Telomerase, the enzyme that stabilizes telomere length is reactivated with almost all cancer types, and may be a useful diagnostic marker for malignancy. Telomerase activity has been detected in germ line cells and most cancer cells, whereas most normal somatic cells have no clearly detectable telomerase activity. In our study, we aim to detect telomerase activity in 20 human central nervous system tumors from Malaysian patients. Telomerase activity was detected based on a highly sensitive procedure consisting of a CHAPS detergent-based extraction from frozen tissues and a PCR-based telomeric repeat amplification protocol (TRAP) using a TRAPEZE Telomerase Detection Kit (Intergen, Co). Telomerase activity was considered positive when a ladder of products was observed starting at 50bp, with 6bp increments. The activity was detected in 30% of the samples analysed, included glioblastoma multiforme, meduloblastoma, paraganglioma and oligodendroglioma. The result of Fisher's exact test indicated that there was a significant association between telomerase activity status with tumor grade (p=0.003). These results suggest that telomerase activity may be an important marker for tumor malignancy.
MeSH terms: Adult; Female; Humans; Malaysia; Male; Sensitivity and Specificity; Biomarkers, Tumor/metabolism*; Central Nervous System Neoplasms/diagnosis*; Central Nervous System Neoplasms/enzymology; Telomerase/metabolism*; Nucleic Acid Amplification Techniques/methods
The intercountry border areas of Thailand have high malaria receptivity and vulnerability that present numerous problems in the control of malaria transmission. This study focused on the 30 provinces of Thailand situated next to neighboring countries, which can be divided into 4 groups: the Thai-Myanmar border (10 provinces), the Thai-Cambodia border (6 provinces), the Thai-Lao border (10 provinces) and the Thai-Malaysia border (4 provinces). The purpose of the present study was to describe the pattern and trend of malaria incidence in the highly endemic provinces along the Thai borders for the 11 years from 1991 to 2001. Analysis of trends showed the distribution of malaria parasites to have shifted from a preponderance of Plasmodium falciparum to Plasmodium vivax along the western border with Myanmar, the northern border with Lao PDR and along the eastern border with Cambodia whereas the southern border with Malaysia the pattern changed from a preponderance of P. vivax to P. falciparum, since 1997. There was a significant difference in annual parasite incidence between borders and non-border districts, especially along the Thai-Myanmar and Thai-Cambodia borders. It is thus evident that all border districts should pay more attention to control of malaria transmission and the activities of the malaria surveillance system, and that monitoring and evaluation of the Thai Malaria Control Program needs to be performed consistently, including some areas where a few malaria cases were found as well as in malaria free areas.
Enteropathogenic Escherichia coli (EPEC) is a leading cause of diarrhea among infants in developing countries. A total of 38 EPEC isolates, obtained from diarrhea patients of Hospital Miri, Sarawak, were investigated through plasmid profile, antibiotic resistance and randomly amplified polymorphic DNA (RAPD) analysis. From the 8 types of antibiotics used, all isolates were 100% resistant to furoxime, cephalothin and sulphamethoxazole and showed high multiple antibiotic resistant (MAR) indexes, ranging from 0.5 to 1.0. In plasmid profiling, 22 isolates (58%) showed the presence of one or more plasmids in the range 1.0 to 30.9 mDa. The dendrogram obtained from the results of the RAPD-PCR discriminated the isolates into 30 single isolates and 3 clusters at the level of 40% similarity. The EPEC isolates were highly diverse, as shown by their differing plasmid profiles, antibiotic resistance patterns and RAPD profiles.
MeSH terms: Adult; Diarrhea/microbiology; Drug Resistance/genetics*; Escherichia coli/classification*; Escherichia coli/drug effects; Escherichia coli/genetics; Escherichia coli Infections/microbiology*; Escherichia coli Infections/epidemiology; Humans; Malaysia/epidemiology; Microbial Sensitivity Tests; Plasmids/genetics; Predictive Value of Tests; DNA Fingerprinting/methods*; Random Amplified Polymorphic DNA Technique*
A 38-year old female with underlying systemic lupus erythematosus was admitted with tuberculous meningoencephalitis. After an initial good response to anti-tuberculous treatment, she developed cerebral infarction and profound hyponatremia. This was due to cerebral salt wasting syndrome, which has only previously been described in 2 cases. The difficulties in diagnosis and management of this case are discussed.
