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Purpose@#To determine the prevalence of diabetic retinopathy (DR) and the factors associated with retinopathy among type 2 diabetes mellitus (DM) patients in Brunei Darussalam. @*Methods@#Cross-sectional study of all type 2 DM patients who attended diabetic eye screening over a 3-month period at one of four government hospitals. We assessed association between DR with the following variables: age, sex, glycated hemoglobin (HbA1c), duration of DM, hypertension, hyperlipidemia, and microalbuminuria. @*Results@#There were 341 patients (female, 58.9%; mean age, 55.3 ± 11.9 years) with a mean duration of DM of 9.4 ± 7.4 years and mean serum HbA1c of 8.4% ± 1.9%. The overall prevalence of any DR was 22.6% (95% confidence interval, 18.8–27.1) with prevalence rates of 4.1% (95% confidence interval, 2.1–6.4) for proliferative DR and 9.7% (95% confidence interval, 6.8–13.2) for vision-threatening DR. Multivariate analysis showed that DR was significantly associated with certain age groups (reduced in older age groups), longer duration of DM (11 years or more), poor control (HbA1c >9.0%) and presence of any microalbuminuria. @*Conclusions@#DR affects one in five patients with DM in Brunei Darussalam, comparable to rates reported for other Asian populations. It is especially worrying that one in ten patients with DM had vision-threatening DR. DR was significantly associated with longer duration of DM, poor control and presence of microalbuminuria but reduced in older age groups. It is important to advocate good control right from the time of diagnosis of DM and institute timely and effective management of retinopathy. DR was significantly associated with longer duration of DM, poor control of diabetes, and presence of microalbuminuria but reduced in older age groups.
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@#Objective: This study is a preliminary work to develop a Malay version questionnaire named ‘Inventori Persepsi bagi Muslim yang Memiliki Masalah Pendengaran (IPM3P)’ to assess the perception on Islamic understanding and practice among Muslim adults with hearing impairment. Methods: The scale development involved three phases: i) generation of domains based on the literature, ii) generation of sub-domains based on literature review and Islamic panel survey, and iii) generation of items. Results: Preliminary version of IPM3P consists of 59 items was produced, representing three domains: Obligation (18 items), Practice (21 items), and Difficulty (20 items), and seven sub-domains (‘Ibadah’, ‘Aqidah’, ‘Muamalat’, ‘Tasawwuf’, ‘Akhlak’,‘Da’wah’, and ‘Sirah’). Conclusion: The preliminary version of IPM3P needs to be psychometrically tested. This pioneering study may become an impetus towards more research pertaining to understanding the effect of hearing loss towards religious life in the future in Malaysia.
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Aims: We aimed at auditing hernia surgeries performed at a secondary care centerand determine the outcome of surgery based on the grade of operating surgeon. Study Design: A single center retrospective study.Place and Duration of Study: Department of Surgery of Ashanti regional Hospitalbetween October 2015 to September 2018.Methodology: We included 259 patients, age ranging between 1 and 84 years, who underwent external hernia surgeries.Information retrieved included patient demographics, type of hernia, duration of hernia, whether hernia was emergency or elective, method of repair, whether surgery was performed by a surgeon or non-surgeon and early post-operative complications. Datawas analyzed using PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc SPSS. Bivariate analysis was done to ascertain relationship between complications and operating doctor.Results: A total of 259 hernia surgeries were performed over the study period. There were186 (71.8 %) males and 73 (28.2 %) females, age range of 1 to 84 years. There were 66 (25.5%) children and 193(74.5%) adults. Children in their first decade were the majority (22.4%) age group followed by adults in their 5thdecade (17%). Inguinal hernia was the most common (75.7%) type of hernia, 49 (18.9%) children and 147(56.6%) adults. There were 32 (12.4%) emergencies. Small bowel (20) was the most common content found in the hernia sac with 6 of them being gangrenous. Hematoma was the most common early complication.The majority (63.7%) of the cases were performed by the general surgeon and (20.1%) by house officers (interns) under supervision. Complications like haematoma, surgical site infection and acute urinary retention were more likely to occur in the non-surgeon operators. There was no statistically significant relation between the grade of operating surgeon and Haematoma (p= 0.28) and surgical site infection (p= 0.76).Conclusion: Hernias are common in children in the first decade and in adults in the 5thdecade. With a well-structured training programme non-surgeon physicians can be trained to perform hernia surgeries with relatively low complication.
