148 patients, 79 males and 60 females were seen in 1978 at Medical Unit Universiti Kebangsaan Kuala Lumpur. For majority of the patients the attacks of asthma begin at an early age. History of allergies were found in majority of the patients. Family history of asthma was noted in about 50%. Of the allergens that triggers of an attack of asthma, household dusts, rhinitis and pollen tops the list. Of the food the common allergens were shrimps, eggs and crabs. Most of the above allergens can be avoided or counteracted.
Study site: Medical Unit, Hospital Kuala Lumpur (UKM unit), Malaysia
Introduction: Violence Against Women has increasingly been recognized in the international areas as an obstacle to women’s development and it may have a myriad of devastating consequences on women’s long or short- term health and wellbeing. The study explored the highlight the prevalence and health effects of Violence Against Women which might reflect the probable causes, the types of injuries, leading factors and consequences of the violence. Methods:Hospital based case study, which was referred to forensic department, Mandalay General Hospital from 1st Jan 2000 to 30th Sept 2000. Personal interview and medical examination of 50-100 victims, girls & women, who were phys-ically and sexually violated was done. Results: Total 92 patients were interviewed and examined, prevalence of dif-ferent age ranging from 5 to 56, were physically and sexually violated during the study period, 62 patients were phys-ically assaulted, and 30 victims were sexually violated. 20-40 age group is more commonly conflicted by physical violence 69.3%) while 10-20 age group were commonly conflicted by sexual violence (56.6%). Pattern of different types of injury and locations are also recorded as a consequence of physical assault and commonest injury is bruise (47%). Commonest location is injury over head & neck (61.8%). Relationship to perpetrator were recorded, physical assaults were commonly by spouse (39%) while sexual assaults were acquaintance (58%). Events leading to violence at home are recorded as nuclear family and alcohol consumption is more common, fights were most common events in community setting. Conclusion: Violence Against Women is neither prevalent nor uncommon in Myanmar. In this study, all forms of injuries were recorded and among them the commonest injuries were bruises, the event leading to violence recorded as fights, alcohol consumption, nuclear family was most common. Violence has a psychological impact on other members of the family, particularly children. However, a multi-sectoral approach has become a necessity to create a happy family, society and nation. It could be achieved by uplifting the socio-economic status of the family, practising the religious teachings and abiding within the framework of the laws. The Trans-National Committed should be formed to effectively minimize trafficking in women and children in the Region.
Thirty-five patients with blunt hepatic injuries treated in a 7-year period are reviewed. The difficulties of diagnosis are stressed in that only 48.6%c were diagnosed
preoperatively. Associated intra-abdominal and concomitant head, chest, pelvic and skeletal injuries accounted for most of these difficulties. Seventeen of the 35 patients had extensive lacerations or intra-lobar ruptures of the liver. Simple linear or stellate lacerated wounds were treated by drainage, or suture, or debridement of the ragged liver edges and suture. Prior to 1964 extensively lacerated liver wounds were treated by gauze packing. Three (60%c) of five patients thus treated died, while the others had multiple complications. Since 1964, packing has been abandoned in favor of major resection and of 11 patients who underwent such procedures only one died. Hepatic resection for severe blunt injuries has the advantages of removal of all devitalized liver, control of hemorrhage, reduction of postoperative complications such as secondary hemorrhage, intraabdominal and hepatic abscesses and hemobilia. Hepatic resection is recommended for subeapsular hematomas with intra-lobar rupture of the liver to avoid hepatic necrosis. These injuries are diagnosed by injection of methylene blue into the common hepatic duct. Low mortality and morbidity in this series is due to improved care of injured pa-tients, early surgical intervention and adequate removal of devitalized lacerated and injured tissues by debridement or major hepatic resection.
