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@#Introduction: The COVID-19 pandemic has forced revolutionary changes in the delivery of medical education and imposed much stress on medical students and academicians. This study aimed at evaluating the level of exposure to COVID-19, COVID-related functional difficulties and concerns experienced by medical students, approximately one year after COVID-19 became significant health and socio-economic issues in Malaysia. Methods: A cross-sectional study using self-administered online questionnaire, was conducted among the undergraduate medical students of a private university in Malaysia. Results: A total of 243 medical students participated. They reported low level of exposure to COVID-19 infection. Majority of them demonstrate moderate level of difficulties in learning (median score of 3, highest score = 4) and high levels of COVID-related concerns (median scores of 4 to 5, highest score = 5). Lowest household income category was a significant predictor of high level of functional difficulties (OR = 3.878, 95%CI: 1.651, 9.110); whilst female gender was a significant predictor of high level of COVID-related concerns (OR = 7.400, 95%CI: 1.920, 28.514). Conclusion: One year following the onset of COVID-19 pandemic in Malaysia, medical students still reported significant functional difficulties in learning and demonstrated high levels of COVID-related concern. Collaborative efforts to mitigate the problems need to be intensified with emphasis on the delivery of online medical education and special attention to female and lower socio-economic group students to prevent detrimental consequences to medical students and medical education. Multi-center and longitudinal studies are recommended.
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@#Introduction: To combat the COVID-19 pandemic, Malaysia started vaccination of front-liners and adults in the community. The latter group might have insufficient knowledge to accept COVID-19 vaccination, therefore this research was to assess the knowledge and acceptance of COVID-19 vaccination among youths, specifically students in a Malaysian college. Methods: A cross-sectional study was conducted among 481 foundation students in Kolej MARA Kulim (KMKU). The minimum sample size, using Epi Info was 214. Students answered an online questionnaire using google form which included demographic data (age, gender) and ten questions on knowledge and acceptance of COVID-19 vaccination. For knowledge questions, students answered “yes”, “no” or “don’t know”, correct answer scoring 1. For acceptance questions, a 5-point Likert scale was used ranging from “strongly disagree” to “strongly agree”. EXCEL and SPSS version 23 were used for analysis with Chi-square test done to test association (significant for p-value <0.05). Results: The response rate was 65.1% with 313 students, (45.4% males, and 54.6% females) aged 18-19 years. The majority (83.7%) had satisfactory to excellent knowledge scores (mean = 6.66 (SD=2.299, 95% CI 6.40-6.91), median = 7 (± IQR =3), while 16.3% obtained poor scores (≤ 4). The majority (90%) accepted vaccination. Higher knowledge scores were associated with higher acceptance rates in both genders (p-value= 0.000). Significantly more females (90.6%) than males (80.3%) had positive attitude towards vaccination (p-value = 0.009). Conclusions: The majority of the foundation students in KMKU were knowledgeable on COVID-19 vaccination and willing to receive the vaccination against the novel coronavirus.
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@#Introduction: Prevalence of malnourished children in Putrajaya was unexpectedly high in 2016. This paper describes the study protocol for a case-control study conducted to identify the associated factors of malnutrition among children under 5 years old in Putrajaya. Methods: This study involved two phases. Phase I was ‘screening’ where all children aged 6-59 months in 118 preschools and four government health clinics were measured for their weight and height. The World Health Organization Anthro software was used to determine the nutritional status of these children. Phase II was the ‘interview’ where children from screening were sampled into four pairs of case and control. The optimum sample size for the case of stunted, wasted, underweight, and overweight were 380, 335, 318, and 308, respectively. The same number of controls were recruited. Parents/caregivers of selected children were approached to obtain data on parental factors, children factors, food intake factors, and environmental factors that contributed to malnutrition. Data analysis was performed by multiple logistic regression in SPSS version 26. Results: Screening phase successfully measured 8,261 (50.1%) children from an estimated 16,500 children under 5 years old in Putrajaya. The number of children who were stunted, wasted, underweight, and overweight were 2,105 (25.5%), 512 (6.2%), 1,516 (18.4%), and 248 (3.0%), respectively. As overweight was undersampled, the number of controls for overweight was doubled to increase the power of the study. Parents/caregivers of selected cases and controls were interviewed in their household or any other venues at their convenience. Conclusion: This protocol promises beneficial outputs to stakeholders and policy makers that can be used for combating malnutrition in children.
