IIUM Medical Journal Malaysia (IMJM)
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A Cross Sectional Study On Quality Of Sleep Among Adult Population In An Urban Area Of Pahang
Get PDFIntroduction: Sleep is one of the important needs in human life and good quality of sleep among adult population reduced the risk factor for adverse health outcome. This study aimed to determine the quality of sleep and its related factors among adult population in an urban area of Pahang. Materials and Methods: Cross sectional study was done on a selected urban housing area in Pahang. Participants were adult population, aged more than 18 years old (observation unit) in selected houses (n=180). Measurements obtained via the questionnaire include respondents’ socio-demographic, co-morbidity, smoking status, physical activity, monthly household income and caffeinated drinks consumed. Sleep quality was measured using the validated Pittsburgh Sleep Quality Index (PSQI). Results: A total of 145 respondents (response rate 81%) were available for data analysis. The prevalence of good sleeper (60%) was more than poor sleeper. Adjusted logistic regression showed that only those who did not take caffeinated drinks in the past one week had higher chance of having good quality of sleep as compared to those who take (OR=3.6, p=0.048). No other significant relationship was seen between quality of sleep and socio-demographic characteristics, exercise or co-morbid history. Conclusion: Majority of adult population in this selected urban area in Pahang have good quality of sleep and result showed significant relationship between quality of sleep with not taking caffeinated drinks, but not other factors. Nevertheless, programs such as sleep quality awareness campaign need to be done to educate the population and maintain this good sleep quality
Chronic Organic Arsenic Induced Liver Ultra Structural Damage
Get PDFIntroduction: Inorganic arsenic is one of the environmental toxins that has been associated with increased risk of cardiovascular diseases and vascular contributions to liver diseases. It has generally been thought to be more toxic than organic arsenic. In human liver, inorganic arsenic promotes vascular remodelling, portal fibrosis and hypertension. The purpose of the current study was to determine whether chronic exposure to organic arsenic impair liver ultrastructure as in inorganic arsenic exposure. Materials and Methods: Twenty eight male SpragueDawley rats were divided into 2 groups with their own control group. They received oral intubation of monosodium- methylarsonate (MSMA) at 63.30 mg/kg body weight for 4 and 6 months duration respectively while the control groups received distilled water. The liver of euthanized rats were perfused- fixed with glutaraldehyde for transmission electron microscopy processing. Results: TEM revealed a marked reduction in the number of mitochondria in both treatment groups. Some typical features of apoptosis are present with pyknotic nuclei of hepatocytes and disintegrated hepatic cytoplasm in 4- month groups. The microvilli of hepatocyte are almost completely absent with the presence of many fibre bundles (collagen fibres) widening the space of Disse. In 6-month treatment group, disintegrated cytoplasms are more prominent with degrading mitochondria of varying stages. Liver sinusoidal endothelial cells (LSEC) of 6-month treatment group are noted to have chromatin condensation with few caveolae seen. Conclusion: Chronic exposure of MSMA leads to necrotic changes of hepatocytes and apoptotic changes in LSEC and collagenisation in the space of Disse
Outcome Of Arthroscopic Vs Mini Open Subacromial Decompression In Treating Shoulder Impingement Syndrome
Get PDFIntroduction: Shoulder impingement syndrome is a common diagnosis leading to shoulder disabilities. Subacromial decompression surgery either arthroscopic or mini open is indicated in patients who failed conservative therapy. Arthroscopic surgery is introduced to reduce soft tissue dissection hence less soft tissue damage and fasten rehabilitation. This study is conducted to compare the outcome of mini open and arthroscopic surgery. Materials and Methods: A cross sectional study was conducted in patients who were diagnosed with shoulder impingement syndrome with or without rotator cuff tear who underwent subacromial decompression surgery, with mini open or arthroscopic surgery at Hospital Tengku Ampuan Afzan, Kuantan. Functional outcome was assessed using American Shoulder and Elbow Surgeon (ASES) score and Constant score. Results: Six