Medical Journal of Malaysia最新文献

Introduction: Zinc oxide nanoparticles (ZnO NPs) exhibit a wide range of biomedical applications majorly used as antiinflammatory, anti-cancer, anti-diabetic, and anti-microbial activity and other biomedical applications because they show less toxicity and are very compatible. Zinc metal is an inorganic and essential element in the human body at the trace level. ZnO NPs are also GRAS substances (Generally Recognized As Safe). This study's main objective is synthesizing zinc oxide nanoparticles using red tea & clove mediated herbal formulation and screening for its antimicrobial, and anti-diabetic properties.

Materials and methods: Red tea and clove-mediated ZnO NPs were synthesized using the green synthesis method. The anti-microbial activity was tested against oral pathogens using the agar well diffusion method, while the anti-diabetic activity was estimated using the alpha-amylase inhibitory assay method by using red tea and clovemediated ZnO NPs.

Results: ZnO NPs were successfully synthesized using red tea and clove-formulated extract. The synthesized ZnO NPs using Aspalathus linearis (red tea) and Syzygium aromaticum (clove) mediated ZnO NPs were characterized using UV visible spectrophotometry and SEM (Scanning Electron Microscope) analysis. The green synthesized ZnO NPs show promising anti-microbial activity by exhibiting a 12 mm zone of inhibition against S. aureus, 11 mm in E. faecalis, 9 mm in S. mutans, and 11 mm in C. albicans. In anti-diabetic activity, the green synthesized ZnO NPs showed a maximum inhibition percentage of up to 80% at the maximum concentration of 50 µg/mL.

Conclusion: Green synthesized ZnO NPs using red tea and clove showed maximum efficacy in anti-microbial properties which can lead to huge potential use as antibacterial agents. Simultaneously, anti-diabetic activity showed an excellent inhibition percentage which can be a potent therapeutic agent in the field of nanomedicine in diabetes management.

Introduction: Vertigo and dizziness are symptoms of various underlying conditions, ranging from benign to severe, affecting up to 40% of adults. Understanding the etiological factors and demographic characteristics associated with these symptoms is crucial for improving diagnostic accuracy and management. This study aims to identify the etiological factors contributing to vertigo and dizziness in a clinical setting and assess the effectiveness of treatment strategies.

Materials and methods: Retrospective cohort study conducted at Department of ENT and Head & Neck Surgery, Saveetha Medical College Hospital, Thandalam, Chennai, Tamil Nadu, India from September 2022 to March 2024. We included patients presenting with vertigo or dizziness, excluding those with non-vestibular dizziness or incomplete medical records. We analysed demographic data, medical history, and clinical findings from patient records. Data analysis was performed. Continuous variables were compared using independent sample t-tests and categorical variables using chi-square tests.

Results: The study included 268 patients, predominantly females (57.8%) and individuals aged 40-50 years (29.9%). Benign Paroxysmal Positional Vertigo (BPPV) was the most common etiological factor (41.0%), followed by orthostatic dysregulation (17.2%) and vestibular peripheral dysfunction (VPD) (16.0%). Clinical presentations and outcomes varied with the underlying etiology. Overall, 91.0% of the patients showed improvement following treatment, with 7.1% achieving full recovery.

Conclusion: This study highlights the complexity of vertigo and dizziness, which are influenced by various factors and demographics. This emphasizes the importance of tailored management strategies and a patient-centered, multidisciplinary approach, emphasizing customized treatments to improve patient outcomes.

Introduction: Second victim experience (SVE) refers to the emotional and psychological impact experienced by healthcare providers who are involved in patient safety incidents (PSIs). Despite growing awareness of patient safety in healthcare organizations, remedial actions often focus only on the first victim, the patient. Therefore, it is important to recognize and address the emotional and physical toll that PSIs to ensure the well-being of and to promote a culture of safety in healthcare settings. Hence, this study was initiated to determine the prevalence of SVE, assess symptoms related to SVE and evaluate the level of support needed by healthcare providers.

