IIUM Medical Journal Malaysia (IMJM)
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Factors Associated with Postpartum Family Planning in a Cohort of Kelantanese Women with Previous Caesarean Delivery in Malaysia
Get PDF Introduction: This community-based, cross-sectional study aimed to identify the factors associated with postpartum family planning use among a cohort of women with recent caesarean delivery in a state with the lowest contraceptive use in Malaysia. Materials and Methods: A total of 281 women aged between 18-49 years old who had caesarean delivery in government tertiary centres in Kelantan from January until April 2017 were enrolled in this study. The study was conducted from January until April 2018. Women were selected through stratified random sampling with probability proportional to size. Data were collected through a validated structured questionnaire. The main outcome was binary (postpartum family planning use or non-use). The factors included socio-demographic details, reproductive history, previous contraceptive use, contraceptive health education received, knowledge, and social support. Simple and multiple logistic regression were conducted to identify significant determinants of postpartum family planning use. Results: The factors associated with postpartum family planning use included a secondary and below education level of women (AOR= 2.37, 95% CI (1.05, 5.34)), previous contraceptive use (AOR= 9.82, 95% CI (4.81, 20.06)), individual health education (AOR= 4.19, 95% CI (1.23, 14.30)), higher knowledge score (AOR= 1.12, 95% CI (1.03, 1.23)), and higher social support score (AOR= 1.09, 95% CI (1.03, 1.16)). Conclusions: here remains a need to enhance personalised contraceptive counselling in the primary care setting as well as to promote longer acting reversible contraceptive methods
Left Vocal Cord Paralysis Secondary to Mitral Valve Disease
Get PDFIntroduction: Ortner’s syndrome, or cardio-vocal syndrome, is a clinical entity characterised by hoarseness (secondary to left-sided recurrent laryngeal nerve palsy) caused by cardiovascular disease. The incidence of Ortner’s syndrome ranges from 0.25 percent to 0.5 percent of all cases of recurrent laryngeal nerve paralysis. Case Report: A 44-year-old Malay gentleman presented with hoarseness and shortness of breath for 4 days. It was associated with mild orthopnea and aspiration symptoms. He denied history of dysphagia, chronic cough, sore throat, chest pain, palpitation and decreased effort tolerance. There was no history of hypertension, diabetes and asthma. He also gave no history of recurrent fever with sore throat during childhood. Results: On examination, the patient appeared tachypnoeic. There was no peripheral oedema, cyanosis or clubbing. His blood pressure was 100/60 mm Hg and his pulse was irregular with a rate of 78/min. Neck examination was normal. Apex beat was not displaced. On auscultation the first heart sound was loud. A grade 3/6 long rumbling diastolic murmur was heard at the mitral area and he had bilateral basal crepitations. Laryngoscopy using 700 scope showed left vocal cord palsy in paramedian position with phonatory gap. Computed tomography (CT) of the thorax showed left atrial enlargement with prominent pulmonary veins. Echochardiography showed left atrial dilatation with thickened mitral valve. Left ventricular systolic function was good with ejection fraction of 70% and coronary angiogram showed normal coronary artery. A diagnosis of severe mitral stenosis with heart failure was made. Preoperatively the patient was stabilized and was referred for dental clearance. Then he underwent surgery for mitral and aortic valve replacement. Post-operatively patient recovered uneventfully. His hoarseness recovered completely after 3 months. Conclusion: Cardiovascular disease should be considered as a differential diagnosis in a patient with hoarseness
The Frankenstein’s Legacy: Transcranial Direct Current Stimulation in Promoting Speech and Language Recovery in Post- Stroke Dysphasia: Malaysian’s Experience
Get PDFTranscranial Direct Current Stimulation (tDCS) is an adjunct to behavioral speech therapy to enhance the recovery of post-stroke dysphasia. Administration of tDCS involves the application of low- amplitude electrical currents through surface electrodes, which are placed onto the scalp to influence the neuronal activity.TDCS montage and patients' clinical characteristics are the important factors in determining the outcome of the intervention. We aim to describe the clinical characteristics, outcomes and local limitation factors of five post-stroke patients who received TDCS combined with behavioural therapy for dysphasia. All patients, except for Case #5 showed improvement at day 10 post-intervention in several speech and language domains. TDCS is a promising adjunctive intervention in enhancing neuroplasticity activity in a post-stroke brain. A further well design case-controlled study is warranted to prove its efficacy in our local population. Local factors and limitations that may influence the outcome should be considered. 
