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Jurnal Sains Kesihatan Malaysia (Malaysian J. of Health Sciences)     Open Access  
Jurnal Undang-undang dan Masyarakat     Open Access  
MALIM : Jurnal Pengajian Umum Asia Tenggara (SEA) J. of General Studies     Open Access   (Followers: 1)
Medicine and Health     Open Access  
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Medicine and Health
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ISSN (Print) 2289-5728
Published by Universiti Kebangsaan Malaysia Homepage  [21 journals]
  • 23rd Medical & Health Research Week

    • Authors: Siti Noorain
      Abstract: Author:  - - Issue:  Vol. 16 No. 2 (suppl) : 2021
      PubDate: Mon, 04 Oct 2021 07:32:41 +000
       
  • Malaysian International (Virtual) Conference on Menopause &
           Women’s Health

    • Authors: Siti Noorain
      Abstract: Author:  - Issue:  Vol. 16 No. 1 (suppl) : 2021
      PubDate: Tue, 24 Aug 2021 02:21:23 +000
       
  • Strangulated Diaphragmatic Hernia in an Elderly Man

    • Authors: Siti Noorain
      Abstract: Author:  ZAKARIA AD HAYATI F NG CY YEAP BT ZAINAL ABIDIN ZA Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Angin pasang otot diafragma kongenital sangat jarang berlaku terutamanya di kalangan orang dewasa. Ia selalunya terjadi selepas kemalangan dan kebiasaannya melibatkan otot diafragma di sebelah kiri. Kami ingin membincangkan satu kes seorang lelaki berumur 68 tahun yang datang dengan masalah usus tersumbat akut disebabkan oleh angin pasang otot diafragma di sebelah kanan. Pemeriksaan klinikal menunjukkan abdomen yang kembung dengan bunyi usus bernada tinggi dan tiada ketulan di dalamnya. Pemeriksaan juga menunjukkan bahawa tiada bunyi pernafasan di dada sebelah kanan. Imbasan tomografi adalah konsisten dengan angin pasang otot diafragma dan usus tersumbat akut. Kami mengetengahkan kes angin pasang otot diafragma kongenital dan menekankan pentingnya untuk pengurusan perioperatif bagi memastikan hasil pembedahan yang berjaya. Correspondance Address:  Firdaus Hayati. Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia. Tel: +6088-320000 ext. 611029 E-mail: firdaushayati@gmail.com, m_firdaus@ums.edu.my Full text:  INTRODUCTION Diaphragmatic hernia commonly occurs in the neonates due to a congenital defect of diaphragmatic muscles (Al Ghafri et al. 2014). It will lead to herniation of abdominal content into the thoracic cavity. The herniated content can be in the form of hollow or visceral organs. Hence, it will manifest as cardio-pulmonary symptoms and failure to thrive among children (Sathyanarayana et al. 2012). It is very uncommon with a rate of 1 : 2500-3000 live births (Malekzadegan & Sargazi 2016). In 20% of cases, the diaphragmatic hernia can occur on the right side and 80% of subjects is on the left side (Malekzadegan & Sargazi 2016). The diaphragm is rarely engaged on both sides. However, it is vice versa among chronic idiopathic diaphragmatic hernia as it is more common to happen on the right side (Ayane et al. 2017).  It is known as Bochdalek hernia if the diaphragmatic defect occurs at the postero-lateral part and Morgagni hernia if at the anterior or central part, in which the former is found more common as compared to the latter (Malekzadegan & Sargazi 2016). In adults, a diaphragmatic hernia is easily identified among post-trauma patients, usually on the left side. However, it is deemed rare to present without any precipitating factors, especially in the elderly (Murchite et al. 2020). A late presentation of diaphragmatic hernia is perplexing especially without aetiology. We report a 68-year-old male who presented to us with an acute intestinal obstruction secondary to a right diaphragmatic hernia and we discuss our immediate successful management for this man. CASE REPORT A 68-year-old male presented to the Emergency Department with a 4-day history of acute intestinal obstruction. He had a change of bowel habit accompanied by constitutional symptoms for the past one month but no other alarming signs of malignancy. He denied any history of trauma, fall or motor vehicle accident. Upon assessment, he was dehydrated but haemodynamically stable. He was neither pale nor jaundiced. Clinically, the abdomen was distended with generalised tenderness and no palpable abdominal mass. The bowel sound was hyperactive. The breath sound was absent on the right side as compared to the left. Digital rectal examination showed an empty rectum with no palpable mass. Blood investigations were within normal range except for a slight acute kidney injury picture. The chest and abdominal radiography revealed a bowel loop in the right chest cavity with a dilated small bowel in the abdomen. The computed tomography (CT) scan was consistent with a diaphragmatic hernia and acute intestinal obstruction (Figure 1 & 2). The patient was posted to the operating theatre for an emergency laparotomy. The anaesthetic management was a rapid sequence induction followed by the insertion of a right-sided double-lumen tube (DLT) size 27 Fr to decompress the right lung. Intraoperatively, a small right sided defect was identified measuring 5 cm x 4 cm in size with small bowel herniated through it. The herniated bowel was reduced back into the abdominal cavity. It was repaired via an interrupted technique of non-absorbable suture. A chest tube was inserted into the right pleural space prior to the abdominal closure. He recovered well postoperatively. One m...
      PubDate: Sat, 26 Jun 2021 04:30:48 +000
       
  • Local Anesthesia Systemic Toxicity (LAST) Treated as Anaphylaxis

    • Authors: Siti Noorain
      Abstract: Author:  Amirudin S ISMAIL MS Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Ketoksikan sistemik bius setempat (LAST) dan anafilaksis adalah kesan sampingan lignocaine yang boleh membawa maut. Namun, kedua-duanya mempunyai tanda-tanda dan rawatan yang berbeza. Kami melaporkan satu kes seorang perempuan berumur 35 tahun datang ke Jabatan Kecemasan (ED) dengan gejala keletihan, mengantuk, dan susah bernafas dengan rasa bendasing dan rasa logam di dalam tekak. Gejala tersebut bermula 15 minit selepas pesakit mendapatkan suntikan di bahagian bahu kanan dengan 250 mg lignocaine bercampur dengan Triamcinolone di Klinik Orthopedik. Pesakit telah dibawa ke kawasan resusitasi dan telah dirawat sebagai anafilaksis. Semasa pemeriksaan lanjut, tekanan darah tidak pernah rendah, tiada tanda-tanda salur pernafasan terjejas, tiada gejala gastrousus, dan tiada penglibatan mukosa yang menjurus kepada diagnosis LAST berbanding anafilaksis. Walau bagaimanapun, pesakit telah beransur-ansur pulih dan dibenarkan pulang selepas pemerhatian di ED selama enam jam. Ini merupakan laporan kes yang pertama yang menunjukkan LAST dirawat dengan berkesan sebagai anafilaksis. Correspondance Address:  Amirudin Sanip. Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +6012-6034863 Email: aremay_best@yahoo.com Full text:  Introduction Lignocaine had been used as local anesthesia (LA) in surgery and as a pain relief since 1949. It was founded by Nils Lofgren, a Swedish chemist (Leung 2014). However, it has a life-threatening adverse effect which is local anesthesia systemic toxicity (LAST) (Christie et al. 2014). The mechanism of action and the treatment are very different from anaphylaxis.  LAST usually happen when LA reaches the circulation trough systemic absorption or accidental intravascular injection. The lipophilic characteristic of the LA allows it to cross the cell membrane and interact with charged targets, which affects the balance between inhibitory and excitatory pathways. It causes toxic effect to various tissue especially in the heart, causing cardiac arrhythmias, and in the brain which will cause seizures (Christie et al. 2014; Sekimoto et al. 2017). Meanwhile, anaphylaxis to LA are extremely rare. In Malaysia there was only one case that had been reported in literature with a positive skin prick test (Noormalin et al. 2005). It is more likely to occur with ester (e.g. cocaine, procaine, and benzocaine) than amide (e.g. lidocaine, bupivacaine, and ropivacaine) type LA (Christie et al. 2014). The allergy to LA may be type I (immediate hypersensitivity reaction) which is mediated by IgE antibodies or type IV (delayed hypersensitivity reaction) which is mediated by sensitised lymphocytes (Ring et al. 2010).  In this case, we presented a patient who had LAST after local anesthesia plus Triamcinolone injection to the right shoulder who improved and recovered after being treated as anaphylaxis in the Emergency Department (ED). We reported this case as there has been no case reported in the literature where LAST was treated as anaphylaxis. Case report A 35-year-old woman weighing 55 kg was rushed to the ED from the Orthopedics Clinic with complaint of difficulty to breath after having LA. She was well prior to the procedure. She came to the clinic for a long head bicep tendonitis follow-up. She was offered LA plus Triamcinolone injection to the right shoulder for pain relief. Intra-procedure, 25 ml of Lignocaine 10% (total dose of 250 mg) mixed with Triamcinolone was delivered into 3 sites of the right shoulder. No blood was drawn back on each injection. After 15 minutes, she complained of drowsiness and lethargy, followed by shortness of breath, foreign body sensation and a metallic taste in the throat. However, there was no perioral numbness and no visual or auditory disturbance. She was a known case of bronchial asthma and eczema without any proper follow-up. She had neither known drugs nor food-allergic before.  Upon arrival to the ED, she was fully conscious of the Glasgow coma scale (GCS) of 15/15. She had tremor and tachypnea with a respiratory rate of 26 breaths/minute. She was only able to talk in phrases. There was no stridor, periorbital edema, lips swelling, or rashes. Blood pressure was 165/76 mmHg, heart rate was 104 beats/minute, oxygen saturation under room air was 97%, and was afebrile. Lungs examination was unremarkable, there were no rhonchi bilaterally. Cardiovascular and central nervous system examinations were normal. Electrocardiogram (ECG) showed sinus tachycardia (Figure 1). She was pushed to resuscitati...
      PubDate: Sat, 26 Jun 2021 04:26:43 +000
       
  • Prolonged Bleeding due to Hirudotherapy (Medicinal Leech Therapy)

    • Authors: Siti Noorain
      Abstract: Author:  Isa Mh Lim KHY Abd-Samat AH Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Terapi lintah adalah sejenis perubatan traditional yang telah lama diamalkan dan semakin popular sejak kebelakangan ini untuk pelbagai penyakit dan aplikasi pembedahan. Walau bagaimanapun, air liur dari lintah mengandungi protein dengan sifat antikoagulan yang boleh mengakibatkan pendarahan yang berpanjangan di kawasan gigitan. Kami melaporkan kes seorang lelaki berusia 35 tahun yang datang ke Jabatan Kecemasan kerana pendarahan yang berlarutan daripada kesan luka gigitan lintah. Beliau tidak mempunyai sejarah perubatan atau pengambilan ubatan yang lain. Beliau menjalani terapi lintah untuk merawat sakit belakang kronik. Selepas terapi, beliau menyatakan bahawa pendarahan tidak berhenti selepas 7 jam dan memutuskan untuk mendapatkan rawatan di hospital. Terdapat luka di bahagian belakang dan kedua-dua kakinya. Semua lukanya bersih tetapi luka di belakang masih berdarah. Ubat adrenalin digunakan sambil memberi mampatan atas luka dan akhirnya pendarahan semakin berkurang dan berhenti. Terdapat banyak kaedah yang dicadangkan untuk menghentikan pendarahan tetapi tiada bukti mengenai kelebihan mana-mana kaedah. Ini adalah laporan kes pertama mengenai komplikasi terapi lintah di Malaysia. Laporan kes ini adalah untuk meningkatkan kesedaran di kalangan pengamal terapi lintah, staf bahagian perubatan kecemasan dan orang awam mengenai komplikasi dari gigitan lintah. Kami juga mencadangkan penggunaan adrenalin topikal sebagai alternatif untuk membantu menghentikan pendarahan daripada luka gigitan lintah. Correspondance Address:  Lim Kristina Hoong Yew. Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +6012-2860279 Email: mystics_hy@hotmail.com Full text:  Introduction Leeches are segmented, hermaphrodite worms found in freshwater areas. There are certain species among them which are sanguinivores-bloodsucking creatures. Leeches have 2 sucker parts, on their anterior and the posterior, respectively, which are used for adherence and creeping (Figure 1). Leeches usually bite warm parts of the body and suck the blood of its prey (Joslin et al. 2017). Although most bites are external, there have been multiple case reports regarding leech bites internally in the rectum, bladder, and vagina. For each feeding, the leeches may suck up to 10-15 ml of blood over 20-30 minutes. Most leech bites occur in the wilderness; however, it may also occur intentionally during medicinal leech therapy (hirudotherapy) which is a form of complementary medicine (Joslin et al. 2017). Medicinal leech therapy has been used since ancient Egyptian times. Although there is no substantial evidence regarding their effectiveness, leech therapy has been experimented on as a treatment to many forms of illnesses such as inflammatory diseases, osteoarthritis and deep vein thrombosis. Leech therapy has also been used for plastic and microsurgical applications. The basis for the therapy lies in the properties of the leech saliva, which contains analgesic, anti-inflammatory and antimicrobial properties (Sig et al. 2017).  However, medicinal leech therapy has its own risk. Leech saliva contains antiplatelet and anticoagulant molecules to prevent clot formation, which is important for the leech to suck blood from its prey. The main molecule is hirudin, which inhibits thrombin and leads to prolonged bleeding at the bite site even after the leech has released itself (Sig et al. 2017). We present a case of medicinal leech therapy complicated with prolonged bleeding. To date, we were not able to find any case report regarding complications arising from medicinal leech therapy in Malaysia after searching through the literature using PubMed. Case Report This is a case of a 35-year-old male who had received medicinal leech therapy to treat his chronic back pain and gout. He presented to the Emergency Department (ED) on the same day of receiving the therapy because of persistent bleeding from his wounds for 7 hours. He denied experiencing any pain over the wounds and did not apply any ointment to the wounds. This was his second time undergoing the therapy; he did not experience any complications during the first encounter. He had no significant past medical history and was never diagnosed with any bleeding disorder. He was not on any antiplatelet or anticoagulant, and there was no family history of a bleeding diathesis. On examination, he had one wound over his lower back at the sacral region, one on the dorsum of ...
      PubDate: Sat, 26 Jun 2021 04:23:49 +000
       
