IIUM Medical Journal Malaysia (IMJM)
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The Use of Multimedia as a Distraction to Reduce Anxiety Reaction among Paediatric Patients During Cast Removal at Hospital Tengku Ampuan Afzan
Get PDFIntroduction: Cast removal procedures can be a daunting experience for children giving rise to anxiety. The objective of this study is to measure the level of anxiety in children during cast removal at Hospital Tengku Ampuan Afzan. Materials and method: An experimental study was conducted with a sample of 40 paediatric patients with upper limb fractures and cast removal were randomly assigned into two groups: with multimedia distraction or without (control). Patient's heart rate was measured using a pulse oximeter before, during and after cast removal. Results: A total number of 20 children were randomized to multimedia distraction and another 20 to control with no distractions. The mean rise in heart rate between preprocedure and during procedure 5.3 beats/min in multimedia distraction group and 16.35 beats/min in control group (P = 0.001). The mean difference in heart rate between the pre-procedure and during the procedure was 5.64 beats/min in the multimedia distraction group and 13.13 beats/ min in the control group (P = 0.05). Conclusion: There was significant decrease in heart rate during cast removal with multimedia distraction. Therefore multimedia distraction is a useful tool in reducing anxiety among children during cast removal
An Investigation on Cytotoxicity Effect of Putrescine-Sulphur Analogues on Breast Cancer (Mcf-7), Human Lung Adenocarcinoma (A549) and Colorectal Cancer (Hct-8) Cell Lines
Get PDFIntroduction: Cancer is one of the global health problems that has a detrimental effect to a person's life. However, chemotherapeutic agents success are subject to the side effects due to lack of specificity in the drug delivery system to cancer cells and an increase risk of systemic toxicity to the normal cells. Polyamine transport system (PTS) is one of the potential pathways for transporting anticancer agent into specific cancer cells. This is due to the upregulation of PTS in cancer cells compared to normal cells for the proliferation activity. The aim of this study was to investigate the cytotoxicity effect of putrescine-sulphur analogues type 1 (PSA-1) and type 2 (PSA-2) on human lung adenocarcinoma cells (A549), human colorectal adenocarcinoma cells (HCT-8) and human breast adenocarcinoma cell (MCF-7). Materials and method: The cytotoxicity effect of newly synthesized PSA-1 and PSA-2 were evaluated on selected cancer cells; MCF-7, A549 and HCT-8 cell lines. The halfmaximal inhibitory concentration (IC50) obtained from tetrazolium bromide (MTT) assay was derived from the dose-response graph for all cell lines. Results: PSA-2 elicited cytotoxicity effect, eventhough the IC50 values were not potent with IC50 of 5.4 mM, 5.2 mM and 7.0 mM for MCF-7/48h, A549/48h and HCT-8/48h, respectively. The PSA-1 compound exhibited cytotoxicity effect in all cell lines, however, the compound failed to induce anti-proliferation at the concentration of 3 mM and above. The cytotoxicity of PSA-2 compound against MCF-7 cell lines showed higher potency compared to A549 and HCT-8 cell lines. Conclusion: It was suggested that PSA-2 compound was able to exert cytotoxicity effect against selected cancer cells, in low potency and is deemed for further investigation to increase its effectiveness against specific cancer cells
An Open Labelled Randomized Clinical Trial of Fluoxetine Versus Dapoxetine Treatment among Men with Premature Ejaculation and its Effect on Marital Satisfaction
Get PDFIntroduction: Premature ejaculation (PE) reduces sexual satisfaction and quality of life. Both SSRI Fluoxetine and Dapoxetine have been used in the treatment of PE. Fluoxetine is used as off-label treatment meanwhile Dapoxetine is the first SSRI specifically designed for PE with short half-life and few side effects. Objectives: To compare the PE symptoms and marital satisfaction score between Fluoxetine and Dapoxetine groups. Materials and method: In this clinical trial, 44 participants aged between 18 and 64 with PEDT score of ≥9 from the Primary Care clinic of Hospital USM, Kelantan were recruited and randomized into two groups; Fluoxetine Group(FG) and Dapoxetine Group(DG). They were prescribed with either daily oral Fluoxetine 20mg or Dapoxetine 30mg on demand twice weekly for 8 weeks. PE symptoms were measured using the Premature Ejaculation Diagnostics Tool(PEDT) score and marital satisfaction score were measured using the Dyadic Satisfaction-Dyadic Adjustment Scale(DS-DAS) score. Measurements were made at baseline and at the 8thweek(post intervention). Results: In FG and DG, 22 and 21 participants completed the study, respectively. PEDT scores reduced significantly within both groups[from 11.41 to 5.45(P<0.001) within FG and from 13.43 to 3.10(P<0.001) within the DG]. At the 8thweek follow-up, PEDT scores was observed to be were lower in DG(6.03 vs. 2.49,P<0.001) after adjustment of the baseline PEDT score. Significantly increased DS-DAS scores were observed in both groups [from 34.50 to 40.68(P<0.001) within FG and from 36.57 to 44.33,(P<0.001) within DG] with no significant difference in DS-DAS scores at the end of study(41.13 vs. 43.86,P=0.055) after adjustment of the baseline DS-DAS score. Conclusion: Reduction in PE symptoms was observed for both groups. At 8 weeks, PE symptoms among participants on Dapoxetine were significantly lower compared to the participants on Fluoxetine at 8 weeks. Treatment of PE with either Fluoxetine or Dapoxetine reduces symptoms of PE and improves marital satisfaction
