INTRODUCTION: Hypertension is highly prevalent in the older people. Chronic disease care is a major burden in the public primary care clinics in Malaysia. Good blood pressure (BP) control is needed to reduce the morbidity and mortality of cardiovascular disease (CVD). This study aimed to determine the status of BP control and its associated factors among older people with hypertension in public primary care clinics.
MATERIALS AND METHODS: A cross-sectional study on hypertensive patients aged 18 years and above was conducted in six public primary care clinics in Federal Territory, Malaysia. A total of 1107 patients were selected via systematic random sampling. Data from 441 (39.8%) patients aged 60 years and more were used in this analysis. BP control was determined from the average of two BP readings measured twice at an interval of 5 min. For patients without diabetes, poor BP control was defined as BP of ≥140/90 mm Hg and ≥150/90 for the patients aged 80 years and more. For patients with diabetes, poor control was defined as BP of ≥140/80 mm Hg.
RESULTS: A total of 51.7% (n = 228) of older patients had poor BP control. The factors associated with BP control were education level (p = 0.003), presence of comorbidities (p = 0.015), number of antihypertensive agents (p = 0.001) and number of total medications used (p = 0.002). Patients with lower education (less than secondary education) (OR = 1.7, p = 0.008) and the use of three or more antihypertensive agents (OR = 2.0, p = 0.020) were associated with poor BP control.
CONCLUSION: Among older people with hypertension, those having lower education level, or using three or more antihypertensive agents would require more attention on their BP control.
A study was carried out on the concentration of REEs (Dy, Sm, Eu,Yb, Lu, La and Ce) that are present in the core marine sediments of East Malaysia from three locations at South China Sea and one location each at Sulu Sea and Sulawesi Sea. The sediment samples were collected at a depth of between 49 and 109 m, dried, and crushed to powdery form. The entire core sediments prepared for Instrumental Neutron Activation Analysis (INAA) were weighted approximately 0.0500 g to 0.1000 g for short irradiation and 0.1500 g to 0.2000 g for long irradiation. The samples were irradiated with a thermal neutron flux of 4.0×10(12) cm(-2) s(-1) in a TRIGA Mark II research reactor operated at 750 kW. Blank samples and standard reference materials SL-1 were also irradiated for calibration and quality control purposes. It was found that the concentration of REEs varies in the range from 0.11 to 36.84 mg/kg. The chondrite-normalized REEs for different stations suggest that all the REEs are from similar origins. There was no significant REEs contamination as the enrichment factors normalized for Fe fall in the range of 0.42-2.82.
INTRODUCTION AND AIMS: It is necessary to ascertain current prescribing of antibiotics for upper respiratory tract infections (URTIs) to address potential overuse. A retrospective analysis was conducted of all prescriptions for URTIs among 10 public primary healthcare centers in Kedah, Malaysia, from 1 January to 31 March 2014.
RESULTS: A total of 123,524 prescriptions were screened and analyzed. Of these, 7129 prescriptions were for URTI, with 31.8% (n = 2269) containing antibiotics. Macrolides were the most commonly prescribed antibiotic, constituting 61% (n = 1403) of total antibiotics prescribed. There was a statistically significant association between different prescribers and diagnoses (p = 0.001) and a weak positive trend suggesting family medicine specialists are more competent in antibiotic prescribing, followed by medical officers and assistant medical officers (τ = 0.122).
CONCLUSIONS: Prescribing practices of some prescribers were inconsistent with current guidelines encouraging resistance development. National antimicrobial stewardship programs and further educational initiatives are ongoing in Malaysia to improve antibiotic use.
KEYWORDS: Malaysia; antibiotics stewardship programs; guidelines; inappropriate use of antibiotics; primary healthcare centres; upper respiratory tract infections
Study site: Klinik kesihatan, Kedah, Malaysia
INTRODUCTION: Opioid dependence is recorded as the most common drug of abuse in Malaysia. Currently, the preferred substitution therapy for most Government treatment centres is methadone used as substitution therapy for opioid dependence. There are, however patients who may benefit from being on the combined buprenorphine-naloxone formulation as substitution therapy instead. We discuss six cases of opioid dependence of varied backgrounds that were treated with buprenorphinenaloxone therapy and their outcomes.
