Displaying publications 61 - 80 of 5567 in total

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  1. Chew SH, Looi I, Neoh KK, Ooi J, Cheah WK, Zariah AA
    Med J Malaysia, 2021 Jan;76(1):12-16.
    PMID: 33510102
    BACKGROUND: Thrombolytic therapy with intravenous alteplase is a well-established treatment for acute ischaemic stroke (AIS). However, in Malaysia, treatment prescription is often limited by the availability of neurologists. The objective was to compare the outcomes of acute stroke thrombolysis therapy prescribed by neurologists in the Seberang Jaya Hospital (SJH) and non-neurologists in the Taiping Hospital (TH).

    METHODS: In this cross-sectional study, all AIS patients who received thrombolytic therapy in SJH and TH between January 2012 and September 2019 were included. Clinical data was extracted from admission records. The outcomes assessed were the percentage of patients who achieved excellent functional outcome at 3 months (modified Rankin scale of 0 to 1), rates of symptomatic intracranial haemorrhage (SICH), and mortality.

    RESULTS: A total of 63 AIS patients who received thrombolytic therapy were included, of which 37 patients (58.7%) were treated in SJH. The median NIHSS on admission was 12 in SJH and 11.5 in TH. In all 21.6% of patients from SJH and 30.7% of patients from TH achieved favourable functional outcome at 3 months (p=0.412). There were no significant differences between the two centres in terms of the rates of SICH (10.8% in SJH and 3.8% in TH, p=0.314) and 3-month mortality (24.3% versus 12.5%, p=0.203).

    CONCLUSION: The 3-month functional outcomes and complication rates of stroke thrombolysis in hospitals with or without neurologists are not significantly different. Thus non-neurologist hospitals may be able to provide thrombolysis service to AIS patients safely and effectively.

  2. Pramana IGAN, Hariani L, Zarasade L
    Med J Malaysia, 2023 Jul;78(4):484-487.
    PMID: 37518916
    INTRODUCTION: Effective antiseptic use is essential in healthcare settings to prevent the spread of diseases, especially in areas with high patient traffic and exposure to various pathogens. One essential pathogenic germ is Acinetobacter baumannii. Octenidine and povidone-iodine have been demonstrated to be effective against A. baumannii in vitro. This study will compare octenidine dihydrochloride and povidone-iodine as wound-cleansing solutions for wounds contaminated with A. baumannii in vivo.

    MATERIALS AND METHODS: Twenty-four rats were divided into three groups: normal saline, octenidine dihydrochloride and povidone-iodine. Wounds were made on the rats' backs, and A. baumannii germs were inoculated into the wounds. After 3 hours, the wound was irrigated with wound cleansing solution according to the group for 30 seconds. Each wound was taken swab culture before and after wound irrigation and tissue culture 5 hours after wound irrigation.

    RESULTS: All specimens showed bacterial colony growth with a median value of 1.22 × 105 CFU before irrigation. Wound irrigation with normal saline did not reduce colony counts, while there was a 3-log reduction to 5-log reduction in the octenidine and povidone-iodine groups. Statistically, there was no significant difference in the mean number of colonies between the octenidine and povidone-iodine groups after irrigation (p = 0.535). However, 3 hours after irrigation, all specimens that experienced 3-log reduction showed regrowth to more than 1 × 105 CFU. In contrast, specimens subjected to 5-log reduction did not exhibit any regrowth.

    CONCLUSION: The antiseptic effectiveness of octenidine dihydrochloride is equivalent to povidone-iodine in eradicating A. baumannii colonies in wounds in vivo.