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Background: Metabolic syndrome (MS) predisposes to left ventricular dysfunction and heart failure, however, alterations in left atrial (LA) function in MS are unknown. Objectives: We aimed to use strain/strain rate (SR) imaging to investigate the effect of MS on LA function. Subjects and Methods: This prospective case control study included a total of 100 subjects divided in to 75 metabolic syndrome (MS) patients referred to Al-Azhar university hospital outpatient clinic for evaluation and treatment of hypertension and/or diabetes mellitus and 25 age and sex matched apparently healthy volunteers as a control group. All subjects underwent conventional echocardiographic examination and assessment of LA function by speckle tracking. Partial correlation and multiple stepwise regression analyses were used to determine the risk factors for impaired LA function. Results: Compared with the controls, the MS patients showed significantly lower levels of mean strain, mean peak systolic SR and mean peak early diastolic SR (P<0.05 for all), with no difference in the mean peak late diastolic SR. Central obesity, hypertension, dyslipidemia and uncontrolled diabetes were independent risk factors for impaired LA function. Conclusion: SR imaging is reliable in assessing LA function in MS patients
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Atrial Function, Left , Case-Control Studies , Echocardiography , Egypt , Metabolic Syndrome/physiopathologyABSTRACT
In the present study, to investigate genetic diversity and phylogenetic relationships among honey bee populations of Iraq ISSR markers were used. Sampling was carried out during summer 2017 from 5 cities of Iraq (Dahuk, Arbil, Sulaymaniyah, Kirkuk, and Kafri). Total DNA was extracted from the head and thorax sections of each worker honey bee, using salting out method with minor modifications. PCR amplification of genomic DNA was performed using 10 ISSR marker primers (A1, A2, A3, A4, A5, A6, A7, A8, A9 and A10). The primers yielded 50 polymorphic bands and number of bands were variable from 8-12 (average 9.62), and percentage of polymorphic loci was 73.6. The estimated genetic diversity for the populations ranged from 0.39 in Kafri population to 0.47 in Arbil population, and total genetic diversity among loci was calculated as 0.47 while average within population genetic diversity was 0.44. GST value was 0.085. The Phylogenetic tree showed two main clusters; the first one comprised of three populations (Dahuk, Arbil, and Sulaymaniyah), and the second one included two communities (Kirkuk and Kafri). Heterozygosity values, Shannon index and the number of alleles of honey bee populations were minimal that could be caused by low definite geographic structure of honey bee populations. This research provided new information regarding genetic diversity in selected local honeybee in Kurdistan region of Iraq and will be useful for selection, future local biodiversity conservation and controlled breeding programs.
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Lymphoma presenting with ulceration is not typical. Wereport a case of relapsed DLBCL in a 73-year-old manpresenting with a chronic non-healing leg ulcer. He hasunderlying varicose veins with recurrent venous ulcers. This patient was diagnosed to have DLBCL six years earlier when he presented with recurrent epistaxis originating from a left nasal cavity nodule. Complete resolution was achieved after eight cycles of R-CHOP and intrathecal methotrexate. For this current problem, this patient was treated with rituximab combined with chemotherapy which resulted in healing of the ulcer.
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Introduction:Patch test is the gold standard diagnostic test for contact allergy. Periodic analysis of the trend ofcontact allergy provides a valuable guide to clinicians. We aim to study the pattern of contact allergyin adults at Hospital Selayang.Methods:This is a retrospective review of patch test data in adults suspected with allergic contact dermatitisbetween January 2011 and December 2013 at Hospital Selayang.Results:There were 705 subjects with 247 males (35%) and 458 females (65%). At least 1 positive reactionwas detected in 546 (77.4%) subjects patch tested with European Baseline Series (EBS) and additionalseries. The top 5 common allergens in the EBS were nickel sulfate (28.7%), cobalt chloride (13.6%),paraben mix (11.6%), balsam of peru (10.6%), and potassium dichromate (10.5%). Among thosepatch tested with rubber additives series, the top 3 allergens were N,N-Diphenylguanidine (DPG),N-Cyclohexyl-N-phenyl-4-phenylenediamine (CPPD), and N-Cyclohexylthiophthalimide. Of thetop 5 common allergens in the group tested with fragrance series, all except Ylang ylang oil werecomponents of fragrance mix I. Among the subjects tested with fragrance series, the top 5 commonallergens were individual components of fragrance mix I and Ylang ylang oil.Conclusion:A multicentre study would reflect better the pattern of allergen exposure of the nation. Furtherevaluation of the prevalence of contact allergy to DPG, CPPD, N-Cyclohexylthiophthalimide andYlang ylang oil would guide the need to incorporate these allergens in routine testing along with EBS.