DISCUSSION: All of the reported patients improved after the induction of buprenorphine- naloxone. Two of the cases highlighted the transfer of patients on methadone to buprenorphine-naloxone due to the adverse effect and interactions of methadone with other medications. During the transfer there were no major adverse reactions noted, and patients were safely able to continue with the maintenance therapy of buprenorphine- naloxone.
CONCLUSION: Buprenorphine-naloxone is a safe and effective drug substitution therapy for opioid dependence. It has fewer interactions with other medications, and has similar efficacy to methadone. Being a partial agonist, it has a less sedating effect making patients more functional.
Abstract
AIM:
Breast cancer is the most common cancer among women worldwide, including Malaysia. In developing countries, predictors affecting breast self-examination (BSE) practice are different. This cross-sectional study was conducted to determine the prevalence of BSE practice and the predictors affecting BSE practice among undergraduate female students in Klang Valley, Malaysia.
MATERIAL AND METHODS:
A cross-sectional study was conducted among 820 female undergraduate students to assess the BSE performance and related determinants of BSE practice in Klang Valley, Malaysia. Data were collected via a self-administered structured questionnaire that was developed for this study.
RESULTS:
The mean age of the respondents was 21.7 ± 1.2 years old. Most of them were single (96.8%), Malay (91.9%) and 19.6% of the participants performed BSE regularly. Multivariate logistic regression modeling revealed that BSE performance was more likely among women who have checked their breast with a doctor (odds ratio = 2.04, P = 0.00), and women who have personal history of breast disease (odds ratio = 4.43, P = 0.03).
CONCLUSION:
The findings showed a low BSE practice rate among young Malaysian women. Hence, the community's breast health awareness is needed to improve breast cancer prevention among young Malaysian women.
KEYWORDS:
Malaysia; breast self-examination; predictors
The sorption and desorption of cyfluthrin mixture isomers were determined using batch equilibration method and mobility was studied under laboratory conditions, using packed soil column. The soil types used in the study were clayey, clay loam and sandy clay loam obtained from three tomato farms in Cameron Highlands. A low Freundlich adsorption distribution coefficient K(ads(f)) for cyfluthrin was observed for clayey, clay loam and sandy clay loam soils (95.69, 21.64 and 8.99 l/kg, respectively). Results showed that cyfluthrin had high Freundlich organic matter (OM) distribution coefficient K(oc) values of 5799, 2278 and 1635 lkg(-1) for clayey, clay loam and sandy clay loam soils, respectively. These values indicate that cyfluthrin is considered immobile in Malaysian soils with different textures, based on the value of K(oc) by McCall. Adsorption of cyfluthrin was significantly (P < 0.05) affected with soil pH, fertilizer NPK, organic matter content and temperature. It was observed that approximately 95.8%, 93.8% and 91.8% of the adsorbed cyfluthrin remained sorbed after four successive rinses for clayey, clay loam and sandy clay loam soils. Soil column test showed that cyfluthrin was not detected in leachate. Cyfluthrin was detected in topsoil and its concentration decreased with depth. The downward movement of cyfluthrin in sandy clay loam soil was more than that in clay loam and clayey soils. Approximately, 80.9%, 77.8% and 67.3% cyfluthrin was observed at the depth of 0-5 cm (rainfall 350 mm) for clayey, clay loam and sandy clay loam soils respectively. Mobility of cyfluthrin showed that the percentage of cyfluthrin leached into soil was not affected by the amount of rainfall. The result clearly showed that cyfluthrin molecules were bound strongly to all the three Malaysian soil types.
