IIUM Medical Journal Malaysia (IMJM)
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Ultra-Processed Food Classification, their Contribution to Sodium and Added Sugar Availability, and its Relationship with Nutritional Status among Adults in Terengganu, Malaysia
Get PDFIntroduction: This cross-sectional study aims to determine the provision of foods according to NOVA classifications (an ultra-processed classification), to assess contribution of sodium and added sugar availability in each of NOVA food groups, and to evaluate nutritional status as well as to determine the relationship between sodium, added sugar availability of each NOVA foods groups and nutritional status among adults in Terengganu. Materials and methods: About 200 respondents aged between 18 and 59 years old from Kuala Nerus, Terengganu were recruited. Their dietary intake from two days of 24-hour dietary recall underwent NOVA classification and analyzed through Nutritionist Pro. All respondents had their blood pressure and fasting blood glucose taken. Spearman’s rank correlation was used to evaluate the relationship between sodium and added sugar each of NOVA food groups and the nutritional status. Results: The total energy intake of the respondents was 1818 kcal + 375.05 per day. The energy contribution of ultra-processed group was 24%. The sodium and added sugar contribution of ultra-processed group were 26% and 63%, respectively. The mean blood pressure and median of blood glucose were normal at 114/79 mmHg and 5.3 mmol/L, respectively. No significant correlation was found between sodium, added sugar availability of each NOVA food groups and nutritional status at p<0.05. Conclusion: Further studies involving vigorous research design need to be carried out in order to really understand the implication of ultra-processed food consumption towards the nutritional status of Malaysian population, as highlighted in the Malaysian Nutrition Research Priorities (2016-2020). ><0.05. Conclusion: Further studies involving vigorous research design need to be carried out in order to really understand the implication of ultra-processed food consumption towards the nutritional status of Malaysian population, as highlighted in the Malaysian Nutrition Research Priorities (2016-2020)
Chyle Leak after a Simple Hemithyroidectomy: An Extremely Rare Situation
Get PDFChyle leak is a well-known complication that can occur after a thyroidectomy with neck dissection; however, it rarely occurs after thyroidectomy alone. Here, we report a case of chyle leak following a left hemithyroidectomy for a benign solitary thyroid nodule. Based on the literature search, this is only the second reported case of a chyle leak after a simple hemithyroidectomy without any central or lateral neck dissection. Amongst the possible causes, we hypothesize that the use of intraoperative nerve monitor may be a contributing factor. Treatment options are explored and the patient was treated successfully with nonoperative management
Comparison of Heart Rate Variability among Young Malay Male Adult with Different BMI and Level of Adiposity
Get PDFINTRODUCTION: Subclinical changes that occur in the heart at an early age may provide valuable information to outline prevention strategies for cardiovascular diseases. Heart rate variability (HRV) reflects regulation of autonomic balance, heart, and vascular tone, which are the determinants of blood pressure. Therefore, this study aimed to determine the difference in heart rate variability (HRV) of Malay male young adult with their BMI and adiposity level. MATERIALS AND METHODS: A total of 201 Malay male young adult aged between 19 to 24 years old were screened and their BMI and adiposity level were measured. Three non -invasive tests; Valsalva Manoeuvre, orthostatic response and 30/15 ratio of heart rate were performed. Short term HRV time and frequency domains were recorded. RESULTS: Despite few significant differences in HRV parameters of overweight/obese subjects, the result is inconclusive to conclude any reduced variability. However, those with high adiposity regardless of their BMI reported significantly lower mean of R -R SD in time domain and lower mean of LF/HF ratio in frequency domain. The orthostatic reflex results revealed that high adiposity subjects had significantly lower mean of LF and HF. A decrement of -0.28 ms2 HF/LF during Valsalva manoeuvre, -0.35 LF ms2 in orthostatic reflex and 0.33 ms2 in orthostatic reflex per 1% of body fat percentage were observed. CONCLUSION: HRV parameters were inversely proportional to the adiposity level which was suggestive of modulation of sympathetic function can occur at an early age
