Aging population will be an inevitable phenomenon around the globe. This study aimed to
assess the quality of life and its associated factors among the elderly population in rural areas of
Kudat, Sabah. A community based cross-sectional study was conducted among elderly aged 60 and
above living in Tambuluran Area of Kudat. Quality of life was assessed using WHOQOL-BREF
questionnaires. Socio-demographic data of the elderly, perceived morbidities and utilization of health
services were collected. Independent sample t-test was used for data analysis. A total of 165
respondents participated in this study with a mean age of 71.42±6.50. The mean WHOQOL-BREF
score was 65.20 ±11.49. Mean scores for physical and psychological domains were lower than
average. Age, marital status, educational level and perceived morbidity were associated significantly
with QOL. In conclusion, QOL was generally average among elderly in rural areas of Kudat.
Therefore, interventions should place emphasis on physical and psychological aspects of life among
these aged population.
Inflammatory myopathies (IM) is a rare inflammatory muscle disorder, which can be broadly divided into 5 subgroups. The accurate diagnosis of subtype of IM can be challenging due to a diverse presentation of the disease. On the other hand, skeletal muscle complication is common in patients with systemic lupus erythematosus (SLE) in the form of myalgia or myopathy. Inflammatory myopathy is a rare association of SLE and the diagnosis and treatment can be quite challenging. A 43-year-old lady with underlying systemic lupus erythematosus (SLE), presented with subacute onset progressively worsening muscle weakness involving upper limbs and lower limbs. Neurological examination showed findings consistent with proximal myopathy, with proximal power of 3/5 and distal power of 4/5. She has elevated creatinine kinase, ALT and AST level. Her myositis-specific autoantibodies were positive for anti-Ku antibodies. Her electromyography showed evidence of active myopathy of the upper and lower limb. Here, we would like to report a case of polymyositis in a patient with SLE.
Rapid Stroke is a common clinical problem. Stroke can be broadly divided into ischaemic and haemorrhagic stroke. Ischaemic stroke can be further classified by TOAST classification into large-artery atherosclerosis, cardioembolism, small vessel occlusion, the stroke of other determined aetiology and stroke of undetermined aetiology. Importantly, we need to be wary of important stroke mimics such as brain tumour, demyelination, intoxication as they can lead to changes in clinical management. Here, we would like to illustrate a case of meningioma which clinically mimics a stroke. This patient is a 78-year-old lady who initially presented with sudden onset right-sided body weakness associated with slurred speech and facial asymmetry. An urgent plain computed tomography (CT) of the brain showed hypodensities at the left middle cerebral artery territory. However, re-evaluation noted her to have a normal Glasgow Coma Scale without any cortical signs, cerebellar sign or dysphasia. In view of these, stroke mimics was suspected. A contrasted CT brain was done which confirmed the diagnosis of meningioma. She was offered surgical intervention for meningioma but she was not keen on it. In conclusion, this case highlighted the importance of clinical evaluation in recognising stroke mimics
Anaerobic digestion is a process by which microorganisms break down biodegradable material in the absence of oxygen. The process involves hydrolysis, acidogenesis and methanogenesis stages. Anaerobic digestion of food waste has been widely investigated for biogas recovery but limited study was performed on phosphorus recovery, which is reported depleting. Food waste is produced every day and dumped on landfill for final disposal which may lead to environmental issues such as odour problems and greenhouse gases release, due to decomposing of food waste, hence impacts global climate change. In anaerobic digestion pH is a very crucial parameter in an attempt to recover phosphorus as it highly influences the production of organic acids during acidogenesis.
Over the last few years, Universiti Malaysia Sabah (UMS) as part of its global marketing initiative opened its doors to international students to take up elective as well full time programmes. In September 2017, 36 nursing students from a university in China completed a 12-week elective /mobility programme in UMS.
Students taking up nursing course bring with them stereotypes and prejudice towards mentally-ill clients. Nurses harbouring such stigmatising attitude can have a profound effect on their subsequent therapeutic relationship and quality of care rendered for the mentally-ill clients. Typically, students who harbour stigmatising views, develop positive mindset after psychiatric posting.
In Malaysia, there is an increase in both demand and prescribing of supplements. Such trend raises the likelihood of adverse events and treatment costs. Numerous prescribing policies have been suggested for better utilization of resources. However, the adherence and improvement from such policies are yet to be fully characterized.
