IIUM Medical Journal Malaysia (IMJM)
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The Effect of Virgin Coconut Oil (VCO) on Physiological Halitosis. A Randomized Controlled Pilot Trial
Get PDFIntroduction: VCO oil pulling therapy has been used as a remedy for oral malodour in traditional Indian folk. Main objective for this research is to study on the effect of VCO oil pulling on physiological halitosis among IIUM Kuantan Campus students. The specific objectives are to evaluate the effect of VCO oil pulling on physiological halitosis and to compare the efficacy of VCO with conventional mouthwash in reducing physiological halitosis. Materials and method: 20 convenient samples were selected based on inclusion and exclusion criteria and divided into two groups, mouthwash and VCO based on single blind randomized controlled trial. Subjects required swishing oil pulling (group A) or rinsing with mouthwash (group B). Breathing analysis was recorded during pre-assessment, post assessment (on day 1short term and day 14-long term) using organoleptic 1, organoleptic 2 (selfassessment) and Tanita device. The results were analysed using paired t-test in SPSS version 22. IREC approval: 2018-061. Result: There were significant difference between pre and post assessment of mouthwash in short term (p<0.001) and long term (p=0.002) period of usage and between group VCO pre and post assessment in short term (p=0.001). However, there was no significant (p<0.05) between group of VCO and mouthwash. Conclusion: VCO has potential to reduce physiological halitosis in immediate observation after the oil pulling procedure. VCO oil pulling and gargling with commercial mouthwash had no significant difference in reducing physiological halitosis
Determining the Association between Oral Health Status and SelfPerceived Oral Health Satisfaction among Residents in the Largest Care Home in East Coast Malaysia
Get PDFIntroduction: Little is known about the association between actual and selfperceived oral health status among residents living in a care home. This study aimed to assess their oral health status and to determine its association with their selfperceived oral health satisfaction. Materials and method: A cross-sectional study was conducted from July to August 2018 among 75 residents of Rumah Ehsan, Terengganu (the largest care home in east coast Malaysia). The oral health status and oral hygiene of the participants were examined. Their sociodemographic profile and self-perceived oral health status were collected through structured interviews. Chi-square, Man-Whitney, and multiple logistic regression tests were used to test the factors associated with the self-perceived oral health satisfaction of the participants. Results: Unsurprisingly, the majority of the participants had poor oral health with high median DMF-T score of 29.0 (IQR=12) and majority (86.7%) had poor oral hygiene. It was intriguing to know that the majority of them (64%) perceived they have good oral health status with 68% satisfied with their current oral health status. There was no significant association between their actual oral health status and their perceived satisfaction. However, increasing age, Malay and those eating dependently were less likely to satisfy with their oral health status. Meanwhile, those who were dependent on the staff to brush their teeth were more likely satisfied with their oral health status. Conclusion: There was a wide discrepancy between the actual and self-perceived oral health status among residents in care homes. Hence, it is crucial to improving awareness and knowledge among them in order to improve their oral health. Factors contributed to their oral health satisfaction should be acknowledged by all dental practitioners
Outcome of Differentiated Thyroid Carcinoma at Two Centres in Kuantan, Pahang
Get PDFIntroduction: Differentiated thyroid carcinoma (DTC) is the commonest thyroid malignancy. Several studies had shown that the outcome of DTC depend on the patient’s age at time of diagnosis, tumor characteristics and initial treatment. The aim of this study was to describe the outcome of DTC and its associated factors among patients diagnosed at Hospital Tengku Ampuan Afzan (HTAA) and International Islamic University Malaysia Medical Center (IIUMMC) Kuantan, Pahang. Materials and method: A retrospective cohort study was carried out among all DTC patients in HTAA and IIUMMC from July 2018 to September 2018. Case report form was used for data collection and it consists of four sections that include sociodemography, disease characteristics, treatment modalities and outcome. Descriptive statistics was used to describe the types of DTC, sociodemographic characteristics, disease characteristics, treatment modalities and the outcome, while chi-square test was used to explore the factors that were associated with the outcome. Result: In DTC, majority were diagnosed with papillary carcinoma (93.5%) than medullary carcinoma (6.5%). Three-quarter of the patients had residual disease at 6 months and the disease persistent in more than half of the patients at 12 months. At two-years follow-up, most of the patients (56.5%) were in disease-free state followed by persistent (26.1%) and residual disease (17.4%). However, there were no significant factors that affect the outcome of the patients. Conclusion: The two-year outcome post-treatment in this study revealed most of the patients were in remission
