Autoimmune Haemolytic Anaemia: A cross sectional study in a Tertiary Haematological Centre (Anemia Hemolitik Autoimun: Kajian Keratan Lintang di Pusat Hemotologi Tertier) / Jurnal Sains Kesihatan Malaysia

@#Autoimmune haemolytic anaemia (AIHA) is a group of disorders wherein autoantibody causes decompensated acquired haemolysis. There has been no epidemiological study of autoimmune haemolytic anaemia (AIHA) in Malaysia. This study retrospectively analysed the epidemiology of AIHA including Evan’s Syndrome in a Tertiary Haematology Centre in Malaysia. Patients diagnosed with AIHA and Evan’s Syndrome at 18 years old and above between 1 January 1994 to 1 October 2020 at the out-patient Haematology Clinic of Hospital Raja Permaisuri Bainun, Ipoh were selected. Patients’ information was retrieved from the outpatient clinic records. A total of 71 patients were included of which predominantly female. The mean age for both genders were comparable. Ethnic stratification revealed AIHA was higher in Malays followed by Chinese and Indian. Warm AIHA was most prevalent at 40.8%, compared to cold AIHA and Evan’s Syndrome (both 23.9%), and mixed AIHA (11.3%). Primary was more common than secondary AIHA followed by Evan’s Syndrome. Approximately half of the secondary AIHA and secondary Evan’s Syndrome were due to SLE. Overall, 67.6% of patients received corticosteroid only and 28.2% combined with immunosuppressant. Individuals at higher age and females have higher risk of developing AIHA and Evan’s Syndrome. The highest prevalence was seen among the Malay ethnic. Primary warm AIHA is the most common type and majority of Evan’s syndrome are secondary to autoimmune diseases.

Synchrotron radiation-based micro-computed tomographic analysis of apical transportation of different Nickel–Titanium rotary systems in curved root canals An in vitro study

Background: In the last few decades, the availability of synchrotron sources has initiated revolutionary advances in X-ray imaging. Aims: The study aimed to evaluate the incidence of apical transportation after root canal preparation with ProTaper Gold (PTG), Hyflex electro discharge machining (HEDM), Reciproc (RPC), and WaveOne Gold (WOG) using synchrotron radiation-based micro-computed tomographic (SR–?CT) analysis. Materials and Methods: Forty mandibular molars were assigned to four experimental groups (n = 10) according to the file system used for the root canal preparation: Group 1: PTG (25/0.08), Group 2: HEDM (25/0.08), Group 3: RPC (25/0.08), and Group 4: WOG (25/0.07). The specimens were scanned on SR–?CT system before and after the root canal preparation. Apical transportation was assessed at 1, 2, 3, 4, and 5 mm section. Statistical Analysis: Two-way analysis of variance and Wilcoxon Mann–Whitney test was used. Results: No significant difference was found between the groups. Transportation in the mesial direction was of greater magnitude than distal transportation for all the files systems. Conclusion: SR–?CT can be used as a reliable diagnostic tool for further implications.

Demineralization of tooth enamel following radiation therapy; An in vitro microstructure and microhardness analysis

Objective: The objective of this study is to evaluate the effects of radiotherapy doses on mineral density and percentage mineral volume of human permanent tooth enamel. Materials and Methods: Synchrotron radiation Xray microcomputed tomography (SRμCT) and microhardness testing were carried out on 8 and 20 tooth samples, respectively. Enamel mineral density was derived from SRμCT technique using ImageJ software. Microhardness samples were subjected to Vickers indentations followed by calculation of microhardness and percentage mineral volume values using respective mathematical measures. Data were analyzed using paired t-test at a significance level of 5%. Qualitative analysis of the enamel microstructure was done with two-dimensional projection images and scanned electron micrographs using μCT and field emission scanning electron microscopy, respectively. Results: Vickers microhardness and SRμCT techniques showed a decrease in microhardness and an increase in mineral density, respectively, in postirradiated samples. These changes were related to mineral density variation and alteration of hydroxyapatite crystal lattice in enamel surface. Enamel microstructure showed key features such as microporosities and loss of smooth homogeneous surface. These indicate tribological loss and delamination of enamel which might lead to radiation caries. Conclusions: Tooth surface loss might be a major contributing factor for radiation caries in head-and-neck cancer patients prescribed to radiotherapy. Such direct effects of radiotherapy cause enamel abrasion, delamination, and damage to the dentinoenamel junction. Suitable measures should, therefore, be worked out to protect nontarget oral tissues such as teeth while delivering effective dosages to target regions

