IIUM Medical Journal Malaysia (IMJM)
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The Effect Of Gargling Green Tea On Salivary Flow Rate On Female With Xerostomia At Puskesmas Darussalam Medan
Get PDFIntroduction: Saliva is important in maintaining the health of the oral environment. A reduction of the saliva flow by 40% to 50% will cause xerostomia. Xerostomia as the main complaint, experience by about 14%-46% of patients. The objective of this research is to find out the influence of green tea gargle to saliva flow rate in xerostomia patient. Materials and Methods: Green tea with the Latin name Camellia sinensis (L). Polyphenol compounds, catechins in this tea cause a bitter taste that can stimulate the central nervous system resulting in increased salivary secretion. Green tea weighing 3 grams, brewed with 20 ml of hot water an let to stand for 5 minutes then strained and used it for gargeling. The subjects of the study were female of Puskesmas Darussalam visitors. The sample was selected using purposive sampling method and they consisted of 20 people for gargling group of green tea and 20 for gargeling aquades. Saliva was obtained by spitting method. Results: The mean difference in salivary flow rate gargling the aquades was about 0.033350 ml / min, while the mean difference of salivary flow rate gargling the green tea was about 0.281750 ml/min. The statistical T test was unpaired, p = 0,000 difference in mean difference of salivary flow rate was significant, between treatment group and control group. Conclusion(s): The group with green tea gargeling was better in stimulating salivary flow rate
15 Years Review of Gastrocnemius Flap Done in Department of Orthopaedics, Hospital Tengku Ampuan Afzan, Kuantan
Get PDFIntroduction: Gastrocnemius flap is the workhorse for wound coverage in the proximal tibia. It can be perform by general orthopaedic surgeon because it is done without the need of microscopic instrumentation. Its coverage can be extended to cover the knee and midshaft of tibia when skin overlying it is included in the flap. Materials and method: From July 2002 till January 2017, 47 patients underwent gastrocnemius flap in our hospital (26 muscular and 21 musculocutaneous flap). 41 flaps were raised from medial, 5 lateral and 1 from both muscle belly. There were 41 males and 6 females with the mean age of 21.4 years old (range 13-82). The flaps were done to cover upper third (29), upper half (6), midshaft tibia (6), knee (2) and distal femur (1). The initial problems were open fracture (30), infection following plating (9), necrotising fasciitis (4), degloving injury (2), pin site infection (1) and melioidosis (1). Eight patients have underlying Diabetes mellitus, 2 Hepatitis B, 3 HIV or 1 COAD. Two patients have sciatic nerve palsy. Results: There was no flap necrosis. Complications include persistence infection in 6 patients which require repeated debridement (5), below knee amputation (1), advancement of flap (1) and additional fasciocutaneous flap (1). Two patients with gastrocnemius musculocutaneous flap had partial failure of skin graft that heals with dressing. One patient develops transient peroneal nerve palsy following the lateral gastrocnemius transfer. Conclusion: Gastrocnemius flap is a reliable and safe procedure in orthopaedic surgery. Problems that occur are associated with inadequate debridement and underestimate the size of flap required
Comparison between Point-Based and Ring-Based Technologies in Keratometric Measurement among Post Myopic Laser Refractive Surgery Patients
Get PDFIntroduction: Corneal power or keratometric value represents two-third of total refractive power of the eye. It is an important parameter in intraocular lens calculation. Purpose of the study was to evaluate repeatability and agreement of keratometric measurements obtained from a six points-based keratometry device; IOLMaster 500 (Carl Zeiss Meditec AG, Jena, Germany) and two Placido disc-based keratometry devices; Atlas Topographer 995 and 9000 models (Carl Zeiss Meditec AG, Jena, Germany). Materials and method: A total of 97 post myopic laser refractive surgery subjects were recruited. Three set of mean corneal power measurements from each device were performed by an examiner in a single visit. The repeatability was evaluated by withinsubject standard deviation, coefficient of variation and intraclass correlation coefficient. A one-way repeated measures analysis of variance was conducted to evaluate keratometric measurement differences between the devices. The BlandAltman analysis was employed to assess inter-device agreement. Results: There were no significant differences of three repeated keratometric measurements in each device (p > 0.05). IOLMaster showed the lowest coefficient of variations in all meridians (< 0.30%).The intraclass correlations were higher than 0.90 in all devices. For inter-device agreement, there were statistically significant differences between Atlas 9000-IOLMaster and Atlas 995-IOLMaster (p < 0.05). The 95% limit of agreement ranged from 0.94 to 1.68. Conclusion: The six points-based technology has a higher repeatability compared to ring based technology in measuring postoperative keratometric measurements. Different keratometry technologies cannot be used interchangeably in clinical setting
Model-Based Insulin Sensitivity for Early Diagnosis of Sepsis in Critical Care
