The National Cardiovascular Database for Percutaneous Coronary Intervention (NCVD PCI) Registry is the first multicentre interventional cardiology project, involving the main cardiac centres in the country. The ultimate goal of NCVD PCI is to provide a contemporary appraisal of PCI in Malaysia. This article introduces the foundation, the aims, methodology, database collection and preliminary results of the first six-month database.
Cancer burden in Malaysia is increasing. Although there have been improvements in cancer treatment, these new therapies may potentially cause an exponential increase in the cost of cancer treatment. Therefore, justification for the use of these treatments is mandated. Availability of local data will enable us to evaluate and compare the outcome of our patients. This will help to support our clinical decision making and local policy, improve access to treatment and improve the provision and delivery of oncology services in Malaysia. The National Cancer Patient Registry was proposed as a database for cancer patients who seek treatment in Malaysia. It will be a valuable tool to provide timely and robust data on the actual setting in oncology practice, safety and cost effectiveness of treatment and most importantly the outcome of these patients.
Colorectal cancer is emerging as one of the commonest cancers in Malaysia. Data on colorectal cancer from the National Cancer Registry is very limited. Comprehensive information on all aspects of colorectal cancer, including demographic details, pathology and treatment outcome are needed as the management of colorectal cancer has evolved rapidly over the years involving several disciplines including gastroenterology, surgery, radiology, pathology and oncology. This registry will be an important source of information that can help the development of guidelines to improve colorectal cancer care relevant to this country. The database will initially recruit all colorectal cancer cases from eight hospitals. The data will be stored on a customized web-based case report form. The database has begun collecting data from 1 October 2007 and will report on its first year findings at the end of 2008.
MeSH terms: Humans; Population Surveillance; Registries/standards; Registries/statistics & numerical data*; Research Design; Colorectal Neoplasms/drug therapy; Colorectal Neoplasms/epidemiology*; Colorectal Neoplasms/surgery; Colorectal Neoplasms/therapy; Multicenter Studies as Topic; Databases, Factual/standards; Databases, Factual/statistics & numerical data; Program Development; Practice Guidelines as Topic; Access to Information
Nasopharyngeal carcinoma (NPC) is a cancer which is common in Asia. We report the establishment and early results of a multi-institutional prospective study of nasopharyngeal carcinoma, which seeks to systematically collect data as well as blood and tumour tissue samples from patients diagnosed with nasopharyngeal cancer at six centres in Malaysia. A total of 484 confirmed NPC cases were reported from the six participating centres between 1st July 2007 and 29th February 2008. Of these, 225 were newly diagnosed cases, 53 were recurrent cases and 206 were in remission at the time of reporting. Amongst the newly diagnosed cases, the most common presenting symptom was the presence of neck lumps (42%). Ophthalmo-neurologic symptoms were the presenting symptoms of 11% of the new cases. The majority of cases (75%) presented at stage III/IV.
Carcinoma of the cervix is the most common malignancy in many developing countries. The purpose of this pilot study on cervical cancer patients treated at selected sites in Malaysia is to examine the achievability of collecting information on patients. The data was collected from the medical records of the patients using case report form. The results reveal that more than 90% of the forms had completed data from all sites. The pilot study has demonstrated that it is feasible to register and collect information on cervical cancer patients using the case report forms. Treatment outcome obtained from this data will form the baseline to establish existing clinical practice and will be useful for treating physicians to monitor the treatment outcome and the late complications and with longer followup to measure the disease free and overall survival. In addition, it is an useful tool as the national indicator.
Colloid cysts are rare intracranial tumors most commonly found in the third ventricle. We present a case of colloid cyst of the third ventricle that manifested as bilateral advance optic disc cupping, superior hemifield defects in the visual fields and normal intraocular pressure.
