INTRODUCTION: Although the Feldenkrais method of rehabilitating chronic obstructive pulmonary disease (COPD) patients have been suggested, its use among practitioners is not widespread owing to preference of the more familiar standard program presently available. Several advantageous of the Feldenkrais Method have been suggested which includes improving the efficiency of movement, posture and, breathing. However how this compares to the standard rehabilitation protocol or pulmonary rehabilitation program (PRP) have not been previously demonstrated. The present study was thus conducted to compare the effectiveness of the Feldenkrais Method to the standard PRP using Borg score and 6 minute walked distance (6MWD) as outcome measurement tools.
RESULTS: There were 17 subjects in the Feldenkrais group (FG) and 19 subjects in the pulmonary group (PG), both of which received therapy for 8 weeks and assessed before and after receiving therapy. There were no improvements observed in the Borg score for the FG (after and before; 6.06+ 1.09 vs. 6.00+0.94). However, improvements in the PG group could be seen (after and before; 3.58+ 1.17 vs. 5.84 +1.01). Improvements in the 6MWD was observed in both groups with no significance differences noted (FG vs. PG; 379+129m vs. 374+80m).
CONCLUSION: The Feldenkrais method does not offer any advantage over the present PRP and in fact the latter offers better improvement in terms of the Borg score. However in view of the small study sample, further study would be needed before a final conclusion can be made.
Study site: Respiratory clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
The objective of the present study is to investigate the impact of socio-demographic factors on the acquisition of health information on Non-Communicable Diseases (NCDs) among Malaysian adults. A robust analysis was conducted on cross-sectional survey data obtained from 398 respondents in Penang (Malaysia) between August to October 2010. An ordered probit model was applied to examine the factors affecting the scale of health information. The results suggest that old individuals, rural dwellers, having chronic disease and history of serious family illnesses are 0.19%, 2.39%, 2.2% and 2.71% less likely to acquire poor health information on NCDs than others, whereas Malays, Chinese, males and those of low educated are 8.76%, 6.22%, 2.94% and 21.62% more likely to acquire poor health information on NCDs than others. Based on these findings, several intervention measures toward increasing the health knowledge among the population are recommended, which include the use of language-based mass media to advertise the information on diseases, designing health awareness campaigns in urban areas and introducing more basic health related subjects and courses into primary and secondary schools.
MeSH terms: Adult; Chronic Disease; Communicable Diseases; Cross-Sectional Studies; Demography; Humans; Language; Malaysia; Male; Mass Media; Surveys and Questionnaires; Information Seeking Behavior
This article presents a brief overview on the importance of adopting healthy behavior during and after the completion of primary cancer treatment. Increasing evidences are advocating physical activity engagement in cancer survivors due to its convincing beneficial outcomes. Today, outcomes from numerous trials confirmed the need to examine beyond physical activity engagement, into physical inactivity as an independent factor for cancer recurrences. Reducing cancer-risk related behaviors via increase physical activity and reduce inactivity is now receiving much attention in the field of cancer survivorship. Both realms of activity and inactivity are now acknowledged as influential independent factors contributing to better care in the field of cancer survivorship.
MeSH terms: Attention; Motor Activity; Neoplasms; Recurrence; Health Behavior; Survival Rate; Survivors; Risk Reduction Behavior
Metastases to the breast from non-mammary malignant neoplasm are relatively rare. We report a case of metastatic disease to the breast from a primary lung adenocarcinoma in a young 22-year-old lady. Computed tomography of the thorax confirmed right upper lobe mass with multiple lung nodules and a breast lump. The diagnosis of breast metastasis was confirmed by fine needle aspiration cytology of the breast lump with histopathological findings and immunohistochemical features consistent with lung adenocarcinoma.
Nasopharyngeal carcinoma (NPC) is a malignant neoplasm arising from the mucosal epithelium of the
nasopharynx, mainly within the lateral nasopharyngeal recess or Fossa of Rosenmuller. Distant metastasis to the cervical spine is the least common site in the vertebral system. This is a case of a 37-year-old lady with stage IV C nasopharyngeal carcinoma with local extension to the cervical spine who presented with right upper limb weakness.
We report two paediatric patients with massive head and neck plexiform neurofibromas who underwent surgical excision. We wish to highlight issues and implications pertaining to the surgery, in particular, the management of intraoperative bleeding often encountered in these cases.
