Background: Depression is a serious mental health illness worldwide. The purpose of the study was to
investigate the relationships between depression and its risk factors of sociodemography, lifestyle, and health
among the adults of the different ethnic groups in Malaysia.
Method: A nationwide database with 10141 observations was used. Multivariable logistic regression analyses
stratified by ethnicity were estimated.
Results: Ethnicity and gender, age, education, marital status and self-rated health were correlated to the
likelihood of having depression. Malay females and smokers (AOR: 2.083) were more likely to suffer from
depression than Malay males (AOR: 0.305) and non-smokers. Higher-income Chinese displayed higher odds of
having depression than lower-income Chinese (AOR: 1.009). Indians and others with secondary-level education
displayed a lower likelihood of developing depression compared to those with primary-level education (AOR:
0.587).
Conclusion: This study could contribute significantly to the formulation and development of an effective
policy directed towards reducing the prevalence of depression in the vulnerable. These were the adults, in
the younger age group, with lower education, with self-rated poor health, being female, unmarried, Malay
and Chinese, and Indians and others. A nationwide policy targeted towards the Malay females to reduce
their depression, with attention to the Chinese with a high income, and to the Indians and others with poor
educational background to improve their knowledge of mental health, would be worthy of consideration.
Locked pubic symphysis is a rare form of pelvic injury that usually occurs after a lateral compression injury to
the pelvis, where the intact pubis is trapped behind the contralateral pubis. To the best of our knowledge, there
were 25 similar cases reported in the English literature since it was first described in 1952. We present a case
of locked pubic symphysis with a left iliac wing fracture and a left femur shaft fracture requiring open reduction
and internal fixation. We also reviewed previous reported cases of locked pubic symphysis and analysed the
pattern of presentation and guide to management of such injuries. We propose a classification system for
grading overlapping pubic symphysis that will provide a better guide to the management of such injuries.
Haemophagocytic lymphohistiocytosis (HLH) is a clinico-pathologic entity caused by increased proliferation
and activation of benign macrophages with haemophagocytosis throughout the reticulo-endothelial system.
Virus-associated HLH is a well-recognised entity. Although majority of parvovirus B19 associated HLH does not
require any specific treatment and carries good prognosis, outcome of children is worse than adults. We report
here a case of HLH associated with acute parvovirus B19 infection in a young healthy patient with underlying
hereditary spherocytosis, with bone marrow findings typical of parvovirus infection. Although this patient
had spontaneous recovery of cell counts, he succumbed due to complication from prolonged ventilation.
Unexpectedly, his immunoglobulin levels were inappropriately normal despite on-going ventilator associated
pneumonia, which reflects inadequate humoral immune response towards infection.
Malaria is a major cause of mortality and morbidity globally. Great efforts have been made in the prevention and the elimination of malaria, especially in controlling the malaria vector, the mosquito. Another promising approach would be the development of malaria vaccines. Malaria vaccine studies can be focused on the pre-erythrocytic-stage antigens and the blood-stage antigens, and on the transmission blocking agents targeting the malaria gametocytes. The blood-stage antigens are the leading candidates in malaria vaccine development, as the blood-stage parasites are responsible for causing symptomatic malaria. Human acquired immunity largely targets on blood-stage antigens. This review focuses on one of the most extensively studied blood-stage antigen, the merozoite surface protein-1 (MSP-1), specifically on its evaluation and immunogenicity in rodents and primate models, and its safety and immunogenicity in human clinical trials.
Background: Set-up errors are errors which are inevitable in radiotherapy. However, they should be kept to a minimum to achieve the maximum radiation dose to a tumour as to maximise treatment efficacy. This study aims to quantify those errors and assess if they remain within the tolerance limit of 5 mm in all directions. This study will also determine the adequacy of the margins for set up error for 3DCRT of rectal cancers at University of Malaya Medical Centre (UMMC).
Methods: A total of 20 rectal cancer patients (July 2018 to May 2019) who were treated with radiotherapy amounting to a total of 119 CBCT images were included in the study. Population systematic errors and random setup errors were calculated.
