Cardio-pulmonary Resuscitation (CPR) is important and should be mastered by House Officers (HO). House officers who have just completed their studies are assigned to acute medical and surgical wards. If a patient in the ward has a cardiac arrest (CA), these doctors are usually the first to attend. Therefore an HO must be confident with CPR skills. They must be competent in performing CPR. The authors assessed 26 new HOs from Universiti Kebangsaan Malaysia Hospital (HUKM) with respect to their self-perception about CPR skills, confidence level in performing CPR and knowledge in performing CPR. Knowledge was assessed by a questionnaire. We found that 16 of 26 (61.5%) assessed themselves to have inadequate knowledge and 46.2% had no confidence in performing CPR. The mean score of the written test was 5.7 ± 1.8. Seven out of 26 (27.0%) HOs had incorrect hand placement position for CPR. Only 4 and 9 out of 26 HOs had their sternal paddle and cardiac apex paddle positions correctly placed respectively. In conclusion, knowledge, perception of skills and confidence levels of HOs on CPR are inadequate and need further assessment and improvement. Medical schools need to review their CPR curriculum in order to prepare HOs adequately to work in emergency situations.
This pilot survey was conducted to determine the main reason and the motivating factors which, influence patients in seeking orthodontic treatment. 115 patients aged 11-30 years old were taken from the orthodontic waiting list at the Dental Faculty, University Malaya dated December 1999 - May 2000. A structured questionnaire was designed and the survey of patients was carried out using the telephone. The desire to have a better dental appearance was the main reason (65 %) given by patients who were seeking orthodontic treatment. The most important motivating factor that influences patients in seeking orthodontic treatment was to attain straight teeth (48 %). In conclusion, patients seek orthodontic treatment mainly due to psychological reason, which is to improve dental appearance and aesthetic. Perceived needs of an orthodontic patient should also be taken into consideration before commencing orthodontic treatment to increase chances of mutually satisfying result for both the orthoqontist and patient.
CWorhexidine gluconate, a dicationic bisbiguanide agent, contains anti-plaque properties. Most chlorhexidine gluconate mouth rinses presently available contain alcohol in varying concentrations. The role of alcohol in these mouth rinses is to act as a preservative and solvent although it may have deleterious effects on the oral epithelium on long term usage. Recently, an alcohol-free 0.12 % w/v chlorhexidine gluconate mouth rinse (Oradex®) has become available in Malaysia. This clinical study is aimed at determining the effects of this alcohol-free product compared to a placebo. A group of 60 meticulously screened subjects were assigned into two groups of 30 each. The first group started using the test product for 2 weeks followed by a washout period of 4 weeks. After this duration, this group used the placebo for a further 2 weeks. The 2nd group underwent similar protocol as the 1st except that this group started with the placebo. Measurements consisting of the following scores were recorded at baseline and after 2 weeks for each group: Plaque, Gingivitis: Papillary Bleeding, Stain and Calculus. Full mouth prophylaxis was carried out for all subjects after measurements at baseline as well as after the 2-week period. They were told to rinse with 15 ml of the designated mouth rinse twice daily for thirty seconds each after tooth brushing. The results of this study indicated that there was significant improvement in the plaque, gingival and papilla bleeding scores compared to the placebo. Stain and calculus scores were significantly increased for the test product when compared to the placebo. In conclusion, this study showed that alcohol-free 0.12 % w/v chlorhexidine gluconate mouth rinse is effective in reducing plaque and gingivitis but causes staining and calculus formation.
The aim of this study was to determine the genotoxicity of a locally produced nanocomposite by Universiti Sains Malaysia, Malaysia using Comet assay. Stem cells from human exfoliated deciduous teeth (SHED) were treated with the nanocomposite at five different concentrations (0.006, 0.0125, 0.025, 0.05, and 0.1 mg/ml) along with concurrent negative (medium alone) and positive control (zinc sulfate heptahydrate) and incubated at 37°C for 24 hours in an incubator at 5% CO2. The tail moment was used to assess the extent of DNA damage. The tail moment for the group of SHED treated with nanocomposite (for all the five different concentrations) was not statistically significant as compared to the negative control, suggesting that the locally produced dental nanocomposite did not induce any DNA damage. Hence, it can be concluded that the locally produced nanocomposite is non-genotoxic on stem cells from human exfoliated deciduous teeth.
