Childhood obesity has become a serious public health problem. The prevalence of overweight and obese children is an increasing trend all over the world. Obesity can be assessed based on triceps skin fold and Body Mass Index (BMI). BMI is widely acceptable around the world because it is easily
calculated based on weight and height. The National Center for Health Statistics (NCHS) in the United State (US) defined obesity as children with BMI greater than 95th centile for age and sex and these children require medical attention1,2.
MeSH terms: Body Weight; Child; Humans; National Center for Health Statistics (U.S.); Public Health; United States; Body Mass Index; Prevalence; Overweight; Pediatric Obesity
Pancreatic metastases are very uncommon and originate most commonly from lung, colon, breast and kidney cancer. Ovarian adenocarcinoma has been reported as a primary site of pancreatic metastasis, but its diagnosis has rarely being reported by endoscopic ultrasound guided fine needle
aspiration (EUS-FNA). We report a case of multiple metastases to the pancreas from ovarian carcinoma occurring four years after original resection of the primary tumour. Our patient presented with severe epigastric pain which was initially treated as acute pancreatitis. Further imaging modalities showed multiple large pseudocystic lesions in the pancreatic head and body. Subsequent EUSFNA confirmed that the lesions were metastatic disease from an advanced ovarian carcinoma. She underwent palliative chemotherapy and the pancreatic lesion showed receding size.
Percutaneous coronary angioplasty(PCI) has evolved from plain old balloon angioplasty(POBA) only to more challenging angioplasty in complex coronary artery disease(CAD) lesions as a result of continuous improvement of stent designs. However, every generation, or new type of stents, has advantages and complications related to the design of the stents which maybe be discovered only in the post-marketing period. Stent compression is a recent entity reportedly happening in a variety of stents and we wish to highlight our local experience with this phenomenon with a particular drug eluting coronary stent associated with coronary wire entrapment.
Dapsone syndrome is a potentially fatal hypersensitivity reaction to sulphone. We report a 12-year-old girl who developed high grade fever associated with intense jaundice, exfoliative skin rash and hepatomegaly after five weeks of starting the multidrug regimen for the treatment of Hansen’s disease. Laboratory investigations revealed presence of leucocytosis with eosinophilia, deranged liver enzymes and an abnormal coagulation profile. Immediate cessation of the offending drug and administration of steroid proved successful. A high level of clinical awareness is fundamental for early diagnosis of dapsone syndrome as initiation of a prompt treatment may lead to rapid recovery.
Background: Acral melanoma involve the non-pigmented palmoplantar and subungual areas and are commonly seen among Asians. Patients commonly display advanced stage of disease at presentation. It may appear unnoticed and mimic benign lesions. Methods: Data for this retrospective study was retrieved from Histopathology Unit, Sarawak General Hospital, Malaysia archive from 2003 to 2009. Result: 62.3% cases of malignant melanoma were acral melanoma. The mean age of diagnosis was 64.3±12.1. The involved sites were the heel (39.4%), middle and frontal plantar area (24.2%), toe (24.2%) and web spaces (9.1%). The clinical presentations were; an enlarging mass (60.6%), nonhealing ulcer (24.2%) and abnormal pigmented lesion (15.2%). Most cases exhibited Breslow thickness >4.00 mm (87.9%) and Clark’s levels V (50%). The majority showed moderate (non brisk) tumour infiltrating lymphocytes (57.6%). Ulceration (84.8%) and lymphovascular involvement were seen (24.2%). Conclusion: Acral melanoma is the commonest malignant melanoma in this Sarawakian cohort. Most of the cases presented with advanced stage disease.
We analysed 580 articles (original articles only) published in
Medical Journal of Malaysia between 2004 and 2008, the
resources referenced by the articles and the citations and
impact received. Our aim was to examine article and author
productivity, the age of references used and impact of the
journal. Publication data was obtained from MyAIS database
and Google Scholar provided the citation data. From the 580
articles analyzed, contributors mainly come from the
hospitals, universities and clinics. Contributions from foreign
authors are low. The useful lives of references cited were
between 3 to 11 years. ISI derived Impact factor for MJM
ranged between 0.378 to 0.616. Journal self-citation is low.
