This study investigates the spatial variation of water quality parameters in Sungai Setiu Basin at ten different locations from March 2010 to February 2011. The water quality was assessed using the Water Quality Index by Malaysian Department of Environment (DOE-WQI) and classified according to the Malaysia Interim National Water Quality Standard (INWQS). Six water quality parameters embedded in the DOE-WQI were dissolved oxygen (DO), biochemical oxygen demand (BOD), chemical oxygen demand (COD), pH, ammoniacal nitrogen (AN) and total suspended solid (TSS). In addition, this study also examined the changes in water quality over the past 10 years by comparing the present water quality to the previous works. The overall mean WQI value obtained was 84.0 which indicate that the Sungai Setiu basin is in clean condition and all measured water quality parameters gave value within the permissible limits of the INWQS classification except for pH which fall in Class III. It can be concluded that water quality in Sungai Setiu does not varies greatly over a decade. Hence continuous monitoring is needed to improve the water quality and minimize water pollution.
Background: Diabetes distress (DD) is an increasingly important part of clinical medicine, diabetes self-management and research topic in people with diabetes mellitus. The present study evaluated the effectiveness of a value-based emotion-focused educational program in Malay adults with type 2 diabetes (VEMOFIT) at 12-month follow-up compared with a program with systematic attention to participants' emotions (attention-control).
Methods: VEMOFIT consisted of four biweekly group sessions and a booster session after 3 months; the attention-control program consisted of three sessions over the same period. Intention-to-treat analysis with multilevel mixed modelling was done to estimate the intervention effect.
Results: Participants (n = 124) randomized to VEMOFIT (n = 53) or attention-control (n = 71). Mean (SD) age 55.7 (9.7) years, median diabetes duration 7.0 (8.0) years and mean HbA1c level 9.7% (82 mmol/mol). The mean DD (DDS-17 scale) level decreased in both groups (from 3.4 to 3.3 versus 3.1-2.5, respectively), significantly more in the attention-control group [adjusted difference -0.6, 95% confidence interval (CI) -1.1, -0.2]. The VEMOFIT group had a significant improvement in self-efficacy (DMSES, range 0-200; adjusted difference 16.4, 99.4% CI 1.9, 30.9). Other outcomes did not differ.
Conclusions: Because the attention-control program resulted in a decreased DD 1 year later, its implementation on a larger scale seems justified.
Trial registration: NCT02730078; NMRR-15-1144-24803.
The requirement of the medical graduate, tabled in the objectives of undergraduate medical education, as envisaged by the Malaysian Medical Council, call for the all round basic doctor to be able to handle any medical emergency, as well as meet the requirements of law in examining, documenting and reporting on the common offences of the Penal Code, where medical documentation is required of law for the purposes of dispensing justice. However, in tabling the amended requirements of the undergraduate syllabus on the lines of those followed in sollie of the more developed nations, we seem to have lost this perspective. The authors discuss, based on his previous experience from another former colonial country viz. India, where the objectives of the undergraduate training is the same, and the influences 011 the legal profession bear a common origin and governance, the relevance of some of these topics, coming under the antbit of Forensic Medicine and Toxicology as an undergraduate subject, in the day-to-day practise of medicine in and out of government service. While this issue has been the frequent topic of discussion in international confereilces and symposia, where the decline in the standards of medico-legal work in the coulltries attending have been blanled on the fall in the standard of undergraduate teaching, due recognition of the pitfalls of the deletion or whittling down of the course content, independent of the overall overhauling of the syllabi of medical schools, to keep up to the trends of overseas universities, has not been accorded in the planing of the coursc revisions, resulting in a deletion of a vital aspect of daily practise of medicine. KEYWORDS: Medico-legal; Undergraduates
100 consecutivnee wly diagnosed patients with nasopharyngeal carcinoma (NPC) since January 1994 were the subjects for studying various factors related to the delay in the confirmation of the diagnosis. 79 of them were ttlales and the peak age of incidence was the 5th decade. 92% of them were Chinese, 7% Malay and 1% Indian. 76% were agriculture worker or labourers with 66% having either no formal education (16%) or only primary level education (50%). For 50% of patients neck swelling was the first symptom, 26% had nasal symptoms, 12% ear symptoms and 11% hads symptoms due to intracranial extension of tumour. As many as 80% were at UICC Stage IV at the time of diagnosis. While the median delay, on the part of patients, in consulting a doctor was 2.5 days, the median delay on the part of the doctors to confirm the diagnosis of NPC was as long as 127 days, which was particularly worse when the patients presented with ear symptoms (266 days) followed by those with neck swelling (94 days). For those patients who were required to undergo more than one nasopharyngoscopy and biopsy the median doctor's delay was 144 days. Since 82% of patients had consulted general practitioners who remained the first-line health-service provider, it is suggested that their level of awareness with regards to NPC be significantly raised so that the delay on their part be greatly minimized. KEYWORDS: Nasopharyngeal carciuotna, delay in diagnosis, patient's delay, doctor's delay.