Blast operations in the vicinity of residential areas usually produce significant environmental problems which may cause severe damage to the nearby areas. Blast-induced air overpressure (AOp) is one of the most important environmental impacts of blast operations which needs to be predicted to minimize the potential risk of damage. This paper presents an artificial neural network (ANN) optimized by the imperialist competitive algorithm (ICA) for the prediction of AOp induced by quarry blasting. For this purpose, 95 blasting operations were precisely monitored in a granite quarry site in Malaysia and AOp values were recorded in each operation. Furthermore, the most influential parameters on AOp, including the maximum charge per delay and the distance between the blast-face and monitoring point, were measured and used to train the ICA-ANN model. Based on the generalized predictor equation and considering the measured data from the granite quarry site, a new empirical equation was developed to predict AOp. For comparison purposes, conventional ANN models were developed and compared with the ICA-ANN results. The results demonstrated that the proposed ICA-ANN model is able to predict blast-induced AOp more accurately than other presented techniques.
Three strains of HIV-1 unique recombinant forms (URFs) descended from subtypes B, B', and CRF01_AE were identified among people who inject drugs in Kuala Lumpur, Malaysia. These three URFs shared a common recombination breakpoint in the reverse transcriptase region, indicating frequent linkage within the drug-injecting networks in Malaysia.
Good knowledge and practice regarding diabetic foot care will reduce the risk of diabetic foot complications and ultimately amputation. This study is conducted to assess patients' knowledge and compliance of diabetic foot care. A cross sectional study performed on patients who were admitted to HSNZ from the 1st September 2013 to 30th April 2014 for diabetic foot infections. They were interviewed with a questionnaire of 15 'yes' or 'no' questions on foot care knowledge and practice. Score of 1 was given for each 'yes' answer. The level of knowledge and practice, whether good or poor, was determined based on the median score of each category. The result was tested using a chi-square test in SPSS version 17. A total of 157 patients were included in this study with a mean age of 56.33 years (31-77). There were 72 male (45.9%) and 85 female (54.1%) patients with the majority of them being Malays (154 patients, 98.1%). Majority of the patients (58%) had poor foot care knowledge while 97 patients (61.8%) had poor diabetic foot care practice as compared to the median score. Based on the chi square test of relatedness, there was no significant association between knowledge and practice with any of the variables. In conclusion, the majority of patients admitted for diabetic foot infections had poor knowledge and practice of diabetic foot care. Education regarding foot care strategies should be emphasized and empowered within the diabetic population.
Study site: Hospital Sultanah Nur Zahirah, Kuala Terengganu,Terengganu, Malaysia
A new tick species belonging to the genus Dermacentor Koch, 1844, namely, Dermacentor limbooliati n. sp., is described. Adults of this species are similar to those of Dermacentor auratus Supino, 1897 and Dermacentor compactus Neumann, 1901, with which it was previously confused. Males of D. limbooliati may be distinguished from those of D. auratus and D. compactus by the following suite of characters: relatively broad conscutum with slightly straightened lateral sides, conscutum widest approximately at mid-length, oval shape of pseudoscutum, central brown patch in the center of pseudoscutum broad and diffused and not continuous with central patch in posteromedian area, conscutum posterior to pseudoscutum rugose, wide and blunt internal spur on coxa I, relatively long, narrow, and pointed external spur on coxa I, numerous internal spurs on coxa IV and trochanter I with moderate and broadly triangular spur with tapering apex. Females of D. limbooliati may be distinguished from those of D. auratus and D. compactus by the following suite of characters: rounded shape of scutum, central brown patch broad and diffused in the center of scutum, relatively long alloscutum setae, genital aperture moderately narrow V-shaped with preatrial fold bulging, wide and blunt internal spur on coxa I, relatively long, narrow, and pointed external spur on coxae I and trochanter I with moderate and broadly triangular spur with tapering apex. D. limbooliati is known from Malaysia and Vietnam where the adults were collected from vegetation, Sus scrofa resting beds, a human, and clothing. The immature stages remain unknown.
