Depression is characterized by symptoms like disturbance in behaviour, cognition and mood. This is commonly known to affect people aged 60 years and above especially those who are also afflicted with illnesses. The objectives of this study were to determine the prevalence of depression and its associated factors among the elderly in a tertiary care centre in Wilayah Persekutuan. A cross-sectional study design was done. Stratified cluster sampling method was used to select the respondents. All elderly patients were selected from the Orthopaedic, Surgical, Gynaecology and Medical wards in a government hospital in Wilayah Persekutuan. A 30-item Geriatric Depression Scale questionnaire was used as a screening instrument. Out of the 246 elderly subjects, 198 were interviewed giving a response rate of 80.5%. The results showed that 54% of the elderly respondents were found to have depressive symptoms. Age (p=0.007), sex (p=0.008), ethnicity (p=0.022) and functional disabilities in bathing (p=0.001), grooming (p=0.007), dressing (p=0.007), using the toilet (p=0.002), transferring from bed to chair and back (p=0.001), mobility (p=0.000) and climbing stairs (p=0.000) were all found to be significantly associated with depression among the elderly respondents. The outcome of this study will have an important impact on the implementation of the health policy for the elderly patients admitted to hospitals.
MeSH terms: Affect; Aged; Animals; Bandages; Cognition; Cross-Sectional Studies; Depression; Depressive Disorder; Government; Grooming; Gynecology; Health Policy; Humans; Orthopedics; Surveys and Questionnaires; Self Care; Prevalence; Tertiary Care Centers
Preferred body sizes appear to decrease markedly with increasing exposure to contemporäry notions of slimness and economic modernity, and reduce even further in industrial settings as socio-economic status increases. Recently a study examining physical attractiveness preferences in Britain and Malaysia, shows that preference for slim ideals varies according to socio-economic status. Malaysians in
Britain and Kuala Lumpur preferred slimmer female bodies than observers in semiurban Kota Kinabalu, who in turn preferred slimmer figures than rural observers in East Malaysia. This study has important implications for the study of body image and eating disorders in Malaysia.
MeSH terms: Feeding and Eating Disorders; Body Image; Female; Great Britain; Humans; Malaysia; Social Class; Asian Continental Ancestry Group; Body Size
This study was done in all UNIMAS medical students from year 1 to year 5 in the year 2004. A questionnaire was used. 290 students participated with a response rate of 72.5%. There were more male students snoring than female (ratio 5.9:1.3). The habitual snoring percentages for all years, first year and final year medical students are 7.2, 9.9 and 3.6 respectively and these are comparatively and relatively low with other studies reported in the last 10 years, and the reasons for this are unknown. However it was interesting to note in this study and others that there are relatively more snoring medical students in the first year than subsequent years. Significant positive correlation of snoring was found with the factors of gender, weight, height and sleep apnoea, all having p<0.0005, but no significant correlation was found in others including examination results.
MeSH terms: Adult; Body Weight; Cross-Sectional Studies; Female; Humans; Male; Surveys and Questionnaires; Sleep Apnea Syndromes; Snoring; Students, Medical; Universities; Prevalence; Young Adult
Objective: The objective of the study is to compare insight in Schizophrenia, bipolar affective disorder with psychosis and major depressive disorder with psychosis. Also to ascertain if impaired insight is associated with poorer psychosocial function. Method: 90 consecutively'admitted patients who were diagnosed with Schizophrenia, bipolar affective disorder with psychosis and major depressive disorder with psychosis were administered the scale to assess unawareness to mental illness to measure insight, the global assessment of function to measure psychosocial function and the brief psychiatric rating scale to measure psychosis.
Results: Schizophrenia was found to be associated wit h the poorest insight compared to the affective disorders. Major depression with psychosis was found to be associated with better insight than bipolar affective disorder. Results being significant in both cases. Also it was noted that there was a negative correlation between insight and psychosocial function.
Conclusion: We can conclude that Schizophrenics have the poorest insight followed by bipolar affective disorder with psychosis and then major depressive disorder with psychosis. We also infer that Schizophrenics have the poorest psychosocial function followed by bipolar affective disorder with psychosis and then major depressive disorder patients with psychosis. Also impaired insight is associated with impaired function.
Symptoms presented by patients suffering from Schizophrenia can be influenced by cultural factors. A case of Schizophrenia presenting with a common cultural medical complaint as a delusion, is described here. The appropriate assessment, identification and treatment have led to an improved out.
