IIUM Medical Journal Malaysia (IMJM)
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Early Functional and Radiological Outcomes Between Plaster Cast and Fiberglass Cast in Stable Thoracolumbar Burst Fracture
Get PDFIntroduction: Burst fracture results from compression failure of both the anterior and middle columns under substantial axial loads. Conservative treatment was a method of treatment for fractures without neurological deficit. This cross sectional study was designed to evaluate the functional and radiological outcome of patient with thoracolumbar burst fracture treated conservatively. Methods: 40 cases were recruited from January 2013 till December 2015. They were followed-up with minimum period of 1 year and evaluated for the functional (Oswetry Disbility Index) and radiological outcomes (kyphotic angle deformity and anterior body compression). Results: 20 patients were treated with body cast made form plaster of Paris and remaining 20 patients with fiberglass cast. In plaster of Paris group, mean kyphotic angle deformity at last follow up was 16.60 ± 2.95 with a mean improvement 4.45 degree and anterior body compression at last follow up was 30.35% ± 10.2 with mean improvement of 9.30%. In fiberglass group, mean kyphotic angle deformity at last follow up was 15.55 ± 3.38 with a mean improvement 7.25 degree and anterior body compression at last follow up was 25.90% ± 7.81 with mean improvement of 3.45%. The functional outcome showed Oswetry Disability Index (ODI) score in plaster of Paris group was 23.70 (SD = 7.82) and in fiberglass group was 18.50 (SD = 5.94). Conclusions: Application of body cast using a fiberglass material give better radiological outcome hence less pain, more functional and higher patient’s satisfaction as compared to plaster of Paris
MLH1 and MSH2 Gene Mutations and Polymorphisms in Six Malay Families with Hereditary Nonpolyposis Colorectal Cancer
Get PDFBackground: Hereditary nonpolyposis colorectal cancer (HNPCC) also known as Lynch syndrome is commonly caused by genetic alterations in any of the four mismatch repair (MMR) genes; MLH1, MSH2, MSH6 and PMS2. This is the first study aimed to investigate genetic variants in Malay HNPCC families. Methods: Six Malay HNPCC families who fulfilled any of the Bethesda criteria were recruited into this study. A total of 3 ml of blood was withdrawn from each patient in the families. The samples were further analyzed using polymerase chain reaction and direct sequencing of the selected exons of MLH1 and MSH2 genes. Results: Two missense mutations and four single nucleotide polymorphisms (SNPs) were identified in six patients. These variants in the MLH1 and MSH2 genes were identified in four families who met the revised Bethesda guidelines. In two families, no mutation and polymorphism was identified in both the exon and intron of the respective genes. Of the mutations and polymorphisms identified, five have never been reported in Malay HNPCC families before. A missense mutation was detected in exon 5 of the MLH1 gene, c.394G>C (p.Asp132His) and four mutations and polymorphisms were detected in the MSH2 gene; heterozygous c.211+98T>C and c.211+9C>G and homozygous c.211+98T>C and c.211+9C>G, c.367-86A>C and c.382C>G. Conclusion: The results represented a new spectrum of mutations and polymorphisms in the Malay HNPCC families. However, a larger study involving additional families and analysis is required to determine the impact and nature of the identified mutations and polymorphisms
Self-perception of Stigma among Epilepsy Patients in Malaysia
Get PDFIntroduction: Epilepsy remains a stigmatised disease across geographical and temporal boundaries. Very little is known about epileptic stigma (ES) in cross-cultural settings. The aim of this study was to assess the prevalence of perceived stigma and factors associated with it, among patients with epilepsy (PWE) at a tertiary care referral hospital in East Coast of Malaysia. Methods: A cross sectional survey among 132 consenting PWE using pre-tested, semi-structured questionnaire in Malay/English language to assess their knowledge, attitude and practices (KAPs). Results: Among 132 respondents, 51.5% were male and 48.5 % were female. Their age ranged from 14 to 70 years (mean=31.6±13.41). Majority (53.8%) of them were aged 30 years or younger. The median number of years they had epilepsy was 8.0 (IQR 4.0-18.8) years and average duration of seizure prior to seeking medical attention was 1.0 (IQR 0.3 - 4.5) year. Most of them (90.9%) did not know the cause of epilepsy; however nearly all (91.7%) believed that it was a disease of the brain. Higher education level respondents possessed significantly higher KAP scores compared to lower education level respondents (p<0.001). Respondents with good KAP scores believed that epilepsy was not contagious and they observed greater social tolerance. Conclusion: Our study suggests that there is an inverse relationship between knowledge and ES. Self-perceived stigma was more common among our PWE. The results suggest that there is a critical need to enhance epilepsy education amongst the PWE beyond mere seizure control
Effects of Virulence Factors On Streptococcus Pneumoniae in Vitro Growth