  • Orbital Aspergillosis Mimicking Giant Cell Arteritis

    • Authors: Siti Noorain
      Abstract: Author:  CHENG TC JEMAIMA CH Amin A MAE-LYNN CB Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Penyakit aspergillosis orbit sangat jarang berlaku tetapi boleh menyebabkan neuropati optik yang sakit. Selain itu, penyakit ini mampu menyerupai giant cell arteritis terutamanya dalam kalangan pesakit tua. Kami ingin melaporkan kes aspergillosis orbit yang berlaku pada seorang lelaki Melayu berumur 65 tahun yang mengadu penglihatan yang kabur secara beransur-ansur dan sakit kepala pada bahagian yang sama. Malangnya, keadaan pesakit tersebut merosot selepas rawatan kortikosteroid dan bertukar menjadi sindrom apeks orbit. Pengimejan dan sampel biopsi menunjukkan aspergillosis orbit. Pesakit menjadi buta akibat diagnosis yang tidak tepat pada peringkat awal. Tujuan laporan ini adalah untuk mengingatkan para doktor agar sentiasa mengambil kira kepentingan epidemiologi penyakit dalam mendapatkan diagnosis yang tepat, terutama apabila pesakit mempunyai tanda-tanda yang luar biasa. Correspondance Address:  Mae-Lynn Catherine Bastion. Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455981 Email: maelynnbdr@gmail.com Full text:  Introduction Orbital aspergillosis is rare but can be potentially fatal in immunocompromised patient (Ali & Lee 2013). It can present with various vague symptoms but lack of clinical signs which makes the diagnosis difficult, leading to a delayed or inappropriate treatment. In this report, we present a case of orbital aspergillosis which mimics giant cell arteritis (GCA). The initial computed tomography imaging failed to demonstrate an early orbital apex lesion which worsened after administration of high dose corticosteroid with the initial working diagnosis of GCA. It is well known that 90-95% of the anterior ischaemic optic neuropathy is non-arteritic in origin. It is caused by perfusion insufficiency of short posterior ciliary arteries to the optic nerve leading to visual loss. Besides that, it can also be caused by vasculitis which is known as GCA. However, GCA is very rare especially among the  Asian population. It was reported to be 20 times less common in Asian than Caucasian patients (Pereira et al. 2010). In a retrospective study in Korea, it was noted the prevalence of GCA in Korean patients was very low, only contributing about 2.1% in patients who suffered from anterior ischaemic optic neuropathy. (Choi et al. 2019). The purpose of this case report is to highlight that despite the blinding condition possibly caused by GCA which is relatively rare, clinicians should make a thorough workout and have a higher index of suspicion on other differential diagnoses, such as infection, especially in an immunocompromised patient as it can potentially become a life threatening condition if treatment involves a high dose of corticosteroid. Case report A 65-year-old Malay man with underlying diabetes, hypertension and ischaemic heart disease presented with a chief complaint of right eye blurring of vision for two weeks. The blurring of vision was generalised, gradual onset and progressively worsened. It was associated with right sided headache for 3 months prior to the presentation. There was no eye pain, redness, haloes or any eye discharge. Patient had nausea but no vomiting. He also had loss of appetite and he lost about 15 kg in 3 months. Patient did not have fever, chills and rigors, night sweat, chronic cough or haemoptysis. There were no constitutional symptoms. Besides that, he did not experience any jaw claudication or scalp pain. On examination, vision of right eye was counting finger with presence of relative afferent pupillary defect on the same eye. There was also reduced optic nerve function (reduced red desaturation and light brightness). His left eye vision was good (6/6). Otherwise, patient’s anterior segment appeared normal. Intraocular pressure was 10 mmHg in both eyes. The optic discs were not swollen or hyperaemic, there was no sectoral pallor seen and cup to disc ratio was 0.3 (Figure 1). Extraocular movement was full. On systemic examination, patient had prominent temporal artery over right side with mild tenderness. However, there was no loss of pulsation. His vital signs were normal with normal dextrostrix. Systemic investigation reviewed raised total white cell count (17.2), raised platelet (511) and raised erythrocyte sedimentation rate (91) with his blood sugar level within normal range. C-reactive protein was 4.84. C...
      PubDate: Sat, 26 Jun 2021 04:18:59 +000
       
  • See Beyond The Seen: Ischemic Cardiomyopathy with Diagnostic Dilemma

    • Authors: Siti Noorain
      Abstract: Author:  ELISE LZE JOHAR MJ Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Kardiomiopati boleh mempunyai etiologi yang berbeza. Pesakit mungkin akan datang dengan simptom-simptom kegagalan jantung akut ataupun sakit dada iskemik, bergantung kepada etiologi kardiomiopati tersebut. Pegawai perubatan yang merawat mempunyai tanggungjawab untuk mencari punca tersebut kerana rawatan segera mungkin akan mengubah prognosis pesakit; pada masa yang sama sedar akan kemungkinan diagnosis yang lain selain daripada yang jelas. Dalam kes ini, kami membentangkan seorang wanita yang datang dengan sesak nafas dan tiada sakit dada. Beliau menunjukkan kadar denyutan jantung dan kadar pernafasan yang laju semasa ketibaan dan elektrokardiogram (ECG) beliau menunjukkan perubahan iskemia di lead inferior dan lateral. Ekokardiogram di sisi katil menunjukkan ventrikel kiri terdilat. Biomarker jantung beliau meningkat, dan ini menyebabkan kejadian iskemia tidak dapat dikecualikan. Beliau akhirnya meninggal dunia. Objektif laporan kes ini adalah untuk menekankan pentingnya mempunyai minda terbuka mengenai diagnosis berbanding yang ada dengan mengetahui bahawa peyakit-penyakit ini mungkin mempunyai ciri-ciri yang sama. Correspondance Address:  Elise Er Lay Ze. Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: 012-9242041 Email: elise.er@yahoo.com Full text:  INTRODUCTION Cardiomyopathy is a disease of the heart muscle that impairs its contractility, having many causes. Dilated left ventricle, in particular could be caused by of dilated or takotsubo cardiomyopathy. The elevation of cardiac markers may point to an ischemic cause, with ischemic cardiomyopathy patients also presenting with dilated ventricle as a complication from previous insults. Dilated or takotsubo cardiomyopathy has their own demographic prevalence (Luk et al. 2009; Templin et al. 2015) and to differentiate these two from ischemic cardiomyopathy would require an angiographic evidence (Felker et al. 2002). This patient presented with signs and symptoms of heart failure, but with a dilated left ventricle at the bedside ultrasound. Concurrently, there was also an elevation in cardiac markers, making an ischemic origin not excludable. The overlapping clinical features possess a challenge in making an accurate diagnosis. The patient was eventually sent for angiogram which revealed a significantly blocked vessel and subsequently collapsed on table during the procedure. CASE REPORT Madam A, a 71-year-old lady with background history of diabetes mellitus and hypertension, presented to us with sudden onset of breathlessness while she was walking to the toilet. There was no chest pain, diaphoresis, palpitation or fever. She had a cough for the past week and visited a general practitioner where she was treated for gastro-esophageal reflux disease (GERD), with no antibiotics given. She claimed to be in compliance with all her medications.  Upon arrival, her temperature was 36.4˚C, blood pressure was 176/90 mmHg, heart rate was 140 beats/minute, respiratory rate of 36 breaths/minute, and saturation was 98% under room air. She was fully conscious and her Glasgow Coma Scale (GCS) was full. However, she was only able to speak few words due to breathlessness. Auscultation of her heart revealed no murmur and there was bibasal crepitations at both lung fields. Her random blood sugar was 33 mmol/L upon arrival. Serum ketone was 0.5 mmol/L. A bedside ultrasound was performed to reveal a B profile over both lung fields. Her bedside echocardiography revealed a dilated left ventricle (Figure 1). Electrocardiogram (ECG)) was done, showing a ST segment elevations at lead II, III, avF, V3 to V6 as shown in Figure 2. After reviewing her ECG, she was treated for acute myocardial infarction with heart failure and the cardiology team was activated. She was planned for pharmacological thrombolysis with tenecteplase while being loaded with aspirin 300 mg and clopidogrel 300 mg stat. In view that she was tachypnoeic, non-invasive ventilation with continuous positive airway pressure mode was started with the anaesthesia team's involvement.  After the case was discussed with the consultant cardiologist, it was decided that she needed an urgent angiogram and percutaneous coronary intervention (PCI). She was electively intubated while waiting to be called to the operation theatre. Her troponin I level came back at 551.3 pg/mL. She was also having hyponatremia with sodium levels of 120 mmol/L. The other electrolytes and her liver function test returned normal. After intubation, she started expe...
      PubDate: Sat, 26 Jun 2021 04:07:11 +000
       
  • Healthcare Professionalsā€™ Experiences on Interdisciplinary Collaboration
           in a Medical Department of a Malaysian General Hospital

    • Authors: Siti Noorain
      Abstract: Author:  Ang WC Abd Rahim SN Abd Rahman NF Muhamad Shukri N Rokimi WR Ng SC Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Anggota profesional kesihatan (HCP) di semua fasiliti kesihatan termasuk hospital-hospital awam di Malaysia perlu bekerjasama untuk memenuhi pelbagai keperluan penjagaan kesihatan. Setakat ini, masih belum ada kajian terperinci berkaitan kolaborasi sebegini di Malaysia. Tujuan kajian ini adalah untuk meneroka kolaborasi antara disiplin di Jabatan Perubatan (wad dan klinik) di sebuah hospital negeri. Empat perbincangan kumpulan berfokus (FGD) telah diadakan. Seorang pakar perubatan, pegawai perubatan, penyelia/ketua jururawat, jururawat terlatih, pegawai farmasi klinikal kanan dan pegawai farmasi muda telah menghadiri setiap FGD. Persampelan bertujuan digunakan untuk merekrut peserta (pencalonan oleh ketua jabatan). FGD dilaksanakan dalam Bahasa Inggeris, tetapi maklum balas  dalam Bahasa Melayu masih diterima dan diterjemahkan ke dalam Bahasa Inggeris. Semua audio FGD dirakam, ditranskrip dan dianalisis secara tematik. Dalam tema kejelasan peranan, kebanyakan peserta berpendapat bahawa doktor mengetuai pengurusan pesakit, sementara jururawat bertugas memantau dan membantu pergerakan pesakit serta pemberian ubat-ubatan. Namun, sebilangan peserta kurang maklum tentang peranan pegawai farmasi. Majoriti percaya bahawa kolaborasi yang berkesan wujud, tetapi tidak mencukupi. Kemahiran komunikasi yang lemah, kekangan berkomunikasi, kekurangan kakitangan dan masa adalah penghalang untuk kolaborasi berkesan. Perbincangan yang lebih kerap antara disiplin dapat memupuk kolaborasi. Meskipun doktor menyedari terdapatnya perkhidmatan klinik kepatuhan terapi ubat-ubatan (MTAC) oleh pegawai farmasi, perkhidmatan kaunseling human immunodeficiency virus (HIV) dan pendidikan diabetes oleh jururawat, sebilangan jururawat dan pegawai farmasi tidak mengambil maklum perkhidmatan ditawarkan masing-masing. Untuk mengelakkan  pertindihan tugas dan pembaziran sumber manusia, promosi perkhidmatan oleh setiap disiplin perlu dipertingkatkan di kalangan HCP.  Correspondance Address:  Ang Wei Chern. Clinical Research Centre, Ministry of Health Malaysia, Hospital Tuanku Fauziah, 01000 Kangar, Perlis, Malaysia. Tel: +604-9738413 Email: wei.ang.1990@gmail.com Full text:  INTRODUCTION The number of patients with multiple and chronic medical conditions is increasing globally. These diseases cause functional and emotional impairment, hence increasing in healthcare demands. To cater for the complex demands, different health care professionals (HCPs) need to have good interdisciplinary collaboration (IDC) (Bodenheimer & Handley 2009).  In Malaysian public hospital settings, doctors, pharmacists and nurses are the three main HCPs who collaborate to provide optimal patient care. These three HCPs routinely participate in ward rounds in medical wards. For outpatient clinics, pharmacists complement doctors’ routine follow-up clinics by providing Medication Therapy Adherence Clinic (MTAC) services on chronic diseases such as diabetes and retroviral disease (RVD). Meanwhile, nurses serve as diabetic educators and HIV counsellors. Improved IDC has been identified as the main strategy for reforming the healthcare system in any countries (McCulloch 2016), including Malaysia. Collaboration in healthcare has been shown to enhance patient outcomes, including reducing preventable adverse drug effects, lowering morbidity and mortality rates, as well as adjusting medication dosages, especially medical-based department in a hospital (Martinez et al. 2013). Besides improving patient care, healthcare providers have also been shown to benefit from teamwork, which includes reduced overlapping task, reduced burnout, and increased job satisfaction (Zhang et al. 2016). Internationally, previous studies explored multidisciplinary teams in anaesthesiology, emergency and intensive care settings (Muller-Juge et al. 2013), other than in the medical wards and clinics. There is no published study regarding IDC among these HCPs in Malaysia. Hence, a study is much needed to give insight into Malaysian hospitals. The study aimed to explore the experience of IDC among HCPs in terms of perceptions, expectations and any challenges faced regarding IDC. It also aimed to assess opinions regarding pharmacist-led MTAC services and nurse-led services. materials and METHODS
      PubDate: Sat, 26 Jun 2021 04:03:20 +000
       
