Medical Journal of Malaysia最新文献

Introduction: Congenital duodenal obstruction (CDO) is a common cause of neonatal intestinal obstruction, most requiring surgery to restore bowel continuity. Duodenoduodenostomy (DD) is the preferred procedure, but duodenojejunostomy (DJ) may be performed when DD is not feasible due to anatomy, particularly in small or premature infants. In our centre, choice of procedure was based on intraoperative findings, tension-free anastomosis feasibility, and surgeon preference. This study compared short-term outcomes of DJ and DD in CDO.

Materials and methods: This is a retrospective study with a cross-sectional about outcome of congenital duodenal obstruction at Hasan Sadikin Bandung General Hospital in 2019-2024. Data were collected through medical records, including gestational age, age at surgery, surgical technique, operation time, time to first feed, time to full feed, length of stay, and mortality.

Results: There were a total of 36 congenital duodenal obstruction patients. There were 4 patients (11%) who died before surgery, and 32 patients (89%) underwent surgery. All procedures were performed open surgery. Duodenojejunostomy was performed in 10 patients (31%), duodenoduodenostomy in 22 patients (69%). Time to first feed (mean) is post operative day 8 vs 9 (P = 0.3), time to full feed (mean) post operative day 27.1 vs 25.4 (p=0.8) and length of stay (mean) 27.6 days vs 34.6 days (p=0.9). Three patient of each group died post operative due to sepsis.

Conclusion: Duodenojejunostomy and duodenoduodenostomy have similar outcomes in neonates with congenital duodenal obstruction. These findings are relevant for surgeons who repair congenital duodenal obstruction with duodenojejunostomy or duodenoduodenostomy in open surgery.

Introduction: Glioblastoma is a malignant brain tumor with a poor prognosis and high fatality rates. Current chemotherapy, primarily with temozolomide (TMZ), is limited by resistance and toxic side effects, underscoring the need for alternative treatments. This study investigates the antiproliferative properties of Neolamarckia cadamba (NC) leaves methanol extract on glioblastoma (U-87 MG) cells as a potential alternative treatment.

Materials and methods: NC leaves were collected, dried, and extracted using methanol via maceration. Phytochemical screening identified active compounds, including phenolics, flavonoids and tannins. U-87 MG cells were cultured in Dulbecco's Modified Eagle's Medium (DMEM) supplemented with 10% foetal bovine serum and 1% Penicillin- Streptomycin. The cells were treated with serial dilutions of NC extract and TMZ as a positive control for 24, 48 and 72 hours. Cytoselective of NC extract is conducted on noncancerous (Vero) cells. Cytotoxicity was assessed using the MTT assay, with IC50 values determined from doseresponse curves. Apoptotic induction was evaluated using Acridine Orange/Propidium Iodide (AO/PI) staining under a fluorescent microscope.

Results: Phytochemical screening of NC leaves extract revealed active compounds such as phenolics, flavonoids, tannins and saponins. The MTT assay demonstrated doseand time-dependent cytotoxicity of NC extract, with IC50 values of 198.7 µg/mL (24 hours), 321.4 µg/mL (48 hours), and 126.3 µg/mL (72 hours). NC extract also shows cytoselective on Vero cells with an IC50 value of more than 100 µg/mL for all timeframes. AO/PI staining confirmed apoptosis induction of the NC extract on U-87 MG cells.

Conclusion: NC extract exhibited low potential as an alternative therapeutic agent for glioblastoma by inducing early apoptosis on U-87 MG cells.

Introduction: In cases of gastroschisis and ruptured omphalocele where primary closure is not feasible, physicians must employ alternative strategies to gradually reduce the herniated contents and promote epithelialization, either through non-surgical methods or with surgical intervention. Negative pressure wound therapy (NPWT) is a device specifically designed to promote wound healing by controlling sub atmospheric pressure. Despite the benefits of NPWT, its use in paediatric patients, particularly congenital abdominal wall defect, remains unclear. This study aimed to assess the benefits of NPWT as part of the treatment strategy for gastroschisis and ruptured omphalocele.

