A study was carried out on 79 female telephone operators working in a Telecommunication Centre in Kuala Lumpur to determine the prevalence of Work Related Upper Limb Disorders (WRULD) and its risk factors. Data collection for this study was done between December 2000 and May 2001. The presence of WRULD was determined based on a guided questionnaire and physical examination. The response rate for this study was 94.9% (n= 75) and results showed that the prevalence of WRULD among the female telephone operators was 48.0%: Stage 1= 38.9%, Stage 2= 19.4%, Stage 3= 38.9%, Stage 4= 0% and Stage 5= 2.8%. In the telecommunication centre, it was found that those with WRULD had a mean of 11.59±9.09 years of employment duration whereas those without WRULD had a mean of 9.89 ± 8.48 years of employment duration. None of the factors studied such as Body Mass Index, age, ethnicity, menstrual cycle, hormone replacement therapy, overtime work, duration of employment in the present unit and in the telecommunication center differ in distribution between subjects with and without WRULD. This could be contributed by factors such as small number of subjects or the common healthy worker effect found in occupational health research. The findings studied of this study show that almost 40.0% of the workers experienced pain and neurological symptoms. Since none of the factors was found to be associated with WRULD, an elaborate study with a case-control design is needed in order to match cases and enable researchers to control the effect of confounding factors. This will ensure risk factors pertinent to WRULD in the Malaysian setting to be identified.
This is a cross sectional study examining quality of life in relation to coping styles among patients with Schizophrenia (N=92) in remission, from June 2002 to December 2002.Remission state is determined by Brief Psychiatric Rating Scale (BPRS). The psychiatric diagnosis was made by treating psychiatrist using the Clinical Interview Schedule for the DSM-IV Diagnosis. They are subsequently asked to complete demographic and clinical data questionnaire and followed by 36-item short-form health survey (SF-36) of the Medical Outcome Study (MOS) for the assessment of quality of life and the Coping Inventory for Stressful Situation (CISS). The QOL in term of overall mental health among patients with schizophrenia was significantly and positively associated with ethnic group (p
Turner syndrome is one of the most common chromosomal abnormalities affecting newborn females. More than half of patients with Turner syndrome have a 45X karyotype The rest of the patients may have structurally abnormal sex chromosomes or are mosaics with normal or abnormal sex chromosomes. Mosaicism with a second X sex chromosome is not usually of clinical significance. However, Turner syndrome patients having a second Y chromosome or Y chromosomal material are at risk of developing gonadoblastoma later in life. The aim of this study is to compare the results of conventional (karyotyping) and molecular cytogenetics (FISH), and discuss the advantages and limitations in the diagnosis of Turner syndrome. We also aim to compare the degree of mosaicism identified using conventional cytogenetics and FISH techniques. Conventional cytogenetics and FISH analyses were performed on eight peripheral blood samples of patients with Turner syndrome collected between 2004 and 2006. From this study, two out of eight patients with Turner syndrome were found to have the sex determining region on the Y chromosome (SRY) gene by FISH analysis. Our results showed that the rate of detection of mosaic cases in Turner syndrome was also increased to 88% after using the FISH technique. We concluded that FISH is more superior to conventional cytogenetics in the detection of the Y chromosomal material. FISH is also a quick and cost effective method in diagnosing Turner syndrome and assessing the degree of mosaicism.
Anaplastic large cell lymphoma (ALCL) is a rare tumour, accounting for approximately 3% of adult non-Hodgkin lymphomas.1 Primary systemic ALCL frequently involves both lymph nodes and extranodal sites. A 44-year-old woman presented with a firm, mobile mass in the left iliac fossa region. Ultrasound findings showed a well defined inhomogenous soft tissue mass, measuring 4x4x2.6cm in the deep subcutaneous region. Histopathological examination revealed that the mass was infiltrated by large lymphoid cells with marked nuclear atypia including kidney-shaped nuclei. These neoplastic cells expressed anaplastic lymphoma kinase (ALK) (both nuclear & cytoplasmic staining), CD30 and EMA but not for T-cell (CD45RO and CD3), and B-cell (CD20 & CD79α) markers. Fluorescence in situ hybridization (FISH) analysis showed a t(2;5)(p23;q35) chromosomal translocation. Subsequently the patient developed shortness of the breath and a thoracic computed tomography (CT) scan showed a mass encasing the right upper lobe bronchus. She also had bilateral axillary lymph nodes, measuring 1 cm in diameter (biopsy was not done). The mediastinum and endobronchial region did not show any abnormalities. She received 6 cycles of CHOP chemotherapy and remained disease free 2 years after diagnosis. ALCL, rarely present as a soft tissue tumour and this disease should be included as a differential diagnosis of any soft tissue mass.