Traumatic bilateral sixth cranial nerve palsy is a rare condition which is typically associated with additional intracranial, skull, and cervical spine injuries. We describe a case of complete bilateral sixth nerve palsy in a 28-year-old female patient after an alleged motor vehicle accident. She had altered level of consciousness but no intracranial lesion or associated skull or cervical spine fracture was detected. In this case, we discussed the differential diagnoses, initial workup, and possible treatment options in cases of traumatic 6th nerve palsy.
The normal aortic valve has three leaflets, which are almost equal in size. A bicuspid aortic valve developed as a result of abnormal aortic cusp formation during early embryogenesis. Complications such as valvular stenosis or incompetence are well known. Delayed in identifying the congenital abnormality or the complications may cause morbidity and mortality. We report two cases of congestive cardiac failure as the results of undiagnosed bicuspid aortic valve with severe aortic incompetence. Both young men in their productive age without cardiac risk factors, were unfortunate to present too late. Although one of them was lucky to survive the ordeal, most late presentation ends up gravely. Aortic valve replacement can be offered if early detection is made. Those with severe disease at diagnosis may require a heart transplant.
Introduction: There is an increasing trend in smoking among rural adolescents compared to urban adolescents in Malaysia. This study was to determine the relationship between religious personality and smoking among form two students from the rural schools in Malacca. Methods: This was an unmatched case-control study conducted from May 2010 to August 2010 among form two school children from rural area in Malacca. There were 484 cases, and 444 controls selected using randomized cluster sampling. The dependent variable was smoking, and the independent factors were religious personality. Validated and reliability-tested questionnaires were used for data collection. Results: The mean age (year) at which smoking was first tried among the cases was 11.39 + 2.107. There were eleven out of twenty three significant differences between religious personality statements in the cases and control group. Those were: reciting the Quran/Holy book/Scriptures even when busy, making efforts to deepen the understanding of the religion, trying to understand the teachings of the religion in the Holy book/Quran, inviting others to perform solat/prayer/religious service, making sure all the family members are following the teachings according to the religion, referring to the learned people when feeling uncertain about the rulings/teachings of the religion, performing work duties enthusiastically because of the religion/God, making efforts to remember death and afterlife often, making efforts to internalize the ethical conduct of the religion in daily life, setting aside money every year for religious purposes and looking for opportunities to give charity. Conclusion: Religious personality is an important factor which may influence adolescents volved in smoking.
MeSH terms: Adolescent; Books; Charities; Child; Emotions; Humans; Malaysia; Personality; Surveys and Questionnaires; Religion; Smoking; Students; Reproducibility of Results; Case-Control Studies; Control Groups
Introduction: In the past, patients with previous abdominal surgery were discouraged from laparoscopic surgery because of perceived increased risk of bowel injury caused by needle and trocar insertion. However, data on the feasibility and safety of surgery of this nature is increasing. We aim to evaluate the surgical outcome of laparoscopic ovarian cystectomy/oophorectomy in previous abdominal surgery. Methods: This is a cross-sectional study with descriptive analysis of retrospective data collection from the electronic medical records of women with laparoscopic ovarian cystectomy/ oophorectomy from January 2000 until Dec 2008. Results from patients with previous abdominal surgery were compared with those of women without prior abdominal surgery. Results: Three hundred and seventeen (317) laparoscopic cystectomies/ oophorectomies were performed during the study period. 71 patients (22.5%) had previous history of abdominal surgery. Adhesions were found in 72% of patients versus 40% (p=0.001) who had previous abdominal surgery but the conversion to open surgery rate was similar (3%, p < 0.05). There was no significant difference in blood loss (134.1 ml ±18.6 vs 119.0 ml ± 9.5), operating time (107 min ± 42.0 versus 102.6 min ± 42.6) and postoperative hospital stay (1.92 days ± 1.0 vs 1.91 days ± 0.7 ). The incidence of peri-operative and post-operative complication showed no significant difference in those who had undergone previous abdominal surgery than those without prior abdominal surgery (p=0.7). The overall complication rate in this series was 0.32 %. Conclusion: Laparoscopic cystectomy/ oophorectomy in the previous abdominal surgery is safe with no increase in morbidity.
