Browse publications by year: 2008

Fulltext Awareness on ex-gratia compensation scheme among medical department staff in a tertiary government hospital in Kuala Lumpur

Su T, Hoe VC

Med J Malaysia, 2008 Oct;63(4):302-5.
PMID: 19385489 MyJurnal

The Ex-Gratia Compensation Scheme was introduced by the Government of Malaysia in 1994 to provide compensation, which is not covered by any prior legislation, for all its workers suffering from injuries and illnesses due to work. Despite more than ten years of implementation, the submission for claims is still minimal and there is an impression that awareness on the provision of Ex-Gratia benefit among government employees, especially health care staff, is poor. A cross sectional survey was conducted at a medical department of a government hospital in Kuala Lumpur to assess the knowledge and awareness level on Ex-Gratia among a representative group of front line health care workers. The results show that the respondents' knowledge on Ex-Gratia is generally poor as compared to knowledge on the Social Security (SOCSO) Schemes. Majority of the respondents are unsure whether they will be compensated in case of occupational illness and injuries. They also do not know what kind of compensation scheme they are currently eligible. There is an urgent need for the Treasury and health care managers to expand the knowledge and awareness on Ex-Gratia among health care workers.

MeSH terms: Awareness*; Female; Health Personnel*; Humans; Malaysia; Male; Workers' Compensation*; Knowledge*
Fulltext Risk factors associated with low birth weight infants in the Malaysian population

Boo NY, Lim SM, Koh KT, Lau KF, Ravindran J

Med J Malaysia, 2008 Oct;63(4):306-10.
PMID: 19385490 MyJurnal

This study aimed to identify the risk factors which were significantly associated with low birth weight (LBW, <2500 g) infants among the Malaysian population. This was a case-control study carried out at the Tuanku Jaafar Hospital, Seremban, Malaysia over a five-month period. Cases were all infants born with birth weight less than 2500 g. Control infant were selected with the help a random sampling table from among infants with birth weight of > or =2500 g born on the same day in the hospital. Of 3341 livebirths delivered in the hospital, 422 (12.6%) were LBW infants. Logistic regression analysis showed that, after controlling for various potential confounders, the only significant risk factors associated with infants of LBW were gestational age (adjusted odds ratio (OR)=0.6, 95% C.I.: 0.5, 0.6; < 0.0001), maternal pre-pregnancy weight (adjusted OR = 0.97, 95% C.I.: 0.95, 0.99; p < 0.0001), nulliparity (adjusted OR = 3.4, 95% C.I.: 2.2, 5.1; p < 0.0001), previous history of LBW infants (adjusted OR = 2.3, 95% C.I.: 1.4, 3.8; p=0.001) and PIH during current pregnancy (adjusted OR=3.3, 95% C.I.: 1.6, 6.6; p = 0.001). A number of potentially preventable or treatable risk factors were identified to be associated with LBW infants in Malaysia.

MeSH terms: Birth Weight; Humans; Infant, Low Birth Weight*; Infant, Newborn; Risk Factors; Logistic Models; Case-Control Studies
Fulltext The outcome of pleomorphic sarcoma at University Malaya Medical Center--a fifteen-year review

