Irreducible dislocation of the interphalangeal joint (IPJ) big toe is a rare injury Hitori et al. (2006) . We report a case of the right big toe IPJ dislocation following a trauma. The problem was diagnosed and managed at other medical centers with standard treatment of closed manual reduction and splint. The right big toe was splinted accordingly and the patient was referred to our orthopedic outpatient clinic. At the clinic, a repeat plain radiograph was ordered due to high suspicion of the irreducible IPJ.
Study site: orthopedic clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Migrants and refugees face challenges accessing both healthcare and good social determinants of health in Malaysia. Participants at the "Migrant and Refugee Health in Malaysia workshop, Kuala Lumpur, 9-10 November 2017" scoped these challenges within the regional ASEAN context, identifying gaps in knowledge and practical steps forward to improve the evidence base in the Malaysia.
Introduction: The goal of this study was to assess the effectiveness of seated combined extension-compression and transverse load (ECTL) traction as a new method for increasing a reduced lordosis of less than 30 degrees in a Malaysian population between the ages of 18 and 60 years. Possible changes in disc height were measured in accordance with the underlying theoretical framework, that suggests the anterior cervical structures would elongate due to creep over the fulcrum of the traction device.
Method: This was a single centre, randomised, blinded controlled clinical trial with parallel groups, used to test the superiority of the seated combined ECTL traction together with physiotherapy exercises when compared with the same physiotherapy exercises used as a control. Fifty randomly allocated subjects who completed the forty treatments over the fourteen weeks were analysed using non-parametric tests for changes in outcomes.
Results: There were no significant changes in outcomes for disc height changes seen in this study. The findings of a greater overall increase in posterior disc height changes compared with anterior disc height changes were in contrast with the proposed underlying theoretical framework for this type of ECTL traction. The greater height changes occurring in the control group were also unexpected.
Conclusion: The findings in this study of the contrasting changes in disc height of greater posterior than anterior height changes, question the underlying theoretical framework as postulated for this type of traction.
Iron deficiency anemia is the most common form of anemia in pregnancy. The present study was carried out to determine the prevalence of antenatal anemia and iron deficiency in the Malaysian population and its correlation with sociodemographic and obstetric profile. It was a cross-sectional study conducted at an urban health clinic over a period of six months. A single blood sample was drawn from apparently healthy pregnant mothers at antenatal booking and sent for laboratory assessment of full blood count and serum ferritin as screening tools for anemia and iron status. SPSS version 19.0 was used for statistical analyses. The results showed that out of 250 subjects, 43.6% had anemia and 31.6% had iron deficiency. Whilst 47.7% of subjects with anemia were iron deficient, 19.1% of subjects without anemia were also iron deficient. Serum ferritin correlated negatively with period of gestation at booking (p<0.001), with 77.6% of these women not having prior iron supplements. Serum ferritin was also significantly lower among grandmultiparae (p=0.01). Iron deficiency was significantly (p=0.024) more common among Indians (42.5%) compared to Malays (33.5%) and Chinese (13.0%). In conclusion, continuation of the current practice of routine antenatal iron supplementation is still warranted and justifiable in Malaysia as there is high prevalence of iron deficiency in pregnancy not only in the presence of anemia but also in the presence of normal hemoglobin values. Keywords: anaemia, ferritn, pregnancy
This study illustrates about the most hazardous and risky activities associated with well drilling operation at on and offshore
oil and gas drilling sites by adopting exploratory research design (quantitative leading to qualitative). In this study researcher has
targeted three oil and gas industries each from Malaysia, Saudi Arabia and Pakistan for the identification of associated hazards
and nature of hazardous activities faced by drilling crew during well drilling operation. Eighty (80) drilling crew members have
been randomly selected for answering the survey questionnaire. Likewise, nine (09) drilling health and safety officials have been
conveniently selected based on their safety expertise in oil and gas drilling field for semi structured in-depth interview. For analyzing
quantitative findings descriptive statistical methods has been used. While for qualitative section thematic analysis approach has
been utilized. Based on the findings, respondents from Malaysian oil and gas industries reported starting drilling activity as highly
hazardous at onshore well drilling, while handling drilling pipe has been considered more hazardous activity at offshore domain.
