An instrumental neutron activation analytical (INAA) technique is used for the determination of thirty elements in five coal samples collected from Kapar power station, imported from Indonesia and Australia. Analyses of the samples are being associated with standards. All irradiations were performed in the nuclear reactor of Malaysia Nuclear Agency (MNA). Samples were counted by Hyper Pure Germanium (HPGe) detector for short period irradiations at MNA, while for the long period irradiations the samples were counted at Universiti Kebangsaan Malaysia (UKM). The concentrations of thirty elements have been determined: The major components are Cl, Ca, Mg, K, Fe, Ti and Na with the mean concentrations in the range between 70±69 ppm- 6100±1639 ppm; and the trace elements are Zr, V, Mn , Sc, Cr, Co, As ,Br ,Rb ,Sb ,Ba , La, Ce, Nd, Sm, Eu, Tb, Yb, Lu, Hf, Th, U and Ta with the mean concentrations in the range between 0.1381±0.0202 - 69.0±2.8 ppm. The results have been compared to the reported data of eight coal samples from the United States and the reported data of Australian bituminous coal.
The objective of this study is to compare low-contrast detectability of computed radiography (CR) and screen/film (SF) mammography systems. The Nijimegen contrast detail test object (CDMAM type 3.4) was imaged at 28 kV, in automatic exposure control mode separately. Six medical imaging physicists read each CDMAM phantom image. Contrast detail curves were plotted to compare lowcontrast detectability of CR (soft copy and hard copy) and SF mammography systems. Effect of varying exposure parameters, namely kV, object position inside the breast phantom, and entrance surface exposure (ESE) on the contrast detail curve were also investigated using soft copy CR. The significance of the difference in contrast between CR and SF, and for each exposure parameter, was tested using non-parametric Kruskal-Wallis test. The low- contrast detectability of the CR (soft copy and hard copy) system was found to be not significantly different to that of the SF system (p>0.05, Kruskal-Wallis test). For CR soft copy, no significant relationship (p>0.05, Kruskal-Wallis test) was seen for variation of kV, object position inside the breast phantom and ESE. This indicates that CR is comparable with SF for useful detection and visualization of low-contrast objects such as small lowcontrast areas corresponding to breast pathology.
Objective: To investigate patient’s perceived satisfaction and adequacy of information given by doctors on prescribed drugs in an outpatient psychiatric setting.
Methods: The sampling was done consecutively with a target sample size of 200 patients. A simple questionnaire that was developed with 10 close-ended questions and yes or no answers was administered by the interviewing team. This questionnaire assessed patients' knowledge on prescribed medications and their perception on the adequacy of information given.
Results: More than 80% of the patients were informed regarding the reasons, timing to take medication(s), duration of drug treatment and type of prescribed drugs. Half of them were informed regarding the side effect profiles of their prescribed medications. Majority of them (80%) were satisfied with the information given despite only 49% of the patients being given adequate information on their medications.
Conclusion: Patients who are adequately informed about their medications are more significantly satisfied than those inadequately informed. (χ2=4.085, p<0.05).
Key words: perceived satisfaction, adequacy of information, prescribed psychotropic drug
Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
MeSH terms: Cross-Sectional Studies; Hospitals, University; Humans; Malaysia; Outpatient Clinics, Hospital; Outpatients; Personal Satisfaction; Surveys and Questionnaires; Patient Satisfaction
Food is closely related with emotion. It often provides comfort and satisfaction. Some individuals choose to turn to food to curb their negative emotion, resulting in disturbances in
eating patterns, such as overeating which lead to obesity and severely controlling food intake, which culminate in eating disorders like anorexia nervosa, bulimia nervosa and binge eating. These disorders are not related to the eating problems per se but often due to underlying or complicated by psychological factors, namely depression, anxiety, impulse control problems and personality. The roles of psychological factors in eating disorders and obesity should therefore not be downplayed. These disorders should be managed comprehensively involving multiple approaches, including not only biological but also psychological interventions provided by a professional team comprising endocrinologists, psychiatrists, dietitians, exercise physicians and surgeons.
