Clozapine is effective in treatment resistant schizophrenia. Priaprism is a rare side effect of Clozapine. It is a urological emergency and can lead to permanent damage to the penis. We present two cases two cases of clozapine induced priapism. Both patients were started on Clozapine in view of treatment resistant. For the first patient, priapism was noted after 2 years on Clozapine and treated conservatively. Clozapine was rechallenged in this patient but in a lower dosage and was augmented with amisulpride. He did not develop priaprism until date. In the second case, patient developed priaprism after 7 months on clozapine and required urological intervention. He redeveloped recurrent episode of priaprism as clozapine was restarted on the previous dose. In conclusion, priaprism is not related to dosage or duration of treatment of Clozapine. Thus, a careful risk-benefit assessment need to done as there is always a risk of priapism to recur when clozapine rechallenged.
This article describes a case of Venous Thromboembolism (VTE), was developed in a patient with treatment-resistant schizophrenia. Patient was a 35 years-old female with treatment resistant schizophrenia who was tolerating her residual symptoms of perceptual disturbances. Despite good adherence towards treatment, she never had a complete symptom-free period. Patient also attempted suicide by trying to drown herself at a nearby beach. Considering the suicidal risk and persistency of her psychosis, patient was then initiated on Clozapine therapy. Over a period of 8 weeks, gradual dose increment resulted in an improvement of her symptoms where she was reported to have less frequency of perceptual disturbances. She was reviewed weekly for both her response and tolerability towards the Clozapine treatment. Entering the 11th week of her Clozapine therapy, Patient was admitted into the hospital for left leg tenderness in which she was later treated to be having deep vein thrombosis (DVT). Ultrasound finding revealed long segment thrombus seen from external iliac vein down to popliteal vein of her left lower limb. Patient’s medication dose was maintained at the same dose up until the 16th week of her Clozapine therapy. There were no recurrences or reports of side effects and improvement of sleep patterns were reported by her but her psychotic symptoms still persists. There are always risks and benefits while treating a patient with Clozapine. Clinician should be aware of the risk of deep vein thrombosis (DVT) among treatment resistant schizophrenia patient.
This article highlights the case of a 44-year old Malay man who is diagnosed as having treatment resistant schizophrenia on Clozapine, which then developed Polycythemia Rubra Vera (PRV). It is known that a major side effect for Clozapine is of agranulocytosis, that is a potentially fatal side effect. However, there have been reported disturbances of other hematological parameters, which result in other abnormalities including leucopenia, leucocytosis, thrombocytopenia, thrombocytosis and eosinophilia. Could this case be a pure medical condition of PRV or is there a relation to the effects of Clozapine? In this paper, the aim is to report a case of blood dyscrasia in a 44-year old male who developed Polycythemia Rubra Vera a year after he was observed to have abnormal full blood count results.
Introduction: Atypical antipsychotic drugs are effective in the treatment of bipolar disorder. Studies have shown that atypical antipsychotic drugs are more superior to typical antipsychotic in term of neurocognitive function, negative symptoms and extrapyramidal side effects. Both aripiprazole and quetiapine are atypical antipsychotic drugs that are effective and commonly used in all phases of bipolar disorder treatment. Objective: The aim of this study is to examine and compare the clinical outcomes of aripiprazole and quetiapine in bipolar disorder patients. Method: This was a retrospective cohort study among patients from psychiatric unit, University Malaya Medical Center. Prescription records dated between January 1, 2013 and December 31, 2014 for psychiatric unit were extracted. The data of the subjects with prescription of the two atypical antipsychotic, namely aripiprazole and quetiapine was extracted. The outcome measures were the co-prescription of antihypertensive drugs, antidiabetic drugs and lipid lowering drugs. Results: A total of 58 subjects were recruited, 11 were on aripiprazole and 47 were on quetiapine. Statistical analysis has shown that both aripiprazole and quetiapine do not have any association with compliance to the medication and also follow up. Study also revealed that there is no association between the aripiprazole and quetiapine group with the metabolic side effects that were measured such as systolic or diastolic blood pressure, waist circumference, weight, glucose level and body mass index. Conclusion: This study has shown that both aripiprazole and quetiapine were similar in terms of metabolic side effect, compliance to medications and follow up.