Chan CYW, Janarthan N, Vivek AS, Jayalakshmi P

Med J Malaysia, 2008 Oct;63(4):311-4.
PMID: 19385491

Pleomorphic sarcoma is the most common sarcoma. Reports of outcome as well as evaluation of prognostic factors in the literature show great variation. We looked at our experience in treating this tumour at University Malaya Medical Center. This is a review of patients diagnosed with Pleomorphic Sarcoma from January 1990 to December 2005 at University Malaya Medical Center. Outcome measures studied are the overall survival, disease free survival and local recurrence of disease. Prognostic factors for survival and local recurrence which were studied are the tumour size, depth, stage, type of surgery, adjuvant therapy, and surgical margin. There were fifty four patients available for analysis of demographics. The mean age at presentation was 52.3 +/- 16.7 years. There were thirty male patients (56%) and twenty four female patients (44%) in the study population. The patients were predominantly Malay (44.4%) and Chinese (42.6%). There were two Indian patients (3.7%) and five patients from other races (9.3%). Thirty patients had disease affecting the extremities while six patients had disease affecting the trunk. Patients with tumour affecting the trunk had 100% mortality. In patients with tumour affecting the extremity, 46.7% presented with Stage 3 disease. The overall median survival was 39 months. The overall survival rate at 3 years was 53.3% and the 5 years was 30.0%. The disease free survival rate at five years was 27.6%. However, if patients who presented with metastasis were excluded, the 5 year survival rate was 60% while the disease free survival was 53.3%. Recurrence rate was 33.3%. Factors affecting survival was stage, size and location of tumour. No factors were found to correlate with higher local recurrence rate. In conclusion, Pleomorphic Sarcoma is a heterogenous disease with variable outcome. In our centre, late presentation with advanced disease significantly affects the overall outcome of this condition. Tumour size and location are important prognostic factors. Inherent tumour behavior and aggressiveness probably outweigh current treatment modalities as the most important prognostic factor in the management of Pleomorphic Sarcoma.

MeSH terms: Adult; Aged; Female; Hospitals, University; Humans; Malaysia; Male; Middle Aged; Neoplasm Recurrence, Local/epidemiology; Prognosis; Sarcoma/mortality*; Sarcoma/pathology; Sarcoma/therapy
Fulltext The effect of "group detailing" on drug prescribing in primary care

Mastura I, Teng CL

Med J Malaysia, 2008 Oct;63(4):315-8.
PMID: 19385492

The quality of physician prescribing is suboptimal. Patients are at risk of potentially adverse reaction because of inappropriate or writing error in the drug prescriptions. We assess the effect of "group academic detailing" to reduce writing drug name using brand name and short form in the drug prescriptions in a controlled study at two primary health care clinics in Negeri Sembilan. Five medical officers in Ampangan Health Clinic received an educational intervention consisting of group academic detailing from the resident Family Medicine Specialist, as well as a drug summary list using generic names. The academic detailing focused on appropriate prescribing habit and emphasized on using the full generic drug name when writing the drug prescription. Analyses were based on 3371 prescriptions that were taken from two clinics. The other health clinic was for comparison. The prescribing rates were assessed by reviewing the prescriptions (two months each for pre- and post-intervention phase). Statistically significant reduction in writing prescription using brand name and using short form were observed after the educational intervention. Writing prescription using brand name for pre- and postintervention phase were 33.9% and 19.0% (postintervention vs pre-intervention RR 0.56, 95% CI 0.48 to 0.66) in the intervention clinic. Prescription writing using any short form for pre- and post-intervention phase were 49.2% and 29.2% (post-intervention vs pre-intervention RR 0.59, 95% CI 0.53 to 0.67). This low cost educational intervention focusing on prescribing habit produced an important reduction in writing prescription using brand name and short form. Group detailing appears to be feasible in the public health care system in Malaysia and possibly can be used for other prescribing issues in primary care.

MeSH terms: Ambulatory Care Facilities; Handwriting; Humans; Malaysia; Drug Prescriptions/standards*; Primary Health Care; Clinical Trial
Fulltext Long term Tai Chi exercise reduced DNA damage and increased lymphocyte apoptosis and proliferation in older adults

Goon JA, Noor Aini AH, Musalmah M, Yasmin Anum MY, Wan Ngah WZ

Med J Malaysia, 2008 Oct;63(4):319-24.
PMID: 19385493 MyJurnal

Effect of Tai Chi exercise on the level of DNA damage using the comet assay, lymphocyte viability and frequency of sister chromatid exchange (SCE) were determined in adults aged above 45. Tai Chi participants of 7 years (n=35), showed higher level of normal DNA and lower level of mild and severely damaged DNA as compared to the sedentary subjects (n=35). The former are suggested to have effective DNA repair mechanism as their frequency of SCE was markedly lower. Higher lymphocyte apoptosis and proliferation found in the Tai Chi participants also indicated that the exercise promotes renewal and regeneration of lymphocytes.

