IIUM Medical Journal Malaysia (IMJM)
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Retrospective Study on the Microbial Drug Resistance Profile and Predictive Risk Factors in Early Infection of Open Fractures
Get PDFIntroduction: This study was conducted to evaluate the susceptibility of microorganisms involved in early infection of open fractures in orthopaedics to current prophylactic antibiotics practice and determine the association of various parameters related to the causative organism, patient, injury and management to the resistance of such microorganisms. Methods: This is a retrospective study that reviewed cases collected from the surgical operations record from January 2015 to December 2017 in Hospital Tengku Ampuan Afzan, Kuantan. A total of 179 cases were collected with 110 cases fulfilling the proposed inclusion / exclusion criteria. They all underwent routine debridement followed by culture and sensitivity. Previous clinical records were traced to identify the various risk factors for infection and evaluate these against the resistance of the microorganisms to prophylactic antimicrobial drugs. Results: Admission to the intensive care unit, blood transfusion, antibiotic regime and duration, fracture grade, injury severity score and duration of admission were all significantly associated with resistance of microorganism. The study also demonstrated the predominance of Gram-negative microorganisms constituting 65.9% of isolates. Gramnegative microorganisms were seen more in higher fracture grades and Injury Severity Scale, and longer duration of admission and antibiotic treatment. The overall susceptibility of microorganisms to antibiotics was also demonstrated with up to 68.6% resistance to cefuroxime and 36.9% to Gentamicin. Staphylococcus aureus and MRSA were the commonest Gram-positive organisms while Pseudomonas and Acinetobacter spp. the commonest Gram-negatives. Conclusion: Admission to Intensive Care Unit, blood transfusion, antibiotic regime and duration, fracture grade, injury severity score and duration of antibiotics have a significant positive predictive value to the development of resistance of microorganisms. The shift to predominantly Gram-negative microorganisms indicate an urgency to modify management of open fracture to achieve optimal results. This will also prevent the emergence of new multi-drug resistance microorganism which is already a worldwide public health problem
Pattern of Herbal and Dietary Supplement Usage and Conventional Medication Adherence among Patients with Chronic Kidney Disease: A Survey Finding
Get PDFIntroduction: There is widespread use of herbal and dietary supplements worldwide among patients despite robust clinical evidence of its efficacy. This may lead to adverse effects, such as diabetes, hypertension, stroke, cardiovascular risk and kidney problems due to inappropriate self-prescription. This study was performed to determine the prevalence of herbal and dietary supplements usage among patients with chronic kidney disease and its association with the socio-demographic background and the conventional medication adherence. Materials and methods: A survey was conducted among 78 chronic kidney disease patients attending the Nephrology Clinic, Hospital Tengku Ampuan Afzan, Kuantan, Pahang. Data were collected using a questionnaire and analyzed using descriptive statistics, Chi Square Test and Fisher’s Exact Test. The p-value was set to be less 0.05 for its level of significance. Results: Most of the patients aged more than 50 years (89.7%), female (53.8%), unemployed (41%) and from lower socioeconomic earners (75.6%). Only 5.2% of respondents reported using herbal and dietary supplements. There was no association between socio-demographic background with the herbal and dietary supplements usage. Similarly, there was no association between herbal and dietary supplements usage and the conventional medication adherence. Conclusion: This study provides a good baseline on the usage of herbal and dietary supplements use among chronic disease patients. It can be concluded that the level of awareness among the patients is good. Nevertheless, a larger study shall be performed in the future to explore the pattern of association
A Rare Cause of Dyspepsia: A Case Report of Gastric Diverticulum
Get PDFA gastric diverticulum is an outpouching from the gastric mucosa. It is extremely rare. It is normally asymptomatic, but some may present with non-specific abdominal pain. A combination of upper gastrointestinal endoscopy and radiological contrast study such as oral barium study and computed tomography are needed to make a definite diagnosis and to rule out other associated pathology. Although treatment with medical therapy has been reported to be effective, the use of open and laparoscopic resection also yields a good outcome in the management of complicated gastric diverticulum. We present a case of symptomatic gastric diverticulum which has been successfully treated with medical therapy
Knowledge, Attitudes and Behaviours Towards Exclusive Breastfeeding Amongst Mothers in Sarawak, Malaysia: A Qualitative Study