patients were recruited in the mini open group while 11 in the arthroscopic group. Of these, all were female in mini open group, aged 56.7 ± 7.9 while seven female and four male in the arthroscopic group aged 55.1 ± 9.4 (p-value 0.733). They were evaluated at 3 to 5 years after surgery in the mini open, and at six months in the arthroscopic group. There was no significant different in the ASES score in the mini open group (89.8 ± 11.7) and arthroscopic group (89.8 ±17.9), with p-value of 0.998. Constant score in the mini open was 18.67 ± 7.61, while in the arthroscopic was 16.18 ± 15.03; and there was no significant difference in this two groups (p-value 0.712). Three patients each has good and fair outcome in the mini open surgery, while six patients has excellent, two each has good and fair; and one has poor outcome in the arthroscopic surgery. Conclusion: There were no significant differences in the functional outcomes between mini open and arthroscopic subacromial decompression surgery
Pulmonary Artery Aneurysm: A Very Rare Entity
Get PDFPulmonary artery aneurysm (PAA) is defined as a focal dilatation of the pulmonary artery. It is noted to be a very rare entity. From literature reviews, only 8 cases of pulmonary artery aneurysms being identified from a total of 109,571 cases within an extended period of 100 years. This gives an incidence of about 0.0073%. It is usually associated with some structural cardiac anomalies, structural vascular anomalies, pulmonary hypertension, vasculitis and infection. However idiopathic pulmonary artery aneurysm has also been identified in some cases. It can be classified as proximal or peripheral PAA depending on its location. Most of the patients are asymptomatic. The symptoms are only seen when complications occurred, such as bronchial or tracheal compression, dissection, rupture, thrombus formation causing pulmonary hypertension. It can be treated conservatively or surgically, especially in a symptomatic patient or if the size is more than 6 cm. We reported a case of left pulmonary artery aneurysm, which is an incidental finding in a patient who underwent a CT pulmonary artery in view of a suspected pulmonary artery embolism when he presented with sudden onset of shortness of breath and left lower limb swelling and pain for one week. A left pulmonary artery aneurysm is seen measuring about 4.2cm (W) x 3.9cm (CC) extending to the proximal branch of descending pulmonary artery. Unfortunately, no further treatment can be given to the patient in view of the patient succumbed from sepsis shortly after the diagnosis
Qualitative Study on Perception of Antenatal Mothers towards Oral Health Care: In-depth interview
Get PDFIntroduction: Attending regular dental check-up is very important to pregnant women. However, many women do not utilize oral healthcare services during the antenatal period. It had been reported in Health Information Management System report (MOH, 2007) that the attendance of antenatal mothers to dental clinic were unsatisfactory. Therefore, the aim of this research was to explore the perception of antenatal mothers towards oral health care. Materials and Methods: In-depth interviews were carried out with a convenience sampling of 20 antenatal mothers across three government health clinics in Selangor, Malaysia. The interview using guided questions which explored participant’s oral health knowledge, attitude and oral health practice. All interviews were audio recorded, transcribed verbatim and analysed by thematic analysis. The interviews were carried out until the saturation of information were achieved. Results: The main themes emerging from the data related to low oral health knowledge, poor attitude and oral health practices during pregnancy. Although all participants have basic knowledge of dental caries development, however, many of them unaware of the significance of preventive dental visits during pregnancy. Poor attitudes and oral health practices among antenatal mothers in this study were due to they had not received the necessary oral health information. Conclusion: Antenatal mother’s perception of oral health care crucially impacts on oral health status, continuity of utilization of oral healthcare services and hence pregnancy outcome. Their views provided a baseline information for planning and formulating appropriate oral health education and promotion strategies
Sacral Tuberculosis: An Atypical Manifestation