MeSH terms: DNA Damage*; DNA Repair; Female; Humans; Lymphocyte Activation*; Lymphocytes/physiology*; Male; Middle Aged; Sister Chromatid Exchange; Apoptosis*; Tai Ji*
Fulltext Audit of newborn screening programme for congenital hypothyroidism

Zarina AL, Rahmah R, Bador KM, Ng SF, Wu LL

Med J Malaysia, 2008 Oct;63(4):325-8.
PMID: 19385494 MyJurnal

Newborn screening for congenital hypothyroidism (CH) was implemented in Hospital UKM in December 2004 using cord blood sample. From the audit over a period of 25 months, a total of 13,875 newborn babies were screened with a coverage of 98.8%. From this cohort, the mean recall rate was 0.32%; unfortunately the mean percentage of recalled babies that came for retesting was only 79.5%. In addition, the mean sample rejection rate was high, i.e. 2.2%. Two babies were diagnosed to have CH. These findings implied that whilst the coverage of screening was good, there is a need for regular surveillance of performance of both clinical and laboratory personnel. In addition, a more concerted effort should be carried out to promote community awareness of such a programme.

MeSH terms: Congenital Hypothyroidism/diagnosis*; Humans; Infant, Newborn; Medical Audit*; Thyrotropin/blood; Thyroxine/blood; Neonatal Screening*
Fulltext Angiokeratoma corporis diffusum

Yap FB, Pubalan M

Med J Malaysia, 2008 Oct;63(4):329-30.
PMID: 19385495 MyJurnal

Angiokeratoma is a dark violaceous keratotic papule which can be solitary or multiple. Generalised systemic angiokeratoma constitute angiokeratoma corporis diffusum, a rare X-linked recessive inborn error of glycosphingolipid metabolism due to deficiency of alpha galactosidase A. Patients with this disease have premature death due to the vascular complications. A case of possible Fabry's disease is presented.

MeSH terms: Adult; Fabry Disease/complications; Fabry Disease/etiology; Fabry Disease/pathology*; Humans; Male
Fulltext A case of cutaneous larva migrans acquired from soiled toilet floors in urban Kuala Lumpur

Robson NZ, Othman S

Med J Malaysia, 2008 Oct;63(4):331-2.
PMID: 19385496 MyJurnal

Despite being a common skin dermatosis in the tropics, physicians in the tropics may miss the diagnosis of cutaneous larva migrans for other pruritic skin manifestation. This is especially in those who live in urban housing with no history of travel. Cutaneous larva migrans, an intensely pruritic skin pathology is mainly contracted by people with history of beach holiday or contact with moist soft sand which had been contaminated with dog or cat faeces. This article reports a patient who presented with intensely itchy papular spots over the dorsum of his foot after walking barefooted in an urban toilet soiled with cat faeces. The patient had initially seen an urban general practitioner who diagnosed the papular skin lesion as an allergic reaction, and prescribed antihistamines. The patient subsequently developed creeping skin lesions and was seen by the author who prescribed albendazole 400 mg twice daily for three days. The patient reported reduction in itching after two days of albendazole treatment and a follow up at ten days revealed a healed infection.

MeSH terms: Adult; Ambulatory Care Facilities; Animals; Animals, Domestic/parasitology; Feces/parasitology; Hospitals, University; Humans; Larva Migrans/diagnosis; Larva Migrans/drug therapy; Larva Migrans/etiology*; Malaysia; Male
Fulltext An arrow in the maxillary sinus

Harvinder S, Jenny L, Gurdeep S

Med J Malaysia, 2008 Oct;63(4):333-4.
PMID: 19385497

We experienced the case of a patient who had a foreign body in the maxillary sinus. The foreign body was an arrow accidentally triggered by the patient while fishing. The foreign body was removed via the Caldwell-Luc approach.