Objective: To assess postgraduate candidates’ knowledge on basic sciences and to compare
their achievement based on two years study in the Department of Psychiatry, National University of Malaysia (UKM), Kuala Lumpur, Malaysia. Methods: This is a study assessing
areas of difficulties in basic sciences for the Malaysian postgraduate candidates sitting for
mock MCQ examination papers in two consecutive years. Results: The candidates in both
years failed on MCQ papers (scoring marks are only 43% and 40% for the year 2006 and
2005 respectively), which is consistent with their final examination outcomes. The candidates in the year 2006 were much superior in neuroanatomy (percentages of median scores: 47% vs. 31%, p
Objective: To describe the setting up of a pilot project on weight management programme for patients with severe mental illness (SMI) in a general hospital setting, the effectiveness of the programme on 5 patients and the feasibility of such programme to be developed in our local setting. Methods: Key staff members from relevant disciplines were involved through out the programme, which was based on dietary education, exercise and behavioural techniques. It was conducted weekly for physical exercise and biweekly for topic discussion with a total duration of 16 weeks. Results: Patients achieved means (SDs) weight loss of 1.78 (2.83) kg; BMI reduction of 0.92 (1.41) kg/m2; and reduction of waist circumference of 6.8 (4.97) cm. Factors associated with positive health outcome were high baseline BMI, high educational level and committed family members. Conclusion: The programme appears to be effective for patients and is feasible to be developed in Malaysian hospitals.
MeSH terms: Body Weight; Diet; Hospitals, General; Humans; Pilot Projects; Weight Loss; Exercise; Body Mass Index; Waist Circumference
We aimed to report the first case of anorexia nervosa in a young Malaysian Malay homosexual man with underlying borderline personality disorder and major depression. Patient and parents were interviewed. The Structured Clinical Interview for DSM IV was used to generate Axis-I diagnosis. The Hamilton Depressive Rating Scale was used to assess the severity of depression. His parents had marital discord. His father was overinvolved. Regarding anorexia nervosa, he had 163 cm height, 46kg weight and a body mass index (BMI) of 17 kg/m2. His four limbs had multiple scratch marks. Laboratory test results showed anemia, leukocytosis and hypoalbuminemia. Family pathology, borderline personality disorder and homosexuality could be the risk factors of anorexia nervosa in this patient.
MeSH terms: Anemia; Anorexia Nervosa; Body Weight; Borderline Personality Disorder; Depression; Depressive Disorder, Major; Fathers; Homosexuality; Humans; Leukocytosis; Male; Parents; Risk Factors; Body Mass Index; Hypoalbuminemia; Diagnostic and Statistical Manual of Mental Disorders
Dissociation, including multiple personality disorder, has long been a controversial topic. Patients with suggestive symptoms are often misdiagnosed as malingering or even having
schizophrenia. The former as a result of the overlooking of a clinician on the fact that suggestibility itself plays a key role in the emergence and perpetuation of this illness and the latter due to the lack of knowledge of the whole dissociative disorder spectrum, often resembling that of a psychotic disorder. Another contributing factor to the small number of patients with this diagnosis is due to the reluctance of a psychiatrist to do so because of his/her lack of experience and also fear of humiliation of being accused of seeking fame from diagnosing this somewhat glamorous phenomenon. In Malaysia, various culture bound syndromes often present with similar symptoms too. This article will attempt to understand this dissociation on the local context using case studies as a reference point.