Anxiety Disorders have been said to account for the majority of psychiatric cases treated in out patient clinics all over the world. However not much input Is being given to it in the teaching of futufe doctors mainly because although it is common it is not generally seen by students posted to psychiatry wards in Malaysia. The students have the advantage of visiting patients in the wards daily but may only spend about 20% of the entire psychiatry posting in the clinics. As such, emphasis in identifying and treating anxiety disorders becomes diminished. More time is spent on discussing management issues of schizophrenia and bipolar disorders when the likelihood of students treating anxiety disorders in primary care and family physician clinics are more after they graduate. This short editorial looks at the current trend in combining psychotherapy and pharmacotherapy in anxiety pathology for the benefit of both practicing doctors and students.
The aim of the study was to acquire background information on computer literacy among schizophrenia patients in Kota Bharu, Malaysia, prior to the introduction of a computerised cognitive remediation programme in the local setting.
Method: Fifty consenting consecutive patients with schizophrenia attending the Universiti Sains Malaysia Hospital psychiatric clinic were surveyed using the Computer Literacy Scale (CLS), a scale designed to specifically look at their level of computer knowledge, confidence and attitude towards computers.
Results: The majority of the patients studied have had schizophrenia for 5 years or less. While the majority of them have used computers befoie, about half had a poor level of knowledge, although they showed reasonable confidence and a positive attitude towards computers. Few played computer games.
Conclusions: Implementation of a computerised cognitive remediation programme in the Malaysian setting has a promising potential based on the results of this study but the programme needs to be adapted in light of the negative attitudes towards the use of games.
Study site: Psychiatric clinc, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
MeSH terms: Attitude; Cognition; Computer Literacy; Computers; Cross-Sectional Studies; Hospitals, University; Humans; Malaysia; Outpatient Clinics, Hospital; Surveys and Questionnaires; Schizophrenia; Software; Video Games
\Elderly abuse exists in our society but is hardly ever reported. This problem often remains undetected because of poor public awareness and lack of knowledge among health care personnel. This article addresses the definition of elderly abuse, characteristics of the abused elderly and their abusers as well as strategies to detect and manage it. Collaboration between health care professionals and government bodies is needed to identify and manage elderly abuse. Ultimately, a legislative "Elder Protective Act" should be implemented to safeguard the rights of our vulnerable elderly.
MeSH terms: Aged; Cooperative Behavior; Government; Health Personnel; Humans; Societies
Introduction: The content of polar compounds (PC) and polymeric triglycerides build up in fried and recycled/reused oils and therefore, these undesirable components are often used as markers of deterioration in edible oil quality. Expert and authoritative agencies have recommended an upper limit of 25% for PC in fried/reused edible oils; beyond this level the oil is considered unsuitable for human consumption. The safety of recycled or repeatedly-heated oils is still very much a concern of both the health authorities and the general public.
Objective: The present study evaluates the safety of long-tern consumption of heated vegetable oils containing 25% of PC on growth, effect on major body organs and reproduction outcome, using the Sprague-Dawley rat model.
Methods: Refined, bleached and deodorised palm olein (PO) and partially hydrogenated soybean oil (HSBO) were repeatedly heated for 5 hours daily with no topping-up at Isoac until a polar compound (PC) content of25% was attained. Refined soybean oil was similarly heated up to 50% PC and used in the positive control diet. All five experimental oils, namely unheated PO (No PC), heated PO (25% PC), unheated HSBO (No PC), heated HSBO (25% PC), and positive control oil (50% PC) were separately incorporated at 30% energy (15% w/w) as the sole dietary fat into nutritionally-adequate purified diets. Each experimental diet was provided ad libitum to a different dietary group comprising 14 male and 20 female Swiss albino rats. After 13 weeks (90 days), 10 males were selected from each group and each male was paired with two females from the same dietary group for the reproductive study. After 4 weeks into the reproductive study (total of 17 weeks on the experimental diets), all 10 males in each group were sacrificed and the usual toxicity tests consisting of blood cell type counts, liver and kidney function tests, and examination (organ-to-body weight ratios and histology) of the liver, kidney, heart and spleen were performed.