Results: Population systematic errors and random setup errors in the vertical, longitudinal and lateral direction were tabulated in Table 1. There is a large deviation (>5 mm) noted in some patients’ setup between the first 3 days and the next successive day of imaging. Clinical target volume (CTV) to planning target volume (PTV) margin were calculated using Van Herk’s margin recipe (M=2.5Σ+0.7σ). The margins were 5.0 mm, 6.2 mm, and 4.0 mm for vertical, longitudinal and lateral directions, respectively. The systematic error for the population was 1.1 mm, 0.9 mm, 0.9 mm in the vertical, longitudinal and lateral directions respectively, while the random error is 3.2 mm, 5.7 mm and 2.5 mm in the vertical, longitudinal and lateral directions respectively.
Conclusion: All of the patients involved in the study were within tolerance limits at some point in their treatment. The results demonstrated that a larger margin is needed in the longitudinal direction. Weekly CBCT is also necessary after the initial 3-day imaging to ensure that patients are kept within the tolerance limits.
This section only examines the clinical findings and some blood chemistly in these workers. A total of 222 men and 28 women were studied. Their ages ranged from 12 to 57 years, the mean being 30.1 (±7.4). Generally most of the physical examination was normal and no external features of infectious diseases were seen. The mean systolic and diastolic blood pressure was 120 (±13) and 76(±8.7) nun Hg respectively. About 8.4% of the population had elevated blood pressure of 140/90 mmHg or greater. About 12.4% of these man and women were underweight (Body mass index (EMI) less than 19 kg/m2) while 11.2% were either overweight or obese (BMI>25) with the mean being 21.8 (±2.7). Only 3 had BMI greater than 30. Three subjects had a lnitral regurgitation murmur thought to be due to mitral valve prolapse. Four others had tinea cruris, six had insignificant axillary lymph-nodes, five had cervical lymph-nodes of which one was due to carcinoma of the tonsil 30 with shotty inguinal lymph-nodes which was thought to of no pathological significance. Four subjects had crepitations and five had rhonchi in their lungs. A full blood count revealed that 16.65% of the man and 32.1°/o of the women had haemoglobin levels of less than 14gm/dl and 12gm/dl respectively. The most striking abnormality was the high prevalence of eosinophilia. 37% of the subjects had eosinophilia counts of greater than 450/dl. About 19.4% of this study population had fasting blood glucose of greater than 6mmol/l but only 1.3% with fasting blood glucose of greater than 7.8 mmo/l. About 22% of the urine examined revealed pro- teinuria but were otherwise unremarkable for the other parameters. This group of foreign workers was made up of a presumably fairly healthy young population. Attempts to look for infectious disease on physical examination, not surprisingly did not reveal any remarkable findings. It could be that the majority of these subjects already had a examination prior to coming into the country and another one soon after arrival. However an indirect measurement of infectious diseases via the eosinophilic count revealed a high prevalence of parasitic infestations. Attempts to examine the end results of social hardship, be it intrinsic before or appearing after arrival indirectly shoved some degree of suffering. There was a fairly high prevalence of anaemia, especially amongst the women. The body mass index also revealed this population to be generally less obese than other populations. The value of medical check-ups has been debated, especially if it were done as a pre-employment procedure. This pilot study has shown that it is not cost-effective to do physical examination or blood chem- istry and urine analysis in hying to identify infectious diseases in the migrant workers. In the light of the paucity of clinical findings in this pilot study, it would be prudent to review the strategy for examining the health status of migrant workers. Perhaps the physical examination can be dispensed with, and blood andurine analysis beveryfocused and directedin order to maximise the cost- effectiveness of this programme. Certainly the high prevalence of eosinophilia needs further evalua- tion.
