Assessing the racial differences in Q angle measurements in relevance to articular cartilage of the femoral condyle: a retrospective ultrasound study / Evaluación de las diferencias raciales en las mediciones del ángulo Q en relación con el cartílago articular del cóndilo femoral: un estudio ecográfico retrospectivo

SUMMARY: The Q-angle is defined as the acute angle formed by the vectors for combined pull of the quadriceps femoris muscle and the patellar tendon. This study aimed to investigate the variations in Q angle with respect to race. Moreover, this study performed ultrasound to evaluate of the thickness of articular cartilage covering the medial and lateral femoral condyle in volunteers with an increased Q angle. The study included 487 Jordanian and 402 Malaysians with age range 18-23 years. Moreover, the study included 30 participants aged between 18 and 22 years, with a total of 15 volunteers with Q >14° and 15 patients with Q ≤14°. Both Q angle and condylar distance were measured by well-trained medical practitioners according to a well-established protocol. The thickness of articular cartilage covering the medial and lateral femoral condyle of the femoral bone was measured using ultrasound. Regardless of race, Q angle was greater in females. Furthermore, Q angle was significantly greater in Arab volunteers compared to Malay volunteers. Q angle significantly increase with increasing condylar distance in both races. Finally, the statistical analysis showed a significantly reduced thickness of articular cartilage on both medial and lateral femoral condyle (P = 0.05) in the Q >14° group. Multiple factors including race and condylar distance and even the articular cartilage of femoral condyle should be considered during the examination and management of knee fractures and condylar diseases.

RESUMEN: El ángulo Q se define como el ángulo agudo formado por los vectores de tracción combinada del músculo cuádriceps femoral y el tendón patelar. Este estudio tuvo como objetivo investigar las variaciones en el ángulo Q con respecto a la raza. Además, se realizó una ecografía para evaluar el grosor del cartílago articular que cubre los cóndilos femorales medial y lateral en voluntarios con un ángulo Q aumentado. El estudio incluyó a 487 jordanos y 402 malayos con un rango de edad de 18 a 23 años. Además, el estudio incluyó a 30 participantes con edades comprendidas entre 18 y 22 años, 15 voluntarios con Q> 14 ° y 15 pacientes con Q ≤ 14 °. Tanto el ángulo Q como la distancia condilar fueron medidos por médicos bien entrenados de acuerdo con un protocolo establecido. El grosor del cartílago articular que cubre los cóndilos femorales medial y lateral del fémur se midió mediante ecografía. Independientemente del grupo racial, el ángulo Q fue mayor en las mujeres. Además, el ángulo Q fue significativamente mayor en los voluntarios árabes en comparación con los voluntarios malayos. El ángulo Q se aumenta significativamente al incrementarse la distancia condilar en ambas grupos raciales. Finalmente, el análisis estadístico mostró una reducción significativa del grosor del cartílago articular en los cóndilos femorales medial y lateral (P = 0,05) en el grupo Q> 14. Durante la exploración y el tratamiento de las fracturas de rodilla y de las enfermedades condilares, se deben considerar múltiples factores, incluida la raza y la distancia condilar e incluso el cartílago articular del cóndilo femoral.

Salvage flow diverter stent across the posterior communicating artery for persistent retrograde filling of a giant internal carotid artery aneurysm after parent vessel occlusion

Giant internal carotid artery (ICA) aneurysms are complex vascular lesions which are difficult to treat with open as well as endovascular surgery. Parent vessel occlusion is a well-established treatment option for such aneurysms. However, there have been a few reported cases of ruptured aneurysms related to the persistent retrograde filling after parent vessel occlusion. We report a case which highlights the usage of the flow diverter stent as a potential treatment strategy for the management of retrograde filling of aneurysms. A 54-year-old female was found to have a giant left ICA aneurysm on a brain magnetic resonance imaging during workup for headaches. She underwent occlusion of the left ICA proximal to the aneurysm using multiple coils. However, follow up angiograms after 6 months and 2 years demonstrated persistent retrograde filling of the left ICA aneurysm through the posterior communicating (PCOM) artery. Eventually, she was successfully treated with a flow diverter stent across the PCOM artery into the distal ICA. Follow up angiogram after 6 months showed patent flow in the PCOM artery and the distal ICA. with complete occlusion of the aneurysm. Using a flow diverter stent after insufficient parent vessel occlusion for giant intracranial aneurysms may be a feasible treatment option and an addition to the neurovascular treatment armamentarium.