Hypermethylation Analysis of p16INK4a and p15INK4b Promoters in Chronic Lymphocytic Leukaemia Patients and Normal Individuals
Get PDFIntroduction: Chronic Lymphocytic Leukaemia (CLL) is a common type of leukaemia in persons of predominantly European descent but is rare in the Asian population. Disparities in CLL incidence among people of Asian and European descent may be related to the genetic make-up of the two different populations. Hypermethylation event might be one of the silencing mechanisms that inactivate the tumour suppressor genes in CLL. The aim of this study was to determine the hypermethylation status of p16INK4a and p15INK4b among CLL patients and normal individuals. Materials & Methods: A total of 25 CLL patients and 25 normal individuals were recruited for this study and their genomic DNA were extracted from the peripheral blood. The hypermethylation status of p16INK4a and p15INK4b were determined using Methylation Specific-PCR (MS-PCR) whereas DNA sequencing method was applied to selected samples for validation of the MS-PCR results. We also evaluated the association between hypermethylation of these genes with the clinical and demographic characteristics of each group of subjects. Results: Among the CLL patients, p15INK4b partialmethylation occurred in 6 (24%) subjects while methylation occurred in 1 (4%) subject. All the remaining patients were unmethylated at p15INK4b. All the samples showed unmethylation at p16INK4a. Statistically significant associations were found between p15INK4b hypermethylation with the presence of CLL (p=0.01) and with race (p=0.02). Conclusion: Further study using a larger sample size is warranted to explore the significance of DNA methylation incidence among the CLL patients of the Malaysian population. Hence, we suggest that hypermethylation at p15INK4b has a huge influence that kick-starts CLL disease among Malaysians and MS-PCR technique is applicable to be used in methylation study
Rare Presentation of Liver Abscess
Get PDFLiver abscess can present in various manners and in some cases causes delays and misdiagnoses. We are reporting 2 cases of rare presentation of liver abscess. The first case is a 64-year-old gentleman presented with right hypochondriac pain since August 2017 and diagnosed to have liver abscess. He was treated with antibiotics and serial imaging for reassessment. However, he presented again this year with right sided anterior abdominal wall swelling. Abdominal computed tomography (CT) showed anterior abdominal wall collection with extension into right internal and external oblique muscles with communication with liver collection at segment VII. An open incision and drainage was performed with drain inserted over the anterior abdominal wall collection. He was then referred to hepatobiliary center for further management. Second case is a 30-year-old gentleman underlying Beta thalassemia major- post splenectomy with Klebsiella pneumonia bacteremia noted to have left multiseptated collection with posterobasal consolidation and left parapneumonic effusion which was initially misdiagnosed as splenic abscess. However, with further imaging was confirmed to be a left liver abscess with focal discontinuity in left hemidiaphragm, which communicates between liver abscess and enlarging left lower loculated pleural effusion. Radiological guided pigtail catheter was inserted and serial imaging showed collection decreasing in size. Extra-abdominal manifestation of a liver abscess is a rare clinical entity and is not well documented. The advent of ultrasound and CT scan, there has been improvement in the rate of early diagnosis even with these uncommon presentations. Percutaneous drainage with antimicrobial therapy remains gold standard for a non-ruptured abscess. Surgical intervention should be considered for large, complex, multiseptated abscesses or in whom percutaneous drainage has failed
Prevalence of Lower Extremity Peripheral Arterial Disease among Diabetic Patients and Its Relationship with Quality Of Life (QOL) In Primary Care: A Single Centre Experience
