Background: Suicide may be conceptualized as an escape from intolerable predicaments,
in particular, mental illness and environmental stressors. The operationalized predicaments
of suicide (OPS) is a 4 category framework designed to assist in the classification of suicide. The objective was to examine whether this framework is potentially useful. Method: 18 psychiatrists from 6 different countries examined 12 written coroners’ reports of suicide and rated each report according to the OPS. 16 of these raters then also completed a qualitative questionnaire regarding the framework. Results: In 89.8% of cases the raters where able to make a decision regarding the drivers which led to the suicides. The respondents displayed modest inter-rater correlation (Kappa = 0.42;P < 0.0001). In the qualitative section, respondents supported the face validity of OPS and considered it potentially useful. Feedback allowed improved wording of the OPS instructions. Conclusion: The OPS has potential as a useful framework. The OPS instructions have been improved and further studies are justified.
MeSH terms: Mental Disorders; Coroners and Medical Examiners; Psychiatry; Surveys and Questionnaires; Suicide; Writing; Reproducibility of Results
Background: This study aimed to determine the perception and level of safety satisfaction
of staff nurses with regards to Occupational Safety and Health (OSH) management practice in the Sabah Health Department, and to associate the OSH management dimensions, to Safety Satisfaction and Safety Feedback. Methods: A cross-sectional study using a validated self-administered questionnaire was conducted among randomly respondents. Results: 135 nurses responded the survey. Mean (SD) score for each dimension ranged from 1.70 ± 0.68–4.04 ± 0.65, with Training and Competence dimension (mean [SD], 4.04 ± 0.65) had the highest while Safety Incidence was the least score (mean [SD], 1.70 ± 0.68). Both mean (SD)
scores for Safety Satisfaction and Safety Feedback was high, 3.28 ± 0.51 and 3.57 ± 0.73, respectively. Pearson’s correlation analysis indicated that all OSH dimensions had significant correlation with Safety Satisfaction and Safety Feedback (r coefficient ranged from 0.176–0.512) except for Safety Incidence. Conclusion: The overall perception of OSH management was rather low. Significant correlation between Safety Satisfaction and Safety Feedback and several dimensions, suggest that each organization to put in place the leaders who have appropriate leadership and supervisory skills and committed in providing staff training to improve staff’s competency in OSH practice. In addition, clear goals, rules, and reporting system will help the organization to implement proper OSH management practice.
MeSH terms: Cross-Sectional Studies; Goals; Leadership; Malaysia; Nurses; Perception; Personal Satisfaction; Surveys and Questionnaires; Safety; Incidence; Occupational Health
Fournier’s gangrene is a severe life-threatening infection involving the perianal area,
perineum, and external genitalia. It demands prompt recognition, critical care therapy, surgical therapy, and a combination of antibiotics. The infection commonly spreads via the fascial planes and causes superficial vascular thrombosis within the Colles’ fascia around the external genitalia. It can extend cephalad to involve the Scarpa’s fascia and Camper’s fascia in the abdominal wall. The treatment would include multiple debridements, which would result in disfiguring scars of the perineum and might lead to significant physical and psychological complications.We describe a case of a 58-years-old man presenting with Fournier’s gangrene resulting from an infection of an impacted urethral stone. The patient previously had obstructive voiding symptoms for 1 month but chose to neglect them. The resultant infection was severe and caused penile and right testicular gangrene. He underwent multiple wound debridements, which included a total penectomy and right orchiectomy. Psychological and rehabilitative support was necessary for him to overcome his
loss and disfigurement.
The current Western psychiatric wisdom states that suicide is always or almost always associated with mental disorder. Careful Asian studies are casting doubt on this conclusion. Using information from the public record (newspapers, coroner’s reports, and various web-based sources), we sought evidence that, in the absence of mental disorder, suicide may be associated with major financial loss. Reports of 15 individuals who completed suicide following major financial loss were identified, thus an association between these events is supported.
