Solitary plasmacytoma of the head and neck is a rare disease entity. Its description in the literature consist of some case reports. Solitary plasmacytoma presenting with exophthalmos are rare. We report a case of intracranial solitary plasmacytoma in an elderly lady with involvement of the right orbitocranial region presenting with severe exophthalmos. The tumour was debulked and radiotherapy was given.
A 66-year-old Malay woman, known hypertensive, presented with post menopausal bleeding associated with clot for three months. She was postmenopausal for last ten years. She also complaints of developing a mass in the abdomen which was growing in size also for last three months. Abdominal examination revealed a twenty week size mass, movable from side to side but unable to get below the mass. Vaginal examination revealed a fleshy fungating mass arising from the uterus coming out through the vagina. Cervix could not be visualized properly. Subsequent histopathology of the removed mass was reported as a Malignant Mixed Mullerian Tumour - Heterologous.
Primary pterygium in children is uncommon but is associated with severe visual problems. Astigmatism is the main visual problem caused by pterygium. Significant amounts of astigmatism occur long before a pterygium encroaches the visual axis. Early surgical intervention is safe and effective. It is associated with significant visual improvement in outcome. This is a case report on seven-year-old Malay boy who presented with a growth over nasal aspect of the right eye of 1 year duration. His right eye visual acuity is affected up to 6/12. The dilemma pased to early surgical interview is the high rate of recurrancean the young age group. This problem is highlighted in this case report.
AIM: To reevaluate the psychometric characteristics of the Malay version of the Edinburgh Postnatal Depression Scale among a sample of postpartum Malay women attending the Bakar Bata Health Center in Alor Setar, Kedah, North West of Peninsular Malaysia.
MATERIALS AND METHODS: 64 women between 4 to 12 weeks postpartum were recruited for there validation study. They were given questionnaires on socio-demography, the 21-item Malay version of the Beck Depression Inventory II (BDI-II) and the 10-item Malay version of the Edinburgh Postnatal Depression Scale (EPDS). All the participants were later interviewed using the Hamilton Depression Rating Scale (HDRS-17) and the Composite International Diagnostic Interview (CIDI). All diagnoses were made based on the Tenth Edition of the International Classification of Diseases (ICD-10)
RESULTS: 9 women (14.1%) were diagnosed to have significant depression (7 mild depressive episodes and 2 moderate depressive episodes according to ICD-10). EPDS was found to have good internal consistency (Cronbach alpha =0.86) and split half reliability (Spearman split half coefficient = 0.83). The instrument also showed satisfactory discriminant and concurrent validity as evidenced by the statistically significant difference in EPDS scores between the depressed group and their non-depressed counterparts (Mann Whitney U test: 2 tailed p value < 0.01) and good correlations between the instrument and both the Malay version of BDI-II and the HRDS-17 (Spearman rank correlation coefficients of 0.78 and 0.88 respectively). At the 11/12 cut-off score the sensitivity of the EPDS is 100%, with a specificity of 98.18%, positive predictive value of 90%, negative predictive value of 100 % and misclassification rate of 1.56%.
CONCLUSION: This study confirmed the reliability and validity of the Malay version of the Edinburgh Postnatal Depression Scale in identifying postpartum depression among recently delivered Malay women attending the Bata Bata Health Center in Alor Setar, Kedah, North West of Peninsular Malaysia.
KEYWORDS: EPDS; postnatal depression; rating scale; validation
Study site: Klinik Kesihatan Bakar Bata, Alor Setar, Kedah, Malaysia
The objective of this study was to determine the prevalence and ethnic distribution of Helicobacter pylori infection in an endoscoped population in North Eastern Peninsular Malaysia.
Quality of life measures are designed to enable patients' perspectives on the impact of health and healthcare interventions on their lives to be assessed and taken into account in clinical decision-making and research. This paper discusses some approaches, methodological as well as interpretative issues of health related quality of life research.
