Universiti Kebangsaan Malaysia Medical Centre Research Articles

A 20-Year Autopsy Study of Myocardial Bridging Among Sudden Deaths

Myocardial bridging (MB) is a condition, where the cardiac muscle overlies the intramyocardial segment of the major epicardial coronary artery. This study aims to analyse the demographics and anatomical characteristics of MB within a pool of 2093 sudden cardiac-related death cases examined at the Forensic Unit of Universiti Kebangsaan Malaysia Medical Centre between 2000 and 2019. In this cross-sectional study, postmortem data collected were gender, racial affiliations, MB anatomical properties, and association with cardiac pathologies entered into the statistical software SPSS version 25 for analysis. The prevalence of MB was 12.9%. It was commoner in males (91.5%). MB was predominant between age 21-40 years old (50.2%). Chinese race showed the highest number of recorded MB cases (24.3%) among local races. MB was mostly found in left anterior descending (LAD) artery (98.2%), with the commonest length of 11-20mm (44.6%), depth of 1-5mm (49.8%), and distance from the ostium of 21-40mm (54.0%). The prevalence of isolated MB (43.2%) was nearly comparable to that of MB with cardiac pathologies (56.8%). MB was mostly associated with atherosclerosis (50.1%) and atheroma formation was mostly proximal to MB (78.3%). MB is a common occurrence and commonly found in the LAD as a single entity. It has a higher preponderance in the male gender among the adult population. In conclusion, the findings not only contribute to a deeper understanding of MB but also hold potential implications for identifying and managing risks related to sudden cardiac-related deaths. It is a pathological condition at a certain length and depth whether it exists as an isolated entity or associated with cardiac pathologies. Atherosclerosis tends to form proximal to MB and might pose a risk for myocardial infarction.

Case report of anti JMH: A high-titer, low-avidity antibody posing difficulty in immunohematological tests

This report presents a patient with anti-John Milton Hagen (JMH) posing difficulties in the immunohematological test in the Blood Bank Unit of Universiti Kebangsaan Malaysia Medical Center. A 1-year-8-month-old boy was referred to our center to rule out acute leukemia from a private hospital. A crossmatch request was sent to the Blood Bank before the bone marrow biopsy. Our testing revealed his blood grouping as O Rh-D positive. His Direct Antiglobulin Test was positive, and his antibody screening and antibody identification showed weak pan-reactivity. However, reactions were negative with enzyme-treated cells. Red cell elution showed interestingly no reaction in the eluate, suspected to be due to drug-induced autoantibody. Further tests of antibody titration and neutralization test suggest it could be a high-titer low avidity (HTLA) antibody, most likely Anti-JMH. Although HTLA antibodies are clinically insignificant, they can cause confusion and delay in issuance of blood products. There are also cases of clinically significant HTLA antibodies. Determining the type of HTLA antibody may guide the extent of further testing required to utilize resources best and, most importantly, to assure patient safety.

Breast Conserving Surgery Post Neo-Adjuvant Chemotherapy for Locally Advanced Breast Carcinoma in a Developing Country: Is It Safe?

Breast conserving surgery (BCS) is the standard treatment for early breast cancer and has similar survival with mastectomy. The role of BCS in locally advanced breast cancer (LABC), post neoadjuvant chemotherapy (NACT), is controversial. Surgeons, especially in developing countries, fear higher margin involvement and local recurrence (LR) in BCS. The aim of this study was to determine the LR in BCS compared to mastectomy in LABC post NACT and to ascertain the percentage of involved surgical margins following both methods of surgery. This was a retrospective study of breast cancer patients seen in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). All patients had NACT followed by either mastectomy or BCS. The patients with Her2 enriched carcinomas did not have access to targeted therapy (Trastuzumab or Pertuzumab). The patients with ill-defined tumours underwent ultrasound assessment in the surgical clinics. All had post-operative radiotherapy. All with ER or PR positive cancers were given Tamoxifen for a minimum of 5 years. This study demonstrated that BCS post NACT was safe to be performed in selected patients with LABC in a developing country.