Objectives: To determine the association of students’ perception of schooling with externalizing/internalizing scores; and to examine the different perceptions related to truancy. Methods:A total of 373 predominantly 16 year-old students attending three high risk schools in Pudu, Kuala Lumpur completed the questionnaires on schooling variables (four items) and externalizing/internalizing syndromes (Youth Self-Report, 112 items). Results: Certain negative perceptions (uncertainty of the schooling purpose, thinking schooling as time wasting) were significantly associated with higher internalizing (p
Objective: This descriptive cross-section, community-based study examined the prevalence of psychiatric morbidity and quality of life (QOL) and the associated factors among family caregivers of hospice patients with cancer. Methods: Subjects were 50 family caregivers of cancer patients under the care of Hospice Malaysia homecare. Home visits were done in Klang Valley. Psychiatric morbidity was detected using GHQ-30 English and Bahasa Malaysia versions, and the QOL was assessed by the Short Form 36 items (SF-36) questionnaire. Results:The study results showed that 54% of respondents had psychiatric morbidity. The educational status and the relationship between family caregivers and the cancer patients were statistically significant (p
MeSH terms: Educational Status; Hospices; House Calls; Humans; Malaysia; Morbidity; Neoplasms; Quality of Life; Surveys and Questionnaires; Residence Characteristics; Prevalence; Caregivers
Objective: To investigate the prevalence of parental stress and psychological wellbeing among parents with autistic children and their associations with dimensions of support system.
Methods: This is a preliminary cross sectional study which randomly selected parents with clinically diagnosed autistic children. Those parents who attended psycho-education session on management of autistic children at Health Psychology Unit were randomly selected to enroll in the study. Psychological wellbeing, parental stress and dimensions of support system were assessed by using the General Health Questionnaire (GHQ-28), the Parenting Stress Index (PSI) and the Provision Social Relation (PSR), respectively.
Results: Of 52 parents with autistic children (34 female and 18 male), about 90.4% of parents had significant parenting stress, and 53.8% of parents showed clinical disturbance in psychological wellbeing. Gender (t=1.67, p=0.02) and occupation (F=4.78, p=0.01) showed statistically significant association with psychological wellbeing. No association found between other socio-demographic factors, parental stress and psychological wellbeing with dimensions of support system among parents with autistic children.
Conclusion: Parents with autistic children have high prevalence of stress and psychological disturbances. Interactions of various factors need to be acknowledged and considered in order to reduce the burden of parents with autistic children.
With the introduction of problem-based learning (PBL) in medical and health professionals’ undergraduate courses, self-directed learning (also known as self-regulated learning) becomes an integral component of the learning process. There may be slight variations in how educators and students perceive self-directed learnin .However, self-directed learning provides an opportunity for collaborative discussion of the new information collected and allows learners to construct new knowledge as they address their learning issues. Therefore, self-directed learning is not just about researching for new knowledge or finding answers for questions; self-directed learning is about developing competencies, skills and attitudes that foster the learning processes. Interestingly, not all learners will be able to adapt this approach of learning once they enroll in a PBL course. The process will develop gradually and require a number of actions from the learner, including: (i) Realising the need to change their learning style to suite the needs of the medical curriculum, (ii) constructing a plan that accommodates the new learning objectives, (iii) Practicing self-directed learning and sharing their experiences with peers, and (iv) Continuing evaluation of their self-directed learning approach and improving their learning style. Therefore, the aims of this manuscript are: (i) discuss the meaning of self-directed learning in the context of PBL, and review the research outcomes in this area, (ii) understand the different factors that may affect student’s self-directed learning strategies, and (iii) briefly explore the meaning of construction of knowledge and how it can enforce students’ self-directed learning, integration of knowledge and deeper understanding of topics learnt.
Primary care practice with its defining features of continuity, comprehensiveness and coordination, is the cornerstone to provide high quality community-based chronic disease management. Poor chronic disease prevention and control at the primary care level will lead to the massive burden of treating complications at secondary care, burden to the patients and their families with regards to morbidity and premature death, and burden to the country with regards to the loss of human capital. Compelling evidence showed that there are innovative and cost-effective interventions to reduce the morbidity and mortality attributable to chronic diseases, but these are rarely translated into high quality population-wide chronic disease care. Primary health care systems around the world were developed in response to acute problems and have remained so despite the increasing prevalence of chronic conditions. An evolution of primary health care system beyond the acute care model to embrace the concept of caring for long term health problems is imperative in the wake of the rising epidemic of chronic diseases. This paper aims to review the evidence supporting high quality and innovative chronic disease management models in primary care and the applicability of this approach in low and middle income countries.
