Dementia is typically characterized by the deterioration of cognitive abilities and is a common disorder
among the elderly in Malaysia. However, behavioral and psychological symptoms are also present
in approximately 90% of dementia patients.1 We report the manifestation of these symptoms in an
elderly woman with dementia and the treatment thereof.
MeSH terms: Aged; Alzheimer Disease; Cognition; Dementia; Female; Humans; Malaysia
Glomus tympanicum is a tumour classified under the group glomus tumours, and is also known
as paragangliomas. It is thought to commonly occur in women in the fifth to sixth decades of life.
Here, we report a case of a 77-year-old lady with multiple co-morbids and a diagnosis of glomus
tympanicum presenting to us. Her symptoms included pulsatile tinnitus, and reduced hearing,
and the management of the case was done with consideration for her underlying multiple comorbidities. This paper also describes the best modality of treatment for this patient with regard
to her background history. The treatment goal was to improve her quality of life and control the
disease.
Lemierre’s syndrome is a systemic complication commonly caused by oropharyngeal infection by
Fusobacterium species, which manifests itself as an internal jugular vein thrombosis formation.
It is a rare occurrence nowadays with the availability of broad spectrum antibiotics for treatment.
Most cases in the literature presented with a life-threatening condition. We are reporting a case of
Lemierre’s syndrome that presented with persistent neck pain and swelling, initially diagnosed as
cervical lymphadenitis.
Introduction: A foreign body (FB) in the upper aerodigestive tract is a fairly common encounter.
Fish bones are the commonest FB seen in adults. The commonest presentation is odynophagia.
Usually, the patient will point at the level of FB on the neck to indicate the location.
Methods: Clinical report.
Results: This case report describes a large FB in an adult with underlying infantile cerebral palsy.
Besides dysphagia, it was associated with drooling of saliva and pain in the throat region.
Conclusion: FB ingestion with complete obstruction of the oesophagus is an emergency. It may
cause total dysphagia as the passage of food is completely blocked.
Introduction: Burst fracture results from compression failure of both the anterior and middle columns under
substantial axial loads. Conservative treatment was a method of treatment for fractures without
neurological deficit. This cross sectional study was designed to evaluate the functional and radiological
outcome of patient with thoracolumbar burst fracture treated conservatively. Methods: 40 cases were
recruited from January 2013 till December 2015. They were followed-up with minimum period of 1 year and
evaluated for the functional (Oswetry Disbility Index) and radiological outcomes (kyphotic angle deformity
and anterior body compression). Results: 20 patients were treated with body cast made form plaster of
Paris and remaining 20 patients with fiberglass cast. In plaster of Paris group, mean kyphotic angle
deformity at last follow up was 16.60 ± 2.95 with a mean improvement 4.45 degree and anterior body
compression at last follow up was 30.35% ± 10.2 with mean improvement of 9.30%. In fiberglass group, mean
kyphotic angle deformity at last follow up was 15.55 ± 3.38 with a mean improvement 7.25 degree and
anterior body compression at last follow up was 25.90% ± 7.81 with mean improvement of 3.45%. The
functional outcome showed Oswetry Disability Index (ODI) score in plaster of Paris group was 23.70 (SD =
7.82) and in fiberglass group was 18.50 (SD = 5.94). Conclusions: Application of body cast using a fiberglass
material give better radiological outcome hence less pain, more functional and higher patient’s satisfaction
as compared to plaster of Paris.
