IIUM Medical Journal Malaysia (IMJM)
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The Effect of Lifestyle Modification Intervention with Motivational Construct on Dietary Macronutrient Intake among Obese Adults
Get PDFIntroduction: An unhealthy dietary practice as a result of environmental and societal changes is increasingly exposed to adults. These unhealthy practices lead to an increased cardiometabolic risk, and obese adults are at a higher risk as compared to normal-weight adults. The best strategy to promote healthy lifestyle practices among Malaysian obese adult is still fragmented. Materials and Methods: A single-centre randomised controlled trial was carried out to determine the effect of the lifestyle modification intervention (LMI) with the motivational construct, in comparison to the current standard LMI on the dietary macronutrient intake among obese adults. The dietary macronutrient intake and changes in body weight were assessed at baseline and after six months. Seventy-nine participants completed the study. Results: Our finding showed that six months of LMI with motivational construct resulted in a higher reduction of total fat and cholesterol from the dietary intake as compared to the control. In addition, the participants in the intervention group had a significant body weight loss after six months (-1.97 kg, 95% CI: -0.324, 1.360, t(39) = 3.397, p = 0.002). Conclusion: This study demonstrates that the intervention had a meaningful impact on improving the dietary macronutrient intake, which is beneficial to support body weight loss in obese adults. Future trials with additional nutritional biomarkers are needed to extend these findings
Medical and Islamic Perspectives on Human Immunodeficiency Virus Infection and its Prevention
Get PDFHuman Immunodeficiency Virus (HIV) that causes Acquired Immune Deficiency Syndrome (AIDS) is one of the world’s most serious health and nation-state destructions. It creates long-term economic and psychosocial impact on the lives of individuals, families and communities. Since the first reported case of HIV/AIDS in Malaysia in 1986, its prevalence has escalated significantly. As of December 2017, there are over 115,263 reported cases of HIV infections in the country and over 40,000 people died from HIV/AIDS.1 Although many religious people regarded HIV infection as a divine punishment for their sins of sexual promiscuity, Islamic teaching emphasises the prevention of the disease and care for people living with HIV or AIDS. It is imperative to discuss the Islamic perspectives in providing ways to prevent the spread of HIV and support to people living with HIV (PLHIV). This article focuses on epidemiological data; highlight the burden of HIV infection/AIDS in Malaysia and its impact on the society, HIV infection from medical perspective and its preventive measures from Islamic viewpoints. A good teamwork among healthcare providers and religious leaders is compulsory as it may improve the preventive strategies to curb the disease in the country
Listening to Islamic Praises (Dzikr) is More Effective in Reducing Perioperative Anxiety Levels when Compared to Nature-Based Sounds in Muslim Patients Undergoing Surgery Under Regional Anaesthesia
Get PDFIntroduction: Many studies have investigated the effects of music on perioperative anxiety and its implication on anaesthetic practice, however there are limited number of studies reported for religious or spiritual intervention in this aspect. We investigated the effects of listening to Islamic praises (Dzikr) and nature-based sounds delivered via headphones as non-pharmacological interventions for perioperative anxiety. Materials and Methods: Sixty-three Muslim patients scheduled for elective lower limb surgery under regional anaesthesia were randomly assigned to listen to Dzikr (Group A), nature-based sounds (Group B) or given headphones without any sounds (Group C). Anxiety levels were assessed using a visual analogue scale for anxiety (VAS-A). Physiological responses (mean arterial pressure, heart rate and respiratory rate) as well as patients’ overall satisfaction level were documented. Results: Patients in Group A demonstrated statistically significant lower VAS-A scores compared to those in Group B and C at 30-minutes after skin incision (p=0.002 and p=0.001 respectively) and at the end of the surgery (p=0.028 and p<0.001 respectively). Patients in Group A recorded significantly higher