Journal of Health and Translational Medicine (JUMMEC)

KNOWLEDGE AND SELF-EFFICACY ON EXCLUSIVE BREASTFEEDING AMONG WORKING WOMEN IN JERANTUT, PAHANG

2023-12-20T14:03:33+08:00

Providing essential nutrients to support healthy growth and development in young infants is commonly achieved through breastfeeding, a traditional means of nourishment. In Malaysia, even though more awareness campaigns on the benefits of exclusive breastfeeding (EBF) remain low than the rate recommended by WHO. This study was done to determine level of knowledge and self–efficacy on exclusive breastfeeding among working women in Jerantut. A cross-sectional study was conducted among the community of working women in Mukim Pedah with the involvement of 375 respondents by convenient sampling. A questionnaire was used to collect data on the respondents' sociodemographic characteristics, breastfeeding knowledge and Breastfeeding Self-Efficacy Scale – Short Form (BSES-SF). 93.1% of respondents had high level knowledge of exclusive breastfeeding, and high level of self-efficacy (83.7%). There was a statistically significant association between breastfeeding education with knowledge level in exclusive breastfeeding (p <0.05). There was a statistically significant association between age, education level, parity, breastfeeding education and experience in breastfeeding with self–efficacy (p<0.95). Exclusive breastfeeding benefits the health of both mother and child; having good knowledge and confidence in EBF may encourage mothers to breastfeed their babies for extended periods.

NATURAL PRODUCTS TARGETING NITRIC OXIDE AS A THERAPEUTIC STRATEGY FOR TREATMENT OF HYPERTENSION: A REVIEW

2024-02-23T14:09:52+08:00

Hypertension remains a significant global health challenge, necessitating the exploration of novel therapeutic strategies. Nitric oxide (NO) signaling plays a pivotal role in blood pressure regulation, making it an attractive target for hypertension management. Natural products have garnered considerable attention for their potential to modulate NO signaling pathways and mitigate hypertension. This review provides a comprehensive overview of natural products targeting NO as a therapeutic strategy for hypertension treatment. We systematically examine the mechanisms by which natural compounds enhance NO bioavailability, promote vasodilation, and exert antihypertensive effects. Key natural products are evaluated for their efficacy in preclinical studies. Furthermore, we discuss the challenges and limitations associated with translating preclinical findings to clinical practice. Overall, this review highlights the promising role of natural products in modulating NO signaling pathways and offers insights into their potential as adjunctive therapies for hypertension management. Further research is warranted to elucidate the optimal dosing regimens, long-term effects, and potential drug interactions of natural compounds in diverse patient populations.

ONLINE FOOD DELIVERY SERVICES USAGE AND ITS ASSOCIATED FACTORS AMONG A WORK POPULATION IN A MIDDLE INCOME COUNTRY, MALAYSIA

2024-01-15T11:41:41+08:00

Online food delivery services (OFDS) are popular due to its availability and convenience. However, OFDS with increasing food availability and choice, and decreasing barriers to food consumption effort may potentially lead to adverse health outcomes such as overweight/ obesity to the users, which is a public health challenge with increasing prevalence worldwide. Therefore, we aimed to determine the frequency and patterns of OFDS usage and its associated factors (socio-demographic characteristics, weight status and health literacy (HL)) among workers. This was a cross-sectional study conducted among civil servants in Peninsular Malaysia. Data collected were socio-demographic characteristics, body mass index (BMI), levels of HL, frequency and patterns of OFDS usage. There were 656 participants with a mean age of 39 (± 6.9) years who were mostly Malays (79.4%) and females (76.4%). The average frequency of OFDS usage was seven times a month with local food being the most frequently ordered type of food (50.3%). Furthermore, coffee and sugar-sweetened beverages (SSBs) were the common types of drinks frequently ordered along with meals. Price was the most important factor (92%) when making food choices. Factors associated with frequent OFDS usage were Malay ethnicity (aOR: 1.78; 95% CI: 1.16, 2.73), high monthly household income (aOR: 2.71, 95% CI: 1.48, 4.97) and age, where the younger the age group, the higher the adjusted odds ratio for its use when compared to the oldest age group. However, there were no associations between frequent OFDS usage with overweight/ obesity and low HL levels. Besides, education levels and occupation were also not associated with frequent OFDS usage. This study contributes to limited studies on OFDS usage and its associated factors among the adult population in Malaysia. Future research could be carried out to explore the association of sociodemography, HL and body mass index among a more diverse Malaysian population.