Recurrent Otorrhea in A Child: Early Sign of Temporal Bone Langerhans Cell Histiocytosis
Get PDFLangerhans cell histiocytosis (LCH) is a rare disease of dendritic origin with uncertain etiology, with predilection in children. A 1-year 6-month girl with history of recurrent otorrhea, presented with mass in the ear canal and computed tomography imaging showed expansile lytic bony lesion in right mastoid with eroded ossicles. Subsequently, histopathological examination confirmed the diagnosis of LCH and chemotherapy was successfully commenced with complete resolution of symptoms. LCH with ear involvement are usually mistaken as other acute or chronic ear disease such as chronic otitis media or mastoiditis. Hence, in children with recurrent otorrhea with ear canal mass, with or without facial nerve palsy, LCH should be considered as one of the differential diagnosis
A Catheter-Related Bloodstream Infection Caused by the Yeast Kodamaea ohmeri
Get PDFCatheter-related bloodstream infections caused by Kodamaea ohmeri are generally not considered due to the relative scarcity of reported cases. This is a case of an 85-year-old man with poorly controlled diabetes mellitus who was initially admitted to our hospital for diabetic ketoacidosis. An internal jugular catheter was inserted as part of the initial management. A week later the patient developed a temperature spike and a yeast identified as Kodamaea ohmeri by ID 32 C (bioMérieux, France) was isolated from both his central and peripheral blood cultures. The catheter was removed and the patient was treated with fluconazole despite the organism’s relatively high minimum inhibitory concentration (2 μg/mL) to this antifungal. The fungemia resolved following a 2-weeks course of fluconazole
Translation and Validity of the Malay Version of the Five-Factor Nonverbal Personality Questionnaire (FFNPQ)
Get PDFIntroduction: The Five-Factor Nonverbal Personality Questionnaire (FF-NPQ) is a non-verbal personality inventory consisting of illustrations of different social situations, designed to measure five broad factors underlying the Big-Five model of personality. This study aimed to prove the validity of the FF-NPQ in Malaysia. Methods: The FF-NPQ instruction and the answer option were translated to the Malay language, which is the main language spoken in Malaysia. A total of 153 university students aged 18–30 years from Universiti Sains Malaysia were involved in this study. Confirmatory factor analysis (CFA), composite reliability and intraclass correlation (ICC) were applied to show evidence of validity by internal structure. Results: CFA indicated that only 26 out of 60 items remained in the final model while maintaining the five personality factors. Each factor had a good composite reliability value of 0.68–0.77. The ICC values from the test-retest analysis ranged from 0.65 to 0.75. Conclusion: Overall, the shortened Malay Version of the FF -NPQ (five-factor, 26 items) exhibited acceptable evidence of validity in Malaysia
Acquired Platelet Dysfunction with Eosinophilia (APDE): Contemplating Physical Abuse
Get PDFIntroduction: APDE is an acquired, transient bleeding disorder characterised by normal platelet counts with eosinophilia. It was previously known as ‘nonthrombocytopenic purpura with eosinophilia’. We report a case of a 3-year-old boy with prolonged history of spontaneous unexplained bruising which was initially investigated by SCAN team for non-accidental injury (NAI). Case report: A 3-yearold boy attended clinic with a 4-month history of recurrent bruising. Parents were unsure of preceded illness, but he remained well with no history of trauma. He has unremarkable medical history and father is a thalassaemia carrier. Upon assessment in clinic, he was subsequently referred for suspected NAI and SCAN team led to a police report with a plan to review in 2-months. Parents later decided to bring the child for further medical assessments which revealed multiple bruises over both thighs, back of shoulder, loin and trunk with varying sizes and ages. They were all non-tender on palpation with no recognisable shapes or patterns. Blood results showed normal liver functions with slightly prolonged APTT 39.8 secs. He has normal platelet count with significant eosinophilia 2.2 x 10^9/L and occasional reactive lymphocytes. Reflecting this result, plan for platelet functions and von Willebrand tests were made. However, due to costs, we decided to treat the child with antihelminthic agent for possible parasitic infestation. He had 3 days course of albendazole and no further bruises appeared after 5 days of completing treatment. Discussion: The clinical presentation of APDE can mimic Idiopathic Thrombocytopenic Purpura in many ways yet normal platelet counts often leads to a delay in diagnosis. Reassuringly, the course of APDE is benign and no treatment is often required. Conclusion: Investigations however are costly, therefore treatment with anti-helminthic agent would be an alternative option in providing assurance to family and medical practitioners dealing with suspected cases
Surgical Management of Paediatric Neglected Humeral Supracondylar Fracture: A Series of 3 Cases in 3 Years
