Browse publications by year: 2013

  1. Arterial embolization of a bleeding gastric Dieulafoy lesion: a case report
    Mohd Rizal MY, Kosai NR, Sutton PA, Rozman Z, Razman J, Harunarashid H, et al.
    Clin Ter, 2013;164(1):25-7.
    PMID: 23455738 DOI: 10.7417/T.2013.1506
    Dieulafoy's lesion is one of an unusual cause of upper gastrointestinal bleeding (U GIB). Endoscopic intervention has always been a preferred non-surgical method in treating UGIB including bleeding from Dieulafoy's lesion. Owing to recent advances in angiography, arterial embolization has become a popular alternative in non- variceal UGIB especially in cases with failed endoscopic treatment. However, managing bleeding Dieulafoy's with selective arterial embolization as the first line of treatment has not been exclusively practiced. We hereby, report a case of bleeding Dieulafoy lesion which had been primarily treated with arterial embolization.
    MeSH terms: Adult; Angiography/methods; Arterioles/abnormalities*; Hematemesis/etiology; Gastrointestinal Hemorrhage/complications*; Gastrointestinal Hemorrhage/diagnosis; Gastrointestinal Hemorrhage/etiology; Gastrointestinal Hemorrhage/therapy*; Humans; Hypertension/complications; Male; Melena/etiology; Risk Factors; Stomach/blood supply*; Stomach/pathology; Stomach/radiography; Treatment Outcome; Ureterolithiasis/complications
  2. An unusual cause of a penetrating injury to the anterior urethra: a thorny situation
    Tan GH, Ho CC, Bahadzor B, Praveen S, Goh EH, Afdzillah AR, et al.
    Clin Ter, 2013;164(1):35-7.
    PMID: 23455741 DOI: 10.7417/T.2013.1509
    Concurrent penetrating injury to the male external genitalia and the anterior urethra is uncommon. This case illustrates an unusual cause of such an injury, and its subsequent management and outcome. A 69-year-old man had his scrotum and anterior urethra pierced by a long thorn when he fell in his farm. He presented with urine leakage from the scrotal wound each time he micturated. Cystoscopic examination confirmed the cause and extent of the injury, and also facilitated the extraction of the thorn. The injury was allowed time to heal by urinary diversion with a urinary catheter. There were no stricture or fistula formations and the patient remained symptom-free at 3 months follow-up. Careful cystoscopic examination was both diagnostic and therapeutic in this case. A conservative approach is a feasible option in the management of selected cases of penetrating anterior urethral injury.
    MeSH terms: Aged; Follow-Up Studies; Humans; Male; Scrotum/injuries*; Scrotum/surgery*; Urethra/injuries*; Urethra/surgery*; Wounds, Penetrating/diagnosis; Wounds, Penetrating/surgery*; Treatment Outcome; Urinary Catheters
  3. Treatment of dementia with herbs: a short review
    Tang CT, Belani LK, Das S, Jaafar MZ
    Clin Ter, 2013;164(1):43-6.
    PMID: 23455743 DOI: 10.7417/T.2013.1511
    Dementia is a common symptom observed in many psychiatric and neurodegenerative diseases. Alzheimer's disease is the most common form of senile dementia seen in the general population. Multiple factors like oxidative stress, apoptosis, mitochondrial dysfunction and inflammation may be related to the neurodegenerative states. Many drugs like cholinesterase have been used for treatment but the progression of the disease still poses a challenge to the clinician. During recent times, herbs have gained much popularity as supplements because of the cost effectiveness, easy availability and fewer side effects. Early diagnosis and proper treatment may help in the prevention of mortality and morbidity concerned with any neurodegenerative disease. Understanding the cellular and molecular biology of the mode of the action of herbal products may be beneficial for researchers and clinicians. The present review article attempts to look into the potential herbal extracts which may act as an antioxidant in combating dementia.