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Introduction:Renal oncocytomas are benign tumours arising from the intercalated cells of the collecting ducts and account for 3% to 7% of primary renal tumours. It was first described by Zippel in 1942. Oncocytomas are mostly asymptomatic and often discovered incidentally. They are often diagnosed postoperatively due to clinical and radiographic challenges in differentiating them from renal cell carcinoma. Presentation of Case:The present study reports two cases of renal oncocytoma in a 61-year-old man who was asymptomatic and a 73-year-old woman who was symptomatic. Relevant clinical and imaging data on the two patients were reviewed. Both patients underwent nephrectomy via flank incisions. Discussion:The typical morphologic features of oncocytoma were observed on histological examination of the excised kidney specimens. The postoperative course of each patient was uneventful and they were discharged 14 and 6-days post-surgery, respectively. In addition, the present study reviews the literature regarding the clinical, radiological and pathological characteristics of renal oncocytoma.Conclusion:Renal oncocytoma though is benign and has an excellent prognosis, the preoperative diagnostic challenges invariable warranted radical nephrectomy.
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Aims:Ventriculoperitoneal(VP) shunt placement is one of the commonest procedures under taken by neurosurgeons to manage
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@#The incidence of neurenteric cyst (NC) is rare amongst spine tumors. It is most often asymptomatic but may present with sensory and motor symptoms. When associated with thoracic vertebra fusion it is not reported before, this complicates the placement of pedicle screw during posterior instrumentation. Herein, we report a case of thoracic spinal neurenteric cyst in a 40-year-old man that presents with chronic back pain, left lower limb weakness and numbness. Elective excision of NC over T6-T7 with laminectomy and multilevel posterior instrumentation was successfully performed with significant improvement of the symptoms. Neurenteric cyst is a rare spinal cord lesion which may cause permanent neurological sequalae. Complete surgical excision with spine fixation in this case provides good long-term outcome.
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Introduction: Recurrent tonsillitis is a major cause of morbidity and may require surgical intervention when medical treatment has failed. Reasons suggested for treatment failure include the use of inappropriate antibiotics aimed at pathogens present on the tonsil surface rather than those present in the tonsil core. Material and Methods: A total of 60 cases of chronic and recurrent tonsillitis which were not responding to medical treatment and are fit and willing for surgery were included in the study. Results: The culture results of tonsillar surface and core tissue revealed that the majority of samples showed pathogens. Out of 120 cultures of tonsillar tissue,14 results showed the growth of commensal flora. Single pathogen was isolated from 86 samples from surface and core of the tonsil. However, 14 cultures of core tissue revealed growth of two pathogens as compared to 6 cultures from the tonsillar surface. Conclusion: Staphylococcus is the most common pathogen isolated from the tosillar surface as well as core followed by GABHS
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@#Background: Occupational Safety and Health Master Plan for Malaysia 2015 was intended to increase awareness, knowledge and commitment to Occupational Safety and Health in all undertaking to reduce the number of injuries, diseases and fatalities. Objectives: The purpose of this study is to determine the effectiveness of Occupational Safety Health Master Plan for Malaysia 2015 (OSH-MP 15) in enhancing government leadership and preventive workplace culture. Methods: This cross sectional study covered all the states in Malaysia, constituting of 309 employers, 350 Occupational Safety Health practitioners and 