Get PDFSacral tuberculosis (TB) is extremely rare and its unusual entity might delay the diagnosis and treatment of this treatable disease. A 38-year-old lady presented with a 1 year history of lower back pain with radiculopathy more to right lower limb. The patient was initially treated as Prolapsed Intervertebral Disc (PID), but showed no improvement despite regular physiotherapy and medication. Subsequently, the pain was confined to the right gluteal area and became more severe. Quality of life was impaired in which patient started using walking aids and stopped working. There was a weight loss of 20kg. No other symptom of TB infection or history of contact with TB patient. Bowel and urinary functions were normal. Examination showed localized tenderness at the right gluteal area. Neurological assessment of both lower limbs were MRC grade 5. Blood investigations were normal including the ESR level (17mm/hour). Mantoux test was positive with 18mm induration. MRI revealed a large rim enhancing paravertebral collection at pre-sacral space which extended into bilateral piriformis and gluteal muscles. The patient underwent CT-guided drainage of both gluteals and specimens taken to confirm the diagnosis of TB. Patient showed significant improvement clinically within 1 week after the drainage procedure and initiation of antituberculous chemotherapy. The initial presentation of this patient mimics PID due to irritation of sciatic nerve at piriformis level. However a change in the presentation and failure of conservative treatment should raise a high index of suspicion and necessitates further investigation to establish correct diagnosis hence proper treatment can be initiated
Soil Transmitted Helminth Infections Among Children Admitted to Hospital Tengku Ampuan Afzan, Kuantan, Pahang
Get PDFIntroduction: Soil-transmitted helminth (STH) infections by Ascaris lumbricoides, Trichuris trichiura and hookworms still persist in poor communities in rural and urban areas. Recent studies in Malaysia focused on Orang Asli communities and few in hospital settings. This study determines the prevalence and risk factors for STH among children admitted to Paediatric ward of Hospital Tengku Ampuan Afzan (HTAA). Materials and Methods: This study was conducted among 133 (77 males, 56 females) paediatric patients in Hospital Tengku Ampuan Afzan from Dec 2017 to May 2018. Faecal samples were examined using wet smear, Kato-Katz, Harada-Mori and sedimentation techniques. Demographic data and hygiene practice information were collected using a pre-tested questionnaire. Results: The overall prevalence of STHs was 6% (A.lumbricoides 5.3%, T.trichiura 0.8%, and hookworms 0.8%). Prevalence among males was 3.9% and females 8.9%. Majority (94.7%) were Malays. There were two Orang Asli children and both were infected, one of whom had a mixed infection. Chi square analysis showed that the important risk factors for STH infections are education level of mother (p<0.05) and father (p<0.05), the source of drinking water (p<0.05), and the method of trash disposal (p<0.05). Conclusion: This study shows that the prevalence of STH infections is low in children due to better socio-economy and good hygiene practice. Differences in individual lifestyles and humid weather condition are probable reasons for sporadic infection to still exist
Treating Women With Urinary Incontinence and Overactive Bladder
Get PDFIntroduction: Pelvic floor Muscle Training (PFMT) commonly used physical therapy for Female Overactive bladder (OAB) and stress urinary incontinence (SUI). However some women has difficulty to understand and comply to PFMT. Our aim is to evaluate the effectiveness of Transpelviner Magnetic Stimulation (TPMS) as a replacement for PFMT. Materials and Methods: A prospective observational study on 53 women with SUI or OAB, were assessed objectively using cough stress test, bladder diary, one hour pad test, perineometry and validated questionnaires. Then, all of them received 10 courses of individualized TPMS therapy over five weeks. Reassessments were done after five weeks and six months of initial treatment. The outcomes were measured by severity index, negative pad test, muscle power, numbers of leaking episodes, daytime frequency and nocturia, negative cough stress test and improvement in specific quality of life questionnaires (QOL) Results: Frequency of micturition in OAB showed reduction from 100% at baseline to 12.5%,(p=0.053) after five weeks and 25%,(p=0.345) after six months. While, SUI reducedfrom 100% to 17.2(0.052) and 27.6% (p=0.826) after six months. Urgency OAB reduced from 100% to 12.5% and SUI reduced from 100% to 41.4%. It appears that after five weeks of treatment, all participants improved in their severity index (75%) followed by OAB (55.6%). However the percentage dropped six months later which was 50% and 12.5%, respectively. These results were consistent for perineal muscles power, one hour pad test and QOL score. Conclusion: TPMS shows significant effectiveness to treat OAB and SUI. However, bigger study is required to compare it with PFMT in treating urinary symptoms