    MeSH terms: Alzheimer Disease/drug therapy; Animals; Antioxidants/therapeutic use*; Dementia/diagnosis; Dementia/drug therapy*; Humans; Plant Extracts/therapeutic use*; Treatment Outcome; Evidence-Based Medicine; Ginger*; Centella*; Bacopa*; Coptis*; Early Diagnosis
  4. Preclinical toxicological evaluations of the sclerotium of Lignosus rhinocerus (Cooke), the Tiger Milk mushroom
    Lee SS, Enchang FK, Tan NH, Fung SY, Pailoor J
    J Ethnopharmacol, 2013 May 2;147(1):157-63.
    PMID: 23458920 DOI: 10.1016/j.jep.2013.02.027
    Lignosus rhinocerus (Tiger Milk mushroom) is distributed in South China, Thailand, Malaysia, Indonesia, Philippines and Papua New Guinea. In Malaysia, it is the most popular medicinal mushroom used by the indigenous communities to relieve fever, cough, asthma, cancer, food poisoning and as a general tonic. In China, this mushroom is an expensive traditional medicine used to treat liver cancer, chronic hepatitis and gastric ulcers. The sclerotium of the mushroom is the part with medicinal value. This rare mushroom has recently been successfully cultivated making it possible to be fully exploited for its medicinal and functional benefits. The present study was carried out to evaluate the chronic toxicity of the sclerotial powder of Lignosus rhinocerus cultivar (termed TM02), its anti-fertility and teratogenic effects as well as genotoxicity.
    MeSH terms: Abnormalities, Drug-Induced/etiology*; Administration, Oral; Animals; Body Weight/drug effects; DNA Damage*; DNA, Bacterial/drug effects*; Escherichia coli/genetics; Female; Fertility/drug effects*; Male; Materia Medica/administration & dosage; Materia Medica/isolation & purification; Materia Medica/toxicity*; Mutagenicity Tests; Organ Size/drug effects; Powders; Pregnancy; Salmonella typhimurium/genetics; Time Factors; Biomarkers/blood; Biomarkers/urine; Rats, Sprague-Dawley; Risk Assessment; No-Observed-Adverse-Effect Level; Toxicity Tests, Chronic; Rats; Fungal Structures
  5. Fulltext Gene expression profiles in primary duodenal chick cells following transfection with avian influenza virus H5 DNA plasmid encapsulated in silver nanoparticles
    Jazayeri SD, Ideris A, Shameli K, Moeini H, Omar AR
    Int J Nanomedicine, 2013;8:781-90.
    PMID: 23459681 DOI: 10.2147/IJN.S39074
    In order to develop a systemically administered safe and effective nonviral gene delivery system against avian influenza virus (AIV) that induced cytokine expression, the hemagglutinin (H5) gene of AIV, A/Ck/Malaysia/5858/04 (H5N1) and green fluorescent protein were cloned into a coexpression vector pIRES (pIREGFP-H5) and formulated using green synthesis of silver nanoparticles (AgNPs) with poly(ethylene glycol) and transfected into primary duodenal cells taken from 18-day-old specific-pathogen-free chick embryos. The AgNPs were prepared using moderated temperature and characterized for particle size, surface charge, ultraviolet-visible spectra, DNA loading, and stability. AgNPs and AgNP-pIREGFP-H5 were prepared in the size range of 13.9 nm and 25 nm with a positive charge of +78 ± 0.6 mV and +40 ± 6.2 mV, respectively. AgNPs with a positive surface charge could encapsulate pIREGFP-H5 efficiently. The ultraviolet-visible spectra for AgNP-pIREGFP-H5 treated with DNase I showed that the AgNPs were able to encapsulate pIREGFP-H5 efficiently. Polymerase chain reaction showed that AgNP-pIREGFP-H5 entered into primary duodenal cells rapidly, as early as one hour after transfection. Green fluorescent protein expression was observed after 36 hours, peaked at 48 hours, and remained stable for up to 60 hours. In addition, green fluorescent protein expression generally increased with increasing DNA concentration and time. Cells were transfected using Lipocurax in vitro transfection reagent as a positive control. A multiplex quantitative mRNA gene expression assay in the transfected primary duodenal cells via the transfection reagent and AgNPs with pIREGFP-H5 revealed expression of interleukin (IL)-18, IL-15, and IL-12β.