Stroke is becoming a major public health issue in our country due to the fact that there isan increasing life span of our population. Due to advancement of acute management of stroke, three out of four people will survive beyond the acute phase of stroke. Stroke careproviders are still debating regarding the exact period of the terminology ‘longer-term stroke’; however many agreed that long-term of stroke refers to the period of one year and thereafter as this period is the determinant for longer-term survival. Management beyond the first year of stroke is complex, encompasses all aspects of patient’s life; physical, psychological and integration into community. Rehabilitation being the cornerstone of longer-term stroke management should now focused on more evidence-based approach as to be effective and relevant to the stroke patients.
Patients’ satisfaction is of critical interest to all healthcare providers. Satisfied patients are more likely to seek health care and to comply with prescribed treatment regimes. The objective of the study was to identify factors that influence patient satisfaction with Emergency Department HUKM (ED HUKM). This study was conducted at ED HUKM from January 2007 till March 2007. A convenience sample of 100 participants was recruited from triage 4. The Davis Consumer Emergency Care Satisfaction Scale (CECSS) was adopted and modified. It consists of 19 questions; used a 5 point, Likert type scale of 1 to 5 (1= completely disagree and 5= completely agree) to measure patient satisfaction with triage, health care providers caring behaviours and health teaching. Results showed that 75 participants (75%) were satisfied. There were no significant difference found between male and female patients with total CESCC scores (t=0.308, p values >0.05). Pearson product moment correlation coefficients showed a positive relationship between total and subscale patient satisfaction scores, caring scores (r=0.905, p value
In this study, functional magnetic resonance imaging (fMRI) is used to investigate func-tional specialisation in human auditory cortices during listening. A silent fMRI paradigm was used to reduce the scanner sound artefacts on functional images. The subject was instructed to pay attention to the white noise stimulus binaurally given at an inten-sity level of 70 dB higher than the hearing level for normal people. Functional speciali-sation was studied using the Matlab-based Statistical Parametric Mapping (SPM5) software by means of fixed effects (FFX), random effects (RFX) and conjunction analyses. Individual analyses on all subjects indicated asymmetrical bilateral activation of the left and right hemispheres in Brodmann areas (BA) 22, 41 and 42, involving the primary and secondary auditory cortices. The percentage of signal change is larger in the BA22, 41 and 42 on the right as compared to the ones on the left (p>0.05). The average number of activated voxels in all the respective Brodmann areas are higher in the right hemisphere than in the left (p>0.05). FFX results showed that the point of maximum intensity was in the right BA41 whereby 599±1 activated voxels were ob-served in the right temporal lobe as compared to 485±1 in the left temporal lobe. The RFX results were consistent with that of FFX. The analysis of conjunction which fol-lowed, showed that the right BA41 and left BA22 as the common activated areas in all subjects. The results confirmed the specialisation of the right auditory cortices in pro-cessing non verbal stimuli.
This is a report of a patient on multiple antipsychotic medications for the treatment of schizophrenia. Often, polypharmacy is not encouraged, however, with the advent of newer atypical antipsychotic agents, this practice may need review. This case will be used to highlight the rare instances when polypharmacy may be useful prior to the commencement of clozapine for the treatment of schizophrenia.