INNOVATIVE NANOPARTICLE DELIVERY OF TEA POLYPHENOLS FOR ENHANCED COLORECTAL CANCER THERAPY

2024-03-26T09:20:03+08:00

Tea polyphenols have demonstrated potential in the prevention and treatment of colorectal cancer. However, its use in clinical settings has been hampered by drawbacks in terms of stability and bioavailability. This review aims to explore and evaluate the potential of nanoparticles as efficient delivery vehicles for tea polyphenols in the context of colorectal cancer therapy. In this review, we summarize studies on the efficacy of tea polyphenols on colorectal cancer and their limitations for colorectal cancer therapy. Moreover, we also discuss the mechanistic signalling pathway of tea polyphenols and how nanotechnology improves the limitations. Furthermore, the mechanisms performed using nanoparticles in drug delivery and the significance of nanoparticles for targeted drug delivery were covered in this review. The future of colorectal cancer therapy may be significantly influenced by the integration of nanotechnology to deliver tea polyphenols. Nanoparticle-based delivery systems promise to overcome inherent challenges associated with the bioavailability and targeted delivery of tea polyphenols. By enhancing solubility, stability, and controlled release, nanotechnology can optimise the therapeutic efficacy of these bioactive compounds.

A CONCEPTUAL MODEL OF FRAILTY IN OLDER ADULTS: A LITERATURE REVIEW

2024-05-01T19:20:29+08:00

This review employed several key procedures to synthesize the current evidence on frailty. An extensive literature search was conducted across major databases to identify relevant studies on frailty definitions, epidemiology, assessment tools, interventions, and conceptual models. The search results were analyzed using bibliometric techniques including thematic mapping with Biblioshiny and co-occurrence network visualization with VOSviewer. These bibliometric analyses identified core research themes, emerging topic clusters, and connections across the frailty literature. The main findings highlighted frailty's multidimensional nature spanning physical, cognitive, psychological, and social domains. While the frailty phenotype by Fried et al. (2) provided an initial operational definition, subsequent models increasingly encompassed a broader biopsychosocial frailty construct. Globally, over 10% of community-dwelling older adults were estimated as frail, with rates exceeding 40% in those over 90 years old. Frailty was associated with numerous adverse outcomes like disability, falls, hospitalization and mortality. Current assessment approaches included the frailty phenotype, frailty index, and various clinical performance tests, though no single comprehensive tool existed. Evidence supported tailoring multimodal interventions combining physical, nutritional, cognitive, psychological and social strategies to individual risk profiles. The principal conclusion was the critical need for a unified, holistic conceptual model elucidating the complex interplay of factors driving frailty's development and progression. Integrating the findings, a biopsychosocial framework was proposed conceptualizing frailty as a multifactorial health state arising from the cumulative impact of interconnected physical, cognitive, psychological, social and environmental determinants over the life course. Such models are essential for advancing frailty science, shaping clinical practices, and informing policies to promote healthy, resilient aging amid rapidly aging populations worldwide.

EFFECTIVENESS OF DIABETES SELF-MANAGEMENT EDUCATION (DSME) AND FAMILY-BASED INTERVENTIONS ON QUALITY OF LIFE IN PEOPLE WITH TYPE 2 DIABETES

2024-04-01T10:22:47+08:00

Diabetes is a health condition that can have a significant impact on quality of life. Therefore, self-care management and family support may be important in helping people with diabetes maintain or improve their quality of life. The purpose of this study was to evaluate the effectiveness of the Diabetes Self-Management Education (DSME) program and family-based interventions in improving the quality of life of people with type 2 diabetes. This research was conducted using a quasi-experimental design with a one-group pre- and post-test. A sample of 54 individuals was selected using purposive sampling technique. Analysis was performed using dependent and independent t-tests. The results indicated that the DSME program was effective in improving quality of life in all domains (p < 0.05). Family-based interventions were shown to improve quality of life (p = 0.045) and psychological (p = 0.010) and environmental (p = 0.029) domains. However, the two interventions did not appear to differ in improving quality of life (p_pre= 0.727; p_post= 0.466). The study concluded that DSME and family-based interventions are effective in improving quality of life in people with type 2 diabetes. These interventions can be implemented in other health care settings.

