A one year study was carried out to determine the outcome of the seminal fluid parameters collected via masturbation and coitus interruptus in 151 patients who were undergoing intrauterine insemination (IUI) and patients who came for seminal analysis. There were no statistically significant differences in terms of volume, concentration, progressive motility and normal morphology from specimens collected via coitus interruptus compared to specimens collected via masturbation. Pregnancy outcomes were also comparable.
Fetus-in-fetu (FIF) is a rare entity in which malformed parasitic twin grows inside the body of its twin. It is most commonly presented with mass in the abdomen. We present a case of a 15-year-old boy who presented with abdominal mass since infancy. Radiological investigations are suggestive of FIF. Intraoperatively, malformed fetus in a sac was found and excised. Postoperatively the patient recovers well and was put on follow-up.
The study investigates the effects of the 11+ and HarmoKnee injury prevention programmes on knee strength in male soccer players. Under-21-year-old players (n=36) were divided equally into: the 11+, HarmoKnee and control groups. The programmes were performed for 24 sessions (20-25 min each). The hamstrings and quadriceps strength were measured bilaterally at 60°·s(-1), 180°·s(-1) and 300°·s(-1). The concentric quadriceps peak torque (PT) of the 11+ increased by 27.7% at 300°·s(-1) in the dominant leg (p<0.05). The concentric quadriceps PT of HarmoKnee increased by 36.6%, 36.2% and 28% in the dominant leg, and by 31.3%, 31.7% and 20.05% at 60°·s(-1), 180°·s(-1) and 300°·s(-1) in the non-dominant leg respectively. In the 11+ group the concentric hamstring PT increased by 22%, 21.4% and 22.1% at 60°·s(-1), 180°·s(-1) and 300°·s(-1), respectively in the dominant leg, and by 22.3%, and 15.7% at 60°·s(-1) and 180°·s(-1), in the non-dominant leg. In the HarmoKnee group the hamstrings in the dominant leg showed an increase in PT by 32.5%, 31.3% and 14.3% at 60°·s(-1), 180°·s(-1) and 300°·s(-1), and in the non-dominant leg hamstrings PT increased by 21.1% and 19.3% at 60°·s(-1) and 180°·s(-1) respectively. The concentric hamstrings strength was significantly different between the 11+ and control groups in the dominant (p=0.01) and non-dominant legs (p=0.02). The HarmoKnee programme enhanced the concentric strength of quadriceps. The 11+ and HarmoKnee programmes are useful warm-up protocols for improving concentric hamstring strength in young professional male soccer players. The 11+ programme is more advantageous for its greater concentric hamstring strength improvement compared to the HarmoKnee programme.
Introduction: Leptin is an adipokine that has strong correlation with the body mass index (BMI). Gestational diabetes mellitus (GDM) is a common medical complication associated with pregnancy. Leptin may lose its correlation with the body mass index (BMI) during diabetes due to hormonal rearrangement. Diet control is the first line management in GDM. Leptin reported to increase in pregnancy and further increases in diabetic patients during GDM screening. There is paucity in the reports concerning Leptin levels in GDM patients on diet control. The present study was aimed to evaluate the changes in maternal leptin in pregnancy complicated by GDM on diet control compared to the normal pregnancy in the 3rd trimesters by comparing the means and to find the correlation of Leptin with the body mass index in both groups.
Methods: The study included 2 groups: normal pregnancy (n = 40) and pregnancy with GDM under diet control (n = 60) both groups are at 38-40 weeks of gestation. Leptin concentration in serum was measured in both groups and statistically tested using student t test. The BMI were measured and correlated with the Leptin level in test groups.
Results: the results indicated that Leptin will nearly triple in the third trimester (38±30 ng/ml) of pregnancy compared to the standard normal non-pregnant. Leptin level was significantly lower in diabetic women on diet control (28±16 ng/ ml) when compared with the non-diabetics (38±30 ng/ml). The hormone has no correlation with the age of the patients but have a positive correlation with the body mass index before and during pregnancy in both groups.