Get PDFIntroduction: Peripheral Occlusive Arterial Disease (POAD) is an important cardiovascular morbidity especially among diabetics. The goal of the treatment is to improve patients’ quality of life (QoL) starting by quantifying the disease burden in our population especially among high risk group such as diabetics. Materials and Methods: This cross-sectional study aims to provide a data on the prevalence of POAD among diabetic population in a primary health care in Kuantan and its’ effects on the patient’s QoL. Additionally, we examined for any other stipulated associated factors that may have contributed towards the development of POAD. We applied a universal sampling for the purpose of patient selection. POAD is universally defined as ankle-brachial index (ABI) of lower than 0.9. Individuals were assessed on validated Malay version of WHOQOL BREF to assess their QoL parameters. P value of <0.05 considered as statistically significant. This study was registered with the National Medical Research Register (NMRR registration no. 17-1375-35710). Results: The prevalence of PAD among diabetic patients in Klinik Kesihatan (Local General Practitioner) Jaya Gading, Kuantan was found to be 20%. We found a significant relationship between lower levels of education (p = 0.016), older age group (p = 0.02) and lower economic class (p = 0.03) with the presence of POAD among diabetics. The presence of POAD has a significant adverse effect on QoL evidenced by lower Physical Domain (p=0.001), Psychological Domain (p=0.066), Social Domain (p=0.005), and Environmental Domain (p=0.027) scores using validated WHOQOL BREF questionnaires. Conclusion: The significant prevalence of POAD among diabetics prompts a greater urgency for early detection to prevent the development of its’ associated morbidity and deterioration of their QoL
Determination of SOX9 Gene Expression In Brain Tumours Among East Coast Malaysia Population
Get PDFIntroduction: SOX9, a members of SOX family, plays a significant roles in developmental processes during embryogenesis, including brain tissue. Few studies have shown that SOX9 has been involved in tumourigenesis of several types of cancer including brain tumour. However, such studies are still lacking in the Malaysian population. The aim of this study was to determine SOX9 expression level in several types of brain tumours in East Coast Malaysia. Materials and Methods: Five formalin-fixed pariffin-embedded brain tumour samples of Malay descendants were sectioned by using microtome. RNA extraction was performed with slight modification by adding Trizol during tissue lysis. The RNA was converted to cDNA using reverse transcription technique before SOX9 expression was detected using RT q-PCR assay in brain tumours normalized to non-neoplastic brain tissues. Results: Overall results displayed that SOX9 gene in all samples were up-regulated. SOX9 overexpression was found in both high and low grade glioma (anaplastic and pilocytic astrocytoma respectively). This is consistence with both low grade (benign) and atypical meningioma. Secondary brain tumour also showed up-regulation when compared to normal brain tissue. Conclusion: Up-regulation in SOX9 expression in selected brain tumours in Malay patients revealed its significant roles in brain tumourigenesis. Functional studies should be carried out to observe the SOX9 functions and mechanism whether they should reflect their diverse roles in Malaysia population
Effectiveness of Progressive Muscle Relaxation in Reducing Depression, Anxiety and Stress among Haemodialysis Patients attending a Public Hospital at Central Java Indonesia
Get PDFThe increasing trend of Chronic Kidney Disease (CKD) prevalence in Indonesia is a public health concern as it increases mortality, morbidity and burden of disease that has great implication on the health economic. In addition, CKD patients who are more likely to undergo hemodialysis is commonly associated with psychological problems such as depression, anxiety and stress and these have added more to the disease burden. Immediate measures such as progressive muscle relaxation (PMR) to reduce the psychological symptoms is of great importance before the symptoms progress into psychiatric disorders. The study was aimed to evaluate the effectiveness of PMR in reducing symptoms of depression, anxiety and stress among patients undergoing hemodialysis. It was a quasi-experimental, pretest-posttest control study that recruited 60 eligible respondents who underwent hemodialysis and was randomly allocated into intervention and waitlist control groups. Respondents in the intervention group performed PMR twice a day for two weeks. Mean scores of depression, anxiety and stress of respondents were examined before and after intervention using Depression, Anxiety and Stress Scale–21 questionnaire (DASS-21). Results showed that mean scores of depression, anxiety and stress differed significantly before and after intervention between groups and within the intervention group (p<0.05). PMR was effective to reduce the psychological symptoms among patients underwent hemodialysis. This highlight the importance to screen psychological symptoms among those patients and PMR should be taught to them as one of the stress-reducing measures.