IIUM Medical Journal Malaysia (IMJM)
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Mak Nyahs in Malaysia: Does HIV/AIDS Knowledge Really Reduce HIV-Related Risk Behaviours?
Get PDFIntroduction. Male-to-female transgender individuals are known as mak nyahs in Malaysia. Akin to many other countries, mak nyahs face discriminations in securing proper employment, thus many end up in sex trade, exposing them to HIV-related high risk behaviours. This paper aims to investigate the knowledge, attitude, and risk behaviours in HIV/AIDS among mak nyahs in Malaysia. Method. Validated questionnaires in local language were used. Knowledge, attitude, and HIV-related risk behaviours were measured. With respondent-driven sampling method, 54 subjects participated in the survey. IBM SPSS was used for data analysis. Results. Majority of the subjects reported to have HIV-related sexual risk, although only a quarter were sex workers. Misconceptions still remained among the subjects. Inconsistent condom use was common. Adequate knowledge did result in better attitude towards HIV/AIDS. However, multiple regression analysis showed that subjects with higher knowledge in HIV/AIDS tend to have higher sexual risks (β = 0.320, p = 0.030). Conclusion. Educating the transgender community about HIV/AIDS does not seem to adequately reduce the HIV-related sexual risks. Other approaches, i.e. socio-cultural values and religious practices may be effective to instil higher levels of awareness and self-responsibility in this community to eliminate HIVrelated high risk behaviours
Perceived Barriers to Exercise in Women with Gestational Diabetes Mellitus
Get PDFIntroduction: Good control of glycaemia negates potential maternal and fetal complications. A diet suitable for women with gestational diabetes mellitus (GDM) is a first line approach. However, little is said about suitable exercise in pregnancy that will potentially help control glycaemia. This pilot study seeks to understand the perceived barriers to exercise in women with GDM. Materials and Methods: This crosssectional study recruited patients with GDM on diet control at the antenatal clinic of Hospital Sultanah Aminah Johor Bahru, Malaysia between October 2017 and January 2018. Those who fulfilled the recruitment criteria were approached and 89 women consented to participate. Data was obtained from antenatal records and a self-administered questionnaire. Results: The mean age of the participants was 33.3 years. More than 80% were Para 1 and above. 69.6% were either overweight or obese at booking of pregnancy. 80.9% were aware that exercise was necessary for women with GDM. Only 6.7% say that healthcare professionals were their source of information on exercise in pregnancy. 77.3% of the women with low physical activity had full time jobs. Housewives (64.5%) had the highest level of physical activity. Tiredness (43.8%), childcare duties (38.2%) and lack of time (27.0%) were the most common perceived barriers to exercise. Nulliparity was significantly associated with tiredness. Conclusion: Main barriers to exercise are tiredness and childcare duties. Health care professionals did little in educating women with GDM on suitable exercise
Determinants of Metabolic Syndrome among Malaysian Government Employees
Get PDFIntroduction: The metabolic syndrome comprises a collection of cardiovascular disease risks, which has been demonstrated to predict type 2 diabetes mellitus and cardiovascular disease. Metabolic syndrome is a crucial health concern in Malaysia, with a prevalence of about 42.5% in the general population based on the ‘Harmonized’ definition. The aim of this study was to ascertain the association between socioeconomic status among Malaysian government employees with metabolic syndrome, compared with those without metabolic syndrome. Furthermore, this study also aimed to ascertain the associated obesity indicators for metabolic syndrome among employees—explicitly body mass index, waist circumference, waist-to-hip ratio, body fat percentage, fat mass index, and waist-to-height ratio. Methods: This cross-sectional study was undertaken at government agencies in Putrajaya, Malaysia, via multi-stage random sampling. A total of 675 government employees were randomly sampled from a list of 3,173 government employees working in five government agencies under five geographical areas. Data on socioeconomic status, anthropometric, biochemical, and clinical assessments were collected. Results: Employees who were males had higher metabolic syndrome prevalence compared to their counterparts (p=0.019). In addition, employees aged between 20 to younger than 30 years had lowest metabolic syndrome prevalence (p=0.002). The risk of having metabolic syndrome