BACKGROUND: Journal advertising is used by pharmaceutical companies to disseminate medicine information to doctors. The quality of claims, references and the presentation of risk results in Australia and the US has been questioned in several studies. No recent evidence is available on the quality of claims, references and the presentation of risk results in journal advertising in Australia and the US and no Malaysian data have been published. The aim of this study was to compare the quality of claims, references and the presentation of risk results in journal advertising in these three countries.
METHODS: A consecutive sample of 85 unique advertisements from each country was selected from journal advertising published between January 2004 to December 2006. Claims, references and the presentation of risk results in medical journal advertising were compared between the three countries.
RESULTS: Less than one-third of the claims were unambiguous claims (Australia, 30%, Malaysia 17%, US, 23%). In Malaysia significantly less unambiguous claims were provided than in Australia and the US (P < 0.001). However, the unambiguous claims were supported by more references than other claims (80%). Most evidence was obtained from at least one randomized controlled trial, a systematic review or meta-analysis (Australia, 84%, Malaysia, 81%, US, 76%) with journal articles being the most commonly cited references in all countries. Data on file were significantly more likely to be cited in the US (17%) than in Australia (2%) and Malaysia (4%) (P < 0.001). Advertisements that provided quantitative information reported risk results exclusively as a relative risk reduction.
CONCLUSIONS: The majority of claims were vague suggesting poor quality of claims in journal advertising in these three countries. Evidence from a randomized controlled trial, systematic review or meta- analysis was commonly cited to support claims. However, the more frequent use of data that have not been published and independently reviewed in the US compared to Australia and Malaysia raises questions on the quality of references in the US. The use of relative rather than absolute benefits may overemphasize the benefit of medicines which may leave doctors susceptible to misinterpreting information.
Agricultural waste, such as sago waste (SW), is one of the sources of pollution to streams and rivers in Sarawak, particularly those situated near sago processing plants. In addition, unbalanced and excessive use of chemical fertilizers can cause soil and water pollution. Humic substances can be used as organic fertilizers, which reduce pollution. The objectives of this study were to produce K- and ammonium-based organic fertilizer from composted SW and to determine the efficiency of the organic-based fertilizer produced. Humic substances were isolated using standard procedures. Liquid fertilizers were formulated except for T2 (NPK fertilizer), which was in solid form. There were six treatments with three replications. Organic fertilizers were applied to soil in pots on the 10th day after sowing (DAS), but on the 28th DAS, only plants of T2 were fertilized. The plant samples were harvested on the 57th DAS during the tassel stage. The dry matter of plant parts (leaves, stems, and roots) were determined and analyzed for N, P, and K using standard procedures. Soil of every treatment was also analyzed for exchangeable K, Ca, Mg, and Na, organic matter, organic carbon, available P, pH, total N, P, nitrate and ammonium contents using standard procedures. Treatments with humin (T5 and T6) showed remarkable results on dry matter production; N, P, and K contents; their uptake; as well as their use efficiency by maize. The inclusion of humin might have loosened the soil and increased the soil porosity, hence the better growth of the plants. Humin plus inorganic fertilizer provided additional nutrients for the plants. The addition of inorganic fertilizer into compost is a combination of quick and slow release sources, which supplies N throughout the crop growth period. Common fertilization by surface application of T2 without any additives (acidic and high CEC materials) causes N and K to be easily lost. High Ca in the soil may have reacted with phosphate from fertilizer to form Ca phosphate, an insoluble compound of phosphate that is generally not available to plants, especially roots. Mixing soil with humin produced from composted SW before application of fertilizers (T5 and T6) significantly increased maize dry matter production and nutrient use efficiency. Additionally, this practice does not only improve N, P, and K use efficiency, but it also helps to reduce the use of N-, P-, and K-based fertilizers by 50%.
This study sought to determine the strategies, methods and frequency of oral care provided for mechanically ventilated patients in Malaysian intensive care units. The study also described nurses' attitudes to providing oral care and their knowledge of the mode of transmission of ventilator-associated pneumonia.