The association between fetal sex and outcome of pregnancy and labor has been well documented in western populations. However, no studies in Malaysia or other developing countries have examined the effect of fetal sex on such outcomes.The main objective of this study was to determine the influence of fetal sex on the outcome of labor at term in a cohort of Malaysian nulliparae.A retrospective observational study was designed using data from 4644 Malaysian nulliparae who gave birth consecutively to singleton male babies at Hospital Sultanah Aminah, Johor Bahru, after normal full-term pregnancies.The results of this study indicate that mothers giving birth to male infants have a greater risk of requiring cesarean delivery because male babies are heavier and have statistically significantly greater head circumference (P < .001). These findings concur with those obtained in western populations and suggest that the differences in outcome observed are biological, not dictated by race, ethnicity, or environmental conditions. Such information could help in the antenatal assessment of Malaysian patients and stimulate more comprehensive studies of the mechanisms involved in this sex-based difference in outcomes. Reasons for such differences are proposed.
Campylobacter jejuni was found to occur at high prevalence in the raw salad vegetables examined. Previous reports describe cross-contamination involving meat; here we investigated the occurrence of cross-contamination and decontamination events in the domestic kitchen via C. jejuni-contaminated vegetables during salad preparation. This is the first report concerning quantitative cross-contamination and decontamination involving naturally contaminated produce. The study was designed to simulate the real preparation of salad in a household kitchen, starting with washing the vegetables in tap water, then cutting the vegetables on a cutting board, followed by slicing cucumber and blanching (heating in hot water) the vegetables in 85 degrees C water. Vegetables naturally contaminated with C. jejuni were used throughout the simulation to attain realistic quantitative data. The mean of the percent transfer rates for C. jejuni from vegetable to wash water was 30.1 to 38.2%; from wash water to cucumber, it was 26.3 to 47.2%; from vegetables to cutting board, it was 1.6 to 10.3%; and from cutting board to cucumber, it was 22.6 to 73.3%. The data suggest the wash water and plastic cutting board as potential risk factors in C. jejuni transmission to consumers. Washing of the vegetables with tap water caused a 0.4-log reduction of C. jejuni attached to the vegetables (most probable number/gram), while rapid blanching reduced the number of C. jejuni organisms to an undetectable level.
This study examined whether the survival of Vibrio cholerae O1 on contaminated cooked rice was influenced by the type of rice. Vibrios survived unchanged on clumps of glutinous white rice (wet, grains adhered) held at room temperature for 24 h. On nonglutinous white rice (slightly moist, grains separate), 30% viable vibrios remained at 24 h. On nonglutinous brown rice (moist, separate, covered with a mucus-like substance), the number of vibrios increased 2.7-fold at 24 h. Survival rates of vibrios on the surfaces of a row of five cooked rice grains after 2 h of exposure at room temperature were 86, 29, 12, and 4% for glutinous rice, white rice, and the endosperm and pericarp of brown rice, respectively. (Each boiled brown rice grain surface was partly pericarp and partly endosperm, which became exposed by a rupture of the pericarp.) Covering each inoculated grain with a similar cooked rice grain surface increased the corresponding figures to 93, 99, 60, and 94%. Scanning electron microscopy revealed that each type of cooked grain surface possessed a distinct microtopography. For example, the surfaces of glutinous rice grains consisted of separated overlapping strips with many holes, while the pericarps of brown rice were flat interspersed with small pits. In conclusion, each type of boiled rice produced a distinct survival pattern of V. cholerae O1 caused by both the distinct gross features and the fine surface characteristics of the rice. The significance of this finding is that the type of rice consumed can be a factor in cholera transmission by contaminated rice.
