Acute kidney injury (AKI) following cardiac surgery is well established but the reported incidence is variable due to varying definitions and criteria. Furthermore there is a paucity of such data from Southeast Asia.
Bacteremia continues to be one of the major causes of morbidity and mortality despite the existence of numerous antimicrobial agents. this study aimed to provide a Malaysian perspective on paediatric community-acquired bacteraemia based on the documentation of epidemiology and antimicrobial profile of the isolated pathogens.
Patients with anterior neck masses commonly present to otorhinolaryngology clinics, but there are limited differential diagnoses for such lesions. Common ones include thyroid nodule and thyroglossal duct cyst. In an elderly patient, a differentiated thyroid carcinoma should be suspected especially if it moves with swallowing. We encountered a typical presentation of a solitary thyroid nodule-like mass with the exception of pulsation in a 65-year-old female. Further investigation, using neck ultrasonography, revealed that it was a variant of right common carotid artery arising from the left common carotid artery. Knowledge of such variants is of great importance as ignorance of such a variation may lead to inadvertent surgical complications during procedures.
Among the gynecological malignancies, ovarian cancer is the most fatal due to its high mortality rate. Most of the identified cases are epithelial ovarian cancer (EOC) with five distinct subtypes: high-grade serous carcinoma, low-grade serous carcinoma, mucinous carcinoma, endometrioid carcinoma, and clear-cell carcinoma. Lack of an early diagnostic approach, high incidence of tumor relapse and the heterogenous characteristics between each EOC subtypes contribute to the difficulties in developing precise intervention and therapy for the patients. MicroRNAs (miRNAs) are single-stranded RNAs that have been shown to function as tumor suppressors or oncomiRs. The miR-200 family, especially miR-200c, has been shown to be implicated in the metastasis and invasion of ovarian carcinoma due to its functional regulation of epithelial-to-mesenchymal transition (EMT). This mini review is aimed to summarize the recent findings of the miR-200c functional role as well as its validated targets in the metastasis cascade of ovarian cancer, with a focus on EMT regulation. The potential of this miRNA in early diagnosis and its dual expression status are also discussed.
Segmentation of objects from a noisy and complex image is still a challenging task that needs to be addressed. This article proposed a new method to detect and segment nuclei to determine whether they are malignant or not (determination of the region of interest, noise removal, enhance the image, candidate detection is employed on the centroid transform to evaluate the centroid of each object, the level set [LS] is applied to segment the nuclei). The proposed method consists of three main stages: preprocessing, seed detection, and segmentation. Preprocessing stage involves the preparation of the image conditions to ensure that they meet the segmentation requirements. Seed detection detects the seed point to be used in the segmentation stage, which refers to the process of segmenting the nuclei using the LS method. In this research work, 58 H&E breast cancer images from the UCSB Bio-Segmentation Benchmark dataset are evaluated. The proposed method reveals the high performance and accuracy in comparison to the techniques reported in literature. The experimental results are also harmonized with the ground truth images.
This study investigated the therapeutic effects of connective tissue manipulation (CTM) in diabetic foot ulcer (DFU). A total of 20 participants (10 in CTM group and 10 in conventional treatment group (CG)) with DFU underwent the conventional DFU treatment. In addition, the CTM group received CTM twice per week for 6 weeks. The percentage wound area reduction (PWAR) and bacterial colonization count (BCC) in log10 colony-forming units (CFU) per ml wound fluid was evaluated at baseline and six weeks. Results showed a significant change in PWAR in CTM (p
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme deficiency worldwide including Malaysia. Screening of cord blood for partial G6PD deficiency is important as they are also prone to develop acute haemolysis. In this study, we determined the prevalence of partial G6PD deficient in paediatric population aged 1 month-12 years and normal term female neonates using OSMMR-D kit with haemoglobin (Hb) normalization and compare it with florescence spot test (FST). A total of 236 children, aged between between 1 month-12 years and 614 normal term female neonates were recruited for this study. Determination of normal means for G6PD activity and; cut-off points for partial and severe deficiency were determined according to WHO Working Group (1989). Determination of prevalence for partial deficiency for both groups (female patient) was done using this enzyme assay kit and findings were compared with FST. In this study, 15.7% (18/115) female children were classified as partial G6PD deficient by quantitative enzyme method (G6PD activity: 4.23-5.26U/gHb). However, FST only detected 0.9% (1/115) with minimal G6PD activity. The prevalence of partial G6PD deficiency in female neonate group was 3.42% (21/614) by enzyme assay versus 0.49% (3/614) by FST. This study concluded that our routine screening method using FST was unable to diagnose female heterozygotes. We recommend using this quantitative enzyme assay method by OSMMR-D kit since it was more sensitive in detecting G6PD deficiency in female neonates compared to FST.