A review of smell and taste dysfunction in COVID-19 patients

@#and taste loss were early subclinical symptoms of COVID-19patients. The objective of this review was to identify theincidence of smell and taste dysfunction in COVID-19,determine the onset of their symptoms and the risk factorsof anosmia, hyposmia, ageusia or dysgeusia for COVID-19infection.Methods: We searched the PubMed and Google Scholar on15th May 2020, with search terms including SARS-COV-2,coronavirus, COVID-19, hyposmia, anosmia, ageusia anddysgeusia. The articles included were cross sectionalstudies, observational studies and retrospective orprospective audits, letters to editor and shortcommunications that included a study of a cohort ofpatients. Case reports, case-series and interventionalstudies were excluded. Discussion: A total of 16 studies were selected. Incidence ofsmell and taste dysfunction was higher in Europe (34 to86%), North America (19 to 71%) and the Middle East (36 to98%) when compared to the Asian cohorts (11 to 15%) inCOVID-19 positive patients. Incidence of smell and tastedysfunction in COVID-19 negative patients was low incomparison (12 to 27%). Total incidence of smell and tastedysfunction from COVID-19 positive and negative patientsfrom seven studies was 20% and 10% respectively.Symptoms may appear just before, concomitantly, orimmediately after the onset of the usual symptoms. Occurspredominantly in females. When occurring immediately afterthe onset of the usual symptoms, the median time of onsetwas 3.3 to 4.4 days. Symptoms persist for a period of sevento 14 days. Patients with smell and taste dysfunction werereported to have a six to ten-fold odds of having COVID-19.Conclusion: Smell and taste dysfunction has a highincidence in Europe, North America, and the Middle East.The incidence was lower in the Asia region. It is a strong riskfactor for COVID-19. It may be the only symptom and shouldbe added to the list of symptoms when screening for COVID-19.KEYW

A cross-sectional study on behavioural and psychological symptoms of dementia in elderly and its impact on quality of life in a tertiary care hospital

Background: Historically, the word dementia was derived from Latin word ‘dementatus’, which means ‘out of one’s mind’. There were 24.3 million people with dementia in the world and 4.6 million are being added every year. Present study was done to evaluate the behavioral and psychological symptoms of dementia in elderly patients and its impact on their quality of life.Methods: It was a hospital based descriptive, cross-sectional study. 100 cognitively impaired patients in the age group of 60 years and above were enrolled. The socio-demographic profile, severity of dementia on MMSE; behavioral disturbances on BPSD; psychiatric illness on NPI; agitation on CMAI and their impact on quality of life, and disability were assessed on WHOQOL-Bref and WHO DAS 2.0 scales, respectively.Results: Out of 110 patients that were screened, 100 participated in the study (response rate 91%). Majority of subjects (53%) were illiterate and belongs to rural background (57%). Mean dementia severity score was 17.01±4.439 SD which was of mild to moderate level. Overall mean age was 68.16±8.16 SD and negatively related (r= -0.652; F=27.044, p<0.001) but weakly associated to severity of dementia. There was a statistically significant increase in the NPI scores with increase in dementia severity (Item score F=91.754, p<0.001 and distress score F=81.647, p<0.001). There was significant increase in agitation/aggression (CMAI) with an increase in severity of dementia. BPSD on NPI item score was weakly related (r=0.757) and caused increase in disability but decrease in quality of life. Dementia severity as per MMSE score was negatively related to WHO DAS disability (r= -0.863), BPSD on NPI item (r= -0.797) and agitation/aggression on CMAI (r= -0.587). WHOQOL-Bref decreases with increase in severity of dementia and disability.Conclusions: Dementia severity was of mild to moderate level and it increased with age. Most common psychiatric symptom was agitation/aggression (76%) and least common was hallucinations (12%). BPSD causes significant decrease in quality of life and an increase in severity of disability.