Studies have shown the importance of metacognition in medical education. Metacognitive skills consist of two dimensions: knowledge of metacognition and regulation of metacognition.
Layang-Layang is a small island part of an oceanic atoll in the Spratly Islands off Sabah, Malaysia. As the reef coral fauna in this part of the South China Sea is poorly known, a survey was carried out in 2013 to study the species composition of the scleractinian coral families Fungiidae, Agariciidae and Euphylliidae. A total of 56 species was recorded. The addition of three previously reported coral species brings the total to 59, consisting of 32 Fungiidae, 22 Agariciidae, and five Euphylliidae. Of these, 32 species are new records for Layang-Layang, which include five rarely reported species, i.e., the fungiids Lithophyllonranjithi, Podabaciasinai, Sandalolithaboucheti, and the agariciids Leptoseriskalayaanensis and Leptoseristroglodyta. The coral fauna of Layang-Layang is poor compared to other areas in Sabah, which may be related to its recovery from a crown-of-thorns seastar outbreak in 2010, and its low habitat diversity, which is dominated by reef slopes consisting of steep outer walls. Based on integrative molecular and morphological analyses, a Pavona variety with small and extremely thin coralla was revealed as Pavonamaldivensis. Since specimens from Sabah previously identified as Pavonamaldivensis were found to belong to Pavonaexplanulata, the affinities and distinctions of Pavonamaldivensis and Pavonaexplanulata are discussed.
BACKGROUND: Anthropometric and lung function characteristics of triathletes are important for the implementation of individual specific training and recovery recommendations. However, limited data are available for these parameters in triathletes. Hence, the aim of this study was to characterize and examine the gender differences of lung function and anthropometry parameters in competitive triathletes from Malaysia.
METHODS: Body composition assessment and lung function tests were performed on sixteen competitive triathletes (nine male and seven female). The subject's body composition profile including muscle mass (kg), fat free mass (kg), and percent body fat was measured using a bio-impedance segmental body composition analyzer. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were measured by Quark PFT2 spirometer.
RESULTS: The anthropometric measurements revealed that male triathletes were significantly taller than female triathletes and had significantly more protein and skeletal muscle mass. The female triathletes, however, had significantly higher percent body fat. Male triathletes had statistically significant higher FVC and FEV1 than female triathletes. Both the male and female triathletes showed a positive correlation between height, fat free mass and the lung function markers FVC and FEV1. This association was not seen with Body Mass Index (BMI) in female triathletes.
CONCLUSIONS: The data from our study shows that anthropometric parameters are directly linked to lung function of a triathlete. We also found the relationship between BMI and lung function to be gender specific in triathletes and is dependent on the body protein and fat content. Hence, body composition characterization is essential and provides valuable information for developing individual specific training modules.
Nipah virus (NiV) first emerged in Malaysia in 1998, with two bat species (Pteropus hypomelanus and P. vampyrus) as the putative natural reservoirs. In 2002, NiV IgG antibodies were detected in these species from Thailand, but viral RNA could not be detected for strain characterization. Two strains of NiV (Malaysia and Bangladesh) have been found in P. lylei in central Thailand, although Bangladesh strain, the causative strain for the outbreak in Bangladesh since 2001, was dominant. To understand the diversity of NiV in Thailand, this study identified NiV strain, using molecular characterizations, from P. hypomelanus in southern Thailand.
Penile augmentation with injection of paraffin is a common practice in South East Asia. Penile paraffinoma occurring due to injection of liquid paraffin to enhance the size of the penis is an uncommon condition. Normally, this procedure is carried out by nonmedical personnel, without the prior knowledge or consultation of any urologist. The occurrence of such a deforming procedure is not commonly known to the medical profession in Malaysia.
