IIUM Medical Journal Malaysia (IMJM)
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Improving Exercise Interventions for Older Adults with Dementia: A Qualitative Exploration of Physiotherapists' Knowledge, Attitudes, and Practices
Get PDFINTRODUCTION: Dementia creates significant challenges to physical activity management in older adults due to progressive cognitive and behavioural impairments. Physiotherapists serve a critical role in designing exercise interventions. However, the lack of standardized dementia-specific training compromises the efficacy of care. Despite evidence on the benefits of physical activity for older adults with dementia (OAwD), the physiotherapists’ knowledge, attitude, and practices (KAP) to meet these specific needs remains unclear. This qualitative study explores the physiotherapists’ KAP in exercise prescription, aiming to identify unmet training needs and inform targeted strategies to optimize therapeutic outcomes for OAwD. MATERIALS AND METHODS: A qualitative approach was used, employing semi structured interviews with 9 physiotherapists experienced in dementia care. Participants were selected through purposive sampling to capture diverse expertise. Data was analysed through thematic analysis uncovering patterns and insights related to KAP and its impact on care delivery. RESULTS: Four central themes emerged: Knowledge (theme 1), attitudes (theme 2), and practices (theme 3 and theme 4). Firstly, physiotherapists emphasized the importance of comprehensive assessments, utilizing tools such as the ‘Timed Up and Go test’ and ‘Montreal Cognitive Assessment’. Secondly, patience and adaptability were highlighted as essential due to cognitive decline associated with dementia. Thirdly, caregiver involvement and education were essential. Fourthly, goal oriented and functional exercises were prioritized. CONCLUSION: Physiotherapists showed a strong understanding of dementia care but highlighted the need for enhanced, specialized training. Addressing these gaps could improve exercise interventions and foster better health outcomes for OAwD.
Streptococcus Gallolyticus Infection and its Interrelation with Colorectal Cancer: Diagnostic Accuracy of Statistical and Machine Learning Models for Early Detection Algorithm
Get PDFINTRODUCTION: Epidemiological studies have emphasized the role of Streptococcus gallolyticus subspecies gallolyticus (Sgg) infection in the development of colorectal cancer (CRC), yet it remains underappreciated. While statistical and machine learning (ML) models can enhance CRC prediction, direct comparisons between them are rare. This study aims to assess the diagnostic accuracy of stool polymerase chain reaction (PCR) for Sgg and immunochemical fecal occult blood test (iFOBT) for CRC detection and to compare multivariable statistical and ML models in predicting CRC. MATERIALS AND METHODS: A hospital-based case-control study with a reversed flow design was conducted, involving 33 CRC cases and 80 controls. The analysis incorporated Asia Pacific Colorectal Screening (APCS) risk factors into three predictive models: logistic regression (LR), decision tree (DT), and ensemble Bayesian boosted decision tree (BDT). RESULTS: Combined testing achieved a net sensitivity of 54%, outperforming individual tests (iFOBT=12.1%, Stool PCR=48.5%). Among the models, the ensemble BDT approach demonstrated the highest classification accuracy for CRC (BDT= 78.1%; DT=72.4%; LR=69.9%). The DT model identified iFOBT as the sole predictor, while the BDT ensemble model prioritized positive stool PCR for Sgg as the primary predictor, followed by normal to overweight body mass index and individuals aged over 53 years. CONCLUSION: The ensemble ML model incorporating Sgg infection demonstrated superior predictive performance. Screening for Sgg in stool samples has the potential as an early CRC detection strategy, particularly for individuals with a normal to overweight BMI and those above 53 years old.