Conclusion: Leptin is increasing in pregnancy as part of the physiological changes. Dieting can decrease Leptin level in diabetics’ pregnant women. Diet can restore the hormonal dysregulation of Leptin. Assessment of Leptin level might be used as an indicator for good diet control during pregnancy.
Study site: Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang, Malaysia
Subdermal etonogestrel implant (Implanon®) is the newest, long term contraceptive implant which has recently been made available to Malaysian women. This prospective study was conducted to determine the effects on selected health indices among 42 women who had consented to Implanon® as their choice of contraception. Health indices were checked prior to Implanon® insertion and six months post insertion. Findings indicate a significant reduction in total cholesterol with a significant increase in total haemoglobin and BMI. However there was no significant change noted in the fasting blood sugar, glycosylated haemoglobin, systolic blood pressure and diastolic blood pressure.
OBJECTIVE: There is paucity of data for Takayasu arteritis (TAK) among South Asians. We aimed to evaluate the clinical features, angiographic findings, as well as treatment and outcome of TAK among Malaysian multiethnic groups.
METHODS: This is a retrospective review of 40 patients with TAK seen in major rheumatology centres in Malaysia between April 2006 and September 2013.
RESULTS: Majority were female patients (92.5%), with a female-to-male ratio of 12:1. Median duration of disease from diagnosis was 66 months (interquartile range, 33-177 months). Fifteen (37.5%) were Malays, 9 (22.5%) each were Indians and indigenous from East Malaysia and 7 (17.5%) were Chinese. Indian and indigenous from East Malaysia were overrepresented in this disease. The mean (SD) age of symptom onset and diagnosis were 25.5 (8.1) and 27.4 (8.4), respectively. The 3 most common clinical presentations at diagnosis were diminished or absent pulse, which occurred in 80% of the patients, followed by blood pressure discrepancy (60%) and arterial bruit (52.5%). There was no difference in clinical presentation among ethnic groups. The subclavian artery was the commonest vessel involved (72.5%), followed by the carotid artery (65%) and renal artery (47.5%). Eight patients had coronary artery involvement, and 2 patients had pulmonary artery involvement. Type I arterial involvement was the commonest (80.0%), followed by type IV (35%), present in isolation or mixed type. Glucocorticoid was the main medical treatment (90.0%). Nineteen patients (47.5%) underwent revascularization procedures. Five patients died during the follow-up period.
CONCLUSIONS: The Malaysian TAK cohort had similarities with and differences from other published TAK cohort. A nationwide TAK registry is needed to determine the prevalence of the disease among different ethnic groups.
We reviewed 31 cases (19 males and 12 females) of spinal tuberculosis seen at the National Tuberculosis Centre from 1985 to 1989. The mean age was 35.4 years. The predominant clinical feature was backache (90.3%), while neurological features were found in 30.9%. An elevated erythrocyte sedimentation rate (in 80.0%) and a positive Mantoux test (in 70.9%) served as useful investigations. Spinal x-ray was abnormal in all cases, the lumbar spine being most commonly involved. Bacteriological or histopathological confirmation was obtained in only 29.0% of cases. The mainstay of treatment was anti-tuberculous chemotherapy with surgery being performed in 41.9% of patients.
The study concerned the identification of the beta-thalassaemia mutations that were present in 24 patients with beta-thalassaemia major who were transfusion dependent. The application of a modified polymerase chain reaction, the amplification refractory system (ARMS) was found to be an effective and rapid method for the identification of the beta-thalassaemia mutations. Six different mutations were detected. Seventy five percent of the patients were Chinese-Malaysians and showed the commonly occurring anomalies: 1. frameshift codon 41 and 42 (-TCTT); 2. the C to T substitution at position 654 of intron 2 (IVS-2); 3. the mutation at position -28(A to G); and the nonsense mutation A to T at codon 17. In the Malays, the common mutations seen were: 1. the G to C mutation at position 5 of IVS-1; 2. the G to T mutation at position 1 of intron 1 (IVS-1); and the A to T at codon 17. The delineation of the specific mutations present will enable effective prenatal diagnosis for beta-thalassaemia to be instituted.
