1.Appraisal of clinical profile and management of juvenile nasopharyngeal angiofibroma in Malaysia.
Shahid Hassan ; Jafri Abdullah * ; Baharudin Abdullah ; Shah Jihan WD ; Hasnan Jaafar ** ; Shafie Abdullah ***
Malaysian Journal of Medical Sciences 2007;14(1):18-22
Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally invasive tumour. Patients are usually in their adolescent age and present with epistaxis and nasal blockage. Diagnosis is based on clinical evaluation and the C.T. scan findings. Pre-operative superselective embolisation (SSE) and surgical excision is the treatment of choice. The outpatient clinic of ORL-HNS hospital of University
Science Malaysia received 25 referrals, all male, majority between 9-13 years of age and few adolescents. Clinically the patients were consistent with symptoms of recurrent epistaxis and nasal blockage. They reported from October 1998 to October 2001 from within the state of Kelantan and the nearby states of Pahang, Kedah and Terenganu. Diagnosis was mostly made on typical radiological findings and the tumours were classified accordingly into four stages. SSE and surgical excision was carried out in all cases. Regular follow-up helped us to identify early recurrences which were treated with salvage surgery or radiotherapy in one case with extensive intracranial extension. A retrospective review of presenting features, diagnostic difficulties, surgical approaches and its outcome is presented. Maxillary swing procedure performed in three cases as a new surgical option in the management of JNA is also discussed.
2.Effects of an indigenous contraceptive herbal formulation on gonadotrophs of the pituitary gland of the rat
Mohd. Nazrul Islam ; Siti Amrah Sulaiman * ; Marina Y. Kapitonova ; Syed Mohsin Sahil Jamallullail
Malaysian Journal of Medical Sciences 2007;14(1):23-27
An indigenous contraceptive herbal formulation consisting of a mixture of Lepidagathis longifolia, Palaquium sp and Phyllagathis rotundifolia is being used by the Temuan Aborigins of Malaysia. Although the previous studies demonstrated that this contraceptive herbal formulation causes anovulatory estrous cycle, altered circulating hormone levels and fetal resorption in rats, but the effects of this formulation on the gonadotrphs of the pituitary gland are yet to be evaluated. The present study was designed to observe the morphometric changes of the gonadotrophs and the plasma concentrations of follicle stimulating hormone and leutinizing hormone. Thirty five Sprague-Dawley adult female rats were randomly divided into 5 groups. Experimental animals were given a combined herbal extract or individual herbal extract at a dose of 540 mg/kg/day subcutaneously for 7 days. Immunostained gonadotrophs were studied by using image analyzer. FSH and LH serum concentrations were determined using RIA. The FSH and LH concentrations were low in animals that received combined herbal extract (p<0.01). FSH concentration was noted to be significantly low in animals that received P.
rotundifolia (p<0.05). The mean cell area and cell density of gonadotrophs of animals that received combined herbal extract were significantly low compared to control group (p<0.05). It was concluded that the herbal extracts do suppress the production of gonaotrophins along with the demonstrable suppresive effect on the FSH cells.
3.An audit of singleton breech deliveries in a hospital with a high rate of vaginal delivery.
Malaysian Journal of Medical Sciences 2007;14(1):28-37
The term breech trial (TBT) has brought about radical changes but it is debatable whether it provides unequivocal evidence regarding the practice of breech deliveries. There is a need to publish the data of a study that was performed before the era of the TBT in a hospital where there was a high rate of breech vaginal delivery. The objectives were to ascertain the incidence, mode of delivery and fetal outcome in singleton breech deliveries. The study design was a retrospective cohort study where 165 consecutive breech and 165 controls (cephalic) were included. Statistical analysis, used were Chi squared and Fischer’s exact test. P<0.05 is taken as the level of significance. The incidence of breech deliveries was found to be 3% and has remained fairly constant but the rate of breech vaginal delivery has fallen and the CS rates have increased. Even though more breech compared to controls were significantly sectioned, majority of the breeches {n=137 (83%)} were planned for vaginal delivery and in these patients two-thirds attained vaginal delivery. There was 1 fetal death in the CS group compared to 12 deaths in the vaginally delivered breech. However, most death in the breech delivered vaginally are unavoidable. In conclusion, there is a high rate of breech vaginal delivery in this series of patients and most perinatal deaths were not related to the mode of delivery.