Get PDFIntroduction: Currently, it is almost impossible to diagnose a patient at the onset of sepsis due to the lack of real-time metrics with high sensitivity and specificity. The purpose of the present study is to determine the diagnostic value of model-based insulin sensitivity (SI) as a new sepsis biomarker in critically ill patients, and compare its performance to classical inflammatory parameters. Materials and method: We monitored hourly SI levels in septic (n=19) and non-septic (n=19) critically ill patients in a 24-hour follow-up study. Patients with type I or type II diabetes mellitus were excluded. SI levels were calculated by a validated glycemic control software, STAR TGC (Stochastic TARgeted Tight Glycemic Controller) (Christchurch, NZ). STAR TGC uses a physiological glucose-insulin system model coupled with stochastic models that capture SI variability in real time. Results: The median SI levels were lower in the sepsis group than in the non-sepsis group (1.9 x 10-4 L/mU/min vs 3.7 x 10-4 L/mU/min, P <0.0001). The areas under the receiver operating characteristic curve (AUROC) of the model-based SI for distinguishing non-sepsis from sepsis was 0.911, superior to white cells count (AUROC 0.611) and temperature (AUROC 0.618). The optimal cut-off value of the test was 2.9 x 10-4 L/mU/min. At this cut-off value, the sensitivity and specificity was 88.9% and 84.2%, respectively. The positive predictive value was 84.2%, while the negative predictive value was 88.9%. Conclusion: The early and relevant decrease of SI in sepsis suggests that it might be a promising novel biomarker of sepsis in critical care. Low SI is diagnostic of sepsis, while high SI rules out sepsis, and these may be determined non-invasively in real-time from glycemic control protocol data
Demographic Characteristic Of Patient With Traumatic Dental Injury Attending Kulliyyah Of Dentistry IIUM Kuantan Campus
Get PDFIntroduction: Traumatic dental injuries (TDI) refer to injury to the teeth and/or peridontium and perioral soft tissues. To date, very few dental trauma studies conducted in the university setting, thus the aim of this research is to provide an epidemiological data of TDI cases among patients attending Kulliyyah of Dentistry (KOD), IIUM Kuantan Campus. Materials and Methods: A total of 32 patient's record with TDI were retrieved from 2012 to June 2016. The inclusion criteria are patients attended KOD for management of dental trauma and diagnosis of TDI was properly documented. Patients attending KOD with complaint other than dental trauma and no proper diagnosis documented were excluded. The classification of dental trauma used is based on WHO Dental Trauma Classification (1978). For cases that were doubtful or with insufficient information, decision was made after further discussion with another examiner. Results: The mean age was 12.31 years old with the highest number of cases occurs in the 6-15 year-old group (37.5%) and male to female ratio of 3:2. Uncomplicated crown fracture was the most common injury in primary and permanent dentition (38% and 67%, respectively). Falls attribute 62.5% of the causes of TDI. November and December recorded the highest number of occurance of TDI cases (25% respectively). Conclusion(s): There is low occurance of TDI cases in KOD. The occurance of TDI cases is associated with school holida
Identification Of PAX9 Single Nucleotide Polymorphism In Class III Malocclusion Patients With Mandibular Prognatism
Get PDFIntroduction: PAX9 (Paired box 9) gene is one of the genes which play significant role during craniofacial development. Single nucleotide polymorphism (SNP) in PAX9 has been associated with Class II/Division 2 malocclusion (with or without hypodontia). However, the relationship between PAX9 SNP marker (rs8004560) with mandibular prognathism (MP) has not been analysed, at least in our local population. This study aimed to detect the presence of PAX9 (rs8004560) SNP in Class III malocclusion patients (with MP) in the local population. Materials and Methods: Genomic DNA were extracted from unstimulated saliva of 31 class I malocclusion (control samples) and 30 patients from Class III malocclusion (MP). Cephalometric measurements were performed prior to saliva samples collection. The DNA was amplified using the specific primers for the marker rs8004560 and the genotyping was done by sequencing. Chi-square test was used to determine the overrepresentation of marker allele (p<0.05). Results: Presence of PAX9 SNP (rs8004560) was detected in local population analysed and the distribution of its genotype and allele could be observed. There were significant differences between allele (p=0.000) and genotype (p=0.000) frequency within control (Class I) and Class III malocclusion. Conclusion(s): The most common allele of a marker flanking PAX9 (rs8004560) was over-represented in the mandibular prognathism (MP) subjects indicating the genetic association of PAX9 (rs8004560) SNP in the incidence of MP. Further studies involving larger number of samples should be developed in order to understand the exact role and mechanism of PAX9 in different classes of malocclusions
Preference Of Dental Practitioner On Antibiotic Prophylaxis For Infective Endocarditis Guidelines: The Cohort Of Klang Valley
