Author: Pei Kuan Lai

Second stage fetal heart rate patterns and neonatal acid-base status

Posted Pei Kuan LaiPosted in Original Article

Authors: Faridah Hanim Zam Zam, Nazimah Idris, Tham Seng Woh.

ABSTRACT

Background: Fetal surveillance in labour is performed mostly to identify fetuses at risk of hypoxia in order to reduce neonatal morbidity and mortality by initiating timely intervention. While normal and abnormal fetal heart rate (FHR) patterns have been well recognised and characterized for the first stage of labour, FHR patterns during the second stage of labour commonly showed some forms of abnormalities leading to problems in interpretation, particularly in predicting fetal hypoxia and acidosis. This study aims to identify patterns of FHR tracing during the second stage of labour associated with neonatal acidosis.

Methods: A prospective cross sectional study was conducted in the Labour Ward of a state referral hospital. The study population were patients with low-risk singleton pregnancies between 37 to 42 weeks gestation who had normal cardiotocograph (CTG) tracing in the first stage of labour. CTG was recorded during the second stage of labour and neonatal umbilical cord blood was obtained for acid-base analysis immediately after birth prior to the delivery of placenta. FHR patterns were grouped according to modified Melchior and Barnard’s classification and matched with neonatal acid-base status. Patients with normal FHR pattern in the second stage acted as control.

Results: A total of 111 matched pairs were analysed. Ninety nine (89.2%) second stage FHR tracings showed abnormal features when compared to control. There were significantly more neonatal acidosis and hypercapnia in type 1b, type 2a, type 2b and type 3 CTG patterns compared to control, in increasing order of severity. In addition, types 2b and 3 showed significant difference in the base excess.

Conclusion: Certain second stage fetal heart rate patterns were found to be associated with neonatal acidosis.

Keywords: fetal heart rate patterns; second stage of labour; neonatal acidosis.

Citation: IeJSME 2012 6(2): 18-23

DOI: https://doi.org/10.56026/imu.6.2.18

Blood glucose level and other biochemical changes induced in normal mice by oral Traditional Chinese Medicine complex for diabetes (TCM-D™)

Posted Pei Kuan LaiPosted in Original Article

Authors: Donald Koh Fook Chen, Joon Wah Mak, Soo Shen Ooi, Kok Fee Mak, Kwai Hoe Chong.

ABSTRACT

Background: A number of Traditional Chinese Medicine (TCM) preparations are being used for the treatment of diabetes mellitus. Some components of these preparations have biochemical effects other than those of lowering blood glucose and indeed have been used for other medical indications in traditional practice. The primary objective of the study was to determine the effect of the oral mixture of Traditional Chinese Medicine for diabetes (TCM-D™ complex) on blood glucose level and the biochemical changes if any, on the liver (ALT, AST, gamma-GT, albumin, globulin) and renal (blood creatinine, urea) functions in normal mice. The oral mixture is an aqueous extract of four well-known traditional Chinese medicinal herbs and consists of Trichosanthes kirilowii Maxim., Paeonia lactiflora Pall., Glycyrrhiza uranlensis Fisch., and Panax ginseng (red) CA Meyer in the proportion of 36%, 28%, 18%, and 18% respectively of the dry weight. These herbs have been shown to have blood glucose lowering activity and have been used for other traditional medicinal purposes. The safety of the combination was evaluated in the present study.

Methods: Experimental Balb/c mice were treated orally via gastric tube with the extract at daily doses equivalent to 1 and 10 times the recommended human dose for 8 weeks. Blood glucose and other biochemical profiles were monitored at pre-treatment and monthly post-treatment until killed.

Results: When compared to pre-treatment levels, the blood glucose levels were significantly lower in treated animals compared to those in the control group. At the recommended TCM-D™ dose the levels in treated animals were significantly lower than that of control animals and at pre-treatment. When compared with pre-treatment, the glucose levels were lowest at Week 8 of treatment, the mean levels being 111.23%, 83.32% and 70.33% in control, and in animals given 1 x and 10 x the recommended TCM-D™ dosage respectively. The blood glucose lowering effect was also associated with a significant weight loss in treated animals. There were transient increases in AST and ALT levels but these reverted to normal at Week 8 of treatment. The levels of bilirubin, g-GT, albumin, creatinine and blood urea were also not significantly different at Week 8 from pre-treatment levels in all groups.

Conclusion: Even at 10 times the dosage recommended for humans, TCM-D™ did not affect the liver and renal functions of treated animals. Treated and control animals remained healthy and normal throughout the period of observation.

Keywords: Trichosanthes kirilowii Maxim., Paeonia lactiflora Pall., Glycyrrhiza uranlensis Fisch., and Panax ginseng (red) CA Meyer, blood glucose lowering, weight loss, biochemical changes.

Citation: IeJSME 2012 6(2): 24-31

DOI: https://doi.org/10.56026/imu.6.2.24

The pH of very dilute solutions of strong acids – a calculation for a medical or biomedical class involving the application of simple numerical skills

Posted Pei Kuan LaiPosted in Research Note

Author: Peter Michael Barling

ABSTRACT

This paper presents the solution to a calculation of the pH of a very dilute solution of a strong acid or base, taking into account the effect of the hydronium or hydroxyl ions generated from the ionisation of the strong acid or base on the ionisation of water, as a second very weak acid. To be solved successfully, this calculation involves the concepts of conservation of charge, pH and the application of the general solution to a quadratic equation. Such an exercise involves the application of skills in basic numeracy, and can provide a core of understanding that can prepare students for many different sorts of calculations that represent real-life problems in the medical and biological sciences. A programme is presented in C++ which enables the work of students to be individualised so that each student in a class can work through a slightly different pH calculation, in such a way that a class supervisor can quickly check each student’s result for accuracy. This exercise is presented as a potential means of enabling students to undertake and master similar types of calculations involving simple or more complex equilibria.

