In Malaysia, therapeutic drug monitoring (TDM) service started in the late 1980s. Serum concentration measurements depend on commercially available drug assays, which are costly. In the present study, we attempted to document the impact of TDM service on cost and patient outcomes.
OBJECTIVES: The purpose of this study was to evaluate a multidisciplinary, interventional, ergonomic education program designed to reduce the risk of musculoskeletal problems by reducing schoolbag weight and correcting poor sitting posture.
METHODS: Data were collected twice before and twice following intervention using the Standardized Nordic Body Map Questionnaire, a rapid upper limb assessment for posture evaluation, and schoolbag weight measurement in children aged 8 and 11 years attending two schools within the central region of Malaysia.
RESULTS: Students who received the ergonomic intervention reported significant improvements in their sitting posture in a classroom environment and reduction of schoolbag weight as compared with the controls.
CONCLUSION: A single-session, early intervention, group ergonomics education program for children aged 8 and 11 years is appropriate and effective, and should be considered as a strategy to reduce musculoskeletal pain among schoolchildren in this age group.
KEYWORDS: assessment; awareness; education; ergonomic; intervention; musculoskeletal pain; school children
Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, drawing on the cases of Thailand, Singapore and Malaysia, three regional hubs for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growth of the medical tourist industry. This article calls for a universal definition of medical tourism and medical tourists to be enunciated, as well as concerted data collection efforts, to be undertaken prior to any meaningful empirical analysis of medical tourism's impact on health systems.
The objective of this review is to better understand the concept of investigator-initiated trials and its benefits. While investigator-initiated trials can be an invaluable tool, there are several challenges in its initiation and management. However, it is for these reasons that Clinical Research Centre (CRC) had developed the Investigator Initiated Trial (IIT) Programme where financial support and technical assistance are provided to local investigators embarking on their own clinical trials. In the course of preparing the review, we found that the inclination of investigator-initiated trials has yet to be well established in Ministry of Health, Malaysia. Given the potential and impact of such trials, clinicians should be aware of their ability as well as the availability of a supportive network in mobilising their concerted research efforts. Greater research collaboration among investigators could foster more innovative, insightful and constructive research.
Registration of research proposal to a publicly accessible website with searchable function allows information sharing and ensures research transparency. The National Institutes of Health Malaysia, realising the importance of research registration, established the National Medical Research Register (NMRR) in 2007. The NMRR functions more than just a local register: it also links to ethics approval and MOH medical research grant application. It thus facilitates researchers in their application to the Ministry of Health Research and Ethics Committee (MREC) and for Ministry of Health research grant. In addition, MREC committee members can review research protocol on NMRR website, thus saving much time and resources. From May 2007 till December 2009, more than 3000 people have registered as NMRR public users and more than 1000 research proposals have been uploaded in NMRR. The number of registration of research proposals, clinical trials and industrial sponsored trials steadily increased from year 2007 to year 2009. The web-based NMRR is the first research register in the world that links research proposal registration to ethical review and research grant application. Its future plan is to be linked with publication. Therefore, it is indeed an innovation that Malaysians should be proud of.
The present paper provides a taxonomic revision of the genus Fecenia with emphasis on the characteristics of the pre-epigynes which are integrated for the first time into an identification key. As a result, one species is revalidated, Fecenia protensa Thorell, 1891, stat. n., and two new junior synonyms for Fecenia protensa are recognised: Fecenia sumatrana Kulczyński, 1908, syn. n. and Fecenia nicobarensis (Tikader, 1977), syn. n. New records are reported: Fecenia ochracea (Doleschall, 1859)from Malaysian Borneo, Fecenia macilenta (Simon, 1885) from Sumatra, Indonesia, Fecenia protensa from Thailand and Malaysia, Fecenia travancoria Pocock, 1899 from Sri Lanka and Thailand, and Fecenia cylindrata Thorell, 1895 from Thailand and Laos. Additional information on the biology of Fecenia is provided and the validity of characters for identifying Fecenia species is discussed.
58 cases of sputum smear negative pulmonary tuberculosis (PTB) were reported to Kinta Health Department between January and June 2011. It was found that 47 cases (81%) were sputum smear negative cases. Six cases (10.3%) were actually sputum smear positive but were wrongly reported as smear negative. Five cases (8.6%) were misdiagnosed as tuberculosis. Majority of these patients (82.7%) sought consultation and treatment after two weeks of having cough. Only 6.9% sought treatment for cough that was less than two weeks old. Accurate diagnosis of PTB is crucial and the Perak State Health Department needs to quickly adopt steps to improve the situation.