Aims: To investigate whether in Malaysia, a mean corpuscular volume (MCV) less than 80 fl and a mean corpuscular haemoglobin (MCH) less than 27 pg will identify carriers in pregnant women with severe forms of thalassaemia, a-thal 1 (a0) and classical b (b0)-thalassaemia. The results from this study will aid the implementation of a national program to screen for thalassaemia.
Methods: For classical b (b0)-thalassaemia, blood samples collected in EDTA from 153 pregnant women were taken for full blood counts and haemoglobin subtyping by automated blood counting and high performance liquid chromatography (HPLC) respectively. For a-thal 1 (a0), the full blood counts were obtained from archives of 30 pregnant women who were genotyped positive for the a-thal 1 (a0) during prenatal diagnosis for Hb Barts hydrops fetalis. The effects of storage on MCV, MCH and Hb A2 were determined by tests done daily for 3 weeks.
Results: By correlating red cell indices with high performance liquid chromatography and genotypic data, we show that mean corpuscular volume (MCV) <80 fl and mean corpuscular haemoglobin <27pg is able to detect all heterozygous carriers of a-thal 1 (a0) and classical b (b0)-thalassaemia. On storage, the MCV of heterozygous carriers with classical b (b0)-thalassaemia rose at 1% a day after 24 hours reaching a mean of 80 fl by day 15. However, the MCH and Hb A2 were stable for 3 weeks.
Conclusion: A mean corpuscular volume (MCV) <80 fl and mean corpuscular haemoglobin <27pg should be recommended as cut-off values for screening of carriers of a-thal 1 (a0) and classical b (b0)-thalassaemia. In blood samples, not processed within a day, MCH with a cut-off value of 27 pg is the recommended choice for screening of carriers. Keywords: Screen, thalassaemia, pregnant, MCV, MCH
Objective: To determine the number of RA cases and to evaluate the demographic patterns in all 4 Rheumatology Referral Centers under the Ministry of Health Malaysia. Materials and methods: One thousand and eighty-four rheumatoid arthritis patients from all 4 centers i.e. Hospital Selayang, Putra Jaya, Seremban and Taiping which are situated in the west coast of West Malaysia, using rheumatoid arthritis database comprising of basic clinical and patient questionnaire, until the end of year 2004 were analysed. Results: At the time of documentation, 88.6% were female at all range of ages especially between age of 25 and 54 years (77.6%) with female to male ratio 8 :1. 52.1% were housewives. Mean age of onset of RA was 49.6 ± 11.8 SD with female 49.3 ± 11.7 SD and male 52.0 ± 12.0 SD (p < 0.05). Indian was the predominant ethnic group (54.5%), followed by Malay (31.4%), Chinese (11.6%) and others (27%). Majority had their education up to secondary level (50.8%), followed by primary (32.6%), and tertiary (6.3%) levels while 10.3% of cases had not received any formal education in their lives. 74.4% were seropositive and 87.3% fulfilled at least 4 out of 7 American College of Rheumatology (ACR) revised criteria for rheumatoid arthritis. 74% were diagnosed RA within 2 years after the onset of arthritis. Seropositivity was not significantly related to gender. Positive rheumatoid factor was dominated by Indian followed by Malay and Chinese. 83.3% were married. 23.3% female and 33.9% male between age group 25-54 were employed. 7.4% had achieved their retirement at time of entry whilst 8.9% were unemployed. Employment status was statistically significant across gender (p < 0.001). The cases differed between rheumatology centers as well as individual practices. Conclusion: There are increasing numbers of RA cases in Malaysia. Results from this study did not reflect the true prevalence of RA in Malaysia. Hence, a larger and more comprehensive database on RA with collaboration of all Government and Private Hospitals in the whole nation will provide better information about the patient case mix in different healthcare settings, treatment practice as well as disease complications. The implementation of rheumatology centers with better regional cooperation, will lead to better treatment and outcome in terms of identification of early as well as established RA cases. Early referral to the centers will be made possible for proper treatment institution and rehabilitation. Hence, improve quality of life including socio-economic status especially among those within the productive age.
