Background & Objective: Modulation of cortical excitability by low frequency repetitive transcranial
magnetic stimulation (rTMS) has demonstrated therapeutic use in epilepsy. This study aimed to evaluate
the efficacy of low-frequency rTMS on refractory epilepsy in a group of Malaysian subjects. Methods:
Nine patients with refractory epilepsy completed the study. All patients received 10 sessions of 1Hz
rTMS (1000 pulses per session) at 90% of resting motor threshold. Outcome measures included seizure
frequency, Symptom Checklist-90 (SCL-90), Beck Depression Inventory II (BDI II) and Quality of
Life in Epilepsy-31 (QOLIE-31). Responders were defined as having ≥ 50% seizure reduction. Results:
The mean age was 33.8 years (SD 11.7), with 4 male. Three patients had mesial temporal sclerosis
(MTS); 4 with focal cortical dysplasia (FCD) and two lesion-negative. Three patients achieved >50%
seizure reduction at 8 weeks post-treatment, with 2 of them had improvement in the number of IED.
All of the responders had FCD. The responders were younger (mean 24.7 vs. 38.3 years old), had
shorter duration of illness (mean 15.7 vs. 30.5 years) and had less frequent seizure frequency prior to
treatment (mean 5.5 vs. 10.8 attacks per week), as compared to the non-responders. Six patients had
improvement in BDI-II scores, two in QOLIE-31 and four in SCL-90 post treatment, irrespective of
seizure control. The mean scores in BDI-II improved significantly with treatment (p
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
Objective: Previous studies have shown milk to contain cancer inhibitors. In this context, this study was conducted to screen the potential cytotoxic properties of four different types of milk, namely cow's milk, goat's milk, mare's milk and human milk.
Methods: In evaluating the cytotoxic properties of milk, two different human leukemia cell lines namely, Raji and CEM-SS were used. The treated and untreated cells of milk were cultured at 37°C in 5% CO2 for 5 days according to standard guidelines. The CellTiter 96® Aqueous (MTS) assay was carried out on the first, third and fifth days to measure cell viability. The percentage of cell viability was determined by comparing the optical density of the treated cells against the untreated controls. One-way ANOYA at p
Objective: To determine the perception of medical students towards mentor-mentee system in Faculty of Medicine and Health Sciences of UNIMAS. Method: It was a cross-sectional study involving all 104 second year and 80 fifth year medical students. A self-administered questionnaire consisting of socio-demographic details, general perceptions on mentor-mentee system, academic support, personal development, and emotional and psychological support was distributed. The data was analysed using the SPSS version 19. Result: Majority of the subjects had a positive outlook towards the mentor-mentee system with a range of 45.6% to 57%. Three of the top rated perceptions were ‘mentor analyses mentee’s examination results and provides constructive feedback’, ‘mentor advises how to improve academic performance’, and ‘mentor gives encouragement and support for the challenges faced’ (66.8%, 68.0% and 62.9% respectively). Pre-cinical medical students had significantly better perception on mentor-mentee system than clinical students (p≤0.002) while those with non-clinician mentors significantly had better perceptions than those with clinician mentors (p≤0.003) on the system. No significant difference was found between the perceptions of males and females for all components (p=0.234 to 0.722). Conclusion: The mentor-mentee system was found to be successful as more than half of the respondents had posititve perception on the system and its aspects. However, pre-clinical students benefited more compared to clinical students, which reflects the need to look at the support given to clinical students. It was recommended that future studies should incorporate the perceptions of mentors.
Patient’s belief towards pain management may affect pain management outcomes and quality of life. The main aim of the present study was to determine the impact of a pre-operative pain education package towards pain belief among patients undergoing orthopaedic surgery in a tertiary hospital. A one-group pre-test post-test design study was conducted on orthopaedic surgery patients. Thirty respondents were recruited and pre-operative pain education was administered individually before surgery. Pre-operative and post-operative pain belief, management scores and side effects were measured using the Barrier Questionnaire (BQ-13). The results reported significant differences between pre-test scores (Mean = 41.87, Standard Deviation = 11.467) and post-test scores (Mean=34.80, Standard Deviation=13.026) of pain belief (t = 2.84, p = 0.004). There were also significant differences between pre-test scores (Mean = 37.10, Standard Deviation = 10.610) and post-test scores (Mean=30.80, Standard Deviation = 11.424) of pain management (t = 3.856, p = 0.0005). Respondent’s gender (t = -2.403, p = 0.023) and ethnicity (F = 5.038, p=0.014) reported significant differences with p value < 0.05, respectively. However, there were no significant differences between educational level, ethnicity, prior surgical history with pain belief (p> 0.05). There was positive impact of the pain education package towards pain belief and painmanagement among respondents who underwent orthopaedics surgery in a tertiary hospital. Reinforcement of pain educational program is pivotal in order to achieve optimal post-operative pain management.
