Malaysian Journal of Medical Sciences最新文献

Background: The aim of this study was to explore the factors associated with the ability to perform activities of daily living (ADL) among post-stroke patients participating in outpatient physical rehabilitation programmes in community hospital in southern Thailand.

Methods: In this cross-sectional study, data were collected from 258 patients diagnosed with stroke through the HOSxP programme from 2018 to 2022. Patients' ADL were assessed using the Barthel Index measurement. Characteristics were described by percentages and medians (IOR). Associations of categorical variables were examined using the chi-squared test, and multiple logistic regressions were employed to identify factors predicting Barthel Index scores among stroke patients. Patients' capacity levels were categorised based on Barthel Index scores and rehabilitation criteria, and unadjusted and adjusted odds ratios (OR/AOR) were presented, with a significance level of 0.05.

Results: Of the 258 stroke patients, 59.30% were male, with a median age of 67 years old. Significant differences in Barthel Index scores were found with respect to gender, age, marital status, comorbidities and duration of rehabilitation (P < 0.05). Binary logistic regression analysis indicated that male stroke patients (AOR = 1.89; 95% confidence interval [CI]: 1.10, 3.26), individuals with single marital status (AOR = 4.62; 95% CI: 1.58, 13.49), absence of comorbidities (AOR = 0.53; 95% CI: 0.29, 0.98), and rehabilitation duration of less than five days (AOR = 4.38; 95% CI: 2.14, 8.96) were more likely to achieve independence in ADL with higher Barthel Index scores (P < 0.05).

Conclusion: Several factors contribute to the effective planning of care and rehabilitation for stroke patients in rural area. Stroke rehabilitation programmes in this region should consider various elements, including patient characteristics, family involvement and clinical factors, to improve ADL performance.

Sepsis remains a significant challenge in the intensive care unit (ICU), with prompt diagnosis and management being critical to improving patient outcomes. Biomarkers have emerged as valuable tools for identifying and predicting sepsis outcomes, with pancreatic stone protein (PSP), procalcitonin (PCT) and C-reactive protein (CRP) as three promising candidates. This systematic review aimed to analyse and compare the diagnostic accuracy of PSP, PCT and CRP regarding sepsis in the ICU. A review of the literature on the diagnostic performance of the three biomarkers was performed using PubMed Central, PubMed, ScienceDirect, Oxford Academic, SpringerLink and Cochrane Library. Data regarding the diagnostic accuracy of the three biomarkers were extracted, compared, and represented as the area under the curve (AUC) receiver operating characteristics (ROC). Three studies examining PSP, PCT and CRP biomarkers in 858 adult patients admitted to the ICU were included in this review. Compared with PCT and CRP, the PSP biomarker, with its unique applications and properties that may potentially benefit patients, doctors and hospitals, performed well and proved reliable in diagnosing sepsis in adult patients. PSP demonstrated reliability in sepsis diagnosis. Further analysis should be conducted to establish a formal, appropriate indication, as well as to determine a suspected sepsis patient's condition when testing each biomarker.

This systematic review aimed to provide information on existing interventional studies that evaluate the efficacy of exercise in populations with increased cardiovascular disease (CVD) risk factors through immune functional perspectives. A literature search was conducted in four databases: PubMed, Scopus, Taylor & Francis and ScienceDirect from January 2012 to February 2023. The articles were screened and evaluated for quality before data were extracted. The review protocol was registered at PROSPERO (CRD42022321704). In total, 18 studies were included for quality appraisal and synthesised evidence indicated that exercise contributes to enhancing the functioning of both innate and adaptive immune responses, potentially serving as an anti-immunosenescent response to exercise in individuals with elevated CVD risk factors. Furthermore, the review emphasised that exercise, irrespective of its type, intensity or mode, was well tolerated by individuals at increased risk for CVD and may have significant implications in generating anti-inflammatory effects.

Background: The fliC locus in Escherichia coli primarily encodes flagellar (H) antigens. Exploring fliC sequence diversity will shed light on the mechanisms of bacterial pathogenicity. This study examined the presence of fliC mutant strains of E. coli in infected patients from different age groups, sexes and sample types in eastern Algerian provinces over a span of 2 years.

Methods: This retrospective, cross-sectional study involved three provinces in eastern Algeria: i) Bordj Bou Arreridj, ii) Setif and iii) Batna. A total of 75 E. coli isolates were obtained from the University State Hospital Centre. Two types of analyses were conducted: i) a bioinformatics analysis of the protein sequences translated from the fliC genes, specifically the fliC flagellar sequences and ii) a multifactorial statistical analysis (multiple correspondence analysis [MCA]) of the population of infected patients, considering various parameters. The fliC protein sequences were aligned using the Multiple Alignment using Fast Fourier Transform (MAFFT) programme. The alignment results were then visualised using the MView programme. Finally, a phylogenetic tree was constructed using the maximum likelihood algorithm in MEGA 11 software.

Results: Bioinformatics analysis highlighted the strong conservation of the structures of the fliC protein sequences, especially at the two N- and C-terminal ends, and strong variability in the central zone. This remarkable fliC intersequence similarity is corroborated by the presence of protein motifs identified in the PROSITE protein motif database.