  • Comparative Analyses of Serological Biomarkers and Disease Characteristics
           between Elderly-onset and Younger-onset Rheumatoid Arthritis

    • Authors: Siti Noorain
      Abstract: Author:  Rajalingham S Syahrul Sazliyana S Abdul Wahab A Mahadzir H Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Penyakit rheumatoid arthritis (RA) boleh terjadi pada bila-bila masa selepas usia 16 tahun. Tujuan kajian ini adalah untuk membandingkan golongan pesakit RA yang mendapat penyakit ini selepas usia 60 tahun (EORA) dengan pesakit yang mendapat penyakit ini pada usia yang lebih muda (YORA), dari segi klinikal dan serologi. Sejumlah 69 pesakit perempuan EORA dan 82 pesakit perempuan YORA telah menyertai kajian ini. Data berkenaan umur semasa diagnosis, aktiviti penyakit semasa diagnosis, ubat-ubatan dan tempoh penyakit dikumpul dengan merujuk kepada rekod pesakit. Sampel darah kesemua subjek diuji dengan ujian serum 'anti-cyclic citrulinated peptide' (anti-CCP), IgA 'rheumatoid factor' (RF), IgM RF dan IgG RF. Kerosakan sendi dan ketidakupayaan fizikal ditentukan melalui 'Modified Sharp Score' (MSS) dan 'Health Assessment Questionnaire-disability Index' (HAQ-DI). Walaupun tempoh masa penyakit dan kekerapan seropositiviti tidak berbeza dengan signifikan antara kedua-dua kumpulan, kumpulan YORA telah mencatatkan aktiviti penyakit yang lebih tinggi dan ketara semasa diagnosis penyakit RA (p=0.009). Selaras dengan penemuan ini, kumpulan YORA mempunyai kerosakan sendi yang lebih teruk (skor MSS sebanyak 17.49+19.04 berbanding 10.04+12.79). Kumpulan YORA telah mempunyai paras IgA RF dan anti-CCP yang jauh lebih tinggi dengan nilai p sebanyak 0.035 and 0.002. Keputusan kajian ini mencadangkan bahawa kumpulan YORA mempunyai kaitan dengan penyakit RA yang lebih serius, kerosakan sendi yang lebih teruk dan paras anti-CCP dan IgA RF yang lebih tinggi. Correspondance Address:  Associate Professor Dr. Rajalingham Sakthiswary. Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91456097 Email: sakthis5@hotmail.com Full text:  INTRODUCTION Rheumatoid arthritis (RA) is a heterogenous disease with a variable age at onset of the disease. Although its peak incidence is in the fourth and fifth decades of life, the onset of RA may occur anytime from adolescence to geriatric age (Kerr 2004). The definition of elderly-onset RA (EORA) or late-onset RA (LORA) in the literature has typically used either 60 (Mueller et al. 2014; Tutuncu et al. 2006) or 65 years (Olivo et al. 1996) as the cut-off age. We decided to use the lower cut-off age of 60 and above to define EORA in this study. The United Nations has historically used the age of 60 and above to define an “older” person (Daily Briefing 2019). The reported prevalence of EORA using a cut off of 60 years in a South Korean nationwide cohort study was 15.33% (Cho et al. 2012)  With increasing life span and expanding ageing populations in many countries across the world, EORA has gained more importance in the recent decades, especially from the 1980s (Reinhard & Calkins 1993). There has been debates on whether younger onset RA (YORA); onset before 60 years, and EORA represent different diseases or the same disease entity with a different expression (Soubrier et al. 2010). Despite the growing importance, EORA has not gained the attention it deserves and rarely been investigated in detail. Due to the heterogeneity and inconsistencies in the conclusions from previous studies which compared EORA with YORA, this study was developed to compare the clinical, laboratory and serological characteristics between Malaysian female EORA and YORA patients. This study is an extension of our previous work on serological and laboratory profiling of Malaysia RA patients (Sakthiswary et al. 2016; Sakthiswary et al. 2014). Materials and mETHODs Study Design   This was a cross-sectional study which involved female rheumatology outpatients using convenient sampling; which was conducted from January  to December 2015 at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The study proposal was reviewed, approved and funded by the UKMMC Ethics & Research Committee (Study Code FF code IP-2014-053).   Sample Size Calculation   The estimated sample size was a total of 139 RA patients with a 10% population proportion and 95% confidence interval as well as 5% margin of error. The following formula was used to calculate the sample size: z2p(1-p)/€2 (z=z score of 1.96 for a confidence interval of 95%, p=population proportion, €=...
      PubDate: Sat, 26 Jun 2021 03:58:28 +000
       
  • Online Oral Hygiene Instructions for Orthodontic Patients in Malaysian
           Population

    • Authors: Siti Noorain
      Abstract: Author:  Malini A ASMA AAA yahya na Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Alat ortodontik kekal menyebabkan pengumpulan plak, yang membawa kepada pembentukan karies gigi dan gingivitis. Oleh itu, arahan kebersihan mulut yang ringkas (OHI) diperlukan untuk mengelakkan berlakunya penyakit ini. "Massive Open Online Course" (MOOC) memastikan pembelajaran adalah interaktif untuk meningkatkan pengekalan pengetahuan. MOOC mengalihkan tanggungjawab pembelajaran OHI kepada pesakit dengan bimbingan jauh dari doktor, dengan itu mengurangkan masa klinikal. Penyelidikan ini bertujuan untuk mewujudkan kandungan pembelajaran MOOC mengenai OHI dalam praktis ortodontik. Tujuan kedua adalah untuk menganalisis data dari pelajar yang mendaftar untuk kadar penyelesaian MOOC, serta masa yang diperlukan untuk menyelesaikan MOOC. Prinsip-prinsip ADDIE iaitu, "Analyse, Design, Develop, Implement dan Evaluate", digunakan untuk membentuk MOOC. Kandungannya berdasarkan risalah OHI yang diterbitkan oleh Kementerian Kesihatan Malaysia. MOOC telah diuji sebelumnya, dan kandungannya diperbaiki berdasarkan maklum balas pengguna dan pakar. MOOC dinamakan “Penjagaan Kebersihan Pendakap Gigi” menggunakan Bahasa Melayu untuk mendidik para pelajar mengenai penjagaan kebersihan mulut dengan peralatan ortodontik. Enam puluh dua pelajar mengikuti MOOC dan 77.4% dapat menyelesaikan kandungan pembelajaran MOOC. Terdapat empat puluh enam pelajar perempuan (74.2%), sementara pelajar lelaki terdiri daripada enam belas (25.8%). Masa median (jarak interkuartil) yang diambil untuk menyelesaikan kandungan pembelajaran MOOC adalah 31.50 minit, (13.00 minit hingga 55.50 minit). Ini menunjukkan bahawa MOOC dapat menjadi platform alternatif untuk mengajar pesakit mengenai OHI dengan peralatan ortodontik tetap. MOOC berpotensi mengurangkan masa klinikal untuk mengajar OHI kepada pesakit. Correspondance Address:  Nurul Asyikin Yahya. Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia. Tel: +603-92896621 Email: nurulasyikin@ukm.edu.my Full text:  INTRODUCTION Fixed orthodontic appliances are meant to correct malocclusion, improve the function and aesthetics of a patient. The brackets and other components present a favourable environment for plaque accumulation, and if not effectively removed, enamel demineralization (Richter et al. 2011) and gingivitis occur (Zachrisson & Zachrisson 1972). Therefore, oral hygiene instruction (OHI), including tooth brushing and diet advice, is necessary to ensure no plaque is retained inside the mouth during treatment. Receiving knowledge on OHI is insufficient to promote behavioural change if it is not retained. Borkowski’s process-oriented model of metacognition shows that with time and repetitive exposure, children who are taught learning strategies can achieve positive change in their behaviour by active participation (Puustinen & Pulkkinen 2010; Sridharan & Kinshuk 2003). Routine advice previously, was through verbal instructions supplemented with written or visual information, such as printed materials and video tapes (Lees & Rock 2000; Thickett & Newton 2006; Thomson et al. 2001). The increased use of technology, as well as  the need  to reduce  face-to-face learning interaction, has shifted towards usage of web-based learning to provide information. A computer-based platform to deliver OHI was found to promote significant knowledge retention compared to written and verbal instructions, proving the popularity of online learning methods such as websites and mobile applications (Moshkelgosha et al. 2017; Alkadhi et al. 2017).  The concept of learning away from the traditional classroom setting, which has been the formal education since 150 years ago in Great Britain,  was first introduced as long-distance learning through correspondence to ease the students from all lifestyles and geographical barriers (Moe 2015). Over time, computer conferencing has enabled the new generation of students to use online education as a replacement for long-distance learning. A new online learning system, the Massive Open Online Course (MOOC), uses this concept to promote long-distance learning by integrating information technology in learning. MOOC has the advantage of reducing costs of education, saving time of travelling and disseminating information to a wider set of learners globally (Nordin et al. 2016). Thus, it serves as an ideal platform for two-way interaction in lifelong learning (Moe 2015).  Despite the notion that a high drop-out rate occurs ...
      PubDate: Sat, 26 Jun 2021 03:55:07 +000
       
  • The Association between Neuroticism Personality Traits and Depressive
           Psychopathology with Quality of Life among Diabetic Patients

    • Authors: Siti Noorain
      Abstract: Author:  Muhammad Meor O HATTA S Luke SyCw Farris Iman Leong A FARAH DEENA AS Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Diabetes mellitus (DM) merupakan penyakit perubatan kronik yang terkait dengan sekuele psikologi dan trait personaliti khusus yang tertentu. Kajian ini bertujuan untuk mengkaji hubungan kualiti kehidupan (QoL) di kalangan pesakit DM dengan gejala 'mood' dan trait personaliti. Seramai 291 responden DM direkrut, di mana data sosio-demografik dan profil yang relevan menggunakan soal-selidik Beck Depression Inventory II (BDI-II), Generalized Anxiety Disorder scale (GAD-7), Big Five Inventory (BFI) dan World Health Organization Quality of Life Instrument-Short Form questionnaire (WHOQoL-BREF) telah direkodkan. Min umur responden adalah 60.43 tahun, di mana hampir separuh daripada mereka adalah lelaki dan telah berkahwin. Kebanyakan responden telah didiagnosa mengalami penyakit diabetes jenis 2 (N = 261, 89.7%) dan median tempoh mengalami penyakit ialah 14.17 tahun (sisihan piawai, SD = 9.72). Perkaitan di antara trait personaliti, komplikasi psikologi dan QoL telah diselaraskan mengikut data demografik, peribadi dan ciri klinikal. Berdasarkan model 'multiple linear regression', selepas penyelarasan mengikut umur, pekerjaan, status pendidikan, pendapatan bulanan, persepsi sokongan sosial, tempoh DM dan variabel lain, kami mendapati neurotisma (BFI) dan min skor BDI masing-masing dikaitkan dengan QoL yang rendah. Kenaikan 1-unit di dalam dua variabel tersebut menyebabkan 3.5 dan 0.6-poin skor pengurangan di dalam QoL (3.465 (95% julat keyakinan, CI -5.788 hingga -1.143) dan -0.560 (95% CI -0.779 to -0.341)) masing-masing dengan nilai p<0.001. Sesungguhnya, intervensi dengan memberi fokus kepada neurotisme dan peningkatan gejala psikopatologi kemurungan dapat membantu perawatan psikologi dalam kalangan para pesakit DM. Correspondance Address:  Professor Dr. Hatta Sidi. Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-9145 6143 Email: hattasidi@hotmail.com Full text:  Introduction According to the International Diabetes Federation (IDF), in 2019, 9.3% of the global population or more than 460 million people suffered from diabetes mellitus (DM). It has been estimated that by 2030, there will be almost 600 million adults with DM, and 700 million by 2045 (International Diabetes Federation 2019). In Malaysia, as of 2019, there are almost 4.0 million people who have DM, and the number is projected to rise to more than 6.0 million by 2045 (Institute for Public Health 2020). Obesity, unhealthy diets such as processed food and sedentary lifestyle have said to be some of the important contributing factors leading to the increase in DM cases (International Diabetes Federation 2019). Several studies have found that lower level of education, daily insulin usage, poorly controlled DM and microvascular complications among patients with DM had negative impact on their quality of life (QoL) (Baghianimoghadam et al. 2007; Pouwer & Hermanns 2009; Cheah et al. 2012; Scollan-Koliopoulos et al. 2013). Those with better glycaemic control and no diabetic complications probably are much more optimistic about their health, and this in turn increases their QoL (Cheah et al. 2012). In a study by Sundaram et al. (2007) geriatric patients with longer duration of DM were found to have better QoL. This is probably due to their greater acceptance of their health status with growing age and better experience in handling the disease. DM and psychiatric disorders shared a bidirectional association-both influencing each other in multiple ways (Renn et al. 2011) and past research have found an increased prevalence of depressive symptoms in patients with Type 2 Diabetes Mellitus (T2DM). In a meta-analysis, Anderson et al. (2001) showed that the presence of DM significantly doubles the odds of comorbid depression as compared to those without DM. A meta-analysis of 9 longitudinal studies reported by Knol et al. (2006) suggested that adults who are clinically depressed have more than one-third increased risk of developing T2DM compared with those who are clinically euthymic. Those with depression have impaired self, social, and occupational functioning. This will both directly and indirectly affect their QoL as they will face much more difficulties in managing their DM. Subsequently, these psychological doma...
      PubDate: Sat, 26 Jun 2021 03:50:01 +000
       