Keywords: pain, education, orthopaedics, patient, surgery
Kehilangan jisim tulang adalah lebih ketara selepas menopaus. Jangka masa menopaus dan umur yang meningkat dikaitkan dengan penurunan jisim tubuh tanpa lemak, peningkatan lemak badan dan peningkatan berat badan. Kajian ini melihat sumbangan relatif jisim tubuh tanpa lemak dan lemak badan ke atas ketumpatan mineral tulang (KMT) di kalangan 139 wanita Cina posmenopaus sihat di Kuala Lumpur. KMT di kawasan seluruh tubuh, tulang belakang ( L2-L4), leher femur dan keseluruhan tulang pinggul diukur dengan alat dual-energy X-ray absorptiometry (DxA). Hasil kajian mendapati 80% daripada wanita posmenopaus Cina mempunyai jisim tulang yang rendah (osteopenia) manakala 8% daripada mereka mengalami osteoporosis di bahagian tulang belakang atau tulang pinggul. Secara keseluruhan, lemak badan mempunyai korelasi yang positif dengan KMT di semua bahagian diukur (keseluruhan tubuh, r = 0.265, p < 0.001; tulang belakang r = 0.214, p < 0.05, leher femur, r = 0.254, p < 0.001; keseluruhan tulang pinggul r = 0.332, p < 0.001). Jisim tubuh tanpa lemak juga mempunyai korelasi yang positif dengan KMT kebanyakan kawasan diukur (keseluruhan tubuh, r = 0.239, p < 0.001; leher femur r = 0.365, p < 0.001; keseluruhan tulang pinggul r = 0.352, p < 0.001) kecuali tulang belakang. Analisis regresi menunjukkan lemak badan dapat meramal KMT pada keseluruhan badan (p < 0.0001) dan tulang belakang (p < 0.005) manakala jisim tubuh tanpa lemak dapat meramal KMT pada tulang femur dan tulang pinggul (p < 0.0001). Hasil kajian menunjukkan kedua-dua lemak tubuh dan jisim tubuh tanpa lemak memainkan peranan dalam mempengaruhi KMT, di mana lemak badan memainkan peranan yang lebih di kalangan wanita posmenopaus. Oleh itu, wanita posmenopaus perlu elakkan mempunyai berat badan yang terlalu rendah (kurang lemak badan) dan mengekalkan jisim tubuh tanpa lemak untuk mencegah osteoporosis.
Methicillin-resistant Staphylococcus aureus (MRSA) infection is important among vas-cular surgical patients. Its effect can be devastating resulting in limb amputation and mortality. We performed a retrospective patients record analysis to determine the pat-tern of MRSA infection among vascular surgical patients in Hospital Kuala Lumpur from January 2005 to December 2007. We also attempted to identify the factors asso-ciated with poor clinical outcome after such infection. There were 999 patients who underwent vascular surgeries in HKL within the analysis period. Of these 24 patients (2.4%) were detected to have MRSA surgical site infection. The infection was commoner among cigarette smokers, patients with diabetes melitus and those who had previous vascular surgery. Most infections occurred in the emergency surgery category and manifested as wound breakdown. Fifty-four percent of the infected pa-tients ended with graft removal, amputations or death. MRSA infection complicating vascular surgery resulted in poor clinical outcome. This serious threat requires intensi-fied preventive measures.
Villoglandular papillary adenocarcinoma was first described by Young and Scully in 1989 as a distinct entity with the histological features of exophytic growth proliferation, villous and papillary architecture and mild to moderate nuclear atypia. We report one case of villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix with lymph node metastasis and reviewed the clinicopathological features of six other cases reported in the literature. Our patient is the seventh similar reported cases. They ranged in age from 29 to 54 (mean, 41) years. Five had lymphovascular invasion. All except our patient were treated with radical hysterectomy and radiotherapy. She was followed-up for 7 months and unfortunately died due to chest infection.
A survey on the diversity of marine macrogastropoda
in Pulau Songsong, Pulau Bidan and Pulau Telor on the
Northern Straits of Malacca was conducted. Specimens
were collected on rocky shores following NaGISA protocol
and the number of marine macrogastropod were recorded.