The characteristics of foveal suppression (FS) in fixation disparity (FD) due to visual stress were investigated and their relationship's between, age, symptoms, and the effect of temporary elimination of FD using prisms on the degree of the FS were analysed. Forty-five presbyopic subjects (15 without FD and 30 with stress related FD) participated in the study. The subjects underwent comprehensive optometric examination prior to the study. Their FS and FD were measured. The FD was later corrected with ophthalmic prisms, the power of which was equally divided between the eyes, and the FS was later verified. Age and FS had no significant correlation for subjects without FD (Spearman's rs = 0.17, p = 0.55, NS) and in subjects with FD (rs = 2.49, p = 0.19, NS), respectively. Correlation between the degree of FS and FD was weak (rs=0.38, p=0.07), however the magnitude of FD significantly increased with age (r=0.27, p=0.04). Subjects with FD had significantly larger degree of FS compared with subjects without FD (Wilcoxon's Z =-0.25, p=0.01). There was no significant difference in the magnitudes of FD (t = -0.38, p=0.07) and in their degrees of FS (Mann-Whitney U = 1.5, p=0.71) between subjects with and without symptoms. Correcting the FD with prisms generally reduced the degree of FS (Wilcoxon's Z =1.96, p=0.04), however, significant change in FS only occured in subjects with symptoms (Z=-1.97, p=0.03), but was not significant in subjects without symptoms (Z=-0.70, p=0.48).
The present study, analyzes data from 1991 to 2000 for rotavirus infection among children with diarrhoea and acute gastroenteritis admitted to the Hospital Universiti Sains Malaysia (HUSM). The Latex Slide Agglutination Test was used for the detection of rotavirus antigens. Out of 1097 stool samples tested, 207 samples or 18.8 % were found to be positive for rotavirus. The infection occurred most frequently in infants and young children from 6 months to 2 years of age. The infection was recorded highest in the year of 2000 - 48 cases (34.1%) and the lowest in 1999 - 5 cases (6.6%). Stool examination and cultures from the rotavirus positive samples revealed no parasites and enteropathogenic bacteria. These observations suggested that rotavirus could still remain as an important agent causing diarrhoea and gastroenteritis in young children admitted to HUSM.
There is a particular importance of determining a basic minimum required 'n' size of the sample to recognize a particular measurement of a particular population. This article has highlighted the determination of an appropriate size to estimate population parameters.
Two hundred and eleven (211) patients with type 2 diabetes mellitus who were on treatment and monitored for complications at the Outpatient Diabetes Clinic in Hospital Universiti Sains Malaysia, Kubang Kerian between 2001 - 2002 were selected for the study. A structured questionnaire was administered to obtain their medical and family history. Physical examination was performed and fasting venous blood sample was collected for plasma glucose and A1C analysis. Of the total 211 patients, only 4 % were on diet treatment alone, 37 % of them were on mono therapy while 59 % were on combination of therapies. Fasting plasma glucose (FPG) > 7.2 mmol/L and glycated hemoglobin (A1C) levels ≥ 7 % were observed in 60 % and 73 % of type 2 diabetic patients, respectively. Glycated hemoglobin level of 28 % of the subjects were < 7 %; 36 % were between 7 - 9 % and 36 % were more than 9 %. The worst glycaemic control was observed in Malay patients. A1C of Malay and non-Malay subjects were 8.7 ± 2.3 % and 7.7 ± 1.7 %, respectively. Younger patients (age group < 50 years) had significantly higher mean A1C than elderly patients. Duration of diabetes had a clear influence on glycaemic level. Patients with recently diagnosed diabetes (duration of disease < 5 years) had the best glycaemic control. In this study a large proportion of the patients had poor glycaemic control. The variables with significant effects on glycaemic control were ethnicity, age and duration of diabetes mellitus. Better treatment strategies and methods should be used to improve diabetes control and to reduce long-term complications of diabetes.