Conclusion: fliC mutations in E. coli were not detected in the clinical samples of patients from hospitals in the three Algerian Provinces. Our analysis revealed that all the samples exhibited characteristics of wild-type virulent bacteria without mutations. A multicentre study is warranted for epidemiological surveillance of fliC mutant strains for future preventive measures.

Background: This study examined the effects of curcumin and vitamin D on high-mobility group box-1 (HMGB-1) mRNA expression in mice infected with Salmonella typhi.

Methods: The experimental design allocated 40 mice, intraperitoneally infected with S. typhi, to pre- and post-test controls randomly divided into four groups (10 mice per group). Mice in group A were treated with the antibiotic levofloxacin (1.95 mg/kg once daily) as the positive control; group B mice were administered curcumin at a dose of 200 mg/kg body weight; group C mice were treated with a curcumin dose of 200 mg/kg BW and vitamin D; and group D mice received distilled water (placebo) as the negative control. The intervention was performed for 5 days. On day 10, HMGB-1 mRNA expression was measured, and the results were compared to those before the intervention.

Results: HMGB-1 mRNA level in group C decreased significantly by 5.76-fold (95% confidence interval: 2.55, 8.98). In contrast, HMGB-1 mRNA levels did not decrease significantly in group B.

Conclusion: These results suggest that the combination of curcumin and vitamin D reduced HMGB-1 mRNA levels in infected mice, highlighting the potential of this combination as an antimicrobial and anti-inflammatory agent.

The insufficient and unspecific target of classical chemotherapies often leads to therapy resistance and cancer recurrence. Over the past decades, discoveries about mesenchymal stem cell (MSC) biology have provided new potential approaches to improve cancer therapy. Researchers have utilised the multipotent, regenerative and immunosuppressive qualities of MSCs and tropisms towards inflammatory, hypoxic and malignant sites in various therapeutic applications. Although MSC-based therapies have generally been demonstrated safe, their effectiveness remains limited when these cells are used alone. However, through genetic engineering, researchers have proven that MSCs can be modified to have specialised delivery roles to increase their therapeutic efficacy in cancer treatment. They can be made to overexpress therapeutic proteins through viral or non-viral genetic modification, which enhances their innate properties. Nevertheless, these engineering strategies must be optimised to increase therapeutic efficacy and targeting effectiveness while minimising any loss of MSC function. This review underscores the cutting-edge methods for engineering MSCs, discusses their promise and the difficulties in translating them into clinical settings, and offers some prospective suggestions for the future on achieving their full therapeutic potential.

Background: The indications for awake craniotomy now spans from resection of tumours at eloquent areas of the brain, deep brain stimulation and treatment of aneurysms to name a few. In the region of East Malaysia where patients have various ethnic backgrounds and native languages, planning and execution of these procedures can be somewhat challenging.

Methods: This is a retrospective analysis of 11 awake surgeries conducted by the Department of Neurosurgery in Sarawak. The indications for awake craniotomy surgery in our sample population were intra-axial lesions in eloquent regions involving important cortical areas and subcortical tracts which were at risk of damage during tumour excision. Patients were assessed for intra-operative and post-operative neurological deficits.

Results: Eleven patients aged 20 years old-70 years old were included in this series. All patients were diagnosed with lesions in eloquent areas of the brain requiring surgical excision. Patients were of various ethnic backgrounds. The spoken language of these patients also varied based on their ethnicity. The histopathological diagnosis of nine patients were consistent with gliomas with three being of high grade. Three patients (27%) developed intra-operative deficits that were not present pre-operatively.

Conclusion: This case series serve to demonstrate the feasibility of awake craniotomies even in centres without vast experiences in awake surgeries and ideal adjuncts which in comparison may be readily available in different centres. Although careful patient selection has been emphasised, it is a difficult feat in a region consisting of at least 30 different ethnic groups with distinct languages and cultures.

Endotoxin contamination in magnetic resonance imaging (MRI) contrast agents can pose a risk to patient safety causing immune reactions. Strict endotoxin limits are enforced for implants and catheters inserted into the body, but there are not clear rules for MRI contrast agents. Here, we investigated the efficacy of chromogenic LAL assay test for screening endotoxin activity in MRI contrast media manufactured in Malaysia. The powdered agent was dissolved in water for injection and endotoxin levels were measured. The coefficient of efficiency value for the standard curve, exhibiting r ² ≥ 0.98, along with the absence of interfering substances and endotoxin activity below the regulatory threshold of 0.5 EU/mL, support the conclusion that the agent is unlikely to be pyrogenic or induce pyrogenic effect.

Physical activity (PA) is crucial for improving stroke survivors' health outcomes and quality of life (QoL). Impaired PA levels are common among stroke survivors, a significant portion of whom spend their days in sedentary occupations. Understanding the factors that influence physical inactivity and addressing the barriers to exercise participation can contribute significantly to improving stroke survivors' health outcomes and prognoses. Therefore, in the current review, we systematically searched five databases (PubMed/Medline, Scopus, SpringerLink, ScienceDirect and Google Scholar) for published studies reporting PA levels among stroke survivors, which yielded 301 potential articles. Based on the identification and screening processes recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR), 13 articles were finally included in the analysis. The results of these studies, covering 1,318 stroke survivors, revealed physical inactivity among most of the participants and significant heterogeneity among the outcome measures used. The factors affecting PA levels among stroke survivors were mainly categorised as physical, psychological, and sociodemographic, and all were significantly associated with PA levels after strokes.