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Toxic epidermal necrolysis (TEN) is a severe mucocutaneous disease characterized by extensive epidermal detachment with drugs as the most probable cause. We describe a unique case of TEN where systemic lupus erythematosus (SLE) was found to be the precipitating underlying disease. Our patient was managed in ICU, however succumbed one month after her diagnosis due to overwhelming sepsis and multiorgan failure.
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Behcet’s disease (BD) is a variant of systemic vasculitides characterized by recurrent oral aphthous ulcers, recurrent genital ulcers with eyes, cutaneous, gastrointestinal, joints, neurological and others organ involvement. Here we aim to describe the demography, clinical patterns and the treatment of 5 cases of BD presented to the Department of Dermatology Hospital Kuala Lumpur between 2002 and 2016. All the patients had a delay in their diagnosis. The clinical characteristics and the choices of treatment in our patients did not differ greatly compared to the reports from other countries. BD could be under-diagnosed in Malaysia as the presenting symptoms are non-specific. Therefore, a high index of suspicion is needed.
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The furnishings provided by the Institute of Higher Learning (IHL) are not suitable with the diverse student’s body shapes. This could leads to lack of comfort in usage of the furnishings as well as affecting the effectiveness of the delivery of the lectures. Therefore, the objectives of this study are to evaluate the student’s comfort level in the current seat of the Lecture Theatre (LT) and to gather student’s anthropometry data. Two hundred and twenty one students were involved in this study from one of the IHL in Selangor. A few similar design of LT were chosen for this study. The Standard Nordic Questionnaire was used to identify the comfort level of students. Eleven body parts measurements of all participated students were collected by using measurement apparatus such as callipers and ruler. Based on the findings, it showed that the current seat in LT is uncomfortable to be used, in line with the results from surveys and mismatch of the seat and student measurement data.
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BACKGROUND: Ischemic preconditioning has been shown to improve the outcomes of hypoxic tolerance of the heart, brain, lung, liver, jejunum, skin, and muscle tissues. However, to date, no report of ischemic preconditioning on vascularized bone grafts has been published. METHODS: Sixteen rabbits were divided into four groups with ischemic times of 2, 6, 14, and 18 hours. Half of the rabbits in each group underwent ischemic preconditioning. The osteomyocutaneous flaps consisted of the tibia bone, from which the overlying muscle and skin were raised. The technique of ischemic preconditioning involved applying a vascular clamp to the pedicle for 3 cycles of 10 minutes each. The rabbits then underwent serial plain radiography and computed tomography imaging on the first, second, fourth, and sixth postoperative weeks. Following this, all of the rabbits were sacrificed and histological examinations were performed. RESULTS: The results showed that for clinical analysis of the skin flaps and bone grafts, the preconditioned groups showed better survivability. In the plain radiographs, except for two non-preconditioned rabbits with intraoperative ischemic times of 6 hours, all began to show early callus formation at the fourth week. The computed tomography findings showed more callus formation in the preconditioned groups for all of the ischemic times except for the 18-hour group. The histological findings correlated with the radiological findings. There was no statistical significance in the difference between the two groups. CONCLUSIONS: In conclusion, ischemic preconditioning improved the survivability of skin flaps and increased callus formation during the healing process of vascularized bone grafts.