Prevalence of Variations in the Anterior Communicating Artery Complex of the Circle of Willis: A CT Angiography Study in Malaysia
Get PDFINTRODUCTION: The anterior communicating artery complex (ACoA complex) within the circle of Willis, contributing to communicating arterial supply to the brain, exhibits significant anatomical diversity. Given the vulnerability of brain tissues to cell death resulting from poor blood supply, knowledge on this variability becomes crucial for diagnosing and managing diseases affecting the arterial supply to the brain. MATERIALS AND METHODS: A cross-sectional study was conducted to determine the prevalence and to give a description of these variations based on reconstructed CT angiographic (CTA) images. We included all individuals who underwent head CT angiography at a hospital in Kuantan, Pahang, Malaysia for various reasons between January 2009 and August 2015. A total of 81 CT angiographic images were analyzed for different variations, encompassing hypoplasia, aplasia, and duplication of the anterior communicating artery, as well as hypoplasia and aplasia of the A1 and A2 segments of the anterior cerebral artery, the A2 segments arising from a common trunk, and the third A2 segment. RESULTS: Ten distinct variation types were identified, with the typical pattern observed in 35.8% of cases. Vascular variations accounted for 64.2%, signifying a higher prevalence compared to previous studies. The cases presenting variations in the anterior communicating artery constituted 43.2%, with the aplasia being the most prevalent anatomical variation at 28.4%. CONCLUSION: The study highlights a higher prevalence of anatomical variations in the ACoA complex than the typical pattern
Impact of Spiritual Well-Being on The Quality of Life Among the Muslim Elderly
Get PDFINTRODUCTION: Increasing elderly population will have an impact on increasing demand for long-term health care. As a person gets older, there is increase in their health problems. The challenges facing the health authorities is to increase life expectancy of people through improving the quality of life of the elderly. Spirituality has become an important aspect of improvement of health related quality of life. This study aims to identify the relationship between spiritual well-being and the quality of life of the elderly living in nursing homes. MATERIALS AND METHODS: This study is a crossectional study conducted in Central Java Province, Indonesia. The sample size was 131 Muslim elderly people living in nursing homes. Study respondents were recruited randomly with criteria of being able to communicate and having good cognitive function. Spiritual well-being was measured using the Spiritual Assessment Scale (SAS) and the Quality of life (QOL) was measured using the WHOQOL-OLD. RESULT: The spiritual well-being of the respondents was mostly low. The QOL of the respondents was mostly low. The results of the Pearson correlation test showed that all three aspects of spirituality had a relationship with all the three domains of QOL. Religious practices have a very strong relationship with psychological functioning (p=0.000, r=0.793). Conclusion: The higher the spiritual well-being, the higher the QOL of the elderly living in nursing homes. The results of this research can be used by nurses in nursing homes to determine interventions to improve spiritual well-being in the elderly
Method for Measuring Speech Enhancement of Electronic Hearing Protection Device: A Systematic Review
Get PDFThe usage of electronic hearing protection devices (e-HPDs) among industrial workers has been introduced among others, to allow more effective communication in noisy environments. The effectiveness of the speech enhancement element of e-HPDs thus needs to be assessed. To date, no standardized speech enhancement assessment method is available. This systematic review aimed to compile and synthesize available information in the literature on speech perception test method of e-HPDs while also assessing the quality of selected studies. The Cochrane methodology was used, with the findings documented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. The International Prospective Register of Systematic Reviews (PROSPERO) was utilized to register this systematic review, with the CRD number assigned as CRD42024526086. Five electronic databases were explored: PubMed, ProQuest, IEEE, Scopus, and ScienceDirect. The quality appraisal was conducted based on Effective Public Health Practice Project (EPHPP) tool. In total ten studies were reviewed, utilizing several speech tests including Hearing in Noise Test (HINT), Speech Recognition in Noise Test (SPRINT), Callsign Acquisition Test (CAT), Modified Rhyme Test (MRT), Quick Speech in Noise Test (QuickSIN), Dutch Monosyllabic Speech Test and Mandarin Disyllabic Word Discrimination Test (WDT) to evaluate speech enhancement capabilities in e-HPDs. In conclusion, speech tests are essential for assessing how well e-HPDs perform enhancing speech in noisy environments. HINT has the strongest quality compared to other speech test for e-HPDs assessment. HINT or its modifications can subsequently be considered in the anticipated standardized speech perception test method of e-HPDs tests worldwid
“Glossofibrolipoma” : An Unusual Presentation of Multiple Fibrolipomas on the Tongue
Get PDFLipomas are slow-developing benign tumours composed of adipose cells depicted as “yellow epulis” by Roux in 1848. Lipoma occurrence is uncommon in oral cavity but even more rare in the tongue region. They present as yellowish, painless mass that may occasionally lead to functional and aesthetic complications. This paper describes a 55-year-old female having multiple tongue lumps that causes mastication difficulties. The lumps were excised in total from its base. The postoperative recovery was uneventful, and no complications were noted. The lumps were histopathologically identified as fibrolipoma which is a variant of lipoma. Histologically fibrolipoma shows infiltrative feature onto adjacent tissue, creating confusion in differential diagnosis. Thus, it is imperative that a careful histological assessment coupled with regular follow-ups are done especially considering the unusual development of fibrolipoma on the tongue