  3. Hisham AN, Aina EN, Zanariah H
    Med J Malaysia, 2000 Mar;55(1):132-4.
    PMID: 11072498
    Hungry bone syndrome (HBS) following successful parathyroid surgery is a well described phenomenon. However, few studies have clearly addressed this syndrome or looked at the outcome of perioperative management. We report a case of HBS following successful parathyroid surgery. The perioperative management is discussed and literature pertaining to this interesting case is reviewed.
  4. Ganapathi P, Nurul Yaqeen ME, Zamzurina AB
    Med J Malaysia, 2020 03;75(2):184-185.
    PMID: 32281607
    'Scimitar' syndrome in adulthood is usually asymptomatic. Significant structural abnormalities symptoms usually manifest early during infancy or young childhood with features of congestive heart failure from significant shunting of the anomalous pulmonary venous drainage. Diagnosis of 'Scimitar' Syndrome in adults is rare and usually an incidental finding on chest radiograph. Here, we report a case of an adult who presented with symptoms in her 40's. This syndrome has never been reported nor discussed in Malaysia. This is the first case report of 'Scimitar' Syndrome in Malaysian literature. The diagnostic dilemma, medical management, and multi-disciplinary management by cardiology, physiotherapy and pulmonary rehabilitation teams are discussed.
  5. Rashid MR, Ong FB, Omar MH, Ng SP, Nurshaireen A, Sharifah-Teh NS, et al.
    Med J Malaysia, 2008 Jun;63(2):113-7.
    PMID: 18942295 MyJurnal
    The long agonistic protocol for controlled ovarian hyperstimulation (COH) is effective and used most often, thus is considered the gold standard. Therefore any new regimen has to be compared in its results with those obtained with the long protocol. This report compares the efficacy of GnRH agonist and antagonist in a retrospective study of IVF/ICSI carried out in a tertiary teaching hospital from 2003 to 2006. Only the first COH cycle followed by IVF-ICSI from 200 couples (agonist = 120 and antagonist = 80) were analysed. The end points studied included the number of oocytes recovered, number of mature (MII) oocytes, fertilization, cleavage, morphology based embryo quality, pregnancy rate, quantity and cost of gonadotrophin. The average age of female subjects was 35.1 +/- 4.7 years with 50% being 35 years and above. Major infertility factors were tubal blockage, male factor and endometriosis altogether comprising 68%. GnRH agonist and antagonist cycle parameters were comparable except lesser amount of gonadotrophin was used with lower resultant costs (both p < 0.0005) in antagonistic regime. Antagonist regime produce somewhat more good quality embryos (p = 0.065), an insignificant difference. A clinical pregnancy rate per embryo transfer of 16.3% in agonist and 20.6% in antagonist regime was achieved respectively. In conclusion, GnRH antagonist protocol produced a COH response, embryonic development and pregnancy rates on par to GnRH agonist regime. Moreover GnRH antagonist protocol required a shorter stimulation period plus fewer complications. Hence GnRH antagonist regime provided means for a friendlier, convenient and cost effective protocol for patients.
  6. Ngoo KS, Ramzisham AR, Joanna OS, Zamrin DM
    Med J Malaysia, 2008 Mar;63(1):61-2.
    PMID: 18935737 MyJurnal
    A middle-aged lady presented with a three-month history of chronic cough. After a long and extensive investigation, CT thorax revealed collapse consolidation of the right lower lung lobe and bronchoscopy showed a polypoidal tumour within the involved bronchus. Thoracotomy and segmental lung resection revealed a peanut in the airways of the fibrotic and infected lung tissue. In view of the rarity of the food particle aspiration in a healthy adult, the delay in presentation and diagnosis in our patient, we would like to highlight this particular case. A high index of suspicion of FBA is necessary to avoid unnecessary anxiety, extensive investigations and overzealous treatment as well as to promote lung conservation.
  7. Ramzisham AR, Johann KF, Talal AR, Joanna OS, Zamrin DM
    Med J Malaysia, 2007 Dec;62(5):416-7.
    PMID: 18705480 MyJurnal
    A 23 year old female with a past history of a lung abscess diagnosed at the age of 13 years presented with recurrent episodes of productive cough. Chest radiograph and a high resolution CT scan of the thorax led to the diagnosis of a left lower lobe lung abscess. She underwent a successful thoracotomy and a left lower lobe lobectomy. Histopathological examination revealed the diagnosis of an infected congenital bronchogenic cyst. The recent literature on this is reviewed.
  8. Siew TY, Zambahari R
    Med J Malaysia, 1986 Sep;41(3):229-32.
    PMID: 3670139
    The left atrial myxoma is important not only because of its relative frequency and diagnostic difficulty but because it can be successfully removed by surgery. However, if untreated, it invariably leads to death. We report three cases seen at the Cardiology Department, General Hospital, Kuala Lumpur in 1985.
  9. Hoe TS, Chan KC, Zambahari R
    Med J Malaysia, 1987 Jun;42(2):90-2.
    PMID: 3503196
    A patient with a cervical aortic arch associated with a coarctation of the aortic arch and a Tetralogy of Fallot presented to the General Hospital, Kuala Lumpur.
  10. Alagappan M, Rampal L, Zalilah MS
    Med J Malaysia, 2019 12;74(6):513-520.
    PMID: 31929478
    INTRODUCTION: This cross-sectional study aimed to determine the prevalence of overweight and obesity and factors associated among secondary school students in Batang Padang District, Perak, Malaysia.

