IIUM Medical Journal Malaysia (IMJM)
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Do Parenting Style and Adolescents’ Self-esteem Contribute to Mental Health Problems among Young Adolescents in Malaysia? An Adolescents’ Perspective
Get PDFIntroduction: Adolescence is a crucial phase in life, as this is the time when they are developing their identity, while at the same time forming relationships with others, including their family members. This study investigated adolescents’ mental health status in Malaysia and its associated factors including self -esteem and parenting style that are experienced by them. Materials and Methods: A cross-sectional study was conducted among 248 school-going adolescents aged 13 and 14 years in Selangor, Malaysia. The validated Malay version of the Strengths and Difficulties Questionnaire (SDQ) was utilized to assess adolescents’ mental health status. In addition, the adolescents’ self-esteem was also assessed using the Rosenberg Self-Esteem Scale Questionnaire while the Parental Bonding Instrument was used to assess their parent’s parenting style. Results: Almost 20% of the adolescents were found to have mental health problems such as emotional and conduct problems, hyperactivity disorder and peer problems. Using multivariate analysis, factors that were associated with mental health problems were family income (AOR=2.788, 95% CI=1.397, 5.563), adolescents’ self-esteem (AOR=0.799, 95% CI=0.668, 0.955) and their perception on parental control (AOR=1.175, 95% CI=1.020, 1.353). Conclusion: This study shows that one fifth of these adolescents had mental health problems. Low socio-economic factors, over controlling parents and poor self-esteem were associated with these problems. In conclusion, it is important to educate parents on effective parenting style, as improper parenting may cause psychological distress among adolescents. Improving families’ socioeconomic status and adolescents’ self-esteem can also enhance their mental health and well-being
Transforaminal Endoscopic Discectomy: A Targeted Spinal Surgery
Get PDFIntroduction: Open discectomy has been the gold standard of care for cases of Prolapsed intervertebral Disc. Tissue dissection is unavoidable in order to access the pathologic disc material. From skin incision, subcutaneous fat tissue, paraspinal muscles, ligamentum flavum, epidural fat, dura and nerve roots has to be encounter before reaching the disc material. With the in out transforaminal endoscopic technique only skin and subcutaneous tissue need to be bridge before reaching the disc material. This technique is also known as a targeted surgical technique. Minimal tissue injury is caused via this technique. Case report: We present 3 case series of prolapsed intervertebral disc which was treated with transforaminal endoscopic technique. Case 1: 49 year old presented with one year history of low back pain and left lower limb sciatica. Straight leg raising sign was positive. MRI showed 2 level disc bulge at L4L5, L5S1 with annular tear at L5S1. Case 2: 26 year old lady presented with 6 months history of low back pain and left lower limb sciatica. Straight leg raising sign was positive. MRI showed extruded disc at L4L5. Case 3: 28 year old lady presented with 8 months history of low back pain and left lower limb sciatica. Straight leg raising sign was positive. MRI showed extruded disc at L5S1 with annular tear. Results: All three patients underwent transformational discectomy. Case 1 and 2 were done under monitored anaesthesia control (MAC) and case 3 was done under epidural. All three patients had satisfactory pain relief with complete resolve of straight leg raising (SLR) test. The 1st patient had longer recovery period possibly because of its chronicity of symptoms. Conclusion: Early recovery is expected hence early return to work can be accomplish. In the future this might be the gold standard of treating prolapsed intervertebral disc
Aeromonas Salmonicida Infection in A Massive Splenic Cyst: A Rare Cause of an Acute Abdomen
Get PDFIntroduction: Cysts of the spleen are most frequently primary or secondary. If it contained an epithelial lining it is referred to as epithelial or epidermoid cysts Other common cause is post-traumatic pseudocysts. Non parasitic cause of infective splenic cyst are rare especially those caused by bacterial infection. They may present as symptoms related to their size with gastric compression or pain, an abdominal mass, rupture, or infection with abscess. Case report: We present a case of massive splenic cyst in a 13 year old boy presenting with acute abdominal pain, this was successfully treated with deroofing of the cyst wall while preserving the function of the spleen. Cultures subsequently grew Aeromonas Salmonicida. The patient was discharged home well. Issues of diagnosis and dilemma in treatment while preserving the spleen in an adolescent will be discussed
Knowledge, Attitude and Practice of Malaysian Medical Doctors on Smoking Cessation Guideline
