IIUM Medical Journal Malaysia (IMJM)
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The Effects of Chronic Low Dose Exposure of Chlorpyrifos on the Rat Kidney
Get PDFAim: An increased incidence of chronic kidney disease (CKD) was reported among agricultural workers who were exposed to organophosphates (OP). There is little information on the effects of chronic low OP exposure on kidney in experimental animals. Thus, the aim of this study was to assess the effects of chronic low subcutaneous exposure of chlorpyrifos (CPF) on the kidney. Methods: Eighteen male Sprague Dawley rats were divided into three groups, with six rats in each group. Group 1 served as control group, and groups 2 and 3 received a subcutaneous vehicle (3% dimethyl sulfoxide + 97% v/v soy oil) or CPF (18.0 mg/kg) respectively, every other day for 180 days. Serum urea, creatinine, uric acid, cystatin C, electrolytes levels, acetylcholinesterase (AChE), and arylesterase (ArE) activities were measured. Histopathological changes in the kidney tissues were examined. Results: Urea, creatinine, uric acid, and cystatin C levels were significantly increased (p < 0.05), while electrolytes were reduced (p < 0.05) in the CPF-treated rats. Both AChE and ArE activities were depressed in the CPF group (p < 0.01 and p < 0.001, respectively). Diffuse necrosis of proximal tubules and glomerular hypercellularity were observed in the kidney in the CPF group. Conclusion: A chronic low dose of CPF via subcutaneous exposure caused considerable renal tubular necrosis and derangement of glomerular function. These findings suggest that chronic occupational OPs exposure can cause kidney damage
Prevalence of Diabetic Retinopathy and its Associated Factors among Diabetic Patients in Primary Care Clinics, Kuantan, Pahang
Get PDFIntroduction: Diabetic retinopathy (DR) is one of the commonest complications of diabetes mellitus. This study was to determine the prevalence of DR and its association with chronic kidney disease (CKD), high HbA1c and dyslipidemia among diabetic patients in government primary care clinics. Materials and Methods: A cross sectional study was carried out. The respondents were selected from diabetic registry at two government primary care clinics in Kuantan, Pahang via stratified random sampling method during the study period from May 2010 to April 2011. The respondents were interviewed and assessed clinically using a structured questionnaire. Retinal examination was performed by accredited staff using non-mydratic retinal imaging and DR was classified according to the International Clinical Diabetic Retinopathy Disease Severity Scale. Results: Out of 400 respondents, 58.8% were diagnosed with diabetes less than 5 years and 51.0% had uncontrolled blood pressure (>130/80 mmHg). The prevalence of DR and maculopathy were 33.5% and of 17.8% respectively. Most of these patients (22.3%) had mild non-proliferative DR. DR patients had higher percentages CKD (17.9% vs. 6.8%; p<0.001) and a higher mean of HbA1C (8.69 vs. 8.11; p=0.015) compared to non-DR patients. The study revealed that DR was independently associated with CKD {OR: 3.46, 95% CI (1.76, 6.80)} and high HbA1c {OR: 1.12, 95% CI (1.02, 1.23)}. Those with dyslipidemia however, has 39% less risk of DR {OR: 0.61, 95% CI (0.39, 0.94)}. Conclusion: This study showed that diabetic patients with CKD and high HbA1c have greater risks to develop DR but has protective risk with dyslipidemia
Evaluation of the Salivary Flow Rate and pH in Patients with Recurrent Oral Ulcers
Get PDFIntroductions: Recurrent oral ulcers primarily effect mucosal surfaces and are among the most common chronic inflammatory diseases. Numerous studies to find the aetiopathogenesis have been conducted however the cause still remains unclear. Saliva is of utmostimportance for oral health maintenance. In current study, saliva was used as a diagnostic tool for comparison of salivary flow rate and pH in patients suffering from recurrent oral ulcers and control group. Materials and Methods: Saliva samples taken from 20 recurrent aphthous ulcer patients and 20 control (healthy) patients using a convient sampling method. Drooling method was used to collect unstimulated whole saliva sample. Pre-weighted specimen bottles were used and then weighed after sample collection on a graduated scale where as chair-side pH meter was used to determine the salivary pH. Independent t-test and Pearson’s correlation were performed. A p-value of less than 0.05 was considered statistically significance. Results: Positive correlation was found between the flow rate and pH in recurrent oral ulcer patients. Patients with recurrent oral ulcers had higher flow rate and pH compared to the control group. These effects were exaggerated in female patients with ulcers. Conclusions: Disturbances in salivary flow rate and pH were not significantly associated with recurrent oral ulcers
The Efficacy of Art Therapy on Mental Health Outcomes Among Breast Cancer Patients: The Current State of Evidence Based on Randomised Controlled Trials