Phorid flies play an important role in forensic cases and can cause myiasis in humans. Studies on phorid flies species diversity are still limited in Malaysia. This research was carried out to collect information about species and frequency distribution of phorid flies as to provide more information on their roles in forensic and medical entomology. Bait trap was used with 100 g beef liver as baits. The species of the flies were identified using identification keys from Disney as well as Brown and Oliver. There were 449 phorid flies found in Kepong, Kuala Lumpur including Megaselia scalaris, Megaselia spiracularis, Megaselia sp. and phorid flies of genus X. Female phorid flies (98.89%) were found more prone to be trapped compared to male phorid flies (1.11%). Most phorid flies trapped in Kepong, Kuala Lumpur were from genus Megaselia and consisted of female flies. A total of five species of phorid flies probably new to science were also discovered. This study showed that Megaselia flies were found indoors rather than in open spaces. This was corresponding to their discoveries among the decomposing corpse found inside premises.
This study reports the vision status of a presbyopic patient who has undergone a corneal inlay procedure. The study
hopes to provide optometrists more insight on the procedure and the co-management involved in such a patient. The
patient, a 48 years-old Chinese woman with presbyopia underwent the corneal inlay procedure three years ago.
She had the inlay implanted in the non-dominant eye to aid near vision i.e. her left eye. The pre and post-operative
evaluations include distance and near visual acuity, fundoscopy, tonometry, Schirmer’s test, slit lamp evaluation, corneal
topography and corneal pachymetry. Near visual acuity for the left eye improved from N14 to N5 immediately after
the procedure. Even after 3 years of post-operative followup, the patient was still able to maintain her near vision. In
conclusion, the corneal inlay procedure helped to improve near vision of this presbyopic patient. Optometrist plays
a very important role in the co-management of such patients alongside with the ophthalmologist in terms of visual
functional assessments pre and post-surgery, counseling of the procedure and managing patients’ expectations.
The knowledge, attitude and practice of breastfeeding among young mothers during pre-Baby Friendly Hospital Initiative implementation was conducted at seven private hospitals in Malaysia. A structured interviewer administered questionnaire was given to all mothers (n=Z52) visiting the antenatal/postnatal clinic of the hospitals. The main respondents were Malays (57.5%) and Chinese (35%) . For most mothers, breastfeeding was combined with supplementary feeds of formula milk, with only 30% breastfed exclusively. The majority of mothers knew that breast-milk contained antibodies and can prevent illness, however many were unaware of breastfeeding's contraceptive effect if practised exclusively. Most mothers did not relate breastfeeding as being environmental friendly. Generally, there was no knowledge gained from the experience of having more children with reference to breastfeeding. Most mothers were influenced by their own beliefs regarding choice of feeding method. Therefore, a mother was empowered with the knowledge of all practical aspects of breastfeeding, it would encourage her to breastfeed her baby.
Study site: seven private hospitals in Malaysia
Despite awareness of the detrimental effects of smoking, many adolescents initiate or continue to smoke. One possible explanation for smoking 13 the belief that it can control body weight. The objective of this study was to determine the association between Body Mass Index and smoking among Malay adolescents in Kota Bharu, Kelantan. A cross·sectional study was conducted between January to June 2005 among 1364 students selected from ten co»educational government secondary schools in Kota Bharu using stratified multistage cluster sampling. Guided self-administered questionnaire and anthropometric measurement were taken. Data was entered using SPSS 12.0 and analysed using STATA 8.0. The overall prevalence of smoking was 6. 7%. The prevalence of smoking among boys was 13.8% and among girls was 1.1%. There was no association between Body Mass Index and smoking. However, the findings may not be generalized to out-of·school youth and other ethnic groups in this country. The study was not conducted anonymously and the use of questionnaire to report smoking status can lead to measurement bias. Strategies aimed at correcting the belief that smoking can reduce weight should be included as one of the components in the prevention of smoking.
