This study aims to determine the relationship between calcium intake and lifestyle factors with bone health status among 56 postmenopausal women in the Evergreen Senior Citizens Club, Petaling Jaya. Purposive sampling technique was used for sample selection. Bone mineral density (BMD) of the femur proximal and lumbar L2-L4 was measured based on the Dual Energy X-ray Absorptionmetry (DEXA) technique at KVOTC Clinic, Subang Jaya. The interview sessions were conducted using a questionnaire followed by anthropometric measurements. The results revealed that the average age of the respondents was 64.0 years old. The average weight and height of the respondents were 53.68 kg and 1.55 meters, respectively. Overall, the average body mass index (BMI) of the respondents was quite satisfactory (22.4 kg/mÂ²) with only 17.9% of them categorized as overweight (>25 kg/mÂ²). The average total calcium intake was 807.31 mg and about 76.2% was contributed by food intake. About 83.9% of the respondents met the recommended calcium intake according to the Malaysian RDA. The average BMD of the lumbar, neck, wards and trochanter was 9.983 Â± 0.178 g/cmÂ², 0.745 Â± 0.126 g/cmÂ², 0.604 Â± 0.150 g/cmÂ² and 0.674 Â± 0.127 g/cmÂ², respectively. About 32.1% of the respondents were categorized as osteoporotic at the femoral wards, while 10.7% respectively was at the lumbar L2-L4 and femoral neck. Half of the respondents had osteopenia at the femoral neck (53.6%) and wards (50.0%) and at the lumbar L2-L4 (53.6%). Pearson correlation test showed significant negative correlations between age and BMD in the neck (r = -0.419, p
MeSH terms: Body Weight; Bone Diseases, Metabolic; Calcium, Dietary; Female; Femur; Femur Neck; Health Status; Humans; Life Style; Surveys and Questionnaires; X-Rays; Bone Density; Body Mass Index; Postmenopause; Overweight
A 23 year-old Chinese woman presented with symptoms of increased intracranial pressure due to obstructive hydrocephalus as a sequel to a mass effect from cerebellar haemangioblastoma. She underwent removal of the right cerebella rhaemangioblastoma and ventriculo-peritoneal shunting. She also had bilateral retinal haemangioblastoma, left renal carcinoma, renal and pancreatic cysts without phaeochromocytoma. A left partial nephrectomy was performed for renal cell carcinoma followed by radiotherapy. She survived the initial episode only to
succumb to another cerebellar haemorrhage 18 months later.
We describe a patient with liver cirrhosis who presented with erosive oral and cutaneous lichen planus (LP) and incidentally was found simultaneously to have thymoma and hepatoma. We support the notion forwarded earlier that LP and chronic liver disease is more than a mere coincidence and that there is a noncoincidental association between LP and thymoma. We believe this is also the first reported case in the English Literature of coexistence of the three condition LP, thymoma and hepatoma complicating liver disease.
Human papillomavirus (HPV) is the commonest sexually transmitted viral infection and one of its manifestations is genital warts or condyloma acuminata. Eight cases of vulvo-vaginal warts were diagnosed between January 1992 and December 1993. There were 4 Malays, 2 Chinese and 2 Indians. The patients’ age ranged from 22 to 43 years (mean 27.9 years). Formalin-fixed, paraffin-embedded tissues were studied by histology and in situ hybridization using biotinylated probes to detect the HPV deoxyribonucleic acid (DNA) of types 6, 11, 16, 18, 31 and 33. All vulvar and vaginal lesions showed typical histopathological features of condylomatous changes. HPV 6 and HPV 11 were detected in 100% (8/8) and 87.5% (7/8) of all cases, respectively. HPVs 16, 18, 31 and 33 were not found. The positive cells were mainly in the upper layers of the squamous epithelium. The hybridization data indicated that the HPV found in this study one of the same types as found in other studies.
MeSH terms: Condylomata Acuminata; DNA; Female; Formaldehyde; Humans; Paraffin; In Situ Hybridization; Papillomaviridae; Human papillomavirus 11; Human papillomavirus 16; Human papillomavirus 6
A case of biventricular neurocytoma is reported. A 36 year old Malay lady presented with headache of 8 months duration. Physical examination revealed signs of increase intracranial pressure. CT-scan and MRI showed tumour in both lateral ventricles. Patient underwent tumour debulking followed by adjuvant radiotherapy. The radiological appearances of central neurocytoma are discussed.
