Medical Journal of Malaysia最新文献

Introduction: Necrotising fasciitis, commonly referred to as "flesh-eating disease," is a rapidly spreading soft tissue infection characterised by extensive necrosis of the skin, subcutaneous tissue, and fascia while sparing the underlying muscle. Despite its low overall incidence, it is a significant soft tissue infection due to its rapid spread and associated high mortality risk.

Materials and methods: This prospective pilot study aims to analyse 25 consecutive cases of necrotising fasciitis to assess various aspects, including age and sex incidence, microbial flora, role of co-morbidities in prognosis, and overall outcome. We conducted a descriptive study involving 25 patients aged 18-84 years diagnosed with necrotising fasciitis over a 6-month period (January 2022 to June 2022) at Saveetha Medical College.

Results: Of the 25 patients treated, 21 (84%) were male and 4 (21%) were female, resulting in a male-to-female ratio of 5.25. The age ranged from 18 to 84 years (Mean age: 50.24 ± Standard deviation, SD=14.175). Trauma was identified as the main precipitating factor in approximately 40% of cases, while Diabetes Mellitus (40%) emerged as the most common co-morbidity. Lower limb involvement was predominant in both male and female patients. The infection was monomicrobial in 32% of cases (Enterococci 16% + Bacteroides 16%) and poly-microbial in 68% with Streptococcus pyogenes + Escherichia coli being the most common organism combination. Wound debridement followed by split skin graft was the most common treatment modality (84%), with the number of debridement sessions varying based on infection severity (corresponding with higher LRINEC scores). Prolonged hospital stay was the most common complication, observed in 52% of cases.

Discussion: Our analysis revealed that necrotising fasciitis is more prevalent in individuals aged over 50 years with a male predominance. Streptococcus pyogenes with Escherichia coli was the predominant microflora, and Diabetes Mellitus emerged as the most common comorbidity. Early recognition, prompt control of diabetes mellitus, aggressive surgical treatment, and supportive therapy are essential steps in managing necrotising fasciitis.

Introduction: Breast cancer is among the leading causes of cancer-related death in women worldwide. Cisplatin is a widely used chemotherapeutic drug because of its strong efficacy in killing various cancer cells. However, it presents several toxicity effects and development of drug resistance. Looking at these shortcomings, there is growing interest in combining conventional chemotherapeutic drugs with natural compounds. Therefore, a natural phenolic compound, methyl gallate, known to have strong anticancer and antioxidant properties, is a potential candidate for enhancing the therapeutic efficacy and reducing the side effects of current chemotherapy drugs.

Materials and methods: This study aims to determine the antiproliferative effect of methyl gallate and its combination with cisplatin on MCF-7 cells using MTT assay. The combination effect was evaluated using MTT assay and then analysed using CompuSyn software. Besides, this study was done to evaluate the morphology of apoptotic cells using AO/PI stain and to determine the ability of the combination treatment to inhibit the migration of MCF-7 cells using wound healing assay.

Results: The cell viability was inhibited dose-dependently with IC ₅₀ values of methyl gallate and cisplatin were 20.21 µg/mL and 13.38 µg/mL respectively. Methyl gallate at fixed concentration combined with the lowest concentration of cisplatin inhibited greater MCF-7 cell growth compared to cisplatin alone with a combination index value of less than 1 indicating the synergistic effect. The MCF-7 cells treated with single and combination drugs exhibited several apoptotic characteristics. Migration of MCF-7 cells was also significantly inhibited by single and combination treatments.

Conclusion: In conclusion, this study suggested that methyl gallate in combination with cisplatin has a good potential to be developed as a chemotherapeutic agent for breast cancer.

Introduction: Pulmonary embolism (PE) is a significant complication in patients with COVID-19, often associated with elevated D-dimer levels. However, there remains uncertainty around the D-dimer threshold for predicting PE in COVID-19 patients as it is influenced by multiple disease factors. This study aimed to establish the D-dimer cut-off value for predicting pulmonary embolism (PE) in patients with COVID-19, evaluate the sensitivity and specificity of this cut-off value, and describe the occurrence of PE and its significant factors.

