Introduction: Nasopharyngeal Carcinoma (NPC) is the second most common cancer among men in Malaysia. Establishing local data will help to improve the treatment strategies and lower the anxiety and depression level among NPC patients. Our aim was to compare the level of symptoms of anxiety and depression and the coping strategies employed between NPC and cancer-free patients. Methods: A comparative cross-sectional study with universal sampling was conducted on 22 NPC patients and 30 cancer-free patients from the Oncology and Radiotherapy Department and Ear, Nose and Throat clinic of Hospital Kuala Lumpur (HKL) between 12 to 29 May 2008. In this study, the symptoms of depression and anxiety were obtained by using the Hospital Anxiety and Depression Scale (HADS) while Brief COPE questionnaire was used to understand patients’ coping strategies. Results: The prevalence of NPC was higher in the Chinese, men, aged between 40 and 59 years, and those from the lower income group. The levels of anxiety and depression symptoms were found to be higher in the NPC group as compared to the cancer-free group. However, only the level of depression was found significantly related to the NPC group (p=0.002). This study also found that the two comparison groups were
using different types of coping strategies. The NPC patients mainly used ‘acceptance’ as their coping strategy while the comparative group most often used ‘religion’. Among the types of coping strategies reported by the patients, ‘use of instrumental support’ type was found to be associated with a lower level of anxiety (p = 0.035) and ‘humour’ type was associated with lower depressive symptoms (p = 0.269). On the contrary, ‘selfblame’ type was associated with both anxiety (p =0.0001) and depression (p = 0.001) symptoms. In addition, patients with different gender, ethnicity, educational levels, and
monthly income were also found to have significant differences in their levels of anxiety and depression as well as type of coping strategies. Conclusions: NPC patients had higher anxiety and depression levels as compared to the comparative group. Different socio-demographic backgrounds and different types of coping strategies had an influence on patients resulting in different levels of anxiety and depression.
Study site: ENT clinic, Hospital Kuala Lumpur, Malaysia
Objective: To assess the prevalence of iron deficiency, anaemia and iron deficiency anaemia (IDA) in women aged 20-40 years and its association with iron intake. Methods: A total of 388 women were recruited from universities and work sites in Kuala Lumpur and its suburbs. The subjects comprised 135 Malays, 130 Chinese and 123 Indians. Dietary intake was estimated using a single 24-hour food recall and a semi-quantitative food frequency questionnaire. Haemoglobin (Hb), haematocrit (hct), mean corpuscular volume (MCV) and serum ferritin were determined. Results: The prevalence of anaemia (Hb
Introduction: HIV/AIDS is one of the leading health problems worldwide. There is an increasing rate among the ages between 13 to 49 years old. School based intervention is an important component of community-based interventions for HIV/AIDS and is the best stage to promote abstinence which is best maintained among those not sexually experienced. Objectives: This study was carried out to determine attitude towards sex among secondary school children in Selangor state. Methods: A cross-sectional study design was used. Four out of nine districts in Selangor state were selected at random. Students were divided according to gender, academic performance (good or poor) with no behavioural problems
and students with evidence of behaviour problems (at risk). Results: Out of 149 students, the majority (56.4%) were females. The majority of students did not think sex should be discussed in depth and do not speak to parents, teachers, religious teachers, counselors, relatives, doctors or nurses but speak to friends regarding sex. More than half watch pornography. A significantly higher percentage of male students in the weak and at-risk group admit to thinking of intimacy (hugging and kissing) with the opposite gender. A higher number of these students would try sex out of curiosity, for fun, because it was difficult to say ‘no’ to and that they would like it. A significantly higher percentage will try sex because they did not want to hurt their girlfriends’ feeling by saying ‘no’. While the majority of students think intimacy will end in sex, a significantly higher percentage of male at-risk students think just talking with the opposite gender will end in sex. The majority of male students responded feeling attracted to the picture of a girl in sexy clothing but a significantly higher percentage of at-risk students also felt attracted to the picture of a girl properly attired. A significantly higher percentage of male at-risk students say parents do not say sex before marriage is wrong and a significantly higher percentage of
male students of weak and at-risk groups say girlfriends say sex before marriage is okay. A significantly higher percentage of weak and at-risk students speak to doctors regarding sex and think sex should be discussed in depth. Conclusion: Weak and at-risk male students appeared to have a more vulnerable attitude towards sex. This may predispose them to risky sexual behaviours leading to HIV/AIDS. Poor academic performance and behaviour problems may not be different as potential sexual risk predictors. The information obtained will be useful in designing intervention programmes in the prevention of HIV/AIDS.
