IIUM Medical Journal Malaysia (IMJM)
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A Case Report of Airway Stenting in Tracheal Compression Secondary to Right Subclavian Artery Pseudo-aneurysm
Get PDFWe report a 55-year old lady with the presentation of stridor and type II respiratory failure requiring tracheal intubation. She had right Horner’s syndrome associated with pleural effusion. Her chest radiograph revealed right upper zone lobulated opacities and therefore right Pancoast tumor was the initial diagnosis. However, her CECT thorax revealed a huge right subclavian artery pseudoaneurysm with severe tracheal compression. This rare condition imposed a significant diagnostic as well as therapeutic challenge. Vascular surgery is the definitive treatment but it is associated with high risks. The exact role of rigid bronchoscopy for airway stenting is unknown due to limited evidence available. Indeed, this form of central airway obstruction may benefit from temporary tracheal stenting whilst the surgical repair of the lesion is planned. It may facilitate early weaning and allows less complicated airway control
Dental Students as Smoking Cessation Counsellors: Patients’ and Providers’ Perspective
Get PDFIntroduction: This study assesses dental students’ and patients’ perceptions on the role of dental students as smoking cessation counsellors as well as the patient’s quit rate at the University of XX. Materials and methods: Self-administered questionnaires were distributed to all senior dental students (n=154) in XX University and telephone call interviews were conducted on their patients (n=169) who received smoking cessation counselling from September 2010 to June 2013. Results: Response rates for dental students and patients were 68.2% and 67.3% respectively. Most of the dental students in this study were females (72.3%) whereas the majority of patients were males (97.6%). An average of six months follow up indicated that 22.5% of patients had quit smoking, 65.3% reduced the number of cigarettes smoked and 6.5% had relapsed. About a third of patients surveyed (33.1%) believed that smoking cessation counselling was extremely helpful compared to what students perceived (5.7%, p<0.01). A higher percentage of patients (89.9%) rated the smoking cessation counselling performance as “excellent”, as compared to students’ rating (58.1%, p<0.01). The majority of the dental students and patients agreed that students should enquire about patients tobacco usage, information regarding the effects of smoking on oral health should be transmitted to patients and that quit smoking assistance should be offered. Conclusion: Smoking cessation counselling conducted by dental students seemed to be effective in assisting patients to reduce the number of cigarettes smoked and in quitting smoking. To some extent, both patients and students had positive attitudes towards smoking cessation counselling
Body Weight Perception Versus Body Weight Status: How Good is The Agreement?
Get PDFIntroduction: Body weight perception is an important underlying psychological factor associated with body weight. Overemphasis on thinness among adolescents can lead to unhealthy dieting practices and eating disorders, whereas underestimation of body weight may increase risk of the development of overweight and obesity. This study measured the agreement between body weight perception and body weight status (BMI) among late adolescents in Kuantan. Materials and Methods: A cross-sectional study was conducted from April to August 2018 among 418 adolescents of six higher learning institutions in Kuantan; aged 17-19 years old. Weight and height were measured and BMI was calculated. Self-administered, validated questionnaires; Figure Rating Scale (FRS) and International Physical Activity Questionnaire (IPAQ) were used. The strength of agreement between BMI and body weight perception was examined using Kappa statistics. Results: Overall, 37.6% of total participants misjudged their own body weight. Of particular note, 51.9% of real underweight participants misperceived body weight as normal weight and overweight while 47.2% of obese participants incorrectly perceived their body weight as overweight. The agreement between body weight perception and body mass index was poor (k=-0.09, p< 0.01). The discrepancy more marked in male (k = -0.11, p<0.01). Conclusions: Body weight perception was not in agreement with actual weight in late adolescents. Accurate body weight perception is an important factor in late adolescent’s weight management behaviour. More effort should be done in order to correct misperception among this age group for their health benefits
Comparison of Bacterial Loads from the Lift Buttons of a Kulliyyah and a Library at IIUM Kuantan and Identification of the Bacteria from Selected Buildings
