Methods: We describe a 22-year-old woman with xanthomatous hypophysitis (XH), its clinical progression over 8 years as well as the treatment effects of prednisolone and azathioprine. Our patient was first referred for severe short stature and delayed puberty at the age of 14 years.
Results: Investigations revealed multiple pituitary deficiencies. Magnetic resonance imaging showed a pituitary mass whereby a partial resection was performed. A full resection was not feasible due to the location of the mass. The histopathologic analysis of the tissue was consistent with XH. The results of secondary workout for neoplasm, infection, autoimmune, and inflammatory disorders were negative. After surgery, a progressive enlargement of the mass was observed. Two courses of prednisolone were administered with a significant reduction in the mass size. Azathioprine was added due to the unsustained effects of prednisolone when tapered off and the concern of steroid toxicity with continued use. No further increase in the mass size was noted after 6 months on azathioprine.
Conclusion: Glucocorticoid and immunotherapy are treatment options for XH; however, more cases are needed to better understand its pathogenesis and clinical progression.
METHODS: Data were collected via the Internet in 24 countries, personal interviews in 7 countries, and both in 2 countries, using the Rome IV diagnostic questionnaire, Rome III irritable bowel syndrome questions, and 80 items to identify variables associated with FGIDs. Data collection methods differed for Internet and household groups, so data analyses were conducted and reported separately.
RESULTS: Among the 73,076 adult respondents (49.5% women), diagnostic criteria were met for at least 1 FGID by 40.3% persons who completed the Internet surveys (95% confidence interval [CI], 39.9-40.7) and 20.7% of persons who completed the household surveys (95% CI, 20.2-21.3). FGIDs were more prevalent among women than men, based on responses to the Internet survey (odds ratio, 1.7; 95% CI, 1.6-1.7) and household survey (odds ratio, 1.3; 95% CI, 1.3-1.4). FGIDs were associated with lower quality of life and more frequent doctor visits. Proportions of subjects with irritable bowel syndrome were lower when the Rome IV criteria were used, compared with the Rome III criteria, in the Internet survey (4.1% vs 10.1%) and household survey (1.5% vs 3.5%).
CONCLUSIONS: In a large-scale multinational study, we found that more than 40% of persons worldwide have FGIDs, which affect quality of life and health care use. Although the absolute prevalence was higher among Internet respondents, similar trends and relative distributions were found in people who completed Internet vs personal interviews.
METHODS: This study employed cross-sectional, self-reported survey methodology. We used the 6-item Kessler screening scale (K6) to assess psychological distress (cutoff score ≥ 13, range 0-24, with higher scores indicating greater psychological distress). Participants self-reported their perceptions of whether they had been bullied at work and how frequently this occurred. A multivariate logistic regression was conducted with ever bullying and never bullying as dichotomous categories.
RESULTS: There were a total of 5235 participants (62.3% female). Participant ages ranged from 18 to 85, mean ± standard deviation (M ± SD): 33.88 ± 8.83. A total of 2045 (39.1%) participants reported ever being bullied. Of these, 731 (14.0%) reported being subject to at least occasional bullying, while another 194 (3.7%) reported it as a common occurrence. Across all income strata, mean scores for psychological distress were significantly higher for ever bullied employees (M ± SD: 8.69 ± 4.83) compared to those never bullied (M ± SD: 5.75 ± 4.49). Regression analysis indicated significant associations (p
METHODS: Self-administered questionnaires adapted from the Nordic Musculoskeletal Questionnaire were sent to 105 physiotherapists at three main public hospitals in Kuala Lumpur, Malaysia. The questionnaire had 12 items that covered demographic information, areas of musculoskeletal problems and physiotherapy techniques that could contribute to work-related musculoskeletal disorders. The data obtained were analyzed using the Statistical Package for Social Science version 14 software.
RESULTS: The overall prevalence of work-related injuries during the past 12 months was 71.6%. Female therapists reported a significantly higher prevalence of work-related musculoskeletal disorders than the male therapists (73.0%, p,0.001). Significant differences were observed between the proportion of therapists who had work-related musculoskeletal disorders and those who did not for the group with a body mass index (BMI) .25 (x² = 9.0, p = 0.003) and the group with a BMI of 18-25 (x² = 7.8, p = 0.006). Manual therapy (58.6%) and lifting/transfer tasks (41.3%) were the two physiotherapy techniques that most often contributed to work-related musculoskeletal disorders.
CONCLUSION: Work-related injuries are significantly higher among the physiotherapists in Malaysia compared with many other countries. Female therapists reported a higher incidence of work-related musculoskeletal disorders in this study, and work-related musculoskeletal disorders were more common among therapists working in the pediatric specialty. This study contributes to the understanding of work-related disorders among physiotherapists from a southeast Asian perspective where the profession is in its development stage.
METHOD: This was a cross-sectional study involving SLE patients aged 18-56 years from Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Employment history was obtained from clinical interviews. WD was defined as unemployment, interruption of employment or premature cessation of employment due to SLE at any time after the diagnosis. SLE disease characteristics, presence of organ damage and Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SLEDAI) flare index were determined from the medical records. Self-reported quality of life (QoL) was performed using the Medical Outcomes Study Short Form-36 (SF-36). Demographic factors, disease characteristics, and QoL were compared between patients with and without WD using statistical analyses.
RESULTS: A total of 215 patients were recruited and the majority were Malay (60.5%), followed by Chinese (33.5%), Indian (4.5%) and others (n = 4, 1.9%). The prevalence of WD was 43.2% (n = 93) with 22.3% (n = 48) patients were unemployed at the time of study. Over half the patients with WD (n = 51, 54.8%) had onset of disability at <5 years from diagnosis. Patients with WD had significantly lower health-related QoL. The independent factors associated with WD were SLEDAI score at diagnosis, frequency of flare, Systemic Lupus International Collaborating Clinics score, being married, had lower education and lupus nephritis.