Results: The heated PO and HSBO diets were well-tolerated by the animals. However, these heated test oils inhibited growth marginally (p>0.05), enlarged the liver, kidney and heart, and markedly raised serum alkaline phosphatase (liver function test) compared to the unheated oils (p
Objectives: This study was carried out to determine the nutritional status of primary
school children aged 6 to 11 years in Sepang District and to compare the results with a
similar study carried out in 1999. Methods: This cross-sectional study was carried out in
Sepang District using stratified random cluster sampling technique. A pre-tested, structured
questionnaire was used to collect the data. Weight was recorded using a digital bathroom
scale TANITA model HD-309 and height was measured by using a SECA Body meter
Model 208. Body mass index (BMI) was calculated as weight in kilograms divided by the
square of height in meters. Classifications of the nutritional status of respondents was
based on WHO classification 1983 and 1995. Data were analysed using SPSS. Results:
The overall mean BMI for the 1,910 respondents was 16.8 (95% CI= 16.67 - 16.99;
SE=0.08). The median BMI was 15 .7 ranging from 9.51 to 36.75 kg/m2. The majority
(84.4%) had normal weight-for-age status, 7.6% respondents had weight-for-age status
below -2 SD of the NCHS-WHO median and 8.0% had weight-for-age status above +2 SD
of the NCHS-WHO median. The prevalence of underweight and overweight was significantly
higher in the males compared to the females (p< 0.05). There was a significant association
between underweight and ethnicity (p< 0.05). The majority (90.3%) had normal heightfor-
age status, 8.8% had height-for-age below - 2 SD of the NCHS-WHO standard median
and 0.9% had height-for-age above 2 SD from the NCHS median. The prevalence of
stunting was significantly higher in the male (10.3%) as compared to 7.4% in the females
(X2 = 5.11, P = 0.02). The majority (81.4%) of the respondents were within the normal
weight-for-height, 3.4% were wasted (weight-for-height was below - 2 SD of the NCHSWHO
median) and 15.2% of the respondents were obese (weight-for-height that is more
than +2 SD of the NCHS-WHO median). The prevalence of wasting was higher in the
females (4.1 %) compared to males (2.8%). The prevalence of obesity was slightly higher
in the males (15.4%) compared to females (14.9%). Conclusion: The overall nutritional
status of primary schools children is good. However, there still exists pockets of population
in Sepang where chronic and acute forms of undernutrition persist in these children.
MeSH terms: Body Weight; Cachexia; Child; Cross-Sectional Studies; Female; Growth Disorders; Humans; Male; Nutritional Status; Obesity; Surveys and Questionnaires; Thinness; Body Mass Index; Prevalence; Malnutrition; Overweight
Objective: Previous studies have shown milk to contain cancer inhibitors. In this context, this study was conducted to screen the potential cytotoxic properties of four different types of milk, namely cow's milk, goat's milk, mare's milk and human milk.
Methods: In evaluating the cytotoxic properties of milk, two different human leukemia cell lines namely, Raji and CEM-SS were used. The treated and untreated cells of milk were cultured at 37°C in 5% CO2 for 5 days according to standard guidelines. The CellTiter 96® Aqueous (MTS) assay was carried out on the first, third and fifth days to measure cell viability. The percentage of cell viability was determined by comparing the optical density of the treated cells against the untreated controls. One-way ANOYA at p
Objective: This study was conducted to determine prevalence and factors associated with obesity in Selangor, Malaysia. Methods: A population-based cross-sectional study was conducted in all districts of Selangor State. All individuals, 15 years and above in the selected households, were included. A pre-tested structured questionnaire was used to collect the data. Weight was recorded using TANITA model HD-309 and height was measured using SECA Body meter Model 208. Statistical analysis was performed using Stata 8.2 taking into account the complex survey design. Results: The overall mean age of the 2219 respondents was 36.6(95% CI 35.7 – 37.6) years. There was no significant difference in the mean age of the males and females (p=0.697). The majority of the respondents were Malays (52.9%), followed by Chinese (30.9%), Indians (15.4%) and
other races (0.9%). The overall mean BMI was 24.1 kg/m2 (95% CI=23.8- 24.4). The overall prevalence of obesity was 12.2% (95% CI 10.6%, 14.0%). There was no significant difference in the prevalence of obesity in the males compared to females (p>0.05). The prevalence of obesity increased with age up to the ages of 40-59 years and then decreased after 60 years. The highest prevalence of obesity was in the 40-59 years age groups in both sexes. The overall prevalence of obesity was significantly higher amongst the Malays (15.2%) compared to the Indians (11.6%) and Chinese (7.3%). Multivariate logistic regression analysis showed that only age and ethnicity were associated with obesity. Sex and educational level were not associated with obesity.