satisfaction levels compared to those in Groups B (p=0.038) and C (p=0.001). No significant differences were seen for the physiological responses, nor was there any additional anxiolytic requirement among the three groups. Conclusion: Listening to Dzikr among Muslim patients was more effective in reducing perioperative anxiety levels when compared to nature -based sounds, in patients who had undergone lower limb surgery under regional anaesthesia. ><0.001 respectively). Patients in Group A recorded significantly higher satisfaction levels compared to those in Groups B (p=0.038) and C (p=0.001). No significant differences were seen for the physiological responses, nor was there any additional anxiolytic requirement among the three groups. Conclusion: Listening to Dzikr among Muslim patients was more effective in reducing perioperative anxiety levels when compared to nature -based sounds, in patients who had undergone lower limb surgery under regional anaesthesia
Living in Rural Areas of Peninsular Malaysia: Risk Factor for Goitre
Get PDFIntroduction: Thyroid disorders are among common medical conditions encountered in clinical practice. However, the disease burden among Malaysian population has not been established. This study was aimed to determine the prevalence of goitre and its associated factors among adult population in Peninsular Malaysia. Materials and Methods: A cross-sectional study was performed in 5 pre-assigned regions in Peninsular Malaysia. Participants’ sociodemographic profile and medical history were recorded. Physical examinations were done looking for abnormalities of the thyroid gland and signs of thyroid dysfunctions. The diagnosis of goitre was made by palpation and corroborated by the repeat examination by another investigator. The World Health Organization (WHO) goitre grading system was used. Fifteen millilitre of blood were withdrawn and analysed at a central laboratory. Results: Among 2190 respondents, the prevalence of goitre was 9.3%. Goitre was associated with positive anti-thyroperoxidase and anti-thyroglobulin antibodies. Females were at higher risk of goitre (adjusted OR = 2.4; 95% CI 1.6–3.5; p<0.001). The other risk factors of goitre were Indian ethnicity (adjusted OR=2.0; 95%CI 1.2–3.3; p=0.006), positive anti-thyroperoxidase (adjusted OR=1.8; 95% CI 1.1-3.1; p=0.024) and living in rural area (adjusted OR = 1.7; 95% CI 1.2–2.5; p=0.002). These areas had been shown to suffer from some degree of iodine insufficiency in the past. Conclusions: The prevalence of goitre in Peninsular Malaysia was comparable with other studies. The main predictors of thyroid disorders are female gender and thyroid antibodies. Living in rural areas was associated with goitre. ><0.001). The other risk factors of goitre were Indian ethnicity (adjusted OR=2.0; 95%CI 1.2–3.3; p=0.006), positive anti-thyroperoxidase (adjusted OR=1.8; 95% CI 1.1-3.1; p=0.024) and living in rural area (adjusted OR = 1.7; 95% CI 1.2–2.5; p=0.002). These areas had been shown to suffer from some degree of iodine insufficiency in the past. Conclusions: The prevalence of goitre in Peninsular Malaysia was comparable with other studies. The main predictors of thyroid disorders are female gender and thyroid antibodies. Living in rural areas was associated with goitre
Normal Vestibulo Ocular Reflex (VOR) gain Measured Using the Video Head Impulse Test (vHIT) in Healthy Young Adults
Get PDFIntroduction: Many new objective tests to assess the function of specific structures of the vestibular organ are currently adopted in vestibular clinics. One of the objective assessments include the video head impulse test (vHIT) where gain & velocity responses of eye relative to the head movements are recorded using an infrared camera. Methods: Thirty normal hearing subjects age between 18 to 25 years old participated in this study. At least ten Lateral, Left Anterior Right Posterior (LARP), and Right Anterior Left Posterior (RALP) responses were recorded for each participant by making small and rapid unpredictable head movements. Results: The average velocity gain for Lateral responses at 40 ms, 60 ms and 80 ms were 1.05 ± 0.003, 1.03 ± 0.002 and 1.01 ± 0.003 respectively. The LARP average velocity regression were 1.01 ± 0.24 for Left Anterior and 1.05 ± 0.25 for Right Posterior, with an average gain asymmetry of 5.13%. The RALP average velocity regression were 1.08 ± 0.31 for Right Anterior and 1.12 ± 0.30 for Left Posterior, with an average gain asymmetry of 5.87%. One sample T-test were conducted to compare Lateral responses to a previous study by Mossman et al. (2015) where significant differences in velocity gain at 60 ms and 80 ms between studies were found where, t (59) = 5.56, p <0.01 and t (59) = 2.86, p >< 0.01 respectively. Conclusion: This indicates the importance of establishing on-site norms for every clinical settings as techniques used and equipment differences could affect the results
