Indigenous populations of Malaysia known as Orang Asli (OA) show huge morphological, anthropological, and linguistic diversity. However, the genetic history of these populations remained obscure. We performed a high-density array genotyping using over 2 million single nucleotide polymorphisms in three major groups of Negrito, Senoi, and Proto-Malay. Structural analyses indicated that although all OA groups are genetically closest to East Asian (EA) populations, they are substantially distinct. We identified a genetic affinity between Andamanese and Malaysian Negritos which may suggest an ancient link between these two groups. We also showed that Senoi and Proto-Malay may be admixtures between Negrito and EA populations. Formal admixture tests provided evidence of gene flow between Austro-Asiatic-speaking OAs and populations from Southeast Asia (SEA) and South China which suggest a widespread presence of these people in SEA before Austronesian expansion. Elevated linkage disequilibrium (LD) and enriched homozygosity found in OAs reflect isolation and bottlenecks experienced. Estimates based on Ne and LD indicated that these populations diverged from East Asians during the late Pleistocene (14.5 to 8 KYA). The continuum in divergence time from Negritos to Senoi and Proto-Malay in combination with ancestral markers provides evidences of multiple waves of migration into SEA starting with the first Out-of-Africa dispersals followed by Early Train and subsequent Austronesian expansions.
The purpose of this research is to analyse the relationship between nonlinear dynamic character and individuals' standing balance by the largest Lyapunov exponent, which is regarded as a metric for assessing standing balance. According to previous study, the largest Lyapunov exponent from centre of pressure time series could not well quantify the human balance ability. In this research, two improvements were made. Firstly, an external stimulus was applied to feet in the form of continuous horizontal sinusoidal motion by a moving platform. Secondly, a multiaccelerometer subsystem was adopted. Twenty healthy volunteers participated in this experiment. A new metric, coordinated largest Lyapunov exponent was proposed, which reflected the relationship of body segments by integrating multidimensional largest Lyapunov exponent values. By using this metric in actual standing performance under sinusoidal stimulus, an obvious relationship between the new metric and the actual balance ability was found in the majority of the subjects. These results show that the sinusoidal stimulus can make human balance characteristics more obvious, which is beneficial to assess balance, and balance is determined by the ability of coordinating all body segments.
Vertigo and dizziness are two common symptoms seen in everyday practice. However, in some cases, making a diagnosis can be challenging. This case report shows the relevance of a careful psychiatric history, which led to the diagnosis of chronic subjective dizziness associated with bilateral peripheral vestibulopathy.
Presently, there is increased in research on job strain and the effects of religiosity on employee well-being. Despite increased recognition of religiosity as a moderator of well-being, limited research has focused on Islamic perspective of moderating job strain. This study examines the moderating effects of Islamic personal religiosity on the relationship between job strain and employee well-being in Malaysian universities. One hundred and seventeen (117) Muslim academic and administrative staff from four public universities were sampled. Data were collected via questionnaires, and our findings show that the effect of job strain on well-being is significant for employees and that personal religiosity of employees contributed to alleviating job strain and enhancing well-being. Thus, the study concludes that Islamic personal religiosity moderates the relationship between job strain and employee well-being.
AIM: This systematic review investigated the oral health status of children with type 1 diabetes.
METHODS: A systematic search was conducted using PubMed/Medline, Web of Knowledge, SCOPUS and EMBASE. The search included all studies published from inception of database to January 2014. A total of 1179 abstracts were analyzed for selection in 2 phases. The first phase selection was based on the title and abstracts alone. The selected abstracts were then included for second phase, where full articles were obtained. The selection was carried out by 2 independent reviewers (Kappa value=0.809). Only 37 articles were included for final analysis in this review.
RESULTS: There is conflicting evidence in the caries experience between children with type 1 diabetes and healthy children. For periodontal health, most studies reported significantly greater plaque accumulation and higher gingival index in children with type 1 diabetes. Cohort studies reported no significant differences in perioodontal parameters over time.
CONCLUSIONS: There is conflicting evidence regarding the caries experience of children with type 1 diabetes, but they exhibit poorer periodontal health status with greater plaque accumulation compared to healthy children. Further studies are warranted to assess the oral health status of children with type 1 diabetes.
KEYWORDS: Caries; Children; Oral health; Periodontal health; Systematic review; Type 1 diabetes
Social support is an essential component for the physical and emotional well-being of postpartum mothers. The objective of this study is to determine the psychometric properties of the revised Malay version Medical Outcome Study (MOS) Social Support Survey using a confirmatory validity approach.
Surgery for Killian-Jamieson diverticulum of the esophagus is scarcely reported in the literature owing to the rarity of this entity. This is a case report of such a diverticulum and a description of the transcervical diverticulectomy that we performed on a 49-year-old lady. The patient was investigated for symptoms of gastroesophageal reflux disease and was diagnosed with a left-sided Killian-Jamieson diverticulum.
