Objective: The purpose of this study is to access the prevalence of anxiety disorders and quality of life factors among hematological cancer patients in a Malaysian hospital. Methods: This study used a cross-sectional research design. It was conducted at the Ampang Hospital in Kuala Lumpur, a tertiary referral center for hematological cancer. Anxiety disorders were diagnosed using the Mini International Neuropsychiatric Interview (MINI); quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQC30) questionnaire. Results: A total of 105 hematological cancer patients participated in the study, which constituted a response rate of 83.3%. The prevalence of anxiety disorders in our sample ranged from 1% to 24.8%. Overall, compared to patients without anxiety disorders, hematological cancer patients with anxiety disorders reported impaired quality of life in regards to emotional functioning, cognitive functioning, insomnia, dyspnoea, nausea and vomiting, appetite loss and constipation (p
Introduction: This multiple-subject fMRI study continue to further investigate brain activation within and effective connectivity between the significantly (p
Physical inactivity is strongly associated with obesity and an increased risk of cardiovascular disease in children and adolescents. A cross-sectional study using multistage random sampling was conducted to determine associations between demographic characteristics, sedentary behaviours and physical activity among adolescents. Data were collected from 785 (414 males and 371 females) Form four students attending 15 schools in Petaling District, Selangor using an adapted self-administered questionnaire. Results showed that more females (50.1%) were physically inactive compared to males (39.6%) (Adjusted odds ratio (OR): 1.55, 95% confidence interval (CI): 1.12-2.15). Physically inactive adolescents were less likely to participate in intramural/house league sports (OR: 1.71, 95% CI: 1.19-2.44), school team sports (OR: 1.45, 95% CI: 1.03-2.04) and individual physical activities outside school (OR: 1.53, 95% CI: 1.11-2.12) compared to their physically active counterparts. Physically inactive adolescents were also less engaged in sedentary activities, such as television watching (OR: 0.69, 95% CI: 0.50-0.94), playing computer/video game (OR: 0.44, 95% CI: 0.28-0.72), talking on the telephone/mobile phone text messaging (OR: 0.47, 95% CI: 0.32-0.69) and reading (OR:0.45, 95% CI: 0.24-0.86) compared to those who were physically active. In this study, physical activity coexists with sedentary behaviour in adolescents. Sedentary activities may not necessarily displace physical activity among youth. In addition, these data suggest that promoting organised sports in school and outside the school among youths may be a potential strategy for increasing physical activity in this population.
Objective: To determine the prevalence of major depressive disorder (MDD) in hematological cancer patients and to investigate MDD with quality of life. Methods: The research, which uses a cross sectional design, has been carried out at Ampang Hospital, Kuala Lumpur. The hospital is a tertiary referral center for cancer cases that include non-Hodgkin lymphoma, acute myelogenous leukemia, acute lymphoblastic leukemia, Hodgkin lymphoma and other hematological cancers. In total, 105 patients with hematological malignancies were included in the study. This study employed the MINI International Neuropsychiatric Interview for diagnosis of MDD, the Patient Health Questionnaire (PHQ-9) for symptom severity of depression and the European Organisation for Research and Treatment of Cancer Quality Of Life questionnaire (EORTC QLQ-C30) to assess the quality of life of the respondents. Result: The response rate was 83.3%. The prevalence of MDD was 24.8% (n=26) with the majority of cases classified as moderately severe depression (38.5%). About 92.3% (n=24) of depressed hematological cancer patients were diagnosed with a current episode of MDD. The depressed patients also had significantly reduced quality of life in physical, role, emotional, cognitive and social domains (p
Introduction: The purpose of the present study was to investigate exploratory factor analysis of the
Beck Anxiety Inventory (BAI) and reports its reliability and validity in Malaysia. Method: One thousand
and ninety participants from four different samples (namely students, general population, medical and
psychiatric patients) completed the Malay version of Beck Anxiety Inventory, as well as additional
questionnaires such as Fear Questionnaire, Anxiety Sensitivity Index, Depression Anxiety Stress Scale, and Catastrophic Cognition Questionnaire. Results: Exploratory factor analysis revealed a three factor solution and accounted for 48.01% of the total variance. The three-factor structure appeared to be; subjective anxiety, autonomic, and neurophysiology. The Cronbach alpha coefficients (α) ranged from 0.66 to 0.89 with satisfactory overall alpha value (.91). Evidence was also found acceptable concurrent validity of the BAI-Malay (range between r=.22 to r=.67). Conclusion: This study shows that the BAIMalay is a reliable and valid instrument to measure symptoms of anxiety in the Malay population
and can be used in research and clinical service in Malaysia. However, replication of study by using
confirmatory factor analysis and application of the instrument among anxiety patients worth of further
investigation.