LIGNOCAINE INFUSION FOR NEUROPATHIC ITCH IN PATIENT WITH NEUROFIBROMATOSIS

2024-05-20T14:23:27+08:00

Neurofibromatosis (NF) is an autosomal dominant neurocutaneous disorder. The itchiness suffered by patients with NF is possibly caused by mast cells. However, transient receptor potential ankyrin 1 (TrpA1) and transient receptor potential vanilloid 1 (TrpV1) have been recently discovered as mediators of itchiness and pain in patients with NF. We reported a patient with NF, afflicted by neuropathic pain and itch, despite despite receiving conservative treatment. Herein, we provided the patient lignocaine infusion, which improved her pain and itch score by 50%. Additionally, her sleep quality, ability to perform housework and engagement in leisure activities were improved. This case report highlights the therapeutic value of lignocaine infusion when conservative treatment is ineffective for chronic neuropathic itch in patients with neurofibromatosis through suppressing TrpA1 and TrpV1.

OLIGOSACCHARIDES IN MILK: EXPLORING NOVEL ANTIFUNGAL PROPERTIES AGAINST CANDIDA ALBICANS AND CANDIDA KRUSEI

2024-02-28T12:59:20+08:00

With the increasing antifungal resistance and prevalence of candidiasis, the aim of this research is to evaluate the potential inhibitory effects and synergistic activities of oligosaccharides present in milk with azoles in inhibiting the growth of Candida albicans and Candida krusei. The oligosaccharides were derived from breast milk (OH), bovine (OB), goat (OG), and formula milk (OF), then confirmed by thin-layer chromatography (TLC). Disk diffusion and microdilution were used to evaluate the antifungal potency of oligosaccharides using disk diffusion and microdilution. The oligosaccharides only showed antifungal activity in microdilution. The statistical analysis showed moderate variability in minimum inhibitory concentration (MIC) values and higher fractional inhibitory concentration (FIC) values. A significantly wide range of MIC in the microdilution assay indicated the effectiveness of this antifungal agent varied across different samples. In the combination test, antagonistic activity was observed between fluconazole and oligosaccharides against C. albicans ATCC 90028. Further research is needed to study the mechanisms of antifungal activity and synergism between oligosaccharides and azoles against Candida species.

BRASH SYNDROME – A RARE CAUSE OF BRADYCARDIA WITH RENAL FAILURE

2023-12-19T14:51:04+08:00

The BRASH syndrome is a rare clinical pentad characterised by bradycardia, renal failure, atrioventricular (AV) blockade, shock and hyperkalaemia. Patients with BRASH syndrome typically present with bradycardia and hypotension due to the synergistic effect of AV node blocker and hyperkalaemia, compounded by underlying renal failure. In this report, we present a young patient with a history of chronic kidney disease and hypertension, who was taking regular beta-blockers and calcium channel blockers, and presented with persistent dizziness, headache and lethargy, which progressed into bradycardia and shock. These symptoms were refractory to initial resuscitation, requiring inotropic support and urgent haemodialysis. The patient was discharged in good condition after initiating regular dialysis. A high index of suspicion and early recognition are key to managing BRASH syndrome. Standard advanced cardiac life support algorithms without calcium are generally impractical for BRASH syndrome. The prognosis for BRASH syndrome is excellent with timely recognition and management.

A SINGLE CENTRE STUDY ON PREVALENCE AND PREDICTIVE FACTORS FOR INCIDENTAL PROSTATE CANCER FOLLOWING TRANSURETHRAL RESECTION OF PROSTATE

2024-02-15T15:38:50+08:00

Background: Many prostate cancers remain undiagnosed until benign prostatic hyperplasia (BPH) surgeries are performed. Transurethral resection of the prostate (TURP) renders subsequent radical prostatectomy technically challenging. Therefore, it is advantageous to identify high-risk patients and consider further investigations prior to BPH surgery.