The aim of this study was to determine the prevalence and extent of diseases present among migrant workers. A total of 809 migrant workers were examined. The mean BMI (Body Mass Index) was 22.3 kg/m2. Only 4.9% of the respondents had blood pressure greater than 140/90 mmHg. Generally the migrant workers examined were healthy, except for subjects with abnormal eosinophilia coutns, which may indicate occult parasitic infestation. Non-communicable disease in particular hypertension and diabetes mellitus are not major problems among migrant workers. Perhaps the target to aim at are the illegal migrant workers where more illness could be detected.
Six cooling towers and eleven sources of potable water in a university campus in Kuala Lumpur were surveyed for the presence of legionellae. One nonmedical building cooling tower and three hot water systems from one ward of the hospital tested positive for Legionella, two of which contained Legionella pneumophila serogroup 1. The identification of Legionella was based on isolation, immunofluorescence and polymerase chain reaction (PCR).
Background: The cytokine cascade in the immunopathogenesis of malaria infection had been widely studied.
However, their specific association with survival and severe infection remained obscure.
Methods: The study investigated the cytokine profiles and histopathological features of malaria in the severe
infection and survival models by using male ICR mice and male Sprague Dawley rats respectively.
Results: The severe model, the infected ICR mice, exhibited a high parasitemia with 100% mortality after
peak parasitemia at day 5 post-infection. The survival model, the infected Sprague Dawley rats, showed
mild parasitemia with full recovery by day 14 of infection. Both severe and survival models showed similar
histopathological severity during peak parasitemia. The severe model produced highly elevated levels of proinflammatory
cytokines, TNF-α and IL-1α, and low levels of the anti-inflammatory cytokine, IL-4; while the
survival model showed low levels of TNF-α and IL-1α with high levels of IL-4.
Conclusion: There were differences in the pathogenesis of the severe and survival models of malaria infection.
These could be a basis for immunotherapy of malaria in the future.
We evaluated the use of Desflurane anaesthesia in this prospective observational audit in the University of Malaya Medical Centre Day Surgery Unit. Fifty ASA I-II unpremedicated day surgery patients received fentanyl and propofol induction after preoxygenation. Desflurane was introduced initially at 2% and the concentration was increased gradually to 4%, then 6%, 8% and 10% in nitrous oxide and oxygen. Patients breathed spontaneously throughout the surgery. Desflurane was switched off at the end of surgery and patients breathed 100% oxygen. The haemodynamic effect, perioperative complications and recovery profiles were recorded. Systolic arterial pressure and heart rate decreased after induction of anaesthesia but returned to baseline value at discharge. Adverse airway event such as coughing and postoperative nausea and vomiting are two unwanted complications. KEYWORDS: Desflurane, day surgery, propofol induction
Cryptococcus neoformans is an encapsulated fungal pathogen that causes severe disease primarily in
immunocompromised patients. Adherence and internalisation of microbial pathogens into host cells often
begin with engagement of microbes to the surface receptors of host. However, the mechanisms involved
remain poorly understood. In this study, we investigated the association of cell surface determinants of C.
neoformans with mammalian cells. Our results showed that treatment with trypsin, but not paraformaldehyde
or heat killing, could reduce host-cryptococci interaction, suggesting the involvement of cell surface proteins
(CSPs) of C. neoformans in the interaction. We extended our investigations to determine the roles of CSPs
during cryptococci-host cells interaction by extracting and conjugating CSPs of C. neoformans to latex beads.
Conjugation of CSPs with both encapsulated and acapsular C. neoformans increased the association of latex
beads with mammalian alveolar epithelial cells, alveolar macrophages and monocyte-derived macrophages.
Further examination on the actin organisation of the host cells implied the involvement of actin-dependent
phagocytosis in the internalisation of C. neoformans in CSP-conjugated latex beads. We hypothesised that
CSPs present on the cell wall of C. neoformans mediate the adherence and actin-dependent phagocytosis
of cryptococci by mammalian cells. Our results warrant further studies on the exact role of CSPs in the
pathogenesis of cryptococcosis.
Background: The adoption of technologically advanced medical devices assisted healthcare providers to
examine and treat diseases. However, technological advancements could increase the threats to safety,
security, and reliability of the devices from complications associated with manufacturing, functionality, and
the clinical application of the devices.