    MeSH terms: Analysis of Variance; Animals; Cells, Cultured; Chick Embryo; DNA, Viral/administration & dosage; DNA, Viral/genetics; Duodenum/cytology; Duodenum/metabolism; Duodenum/physiology*; Duodenum/virology*; Particle Size; Plasmids/administration & dosage; Plasmids/genetics; Recombinant Fusion Proteins/genetics; Recombinant Fusion Proteins/metabolism; Recombinant Fusion Proteins/chemistry; Silver/chemistry*; Transfection/methods*; Cytokines/metabolism; Hemagglutinin Glycoproteins, Influenza Virus/genetics*; Hemagglutinin Glycoproteins, Influenza Virus/metabolism; Hemagglutinin Glycoproteins, Influenza Virus/chemistry; Green Fluorescent Proteins/genetics; Green Fluorescent Proteins/metabolism; Green Fluorescent Proteins/chemistry; Influenza A Virus, H5N1 Subtype/genetics*; Metal Nanoparticles/chemistry*
  6. Nutrient composition, antioxidant properties, and anti-proliferative activity of Lignosus rhinocerus Cooke sclerotium
    Yap YH, Tan N, Fung S, Aziz AA, Tan C, Ng S
    J Sci Food Agric, 2013 Sep;93(12):2945-52.
    PMID: 23460242 DOI: 10.1002/jsfa.6121
    Lignosus rhinocerus (tiger milk mushroom) is an important medicinal mushroom used in Southeast Asia and China, and its sclerotium can be developed into functional food/nutraceuticals. The nutrient composition, antioxidant properties, and anti-proliferative activity of wild type and a cultivated strain of L. rhinocerus sclerotia were investigated.
    MeSH terms: Antineoplastic Agents/analysis; Antineoplastic Agents/isolation & purification; Antineoplastic Agents/pharmacology*; Antineoplastic Agents/chemistry; Antioxidants/analysis; Antioxidants/isolation & purification; Antioxidants/pharmacology*; Antioxidants/chemistry; Asia, Southeastern; Biological Products/isolation & purification; Biological Products/pharmacology*; Biological Products/chemistry; Breast Neoplasms/drug therapy*; Carcinoma/drug therapy*; Female; Food, Fortified; Humans; Malaysia; Medicine, Chinese Traditional; Medicine, East Asian Traditional; Nutritive Value; Phenols/analysis; Phenols/pharmacology; Polyporaceae/growth & development; Polyporaceae/chemistry*; Species Specificity; Dietary Supplements; Inhibitory Concentration 50; Mycelium/growth & development; Mycelium/chemistry*; Cell Proliferation/drug effects; Wilderness; MCF-7 Cells
  7. Fulltext Nicotine-induced cessation of embryonic development is reversed by γ-tocotrienol in mice
    Kamsani YS, Rajikin MH, Mohamed Nor Khan NA, Abdul Satar N, Chatterjee A
    Med Sci Monit Basic Res, 2013 Mar 06;19:87-92.
    PMID: 23462735 DOI: 10.12659/MSMBR.883822
    BACKGROUND: This study aimed to evaluate the adverse effects of various doses of nicotine and protective effects of different concentrations of gamma-tocotrienol (gamma-TCT) on in vitro embryonic development and lipid peroxidation in mice.

    MATERIAL AND METHODS: A) Effects of various doses of nicotine on in vitro embryonic development: Female mice were treated with 1.0, 3.0, or 5.0 mg/kg/day nicotine for 7 consecutive days. Animals were superovulated, cohabited overnight, and sacrificed. Embryos were cultured in vitro. Plasma was assayed. B) Effects of concomitant treatment of nicotine concurrently with various doses of gamma-TCT on in vitro embryonic development: Female mice were treated with nicotine (5.0 mg/kg/day), gavaged gamma-TCT of 30, 60, or 90 mg/kg/day or nicotine concurrently with gamma-TCT of 3 different doses for 7 consecutive days. Animals were superovulated, cohabited overnight, and sacrificed. Embryos were cultured and plasma was assayed.

    RESULTS: A) Effects of various doses of nicotine on in vitro embryonic development: Number of hatched blastocysts decreased in 1.0 and 3.0 mg/kg/day nicotine groups. Nicotine at 5.0 mg/kg/day stopped embryo development at morula. MDA concentrations increased following all nicotine doses. B) Effects of concomitant treatment of nicotine concurrently with various doses of gamma-TCT on in vitro embryonic development: Embryo development was completed in all groups. MDA concentration increased only in the group treated with nicotine concurrently with 30 mg/kg/day gamma-TCT.