Similarly, in the context of Saudi Arabia, respondents highlighted that the handling drilling pipes are cause of major injuries at onshore
well drilling site. Whereas drilling fluid preparation and coring process is considered harmful at offshore sites. In contrast, participant
from Pakistan indicated coring process as a highly hazardous activity at on and offshore well drilling operation. According to overall
results based on the participant response, oil and gas well drilling operation at onshore domain is considered more hazardous
at Pakistani oil and gas industry as compare to other targeted industries with mean range 3.42. While for offshore well drilling,
Malaysian industry is recorded highly hazardous as compare to others leading with mean value 3.39 and related with chemical and
safety hazards in well drilling activities.
The construction industry is one of the largest sectors in Malaysia. This industry has become one of the main contributors
for national economic development and consistently contributes 3% to 5% to the national Gross Domestic Product (GDP). This
sector has also opened up job opportunities for various levels of employment. High demands and rapid urbanization offer huge
opportunities for registered contractors. Despite contributing in enhancing national economics, this sector has been regarded as one
of the most dangerous and hazardous workplaces due to the type of nature and the job activities at construction sites. According to
the International Labour Organization (ILO), 2.3 million fatalities related to occupational accidents and illnesses are estimated to
occur each year. Furthermore, 4 percent of world GDP is estimated to be lost due to occupational accidents and illnesses. The number
of fatality accidents in the construction industry was the highest with 652 cases of non-permanent disability (NPD) and permanent
disability (PD) accidents in the period 2007 to 2015, equivalent to 72.44 cases per year and representing 48.77% of the construction
industry. The huge gap between the number of accidents reported to SOCSO and DOSH becomes a major concern due to a rising
number of underreported cases of fatalities and injury in the construction sector, especially those involving foreign labour. The margin
between accidents reported to SOCSO and DOSH is 97.49%. Regards to rapid developments, safety measures to improve performance
management of OSH should be emphasized to reduce losses of life, property and productivity.
Legislation that governs the health and safety of communities near major-hazard installations in South Africa is largely based on existing legislation that had been developed in the United Kingdom and other European Union countries. The latter was developed as a consequence of several major human-induced technological disasters in Europe. The history of the evolution of health-and-safety legislation for the protection of vulnerable communities in European Union (EU) countries, France, Malaysia and the USA is explored through a literature survey. A concise comparison is drawn between EU countries, the USA and South Africa to obtain an exploratory view of whether current South-African legislation represents an optimum model for the protection of the health-and-safety of workers and communities near major-hazard installations. The authors come to the conclusion that South-African legislation needs revision as was done in the UK in 2011. Specific areas in the legislation that need revision are an overlap between occupational health and safety and environmental legislation, appropriate land-use planning for the protection of communities near major-hazard installations, the inclusion of vulnerability studies and the refinement of appropriate decision-making instruments such as risk assessment. This article is the first in a series that forms part of a broader study aimed at the development of an optimised model for the regulatory management of human-induced health and safety risks associated with hazardous installations in South Africa.
Positive emotion is often neglected in the depressed patients due to the lack of assessment tool. Positive Emotion Rating Scale (PERS) is a newly invented self-report questionnaire, nevertheless has an impressive psychometric properties.
Objective: The aim of this study was to study the psychometric properties of the Malay version PERS (PERS-M), in order to facilitate its use in the local setting.
Method: In this cross-sectional study convenient sampling, total of 43 depressed subjects and 85 non-depressed subjects who were presented to the outpatient clinic of HBUK were recruited. Both groups were assessed with PERS-M, original PERS, Dispositional Positive Emotion Scale (DPES), Malay version of Snaith-Hamilton Pleasure Scale (SHAPS-M) and Malay version of Center for Epidemiological Studies Depression CESDM).
Results: PERS-M displayed good internal consistency (Cronbach’s α = 0.89), parallel reliability (intraclasss coefficient = 0.95, p<0.001) and concurrent validity with the DPES (r=0.32, p<0.05) and SHAPS-M (r=0.77, p<0.01). The PERS-M was negatively correlated with CESD-M (r= -0.61, p<0.01). The optimal cut-off value was 32, with sensitivity = 0.68 and specificity = 0.63, positive predictive value of 0.49 and negative predictive value of 0.79. The area under the curve (AUC) for receiver operating characteristic (ROC) was 0.71 (95% CI = 0.604 - 0.813).
Conclusion: the PERS-M is a brief and easy to administer tool to measure positive emotion in depressed subjects, with demonstrable satisfactory psychometric properties.