360 employees as respondents. There were three questionnaires for three different groups which were employers, Occupational Safety Health practitioners and general employees. The respondents were selected through random sampling. Results: For strategy 1, there was a significant difference in mean of effectiveness of OSH-MP15 between sectors for general workers [F (11, 348) =12.06, p=<0.001], OSH practitioners [F (11, 338) =1.19, p=0.033] and employers [F (11, 297) =5.62, p=<0.001]. For strategy 2, a significant difference in mean of effectiveness of OSH-MP15 between sectors was found for general workers [F (11, 348) =4.52, p=<0.001], OSH practitioners [F (11, 338) =2.28, p=0.011], employers [F (11, 297) =5.74, p=<0.001]. Conclusion: There was a significant difference between the effectiveness of fostering, and enhancing government leadership and inculcating preventive workplace culture among respondents. This study acts as the baseline data for the effectiveness of Occupational Safety and Health Master Plan 2015 in enhancing government leadership and preventive workplace culture.Keywords: Occupational Safety; health; leadership; prevention; accidents
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Background: The availability of obesity specific quality of life measurement tool is limited. The Malay version of Impact of Weight on Quality of Life-Lite is an obesity specific quality of life questionnaire which has been translated for use in Malaysia. The aim of this study is to evaluate the validity and reliability of this tool to measure quality of life among different body mass index (BMI) groups.Methods: One hundred and twenty subjects with different BMI categories attending an outpatient government clinic participated in this study. The translated Malay version of IWQOL-Lite was used for assessment. The validity of this questionnaire was examined using content validity, criterion validity and construct validity. Reliability analyses used in this study were internal consistencies and test-retest reliability. Results: The Malay version of IWQOL-Lite showed good psychometric properties whereby the content validity was sufficient as measured by expert panels. The mean score of all IWQOL-Lite domains were able to discriminate between different BMI groups. Good internal consistency was demonstrated by Cronbach alpha of 0.936. Test-retest reliability ranged from 0.828 to 0.932. The physical function score (IWQOL-Lite) correlated positively with Physical Component Summary of Short Form-36 questionnaire. Exploratory factor analysis found that the questions loaded on five domains. Conclusion: The results suggest that the Malay version of IWQOL-Lite is a valid and reliable tool to measure quality of life among obese and overweight subjects in Malaysia.
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Introduction: Health education is an essential part of controlling the risk of myocardial infarction (MI). This study evaluates the effects of one-on-one education programmes on the cardiovascular health index among patients with MI.Methods: A quasi-experimental study was conducted in Kuala Lumpur Hospital, Malaysia. Data were collected from November 2014 to January 2015 with a total of 58 respondents who met the inclusion criteria. The respondents received a 20-min one-on-one education programme regarding coronary heart disease, treatment and prevention, and healthy lifestyle. A questionnaire comprising demographic data was administered and the cardiovascular health index was measured before and after four weeks of the education programme. Data were analysed with descriptive and inferential statistics.Results: There were statistically significant decreases in the score of anxiety, stress, depression, body mass index, and smoking status (P < 0.001) between pre-test and post-test.Conclusion: The findings suggest that the one-on-one education programme could improve the cardiovascular health index of patients with MI. Furthermore, nurses need to develop and implement a standard education structure programme for patients with MI to improve health outcomes.