Objectives: This study aims to report the prevalence of incidental prostate cancer (IPC) following TURP at Penang General Hospital and to develop predictive factors for IPC.

Methods: This retrospective observational study reviewed patients who underwent TURP for presumed BPH over the past five years. Clinicopathological variables studied included patient age, serum prostate-specific antigen (PSA) level, prostate volume, PSA density, resected prostatic tissue weight, and histopathological assessment of the resected specimen.

Results: A total of 220 patients underwent TURP for presumed BPH from April 2018 to April 2023. Thirteen patients (5.9%) had IPC, including seven patients with T1a disease and six patients with T1b disease. The most common cancer detected was ISUP grade group 1 (n = 6), followed by grade groups 2 (n = 4), 3 (n = 2), and 4 (n = 1). Stepwise binary logistic regression analysis revealed that a PSA density of >0.15 ng/ml² (p = 0.001) and low resected prostatic tissue weight (p = 0.024) correlated with an increased prevalence of IPC, with odds ratios of 26.1 and 0.9, respectively.

Conclusions: The prevalence of IPC at Penang General Hospital is 5.9%. A PSA density of >0.15 ng/ml² and low resected prostate volume are associated with a higher risk of IPC following TURP. Patients at risk should be offered further investigations, such as mpMRI of the prostate and/or repeat prostatic needle biopsy prior to BPH surgeries. Additionally, pathologists should consider examining the specimens of at-risk patients in their entirety rather than using standard handling procedures.

DIAGNOSING OVARIAN TORSION IN THE EMERGENCY DEPARTMENT: A CASE REPORT AND LITERATURE REVIEW

2024-05-05T16:54:06+08:00

Diagnosing acute abdomen in emergency department setting, especially in women of childbearing age, is challenging. The patient may present with non-specific complaints. We were presented with a case of a 28-year-old lady with no known medical illness complaining of sudden onset left-sided abdominal pain. Multiple analgesics were given, but her pain persisted. Bedside ultrasonography was performed and noted a multiloculated cyst over the left ovary, with the largest measuring 4 x 4 cm. She then underwent laparoscopic left salpingo-oophorectomy, revealing an engorged, gangrenous left fallopian tube and the left ovarian cyst was twisted three times. Histopathological examination confirmed a left ovarian haemorrhagic twisted ovarian cyst with a paratubal cyst. This case concludes that acute abdominal pain in women of childbearing age requires prompt and thorough investigation. Clinicians should consider several potential diagnoses, including ovarian torsion.

UNEXPLAINED NEUROLOGICAL DEFICIT WITH IMPAIRED VASCULAR PERFUSION: A MISSED TELL-TALE SIGN OF AORTIC DISSECTION PRESENTING IN A DISTRICT HOSPITAL

2024-05-31T12:20:20+08:00

Acute aortic dissection can present with a diverse range of clinical signs and symptoms. It is a condition with high morbidity and mortality that could be missed without a high index of suspicion. This case examines a 45-year-old gentleman who presented to a district hospital with hemodynamically unstable, acute right-sided body weakness associated with a fall the day prior. He also reported frank haematuria, with suprapubic, pelvic, and right thigh pain for the past three days. A preliminary diagnosis of cerebral vascular accident with a need to rule out intracranial bleeding was made, and he was arranged for an urgent computed tomography brain scan at a secondary hospital. Unfortunately, he eventually succumbed to cardiac tamponade secondary to aortic dissection.

This case highlights the challenge clinicians face in identifying a vascular emergency that disguises with a history of trauma. This challenge is further amplified in hospital settings with scarce resources and expertise. Therefore, a thorough history taking, a focused physical examination, and a high index of suspicion are crucial for making an accurate diagnosis.

POSTPARTUM PITUITARY APOPLEXY: A CASE REPORT

2024-05-01T16:45:57+08:00

Background: Postpartum pituitary apoplexy is an extremely rare neurological emergency. It may present with sudden onset of headache, vomiting, nausea and visual disturbances. This potentially life-threatening emergency requires a high index of suspicion from the attending clinician. Postpartum pituitary apoplexy was challenging to diagnose because of its symptoms that overlapped with multiple conditions. There are limited number of case reports on postpartum pituitary apoplexy.

