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Background@#The awareness and practice of pelvic floor muscle exercise (PFME) in the prevention and reduction of the rate of urinary incontinence among pregnant women was considerably poor, despite the increased prevalence of urinary incontinence during pregnancy across Malaysia. There healthcare providers do not give adequate attention to the potential impact of PFME on urinary incontinence and there is limited local intervention addressed urinary incontinence during pregnancy. The objective of this study was to determine the effectiveness of a newly developed PFME intervention in terms of knowledge, attitude, practice, self-efficacy, and urinary symptoms. @*Methods@#A single-blinded, two-armed, randomized control trial was included pregnant women from 18 to 20 weeks of gestation and was conducted at the Maternity Hospital of Kuala Lumpur. The intervention group received PFME in addition to the usual perinatal care. The data were collected using validated questionnaires at 4 time points: baseline, post-intervention in the early third trimester, late third trimester, and early postnatal period. The intervention effects were analyzed using a generalized estimating equation. @*Results@#The primary analysis included pregnant women who had at least one follow-up; 122 women (71.8%) in the intervention group had significant improvement in knowledge, attitude, practice, and self-efficacy, as well as in the severity of urinary incontinence over time. However, improvement was not observed in self-reported urinary incontinence. @*Conclusion@#PFME can be considered an effective initial intervention to provide information about urinary incontinence prevention to pregnant women.
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@#Introduction: Obesity is a global issue called as “globesity”. Overweight and obesity may lead to many noncommunicable diseases (NCDs). Primary care is the first centre to monitor and follow-up the progress of NCD patients. Therefore, the objective of this study was to determine the effectiveness of an integrated-Weight Management Programme (i-WMP) to reduce body weight among NCD patients from two Government primary care clinics from Hulu Langat District. Methods: This study was single-blinded randomised controlled trial by design. There were 244 eligible patients were randomised into intervention (n = 122) or wait-list control group (n = 122). The i-WMP was developed based on the behaviour change wheel through the operationalization of behaviour change techniques. The duration of this intervention programme was four weeks. Data collected at week 0, week 4, and week 12. The software IBM SPSS was used to analyse the data. Generalized linear mixed model analysis with intention-to-treat principle was applied. Results: The retention rate was 74.2%. Findings showed that the i-WMP was significantly effective in reducing not only body weight as primary outcome but also secondary outcomes such as waist-to-height ratio, waist circumference, body mass index, and total sitting time. It also improved effectively other secondary outcomes such as participants’ knowledge, attitude, and practice towards dietary and towards physical activity. However, no significant changes were reported for body fat percentage and total physical activity metabolic equivalent of task-minutes/week. Conclusion: Implications surrounding the implementation of i-WMP in the primary care clinics are recommended.
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@#Knee osteoarthritis is the commonest cause of knee pain in the elderly. It is characterized by unresolved pain, limitation of motion and reduced quality of life. Total knee arthroplasty (TKA) is a safe and effective method in treating chronic knee osteoarthritis. We report a rare case of a seventy-seven-year-old Chinese female with multiple comorbidities and bilateral degenerative osteoarthritis who had sought services of traditional and complementary medicine (TCM) for pain relief. The patient experienced unresolved pain and superficial skin scars following the unregulated procedure. This paper aims to outline the importance of awareness among surgeons regarding the unregulated practice of TCM that may exacerbate chronic osteoarthritis, joint synovitis, influence the surgical approach for future procedures with the presence of scars and prosthetic joint infection risk.