Get PDFIntroduction: Lift buttons are among the potential fomites in transmitting infectious microorganism to the community. The daily use of lift buttons by different people with various hygiene practices can contribute to the colonization of microorganism on the touched surfaces. There is a little published research on microbial colonization on lift buttons in Malaysia, especially in the campus setting. Hence, this study aimed to identify and compare the bacterial load on lift buttons from a kulliyyah (faculty) and the library at IIUM Kuantan. Materials and Methods: A total of 42 swab samples were collected aseptically from the lift buttons and cultured on nutrient, mannitol salt and MacConkey agar for bacterial enumeration and isolation. Gram staining, microscopy examination and molecular amplification of the 16S rDNA gene by polymerase chain reaction were performed for further characterization of the bacteria. Results: Out of 42 swab samples collected (kulliyyah: n = 25, library: n = 17), 88.4% of the samples confirmed the presence of bacteria with the lift buttons in the kulliyyah showed a higher percentage of bacterial isolation (92%) compared to the library (84%). Grampositive cocci clustered bacteria dominated the isolates followed by Gram-positive bacilli, Gram-positive cocci tetrads and Gram-negative coccobacilli. Based on culture growth, Gram-staining features and 16S rDNA gene sequencing, isolated bacteria were identified as Staphylococcus sp., Staphylococcus kloosii, Bacillus cereus, Kocuria palustris, Yersinia mollaretii, Bacillus sp., Micrococcus sp., and other Gram-positive cocci. Conclusion: The results revealed a high bacterial load on lift buttons which can be a source of bacterial transmission
Perceptions Among Muslims in Malaysia Towards Dental Procedures During Fasting Month
Get PDFIntroduction: A few studies reported that there is reduced in dental attendance among Muslim patients during fasting month. This study aims to assess the perceptions among Muslims in Malaysia on common dental procedures during fasting. Materials and Methods: A structured questionnaire was used to assess the perception about common dental procedures and dental attendance during fasting on 377 Muslim adults in Kuantan, Malaysia. The total cumulative score derived from the perception section was categorized into good and poor perception based on the median score, where a score less than the median score was categorized as poor perception and a score equal to or more than the median score was categorized as good perception. We further examined the association between perception score with sociodemographic data and dental attendance. Results: Majority respondents perceived that most of the dental procedures will not nullify their fast with 50.9% of them categorized as having a good perception based on median score. There was a significant association between perception with education level (p=0.04) and Islamic education level (p<0.001). There was also a significant association between their perception and dental attendance during fasting month (p=0.04). It also showed that dental attendance during fasting month was poor across both groups with poor and good perception. Conclusion: The majority of the Muslims perceived that most dental procedures did not nullify their fast. However, their willingness to come for dental treatment during fasting was poor regardless of the perceptions. Hence, further research is necessary to explore the reason behind this
Prevalence of Osteoporosis and Risk of Developing Fragility Fracture in Post-Menopausal Women
Get PDFIntroduction: Osteoporosis and fragility fracture pose major health concern and cause significant financial burdens in healthcare system. The objectives of this study were to determine the prevalence of osteoporosis among post-menopausal women and to predict the risk of having the major osteoporotic and hip fracture in 10 years using the WHO Fracture Risk Assessment Tool. Materials and Methods: This was a cross-sectional study spanning over a two-year period (from June 2015 to June 2017) investigating post-menopausal women who did their Bone Mass Density (BMD) test at Hospital Melaka. Collected BMD data and parameters were used for analysif of the prevalence of osteoporosis among the study population and FRAX calculation was used to predict the average risk of fragility fracture in 10 years. Statistical analysis was done using SPSS statistical package. Results: Prevalence of osteoporosis among 388 post-menopausal women age 45 to 90 years old was 29.9%. More than half of patients had osteoporosis were Chinese (51%) followed by Malay (43%), Indian (5%) and others (1%). The 10 years average percentage of developing major osteoporosis was 10.81 ± 9.55 %, while the average percentage of developing hip fracture was 4.20 ± 6.53. Conclusion: Prevalence of the post-menopausal women who were osteoporotic was about 30% which is comparable to other countries (Japan, Egypt, Australia, Mexico, Argentina and India). The 10 years average percentage of developing major osteoporosis and hip fracture in our study is quite high, approximately around 20% and 10%, respectively
