IIUM Medical Journal Malaysia (IMJM)
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Engaging and Empowering Parents of Children with Down Syndrome-The Role of Parents Support Group
Get PDFChildren with Down syndrome are known to have intellectual disability, developmental milestone delay and may also have associated medical conditions. Having a child with Down syndrome could be physically and emotionally challenging to the affected family members. The impact on a family can be multifaceted which can alter the family dynamics and harmony. Most parents felt inadequate with the information given by the healthcare providers. Parents support group plays an important role to support and provide information and resources to other parents of children with Down syndrome. The knowledge and experience on raising the children with Down syndrome are shared with the new parents. This includes the importance of Early Intervention Program (EIP), inclusive education, the benefits of People with Disability card, sharing success story of people with Down syndrome and providing emotional support to the family to boost their confidence and keeping up their positive spirit in raising their children, regardless of their religions and beliefs. Apart from that, we also organize and participate in activities to raise public awareness, advocating for the rights, inclusion and well being of people with Down syndrome, through social and mass media and annual celebration of World Down Syndrome Day on the 21st March. We promote the benefits of inclusive environment so that people with Down syndrome are able to enjoy full and equal rights on an equal basis with other people; enabling them to live, work and participate with confidence and individual autonomy, fully included in society alongside their friends and peers. As healthcare professionals and parents of a child with Down syndrome, we are sharing our own experiences in engaging with other parents of children with Down syndrome to understand the issues and concerns, sharing resources available around them and ways to support them throughout the journey of raising a child with Down syndrome
Physicochemical Characteristics of Malaysian Stingless Bee Honey from Trigona Species
Get PDFThe physicochemical properties of stingless bee honey are diverse according to origin of geographical or botanical and fruit or flower season. These factors result in production of honey with different colour, pH, ash and water content although the bee species is similar. To date, the physicochemical properties of honey from Malaysian Trigona species are unknown. Therefore, determination of physicochemical properties of honey from stingless bee is crucial for Malaysian researchers in order to analyse the purity of the honey. Five honey samples were used for the current study. Four samples were stingless bee honey from two of the most common domesticated Malaysian stingless bee species; Trigona thorasica and Trigona itama. Meanwhile, one sample was from Tualang honey. For stingless bee honey, the values for pH, moisture content, electrical conductivity, ash content and hydroxymethylfurfural (HMF) were 2.79±0.04 to 2.95±0.02, 28.3±0.68 to 33.7±0.51, 0.47±0.22 to 0.55±0.38, 0.132±0.03 to 0.532±0.83 and 0.080±0.16 to 3.42±1.03, respectively. The colour of stingless bee honey varies based on observation or absorbance assay. The study described the physicochemical properties derived from Malaysian bees of Trigona thorasica, Trigona itama, and Apis Dorsata
Structural Changes in the Urinary Bladder of Streptozotocin-Induced Diabetic Rats and the Possible Protective Role of Insulin
Get PDFIntroduction: Diabetes mellitus possesses severe adverse effects on the urinary bladder. Urinary bladder dysfunction is a common health problem affecting diabetic patients causing recurrent infections and urinary incontinence. Objective: To evaluate the histopathological changes in the tissue of urinary bladder in Streptozotocin (STZ) diabetic rats and the protective role of insulin. Methods: Thirty rats were classified into three groups: a control group which received no treatment (Group A), STZ diabetic group (Group B) and Insulin diabetic group (Group C). Animals were sacrificed after six weeks and urinary bladders were harvested and processed for light and electron microscopy. Results: Several histopathological changes were observed in the urinary bladder of the diabetic group including an increase in the thickness of the urothelium, epithelial cells with dark nuclei and large lenticular vesicles, and wide intercellular spaces with numerous collagen fibers. Treatment with insulin reduced the pathological changes induced by STZ. Conclusion: Diabetes mellitus caused significant pathological changes in the urinary bladder of experimental rats. For instance, treating diabetic animals with insulin prevented the development of damaging effects of diabetes on the urinary bladder
Development and Validation of the Malay Premature Ejaculation Diagnostic Tool (MAPET): A Two-Phase Study
Get PDFIntroduction: A validated diagnostic questionnaire is needed in the South-East Asia region, particularly in Malaysia to detect Premature Ejaculation (PE). The objective of this study was to determine the linguistic validity of the Malay Premature Ejaculation Diagnostic Tool (MAPET). Materials and Methods: This study was conducted in a teaching hospital. The first phase involved experts’ group discussions to develop the face, content, and factorial validity of the MAPET. The second phase measured the concurrent validity of MAPET. Results: We found that the MAPET has specificity, sensitivity, positive predictive value, and negative predictive value of 79.3%, 92%, 76.7% and 93.1%, respectively in the assessment of PE. The higher score indicates severity of PE. Conclusions: MAPET is a valid self-report instrument for the assessment of PE
