The objectives of this study were to estimate the maxillary arch measurements, to assess the validity of Pont’s & Korkhaus’ Indices; to determine the relationship between maxillary arch form with head form; and to estimate the cephalic index. (CI) of the study population. A cross-sectional study was conducted on 85 mature Malay students, 28 male students (32.98%), 57 females (67.02%) attending Teachers’ Training College. Their mean age was 23.9 yr, and Cephalic Index (CI) 86.4 (95% Confidence Interval 85.5-87.3). Arch and head dimensions were significantly larger in males than in females. CI was not significantly different between males and females. Means of anterior arch width (AAW), posterior-archwidth (PAW) and arch-length (Lu) were 35.57mm, 47.3mm and 18.01mm respectively. They were significantly different from their corresponding Indices. Correlation Coefficient between bizygomatic width and anterior-arch-width was 0.18 and was not significant in both sexes of the present population.
Lecture handouts are widely used instructional tools. Handouts supplement rather than substitute students’ regular reading. It is now a common practice to supply PowerPoint handouts and publish lecture handouts on the web for students’ access. A study was conducted among the first year medical students (n=142) of School of Medical Sciences (SMS), Universiti Sains Malaysia (USM) in order to determine their perceptions and expectations with regards to lecture handouts provided to them. The majority of the students reported that they read the lecture handouts as a reference and found them useful as a guide for future learning. More than half (68%) of the students expressed dissatisfaction with the overall presentation format of the handouts which is mainly technology-related i.e. PowerPoint and photocopying. This study indicated that students’ expectations and experiences were positive towards the use of handouts. They used handouts as a means of supplementing rather than substituting their learning. Much care is needed when educators supply computer-based handouts, as this study shows a number of limitations when students use them. Medical schools should consider publishing web-based handouts with online and other facilities to make it interesting and effective.
Cardiovascular disease (CVD) has been the number one cause of death since the last three decades in Malaysia and diabetes mellitus and hypertension are considered as major risk factors. A study to reduce risk factors for cardiovascular diseases in the community (PIKOM) through education and lifestyle changes was undertaken. The study population was from four different areas in Peninsular Malaysia – Kota Bharu and Bachok in Kelantan ; Raub in Pahang; Gunung Besout in Perak and Felda Palong in Negri Sembilan. The subjects invited to participate in this study ware aged between 30 – 65 years, did not have any debilitating illnesses and no known history of diabetes mellitus, hypertension or cardiovascular disease. Subjects were asked to come to the local clinic in a fasting state and after physical examination, blood was taken for plasma glucose and lipids. Oral glucose tolerance test (OGTT) was then performed. A total of 4,121 subjects participated in the study. The proportion of subjects with diabetes mellitus was highest in Felda Palong area (20.3%) and lowest in Raub area (7.1%). The proportion of subjects with hypertension was also highest in Felda Palong area (38.6%) and lowest in Raub area (29.1%). This could be attributable to the subjects in Felda Palong having the highest mean Body Mass Index (BMI) and Waist-to-Hip Ratio (WHR). There were significant associations between diabetes and hypertension with age and obesity. Subjects with diabetes mellitus and hypertension also had the highest mean age, BMI, WHR and plasma cholesterol. In conclusion, the proportion of patients with risk factors for CVD was high and intervention studies through education and lifestyle changes were being carried out to see their effectiveness.
