IIUM Medical Journal Malaysia (IMJM)
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Physiological and Psychological Effects of Listening To Holy Quran Recitation in the Intensive Care Unit Patients: A Systematic Review
Get PDFStress and anxiety are common among intensive care unit (ICU) patients especially those who are on mechanical ventilation. Non-pharmacological interventions such as music and prayer are recommended because they are opioid sparing, easy to provide, cheap and safe. There is a growing body of evidence on the effects of Holy Quran Recitation (HQR) in reducing stress and anxiety in critically ill Muslim patients. The aim of this review is to evaluate the physiological and psychological effects of HQR specifically in ICU setting. This review was performed on articles published between 2007 and 2018. Extensive search was done using PubMed, ISI Web of Knowledge, Scopus and Google Scholar. Systematic review articles are also assessed and relevant literatures are hand searched based on reference lists and citations made in key publications. Studies related to HQR which were done outside adult ICU setting were excluded. A total of nine articles are included in the final list for detail analysis. Findings of this review revealed six studies with significant results in improving stress responses, hemodynamic stability and conscious levels. HQR is a potential nonpharmacological tool to reduce stress and can also be used as auditory stimulus to improve conscious level in comatose patients. More studies in this area are recommended aiming for low risk of bias, appropriate calculation of sample size and adequately powered to detect significant outcomes
Stage IV Burkitt Lymphoma Presenting with Eyelid Swelling
Get PDFBurkitt lymphoma is a rare and aggressive tumour which predominantly affects children. We report a case of Stage IV Burkitt lymphoma (non-endemic type) in a 5-year-old immunocompetent Malay child who initially presented with left upper eyelid swelling. Clinical examination revealed a soft solid swelling over the left upper lid, extending temporally up to the lacrimal gland. Computed tomography (CT) scan showed a homogenous mass of soft tissue density with intracranial and left orbital involvement. Incisional biopsy of the mass revealed histological changes suggestive of B lymphoblastic lymphoma or leukemia. She was treated with 6 cycles of chemotherapy. Post chemotherapy, the left temporal and upper eye lid swelling subsided. Clinicians need to be on alert when encountering children with eyelid swelling, as this could be an initial presenting feature of Burkitt lymphoma without other systemic symptoms. A delay in diagnosis can lead to aggressive orbital involvement followed by permanent visual loss
Intestinal Evisceration in Domestic Violence: A Stab Wound Injury
Get PDFA 9-year-old girl, waken up from sleep with acute abdomen. Noted by care-taker, evisceration of small bowels from a stab wound at the epigastric region. She was brought to ED with class II shock and mild pallor. Her caretaker lodged a police report after noticed her schizophrenic uncle left home with a knife. Following adequate resuscitation, she had emergency laparotomy. A moderate gastric content contamination with multiple sites of perforation at the stomach, small bowels and its mesentery was seen and repaired primarily. Postoperatively, she was ventilated in ICU, provided with parenteral nutrition and institution of broad-spectrum antibiotics. She was extubated and transferred to HDW on day 4 and make a complete recovery on day 10. Discussion: Paediatric penetrating abdominal injury is much less common as compared to blunt abdominal injury. It is important to determine the mechanism of injury as it influences the management decision. The colon and small bowels are the most commonly injured hollow organs in penetrating injury. A bowel injury in trauma is a leading cause of morbidity and mortality. Managing postoperative bowel injury in paediatric required a multidisciplinary team approach for a successful outcome. A well-prepared surgical team with a well-equipped operation room, availability of blood substitutes and the necessary investigations are all the important links in the management of the patient of bowel evisceration
The Alarming Community Concern on Household Insecticide Exposure and Usage