Although nasopharyngeal carcinoma (NPC) is common in this part of the world, the incidence among children is still very low worldwide. The diagnosis is sometimes delayed because of the late reporting of the symptom by the patient or parents, or difficulty in reaching the final diagnosis due to its hidden anatomical location. The challenges include the difficult endoscopy in children, inability to differentiate an adenoid from the tumour on radiograph and often the inconclusive fine needle aspiration findings. If the tumour mass at Fossa of Rosenmuller can be clearly appreciated and biopsied with undoubtedly proven histology of NPC, the diagnosis can be straight forward and treatment can be commenced as early as possible. We report a 10-year-old child presented with bilateral neck cervical lymphadenopathy and epistaxis with fine needle aspiration cytology (FNAC) of the neck mass reported as lymphoma. Further work-up confirmed he was suffering from NPC.
PURPOSE: A survey on new Malaysian drivers was conducted in Malaysia between year 2006-2009. The objective of this study was to look at the effectiveness of the present computerized visual screening tool and to compare it with the conventional testing method.
METHODS: A total of 3717 drivers aged 19±6 years, who had passed in the computerized visual screening, participated in this study.
RESULTS: 250 subjects achieved less than 0.3 LogMAR with their best eye and 83 subjects failed the Ishihara Test after retested using the conventional tool.
CONCLUSION: These finding showed the computerized visual screening test failed to filter some subjects according to the standards set.
KEYWORDS: Visual acuity; colour vision; driving; vision
Delirium in the elderly is a challenging and under-recognized problem in the community. Early detection and management improves outcomes and quality of life for the elders with delirium at home.1 Family physicians (FP) play a key role in the assessments, early identification, and management of delirium and in the support and education of patients and their family caregivers.1 Clinical analysis of this case illustrates the bio-psychosocial spiritual model of approach to management of delirium in an elderly patient in the home setting.
Speech-language pathologists (SLPs) practising in Malaysia face similar dilemmas as their counterparts in more developed countries when it comes to deciding on discharge/termination of services for their patients. Furthermore, discharge dilemmas appear to be a frequent and inevitable part of their everyday practice. In an interview conducted for the purpose of this paper, it was clear that many SLPs found it difficult to articulate or justify the process they took to reach a decision on whether or not to terminate their services or discharge their patients. Much of the difficulty is anchored on the need to be realistic and function within the confines of limited resources. Malaysian SLPs were aware of the ideals that had to be abandoned along the way but had not allowed guilt to dissuade or discourage them from providing what they perceived as the next best available service. The not-so ideal decisions made by these SLPs may be frowned upon by international standards but must be examined within the local historical perspective of the development of the SLP profession in Malaysia. The dilemma will continue until the country produces SLPs in sufficient numbers but the profession is reminded that less-than-ideal practices may perpetuate over time into unhealthy traditions that will require major efforts to be undone.
Volatile oils of Aquilaria malaccensis Benth. (Thymelaeaceae) from Malaysia were obtained by hydrodistillation and subjected to detailed GC-FID and GC/MS analyses to determine possible similarities and differences in their chemical composition in comparison with the commercial oil. A total of thirty-one compounds were identified compared with twenty-nine identified in the commercial oil. The major compounds identified were 4-phenyl-2-butanone (32.1%), jinkoh-eremol (6.5%) and alpha-guaiene (5.8%), while the major compounds in the commercial oil were alpha-guaiene (10.3%), caryophellene oxide (8.6%), and eudesmol (3.2%). The results of the present study showed that more than nine sesquiterpene hydrocarbons were present, which is more than previously reported. Analysis also showed that the number of oxygenated sesquiterpenes in this study were much less than previously reported. Among the compounds detected were alpha-guaiene, beta-agarofuran, alpha-bulnesene, jinkoh-eremol, kusunol, selina-3,11-dien-9-one, oxo-agarospirol and guaia-1 (10), 11-dien-15,2-olide.
