Introduction: Epidemiology of fungal infections in an infectious disease reference centre is different from other institutions. This study aimed to look at the scenario of fungal infections at an infectious disease reference centre in Malaysia. Methods: All positive fungal cultures from an infectious disease reference centre were identified by routine mycology laboratory methods. Patient demographic, laboratory and clinical data were collected and analyzed. Duplicate data were excluded. Results: Middle-aged Malay males were the most common group. However, increased proportions of Chinese, Myanmar and Indonesians reduced the Malay predominance in HIV-positive group. In all patients, Candida species represented 64.1% isolates, followed by Cryptococcus neoformans (14.7%) and Penicillium marneffei (14.7%). Among HIVpositive individuals, C. neoformans (37.9%) was the most common species, followed by P. marneffei (35.6%) and all Candida species (17.2%). In contrast to other non-infectious disease reference centres, common causes of fungaemia included P. marneffei (43.5%), Candida species (25.8%), C. neoformans (24.2%) and H. capsulatum (6.5%). Conclusion: The prevalence of fungal infection at an infectious disease reference centre is different from other non-infectious disease reference centres. This may have an impact on current antifungal practice especially empiric antifungal therapy, patient morbidity and mortality.
To study the prevalence of Helicobacter Pylori (H. pylori) infection, according to ethnicity, gender and endoscopic findings among the patients underwent the oesophago-gastro-duodenoscopes (OGDS) at gastroenterology endoscopy unit, Hospital Serdang, Selangor, Malaysia. The database of all whom underwent OGDS at the gastroenterology endoscopy unit, Hospital Serdang from 1st August 2010 to 31st July 2012 was collected and assessed, retrospectively. A total of 924 patients who underwent OGDS were analyzed for the H. pylori infection by using Campylobacter-like organism (CLO) test. 130 (14.07%) tested positive, and their data were further studied according to gender, ethnicity, age group, initial indication for OGDS and endoscopic finding. The prevalence rate among males was 15.15% (70/462), while it was 12.99% (60/462) among females. In terms of ethnics, H. pylori infection was commonly found among Indian and Chinese with prevalence rate of 25.13% (50/199) and 17.41% (51/293) respectively. These figures are significantly higher than the 6.01% (25/416) for Malays. The age group (31-50 years old) had the highest prevalence rate of H. Pylori infection, which is of 18.55% (41/221). No significant difference was observed among initial indications for OGDS. Erosions were the commonest finding in H. pylori positive group with rate of 51.54% (67/130). However, erosions were not uncommon in H. pylori negative group as well with the rate of 48.61% (386/794). H. pylori infection rate among Malaysians was generally low, with the highest rate in Indians, followed by Chinese and relatively low in Malays. No significant difference between the prevalence rate of H. pylori infection in male and that in female was found. Erosions were equally common in either H. pylori positive or H. pylori negative group.
Stress in the work place is a global major risk factor to worker’s health, which triggers the workers to be poorly motivated and less productive. Objectives: The objective of the study was to determine the prevalence of job stress and its associated factors among Universiti Putra Malaysia staff. Methods: This is a cross sectional study involving 511 academic and non-academic staff of Universiti Putra Malaysia in Serdang. Probability proportionate to size was used for calculating the required sample size. Results: The overall prevalence of stress was 21.7% (21.0% among male and 23.0% among female). The variables found to be significantly associated with stress were: Job demand, coworker support, depression, anxiety, focus and venting of emotion and self-blame (p
Tobacco use among females is a rising public health issue. Further insight into the smoking epidemic can be gained from studying a specific subgroup of interest within the population. Determining predictors of each tobacco smoking type is necessary for planning tobacco specific intervention programmes. The aim of this study was to determine the prevalence of ever tobacco use and its associated socio-demographic factors among Saudi female adolescents aged 12 to 19 in Jeddah. A cross-sectional analytical study was conducted among female students from intermediate and high secondary schools in Jeddah during the academic year 2012-2013. Sampling with probability proportionate to size was used to select a sample of 5,150 students from 40 schools. The data were collected using validated self-administrated questionnaire that required information on tobacco use behaviours and selected socio-demographic characteristics. A total of 5,073 students participated in this study of whom 51.6% were from intermediate grades, and 83.1% from public schools. The prevalence of ever tobacco use was 44.2% (36.2% water pipe and 30.9% cigarettes). The significant predictors of ever tobacco use were student’s age, mother’s education, family structure, residence location and monthly student’s allowance. In conclusion, ever tobacco used is highly prevalent among female adolescents in Jeddah. Designing intervention programmes aimed at preventing Saudi female adolescents from smoking should include all forms of tobacco use.
