IIUM Medical Journal Malaysia (IMJM)
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Evaluation of Anti-Biofilm Activity of Virgin Coconut Oil (Avco) Against Streptococcus Mutans ATCC 2157
Get PDFIntroduction: Dental caries has remained a major oral health problem worldwide. Streptococcus mutans is considered as a vital cariogenic agent in the oral cavity. It can synthesise soluble and insoluble glucans from sucrose by glucosyltransferases enzymes and develops stable biofilm on the tooth surface. In the previous study, the fatty acids profile of activated virgin coconut oil (AVCO) have been described, and it includes the excellent antimicrobial activity of the oil. The current study aims to evaluate the antibiofilm effect of AVCO against the Streptococcus mutans ATCC 2157 biofilm in vitro. Materials and method: The minimum biofilm inhibition concentration (MBIC) and the minimum biofilm eradication concentration (MBEC) for antibiofilm activity were determined by serial dilution method, and biofilm thickness on S. mutans was quantified by confocal laser scanning microscopy (CLSM). Results: At the concentra-tion of 15.63 mg/ml of AVCO, it successfully inhibits the development of S. mutans ATCC 21575 biofilm and AVCO (62.52 mg/ml) eradicate biofilm that was formed by the bacteria. The z-stack images obtained from CLSM allows the construction of 3-D biofilm structure and a significant difference in the thickness of S. mutans ATCC 21575 biofilm pre and post-treatment with AVCO were observed. Conclusion: AVCO showed good potential as anticaries where it possesses the ability to inhibits and eradicate S. mutans ATCC 21575 biofilm. A future study to evaluates the interaction of individuals fatty acids present in AVCO against proteins that relate to biofilm formation of S. mutans can be performed utilising the molecular docking tools
Advanced Sacral Chordoma: A Multidisciplinary Team Approach
Get PDFIntroduction: Sacral chordomas are rare, low-grade and slow growing malignant bone tumours arising from the sacral bone. They are locally aggressive with the tendency to metastasize to the lungs. Surgical resection remains the mainstay of treatment of sacral chordomas. However, most patients presented late with large tumours and intra-abdominal extension making en bloc resection highly challenging. Besides that, surgical resection poses risk of injury to the surrounding structures such as major blood vessels, bladder, ureters and rectum due to their proximity to the tumour. Therefore, multidisciplinary team approach is vital in ancipitating possible complications and preventing surgical morbidity. We present a case of advanced sacral chordoma which has been successfully resected with the assistance of pre-operative selective arterial embolization as a pre-emptive therapy. Case report: A 58-year-old lady presented with a large sacral chordoma (17.17 cm x 27.3 cm x 30.5 cm) with sacral erosion, infiltration to gluteus maximus, medius and minimus muscles and lung metastasis. A decision to perform a surgical resection was made to alleviate the pain secondary to sacral nerve compression. Anticipating massive bleeding intra-operatively, pre-operative arterial embolization was performed involving one branch of right internal iliac artery as well as five branches of left internal and external iliac arteries using endovascular coils. The tumour was resected with partial sacrectomy from S2 and below. Intra-operatively, 6 pints of packed cells were transfused with estimated blood loss of 4 litres. The patient recovered well after the surgery. She was pain-free post-operatively with no lower limb neurological deficit. Conclusion: Surgical resection remains the treatment of choice for sacral chordoma. Pre-operative selective arterial embolization can reduce intra-operative bleeding and avoid a potentially convoluted surgery
Can Doctors Be App Developers? Our Experience As Medical Educators
Get PDFIntroduction: Smartphone and mobile apps have become an indispensable companion in our modern-day living and working environment. In the medical field, web browsers and medical apps have transformed the medical practice as the most current knowledge, best practices, medical references, and calculators are available instantaneously at our fingertips. However, these functionality and usage are limited by the creativity and imagination of the app developers. To overcome these limitations, doctors should think out-of-the-box and educate themselves to be appdevelopers to create functional and useful apps in their field. Our aim was to create medical apps from ground-up independently without formal software development training. Material and method: Hybrid app technology is a popular method for creating apps for newbies due to the familiarity with web browsers. We explore the Ionic© Framework which is a free and open-source front-end with good resources and documentation. This programming technology assumes that everyone has experience with web browsers and