Materials and methods: The Second Victim Experience and Support Tool for Recovery (SVEST-R) questionnaire was utilized to conduct an anonymous survey on the healthcare providers in Sarawak General Hospital (SGH) from August to October 2018.

Results: A total of 482 respondents participated in the survey and 46.1% of the respondents reported SVE following their involvement in PSIs. Notably, symptoms such as flashbacks, fear, and stress tend to persist for longer durations compared to other symptoms. It is worth noting that non-work-related support received the highest mean (medical doctors = 3.83; nurses = 3.70), indicating that respondents preferred to seek emotional support from their friends and families. Furthermore, nurses reported a significantly higher experience of absenteeism following PSIs than doctors (p=0.003). In addition, most respondents expressed a desire for discussion or counselling with a respected peer or supervisor following their involvement in PSIs.

Conclusion: Present study reported a relatively high prevalence of SVE among healthcare providers at SGH. Hence, proactive measures, including non-work related and supervisor support, are essential in facilitating their overall well-being and successful recovery.

Introduction: Cancer is one of the leading causes of morbidity and mortality worldwide. Breast cancer risk has risen due to lifestyle choices and genetic factors. Women with breast cancer symptoms experience lower quality of life (QoL), particularly in psychological and physical domains, compared to healthy women. Several studies reveal that poor QoL among breast cancer patients increases the risk of psychological distress. This study aimed to develop, implement, and evaluate the effectiveness of a counselling module in improving the QoL among breast cancer patients undergoing chemotherapy at the Institut Kanser Negara (IKN).

Materials and methods: A single-blinded Randomized Controlled Clinical Trial was conducted at the IKN between January 2023 and June 2023. The estimated sample size was 120 participants. A sequential numbering system assigned a unique identifier to each participant until a total of 120 participants were recruited, with 60 participants in both the intervention and control groups. The intervention group received chemotherapy counselling using a newly developed module. QoL and depression were assessed at multiple time points using a validated questionnaire. Data were analysed using SPSS version 26, with independent tests and two-way repeated measures ANOVA. A p-value < 0.05 was considered significant, and partial eta squared was used to measure effect size.

Result: Overall, in age distribution, the intervention group had the highest percentage of participants in the 41-60 years category (40.0%), whereas the control group had the highest percentage of participants aged ≥61 years (38.3%). The counselling module was effective in improving QoL and depression among participants at baseline and for three consecutive follow-ups following interventions. The QoL showed improvement in all four domains in the intervention group, which were Physical Health (p < 0.001), Psychological (p < 0.001), Social Relationship (p < 0.001), and Environment (p = 0.001). There was also a moderate effect reduction on depression (p < 0.001).

Conclusion: The newly developed counselling module was effective in improving the QoL and depression among breast cancer patients. Repetitive counselling sessions by pharmacists, which were conducted during the module implementation, played a key role in ensuring the well-being of breast cancer patients throughout the treatment journey.

Introduction: The coronavirus disease of 2019 (COVID-19) predominantly impacts the pulmonary system; however, it also has harmful consequences for the cardiovascular system through the occurrence of myocardial injury.

Materials and methods: This retrospective study analysed 119 COVID-19 patients admitted to Al-Sultan Abdullah Hospital (HASA) from March until December 2020. Demographics, medical histories, admission laboratory results, electrocardiogram (ECG), echocardiogram (echo), were captured from the hospitals' health records. Myocardial injury is an injury to the myocardium that can be diagnosed by elevated cardiac troponin T or I level above the 99th percentile upper reference limit (URL), an abnormal ECG, and an abnormal echo. Data were analysed using Statistical Package for Social Sciences (SPSS) Version 27.

Results: From this study, it was founded that the prevalence of myocardial injury is 36.1% (43 subjects out of 119). The risk factors are older age (odds ratio, 2.347; p=0.028), males (odds ratio, 2.019; p=0.125), Indians (odds ratio, 3.659; p=0.296), hypertension (odds ratio, 2.776; p=0.009), diabetes mellitus (odds ratio, 1.732; p=0.155) and category 4 and 5 COVID-19 patients (odds ratio, 2.325; p=0.038).

