Medical Journal of Malaysia最新文献

Introduction: Accidental oesophageal intubation is a significant cause of death or neurological injury during anaesthesia in the perioperative period, making it crucial to confirm the correct placement of the tracheal tube immediately. In the operating room, anaesthesiologists typically use indirect methods to verify tracheal tube positioning. Ultrasonography (USG) can be employed to confirm whether the endotracheal tube (ETT) is correctly placed in the trachea. This study evaluates the use of USG in supervising a trainee during intubation and also examines the time it takes for USG to identify the tube's entry into the trachea or oesophagus in real-time.

Materials and methods: The study included 90 patients with ASA physical status 1 and 2 who were scheduled for elective surgeries under general anaesthesia. Preoperative data were collected on patient characteristics, airway measurements, and baseline haemodynamic parameters. Anaesthetic management was kept consistent across all participants. The 90 patients were divided into three groups of 30 each, with intubation performed by either an intern, resident, or faculty member, assigned through computergenerated randomisation. A high-frequency linear ultrasound probe (9-14MHz) was placed at the suprasternal notch and slightly moved to the left. In this view, at the level of the suprasternal notch, the oesophagus appears posterolateral to the trachea. During laryngoscopy, the Cormack-Lehane grade was recorded. The anaesthesiologist performing the ultrasound simultaneously measured the time taken to confirm endotracheal intubation. In cases of oesophageal intubation, the "double track" sign was used for identification, and the time required to make this identification was recorded. The times for confirming intubation into the trachea and oesophagus were documented for all three groups. SPSS Version 20.0 software was used for statistical analysis. The study employed mean, standard deviation, chi-square test, ANOVA, and Duncan Multiple Range Test (DMRT) for data analysis.

Results: The patient characteristics and demographic data showed no significant statistical differences. Oesophageal intubation was detected as quickly as 2 seconds, and the average time in seconds to confirm endotracheal tube placement was recorded for each group as follows: Faculty < Resident < Intern (Mean time: 17.5 < 26.8 < 53.6 seconds). The ANOVA test indicated statistically significant differences in tracheal intubation times among the three groups. Further analysis with the Duncan Multiple Range Test (DMRT) confirmed that the timing differences between the groups were statistically significant.

Discussion: Ultrasound is a valuable tool in training scenarios where a physician supervises less experienced practitioners. It provides a fast and reliable method for confirming correct endotracheal intubation.

Introduction: Depression is a prevalent mental health disorder and a growing public health concern. Understanding its burden, this study aimed to determine the prevalence of depression and identify its associated factors among suburban adult residents of Kuala Nerus, Malaysia.

Materials and methods: A community-based cross-sectional study was conducted among 689 adults aged 18 and above who had resided in a suburban area for at least one month and were proficient in Bahasa Malaysia. Data were collected through a house-to-house survey using a pre-tested, validated questionnaire administered via Google Form. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), and multiple logistic regression analysis was performed to identify associated factors.

Results: The prevalence of depression among respondents was 26.4% (95% CI: 23.1, 29.7). Multiple logistic regression analysis identified several significant factors associated with depression. Older age (adjusted OR: 0.972, 95% CI: 0.948, 0.996; p=0.020), being married (adjusted OR: 0.377, 95% CI: 0.188, 0.754; p=0.006), engaging in physical activity (adjusted OR: 0.669, 95% CI: 0.459, 0.976; p=0.037), and higher total knowledge scores (adjusted OR: 0.883, 95% CI: 0.825, 0.945; p < 0.001) were less likely to have depression. Conversely, being female (adjusted OR: 1.614, 95% CI: 1.076, 2.421; p=0.021) and having a history of depression (adjusted OR: 2.977, 95% CI: 1.122, 7.899; p=0.028) were more likely to have depression.

Conclusion: The study highlights the substantial burden of depression in suburban communities and underscores the need for targeted mental health interventions. Efforts to improve mental health literacy and promote protective factors, particularly among vulnerable groups such as younger individuals and females, are essential. Further research is warranted to develop effective prevention and treatment strategies.