The Rohingya is a group of refugees from Myanmar who have been residing in Malaysia since the 1980s. At present, there is no published information on health and nutritional status of refugee children
in Malaysia. This study was conducted to assess nutritional status of the Rohingya children aged
6 months to 12 years old (N=87) and to determine the associations between nutritional status with
socio-demographic, dietary diversity and health (birth weight, immunization and childhood illness)
variables. Children were measured for weight and height while their guardians were interviewed for
socio-demographic, dietary diversity and health information. About 27.5% of the Rohingya children
were underweight, 11.5% stunted, 16.1% thin and 12.6% at risk of overweight and overweight. The
percentage of children with low birth weight (< 2.5 kg) and no immunization was 17.8% and 11.5%,
respectively. Fever (67.8%) and flu (62.1%) were the most common childhood illnesses reported in
previous month with 44-75% of the children with these illnesses did not receive any medical treatment.
The mean dietary diversity score was 8.9+3.2 out of a possible 14, with a higher score indicating a
more diverse diet. There were significant correlations between frequency of immunization received
by the children with weight-for-age-z score (rs=0.27, p
Monoclonal gammopathies result from an overproduction of a single abnormal clone of plasma cell
or B lymphocyte that produce an immunologically homogenous immunoglobulin (Ig) commonly referred to as paraprotein or monoclonal (M) protein. The circulating M-protein may consist of an intact immunoglobulin, the light chain only, or (rarely) the heavy chain only. The heavy chain is from one of the five immunoglobulin classes G, A, M, D or E, while the light chain is either kappa (κ) or lambda (λ) in type. Accurate detection and quantitation of monoclonal immunoglobulins is important for the diagnosis and management of monoclonal gammopathies. We report a case of a 71 year old lady with a history of chronic gastritis and recurrent lower respiratory tract infection whereby no specific diagnosis was made until a computed tomography (CT) guided lung biopsy and orogastroduodenoscopy (OGDS) 5 years later from the onset of initial symptoms revealed pulmonary and gastric amyloidosis, respectively.
Clonal disorders of LGL may either be CD3+ CD56- or CD3- CD56+ phenotype and these have been designated as T-cell leukaemia (T-LGL) or natural killer cell (NK)-LGL leukaemia respectively. Clonality is usually demonstrated by clonal rearrangement of T-cell receptor gene rearrangement or identified by flowcytometry analysis. Most patients with T-LGL will have an indolent course. In this report we described an aggressiveness of disease in a patient with clonal CD3+ LGL leukaemia whose cells also co-expressed CD56 diagnosed by flowcytometry. The patient responded well to interrupt ALL standard risk protocol however succumbed to her disease while waiting for upfront stem cell transplant. This case highlights on both the classical laboratory findings of rare entity of disease as well as a review of the literature pertaining particularly on its management.
Mucoepidermoid carcinoma and squamous cell carcinoma are tumors found predominantly in the elderly. Most of the cases reported were from patients of more than 50 years old. In our case, it affects a young patient, a 26 year old lady who has a history of a severely burnt and scarred face since childhood. She represents a rare case of a high grade aggressive tumor involving her right eyelid and right parotid gland.