Salvage flow diverter stent across the posterior communicating artery for persistent retrograde filling of a giant internal carotid artery aneurysm after parent vessel occlusion

Giant internal carotid artery (ICA) aneurysms are complex vascular lesions which are difficult to treat with open as well as endovascular surgery. Parent vessel occlusion is a well-established treatment option for such aneurysms. However, there have been a few reported cases of ruptured aneurysms related to the persistent retrograde filling after parent vessel occlusion. We report a case which highlights the usage of the flow diverter stent as a potential treatment strategy for the management of retrograde filling of aneurysms. A 54-year-old female was found to have a giant left ICA aneurysm on a brain magnetic resonance imaging during workup for headaches. She underwent occlusion of the left ICA proximal to the aneurysm using multiple coils. However, follow up angiograms after 6 months and 2 years demonstrated persistent retrograde filling of the left ICA aneurysm through the posterior communicating (PCOM) artery. Eventually, she was successfully treated with a flow diverter stent across the PCOM artery into the distal ICA. Follow up angiogram after 6 months showed patent flow in the PCOM artery and the distal ICA. with complete occlusion of the aneurysm. Using a flow diverter stent after insufficient parent vessel occlusion for giant intracranial aneurysms may be a feasible treatment option and an addition to the neurovascular treatment armamentarium.

Obstructive Sleep Apnea in Primary Health Care Settings

Background: Obstructive sleep apnea (OSA) despite being the most common type of sleep disorder, may presenta myriad of clinical features, ranging from simple fatigue and lack of concentration to per-sonality changes andheart diseases. The association between the genetic, physiological built, so-cial status, and behaviour plays themajor role in disease risk factors diagnosis and management plans. The most often used treatment method of OSAis Continuous Positive Airway Pressure (CPAP) aimed at monitoring respiratory effort and Apnea-HypopneaIndex (AHI) measuring the number of apnea and hypopnea events per hour of sleep or the RespiratoryDisturbance Index (RDI). Objective: The focus of this paper is providing a review on obstructive sleep apnea,different treatment ap-proaches and the recent perspectives with regard to family physicians’ enrolment inmanagement and modulation of pain in OSA patients. Methodology: PubMed database was used for articlesselection using the keywords obstructive sleep apnea, its evaluation, management, and diagnosis. Conclusion: Insummary, family doctors and primary care providers play a major role in controlling OSA and are involved indealing with CPAP, AHI measurement and RDI. Obstructive sleep apnea re-quires a high cost which may furthercontribute to late detection, complications deterioration, and increasing in the drop of follow-ups. Increasingawareness of the primary care providers especial-ly family physicians would help to avoid such outcomes. OSAremains a common condition that requires attention, identification, and more directed research.

Addition of rituximab to hyper-CVAD improves overall survival in newly diagnosed Burkitt leukemia/lymphoma from the Middle East and North Africa region

Background: Burkitt leukemia/lymphoma (BL) is a highly aggressive malignancy treated with intensive combinational chemotherapy. However, there is paucity in the literature with regards to outcome in patients with BL from the Middle East and North Africa Region (MENA).Methods: We examined the impact of incorporation of the monoclonal antibody rituximab within a chemotherapy backbone of hyper-fractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, cytarabine and methotrexate (hyper-CVAD). Between 2007 to 2016, a total of 21 patients were identified and data retrospectively collected with median follow up was 32 months (1.1-120). The cohort was stratified based on exposure to rituximab and there was no significant difference regarding gender, age, stage, presence of constitutional symptoms, baseline presenting blood counts and proportion of patients completing prescribed therapy regimen between the strata.Results: Estimated overall survival (OS) of the entire cohort at 2 years was 71.1%; however, patients who received rituximab in conjunction with hyper-CVAD had a statistically significant improvement in 2-year OS at 81.2% vs 40% (p=0.048).Conclusions: In conclusion, we observed that incorporation of rituximab within a hyper-CVAD backbone improved OS in BL patients from the MENA region. These results warrant further evaluation.