SJV Chelvanayakam (1898-1977), a ranking civil lawyer and legislator, was probably the well known Parkinson disease victim in the 20th century Sri Lanka. He was born in Ipoh, Malaya, where his father had moved in the last decade of the 19th century for professional advancement. Ipoh was then an attractive location for migrants from China and the Indian subcontinent since it was in the Kinta valley--touted then, as the world's richest single tin field. Chelvanayakam was brought to Jaffna peninsula when he was aged four (in 1902 or 1903) by his mother, who returned to her native Tellipalai town partly due to indifferent health during her stay in Kinta region. In this communication, I present a hypothesis that organotin exposure as a foetus or during infancy at his place of birth is likely to have been a contributing factor to Chelvanayakam's Parkinsonism. It seems to fit the available circumstantial evidence.
MeSH terms: Famous Persons*; Humans; Jurisprudence; Sri Lanka; History, 20th Century
The treatment preferences of 109 general practitioners (GPs) for childhood asthma were determined. Availability and adherence to clinical practice guidelines (CPG) for the treatment of childhood asthma was also assessed. Ninety eight (90%), 60 (55%) and 33 (30%) GPs considered nocturnal symptoms > 2 times/week, exercise induced wheeze and cough respectively as indications for preventer therapy. An oral preparation was preferred for relief medication [72 (66%) for 2-5 years, 60 (55%) for > 5 years]. An inhaled preparation was however preferred for preventer medication [60 (55%) for 2-5 years, 85 (78%) for > 5 years]. The oral form was more likely prescribed for asthmatic children 2-5 years (p < 0.001). Corticosteroids and ketotifen were the commonest inhaled and oral preventer treatment prescribed respectively. Only 36(33%) GPs have a CPG copy for reference. Children with asthma symptoms that require preventer therapy may not always be identified in general practice. The oral route remains important for asthma medication especially in young children. The accessibility to the CPG among GPs is disappointing.
Study site: General practitioners attending a pharmaceutical industry sponsored asthma management workshop
MeSH terms: Asthma/drug therapy*; Child; Cross-Sectional Studies; Family Practice/statistics & numerical data*; Humans; Malaysia; Pediatrics/statistics & numerical data*; Practice Patterns, Physicians'/statistics & numerical data*; Surveys and Questionnaires; Chi-Square Distribution; Practice Guidelines as Topic; Anti-Asthmatic Agents/therapeutic use*; Guideline Adherence; General Practitioners
Seventy patients presented with acute asthma at the emergency department of the University of Malaya Medical Centre, Kuala Lumpur were recruited over a two-week period in July 2001. Fifty-one (73%) patients belonged to the poorly controlled group. Fifty-seven (81%) patients were using inhaled salbutamol but 21 (30%) were still using oral short acting salbutamol. Only 32 (46%) patients used inhaled corticosteroids. In the poorly controlled group, 22 (43.1%) patients were not on regular inhaled corticosteroids, 35 (68.6%) were not receiving "add-on" medication and 18 (35%) did not have regular follow up. The emergency department should implement a protocol for asthma management and follow up to achieve better long term patient care.
A study was done on survival of patients surgically treated for lung cancer from 1995-2001. The average operative rate for 852 patients was 4.8%. In 67 surgically treated patients (54M, 13F), the commonest histological type was squamous cell carcinoma (52.2%) followed by adenocarcinoma (26.9%). The surgical-pathological stage was stage I in 52.2%. Postoperatively, five-year survival was 29%, with a median survival of 27 months. Completeness of resection was the foremost determinant of survival outcome and stage higher than stage I was an adverse prognostic factor. These results indicate that the current outlook for lung cancer patients remains poor.
In Malaysia, there is limited information on the mortality and morbidity after an acute stroke in hospitalised patients. The objective of the study was to identify the type, time of onset, and frequency of medical and neurological complications following an acute ischaemic stroke. Consecutive patients with acute ischaemic stroke who were admitted to Hospital Universiti Kebangsaan Malaysia from June 2000 to January 2001 were observed. The complication rate was 20.9%. The most common individual complication was pneumonia (12.3%), followed by septicaemia (11.0%), urinary tract infection (4.3%), and upper gastrointestinal haemorrhage (3.7%). The overall mean length of stay was 7.48 days. The independent risk factors for complications were diabetes mellitus (OR 2.87; 95%CI 1.06 to 7.78), middle cerebral artery (MCA) infarcts (OR 10.0; 95%CI 4.1 to 24.3), and Glasgow coma score (GCS) less than 9(OR 3.8; 95%CI 1.03 to 14.3). Infection was the commonest complication observed. Patients with diabetes mellitus, poor GCS and large MCA infarcts had a higher risk of developing complications.
