Vitiligo is a chronic disease and can have significant impairment on patients' quality of life (QoL). Studies have shown that limitations in QoL are similar in magnitude to patients with other chronic skin diseases like psoriasis. The objective of this study was to assess the quality of life (QoL) of patients with vitiligo attending the dermatology clinic of a tertiary hospital in Malaysia.
Study site: Dermatology clinic, Hospital Kuala Lumpur, Malaysia
INTRODUCTION: Public knowledge and attitudes towards antibiotics play a vital role in the success of the treatment process. This study aimed to assess public knowledge and attitudes toward antibiotic usage which could serve as baseline data for future studies within a government hospital setting in Malaysia.
METHODOLOGY: A self-administered cross-sectional survey involving 408 respondents was conducted using a validated questionnaire at an outpatient pharmacy department in Penang Hospital, Malaysia, from February to March 2009.
RESULTS: Nearly 55% of the respondents had a moderate level of knowledge. Three quarters of the respondents (76.7%) could correctly identify that antibiotics are indicated for the treatment of bacterial infections. However, 67.2% incorrectly thought that antibiotics are also used to treat viral infections. About 59.1% of the respondents were aware of antibiotic resistance phenomena in relation to overuse of antibiotics. With regard to attitudes, 38% believed that taking antibiotics when having cold symptoms could help them to recover faster, while 47.3% expected antibiotics to be prescribed for common cold symptoms. Age, race and educational level were among the demographic characteristics significantly associated with knowledge and attitudes toward antibiotic use. Poor level of knowledge was found in less than one-third of the respondents whereas more than one-third of the respondents wrongly self-medicate themselves with antibiotics once they have a cold.
CONCLUSION: Educational interventions are needed to promote prudent use of antibiotics among the public.
Study site: outpatient pharmacy, Hospital Pulau Pinang, Malaysia
Aim: Autoantibodies against cyclic citrullinated peptide (anti-CCP) are considered to be a sensitive and specific marker for rheumatoid arthritis (RA). This study evaluated the diagnostic and analytical performances of the automated anti-CCP assay.
Materials and Method: Sera from 80 patients with established RA, 65 from other rheumatic diseases (non-RA) and 55 from healthy controls were studied using second generation anti-CCP. Rheumatoid factor (RF) was also assayed in each sample, and the results were compared to the anti-CCP fi ndings. Serum pools were used to determine the precision and linearity.
Results: At a cut-off of 7.4 U/ml for anti-CCP, the sensitivity and specificity for RA were 65% and 98% respectively. RF had a sensitivity of 58% and a lower specifi city of 93 % than anti-CCP. Conclusion: The high specificity of the assay suggests that anti-CCP is useful in the diagnosis of rheumatoid arthritis and in our cohort of study population anti-CCP exhibits a better diagnostic value than RF. A considerable proportion (28%) of RF-negative RA patients were anti-CCP positive. Based on analytical performance of the assay, we conclude that full automation and high throughput features of AxSYM makes it an ideal platform for routine testing of anti-CCP.
Study site: Rheumatology clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
The main objective of this paper is to examine the psychometric properties of the Malay Version of the Hospital Anxiety and Depression Scale (HADS), tested on 67 husbands of the women who were diagnosed with breast cancer. The eligible husbands were retrieved from the Clinical Oncology Clinic at three hospitals in Kuala Lumpur, Malaysia. Data was collected at three weeks and ten weeks following surgery for breast cancer of their wives. The psychometric properties of the HADS were reported based on Cronbach' alpha, Intraclass Correlation Coefficients (ICC), Effect Size Index (ESI), sensitivity and discriminity of the scale. Internal consistency of the scale is excellent, with Cronbach's alpha of 0.88 for Anxiety subscale and 0.79 for Depression subscale. Test-retest Intraclass Correlation Coefficient (ICC) is 0.35 and 0.42 for Anxiety and Depression Subscale, respectively. Small mean differences were observed at test-retest measurement with ESI of 0.21 for Anxiety and 0.19 for Depression. Non-significant result was revealed for the discriminant validity (mastectomy vs lumpectomy). The Malay Version of the HADS is appropriate to measure the anxiety and depression among the husbands of the women with breast cancer in Malaysia.
