OBJECTIVE: The aim of this audit was to determine the frequency of histological changes compatible with Coeliac disease among patients undergoing elective diagnostic oesaphago-gastro-duodenoscopy (OGDS) under the care of a single practitioner in a Malaysian hospital.
MATERIALS AND METHODS: The archived endoscopically obtained duodenal biopsy specimens of 241 consecutive Malaysian subjects undergoing elective diagnostic (OGDS) were reviewed by a pathologist blinded to the clinical data. Based on intra-epithelial lymphocyte counts, crypt hyperplasia and villous atrophy, each subject was assigned to one of the categories of the Modified Marsh classification for the histological diagnosis of Coeliac disease. The clinical charts of all subjects were reviewed by a single gastroenterologist blinded to the findings of the histological review.
RESULTS: Of the 241 study subjects, 132 (54.8%) were females. There were 56 (23.2%) Malays, 90 (37.3%) Chinese, 88 (36.5%) Indians and seven (2.9%) from the other category. The median age of the study sample was 49 years (range 15- 88 years). The OGDS was done as part of screening in 15(6.2%) subjects while in the remaining it was part of the investigation of a clinical problem. Based on histological findings, none of the subjects could be assigned to a modified Marsh class of >1. The prevalence of histological changes compatible with Coeliac disease in the study was 0% (binomial exact one-sided 97.5 % confidence interval 0- 1.52%).
CONCLUSION: In conclusion, this audit provides no evidence that active Coeliac disease is significantly under-detected among symptomatic patients presenting for diagnostic OGDS. The possibility that a significant number may have potential coeliac disease cannot be excluded.
METHODS: A cross-sectional study was conducted among 445 healthcare workers using a validated questionnaire based on local PPC guideline published by the Ministry of Health Malaysia (MOH).
RESULTS: The results showed that many respondents were in the implementation action stage (57%), followed by the maintenance stage (20%), preparation stage (19%), contemplation stage (4%) and pre-contemplation stage (<1%). Further categorisation showed that only 43% of the respondents are successfully implementing PPC according to the standard of MOH. Clinics lead by the Family Medicine Specialist (Adjusted Odds Ratio, AOR 2.845; 95% Confidence Interval, 95%CI: 1.839, 4.40), daily usage of teleprimary care system (TPC) in the clinic (AOR 1.563; 95%CI: 1.019, 2.397), and attended TPC training (AOR 3.358; 95%CI: 2.221, 5.075) were significantly determining the success of PPC implementation.
CONCLUSION: The emphasis on motivation and rewards among the healthcare workers, provision of good internet connection at health clinics and developing a comprehensive model of PPC training targeting the specific healthcare workers are mandatory to enhance the PPC services implementation.
MATERIALS AND METHODS: A total of 240 patients (mean age 53.1, 167 males and 73 females) from Hospital Kuala Lumpur and the National Cancer Institute were enrolled in this research. All patients were interviewed individually in which they completed a thorough case history and swallowing screening test, including the water swallow test.
RESULTS: The results revealed that 43.3% of patients had dysphagia. In multivariate logistic regression, occupation of the patients was found to be associated with dysphagia, i.e., working in service and sales sector (adjusted Odds Ratio, aOR=0.36, 95% Confidence Interval, 95%CI: 0.13, 0.99). Compared to patients without treatment, those who had chemoradiotherapy (aOR=4.45; 95%CI: 1.10, 17.99) were at an increased odd of developing dysphagia.
DISCUSSION: This study showed that occupation, cancer stage, and type of treatment received by the head and neck cancer patients were crucial factors associated with the development of dysphagia. These findings guide the clinicians in identifying head and neck cancer patients who are at greater risks of developing dysphagia.
METHODS: In the first stage, a preliminary list of items measuring socio-cultural and religious beliefs during menstruation was generated. In the second stage, exploratory factor analysis was performed. Finally, confirmatory factor analysis using reflective measurement model and structural equation modelling was performed using partial least squares. The practices of these beliefs were included as mediating effect. Biological symptoms of menstruation were added in as another factor.
RESULTS: A total of 400 female students from the Universiti Malaysia Sarawak, Malaysia were recruited. A preliminary list of 22 items was first generated. From the confirmatory factor analysis, two factors were iteratively removed due to poor factor loadings. Four factors were retained, i.e., i) "religious beliefs"; ii) "unpleasant (or dirty) nature of menstruation"; iii) "personal restrictions (dietary and behavior)"; and iv) "restrictions of interactions with male gender". In structural equation modelling, only 2 factors, i.e., the practices of "personal restrictions (dietary and behavioural)" and "restriction of interactions with males" had significant negative impact on quality of life.
CONCLUSION: Menstruation should not be viewed purely from a biological lens as there are layers of sociocultural and religious beliefs surrounding it.