The aims of this study were to translate the Michigan Diabetes Knowledge Test (MDKT) into the Malaysian language, and to examine the psychometric properties of the Malaysian version. A standard translation procedure was used to create the Malaysian version of the MDKT from the original English version. A convenience sample of 307 outpatients with type 2 diabetes was identified between May and October 2009. All data were collected from the Penang General Hospital, Penang, Malaysia. Instruments consisted of the Malaysian version of the MDKT and a socio-demographic questionnaire. Medical records were reviewed for haemoglobin A1c (HbA1c) levels and other clinical data. Reliability was tested for internal consistency using Cronbach’s alpha coefficient. Employing the recommended scoring method, the mean±SD of MDKT scores was 7.88±3.01. Good internal consistency was found (Cronbach’s alpha = 0.702); the test-retest reliability value was 0.894 (p<0.001). For known group validity, a significant relationship between MDKT categories and HbA1c categories (chi-square = 21.626; p≥0.001) was found. The findings of this validation study indicate that the Malaysian version of the MDKT is a reliable and valid measure of diabetes knowledge which can now be used in clinical and research practice.
KEY WORDS: diabetes knowledge; validation; Michigan test; translation
Study site: Diabetes Clinic, Hospital Pulau Pinang, Pulau Pinang, Malaysia.
Coronary Heart Disease (CHD) is recognised as an important public health problem in Malaysia. Hyperlipidaemia is one of the main risk factors related to CHD. The mainstay of treatment is diet therapy which should be maintained even if drug treatment is indicated. Since dietitians are the primary providers of dietary treatment to hyperlipidaemic patients, this retrospective study attempts to report the dietary approaches and methodologies adopted by Malaysian dietitians in managing their patients. A postal questionnaire covering various aspects of dietary management of hyperlipidaemia were sent to 47 dietitians practicing in private and government hospitals. A response rate of 53 % was elicited. The survey found that there was a disparity amongst the respondents in the approach to the dietary management of hyperlipidaemia in Malaysia. This was largely due to the absence of a standardised dietary protocol for general lipid lowering in patients with hyperlipidaemia.
Study site: Private and public hospitals in Malaysia
Introduction: Malnutrition is associated with poorer outcomes following treatment for colorectal cancer (CRC). This study evaluates the relationship between nutritional status using scored Patient Generated-Subjective Global Assessment (PG-SGA) with the validated European Organisation for Research and Treatment of Cancer questionnaire (EORTC-QLQ C30) which consists of five functional scales, three symptoms scales and one item of global health/quality of life (QOL).
Methods: A total of 42 CRC patients at oncology outpatient clinics from two hospitals in Malaysia participated in the study from March 2011 to March 2012. The participants were classified as either well-nourished (PG-SGA A) or malnourished (PG-SGA B and C).
Results: The majority of patients were Chinese, male, with a mean age of 57.1 ± 9.8 years and had been diagnosed with stage 2 CRC. Well-nourished patients had statistically significantly better QOL scores on symptom scales: fatigue (p<0.001), nausea and vomiting (p<0.05), and pain (p<0.001) compared to malnourished patients. PG-SGA was strongly correlated with the main domains of the QOL: global health status (r = -0.395, p<0.05), fatigue (r = 0.816, p<0.001), nausea and vomiting (r = 0.730, p<0.001) and pain (r= 0.629, p<0.001). The better the nutritional status (lower total mean score of PG-SGA), the higher the QOL (high mean score of global health status).
Conclusion: The scored PG-SGA is suitable for use as a nutrition assessment tool to identify malnutrition and it is associated
with QOL among this population.
Key words: Chemotherapy, colorectal cancer patient, malnutrition, nutritional status, PGSGA score, quality of life
Study site: Oncology clinics, Hospital Kuala Lumpur, Hospital Selayang, Kuala Lumpur, Malaysia
Rhinocort and Eltair are both the patented and generic equivalent of the topical nasal steroid budesonide. A study consisting of 42 patients was conducted at the ENT department of Hospital Ipoh to compare the response of patients who were using Rhinocort prior to Eltair. The results show statistically significant symptomatic response and lower complications with Rhinocort compared to Eltair.