    METHODS: Out of the 7247 students in the ten selected schools studied, a total of 6248 students (2928 males, 3320 females) took part. A validated self-administered questionnaire was used. Data was analysed using SPSS version 22. Multivariable logistic regression was used to determine the adjusted odd ratio.

    RESULTS: The prevalence of overweight and obesity was 16.0% and 11.5% respectively. Obesity/overweight was significantly (p<0.05) associated with gender, age, ethnicity, education level of father, education level of mother, physical activity, disordered eating, smoking status, body size perception and body part satisfaction. The multivariable analysis results showed that the odds of being overweight/obesity were higher in males compared to females (OR 1.56, 95%CI: 1.37, 1.77). The results also showed that the odds of being overweight/obesity were highest among those in age group 12 and 13 years and among Malay ethnicity. The odds of overweight/obesity were higher in those who was dissatisfied with their body parts, (OR 1.96, 95%CI: 1.71, 2.25), dissatisfied with their body size (OR: 4.25, 95%CI: 3.60, 5.02), low physical activity (OR 1.23, 95%CI: 1.06, 1.44), current smokers (OR 1.38, 95%CI: 1.07, 1.78) and at risk of having eating disorder (OR: 1.39, 95%CI 1.22, 1.59).

    CONCLUSION: The overall prevalence of overweight and obesity is high. The findings from this study can be used by policy makers to plan an integrated intervention program in schools.