Keywords: Positive Emotion, Depression, Psychometric Properties, Instrument
Study site: Psychiatric clinic, Hospital Bahagia Ulu Kinta, Perak, Malaysia
This article aims at exploring the trust establishment among patients with depression during their journey to psychiatric patient-hood. This study was undertaken in government hospital involving 29 psychiatric outpatient users in Kedah and Pulau Pinang respectively using phenomenological study and gender lens. Semi-structured in-depth interview and non-participant observation were the tools used in data collection. The data explicated with the aid of a qualitative data analysis tool, Atlas.ti., version 7.5. Through the findings, the study identified “Trust” appears critical in the accounts of the patients in shaping the doctor-patient relationship. Five interlocking subthemes describing the health professional’s characteristic while giving the service include doctor’s integrity, concern, competencies, empathy, and autonomy enabler. The findings had highlighted that both female and male physicians had different approach to their patients, where the female physician had better chances in getting the mandate of trust. This research is useful to health professionals and governance of mental health care to fulfil the patients’ needs based on their genders.
Study site: government hospital involving 29 psychiatric outpatient users
in Kedah and Pulau Pinang
Objective: Lead toxicity constitutes a major environmental risk to health in both animals and humans of all ages. It is more severe in young children than adults. Blood transfusion is an important source of lead exposure and may predispose premature infants to lead toxicity. Thalassaemia is common in Malaysia and majority of patients require frequent blood transfusion. The objective of this study was to determine whether regular blood transfusion contributed to high blood lead levels in paediatric thalassaemic patients.
Method: This was a cross sectional study conducted at the Paediatric Thalassaemia Day Care Unit, General Paediatric Ward and Paediatric Clinic in Hospital Universiti Sains Malaysia (HUSM). A total of 90 patients were included, 45 were thalassaemic transfusion dependant patients and the other 45 were control, who were of the same age and sex with patients group and had never been transfused. The blood samples were taken preand post-transfusion for thalassaemic and control groups. Blood lead levels were analyzed using standard Atomic Absorption Spectrometer (AAS) analysis.
Results: The overall mean plasma lead levels (2.13 + 1.72µg/dL) were lower than those of standard CDC recommendations. The independent t-test showed that plasma lead levels in thalassaemic group were significantly (p < 0.05) lower than the levels in controls. However, the ANCOVA analysis revealed the plasma lead levels were not significantly (p > 0.05) different between the two groups. Thus, suggesting that the reduced plasma lead level in thalassaemic group was due to the administration of iron chelators. Increased frequency of blood transfusion also did not significantly (p > 0.05) increase plasma ferritin or lead levels in thalassaemic patients.
Conclusion: This study shows that transfusion dependent thalassaemic infants have comparable plasma lead levels to those of age- and sex-matched controls, after taking into consideration the administration of iron chelators.
Study site: Paediatric Thalassaemia Day Care Unit, General Paediatric Ward and Paediatric Clinic in Hospital Universiti Sains Malaysia (HUSM)
Objectives: This is a retrospective study in which all neonates with confirmed dengue fever mother admitted to our special care nursery from March 2014 to March 2015 were recruited. This is to determine the percentage of positive dengue serology in the neonates of mother with confirmed dengue fever and to investigate the correlation between the duration of maternal illness with these neonatal seropositivity of dengue antibody and their presenting symptoms.
Method: A total of 22 neonates whose mother with confirmed dengue fever were recruited out of which 14 (63.6%) neonates of confirmed dengue fever mothers had positive dengue serology.
Results: Eight out of fourteen neonates were dengue seropositive when mother dengue illness was between day 1 to 5 of illness (acute phase) at the time of delivery. Thirteen out of twenty-two neonates (59%) were symptomatic, out of which 61.5% (8 out of 13) were delivered during maternal acute phase of illness.
Conclusion: From this study, we concluded that neonates were more likely to be dengue seropositive and symptomatic when mother presented in acute phase of illness during delivery. However, our sample size was small, only 22 neonates were recruited from a single centre, therefore a larger sample size from multicentre is required in future.
Background: Early detection of alcohol abuse and associated risk(s) is necessary. It requires easy and reliable screening tools that are culturally
adapted to the local context.
