IIUM Medical Journal Malaysia (IMJM)
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Localized Erythematous Pappular Rash: A Rare Presentation Of Essential Thrombocythemia
Get PDFEssential thrombocythemia (ET) is one of the myeloproliferative neoplasms which typically presents with thrombotic vasomotor symptoms or bleeding tendencies. Papular rash is a rare manifestation of ET and may cause delay in making the diagnosis and hence institution of the treatment. We report a case of ET in a 50- year-old gentleman, who presented with nonspecific localized erythematous papular rash over his right thigh associated with recurrent mild pain in the affected thigh for one year. He was not any drugs prior to the onset of the rash. He had no history suggestive of haematological disorder such as bleeding tendencies, recurrent fever or anaemic symptoms. He also had no constitutional symptoms or any palpable masses. He was managed conservatively initially at primary care clinic but the problem persisted. A full blood count was subsequently performed which revealed an isolated thrombocytosis of 880 x 109 /L. He was referred to the haematology team for the further management and a diagnosis of ET was then made. Both the platelet counts and the lesion improved with hydroxyurea treatment. This case report illustrates a rare chronic manifestation of myeloproliferative neoplasm detected at a primary care clinic
Midterm Outcome of Total Knee Arthroplasty in East Coast Population of Hospital Tengku Ampuan Afzan Kuantan
Get PDFIntroduction: Total knee replacement (TKR) is an excellent advancement in medical treatment which gives good joint function and pain relief for degenerative diseases of joint since it was introduced in Malaysia since 1970. The purpose of this study was to evaluate the midterm functional outcome of patients undergone TKR using the NexGen LPS Flex prosthesis between January 2005 until April 2006 in primary osteoarthritis patients in our local east coast population. Materials and Methods: Forty six patients, 87% female (n=40) and 13% male (n=6), aged 54 to 81 (mean, 69±5.69) years underwent primary TKR using the hi-flex knee prosthesis (Zimmer) performed by two different surgeons were followed up for a minimal of five years. All used the same technique of surgery, medial parapatellar incision, cruciate substitute and cemented. Assesment were made based on the quality of life outcome score (SF-36) and the Oxford-12 knee scoring system questionnaires. Results: Oxford-12 revealed that patients had mild problems in terms of function and pain with the average function and pain score of 14.35±4.21 and 9.28±3.01 compared to a maximum possible score of 35 and 25 respectively. For eight health domains of SF-36, patients had the highest score (i.e. good health) for role emotional (RE), followed by mental health (MH), and social functioning (SF). This resulted in a higher score for mental component summary (MCS) than physical component summary (PCS). Since a low score of Oxford-12 indicates a better state of health compared to high score for SF-36, negative correlation between them was expected. Conclusion: The NexGen LPS-Flex TKR had good midterm functional outcome. Overall, TKR were found to be effective in terms of improvement in health-related quality-of-life dimensions
Psychosocial Distress and Blood Pressure among Young Adults: Role of Cortisol as Mediator
Get PDFIntroduction: Hypertension is the most prevalent risk factor of cardiovascular diseases in Malaysia. 17.3% of hypertension cases in Malaysia is attributed to adults aged 18 to 39 years. Psychosocial distress is a possible risk factor for elevated blood pressure in young adults, and cortisol could be the mediating factor. The aim of this study is to evaluate the mediating role of cortisol in hypertension and psychosocial distress in young adults. Materials and Methods: A comparative crosssectional study was conducted in 240 young adults aged 45 years or less. The body mass index, waist circumference and blood pressure parameters were recorded. Serum cortisol, creatinine, fasting blood glucose and lipid profile were measured following acute mental stress test. Psychosocial distress was assessed using the DASS-21 questionnaire. Results: Mean (standard deviation) values for SBP, DBP and MAP were 126.0 (16.3), 84.1 (12.2) and 98.1 (13.1) mmHg respectively. Anxiety was significantly associated with systolic blood pressure (β = 0.644), diastolic blood pressure (β = 0.454) and mean arterial pressure (β = 0.516) after adjusting to sex, age and cortisol. However, it was not mediated by cortisol. Depression and stress were not found to have any effect on blood pressure of the young adults studied. Conclusion: The data suggest that there is no elevated risk for psychosocial distress and hypertension that cortisol poses in young adults
The Diagnostic and Predictive Value of Plasma Cystatin C in Acute Kidney Injury Secondary to Sepsis in The Intensive Care Unit