Introduction: Positive emotions in depressed patients are always disregarded and overlooked due to the inadequacy of assessment tool. There is a newly developed self-report scale, yet has good psychometric properties named Positive Emotion Rating Scale (PERS). Objective: The aim of this study were to translate and examine the psychometric properties of the Chinese version PERS (PERS-C). Method: This is a cross-sectional study involved 52 depressed and 106 control subject. Both groups were assessed with PERS-C, original PERS, Malay version of Snaith-Hamilton Pleasure Scale (SHAPS-M) and Malay version of Center for Epidemiological Studies Depression (CESDM). Results: PERS-C displayed good internal consistency (Cronbach’s α = 0.91) and parallel reliability with PERS (r = 0.95, p
Background: The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) developed by the World Health Organization is designed to identify individuals at risk for alcohol use problems and provide brief intervention.
Objectives: To evaluate the validity and reliability of the ASSIST in Malaysia’s official language, the Bahasa Malay, among a group of alcohol users. The study also aimed to assess the impact of alcohol on the quality of life of patients.
Methods: The final version of ASSIST-M was administered to 51 patients who were identified as alcohol users and attended the outpatient psychiatric clinic during a three-month period from September to November of 2012. Patients completed ASSIST, ASSIST-M, Mini-International Neuropsychiatric Interview (M.I.N.I.), Malay version of The Alcohol Use Disorders Identification Test (AUDIT-M), CAGE Assessment for Alcohol Abuse (CAGE), and the World Health Organization Quality of Life Scale-Brief-Malay version (WHOQoL-Brief-M). Statistical procedures were performed to assess the reliability and validity of the ASSIST-M.
Results: Factor analysis of ASSIST-M yielded one factor similar to the factor structure of the English version. The Cronbach’s α coefficient of ASSIST-M was 0.80. The parallel reliability of the ASSIST-M was high with the intra-class correlation (ICC) of 0.96 (P< 0.01). The test–retest reliability of the ASSIST-M after the 1-week interval was high with the ICC of 0.94(P< 0.01). The ASSIST-M was positively correlated with the AUDIT-M (r =0.67, p <0 .01) and the CAGE (r=0. 57, p < 0.01). ASSIST-M score showed a negative and statistically significant relationships with the physical (r= -0 .28, p < 0.01) and social relationship (r= -0.37, p<0.01) subscales of the WHOQoL-Brief-M. The optimal cutoff point for ASSIST-M for alcohol use disorder was more than 14 with the with a sensitivity of 84.21 %, specificity of 84.38 %, positive predictive value (PPV) of 76.19% and negative predictive value (NPV) of 90%.
Conclusions/Importance: The ASSIST-M displayed a fair psychometric performance in assessing alcohol use disorder in Malaysia.
Keywords: Alcohol Dependence, ASSIST, ASSIST-M, M.I.N.I., CAGE, WHOQoL
Study site: Psychiatric clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Performance injuries among musicians have been widely discussed for decades. However, despite the growing number of classical pianists, this is still a new issue in Malaysia. Therefore, this study aimed to investigate the level of knowledge of playing-related musculoskeletal disorders (PRMDs) among tertiary music students in Malaysia. A survey was conducted among classical piano students at tertiary institutions of Kuala Lumpur and Selangor. Out of 192 respondents, 76% knew that piano playing can cause PRMDs. Slightly over three-quarters of respondents (77.1%) learned about PRMDs from music educators. The survey revealed that the belief in "no pain, no gain" was still ingrained in their minds, as 50.5% respondents believed that pain experienced while playing the piano was normal and 51.6% of them considered that pain must be experienced to improve their piano skill. The respondents were also scored on questions on terminologies of pianist injury and specific PRMD examples: 7.8% of respondents scored high in the questions on the general terminology, while 99.5% of them scored low in the questions on the specific examples of PRMDs. This finding indicated a lack of knowledge of specific musicians' injuries among classical piano students. The attitudes to pain and the level of understanding of the significance of potential injuries indicate that increasing PRMD awareness and introducing courses on PRMD prevention at tertiary institutions are warranted.