Four new and one unidentified species of Neohaliotrema Yamaguti, 1965 were obtained from the gills of the Indo-Pacific sergeant Abudefduf vaigensis (Quoy & Gaimard) off Pulau Langkawi, Malaysia. The five species, N. malayense n. sp., N. bombini n. sp., N. andamanense n. sp., N. parvum n. sp. and an unidentified Neohaliotrema sp. (similar to N. macracanthum Zhukov, 1976), are described and distinguished based mainly on features of the haptor. Species of this genus are divisible into two groups, the 'maomao group', with two pairs of morphometrically modified 'marginal' hooks and a fenestrated haptor, and the 'gracile group', with morphologically similar marginal hooks and an entire haptor. With the exception of N. bombini n. sp., the species described fit within the 'maomao group'. It is suggested that the more complex Neohaliotrema species of the 'maomao group' have modified hooks 1 and 2 on a haptoral 'isthmus' between two large apertures, i.e. 'windows', whereas the less complex species lacking these features are those of the 'gracile group'. Neohaliotrema spp. have only a single pair of pigmented eye-spots. A fenestrated haptor is unique to the Neohaliotrema spp. of the 'maomao group'. The generic diagnosis of Neohaliotrema is amended to include new data and a key to its known species is presented.
The concentration of ochratoxin A (OTA) in 120 commercial pepper (84 pre-packed and 36 bulk samples), which consist of local and imported white and black pepper in powder and seed form in Malaysia were determined. The objective of the study was to investigate and compare OTA concentration in black pepper and white pepper being commercialized in Malaysia. Determination method was based on HPLC with fluorescence detection coupled with immunoaffinity column clean-up step. Mobile phase consisted of acetonitrile-water-acetic acid (49.5:49.5:1.0, v/v/v), and flow rate was 1 ml/min. The LOD was 0.02 ng/g, and the average recovery values of OTA ranged from 79.5 to 92.0% in black pepper and 81.2-90.3% in white pepper. A total of 57 samples (47.5%) were contaminated with OTA ranging from 0.15 to 13.58 ng/g. The results showed that there was a significant difference between type of pepper and brands. OTA concentration in black pepper was significantly higher than white pepper (p < 0.05). The highest concentration of ochratoxin, 13.58 ng/g, was detected in a sample of black pepper seed followed by 12.64 ng/g in a sample of black pepper powder, both were bulk samples purchased from open market.
PURPOSE: A cross sectional descriptive study, which involved government hospitals and health clinics from Peninsular Malaysia sought to identify the continuing professional education (CPE) needs and their readiness for E-learning. This paper focuses on the first phase of that study that aimed to determine the factors that influence nurses' participation in CPE.
METHODS: Multistage cluster sampling was used to recruit 1,000 nurses randomly from 12 hospitals and 24 health clinics from four states in Peninsular Malaysia who agreed to be involved. The respondent rate was 792 (79.2%), of which 562 (80%) had participated in CPE in the last 12 months.
RESULTS: Findings suggested that updating knowledge and providing quality care are the most important factors that motivate participation in CPE, with respective means of 4.34 and 4.39. All the mean scores for educational opportunity were less than 3.0. Chi-square tests were used to test the association of demographic data and CPE participation. All demographical data were significantly associated with CPE participation, except marital status.
CONCLUSIONS: Implementation of mandatory CPE is considered an important measure to increase nurse's participation in CPE. However, effective planning that takes into consideration the learning needs of nurses is recommended.
Junior doctors are often the "first line" doctors called to attend to patients in cardiac arrest. We performed an anonymous questionnaire study from October 2008 to December 2008 to assess the knowledge, attitude and skill of cardiopulmonary resuscitation among junior doctors in Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab II. Out of the 100 questionnaire forms sent out, 70 were returned completed. The majority (85.8%) stated that they were not confident of managing a resuscitation case. There was a statistically significant (p<0.001) association between duration of clinical practice and confidence level. Up to 77.1% said that BLS should be re-certified every two years.
