Introduction: Nasopharyngeal Carcinoma (NPC) is the second most common cancer among men in Malaysia. Establishing local data will help to improve the treatment strategies and lower the anxiety and depression level among NPC patients. Our aim was to compare the level of symptoms of anxiety and depression and the coping strategies employed between NPC and cancer-free patients. Methods: A comparative cross-sectional study with universal sampling was conducted on 22 NPC patients and 30 cancer-free patients from the Oncology and Radiotherapy Department and Ear, Nose and Throat clinic of Hospital Kuala Lumpur (HKL) between 12 to 29 May 2008. In this study, the symptoms of depression and anxiety were obtained by using the Hospital Anxiety and Depression Scale (HADS) while Brief COPE questionnaire was used to understand patients’ coping strategies. Results: The prevalence of NPC was higher in the Chinese, men, aged between 40 and 59 years, and those from the lower income group. The levels of anxiety and depression symptoms were found to be higher in the NPC group as compared to the cancer-free group. However, only the level of depression was found significantly related to the NPC group (p=0.002). This study also found that the two comparison groups were
using different types of coping strategies. The NPC patients mainly used ‘acceptance’ as their coping strategy while the comparative group most often used ‘religion’. Among the types of coping strategies reported by the patients, ‘use of instrumental support’ type was found to be associated with a lower level of anxiety (p = 0.035) and ‘humour’ type was associated with lower depressive symptoms (p = 0.269). On the contrary, ‘selfblame’ type was associated with both anxiety (p =0.0001) and depression (p = 0.001) symptoms. In addition, patients with different gender, ethnicity, educational levels, and
monthly income were also found to have significant differences in their levels of anxiety and depression as well as type of coping strategies. Conclusions: NPC patients had higher anxiety and depression levels as compared to the comparative group. Different socio-demographic backgrounds and different types of coping strategies had an influence on patients resulting in different levels of anxiety and depression.
Study site: ENT clinic, Hospital Kuala Lumpur, Malaysia
Language studies were done on four multilingual dextral Chinese patients who developed dysphasia from various causes. The left hemisphere appeared to be dominant for all the languages in the four patients. All the languages and dialects were universally involved during the development of dysphasia. In one patient,
there was evidence of delayed restitution in the patient's mother tongue (Hokkien) comparing with Mandarin and English which were the languages used in the hospital and for reading.
Gas-forming infection of the kidneys can affect either the parenchyma or the collecting system. They are known as emphysematous pyelonephritis (EPN) and emphysematous pyelitis (EP) respectively. Bilateral EPN is a fairly established entity and numerous articles about this condition have been published. However, much less is known about bilateral EP. We report a rare case of bilateral EP and a literature review of this disease. A 66-year-old woman with long-standing bilateral staghorn calculi presented with bilateral EP and severe sepsis. She was treated with antibiotics and bilateral double-J stents to drain the upper urinary tracts. She recovered after 1 month of intensive care and medical therapy. Percutaneous nephrolithotomy (PCNL) had been scheduled to treat her staghorn calculi. A literature search on MEDLINE and Google Scholar with the terms "bilateral emphysematous pyelitis" only found 1 case report in English and another 2 reports in the Korean language that discussed bilateral EP. The collective experience of these few cases, including the present case, suggests that bilateral EP runs a more benign course than bilateral EPN. It should be diagnosed as soon as possible with computed tomography (CT) scans of the renal system. Current evidence shows that can be treated successfully with timely antibiotics. Drainage of the collecting system either percutaneously or with placement of double-J stents might facilitate recovery.
Peritoneal radionuclide scan is an established imaging modality for evaluating peritoneopleural communications. In this case report, unusual mediastinal lymph node radiotracer uptake is seen in a patient with portal hypertension on peritoneal scintigraphy. This was suspected to be due to marked lymphatic enlargement from longstanding portal hypertension since childhood, permitting passage of the large Tc-99m MAA particle. The nodes were morphologically benign on CT. Mediastinal lymph node uptake on peritoneal scintigraphy is rare but should not raise undue clinical concern, particularly in a patient with chronic portal hypertension. Anatomic correlation with SPECT-CT can provide reassurance.
Vancomycin has been documented to cause various adverse cutaneous reactions. We present a case report of a man, who developed a large localized erythematous plaque in his forearm following parenteral vancomycin therapy. We believe this to be the first reported case of such cutaneous reaction associated with parenteral vancomycin therapy.
Topical keratolytic agents such as benzoyl peroxide (BP) and salicylic acid (SA) are one of the common treatments for inflammatory skin diseases. However, the amount of drug delivery through the skin is limited due to the stratum corneum. The purposes of this study were to investigate the ability of fish oil to act as penetration enhancer for topical keratolytic agents and to determine the suitable gelator for formulating stable fish oil oleogels. 2 types of gelling agents, beeswax and sorbitan monostearate (Span 60), were used to formulate oleogels. To investigate the efficacy of fish oil oleogel permeation, commercial hydrogels of benzoyl peroxide (BP) and salicylic acid (SA) were used as control, and comparative analysis was performed using Franz diffusion cell. Stability of oleogels was determined by physical assessments at 20°C and 40°C storage. Benzoyl peroxide (BP) fish oil oleogels containing beeswax were considered as better formulations in terms of drug permeation and cumulative drug release. All the results were found to be statistically significant (p<0.05, ANOVA) and it was concluded that the beeswax-fish oil combination in oleogel can prove to be beneficial in terms of permeation across the skin and stability.