MeSH terms: Problem Behavior; Acquired Immunodeficiency Syndrome; Child; Clothing; Counseling; Cross-Sectional Studies; Emotions; Erotica; Exploratory Behavior; Female; Humans; Male; Marriage; Parents; Schools; Sexual Behavior; Sexual Partners; Students; Friends
Objective: The purpose of this study was to evaluate the clinical behaviour, pathological findings, survival and prognostic factors in young women in comparison to menopausal women with epithelial ovarian malignancy. Methods: A retrospective analysis of 141 patients (67 for age below 40 years and 74 menopausal) treated between 1980 and 2000 was conducted. Results: Irrespective of the stage, the most common clinical presentation was abdominal distension in both young (78%) and menopausal women (66%). In young women, 52% presented at an early stage of the disease and in menopausal women this was seen in 22% (p-value
Toxoplasmosis, caused by an intracellular protozoan parasite, Toxoplasma gondii, is widespread throughout the world. The disease is of major medical and veterinary importance, being a cause of congenital disease and abortion in humans and in domestic animals.[1] In addition, it has gained importance recently due to toxoplasma encephalitis in AIDS patients.[2] T. gondii was discovered 100 years ago. Its identification was rapidly followed by the recognition that it was a human pathogen. During the past 100 years, the spectrum of diseases caused by this ubiquitous pathogen has expanded to include both congenital and acute infections as well as the recognition of diseases caused by this pathogen in the immune-compromised host. Recent data on behavioural changes in animals due to chronic toxoplasmosis is leading to research on the effect of this pathogen on the behaviour of humans.[3] Experimental studies on T. gondii have resulted in it becoming a model organism for studies on host pathogen interactions. Integration of clinical and experimental data on T. gondii should continue to lead to important insights into improvements in diagnosis for clinical management and vaccine development for control of toxoplasmosis.
Introduction: Accurate yet inexpensive methods for measuring free-living energy expenditure (EE) are
much needed. The aim of this study was to determine the feasibility of heart-rate monitoring method
(HRM) in measuring EE as compared to the established activity diary (AD) method. Methodology:
Minute-by-minute HRM and an activity diary (AD) were used simultaneously in 34 young adults (18
females, 16 males; mean age 21.5 ± 1.5 years). Estimates of the EE from HRM were based on individual
calibration using the Flex-HR procedure while EE from AD were calculated using both individually
measured and published energy cost of various activities. Total daily energy expenditure (TDEE) and its
components (EE during sleep, during rest and during physical activity) were compared using Student
paired-t tests. Results: TDEE from HRM method averaged 8.17 ± 2.00 MJ/day compared to 8.50 ±
1.28 MJ/day from AD method. Although large intra-individual differences were found (ranging from
-36.9% to 47.4%), there was no significant difference between the two methods (mean difference -3.6 ± 19.4%). The limits of agreement (mean ± 2SD) were -3.77 and 3.11 MJ/day. There were no significant
differences for any of the TDEE components between the two methods, except for EE during sleep
(p
MeSH terms: Adult; Calibration; Energy Metabolism; Female; Humans; Individuality; Male; Motor Activity; Rest; Sleep; Students; Young Adult
Objective: This study investigates functional specialisation in, and effective connectivity between the
precentral gyrus (PCG) and supplementary motor area (SMA) in seven right handed female subjects.
