The Malaysian Journal of Medical Sciences has in its 25 years “Silver Jubilee” achieved another milestone of being visible to the biomedical community when it was accepted in PubMed. The journal aim to increase its readership so as to increase impact in the biomedical field amongst its Asian readers despite having a high rejection rate. This was done to maintain quality of the manuscripts published over the years. PubMed listing should enable more manuscripts to be cited as its the leading biomedical journal for the Asian community.
database; reviewer; statistic; manuscript; publishing
The following four possible pathways for itching sensation have been suggested by recent reports. 1) Histaminergic TRPV1-positive pathway: Although histamine-positive nerve fibers cannot strictly be classified as “itch specific” due to their excitation also by pure algogens (making them itch-selective), the existence of a subpopulation of nociceptors responsible for itching is strongly suggested. Moreover, the TRPV1-expressing neurons have been suggested to be the main sensors and mediators of itching. 2) Histaminergic TRPV1-negative pathway: The scratching behavior caused by itching was not different between capsaicin-pre-treated and vehicle-treated (control) mast cell-rich NC mice. This result suggests the existence of a capsaicin-insensitive (TRPV1-negative) histaminergic pathway. 3) Non-histaminergic PAR-2 pathway: Protease-activated receptor 2 (PAR-2) has been shown to play a role in the itching of atopic dermatitis (AD). The itch evoked by cowhage (a non-histaminergic pruritogen that activates PAR-2) is very similar in characteristics to the itch evoked by conditions such as AD. 4) Non-histaminergic serotonin (5-HT) pathway: 5-HT alone applied to the human skin evokes an itching sensation and has been suggested to be involved in the itching associated with pruritic diseases, such as polycythemia vera and cholestasis.
itch; TRPV1; histamine; PAR-2; serotonin
The cytochrome P450 enzymes (CYP) play an important role in the metabolism of many therapeutic agents. The activities of different enzymes exhibit variability in different populations, which causes variations in drug response or toxicity. The CYP2B6 and CYP2C8 enzymes are encoded by polymorphic genes characterised by different single nucleotide polymorphisms (SNPs). Several of these CYP variants are often associated with slow metabolism phenotypes. This study aimed to analyse the frequencies of allelic variants of CYP2B6 and CYP2C8 in the Mozambican population.
Using a polymerase chain reaction and restriction fragment length polymorphism assay (PCR-RFLP), the frequencies of the allelic variants of CYP2B6 (c.64C>T, c.516G>T, c.777C>A, c.785A>G, c.1459C>T) and CYP2C8 (c.805A>T, c.416G>A, c.1196A>G, c.792C>G) were determined in 360 Mozambican blood donors.
The frequencies of the allelic variants of the CYP2B6 gene were 0.057, 0.426, 0.0, 0.410, and 0.004. For the CYP2C8 gene, the frequencies of the allelic variants were 0.160, 0.048, 0.0, and 0.005. No significant differences were observed between the gender and geographic distribution of volunteers around the country.
The frequencies of the allelic variants of the CYP2B6 and CYP2C8 genes were found to be homogeneously distributed in the Mozambican population and were comparable to other African populations. Further studies are required to explore the impact of these variants on the clinical response (efficacy and toxicity) of drugs, including antimalarials.
allele frequency; CYP2B6; CYP2C8; polymorphism
Hippocampal volume is affected by several psychiatric illnesses of old age, as well as by normal aging. It is important to have a normal data in a population to assist in diagnosis. The aim of this study is to determine hippocampal volume in normal Malay people aged 50 years old and older.
This was a cross-sectional study of the normal Malay population aged 50 to 77 years. We included 43 participants, representing 19 men and 24 women. Magnetic resonance imaging (MRI) was performed using a GE Signa Horizon LX 1.0 Tesla. Oblique coronal images of temporal lobes were obtained and hippocampal volumetry was done manually and normalised with intracranial volume.
Mean right and left hippocampal volumes (HCVs) were 3.43 cm³ (SD 0.32) and 3.26 cm³ (SD 0.34), with a significant difference between them (P < 0.001). Total mean HCVs exhibited no significant difference between men and women (P = 0.234). The means of the normalised right and left HCVs were 3.42 cm³ (SD 0.31) and 3.26 cm³ (SD 0.32).