Haemoglobin Bart's hydrops fetalis is the result of complete absence of functional alpha-globin genes where the fetus is homozygous for the alpha 0-thal gene. Prenatal diagnosis can be made by analysis of fetal DNA from chorionic villus, amniotic cells and fetal blood. Earlier studies for analysing genomic DNA needed digestion with restriction enzymes and hybridisation to radiolabelled probes which took 2 weeks. We have used the polymerase chain reaction (PCR) and non-radioactive primers to identify specific target sequences with results available within 1-3 days for the diagnosis of haemoglobin Bart's syndrome. With fetal blood samples, complete absence of alpha-chain synthesis is confirmed by globin chain electrophoresis on cellulose acetate pH 6.0.
Nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely used for the treatment of inflammation. However, despite their effectiveness, most NSAIDs cause various side effects that negatively affect the management of inflammation and, in part, pain. Thus, there is a need to search for new anti-inflammatory agents with few, or no, side effects. Natural products of plant, animal, or microorganism origin have been good sources of new bioactive compounds. The present study was carried out to evaluate the acute and chronic anti-inflammatory activities of the essential oil of the rhizomes of Zingiber zerumbet (Zingiberaceae) using the carrageenan-induced paw edema and cotton pellet-induced granuloma tests, respectively. The effect of the essential oil on inflammatory- and noninflammatory-mediated pain was also assessed using the formalin test. Essential oil of Z. zerumbet, at doses of 30, 100, and 300 mg/kg, was administered intraperitoneally to rats. The substance exhibited significant anti-inflammatory activity both in acute and chronic animal models. The essential oil also inhibited inflammatory- and noninflammatory-mediated pain when assessed using the formalin test. In conclusion, the essential oil of Z. zerumbet possessed anti-inflammatory activity, in addition to its antinociceptive activity, which may explain its traditional uses to treat inflammatory-related ailments.
Leiomyomas are the most common benign tumour of the uterus, occurring in 20-40% of women in reproductive age.Most of the myomas arise in the uterus, however extrauterine sites include fallopian tubes, cervix, round ligament, ovary and urethra. A single or polypoidal mass in the vagina is usually a leiomyomatous polyp arising from the cervix or from the cavity of the uterus. Leiomyoma developing de novo from the fibromuscular elements of the vagina is a rare entity. When such a tumour arises from anterior wall of the vagina it is often mistaken for a cervical fibroid. Parasitic leiomyoma is the rarest type of leiomyoma and develop when a leiomyoma attaches itself to another organ. Vaginal leiomyomas usually arise from anterior vaginal wall. We report a case of parasitic leiomyoma in the vagina together with uterine leiomyoma in a 48 year old lady presented with palpable mass perabdomen and anaemic symptoms. The size and location of the tumours necessitated abdominal and vaginal approach for better surgical access.
OBJECTIVES: E-cigarette use has become popular, particularly among the youth. Its use is associated with harmful general and oral health consequences. This survey aimed to assess self-reported oral hygiene practices, oral and general health events, and changes in physiological functions (including physical status, smell, taste, breathing, appetite, etc.) due to E-cigarette use among dental students.
METHODS: This online, multicounty survey involved undergraduate dental students from 20 dental schools across 11 different countries. The questionnaire included demographic characteristics, E-cigarette practices, self-reported complaints, and associated physiological changes due to E-cigarette smoking. Data were descriptively presented as frequencies and percentages. A Chi-square test was used to assess the potential associations between the study group and sub-groups with the different factors. Statistical analysis was performed using SPSS at P
Monoamniotic twin pregnancy is a rare type of twin pregnancy which poses risk of cord entanglement and
sudden death of either one or both fetuses. The role of antenatal surveillance by Ultrasound Doppler for
umbilical cord and ultrasonic evidence of cord entanglement or knotting may predict the pregnancy outcome
but yet unavoidable. The discussion will include antenatal surveillance in this rare type of pregnancy.