Keywords: pH, numerical skills, dilute solution, ionisation.

Citation: IeJSME 2012 6(2): 32-38

DOI: https://doi.org/10.56026/imu.6.2.32

Importance of a standardized oncology curriculum in Malaysia

Posted Pei Kuan LaiPosted in Research Note

Authors: Sangeetha Poovaneswaran, Rumi Khajotia, Thiruselvi Subramaniam.

ABSTRACT

The incidence of cancer in Malaysia is rising alarmingly and newly qualified doctors will be expected to be competent in the basic management of cancer patients. However, the opportunity to gain experience in oncology management will remain limited unless these students are stationed in an oncology unit which is solely dedicated to the treatment of such patients. Therefore, it is essential that undergraduate medical school training equips students with a sound knowledge-base, so that they can confidently manage basic oncological conditions appropriately. With the many private and local medical universities across the country, it is important that oncology training be standardized and reflective of the local resources available, and government health policies. As a result, having a standardized curriculum would help create a framework whereby competencies in cancer management would be accurately assessed.

Keywords: oncology, curriculum, medical education.

Citation: IeJSME 2012 6(2): 39-42

DOI: https://doi.org/10.56026/imu.6.2.39

A study to assess the knowledge on self-blood pressure monitoring (SBPM) among hypertensive patients in selected wards of Hospital Lam Wah Ee, Malaysia

Posted Pei Kuan LaiPosted in Research Note

Authors: Mini Rani Mary Beth, Shin Yan Low, Poh Yoke Chung.

ABSTRACT

Self-blood pressure monitoring (SBPM) at home creates greater awareness and patient participation in their treatment prevents hypertensive complications and helps facilitate doctors to make decisions on treatment. A study was conducted to assess the knowledge on self-blood pressure monitoring (SBPM) among hypertensive patients in selected wards of Hospital Lam Wah Ee, Malaysia. The results showed only 21 (32.3%) respondents monitored their blood pressure and 44 (67.7%) did not monitor their blood pressure at home. A total of 12 (18.4%) respondents reported that they monitored their blood pressure at home because they were aware of complications of hypertension. From those respondents who did not monitor blood pressure at home, only 13 (29.5%) respondents planned to carry out SBPM at home in the future. The overall knowledge score results for self-blood pressure monitoring showed that 6 (9.2%) subjects scored 8 and above, 42 (64.6%) scored 5-7, and 17 (26.1%) scored less than 4. The findings from the study will help the nurses understand the level of knowledge on SBPM among hypertensive patients, and include training and health education during hospitalisation reinforcing the importance and the technique of performing SBPM at home. It also helps to identify patients with poor control of blood pressure so that they can be referred to the physician for further treatment.

Keywords: Self-blood pressure monitoring, hypertension.

Citation: IeJSME 2012 6(2): 43-45

DOI: https://doi.org/10.56026/imu.6.2.43

Acute lymphangitis in a preschool child: A case report

Posted Pei Kuan LaiPosted in Case Study & Report

Author: Loh Huai Seng

ABSTRACT

A 3-year old preschool boy presented with a pruritic red streak at the dorsum of his right foot traveling upward from the affected site which was red and swollen. Insect sting was the more likely trigger which had caused the cellulitis and subsequently the acute lymphangitis.

Keywords: cellulitis, insect stings, lymphangitis, preschool child, streptococcal infections.

Citation: IeJSME 2012 6(2): 46-48

DOI: https://doi.org/10.56026/imu.6.2.46

Association between house dust mite (HDM) sensitisation and asthma control using skin prick test and HDM antigen specific IgE levels in saliva of Malaysian children

Posted Pei Kuan LaiPosted in Original Article

Authors: Keat Seong Teo, Cheong Wooi Cheah, Joon Wah Mak.

ABSTRACT

Background: Sensitisation to house dust mite (HDM) has been regarded as a major risk factor for development of asthma. This study was carried out to investigate the profiles of HDM sensitisation among Malaysian children with asthma.

Material and Methods: The association between HDM sensitisation and control and severity of asthma was investigated. The salivary HDM specific IgE levels were quantified in different grades of control and severity of asthma in 125 unselected asthmatic children aged 5-12 years old attending the asthma follow-up clinic in Hospital Tuanku Ja’afar Seremban. An additional 29 non-asthmatic patients were selected as control. The skin prick test to assess sensitisation to Dermatophagoides pteronyssinus (DP) and Dermatophagoides farinae (DF) was performed on all the participants. A questionnaire regarding the control and severity of asthmatic symptoms of the subject was administered. Saliva was collected by voluntary spitting and ELISA was used to quantify the IgE specific to HDM antigen.

Results: There was a significant association between sensitisation to DP and DF and the control of asthma. The association between DP sensitisation and severity of asthma just failed to reach a significant level although there is a clear trend for this. Significant association was found between DF sensitisation and severity. The HDM specific IgE in the saliva was significantly higher in asthmatic patients compared to non-asthmatic patients. There was no significant difference between the specific IgE levels in patients with different severity status of asthma.

Conclusion: Salivary IgE levels may not be an appropriate indicator of the patients’ asthmatic condition in this study. However, it can be concluded that there is significant association between the sensitisation of HDM and the control and severity of asthma.

Keywords: Dermatophagoides pteronyssinus, Dermatophagoides farina, childhood asthma, house dust mite specific-salivary IgE.

Citation: IeJSME 2015 9(2): 3-12

DOI: https://doi.org/10.56026/imu.9.2.3