The mean right and left hippocampal volumes were significantly different in this study. Men had slightly larger mean HCVs but the difference was not statistically significant. It was found that normalisation further reduces the mean volume difference between the genders.
magnetic resonance imaging; hippocampus; normal value; Malay; aged; 50 and over
There is supportive evidence that multiple sclerosis (MS) could potentially affect the peripheral nervous system. We assessed peripheral sensory and motor nerve involvement in patients with MS by a nerve conduction velocity test.
We studied 75 patients who had a relapsing-remitting or secondary progressive pattern. We measured amplitude, latency, conduction velocity, Hoffmann reflex (H-Reflex), and F-Waves.
The amplitude of the right tibial, right proneal, left tibial, left proneal, and left median motor nerves was less than the mean for the normal population. Right ulnar sensory conduction in the patients showed an amplitude that was less than that of the normal population; there was no significant change in the amplitude of other sensory nerves. Latencies of the right and left median and right proneal motor nerves and left ulnar sensory nerves were statistically less than that of the normal population. Mean motor conduction velocity and F-wave conduction did not differ significantly from the normal population. H-reflex latencies of the right and left lower limbs were significantly more prolonged than those of the normal population.
Our results suggest possible peripheral motor nerve abnormalities in MS patients, especially with the amplitude of the motor nerves; however, our results do not demonstrate any significant difference among the nerve conduction velocity parameters of sensory nerves between MS patients and the normal population.
demyelination; latency; multiple sclerosis; nerve conduction velocity; peripheral neuropathy
Diabetes mellitus is associated with a greater likelihood of developing certain oral mucosal disorders. This study was aimed at assessing the prevalence of oral mucosal lesions (OMLs) in patients with type 2 diabetes (DM2) and to investigate the association of such lesions with metabolic control of the disease.
This cross-sectional study involved 391 patients with DM2 and 391 non-diabetic control subjects. Demographic information and data on the duration and type of diabetes, glycosylated hemoglobin (HbA1c) values, medical history, and current use of medication were obtained from medical records. Detailed oral examination was performed in accordance with international criteria.
The prevalence of OMLs was significantly higher among diabetic patients (45.5%) than among control subjects (38.4%) (P = 0.042). Patients with diabetes had a higher prevalence of geographic tongue (GT) (P = 0.017), denture stomatitis (P = 0.018), and angular cheilitis (P = 0.006) than controls. Overall, diabetic patients with poor metabolic control had a significantly higher prevalence of OMLs and xerostomia than patients with moderately and well-controlled disease (P < 0.05).
The prevalence of OMLs was significantly higher in diabetic patients than in control subjects. Higher occurrence of OMLs was significantly associated with poor metabolic control.
diabetes mellitus type 2; prevalence; mouth mucosa; oral pathology
The concentrated potassium chloride injection is a high-alert medication and replacing it with a pre-mixed formulation can reduce the risks associated with its use. The aim of this study was to determine the clinical characteristics of patients receiving different potassium chloride formulations available at a private institution. The study also assessed the effectiveness and safety of pre-mixed formulations in the correction of hypokalaemia.
This was a retrospective observational study consisting of 296 cases using concentrated and pre-mixed potassium chloride injections in 2011 in a private hospital in Kuching, Sarawak, Malaysia.
There were 135 (45.6%) cases that received concentrated potassium chloride, and 161 (54.4%) cases that received pre-mixed formulations. The patients’ clinical characteristics that were significantly related to the utilization of the different formulations were diagnosis (P < 0.001), potassium serum blood concentration (P < 0.05), and fluid overload risk (P < 0.05). The difference observed for the cases that achieved or maintained normokalaemia was statistically insignificant (P = 0.172). Infusion-related adverse effects were seen more in pre-mixes compared to concentrated formulations (6.8% versus 2.2%, P < 0.05).
