Dysmenorrhea is one of the leading causes of pelvic pain and menstrual disorder among women during childbearing age. The burden of dysmenorrhea is greater than any other gynaecological complaint. Some women have severe dysmenorrhea which renders them incapacitated for days each menstrual cycle requiring absence from study or duty, frequently requiring pain killer, restriction of daily performance, poor sleep, negative moods such as anxiety and depression. A 31-year-old female presented with severe dysmenorrhea and heavy menstrual bleeding (HMB) as a cause of multiple uterine fibroids, underwent surgeries to remove 100 fibroids from her uterus which has improved her quality of life, eliminating her dysmenorrhea and menstrual abnormalities
The population of Malaysia is estimated in 2018 to be around 32.04 million and 23.5% of the population resides in rural areas. The Ministry of Health has provided healthcare services to the rural areas with the access of modern healthcare facilities based on the two-tier healthcare system. In remote areas, mobile health clinic is the extension of healthcare service by the nearest static health clinic. However, most of the remote areas only covered by a community clinic or Klinik Desa which is limited for mother and child healthcare. There is demand from the people in remote areas for static health clinic or Klinik Kesihatan. Objectives: This study is to evaluate and compare the effectiveness between two health services in remote areas applied in Sabah. This study also determines which type of health services that able to worth the service to people in remote areas. Methods: This is a descriptive study. Data was taken from HMIS report (Per PL 206) under Sabah State Health Department. The data analysed by using Microsoft Excel. Results: This study was conducted based from the data obtained in 2015 till 2017 for the number of patients attended to static health clinics and mobile health clinics on selected remote areas. For example, Jambongan Health Clinic only have an average of 10 – 15 patients per day while the Mobile Health Clinic team under Beluran Health District which covers the adjacent remote areas of Jambongan Island have more than 20 patients per day on a single visit. Another example is from Terian Health Clinic in Penampang, which only have an average of 5 – 10 patients per day. However, on the mobile health team on a single visit to the village next to Terian which is Kg. Buayan, the average patients attended for the service is mo re than 20 patients. Conclusion: From the study, it was noted that people in remote areas prefer the mobile health service to visit their villages. This can be due to financial issue and limitation of transportation service to the nearest static clinic. The density of population and the development of the rural areas play important roles for the healthcare service to be effective in remote areas.
Hypophosphataemia occurs in an abnormally low serum phosphate level. Three main mechanisms are postulated: decreased intestinal absorption, increased renal excretion, and extracellular shifts to intracellular compartments. It is potentially a fatal disease if not intervene. The management is merely treating the underlying disorder, giving phosphate supplement and requiring close biochemical monitoring. The incidence of symptomatic isolated hypophosphataemia is extremely rare. In this case report, a 33-year-old man presented with three days history of dysphagia, inability to complete sentences and generalized muscle weakness. He developed blurred vision especially upon exposure to bright light. He had a history of single parathyroidectomy for parathyroid adenoma 2 years ago. Physical examinations were unremarkable. Laboratory investigations were normal except for phosphate level of 0.30 mmol/L. Intravenous KH2PO4 with a dosage of 10 mmol was administered in slow bolus in 3 hours. His symptoms resolved slowly after correction. Although isolated hypophosphataemia is rare but need to recognize the symptoms and signs of hypophosphataemia and treat accordingly.
Fracture is common after trauma. Proximal humeral fracture can occur in the elderly after fall and in youngsters after motor vehicle accidents (MVA) and sport injuries. A 37-year-old man was admitted with a fracture of his left proximal humerus following an MVA. He sustained a 3-part fracture and treated surgically using a PHILOS plate. There are few options in managing proximal humerus fracture ranging from conservative to surgical intervention based on its severity. We reminiscent the usage of PHILOS plate as a mode of treatment of such fracture.
Fat embolism syndrome is manifested by the fat globule presence in the pulmonary and systemic circulation. A 34-year-old man was involved in a motor vehicle accident with a fracture of the left femur and avulsion fracture of the left posterior cruciate ligaments. He developed signs and symptoms that suggested an early diagnosis of fat embolism syndrome. Intravenous methylprednisolone administration was administered as part of the treatment. The role of methylprednisolone in a patient with fat embolism syndrome is controversial due to unproven effectiveness. In this case, fat embolism syndrome after a femur fracture was treated successfully with methylprednisolone.