Cerebral toxoplasmosis is a rare complication of systemic lupus erythematosus (SLE). An 18 year old male student, newly diagnosed to have SLE, developed neurological symptoms two days after completing intravenous methylprednisolone. Computed tomography (CT) scan showed features consistent with a diagnosis of probable cerebral toxoplasmosis. He responded dramatically to antitoxoplasma therapy. To our knowledge, this is the first case report in the literature that presents a newly diagnosed SLE patient who rapidly developed cerebral toxoplasmosis following administration of intravenous methylprednisolone. Our case illustrates that this drug is potentially fatal and the importance of differentiating cerebral infection from neuropsychiatric lupus.
Malaysia's national health statistics for the last half century show a remarkable improvement in the nation's health status. One important factor for this improvement is the Malaysian government's proactive intervention in the health sector. Among others, e-health has played a vital role in delivering and managing healthcare services in Malaysia. While the Government has integrated telehealth in its national digital infrastructure re-design, it has heavily invested in telehealth. The enactment of new laws to facilitate telehealth practices can also be noted as an important measure.
The use of 0.5 mg/0.05 ml of ranibizumab intracamerally, to induce regression of iris neovascularisation in a non-diabetic patient, is reported. A 55-year-old Malay man presented with left eye rubeosis and hyphaema secondary to ischaemic remnant retinal flap in his silicone filled pseudophakic eye. Regression of rubeosis and resolution of hyphaema was noted within 4 days of injection of intracameral ranibizumab, allowing repeat vitrectomy to be performed without much bleeding, thus facilitating removal of his intraocular lens and laser to remaining flap. One month postoperatively he remained comfortable with counting fingers vision similar to the pre-hyphaema period.
This paper presents a forecasting study of municipal solid waste generation (MSWG) rate and potential of its recyclable components in Kuala Lumpur (KL), the capital city of Malaysia. The generation rates and composition of solid wastes of various classes such as street cleansing, landscape and garden, industrial and constructional, institutional, residential and commercial are analyzed. The past and present trends are studied and extrapolated for the coming years using Microsoft office 2003 Excel spreadsheet assuming a linear behavior. The study shows that increased solid waste generation of KL is alarming. For instance, the amount of daily residential SWG is found to be about 1.62 kg/capita; with the national average at 0.8-0.9 kg/capita and is expected to be increasing linearly, reaching to 2.23 kg/capita by 2024. This figure seems reasonable for an urban developing area like KL city. It is also found that, food (organic) waste is the major recyclable component followed by mix paper and mix plastics. Along with estimated population growth and their business activities, it has been observed that the city is still lacking in terms of efficient waste treatment technology, sufficient fund, public awareness, maintaining the established norms of industrial waste treatment etc. Hence it is recommended that the concerned authority (DBKL) shall view this issue seriously.
The influence of rain and malathion on the initial oviposition as well as development of blowfly species infesting rabbit carcasses decomposing in sunlit and shaded habitats were studied over a period of 1 year in Kelantan, Malaysia. Chrysomya megacephala (Fabricius) was the most dominant species that infested the carcasses, followed by Chrysomya rufifacies (Macquart). In general, rain, depending on its intensity, delayed initial oviposition by 1-2 days and prolonged the pupation period by 1-3 days. The presence of malathion in the carcasses delayed initial oviposition by 1-3 days and prolonged the pupation period by 2-3 days. These findings deserve consideration while estimating postmortem interval since rain is a commonplace occurrence in Malaysia and malathion is one of the common poisons as an agent for choice to commit suicide.
A 36-year-old Malaysian woman with erosive arthritis presented with multiple asymptomatic skin colored papulonodules on the hands, elbows, knees, ears, and feet; many macules, papules, and plaques were photodistributed. Progressive, erosive arthritis began about 18 months after the onset of skin involvement. Initially the patient was diagnosed to have dermatomyositis due to her skin findings, but later proved to have multicentric reticulohistiocytosis based on the typical histopathological features of histiocytic multinucleated giant cells with eosinophilic ground glass cytoplasm on skin biopsy. Workup for associated diseases including malignancies was negative. Her skin lesions and joint pain responded to treatment with methotrexate and prednisolone.