Mild cognitive impairment (MCI) is a common disorder among elderly and may worsen to dementia. The aim of this study is to develop a nutrition and lifestyle booklet to implement better lifestyle modification, as an effort to delay cognitive decline. A series of discussions with a research group comprising of dieticians, nutritionists, a geriatrician and a public health physician were conducted to ascertain the content of the booklet. There were seven guidelines in the booklet including; eat more fish, eat more foods rich in folic acid, eat more fruits and vegetables, exercise regularly, do activities to stimulate memory, stop smoking and alcohol drinking and stay cheerful and positive. Evaluation of acceptance for the booklet was carried out which comprised of assessment on content, graphic and design among elderly and health staff at health clinic in Cheras. The assessment involved 15 Malay elderly subjects aged 60 to 81 years (mean age 66.1 ±6.6 years), with 60.0% men and 40.0% women and 10 health staff aged 36.6 ± 12.0 years, with range of 27 to 58 years, consists of 20.0% men and 80.0% women also participated. Most of elderly subjects (80.0%, n = 12) indicated they understood information in the booklet. Meanwhile, 20.0% (n = 3) of elderly expressed they did not fully understand the content of the booklet in particular on sentence and terminology. All health staff (100.0%) understood the information in the booklet. This booklet was well accepted by elderly subjects and health staff, however adding more graphics, simplifying sentence structures and minimizing scientific terminologies to improve understanding were suggested. The booklet has the potential to increase the nutritional and health knowledge of elderly specifically with MCI. This would motivate them to adopt healthy eating and lifestyle, thus reducing cognitive decline and prevent dementia.
Keywords: Cognitive, education, booklet, elderly, lifestyle
Pseudohyperkalemia is a spuriously high serum potassium measurement in a patient with no clinical evidence of hyperkalemia. It has been reported to occur in patients with leukocytosis and thrombocytosis. Only a few cases of pseudohyperkalemia have been reported in patients after splenectomy. Two cases of pseudohyperkalemia occurring after emergency splenectomy for abdominal trauma are presented to highlight their clinical presentation and sequalae. Consecutive patients who underwent emergency splenectomy for trauma and subsequently developed pseudohyperkalemia were monitored in Universiti Kebangsaan Malaysia Medical Centre for their clinical sequalae. Both the patients developed leukocytosis, thrombocytosis and high serum potassium level within 2-weeks of their splenectomies. They did not demonstrate any symptoms and signs of hyperkalemia. Their conditions resolved spontaneously without any specific treatment. Pseudohyperkalemia should be suspected in a similar clinical scenario to avoid unnecessary treatment that could lead to severe hypokalemia.
A study to determine the impact of leachate from operating and closed landfills into the surface water and groundwater systems in the state of Selangor was conducted in the year 2009. Groundwater was a major source of water for various uses in Selangor, Malaysia and was especially important for industrial purposes. The presence of high numbers of landfill sites was seen to have increased the risk of groundwater contamination. There were 20 landfill sites in the state of Selangor and seven of them were still operating and 13 closed. The landfills are classified into four categories, which were: (a) landfills operating at critical stages without controls to prevent pollution into the environment; (b) open dumpsites that have the capacity to continue to accept waste but needed to be upgraded to manage leachate and gas; (c) landfills that were closed but no safety closure plan was carried out; and (d) engineered landfills with up to date technologies. As most of the landfills were built prior to 1989, they were not subjected to the Environmental Impact Assessment requirements, hence, they were being poorly managed and were badly sited. The non-engineered sites had no proper pollution controls such as cover materials, liner materials, groundwater monitoring wells, leachate collection ponds and treatment, and methane gas collection pipes. This study revealed that the surface water and groundwater at and nearby the landfill sites were contaminated at various levels due to the landfill sites and operation. A comparison between the current quality of surface water and groundwater with their respective standards and background levels was carried out to survey the trend of the contamination. However, the limited financial resources hindered a very thorough investigation and restricted the number of samples collected and parameters analysed.
