Epilepsy is the most common neurological disorder in pregnancy. The effects of epilepsy include congenital abnormalities which are increased 2-3 fold. The babies born suffer from haemorrhagic disease of newborn. Preconception management and folic acid supplementation is important in optimizing outcome. With close monitoring and proper management, more than 90% of mothers have no complications throughout their pregnancy. Hormonal contraception dosage need to be increased due to the enzyme inducing nature of the anti epileptics drugs.
Sudden sensorineural hearing loss (SSNHL) is an otology emergency and carries significant morbidity if the diagnosis is missed. It can present to any specialty but in our local setting the patient usually presents to primary care as it is easily accessible. We present a case of SSNHL that was initially presented to a primary care centre and the patient was reassured without any investigation being carried out. SSNHL has many causes thus making diagnosis difficult. However, with knowledge of its possible, a diagnosis can be made and appropriate management can be advocated to the patient. Hence, we discuss the three main causes of SSNHL, while emphasizing the immune system-mediated mechanism as the main cause in this case.
Emotional disorders are common human emotional states that include anxiety, depression, social impairment and somatic symptoms. Emotional disorders are common in the community and therefore an important issue in primary care practice. The objective of this study was to determine the prevalence of emotional disorders among adults at a rural primary care clinic in Malaysia and to identify the associated factors. A cross-sectional study was conducted at Klinik Kesihatan Sungai Mati, Muar, Johor from 1st November to 31st December 1998. A self-administered 30-item General Health Questionnaire (GHQ-30) was used to screen for emotional disorders. Out of 414 patients seen during the study period, 368 fulfilled the selection criteria and agreed to participate in the study (response rate 88.9%). The prevalence of emotional disorders among the adult patients in this study was 15.2%. Factors such as age, race, gender, marital status, education level and employment were analyzed for association with emotional disorders. However, none of these factors were found to be significantly associated with emotional disorders in this study.
Anaemia is present in 31.3% of male and 73.6% of female subjects heterogenous for beta thalassaemia. In males, none had serum ferritin (SF) levels less than 10 ng/ml. In contrast, female subjects with haemoglobins less than 12 gm/dl, had SF levels less than 20 ng/ml. Statistical differences in the Hb, RBC, MCV, MCH, MCHC abd HBA were found with the normal groups (p<0.001). Comparison of the SF levels in both the males and females show no difference from those in the normal groups (p<0.10). Iron loading was not a significant feature in both the males and females. Correlation of the SF with age shows a weak negative correlation. Married females with children showed that the SF levels fell significantly with increasing age, suggesting the possibility that repeated pregnancies may deplete iron stores as reflected by the SF levels. In countries where iron deficiency and thalassaemia are highly prevalent, assays of serum ferittin will indicate if there is a need for supplemental iron in subjects hetergenous for beta thalassaemia.
5% of hospital admissions in Malaysia each year consist of patients suffering from renal diseases; from these 600 new cases of chronic renal failure will be diagnosed. The common causes of chronic renal failure in Malaysia in order of frequency are chronic glomerulonephritis, diabetic nephropathy, obstructive uropathy, malignant hypertension, chronic pyelonephritis, SLE nephritis and gouty nephropathy. Prevention of renal diseases require good control of the underlying conditions.
Cardiovascular disease has been the premier cause of hospital-registered deaths in Malaysia for the past 8 years. Among these reported deaths, 31% were caused by coronary heart disease in 1982. A healthy lifestyle to control the coronary risk factors would help to reduce the incidence of coronary heart disease in future.
The present study aimed to examine and compare results from two questionnaire pretesting methods (i.e., behavioral coding and cognitive interviewing) in order to assess systematic measurement bias in survey questions for adult smokers across six countries (USA, Australia, Uruguay, Mexico, Malaysia and Thailand). Protocol development and translation involved multiple bilingual partners in each linguistic/cultural group. The study was conducted with convenience samples of 20 adult smokers in each country. Behavioral coding and cognitive interviewing methods produced similar conclusions regarding measurement bias for some questions; however, cognitive interviewing was more likely to identify potential response errors than behavioral coding. Coordinated survey qualitative pretesting (or post-survey evaluation) is feasible across cultural groups, and can provide important information on comprehension and comparability. Cognitive interviewing appears a more robust technique than behavioral coding, although combinations of the two might be even better.
Cough associated with angiotensin converting-enzyme (ACE) inhibitor therapy has been reported in Western communities, where its incidence is disputed. We, therefore, reviewed our patients who were treated with captopril primarily for congestive cardiac failure. 19 of 61 patients (31.1%) receiving an ACE inhibitor had volunteered cough as an important adverse effect, compared with only one of 59 patients who recieved other treatment. In 3 patients, the cough was intolerably severe to require discontinuation of treatment. Another 7 patients were withdrawn from ACE inhibitor treatment because of other adverse effects including deteriorating renal function, insomnia, dizzy spells, ageusia and proteinuria, and skin rash. We suggest that although ACE inhibitors are very beneficial in improving the clinical status of congestive heart failure, intolerable adverse effects are not uncommon and might mandate withdrawal in a sizeable minority (16.4%).
