IIUM Medical Journal Malaysia (IMJM)
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Level of Sexual and Reproductive Health Knowledge and Attitude Among Early Adolescent
Get PDFIntroduction: Topic on sexuality has largely remained a taboo subject for discussion between parents and their children in Malaysia, which might contributed to increase sexual activity among adolescent age group. This study was undertaken to assess the level of knowledge, attitude and their associated factors among standard 4 and 5 students in a primary school in Kuantan, Pahang. Materials and Methods: A cross-sectional study was conducted involving 281 students from standard 4 and 5 students using a self-administered validated Malay version KAPSRH questionnaire. Universal sampling was used for selection of students who fulfilled the inclusion and exclusion criteria. Descriptive statistics was used to explain respondents' background characteristics and multiple logistic regression was used to find the association. Results: Of the 252 students completed the surveys, 135 were males and 117 were females with the mean age of 10.47. It was found that more that half students reported to have good knowledge (56.3%) and attitude (59.4%) towards sexual and reproductive health. Year of study (p<0.0001), involvement in religious activities (p<0.0001) and household income were associated with both knowledge and attitude. While prayers (p=0.04), practice fasting (p=0.03), mothers' education (p<0.0001), fathers' education (p<0.0001) and fathers' working status (p=0.04) were associated with good attitude only. Conclusion: Although majority of the students have good level of sexual and reproductive health knowledge and attitude , there is still room for improvement. Parents, schools and health care providers are challenged with the task of providing adolescents with accessible sexual and reproductive health information to promote healthy sexual and reproductive lives
Functional Outcome of Neurotization to The Musculocutaneous Nerve in Traumatic Brachial Plexus Injury
Get PDFIntroduction: Neurotization procedures to the elbow flexors are commonly done in traumatic brachial plexus injury (BPI). The objective of this study was to evaluate the recovery of elbow flexors in patients who underwent neurotization procedure to musculocutaneous nerve in the panplexus and upper trunk BPI. Materials and Methods: This was a cross sectional study involving 70 patients who underwent neurotization to elbow flexor. A total of 31 patients (44%) had panplexus injury and 39 (56%) had upper trunk BPI. Elbow flexor motor power and post-operative Disabilities of the Arm, Shoulder and Hand (DASH) score were evaluated. Results: The mean age of the patients was 22.7 years. Patients with panplexus BPI underwent neurotization to the elbow flexor using spinal accessory nerve as a donor and patients with upper trunk BPI used either ulnar or median nerve as a donor. The results of elbow flexors recovery in panplexus BPI were good (MRC grade 4 and 5) in 11 patients (35.5%) and poor in 20 patients (64.5%). Conversely, the recovery of elbow flexors in upper trunk BPI were better with 28 patients (71.8%). Good post-operative DASH score (score <50 points) were noted in 29 patients (74.4%) with upper trunk BPI. Only seven patients (22.6%) with panplexus BPI showed good post-operative DASH score. Majority of patients with panplexus BPI demonstrated poor recovery of elbow flexor and post-operative DASH score as compare to upper trunk BPI (p= 0.002). Conclusion: Overall, this study showed significantly better functional outcome of neurotization procedure to elbow flexor in upper trunk BPI than in panplexus BPI
Grisel Syndrome: Prompt Diagnosis, Prompt Management Equals Happy Ending
Get PDFGrisel syndrome is a rare cause of torticollis resulting from subluxation of the atlanto-axial joint (C1-C2 vertebra) joint from surrounding soft tissue inflammation. Atlanto-axial joint injuries typically occur in the setting of trauma. However, here we report a case of a non-traumatic cause of atlanto-axial joint subluxation in a child. The child initially presented to our centre with 5 days history of torticollis preceded by a few days of upper respiratory tract symptoms. The initial radiograph of the cervical spine did not demonstrate any obvious abnormality. However, due to a high index of suspicion by the attending physician, a CT of the cervical spine was performed, which indeed revealed an atlanto-axial subluxation. The patient was put on cervical traction for a few days, and discharged well with soft collar and analgesia
Ethical Issues on using Invertebrates in Environmental and Biomedical Practices – A Case Study on Living Fossil Horseshoe Crab