Clinical Outcomes of Topical Bevacizumab for the Treatment of Corneal Neovascularization.

Background and objective In corneal neovascularization, the peri-corneal vascular structure grows into a normally avascular cornea. This is due to an imbalance between the angiogenic and anti-angiogenic factors that sustain corneal transparency. There are various etiologies of this condition, and they can be divided into infective or non-infective causes, such as inflammation, trauma, or surgical causes. Corneal neovascularization has been shown to improve with the current treatments using steroids and anti-vascular endothelial growth factors. This study aimed to evaluate the effectiveness of topical bevacizumab as an anti-angiogenic agent in patients with corneal neovascularization. Methods This retrospective study included patients who suffered corneal neovascularization of various etiologies and completed six months of topical bevacizumabtherapy between 2020 and 2022 at the Universiti Kebangsaan Malaysia Medical Centre. Results A total of 16 patients received treatment with topical bevacizumab over the three-yearstudy period. Based on specified inclusion and exclusion criteria, 12 patients were eligible for inclusion in this study. Eight patients (66%) showed improvement in terms of either 'clock hours' of improvement, morphology, or regression of corneal neovascularization. All infective causes of corneal neovascularization showed improvement on completion of bevacizumab compared to other causes. Conclusion Topical bevacizumab can be one of the treatment choices for corneal neovascularization. As the outcome varies depending on the severity and chronicity of the condition, the attending ophthalmologist should treat each case differently. Although topical bevacizumab is more effective in mild and moderate cases, the indications for its use in chronic cases remain debatable as the results are unfavorable in such cases.

The Effect of Tobacco Smoking on Corneal Endothelium and Central Corneal Thickness

We aimed to study the impact of tobacco smoking towards central corneal thickness, morphology, and corneal endothelial cell density (ECD) in healthy subjects. This cross-sectional study recruited consecutive patients who visited the Ophthalmology Clinic, Universiti Kebangsaan Malaysia Medical Centre, from April 2017 to August 2018 who were active smokers and non-smokers. Active smokers were further divided into heavy and light smokers according to the number of pack-years smoked. The nicotine dependency level was measured using the Fagerstrom test and divided into low, moderate, and severe dependency. Non-contact specular microscopy was performed. Parameters studied included the ECD, percentage of hexagonality (HEX), coefficient of variation of cell size (COV), and central corneal thickness (CCT). A total of 84 eyes from 84 subjects were included, with 42 in the smoker and 42 in the non-smoker groups. The mean age was 38.3 ± 6.7 and 39.2 ± 10.7 years in the smoker and non-smoker groups, respectively. The mean ECD, HEX, and COV were 2783 ± 316 vs. 2877 ± 333 cells/mm2, 55.0 ± 6.7% vs. 55.0 ± 7.7% and 32.7 ± 4.4% vs. 32.2 ± 4.1% in the smoker and non-smoker group, respectively. However, none were statistically significant (p>0.05). The mean CCT was also not statistically different, with 532.6 ± 30.8 μm in the smoker group and 530.5 ± 30.8 μm in the non-smoker group. No statistically significant difference was found between light and heavy smokers and addiction levels. There was a statistically significant but weak negative correlation between ECD and duration of smoking (r = -.370, p = 0.016) and a weak positive correlation between COV and number of pack-years smoked (r = .344, p = 0.025). Smoking did not significantly affect corneal ECD, cellular morphology, or CCT.

A study of ear biometrics in autopsied cases at the Universiti Kebangsaan Malaysia Medical Centre

BackgroundThe ears have increasingly been recognized as one of the supportive tools in forensics, based on the identification of landmark variations of ear biometrics in living persons. However, no studies on the reliability of such comparisons have been done on the deceased.MethodsThe study aimed to investigate the correlation between ear biometrics and the age, sex, and stature of the deceased. The study was conducted on 181 deceased persons, aged between 18 and 70 years old on cases received by the Forensic Unit of Universiti Kebangsaan Malaysia Medical Centre. Documentation of age, sex, race, and height was recorded, and photographs of bilateral ears were taken. Measurements of twelve ear biometrics based on the Iannarelli method and ear length and ear width were taken from the photographs.ResultsResults showed that there was a significant difference between males and females in six ear biometrics. There was also a significant correlation between ear biometrics, that is, ear length and ear width with the age and height of an individual.ConclusionsIn brief, there exists a significant difference between males and females in ear biometrics with good correlations between ear biometrics and the height and age of an individual. Hence, the ear can be used for personal identification in the forensic field.

