Objective: To evaluate the factors that contributes to the decision for termination of pregnancy in prenatally diagnosed fetal anomaly cases.
Methods: A retrospective analysis of all cases of prenatally diagnosed fetal anomaly who delivered between 1 January 2007 and 30 June 2009 in two tertiary hospitals in Malaysia.
Results: A total of seventy-two (72) prenatally diagnosed pregnancies with fetal anomalies were identified. Mean maternal age was 29.8 ± 5.5 years and mean parity 1.47 ± 1.8. 70.8% of patients were ethnic Malay, 15.3% Chinese and 12.5% ethnic Indian. 22 (30.6%) fetuses were lethally abnormal. The overall pregnancy termination rate was 29.2%. 50% of pregnancies with lethally abnormal fetuses were terminated compared to 20% of pregnancies with non-lethal abnormality (p
This study was done in all UNIMAS medical students from year 1 to year 5 in the year 2004. A questionnaire was used. 290 students participated with a response rate of 72.5%. There were more male students snoring than female (ratio 5.9:1.3). The habitual snoring percentages for all years, first year and final year medical students are 7.2, 9.9 and 3.6 respectively and these are comparatively and relatively low with other studies reported in the last 10 years, and the reasons for this are unknown. However it was interesting to note in this study and others that there are relatively more snoring medical students in the first year than subsequent years. Significant positive correlation of snoring was found with the factors of gender, weight, height and sleep apnoea, all having p<0.0005, but no significant correlation was found in others including examination results.
Abstract: A total of 307 Malaysian children and their parents were surveyed to ascertain the prevalence of mental health problems amongst urban primary and secondary school children. The results indicated that secondary school children report slightly higher rates of depressive symptoms, whereas primary school children report higher rates of social problems. There was also a discrepancy between child and parents reports of children’s emotions and behaviours. Children’s self-reports of aggressive behaviours where higher than their parents’ reports. Alternatively, parents reported lower levels of their childrens’ emotional problems, as compared with the childrens’ self-report. When gender was taken into consideration, females were reported to be more aggressive, withdrawn, and have more attention problems when compared with males.
We report a 35 year-old Iranian female who presented with a sudden onset of left sided hemiparesis associated with temporary loss of consciousness of about 3 minutes. Neurological examination revealed a power of 0/5 over the left upper/lower limbs but reflexes were normal and plantar reflex was downgoing and equivocal. A computed tomography scan was done and it revealed mild bilateral frontal atrophy and a temporal arachnoid cyst which was decidedly an incidental finding and it did not have any relation to the clinical presentation. Electroencephalogram and other laboratory findings were all normal. When the psychiatric team interviewed her, it was revealed that the patient had recently experienced a major stressful event just prior to the hemiparesis. On further interview, the patient had complained of delusions of persecution, delusions of reference and also auditory hallucinations for approximately a year prior to admission. There have been only a spatter of reports of conversion symptoms seen in patients with schizophrenia and this is such a case.
Thyroid diseases are common in women, including at the time of pregnancies. Many typical features of hyperthyroidism are common in normal pregnancies and this may delay or mask the diagnosis. Uncontrolled thyrotoxicosis increases the rate of miscarriage, intrauterine growth restriction (IUGR), premature labour and perinatal mortality. Multi-disciplinary efforts are required to achieve optimal control of thyrotoxicosis. Anti-thyroid drugs are safe and should be used with the lowest possible doses. Radioiodine treatment is contraindicated during pregnancy and lactation. Indications of surgery include: compression symptoms, thyroid malignancy, non-compliance to medications or when the patient develop drugs side effects
Current asthma treatment is directed by severity of symptoms and lung function. In Malaysia, spirometry is not widely available and therefore not used in most medical consultations. In 163 asthmatic patients [mean (95% CI) age: 41 (38-44) yrs; 29% male; 32% Malays, 32% Chinese, 34% Indians] who were being followed up in a State Hospital medical outpatient clinic and a large urban-based health clinic, we studied the effect on Global Initiative for Asthma (GINA) disease severity classification and the appropriateness of currently prescribed treatment when forced expiratory volume in one second (FEV1) was considered together with symptom severity. We showed that 52% of the patients were upgraded to a higher severity classification and 71% of the patients were under-treated. If based on symptoms alone to assess severity, 39% of the patients were still under-treated. We concluded that the disease severity in many asthmatic patients might have been underestimated and therefore not adequately treated, because spirometry was not available or used to assess asthma severity. The use of spirometry should be advocated more widely among clinicians treating asthma in Malaysia.
Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan; Klinik Kesihatan Seremban, Malaysia
Thyroxine has been shown to have a beneficial effect on renal function in cases of impending renal failure in ani-mal studies.'5 Studies of the use of thyroxine in humans in impending renal failure are scarce. The aim of this study was to assess the effect of oral thyroxine on the renal function of asphyxiated term neonates who often have renal impairment.
A randomised control trial was conducted, involving 30 term asphyxiated neonates. The study group (n=15) was given thyroxine (50 pg) orally on days 1, 2 and 3 of life and placebo was given to the control group (n=15). Renal function was studied on day 1 and day 4 of life. The two groups did not differ significantly as regards gestational age, birth weight, severity of asphyxia, preg-nancy or delivery complications, fluids administered and drugs used. There was no significant difference in urine output, creatinine clearance and fractional excretion of sodium on day 1 but there was a trend towards a worse renal function on day 1 in the treatment group. The creatinine clearance was significantly better in the treat-ment group on day 4 (p = 0.017). Urine output and fractional excretion of sodium on day 4 were better in the treatment group but the differences did not reach statistical significance (p = 0.14 and 0.057 respectively). Statistical analysis on the differences between day 4 and day 1 showed statistical significance only for creatinine clearance: creatinine clearance day 4 minus creatinine clearance day 1 was 52.6 (±32.4) for the thyroxine group and 7.3 (±7.8) for the controls (p= 0.006).
These data support the hypothesis that thyroxine may have a significant beneficial effect on the renal function in term neonates with perinatal asphyxia. Thyroxine may be proven useful in future for patients with impending renal failure.
A 45-year-old Malay housewife was seen at a health clinic with the chief complain of recurrent lower abdominal pain for 9 months. The pain was colicky in nature and occasionally it radiated to the back. There was no history of fever, vaginal discharge or any urinary or bowel symptoms. She had been using an intrauterine contraceptive device (IUCD Cu250) for the past 5 years. The last change of the IUCD was 2 years ago. Her annual pap smear results were normal. She had been to many primary care clinics and was reassured by the doctors that her symptom was due to her IUCD. She was prescribed mefenamic acid repeatedly for the past 9 months. However her symptoms worsen and she was worried because prior to this she did not have similar problems. Her physical examination was unremarkable. On pelvic examination, the IUCD string was visualised, indicating that her IUCD was still in-situ. Her cervix was pink and healthy. There was no abnormal vaginal discharge.
Milk lipids play an important role in the early nutrition of an infant's life. A study was undertaken to investigate the total lipid content of milk obtained from urban, exclusively breastfeeding Malaysian mothers offill term infants. Results from approximately 600 samples analysed using a commercial kit [MerckotestO] , showed that the total lipid concentration was lowest in colostrum [1.9 + 0.1 g/dl J, however this value increased gradually with days of lactation and attained a maximum concentration of 3.1 ± 0.1 g/dl during the mature milk stage. This agrees with results from other studies that the total lipid content is indeed influenced by the stage of lactation. The effect of socioeconomic factors such as income and parity on the milk lipids was also investi-gated and the results revealed that the above factors had no significant influence on the total lipid content of Malaysian mother 's milk obtained during all three stages of lactation studied [colostrum, transitional and mature milk] . However; ethnicity showed significant influence during the mature but not in the early [colostrum and transitional] stage of lactation. This however, is not filly explained by this study. As a whole, this study suggests that the human breast, through a mechanism that is ill understood, maintains cm optimal level of total lipid in milk despite their differing cultural and genetic background. It is hoped that such scientific evidence will instil more confidence among breastfeeding mothers in this fast developing cosmopolitan nation.