MeSH terms: Adolescent; Adult; Cross-Sectional Studies; Female; Humans; Health Knowledge, Attitudes, Practice*; Malaysia; Male; Musculoskeletal Diseases/etiology*; Music*; Occupational Diseases/etiology; Surveys and Questionnaires; Students*; Young Adult; Musculoskeletal Pain/etiology*
Bera Lake is the largest natural fresh water reservoir in Malaysia. It has vital environmental and ecological importance for human and wild life. Nevertheless, water quality of this lake has been degraded during the last few decades due to land development projects at catchment area. Therefore, a comprehensive water quality assessment of Bera Lake was implemented in order to compare current water quality with the implementation of land development projects. In situ water quality surveying was implemented using calibrated full option Hydrolab DS 5. Eleven parameters viz., temperature, depth of sampling, salinity, Turbidity, total dried solid, pH, NH4(+), N03(-), Cl(-), saturation percentage of dissolved oxygen, specific conductivity were recorded in fifty one stations at 0.2h, 0.5h, and 0.8h depth. National Water Quality Standards for Malaysia (NWQS) and Water Quality were used to evaluate Bera Lake quality based on previous and resultant data. Vertical water quality analysis revealed a clear stratification in Bera Lake water profile in terms of temperature, dissolved oxygen, chloride (Cl(-)), nitrate (NO(3)), pH and specific conductivity (EC) parameters. Results clearly demonstrate the important role of land use changes since 1972 in the physico-chemical condition of water quality at Bera Lake. Classifications of water quality before and after land development project were calculated as class II and class V, respectively. A long-term and comprehensive monitoring of water quality assessment is recommended in order to reach plan of sustainable water resources use with conservation approach.
MeSH terms: Ammonia; Chlorides/chemistry; Conservation of Natural Resources/methods*; Conservation of Natural Resources/trends*; Environmental Monitoring*; Hydrogen-Ion Concentration; Malaysia; Nitrogen Oxides/chemistry; Oxygen/chemistry; Temperature; Water Pollutants, Chemical/chemistry*; Lakes*; Water Quality*
The sources, distribution, transformation, toxicity and accumulation of persistent organic pollutants (POPs) in aquatic and terrestrial ecosystems have attracted global concern and attention over the last several decades. Although, POPs are toxic, degrade slowly and have a tendency to accumulate in the food chain, they are still widely used worldwide in many fields, such as industrial and agricultural activities. In addition, discharge of POPs into waterways may lead to serious health-related and environmental problems. This review provides an overview of the continental distributions of many types of POPs and the health risks associated with the exposure to POPs in daily life. This review also discusses the distribution of POPs in Malaysia, and the future work that will be conducted in the Klang River, one of the basins subjected to pollution due to development and urbanization.
Perishable products must be transported quickly from its production area to the markets due to the climatic conditions of Malaysia. Deterioration of fresh produce is affected by temperature and delivery time. The cost to achieve such timely delivery of perishable food can affect the revenue of suppliers and retailers. Choosing an efficient delivery route at right time can reduce the total transportation cost. However, insufficient attention has been given to transportation issues with regards to fresh food delivery of greater Kuala Lumpur. The present study involves adoption of the Geographic Information System (GIS) modelling approach to determine the fastest delivery routes for fresh products to several hypermarkets. For this purpose, ArcGIS software was adopted for solving the problem of a complex road networks. With a goal of realizing the shortest time for delivery route planning, impedance function would be integrated by taking into account the time emphasized in the study. The main findings of this study include determination of efficient routes for delivery of fresh vegetables based on minimal drive time. It has been proposed that the fastest route model for delivery of fresh products is based on comparing two time frames within a day. The final output of this research was a map of quickest routes with best delivery time based on two time frames.
MeSH terms: Conservation of Natural Resources; Food/economics*; Humans; Malaysia; Software*; Transportation/economics*; Databases, Factual; Geographic Information Systems*
Degradation or decline of soil quality that cause shallow slope failure may occur due to physical or chemical processes. It can be triggered off by natural phenomena, or induced by human activity through misuse of land resources, excessive development and urbanization leading to deforestation and erosion of covered soil masses causing serious threat to slopes. The extent of damage of the slopes can be minimized if a long-term early warning system is predicted in the landslide prone areas. The aim of the study was to characterize chemical properties of stable and unstable slope along selected highways of Malaysia which can be manipulated as indicator to forecast shallow slope failure. The elements in soil chemical properties contributed to each other as binding agents that affected the existing soil structure. It could make the soil structure strong or weak. Indicators that can be used to predict shallow slope failure were low content in iron, lead, aluminum, chromium, zinc, low content of organic carbon and CEC.