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Background: Ruptured cerebral aneurysm is a life-threatening condition that requires urgent medical attention. In Malaysia, a prospective study by the Umum Sarawak Hospital, Neurosurgical Center, in the year 2000–2002 revealed an average of two cases of intracranial aneurysms per month with an operative mortality of 20% and management mortality of 25%. Failure to diagnose, delay in admission to a neurosurgical centre, and lack of facilities could have led to the poor surgical outcome in these patients. The purpose of this study is to identify the factors that significantly predict the outcome of patients undergoing a surgical clipping of ruptured aneurysm in the local population. Material and Method: A single center retrospective study with a review of medical records was performed involving 105 patients, who were surgically treated for ruptured intracranial aneurysms in the Sultanah Aminah Hospital, in Johor Bahru, from July 2011 to January 2016. Information collected was the patient demographic data, Glasgow Coma Scale (GCS) prior to surgery, World Federation of Neurosurgical Societies Scale (WFNS), subarachnoid hemorrhage (SAH) grading system, and timing between SAH ictus and surgery. A good clinical grade was defined as WFNS grade I–III, whereas, WFNS grades IV and V were considered to be poor grades. The outcomes at discharge and six months post surgery were assessed using the modified Rankin’s Scale (mRS). The mRS scores of 0 to 2 were grouped into the “favourable” category and mRS scores of 3 to 6 were grouped into the “unfavourable” category. Only cases of proven ruptured aneurysmal SAH involving anterior circulation that underwent surgical clipping were included in the study. The data collected was analysed using the Statistical Package for Social Sciences (SPSS). Univariate and multivariate analyses were performed and a P-value of < 0.05 was considered to be statistically significant. Result: A total of 105 patients were included. The group was comprised of 42.9% male and 57.1% female patients. The mean GCS of the patients subjected to surgical clipping was 13, with the majority falling into the good clinical grade (78.1%). The mean timing of the surgery after SAH was 5.3 days and this was further categorised into early (day one to day three, 45.3%), intermediate (day four to day ten, 56.2%), and late (after day ten, 9.5%). The total favourable outcome achieved at discharge was 59.0% as compared to 41.0% of the unfavourable outcome, with an overall mortality rate of 10.5%. At the six-month post surgery review (n = 94), the patients with a favourable outcome constituted 71.3% as compared to 28.7% with an unfavourable outcome. The mortality, six months post surgery was 3.2%. On a univariate analysis of early surgical clipping, patients with a better GCS and good clinical grade had a significantly better outcome at discharge. Based on the univariate study, six months post surgery, the timing of the surgery and the clinical grade remained significant predictors of the outcome. On the basis of the multivariate analysis, male patients of younger age, with a good clinical grade, were associated with favourable outcomes, both at discharge and six months post surgery. Conclusion: In this study, we concluded that younger male patients with a good clinical grade were associated with a favourable outcome both at discharge and six months post surgery. We did not find the timing of the surgery, size of the aneurysm or duration of surgery to be associated with a patient’s surgical outcome. Increasing age was not associated with the surgical outcome in a longer term of patient’s follow up.
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Objective:To identify the phytochemical compounds from Annona muricata (A. muricata) and to determine their in vitro anti-proliferative activities against breast cancer cells, MCF7 and MDA-MB-231.Methods:A. muricata leaves were successively extracted by soxhlet method using n-hexane, ethyl acetate and methanol, and decocted with water. Each extract was analysed by gas chromatography mass spectrometry (GCMS) and characterized with Wiley and NIST library searches. Anti-proliferative activity of each extract was evaluated on MCF7 and MDA-MB-231 breast cancer cells using MTT assay.Results:The GCMS analysis of different solvent extracts of A. muricata leaves showed presence of different chemical groups of compounds such as steroids, terpenoids, phenolic compounds, sugars, sugars alcohol and others including vitamin E. Ethyl acetate leaves extract exhibited the lowest ICConclusion:Steroids and phenolic compounds were the main phytocompound groups identified from all A. muricata leaves extracts. The antiproliferative activity of n-hexane and ethyl acetate extract towards breast cancer MCF7 and MDA-MB-231 respectively might be due to the presence of biologically active compounds in the extracts, hence, providing some scientific evidences of the effectiveness of its traditional usages.