Assessment of Marital Dissatisfaction and Its Association with Sexual Dysfunction and Psychiatric Morbidities among Primary Health Attenders in Malaysia
Get PDFIntroduction: Marital satisfaction is vital to the wellbeing and functioning of the individual and family. Marital dissatisfaction can lead to detrimental effects on mental, physical and family health. The study aimed to determine the proportion of marital dissatisfaction in outpatient setting and its association with sexual functioning and psychiatric morbidity in Kuala Lumpur, Malaysia. Materials & Methods: A crosssectional study was conducted in selected primary care using purposive sampling. Data collection was done using socio-demographic questionnaire and several validated Malay version of self-administered questionnaires. Marital satisfaction was measured by the Malay version of Golombok–Rust Inventory of Marital State (Mal-GRIMS). Results: The prevalence of marriage dissatisfaction in sample population was about 37.3% with almost equal prevalence in both, 36.5% (male) and 37.8% (female). Using a regression analysis, the significant factors that affect marital dissatisfaction were respondent’s age group between 31- 40 years old (Adjusted Odds Ratio, AOR. =11.4, 95% Confidence Interval, CI. =1.2-110.9), spouse’s salary of RM1000-RM2000 (lower income category) (AOR=7.3, 95% CI= 1.9-28.1), anxiety case (AOR= 4.8, 95% CI=1.1- 21.5), depression case (AOR= 4.8, 95% CI=1.0-22.8), female sexual dysfunction in term of arousal function (AOR= 0.01, 95% CI=0.0-0.7), satisfaction dysfunction (AOR= 9.4, 95% CI= 1.5-58) and pain function (AOR=43.7, 95% CI=1.28 - 1489.2). Conclusion: Marital dissatisfaction can be influenced by financial factor, sexual dysfunction and presence of psychiatric morbidity. Hence, in management of marital discord, thorough screening of these factors should be prioritized in clinical setting
Ultra-Morphological Changes of Trichophyton Rubrum Treated with Hydroxychavicol
Get PDFTrichophyton rubrum is a common pathogenic fungal species that is responsible for causing infection on human skin, hair and nail. The antifungal-resistant strains complicate the treatment regime. Hydroxychavicol (HC) is one of the main compounds from Piper betel leaf that have antifungal potential and its mechanism of action has not been studied yet. The objective of this preliminary study to determine the antifungal properties of HC against T. rubrum using transmission electron microscope (TEM) on gross and ultrastructure of T. rubrum hypha. T. rubrum was treated with HC and miconazole (MI) at concentrations of 1.25, 2.5, 5 and 10 mg/mL for 1, 3, 5 and 7 days continuously. Generally, fungi structures became more severely damaged at increasing treatment duration. Microscopically, the fungi’s cell wall treated with HC showed a rough surface, shrinkage and demolition similar to the MI treated group. The fungi organelles were also demolished and disorganized. This study revealed that HC has the ability to inhibit T. rubrum growth and has potential to be an antifungal agent for skin infections
Accuracy of Fine Needle Aspiration Cytology in Solitary or Dominant Nodular Goitre: A Single Centre Study
Get PDFBackground: Thyroid swelling or goitre is a common condition, either asymptomatic or symptomatic. The diagnosis is usually established by ultrasound or fine needle aspiration cytology (FNAC) as a gold standard. The sensitivity of the test is inversely related to increasing size of the nodule. The objective of this study is to evaluate the accuracy of FNAC especially in cases of large goitre. Material and methods: This is a retrospective study on patients who underwent thyroidectomy between January 2000 to December 2007 for solitary or dominant nodular goitre. The analysis was made only on those patients with complete data on FNAC and histology. Result: There were 235 patients, but only 161 patients were analysed after excluding the suspicious and inadequate sample. The patients’ mean age was 42.1 year old (21 to 60). The size of the thyroid nodule ranged from 2.1 to 5.0 cm (mean = 3.9 cm). The overall sensitivity was 67.4% and the overall accuracy was 86.3%. The accuracy of FNAC according to the sizes above and below the value were as follows; 2 cm (72.2% vs. 88.1%); 3 cm (88.0% vs. 87.4%) ; 4 cm (86.6% vs. 84.4%) ; 5 cm (87.3% vs. 78.8%). This was most obvious in the sensitivity of the FNA which also showed reducing trend as the nodules increased in size. Conclusion: FNAC is an essential diagnostic tool in the management of nodular goitre. Our study showed that the accuracy of FNAC decreased as the size of the nodule getting bigger. Cautious approach should be taken in the management of large goitre and decision should not be based only on the result of FNAC