Get PDFIntroduction: Plasma Cystatin C (pCysC) is one of the functional biomarker for AKI. This study evaluates the utility of pCysC in diagnosing AKI, predicting death and its correlation with eGFR in septic critically ill patients. Materials and Methods: This is a two centre, prospective observational study of septic critically ill patients. The inclusion criteria were patients older than 18 years old with sepsis, SOFA score of≥2 and procalcitonin level ≥ 0.5 ng/ml. Serum Creatinine (sCr) and pCysC were measured at 0, 4, 24, 28, 48, and 52 hours. AKI was defined based on creatinine criteria of the KDIGO guideline. Results: Seventy patients were recruited into this study, of which 32 (45.7%) had AKI and 15 (21.4%) died. pCysC diagnosed AKI in all six time intervals with AUC of 0.859, 0.858, 0.876, 0.918, 0.887, and 0.879 for 0 hour, 4, 24, 28, 48, and 52 hours, respectively (p <0.0001). It did not predict death at any time interval, with an AUC range of 0.053 to 0.608 (p>0.1). pCysC showed strong negative correlation with all estimates of GFR, with the best profile recorded at 28 hours. Correlation coefficient for eGFRCG, eGFRMDRD, eGFRCKD-EPI and keGFR were -0.778, -0.763, -0.808, and -0.781, respectively (p <0.0001). There is no correlation between cardiac output and pCysC, and eGFR. Correlation coefficient were between -0.208 to 0.267 (p >0.1). Conclusion: pCysC diagnosed AKI in septic critically ill patients and strongly correlated with all estimates of GFR. However, pCysC did not predict death, nor correlate with cardiac output
Topographical Changes of Rat's Colonic Mucosal After Chronic Arsenic Exposure - A Scanning Electron Microscopy Study
Get PDFIntroduction: Human are exposed to arsenic threats in several ways. Our drinking water for instance, can be hazardous due to the contamination of arsenic-based pesticide and herbicide into our water supply. The most vulnerable part of our body due to ingestion of arsenic is our gastrointestinal system. Thus, the aim of this study was to determine the effects of chronic exposure to organic arsenic (Monosodium methylarsonate, MSMA) on the surface topography of rat's colonic mucosa by using scanning electron microscope (SEM). Materials and Methods: 30 Sprague Dawley rats were given daily oral gavage of MSMA 42.13 mg/kg, which is 1/30 LD50, and 30 Sprague Dawley rats acted as control. 10 exposed rats and 10 control rats were sacrificed at regular intervals (2 months, 4 months and 6 months) and their colon specimens were examined by SEM. Results: In the control group, the colonic mucosa appeared normal with uniform size individual glandular units and has a central crypt orifice. The goblet cells were located in between the absorptive cells to produce mucous. In the exposed group, the rat's colonic mucosa showed increasing features of surface alterations such as haphazard shape of glandular units, slit-like crypt opening and less goblet cells with reduced number of microvilli. Conclusion: There were topographical changes of colonic mucosa of rats exposed to chronic low dose of organic arsenic
Utility of Small Molecule TLR4 Antagonist (+)-Naltrexone in Suppression Of Preterm Birth Induced In Mice By Platelet Activating Factor
Get PDFIntroduction: Microbial and sterile triggers of inflammation can activate Toll-like receptors (TLR) to initiate synthesis of pro-inflammatory cytokines that in turn drive the parturition cascade leading to preterm delivery (PTD). Platelet activating factor (PAF) has been identified as a key endogenous sterile inflammatory trigger that is elevated in the amniotic fluid in both normal and PTD in human. Intrauterine administration of PAF in mice results in PTD. We investigated the role of TLR4 in PAF-induced PTD. Materials and Methods: BALB/c females were administered PAF or vehicle i.p on gestational day (gd) 16.5, followed by treatment with the small molecule TLR4 antagonist, (+)-Naltrexone, or vehicle control. Mice were observed for PTD, and in the absence of PTD mice were killed on gd 18.5 and implantation sites, fetal viability and fetal and placental weights were determined. Results: PAF administration lead to PTD in 64% (9/14 mice), with reduced numbers of viable fetuses compared to vehicle controls. (+)- Naltrexone administration to mice given PAF was able to prevent PAF-induced PTD and viable fetuses were comparable in number to control groups. Secondly, wildtype and Tlr4-/- BALB/c female mice were mated to males of the same genotype, and were challenged with PAF or vehicle on gd 16.5. Tlr4-/- females had 17% (2/12 mice) of PTD, with the number of viable fetuses similar to wildtype females when administered with PAF, suggesting that PAF may activate TLR4- independent pathways to drive fetal inflammatory injury. Conclusion: PAF is a clear mediator of inflammation-driven PTD, through TLR4-dependent and TLR4- independent pathways
Comparative Leaf Anatomy of Selected Medicinal Plants in Acanthaceae
