IIUM Medical Journal Malaysia (IMJM)
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Compliance of Hour-1 Sepsis Care Bundle in Patients with Surgical Infection Requiring Surgery in Hospital Tengku Ampuan Afzan
Get PDFIntroduction: Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. According to Sepsis 3 definition, an increase of 2 or more in the qSOFA score should create a suspicion of sepsis and organ dysfunction. It is a dire condition as studies show; patients with a qSOFA score of ≥ 2 have a mortality rate of ≥ 0%. The Surviving Sepsis Campaign guidelines have depicted an Hour-1 Sepsis Bundle in managing patients with sepsis which has proven to reduce morbidity and mortality. The objective of this study was to analyze the demographic data of patients presenting with surgical sepsis requiring surgery and compliance to the Hour-1 Sepsis Bundle, concurrently the mortality rate of these patients. Materials and Method: A retrospective epidemiological study was done from the 1st of October to the 31st of December 2018. Patients included in the study were all patients with evidence of surgical infection requiring emergency surgery and patients presenting with trauma were excluded. This number of patients was then scrutinized into patients with evidence of sepsis, subsequently the compliance to the Hour-1 Sepsis Bundle. Results: The analysis showed that 23 of the 156 patients with surgical infection requiring surgery were in sepsis. Of this, 5 patients succumbed during the same admission. Results also showed patients who developed sepsis in their 5th decade of life are more susceptible to death. In accordance with the Hour-1 Sepsis Bundle, compliance to measuring lactate level was 70%, obtaining blood culture was 47.8%, administration of antibiotics was 82.6% and rapid administration of crystalloid was 0%. All three patients requiring vasopressors were started on vasopressors within the hour. Conclusion: Compliance to the Hour-1 Sepsis Bundle in whole was unsatisfactory. This was noticeably apparent especially to fluid resuscitation where it was not delivered as recommended by the Sepsis Bundle
The Neorectum Reservoirs
Get PDFThe incidence of rectal dissection is increasing with the rise of rectal cancer all over the world. This technique has been used regularly to provide a reasonable quality of life for patients. The concern raised was the functions of these neorectum to replace the original rectum. Several configurations have been suggested namely the straight end-to-end coloanal anastomosis, side-to-end coloanal anastomosis, colonic Jpouch and the transverse coloplasty to suit the anatomy of the deep pelvis. Apparently, there was no difference in terms of functional outcome among all these four types of reconstructions. However, these configurations have seen the emergence of anterior resection syndrome or a pragmatic defaecatory dysfunction as their complications. Furthermore, the neorectum functions are affected by many other factors such as preoperative chemoradiotherapy, septic complications, and others more
The Pursuit of Covid-19 Animal Models
Get PDFCoronavirus disease 2019 (COVID-19) is a contagious disease instigated by a recently discovered coronavirus, the 2019 novel coronavirus (2019-nCoV). It has infected over 14 million people worldwide from all age groups. This virus is conveyed through big droplets produced during coughing and sneezing by the infected individuals. COVID-19 precipitates acute respiratory distress syndrome which leads to morbidity and mortality in severe cases. To date, there is neither an established specific antiviral treatment for COVID-19, nor vaccine available. Preventive measure of social distancing is deemed to be the most effective way to avoid the spread of the virus. Scientists are currently in search of appropriate COVID-19 animal models for use in research works related to pathogenesis, potential drug treatments and vaccine development. This review delivers a pithy overview of the currently available COVID-19 animal models published in the literatures
Behavioural Issues among Primary Schoolchildren with Colour Vision Deficiency
Get PDFIntroduction: Colour vision deficiencies may raise behavioural changes among children. This study explores the presence of any behavioural issues faced by primary schoolchildren with congenital red-green colour vision deficiency (CRGCVD). Materials and Methods: Male schoolchildren, aged 8-11 years old, from 10 randomly selected schools in Klang Valley were screened using Ishihara plates and Farnsworth D-15 test. Children with CRGCVD (study group) and without CRGCVD (control group) were asked to complete the Strength and Difficulties Questionnaire (SDQ) for children (self-report) while their class teachers completed the SDQ for teachers (teacher- report). Difficulty scores were calculated. The test categorised behaviour into 3 categories based on the difficulty scores into ‘normal’, ‘borderline’ and ‘abnormal’ behaviours. Nonparametric test was used to compare the median of difficulty scores between control group and study group. Spearman correlation was used to determine association between self-report SDQ and teacher-report SDQ. Results: A total of 134 schoolchildren were recruited in this study, of which 44 had CRGCVD and 90 were in the control group. Teacher-reported SDQ for the children were obtained from 134 teachers. No statistically significant differences (p>0.05) were noted between the total SDQ scores of children with and without CRGCVD using self-report SDQ and teacher-report SDQ. The total difficulty scores of self-report SDQ and teacher-report SDQ were poorly but significantly correlated. Teachers rated 9.09% of children with CRGCVD as falling under the ‘abnormal’ category, slightly higher than self-rated of 2.27%. Conclusion: This study found no prominent behavioural issues among schoolchildren with CRGCVD
Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index as an Assessment Tool to Indicate Total Knee Arthroplasty in Patients with Primary Knee Osteoarthritis
