The prevalence of aging population is increasing not only in developed countries, but also in developing countries like Malaysia. The aim of this study was: (1) to determine the prevalence of physical and mental health problems, and (2) to determine the association of these health problems with socio demographic factors among the elderly in a rural community in Sepang, Selangor. A cross sectional study design was used. Five out of nine villages were selected via random sampling. The elderly in the selected villages were interviewed using a pre-tested structured questionnaire which included the GDS-30, ECAQ and Barthel Index. Out of 263 elderly residents (6.2% of the total population), 223 agreed to participate in the study giving a response rate of 84.8%. The mean age of the respondents was 69.7 + 6.8 years with a median of 68 years. The prevalence of physical health problems such as chronic illness and functional dependence were 60.1% and 15.7%, respectively. While the prevalence of mental health problems such as depression and cognitive impairment were 7.6% and 22.4%, respectively. Among the health problems studied, depression was found to be significantly associated with unemployment (p<0.05), where as cognitive impairment was significantly associated with age, gender, ethnicity, marital status and level of education (p<0.05).
The new millennium has been regarded as a genomic era. A lot of researchers and pathologists are beginning to understand the scientific basis of molecular genetics and relates with the progression of the diseases. Central nervous system (CNS) tumours are among the most rapidly fatal of all cancers. It has been proposed that the progression of malignant tumours may result from multi-step of genetic alterations, including activation of oncogenes, inactivation of tumour suppressor genes and also the presence of certain molecular marker such as telomerase activity. In this paper, we review some recent data from the literature, including our own studies, on the molecular genetics analysis in CNS tumours. Our studies have shown that two types of tumour suppressor genes, p53 and PTEN were involved in the development of these tumours but not in p16 gene among the patients from Hospital Universiti Sains Malaysia (HUSM). Telomerase activity also has been detected in various types of CNS tumours. Thus, it is important to assemble all data which related to this study and may provide as a vital information in a new approach to neuro-oncology studies in Malaysia.
Gene therapy is a promising approach towards cancer treatment. The main aim of the therapy is to destroy cancer cells, usually by apoptotic mechanisms, and preserving others. However, its application has been hindered by many factors including poor cellular uptake, non-specific cell targeting and undesirable interferences with other genes or gene products. A variety of strategies exist to improve cellular uptake efficiency of gene-based therapies. This paper highlights advancements in gene therapy research and its application in relation to anti-cancer treatment.
A 66-year-old Malay woman, known hypertensive, presented with post menopausal bleeding associated with clot for three months. She was postmenopausal for last ten years. She also complaints of developing a mass in the abdomen which was growing in size also for last three months. Abdominal examination revealed a twenty week size mass, movable from side to side but unable to get below the mass. Vaginal examination revealed a fleshy fungating mass arising from the uterus coming out through the vagina. Cervix could not be visualized properly. Subsequent histopathology of the removed mass was reported as a Malignant Mixed Mullerian Tumour - Heterologous.
Primary pterygium in children is uncommon but is associated with severe visual problems. Astigmatism is the main visual problem caused by pterygium. Significant amounts of astigmatism occur long before a pterygium encroaches the visual axis. Early surgical intervention is safe and effective. It is associated with significant visual improvement in outcome. This is a case report on seven-year-old Malay boy who presented with a growth over nasal aspect of the right eye of 1 year duration. His right eye visual acuity is affected up to 6/12. The dilemma pased to early surgical interview is the high rate of recurrancean the young age group. This problem is highlighted in this case report.
AIM: To reevaluate the psychometric characteristics of the Malay version of the Edinburgh Postnatal Depression Scale among a sample of postpartum Malay women attending the Bakar Bata Health Center in Alor Setar, Kedah, North West of Peninsular Malaysia.
MATERIALS AND METHODS: 64 women between 4 to 12 weeks postpartum were recruited for there validation study. They were given questionnaires on socio-demography, the 21-item Malay version of the Beck Depression Inventory II (BDI-II) and the 10-item Malay version of the Edinburgh Postnatal Depression Scale (EPDS). All the participants were later interviewed using the Hamilton Depression Rating Scale (HDRS-17) and the Composite International Diagnostic Interview (CIDI). All diagnoses were made based on the Tenth Edition of the International Classification of Diseases (ICD-10)
RESULTS: 9 women (14.1%) were diagnosed to have significant depression (7 mild depressive episodes and 2 moderate depressive episodes according to ICD-10). EPDS was found to have good internal consistency (Cronbach alpha =0.86) and split half reliability (Spearman split half coefficient = 0.83). The instrument also showed satisfactory discriminant and concurrent validity as evidenced by the statistically significant difference in EPDS scores between the depressed group and their non-depressed counterparts (Mann Whitney U test: 2 tailed p value < 0.01) and good correlations between the instrument and both the Malay version of BDI-II and the HRDS-17 (Spearman rank correlation coefficients of 0.78 and 0.88 respectively). At the 11/12 cut-off score the sensitivity of the EPDS is 100%, with a specificity of 98.18%, positive predictive value of 90%, negative predictive value of 100 % and misclassification rate of 1.56%.