MeSH terms: Coroners and Medical Examiners; Humans; Psychotic Disorders; Suicide; Internet; Asian Continental Ancestry Group
Background: Oxidative stress is associated with the pathogenesis of cardiovascular diseases. The process of deep-fat frying in dietary cooking oil plays a role in the generation of free radicals. In this study, palm olein heated to 180 °C was tested for its effect on the activity of blood pressure–regulating enzymes and lipid peroxidation. Methods: Forty-two adult male Sprague-Dawley rats were equally assigned into 6 groups. The first group was fed with normal rat chow as the control group, and the subsequent groups were fed with rat chow fortified with 15% weight/weight of the following: fresh palm olein, palm olein heated once, palm olein heated twice, palm olein heated 5 times, or palm olein heated 10 times. The duration of feeding was 6 months. Fatty acid analyses of oil were performed using gas chromatography. Peroxide values were determined using standard titration. Plasma was collected for biochemical analyses. Results: Repeatedly heated palm olein increased the levels of peroxide, angiotensin-converting enzyme, and lipid peroxidation as well as reduced the level of heme oxygenase. Fresh palm olein and palm olein heated once had lesser effects on lipid peroxidation and a better effect on the activity of blood pressure–regulating enzymes than repeatedly heated palm olein. Conclusion: Repeatedly heated palm olein may negatively affect the activity of blood pressure–regulating enzymes and increase lipid peroxidation.
A young gentleman of Indian descent with oculacutaneous albinism (OCA) was found to have severe pulmonary fibrosis at first presentation. Following investigations, he was diagnosed with Hermansky-Pudlak Syndrome (HPS). It is a genetic condition characterised by albinism, bleeding
diathesis and multisystem disorder observed in individuals of particular descents. Although there is no curative treatment apart from lung transplantation, preventive measures to minimise pulmonary insult may change the natural history of the disease. Therefore HPS should be actively sought, monitored and risk factors addressed in individuals with OCA and bleeding diathesis particularly
those of Indian descent as they may develop serious complications such as pulmonary fibrosis in the future.
We report a case of an inflammatory pseudotumour (IP) involving the floor of the skull base, which demonstrated aggressive behavior both clinically and radiologically. In this case, the diagnosis was established by clinical presentation, magnetic resonance imaging (MRI), histopathological examination (HPE) and the dramatic response towards high dose steroid therapy. The clinical features improved with oral cyclophosphamide in combination with oral steroid, which were given for a period of three months.
MeSH terms: Cyclophosphamide; Granuloma, Plasma Cell; Magnetic Resonance Imaging; Radiology; Steroids; Skull Base
All around the world, there is growing evidence of the association between psoriasis and comorbidities which increase the risk of cardiovascular disease. This study aims to determine the prevalence of various comorbidities among adult psoriasis patients in Malaysia. A cross-sectional study was conducted among patients in the Malaysian Psoriasis Registry from January 2007 to December 2008. A total of 2,267 adult patients with psoriasis from 13 dermatology centers were included. Prevalence of various comorbidities were: hypertension 25.9%, diabetes mellitus 17.7 %, dyslipidaemia 17.8%, overweight 33.2%, obesity 20.7%, ischaemic heart disease 5.8% and cerebrovascular disease 1.4%. These comorbidities were more prevalent in patients with psoriasis of late-onset and longer duration. Active screening of these comorbidities in all adult psoriasis patients is recommended.
Fish is one of the major sources of protein among Malaysians. This has made incidents of fish bones lodged in the throat fairly common clinical problems. Plain radiograph, which is the first line of imaging in such cases, has been reported to have low sensitivity. Besides the location, the degree of radio-opacity of the bone is another important factor and is species dependent. This study was undertaken to determine the radio-opacity of bones from commonly consumed fish in Malaysia. A total of 15 types of fish were identified, six of them were opaque even when embedded and three were visualized in the simulated airway. In terms of radio-opacity, the commonly consumed fish in Malaysia possessed opaque bones and this fact can help doctors identify the location of the foreign body in the throat.