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Background/Aims@#Crohn’s disease (CD) and intestinal tuberculosis (ITB) remain “difficult-to-differentiate” diseases. We have previously documented peripheral blood frequency of CD4+CD25+FOXP3+ T-regulatory cells (Treg) as a biomarker to differentiate CD and ITB. We tried to validate these results in a larger cohort of CD and ITB patients. @*Methods@#Seventy treatment naïve patients of CD (n = 23) and ITB (n = 47) (diagnosed by standard criteria) were recruited prospectively from October 2016 to May 2017. Patients with history of antitubercular therapy in the past were excluded. The frequency of Treg cells in peripheral blood was determined by flow cytometry, and compared between CD and ITB patients. @*Results@#Similar to our previous study, frequency of Treg cells in peripheral blood was significantly increased in ITB as compared to CD patients (40.9 [interquartile range, 33–50] vs. 24.9 [interquartile range, 14.4–29.6], P 31.3% had a sensitivity and specificity of 83% and 82.6% respectively, to differentiate ITB from CD. Even for the indeterminate cases (n = 33), Treg cell frequency had similar diagnostic accuracy with an AUC of 0.85 (95% confidence interval, 0.68–0.95) and a cutoff of 32.37% had sensitivity and specificity of 87% and 95% respectively, to differentiate ITB from CD. @*Conclusions@#The current findings validate that the increased frequency of CD4+CD25+FOXP3+ Treg in the peripheral blood can be used as a biomarker with high diagnostic accuracy to differentiate ITB from CD.
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@#Introduction: Dexmedetomidine, a selective α2 -adrenoreceptor agonist is an important adjuvant to general anaesthetic practice in view of its potent sedative, anaesthetic-sparing and analgesic effects. We investigated the effect of a single dose pre – induction dexmedetomidine on the anaesthetic requirement during surgery and pain profile. Methods: 60 patients who were ASA I - II and planned for orthopaedic procedures under general anaesthesia were recruited. Patients were randomized into 2 groups: Group D received intravenous (IV) dexmedetomidine 1 µg/ kg (n=30) preoperatively or Group P received normal saline (n=30) instead. Both groups were induced with standardised IV induction agents and anaesthesia maintained with Sevoflurane, titrated using the bispectral index scale. The expired fraction of sevoflurane and haemodynamic parameters were recorded at 5-minute intervals intraoperatively. Postoperatively, postoperative pain score (VAS) was documented at 30 minutes recovery. Results: Our study showed a 27.8% reduction in the intraoperative expired fraction of sevoflurane requirement in group D versus 11.5% reduction in Group P (p < 0.001) and a lower mean heart rate in Group D as compared to Group P [mean (CI): 69.20 (64.03, 74.37) versus 82.00 (72.12, 91.87) per minute, p = 0.00]. The mean (SD) VAS for 30 minutes postoperative pain was significantly lower in group D when compared to group P [1.507(0.275) vs 2.209(0.403), p = 0.00]. Conclusion: This study has shown that a single dose of pre-induction dexmedetomidine was able to significantly reduce anaesthetic requirement of sevoflurane and mean heart rate intraoperatively and postoperative pain.
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@#Diabetes mellitus has reached epidemic levels in Malaysia due to increase in its risk factors such as obesity, dietary and sedentary lifestyle. In patients with uncontrolled diabetes mellitus, diabetic foot ulcer (DFU)is a common complication. Managing diabetic foot infection is often multifactorial and intricate. The management DFU demands multi-speciality approach and often tedious. Hyperbaric oxygen therapy (HBOT) is a promising adjunctive treatment used to enhance the healing process plus reduces cost and recovery time. This is a case of a 52 years old lady, with underlying poorly diabetes mellitus, who presented with diabetic foot ulcer Wagner IV classification in sepsis. She underwent trans-metatarsal amputation followed by split skin grafting with additional adjunctive HBOT in a tertiary hospital.