Conclusion: Myocardial injury is prevalent among patients affected by COVID-19 and is associated with older age, hypertension and category 4 and 5 COVID-19. The researchers suggested conducting a more thorough investigation of the sizable population in multiple settings and conducting a prospective study where all infected COVID-19 patients have to undergo several tests, such as ECG, troponin T, and echocardiogram.

Introduction: Selenium nanoparticles (SeNPs) have drawn a lot of interest among researchers because of their distinct impact on antioxidant activity, anti-inflammatory tests, antibacterial activity, and in the treatment of various diseases. A. linearis has shown great findings in biomedical applications because of its physio-chemical compounds such as Aspalathin, orientin, and isoorientin. The increasing demand for eco-friendly and sustainable nanomaterial synthesis has led to the development of green methods utilizing natural resources. The study's main objective is to synthesize green SeNPs using Aspalathus linearis and then test them for cytotoxic, anti-inflammatory, and anti-diabetic properties.

Materials and methods: A UV-visible spectrophotometer and SEM were used to characterize the green synthesized SeNPs. The anti-inflammatory and anti-diabetic activities of green synthesized SeNPs were measured using the alphaamylase inhibitory & beta-glucosidase enzyme inhibition assay and the egg albumin, bovine serum albumin, and membrane stabilization assays. A test for the mortality of brine shrimp was used to determine the cytotoxic impact of SeNPs.

Results: A. linearis powder was used for the green synthesis of selenium nanoparticles, which exhibited the highest peak at 440 nm when analyzed using a UV-visible spectrophotometer. The In vitro anti-inflammatory effect of synthesized SeNPs was maximally inhibited by 44-83% in the bovine serum albumin assay 54-79% in the egg albumin assay, and 54-86% in the membrane stabilization assay compared with standard. The inhibition percentage of antidiabetic activity was found to be 50-86% in the alphaamylase assay and 49-85% in the beta-glucosidase assay when compared to standards at various concentrations. Furthermore, the cytotoxicity impact shows that 70% of brine shrimp were alive at the maximum fixation of 80 µg/mL.

Conclusion: The SeNPs showed concentration-dependent anti-inflammatory and anti-diabetic action, and the green synthesized SeNPs demonstrated an excellent antiinflammatory and anti-diabetic agent. The brine shrimp lethality assay confirmed the SeNPs' biocompatible nature even at high concentrations with less toxicity. Hence the study may enhance SeNPs in developing inflammation drugs and can also be utilized in diabetes management.

Ocular toxoplasmosis is the leading cause of infectious retinochoroiditis in both adults and children. It is caused by the obligate intracellular parasite, Toxoplasma gondii. It is a common cause of posterior uveitis and focal retinitis, typically seen in immunocompetent individuals as a primary infection or in immunocompromised individuals as reactivation of latent infection. Here, we report a rare case of a 29-year-old immunocompetent female presenting with gradual, painless diminution of vision in the left eye associated with headache for over one month. She had a history of hypertension but no other significant medical history. On ocular examination anterior segment was unremarkable and fundus examination of left eye showed "Headlight in fog appearance" suggestive of vitritis. Serological evaluation revealed positive for Toxoplasma IgG antibodies. The patient was treated with cotrimoxazole, oral prednisolone, and topical steroids for 4-6 weeks. Following treatment, her visual acuity improved to 6/6 in left eye. This case highlights the importance of considering ocular toxoplasmosis in the differential diagnosis of unilateral vitritis, even in immunocompetent patients.