Assessment of Sphenoid Sinus Variations and Its Related Neurovascular Structures Using Contrasted Thin Slice Computed Tomography Scan Of The Brain
Get PDFIntroduction: Sphenoid sinus is the most variable structure in human. The prevalence of anatomical variations varies with the population. Increasing endoscopic procedures around the sphenoid sinus and advances in imaging techniques, allowed precise evaluation of sinus anatomical variation in each population. This study measured the prevalences and described the variations of the sphenoid sinus using thin slice contrasted computed tomography scan of brain scans. Materials and Methods: A retrospective cross-sectional study of 250 brain scans of patients between 18-60 years old attending Hospital Tengku Ampuan Afzan, Kuantan, Pahang from 1st January to 31st December 2017. The sphenoid sinus pneumatization types, volume, optic nerve relation according to Delano’s classification, internal carotid artery relation, and the number of sinus septum and attachment site were studied. Results: Post sellar pneumatization type was most common (52%). The mean sinus volume was 19 cm³ which was significantly different between genders. Delano optic nerve type 1 was most frequent (43%) and most were seen bilaterally with significant differences between gender. The internal carotid artery was seen non-protruded 41.6% cases, protruded in 36.4% cases, and protrusion with wall dehiscence in 22% cases. Two septate sinuses were more prominent (44.3%), aseptate sinus in 2.4% cases. The principle septa attachment site was sella (28%), internal carotid artery related septa found in 10% cases and 3.2% of cases with optic nerve septal attachment. Conclusion: This study revealed the presence of all sphenoid sinus variations amongst the study population. The preoperative determination of these anatomical variations minimizes vital neurovascular structures injury
Biomechanical Analysis of Crossed Pinning Construct on Supracondylar Fracture of Humerus in Children: Does Point of Crossing Matters?
Get PDFIntroduction: Percutaneous pin fixation either by crossed pinning construct (CPC) or lateral divergent pinning construct (LDPC) are the recommended treatment for displaced supracondylar humerus fractures (SCHF) in children. Several studies had compared the biomechanical stability between these two, however, a biomechanical analysis of varying crossing point location in CPC has not been performed previously. The aim of this study was to compare the stability of various crossing point location in CPC and LDPC. Materials and Methods: Thirty synthetic humeri were osteotomized at mid olecranon fossa, anatomically reduced and pinned using two 1.6 mm Kirschner wiresin five different constructs namely centre point, medial point, lateral point, superior point and LDPC. Six samples were prepared for each construct and were tested for extension, flexion, valgus, varus, internal rotation and external rotation forces by using Universal Tensile Machine and the data were analysed with R Statistic. Results: The centre point CPC was the stiffest while the LDPC and medial point CPC were the least stiff construct for linear and rotational force respectively. Lateral point CPC, and superior point CPC showed no statistically significant difference when compared to centre point CPC. Conclusion: The centre point CPC was the most stable construct while the LDPC and medial point CPC were the least stable. The stability of lateral point CPC and superior point CPC were statistically comparable to centre point CPC. Clinically, this will help the treating surgeon to reduce the numbers of attempt during K-wire insertion in order to get perfect centre point CPC
Cervical Spondylotic Radiculopathy: The Role of Conservative Management
Get PDFIntroduction: Cervical spondylotic radiculopathy is common and most patients experiencing an acute episode of unilateral radiculopathy without major motor deficit and no evidence of cord compression can be managed by non-operative measures. This study aimed to determine the severity of degenerative changes on plain radiograph among patients with cervical spondylotic radiculopathy and patient's self rated outcomes following conservative treatment. This study also looked into the correlation between pain with disability of patient, severity of degenerative changes of the cervical spine and different level of root compression. Materials and Methods: An observational cohort study where all patients with newly diagnosed cervical spondylotic radiculopathy were recruited from December 2016 to January 2018. Patient rated pain score and neck disability index at presentation and three months after conservative treatment were evaluated. Demographic data, radiographic severity grade, neck disability index and pain score were documented and analyzed via descriptive analysis and Pearson correlation test. Results: There were 29 patients recruited, with mean age of 49 years old. Forty one percent of patients had Grade 2 radiographic severity changes. Patient rated outcomes with neck disability index and pain score showed moderate improvement after conservative treatment (r=0.523, p<0.01). There was significant correlation between pain score and neck disability index (p<0.001). However, pain score showed no significant correlation between radiographic severity grade and different level nerve root compression. The power of this study is 0.8 with PASS 11 calculation. Conclusion: Patients with cervical spondylotic radiculopathy who were treated conservatively showed favorable clinical outcome
