The story of clinical genetics is a relatively new one, first spearheaded by paediatrics but increasingly, has taken root in all branches of medicine leading to ‘personalised medicine’. There are expectations that this revolution in genetics will pave the way to genomic medicine and a cure for all inherited disorders. The development of the field of Clinical Genetics and genetic counselling in Malaysia is still in its infancy. Using evidence-based data on genetic disorders such as birth defects, inborn errors of metabolism, genetic syndromes, neurological disorders and hereditary cancers, that hitherto have not been well documented in Malaysia, this review article will focus on findings and issues that will present a unique insight and opportunity to understanding the complex genetic counselling issues related to clinical genetics in Malaysia.
Evidence-based recommendations on intrapartum care are important to ensure the safety of mothers and neonates. The objective of this study was to compare two established guidelines for intrapartum care to provide clinicians with more comprehensive recommendations on intrapartum management. We carried out a descriptive analysis of guidelines from the Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines published by the World Health Organization, and the Perinatal Care Manual published by the Ministry of Health Malaysia, on intrapartum care to determine differences, if any, with regards to management. Latent, active and the second phase of labour are defined differently in both guidelines. Both guidelines showed high similarity in the steps of clinical management for all phases of labour but differed in foetal monitoring methods, indications for episiotomy, mood and behavior assessment, universal precautions, pain management, and placental disposal. Both guidelines had similar managements for most of the problems encountered during the intrapartum period except for preterm labour and multiple births which have substantial differences. Malaysian guidelines highlight additional systems such as the red alert system, and referral and retrieval system, which would enhance the quality of intrapartum management. The IMPAC guidelines emphasize supportive care, birth companionship, maternal care and monitoring up to one hour after placental delivery; and home birth management; these are inadequately explained or lacking in Malaysian guidelines. From the comparison, it was seen that substantial variation exists in intrapartum management between both guidelines that indicates the need for better evidences to synthesize a more comprehensive set of guidelines for the improvement in intrapartum care.
Wound management is important as it helps to promote healing without microbial infection. Euphorbia hirta, a species of Euphorbiaceae family, also known as Ara tanah among Malaysians, is traditionally used to promote wound healing where its poultice is applied to the sores on the legs, bruises and wounds. Several reported pharmacological properties including antioxidant, antimicrobial, antidiabetic, anti-anaphylactic activities have been reported on this plant. The aim of this review was to evaluate the wound healing effects of E. hirta. Information involving only in vivo studies on wound healing effect of E. hirta was searched using electronic databases. The electronic databases include PubMed, Google Scholar, Ovid, CENTRAL, LILACS, and ClinicalTrials.gov from year 1962 to 2020. A total of five out of 70 studies were included and assessment was made. All included articles studied different wound models in rats. All showed significant wound healing activity with different mechanism of action for incision, excision and dead space wound. Quality assessment of the included studies suggested that experimental animal study design can be improved. It can be concluded that E. hirta displayed potential as a wound healing agent in vivo studies although further research on structure-activity relationship of compounds responsible for the wound healing effect and toxicological studies before it can proceed to clinical studies.
Osteoarthritis (OA) affects millions of people worldwide with its irreversible destruction of articular cartilage. Recently, the potential of using chondrogenic differentiated multipotent mesenchymal stromal cells (cMSCs) for OA treatment is being assessed. Preliminary clinical studies have been encouraging. However current studies have also demonstrated that cMSCs are not biochemically and biomechanically identical to native articular chondrocytes (ACs). Thus, there is an urgent need for the implementation of proteomic applications as proteomics involve protein identification, relative quantification of proteins and studies of post-translational modification which reveal novel regulating processes of complex mechanisms such as in chondrogenesis. A comprehensive understanding of chondrogenesis is essential for the establishment of an effective cMSC model to regenerate cartilage. In this article, we will review current proteomic studies on chondrogenesis, focusing on recent findings and the proteomic approaches utilised.
Steroids remain an important component of maintenance immunosuppression after renal transplantation. Their anti-inflammatory action is partly due to the sequestration of CD4+ lymphocytes in the reticuloendothelial system. Steroids bind to intracellular receptors and the resulting steroid-receptor complex alters the transcription of cytokines by binding to glucocorticoid response elements on DNA. Transcription factors whose actions are altered by glucocorticoids include activating protein-1 (AP-1) and nuclear factor-B (NF-B). The main cytokines whose production by antigen-presenting cells is inhibited by steroids are interleukin-1 (IL-1), required for helper T-cell activation, and IL-6, required for B-cell activation. Other pro-inflammatory cytokines such as interferon gamma and tumour necrosis factor are also inhibited. This multiplicity of immunosuppressive actions is not fully replicated by other immunosuppressants. However, there are concerns about the long-term side effects of steroids. This review will examine the attempts at steroid withdrawal or steroid avoidance in renal transplant patients.