Introduction: Epilepsy remains a stigmatised disease across geographical and temporal boundaries. Very little is known about epileptic stigma (ES) in cross-cultural settings. The aim of this study was to assess the prevalence of perceived stigma and factors associated with it, among patients with epilepsy (PWE) at a tertiary care referral hospital in East Coast of Malaysia. Methods: A cross sectional survey among 132 consenting PWE using pre-tested, semi-structured questionnaire in Malay/English language to assess their knowledge, attitude and practices (KAPs). Results: Among 132 respondents, 51.5% were male and 48.5 % were female. Their age ranged from 14 to 70 years (mean=31.6±13.41). Majority (53.8%) of them were aged 30 years or younger. The median number of years they had epilepsy was 8.0 (IQR 4.0-18.8) years and average duration of seizure prior to seeking medical attention was 1.0 (IQR 0.3 - 4.5) year. Most of them (90.9%) did not know the cause of epilepsy; however nearly all (91.7%) believed that it was a disease of the
brain. Higher education level respondents possessed significantly higher KAP scores compared to lower education level respondents (p
Introduction: The oil extract of black cumin seeds Nigella sativa (NSO) demonstrated considerable
preservation of spatial cognitive functions in rats subjected to chronic brain hypoperfusion (CBH). The hippocampal CA1 region pyramidal cells are the earliest neurons suffering neurodegeneration following CBH. Objective: The current study was devoted to assess the protective effects of Nigella sativa (NSO) treatment on CA1 hippocampal pyramidal cells of rats subjected to chronic brain hypoperfusion (CBH) that was achieved through permanent two vessel occlusion (2VO) procedure. Methods: Twenty four rats were equally divided into three groups; sham control, untreated 2VO and NSO treated group (2VO with daily oral NSO treatment. After the 10th postoperative week coronal sections of the hippocampus were collected for histopathological and electron microscopical examinations. Results: The number of viable pyramidal cells within CA1 hippocampal region in sham control and NSO treated groups was significantly higher than that of untreated 2VO group, while the difference was not significant when comparing the viable pyramidal cells number of sham control with NSO treated groups. Furthermore, 2VO group showed marked intracellular ultrastructural distortions that were less pronounced in NSO treated group. Conclusion: NSO displayed a robust potential to protect hippocampal pyramidal cells from CBH induced neurodegeneration putting forward its prospective neuroprotective activity against age related cognitive decline of Alzheimer’s disease and vascular dementia.
Introduction: Caring for those with dementia affects the quality of life for both the caregivers and the patients themselves, particularly in the informal care system here in Malaysia. To date, only a few studies have explored from the family caregivers’ perspectives in the communities of different cultural background. The purpose of this study is to describe the Malaysian family caregivers’ perspectives of their experiences in providing care to for their family members suffering from moderate to severe dementia in Kuala Lumpur, Malaysia. Methods: This qualitative study involved in-depth individual interviews with twelve caregivers to patients with moderate to severe dementia. Participants were recruited via purposive sampling from the outpatient psycho-geriatric clinic at UKM Medical Centre, Kuala Lumpur. All interviews were audio-recorded and transcribed verbatim. Transcribed data was later analysed using a thematic approach. Results: Four themes identified in this study were; i) the feeling that ‘it is like caring for a baby’, ii) the caregivers’ perception of inadequate knowledge and skills, iii) the need for caregivers’ support system and iv) the importance of spirituality in enhancing care giving experiences. Conclusions: The framework of care shared by the caregivers in this study demonstrated strong cultural and spirituality influences in addition to the common issues of the challenges in managing the behavioural and psychological symptoms in people with dementia. Hence, culture and spirituality aspects should be addressed in the development of appropriate intervention to manage the needs of informal caregivers in this community.
MeSH terms: Dementia; Emotions; Patient Care; Humans; Malaysia; Outpatients; Quality of Life; Stress, Psychological; Caregivers; Spirituality; Qualitative Research
Introduction: The metabolic syndrome comprises a collection of cardiovascular disease risks, which has been demonstrated to predict type 2 diabetes mellitus and cardiovascular disease. Metabolic syndrome is a crucial health concern in Malaysia, with a prevalence of about 42.5% in the general population based on the ‘Harmonized’ definition. The aim of this study was to ascertain the association between socioeconomic status among Malaysian government employees with metabolic syndrome, compared with those without metabolic syndrome. Furthermore, this study also aimed to ascertain the associated obesity indicators for metabolic syndrome among employees—explicitly body mass index, waist circumference, waist-to-hip ratio, body fat percentage, fat mass index, and waist-to-height ratio. Methods: This cross-sectional study was
undertaken at government agencies in Putrajaya, Malaysia, via multi-stage random sampling. A total of 675 government employees were randomly sampled from a list of 3,173 government employees working in five government agencies under five geographical areas. Data on socioeconomic status, anthropometric, biochemical, and clinical assessments were collected. Results: Employees who were males had higher metabolic syndrome prevalence compared to their counterparts (p=0.019). In addition, employees aged between 20 to younger than 30 years had lowest metabolic syndrome prevalence (p=0.002). The risk of having metabolic syndrome was almost 10 times more likely in men with a waist-to-hip ratio of ≥0.90 compared to men with a waist-to-hip ratio of
MeSH terms: Adipose Tissue; Cardiovascular Diseases; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Government Agencies; Humans; Malaysia; Male; Obesity; Social Class; Body Mass Index; Prevalence; Waist-Hip Ratio; Waist Circumference; Waist-Height Ratio; Government Employees
Introduction: Abdominal obesity and inflammation are two independent risk factors for cardiovascular disease. However, the inter-relationship between these two factors among Malay population is fragmented. The purpose of this study is to determine the association between waist circumference as a measure of abdominal obesity and high-sensitivity C-reactive protein as an indicator of inflammation status among Malay obese adults in Kuantan, Pahang. Materials and Methods: Ninety-three apparently healthy obese adults (BMI between 27.5 and 39.9 kg/m2 ) aged between 20 to 62 years old were recruited in this study (68% men and 32% women). Circumference tape was used to measure the waist circumference and fasting venous blood was obtained to determine the high-sensitivity C-reactive protein level. Results: On average, the waist circumference of obese men and women was 103 cm (SD = 8.7) and 94 cm (SD = 7.0), respectively. The median (IQR) of the hs-CRP level of the study participant was 3.80 mg/L (1.5, 10.1). The Kendall’s Tau correlation reveals that there is a significant positive linear correlation between waist circumference and hs -CRP level in obese men (r (30) = 0.355, p = 0.006) and women (r (63) = 0.177, p = 0.043). Conclusion: There is a significant inter-relationship between waist circumference and hs-CRP level among apparently healthy obese adults in Kuantan, Pahang. This study suggests that assessment of hs-CRP level is beneficial to predict the risk for future cardiovascular disease event and facilitate the management of obesity in this population. A prospective clinical study is recommended to confirm the findings.
