IIUM Medical Journal Malaysia (IMJM)
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Prevalence and Associated Factors of Diabetic Foot at Risk among Type 2 Diabetes Mellitus Patients Attending Primary Health Clinics in Kuantan
Get PDFIntroduction: The diabetic foot at risk is the diabetic foot which is at risk of ulceration, hence the importance of identifying the foot at this stage. This study aims to assess the prevalence of diabetic foot at risk and its associated factors among type 2 diabetes mellitus patients’ attending primary health clinics in Kuantan. Methods and methods : This was a cross-sectional study conducted at four primary health clinics in Kuantan involving 450 study participants who were selected by using universal sampling method. Foot examination was carried out and foot at risk was classified based on the Kings’ Classification. Multiple logistic regressions were performed to identify the predictors for diabetic foot at risk. Results: The prevalence of diabetic foot at risk was 31.3%. Multivariate logistic regression analysis identified age (OR 1.04, 95% CI: 1.01-1.06), smoker (OR 4.11, 95% CI: 1.96-8.63) and duration of diabetes more than 10 years (OR1.77, 95% CI: 1.05-2.98) as risk factors for diabetic foot at risk. Respondents with higher diabetic foot practice score (OR 0.87, 95% CI: 0.77-0.98) have lesser risk of developing diabetic foot at risk. Conclusion: Patients who are older, smoker and/or have chronic diabetes are predicted to be at higher risk to develop the diabetic foot at risk. This study also showed that patients with better foot care practice has lesser risk. Therefore, these are the groups of patients that need to be targeted for early detection and intervention to prevent serious complications
Psychological Well-Being among Nursing Students
Get PDFIntroduction: Nursing students are subjected to a variety of stressors during their study. Severe and prolonged stressors may affect the psychological well-being in the form of depression, anxiety and stress which may affect students’ academic performance, physical health and quality of life. Therefore, this study aimed to determine the rate and severity of depression, anxiety and stress symptoms and also to assess the relationship between these symptoms with stressors faced by the students. Materials and method: A sample of 174 nursing students from International Islamic University Malaysia participated in this study. Depression Anxiety, Stress Scale (DASS-21) was used to assess the psychological well-being by determining the prevalence and severity of depression, anxiety and stress (DAS) symptoms. The sources of stressors were identified by giving the students a list of the most possible source of stressors which were chosen depending on previous studies, and then the severity of stressors and their relationship with these symptoms were assessed. Results: The overall prevalence of depression, anxiety and stress symptoms was 51.7%, 81.6% and 43.1% respectively but it was found that 13.2%, 44.3% and 10.3% of nursing students have clinically significant depression, anxiety and stress respectively. No significant differences between the gender and age of students in relation to DAS symptoms. Regarding the source of stressors, the top five stressors decided by the students were fear of failing, examination and grades, study pressure and obligations, fear of unemployment after graduation and academic overload. Conclusion: Depression, anxiety and stress symptoms are present among nursing students which require early intervention. Academic factors can be considered as sources of stressors that may precipitate emotional disturbances among the nursing students
Predictors of Pediculosis Capitis among Primary School Children in Kuantan, Pahang
