IIUM Medical Journal Malaysia (IMJM)
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MRI Evaluation of Anterolateral Ligament of the Knee: A CrossSectional Study in Malaysia
Get PDFIntroduction: Anterolateral ligament (ALL) of the knee has been demonstrated to be an important secondary restrainer in providing rotational stability to the knee. ALL stabilizes the internal tibial rotation with increasing knee flexion. ALL injuries with concomitant anterior cruciate ligament (ACL) injuries have a higher grade of pivot shift. Magnetic resonant (MR) studies on ALL have been performed but there is no such data among the Malaysian population. We aim to investigate the reproducibility of ALL identification on 1.5T MRI and the association with other ligamentous injuries. Materials and method: Magnetic resonant imaging of the knees with suspected ligamentous injuries from 1st January 2017 to 30th June 2017 were reviewed for suitability of this study. Post-operative MRI and MRI of patients with suspected tumour at the knee region were excluded. 1.5T MRI (Siemens Medical Solution) was used for assessment of all the knees. All MRIs were double read and approved by a consultant radiologist. Results: A total of 36 knee MR images were obtained from 31 patients during the study period. 5 patients were excluded (3 for suspected tumour and 2 for post-operative). Mean age of the patients was 29.44. All three components of ALL were identified in 20 MRIs (55.6%): femoral component (75%); meniscal (69.4%) and tibial (58.3%). There were 11 knees identified to have ALL injury, which was associated with ACL injury. Discussion: ALLs are best visualized on coronal views (PD, PD FS and T2) with lateral inferior genicular artery as a guide to locate the bifurcation of meniscal and tibial components. Delineation of ALLs from other surrounding structures such as lateral collateral ligaments, iliotibial band and popliteus tendon was done in both coronal and axial views. Conclusion: ALLs of the knees are delineated in more than half of the MR images. There is an association between ALL injuries and ACL injuries
Chronic Low Dose Organic Arsenic Induced Liver Structural Damage
Get PDFIntroduction: Over the decades, organic arsenic has been thought to be less toxic than inorganic arsenic. Monosodium methylarsonate (MSMA) is a potent organoarsenical herbicide that is still being used in most Asian countries. Reported studies on the effects of organic arsenic are mainly to the gastrointestinal system, however there are limited research on its impacts to the liver. Therefore, this study aimed to investigate the effect of MSMA exposure on hepatocytes and liver sinusoidal endothelial cells (LSEC). Materials and Methods: Fourteen Sprague Dawley rats (n=14) were divided equally into arsenic-exposed (n=7) and control (n=7) groups. The rats in arsenic-exposed group were given MSMA at 63.20 mg/kg daily for 6 months through oral gavage. While the rats in control group were given distilled water ad libitum. At the end of the duration, they were euthanized and underwent liver perfusion for tissue preservation. Liver tissues were harvested and processed for light microscopy, scanning and transmission electron microscopy. The findings were analysed descriptively. Results: MSMA had caused necrotic and apoptotic changes to the liver. Normal organelles morphology were loss in the hepatocytes while LSEC revealed defenestration. Conclusion: In this study, chronic low dose organic arsenic exposure showed evidence of toxicity to hepatocytes. Interestingly, LSEC demonstrated capillarization changes
Predicting Sexual Intention to Engage in Premarital Sex Among Late Adolescent in Kuantan Government Secondary Schools: An Application of Theory of Planned Behaviour
Get PDFIntroduction: Based on the Theory of Planned Behaviour (TPB), sexual intention is determined by three main socio-cognitive factors which are permissive attitudes, social-norms and self-efficacy in performing premarital sexual activity. Premarital sex associated with increased risk of sexually transmitted diseases and detrimental social implications. The aim of this study was to explore the correlation of the socio-cognitive factors in predicting intention to engage in premarital sex amongst late adolescents in Kuantan government secondary schools. Method: This cross-sectional study was conducted among 466 pre-university students aged 18-19 years from nine government secondary schools in Kuantan district. A self-administered validated Youth Sexual Intention Questionnaire (YSI-Q) was used. Statistical analyses were done using IBM SPSS version 