  • Knowledge and Perception of Malaysian Forest Fringe Population towards
           Zika Infection

    • Authors: Siti Noorain
      Abstract: Author:  rozita H Chin Mun W Mohd Rohaizat H Nadia Aqilla S Hani Kartini A Raja Mohd Azim RH Sharifah Ezat WP Sazaly AB Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Organisasi Kesihatan Sedunia (WHO) telah mengisytiharkan jangkitan Zika sebagai Kecemasan Kesihatan Awam Antarabangsa pada tahun 2016. Kajian ini dijalankan bagi menilai pengetahuan dan persepsi risiko terhadap jangkitan Zika dalam kalangan populasi pinggiran hutan di Malaysia. Kajian keratan rentas melibatkan 433 responden dewasa yang telah melengkapkan soal selidik mengenai pengetahuan dan persepsi terhadap jangkitan Zika. Analisis dua hala pada kemampuan responden dan item diuji menggunakan 'Statistical Package for the Social Sciences'  (SPSS) dan Rasch. Tahap pengetahuan dan persepsi diuji terhadap variabel sosiodemografik / sosioekonomi menggunakan Pearson’s Chi Square dan kovariat dilaraskan pada tahap multivariat menggunakan regresi logistik binari. Kedua-dua domain pengetahuan dan persepsi disasarkan dengan baik. Berdasarkan hasil SPSS dan Rasch, lebih daripada separuh responden yang terlibat menunjukkan tahap pengetahuan dan persepsi risiko yang rendah [Skor pengetahuan: 50.8% (SPSS), 55.4% (Rasch); skor persepsi: (58.0% (SPSS), 58.2% (Rasch)]. Dengan kovariat yang telah dilaraskan, responden bukan bumiputera yang mempunyai tahap pendidikan tinggi, pendapatan isi rumah yang tinggi serta pergi ke hutan sejak kebelakangan lepas menunjukkan tahap pengetahuan yang baik. Perempuan dewasa yang telah menopaus dari Perak pula menunjukkan tahap persepsi risiko terhadap Zika yang baik. Walau bagaimanapun, secara keseluruhannya, majoriti populasi pinggiran hutan di Malaysia mempunyai pengetahuan dan persepsi risiko terhadap jangkitan Zika yang lemah. Instrumen soal selidik ini merupakan alat penilaian jangkitan Zika yang sesuai digunakan dalam kalangan populasi pinggiran hutan di Asia Tenggara. Correspondance Address:  Chin Mun Wong. Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +6019-2673642 Email: chinmun0204@yahoo.com Full text:  INTRODUCTION Zika virus (ZIKV) infection, a re-emerging infection that has been declared as Public Health Emergency of International Concern in year 2016 by World Health Organization (WHO), affected travel and trading, has recaptured the world’s attention after almost a century (Musso et al. 2014; WHO 2016). Recent outbreaks associate microencephaly and Guillain-Barre syndrome with Zika infection (Hughes et al. 2016). The Flavivirus is transmitted primarily by vector mosquitoes Aedes sp., and secondary routes, including sexual transmission, maternal to child transmission, blood transmission and possibly through various body fluids (Anderson 2017; Musso et al. 2015), including vaginal and seminal fluid, with longest incubation of 6 months reported in seminal fluid. Also, the virus seems to evolve fast; from 2004 to 2015, the spectrum of disease advanced from mostly asymptomatic (80% of the time), to haematospermia, microencephaly in new-born, and Guillain-Barre syndrome as acute inflammatory ascending paralysis (Brasil et al. 2016; Karwowski et al. 2016; Roze et al. 2016; Turmel et al. 2016; Uncini et al. 2017; Saba Villarroel et al. 2018). Despite hosting the Asia lineage of ZIKV  (Marchette et al. 1969; Pond 1963) which exploded massive outbreaks of Zika related microencephaly and Guillain-Barre syndrome in Latin America (year 2007-2016) (Musso et al. 2014), Malaysia only reported one suspected local Zika transmission in 2019 since the discovery of the P6-740 strain in 1954 (Smithburn 1954; Lim et al. 2017; Malay Mail 2019). There was no reported neurological complications or birth defect associated with Zika in the surveillance pathways of Zika, but under-reporting is possible due to the challenge of screening and diagnosis (Lim et al. 2017). Forest fringes represent the zone of sylvatic-urban cycle transition for Zika (Wolfe et al. 2001). It is worth investigating the forest fringe population’s knowledge and perception towards the disease as ZIKV infected mosquito was discovered locally in 1954 (Smithburn 1954). Knowl...
      PubDate: Sat, 26 Jun 2021 03:36:34 +000
       
  • Stature Estimation from Dry Bone and Radiographic Clavicular Measurements
           in A Thai Population

    • Authors: Siti Noorain
      Abstract: Author:  Pongpon T Karnda M Sukon P Pasuk M Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Perawakan merupakan salah satu ciri biologi utama yang berguna dalam pengelasan rangka si mati yang belum dikenalpasti. Malah, data tepat dari populasi adalah penting dalam kerangkaan antroplogi forensik. Namun begitu, kajian mengenai tajuk ini adalah terhad disebabkan tumpuan biasanya diberikan kepada “long bones”. Kajian ini cuba mewujudkan persamaan (equation) mengenai anggaran perawakan daripada ukuran tulang klavikular kering dan radiografi. Kedua-dua belah tulang klavikular dari si mati perempuan (25) dan lelaki (112) diasingkan di sebuah bilik autopsi di Bangkok, Thailand. Dua belas pembolehubah diukur bagi setiap sisi tulang. Hasil dapatan kajian menunjukkan bahawa ketinggian dapat ditentukan dengan menggunakan 3 pembolehubah dalam sebuah model analisis regresi bertahap bagi mayat yang jantinanya belum dikenalpasti, dengan R2 = 0.49 serta ralat piawai anggaran (SEE) 5.238 cm. Malah, ketinggian hujung sternal tulang klavikular boleh diguna pakai bagi menganggar perawakan bagi kes yang melibatkan serpihan tulang klavikal yang dijumpai di tempat kejadian (R2 = 0.238 dan SEE 6.353 cm). Panjang maksimum  dari pengukuran radiografi menujukkan korelasi serta “model fit” yang terbaik dengan perawakan (R = 0.562, R2 = 0.316 dan SEE 6.020 cm). Hasil kajian ini menujukkan teknik yang komplementari dan berguna kepada pakar forensik antropologi untuk menghasilkan profil biologi bagi kerangka mayat yang belum dikenalpasti dalam kes dimana “long bones” tidak dijumpai. Tambahan pula, penganggaran perawakan daripada ukuran radiografi mampu diguna pakai dalam kes yang melibatkan “skeketonisation” separa.  Correspondance Address:  Professor Pasuk Mahakkanukrauh. Excellence Center in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, 50200, Thailand. Tel: +66-53-949-474 ext 6142 Email: pasuk034@gmail.com Full text:  Introduction Death investigations need to be carried out by a multidisciplinary team, including forensic pathologists, crime scene investigators and the police. The medical examiner is also needed for medicolegal investigations, depending on the country’s laws (Saukko & Knight 2015; Spitz 2006). An identification of the deceased is obligatory for medicolegal analyses, since the associated medicolegal enforcers can use this evidence as the basis of an investigation. However, the condition of the corpse’s soft tissues can make accurate identification problematic. For instance, progressively decomposed or severely burnt bodies cannot be identified by visual identification alone, since a fingerprint is not obtainable from skeletonised remains (Ranson 2016). Forensic anthropology is the study of legal inquests, which can be valuable in partially or completely skeletonised cases. Biological profiles of skeletonised remains consist of the following factors i.e. ancestry, age, sex and stature. Medicolegal investigators can apply this information to narrow down the possible ante-mortem data before progressing to the next process, achieving a positive identification of the unknown deceased (Blau & Ubelaker 2016).  There are many advantages to using clavicles to determine biological profiles of unknown skeletal remains (Akhlaghi et al. 2012). Firstly, the clavicle does not support the body weight and is not manipulated by childbirth, unlike the pelvis. Therefore, the clavicle’s degenerative changes are less affected by human diversity and multiplicity than the pelvis. Secondly, the clavicle has a characteristic shape which can be identified by forensic anthropologists. Thirdly, forensic practitioners do not need specific equipment or much time to make clavicular measurements. Fourthly, the clavicle could endure, and be retrieved from, crime scenes, and might be useful to create biological profiles since its configuration is a compact bone. Fifthly, the clavicle can be easily removed from the body in an autopsy. Finally, recent studies suggest that assessment of the clavicle yields good results in sex estimations (Akhlaghi et al. 2012; Frutos 2002; Králík et al. 2014; Papaioannou et al. 2012; Sehrawat 2018; Spradley & Jantz 2011; Tise et al. 2013) and could be used to estimate stature, even though studies are few (Rani et al 2011; Balvir et al 2012).   Stature Estimation from Clavicular Measurements   Stature is one of the key biological features which contributes to recognis...
      PubDate: Sat, 26 Jun 2021 03:28:03 +000
       
  • Obstructive Sleep Apnea and Its Association with Sleep Quality, Daytime
           Sleepiness, Depression and Attention Span

    • Authors: Siti Noorain
      Abstract: Author:  Suzaily W ROSDINOM R Nurhazrina H Lee LT Sara Nadia J Rafiqah A Goh WH Nuralia AR Abdullah Sani M Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Apnea tidur obstruktif (OSA) mempunyai banyak kesan fizikal dan psikososial kepada seseorang individu. Oleh itu, kajian ini bertujuan untuk mengkaji kualiti tidur, tahap mengantuk pada waktu siang, kemurungan dan jangka masa perhatian pada pesakit yang mempunyai OSA. Ini adalah kajian keratan rentas dalam kalangan pesakit yang baru didiagnosis menghidap OSA di sebuah hospital di Malaysia. Data sosiodemografi dan klinikal, "Epworth Sleepiness Scale", "Pittsburgh Sleep Quality Index", "Patient Health Questionnaire" dan "Comprehensive Trail Making Test" digunakan sebagai instrumen. Hasil kajian dianalisis dan dipersembahkan menggunakan pengujian Chi-Square, One-Way ANOVA dan "Independent-Sample T-test". Sebilangan besar responden menunjukkan kualiti tidur yang buruk dan jangka masa perhatian yang rendah. Kira-kira separuh daripada responden mempunyai rasa mengantuk yang berlebihan pada waktu siang. Terdapat hubungan yang signifikan di antara kualiti tidur dan tahap mengantuk pada waktu siang (nilai-p=0.051), tahap mengantuk pada waktu siang dengan kemurungan (nilai-p=0.049) dan keterukan OSA dengan kemurungan (nilai-p=0.026). Mengantuk pada waktu siang dikaitkan dengan status bekerja (nilai-p=0.009) dan status memandu (nilai-p=0.033). Kesimpulannya, kebanyakan pesakit OSA mempunyai kualiti tidur yang buruk, mengantuk pada waktu siang yang berlebihan dan tumpuan yang terganggu. Oleh itu, OSA harus didiagnosis dan dirawat lebih awal, terutama pada pesakit yang masih bekerja dan aktif memandu. Correspondance Address:  Associate Professor Dr. Suzaily Wahab. Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-9145 5555 ext 6142 Email: suzailywhb@yahoo.com Full text:  Introduction  An estimated 936 million adults aged 30-69 years old have obstructive sleep apnoea (OSA) and about 425 million of them required treatment, based on American Academy of Sleep Medicine (AASM) 2012 and apnea-hypopnea index (AHI) criteria (Benjafield et al. 2019). The number may be higher in elderly population. The high prevalence of OSA could be due to the increasing prevalence of obesity due to current sedentary lifestyle (Benjafield et al. 2019). OSA is recognised as repetitive pauses in breathing, especially during sleeping and associated with reduction of oxygen saturation. The diagnosis of OSA is done using a polysomnography study which is also known as the sleep study test (Qaseem et al. 2014). There are various parameters which are recorded in this test, such as electrocardiography (ECG), electroencephalography (EEG), electro-oculogram (EOM), pulse oximetry, sleeping position, heart rate, and the contraction of leg muscles. The severity of OSA is defined by AHI, where the cut off of AHI is taken at the score of 5, 15 and 30; where 5 for mild, 15 for moderate and 30 for severe. (Gharibeh & Mehra 2010). Normally, young adults have a night sleep of approximately seven and a half hours on weekdays and slightly longer on weekend (Carskadon & Dement 2005). In OSA patient, their sleep pattern and sleep quality can be disrupted via several mechanism. The respiratory disturbance due to OSA will stimulate ventilatory effort and reduce oxygen level within the body, resulting in arousal from sleep that occur repetitively (Somers et al. 2008). This fragmented sleep reduces sleep quality among OSA patient compared to healthy people which was proved by one study among OSA population (Lusic Kalcina et al. 2017). Apart from the sleep fragmentation, OSA also interrupts the pattern of sleep cycles. A normal night involves six sleep cycles with the transition between light sleep and deep sleep (Chami et al.  2010). The severity of OSA is associated with prolong duration of light sleep and reduce duration of deep sleep (Fischer et al. 2012; Pedersen 2019).  The link between OSA and attention has been documented by pr...
      PubDate: Sat, 26 Jun 2021 03:23:55 +000
       