To aid future curriculum revision and planning, a batch of newly graduated medical students were surveyed using a questionnaire containing items representing possible areas of concern during house-officership. Students rated items representing communication issues as areas of concern. They did not agree that areas concerning responsibilities as a doctor, continuing medical education, theoretical and practical skills and potentially stressful working conditions were problem areas. Communication skills should remain among the priority areas for undergraduate. training. Students should also be given more information about the houseofficership period prior to graduation. Further study is needed to confirm perceived strengths of the USM curriculum suggested by the study, which are skills in finding
resources for further learning and skills in leadership. A task-analysis of the houseofficership
period is also needed.
MeSH terms: Curriculum; Education, Medical, Continuing; Leadership; Physicians; Surveys and Questionnaires; Students, Medical
Absorbed dose to water was measured with ionisation chambers NE 2561 (#267), NE 2581 (#334), NE 2571 (#1028), using the IAEA standard water phantom. The ionisation chamber was inserted in the water phantom at a reference depth dependent on the type of the radiation quality used. Three radiation qualities were used namely 1.25 MeV gamma ray, 6 MV x-rays and 10 MV x-rays. The values of the absorbed dose to water were determined by the NK- and NX- based methods, i.e with the use of IAEA, HPA, NACP, AAPM, NCRP and ICRU protocols. The aim of this study was to make an intercomparison of the results, by taking the IAEA protocol as a standard. The largest deviation contributed by any of these protocols was recorded for each quality. It was found that AAPM, NCRP and ICRU protocols contributed 0.94% for 1.25 MeV gamma ray, NACP contributed 2.12% for the 6 MV x-rays, and NACP contributed 2.35% for 10 MV x-rays. Since the acceptable limit of deviation set by the IAEA for this absorbed dose work is Â± 3%, it is clear that the overall deviations obtained were all satisfactory.
A random amplified polymorphic DNA (RAPD) fingerprinting method has been developed to differentiate Vibrio vulnificus strains isolated. Twenty-nine strains isolated from cockles and twenty-one strains isolated from shrimps were analyzed. A total of 10 primers were screened with Vibrio vulnificus strains to identify those capable of generating DNA polymorphisms and two primers were selected. Primer GEN 1-50-01 and GEN 1-50-08 produced polymorphisms in most strains tested, with the band sizes ranging from 10.0 to 0.25 kb pair. Dendrogram analysis showed that primer GEN 1-50-01 produced 10 clusters and 24 single strains at a 40% similarity, whereas primer GEN 1-50-08 produced 11 clusters and 20 single strains at a 40% similarity. This study revealed the potential use of PCR fingerprinting in epidemiological studies.
MeSH terms: Animals; DNA; Polymorphism, Genetic; Shellfish; Epidemiologic Studies; DNA Primers; Random Amplified Polymorphic DNA Technique; Vibrio vulnificus; Cardiidae
Nosocomial infection is a common problem in the Neonatal Intensive Care Unit (NICU) and a knowledge of the pattern of nosocomial infection will contribute greatly to the intensification of infection control measures and the development of antibiotic policies in the NICU. This study aims to compare the incidence and clinical characteristics of neonates with nosocomial infection in NICU of both Kuala Terengganu Hospital (HKT) and Universiti Sains Malaysia Hospital (HUSM). Neonates who had both clinical signs of sepsis and positive blood cultures, 48 hours after admission to NICU, from 1st January to 31st December 1998, in both hospitals were retrospectively studied. Among neonates admitted to NICU, 30 (5.4%) in HKT and 65 (3.6%) in HUSM had nosocomial infection (p = 0.07). The mean duration of hospitalisation was shorter (HUSM 37 days, HKT 49 days; p = 0.02), and the number of neonates with predisposing factors for infection is higher (HUSM 100%, HKT 73.3%; p < 0.001) in HUSM compared with HKT. There were no differences in gestation, mean age of onset of infection and mortality between both hospitals. The most common organism isolated from the blood in HKT was Klebsiella pneumoniae (33.3%), and in HUSM Klebsiella aerogenes (24.6%). Half of Klebsiella pneumoniae isolates were resistant to cephalosporins and aminoglycosides in HKT and a similar number of Klebsiella aerogenes isolates were resistant to piperacillin and aminoglycosides in USM. In conclusion nosocomial infection is a common problem in both hospitals. Except for more frequent predisposing factors for infection in HUSM, and a longer duration of hospital stay among neonates in HKT, the clinical characteristics of neonates with nosocomial infection in both hospitals were similar.
