Objectives: The objectives of our study were to determine the mean age of onset of thelarche and menarche,
to determine the ages of each stage of puberty and to investigate if there are any ethnic differences in these
ages amongst female adolescents in Kuala Lumpur, Malaysia.
Methods: This was a cross-sectional study involving three secondary schools in Cheras, Kuala Lumpur. A total of
730 students were recruited via stratified random sampling. Self-administered survey forms on menstruation
and puberty were used.
Results: Out of 730 recruited respondents, 385 (52.74%) completed the survey and informed consents were
obtained from their parents/legal guardians. Our respondents’ ages ranged between 13 to 17 years old with
the median (IQR) age of 14.00(2.00) years. With regards to ethnicity, 329 (85.50%) were Malay, 46 (11.90%)
were Chinese, 9 (2.30%) were Indian and 1(0.30%) was a Bajau. The mean age for breast development
(thelarche) and menarche were 11.72 ±1.10 and 11.97±1.11 years respectively. The majority, 363 (94.30%),
out of 385 respondents had attained menarche. There appeared to be a later onset of puberty amongst
Malays comparatively.
Conclusion: The mean ages of pubertal onset and menarche amongst female adolescents in the Cheras area
are similar to those reported worldwide.
The objective of this study was to determine the factorial validity of the Chinese version of the General Family
Functioning subscale (GF-12) and to assess parents’ perceived family functioning of children with or without
chronic respiratory disease in Malaysia. Thirty two parents of children with chronic respiratory disease and
30 parents of healthy children were recruited. The GF-12 was administered at baseline and 2 weeks later.
Confirmatory factor analysis showed that our instrument was a 1-factor model assessing general family
functioning. Cronbach’s α value was 0.950. Test-retest reliability coefficient ranged from 0.490-0.790. The overall
mean (standard deviation) score was not significantly different between parent’s perceived family functioning
of children with or without respiratory disease [1.83(0.63) versus 1.65(0.46), p=0.385]. The Chinese version
of the GF-12 was found to be a valid and reliable instrument to assess family functioning in Malaysia. Parents
in the present study showed healthy perceived family functioning (total score >2.00).
Phenytoin is commonly prescribed for the prophylaxis of seizures in neurosurgical patients. A phenytoininduced
serious adverse effect of thrombocytopenia has been reported in the literature. The concurrent
use of dexamethasone, another commonly prescribed drug in neurosurgical patients, has been reported to
aggravate this adverse haematological effect. We present a report of phenytoin-induced thrombocytopenia
in a patient concurrently prescribed with dexamethasone, after an intracerebral haemorrhage secondary to
a rupture of an arteriovenous malformation. The thrombocytopenia was noted after two weeks of phenytoin
medication. Phenytoin was immediately withheld, and seven units of random donor platelets were transfused.
A gradual resolution of thrombocytopenia was observed within a week.
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.
Pulmonary embolism is the obstruction of the pulmonary artery or its branches, commonly by thrombus or
fat. We report an unusual case of double pathology - both pulmonary thromboembolism and fat embolism
syndrome in a patient with bilateral femur and bilateral tibia fractures. This highlights the importance of a high
index of suspicion of these conditions while managing patients with multiple long bone fractures. Morbidity
and mortality can be significantly reduced with prompt and appropriate prevention strategies.
Phyllodes tumour is a rare entity, affecting mainly middle aged women. It consists of a spectrum of disease
from benign tumour to highly aggressive malignant form. We present a case of massive ruptured malignant
Phyllodes tumour, and its subsequent management.