><0.005). PMR was effective to reduce the psychological symptoms among patients underwent hemodialysis. This highlight the importance to screen psychological symptoms among those patients and PMR should be taught to them as one of the stress-reducing measures
Role of the Immunohistochemical Marker (Ki67) in Diagnosis and Classification of Hydatidiform Mole
Get PDFIntroduction: Since the hallmark of gestational trophoblastic disease is trophoblastic proliferation, Ki67 is regarded as the best marker in studying hydatidiform mole.This study was conducted to evaluate the role of this proliferative marker in distinguishing among hydropic abortion, partial and complete hydatidiform mole. Materials and methods: This is a cross sectional study involving the application of Ki67 on a total of 90 histological samples of curetting materials from molar (partial and complete mole) and non molar hydropic abortion belong to Iraqi females, so three study groups were created. Immunohistochemical expression in villous cytotrophoblasts, syncytiotrophoblasts and stromal cells were recorded separately by three independent observers and the results were correlated statically. Results: The mean number of stained nuclei of villous cytotrophoblasts and stromal cells was the highest in complete mole and the lowest in non molar hydropic abortion. There is a significant statistical relationship regarding Ki67 labeling index in villous cytotrophoblasts between partial moles and hydropic abortion, complete mole and partial moles, hydropic abortion and complete mole. Regarding Ki67 labelling index in villous stromal cells, a significant statistical relationship achieved when the correlation done between partial mole and hydropic abortions, hydropic abortion and complete mole, while a non significant statistical relationship was achieved if the correlation done between partial and complete mole. All villous syncytiotrophoblasts showed negative results. Conclusion: Ki-67 labeling index in villous cytotrophblastic cells are useful in separating between partial moles and hydropic abortion, partial mole and complete mole, hydropic abortion and complete mole. While Ki-67 labeling index in villous stromal cells is only useful in separating between partial moles and hydropic abortion, hydropic abortion and complete mole
Knowledge, Perceptions and Practices of Malaysian Hajj Pilgrims for Prevention of Influenza-like illness (ILI) in 2013 Hajj Season
Get PDFIntroduction: Influenza-like illnesses (ILI) were defined as a triad of cough, sore throat and fever. The aim of this study is to determine the changes in knowledge, perceptions and practices towards preventive measures of succumbing to ILI before and after hajj among Malaysian hajj pilgrims. Methodology: An openlabeled randomized control trial study performed on five hundred Malaysian hajj pilgrims in the year 2013. After validated pre-hajj questionnaires completed, 250 subjects were given health education, benzalkonium -based handrub and demonstration of the handrub usage together with pamphlets and labelled as an intervention group. Another 250 subjects from another flight batch were given the same questionnaires without health education with unmedicated hand lotion as a control group. The knowledge, perception, practices and compliances to the handrub practice in both groups were compared with the pre-hajj results. Results: No significant difference between pre and post hajj knowledge and practice among hajj pilgrims in intervention group. Pre hajj perception score [ M (IQR) = 30 (5.00), Z= -2.441, p < 0.05 ] is much higher compared to post hajj perception [ M (IQR) = 29 (6.00), Z = -2.441, p < O.O5 ]. No significant difference between pre and post hajj knowledge, perception and practices among hajj pilgrims in control group. Hand hygiene compliance was not improved with provision of health education and free handrub supply. Conclusion: No significant changes in knowledge, perceptions and practices of Malaysian hajj pilgrims pre and post-hajj in both groups. Provision of handrub did not improved hajj pilgrims compliance