Get PDFIntroduction: Exclusive breastfeeding is recommended as the optimal method of infant feeding for the first six months, but the rate remains low in many countries, including Malaysia. It is important to understand barriers preventing exclusive breastfeeding, to enable tackling these issues and thereby improving maternal and child health. This study aims to do this by exploring the knowledge, attitudes and behaviours of mothers towards breastfeeding in Sarawak, Malaysia. Material and Methods: Qualitative methods were employed, using semi-structured interviews with an interpreter, conducted in Sarawak General Hospital between 16th April and 11th May 2012. Convenience sampling was used to recruit participants from the maternity wards. Interviews were conducted using a topic guide, were audio-recorded and transcribed verbatim. Analysis was based on conventional content analysis, with codes and themes developing from the interviews. Results: Analysis of the 17 interviews identified five major themes; (1) positive attitudes towards breastfeeding, (2) lack of knowledge relating to exclusive breastfeeding, (3) fear of insufficient milk, (4) methods to improve awareness and knowledge of breastfeeding, (5) improvements in the workplace. There is a lack of knowledge amongst mothers in Malaysia regarding breastfeeding, causing anxiety and early discontinuation of breastfeeding. Methods to improve education of mothers and healthcare staff have been suggested, as well as improvements to encourage breastfeeding in the workplace. Conclusion: Focused education for new mothers and widespread community education may help improve breastfeeding continuation rates. The provision of workplace facilities and flexible working hours for new mothers may help overcome physical barriers preventing breastfeeding continuation once back at work
Surgical Challenges in Management of Transected Pancreatic Duct in Blunt Trauma
Get PDFIsolated blunt pancreatic injury with ductal involvement is rare following a motor vehicle collision, but correlates with significant morbidity and mortality. We reported a 15-year-old male who presented to emergency department after sustained motor vehicle collision. Post trauma, he appeared drowsy but hemodynamically stable. Abdominal examination was unremarkable but FAST scan was positive and he was subjected for CECT abdomen and showed pancreatic laceration at the body with suspicious of pancreatic duct injury. He was planned for emergency exploratory laparotomy and intra-operatively noted pancreatic head laceration with transected pancreatic duct. The case proceeded with ligation of pancreatic duct cephalic stump, and distal pancreaticogastrostomy. Post operatively, the patient recovered well and he was discharged home on day 6 post operatively. Upon follow up visit, he was asymptomatic with repeated ultrasonography of abdomen showed no evidence of intra-abdominal collection. Discussion: Pancreatic injuries with ductal disruption are of special significance. Apart from bleeding, the leak of enzyme rich of pancreatic juice incites vigorous inflammatory cascade that lead to catastrophic changes in patient metabolism and its sequelae including pancreatic necrosis, peripancreatic abscess, pseudocyst, enteric fistulae and organ failures. In a hemodynamically stable patient, CECT abdomen is the investigation of choice to detect pancreatic duct involvement. Pancreatic injury with ductal involvement require surgical management to prevent the complication of pancreatic enzyme leak. Non operative measure is found to be useful in selected patient. The criteria for nonoperative group are stable hemodynamically, a controlled leak wall off like pseudocyst, absent associated injury or pancreatic necrosis. Non-operative strategy requires multidisciplinary involvement with excellent nutritional support, expert endoscopist and interventional radiologist
A Rare Case Report of Ectopic Tooth in Submandibular Salivary Gland’s Duct
Get PDFThis case report highlights mandibular tooth in an ectopic position in the floor of the mouth, associated with submandibular salivary gland, which was completely obliterating the Wharton duct. Very few such cases have been reported in the literatures. Since ectopic tooth may lead to pain, discomfort sensation upon mastication, and even infection (sialadenitis), its diagnosis and treatment is essential
Outcome of Delayed Decompression Surgery for Cauda Equina Syndrome secondary to Lumbar Disc Herniation: A Case Report
Get PDFCauda equina syndrome (CES) is a constellation of symptoms which consist of low back pain, sciatica, saddlearea paraesthesia, urinary or faecal incontinence, with or without motor weakness, and sensory deficit. Surgical decompression is indicated as soon as possible, as decompression within 48 hours from onset allows maximum improvement of symptoms. Recovery usually occurs months or years postoperatively. We report a case of a patient with cauda equina syndrome secondary to massive lumbar disc herniation who had undergone urgent decompression one week after onset of urinary and bowel dysfunction. The clinical outcome post surgery was also discussed
Prevalence and Determinants of Pre-Hypertension among Undergraduate Preclinical Medical Students in Central Malaysia