    CONCLUSIONS: Nicotine impairs in vitro embryo development and increases MDA in plasma. The deleterious impact of nicotine on embryo development is reversed by supplementing gamma-TCT concurrently with nicotine.

    MeSH terms: Animals; Blastocyst/pathology; Chromans/pharmacology*; Disease Models, Animal; Dose-Response Relationship, Drug; Female; Malondialdehyde/blood; Nicotine/pharmacology; Time Factors; Vitamin E/analogs & derivatives*; Vitamin E/pharmacology; Lipid Peroxidation*; Thiobarbituric Acid Reactive Substances/analysis; Embryo Culture Techniques/methods; Embryonic Development/drug effects*; Mice
  8. Fulltext Computed tomographic findings of cerebral fat embolism following multiple bone fractures
    Law HL, Wong SL, Tan S
    Singapore Med J, 2013 Feb;54(2):e28-30.
    PMID: 23462838
    Fat embolism to the lungs and brain is an uncommon complication following fractures. Few reports with descriptions of computed tomographic (CT) findings of emboli to the brain or cerebral fat embolism are available. We report a case of cerebral fat embolism following multiple skeletal fractures and present its CT findings here.
    MeSH terms: Accidents, Traffic; Embolism, Fat/diagnosis*; Femoral Fractures/complications; Humans; Male; Radiography, Thoracic; Tomography, X-Ray Computed*; Treatment Outcome; Intracranial Embolism/diagnosis*; Young Adult
  9. Fulltext Regular paracetamol in severe dengue: a lethal combination?
    Gan CS, Chong SY, Lum LC, Lee WS
    Singapore Med J, 2013 Feb;54(2):e35-7.
    PMID: 23462840
    An eight-month-old female infant with severe dengue disease, who was repeatedly given therapeutic paracetamol for severe dengue, developed fulminant liver failure with encephalopathy, gastrointestinal haemorrhage and severe coagulopathy. She responded to supportive measures and N-acetylcysteine infusion. This case highlights the potential danger of administering repeated therapeutic doses of paracetamol in childhood severe dengue disease with hepatitis.
    MeSH terms: Acetaminophen/adverse effects*; Acetaminophen/therapeutic use; Blood Coagulation; Female; Hepatic Encephalopathy/drug therapy; Humans; Infant; Treatment Outcome; Liver Failure, Acute/chemically induced*; Severe Dengue/drug therapy*; Antipyretics/adverse effects*; Antipyretics/therapeutic use
  10. Diabetes and infections-hepatitis C: is there type 2 diabetes excess in hepatitis C infection?
    Naing C, Mak JW, Wai N, Maung M
    Curr. Diab. Rep., 2013 Jun;13(3):428-34.
    PMID: 23463119 DOI: 10.1007/s11892-013-0370-3
    Individual epidemiologic studies as well as the pooled analysis of observational studies have indicated the association between type 2 diabetes (T2D) and hepatitis C virus infection (HCV). Whether HCV infection is the cause of diabetes or diabetic patients are more prone to get HCV infection is still in question. The objective of the present review was to provide answers to this issue, based on available evidence from epidemiologic, molecular, experimental and therapeutic studies. Our current understanding of how chronic HCV infection could induce T2D is incomplete, but it seems twofold based on both direct and indirect roles of the virus. HCV may directly induce insulin resistance (IR) through its proteins. HCV core protein was shown to stimulate suppressor of cytokine signaling, resulting in ubiquitination and degradation of tyrosine kinase phosphorylated insulin receptor substrates (IRS1/2) in proteasomes. HCV-nonstructural protein could increase protein phosphatase 2A which has been shown to inactivate the key enzyme Akt by dephosphorylating it. Insulin signaling defects in hepatic IRS-1 tyrosine phosphorylation and PI3-kinase association/activation may contribute to IR, which leads to the development of T2D in patients with HCV infection. The peroxisome proliferator-activated receptors (PPARs) are also implicated. PPARα/γ, together with their obligate partner RXR, are the main nuclear receptors expressed in the liver. PPARα upregulates glycerol-3-phosphate dehydrogenase, glycerol kinase, and glycerol transport proteins, which allows for glucose synthesis during fasting states. Decreased activity of PPARs could attribute to HCV-induced IR. Immune-mediated mechanisms may be involved in the indirect role of HCV in inducing IR. It is speculated that TNF-alpha plays a major role in the pathogenesis of IR through lowering IRS1/2. Furthermore, HCV infection- triggered ER stress could lead to the activation of PP2A, which inhibits both Akt and the AMP-activated kinase, the regulators of gluconeogenesis. In summary, we illustrate that HCV infection is accompanied by multiple defects in the upstream insulin signaling pathway in the liver that may contribute to the observed prevalence of IR and diabetes. Future studies are needed to resolve this issue.