Migration is a widespread phenomenon throughout the world and it has been under way since time immemorial. While studies have focused on the causes of migration and the impact of migrants, studies focusing on the emotional experience of the left-behind older persons’ adjustments in their twilight years after the departure of their adult children, are few and far between. Thus, the perspectives of these left-behind older parents/persons are less understood. This paper aims to contribute to the literature by addressing the gap which will be filled through the experiences of left-behind Malaysian older persons. Drawing on in-depth interviews extracted from a qualitative study that focused on the strength of long-term marriages among Malaysian Chinese couples, this paper captures four older couples’ experiences that depict their feelings about their adult children’s migration. Analysis suggests that the children’s migration was induced by a lack of support and resources, followed by unequal educational opportunities. To deal with the gap left by their children, these older urban parents depend on kinship connection and community support in times of need. Government initiatives may also be able to empower the community in innovating and implementing plans which are tailored to the needs of the older parents left behind by children who have migrated. The living arrangements and recent bereavement experiences captured from the older couples can serve as cues for healthcare professionals and social support providers to assess the risks of social isolation and suicide among these left-behind older parents.
The current issue of JUMMEC touches on many diverse topics and in many ways reflects the evolution of modern medicine from the practice of acupuncture to epidemics facilitated by modern travel to the subject of ethics including controversies surrounding financial incentives given in promoting organ donation.(Copied from article).
Systemic lupus erythematosus (SLE) is one of the commonest systemic autoimmune diseases that can present with variable clinical manifestations. Intravenous Immunoglobulin (IVIG) has been used as a salvage therapy for severe lupus with encouraging results though there is yet randomised trial to support the usage. This report highlights the efficacy and safety of high dose IVIG in SLE patients with multi-organ involvement particularly lupus nephritis. We also reviewed the literature on the usage of IVIG for lupus nephritis. However, more studies are needed to further clarify the optimal therapeutic dosage and regime for IVIG and to identify the group of patients who might benefit the most from this expensive therapy.
Anaemia in patients on renal replacement therapy is a cornmon problem and response to treatment with erythropoietin may be limited by functiollal iron deficiency. We recently studied prospectively for 22 weeks the effect of iron supplemetltation via intramuscular and oral vs intramuscular vs oral routes in 16 patients on chronic haemodialysis with renal anaenlia treated with erythropoietin injections. The rise in haemoglobin was significant in all patients except those on intramuscular iron only. This study supports unconfirmed observations that oral iron supplementation may be effective in patients with renal anaemia associated with functional iron deficiency. KEYWORDS: Renal, Anaemia, Erythropoietin, Iron deficiency, Oral, Parenteral.
Despite being the major cause of cancer-related death in Malaysian women,local data on patterns of breast cancer relapse and their long term outcomes are still scarce. We conducted a retrospective study on all patients treated for non-metastatic invasive breast cancer in 1999-2000 at the University of Malaya Medical Centre (UMMC), who subsequently developed relapse. We sought to analyse the patterns of relapse, their associated clinicopathological features and the overall survival ratefollowing the relapses. Univariate and multivariate analyses were used to analyse demographics and clinicopathological factors. Survival was analysed using the Kaplan and Meier method and compared by the log rank test. A total of 268 patients with a mean age of 50, were identified for the study. At a median follow-up of 50 months, 73 patients (27.2%) had relapsed. Local, regional and distant relapse rates were 5.5%, 1.9% and 19.8% respectively, whereas, the 5-year survival rates were 61%, 40% and 21% respectively (p < 0.01). Most relapses occurred within the first five years of diagnosis. Patients with long disease-free interval had better survival. The most common distant relapse site was the lungs while bone was the distant relapse site with the best prognosis. Disease stage, nodal status and oestrogen receptor status were found to have correlation with the risk of relapse. We concluded that the survival of patients with relapsed breast cancer was associated with the site(s) of first relapse and the disease free interval and clinicopathological factors can be used to predict the risk of relapse.
Background:Past research evidenced that the individuals from low socio economic status (SES) families were having a higher prevalence of mental health problems when compared to higher income families. Therefore, this study aimed to examine the prevalence of the depressive symptoms among parents by socio-demographics profile: age, number of children living in a household, marital age, and household income.
Objective:The purpose of this study also aims to examine other variables that correlate to the symptoms.
Methods:A total of 205 participants consisting of fathers and mothers from four People’s Housing Projects (PHP) around Kuala Lumpur completed a self-report questionnaire which included a demographic profile form, Beck’s Depression Inventory (BDI), Parenting Daily Hassle Scale (PDHS) and Social Support Scale were used in order to measure all the variables that possibly added to the depressive symptoms among the parents. Correlation analyses were used to assess the relative significance of all the variables tested in this study.
Results:40.4% of the respondents reported a mild depression whilst another 4.4% reported a moderate level of depressive symptoms and 2.4% of them reported a severe level. The majority of the respondents reported a moderate to a high level of daily hassles and reported that their spouses were their supporters in any difficult situation. From the correlation analysis, only three variables;the household income, parenting daily hassles score and social support found the significance correlation to the depressive symptoms among the low SES parents in Kuala Lumpur.