The health related quality of life (HRQoL) of chronic obstructive pulmonary disease (COPD) patients is greatly influenced by their health status. The Health Index Questionnaire - Short Form 36 (SF-36) and St George Respiratory Questionnaire (SGRQ) are commonly used to assess the HRQoL of COPD patients. Objective: This study investigates differences in HRQoL following sessions of pulmonary rehabilitation program (PRP) with a control group (CG) that had no intervention. Method: This quasi-experimental study involving 17 subjects assigned to the CG and 16 subjects in the intervention group (IG). Ethical approval was obtained from the relevant authority. Both groups were given the health index questionnaires- SF-36 and SGRQ prior and 5 weeks after the intervention. The CG only had medication while the IG performed exercises (cycling, treadmill walking, upper limb strengthening exercise and stair climbing exercise). Results: Data analysis using SPANOVA demonstrated significant improvement in HRQoL measured from SF-36 in domains of bodily pain (p=0.005), vitality (p=0.021) and mental health (p=0.002) in IG unlike the CG. Similarly, SGRQ, also shows improvement in symptom (p=0.028), activity (p=0.004) and total score (p=0.012. Conclusion: The 5 weeks pulmonary rehabilitation program demonstrated improvement in HRQoL among COPD
patients.
Sexual dysfunction is common but not often assessed in the routine clinical care among males on opiate substitute treatment.
Objective: To determine the association between clinical variables and erectile dysfunction (ED) among men on methadone maintenance therapy (MMT).
Methods: A cross-sectional study involving 108 participants who attended the Drug Clinic, Hospital Kuala Lumpur. The instruments used include the Structured Clinical Interview for DSM-IV Axis-I Disorder (SCID-I), Beck Depression Inventory (BDI) and International Index of Erectile Function-15 (IIEF-15).
Results: Concurrent heroin abuse was significantly associated with presence of ED (p=0.024). Treatment factors including methadone dose and duration of methadone treatment were not significantly associated with ED.
Conclusion: Education on sexual dysfunction as a potential adverse effect and its association with illicit heroin use should be considered in the doctor-patient consultation to encourage treatment adherence and abstinence from heroin.
Study site: Drug Clinic, Hospital Kuala Lumpur, Malaysia
Pneumonia is one of the most common complications of stroke with significant impact on patients’ outcome. The aim of this study is to look for the predictors of stroke-associated pneumonia (SAP) and its 30-day mortality and to analyse the survival of ischaemic stroke patients with pneumonia. Methodology: This is a prospective observational study, involving all acute first time ischaemic stroke patients admitted to a tertiary hospital that fulfilled the inclusion and exclusion criteria over a 6-month period. Demographic data were obtained on admission. Patients were reassessed for SAP, on day 5 and day 30. Assessment was done using the National Institutes of Health Stroke Scale (NIHSS) score, Barthel index and modified Rankin scale (MRS). All patients with pneumonia were assessed with the pneumonia severity index (PSI) for SAP. Results: One hundred and twenty patients were enrolled consecutively within the 6-month study period. 15.8% developed SAP. Independent predictors of SAP were clinical dysphagia (OR 76.32; 95%CI 4.46 to 1307.05), random blood glucose (RBS) on admission (OR 1.34; 95%CI 1.06 to 1.68) and NIHSS score on admission (OR 1.15; 95%CI 1.02 to 1.30). Independent predictors for 30-day mortality were NIHSS score on day 5 (OR 1.20; 95%CI 1.08 to 1.33) and occurrence of pneumonia (OR 14.90; 95% CI 3.34 to 66.42). There was a significant difference in mean survival between SAP and non-SAP patients. Conclusions: Clinical dysphagia, RBS on admission and NIHSS score on admission were independent predictors of SAP. NIHSS score on day 5 and pneumonia were independent predictors of 30-day mortality. SAP patients had shorter survival
time compared to non-SAP patients.