  • Public Knowledge, Attitudes and Self-Practice towards Diabetes Mellitus in
           Kangar, Perlis

    • Authors: Siti Noorain
      Abstract: Author:  Soo pp dali n shakar ns Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Di Malaysia, Perlis merupakan salah sebuah negeri yang menunjukkan angka tertinggi yang mempunyai pesakit diabetes mellitus (DM). Pencegahan dan pengurusan DM adalah bergantung kepada amalan kendiri dalam kehidupan seharian. Walau bagaimanapun, masih banyak informasi yang tidak diketahui mengenai faktor-faktor yang mempengaruhi penglibatan orang ramai dalam amalan kendiri terhadap DM yang mungkin telah menyumbang kepada prevalensi DM yang tinggi di Perlis. Kajian ini dilakukan untuk menilai pengetahuan, sikap, serta faktor-faktor yang berkaitan dengan amalan kendiri terhadap DM di kalangan masyarakat di Kangar, Perlis. Kajian keratan rentas telah dilakukan bermula pada Jun 2018 selama tiga bulan. Peserta yang layak dijemput untuk melengkapkan soal selidik di kawasan awam di Kangar. Analisis deskriptif mengenai ciri-ciri sosiodemografi, sejarah perubatan, pengetahuan, sikap dan amalan kendiri terhadap DM telah dilakukan. Ujian t-test dan korelasi Spearman telah digunakan untuk menilai hubungan antara sosiodemografi, sejarah perubatan, pengetahuan, dan sikap masyarakat di Kangar dengan amalan kendiri terhadap DM. Regresi linear berganda digunakan untuk menganalisis hubungan di antara pembolehubah dalam kajian ini. Sebanyak 319 responden bersetuju dan mengambil bahagian dalam kajian ini. Kebanyakan responden ialah perempuan (66.5%), Melayu (94%), dan mempunyai pendidikan tinggi (51.7%). Secara keseluruhan, kebanyakan peserta mempunyai skor pengetahuan (80.3%), sikap (98.4%), dan amalan kendiri (97.2%) yang baik terhadap DM. Hubungan positif yang signifikan secara statistik didapati antara usia, tahap pendidikan, dan skor sikap dengan amalan kendiri terhadap DM (p<0.05). Kajian ini menunjukkan bahawa program pendidikan mengenai rawatan kendiri DM harus bermula seawal dari peringkat sekolah untuk menjelaskan tentang pengurusan DM yang betul. Correspondance Address:  Pei Pei Soo, Pharmaceutical Services Divisions, State Health Department of Perlis, 48C, Jalan Raja Syed Alwi, Kampung Guar Syed Alwi, 01000 Kangar, Perlis, Malaysia. Tel: +6049765033 ext 1104 Email: peipeisoo@hotmail.com Full text:  INTRODUCTION  Diabetes mellitus (DM) is an illness that occurs when there is a chronic increase in blood glucose concentration or hyperglycaemia (Ministry of Health Malaysia 2015). DM is a silent and progressive disease. During the initial phase of the disease, it could show no symptoms. Some may take many years to develop the symptoms and experience long-term DM complications, such as retinopathy, nephropathy, sexual dysfunction, and diabetic neuropathy (Fowler 2008). DM is also one of the key risk factors for cardiovascular diseases, which contributes to the leading causes of death in Malaysia (Aniza et al. 2016).   The prevalence of DM has increased globally. In 2000, more than 170 million individuals in the world were diagnosed with DM (Wild et al. 2004). The figure is estimated to increase to 366 million by the year 2030. In Malaysia, DM remains the most prevalent non-communicable disease affecting the public. The prevalence of DM increased from 11.2% in 2011, 13.4% in 2015, to 18.3% in 2019 for adults above 18 years old, based on the latest National Health and Morbidity Survey (Institute for Public Health 2020b). There was a considerable variation of DM prevalence rate between different states in Malaysia, with the second highest prevalence of DM was found in Perlis (32.6%) (Institute for Public Health 2020b). Perlis is the smallest state located in the north of Peninsular Malaysia. Up to 2015, a total of 33,090 diabetic patients was found in Perlis (Institute for Public Health 2015). The number of adults with DM in Perlis increased to 52,184 in 2019 (Institute for Public Health 2020b). Conceivable reasons for the steady increment in the prevalence of DM in Asian countries may include poor nutritional habits, physical inactivity, urbanisation, low health literacy, and poor attitudes towards DM management among the overall population and diabetic patients (Bollu et al. 2015). Disease awareness, early diagnosis and patients’ active involvement in controlling blood glucose levels are associated with knowledge, attitudes, and self-practice towards DM. Patients with insufficient knowledge regarding their illness frequently have poor self-management skills (Perera et al. 2013). DM self-care activities involve following a diet plan with high fibre, low sugar, and fat intake, staying active, regular blood glucose monitoring, and foot care. These activities could improve glycaemic control, reduce DM complications, and subsequ...
      PubDate: Sat, 26 Jun 2021 03:20:09 +000
       
  • Screening for Premature Coronary Artery Disease (CAD) using Coronary
           Artery Calcium (CAC) Score: A Primary Prevention Pilot Study

    • Authors: Siti Noorain
      Abstract: Author:  Mohd Ruslan M Mohd Shawal FM Norzailin AB Shathiskumar G Tiau WJ Oteh M Hamat Hamdi CH Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Penyakit Sindrom Koronari Akut (ACS) boleh dipercepatkan oleh faktor keluarga yang mempunyai sejarah penyakit koronari arteri (CAD). Kadangkala penilaian faktor risiko tidak berjaya untuk menjangkakan sindrom ini. Siasatan tambahan dengan menggunakan skor kalsium arteri koronari (CAC) boleh digunakan dalam pencegahan penyakit ini. Ini adalah kajian perbandingan secara terus yang merekrut ahli keluarga fasa pertama (FDR) asimptomatik bagi populasi muda berbanding dengan populasi muda yang tiada sejarah keluarga berpenyakit CAD yang bermula dari September 2017 hingga Mac 2018 di Klinik Kardiologi Pusat Perubatan Universiti Kebangsaan Malaysia. Sejumlah 36 peserta telah direkrut dengan bilangan yang sama bagi setiap kumpulan. Majoriti dalam setiap kumpulan adalah wanita dengan nilai peratusan 67%. Populasi keluarga yang mempunyai sejarah penyakit koronari adalah lebih muda [min (SD) umur 36.9 (4.9) berbanding 38 (3.8) dari populasi yang lain]. Kedua-dua kumpulan mewakili faktor risiko yang tinggi termasuk berat badan berlebihan dan obesiti, obesiti abdomen, serta dislipidemia. Dislipidemia yang baru dijumpai adalah signifikan bagi kumpulan dengan sejarah keluarga (83.3% berbanding 44.4%, P<0.01). Kedua-dua kumpulan yang disaring berada dalam kumpulan "Framingham Risk Score"  berisiko rendah atau sederhana. Skor CAC lebih tinggi bagi kumpulan dengan sejarah keluarga (11.1% berbanding 0%, P>0.05). Kesimpulannya, CAC mungkin tidak relevan untuk pemeriksaan pada populasi yang lebih muda. Walau bagaimanapun, penemuan faktor risiko masih tahap membimbangkan dalam golongan muda. Correspondance Address:  Dr. Hamat Hamdi Che Hassan. Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-9145 6795 Email: hamathamdi@gmail.com Full text:  INTRODUCTION Coronary artery disease (CAD) has caused significant morbidity and mortality in the world (Mendis et al. 2011; Donghee et al. 2015). Despite improvements in outcomes in recent years, prevalence of premature CAD seems to increase, particularly in developing countries. In Southeast Asia itself, cardiovascular disease (CVD) alone accounted for 45% of total non-communicable disease mortality and affects the younger age group (Dhillon et al. 2012). Acute coronary syndrome (ACS) patients in Malaysia that need percutaneous coronary intervention (PCI) represent a younger population with mean age of 57 years old; surprisingly, 24.4% of the total patients were aged below 50 years. This may be attributed to the rising prevalence of risk factors such as hypertension, dyslipidemia, diabetes and smoking (Ahmad & Sim 2011). Literature reviewed estimates prevalence of premature CAD at 3-10% among those aged of 45 years old and younger (Egred et al. 2005). The coronary score could be used to guide the treatment in the intermediate risk group to prevent CAD (Jana et al. 2020; Chua et al. 2020).  There are establish non-modifiable independent risk factors such as advance age, being male, some ethnicity and a family history of premature CAD. Furthermore, it has been shown in some epidemiologic studies that family history can be more significant if it concerns first degree relative (FDR) (Nasir et al. 2004; Nasir et al. 2007). This may be explained by genetic predisposition and shared culture among family members as well as interplay among the multiple risk factors (Ties et al. 2012).  Young patient with CAD can have worst outcome during the first presentation of acute myocardial infarction (AMI) which includes mortality (Lerner & Kannel 1986). Studies have also managed to show a higher prevalence of single vessel CAD which may account for its rapid onset as opposed to the gradual progression seen in mature CADs (Muda et al. 2013; Ahmed Hussein 2012; Christus et al. 2011). As such, screening in the younger population is essential for early detection of CAD risk factor so early interventions can be taken to avoid catastrophic events. However, traditional risk algorithms such as the Framingham Risk Score (FRS) can miss FDR in the diagnosis of premature CAD (Sailam et al. 2008). Thus...
      PubDate: Sat, 26 Jun 2021 03:16:36 +000
       
  • Clinical Characteristics, Predictors and Outcome of Children with
           Complicated Parapneumonic Effusion: A Single Centre Experience

