IIUM Medical Journal Malaysia (IMJM)
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Pain Intervention for Trigeminal Neuralgia
Get PDFIn the management of chronic pain, stepwise oral analgesics of graded strength are considered as first-line therapy. Minimally invasive interventional procedures remain an option for its treatment when pharmacological therapy fails to control the pain. We reported three classical cases of chronic trigeminal neuralgia that were managed with two types of pain intervention approaches after failing conservative management. In the first case, percutaneous pulse radiofrequency was directed directly to the trigeminal nerve while the other two patients were approached through Gasserian Ganglion. The first method used a traditional technique of pulse radiofrequency approaches. The nerve was identified using sensory stimulation and pulse radiofrequency was delivered once the nerve was confirmed. The second method was similar to the first one but with different approach. Under fluoroscopic control, a radiofrequency needle was introduced into the cheek’s skin ipsilateral to the pain. The needle was directed towards the cranial base in front of the foramen ovale. The success of a trigeminal nerve block depends on proper identification of the anatomic landmarks and the nerve itself. The two different approaches of pain interventions offer more than 50% pain reduction. The trigeminal nerve approaches offer less risk as compared to Gasserian ganglion which is nearer to the brainstem and subarachnoid area. These procedures offer the ability to limit the sensory deficit to a preselected region of the face and to produce hypoalgesia or analgesia without anesthesia
Pcr-Based Construction and Transformation of Cody Gene Deletion Construct in Streptococcus Pneumoniae
Get PDFIntroduction: Streptococcus pneumoniae (S. pneumoniae) is a gram-positive diplococci belonging to the genus Streptococcus and it is a well-studied pathogenic bacterium. Pneumococcal diseases such as otitis media, pneumonia, sepsis and meningitis caused by pathogenic strains of S. pneumoniae still brought significant mortality and morbidity worldwide. The pathogenicity of S. pneumoniae is exerted by various virulence factors and one of it is the enzyme hyaluronate lyase. Hyaluronate lyase plays a major role in the invasive capability of S. pneumoniae. Its mechanism of action and crystallographic structure have been determinedbut its regulatory mechanism is still poorly understood. Drawing connections between the nutritional behaviour and invasive property of S. pneumoniae, CodY regulator is hypothesized as a potential hyaluronate lyase regulator. This work was aimed to construct CodY deficient mutant of S. pneumoniae to form foundational work for the study of CodY regulatory effect on hyaluronate lyase. Materials and method: A single gene-deletion method was chosen to create CodY mutant construct containing aphA-3 gene (encoding kanamycin resistance protein) replacement cassette by employing recombinant fusion PCR method. A single band DNA product at the expected size of 2,563 bp after recombinant fusion PCR was visualized on agarose gel electrophoresis. This indicated that the linear recombinant amplicon has been successfully constructed. The recombinant amplicon was transformed into S. pneumoniae cells of Malaysian local clinical isolate by employing the competence stimulating peptide (CSP-1) to enhance and induce natural competence. Results: No viable CodY mutant was evident post-transformation. The negative transformation result was postulated to be due to the essential nature of CodY regulator. Conclusion: This work can provide basis for recombinant fusion PCR method in designing and constructing single gene deletion construct. However, further work is needed to identify the regulatory agent of hyaluronate lyase
Prediction of Clinical Symptoms of Schizophrenia Based on Comt Methylation Marker
Get PDFIntroduction: The dopamine hypothesis of schizophrenia is based on the fact that hyperdopaminergic state is involved in causing psychosis and antipsychotic drugs block the dopamine receptor. COMT regulates the homeostatic levels of neurotransmitter dopamine in the synapses and plays a role in the neurocognitive function. The dysregulation of dopamine in the prefrontal cortex influences the cognitive function and the severity of the psychotic symptoms in schizophrenia. During epigenetic event, methylated COMT gene may cause reduction in its expression and contribute to the clinical presentation of schizophrenia. Therefore, the aim of this study was to assess the feasibility of using COMT DNA methylation for the prediction of specific psychotic presentation of schizophrenia. Materials and method: In this study, 138 schizophrenia patients were recruited from the Psychiatry Clinic, Hospital Tengku Ampuan Afzan, Kuantan Pahang. Genomic DNA from peripheral blood was subjected to the Methylight Taqman® analysis for quantitative measurement of the COMT DNA methylation. The psychopathological symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Results: The regression analysis showed that the Positive and Excited subdomains of PANSS were significant predictors of COMT hypomethylation (β= -0.288, p= -0.031; β= - 0.288, p= -0.031). The Excited subdomain of PANSS was negatively correlated with COMT DNA methylation (r 2 = -0.380, p= 0.000) as well as the Depressed subdomain (r 2 = -0.288, p= 0.001). Conclusion: The relationship between DNA methylation of COMT with the positive, excited and depressed symptoms might indicate the epigenetic role of COMT gene in the manifestation of schizophrenia
Retrograde Cement Extrusion into Femoral Nutrient Vessels Following Uncomplicated Total Hip Arthroplasty
