IIUM Medical Journal Malaysia (IMJM)
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Devastating Insomnia Experience Following General Anaesthesia for Mastoidectomy Surgery
Get PDFSleep disorder including insomnia is one of the complications of general anaesthesia. It is not uncommon and it is temporary but majority remains unnoticed and untreated. The effect of insomnia ranges from mild to severe, influencing both physical and mental health. Surgeon and anaesthetist need to identify this complication so that an appropriate treatment can be delivered. In complicated case, psychiatrist involvement is crucial. The treatment is symptomatic and temporary. We reported a case of distressful sleep disorder as a sequelae of general anaesthesia for mastoidectomy surgery. Subsequently after symptomatic treatment, he recovered completely and regained his normal sleep pattern
Hanging: A Ten-Year Retrospective Review of Malaysian Forensic Cases
Get PDFIntroduction: Hanging is one of the most common methods of suicide in Malaysia, and to date, there is a rise in the number of deaths by hanging among adults. The purpose of this study was to determine the pattern of hanging in Malaysia from the year 2000 till 2009. Methods: The sample comprised 108 cases received at the Universiti Kebangsaan Malaysia Medical Centre, and five parameters, namely, age, sex, racial affiliation, marital status, and medical history were studied. Results: Of the 108 cases, 56% was reported to be Chinese. Suicide by hanging was more predominant in males (81%), and a high number of cases were seen in age groups of 21 to 30, 31 to 40 and 41 to 50 years. Of the cases studied, half of them were married, and previous history of physical and mental illness and alcohol intoxication were reported. Conclusions: In brief, this data would help the higher authorities in detecting the causes of suicide by hanging, as well as detecting the high risk groups with suicidal tendencies. In this way, suicide can be prevented and thus, the rate of suicide by hanging could be reduced in Malaysian
Comparison of Blood Loss using Intra-Articular Injection of Tranexamic Acid after Total Knee Replacement
Get PDFIntroduction: Total knee replacement (TKR) is one of the most common surgeries in orthopedic field. Up to 1/3 of the patients require blood transfusion postoperative. Allogenic transfusion has many side effects. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent. We explore the usage of TXA in reducing blood loss and transfusion rate by injecting it into the knee joint during surgery. Materials and method: This is a retrospective study done in Hospital Tengku Ampuan Rahimah, Klang. Medical records of patient undergoing TKR between 1 January 2018 till 31 December 2018 were reviewed. Study sample was calculated as 90 patients and divided into 2 groups, one receiving TXA (study) and the other not receiving TXA (control). Post-operative hemoglobin levels and transfusion rate was recorded. Results: 45 patients in study group (17 male, 28 female) had a mean age of 65.4 years old and 45 patients in control group (24 male, 21 female) had a mean age of 64.2 years old. Mean post-operative hemoglobin drop in study group was 1.08 g/dL vs 1.86 g/dL in control group. Repeated measure ANOVA determined a p value of 0.001 which shows a significant correlation. Total transfusion rate in study group was 1 vs 9 in the control group. Using chi-square test, the p-value was 0.007 which again shows a statistically significant result. Conclusion: Intra-articular injection of TXA following TKR reduces blood loss and the need for blood transfusion without increasing any complication. This prevents many patients from undergoing a potentially hazardous blood transfusion. A routine usage of intra-articular TXA in patients undergoing TKR is recommended. However a large and well designed RCT is required to investigate the risk and benefits of TXA
Prevalence of Depression among Transgender Male to Female in Kuantan, Pahang
Get PDFIntroduction: Transgender is an umbrella term for persons whose gender identity, gender expression or behaviour does not conform to that typically associated with the sex to which they were assigned at birth. Transgender individuals are particularly vulnerable to mental health concerns and psychological distress. Objective: This study aims to assess the prevalence of depression and associated risk factors among transgender male to female in Kuantan, Pahang. Material and method: This was a cross-sectional study conducted among 96 transgender male to female in Kuantan, Pahang. A convenient type of sampling was used as a mean of data collection. A selfadministered validated Malay version of Beck Depression Inventory(BDI) was used to screen for depression. Result: Majority of the respondent were Malay (82.3%), Muslim (99%), unmarried (93.8%) and monthly income <RM2300 (91.7%). Prevalence of depression among transgender male to female in Kuantan is 37.5%. There is no significant association between sociodemographic data of participants and depression. Conclusion: This study shows that almost one third of transgender male to female are at risk of depression. Therefore, screening for mental health assessment is recommended so that important measures can be taken to prevent depression among this high-risk group
Comparison of Immediate Effects Oon Usage of Dual Polymer Artificial Tears on Changes in Tear Film Characteristics