CONCLUSION: This study confirmed the reliability and validity of the Malay version of the Edinburgh Postnatal Depression Scale in identifying postpartum depression among recently delivered Malay women attending the Bata Bata Health Center in Alor Setar, Kedah, North West of Peninsular Malaysia.
KEYWORDS: EPDS; postnatal depression; rating scale; validation
Study site: Klinik Kesihatan Bakar Bata, Alor Setar, Kedah, Malaysia
The objective of this study was to determine the prevalence and ethnic distribution of Helicobacter pylori infection in an endoscoped population in North Eastern Peninsular Malaysia.
Quality of life measures are designed to enable patients' perspectives on the impact of health and healthcare interventions on their lives to be assessed and taken into account in clinical decision-making and research. This paper discusses some approaches, methodological as well as interpretative issues of health related quality of life research.
The characteristics of foveal suppression (FS) in fixation disparity (FD) due to visual stress were investigated and their relationship's between, age, symptoms, and the effect of temporary elimination of FD using prisms on the degree of the FS were analysed. Forty-five presbyopic subjects (15 without FD and 30 with stress related FD) participated in the study. The subjects underwent comprehensive optometric examination prior to the study. Their FS and FD were measured. The FD was later corrected with ophthalmic prisms, the power of which was equally divided between the eyes, and the FS was later verified. Age and FS had no significant correlation for subjects without FD (Spearman's rs = 0.17, p = 0.55, NS) and in subjects with FD (rs = 2.49, p = 0.19, NS), respectively. Correlation between the degree of FS and FD was weak (rs=0.38, p=0.07), however the magnitude of FD significantly increased with age (r=0.27, p=0.04). Subjects with FD had significantly larger degree of FS compared with subjects without FD (Wilcoxon's Z =-0.25, p=0.01). There was no significant difference in the magnitudes of FD (t = -0.38, p=0.07) and in their degrees of FS (Mann-Whitney U = 1.5, p=0.71) between subjects with and without symptoms. Correcting the FD with prisms generally reduced the degree of FS (Wilcoxon's Z =1.96, p=0.04), however, significant change in FS only occured in subjects with symptoms (Z=-1.97, p=0.03), but was not significant in subjects without symptoms (Z=-0.70, p=0.48).
Phytochemical studies on rhizome of Etlingera elatior have resulted in the isolation of 1,7-bis(4-hydroxyphenyl)-2,4,6-heptatrienone (1), demethoxycurcumin (2), 1,7-bis(4-hydroxyphenyl)-1,4,6-heptatrien-3-one (3), 16-hydroxylabda-8(17),11,13-trien-16,15-olide (4), stigmast-4-en-3-one (5), stigmast-4-ene-3,6-dione (6), stigmast-4-en-6b-ol-3-one (7), 5α,8α-epidioxyergosta-6,22-dien-3β-ol (8). 1 and 4 were new compounds. Compounds 5 and 7 displayed high antitumour-promoting activity. Ethyl acetate extract showed a very significant cytotoxic activity against CEM-SS and MCF-7 cell lines (4 μg/ml and 6.25 μg/ml respectively). The antitumour-promoting activity was determined by EBV-EA assay and cytotoxic activity was determined by MTT assay.
Rheumatic mitral stenosis is prevalent in this part of the world and it gives rise to wide array of manifestations. However, hoarseness of voice secondary to recurrent laryngeal nerve paralysis (Ortner's syndrome) is an uncommon manifestation. This case illustrates an uncommon presentation in a common disease. A 29-year-old lady presented with a 2-year history of hoarseness of voice. Physical examination revealed a mid-diastolic murmur and left vocal cord paralysis. Echocardiography confirmed mitral stenosis with pulmonary hypertension. She underwent percutaneous mitral balloon valvotomy in 1991 with return of normal speech after a few months. The recurrent laryngeal nerve paralysis is mainly due to the compression by an enlarged pulmonary artery as initially thought. This complication is rarely seen nowadays due to greater awareness of the disease and earlier intervention. With the advent of percutaneous transvenous mitral valvotomy in the nineties, effective non-surgical intervention is plausible.