Tamoxifen, an oral medication that blocks estrogen activity, is frequently prescribed for the treatment of advanced breast cancer and as an additional therapy following surgical removal of early stage disease. A 45-year-old female with a history of breast carcinoma treated with tamoxifen presented with sudden onset bilateral visual impairment for 4 days. On ocular examination, the patient exhibited optic disc edema with hyperemia and bilateral anterior pathway defects in visual evoked potentials. Magnetic resonance imaging revealed a thickened right optic nerve sheath with patchy enhancement of the left optic nerve sheath. The patient was diagnosed with bilateral optic neuritis and treated with intravenous methylprednisolone, which resulted in significant improvement in visual acuity and resolution of optic disc edema. This case underscores the importance of vigilant ophthalmological monitoring in patients undergoing tamoxifen therapy to facilitate the early detection and management of ocular complications.

Introduction: Cataract is a leading cause of visual impairment globally and in Malaysia, with surgery being the definitive treatment. While intracapsular cataract extraction (ICCE) is now less commonly performed due to advancements in surgical techniques, it remains essential in specific cases, such as those with weak zonular support. This study aims to evaluate the incidence, clinical profiles, and visual outcomes of patients who underwent ICCE, with or without intraocular lens (IOL) implantation, at Hospital Melaka, Malaysia, over the past decade.

Materials and methods: A retrospective review was conducted on patients who underwent ICCE at Hospital Melaka, Malaysia, from January 2014 to December 2023.

Results: A total of 143 ICCE surgeries were performed on 135 patients. Most patients were male (n=88, 65.2%), with females comprising 34.8% (n=47). Most surgeries were performed on patients aged 60-69 years (n=48, 35.5%), followed by those aged 50-59 years (n=31, 23.0%) and 70-79 years (n=28, 20.7%). Incidence was lower among patients below 50 years and above 80 years. In terms of ethnicity, the highest incidence was among Malays (n=77, 57.0%), followed by Chinese (n=42, 31.1%) and Indians (n=15, 11.1%). The leading cause of ICCE was senile cataract with weak zonular support (n=58, 40.6%), followed by trauma (n=33, 23.1%), intraoperative complications (n=30, 21.0%), congenital cataracts (n=14, 9.8%), pseudoexfoliation (n=4, 2.8%), and lens-induced glaucoma (n=4, 2.8%). Post-surgery, 76 patients (53.1%) were left aphakic. Among those receiving IOL implants, 21.0% (n=30) had anterior chamber IOL, 14.7% (n=21) received an iris-claw IOL, and 11.2% (n=16) had a scleral-fixated IOL. Twelve weeks after IOL implantation, 60.9% (n=39) achieved good visual acuity of 6/12 or better, while 17.2% (n=11) had moderate vision (6/18 to 6/36), and 21.9% (n=14) had poor vision (worse than 6/60).

Conclusion: The incidence of ICCE was low, accounting for only 0.66% of the 21,596 cataract surgeries performed at Hospital Melaka, Malaysia, during the study period. The primary indication was senile cataracts with weak zonular support. Most patients achieved favourable visual outcomes at 12 weeks postsurgery following IOL implantation, with the iris-claw IOL showing superior postoperative visual results compared to other IOL types.

Introduction: Green tea is a medicinal beverage extracted from the plant Camellia sinensis. Antioxidants that exist naturally can be extracted as pure compounds from their parent materials for nutraceutical and medicinal applications. The present study aims to assess the antioxidant activity of Zinc oxide-titanium dioxide nano-composites (ZnO-TiO2 NCs) containing green tea extract.

Materials and methods: The antioxidant activity was tested by Hydrogen Peroxide [H2O2] assay, Fluorescence recovery after photo-bleaching [FRAP] assay and 2, 2-diphenyl-1- picrylhydrazyl[DPPH] assay. All tests have shown very good results for the ZnO-TiO2 NCs.

Results: In this study, we present a straightforward, ecofriendly alternative for producing non-toxic zinc oxide and titanium oxide nano-composite material. This study could make a valuable contribution and create new opportunities in the market such as biological and pharmaceutical applications.

Conclusion: The in vitro tests concluded that the novel nanocomposite containing ZnO-TiO2 and green tea extract has good anti-oxidant properties and it is non-toxic to the biological systems.