This study provides insight into the utilization of potassium chloride injections at this specific institution. The results support current recommendations to use pre-mixed formulations whenever possible.
potassium chloride; electrolytes; hypokalaemia; drug utilization evaluation; drug-use review
The learning climate has been found to be significant in determining students’ academic achievement and learning. The purpose of this study was to measure the viewpoints of nursing students toward their learning environment at Rafsanjan University of Medical Sciences (RUMS).
This descriptive, cross-sectional study was performed on 202 nursing students using the Dundee Ready Educational Environment Measure (DREEM). The items, as well as scale scores were compared among nursing students. Also, data was analysed by SPSS19 using t test and ANOVA.
The total mean DREEM score was 114.3 (SD 20.6) out of 200 (corresponding to 57.15% of the maximum score), which was considered as more positive than negative. The subscale with the highest mean score was Students’ Perceptions of learning. Mean score of this subscale was 27.3/48 0 (SD 5.9) corresponding to 56.87% of the maximum score. The lowest mean score was for the Academic Self-perceptions 20.31/32 (SD 4.51) (53.44%), The total DREEM score for female students was significantly higher than for males (P = 0.01). The total scores of new entry students were significantly higher than the others (P = 0.01).
The school’s educational climate was generally perceived positively by students, but specific areas identified by students as needing improvement. It is essential for managers to make a greater effort to create an appropriate educational environment in order to provide and maintain high quality learning environments for students.
environment; education; Iran; nursing students; Psychometrics perceptions
Although suicide is commonly linked with mental disorder, the notion that suicide may occur in response to predicaments has been the subject of much recent study and attention. A predicament in this context refers to an uncomfortable situation from which escape is difficult. We aimed to examine the predicaments of people whose suicide was captured on film and displayed on the public record.
The authors’ extensive private library and the web were explored for examples of suicide on film. The authors viewed the films and associated records, and extracted and listed details of the suicides.
Six individual cases and two groups (totalling 2200 plus individuals) were identified. The individual cases were Thich Quang Duc (1963), Christine Chubbuck (1974), Budd Dwyer (1987), Daniel Victor Jones (1998), Michael Marin (2012) and Jordon Romero (2012). The two groups were the Japanese Kamikaze pilots of 1944/1995, and those who jumped from the burning “Twin Towers” on September 11, 2001. One of the six individuals has evidence of a mental disorder, and all (individual and group cases) were in potent social/environmental predicaments.
Both psychological autopsies and our clinical experience suggest that suicide is often associated with mental disorder. Nevertheless, social/environmental predicaments may lead to suicide. This study suggests that individuals whose suicide is captured on film are often seeking public exposure of their fatal act.
film; mass media; predicament; suicide; internet
The incidence of multidrug resistant enteric fever is increasing alarmingly. This study was planned to determine the rate of isolation of Salmonella spp. and to compare the isolates for their epidemiological parameters and antimicrobial susceptibility patterns at our center.
The study was conducted over a span of three years with a total of 8142, 8134, and 8114 blood culture samples processed for the years 2008, 2009, and 2010 respectively. The minimum inhibitory concentration (MIC) for ciprofloxacin and chloramphenicol was determined using an agar dilution method. The MIC for ciprofloxacin was also confirmed by Epsilon-test (E -test) strips.
Of the total 302 Salmonella spp. isolated, 257 were Salmonella enterica serotype Typhi (85.1%) and 45 (14.9%) were S. enterica serotype Paratyphi A. The majority of the isolates recovered were from the pediatric age group (54.6%) and males (60.6%). Complete susceptibility was observed to chloramphenicol, cefotaxime, ceftriaxone, and azithromycin over the last two years (2009 and 2010), with an increase in resistance to nalidixic acid (100%) and ciprofloxacin (13.6%).