Familial defective apolipoprotein B-100 (FDB) is an autosomal dominant genetic disorder associated with hypercholesterolaemia and premature coronary heart disease. FDB is caused by mutations in and around the codon 3500 of the apolipoprotein B (apo B) gene. Apo B R3500Q mutation is the first apo B mutation known to be associated with FDB and it is the most frequently reported apo B mutation in several different populations. The objective of the present study was to determine the association of apo B R3500Q mutation with elevated plasma cholesterol concentration in Kelantanese population in which both hypercholesterolaemia and coronary heart disease are common. Sixty-two Malay subjects with hyperlipidaemia, attending the lipid clinic at Hospital Universiti Sains Malaysia, Kelantan, were selected for this study. The DNA samples were analysed for the presence of apo B R3500Q mutation by polymerase chain reaction-based restriction fragment analysis method using mutagenic primers. This mutation was not detected in the subjects selected for this study. Apo B R3500Q mutation does not appear to be a common cause of hypercholesterolaemia in Kelantanese Malays.
In direct age-adjustment, a common age-structured population is used as standard. This population may actually exist (e.g., United States population, 1999) or may be fictitious (e.g., two populations may be combined to create a standard). In indirect age-adjustment, a common set of age-specific rates is applied to the populations whose rates are to be standardized. The simplest and most useful form of indirect adjustment is the standardized mortality ratio (SMR).
MeSH terms: Emotional Adjustment; Reference Standards; United States
The Telegu community was brought into Sarawak in 1900 by Rajah Charles Brooke as labourers. Today, there are 92 members belonging to three generations of Telegus in Sarawak. Due to the need to communicate with people around them, the first generation who spoke Telegu at home started speaking Bazaar Malay with Malay, Dayak and Chinese neighbours in Batu Satu, which was an early Telegu settlement. The Telegu children first stayed in Pendam, a typical Malay village, and later in Batu Satu, a typical Hokkien Chinese area. Due to these linguistic environments, they eventually developed Telegu pidgin Malay with words borrowed from Sarawak Malay, Hokkien and English to become their new home language. Today, Bazaar Malay is still spoken by the first generation of Telegus with neighbours in Batu Satu and their own pidgin Malay is spoken among the second generation of Telegus. However, the third generation speaks fluent English and Standard Malay in addition to the Sarawak Malay dialect. Data was obtained through audio recording of home conversations, so as to ascertain the varieties of Malay used by the three generations of Telegus today, i.e. Bazaar Malay (G1), Telegu pidgin Malay (G2), Standard Malay (G2 &G3) and Sarawak Malay dialect (G3).
During a 24-month period, 21 children with acute bacterial meningitis were identified and studied. The majority of the children was from low socio-economic group and the male:female sex ratio was equal. Seventeen children (81%) were aged twelve months or below. In 15 (71.5%) of the children. Haemophilus influenzae type b was recovered, while Streptococcus pneumoniae was isolated from 4 children. Neisseria spp and Salmonella spp were identified respectively in each of the other two cases. The case fatality was four (19.0%) with nine others (42%) exhibiting neurological sequelae. Except for the Salmonella spp strain that was resistant to the cephalosporin, the rest of the bacterial species were sensitive to the commonly used antibiotics. As Haemophilus influenzae type b is still the most prevalent cause of acute bacterial meningitis, it is therefore strongly recommended that the national immunisation programme in this country should include the vaccine for it in our effort to minimise the mortality and morbidity caused by this organism.
MeSH terms: Anti-Bacterial Agents; Cephalosporins; Child; Female; Humans; Male; Neisseria; Salmonella; Sex Ratio; Streptococcus pneumoniae; Vaccines; Prevalence; Meningitis, Bacterial; Immunization Programs; Haemophilus influenzae type b
It is very rare indeed in the practice of children's orthopaedics today in Malaysia that the natural history of long bone osteomyelitis is seen. A case is presented where a shoulder abscess in a 3-year-old child developed into septic arthritis of the shoulder and subsequently chronic osteomyelitis of the adjacent humerus. The parents refused active surgical debridement and sequestrectomies. Three years later the child had regenerated a new humerus over the sequestra. Radiographs are presented illustrating the entire natural history of osteomyelitis with the regeneration of a new humerus.