Papel do exercício combinado sobre a dor de dismenorréia primária em mulheres jovens: uma quase-experiência / Role of combined exercise on primary dysmenorrhea pain among girls: a quasi-experiment

INTRODUÇÃO: Dismenorréia primária é uma dor que atinge o abdômen inferior antes e durante a menstruação. A dismenorréia primária é dor que mais afeta mulheres durante a adolescência. Felizmente, para muitas, o problema alivia à medida que amadurecem, particularmente após uma gravidez. Embora possa ser doloroso e por vezes debilitante por breves períodos de tempo, não é prejudicial. OBJETIVO: Investigar os efeitos de exercícios selecionados sobre a dor de dismenorréia primária em mulheres jovens. MÉTODO: Mulheres jovens com idade de 21,1 ± 2,0 anos foram incluídas neste estudo. A intervenção com exercícios incluiu fortalecimento do grupo muscular central (Core), flexibilidade, exercícios do barril e de resistência. A duração da intervenção foi de nove semanas com frequência de duas sessões por semana e duração de 30 minutos. O projeto foi aprovado pelo comitê de ética no hospital de Kasturba Universidade de Manipal, Índia (número de registro: IEC315 / 2015) RESULTADOS: Os exercícios reduzem a intensidade da dor entre mulheres jovens com dismenorréia. A escala analógica visual (VAS) foi utilizada para medir a intensidade da dor. Houve uma diferença significativa na pontuação para as condições pré-teste (6.94 ± 1.33) e pós-teste (5.02 ± 1.15), p < 0,001. CONCLUSÃO: Este estudo mostra que o exercício misto de flexibilidade, estabilidade do centro de força e exercício do barril pode reduzir a dor primária da dismenorréia entre as meninas. [AU]

INTRODUCTION: Primary dysmenorrhea is the pain of lower abdominal before and during the menstruation. Primary dysmenorrhea is more likely to affect girls during adolescence. Fortunately for many women, the problem eases as they mature, particularly after a pregnancy. Although it may be painful and sometimes debilitating for brief periods of time, it is not harmful. OBJECTIVE: The purpose of this study was to investigate effects of selected exercise on primary dysmenorrhea pain among girl. METHOD: Young women aged (21.1±2.0) were included in this study. The intervention with exercises included core strengthening, flexibility, kegel and endurance exercises. The duration of the intervention was eigth weeks, two times per week with duration of 30 minutes per session. Visual Analogue Scale (VAS) was used to measure the intensity of pain. RESULTS: The results show that exercise effects to reduce pain intensity among young women with dysmenorrhea. There was a significant difference in the score for pre-test (M: 6.94, SD: 1.33) and post-test (M: 5.02, SD: 1.15) conditions; t (9.1) = 2.34, p= 0.000. CONCLUSION: This study shows that the mixed exercise of flexibility, core stability and kegle exercise can reduce the primary dysmenorrhea pain among girls. [AU]

Five cases of iatrogenic cerebrospinal fluid (CSF) rhinorrhoea: Early management is crucial

Endoscopic sinus surgery (ESS) is a standard treatment forrhinosinusitis, which failed optimum medical therapy.Iatrogenic cerebrospinal fluid (CSF) rhinorrhoea can occurduring ESS warrants early repair of the leakage. Thecommon sites for CSF leakage are cribriform plate, foveaethmoidalis, and anterior ethmoid sinuses. We present fivecases of iatrogenic CSF rhinorrhoea due to ESS and itsmanagement.

Quality of life and recurrence of disease in patients with eosinophilic and non-eosinophilic chronic rhinosinusitis with nasal polyposis

Objective: To assess the quality of life (QoL) and recurrenceof disease in patients with eosinophilic (ECRSwNP) andnon-eosinophilic chronic rhinosinusitis with nasal polyposis(non-ECRSwNP) post endoscopic sinus surgery (ESS).Methodology: A cross-sectional comparative study wascarried out in the Otorhinolaryngology – HNS Department,Universiti Kebangsaan Malaysia Medical Center (UKMMC).Subjective assessments of nasal symptoms and quality oflife (QoL) using SNOT-22 and Visual Analogue Scale (VAS)and objective endoscopic assessment was undertakenusing a modified Hadley endoscopic examination.Results: There was no significant statistical difference in thequality of life between the ECRSwNP and non-ECRSwNPgroups as evidenced by the SNOT-22 score and the VAScomparison (p>0.05). However, there was a significantdifference in terms of recurrence of disease with thepresence of nasal polyps on endoscopic examination. (p =0.016)Conclusion: In conclusion, we found that there is nosignificant difference in QoL between ECRSwNP and nonECRSwNP.There is higher frequency of recurrence of nasalpolyps amongst ECRSwNP.