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4.Development of a purification method of pure primary lymphocytes for cell viability assays.
Chan Kok Keong ; Vishna Devi V Nadarajah * ; Tay Ju Lee
Malaysian Journal of Medical Sciences 2007;14(1):38-45
The maintenance of pure primary lymphocytes culture for long periods may be difficult because of its inability to divide continuously. In addition, lymphocytes separation methods such as Ficoll-Paque, RBC lysis and immunomagnetic microbeads separation may have some affect on cell viability. The objective of this study is to determine various types of lymphocytes purification methods, in order to prolong primary lymphocytes culture to 72 hours. The second objective is to use these primary lymphocytes as targets for quantitative and qualitative cell viability assays when analysing the action of toxins isolated from natural products. Human blood was drawn and purified by using Ficoll-Paque, RBC lysis or
immunomagnetic separation column method in various combinations. The purified lymphocytes were also grown with and without the growth enhancement factor, concanavalin-A. Cell viability assays were carried out for 72 hours at 24 hours interval. The lymphocytes purified using RBC lysis method, with or without concanavalin-A can prolong 100% cell viability for 72 hours whilst lymphocytes purified using Ficoll-Paque and supplemented with concanavalin-A showed an increase in cell viability of over 250% at 72 hours incubation. It was observed only lymphocytes purified using Ficoll-Paque followed by the immunomagnetic microbeads separation method and supplemented with concanavalin-A showed overall cell viability increase, reaching 300% at 72 hours incubation. This method was a reliable model to test the cytotoxicity of the Bacillus thuringiensis parasporal inclusion, suggesting that the method achieves the objectives of the study.
5.Does Overnight Culture of Cleaved Embryos Improve Pregnancy Rate in Vitrified-Warmed Embryo Transfer Programme?
Azam Agha-Rahimi ; Marjan Omidi ; Fatemeh Akyash ; Azita Faramarzi ; Forough Alsadat Farshchi
Malaysian Journal of Medical Sciences 2019;26(2):52-58
Background: Vitrification is a routine procedure in assisted reproductive technique (ART)
lab. However, there is widespread variability between protocols of different centres. The aim of
this study was to compare the chemical pregnancy, clinical pregnancy and live birth rates between
one-day embryo culture and immediate transfer for frozen-thawed embryo transfer (FET) cycles.
Methods: In this cohort retrospective study, 366 FET cycles were divided into two groups:
Group A, the embryos were warmed one day before transfer, and were cultured overnight;
Group B, the embryos were warmed on the same day of transfer, at least were cultured 1 h before
embryo transfer (ET). Chemical and clinical pregnancy and live birth rates were compared between
two groups.
Results: The chemical pregnancy was higher in group A than B (37.9% versus 28.9%), but
this difference was not significant (P = 0.07). Clinical pregnancy (30.8% versus 24.1%) and live
birth (19.8% versus 22.05%) were similar in group A and B, (P = 0.15), and (P = 0.8).
Conclusion: In conclusion, overnight culture and confirmation of mitosis resumption was
not essential for FET cycles in vitrification method.
6.Serum Ferritin Levels: A Potential Biomarker to Represent Child-Turcotte-Pugh Score among Decompensated Liver Cirrhosis Patients
Taufik Sungkar ; Muhammad Fakhrur Rozi ; Leo Basa Dairi ; Lukman Hakim Zain
Malaysian Journal of Medical Sciences 2019;26(2):59-65
Background: Liver cirrhosis and the child-Turcotte-Pugh (CTP) score are inseparable
entities in liver disease. CTP score is largely known as the mortality and prognosis predictor.