was almost 10 times more likely in men with a waist-to-hip ratio of ≥0.90 compared to men with a waist-to-hip ratio of <0.90 (p<0.001). Women with a waist-to-hip ratio of ≥0.85 were approximately 33 times more likely to have metabolic syndrome as compared to women with waist-tohip ratios of <0.85 (p<0.001). Men with a waist circumference of ≥90 cm were approximately twice as likely to have metabolic syndrome, compared to men with waist circumferences of <90 cm (p=0.030). The risk of having metabolic syndrome was almost three times more likely in women with a waist circumference of ≥80 cm compared to women with waist circumferences of <80 cm (p<0.001). Furthermore, the risk of having metabolic syndrome was almost five times more likely in women with fat mass indexes in Quartile 4 (≥7.93), compared to women with fat mass indexes in Quartile 1 (<5.25) [p<0.001]. On the other hand, men with waist-to-height ratios of <0.445 were 75% less likely to have metabolic syndrome as compared to men with waist-to-height ratios of ≥0.625 (p=0.020). Women with waist-to-height ratios of 0.445 to <0.525 were 95% less likely to have metabolic syndrome as compared to women with waist-to-height ratios of ≥0.625 (p<0.001). In addition, women with waist-to-height ratios of 0.525 to <0.625 were 77% less likely to have metabolic syndrome as compared to women with waist-to-height ratios of ≥0.625 (p<0.001). Conclusion: Gender and age were associated with metabolic syndrome prevalence. Waist-to-hip ratio, waist circumference, and waist-to-height ratio seems to be the better obesity indicators to predict the presence of metabolic syndrome than body mass index and body fat percentage in both men and women
Methemoglobinemia – Two Uncommon Presentations
Get PDFTwo rather different cases of methemoglobinemia are presented. The first case is an infant who had a circumcision procedure with prilocaine. The second case involves a 14-year-old girl who attempted suicide with an overdose of metoclopramide and butamirate citrate. The attention is drawn to differences in hospital admission and management especially with respect to methemoglobin level and age. If methemoglobin levels reach ≥ 10%, cyanosis would appear first. Symptoms of hypoxemia and diminished oxygen transport do not develop until levels reach 30 to 40%. Not only early intervention is crucial but also patients should not be discharged from the hospital too soon. Doctors should be able to identify high risk patients, paying a special attention to infants younger than three months old who might be at an increased risk of methemoglobinemia which is a potentially lethal complication of prilocaine. As for our second case, methemoglobin level has not increased, despite an overdose of metoclopramide. This may be due to age or timely elimination of toxic agents by gastric lavage, catharsis and administration of procyclidine
Prevention of Brain Hypoperfusion-Induced Neurodegeneration in Rat’s Hippocampus by Black Cumin Fixed Oil Treatment
Get PDFIntroduction: The oil extract of black cumin seeds Nigella sativa (NSO) demonstrated considerable preservation of spatial cognitive functions in rats subjected to chronic brain hypoperfusion (CBH). The hippocampal CA1 region pyramidal cells are the earliest neurons suffering neurodegeneration following CBH. Objective: The current study was devoted to assess the protective effects of Nigella sativa (NSO) treatment on CA1 hippocampal pyramidal cells of rats subjected to chronic brain hypoperfusion (CBH) that was achieved through permanent two vessel occlusion (2VO) procedure. Methods: Twenty four rats were equally divided into three groups; sham control, untreated 2VO and NSO treated group (2VO with daily oral NSO treatment. After the 10th postoperative week coronal sections of the hippocampus were collected for histopathological and electron microscopical examinations. Results: The number of viable pyramidal cells within CA1 hippocampal region in sham control and NSO treated groups was significantly higher than that of untreated 2VO group, while the difference was not significant when comparing the viable pyramidal cells number of sham control with NSO treated groups. Furthermore, 2VO group showed marked intracellular ultrastructural distortions that were less pronounced in NSO treated group. Conclusion: NSO displayed a robust potential to protect hippocampal pyramidal cells from CBH induced neurodegeneration putting forward its prospective neuroprotective activity against age related cognitive decline of Alzheimer’s disease and vascular dementia
Early Analysis of Peripheral Obstructive Arterial Disease in Patients with Diabetes Mellitus in Primary Care Setting in Kuantan, Malaysia: Are There Differences?
