IIUM Medical Journal Malaysia (IMJM)
Not a member yet
1450 research outputs found
Sort by
A 5-year review of malaria surveillance in Kuching, Sarawak
Get PDFIntroduction: Malaria is endemic in Sarawak contributing to the highest incidence rate in Malaysia. Kuching division consists of three main areas, namely Kuching district, Lundu and Bau. This review aims to highlight the trends of malaria over the past five years in terms of demographic characteristics and vector control programmes and to identify factors that contribute to the difficulty in malaria control programme in this state. Materials and Methods: This is a descriptive review of malaria cases based on surveillance data compiled from 2000 to 2004. Data is analysed based on demographic background, malaria species, type of malaria infection and vector control activities between the three districts. Results: Lundu has the highest average 5-year incidence rate per 10,000 population of 121.97 as compared to the national figure of 4.10. Malaria is more prevalent in males (14.3%) than females (5.7%). Among the race, Dayaks had the highest prevalence rate (66.5%). Peak age affected is between 15 to 40 years. The predominant species was Plasmodium vivax (65.4%) followed by Plasmodium falciparum (32.8%). For occupation, the majority of cases were among villagers (55.2%) followed by foreign workers (19.0%). Cases were detected mainly by passive case detection (82.7%) and blood film for malarial parasites was positive in 2.67%. For malaria control activities, focal spraying were successfully done in 94.4% of the structures, regular spraying in 89.5% structures, impregnated bednet distribution among 38.2% population and mass drug administration distributed among 80.7% of the population. Conclusion: Results analysis has shown that the incidence rate of malaria in Kuching division is very high, particularly in Lundu district. Although activities conducted by the malaria control programme is sufficient, it has not been able to successfully reduce the incidence of malaria in this region. Problems identified include difficulty in accessing the affected areas, movements of illegal immigrants, financial constraints and lack of training of field staff involved in malaria control. Recommendations include integrating malaria control measures with cross border agents, community participation, aggressive surveillance programmes and improvement of vector control
Noise Exposure and Hearing Threshold Profile among Zumba Fitness Regulars in Kuantan, Pahang, Malaysia
Get PDFINTRODUCTION: Recreational noise exposure has become a major threat to the hearing system, and this includes exposure to loud noise during group exercises such as Zumba Fitness, where loud music plays an important role. This study aimed to assess the noise exposure and hearing threshold profile among Zumba Fitness regulars in Kuantan, Malaysia. MATERIALS AND METHODS: Noise exposure and hearing profile threshold were measured during Zumba Fitness sessions at a fitness studio in Kuantan, Malaysia from 24th June 2014 to 12th August 2014. Noise exposure was measured using a noise dosimeter for one hour of Zumba Fitness session with a total of nine sessions run by three different instructors while sound level pressure was taken using a sound level meter during ambient, peak session and during cooling down. Thirty participants answered questionnaires and underwent pure tone diagnostic audiometry test at a local clinic for hearing threshold documentation. RESULTS: Some areas of the hall posed higher risks of causing noise-induced hearing loss especially near the amplifiers. There were periods when the hearing level exceeded 115 dBA. Early abnormal pattern could be observed in the hearing profiles of some of the participants to suggest preliminary hearing problems. CONCLUSION: Zumba Fitness regulars have a risk of developing noise-induced hearing loss and preventive steps should be properly addressed as NIHL is permanent and irreversible
Interaction of Hematological Analysis and α-globin Genotypes among Eligible Blood Donors
Get PDFIntroduction: Alpha thalassaemia is one of the haemoglobin disorders in which the carriers of alpha thalassaemia may have normal haemoglobin level and are eligible to donate blood which may bring complications. This study is to investigate the interaction of haematological parameter with α-globin genotypes among eligible blood donors. Materials & Methods: A cohort study with 270 eligible blood donors were analysed for red cell indices. Alpha-globin (α-globin) genotyping was performed for seven deletions, six point mutations and two triplications. Statistical analyses were performed to compare the α-globin genotypes with haematological data. Results: High prevalence of α-thalassaemia carriers (7.7%, 21/270) was found among blood donors. All of them did not show anaemic pictures with a normal Hb level (>12 gm/dl). Five genotypes were identified consisting of 249 αα/αα (92.2%), nine -α 3.7/αα (3.3%), nine-- SEA/αα (3.3%), two -α 4.2/αα (0.7%) and one ααCS/αα (0.4%). Different α-globin genotypes showed a significant difference in RBC, MCV, MCH, MCHC, RDW, and Hct/Hb ratio (p<0.05) due to the different extent of α-globin chain reduction. Conclusion: Our study concluded that by using Hb level alone is not sufficient to screen for the eligibility of blood donors. Full blood count (FBC) screening with borderline MCV and MCH levels might be able to rule out silent α-thalassemia carriers. FBC and molecular characterisation should be incorporated together to properly rule out α-thalassaemia carriers.><0.05) due to the different extent of α-globin chain reduction. Conclusion: Our study concluded that by using Hb level alone is not sufficient to screen for the eligibility of blood donors. Full blood count (FBC) screening with borderline MCV and MCH levels might be able to rule out silent α-thalassemia carriers. FBC and molecular characterisation should be incorporated together to properly rule out α-thalassaemia carriers
