Medical Journal of Malaysia最新文献

Seborrheic keratosis (SK) is a prevalent hyperkeratotic dermatological condition characterized by benign proliferation of epidermal keratinocytes, typically occurring in the middle to advanced stages of life. While the trunk is the primary site for lesions, they can also manifest on the extremities, face, and scalp. Although SK is typically benign, there can be morphological overlap with malignant skin lesions, necessitating meticulous differentiation for an accurate diagnosis. This case report describes a 63-year-old male presenting with scalp swelling that was, initially suspected to be malignant. However, histopathological examination revealed pigmented seborrheic keratosis, prompting the need for a comprehensive management approach. Surgical excision with a rotational flap cover was performed successfully, highlighting the importance of precise diagnosis and management in addressing cutaneous lesions. The exact etiology of SK remains elusive, with potential genetic associations implicated in its pathogenesis. Although treatment may not always be necessary, various modalities are available for lesion removal or symptom management, with surgical intervention reserved for cases exhibiting signs of malignancy. Clinicians should be aware of the atypical presentations of SK and, emphasize the need for a multidisciplinary approach involving dermatologists, pathologists, and surgeons for optimal outcomes.

Introduction: Quorum sensing (QS) enables bacteria to coordinate colony-wide activities, including those associated with infections. Quorum quenching (QQ) inhibits QS and is a promising method for controlling bacterial infections. Several In vitro experiments have been conducted to identify nanoparticles (NPs) as potential quorum quenching inhibitors. This review examines the potential of nanoparticles for quorum quenching, focusing on the QS-regulated pathogenicity of wound pathogens.

Materials and methods: Observational studies were conducted to explore the capacity of nanoparticles to quorum quench wound pathogens.

Results: A review of observational studies indicated that nanoparticles exhibit significant quorum-quenching capabilities against wound pathogens. Numerous nanoparticles, including silver, gold, and zinc oxide, have been demonstrated to inhibit QS-regulated activities, thereby reducing bacterial virulence and biofilm formation. These results suggest that nanoparticles could serve as potent agents for mitigating bacterial infections and enhancing wound healing.

Conclusion: Nanoparticles show considerable potential as quorum-quenching agents, effectively decreasing bacterial virulence and biofilm formation in wound pathogens. These results indicate promising applications of nanoparticles in managing bacterial infections and improving wound healing.

Introduction: Psoriasis is a chronic inflammatory skin condition often associated with comorbidities that may impact cognitive function. This study aims to determine if psoriasis is associated with the risk of cognitive impairment and to assess the relationship between cognitive impairment and various disease-related factors, including psoriasis severity, disease duration, and the presence of psoriatic arthropathy, using the Virtual Cognitive Assessment Tool (VCAT).

Materials and methods: A total of 160 individuals were selected, comprising 80 psoriasis patients and 80 controls, matched for age, gender, ethnicity, marital status, education levels, and prevalence of comorbidities. Cognitive function was assessed using the VCAT. The relationship between cognitive impairment and various disease-related factors, including psoriasis severity measured using Psoriasis Area Severity Index (PASI scores), disease duration, and the presence of psoriatic arthropathy, was examined.

Results: The mean VCAT scores for the psoriasis and control groups were 25.38 (SD = 3.18) and 25.94 (SD = 2.67), respectively, with no significant difference between the two groups (p = 0.227). While most cognitive domains showed no significant differences, the VCAT attention sub-score was significantly lower in psoriasis patients (p < 0.05). There was no significant association between psoriasis and cognitive impairment. No significant association was found between cognitive function and PASI scores nor psoriatic arthropathy. A negative association was found between disease duration and VCAT scores, suggesting longer disease duration correlates with lower cognitive function (p = 0.05).

Conclusions: This study did not find broad cognitive impairment in psoriasis patients compared to controls, the specific deficit in attention and its association with the duration of psoriasis warrants further investigation. Understanding and addressing the cognitive aspects of psoriasis could significantly improve the overall quality of life for these patients.

Introduction: Silver nanoparticles (AgNPs) are effective against almost all kinds of pathogenic organisms. The green synthesis of AgNPs utilizing extracts from medicinal plants is being researched to examine the therapeutic advantages of AgNPs because the chemical production of AgNPs is more toxic. In this study, the stem extract of Ocimum Gratissimum (OG) also known as Karunthulasi or wild basil for green synthesis of AgNPs and evaluating their antiinflammatory and antimicrobial effects.

Materials and methods: The produced nanoparticles were characterized using UV-visible spectroscopy. The Bovine Serum Assay (BSA) and Egg Albumin (EA) assays were used to assess the anti-inflammatory effects. The protein denaturation of AgNPs was calculated and compared to a standard to determine the anti-inflammatory activity of green synthesized AgNPs. Using varying concentrations of OGmediated AgNPs in Mueller Hinton Agar (MHA), the antimicrobial effects of OG have been investigated against E. coli, S. aureus, and Pseudomonas sp. Additionally, by measuring optical density, the time-kill curve analysis for E. Coli and S. Aureus has been examined from one hour for up to five hours.