Pharmacotherapy for Comorbid Adult Attention-Deficit Hyperactivity Disorder and Stimulant Dependence: A Systematic Review
Get PDFComorbid adult attention-deficit hyperactivity disorder (ADHD) and stimulant dependence is widely recognized, but efficacy of pharmacotherapy in this patient population is not well established. We aimed to review whether pharmacotherapy is efficacious in reducing ADHD symptoms and stimulant use in comorbid adult ADHD and stimulant use disorder. English articles until June 2017 were systematically searched in electronic databases (MEDLINE and PsycINFO), an online clinical trials register (ClinicalTrial.gov), and through hand-search of article references. Randomized, double-blind, placebo-controlled trials that studied efficacy of pharmacotherapy in adults with comorbid ADHD and stimulant dependence were included. Two reviewers assessed studies for inclusion and extracted data; disagreements were resolved by consensus. Study outcomes included were changes in ADHD symptom severity, substance abstinence, treatment retention rates and safety. From the 1394 records identified, five trials (n=358) were included. Four studies involved methylphenidate; in another study extended-release mixed amphetamine were used. The comorbid stimulant was cocaine in three studies, and amphetamines in the rest. All were short-term studies involving predominantly young male adults conducted in outpatient settings. There is early promising but mixed evidence for therapeutic efficacy in improving ADHD symptoms. Stimulant medications did not worsen stimulant dependence or adverse effects of stimulant medications. Side effects were mild and tolerable. High attrition rates and small sample size limited the generalizability of findings. Current limited evidence suggests that stimulant treatment for comorbid adult ADHD and stimulant dependence is feasible. Welldesigned trials with adequate power are needed for more robust evidence on ADHD and stimulant use outcomes
Internet Addiction among Secondary School Students in Klang Valley, Malaysia: What is the Association with Depressive Symptoms, Anxiety Symptoms, and SelfEsteem?
Get PDFIntroduction: Internet addiction is becoming a global problem and has been associated with mental health issues such as depression and anxiety. There is a strong need for local research, given the recent rise of mental health issues amongst children and adolescents in Malaysia, as well as lack of research in this field locally. Methods: This study assessed the prevalence of internet addiction, and its association with internetrelated factors, depressive symptoms, anxiety symptoms, and self-esteem, amongst selected secondary school students in the Klang Valley, Malaysia. In a cross-sectional study, 199 adolescents were conveniently chosen from six randomly selected secondary schools within Klang Valley. Subjects completed a demographic questionnaire, as well as Malay versions of the Internet Addiction Test (MVIAT), Children’s Depression Inventory (CDI), Depression Anxiety Stress Scales-21 anxiety subscale (DASS-21) and Rosenberg Self-Esteem Scale (RSES). Multiple logistic regression analysis was carried out. Results: This study found that 49.2% of students were addicted to the internet. Significant factors associated with internet addiction were spending longer hours online during the holidays (OR 1.20, CI 1.01-1.35), easy access to a computer (OR 4.01, CI 1.50 - 10.76), confiding on the internet (OR 4.07, CI 1.49-11.13), severe level of anxiety (OR 3.63, CI 1.04-12.73) and high depression scores (OR 1.10, CI 1.01-1.20). Contrary to previous studies, self-esteem was not found to be significantly associated with internet addiction. Conclusion: This study has important implications in relation to clinical practice, research, and policy-making in Malaysia
Muslim Female Healthcare Personnel Dress Code: A Proposed Guideline