Our purpose is to report on the epidemiological variables and their association with the results of the exercise tolerance test (ETT) in the series of patients referred for standard diagnostic ETT at Seremban Hospital during the year 2001. ETT is widely performed, but, in Malaysia, an analysis of the associations between the epidemiological data and the results of the ETT has not been presented. All patients referred for ETT at Seremban Hospital who underwent exercise treadmill tests for the year 2001 were taken as the study population. Demographic details and patients with established heart disease (i.e. prior coronary bypass surgery, myocardial infarction, or congestive heart failure) were noted. Clinical and ETT variables were collected retrospectively from the hospital records. Testing and data management were performed in a standardized fashion with a computer-assisted protocol. This study showed that there was no significant predictive epidemiological variable on the results of the ETT. However, it was found that there was statistically significant difference between the peak exercise time of males and females undergoing the ETT.
This study was done to determine the prevalence of dental anomalies and facial profile abnormality and its association with the non-syndromic cleft lip and palate (CLP) as compared to the non-cleft children. A comparative cross sectional study was conducted where the case group consist of 98 non-syndromic CLP children-unilateral (UCLP) and bilateral (BCLP) who attended the Combined Clinic at Kota Bharu Dental Clinic (KBDC) while the comparison group comprised of 109 non-cleft children who attended the outpatient clinic at KBDC. Their ages were between 3 to 12 years old. Clinical oral and facial profile examinations were carried out to look for dental anomalies (morphology, number and alignment of teeth) and facial profile abnormality. The prevalence of anomalies in morphology of teeth in CLP (24.5%) and non-cleft (10.1%), number of teeth in CLP (44.9%) and non-cleft (7.3%), mal-alignment in CLP (79.6%) and non-cleft (27.5%) and facial profile abnormality in CLP (26.5%) and non-cleft (9.1 %). There was a significant association between CLP and anomalies in morphology, number, mal-alignment and abnormality in facial profile; (p < 0.05). Therefore, there was a high prevalence and risk of dental anomalies and facial profile abnormality in the CLP children compared to the non-cleft children.
Children with bronchiolitis from Hospitals Universiti Sains Malaysia (HUSM) and Hospital Kota Bharu (HKB) were student using the Kristjansson Respiratory Score and the Wang Respiratory Score respectively. Saturation of oxygen (S(a)O(2)) was measured with a pulse-oximeter while the child is breathing room-air. Two observers assessed the respiratory scores in all children independently. The correlation between respiratory scores and S(a)O(2) was assessed using Spearman's Rho, and the inter-rater reliability of respiratory scores determined using intraclasscorelation coefficient. There were 29 children in HUSM and 25 from HKB with a median age of 8 months (IQR 4.5 months) and 9 months(IQR 7 months) respectively. In HUSM, the median Kristjansson Respiratory Score for both observers was 4 (IQR 2), and the median S(a)O(2) was 96% (IQR 3%). The correlation coefficient between the Kristjansson Respiratory Score and S(a)O(2) for the first observer was - 0.75 (p <0.001), and for the second observer -0.73 (p <0.001). In HKB, the median Wang Respiratory Score was also similar for both observers (median 4 IQR 4.5), and the median (IQR) for S(a)O(2) was 96% (2%). The correlation coefficient between the Wang Respiratory Score and S(a)O(2) for the first observer was -0.41 (p = 0.04) and for the second observer -0.43 (p = 0.03). The inter-rater reliability between the first and second observer was high for both the Kristjansson Respiratory (ICC 0.89) and the Wang Respiratory Scores (ICC 0.99). In conclusion the validity of the Kristjansson Respiratory Score was high whereas the validity of the Wang Respiratory Score was moderate in the assessment of the severity of acute bronchiolitis. Both respiratory scores and physical signs showed high agreement between observers. The Kristjansson Respiratory Score should be considered for use by medical personnel in the assessment of the severity of acute bronchiolitis in children.