MeSH terms: Body Weight; Cross-Sectional Studies; Ethnic Groups; Family Characteristics; Female; Humans; Malaysia; Male; Obesity; Surveys and Questionnaires; Body Mass Index; Prevalence; Logistic Models
Objectives: This study aimed to evaluate the UBI MAGIWELTM ζ-GLOBIN ELISA Kit for the presumptive diagnosis of αo-thalassaemia. The ELISA results obtained were confirmed by molecular characterisation of αo-thalassaemia using a Duplex-PCR. Methods: Routine peripheral blood counts and red cell indices were determined in 94 blood samples sent for Hb analysis. Hb subtypes were quantified by high performance liquid chromatography (HPLC) and Hb electrophoresis conducted on agarose gel at pH 8.5. Zeta-globin chain levels were determined using the UBI MAGIWELTM ζ-GLOBIN ELISA Kit. Molecular analysis was performed using a duplex-PCR which simultaneously amplifies
a normal 136 bp sequence between the ψα−α2-globin genes and a 730 bp Southeast Asian deletion-specific sequence (–SEA) between the ψα2−θ1-globin genes. Results: Using the ELISA assay kit, 20 blood samples were presumptively identified as α-thalassaemia carriers from elevated ζ-globin chains (OD>0.3) while the remaining 74 blood samples showed OD
Introduction: Curcumin, a natural compound present in turmeric (Curcuma longa) has been known to possess both anti-inflammatory and antioxidant effects. Objectives: The objectives of the study were to evaluate the cytotoxic activities and to determine the mode of cell death induced by curcumin towards the human mammary carcinoma cells (MDAMB-231). Methodology: Cytotoxicity of curcumin and its effect on cell viability were determined by using MTT assay and trypan blue dye exclusion method, respectively. The mode of cell death was detected by viewing under a light microscope and through DNA fragmentation analysis. Results and discussion: Curcumin was cytotoxic to MDA-MB-231 cells with the IC50 of 17.25 ì g/ml. Cell viability treatment using curcumin at concentrations of 30 ì g/ml and 10 ì g/ml was significantly (p
Introduction: It is estimated that 4.9 million people worldwide died in 2000 as a result of their addiction to nicotine, about half of them prematurely. This huge death toll is rising rapidly, especially in low and middle income countries where most of the world’s 1.2 billion tobacco users live.
Objectives: This study aimed to determine (i) the prevalence of smoking among the community aged 18 and above in Terengganu state, and (ii) the relationship between smoking and age, sex, educational level, family and peer influence.
Methods: A cross-sectional study design was used in this study and data was collected using a standardised pre-tested structured questionnaire.
Results: The overall mean age of the respondents was 38.9 (95% CI= 37.7 – 40.2) years. The majority of the respondents were Malays (99.1%). Of the 653 respondents, 32.2% and 23.6% were ever and current smokers respectively. Of this, 211 ever smokers, 199 (94.3%) were males and only 12 (5.7%) were females. The prevalence of ever and current smokers for males was 73.2% and 53.7% respectively compared to the females (3.1% and 2.1% respectively). There was a significant association between smoking status and sex (p<0.001). The prevalence of ever smokers was lowest amongst respondents with college or university educational level. However, for current smokers, those with college or university education had the highest prevalence. The overall mean initiation age of ever smokers was 19.7 years (95% CI = 18.8 – 20.7). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001). The mean duration of smoking for the current smokers was 21.6 (95% CI= 19.1 – 24) years. There was also no significant difference in the mean duration of current smoking for males compared to the females (p = 0.5). The majority (93.4%) of the ever smokers started either because their friends asked them to try or they were trying for fun. The quit ratio was 27%.