Introduction: Dyslipidaemia is a major cardiovascular risk factor associated with elevated low-density lipoprotein (LDL) cholesterol and triglyceride levels. While statins are the primary treatment, inflammation remains a significant predictor of cardiovascular events, highlighting the need for adjunctive therapies targeting both lipids and inflammation. Quercetin, a flavonoid with antioxidant and antiinflammatory effects, has shown promise in preclinical models, although clinical results are mixed. This study investigates the effects of quercetin on lipid profiles, inflammatory biomarkers (bradykinin, C-reactive protein [CRP], interleukin-6 [IL-6]) and angiotensin-converting enzyme 2 (ACE2) levels in a rabbit model of dyslipidaemia, exploring its potential as an adjunctive therapy for dyslipidaemia.

Materials and methods: Twenty male New Zealand White rabbits were randomly assigned to four groups (n=4): control, high-fat diet (HFD), HFD with quercetin (20 mg/kg/day), and HFD with atorvastatin (0.43 mg/kg/day, positive control). Rabbits received either a standard or HFD (1.2% cholesterol, 10% coconut oil) alone or HFD with quercetin or atorvastatin co-administered orally for 12 weeks. Blood samples were collected pre- and posttreatment for serum analysis. Body weight was measured weekly, and serum lipid profiles (total cholesterol, triglycerides, high-density lipoprotein [HDL], and LDL) were measured post-treatment. Serum levels of bradykinin, IL-6, CRP, and ACE2 pre- and post-treatment were quantified using enzyme-linked immunosorbent assay.

Results: The HFD significantly increased body weight, total cholesterol, triglycerides, and LDL cholesterol in rabbits, while atorvastatin and quercetin co-treatments effectively reduced total and LDL cholesterol levels (p < 0.05) but had no impact on body weight. Neither HFD nor treatments significantly altered HDL cholesterol, bradykinin, IL-6, CRP, or ACE2 levels after 12 weeks. Changes in these inflammatory and enzymatic markers from pre-treatment to post-treatment were also not significant across groups.

Conclusion: Quercetin demonstrated lipid-lowering effects, particularly on total and LDL cholesterol, in a rabbit model of dyslipidaemia. However, it did not significantly affect systemic inflammatory or enzymatic markers. These findings suggest potential lipid-lowering effects independent of inflammation. While quercetin was not superior to atorvastatin, it shows promise as a natural adjunct or alternative therapy.

Introduction: Biliary atresia (BA) is a congenital anomaly often found in neonates, with an incidence reaching 1:5500 per birth. BA is frequently associated with cytomegalovirus (CMV) infection in the patient, which causes a clinical appearance different from other types of BA. BA is usually treated by Kasai procedure, with cholangitis being the most common complication of this procedure. CMV infection is found to affect post-operative survival and bilirubin levels. However, it remains unclear whether the infection may affect the incidence of cholangitis in BA patients post-Kasai procedure.

Materials and methods: This retrospective study used the medical records of 33 BA patients who underwent the Kasai procedure in Dr. Sardjito Hospital between 2017 and 2021.

Results: Among 33 patients, 17 (51.5%) were infected with CMV, and 12 (36.4%) developed cholangitis. The frequency of cholangitis following the Kasai procedure is not significantly influenced by the CMV infection (p=0.615). Interestingly, the incidence of cholangitis is significantly associated with the pre-operative gamma-glutamyl transferase (GGT) levels (p=0.026). Furthermore, preoperative ALP appears to have a protective effect against cholangitis, with these associations nearly reaching a significant level (p=0.093).

Conclusion: CMV infection is unlikely to impact the incidence of cholangitis after the Kasai procedure in BA patients. Notably, the pre-operative GGT level might affect the incidence of cholangitis following the Kasai procedure, thereby increasing their risk.

Introduction: Retinoblastoma is the most common primary intraocular cancer worldwide. Research into factors associated with mortality in retinoblastoma from the Southeast Asian region is currently limited. The present study aims to identify the associated factors that predict mortality among retinoblastoma patients in Malaysia.

Materials and methods: A retrospective cohort study was conducted on retinoblastoma patients diagnosed between January 2004 and April 2023 at hospitals with paediatric ophthalmology services in Malaysia. Data were collected from the Retinoblastoma Registry of the National Eye Database and patients' medical records. The adjusted hazard ratio (AHR) was used in the multivariable Cox regression model to identify the factors associated with mortality among retinoblastoma patients.