Evaluation of High Resolution Melting Technique for Detection of JAK2-V617F Mutation in Formalin-Fixed Paraffin-Embedded Specimen from Myeloproliferative Neoplasm Cases
Get PDFIntroduction: Myeloproliferative neoplasm (MPN) is a group of myeloid disorder which lead to erythrocytosis, thrombocytosis and leukocytosis. MPN with BCR-ABL positive is chronic myeloid leukemia (CML) while BCR-ABL negative MPN includes polycythemia vera (PV), essential thrombocytemia (ET) and primary myelofibrosis (PMF). One of the major criteria for diagnosis of BCR-ABL negative MPN is the presence of JAK2-V617F mutation which is positive in 95% of PV and around 60% of ET and MF. Beside peripheral blood specimen, Formalin-Fixed Paraffin-Embedded (FFPE) marrow specimen can be used for detection of this mutation. Unfortunately, FFPE produces low quality DNA that put a challenge for successful amplification of DNA. We aimed to evaluate the utility of High Resolution Melting (HRM) analysis for detection of JAK2-V617F mutation in FFPE specimen from MPN cases. Materials and Methods: This study is a descriptive cross-sectional study. Forty FFPE marrow specimens were retrieved from the year 2014-2016. Bio-Rad Precision Melt Analysis software was used for analysis of HRM data. Allele-specific PCR was done for validation of results. Positive samples were subjected to Sanger sequencing. Results: JAK2-V617F mutation was positive in 3 out of 4 in PV, 0/2 in ET, 4/4 in PMF, 4/10 in non-classified MPN and 1/20 in CML. Level of agreement between HRM and AS-PCR was 97.5%. Conclusion: HRM is a rapid and powerful diagnostic assay, which is suitable for detection of JAK2-V617F mutation in FFPE marrow specimen
Idiopathic Thrombocytopenic Purpura & Total Knee Arthroplasty: How Low Can You Go
Get PDFIdiopathic thrombocytopenic purpura or ITP is an autoimmune disorder with a reduction in circulating platelets, it subjects patients to spontaneous torrential bleeding even with trivial trauma. In this case report we share our experience conducting a TKR in a patient with refractory ITP. A 64-year-old patient with ITP complicated with history of ICB in 2001 presented with bilateral knee pain. Her platelet counts were 60x109 /L despite previous steroidal and immunoglobulin therapy. After discussion haematologist a manual platelet count under microscopy had 15-20/hpf large platelets with estimated counts to be 100x109 /L. She underwent a cemented right TKR under general anaesthesia. No femoral/sciatic block was performed nor was a tourniquet applied fearing an intramuscular haematoma/ecchymosis. Two grams of intravenous tranexemic acid was given prior to the surgery and four units of platelets were transfused intraoperatively. Despite no tourniquet, she clotted very well and blood loss was minimal. Thereafter, ITP is an immune disorder where patients form antibodies towards their own platelets resulting in increased platelet destruction and a decrease in platelet formation. Remaining circulating platelets are bigger than usual platelets, however, their function are not impaired. ITP guidelines by the British Journal Of Haematology dictate a minimal platelet count of 50x109 /L for minor surgical procedures and 80x109 /L for major surgical procedures. It is still safe to perform TKR in ITP patients. However a combined approach with haematology is advocated as manual platelet counts give a better representation of the actual number of circulating platelets compared to routine blood counts
Knowledge and Practices on i-Ta'aleem and other Educational Technologies among International Islamic University Malaysia Kulliyyah of Medicine Lecturers
Get PDFIntroduction: Technologies in the classroom require teacher’s knowledge and skills in utilizing it. Teaching for medical student can be different in some areas. To date, no studies has been conducted on the use of technologies among medical lecturer in International Islamic University Malaysia (IIUM). Thus, the objective of this survey is to determine the level of awareness, practice and perception of learning management system (i-Ta’aleem) and educational technologies among Kulliyyah of Medicine (KOM) lectures. Materials and Methods: This cross-sectional study was conducted among all IIUM KOM lecturers. Only 26.1% responded to the self-administered questionnaire which was distributed via google form for one month. Descriptive analysis was used to analyze the background information and their awareness, practice and perception. Results: Majority of the respondents were male (56.8%), permanent staff (94.6%) with mean years of service at IIUM was 6.7. Most of them owned technology tools [smartphone (100%), personal computer (73.0%), tablet (54.1%) and laptop (97.3%)]. All of them heard about i-Ta’aleem. However, 78.4% never use i-Ta’aleem and only a small percentage of them always uses other technologies for their teaching and learning (2.7% to 5.4%) except the usage of laptop (48.6%) and projector (59.5%). Conclusion: Although the lecturers were aware about i-Ta’aleem and owned high technology tools and gadget, only a small percentage of them use it in teaching activities