Objectives: The aims of this study were to cross culturally adapt, test for its reliability and validity of the Malay version of Alcohol Use Disorder Identification Testing (AUDIT-M).
Methods: The cross-cultural adaptation process involved four stages: translation, synthesis, back translation and field pre-testing. The final version of AUDIT-M was pre-tested and post-tested within a 10-day interval among 37 respondents at the Tampin Health Clinic. Analysis of reliability and validity testing were done using SPSS version 21.
Results: There were 37 participants in this study. The Intra-Class Correlation (ICC) with single measures of the test-retest scores was 0.93 (Cronbach alpha = 0.97), while the internal consistency reliability yielded (Cronbach alpha=0.92). Validity testing for the Pre-test and Post-test analysis with the Pearson correlation analysis was r=0.938.
Conclusion: The translated Malay version of the AUDIT-M was found to be easy to understand and adaptable in the Malaysian context.
Tuberculosis in children remains a public heath concern in Malaysia and other developing countries. Mycobacterium tuberculosis (TB) infection of the liver, known as hepatic TB, is an extra pulmonary manifestation of TB. Tuberculous bacilli can reach the liver via hematogenous dissemination through hepatic artery, or by local spread from the gastrointestinal tract via portal vein [1].(Copied from article)
Background: Medical schools are escalating changes
to meet the need for doctors competent to work in the
era of precision medicine. Information on the current
level of awareness of precision medicine among medical
students can help effect the necessary changes in the
medical curriculum. A cross-sectional comparative
study was done to assess the knowledge, attitude and
perception toward the practice of precision medicine
among junior and senior medical students in a medical
school in Malaysia.
Materials and Method: A survey instrument measuring
attitude toward precision medicine, perceived
knowledge of genomic testing concepts, and perception
toward ethical consideration related to precision
medicine, was distributed to junior and senior medical
students. Comparisons were made between senior and
junior medical students.
Results: Only about one-third of the 356 respondents
had heard of precision medicine although 92.7%
expressed interest to learn more about precision
medicine. Overall, junior and senior medical students
had positive attitude toward the adoption of genomeguided
prescribing and precision medicine but were
uncomfortable with their knowledge of genomic testing
concepts. Both junior and senior students were largely
well grounded in their understanding of ethical issues
related to precision medicine.
Conclusions: Knowledge of precision medicine was low
among junior and senior medical students. Although
the students supported the use of precision medicine,
they did not feel adequately prepared to apply genomics
to clinical practice. Their perceptions on ethical issues
related to precision medicine were sound. Seniority did
not appear to influence the perceptions of the students.
Background: It is an undeniable fact that exposure to tobacco smoke from the ambiance poses harmful effects to human health. Although many countries including Malaysia have imposed smoking bans and restrictions in indoor and outdoor public places, yet, to achieve a zero exposure to tobacco smoke from one’s surroundings remains a challenge.
Objective: The objectives of this study were to determine the second-hand smoke (SHS) knowledge and percentage of exposure among adults of rural Pedas, Negeri Sembilan and assess the association between socio-demographics and knowledge of SHS among these adults.
Methods: A cross sectional study with convenient sampling was carried out on 485 adults in Pedas, Negeri Sembilan. The instrument used was a validated questionnaire which was adapted with permission to suit the sample under study. The data collected were analysed with SPSS Statistics for Windows, Version 24.0.
Results: The percentage of SHS exposure among the non-smoking adults in rural Pedas, Negeri Sembilan was high (95.5%). More than 30% of the non-smoking respondents reported a daily exposure to SHS. The adults from this study however have good knowledge of SHS effects on health. A Mann-Whitney U test result revealed that knowledge on SHS scores was significantly higher for the non-smokers than that of smokers (U=17645, p < .001, r=.18). The top three locations identified as the most common places for SHS exposure were restaurants (38.9%), followed by workplace (26.2%) and home (19.4%).
Conclusions: The percentage of SHS exposure among the non-smoking adults of rural Pedas, Negeri Sembilan is high. Although the adults in this study have good knowledge of SHS health consequences, yet they are unavoidably exposed to SHS because smoking still occurs within their home, workplaces and public places. Our findings suggest the need for more comprehensive, assertive and strongly enforced policies to ban smoking in public areas, not only in this community but all across Malaysia.