Methods: Unimanual (UNIright and UNIleft) and bimanual (BIM) self-paced tapping of hand fingers were
performed by the subjects to activate PCG and SMA. Brain activations and effective connectivity were
analysed using statistical parametric mapping (SPM), dynamic causal modeling (DCM) and Bayesian
model selection (BMS) and were reported based on group fixed (FFX) and random (RFX) effects
analyses. Results: Group results showed that the observed brain activation for UNIright and UNIleft fulfill contralateral behavior of motor coordination with a larger activation area for UNIright. The activation for BIM occurs in both hemispheres with BIMright showing higher extent of activation as compared to BIMleft. Region of interest (ROI) analyses reveal that the number of activated voxel (NOV) and percentage of signal change (PSC) on average is higher in PCG than SMA for all tapping conditions. However, comparing between hemispheres for both UNI and BIM, higher PSC is observed in the right PCG and the left SMA. DCM and BMS results indicate that most subjects prefer PCG as the intrinsic input for UNIright and UNIleft. The input was later found to be bi-directionally connected to SMA for UNIright. The bi-directional model was then used for BIM in the left and right hemispheres. The model was in favour of six out of seven subjects. DCM results for BIM indicate the existence of interhemispheric connectivity between the right and left hemisphere PCG. Conclusion: The findings strongly support the existence of functional specialisation and integration i.e. effective connectivity in human brain during finger tapping and can be used as baselines in determining the probable motor coordination pathways and their connection strength in a population of subjects.
Introduction: In recent years there has been an increase in the number of young people in prison. This
study is the first to look at the proportion of psychiatric disorders among young adult prisoners. Objective: The main objective is to determine the percentage of psychiatric disorders among young adult male prisoners Method: A cross sectional study of young adult male prisoners, with ages ranged between 18 and 21 years old, was conducted between September and December, 2008 at the Kajang Prison. A total of 225 inmates participated in the study which used the Mini International Neuropsychiatric Interview (M.I.N.I) as its instrument. Results: The percentage of psychiatric disorders was 60.0%. Alcohol and substance related disorders had the highest prevalence at 50.2%, followed by Major Depressive Disorders and Dysthymia at 16.9%. About 39.6% were observed to have antisocial personality disorder. Psychiatric disorders were found to have significant differences (p
Introduction: Schoolbag weight across different types of school and schoolbag content has not been
studied in Malaysia. This cross sectional survey determines the weight of schoolbags, its content and
occurrence of back pain among primary school children in different medium primary school in Kuala
Lumpur. Methods: Students’ body weight, and schoolbags weight were measured using a calibrated
scale. Schoolbag content was examined, and weighed according to necessary learning materials
or unnecessary materials. Back pain in the past one week was assessed using a self-administered
questionnaire, adapted from previous studies. Results: A total of 358 students (167 male, 191 female)
were enrolled, of which 119 were from National School (NS), 122 from Chinese Medium School (CMS)
and 117 from Tamil Medium School (TMS). The mean schoolbag weight was 4.55±1.62kg for NS,
8.53±1.94kg for CMS and 6.06±2.09kg for TMS, which was 11.7%, 22.0% and 16.6% of body weight,
respectively. The mean weight of unnecessary schoolbag content was 0.64(0.91)kg for NS, 2.18(1.49)kg for CMS and 1.96(1.56) for TMS students. Back pain was detected in 87.0% NS students, 68.0% CMS students and 66.7% TMS students. Significant association was found between occurrence of back pain and types of school ( 2=16.64,p=0.00). Conclusions: Students from all the three mediums primary school, in particular Chinese medium school carry school bag heavier than that generally recommended, with unnecessary materials weigh up to 2kg. The occurrence of back pain is high and this is associated with the types of school.
MeSH terms: Back Pain; Body Weight; Child; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Surveys and Questionnaires; Schools; Students
Introduction: This study examined a cognitive model of depression among undergraduate students of
medical and allied health sciences. Methods: Participants (N = 279) completed a series of questionnaires related to depression (Beck Depression Inventory-Malay), negative cognitions (Automatic Thoughts Questionnaire-Malay), dysfunctional attitude (Dysfunctional Attitude Scale-Malay), stressful life events (Life Events Survey), self-efficacy (General Self-Efficacy) and quality of life (WHO Quality of Life- BREF). Results: Results of descriptive analysis revealed a higher percentage of severe depression among males when compared to female students. Results of structural equation modeling indicated an adequate fit of the model ( 2= 21.29, df = 15, p > .13; GFI = 0.97; CFI = 0.97; RMSEA = .04).
