Background: Achalasia cardia, not an uncommon disease, is diagnosed based on a good history, upper endoscopy, barium swallow, and standard esophageal manometry, is often diagnosed late and best care is delayed.
Materials and Methods: Complete records of treatment naïve patients with achalasia from 1st January 2000 till 20th November 2004 were reviewed.
Results: A total of 42 patients, with average presenting age at 45±17 (range 19-83) years with 15 males:27 females with 22 Malays:15 Chinese:5 Indians, were analysis. Compared to our upper endoscopy attendees, there is a trend towards a younger age group (p>0.05) but clearly demonstrating a female preponderance (p<0.005) and towards the Malays but sparing the Indians (p< 0.05). The classical symptom of dysphagia was noted in all cases (100%). Regurgitation in 37 patients (88%), heartburn in 15 patients (36%), weight loss in 10 patients, nocturnal cough in 16 patient, retro-sternal chest discomfort in 2 patients and hemetemesis in 2 patient. One patient presented with aspiration pneumonia and another had concomitant active pulmonary tuberculosis and 9 had concomitant constipation (21%). The duration of illness before diagnosis was 66±90 (range 3-360) months and their presenting weight was 52±12 (range 33-82) kg. Barium swallow examination confidently diagnosed achalasia in 28 patients (67 %). The remaining was marked as dysmotility disorder (7 cases), possible carcinoma of the esophagus (in 2 patients) and dysmotility with possible achalasia (in 5 patients). Ten had mega-esophagus and two had epiphrenic diverticulum with no pseudo-achalasia. Standard esophageal manometry, performed in 39 cases, all demonstrated aperistalsis with one vigorous achalasia. The manometric assembly failed to pass through the
sphincter in 14 cases (36%), includes 8 patients with mega-esophagus, and LES assessment was not possible. Four cases demonstrated normal LES pressure but demonstrated incomplete relaxation (normotensive achalasia). Dilatation was performed with a 30 mm Rigiflex pneumatic dilator under fluoroscopy at 7psi for 3-30 seconds after loss of waist in 40 patients without complications and excellent symptomatic relief with 3-12 months post procedural weight gain of 7±5 (range: 0-19) kg. Six patients required a second dilatation and another required two further dilatation. The pneumatic dilatations durability during this short study was excellent at 29±11 (range 8-48) months. Similar efficacy and safety profile was noted in patients with mega-esophagus.
Conclusion: Barium swallow (especially in advanced disease) and manometry (especially in early disease) serve as essential tools for the diagnosis of achalasia and they complement each other. We report two patients presenting with hemetemesis. We obtained excellent results with pneumatic dilatation without any
complications and this extends to advanced cases of achalasia with mega-esophagus.
LABOURERS in factories in South Malaya who cut up pineapples by hand for canning invariably show an abnormality of those parts of the body which are exposed to slight pressure and pineapple juice, notably the palmar surfaces of the fingertips and the periphery of the palms. At the beginning of the canning season, the left hand, which comes more into contact with the fruit than the knife-holding hand, becomes sore and small superficial raw areas on the fingertips are often seen. Within several days, however, these heal, and the skin ceases to be sore. The labourers state that this tolerance to the pineapple juice is due to the development of an abnormality of the skin, which in the affected area becomes bluish-white and so smooth that fingerprints may be completely lost. Deep cracks are sometimes seen in the region of the skin creases. These often stay raw and bleeding for a long time, and show no clinical signs of infection, presumably because of removal of dead tissues by enzymatic action.
Citation: A Practical Guide for the Pharmacological Management of T2DM Patients Across the Cardiovascular Risk Continuum. Kuala Lumpur: Malaysian Endocrine and Metabolic Society; 2019
Citation: Wan Bebakar WM, Ismail M, Sharif J. Preliminary report of an audit of diabetes control and management (DRM-ADCM) July to December 2008. Kuala Lumpur: Diabetes Registry Malaysia; 2009
Introduction: The Royal College of Medicine Perak under Universiti Kuala Lumpur started its own undergraduate medical degree programme in 2007. As part of the review and evaluation of communication skills (CS) training, the performance of the two pioneer batches of final year students in CS Objective Structured Clinical Examinations (OSCEs) stations in the 2012 and 2013 were analysed.
Methods: The CS OSCE stations were analysed based on the percentage of students obtaining a satisfactory performance in each CS component. Overall performance in each CS component was considered satisfactory, if ≥ 50% of students achieved satisfactory performance or unsatisfactory, if < 50% of students achieved satisfactory performance. The two cohorts were compared for any significant statistical difference (p < 0.05) in their performance.