Assessment method of medical students by conducting examination is to identify the quality and quantity of their academic performance. Essay paper is one of the most common assessment tools in the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah. Double marking is a means by which academic staff attempts to produce fair results for the students. Eighty eight medical students sat for three sets of Essay Papers of Professional I examination in March 2012. The double marking on the essay papers was done by two lecturers of each clinical department concerned for each discipline. Inter-examiner agreement and its effect on the reliability of the final score for the students were calculated by using Kappa statistics and Intra-class Correlation Coefficient (ICC). Reliability coefficient of the scores were also calculated for the different disciplines. In Part A essay paper, Cohan’s Kappa was 0.48 (p
A 40 year old, Muslim patient was brought to the clinic for his chronic 20-year long problem alcohol drinking habits. He was treated in the nursing home and was further directed to the in house rehabilitation centre. Psychotherapists after counselling sessions after a detailed behaviour analysis arrived at cognitive behaviour therapy combined with electric shock aversion therapy after consent from the patient. Seven sessions of therapy, relieved the alcohol craving habit. Patient’s insight and preparedness to lead an alcohol free family life was the major positive behavioural asset. Electric shock therapy with psycho-education and counselling found to benefit long term alcohol problem behaviour.
Tuberculosis (TB) is an ancient disease dated back from ancient Greece time. Once rare in developed countries, now it has re-emerged due to immigration and secondary immunodeficiency. A 27-year-old lady had left knee pain for the past 4 years, went for knee diagnostic arthroscopy procedure, and diagnosed as pigmented villonodular synovitis (PVNS) of the left knee. Despite regular analgesics and physiotherapy, patient symptoms worsen. Two years after the initial treatment, the patient went for a further workout and diagnosed as knee tuberculosis, commenced on anti-TB treatment, the patient still left complicated with a stiff knee and fixed flexion deformity. Identification of knee tuberculosis during the initial phase is crucial as late diagnosis and treatment will leave the patient with debilitating complications.
Obscure gastrointestinal bleeding is a surgical enigma of disastrous proportions. Patient’s haemodynamic status often dictates the path of management ranging from endoscopy, embolization and/or surgery. Minority of the cases has failed to identify the exact source of bleeding during endoscopic and imaging techniques. Emergency surgery is warranted in hypovolaemic shock which has failed to respond to fluid and blood resuscitation. We present a 72-year-old male with an obscure upper gastrointestinal bleeding due to ruptured cystic artery pseudoaneurysm and illustrate the rarity of the presentation with successful management.
Introduction: Maternal death is a sensitive health indicator being monitored closely by the Ministry of Health. Obstetric emergency (OE) protocol is introduced to manage OE and to improve maternal outcome. However, there is no national OE guideline available and the OE protocol varies among different institutions. The current audit aims to evaluate the service quality during OE in Duchess of Kent Hospital (DOKH) in accordance with OE protocol DOKH revision-2017.
Hepatic involvement in extra-pulmonary tuberculosis (TB) is rare, even in the endemic area. It has a high mortality rate as it can easily be misdiagnosed due to its rarity and non-specific presentations, and the treatment can be challenging for its hepatotoxic side-effect. A 55-year old man who was newly diagnosed with AIDS and pulmonary TB which complicated with anti-TB-induced transaminitis, presented with a few weeks history of fever and persistent diarrhoea. It was initially treated as microsporidia infection but the symptoms persisted despite given antiparasitic agent for more than a week. He was subjected to computed tomography (CT) scan of the abdomen and noted multiple hypoechoic lesion at multiple segments of the liver, which later confirmed to be liver TB by liver biopsy. As he could not tolerate Akurit-4 (Rifampicin 150 mg, Isoniazid 75 mg, Pyrazinamide 400 mg and Ethambutol 275 mg), the second-line treatment was given instead. He is currently well on regular clinic appointment. The objective of this case report is to share the rare occurrence of hepatic TB and the difficulty to treat it as the hepatotoxic effect of anti-TB medications complicate the liver damage due to the infection.