Cigarette smoking is so widespread that even medical workers are not exempted. A cross sectional survey was conducted among health care workers of the Institute of Respiratory Medicine, Hospital Kuala Lumpur to determine the prevalence of smoking and to assess readiness among the current smokers to quit. A total of 165 workers from all categories was surveyed using a pre-tested self-administered questionnaire, The survey began in Mac 2002 and ended in April 2002, The survey showed that 24.8% of the workers surveyed were current smokers. Only male workers were found to smoke and the prevalence among them was 60.3%. Majority were moderate smokers, smoking between 10 to 20 cigarettes a day and were mainly lower category of workers, Median age of starting to smoke was 17.6 years, There were 20 smokesr ( 52.6%) who were ready to quit. This study found the prevalence of smoking among male health care workers to be higher than males in the general population. The low level of education of these workers seemed to influence smoking status.
Objective: The relationships between awareness, knowledge and attitudes (AKA) and coping mechanisms among people with epilepsy (PWE) have not been well-explored particularly in Asia. This study aimed to: identify preferred coping strategies, correlate between AKA and coping mechanisms and compare coping strategies of PWE with different AKA levels. Methods: A cross-sectional sample of epilepsy outpatients was recruited from the Neurology Clinic, Hospital Sultanah Nur Zahirah, Kuala Terengganu. The participants completed the Malay AKA Epilepsy and the Malay Brief COPE instruments. The data was analysed using non-parametric statistics. Results: Sixty out of 72 patients (response rate = 83.3%) consented
participation (median age = 27.5 years; male = 53.3%; unmarried = 63.3%; Malay = 90.0%; SPM education = 54.2%; unemployed = 35.0%; rural residents = 70.0%). Religion was the most preferred coping strategy (93.3%), followed by Emotional Support (86.7%) and Instrumental Support (81.7%). Awareness was negatively correlated with Instrumental Support (rs = -0.268; p
Study site: Neurology Clinic, Hospital Sultanah Nur Zahirah, Kuala Terengganu.
Tuberculous (TB) biliary stricture with calcified liver nodules rendering obstructive jaundice is a rare clinical phenomenon. Recently, we encountered a young patient with obstructive jaundice who was investigated in a general hospital. He was sent to our hospital for subsequent management after undergoing a series of investigations and biliary stenting. The radiological imagings performed revealed multiple calcified lesions in the liver with proximal bile duct strictures. Blood investigations, tumor markers and tuberculous work up were not remarkable. Subsequently, he underwent laparotomy and biliary reconstruction. Postoperatively, he was discharged well. Histopathological examination of the hepatoduodenal nodes showed chronic infections and granulomatous lymphadenitis, suspicious of a mycobacterium infection.
Low back pain (LBP) is a major medical and social problem associated with disability and work absenteeism. Since the effect on unawareness on back care among hospital staff may affect the smooth running of the services to the public and patients, it is the objective of this study to identified the awareness of back care among nurses so that preventive measures can be taken. About 80 nurses working in the outpatient clinic was survey using self addressed questionnaires which were adapted from Zutphen Physical Activity Questionnaire at Queen Elizabeth Hospital, Kota Kinabalu. Demographic analysis demonstrated that among the eighty nurses that responded, 37.5% (n=30) are Malays, 25% (n=25) Chinese and 37.5% (n=30) ( to include other Sabahan tribes). Their age group varies between 23 to 55 years of age. A total of 72 nurses, both agreed (45%,n=36) and strongly agreed (45%,n=36) that understanding good postures is important to prevent LBP. They felt strongly (55%, n=44) about the importance of correct lifting techniques, and having a well-designed workplace (50%,n=40). Regarding factors that cause LBP, 55% (n=44) of them strongly agreed that good lifting technique can prevent LBP while 56 (70%) agreed that prolong sitting doing computer work can cause LBP. About 60% (n=48) also agreed that LBP can cause stress and that 45% (n=36) of them strongly agreed that being overweight than average can worsen LBP. However, 40% (n=32) provide a neutral answer to whether height have any influence on LBP while 50% (n=40) agreed that weak back muscles can worsen the backache further. However, 45% (n=36) agreed that games that involved back movement have high risks and 55% (n=44) agreed that swimming helps to strengthen back muscle. The environmental factors addresses issues of footwear and soft mattress where 60%(n=48) agreed while 15%(n=12) strongly agreed that good footware and appropriate use of soft mattresses 60% (n=48) can prevent LBP. This study have demonstrated that the nurses that participated had a clear understanding and knowledge on back care even though a wider study need to be carried out to ensure validity of study finding.
