Displaying publications 1 - 20 of 925 in total

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  1. Zulkufli NS, Sthaneshwar P, Chan WK
    Singapore Med J, 2023 Mar;64(3):188-195.
    PMID: 35139628 DOI: 10.11622/smedj.2022019
    INTRODUCTION: The diagnosis of Wilson disease (WD) is plagued by biochemical and clinical uncertainties. Thus, calculated parameters have been proposed. This study aimed to: (a) compare the diagnostic values of non-caeruloplasmin copper (NCC), NCC percentage (NCC%), copper-caeruloplasmin ratio (CCR) and adjusted copper in WD; and (b) derive and evaluate a discriminant function in diagnosing WD.

    METHODS: A total of 213 subjects across all ages who were investigated for WD were recruited. WD was confirmed in 55 patients, and the rest were WD free. Based on serum copper and caeruloplasmin values, NCC, NCC%, CCR and adjusted copper were calculated for each subject. A function was derived using discriminant analysis, and the cut-off value was determined through receiver operating characteristic analysis. Classification accuracy was found by cross-tabulation.

    RESULTS: Caeruloplasmin, total copper, NCC, NCC%, CCR, adjusted copper and discriminant function were significantly lower in WD compared to non-WD. Discriminant function showed the best diagnostic specificity (99.4%), sensitivity (98.2%) and classification accuracy (99.1%). Caeruloplasmin levels <0.14 g/L showed higher accuracy than the recommended 0.20 g/L cut-off value (97.7% vs. 87.8%). Similarly, molar NCC below the European cut-off of 1.6 umol/L showed higher accuracy than the American cut-off of 3.9 umol/L (80.3% vs. 59.6%) (P < 0.001). NCC%, mass NCC, CCR and adjusted copper showed poorer performances.

    CONCLUSION: Discriminant function differentiates WD from non-WD with excellent specificity, sensitivity and accuracy. Performance of serum caeruloplasmin <0.14 g/L was better than that of <0.20 g/L. NCC, NCC%, CCR and adjusted copper are not helpful in diagnosing WD.

  2. Zulkifli SN
    Singapore Med J, 1992 Oct;33(5):474-7.
    PMID: 1455271
    The significance of high blood pressure to cardio- and cerebrovascular disease is well recognized. The associated mortality and morbidity risks call for multiple approaches to control the development of high blood pressure. Recent studies have shown that precursors of cardiovascular disorders may be apparent from a young age, and that these can persist and contribute to disease in later life. With regard to blood pressure, the phenomenon of persisting at the same rank has been referred to as tracking. This allows for the possible identification of high-risk groups, for whom early intervention can be initiated. In this paper, some of the findings of studies on blood pressure tracking are reviewed.
  3. Zulhabri O, Rahman J, Ismail S, Isa MR, Wan Zurinah WN
    Singapore Med J, 2012 Jan;53(1):26-31.
    PMID: 22252179
    K-ras gene mutations in codons 12 and 13 are one of the earliest events in colon carcinogenesis.
  4. Zuhdi AS, Ahmad WA, Zaki RA, Mariapun J, Ali RM, Sari NM, et al.
    Singapore Med J, 2016 Apr;57(4):191-7.
    PMID: 26768171 DOI: 10.11622/smedj.2015145
    The elderly are often underrepresented in clinical trials for acute coronary syndrome (ACS), and cardiologists commonly face management dilemmas in the choice of treatment for this group of patients, particularly concerning the use of invasive revascularisation. This study analysed the characteristics of hospitalised elderly patients with ACS, and compared the outcomes of treatments.
  5. Zueter AM, Mohamed Z, Abdullah AD, Mohamad N, Arifin N, Othman N, et al.
    Singapore Med J, 2014 Jul;55(7):367-71.
    PMID: 25091885
    INTRODUCTION: Strongyloidiasis is one of the most commonly neglected but clinically important parasitic infections worldwide, especially among immunocompromised patients. Evidence of infection among immunocompromised patients in Malaysia is, however, lacking. In this study, microscopy, real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assays (ELISAs) were used to detect Strongyloides stercoralis (S. stercoralis) infection among cancer patients in a Malaysian hospital.

    METHODS: A total of 192 stool and serum samples were collected from cancer patients who were receiving chemotherapy with or without steroid treatment at a hospital in northeastern Malaysia. Stool samples were examined for S. stercoralis using parasitological methods and real-time PCR. Serology by ELISA was performed to detect parasite-specific immunoglobulin G (IgG), IgG4 and immunoglobulin E (IgE) antibodies. For comparison, IgG4- and IgG-ELISAs were also performed on the sera of 150 healthy individuals from the same area.