    • Authors: Siti Noorain
      Abstract: Author:  Hasniah Al Nur Azah MI Faizah MZ Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Jangkitan bakteria di paru-paru boleh menyebabkan pengumpulan cecair pada bahagian pleura, dikenali sebagai parapneumonia efusi (PPE). Faktor ramalan kepada tahap kerumitan PPE tidak di ketahui. Kajian ini dilakukan untuk mengenali ciri-ciri, faktor ramalan dan hasil rawatan kanak-kanak yang mengalami PPE di Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM). Data pesakit PPE kanak-kanak yang dimasukkan ke PPUKM dari Januari 2010 ke Disember 2017 dikaji secara retrospektif. Pesakit dibahagikan kepada dua kumpulan iaitu PPE tahap sederhana dan PPE tahap rumit. Dari 45 orang pesakit yang dikaji, 20 (44.4%) pesakit mempunyai PPE tahap sederhana, manakala 25 (55.6%) mengalami PPE tahap rumit. Median umur pesakit adalah 32 bulan (IQR 16-63). Jenis bakteria yang paling biasa di temui adalah Streptococcus pneumoniae (61.9%), diikuti oleh Mycoplasma pneumoniae (19.0%) dan Staphylococcus aureus (4.8%). Didapati hanya 11.1% pesakit kanak-kanak menerima suntikan vaksin pneumokokal. Tiada perbezaan yang ketara dalam perbandingan ciri-ciri klinikal antara pesakit PPE tahap sederhana dan rumit. Ujian ultrasound toraks hanya dilakukan ke atas 62.2% pesakit. Majoriti (95.0%) pesakit PPE tahap sederhana sembuh dengan hanya rawatan antibiotik. Manakala 60.0% dari pesakit PPE tahap rumit memerlukan rawatan intervensi surgeri. Purata jangkamasa pesakit menerima rawatan di hospital bagi PPE sederhana adalah 10 (4.0) hari, manakala bagi PPE rumit adalah 28 (16.5) hari. Kesimpulannya, ciri-ciri klinikal tidak dapat meramal tahap kerumitan PPE. Penggunaan ujian ultrasound toraks sebagai ujian utama dalam diagnosis dan tahap PPE perlu ditekankan. Rawatan antibiotik adalah berkesan untuk PPE tahap sederhana, manakala untuk PPE tahap rumit, kajian prospektif yang lebih besar diperlukan untuk menentukan kumpulan kanak-kanak yang bermanafaat untuk menerima rawatan intervensi lebih intensif.  Correspondance Address:  Associate Professor Dr Hasniah Abdul Latif. Department of Paediatrics, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603 91455395/91457888 Email: hasniah@ppukm.ukm.edu.my Full text:  Introduction  Parapneumonic pleural effusion (PPE) develops in about 40% of hospitalised children with bacteria pneumonia (Obando et al. 2008). Streptococcal pneumoniae is invariably the leading aetiological agent for PPE. Although the introduction of conjugate pneumococcal vaccine decreased the incidence of bacterial pneumonia, the rate of PPE was noted to have increased (Grijalva et al. 2010; Kaplan et al. 2004; Li & Tancredi 2010). The steps that leads to the development of PPE and empyema are as the following: i.e. (i) stage 1, described as the early exudative phase, constitutes the collection of thin reactive fluid and few cells in the pleural space; (ii) stage 2, described as fibropurulent phase, involves the formation of loculations; and (iii) stage 3 is the organisation phase and it involves the creation of a thick layer of fibrin that encloses the lung (Hamm & Light 1997). Factors that contribute to the progression to complicated PPE remains uncertain (Roxburgh et al. 2008). Previous studies have suggested that children with complicated pneumonia or empyema tend to be from the older age group of ≥ 3 years old, had prolonged fever before hospitalisation and received ibuprofen or antibiotics prior to hospitalisation (Byington et al. 2002; François et al. 2010).  The treatment of thoracic empyema depends on the clinical presentation and the stage of the disease. The initial treatment of empyema is to begin empiric antibiotic therapy for prompt eradication of the causative organism; the second step is directed to drain the purulent fluid in order to restore pleural fluid circulation, allowing lung re-expansion and improvement of lung function (Jaffé & Balfour-Lynn 2005). The therapeutic management of paediatric PPE and the impact of initial therapeutic interventions on clinical outcome are the subject of controversial discussions with a striking lack of consensus on the treatment between centres (Hafen et al. 2016). To the best of our knowledge, there is no local data pertaining to the management practices and outcome of PPE in children. Our experience in managing these group of children may help in preparing local guidelines for better management of childhood PPE. This study was aimed to describe the clinical characteristics, predictors for complicated PPE and outcome of children with simple and compl...
      PubDate: Fri, 25 Jun 2021 12:48:47 +000
       
  • Demoralisation in Cancer Patients: The Association with Distress,
           Depression and Positive Emotion

    • Authors: Siti Noorain
      Abstract: Author:  Chin HL Ng CG Thong KS Seed HF Aili H Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Pesakit kanser mengalami tekanan dan kemurungan yang tinggi. Pemahaman tentang hubungan psikologinya seperti demoralisasi dan emosi positif membantu dalam pengurusan keadaan ini. Objektif kajian adalah untuk mengkaji hubungan antara demoralisasi dan emosi positif, iaitu emosi yang menyenangkan seperti kegembiraan, kebanggaan, kepuasan dan sayang, dengan kemurungan dan tekanan bagi pesakit kanser. Faktor yang berkaitan dengan sosiodemografi dan klinikal juga dikaji. Kajian ini merekrut 178 pesakit kanser dari hospital universiti tempatan. Mereka dinilai menggunakan skala "Demoralization Scale" versi Bahasa Melayu (DS-M), skala "Positive Emotion Rating Scale" (PERS), skala "Centre for Epidemiologic Studies Depression Scale" (CESD) dan skala "Distress Thermometer". Umur rata-rata subjek adalah 53.6 + 16.51 tahun, dengan 24% dari mereka berada pada tahap lanjut kanser. Hampir 38% subjek mengalami demoralisasi. Daripada jumlah itu, 61.2% mengalami kemurungan, 52.2% mempunyai emosi positif rendah, dan 68.7% mengalami tekanan. Demoralisasi berkorelasi positif dengan kemurungan (r=0.78, p<0.01) dan tahap tekanan (r=0.64, p<0.01) tetapi berkorelasi negatif dengan emosi positif (r=-0.69, p<0.01). Kesimpulannya, demoralisasi sangat lazim dan berkaitan dengan kemurungan dan tekanan bagi pesakit barah. Penilaian dan pengesanan awal demoralisasi dalam kalangan pesakit barah harus mendapat perhatian yang lebih. Kajian lanjut mengenai pengurusan keadaan ini diperlukan. Correspondance Address:  Dr Thong Kai Shin. Faculty of Medicine, Universiti Tunku Abdul Rahman, Sungai Long Campus, Bandar Sungai Long, Cheras, 43000 Kajang, Selangor. Tel: +603-9086 0288 Email: kai_shin82@yahoo.com Full text:  Introduction The Malaysian National Cancer Registry Report showed that more than 100, 000 cases of cancer were diagnosed from the year 2007 to 2011 with 35.8% of these patients presented at the late stages of cancer (Azizah et al. 2016). The diagnosis of cancer threatens the physical well-being and overall quality of life of the patients (Richardson et al. 2017). In addition to psychological distress, depression also receives vast attention in the management of cancer patients (Massie 2004; Mitchell 2011). Depression is one of the most enfeebling disease of the world and has been reported to be high in prevalence among Malaysian population, especially among women (Norfazilah et al. 2015). Depression also results in a lower quality of life and reduced general well-being of cancer patients (Karakoyun-Celik et al. 2010; Smith et al. 2008). Many literatures had indicated a deficit of positive emotions in patients with depression. However, these positive emotions that comprised of discrete pleasant emotions, such as joy, pride, contentment, or love were often ignored (Ng & Hazli 2016). We recognised demoralisation as a unique and widespread occurrence among patients with terminal illnesses, including cancer (Vehling et al. 2017; Vodermaier et al. 2009).  Demoralisation has been defined as an existential distress syndrome that consists of incapacity of coping, helplessness, hopelessness, loss of meaning and purpose, as well as  impaired self-esteem. Frankl (1973) characterised demoralisation as a state of distress, occurring in patients specifically in a life-threatening situation or people facing threats to their well-being. Increasing researches on the demoralisation syndrome have advocated its diagnostic value and utility in a palliative setting (Clarke et al. 2005; Kissane et al. 2001).  In the last few years, demoralisation is an essential topic of discussion in palliative care (Robinson et al. 2015). The issue has become an important clinical matter in palliative care since there is evidence to support the claim that managing the mental health needs of these patients is a crucial part of the treatment process of cancer (Robinson et al. 2016). Many believe that the demoralisation is a precursor to severe depression and suicidality in these ill individuals (Rickelman 2002; Robinson et al. 2015; Strada 2009).  Demoralisation is frequently encountered in cancer patients, especially those in advanced staging. It is a psychological condition that is potentially treatable but often neglected by the clinicians. Generally, the clinicians are paying more attention to the illness or other negative emotion such as de...
      PubDate: Fri, 25 Jun 2021 12:45:43 +000
       
  • A Forensic Study of Ethnicity and Sex Differences in Fingerprint Patterns
           in a Malaysian Sub-population

    • Authors: Siti Noorain
      Abstract: Author:  Lee Lc Darrelyn Cn Nurul Syafiqah A Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Cap jari merupakan sejenis bahan bukti yang paling biasa dijumpai di tempat kejadian. Disebabkan keunikan corak cap jari, ia berguna untuk pengenalpastian suspek. Pada kebiasaannya, sumbangan cap jari yang dipertikaikan agak terhad disebabkan oleh kekaburan minutia atau ketiadaan suspek yang berpotensi. Walau bagaimanapun, ia masih berguna jika etnisiti atau jantina cap jari yang dipertikaikan dapat ditaabirkan untuk mengecilkan skop pencarian suspek. Oleh demikian, kajian ini bertujuan memeriksa perbezaan jantina dan etnisiti dalam corak cap jari di kalangan tiga kumpulan etnik utama di Malaysia, iaitu Melayu, Cina dan India. Sejumlah 2000 cap jari telah dikutip daripada sepuluh jari bagi 200 subjek Malaysia (99 lelaki dan 101 perempuan). Setiap tiga kumpulan etnik itu diwakili oleh sekurang-kurangnya 60 subjek. Statistik perihalan dan ujian hipotesis telah dijalankan untuk menilai variasi jantina dan etnisiti dalam corak cap jari. Tambahan pula, analisis penghubungan mudah juga dijalankan untuk menyokong statistik perihalan dan statistik pentakbiran. Dengan mempertimbangkan corak cap jari semua sepuluh jari, membulat merupakan corak yang paling kerap di Melayu (23.0%) dan India (23.2%); sementara Cina (13.9%) menunjukkan frekuenksi sedikit tinggi dalam pusaran berbanding Melayu (9.6%) dan India (10.3%). Taburan relatif corak cap jari lelaki adalah serupa dengan taburan relatif corak jari perempuan. Sebagai kesimpulannya, corak cap jari mungkin boleh digunakan untuk menaabir etnisiti suspek daripada jantina suspek dalam konteks Malaysia.  Correspondance Address:  Loong Chuen Lee. Program Sains Forensik, Fakulti Sains Kesihatan, Basemen 1, Perpustakaan Tun Seri Lanang, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor Darul Ehsan, Malaysia. Tel: +603-8921 7202. Email: lc_lee@ukm.edu.my Full text:  Introduction Fingerprint is one of the most common evidence found at a crime scene. It can be deposited on various types of surfaces or substrates (Meuwly 2009). Owing to the uniqueness of fingerprint, it is very useful in forensic investigation for suspect identification by comparing the questioned fingerprint recovered from a crime scene with a suspect’s fingerprint. Matching is achieved if both the fingerprints show similarities in minutia types and locations. Therefore, reliability of the matching is heavily affected by the quality of the questioned fingerprint (Fieldhouse 2011; Ulery et al. 2011). In practice, fingerprint collected from a crime scene may be blurred, degraded or partial. In such circumstances, the comparison analysis may not accurately identify the right suspect (Neumann 2012). However, the fingerprint pattern, i.e. loop, arch and whorl could be inferred with high confidence even the fingerprint is partial. Typically, fingerprint features can be divided into three levels i.e. (i) level-1 (pattern); (ii) level-2 (minutiae points); and (iii) level-3 (e.g. pores and ridge contours) (Kryszczuk et al. 2004). Among these features, level-2 features are the most studied ones in the forensic literature. Numerous works have been carried out on sex determination from fingerprint ridge density by using a variety of populations (Adamu et al. 2018; Adamu & Taura 2017; Ahmed & Osman 2016; Dhall & Kapoor 2016; Gutierrez-Redomero & Alonso-Rodriguez 2013; Nayak et al. 2010; Taduran et al. 2016). In general, most of the works indicated that male tends to show less number of ridge counts than the female. However, accurate calculation of ridge density is much easier to be performed in a rolled than a plain print. Unfortunately, in practice, very unlikely a rolled print would be found at a crime scene.  On the other hand, level-3 features concerning the fine details of fingerprint, e.g. pores and ridge contours, are of limited use in real forensic investigation. As mentioned above, quality of the fingerprint collected from a crime scene can be very low and thus it is impractical to explore the level-3 features in forensic investigation except for biometric security technology. Moreover, Gupta et al. (2008) found that the reproducibility of friction ridge pore detail in identifying a person is too low for a reliable personal identification.  In contrast, level-1 features referring to the fingerprint patterns have been studied mainly for estimating frequency of occurrence in a population but not on discriminating sex or ethnicity (Kapoor & Badiye 2015; Nithin et al. 2009; Wijerathne et al. 2013). Additionally, a few studies have demonstrated the use of fingerprint pat...
      PubDate: Fri, 25 Jun 2021 12:42:18 +000
       
  • The Incidence of Low Back Pain among Healthcare Students and Their Beliefs
           on Its Association with Physical Function