Get PDFIntroduction: Prevalence of active smokers in Malaysia is remaining high (22.8%) despite the wide availability of quit-smoking services. Rather than look at the patients’ factors alone, the possible negative factors from health care providers should also be explored. Therefore, knowledge, attitude and practice of the healthcare professional on smoking cessation intervention needs to be assessed, especially among the primary care doctors. This can be done during national conference gathering all doctors from Malaysia. Materials and Method: A crosssectional study was conducted among medical doctors attending First East Coast Symposium on Specialized Care at Primary Care Level at Grand DarulMakmur, Kuantan on 1st to 2nd December 2019, using validated questionnaire of Knowledge, Attitude and Practice of Medical Doctors on Smoking Cessation Guidelines; consisting 17 questions to determine the KAP score. The difference between the median KAP scores between age, gender, ethnicity, religion, profession, location of clinic, availability of specialist at clinic, numbers of smokers seen and presence of smoking cessation training were assessed using Independent sample T-test and One-way ANOVA. Results: A total of 131 primary care doctors involved in the study. Majority were female (80.9%), Malay (96.2%), medical officers (74.8%), government doctors (90%) and haven’t undergone any kind of smoking cessation training (65.5%). The higher KAP score were statistically associated (p < 0.05) with history of attending training program (mean 35.7 score) and in charge of quit smoking clinic (mean 35.4 score). No significant difference of score between government (mean 32.0 score) and private doctors (mean 29.9 score). Conclusions : Majority of the involved primary care doctors had low KAP score. Being a family medicine specialist, in charge in stop smoking clinic and have attended smoking cessation training program were significantly associated with high KAP score. Therefore, more smoking cessation training should be provided for doctors
Prevalence of Risks for Obstructive Sleep Apnoea and Its Risk Factors among Adults Attending Government Primary Health Clinics in Kuantan
Get PDFIntroduction: Obstructive sleep apnoea (OSA) is a sleep related breathing disorder with recurrent episodes of apnoea or hypopnoea occurring during sleep. It is associated with increased risk of cardiovascular disease and prone to accidents. However, there is no applicable study that assess the risk for OSA at the primary care level. Objective: This study aims to assess the prevalence of risk for OSA and OSA symptoms and its associated risk factors among adults attending primary care clinics. Materials and method: This cross-sectional study was conducted among 252 adults attending four Klinik Kesihatan in Kuantan, Pahang. The inclusion criteria was adults age 30 years old and above. The exclusion criteria were a known case of Hypothyroidism, Depression and pregnancy. A self-administered validated Malay version of Berlin Questionnaire(BQ) was used to screen for high risk of OSA. The statistical analyses were done using IBM SPSS version 23.0. Results: Majority of the respondents were male (54%), Malay (87.7%), and married (79.4%). The prevalence of High Risk for OSA was 32.9%. Among these, 94% of them presented with snoring and 16.9% presented with excessive daytime sleepiness. Among male, Malay and married; 48%, 32.6% and 36.5% respectively was shown to be High Risk for OSA. The risk factors that were found significantly associated with High Risk of OSA includes younger age (AOR=0.951 CI=0.923-0.980); higher BMI classification with obese type 1 (AOR=2.604 CI=1.278-5.308), obese type 2 (AOR=3.882 CI=1.078-13.975) and obese type 3 (AOR=6.800 CI=1.164-39.717); higher neck circumference (AOR=1.109 CI=1.007-1.221); hypertension (AOR=2.297 CI=1.122-4.702); and hypercholestrolaemia (AOR=2.040 CI=1.050-3.965). Conclusions: This study shows that nearly one third of the adults attending primary health clinic are at High Risk for OSA and nearly 17% of them presented with excessive daytime sleepiness. Further study need to be carry out particularly among those of younger age, higher BMI classification, and with co-morbidities
Achilles Tendon Rupture: Double the Trouble
Get PDFIntroduction: Achilles tendon is the strongest tendon in the body . Achilles tendon rupture is a debilitating ankle injury especially among the athletes. We would like to highlight an unusual case of acute dual-level injuries of the Achilles tendon. Case report: A 30-year-old footballer presented with left ankle injury during a football tournament. Examination revealed tenderness at posterior left heel, palpable gap at Achilles tendon region and positive Thompson test. Radiological assessment showed dual-level injuries of the Achilles tendon-proximally was a rupture at musculotendinous junction and distally was an avulsion calcaneal fracture. We performed a mini-open approach Achilles tendon reconstruction for this patient. First, we reconstructed the distal avulsion calcaneal fracture using double row anchor sutures technique. Next, we repaired the proximal ruptured Achilles tendon using percutaneous Achilles reconstruction system (PARS) from Arthrex. Postoperatively, patient was put on functional rehabilitation protocol. At present, patient recovers well and regains back the Achilles tendon function. In conclusion, segmental Achilles tendon injury is rare and its surgical treatment can be challenging and must be well-planned
Validation of Corrupted Medical Image Labelling using Deep Neural Network
Get PDFIntroduction: Deep Neural Networks (DNN) has been successfully applied in a variety of medical image analysis. However, in building a good DNN model, it requires validated label from medical experts. The task of getting labels validated by the medical expert is quite a challenge due to the complexity of the image as well as large variability between the experts. Thus, this research investigates the effect of corrupted medical label on deep neural network for analysing diseases. Materials and method: In investigating this issue, a chest X-ray dataset comprising of 2560 images with 14 multilabel diseases from the National Institutes of Health (NIH) are examined. The DNN models that are explored are MobileNet, which is a base network that uses a depth-wise separable convolutional in building lightweight DNN and Xception, which is also utilised depth-wise separable convolutional with inception modules as an intermediate step in between regular convolutional and the depthwise convolutional. Different training and testing sizes are presented to the models with different ranges of corrupted labels from 10% to 50%. The training and validation accuracy is compared for each of the test cases together with other statistical analysis. Results: Based on the conducted experiments, it can be highlighted that both models can classify the diseases with the accuracy of more than 80% if the images have been previously trained by the model for different sizes of the corrupted labels. For the unseen or previously untrained images, the models can reach the accuracy of 70% and as the sizes of corrupted label increases, the accuracy will decreases as low as 50%. Conclusion: To conclude, corrupted labels have a critical effect on the DNN models. Thus, it is very essential to study the effect of the corrupted medical images label to ensure the reliability of the DNN models for medical imaging