Materials and methods: A retrospective analysis was conducted on 320 patients with COVID-19 who underwent computed tomography pulmonary angiography (CTPA) due to clinical suspicion of PE between 2020 and 2021 at a single centre in Malaysia. Clinical and biological factors associated with PE were analyzed, including age, sex, race, and D-dimer levels.

Results: Among the study population, 23.4% of males and 15.4% of females tested positive for PE, with no significant differences noted across racial groups. Age was significantly associated with PE development (p = 0.013). Ddimer levels in PE-positive patients were five times higher than in PE-negative patients (p = 0.001). An optimal D-dimer cut-off of 2799 ng/ml level was identified with an area under the curve (AUC) of 0.744 (95% CI: 0.676-0.813), and sensitivity of 81%, and specificity of 51%.

Conclusion: This study highlights the role of D-dimer as a predictive biomarker for PE in COVID-19 patients. The identified cut-off value offers a practical threshold for clinical decision-making, balancing sensitivity and specificity. Further studies are needed to validate these findings in broader population.

Introduction: Resilience is crucial for breast cancer patients. It can enhance mental health and treatment outcomes. Group counselling intervention supports these patients by fostering their inner strength and helping them cope with the psychological impacts of their diagnosis and treatment. This intervention has improved their quality of life.

Materials and methods: This study used a mixed design. It was conducted in two stages: i) Phase I: literature search, interviews, and focus group discussions (FGDs); ii) Phase II: module development, content, and face validation for the Group Counselling Resilience Module Intervention (GCReMI). Interviews and FGDs were used to gather information from patients and healthcare workers. Ten independent experts assessed the content validity, while ten counsellors and breast cancer patients evaluated the face validity.

Results: Twenty-three participants took part in the interviews and FGDs. Data saturation was reached at the third FGD and the fourteenth in-depth interview. Two themes emerged from the qualitative analysis and were integrated into the module. The final GC-ReMI module included nine subthemes. The content validity index (CVI) was 0.84, and the face validity index (FVI) was 1.0 for counsellors and 0.97 for breast cancer patients, all of which meet satisfactory levels.

Conclusion: The GC-ReMI module has satisfactory and acceptable content and face validity, suggesting its potential as a valuable psychoeducational tool for enhancing resilience among breast cancer patients.

Introduction: Preeclampsia is a multi-organ system disorder that is responsible for a significant rate of maternal and perinatal morbidity and mortality worldwide. Though many studies have worked on the risk factors, there is a limited study on the adverse maternal outcomes highlighting the comparison between antepartum preeclampsia/eclampsia (APE/E), intrapartum preeclampsia/eclampsia (IPE/E) and postpartum preeclampsia/eclampsia (PPE).

Materials and methods: A retrospective cohort study was conducted by reviewing records of gestational induced hypertension patients who progressed to having preeclampsia/eclampsia at admitted at the Federal Teaching Hospital, Birnin Kebbi, between January 2009 and December 2019.

Results: The multinomial logistic final model identified six maternal adverse outcomes of preeclampsia/eclampsia: stillbirth, (ARR 0.86 and 0.31, respectively), preterm delivery (ARR 8.55 and 3.10, respectively), induction of labour (ARR 0.39 and 0.36, respectively), maternal death (ARR 12.28 and 8.75, respectively), low birth weight (ARR 0.09 and 0.11, respectively) and convulsion (ARR 8.17 and 8.22, respectively).

Conclusion: These study findings offer valuable insights into the adverse maternal outcomes of preeclampsia and eclampsia within the Nigerian context. It serves as a potential research project that can be applied to the clinical setting to help clinicians manage preeclamptic and eclamptic patients better.

Introduction: Biliary atresia (BA) is an idiopathic disease characterized by progressive fibro-obliteration of extra- and intrahepatic biliary ducts manifesting jaundice >2 weeks. The primary treatment for BA is the Kasai procedure. However, patient survival in BA is influenced by several prognostic factors. We aimed to identify the prognostic factors for 5-year survival of BA patients following the Kasai procedure at Dr. Sardjito Hospital, Yogyakarta, Indonesia.