Background: Overweight and obesity are defined as abnormal or excessive fat accumulation that may impairhealth. Body mass index is a simple index of weight-forheight that is commonly used in classifying overweight and obesity in adult populations and individuals. Objectives: A study was conducted to screen the medical students of AIMST University for overweight/obesity using Body Mass Index(BMI) and to determine the prevalence
among them. Materials and methods: This is an institution based cross sectional study was conducted among 290 medical students using a pre-tested questionnaire and measured their Body Mass Index (BMI). Data obtained was analyzed statistically by calculating proportions. Results: Out of 290 students who participated in the study, 45.2% were males. In the study, 14.8% were found to be overweight (BMI 23-24.9kg/m2); 13.7% of males and 15.7% of females. Pre-obese students (BMI 25-29kg/m2) accounted for 15.9% of the total (males 18.3% and females 13.8%). 5.2% were found to be obese (BMI >30kg/m2): males 9.2% and females 1.9%. Also 14.8% were found to be underweight (males 12.2% and females 17.0%). The study group consisted of 63.8% Indian, 32.4% Chinese and 3.8% Malay students. Conclusions: The study reveals that the prevalence of overweight and obesity among the medical students of AIMST University is on the high, which is comparable to the findings of earlier studies conducted in Malaysia, reinforcing the need to encourage healthy lifestyle, healthy food habits and a physically active daily routine, among the adolescents and youth of this country.
MeSH terms: Adolescent; Adult; Body Weight; Cross-Sectional Studies; Female; Food Habits; Humans; Life Style; Malaysia; Male; Obesity; Surveys and Questionnaires; Students, Medical; Thinness; Universities; Body Mass Index; Prevalence; Overweight
Melanomas on the foot are difficult to differentiate from diabetic foot ulcers (DFU). In particular, acral lentiginous misdiagnosed. We present two patients with diabetes mellitus and malignant melanomas of the foot initially diagnosed as DFU. Both cases were treated with wide excision amputation and local dissection, without adjuvant chemotherapy or radiotherapy. Both patients remain disease-free up to the last follow-up visit. It is important to maintain a high index of suspicion and a skin biopsy should be done in any DFU with atypical features.
Endoscopic injection of N-Butyl-2-cyanoacrylate is a widely accepted treatment for esophagogastric varices. This procedure is commonly associated with minor complications which include transient pyrexia and abdominal discomfort. Serious vascular complications
secondary to systemic embolization of cyanoacrylate have rarely been reported. We describe the CT findings of extensive splenic infarction in a patient following cyanoacrylate injection for gastric varices.
This study aims to determine the risk factors associated with diabetic retinopathy (DR) among natives and nonnatives Sarawakians who were seen at 3 public hospitals and one health clinic in Sarawak. It is a cross sectional study where data on patients with DM were collected by staff at these healthcare facilities and entered into the web-based Diabetic Eye Registry. Univariate and multivariate analysis was used to determine the association factors for DR. DR was significantly less associated with natives (24.4%) compared to non-native Sarawakians (34.1%) (p
MeSH terms: Ambulatory Care Facilities; Cross-Sectional Studies; Diabetic Retinopathy; Hospitals, Public; Humans; Malaysia; Registries; Risk Factors; Multivariate Analysis; Internet; Population Groups
Introduction:The Vertigo symptom scale (VSS) is a well established tool for the evaluation of vestibular disorders and the associated symptoms of autonomic arousal and somatosensation. By using a validated Malay version of vertigo symptom scale (MVVSS) questionnaire, the severity of the vertigo from patients’ perspective can be determined
and rated. Before MVVSS can be applied clinically among Malaysians, it was of interest to determine its clinical value in identifying vestibular disorders. Method: Forty normal and 65 PVD subjects participated in this cross-sectional study. Normal subjects were recruited amongst Universiti Sains Malaysia (USM) staff and students who had no history of ear and vestibular disorders. Results: Mean total score of MVVSS in normal and PVD subjects were 13.9 ± 11.1 and 30.1 ± 20.9, respectively. When the total scores of normal and PVD group were compared, the Mann-Whitney U test showed that there was a significant difference between the two groups (p
Introduction: Surgical site infection (SSI) after craniotomy even though rare, poses a real risk of surgery and represents a substantial burden of disease for both patients and healthcare services in terms of morbidity, mortality and economic cost. The knowledge of risk factor for surgical site infection after craniotomy will allow the authority to implement specific preventive measures to reduce the infection rate. Therefore, the objectives of this study are to determine the incidence and the risk factors of surgical site infection after craniotomy.