Get PDFIntroduction: Diabetes mellitus is a known risk factor for the development of Peripheral Obstructive Arterial Disease (POAD). POAD is also one of the major cause of limb loss in diabetic patients. Yet, there is no Ankle-Brachial Index (ABI) screening among the diabetic population to quantify the disease burden or detect the disease at an early stage. This study aimed to find out the prevalence of POAD among diabetic patients in primary care and the associated risk factors and its implication on their quality of life. Materials and Methods: Ninety diabetic patients were included in this universal survey at Klinik Kesihatan (KK) Jaya Gading. ABI of lower than 0.9 was used to define POAD. A validated WHO-QOL BREF Malay version was used to assess the Quality of Life. Results: The prevalence of POAD among diabetic patients in KK Jaya Gading, Kuantan was found to be 20%. Age was a significant risk factor (p=0.005). Social domain of the Quality of Life was significantly affected in patients with POAD. Conclusion: The prevalence of POAD among diabetics in the primary care was relatively high and this supports early screening to prevent further deterioration
Magnetic Resonance Imaging Procedure for Ventilated Intensive Care Patient in the International Islamic University Malaysia Medical Centre: Issues and Challenges
Get PDFManaging a ventilated patient in the Intensive Care Unit (ICU) for Magnetic Resonance Imaging (MRI) procedure requires precise planning. Vigilant anesthetist with adequate MRI compatible monitoring of a critically ill patient and in preparation of any crisis event during transport to MRI suite, during MRI and return journey to ICU is essential. Problems in transporting ICU patient are usually equipment related, deterioration in gas exchange and increased rate of ventilator associated pneumonia. Preparation includes clinical reassessment for swift and systematic transport, airway management, optimum sedation and record keeping close to the patient. This is a case report of a 64 year-old gentleman who presented to International Islamic University Malaysia Medical Centre with right sided headache for one week associated with high intracranial pressure symptoms. His initial Glasgow Coma Scale (GCS) was 15/15 and Computed Tomography (CT) scan of his brain showed bilateral acute-on-chronic subdural haemorrhage, uncal herniation and minimal midline shift. His GCS dropped to 6/15 (E1V1M4) in the ward and proceeded with right craniectomy, evacuation of clot and duraplasty. Post operatively, his GCS improved to 15/15 in ICU and was extubated. On Day 2 post extubation, his GCS dropped to 6/15 (E1V1M4) and intubation was performed. Repeat CT Brain in ICU showed no evidence of new bleeding or mass effect. MRI was performed and it showed acute infarctions at right pons and right occipital region. Tracheostomy was done and the patient was sent to the general ward on fixed performance mask
Prevalence of Thyroid Disorders in Pregnant Women In Hospital Tengku Ampuan Afzan & International Islamic University Malaysia Medical Centre
Get PDFIntroduction: Data on the burden of thyroid disease in pregnant women in our community is scarce albeit the detrimental effects it brought to both the mother and fetus if left untreated. The aim of this study was to determine the prevalence of thyroid disorders, socio-demography distribution, and method of diagnosis in pregnant women of both tertiary centres in Kuantan, Pahang. Materials and Methods: A retrospective cross sectional study involving patients under follow ups at the Endocrine and Obstetric Clinics of Hospital Tengku Ampuan Afzan (HTAA) and International Islamic University Malaysia Medical Center (IIUM MC) from the 1st January until the 30th June 2017. Out of 923 pregnant women, 29 were found to have thyroid disorders. Detailed demographic data and thyroid function test readings were taken from their medical records and thyroid status were determined from TSH and FT4 readings