    MeSH terms: Diabetes Mellitus, Type 2/etiology*; Hepatitis B/complications; Hepatitis C/complications*; Humans; Models, Biological; Public Health; Risk Factors
  11. Optimization of palm oil physical refining process for reduction of 3-monochloropropane-1,2-diol (3-MCPD) ester formation
    Zulkurnain M, Lai OM, Tan SC, Abdul Latip R, Tan CP
    J Agric Food Chem, 2013 Apr 3;61(13):3341-9.
    PMID: 23464796 DOI: 10.1021/jf4009185
    The reduction of 3-monochloropropane-1,2-diol (3-MCPD) ester formation in refined palm oil was achieved by incorporation of additional processing steps in the physical refining process to remove chloroester precursors prior to the deodorization step. The modified refining process was optimized for the least 3-MCPD ester formation and acceptable refined palm oil quality using response surface methodology (RSM) with five processing parameters: water dosage, phosphoric acid dosage, degumming temperature, activated clay dosage, and deodorization temperature. The removal of chloroester precursors was largely accomplished by increasing the water dosage, while the reduction of 3-MCPD esters was a compromise in oxidative stability and color of the refined palm oil because some factors such as acid dosage, degumming temperature, and deodorization temperature showed contradictory effects. The optimization resulted in 87.2% reduction of 3-MCPD esters from 2.9 mg/kg in the conventional refining process to 0.4 mg/kg, with color and oil stability index values of 2.4 R and 14.3 h, respectively.
    MeSH terms: alpha-Chlorohydrin; Esters; Glycerol/analogs & derivatives*; Glycerol/chemical synthesis; Gas Chromatography-Mass Spectrometry; Plant Oils/isolation & purification*; Plant Oils/chemistry
  12. Fulltext Prevalence and associated factors of stress, anxiety and depression among prospective medical students
    Yusoff MS, Abdul Rahim AF, Baba AA, Ismail SB, Mat Pa MN, Esa AR
    Asian J Psychiatr, 2013 Apr;6(2):128-33.
    PMID: 23466109 DOI: 10.1016/j.ajp.2012.09.012
    Many studies have reported that the prevalence of psychological distress among medical students during medical training was high. However, there are very few studies exploring on the psychological health of prospective medical students. This study aimed to determine the prevalence and associated factors for stress, anxiety and depression symptoms among the prospective medical students. A cross-sectional study was done on two cohorts of applicants to a public medical school. A total of 839 applicants were invited to participate in the study. The 21-item Depression Anxiety Stress Scale was administered to the applicants after they completed interviews. A total of 743 (92.2%) applicants took part in the study. The prevalence of moderate to extremely severe level of stress, anxiety and depression were 3.6%, 54.5% and 1.9%, respectively. Stress was significantly associated with extra-curricular activity (p<0.001) and race (p<0.001). Anxiety was associated with extra-curricular activity (p<0.001), race (p<0.001), mother education level (p=0.002) and CGPA group (p=0.034). Depression was associated with academic performance in class (p<0.001) and race (p=0.004). Prevalence of stress and depression among entering medical students was low; however prevalence of anxiety was high which could be due to worry about the interviews to enter medical course. The associated factors of psychological distress among prospective medical students were related to academic, non-academic, parent education and cultural backgrounds.