Material and methods: This study highlights an observational prospective study on adult patients who has undergone neurosurgical procedures in Hospital Kuala Lumpur (HKL) over a period of 2 years (June 2007 to June 2009). The neurosurgical procedures are craniectomy, craniotomy, cranioplasty and burrhole. A total of 390 cases fulfilled the requirements of inclusion and exclusion criteria were included in the study. Every patient in the study population was prospectively evaluated for development and risk factors for SSI. The follow-up cases were done by direct observation of the wound during their post-operative stay and ideally up to and including day 30 post-operatively, either as in-patients or through post discharge surveillance i.e. follow-up in the clinic 30 days post-operatively. SSIs were defined according to the Center for Disease Control definitions. Incidence was calculated per patient. Univariate Simple Logistic Regression analysis was used to analyse
the association of the risk factors and SSI. Results: A total of 30 post craniotomy surgical site
infections (SSI) has been identified among 390 cases included in the study, resulting in an overall infection rate of 7.7%. This included 19 with superficial wound infection (63.3%), 9 with bone flap osteitis (30%) and 2 with organ/space infection (6.7%). Most of SSIs were detected during in patient cases accounting for 20 cases. The mean time between surgery and the onset of infection was 11.8 ± 21.8 days (median 10 days). The predominantly isolated organism in patients with SSIs were Staphylococcus aureus (11 or 36%) followed by MRSA (4 or 13%), and Acinetobacter spp (3 or 10%). Independent risk factors for SSI were surgeries that were performed by specialist (OR, 76.90 CI, 1.22-39.04.9; P 0.029) and senior medical officer (OR, 8.69 CI, 1.39-54.29.04.9; P 0.021) and surgery that was done for
infective causes (OR, 4.44 CI, 1.33-14.81; P 0.015). ASA 2 and clean contaminated wound were independent predictive risk factors for SSI. Conclusions: Post craniotomy surgical site infection remains an important problem in neurosurgery. Identification of risk factors for SSI should help us to improve patient care, reduce mortality, morbidity and economic burden of health care cost. Post surgical surveillance is important as well to identify the reliable risk
factors for SSI.
MeSH terms: Acinetobacter; Adult; Centers for Disease Control and Prevention (U.S.); Craniotomy; Follow-Up Studies; Patient Care; Humans; Morbidity; Neurosurgery; Osteitis; Prospective Studies; Risk Factors; Staphylococcus aureus; Surgical Wound Infection; Trephining; Incidence; Logistic Models; Health Care Costs; Methicillin-Resistant Staphylococcus aureus
Introduction: The importance of early recognition and treatment of sepsis and its effects on short-term survival outcome have long been recognized. Having reliable indicators and markers that would help prognosticate the survival of these patients is invaluable and would
subsequently assist in the course of effective dynamic triaging and goal directed management. Study Objectives: To determine the prognosticative value of Shock Index (SI), taken upon arrival to the emergency department and after 2 hours of resuscitation on the shortterm outcome of severe sepsis and septic shock patients. Methodology: This is a retrospective observational study involving 50 patients admitted to the University of Malaya
Medical Centre between June 2009 and June 2010 who have been diagnosed with either severe sepsis or septic shock. Patients were identified retrospectively from the details recorded in the registration book of the resuscitation room. 50 patients were selected for this pilot study. The population comprised 19 males (38%) and 31 females (62%). The median (min, max) age was 54.5 (17.0, 84.0) years. The number of severe sepsis and septic shock cases were 31 (62%), and 19 (38%) respectively. There were 17 (34%) cases of pneumonias, 13 (26%) cases of urological sepsis, 8 (16%) cases of gastro intestinal tract related infections and 12 (24%) cases of other infections. There were a total of 23 (46%) survivors and 27 (54%) deaths. The value of the shock index is defined as systolic blood pressure divided by heart rate was calculated. Shock Index on presentation to ED (SI 1) and after 2 hours of resuscitation in the ED (SI 2). The median, minimum and maximum variables were tested using Mann-Whitney U and Chi square analysis. The significant parameters were re-evaluated for sensitivity, specificity and cut-off points. ROC curves and AUC values were generated among these variables to assess prognostic utility for outcome. Results: Amongst all 7 variables tested, 2 were tested to be significant (p: < 0.05). From the sensitivity, specificity and ROC analysis, the best predictor for death was (SI 2) with a sensitivity of 80.8%, specificity of 79.2%, AUC value of 0.8894 [CI95 0.8052, 0.9736] at a cut-off point of ≥1.0. Conclusion: (SI 2) may potentially be utilized as a reliable predictor for death in patients presenting with septic shock and severe sepsis in an emergency department. This
parameters should be further analyzed in a larger scale prospective study to determine its validity.
