Objective: This case report highlights folie a duex of a caregiver that complicate the management of a case of childhood onset schizophrenia.
Methods: We report a case of a young Malay girl with symptoms of schizophrenia and her caregiver who share her delusion.
Result: Folie a duex in the caregiver caused difficulty in the initiation and maintenance of treatment of a child with schizophrenia.
Conclusion: Treating children with schizophrenia is not easy and could be complicated by the folie a duex in caregiver. Although Child Act 2001 can be applied in order to deliver appropriate treatment to this group of patients, one must be cautious about the implication in therapeutic alliance.
Objective: Truancy is a disciplinary problem, which frequently occurs among school students and it has many contributory as well as inter-related factors. It is a growing problem in this country and it often becomes a prelude to other delinquent behaviours. The study objective is to determine the prevalence of truancy as well as factors related to it including psycho-behavioural factors. Methods: A cross-sectional study involving 556 Malay student’s selected using multi-stage sampling was conducted. Results: The overall prevalence of truancy is 30.2%. The predictors to truancy are age, students who frequenting entertainment centre, students who have not completed Quran recital, coping strategies using problems solving methods and time spent watching television/video. There is a significant association between truancy and psycho-behaviour such as watching video/internet pornography, frequenting entertainment centre, smoking, motorcycle racing and dating a special friend. Conclusion: Truancy is a social issue, which must be given serious attention by all concerned components of the society.
Objective: The objective of this study is to identify the correlation between psychological factors and insomnia and the impact of insomnia on daytime sleepiness. Methods and Results: The participants were recruited through convenient sampling and consist of 173 working adults in Georgetown, Penang, aged 20 to 60 years. Participants completed the General Health Questionnaire (GHQ), Athens Insomnia Scale (AIS) and Epworth Sleepiness Scale (ESS). The results revealed that the prevalent of insomnia was 34.7%. There was a positive correlation between psychological distress and insomnia r = .481, p < .001 and also a positive correlation between insomnia and daytime sleepiness r = .334, p < .001. Conclusion: It is concluded that psychological distress typically causes sleep difficulties, and sleep deprivation leads to daytime sleepiness.
MeSH terms: Adult; Humans; Disorders of Excessive Somnolence; Sleep Initiation and Maintenance Disorders; Surveys and Questionnaires; Sleep Deprivation; Sleep Stages; Stress, Psychological; Prevalence
Objective: The objective of this study was to determine the prevalence of the most common phobias and associated factors among university students. Methods: This cross-sectional study was carried out at Management and Science University (MSU). Random sampling was performed throughout all faculties. The questionnaires were distributed randomly at classes, library and university cafe within MSU. Diagnosis of anxiety disorders were established according to DSM-IV criteria. These criteria are included in Liebowitz Social Anxiety Scale (LSAS). The questionnaire consists of two sections. The first section consists of socio-demographic characteristics such as (age, sex, race, type of faculty and income); the second section is LSAS standard questionnaire. Multiple linear regression using backward analysis was performed to obtain the associated factors. Results: A total number of four hundred sixty eight (468) students participated in this study. The majority of them were older than 20
years old, female, Malay and from non-medical and heath faculties (59.6%, 69.6%, 77.8%, 68.8%; respectively). Regarding history of abuse during childhood, the majority of the university students reported that there was no sexual, physical and emotional abuse during childhood (98.5%, 97.4%, 82.1%; respectively). The majority of the students (53.85%) reported that they have phobia. The highest type of phobia reported among university students was phobia from snake (11.5%), followed by speaking in front of crowd (9.2%) and the lowest were phobia of speed, dolls phobia, ropes phobia. Types of faculty, smoking status and history of physical abuse during childhood were the factors that significantly influence the social anxiety among university students in univariate and multivariate analysis. Conclusion: The prevalence of phobic symptoms among university students was
high types of faculty; smoking status and history of physical abuse during childhood significantly influenced social anxiety among university students. Education and counseling university students is necessary to educate the students who suffer from phobia to cope with different situations during study period.