Materials and methods: This observational analytic study employed a retrospective cohort design, included BA patients who underwent Kasai procedures at our hospital between January 2012 and December 2018.

Results: There was no association between age at surgery (p=0.408), TB7 (p=0.973), operator experience (p=0.649), AST0 (p=0.973), AST7 (p=1), the AST7/AST0 ratio (p=0.682), ALT0 (p=0.682), ALT7 (p=0.697), and the ALT7/ALT0 ratio (p=1) with 5-year survival in BA patients after Kasai procedure. A log-rank analysis showed no significant results: age at surgery (p=0.264), TB7 (p=0.961), operator experience (p=0.479), AST0 (p=0.993), AST7 (p=0.931), AST7/AST0 ratio (p=0.562), ALT0 (p=0.708), ALT7 (p=0.640), and ALT7/ALT0 ratio (p=0.963).

Conclusion: The timing of surgery, total bilirubin levels at 7 days post-surgery, surgeon experience, and both pre-and post-operative AST and ALT may not predict 5-year survival outcomes in BA patients following Kasai surgery. Further extensive cohort studies are necessary to confirm these preliminary findings.

Introduction: Oxybenzone (benzophenone-3) is a widely used organic compound in sunscreens and other personal care products due to its ability to absorb ultraviolet (UV) radiation. It is effective in protecting the skin from harmful UV rays, thereby reducing the risk of skin cancer and photoaging. However, increasing concerns have emerged regarding the environmental impact of oxybenzone, particularly in marine ecosystems.

Materials and methods: A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Web of Science. Keywords included "oxybenzone," "sunscreen," "ecotoxicology," "marine organisms," and "environmental impact." Studies published from 2000 to 2023 were included to ensure a thorough understanding of the topic.

Results: Oxybenzone has been detected in various marine environments, with concentrations ranging from nanograms to micrograms per litre. Oxybenzone has been shown to cause bleaching in corals, impairing their ability to recover from stress. Research indicates that oxybenzone exposure can lead to endocrine disruption in fish, affecting reproductive success and behaviour. Oxybenzone has been found to be toxic to various invertebrates, including mollusks and crustaceans. Sub-lethal effects include impaired growth and development, as well as altered feeding behaviour. The data indicate a clear concentration-response relationship for oxybenzone toxicity across different species. Lower concentrations tend to produce sub-lethal effects, while higher concentrations can lead to mortality.

Discussion: The findings of this review highlight the significant ecotoxicological risks posed by oxybenzone in marine environments. The widespread use of oxybenzone in sunscreens, combined with its persistence in aquatic ecosystems, raises concerns about its long-term effects on marine biodiversity. A balanced approach that considers both human health and environmental sustainability is essential for the future of sunscreen formulations.

Introduction: The study assessed and compared the efficacy of Budesonide steroid nasal douching versus Fluticasone nasal spray in preventing recurrence of symptoms and nasal polyps post-FESS.

Materials and methods: A prospective cohort study conducted in the Department of ENT, Saveetha Medical College and Hospital, Thandalam from June 2022 to June 2023 involving 60 patients diagnosed as Chronic sinusitis with polyposis were scheduled for FESS. Inclusion criteria included adults aged 18 and above with a confirmed diagnosis based on clinical symptoms, endoscopic findings, and radiological imaging. The severity of CRS was evaluated with SNOT22 score and Lund-Kennedy Endoscopic grading system. Patients were randomly assigned to two groups: Group A which was started on Budesonide nasal irrigation twice a day, and Group B, which received Fluticasone nasal spray.

Results: The average age of participants were 33.23 years, with an even distribution between females and males. Preoperative SNOT-22 and Lund-Kennedy scores were similar between both groups. One month postoperatively, both the groups had similar SNOT22 scores, but the Budesonide group had significantly lower Lund-Kennedy scores. At three months, no significant differences were observed. However, at six months, the Budesonide group had significantly lower SNOT22 and Lund-Kennedy scores when compared to the patients receiving Fluticasone.