Nevertheless, ferritin emerges as a simple biomarker related to prognosis. The study aimed to
determine whether there was a significant correlation between serum ferritin levels and CTP score.
Methods: The study analysed 54 decompensated liver cirrhotic patients including
17 females and 37 males between May 2016 and May 2017 at the Haji Adam Malik General Hospital,
Medan, Indonesia. Ferritin levels were, then, divided into trichotomous cut-off value (< 200 ng/
mL, n = 22; 200–400 ng/mL, n = 5; and > 400 ng/mL, n = 27). Data was analysed using SPSS
version 12.0 (continuous variables were assessed by the Kruskal-Wallis test and Chi-square test
was used for categorical variables). In addition, Spearman correlation test was used to determine
any significant correlation between ferritin levels and CTP score.
Results: Based on data analysis, gender and CTP score were related to higher ferritin
levels (P = 0.002 and P = 0.018, respectively). Furthermore, a significant correlation between
serum ferritin levels and CTP score was obtained in to moderate degree (P = 0.000; r = 0.487).
Conclusions: There might be a significant role of serum ferritin levels in predicting
mortality and prognosis among decompensated liver cirrhosis patients but it still needs further
attention.
7.Laboratory Study on Injection Force Measurement on Syringe and Needle Combinations
Theddeus Octavianus Hari Prasetyono ; Prasasta Adhistana
Malaysian Journal of Medical Sciences 2019;26(2):66-76
Background: This study aimed to measure the least initial and maintenance forces of syringe
and needle combinations to provide a reference for local anesthetic injection.
Methods: An experimental study was conducted in our Physics Laboratory during
September 2015. A series of syringes sized 1 mL, 3 mL, 5 mL, 10 mL and 20 mL were paired with
the original needles, 27G, 27G spinal and 30G. Each combination was tested three times using a
compression testing Instron 5940 Series to measure initial and maintenance forces. Statistical
analysis was performed using One-way ANOVA.
Results: The lowest initial force was shown by the combination of 1 mL syringe and 27G
spinal needle. However, the 1 mL syringe showed no significant difference across the needles
[F(3, 8) = 3.545; P < 0.068]. The original and 27G needle showed mean difference 0.28 (95%CI:
−0.19, 0.75; P = 0.420). The lowest maintenance force was measured in the combination of 1 mL
syringe and its original 26G needle. On the contrary, both the highest initial and maintenance
forces were shown by the combination of 10 mL syringe and 30G needle.
Conclusion: The 1 mL syringe with original 26G needle shows the best combination.
8.The Use of Medicines with Anti-cholinergic Properties and Their Health Impacts among Hospitalised Malaysian Geriatric Patients
Izyan A Wahab ; Bakht Akbar ; Zainol Akbar Zainal ; Mohd Farizh Che Pa ; Basariah Naina
Malaysian Journal of Medical Sciences 2019;26(2):77-87
Background: Studies have shown that the use of medicines with anti-cholinergic (Ach)
properties can increase elderly patients’ risk of experiencing falls, confusion, and longer hospital
stays (LOS). These adverse effects are preventable with appropriate intervention. Little is known
about the use of medicines with Ach properties and their impact on Malaysian elderly patients.
This study aimed to investigate the use of medicines with Ach properties and their impact on fall
risk, confusion, and longer LOS among hospitalised elderly patients.
Methods: This study utilised a cross-sectional design and was conducted at a single centre
where convenience sampling was employed to collect data from elderly patients (> 60 years)
admitted to geriatric and medical wards at Hospital Tuanku Ja’afar during a 2-month period (July
2017–August 2017). Patients were excluded from this study if their hospital admission was planned
for an elective procedure or if neurocognitive and hepatic impairment were diagnosed prior to the
hospital admission. Medicines with Ach properties were identified and classified according to the
anti-cholinergic drug scale (ADS). Univariate and multiple logistic regression statistical analyses
were performed to assess its impacts on falls, confusion, and LOS.