A sample of 204 handicapped children below 12 years of age consisting of 121(59.3%) males and 83 (40.7%) females who were classified into various types of mental and physical handicaps, were surveyed in April and May 1996. The majority of those with mental handicaps were Down Syndrome while those with cerebral palsy were the mostfrequent cause of physical handicaps. A structured questionnaire was used for interviewing the children parents to evaluate their attitude towards their handicapped children. The majority of the parents expressed their opinions that having handicapped children was not a burden to them although these children had to be given more attention. However, a significant minority felt that the child would be afinancial burden to the family and that he/she would restrict the social life of the family. The majority of the children were sent to school, as parents felt it was their duty to do so. For those children not attending school, the majority of parents felt that the children would not benefit by going. The others could not do so because offinancial constraints or because of the distance between home and school. For these children, provid-ing hostel facilities in a boarding school could be the answer. This study shows that parental love and support plays a major role in ensuring optimal growth and development of a handicapped child
Introduction: Emotional intelligence (EI) refers to the ability to perceive, control and evaluates emotion. Research results found that EI is relevant to organizational development and manpower development. It is also important to academic success, emotional adaptability, stress management and other lifestyle issues. EI principles help one to understand and assess people's behaviors, interpersonal skills, attitudes and potentials. It also plays an important role in human resource planning, job placement and recruitment interviews and selection, business development, customer care services, and more. The study focused on exploring students’ EI, subscales of EI (i.e., personal competencies and social competencies) and its associated factors. Methods: A cross-sectional study was conducted on 571 medical students from year 1, 3 and 5. Years of study, gender, and ethnic groups were included as factor variables. USM Emotional Quotient Inventory (USMEQ-i) was used to measure EI, personal competence and social competence. Results: Years of study significantly associated with EI (F = 18.41, p < 0.001), personal competency (F = 16.93, p < 0.001) and social competency levels (F = 12.92, p < 0.001). There was a decreasing pattern of EI, personal competency and social competency level as medical training progresses. Male significantly had a higher EI (t = -1.99, p < 0.05) and personal competence (t = -1.99, p < 0.05) levels than female medical students. Nevertheless, male and female students had equal levels of social competence (t = -1.39, p = 0.730). Ethnic groups demonstrated no significant association with EI, personal competency and social competency level. Conclusion: This study found that years of study were the main associated factor, followed by gender. In addition, there is a cause of concern regarding the decreasing pattern of EI throughout medical training. Further research is required to investigate this concern, so that appropriate intervention can be taken to alleviate the concern.
Recently, the integration of mobile phone apps into healthcare system is increasing as a result of the availability of medical applications. This study determined the perception of readiness of community pharmacists on the use of mobile smartphone as a health monitoring tool and the relationships between perception and readiness with selected demographic variables of the respondents. Methods: A crosssectional survey was conducted by distributing a modified 15-item instrument to a convenience sample of pharmacists (n = 245) across Malaysia by post. Statistical analyses were performed using SPSS version 20. Results: Response rate was 31.4% (n= 77). The mean age of the respondents was 35.5 ± 6. 52 years. The sample consisted of mostly women (71.4%). Overall, there were moderate “positive responses” across the two domains. Positive perception ranged from 54.5% to 66.2% and positive readiness ranged from 55.8% to 64.9%. No significant associations between perception and readiness with the selected demographic variables were detected (age, gender, location and outlet type). Conclusions: This study demonstrated that there was generally positive perception of mobile phone use for pharmaceutical care among community pharmacists in Malaysia. They were also ready to adapt it to improve pharmaceutical care delivery to patients.