Get PDFIncreasing utilization of living animals in ecological and biomedical research has drawn serious concerns in terms of animal welfare and ethical practices in animal handling. Significant attention has been given to animals of higher taxonomical hierarchy especially vertebrates such as fishes, rodents, reptiles and mammals, while ethical framework on invertebrate handling and welfare is less addressed (except for cephalopods). The definition of ‘Animal’ itself by any international consortia or Animal Research Act (ARA) does not include invertebrates as an animal entity. This is due to the lack of standard ethical framework to understand the pain and other physiological stress experienced by the invertebrate test animal. One such example would be the living fossil ‘horseshoe crab’ which is extensively bled to obtain its blue blood that is used for endotoxin quantification in biological samples. The biomedical bleeding itself leads to 15-30% post bleeding mortality of crabs, while pain and stress caused by the bleeding practice is not studied. Hence, this paper discusses the technicality of establishing standard framework for invertebrate handling. The paper also highlights the shari’ah (Islamic law) principles on scientific experimentations on animal subjects, particularly the norms related to the adoption of invertebrates in environmental and biomedical practice. Comprehensive review of ethical regulations in animal experiments, especially invertebrates, would be beneficial for revising and improving existing animal ethical practices
Identification of VASA Gene Expression in In-vitro Culture From Non-Obstructive Azoospermia (NOA) Testicular Biopsy Cells: A Study to Unlock Knowledge of Male Infertility
Get PDFThe expression product of VASA gene is widely conserved germ line marker and participates to regulate the development of reproductive system and spermatogenesis in healthy man. Azoospermic is a condition which the man is unable to produce any sperm cells for reproduction activity. This condition produced has bad impact to the man since the ability to produce their own progeny will be interrupted or blocked forever. Not only the family bloodline of the man would be ended, the psychological issue like shamefulness and low self-esteem occurs. In Islam, seeking knowledge is an obligatory to Muslims in order to solve problems and improve lives. Thus to unveil the problem of azoospermic man we aimed to determine the level of VASA gene expression in samples of testes cells of non-obstructive azoospermic (NOA) and compare it with sperms of healthy man. Samples were taken from three NOA patients by testicular sperm extraction (TESE) to obtain testicular biopsies. Testicular cells were isolated and cultured in supplemented knockout DMEM media. VASA gene expression was determined by reverse transcriptase polymerase chain reaction (RT-PCR). The VASA gene expression from sperm of healthy man was also determined for comparison purpose. It was demonstrated that the addition of growth factor significantly increased SSC-like cells colony formation in tissues obtained from NOA patients. No VASA expression was detected in spermatogonial-like stem cells culture on day 1, 7, 14 and 21 in each of the azoospermic samples. Our findings shown VASA gene was not expressed in spermatogenesis in vitro culture that might be associated with the abnormal differentiation of primordial germ cells that lead to male infertility. Islam also teaches us to not have feelings of despair and for problems that we are facing but to find the solution and consider the problem as a test from the Almighty. All the tests should be handled with strong believe since only Allah (SWT) knows what the best for us and each of the tests will have justified wisdom and benefits which we as human being are unable to realise thoroughly
Modern Investigation toward Shari’ah Compliance: Squatting Uroflowmetry
Get PDFINTRODUCTION: Standard uroflowmetry is performed in a standing position and it is an important investigation for those who are suspected of having lower urinary tract symptoms such as benign prostatic hyperplasia (BPH). Effects of changing positions during uroflowmetry have also been investigated previously but mixed conclusions were made. For Muslims, voiding in squatting position is encouraged as part as daily practice. This is mainly due to cleanliness reason and many Hadiths have emphasised about it. Objective: The aim of this study is to compare uroflowmetry findings between squatting and standing positions amongst BPH patients attending urology clinic Hospital Tengku Ampuan Afzan (HTAA). Methods: This is a cross section observational study carried out from March 2015 to December 2015. The maximum flow rate, average flow rate, voiding volume, total voiding time and post-voiding residual volume were measured and recorded. Results: The results were then compared and analysed. 64.2% of patients were non-Muslims. 78.0% of the patients voiding habit were standing and 12.2% squatting position at home. The average International Prostate Symptom Score (IPSS) was 12.07 and 63.4% of them were in moderate group disease. Post void residual (PVR) volume showed a reduction in squatting position (p<0.05). Otherwise there was no significant difference seen in other parameters. Conclusion: This study showed that voiding in squatting position, which is shari’ah compliant is not inferior compare to standard uroflowmetry. Therefore Muslim patients should be given the option to perform uroflowmetry in a squatting position if available. This may yield better results
Prevalence of Depression amongst Caregivers of Stroke Patients Attending Hospital Universiti Sains Malaysia