Case presentation: We present a case of a 30-year-old multipara with gestational diabetes mellitus presented with on and off headache since 37 weeks period of gestation. Her complaint was not investigated by medical personnel during her routine antenatal follow-up until she had a normal delivery. Subsequently, she developed diplopia, nauseated and vomiting episodes post-delivery but she only came to seek treatment in our emergency department on day 12 post-partum as symptoms are not resolving. Initial Contrast Enhanced Computed Tomography (CECT) of Brain revealed enhancing sellar lesion causing widening of pituitary fossa which then she was scheduled for Magnetic Resonance Imaging (MRI). MRI brain revealed lobulated sellar and suprasellar mass with mass effect to optic chiasm and she underwent endoscopic endonasal transsphenoidal excision of tumour. Post operatively, her vision improved and she was discharged subsequently with oral hormonal supplements.

Conclusion: Diagnosis of pituitary apoplexy should be suspected whenever headache and neurological deficits are present although it is an extreme rare condition.

ORAL HEALTH IMPACT AMONG PERIODONTAL PATIENTS AT SUPPORTIVE PERIODONTAL CARE: A CROSS-SECTIONAL STUDY

2024-06-28T13:20:53+08:00

Periodontitis is a chronic inflammatory disease that affects the supporting structures of the teeth, leading to progressive attachment loss and bone destruction. It significantly impacts the quality of life of affected individuals. Despite this, there is a lack of research focused on patients in supportive periodontal care (SPC) within periodontal treatment. This study aimed to determine the impact of periodontitis and other possible factors on oral health-related quality of life (OHRQoL) among patients in SPC using the Malaysian version of the Oral Health Impact Profile (OHIP-14). This study included 219 individuals diagnosed with periodontal disease who had completed active periodontal treatment and were now on regular maintenance. All participants completed the OHIP-14 questionnaire, along with socioeconomic and demographic surveys. A calibrated clinician conducted clinical periodontal examinations to evaluate the patients’ current periodontal conditions. The findings indicate that periodontal diseases significantly affect OHRQoL. The OHIP-14 scores were linked to variables such as age, race, educational background, household income, overall health, duration of SPC, and satisfaction levels regarding general oral and periodontal health. The highest OHIP-14 domain scores were for psychological discomfort, followed by functional limitation and physical disability. Discomfort due to food being stuck had the highest mean score of 2.27 ± 1.11, while avoidance of socializing had the lowest mean score of 0.48 ± 0.83. Multiple linear regression analyses highlighted that being Malay, medically healthy, and having a higher education level had a more pronounced impact on OHRQoL. These findings underscore the significant negative impact of periodontitis complications on OHRQoL during SPC, with race, medical status, and education level being critical influencing factors.

A CASE REPORT ON PRIMARY RENAL LYMPHOMA - A DIAGNOSTIC DILEMMA

2024-05-21T14:46:59+08:00

Primary Renal Lymphoma (PRL) is diagnosed when lymphoma affects the kidneys and there is no evidence of lymphatic manifestation outside the kidneys. PRL is very rare, with an incidence of less than 1%. This case report highlights Computed Tomography (CT) features of PRL in a 68-year-old female with histology-confirmed renal lymphoma. She presented with worsening left flank pain for two months, associated with constitutional symptoms. Abdominal examination reveals a tender mass in the left hypochondriac region, extending to the left lumbar region. Ultrasound revealed an irregular, solid hypoechoic lesion with cystic spaces in the left kidney. Multiphasic CT renal revealed a large ill-defined mass with poor enhancement in both corticomedullary and nephrographic phases, with no significant washout in the delayed phase. It has a low attenuation value of +30 to +50HU on non-enhanced CT and contains no calcification. Meanwhile, in other renal malignancies, particularly Renal Cell Carcinoma (RCC), a renal mass will exhibit significant enhancement with contrast washout in the delayed phase. RCC often demonstrates early infiltration into the Inferior Vena Cava (IVC). The patient is treated with chemotherapy, and a follow-up Positron Emission Tomography-Computed Tomography (PET-CT) presents a smaller left renal mass. In conclusion, a hypovascular renal mass on CT should raise the suspicion of a PRL, and early tissue diagnosis is important to avoid unnecessary nephrectomy.