Results: A total of 402 retinoblastoma patients were included in the study. Of these, 22 (5.5%) patients died, while 353 (87.8%) were alive and under follow-up at the end of the study, and 27 (6.7%) were lost to follow-up. The univariable Cox regression model identified laterality, lag time, and recurrence as the associated factors. The multivariable Cox regression model confirmed that bilateral (AHR: 3.64; 95% CI: 1.46, 9.02; p=0.004) and longer lag time (AHR: 4.03; 95% CI: 1.57, 10.35; p=0.004) were independent predictors of mortality.

Conclusion: This study found that bilateral and longer lag time were independent prognostic factors associated with higher mortality among retinoblastoma patients in Malaysia. These results highlight the utmost importance of early diagnosis and access to appropriate treatment to improve survival outcomes for retinoblastoma patients.

Introduction: Stroke is one of the leading causes of disability worldwide, imposing a significant public health and economic burden. Oxidative stress, which results from an imbalance between free radical production and antioxidant defences, exacerbates stroke outcomes via its role in promoting neuroinflammation and tissue damage. Superoxide dismutase (SOD), a critical antioxidant enzyme, plays a key role in mitigating oxidative stress. This study evaluates the effect of transcranial direct current stimulation (tDCS) on serum SOD levels in ambulatory ischaemic stroke patients with mild cognitive impairment.

Materials and methods: In this randomized pilot study, 30 ischaemic stroke survivors (aged 20-65 years) were divided into two groups: control intervention physiotherapy (CIP, n=15) and tDCS combined with CIP (tDCS+CIP, n=15). Each group underwent 30-minute sessions, three times weekly, over four weeks. Serum SOD levels were measured pre- and post-intervention using SOD Activity Assay Kit. Paired t-test was used to evaluate within-group changes, and independent t-test assessed between-group differences and the influence of stroke risk factors such as body mass index and blood pressure.

Results: The tDCS+CIP group exhibited a significant increase in serum SOD levels post-intervention (289.02±64.94 U/L from 215.58±53.65 U/L, p=0.001), compared to the CIP group (216.67±45.02 U/L from 198.04±40.74 U/L, p=0.001). No significant association was observed between serum SOD levels and the studied risk factors.

Conclusion: tDCS combined with conventional therapy significantly improves serum SOD levels, suggesting its potential as an adjunctive treatment for reducing oxidative stress in stroke rehabilitation. Further studies with larger sample sizes and extended follow-up are recommended to validate these findings and explore long-term benefits.

Introduction: Chronic obstructive pulmonary disease (COPD) is the third most prevalent cause of death in India. In 2012, over 3 million people succumbed to COPD, accounting for 6% of global deaths. COPD is the second most common respiratory disease after pulmonary tuberculosis. Early identification of cardiac manifestations may guide clinicians in implementing timely interventions to manage both the respiratory and cardiac aspects of COPD. This study aims to analyse the ECG changes in COPD patients and their correlation with airflow restriction.

Materials and methods: This cross-sectional observational prospective study was conducted on 50 patients with COPD at Kurnool Medical College for a period of two years from December 2019 to June 2021. The ECG was recorded using a spectrophotometer.

Results: The most frequent ECG abnormalities were RS in V6 (60%), Incomplete Right Bundle Branch Block (40%), and Right Axis Deviation of QRS (34%). The correlation analysis demonstrated significant associations between specific electrocardiographic changes and FEV1/FVC ratio. The P wave axis, QRS, P wave height, R V6 height, and RBBB showed statistically significant correlations with FEV1.

Discussion: Our findings highlight the prevalence of electrocardiography changes in chronic obstructive pulmonary disease patients, with specific ECG anomalies demonstrating a correlation with the severity of both COPD and pulmonary functional impairment. Further research is warranted to validate these associations and explore their implications for clinical management.