The prediction models of MWQI in mangrove and estuarine zones were constructed. The 2011-2015 data employed in this study entailed 13 parameters from six monitoring stations in West Malaysia. Spatial discriminant analysis (SDA) had recommended seven significant parameters to develop the MWQI which were DO, TSS, O&G, PO4, Cd, Cr and Zn. These selected parameters were then used to develop prediction models for the MWQI using artificial neural network (ANN) and multiple linear regressions (MLR). The SDA-ANN model had higher R2 value for training (0.9044) and validation (0.7113) results than SDA-MLR model and was chosen as the best model in mangrove estuarine zone. The SDA-ANN model had also demonstrated lower RMSE (5.224) than the SDA-MLR (12.7755). In summary, this work suggested that ANN was an effective tool to compute the MWQ in mangrove estuarine zone and a powerful alternative prediction model as compared to the other modelling methods.
Disasters are defined as extraordinary events which occur abruptly, bringing great damage or harm, loss, and destruction to people and the environment. Nurses may have a more conflict and difficulties in disaster decision making where the victim condition need to be treated in disaster place. Nurses play a key role in hospital as a leaders and managers in the disaster operation and command center but limited data shows that the nurses experience in disaster management. The aim of this study is to evaluate the perception of knowledge and skills on the preparedness in disaster management among nurses in community clinics. A descriptive cross-sectional study was conducted in 27 government clinics in one of the states in Malaysia with a convenient sampling, 260 participants are selected. The questionnaire consisted of three sections; socio-demographic characteristics, the perception of knowledge and skill towards preparedness for disaster management rated on a Likert scale. In the effort to collect the intended data, a self-report questionnaire adapted and modified from Disaster Preparedness Evaluation Tool (DPET) was implemented (Alrazeeni, 2015). This study revealed that Nurses in these community clinics were moderate in terms of the perception of knowledge (Mean= 3.65, SD= 0.61) and the perceived skills (Mean= 3.68, SD= 0.56) on the preparedness in Disaster Management. Nevertheless, they were interested in disaster preparedness management training (n=227, 87.3%) and were confident as first responders of disaster (Mean= 3.88, SD= 0.61). However, they were not much involved in disaster preparedness plan (Mean= 3.23, SD= 0.90) and claimed that there was a lack of leadership figure in disaster situation (Mean= 3.06, SD= 0.92). In conclusion, nurses in community clinics need to gain knowledge and skills by involving themselves in disaster planning and drills as the preparation for disaster management for them to be the first responders in helping and managing people in this situation.
Introduction: The study attempts to evaluate the students’ perception of pharmacology as a
subject, its usefulness in future practice, teaching methods currently used, and their patterns of
learning and preparing for exams. Methods: A structured, self-administered questionnaire was
distributed to second year medical students. Results: Of the 125 students who participated,
22.73 % considered pharmacology more important than any other subject. The students found
small group sessions most interesting followed by directed self-learning, computer aided
learning and lectures. Of those who responded, 79 and 66 % suggested to increase the small
group and directed-self-learning sessions respectively. Up to 40 % of the students felt that
pharmacology teaching must be through case-based discussions and 20 % requested for more
practical sessions. Conclusions: It appears that majority of students entering the medical
schools has little prior knowledge of pharmacology. While going through the preclinical years
they understood the importance of pharmacology and its application in future practice,
however, they tend to develop interest in one or other topics. Students prefer to have a greater
number of small group sessions as they feel that these sessions are most useful for learning.
Majority of the students tend to use both the textbooks and lecture notes and study regularly
for better performance in examinations. The students also preferred to have more case-based
learning sessions incorporated into the small group sessions.
KEYWORDS: Pharmacology teaching, student perception, teaching methodologies
Introduction: Little is known about anxiety symptoms among diabetic patients, especially among those who are living in rural areas in Malaysia. Thus, the aim of this paper is to investigate the prevalence of anxiety among diabetic patients and factors associated with anxiety in rural communities in Malaysia.
Methods: A cross-sectional study involving 464 diabetes mellitus patients in rural health districts and outpatient clinics in Malaysia was conducted. Each participant was interviewed using the Hospital Anxiety and Depression Scale.
Results: Respondents consisted of 193 (41.6%) males and 271 (58.4%) females. The mean age of participants was 59.65 ± 10.16 years and the mean duration of diabetes mellitus was 6.9 ± 6.3 years. Results indicate that 15% of the participants have anxiety symptoms. Multiple logistic regression analysis revealed that patients with history of ischemic heart disease and depression and those who were underweight have higher anxiety scores with adjusted OR 5.06 (95% CI 1.79 to 14.27), 27.71 (95% CI 14.23 to 53.98) and 14.6 (95% CI 2.49 to 84.82), respectively.
Conclusions: This study suggests that although the prevalence of anxiety among diabetics is low, primary care physician should be trained to identify high risk patients and to manage their condition in order to improve the clinical outcome.