Patient education has been considered as an integral component of care for patient after myocardial infarction. Post myocardial infarction patients require information and knowledge related to their conditions to reduce anxiety and aid recovery. The objective of this study was to identify nurses’ perception on information needs of post MI patients of UKMMC. A cross sectional study using Cardiac Patient Learning Needs Inventory (CPLNI) adopted from Timmins and Kalizer (2002) was used. It comprises seven cate-gories: related to anatomy and physiology, psychological factor, life style factor, medi-cation information, dietary information, physical activity, and symptom management. This study was conducted in coronary care unit (CCU), coronary rehabilitation ward (CRW), medical ward 1 and medical ward 2 from January 2007 to March 2007. 56 res-pondents (96%) who fulfilled the inclusion criteria were recruited in this study. Results showed that CCU and CRW respondents ranked symptom management as their first ranking followed by medication, life style factor, anatomy and physiology, dietary in-formation, physical activity and psychological factor. However, respondents in Medical Ward 1 and 2 reported and ranked medication information as their top priorities fol-lowed by symptom management, psychological factors, dietary information, physical activity, anatomy and physiology and life style factor. There were significant differ-ences between ward nurses’ responses with their perception related to anatomy and physiology, psychology factor, life style factor, physical activity, and symptom man-agement with p value
A cross-sectional study was undertaken to evaluate if outpatient administration of in-travenous iron sucrose complex (Venofer) was a sensible option in treating iron defi-ciency anaemia during pregnancy and puerperium. A total of 120 patients with iron deficiency anaemia were recruited from the Obstetric Day Care Clinic at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) over 18 months from March 2003 to August 2004. The main outcome measures were haemoglobin increment, patients’ compliance, adverse effects and saving from hospitalization fees. The pre-treatment haemoglobin (Hb) level was 8.5+0.85g/dl for the antenatal patient and 7.6+0.80 g/dl in the post-partum group. The mean post-treatment haemoglobin increment at day four-teenth was 3.52+0.75g/dl. One patient developed skin rash while another had low-grade pyrexia. Seven patients experienced mild metallic taste. There were no serious side effects or anaphylactic reactions. Ten patients (8.3%) did not complete their ther-apy - eight delivered before completion of treatment; another two defaulted following delivery. The average number of Venofer used was seven ampoules i.e. 700mg per person, most of them required three sessions to complete the course. Outpatient treatment allows each patient to save hospitalization fees of RM45 per day, which to-talled up to RM135 for a 3-days ward stay. An estimation of RM16,200 hospitalization fees for the 120 patients was avoided during the study period. In conclusion, outpatient treatment of anaemia in pregnancy and post-partum period using Venofer was safe and feasible, with high patient compliant and cost-savings from hospitalization fees.
Study site: Obstetric Day Care Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Methicillin-resistant Staphylococcus aureus (MRSA) infection is important among vas-cular surgical patients. Its effect can be devastating resulting in limb amputation and mortality. We performed a retrospective patients record analysis to determine the pat-tern of MRSA infection among vascular surgical patients in Hospital Kuala Lumpur from January 2005 to December 2007. We also attempted to identify the factors asso-ciated with poor clinical outcome after such infection. There were 999 patients who underwent vascular surgeries in HKL within the analysis period. Of these 24 patients (2.4%) were detected to have MRSA surgical site infection. The infection was commoner among cigarette smokers, patients with diabetes melitus and those who had previous vascular surgery. Most infections occurred in the emergency surgery category and manifested as wound breakdown. Fifty-four percent of the infected pa-tients ended with graft removal, amputations or death. MRSA infection complicating vascular surgery resulted in poor clinical outcome. This serious threat requires intensi-fied preventive measures.
Ginger extract has been reported previously by our group to exhibit anticancer and an-tioxidant effects by reducing tumour burden and lipid peroxidation respectively in he-patocarcinogenesis induced rats. The current study examined the expression of pro-apoptotic protein caspase-8 and anti-apoptotic protein Bcl-2 in hepatocarcinogenesis treated rats. Thirty normal male Wistar rats were divided into 5 groups based on the diet given: i) control (normal rat chow), ii) olive oil, iii) ginger extract (100mg/kg body weight), iv) choline deficient diet + ethionine, CDE (to induce liver cancer) and v) CDE+ ginger extract. Rats were killed at week 8, and liver tissues were excised for immuno-histochemical study to identify pro-apoptotic and anti-apoptotic proteins, caspase-8 and Bcl-2. The observation on H&E staining confirmed the CDE diet induced liver can-cer as indicated by the presence of numerous oval cells. Identification of Bcl-2 expres-sion showed that 91.6% (11/12) of the samples from the CDE group revealed positive staining while treatment with ginger extract however inhibited the expression with only 8.4% (1/12) samples showing positive staining for Bcl-2. As for caspase-8 protein, 41.7% (5/12) of the samples from CDE group showed positive staining, which in-creased to 100% (12/12) with ginger extract treatment. Our findings suggest that gin-ger extract has an anticancer effect by inducing apoptosis in liver cancer cells via up-regulation of the expression of pro-apoptotic protein, caspase-8 and down-regulation of the expression of anti-apoptotic protein Bcl-2.