Migraine with aura is one of the major subtypes of migraine, and can be associated with ischaemic brain infarction. Use of oral contraceptive pills (OCPs) increases the risk of infarction in this type of migraine. Seizures and migraine also have a complex relationship, one element of which is migraine- triggered seizures. We report a case of bilateral occipital lobe infarction and migraine-triggered seizures, most likely precipitated by oral contraceptive pills (OCPs) in a patient with migraine with visual aura. OCPs, triptans and ergotamines should be used cautiously in these patients. Methods of birth control other than OCPs should be considered.
Background: This cross-sectional study aimed to investigate the prevalence of the caregiving burden among women who are caregivers to elderly with stroke and factors influencing it. Respondents identified through purposive sampling at the Universiti Malaya Medical Centre from October to December 2007.
Methods: Direct methods of data collection (clinical and housing) and indirect (postal) used a structured questionnaire distributed to the guards. Measurements taken include sociodemographic variables of patients and caregivers, the patient, the care, relationships with caregivers and patients with information about stroke. Zarit Burden Interview (ZBI) short version was used to measure the burden of care. Carers' Assessment of Managing Index (Cami) was used to assess coping strategies. A total of 96 respondents took part in this study.
Results: The study showed that prevalence of caregiving burden was 35.4%. Burden of care was found to have significant relationships with factors such as marital status, caregivers (p = 0.017), family income (p = 0040) and the patients (p = 0.000). Significant correlation obtained for the coping strategies with the burden (r =- 0228, p 0026).
Conclusion: The conclusion shows that policy makers and program managers should appreciate and assist caregivers in performing the role of care. Intervention programs should be designed to suit the needs of the heterogeneous guardian.
This study aims to examine the vancomycin initial dosing and the resultant trough level in paediatric patients. In this retrospective observational study, all therapeutic drug monitoring (TDM) records of paediatric patients admitted to Sabah Women and Children Hospital (SWACH) from January 2011 to September 2013 were reviewed and 116 patients without renal disease were included in the study. Of the total, 38.8% were neonates, 32.8% were infants and 28.4% were children. The majority of the patients were intensive care patients (69.0%) and the most common clinical indication for vancomycin was sepsis (44.8%). The four initial dosing regimens identified were 40 mg/kg/day (38.8%), 30 mg/kg/day (31.0%), 60 mg/kg/day (25.0%) and 45 mg/kg/day (5.2%). The distribution of initial dosing regimen was significantly different between the three age groups (p40 mg/kg/day (p=0.007). The proportions of those who achieved the target therapeutic range (10–20 mg/L) in the 2 dosing groups were 30.9% and 60.0% respectively. In conclusion, the study showed that the initial dosing of >40 mg/kg/day is more likely to achieve the target therapeutic range (10–20 mg/L) compared to the initial dosing of ≤40 mg/kg/day.
Individualising a drug dosage regimen is more appropriate if it is based on pharmacokinetics data derived from local populations. In this study, we estimated valproic acid (VPA) and carbamazepine (CBZ) clearances in the Malaysian population from routinely collected therapeutic drug monitoring (TDM) data. We also evaluated the effects of gender, age, weight and concurrent antiepileptic drug (AED) therapy on VPA and CBZ clearance. Data was collected retrospectively from TDM forms of adult patients. Apparent drug clearance was estimated based on the standard steady state clearance equation. Mann-Whitney and KruskalWallis tests were used to evaluate gender and therapy differences, while Spearman’s Rank correlation was used to determine the associations of age and weight with clearance. One hundred thirty-two samples for VPA and 67 for CBZ were included in the analysis. Patients’ ages ranged from 15 to 72 years old. Mean VPA and CBZ clearances were found to be 0.36 l/kg/d and 1.60 l/kg/d, respectively. VPA clearance correlated positively but poorly with weight. Our results showed significant differences in (i) VPA clearance among male and female patients and (ii) VPA clearance between monotherapy and combination therapy. These findings provide a guide to initiate maintenance doses of VPA and CBZ in our local patients. Awareness of factors influencing drug clearance should help to optimise patients’ dosing regimens.