Fertility Services & Training: What the Future Beholds

The world of assisted reproductive technology is rapidly expanding worldwide with new improvements and constantly developed techniques. Two of the important factors affecting the success of any centre are the reproductive clinician and the embryologist. While training programme for reproductive clinician has been established, less so is said for embryologist. As the pioneer and leading fertility centre amongst universities in the country, Universiti Kebangsaan Malaysia Medical Centre (UKMMC) is making steps towards introducing a clinical embryology programme that is hoping to set a standard for embryologist training for the country and region. Fertility preservation is an area of assisted reproduction that is fast gaining recognition. It gives hope, especially to young oncologic patients for future reproduction. International success with ovarian tissue cryopreservation and reimplantation culminating with the first birth in 2004 gives hope to these patients. With the current plans of expansion and training of our reproductive centre, an oncofertility unit with ovarian cryopreservation facilities will be soon established to cater to the needs of the country.

Retinal changes and cardiac biomarker assessment in relation to chronic kidney disease: a single centre study

BackgroundThe prevalence of chronic kidney disease (CKD) is rising in Malaysia. Early detection is necessary to prevent disease progression, especially in terms of cardiovascular (CV) risk, the main cause of death in end-stage renal disease (ESRD). Retinal changes have proven to be a good predictor of CKD whereas cardiac biomarkers are useful in cardiovascular risk stratification. We aimed to demonstrate the correlation between retinal changes and cardiac biomarkers with CKD.MethodsThis single-centre cross-sectional study was conducted among patients with CKD stages 3, 4, and 5 (not on dialysis) from the Nephrology Clinic, Universiti Kebangsaan Malaysia Medical Centre. A total of 84 patients were recruited with an even distribution across all three stages. They underwent fundus photography where images were analysed for vessel calibre (central retinal venular equivalent (CRVE), central retinal arterial equivalent (CRAE), and tortuosity indices. Optical coherence tomography was used to measure macular volume. Blood samples were sent for laboratory measurement of high-sensitivity C-reactive protein (hs-CRP) and asymmetric dimethylarginine (ADMA). These parameters were analysed in relation to CKD.ResultsThe mean age was 58.8 ± 11.7 years, with 52.4% male and 47.6% female patients. Among them, 64.3% were diabetics. Retinal vessel tortuosity (r = -0.220, p-value = 0.044) had a negative correlation with the estimated glomerular filtration rate (eGFR). CRVE showed a positive correlation with proteinuria (r = 0.342, p = 0.001) but negative correlation with eGFR (r = -0.236, p = 0.031). Hs-CRP positively correlated with proteinuria (r = 0.313, p = 0.04) and negatively correlated with eGFR (r = -0.370, p = 0.001). Diabetic patients had a higher CRVE compared to non-diabetic patients (p = 0.02). History of ischaemic heart disease was associated with a smaller macula volume (p = 0.038). Male gender (r2 = 0.066, p = 0.031) and HbA1c had a positive influence (r2 = 0.066, p = 0.047) on retinal vessel tortuosity. There was a positive influence of age (r2 = 0.183, p = 0.012) and hs-CRP (r2 = 0.183, p = 0.045) on CRVE. As for macula volume, it negatively correlated with diabetes (r2 = 0.015, p = 0.040) and positively correlated with smoking (r2 = 0.015, p = 0.012).ConclusionOur study showed that eGFR value affects retinal vessel tortuosity, CRVE and hs-CRP. These parameters bear potential to be used as non-invasive tools in assessing CKD. However, only macula volume may be associated with CVD risk among the CKD population.