Accreditation is a process by which official accrediting bodies evaluate institutions using a set of criteria and standards, following established procedures, to ensure a high quality of education needed to produce highly competent graduates. Additional objectives include (1) ensuring quality institutional functioning, (2) strengthening capabilities of educational institutions for service to the nation and (3) improving public confidence in medical schools. The accreditation process provides an opportunity for the institution to critically reflect upon all the aspects of its programme and the level of compliance or attainment of the requirements. The self-evaluation exercise, which identifies strengths and weaknesses, is perceived as formative. It is envisaged that eventually institutions will adopt a learning culture for curriculum development, implementation, monitoring and matching the outcomes. In conclusion, periodic accreditation activities can act as a "monitoring" system to ensure that the quality of medical education is maintained according to established standards.
All percutaneous tracheostomies performed in the general intensive care unit (ICU), Hospital Sultanah Aminah, Johor Bahru, Malaysia, from July 1999 to June 2002 were studied. The tracheostomies were performed as an elective bedside technique in the ICU. A total of 352 percutaneous tracheostomies were performed. Eighty-eight percent of the tracheostomies were completed within 15 minutes. The most common complication was bleeding which occurred in 52 patients (14.7%). The rest of the complications encountered were:- transient hypoxia twelve (3.4%), inability/ difficulty to insert tracheostomy tube eight (2.3%), false passage four (1.1%), transient hypotension two (0.6%), pneumothorax two (0.6%), peristomal infection two (0.6%), subcutaneous emphysema one (0.3%), cuff rupture one (0.3%), oesophageal cannulation one (0.3%), and granuloma formation one (0.3%). Conversion to conventional tracheostomies were performed on 7 patients (2%). There was one unfortunate death related to percutaneous tracheostomy. In conclusion, percutaneous dilational tracheostomy can be used safely to manage the airway of critically ill patients.
We report two patients with myopathic dropped head syndrome, a rare and interesting neuromuscular syndrome characterised by a predominant weakness of the neck extensor muscles. The first patient, a middle aged Chinese man, presented with progressive weakness of neck extension but his clinical course later stabilised despite a lack of response to corticosteroids. Muscle biopsy revealed a necrotising myopathy with no evidence of inflammation. This patient supports the existence of an idiopathic restricted non-inflammatory myopathy, a so called isolated neck extensor myopathy syndrome which is recognised to pursue a less progressive, more benign course. Our second patient had histopathological evidence for polymyositis; there was a favourable response to steroids. Our cases underscore the fact that there may be a spectrum of pathological processes associated with the myopathic dropped head syndrome ranging from non-inflammatory muscle necrosis to a full blown inflammatory myositis.
The effects of scanning rates (1, 5, 10 and 20 degrees C/min) on the DSC cooling profiles of 11 vegetable oils have been determined in order to monitor peak transition temperatures, onset temperatures and crystallisation enthalpies. Triacylglycerol (TAG) profiles and iodine value analyses were used to complement the DSC data. The melted samples exhibited complicated crystallising exotherms. As the cooling rate increased, the crystallisation temperature decreased and the breadth of the crystallisation exotherm on cooling from the melt increased. In addition, the intensity of the exothermic peak increased somewhat when the cooling rate was increased. At slow cooling rates, TAG had more time to interact. It is conceivable that, at a low cooling rate (1 degree C/min), a prominent exotherm would be observed on crystallisation of vegetable oils and fats. The occurrence of one exotherm upon cooling indicated the co-crystallisation of the TAG upon slow cooling. On the basis of the corollary results obtained, vegetable oils may be differentiated by their onset temperature (Ton) values in the DSC cooling curves. Generally, there was a shift of Ton toward lower values with increasing cooling rates.
The melting curves of 11 vegetable oils have been characterised. Vegetable oil samples that were cooled at a constant rate (5 degrees C/min) from the melt showed between one and seven melting endotherms upon heating at four different heating rates (1, 5, 10 and 20 degrees C/min) in a differential scanning calorimeter (DSC). Triacylglycerol (TAG) profiles and iodine value analyses were used to complement the DSC data. Generally, the melting transition temperature shifted to higher values with increased rates of heating. The breadth of the melting endotherm and the area under the melting peak also increased with increasing heating rate. Although the number of endothermic peaks was dependent on heating rate, the melting curves of the oil samples were not straightforward in that there was no correlation between the number of endothermic peaks and heating rates. Multiple melting behaviour in DSC experiments with different heating rates could be explained by: (1) the melting of TAG populations with different melting points; and (2) TAG crystal reorganisation effects. On the basis of the corollary results obtained, vegetable oils and fats may be distinguished from their offset-temperature (Toff) values in the DSC melting curves. The results showed that Toff values of all oil samples were significantly (p < 0.01) different in the melting curves scanned at four different scanning rates. These calorimetric results indicate that DSC is a valuable technique for studying vegetable oils.