    RESULTS: Of the 192 samples examined, 1 (0.5%) sample was positive for S. stercoralis by microscopy, 3 (1.6%) by real-time PCR, 8 (4.2%) by IgG-ELISA, 6 (3.1%) by IgG4-ELISA, and none was positive by IgE-ELISA. In comparison, healthy blood donors had significantly lower prevalence of parasite-specific IgG (2.67%, p < 0.05) and IgG4 (2.67%, p < 0.05) responses.

    CONCLUSION: This study showed that laboratory testing may be considered as a diagnostic investigation for S. stercoralis among immunocompromised cancer patients.
  6. Zilfalil BA, Sarina S, Liza-Sharmini AT, Oldfield NJ, Stenhouse SA
    Singapore Med J, 2006 Feb;47(2):129-33.
    PMID: 16435054
    Cystic fibrosis (CF) is one of the common genetic disorders in the western world. It has been reported to be very rare in Asian populations. According to the Cystic Fibrosis Genetic Analysis Consortium, more than 1,000 mutations of the CF gene have been identified. The CF gene, named the cystic fibrosis transmembrane conductance regulator (CFTR), is located on chromosome 7 and composed of 27 exons. This study aims to detect possible CFTR gene mutations in Malays.
  7. Zayzan KR, Yusof NM, Sulong AF, Zakaria Z, Ab Rahman J
    Singapore Med J, 2020 Dec 02.
    PMID: 33264560 DOI: 10.11622/smedj.2020164
    INTRODUCTION: The clinical outcomes and factors associated with treatment failure of post-traumatic osteomyelitis have been investigated by many studies. However, limb functionality and quality of life following treatment for this condition have not been thoroughly studied.

    METHODS: This was a cross-sectional study that included 47 patients with post-traumatic osteomyelitis of the lower limb. Functional outcome was assessed using the Lower Extremity Functional Score (LEFS), and quality of life was assessed using the validated Malay version of Short Form-36 version 2.

    RESULTS: Mean follow-up time was 4.6 (range 2.3-9.5) years. Median age was 44 years. Osteomyelitis was located in the tibia for 26 patients and in the femur for 21 patients. Osteomyelitis was consequent to internal infection in 38 patients and due to infected open fractures in nine patients. 42 (89.4%) patients had fracture union and control of infection. Bone defect was found to be a significant contributing factor for treatment failure (p = 0.008). The median LEFS for the success group was 65 when compared to 49 for the failure group. Although the success group showed better scores with regard to quality of life, the difference between the two groups was not statistically significant.

    CONCLUSION: The success rate for post-traumatic osteomyelitis of the lower limb was high. The presence of a bone defect was associated with treatment failure. Successfully treated patients had significantly better functional outcomes than failed ones.