Retrospective Review of Management of Diabetic Retinopathy in Pregnant Diabetics at Hospital Universiti Kebangsaan Malaysia

Diabetic retinopathy (DR) may progress when diabetic women pregnant. It is clear that DR cases are increasing around the world and the danger is alarming. This is a retrospective case with 168 pregnant patients which were traced from the registry held by Endocrine Antenatal Clinic, Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre from 2016 to 2019. Of the 138 pregnancies in pre-existing diabetics, 97 records (70.3%) were found to have only one follow-up with incomplete ophthalmology records or defaulters. Only 41 pregnancy records (29.7%) completed with at least two ophthalmology reviews during the pregnancy. Progression of DR was noted in seven of these pregnancies, giving a rate of 17.0%. One eye of one patient progressed from mild non-proliferative DR to sight-threatening proliferative DR (PDR). When comparing the group of progressors with non-progressors, there was no statistically significant difference for risk factors (age, gender, ethnicity, type of diabetes, duration of diabetes, HbA1c level, hypertension, presence of maculopathy, risk factors for diabetes and fetal ultrasound findings). The rate of repeated follow-up for retinopathy during pregnancy in diabetics is about 30%. This study suggested that no risk factors were identified for DR progression.

Malay Happiness at Workplace Index: Psychometric Properties Study

The present study aimed to validate the Malay Happiness at Workplace (M-HAW) index questionnaire. A cross-sectional survey study with a convenience sampling method was carried out at Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia. The forward-backward approach was used to translate the original 11 items of the M-HAW questionnaires, which were then distributed to respondents. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were utilised to assess the questionnaires’ validity and reliability. A total of 501 healthy individuals were included in the study, with 72% female respondents and a mean age of 37.63 + 7.60. The questionnaire was generally well-received by participants, and reliability standards were met (Cronbach’s α = 0.95). The EFA shows two distinct factors, namely individual and environmental factors. The CFA shows that the model was fit (RMSEA= 0.076, CFI= 0.978, x2/df= 3.31). The M-HAW demonstrated its validity as a good tool for determining happiness in the workplace. The M-HAW questionnaire can be used as a screening tool to measure happiness, and should be able to help an organisation provide suitable interventions to improve employee happiness.

Evaluation of cardiac operative risk and outcome using EuroSCORE II for coronary artery bypass graft surgery

Background: The original EuroSCORE was proposed in 1995, with a predicted mortality rate of 3.9%. The study aimed to assess the validity of the European System for Cardiac Operative Risk Evaluation-II (EuroSCORE II), presented in 2012, in predicting 30-day in-hospital mortality with the observed mortality in cardiac surgical patients operated in Universiti Kebangsaan Malaysia Medical Centre (UKMMC).Methodology: It was a retrospective study on patients who had undergone coronary artery bypass graft surgery during 6 y from January 01, 2011 to December 31, 2016, in UKMMC. Comparison between the output of the EuroSCORE II obtained and compared with the patients’ actual postoperative outcome. Results: The actual in-hospital mortality rate was 6.8%. In comparison, the predicted mortality rate by the median EuroSCORE II was 1.23%. Receiver operating characteristics (ROC) curve analysis showed an excellent discriminatory power with the area under the curve (AUC) of 0.844 (95% CI 0.705 - 0.983, P < 0.001) between the survivors and non-survivors. Conclusion: This single-center retrospective study of validation showed that the overall observed mortality was under-predicted by EuroSCORE II. However, it demonstrated a good calibration with excellent discriminatory power in predicting 30 days in-hospital mortality risk among patients undergoing coronary artery bypass graft surgery. Abbreviations: BMI: Body Mass Index; CCS: Canadian Cardiovascular Society; LVEF: Left Ventricular Ejection Fraction; NYHA: New York Heart Association; PA: Pulmonary Artery Key words: Risk assessment; Hospital mortality; Cardiac surgery Citation: Mokhtar MN, Abdullah FH, Rahman MRA, Ooi JSM. Evaluation of cardiac operative risk and outcome using EuroSCORE II for coronary artery bypass graft surgery. Anaesth. pain intensive care 2023;27(3):307−314; DOI: 10.35975/apic.v27i3.2228 Received: November 15, 2022; Reviewed: April 17, 2023; Accepted: April 19, 2023

International Section for Early Career and Training Stroke Beyond Borders: Building Strategies to Improve Stroke Care Worldwide.