    • Authors: Siti Noorain
      Abstract: Author:  Gurbinder KJS Rosnita H Nurul Shafina MZ Nur Athirah AHL Ahmad Farhan S Mohd Zairin Z Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Kadar kekerapan sakit belakang yang lebih tinggi da;am kalangan profesional penjagaan kesihatan menyebabkan mereka kerap dimasukkan ke hospital, tidak hadir bekerja, dan bersara awal. Kepercayaan pemberi penjagaan kesihatan mengenai sakit belakang adalah penting dalam proses pemulihan pesakit yang menderita akibat sakit belakang. Kajian ini bertujuan untuk mengkaji insiden sakit belakang dalam kalangan pelajar prasiswazah kesihatan dan kepercayaan mereka terhadap perkaitan antara sakit belakang dan fungsi fizikal. Kajian keratan rentas digunakan untuk mengumpulkan data dalam talian dari pelajar prasiswazah kesihatan bagi semua tahun pengajian dari empat program. Alat soal-selidik  "Extended Nordic Musculoskeletal Questionnaire" (NMQ-E) dan "Health Care Providers’ Pain and Impact Relationship Scale" (HC-PAIRS) masing-masing digunakan untuk menentukan sakit belakang dalam kalangan pelajar dan kepercayaan mereka terhadap kesan sakit belakang pada fungsi fizikal. Seramai 239 pelajar mengambil bahagian dalam kajian ini dengan purata usia 21.90 tahun. Pelajar perempuan (74.5%) melebihi lelaki (25.5%). Ramai pelajar pernah mengalami sakit belakang sepanjang hayat hidup (82%) dan 12 bulan terakhir (55.2%) dengan permulaan pada awal usia remaja. Pelajar fisioterapi dan jurupulih carakerja mengalami sakit belakang pada kadar kekerapan yang lebih rendah pada bulan lepas dan hari pengumpulan data. Kadar kekerapan sakit belakang dalam kalangan pelajar lelaki dan perempuan adalah sama, tetapi lebih tinggi dalam kalangan pelajar tua berbanding pelajar muda. Pelajar jurupulih carakerja dan fisioterapi masing-masing didapati mempunyai kepercayaan yang lebih negatif dan positif terhadap sakit belakang. Kadar kekerapan sakit belakang yang lebih tinggi dalam kalangan pelajar pemberi penjagaan kesihatan memerlukan intervensi yang sesuai untuk mengatasinya. Kepercayaan positif yang sedikit dalam kalangan pelajar pemberi penjagaan kesihatan memerlukan tindakan segera untuk menanamkan kepercayaan positif dalam diri mereka. Correspondance Address:  Gurbinder Kaur Jit Singh. Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91456259 Email: gurbin@ppukm.ukm.edu.my Full text:  INTRODUCTION  Low back pain (LBP) is a common health problem among the global population, irrespective of age groups (Kennedy et al. 2014; Hafeez et al. 2013).  Health care personnel are the main sufferer of LBP with a prevalence rate of around 56-74% compared to other professional workers (Hafeez et al. 2013), and it is also the common cause of frequent hospitalisation among them (Karahan et al. 2009). Chronic LBP leads to disability which causes work absenteeism and early retirement (Igwesi-Chidobe et al. 2019; Becker et al. 2010). Chronic LBP not only disrupts productivity and reduces revenue to industrialised countries, but also impairs quality of life of the disabled person and becomes a financial burden to the family (Deckers et al. 2015; Becker et al. 2010).  Several studies reported LBP among the healthcare students of the nursing, medical and physiotherapy programmes at different time intervals (Vincent-Onabajo et al. 2016; Falavigna et al. 2011; Mitchell et al. 2009). Both nursing (79%) and physiotherapy (45.5%) students reported a significantly much higher incidence of LBP for a lifetime than during a 7-day interval (Vincent-Onabajo et al. 2016; Mitchell et al. 2009). The prevalence of LBP among the physiotherapy students was notably high for the different time intervals of the lifetime, the last 12 months, and the day of data collection when compared with the medical students (Falavigna et al. 2011).  One’s belief on the functional abilities of patients with LBP is important in determining the development of chronic LBP disability as high levels of negative beliefs on the functional abilities of patients with LBP are known to be related to the presence of LBP and disability related to LBP (Burnett et al. 2009). A person’s beliefs are shaped by ones’ culture, learning and experience of LBP (Burnett et al. 2009; Ferreira et al. 2004). Healthcare providers...
      PubDate: Fri, 25 Jun 2021 12:36:51 +000
       
  • Evaluating Improvement in Acute Stroke Management following Pre-hospital
           Initiation of Acute Stroke Service

    • Authors: Siti Noorain
      Abstract: Author:  Jessica AN Wan Asyraf wz NIK AZLAN NM Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Pemberitahuan pra-hospital kepada pasukan strok dalam memberi amaran mengenai pesakit strok akut yang akan tiba ke hospital dijalankan di beberapa negara di seluruh dunia. Pada masa ini perkara ini tidak diamalkan di Malaysia. Kajian ini menilai kebolehlaksanaan dan kesan terhadap masa yang diambil dari ketibaan pesakit di Jabatan Kecemasan kepada penilaian pasukan strok ketika pemberitahuan pra-hospital digunakan. Tempoh kajian kawalan kes ini adalah di antara Jun 2018 hingga Januari 2019. Fasa kawalan terdiri daripada pasukan strok yang mengaktifkan secara konvensional setelah penilaian di hospital oleh pegawai perubatan kecemasan. Ini kemudian diikuti dengan fasa intervensi di mana pengaktifan pasukan strok dilakukan oleh kakitangan "Prehospital Emergency Care" (PHC) di tempat kejadian. Latihan kakitangan PHC dalam mengenali strok akut didasarkan pada pengenalpastian kelainan BE-FAST (Imbangan, Mata, Wajah, Lengan dan Ucapan). Objektif kajian ini adalah untuk membandingkan masa antara dua kumpulan untuk waktu tinjauan pasukan strok akut, pintu untuk imbasan 'computerised tomography' (CT) dan waktu untuk trombolisis. Tiga puluh sembilan pesakit dianalisa (kawalan n=29, intervensi n=10). Hasilnya tidak signifikan (p>0.05). Waktu purata dalam beberapa minit untuk fasa kawalan vs fasa intervensi adalah seperti berikut: waktu masa tiba pesakit ke penilaian pasukan strok, 25.96 + 39.16 vs 15.9 + 13.14, waktu tiba pesakit ke imbasan CT dijalankan adalah 43.04 + 40.00 berbanding 25.8 + 11.35. Hanya 3 pesakit yang menjalani terapi trombolitik dalam tempoh kajian. Kekangan yang dihadapi adalah data bukan parametrik dengan kekurangan bilangan kes strok akut yang didapati dalam tempoh intervensi. Dengan latihan berterusan di kalangan kakitangan pra-hospital dalam mengesan strok akut, kebolehlaksaan dapat ditingkatkan. Correspondance Address:  Nik Azlan Nik Muhamad. Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +6012-3956197 Email: nikazlanmuhamad@hotmail.com Full text:  INTRODUCTION Stroke awareness and detection among Malaysian population is still poor (Anuar et al. 2014). Reliance on Prehospital Emergency Care (PHC) team is crucial in identifying an acute stroke. Benefits of early thrombolytic therapy is proven, hence, rapid and effective response is critical. Accurate stroke identification by the prehospital team enables prehospital activation of the receiving hospital stroke team prior to patient arrival (Rajajee & Saver 2005) This allows time for preparation and immediate standby of the managing team.  Universiti Kebangsaan Malaysia Medical Centre (UKMMC) is a tertiary referral hospital in Kuala Lumpur. Acute Stroke thrombolysis service for ischemic stroke started in 2009. This includes forming an acute stroke team and incorporating computerised tomography (CT) perfusion as a part of UKMMC stroke protocol. From January 2010 to December 2011, the time from symptom to CT perfusion scan was delayed at an average of 211 minutes. (Hashim et al. 2013). Prehospital activation of stroke team has been proven elsewhere as a method to shorten delay in door to needle time (Zhang et al. 2018) To the best of our knowledge, prehospital activation of stroke team has not yet been implemented in Malaysian hospitals. No data is available in feasibility and improvement of door to stroke team review, CT scan and thrombolytic therapy following prehospital stroke team activation in Malaysia. Readiness and reliability on a developing young pre-hospital care system in diagnosing and confidence in alerting stroke team could be assessed.  This study acts as a pioneer study in prehospital activation of stroke team in Malaysia. Expected result are shorter door to stroke team review, CT and thrombolysis time. Training of PHC staff in detecting acute stroke and methods in alerting stroke team was done prior to intervention. If the protocol was feasible, routine implementation can be done. Objective of this case control study was to compare mean time of door to CT scan, door to stroke team review and door to thrombolytic therapy between control and intervention phase.  MATERIALS AND METHODS Time was recorded in minutes. Control phase was during the initial 4 months (1st June 2018 to 30th September 2018). In this phase, conventional acute stroke service initiation was maintained. Patient with suspicion of acute stroke was brought to Emergency Dep...
      PubDate: Fri, 25 Jun 2021 12:31:51 +000
       
  • The Big-Five Personality Traits and Quality of Life in Elderly Malaysian
           Patients with Diabetes Mellitus: A Cross-Sectional Study

    • Authors: Siti Noorain
      Abstract: Author:  Woon LSC Gosse PJ Kaunismaa es Mainland rl ARUN R HATTA S Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Walaupun penyakit kencing manis sering dijumpai dalam kalangan warga emas serta memberi kesan yang ketara terhadap kualiti hidup (QOL) seseorang, kita masih tidak mengetahui secara jelas cara trait personaliti mempengaruhi QOL. Kajian keratan rentas ini yang dijalankan di Pusat Perubatan Universiti Kebangsaan Malaysia adalah bertujuan untuk menentukan hubung kait di antara trait personaliti dan QOL dalam kalangan warga emas (berumur ≥60 tahun) yang mengalami penyakit kencing manis. Maklumat sosio-demografik dan klinikal telah dikumpulkan. QOL diukur dengan soal sedilik WHO Quality of Life-BREF (WHOQOL-BREF) sementara trait personaliti pula dinilai dengan Big Five Inventory (BFI). Kemurungan dan keresahan diukur dengan pengujian soal selidik Beck Depression Inventory-II (BDI-II) dan Generalized Anxiety Disorder 7-item (GAD-7) masing-masing dan diambil dalam analisa statistik. Terdapat sebanyak 170 peserta kajian yang melibatkan diri (umur median = 69.0 tahun; IQR: 65.0-73.0; dengan 51.2% lelaki). Menggunakan model ‘stepwise linear regression’, didapati skor kehematan (β=0.156; P=0.044) dan skor neurotisisme yang negatif (β=-0.176; P=0.028) amat berkait dengan QOL yang baik di dalam domain kesihatan fizikal. Sementara nilai skor ekstraversi (β=0.209; P=0.001) dan skor kehematan yang tinggi (β=0.248; P<0.001) pula amat berkait dengan QOL yang baik di dalam domain kesihatan psikologi. Ketinggian skor kepersetujuan (β=0.286; P<0.001) amat berkait rapat dengan QOL yang baik di dalam domain perhubungan sosial. Akhirnya, skor kepersetujuan yang tinggi (β=0.327; P<0.001) dan darjah neurotisme (β=-0.223; P=0.001) didapati amat berkait dengan QOL yang baik di dalam domain persekitaran. Trait personaliti berkait rapat dengan semua domain QOL di kalangan pesakit warga emas yang mengalami penyakit kencing manis. Personaliti sebelum jatuh sakit (premorbid personality) mungkin mempunyai peranan penting di dalam mempengaruhi kesan penyakit kencing manis terhadap kehidupan pesakit warga emas.   Correspondance Address:  Luke Sy-Cherng Woon. Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91456423 Email: lukewoon@ukm.edu.my Full text:  Introduction Diabetes mellitus (DM) is a common disease associated with significant microvascular and macrovascular complications (Fowler 2008). As optimal glycaemic control is crucial in preventing these complications, maintaining glycaemic control is essential. This can only be achieved through the combination of rigorous lifestyle modifications and pharmacotherapy. In this respect, elderly patients with diabetes require different management approaches than their younger counterparts. Geriatric populations face specific challenges related to health, including frailty, functional limitation, changes in cognitive ability and mental health, as well as increased dependency on others for care (Gregg et al. 2002). With this complexity of care comes a need to better understand the psychosocial factors that influence the health of this population. While certain social, clinical, and psychological factors that impact DM management have been highlighted in previous studies, the influence of personality traits on the quality of life (QOL) in elderly patients with diabetes has not been adequately explored. The Big Five Model of personality includes the following domains i.e., extraversion, agreeableness, neuroticism, conscientiousness, and openness to experience (Costa & McCrae 1990). These traits are believed to remain stable across time. In a large nationally representative sample of adults in Australia, personality, as measured according to the Big Five Model, changed minimally across four years (Cobb-Clark & Schurer 2012). Another study followed individuals over 45-years and found stability in the domains of neuroticism, conscientiousness, and openness to experience across time (Soldz & Vaillant 1999). As diabetes is a chronic condition, it is important to consider the impact of stable factors such as personality on long-term disease management in these individuals.  Personality may impact disease perception and QOL in individuals with d...
      PubDate: Thu, 10 Jun 2021 03:10:54 +000
       
  • Impact of CD34+ Stem Cell Dose on Engraftment Period in Allogeneic
           Peripheral Blood Stem Cell Transplanted Patients