Wan Khairunnisa Wan Juhari, Khairul Bariah Ahmad Amin Noordin, Wan Faiziah Wan Abdul Rahman, Andee Dzulkarnaen Zakaria, Ahmad Shanwani Mohd Sidek, Muhammad Radzi Abu Hassan, et al.
Background: Hereditary nonpolyposis colorectal cancer (HNPCC) also known as Lynch syndrome is commonly caused by genetic alterations in any of the four mismatch repair (MMR) genes; MLH1, MSH2, MSH6 and PMS2. This is the first study aimed to investigate genetic variants in Malay HNPCC families. Methods: Six Malay HNPCC families who fulfilled any of the Bethesda criteria were recruited into this study. A total of 3 ml of blood was withdrawn from each patient in the families. The samples were further analyzed using polymerase chain reaction and direct sequencing of the selected exons of MLH1 and MSH2 genes. Results: Two missense mutations and four single nucleotide polymorphisms (SNPs) were identified in six patients. These variants in the MLH1 and MSH2 genes were identified in four families who met the revised Bethesda guidelines. In two families, no mutation and polymorphism was identified in both the exon and intron of the respective genes. Of the mutations and polymorphisms identified, five have never been reported in Malay HNPCC families before. A missense mutation was detected in exon 5 of the MLH1 gene, c.394G>C (p.Asp132His) and four mutations and polymorphisms were detected in the MSH2 gene; heterozygous c.211+98T>C and c.211+9C>G and homozygous c.211+98T>C and c.211+9C>G, c.367-86A>C and c.382C>G. Conclusion: The results represented a new spectrum of mutations and polymorphisms in the Malay HNPCC families. However, a larger study involving additional families and analysis is required to determine the impact and nature of the identified mutations and polymorphisms.
Introduction: Mak nyahs (male-to-female transgenders) often consume feminizing hormones to achieve and maintain the female physical appearance. They do it without professional prescription/advise, and often take excessive doses. This renders them at risk of developing complications of hormone consumption. This paper provides some quantitative data on hormone consumption among mak nyahs in Kuantan, Pahang, in Malaysia. Materials and Methods: A cross-sectional study was carried out from July to August in 2015 among 35 mak nyahs. Convenience sampling was used. Participants who gave consent answered an interview-guided questionnaire which documents socio-demographic profile, hormone usage, and morbidities as a result of hormone consumption. Data was analysed using SPSS, Version 16.0. (version 16). Results: Majority of the subjects were Malays (91.4%) and Muslims (97.1%), their median (IQR) age being 31 (±17) years, more than half (57.1%) were between 20 to 40 years old. Most (80.0%) of them are sex workers. Oral hormone was most commonly used (88.6%), while more than half (67.7%) of them added hormone injections. Almost all subjects purchased hormones over the counter from local pharmacies (94.2%). However, many received information on hormone from non-professional sources. Possible adverse effects of hormones reported among subjects were hypertension, ischemic heart disease, diabetes mellitus, and venous thrombo-embolism. Conclusion: Hormone consumption was very common among the subjects in this study, and may be associated with certain medical problems. Medical personnel must pay more attention in educating the mak nyahs on adverse effects of hormones consumption. Mak nyahs should also be screened for complications every time they seek medical attention.