Subclinical hypothyroidism (SHT) is a biochemical diagnosis, defined as an elevated Thyroid Stimulating Hormone (TSH) with normal free thyroxine (FT4). It affects 4-10% of the adult population and is more prevalent in elderly women. Its commonest cause is autoimmune thyroiditis, detected by anti- thyroid peroxidase antibody (TPO-Ab). About 2-5% of SHT patients progress to overt hypothyroidism annually. The SHT prevalence among depressed patients ranges between 3% and 17%. This study aimed to determine the prevalence of SHT and TPO-Ab positivity among patients diagnosed with depressive disorders. It was a cross-sectional study carried out in the Universiti Kebangsaan Malaysia Medical Centre over a 12 months period. Serum TSH, FT4 and TPO-Ab were measured. Results showed that 82% of depressed patients were euthyroid, 4% had SHT, 11% had subclinical hyperthyroidism and 2% had discordant thyroid function. TPO-Ab positivity among the subjects was 7%, one of whom had SHT. In conclusion, the prevalence of SHT and TPO-Ab positivity in the study population, at 4% and 7%, respectively, were comparable to previous findings.
The aim of the study was to determine coping strategies among breast cancer patients with depression and anxiety during chemotherapy. Methods: Breast cancer patients with confirmed diagnosis who were undergoing out-patient chemotherapy at the Oncology Unit, University Malaya Medical Centre were invited to participate in the study. They were assessed on their socio demographic profiles and clinical history. The Hospital Anxiety Depression Scale (HADS) was used by patients to report anxiety and depression. The Brief COPE Scale was used to assess coping strategies among the patients. Results: One hundred and forty one patients with mean age of fifty years participated in the study. Prevalence for depression was 19.1% and prevalence for anxiety was 24.1%. Patients who were having anxiety symptoms scored significantly higher on denial, behavioural disengagement and venting as their coping strategies compared to patients who were not anxious. Patients with depressive symptoms scored significantly higher in behavioural disengagement and self-blame as their coping strategies compared to those who were not depressed. Conclusion: Breast cancer patients undergoing chemotherapy experienced high level of depressive and anxiety symptoms. However different coping strategies were adopted to cope with their illness, chemotherapy treatment, practical and family problems, emotional and physical symptoms.
Study site: Oncology clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
This study aims to determine the prevalence of obsessive compulsive disorder (OCD) among schizophrenic patients and the association of this condition with clinical and selected neurocognitive factors. This is a cross sectional study on one hundred schizophrenic patients who attended psychiatric clinic in National University Hospital and Kuala Lumpur Hospital over a four-months period. All patients diagnosed as schizophrenia according to DSM 1V were assessed using Mini International Neuropsychiatric Interview (MINI) Version 5 for the presence of Obsessive Compulsive Disorder, Brief Psychiatric rating Scale (BPRS) for severity of psychosis and Yale Brown Obsessive Compulsive Scale (YBOCS) for severity of obsessive compulsive (OC) symptoms. Socio-demographic data were obtained by direct interview. The neurocognitive assessment were done using Mini Mental State Examination , Rey Auditory Verbal Learning Test (RAVLT) and Digit Span. Fifteen percent of schizophrenic patients (15%) in this sample were found to have a diagnosis of Obsessive compulsive Disorder (OCD). The OCD and non-OCD schizophrenic patients did not differ significantly in term of age ,gender, race and family history of mental illness. However they differ significantly on employment, type of treatment medication and the presence or severity of current psychosis. Schizophrenic patients with OCD also showed no significant different in selected neurocognitive functions.