Congenital heart disease accompanied with pectus excavatum is very rare, we present our experienced in one step surgery of pectus and cardiac repair and staged procedure at our institution. We retrospectively reviewed medical records for patients who underwent a hybrid repair of both pectus and CHD between 2022 and 2023 in RSUP dr. Sardjito, Indonesia. Of these patients, 2 patients had both pectus and CHD. The first patient was using one-staged produce operation began with ASD repair than the patient proceeded with pectus repair. During pectus repair, the patient experienced worsening hemodynamics, the total operation took time seven hours. During those seven hours, there was 1400 cc of bleeding. The patient's condition was stationary and worsened within 72 hours. The patient died three days after surgery due to sepsis, MODS, and hyperlactatemia. Meanwhile the second patient underwent two-staged produce showed good result. The total duration of the operation is half shorter than the one-step operation experience, bleeding during the operation also appears to be at least 300 cc. After surgery, the patient's condition was stable and the vital sign was satisfactory. The patient currently has no complaints, including no concerns about unstable hemodynamics caused by the pectus condition. The timing and approach to surgical correction of pectus excavatum in patients with congenital heart disease must be individualized. Factors such as age, anatomical development, cardiopulmonary status, and the complexity of the cardiac defect should guide the decision between single-stage and two-stage procedures. While early intervention carries the risk of recurrence due to ongoing growth, delayed or staged surgery may offer better longterm stability and outcomes, particularly in complex or adult cases.

Hirschsprung disease (HD) is a congenital condition characterized by the absence of ganglion cells in the distal intestine, leading to bowel obstruction. While the use of frozen sections during biopsy is common practice, discrepancies with immunohistochemistry results and the unavailability of frozen section technology in certain pediatric surgical facilities in Indonesia highlight the need for alternative diagnostic approaches. This study evaluates the effectiveness of Single Incision Laparoscopy-Assisted Extracorporeal (SI-ECo) leveling biopsy with immunohistochemistry as a reliable alternative to frozen sections in the preoperative management of Hirschsprung disease, especially in facilities lacking frozen section capabilities. We present three cases of pediatric patients diagnosed with HD confirmed through rectal biopsy. Each patient underwent an SI-ECo leveling biopsy, successfully identifying the ganglionic zone by locating ganglion cells in the distal sigmoid. Based on these findings, subsequent transanal endorectal pull-through (TEPT) procedures were performed. The results demonstrated that SI-ECo leveling biopsy effectively identifies the ganglionic zone, providing a less invasive and precise method for preoperative planning. Leveling biopsy with SILS offers an effective method for identifying the ganglionic zone in Hirschsprung disease. SIECo reduces diagnostic discrepancies and provides higher specificity for detecting ganglion cells compared to frozen sections before the pull-through procedure. SI-ECo leveling biopsy with immunohistochemistry offers a practical, accurate, and less invasive alternative for diagnosing and managing Hirschsprung disease. It reduces the risk of discrepancies observed with frozen sections, making it a viable option for facilities without access to frozen section technology.

Introduction: Hirschsprung disease (HSCR) is a congenital condition characterized by the absence of ganglion cells in the distal colon, resulting in bowel obstruction and motility disorders. Recent studies have highlighted the role of intestinal microbiota in intestinal health and disease, yet its specific alterations in HSCR patients remain unclear. This study aimed to investigate the intestinal microbiota profile of children with HSCR and compare it with healthy controls to identify potential microbial signatures associated with the disease.

Materials and methods: This comparative cross-sectional study analyzed fecal samples from 7 preoperative HSCR patients and 3 healthy controls using 16S rRNA gene sequencing. Inclusion criteria required no antibiotic use within the previous two weeks. Clinical data, including nutritional status, medication history, bowel management methods, and history of HAEC, were recorded. Microbiota composition was compared at the phylum and family levels.

Results: HSCR patients exhibited significantly higher relative abundance of Enterobacteriaceae (mean 0.2582) compared to healthy controls (mean 0.0236), representing an approximately eleven-fold increase. HSCR patients also showed decreased proportions of Firmicutes, Actinobacteria, Bacilli, and Clostridia, while Bacteroidales were increased. Classification of taxa revealed a reduction in beneficial bacteria (e.g., Lactobacillus, Bifidobacterium) and enrichment of potentially pathogenic taxa (e.g., Escherichia-Shigella).

Conclusion: HSCR patients demonstrate a distinct dysbiotic microbiota profile, with reduced beneficial taxa and elevated Enterobacteriaceae levels. These findings highlight potential microbiota-targeted strategies for clinical management of HSCR.