Get PDFThe present concepts in Total Hip Arthroplasty advocate mechanical cement interlock with trabecular bone utilising the third-generation cementing technique. However, the force generated can easily reach peak pressure of 122 kPa to 1500 kPa, leading to extrusion of cement through nutrient foramina into femoral cortex into nutrient vessels, henceforth the retrograde arteriovenogram. A 76 years old lady who premorbid ADLindependent had a fall and sustained a closed right neck of femur fracture. She underwent cemented right total hip arthroplasty. Acetabulum cup of 47mm and femoral stem size 1 was utilized. Femoral canal was prepared and medullary cavity plug inserted before retrograde cement was introduced using the cementing gun. Intraoperative no complications were noted. This case has been followed up to a year with no adverse effect. The post-operative radiograph demonstrated a linear radio-opacity communicating with the posterior aspect of the femoral shaft which continues proximally and medially for approximately 10cm. Its uniformity in shape and position corresponds to the vascular supply of proximal femur. In Farouk et al cadaveric study, nutrient vessel arises in 166 ± 10 mm from the greater trochanter and is a branch of the second perforating artery from the deep femoral artery. Knight et al infer that retrograde cement extrusion occurs in female patients with small stature and small endosteal canal. Cement extrusion unlikely will influence the long haul survival of prosthesis as shown in the radiograph that cement is well pressurized to interlock with the endosteal bone. Moreover, because of extensive anastomoses of perforating branches of the deep femoral artery, segmental obliteration of nutrient artery alone is unlikely to lead to vascularity issues. Cement extrusion into the nutrient foramen is a vital differential in presence of posterior medial cement in the diaphysis of the femur following total hip replacement. This is to differentiate from extra osseous extrusions due to the iatrogenic breach of the femoral cortex suggesting periprosthetic fracture which affects the long term survival of prosthesis
Prevalence and Clinical Characteristics of Metabolic Syndrome among Malaysian Hypertensive Subjects using the International Diabetes Federation Definition
Get PDFIndividuals with metabolic syndrome are at increased risk for developing cardiovascular disease and diabetes mellitus. This study was carried out to determine the prevalence of metabolic syndrome and clinical characteristics in hypertensive patients according to the criteria of the new International Diabetes Federation (IDF) definition. Hypertensive patients were recruited from the Medical Out-Patient Department, Kuantan Hospital. The five components of metabolic syndrome were examined which included blood pressure (≥130/85 mmHg), fasting glucose (≥5.6mmol/L), fasting triglycerides (≥1.7 mmol/L), high-density lipoprotein (HDL) cholesterol level (<1.03mmol/L in males and ><1.29mmol/L in females), and abdominal obesity (waist circumference: men>90cm; women>80cm). Out of 139 hypertensive patients, there were 113 met all the selection criteria consisted of 61 male and 52 female subjects. The participants’ age ranged from 21 to 91 years (51.9±16.8 years; mean±SD), and body mass index 13.5-42.3 kg/m2 (27.5±4.9 kg/m2 ). According to the IDF criteria, the prevalence of central obesity was 67.2% in men and 84.6% in women. Among the 113 hypertensive subjects over 21 years of age, 51 subjects or 45.1% had metabolic syndrome. The present data revealed that there was high prevalence of metabolic syndrome in Malaysian hypertensive subjects. This finding was supported by the fact of high prevalence of central obesity among the study subjects
Psychiatric Morbidities among Attenders of an Islamic Spiritual Healing Centre in Malaysia
Get PDFIntroduction: Traditional medicine which includes Islamic faith healing centre is still an important place to seek treatment whether for psychiatric reasons or others. This study aims to determine the prevalence of psychiatric illness among attenders of an Islamic spiritual healing centre and to understand patients’ illness attribution and their religiosity. Methods: A cross-sectional study was done with a systematic random sampling to obtain the prevalence of psychiatric illness which was diagnosed using Malay version of Mini International Neuropsychiatric Interview (M.I.N.I). Religiosity was measured using Hatta Islamic Religiosity Scale 1996 (HIRS96) and illness perception using Brief Illness Perception Questionnaire (BIPQ). Results: The prevalence of psychiatric illness among the attenders was 53.5%. Depressive disorder were more prevalent (41.5%) followed by anxiety disorder (28.3%), bipolar disorder (16.8%) and psychotic disorders (5.9%). More than half (58.8%) of attenders attributed their illness to supernatural causes but there were no significant difference between those with psychiatric illness and those without in terms of their attribution to supernatural causes, p=0.197.Generally, the patients had a higher religiosity score. Conclusion : This high prevalence shows a need for collaboration with the spiritual healing practitioners to improve delivery of treatment to patient and this would be a more holistic approach
An Audit On Waiting Period For Alveolar Bone Graft (ABG) After Pre-ABG Orthodontic Treatment In Abdul Samad Orthodontic Clinic