Budesonide/Formoterol (Symbicort) combination therapy as both maintenance and reliever treatment (SMART) is a novel approach in asthma management. We examined its 'real-life effectiveness' in treating Malaysian patients with moderate-to-severe asthma in whom despite on combined inhaled corticosteroids and long-acting beta2-agonist, were still inadequately controlled. In a retrospective study, 22 eligible adult patients on SMART [mean (range) age: 49 (36-65) years; FEV1: 41 (21-74)% predicted] were identified from medical records of an urban-based university hospital chest clinic, and their clinical outcomes studied at three months. Another 16 patients [50 (14-66) years; 48 (20-91)% predicted] of similar severity and treatment (i.e. Symbicort maintenance treatment plus short-acting beta2-agonist as reliever), but not on SMART, were used as comparator over the same assessment period. In addition, the patients were separately interviewed with standard questionnaire on their satisfaction and compliance to the SMART approach. In SMART group, rescue treatment requirement (p<0.001) and FEV1 [median difference = 2.5%, p=0.015; mean difference: 90 ml, p=0.013] showed significant improvement while in comparator, there was significant improvement only in the requirement for rescue treatment (p=0.023). Hospital admission rates were significantly reduced in SMART group compared to the other (p=0.039), but not in emergency treatment. Five patients asked to discontinue SMART while all others were satisfied, compliant and perceived improvement of their asthma with SMART. The maximum daily doses of inhaled budesonide and formoterol were 1400 microg and 31.5 microg respectively. Our preliminary findings suggest that SMART approach can be attempted as an effective and safe treatment option for patients with inadequately controlled moderate-to-severe asthma in Malaysian setting.
Study site: Chest clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia
Chronic venous disorders range from telangiactasia or spider veins to varicose veins, venous swellings, skin changes and venous ulcerations. The aim of this study is to assess outcome of varicose vein surgery in the ethnically diverse population of Penang, Malaysia. This study is a retrospective analysis of patients seen from 1999 to 2004. All patients who presented to the outpatient clinic of our surgical department with saphenofemoral junction (SFJ) and/or saphenopopliteal junction (SPJ) reflux associated with incompetence of the great saphenous vein (GSV) or small saphenous vein (SSV) respectively underwent classical varicose varicose vein surgery. A single surgeon at a single institution performed the surgeries. Data from pre-operative, post-operative and follow-up procedures were recorded in case report forms. A total of 202 cases were treated. Of these, 200 were qualified by the inclusion criteria and follow-ups, with 23 who were treated bilaterally. Of those treated, Chinese comprised 47.5%, Indians 27.0%, Malays 12.5% and foreigners 13.0% (largely Indonesian Chinese, British and Americans). The average age was 52.1 years. Indians had the highest average BMI of 29.2, compared to the Chinese who had the lowest of 24.6. Based on occupation, housewives (43.0%), blue collar workers (19.0%), salespersons (12.0%) and factory workers (9.5%) were among those afflicted with varicose veins. While local Chinese predominated in the business groups (salespersons and food-related workers), the Indians and Malays in this study were mainly factory workers and/or blue collar workers. Symptomatology in descending order of severity included pain in 80.0% of cases, swelling in 65.5%, heaviness in 53.5%, cramps in 53.0%, lipodermatosclerosis in 39.0%, superficial thrombophlebitis in 33.5%, venous ulceration in 32.0%, eczema 22.0% and cellulitis in 12.5% of patients. Post surgery pains dropped to 9.9%, cramps 6.4%, heaviness 5.5% and swelling 5.3% (p<0.0001 in all groups). Indians had the highest rate of venous ulcers (35.2% of all Indians treated) possibly due to their high BMI and low socioeconomic background. In cases of venous ulcers, gram negative infections (49.8%) were more common than gram positive infections at 18.8%. Operative procedures performed included great saphenous vein high ligation in 96.5% of cases, stripping 93.5% and multiple avulsions in 98.5%, saphenous popliteal junction ligation with multiple avulsions in 13.0% and subfascial ligation in 10.5%. Operative complications included induration (40.0% of cases), bruising in 49.5%, pains in 15.0%, paraesthesia in 3.5%, wound infection in 4.0%, deep venous thrombosis in 3.0% and ulcer recurrence in 7.5%. A total of 96.2% of patients treated expressed satisfaction with varicose vein surgery. Late presentations of chronic venous insufficiency, possibly as a result of poor understanding and inadequate education on diet, weight control, use of stockings and change in lifestyle by patients, employers and general practitioners are probably the cause of high rates of severe chronic venous disease especially venous ulcerations in the local community. However, classical varicose vein surgery is widely applicable across diverse ethnicities with a high rate of success.