HomeStrokeAhead of PrintStroke Beyond Borders: Building Strategies to Improve Stroke Care Worldwide No AccessResearch ArticleRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessResearch ArticleRequest AccessStroke Beyond Borders: Building Strategies to Improve Stroke Care Worldwide Ana Claudia de Souza, Vasileios Lioutas, Ivy Sebastian, Wan Asyraf, Pablo Amaya, Eva Rocha, Meron Gebrewold, Miguel A. Barboza and Sheila Cristina Ouriques Martins Ana Claudia de SouzaAna Claudia de Souza https://orcid.org/0000-0002-8722-9988 Department of Neurology, Hospital Moinhos de Vento, Brazil (A.C.d.S., S.C.O.M.). Search for more papers by this author , Vasileios LioutasVasileios Lioutas https://orcid.org/0000-0002-8521-0036 Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (V.L.). Search for more papers by this author , Ivy SebastianIvy Sebastian https://orcid.org/0000-0002-9196-3130 Department of Neurology, St. Stephen’s Hospital, Delhi, India (I.S.). Search for more papers by this author , Wan AsyrafWan Asyraf https://orcid.org/0000-0002-0880-3591 Medical Department, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur (W.A.). Search for more papers by this author , Pablo AmayaPablo Amaya https://orcid.org/0000-0002-5371-1311 Department of Neurology, Stroke Program, Fundación Valle del Lili, Cali, Colombia (P.A.). Search for more papers by this author , Eva RochaEva Rocha https://orcid.org/0000-0002-0981-3919 Department of Neurology, Federal University of São Paulo, Brazil (E.R.). Search for more papers by this author , Meron GebrewoldMeron Gebrewold Correspondence to: Meron Gebrewold, MD, Department of Neurology, Addis Ababa University, NBH1, 4killo King George VI St, Addis Ababa, Ethiopia. Email E-mail Address: [email protected] https://orcid.org/0000-0002-8839-6497 Department of Neurology, College of Health Sciences, Addis Ababa University, Ethiopia (M.G.). Search for more papers by this author , Miguel A. BarbozaMiguel A. Barboza https://orcid.org/0000-0002-1037-962X Department of Neurosciences, Hospital Dr. Rafael A. Calderón Guardia, San José, Costa Rica (M.A.B.). Search for more papers by this author and Sheila Cristina Ouriques MartinsSheila Cristina Ouriques Martins https://orcid.org/0000-0002-8452-712X Department of Neurology, Hospital Moinhos de Vento, Brazil (A.C.d.S., S.C.O.M.). Hospital de Clínicas de Porto Alegre, Brazil (S.C.O.M.). Search for more papers by this author Originally published2 Jun 2023https://doi.org/10.1161/STROKEAHA.122.038459Stroke. 2023;0FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Discloures, see page XXX.Correspondence to: Meron Gebrewold, MD, Department of Neurology, Addis Ababa University, NBH1, 4killo King George VI St, Addis Ababa, Ethiopia. Email [email protected]com Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.122.038459PMID: 37264914 Originally publishedJune 2, 2023 KeywordsdeliverygoalmorbidityincomesocioeconomicPDF download Advertisement SubjectsIschemic Stroke

The effect of fine-particle size and extrafine particle size inhaled corticosteroid in reducing airway resistance in asthmatic patients