A nonconsanguineous asymptomatic couple, were identified as carriers of factor VII (FVII) deficiency when two of their newborn children died of massive intracranial hemorrhage secondary to severe congenital FVII deficiency. Complete sequence analysis of the factor VII (F7) gene in this couple indicated that the mother was heterozygous for an A to G transition at position -2 of the exon 5 acceptor splice site, and the father was heterozygous for a G to T transversion at position +1 of the exon 6 donor splice site. This information allowed us to exclude a compound heterozygous deficiency state in a subsequent pregnancy using PCR/direct sequencing of the F7 gene using DNA obtained from chorionic villi at 10 weeks' gestation. Our experience with the family reported here further supports the conclusion that mutation-specific detection is reliable in the prenatal exclusion of severe bleeding disorders.
Although the incidence of complications of otitis media that require surgical interventions has decreased substantially over the past few years, it is a prevailing condition for which clinicians should remain vigilant.
A cross sectional descriptive study on breast feeding practices in an urban clinic was conducted among 136 mothers aged between 21-49 years who were interviewed using a questionnaire. Malays constituted 61% of the respondents, Chinese 22.8% and Indians 16.2%. Mojority of these were working mothers and although the initiation of breastfeeding was high (99.3%), exclusive breastfeeding was only 12.5%. A large proportion (33.8%) dtopped prior to 3 months. Majority of the Chinese mothers (61.3%) stipped before 3 months as compared to the Indian (40.9%) and Malay (21.7%) mothers (p<0.001). Mean age of introducing complementary foods at 3 months is below the accepted age of 4 to 6 months for weaning. Ever-breast feeding rate is high in this urban setting but more efforts are needed to effect a higher rate of exclusive breastfeeding and longer duration of breastfeeding.
Ewing's sarcoma is a rare malignant tumor of the foot in children. We report a case of Ewing's sarcoma of the talus in a four-year-old Chinese girl to highlight the initial difficulty in diagnosis and the clinical course of the disease. She was initially diagnosed as osteomyelitis of the talus and died eight months after presentation with pleural and spinal metastases. To the best of our knowledge, Ewing's sarcoma of the talus in a young child has never been reported in Malaysia.
Thirty-two children with femoral shaft fractures were treated conservatively with initial skin traction followed by an additional period in a spica cast. After 12 to 20 months of follow up, none had any pain and all of them were attending school without problems. Shortening of more than 2 cm occurred in 6 (19%) of the 32 patients. The most important factor associated with shortening was an overlap of more than 2 cm of shortening of the fracture ends at the time of cast fitting. The average compensatory overgrowth at final assessment was 7 mm. Angular deformity did not pose a problem. This is a safe, simple and practical method to treat childhood femoral shaft fractures.
It is usually a major task providing soft tissue cover to significant defects of the lower leg. A wide variety of flaps and techniques are available, each with its advantages and limitations. Previously described anatomic study of the septocutaneous vessels of the leg have indicated a consistent lower most perforator at 9-12 cm from the tip of the medial malleolus. An island fasciocutaneous flap based on this perforator vessels can be raised subfascially. After the vessels have been dissected clean down to the posterior tibial artery, it can be rotated up to 180 degrees degrees. Successful soft tissue reconstruction was achieved in 18 patients. Most of the tissue loss was due to trauma and were around the ankle and the heel. There were 7 minor complications which resolved completely after 2 months. Its simplicity of design and elevation plus its extensive arc of rotation makes it a reliable and versatile flap in the reconstruction of lower leg defects.
Thirty-eight tibial plateau fractures were treated with open reduction and internal fixation. The fractures were classified into six groups (Hohl's 1991 Classification) and the clinical results were evaluated using the Rasmussen (1973) criteria. The average follow-up period was 2.07 years. Overall there was one excellent, thirty-four (34) good, three fair and no poor results. In three patients with less than a good score there were other associated ipsilateral injuries and delayed mobilisation of the knee joint. There was no direct association between the type of internal fixation and the end result.
Heat stroke, which is also known as "sun stroke," is a medical emergency, and fatalities can occur unless it is diagnosed early and treated efficiently. Heat stroke may manifest quite suddenly, giving little time to differentiate it from extreme physical exhaustion in collapsed subjects. It is also known to lead to serious disseminated intravascular coagulation. Sudden death in a young female is presented who collapsed after trekking in a hilly, jungle area in Malaysia on a warm, humid day. She had joined a weight reduction programme a few weeks earlier. She was found collapsed and in a semiconscious state in the jungle by her groupmates and was taken to hospital. On admission she was unconscious, hyperpyrexic, with rapid, thready pulse and a low blood pressure. Biochemical studies revealed metabolic acidosis, elevated liver and cardiac enzymes and impairment of renal function. Her coagulation profile was found to be impaired and she started bleeding through the mouth and nostrils. She also developed watery diarrhoea and initially a septicaemic condition, including acute enteritis was suspected. Despite active treatment, her condition deteriorated and she died eight hours after admission. Autopsy confirmed a generalised bleeding tendency, with pulmonary, oesophageal and gastrointestinal mucosal haemorrhages. Flame-shaped subendocardial shock haemorrhages were seen in the interventricular septum on the left side of the heart. The findings support a diagnosis of heat stroke. Various aspects related to heat stroke, the autopsy diagnosis and its prevention are discussed.