Get PDFIntroduction: Pre-hypertension, a classification of blood pressure ranging from 120–139 mm Hg systolic and/ or 80–89 mm Hg diastolic, has been introduced to identify those high-risk group of developing hypertension to implement early intervention to halt disease progression. This study determines the prevalence of pre-hypertension and its determinants among undergraduate preclinical medical students in Malaysia. Materials & Methods: This was a cross-sectional study conducted among 158 registered second year medical students at one research university in central Malaysia from January to April 2018. Results: The prevalence of pre-hypertension was 20.6% among undergraduate preclinical medical students. The most respondent was female (69.9%), Malay ethnic (50.6%) who had normal body mass index (67.3%), no depression (79.5%), no anxiety (60.3%), no stress (68.6%), low physical activity level (44.9%), never smoked (95.5%), and never consumed alcohol (87.8%). Some respondents had positive family history of hypertension (43.6%) and diabetis mellitus (31.4%). After adjusted for all variables, gender (AOR=14.45, 95% CI 5.58-37.43) and depression status (AOR=6.37, 95% CI 1.29-31.49) were significantly associated with pre-hypertension. Conclusion: The prevalence of pre-hypertension among preclinical medical students was lower compared to other country, predicted by gender and depression status. However, further comprehensive multicentered studies in Malaysia with larger sample size is recommended to get more precise results in identifying determinants for pre-hypertension so that early intervention could be implemented nationwide
Proteomic Profiles of Young Adults with Acute Myocardial Infarction
Get PDFIntroduction: Proteomic profiling is essential in understanding the pathophysiological process of multifactorial diseases such as acute myocardial infarction (AMI). Despite the increasing incidence of AMI in young adults, proteomic-based study focusing on young AMI remains limited. This study aimed to examine the plasma proteomic profiles of young adults with AMI compared to control subjects. We also hope to identify disease-specific protein biomarkers that contribute to the development of AMI in the young. Methods: Pooled plasma protein from 10 AMI patients aged 18 to 45 years and 10 age, gender and race - matched volunteers were separated using two-dimensional electrophoresis (2-DE). The spots proteins were analysed using the PD Quest analysis software. The spots proteins that were found to have been expressed differently between the two groups were identified by Matrix Assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF) Mass Spectrometry. Results: There were three differently expressed proteins namely Apolipoprotein AI (Apo AI), Apolipoprotein AIV (Apo AIV) and Haptoglobin (p < 0.05). The expressions of these proteins were found to be increased in young patients with AMI compared to control subjects. Conclusion: The up regulation of Apo AI, Apo AIV and Haptoglobin in AMI patients indicate their important roles in the development of atherosclerotic disease. Thus, Apo AI, Apo AIV and Haptoglobin are potential disease biomarkers for young AMI
Socioeconomic Disparity and Depression Among Internal Migrant Workers In Myanmar
Get PDFBackground: Over the past few decades, Myanmar has faced mass internal migration to seek job opportunities and pursue a better life. Migration gives rise to unambiguous stress and depression. This study aimed to assess the magnitude of depression and to identify the association between socioeconomic disparity and depression among migrant workers in Myanmar. Methods and Materials: Cross-sectional study was done among 1,201 migrants in Yangon Region. To assess the socioeconomic status, mental health status, accessibility of health care service and Quality of Life by developing self–administered questionnaire. The Generalized Linear Mixed Model was applied to determine the association between socioeconomic disparity and depression after adjusting for other covariates. Result: Their average age was 31.44 ±10.31 years. Gender distribution was not much different. About one third of respondents were factory workers and had low level of education. The magnitude of depression was 38.22% (95%CI= 35.50-41.00). Regarding the socioeconomic disparity, adequacy of income (AOR= 1.79, 95%CI: 1.35-2.37, p value<0.001) and floor surface area of the houses (AOR= 1.21, 95%CI: 1.00-1.47, p value><0.001) were strongly associated with depression. Moreover, other factors that were associated with depression were stress, quality of life and burden of medical service cost. Conclusion: Two-fifth of internal migrant workers suffered depression. The findings highlighted to develop intervention aimed to improve mental health status among migrants. In order to achieve the sustainable development goals, it is important to make investment on mental health of the migrant workers.> <0.001) were strongly associated with depression. Moreover, other factors that were associated with depression were stress, quality of life and burden of medical service cost. Conclusion: Two-fifth of internal migrant workers suffered depression. The findings highlighted to develop intervention aimed to improve mental health status among migrants. In order to achieve the sustainable development goals, it is important to make investment on mental health of the migrant workers