Out of the 580 sampled articles, 76.8% have been cited at
least once over the 5 years and the ratio of total publications
to citations is 1: 2.6.
Polymorphisms within the β2-adrenergic receptor (ADRB2) gene have been repeatedly linked to hypertension. Among the ADRB2 polymorphisms detected, Arg16Gly and Gln27Glu codons are considered the two most important variations. The amino acid substitution at these codons may lead to abnormal regulation of ADRB2 activity. The aim of the present study was to assess the association between ADRB2 polymorphisms and hypertension. This case-control study consisted of 100 unrelated subjects (50 hypertensive and 50 matched normal controls). Arg16Gly and the Gln27Glu polymorphisms were analyzed by polymerase chain reactionrestriction fragment length polymorphism assay. There were no significant evidence of association in allelic and genotypes distribution of Arg16Gly and Glu27Gln with blood pressure and hypertension. These findings suggest that the variation within codon 16 and 27 of ADRB2 gene were unlikely to confer genetic susceptibility for hypertension in our population samples.
Type-2 diabetes mellitus (T2DM) patients who were on gliclazide co-administered with metformin were changed to pre-combined glibenclamide-metformin tablets in the Endocrine Clinic, Penang Hospital. We conducted a retrospective study to evaluate the differences in glycaemic control and treatment cost following the change. Eighty patients (60% females) with a mean age of 55 years old were studied. Mean glycosylated haemoglobin (HbA1c) reduction was -0.92% (p
MeSH terms: Blood Glucose; Diabetes Mellitus, Type 2; Female; Glyburide; Gliclazide; Hemoglobin A, Glycosylated; Humans; Metformin; Retrospective Studies; Tablets; Health Care Costs
Objective: Ear, nose and throat foreign bodies are common in ENT clinical practice. This study was designed to establish the local data of otorhinolaryngeal foreign bodies in term of prevalence among paediatric and adult groups, the clinical features, types of foreign body at different sites, and laterality of foreign bodies. Method: This study was carried out at ENT department, Sarawak General Hospital, Malaysia, from 1st January 2005 to 31st December 2009. A total of 1084 cases were included and statistically analyzed. Result: Ear foreign bodies showed the highest incidence
which was consisted of 480 (44.3%) cases, followed by nose in 270 (24.9%) cases, pharynx in 251(23.2%) cases, esophagus in 57 (5.3%) cases and laryngo-tracheobronchial tree in 26 (2.4%) cases. Otorhinolaryngeal foreign bodies occurred more frequently in 0-10 year old age group which
constituted 651 (60.1%) cases. The descending order of frequency for foreign body sites in adult was pharynx (17.2%), ear (12.8%), esophagus (3.1%), nose (1.7%) and laryngo-tracheobronchial tree (1.1%). The type of foreign bodies varies with age group and site of foreign body lodgement. In general, common foreign bodies in both adult and children were food related, with the additional of small objects such as plastic toy in paediatric group. Conclusion: Otorhinolaryngeal foreign bodies were found more frequently in children. The types of foreign body were different from age group and sites of foreign body lodgement. The local food constituted the highest incidence of ear, nose, and throat foreign bodies with additional of plastic toys in paediatric group.
Background: Self-esteem is a person’s appraisal of his own worth, significance, attractiveness, and competence. Low self-esteem could also lead to social, health and psychological problems including eating disorders. Eating disorder is when a person uses measures such as dieting, restricting intake of food or purging to control his or her body weight. Objective: The current study explores the relationship between self-esteem and anorectic eating concerns among female university students in Malaysia. Method: 217 female university students were studied, using Rosenberg’s Self Esteem Scale (SE-10) and Eating Attitude Test (EAT-40). Results: Students with low self esteem had higher anorectic eating concerns. Race of the student had no significance in predicting eating disorder. Age plays an important role in eating disorder. Young students with low self-esteem are more vulnerable to anorectic eating concerns than older students. Conclusion: It was found that there exists an inverse but low correlation between the two variables self esteem and anorectic eating concerns.
