IIUM Medical Journal Malaysia (IMJM)
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Severe Oro-laryngeal Thrush Following Excessive Use of Steroid Inhaler
Get PDFIntroduction: Inhaled steroids such as fluticasone propionate and beclomethasone dipropionate play an important role in the treatment of bronchial asthma. Its usage facilitates disease control in asthmatic patients, resulting in improved quality of life. Because of its benefit, the inhaled steroid is used extensively, at higher doses and for longer duration. However, the localized effects of inhaled corticosteroids on oral/laryngeal mucosa, such as fungal infections can be problematic. Case Report: We report a case of oropharyngeal and laryngeal candidiasis following a long period and high doses of inhaled steroid in a 42-year-old male. He presented with a complaint of increasing tiredness, phlegm, intermittent wheezing and hoarseness for 2-3 months. There was no weight loss or loss of appetite. He has been using inhaled steroids and long acting bronchodilators in increasing doses for his claimed ‘wheezing’ despite the negative history of asthma. The inhaled steroids were fluticasone dipropionate at doses of 500-100 mcg daily for 2-3 months. Results: Examination revealed widespread oral thrush involving the oral cavity, oropharynx and larynx. There was no cushingoid habitus. His muscle power was of 5/5 bilaterally and his lungs were clear. Lung function and chest film were also normal. The steroid was stopped immediately and flucanozole and nystatin syrup were prescribed. The patient made an uneventful and complete recovery. Conclusion: We conclude that patients on inhaled corticosteroids should be monitored for local side effects. Physicians should be aware not only of the systemic but also of the local side effects of inhaled corticosteroids. Patients may increase doses without the knowledge of their physicians and subsequently suffer the adverse effects either local or systemic
Performance of the Final Year Medical Students - Universiti Malaysia Sabah in the End Surgical Senior Posting (SSP) Examination
Get PDFIntroduction: Assessment methods are used to provide students with both formal and informal feedback on their progress, and should be congruent with the objectives of the curriculum. To achieve this, it is necessary to bring the theories of learning and assessment together. Senior surgical posting is an intensive eight weeks attachment with overall surgical revision, provide an opportunity for the students to develop clinical skills, knowledge and attitudes, at it’s end the students will be evaluated through three forms of assessment, their knowledge by MCQs, MEQs, and essay and their clinical skills by OSCE, short case and long case examination together with that there was continues assessment (log book and two handwritten case reports), the passing marks is 65 of 100, and passing the clinical section is mandatory. Materials and Methods: This paper studied the performance of final year (Year 5) medical students Universiti Malaysia Sabah (UMS)-school of medicine in the end senior surgical posting examination. Results and Conclusion: Through analysis of the data of their assessment results in this examination, it shows that the continuous assessment have strong effect on the final results of the students, and students have defect in theory back ground reflected by their poor MCQs performance, and the mode of UMS students learning is more towards deep approach
High Prevalence of Thyroid Antibodies in Urban Population of Peninsular Malaysia
Get PDFINTRODUCTION: Thyroid antibodies are closely related to autoimmune thyroid disorders. To date, there are no data on the prevalence of these antibodies among the Malaysian population. This study aimed to determine the prevalence of thyroid antibodies; and the factors associated with thyroid antibodies in the Malaysian adult population. MATERIALS AND METHODS: A cross-sectional study was performed in 5 preassigned regions in Peninsular Malaysia. Participants’ sociodemographic profile and medical history were recorded. Physical examinations were done looking for abnormalities of the thyroid gland and signs of thyroid dysfunctions. Fifteen mils of blood were withdrawn and analysed for thyroid function, anti-thyroperoxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies at a central laboratory. RESULTS: Among the total of 2190 respondents, the overall prevalence of positive anti-TPO and anti-TG antibodies were 12.2% and 12.1%, respectively; mainly found in urban and coastal areas. Only 7% to 9% of those with positive anti-TPO or antiTG antibodies had either hypo- or hyperthyroidism. The predictors for positive anti-TPO antibody were female [adjusted OR 1.7 (95%CI: 1.2–2.4); p=0.001], Indian [adjusted OR 1.9 (95%CI: 1.1–3.1); p=0.020], and having a goitre [adjusted OR 1.8 (95%CI: 1.2–2.8), p=0.004]. The predictors of positive anti-TG antibody was female [adjusted OR 2.3 (95%CI: 1.6–3.3); p<0.001], and having a goitre [adjusted OR 2.0 (95%CI: 1.3–3.4), p=0.001]. Those living in rural areas had 38% lower risk of having positive anti-TG. CONCLUSIONS: The prevalence of positive anti-TPO and anti-TG antibodies were 12.2% and 12.1%, respectively; were higher among the urban and coastal populations. Those living in rural areas had lower risks of anti-TG antibody
Cardiovascular Outcomes and the Use of Oral Antidiabetic Drugs: A Review of Current Evidence from Observational Studies
Get PDFType 2 diabetes mellitus (T2DM) is a major global disease burden that affects millions of people worldwide. The disease is well known to predispose patients to a wide range of macro- and microvascular complications. Cardiovascular complications are common macrovascular consequences among patients with T2DM. The primary goal of T2DM management is to achieve proper glycaemic control that helps to avoid or delay the incidence of disease complications. T2DM management involves the utilisation of oral antidiabetic medications and injectables, including insulin. Hence, we conducted this work to discuss and summarise the cardiovascular outcomes associated with the oral antidiabetic pharmacotherapy prescribed for patients with T2DM. The agents involved were metformin, sulfonylurea, dipeptidyl peptidase-4 inhibitors, thiazolidinediones, alpha-glucosidase inhibitors, and sodium-glucose cotransporter-2 inhibitors. We decided to focus on the findings reported from observational studies published between 2009 to 2019 to provide an updated and more realistic insight on these cardiovascular outcomes associated with the oral antidiabetic drugs in the usual clinical practice