MeSH terms: Blood Glucose; Cardiovascular Diseases; Cause of Death; Cholesterol; Diabetes Mellitus; Fasting; Glucose Tolerance Test; Humans; Hypertension; Life Style; Lipids; Malaysia; Obesity; Residence Characteristics; Risk Factors; Body Mass Index; Waist-Hip Ratio
Adverse effects and tolerance to dry powder of aerial part of Andrographis paniculata (Burm.f.) Nees were studied in 20 patients with type 2 diabetes mellitus for a period of 12 weeks. Patients were given powdered A. paniculata starting with 600 mg daily, gradually increasing to a maximum of 1.8 gm daily. Parameters monitored included body weight, blood pressure, liver function tests, renal function tests, cardiac enzymes, haemogram, serum electrolytes, fasting blood glucose, HbA1c, blood cholesterol, serum triglycerides and blood hormone levels (triiodotyronine, thyroxine, thyrotropin, insulin, fasting cortisol). None of the above mentioned parameters showed significant change during the study period except for a fall in HbA1c by 5.46%(p
MeSH terms: Blood Glucose; Blood Pressure; Blood Pressure Determination; Body Weight; Cholesterol; Diabetes Mellitus, Type 2; Drug Tolerance; Electrolytes; Fasting; Humans; Hydrocortisone; Insulin; Liver Function Tests; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine; Triglycerides; Plant Components, Aerial; Andrographis
The aim of this study is to determine the total phenolic content and primary antioxidant activity of methanolic and ethanolic extracts of four aromatic plants’ leaves namely knotweed (Polygonum minus), curry (Murraya koenigii), kaffir lime (Citrus hysrix) and fragrant screwpine (Pandanus odurus). Total phenolic content (TPC) assay using Folin-Ciocalteu method was used to assess the presence and level of phenolic compounds in each sample. The present study showed that both methanolic and ethanolic extracts of P. minus had the highest TPC and followed by M. koenigii, C. hystrix and P. odorus. Primary antioxidant activity in terms of free radical scavenging activities of both methanolic and ethanolic extracts was then measured by 2, 2, diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging activity assay. The lowest EC50 values based on the DPPH. radical scavenging activity were shown by P. minus extracts as compared to the other samples. For both ethanolic and methanolic extracts, the correlations between TPC and EC50 based on the DPPH. radical scavenging activity assay were negative and weak. Relatively, the present results suggest that of the four aromatic plants, P. minus and M. koenigii have shown potential as sources of natural antioxidants.
Pedicle screw system has increasingly been used for correction of thoracic scoliosis. It offers several biomechanical advantages over hook system as it controls all three-column of the spine with enhanced stability. Of many techniques of pedicle screw placement in the thoracic spine, the funnel technique has been used in Sarawak General Hospital since 2002. This prospective study aims to assess the accuracy of the placement of thoracic pedicle screws using the funnel technique in the corrective surgery of idiopathic scoliosis. A total of 88 thoracic pedicle screws were inserted into the T4 to T12 vertebrae of 11 patients. Post-operative CT-scan was performed to evaluate the position of the pedicle screw. Seventy six (86.4%) screws were noted to be totally within the pedicle. There was no screw with medial violation of the pedicle, 8 (9.1%) screws breeching the lateral wall of the pedicle and 4 (4.5%) screws with anterior and lateral penetration of the vertebral body. No clinical sequel with the mal-positioned screws was noted. In conclusion, the funnel technique enabled simple, accurate and reliable insertion of pedicle screw even in the scoliotic thoracic spine without the need of any imaging guidance. It is however imperative for the surgeon to have a thorough knowledge of the thoracic spine anatomy, and to be familiar with the technique to insert these screws diligently.
A descriptive prospective study of 16 children with injuries inflicted by bicycle spokes and chain was undertaken to identify the demographic profiles of such injuries. Aspects of preventive measures are proposed.
Stigmatising attitudes towards mental illness may improve with clinical exposure during medical school training. Attitudes of 48 fourth year medical students in Universiti Kebangsaan Malaysia were assessed before and after their compulsory attachment in Psychiatry, using the Attitude Towards Psychiatry-30 (ATP) and the Attitude towards Mental Illness (AMI) questionnaires. ATP scores improved significantly with training (104.8 and 114.4, pre- and post-attachment respectively) as did AMI scores (63.4 and 68. 1 respectively). Both improvements were statistically significant. (ATP: z= 4.55, p < 0.0005) (AMP z= 3.75, p < 0.0005 ). Attitudes towards mental illness appeared to have become more favourable with clinical training in psychiatry.