A study was conducted to determine the clinical factors that affect the quality of life in adult asthmatics. As part of their routine follow-up visit, 399 patients completed the SF-36 quality of life questionnaire, had peak expiratory flow rate readings (PEFR) taken and were interviewed to determine current symptom severity. The grade of severity of asthma was verified by the consultant physician in-charge. The mean age of the patients was 41.8 years and 31.8% of the patients were men. Most of the patients were Malay (64.7%), 89% had at least secondary level education and the mean duration of asthma was 17.6 years. The majority of patients had moderate or severe disease (43.6% and 55.9% respectively). For asthmatics with moderate or severe symptoms of chest tightness and/or shortness of breath, all domains of SF-36 scored significantly lower than those with mild symptoms, with the exception of the domain bodily pain. Patients with moderate/severe cough recorded significantly lower scores than those with mild cough for all domains except for bodily pain and social functioning. Only the physical functioning, role physical, general health and role emotional scores were significantly worse in those with a consultant grade of severe asthma compared to those with mild/moderate asthma. Patients with PEFR < 80% predicted had lower scores for the domains physical functioning, role physical and general health than those with PEFR > or = 80% predicted, but the scores for the other domains were similar in both groups. Quality of life is significantly impaired in adult asthmatics with current respiratory symptoms. However, consultant grade of severity of asthma and PEFR readings do not affect quality of life scores as much.
Study site: Asthma clinics, hospitals, Malaysia
Comparative surgical audit to monitor quality of care should be performed with a risk-adjusted scoring system rather than using crude morbidity and mortality rates. A validated and widely applied risk adjusted scoring system, P-POSSUM (Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality) methodology, was applied to a prospective series of predominantly general surgical patients at the Sarawak General Hospital, Kuching over a six months period. The patients were grouped into four risk groups. The observed mortality rates were not significantly different from predicted rates, showing that the quality of surgical care was at par with typical western series. The simplicity and advantages of this scoring system over other auditing tools are discussed. The P-POSSUM methodology could form the basis of local comparative surgical audit for assessment and maintenance of quality care.
MeSH terms: Adult; Aged; Humans; Malaysia; Medical Audit/methods*; Middle Aged; Prospective Studies; Quality Assurance, Health Care*; Surgical Procedures, Operative/mortality*; Chi-Square Distribution
We retrospectively analyzed all patients presenting with upper gastrointestinal bleeding to Seremban Hospital over a one-year period. A quarter of the oesophagogastro-duodenoscopies (OGD) performed were performed as emergency for upper gastrointestinal tract bleeding. Gastric ulcers and duodenal ulcers were the two most common findings. Our results suggest that there is a male preponderance of 2:1, the Chinese were more likely to be affected and the elderly (> 60 years) were at highest risk.
The cornerstone of asthma management is achieving adequate symptom control and patient education. We studied in our local population of asthmatic patients how well their symptoms were controlled with currently prescribed treatment and their insight into the disease and its management. Over a 6-month period, 93 asthmatics recruited from two local government health clinics and a state hospital were interviewed using a standard questionnaire. Patients were classified into 4 groups based on the treatment they were on according to Global Initiative for Asthma (GINA) treatment guidelines. The number of patients in Step 1 (rescue medication alone), Step 2 (1 controller medication), Step 3 (2 controller medications) and Step 4 (at least 3 controller medications) were 8, 39, 34 and 12, respectively. Except for day symptoms in Step 1 group, fewer than 50% achieved minimum day or night symptoms and no restriction of daily activities. Questions on patient insight were only available for 50 patients. Weather change (74%), air pollution (66%) and physical stress (46%) were the three highest ranked common asthma triggers. More than half correctly recognized the important symptoms of a serious asthma attack but fewer than 15% were familiar with the peak flow meter and its use or with the asthma self-management plan. Most patients perceived that their treatment had helped reduce disease severity and exacerbations. We conclude that symptom control and some aspect of patient education are still lacking in our local asthmatics.
Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan; Klinik Kesihatan Seremban; Klinik Kesihatan Ampangan, Malaysia
This study was undertaken to clinically estimate the prevalence of diabetic peripheral neuropathy amongst patients attending an outpatient clinic and to evaluate their risk factors for developing peripheral neuropathy. It was a cross-sectional study of 134 diabetes mellitus patients who attended the Primary Care Clinic, University Hospital, Kuala Lumpur. The patients were interviewed for their demographic data, past and present medical/surgical history, social history, personal habits and symptoms of peripheral neuropathy. Foot examination and clinical neurological tests were conducted and the presence of peripheral neuropathy was assessed. The main outcome measures were the Neuropathy Symptom Score and the Neuropathy Disability Score. The prevalence of diabetic peripheral neuropathy was found to be 50.7%. Peripheral neuropathy was related to the age of the patient and the duration of diabetes but did not seem to be significantly related to diabetic control. To conclude, there was a high prevalence of peripheral neuropathy amongst the diabetics in this study. These patients developed peripheral neuropathy at a younger age and shorter duration of diabetes compared to a similar study that was done in the UK.