Get PDFIntroduction: The timing of ABG procedure in a cleft patient is crucial to provide room and bony support for the eruption of canine. However, there seems to be a delay in execution of this procedure in certain centres. Material and Methods: Sample consists of records of cleft patients treated from 2000-2016. The date and age for commencement of active orthodontic treatment, date referred for ABG and date ABG done were retrieved. The centres that conducted these surgeries identified. Results: The mean age at start of treatment was 11.03 for males and 11.47 for females. Average waiting period for ABG was 11.75 months with the shortest was 12 days and the longest was 35 months. Conclusion(s): Delay in ABG increase the risks associated with prolonged wear of fixed orthodontics. Distribution of burden of care among the surgical centres to reduce this waiting time should be taken into consideration for the benefit of patients
Assessment Of Prevalence, Length And Position Of Anterior Loop Of Inferior Alveolar Nerve: A Study Using CBCT
Get PDFIntroduction: Adequate space is required in the interforaminal region for anterior mandibular surgery, where the anterior loop is located within this region. The aim of this study is to evaluate the prevalence of the anterior loop (AL) of the inferior alveolar nerve, and to measure its length and position in patients attending Kulliyyah of Dentistry using cone beam computed tomography (CBCT). Materials and Methods: CBCT images of mandibles from 70 patients (140 hemimandibles) were selected and evaluated in this retrospective study. A single detector, multiple slits CBCT machine was used for this purpose. The comparison was made based on gender, age and race. The prevalence, position and length of the AL were assessed using Romexis® software version 2.8.0.R. Results: An anterior loop was identified in 16.4% of the examined mandibles and mostly observed on the right side (21.4%). The prevalence of AL was significantly higher in males (69.6%) compared to females (30.4%). The mean anterior loop length recorded was 2.59 mm (± 1.63), ranged from 0.80 mm to 6.00 mm. Most of the loops were found located inferior to the apex of lower right second premolars (60%). Conclusion(s): In this study, the prevalence of AL found is significant and the length of AL was varied greatly. Although AL is an anatomical variation, findings of this study might be useful in determining the safe distance and to preserve the neurovascular bundle before an implant placement or osteotomy in the anterior region of mental foramen
Prevalence, Symptom Severity And Risk Factors Of Musculoskeletal Disorders Among Dental Therapists In Malaysia
Get PDFIntroduction: Dental therapists are one of the main dental workforce in Malaysia and are exposed to various risk factors of MSD. However, studies on MSD among dental therapists are limited. The objectives of this study were to determine the prevalence, the sites affected, the symptom severity, the impact, the risk factors and the association between individual, biomechanical, physical and psychosocial risk factors with prevalence of MSD among dental therapists. Materials and Methods: A survey was conducted using self-administered questionnaire which was distributed to all dental therapists in Perak, Terengganu and Kuala Lumpur in February 2017, from which a response rate of 89.2% was achieved. Results: There was a high prevalence of MSD (87.5%) among the respondents. The MSD was found to be affecting mainly the back (69.7%), neck (66.7%), shoulders (58.7%) and wrists/hands (50.2%) while MSD of the elbow and lower extremities was found to more severe and often affect their daily work. Most of the respondents who reported MSD accommodated their own symptoms with analgesics or sought alternative treatment (20.1%). Majority reported that they often used vibratory instruments (76.1%), involved in biomechanical risk activities, and perceived that they have a high job demand and lack of authority to make decisions related to work. Age (OR: 3.58; 95% CI: 1.644, 7.773), number of extractions (OR: 4.69; 95% CI: 1.348, 16.327) as well as psychosocial factors (OR: 4.05; 95% CI: 1.547, 10.613) were significantly associated with prevalence of MSD. Conclusion(s): Therefore, preventive measures should be implemented to reduce the burden of MSD
Screening Of Fatty Acid Compound Of S. Polycystum For Anti-Cariogenic Potential
Get PDFIntroduction: Dental caries is the most common yet preventable disease. Study found that seaweed exhibits anti-cariogenic properties. However, little attention have been given to the study on anticariogenic properties of seaweed and the bioactive compound that responsible for the anticariogenic activities have not adequately investigated. This study was conducted to evaluate the best extraction methods for S. polycystum and to determine the fatty acid compounds of S. polycystum that have anti-cariogenic potential against oral cariogenic bacteria. Materials and Methods: Dried seaweeds were extracted by soxhlet using three different solvents (methanol, dichloromethane and hexane). The crude extracts were kept in a close container at -20 degree Celsius. The bioactive compound of the crude extract of seaweeds was analyzed using Gas Chromatography Mass Spectrometer (GCMS). Results: Highest extraction yield in S. polycystum was produced by methanol extraction followed by hexane and dichloromethane. GCMS analysis revealed that the presence of palmitic acid (18.02%) as major compound, followed by oleic acid (8.44%), lauric acid (5.23%), myristic acid (3.60%), heptadecanoic acid (2.23%), 9-hexadenoic acid (1.82%) and the lowest is 2-methylhexadecan-1-ol (1.75%). Conclusion(s): Methanol extraction is the most efficient solvent as it produced the highest extraction yield in S. polycystum.Lauric acid, palmitic acid, myristic acid and oleic acid detected in S. polycystum have been reported to exhibit antimicrobial activities thus proved the potentiality of S. polycystum as anti-cariogenic agent