Background Bronchial asthma is characterised by chronic inflammation of both large and small airways. Extra-fine formulation of inhaled corticosteroid (ICS) can achieve a higher peripheral lung deposition leading to improved asthma control. We investigated the effect of extra-fine and fine particle size inhaled ICS with airway resistance and severity of symptoms in asthmatic patients. Methods Prospective interventional study of outpatient asthmatics in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Subjects were grouped based on pre-existing inhalers; extra-fine and fine inhaled corticosteroid (ICS)/long acting beta agonist (LABA). Crossover was at week 7 and treatment regime continued for 7 weeks. Subjects were assessed at week 0, 6 and 13 using asthma control test (ACT) score, forced expiratory volume in 1 s (FEV1) and impulse oscillometry (IOS) Inhaler technique was assessed periodically. Results Thirty-four subjects were recruited. Median asthma duration was 20 years. Twenty subjects (58%) in fine ICS/LABA and 14 (42%) in extra-fine ICS/LABA group. Thirty-one subjects were analysed before crossver. There was a significant improvement of FEV1 in the extra-fine ICS/LABA group (1.7 ± 0.47 to 1.88 ± 0.5; p = 0.01). ACT score reduced significantly in extra-fine ICS/LABA group (23 ± 5 to 21 ± 4; p = 0.04) at week 0–6. Week 7–13 showed a significant improvement of ACT score (16.5 ± 3 to 20 ± 3; p = 0.01) and FEV1 (1.71 ± 0.96 to 1.81 ± 1.02: p = 0.01) in extra-fine ICS/LABA. There was no significant difference in (IOS) parameters between the groups. Conclusion There was an improvement of FEV1 and ACT score with extra-fine ICS/LABA with no benefit in airway resistance.

Split Tummy Exercise Program for Reducing Diastasis Recti in Postpartum Primigravidae: A Randomized Controlled Trial.

Diastasis rectus abdominis (DRA) involves the separation of the midline abdominal muscles and linea alba and affects more than half of postpartum women. This study aimed to assess the effect of a split tummy exercise program (STEP) on DRA closure in postpartum mothers. A randomized controlled trial was conducted from 2008 to 2020 at the Obstetrics and Gynaecology Clinic of the Universiti Kebangsaan Malaysia Medical Centre. Primigravida mothers diagnosed with DRA were selected and randomly assigned to the intervention (n=21) or control (n=20) group. The intervention group underwent a home-based STEP consisting of three phases of nine abdominal exercises. DRA size was assessed at baseline and at 8 weeks postpartum using two-dimensional ultrasound. The mean age of the participants was 28 years (standard deviation, 3.6), with the majority of Malay ethnicity (87.8%) and working mothers (78%). After 8 weeks, the intervention group showed a significant reduction in DRA size of up to 27% (mean difference, 6.17 mm; 95% confidence interval, 3.7-8.7; P<0.001). No significant intergroup DRA changes were observed after 8 weeks of follow-up. Early postpartum screening for DRA should be advocated to allow early STEP intervention to ensure favorable outcomes. STEP intervention is an effective postnatal training program for managing DRA.

Biomarkers for Premature Coronary Artery Disease (PCAD): A Case Control Study.

Coronary artery disease (CAD) is often associated with the older generation. However, in recent years, there is an increasing trend in the prevalence of CAD among the younger population; this is known as premature CAD. Although biomarkers for CAD have been established, there are limited studies focusing on premature CAD especially among the Malay male population. Thus, the aim of this research was to compare the biomarkers between premature CAD (PCAD) and older CAD (OCAD) among Malay males. Subjects, recruited from the Universiti Kebangsaan Malaysia Medical Centre and National Heart Institution, were divided into four groups: healthy control &lt; 45 years old; premature CAD (PCAD) &lt; 45 years old; healthy control &gt; 60 years old; and older CAD (OCAD) &gt; 60 years old, with n = 30 for each group. Ten potential markers for CAD including soluble sVCAM-1, sICAM-1, interleukin-2, interleukin-6, interleukin-10, Apo-E and Apo-A1, homocysteine, CRP, and vitamin D levels were examined. Our results revealed premature CAD patients had significantly higher values (p &lt; 0.05) of sVCAM-1, CRP, interleukin-6, and vitamin D when compared to the age-matched controls. Similarly, older CAD patients showed higher levels of sVCAM-1, CRP, and interleukin-2 when compared to their age-matched controls. After adjusting for multiple parameters, only CRP remained significant for PCAD and interleukin-2 remained significant for CAD. This indicates that premature CAD and older CAD patients showed different profiles of protein biomarkers. CRP has the potential to become a biomarker for premature CAD while interleukin-2 is a better biomarker for older CAD together with other typical panels of protein biomarkers.