22.0. Results: Permissive attitude (r=0.579, p<0.001), perception of social-norms (r=0.513, p<0.001) and perceived self-efficacy (r=0.253, p<0.001) were positively correlated with the sexual intention towards premarital sex. The higher the permissive attitude, social-norms and perceived self-efficacy, the higher the sexual intention score. There was a significant difference in the level of sexual intention between male (35.6%) and female (64.4%) with mean (SD) score of 10.54 (3.8) and 7.3 (2.9) respectively. Students with premarital sex experience (1.5%) showed significantly higher score in sexual intention than student without premarital sex experience (t=4.54, p<0.001). Conclusion: This study confirmed permissive attitude, perception of social-norms and perceived self-efficacy were positively correlated with sexual intention towards premarital sex among the late adolescents. Therefore, it is important to consider this TPB theoretical framework in designing sexual abstinence intervention to curb the unsafe sexual behaviour
Diagnostic Accuracy of Intraoperative Frozen Sections in the Diagnosis of Central Nervous System Lesions: A Hospital-Based Study
Get PDFIntroduction: Intraoperative frozen section (FS) is an important tool in the management of neoplastic and non-neoplastic central nervous system (CNS) lesions. Although the final pathological diagnosis is based on the findings in paraffin tissue sessions, interpreting FS of CNS lesion is to assist the neurosurgeon in making the accurate judgment regarding the nature of the lesion and tissue adequacy. This study was to evaluate the agreement between FS and paraffin sections (PS) results; and to highlight the possible causes of error in discrepancy between FS and PS. Materials & Methods: This is a retrospective study of 85 cases of FS. H&E stained sections of both FS and PS of all these cases were reviewed with their histopathological reports. FS and PS results were compared. Possible causes of errors were reviewed and recorded. Results: Out of 85 cases; 76 cases (89.4%) showed no discrepancy, 2 cases (2.4%) minor discrepancy and 7 cases (8.2%) discrepancy. Sensitivity and specificity of FS were 90.1% and 85.7% respectively. Positive predictive value was 97.0% and negative predictive value was 63.1%. The false positive rate was 14.2% and false negative rate was 36.8%. The overall accuracy of FS was 89.4%. Conclusion: Our results showed high accuracy and specificity of FS. Therefore, FS is still useful, an effective tool for neurosurgeon although there are some challenges for histopathologists in reporting FS. The commonest discrepancy was seen between reactive gliosis and low-grade glioma. Over-diagnosis or under-diagnosis of FS can be reduced by closed cooperation among pathologist, neurosurgeon and radiologist
Assessment of Food Security, Anthropometric and Cognitive Function among Orang Asli Children in Pahang, Malaysia
Get PDFIntroduction: Forest clearing for agriculture plantations and local community settlements may triggerfood insecurity, which causes poor development, predominantly in Orang Asli children. This cross-sectionalstudy was conducted to determine the relationships between food security and anthropometric and cognitivefunction among Orang Asli children in Temerloh, Pahang. Materials and methods: A total of one hundred andsixty-seven children (ages 7 to 11) from five selected Orang Asli villages (Kampung Sungai Enggang, KampungPenderas, Kampung Pasu, Kampung Lubok Wong, and Kampung Pian) were involved in this study. The foodsecurity index was assessed using the Radimer/Cornell Hunger and Food Insecurity Instrument.Anthropometric indices were based on height-for-age and BMI-for-age Z-scores, while cognitive performancewas tested using Raven’s Coloured Progressive Matrices (R-CPM). Results: A majority (91.6%) of therespondents reported some kind of food insecurity (12.6% household food insecure, 74.2% individual foodinsecure, and 4.8% child hunger). Rates of stunting, thinness, and overweight/obesity were 25.8%, 16.2%,and 18.0%, respectively. A majority (46.1%) of the children had average cognitive scores, followed by belowaverage (38.3%) and above average (15.6%), respectively. Height-for-age was significantly associated withcognitive function (p=0.008). Among sociodemographic factors, household size (p=0.007) and householdincome (p<0.05) were significantly associated with the food security index, whereas the educational statusof the child was significantly associated with height-for-age (p=0.013) and cognitive function (p=0.003).Conclusion: Food insecurity remains a risk factor for child development impairment in the Orang Aslicommunity. Undernutrition remains a major health concern among respondents; however, no associationwas found between food security index and cognitive function