METHODS: A cross-sectional study was conducted by utilising the data from the Cambodia Demographic Health Survey (CDHS). The records of 5901 pregnant women who fulfilled the inclusion criteria were reviewed. Multiple logistic regression was used to identify the association on the influence of health services and pregnancy factors on incomplete TT vaccination while controlling other covariates. Adjusted odds ratio (aOR) and 95% confidence interval (95%CI) was reported.
RESULTS: More than one-third of the respondents had incomplete TT vaccination (38.25%, 95%CI: 37.00, 39.48%). Health services as well as pregnancy factors were statistically associated with incomplete TT vaccination such as received antenatal care (ANC) from other health personnel beside midwife (aOR=1.83; 95%CI: 1.49, 2.24), had
MATERIALS AND METHODS: All dengue patients hospitalised at King Chulalongkorn Memorial Hospital, Bangkok, Thailand during 1987-2008 and aged 0-15 years were included. All parameters were compared between patients in two groups: aged 0-2 years and >2-15 years.
RESULTS: Of the 2,221 children who were diagnosed with dengue, 179 were children aged 0-2 years compared with 2,042 children aged >2-15 years. The early childhood group presented significantly more frequently with hepatomegaly, drowsiness, diarrhoea, rash, convulsions, splenomegaly, and unusual manifestations. Dengue fever (DF) was more common in the early childhood group and dengue haemorrhagic fever (DHF) was less common. The mortality rate of the early childhood group was 1.67%, which was significantly higher than that of the comparative group. Approximately 65% of study subjects were serologically proven to have primary infection, compared to 9.8% of older children.
CONCLUSIONS: Clinical manifestations of dengue infection in early childhood are different in some aspects from those of dengue infection in older children, and mortality is higher. To effectively prevent dengue infection morbidity and mortality in children, it is essential that clinicians correctly recognize and diagnose dengue infection, particularly in early childhood.
METHOD: A retrospective observational study amongst AMA mothers was done in Universiti Kebangsaan Malaysia Medical Centre, a Malaysian teaching hospital. The data over a period of three years (January 2013 - December 2016) obtained from the Maternal Foetal Medicine clinic registry was analysed. AMA mothers with singleton pregnancy presenting for foetal structural anomaly scan was included. They were later subdivided into 2 groups (35-39 years and ≥ 40 years). The logistic regression analysis was used to analyse the association of the chromosomal anomalies and the age groups.
RESULTS: In all 486 patients were recruited and 84 patients were identified with foetal anomaly (17.3%). There was no significant difference in the prevalence of foetal anomalies or significant association with a specific structural foetal anomaly identified (p>0.05). However, the number of followups for these patients are significantly higher (p<0.001).
CONCLUSION: The prevalence of structural foetal anomalies identified in detailed ultrasonography was low in AMA mothers. Hence, referral criteria for detailed anomaly ultrasonography need to be re-looked.
METHODS: This is a retrospective case control study in Hospital Seri Manjung and Hospital Teluk Intan, Perak, Malaysia. P. aeruginosa bacteraemia cases that occurred between 1st January 2015 to 31st December 2019 were included, whilst E. coli bacteraemia cases that occurred within the same period were recruited successively until 1:2 case control ratio was achieved. Subjects below 12-year-old and those with polymicrobial bacteraemia were excluded. Demographic, clinical and treatment data were collected using pre-tested data collection forms by trained investigators.
RESULTS: A total of 61 patients with P. aeruginosa bacteraemia and 122 patients with E. coli bacteraemia were included. Recent admission in the earlier three months, regular haemodialysis, immunosuppressive therapy in the past 30 days, chronic wound/pressure sore at presentation and indwelling urinary catheter at presentation were identified as independent predictors of CO pseudomonal bacteraemia. Whilst older age was identified as a negative predictor of CO Pseudomonal bacteraemia (all p<0.05). The 30-day mortality rate was 34.4% in subjects with P. aeruginosa bacteraemia and 27.0% in those with E. coli bacteraemia (p=0.302). Predictors of 30-day mortality for community onset gram negative bacteraemia were as follow: older age, underlying solid tumours, neutropaenia at presentation, in-patient mechanical ventilation, and inpatient nasogastric tube insertion. Unexpectedly, receipt of inappropriate empirical antibiotics which was switched later (delayed and non-delayed switching) was identified as the negative predictors of mortality (all p<0.05).
CONCLUSION: It is prudent to restrict the usage of empirical anti-pseudomonal antibiotics among individuals at risk as liberal usage of broad-spectrum antibiotics engenders emergence of drug resistant organism, particularly in district setting where community onset pseudomonal bacteraemia remains scarce. Subjects with elevated risk of mortality should receive early escalation of care as per sepsis management guidelines.