Results: A total of 145 elderly patients with a mean age of 71.59 years old (SD = 8.02) were
included in the study. Fifty-two percent of the participants were female, and the average hospital
stay was 6 days (SD = 2.09). Medicines with Ach properties were administered in 62% (n = 90) of
the cases. The most commonly prescribed medicine with Ach properties was furosemide (n = 59),
followed by ranitidine (n = 44), warfarin (n = 23), and methylprednisolone (n = 22). Compared
to patients who did not receive medicines with Ach properties, patients who received them had a
significantly higher risk of falls [odds ratios (OR) = 2.61; 95%CI: 1.18, 5.78; P = 0.018], confusion
(OR = 3.60; 95%CI: 1.55, 8.36; P = 0.003), and LOS (OR = 4.83; 95%CI: 2.13, 10.94; P < 0.001).
Multiple comorbidities also showed a significantly increased risk of falls (OR = 3.03; 95%CI: 1.29,
7.07; P = 0.010).
Conclusion: Medicines with Ach properties had a significant impact on elderly patients’
health. Strategies for rationally prescribing medicines with Ach properties to Malaysian elderly
patients need to be improved and be recognised as an important public health priority.
9.Stressors and Coping Strategies during Clinical Practice among Diploma Nursing Students
Rusnani Ab Latif ; Mohd Zarawi Mat Nor
Malaysian Journal of Medical Sciences 2019;26(2):88-98
Introduction: Consistent with the significant of the stress issue in education, this study
aimed to survey type of stressors and identifies the coping strategies used by diploma nursing
students during clinical practices.
Methods: A descriptive cross-sectional study was carried out at the Kubang Kerian
Nursing College, Kelantan which involved 346 respondents using simple random sampling
method. The inclusion criteria were year one, two and three of nursing students who have clinical
posting and voluntarily joining the study. Perceived Stress Scale (PSS) and Brief COPE inventory
were utilised in the data collection. Higher mean score indicates higher degree of stress.
Results: Clinical assignments and workload were the main stressor (mean = 3.19,
SD = 1.09). Religion approach was the most coping strategy applied (mean = 3.30, SD = 0.71).
Pearson’s correlation coefficient test found that six domains of stressors during clinical practices
(taking care of patients; clinical educators/instructors and ward staff; clinical assignments and
workload; peers and nursing students from other college; lack of professional knowledge and skills
and clinical environment) were statistically significant correlation with coping strategies, where
P-value < 0.05.
Conclusion: Clinical assignment was the main stressor among nursing students; therefore,
successful activities should be promoted to help them in managing clinical assignment and
enhancing knowledge in religion.
10.Confirmatory Factor Analysis of the Malay-Language Transtheoretical Model of Physical Activity among Malaysian Primary School Children
Hussein Rizal ; Mawar Siti Hajar1, ; Yee Cheng Kueh ; Ayu Suzailiana Muhamad ; Garry Kuan
Malaysian Journal of Medical Sciences 2019;26(2):99-113
Introduction: The transtheoretical model (TTM) is an integrative model of intentional
change consisting of stages of change, processes of change, decisional balance and self-efficacy.
This study aimed at validating the TTM questionnaires on physical activity for Malaysian children
using confirmatory factor analysis.
Methods: The participants were 381 Malay students (188 male; 193 female), aged 10–12
years old, with a mean age of 10.94 (SD = 0.81). The original version of the TTM was translated into
the Malay language using forward and backward translation. Certain phrases were adapted based
on the local culture and vocabulary suitable for primary school students.
Results: The final measurement models and their fit indices were: processes of change
(CFI = 0.939, TLI = 0.925, SRMR = 0.040, RMSEA = 0.030); decisional balance (CFI = 0.897,
TLI = 0.864, SRMR = 0.045, RMSEA = 0.038); and self-efficacy (CFI = 0.934, TLI = 0.915,
SRMR = 0.042, RMSEA = 0.032).
Conclusion: Care must be taken when using the TTM with children, as it has been
prevalently validated with adults. The final version of the TTM questionnaire for Malay primary
school children had 24 items for process of changes, 13 items for self-efficacy and 10 items for
decisional balance.