CONCLUSION: We found a high rate of WD in patients with SLE and it was significantly associated with SLE-related factors, in particular higher disease activity, presence of renal involvement and organ damage.
METHODS: A cross-sectional study of patients with advanced CKD (stage 4 and 5 non-dialysis) treated in our centre. We interviewed those aged 18 to 60 years old who were selected based on random sampling of their employment status and associated factors. Work disabilities and quality of life were assessed using work productivity and activity impairment (WPAI-GH) questionnaire and kidney disease and quality of life (KDQOL-36) questionnaire. These questionnaires were assisted by the main investigators to aid participants in facilitating their response process.
RESULT: A total of 318 patients recruited, 53.5% were males, with a mean age of 49.0 ± 9.0 years old. The main cause of CKD was diabetes (67.0%) followed by hypertension (11.3%). Majority of them were obese (55.3%) with a mean body mass index of 28.81 ± 6.3 kg/m2. The mean household income was RM 4669.50 ± 3034.75 (USD1006.27 ± 653.99). The employment rate was 50% (n = 159). 86% of the unemployed patients were in B40 income category. Multiple Logistic Regression was performed on the significant factors affecting employment status showed one year increase in age increased 6.5% odds to be unemployed. Female and dyslipidaemia had 2.24- and 2.58-times higher odds respectively to be unemployed. Meanwhile, patients with tertiary level of education were 81% less odds to be unemployed. Patients with advanced CKD had a mean percentage of 24.35 ± 15.23 work impairment and 13.36 ± 32.34 mean percentages of face absenteeism due to the disease burden. Furthermore, patients who were unemployed had significant perceived symptoms and problem lists, effects, and burden of kidney disease (p<0.01) and showed poor mental and physical composites (p<0.01) as compared with those who were employed.
CONCLUSION: The employment rate of advanced CKD patients was low with half of patients lost their jobs due to the disease burden and had poor mental and physical composites of quality of life. This raises the concern for financial support for long term renal replacement therapy.
METHODS: A cross-sectional study was conducted using self-administered questionnaires. Data collected from 374 women were analysed and represented via descriptive statistics.
RESULTS: Out of the 374 participants, 285 (76.2%) reported using at least one type of T&CM to conceive, during pregnancy or in the postpartum period. The majority of the participants identified that T&CM is all about plants or natural products without chemicals or drugs (n = 267, 71.4%, p
METHODS: A cross-sectional observational study was conducted to assess the effect of health-related and psychosocial correlates on HRQOL of IDDM patients in Penang, Malaysia. The participants were recruited from five governmental diabetic clinics. Patients with insulin use only, IDDM diagnosed at least 1 year earlier, were identified from clinical registers. The sample was then age stratified for 20-64 years, and severe complications (e.g., end-stage renal failure, hemodialysis, and liver cirrhosis) were excluded; a total of 1003 participants were enrolled in the study. Multivariate regression analysis was used to predict the response.
RESULTS: A total of 853 (100%) participants were enrolled and completed the study. Women exhibited significantly higher/better mental health (p < 0.013) and health perception scores (p < 0.001) despite high prevalence of impaired role (49.2%), social (24.2%), and physical (40.5%) functionings as compared to men. Women with longer diabetes exposure and uncontrolled glycemic levels (HbA1c) have poorer HRQOL. Availability of social support showed no significant association with either HRQOL or diabetes distress levels. Diabetes distress levels remained not associated with social support. Women also showed significantly higher association with health perception (15% versus 13% men, p < 0.001) and mental health (13% versus 11% men, p < 0.001) in diabetes-specific psychosocial factors. Thus, among women alone, diabetes-related specific and psychosocial factors explained 15% and 13% of variations in HRQOL extents, respectively.
CONCLUSION: Women exhibit extensive and significant patterns with health-related factors and diabetes-specific psychosocial factors (self-efficacy, social support, and DLC) to improve HRQOL. Also, women have significantly high reported distress levels and low social functioning compared to men.
METHODS: An online survey of 990 MSM was conducted between March and April 2016. Eligibility criteria included being biological male, Malaysian citizen, 18 years of age or above, identifying as MSM, and being HIV negative or unknown status. Participants' demographics, sexual and drug use behaviors, attitudes towards PrEP, and preferences regarding future access to PrEP were collected. Bivariate analysis and logistic regression were performed to determine factors associated with willingness to use PrEP.
RESULTS: Fewer than half of participants (44%) knew about PrEP before completing the survey. Overall, 39% of the sample were willing to take PrEP. Multivariate logistic regression indicated that Malay men (AOR: 1.73, 95% CI:1.12, 2.70), having 2 or more male anal sex partners in the past 6 months (AOR: 1.98, 95% CI: 1.29, 3.05), previous knowledge of PrEP (AOR: 1.40, 95%CI: 1.06, 1.86), lack of confidence in practising safer sex (AOR: 1.36, 95% CI: 1.02, 1.81), and having ever paid for sex with a male partner (AOR: 1.39, 95% CI: 1.01, 1.91) were independently associated with greater willingness to use PrEP, while men who identified as heterosexual were less willing to use PrEP (AOR, 0.36, 95% CI: 0.13, 0.97). Majority of participants preferred to access PrEP at affordable cost below 100 Malaysian Ringgit (USD25) per month from community based organisations followed by private or government hospitals.
CONCLUSIONS: Overall, MSM in Malaysia reported a relatively low level of willingness to use PrEP, although willingness was higher among those previously aware of PrEP. There is a need to provide PrEP at affordable cost, increase demand and awareness of PrEP, and to provide access to this preventative medication via diverse, integrated and tailored sexual health services.