Follicular thyroid cancer with sternal metastasis - challenges and outcomes

Sternal metastasis from differentiated thyroid carcinoma (DTC) is rare and presents a conundrum for surgeons. We present a lady diagnosed with follicular thyroid carcinoma and sternal metastasis who underwent thyroidectomy, sternectomy and sternoplasty with titanium mesh and acrylic plate. She developed a surgical site infection, of which multiple conservative approaches were attempted. She eventually required removal of the implant. Closure of sternal defect was completed with bilateral pectoralis major advancement flaps. This article highlights a series of complications faced during the course of treatment and how they were managed in a tertiary healthcare centre.

Morphological, molecular characterization and taxonomic status of Triplophysa marmorata and Triplophysa kashmirensis (Cypriniformes: Nemacheilidae) from Kashmir valley, India

AbstractIn India the distribution of genus Triplophysa has been reported only in the upper drainage of the Indus River in Jammu and Kashmir and Lahul and Spiti area of Himachal Pradesh. There is no study on the taxonomic characterization of this genus from Kashmir Himalaya. Therefore the present study was aimed to characterize two important fish species Triplophysa marmorata and T. kashmirensis from Kashmir valley, by using morphometric and molecular tools. It is difficult to discriminate these two species due to the poor quality of original descriptions, and the lack of good reviews. Keeping this in view, a morphometric and molecular study was conducted. Morphometric data were analyzed by using univariate analysis of variance (ANOvA) and multivariate analyses (Principal component analysis) and mtDNA marker Cytochrome oxidase 1 was used for molecular support. Altogether, 22 morphometric characters were used and 15 characters were found significantly variable (P < 0.05). First two components of principal component analysis (PCA) i.e. PC1 and PC2 grouped these two species into separate clusters. The Cytochrome oxidase 1 analysis showed that the mean intraspecific nucleotide divergence (K2P) was 0.001 and interspecific nucleotide divergence was 0.007. Despite having low K2P divergence, these two species got separated into two distinct clades in both Neighbour joining (NJ) and Unweighted Pair Group Method with Arithmetic Mean (UPGMA) tree building methods. But the pattern of clade formation showed that these species were recently radiated from each other and may have the same ancestor. Furthermore, these two species were found closer to Nemacheilidae than to Balitoridae family in the phylogenetic analysis. The molecular divergence between these species was also supported by variance in morphometric data. This work may build the base for the revision of taxonomic identity of these two important fishes of genus Triplophysa. The present investigation formulated that, based on morphological and mtDNA COI sequences analysis, these two taxonomic Triplophysa species should be considered as valid. The results may further assist to enhance the knowledge of the ichthyologists in understanding the ichthyofauna of Kashmir valley and will help them in planning strategies for conservation and management of these less studied small indigenous species along their natural range of distribution. Rev. Biol. Trop. 64 (2): 473-482. Epub 2016 June 01.