In vitro lymphocyte proliferative response of peripheral blood leucocytes (PBL) to purified Toxoplasma gondii antigen were evaluated by 3[H] methyl thymidine incorporation in patients acutely and chronically infected with Toxoplama gondii. PBL from three patients with acute sylnptonlatic toxoplaslnosis showed no response to T. gondii antigen during the emergence of anti-Toxoplasma 1gM antibodies and the response returned as the infection became chronic. Lymphocytes of twelve chronically-infected patients responded positively to the antigen. In all patients the lymphocyte proliferative response to the mitogen, Concanavalill A (Con A) was normal. Analysis of Toxoplasma proliferative response of PBL from a patient with acute toxoplasrnosis showed that CD8+ cells were responsible for induction of suppression while the response during the chronic infection was lnediated by CD4+ cells. In human toxoplasmosis there was antigen-specific lymphocyte unresponsiveness during the acute phase of the infection and it appears that the initnunesuppression was mediated by CD8+ cells. KEYWORDS: Toxoplasmosis-lymphocyte blastogenesis-antigen specific-CD4+, CD8+
Problem-based learning (PBL) i s an educational reform that is now becoming a household word in higher education, particularly in medical schools. Many medical schools have implemented a full problem-based learning curriculum (PBLC) whiIe some have included PBL into selected units of the course in an otherwise conventional cumculum (embedded PBL) and others run their tutorials in a PBL manner within a modified conventional curriculum (hybrid curriculum). Yet there are others who claim that small components of PBL in a conventional curriculum are not PBL at all. Thus amateurs in the subject matter find difficulty in evaluating the logistics and outcome of these variations. This article focuses or, the general characteristics of PBL and how this learning method can help enhance independent learning and critical thinking, whether in a full, embedded or hybrid curriculum. The extent of PBL to be included and which of the three types is to be adopted depends on the objective of the undergraduate medical course as determined by the faculty, resources available, limitations, feedback on the existing curriculum and various other factors. KEYWORDS: Problem-based Learning (PBL); Embedded PBL; Hybrid PBL; New Integrated Curriculum (NIC).
The air pollution index (API) has been recognized as one of the important air quality indicators used to record the
correlation between air pollution and human health. The API information can help government agencies, policy makers
and individuals to prepare precautionary measures in order to eliminate the impact of air pollution episodes. This study
aimed to verify the monthly API trends at three different stations in Malaysia; industrial, residential and sub-urban areas.
The data collected between the year 2000 and 2009 was analyzed based on time series forecasting. Both classical and
modern methods namely seasonal autoregressive integrated moving average (SARIMA) and fuzzy time series (FTS) were
employed. The model developed was scrutinized by means of statistical performance of root mean square error (RMSE).
The results showed a good performance of SARIMA in two urban stations with 16% and 19.6% which was more satisfactory
compared to FTS; however, FTS performed better in suburban station with 25.9% which was more pleasing compared
to SARIMA methods. This result proved that classical method is compatible with the advanced forecasting techniques in
providing better forecasting accuracy. Both classical and modern methods have the ability to investigate and forecast
the API trends in which can be considered as an effective decision-making process in air quality policy.
Termites are found in various habitats, particularly diverse communities occurring in tropical forest and peatlands.