Learning environment in the universities plays an important role in producing highly competent graduates especially in nursing profession. Thus, the most important as-pects are the teaching activities and as well as student – teacher interaction in daily environment in the university. To investigate the International Islamic University Malay-
sia (IIUM) nursing students experience towards their teachers and to identify the rela-tionship between teaching and students learning perception in their learning environ-ment. This study used quantitative method and utilized two out of five subscales in Dundee Ready Educational Environment Measurement (DREEM). The subscales used
were students’ perception of learning (SPoL) , students’ perception of teacher (SPoT)
and total items in these both subscales are 12 and 11 items, respectively. The ques-tionnaire results revealed that IIUM nursing students scored 28.54/48.00 in (SPoL) and
28.13/44.00 in (SPoT). Both findings showed the IIUM nursing students’ experience their teachers and the learning environment are moving in towards positive directions. The regression finding was 51% of the total variation in students’ perception of teacher score was explained by students’ perception of learning. Although the overall sub-scales (SPoL) score in the current study falls in the category of a more positive per-ception, 2 out of 12 items were poorly scored by the IIUM nursing students. The re-searcher strongly agrees that listening to the expression of students is an important consideration for an educational institution. The overall mean score for (SPoT) showed that the students perceived their teachers as moving in the right direction. In this pre-sent IIUM study, one item showed a mean score of less then 2.00. As a result, these two subscales most probably should reflect the same outcome such as in their aca-demic performance and experience greatly during their student life on campus. The arising issues from this DREEM study at IIUM embrace the need for the creation of supportive environment as well as designing and implementing interventions to remedy unsatisfactorily elements of the learning environment for more effective and successful teaching and learning to be realised.
The increasing health care cost and public awareness on the delivery of high quality services has forced healthcare service providers to look into the healthcare delivery system. Clinical Pathway (CP) has been introduced in many hospitals and has been accepted as a beneficial tool in assisting healthcare organizations worldwide. Further, the CP also provides consistently high quality and coordinates services with minimum resources. It is proven to be a beneficial tool in other countries. CP is recently being introduced into the Malaysian healthcare system. The aim of this article was to high-light the benefits of CP in improving healthcare quality and controlling the medical cost. The relevant articles have been reviewed. The majority of literature reviewed con-cluded that there were positive effects in implementing CP. The CP was found to be significant in reducing length of stay and medical cost. The introduction of evidence based medicine, clinical outcomes, clinical audit, multidisciplinary communication, teamwork and care planning were also improved by CP. The challenges for healthcare providers and healthcare managers are to participate and be fully committed in path-way development and implementation in order to improve healthcare quality and cost control.
Oxidative stress has been associated with postmenopausal osteoporosis which pre-disposes to risk of fracture. Palm tocotrienol is a potent antioxidant and has the poten-tial to be used for treatment of post-menopausal osteoporosis. The aim of the study is to determine if palm tocotrienol supplementation could alleviate oxidative stress in ovariectomised rat model and improve its bone strength. The rats were di- vided into four groups: (i) sham-operated group (SHAM) (ii) ovariectomised-control group (OVX) (iii) ovariectomised and given 60mg/kg α-tocopherol by oral gavage (OVX + ATF) (iv) ovariectomised and given 60mg/kg palm tocotrienols by oral gavage (OVX + PTT). After eight weeks of treatment, blood samples were taken to measure oxida-tive status (MDA, SOD and GPX) while the femurs were biomechanically tested for strength and resistance to fracture. Ovariectomy was shown to induce oxidative stress as shown by the raised MDA levels and reduced GPX activity. Palm tocotrienols seemed to offer protection against the ovariectomy-induced oxidative stress as shown by the suppression of MDA levels and raised GPX and SOD activities in the OVX+PTT group. In comparison, α-tocopherol was only able to raise the SOD but not as high as palm tocotrienols. The biomechanical tests have shown that ovariectomy has not af-fected the bone strength significantly after eight weeks. Palm tocotrienols supplemen-tation for eight weeks was effective in preventing oxidative stress in a post-meno-pausal rat.