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Objectives: Following penile prosthesis implantation [PPI], patients may complain of a decrease in visible penis length. A dorsal phalloplasty defines the penopubic junction by tacking pubic skin to the pubis, revealing the base of the penis. This study aimed to evaluate the efficacy of a dorsal phalloplasty in increasing the visible penis length following PPI
Methods: An inflatable penile prosthesis was implanted in 13 patients with severe erectile dysfunction [ED] at the Kamal Shaeer Hospital, Cairo, Egypt, from January 2013 to May 2014. During the surgery, nonabsorbable tacking sutures were used to pin the pubic skin to the pubis through the same penoscrotal incision. Intraoperative penis length was measured before and after the dorsal phalloplasty. Overall patient satisfaction was measured on a 5-point rating scale and patients were requested to subjectively compare their postoperative penis length with memories of their penis length before the onset of ED
Results: Intraoperatively, the dorsal phalloplasty increased the visible length of the erect penis by an average of 25.6%. The average length before and after tacking was 10.2 +/- 2.9 cm and 13.7 +/- 2.8 cm, respectively [P <0.002]. Postoperatively, seven patients [53.8%] reported a longer penis, five patients [38.5%] reported no change in length and one patient [7.7%] reported a slightly shorter penis. The mean overall patient satisfaction score was 4.9 +/- 0.3. None of the patients developed postoperative complications
Conclusion: A dorsal phalloplasty during PPI is an effective method of increasing visible penis length, therefore minimizing the impression of a shorter penis after implantation
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Introduction: Computed tomography (CT) is the preferred diagnostic toolkit for head and brain imaging of head injury. A recent development is the invention of a portable CT scanner that can be beneficial from a clinical point of view. Aim: To compare the quality of CT brain images produced by a fixed CT scanner and a portable CT scanner (CereTom). Methods: This work was a single-centre retrospective study of CT brain images from 112 neurosurgical patients. Hounsfield units (HUs) of the images from CereTom were measured for air, water and bone. Three assessors independently evaluated the images from the fixed CT scanner and CereTom. Streak artefacts, visualisation of lesions and grey–white matter differentiation were evaluated at three different levels (centrum semiovale, basal ganglia and middle cerebellar peduncles). Each evaluation was scored 1 (poor), 2 (average) or 3 (good) and summed up to form an ordinal reading of 3 to 9. Results: HUs for air, water and bone from CereTom were within the recommended value by the American College of Radiology (ACR). Streak artefact evaluation scores for the fixed CT scanner was 8.54 versus 7.46 (Z = -5.67) for CereTom at the centrum semiovale, 8.38 (SD = 1.12) versus 7.32 (SD = 1.63) at the basal ganglia and 8.21 (SD = 1.30) versus 6.97 (SD = 2.77) at the middle cerebellar peduncles. Grey–white matter differentiation showed scores of 8.27 (SD = 1.04) versus 7.21 (SD = 1.41) at the centrum semiovale, 8.26 (SD = 1.07) versus 7.00 (SD = 1.47) at the basal ganglia and 8.38 (SD = 1.11) versus 6.74 (SD = 1.55) at the middle cerebellar peduncles. Visualisation of lesions showed scores of 8.86 versus 8.21 (Z = -4.24) at the centrum semiovale, 8.93 versus 8.18 (Z = -5.32) at the basal ganglia and 8.79 versus 8.06 (Z = -4.93) at the middle cerebellar peduncles. All results were significant with P-value < 0.01. Conclusions: Results of the study showed a significant difference in image quality produced by the fixed CT scanner and CereTom, with the latter being more inferior than the former. However, HUs of the images produced by CereTom do fulfil the recommendation of the ACR.
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Introduction: Symptomatic chronic subdural hematomas (CSDH) remain one of the most frequent diagnoses in current neurosurgical practice. Burr-hole craniostomy with irrigation and placement of close-system drainage is the current recommended surgery for symptomatic CSDH. The aim of this study is to perform a direct comparison between two surgical techniques in the treatment of symptomatic CSDH, which have been proven in previous studies to be efficient. Our main objective was to compare the efficacy of placement of a subperiosteal drain (SPD) and a subdural drain (SDD) following single burr-hole craniostomy and irrigation, and to demonstrate any significant differences in terms of overall surgical complications, functional outcome at three months and mortality rate. Materials and Methods: The study was carried out in two local neurosurgical centres. The SPD group was performed in Hospital Umum Sarawak (HUS) and the SDD group was performed in Hospital Sultanah Aminah Johor Bahru (HSAJB), from 1 January 2012 till 30 January 2014 with a total of 30 patients in both treatment groups. Results: Overall, there were no statistically significant difference in terms of patient general characteristics, pre-operative and post-operative symptoms, Markwalder grades, postoperative hematoma volume and recurrence, mortality and functional outcome at discharge and at three month follow-up between both groups. Albeit not achieving statistical significance, we observed a lower rate of surgical complication especially for post-operative intracranial hematoma with placement of the SPD system. Conclusions: Our study concludes that both treatment methods proved to be highly effective in the treatment of CSDH. However, with a lower overall surgical complication rate, treatment with single burr-hole craniostomy, irrigation and placement of the SPD system can be considered a treatment of choice for the management of symptomatic CSDH.