Termites are beneficial insects, which function as soil engineers, improving the soil quality. However, in peatlands
converted to commercial oil palm plantations, they are considered as pests. There is lack of studies on termite communities
in converted peatlands in Peninsular Malaysia. Thus, this study investigated termite species associated with oil palm
stands in three soil types (clay, shallow peat and deep peat) in Endau Rompin Plantation. The stand scouting method
was used to record the numbers and types of termites associated with palm trees in the individual stands on different
soil types. A total of 29 termite species associated with the palm stands were identified morphologically. All the species
belonged to the families Rhinotermitidae and Termitidae. Twenty-three of the 29 species were found in the shallow peat,
16 in clay soil and 15 in deep peat. The community structure was synthesized by two-way cluster analysis with Sorensen
(Bray Curtis) distance measure. Five termite groups associated with two soil types (clay soil and shallow/deep peat)
were generated. Moisture levels and organic content were likely to determine the presence of soil feeders identified in
the presence study. This study provides information on the status of termite species in oil palm plantation areas. Such
information may be useful in future planning strategies by the plantation management.
Fifty-seven accessions of torch ginger (Etlingera elatior) collected from seven states in Peninsular Malaysia were evaluated for their molecular characteristics using ISSR and SSR markers to assess the pattern of genetic diversity and association among the characteristics. Diversity study through molecular characterization showed that high variability existed among the 57 torch ginger accessions. ISSR and SSR molecular markers revealed the presence of high genetic variability among the torch ginger accessions. The combination of different molecular markers offered reliable and convincing information about the genetic diversity of torch ginger germplasm. This study found that SSR marker was more informative compared to ISSR marker in determination of gene diversity, polymorphic information content (PIC), and heterozygosity in this population. SSR also revealed high ability in evaluating diversity levels, genetic structure, and relationships of torch ginger due to their codominance and rich allelic diversity. High level of genetic diversity discovered by SSR markers showed the effectiveness of this marker to detect the polymorphism in this germplasm collection.
A survey was done to assess the chest radiographs of a selected group of immigrants. The objective is to ascertain the rpesence of abnormalities especially the presence of tuberculosis. Five hundred and eleven (511) chest radiographs (PA view) were evaluated. majority of the chest radiographs were normal, except for 2 cases of hilar lymphadenopathy, 4 cases of scoliosis and cervical rib, an old case of fracture of the clavicle and a case of cardiomegaly. Only 2 cases of TB were detected.
Euthanasia is one of the most controversial topics of the 21st century after cloning and genetic engineering. Has this issue arisen now due to changes in attitude and perception on life of the modem society? This project was undertaken to study the opinions of 2 selected groups of people and secondly, to highlight the legal, ethical and religious controversies on euthanasia. Two groups comprising medical undergraduates and medical personnel were given a questionnaire pertaining 10 his/her opinion and altitude towards euthanasia. The second part of the project was conducted via interviews. The overall opinion from 399 respondents showed that 67.91% are against the practice of euthanasia. Religion is a powerful force against it as Malaysians in general are God-fearing people. There should be proper guidelines explaining how a doctor should respond to patients or family members of patients who request for euthanasia to be performed. It is not legal in Malaysia, but the court has the inherent power to permit it should a particular case have substantial reasoning and evidence. In conclusion, the level of awareness on euthanasia among medical staff and undergraduates is satisfactory. However, most of them do not approve euthanasia in Malaysia.
Citation: Garispanduan pengendalian dan pengurusan rekod perubatan pesakit bagi hospital-hospital dan institusi perubatan. Putrajaya: Kementerian Kesihatan Malaysia; 2010
Translation:
Guideline on the handling and management of medical records for hospitals and medical institutions. Putrajaya: Ministry of Health, Malaysia; 2010
Achieving smoking cessation is an arduous process, where smokers try different methods or approaches to achieve cessation. Quit smoking attempts play an important role in smoking cessation.Thus, this study was conducted to determine the factors associated with attempt-to-quit smoking among the currentsmokers in Sarawak.This cross-sectional study was conducted among adult smokers in Sarikei, Sarawak by face-to-face interview using an adapted and validated questionnaire. Non-probability sampling method was used to select the study place. An adult smoker was selected systematically from each selected household. A total of 482 smoker households were identified with a response rate of 92.3%. Data was analysed using IBM SPSS Version 22.0. A p-value of <0.05 was considered statistically significant. The mean (SD) age of the smokers was 36.3(13.3) years. However, the mean (SD) age of smoking initiation was 18.5(4.8) years. Majority of the smokers were male (91.5%), with the male to female ratio being 1:0.1. Mean (SD) score on The Fagerström Test for Nicotine Dependence was 4.75(2.4), while motivation to quit smoking score was 3.04(1.0). Majority of the smokers (83.1%) hadever seen pictorial health warnings on cigarette packs. More than half of the smokers (54.8%) had ever tried to quit smoking. Binary logistic regression analysis revealed that marital status, religion, ethnicity, pictorial health warnings on cigarette packs and motivation to quit smoking appeared to be the significant predictors of attempt-to-quit smoking (p<0.05). Understanding the attempts to quit smoking will assist inclinical expectations. Thus, a smoking cessation programme should be designed in line with these factors, to aid quit smoking attempts.