Conclusion: The findings also indicated the potential roles of self-efficacy in mediating depression.
The results are discussed in terms of self-regulating strategies of managing depression and the roles that university authorities may play in helping students to regulate depression.
MeSH terms: Cognition; Depression; Depressive Disorder, Major; Female; Life Change Events; Male; Quality of Life; Surveys and Questionnaires; Students; Universities; Self Efficacy
Hypertension is one of the major risk factors for coronary heart disease and the most important factor for cerebrovascular diseases. Adherence to treatment is a fundamental pre-requisite for therapeutic benefit in hypertensive patients. Adherence is a complex behavioural process that is strongly influenced by the way in which patients live, as well as the psychological and social support system.
Aim: To understand and conceptualize the experience of people on long-term antihypertensive treatment Method: Qualitative analysis using semi-structured interviews with ten hypertensive patients from the medical clinic of Kuala Lumpur General Hospital.
Results: Although the participants were aware of having high blood pressure they declined receiving any treatment at the early stage of the disease. Fear of death and disease complications are reinforcements for participants to adhere to medication. They perceived the label of “hypertension” will affect their self-identity and social role. Positive thinking regarding medication assists participants to adhere to treatment. Conversely, participants who perceived medication negatively also adhere to a medication regime, as adherence behaviour satisfies the family. Participants justified modifying their regimen or taking Complementary and Alternative Medicine (CAM) as they believe know the their body best. However, participants wished to obtain more information regarding hypertension and its treatment from the doctors.
Conclusion: In finding the fine balance between stepping in and holding back treatment and care, health professionals need to know their clients in context. This balance can only be achieved by establishing processes of negotiation within an ongoing therapeutic relationship.
Study site: medical clinic of Kuala Lumpur General Hospital.
Introduction: The Cyclooxygenase-2 (COX-2) enzyme is responsible for the synthesis of prostaglandin which is responsible for inflammation and pain. Celecoxib a cyclooxygenase-2 inhibitor was first used as a non-steroidal anti-inflammatory drug in 1999. Celecoxib is as effective as NSAIDs but causes less ulceration of the gastrointestinal tract, hence it is commonly used. It has been widely used in patients with osteoarthritis and rheumatoid arthritis. We present 3 cases of temporary psychiatric disorders associated with consumption of celecoxib, two of the patients presented with auditory hallucinations while one was diagnosed to be having depression. None had pre-existing psychiatric disorders or consumed alcohol or substance of abuse. All 3 patients recovered from their temporary psychiatric disorders after stopping celecoxib. Discussion: It is important to be aware of the psychiatric side effects when prescribing the drug for prolonged periods.
Background: Vertigo Symptom Scale (VSS) by Yardley et al. (1992) is one of the disease specific
questionnaires used widely in clinical settings. It is conducted in English and had been translated into six languages including Dutch, French, German, Spanish, Swedish, and Turkish. It has been acknowledged as a good subjective tool to determine the severity of balance disorders. Objective: To develop a valid Malay version of VSS (MVVSS) using appropriate translation methods and validation technique. Method: Forward and backward translation was performed by four professionals from different fields. The translated questionnaire was then assessed for its test reliability based on an experiment on 30 normal subjects. Further, to determine the cultural adaptation issues, the face validity of MVVSS was assessed from 32 normal subjects. They were asked to fill in the MVVSS questionnaire accordingly and give opinions regarding its language, understanding and overall format of questionnaire. Results: Final results of the translation process showed sufficient concurrence among the professionals involved. The reliability test among the normal subjects also showed a high Cronbach’s alpha value (0.90). The face validity method on 32 subjects (mean age of 29.9 ± 9.2 years) showed good feedbacks in terms of language, understanding and overall format of the MVVSS. Conclusion: The translation process was successful and the further validation showed an adequate face validity response. This suggests that our MVVSS has been culturally adapted and can be used in all Malay conversing patients.