Clubfoot is associated with leg length inequality, with the affected leg being shorter as a consequence of the hypoplasia. Early treatment of a minimally hypoplastic clubfoot usually allows catchup growth and both legs equalise in length after a few years. Late treatment however is associated with a shortening of the affected foot. A case is described where late treatment of a severe clubfoot is assocated with lengthening of the affected leg.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked red blood cell enzymopathy common in malaria endemic areas. Individuals affected by this disease show a wide variety of clinical signs including neonatal jaundice. In this preliminary report we describe the heterogeneity of G6PD deficient gene in neonatal jaundice in the Malay population in Kelantan. Thirteen G6PD deficient Malay neonates with hyperbilirubinemia were subjected to mutation analysis of the G6PD gene for known candidate mutations. Molecular defects were identified in the 13 patients studied. Though all of these were mis-sense mutations, identified nucleotide changes were heterogeneous. Six patients were found to have a C to T nucleotide change at nucleotide 563 of the G6PD gene (C563T), corresponding to G6PD Mediterranean; three cases had a single nucleotide change at T383C (G6PD Vanua Lava), two cases had G487A (G6PD Mahidol) and two cases had G1376T (G6PD Canton). These findings suggest that there are heterogeneous mutations of the G6PD gene associated with neonatal jaundice in the Malay population in Kelantan.
A community-based study of childhood injuries in Kedah was undertaken in January-March 1996. The aims were to determine the types and frequencies of injuries reported; to assess the association between injury and selected variables (age, sex, place, number of children in the family, presence of care-givers and treatment); and to recommend further research and policy for childhood injury prevention. A total of 448 injuries were recorded from 1089 children in 451 randomly selected households. The incidence was 411.4/1000. There appeared to be a decrease in risk of injury as the number of children per household increased. The effect of lower age on injury was significant (p>0.05). Male children were 1.5 times more likely to injure themselves than female children when data were controlled for number of children in the household. Falls accounted for 53.3% of all injuries sustained, and occurred more frequently when the child was with non-family members. Different injury categories were associated with different caregiver categories. It is concluded that child injury prevention programmes require more data on injury situations and collaborative efforts between clinical, health and and behavioural professionals.
This paper looks at some of the problems encountered when cases of abuse and injuries occur in children placed in child care in an urban community in Malaysia. It is based on the study of 37 children referred to our hospital's Child Protection Services over the past four years for injuries and incidents where the child-minders came under suspicion. They constituted 12% of the 285 children referred to the Child Protection Team during that period for evaluation of suspected child abuse. Twenty six children had experienced physical trauma. Fifty eight percent of these were young infants with cranial injuries or limb fractures but no history to explain their occurrence. Four had superficial injuries from accidents secondary to inadequate supervision. The other 11 children had been sexually abused. The perpetrators in 73% of cases were either the husbands or sons of the child-minder. Ninety five percent of the incidents occured at home-based nurseries. Prospects of any punitive measures were remote in most instances due to uncertainty about the perpetrator, or insufficient corroborative evidence required in sexual abuse cases. There were three documented cases where the family refused to lodge a police report or co-operate with investigations out of a reluctance to implicate or offend the child-minders who were mainly neighbours, relatives or friends in 58% of cases. Ninety seven percent of the facilities were unregistered, making surveillance for recurrent incidents and adherence to safety standards difficult. These incidents were almost certainly an underestimate of the problem. Training of child-care providers, improved legislation and enforcement as well as education of parents to choose suitable facilities are issues which need to be tackled.
Lumbar puncture (LP) is an important procedure both for diagnostic and therapeutic purposes. In Kelantan, Malaysia, on many occasions consent for this procedure is not granted by patients or guardians. The aim of this study was to find out the factors that influence the decision to grant or refuse the consent for LP. This was a cross-sectional study in which 86 parents (who agreed or refused to give consent for LP on their child) were interviewed by using a standard questionnaire. A scoring system was used to assess their knowledge about the purpose and technique of the procedure. Consent for LP was granted in 23 and refused in 27 children. The refusal rate was significantly higher when family members other than parents made the decision. The factors which did not play a statistically significant role in decision-making included: age of the child and parents; gender of the patient; number of children in the family; patient's birth order among the siblings; place of residence; monthly income of the family; parents' level of education; and number of days after admission when LP was requested. The factors that positively influenced the decision to give consent included knowledge about the purpose of LP and underlying disease. In order to receive positive consent for LP it is concluded that the parents/guardians and other family members who may influence the decision-making should be explained the role of LP in (1) making diagnosis and (2) choosing right antibiotics for treatment. They should also be informed about the side-effects of antibiotics, which may be used unnecessarily in unconfirmed cases of central nervous system infections.
MeSH terms: Anti-Bacterial Agents; Birth Order; Central Nervous System Infections; Child; Cross-Sectional Studies; Decision Making; Family; Humans; Malaysia; Parents; Surveys and Questionnaires; Spinal Puncture; Siblings