Study site: Oncology clinic, University of Malaya Medical Centre (UMMC), Hospital Kuala Lumpur, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
The influence of awareness, knowledge, and attitudes (AKA) on the health-related quality of life (HRQoL) of patients with epilepsy has not been widely established. The aims of this preliminary study were to (1) assess general AKA and HRQoL levels, (2) correlate AKA and HRQoL levels, and (3) compare the HRQoL of patients with epilepsy with different AKA levels. A cross-sectional sample of outpatients with epilepsy were recruited from the Neurology Clinic, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia. Data analysis was carried out using the Statistical Package for Social Sciences Version 15 employing descriptive and nonparametric statistics. On written consent, included patients completed the Malay AKA Epilepsy and the Malay Quality of Life in Epilepsy-30 (MQOLIE-30) instruments. Across all patients, both AKA levels (median: 80.0, range: 0-170) and overall HRQoL (median 51.5; range 15-97) were moderate. Awareness was significantly correlated only with Seizure Worry (r(s)=+0.29, p<0.05), whereas Knowledge was not significantly linked to any domain. However, Attitudes was significantly correlated with all domains (r(s)=+0.35 to +0.47, p<0.01) except Medication Effects and Seizure Worry. Patients with good AKA levels (Total Score ≥ median) experienced significantly better Overall Quality of Life and Cognitive Functioning (p<0.05). Findings showed that AKA may play an important role in influencing patients' HRQoL, suggesting that epilepsy treatment efforts should also focus on enhancing AKA through epilepsy awareness to improve health outcomes.
Study site: Neurology Clinic, Hospital Sultanah Nur Zahirah
The aim of our study is to describe the impact of tight control strategy on the care of RA patients in Sarawak General Hospital. We performed a prospective study of all patients with a diagnosis of RA who received treatment at the Rheumatology Clinic in Sarawak General Hospital over a 1-year period. Systematic DAS-driven treatment adjustments aimed to achieve low disease activity (DAS 28-ESR <2.6) were carried out in the clinic over the 1-year period. Disease activity and treatment regimes of all 142 patients were collected for at baseline and 1 year later for statistical analysis. Our patients have a significantly lower DAS 28 with a mean of 2.99 ± 0.95 compared with baseline of 4.31 ± 1.34 (p < 0.000). More patients were in remission 1 year later compared to baseline (36.6% vs 11.3%). Tight control strategy has a positive impact on the care of RA patients in our centre. By optimising the care of RA through tight control strategy, RA can be better controlled in our centre.
Study site: Rheumatology clinic, Sarawak general hospital
A cross-sectional study was conducted among 300 Malaysian women in the obstetrics and gynecology outpatient clinic in a selected hospital in Bangi, Selangor to determine the level of knowledge of HPV and HPV vaccines, attitudes toward HPV vaccination and barriers of being vaccinated. Factors associated with knowledge and attitudes were also addressed with a questionnaire. Seventy eight women (26%) had heard about the HPV virus and 65 about HPV vaccines (21.7%). Marital status was associated significantly with awareness of HPV and HPV vaccine (p=0.002, p=0.002; respectively), in addition to level of education (p=0.042). The percentages of women who reported correct answers for the questions on knowledge of HPV and HPV vaccine ranged from 12% to 25%. One hundred fifty nine respondents (53%) had a positive attitude toward HPV vaccination. Age, marital status, and level of education were associated significantly with attitude (p<0.001, p<0.001, p=0.002; respectively). The most important barriers reported were 'unawareness of the vaccine' 'concerned about side effects' and 'afraid of needles'. This study found a very low level of knowledge of HPV and HPV vaccine. Education of population is highly recommended and barriers to being vaccinated should be dealt with seriously.