Objective: The aim of this study is to evaluate the outcome of pregnancy in prenatal and postnatal period of pregnancy complicated with thick nuchal translucency but normal karyotype. Methods: This is a retrospective study of 119 singleton pregnancies with increased NT (NT > 2.5mm) but a normal karyotype over a 3 year period. The records of ultrasound at 18-20 and 25-26 weeks’, antenatal and postnatal details were reviewed. The developmental and health outcomes of the surviving children were obtained through telephone conversation with the family. Adverse outcome such as miscarriages, termination of pregnancy, intrauterine death, structural anomalies and neurodevelopment delay were analysed. Results: Out of 119 foetuses with increased NT but normal karyotype, 11.8% of pregnancies ended with miscarriages, termination of pregnancy and intrauterine death. 89.9% foetuses were structurally normal. 12.9% presented with structural anomalies in the second-trimester ultrasound scan. 81.8% showed major malformations, out of which 44% consisted of heart defects. 1% of foetuses were syndromic and 1.9% had developmental delay. 96.8% of foetuses with NT equal to or greater than the 95th percentile (3.4mm) and 80% with NT equal to or greater than the 99 percentile (5.5mm) had a normal outcome. 50% of foetuses with thickened nuchal fold had a poor outcome. Postnatal follow-up was established for all infants and toddlers, and abnormalities were observed in 5.6% of them. Chances of having a live and healthy infant decreases with increased NT, corresponding to 80% for NT equal to or greater than 5.5mm. Conclusion: We have provided data that may help in the counselling of parents and increasing their confidence on a favourable pregnancy outcome. In cases with increased nuchal translucency but normal karyotype, the chances of normal pregnancy success rate is 89.9%. Parents can be reassured that thickened nuchal translucency with a normal karyotype and normal targeted ultrasound between 20-22 weeks gestation, the risk of adverse perinatal outcome and postnatal developmental delay is not increased in comparison with that of the general population. This seems to be the case for all degrees of increased nuchal translucency.
Introduction: Prehypertension precedes overt hypertension and has been acknowledged by many guidelines.
Hypertension is an important risk factor for cardiovascular disease in Malaysia. Hypertension prevalence is
at 42.6% and population-based control is poor at 26.8%. The objective of the study is to ascertain the
cardiovascular risk profile of prehypertensive and mildly hypertensive young adults against age-matched
controls in rural Malaysia. Methods: 484 (four hundred and eighty four) subjects attending primary care
clinic were screened. 91 (Ninety one) young adults with pre/mild hypertension and normotensive, agematched controls were enrolled. The blood pressure and biochemical profiles for both groups were assessed
and compared. Results: Fifty-four subjects and 37 controls were enrolled. Amongst subjects, 46.3% had
prehypertension and 53.7% had mild hypertension. Mean values compared to age-matched controls for MAP
were 102.68 ± 7.48 vs 83.25 ± 6.08 mmHg (p< 0.001), LDL 3.75 ± 0.95 vs 3.32 ± 0.93 mmol/L (p=0.03), FBG
4.65 ± 0.54 vs 4.33 ± 0.42 mmol/L (p=0.03), BMI 28.81 ± 5.16 vs 24.12 ± 4.91 (p< 0.001). The mean BP was
significantly associated with BMI, FBG, triglycerides, HDL and the TC/HDL ratio. Conclusions: Greater BMI,
FBG, HDL, triglyceride levels and TC/HDL ratio characterised the young adults with pre/mild hypertension.
The data suggests that hypertension in young adults is secondary to metabolic syndrome.
MeSH terms: Adult; Blood Pressure; Blood Pressure Determination; Cardiovascular Diseases; Cardiovascular System; Humans; Hypertension; Malaysia; Primary Health Care; Risk Factors; Triglycerides; Body Mass Index; Prevalence; Young Adult; Prehypertension
Introduction: A validated diagnostic questionnaire is needed in the South-East Asia region, particularly in Malaysia to detect Premature Ejaculation (PE). The objective of this study was to determine the linguistic validity of the Malay Premature Ejaculation Diagnostic Tool (MAPET). Materials and Methods: This study was conducted in a teaching hospital. The first phase involved experts’ group discussions to develop the face, content, and factorial validity of the MAPET. The second phase measured the concurrent validity of MAPET. Results: We found that the MAPET has specificity, sensitivity, positive predictive value, and negative predictive value of 79.3%, 92%, 76.7% and 93.1%, respectively in the assessment of PE. The higher score indicates severity of PE. Conclusions: MAPET is a valid self-report instrument for the assessment of PE.
