This voluntary, anonymous questionnaire survey was performed to assess the willingness of Basic Life Support (BLS) participants to perform bystander cardiopulmonary resuscitation (CPR). A total of 55 dental students and 73 school teachers were assessed on their willingness to perform bystander CPR after completion of their BLS training. In general, only 29.0% of the total 128 participants said that they would offer to perform CPR under any cardiac arrest condition and 69.0% said that they would just offer to call the ambulance but they would not offer to perform CPR. When analyzed separately, only 16.4% of school teachers said that they would perform CPR as compared to 45.5% of dental students (p < 0.001). Knowing how to perform CPR does not necessarily translate into willingness to perform CPR.
A cross sectional study was conducted among military armoured vehicle drivers in the two largest mechanized battalions with the objective to determine the prevalence of low back pain (LBP), and its association with whole body vibration (WBV) and other associated factors. A self-administered questionnaire and Human Vibration Meter were used in this study. A total of 159 respondents participated in this study and 102 (64.2%) of them were subjected to WBV measurement. One-hundred-and-seventeen respondents complained of LBP for the past 12 months giving a prevalence of 73.6%. The prevalence of LBP among tracked armoured vehicle drivers was higher (81.7%) as compared to wheeled armoured vehicle drivers (67.0%). The mean acceleration at Z-axis in tracked armoured vehicles (1.09 +/- 0.26 ms(-2)) and wheeled armoured vehicles (0.33 +/- 0.07 ms) were the dominant vibration directions. The mean estimated vibration dose value (eVDV) for eight-hour daily exposure at Z-axis (19.86 +/- 4.72 ms(-1.75)) in tracked armoured vehicles showed the highest estimation. Based on the European Vibration Directive (2002), the mean eVDV at Z-axis in tracked armoured vehicles exceeded exposure action value (EAV) (> 9.1 ms(-1.75), but did not exceed exposure limit value (ELV) (<21.0 ms(-1.75)). Logistic regression analysis revealed that only driving in forward bending sitting posture (OR = 3.63, 95% CI 1.06-12.42) and WBV exposure at X-axis (OR = 1.94, 95% CI 1.02-3.69) were significant risk factors to LBP. Preventive measures should be implemented to minimize risk of WBV and to improve ergonomic postures among drivers.
This retrospective study examined the G/P type of rotavirus in RNA samples that have previously been e-typed by RNA-PAGE in 1996. The results were then compared to 2007 samples to ascertain the extent of changes that may have occurred in this 11-years time interval. The G and P genotypes were determined by hemi-nested PCR and further analysed by phylogenetic study. In 1996, the G/P combination G1P[8], G(UT)P[8] and G1P(UT) prevalence rate were 81%, 9% and 7%, respectively. As expected, the G9 genotype which has already emerged worldwide was identified in 42% of the 2007 samples with the remaining 33% G1P[8] and 25% G1P(UT) Analysis of the RNA pattern showed that majority of the isolates were long e-type in both series, nevertheless minor differences within electropherotypes were observed. Genetic diversity in some strains of the human group A rotaviruses was analysed by phylogenetic methods. These findings will help in the decision to introduce rotavirus vaccines within the next decade.
Observations of racial differences in the prevalence of Helicobacter pylori in Malaysia have been intriguing. The Indians and Chinese consistently have a higher prevalence compared to the Malays. The racial cohort theory has been proposed to explain these differences where transmission and perpetuation of infection takes place within a racial group rather than between races, races being separate owing to the low rate of interracial marriages. Studies have demonstrated distinctive bacterial strains between races. Phylogenetic studies have shown that H. pylori isolates amongst Chinese and Indians are distinctive while Malays have Indian and other strains suggesting a more recent acquisition of the bacterium from Indians. H. pylori is recognized as the major causative factor in peptic ulcer disease and gastric cancer. Despite the high prevalence of H. pylori, Indians have a relatively low prevalence of peptic ulcer disease and a low incidence of gastric cancer. This paradox with regards to gastric cancer has been termed the "Indian enigma". Bacterial strain differences between races may be putative but this observation may also indicate gastroprotective environmental factors or a lower genetic susceptibility to develop cancer in the Indians.