Study site: Hospital, Bangi, Selangor, Malaysia
Various factors may contribute to a hypercoagulable state and acute vascular thrombosis. A prospective study was conducted involving 165 coronary heart disease (CHD) patients from the Cardiology Unit, Hospital Universiti Sains Malaysia. The purpose of this study was to investigate the relationship among factor VIII (FVIII), prothrombin time (PT), activated partial thromboplastin time (APTT), and activated protein C resistance (APC-R) state among CHD patients and to look for potential clinical applications from these laboratory findings. There were 110 cases diagnosed as acute coronary syndrome (ACS), whereas another 55 were stable coronary artery disease (SCAD) patients. PT, APTT, FVIII, and APC-R assays were performed on all subjects. There was a significant difference between the FVIII level and the APTT results (P value < 0.0001). A negative relationship was found between the FVIII level and the APTT from linear regression analysis (R(2) = 10%, P value < 0.0001). For each 1% increase in the FVIII level, the APTT was reduced by 0.013 s (95% confidence interval (CI) between -0.019 and -0.007). Interestingly, none of the SCAD patients had abnormally short APTT. Approximately 68.4% of cases with a positive APC-R assay were found to have a high FVIII level. In conclusion, the APTT test is a potential hemostatic marker for hypercoagulable state including in arterial thrombosis.
Study site: Cardiology unit (outpatient and inpatient), Hospital Universisti Sains Malaysia (HUSM), Kelantan, Malaysia
Chronic venous disorders range from telangiactasia or spider veins to varicose veins, venous swellings, skin changes and venous ulcerations. The aim of this study is to assess outcome of varicose vein surgery in the ethnically diverse population of Penang, Malaysia. This study is a retrospective analysis of patients seen from 1999 to 2004. All patients who presented to the outpatient clinic of our surgical department with saphenofemoral junction (SFJ) and/or saphenopopliteal junction (SPJ) reflux associated with incompetence of the great saphenous vein (GSV) or small saphenous vein (SSV) respectively underwent classical varicose varicose vein surgery. A single surgeon at a single institution performed the surgeries. Data from pre-operative, post-operative and follow-up procedures were recorded in case report forms. A total of 202 cases were treated. Of these, 200 were qualified by the inclusion criteria and follow-ups, with 23 who were treated bilaterally. Of those treated, Chinese comprised 47.5%, Indians 27.0%, Malays 12.5% and foreigners 13.0% (largely Indonesian Chinese, British and Americans). The average age was 52.1 years. Indians had the highest average BMI of 29.2, compared to the Chinese who had the lowest of 24.6. Based on occupation, housewives (43.0%), blue collar workers (19.0%), salespersons (12.0%) and factory workers (9.5%) were among those afflicted with varicose veins. While local Chinese predominated in the business groups (salespersons and food-related workers), the Indians and Malays in this study were mainly factory workers and/or blue collar workers. Symptomatology in descending order of severity included pain in 80.0% of cases, swelling in 65.5%, heaviness in 53.5%, cramps in 53.0%, lipodermatosclerosis in 39.0%, superficial thrombophlebitis in 33.5%, venous ulceration in 32.0%, eczema 22.0% and cellulitis in 12.5% of patients. Post surgery pains dropped to 9.9%, cramps 6.4%, heaviness 5.5% and swelling 5.3% (p<0.0001 in all groups). Indians had the highest rate of venous ulcers (35.2% of all Indians treated) possibly due to their high BMI and low socioeconomic background. In cases of venous ulcers, gram negative infections (49.8%) were more common than gram positive infections at 18.8%. Operative procedures performed included great saphenous vein high ligation in 96.5% of cases, stripping 93.5% and multiple avulsions in 98.5%, saphenous popliteal junction ligation with multiple avulsions in 13.0% and subfascial ligation in 10.5%. Operative complications included induration (40.0% of cases), bruising in 49.5%, pains in 15.0%, paraesthesia in 3.5%, wound infection in 4.0%, deep venous thrombosis in 3.0% and ulcer recurrence in 7.5%. A total of 96.2% of patients treated expressed satisfaction with varicose vein surgery. Late presentations of chronic venous insufficiency, possibly as a result of poor understanding and inadequate education on diet, weight control, use of stockings and change in lifestyle by patients, employers and general practitioners are probably the cause of high rates of severe chronic venous disease especially venous ulcerations in the local community. However, classical varicose vein surgery is widely applicable across diverse ethnicities with a high rate of success.