    MeSH terms: Adolescent; Anxiety Disorders/epidemiology*; Cross-Sectional Studies; Depressive Disorder/epidemiology*; Female; Humans; Malaysia/epidemiology; Male; Risk Factors; Stress, Psychological/epidemiology*; Students/psychology*; Students, Medical*; Prevalence; Young Adult; Self Report
  13. Fulltext Beta-blockers in Cardiovascular Disease: Do not throw out the baby with the bathwater
    Ong HT
    Med J Malaysia, 2013;68(1):1-3.
    PMID: 23466756
    MeSH terms: Cardiovascular Diseases*; Humans
  14. Fulltext Zoonotic malaria in Malaysia
    Lim KG, Singh B
    Med J Malaysia, 2013;68(1):4-5.
    PMID: 23466757
    MeSH terms: Animals; Anopheles*; Humans; Malaria*; Malaysia
  15. Fulltext Antibiotic sensitivity and spectrum of bacterial isolates in otorhinolaryngological infection: a retrospective study
    Sia KJ, Tang IP, Prepageran N
    Med J Malaysia, 2013;68(1):6-9.
    PMID: 23466758 MyJurnal
    OBJECTIVES: To identify the common bacteria of otorhinolaryngological (ORL) infection in three general hospitals in the state of Sarawak, East Malaysia and to determine the antibiotic sensitivity of the common bacteria to update local antibiotic policy.
    METHODS: All specimens with positive monoclonal culture, received from inpatient and outpatient Otorhinolaryngology Department in the year 2009 and 2010 were included in the study. Patients' demographics, nature of specimens, bacterial isolates and antibiotic sensitivity were analysed by using the Statistical Package for the Social Sciences (SPSS).
    RESULTS: A total 244 positive monoclonal cultures were identified. Staphylococcus species and Gram negative bacilli were the commonest bacteria of ORL infections. Common ORL bacteria remain sensitive to our front line antibiotics. There are a number of multi-drug resistant isolates of MRSA, ESBL Klebsiella pneumoniae and Acinetobacter baumanii in the hospital-acquired infections.
    CONCLUSION: Although resistance to antimicrobial agents is growing worldwide, first line antibiotics still show significant therapeutic advantage in our local setting. The low resistance of bacterial isolates in our community reflects judicious use of antibiotics in our routine clinical practices.

    Study site: Sarawak General Hospital, Sibu Hospital and Miri Hospital
    MeSH terms: Cross Infection; Hospitals, District; Hospitals, General; Humans; Malaysia; Microbial Sensitivity Tests*; Outpatient Clinics, Hospital; Retrospective Studies; Drug Resistance, Bacterial
  16. Fulltext Prevalence of peripheral arterial disease and abdominal aortic aneurysm among patients with acute coronary syndrome
    Leong BDK, Ariffin AZ, Chuah JA, Voo SY
    Med J Malaysia, 2013;68(1):10-2.
    PMID: 23466759 MyJurnal
    INTRODUCTION: Peripheral arterial disease(PAD) and abdominal aortic aneurysm(AAA) are two important underdiagnosed vascular pathologies. As they share common risk factors with coronary arterial disease, we conducted a study to look at their prevalence among patients with acute coronary syndrome(ACS).
    MATERIALS AND METHODS: Patients with ACS admitted to Queen Elizabeth Hospital, Malaysia, from February 2009 till August 2009 were screened prospectively for PVD and AAA. Patients' data and clinical findings were gathered and analyzed. Measurements of ankle brachial index (ABI) and abdominal aortic diameter were performed by a single assessor. PAD was defined as ABI ≤ 0.9 or diabetic patients with signs and symptoms of PAD and absence of pedal pulses. AAA was defined as abdominal aortic diameter ≥ 3cm.
    RESULTS: 102 patients were recruited with mean age of 59.5 years old. Male: female ratio was 6:1. 40.2% of patients had NSTEMI; 45.1%, STEMI and 14.7%, unstable angina. Risk factors profile is as follows: hypertension- 68.6%, smoking- 56.9%, hypercholesterolemia- 52.9%, diabetes mellitus- 35.3% and history of stroke- 5.9%. Median ABI was 1.1 with lowest reading of 0.4. Mean abdominal aortic size was 2.0cm with largest diameter of 3.3cm. PAD was present in 24.5% of patients and AAA in 2.0%. 68.0% of patients with PAD were asymptomatic. Smoking and age more than 60 years were independent predictors for PAD among ACS patients.