The high morbidity and mortality caused by smoking is a major public health problem today. Smoking prevention has been acknowledged and identified as a long-term measure to overcome this problem. This is a longitudinal knowledge; attitude and practice (KAP) study among form five students over l year. The response rate at follow‘up was 251/337 (74.5 %). The smoking prevalence changed after 1 year (from 29.7% to 26. 7%) after one year. The male to female smoking rates were 52.1% to 3.1% respectively. Students who smoke were found to have a positive attitude as well as poor knowledge of the risks of smoking. The initiation risk factors identified were being male and having a friend who smokes Positive peer influence also contributed to smoking cessation after a period of one year. Holistic measures that stress on micro macro and approaches such as health education programe to enhance knowledge of smoking hazards and community participation ( cooperation of school, family and community member) should be fomtulated in order to reduce initiation of smoking among the adolescents. Quit smoking programmes must also be readily available.
Recent years have witnessed unprecedented changes in the design and demands of work, and the emergence of job stress as a major concern. The aim of the study was to determine the psychosocial problems in relation to nature of work among female nurses at Hospital Selayang. The study was a cross-sectional study and the study population comprised of female nurses who are currently working at Hospital Selayang. A total of 393 study subjects were randomly selected and each respondent has been given a set of complete validated self-administrated Copenhagen Psychosocial Questionnaire. The result showed that the prevalence of having psychosocial problems was 24.9%. It is show that married nurses with more than three children has 3.54 (95%CI: 1.81-6.94) higher risks to have the problems compared to those with 3 or less children. Shiftwork nurses have 1.74 (95%CI: 1.01-2.99) more risk to have psychosocial problems compared to those who are not doing shiftwork. From the crude odds ratio, nurses who have served the service for more than seven years, there was 1.53 times more risk (95%CI: 0.89-2.63) to have psychosocial problems compared to those who only have service of seven years or less. From multivariate analysis, the risk of having psychosocial problems among nurses who are doing shiftwork found to be two times greater than those who are not doing shiftwork (OR=2.15; 95%CI: 1.12- 4.11) . Psychosocial problems in relation to nature of work among nurses at Hospital Selayang are higher among nurses who are doing shdtwork. The hospital management needs to overcome the problems and organizing the mental health programs among workers.
Cervical cancer is preventable by detecting precancerous states through Pap smear screening, followed by appropriate treatment. In Malaysia, even with a high incidence of cervical cancer and accessible screening program, the uptake of Pap smear screening was still low. Lack of knowledge, embarrassment, fear for the test and results are the factors reducing participation. The aim of this study was to determine the change in knowledge and attitude regarding the Pap smear screening as well as knowledge on cervical cancer among women in Mukim ]aya Setia after educational intervention. A community trial was conducted in August 2005 where 80 women were randomly selected. The women were interviewed for assessment prior to the intervention, using a set of structured questionnaire. The women underwent educational intervention programmes on cervical cancer and Pap smear screening. After a week, the women were re-assessed using the same set of questionnaire for their post intervention knowledge and attitudes. Scores were given for each answer, which were totaled and analyzed. The mean (SD) age was 41.1 (10.37) years. Most were housewives (87.5%), within the low income group (91.2%), of less than RM 1000.00 income per household. Most of the women received their education up to the secondary level only (97.5%). Despite their poor economic status, most of them had more than three children (68.8%). There was a significant improvement in knowledge of Pap smear (mean difference= 4.3, 95% CI= 3.55, 5.10) and cervical cancer (mean difference= 10.7, 95% CI= 10.03, 11.37) as well as attitude to Pap smear (mean difference= 7.1, 95% CI= 5.72, 8.47) after educational intervention. The knowledge and attitudes towards Pap smear screening as well as knowledge on cervical cancer among rural women in Mukim ]aya Setia, Kota Bharu improved after educational intervention.
The rapid development in the health sector has spurred many healthcare organizations to improve their productivity and quality, particularly in terms of service. Clinical Pathways was introduced with the objective of improving the quality of care and services in health; while at the same time eyeing the possibility of reducing the medical expenses. It can be defined as a document based tool that links the best available evidence and clinical practice and provides recommendations, the process and time frame for the clinical management of healthcare. A cross sectional study was carried out at University Kebangsaan Malaysia Medical Centre (UKMMC) Malaysia with the aim to evaluate the level of knowledge about Clinical Pathways (CP) and to ascertain its level of practice in the implementation of CP among healthcare workers at UKMMC; and to establish correlated determinant factors. The study involved a total of 127 respondents; majority of whom were female (77.2%), aged between 32 and 45 years (51.2%), working as nurses (71.7%), and having working experience of six years or longer (52.0%) at UKMMC. The findings reveal that 52.8% of respondents agreed that there is a proper implementation of the Clinical Pathways (CP) programme at UKMMC; and that 52.0% of the respondents have a higher level of knowledge about CP and 70.1% of them practiced it well. The findings also unravel two factors (position and working experience) as the predictors of respondents’ level of knowledge about CP, and position as a predictor representing the practice of it at UKMMC. It can be safely surmised that most of the respondents have a higher level of knowledge about Clinical Pathways and that they practice it well in their daily task as healthcare workers.