Get PDFIntroduction: Caregiving for stroke patients is a challenging task both emotionally and physically. Studies have shown that caregiving can affect caregivers’ wellbeing that could lead to depression. Objective: This study was carried out to determine the prevalence and associated risk factors of depression amongst caregivers of stroke patients attending Hospital Universiti Sains Malaysia (HUSM) in Kelantan over a 6 month period. Methodology: This is a cross sectional study at the primary care clinic in HUSM over a period of 6 months. A total of 116 caregivers of medically documented stroke patients who fulfilled the inclusion and exclusion criteria were recruited via convenience sampling. The brief patient health questionnaire (PHQ-9) were used to assess their depression. Descriptive statistics and bivariable analysis was used using SPSS version 23.Results: 63.8% of the caregivers of stroke patients are depressed. Caregiver’s burden, ethnicity and patient’s ethnicity were found to be significant associated risk factors for depression.Conclusion: Screening for depression in caregivers especially those with risk factors must be carried out in the clinic in order to detect and intervene early. Coping mechanisms especially in the religious aspect should be elicited in future studies
Suggested Insulin Regimen for Pregnant Women with Diabetes Who Wish To Fast in Ramadan
Get PDFIntroduction: Pregnant women are among those who are exempted from Ramadan fasting. Despite that, many pregnant women had chosen to fast despite understanding the risk of complications especially hypoglycaemia. In Hospital USM (HUSM), an insulin regime for pregnant women who wish to fast was designed based on expert opinion of obstetricians, but its safety and efficacy are yet to be determined. Objective: To determine the safety and efficacy of the formulated insulin regime using subcutaneous Actrapid® and Insulatard® amongst pregnant women with diabetes who fast in Ramadan. Methodology: Pregnant patients with diabetes on insulin who wish to fast during Ramadan were invited to participate in the study. The total daily dose of insulin requirement prior to Ramadan was divided 3 parts; 2/3 for iftar (sunset meal) and 1/3 for sahur (pre-dawn meal). For each timing, 2/3 of the calculated dose was given as short-acting insulin Actrapid® and remaining 1/3 as intermediate-acting insulin Insulatard®. Three patients were monitored in the ward while fasting for two days. Blood glucose checked eight times a day. Following that, eight patients were followed up during Ramadan fasting with this regime. Weekly blood sugar profile (BSP) was taken and glycaemic control evaluated. Results: All patients were able to fast without any hypoglycaemic episode, both during in-patient study and during out-patient Ramadan fasting. Mean daily blood glucose per day for in-patient monitoring was 7.3 mmol/l with the lowest being 4.56 mmol/l in the afternoon. During Ramadan fasting, average glucose level was higher (6.79 mmol/l) compared to prior to Ramadan value (5.67 mmol/l) (p> 0.05). However, improvement of glycaemic control was observed towards end of Ramadan. Conclusion: Pregnant women with diabetes treated with insulin can fast safely during Ramadan using the suggested insulin regime with improvement of glycaemic control observed at the end of Ramadan
Survey of Musculoskeletal Pain among Dental Clinician in Kulliyyah of Dentistry IIUM
Get PDFThis study aimed to determine the prevalent site of musculoskeletal pain and its associated risk factors among dental clinicians at the Kulliyyah of Dentistry, IIUM. A validated, pilot-tested self-administered questionnaires were distributed to 160 dental clinicians between March and June 2014 using convenience sampling method. Inclusion criteria includes dentist, clinical supervisors or clinical dental students. Dental clinicians whom were diagnosed with musculoskeletal disorders were excluded. Data obtained were recorded and analyzed using statistical package for the social science (SPSS) software version 19. Pearson correlation test was used to determine the association between the risk factors and pain sites. A total of 146 participants completed the questionnaire (91.3% response rate). The sample consist of 40 dentists (27.4%), 36 Year 3 students (24.7%) and 35 participants (24%) respectively from Year 4 and Year 5. There was high prevalence of neck pain (79.5%), back shoulder pain (74.7%) and lower back pain (71.9%) among dental clinicians. Significant correlation was found between physical activities with upper body region pain sites (r = 0.170, p=0.042) and lower body region pain sites (r = 0.221, p=0.008). There was a significant association between repetitive movements and wrist bending with upper and lower body region pain sites (r = 0.320, p = <0.001) (r = 0.278, p =0.001). No correlation between awkward postures with upper and lower body pain sites. This paper will relate to the Islamic teaching on moderation in working and in maintaining healthy lifestyle. The most prevalent site of musculoskeletal pain experienced by dental clinicians was at the neck area and the least was on the left arm. Repetitive movements, wrist bending and physical activities were associated with upper and lower body region pain sites