MeSH terms: Asia, Southeastern; Hospitals, Teaching; Linguistics; Malaysia; Male; Surveys and Questionnaires; Sensitivity and Specificity; Self Report; Premature Ejaculation
Hydroxychavicol (HC) is a phenolic compound of betel leaf (Piper betle). It has been reported to have antifungal properties against dermatophytes including T. rubrum. The aim of this study was to identify the effects of the HC against T. rubrum. Broth dilution method was used to determine the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of the HC. Microscopic study of the treated fungus was done by transmission electron microscope (TEM). Cytotoxicity study using pre-adipocyte (3T3-L1) cell line was performed by means of MTT cell proliferation assay. The MIC and MFC results of the HC were both 0.49 µg/ml. Microscopic study revealed the destruction of the fungal cell wall and organelles. Cytotoxicity study showed HC to be non-toxic to the tested human cell line. In conclusion, HC may potentially be used as an alternative therapeutic agent against T. rubrum infections.
This study aimed to develop a questionnaire in Malay language for the identification of risk factors for myopia among primary school children aged 10 to 12 years old in Malaysia. Materials and Methods: The study commenced in October 2012 till Julai 2013 in two main phases. The first phase was a pilot study for the construction of questionnaire items by literature review and discussion with the experts. A total of 103 parents of primary school children were randomly selected to test the comprehensibility of the preliminary questionnaire. The second phase was the actual study which involved parents of 353 primary school children , 132 were parents whose children were myopes and 221 parents whose children were nonmyopes. Results: Discussions with experts in human vision science identified 5 main domains and 71 items for the preliminary questionnaire. A total of 55 items were retained for the actual study phase in view of statistically good correlation (r = 0.4 and above). Predictive validity by chi-square test allowed 28 items to be retained because of significant association with myopia (p
MeSH terms: Child; Humans; Language; Malaysia; Myopia; Parents; Pilot Projects; Surveys and Questionnaires; Risk Factors; Chi-Square Distribution
This study assesses dental students’ and patients’ perceptions on the role of dental students as smoking cessation counsellors as well as the patient’s quit rate at the University of XX. Materials and methods: Self-administered questionnaires were distributed to all senior dental students (n=154) in XX University and telephone call interviews were conducted on their patients (n=169) who received smoking cessation counselling from September 2010 to June 2013. Results: Response rates for dental students and patients were 68.2% and 67.3% respectively. Most of the dental students in this study were females (72.3%) whereas the majority of patients were males (97.6%). An average of six months follow up indicated that 22.5% of patients had quit smoking, 65.3% reduced the number of cigarettes smoked and 6.5% had relapsed. About a third of patients surveyed (33.1%) believed that smoking cessation counselling was extremely helpful compared to what students perceived (5.7%, p
Septic arthritis is uncommon in immunocompetent young adults. It typically presents in individuals with underlying risk factors. Isolation of Group A Streptococcus (GAS) as the causative agent of septic arthritis is usually associated with autoimmune diseases, chronic skin infections or trauma. Here we report a case of a young lady who is immunocompetent without any prior history of trauma, who presented with an abrupt onset of left knee pain and swelling to the emergency department. An initial diagnosis of acute gout was made and she was treated with non-steroidal anti-inflammatory drug (NSAID). She presented again two days later to a primary care clinic with worsening knee pain and severe left calf pain. A clinical diagnosis of septic arthritis was suspected and the patient was urgently referred to the Orthopaedic team. Synovial fluid from the knee joint aspiration showed growth of GAS. A diagnosis of necrotizing fasciitis was also made as the culture taken from the left calf during incision and drainage (I&D) procedure showed a mixed growth. She eventually underwent surgical debridement twice, together with the administration of several courses of intravenous antibiotics leading to her full recovery after 45 days. This case demonstrates the challenge in making a prompt diagnosis of septic arthritis and probable Type II necrotizing fasciitis in an immunocompetent adult without underlying risk factors. Any delay in diagnosis and treatment would have increased the risk of damage to her knee joint and this may be fatal even in a previously healthy young adult.
Turner syndrome is one of the most common sex chromosome abnormalities with an estimated true prevalence of 1 in 2,000 in newborns. This case report is of a girl who presented to the adult endocrinologist at 16 years of age and subsequently diagnosed with Turner syndrome. Despite frequenting clinics for unrelated ailments, her short stature was overlooked hence not investigated for a causative pathology. The aim of this report is to explore the diagnostics of Turner syndrome, hormone treatments available and the importance of starting treatment early.