Get PDFIntroduction: Supracondylar fracture of the humerus is common among paediatric population. In our country, it is not uncommon for patients to present late to the hospital after an injury. Devnani reported a case series of 28 children who sustained supracondylar humerus fracture and presented late (mean 5.6 days) to the hospital. We report our experience in managing 3 patients who presented late (range 15 days to 8 months) with neglected supracondylar humerus fracture in 3 years. Case report: Case 1: A right hand-dominant 5-year-old boy sustained a fall 8 months prior to presentation to the hospital. He was treated with traditional methods immediately after the injury. He presented with malunion of left humeral supracondylar fracture with varus deformity and limited left elbow range of movements. An open reduction (lateral approach) and corrective osteotomy were performed and 2 lateral K-wires were inserted. Case 2: A 10-year-old boy with right hand dominance sustained a closed left supracondylar humerus fracture Gartland 3 after a fall. His parents initially refused any surgical intervention. However, they finally agreed for surgery on day 15 post-trauma. An open reduction (posterior approach) and callus removal were done and 2 crossed K-wires were inserted. Case 3: A right hand-dominant 5year-old girl had history of fall 1 month prior to presentation to the hospital. She was treated with traditional methods initially. She presented with malunion of the left supracondylar humerus fracture with limited range of motion of her left elbow. An open reduction (posterior approach) and corrective osteotomy were performed and 2 crossed K-wires were inserted. Discusssion: Two patients underwent open reduction via the posterior approach and 1 patient via the lateral approach. Only one patient required callus removal while 2 patients required osteoclasis. All patients recovered without complication and there was improved range of movement of the elbows. Conclusion: Surgical intervention is the treatment of choice in managing neglected supracondylar humerus fracture
Prevalence of Overweight and Obesity among Primary Healthcare Workers In Perak, Malaysia
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Introduction: Overweight and obesity has been emerging as one of the most common and preventable nutritional problems worldwide. In 2016, 39% and 13% of the adult population worldwide was classified as overweight and obese, respectively. Materials and Methods: We conducted a cross-sectional study at 12 selected health clinics in Perak, Malaysia, and we used multi-stage cluster random sampling to determine the prevalence of overweight and obesity among the primary healthcare workers and the associate factors of obesity indices. Each respondent was required to complete a self-administered questionnaire on their socio-demographic characteristics. In addition, we took anthropometric measurements, including height, weight, BMI, waist circumference, and body fat percentage, of the participants. Results: We recruited 261 primary healthcare workers. Overall, 49.9% of the healthcare workers were overweight or obese, 51.0% were at risk of having abdominal obesity, and 79.6% had a high body fat percentages. Age and self-reported health status were significantly associated with all the obesity indices. Educational level showed significant association with BMI and waist circumference, while occupational status showed an association only with BMI. Older age and professionals were predictors for high obesity indices. Conclusion: The prevalence of obesity among the primary healthcare workers was higher than among the general population. An immediate intervention programme is needed to reduce the prevalence of overweight and obesity among primary healthcare workers
Knee Pain During Islamic Prayer after Anterior Cruciate Ligament Reconstruction Using Hamstring and Bone Patellar Tendon Autograft
Get PDFIntroduction: Hamstring tendon (HT) and bone patellar tendon bone (BPTB) are the commonly used autograft in an anterior cruciate ligament reconstruction surgery. The BPTB is said to have more incidence of anterior knee pain compared to HT. The study aimed to compare the severity of knee pain during Islamic prayer kneeling. Methods: A cross sectional cohort analysis of patients undergoing ACL reconstruction surgery using BPTB with HT autografts was conducted to determine differences in postoperative pain while kneeling and ability to pray in normal position. Kneeling during prayer and the ability to sit while performing prayer were assessed at 3rd, 4th, 5th and 6th month. Results: There were no significant differences in mean pain score while kneeling at 3rd, 4th, 5th and 6th month. The mean difference of patient’s ability to perform normal prayers for BPTB (3.56+1.16) and HT (3.30+1.05) was found insignificant. The average number of patients in both groups was able to pray between 3 to 4 months post operatively as full range of motion of knee is allowed within this period. Total 49 patients (BPTB 23, HT 26) out of 60 were able to pray normally within 4 months post-operation. Mostly delayed due to anterior knee pain. Conclusion: There is no different in term of knee pain during kneeling while performing Islamic prayer between those who had their ACL reconstructed either using BPTB or HT autograft