Get PDFIntroduction: The struggle of Muslim women to comply with Islamic teaching while working in the healthcare sector has been a long-standing issue. Following the case of a Muslim nurse who was allegedly fired for non-adherence to the short-sleeve uniform rule, the Malaysian Muslim Consumers Association highlighted the need for a uniform guideline to prevent similar instances. Yet, no guideline has been issued to date. Materials and Methods: This conceptual study employed library research method to gather relevant materials. Library research was able to retrieve guidelines from seven Muslim-minority countries but none from Muslim-majority countries. Document analysis of the materials gathered was undertaken. The different guidelines were compared, with special reference to awrah-related issues. Results: Several major issues that healthcare personnel dress code considers are the safety, health, cleanliness, and comfort for both patients and healthcare personnel. Islamic dressing requirement is not only in line with clinical practice but Islam also highly promotes maintenance of safety, health, cleanliness, and comfort. The widely adopted ‘bare below the elbows (BBE) policy is the only practice that may contradict Islamic rules. However, some healthcare institutions in Muslim-minority countries allow modifications of uniform rules on religious grounds; some of the modifications are not observed in Muslim-majority countries. When providing direct patient care that requires BBE, the use of disposable over-sleeves is a good alternative to adhere to both clinical and Islamic standards. Conclusion: Healthcare personnel dress code policy that is concordant to both clinical and Islamic standards is possible although it may require greater resources
Reliability Measurement of Corneal Wavefront Aberrations using Corneal Videokeratograph Atlas 9000
Get PDFIntroduction: Accurate corneal wavefront aberration measurements are essential in determining patient’s suitability, vision outcomes and patient satisfaction in laser refractive surgeries. This study aimed to evaluate the reliability measurement of higher-order aberration (HOA) using corneal videokeratograph Atlas 9000. Materials and method: 38 eyes of 19 participants were recruited in this study. Comprehensive eye examination was done to ensure all participants eligibility, and any conditions in which obstruct the central cornea were excluded. Corneal wavefront aberrations were measured based on Zernike polynomials. In assessing repeatability, three repetitive measurements in five minutes in a single session were taken by 2 experience examiners. For reproducibility measurement, similar approach was done with the time-interval between measurements was set at one week. Bland-Altman, limits of agreement (LoA) and intraclass correlation coefficients (ICCs) were used to evaluate the reliability measurement. Results: Bland-Altman and LoA findings revealed no significant differences for both repeatability and reproducibility measurement. For repeatability testing, the mean differences for vertical trefoil, oblique trefoil and spherical aberration were -0.096 ± 0.493, 0.001 ± 0.048, 0.008 ± 0.035, 0.004 ± 0.029, 0.010 ± 0.053 with LoA of 1.930, 0.188, 0.138, 0.114, and 0.208 respectively. Intraclass correlation coefficient (ICC) excellent reliability of 0.841 for all parameters. Likewise, reproducibility testing showed similar findings with the mean difference were -0.018 ± 0.091, 0.016 ± 0.061, -0.0004 ± 0.036, -0.002 ± 0.042, 0.003 ± 0.026, with LoA of 0.356, 0.24, 0.141,0.164, and 0.102 respectively. Intraclass correlation coefficient (ICC) shows excellent reliability of more than 0.9 for all parameters. LoA of less than 1.0 were observed in all measurements (except for repeatability of vertical trefoil) indicates high consistency of the measurements. Conclusions: Corneal videokeratograph Atlas 9000 provides excellent HOA measurement reliability
Quantitative Evaluation of Effectiveness of Hospital Mesra Ibadah Course: A Pre-Post Study
Get PDFIntroduction: Solat or prayer, as one of the five pillars of Islam, and it is associated with bio-psycho-social benefits in Muslim patients. Â Many Muslim patients neglected solat while being hospitalized as they are unaware of the convenience (rukhsoh) available for them. Ibadah Friendly Hospital Courses have been conducted in different states of Malaysia to impart knowledge to the hospital staff who can in turn educate their patients. This study aims to construct a content-validated assessment tool and to assess the effectiveness of a state-level Hospital Mesra Ibadah course. Materials and methods: A self-administered questionnaire was constructed and content-validated by a panel of three experts (two religious teachers and one consultant spine surgeon). All 15 questions achieved item-level content validity index (I-CVI) of 1.00 after two rounds of validation. The questionnaires were distributed