Malaysia is considered a hyperendemic area for canine heartworm (Dirofilaria immitis) due to its favorable climate for the completion of the parasite life cycle. This study provides an updated prevalence data on D. immitis in owned dogs from Kuala Lumpur, Malaysia and compares the trends of D. immitis in Malaysia. In the period between December 2017 and June 2018, 3.85% (5/130) dog blood samples tested positive for the presence of D. immitis antigen. A majority of the tested dogs (122/130) were not on rigorous heartworm prevention. After collating and analyzing information from 10 historical studies (1970-2017), we identified a significant decline in prevalence of D. immitis antigen in Malaysia, after the year 2000. Historically, the prevalence of D. immits antigen in owned dogs was significantly lower than the prevalence seen in stray dogs in Malaysia. This study demonstrates that D. immitis remains active in Kuala Lumpur, implying that accurate compliance of heartworm prevention is essential in Malaysia.
Psychological literature on race has discussed in depth how racial identities are dialogically constructed and context dependent. However, racial identity construction is often not compared across different socio-political contexts. By researching racial identity construction in three different multicultural countries, Malaysia, Singapore, and the United Kingdom, we examined how three racial identities, Chinese, Malay, and Indian, are constructed among Malaysians and Singaporeans in this qualitative study comprised of 10 focus group discussions (N = 39). We applied Dialogical Analysis to the data. This paper shows that both racial ingroups and outgroups constructed all three racial identities, with ingroups constructing their identities more heterogeneously compared to outgroups. Participants also engaged with colonial constructions of the three racial identities. The geographical locations, and therefore their perceptual contexts, of the participants differed. Yet, colonial constructions of race endured in contemporary identity construction and were contested in the group settings. We conclude that the socio-political context as understood by the context of colonialism and post-coloniality influenced their racial identity constructions. Participants, regardless of differences in geographical location, used similar colonial constructions of Malay, Chinese, and Indian identities to position themselves as well as Others in their group interactions. These findings show that there is value in conceptualising the context beyond that which individuals are immediately presented with, and that psychologists should consider the inclusion of cultural legacies of colonialism in their conceptualisation of the present context.
Objective: The aim of this study was to study the rate of readmission and look into factors that may contribute to this. Methods: This is a retrospective descriptive study of all psychiatric patients who were discharged from University Malaya Medical Center (UMMC). Case notes of those discharged during the study period was retrieved and analyzed. Those fulfilling the inclusion criteria were recruited and subjected to a questionnaire. Results: A total 107 patients were identified and only 95 participated. The readmission rate was 16.8%. Severity of illness was identified as the main risk factor for readmission in this study. Conclusion: Our readmission rate was similar to some developed nations and indicated good quality of care in UMMC. There appears to be other factors that may influence rate for readmission other than quality of in-patient care and outpatient community care. Keywords: readmission, mental illness, quality of care, Malaysia
The Beck Depression Inventory (BDI) has been shown to have good psychometric properties in Western and non-Western populations for the past 40 years. The present study reported on the factor structures and provided evidence of the psychometric properties of the BDI for the Malays in Malaysia. A total of 1090 Malays in four samples (students, general community, general medical patients, and patients with major depressive disorders) were recruited in this study. They completed a battery of questionnaires that included symptoms, cognition and quality of life measures. Two factors of the BDI-Malay namely Cognitive/Affective and Somatic/Vegetative were extracted from Exploratory Factor Analysis (EFA) and were confirmed through Confirmatory Factor Analysis (CFA). Internal consistency (Cronbach's ) ranging from = .71 to .91 and validity of the BDI-Malay were satisfactory. The BDI-Malay can be used with confidence as an instrument to measure levels of depression for Malays in Malaysia. Keywords: Beck Depression Inventory, Malaysia, psychometric, confirmatory factor analysis
This study assesses dental students’ and patients’ perceptions on the role of dental students as smoking cessation counsellors as well as the patient’s quit rate at the University of XX. Materials and methods: Self-administered questionnaires were distributed to all senior dental students (n=154) in XX University and telephone call interviews were conducted on their patients (n=169) who received smoking cessation counselling from September 2010 to June 2013. Results: Response rates for dental students and patients were 68.2% and 67.3% respectively. Most of the dental students in this study were females (72.3%) whereas the majority of patients were males (97.6%). An average of six months follow up indicated that 22.5% of patients had quit smoking, 65.3% reduced the number of cigarettes smoked and 6.5% had relapsed. About a third of patients surveyed (33.1%) believed that smoking cessation counselling was extremely helpful compared to what students perceived (5.7%, p
Introduction: A validated diagnostic questionnaire is needed in the South-East Asia region, particularly in Malaysia to detect Premature Ejaculation (PE). The objective of this study was to determine the linguistic validity of the Malay Premature Ejaculation Diagnostic Tool (MAPET). Materials and Methods: This study was conducted in a teaching hospital. The first phase involved experts’ group discussions to develop the face, content, and factorial validity of the MAPET. The second phase measured the concurrent validity of MAPET. Results: We found that the MAPET has specificity, sensitivity, positive predictive value, and negative predictive value of 79.3%, 92%, 76.7% and 93.1%, respectively in the assessment of PE. The higher score indicates severity of PE. Conclusions: MAPET is a valid self-report instrument for the assessment of PE.