ResumenEn la India, la distribución del género Triplophysa se ha reportado solo en la parte superior del río Indus en Jammu, Kashmir, Lahul y Spiti en el área de Himachal Pradesh. No existen publicaciones acerca de la caracterización taxonómica de este género en Kashmir Himalaya. Por lo tanto, en este estudio se caracterizaron dos especies del valle de Kashmir: Triplophysa marmorata y T. kashmirensi, mediante el uso de herramientas morfométricas y moleculares. Es difícil diferenciar entre estas dos species debido a las vagas descripciones originales y a la falta de buenas revisiones. Debido a esto se realizó un estudio morfométrico y molecular. Los datos morfométricos se analizaron mediante un ANOvA y un análisis de componentes principales y el marcador del gen de la citocromo oxidasa 1 se usó para apoyo molecular. En general, se usaron 22 caracteres morfométricos y 15 fueron significativos (P < 0.05). Los dos primeros componentes del análisis de components principales (PCA), PC1 y PC2, agruparon estas dos especies en clusters separados. El análisis con citocromo oxidasa 1 mostró que el promedio de divergencia del nucleótido intraespecífico (K2P) fue de 0.001 y la divergencia del nucleótido intraespecífico fue de 0.007. A pesar de la baja divergencia de K2P, estas dos species se separan en dos clados diferentes tanto por el método NJ como por el método UPGMA. Sin embargo, el patrón de formación del clado mostró que estas species radiaron recientemente una de la otra y que podrían tener un ancestro en común. Además, en el análisis filogenético estas dos especies se encontraron más cerca de la familia Nemacheilidae que de Balitoridae. La divergencia molecular entre estas dos especies también fue respaldada por la varianza en los datos morfométricos. Este estudio puede establecer la base para una revisión taxonómica de estos dos importantes peces del género Triplophysa. Esta investigación postuló que, basada en análisis morfológicos y de secuencia de ADNm COI, estas dos especies taxonómicas de Triplophysa deben considerarse válidas. Los resultados pueden contribuir a mejorar el conocimiento de los ictiólogos en la comprensión de la ictiofauna del valle de Kashmir y les ayudará a planear estrategias de conservación y manejo de estas dos pequeñas especies indígenas y poco estudiadas en su rango de distribución natural.

Observational Study To Evaluate Patterns Of Prescription In A Psychiatry Outpatient Department In A Tertiary Care Teaching Hospital.

Objective: To study the prescription patterns in a psychiatry outpatient department in a tertiary care teaching hospital. Methodology: An observational study was conducted from August 2007 to January 2008 in a psychiatry outpatient department in a tertiary care teaching hospital. A total of 300 patients suffering from 3 major classes of psychiatric illnesses (Schizophrenia & other psychotic disorders, Mood disorders, Anxiety disorders as diagnosed by Psychiatrists). The data from the prescription card of the patients was noted in a structured pro forma. Results: Prescription analysis showed that average number of drugs per encounter (Mean ± SD) was 2.53 ± 0.97. Not a single drug was prescribed by generic name. Injection was prescribed in 5% of prescriptions. 67.41% of drugs were prescribed from hospital formulary while 60.03% of drugs were actually dispensed from the hospital pharmacy. In Schizophrenia and other psychotic disorders, most common antipsychotic drug prescribed was Trifluoperazine followed by Chlorpromazine. In mood and anxiety disorders, most common drug prescribed was Imipramine and Chlordiazepoxide respectively. Conclusion: The present study could serve as a platform upon which further studies in prescription analysis of psychotropic drugs can be undertaken to investigate the scope for improvement in prescribing practices in psychiatry.

Caring for the dying in a developing country, how prepared are we?

End of life care is framework to allow for a peaceful, comfortable and dignified death while considering the patients’ personal and religious values, bioethics and knowledge of the disease process. A well planned end of life pathway should allow for the flexibility to shift from an active (or aggressive) treatment approach to one of comfort and care when initial interventions have failed. The need for this pathway is most apparent in the intensive care setting. Implementation of a pathway will face various challenges due to religious and cultural beliefs, education of healthcare providers to carry out difficult discussions and larger socioeconomic implications. Clear medico-legal framework will be required to support this pathway. In conclusion, an end of life pathway tailored to our local needs is the way forward in allowing for dignified death of terminally ill patients; this will require the active participation of medical societies, religious leaders, healthcare providers, patients and their care givers.

Serotonin syndrome due to fluoxetine and tramadol in renal impaired patient.

Serotonin syndrome causes confusion or altered mental status; other symptoms include myoclonus, shivering, tremors, diaphoresis, hyperreflexia, incoordination, fever and diarrhoea. Tramadol possesses dual pharmacological effects i.e., a weak opiate agonist at mu, kappa and delta opiate receptors along with reuptake inhibition of norepinephrine and serotonin. Risk associated with tramadol increases when co-administered with serotonergic antidepressants or MAOIs (monoamine oxidase inhibitors) and in renal impaired. The incidence of this syndrome is less than 1% as most of the cases remain unreported. The case highlights the fact that interaction between serotonergic agents like fluoxetine and tramadol especially in the presence of co-morbid medical illness can lead to serotonin syndrome.

Low molecular weight thiols: glutathione (GSH), mycothiol (MSH) potenail antioxidant compound from actinobacteria.