Get PDFThe utilization of insecticide in a household environment is a necessity especially for those living in the tropical country such as Malaysia. Tropical climate with high humidity and urbanization lead to pests breeding problem hence contributing to the spread of vector diseases such as dengue. Household insecticide such as aerosol sprays, coils and mats are made from a combination of chemicals from type 1 pyrethroid group which are recognized as safe and have minimal toxic effects on human. However, there have been cases of accidental and intentional insecticide poisoning which demonstrates the lack of studies on factors of knowledge, attitude and practice of insecticide usage, the exposure as well as clinical presentation since the symptoms are similar to other compounds which may lead to misdiagnosis. These insecticide chemicals do not only exert toxic effects to pest but to human too due to its highly toxic characteristic which causes diseases such as asthma, cancer, and other diseases following short or long-term exposure to the chemicals. As a result, there is a growing community health concern regarding the uncertainty and risk of insecticide exposure to human. Thus, the risk assessment of community’s knowledge, attitude and practice regarding the insecticide are essential in aiding towards the development of improving insecticide profile, safer insecticide handling and exploration of insecticide alternative. This will result in better insecticide awareness, as well as minimize the insecticide risk exposure and its adverse health effects to the community
Single-Staged Transoral Intra-Lesional Excision of Aneurysmal Bone Cyst of Axis (C2) Vertebra and Temporary Stabilization of Upper Cervical Spine in an Adolescent: A Case Report
Get PDFAneurysmal bone cyst (ABC) infrequently occurs within the upper cervical vertebrae. Various therapeutic options have been reported in the literature. We would like to share our experience in managing a case of a 16-year-old girl diagnosed with ABC at the body of axis (C2) vertebra. Serious attention had to be given on the stability of the cervical spine following tumour resection, which can be affected by the mode of treatment chosen. Instability can have a detrimental effect on the cervical spine, in which case may necessitate further surgery. We performed a single-staged intra-lesional curettage via a transoral approach and temporary non-fusion posterior stabilization of C1 lateral mass screw and C2 pedicle screw. The implants were removed after six months once ossification of C2 has taken place to regain full motion of the neck. There was no evidence of recurrence or instability of the cervical spine three years following surgery
Periodic Assessment of Antenatal and Post Natal Serum Endothelin-1 (ET-1) and Nitric Oxide (NO) Levels in Hypertensive Disorders of Pregnancy (HDP)
Get PDFHypertensive Disorders of Pregnancy (HDP) is an independent risk factor of cardiovascular (CVS) disease with endothelial dysfunction postulated to be the pathophysiology. Endothelin-1 (ET-1), a potent vasoconstrictor, has been identified as a pivotal mediator in HDP. Disturbances in nitric oxide (NO) bioavailability found in endothelial dysfunction may increase susceptibility to cardiovascular diseases such as hypertension. The study aims to determine serial ET-1 and NO levels in patients with HDP and its role in persistent endothelial dysfunction. Thirty-six pregnant women from the following categories (i) normal pregnant women (Control) (ii) chronic hypertension during pregnancy (CH) and (iii) pregnancy induced hypertension (PIH) participated in this study. Blood pressure indices measurements and sample collection were done at antepartum (32 weeks) and postpartum (8 weeks and 12 weeks). ET-1 and serum NO were measured using the Human ET-1 (Endothelin-1) ELISA Kit and Nitric Oxide (total) detection kit respectively. Results: Serum ET-1 was significantly higher in patients with CH (55.3 pg/ml) and PIH (35.6 pg/ml) compared to Control (11.8 pg/ml) during antenatal until 3 months postpartum (CH 38.3 pg/ml, PIH 29.5 pg/ml, Control 1.9 pg/ml). This was accompanied by significantly lower levels of serum NO in HDP patients. Persistently higher than normal levels of ET-1 and lower than normal levels of NO up to 3 months postpartum in patients with history of HDP indicate presence of persistent endothelial dysfunction despite BP normalisation in PIH patients. Long term NO/ET-1 imbalance may account for the increased CVS disease risk
Evaluation of High Resolution Melting Technique for Detection of JAK2-V617F Mutation in Formalin-Fixed Paraffin-Embedded Specimen from Myeloproliferative Neoplasm Cases
Get PDFMyeloproliferative neoplasm (MPN) is a group of myeloid disorders which leads to erythrocytosis, thrombocytosis and leucocytosis. MPN with BCR-ABL positive is chronic myeloid leukaemia (CML) while BCR-ABL negative MPN includes polycythaemia Vera (PV), essential thrombocytemia (ET) and primary myelofibrosis (PMF). One of the major criteria for diagnosis of BCR-ABL negative MPN is the presence of JAK2-V617F mutation which is positive in 95% of PV and around 60% of ET and MF. Beside peripheral blood specimen, formalin-fixed paraffin-embedded (FFPE) marrow specimen can be used for detection of this mutation. Unfortunately, FFPE produces low quality DNA that put a challenge for successful amplification of DNA. We aimed to evaluate the utility of High Resolution Melting (HRM) analysis for detection of JAK2-V617F mutation in FFPE specimen from MPN cases. This study is a descriptive crosssectional study. Forty FFPE marrow specimens were retrieved from the years 2014-2016. Bio-Rad Precision Melt Analysis software was used for analysis of HRM data. Allele-specific PCR was done for validation of results. Positive samples were subjected to Sanger sequencing. JAK2-V617F mutation was positive in 13 out of 40 MPN cases. Level of agreement between HRM and AS-PCR was 97.5%. HRM is a rapid and powerful diagnostic assay which is suitable for detection of JAK2-V617F mutation in FFPE marrow specimen