A 63 year old male with a history of gout and hypertension presented with carpal tunnel syndrome. He gave history of bilateral wrist pain associated with numbness over the median nerve distribution of the hand. Tinels sign and Phalens test were positive with no obvious thenar muscle wasting on examination. Tophaceous deposits in the flexor tendons and within the synovium of the wrist joint was seen during surgery and this established gout as the cause of
median nerve entrapment in this patient.
Paraspinal abscess and spondylodiscitis due to Citrobacter koseri is a very rare condition. We report a remarkable case of Citrobacter koseri bacteraemia complicated by paraspinal abscess and spondylodiscitis in a patient who has successfully been treated in our hospital. Our patient demonstrates one of the common challenges in the practice of infectious disease medicine, wherein an innocuous presentation may and often underlie a serious infection. This case report elucidates to us that the diagnosis of a paraspinal abscess and spondylodiscitis requires a high index of suspicion in at risk patient presenting with compatible signs and symptoms.
This study was conducted to detect the presence of heterogenous vancomycin-intermediate Staphylococcus aureus (heteroVISA) among MRSA isolates in a major hospital. Forty-three MRSA isolates with vancomycin MIC 2 µg/ml collected in 2009 was screened for heteroVISA using Etest Glycopeptide Resistance Detection (GRD) and confirmed by population analysis profile-area under curve method. The genetic relatedness of heteroVISA strains with other MRSA was examined by pulsed-field gel electrophoresis (PFGE) method. Two isolates were shown to be heteroVISA and derived from the same clone. This showed that heteroVISA strains were already present among our local strains since 2009 and were genetically related to other susceptible strains.
MeSH terms: Glycopeptides; Staphylococcal Infections; Staphylococcus aureus; Vancomycin; Electrophoresis, Gel, Pulsed-Field; Area Under Curve; Disk Diffusion Antimicrobial Tests; Methicillin-Resistant Staphylococcus aureus
Although few studies concerning optic neuritis (ON) in Asian countries have been reported, there is no report about ON in Malaysia particularly within the Malay population. We aimed to determine the clinical manifestation, visual outcome and aetiology of ON in Malays, and discussed the literature of ON studies in other Asian populations. This was a retrospective study involving 31 consecutive patients (41 eyes) with ON treated at Hospital Universiti Sains Malaysia commencing from July 2005 till January 2010 with a period of follow-up ranging from 18-60 months. The clinical features, laboratory results, possible aetiology, and visual acuity after one year were analysed. Females were the predominant group. The age of the patients ranged between 3-55 years and peaked
between 21-30 years old. 67.7% of the patients had unilateral involvement. Pain on ocular movement was observed in 31.7% of the affected eyes. 73.3% of 41 involved eyes showed visual acuity equal 6/60 or worse on presentation. Paracentral scotoma was the most common visual field defect noted. Optic disc papillitis proved more widespread compared to the retrobulbar type of ON. The aetiology was idiopathic in more than 50%, while the risk of multiple sclerosis was extremely low (3.2%) in our series. 66.0% demonstrating visual acuity improved to 6/12 or better at one year after the attack. 16.1% showed evidence of recurrence during follow-up. In conclusion, the clinical
profile and aetiology of ON in Malay patients are comparable to other ON studies reported by other Asian countries.