Materials and methods: A literature search was conducted through electronic databases including Pubmed, ScienceDirect and JSTOR from inception through January 2025. The outcomes identified included NPWT application details (pressure, timing, duration), outcomes related to length of stay, initial feeding, complications, wound progression, and follow-up results. Quality assessment was not conducted as the review aimed to provide a broad overview of the topic.

Results: Sixteen studies were included in the final analysis. Subjects consisted of 41 patients (32 gastroschisis, and 9 ruptured omphalocele), with a mean gestational age of 36.9 weeks and a mean birth weight of 2,216 g. The most common herniated contents were small bowel and liver, with an average defect size of 6 cm. The initial NPWT pressure ranged from -25 mmHg to -100 mmHg, with -40 mmHg being the most common starting pressure. At 10-12 months followup, most subjects demonstrated no fascial defects and intact epithelialized skin. NPWT was found to be an effective alternative, particularly as part of immediate primary closure, facilitating wound healing during staged closure, or managing infection. Although most evidence came from case reports or series, and there is a lack of standardized protocols for NPWT, its benefits over conventional care were evident.

Conclusion: NPWT shows its benefit in adjunct to delayed closure, primary suture less closure, and in the management of gastroschisis and ruptured omphalocele. Future research should further investigate the optimal use of NPWT in a larger larger prospective or randomized controlled trials to refine protocols and better understand its long-term benefits and risks.

Introduction: Hirschsprung disease (HSCR) is due to the failure of enteric nervous system precursors to colonize the distal intestine in embryonic development, with surgical treatment like the Duhamel procedure as a definitive intervention. However, complications leading to functional disorders may occur, especially with increased eosinophil levels. No studies have assessed the effect of peripheral blood eosinophil and lymphocyte counts on functional outcomes in HSCR patients post-Duhamel procedure.

Materials and methods: This observational retrospective study involved 54 patients undergoing Duhamel procedures from January 2014 to June 2020 at Dr. Sardjito Hospital. Patient records were analyzed using the Mann-Whitney U test for continuous variables and the Chi-Square test for categorical variables.

Results: The majority of patients had normal eosinophil levels (78.8%) and normal lymphocyte counts (96.2%). Functional outcomes revealed that 49 patients (94.2%) had no voluntary bowel movements (VBM), 45 patients (86.5%) did not experience constipation, and 48 subjects (92.3%) had no soiling issues. There was no significant association was found between eosinophilia and functional outcomes in Hirschsprung disease patients after Duhamel procedure (p > 0.05). Similarly, there was no significant association between lymphocytosis and functional outcomes in these patients following Duhamel procedure (p > 0.05) CONCLUSION: The functional outcomes of patients with Hirschsprung disease post-Duhamel procedure at our institution are favorable with most having normal eosinophil and lymphocyte counts. Eosinophilia and lymphocytosis might not significantly affect the outcomes of Hirschsprung disease patients after undergoing the Duhamel procedure at Dr. Sardjito Hospital.

Introduction: Single-incision laparoscopic surgery (SILS) and conventional laparoscopic surgery (CLS) are minimally invasive surgical techniques that are widely used as the treatment of appendicitis. While both techniques have demonstrated several advantages over laparotomy, such as reduced postoperative pain and faster recovery, SILS is hypothesized to further enhance clinical outcomes due to its less invasive approach. Hence, systematic comparisons of SILS and CLS are necessary to delineate the most efficient surgery for pediatric surgeons. This study aimed to compare postoperative outcomes between SILS and CLS in pediatric appendicitis, specifically focusing on complication rates, length of hospital stay (LOS), and duration of surgery.

Materials and methods: A comprehensive search of four databases (PubMed, ProQuest, Scopus, and ScienceDirect) was conducted in October 2024 to identify the eligible studies. Meta-analysis was performed using Comprehensive Meta-Analysis software, applying a random-effects model to calculate pooled effect sizes. Heterogeneity was evaluated using the I² and Q statistics to assess consistency across studies.