MeSH terms: Ethnic Groups; Hispanic Americans; Humans; Language; Surveys and Questionnaires; Sweden; Translations; Vertigo; Reproducibility of Results
Introduction: The vast majority of in vitro research on microglia are based on cells isolated from
neonatal animals (3-5 days of age). Studying microglia of adults has been limited by the lack of a suitable culture system that supports their growth. In this study, we describe a protocol for growing microglia of adults based on modifications of the technique for culturing microglia isolated from neonatal rats. Methods: Mixed glia isolated from adult rats (age range of 1 month to 3 years old) were seeded in
culture flasks coated with poly-L-lysine. Cells were maintained in DMEM media supplemented with
insulin-transferrin-selenium (ITS) and recombinant human macrophage colony-stimulating factor
(M-CSF). Mild trypsinisation was carried out to isolate microglia from mixed glia culture. Results:
Microglia cells of adult rats were successfully grown in vitro. For the expansion of adult microglia,
it was observed that coating the cell culture flasks with poly-L-lysine was crucial to encourage cell
adherence. The substitution of insulin in culture media with ITS was found to improve cell yield and
reduced the number of days required for culture from 28 days to 14 days. Addition of M-CSF to cell
culture medium, along with the improvisations described above provided the best adult microglia cell
yield (2.91 ± 0.56 x 106 cells) compared to the technique of replating cells (0.91 ± 0.65 x 106 cells;
p
This study targeted two candidate genes from the best known regulator of blood pressure; the rennin angiotensin system; the ACE gene I/D polymorphism and the angiotensinogen M235T polymorphism. The study aimed to determine the genotypes trend between two different populations; the primary hypertensive patients, and the normal populations. 126 subjects were involved in this study (86 primary hypertensive patients and 40 normal individuals). All demographic factors were considered and analyzed. Insertion/deletion polymorphisms of the ACE gene were determined by an assay based on the polymerase chain reaction (PCR). Polymorphism analysis using PCR-RFLP procedure was used to identify the missense mutation M235T of the AGT gene. All significant data was collected using standardized case report form. The association of the different genotypes and the subjects’ condition was analyzed using the chi squared and odds ratio analyses. In the pooled analysis of both groups, it was shown that the polymorphisms in these genes were significantly associated with the incidence of primary hypertension, p<0.05. Results also showed that the D allele of the ACE gene may be associated with increased risk of primary hypertension (p<0.05, O.R: 3.0 [C.I: 1.25 – 5.35]). The angiotensinogen M235T polymorphism also showed a significant result; the T allele is associated with increased risk of primary hypertension (p<0.05, O.R: 2.56[C.I: 1.55 – 5.28]). This knowledge of the candidate genes of rennin angiotensin system has rendered it possible to show that gene polymorphism in symphony leads to the individual risk of primary hypertension.
Keywords: ACE, M235T, rennin, hypertension
Study site: University Kebangsaan Malaysia Medical Center and International Medical University Cardiology Clinic
Objective: Mesenchymal stem cells (MSC) are multipotent, non-haematopoietic stem cells that are
capable of differentiating into different varieties of mature cell types such as osteoblasts, chondrocytes, adipocytes, and myoblasts. There is abundant evidence showing that MSC not only affect the differentiation of haematopoietic progenitors, but also the function of mature cells like lymphocytes and neutrophils. However the effect of MSC on neutrophil function and its responses is not well studied. Therefore, this study was conducted to assess the effect of MSC on neutrophil nitric oxide production. Method: Neutrophils from heparanised venous blood were isolated using Ficoll-Hypaque density gradient centrifugation followed by Dextran sedimentation and red blood cell (RBC) lysis. Isolated neutrophils were on average of 97% purity as determined by morphologic analysis. MSC were generated from human bone marrow and characterised by immunophenotyping (monoclonal antibodies CD105, CD73 and CD34) using a flowcytometer. In order to test the effects of MSC on neutrophil function, isolated neutrophils were co-cultured in the presence or absence of MSC at different ratios for 24 and 48 hours. The amount of nitric oxide released was used as an indication of oxidative burst and measured using the Griess assay. Result: The results indicate that MSC neither elevate the NO level when cocultured with resting neutrophils nor alone. However MSC profoundly inhibit the secretion of nitric oxide in PMA stimulated neutrophils after 24hr of incubation. Conclusion: MSC exert an immunomodulatory effect on neutrophil by suppressing neutrophil oxidative burst in vitro.