Acute Myocarditis in a Young Infant: When to Investigate Clinical Suspicion
Get PDFIntroduction: In Malaysia, a course of vaccination DTaP/IPV/Hib was introduced in 2008, replacing the 2006 DwPT-HBV/Hib+OPV vaccines. Severe systemic adverse reactions after diphtheria, tetanus and pertussis vaccination are uncommon. Cardiac complications are rarely reported and is most probably implicated to the pertussis component. We describe a rare case of acute myocarditis that developed 60 hours after DTaP/IPV/Hib vaccination. Case report: A 2-month old infant presented to emergency department after her first diphtheria, tetanus and pertussis vaccination due to severe respiratory distress and cyanosis. She had her BCG and two Hepatitis B vaccinations previously with no major side effects. Parents reported that she was feverish for 48 hours post vaccination with no other associated symptoms. Prior to presentation, she went floppy and was immediately brought to hospital. On arrival, she was tachypnoeic and cyanotic with hypoperfusion and hypotensive. She was also noted to have hepatomegaly. She was grunting and her level of consciousness deteriorated. She was immediately intubated and her first blood gas showed profound metabolic acidosis with pH 6.6, base excess -24mmol/L, lactate 14mmol/L and bicarbonate 4mmol/L. She required fluid boluses and inotrope infusion was commenced. She received antibiotics and sodium bicarbonate to correct her acidosis. Her echocardiography showed global hypokinesia, CK 3018 and positive Troponin. She was treated with immunoglobulin for myocarditis and on high frequency oscillation for 4 days before being extubated on day 11 of admission. All her viral serology and cultures came back negative. Discussion: Cardiac complications after diphtheria, tetanus and pertussis and other vaccinations are exceptionally uncommon. This patient developed sudden onset cardiogenic deterioration after an expected fever-like illness post vaccination. Given her viral screening and cultures were negative, this make acute myocarditis post vaccination a remote possibility. We concur that evaluation of cardiac state should be considered in recently vaccinated infants who manifest with cyanosis, hypoperfusion and drowsiness
Back to the Nature: Effects of Non-Pharmacological Modalities in Mechanically Ventilated Neonates
Get PDFIntroduction: Neonates refers to the first 28 days of life, they are vulnerable to physiological changes. About 15% of neonates get admitted to NICU and a significant number of them end up in ventilation. This study assessed the beneficial role of non- pharmacological modalities on recovery with a better outcome of ventilated babies in NICU. Material and Methods: The study is a quantitative cross-sectional study for 9 months of NICU at IIUMMC. The study will include top conditions warranting neonatal intensive care unit (NICU) admissions and ventilation as preterm, respiratory distress, neonatal sepsis, HIE, and others. They are divided into two (2) groups; the first group will keep the standard practice and assigned as a control group. The second group will afford all or most of a package of non-pharmacological and sensory stimuli like a kangaroo, feeding, non-nutritive sucking, swaddling, skinto-skin contact, sensory saturation, soft massage, away irritant odour, Normal visual experience during daytime and dime light at night-time. decrease sound pollution, and voice stimulation assessing soft music or recitation of the Qur’an according to family preference. We will assess stabilizing vital signs, behavioural assessment, extubating timing, Short term outcome. Results: Adding non-pharmacological modalities could reduce the dose requirements for sedation and analgesics and has a positive effect on the neurodevelopmental outcome. Conclusion: nonpharmacological strategies besides other modalities improved short-term outcomes and the recovery of ventilated babies. The importance of coming back to nature, the effect of special senses and sensory stimulation on neonatal recovery, and ease extubation
Adult Onset Intestinal Malrotation: An Often Neglected Entity
Get PDFIntroduction: Intestinal malrotation is a consequent of deviation from the normal 270 degrees counter-clockwise rotation of the midgut during embryogenesis. It is a typically paediatric disease that manifest itself in the first month of life, usually as midgut volvulus. However adult manifestation of intestinal malrotation is not unheard of, albeit rare. Case report: his is a case report of 46 year old man with chronic abdominal pain who was subsequently diagnosed with intestinal malrotation. He was initially referred for barium enema following an incomplete colonoscopy. The suspicion of intestinal malrotation arose during barium enema, as the large bowel loops were all located on the left side. He subsequently had a plain CT following the barium enema, which confirmed the suspicion. In view of this finding, the patient was offered Ladd’s procedure by the surgical team. The patient duly declined and opted for conservative watchful waiting instead