MeSH terms: Chronic Disease; Cost-Benefit Analysis; Delivery of Health Care; Humans; Morbidity; Primary Health Care; Prevalence; Review; Disease Management; Mortality, Premature; Secondary Care
Breast cancer is one of the most significant health concerns worldwide. The discovery of molecular changes at the gene level represents a critical milestone toward the development of novel targeted therapy specific to cancer cells. The recognition of the significance of the HER-2/neu oncogene is a landmark in the treatment and prognostication of breast cancer. The human epidermal growth factor 2, HER-2/neu (c-erbB- 2) oncogene, a member of the growth factor receptor family, is amplified in 10-34% of patients with invasive breast cancer and associated with more aggressive disease and poorer prognosis. The development of an immunotherapeutic, trastuzamab (Herceptin), to the extracellular domain of HER-2/neu has provided significant improvements in the outcome of HER2 positive breast cancer patients in the adjuvant, neoadjuvant and metastatic setting. This paradigm shift in breast cancer treatment has made it imperative to measure HER-2/neu amplification status to correctly identify and assign breast cancer patients for Herceptin therapy. There is an increasing demand for the development of clinically meaningful and reproducible assays for HER-2/neu on archived and prospective histological and cytological samples, their integration with prospective molecular methods and therapeutics is a challenge that pathologists must now address. This review focuses on current and future methodologies for measuring HER-2/ neu in breast cancer and also includes a synopsis on the role of HER2/neu gene in breast cancer, its association with histological types and grades, familial and male breast cancer.
MeSH terms: Trastuzumab; Female; Humans; Male; Prognosis; Prospective Studies; Breast Neoplasms, Male; Receptor, ErbB-2; Genes, erbB-2; Neoadjuvant Therapy; EGF Family of Proteins
The issue of antibiotic resistance has been around ever since the first antibiotic penicillin was introduced to the world. It continues to rise, becoming a major problem across the globe and Malaysia is no exception. Hospital is a critical component of the antibiotic resistance problem worldwide. The problems of antibiotic resistance are typically magnified in a hospital setting due to the common variables in the hospital environment that favour its development. These include a combination of highly susceptible patients, intensive and prolonged antibiotic use, and crossinfection resulting in nosocomial infections with highly resistant bacterial pathogens such as multi-resistant gram-negative rods, vancomycin resistant enterococci (VRE) and methicillinresistant Staphylococcus aureus (MRSA) as well as resistant fungal infections. Transmission of highly resistant bacteria from patient to patient within the hospital environment amplifies the problem of antibiotic resistance and may result in the infection of patients who are not receiving antibiotics. Transmission of antibiotic-resistant strains from hospital personnel to patients or vice versa may also occur. What are the available strategies and what works best in managing antibiotic resistance in the hospital? This review will highlight the seriousness of the resistance problem and identify actions that address it especially in the context of improving the problem in Malaysian hospitals.
