OBJECTIVE: Non-adherence is a serious issue among the participants in pulmonary rehabilitation program (PRP). Till date, no clinical tool is available to screen participants who will show poor adherence towards PRP. This study aimed to develop and validate a tool called "Adherence to Pulmonary Rehabilitation Questionnaire (APRQ)", a self-administered questionnaire to screen the risk of non-adherence to PRP among the patients with chronic obstructive pulmonary disease. APRQ comprises of 6 main constructs such as disease management behaviour, perceived treatment benefits, emotional factors, perceived severity of disease, barriers towards treatment and coping attitude.
MATERIALS AND METHODS: This was a preliminary validity study carried out in the physiotherapy department and respiratory clinic in an university teaching hospital. A total of 109 patients with average age of 58.8 ± 1 year participated in the study. The inclusion criteria for subjects were: patients diagnosed with chronic obstructive pulmonary diseases (COPD) (Stage II and III). Exclusion criteria include those COPD patients with mental problems and disabled patients. The tool was developed based on thematic analysis and in-depth interview with focus group and literature search on the factors that lead to non-adherence among the PRP's participants. Principal component analysis was carried out to examine the construct validity and content validity of APRQ.
RESULTS: A total of 20 items were created under 6 constructs. However, 2 items (smoking and hospital admission) were eliminated due to poor correlations. Thus, the final version of APRQ was developed and validated with 18 items. Reliability was measured using internal consistency and achieved Cronbach's Alpha of 0.762.
CONCLUSIONS: The findings from this preliminary study supports that APRQ may be a valid and reliable tool to screen adherence towards PRP among chronic lung disease patients.
Study site: Respiratory clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
ABO incompatibility and glucose-6-phosphate dehydrogenase deficiency G6PD are common haematological problems affecting the newborn. The resulting haemolytic disease of foetus and newborn (HDFN) caused by either of these pathologies generally follows a benign course. It is typically characterized by mild jaundice without significant anaemia. ABO incompatibility alone as a cause of foetal hydrops is extremely rare. We report a case of a newborn baby girl with an anti-B isoimmunisation and G6PD deficiency manifesting with hydrops foetalis, anaemia and hyperbilirubinaemia, born to a mother with blood group O.
A new species of cave crab, Stygothelphusa antu new species, is described from limestone formations in Temurang, Sarawak, Malaysia. The new species is the most highly adapted to a cavericolous lifestyle among the four known species of Stygothelphusa, having a pale body pigmentation, reduced eyes and elongated pereopods. In contrast, the other three species have normal eyes that almost completely fill the orbits. The new species also differs from its congeners by a number of carapace, pereopod and gonopod characters.
Two new black fly species, Simulium (Gomphostilbia) tekamense and Simulium (Gomphostilbia) jerantutense, are described based on adult females emerged from pupae in Peninsular Malaysia, and assigned to the binuanense subgroup of the batoense species-group in the subgenus Gomphostilbia. Simulium (G.) tekamense sp. nov. is characterized in the female by the subcosta with 0-2 hairs, and presence of a deep notch on the apex of the mediolongitudinal ridge of the cibarium, and in the pupa by one of two paired gill filaments of the middle triplet much thicker than the counter filament. Simulium (G.) jerantutense sp. nov. is characterized in the female by the short claw tooth 0.46 times the length of the claw, and in the pupa by the gill filaments arranged as [2+1+(1+2)]+2 filaments from dorsal to ventral. Taxonomic notes are given to distinguish these new species from related species.
Cyrtodactylus metropolis sp. nov. from Batu Caves massif, Selangor, Peninsular Malaysia is differentiated from all congeners by having a unique suite of morphological and color pattern characteristics. Remarkably, this species has been overlooked despite a plethora of field studies at Batu Caves from 1898 to the present and no specimens had ever been examined until now. As with all other limestone forest-adapted Cyrtodactylus in Peninsular Malaysia, C. metropolis sp. nov. is not a cave-adapted species but is far more common on the exterior surfaces of the Batu Caves limestone massif and its surrounding limestone vegetation. We suggest that researchers devote time exploring the exterior surfaces of limestone massifs as well the interiors of their caves.