Study site: Surgical clinic, Penang Adventist Hospital, Pulau Pinang, Malaysia
Empty Nose Syndrome (ENS) is a rare and controversial sequelae from previous radical turbinate surgery. We report on a 50-year-old Chinese gentleman with long-standing nasal problems who has had radical turbinate surgery many years prior to presenting at the ENT clinic with mucoid nasal discharge and chronically blocked nose. His nasal cavities were ironically very patent and there were only minor remnants of his turbinates bilaterally. We treated him medically for several years with nasal steroids, antihistamines and leukotriene receptor antagonists and his nasal symptoms have reduced significantly.
Study site: ENT clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
The aim of this study was to assess the bone mineral density (BMD) of premenopausal patients with systemic lupus erythematosus (SLE) on corticosteroids (CS) and to determine the influence of CS and other risk factors on BMD. A total of 98 premenopausal patients with SLE were recruited from outpatient clinics in two teaching hospitals. Risk factors for osteoporosis were determined, and BMD was measured using dual-energy x-ray absorptiometry. The mean age of the patients was 30.05 +/- 7.54 years. The mean dose of prednisolone at time of BMD measurement was 18.38 +/- 10.85 mg daily. Median duration of CS use was 2.5 years (range 0-20). Median cumulative dose of CS was 9.04 g (range 0.28-890.0). Six patients (6.1%) had osteoporosis, 41 (41.9%) had osteopenia and 51 (52.0%) had normal BMD. Lumbar spine T score correlated with cumulative CS dose (P = 0.019). Duration of CS intake correlated with femoral neck T score (P = 0.04) and trochanter T score (P = 0.008). There was no correlation between BMD and race, SLE Disease Activity Index score, smoking and self-reported calcium intake or exercise. Only 52% of these patients had normal BMD. The duration and cumulative dose of CS intake was significantly correlated to BMD, but not the other commonly assessed risk factors. These findings suggest that premenopausal patients with SLE on CS should have their BMD measured at regular intervals to fully assess their osteoporosis risk.
Study site: outpatient clinics in two teaching hospitals
The Malaysian people consist of several ethnic groups including the Malay, the Chinese, the Indian and the Orang Asli (aboriginal Malaysians). We collected blood samples from outpatients of 2 hospitals in the State of Selangor and identified 27 glucose-6-phosphate dehydrogenase (G6PD)-deficient subjects among these ethnic groups. In the Malay, G6PD Viangchan (871GA, 1311CT, IVS11 nt93TC) and G6PD Mahidol (487GA) types, which are common in Cambodia and Myanmar, respectively, were detected. The Malay also had both subtypes of G6PD Mediterranean:the Mediterranean subtype (563CT, 1311CT, IVS11 nt93TC) and the Indo-Pakistan subtype (563CT, 1311C, IVS11 nt93T). In Malaysians of Chinese background, G6PD Kaiping (1388GA), G6PD Canton (1376GT) and G6PD Gaohe (95AG), which are common in China, were detected. Indian Malaysians possessed G6PD Mediterranean (Indo-Pakistan subtype) and G6PD Namoru (208TC), a few cases of which had been reported in Vanuatu and many in India. Our findings indicate that G6PD Namoru occurs in India and flows to Malaysia up to Vanuatu. We also discovered 5 G6PD-deficient cases with 2 nucleotide substitutions of 1311CT and IVS11 nt93TC, but without amino-acid substitution in the G6PD molecule. These results indicate that the Malaysian people have incorporated many ancestors in terms of G6PD variants.