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Background/Aims@#Crohn’s disease (CD) and intestinal tuberculosis (ITB) remain “difficult-to-differentiate” diseases. We have previously documented peripheral blood frequency of CD4+CD25+FOXP3+ T-regulatory cells (Treg) as a biomarker to differentiate CD and ITB. We tried to validate these results in a larger cohort of CD and ITB patients. @*Methods@#Seventy treatment naïve patients of CD (n = 23) and ITB (n = 47) (diagnosed by standard criteria) were recruited prospectively from October 2016 to May 2017. Patients with history of antitubercular therapy in the past were excluded. The frequency of Treg cells in peripheral blood was determined by flow cytometry, and compared between CD and ITB patients. @*Results@#Similar to our previous study, frequency of Treg cells in peripheral blood was significantly increased in ITB as compared to CD patients (40.9 [interquartile range, 33–50] vs. 24.9 [interquartile range, 14.4–29.6], P 31.3% had a sensitivity and specificity of 83% and 82.6% respectively, to differentiate ITB from CD. Even for the indeterminate cases (n = 33), Treg cell frequency had similar diagnostic accuracy with an AUC of 0.85 (95% confidence interval, 0.68–0.95) and a cutoff of 32.37% had sensitivity and specificity of 87% and 95% respectively, to differentiate ITB from CD. @*Conclusions@#The current findings validate that the increased frequency of CD4+CD25+FOXP3+ Treg in the peripheral blood can be used as a biomarker with high diagnostic accuracy to differentiate ITB from CD.
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@#The first case of COVID-19 was reported in Malaysia on the 25 January 2020. By the 20 January 2021, the cumulative numbers reported confirmed cases of COVID-19 had reached 169,379 including 630 deaths. Malaysia has been hit by three waves of COVID-19. This article reports on the three waves, the current situation and some of the possible factors associated. It outlines the need to reassess the overall situation, re-strategize the approach in order to contain the spread. The first COVID-19 wave lasted from 25 January to 16 February 2020, the second wave occurred between the 27 February 2020 and the 30 June 2020. The current third wave began on 8th September 2020.The sudden surge of cases in the third wave was mainly due to the two largest contributors, namely the Benteng Lahad Datu cluster in Sabah state and Kedah's Tembok cluster. The current situation is critical. The daily confirmed cases of COVID-19 continue to soar. The challengers faced by healthcare workers and other front liners is tremendous. Non-communicable diseases such as cardiovascular diseases, diabetes and cancer are the leading cause of death in Malaysia. A paradigm shift in the approach is required to ensure the sustainability of the normal healthcare services provided by the government especially for the lower income groups. There is also a need to expedite the tabling of Tobacco Control Bill in coming parliament session which is long overdue. H.E. the King of Malaysia has called on all Malaysians to put aside political, racial and religious differences and show the spirit of loyalty, humanitarianism and steadfastness in fighting the COVID-19 pandemic.
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In many countries, homeopathic preparation is believed to be an effective medicine for various ailments.However, there are limited scientific evidences in regard to its usage, safety, and efficacy. It is necessary toupdate this age-old scientific wisdom in different aspects, including pharmacologic and therapeutic potentials.In this study, we assessed the safety profile of homeopathic preparation of Gymnema sylvestre (HPGS). Itschemical constituents were deciphered using LCMS approaches. HPGS was subjected to an acute toxicitystudy (OECD-423 guidelines) using Sprague Dawley rats. The administration of HPGS did not produce anytoxic symptoms or show mortality at the dose level of 300 mg/kg body weight. Phytochemical analysis revealedthat HPGS contained alkaloids, saponins, and flavonoids. These results demonstrated the non-toxic nature ofHPGS in vivo, suggesting a long-term usage in clinical practices when administered orally
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Background: Juvenile Idiopathic Arthritis (JIA) is the most common autoimmune inflammatory synovial arthritis causing wide range of disability in children. The involvement of temporo-mandibular joint (TMJ) in JIA varies ranging from 17% to 87%. Unlike other synovial joints, the TM joint is particularly vulnerable to inflammatory damage as the mandibular growth plate is superficial. JIA is a clinical diagnosis and is characterized by synovial hyperplasia and inflammation leading to joint effusion. TMJ involvement is clinically difficult to assess and often goes untreated. Children with TMJ arthritis have mastication dysfunction and pain. Delayed detection and treatment leads to abnormalities like micrognathia, jaw deformity, facial dysmorphism and chewing problems. MRI is the most sensitive modality to diagnose synovitis and involvement of TMJ in children of JIA.Methods: A cross-sectional observational study was undertaken in 30 children diagnosed as JIA as per ILAE criteria. They were evaluated clinically followed by contrast enhanced MRI for evidence of TMJ arthritis.Results: Of the 60 joints evaluated, clinical involvement was found in 18 joints (10 patients). 12(66.7%) out of them had MRI changes. 3(7.1%) joints out of 42 asymptomatic joints had MRI changes. 13 joints had synovial hypertrophy, 8 joints showed bone erosions. Bone marrow edema was seen in 2 joints, with no evidence of cartilage involvement in any joint. The sensitivity, specificity, PPV and NPV of clinical examination to diagnose TMJ arthritis as compared to MRI was 80.0%, 86.7%, 66.7% and 92.7% respectively.Conclusions: With paucity of clinical signs and symptoms, early involvement of TMJ arthritis in children of JIA can be detected by MRI to prevent long term disability in patients.