MeSH terms: Physical Abuse; Anxiety; Anxiety Disorders; Counseling; Cross-Sectional Studies; Female; Humans; Malaysia; Phobic Disorders; Surveys and Questionnaires; Smoking; Students; Universities; Prevalence; Multivariate Analysis; Linear Models; Diagnostic and Statistical Manual of Mental Disorders
Kerion is an inflammatory type of tinea capitis which can be mistaken for bacterial infection or folliculitis as both conditions display similar clinical features. It occurs most frequently in prepubescent children and rarely in adults. We report a 26-year-old woman who presented with multiple tender inflammed nodules on her scalp. Her condition was misdiagnosed as bacterial abscess and treated with multiple courses of antibiotics without improvement. Later, her condition was re-diagnosed as kerion based on clinical appearance, history of contact with infected animal and Wood's lamp examination. symptoms and lesions resolved completely with systemic antifungal treatment leaving residual scarring alopecia. The delay in the diagnosis and treatment of this patient resulted in permanent scarring alopecia.
A nasopharyngeal (Tornwaldt's) cyst is uncommon. It is often asymptomotic; however it may cause problem if it too big becomes. We present a case of a 24-year-old Malay girl who had been a habitual snorer for years but was unaware of the significance of her problem. Opportunities for an earlier referral and assessment were missed since we were not aware of her history despite previous related but non-specific consultations at our primary healthcare centre. She was referred to us a few years later when her nasopharyngeal cyst became infected. After a course of antibiotics, she proceeded with an endoscopic resection of the nasopharyngeal cyst. A follow-up visit six months later did not reveal a recurrence. This case highlights the importance of a good history for the diagnosis of a nasopharyngeal cyst.
MeSH terms: Anti-Bacterial Agents; Cysts; Endoscopy; Female; Follow-Up Studies; Humans; Malaysia; Neoplasm Recurrence, Local; Primary Health Care; Referral and Consultation
Complications that may occur while performing myomectomy in pregnancy can be prevented in a well-optimised surgery. Counselling and comprehensive peri-operative preparations are mandatory to minimise litigations and untoward events. Myomectomy in pregnancy remains a contentious issue. Degeneration of fibroid during pregnancy is common. However, conservative management suffices in majority of cases. In non-responsive conservative treatment, myomectomy may be an option. This article discusses our experience in treating a 38-year-old woman in her fourth pregnancy at 15 weeks gestation with symptomatic uterine fibroid. She had persistent abdominal pain since nine weeks gestation. She developed fever and acute abdomenat at 15 weeks and the uterus was larger than dates.Ultrasound scan confirmed single pregnancy with a large intramural fibroid showing degenerative changes. A myomectomy was performed as a preventive measure to prevent massive haemorrhage. Although performing myomectomy during pregnancy is considered controversial, complications can be minimised with properly-planned surgery.
Vitamin B12 deficiency is a well-known cause of megaloblastic anaemia and pancytopenia. However, the incidence in pregnancy is rarely reported. We present a case of a 32-year old multigravid woman who was diagnosed with megaloblastic anaemia since 22 weeks gestation and progressed to develop severe pancytopenia at 30 weeks gestation. She was also diagnosed with vitamin B12 deficiency related to dietary and sociocultural habits. Folate and iron levels were normal throughout pregnancy. Treatment with parenteral cyano-cobalamin resulted in sustained improvement of haematological parameters. The pregnancy was carried to term and the baby was born weighing 2,050gm but otherwise well at birth and had normal developmental milestones thereafter. This case illustrates the clinical presentation of maternal vitamin B12 deficiency and demonstrates the importance of detecting and treating maternal vitamin B12 deficiency during pregnancy in at-risk patients. Failure to diagnose and institute treatment carries significant risks to both mother and child. Oral vitamin B12 supplementation should be considered for patients who are strict vegetarians or consume very little animal products.
Neck mass is a common condition in primary care. The most common affected area is the cervical lymph node. The neck region is also prone infection as structurally the nodes and spaces are in close contact with the upper respiratory tract and the alimentary tract. Oral cavity is one of the most common route for harbouring infection. Poor oral hygeine and periapical dental problems are the main causes. Thus, it is important to perform a complete oral cavity examination even when trismus is present. Besides dental caries, floor of the mouth should be inspected for oedema that may impose threat to the upper airway. We report a case of Ludwig's angina originating from a periapical lesion of the lower molar stressing the importance of oral examination in patient with neck mass.