Study site: Surgical clinic, Penang Adventist Hospital, Pulau Pinang, Malaysia
This is a cross-sectional study investigating the profile of children with disability registered with the primary health care clinics in Malaysia. The purpose of the study was to assess the developmental stage of children with disability. Secondary data from the pilot project conducted by the Family Health Development Division, Ministry of Health Malaysia was used in this study. The study period was for six months from 1st August 2004 until 31st January 2005. A total of 900 disabled children were selected in this study. Schedule of Growing Scale (SGS) II was used for analysis. Results showed more boys than girls were affected with a ratio of 6:4. The mean total SGS score increases as the age of the child increased. The score was highest in delayed speech cases and lowest in cerebral palsy cases. The performance among children with delayed speech was the highest while children with cerebral palsy were the lowest. There was a statistically significant difference between the major ethnic groups in delayed speech and attention deficit hyperactive disorder.
Questionnaire: Denver Developmental Assessment Test II chart; DSST; Schedule of Growing Scale II; SGS
MeSH terms: Ambulatory Care Facilities; Child; Child, Preschool; China/ethnology; Cross-Sectional Studies; Female; Humans; India/ethnology; Infant; Malaysia; Malaysia/ethnology; Male
The National Medicines Use Survey (NMUS) which started in 2004 and is still ongoing was conducted with the intent to continuously and systematically collect data on the use of medicines, to provide an overview on the use of medicines in Malaysia. The objective of the NMUS is therefore to quantify the present state and time trends of medicines utilization at various levels of our health care system whether national, regional, local or institutional. From the data available, for the Year 2005, the most commonly used medicine in Malaysia were anti-diabetic medications, of which glibenclamide is the most common followed by metformin, were the top 2 of the list of drugs utilized in DDD/1000 population/day. Collectively, however, taking into account the various antihypertensives by therapeutic groups, anti-hypertensive medicines were more commonly used than anti-diabetics. Hypertension and diabetes mellitus are the two most prevalent chronic disorders in the country and thus, such high medicines utilization rates for these conditions are to be expected. From the general practice prescription data, it was estimated that a patient with hypertension was prescribed a median of only one (1) anti-hypertensive medication. This means, the vast majority of patients (81%) were on monotherapy, which is hardly sufficient to achieve treatment target. Clearly then, given the prevalence of hypertension, many patients were not on drug treatment at all, and of those treated, their drug treatment are likely to be inadequate.
MeSH terms: Ambulatory Care Facilities; Cross-Sectional Studies; Drug Utilization/statistics & numerical data*; Hospitals; Humans; Malaysia; Private Practice; Databases, Factual; Health Care Surveys; Prescription Drugs*
The knowledge related to contact lens wear and practice care of contact lenses among medical students of University of Malaya was assessed through a structured questionnaire. One hundred and twenty-one contact lens wearers participated in this study. Majority of contact lens wearers were females (106, 87.6%); the duration of contact lens wear varied from less than six months to two years or more; 53 (43.8%) cited cosmetic purpose for wearing contact lens; 16 (13.2%) were not removing their contact lenses prior to sleeping at night. Despite 107 (88.4%) were aware of complications of contact lens usage, only 102 (84.3%) were adhering strictly to proper hygiene and contact lens care; and 17 (14%) continued wearing in spite of eye symptoms. Forty seven (38.8%) students sought ophthalmic consultation for eye problems. Improper practice of contact lens wear and care even in educated users such as medical students could increase the risk of complications. Therefore, a need for more education to the consumers is desired.