the modern browsers essentially run on three technology stacks which are Hypertext Markup Language (HTML), JavaScript and Cascading Style Sheets (CSS). The HTML is a standard markup language for web browser while JavaScript is a scripting language for running commands and functions. The CSS is used for describing how HTML elements should be displayed. Results: We successfully published three apps on the Apple AppStore and Google Play, namely, OrthoBoard©, OpList and OOLH. Based on our experience of designing, coding, testing and deploying the apps, it is not impossible for medical doctors to achieve this goal and utilizing the app-development skills as an armamentarium for teaching, learning, and medical practice tools. Conclusions: App development is an essential skill especially for medical educators to leverage the technological advancement in their teaching and learning as well as medical practice in tandem with our nations’ aspiration towards Education 4.0
Persistent Left Sided Superior Vena Cava: The Perplexity of Picc
Get PDFIntroduction: Persistent left superior vena cava is a rare anatomic anomaly, found only about 0.3-0.5% of the general population. On top of that, about 12% of patient has associated congenital cardiac anomaly. Typically, this anomaly is found as an incidental finding as patient is generally asymptomatic. However, it is important to recognize such anomaly in order to avoid complication during placement of central venous catheter. Case report: We herein report a case of an incidental finding of persistent left sided superior vena cava (SVC) upon insertion of peripherally inserted central catheter (PICC). Initial difficulty and perplexity during insertion of PICC with the tip of catheter keep pointing towards the left side of the heart leads us to proceed with central venogram that confirmed such anomaly
Oral Health Related Quality of Life (OHRQoL) Among Malaysian Children: A Systematic Review
Get PDFIntroduction: Oral caries is a major public health issue around the globe, and it is the most prevalent noncommunicable disease (NCD). Children are mostly the population affected by this disease, which affects their quality of life. Therefore, measures to quantify this aspects of quality of life should be established to investigate the current status and to develop future intervention and prevention. The objective of this article is to systematically review the studies related to children's quality of life with regard to their oral health among Malaysian population. Materials and Method: Scopus-indexed articles were retrieved following an advanced search with the following search string, TITLE-ABS-KEY((oral OR dental) AND (child* OR kid* OR (primary dentition)) AND (quality of life) AND Malaysia*), resulting in a final of eight shortlisted and reviewed articles based on the review objective. Results: A few valid and reliable instruments were tested and validated, namely Malaysian version of Early Childhood Oral Health Impact Scale (ECOHIS), Malay Child Oral Impacts on Daily Performances (Malay Child-OIDP), Malaysian version of the Oral Health Impact Profile questionnaire (OHIP-14), and the most commonly used child oral-health-related quality-of-life (OHRQoL). However, Dental Aesthetic Index (DAI) score did not predict the effect of malocclusion on the OHRQoL. Oral caries was highly prevalent among Malaysian Orang Asli children. Oral health did not only have an impact on quality of life in Malaysian preschool children, but also on their caregivers. A health-promoting school model namely the Doktor Muda Programme for primary schools in Malaysia showed some positive impacts on children’s oral health related quality of life. Conclusion: Further research among Malaysian children population with regard to their oral health related quality of life should be continued for the benefits of communities at large
The Effect of Low Heel Raise to Forefoot Plantar Pressure in Diabetic Patients with Tight Tendon Achilles
Get PDFIntroduction: The purposes of this study were to investigate the effects of raising the heel to the forefoot plantar pressure (PP) in diabetic patients with or without limited ankle dorsiflexion due to tight tendon Achilles (TA). Materials and methods: Plantar pressure recordings and gait tests were performed in the two groups of subjects with diabetes (tight TA, n=17; normal TA, n=13) with the heel raised from 1 cm to 3 cm. Results: There were no significant forefoot pressure difference between both intervention groups (p < 0.05). Plantar pressure reduction was seen in the medial (10-30%) and lateral metatarsal heads (20-50%) as well as the heel (2-38%) when heel raise was increased from 1 to 3 cm. However, reciprocal pressure increase was seen at hallux (11-76%), toes (1-200%) and midfoot (22-100%) with increased heel height. Conclusion: Heel elevation up to 2 cm is recommended for footwear prescription for to diabetic patients. A higher heel raise may may cause plantar pressure elevation to the hallux which is one of the high risk regions for plantar ulceration in diabetics