Results: Six studies, encompassing a total of 838 children who underwent laparoscopic appendectomy, were included. The pooled analysis showed no statistically significant difference in complication rates between SILS and CLS (OR: 1.421, 95% Confidence Interval: 0.609-3.314, p=0.416), nor in length of hospital stay (SMD: -0.003, 95% Confidence Interval: -0.252-0.247, p=0.983).

Conclusion: Both SILS and CLS demonstrate favorable outcomes for pediatric appendicitis surgery, with minimal differences in complication rates and recovery times. These findings suggest that both techniques were feasible choices, allowing for flexibility in choosing the surgical approach based on patient-specific factors and surgical expertise.

Introduction: Fistulectomy, though effective for treating lower anal canal fistulas, is associated with longer operative times, larger incisions, delayed wound healing, and a higher risk of flatus incontinence. Negative Pressure Wound Therapy (NPWT), which applies controlled vacuum pressure to promote wound healing, may offer a solution to these challenges. This study evaluates the effectiveness of NPWT in enhancing postoperative recovery following fistulectomy.

Materials and methods: This prospective study included 20 patients who underwent fistulectomy at Saveetha Medical College and Hospital. NPWT was applied postoperatively, and patient data-including wound characteristics, healing outcomes, and complications-were collected and analysed. The therapy aimed to accelerate granulation tissue formation, reduce tissue oedema, and minimise infection, thereby reducing hospital stay duration.

Results: Among the 20 patients, the majority were male (75%) and aged between 31 and 60 years. Intersphincteric fistulas were most common (60%), and Escherichia coli was the predominant organism cultured (80%). Laboratory analysis showed normal haemoglobin levels, variable leukocyte and platelet counts, and stable albumin. Thyroid hormone levels varied widely and appeared to influence recovery. The mean postoperative hospital stay was 7.45 days. Patients aged 20-40 years who received NPWT had a shorter hospital stay (6.7 days) compared to those receiving traditional dressings (8.2 days).

Conclusion: NPWT appears to enhance wound healing and reduce hospital stay in post-fistulectomy patients. Although still an uncommon approach for anal fistulas, the promising outcomes observed in this study suggest NPWT may be a valuable addition to routine clinical practice and merit further investigation.

Introduction: This review explores instructional approaches for AR-enhanced learning to improve student motivation, engagement, and learning outcomes. With AR technology gaining momentum, educators aim to implement best practices that leverage its benefits in diverse subject areas.

Materials and methods: Using a systematic review approach and following PRISMA guidelines, this study analyzed 26 peer-reviewed articles published from 2014 to 2024.

Results: Findings were grouped around three central themes: AR's impact on learning and motivation, instructional approaches that support AR integration, and barriers to AR adoption in educational contexts. The analysis suggests that inquiry-based and collaborative approaches with AR improve student engagement, understanding, and academic performance. These results underscore the need for thoughtfully designed AR activities that provide a balance between student autonomy and guided instruction to avoid cognitive overload. However, challenges like accessibility, inclusivity, and limited resources remain obstacles to broader implementation, especially in under-resourced areas.

Conclusion: Future research should concentrate on developing standardized frameworks for AR in education, improving inclusivity, and assessing AR's long-term impact on learning outcomes across various educational settings.

Introduction: Hirschsprung's disease (HSCR), commonly known as aganglionic megacolon, is a rare congenital intestinal illness. Hirschsprung-associated enterocolitis (HAEC), an HSCR complication, is the major cause of morbidity and mortality in patients. Many research has highlighted specific microbiomes that promote HAEC, although there is still controversy on microbiome management. The aim of this study is to profile the gut microbiome of paediatric patients on HSCR with or without HAEC.

Materials and methods: We conducted an analytical descriptive systematic review of relevant case reports from inception research articles between January 2014 to October 2024 using 3 databases following PRISMA guidelines. We extracted data of gut microbiomes in humans with HSCR with or without HAEC. Data about microbiome's effects on gut physiology were also extracted.