Conclusion : The prevalence of ever and current smokers in males is very high (73.2% and 53.7% respectively) compared with the females (3.1% and 2.1% respectively). The mean initiation age for the males (19.1 years) was significantly lower compared to 29.8 years for the females (p<0.001). Key words: Smoking, prevalence, initiation age, duration, Terengganu state
Objective: A baseline functional magnetic resonance imaging (fMRI) study was carried out on a healthy right-handed male subject to attain further insights into the basic neuronal control mechanisms of bimanual and unimanual movements of hand fingers, an area that is still not fully understood. Methods : The study used the basic unimanual and bimanual movements of the left- and right-hand fingers to stimulate neuronal activity in the cerebral cortices. The subject was instructed to sequentially press his fingers either unimanually (UNI) or bimanually (BIM), against the thumb in a consistent alternative manner during the functional scans. The data were analysed using the MATLAB and SPM2 software packages. Results : Brain activations obtained via the F-test indicate a larger activation area as compared to that obtained from the T-test. The results showed that, the activated brain regions due to the self-paced finger movements are the precentral and postcentral gyrii covering the primary motor, premotor and somatosensory primer areas. The activestate signal intensity was found to be significantly (p < 0.05) higher than that of the resting-state. For UNI, brain activation showed contra-laterality with a larger activation area and a higher signal intensity at the point of maximum intensity for the left-hand finger
movement (UNIleft) compared to the right-hand finger movement (UNIright). Small ipsilateral activations were observed during UNIright and UNIleft. For BIM, the activation was observed in both hemispheres with the right hemisphere showing a higher signal intensity and coverage. The results support the fact that for a right-handed person performing either UNI or BIM type of movement, the activated motor area on the right hemisphere of the brain (movement of the left hand fingers) experience a higher intensity and larger coverage of hemodynamic response compared to the left hemisphere of the brain (movement of the right hand fingers). Analyses performed on the activated regions of interest (ROI) by
comparing the unimanual and bimanual types of activations revealed that during BIM, there are voxels in the left hemisphere controlling the movement of the left hand fingers (BIMleft) and voxels in the right hemisphere controlling the movement of the right hand fingers (BIMright). The interactions observed in this study resemble the existence of interhemispheric connection between both hemispheres during BIM. Conclusion : Although this is a single subject study, the hemodynamic response and the neuronal control mechanism in the cerebral cortices based on the BOLD mechanism can be studied and evaluated using fMRI and SPM.
MeSH terms: Fingers; Hand; Hemodynamics; Functional Laterality; Magnetic Resonance Imaging; Male; Motor Cortex; Movement; Software; Thumb
Malaria remains one of the most important infectious diseases worldwide considering that 40% of the world’s population live in health risk areas and millions of febrile episodes due to malaria infection occur annually in children under the age of five in Africa alone and almost 3 million patients, primarily children, die each year. Among the various measures envisaged, to contain the disease, the concept of a vaccine to protect humans against malaria appears particularly attractive. The development of an effective malaria vaccine represents one of the most important approaches to provide cost-effective intervention, in addition to currently available malaria control strategies. Here, we review malaria as a public health problem and the status and promise in malaria vaccine development.
MeSH terms: Africa; Child; Fever; Humans; Malaria; Public Health; Global Health; Malaria Vaccines
Cancer immunotherapy is a form of treatment protocol for cancer patients that has been studied intensively over the last two decades. The undesirable side effects during the course of conventional treatment has lead to the development of immunotherapy as an alternative treatment modality. This approach encompasses the use of three different strategies with various immunotherapeutic modalities including (i) cytokines and monoclonal antibodies; (ii) activation of antigen presentation cells (APC) by using antigen-specific peptides or sources of antigens such as tumour lysate; and finally (iii) adoptive transfer of ex vivo activated autologous cytotoxic T-cells. Due to specific-targeting by antigen-specific monoclonal antibodies, dendritic cells and activated CD8+ T-cells, immunotherapy can eliminate tumour
cells efficiently but the normal tissues are unaffected. Despite years of investigation, the outcome of immunotherapy-based clinical trials are inconsistent with very low response rates from patients. Several mechanisms have been proposed to contribute to this failure including the presence of regulatory T-cells (Treg), immunomodulatory cytokines, and aberrant gene expression in tumour cells. This review summarises information from about 140 articles and review papers. In addition, it also provides an update on recent trends in combinational immunotherapy with conventional therapy and encouraging results have been obtained. Reevaluation of previous studies is necessary to fine-tune the design and approach of immunotherapy to ensure better treatment outcomes.
Malignant hypertension affects less than 1% of people with high blood pressure, and is a hypertensive emergency. It is rare for patients to present initially with this form of elevated blood pressure, which is almost always associated with acute target organ damage, which can manifest in many forms including ocular, neurological, cardiac and renal. This treatable condition is associated with a high rate of morbidity and mortality therefore, early detection and immediate management is of paramount importance.
The treatment of large ulcers is a problem. Closure with flaps and even skin grafts in compromised patients is often fraught with risks. Dressing these large wounds is also a problem, as they are often heavily exudative. We report our experience using the vacuum-assisted closure technique in managing difficult ulcers in four patients. A modification of the technique using cheap, easily available materials is described. The vacuum-assisted suction is an effective treatment for large ulcers in compromised patients. It facilitates considerable contraction of the wound, and in smaller wounds; the vacuum-assisted closure allows sufficient contracture to enable delayed primary closure. We recommend the use of this method of wound dressing and closure in large wounds particularly, in high-risk patients where extensive flap coverage or even split skin graft would incur considerable risk.