The National Health Morbidity Survey 1996 showed only 34.2% of women aged 20 years and above had done breast self examination (BSE). This data showed the practice of BSE is still low despite of various awareness programmes and activities carried out. A cross sectional study through Systematic Random Sampling was done at Out Patient Department, Kuantan Health Office to know the knowledge and practice of BSE among women aged 20~60 years. The results showed 94.9% respondents had received information about BSE, however only 31.6% knew the appropriate time to do BSE, 14.7% knew the purpose of doing at that time and only 29.9% knew how frequent they should do BSE. 74% of respondents did BSE, however 70.2% of them did not do monthly and 67.2% did not do at the suggested time. There was an association between the practice of BSE with the knowledge and sociodemographic characteristics i.e. educational level, income, ethnic group and marital status.
Key word: Breast self-examination, breast cancer, Kuantan.
Study site: Klinik Kesihatan, Kuantan, Pahang, Malaysia
Corporate culture can simply be defined as “The way we do things around here". It comprise of assumptions, values, norms and tangible signs. Ministry of Health has started its culture building in 1991. Prior to this study, there have been two studies to evaluate its implementation. There were two types of respondents, where administered questionnaires were sent to all head of departments and all U3 medical ojjicers in public services in Malaysia, About 50% (n=126) of head of departments and only 18% (n=1321) of medical ojjicers responded. The study shows that at least 83% of head of departments perceived that the three core value of corporate culture has been implemented in their departments. However for rites and rituals, less than habf of them have implemented it. Singing of corporate song is done more in hospital as compared to health. As for medical officer, only 28% of them have received training on corporate culture. Among those who have received training, only a quarter understood the meaning of corporate culture. Doctors were also asked to give opinion on how to generate a caring doctor. About one-third suggested to reduce the workload of doctors. Apart from increasing manpower, workload can also be reduced by reengineering the system and upgrading the doctors’ competency.
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.
Organ shortage is a major concern in many countries. The objective of this paper was to investigate the factors that contribute to the low quantity of organ donation in Malaysia. The 1311 respondents in this survey came from the three main ethnic groups in Malaysia (Malay, Chinese and Indian). The survey was based on these components: The reason for not pledging to become a donor; the reason of refusing to become a donor; and whether non-fungible incentive would influence decision. The lack of information and trust were the factors that influenced the respondents to remain apathetic to organ donation. The results denote that people are unlikely to become a donor even if non-fungible incentive were provided to them. Thus, it is important for the government bodies to evaluate the programme and strategies of public education in relation to organ donation.
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.
Introduction: Schoolbag weight across different types of school and schoolbag content has not been
studied in Malaysia. This cross sectional survey determines the weight of schoolbags, its content and
occurrence of back pain among primary school children in different medium primary school in Kuala
Lumpur. Methods: Students’ body weight, and schoolbags weight were measured using a calibrated
scale. Schoolbag content was examined, and weighed according to necessary learning materials
or unnecessary materials. Back pain in the past one week was assessed using a self-administered
questionnaire, adapted from previous studies. Results: A total of 358 students (167 male, 191 female)
were enrolled, of which 119 were from National School (NS), 122 from Chinese Medium School (CMS)
and 117 from Tamil Medium School (TMS). The mean schoolbag weight was 4.55±1.62kg for NS,
8.53±1.94kg for CMS and 6.06±2.09kg for TMS, which was 11.7%, 22.0% and 16.6% of body weight,
respectively. The mean weight of unnecessary schoolbag content was 0.64(0.91)kg for NS, 2.18(1.49)kg for CMS and 1.96(1.56) for TMS students. Back pain was detected in 87.0% NS students, 68.0% CMS students and 66.7% TMS students. Significant association was found between occurrence of back pain and types of school ( 2=16.64,p=0.00). Conclusions: Students from all the three mediums primary school, in particular Chinese medium school carry school bag heavier than that generally recommended, with unnecessary materials weigh up to 2kg. The occurrence of back pain is high and this is associated with the types of school.
This review explores the digestibility of lactose by Malaysians, and the value of milk and other milk-derived products as sources of appropriate nutrition for Malaysians. Increased calcium intake through consumption of milk is an effective mechanism for increasing calcium uptake from the diet and thereby minimising the risk of development of osteoporosis in later life. Detailed information about rates of lactose intolerance, and adaptation to dietary lactose and its consequences for Malaysians, will help in the formulation of dietary advice, and improve commerial food manufaturing practice and Government policy
directed to the minimization of rates of osteoporosis, which presents a substantial morbidity risk to elderly female Asians in particular.