Since its recognition about 150 years ago, there has been much progress in the understanding of the pathogenesis, prevention, early detection and management of carcinoma of the uterine cervix. Important historical landmarks include the (1) recognition of pre-invasive and pre-clinical lesions, and the devise of various systems for reporting these lesions, (2) improvements in diagnostic techniques particularly colposcopy, (3) advent of therapeutic procedures (electrocoagulation, cryotherapy, laser therapy and loop electrosurgical excision), and (4) recognition of the aetiological relationship between the human papillomavirus and cervical neoplasia. The susceptibility of the cervical transformation zone to malignant change is now well recognised. The WHO classification system remains the one most commonly utilised for histological reporting of cervical cancers. In the recent 1994 update, cervical carcinoma is divided into 3 main categories: squamous cell carcinoma, adenocarcinoma and other epithelial tumours. Squamous cell carcinoma (60-80%) predominates among invasive cervical carcinoma. Recognised variants include verrucous, warty (condylomatous), papillary squamous (transitional) and lymphoepithelioma-like carcinoma. Adenocarcinoma (5-15% of invasive carcinomas) shows an increasing trend in young females. Like its squamous counterpart, preinvasive and microinvasive versions are known. Variants such as mucinous, endometrioid, clear cell, mesonephric, serous, villoglandular and minimal deviation carcinoma are now defined. Adenosquamous carcinoma (5-25%), adenoid-cystic, adenoid-basal, neuroendocrine and undifferentiated carcinomas constitute other epithelial tumours of the cervix. The management of invasive cervical carcinoma remains heavily dependent on its stage. The FIGO staging system remains the most widely used. The 1995 update provides more definite criteria in subdividing stage IA tumours by delimiting stromal invasion of stage IA1 lesions to a maximum depth of 3 mm and a horizontal axis of 7 mm. In Malaysia, an appreciation of the cervical carcinoma problem has to take into consideration the population at risk, its multi-ethnicity, its socio-economic and geographical diversities and the constraints of the health care system. Females form 48.9% of the Malaysian population. 52.9% of them are in the sexually active age group of 15-50 years, indicating a significant population at risk for cervical carcinoma. Cervical carcinoma was the third most common cause of death due to solid tumours among Malaysian females in 1995 following carcinoma of the breast and respiratory tract. East Malaysia is predominantly rural with many communities having limited modern facilities. Such areas imply a lower educational and socio-economic status, raising the worry of a population at higher risk for developing cervical carcinoma. The population: doctor for Malaysia of 2153:1 compares poorly with nearby Singapore. Besides a shortage of doctors, there is also an uneven distribution of doctors, resulting in a ratio in East Malaysia of > 4000:1. Although Malaysia does not have a national cervical cancer-screening programme, many action plans and cancer awareness campaigns have been launched throughout the years, which appear to have made an impact as evidenced by the decreasing mortality rates from cervical carcinoma. Another interesting feature of cervical carcinoma in Malaysia relates to its multiethnic population. In Malaysian Chinese and Malay females, the prevalence of cervical carcinoma ranks second to breast cancer whereas the pattern is reversed in Malaysian Indian females. Studies into its aetiology and pathogenesis are being undertaken and may shed more light on this matter.
144 placentas were sampled from all cases of stillbirth weighing 500 g and above seen over a period of thirteen months in the UKM Unit of the Maternity Hospital, Kuala Lumpur. Sampling was limited to 1-3 blocks per placenta for histological study. Placental abnormalities were found in 121 (85%) placentas, 78 of which had definite lesions known to contribute to foetal death while the remainder showed lesions suggestive of an underlying disease. This study supports the usefulness of limited sampling of the placenta in the face of unavailability of complete placental examination and autopsy for assessment of the cause of stillbirth.
A rare case of primary squamous cell carcinoma of the thyroid is reported herein. A 64-year-old Malay lady presented with a gradually enlarging thyroid nodule for the past 6 months and underwent total thyroidectomy. Histopathology revealed a squamous cell carcinoma of the thyroid with complete resection. Possible primary tumour elsewhere was excluded. Postoperative irradiation was given and patient is still alive after 2 years of follow-up.
We report on the case of a 38-year-old Malay housewife diagnosed with conversion disorder. It was believed that 'evil spirits' caused her symptoms. The patient was eventually treated by the Main Puteri, a Malay shamanistic healing ceremony, after previous treatments failed. The patient improved on the third day of the performance, which was attributed to the departure of the spirits from her body. This case documents the potential benefits of indigenous psychotherapy.