MeSH terms: Adult; Foreign Bodies/radiography; Foreign Bodies/surgery*; Hospitals, General; Humans; Malaysia; Male; Maxillary Sinus*
Fulltext Endoscopic resection of primary nasoseptal chondrosarcoma

Jenny L, Harvinder S, Gurdeep S

Med J Malaysia, 2008 Oct;63(4):335-6.
PMID: 19385498 MyJurnal

Chondrosarcoma of the nasal septum is an extremely rare malignant tumor. It accounts for only 10% to 20% of primary bone tumors, with approximately 10% found in the head and neck. A case is presented here to illustrate its presentation, evaluation and surgical treatment.

MeSH terms: Adolescent; Chondrosarcoma/pathology; Chondrosarcoma/radiography; Chondrosarcoma/surgery*; Endoscopy; Humans; Male; Nasal Septum*; Nose Neoplasms/pathology; Nose Neoplasms/radiography; Nose Neoplasms/surgery*; Tomography, X-Ray Computed
Fulltext Endoscopic orbital decompression for optic neuropathy in thyroid ophthalmopathy

Tang IP, Prepageran N, Subrayan V, Tajunisah I

Med J Malaysia, 2008 Oct;63(4):337-8.
PMID: 19385499 MyJurnal

Optic neuropathy, an uncommon manifestation occurs in 5% of patients with Graves' ophthalmopathy. Its outcome is good if early and proper treatment given. We reported a 49 years old male patient of Graves' disease with bilateral optic neuropathy. He underwent bilateral transnasal endoscopic orbital decompression with marked improvement of visual acuity bilaterally. The preoperative visual acuity was 6/36 in his right eye and 6/60 in his left eye. Two days after operation, his visual acuity was 6/12 in his right eye and 6/24 in his left eye. Transnasal endoscopic orbital decompression is a choice of treatment in optic neuropathy in thyroid ophthalmopathy after trial of corticosteroids.

MeSH terms: Case Reports; Endoscopy; Humans; Hyperthyroidism*; Malaysia; Malaysia/ethnology; Male; Middle Aged; Optic Nerve Diseases/surgery*; Visual Acuity; Decompression, Surgical/methods*; Graves Ophthalmopathy/complications*
Fulltext The use of paramedian forehead flap reconstruction after wide excision of basal cell carcinoma of the nose

Chew YK, Noorizan Y, Khir A, Brito-Mutunayagam S, Prepagaran N

Med J Malaysia, 2008 Oct;63(4):339-40.
PMID: 19385500 MyJurnal

Basal cell carcinoma (BCC) is an indolent, slow-growing malignant skin tumour. Approximately 70% of the tumours occur in the head and neck region. The nose is a common site for malignant skin tumours, such as basal cell carcinoma and squamous cell carcinoma because it is exposed to the sun. Excision of the BCC will leave the nose with a soft tissue defect which requires reconstruction. This report illustrates a case of BCC of nose whereby a wide excision and reconstruction was performed with a paramedian forehead flap.

MeSH terms: Aged; Carcinoma, Basal Cell/surgery*; Female; Forehead; Humans; Nose Neoplasms/surgery*; Rhinoplasty/methods*; Surgical Flaps*
Fulltext Cerebrospinal fluid rhinorrhoea secondary to amyloidosis of the sphenoid sinus

Ali EA, Philip R, Prepageran N, Peh SC

Med J Malaysia, 2008 Oct;63(4):341-2.
PMID: 19385501 MyJurnal

Amyloidosis of the skull base is a rare entity. A patient with localized amyloidosis of the sphenoid sinus presented at our institution with cerebrospinal fluid rhinorrhoea. Endoscopic excision of the lesion and multilayered obliteration of the sphenoid sinus resolved the symptoms.

