Participants in BW group performed the brisk walking exercise, 3 sessions per week for 6 weeks. Participants in C group maintained their sedentary lifestyle and refrained from any other training programme. Results: After 6 weeks of intervention, plasma lipoprotein(a) level was significantly reduced in both BW and C groups. There were also significant reductions in waist circumference, percent body fat and resting blood pressure in BW group. However, there were no significant differences in total antioxidant status and aerobic fitness after the brisk walking programme. Conclusion: 6 weeks of brisk walking programme reduces plasma lipoprotein(a), percent body fat, waist circumference and resting blood pressure in overweight and obese females. Therefore, brisk walking is an appropriate exercise to reduce some of the risk factors for noncommunicable diseases among overweight and obese females
Relevant Local Fatwā on The Issues of Using Human Tissues in Articular Cartilage Tissue Engineering Experimentation
Get PDFIn articular cartilage tissue engineering (ACTE) experimentation, the researchers have utilised cells and tissues sampled from the human donor for research purposes. The cells and tissues may be harvested from the living donor’s discarded tissues through a medical procedure, e.g. the total knee replacement surgery. The small pieces of a tissue sample taken from the human donor are essential to study the articular cartilage regeneration for treating joint disease, i.e. osteoarthritis. However, the procedure has raised some ethical and fiqh (Islamic jurisprudence) concerns. The study was done by utilising the secondary analysis of local Muslim jurists’ opinions (fatwā) related to the sampling of human biological samples. This paper explores the scenarios of using cell sources taken from the living human donor through the existing fatwā of local Muslim jurists (fuqahā`). The scenarios include: (1) taking samples from the living donor, and (2) discarding human tissue, as practised in ACTE experimentation. The current fatwā has shown that honouring every part of a human body is considered essential in Islam. ACTE researchers may utilise the biological samples from living donors as alternatives in studying articular cartilage regeneration. The donation of human biological samples for research purposes in ACTE experimentation, obtained from a medical procedure, may be permissible, should the stipulated terms and conditions were observed, and the procedure does not cause any additional harm to the donor
F-18 FDG PET-CT in a Case of Unsuspected Bilateral Adrenal Histoplasmosis
Get PDFHistoplasmosis is a common fungal infection in endemic countries including Malaysia. Although it is commonly diagnosed in immunosuppressed individuals, there is a preponderance of immunocompetent individuals among individuals with disseminated disease involving adrenal gland. There is a diagnostic dilemma in most patients as the clinical presentation, biochemical parameters and imaging features are frequently non-specific. On 18F-FDG PETCT, histoplasmosis shows high FDG avidity. However, due to overlapping features with other disease conditions, tissue biopsy remains as the confirmatory test. In this report, we present a case of disseminated histoplasmosis with high FDG uptake in the adrenal glands and lymph nodes which mimic a metastatic cancer
Traditional and Complementary Medicine (T&CM) Use and its Association with Diabetic Control among Diabetic Patients in a Tertiary Centre, Kuantan Pahang
Get PDFINTRODUCTION: Diabetes mellitus is a major global health concern worldwide. The fact that it is a lifelong chronic illness contributes to the increasing tendency of seeking traditional and complementary medicine (T&CM), yet study regarding this remains limited. This study aimed to measure the prevalence of T&CM use among diabetic patients and its association with diabetic control. MATERIALS AND METHODS: A cross sectional study was conducted at Hospital Tengku Ampuan Afzan (HTAA), Kuantan between July and August 2018. Following written consent, 136 type 2 adult diabetic patients in medical ward and those attending diabetic clinic were interviewed regarding the use of T&CM; and their blood investigation results were collected from patients’ medical records. A data collection form was used as study instrument. Descriptive statistic was used to measure the prevalence while chi-square test and independent t-test were used to find associations between T&CM use and study background and diabetic control. RESULTS: Low prevalence of T&CM use (16.9%) was found, predominated by retiree group (p<0.05). Majority of patients used T&CM as additional treatment for diabetes (60.9%) and the usage was influenced by friends, family members and advertisement. There was a significant difference in Glycosylated haemoglobin A1c (HbA1c) and Estimated Glomerular Filtration Rate (eGFR) levels between inpatient and outpatient T&CM users (p><0.05). CONCLUSION: 1 in every 6 diabetic patients in HTAA, Kuantan were using T&CM along with conventional diabetic medications in which retirees are predominated. No associations were found between T&CM uses and diabetic control. Outpatient T&CM users had lower HbA1c level with higher eGFR compared to inpatient users. ><0.05). Majority of patients used T&CM as additional treatment for diabetes (60.9%) and the usage was influenced by friends, family members and advertisement. There was a significant difference in Glycosylated haemoglobin A1c (HbA1c) and Estimated Glomerular Filtration Rate (eGFR) levels between inpatient and outpatient T&CM users (p<0.05). CONCLUSION: 1 in every 6 diabetic patients in HTAA, Kuantan were using T&CM along with conventional diabetic medications in which retirees are predominated. No associations were found between T&CM uses and diabetic control. Outpatient T&CM users had lower HbA1c level with higher eGFR compared to inpatient users
Metabolic and Pancreatic Derangement in type 2 Diabetic Rat
Get PDFIntroduction: The prevalence of diabetes mellitus is increasing globally, despite the best current therapies available. A large diversity of animal models has been developed for better understanding the pathogenesis of diabetes mellitus. This study aimed to develop a rat model that mimics the metabolic characteristics of human type 2 diabetes mellitus. Methods: Twenty-four male Sprague–Dawley rats (200–250 g) were divided into two groups and fed either a commercially available standard pellet diet (n=8) or a self-prepared high-fat diet (HFD) (n=16) for 6 weeks. HFD-fed rats were significantly obese compared to standard-fed rats. Eight of the obese rats were injected a single low dose of streptozotocin (STZ) at 35 mg/kg intraperitoneally to induce type 2 diabetic rat (T2DR) and were monitored for 6 weeks. Results: The weekly fasting blood glucose levels (FBG) in T2DR remained consistently high throughout the 6 weeks. The T2DR group exhibits decreased body weight, increased water intake, increased 24-hour urine volume with microalbuminuria, hyperlipidemia, altered liver and kidney functions, and structural changes of the islet of Langerhans. Conclusion: This model simulates the natural disease progression and metabolic characteristics of type 2 diabetic patients. This model mimics the human syndrome that can be maintained at a reasonable cost, and easy to develop