Probiotics are live, microbial cells with several beneficial health effects on humans. The beneficial effect of probiotics mainly depends on their survival in the gastrointestinal tract. The health-promoting properties of certain LAB inhabiting the human gastrointestinal tract encouraged the food industry to develop new functional food products containing probiotic. Selection of a microbial strain for the incorporation into food products requires both in vitro and in vivo evaluations
Melioidosis is a tropical infectious disease cause by gram-negative bacterium, Burkholderia pseudomallei. It is predominantly in tropical climate especially Southeast Asia and Northern Australia. This disease is associated with significant mortality due to early onset of sepsis.
Calcineurin inhibitors, cyclosporine and tacrolimus are increasingly becoming part of the standard immunosuppresant therapies for renaltransplanted patients in Malaysia. In this study, the clinical safety and efficacy of cyclosporine and tacrolimus in a Malaysian renal-transplanted population is compared. A fourteen-year retrospective review on all renal-transplanted patients (from September 1991 to September 2015) or patients being followed up at University Malaya Medical Centre (UMMC) on cyclosporine or tacrolimus regime was conducted. We collected the clinical and laboratory parameters at 3-month, 6-month, 7-month, 8-month, 9-month, 10-month, 11-month, 12- months, 2-year and 3-year following from transplantation for each drug. The mean cyclosporine and tacrolimus trough levels were within the recommended therapeutic ranges (189.16 ± 69.10 ng/ml and 7.84 ± 2.18 mg/day respectively). The mean low-density lipoprotein (LDL) was significantly higher at eleven months for tacrolimus compared to cyclosporine. Similarly, the mean total bilirubin level was significantly higher with cyclosporine as compared to tacrolimus between 3 – 9 months post transplantation but did not show any significant difference (p = 0.49). The overall monthly means of serum uric acid levels in patients were also similar, 380 ± 87 mg/dL (cyclosporine) and 390.96 ± 95.97 mg/dL (tacrolimus) (p = 0.49). The Kaplan-Meier survival rate is significantly longer (p = 0.03) with cyclosporine-based treatment as compared to tacrolimus. Overall, cyclosporine and tacrolimus did not show any significant difference in terms of safety and efficacy parameters among Malaysian renal-transplanted patients indicating that they may be used interchangeably.
Getting appropriate healthcare is a challenge to the citizens in Malaysia due to the limited facilities, healthcare providers, and cost of healthcare. Uberization of healthcare will help fill this gap. Uberization helps modify the market or economic model with the introduction of a cheaper and more effective alternative service by introducing a different way of buying or using it, with the use of mobile technology. With powerful artificial intelligence engines operating on cloud servers, mobile apps can provide a better healthcare experience for patients. With uberization application, the patient need not come to the hospital to see a doctor before a treatment can be planned. Once a request is made by the patient, the healthcare providers can come to see the patient at an agreed place. This article aims to explore the possible uberization of healthcare in Malaysia.
In Malaysia nasopharyngeal carcinoma (NPC) is ranked as number fourth (5.2%) from all cancer and third (8.4%) most common cancer among male population. Nasopharyngeal carcinoma in Malaysia mostly occurs among Chinese (49%), followed by natives of Sabah and Sarawak (28%) and Malay (22%). There were multiple researches done to determine the risk factors for nasopharyngeal carcinoma and most of them from western pacific region. Prevalence of nasopharyngeal carcinoma in Sabah in 2013 is about 106 cases while in 2012 is 75 cases. It shows almost 30% increment from previous year. A total of 53 patients were diagnosed NPC in 2013 from Kota Kinabalu locality and it contributes more than 50% from total prevalence NPC in 2013. NPC is common in local Sabahan, especially in Kadazan and Dusun ethnicity. In 2013, the youngest are 11 years old and the eldest are 84 years old. The upward trend of NPC cases in younger age group is worrisome for us. Thus it is very important to determine the risk factors associated with NPC and this would help the health provider and other stakeholders to do planning in prevention of NPC such as awareness programme or cancer screening for the target high risk group especially for Sabah population.