Citation: Clinical Practice Guidelines: Screening of diabetic retinopathy. Putrajaya: Ministry of Health, Malaysia; 2011
Quick Reference: http://www.acadmed.org.my/view_file.cfm?fileid=489
Training Module: http://www.acadmed.org.my/view_file.cfm?fileid=470
Older version: Clinical Practice Guideline on diabetic retinopathy. Kuala Lumpur: Ministry of Health, Malaysia; 1997. ISBN: 983-9417-07-X
http://www.acadmed.org.my/view_file.cfm?fileid=229
BACKGROUND: Despite perennial sunshine, vitamin D deficiency is prevalent among Malaysians especially pregnant women. This study determines the vitamin D status and its associated factors among third trimester pregnant women attending government health clinics in Selangor and Kuala Lumpur, Malaysia.
METHODS: Information on socio-demographic characteristics, obstetrical history, and sun exposure were obtained through face-to-face interviews. Vitamin D intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). Serum 25-hydroxyvitamin D concentration was measured and classified as deficient (< 30 nmol/L), insufficient (30-50 nmol/L), and sufficient (≥ 50 nmol/L).
RESULTS: Of the 535 pregnant women recruited, 42.6% were vitamin D deficient. They consumed an average of 8.7 ± 6.7 μg of vitamin D daily. A total of 80.4% of the vitamin D were obtained from the food sources, while 19.6% were from dietary supplements. Fish and fish products showed the highest contribution to vitamin D intake (35.8%). The multivariable generalized linear mixed models, with clinic as a random effect, indicates that higher intake of vitamin D is associated with lower odds of vitamin D deficiency among pregnant women (OR = 0.96; 95% CI = 0.93-0.99). The odds of having vitamin D deficiency was reduced by 87% in non-Malays (OR = 0.14; 95% CI = 0.05-0.41) compared to Malays. No associations were found between age, educational level, monthly household income, work status, gravidity, parity, pre-pregnancy body mass index, total hours of sun exposure, total percentage of body surface area, and sun exposure index per day with vitamin D deficiency.
CONCLUSION: Vitamin D deficiency is prevalent among Malaysian pregnant women. Considering the possible adverse obstetric and fetal outcomes of vitamin D deficiency during pregnancy, future nutrition education should emphasise on vitamin D-fortified foods consumption among pregnant women by taking into consideration ethnic differences.
The majority of patients with upper gastrointestinal bleeding due to peptic ulcers stop bleeding spontaneously. The remainder of patients who have persistent or recurrent bleeding will require surgicaJ or endoscopic intervention. Medical therapy provides an attractive alternative to these two treatment options. The advent of H2 antagonists in the mid 19705 revolutionized the treatment of peptic ulcer disease as it provided good ulcer healing with a treatm.ent course of 6-8 weeks. A more potent acid suppressingdassof drugs: the proton-pump inhibitors (PPJ's) were introduced in the late 19805 and provided even better and faster ulcer healing. It was natural that the acid suppressing drugs were also used for the treatment of ulcer bleeding. Intravenous H2 antagonist and more recently intravenous PPJ's have routinely been prescribed in many hospitals as soon itS a bleeding patient is admitted. Critical evaluation of the literature shows, however, that H2 antagonists are no more effective than placebo in stopping ulcer bleeding. The prJ's, on the other hand, have been shown in several clinical studies to have a beneficial effect. The action of acid suppression in stopping ulcer bleeding is believed to be due to its effect in the stabilization of an ulcer clot by providing a high pH milieu and to commence the process of ulcer healing. KEYWORDS: Upper gastrointestinal bleed(UGIB), proton pump inhibitors(PPls), H2 antagonists