Biliary Stent Migration Causing Simultaneous Duodenal and Distal Ileal Perforation: A Rare Complication
Get PDFIntroduction: Endoscopic retrograde cholangiogram pancreatography (ERCP) and biliary stenting is a minimally invasive procedure widely utilised to relieve biliary obstruction. Although not common, it is related with several possible complications. Stent migration causing duodenal perforation is 1 of its rare complications as being described in several previous case reports. However up to date there is no case report on migrated stent with subsequent duodenal and distal ileal perforation as will be discussed here. Importance of radiological examinations and its related findings in diagnosing this very rare complication will be described in this article
The Effect of Probiotics on the Development of Oral Cancer: A Systematic Review and Meta-Analysis
Get PDFIntroduction: The prevalence of oral cancer has been reported annually along with high mortality rate. Probiotics have been suggested to possess anti-cancer properties, however the role of these microorganisms on oral cancer is remain unclear. The objective of the present study is to identify the mechanisms exerted by probiotics on oral carcinogenesis by using systematic review and meta analysis with the hypothesis that probiotics inhibit oral carcinogenesis. Materials and method: Comprehensive literature search was conducted on PubMed, Scopus and Web of Science electronic database from January 2019 until April 2019. Main keywords that were used are “probiotic” AND “oral cancer”. Articles that were published in English language were included in this review. Articles were selected independently by three authors and inspected independently by another researcher. The titles and abstracts of the studies were screened to identify studies that meet the inclusion criteria. Full text articles of the remaining studies were assessed to determine the availability to be included in the review. Meta-analysis was conducted by using RevMan 5 software, and the result was graphically plotted on the forest plot. This review was done according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA-P) 2015 guidelines. Results: After thorough screening of the full text articles, seven papers were eligible to be included in the systematic review. The included articles were mainly discussed on the association of probiotics and oral cancer. Two from the seven papers were selected to be analyse for quantitative synthesis (meta-analysis). The present study also showed that, Lactobacillus salivarius REN produces protective effect from developing neoplastic tongue lesions with odd ratio < 1. Conclusion: Probiotics were found to confer positive effect as an inhibitory agent against the oral carcinogenesis thus supported the hypothesis of the present study that probiotics can inhibit oral carcinogenesis
Developing a Framework to Improve the Training of Medical Practitioners in Doctor-Patient Communication Toward Enhancing Societal Well Being
Get PDFIntroduction: Doctor-patient communication is a crucial, unique yet complex relationship in clinical practice due to its therapeutic qualities. With the current emphasis on patient-centred care and patient autonomy, medical practitioners are not only expected to possess clinical and biomedical knowledge but also the skills to develop a therapeutic doctor-patient relationship. Nevertheless, this expectation proves to be an uphill battle to physicians as evidenced from patient complaints which among others include lack of appropriate non-verbal behaviours, absence of paralinguistic elements, lack of trust and empathy. Moreover, unsatisfactory doctorpatient communication has been identified as one of the major elements in litigation cases in the medical field. One fundamental factor which leads to this predicament is the ineffective training of communication skills at the medical schools. Hence, this project aspires to develop a training model on doctor-patient communication skills based on patient-centred approach. The model will give more emphasis on the linguistics and psychosocial aspects of communication. Materials and method: Utilising both qualitative and quantitative approaches i.e. survey, observation, interview, psychological profiling, persona analysis and document analysis, the project aims to identify 1) the key communicative features and 2) the key clinical and psychosocial features to be incorporated in the model. It will then operationalise these features to conceptualise an expert assistance system which shall be used in the training of future physicians. The study will be conducted at the IIUM Kulliyyah of Medicine and it will involve medical students at the undergraduate level. Conclusion: The findings from this proposed research are significant in improvising and enhancing the current training on communication skills provided at the medical schools. With a more ‘humane’ approach to training, indirectly, it will increase the effectiveness in the delivery of health care and achieve sustainability in good health and well-being (SDG3) of the nation