Results: Satisfactory performance was obtained in basic CS (courtesy, appropriate non-verbal and verbal CS), stating intention of session, recognizing patient’s cues, checking and addressing patient’s perceptions and concerns, checking patient’s understanding, breaking bad news and maintaining a professional attitude. The performance was unsatisfactory in assessing prior knowledge, discussing patient management and checking patient’s coping skills. Both the two cohorts’ performance did not differ significantly.
Conclusion: Overall the students’ performance was satisfactory except for assessing prior knowledge, discussing management and checking patients’ coping skills.
Introduction: A cross-sectioned study was carried out on 1016 drug addicts from Johor state to better understand their profile.
Method: A structured questionnaire prepared in three languages was used to collect the data which was analyzed using the Statistical Package for Social Sciences.
Result & Discussion: The overall mean age of the respondents was 33.8 (95% CI= 33.3 - 34.4) years and ranged from 16 to 61 years. ANOVA post hoc multiple comparison tests showed that there was a significant difference in the mean age between Malays and Chinese (p<0.05). The majority of the respondents were Malay (79.6%) and had secondary education (72.1%) or primary education (21.7%). The majority (79%) was either semi-skilled or unskilled. More than 70% had mores than five siblings. About 36% of the respondents had past a history of discipline problem at school. The majority (99.6%) of the drugs addicts had smoked before and more than 90% were currently smoking. More than 80% had consumed alcoholic beverages. The majority did not use condom when they had sex. Only 24% stated that they did use a needle or syringe that had previously been used by someone else. Less than 4% had either bleached or boiled the needle or syringe that had previously been used by someone else. About 17% were tested positive for HIV. The mean age at which the respondents first started injecting drugs was 21.5 (95% CI= 20.7 - 22.2) years. ANOVA post hoc multiple comparison tests showed that there was no significant difference in the mean age of the different ethnic groups at which the respondents first started injecting drugs. The majority (84.2%) of the drug addicts started injecting drugs between 10 and 20 years of age. Friends introduced 80% of the drug addicts to drugs. The common reasons given for first taking drugs was " I was curious about the feeling of taking drugs (43.6%), "my friends asked me to try" (23.4%), "to release tension" (15.6%) and 5% stated "to try for fun", and 3% that they were "depressed". The majority (64.2%) of the drug addicts spend RM 500 or more per month on drugs and more than 10% of them spend as much as RM 1000 or more per month.
Conclusion: These results indicate an urgent need for a more comprehensive prevention program involving family, schools, commmunities and the media and aimed at reducing drug abuse. Keywords: Profile, drug addicts, Malaysia
Citation: Hitchman SC, Fong GT. The Bad With the Good? The Relation Between Gender Empowerment and Female-to-Male Cigarette Smoking Rates Across 74 Countries. ITC Project Working Paper Series. University of Waterloo, Waterloo, Ontario, Canada.; 2010
Objective: Worldwide it is estimated that men smoke at nearly five times the rate of women. However, there is wide variation across countries in the gender smoking ratio (ratio of female-to-male smoking prevalence rates). Lower smoking rates among women have been attributed to social norms against women smoking, and women’s lower social status and economic resources. We tested the hypothesis that in countries with higher gender empowerment, the gender smoking ratio would be closer to 1.
Methods: We correlated the gender smoking ratio (calculated from the 2008 WHO Global Tobacco Control Report) and the United Nations Development Programme’s Gender Empowerment Measure (GEM). Because a country’s progression through stages of the tobacco epidemic and its gender smoking ratio has been attributed to its level of development, we also examined this relation partialling on economic development (Gross National Income (GNI) per capita), and income inequality (Gini).
Findings: The gender smoking ratio was significantly and positively correlated with the GEM. GEM was also the strongest predictor of the gender smoking ratio when controlling for GNI per capita and Gini in a multiple regression analysis.
Key Conclusions: The findings identify a challenge for countries undergoing economic development and greater gender equality: can such progress take place without a corresponding increase in smoking rates among women? These findings thus highlight the need for strong tobacco control in countries in which gender equality is increasing.