Study site: Kajang District Hospital and the Hospital Orang Asli Gombak, Selangor, Malaysia
Diabetic Eye Registry, a web based registry hosted at the National Eye Database (www.acrm.org.my/end) collects data in a systematic and prospective nature on status of diabetic retinopathy (DR) among diabetics seen for the first time at Ministry of Health ophthalmology clinics. The 2007 report on 10,586 diabetics revealed that 63.3% of eyes examined had no DR, 36.8% had any form of DR, of which 7.1% had proliferative diabetic retinopathy. Up to 15.0% of eyes had vision threatening DR requiring laser or surgery at their first visit. Data on diabetic eye registry is useful in monitoring the quality of diabetic management, particularly in eye screening as reflected by the proportion of patients with severe DR needing intervention at the first visit to Ophthalmology clinics.
Osteoporosis is a silent disease and becomes clinically significant in the presence of fragility fracture. Identifying risk factors that are associated with osteoporosis in the community is important in reducing the incidence of fragility fracture. The aim of this study is to identify risk factors associated with fragility fracture in the Seremban District of Malaysia. This is a population comparison study between orthopedic ward patients and outpatients attending a community health clinic for 6 months. Epidemiological data and the possible risk factors for osteoporosis were collected by direct interview. This study demonstrates that advancing age, low body weight, smoking, lack of regular exercise, low consumption of calcium containing foods, and using bone depleting drugs (steroids, thyroid hormone, and frusemides) are major risk factors for fragility fracture. Most of these risk factors are modifiable through effective lifestyle intervention.
Study site: Klinik Kesihatan Seremban; Hospital Seremban, Negeri Sembilan, Malaysia
OBJECTIVE: This study aimed at evaluating the relationship between severity of visual impairment and depression among elderly Malaysians attending an eye clinic.
METHODS: This was a cross-sectional study. The study population included patients, aged>or=60 years who attended the Eye Clinic in University Malaya Medical Centre. Exposure measurement was based on ophthalmologic examinations by an ophthalmologist. Data on outcome were measured using the Geriatric Depression Scale.
RESULTS: After adjusting for important confounders, severity of visual impairment either having low vision or blind were independent risk factors of depression. The odds of developing depression among elderly with low vision were 2 times more than those with normal vision, and elderly who were blind had almost 5 times the odds to be depressed compared with those having normal vision.
CONCLUSION: Findings from this study suggest a positive relationship between the severity of visual impairment and depression among elderly Malaysians.
Study site: Eye Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Device, Questionnaire & Scale: Geriatric Depression Scale (GDS-15)
The aims of the study were to determine the prevalence of peripheral arterial disease (PAD) in diabetic patients and in different ethnic groups at a primary care setting, and to evaluate risk factors associated with PAD in these diabetic patients. A cross sectional study of 200 diabetic patients over 18 years old who attended a primary care clinic at a teaching hospital in Kuala Lumpur, Malaysia was carried out. Face-to-face interviews were conducted using structured questionnaires for demographic characteristics and risk factors evaluation. Blood pressure measurements, assessment of peripheral neuropathy and ankle brachial pressures were performed. PAD was diagnosed by an ankle brachial pressure index (ABPI) of <0.9 on either leg. The overall prevalence of PAD was 16% in this diabetic population. The prevalence of PAD was 5.8% in Malays, 19.4% in Chinese and 19.8% in Indians. The prevalence of peripheral neuropathy was 41%, foot ulcer 9.5%, and gangrene 3.0%. The presence of foot ulcer was weakly associated with PAD (P=0.052). No significant relationships were found between age, gender, smoking status, duration of diabetes mellitus, hypertension, dyslipidaemia, and PAD. PAD is common in the diabetic population of this study.