Get PDFIntroduction: Streptococcus pneumoniae remains as a major causative agent for morbidity and mortality cases in the world. The pathogenicity of this bacterium is attributed to many virulence factors. These factors, though not all had been extensively investigated at the molecular level in various mutant studies. However, of these studies, none of them were using local Malaysian isolate. Materials and Methods: Therefore, to better understand the growth pattern of local mutants a growth curve study and optochin disk susceptibility test were conducted. Several virulence genes (i.e hyl, ugl, ccpA, nanA, and ply) were targeted for this local mutant construction. Pneumococcal mutants were constructed by employing genome-wide deletion technique using high throughput polymerase chain reaction (PCR). Linear knockout construct was established by fusing the kanamycin resistance protein encoding gene, aphA-3 with 1 Kb homologous sequence up and down stream of the respective targeted genes. The gene was knocked out by allelic replacement mechanism. Results: Glycosaminoglycan (GAG) gene cluster mutants (∆hyl- and ∆ugl-) took two days compared to 3 others to grow on brain heart infusion (BHI)-kanamycin agar plate following transformation. This indicated a variance in the mutant growth pattern. Therefore, a growth curve study was conducted to validate the previous observation. We report different time span of log phase in growth curve pattern of mutants relative to the wild type strain. Meanwhile, comparison of zone of inhibition using optochin disk showed non-identical inhibition diameter (≥ 14mm) corresponding to the wild type (14.3mm). Conclusion: The difference in growth pattern was attributed to nutritional role of certain gene
Establishment of Simultaneous Detection and Quantitation of HCVRNA by Third Generation Intercalating Dye Real-time PCR
Get PDFIntroduction: Rapid quantification of hepatitis C virus is helpful in determining and monitoring of the disease progression and nature of the virus replication. The aim of the present study was to establish a fast, specific and sensitive tool for HCVRNA quantification. Materials and Methods: A total of 50 serum samples, comprising of 40 HCV-positive and 10 HCV-negative, were included in our study. RNA was extracted, reverse transcribed, and then subjected to real-time PCR amplification. Real-time PCR using EvaGreen dye and primers targeting a 5’UTR was carried out. Reference samples with known viral load were treated similarly to the unknown samples and used to create the standard curves. Results: Our method showed a high level of analytical specificity and accuracy, with a low limit of detection (~2 IU/ml). It yielded repeatable results with less than 4% of intra- assay variation. The assay covered a broad dynamic range of quantification, ranging from 0.34 to 6 log IU/ml. The diagnostic sensitivity, specificity, and accuracy were all 100%, indicating neither false positive nor false negative results were obtained. Conclusion: The developed real time PCR using EvaGreen dye has demonstrated a highly analytical and diagnostic performance for HCV quantification, suggesting its potential in clinical diagnosis and management
Factors Associated with Deep Surgical Site Infection in Spinal Surgery
Get PDFIntroduction: Surgical site infection (SSI) rate in spinal surgery ranges from 1% to 9%, depending on the type of procedure and institution. SSI gives rise to increased morbidity, poorer outcomes and increased healthcare costs. Various risk factors have been reported in the literature but there is no such related report from Malaysia. This pilot study aimed to determine the incidence and risk factors of deep surgical site infections which require surgical debridement in patients who had undergone spinal surgeries. Materials and Methods: Patients who had undergone spinal surgery at Hospital Tengku Ampuan Afzan, Kuantan from the 1 st January 2016 to the 31st December 2017 were included in this study. Associations between SSI and risk factors were analysed with IBM SPSS version 21. Age, body mass index, number of vertebral level involvement, hemoglobin reduction and white blood cell count were analysed by the student t-test while gender, smoking status, spinal cord involvement, fracture dislocation at thoraco-lumbar junction and history of pre-operative blood product transfusion were analysed by Fisher’s exact test. Results: Four (17%) out of 24 patients developed deep SSI which required surgical debridement. Fracture dislocation at the thoraco-lumbar junction (p=0.008) and history of pre-operative blood product transfusion (p=0.003) were associated with deep SSI. Conclusions: This study highlighted different risk factors associated with deep SSI in spinal surgeries. A larger study is needed to further confirm these findings
Risk Factor Profile Of Young Adults With Acute Myocardial Infarction: A Preliminary Finding