The aim of the study was to assess the prevalence of Sarcocystis infection in wild and peri-urban rodents in some states in Peninsular Malaysia. The thigh muscle from these rodents were formalin preserved, sectioned and stained with hematoxylin and eosin and examined under light microscopy. Of the 146 muscle tissue examined only 73 were positive for Sarcocystis infection.
Morphological identification showed the presence of some new morphological types to be present. Different species of Sarcocystis were seen in the sections but more extensive studies are needed to identify them to species level.
There have been concerns about the growing number of children living in residential homes in Malaysia. The objective of this study was to determine the presence of depression and its association with the socio-demographic, personal characteristics and coping skills of adolescents residing in fourteen residential homes in Kinta Valley, Perak. A total of 235 adolescents participated in the study. They completed a self-report questionnaire gathering socio-demographic and personal factors, the Adolescent Coping Scale (ACS) and were assessed for presence of depression using The Mini International Neuropsychiatric Interview for children and adolescents (MINI Kid). The prevalence of depression was found to be 9.8 %, with 43% of the participants had history of being abused. Emotional abuse (OR=25.95, CI=4.51-149.43) and maintaining contact with parents (OR=0.02, CI=0.003- 0.10) were significant factors associated with being depressed. Depression is common among adolescents living in the residential homes. Detecting depression and understanding factors associated with depression allows appropriate management and intervention strategies.
Background: The General Health Questionnaire is a widely used scale to measure psychological distress. This scale is available in many languages. The original version comprised of 60 items. It is available in 30-items, 28- items, 20-items and 12-items. The shorter version is as good as the longer version of the scale. Objective: The aim of this investigation was to determine the sensitivity, specificity and reliability of the 12-item. General Health Questionnaire (GHQ-12) among university students. Method: A total of 280 undergraduate students were selected using convenient sampling. Result: The results of this study showed that the GHQ-12 is multidimensional and contains three factor structures. It has a high internal consistency and a useful instrument to measure the psychological wellbeing of university students in Malaysia Previous authors have suggested that the cut-off point is determined by the mean. Findings from this study, based on sensitivity and specificity, suggests that mean may not be a good option. This study recommends the best cut-off point is determined by the ROC. Conclusion: This study shows that the GHQ-12 is a valid and reliable instrument to detect psychological distress among university students. The optimum cut-off point
of the GHQ-12 score to detect psychological distress was 15/16.
Tendon rupture is a rare complication that occurs in patients receiving corticosteroid therapy. We report a case of a middle-aged man with mixed connective tissue disease who presented with spontaneous biceps tendon rupture 5 weeks after initiation of high-dose corticosteroid therapy. Musculoskeletal ultrasonography was performed at the clinic and helped to confirm the diagnosis. It is a new imaging modality that is increasingly used in rheumatology clinics in Malaysia as it serves as an extension to physical examination. Musculoskeletal ultrasonography is preferred by patients as it is noninvasive, does not involve ionising radiation, painless, relatively inexpensive and can be performed readily at the clinic.
KEYWORDS: corticosteroid; musculoskeletal ultrasonography; tendon rupture
Quinsy is a common encounter in family physician practice. It is defined as a collection of purulent material in the peritonsillar space, giving appearance of unilateral palatal bulge. Presenting symptoms include trismus, muffled voice, odynophagia, and ipsilateral otalgia. When the diagnostic needle aspiration reveals no pus, the diagnosis is changed into peritonsillar cellulitis or also known as perintonsillitis. Peritonsillitis is sufficiently treated with antibiotics unlike a quinsy which warrants surgical incision and drainage.
A 28-year-old man presented with a chief complaint of rashes all over his body. He had a history of a trip to Langkawi Island, a famous island resort off the west coast of Malaysia, over the Chinese New Year’s weekend. According to him, he had a lot of fun with a group of friends at the sunny beach and the beautiful sea. There were no untoward incidents and they were perfectly well when they returned home after a 2-day trip. On the evening of the second day after his return, he noticed rashes appearing over his body, notably on shoulders and trunk. These rashes were little painful in nature.