Association between ankle-brachial systolic index, pulse oximetry gradient index and CT angiogram of lower limb among type 2 diabetic for detecting peripheral arterial disease

Background: Peripheral arterial disease (PAD) is a known macrovascular complication of type 2 diabetes. Most primary care clinic has no establish algorithm on how to screen patient with PAD. Hereby, we conducted a study among patient in tertiary hospital diabetic unit, by using simple useful, handy test and correlate the tests with diagnostic imaging to detect PAD in our local community in Kubang Kerian, Kelantan. Objective: To determine association between ankle-brachial systolic index, pulse oximetry and CTA lower limb for detecting peripheral arterial disease among Type 2 Diabetic patients. Methodology: Patients who attended Diabetic Specialist Clinic HUSM were eligible for the study. Adult patients with Type 2 DM has HbA1c more than 6.5% in 3 months were recruited. Symptoms of claudication were assessed using ECQ. The lower limb perfusion was evaluated by ABSI and PO gradient. Radiologically the perfusion was assessed using CTA LL as a gold standard. The severity of stenosis was categorized into <50% (minimal to mild stenosis) and ≥50%(moderate to severe stenosis). The site of stenosis (above and below knee) were also analysed. Results: A total of 22 limbs from 11 patients were analysed. A strong association between abnormal ABSI and LPO gradient (r = 0.818, p = <0.001) in this study was obtained. There is significant fair association between ABSI findings and history of lower limbclaudication (r = 0.378, p = 0.076) between patients. There was statistically significant association between present of stenosis and abnormal ABSI or PO gradient (p = 0.016). On further analysis, the odd of having abnormal ABSI or PO gradient value is 12 times higher in patient with moderate to severe stenosis than those with minimal to mild arterial PAD (ORc ,95% CI). In single logistic regression, the odd of having abnormal ABSI or PO gradient value is 8 times higher in patient with moderate to severe below knee arterialstenosis (≥ 50% stenosis) than those with minimal to mild (<50%) above and below knee PAD (p = 0.037). Conclusions: Patients who have severe below knee PAD has shown strong association with abnormal ABSI and PO. PO gradient has significant association with PAD as equal as ABSI and the result was confirmed by CTA LL study

Factors affecting commencement and cessation of betel quid chewing behaviour in Malaysian adults

<p>Abstract</p> <p>Background</p> <p>Betel quid chewing is a common habit widely practiced in Southern Asian populations. However, variations are seen in the content of a betel quid across the different countries. Factors associated with commencement and cessation of this habit has been numerously studied. Unfortunately, data on Malaysian population is non-existent. This study aims to determine the factors associated with the inception and also cessation of betel quid chewing behaviour among Malaysian adults.</p> <p>Method</p> <p>This study is part of a nationwide survey on oral mucosal lesions carried out among 11,697 adults in all fourteen states in Malaysia. The questionnaire included sociodemographic information and details on betel quid chewing habit such as duration, type and frequency. The Kaplan-Meier estimates were calculated and plotted to compare the rates for the commencement and cessation of betel quid chewing behaviour. Cox proportional hazard regression models were used to calculate the hazard rate ratios for factors related to commencement or cessation of this habit.</p> <p>Results</p> <p>Of the total subjects, 8.2% were found to be betel quid chewers. This habit was more prevalent among females and, in terms of ethnicity, among the Indians and the Indigenous people of Sabah and Sarawak. Cessation of this habit was more commonly seen among males and the Chinese. Females were found to be significantly more likely to start (p < 0.0001) and less likely to stop the quid chewing habit. Females, those over 40 years old, Indians and a history of smoking was found to significantly increase the likelihood of developing a quid chewing habit (p < 0.0001). However, those who had stopped smoking were found to be significantly more likely to promote stopping the habit (p = 0.0064). Cessation was also more likely to be seen among those who chewed less than 5 quids per day (p < 0.05) and less likely to be seen among those who included areca nut and tobacco in their quid (p < 0.0001).</p> <p>Conclusion</p> <p>Factors that influence the development and cessation of this behaviour are gender, age, ethnicity, and also history of smoking habit while frequency and type of quid chewed are important factors for cessation of this habit.</p

Factors affecting commencement and cessation of smoking behaviour in Malaysian adults

<p>Abstract</p> <p>Background</p> <p>Tobacco consumption peak in developed countries has passed, however, it is on the increase in many developing countries. Apart from cigarettes, consumption of local hand-rolled cigarettes such as <it>bidi </it>and <it>rokok daun </it>are prevalent in specific communities. Although factors associated with smoking initiation and cessation has been investigated elsewhere, the only available data for Malaysia is on prevalence. This study aims to investigate factors associated with smoking initiation and cessation which is imperative in designing intervention programs.</p> <p>Methods</p> <p>Data were collected from 11,697 adults by trained recording clerks on sociodemographic characteristics, practice of other risk habit and details of smoking such as type, duration and frequency. Smoking commencement and cessation were analyzed using the Kaplan-Meier estimates and log-rank tests. Univariate and multivariate Cox proportional hazard regression models were used to calculate the hazard rate ratios.</p> <p>Results</p> <p>Males had a much higher prevalence of the habit (61.7%) as compared to females (5.8%). Cessation was found to be most common among the Chinese and those regularly consuming alcoholic beverages. Kaplan-Meier plot shows that although males are more likely to start smoking, females are found to be less likely to stop. History of betel quid chewing and alcohol consumption significantly increase the likelihood of commencement (p < 0.0001), while cessation was least likely among Indians, current quid chewers and kretek users (p < 0.01).</p> <p>Conclusions</p> <p>Gender, ethnicity, history of quid chewing and alcohol consumption have been found to be important factors in smoking commencement; while ethnicity, betel quid chewing and type of tobacco smoked influences cessation.</p

Image-guided system endoscopic drainage of orbital abscess caused by methicillin-resistant Staphylococcus aureus in an infant

Introduction: The management of orbital abscesses in neonates and infants is very challenging. Surgical drainage of the abscess is aimed at removing the pus and preventing blindness. We describe a case of orbital abscess in an infant that was caused by methicillin-resistant Staphylococcus aureus and that was successfully drained with image-guided endoscopic surgery. Presentation of case: A 39-day-old infant presented with progressive right maxillary swelling complicated by methicillin-resistant Staphylococcus aureus orbital abscess. Tooth bud abscess was the most likely primary cause and a combination of intravenous antibiotics was initially prescribed. The collection of intra-orbital pus was removed using image-guided system-aided endoscopic surgical drainage. Discussion: Prompt diagnosis and management are very crucial. Endoscopic drainage of these abscesses in children has been described. Image-guided drainage of the orbital abscess is a newer technique that has been reported in a teenager and in adult patients. This is the first reported case of endoscopic orbital drainage surgery in an infant. The procedure was performed successfully. This approach provides for better identification of the anatomical structures in a very young patient. Injuries to the medial rectus, globe and optic nerve can be avoided with this technique. Conclusion: Aggressive management of orbital abscesses in infants is mandatory. Image-guided endoscopic orbital drainage offers precise visualization and a safer technique in a relatively smaller orbit

Production of perfume for sinusitis from clove oil by extraction using steam distillation method

Essential oils are part of the aromatherapy agent to treat some diseases [1]. Essential oils are extracted from the flowers, barks, stem, leaves, roots, fruits and other parts of the plant by various methods. But some of the people do have a respiratory system problem that is an allergy to the smell from perfume [2]