MeSH terms: Adenosine Monophosphate; Attitude; Mental Disorders; Malaysia; Psychiatry; Surveys and Questionnaires; Schools, Medical; Stereotyping; Students, Medical
A study was undertaken to 1) determine the effects of tobacco smoke exposure on maternal and neonatal weight and body mass index (BMI) and placental weight, volume and surface area and 2) establish any correlations between the placental surface area, volume and weight with maternal and neonatal body weight and BMI in mothers exposed to cigarette smoke. A total of 154 full-term placentae, 65 from mothers exposed to tobacco smoke and 89 from non-exposed mothers were collected from Kuala Lumpur Maternity Hospital. The placental surface area was determined using a stereological grid, the volume by Scherle’s method and the weight by using an electronic weighing machine. In general there were no differences in maternal, placental and neonatal parameters between the exposed and non-exposed groups. However, there were significant correlations between placental weight with maternal weight and maternal BMI in both exposed C r= 0.315; p= 0.013) and C r= 0.265; p= 0.038), and no-exposed (r = 0.224; p= 0.035) and C r= 0.241: p= 0.023) mothers. It was also found that the maternal weight on admission correlated significantly with placental weight in both Malay (r= 0.405; p= 0.020) and Indian (r= 0.553; p= 0.050) passive smokers. Correcting the placental parameters for the maternal weight had no effect on the results.
MeSH terms: Body Weight; Female; Hospitals, Maternity; Mothers; Placenta; Smoke; Smoking; Tobacco; Body Mass Index
From July through December 1997, 11 previously healthy children in Peninsular Malaysia succumbed to an illness clinically characterised by an acute severe refractory left—ventricular failure, following a brief prodromal illness, in the midst of an outbreak of hand, foot and mouth disease (HFMD), similar to the reported experience in Sarawak and Taiwan. Retrospective reviews of the clinical features and results of laboratory, pthological and virological investigation of cases were conducted. The median age 11 case-patients was 31 months (range, 13 to 49 months); 6 were males. A brief prodromal illness of 3 days (range, 2 to 5 days) was characterised by fever (axillary temperature > 38oC) (100%), oral ulcers (72%). extremity rashes (45%) and significant vomiting (55%). Upon hospitalisation, 7 of 11 ease—patients had features suggestive of cardiogenic shock, while 4 of 11 case—patients developed shock during hospitalisation as evidenced by markedl sustained tachycadia (heart rate ≥ 180 beats per minute), poor peripheral pulses and peripheral perfusion. mottled extremities, pulmonary oedema (haemorrhagic pulmonary secretion in 8 of 11 cases during tracheal intubation, often precipitated hi conservative crystalloid boluses, and radiographic evidence of acute pulmonary oedema in 5 of 7 cases ) and markedly impaired left ventricular function on echocardiographic examination (7 of 7 cases). Three of 4 case—patients bad aseptic meningitis while one case-patient also had an acute flaccid paraparesis. Despite supportive a therapy, death occurred within a median of 13.4 hours following hospitalization. Post—mortem findings (all 8 specimens examined) consistently demonstrated brain-stem encephalitis with foci of neuronal necrosis and micro-abscesses. None of the 11 specimens examined reealed histological evidence of myocarditis. Enterovirus 71 (EV71 ) was detected in 10 of 11 case-patients, many (7) from various sterile tissue sites ( 5 from central nervous tissues). No other viruses inises were isolated or identified. Clinical features and pathological studies closely paralleled the reported experience in Sarawak and Taiwan. The uniform necropsy findings of necrotizing brain—stem encephalitis coupled with essentially normal myocardial histology, in concert with the concurrent and consistent detection of EV71 points to a primary EV71 encephalitis; as yet unclear neurogenic mechanisms may account for the cardiovascular manifestations.
Twenty percent of all childhood deafness is due to mutations in the GJB2 gene (Connexin 26). The aim of our study was to determine the prevalence and spectrum of GJB2 mutations in childhood deafness in Malaysia. We analyzed the GJB2 gene in 51 deaf students from Sekolah Pendidikan Khas Alor Setar. Kedah. Bidirectional sequencing indicates that 25% of our childhood deafness has mutation in their GJB2 gene. Sixty two percent of these children demonstrate V371 missense mutation. Interestingly, V371 mutation in the GJB2 gene have been reported as polymorphism in Western countries, however in our country it behaved as a potentially cliseaae-causing missense mutation, causing childhood deafness as it was not found in the normal control.