    CONCLUSIONS: PAD is strongly correlated with CAD with old age and smoker as independent predictors. However, association between AAA and ACS could not be established.
    Study site: Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
    MeSH terms: Adult; Hospitals, General; Humans; Inpatients; Malaysia; Prevalence; Aortic Aneurysm, Abdominal; Acute Coronary Syndrome*; Ankle Brachial Index; Peripheral Arterial Disease*
  17. Fulltext Clinical-Epidemiological Pattern of Primary Immunodeficiencies in Malaysia 1987-2006: A 20 year experience in Four Malaysian Hospitals
    Noh LM, Nasuruddin BA, Abdul Latiff AH, Noah RM, Kamarul Azahar MR, Norzila MZ, et al.
    Med J Malaysia, 2013;68(1):13-7.
    PMID: 23466760
    To determine the clinical and epidemiological characteristics of patients seen with primary immunodeficiencies referred at four Malaysian Hospitals between 1987 to 2007.
    MeSH terms: Humans; Immunologic Deficiency Syndromes; Malaysia; Surveys and Questionnaires; Registries*; Delayed Diagnosis*
  18. Fulltext Medical nutrition therapy administered by a dietitian yields favourable diabetes outcomes in individual with type 2 diabetes mellitus
    Mohd Yusof BN, Ruzita AT, Norimah AK, Kamaruddin NA
    Med J Malaysia, 2013;68(1):18-23.
    PMID: 23466761 MyJurnal
    AIM: This prospective, single-group, pre-post design trial was conducted to evaluate the effect of individualised Medical Nutrition Therapy intervention administered by a dietitian in individuals with type 2 diabetes mellitus on glycaemic control, metabolic parameters and dietary intake.
    METHODS: Subjects (n=104; age=56.4 ±9.9 years; 37% male; years of diagnosis = 6.3 ±4.9 years) treated with diet and on a stabile dose of oral anti-diabetic agents were given dietary advice by a dietitian for a 12 week period. Individualised dietary advice was based on Malaysian Medical Nutrition Therapy for adults with type 2 diabetes mellitus. The primary outcome measure was glycaemic control (fructosamine and HbA1c level) and the secondary outcome included measures of anthropometry, blood pressure, lipid profile, insulin levels dietary intake and knowledge on nutrition.
    RESULTS: At week 12, 100 subjects completed the study with a dropout rate of 3.8%. The post-Medical Nutrition Therapy results showed a significant reduction of fructosamine (311.5 ±50 to 297 ±44 umol/L; P< 0.001) and HbA1c (7.6 ±1.2 to 7.2 +1.1%, p<0.001) with pronounced reduction for subjects who had very high HbA1c levels of >9.3% at baseline. Waist circumference (90.7 ±10.2 to 89.1 ±9.8 cm, p<0.05), HDL-cholesterol (1.1 ±0.3 to 1.2 ±0.3 mmol/L, p<0.05), dietary intake and nutrition knowledge score (42 ±19 vs. 75 ±17%; p< 0.001) were significantly improved from the baseline.
    CONCLUSIONS: Individualised Medical Nutrition Therapy administered by a dietitian resulted in favourable diabetes outcomes, which were more apparent for individuals with higher than optimal HbA1c levels at the start of the study.
    MeSH terms: Blood Glucose; Hospitals, University; Humans; Malaysia; Prospective Studies; Clinical Trial; Nutrition Therapy; Nutritionists*
  19. Fulltext Assessing HIV/AIDS knowledge and stigmatizing attitudes among medical students in Universiti Putra Malaysia
    Chew BH, Cheong AT
    Med J Malaysia, 2013;68(1):24-9.
    PMID: 23466762 MyJurnal
    OBJECTIVE: Medical students are future doctors who are trained to treat all kind of diseases including people living with HIV/AIDS (PLWHA) without prejudice. This study was to determine the factors associated with knowledge on HIV/AIDS and stigma towards PLWHA among medical students.