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Background: Peripherally inserted central catheter (PICC) have become essential for a safe and reliable long term venous access in all neonatal intensive care units (NICU) for providing long term intravenous fluids and medications. However, they associated with central line blood stream infections (CRBSI) infections and it is postulated that this risk is more on during their removal but the true incidence is not known. The objective was to evaluate the incidence and identify risk factors associated with CRBSI following the PICC removal in preterm neonates.Methods: This was a retrospective cohort study was done on <37 weeks premature neonates. Data included patient particulars, location of PICC placement, days of PICC, antibiotics and TPN through PICC, infections noted during or within 48 hours of PICC removal.Results: A total of 238 PICC removals in 215 neonates were analysed which did not show a significant difference in the prevalence of CRBSI within 48 hours of PICC removal. However, there was an increase in odds for sepsis following PICC removal in less than 29 weeks gestation and if it was not used for antibiotic infusion for more than 48 hours preceding its removal.Conclusions: This study does not support the use of prophylactic antibiotics during PICC removal in neonates as there was no increase in the incidence of CRBSI following PICC removal. However, they may have a role in very low gestation age, low birth weight infants who have not recently received antibiotics prior to PICC removal.
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@#The COVID-19 outbreak has resulted in a health crisis that is unprecedented. The global and local status of COVID-19 outbreak is a rapidly evolving situation. When the pandemic erupted even the super powers and high-income countries struggled on how to tackle the crisis in their own countries. They were all startled with the sudden turn of events and no country was prepared for this catastrophic event that has posed the world with new challenges, not only, for the governments and healthcare workers but also humanity. This editorial addresses issues as of first of May 2020.
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@#The Coronavirus disease (COVID-19) pandemic (caused by the virus SARS-CoV-2) is the greatest threat not only to global health but also has far reaching socio economic impact on nearly all the countries in the world. The first 4 cases of COVID-19 was first reported on the 29th December 2019, all linked to Huanan (Southern China) seafood wholesale market. 1,2 On the 31st December 2019, the World Health Organization (WHO) China Country Office was informed of a pneumonia of unknown cause, detected in the city of Wuhan in the Hubei province, China
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@#A 68-year-old female presented with a 1-month history of lower back pain with right-sided radiculopathy and numbness. She was diagnosed with lumbar spondylosis and treated conservatively with analgesia and physiotherapy. Imaging showed multiple susuk, a metal alloy, in the lower back region and other regions of the body. The patient had undergone traditional medicine consultation 10 years earlier when the susuk was inserted in the lower back as talisman. The practice of the insertion of susuk is popular in rural East Malaysia and Indonesia. These foreign bodies act as possible causes of chronic inflammation and granuloma formation. In addition, the localised heighten peril upon imaging. This report suggests that the insertion of multiple susuk as talisman carries risk to safety of patients when imaging, and this practice complicates the management of musculoskeletal disorders
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@#Intramedullary nailing is the preferred method of closed shaft fracture fixation of long bones. One of the most dreaded complications to occur following internal fixation of a lower limb fracture is pseudo- or false aneurysm which can lead to the loss of the limb due to acute ischemia. This diagnosis is made by contrast angiogram of the limb. Pointers to the diagnosis include absent distal limb pulsation as well as other signs of acute ischemia post trauma or surgery. We present a case of development of pseudo-aneurysm in an elderly patient following open reduction and internal fixation of a femoral fracture. This case report outlines a prompt multidisciplinary approach of management in a rare case of pseudoaneurysm post fixation of long bone.