Distances and the number of the same species were
converted into Relative Abundance unit (individuals per
100 m2
). A total of 15 species of marine macrogastropoda
were found from seven families namely Neritidae,
Trochidae, Ceriitidae, Littorinidae, Turbinidae, Muricidae
and Potamididae. Seven macrogastropoda species were
newly recorded from these three islands. Morula marginatra
was the most dominant species and Pulau Songsong had
the highest genera and species diversity among the three
islands. (Copied from article).
Background: Increased maternal anxiety level has been reported to have detrimental effects on the physical outcome of pregnancies such as not achieving vaginal births. This study thus aims to determine the level and factors affecting mental preparedness among mothers with normal pregnancies and its correlation with birth outcomes.
Methods: Three hundred healthy mothers above 37 weeks of gestation in the early stage of labour were assessed for their level of mental preparation before birth process and outcomes after births which include general feeling (euphoria), ability to withstand labour pain and bonding with the new born. The successfulness of vaginal birth and other data on factors affecting mental preparation were also collected.
Results: The level of mental preparedness was found good in 78% of the mothers, mainly determined by their socioeconomic status, family support and personal ability to adjust to changes. Age (p= 0.048), parity (0.00) and income (0.01) were found to influence mental preparedness significantly. Race, occupation, education level and marital status are however not significantly related. Poor mental preparedness is associated with greater pain during labour. A correlation analysis also found a positive relationship between the level of mental preparation and mental outcomes following birth in these mothers but it did not significantly influence the mode of delivery.
Conclusion: Mental preparation before birth seems to have an effect on mental outcomes of mothers following birth process. It is vital that mothers of the younger age group with no previous obstetric experience be given more attention in preparing them mentally before they face the painful birth process.
Pharmacogenomics (or pharmacogenetics), the study of the effects of genetic differences on a person’s response to drugs, can help in optimizing drug efficacy and minimizing adverse drug reactions. Interperson difference in drug metabolism is one of the important consequences of such genetic variation. This variation is determined in part by mutations in cytochrome P450 enzymes (CYPs). IMU is part of a major collaborative research project in the area of phamacogenetics and drug metabolism. Working together with USM and UiTM, our group has, since 2000, generated useful population database on genetic polymorphism of various CYP isoforms. We have successfully genotyped three major ethnic groups, Malay, Indian and Chinese for their allelic frequency of important isoforms. These include CYP2D6, CYP2C9, CYP2C8 and CYP2A6. Data generated so far collectively have contributed to our effort in mapping and constructing genomic database for Malaysian population.
Since early 2002, our research has been focusing on developing in vitro methods in studying the functional consequences of genetic polymorphism of CYP enzymes. Using site-directed mutagenesis, CYP mutants, carrying nucleotide changes as reported in known alleles in human populations, were generated and expressed in E. coli system, and the expressed recombinant proteins were characterized using enzyme assays to determine the functional consequences of mutations. We have established a series of HPLC (high performance liquid chromatography)-based and fluorescence-based assays to investigate CYP activities. Assays that have been developed include tolbutamide methylhydroxylase, paclitaxel 6α-hydroxylase, dextromethorphan O-demethylation, testosterone 6β-hydroxylation and coumarin 7-hydroxylase assays. These assays serve as activity markers allowing comparison of catalytic activities of mutant proteins generated. Another focus of our work is to use the developed assays as a screening tool to investigate drug-herb interactions. This was achieved by co-incubation of herbal extracts and active constituents with the probe substrates in the assays followed by characterization of the kinetic behaviors of the enzymes involved using various pharmacokinetic parameters such as Km, Vmax, IC50 and Ki. This work is currently carried out with collaboration from the Institute for Medical Research (IMR) and is supported by MOSTI’s eScienceFund under RM9. It is envisaged that this screening work will give us insights on the potential of the commonly used herbs to cause pharmacokinetic interactions with other drug substrates, and allow us to elucidate the mechanisms involved in the interactions.
Important bioactive molecules are molecules that are pharmacologically active derived from natural sources and through chemical synthesis. Over the years many of such molecules have been discovered through bioprospective endeavours. The discovery of taxol from the pacific yew tree bark that has the ability in stabilising cellular microtubules represents one of the hallmarks of success of such endeavours. In recent years, the discovery process has been aided by the rapid development
of techniques and technologies in chemistry and biotechnology. The progress in advanced genetics and computational biology has also transformed the way hypotheses are formulated as well as the strategies for drug discovery. Of equal importance is the use of advanced drug delivery vehicles in enhancing the efficacy and bioavailability of bioactive molecules. The availability of suitable animal models for testing and validation is yet another major determinant in increasing the prospect for
clinical trials of bioactive molecules.