This is a cross sectional study of 40 patients diagnosed with chronic rhinosinusitis using the Lanza Kennedy diagnostic criteria based on nasal endoscopy (NE), and on computer tomography (CT) of the paranasal sinuses. The purpose of the study is to demonstrate the effectiveness and limitations of CT, and NE in the assessment of chronic rhinosinusitis. This study shows that CT was superior in detecting OMC involvement, presence of concha bullosa, paradoxical turbinate and nasal septal deviation. NE was better at detecting polyps.
There are well-established guidelines regarding the use of Angiotensin converting enzyme inhibitors (ACEI) in the management of heart failure (HF). In-spite of that, many studies has documented underutilization of ACEI. Thus, this retrospective observational study aimed to evaluate the utilization of ACEI, to identify the pattern of ACEI use and the factors that might contribute to underutilization of ACEI. The target population was hospitalized HF patients in University Malaya Medical Centre (UMMC). Of 321 hospitalized HF patients, only 57% of them were treated with ACEI. 51.2% of the patients treated with ACEI received low dose (< or = 25% from target dose) at discharge. Factors that have significant association with the underutilization of ACEI included serum potassium and creatinine, chronic renal failure and other concurrent medications used (frusemide, aspirin, potassium chloride, calcium channel blockers and angiotensin receptor blockers). The findings indicated that the utilization of ACEI in the management of HF in UMMC is considerably low.
MeSH terms: Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors/therapeutic use*; Drug Utilization; Female; Heart Failure/complications; Heart Failure/drug therapy*; Humans; Male; Middle Aged; Retrospective Studies; Cohort Studies; Young Adult
Health care workers (HCW) are at high risk of acquiring blood-borne diseases. This study compared the risk of infection among HCW in different hospital units and also between HCW and students in medical fields. This cross-sectional study involved pre-tested questionnaires that were completed by 625 HCW and undergraduate students undergoing clinical attachments from February to August 2001. The respondents were separated into two groups: i) HCW from Hospital Kuala Lumpur, HKL (n=241) and Hospital Universiti Kebangsaan Malaysia, HUKM (n=153) ii) Medical students from Universiti Kebangsaan Malaysia, UKM (n=171) and HUKM student nurses (n=60). The results obtained showed that the risk of transmission of blood-borne infections varied significantly according to professional ranks (p<0.05) and to hospital units (p<0.05). The medical intensive care (ICU), haemodialysis, and nephrology and urology units had the highest scores for the risk of infection while the diagnostic laboratory had the lowest risk of infection (p<0.05). Preventive measures taken by the subjects in this study were not satisfactory especially with reference to the use of personal protective equipment and the practice of universal precautions.
We audited the standard of care provided to 200 consecutive type 2 diabetic patients attending our hospital general medical clinic. Data on diabetes related processes and outcome measures were collected. Annual testing rates (blood pressure 100%, fasting lipid profile 91.8%, HbA1c 69%) were higher compared to complications screening rates (Eye 69%, albuminuria 51%, foot 22.4%). Lifestyle intervention was lacking with BMI documented in 38.3% of patients and smoking history in 46%. Fifty percent and 41% of patients with HbA1c > 7.5% were referred to diabetes educator and dietitian respectively. For outcome measures, 26% of patients achieved HbA1c < or = 7%, 33% achieved BP < or = 130/80 while 56% achieved LDL < or = 2.6 mmol/L. Aspirin was prescribed in 78% and ACE inhibitor or angiotensin receptor blocker in 91.8% of patients. Lifestyle intervention and complication screening are the two major areas of deficiencies in the care of type 2 diabetic patients in our hospital general medical clinic.
Study site: General medical clinic, Sarawak General Hospital, Kuching, Sarawak, Malaysia
MeSH terms: Aged; Aspirin; Diabetes Mellitus, Type 2/complications; Diabetes Mellitus, Type 2/diagnosis; Diabetes Mellitus, Type 2/therapy*; Female; Hospitals, General*; Hospitals, Public*; Humans; Life Style; Malaysia; Male; Medical Audit; Middle Aged; Outpatient Clinics, Hospital*; Retrospective Studies; Cohort Studies; Treatment Outcome