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@#health concerns, triggering an escalated burden to healthsystems worldwide. The pandemic has altered people’sliving norms, yet coherently escalating countries’ socio-economic instability. This real-time consensus review aimsto describe the epidemiological trends of COVID-19pandemic across six South-East Asian nations, and country-specific experiences on pandemic preparedness, responsesand interventions.Methods: Consensus-driven approach between authorsfrom the six selected countries was applied. Countryspecific policy documents, official government mediastatements, mainstream news portals, global statisticsdatabases and latest published literature available betweenJanuary-October 2020 were utilised for information retrieval.Situational and epidemiological trend analyses wereconducted. Country-specific interventions and challengeswere described. Based on evidence appraised, a descriptiveframework was considered through a consensus. Theauthors subsequently outlined the lessons learned,challenges ahead and interventions that needs to be in placeto control the pandemic. Results: The total number of people infected with COVID-19between 1 January and 16 November 2020 had reached48,520 in Malaysia, 58,124 in Singapore, 3,875 in Thailand,470,648 in Indonesia, 409,574 in Philippines and 70,161 inMyanmar. The total number of people infected with COVID-19 in the six countries from January to 31 October 2020 were936,866 cases and the mortality rate was 2.42%. Indonesiahad 410,088 cases with a mortality rate of 3.38%, Philippineshad 380,729 cases with a mortality rate of 1.90%, Myanmarhad 52,706 cases with a mortality rate of 2.34%, Thailand had3,780 cases with a mortality rate of 1.56%, Malaysia had31,548 cases with a mortality rate of 0.79%, and Singaporehad 58,015 cases with a mortality rate of 0.05% over the 10-month period. Each country response varied depending onits real-time situations based on the number of active casesand economic situation of the country. Conclusion: The number of COVID-19 cases in thesecountries waxed and waned over the 10-month period, thenumber of cases may be coming down in one country, andvice versa in another. Each country, if acting alone, will notbe able to control this pandemic. Sharing of information andresources across nations is the key to successful control ofthe pandemic. There is a need to reflect on how thepandemic affects individuals, families and the community asa whole. There are many people who cannot afford to beisolated from their families and daily wage workers whocannot afford to miss work. Are we as a medical community,only empathising with our patients or are we doing ourutmost to uphold them during this time of crisis? Are thereany other avenues which can curb the epidemic whilereducing its impact on the health and socio-economiccondition of the individual, community and the nation?
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@#594Med J Malaysia Vol 75 No 5 September 2020SUMMARYMorel-Lavallee lesions (MLL) are post-traumatic, closedinternal degloving injuries that can result in severecomplications if not diagnosed early. It is conventionallyseen in cases of the high energy injuries of the pelvis andlower limb. The accumulation of extravasated blood,secondary to fracture and soft tissue damage may causeinternal degloving injury, skin necrosis, soft tissue damageand acute osteomyelitis. We report here the clinical andradiological features in a 32-year-old male referred from theemergency department of a tertiary hospital who hadsustained high energy motor vehicle accident. Onexamination, there was a fluctuant, mobile, non-tendersubcutaneous mass over the distal arm with suspicion ofinternal degloving injury. Plain radiographs showed nofractures. Ultrasound showed a fluid collection with thepresence of septations and echogenic debris within thecollection. Extravasation was noted between subcutaneoustissue layer and fascia at the posterolateral aspect of thearm. Wound debridement under general anaesthesia wascarried out. Intraoperative findings reported a significantamount of thick serous fluid with necrotic debris. Unhealthyskin and fat layers were debrided. Underlying muscles werefound to be healthy. The results of the intraoperative fluidculture and sensitivity showed no growth. Negative pressurevacuum dressing was carried out. After five cycles ofvacuum dressing, the wound showed signs of healing withan improved range of motion of the elbow. Orthopaedicsurgeons need to be vigilant of the possibility of MLL in theupper limb as a differential diagnosis in the management ofhigh energy trauma.