Get PDFIntroduction: Pediculosis capitis is a worldwide problem which carries significant consequences among the school children and caregivers. This study aims to investigate the prevalence and predictors of Pediculosis capitis among primary school children in Kuantan, Pahang. Materials and method: An analytical crosssectional study using two-stage cluster random sampling was carried out among 1,365 primary school children in seven schools in Kuantan, Pahang. A selfadministered validated questionnaire was used followed by hair and scalp examination. Results: The median age of the respondents was 8.0 years. Majority of them were males (53.41%), Malays (60.29%), household income between RM1000RM2999 (31.87%) and from urban school location (98.68%). The overall prevalence of Pediculosis capitis was 9.6% (n=131). Multivariate logistic regression analysis showed that predictors for Pediculosis capitis were female (Odds ratio (OR)=8.571, 95% Confidence interval (CI)=5.024-14.620), Indian (OR=5.560, 95% CI=3.384-9.136), those with siblings more than five (OR=2.644, 95% CI=1.044-6.700), history of contact with infested person (OR=2.445, 95% CI=1.619-3.691) and urban school location (OR=0.030, 95% CI=0.284-0.091). Conclusion: Pediculosis capitis is a common public health problem affecting primary schoolchildren in Kuantan, Pahang and those levels are of epidemic importance. Hence, preventive measures are necessary to reduce the transmission of head lice among school children
Systolic Time Interval (STI) in Hypothyroid Patients Receiving High Dose L-Thyroxine
Get PDFIntroduction: Systolic Time Interval (STI) is a simple,noninvasive and precise technique to assess left ventricular (LV) function. It measures aortic Pre-Ejection Period (PEP) over Left Ventricular Ejection Time (LVET) from echocardiogram. Thyrotoxicosis will enhance LV function and cause reduction of STI. This study was perform to measure the changes of STI after administration of high dose L-thyroxine and to determine the correlation between high dose L-thyroxine administration and STI. Materials and Method: A Total of 22 patients were screened. Those with cardiac diseases and high Framingham risk score were excluded. Nine patients were started on high dose L-thyroxine (7x their usual dose) once a week during the month of Ramadan.Thyroid hormones ( T3,T4,TSH)Â and STI (PEP/LVET) were measured at baseline and within 24 hrs after high dose L-thyroxine ingestion. Results: All patients have normal thyroid hormones level and normal cardiac function at baseline. The median dose (mcg) of L-thyroxine was 600 (437.5,700) while the median level of fT4 (pmol/L) was 17.43(12.38,20.8). Despite the significant increment of fT4 after Lthyroxine ingestion [baseline 13.21(8.19,14.63) vs high dose 17.43(12.38,22.55) p; 0.011] there was no significant change in STI [baseline 0.3(0.2,0.4) vs high dose 0.28(0.26,0.45) p; 0.513]. There was no correlation found between the dose of Lthyroxine and STI (r=0.244 , p;0.526). Conclusion: Administration of high dose Lthyroxine did not significantly alter STI despite significant increment of fT4 level unlike the naturally occurring thyrotoxicosis.Therefore ‘exogenous’ administration of high dose L-thyroxine is cardiac safe
Pilgrims' Health Screening Profile from a FELDA Settlement in Pekan, Pahang
Get PDFIntroduction: Good physical health or istitha’ah is one of the shariah requisite to perform hajj pilgrimage. Hence, passing the health screening is mandatory for the pilgrim to-be in Malaysia. The aim of this study is to describe the pilgrims’ health screening profile from a FELDA settlement in Pekan, Pahang. Materials and method: All 26 candidates from Chini’s FELDA cluster who were selected for hajj pilgrimage in 2017 underwent health screening at a nearby health clinic. Data from this health screening were analysed descriptively using SPSS software version 23.0. Results: Candidates consists of 11 men and 15 women aged between 48 to 86 years with the mean age of 61. Result showed that both sexes have comparable mean age and body mass index. Most of the candidates (88.5%) have at least 1 chronic medical problem (excluding overweight) while 54% have at least 2 or more medical problems. Women have higher prevalence of non-communicable disease (NCD) conditions namely obesity, hypertension, and diabetes (40%, 60%, and 40%) compared to men (27%, 45% and 36% respectively). This figure is higher than 2015 national figure for age specific: 50 years group (obesity 36.6%, hypertension 49.3%, diabetes 27%). In addition, 20% of the women also have anaemia while none in men. Conclusion: Majority of the candidates in this group are elderly and have at least two chronic medical problems. Women have higher prevalence of NCD and anaemia than men. Thus, based on the findings, early and focused pilgrims’ health screening especially among elderly female is essential and appropriate action should be taken in order to reduce risk for morbidity and mortality during hajj pilgrimage
A Traditional and Complementary Medicine (T&CM) Use and Its Association with Diabetic Control among Diabetic Patient in SingleCenter