The aims of this study were to examine the clinical and laboratory features of Malaysian patients with systemic lupus erythematosus (SLE) and to identify any difference in disease expression between the different genders and among the three major ethnic groups of Malaysia. Retrospective analysis of all patients with SLE admitted to and followed-up at University Hospital Kuala Lumpur from 1974-90 was undertaken. Ethnic Chinese had the highest prevalence of SLE compared to other ethnic groups. There was a high incidence of renal disease, 74% of patient had significant proteinuria and half of these had associated nephrotic syndrome. Indian patients had significantly less incidence of skin manifestation compared to other racial groups. No difference in disease expression was detected between the ethnic Chinese and Indians and between the male and female patients. The overall 5 y and 10 y survival rates were 82% and 70% respectively. Indian patients had the poorest survival rates. Survival rates are similar among the Chinese and Malay patients. Our findings are in broad agreement with those previously reported.
This community study on headache in Malaysia was based on IHS diagnostic criteria and showed the last-year prevalence of migraine was 9.0%. Migraine with aura accounted for only 10.6% of the migrainous population. The last-year prevalence of tension headache was 26.5% (94.4% episodic, 5.6% chronic) and 28.2% for other types of headache. No case of cluster headache was found. Almost two thirds of the migraine subjects graded their headaches as severe, while almost 60% of the tension headache subjects and almost 70% of the other headache subjects graded their headaches as mild. Overall, there was higher prevalence in females for migraine and tension headache, and in males for the other types of headache. The prevalence of headache was lower among those younger than 15 and older than 65 years of age. No significant differences were found in the prevalence of headache among the different racial groups nor among the urban versus the rural population. All the headache types shared the same triggering factors suggesting that different physiological characteristics are responsible for the type of pain suffered. In the location of this community with its tropical climate, headache was attributed to sun exposure in 51.9% of the migraine subjects, 55.7% of the tension headache subjects, and 36.6% of the group with other headaches.
Three building complexes in Kuala Lumpur were surveyed for the presence of legionellae in cooling towers. The organisms were grown from 12 out of 46 samples of water collected from 30 towers. L. pneumophila serogroups 1 and 7 were the commonest serogroups isolated. None belonged to the Pontiac subgroup of L. pneumophila serogroup 1.
Three patients involved in road traffic accidents were suspected to have obstructive sleep apnoea (OSA). Two of them fell asleep while riding motorcycles and one patient fell asleep behind the wheel of a truck causing it to overturn. The diagnosis of OSA in each case was suspected based on a history of loud snoring, restless sleep, and excessive daytime somnolence and was confirmed by sleep studies.
Spinal vascular malformation is an uncommon but potentially treatable cause of myelopathy. We describe two cases of angiographically proven spinal vascular malformation in Malaysia. The first case is a 47-year-old man who had a progressive myelopathy and the second a 60-year-old man with intermittent attacks of transient paraparesis leading to paraplegia. As the clinical presentation of spinal vascular malformation is variable, it should be considered as a cause of patients with myelopathy.
The clinical course of 18 patients with Wilson's disease is reported. There were 13 males and five females of whom one is Malay. The prevalence of Wilson's disease in Malaysia is probably the same as elsewhere. Being a genetic syndrome, the genetic carrier rate for Wilson's disease is probably lower amongst the Malays. At diagnosis, the clinical signs were predominantly hepatic in 10 patients, neurological in five patients with three asymptomatic cases. All patients were commenced on penicillamine but poor compliance was observed in many patients. Two patients defaulted follow-up and seven patients died. Out of the nine surviving patients, only four are well with no clinical symptoms.
A self-administered questionnaire survey was conducted among sawmill managers in Sarawak to explore certain health and safety aspects of workers in this industry. The survey reveals that many sawmills are lacking in the provision of occupational health facilities and activities for their employees.
A study of 12 patients with clinically definite multiple sclerosis (CDMS) using high dose infusion CT showed overall abnormality of 75% with an average of 2.5 lesions per patient. 75% of the patients showed abnormality of the cerebrum, mostly asymptomatic. The main changes were ventricular dilatation and asymmetry, isolated or generalized cerebral atrophy, areas of low attenuation mainly in the deeper parts of the cerebrum and the peri-ventricular area. 25% of the patients showed changes in the brainstem and none was seen in the cerebellum. The abnormality was more florid in patients with clinically disseminated forms of the disease. The study demonstrated that asymptomatic cerebral involvement is common among Asian patients with MS and CT is a useful tool in the overall assessment and diagnosis of Asian MS patients.