Detection of Mismatch Repair and Microsatellite Instability in Colorectal Cancer Patients
Get PDFIntroduction: Colorectal cancer is the third most common cancer worldwide. Microsatellite instability (MSI) contributes to be one of the main mechanisms in colorectal cancer. Individuals with MSI tumors have loss of expression of one or more Mismatch Repair proteins. MSI tumors have better survival rate than microsatellite stable (MSS) tumors, poor response to 5FU-based adjuvant chemotherapy and relatively successful immunotherapy in metastatic MSI tumors. Immunohistochemistry recognizes altered gene by recognizing loss of its protein product. Based on the presence or absence of Mismatch repair proteins, groups are classified into Mismatch repair proficient (MMR-p) and Mismatch repair deficient (MMR-d). Aim: To investigate the immunohistochemical profile of Mismatch repair proteins namely: hMLH1, hMSH2, hMSH6, and hPMS2 in surgically resected colorectal cancer specimens. Materials and Method: A total of 76 cases were selected from the Histopathology Department of HTAA to determine MMR protein expression status. Cases were either MMR-p or MMR-d. Results: Of the specimens which were properly immunostained, seventeen out of seventy-six cases (22.37%) showed loss of one or more MMR proteins expression and thus were MMR-d. MLH1, MSH2, MSH6 and PMS2 protein expression was detected as 85.53% (65/76), 81.6% (62/76), 88.16% (67/76), and 76.32% (58/76), respectively. Conclusion: Mismatch repair proteins profile should be done using immunohistochemistry in local laboratories on these selected cases before referring for the expensive molecular test
The Validation of Questionnaire on End of Life Care Knowledge, Perceptions and Preferences among End Stage Renal Disease Patients on Haemodialysis in Kuantan
Get PDFIntroduction: There has been an increasing awareness on the end of life care for end stage renal disease (ESRD) patients and patients’ factors have been identified as pivotal elements in directing its implementation. Questionnaire has been a useful tool by researchers to assess on patients’ knowledge, perceptions and preferences on end of life care. However, up to date, there is no validated questionnaire developed in Malaysia for such purposes. Thus, this study aims to develop and validate questionnaires on end of life care knowledge, perceptions and preferences among ESRD patients in Kuantan. Materials and method: A cross-sectional study among haemodialysis (HD) patients aged 18 and above from 14 out-patient HD centres was performed. This study was divided into 4 phases i) developing the questionnaire involving related specialists and pre testing, ii) improving and editing the questionnaire and redistribution to 50 respondents for the pilot study, iii) factor analysis and iv) internal consistency reliability testing of the questionnaire. Results: The result of Factor analysis with Varimax rotation performed identified 3 domains for the 41 items, with 10 to 20 items in each domain. All the 41 analyzed items had a good factor loading of more than 0.4 with the lowest value of 0.421 and were nicely fit into 3 respective domains; knowledge, perception and preference. Internal consistency reliability analysis performed indicates that Cronbach’s α was between 0.5 to 0.7 for all factors which were higher than the level set for this study which is 0.5. Conclusion: The questionnaire is successfully validated and considered as a useful tool to be used. Nonetheless, improvement will still be necessary from time to time to ensure its relevance especially if it is to be used by different populations or countries of different background than Malaysia
Metachronous Osteosarcoma: A Rare Case Report
Get PDFIntroduction: Osteosarcoma is a common primary sarcoma of the bone, constituting approximately 0.07% of all neoplasms. Rarely, some patients with osteosarcoma have multiple skeletal sites involvement, either synchronous or metachronous. Metachronous osteosarcoma is a rare form of osteosarcoma in which osteosarcomatous lesions occur distant from the primary osteosarcoma site more than 6 months after the initial treatment without pulmonary manifestation. Case Report: We present a case of metachronous osteosarcoma in a 16-year-old female who was initially treated for non-metastatic osteosarcoma of the left distal femur with neoadjuvant chemotherapy, wide excision, endoprosthesis and followed by adjuvant chemotherapy. Serial follow-up did not show evidence of distant metastasis. Nevertheless, she presented 3 years later with a progressively enlarging left proximal forearm mass and re-staging revealed an osteosarcoma of the same histological type. She underwent combination of chemo- and radio- therapy but subsequently succumbed to the disease due to lung metastasis. Conclusion: With the advent of diagnostic and therapeutic techniques, the 5-year survival rate of nonmetastatic osteosarcoma ranges around 60-70%. Albeit it is rare, a metachronous osteosarcoma can present difficult challenges to the treating physician