Tuberculosis (TB) is a major public health problem worldwide. It is estimated that 2 billion people, a third of
the world population, have TB infection, but are not down with the disease. Globally, incident cases of TB
showed a rising trend, with a 6.6 million reported in 1990, 8.3 million in 2000, 9.24 million in 2004, and an
estimated 9.27 million incident cases in 2007. The aim of this study was to evaluate the treatment outcome of
TB patients in Nigeria in the state of Jigawa. A cross sectional retrospective study was conducted to evaluate the
treatment outcome in directly observed treatment with a short course for tuberculosis (TB DOTS) in facilities
in the state between the years 2010 to 2014. The study population were all the patients with TB, who had
access to DOTS therapy. Data were collected from the various local governmental areas for tuberculosis control
(LGA TB) register. The LGA TB control registers contained basic information of the patients, and a statistical
software SPSS-V22.0 was used to analyse the data. A total of 963 TB patients were studied. More than half
(57.4%) of the patients were male, and nearly three- fourths (71.2%) of the patients accessed care from urban
local government areas in the state. The greater majority (96.3%) of the cases had pulmonary tuberculosis
(PTB). Among the patients, more than two-fifths (45%) were cured, and a little over one-fifth (20.6%) of them
were HIV positive. This study revealed that the treatment success rate (TSR) in the Jigawa State of Nigeria
was higher than the overall TSR of Nigeria, and the defaulter rate in this state was lower than the Nigerian
average. The aim of this study was to evaluate the treatment outcome of TB patients in Nigeria in the state
of Jigawa. A cross sectional retrospective study was conducted to evaluate the treatment outcome in directly
observed treatment with a short course for tuberculosis (TB DOTS) in facilities in the state between the years
2010 to 2014. The study population were all the patients with TB, who had access to DOTS therapy. Data were
collected from the various local governmental areas for tuberculosis control (LGA TB) register. The LGA TB
control registers contained basic information of the patients, and a statistical software SPSS-V22.0 was used
to analyse the data. A total of 963 TB patients were studied. More than half (57.4%) of the patients were
male, and nearly three- fourths (71.2%) of the patients accessed care from urban local government areas in
the state. The greater majority (96.3%) of the cases had pulmonary tuberculosis (PTB). Among the patients,
more than two-fifths (45%) were cured, and a little over one-fifth (20.6%) of them were HIV positive. This study
revealed that the treatment success rate (TSR) in the Jigawa State of Nigeria was higher than the overall TSR
of Nigeria, and the defaulter rate in this state was lower than the Nigerian average.
The anterior cruciate ligament (ACL) deficient knee has been subjected to various research and many conclusions
have been drawn to the loss of function in relation to it. ACL reconstruction is also very commonly done as
this ligament damage is the most common injury in sports. Muscle strength and proprioception have been
postulated to be affected alongside this injury. We conducted a cross sectional study in 19 patients who have
ruptured their ACL. We measured their muscle strength, thigh muscle bulk and proprioception in comparison
to their contralateral normal knee. The Biodex Isokinetic machine was used to measure the muscle strength
and proprioception. The thigh circumference was measured manually using a measuring tape. There was
significant reduction of muscle strength and thigh circumference in the ACL deficient limb as compared to the
normal side, p
The study aimed to assess whether sharing of health services improved service quality in health centers in Kampala Capital City Authority (KCCA). With multi-stage sampling, data was gathered by face to face interviews, via translators from residents in the five divisions of KCCA, using a questionnaire. Schedules were made with Local Council I chairmen, and support to fill in the questionnaire was given to the respondents. The statistical methods used for analysis included a Chi-square, Spearman correlations and hierarchical regression. The study found that regarding tangibility, sharing health services significantly determines the number of modern medical equipments (p=0.000) and the number of medical personnel that had a neat and professional appearance (p=0.000) but did not determine the number of visually appealing health facilities (p=0.386). Recentralizing health care changed the mode of delivery. Health workers were responsive, reliable and provide better care for patients. There was increased availability of basic medical equipment, and health workers were neater in appearance with increased confidence and hence were better able to provide for the safety of residents.
Study site: clinic, Kampala, Uganda
There is a high incidence of 36% to 83% of respiratory dysfunction in patients with acute cervical spinal cord
injury. Complications arising from respiratory dysfunction remain one of the most common causes of morbidity
and mortality in the spinal cord injured population. Specialized pulmonary care and therapy can help individuals
with tetraplegia to maintain a stable respiratory status allowing active participation in active rehabilitation.
This would allow them to achieve rehabilitation goals of independent function and community reintegration.