Get PDFIntroduction: This study aimed to evaluate the short-term efficacy of artificial tears (AT) instillation on tear film quality and quantity utilising two dual polymer artificial tears; Systane Hydration preservative (SH) and non-preservative (SHUD) in 60 minutes observation period compared to normal saline. Materials and methods: One hundred eyes of 50 participants involved in this prospective, double-masked randomised study. Viscosity and pH of both AT were evaluated using Rheometer and digital pH-meter respectively prior to tear film characteristics assessment. Tear break-up time (TBUT) and tear meniscus height (TMH) were measured at baseline, 5, 15 and 60 minutes after instillation. Tear ferning pattern (TFP) were compared between baseline and 60 minutes after instillation. One-way analysis of variance (ANOVA) was used to evaluate the effects of both AT instillation. Independent T-test was employed to compare between the two groups (SH vs SHUD) for each specific time-interval. P-value of 0.05 was set as the level of significance. Results: The viscosity of SH and SHUD was 0.0267Pa.s and 0.03273Pa.s respectively with pH of 7.85 for SH and 7.74 for SHUD. Both AT showed significant increment in TBUT between baseline and 15 minutes (SH: 5.82 ± 1.063, p = 0.01; SHUD: 6.02 ± 0.979, p<0.001), and 60 minutes (SH: 6.22 ± 0.616, p<0.001; SHUD: 6.34 ± 0.658, p<0.001). SHUD demonstrated significant increment in TMH at every measurement taken (0.1996 ± 0.02449, p<0.001 at 5min, 0.2038 ± 0.02276, p<0.001 at 15min and 0.2068 ± 0.02094, p<0.001 at 60min). Likewise, in SH group, significant increment in TMH at 15 minutes (0.1994 ± 0.02325, p < 0.001) and 60 minutes (0.2012±0.02379, p<0.001) were noted. With regards to TFP, both groups revealed improvement in TF grading (both, p<0.001) at 60 minutes. No significant improvement was noted in control group. Conclusion: Both SH and SHUD improved tear film characteristics at 60 minutes following instillation. However, SHUD is more effective as faster improvements were noted in all intended parameters
Isolated Axillary Nerve Injury following a Blunt Trauma
Get PDFIntroduction: Axillary nerve supplies deltoid muscle long head of triceps and teres minor in the arm and supply regimental batch area over the inferior part of shoulder. Anterior dislocation of shoulder, latrogenic injury to the nerve during shouder injection and brachial plexus injury can cause axillary nerve injury. Case report: We report a rare case of isolated axillary nerve injury in a 20 year old lady. She was admitted following a low speed fall from motorcycle and sustain abrasion wound over the right side of the face and shoulder. There was no direct or tractional injury to the shoulder during the incidence.During admission she complaint of progressive right shoulder weakness with MRC power of 2 and sensory loss over regimental patch area. On examination there was no tenderness to the shoulder area or neck and she was unable to abduct her right shoulder with full passive range of motion. Patient was subjected to nerve conduction study four months later and revealed slower sensory conduction and deltoid muscle amplitude decreased compared the left side. At 7 months post trauma she is recovering with deltoid power of 4 after multiple physiotherapy session. Isolated axillary nerve injury following a blunt trauma is a rare condition with multiple reported cases showed poor recovery. One should wait for regeneration of nerves to complete before offering any surgical intervention to the patient. As in our case, patient showed remarkable improvement after seven months with conservative management thus avoiding the complication of surgery
Systematic Review on The Effectiveness of Using Carbon Monoxide Measurement in Smoking Cessation Intervention
Get PDFIntroduction: Carbon monoxide measurement is one of the biomedical risk assessments in smoking cessation. With the advancement in medical devices, risk assessment among smoker using carbon monoxide can be an effective intervention for quit smoking. A systematic review was conducted on the effectiveness of using carbon monoxide measurement in smoking cessation intervention. Material and methods: A systematic review and narrative synthesis were done using PRISMA guideline. A broad database search on English literature was conducted including Medline, PubMed, Scopus and Science Direct from 2008 till 2017. Additional studies were also searched through snowballing technique by searching the bibliographies of selected studies. Five studies met the criteria with two studies were done in clinical settings while the other was done at population settings. The studies were conducted in the United States of America, United Kingdom and South Korea. All study were two-arm randomized controlled trials with variation in the outcome measurement mainly intention to quit, quit attempt and smoking abstinence. There was also variation in the duration of follow up ranging from 1 week to 12 months. Results: Only three studies found statistically significant increased in motivation or intention to quit smoking but only at 1 month follow up. All five study found no significant difference in frequency of quit attempt or smoking abstinence. Most of the studies recruited participants based on voluntary participation thus limiting the generalizability of the results. Conclusions: The present review has found limited studies on the effect of carbon monoxide measurement intervention for quit smoking. It may only be beneficial at the motivational level and not translated into behavioural changes. However, the effect too was short term and not sustained in the long term
Predicting Workplace Fecal Occult Blood Test Screening Uptake using Generalized Estimating Equations: A Sensitivity Analyses