Get PDFIntroduction: Antibiotic prophylaxis guidelines for infective endocarditis have been regularly revised and modified based on current scientific evidence. These guidelines commonly regarded as standard of care and determine the medicolegal standards. The aim of this study was to elicit the current practice of prophylaxis antibiotic for Infective endocarditis among general dental practitioner in Klang Valley. Materials and Methods: A standardized questionnaire forms were distributed to the selected dental practitioners in Klang Valley by mail. Results: 43 out of 427 questionnaires was answered and posted back. 70.6% of the respondent claimed to be following guidelines that advocate antibiotic prophylaxis for the prevention of infective endocarditis (American Heart Association, British Cardiac Society, European Society of Cardiology) while others claimed to be following The National Institute for Health and Clinical Excellence guidelines (no antibiotic prophylaxis). However, majority of the respondent showed poor compliance towards the guideline. Several barriers have been identified. Conclusion(s): Majority of the respondent preferred to choose AHA guidelines for antibiotic prophylaxis. However, adherence to the guidelines seems to be low. Efforts to increase awareness of the guidelines among the dental practitioner should be taken
Suppression of Otoacoustic Emission using Schroeder Harmonic Complexes as Suppressing Stimuli
Get PDFIntroduction: Medial Olivocochlear Reflex (MOCR) causes inhibition of outer hair cell activity upon noise stimulation and acts as protective mechanism of the ear against noise. MOCR can be recorded through the suppression of Otoacoustic Emission (OAE). The mechanism of MOCR function was still unclear and whether the function is affected by the phase of incoming noise requires further investigation. This research aimed to identify the effect of MOCR activity ; i) at different frequency; ii) when using different phases of Schroeder harmonic complexes as the suppressor noise. Materials and method: Twenty six normal hearing subjects were recruited. The suppression was analysed by looking at amplitude difference of Distortion Product of Otoacoustic Emission (DPOAE) in the absence of noise and in the presence of noise in contralateral ear, at different tested frequencies (1, 1.5, 2, 3, 4, 6 kHz). Results: There was significantly higher suppression amplitude for frequency 1-2 kHz compared to higher frequencies (p<0.05). Significant higher suppression was observed when negative phase of Schroeder harmonic complexes (c: -1) was used as suppressing stimuli compared to that of positive phase (c: +1) (p<0.05). Conclusion: These findings showed that MOCR; i) is enhanced at mid-frequency region, and ii) has the ability to inhibit the outer hair cell active mechanism differently upon stimulation with different phases of noise
Educating Future Medical Professionals with the Fundamentals of Law and Ethics
Get PDFThe increasing awareness amongst the society on medico-legal issues as well as the growth of consumerist attitude towards the provision of medical services has caused the medical profession to be subjected to vociferous criticism if they do not meet rising expectations of the society. Substandard services have not been well tolerated and paternalistic approaches in medical treatment are considered to be outmoded and inappropriate. Any dissatisfaction on the part of the patient towards medical services provided nowadays may easily trigger claims in the court of law. This changing trend has also fundamentally changed the behaviour of the courts towards the medical profession. Judicial and legislative interventions in medical practice have created more and more rights for the patients and consequently, corresponding legal duties for the medical profession to uphold. In the present healthcare setting, the medical profession will not be able to provide infallible services without knowledge of the legal standards which they have to adhere. Thus, educating future medical professionals with the fundamentals of law and ethics would ensure greater accountability, knowledge and personal commitment in providing medical services to the society as the ideals of professionalism not only require them to have the necessary expertise, dedication, respect, compassion, empathy, honesty, altruism, responsibility, integrity, self-improvement and accountability but also adherence to the demands of law and highest ethical standards
The Risk and Associated Factors of Female Sexual Dysfunction (FSD) in Women with Psoriasis
Get PDFIntroduction: Psoriasis is a chronic, immune mediated, hyperproliferative skin disease that has substantial impact on the sexual functions. This study aimed to determine the prevalence and associated factors of female sexual dysfunction (FSD) in patients with psoriasis. Methods: A cross-sectional study involving 79 women with psoriasis attending two Dermatology Outpatient Clinics were interviewed and assessed for female sexual dysfunction and severity of psoriasis. The socio-demographic and clinical characteristics of the subjects were compared between the women with and without sexual dysfunction. The subjects were interviewed using Mini International Neuropsychiatric Interview (M.I.N.I.) to exclude any existing psychiatric illness. Sexual dysfunction was assessed using a validated questionnaire on sexual function and the severity of psoriasis was assessed using Psoriasis Area and Severity Index (PASI). Results: The prevalence of FSD in the patients with psoriasis was 20.3%, with hypoactive sexual desire being the most prevalent problem (44.3%). Sexual dysfunction was associated with older age, menopause, low body mass index, longer duration of marriage and presence of psoriasis in the genital area. Female sexual dysfunction was highly prevalent in patients with psoriasis. Conclusion: Management of psoriasis should include assessment in patients’ sexual health. Genital area involvement with psoriasis should not be overlooked as it can cause significant psychosexual distress