The extent of industrial trans fatty acids (TFA) in the food supply is unknown in Malaysia, whilst TFA disclosure on food labels is not mandatory by Malaysian food standards. Supermarket foods such as dairy products, fats and oils, meat products, snack foods, soups, and confectionery are commonly cited to be major contributors of TFA in the diet. A consumer survey (n = 622) was used to develop a food listing of these 'high risk' foods. TFA content of high-risk foods were analysed by gas chromatography. Food samples (n = 158) were analysed and their total TFA content were compared with Malaysian Food Standards. A wide variation in TFA content within food categories was indicated. Of the foods containing TFA, many food labels did not cite TFA content or the use of partially hydrogenated vegetable oils (PHVO) as an ingredient. Hypothesised estimates of TFA intake from these supermarket foods in a sample day's menu providing 2000 kcal projected a minimum intake of 0.5 g and a maximum intake of 5.2 g TFA. This study found there was no voluntary disclosure of TFA content on food labels or identifying PHVO as an ingredient. It appears that health education targeting consumers to minimise TFA consumption is required supported by mandatory PHVO disclosure on the food label.
A complex HIV-1 unique recombinant form involving subtypes CRF01_AE, B, and B' was recently identified from an injecting drug user in Malaysia. A total of 13 recombination breakpoints were mapped across the near-full-length genome of isolate 10MYPR226, indicating the increasingly diverse molecular epidemiology and frequent linkage among various high-risk groups.
In the past two decades, Fusarium species have been increasingly recognized as serious pathogens in immunocompromised patients. The outcome of fusariosis in the context of severe persistent neutropaenia has been almost universally fatal. The treatment of fusariosis in immunocompromised patients remains a challenge and the prognosis of systemic fusariosis in this population remains poor. This report presents a case of fatal fusariosis in a 37- year-old patient who was diagnosed with precursor-B cell Acute Lymphoblastic Leukaemia (ALL).
A new species of Leptolalax is described from Kinabalu National Park in western Sabah, Malaysian Borneo. The new species had been assigned to L. dringi, L. gracilis, or L. fritinniens in the past. It differs from all congeners, including these species, by a unique combination of morphological characters, including small body size, rounded snout, narrower interorbital than upper eyelid, basal toe webbing, smooth skin with tiny tubercles on dorsum and dorsal side of head, small pectoral glands, absence of supraaxillary glands and ventrolateral glandular ridges, spotted venter, advertisement call consisting of long series of 1-149 notes, each composed of three or four pulses, and dominant frequency at 6.90-7.35 kHz, without prominent frequency modulation.
Since 1992, surveillance for acute flaccid paralysis (AFP) cases was introduced in Malaysia along with the establishment of the National Poliovirus Laboratory at the Institute for Medical Research. In 2008, the Ministry of Health, Malaysia, approved a vaccine policy change from oral polio vaccine to inactivated polio vaccine (IPV). Eight states started using IPV in the Expanded Immunization Programme, followed by the remaining states in January 2010. The objective of this study was to determine the viral aetiology of AFP cases below 15 years of age, before and after vaccine policy change from oral polio vaccine to inactivated polio vaccine. One hundred and seventy-nine enteroviruses were isolated from the 3394 stool specimens investigated between 1992 and December 2012. Fifty-six out of 107 virus isolates were polioviruses and the remaining were non-polio enteroviruses. Since 2009 after the sequential introduction of IPV in the childhood immunization programme, no Sabin polioviruses were isolated from AFP cases. In 2012, the laboratory AFP surveillance was supplemented with environmental surveillance with sewage sampling. Thirteen Sabin polioviruses were also isolated from sewage in the same year, but no vaccine-derived poliovirus was detected during this period.
Brachial plexopathy is usually related to trauma like direct injury to the nerve and stretching injuries. Neurological complications following bee sting are uncommon. Here, we describe a rare case of acute brachial plexopathy as a neurological complication following bee sting. A23-year-old maleinitially presented with angioedema and anaphylactic shock one hour after a bee stung at his neck. Twenty four hours after the incidence, he presented with sudden onset of left upper limb weakness. Nerve conduction study and electromyography had shown evidence of left brachial plexopathy.