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Rabbits , Bony Callus , Brain , Free Tissue Flaps , Heart , Ischemic Preconditioning , Jejunum , Liver , Lung , Microsurgery , Muscles , Radiography , Skin , Tibia , TransplantsABSTRACT
Accurate prediction for prognosis is important for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease [AECOPD] requiring mechanical ventilation [MV] and for proper assessment of decision making regarding plane of management and ongoing hospital morbidity and mortality. The present study was designed to determine the predictability of non invasive parameters including APACHE II score, arterial blood gases [ABGs] and bedside Echocardiography in management of critically ill patients with COPD exacerbation either invasively or conservatively. The study was conducted on 60 adult patients [50 male and 10 female] with AECOPD, with mean age 60.1 +/- 6.2 were admitted to intensive care unite [ICU]. All patients were subjected to arterial blood gases [ABGs], APACHE II score and bedside Echocardiography study. Patients were divided into two groups according to ventilatory requirement invasive or non invasive into group I [34 patients] with need of MV and group II [26 patients] with success of conservative treatment. We found that APACHE II score, had a high predictive value for MV necessity, it was 19.17 +/- 3.4 in the group I Vs 11.46 +/- 4.4 in the group II also Doppler evidence of pulmonary hypertension had high predictive value for MV necessity. The mean value of PASP was 48.95 +/- 12.44mmHg in group I, Vs 30.71 +/- 6.5mmHg in group II with significant p value. The mean value of PAPm was 42.08 +/- 6.89mmHg in group I Vs 31.50 +/- 7.71 mmHg in group II with significant p value. Increases in the APACHE II score, the mean pulmonary artery pressure [PAPm] and pulmonary artery systolic pressure [PASP] were significantly more in patients who died in comparison to survivors in the group I. APACHE II score, bedside Echocardiography and routine arterial blood gases could be used as a marker to identify patients at the time of admission who are likely to have a poor prognosis, so that such patients can be managed aggressively, either medical conservative treatment or mechanical ventilation [NIPPV or Invasive MV]
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Humans , Male , Female , Acute Disease , Decision Making , Blood Gas Analysis , APACHE , Prognosis , Echocardiography , Respiratory Function TestsABSTRACT
Twenty-five patients were operated for thyroid malignancy in dept. of Surgery, SRGH, Lahore over a period of 3 years. From Nov 2001 to Nov 2004. Carcinoma was diagnosed on FNAC in 10 pts [40%] and Total Thyroidectomy planned as first and definite procedure. In rest of 15 patents [60%] complete thyroidectomy was performed after initial total lobectomy and subsequent Histopathology. Eight pts were found to have follicular carcinoma and 16 had papillary carcinoma revealed on H/P of resected specimen. Thyroid function tests in almost all showed euthyroid status. The only exception was a female pt who`s hormonal assay showed hypothyroidism but she was operated for FNAC suggested follicular adenoma. All the pts had Iodine-131 whole body scan for residual thyroid and metastatic disease. No thyroxin was started before Iodine-131 scan. Twenty pts were given single dose of 50-75 miCu ff radioiodine, followed by thyroxin in suppressive dose. No recurrence of tumor noted during follow-up 2 years. Only one pt diagnosed finally as thyroiditis on histology of resected specimen. On FNAC, she had suspicion of follicular neoplasm mandating thyroidectomy. A female prepondondrance with age ranging from 15-45 yrs was observed
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Until recently, relatively few studies have focused on the health effects of passive or involuntary smokers. This study was planned to see the effects of passive smoking on pulmonary functions in children of both sexes. Pulmonary function tests of 100 children, 50 passive smokers [38 males and 12 females] and 50 non-passive smokers i.e. controls [36 males and 14 females] were performed on a computerized s-Model Vitalograph psirometer in Pakistan Medical Research Council, Research Centre, Jinnah Post-graduate Medical Centre, Karachi. Amongst male passive smokers, there was statistically significant reduction in FEV/FVC% FEF 25%-75% and PEF [P<0.001]. Also FEV/VC% and MVV were significantly low [P<0.01]. Amongst female passive smokers FEF 25-75% showed a highly significant decrease [P<0.001], whereas FEV/FVC% and PEF were low [P<0.01]. Both sexes i.e. male and female passive smokers consumed more time for forced expiratory flow 25-75% as compared to controls [P<0.001] and [P<0.01] respectively
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Humans , Male , Female , Tobacco Use Disorder , Child , Respiratory Function TestsABSTRACT