Results: The green synthesized AgNPs were developed successfully using a plant Ocimum gratissimum. The synthesized AgNPs exhibited a maximum absorption peak at 440 nm and SEM analysis revealed that the synthesized AgNPs were spherical and oval. The result findings of the anti-inflammatory activity reveal that AgNPs have great potential when compared to the standard. At the concentration of 50 μg/mL, AgNPs exhibit 76% in BSA assay and 74% in EA assay, where the standard shows 80% inhibition. The antimicrobial activity showed a zone of inhibition around 19mm for E. coli and a 20mm zone of inhibition for S. aureus and Pseudomonas sp., which shows the efficacy of AgNPs. The time-kill assay shows that the optical density of E. coli and S. aureus was reduced to 0.1 after 5 hours of incubation, which shows the potential of green synthesized AgNPs.

Conclusion: OG-mediated AgNPs have both antiinflammatory and antimicrobial effects. Anti-inflammatory effects are better when compared to standard drugs. Antimicrobial effects are better for Gram-negative bacteria.

Introduction: Neonatal circulatory shock poses a significant challenge in intensive care settings and necessitates early recognition and intervention to prevent adverse outcomes. The perfusion index (PI), derived from pulse oximetry signals, is a potential adjunct tool for assessing peripheral perfusion and predicting shock in neonates. This prospective observational study aimed to evaluate the correlation between PI and circulatory shock in neonates with the goal of establishing PI as an objective parameter for early shock identification.

Materials and methods: Study was conducted in the neonatal intensive care unit (NICU) of Saveetha Medical College Hospital, India, in 2023, between January and June. This study enrolled 100 neonates who underwent hemodynamic monitoring over 48-72 hours. Hemodynamic parameters including heart rate, blood pressure, and PI were systematically recorded. Statistical and Receiver operating characteristic curve analyses were used to assess the relationship between PI and shock.

Results: Neonates experiencing shock exhibited significantly lower PI values than those without (P < 0.05). ROC curve analysis identified a PI threshold of 0.7 for predicting shock, demonstrating a high sensitivity (92.5%) and specificity (94.78%). Additionally, a significant association was observed between PI and serum lactate level (p < 0.05), underscoring the utility of PI as a predictor of shock severity.

Conclusion: The study suggests that a PI < 0.7 may serve as an indicator of circulatory shock in neonates, offers good sensitivity and specificity. The PI, along with clinical parameters and serum lactate levels, is a valuable tool for early shock identification in neonatal intensive care. Further research, including multicenter studies, are warranted to validate these findings.

Introduction: Pregnancy induces physiological changes, including alterations in cardiovascular dynamics, predisposing pregnant women to supine hypotension syndrome (SHS) during lower-segment cesarean section (LSCS) under spinal anesthesia. Various methods, including manual displacement of the uterus and use of wedges or cushions, have been proposed to prevent SHS, but their effectiveness remains variable. This study aimed to compare the efficacy of a novel 3D-printed uterine displacement device with that of a traditional wedge in preventing SHS during LSCS after spinal anesthesia.

Methodology: This prospective, randomized, controlled trial enrolled pregnant females undergoing LSCS after spinal anesthesia. The participants were randomized into two groups: a novel 3D device group and a traditional wedge group. Primary outcome measures included the incidence of SHS, while secondary outcomes included maternal hemodynamic parameters, fetal outcomes, feasibility, ease of use, and the safety profile of the devices.

Results: Baseline characteristics were well balanced between the two groups. Although some differences in maternal hemodynamic parameters were noted, the incidence of SHS was significantly lower in the novel 3D device group than that in the traditional wedge group. Fetal outcomes did not differ significantly between the groups. The novel 3D device demonstrated high compatibility with various patient anatomies and was easy to integrate into routine practice. The adverse event profiles were similar between the groups.

Conclusion: This study highlights the potential of a novel 3D-printed uterine displacement device for preventing SHS during LSCS, thereby improving maternal and fetal outcomes. Future research should further validate these findings and explore the long-term implications of the maternal and neonatal outcomes.

Barotrauma is a medical condition caused by sudden pressure changes in the body causing damage to multiple parts of the body. However, it is an infrequent occurrence when it comes to Colo-rectal perforation, wherein the trauma occurs due to the insufflation of compressed air through the anus. Several factors influence the outcome of a patient with colonic perforation due to barotrauma such as the severity of the injury, hemodynamic status of the patient, the patient's general health and well-being, the time taken for active medical/ surgical intervention since the injury, aggressive intravenous antibiotics administration to prevent sepsis, post-operative complications like surgical site infection, post-op ileus, anastomotic leak, etc. Overall, the patient's prognosis largely depends on early diagnosis, effective initial resuscitation, timely surgical intervention, and intensive post-operative care for a favorable outcome. Recently, we came across 2 cases of extensive pneumoperitoneum with Colo-rectal perforation as a result of the forceful insufflation of compressed air through the anus. Prompt medical intervention was necessary to prevent any further complications and they underwent surgical repair of the colorectal perforation.