Level Of Indoor Air Quality Among Malaysian Commuter Users: A Case Study

@#Research on environmental ergonomics of train/commuter is very limited. Thus, this study was conducted with aims to determine the environmental ergonomic of public transport, whether it is in accordance to indoor air quality standard inside women coach cabin train during operations. Although the number of passengers is increasing, some claimed that the indoor air quality for the Malaysian commuter train is uncertain, especially at peak times. Unsatisfactory feedback from some respondents—especially female passengers—will affect other passengers to remain loyal to use this facility as one of the main transportation to reduce the traffic congestion that will be faced if using private vehicles. The study conducted during peak hours on the weekends and the trip took exactly two hours and covered 18 main stations. The measurement devices placed at the centre of the cabin Komuter using Air Quality Meter (AIRFLOW Instrument Model TA465). The main parameters measured were temperature, humidity, and carbon dioxide (CO2). This study also counts the number of passengers riding the train. The results showed that the indoor air quality (AIQ) level of the morning hour will affect passengers’ health more compared to the evening hour (this is due to the CO2 level that has exceeded the safety standard). Morning hour gave higher reading of CO2 (43.8%) and relative humidity (17%) compared to evening hour. Evening hours also showed greater temperature at 3%. The findings can give awareness to the train company to improve the IAQ by installing a suitable ventilation system and can give comfort to the passengers when travelling using Malaysian commuter train The results showed that the indoor air quality (AIQ) level of the morning hour will affect passengers’ health more compared to the evening hour (this is due to the CO2 level that has exceeded the safety standard). Morning hour gave higher reading of CO2 (43.8%) and relative humidity (17%) compared to evening hour. Evening hours also showed greater temperature at 3%. The findings can give awareness to the train company to improve the IAQ by installing a suitable ventilation system and can give comfort to the passengers when travelling using Malaysian commuter train.

role of olive leaves and pomegranate peel extracts on diabetes mellitus induced in male rats

Background: Metabolic diseases such as diabetes mellitus [DM] were progressively widespread all over the world and the alteration of oxidative stress and antioxidants associated with DM was established

Aim of the Work: The natural products were used in many ancient cultures to overcome the DM, so pomegranate peel and olive leaves will be investigated in this work

Materials and Methods: Adult male albino rats [Sprague Dawley], weighing 220-250 g, were used in this study. Animals were classified into five groups, five rats in each group. Control group: rats were served as normal healthy control and were received no treatment but only normal chow diet and water ad libitum for 4 weeks. Diabetic group: rats were intraperitoneal injected with STZ at dose of 40 mg / kg b. wt. for a single dose. Diabetic and olive leaves extract group: diabetic rats were orally administered with watery extract of olive leaves at dose of 250 mg / kg b. wt. for 4 weeks. Diabetic and pomegranate peel extract group: diabetic rats were orally administered with pomegranate peel at 250 mg / kg b. wt. for 4 weeks. Diabetic and mix of olive leaves and pomegranate peel group: diabetic rats were orally administered with pomegranate peel and olive leaves at 250 mg / kg b. wt. for 4 weeks

Results: The oxidative stress markers such as lipid peroxidation and hydrogen peroxide were increased but there was a decrease in the antioxidants makers such as glutathione peroxidase, superoxide dismutase, glucose-6-phosphate dehydrogenase, reduced glutathione and total antioxidants capacity in the liver of diabetic rats. The expression of insulin receptor and glucose transporter 2 genes was inhibited in liver of diabetic rats. Watery extracts of olive leaves and pomegranate improved the biochemical and molecular changes associated with DM