Practical Islamic and Research Ethics: The Use of Animal Model in Orthopaedic Research
Get PDFIntroduction: The growing of mortality and morbidity that are related to orthopaedic cases have contributed to the development and innovation of technology which actively seeks for the best treatment options. In order to achieve the goal, animal models have been used as a bridge from in vitro to the clinical study to provide insights both as a precursor and beneficial to human-based research. Many animal models have been developed to investigate bone regeneration, pathological changes and reparation. Besides, animal models are used more commonly in orthopaedic innovation and development. Through the practical application of the 5Rs (reduction, refinement, replacement, reproducibility and responsibility) principles that correlate with the Islamic ethics in this research, this study aimed to provide an ultimate ethical standard on animal use in orthopaedic research. Besides the texts of the Qur’an and the prophetic narrations (hadith), both Muslim jurists (fuqaha) and ethicists’ relevant opinion on these matters would be unveiled. As from the Islamic viewpoints, the usage of animal is permittable for scientific research purposed within the permissible limits described by the Shari’ah and guided by ethical values derived from the Divine Revelations (al-wahy al-Ilahyi). By practising the guidelines, it is hoped that these ethical guidelines will help to educate the Muslim scholars and researchers to substantive improvements in terms of quality and the ethical standards of animal studies in orthopaedic research
The Impact of Paediatric Anaesthesia Information Leaflet in Reducing Parental and Child Anxiety in Paediatric Surgery
Get PDFIntroduction: The process of anaesthesia is one of the most important anxiety precipitating factors for both parent and child who is going for operation. Parental anxiety may adversely affect the children during perioperative period. Studies have shown that anxious parents would want to be provided with more information prior to their child’s surgery. We examined the effects of additional paediatric information leaflet on parents and children in reducing pre-operation anxiety. Materials and methods: This was a randomized controlled trial involving 70 parentchild dyads in Hospital Raja Perempuan Zainab II (HRPZ II), Kelantan. Inclusion criteria were child aged 3 to 12 years old who underwent elective surgery. Parents were assigned to intervention and control groups. The former received the information leaflet and the later received standard preparation.. Parents were compared on their anxiety level using Depression Anxiety Stress Scales 21 (DASS-21) (anxiety domain) in the holding area. Children were compared on their emotional state level before induction of anaesthesia using Children’s Emotional Manifestation Scale (CEMS). Results: The number of parents who were anxious was similar in both groups (11 (31%) vs. 7 (21%), p =.34). There were no differences in the children’s anxiety state between interventional and control groups as depicted by the CEMS score (7.5 (6.0-9.75) vs. 8.0 (7.0-15.0), p= .12). Conclusion: Parent-child dyads in HRPZ II did not show improvement in the anxiety level with the inclusion of paediatric anaesthesia information leaflet. Further study is needed with larger number of participants involving other selected tertiary hospitals in Malaysia
A Rare Case of Polypoidal Cystitis in Adult without History of Prolong Catheterization
Get PDFIntroduction: Polypoidal cystitis is a rare lesion of the bladder mucosa characterized by benign exophytic inflammation,epithelial proliferation and development of polypoid mass without evidence of neoplasm histologically. Polypoid cystitis is rarely seen in patient without prolong used of indwelling catheter. Other cases of polypoidal cystitis are associated with post-radiation, post chemotherapy bladder reaction, colovesicular fistula are extremely rare. Case Report: 66 year old Malay male ,underlying hypertension and Benign Prostatic Hyperplasia (BPH) on treatment, complaining of difficulty in urination, straining on voiding for the past 6 months and on and off  hematuria for the past 2 months. He denied any history of CBD insertion or prolong cataheterization. Blood investigations are Normal. X-Ray KUB showed unremarkable. Ultrasound KUB revealed Prostatomegaly, no evidence of renal or ureteric calculi or evidence of Obstructive uropathy,No obvious bladder mass. Cystoscopy Examination (CE) showed enlarged occlusive prostate and noted bladder growth at base of bladder. The growth is malignant looking however no active bleeding seen. No bladder stone seen. Patient subsequently underwent TransUrethral Resection of Bladder Tumor (TURBT) and Trans-Urethral Resection of Prostate (TURP) in same setting. Intra operatively was uneventful. HistoPathological Examination (HPE) from TURBT specimens showed in favour of Polypoidal Cystitis and TURP revealed Nodular Hyperplasia. Discussion: Polypoidal Cystitis is a form or chronic cystitis characterized by exophytic inflammatory  lesion of bladder mucosa. The polypoidal mass is mimicking neoplasm. At the initial evaluation, it may be confused with transitional cell carcinoma of the urinary bladder, especially in patient without an indwelling catheter. The most common aetiology of this condition is long-standing indwelling catheterization.. There is also reported that any factors that irritates the bladder mucosa may result in Polypoidal Cystitis.  In our patient ,there was no history of such other causes, including prolong catheterization, fistula, urinary calculi or radiation therapy