    • Authors: Siti Noorain
      Abstract: Author:  Suria AA Hazlina Diyana B Zed Zakari AH NURASYIKIN Y YOUSUF R AZMA RZ Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Sel stem progenitor hematopoietik yang diperolehi dari darah periferal telah lama digunakan untuk merawat pesakit malignansi hematopoietik. Kejayaan transplantasi allogenik sel stem darah periferal (PBSCT) yang mengambil kira kadar pemulihan hematopoietik sel dan engrafmen adalah bergantung pada jumlah sel stem CD34+ yang disuntik. Kajian ini bertujuan untuk mengaitkan jumlah sel CD34+ yang disuntik dengan tempoh engrafmen. Kajian retrospektif ini melibatkan 62 pesakit dengan malignansi hematopoietik yang telah menerima PBSCT di Pusat Perubatan Universiti Kebangsaan Malaysia dari tahun 2011 hingga 2015. Kesan infusi sel stem CD34+ pada engrafmen oleh neutrofil dan platelet dan pencapaian chimerism lengkap telah dikaji. Pesakit dibahagikan kepada dua kumpulan berdasarkan jumlah sel stem CD34+ yang disuntik. Kumpulan A terdiri daripada 9 pesakit yang menerima infusi <5x106 sel/kg CD34+ sel stem sementara kumpulan B terdiri dari 53 pesakit yang disuntik dengan ≥5x106 sel/kg CD34+ sel stem. Data dikumpulkan dan dianalisa. Pesakit Kumpulan B dikaitkan dengan engrafmen neutrofil yang lebih cepat: 12 (10-14) hari sementara kumpulan A adalah 15 (10-21) hari (p=0.002). Engrafmen platelet juga lebih cepat dalam kumpulan-B: 17 (12-25) hari berbanding dengan kumpulan A: 18 (15-30) hari. Kimerisme lengkap dalam kumpulan B berlaku dalam 30 (15-90) hari dan pada kumpulan A adalah 60 (30-240) hari. Kadar pencapaian engrafmen platelet (p=0.149) dan kimerisme lengkap (p=0.021) tidak banyak dipengaruhi oleh jumlah sel CD34+. Kajian ini telah menunjukkan bahawa infusi sel stem ≥5x106 sel/kg CD34+ sel induk dapat memendekkan masa untuk engrafmen hematopoietik sel terutamanya engrafmen neutrofil. Correspondance Address:  Associated Professor Dr Suria Abdul Aziz. Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91459494 Email: suria.abdulaziz@gmail.com Full text:  INTRODUCTION Over the years haematopoietic progenitor stem cells from the peripheral blood have increasingly been used for stem cells transplantation primarily to treat patients with different types of malignant haematologic disorders (Körbling & Freireich 2011). Among the common complications of allogeneic stem cell transplant,  graft-versus-host disease (GVHD) is one of the  serious or fatal complication where  the transplanted donor T-lymphocytes react to foreign host cells and cause injury to the host tissue (Bittencourt et al. 2002; Singhal et al. 2000). Therefore, for every haematopoietic stem cell transplant cases, the best matched Human Leukocyte Antigen (HLA) donor is identified (Nor Rafeah et al. 2017) to prevent or minimise the risk of GVHD and thus promote engraftment (Cutler & Antin 2001).  Engraftment is a significant milestone in allogeneic stem cell transplant recovery. During engraftment the transplanted stem cells  grows and forms new haematological cells and this usually occurs between 14 to 28 days after the allogenic bone marrow transplant (BMT) which is achieved earlier in case of peripheral blood stem cells transplant (PBSCT). In PBSCT, neutrophil engraftment is achieved one to six days earlier  while  platelet engraftment is achieved four to seven days earlier than BMT (Cutler & Antin 2001). Engraftment is defined as the recovery of neutrophil and platelet after a period of aplasia (Brown 2017). It is considered when the absolute neutrophil count (ANC) is ≥0.5 x 109/L for three consecutive days. The second sign of engraftment is when the platelet count continues to increase ≥20 x 109/L for 3 consecutive days without a platelet transfusion in the 7 preceding days (Teltschik et al. 2016). It is important  for the clinician to closely monitor the neutrophil and platelet count increment post hematopoietic stem cell transplantation (HSCT) to evaluate engraftment. Another method of monitoring engraftment is by monitoring chimerism in the transplanted patients. In the post transplant patients, determination of the degree of chimeras reflects whether the engraftment is successful or not (Hamidah et al. 2011). Generally chimerism describes the presence of cell populations that were derive...
      PubDate: Thu, 10 Jun 2021 03:05:23 +000
       
  • The Effects of Preoperative Sugarless Gum Chewing on Gastric Fluid Volume
           and pH

    • Authors: Siti Noorain
      Abstract: Author:  Siti Zubaidah MZ Azlan Sani S Muhammad M Joanna Ooi SM Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Terdapat kekurangan dalam konsensus tentang pengunyahan gula-gula getah semasa tempoh berpuasa sebelum pembedahan disebabkan oleh bukti yang bercanggah. Tujuan penyelidikan ini adalah untuk mengenalpasti kesan-kesan pengunyahan gula-gula getah ke atas isipadu dan pH cecair perut. Kajian prospektif dan secara rawak ini telah dilakukan ke atas pesakit-pesakit yang menjalani pembedahan elektif dengan pembiusan umum. Seramai 60 orang pesakit yang telah berpuasa semalaman dibahagikan antara kumpulan “tanpa gula-gula getah” sebagai kumpulan kawalan dan “kumpulan gula-gula getah” sebagai kumpulan intervensi yang mengunyah satu keping gula-gula getah setelah dipanggil ke dewan bedah. Pesakit-pesakit tersebut kemudiannya ditanya samada pengunyahan gula-gula getah ini dapat mengatasi rasa lapar atau mengurangkan kegelisahan. Isipadu dan pH cecair perut ini diukur sebaik sahaja proses pembiusan diaruhkan. Pengunyahan gula-gula getah tidak menunjukkan kesan yang ketara ke atas isipadu cecair perut [30.4+13.6 ml (kawalan) vs 29.1+11.6 ml (intervensi), p = 0.693] dan pH cecair perut [1.4+0.4 (kawalan) vs 1.6+0.4 (intervensi), p = 0.05) disebaliknya mengurangkan kegelisahan sebanyak 90.3% di kalangan pesakit yang mengunyah gula-gula getah. Pengunyahan gula-gula getah sebelum pembedahan didapati tidak meningkatkan isipadu cecair perut atau menurunkan lagi keasidan cecair perut serta dapat mengurangkan kegelisahan di kalangan pesakit sebelum pembedahan. Correspondance Address:  Professor Dr. Joanna Ooi Su Min. Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455872 Email: joanna@ppukm.ukm.edu.my Full text:  Introduction General anaesthesia is generally safe but respiratory complications such as anaesthesia-related aspiration that involves inhalation of material into the airway below the level of the true vocal cords can be fatal. This may result in a wide range of clinical outcomes, being asymptomatic to severe pneumonitis and acute respiratory distress syndrome (ARDS) (King 2010). In 1946, Mendelson (1946) first described the relationship between aspiration of solid and liquid matter and pulmonary sequelae in obstetric patients. The incidence of pulmonary aspiration, morbidity and mortality in an adult population is estimated to be 1 in 7000, 1 in 16,000 and 1 in 100,000, respectively. Therefore, to reduce the risk of aspiration, preoperative fasting is mandatory before anaesthesia (Sakai et al. 2006). The prescribed 6-8 hours of fasting is sometimes prolonged to more than 8 hours for various reasons that may result in patient irritability, anxiety, hunger and thirst in the perioperative period (Scarlett et al. 2002). Some patients may chew gum during the fasting period despite preoperative orders to avoid oral intake. Until now, there is still no consensus on whether gum chewing is allowed or otherwise during the preoperative fasting period.  According to the current edition of American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting, it is recommended that fasting from solid food for 6-8 hours and clear fluids for 2 hours is essential before elective procedures that require general anaesthesia, regional anaesthesia or procedural sedation with analgesia (American Society of Anesthesiologists Committee 2011). The European Society of Anesthesiology included in their recommendation that “patients should not have their operation cancelled or delayed just because they are chewing a gum, sucking a boiled sweet or smoking immediately before the induction of anaesthesia” (Smith et al. 2011). Some anaesthetists cancelled these cases as they are certain that gum chewing will increase the gastric volume and place the patient at risk for aspiration during induction of anaesthesia. Physiologically, gastric acid secretion is divided into three phases, which include the cephalic, gastric and intestinal phases. The cephalic phase is initiated by sham feedings while both the gastric and intestinal phases are initiated by distension and by certain compounds entering the digestive tract segment. The act of chewing is similar to sham feeding in which not only does it stimulate cephalic phase of gastric acid secretion but also accelerates and enhances stomach and gut motility (Apostolopoulos et al. 2008; Noble et al. 2009).
      PubDate: Thu, 10 Jun 2021 02:27:23 +000
       
  • The Efficacy of Prophylactic Intravenous Granisetron in Preventing Post
           Anaesthesia Shivering in Gynaecological Patients Undergoing Surgery Under
           General Anaesthesia

    • Authors: Siti Noorain
      Abstract: Author:  Adania A Joanna Ooi SM Issue:  Vol. 16 No. 1 : 2021 Abstrak (In MALAY language):  Menggigil selepas bius umum merupakan salah satu komplikasi yang paling kerap berlaku sewaktu pesakit sedar daripada pembiusan umum dengan kadar di antara 5 hingga 65%. Keadaan ini meningkatkan penggunaan oksigen dan penghasilan karbon dioksida yang akan menyebabkan kelewatan dari segi pemulihan daripada pembiusan serta kejadian lain yang tidak diingini. Granisetron merupakan salah satu jenis ubat yang digunakan untuk mencegah keadaan menggigil selepas bius umum. Kajian prospektif, sulit berganda dan secara rawak dijalankan untuk membandingkan keberkesanan ubat IV granisetron sebagai profilaksis untuk mencegah keadaan menggigil selepas pembiusan dalam dos 2 mg dan 3 mg. Seramai 104 orang pesakit yang terdiri daripada ASA I dan II yang dijadualkan untuk pembedahan elektif ginekologi telah dibahagikan secara rawak kepada dua kumpulan iaitu Kumpulan A dan Kumpulan B yang masing-masing menerima 2 dan 3 mg IV granisetron. Semua pesakit telah dibius dan intubasi trakea dilakukan selepas kelumpuhan otot. Bacaan suhu pesakit dasar dan berkala diukur secara perioperatif. Insiden dan keparahan menggigil selepas pembedahan telah dinilai dengan Klasifikasi ‘Wrench Scoring’. Seramai 8.3% dan 16.7% pesakit daripada Kumpulan A dan B masing-masing mengalami keadaan menggigil dengan perbezaan yang tidak ketara (p=0.199). Kesemua pesakit yang menggigil daripada kedua-dua kumpulan mengalami tahap menggigil Gred 1 kecuali seorang pesakit dari Kumpulan B mengalami Gred 2. Tiada pesakit mengalami tahap menggigil Gred 3 atau 4 selepas pembedahan atau mengadu loya atau muntah ketika di tempat pemulihan. Kedua-dua dos IV granisetron adalah berkesan untuk mengurangkan insiden dan keparahan menggigil selepas pembedahan ginekologi dengan pembiusan am tanpa kesan sampingan yang kurang menyenangkan. Correspondance Address:  Professor Dr. Joanna Ooi Su Min. Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455872 Email: joanna@ppukm.ukm.edu.my Full text:  Introduction Shivering is defined as an involuntary and oscillatory muscular activity that increases the metabolic rate to maintain normal body temperature. It is an unpleasant feeling, which may cause uneasiness and discomfort to patients recovering from general anaesthesia. Post-anaesthetic shivering is one of the commonest complications during emergence from anaesthesia with a rate of occurrence between 5-65% and is usually preceded by perioperative core hypothermia and vasoconstriction (Buggy & Crossley 2000; Miller et al. 2009). General anaesthesia impairs the central thermoregulation which results in perioperative hypothermia. It widens the inter-threshold range by +4°C, whereby the autoregulation of core temperature is not triggered resulting in patients developing intraoperative hypothermia. This is further compounded by the effects from the anaesthetic drugs used that cause peripheral vasodilation which redistributes body heat from the central to the peripheries. Other methods of heat loss include exposure to the cold environment in the operating theatre (OT), heat loss via radiation and convection, insensible evaporative loss from exposure of visceral organs during surgery, intraoperative blood loss and prolonged surgical duration which contributes to perioperative hypothermia (Bhattacharya et al. 2003; Miller et al. 2009).  Post-anaesthetic shivering increases double or even triple oxygen consumption and carbon dioxide production. There will be excessive sympathetic nervous system stimulation which increases metabolic heat production up to 600% above basal level (De Witte & Sessler 2002; Bhattacharya et al. 2003; Lopez 2018). High production of carbon dioxide may lead to metabolic acidosis which subsequently causes prolonged drug metabolism, delays recovery from anaesthesia, prolongs coagulation time, decreases clot formation, increases adverse myocardial outcomes and perioperative mortality (Gargari & Anvari 2017). There is also a risk of delayed wound healing, wound infection and prolonged hospitalisation (Buggy & Crossley 2000; Miller et al. 2009; Gargari & Anvari 2017). Post-anaesthetic shivering can be prevented by maintaining normothermia during surgery. Non-pharmacological methods in preventing intraoperative hypothermia include the use of forced air-warming devices, radiant heaters, passive insulation using cotton drapes and administration of pre-warmed intravenous fluids. To date, various drugs have been used to prevent or treat post-anaesthetic shivering which include alpha-2 a...
      PubDate: Thu, 10 Jun 2021 02:23:22 +000
       
 
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