Get PDFIntroduction: Acute myocardial infarction (AMI) is a major cause of death around the world. There are limited studies of risk factor profile in young adults with AMI. This study aimed to assess the risk factor profile of young adults with AMI at the emergency department of Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang. This is a preliminary result of young adults (age between 18 to 45 years old) who presented to the emergency department of HTAA. Materials and Methods: This cross-sectional study was conducted in HTAA from the 31st July 2017 to the 11th June 2018 involving 709 patients who were diagnosed with AMI. Seventy seven patients were less than 45 years old. However, only 55 were recruited for analysis who fulfilled the inclusion and exclusion criteria. Results: The prevalence of young adults with AMI was 10.9% with mean age of 38.8 ± 5.1 years old and 96.4% were male. Eighty percent of the patients were Malay followed by 10.9% Chinese and 9.1% were Indian. 83.6% were married while 14.5% were unmarried and 1.8% were divorcees. Majority of patients (81.8%) had income less than RM4000. The common risk factors of young adults with AMI presented to HTAA was smoking (80%) followed by increased waist circumference (54.5%), obesity (52.7%), hypertension (40%), hypercholesterolaemia (27.2%), family history of ischaemic heart disease (27.2%), and diabetes mellitus (21.8%). Conclusion: AMI in young adults almost exclusively occurs in male. Smoking and obesity were the most common risk factors in young adults with AMI in HTAA
Assessment of Dental Development in Children with Hypodontia and Hyperdontia: A Case Control Study
Get PDFThe aim is to investigate the dental development (DD) in children with hypodontia and hyperdontia compared to age, gender, and race matched controls.A match-pair case control study was conducted among children aged 5 to 14-year-old, attending the Dental Polyclinic, IIUM, from December 2011 until September 2014. Willem’s method was used to analyze the dental age (DA) using panoramic radiograph. The difference between dental age of hypodontia/hyperdontia children and the controlswas analyzed using analysis of covariance (ANCOVA). The differences between dental and chronological ages (CA) and the differences in DA and CA with the numbers of missing teeth were analyzed using t-test. Intra-class correlation coefficient between examiners ranged from 0.98-0.99. The result is that27 hypodontia and 12 hyperdontia samples were recruited and compared to a total of 78 matched controls. Both male (n=12) and female (n=15) hypodontia children had statistically significant delay in DD (p=0.000). There was no significant difference in the DD of male (n=7, p=0.811) and female (n=5, p=0.235) in hyperdontia children compared to the matched controls. No differences were observed between DA and CA with the number of missing teeth. Unlike hyperdontia children, hypodontia children showed delayed DD in comparison to age, gender, and race matched controls. There was no association between magnitudes of dental development delay in hypodontia children with the number of missing teeth. This study provides valuable baseline information for provision of better treatment planning for those hypodontia and hyperdontia children that may involve inter-disciplinary management
Depression, Anxiety, And Stress Among Adolescents In Kuantan And Its Association With Religiosity- A Pilot Study
Get PDFAdolescence is a period of time when the development of personality and psychology is taking place. Studies have shown that religiosity can affect the mental health of a person. Many tools have been developed to assess religiosity of a person; one of them is the Santa Clara Strength of Religious Faith (SCSORF) scale. In this study, a translation and validation for SCSORF Malay Version (SCSORF-M) is done, and subsequently used to look for the association between religiosity and mental health in adolescents. Fifty questionnaire papers have been distributed to 50 students in secondary schools in district of Kuantan. The mean score for depression, anxiety, and stress are 5.83, 5.59, and 8.34 respectively. Only 10 (24.4%) have no depression, 9 (22%) have no anxiety, and 13 (31.7%) have no stress. The mean score for SCSORF-M scale was 35.3 (range 25-40). Family income has shown to correspond negatively with the depression, anxiety, and stress, while religiosity has shown to be correlating negatively with depression and stress, but positive correlation with anxiety. SCSORF-M has positive convergent correlation with Duke’s University Religiosity Index Malay Version (DUREL-M) in all domains. SCSORF-M has shown good Cronbach’s alpha value (0.84). In conclusion, religiosity is an important factor to contribute to the outcome of mental health among adolescents. SCSORF-M can be used as an assessment tool for religiosity
Latent Class Analysis of Dental Treatment: Observed in IIUM Dental Specialist Clinic, Kuantan, Pahang
Get PDFResearch into dental treatment via statistical perspective was unraveled through a relation between theoretical and experimental probability. This assessment of association was examined using statistical test over Confirmatory Factor Analysis (CFA) and Latent Class Analysis (LCA). Theoretical results of the prevailing difference between the direct and indirect upshot was verified through a technique known as integrated model by using Mplus® software package. The results expressively show that the dental treatment from the indirect effect has better performance than the direct effect. Besides that, there is a dramatic improvement of dental treatment from different type of malocclusion analysis. Three classes of different type of malocclusion analysis play an important role as mediator for demographic variable and type of dental treatment