Effect of Quercetin and Glibenclamide Combination on PPAR-γ and Oxidative Stress: A Study on Cardiac Tissue of Diabetic Animal Model
Get PDFINTRODUCTION: Type 2 diabetes mellitus (DM) contributes to cardiac failure through oxidative stress and reduced expression of peroxisome proliferator-activated receptor-γ (PPAR-γ). PPAR-γ plays a protective role by enhancing metabolism and mitigating oxidative stress. Quercetin has been shown to activate PPAR-γ and reduce lipid peroxidation. This study aims to evaluate the effects of combining quercetin with glibenclamide on cardiac PPAR-γ expression and lipid peroxidation in diabetic rats. MATERIALS AND METHODS: This experimental study involved 25 paraffin-embedded cardiac tissue samples from three-month-old Wistar rats, divided into five groups: healthy control, diabetic control (placebo), diabetic with glibenclamide (5 mg/kg/day), diabetic with quercetin (20 mg/kg/day), and diabetic with both glibenclamide and quercetin. Treatments were administered orally for 4 weeks. Cardiac PPAR-γ expression was assessed via immunohistochemistry, and malondialdehyde levels were measured using the thiobarbituric acid reactive substances (TBARS) assay. RESULTS: Both quercetin and glibenclamide monotherapies significantly increased cardiac PPAR-γ expression. However, the combination therapy further enhanced PPAR-γ expression compared to either treatment alone (p<0.05). Malondialdehyde levels significantly decreased in all treated diabetic groups compared to the diabetic control, with no significant difference between monotherapy and combination groups. CONCLUSION: The combination of quercetin and glibenclamide enhances cardiac PPAR-γ expression more effectively than monotherapy, while reducing lipid peroxidation to a similar extent. This suggests potential synergistic benefits in managing oxidative stress-related cardiac complications in type 2 DM
Gender and Ethnic Differences in Stress and Lifestyle Factors Post COVID-19 Lockdown Among Medical Students
Get PDFIntroduction: Lifestyle choices can significantly impact students' stress levels, especially during the COVID-19 lockdowns. It is not known whether the management of lifestyle behaviours and stress factors post COVID-19 lockdown differs between genders and ethnicities in Malaysia. Materials and Methods: A cross-sectional study was conducted among 345 medical students in a private Malaysian University willing to participate. The demographic details were collected after obtaining their consent for participation. Lifestyle and stress questionnaires were administered online, and multiple logistic regression analyses were used to analyse their lifestyle and stress factors post COVID-19 lockdown. Results: Male students tend to have a strict exercise regime (p<0.0001) and reported low alcohol consumption (p=0.002). Female students did less exercise (p=0.007) and experienced an increase in muscular aches (p<0.0001). They also tend to bring work home at night (p=0.032), have insufficient hours to do all duties (p=0.038), and have altered appetites (p=0.001). Both Indian (p=0.011) and Chinese (p=0.006) participants can still cope with the present working environment. Indian respondents tend to get sick more frequently than other ethnicities (p=0.043). Malay (p=0.007) and Chinese (p=0.024) respondents are less likely to experience muscular pain. Chinese students are less likely than other ethnicities to have sick parents (p=0.027), while Malay students have family members with illnesses like high blood pressure and diabetes (p=0.019). Conclusion: Developing targeted student support learning such as stress management workshops, time management training, and comprehensive wellness programs tailored to different genders and ethnicities could reduce stress and promote a healthier lifestyle
Effect of Tualang Honey Supplementation in Weight Reduction and Dyslipidaemia in High Cholesterol Diet- induced Obese Rats
Get PDFINTRODUCTION: Obesity is a key risk factor for many chronic diseases. Malaysia records the highest prevalence of obesity in Southeast Asia. Tualang honey has been proven to treat many chronic diseases but its effect on weight reduction has yet to be well-studied. This study aimed to investigate the effects of Tualang honey (TH) supplementation on body weight and lipid profile in a 12% high cholesterol diet (HCD) induced obesity rat model. MATERIALS AND METHODS: Forty male Sprague-Dawley rats were assigned to five groups (n=8): Group 1 (normal diet), Group 2 (normal diet + TH 3.0 g/kg), Group 3 (12% HCD), Group 4 (12% HCD + TH 3.0 g/kg), and Group 5 (12% HCD + Orlistat 10 mg/kg). Diets were administered for 12 weeks, followed by treatments for six weeks. Body weight was measured weekly, and blood was collected for lipid analysis at the end of the study. RESULTS: We demonstrated a significantly lower final body weight of rats in Group 2 (328.25 ± 25.49 g) compared to Group 1 (409.13 ± 16.33g) (p<0.001) and in Group 4 as compared to Group 3 (343.88 ± 44.24 g vs 471.00 ± 19.55g, p<0.001). The administration of TH also significantly reduces the cholesterol (Med=1.8 mmol/L, IQR=0.7 vs Med=3.2 mmol/L, IQR=0.8, p<0.05) and triglyceride level (Med=0.9 mmol/L, IQR=0.3 vs Med=1.5 mmol/L, IQR=1.0, p=0.001) in Group 4 compared to Group 3. CONCLUSION: Tualang honey supplementation has been shown to reduce body weight and improve lipid profiles in 12% HCD-induced obese rats