Prevalence of diabetes is escalating both globally as well as in Malaysia. With the epidemic of diabetes and its related morbidities and mortalities, health care professionals are facing an unprecedented challenges in controlling the disease. Objective: To determine the metabolic control and the cardiovascular risk factors among type 2 diabetic patients in a primary care setting. Method: This was a cross sectional study conducted in a primary care clinic in Selangor, Malaysia. Inclusion criteria were all type 2 diabetic patients aged 18 and above and were being followed-up for more than six months prior to the recruiting period in May 2009. The demographic data were obtained through face- to-face interview. Height, weight and blood pressure of the patients were taken during the day of data collection. The co-morbidities and laboratory results were obtained from the medical records. Results: Two-hundred patients were recruited. The mean age was 58.6 (SD=10.5) with 79.0% of the patients aged more than 50 years old. The majority of the patients were female (62.5%). One-tenth (11.5%) were smokers. More than half of the patients (64.0%) had co-morbid of hypertension and half of them (50.5%) had dyslipidaemia. A total of 72.5% of the patients had 3 or more cardiovascular risk factors. Less than one fifth of the patients had achieved the target of control for glycaemia, blood pressure, LDL and BMI. Those age 60 and above had significantly higher proportion of patients achieving fasting blood glucose control (p=0.033). Conclusion: The majority of type 2 diabetic patients had multiple cardiovascular risk factors (3 or more risk factors) and had not achieved the recommended goals in
metabolic control.
Heart failure is chiefly the end stage of primary hypertension and a major public health problem in Malaysia. The aim of this work is to investigate the level of BNP that may discriminate between primary hypertension patients without heart failure and primary hypertensive patients with heart failure. This study was conducted on 60 hypertensive patients without any clinical symptoms of heart failure referred for echocardiography to evaluate the ventricular function. Patients with metabolic diseases and terminal diseases were excluded from the study. The BNP levels were assessed using the Triage Meter from Biosite Diagnostics. Results showed that BNP level display a negative correlation with ejection fraction (Pearson correlation test). The significant result (paired t test, p < 0.05) proves that both predictors are very important and relates to each other. Low ejection fraction is significantly marked with raised BNP level suggesting that BNP may play potential role as screening tool for early detection of heart failure in primary hypertensive patients.
Study site: (Universiti Kebangsaan
Malaysia Medical Center and International Medical University cardiology clinic, Seremban
Saccular aneurysms associated with moyamoya disease are commonly located in the vertebrobasilar circulation. Anterior circulation aneurysm associated with moyamoya disease is uncommon and is usually treated by neurosurgical clipping. Objective: We report a succesful treatment using the endovascular approach in a case of ruptured anterior communicating artery aneurysm in unilateral moyamoya disease. Clinical Presentation: A 23 year old man presented with a 5 day history of headache, diplopia and fever. Computed Tomography (CT) scan and cerebral angiogram showed a bilobed anterior comunicating artery aneurysm. There was also severe M1 segment stenosis of the left middle cerebral artery with multiple collaterals, representing moyamoya vessels. Intervention: Treatment was done under general anesthesia and followed the standard practice for endovascular treatment. The aneurysm was occluded with three detachable platinum microcoils (Microplex®, Microvention®). Conclusion: Endovascular treatment can be a treatment option for ruptured anterior circulation saccular aneurysms associated with moyamoya disease.
Obesity is a well-established risk factor for coronary heart disease, ischemic stroke, type 2 diabetes, cancers of the breast, colon, prostate and other organs. Objectives: To determine the prevalence of obesity and associated factors among university staffs. Methods: A cross sectional study was carried out among university staffs of University Putra Malaysia using a self-administered validated pre-tested questionnaire. Weight was measured using a digital bathroom scale (TANITA Model HD 319) and height was measured using a SECA Body Meter Model 206. Body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters (kg/m2). A p value of
The Clitoria ternatea (Fabaceae) root, seed, and leaf are commonly used in Ayurvedic medicine in Malaysia and Indonesia. The methanol leaf extracts of C. ternatea was tested for toxicity by means of brine shrimp lethality test and acute oral toxicity assay. In the brine shrimp lethality test, the leaf extract were non-toxic or showed weak lethality (LC50 > 1 mg/ml) at the 6 h, 12 h and 24 h incubation period. Nevertheless, at the 48 h incubation time, the leaf extract exhibited moderate toxicity activity with LC50 values of 0.49 mg/ml. In the acute toxicity study using mice, the median lethal dose (LD50) of the extract was found greater than 2000 mg/kg, and we found no pathological changes by means of macroscopic examination of tissues of mice treated with the extract. We conclude that the C. ternatea leaf extract is not toxic in mice and brine shrimp.