MeSH terms: Appetite Depressants; Feeding and Eating Disorders; Body Weight; Eating; Female; Malaysia; Self Concept; Students; Universities
Methamphetamine production and abuse increased significantly in Malaysia. Lesbian, gay, bisexual and transgender (LGBT) populations have higher prevalence of substance abuse compared to general population. Their unmet needs pose greater challenges in managing their substance related disorders. This paper described the agony of a Malaysian lesbian with gender identity disorder who abused substances and developed amphetamine-induced psychosis. Her sexual identity issue was explored in managing her substance related disorders to improve her outcome.
This case report highlights on the dilemma in making a decision for termination of pregnancy (TOP) for a muslim rape victim in Malaysian setting. We report a case of 17 year-old student at 7 weeks of pregnancy after being gang-raped, who, together with her parents, had requested for a TOP. Psychiatric assessment showed that the patient suffered from a major depressive disorder and post-traumatic stress disorder which justified termination of pregnancy on a psychological and clinical basis. However the available Malaysian Islamic fatwa had caused some uncertainties on the final decision making. This case demonstrated on the needs to understand the relevant issues beyond clinical judgment in relation to TOP in our setting which encompasses the legal provision, ethical obligation as well as the needs for a clear religious understanding and stand to support the medical decision.
This study explores the quality of life, social integration and the effects of perceived stigma of people with mental illness living in the community. Adopting a complimentary mixed method, this study was represented by 165 people with mental illness in Kuching, Sibu and Miri. Findings indicated that the quality of life scale was poor, 49.67% and 78.43% often experienced stigma. Anticipated stigma 43.79%; 16.99% all the time and 4.58% never experienced stigma. Findings also noted that people with mental illness living in the community are still largely depending on and needed continuous support from their family members/carers for financial aid and their living arrangement for a “better” quality of life. Where treatment is concerned, follow up care at home by health care providers continue to play a significant role. In order to “erase” the perceived or stigma experienced, establishing therapeutic relationship, communication and creating awareness on “stigma discrimination paradigm” poses a phenomenal challenge in the current misrepresentations of mental health messages.
MeSH terms: Mental Disorders; Follow-Up Studies; Mental Health; Perception; Quality of Life; Residence Characteristics; Caregivers; Social Stigma
Introduction: There is increasing awareness of the contribution of perceived social support (PSS) to emotional and physical well-being. Numerous scales measuring PSS have been developed, including the widely used Multidimensional Scale of Perceived Social Support (MSPSS). The psychometric properties of the MSPSS have been demonstrated in diverse samples, however mostly are conducted in English. Malay is the official languange in Malaysia, and this study was conducted to provide evidence of the validity and reliability of a Malay version MSPSS (MSPSS-M) suited for our population.
Methods: This is a cross sectional study. The socio-demographic and clinical information of the selected patients from psychiatric outpatient clinic over a 3-month period, were obtained via pre-designed questionnaire, interviews and medical records. Assessment of psychiatric symptoms and social support were measured by various instruments including the Brief Psychiatric Rating Scale (BPRS-E), Depressive, Anxiety and Stress Scale (DASS) and MSPSS-M.
Results: Data were reported for 228 psychiatric outpatients with the mean age of 40.3 years old. The 3-factor structure of the MSPSS-M (significant others, family, and friends) fitted the data well. The MSPSS-M showed good internal consistency (Cronbach α of 0.89) and validity. The scores of the total subscales for MSPSS-M were negatively correlated with the depression subscale in DASS (P < 0.05). BPRS was negatively correlated with significant others (P < 0.01) compared to the other two subscales in MSPSS-M.
Conclusions: The Malay version MSPSS (MSPSS-M) is a psychometrically valid instrument with high internal consistency, which is useful in assessing perceived social support in Malaysian population.