The class of Actinobacteria is a large group of gram-positive bacteria and having high G+C content. Actinobacteria also produced curious compound like thiols mainly Mycothiol (MSH) and Glutathione (GSH). MSH is also known as mycothiol and comprised of a cysteine residue with an acetylated amino group which is linked to glucosamine to inositol but Glutathione (GSH) having gamma peptide linkage between cysteine group which is attached by normal peptide linkage to a glycine and the carboxyl group of the glutamate side-chain. These thiols play a key role in maintaining a reducing environment in the cell, which is necessary for regular metabolic activities and represent adaptation under stress condition for survival of organisms. Both Mycothiol and glutathione (GSH) having property to protect cells against oxygen toxicity but MSH shows 7 fold slower ability to resistance of autoxidation compare to GSH but GSH is absent in archaebacterium and rarely found in Streptomycetes strains (Streptomyces lactamdurans). In this review article we discussed about the GSH and MSH structure, properties and how GSH is better than MSH in the case of antioxidant production.

Low Frequency magnetic field induces depression by rising nitric oxide levels in the mouse brain.

The present study was designed to investigate the influence of Extremely low frequency magnetic field (ELF MF) on depression related behavior, and mechanism involved therein. Mice were exposed to ELF MF (50Hz, 10G) 8h/day for 7, 30, 60, 90 and 120 days. Depression was assessed using forced swim test (FST), in which no significant effect was observed on 7t h, 30t h, 60t h, 90t h exposure day. However, depression was observed on 120t h exposure day. It is evident that ELF MF exposure modulates level of nitric oxide (NO); therefore, the level of NO was measured in the regions of brain viz; cortex, striatum, hippocampus and hypothalamus. Results established that ELF MF elevated NO levels in the regions of brain. Furthermore, the implication of NO was assessed by nitric oxide synthase (NOS) inhibitors suggesting the involvement of NO in ELF MF induced depression.

Association between stress, sleep quality and temporomandibular joint dysfunction: simulated Mars mission

The aim of this study was to test the association between quality of sleep and stress in individuals with TMD [temporomandibular joint dysfunction] in simulated Mars mission. The 24 healthy crew members were recruited. The physiological measures of systolic blood pressure [SBP], diastolic blood pressure [DBP], and heart rate [HR] were recorded. The Symptom Checklist-90-revised was used which was based on nine dimensions of psychological functioning. The Multidimensional Pain Inventory was pain severity, social and physical activities, affective distress, social support, and feelings of life control. The Pittsburgh Sleep Quality Index was used to measure the number of hours spent in bed and during asleep, frequency and reasons for awakening, and difficulty returning to sleep after awakening. The orofacial pain questionnaire was applied to measure pain experience using descriptors from the McGill Pain Questionnaire. Salivary cortisol and melatonin were measured. The 15 crew members reported temporomandibular joint pain after 6 days of mission. On dental examination, 5 crew members reported simple muscle pain [SM] and other 10 crew members with TMD. The TMD group endorsed more affective descriptors of their pain experience. Compared to the TMD group, the SM group also reported significantly poorer sleep duration. The TMD group reported nonsignificantly more daytime dysfunction than the control. Higher levels of salivary cortisol and salivary melatonin were reported in the TMD group as compared to other group. This study concludes that both quality of sleep and stress levels due to extreme condition [simulated Mars mission] were associated with TMD in simulated Mars mission

Pansinusitis with subdural empyema in an adult: a rare entity

We report a case of an elderly diabetic woman who presented to emergency department with sudden right sided body weakness. On imaging she had subdural empyema complicating acute rhinosinusitis. Evacuation of emphysema and endoscopic sinus surgery resulted in full neurological recovery. Clinician must have a high index of suspicion of possible intracranial suppurative complication as its often manifest as nonspecific clinical presentation in elderly diabetic patients with acute rhinosinusitis, despite improvements in antibiotic therapies

Fungal sinusitis in immunocompetent patient: a case report

We present a case of fungal sinusitis which occur in an immunocompetent patient and responded well with sinus clearance under clinic setting. Early diagnosis is essential in order to avoid high morbidity and mortality associated with the destructive disease and to initiate treatment before irreversible condition arise. It is necessary to distinguish the invasive disease from the non-invasive as the treatment and prognosis are different in each