A 20-year study of fatal pressure on the neck in autopsied cases at the Universiti Kebangsaan Malaysia Medical Center

A 20-year study of fatal pressure on the neck in autopsied cases at the Universiti Kebangsaan Malaysia Medical Center

Comparing Postoperative Sore Throat (POST) Following Intubation using Macintosh Laryngoscope Versus C-MAC® Video Laryngoscope

Postoperative sore throat (POST) is a common complication with incidence of 30-90% when intubation was done using conventional Macintosh laryngoscope. Although POST is usually self-limiting and with no long-term morbidity, it can lead to patient’s discomfort and dissatisfaction in the postoperative period. The objective of this study was to compare the incidence of POST following intubation using Macintosh laryngoscope and C-MAC® videolaryngoscope (VL) at various time intervals post anaesthesia. This prospective randomised controlled study comprised of 128 patients with American Society of Anesthesiologists (ASA) I and II status who underwent elective surgery under general anaesthesia in Universiti Kebangsaan Malaysia Medical Centre. All recruited patients have normal airway and divided randomly into Group 1 and Group 2 that used Macintosh laryngoscope and C-MAC® VL during intubation, respectively. Patients were evaluated for sore throat, hoarseness of voice, dysphagia and coughing at recovery, 6 hours, 12 hours and 24 hours after intubation. Severity of POST was assessed using numerical rating scale (NRS). Incidence of POST was found to be higher in the Macintosh laryngoscope group (61.9%) compared to C-MAC® VL group (47.9%) although the difference was not statistically significant (p=0.107). Median pain score was used to assess the severity of POST, showing low and comparable in both groups at all time intervals. There were also no significant differences seen in hoarseness of voice, coughing and dysphagia for both groups during postoperation. Incidence of POST following intubation using C-MAC® VL and conventional Macintosh laryngoscope were comparable. This study revealed that severity of POST was generally low in both groups.

Excessive smartphone use and its correlations with social anxiety and quality of life among medical students in a public university in Malaysia: A cross-sectional study.

Smartphone usage has significantly increased in the last decade among young adults has significantly increased in the last decade. While its benefits are undeniable, its negative implications are increasingly emerging. Studies are needed to investigate the effects of excessive smartphone use on a young person's life. This study aimed to determine the prevalence of excessive smartphone use among medical students and its relations with social anxiety, self-esteem, and quality of life. A cross-sectional study was conducted among medical students from Universiti Kebangsaan Malaysia (UKM) in UKM Medical Center. A total of 273 students have consented to participate and completed self-reported questionnaires encompassing sociodemographic information, the Short Version Smartphone Addiction Scale (SAS-SV), the Social Interaction Anxiety Scale (SIAS), the World Health Organization Quality of Life (WHOQOL-BREF) and the Rosenberg Self-esteem Scale (RSES). Sociodemographic data, SIAS score, WHOQOL-BREF score and the Rosenberg Self-esteem Scale score were treated as independent variables. Smartphone addiction Scale score was treated as the dependent variable. Bivariate analysis was used to explore the relationship between independent and dependent variables using the Fisher exact test, Pearson Chi-Square and Pearson correlation coefficient. Multiple linear regression analysis was used to analyze the variables with a p-value of < 0.05 from the Pearson correlation coefficient test. The percentage of excessive smarphone use among UKM medical students is 48%. The bivariate analysis showed that excessive smartphone use has a small but significant positive correlation with social anxiety (r = 0.173, p = 0.004) and negative correlations with physical health (r = -0.133, p = 0.028), psychological wellbeing (r =-0.135, p = 0.026), social relationships (r = -0.232, p = 0.001), environment (r = -0.260, p = 0.001) and self-esteem (r = -0.128, p = 0.035). In the multiple regression analysis, a better environment predicted a reduced risk for smartphone addiction (β = -0.233, p = 0.013). Almost half of the students were found to have smartphone overdependence. Excessive smartphone use has shown a significant relationship with an increased risk for social anxiety, reduction in self-esteem, and quality of life among medical students. A closer look into the possible intervention is needed in the future to curb the negative effects arising from excessive smartphone use.