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Background and study aims: Helicobacter pylori infection is common in Egypt. It has been associated with gastritis, ulcers and it is a risk factor for gastric cancer. We aimed to study the correlation between the presence of H. pylori virulence factors and the histopathological and endoscopic findings in gastric biopsies
Patients and methods: Gastric biopsies from thirty seven patients scheduled for diagnostic endoscopy in Cairo University hospital were included in the study. All gastric biopsies were subjected to histopathological examination and PCR assay for detection of 16S rRNA gene to diagnose H. pylori infection, detection of H. pylori virulence factors by PCR for cagA and vacA genotypes and serological analysis of H. pylori [cagA, vacA, P25, and P19] IgG antibodies by immunoblot assay were done
Results: H. pylori infection was detected in 23 [62.2%] cases by histopathology while 28/37 [75.7%] were positive for H. pylori 16S rRNA gene by PCR. By PCR seventeen samples out of 37 [45.9%] were positive for cagA gene and five [13.5%] for cag empty site gene
Conclusion: the most common vacA genotype identified was vacA s2m2 genotype in 10 [27.02%]. No statistical correlation was found between IgG antibodies against different antigens of H. pylori virulence factors [cagA, vacA, p25, and p19] and the degree of gastritis except for IgG antibodies against the UreA antigen
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Background: an effective polymer gel dosimeter can be fabricated by varying the composition of its chemical components
Materials and Methods: the MAGAT gel dosimeter formulations that used different compositions of Methacrylic acid [MAA] and gelatin were extensively investigated in the present study according to the R2-dose response and R2-dose sensitivity. The irradiation of MAGAT gel was performed by 6-MV photon beam at a dose range 1 to 10 Gy and was imaged by 1.5T Magnetic Resonance Imaging [MRI]. The dose response of MAGAT gel dosimeter was obtained from spin-spin relaxation rate [R2] of MRI signal
Results: the MAGAT gel dosimeter composed of 5% gelatin and 6% MAA gave the highest sensitivity [1.1180 s[-1]Gy[-1]]
Conclusion: understanding the effects of the compositional changes will help to clarify the mechanisms involved in the dose response of the MAGAT gel dosimeter
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Mental health services in the Eastern Mediterranean Region are predominantly centralized and institutionalized, relying on scarce specialist manpower. This creates a major treatment gap for patients with common and disabling mental disorders and places an unnecessary burden on the individual, their family and society. Six steps for reorganization of mental health services in the Region can be outlined: [1] integrate delivery of interventions for priority mental disorders into primary health care and existing priority programmes; [2] systematically strengthen the capacity of non-specialized health personnel for providing mental health care; [3] scale up community-based services [community outreach teams for defined catchment, supported residential facilities, supported employment and family support]; [4] establish mental health services in general hospitals for outpatient and acute inpatient care; [5] progressively reduce the number of long-stay beds in mental hospitals through restricting new admissions; and [6] provide transitional/bridge funding over a period of time to scale up community-based services and downsize mental institutions in parallel
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Mental Disorders , Primary Health CareABSTRACT
Maternal and child health [MCH] programmes are the most logical and appropriate platforms for integration of mental health care in an equitable, accessible and holistic manner. Such integration has the potential to improve both mental and physical health synergistically. Key steps to successful integration include a] recognition, at the highest international and national policy forums, that mental health and well-being is a generic component of MCH that does not compete with MCH programmes but instead complements them; b] tailoring the training and supervision of MCH and primary care personnel so they can recognize and assist in the management of common maternal and child mental health problems, recognizing that this, in turn, will enable them to be more effective health-care workers; c] adapting effective interventions to local contexts; and d] investing in implementation research so that these approaches are refined and scaled-up, leading to improved outcomes for all MCH programmes