Assessment of Calibration on Clinical and Practical Supervision among Dental Lecturers
Get PDFAim: The purpose of this assessment was to examine the variation among faculty members of Kulliyyah of Dentistry in supervising the clinical work of students. Introduction: Consistency in the evaluation of clinical decision-making is necessary for reliable assessment of student performance and effectiveness of clinical teaching. However little has been done to examine variation in dental clinical supervision. As a professional dental practitioner and lecturer, I feel this exercise is crucial as to give the best and ‘adil (justice) to students when doing assessment of work. Materials & Methods: Twenty clinical lecturers from Kulliyyah of Dentistry were given a set of criteria of rubric, and undergone twelve stations of clinical models focusing on several procedures in dentistry clinical works. The rubric and clinical models were prepared in six different groups of specialty: Periodontic, Conservative, General Dental Practitioner, Oral Surgery, Endodontic and Prosthodontic Dentistry. Lecturers go for baseline calibration and received training by 6 content experts immediately. Re-calibration was done after training. The time given for each station is 5 minutes. The rubrics consist of 57 points. The examination used dental mirror, dental probe, dental models, x-rays, copies of students’ case note and manikin. Kappa statistics were used to determine inter-examiner reliability at baseline and re-calibration. Results: For inter-examiner statistic, the baseline calibration on 20 clinical lecturers indicated an inter-rater kappa ranging from 0.05-0.5.Re-calibration on the same 20 packages after training indicated an inter-rater kappa of 0.11-0.42. Activity kappa was in the slight to moderate agreement. Performance of majority of examiners improved with time. Conclusion:The calibration of clinical lecturers should be performed regularly as it is crucial to maintain the uniformity of the examiners reliability. Furthermore the training needs to be conducted in an effective environment to improve performance. It is hoped that continuous training nurturing the “righteous individuals” which is one of the goals in Shariah principle
Post-Streptococcal Acute Glomerulonephritis in a 7- Year-Old Boy: Islamic Perspective on the Prevention of the Disease
Get PDFAcute glomerulonephritis is inflammation of the kidney mediated by an immunological process. Group A βhaemolytic streptococcal infection is common in children aged 5-12 years old and can lead to acute poststreptococcal glomerulonephritis which may develop after recovery from a streptococcal throat infection or skin infection (impetigo). 97% of cases occur in less developed country. The incidence has decreased in industrialized nations due to improved hygienic condition. A 7-year-old boy, the eldest child of 4 siblings from a divorced parent, was admitted to Hospital Tengku Ampuan Afzan Kuantan in March 2015 due to facial puffiness for 1 day duration. There was also dark colored urine. Patient had history of productive cough for 3 days and fever for 2 days. Father also complained of skin ulcer on patient’s right feet for about 1 month. There was hypertension (198/80 mmHg). Urine examination showed hematuria, proteinuria, and leucocyturia. Anti-streptolysin O titre was high (1:800) and complement C3 level was low (0.29). Patient was treated with antibiotic, diuretic, and anti-hypertension. The child is entrusted to the parents who will be called by the Almighty, who will ask them about this trust. Parents play vital role in maintaining and promoting the good health of the children. Parents should also pay attention to cleanliness, personal hygiene and the prevention of disease, especially infection. Islam paid attention to washing hands and cleansing the air inhaled into the lungs by regular cleaning of the nose as part of ablution before performing prayer. Parents are responsible in preserving life, health and growth of their children. Caring for cleanliness and hygiene is not only deemed a good habit in Islam but also rendered into rituals that constitute part of the faith itself