Ectoparasitic infestations including pediculosis capitis are common in people of disadvantaged communities as they live in overcrowded institutions, a condition that often favourable for disease transmission. In this study, we evaluated the prevalence of head lice infestation among disadvantaged children aged between five to 14 years-old living in five poor conditions located across the Klang Valley, Malaysia. Of total 335 children examined, 14% were positively infected with head lice. Molecular analysis using the universal cytochrome c oxidase subunit I ( COI) barcoding gene on total of 167 head lice collected in this study indicated they are belonging to the A and C clades; confirming the global distribution of clade A and expansion of clade C in Southeast Asia, which is reported for the first time in Malaysia.
Multi-drug resistant staphylococci including methicillin-resistant Staphylococcus aureus
(MRSA) and Methicillin-resistant Staphylococcus epidermidis (MRSE) are among the emerging
pathogens and have become a threat to both human and animals. Foods of animal origin can
easily be contaminated by these bacteria if handled unhygienically or exposed to contaminated
environmental surfaces. The objective of this study was to investigate the occurrence of MRSA
and MRSE in raw chicken meat sold at wet markets in Kota Bharu, Kelantan, Malaysia. One
hundred fresh raw chicken meat samples were collected from three different wet markets in
Kota Bharu, Kelantan. Routine isolation and identification, selective media (Brilliance MRSA2
agar), antimicrobial sensitivity test (AST), minimum inhibitory concentration test (MIC), and
polymerase chain reaction (PCR) amplification of nucA gene and the resistant gene, mecA
were conducted. Based on bacteriology results and growth on selective media, MRSA and
MRSE were detected in 43% (43/100) of the raw chicken meat samples. Using the PCR assay,
77% (34/43) isolates were positive for nucA gene. The detection of these emerging multidrug
resistant bacteria in chicken meat intended for human consumption implies the potential
contamination of food items by the bacteria which in turn may pose risk to the public health.
This study reports for the first time molecular detection of Anaplasma platys infection in 4 (13.3%) of 30 Malaysian dogs investigated. A low occurrence (3.3%) of Babesia gibsoni was also noted, being detected in one of the 30 dogs. Rickettsia, Bartonella, Orientia tsutsugamushi, and Ehrlichia DNA were not detected in the dog blood samples. The role of A. platys as an agent of canine anaplasmosis and its transmission through Rhipicephalus sanguineus ticks merits further investigation.
Objective: Lower Urinary Tract Symptoms (LUTS) is a highly prevalent disease which varies by geography
and culture. It influences the quality of life and has social implication. The objectives of this study are to
estimate the prevalence of LUTS among women attending our gynaecology clinic, the associated risk factors
and their quality of life. Method: This is a cross sectional study on women attending gynaecology clinic in a
tertiary centre. Participants were given 3 sets of validated self-answered questionnaire, UDI-6, IIQ-7 and
OAB V8. Results: the prevalence of luts is 50.6% which is common among Malay women. Forty nine percent
is due to stress urinary incontinence (SUI). The risk of LUTS is significantly associated with obesity (AOR =
12.14 95% CI = 1.21 to 121.99, p – value = 0.034), higher parity (AOR = 1.68 95% CI = 1.26 to 2.24, p – value =
Lifestyle has been shown to exert a major impact on the quality of life and health in mid-life women coping with menopausal changes. This study aimed to assess the efficacy of a lifestyle intervention package in improving nutritional knowledge and composition, dietary habits and related health status in mid-life women. Between Nov 1999 to Oct 2001, 360 disease free women, non users of HRT, aged 45 years and above with intact uterus were recruited into the study. The women were randomised into three groups - I (control), II (lifestyle intervention) and III (lifestyle intervention with HRT) respectively. After 12 months, 85.6% completed the study. The lifestyle intervention programme, well accepted by the participants, brought about an improved dietary composition, better eating habits, more exercise participation and increment in knowledge with concomitant improvement of the health status. The benefits observed were significant reduction in energy, fat and carbohydrate intake with increased intake of legumes; milk and cheese/yogurt; and reduction of tea and coffee. Body weight was reduced and more importantly preventing abdominal obesity in the intervention groups with HRT was more effective. Further adaptations of the dietary component with advice on obtaining micronutrients from local produce would contribute towards a more balanced diet in midlife women as dairy products were not popular and these women had low meat intake.