Conclusion: The results showed a hypoglycaemic, hypocholesterolemic and hypolipidemic action of olive leaves and pomegranate peel

Stool Patterns of Malaysian Adults with Functional Constipation: Association with Diet and Physical Activity

Introduction: Diet and lifestyle modification is commonly used in constipation management. As there is a dearth of studies on this topic in Malaysia, we aim to elucidate the relations between stool patterns, dietary intake and physical activity levels among adults with functional constipation. Methods: From a database collected via surveys at public events, a convenience sample of 100 adults diagnosed with Rome II-defined functional constipation was enrolled in this cross-sectional study. After severity assessment using the Chinese Constipation Questionnaire, subjects completed 2-week bowel movement diaries to determine stool frequency, consistency and output. Dietary intake and physical activity levels were assessed twice using three-day 24-hour diet recalls and International Physical Activity Questionnaire, respectively. Ninety subjects who completed the study were included in the analysis. Results: Mean weekly stool frequency was 3.9±1.9 times, consistency score was 2.6±0.6 (range 1.0-4.0), output was 11.0±6.3 balls (40 mm diameter) and severity score was 10.3±3.3 (range 5.0-22.0). Mean daily dietary intakes were: energy 1,719±427kcal, dietary fibre 15.0±4.9g and fluid 2.5±0.8L. The majority of subjects were physically inactive. Stool frequency and output were positively associated with dietary fibre (rs=0.278, P<0.01; rs=0.226, P<0.05) and fluid intake (rs=0.257, P<0.05; OR=3.571, 95% CI [1.202-10.609]). Constipation severity was associated with higher physical activity levels (OR=2.467, 95% CI [1.054-5.777]). Conclusion: Insufficient intake of dietary fibre and fluid are associated with aggravated constipation symptoms. Further studies are necessary to confirm usefulness of dietary intervention in treatment of constipation as dietary factors alone may not influence overall severity and stool consistency, an integral element of constipation.

Lowering Dietary Glycaemic Index through NutritionEducation among Malaysian Women with a History of Gestational Diabetes Mellitus

Introduction: Gestational diabetes mellitus (GDM) increases risks for type 2 diabetes and cardiovascular diseases. Low glycaemic index (GI) diets improve cardio-metabolic outcomes in insulin-resistant individuals. We examined the feasibility of lowering GI through GI-based-education among Asian post-GDM women. Methods: A 3-month investigation was carried out on 60 Malaysian women with a mean age of 31.0±4.5 years and a history of GDM. Subjects were randomised into two groups: LGIE and CHDR. The CHDR group received conventional healthy dietary recommendations only. The LGIE group received GI based-education in addition to conventional healthy dietary recommendations. At baseline and after 3-months, dietary intake of energy and macronutrient intakes including GI diet and glycaemic load was assessed using 3-day food records. Diabetes-Diet and GI-concept scores and physical activity levels were assessed using a questionnaire. Adherence to dietary instructions was measured at the end of 3 months. Results: At the end of 3 months, the LGIE group had significant reductions in energy intake (241.7±522.4Kcal, P=0.037, ES=0.463), total carbohydrate (48.7±83.5g, P=0.010, ES=0.583), GI (3.9±7.1, P=0.017, ES=0.549) and GL (39.0±55.3, P=0.003, ES=0.705) and significant increases in protein (3.7±5.4g, 0.003, ES=0.685) and diet fibre (4.6±7.3g, P=0.06). The CHDR group had a significant reduction in fat only (5.7±9.4g, P=0.006, ES=0.606). There was a 30% increase in GI-concept scores in the LGIE group (p< 0.001). Changes in GI-concept scores correlated significantly to the reduction in dietary GI (r = -0.642, P=0.045). Dietary adherence was comparable in both groups. Conclusion: GI-education improves GI-concept knowledge and helps lower dietary glycaemic index among women with a history of GDM.