The main objective of this study was to obtain information regarding the effects of educational and socio-economic status of the patients on the prescribing pattern of non-steroidal antiinflammatory drugs (NSAIDs) by the qualified medical personnel in the outpatient departments (OPDs) of two selected polyclinics in Kota Kinabalu, Sabah, Malaysia. A total of 200 selected patients (100 from each polyclinic) attending the OPDs were interviewed using a questionnaire. Again data were collected, photocopied and later analyzed. Educated and higher income group of patients mostly attended in a Private Polyclinic (PPC) whereas less educated and lower income group of patients generally attended UMS Polyclinic (UPC). This was reported as a probable reason for the wide variations in the prescribing pattern with respect to pharmacological subclasses of NSAIDs in the OPDs of two polyclinics. The present results strongly support that probable reason. The number of patients taking NSAIDs before coming to hospital was more in PPC compared to UPC. They were influenced by pharmacists, friends and doctor’s advice given previously. In conclusion, it may be mentioned that overall prescribing pattern of NSAIDs among two polyclinics is rational.
Organ transplant has become a main stream important medical procedure commonly used in hospitals. However, for organ transplant programme to be successful, it heavily relies on the public to voluntarily register for organ procurement. Effort to promote awareness and register public as organ donors has been ongoing, but public response to commit and register as donors has been lukewarm. Arguably, healthcare personnel and nurses are in a key position to educate and advocate for organ donation but often, ironically healthcare personal themselves are reluctant or unwilling to commit as organ donors. Thus, in the context of student nurses in Universiti Malaysia Sabah (UMS), the question arises, what is their stance and views regarding organ donation.
Wegener’s granulomatosis (WG) is a necrotizing
granulomatous inflammation. A 40-year-old lady
of Malay descent presented with unresolving
bilateral painful red eyes for three weeks. Clinical
examination revealed that best corrected vision
acuity of 6/9 for both eyes. Slit lamp examination
revealed diffuse scleritis. Other Investigations
result like UFEME blood cell: 2+, C-reactive
protein 70.06 mg/L and ESR of 125 mm/h
suggestive on acute inflammations. Connective
tissue screening revealed cytoplasmic ANCA
was positive and was supported by Anti-Serine
Protease3 (PR3) 68. All the investigation results
revealed that she had Wegener’s granulomatosis
with ophthalmology manifestation in the
form scleritis. Patient was treated with guttae
Maxidex QID to reduce cells that present in
anterior chamber and oral ibuprofen 400 mg
thrice daily. Subsequently, oral prednisolone
and oral cyclophosphamide with oral Bactrim
were commenced. Patient responded well and
redness resolved. There are many differential
diagnoses for chronic conjunctivitis but to rule
out connective tissue disease should be one of the
primary differential diagnoses in young female.
Oral immunosuppressive and Trimethoprim/
Sufmethoxazole (Bactrim) were been found
beneficial and symptoms were resolved. Wegener’s
granulomatosis is a great mimicker as exemplified
in this case. This disease can be misdiagnosed and
maltreated as conjunctivitis. Thus, the authors
wish to emphasize that WG is one the differential
diagnoses that need to be considered in a person
with bilateral scleritis.
Ovarian carcinoma is the fifth common cause of cancer death among women in Malaysia, with five-year survival rates of 30%. It has been associated with delayed diagnosis, advanced stage of presentation and poor prognosis due to vague symptoms and lack of effective screening. The continued high fatality rate has underpinned efforts to develop effective screening tests and newer therapies that could impact on prognosis. New insights into proteomic analysis and genomic tests with a better understanding of the target lesion have leading to discovery of new treatment modalities in ovarian carcinoma. We present a 58-year-old lady with Stage IV ovarian cancer who had lower abdominal pain and mass, constipation and voiding frequency for six months duration. Ultrasound guided biopsy revealed serous adenocarcinoma likely ovarian in origin. CT scan showed gross ascites and right ovarian mass with infiltration to adjacent small bowel. Tumour markers CA 125 and LDH were high. She has received neoadjuvant chemotherapy followed by cytoreductive surgery and currently in remission.