Gamma-tocotrienol (GTT) has been shown to exhibit significant antitumor activity in a variety of tumor cells. Previous findings have demonstrated that GTT had antiprolifera-tive effects on a liver cancer cell line (HepG2) with an IC50 value of 170μM. In this study, two dimensional gel electrophoresis (2DE) was used to determine changes in protein expression in HepG2 cell line following treatment with GTT. The ultimate aim is to identify the possible molecular mechanisms involved in GTT antitumor activity. This study is focused on obtaining a 2DE protein profile for HepG2 cell line with and without
GTT treatment. In the preliminary analysis of the resulting 2DE profiles, 18 protein spots were found to be differentially expressed in cells treated with GTT. This observa-tion is confirmed by extending the analysis to a larger sample size. By studying the effects of GTT treatment on differential protein expression in HepG2 cells the underly-ing mechanisms involved in the antitumor activity of GTT may be elucidated.
Dental students need to be equipped with skills, knowledge and positive attitudes while providing dental care to the elderly. Reports from Ministry of Health alaysia indicatedthat the prevalence of dental caries and periodontal disease was high among older people in the country. The aim of this study was to assess the knowledge and perception of final year dental students towards the elderly in relation to training of geriatric dentistry in Universiti Kebangsaan Malaysia edical Centre (UKMMC). All the final year dental students were required to complete a questionnaire that comprised of 3 sections: 1) Palmore’s Facts on Aging Quiz II, 2) Oral health and social concerns of patients, and 3) Perception towards the teaching of geriatric dentistry. A total of 83 students participated in the study. Twenty-four per cent (n=20) scored more than 70% to questions on knowledge about older people and 73% (n=61) scored between 50 -700%. The students had ranked physical disability, transportation problems andcomplex and overlapping priorities as reasons for elderly not keeping to their appointments. Majority of the students reported that lack of educational resourcematerials and very minimum clinical sites experience were the main barriers facedduring the course. In conclusion, majority of the students had moderate to goodknowledge about older people and were able to recognize issues of social oncerns that can influence their oral health. In general, there were not many changes in the perceived competencies of managing older patients following the geriatric module.
This was a retrospective study of operative records between 2000 – 2007 from two ear, nose and throat (ENT) referral centers in Malaysia to review demographic patterns, clinical presentations and management of retropharyngeal abscess (RPA). Our case series comprised of eight patients with five females and three males with a median age at presentation of 47 years. Comorbid factor in this series was diabetes mellitus, with four patients having diabetes. There were three cases of fish bone ingestion. The commonest presentation was dysphagia or odynophagia. None of them had fever. All patients were treated with broad spectrum intravenous antibiotics (IV) and drainage was performed for the abscess. Four patients underwent transoral drainage with three having the cervical approach and one having spontaneous ruptureAll patients recovered well from the infection and only one patient passed away due to septicaemia. In conclusion, patients with retropharyngeal abscess may present with vague symptoms of sore throat, odynophagia without fever due to partial antibiotics treatment. A correct diagnosis should be made so that adequate treatment can be given to prevent mortality.
The advantages of breastfeeding have been well established. The objective of this study was to determine the practice and knowledge of breastfeeding in an urban com-munity and identify the influencing factors. This is a cross-sectional study. All mothers attending the Maternal and Child Health Clinic during the study period, who fulfilled the selection criteria, were included in the study. The mothers were interviewed using a self administered questionnaire. A total of 162 mothers participated in the study. The prevalence of initiating breastfeeding during the first week after childbirth was 93.8%. Breastfeeding was found to be higher among Malay mothers (p value
Study site: a Child Health Clinic in Cheras Baru, Kuala Lumpur
Drug administration is an integral part of nurses role in nursing practice. In relation to their diverse roles, nurses are required to have adequate knowledge and good practice. The purpose of this study is to examine the level of knowledge, attitude and practice of nurses in the medical wards administering oral medication and to assess whether nurse’s knowledge, attitude and practice is associated with working experience and professional education (post basic training). A cross-sectional study was conducted on forty (40) nurses working in the Medical wards in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Questionnaires were used to measure the level of knowledge and attitude of nurses and a direct observation technique with checklist to record the practice of nurses. The mean score for knowledge (13.8), attitude (16.4) and practice (10.7) were all within average distribution. No significant difference was found between knowledge and practice of nurses with working experience and post basic training. However, the influence of working experience on attitude of nurses in serving oral medication was found to be significant (p= 0.045). Nurses in medical ward, Universiti Kebangsaan Malaysia Medical Centre, were found to possess an average level of knowledge and attitude in administering oral medication. In addition, this study suggest that work experience of nurses has no influence on knowledge gain and good practice in administering oral medication..