Study site: Outpatient diabetic clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
Ambulatory blood pressure monitoring (ABPM) devices are increasingly being used in the assessment of hypertension. The purpose of the study was to investigate patient's diurnal BP variation and to further determine the differences of BP readings between male and female patients and the effects of age in patients who attended the clinic with essential hypertension. In addition, evidence of relationship between the parameters recorded by 24-hour ABPM was also investigated. This study was conducted in an outpatient specialist clinic. Two indices were used to demonstrate the diurnal BP variation. Firstly, the diurnal systolic blood pressure (SBP) and diastolic blood pressure (DBP) variations which were calculated as night/day BP ratio for SBP and DBP respectively. Anyone scoring less than 100% were categorised as dippers. Secondly, nocturnal falls in SBP and DBP were calculated as (awake SBP-sleep SBP)/awake SBP x 100 and (awake DBP-sleep DBP)/awake DBP x 100 respectively. The results showed that there was no significant difference in the mean BP between male and female patients. In general, the study sample were categorised as dippers and non dippers. There were more male dippers than female dippers. Finally correlation analysis revealed that age is related to SBP variables whilst night HR showed positive correlation with night time BP. It is concluded that ABPM was shown to be a useful tool to analyse the variation and prevalence of cardiovascular risk markers in hypertensive patients and can easily be done in an outpatient set-up.
Road accident is 'a global tragedy' with ever-rising trend. The goal of this article includes review of the causes and nature of accidents, statistical data regarding road accidents and the economical impact. 1.17 million deaths occur each year worldwide due to road accidents 70 % of which occur in developing countries. 65% of deaths involve pedestrians, 35 % of which are children. Estimates suggest that 23-34 million people are injured worldwide every year in road crashes - a value almost twice that previously estimated. It is estimated that more than 200 U.S. citizens die each year due to road accidents abroad. Every year in Europe, more than 50,000 peoples are killed in road accidents, and more than 150,000 remain disabled. It is a sad fact that the total number of road accidents in Malaysia exceeded 223,000 in 1999. On the average, 16 persons died from these road accidents, every single day in 1999. Lack of attention, reckless driving, lack of proper protection, speeding, bad personal habits, social and behavioral misconduct and inconsiderate drivers of larger vehicles are some of the problems that cause accidents. In Malaysia, motorcycle fatal accidents (60%) warrant a high degree of concern. Young children and senior citizens are found to be in the vulnerable age group. In Malaysia, in 1999 alone, general insurers paid RM1.67 billion or an average of RM4.6 million a day on motor claims. It is now recognized that road traffic accidents represent a major public health problem, because of the high number of victims involved and because of the seriousness of the consequences for themselves and for their families.
The incredible power of DNA technology as an identification tool had brought a tremendous change in crimnal justice . DNA data base is an information resource for the forensic DNA typing community with details on commonly used short tandem repeat (STR) DNA markers. This article discusses the essential steps in compilation of COmbined DNA Index System (CODIS) on validated polymerase chain amplified STRs and their use in crime detection.
The prevalence of aging population is increasing not only in developed countries, but also in developing countries like Malaysia. The aim of this study was: (1) to determine the prevalence of physical and mental health problems, and (2) to determine the association of these health problems with socio demographic factors among the elderly in a rural community in Sepang, Selangor. A cross sectional study design was used. Five out of nine villages were selected via random sampling. The elderly in the selected villages were interviewed using a pre-tested structured questionnaire which included the GDS-30, ECAQ and Barthel Index. Out of 263 elderly residents (6.2% of the total population), 223 agreed to participate in the study giving a response rate of 84.8%. The mean age of the respondents was 69.7 + 6.8 years with a median of 68 years. The prevalence of physical health problems such as chronic illness and functional dependence were 60.1% and 15.7%, respectively. While the prevalence of mental health problems such as depression and cognitive impairment were 7.6% and 22.4%, respectively. Among the health problems studied, depression was found to be significantly associated with unemployment (p<0.05), where as cognitive impairment was significantly associated with age, gender, ethnicity, marital status and level of education (p<0.05).