The aim of this study was to investigate the acute (one-day treatment) effect of a methanol extract of
Orthosiphon stamineus, Benth on glutathione-S-transferase (GST) activity in streptozotocin (STZ)-induced diabetic young male and female Sprague Dawley (SD) rats. The methanol extract of O. stamineus was administered orally (5, 31.25, 125 and 500 mg/kg) to diabetic rats, and the effect on GST activity was measured by the method of Habig et al. (1974). No lethality and no significant changes in body weight and water intake were observed in the treated group as compared to the control group. A significant increase in the activity of GST was observed in the liver S-9 cytosolic fraction of diabetic male SD rats treated with 125 mg/kg (P < 0.01) and 500 mg/kg (P < 0.01) of the methanol extract O. stamineus. Administration of 500 mg/kg (P < 0.01) of the methanol extract of O. stamineus to diabetic female SD rats increased GST activity when compared to the control group. This study indicates that the methanol extract of O. stamineus could affect the activity of GST in rat liver and the effect seen was dose-dependent.
Red cell alloimmunisation is defined as the development of antibodies in response to foreign red cell antigens through transfusion or pregnancy. In pregnant women even without the history of previous blood transfusion, this is possible through previous or current pregnancy with the presence of paternal red cell antigen inherited by the fetus. This study was aimed to determine the prevalence of red cell alloimmunisation among pregnant women without previous history of blood transfusion and the association with number of pregnancy and history of obstetric complications. This was a cross-sectional study in which 150 pregnant women were randomly selected from the antenatal clinic. Ten mls of peripheral blood was obtained for antibody screening using indirect antiglobulin test besides the routine antenatal screening. In this study, the majority (37.3%) of the women were primigravidae. Red cell alloantibodies were detected in two out of 150 (1.3%) patients which were subsequently identified as anti-C and anti-D. However none of the primigravida was alloimmunised. One woman of gravida 2 (2.9%) and gravida 3 (3.6%) each were positive for alloimmunisation. One of them also had a bad obstetric history. This study showed that the prevalence of red cell alloimmunisation among pregnant women was low in this centre. Nevertheless, red cell alloantibody screening test should be made available to reduce possible complications of alloimmunisation in mothers and fetuses.
Study site: Antenatal clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Orbital cellulits is one of the life threatening event that should not be missed out and must be distinguished from preseptal cellulitis. It is an infective process involving ocular adnexal structures posterior to the orbital septum. High index of suspicion is the key to its diagnosis as even experienced physician can miss. Here, we present a case of a 15-year-old female who presented with progressive swelling over right forehead associated with high grade fever, headache and purulent discharge of the swelling. She was diagnosed with sepsis due to right forehead abscess and was treated with intravenous antibiotics followed with admission. However, she suddenly deteriorated in the ward which required intubation and thereby Intensive Care Unit (ICU) admission. Investigations revealed fluid collection at right retrobulbar space suggestive of an abscess where emergency drainage was carried out. Unfortunately, her condition worsened and patient succumbed at day-10 of admission, despite all efforts.
A 69-year-old lady was diagnosed to have mucoepidermoid carcinoma of hard palate 3 years ago. She completed 20 cycles of external beam radiotherapy and 5 cycles of mould brachytherapy and remained asymptomatic until she again presented to us with the recurrence of a painless mass at the hard palate. The hard mass appeared as an ulcerated dimple measuring 2 x 1 cm located at the junction of the hard and soft palate, more towards the right. Excision biopsy of the mass was done with a 1cm circumferential margin deep to the periosteum, with the resulting exposed bony defect covered with a rotational flap from the soft palate. During follow-up, the patient complained that the saliva came up into the nose whenever she swallowed. Oral examination (Figure 1) and flexible nasopharyngolaryngoscopy (FNPLS) (Figure 2) were performed. What is your diagnosis?