Tropical agriculture is expanding rapidly at the expense of forest, driving a global extinction crisis. How to create agricultural landscapes that minimise the clearance of forest and maximise sustainability is thus a key issue. One possibility is protecting natural forest within or adjacent to crop monocultures to harness important ecosystem services provided by biodiversity spill-over that may facilitate production. Yet this contrasts with the conflicting potential that the retention of forest exports dis-services, such as agricultural pests. We focus on oil palm and obtained yields from 499 plantation parcels spanning a total of ≈23,000 ha of oil palm plantation in Sabah, Malaysian Borneo. We investigate the relationship between the extent and proximity of both contiguous and fragmented dipterocarp forest cover and oil palm yield, controlling for variation in oil palm age and for environmental heterogeneity by incorporating proximity to non-native forestry plantations, other oil palm plantations, and large rivers, elevation and soil type in our models. The extent of forest cover and proximity to dipterocarp forest were not significant predictors of oil palm yield. Similarly, proximity to large rivers and other oil palm plantations, as well as soil type had no significant effect. Instead, lower elevation and closer proximity to forestry plantations had significant positive impacts on oil palm yield. These findings suggest that if dipterocarp forests are exporting ecosystem service benefits or ecosystem dis-services, that the net effect on yield is neutral. There is thus no evidence to support arguments that forest should be retained within or adjacent to oil palm monocultures for the provision of ecosystem services that benefit yield. We urge for more nuanced assessments of the impacts of forest and biodiversity on yields in crop monocultures to better understand their role in sustainable agriculture.
BACKGROUND: Children with chronic illness may have depressive symptoms. The purpose of this study was to determine the prevalence of depressive symptoms among children attending a pediatric gastroenterology outpatient clinic in Malaysia, and whether it differed by age, gender and diagnosis.
METHODS: This was a cross-sectional study, with data collected over a 16 month period (April 2010-July 2011). Patients aged 7-17 years on follow up at the pediatric gastroenterology clinic at University Malaya Medical Centre, Kuala Lumpur, were recruited consecutively. They were classified into high, average and low scores based on responses to questions in the Children's Depression Inventory (CDI; high, T-score >55; average, T-score 45-55; low, T-score <45). Children with high scores were considered to have depressive symptoms.
RESULTS: The response rate was 93%. One hundred children (44 boys; 56 girls) were studied. Major diagnoses were: functional abdominal pain (n = 22), inflammatory bowel disease (n = 26), biliary atresia (n = 17) and miscellaneous gastrointestinal conditions (n = 35). The overall prevalence of high CDI for depressive symptoms was 27.0%, while 43.0% and 30.0% had average and low scores, respectively. There were no significant differences in the prevalence of high scores among children with different diagnoses.
CONCLUSIONS: Depressive symptoms were common among children attending a pediatric gastroenterology clinic. It is important to recognize symptoms of depression in children with gastrointestinal disorders.
KEYWORDS: Children's Depression Inventory; depression; gastrointestinal disorders; outpatient; pediatric
Study site: Pediatric gastroenterology clinic, University Malaya Medical Centre (UMMC)
Three species of otter can be found throughout Malay Peninsula: Aonyx cinereus, Lutra sumatrana, and Lutrogale perspicillata. In this study, we focused on the A. cinereus population that ranges from the southern and the east coast to the northern regions of Malay Peninsula up to southern Thailand to review the relationships between the populations based on the mitochondrial D-loop region. Forty-eight samples from six populations were recognized as Johor, Perak, Terengganu, Kelantan, Ranong, and Thale Noi. Among the 48 samples, 33 were identified as A. cinereus, seven as L. sumatrana, and eight as L. perspicillata. Phylogenetically, two subclades formed for A. cinereus. The first subclade grouped all Malay Peninsula samples except for samples from Kelantan, and the second subclade grouped Kelantan samples with Thai sample. Genetic distance analysis supported the close relationships between Thai and Kelantan samples compared to the samples from Terengganu and the other Malaysian states. A minimum-spanning network showed that Kelantan and Thailand formed a haplogroup distinct from the other populations. Our results show that Thai subspecies A. cinereus may have migrated to Kelantan from Thai mainland. We also suggest the classification of a new subspecies from Malay Peninsula, the small-clawed otter named A. cinereus kecilensis.