Rheumatoid arthritis (RA) is a chronic inflammatory condition that can be associated with abnormal bone turnover and hence osteoporosis. Osteocalcin (OC) levels are increased in conditions with high bone turnover, including high RA disease activity. Thus, OC levels could possibly be used as a marker to assess bone health and disease activity in RA patients. As there have been no previous studies looking at serum OC levels in Malaysian RA patients, this study was performed to examine possible correlations between OC, bone mineral density (BMD) and disease activity in this population. A cross-sectional study of 75 female RA patients and 29 healthy controls was performed. Serum OC was measured using a Quantikine® ELISA kit. Dualenergy x-ray absorptiometry (DXA) was used to assess BMD. Serum OC levels were not significantly different between RA patients (median 14.44 ng/mL, interquartile range [IQR 12.99]) compared to healthy controls (median 11.04 ng/mL IQR 12.29) (p=0.198). Serum OC increased with age (Spearman’s rho r=0.230, p=0.047). There was no significant correlation between serum OC and body mass index (BMI), menopause status, BMD, DAS28, swollen or tender joint counts. Overall, there were 11 (14.7%) patients with osteoporosis and 27 (36.0%) with osteopenia. Menopause status was significantly associated with BMD at all sites (lumbar spine p=0.002, femoral neck p=0.004, total hip p=0.002). Serum OC were similar in RA patients compared to healthy controls. In RA patients, serum OC did not correlate with RA disease activity or BMD. Menopause status remains an important influence on BMD. Thus, measuring serum OC levels in Malaysian RA patients was not useful in identifying those at risk of low BMD.
Study site: Rheumatology clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, and Klinik Pakar Puchong, Kuala Lumpur, Malaysia
Dengue incidence has grown dramatically in recent decades and become a global incidence especially in the
urban area. Ministry of Health (MOH) Malaysia reported that the number of dengue cases since January
2014 until June 2014 was 38. 411 cases which was higher compared to the number reported in year 2013 (10,
910 cases). The objective of the study was to determine the knowledge and preventive practices of dengue
among residents in Flat Pandan Indah, Ampang Selangor. A cross sectional study design with convenience
sampling method was adopted in this study. A total of 298 respondents living in Flat Pandan Indah were
recruited based on the inclusion criteria. A validated questionnaire that measures knowledge and preventive
practices of dengue was completed by respondents. More than half of the respondents had scored 61.7%
with good knowledge regarding dengue. However, 50.3% of the respondents had a limited extent of dengue
practice. Almost all of the respondents (95.6%) reported that television or radio as the main source for
information on dengue. The common preventive measures used by the respondents were cleaning the
house (n=148, 49.7%), eliminating standing water around the house (n=123, 41.3%) and covering water
containers in the home (n=120, 40.a3%). There was no correlation between dengue knowledge and
preventive practice score (p = 0.109). The study revealed that majority of the respondents had good
knowledge regarding dengue but the practices to prevent dengue are poor. Thus, health education program
focusing on dengue prevention practices should be done on the community members in the future.
Objective: Pathological laughter, pseudobulbar affect or a myriad of its other synonyms, is a condition common secondary to neurological injury, presenting with uncontrolled laughing or crying, appearing to be mood-incongruent and significantly debilitating. The objective of this case report is to highlight a rare case of pathological laughter associated with Cerebral Lupus.
Methods: We report a case of a 27-year-old lady presenting with signs and symptoms of stroke with dysarthria progressing to aphasia and then pathological laughter, with an underlying poorly controlled Systemic Lupus Erythematosus, manifesting as Cerebral Lupus.
Results: An improvement in affect congruency followed by decreased frequency of outbreaks among bouts of pathological laughter.
Conclusion: The combination of Escitalopram and Topiramate is effective in the symptomatic treatment of Pathological Laughter.
Sickle cell disease (SCD) in pregnancy is uncommon in Malaysia. We present a case of sickle cell disease in pregnancy with maternal and fetal complications. The patient presented with acute pain crisis and hemolysis in the third trimester. Despite thromboprophylaxis, she developed deep vein thrombosis. The pregnancy was further complicated by severe pre-eclampsia and intrauterine growth restriction which require preterm caesarean section. The baby was admitted to Neonatal Intensive Care Unit due to prematurity and low birth weight. Multidisciplinary
approach in managing pregnant patient with SCD is essential in achieving good obstetrics outcome.
Keywords: anemia, sickle cell disease, pregnancy outcomes