In our study, we found augmentation of resistance to nalidixic acid and fluoroquinolones and complete sensitivity to ceftriaxone along with reemergence of chloramphenicol sensitivity for Salmonella isolates. This report emphasises the necessity of continuous surveillance of antibiograms of enteric fever isolates in an area.
antibiotic resistance; ceftriaxone; ciprofloxacin; enteric fever; Salmonella
H7N9 avian influenza is the latest subtype of influenza virus to emerge in the world. By April 17, 2013 in Shanghai, a total of 31 confirmed cases were reported, and 11 of these patients died. The epidemiological characteristics and the clinical progress of this new human flu infection are still not clear. Thirteen confirmed patients have now been treated in Shanghai Public Health Clinical Center. Among the first batch of patients, hospitalised at the beginning of April 2013, two who were admitted with the same estimated date of onset of disease had very different outcomes. After active treatment at the Centre, one recovered by April 18, 2013, but one patient entered critical condition and died on April 11, 2013. The clinical and laboratory characteristics in hospital are here analysed and compared to learn more about H7N9 avian influenza. Confirmation that the observed differences are valuable for prognosis and treatment decisions for H7N9 patients awaits authentication by analysis of more patients.
H7N9; avian influenza; infectious disease; clinical; laboratory; characteristics
Adipose tissue provides an abundant source of multipotent cells, which represent a source of cell-based regeneration strategies for urinary bladder smooth muscle repair. Our objective was to confirm that adipose-derived stem cells (ADSCs) can be differentiated into smooth muscle cells.
In this study, adipose tissue samples were digested with 0.075% collagenase, and the resulting ADSCs were cultured and expanded in vitro. ADSCs at passage two were differentiated by incubation in smooth muscle inductive media (SMIM) consisting of MCDB I31 medium, 1% FBS, and 100 U/mL heparin for three and six weeks. ADSCs in non-inductive media were used as controls. Characterisation was performed by cell morphology and gene and protein expression.
The differentiated cells became elongated and spindle shaped, and towards the end of six weeks, sporadic cell aggregation appeared that is typical of smooth muscle cell culture. Smooth muscle markers (i.e. alpha smooth muscle actin (ASMA), calponin, and myosin heavy chain (MHC)) were used to study gene expression. Expression of these genes was detected by PCR after three and six weeks of differentiation. At the protein expression level, ASMA, MHC, and smoothelin were expressed after six weeks of differentiation. However, only ASMA and smoothelin were expressed after three weeks of differentiation.
Adipose tissue provides a possible source of smooth muscle precursor cells that possess the potential capability of smooth muscle differentiation. This represents a promising alternative for urinary bladder smooth muscle repair.
adipose; stem cells; muscle cells; regeneration; bladder wall
The liver is a common visceral site for metastatic tumours. Radiological features of the liver, fine needle aspiration cytology (FNAC) and histopathological evaluation (HPE) of liver nodules have a significant role in pre-operative diagnosis of liver lesions. In an intraoperative setting, frozen section biopsy plays a major diagnostic modality but the role of imprint cytology of liver nodules is also appealing. Imprint cytology is a valuable and precise tool in diagnosing the lesions for a rapid intraoperative diagnosis. This study presents a case of colorectal cancer liver metastasis diagnosed by imprint cytology intraoperatively.
cytology; frozen section; imprint; intraoperative; liver; metastasis
Chordoid meningioma, classified as atypical meningioma according to the World Health Organisation (WHO) classification, is a rare subtype, which represents only 0.5% of all meningiomas and is associated with a high incidence of recurrence. Multiple intracranial meningiomas are rare in non-neurofibromatosis patients. We present a female patient with both of these rare types of meningioma. The patient presented with two concurrent intracranial meningiomas, with one a meningotheliomatous subtype and the other a chordoid meningioma. Given the wide array of histological differential diagnoses in chordoid meningioma, immunohistochemistry has a significant role to play in differentiating them. Recurrence in chordoid meningioma can be generally predicted based on the extent of resection, the percentage of chordoid element, and proliferation indices.
meningotheliomatous meningioma; multiple meningiomas; benign meningioma; immunohistochemistry; recurrent brain tumor
Paratesticular liposarcoma is a rare entity. Compared to other genitourinary sarcoma, it is usually detected earlier and is easily resectable, resulting in an excellent prognosis. The recurrence of well-differentiated paratesticular liposarcoma after complete resection is extremely rare. Optimal management of the tumour recurrence includes complete re-excision and radiotherapy to the area of recurrence. Here, we describe a 48-year-old man with a recurrent left paratesticular well-differentiated liposarcoma, six years after its complete excision. Our discussion focused on the therapeutic strategy to prevent tumour recurrence. It is hoped that this case discussion can increase the awareness of this condition and assist in its management.