Background: Patients’ satisfaction with their nursing care is an important issue in assessing the quality
of nursing care. In Iran, cancer patients’ satisfaction at teaching hospitals of Tehran City has not been
investigated. Aim: A cross sectional study was conducted to determine the level and identify factors that contributed to patients’ satisfaction in nursing care provided at selected teaching hospitals in Tehran City, Islamic Republic of Iran. Method: A proportional stratified sampling method was used and data were collected via face-to-face interview based on a validated Patient Satisfaction Questionnaire (PSQ). A total of 384 cancer patients aged 14 years and above were selected. Result: The majority of respondents were males (201, 52.4%), age group 45-54 years (102, 26.4%); employed (202, 52.6%) and with a family monthly income of US$200-500 (234, 60.9%).The majority (314, 81.8%) of respondents were hospitalized between 2 to 5 days, and most (204, 54.0%) of them were admitted to teaching hospital B of The University of Medical Science.1 A majority of the respondents (318, 82.8%) was satisfied with the nursing care provided, while the others (66, 17.2%) were not. Generally, most of the respondents were satisfied with the amount of information given by the nurses (294, 76.6%), technical quality (295, 76.8%), interpersonal relationship (371, 96.6%), and physical environment (267, 69.5%). There was a positive significant relationship between patients’ satisfaction and type of hospital ( 2=4.985; df=1; p=0.026, n=384). Using the University’s hospital type was found to be the best predictor for level of satisfaction. Conclusion: Most of the respondents were satisfied with the nursing care. However, the respondents suggested several improvements such as increasing the number of doctors, improving socioenvironment factors in terms of privacy and interpersonal relationship, and improving on the existing facilities. Further research is needed to study in depth the socio-cultural and environment parameters which are relevant to patients’ satisfaction with nursing care.
A 42 years old gentleman presented with predominant low back pain associated with bilateral lower limb neurological deficit leading to an initial diagnosis of lumbar stenosis. Further history taking and examination revealed upper limb neurological deficit, and the lower limbs actually presented with upper motor neuron instead of lower motor neuron signs. Imaging studies confirmed the clinical findings with presence of both cervical and lumbar spinal stenosis. Twostage decompression procedures were performed at 6 monthintervals starting with cervical decompression. Postoperative improvement was noted on follow-up. This case highlights the importance of accurate diagnosis of cervical pathology for patients presenting with or referred for predominantly lumbar symptomology
MeSH terms: Constriction, Pathologic; Follow-Up Studies; Humans; Lumbosacral Region; Medical History Taking; Motor Neurons; Neck; Spinal Stenosis; Low Back Pain; Decompression, Surgical; Upper Extremity; Lower Extremity
Necrotising fasciitis caused by Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a new entity. Although it is recognised worldwide, there have been no reported cases to date in Malaysia. We report a case of necrotising fasciitis of the left lower limb in an otherwise healthy 20-year-old man. He presented with septic shock and despite the paucity of clinical signs in the limb, the infection was aggressive. Methicillin-Resistant Staphylococcus aureus (MRSA) was isolated from the deep fascia of the leg. Panton-Valentine leucocidin gene (PVL), which is a stable genetic marker for CA-MRSA strain, was positive in this case. This case of community acquired MRSA necrotising fasciitis is of concern and may herald the emergence of this resistant organism in Malaysia. Vigilant surveillance and microbiological monitoring is needed to follow this CA-MRSA trend.
We report a case of a 59-year-old female who presented in the general orthopaedic clinic with triggering of her right middle finger. She did not respond to conventional treatment methods; subsequently she underwent surgical open release under local anaesthesia. Five months postoperatively, the patient presented with signs and symptoms of acute flexor tenosynovitis, and was thought to have a postoperative infection. Re-examination by a hand surgeon raised the possibility of a different aetiology. Based on clinical findings and response to initial treatment, giant cell tumour of the flexor tendon sheath was suspected and later confirmed following surgical biopsy. A high index of suspicion and knowledge of the variegated presentations of giant cell tumour in the hand are beneficial in these types of cases.