  8. Zarina AL, Hamidah A, Zulkifli SZ, Zulfiqar MA, Jamal R
    Singapore Med J, 2007 Dec;48(12):e320-2.
    PMID: 18043827
    Pancreatic carcinoid tumours are rare, particularly within the paediatric population. The clinical presentation is largely dependent on the functionality of the tumour. Although the tumour is generally slow-growing, surgical resection is still the mainstay of curative treatment. Morbidity is, however, significantly contributed by secretion of excess hormones; in view of this, biotherapy is an important treatment strategy. Octreotide, a somatostatin analogue, has been shown to be successful in both symptomatic control and stability of tumour progression. We report a 12-year-old girl, who presented with hypertensive crisis, and showed good response to a combination of chemotherapy and octreotide.
  9. Zalilah MS, Khor GL, Mirnalini K, Norimah AK, Ang M
    Singapore Med J, 2006 Jun;47(6):491-8.
    PMID: 16752017
    INTRODUCTION: Paediatric obesity is a public health concern worldwide as it can track into adulthood and increase the risk of adult morbidity and mortality. While the aetiology of obesity is multi-factorial, the roles of diet and physical activity are controversial. Thus, the purpose of this study was to report on the differences in energy intake, diet composition, time spent doing physical activity and energy expenditure among underweight (UW), normal weight (NW) and at-risk of overweight (OW) Malaysian adolescents (317 females and 301 males) aged 11-15 years.
    METHODS: This was a cross-sectional study with 6,555 adolescents measured for weights and heights for body mass index (BMI) categorisation. A total of 618 subjects were randomly selected from each BMI category according to gender. The subjects' dietary intake and physical activity were assessed using self-reported three-day food and activity records, respectively. Dietary intake components included total energy and macronutrient intakes. Energy expenditure was calculated as a sum of energy expended for basal metabolic rate and physical activity. Time spent (in minutes) in low, medium and high intensity activities was also calculated.
    RESULTS: The OW adolescents had the highest crude energy intake and energy expenditure. However, after adjusting for body weight, the OW subjects had the lowest energy intake and energy expenditure (p-value is less than 0.001). The study groups did not differ significantly in time spent for low, medium and high intensity activities. Macronutrient intakes differed significantly only among the girls where the OW group had the highest intakes compared to UW and NW groups (p-value is less than 0.05). All study groups had greater than 30 percent and less than 55 percent of energy intake from fat and carbohydrate, respectively.
    CONCLUSION: The data suggested that a combination of low energy expenditure adjusted for body weight and high dietary fat intake may be associated with overweight and obesity among adolescents. To prevent overweight and obesity among children and adolescents, strategies that address eating behaviours and physical activity are required. Various segments of the society must be involved in efforts to promote healthful dietary intakes and active lifestyle in children and adolescents.
  10. Zainudin BM, Rafia MH, Sufarlan AW
    Singapore Med J, 1993 Apr;34(2):148-9.
    PMID: 8266157
    Lignocaine spray for anaesthetising the nasal mucosa for fibreoptic bronchoscopy often causes discomfort to the patient. We compared two techniques of applying nasal topical anaesthesia using either lignocaine spray (group A: 25 patients) or gel (group B: 30 patients) to assess patients' tolerance to the procedure. Both groups received 100 mg of lignocaine in the nostril, 40-50 mg to oropharynx, 120 mg to vocal cords and 40-100 mg to trachea and bronchi. Throat anaesthesia was the most common unpleasant part experienced by both groups of patients (34.5%), followed by examination of bronchi (30.6%) and nasal anaesthesia (21.8%). Significantly more patients in group A experienced discomfort or pain during nasal anaesthesia as compared to group B (p < 0.001). Patients' tolerance to the bronchoscopy was similar in both groups and the examination was performed satisfactorily in all patients. Thus, lignocaine gel is a simple technique, effective and less irritating as compared to lignocaine spray for topical nasal anaesthesia.
  11. Zainudin BM, Ismail O
    Singapore Med J, 1990 Dec;31(6):629-31.
    PMID: 2281365
    A 44-year-old Indian housewife presented with prolonged cough, intermittent fever, loss of weight and shortness of breath on exertion. Physical examination revealed a thin lady with fine crackles on both lungs. Marked eosinophilia and elevated erythrocyte sedimentation rate were noted on peripheral blood. Chest radiograph showed characteristic bilateral infiltrates affecting the periphery of both lungs. Treatment with corticosteroid resulted in dramatic improvement in symptoms, signs and radiographic changes within a few days.
  12. Zainal N, Rahardja A, Faris Irfan CY, Nasir A, Wan Pauzi WI, Mohamad Ikram I, et al.
    Singapore Med J, 2016 Dec;57(12):690-693.
    PMID: 26805669 DOI: 10.11622/smedj.2016019
    INTRODUCTION: This study aimed to determine the prevalence of asthma-like symptoms among schoolchildren with low birth weight (LBW), and to compare the lung function of these children with that of children with normal birth weight.

    METHODS: This was a comparative cross-sectional study. We recruited children aged 8-11 years from eight primary schools in Kota Bharu, Kelantan, Malaysia. The children were divided into two groups: those with LBW (< 2,500 g) and those with normal birth weight (≥ 2,500 g). Parents of the enrolled children were asked to complete a translated version of the International Study of Asthma and Allergies in Childhood questionnaire. Lung function tests, done using a MicroLoop Spirometer, were performed for the children in both groups by a single investigator who was blinded to the children's birth weight.

    RESULTS: The prevalence of 'ever wheezed' among the children with LBW was 12.9%. This value was significantly higher than that of the children with normal birth weight (7.8%). Forced vital capacity (FVC), forced expiratory volume in one second, and forced expiratory flow when 50% and 75% of the FVC had been exhaled were significantly lower among the children with LBW as compared to the children with normal birth weight.

    CONCLUSION: LBW is associated with an increased prevalence of asthma-like symptoms and impaired lung function indices later in life. Children born with LBW may need additional follow-up so that future respiratory problems can be detected early.