Study site:outpatient clinic, Queen Elizabeth Hospital, Kota Kinabalu
This is a retrospective review of 18 patients with tibial plateau fractures Schatzker type VI. These cases were performed in our medical centre from January 2003 to December 2004. The Ilizarov technique (Russian technique) using the ring external fixator was the technique performed. Articular reconstruction and joint alignment were achieved with traction and olive wires with washers. One case required percutaneous elevation of the articular surface and bone grafting through a cortical window. Average clinical union was achieved within 4 months of trauma. Mean final knee flexion was 85°, which is compatible with walking. All patients successfully returned to their previous occupations. In conclusion, the Ilizarov technique has been shown to be a good option and a viable tool in the management of these complex and unstable injuries.
Accidental needle-stick injuries (NSIs) are a hazard for health-care workers and general public health. Orthopaedic surgeons may be more prone to NSIs due to the prevalence of bone spikes in the operative field and the use of sharp orthopaedic instruments such as drills, saws and wires. A hospital-based cross sectional study was conducted in the orthopedic wards of Melaka General Hospital. The prevalence of NSIs was 32 (20.9%) and majority of it occurred during assisting in operation theatre 13(37.4%). Among them six (18.8%) were specialist, 12(37.5%) medical officer, 10 (31.2%) house officer and four staff nurses (12.5%). Among the respondents 142 (92.8%) had been immunized against Hepatitis B and 148 (96.7%) participants had knowledge regarding universal precaution. The incidence of NSI among health care workers at orthopaedics ward was not any higher in comparison with the similar studies and it was found out that the prevalence was more in junior doctors compared with specialist and staff nurses and it was statistically significant.
Diabetic foot disease is the leading cause of non-traumatic amputations of the lower limb, hence a major health care and socioeconomic burden. It has been found that most of the costs occur in the inpatient setting; therefore this study is to quantify the costs of managing inpatient diabetic foot infections (DFI). We treated 182 inpatients from May 2012 till April 2013 and analysed the cost of antibiotic usage, wound dressing, surgical procedure, admission and basic investigation costs. The total cost was ~ USD 11,000 (2013). This number, however, only reflects the cost for managing an acute infection. The price for follow-up care as an outpatient, rehabilitation and indirect costs (emotional suffering, reduced productivity) is estimated to be much more.
Study site: Diabetic Inpatient Registry, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
Current asthma treatment is directed by severity of symptoms and lung function. In Malaysia, spirometry is not widely available and therefore not used in most medical consultations. In 163 asthmatic patients [mean (95% CI) age: 41 (38-44) yrs; 29% male; 32% Malays, 32% Chinese, 34% Indians] who were being followed up in a State Hospital medical outpatient clinic and a large urban-based health clinic, we studied the effect on Global Initiative for Asthma (GINA) disease severity classification and the appropriateness of currently prescribed treatment when forced expiratory volume in one second (FEV1) was considered together with symptom severity. We showed that 52% of the patients were upgraded to a higher severity classification and 71% of the patients were under-treated. If based on symptoms alone to assess severity, 39% of the patients were still under-treated. We concluded that the disease severity in many asthmatic patients might have been underestimated and therefore not adequately treated, because spirometry was not available or used to assess asthma severity. The use of spirometry should be advocated more widely among clinicians treating asthma in Malaysia.
Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan; Klinik Kesihatan Seremban, Malaysia
Caring for a family member with dementia is associated with distress and several caregiver factors are known to be determinants of burden of care.
Objective: To determine the relationship between the caregivers’ sociodemographic variables and their perceived burden of care.
Methods: Patients diagnosed as having dementia with their caregivers were selected through a non-randomised sampling method from the psychogeriatric and memory clinics in Universiti Kebangsaan Malaysia Medical Centre and Hospital Kuala Lumpur. Burden of care was assessed using the Zarit Burden Interview.