Introduction: Patients with mental disorders in Malaysia often seek help from traditional healers prior to consulting psychiatric service. The objective of the study is to determine the prevalence and experience of contact with traditional healers among patients with first-episode psychosis in Hospital Kuala Lumpur (HKL). Methods: This is a hospital-based cross-sectional descriptive study of 50 in-patients with first-episode psychosis in HKL. Structured Clinical Interview for DSM-IV Clinical Version for Axis I Disorders (SCID-CV) was used for establishing diagnosis. Socio-demographic data, information on help-seeking pathways, and experience of contact with traditional healers were determined through face-to-face interview and semi-structured questionnaires. Results: Twenty seven (54%) of the patients had at least one contact with traditional healers prior to consulting psychiatric service, and it was the most popular first point of non-psychiatric help-seeking contact (48%). About a quarter of them (24%) had 3 or more contacts with traditional healers prior to consulting psychiatric service. The most common type of traditional treatment received was prayer (25, 96.3%). Only 2 patients (7.41%) reported having some beneficial effects from traditional treatments. There were two patients who reported having adverse experience with traditional healers. Among those who had sought help from traditional healers, one third was recommended by at least one of their traditional healers to seek medical help. Conclusion: History of contact with traditional healers prior to consulting psychiatric service was common among inpatients with first-episode psychosis in HKL. There may be potential meaningful collaborations between psychiatrists and traditional healers for better management of patients.
Steroid is commonly used for various connective tissue diseases and immunological related disorders. Psychiatric side effects are common in patient with systematic treatment of steroid. The reported prevalence ranges from 6% to 28%. Antidepressant-induced mania occurs when the mood of a patient switches to manic or hypomanic from depression after the use of antidepressant. We reported a case of a 55 year old lady, who presented with agitation and grandiosity after the treatment with antidepressant. She was initially diagnosed as having Bell’s palsy with unilateral facial muscle weakness. Oral prednisolone was prescribed for seven days where she became depressed, having auditory hallucination and delusion of guilt. She was then started on antidepressant where she became irritable, agitated and developed grandiose delusion. The antidepressant was withheld and she was started on atypical antipsychotic. Her condition improved and discharged well after three days of stay in the ward.
Parkinson Disease (PD) is a neurodegenerative disorder of the central nervous system that often impairs the patient’s motor skills, speech and other functions. The four cardinal signs of parkinsonism are resting tremor, bradykinesia, cogwheel rigidity and postural instability. The prevalence of depression in PD ranges from 4% to 75%. However depression in PD is often mistakenly as the presentation of the disease itself. Therefore this paper reviewed the clinical feature of depression in PD and explored the aetiology of depression in PD.
Adolescent smoking is an emerging health concern in the developing countries. A cross-sectional study is conducted to determine the prevalence and smoking behaviour of adolescents in Sarawak. The prevalence of smoking is 32.8% with mean age of initiation at 12.8±1.9 years. Most (67.2%) adolescents are experimental smokers and the majority (67.9%) did not smoke on a daily basis. Branded cigarettes are preferred (83.1%) and the cigarettes are obtained either from friends (49.1%) or self purchased (43.6%). Students prefer to smoke at their friend’s house (31.0%) or at school (25.3%). Smoking prevalence among adolescents in Sarawak is high and begins early. Early intervention on smoking prevention and risk awareness is perhaps more effective if initiated before the age of 12 years.
Rapid epidemiological transition globally has witnessed a rising prevalence of major chronic diseases such as hypertension, diabetes, hyperlipidaemia, obesity, chronic respiratory diseases and cancers over the past 30 years. In Malaysia, these conditions are commonly managed in primary care and published evidence has consistently shown suboptimal management and poor disease control. This in turn, has led to the massive burden of treating complications in secondary care, burden to the patients and their families with regards to morbidity and premature death, and burden to the country with regards to premature loss of human capital. The crushing burden and escalating health care costs in managing chronic diseases pose a daunting challenge to our primary care system, as we remain traditionally oriented to care for acute, episodic illnesses. This paper re-examines the current evidence supporting the implementation of Wagner Chronic Care Model in primary care globally; analyses the barriers of implementation of this model in the Malaysian private general practice through SWOT (strengths, weaknesses, opportunities and threats) analysis; and discusses fundamental solutions needed to bridge the gap to achieve better outcomes.