In-vitro Study: Camp Overshoot Caused by Chronic Morphine Alleviated by the Synergistic Combination of Zamzam Water and Methadone in Human Primary Glioblastoma Cell Line (U-87 MG)
Get PDFIntroduction: Zamzam water is blessed water originated from Mecca and is believed by Muslims to have the ability to cure illness. This ability to cure illness is due to the fact that zamzam water has higher concentration of minerals especially sodium, calcium and magnesium which play a vital role. Sodium is reported to be involved in the regulation of the Mu-Opioid Receptor, which indirectly leads to the production of cAMP. Hence, this current study was carried out to investigate the synergistic effects of zamzam water and methadone combination on cAMP levels in human primary glioblastoma cell line (U-87 MG) after chronic morphine administration. Materials and Methods: The time course and concentration of morphine on U-87 MG cell line was determined. The U-87 MG cell line was incubated with morphine (25 µL/mL) for 24h, to make the cell dependent on morphine and later treated with different combinations of 3.2 mL of zamzam water and methadone (5, 10, 25 µL/mL). The levels of cAMP was determined using the enzyme-linked immunosorbent assay kit. Results: The result revealed that 3.2 mL of zamzam water incubated with 10 µl/ mL of methadone significantly prevented the overshoot production of cAMP level (p<0.05) in U-87 MG cell line after 48h incubation when compared to the untreated samples. Conclusion: These finding suggest that co-treatment with zamzam water and methadone could possibly avoid tolerance and dependence on chronic morphine treatment by preventing the up-regulation of cAMP level.><0.05 in U-87 MG cell line after 48h incubation when compared to the untreated samples. Conclusion: These finding suggest that co-treatment with zamzam water and methadone could possibly avoid tolerance and dependence on chronic morphine treatment by preventing the up-regulation of cAMP level
Eurycoma longifolia Root Aqueous Extract Augments the Testosterone Level and Spermatogenesis in Adult Male Rats
Get PDFIntroduction The Eurycoma longifolia (EL) root aqueous extract has long been used as an enhancer of male sexual performance. However, data from previous studies in both human males and experimental male animals on the testosterone level in those given the EL extract orally were at best insufficiently conclusive. Materials and Method Sixty-four healthy adult male Sprague Dawley rats were acclimatized, and randomized into six test groups and one control group. All rats where given either the aqueous EL extract or distilled water via metal gavage needle. The first three test groups received the low (50mg/kg bw), medium (100mg/ kg bw) and high (200mg/kg bw) doses respectively of the EL daily for 15 days only. The second three test groups continued receiving the same daily treatment doses for 30 days. The controls were given distilled water only. At the end of each of the study period, blood samples were collected via cardiac puncture and the rats were euthanized. The testicles were obtained, weighed, and processed for histological examination. Results The sera testosterone levels were higher in animals which received the medium and high doses for both treatment duration. Rats which received medium and high oral doses of EL showed an increase of spermatogenesis and mature spermatozoa. Conclusion The optimal enhancing effect on sera testosterone levels and testicular spermatogenesis of EL treatment in adult male rats was observed with the medium dose of 100mg/kg bw given once daily for both 15 and 30 days
Agitated Depression; The Challenges in Management and the Role of Maintenance Electroconvulsive Therapy
Get PDFThis case report highlights the challenges encountered and the role of maintenance electroconvulsive therapy (ECT) in the management of a depressed patient who presented with symptoms of agitation. Despite on an adequate dosage and duration of medications, the patient showed poor improvement and persistent agitation. Upon commencing maintenance ECT in addition to the pharmacotherapy, the patient’s condition markedly improved. As conclusion, maintenance ECT may be another option in managing agitated depression