Background: Nosocomial infection is among the leading problem in many major hospitals resulting in soaring cost expenditure in managing its affect.Hand washing practice is a crucial preventive way to contain such mischief but many ignored its importance. This is perhaps due to lack of appropriate role modeling from senior practitioners.
Subjects and methods: Our study examined the prevalence of hand washing practice among medical students from year 3 to 5 and compared it to their knowledge and level of awareness on its importance in clinical practice. 142 students were randomly observed during their clinical work in the wards on this practice and questionnaires were later distributed to 268 students from all semesters on their knowledge on the technique and awareness on its importance.
Results: Out of 142, almost 80% washed their hands but only 41.6% performed effective hand washing. In contrary, 80 to 90% showed good level of knowledge and awareness as well as perception about its importance in clinical practice.
Conclusions: The contradictory findings between the actual practice of hand washing and knowledge as well as awareness suggest that enforcement on the practice is necessary. This requires motivation and cooperation from all health alliances and higher authority in the health system. Remedial measures are much needed in order to contain high incidence of nosocomial infection in our local practice.
Introduction: Lipid-modifying drugs have been used to treat dyslipidemia as well as for the primary
and secondary prevention of CVDs and stroke. Objectives: This study aims to describe the drug
utilization pattern of lipid-modifying drugs in a private hospital. Method: A retrospective study was
carried out in outpatient of the selected hospital. Patients were selected based on inclusion and
exclusion criteria by using convenience sampling. Data were collected through KCIS by retrieving
patients’ registration number. Defined daily dose (DDD) was calculated and compared to World
Health Organization DDD. Medicine prices were also analysed. Results: A total of 180 patients’
record were analysed, 70% of them were male; 40.6% of the patients were from the age range of 50
to 59 years old; ethnicity breakdown was Malay (69.4%), Indian (18.3%) and Chinese (12.2%).
Among all lipid-modifying drugs, utilization of statins was the highest as statins are the preferred
line in the treatment of dyslipidemia. Innovator brands were more preferred where most of the lipidmodifying
drugs used in the selected hospital are innovator brand drugs. In terms of cost, lipidmodifying
drugs contributes to about 27% of the total cost of prescription in average. Conclusion:
The utilization of all lipid-modifying drugs in the selected hospital was lower as compared to WHO
DDD. As compared to combination therapy, monotherapy with atorvastatin was generally preferred
in the selected hospital. The utilization of atorvastatin was found to be the highest in the OPD of the
selected hospital.
Childhood undernutrition while being a preventable condition remains a major public health issue because it contributes to the mortality and morbidity of children globally. Intervention strategies to improve the nutritional status of children include therapeutic food, cash transfers, antibiotics and nutritional education. The objective is to review the effects of various nutritional interventions in addressing undernutrition in children. Methods: Comprehensive search of literature in electronic databases were conducted in PubMed, Science Direct, and Scopus containing the Medical Subject Headings (MeSH) and the title terms ‘Undernutrition’ OR ‘Malnutrition AND ‘Intervention’ OR ‘Management’ AND ‘Children’ OR ‘Childhood’ between January 2000 and August 2019. Of the 4358 studies that were identified, 17 studies matched the inclusion criteria and were reviewed. Results: Therapeutic food is an integral part of nutritional interventions in majority of the studies along with cash transfers and nutritional education. The most consistent outcome in most of the studies was improvement in the nutritional status which subsequently reduces the undernutrition in children. Conclusion: Therapeutic food, conditional cash transfer and nutritional education yielded the best outcome in alleviating undernutrition in developing countries.
De Quervain's tenosynovitis is a common cause of radial sided wrist pain and is described as an entrapment tendinitis of the tendons in the first extensor compartment. Physiotherapy and splinting are initial conservative treatment. Steroid injections are an effective treatment modality but may fail due to the anatomical variation in the first dorsal compartment of the wrist. We present a 39-year-old female who failed conservative treatment. She received a steroid injection, but symptoms resolved for 6 months only. We proceeded to surgery and noted three subcompartments consisting of one for the extensor pollicis brevis and two for the abductor pollicis longusas opposed to one extensor compartment. The steroid injection may have failed to infiltrate all the subcompartments resulting in treatment failure. General practitioners and surgeons must be aware of this variation if there are to provide effective treatment. Ultrasonographic guidance may be required for steroid injections in recalcitrant de Quervain's disease.