Heart failure (HF) is a major burden in almost all countries. The prevalence of symptomatic HF is still high. Despite our best understanding of its pathophysiologic mechanisms and the recent advances in pharmacologic therapy, it remains a highmortality and morbidity disease. About 30-50% of patients with HF have concurrent electrical delay in the electrocardiogram (ECG), mainly in the form of LBBB.1 This kind of conduction delay commonly occurs in patients with idiopathic dilated cardiomyopathy and ischemic cardiomyopathy as well. The abnormality of left ventricle (LV) conduction will lead to a change in LV contraction pattern resulting dyssynchronized with right ventricle) contraction. Thus, a dyssynchronous LV contractile pattern usually manifested by late activation of the LV lateral wall which in turn impairs LV systolic function, reduces cardiac output, raises filling pressure and worsens mitral regurgitation2. Cardiac resynchronization therapy (CRT) improves cardiac function and exercise capacity leading to an improved survival in patients with advanced heart failure and ventricular conduction delay.3 The underlying mechanisms of these beneficial effects are not fully understood, but they appear to be related to a restored coordination of the left (LV) and right ventricular (RV) contraction and relaxation.4 These effects may directly lead to augmented contractility and reduction of LV filling pressures.5 Echocardiography has been widely used to identify patients who are candidates for CRT and to monitor the response in LV function at follow-up after device implantation. This review addresses the applications of CRT in patients with moderate– severe heart failure and the role of echocardiography in optimizing CRT including patient selection, risk and benefit of CRT and appropriate measures.
Objective: The objective of this study is to identify the correlation between psychological factors and insomnia and the impact of insomnia on daytime sleepiness. Methods and Results: The participants were recruited through convenient sampling and consist of 173 working adults in Georgetown, Penang, aged 20 to 60 years. Participants completed the General Health Questionnaire (GHQ), Athens Insomnia Scale (AIS) and Epworth Sleepiness Scale (ESS). The results revealed that the prevalent of insomnia was 34.7%. There was a positive correlation between psychological distress and insomnia r = .481, p < .001 and also a positive correlation between insomnia and daytime sleepiness r = .334, p < .001. Conclusion: It is concluded that psychological distress typically causes sleep difficulties, and sleep deprivation leads to daytime sleepiness.
Objective: Truancy is a disciplinary problem, which frequently occurs among school students and it has many contributory as well as inter-related factors. It is a growing problem in this country and it often becomes a prelude to other delinquent behaviours. The study objective is to determine the prevalence of truancy as well as factors related to it including psycho-behavioural factors. Methods: A cross-sectional study involving 556 Malay student’s selected using multi-stage sampling was conducted. Results: The overall prevalence of truancy is 30.2%. The predictors to truancy are age, students who frequenting entertainment centre, students who have not completed Quran recital, coping strategies using problems solving methods and time spent watching television/video. There is a significant association between truancy and psycho-behaviour such as watching video/internet pornography, frequenting entertainment centre, smoking, motorcycle racing and dating a special friend. Conclusion: Truancy is a social issue, which must be given serious attention by all concerned components of the society.
Primary care practice with its defining features of continuity, comprehensiveness and coordination, is the cornerstone to provide high quality community-based chronic disease management. Poor chronic disease prevention and control at the primary care level will lead to the massive burden of treating complications at secondary care, burden to the patients and their families with regards to morbidity and premature death, and burden to the country with regards to the loss of human capital. Compelling evidence showed that there are innovative and cost-effective interventions to reduce the morbidity and mortality attributable to chronic diseases, but these are rarely translated into high quality population-wide chronic disease care. Primary health care systems around the world were developed in response to acute problems and have remained so despite the increasing prevalence of chronic conditions. An evolution of primary health care system beyond the acute care model to embrace the concept of caring for long term health problems is imperative in the wake of the rising epidemic of chronic diseases. This paper aims to review the evidence supporting high quality and innovative chronic disease management models in primary care and the applicability of this approach in low and middle income countries.
Accepted 8 February 2012.
Introduction Social norms, though an important contributing factor of adolescent smoking in developed countries, has not been extensively studied in Malaysia. The objective of this study was to determine the association between certain perceived norms regarding smoking with smoking status among Malaysian secondary school students in Kota Tinggi, Johor.