Aim: To examine the safety threats, cost implication, and bioethical standards of the manufacturing processes
and the functionality of advanced medical devices.
Subject and Methods: The study was a narrative review through a qualitative research methodology. The
secondary data was gathered from online databases including ProQuest, ResearchGate, CINAHL/EBSCOhost,
PubMed, and ScienceDirect, from books, journals, conference proceedings, and other web publications
between 2007 and 2017.
Results:There were safety hazards from human errors in the interpretation and the use of the advanced medical
devices. Equipment imperfections and poor processes of maintenance and procurement affected the effective
functionality of these medical devices. Healthcare expenditure was high, Social and bioethical considerations,
users’ complaints and post-market surveillance were essential in ensuring the safety of the devices and the
maintenance of quality life for the users.
Conclusion: Safety hazards and cost implications of the use of technologically advanced medical devices were
significantly high Social and bioethical standards in the manufacturing of medical devices contributed towards
the production of safer devices.
Many studies have shown that failure in the control of hypertension with oral antihypertensives could be associated with noncompliance. The present study was conducted to assess the compliance rate to antihypertensive therapies and also to determine factors related to any noncompliance. The study was conducted in a teaching hospital in Kuala Lumpur. Data was collected from patients' medical records and via personal interview using a structured questionnaire. Out of a total of 175 respondents recruited in the study, 49.1% missed at least a dose of their antihypertensive agents during a one·month period. The most common reason given by respondents who were not compliant to their antihypertensive therapies was forgetfulness (91.8%), followed by too busy (20.0%) and insufficient medication supplied to them (18.8%). None of the factors analysed, including the demography of the respondents, their knowledge about hypertension and the types of antihypertensive therapies they were on, had any statistically significant influence on the compliance behaviour of the respondents to their antihypertensive therapies. However, more than 80% of the respondents kept their appointment to see their doctor and only this factor appeared to be related to the medication compliance behaviour although it still did not reach any statistical significance. KEYWORDS: Compliance, antihypertensive agent, blood pressure, knowledge
There had been increased and strong public interests in rare diseases and orphan drugs as well as the issue of
compulsory licencing for expensive medications in Malaysia in the mass-media and social media. We reviewed
the issues of orphan drugs and the challenges faced in many countries in developing appropriate health financial
modelling as well as getting accurate data on rare diseases. We also reviewed the old off-patent medications
and the developments on how policy-makers can intervene to make expensive treatment affordable and
sustainable for patients and the country.
Squamous cell carcinoma of the tongue is a highly malignant condition and results in high mortality and morbidity in patients despite its early detection (1). Early surgical interventions have been found to reduce mortality but in many reports, tongue reconstructions using live grafts have been found to reduce normal tongue function of speech, swallow and taste. In contrast, our report using free radial forearm flap (FRFF) to reconstruct the defect left over after a radical tongue resection in a 38-year-old gentleman with oral cancer has shown promising results. This type of reconstruction has left the patient with a functional and cosmetically acceptable tongue with minimal alteration in recognizable speech.
Background: In Malaysia, the prevalence of adolescents’ suicidal ideation has increased over the years. Therefore, it is crucial to investigate the predictors of suicidal ideation among adolescents. Hence, the aim of this study was to examine the predicting effects of depression and self-esteem on suicidal ideation among Malaysian adolescents. In addition, the relationships between depression, self-esteem, and adolescents’ suicidal ideation were explored as well.
Methods: By using a multistage cluster sampling method, a cross-sectional study was conducted in secondary schools in Kuala Lumpur, Malaysia. The participants were comprised of 852 adolescents (51% males and 49% females) aged 13-17 years old who completed self-administered questionnaires. Pearson’s Correlation analysis was used to analyse the relationships among depression, self-esteem, and adolescents’ suicidal ideation, while Standard Multiple Regression analysis was used to examine the predicting effects of depression and self-esteem on adolescents’ suicidal ideation.