Clippers the Brain Biter: An Adolescent’s Experience
Get PDFIntroduction: Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids is a rare inflammatory Central Nervous System disorder prominently affecting the brainstem. We present an adolescent’s reflection on this condition complicated with Epstein-Barr virus induced CNS Lymphoma. Case report: A 16-year-old boy presented about 5 years ago with a balance problem. He was diagnosed by MRI after ongoing debate whether this is juvenile multiple sclerosis. He initially responded to methylprednisolone but developed acute deterioration requiring 8 cycles of Infliximab and Methylprednisolone. He then confirmed cerebellar lymphoma 2 years later hence commenced on chemotherapy and radiotherapy after posterior fossa decompression. He gradually losses his motor skills, left hemiparesis and spasticity. He needs tracheostomy and gastrostomy due to poor bulbar function. Now, he is fully dependent and requires chest physiotherapy and suctioning and cystostomy for urinary incontinence. He has multiple PICU admissions due to recurrent aspiration, acute cerebellar oedema and post posterior fossa decompression. He worries about family breakdown as mum is his sole carer and having regular nightmare. He changed school to meet his care demands and unsure how to adapt to new environment. Social experience makes him anxious due to lack of understanding about his condition. He is evidently having low self-esteem and confidence. Discussion: Children palliative care team has been involved since diagnosis to support him and family. He is understandably depressed and clinical psychologist input bear minimal impact. He is fully aware of the current situation and his wish to rap Eminem’s songs like he used to do it before. Conclusion: Early aggressive treatment in CLIPPERS aim to prevent neuroaxonal loss. However, due to bellicose nature of the condition, the prognosis is relatively poor. Managing adolescent expectation after gradual deterioration is challenging especially, he is aware that achieving ‘normality’ is impossible as the treatment advancement still in limbo
Smartphone Addiction and Its Relationship with Psychological Health among Clinical Years Medical Students of International Islamic University Malaysia (IIUM), Kuantan
Get PDFIntroduction: Smartphones has now become a common and almost essential tool in our daily living activities. Students are among those who uses smartphones regularly which could lead to addiction if overused. This study aims to measure the prevalence of smartphone addiction and its relationship with psychological health among clinical year medical students in International Islamic University Malaysia (IIUM), Kuantan. Materials and method: A total of 203 Medical students in their clinical years were recruited via quota sampling method. The students filled in a four part online-based questionnaire consisted of questions on sociodemographic characteristics, smartphone usage information, Smartphone addiction scale-short version (SAS-SV) and WHOQOL-BREF. Data was analysed using IBM SPSS Statistics. Result: The prevalence of smartphone addiction among clinical year Medical students in IIUM was 51%. Bivariate analysis showed that majority of students chose social networking as their primary purpose of smartphone usage and this is significantly associated with smartphone addiction (p-value:0.037). Following multiple logistic regression analysis, students who had chosen games as their primary purpose of smartphone usage are 88% less likely to be related with smartphone addiction (p-value: 0.009, 95% CI: 0.025-0.595) compared to those who used it for academic performance tasks. Students who are not addicted to smartphones reported significantly better psychological quality of life compared to those who are addicted (p-value<0.001). Conclusion: Half of IIUM’s Medical students in clinical years have smartphone addiction and those with smartphone addiction was found to have poor psychological health. Immediate intervention such as creating awareness in the campus is important in curbing this problem
The Use of Active Melioidosis Detect TM in Early Diagnosis of Melioidosis in Hospital Tengku Ampuan Afzan and Hospital Sultanah Nur Zahirah