The Effects of Ficus Carica Fruit on Bone Markers and Oestrogen Level of Post-Menopausal Osteoporotic Rats
Get PDFIntroduction: Post-menopausal osteoporosis is the most common type of osteoporosis, which occurs due to a deficiency of oestrogen following menopause. Considering the adverse effects of oestrogen replacement therapy, natural products may serve to replace the current conventional treatment. Ficus carica (FC) which is commonly known as fig may have a potential in treating post-menopausal osteoporosis due to their abundance of important minerals and bioactive compounds such as phenolic, flavonoid and anthocyanins. This study aimed to evaluate the effects of FC on bone metabolism of ovariectomized rats. Materials and Methods: Fifty-six female Spraque-Dawley rats were randomly divided into seven groups; SHAM operated (SHAM), ovariectomized control (OVX), ovariectomized + 64.5 µg/kg oestrogen (ERT), ovariectomized + 50 mg/kg aqueous extract of FC (AQ50), ovariectomized + 100 mg/kg aqueous extract of FC (AQ100), ovariectomized + 50 mg/kg raw FC (RW50), and ovariectomized + 100 mg/kg raw FC (RW100). After eight weeks of treatments, rats were euthanized and femurs were dissected out to measure bone osteocalcin, Ctelopeptide of type 1 collagen and bone estrogen level. Results: RW50 and RW100 showed an increasing trend in osteocalcin levels and also oestrogen level, but no significant difference between all groups. RW50 and RW100 also showed significantly reduced C-telopeptide of type 1 collagen levels compared to OVX group. Conclusion: These findings suggested that raw FC at the doses of 50 mg/kg and 100 mg/kg have potential to improve bone in treating post-menopausal osteoporosis. However, this need to be confirmed with higher doses
Management of Traumatic Perineal Degloving Injury: A Case Series
Get PDFDegloving injury is severe and commonly results from a huge rotational force which avulses the skin and subcutaneous tissue from its underlying fascia. This injury is associated with high morbidity and mortality if mismanaged. Perineal degloving injury commonly associated with urethral injury which can be further classified into anterior and posterior urethral injury. This study retrospectively evaluated management of traumatic perineal degloving injury compared to standard approach. A total of 3 cases of open perineal degloving injuries been identified and was managed at our centre at the year 2017. 2 cases of degloving wound of scrotum and one case of crush perineal injury with transected posterior urethral were included. We reviewed methods of management and clinical outcomes of these patients. All patients promptly underwent wound debridement and surgical repair after immediate diagnosis and resuscitation. Suprapubic insertion of catheter is crucial in managing the urethral injury. The case of crush perineal injury with transected urethral treated with operation primary urethral anastomosis, de-functioning of stoma and external fixation of pelvis. Unfortunately, this case was complicated with rupture at anastomotic urethral site after a traumatic CBD insertion during his hospitalization and he was treated conservatively with CBD. All patients did well clinically with their wounds healed well. We showed a multidisciplinary team approach consisting of colorectal surgeon, urologist, orthopaedics surgeon and plastic surgeon, together with prompt diagnosis provides the best outcome were for the treatment of open perineal degloving injury
Perspectives Review of Management in Renal Injury: A Single Centre Experience