Evidence-based data confirm the relationship between an increased availability of effective contraception and reduction in induced abortion rate. In Malaysia, the contraception prevalence rate in 1966 was 8.8 per cent to 52 per cent in 1984, but has levelled off since then. In recent years there has been increasing report of babies ‘abandonment’ in Malaysia. The aim of this study is to determine the knowledge, attitudes and practices related to contraception among women and doctors in Kota Kinabalu the capital of Sabah, Malaysia. Descriptive and analytical community-based cross-sectional study was used. A total of 240 women and 60 doctors were selected from either private or public clinics. The instrument used was face-to-face interview for the women and self-administered questionnaires for doctors. Analysis was done using SPSS version 21. The doctors (80%) felt that contraception is extremely important, and routinely discuss (63%) with their patients. Oral contraceptive pill (97%) is the most common type of contraceptive available in their clinics. About 68% of doctors surprisingly cited that abstinence plays a major part in their contraceptive advice. The average correct answer by doctors on knowledge is 62%. The women surveyed (98.8%) have heard of contraception. The main reason for using is for spacing of pregnancy and many stopped or did not use because of fear of side effects. Women attending the public clinic appear to know more about female and male sterilization and intrauterine contraceptive device compared to those attending private clinic. Further research is needed to reinforce this study.
Study site: Klinik Kesihatan (maternal and child health clinics), private general practitioner clinics. Kota Kinabalu, Sabah, Malaysia
Breast cancer is the number one malignancy in women worldwide. It tends to metastasize distantly via lymphatic and haematogenous route. Skeletal metastases are frequent with more than three quarter of cases in all malignant bone tumours. Breast cancer can infiltrate the axial bone especially spine, but rarely affect the temporomandibular joint. In view of its rarity and the significance of early detection, the diagnosis is always challenging and shall be considered in the differential diagnosis. We endeavour to highlight this unfortunate 37-year-old premenopausal lady who had just undergone left mastectomy and axillary dissection but was complicated with left temporomandibular joint metastasis.
Probiotics are live, microbial cells with several beneficial health effects on humans. The beneficial effect of probiotics mainly depends on their survival in the gastrointestinal tract. The health-promoting properties of certain LAB inhabiting the human gastrointestinal tract encouraged the food industry to develop new functional food products containing probiotic. Selection of a microbial strain for the incorporation into food products requires both in vitro and in vivo evaluations
Oxidative stress is an imbalance in redox coupling
in the body. Lack of antioxidants to scavenge the
reactive oxygen species produces adverse effects
on health. The causes for an imbalance in redox
coupling are multi-factorial. Though, reactive
oxygen species are beneficial in the body, excessive
generation and lack of proper scavenging may
pose a threat. Both internal and external factors
may elevate the level. Environmental pollution is
a major contributor. Man-made chemicals such as
pesticides, heavy metals, and carbon combustion
products are blamed. Chronic exposures lead to
disease processes through oxidative stress. They
mediate pro-inflammatory cytokines and produce
free radicals. Pro-oxidant to antioxidant mismatch
leads to the adverse effects. Nrf2 activates a number
of genes that encode the antioxidants. Glutamate
cysteine ligase is activated in response to Nrf2
and it is a key enzyme for GSH production. Nrf2
functionality protects the cells from environmental
pollutants. Nrf2 mediates the antioxidant response
due to chemical insults, translocated in the cell
nucleus. Oxidative stress is known to induce a
number of diseases such as genetic abnormalities,
carcinogenesis, cardiovascular and respiratory
diseases, neuro-degeneration - Parkinson’s and
Alzheimer’s diseases. Pesticides are the major
pollutants. Studies confirm oxidative stress and
environmental pollution need to be addressed for
public welfare.