Twenty years ago in 1985 a pilot project for a national rubella immunization programme was carried out by the Ministiy of Health in four states, following two years of planning including a thorough review for justifying the programme . It was clear then that active immunization against rubella was the only effective way of preventing and subsequently eliminating congenital rubella syndrome (CRS), by far the most important consequence of rubella infection and the most compelling justification for a national immunization programme. Measures like isolation of infected persons to segregate them from infecting a pregnant woman are not feasible, for many reasons, not least of them being the fact that a large majority of infections remain sub-clinical, and if at all manifested, the symptoms vary and are generally mild.
Community acquired pneumonia (CAP) is a common illness and potentially life threatening especially in older adults and those with co-morbid disease. It is a major cause of morbidity and death worldwide. Recognising the clinical importance of CAP, many countries have developed national guidelines for the management of this condition. In Malaysia, the Malaysian Thoracic Society together with the Ministry of Health and the Academy of Medicine, Malaysia are developing guidelines for the management of CAP in adults.
The aim of this study was to determine the prevalence of functional impairment and its associated factors among patients aged 60 years and above attending Klinik Kesihatan Batu 9 Ulu Langat, Selangor. This is a cross sectional community health clinic based study. A total of 260 elderly patients attending the community health clinic were interviewed. They were clinically assessed for functional impairment by the 9 item Instrumental Activities of Daily Living (TADL) scale. There were 118 (45.4%) elderly male and 142 (54.6%) elderly female with age ranging from 60 years to 92 years with the mean age of 67.5 and 65.5 years for male and female respectively. Chinese form the largest population (42.3%) followed by Malay (36.5%), Indian (19.2%) and others (2.0%). The overall prevalence of funtional impairment among elderly aged 60 ears and above in this study was 33.5%. Among the functionally impaired. two patients (0.8%) were totally dependent. There were significant associations between functional impairment and older age (p=0.025), lower income group (p=0.010), lower education level (p=O.030) and history of chronic medical illness (p=0.020). Functional impairment had no significant association with ethnic group, gender, occupation and living arrangement. For daily activities that were assessed, the commonest impairment was inability to perform shopping (40%) followed by impairment in climbing up staircase (36.6%) and impairment in taking medication (35%). Advanced age, lower income, lower education and history of medical illness are associated with functional impairment. Functional impairment is an important consideration in caring for the elderly patients in the community. These findings have implications in caring of the elderly in which attention need to be paid to activities such as shopping, climbing stairs and taking medication. The use of the IADL scale is feasible for screening of functional impairment among the elderly population in the community.
Results of construct validity and reliability of the SF-36 are described, based on data from a multi-centre study on asthmatics and a population based survey. Questionnaire refinement was carried out between the two studies. Quality of data was good, with all items having less than 0.5% missing values. Floor and/or ceiling effects were observed for REE. REP, PF and SF. For scaling assumptions, correlations between each items and its hypothesized scale were all above 0.50, except for one item in PF, and for both items in SF. Item discriminant validity was an issue for items in VT, SF and MH scales. Cronhach’s as for all scales exceeded the recommended 0.70 level, except for SF. Only one latent dimension was identified in principal component analysis, and only 52-53% of variance accounted for. As expected, PF shows high correlations with the physical component while MH was highly correlated with the mental component. Contrasting findings in the loadings of other scales were observed in the asthma data. Age, disease severity and presence of self-reported handicap/disability significantly affect PF, while MH demonstrates no obvious pattern with declining age. In essence, the Malay version of SF-36 could he used in Malaysia, with its generally acceptable internal consistency and validity. The caveat is in the call for additional domains of importance to Malaysians that is not covered by the instrument, and in the caution to be employed when using and construing the instrument.