Background: A 9 year old boy presented with history of persistent headache and recurrent vomiting for 1 month post dental extraction. CT brain was performed for the possibility of space occupying lesion but it was normal. Subsequently, he was treated as migraine after exclusion of meningitis and intracranial lesion. Unfortunately, he developed 3rd, 4th and 6th cranial nerve palsy two weeks later. Repeated CT brain showed subtle finding and inconclusive. MRI brain performed at the time showed features suggestive of basal skull osteomyelitis with congestion of right orbit and optic nerve swelling. Case was referred to Paediatric Neurologist and he was diagnosed to have cranial nerve palsy secondary to basal skull osteomyelitis, post dental extraction.
Conclusion: Dental procedure is common among children, however basal skull osteomyelitis with cranial nerve palsy is a rare complication. Adequate treatment of dental infection post dental procedure is important to prevent this complication.
Neonates are obligate nasal breather until they are at least two to five months old. Congenital nasal airway obstruction is one of the commonest causes of respiratory problem in newborn. Congenital nasal pyriform aperture stenosis (CNPAS) was first described by Brown et al in 1989 [1] and is a rare cause of nasal airway obstruction which may clinically mimic choanal atresia.(Copied from article)
Adrenal hemorrhage (AH) is a relatively uncommon condition (0.55-1.9%) during the neonatal period [1]. The adrenal gland is vulnerable to haemorrhage because of its large size and high vascularity. Clinical features of AH are variable and nonspecific. AH in a newborn can present as anemia, hyperbilirubinemia, abdominal mass, painful swelling or hematoma of the scrotum, acute adrenal crisis or shock [2]. We report such a case of adrenal haemorrhage in a newborn.(Copied from article)
Since 1994 to 2009, ascribed by the good coverage of immunization, the incidence of pertussis has been less than 1 in 100,000 populations [1]. Nevertheless, the incidence and prevalence increased tremendously for the past 2 years, i.e. 2014 and 2015.(Copied from article)
Tuberculosis in children remains a public heath concern in Malaysia and other developing countries. Mycobacterium tuberculosis (TB) infection of the liver, known as hepatic TB, is an extra pulmonary manifestation of TB. Tuberculous bacilli can reach the liver via hematogenous dissemination through hepatic artery, or by local spread from the gastrointestinal tract via portal vein [1].(Copied from article)
Scurvy resulting from dietary deficiency of vitamin C is characterized by anaemia, tender limbs swelling and hemorrhagic manifestations such as petechiae and bruises. We report a case of scurvy in a 13 years old boy with cerebral palsy who presented with history of limbs bruising and swelling for 2 months. On examination, he was cachexic and pale with poor dentition and swollen gum. There were extensive bruises and swollen limbs as well. His platelet count and coagulation profile were normal. Limbs X-ray revealed classical scorbutic changes in the long bones. Serum ascorbic acid level was low
Hepatopulmonary syndrome (HPS) is characterized by the triad of liver disease, pulmonary vascular dilatation and arterial oxygenation abnormality. It occurs in 4% to 47% in patient with liver cirrhosis [1]. We describe 2 cases of HPS with recovery from hypoxaemia after liver transplantation.(Copied from article)
Subcutaneous fat necrosis is a recognised complication of hypothermia. There appears to be a resurgence in this condition when therapeutic hypothermia emerges as a standard of care for asphyxiated infants. The TOBY trial reported an incidence of 0.1% for 1239 infants cooled.(Copied from article)
MeSH terms: Fat Necrosis; Humans; Hypothermia; Hypothermia, Induced; Infant; Necrosis; Incidence; Subcutaneous Fat; Standard of Care
Objective: To study the demographic, clinical features, management and outcome of neonatal tetanus treated at Tawau Hospital.
Method: A retrospective study of neonatal tetanus admitted to a district hospital in Sabah was conducted.
Results: In 2015, the hospital handled 18 cases of babies with neonatal tetanus in the Tawau Hospital. This implies an occurrence of 1.5 cases per month. All the mothers were non-citizens and did not have any proper antenatal follow up. All the tetanus babies required invasive mechanical ventilation with a median of 20 days (range, 5 to 32 days). The survival rate was 94.4%.
Conclusion: Despite the promotion of maternal and childhood vaccination along with hygienic practices of delivery, neonatal tetanus still remains a threat to babies born in Sabah.