The objective of this study is to identify whether emotional intelligence among employees between grades N17 to N27 substantially affects their work motivation in the organisation of Mardi. This study used the instruments of Emotional Competence Inventory (ECI) and Employee Performance Measure. Data were collected by using questionnaires that were distributed to 50 staffs in Human Resources Management Division, Headquarters of MARDI, Serdang, Selangor. The results of correlation analysis showed that the relationship between emotional intelligence and motivation among employees in Grade 17 to 27 that are working in MARDI is not significant. In addition, the different levels of emotional intelligence according to their positions were not significant, however, for different levels of self-motivation by grade showed a significant and positive relationship. The research findings can give a good benefit to MARDI Division Human Resources Management in the effort of improving the quality of work and services among support staffs.
Sivasampu S, Lim Y, Abdul Rahman N, Hwong WY, Goh PP, Abdullah NH
Citation: Sivasampu S, Lim Y, Abdul Rahman N, Hwong WY, Goh PP, Abdullah NH. National Medical Care Statistics: Primary Care, 2012. Kuala Lumpur: National Clinical Research Centre, Ministry of Health, Malaysia; 2014
The Asian Prostate Cancer (A-CaP) Study is an Asia-wide prospective registry study for surveying the treatment outcome of prostate cancer patients who have received a histopathological diagnosis. The study aims to clarify the clinical situation for prostate cancer in Asia and use the outcomes for the purposes of international comparison. Following the first meeting in Tokyo on December 2015, the second meeting in Seoul, Korea 2016, the third meeting in Chiang Mai, Thailand, on October 2017, the fourth meeting was held in Seoul, again on August 2018 with the participation of members and collaborators from 13 countries and regions. In the meeting, participating countries and regions presented the current status of data collection and the A-CaP office presented a preliminary analysis of the registered cases received from each country and region. Participants discussed ongoing challenges relating to data cleaning and data up-dating which is the next step of the A-CaP study following the data collection phase between 2016 and 2018. There was specific difference in term of the patient characteristics, and initial treatment pattern among East Asia, Southeast Asia and Turkey, and Jordan. Finally, a close relationship between prevalence of PSA test and disease stage of the patients at diagnosis in Japan and Malaysia was discussed.
This paper presents a conceptual approach to the integration of Islamic perspectives into a Medical Imaging Curriculum to the concept of Outcome-Based Education (OBE). This work is seen within the context of harmonising Islamic principles to a currently accepted concept in education. Although there have been discussions that question the concept of OBE, this paper contends that the integration can benefit from the practicality aspect of OBE. This can reduce the complexities and fatigue in addressing the integration using an educational approach that is different to that being applied to the human sciences. This paper features the main elements in OBE in the form of Islamic programme educational objectives, Islamic programme outcomes, and Islamic domain learning outcomes. The justification to use domain learning outcomes instead of course learning outcome is given. The teaching and learning strategies, as well as the assessment, are examined through a lens that serves to provide a desirable, practical and holistic model of Islamic integration. It is felt that the currently accepted teaching and assessment methodologies can be adapted for the integration exercise. This work also highlights two often overlooked elements of OBE; teacher and student characteristics. The various terminologies that describe the Islamic teacher characteristics and the differences in student learning styles and preferences are presented. Furthermore, suggestions are made to align the assessment of the integration to various taxonomies of learning, with the aim in evaluating the internalisation of the Islamic essences. This work contents that a holistic approach towards integration of Islamic perspectives into Medical Imaging curriculum can be realised.
This research investigated the unit-root tests using nonparametric sequences-reversals (S-R), Phillip-Perron (PP) tests and parametric Augmented Dickey-Fuller (ADF) test for the Malaysian equity indices. Under the considerations of drift and structural break, it was found that during the restructuring period after the Asian financial crisis, most of the indices provided evidences against the unit-root tests. These results are somewhat contrasted with the conventional unit-root tests that ignored the impact of structural changes. In addition, the S-R tests were found to have little power to identify the deviations from the unit-root even after the inclusion of structural break.
Some basic requirements are set for small clear specimen data to incorporate Malaysian timbers into equivalent European timber strength classes. In general, the correlation between structural and small clear specimen test results must be established for every timber group regardless of origin. This paper introduces a sort-plot technique for analysing the correlation of some mechanical properties of timber in selecting appropriate parametric model. Bending test was conducted on mixed species hardwoods for the determination of strength and stiffness values of both structural and small size specimens. The results showed that the sort-plot diagrams demonstrate an obvious linearity pattern between timber properties despite having poor regression values. The technique verified that properties of timber in structural and small size specimens correlated linearly.