Non-cirrhotic portal hypertension (NCPH) is clinically defined as the presence of portal hypertension in the background of non cirrhotic liver. It is diagnosed by the findings in ultrasound of the hepatobiliary system and also oesophagogastroduodenoscopy (OGDS) that consistent with that of a portal hypertension, but otherwise has a relatively normal liver function and echotexture. The treatment mainly focuses on primary and secondary prophylaxis of variceal bleeding both pharmacologically like non-selective beta-blockers and octreotide, and non-pharmacologically like endoscopic band ligation of varices and sclerotherapy. In advance cases, sometimes surgery such as Porto systemic shunt or splenectomy may be required especially in patients with uncontrolled variceal bleeding or with symptomatic hypersplenism. Here we report a case of a young man who presented with upper gastro-intestinal bleeding, which was initially thought from a bleeding ulcer but was found to be secondary to oesophageal and gastro-oesophageal varices. Apart from having mild ascites, he has no other features of portal hypertension. His liver biochemistry and echotexture were also normal. Unfortunately, the patient was lost to follow up while he was still in the early stage of investigating the condition. The purpose of this case report is to share an uncommon occurrence of NCPH in East Malaysia, where liver cirrhosis predominates the aetiology of portal hypertension. Also, to the best of our knowledge, there is a very limited reporting of a similar case in this region.
It is important to prepare the nursing students to be confident and able to interact with the patients,
colleagues, doctors and other staff because the nature of nursing work included a high degree of personal
and group interaction. Continuous communication and interaction in nursing work are some of the
important factors for self-esteem among nurses. Self-esteem affects the relationship between job roles and
job satisfaction as well as the link between work performance and work roles conflict. The objective of this
study is to examine the effects of low self-esteem on clinical performance among first year nursing students
at private nursing college in Kota Kinabalu, Sabah. A descriptive qualitative study was conducted among
10 first year nursing students in one of the private nursing college. Data was collected through one to one
interviews using semi-structured questions. The interview question was structured based on observation
and literature review. The design is ideal because it facilitate the collection of data from a small number of
participants through personal interview. The collected data was transcribed into verbatim and analysed by
identifying the themes via coding and categorization. The results showed there are two main themes
emerged from the study: Defensive behavior and poor communication as the effects of low self-esteem on
the students’ clinical performance. As conclusion from this study, defensive behavior and poor
communication and are the obvious effects of low self-esteem among the first year nursing students in a
private nursing college. This study revealed the needs to equip the students with more conducive learning
environment facilitate suitable motivational and mentoring approaches and practice good communication
skills. Future research suggested, extends the study to the public nursing college for outcomes comparison
and evaluation.
Liver, an important organ of metabolism, is damaged when exposed to chemicals, toxins, infectious agents, drugs and food additives. Arachis hypogaea (peanut) being organic may have free radical scavenging activity, which could protect the liver from damage. Objective: To evaluate the effect of Arachis hypogaea on liver marker enzymes such as serum AST(aspertate transaminase) and
ALT(alanine transaminase) and histology of liver in Wistar albino rats. Methods: Twenty healthy Wistar albino male rats (120 – 150 grams, 90 – 120 days old) were acclimatized for 14 days and divided equally into control group (n = 10) and experimental group (n = 10). Control group received standard pellet for 21 consecutive days. The experimental group received peanut powder 500mg/kg body weight/day; orally) mixed with food for the same period. All the animals were killed on 22nd day. Blood and liver samples were collected. Levels of serum AST, ALT and bilirubin were estimated and the liver was processed for histology. Results were statistically analyzed by
2 sample t-test. Results: Final body weights were significantly (p
Foot shape significantly varies with age, sex and ethnicity. Information on gender and racial differences in foot shape is also useful to forensic scientists identifying isolated remains. Literature survey revealed that there are not enough studies on correlation of foot shape with changes in body weight. Hence this cross-sectional and analytical study was carried out to evaluate the correlation of foot shape with changes in body weight within same race and ethnicity. A total number of 110 male medical students of 3rd and 4th year of Bengali ethnicity were chosen through purposive sampling. Foot index was calculated by dividing the foot length with the foot width. On the basis of foot index, foot shapes were classified into slender, standard and broad. Correlation of the foot shape with the body weight was assessed. Both right and left foot indices showed significant negative correlations with the body weight (r = −0.214, p = .033 and r = −0.282, p = 0.005 respectively). This approach of categorization will help in making best fit footwear for males. It will also serve as a baseline data for forensic investigators.