Get PDFIntroduction: The WOMAC questionnaire is used extensively in the assessment of knee osteoarthritis butnot as an indicator of total knee arthroplasty (TKA). We aimed to assess if the WOMAC score can be used asan assessment tool to indicate TKA in primary knee osteoarthritis. Materials and Methods: Patients withprimary knee osteoarthritis Kellgren and Lawrence grades 3 or 4 were assessed separately by either one oftwo arthroplasty surgeons for indications to undergo TKA and evaluated using the WOMAC score. Patients whohad received any form of intra-articular knee injection within six months before assessment were excluded.Patients were divided into two groups; indicated for TKA, and for non-surgical treatment. The mean WOMACscore of patients from both groups was compared using Independent t-test. The accuracy at different cut-offpoints in the score indicated for TKA was determined using the receiver operating characteristic (ROC) curveplotted on sensitivity and 1-specificity graph. Results: The study included 74 patients with a mean age of62.5 years (SD=8.26). There was a significant difference in the total WOMAC score (p<0.001) and itscomponents between patients of the two groups. At the cut-off point of 30, the specificity and sensitivity ofthe score indicated for TKA was 91.18% and 95.00% respectively. The positive predictive value was 93.24%.Conclusion: We recommend all primary knee osteoarthritis Kellgren and Lawrence grades 3 or 4 with ascore of 30 and above should be referred to an arthroplasty surgeon for the possibility of requiring TKA
Oral Health Literacy among Public University Undergraduate Students and Associated Factors
Get PDFIntroduction: Oral health literacy is an essential element of an individual to make better oral health decision. Low oral health literacy (OHL) is associated with poor oral health decision and outcome. This study aimed to determine factors associated with oral health literacy among undergraduate students in one of the public universities of Malaysia. Materials and methods: This is a cross-sectional study which was undertaken among the undergraduate students of Universiti Sains Islam Malaysia (USIM). Sample selection was done randomly. A validated oral health literacy index of Malay version was used throughout the study. Ethical approval was obtained from the University Research Ethics Committee and respondents had given their consent prior to the data collection. Data analysis was performed using IBM SPSS software version 24.0 and the significant level was set at p< 0.05. Results: The mean oral health literacy of the university undergraduate students was 77.7 (95% CI= 76.75, 78.71). Multiple linear regression indicated that female has higher OHL (β= 4.19; 95% CI= 1.99, 6.39; p< 0.001), social science stream has lower OHL (β= -9.14; 95% CI= - 11.20, -7.07; p< 0.001) and higher education level of father had higher OHL (β= 1.97; 95% CI= 0.10, 3.83; p= 0.039) than their counterparts. Conclusion: Oral health literacy is higher among the science streams students compared to the social sciences streams. This suggests that science education might play a significant role in health literacy and improving health outcomes
Surgical Excision of Dumbbell-shaped Vagus Nerve Schwannoma: A Case Report
Get PDFSchwannoma is a benign peripheral nerve sheath tumour that arises from the uncontrolled proliferation of Schwann cells. Intracranial and extracranial vagus nerve schwannoma is an extremely rare entity that poses a surgical challenge due to its delicate location in the cerebrum and parapharyngeal space adjacent to major neck vessels. This report describes a unique case of a 42 years old female with left dumbbell vagus nerve schwannoma, involving both the intracranial and extracranial portion of the left vagus nerve, extending into the parapharyngeal space. She underwent a two-stage surgery in which intracranial vagus schwanomma was debulked initially, and excision of the extracranial schwanomma in the parapharyngeal space was performed in a later setting via a transcervical approach
Matrix Metalloproteinases In Cancer Biology: A Review
Get PDFMatrix metalloproteinases (MMPs) are a group of proteinases that are involved with the enzymatic breakdown of the extracellular matrix and basement membrane components. These enzymes are important in regulating vital physiological functions such as embryonic development, wound healing and tissue remodelling. However, several disorders may result from the exaggerated function of these enzymes such as ulcers, rheumatoid arthritis and invasive tumours. In tumours, the effect of these enzymes is not limited to invasion as it was traditionally believed but it also extends to the other oncogenic hallmark processes such as proliferation, angiogenesis, epithelial-mesenchymal transition and evasion from apoptosis. Therefore, it is essential to thoroughly understand the molecular mechanisms involved in these enzymes in cancerous tissue based on recent literature. Several reviews have highlighted the function of these enzymes in malignancies however the aim of this was to provide more recent overview to their role in malignant transformation and progression and in a briefer approach summarizing the complex molecular pathways. Online databases such as PubMed, Google scholar, Web of Science and MEDLINE were used to identify relevant articles. This approach would assist researchers by providing a list of the potential molecular targets in the sequence of changes related to these enzymes. This might help in designing a safer and a more specific targeted treatment for patients with cancer
Mnemonic and Histopathological Assessment of the Neuroprotective Effects of Murraya Koenigii Leaves Extract in Rats with Partial Global Cerebral Ischaemia
Get PDFIntroduction: Preclinical studies have reported that Murraya koenigii leaves (MKL) could enhance memory. MKL is also known for its antioxidant activity. The current study was to assess the possible neuroprotective potential of MKL methanolic extract in a two vessel occlusion (2VO) rat model of partial global cerebral ischaemia. Methods: Rats were divided into memory and learning groups. Each group was subdivided into sham control, untreated 2VO and MKL-treated 2VO subgroups. The Morris water maze test was implemented to assess the rats’ cognitive function postoperatively. Brain samples were histopathologically examined for viable neurons within the CA1 hippocampal region. Results: Water maze test findings showed that MKL positively improved memory and learning impairments. However, this improvement in memory test for the treated group was still significantly inferior to that of the healthy control group. Additionally, MKL treated group exhibited insignificant difference in the number of viable hippocampal CA1 pyramidal neurons from that of the untreated 2VO group, whereas both MKL treated and untreated 2VO groups showed significantly less viable neurons when compared with the control group. Conclusion: MKL extract modestly improved memory without providing substantial neuroprotective action to the hippocampal neurons in rats with chronic partial global cerebral ischaemia