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@#Proper understanding the ‘Instructions to authors’ for a particular journal is the key towards successful submission of a manuscript which will lead to it being published. Common errors that are frequently made by authors in their submission to the Malaysia Journal of Malaysia (MJM) that lead to rejection of their submission or requiring major revisions or minor revisions are listed and discussed in this article. Outright rejection prior to even a peer review process may be made for an article due to: it is poorly written or when there is suspicion on the authenticity of the submission, which contains elements that are suspected to be plagiarised, it is a duplicate submission or not in the format required by the MJM. The editor in charge of the issue makes a recommendation to the Editor in Chief for the final decision.
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The study was conducted to elucidate the genotoxic effect of deltamethrin in Swiss Albino male mice following oral exposure, by comet assay and micronuclei induction test. Deltamethrin was administered at the dose rate of 1.5 mg/kg bwt, 1.0 mg/kg bwt and 0.5 mg/kg body weight. Mean head DNA percentage, mean tail DNA percentage, mean tail length and mean olive moment were the endpoints for the comet assay. Deltamethrin resulted in a significant comet formation at 15, 30 and 60 days of oral exposure in a dose and time dependent manner. Mean tail DNA% at 15, 30 and 60 days of exposure to deltamethrin was 59.28, 57.74 and 63.14, respectively. The results were found to be significantly different in treatment groups as compared to the control groups. Micronucleated normochromatic erythrocytes, micronucleated polychromatic erythrocytes and polychromatic erythrocytes percentage were the endpoints for the micronuclei induction test. Deltamethrin induced significantly higher number of micronuclei in treatment group than the negative control. In conclusion, present study indicates that pesticides are slow poison and even a low dose of pesticide can cause genotoxicity and other biological effects when exposed to for longer duration.
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Background: In India, gram-positive infections (GPIs) particularly, methicillin-resistant Staphylococcus aureus (MRSA) prevalence is reported to increase exponentially. The overall mortality rate among patients with multi drug resistant GPIs in ICU setting are as high as 16%, despite the availability of various therapeutic options. Aim of the study is to determine the burden of GPIs in critical care settings and to understand the practising behaviour among the specialists in the management of MRSA infections.Methods: The survey was conducted among 264 critical care specialists who attended the Annual National Conference of Indian Society of Critical Medicine held in February 2019 at Mumbai. The delegates were administered a validated 10 question survey.Results: In the survey, 72% of the respondents agreed to the rising prevalence of MRSA and associated increased mortality rate of >16%. Empirical gram positive cover is being given to 30-40% of ICU patients, with ABSSSI being listed as a major indication followed by CAP, VAP, CLABSI and DFI. 46% of the doctors listed vancomycin as their preferred anti-MRSA agents followed by teicolplanin and linezolid. However, more than 80% of the doctors feel that nephrotoxicity in vancomycin, thrombocytopenia in linezolid and poor biofilm penetration are major limitations of these anti-MRSA agents.Conclusions: The survey highlighted the increasing trend in the prevalence and associated mortality in GPIs in critical care settings in India. Further, the limitations of existing anti-MRSA agents have invoked the need for a newer agent with a broad spectrum anti-bacterial activity along with improved safety profile and effective biofilm penetration, which can be used as a suitable alternative empiric therapy to manage GPIs.