Although the Ministry of Health Malaysia has been encouraging the practice of Traditional and Complementary Medicine (T&CM)1, 2 , 3, 4 but patients/clients has not been able to apply it for their need of medical treatments and sometimes it leads to negative outcomes due to lack of knowledge on T&CM and its safe applications5,6’ 7,8 Most of the western-trained physicians are ignorant of risk and benefits of T&CM9,10,11 . This study was aimed to determine the gap between knowledge regarding T&CM and perception on education in T&CM among the medical staffs in five selected hospitals in Malaysia. A cross-sectional survey was done at five public hospitals among medical staff in Malaysia by using quantitative methods. A total of 477 medical staffs were involved in this study. The study showed that the overall knowledge of T&CM among the medical staffs were poor (61.2%). Having good knowledge regarding T&CM were significantly higher in Hospital Duchess of Kent (52%, p=0.001), among the non-Malays (44%, p=0.047) and pharmacists (47.2%, p=0.030). Positive perception on health education in T&CM among medical staffs were high (85.3%) especially among females (88.1%, p=0.002) and pharmacists (93.7%, p< 0.001). The use of T&CM among the general population is relatively high in Malaysia and many patients increasingly seek the information on T&CM therapies from medical staffs. Knowledge regarding T&CM was poor in this study because most of the medical staffs have not been exposed to T&CM education. This interesting scenario between poor knowledge and high positive perception on health education in T&CM shows the demand of urgent intervention in educating the medical staffs. We recommend that medical staffs must have some basic education and knowledge about T&CM before they could offer advice to their patients. Doctors are of the utmost important in this regard because they play a very important role in patient care. Providing T&CM education to medical staff may help to integrate T&CM into the mainstream medicine.
To observe the maternal and neonatal outcomes among women with diabetes mellitus in pregnancy as compared to healthy control. A case-control study involving 400 women with DM who delivered between 2005 to 2009 was done with age-matched control group. A total of 305 women (76.25%) were gestational diabetes mellitus (GDM) on diet control, 79 (19.75%) were GDM on insulin and 16 (4%) were pre-existing DM. The mean body mass index of the women with diabetes was higher compared to the age-matched healthy women (p
Introduction: To analyze the ART outcome and factors associated with successful ART treatment for infertile couples in a newly set up medical university IVF centre. Methods: A six-month cohort study of patients undergoing their first assisted reproductive technique cycle was conducted at IIUM fertility centre, Kuantan (from 15th June until 31st Dec 2009). Outcome measures include clinical pregnancy rate, ongoing pregnancy rate, take home baby rate and complications rate. Results: Fifty-five first cycles of IVF/ICSI were studied. Mean embryo per transfer was 2.1±0.8. Four patients were pregnant (23.5%) from a single embryo transfer (SET). Clinical pregnancy rate was 30.9% (17/55). Ongoing pregnancy rate was 23.6% (13/55) and take home baby rate was 21.8% (12/55). There was only one twin pregnancy. Nine patients (16.4%) had OHSS whereby 77.8% were mild and 22.2% were moderate. Conclusion: Take home baby rate at the IIUM fertility centre is comparable to most established ART centres in Malaysia considering that this is only the first year of operation.
Giant cell tumours of bone are best treated by extended curettage and filling in of the defect with cement or bone graft. In more advanced stages, when there is extensive loss of cortical bone cover, containment of the filling material is not possible and resection and reconstruction is required. We report a case of a recurrent giant cell tumour of the distal tibia in a 21-year-old female with extensive cortical bone loss in which polypropylene surgical mesh was used to contain the bone cement, thus avoiding a resection.
We report a rare case of septic arthritis of the lumbar facet joint (SALFJ) with co-existing spondylolisthesis of the L5 on S1 vertebra and discuss possible differential diagnoses, diagnostic difficulties and management of this condition.