MeSH terms: Asthma; Malaysia; Male; Psychometrics; Surveys and Questionnaires; Reproducibility of Results; Principal Component Analysis; Self Report
A cross sectional study using a self-administered questionnaire to determine the perceptions of primary care doctors towards evidence-based medicine (EBM) was conducted in Melaka state. About 78% of the primary care doctors were aware of EBM and agreed it could improve patient care. Only 6.7% of them had ever conducted a Medline literature search. They had a low level of awareness of review publications and databases relevant to EBM; only about 33% of them were aware of the Cochrane Database of Systemic Reviews. Over half of the respondents had at least some understanding of the technical terms used in EBM. Ninety percent of the respondents had Internet access and the majority of them used it at home. The main barriers to practicing EBM were lack of personal time and lack of Internet access in the primary care clinics.
MeSH terms: Cross-Sectional Studies; Patient Care; Humans; Primary Health Care; Surveys and Questionnaires; MEDLINE; Evidence-Based Medicine; Internet; Physicians, Primary Care
In 1978 at Alma Ata, Malaysia endorsed the World Health Organization’s Declaration of Health for All through Primary Health Care. Since then Malaysia has made great strides in meeting its objectives. There is now an expanded scope of services with better facilities in the public community polyclinics. Primary Care departments have been established in the local universities, either independently or as part of community medicine. Medical students now have better exposure to primary care. Postgraduate specialist training (M.Med. in Family Medicine) is offered by three public universities.
MeSH terms: Community Medicine; Family Practice; Malaysia; Primary Health Care; Residence Characteristics; Specialization; Students, Medical; Universities; Global Health
A cross-sectional survey of 400 medical students of multicultural backgrounds at the University of Malaya was conducted to understand their attitudes towards euthanasia and factors related to medical decisions and ethical reasoning concerning the prolongation of life, the right to die and euthanasia. The student respondents completed self-administered questionnaires that comprised of twelve questions with multiple stems addressing personal perceptions, knowledge, attitudes, and decisions about euthanasia and the relief of suffering. The majority of respondents (52%) were for the withdrawal of active therapy in a patient suffering from a terminal painful disease while 48% of them were against it. Seventy-one percent of the students involved in the study were against the idea of active euthanasia i.e. the administration of a lethal injection. However, 27% of the respondents felt that there was a moral justification to assist patients to die. Thirty-two percent of the respondents favoured the legalization of euthanasia in Malaysia while 67% of them were strongly against it. The majority (61%) of respondents would not practice euthanasia as a doctor nor would they have performed on themselves if or when it became legal. The main issue surrounding euthanasia that concerned the respondents was the misuse of it by unethical practitioners and they felt that further debate on the matter was essential, both within the local and international communities.
MeSH terms: Attitude; Capital Punishment; Cross-Sectional Studies; Euthanasia; Humans; Life Support Care; Malaysia; Morals; Physicians; Surveys and Questionnaires; Right to Die; Students, Medical; Euthanasia, Active
Health-related quality of life (HRQoL) assessment is important in healthcare outcomes. This study aimed to determine the feasibility, reliability and validity of the Malay McGill Quality of Life Questionnaire — Cardiff Short Form (MMQOL-CSF) in advanced cancer population. Patients either completed the MMQOL-CSF alone or in addition to its long version. The study recruited 116 participants (average age = 44 years old). On average, MMQOL-CSF was completed in 5.4 minutes. Most domains showed evidence of reliability (Croanbach’s $\b{\alpha}$= 076-092). Correlation with its long version was moderate to strong ($r_s$ = 0.54-087). The MMQOL-CSF was a feasible, reliable and valid HRQ0L instrument in this population.
MeSH terms: Health Services; Humans; Neoplasms; Psychometrics; Quality of Life; Surveys and Questionnaires; Reproducibility of Results
It has been approximately two decades since the first case of the Acquired Immunodeficiency Syndrome was reported in Malaysia. Following a small increase in the number of new reported cases of HIM infection and AIDS in the few ensuing years, a rapid explosion of the epidemic took place in the mid 1990s with 4000 and latterly close to 7000 new HIV infections reported annually. The cumulative total reported HIV cases to September 2004 was 61486, with 8955 AIDS cases. The number of deaths due to AIDS to date has totalled a staggering 6665 cases.