Objective: To determine the prevalence of eye diseases and visual impairment among new patients at the eye clinic of Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang. Method: In this cross-sectional prospective study, 1081 new patients were examined over a period of six months. Age, gender, ethnicity, visual acuity and diagnosis were noted from the medical records. Results: Out of 1081 examined, 607 (56.1%) were males, 783 (72.4%) were Malays. The mean age of patients was 45.2 years (ranging from one month to 91 years). Cataract (248, 22.9%) was the most common eye disease, followed by retinal diseases (124, 11.5%) and ocular trauma (106, 9.8%). Majority of the patients (48) suffering from ocular trauma
had foreign body cornea. In 85 premature infants screened for retinopathy, 19 showed different stages of retinopathy of prematurity. Visual impairment was noted in 89 (8.2%) patients, severe visual impairment in 12 (1.1%) and blindness in 35 (3.2%); vision could not be determined in 85 premature infants (7.9%). Cataract was singled out as the cause of severe visual impairment in 11 out of 12 patients. Conclusion: Health education at primary health centres and availability of eye specialists in all the district hospitals will facilitate the rehabilitation of visually impaired and blind persons by providing early treatment for eye problems (specifically prescription for spectacles, medical treatment and cataract surgery with intraocular lens implantation).
This paper highlights an uncommon complication of a percutaneous transthoracic needle biopsy (PTNB). A patient with rheumatoid arthritis who was on immune suppressive drugs underwent a PTNB of a lung nodule. The histology showed “organizing usual interstitial pneumonia-like changes.” Unfortunately, one month after the PTNB, she developed a large deep-seated chest wall abscess at the biopsy needle tract and the previously seen lung nodule was larger. Nocardiosis sp. was isolated from the chest wall abscess. The lung and chest wall lesions were resolved with Bactrium and Fluconazole. The final diagnosis was pulmonary nocardiasis complicated by chest wall seeding following the PTNB procedure.
New generations of scientists and other academics who have grown up with social networking and viewsharing as a way of life are becoming movers in research communities, ushering in the use of networking as a standard knowledge sharing tool.Additionally, emerging economies, especially the BRIC countries (Brazil, Russia, India, and China), are creating new demand for access and new content. The exponential growth of cheap and reliable Internet access in these emerging economies is enabling access to online materials as never before. India and China are expanding their research capacity by expanding their university base and PhD student enrolment, creating further demand for effective publication and results-sharing channels. Added to this is the need to ensure that such research efforts will be able to contribute truly global solutions to the many challenges we face today. Such efforts require global collaboration and more inclusive shared approaches as research solutions increasingly lie outside a single discipline or organisation.
Background: Medical physicists are essential members of the radiation oncology team. Given the increasing complexity of radiotherapy delivery, it is important to ensure adequate training and staffing. The aim of the present study was to update a similar survey from 2008 and assess the situation of medical physicists in the large and diverse Asia Pacific region.
Methods: Between March and July 2011, a survey on profession and practice of radiation oncology medical physicists (ROMPs) in the Asia Pacific region was performed. The survey was sent to senior physicists in 22 countries. Replies were received from countries that collectively represent more than half of the world’s population. The survey questions explored five areas: education, staffing, work patterns including research and teaching, resources available, and job satisfaction.
Results and discussion: Compared to a data from a similar survey conducted three years ago, the number of medical physicists in participating countries increased by 29% on average. This increase is similar to the increase in the number of linear accelerators, showing that previously identified staff shortages have yet to be substantially addressed. This is also highlighted by the fact that most ROMPs are expected to work overtime often and without adequate compensation. While job satisfaction has stayed similar compared to the previous survey, expectations for education and training have increased somewhat. This is in line with a trend towards certification of ROMPs.
Conclusion: As organisations such as the International Labour Organization (ILO) start to recognise medical physics as a profession, it is evident that despite some encouraging signs there is still a lot of work required towards establishing an adequately trained and resourced medical physics workforce in the Asia Pacific region.