Results: Age, gender, educational achievement, ethnicity and kinship of the 65 caregivers did not show any significant statistical difference in relation to their perceived burden. Conclusion: Burden in caring after patients with dementia was not significantly determined by the sociodemographic characteristics of their caregivers
Study site: Psychogeriartic clinics and memory clinics of Pusat Perubatan University Kebangsaan Malaysia (PPUKM) and Hospital Kuala Lumpur (HKL), Kuala Lumpur, Malaysia
Great importance has been attributed to birth weight all over the world because it is considered as one of the best predictors of prenatal survival and a good indicator of quality life. The objective of this study was to determine the prevalence of low birth weight babies (LBW) and factors related to it in Baghdad city. A cross sectional study was carried out in four general hospitals in Baghdad city, Iraq. A total of 225 newborn babies, alive, singleton and without congenital malformation were selected randomly from these four general hospitals.The result of the study showed the prevalence rate of low birth weights was 21.3%. Mothers’ educational level, monthly family income, mothers with chronic hypertension, mothers with history of previous low birth weight infants and anemic mothers were significantly associated with low birth weight babies (P= 0.03, 0.01, 0.02,
Introduction: Nasopharyngeal Carcinoma (NPC) is the second most common cancer among men in Malaysia. Establishing local data will help to improve the treatment strategies and lower the anxiety and depression level among NPC patients. Our aim was to compare the level of symptoms of anxiety and depression and the coping strategies employed between NPC and cancer-free patients. Methods: A comparative cross-sectional study with universal sampling was conducted on 22 NPC patients and 30 cancer-free patients from the Oncology and Radiotherapy Department and Ear, Nose and Throat clinic of Hospital Kuala Lumpur (HKL) between 12 to 29 May 2008. In this study, the symptoms of depression and anxiety were obtained by using the Hospital Anxiety and Depression Scale (HADS) while Brief COPE questionnaire was used to understand patients’ coping strategies. Results: The prevalence of NPC was higher in the Chinese, men, aged between 40 and 59 years, and those from the lower income group. The levels of anxiety and depression symptoms were found to be higher in the NPC group as compared to the cancer-free group. However, only the level of depression was found significantly related to the NPC group (p=0.002). This study also found that the two comparison groups were
using different types of coping strategies. The NPC patients mainly used ‘acceptance’ as their coping strategy while the comparative group most often used ‘religion’. Among the types of coping strategies reported by the patients, ‘use of instrumental support’ type was found to be associated with a lower level of anxiety (p = 0.035) and ‘humour’ type was associated with lower depressive symptoms (p = 0.269). On the contrary, ‘selfblame’ type was associated with both anxiety (p =0.0001) and depression (p = 0.001) symptoms. In addition, patients with different gender, ethnicity, educational levels, and
monthly income were also found to have significant differences in their levels of anxiety and depression as well as type of coping strategies. Conclusions: NPC patients had higher anxiety and depression levels as compared to the comparative group. Different socio-demographic backgrounds and different types of coping strategies had an influence on patients resulting in different levels of anxiety and depression.
Study site: ENT clinic, Hospital Kuala Lumpur, Malaysia
A study was conducted to evaluate the extent of sleep problems among children aged between 6 to 15 years old who were followed up at Penang Hospital Paediatric Clinic for various neurological disorders and compared to those with other paediatric illnesses and their healthy siblings. A parental questionnaire was used to assess sleep problems in 48 children with neurological disorders and compared to 46 of their healthy siblings, 59 children with non-neurological paediatric illnesses and 67 of their healthy siblings. Sleep problems were clustered into five subscales: bedtime difficulties, parental involvement at time of sleep, sleep fragmentation, parasomnias and daytime drowsiness. Children with neurological disorders had significantly more sleep problems than did their siblings, those with non-neurological paediatric illnesses and their healthy siblings (p < 0.001). This was particularly so in areas of bedtime difficulties (p>0.001), the amount of parental involvement (p
An outbreak of Methicillin Resistant Staphylococcus aureus (MRSA) in the Neonatal Intensive Care Unit (NICU), Seremban Hospital is reported. The pattern of colonisation and infection with the MRSA was studied for the 1 year period between May 1987 till April 1988. There were few serious MRSA infections. The majority of patients were either colonised or superficially infected. The organism was resistant to all Penicillins, Gentamicin and most Cephalosporins. Netilmicin and Amikacin have shown good activity against MRSA.