Get PDFIntroduction: Breast cancer is the most common cancer among women. Psychosocial distress, in the forms of depression and anxiety, regularly accompanies breast cancer diagnosis and throughout its treatment. Hence, it is important to objectively assess the therapy options that may help this distress. One of the most flexible psychotherapy modalities is the art therapy as it may be incorporated in many settings. The purpose of this systematic review is to determine the efficacy of art therapy (via creative paintings) on the mental health outcomes of female breast cancer patients. Material and Methods: Related articles were identified from Medline (OvidSP), ScienceDirect, Pubmed, EbscoHost-Academic Search Premier and Wiley Online Library. Screenings were performed based on the criteria that the study must be a randomised control trial (RCT) that investigated the effect of art therapy in breast cancer. Data were extracted using standardised forms, followed by evaluation of quality of reporting using CONSORT Guidelines. Results: Six RCTs were identified. Based on the heuristic synthesis of data extraction results, none of the studies can be considered as studies with acceptable quality, although four of them showed promising results. Conclusion: There is inconclusive evidence of the efficacy of art therapy (via creative paintings) for the improvement of mental health outcomes among female breast cancer patients
Issues on Purification of Surgical Instruments Practice from Najasah (Najis) of a Dog
Get PDFIntroduction: From Quran, dogs were mentioned several times in different perspectives. Surah al-Maidah , informs that a hunting dog’s catch is lawful to be eaten. An authentic hadith about a prostitute who gave water to a dog and her sins were forgiven and was promised heaven. Case report: MrJ, 35 years old gentleman, sustained 3cm x 2cm over left leg following a dog bite. Patient underwent emergency operation and appropriate antibiotic given. After operation, the nurse had washed entire surgical instruments with taharah soap, washed it again six times with water and followed by enzymatic detergent before sending for autoclaving. Discussion: The status of dog impurities and how to clean it derived from hadith narrated by Abu Hurairah: ‘Rasulullah PBUH said: ‘Cleaning a utensil that has been licked by a dog is by washing it seven times and one of the washing cycle is mixed with soil”. Majority Muslims in Malaysia follow Shafi'i sect, where dog’s saliva and all its body are considered ritually mughallazah. Thus, if touched, they are required to cleanse the body part that came into contact with a specific Islamic ritual as mentioned. Up to date, there is no official guideline from KKM or JAKIM related to this. Surgical instruments used for the operation related to dog bite injury were not in direct contact with the dog. This practice imposes unnecessary steps for staffs. Apart from that, there are no study done on the effect of commercially manufactured soil-based soap to surgical instruments. The information regarding content also unclear. Surgical instruments are sensitive and expensive, thus improper handling can expedite damage to the instruments. Conclusion: KKM and JAKIM are recommended to produce SOP regarding this issue. Effort should be done to produce medical grade soil-based cleansing agent. Study should be done to evaluate the safety to surgical instruments
Upper Tract Transitional Carcinoma: An Array of Imaging Conundrum
Get PDFCase report: We report a 38-year-old gentleman who presented with painless haematuria for 6-months duration. Contrast-enhanced CT renal revealed a large, calcified intrapelvic mass with calyceal extension confined within the right kidney with moderate pelvicalyceal dilatation but no evidence of synchronous lesion elsewhere. Histopathological analysis showed high grade urothelial carcinoma of the renal pelvis with invasion of the renal parenchyma. Upper tract urothelial carcinoma (UTUC) which was once thought similar to urothelial carcinoma of the bladder (UCB), is increasingly being recognized as a different entity. However, heterogenous array of imaging manifestations of UTUC is also increasingly being encountered and pose diagnostic challenges though UTUC is not as prevalent as UCB which is easier to diagnose. Despite distinctive features against renal cell carcinoma (RCC), UTUC may mimic numerous other renal pathology especially the benign ones hence imaging plays a pivotal role to ascertain the diagnosis. This disease is usually treated with radical nephroureterectomy with superadded neoadjuvant chemotherapy for high risk cases. Less invasive endoscopic resection is also offered in certain cases but stringent surveillance of the whole urinary tract as well as post-operative follow-up are mandatory
A Case of Persistent Retroperitoneal Abscess with Large Right Perinephric Collection
Get PDFIntroduction: Retroperitoneal abscess is a rare condition which is difficult to diagnose and treat because of its insidious onset and nonspecific clinical manifestations. Case Report: 55 years old male, underlying DM, Hypertension, Gouty arthritis. Referred to us for right Hypochondriac pain with persistent fever for past 2 days duration. Abdominal examination showed soft, tender over right side of abdomen, localized guarding. An abdominal CT scan showed right pyonephrosis complicated by a large right perirenal collection.Right Nephrostomy was performed. 