MeSH terms: Abdomen; Tissue Adhesions; Cross-Sectional Studies; Female; Humans; Length of Stay; Needles; Ovariectomy; Laparoscopy; Retrospective Studies; Surgical Instruments; Cystectomy; Incidence; Electronic Health Records; Operative Time; Conversion to Open Surgery
Introduction: School vision screening program is a scheduled program under the Ministry of Health, Malaysia for 7, 12 and 15 years-old children in the government schools. The aim of this study was to review the school vision screening program from the perspective of the personnel involved as the screener. Methods: The evaluation of the performance of the screener was based upon the accurate referrals' outcome from the school health database of Betong Division in Sarawak, Malaysia in the year of 2008. Results: The total accuracy of the referrals was 50.7%. Lower accuracy of the referrals was found significantly associated with Grade 1 [χ2 (2.N=304) = 28.810, p
MeSH terms: Child; Government; Humans; Malaysia; Referral and Consultation; School Health Services; Schools; Vision Screening
Introduction: The New Zealand White (NZW) rabbit model is commonly used for the research of
posterolateral intertransverse lumbar arthrodesis. The standard approach reported by many
researchers are a muscle splitting approach through the intermuscular plane between multifidus and longissimus muscles. Methods: In this research the fusion bed was exposed by retracting the three groups of paraspinal muscles (multifidus, longissimus and iliocostalis) medially. Results: This alternative method showed good exposure of the transverse processes and intertransverse membrane with less bleeding from the muscles observed. No death due to surgical complication was observed out of twenty-four rabbits operated. Conclusion: An easy and safe method for performing posterolateral intertransverse lumbar arthrodesis was demonstrated and recommended as an alternative approach for surgery on New Zealand White rabbits.
Introduction: We aim to investigate the effect of vasectomy on the histology of the testis as well as to evaluate DNA fragmentation in testicular tissue of male mice. Methods: Bilateral vasectomy was performed on 20 mature male mice; 10 control mice underwent sham-operation. After 6 weeks, the testes were evaluated for histological changes and DNA fragmentation by single cell gel electrophoresis (comet assay). Results: Marked alterations were observed in the testes of vasectomized mice, including degeneration of spermatids, thickened basement membrane, dilatation of the seminiferous tubules, exfoliation of germ cells, reduction in the seminiferous cell population, vacuolated appearance of the epithelium in the tubules and marked interstitial fibrosis. Single cell gel electrophoresis showed a highly significant (P
Introduction: The New Zealand White (NZW) rabbit model is commonly used for the research of
posterolateral intertransverse lumbar arthrodesis. The standard approach reported by many researchers are a muscle splitting approach through the intermuscular plane between multifidus and longissimus muscles. Methods: In this research the fusion bed was exposed by retracting the three groups of paraspinal muscles (multifidus, longissimus and iliocostalis) medially. Results: This alternative method showed good exposure of the transverse processes and intertransverse membrane with less bleeding from the muscles observed. No death due to surgical complication was observed out of twenty-four rabbits operated. Conclusion: An easy and safe method for performing posterolateral intertransverse lumbar arthrodesis was demonstrated and recommended as an alternative approach for surgery on New Zealand White rabbits.
Ewing's sarcoma is a rare tumor first discovered by James Ewing in 1921. It is more common in bone or skeletal component compared to soft tissue or extraosseous Ewing's sarcoma. Among soft tissue Ewing’s, spinal cord involvement is rarer with only nine cases reported. We report a case of nine-year-old Malay girl who presented with low back pain for two months following a fall with progressive neurological deficits of bilateral lower limb. Magnetic resonance imaging was suggestive of a well-defined margin of intradural extramedullary tumor. With nerve sheath tumor in mind, surgical excision with laminectomy L2-S1 was performed. Intraoperative finding was an extradural mass from L3-L5 with extension to bilateral neuroforamen. Histopathology report defined a round cell tumour of Ewing’s sarcoma from the mass.
MeSH terms: Bone and Bones; Child; Female; Humans; Laminectomy; Magnetic Resonance Imaging; Sarcoma, Ewing; Spinal Cord; Low Back Pain; Neuroectodermal Tumors, Primitive, Peripheral; Nerve Sheath Neoplasms; Lower Extremity
Due to globalizing trend of homogenisation of culture, changes in the health care delivery system and market economics infringing on the practice of medicine, there has been a gradual shift in the attitude of the medical community as well as the lay public towards greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As the subject has gained worldwide prominence, we want to review this topic from Islamic perspective due to its significance in medical ethics and clinical practice.
Introduction: The aim of this study is to determine the prevalence of otitis media with effusion (OME) in Malaysian children between three months to twelve years of age and to identify the risk factors associated with it.