  11. Rameezan BAR, Zaliha O
    Med J Malaysia, 2005 Dec;60(5):548-59.
    PMID: 16515104
    Stroke is a leading cause of death and disability in most developed countries and developing nations. Majority of the stroke survivors are left with significant physical and cognitive impairments. In addition to the improved acute stroke care, they often benefit from rehabilitation in improving their function. This was the first study done to document function for post stroke patients in Malaysia. It was prospective study conducted to document functional status of acute stroke patients upon admission, discharge and at 3 months post stroke. Assessment of functional status for these patients are based on their activities of daily living and ambulation i.e. self-care, sphincter control, mobility, locomotion, communication and social cognition. It is also aimed to describe their demographic and clinical characteristics. Correlation of functional status at 3 months post stroke with the initial severity of stroke was also explored. A total of fifty-one patients with acute stroke in University Malaya Medical Centre (UMMC) were recruited. The patient's age ranged from 38 to 83 years with a mean of 60.2 years. Thirty-six patients (71%) were first stroke sufferers and fifteen patients (29%) had recurrent stroke. At discharge from acute stay, 13% of patients were able to ambulate with aids and 87% needed assistance for ambulation in varying degrees. Eighty-two percent of patients showed improvement in overall function (both motor and cognition) at 3 months post stroke. Sixty percent of patients were independent in ambulation and 40% required assistance. Significant correlation was seen between the initial severity of stroke and functional status at 3 months post stroke. Functional status of patients with stroke has improved at 3 months post stroke. A comprehensive rehabilitation medicine programme should be incorporated into management of stroke patients to expedite functional recovery and improve patient's independence.
  12. Naicker AS, Roohi SA, Naicker MS, Zaleha O
    Med J Malaysia, 2008 Jun;63(2):104-8.
    PMID: 18942293 MyJurnal
    Bowel Dysfunction is one of the least looked at problems in Spinal Cord Injury (SCI). The goals of this study are to understand bowel dysfunction in SCI and its effects on quality of life (QOL). Cross-sectional study based on interview and assessment of 41 clients. A majority of them were dissatisfied. Bowel opening time was long in about 65% while 76.6% were incontinent. Socially, approximately half refrained from outings even though 90.3% of them carried out bowel evacuation before going out. Attention to bowel education is necessary to improve social continence.
  13. Amalourde A, Vinayaga P, Naveed N, Choon SK, Zaleha O
    Med J Malaysia, 2004 Dec;59 Suppl F:8-13.
    PMID: 15941154
    In our centre the non-availability computerized exercise machines limits the objective monitoring of strength rehabilitation. We undertook this research programme to objectively measure triceps muscle strength by interfacing NORSK-Gym machine with accelerometer and positional transducers to a computer. This data was tabulated and processed using Microsoft Excel. The positional transducer was first calibrated and it showed an excellent Pearson Correlation Coefficients against a standard metric reading (r = 0.9999). Peak Force was used as a test parameter for isotonic triceps muscle strength measurements. The criterion-referenced validity was established as the peak forces measured using the accelerometer and positional transducer demonstrated identical Peak Forces (r = 0.94). Analysis of our mean Peak Force measurements using non-biological force as well as the intra-individual reproducibility demonstrated excellent Pearson Correlation Coefficients (r) = 0.982-0.998 and 0.929-0.972 respectively. This computerized adaptation of the NORSK-Gym machine produced an objective, valid and reproducible triceps muscle strength measurement.
  14. Marwyne MN, Loo CY, Halim AG, Norella K, Sulaiman T, Zaleha MI
    Med J Malaysia, 2011 Oct;66(4):313-7.
    PMID: 22299549 MyJurnal
    Obesity and overweight are strong independent risk factors for chronic kidney disease (CKD). Using serum creatinine-based estimated glomerular filtration rate (eGFR) equations in these subjects may be inaccurate. On the other hand, cystatin C-based eGFR equations may overestimate CKD prevalence as recent findings suggest an association of cystatin C with obesity. The objective of this study was to assess the accuracy of a cystatin C-based eGFR equation compared to two creatinine -based eGFR equations in overweight and obese subjects.
  15. Pang YK, Liam CK, Leow CH, Shyamala P, Zal AR
    Med J Malaysia, 2006 Jun;61(2):147-50.
    PMID: 16898303 MyJurnal
    Many studies have shown that tracheobronchial stenting is effective in relieving respiratory distress secondary to major airway obstruction due to lung or oesophageal cancer. A retrospective review on the benefits and complications of self-expandable metallic stent (SEMS) insertion through flexible bronchoscopy for the palliative treatment of upper airway obstruction in University Malaya Medical Centre was performed. Ten patients underwent this procedure. Relief of dyspnoea was immediate following stent insertion in all patients. Stent migration occurred in one patient and three patients had restenosis of the central airway. We conclude that tracheobronchial stenting via flexible bronchoscopy is feasible and safe.
  16. How SH, Liam CK, Jamalludin AR, Chin SP, Zal AB
    Med J Malaysia, 2006 Dec;61(5):558-63.
    PMID: 17623956 MyJurnal