The use of atypical antipsychotic agents in early onset schizophrenia is rising despite its limited data on efficacy, safety and tolerability. Early onset schizophrenia warrants effective pharmacological treatment that is safe and well tolerated by children and adolescent population. Existing atypical agents are not completely free of side effects. Aripiprazole has unique properties that differ from other atypical antipsychotics and fill up the missing gaps, as it is associated with minimal metabolic complications and extrapyramidal side effects that are more commonly seen in other atypical agents. It offers a better option for this population and may possibly be considered as first line treatment in future. This case report demonstrates the efficacy and safety of Aripiprazole in children and adolescent population.
Cushing's syndrome is a pathological condition associated with excessive cortisol production, the commonest etiology being Cushing's disease. Corticosteroids in high doses have been used in the management of Steven Johnson Syndrome (SJS) with favourable outcome. We describe a patient with Cushing's disease who developed SJS, one week after taking sperulina a product from sea-weed while waiting for transphenoidal surgery.
Ureteral triplication is a rare congenital anomaly of the urinary tract. We report a case of ureteral triplication with contralateral partial kidney duplication in a patient with right loin pain. The development and types of ureteral triplication and the features of type 2 ureteral triplication on intravenous urography and magnetic resonance urography are described.
We set out to investigate whether neckties worn by doctors are more likely to be contaminated with Methicillin resistant Staphylococcus aureus (MRSA) compared to neckties worn by preclinical medical undergraduates who have never been exposed to a hospital environment. We discovered that more than half (52%) of neckties worn by doctors were contaminated with Staphylococcus and out of these, 62% of them were identified as MRSA. In contrast, none of the student's ties were contaminated with MRSA. Due to the high prevalence of staphylococcus detected on doctors' neckties, we recommend that health care workers do not wear neckties.
Physical activity is the first line approach and one of the main factors in preventing chronic diseases. Currently there is the increasing percentage of sedentary life style or lack of exercise among adolescents. The main objectives of the study were to determine the prevalence of inactivity and the factors influencing physical activity in adolescents. A cross sectional study was carried out among secondary school students aged 14 and 16 in Petaling District, Selangor, Malaysia. A total of 519 respondents participated in this study. Their physical activity level was measured using the International Physical Activity Questionnaire (IPAQ). The active group was classified as those having levels of equal or more than 600 met-min per week while less than 600 met-min per week was considered inactive. Response rate in this study was 95.4%. The prevalence of inactive in adolescents was 20.8%. Female adolescents, non-working mother, time constraint, exercise only when having ample time and stretching before exercise are predictor factors for being inactive among adolescents. Steps need to be taken to persistently ensure that the physical activity among adolescents be increased continuously.
Koh and others have reported (in this issue of the MJM) the high prevalence of Methicillin resistant Staphylococcus aureus (MRSA) on doctors’ neckties. As they have pointed out, this is nothing new, and like other studies with similar findings. They also point out that patient’s confidence and satisfaction are not affected by doctor’s not wearing neckties. They also referred to the British Department of Health decision to ban the use of neckties, long sleeve shirts and jewellery, and the Scottish government’s intention to ban the wearing of white coats, including neckties, to stop the spread of infections. They support the call by The Malaysian Medical Association to avoid the use of neckties.
Durian may inflict severe body injury when it drops from the tree. This case report describes a patient who presented with facial and penetrating eye injury when a ripe durian fruit dropped onto her face while harvesting the fruits under the tree. The authors emphasized the importance of facial and eye protective devices during durian fruit harvesting season.
We report a case of a 16 years old girl who presented sequentially with primary amenorrhoea, hypertension and hypokalaemia. Eight years later, she was finally diagnosed with 17alpha-hydroxylase deficiency congenital adrenal hyperplasia. Previous antihypertensive medications were stopped. Hydrocortisone alone successfully maintained normotension and normokalaemia.