adult; genitourinary; liposarcoma; sarcoma
Phrenic nerve palsy causing hemidiaphragm paralysis is a very uncommon feature of thoracic aortic aneurysm. In one case, a 45-year-old man complained of chronic chest pain, dysphagia, and hoarseness of voice; posteroanterior view chest radiograph revealed lobular enlargement of the superior mediastinum and elevated right hemidiaphragm. Contrast-enhanced computed tomography (CT) of the thorax revealed a giant partially thrombosed aneurysm originating from the ascending aorta and extending into the aortic arch, causing a widening of the aorta-pulmonary window and a compression of the thoracic esophagus. Right hemidiaphragm elevation was explained by the gross mass effect of the aneurysm on the right hilum, causing right phrenic nerve palsy. The patient was to be operated on for surgical correction of the aneurysm, but died before surgery due to spontaneous rupture.
dysphagia; hoarseness; thoracic aortic aneurysm; palsy; phrenic nerve
President Obama of the United States of America announced this April the Brain Research Through Advancing Innovative Neurotechnologies (BRAIN for short) investment, while Professor Henry Markram’s team based in the European Union will spend over a billion euros on the Human Brain Project, breaking through the unknowns in the fifth science of the decade: Neuroscience. Malaysia's growth in the same field needs to be augmented, and thus the Universiti Sains Malaysia’s vision is to excel in the field of clinical brain sciences, mind sciences and neurosciences. This will naturally bring up the level of research in the country simultaneously. Thus, a center was recently established to coordinate this venture. The four-year Integrated Neuroscience Program established recently will be a sustainable source of neuroscientists for the country. We hope to establish ourselves by 2020 as a global university with neurosciences research as an important flagship.
brain science; history; Malaysia; mind; neuroscience; Universiti Sains Malaysia
Tualang honey (TH) is a Malaysian multifloral jungle honey. In recent years, there has been a marked increase in the number of studies published in medical databases regarding its potential health benefits. The honey is produced by the rock bee (Apis dorsata), which builds hives on branches of tall Tualang trees located mainly in the north-western region of Peninsular Malaysia. This review collates the results of the various studies of TH that range from research on tissue culture to randomised control clinical trials. Findings thus far show that, TH has antimicrobial, anti-inflammatory, antioxidant, antimutagenic, antitumor, and antidiabetic properties, in addition to wound-healing attributes. Some of its properties are similar to the well-researched Manuka honey (New Zealand and/or Australian monofloral honey). Distinct differences include higher phenolics, flavonoids, and 5-(hydroxymethyl) furfural (HMF). Compared with Manuka honey, TH is also more effective against some gram-negative bacterial strains in burn wounds.
ailments; antitumor; properties of Tualang honey; Tualang honey; wound healing
This was a preliminary study to test for the presence of multiple antibiotic-resistant extended spectrum β-lactamase (ESBL) producing bacteria in Malaysian urban surface waters. Although the literature review revealed several published papers on clinical ESBL isolates in Malaysia, none were found on ESBL isolates obtained from local surface waters
Isolated bacterial species were tested for resistance to cefotaxime, amoxicillin/clavulanate and aztreonam, and susceptibility to imipenem and meropenem using antibiotic susceptibility testing (AST) by disc diffusion. This served as a screening step to detect bacteria that could be potential ESBL species. 16S ribose ribonucleic acid (rRNA) polymerase chain reaction (PCR) testing with two clusters of bla (β-lactamase) gene primers was used to test for the bla genes CTX-M (Groups 1, 2, 9), OXA-1, SHV and TEM.
A total of 19 isolates were found, possessing at least one of the bla genes tested for. There was a relatively high occurrence of CTX-M genes (84.2%) among these, followed by TEM genes (47.4%). The isolates were identified as Enterobacteriaceae (89.5%), predominantly Escherichia coli and Klebsiella pneumoniae.