Radiology is a relatively high-cost and high-maintenance aspect of medicine. Expertise is constantly required, from acquisition to its use and quality assurance programmes. However, it is an integral part of healthcare practice, from disease diagnosis, surveillance and prevention to treatment monitoring. It is alarming that two thirds of the world is deficient in or lacks even basic diagnostic imaging. Developing and underdeveloped countries need help in improving medical imaging. Help is coming from various organisations, which are extending hands-on teaching and imparting knowledge, as well as training trainers to increase the pool of skilled practitioners in the use of imaging equipment and other aspects of radiology services. The scene for social radiology is changing and set to positively impact the world in the (near) future.
Orthodontic elastic bands are an important iatrogenic etiologic factor in the causation of periodontal attachment apparatus breakdown. Appropriate diagnosis and a well constructed treatment plan tailor-made to suit the requirements of the particular patient is imperative for management of periodontal lesions induced by subgingival retention of rubber band. There are conflicting reports regarding the reattachment and regeneration of lost periodontal supporting tissues in such cases. The present case report highlights the spontaneous reversal and correction of periodontal destruction due to iatrogenic orthodontic elastic band displacement deep into the subgingival tissues.
This study was performed to compare the oxidative quality of repeatedly heated palm and soybean oils, which were used to fry keropok lekors and potato chips. Method: A kilogramme of keropok lekors or potato chips was fried in 2.5 L of palm or soybean oil at 180 °C for 10 minutes. The frying process was repeated once and four times to obtain twice-heated and five-times-heated oils. The peroxide value and fatty acid composition of the oils were measured. Results: Frequent heating significantly increased the peroxide values in both oils, with the five-times-heated oils having the highest peroxide values [five-times-heated palm: 14.26 ± 0.41 and 11.29 ± 0.58 meq/kg vs fresh: 2.13 ± 0.00, F (3,12) = 346.80, P < 0.001; five-times-heated soybean: 16.95 ± 0.39 and 12.90 ± 0.21 meq/kg vs fresh: 2.53 ± 0.00 oils, F (3,12) = 1755, P < 0.001, when used to fry keropok lekors and potato chips, respectively]. Overall, both oils showed significantly higher peroxide values when keropok lekors were fried in them compared with when potato chips were fried. In general, the heated soybean oil had significantly higher peroxide values than the heated palm oil. Fatty acid composition in the oils remained mostly unaltered by the heating frequency. Conclusion: Keropok lekors, when used as the frying material, increased the peroxide values of the palm and soybean oils. Fatty acid composition was not much affected by the frequency of frying or the fried item used.
Background: The objective of this study was to determine the effectiveness of MMT program among injecting drug users (IDUs) in Kota Bharu , Kelantan. Methods: The study was a retrospective study based on the records of injecting drug users (IDUs) involved in the MMT program from November 2005 to 31st January 2008, registered at the Psychiatric Clinic of Hospital Raja Perempuan Zainab II. Opiate Treatment Index (OTI) was used as the research instrument. Repeated measures ANCOVA was used to compare the mean scores during the entry period and after completing twelve months of MMT program after adjusted for age, marital status and level of education. Results: A total of 117 file records were reviewed. There was significant reduction in the mean scores after 12 months of heroin Q score , HIV Risk-taking Behavior Scale and health scale after adjusted for age, marital status and level of education. For Heroin Q score, mean difference was 2.01 (95% CI: 1.45, 2.56), for HIV Risk-taking Behavior Scale, mean difference was 7.64 (95% CI: 6.03, 9.26); and for health scale, mean difference was 5.35(95% CI: 3.90, 6.79). Conclusion: This study supports the evidence that MMT program is effective in treating heroin and opiate dependence.
MeSH terms: Animals; Heroin; Filing; Opioid-Related Disorders; Research; Retrospective Studies; Risk-Taking; Skates (Fish); HIV Infections; Marital Status; Drug Users
Telemetric EEG in the rat’s brain has been used for experiments which tests the effects of an antiepileptic compound on it’s antiseizures activity. A simple classification correlating epileptiform discharge and Racine’s behavioral activity is discussed.