Retrospective review comparing intrapleural fibrinolytic therapy (alteplase) and surgical intervention in complex pleural effusion

BackgroundIntrapleural fibrinolytic therapy (IPFT) is one of the treatment options for complex pleural effusion. In this study, the IPFT agent used was alteplase, a tissue plasminogen activator (t-PA). This study aims to determine the difference in the outcome of patients with complex pleural effusion between IPFT and surgery in terms of radiological improvement, inflammatory parameters, length of stay, and post-intervention complications.MethodsA retrospective review of patients with complex pleural effusion treated at Universiti Kebangsaan Malaysia Medical Center from January 2012 to August 2020 was performed. Patient demographics, chest imaging, drainage chart, inflammatory parameters, length of hospital stay, and post-intervention and outcome were analyzed.ResultsFifty-eight patients were identified (surgical intervention, n = 18; 31% and IPFT, n = 40, 69%). The mean age was 51.7 ± 18.2 years. Indication for surgical intervention was pleural infection (n = 18; 100%), and MPE (n = 0). Indications for IPFT was pleural infection (n = 30; 75%) and MPE (n = 10; 25%). The dosages of t-PA were one to five doses of 2–50 mg. The baseline chest radiograph in the IPFT group was worse than in the surgical intervention group. (119.96 ± 56.05 vs. 78.19 ± 55.6; p = 0.029) At week 1, the radiological success rate for IPFT and surgical intervention were 27% and 20%, respectively, and at weeks 4–8, the success rate was 56% and 80% respectively. IPFT was associated with lesser complications; fever (17.5%), chest pain (10%), and non-life-threatening bleeding (5%).ConclusionIPFT was comparable to surgery in radiological outcome, inflammatory parameters, and length of stay with lesser reported complications.

Sexual Dysfunction among Gynaecological Cancer Survivors: A Descriptive Cross-Sectional Study in Malaysia

Sexual dysfunction is a major issue among gynaecological cancer survivors. This study aimed to evaluate the prevalence of sexual dysfunction among survivors of gynaecological cancer in Malaysia and to determine its risk factors. A cross-sectional study was conducted of 116 married women with gynaecological cancer who attended the gynaeoncology and oncology clinics at Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Sociodemographic and clinical data were collected. Sexual dysfunction was measured using the Malay Version Female Sexual Function Index (MVFSFI). Univariate and multivariate logistic regression analyses were used to determine the risk factors of female sexual dysfunction. The prevalence of sexual dysfunction among gynaecological cancer survivors was 60% (70 out of 116). Sexual dissatisfaction was the most prevalent domain of sexual dysfunction at 68.1%. Sexual dysfunction was significantly associated with low education levels (Primary level, AOR = 4.92, 95% CI: 1.12-21.63; secondary level, AOR = 4.06, 95% CI: 1.14-14.44). Non-Malays were significantly more likely to have sexual dysfunction compared with Malays (AOR = 3.57, 95% CI: 1.16-11.06). In terms of treatment, combinations of surgery and radiotherapy (AOR = 4.66, 95% CI: 1.01-21.47) as well as surgery and chemoradiation (AOR = 5.77, 95% CI: 1.20-27.85) were considered. Gynaecological cancer survivors with lower education levels, non-Malay ethnicity, and receiving treatment combinations of surgery and radiotherapy or surgery and chemoradiation have a higher risk of sexual dysfunction. A holistic approach in managing the various sociocultural and clinical issues is required to prevent sexual dysfunction among these patients.