Get PDFIntroduction: Diabetes Mellitus is a major global health concern worldwide with increasing trend as reported in the National Health Morbidity Survey 2015. Due to the fact that diabetes mellitus is a life long chronic illness and incurable, it contributes to the increased tendency of seeking Traditional Complementary Medicine (TCM). The objective of this study is to measure the prevalence of CM use among diabetic patients and its association with diabetic control. Materials and Method: A cross-sectional study was performed at Hospital Tengku Ampuan Afzan, between July to August 2018. 136 Type II adult diabetic patients in medical ward and diabetic clinic were interviewed regarding the use of CM, and their blood investigations results were collected from patients' medical records. A data collection form was used as the study instrument. Descriptive statistic was used to measure the prevalence while Fisher exact test and Independent t-test were used to find associations between CM usage with study background and diabetic control. Results: Low prevalence of Traditional Complementary Medicine use (16.9%) was found with retired group of respondents was identified to be the predominant group (p-value=0.025). Majority of patients used CM as an additional treatment for diabetes (60.9%). Friends, family members and advertisement were the main influential factors in starting and using CM. A significant difference in eGFR value was reported between inpatient and outpatient CM users with a p-value of 0.001. No positive association was observed for HbA1c level. Conclusion: 1 in every 6 diabetic patients in HTAA, Kuantan were using Traditional Complementary Medicine along with conventional diabetic medications in which retirees were the major group identified. eGFR was the diabetic control parameter that had been found to have a significant association with diabetic inpatients and outpatient CM users in this study
The Effect of Oral Probiotic Streptococcus Salivarius K12 on Candida Albicans Biofilm Formation
Get PDFIntroduction: Oral cancer is the sixth most common cancer worldwide with Candida albicans infection being one of the aetiological factors for the disease. Meanwhile, Streptococcus salivarius K12 is an oral probiotic that is beneficial to the oral cavity. The objective of the present study is to determine the effect of S. salivarius K12 on C. albicans biofilm-forming ability with the hypothesis that S. salivarius K12 inhibits biofilm formation of C. albicans Materials and method: To assess the effect of S. salivarius K12 on C. albicans biofilm formation, S. salivarius K12, lab strain C. albicans MYA-4901 and clinical isolates from oral cancer, ALC2 and ALC3 were grown in both nutrient broth (NB) and RPMI. In a mono-species biofilm, 105 of C. albicans cells and 106 of S. salivarius K12 cells were grown separately in a 96-well plate. In contrast, both microorganisms were combined for polymicrobial biofilms with similar cell numbers as in mono-species. The biofilms were incubated for 72 hours at 37°C and the media were replenished every 24 hours. Finally, the crystal violet assay was conducted, and the optical density was measured at OD620nm. Results: Polymicrobial biofilms of C. albicans (MYA-4901 and ALC3) with S. salivarius K12 when grown in NB, exhibited a decrease by 64.5 ± 25.8% and 83.7 ± 5.4%, respectively when compared to the expected biofilms which were predominated by yeast form. Furthermore, polymicrobial biofilms of C. albicans (ALC2 and ALC3) with S. salivarius K12 showed a decrease by 62.5 ± 25.6% and 55.9 ± 17.1 %, respectively when compared to the expected biofilms when grown in RPMI that were predominated by hyphal form. Conclusion: S. salivarius K12 inhibited polymicrobial biofilms formation of C. albicans yeast and hyphal forms, thus supported the hypothesis that S. salivarius K12 inhibits biofilm formation of C. albicans
Medicinal Properties Screening of Mallotus paniculatus Extract