Results: Depression had a positive correlation with adolescents’ suicidal ideation (r = .290, p < .001), while self-esteem had a negative correlation with adolescents’ suicidal ideation (r = -.283, p < .001). Results also showed that both depression (β = .200, p < .001) and self-esteem (β = -.186, p < .001) significantly predicted adolescents’ suicidal ideation.
Conclusion: The study found that depression is a risk factor, while self-esteem is a protective factor of adolescents’ suicidal ideation.
Background: Astrocytic gliomas are the most common primary brain tumors that developed from glial origin.
The angiogenic cell population from brain tumor enhances the recruitment of circulating cancer stem cells
homing towards tumor site.
Objectives: This study aimed to investigate the tumor angiogenic cell population that stained with CD133+
and VEGFA+ markers and its association with circulating cancer stem cell (CD133+/VEGFR2-) population in the
peripheral blood mononuclear cells (PBMCs) of astrocytic glioma patients.
Methods: A total of 22 astrocytic glioma patients from Hospital Universiti Sains Malaysia who consented to
the study were included. Tumors (n=22) were sliced and stained with CD133+ and VEGFA+ angiogenic markers
and counter stained with DAPI. The circulating cancer stem cells (CD133+/VEGFR2-) in PBMCs (n=22) were
quantified using FACS based on the expression of CD133 and VEGFR2 markers. The paired t-test and Pearson
correlation were used for the data analysis.
Results: The percentage of angiogenic cell population was significantly higher in brain tumor compared to
adjacent normal brain tissue (1.25 ± 0.96% vs. 0.74 ± 0.68%; paired t-test=2.855; df=21, p = 0.009). Positive
correlation was found between the angiogenic cells of brain tumor tissue and adjacent normal brain tissue
(Pearson correlation, r = 0.53, p = 0.011). Significant positive correlation was found between angiogenic cells
in glioma tumor and cancer stem cells in peripheral circulating systems of astrocytic glioma patients (Pearson
correlation, r = 0.42, p = 0.049).
Conclusion: Angiogenic cells in the brain tumor resident promote the recruitment of circulating cancer stem cells
homing to the tumor site and induce the proliferation and growth of the tumor in astrocytic glioma patients.
Background: This paper investigates the quality of life of brain pathology patients in relation to their sociodemographic
profiles and clinical factors.
Methods: This is a cross-sectional study done at a tertiary referral hospital in Kuala Lumpur. A total of 100
patients were recruited in the study after excluding 22 patients who did not met the exclusion criteria. The
European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) self-administered
questionnaire was utilized in the study. The Global health status/QoL, Physical functioning, Role functioning,
Emotional functioning, Cognitive functioning, Social functioning, Fatigue, Nausea and vomiting, Pain, Dyspnoea,
Insomnia, Appetite loss, Constipation, Diarrhoea, and Financial difficulties were assessed in this study.
Results: The most severe impairment in functioning was with lowest score of cognitive functioning (mean
score=61) and the most severe symptom was fatigue (mean score=45). There were significant differences in
quality of life scores in different socio-demographic groupsand types of brain pathology patients. Patients aged
below 40 years old or less had better physical functioning, less symptoms of fatigue and insomnia compared
to patients who were more than 40 years old. Male patients faced more financial difficulties compared with
female patients. Patients who were married had increased insomnia compared to the single patients. Employed
patients had better physical functioning and less financial difficulties compared with patients who were
unemployed. Patients who earned >RM 2500.00 monthly had better physical functioning, less symptoms of pain and less financial difficulties than patients who earned ≤RM 2500.00. Patients with qualifications lower
than SPM tended to face more financial difficulties compared to patients with qualifications of SPM or higher.
Meningioma patients had better social functioning compared with others, whereas Carvenoma patients had
better physical functioning. Meningioma patients had more symptoms of insomnia compared with other
patients. All the findings were with p value less than 0.05.
Conclusion: The quality of life of patients with brain pathology is affected by socio-demographic factors and
clinical diagnoses. Efforts should be made to improve the overall quality of life of these patients.