MeSH terms: Amyloidosis/complications*; Amyloidosis/surgery; Cerebrospinal Fluid Rhinorrhea/etiology*; Humans; Male; Middle Aged; Paranasal Sinus Diseases/complications*; Paranasal Sinus Diseases/surgery; Sphenoid Sinus*
Fulltext Two stage penile reconstruction with free prefabricated sensate radial forearm osteocutaneous flap

Ramesh S, Serjius A, Wong TB, Jagjeet S, John R

Med J Malaysia, 2008 Oct;63(4):343-5.
PMID: 19385502 MyJurnal

Penile reconstructive surgeries are performed mainly as radical treatment for conditions associated with congenital abnormalities of the urethra or penis, after penile trauma, penile cancer, short penis, corporal fibrosis and in cases of gender reassignment. We present here a method of penile reconstruction with a pre fabricated radial forearm free flap incorporating the segment of the radius for structural support.

MeSH terms: Amputation, Traumatic/surgery*; Forearm; Humans; Male; Middle Aged; Penis/surgery*; Surgical Flaps*; Reconstructive Surgical Procedures/methods*
Fulltext Recurrent Chromobacterium violaceum infection in a patient with chronic granulomatous disease

Sureisen M, Choon SK, Tai CC

Med J Malaysia, 2008 Oct;63(4):346-7.
PMID: 19385503 MyJurnal

We report a rare case of recurrent infection of Chromobacterium violaceum in an immunocompromised patient. Despite the high mortality rate associated with this infection as reported in the literature, this patient survived three episodes of recurrent infection. We believe that with high clinical suspicion, prompt treatment and appropriate antimicrobial agents, it is possible for clinicians to treat this infection effectively and reduce the mortality rate.

MeSH terms: Child; Chromobacterium*; Granulomatous Disease, Chronic/complications*; Humans; Male; Recurrence; Gram-Negative Bacterial Infections/etiology*
Fulltext Endocannabinoid system and cardio-metabolic risk

Loh KY, Kew ST

Med J Malaysia, 2008 Oct;63(4):348-50; quiz 351.
PMID: 19385504 MyJurnal

Recent research in bio-medical science has shown an integral role of endocannabinoid system (ECS) in determining cardio-metabolic risk of human body. The mechanism is mediated through binding of endocannabinoids at the CB1 receptors. The stimulation of CB1 receptor in the brain is believed to control and mediate the effects on appetite. In normal physiology, CB1 receptors activation is responsible for energy homeostasis, govern emotions and behaviors such as anxiety, fear, appetite, food and water intake. CB1 receptors also found in peripheral tissues like liver, pancreas, skeletal muscles and adipose tissues, which play an important role in lipid and glucose metabolism. Over-activation of ECS is associated with various metabolic diseases such as dyslipidemia, insulin resistance, lipogenesis, excessive weight gain and increasing intra-abdominal obesity. All these events lead to increased cardiovascular risk. Use of selective CB1 receptor blocker such as rimonabant has shown to reduced waist circumference, better glycemic control, lower triglyceride levels, raise HDL cholesterol and over all reduction in total body fat. This drug has been recommended for patients with metabolic syndrome.

MeSH terms: Animals; Cardiovascular Diseases/etiology*; Humans; Obesity/etiology*; Piperidines/therapeutic use; Pyrazoles/therapeutic use; Metabolic Syndrome X/etiology*; Receptor, Cannabinoid, CB1/physiology; Cannabinoid Receptor Modulators/physiology; Endocannabinoids
GUT 2008. Abstracts of the Annual Scientific Meeting of the Malaysian Society of Gastroenterology and Hepatology, 21-24 August 2008

Med J Malaysia, 2008 Aug;63 Suppl B:1-69.
PMID: 19391197
MeSH terms: Animals; Digestive System Diseases*; Gastroenterology*; Humans
Incidence of microsporidia in cancer patients

Lono AR, Kumar S, Chye TT

J Gastrointest Cancer, 2008;39(1-4):124-9.
PMID: 19459072 DOI: 10.1007/s12029-009-9065-z