Conclusion:The prevalence of the depressive symptoms among the low SES and the correlated variables were determined. Further research on intervention to educate parents is needed to react to the present findings and to reduce the transmission risk to the children as well as to develop a healthy nation.
Nine local plant species were picked randomly and their aqueous extracts have been screened to know their effects on the phagocytic capability and intracellular killing of StapllylococclIs al/rellS bacteria by mouse peritoneal macrophages. Macrophage cultures were incubated with different concentration of each plant extracts forI hour. Among these aqueous extracts, Ageratum conyzoides and Malastoma melabathricum inhibited the phagocytic capability and intracellular killing of Stapllylococclls aureus compared with controls. Elicited (activated) cells have more phagocytic capability and intracellular killing than the resident (normal) macrophages. There were no differences in the viability of cells between treated cells (with extracts) and controls (without extracts). KEYWORDS: Aqueous plant extracts, murine macrophage, phagocytosis.
The objectives of this study were: (1) to detect group B streptococcus (GBS) carriers among antenatal patients during pregnancy ( 35 to 37 weeks) in the University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia, and (2) to give antibiotic prophylaxis during the intrapartum period for the GBS carrier patients. The aim is to prevent early onset of GBS infection in newborn. This pilot study was carried out from 1st July 2005 to 31st August 2005. It is a prospective study involving 56 pregnant women who were seen at the antenatal clinic in the UMMC between 35 to 37 weeks gestation. High vaginal swab and low vaginal together with endoanal swab were taken for culture and sensitivity. The antibiotic prophylaxis was started early in the intrapartum period for patients with positive culture for GBS. GBS was detected in 18 patients which contributes to about 32% of the study population. The proper choice of antibiotic is important in successful disease prevention.
Study site: Obstretic and gynaecological clinic, University Malaya Medical Centre (UMMC)
The objective of the present study is to investigate the impact of socio-demographic factors on the acquisition of health information on Non-Communicable Diseases (NCDs) among Malaysian adults. A robust analysis was conducted on cross-sectional survey data obtained from 398 respondents in Penang (Malaysia) between August to October 2010. An ordered probit model was applied to examine the factors affecting the scale of health information. The results suggest that old individuals, rural dwellers, having chronic disease and history of serious family illnesses are 0.19%, 2.39%, 2.2% and 2.71% less likely to acquire poor health information on NCDs than others, whereas Malays, Chinese, males and those of low educated are 8.76%, 6.22%, 2.94% and 21.62% more likely to acquire poor health information on NCDs than others. Based on these findings, several intervention measures toward increasing the health knowledge among the population are recommended, which include the use of language-based mass media to advertise the information on diseases, designing health awareness campaigns in urban areas and introducing more basic health related subjects and courses into primary and secondary schools.
The rapid aging of populations worldwide demands major changes across all aspects of health care for older persons. Geriatric medicine which is that branch of of medicine which is concerned with the clinical, preventive and rehabilitative aspects of care of older persons, has much to offer in relieving the suffering and increasing the disability free years they can enjoy. Recent advances in Geriatric Medicine based on well designed randomised trials and meta-analysis that are clinically significant to the practicing physician are reviewed in this article. KEYWORDS: Recent advances, Geriatric Medicine, Older persons.
The purposes of the study were: (1) to determine the agility and leg power among Malaysian national junior netball players and (2) to determine the impact of eight-week aerobic and strength-training programme on these two variables. A total of 21 netball players from Bukit Jalil Sport School were selected as the subjects in this study. The SEMO Agility Run test was used to determine the agility level while leg power was measured using the Vertical Jump test. Pre-test and post-test results showed no significant differences in the agility and leg power level among the netball players. The mean values for the agility and leg power post-test were 12.59 (SD = 0.56) seconds and 50.24 (SD = 4.90) cm respectively. The pre-test and post-test results for different playing positions recorded the highest improvement in agility and leg power among attacker, followed by centre, and defender. Thus, the training conducted in this study was found to have improved agility and leg power marginally, especially among attacker and centre netball players.
The aim of the study was to compare the body fat percentages between Malaysian national women basketball players and netball players. Both basketball and netball players were elite players who represented Malaysia in the 1997 Southeast Asia Games in Jakarta, Indonesia and the 1998 Commonwealth Games in Kuala Lumpur. The percentage of body fat was determined by means of skinfold measurement at seven different locations. Results of the findings showed that overall, the basketball players had higher percentages of body fat than netball players. The average percentages of body fat of basketball and netball players were 19.68 ± 4.93% and 18.93 ± 4.41%, respectively. Both Malaysian national basketball and netball players' average percentage of body fat were found to be higher than the ideal average percentage of body fat range between 10-16% for female athletes in elite team sports. The players in the defence position in basketball were found to have the highest percentage of body fat (23.00%), followed by centre position players (21.62%) and attack position players (15.10%). These results differed from netball players' in similar playing positions. Among the netball players, the defence position players had the highest percentage of body fat (21.00%), followed by attack position players (18.63%), and centre position players (16.57%).