Introduction: Acne vulgaris is a chronic inflammatory dermatosis caused by Propionibacterium acnes. Clinicians are constantly attempting to discover the best antibiotic regimes in treating acne vulgaris. This study compares two regimens in terms of efficacy, tolerability, compliance and recurrence rate to make recommendation on which is the best regime. Methods: An open-labelled prospective randomized investigator-blinded interventional study was carried on moderate acne vulgaris patients. Patients were assigned to treatment arm at enrolment followed by fol- low-up and maintenance visits. Demographic data were collected at enrolment and questionnaire enquiring acne condition, general health and quality of life impairment were filled at every visit followed by blinded dermatologist assessment. Antibiotic tablets were provided based on assigned arm until follow-up 3. Results: 26 mild acne vulgaris patients aged 17 to 29 years were recruited. Physician assessment based on GAGS and photo assessment analysis showed an overall significant change (p0.05) were found between regimens. Similarly, patient self-perceived assessment and CADI assessment also showed overall significant changes (p
Introduction: Compression of the median nerve in pregnancy is thought to be due to fluid retention within the carpal tunnel space. We aim to discover the cause of carpal tunnel syndrome (CTS) in pregnancy using high resonance ul- trasonography. Methods: This is a cross-sectional study where obstetric patients were screened for CTS and subjected to a non invasive ultrasonic imaging. Results: A total of 63 patients were seen with 25 diagnosed to have CTS (39.7%) and 38 patients had none (60.3%) based on a screening tool. Age ranged from 20-42 years old with the highest range in the 28-30 year old group (34.9%). In patients with CTS, the cross sectional area of the median nerve inside the tunnel was a mean of 0.908 cm ie larger, while non-CTS patients had a mean of 0.797 cm inside the tunnel. The transverse carpal ligament (TCL) measured a mean of 0.0988 cm in the CTS group (ie thinner) and 0.1058 cm in the non-CTS group. Median nerve mobility at equal to or less than one tendon width was 80% in pregnant women with CTS and 92.1% for those without. No fluid was present within the carpal tunnel of all patients. The results were sta- tistically not significant. Conclusion: Ultrasonographic evidence in pregnant women with CTS shows a larger median nerve, a more mobile median nerve and a less thick transverse carpal ligament. There is absence of fluid retention and synovitis ruling out extrinsic compression of the median nerve as cause of CTS in pregnancy.
Wound management is important as it helps to promote healing without microbial infection. Euphorbia hirta, a species of Euphorbiaceae family, also known as Ara tanah among Malaysians, is traditionally used to promote wound healing where its poultice is applied to the sores on the legs, bruises and wounds. Several reported pharmacological properties including antioxidant, antimicrobial, antidiabetic, anti-anaphylactic activities have been reported on this plant. The aim of this review was to evaluate the wound healing effects of E. hirta. Information involving only in vivo studies on wound healing effect of E. hirta was searched using electronic databases. The electronic databases include PubMed, Google Scholar, Ovid, CENTRAL, LILACS, and ClinicalTrials.gov from year 1962 to 2020. A total of five out of 70 studies were included and assessment was made. All included articles studied different wound models in rats. All showed significant wound healing activity with different mechanism of action for incision, excision and dead space wound. Quality assessment of the included studies suggested that experimental animal study design can be improved. It can be concluded that E. hirta displayed potential as a wound healing agent in vivo studies although further research on structure-activity relationship of compounds responsible for the wound healing effect and toxicological studies before it can proceed to clinical studies.
The distribution of heavy metals (Cu, Zn, Cd, Pb) in surface sediments was examined in waters off the coast of Marang, Terengganu. A total of 20 samples were collected using Ponar grab and analysed by inductively coupled plasma-mass spectrometer after closed digestion with acid. The sediments were filtered using a dry sieving method to determine their particle size. The spatial distribution maps on the concentration of selected metals were drawn using the ArcGIS software. Results showed that the average concentration of Cu, Zn, Cd, and Pb were 2.33±0.38 µg/g dry weight, 28.4±3.78 µg/g dry weight, 0.09±0.01 µg/g dry weight and 8.35±1.48 µg/g dry weight, respectively. The level of pollution was also evaluated using the Index of Geoaccumulation (Igeo) and Pollution Load Index (PLI). All Igeo and PLI values obtained were low, which indicated low or no pollution. Meanwhile, the sediment mean size ranged between -0.77Ø and 3.18Ø, which characterised a sandy type of sediment. Correlation analysis showed a positive correlation between the heavy metals and sediment size. The results indicated that there was a common source of heavy metal pollution in the study area, possibly from shipping activities. Overall, there was no significant heavy metal pollution in the waters off Marang. This finding is important as the data could be used to evaluate the risk of metal contamination and the impact of anthropogenic activities on the marine environment.