Results: This study identified 244 citations; 17 articles were included and analyzed. Proteobacteria were the most common bacteria in HSCR patients developing HAEC and Bacteroidetes were the most common bacteria found in HSCR patients without HAEC.

Conclusion: Proteobacteria were associated in HSCR patient developing HAEC. Therefore, gut microbiome dysbiosis may also be the key point to prevent HAEC.

Introduction: Appendicitis is a common acute surgical condition globally, primarily diagnosed through clinical assessment, imaging, and laboratory markers. The Appendicitis Inflammatory Response (AIR) score, which utilises various clinical and laboratory parameters, is often employed to predict appendicitis more accurately. However, diagnostic improvements, especially in ambiguous cases, are needed. Alkaline phosphatase (ALP), a marker linked to inflammation, may enhance the AIR score's diagnostic precision by reflecting the severity of inflammation more accurately. This study aims to assess the impact of integrating ALP levels into the AIR score.

Materials and methods: This observational study was conducted at Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences. Patients suspected of acute appendicitis were evaluated over one year (2022-2023). Patients were assessed using the AIR score with and without the inclusion of ALP levels. ALP levels were measured along with standard laboratory markers. Statistical analyses were performed using SPSS, assessing the specificity, sensitivity, NPV, and PPV of the AIR score.

Results: A total of 112 patients enrolled: 64 males (57%) and 48 females (43%), most presented with right lower quadrant pain. The median ALP level was 215 IU/L. Initial analyses showed an AIR score sensitivity of 80% and specificity of 75%, which improved to 92% and 85%, respectively, with the inclusion of ALP. The ROC curve analysis indicated an AUC improvement from 0.78 to 0.92 with ALP. This established an optimal ALP cutoff at 90 IU/L. The p-value for AIR is 0.012, whereas the P-value for AIR+ALP is 0.001.

Discussion: Integrating ALP into the AIR score significantly enhances its diagnostic accuracy for appendicitis. This suggested ALP's potential as a valuable biomarker in appendicitis diagnosis. This integration could improve clinical decision-making and patient outcomes, reducing unnecessary surgeries and associated healthcare costs.

Introduction: Dyslipidemia in metabolic syndrome characterized by low cardiometabolic indexes (TG/FBG, TG/HDL-C, and LDL-C/HDL-C) pose inherent risks for the development of diabetic cardiomyopathy. The tangible association between type 2 diabetes mellitus (T2DM) and Heart Failure with Preserved Ejection Fraction (HFpEF) initiated by diastolic dysfunction also has been widely studied. However, whether cardiometabolic indexes may be independently associated with left ventricular (LV) diastolic dysfunction in T2DM patients with HFpEF remained elusive. The aim of this study is to investigate the association between cardiometabolic indexes (TG/FBG, TG/HDL-C, and LDL-C/HDL-C) and diastolic dysfunction in T2DM patients with HFpEF.

Materials and methods: In this cross-sectional study, we analyzed electronic medical records from October 2021 to January 2022 from Dr. Sardjito Hospital. A total of 55 T2DM patients with clinical HFpEF were enrolled. Baseline characteristics, clinical and laboratory variables, medication, and echocardiography data were obtained. Cardiometabolic indexes are presented as numeric data (median with IQR). Meanwhile, the diastolic function is presented as categorical data based on the echocardiographic parameters. Mann-Whitney analysis was performed. P-value <0.05 represent significant associations.

Results: In a cohort of 55 T2DM patients with HFpEF, subjects with diastolic dysfunction demonstrated significantly lower median values for TG/FBG (p=0.015), TG/HDL-C (p=0.003), and LDL-C/HDL-C (p=0.044) compared to those with normal diastolic function. These findings suggest a potential, albeit paradoxical, link between these cardiometabolic markers and impaired ventricular relaxation in this population.

Conclusion: TG/FBG, TG/HDL-C, and LDL-C/HDL-C were significantly associated with diastolic dysfunction. Optimal dyslipidemia control represented by high TG/FBG, TG/HDLC, and LDL-C/HDL-C may become an appealing approach to prevent HFpEF progression in T2DM patients.