Get PDFIntroduction: Melioidosis is endemic in Malaysia and an important cause of sepsis. Current gold standard for diagnosis is by culture method,but its long procedure will delay the treatment leading to hospital-related mortality.Thus,a good rapid test is needed to reduce its mortality burden. Recently, Active Melioidosis Detect (AMD) have been shown to be useful. Objectives: (1)To measure the sensitivity and specificity of AMD. (2)To study the sensitivity and specificity of early morning urine AMD compared to spot urine AMD. Materials and method: A prospective crosssectional study of clinically suspected melioidosis patients in HTAA and HSNZ from April until December 2018. Blood and urine samples were tested with AMD. Test results were analysed for sensitivity, specificity,positive predictive value and negative predictive value. Results: A total of 89 patients were included in this study.The mean age is 52 years old, and 56.3% were male gender.64% of patients have diabetes mellitus.11 patients have positive blood culture for Bukholderia pseudomallei, 4 of them were tested positive for AMD.3 of them presented with septic shock (3.4%), however none died.The sensitivity of the AMD was 36.4% ([95% CI 12.4 to 68.4]) and the specificity was 66.7% ( [95% CI 46.0 to 82.8]) in all samples, with positive predictive value of 30.7% and negative predictive value of 72%.Blood samples have lower sensitivity of 9.1% ([95% CI 4.8 to 42.9]) with high specificity of 100% ([95% CI 84.5 to 100]). Urine spot samples have higher sensitivity compared to serum and morning urine, with 36.4% ([95%CI 12.4 to 68.4]) and specificity of 88.9% ([95% CI 69.7 to 97.1]). Conclusion: From this pilot study, this test requires further evaluation before incorporating as point of care assay
Non-communicable Disease Risk Factors among Orang Asli in Tasik Chini, Pahang
Get PDFIntroduction: The health status of Orang Asli (OA) in Malaysia often lag behind other races with under-nutrition and communicable diseases remain significant. While there is an upward trend of non-communicable diseases (NCD) in this country due to modernisation of lifestyle, how this change affecting OA is a public health interest. Materials and method: A community based survey was conducted involving 225 OA from Jakun tribe aged above 18 years living in three villages around Tasik Chini, Pahang in 2017. Results: There were low prevalence of overweight and high blood pressure (18.8% and 14.2%). Random blood sugar 5.6 mmol/L was found in 23.4% but only five villagers (0.02%) were eventually diagnosed with diabetes mellitus. Majority (63.7%) of OA in the three villages smoke products of tobacco. Conclusion: The NCD risk among this fringe OA community is still insignificant as shown by low prevalence of overweight, high blood pressure, and diabetes even when compared to national figures for other Bumiputera in Malaysia (30%, 18.6%, and 10.7% respectively). However, the prevalence of smoking was strikingly higher than 2015 national figure for other Bumiputera (25.8%). This is contributed by high rate of smoking among women and established cultural practice. The findings highlighted the need for customization in smoking intervention for OA
Arthroscopic Treatment of Snapping Scapula Syndrome: A Case Report
Get PDFIntroduction: Snapping scapula syndrome is a condition with audible and palpable grating localized to the superomedial angle of the scapula associated with pain. The etiology is likely secondary to anomalous tissue between scapula and chest wall (e.g. bursitis, hooked superomedial angle scapula, Luschka tubercle, malunited rib/scapula fracture and osteochondroma). Case report: We present a case of a 17year-old gentleman, with chronic pain over bilateral upper scapula associated with grating sound upon shoulders movement. Examination revealed significant audible crepitus on bilateral scapula without restriction of shoulders motion. MRI showed no abnormal finding. An attempt for conservative approach including physical therapy and steroid/local anaesthesia injection has been unsuccessful. We subsequently performed an arthroscopic bursectomy and superomedial angle scapula decompression on the right scapula. There were inflammed bursa with fibrotic tissue and prominent superomedial angle of scapula observed during the surgery. Postoperatively, the symptom over right scapula completely resolved with good patient satisfaction. At present, patient is scheduled for the similar surgery on the remaining symptomatic left scapula. In conclusion, arthroscopic scapulothoracic bursectomy with superomedial angle scapula decompression is a reliable treatment for snapping scapula syndrome with predictably high rates of pain relief, patient satisfaction as well as improvement in functional outcomes