There is scarce or no data on prevalence and presentation of acute coronary syndrome (ACS) among women of reproductive age. Furthermore, whether women of reproductive age presenting with ACS have the same risk factors as men and older women is not known.
For over 150 years, ecologists have been striving to explain fundamental patterns of biological diversity, such as the observation that communities invariably consist of common and rare species, and to unravel the processes that underpin these patterns. This task is increasingly urgent given the accelerating loss of biological diversity. Although fishes are the most diverse vertebrate taxon and fish communities occur in a wide range of habitats, they have been relatively little studied in the quest to elucidate the processes that shape patterns of biological diversity. Here, some of the topics that investigations of fish assemblages can illuminate are highlighted. These include the characteristics of ecological communities and the role that dispersal limitation plays in structuring them, the distinction between core and occasional species, the insights that evaluating abundance in different currencies can bring and the assessment of community capacity. Questions are identified that future investigations of fish communities might tackle and a case study of a biodiverse ecoregion (Thailand and Peninsula Malaysia) is used to illustrate the need for better links between these ecological questions and effective conservation practice.
Four new species of Tambinia Stål (Hemiptera: Fulgoromorpha: Tropiduchidae), Tambinia conussp. n. (Papua New Guinea), Tambinia maculasp. n. (Malaysia: Borneo), Tambinia robustocarinasp. n. (Malaysia: Sabah) and Tambinia sexmaculatasp. n. (Australia: Kuranda) are described and illustrated from the Pacific region. The diagnostic characters of this genus are redefined. A checklist and a key to the known species of Tambinia are provided.
Measurement of quality of life among prostate cancer patients helps the health care providers to understand the impact of the disease in the patients' own perspective. The main aim of this study is to measure the quality of life among prostate cancer patients at University Malaya Medical Center (UMMC) and Universiti Kebangsaan Malaysia Medical Centre (UKMMC) and to ascertain the association factors for physical coefficient summary (PCS) and mental coefficient summary (MCS). A hospital based, cross sectional study using the Short Form-36 (SF-36) questionnaire was conducted over a period of 6 months. A total of 193 respondents were recruited. Their total quality of life score was 70.1± 14.7 and the PCS score was lower compared to MCS. The factors associated for PCS were: age, living partner, renal problem, urinary problem of intermittency, dysuria and hematuria. Factors associated for MCS were: age, living partner, renal problem, presenting prostatic specific antigen and urinary problem of intermittency and dysuria. Our prostate cancer patients had moderate quality of life in the physical health components but their mental health was less affected.
The incidence of hepatocellular carcinoma (HCC) in Malaysia for the year 2001 was 2.8 per 100,000 people. The mortality rate is increasing. A retrospective cohort study measuring the survival of HCC patients who received treatment in Selayang Hospital was conducted from 1 January 2003 to 31 December 2006. The main objectives of the study were to measure the survival of the patients and to understand the influencing factors, especially ethnicity. The subjects were newly diagnosed cases of HCC by CT scan and histopathological assessment who underwent futher investigations and treatments in Hospital Selayang (inception cohort). The survival time was measured from the date of diagnosis until the subjects died, or failed to follow-up at the end of the study period (31 December 2007). A total of 299 patients were selected with 95 patients dying, the majority among Chinese (39.1%). Subgroup analysis according to ethnicity proved significantly that Chinese patients who had smaller tumor, less number of nodules, low AFP level, Child Pugh Class A and received surgical treatment had a better median survival rate compared to other ethnic groups. Malay (cHR: 1.3, 95%CI; 0.89-1.85) and Indian (cHR: 1.3, 95%CI; 0.74-2.26) patients had a poor survival compared to Chinese patients, but not in the final model. Therefore ethnicity may play a role in survival of HCC patients, but not as a main hazard prognostic factor.
Descriptions of four new species of the genus Philanthaxia Deyrolle, 1864: Philanthaxia pseudoaeneasp. n. (Thailand), Philanthaxia jaklisp. n. (Indonesia, Sumatra), Philanthaxia chalcogenioidessp. n. (Indonesia, Sabah) and Philanthaxia lombokanasp. n. (Indonesia, Lombok) are given. The new species and male genitalia are illustrated and compared with the most similar congeners. Sexual dimorphism of Philanthaxia iris Obenberger, 1938 is described and discussed.