Materials and methods: This is a cross-sectional study consists of 153 children selected by stratified random sampling method. Parents of these children were interviewed with a structured questionnaire. Clinical examination, including otoscopic examination and tympanometry was performed for each child.
Results: The prevalence of OME was 18.3%. There was no statistical significant relationship between OME and gender, race, household size, attendance to daycare center, breast feeding, and exposure to passive smoking, allergy, and asthma.
Conclusion: The prevalence of OME is 18.3% in Malaysian children between three months to twelve years of age. Frequency of AOM is a statistically significant factor to the development of OME later in life. The different risk factors associated with OME are still controversial.
MeSH terms: Acoustic Impedance Tests; Asthma; Breast Feeding; Child; Child Day Care Centers; Cross-Sectional Studies; Hospitals, University; Humans; Hypersensitivity; Malaysia; Otitis Media with Effusion; Parents; Surveys and Questionnaires; Risk Factors; Tobacco Smoke Pollution; Prevalence; Otoscopy
Introduction: The purpose of this study was to determine the prevalence of defaulters of immunization, and their associated risk factors among children age 12 to 24 months. Materials and Methods: A cross-sectional study was conducted in all government's maternal child health clinics in District of Kota Kinabalu, Sabah. Data was collected using a standardised questionnaire from July to November 2006. Results: The prevalence rate for defaulting immunization was 16.8% from the 315 respondents. Bivariable analysis showed various significant factors associated with defaulters such as mother’s employment status, family mobility, transportation and cost. Nonetheless, multivariable analysis showed only mother’s age, mother employment status and family size were the significant predictors for defaulting immunization. Immunization that had the highest rate of defaulters was DPT–OPV booster dose (56.6%), followed by MMR immunization (43.4 %) and
DPT-Hib/OPV and Hep B third dose (37.7%).Conclusion: Employed mothers with bigger family size should be more closely monitored and advised to reduce the chance of defaulting on the immunization. Health promotion activities also should focus to these groups of mothers.
MeSH terms: Child Health; Ambulatory Care Facilities; Child; Cross-Sectional Studies; Employment; Family Characteristics; Health Promotion; Humans; Immunization; Malaysia; Mothers; Surveys and Questionnaires; Risk Factors; Transportation; Vaccination; Prevalence; Haemophilus influenzae type b
Introduction: Anterior border of the tibia is covered only by a thin layer of protective tissue. Plating of the tibia often results in wound complication and infection if the injury to this area is not recognized. We review our results of managing infection following plating of the tibia using a protocol base on the status of bone healing and the presence of bone or soft-tissue defect. Methods: Eight cases of infection following plating of the tibia were managed according to stage procedures protocols and classification, which is based on the state of bony union and the defect following wound debridement. The soft-tissue defects were managed with local flaps, and the bone defects were managed with Illizarov bone transport. Results: Three patients had more than one bacterium isolated. Gram negative organisms were isolated from seven patients. Methicillineresistant Staphylococcus aureus was isolated in two patients. All patients achieved union with a mean union
time of seven months. The infections were controlled in seven patients. One patient had minimal sinus discharge but refused further treatment. Conclusions: The stage protocol for the management of infection following plating of the tibia is practical and produces excellent results.
Introduction: HCV infection is frequent in patients undergoing maintenance haemodialysis, with prevalence between 8 and 10%. Hepatitis C has an adverse effect on both patient and graft survival in those who get renal transplants. There are relatively scarce reports on the natural fluctuation in viral load level in patients on chronic haemodialysis. Materials and Methods: This is a longitudinal short-term three months study, where 27 chronic haemodialysis patients infected with known HCV genotypes were recruited from seven haemodialysis centres in Pahang. Serum samples were collected monthly, both pre- and post-haemodialysis sessions, over a period of three months. Viral RNA was extracted from serum using QIAamp Viral RNA Extraction kit (Qiagen). The HCV viral load was measured using one-step reverse transcriptase qPCR (Applied Biosystems) targeting the 5`HCV non-coding region (5’UTR). The serum α-IFN level was measured using commercial ELISA kit (Amersham, UK). Six biochemical liver function tests (AST, ALP, TP, albumin, ALT and TB) were also done for all pre-haemodialysis samples. Results: All patients showed persistent low level viral load that varied significantly over the study period (p = 0.001). HCV genotype 1 viral load was significantly higher than that of genotype 3. Conclusion: No apparent correlation could be recognized between the viral loads and the corresponding interferon-alpha levels which were detectable in only a few patients during the period of study.