The aim of this study was to determine the prevalence of hypertensive retinopathy, features of hypertensive retinopathy and visual outcome in hypertensive disorders in pregnancy in Hospital Universiti Sains Malaysia, Kelantan, Malaysia. A prospective observational hospital based study involving 154 patients (308 eyes) with hypertensive disorders in pregnancy was conducted. All subjects were examined once during antenatal period, at a minimum of 35 weeks of gestation for blood pressure, visual acuity and funduscopy. The similar protocol was repeated at six weeks postnatal period. Thirty-two point five percent had hypertensive retinopathy. Ninety eight percent had visual acuity 6/6 during antenatal assessment, while 100.00% gained 6/6 at postnatal period. Generalized arteriolar narrowing was the most common retinopathy observed. There was no statistically significant association between presence of hypertensive retinopathy and maternal age, presenting visual acuity, systolic/diastolic blood pressure (p>0.05). We conclude that prevalence of hypertensive retinopathy is 32.5%, and majority had good visual acuity during antenatal and postnatal period. Hypertensive retinopathy is insignificantly associated with maternal age, presenting visual acuity and blood pressure.
Study site: Ophthalmology Clinic, Antenatal Clinic and Obstetric Ward of Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
The third National Health Morbidity Survey was conducted in 2006 on a nationally representative sample of population in Malaysia in order to obtain community-based data and information on the prevalence of chronic illness. Of 57,500 eligible respondents 56710 (98.6%) participated in the study. Estimated overall prevalence of chronic illness in the Malaysian population within a recall period of one year was 15.5% (95% CI 15.1% - 15.9%). Chronic illness was reported significantly higher among the females, 16.8% (16.3 - 17.3). The most common chronic illness was hypertension (7.9%, 7.6 - 8.2), followed by diabetes mellitus (4.0%, 3.8 - 4.2) and highest reported by the Indians (19.7%, 18.4 - 21.0). Among the respondents who had sought treatment for chronic illness from government health facilities, Malays (65.8%) and those with monthly household income of less than RM400 (76.6%) were the highest. Chinese (44.5%) and those with household income of RM5000 and above (54.3%) were the highest groups who sought treatment from the private health facilities. Most of the respondents reported mild illness was the main reason for not seeking treatment for their chronic illness. It is hoped that the results of this survey will help the Ministry of Health Malaysia to enhance health programmes and planning resource allocation in order to improve health status of the population.
Study name: National Health and Morbidity Survey (NHMS-2006)
A systematic approach to death registration and reporting is essential for studies and comparison within or between countries. One of the accepted methods in the system is to have medically certified death. The objective of this study was to improve the proportion of medically certified death (MCD) in the state of Malacca. Structured questionnaires were used by Medical Assistants (MAs) in the investigation of the cause of death for non-medically certified deaths. Data on certification of death by MAs in Malacca was analysed and compared with the total deaths obtained from the Department of Statistics. Possible determinants of deaths were investigated. Total deaths in the state of Malacca during the study period from 2000 - 2001 were 5941. About 35% (883/2493) of the total deaths in year 2000 and 45% (1550/3448) in 2001 certified by MAs were examined. By districts, 50.6% were certified in the district of Malacca Tengah, 13.4% Jasin and 36.0% Alor Gajah in 2000; 65.9% occurred in Malacca Tengah, 11.0% Jasin and 23.2% Alor Gajah in 2001. This project helped to increase the percentage of the medically certified deaths in Malacca from 49.8% in year 1998, 49% in 1999 to 73% in 2000 and 85% in 2001. The proportion of MCD in Malacca in 2000 (73%) may be increased to 93% if all MCDs done by MAs were accepted by the Department of Statistics. There is still a high proportion (23.6%) of ill-defined conditions such as old age and sudden death being diagnosed by MAs. The study shows that the quality of mortality data particularly in the percentage of medically certified deaths can be improved.