Discussion: While Budesonide and Fluticasone are both effective post-FESS treatments, Budesonide nasal irrigation may offer better long-term symptom control and endoscopic outcomes. The broader nasal coverage achieved through nasal douching could contribute to its enhanced therapeutic effect.

Introduction: Together with the clinical and radiological evaluation, patient-reported outcome measures (PROMs) provide a valuable tool to measure the success of TKA. This prospective study looked at the clinical outcome and patients' satisfaction following TKA using different PROM and scores at one-year post-operative.

Materials and methods: A prospective cohort study was performed at an elective arthroplasty unit in Menoufia University Hospitals, Egypt, on 132 patients who received primary TKA from 1 May 2021 to 1 May 2022 with a minimum one-year follow-up. All Patients received fixed bearing posterior stabilized knee TKA because knee arthritis, either primary or secondary to autoimmune disorder were included. Demographic data were collected: age, sex, weight, height, body mass index (kg/m2), comorbidities, socioeconomic status, and occupation. Three scores were used for prospective evaluation. Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC), and VAS (Visual Analogue Scale). During the follow-up visits, the participants were then asked to conduct their PROM (6 months and one year), and radiological and functional outcomes were recorded.

Results: 132 patients with mean age 58.5±8.1 (range 35 to 80), a higher proportion of the patient's population were females 105 (79.5%), the body mass index was 28.8±1.37. Comparing the results received on 6 months and 12-month follow-up visits to that recorded preoperative. significant improvement of OKS, WOMAC score, and VAS, this was seen when comparing the measures at 6 months postoperative to the preoperative,12 months postoperative to the preoperative, and 6 months postoperative to 12 months postoperatively, with significant improvement between each of the pairs (P= <0.001). Correlation between both OKS and WOMAC score at 12 months postoperative and age, and BMI. At the 12-month follow-up visit, patients who gave responses on a 4-point Likert scale, with overall patient satisfaction was 72.7% (96 patients); with a dissatisfaction rate of 27.3% (36 patients).

Conclusion: Despite being highly successful in relieving pain, TKA does not meet the expectations of all patients, especially those with demanding levels of knee activities. PROMs that measure functional outcomes should consider patients of different cultures and lifestyles.

Introduction: Tuberculous meningitis (TBM) is a severe manifestation of extrapulmonary tuberculosis that can lead to debilitating neurological complications. Seizures in TBM pose diagnostic and therapeutic challenges and are associated with adverse outcomes and prolonged hospitalisation. This study aims to determine the prevalence, risk factors, and outcomes associated with seizures in patients with TBM patients.

Materials and methods: A retrospective observational study was conducted on 96 adult patients diagnosed with TBM at a tertiary hospital in Malaysia. Patients with the diagnosis of tuberculous meningitis were included and classified into the seizures and non-seizures groups. Clinical, laboratory, radiological, and treatment-related variables were analysed. Antiseizure medication use and neurological outcomes were also assessed.

Results: Seizures occurred in 30.2% (n=29) of patients; generalized seizures were the predominant type. Patients with seizures were more likely to present with altered behaviour (48.3% vs 31.3%) and focal neurological deficits (24.1% vs 14.9%). Patients with seizures were more likely to be on antiseizure medications, particularly phenytoin, valproate and levetiracetam (p<0.05). Lower Glasgow Coma Scale scores on admission were more common among seizure patients (17.2%) compared to non seizure group (7.5%). Patients with seizures had higher rates of mortality (27.6% vs. 13.4%) and poor functional outcomes compared to those without seizures.

Conclusion: Seizures are common in TBM and are associated with worse clinical outcomes. Early clinical signs such as altered behaviour and focal deficits may help identify high-risk TBM patients with seizures. Seizures in TBM are associated with worse neurological outcomes. The common antiseizure therapy initiated for treatment include phenytoin, valproate and levetiracetam. Further prospective studies are needed to refine risk stratification and optimize management.