Remeasurement, Evaluation And Comparison The Health Services Utilization Among Women Staff At Universiti Kebangsaaan Malaysia After Eleven Years Period

A cross-sectional study was carried out in July-October 2012 in UKM to remeasure, evaluate and compare the changes in health services utilization level among women staff in UKM with a previous study done in 2001 and its influencing factors. The services studied were blood pressure (BP) measurement and Pap smear test. A total of 234 respondents aged between 18 and 55 were selected using stratified random sampling from Bangi, Kuala Lumpur and UKMMC, Malaysia. Data was collected via self-administered questionnaire and was analyzed by using SPSS version 17.0. Majority 85.9% of the respondents were found to have utilized at least one BP measurement which is higher compared to previous study. The Pap smear test, 64.5% of women have had a Pap smear test done also higher compared to previous study. Multivariate analysis shows the factors associated with BP measurement are age (OR 2.7, CI 95% 1.2, 6.3), family history of general health problems (OR 3.4, CI 95% 1.5, 7.6), and health staff influence (OR 5.2, CI 95% 1.1, 25.5). The factors associated with Pap smear test are marital status (OR 62.8, CI 95% 7.2, 546.4), general health problems (OR 2.3, CI 95% 1.2, 4.5), family planning (OR 6.9, CI 95% 3.0, 16.5) and self-interest (OR 3.3, CI 95%, 1.3, 8.6). The level of health services utilization on BP measurement and Pap smear test in 2012 is higher than 2001. For both BP measurement and Pap smear test the determinant factors are differed in the aforesaid years.

Parental Concerns and Control in Feeding of 9 to 12-Year-Old Children in a Primary School in Kuala Lumpur, Malaysia

Introduction: Body weight of children is affected by many factors including food habits which are influenced by their parents. Studies in the West have shown that parents tend to control child feeding in response to their child’s weight status. The aim of this study was to assess Malaysian parental concerns about child weight and the control they exert on child feeding. Methods: This crosssectional study was conducted on parents and their children aged 9 to 12 years from a primary school in Kuala Lumpur. The weight status of the children was classified according to the body mass index-for-age growth chart. Parental concerns about child weight and control in child feeding was assessed using the adapted Malay version of Child Feeding Questionnaire. Results: A total of 204 parents participated in this study. The study found that being a female served as a protective factor against becoming overweight (OR:0.28, CI:0.13-0.62). Parents with overweight children were significantly older (OR:1.08, CI:1.01-1.15), concerned about their child’s weight (OR:2.77, CI:1.49-5.12) and controlled their child’s feeding by restricting food intake(OR:2.70, CI:1.30-5.60). They were less likely to pressure their children to eat (OR:0.32, CI:0.19-0.56). Parents from the low income group were more likely to have underweight children (OR: 4.15, CI:1.28-13.47). Conclusion: There was significant difference in level of parental concern across differing child weight status. Parents with overweight children were likely to be more concerned about their child’s weight, tending to control their feeding. In contrast, parents with underweight children did not exert control on their feeding.

Antioxidant intake and status, and oxidative stress in relation to breast cancer risk: a case-control study.