Introduction: Hodgkin lymphoma (HL) is a hematopoietic malignancy characterized by the presence of Reed Sternberg cells, with generally favourable outcomes compared to other hematological malignancies. This study aims to determine the socio-demographic, clinical and treatment characteristics, as well as the short-term overall survival (OS) and progression-free survival (PFS) rates, of HL patients treated at Hospital Universiti Sains Malaysia (USM), a tertiary centre in northeast peninsular Malaysia.

Materials and methods: We conducted a retrospective cohort study of HL patients treated from January 1, 2006, to December 31, 2018, with follow-up until December 31, 2021. Data on demographics, clinical features, treatments, and outcomes were analyzed. OS and PFS were estimated using the Kaplan-Meier method.

Results: Among 126 patients, the median follow up was 41 months. Most were male (55.6%) and of Malay ethnicity (97.6%). Nodular sclerosis was the predominant histology (52.4%), with 77.8% presenting with advanced-stage disease. All patients received chemotherapy, while 23.1% underwent combined modality therapy either with radiotherapy or immunotherapy. Post-treatment, only 34.1% achieved complete response. The 3-year OS and PFS rates were 74.9% and 59.5%, respectively-relatively lower than rates reported in developed countries. Independent adverse prognostic factors for OS and PFS included advanced-stage disease, bulky disease, elevated erythrocyte sedimentation rate.

Conclusion: This study highlights the need for tailored treatment approaches to improve HL outcomes in northeast Peninsular Malaysia. The relatively modest OS and PFS rates compared to developed nations suggest potential benefits from enhanced access to advanced therapied and diagnostic tools like positron emission tomography computed tomography (PET-CT) scan.

Introduction: As an occupational therapist, listening and empathy are critical components of practice because they are the foundation for developing therapeutic rapport with patients and their relatives. Currently, there is still no study regarding the level of empathy and listening styles among Occupational therapists in Malaysia. This study investigates the level of empathy and listening styles among occupational therapists in Malaysia and to examine their correlations.

Materials and methods: A cross-sectional study was conducted with 244 occupational therapy practitioners; 43 males; and 181 females. The level of empathy and listening style were assessed using the Jefferson Scale of Empathy Health Professional version and Listening Styles Profile- Revised questionnaires. Data were collected using Google Form. Analysis data were done using IBM SPSS Statistical Software version 26.

Results: Statistical analysis showed that Malaysia occupational therapists preferred perspective taking (mean 55.67, Standard Deviation, SD 10.54) in empathy and the analytical listening in listening styles approach (mean 34.71, SD 6.76). In addition, there was a moderate to strong significant correlation between the level of empathy and listening styles (r= 0.419 to 0.648, p<0.05). Furthermore, there is significant difference between listening styles and empathy in relation to gender (male>female) p=0.001-0.038), race (Indian higher than Malay and Chinese) and areas of practice (paediatric higher than psychiatric) (p= 0.016 to 0.039).

Conclusion: The findings are helpful for occupational therapists to improve their quality services by being more listening and empathetic while providing proper intervention to the patients.

Introduction: The biomedical potential of silver nanoparticles (Ag NPs) synthesized with Zingiber officinale and Ocimum gratissimum herbal formulation was investigated in this study. The study aims to reveal their applications in various biomedical fields. The study evaluates the antioxidant, thrombolytic, and antimicrobial potential of Zingiber officinale and Ocimum gratissimum herbal formulation-mediated Ag NPs.

Materials and methods: Biogenically synthesized silver nanoparticles (Ag NPs) from an herbal formulation containing Zingiber officinale and Ocimum gratissimum were tested at various concentrations using the DPPH (2,2- diphenyl-1-picrylhydrazyl) assay. The absorbance was measured at 517 nm to quantify DPPH free radicals. With Ag NP concentrations, the H2O2 test exhibited increased activity. This work evaluated the antibacterial activity of Ag NPs mediated by Zingiber officinale and Ocimum gratissimum against Staphylococcus aureus, Streptococcus mutans, Candida albicans, and Enterococcus faecalis.

Results: The utilization of herbal formulations from Z. officinale and O. gratissimum to synthesize Ag NPs revealed considerable therapeutic effectiveness. At a concentration of 50 μl, the maximal inhibition was 76%, which is comparable in effectiveness to that of standard ascorbic acid. Significant blood clot dissolution was observed during thrombolytic testing at a concentration of 100μg/ml, indicating promising prospects for the treatment of thrombotic disorders. Nanoparticles dose-dependently inhibited E. faecalis, C. albicans, S. aureus, and S. mutans in antibacterial testing. These results show the potential of the nanoparticles as supplementary or alternative treatments to conventional antibiotics, particularly in light of the increasing prevalence of antibiotic resistance.

Conclusion: The further investigation of nanoparticles into their mechanisms and efficacy in therapeutic applications, positioning Zingiber officinale and Ocimum gratissimum formulation-mediated Ag NPs as viable candidates in developing antioxidant, thrombolytic, and antimicrobial treatments.