This study sought to explore the impact of Malaysian nurses' perceptions, knowledge and experiences in preterm infant skin care practices using a descriptive approach. Questionnaires were distributed to Neonatal Intensive Care Unit (NICU) nurses in one teaching hospital in Malaysia. A knowledge gap was revealed among nurses in both theoretical and practical knowledge of preterm infant skin. Nurses working for more than 5 years in NICU or having a Neonatal Nursing Certificate (NNC) were not predictors of having adequate knowledge of preterm infants' skin care. The results highlight the complex issue of providing effective skin care to preterm infants. However, a specific finding related to nurses' confidence provides some direction for future practice and research initiatives. Clear clinical evidence-based guidelines and Continuing Nursing Education on relevant topics of preterm infants' care may provide the required knowledge for the nurses.
INTRODUCTION: The Three-Factor Eating Questionnaire was first constructed to measure eating behavior in an English population in the United States. It has been validated and translated for various populations in different languages. The aim of this article is to describe a systematic process for translating the questionnaire from English to Malay language.
METHODOLOGY: The report of the International Society for Pharmacoeconomics and Outcome Research (ISPOR) Task Force was used as the basis for the systematic translation process. The process began with preparation; followed by forward translation (2 independent translators), reconciliation, back translation (2 independent translators), back translation review, harmonization, cognitive debriefing, review of cognitive debriefing results and finalization, proofreading; and ended with the final report. Four independent Malay translators who fluent in English and reside in Malaysia were involved in the process. A team of health care researchers had assisted the review of the new translated questionnaires.
RESULTS: Majority of the TFEQ-R21 items were experiencing, conceptually and semantically equivalence between original English and translated English. However, certain phrase such as "feels like bottomless pit" was difficult to translate by forward translators. Cognitive debriefing was a very helpful process to ensure the TFEQ-R21 Malay version was appropriate in term of wording and culturally accepted. A total of four redundant comments in regards to response scale wording, word confusion and wording arrangement.
CONCLUSION: The systematic translation process is a way to reduce the linguistic discrepancies between the English and Malay language in order to promote equivalence and culturally adapted TFEQ-R21 questionnaire.
OBJECTIVES: To determine the prevalence of aspirin resistance and associated risk factors based on biochemical parameters using whole blood multiple electrode aggregometry.
METHODS: The study was conducted at the outpatients cardiology clinic of the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from August 2011 to February 2012. Subjects on aspirin therapy were divided into two groups; first-ever coronary event and recurrent coronary event. Aspirin resistance was measured by a Multiplate(®) platelet analyser.
RESULTS: A total of 74 patients (63 male, 11 female), with a mean age of 57.93 ± 74.1years were enrolled in the study. The patients were divided into two groups -first-ever coronary event group (n=52) and recurrent coronary event group (n=22). Aspirin resistance was observed in 12 out of 74 (16%) of the study patients, which consisted of 11 patients from the first-ever coronary event group and one patient from the recurrent coronary event group. There were significant correlations between aspirin resistance and age (r = -0.627; p = 0.029), total cholesterol (r = 0.608; p = 0.036) and LDL (r = 0.694; p = 0.012). LDL was the main predictor for area under the curve (AUC) for aspirin resistance. However, there was no association between aspirin resistance and cardiovascular events in both groups in this study.
CONCLUSIONS: Aspirin resistance was observed in 16% of the study population. LDL was the major predictor of aspirin resistance. No association was found in the study between aspirin resistance with recurrent coronary events.
KEYWORDS: Aspirin resistance; Multiplate® platelet analyser; aspirin responsiveness; first-ever coronary event; recurrent coronary event