There appears to be a high occurrence of ESBL-bacteria in local surface waters, among these being opportunistic pathogens. The persistence and spread of these species in the environment poses a threat to exposed human populations.
extended spectrum β-lactamase (ESBL); bla (β-lactamase) gene; surface water; opportunistic pathogen; antibiotic resistance
Different target-filter combinations in computed radiography have different impacts on the dose and image quality in digital radiography. This study aims to evaluate the mean glandular dose (MGD) and modulation transfer function (MTF) of various target-filter combinations by investigating the signal intensities of X-ray beams.
General Electric (GE) Senographe DMR Plus mammography unit was used for MGD and MTF evaluation. The measured MGD was compared with the dose reference level (DRL), whereas the MTF was evaluated using ImageJ 1.46o software. A modified Mammography Accreditation Phantom RMI 156 was exposed using different target-filter combinations of molybdenum-molybdenum (Mo-Mo), molybdenum-rhodium (Mo-Rh) and rhodium-rhodium (Rh-Rh) at two different tube voltages, 26 kV and 32 kV with 50 mAs.
In the MGD evaluations, all target-filters gave an MGD value of < 1.5 mGy. The one-way ANOVA test showed a highly significant interaction between the MGD and the kilovoltage and target-filter material used (26 kV: F (2,12) = 49,234, P = 0.001;32 kV: F (2,12) = 89,972, P = 0.001). A Tukey post-hoc test revealed that the MGD for 26 kV and 32 kV was highly affected by the target-filter combinations. The test of homogeneity of variances indicates that the MGD varies significantly for 26 kV and 32 kV images (0.045 and 0.030 (P < 0.05), respectively). However, the one-way ANOVA for the MTF shows that no significant difference exists between the target-filter combinations used with 26 kV and 32 kV images either in parallel or perpendicular to the chest wall side F (2,189) = 0.26, P > 0.05).
Higher tube voltage and atomic number target-filter yield higher MGD values. However, the MTF is independent of the X-ray energy and the type of target-filter combinations used.
mean glandular dose (MGD); modulation transfer function (MTF); computed radiography; spatial resolution; image processing
The menace of substance abuse is not only a socially unacceptable reality, but in its entirety is a disease and emerging as a major public health challenge.
To study the socio-demographic and clinical profile of patients attending the drug de-addiction centre.
A descriptive study was undertaken in a drug de-addiction centre at the Police Hospital in Srinagar, and all patients (198) who were admitted during this period were interviewed.
The mean (SD) age of patients was 26.8 years (SD 7.37), and over half (56%) belonged to the lower-middle social class. Poly-substance abuse was seen in 91.9%; medicinal opioids and cannabis were the most common substances abused. Most common age of initiation was 11–20 years (76.8%), with peer pressure and relief from a negative mood state being the most common reasons given for starting the drug(s). Prevalence of a co-morbid psychiatric disorder was high, on the order of 49.5%. A high rate of volatile substance use was observed among adolescents (54.5%).
A pattern of poly-substance abuse was found to be quite common in patients, and use of volatile substances at a very young age emerged as a new trend. The dreadful repercussions of substance abuse justify the urgency to evolve a comprehensive strategy.
addiction; de-addiction centre; drug abuse; polysubstance
We aim to assess serum sodium and potassium levels in patients with different types of cerebro-vascular accidents (CVA) in comparison to control group.
A comparative cross-sectional study conducted on patients admitted to the emergency department from January to August 2012. Control group consisted of patients admitted to emergency department due to common cold, urinary tract infection, low back pain, cluster, and tension headache or migraine. Serum sodium and potassium levels were measured via standard laboratory methods.
There were 77 patients in control group and 78 in CVA group. Forty nine patients from the CVA group had ischemic CVA, 11 had hemorrhagic CVA and 18 suffered a transient ischemic attack (TIA). Serum sodium level in control group was significantly lower than in patients with TIA, ischemic CVA, and hemorrhagic CVA (P < 0.001). Serum potassium level in control group was higher than patients with TIA, ischemic CVA, and hemorrhagic CVA (P < 0.001). Patients with hemorrhagic CVA showed significantly lower serum potassium level than patients with TIA and ischemic CVA (P < 0.001). Correspondingly, it was observed that serum sodium to potassium ratio was higher in patients with TIA, ischemic CVA, and hemorrhagic CVA (P < 0.001). In patients with hemorrhagic CVA serum sodium to potassium ratio was higher when compared to patients with TIA and ischemic CVA (P < 0.001).