The pandemic of obesity is of great concern as its associated co-morbidities are devastating; causing lifelong burden to individual’s health and is economically costly to a country. Factors that lead to obesity are a combination of environmental and genetic factors. The Pro-opiomelanocortin (POMC) gene resides in chromosome 2p23.3, and its protein is composed of 241 amino acids which is responsible for the production of polyhormones that regulate appetite and food intake. The study aimed to investigate the prevalence of the RsaI single nucleotide polymorphism (SNP) site in the 5’-untranslated region (UTR) of POMC and its possible association with obesity among 302 multi-ethnic Malaysian subjects (142 obese, 160 non-obese; 120 males, 182 females) from the Kampar Health Clinic. Subjects were recruited by convenience sampling with informed consent and socio-demographic data as well as anthropometric measurements were taken. Subjects were genotyped by polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) analysis using DNA extracted from blood. The distribution of the RsaI genotypes was significantly different among the different ethnicities, but the mutated RsaI (- / -) genotype was rare as it only occurred in 8.9% of the subjects. With the frequency of the RsaI (-) allele of 0.31, it was associated with the percentage of skeletal muscles (p
We report a case of factitious dermatitis in a 17 year female student who presented with recurrent pain .swelling and subcutaneous crepitations of the forearm. A thorough investigation was done. Full blood count, erythrocyte sedimentation rate was normal. Plain radiographs revealed the presence of subcutaneous emphysema. MRI showed similar findings and revealed normal muscles. Colonoscopy and OGDS were normal. except for a small polyp at the gastro-esophageal junction. Based on the clinical findings and lack of correlation with the investigations a diagnosis of factitious subcutaneous emphysema was made.
Work-Related Hand Injuries (WRHIs) may result in disability and diminished productivity and cause economic impacts not only to the individual, worker’s families and industries, but to the local community as well.
Objectives: To determine the prevalence of severe Work-Related Hand Injuries (WRHIs) and factors associated at a tertiary hospital.
Methods: A pre-tested validated questionnaire was used to obtain data. All patients 18 years and above with WRHIs seen at a tertiary hospital between January 2010 and June 2010 were included in the study. Data was analysed using SPSS version 18.
Results: Out of the 297 industrial accidents, 74 (24.9%) were WRHIs. Among those with WRHIs, (47.3%) of them had severe hand injuries. The overall mean age of the respondents was 30.36 (± 9.54 SD) years. Majority (82.5%) of the injuries occurred between Mondays to Friday. Majority (70.1%) of hand injuries were caused by machine and 48.6% of the hand injuries occurred when the hand was caught in the operating part of the machine. Majority (62.1%) of the respondents had fingers’ injuries and 32.4% had open fracture. Bivariate analysis showed that there was significant association between severity of WRHIs and locations of injury, mechanisms of injury, sources of injury and sectors of industry (p < 0.05). Logistic regression analysis showed that WRHIs was significantly associated with source of injury and sector of industry. Respondents with hand injury resulted while operating on mechanical machine was 26 times more likely to report severe WRHIs than those with other sources of their hand injury like (sharp tool, heavy door, and wet floor). Respondents working in metal-machinery industries were eight times more likely to report severe WRHIs than those who working in other sectors of industry like (wood-furniture, constriction, food preparing, service and automotive).
Conclusions: WRHIs contributed to 24.9% of all industrial accidents seen at the emergency department and orthopaedic clinic and 47.3% of the respondents with WRHIs had severe hand injuries. Severity of WRHIs was significantly associated with sources of injury and sectors of industry.
Study site: emergency room, orthopaedic ward, general surgery ward and the orthopaedic outpatient clinic of a tertiary hospital