To observe the systolic blood pressure response to Valsalva maneuver in cases of chronic obstructive pulmonary disease [COPD]. To correlate the Valsalva responses with left ventricular ejection fraction [LVEF]. In all subjects the standard Valsalva maneuver was performed in the supine position and systolic blood pressure responses were characterized as a [a] Sinusoidal [Normal] [b] Absent over shoot and [c] Square wave [Abnormal]. LVEF was performed in all COPD subjects. Setting: Physiology Department BMSI, Medical Department, Chest Medicine Department J.P.M.C. and NICVD Karachi. A total of 95 male subjects were included, during the course of present study, out of which 30 subjects were healthy controls and 65 subjects were COPD with and without Cardiac failure. The Valsalva responses were strongly correlated with LVEF. Sinusoidal response was observed in all [100%] healthy control subjects, 21 [60%] of the 35 COPD subjects without cardiac failure and only 1 [3.33%] of 30 COPD subjects with cardiac failure, Absent overshoot was observed in 14 [40%] of the 35 COPD Subjects without Cardiac failure and 5 [16.67%] of the 30 COPD subjects with cardiac failure, square wave response was only observed in 24 [80%] of the 30 COPD subjects with cardiac failure. LVEF of 22 sinusoidal responses is 74.36 [ +/- 1.30], while 19 absent over shoot responses is 46.47 [ +/- 2.67] and 24 square wave responses is 29.67 [ +/- 1.69]. It is concluded that in the presence of physician systolic blood pressure response to Valsalva maneuver is a simple, safe and non-invasive technique than the more sophisticated test LVEF in early detection of cardiac failure
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Humans , Male , Heart Failure , Pulmonary Disease, Chronic Obstructive/physiopathology , Blood Pressure , Stroke Volume , Heart VentriclesABSTRACT
Ventilatory lung functions and peripheral blood eosinophil count have proved valuable screening guidelines both in diagnosis and prognosis of asthma. Furthermore, blood eosinophilia differentiates asthma from other inflammatory conditions of the airways. The present study was planned to ascertain the role of absolute eosinophil count in impairment of ventilatory lung functions of asthmatic subjects [both sexes, aged 15-45 years] attending out patients department of Thoracic Medicine at Jinnah Postgraduate Medical Centre in [JPMC] Karachi. 30 healthy controls and fifty asthmatics were investigated. Ventilatory lung functions were recorded by Autospiro [Model - AS500] Spirometer, whereas, peripheral blood eosinophil count was determined by direct method. The data revealed absolute eosinophil count/ul 137.13 ' 17.81 and 201.86' 28.64 [Mean ' S.E.M.] in male and female controls respectively. The eosinophil count/ul in asthmatic counterparts were found to be 442.0' 48.52 [Mean ' S.E. M.] which were statistically significant [P<0.001] as compared to controls. The asthmatics exhibited a trend of decline in forced vital capacity [FVC], forced expiratory volume in first second [FEV1], FIEF 25-75, and peak expiratory flow rate [PEF] in relation to increasing absolute eosinophil count. The present data suggest the reciprocal impairment of ventilatory functions in asthmatics with an increase in absolute eosinophil count. It reflects the critical role of eosinophils in the spasm and inflammation of the airways
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Humans , Male , Female , Respiratory Function Tests , Eosinophils , Leukocyte Count , Asthma/bloodABSTRACT
Haemoglobin [g/dl] and haematocrit [%] values were determined in 30 healthy controls and 40 patients with ischaemic heart disease. Both groups were non-smokers. Haemoglobin and haematocrit values [mean +/- SE] in patients were 15.65 +/- 0.18 and 46.45 +/- 0.49 and in controls 14.30 +/- 0.14 and 41.50 +/- 0.23. Significantly higher [P< 0.001] haematocrit value by influencing the blood viscosity may impose extra burden on the ischaemic heart
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Male , Hematocrit/analysis , Smoking , /diagnosis , Blood ViscosityABSTRACT
The endogenous creatinine clearance was studied in 33 normal subjects and in 80 patients with different renal disorders including chronic renal failure, nephrotic syndrome and renal calculi. Creatinine clearance apparently increased with advancing age in normal subjects and in the patients with renal calculi upto fourth decade after which it followed a gradual decline, but these age related changes in creatinine clearance were not found to be significant statistically. No such age related pattern of variations in creatinine clearance was observed in patients with chronic renal failure and with nephrotic syndrome. In patients with renal calculi, the values of creatinine clearance were apparently higher as compared with the normal subjects for all the age groups. On the other hand in the patients with chronic renal failure, the values of creatinine clearance were considerably lower than those seen in the normal subjects of corresponding age groups. In patients with nephrotic syndrome, the creatinine clearance was found to be significantly low [P < 0.05] as compared with the normal subjects after the age of 20 years