    METHODS: This was a cross sectional study with stratified random sampling conducted in a public university, Malaysia. The participants were preclinical-year (year 1 and year 2) and clinical-year (year 3 and year 4) medical students. Simple randomisation was carried out after stratification of medical students into preclinical and clinical-year. The self-administered questionnaires were consisted of socio-demographic data, items assessing HIV/AIDS knowledge and items assessing stigmatisation attitudes towards PLWHA.
    RESULTS: We had 100% response rate of 340 participants. Pre-clinical and clinical year medical students each contributed 170 (50%). Majority was female (64.1%). About two-thirds (60.6%) was Malay, followed by Chinese (31.2%) and Indian (7.1%). Pre-clinical students were significantly more stigmatizing in subscale of "attitudes towards imposed measures" (t=3.917, p<0.001), even with adjustment for previous encounter and ethnicity (B= 1.2, 95% CI 0.48 to 1.83, p=0.001). On the other hand, clinical students were found to be significantly less comfortable in handling HIV/AIDS cases (t=0.039, p=0.039), even after controlled for previous encounter and ethnicity (B=0.6, 95% CI 0.29 to 0.98, p< 0.001).
    CONCLUSION: Clinical encounter with PLWHA was associated with higher knowledge in HIV/AIDS. Medical students in preclinical years were having stigmatizing attitude towards imposed measures compared to the clinical years who had more stigmatizing attitude in being less comfortable with PLWHA.
    MeSH terms: Acquired Immunodeficiency Syndrome*; Cross-Sectional Studies; Humans; Health Knowledge, Attitudes, Practice; Malaysia; Students, Medical*; Universities; HIV Infections; Social Stigma
  20. Fulltext Colonoscopic prioritization in colorectal carcinoma screening using quantitative immunochemical faecal occult blood test: a pilot study
    Chong HY, Roslani AC, Law CW
    Med J Malaysia, 2013;68(1):30-3.
    PMID: 23466763 MyJurnal
    BACKGROUND: Screening for colorectal cancer (CRC) improves outcomes and reduces its incidence. However, population-based screening in Malaysia continues to be a challenge, in view of cost and limited availability of colonoscopic skills and facilities. Conventional qualitative faecal occult blood tests help to prioritize those who require earlier colonoscopies, but cannot distinguish between benign and malignant causes. Recently, quantitative immunochemical faecal occult blood tests (qFOBT) have demonstrated some discriminatory ability in distinguishing benign and malignant causes. We aim to assess feasibility of qFOBT as a tool for stratification of colonoscopic priority in asymptomatic patients.
    METHODS: A health awareness exhibition was held in a major shopping complex in Kuala Lumpur on 6 and 7 Feb 2010. All asymptomatic individuals> 40 years, and those < 40 with family history of CRC, were invited to participate. Eligible participants were given a questionnaire and screened using a qFOBT. A faecal haemoglobin level of 100 - 199 ng/mL was considered moderately positive, while a level of 200 ng/mL or more was strongly positive. Participants with a strongly positive qFOBT result were scheduled for a colonoscopy within the month, while those who were moderately positive were scheduled within 3 months.
    RESULTS: A total of 125 (82%) participants returned the qFOBT kit, of which 70 (56%) were male. The median age was 54 years. Majority of the participants were Chinese (60%), followed by Malay (25%), Indian (12%) and others (3%). Twelve (10%) participants were tested positive and were advised to undergo colonoscopy but 9 (75%) declined colonoscopy and further investigations citing lack of time as the reason. Of the 3 participants (all in the moderately positive group) who underwent colonoscopy, 2 had a family history of CRC. Colonoscopic findings revealed haemorrhoids in one participant and two participants had histologically proven benign sigmoid colonic polyps.
    CONCLUSION: The use of qFOBT as a tool to screen and prioritize asymptomatic patients for early colonoscopy in CRC screening is logistically feasible. However, in order for it to be effective, measures to improve compliance to colonoscopy need to be taken.
    MeSH terms: Colonoscopy*; Humans; Mass Screening; Occult Blood*; Pilot Projects; Colorectal Neoplasms
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