A survey was carried out to determine the prevalence of bronchial asthma and their contributing risk factors among Orang Asli subgroups living in Malaysia using IUATLD questionnaire and spirometry without being discriminatory towards age or gender. Of the 1171 distributed questionnaires, 716 (61.1%) comprising of 62.7% Semai Pahang, 51.3% Temiar, 74.2% Mah Meri, 65.6% Semai Perak, 53.6% Temuan, 53.8% Semelai, 61.1% Jakun and 67.4% Orang Kuala subgroups completed their questionnaire and were included in the data analysis. Participants comprised 549 (76.7%) children and 167 (23.3%) adults, age between 1 to 83 years old, 304 (42.5%) males and 412 (57.5%) females. The overall prevalence of bronchial asthma was 1.4% of which 1.5% was children, 1.3% adults, 1.0% male and 1.7% female, respectively. Of the 8 subgroups surveyed, 5 out of 10 confirmed asthma cases were Semai Pahang, followed by 3 cases among Mah Meri, and one case each among Temuan and Semai Perak subgroups, respectively. This study also demonstrated that the prevalence of self-reported and confirmed bronchial asthma tend to be higher among those who had close contact with pets, smoking individuals and among those who had a family history of asthma.
Opportunistic pneumonias are major causes of morbidity and mortality in HIV infected individuals. The majority of new HIV infections in Malaysia are adults aged 20 to 39 years old and many are unaware of their HIV status until they present with an opportunistic infection. HIV associated opportunistic pneumonias can progress rapidly without appropriate therapy. Therefore a proper diagnostic evaluation is vital and prompt empiric treatment of the suspected diagnosis should be commenced while waiting for the results of the diagnostic studies. Tuberculosis, Pneumocystis pneumonia (PCP) and recurrent bacterial pneumonias are common causes of AIDS-defining diseases and are discussed in this article.
OBJECTIVE: To evaluate tears of newly diagnosed keratoconus patients attending the Optometry clinic in Malaysia and to compare this with tears of normal myopic subjects.
METHODS: The ocular surface of newly diagnosed keratoconus patients were evaluated using tear break up time (TBUT) test, non invasive tear break up time test (NIBUT) and Schirmer test. Twenty keratoconus patients (40 eyes) and 40 normal subjects (80 eyes) participated in this study.
RESULTS: Significantly lower TBUT and NIBUT values were found in keratoconus patients than normal control subjects (p<0.05). Mean TBUT and NIBUT for keratoconus patients were 3.99±1.69s and 7.03±3.48s and for normal subjects were 7.24±4.39s and 13.67±10.81s respectively. However, no significant difference was detected in Schirmer test values. Mean values of Schirmer tests I and II for keratoconus patients were 20.52±10.66mm and 10.71±10.43mm and for normals were 23.83±11.34mm and 13.27±8.28mm accordingly.
CONCLUSION: It was concluded from this study that keratoconus patients have poor tear stability which need to be considered appropriately during management of the patients.
Study site: Optometry clinic, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
In view of the alarming increase in the incidence of diabetes mellitus in Malaysia, we conducted a study to assess the awareness of complications of diabetes among the diabetics attending the peripheral clinics in Melaka. The study period was from January 2007 to December 2007. 351 patients were included in the study. 79.8% were aware of the complications of diabetes mellitus and 87.2% were aware that diabetes can affect the eyes. However, only 50% of the patients underwent an ophthalmological evaluation. Although awareness was good, the motivation to undergo the assessment was poor.
Study site: Klinik Kesihatan Peringgit, Klinik Kommunity Ayer Keroh, Melaka, Malaysia
Focal eventration of the diaphragm with transthoracic kidney is a very rare condition. It is usually asymptomatic and often revealed as an incidental finding on imaging studies. We presented a case of previously undiagnosed focal eventration of left hemidiaphragm with transthoracic left kidney confused with traumatic diaphragmatic hernia. Differentiation of these two conditions is important as each were managed differently. A traumatic diaphragmatic hernia needs early surgical intervention whereas no treatment was required for focal diaphragmatic eventration in most cases. Diagnostic laparoscopy confirmed the findings in this case and the patient was managed conservatively.