Study site: primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
The aim of our study is to describe the pattern, clinical features, treatment regimes, and disease activity among the patients treated for rheumatoid arthritis (RA) in the Sarawak General Hospital. We performed a cross-sectional study of all patients with a diagnosis of RA who received treatment at the General Medical Clinic and the Rheumatology Clinic in Sarawak General Hospital over a 1-year period from 1st June 2006 to 31st May 2007. Demographic data, clinical features, and disease activity of all 154 patients were collected for statistical analysis. Rheumatoid arthritis afflicts all the major racial groups in Sarawak including the native population. Our patients have a mean disease duration of 5.4 years (SD 5.69) and a mean duration of delay in diagnosis RA and initiation of disease-modifying antirheumatic drug (DMARD) treatment of 42.9 months (SD 60.1). They have a low rate of interstitial lung disease (6.5%) and rheumatoid nodules (4.5%). Rheumatoid factor was positive in 65.5% of our patients. They have a mean Disease Activity Score (DAS) 28 score of 4.28 (SD 1.33). Only 12.5% of our patients are in remission with DAS 28 < 2.6 and 30.9% of our patients are having high disease activity with DAS 28 > 5.1. Despite the high usage of DMARDs in Sarawak (>80%), our patients have severe disease with high disease activity indices. This is most likely due to delay in diagnosis and initiating DMARDs in RA patients in Sarawak.
Study site: General Medical Clinic and the Rheumatology Clinic in Sarawak General Hospital
This is a cross-sectional study to determine the prevalence of insulin resistance and its associated factors in Hospital UKM patients with schizophrenia using the Homeostatic Model Assessment (HOMA) model. Fasting glucose and insulin from 85 patients were obtained. Fasting glucose revealed 15% of the patients were diabetic, while another 15% had impaired fasting glucose. Using the HOMA model, 68% of the patients had insulin resistance. Univariate analyses found BMI (p < 0.001) and waist circumference (p < 0.001) to be associated with insulin resistance. The statistical significance disappeared after multivariate analyses. All patients with schizophrenia should be screened and managed as a group at high risk for development of diabetes with emphasis on body weight management.
Study site: inpatient and outpatients, Psychiatric department, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Although the disease burden of dengue is increasing, the impact on the quality of life (QoL) has not been investigated. A study to determine the QoL of confirmed dengue patients using the EuroQol visual thermometer scale was carried out at the University Malaya Medical Center. Of the 207 participants, 40% were ambulatory and 60% were hospitalized. Of eight health domains, 6.2 and 5.0 domains were affected in the hospitalized and ambulatory cohorts, respectively (P < 0.001), with cognition and interpersonal activities affected most. All patients experienced a drastic decrease in their QoL from the onset of symptoms. The QoL deteriorated to the lowest point (40% of healthy status) between the third and seventh days of illness. The duration of impaired QoL (9 days for ambulatory or 13 days for hospitalized patients) was longer than the duration of fever (5 and 7 days, respectively). Symptomatic dengue has major effects on patients' health.
Study site: e outpatient or inpatient care at the University Malaya Medical
Center.
OBJECTIVES: To examine the prevalence, characteristics, and impact of sexual dysfunction in our primary care referral population.
METHODS: Participants seeking treatment for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) were recruited from general urology clinics. The subjects completed the National Institutes of Health-Chronic Prostatitis Symptom Index, International Index of Erectile Function-5, and selected questions from the University of Washington Symptom Score. Additional information on demographics and medical and treatment history were also obtained. Sexual dysfunction was defined as self-reported erectile dysfunction (ED) or ejaculatory difficulty, or both.
RESULTS: Of 296 participants with CP/CPPS, 214 (72.3%) reported sexual dysfunction. The National Institutes of Health-Chronic Prostatitis Symptom Index total score averaged 22.5 +/- 6.9 for participants with sexual dysfunction compared with 20.4 +/- 7.8 for participants who did not report sexual dysfunction (P = 0.03). Of the 214 participants with sexual dysfunction, 54 (25.0%) complained of ED only, 71 (33.4%) complained of ejaculatory difficulties only, and 89 (41.6%) complained of both ED and ejaculatory difficulties. Men reporting both ED and ejaculatory difficulty reported worse CP/CPPS symptoms (analysis of variance, P = 0.042) and worse quality of life (analysis of variance, P = 0.006) than men without sexual dysfunction.
CONCLUSIONS: Sexual dysfunction was reported by almost three quarters of patients with CP/CPPS. Patients with CP/CPPS and sexual dysfunction experienced substantially worse symptoms, particularly worse quality of life, than other patients with CP/CPPS. Sexual dysfunction merits consideration as an important aspect of CP/CPPS and a potential outcome measure.