INTRODUCTION: Microsporidia are considered opportunistic pathogens as evidenced by the significant detection in immunocompromised HIV/AIDS population. Cancer patients receiving chemotherapy are considered to be immunosuppressed.
MATERIALS AND METHODS: Stool samples were collected from 311 cancer patients in the Klang Valley. Each sample underwent water-ether concentration and staining with modified trichrome stain.
RESULTS AND DISCUSSION: Sixty-eight samples were positive by oil immersion examination. Polymerase chain reaction amplification with specific primers on those samples amplified Encephalitozoon intestinalis from two of the samples and Encephalitozoon hellem from one sample.

MeSH terms: Adult; Aged; Female; Humans; Male; Middle Aged; Neoplasms/microbiology*; Incidence; Polymerase Chain Reaction; Microsporidia/isolation & purification*; Microsporidia/ultrastructure; Microscopy, Electron, Transmission
Fulltext Exploring why girls smoke in Malaysia--a qualitative approach

Al-Sadat N, Binns CW

Asia Pac J Public Health, 2008 Oct;20 Suppl:6-14.
PMID: 19533855

The fast increase in the rate of uptake of smoking amongst adolescent girls in Malaysia is a public health concern. The objective of this study was to investigate factors that influenced the initiation of smoking and the effects of advertisement on consolidating the smoking habit among teenage girls in the urban city of Kuala Lumpur. Qualitative research was conducted using both interviews and focus group discussions with groups of adolescent girls. Data collected was analysed using grounded thematic theory methodology and validated using methodological triangulation. The reasons for initiating smoking elicited from the study can be grouped into 4 general themes; influence by peers, influence of seeing parents smoking, misguided belief that it could alleviate stress and finally that it would impress others. Smoking imageries in media and advertisements were not primary influencing factors in the initiation of smoking but it encouraged them to progress to become regulars. Ways should be sought to empower girls to feel more confident about resisting pressures to initiate smoking. This could be done through activities such as positive peer sports, education on how to alleviate stress and curbing of smoking imageries in the media.

MeSH terms: Adolescent; Adolescent Behavior/psychology*; Advertising as Topic; Female; Humans; Health Knowledge, Attitudes, Practice; Malaysia; Sex Factors; Smoking/psychology*; Social Behavior; Young Adult
A biomarker for exposure to organophosphate and carbamate pesticides

Lubis SH, El Sersi M, Hussein SH, Sakian NI, Salleh R, Rafai J, et al.

Asia Pac J Public Health, 2008 Oct;20 Suppl:162-5.
PMID: 19533876

A cross sectional study was conducted to investigate the effects of pesticide exposure (organophosphate and carbamate) using nerve conductive velocity, current perception threshold (CPT). Cluster random sampling was employed to recruit 64 paddy farmers and 22 fishermen in June 2006. The duration of pesticide exposure was between (5-20) years. The CPT values were measured using Neurometer CPT/Eagle, on the index finger and the great toe with three neuroselective frequencies range (2000, 250, and 5 Hz). The results showed that at the three different frequencies, the CPT values were significantly elevated among farmers on both the medial and peroneal nerves (P < .002). The measurement of CPT can be used as a biomarker to determine and monitor the effects of organophosphate and carbamate exposure among workers who may have been exposed.

MeSH terms: Adult; Aged; Agricultural Workers' Diseases/chemically induced*; Agricultural Workers' Diseases/diagnosis*; Agricultural Workers' Diseases/physiopathology; Agriculture; Carbamates/poisoning*; Cross-Sectional Studies; Fisheries; Humans; Malaysia; Middle Aged; Neural Conduction/drug effects*; Neural Conduction/physiology; Peripheral Nerves/drug effects*; Peripheral Nerves/physiopathology; Pesticides/poisoning*; Sensory Thresholds/drug effects; Sensory Thresholds/physiology; Occupational Exposure; Young Adult; Organophosphate Poisoning*

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