Heart failure (HF) is a major burden in almost all countries. The prevalence of symptomatic HF is still high. Despite our best understanding of its pathophysiologic mechanisms and the recent advances in pharmacologic therapy, it remains a highmortality and morbidity disease. About 30-50% of patients with HF have concurrent electrical delay in the electrocardiogram (ECG), mainly in the form of LBBB.1 This kind of conduction delay commonly occurs in patients with idiopathic dilated cardiomyopathy and ischemic cardiomyopathy as well. The abnormality of left ventricle (LV) conduction will lead to a change in LV contraction pattern resulting dyssynchronized with right ventricle) contraction. Thus, a dyssynchronous LV contractile pattern usually manifested by late activation of the LV lateral wall which in turn impairs LV systolic function, reduces cardiac output, raises filling pressure and worsens mitral regurgitation2. Cardiac resynchronization therapy (CRT) improves cardiac function and exercise capacity leading to an improved survival in patients with advanced heart failure and ventricular conduction delay.3 The underlying mechanisms of these beneficial effects are not fully understood, but they appear to be related to a restored coordination of the left (LV) and right ventricular (RV) contraction and relaxation.4 These effects may directly lead to augmented contractility and reduction of LV filling pressures.5 Echocardiography has been widely used to identify patients who are candidates for CRT and to monitor the response in LV function at follow-up after device implantation. This review addresses the applications of CRT in patients with moderate– severe heart failure and the role of echocardiography in optimizing CRT including patient selection, risk and benefit of CRT and appropriate measures.
Epilepsy is a common neurological disorder in childhood. In a majority, the cause of epilepsy remains a mystery in spite of extensive investigations. The aim of drug treatment is to effectively stop the seizures with minimum of side effects, causing no impairment of long term learning abilities of the child. Up to 30% of children with epilepsy may continue to have seizures in spite of adequate drug therapy. In this review, an overview of the recent advances that affect the diagnosis, prognosis and therapy of childhood epilepsy including the dilemmas of everyday practice is presented.
Chronic Myeloid Leukemia (CML) is a clonal disorder thought to originate in a single abnormal haematopoietic stem cell. This myeloproliferative fatal stem cell disorder comprises
approximately 14% of all leukemias. In most cases, CML runs a triphasic course, which includes an initial chronic phase that transforms eventually into a blastic phase resembling acute leukemia. In 60%- 80% of patients, an intermediate or accelerated phase precedes the terminal blastic phase. Accelerated phase and blastic phase sometimes are lumped together and considered to be
advanced phase CML. The entire continuum from chronic phase to blastic phase lasts a median of 3 to 5 years . This time period can be broken down in to the chronic phase which if untreated,
lasts for 2 to 5 years and finally the fatal blastic phase, which lasts from 3 to 6 months. A patient can present in any of these 3 stages.
Molecular techniques involving the application of DNA based molecular markers for the conservation and management of endemic and endangered species have assumed significance as
genome sequencing projects have generated an extensive database which can be mined for informative genomic regions. Scientific approaches towards conservation involve several stages, which encompass determination of appropriate genomic regions for characterization, design and testing of specific molecular markers, screening of multiple populations and statistical treatment and
interpretation of data. Population data can be utilized to develop controlled breeding and relocation programs aimed at ensuring that genetic diversity within populations of endangered species is
sustained within the context of an overall conservation program. The information derived as a result of this approach can be applied to establish a scientific and legal framework for the conservation of endemic species. Species specific genomic markers can be applied to enforce the implementation of CITES within the guidelines of a national biodiversity conservation policy.
DNA microarray technology has permitted large scale parallel analysis of gene expression of several diseases, including cancers. Real-time PCR has become a well-established procedure for
quantifying levels of gene expression. We evaluated Real-Time PCR to validate differentially expressed genes identified by DNA arrays. Gene expression of three different grade of transitional cell carcinoma (TCC) of human bladder cancer was determined using microarray slide containing cancer-related genes. Data obtained were sorted according based on the ratios between Cy3 and Cy5 dyes used and revealed 119, 235 and 183 differentially expressed genes in TCC WHO Grades I, II and III, respectively. Real-time PCR used SYBR Green-1 dye detection to validate relative change in gene expression. Real- Time PCR confirmed the change in gene expression of 17 of 28 (75%) genes identified by microarray. Real-Time PCR also suggest that genes identified by microarray with two or higher fold change cannot be eliminated as false nor be accepted as true without validation. Real-Time PCR based on SYBR Green- 1 is well-suited to validate DNA array results because it is quantitative, rapid and requires less RNA compared to the conventional assays.