Get PDFIntroduction: Many studies have shown the effectiveness of educational modules on increasing colorectal cancer screening uptake at individual level but not adjusted for potential clustering effect such as workplace. Longitudinal studies on workplace colorectal cancer screening require a series of analysis under different conditions due to heterogeneity of workplace population. To achieve this, a sensitivity analysis based on Generalized Estimating Equations was conducted to determine the robustness of the predictive performance of health education module in increasing screening uptake. Materials and Method: A parallel, single blind, cluster randomized trial was conducted among 15 organizations in Kuantan, Pahang. Intervention group received a complex Health Education Module comprising of group education, practical session on fecal occult blood test usage and WhatsApp group follow-up, while control group received standard colorectal cancer screening brochure. Sensitivity analyses using intention to treat analysis with interaction term, compatibility term, behavioral intention term and key assumption term were performed. Data were imputed and analysed using generalized estimating equation with IBM SPSS version 23. Pooled adjusted odds ratio was calculated using random effect model with inverse variance weighting using RevMan version 3.5. Results: A total of 166 participants from 15 organizations were recruited in the study. Intervention and control group were comparable at baseline (P>0.05). Health Education Module given in intervention group significantly increased the uptake of FOBT by nearly 5 times compared to control group in sensitivity analyses (pooled adjusted OR=4.60, 95% CI=2.65-7.99, I2=47%, P<0.001). Conclusions: Health Education Module was robust in facilitating fecal occult blood test uptake in different predictive models. Health Education Module should be implemented as a workplace health promotion program to improve colorectal cancer screening for early detection and prompt treatment
Outpatient Error in Perception of Medication; is it a Miscommunication Problem?
Get PDFIntroduction: The NCC for Medication Error defines it as any preventable event that may lead to inappropriate medication use or patient harm while the medication is in control of the healthcare professionals, patients or consumers. The annual cost of drug related morbidity and mortality is US $177 billion in America. The FDA states that one death per day and 1.3 million people were injured yearly due to medication error. The objectives of this study were to comply with patients’ safety goals, to achieve zero medication error and to ensure compliance among outpatients.Materials and Methods: All outpatients’ prescriptions were analyzed prospectively from January to December 2009. The data were categorized according to incomplete prescription, inappropriate drug regimen, illegibility and wrong administration to patients. We introduced a coloured labeling system to improve patient understanding of medication administration routes and frequency. Results: Data analysis between January and May 2009 showed medication error in outpatients was high. By doing root-cause analysis, we identified the main cause of medication error was miscommunication between pharmacist and outpatients. To correct this error, visual reinforcement on the routes of administration was done to enable patients to better understand the right administration of medications. From June to October 2009 post implementation showed reduction of medication error from 1.34% to 0.82%. Zero medication error was achieved in the last two months. Feedback from patients revealed that 88.2% agreed poor labeling was the main cause of wrong administration of drugs at home. Conclusion: Although studies had been done on inpatient medication errors, we had no data over outpatients’ prescription trends. Although this study was simple, yet by creating multi-colored labels which were user friendly we have shown that outpatients’ medication error can be rectified
Poor Sleep Quality among Medical Students in International Islamic University Malaysia (IIUM) and Its Association with Mental Health and other Factors
Get PDFINTRODUCTION: Poor sleep quality is a common problem experienced by medical students worldwide. Therefore, this study aimed to measure the prevalence of poor sleep quality among medical students in International Islamic University Malaysia (IIUM) and its association with mental health and other factors. MATERIALS AND METHODS: A cross-sectional study using convenience sampling was conducted among 500 medical students in IIUM Kuantan. A validated self-reported questionnaire including sociodemographic, socioeconomic, lifestyle, Pittsburgh Sleep Quality Index and Depression Anxiety Stress Score 21 was distributed from 15th July to 31st August 2019. Descriptive statistics were used to measure the prevalence of poor sleep quality. Chi- square test, Fisher’s exact test, independent sample T-test, and multiple logistic regression were used to measure the association between risk factors and sleep quality. RESULT: The response rate was 91.2%. The prevalence of poor sleep quality was 59.6%. Multiple logistic regression analysis revealed level of study (clinical year (AOR=0.44, 95% CI: 0.29 - 0.66) and depression (yes (AOR: 1.71, 95% CI 1.03-2.83) contributed independently on poor sleep quality among medical students. There was no significant relationship between tahajjud practice and poor sleep quality. CONCLUSION: More than half of IIUM medical students have poor sleep quality. Those students who were in the pre-clinical year and had depression were independently associated with the occurrence of poor sleep quality. Early intervention is compulsory to overcome this problem among medical students in IIUM.