Study site: psychiatric clinic, University Malaya
Medical Center (UMMC)
MeSH terms: Anxiety; Cross-Sectional Studies; Demography; Depression; Depressive Disorder; Hospitals, University; Humans; Malaysia; Medical Records; Outpatient Clinics, Hospital; Outpatients; Brief Psychiatric Rating Scale; Perception; Psychometrics; Surveys and Questionnaires; Social Support; Reproducibility of Results; Friends
Introduction Clinical guidelines recommend the use of a single antipsychotic drug at standard doses. In clinical practise high-dose and combined antipsychotics are common. Methods A clinical audit of antipsychotic prescribing for patients in a forensic ward in a Malaysian hospital was undertaken using Prescribing Observatory for Mental Health-UK (POMH) standards and compared to POMH data. Results The level of high dose prescribing between Malaysian and the UK was comparable. There were low levels of the use of ‘as required’ (PRN) medication in Malaysia compared to the UK. The use of combined prescribing was more common in Malaysia. Discussion Levels of high dose antipsychotic prescribing are unsatisfactory across both jurisdictions. Specific quality improvements in Malaysia need to centre on the use of combination antipsychotics.
Background: Personality disorders is one of the most assessed mental health problems among prison population. To date, no local psychometric instrument to assess personality disorder is available in Malaysia. Objective: The aim of this study is to validate the Malay-translated version of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) among prisoner. Methods: A cross-sectional study was designed, involving female prisoners (n=90). Face validity, factor analysis, and reliability testing were conducted with a one-week interval test-retest. Results: The translated instrument produced four factors structure. The internal consistency is moderate (α=.64), with high test-retest reliability (ICC=.82). Conclusion: The Malay-translated version of the MSI-BPD was found valid and reliable to identify borderline personality disorder among female prisoner in future studies.
Inner child work is a therapeutic tool that has been known to be very beneficial in working through issues from one’s past that can largely influence one’s present life. However, it is apparently not widely applied in the local therapy setting. This paper describes the use of inner child work in dealing with a patient who presented with anger and marital problems, and who was carrying a lot of emotional baggage.
MeSH terms: Anger; Child; Emotions; Humans; Life; Family Conflict
Background: The Malay short version of Depressive Anxiety and Stress Scale (DASS-21) has been widely used as a tool to measure psychological parameters in studies in Malaysia. The version has been found to be reliable for clinical and non-clinical populations. Objectives: To analyse and establish the psychometric properties of the Malay version of the DASS 42-item (BM DASS-42) among medical students. Methods: Concurrent forward and backward translations of original English DASS-42 were completed. Construct validity of the DASS-42 was established by looking at its exploratory factor analysis. Malay DASS-42 and Malay HADS were administered to a total of 411 medical students. Results: Reliability of DASS-
42 revealed excellent Cronbach’s alpha values of 0.94, 0.90 and 0.87 for depressive, anxiety and stress domains respectively. Construct validity yielded 38 items out of 42 items (90%) had good factor loadings of 0.4 and more. DASS and HADS were strongly correlated for both anxiety (r=0.87) and depression (r=0.68) domains. Conclusions: The BM DASS-42 had admirable psychometric properties among the tested population. Further studies are needed to verify these preliminary outcomes in other Malaysian subjects.
Objective: The aim of the study was to determine the early readmission rate among the psychiatric patients discharged from a teaching hospital in Malaysia. The associated factors were also examined. Methods: This is a prospective and observational study. The socio-demographic and clinical data of 202 patients from the psychiatric ward were collected on discharge along with the administration of instruments including Brief Psychiatric Rating Scale (BPRS), Life Events Questionnaire (LEQ), and Multidimensional Scale of Perceived Social Support (MSPSS). Assessment of compliance to medication and substance use was reliant on self-report data. Medication compliance was categorized as “poor” vs “good”, whereas poor compliance was the complete discontinuation of medication for at least two weeks. The patients were followed up to determine whether they were readmitted within 6 months. Results: At the end of 6 months follow-up, 32.2% of the subjects were readmitted. Univariate regression analysis indicated that patients with psychotic disorder, past episodes, previous admission, poor compliance, on conventional or depot injectable antipsychotic and higher BPRS scores on discharge were significantly associated with early readmission (p
Clozapine is an effective anti-psychotic and has long been used as an intervention for treatment-resistant schizophrenia. This case report will highlight the use of Clozapine up to 100 mg ON as a second-line medication to achieve satisfactory response after 5 weeks in an adolescent who was recently diagnosed with schizophrenia.