The new millennium has been regarded as a genomic era. A lot of researchers and pathologists are beginning to understand the scientific basis of molecular genetics and relates with the progression of the diseases. Central nervous system (CNS) tumours are among the most rapidly fatal of all cancers. It has been proposed that the progression of malignant tumours may result from multi-step of genetic alterations, including activation of oncogenes, inactivation of tumour suppressor genes and also the presence of certain molecular marker such as telomerase activity. In this paper, we review some recent data from the literature, including our own studies, on the molecular genetics analysis in CNS tumours. Our studies have shown that two types of tumour suppressor genes, p53 and PTEN were involved in the development of these tumours but not in p16 gene among the patients from Hospital Universiti Sains Malaysia (HUSM). Telomerase activity also has been detected in various types of CNS tumours. Thus, it is important to assemble all data which related to this study and may provide as a vital information in a new approach to neuro-oncology studies in Malaysia.
Gene therapy is a promising approach towards cancer treatment. The main aim of the therapy is to destroy cancer cells, usually by apoptotic mechanisms, and preserving others. However, its application has been hindered by many factors including poor cellular uptake, non-specific cell targeting and undesirable interferences with other genes or gene products. A variety of strategies exist to improve cellular uptake efficiency of gene-based therapies. This paper highlights advancements in gene therapy research and its application in relation to anti-cancer treatment.
A case of a 53-year old-single, Kelantanese lady with a diagnosis of paranoid schizophrenia for 28 years is reported with aims to illustrate the influence of life experiences particularly based on education and intelligent on delusion illustrate the evolving nature of the complexity of delusions as well as to show the importance of documentation in psychiatric practice. We concluded that this patient had used defense mechanism of suppression, reaction formation and persecution throughout her delusion. The final persecutory delusion evolved through series of transformation via object of admirations. We postulated that in-depth emotional insight about effects of schizophrenia might have contributed to her self-reflection that have made her frustrated with her poor achievement in life.
The incidence of deep vein thrombosis is believed to be rare in Asians. During recent years, a few reports have appeared with high incidence in orthopaedic patients comparable to Western studies. This study was carried out to find out the incidence of post-operative deep vein thrombosis (DVT) after major surgical procedures in general surgical patients in an Asian population. In a prospective study of 45 consecutive Asian patients after major general surgery, colour-flow duplex scan of the legs as an initial screening was done twice within two weeks. Mean age of the patients was 54 years 5 months and 87% of patients were included in the moderate and high risk group for deep vein thrombosis. Ascending venography was used to confirm deep vein thrombosis on patients with equivocal or positive results from colour flow duplex scan. One patient showed positive evidence of post-operative deep vein thrombosis on colour flow duplex scan which was further confirmed by ascending venography; giving an incidence of 2.2%. The incidence of post-operative deep vein thrombosis in general surgical patients is lower than the Western studies.
Hypertension is the major cause of congestive cardiac failure all over the world. It is under diagnosed and achievement of optimal therapy is difficult and costly. Diastolic dysfunction is an early poor prognostic factor in hypertension and is a reversible condition. Early detection and treatment is necessary to avoid cardiac complications. The objective of this study was to assess the occurrence of diastolic dysfunction in hypertensive patients referred for echocardiograph assessment of left ventricular function in a secondary hospital. It was also designed to determine whether contributing factors such as age, gender, systolic and diastolic pressure, duration of hypertension, previous myocardial infarct or ischemic heart disease and choice of anti-hypertensive drugs influence the development of diastolic dysfunction in these hypertensive patients. The analysis of diastolic dysfunction was based on the E/A ratio using Doppler echocardiogram. All of the patients were recruited from the Echocardiography Unit, Department of Medicine, Seremban General Hospital. Fifty patients with history of hypertension were selected for the study. Out of These 22 patients (44%) were found to have diastolic dysfunction; 39.1% of male patients (9 out of 23) and 48.1% of female patients (13 out of 27). Other contributing factors of diastolic dysfunction were found in patients : (a) with more than 8 years history of hypertension (12%) (b) with history of preexisting IHD/AMI (20%), (c) stages II - III of systolic hypertension based on 6th Joint National Committee recommendation (73%) (d) on ACE-inhibitor (18%) and (e) on Beta-blocker (28%) In conclusion, the study had demonstrated that the duration of hypertension, both systolic and diastolic blood pressure and age of patients are important prognostic indicators in predicting the development of diastolic dysfunction in hypertensive patients.