to participants of a state-level Hospital Mesra Ibadah course to compare the participants’ pre-course test score and post-course test score. Results: A total of 88 participants (48.9%) were included in this study. There was a significant difference in the pre-course test mean score and post-course test mean score among the participants. There was also a significant reduction of unsure answer after the course. There was no significant association found between the gender, place of working and occupations with the pre-post test score difference. Conclusion: This study demonstrates that the Hospital Mesra Ibadah course is effective in imparting as well as consolidating the knowledge among participants, hence it should be routinely organized to benefit more participants
Minimally Invasive Surgery in Treatment of Traumatic Thoracolumbar Spinal Injuries: A 2-Year Experience
Get PDFIntroduction: Majority of the traumatic spine injuries are located at the thoracolumbar region. They can be compression fractures, burst fractures, flexionextension injuries (Chance fractures), dislocations, or any of the combination. Surgery is indicated for patients with thoracolumbar injury classification scoring (TLICS) of 4 or more. Traditionally, surgical approaches for thoracolumbar spinal injuries involve open surgery, instrumentation with/without decompression. In our previous study, open surgery for traumatic thoracolumbar injuries and history of blood transfusion have been found to be associated with higher risk of deep surgical site infection requiring surgical debridement. With the advent of modern implants and equipments, minimally invasive surgery (MIS) has been made possible for spine surgeries. We report our two-year experience in utilizing MIS to treat traumatic thoracolumbar spinal injuries. Materials and method: Patients who underwent spinal surgeries at Hospital Tengku Ampuan Afzan, Kuantan from July 2017 to July 2019 were screened for suitability to be included in this study. Only patients who underwent spinal minimally invasive surgeries have been included in this study. Patients who underwent open spinal surgeries were excluded. Results: A total of 8 patients were included in this study. There were 3 burst fractures and 5 chance fractures. All patients underwent a minimum of 4-level posterior spinal instrumented fusion with MIS techniques and 2 patients had laminectomy at the injured level for decompression. All but one patient did not require blood transfusion and there was no incidence of surgical site infection among these patients. Conclusion: Minimally invasive surgery (MIS) is a better option compared to open surgery in treating traumatic thoracolumbar spinal injuries. By minimizing the surgical incision, we are able to reduce blood loss and avoid deep surgical site infection
Post Endoscopic Retrograde Cholangiopancrea-Togram (ERCP) Perforation Managed Successfully Conservatively: A Case Report
Get PDFIntroduction: We aim to report an uncommon case of post ERCP perforation that effectively managed conservatively in non-hepatobiliary surgery centre. Case report: A 46-year-old man diagnosed to have obstructive jaundice secondary to distal common bile duct (CBD) stone. He underwent ERCP at a private centre, sphincterotomy was performed, but, the operator had failed to insert the stent and complicated with post ERCP perforation evidenced by contrast extravasation beyond 1/3rd of the CBD and referred to our centre. Patient was subjected for re ERCP. There were difficulties in cannulating the CBD and stent was inserted. Cholangiogram revealed contrast leak around the pancreatic duct and bifurcation of hepatic duct. There was no evidence of CBD stone. Computed Tomography (CT) of the abdomen revealed extensive subcutaneous emphysema on the right side of the abdomen to right inguinal region, extensive retroperitoneal free air and pneumoperitoneum, but there were no free fluid or contrast extravasation. The patient subjected for non-operative management (NOM) for the complication and kept fasting with total parenteral nutrition and intravenous antibiotic. He recovered well with the opted management. Patient was programmed with Gastrograffin study after 10 days that showed no evidence of contrast leak to suggest free bowel injury. He was allowed orally after that and was discharged well after 15 days with stent in situ. During follow up, he was well, and the stent removed after 3 months. Patient planned for laparoscopic cholecystectomy and on table cholangiogram. Conclusion: Post ERCP perforation is uncommon but lethal. Early recognition of the complication is crucial hence appropriate management can be arranged to avoid death. To date, surgery is not the only choice available to manage this complication