A case control study was carried out to investigate associations between breast cancer risk, antioxidant status and oxidative stress among women in Klang Valley and Selangor. A total of 57 newly diagnosed cases aged 30 to 66 years old participated and were matched for age and ethnicity with 139 controls with no diagnosis of cancer or other chronic diseases. An interview based questionnaire designed to collect information on demographic and socioeconomic status, as well as reproductive, medical and dietary history was used. Anthropometric measurements including weight, height, waist and hip circumference were made and a 10 ml fasting venous blood sample was taken for glucose testing and analysis of plasma vitamin antioxidants and malondialdehyde. Hair and toenail samples were taken for selenium analysis. Results showed that the mean intake of vitamin A, vitamin E and selenium among cases (606.8 +/- 334.8 microg/d, 6.1 +/- 2.4 g/d, 56.9 +/- 16.2 microg/d) was lower than controls (724.7 +/- 414 microg/day, 6.9 +/- 3.0 g/d, 60.8 +/- 17.5 microg/d, respectively) (p<0.05 for all parameters). A similar trend was noted for plasma vitamin A and E and also selenium in hair and toenails. Poor antioxidant status as indicated by low plasma vitamin A (<284.3 microg/l or <366.3 microg/l) increased risk of breast cancer by approximately two fold, whilst low plasma vitamin E (<2.5 mg/dl, <2.8 mg/dl and <3.1 mg/dl) increased the risk by two to three fold [Adjusted OR 2.97 (95% CI 1.38-3.48), 2.32 (95% CI 1.07-2.41) and 2.12 (95% CI 1.00-4.21)]. Cases had a greater level of malondialdehyde 4.4 +/- 1.1 mmol/g protein), an indicator of oxidative stress, as compared to controls (3.2 +/- 1.7 mmol/g protein) (p<0.05). A high level of MDA (> or = 4.8 mmol/g protein) was associated with breast cancer [Adjusted OR 6.82 (95% CI 1.95-23.9)]. It is concluded that a poor antioxidant status and high oxidative stress are associated with breast cancer risk. Thus, it is essential for Malaysian women to obtain a good antioxidant status by consuming a diet rich in vitamins A and E as well as selenium and adopt healthy behaviour to reduce oxidative stress in order to prevent breast cancer.

Daily Energy Intake from Meals and Afternoon Snacks: Findings from the Malaysian Adults Nutrition Survey(MANS)

Meal and snack patterns are associated with energy and nutrient intakes and consequently health and nutritional status. The aim of this paper is to describe the percentage of daily energy intake from meals and afternoon snack among Malaysian adults. The study included a representative sample of adults aged 18- 59 years (n=7349) from a nationwide Food Consumption Survey conducted by the Ministry of Health. Information on dietary intake was obtained using a one day 24-hour diet recall (24-HDR). Dietary data on 6886 adults were analysed using Nutritionist ProTM and statistical analysis was carried out using the SPSS 13.0. The median percentage of daily energy intake is reported only for adults consuming meals and afternoon tea and by socio-demographic characteristics as well as body mass index (BMI) status. More than 80% of Malaysian adults consumed morning meals, lunch and dinner and 54% reported having afternoon tea. The median percentage of energy intake from morning meals, lunch, dinner and afternoon tea was 29.9%, 30.5%, 32.4% and 17%, respectively. There were variations in the median percentage of energy from meals and snacks according to the socio-demographic variables and BMI status. It is important to understand the eating patterns of Malaysians as the information can assist in efforts to address obesity and diet-related chronic diseases among adults.

Screening for psychosocial problems in children tending the pediatric clinic at King Khalid University Hospital [KKUH] in Riyadh [KSA]

Psychosocial problems are highly prevalent among children and adolescents. One approach to facilitating recognition and referral of these problems is to use parent-completed screening questionnaire as part of routine primary care. The purpose of this study was to determine the prevalence and type of psychosocial problems in a random sample of children attending the pediatric clinic at KKUH at the time of the study. A 2-part questionnaire was designed for the study. The first part contained basic biographic data in addition to items which reflect the socioeconomic status of the family. The second part of the questionnaire comprised the inventory, which is a modified version of the Pediatric Symptoms Checklist [PSC]. The inventory consisted of 38 items classified into five categories. The total score of the inventory ranged from 0-114. Three-hundred-twelve questionnaires were completed. The average of the total score was only 22.3 out of 114. The lowest score was 0 and the highest 84. The average scores of behavioral symptoms [BS] were the highest [7.03 out of 27] while that of the learning problems [LP] was the lowest [1.5 out of 18]. The average score for mood symptoms [MS] was 5.6 out of 24, that for personality characteristics [PC] was 4.5 out of 24 and that for somatic symptoms [SS] was 4.3 out of 24. This study revealed the feasibility of screening for behavioral problems of children in an outpatient setting. It is necessary to implement screening procedures for psycho-behavioral problems, and train pediatricians to screen children presenting at clinics