Methods Data were collected from 2311 respondents consisting of 1379 male and 923 female secondary school students in Kota Tinggi district via a self administered questionnaire. Five perceived norms regarding smoking were assessed, namely: perceived peer smoking prevalence, perceived parental reaction towards adolescent smoking, perceived public perception of adolescent smoking, ever noticed peers smoking inside and outside school and perceived enforcement of anti-smoking policy in school and their association with smoking status. Multiple logistic regressions controlling for gender, peer smoking and family smoking was performed.
Results Of the five perceived norms, four were associated with smoking status, (perceived peer smoking prevalence (p
Poor adherence to antiepileptic drug (AED) therapy can lead to various undesirable complications. Identifying the contributing factors of poor adherence is beneficial in assisting health care professionals to provide optimal interventions to control the seizures. This study aimed to identify the prevalence and factors affecting the adherence level to AED therapy in a multiracial population with epilepsy. This cross-sectional study was conducted at the neurology clinic of a tertiary care setting. Researcher-assisted questionnaire was utilised. Adherence level was assessed using validated Modified Morisky Adherence Scale-8. A total of 145 patients with epilepsy were included in this study. The prevalence of poor adherence to AED therapy was 64.1%. Poor adherence level was significantly associated with younger age (χ2 = 7.609, p = 0.022), medication adverse effects (χ2 = 5.075, p = 0.020), shorter duration of epilepsy (r = 0.180, p = 0.030) and uncertainty about the necessity for AEDs (χ2 = 11.803, p = 0.001).
Conclusion, prevalence of poor adherence to antiepileptic drugs was high and factors associated with poor adherence to AEDs were identified for a multiracial population with epilepsy.
Study site: Neurology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Occupational tasks of linemen are highly associated with the development of work related musculoskeletal disorders (WRMDs). Although linemen are prone to develop WRMDs, there is paucity of information on the prevalence of WRMDs and related occupational causative factors. Therefore, the present review was conducted to report on the prevalence of WRMDs and to outline causative risk factors within occupational tasks in the lineman profession. Literature search was conducted in various databases such as Scopus, PubMed and ScienceDirect for articles published between 1996-2013. The articles were analyzed, selected and retrieved based on predetermined objectives, inclusion criteria and Medical Subject Headings (MeSH). In the review process only articles published in English were considered. The review identified moderate to high prevalence of WRMDs among the linemen population. Back and shoulder regions were highly affected compared to the other body regions. The review also reported occupational tasks such as bar installation, insulator fixation and manual handling of tools as high risk tasks that lead to the development of WRMDs. In addition, occupational tools such as ladders, manual cutters and manual presses were also identified as a potential ergonomic hazard. In conclusion, the current review identified that WRMDs are common in the back and shoulder regions among linemen. Also, a number of occupational risk factors were identified to be associated with WRMDs among the linemen. Hence, future research on prevention and intervention studies concerning lineman profession population in order to develop a good job practice are recommended. Int J Occup Med Environ Health 2016;29(5):725-734.
Pulmonary epithelioid hemangioendothelioma is an uncommon lung malignancy of endothelial origin. Besides demonstrating unpredictable presentation features and prognosis, the paucity of established treatment guidelines remains a challenge in managing these patients. We present two patients. The first patient presented with chronic productive cough over 1-year duration. He was initially diagnosed and showed partial response to treatment for cardiac failure. A persistent right upper zone consolidation on chest radiograph prompted further investigations which revealed the diagnosis of pulmonary epithelioid hemangioendothelioma. The second patient presented with right-sided hemiparesis for 1-month duration. Initial computer tomography scan of the brain showed findings of distant metastatic foci. Subsequent investigations revealed pulmonary epithelioid hemangioendothelioma as the primary lesion. Both patients succumbed without any treatment due to rapid progression of the disease. We believe that pulmonary epithelioid hemangioendothelioma is undoubtedly rarely reported in south-east Asia region. In these two case reports, the patients were diagnosed in west and east Malaysia, respectively, in the same year (2015). Both cases highlight the increasing prevalence of pulmonary epithelioid hemangioendothelioma. We postulate that this could possibly be secondary to the advancement in diagnostic capabilities and improved healthcare facilities available in this region. Late presentation of pulmonary epithelioid hemangioendothelioma generally results in grave prognosis. Further investigations are required to elucidate the nature of progression and therapeutic options for patients with pulmonary epithelioid hemangioendothelioma.