    We studied the prevalence of raised serum CA125 in patients with pleural effusions and explored factors affecting its level. Sixty four patients with benign effusions and 36 patients with malignant effusions admitted to the University Malaya Medical Centre from May 2001 to January 2002 were included in the study. There were no significant differences in age, gender and ethnicity of the patients with benign and malignant effusions. There was also no difference in the frequency of the side of pleural effusion between the two groups but compared to benign effusions, a higher proportion of malignant effusions was moderate to large in size (66% versus 39%, p = 0.011). Serum CA125 levels were above 35U/dL in 83.3% and 78.1% of patients with malignant and benign effusions, respectively (p = 0.532). All patients with underlying malignancy and 95.3% of patients with benign effusions had pleural fluid CA125 levels above 35U/dL (p = 0.187). The median levels of CA125 were higher in the pleural fluid than in the serum in all aetiological groups. Higher serum CA125 levels were more likely to be found in patients with moderate to large effusions (p = 0.015), malignant effusions (p = 0.001) and in female patients (0.016). Serum CA125 level showed significant correlation with pleural fluid CA125 level (r = 0.532, p < 0.001) but not with pleural fluid total white blood cell count (r = -0.092, p = 0.362), red blood cell count (r = -0.082, p = 0.417) and lactate dehydrogenase level (r = 0.062, p = 0.541). We conclude that serum CA125 is commonly elevated in patients with benign and malignant pleural effusions.
  17. Liu WJ, Chew TF, Chiu AS, Zaki M
    Med J Malaysia, 2006 Dec;61(5):540-6.
    PMID: 17623953 MyJurnal
    The aims of this retrospective analysis were (i) to examine the trends of quality of life (QoL) scores and (ii) to identify the risk factors for QoL scores among 6908 dialysis patients entering dialysis between 1997 and 2002. The Spitzer QoL Index was the instrument used by the National Renal Registry of Malaysia to assess the QoL amongst dialysis patients. Demographic and biochemical data were analysed to identify risk factors for poor QoL. The median QoL-index score ranged between 9 and 10. Significant risk factors for poor QoL were female gender, age > 40, diabetes, cohort starting dialysis 2001-2002, haemodialysis modality, body mass index < 18.5, albumin < 30g/dL, cholesterol < 3.2 mmol/L, haemoglobin < 10 g/dL, diastolic blood pressure of > 90 mHg, iPTH < 100 pg/ml. The overall QoL of dialysis patients is satisfactory. The negative impact of diabetes and haemodialysis on QoL warrants further evaluation as each factor involves 50% and 90% of our dialysis population.
  18. Liu WJ, Zaki M
    Med J Malaysia, 2004 Dec;59(5):649-58.
    PMID: 15889568 MyJurnal
    This survey aims to identify prevalence, reasons and predictors of noncompliance among renal transplant patients followed up in Hospital Kuala Lumpur (HKL). All adult renal transplant patients who were at least 6 months post transplant were recruited from 10/2001 till 5/2002. Patients who consented were interviewed by a medical doctor or research assistant based on questionnaire. Noncompliers were defined as those who missed or self adjusted any dose of immunosuppressant within the preceding 4 weeks. Inter-rater agreement was assessed prior by Kappa (K) scores and they were acceptable. Out of 304 patients, 246 patients volunteered; of whom 144 (58.5%) were males. Twenty-one (9.3%) were noncompliers. Reasons for noncompliance included forgetfulness (n=8), financial constraints (n=1), fear of rejection (n=1), side effects (n=9), decision not to take (n=6), difficulty in breaking medication into correct dosages (n=1). Significant predictors of noncompliance were longer duration of transplant noncompliance to other drugs, regular use of nonprescription drugs; the lack of symptoms of fat facial cheeks and infection. Surveillance for noncompliance should not be relaxed as its predictors are diverse and persistent, especially in those who are at high risks.
  19. Lim TO, Lee DG, Zaki M
    Med J Malaysia, 2000 Jun;55(2):188-95.
    PMID: 19839147
    We determined the provision for dialysis treatment in Malaysia. There were 181 dialysis centres as at 1st June 1999 (161 Haemodialysis (HD) and 20 Continuous Ambulatory Peritoneal Dialysis (CAPD) centres), providing treatment for 5614 patients. This is equivalent to an estimated prevalence rate of 253 patients per million population (pmp) and new dialysis acceptance rate of 49 patients pmp. Dialysis facilities were widely distributed throughout the country though rather unevenly among states. Penang, Selangor/KL, Malacca led with number of dialysis patients pmp ranging from 417 to 480. Kelantan and Sabah had the lowest provision with 51 and 64 patients pmp respectively. There were more centres and HD capacity in the private sector while the Non-Government Organisation and public sectors had about the same capacity. However the public sector had more patients on account of availability of CAPD and home HD services, as well as low HD capacity to patient ratio. The number ofcentres, HD capacity and patients have increased rapidly especially since 1991; the estimated growth rates were 16.5 centres/year, 658 capacity/year, and 392 patients/year respectively. There was also a trend toward increasing over-capacity in the private and NGO sectors. In conclusion, the level of dialysis provision is increasing, indicating increasing accessibility of dialysis treatment in Malaysia. Over-capacity is a concern in the private and NGO sectors. Thus funding agencies should be encouraged to source provision from those sectors. The public sector still has the crucial role of providing for under-served areas in the country.
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