This study shows that higher serum sodium and lower serum potassium level may be associated with higher incidence of CVA. Further studies are paramount to elucidate the role of serum electrolyte levels in vascular events.
cerebro-vascular accident; cross-sectional studies; emergencies; sodium; potassium
Takayasu arteritis is a condition of unknown aetiology that affects the aorta and its primary branches. The disease has been primarily recognized and described in Asia. The aims of this study were to identify the main clinical, laboratory, and angiographic features of Takayasu arteritis in Iranian patients over a 10 year period from 2000 to 2010.
Data were obtained from angiographic and medical records of patients treated at Shahid-Rajai, Taleghani, and Loghman Hospitals during the above-mentioned time period. The criteria for definitions and findings were those proposed by the American College of Rheumatology.
A total of 15 patients were identified. The median age at presentation was 36 years and 73.3% of patients were females. Fever was the most common presentation. According to “modified” National Institute of Health criteria, 44.7% of patients were in the acute phase of disease with systemic symptoms such as fever, weight loss, and elevated C-reactive protein (CRP) levels. Immunological markers such as antinuclear antibodies (ANA) and antineutrophil cytoplasmic antibodies (C-ANCA) were absent. The tuberculin test result was positive in 40% of the patients. Vascular bruit was present in 86.7% and hypertension was detected in 53.3% with 13.3% having associated renal artery stenosis. The angiographic manifestations were classified as; type I, cervicobrachial type (26.6%); type II, thoracoabdominal type (20.0%); type III, peripheral type (6.6%); and type IV, generalised type (46.7%). Coronary arteries were involved in three cases, pulmonary in two and renal in two.
Based on our findings, the most common clinical, laboratory and angiographic findings were fever, increased erythrocyte sedimentation rate (ESR) and stenosis, respectively. Because of dangerous consequences of this disease, attention to fever and increased ESR, especially in young women may be helpful for physicians to prevent diagnosis delay.
Takayasu arteritis; systemic vasculitis; arteriography; claudication; tuberculosis
This study was undertaken to evaluate patient satisfaction after spinal anaesthesia, which is the most frequently administered anaesthesia in obstetric patients.
A cross-sectional study of patients who underwent caesarean section under spinal anaesthesia in the operating rooms of Hospital Teluk Intan was conducted. Post-operative survey of patients on the day after surgery was conducted by collecting pre-operative and intra-operative data on a constructed questionnaire. Post-operative data, including satisfaction and understanding the anaesthetist’s explanation regarding anaesthesia, satisfaction in receiving spinal anaesthesia and adverse effects, and willingness to accept or refuse spinal anaesthesia for a similar surgery again, were inquired by trained anaesthesia personnel.
A total of 200 pregnant patients, with age ranging from 17 to 45 years, were surveyed: 64.5% Malay, 17% Indian, 14% Chinese and 4.5% others. All (100%) the patients were satisfied with the explanation provided regarding the choices of anaesthesia, but 2% could not concentrate on the explanation because of labour pain. Overall, the average satisfaction with spinal anaesthesia administration was divided into 194 (97%) satisfied patients and 6 (3%) dissatisfied patients. Factors associated with dissatisfaction were inadequate analgesia during surgery and failed spinal anaesthesia. Post-operative complications included spinal headache 5 (2.5%), post-operative nausea and vomiting (PONV) 1 (0.5%), pain at the surgical site 2 (1%) and backache 2 (1%). Furthermore, 177 (88.5%) patients would opt for spinal anaesthesia in future for similar surgery, if required; 16 (8%) would not; and 7 (3.5%) were not sure. The reasons for refusal to receive spinal anaesthesia were as follows: awareness and failed regional anaesthesia.
The patients receiving spinal anaesthesia demonstrated a high rate of patient satisfaction. Ensuring the quality of spinal anaesthesia, improving clinical skill of the anaesthesiologists, and prevention of side effects might improve patient satisfaction.
spinal; anaesthesia; patient satisfaction; caesarean section