Get PDFComparative leaf anatomy study were conducted in three taxa of Acanthaceae from peninsular Malaysia. Three chosen taxa were Acanthus ebracreatus (Vahl), Andrographis paniculata (Burm.f.) Wall. ex Nees and Chroesthes longifolia (Wight) B. Hansen which is commonly used as traditional medicine especially in peninsular Malaysia. The main objective is to identify the leaf anatomical characteristics that can be used in plant identification and also for supportive data in plant classification. The procedures involved such as cross section using sliding microtome on the petiole, lamina, midribs and marginal, leaf clearing and observation under light microscope. Results have shown the similarities and variations in leaf anatomical characteristics. The anatomical characteristics observed include petiole and midrib outlines, patterns of petiole and midrib vascular bundles, presence of cystolith cells, presence of hypodermis layers in lamina and presence and types of trichomes. In conclusion, results showed that anatomical characteristics have taxonomic significance that can be used in classification especially at species level
A Pedometer-based Intervention with Daily Walking Steps and its Relationship with Nutritional Status among Overweight/Obese University Students in Kuala Terengganu
Get PDFIntroduction: The aim of this study was to determine the effects of pedometer-based intervention and the relationship between daily walking steps and nutritional status among overweight/obese university students in Kuala Terengganu. Materials and methods: The study was an 8-week intervention study that included 23 overweight/obese university students. After 7 days of baseline activity, anthropometric data such as weight, height and waist circumference and a one-day dietary record were taken. The participants were divided into a control and case group. The control group (n=15) was instructed to continue with their normal activities and habits throughout the 8 weeks. The case group (n=8) was instructed to walk based on the targeted number of steps. Data such as body weight, waist circumference and a one-day dietary record were taken after the intervention. Results: Both case and control group show significant differences in body mass index (BMI) with p=0.017 and p=0.047 respectively. However, there is a large and significant difference between walking steps and BMI before and after intervention for the case group. There were no differences in any other study parameters during the 8-week study. Conclusion: In conclusion, short-term intervention with a pedometer increased physical activity and positively affected the BMI of overweight/obese participants. The use of a pedometer was efficient in measuring daily physical activity (r= 0.756, p< 0.05)
Anticancer Activity of Acetogenins from Annona Muricata Fruit
Get PDFMedicinal plants become very important in our days for their therapeutic benefits to humankind. It sustains human health, and it is commonly known as herbal medicines since ancient times. Annona muricata is a heart-shaped fruit that is consumed raw or as the fruit juice in the tropical area. A. muricata is used in traditional and alternative medicine to treat different ailments such as diabetes, hypertension, respiratory and skin illness, inflammation and cancer. A. muricata contains essential anticancer agents named acetogenins that play the significant role in various cancer types. Acetogenins are strong nicotinamide adenine dinucleotide oxidase inhibitors of the cancer cell's mitochondrial membrane but showed neurotoxic effects in rats. Therefore, acetogenins need to be further investigated to determine the exact mechanisms of action, long-term safety, optimal dosage, and potential side effects. Given the extensive studies on A. muricata, this review focuses on the phytochemistry, medicinal uses, biological activities and the mechanisms of action for the fruit extracts and acetogenins, to stimulate further studies on the fruit pulp used for human consumption
The Guru-UKM Method: Synergistic Effect of Hydrogel, Hydrofibre and Dermal Conservation in Burn Wound Management
Get PDFInitial wound care idioms were designed around a moist dressing in presumed better wound healing. As wound care advances, innovations of dressings were formed. In the Guru-UKM Method (GUM), we combined two well-established dressings producing a synergistic effect in burn wound management. Patients with deep partial thickness burns were selected for the GUM. From the time of admission, they receive 2 cycles of paraffin tulle dressings once every two days to allow demarcation, then are reassessed for suitability of the GUM technique. We discuss 7 different burn cases that presented to our Burn Unit from January 2014 – June 2015.All dressings should create a suitable moist environment for healing, yet should be a painless dressing to help the patient return to normal function as soon as possible. In burn wounds, a suitable dressing ideally also biochemically debrides fibrin and softens hardened eschar and slough, without necessitating the patient to undergo general anaesthesia and surgical debridement. The Guru-UKM Method is a combination dressing technique that facilitates optimal burn wound management