Prevalence Rates of Chlamydia Trachomatis and Other Sexually Transmitted Organisms in Infertile Couples Attending a Tertiary Medical Centre in Malaysia
Get PDF INTRODUCTION: Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG) infections are well recognized and prevalent sexually transmitted infections (STIs). The role of Mycoplasma spp and Ureaplasma spp are still controversial as some are commensals of genitourinary tract. OBJECTIVES: To estimate the prevalence rate of 7 organisms: Chlamydia trachomatis, Neisseria gonorrhoea, Mycoplasma genitalium, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP) in infertile married couples during infertility evaluation. MATERIALS & METHODS: A total of 274 samples from all of the 137 couples who attended the reproductive center from June to December 2014 were collected. Detection of the organisms was performed using multiplex polymerase chain reaction. RESULTS: STI-associated organisms were detected in 35.4% (97/274) of subjects. The prevalence rates of CT, MG, TV, UU, MH were 7.3%,1.1%, 0.4%,5.4% and 5.1% respectively. Twenty-one (7.7%) subjects were positive for more than one organism. 24/274 (8.8%) of subjects had history of urogenital tract-related symptoms and 50% (12/24) were tested positive to one or more organisms. The presence of symptoms in both male and female subjects were found to be 10% (2/20) in CT infection, 10% (7/67) in UP, 14% (2/14) in MH and 13% (2/15) in UU infections. CONCLUSION: Sexually transmitted organisms were detected in one third of subjects planning for fertility evaluation. The absence of symptom in most subjects particularly in CT infection emphasizes the need for microbiological screening during infertility evaluation. The presence of genital ureaplasmas and mycoplasmas in infertile couples should not be neglected. There is a growing need to clarify whether their roles are simply colonizers or pathogens implicated in infertility
Neck Swelling in A Child: Now You See it, Now You Don’t?
Get PDFJugular Ectasia is a rare benign swelling due to dilatation of jugular vein, which can occur in the internal, external or an anterior jugular vein. It is characterized by painless, soft, compressible unilateral swelling appeared on Valsalva maneuver. A 3-year-old boy presented with 2 months history of prominent mass over the right side of the neck on Valsalva maneuver is subjected to Doppler ultrasonography (USG) of the neck. Doppler Ultrasonography (USG) of the neck revealed prominent right jugular dilatation during Valsalva without any focal lesion with the normal caliber of the left internal jugular vein. Jugular ectasia should be included in the differentials of a benign neck swelling in children despite infrequently encountered. Dilated jugular vein on ultrasound Doppler on Valsalva maneuver is pathognomic of jugular ectasia. Early diagnosis with serial follow up can reduce parent’s anxiety and will reduce complications
From Islamic Input in Medical Program to Islamic Medical Practice: The Journey from Kulliyyah of Medicine to IIUM Medical Centre
Get PDFEnteral Nutrition In 6 Malaysian Intensive Care Units: A Point Prevalence Study of Prescription Practices
Get PDFINTRODUCTION: Enteral nutrition (EN) is the first line of nutrition therapy for critically ill patients with an intact gastrointestinal tract. Even though intensive care units (ICUs) generally have established feeding protocols, prescribing practices to achieve nutrition goal is still widely variable among intensive care practitioners. The aim of this study was mainly to investigate commonly prescribed types and energy concentration in EN formulations including protein prescription. MATERIALS AND METHODS: This was an observational, point prevalence study, involving six level 3 ICUs in Malaysia. All patients aged type of EN formulation and protein prescription recorded. RESULTS: A total of 109 patients were included in the analysis out of which 78% of them were mechanically ventilated. At the point of the study, more than 16 years of age in the participating ICUs on the 11th of October 2016 were enrolled in this study and 71.5% (78/109) received EN. Among the EN group, 68% (53/78) received standard formulation feeds (1kcal/ml) while the rest received energy dense formulation (>1kcal/ml). Fluid restriction was the main indication for energy dense formulation prescription, occurring in almost all (24/25) of the patients. There was no report of feeding intolerance. Only 2/109 received parenteral nutrition (PN) giving the EN to PN ratio of 30:1. The mean protein prescription was 0.9g/kg (SD± 0.4). CONCLUSION: Prescription of EN was 30 times more frequent than PN in these ICUs. In those receiving EN, standard formulation feed was 3 times more commonly prescribed than energy dense feeds with fluid restriction being the main indication of the latter. Protein prescription was less than the guideline recommendation