The Malay version of the Medical Outcome Study (MOS) Social Support Survey was validated among a sample of postpartum Malay women attending selected health centers in Kedah, North West of Peninsular Malaysia. 215 women between 4 to 12 weeks postpartum were recruited for the validation study. They were given questionnaires on socio-demography, the Malay-versions of the MOS Social Support Survey, Edinburgh Postnatal Depression Scale (EPDS) and the 21-items Beck Depression Inventory-II (BDI-II). 30 of the women, who were bilingual, were also given the original English version of the instrument. A week later, these women were again given the Malay version of the MOS Social Support Survey. The scale displayed good internal consistency (Cronbach's alpha = 0.93), parallel form reliability (0.98) and test-retest reliability (0.97) (Spearman's rho; p<0.01). The negative correlations of the overall support index (total social support measure) with the Malay versions of EPDS and BDI-II confirmed its validity. Extraction method of the 19 items (item 2 to item 20) from the MOS Social Support Survey using principle axis factoring with direct oblimin rotation converged into 3 dimensions of functional social support (informational, affectionate / positive social interaction and instrumental support) with reliability coefficients of 0.91, 0.83 and 0.75 respectively. The overall support index also displayed low but significant correlations with item 1 which represents a single measure of structural social support in the instrument (p <0.01). The Malay version of the MOS Social Support Survey demonstrated good psychometric properties in measuring social support among a sample of Malay postpartum Malay women attending selected health centers in Kedah, North West of Peninsular Malaysia and it could be used as a simple instrument in primary care settings.
Increased international collaboration in clinical trials has created a need for cross culturally valid instruments to assess the quality of life and behavioural disorders. Cross cultural studies of depressive symptomatology, in particular, must be preceded by an exhaustive study of the psychometric properties of the instruments to ensure the validity of the comparison. In this article, we examined the validity, reliability and factor structure of the Malay version of the Beck Depression Inventory II (BDI-II) among Malay postpartum women attending selected health centres in Kedah, North West of Peninsular Malaysia. Our findings indicated that the current version of the BDI-II is psychometrically strong and appropriate for use in assessing depressive symptomatology among this group of women.
Schizophrenia is a complex biological disorder with multifactorial mode of transmission where non-genetic determinants are also play important role. It is now clear that it involves combined effect of many genes, each conferring a small increase in liability to the illness. Thus no causal disease genes or single gene of major effects, only susceptible genes are operating. Given this complexity, it comes as no surprise of the difficulty to find susceptible genes. However, schizophrenia genes have been found at last. Recent studies on molecular genetics of schizophrenia which focused on positional and functional candidate genes postulated to be associated with schizophrenia are beginning to produce findings of great interest. These include neuregulin (NRG-1, 8p12-21), dysbindin, (DTNBP1,6p22.3), G72 (13q34) / D-amino acid oxidase (DAAO,12q24), proline dehydrogenase (PRODH-2, 22q11.21), catechol-O-methyltransferase (COMT, 22q11.21), regulator of G protein signaling (RGS-4), 5HT2A and dopamine D3 receptor (DRD3). Applications of microarrays methods were able to locate positional candidate genes related to dopaminergic, serotonergic and glutamatergic neurotransmission. New genome scan project, seen in the light of previous scans, provide support for schizophrenia candidate region on chromosome 1q, 2q, 5q, 6p, 8p, 10p, 13q,15q and 22q. Other reports described including the application of LD mapping and positional cloning technique, microarray technology and efforts to develop quantitative phenotype. More exciting finding is expected in near future with the completion of Hap Map project.
Intra-operative frozen section plays an important role in the management of surgical patients and yet it must be used prudently to avoid the indiscriminate usage of this important technique. As it is subjected to many limitations in comparison to the paraffin embedded tissue sections, this review aims to highlight the important concepts and principle of intra-operative frozen section consultation as well as discussing the limitations of this technique. This will then allow the endusers of this technique to be more informed and more selective in their decisions when requesting for a frozen section report.
The association between pure red cell aplasia (PRCA) and autoimmune haemolytic anaemia (AIHA) has rarely been reported. PRCA represents an isolated process, characterized by normochromic, normocytic anaemia, reticulocytopenia and erythroid hypoplasia in the bone marrow, and may be attributable to infection with Parvo virus B19. AIHA is a condition in which peripheral red blood cell destruction is induced by the presence of autoantibodies. However, the co-existence of these conditions is very rare, since only few cases of PRCA and AIHA associated with malignant lymphoma (ML) were reported. A case of PRCA and AIHA was detected and described, for the first time in Malaysia, in a 10-year-old child suffering from non-Hodgkin lymphoma from the Department of Haematology, Universiti Sains Malaysia. Following the induction course of chemotherapy, the patient turned anaemic, with tendency for red cell clumping, reticulocytopenia and anisocytosis. AIHA was suspected in spite of the weak Coomb reaction obtained. The bone marrow aspirate revealed the presence of giant pronormoblasts, suggesting PRCA. Serological tests for Parvo virus and other viruses were negative.