Study site: Primary care clinc, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
MeSH terms: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Ambulatory Care Facilities*; Cross-Sectional Studies; Diabetic Neuropathies/epidemiology*; Female; Hospitals, University; Humans; Malaysia/epidemiology; Male; Middle Aged; Outpatient Clinics, Hospital; Primary Health Care; Risk Factors; Prevalence; Chi-Square Distribution
The poor prognosis for patients with nasopharyngeal carcinoma is principally due to its advanced stage at the time of diagnosis. The symptoms and clinical findings at presentation of 56 patients with confirmed nasopharyngeal carcinoma is described and analysed. Recognising the common modes of presentation is essential to diagnose the disease at an early stage.
Lymphomas, ranked twelve among all cancers world-wide in the 1990s, in which it is more prevalent in males compared to females. A previous study on lymphomas in East Malaysia for a period of 3 years from 1981-1983 showed that the pattern of lymphomas conformed to the general pattern observed in Asia. Current study reviews lymphoma cases from the Department of Pathology, Queen Elizabeth Hospital, Sabah between 1997 and 1999, with the aim of investigating if the spectrum and pattern in Sabah has since changed, a decade later. A total of 91 confirmed lymphoma cases were phenotyped with a panel of antibodies and classified using the new WHO proposed list of lymphoid neoplasms. The 1981-1983 series was reviewed and cases reclassified accordingly for comparison. There are 83 (91.2%) NHL and 8 (8.8%) HL cases in this series, a ratio of NHL to HL of 9:1. Of the 83 cases of NHL, 66 (79.5%) were confirmed B-cell type, 13 (15.7%) T-phenotype, 1(1.2%) null cell type and one case unclassified. Diffuse large B-cell lymphoma is the most prevalent, (65.1%), followed by Burkitt's lymphoma and follicular lymphoma, (10.6%) each. Lymphoma pattern concurs with the previous series from Sabah, with higher prevalence of diffuse large cell lymphoma and lower incidence of follicular lymphoma and HL, as seen elsewhere in Asia. There is an overall increase in the number of cases of NHL in the 1990s. However, the proportion of T-NHL is reduced when compared to the series in the 1980s.
Two thousand five hundred and eight subjects from the state of Kelantan in North-East Peninsular Malaysia were included in this study to determine the prevalence of hypertension and their association with cardiovascular risk factors. The overall prevalence of hypertension was 13.9%. There was no difference in the prevalence of hypertension between the males and females. The prevalence increased with age--the highest being in those above 70-years old. Subjects with hypertension also had a higher prevalence of diabetes mellitus (19.0%), obesity (39.4%) and hypercholesterolaemia (70.7%) than non-hypertensive subjects. Of the hypertensive subjects, 83.3% had 1 other risk factor for cardiovascular disease, 66.7% had 2 other risk factors and 16.7% had more than 2 risk factors. Other than age, body mass index, plasma glucose, total cholesterol and LDL-cholesterol, hypertensive subjects also had a higher mean serum urea, creatinine, uric acid and triglyceride than non-hypertensive subjects. In conclusion, hypertension is a common disease in this area and is associated with multiple risk factors for cardiovascular disease. The prevalence is likely to increase in the near future with increasing affluence and becoming a major health problem.
A retrospective study was conducted at the Hospital Sultanah Aminah Johor Bahru to determine the outcome of trabeculectomy surgeries over a period of 4 years. One hundred and two eyes were followed up to a maximum of 63 months (mean 34.2 months). The 2-year survival rates for plain trabeculectomies, 5-Fluorouracil augmented trabeculectomies and Mitomycin-C augmented trabeculectomies were 52.9%, 27.3% and 60.5% respectively. The commonest complications noted were cataract formation (25%) and hyphaema (11%). Mitomycin-C induced complications were rarely seen. At last follow-up, 54% of eyes had intraocular pressures below 21 mmHg without medication, while 34% of eyes had intraocular pressures below 21 mmHg with medication. Vitreous at the trabeculectomy site was a statistically significant predictor of operative failure.
Between 1st January 1999 and 31st December 2000, 452 foreign nationals were treated at the Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru. Eighty-five percent were male. The peak age range was from 21 to 30 years old. The patients were predominantly Indonesians (61%). A history of trauma was present in 63% of patients. Eight percent of eyes had severe visual impairment. Six patients (1.3%) were blind by WHO standards. Traumatic eye conditions, inflammatory/allergic eye conditions and degenerative eye conditions comprised 66%, 13% and 10% respectively of ocular pathology seen. The commonest ocular findings were corneal foreign body, corneal abrasion and subconjunctival haemorrhage.