Alcohol consumption has consequences for the health and quality of life of individuals and communities. It is a problem among some of the Indigenous groups of Sabah and Sarawak with some of the highest prevalence of risky drinking in Malaysia. Alcohol is considered to be part of the culture of some of these Indigenous groups and a way to maintain the connection to their culture and traditions. However, drinking too much on a single occasion and drinking regularly over time is not a part of the culture. Therefore, this study aimed to investigate the positive and negative effects of alcohol on quality of life (QoL) of an Indigenous community of Sabah. A total of 56 villagers from the West Coast Division of Sabah were interviewed in focus group discussions using the diamond dialogue tool. Data were analysed using thematic analysis and revealed that alcohol consumption has both beneficial and adverse effects on health, behavioural, social, economic and psychological factors, depending on the drinking patterns. These harmful results suggest that awareness and harm-reduction programmes may help to empower the Indigenous groups of Sabah to reduce alcohol-related harm
Alcohol misuse compromises the quality of life of individuals, families, communities and whole societies in a variety of ways. Malaysia acknowledges the problems, implementing policies and health promotion activities in line with the World Health Organization Global Strategy to reduce the harmful use of alcohol by 10% between 2010 and 2025. Sabah, one of two Malaysian states on the island of Borneo, has more than 30 different indigenous ethnic groups. Alcohol production and consumption have traditional and unique roles in the cultural practices of many of these groups, making one common programme difficult to implement. Preliminary research suggests that alcohol is a serious problem in indigenous communities in Sabah. It also shows lack of knowledge on recommended limits for alcohol consumption and understanding of alcohol-related harm. The objective of this action-research is to produce a toolkit that will transfer knowledge and empower communities to adopt safer drinking and reduce alcohol-related harm. It must be attractive, appropriate, easily understood and be able to be tailored to suit different communities. The alcohol tool-kit was developed by a group of academicians using evidence-based information. Qualitative research methods were used to evaluate the initial alcohol tool-kit. A purposive sample of 45 village representatives was selected and divided into 5 groups for focus group discussion. Their feedback was recorded and transcribed verbatim. The alcohol tool-kit was edited accordingly. All participants agreed the alcohol tool-kit was important and can empower communities to reduce alcohol-related harm directly improving their quality of life. The amended alcohol tool-kit will be recommended for health promotion material and evaluated from time to time.
Organ transplant has become a main stream important medical procedure commonly used in hospitals. However, for organ transplant programme to be successful, it heavily relies on the public to voluntarily register for organ procurement. Effort to promote awareness and register public as organ donors has been ongoing, but public response to commit and register as donors has been lukewarm. Arguably, healthcare personnel and nurses are in a key position to educate and advocate for organ donation but often, ironically healthcare personal themselves are reluctant or unwilling to commit as organ donors. Thus, in the context of student nurses in Universiti Malaysia Sabah (UMS), the question arises, what is their stance and views regarding organ donation.
Palmaris longus (PL) tendon is regularly used in reconstructive surgeries as a donor tendon because it is observed as an accessory muscle and has little practical use to the human hands. It is only found in mammals. For example, the orangutan has PL but it is absent variable in the higher class of apes such as gorillas and chimpanzees. The absence of PL in humans appears to be hereditary, but the genetic transmission is unclear. The main objective of this study is to determine the prevalence of PL tendon absence in pre-clinical medical students of UMS and to compare the lack between gender and ethnic groups. By using standard Schaffer’s test, we examined the presence or absence of PL tendon among the first and second-year medical students of UMS. Four additional tests, Thompson’s test, Mishra’s test I, and II, Pushpakumar’s tests were used to determine whether PL present or not. A total of 134 volunteers were examined, and 91.8% were right-handed, and 8.2% were left-handed. The overall absence (bilateral and unilateral) of PL tendon was 23.9%, whereas unilateral absent was 17.9%, and bilateral absent was 6.0%. The high prevalence of absence of PL tendon among females 25.5% compared to males 20.0%. Chinese and Indian have a higher incidence of PL tendon absence followed by Kadazandusun and Malay. In this study, there were different figures for each ethnic group. The prevalence of absence of PL varies depending on the populations.
The current COVID-19 pandemic has forced many clinical disciplines to evolve to function safely and still provide the necessary care. Otorhinolaryngology (ORL) is a field that has been greatly affected by this highly transmissible viral pathogen. Aerosolizing procedures, proximity examination and other common procedures must be revamped to suit current time. The usual norm ORL procedures need also be altered to incorporate safeguards to protect both patient and healthcare workers. This recommendation for current practices aims to give a practical approach to modify current practices to maintain safety during the pandemic. These recommendations are the consensus amongst ORL practitioners in Hospital Sungai Buloh which is the designated COVID-19 centre for Malaysia’s central region and is currently being practised.