  13. Zainal D, Loo CS
    Singapore Med J, 1996 Feb;37(1):44-7.
    PMID: 8783912
    Acute renal failure (ARF) has undergone many changes with advances both in diagnosis and therapy. A retrospective study covering three and a half years from June 1986 to December 1989 of adults admitted to Hospital of the University of Science Malaysia examined the various aspects of presentation of the syndrome, management and areas where improvement can be made. A total of 164 patients were included in the study. 61.6% were male and 38.4% were female. The mean age was 49.8 +/- 17.2 years with 70% of patients being more than 40 years old. The aetiologies of acute renal failure were analysed and discussed. The majority of the patients (80%) had non-oliguric acute renal failure. Oliguric acute renal failure patients have higher mortality and more frequently need dialysis. Early recognition of acute renal failure and discerning use of nephrotoxic drugs could result in decrease in incidence and severity of renal failure.
  14. Zainal D, Loo CS
    Singapore Med J, 1995 Aug;36(4):379-82.
    PMID: 8919150
    Acute (stab) peritoneal dialysis is commonly practised in Malaysia. This study is designed to improve the management of peritoneal dialysis (PD) in Hospital University Science Malaysia (HUSM). Consecutive peritoneal dialysis (PD) on adult inpatients from May 1992 to September 1992 were reviewed prospectively. There were 40 episodes of peritoneal dialysis on 27 patients during this period given at the rate of 2 PD per week. The mean age of patients were 53 +/- 15 years. Uraemia was the main indication for dialysis, while hyperkalaemia and pulmonary oedema were indications for urgent dialysis. Complications occurred in 14 episodes of dialysis (35%). The most common complication was bleeding in the peritoneal cavity while peritonitis was the second most common complication. Dialysis episodes complicated by peritonitis were done by less experienced performers compared to uncomplicated dialysis episodes. Overall mean time spent on each dialysis and time per cycle were longer than recommended (59 +/- 24 hours and 77 +/- 14 minutes). In conclusion, acute PD performed on patients admitted in Hospital University Malaysia was safe and had complication rates comparable to other established centres. However, improvements are possible through closer supervision of new doctors and tighter nursing precautions.
  15. Zainal D, Baba A
    Singapore Med J, 1994 Aug;35(4):374-5.
    PMID: 7899895
    Urinary tract infection is the most common of bacterial infections. Screening children for asymptomatic bacteriuria to prevent pyelonephritis and renal scarring is widely recommended. In Malaysia no such attempt has been made to establish the prevalence of asymptomatic bacteriuria. Bacteriuria was screened among 44,816 healthy school children from three different districts in Kelantan. There were 23,132 boys and 21,684 girls. The prevalence of bacteriuria was 0.12% after second screening. Higher prevalence was seen in other reports.
  16. Zainal D
    Singapore Med J, 1994 Jun;35(3):303-5.
    PMID: 7997910
    Renal tubular acidosis (RTA) is a defect in urinary acidification in the absence of renal failure. All records of patients admitted to adult medical wards at the University Hospital USM (HUSM), Kelantan between 1986 to 1990 with the diagnosis of renal tubular acidosis were reviewed. Sixteen (16) patients were identified and fulfilled the diagnostic criteria. Their mean age at presentation was 28.9 +/- 0.74 years. The triad of muscle weakness, hypokalaemia and systemic metabolic acidosis were the characteristic features at presentation. Normal serum alkaline phosphatase and skeletal X-rays were noted. Their prognosis were generally good. Their mean serum bicarbonate and potassium on follow up were 17.84 +/- 0.35 and 3.82 +/- 0.05 mmol/L respectively. The importance of regular follow-up and long-term management is emphasised.
  17. Zaid ZA, Chan SC, Ho JJ
    Singapore Med J, 2007 Oct;48(10):895-9.
    PMID: 17909672
    A study was done between December 2005 and January 2006 to determine the prevalence of emotional disorders among medical students in a private medical school in Ipoh, Perak, Malaysia and to determine the demographical characteristics, contributing factors and the key person consulted for emotional problems.
  18. Zahari M, Mohd Ali AK, Chandrasekharan S
    Singapore Med J, 1996 Jun;37(3):285-7.
    PMID: 8942231
    To determine the incidence of delayed intracranial haemorrhage and the indication for repeat computed tomography (CT), a one and a half year retrospective study was made. A total of 289 patients had CT scan for head injury of which 78 (26.9%) had multiple scans. Out of these, 5 patients developed delayed haemorrhages (one extradural, one subdural, and three intracerebral haematoma). The incidence of delayed intracranial haemorrhage in our series is small when compared with others. The main predisposing factors are decompressive surgery, hyperventilation and cerebral dehydration therapy. It is important to know when to repeat the CT scan. A review of the literature regarding this aspect is presented and compared with our protocol. Intracranial pressure monitoring plays an increasingly important role in the management of head injury and should be used to decide the patient requiring repeat CT. Follow-up CT without other indication is not necessary.
  19. Yusoff N, Low WY, Yip CH
    Singapore Med J, 2012 Jan;53(1):36-9.
    PMID: 22252181
    The Breast Module (BR23) is increasingly being used worldwide in breast cancer research. This study evaluates the appropriateness of the translated version (i.e. BR23-Malay version) as a useful tool for the Malaysian population who could understand Malay, and examines the reliability and validity of the BR23-Malay version.
  20. Yusof NM, Halim AS
    Singapore Med J, 2012 Sep;53(9):591-4.
    PMID: 23023900
    Infection following grade IIIB open tibial fracture is common. The primary aim of managing this condition is to achieve control of infection before the bone reconstruction procedure is performed. The outcomes for such patients have not been evaluated in the literature. This study was conducted to examine the outcome of a multi-stage procedure for the treatment of infected grade IIIB open tibial fractures.
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