The Effects of Holy Quran Recitation on Physiological Stress Response in Mechanically Ventilated Intensive Care Unit Patients: A Pilot Study
Get PDFIntroduction: Mechanically ventilated intensive care unit (ICU) patients are exposed to stress due to the disease, intervention and surroundings. Pharmacological treatment is commonly used to reduce stress however it could give adverse effects. This study examined whether listening to Quranic recitation helps in reducing stress by observing the effects on vital signs, pain score, anxiety score and serum cortisol level. Methodology: Forty mechanically ventilated ICU patients of IIUM Medical Centre who fulfilled weaning criteria were randomised into Quran (n=7) and control groups (n=23). Patients in the Quran group received 30 minutes of uninterrupted bed rest while listening to Surah Al-Mulk via mp3 player followed by 30 minutes bed rest. For control group, 60 minutes of uninterrupted bed rest was allocated. APACHE score, SOFA score, pain score, anxiety score, serum procalcitonin and serum cortisol were taken before and after intervention. Heart rate (HR), respiratory rate (RR), systolic (sBP) and diastolic (dBP) blood pressure were recorded at 5 minute intervals throughout the intervention period. Results: In the Quran group, vital signs showed decreasing trend from minute 0-30 but increased after minute 60. Both pain and anxiety scores in Quran group showed decreasing trend throughout 60 minutes. In control, the vital signs, pain and anxiety score are unchanged. Serum cortisol in both groups showed increasing trend after the intervention. Conclusion: This preliminary finding demonstrated the potential effects of listening to Quranic recitation in reducing physiological stress response in mechanically ventilated ICU patients. The small sample size may explain decreasing trends but non-statistically significant results
Translation and Validation of Malay Version of the Simplified Diabetes Knowledge Test
Get PDFIntroduction: Type 2 diabetes mellitus is a non-communicating disease with an increasing trend in Malaysia. One of the most important aspects in the selfmanagement of diabetes mellitus is the assessment of knowledge among diabetes patients. This study aimed to translate and validate the Malay version of Modified Diabetes Knowledge Test (DKT) questionnaire. Methods: A standard back-to-back translation procedure was used to translate the simplified version of the DKT questionnaire from the original version. A total of 120 outpatients with type 2 diabetes mellitus from the government primary care clinic were selected to answer the questionnaire which consists of socio-demographic and diabetes characteristics questions as well as the 20-item DKT questions. Reliability and validity were tested with Cronbach’s alpha and Exploratory Factor Analysis. Results: The Cronbach’s alpha for the translated questionnaire was acceptable (α=0.573) with the Cronbach’s alpha excluding each item ranged from 0.517 to 0.602. Factor analysis with Varimax rotation identified 6 domains for the 18 items, with 2 to 6 items in each domain. Conclusion: This version of simplified DKT is proven to be valid and reliable, and can be used with caution as a brief assessment of knowledge among diabetic patients specifically tailored for Malaysian population
Tuberculous Encephalopathy Mimicking Limbic Encephalitis and Large Intraparenchymal Mass: A Challenge In Diagnosis
Get PDFTuberculosis of central nervous system (CNS TB) being endemic in Malaysia, most commonly presents as tuberculoma or meningitis. Less commonly, this specific disease entity presents as cerebritis, miliary form, encephalitis and large intraparenchymal mass. At the cellular level, it was even postulated that the pathogenesis of the most common form of CNS TB is way different from the rarer form of encephalitis. Parenchymal involvement of CNS TB is primarily believed as a result of leptomeningeal/ ependymal extension or gross occlusion of basal arteries due to exudates and arteritis. However, the pathogenesis of TB encephalitis was postulated to result from type IV direct (allergic type) hypersensitivity which is similar to other demyelinating diseases at present. Here, we highlight an extremely rare imaging manifestation of CNS TB, which impersonates limbic encephalitis and large intraparenchymal mass imposing a diagnostic dilemma