We evaluated feasibility of physical activity measurement by accelerometry among older Malay adults living in semi-rural areas in Malaysia. Results showed that 95% of 146 participants (aged [SD] 67.6 [6.4] years) were compliant in wearing the accelerometer for at least five days. Fifteen participants were asked for re-wear the accelerometer because they did not have enough valid days during the first assessment. Participants wore the accelerometer an average of 15.3 hr in a 24-hr day, with 6.5 (1.2) valid wear days. No significant difference in valid wear day and time was found between men and women. Participants who are single provide more valid wear days compared with married participants (p < .05), and participants with higher levels of education provide longer periods of accelerometer wearing hours (p < .01). Eighty-seven percent of participants reported 'no issues' with wearing the meter. This study suggests that accelerometry is a feasible method to assess the physical activity level among older Malay adults living in semi-rural areas.
Severe maternal conditions have increasingly been used as alternative measurements of the quality of maternal care and as alternative strategies to reduce maternal mortality. We aimed to study severe maternal morbidity and maternal near miss among women in two tertiary hospitals in Kota Bharu, Kelantan, Malaysia.
Involvement of pharmacists in improving medication adherence among diabetic patients is recognized globally. In Malaysian healthcare system, pharmacists are also operating health services i.e. Diabetes Medication Therapy Adherence Clinic (DMTAC). This study aimed to assess the clinical outcomes of patients managed by pharmacists (DMTAC), in a Malaysian hospital setting. This was an open labelled randomised study. Type 2 diabetes patients with HbA1c ≥8% were recruited and arbitrarily divided into the intervention group (usual care plus DMTAC) and the non-intervention group (usual care only). Those enrolled in the intervention group were scheduled for follow-up for eight consecutive visits. Improvements in lab results were compared longitudinally (pre and post analysis) between the groups. Data analysis was done using PASW 18® version. A total of 76 patients were enrolled, with 39 patients in the intervention group and 37 patients in the non-intervention group. Mean HbA1c (-0.90% vs. -0.08%, p=0.011) and fasting blood glucose levels (-3.45 mmol.l vs. +0.79 mmol/l, p=0.002) reduced significantly between the intervention group vs. non-intervention group. Total cholesterol and low-density lipoprotein cholesterol (LDL-C) were also significantly reduced in the intervention group (TC -0.34 mmol/l, p=0.018) (LDL -0.45 mmol/l, p=0.001). In conclusion, pharmacists managed DMTAC significantly improved glycaemic control and lipid profile of diabetic patients.
Study site: Outpatient Clinic, Hospital Pulau Pinang, Malaysia
The marbled cat Pardofelis marmorata is a poorly known wild cat that has a broad distribution across much of the Indomalayan ecorealm. This felid is thought to exist at low population densities throughout its range, yet no estimates of its abundance exist, hampering assessment of its conservation status. To investigate the distribution and abundance of marbled cats we conducted intensive, felid-focused camera trap surveys of eight forest areas and two oil palm plantations in Sabah, Malaysian Borneo. Study sites were broadly representative of the range of habitat types and the gradient of anthropogenic disturbance and fragmentation present in contemporary Sabah. We recorded marbled cats from all forest study areas apart from a small, relatively isolated forest patch, although photographic detection frequency varied greatly between areas. No marbled cats were recorded within the plantations, but a single individual was recorded walking along the forest/plantation boundary. We collected sufficient numbers of marbled cat photographic captures at three study areas to permit density estimation based on spatially explicit capture-recapture analyses. Estimates of population density from the primary, lowland Danum Valley Conservation Area and primary upland, Tawau Hills Park, were 19.57 (SD: 8.36) and 7.10 (SD: 1.90) individuals per 100 km2, respectively, and the selectively logged, lowland Tabin Wildlife Reserve yielded an estimated density of 10.45 (SD: 3.38) individuals per 100 km2. The low detection frequencies recorded in our other survey sites and from published studies elsewhere in its range, and the absence of previous density estimates for this felid suggest that our density estimates may be from the higher end of their abundance spectrum. We provide recommendations for future marbled cat survey approaches.