Get PDFIntroduction: Traditionally, Mallotus paniculatus (Balik Angin) plant is used in the treatment of various diseases in rural areas such as remedy after childbirth, wound healing and fever. In this present study, four medicinal properties of the plant were investigated which included antibacterial, antifungal, anticancer and antioxidant activities. Materials and Methods: Potential medicinal compounds were extracted from the plant leaves by sonication with 3 different solvents namely ethanol, ethyl acetate and hexane respectively. The antibacterial and antifungal properties were determined using disc diffusion agar and broth dilution assay, the antioxidant activity by DPPH scavenging assay and the anticancer effect by MTT assay. Results: From the screening of the medicinal properties, M. paniculatus leave extracts were shown to possess antibacterial, antioxidant and anticancer properties but not antifungal properties. Ethanolic and ethyl acetate extracts of the leave were active against gram positive bacteria (Staphylococcus aureus and Bacillus subtilis) but not gram negative bacteria (Pseudomonas aeruginosa and Escherichia coli). The antioxidant activity of the ethanolic crude extract was high; with IC50 of 30 μg/ml comparable with the positive controls; ascorbic acid and butylated hydroxytoluene (BHT). Both ethanolic and ethyl acetate extracts were cytotoxic against breast cancer (MCF7), colon cancer (HT-29), cervix cancer (Hela) cell lines. Conclusion: M. paniculatus leave extract has many potential medicinal values for further studies
In Vitro Antileptospiral Activity of Trigona thoracia Propolis and its Synergistic Effects with Commonly Prescribed Antibiotics
Get PDFIntroduction: Trigona thoracica propolis is known to have antimicrobial properties, however its antileptospiral properties and its synergistic effects with commonly prescribed antibiotics are scarcely documented. This study aimed to evaluate the antileptospiral properties of Trigona thoracica against pathogenic Leptospira species (spp.) and to study its synergistic effects with commonly prescribed antibiotics. Materials and Methods: The tested Leptospira serovars were Australis, Bataviae, Canicola and Javanica. Aqueous extract propolis (AEP) and ethanolic extracts propolis (EEP) were used. Broth dilution methods were used to determine the Minimum Inhibitory Concentration (MIC), Minimum Bactericidal Concentration (MBC) and the synergistic effects between the propolis and the tested antibiotics. The synergistic effects was evaluated by using the fractional inhibitory concentration (FIC) index. Morphological changes of the treated Leptospira were observed under a Scanning Electron Microscope (SEM). Results: The AEP and EEP were found to have antileptospiral properties against the tested Leptospira spp. The synergy result showed that only combination of AEP and penicillin G against serovar Australis has demonstrated synergistic effect with the FIC index of 0.38. Morphological study using SEM showed significant structural changes of the treated Leptospira spp. Conclusions: The result suggests that Trigona thoracica propolis could potentially be used as either a complimentary or an alternative therapeutic agent against pathogenic Leptospira spp
The Impacts of Climate Variability on Cholera Cases in Malaysia
Get PDFIntroduction: Altered weather patterns and changes in precipitation, temperature and humidity resulting from climate change could affect the distribution and incidence of cholera. This study is to quantify climate-induced increase in morbidity rates of cholera. Material and Methods: Monthly cholera cases and monthly temperature, precipitation, and relative humidity data from 2004 to 2014 were obtained from the Malaysian Ministry of Health and Malaysian Meteorological Department, respectively. Poisson generalized linear models were developed to quantify the relationship between meteorological parameters and the number of reported cholera cases. Results: The findings revealed that the total number of cholera cases in Malaysia during the 11 year study period was 3841 cases with 32 deaths. Out of these, 45.1% of the cases were among children below 12 years old and 75% of the cases were from Sabah. Temperature and precipitation gave significant impact on the cholera cases in Sabah, (p<0.001) while precipitation were significant in Terengganu (p<0.001), and Sarawak (p=0.013). Monthly lag temperature data at Lag 0, 1, and 2 months were associated with the cholera cases in Sabah (p<0.001). The change in odds of having cholera cases were by the factor of 3.5 for every 1ºC increase in temperature. However, the contribution of rainfall was very mild, whereby an increase of 1 mm in precipitation will increase the excess risk of cholera by up to 0.8%. Conclusion: This study concludes that climate does influence the number of cholera cases in Malaysia