using the trimester-specific thyroid reference range. Results: The prevalence of thyroid disorders in both centres was 3.14%, with specific prevalence of 2.80% for HTAA and 6.12% for IIUM MC. Nearly half of them were hyperthyroid (47.85%), 17.4% was hypothyroid and Graves’ disease dominated the diagnosis of thyroid disease (30.43%). Significant association was found in weight changes with patients’ thyroid status; reduction in weight in first trimester and increment in weight in second trimester were mainly seen in the hyperthyroid group (p<0.01, p=0.027). Conclusion: The acceptable prevalence of 3.14% for thyroid disorders in pregnancy could be contributed by the iodine availability in this community. High prevalence of Graves’ disease warrants future screening for maternal thyroid stimulating immunoglobulin amongst hyperthyroid women
Development and Validation of a new Multidimensional Questionnaire called Muslim Medical Student Questionnaire (MMSQ) among Malaysian Undergraduates
Get PDFIntroduction: A handful of medical schools have implemented the Islamic input in medical program into their medical curricula. However we are facing a setback as there is no validated standard assessment tool to measure the effectiveness of this academic input for undergraduate medical programme. Therefore the objective of this study is to design a scale that is able to gauge the impact of the Islamic input among medical undergraduates. Materials and Methods: The construction of a new scale is based on the 5 stages of standard questionnaire design. To validate the newly designed scale, it was administered to all the medical students who granted their consent. Results: A total of 520 students from all academic years of a medical school were enrolled in the validation stage. Bartlet’s KMO value is 0.9. From 46 items, 67% had good factor loading (>0.4). Cronbach’s alpha values of 0.78, 0.85 and 0.13 were obtained for Attitude, Practice and Knowledge domains respectively. We identified the 3 domains by using exploratory factor analysis. Conclusion: The scale has good psychometric values for both reliability and validity
Ovitrap Surveillance of Aedes aegypti and Aedes albopictus in Dengue Endemic Areas in Keramat and Shah Alam, Selangor in 2016
Get PDFIntroduction: Entomological surveillance is crucial to determine the abundance of dengue vector and to evaluate breeding areas of Aedes aegypti and Aedes albopictus. The objective of this study is to determine the distribution and breeding preference for both Ae. aegypti and Ae. albopictus in dengue endemic areas. Materials and Methods: Ovitraps surveillance was conducted in two dengue endemic areas; AU2, Keramat and Seksyen 7, Shah Alam, Selangor. A minimum number of 100 ovitraps were deployed for 5 days in the study sites. Samples collected were brought back to the lab and all larvae recovered were identified to species level. Results: The ovitap index (OI) in both localities exceeded the transmission threshold of 10% with the OI recorded ranged from 42.3-79.8% in AU2, Keramat and 16.7-42.9% in Seksyen 7, Shah Alam. Ae. albopictus was the dominant species in AU2 Keramat with the highest ratio Ae. aegypti to Ae. albopictus recorded was 1.00:22.79. Nonetheless, in Seksyen 7, Shah Alam the difference in Ae. aegypti to Ae. albopictus ratio is not really prominent with 1.00:3.61 for ovitraps deployed outdoor and 3.40:1.00 for ovitraps set indoor. It was determined that single infestation of either Ae. aegypti or Ae. albopictus is more frequent for ovitraps deployed indoor and/or outdoor, respectively. It was also determined that mixed infestations were found in this study indicating that both species can oviposit in the same container. Conclusion: This study indicates that OI is still above transmission threshold in both study sites. While Ae. aegypti and Ae. albopictus remain as a dominant indoor and outdoor breeder, respectively, mixed breeding of Aedes species in a same container was also observed