1 week later, patient had fever and persistent right sided abdominal pain with increasing septic parameters. CT abdomen performed and showed Right pyonephrosis complicated by a large right perinephric abscess extending into the pelvic and inguinal region. Right Perinephric drainage performed. Patient developed worsening sepsis, repeated CT abdomen revealed residual multiloculated right perinephric collection. Open retroperitoneal drainage was performed, noted retroperitoneal abscsess, caccon right kidney and peritoneal, slough ,unhealthy tissue and necrotic debris over right psoas muscles.1 week after surgery, patient still not improving, repeated CT Abdomen showed features of D2 ischemia with focal retroperitoneal perforation causing large and recurrent right perinephric inflammation with increasing intraabdominal free fluid and enlarging right perinephric collection. Laparotomy done shiwed 1L clear ascites intraperitoneally, no pus collection seen. Cocoon inflammatory mass involving hepatic flexure and duodenum to the retroperitoneum, hepatic flexure appeared normal with no intraluminal mass.Right retroperitoneal exploration done, noted adhesion between hepatic flexure to Gerota's fascia, pus ~30ml at upper part of Gerota's fascia. Repeated CT abdomen showed slightly larger right paracolic gutter collection with similar right perinephric collection. Discussion: Retroperitoneal abscess is very rare. Retroperitoneal abscess may result from a variety of causes, such as pyelonephritis, pancreatitis, retroperitoneal appendicitis, diverticulitis, peptic ulcer disease, perforated cancer, infammatory bowel disease, spinal infection, trauma, and post instrumentation. For our patient ,the exact aetiology of retroperitoneal collection and peri renal collection are still unknown
Synchronous Esophageal and Renal Malignancies with Unexpected Site of Metastasis: A Case Report
Get PDFIntroduction: Esophageal cancer is the fifth most common cancer in Asia. Synchronous malignancies with an esophageal malignancies is not uncommon however synchronous esophageal malignancy and renal cell carcinoma is rare. Case Report: A 70 years old non smoker man with comorbid of hypertension and diabetes mellitus presented with multiple episode of hemoptysis and pleuritic chest pain within one day duration. He also complaint of worsening dysphagia to solid food for 1 month duration with constitutional symptoms. Otherwise he does not have any other symptoms. Clinically he was pale and cachexic, otherwise all systemic examination was unremarkable. His blood investigation reveal low hemoglobin level of 9.9g/L with normal coagulation and renal profile. He underwent Oesophagoduodenoscopy which showed a tumor narrowing the lumen of the lower esophagus. Biopsy of the tumor revealed esophageal adenocarcinoma. CT thorax, abdomen and pelvis showed smooth circumferential wall thickening of the distal part of the esophagus near the gastroesophageal junction. Incidentally, there were heterogenous enhancing lobulated mass seen at the lower pole of left kidney with no obstructive uropathy features. Otherwise, others solid organ were normal. A left renal mass biopsy performed revealed renal cell carcinoma. An oncologist opinion was gathered for initiation of palliative chemotherapy however he developed symptomatic malignant pleural effusion which need a drainage. HRCT Thorax revealed multiple bilateral intrapulmonary nodule. He also complaint of a new right upper eyelid mass that increasing in size with contact bleeding however does not affect his visual. An assessment from an ophthalmologist and CT orbital performed consistent with features of a metastasis. Conclusion: Synchronous malignancies with an esophageal malignancies is not uncommon. Most common site reported is head and neck followed by lung malignancies. However synchronous esophageal malignancies and renal cell carcinoma is rare. Esophageal malignancies often have distant metastasis to the liver, lung and bone however rare to the eyelid
Intervention to Reduce Needle Stick Injuries
Get PDFIntroduction: Healthcare workers face the risk of infection from potentially deadly diseases from the use of unsafe needles every day. It has been estimated that over 350,000 needlestick and sharps related injuries occur annually with an average of 1,000 infections annually and over 100 deaths by the CDC (Centers for Disease Control & Prevention). It has been reported that 0.6 cases in average of needle stick injury incident occurred in KPJ Seremban almost every month in 2008. Analysis was done and it was that found that the majority of cases were due to failure to adhere to universal precautions. Materials and Methods: A retrospective study was done (January to December 2008). Data was collected from reviewed incidence reports. Statistics showed that needle stick injuries occurred after a procedure and during disposal of used needles. We then introduced several measures with these aims; to inculcate ‘Safety Culture’ among healthcare workers through quality training, to ensure that all newly qualified healthcare workers are well trained in handling sharp devices, to reduce the incidence of needlestick injuries, to do effective monitoring audit, to convey knowledge to healthcare workers on safety practices by Infection control team. These strategies included; High quality education and training to all staffs conducted continuously, identifying those at risk, introduce safer medical devices – using of Angiocath for setting IV line and needle-less injection port and providing for a secure work environment. Results: 1) Needle stick injury cases reduce 65% as compared to last year. 2) Through surveys and questionnaires, 95% of healthcare workers understand and adhere to universal precautions in 2009 as compared 30% in previous year. 3) Number training conducted increased from 7days in year 2008 to 21 days in year 2009. Conclusion: Collaborative and participative approaches are helpful in reducing the transmission of blood borne pathogens and other sharps-related injuries