Solid waste comprised of a grass clippings mixture was decomposed using a locally-made compost bin in Pulau Pinang, Malaysia, to eliminate challenges associated with improper waste disposal. Bulk density, pH, moisture content, nutrients content, nitrogen (N), phosphorus (P), potassium (K), iron (Fe), zinc (Zn), copper (Cu) and carbon/nitrogen (C/N) ratio were determined over 77 days. A 34% reduction in compost bin volume was observed and bulk density and pH were also reduced from 732 to 482 kg m(-3) and 7.82 to 8.41, respectively, indicating fairly good performance. The final moisture content and C/N ratio were 44.06% and 14 : 1, respectively, and the results also showed that the presence of nutrients and heavy metals in the final compost were within acceptable limits for use as a soil conditioner. Final concentrations of N, P and K were 347 mg kg(-1), 510 mg kg(-1) and 14.8 g kg(-1) and for heavy metals, Fe, Zn and Cu were 5308, 300 and 20 mg kg(-1), respectively, which considerably assisted in the decomposition process. Processed waste materials from the bin were shown to be excellent organic fertilizers with over 75% germination index for seeds grown into bean sprouts in 72 h. An improved bin design to eliminate greenhouse gas emission into the environment is suggested.
Magnetic Resonance-guided focused Ultrasound Surgery (MRgFUS) is gaining popularity as an alternative to medical and surgical interventions in the management of symptomatic uterine fibroids. Studies have shown that it is an effective non-invasive treatment with minimal associated risks as compared to myomectomy and hysterectomy. MRgFUS can be offered to a majority of patients suffering from symptomatic uterine fibroids. It has been suggested that the use of broader inclusion criteria as well as the mitigation techniques makes it possible to offer MRgFUS to a much larger subset of patients than previously believed. This paper will describe how MRgFUS treatment for uterine fibroids is performed at the University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
Langerhans cell histiocytosis of the spine frequently presents as a solitary lesion and rarely results in neurological deficit. Involvement of thyroid tissue is also rare, even in multifocal disease presentations. We present an unusual variant of Langerhans cell histiocytosis in a 37-year-old man presenting with profound quadriparesis and incidental thyroid involvement. MR imaging and skeletal radiographs revealed widespread involvement of the spine. The patient underwent surgical resection of the tumour and stabilization of the spine. Diagnosis was confirmed by histological and immunohistochemistry analysis. Langerhans cell histiocytosis should be included in the differential diagnosis of radiolucent lesions of the spine in adults.
Adult-onset dermatomyositis has been found to be associated with underlying malignancies in up to 40% of patients. The aims of this study were to determine the demographic profile, the underlying cancer and outcome in patients with dermatomyositis. This was a retrospective review of 38 patients with dermatomyositis seen over a 12-year period in the Department of Dermatology, Kuala Lumpur Hospital. Of these, 18 (47.4%) had an associated underlying malignancy. The male to female ratio was 2:1. Ten patients (55.6%) were Chinese. The youngest patient encountered was 32 years old. Nasopharyngeal carcinoma (61.1%) was the most common malignancy in our study population. Tumour markers were not useful as the initial screening for malignancies. Thorough screening for malignancy is imperative in adult dermatomyositis especially those above 40 years old.
INTRODUCTION: Gout is an increasingly common medical problem. The traditional risk factors of male sex and high red meat or alcohol consumption have been joined with newer risks such as increased life expectancy, and the metabolic syndrome (hypertension, diabetes, dyslipidaemia, truncal obesity).
METHODS: This was a retrospective study to determine the epidemiology, clinical features, associated conditions as well as renal related conditions in existing gout patients followed-up in Rheumatology outpatient clinic, Hospital Tuanku Ja'afar, Seremban.
RESULTS: Over a three month period, we identified 54 gouty patients on our follow-up, the majority being male, Malay ethnicity, with the age of onset in the third and fourth decades of life. Commonly associated risk factors were hypertension, hyperlipidaemia and obesity. However, underlying history of diabetes mellitus, alcohol consumption, and family history were not commonly associated with gout in our group of patients. Half of our patients had at least two or more joints involvement. About half of the patients with tophaceous gout had renal impairment.
CONCLUSION: Our series of gout patients highlight the high prevalence of cardiovascular risk factors. The high prevalence of tophi and renal impairment is a cause for concern.
Study site: Rheumatology outpatient clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia.
This is the photograph of an adult male with Human Immunodeficiency Virus -Hepatitis C virus (HIV-HCV) co-infection. He was on highly active antiretroviral therapy (HAART) for HIV infection. The liver function tests showed hypoalbuminemia and elevated serum transaminases while liver ultrasonography showed coarse echotexture compatible with liver cirrhosis.