Get PDFIntroduction: Renal injury occurs in 1%–5% of all trauma cases. The objective of this retrospective study is to register a clinical audit on renal injury management of a single center. Materials and Methods: All renal–related trauma cases presented to Penang Hospital between August 2015 and July 2017 were included in this audit. These injuries were classified using American Association for the Surgery of Trauma (AAST) renal injury scale. Results: A total of 145 cases of renal trauma were audited; of which 40 cases of Grade I injury, 30 cases of Grade II, 45 cases of Grade III and 30 cases constituting Grade IV and V injury. Broadly, these patients were managed via two main approaches; 138 (95.27%) via conservative approach and 7 (4.83%) via surgical intervention. Among those who underwent surgical intervention, 3 had emergency nephrectomy performed while the other 4 had ureteric stenting. Conclusion: Literature review had shown up to 95% of renal injuries can be successfully managed conservatively, especially in cases of blunt trauma. The clinical audit of our center demonstrates that the perspective of renal injury management is in par with internationally acclaimed general consensus; hence affirms the feasibility of conservative management in a vast number of cases, with a prudential role for surgical intervention in severe injuries
The Effects of Aquilaria malaccensis Leaves Aqueous Extract on Sperm of Sprague Dawley Rats towards Early Embryogenesis
Get PDFIntroduction: Oxidative stress induced by excessive and unopposed levels of reactive oxygen species in male reproductive system results in impaired sperm quality, fertilization capacity and poor embryo development. Our goal is to assess the potential effects of Aquilaria malaccensis (AM) leaves, a plant with strong antioxidant property on early embryo development in vitro and embryo quality following fertilization with cyclophosphamide (CP) exposed rat sperm. Materials and Methods: Twenty four male Sprague Dawley rats were allocated into eight groups of three rats (n = 3): control, CP only (200 mg/kg), AM only (100 mg/kg, 300 mg/kg and 500 mg/kg) and CP + AM (100 mg/kg, 300 mg/kg and 500 mg/kg). Animals were sacrificed after 63 days of treatment and sperm from caudal epididymis were taken for in vitro fertilization (IVF) with oocytes from untreated female. Fertilization, embryo division and embryo morphology were examined at 8 and 48 hours post insemination and compared between groups. Statistical evaluations were performed using Chi-Square test and Fisher’s exact test and p-value <0.05 was considered significant. Results: Administration of AM leave extract at 100 mg/kg/day to normal rats and CP-exposed rats has significantly increased (p><0.05) the fertilization rate, early cleavage rate and embryo quality when compared to CP only treated group. However, other groups showed no significant differences. Conclusion: Overall, the present results indicate the potential of AM leave extract supplementation to improve the fertility and early embryo development in male rat exposed to CP by inhibiting the oxidative processes and scavenging free radicals.>
Validation of the Malay Version of the Hospital Anxiety and Depression Scale among Patients with Traumatic Brain Injury
Get PDFIntroduction: Depression and anxiety are common complications associated with traumatic brain injury (TBI) patients but screening tools which are validated to assess these complications in the TBI population are scarce. This study investigated the validity of the Malay version of Hospital Anxiety and Depression Scale (HADS) to screen for depression and anxiety among Malaysian TBI patients. Materials and Methods: This cross -sectional study recruited 101 TBI patients in which they were administered the Malay version of HADS and the Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorder 4th Edition (DSM-IV) for Axis I Disorders (SCID-I) (as comparison tool). Internal consistency (Cronbach’s α) and concurrent validity (using receiver operating characteristics) of the Malay version of HADS were evaluated. Results: The total Malay version of HADS score and its anxiety subscale exhibited good internal consistency of 0.80 and 0.78 respectively, but the internal consistency of its depressive subscale was low at 0.57. The depressive subscale of the Malay version of HADS exhibited high area under the curve (AUC) of 0.86, specificity of 82%, sensitivity of 76% and negative predictive value of 91% but its positive predictive value was 58%, at cut-off point of 8/9. While the anxiety subscale also demonstrated high AUC of 0.88, specificity of 71%, sensitivity of 93% and negative predictive value of 98% its positive predictive value was only 34%. Conclusion: The Malay version of HADS is a valid screening tool for depression and anxiety among Malaysian TBI population