Balloon Dilatation of Laryngotracheal Stenosis: Hospital Ampang Experience
Get PDFThe upper airway is a crucial structure. It becomes a grave problem should it be narrowed. Several methods of treatment were rendered for patients with laryngotracheal stenosis. We share our experience with the combination total intravenous anaesthesia and apneic pause technique with or without steroid injection. Four cases of laryngotracheal stenosis were observed in Hospital Ampang: two adult and two paediatric cases. Age, gender, causative factor, stenosis segment length, grade or severity were observed before and after dilatation, number of dilatation were observed and compared. The outcome measures are decannulation and avoidance of tracheostomy. All cases had improvement of symptoms. Half or 50% of the patient required repeated balloon dilatations. The paediatric cases successfully avoided tracheostomy while the adult cases successfully decannulated with no complication from the procedure. Balloon dilatation by total intravenous anaesthesia coupled with apneic method is a safe and effective method of treatment for the narrowed airway
Multiple Cavitating Pulmonary Nodules Secondary To Hodgkin’s Lymphoma
Get PDFWe report a 26-year old lady who presented with chronic cough and breathlessness associated with subtle TB symptoms for 1 year. Her CT thorax showed multiple cavitating pulmonary nodules with mediastinal and cervical lymphadenopathy. Cervical lymph node biopsy and CT-guided pulmonary biopsy at our centre confirmed the diagnosis of Hodgkin’s lymphoma with pulmonary infiltrations. She was successfully treated with ABVD regime but later developed life-threatening bleomycin-induced pulmonary fibrosis. Sadly, she succumbed to respiratory failure due to severe pneumonia with possibility of bleomycin-induced pulmonary fibrosis. Multiple cavitating pulmonary nodules secondary to lymphoma is rare and in TB endemic area, it may result in delayed diagnosis and treatment
Anti-Cancer Activity Of Luvunga Scandens Extract Against Squamous Cell Carcinoma
Get PDFIntroduction: Squamous cell carcinoma is reported as one of the most common types of cancer with increasing numbers of occurrence. Luvunga scandens is a plant possessing many bioactivities and general health effects, yet its anti-proliferative effect is under reported and need to be scientifically evaluated. Materials and Methods: MTT assay was used to assess the cytotoxicity of the plant against human squamous carcinoma cells in addition to the safety assessment for human dermal fibroblast cell line (HDF). The morphological changes of L. scandens treated squamous carcinoma cells has been confirmed by SEM, the apoptosis of the plant against squamous carcinoma cells has been tested using caspase 3/7 assay, followed by cell cycle analysis done using a flowcytometer on squamous carcinoma cells treated with the IC50 dose of L. scandens plant. Results: The plant's extract possesses cytotoxic effect against squamous carcinoma cells with IC50 readings; (methanol= 37.5 mg/mL, dichloromethane= 38 mg/mL, hexane= 37.5 mg/mL), and safe on HDF cells. The SEM results demonstrate that L. scandens treated cells showed an overall change in the cell shape, alteration of surface morphology, absence of microvilli and appearance of blebs. Caspase 3/7 assay results show that L. scandens dichloromethane extract produces the highest level of apoptosis against squamous carcinoma cells. For cell cycle analysis, all the L. scandens treated squamous carcinoma cells show high readings in the sub-G1 phase. Conclusion(s): This in vitro study has proved that L. scandens plant exhibit anti-proliferative effects against Squamous carcinoma cells, hence, it can be considered as a new promising potential anti-cancer therapy
Cytopathological Effects Of Smoking On Clinically Normal Oral Mucosa
Get PDFIntroduction: Smoking is a well-known cause of oral disease and oral cancer. Several dysplastic cytological changes occur before the appearance of the clinical lesion. This study aimed to investigate the cytopathological effects of smoking in clinically normal oral mucosa of cigarette smokers. Materials and Methods: A total of 40 cigarette smokers and 40 nonsmokers (control group) were included in this study. All participants had clinically normal oral mucosa. Oral smears were obtained from the side of the tongue and floor of the mouth using a Cytobrush. The smears were stained by Papanicolaou stain and examined under light microscope for inflammation, hyperkeratinization and dysplasia. Results: There was a significantly higher rate(p<0.005) of inflammation 63%, hyperkeratiniztion 62% and mild dysplasia 26% among smokers than non-smokers where the rates were 35%, 12% and 2% respectively. Conclusion: Smoking causes significant cytopathological changes in normal oral mucosa, the detection of which is important to prevent progression into carcinoma. The procedure is fast, painless and inexpensive