Mechanical insufflation-exsufflation (MIE) therapy is an option for secretion management in individuals with
acute spinal cord injury. In this paper, we present our experience using MIE as an adjunct to management of
secretions in the spinal cord injured population at the University of Malaya Medical Centre.
In the current study, we report a new technique to place a tunnelled peripherally inserted central catheter
(PICC) at the upper arm of patient under real-time ultrasound-guided venipuncture using disposal equipment
provided within a standard PICC set. The tunnelling of the PICC required an extra time of 5 minutes but was
well tolerated by all patients involved in the study. The tunnelled PICC was applied on 50 patients and the
infection rate as well its catheter dwell time were compared to another 50 patients with conventional PICC.
The rate of patients who developed infection decreased from 34% for conventional PICC to 16% in tunnelled
PICC patients. The central line-associated blood stream infections rate was also decreased from 4.4 per 1000
catheter-days for conventional PICC to 1.3 per 1000 catheter-days for tunnelled PICC. The mean time to infection
development for tunnelled PICC (24 days) was longer than those observed with conventional PICC (19 days).
Tunnelled PICC has also increased the mean catheter dwell time from 27 days (for conventional PICC) to 47
days. Tunnelling a PICC has the potential to reduce the infection rate while increase the catheter dwell time.
The study was taken to assess the feasibility of diffusion-weighted imaging (DWI) and apparent diffusion
coefficient (ADC) mapping using different b-values for magnetic resonance-guided focused ultrasound (MRgFUS)
treatment of uterine fibroid and adenomyoma.
The contrast-enhanced T1-weighted image (cT1WI) as well as DWIs and ADC maps of different b-values (i.e.
200, 600 and 800 s/mm²) were obtained from nine fibroid and five adenomyoma patients, immediately after,
and 12 months after MRgFUS treatment. The image contrast score, non-perfused volume (NPV) and NPV
ratio obtained were compared to determine the feasibility of DWI and ADC mapping for MRgFUS treatment
outcome evaluation.
Our finding showed that immediately after MRgFUS treatment, the DWI acquired using 200 s/mm² b-value
gave the highest image contrast score among all other b-values. The NPV calculated from DWI of 200 s/
mm² showed the best correlation (R² = 0.938) with post-contrast NPV. At 12 months follow-up, there was no
specific b-value considered as significantly superior to others in terms of image contrast. However, the NPVs
and NPV ratios obtained from all DWIs and ADC maps of different b-values were in good agreement with the
post-contrast NPV and NPV ratio.
We observed that the DWI, particularly obtained with a low b-value (i.e. 200 s/mm²), is feasible for delineation
and quantitative volumetric evaluation of the ablated region immediately after the MRgFUS treatment. At 12
months follow-up, both DWIs and ADC maps are feasible for NPV and NPV ratio calculation.
The positive response to tamoxifen in ERa-positive breast cancer patients is usually of a short duration as many
of the patients eventually develop resistance. Our preliminary results show that aloe emodin extracted from
the leaves of the Aloe barbadensis Miller demonstrated a cytotoxicity that is selective to ERa-positive breast
cancer cells (MCF-7), but not to ERa-negative breast cancer cells (MDA-MB-231) and to the control cells (MCF-
10A). The objective of this study was to test the hypothesis that aloe emodin may enhance the response of
MCF-7 cells to treatment with tamoxifen. MCF-7 cells were treated with aloe emodin alone, tamoxifen alone
or a combination of emodin and tamoxifen, at their respective IC50 concentrations and at different time points
of 24 hours, 48 hours and 72 hours. The respective IC50s were the concentrations of aloe emodin and tamoxifen
required to achieve 50% inhibition of the cells in the study. Cell viability and apoptosis were determined using
trypan blue exclusion and DNA fragmentation assays, respectively. The involvement of RAS/MEKs/ERKs genes
of MAPK signalling pathways with aloe emodin was determined using QuantiGene 2.0 Plex assay. Data was
evaluated using the one-way ANOVA test. Our findings showed that aloe emodin enhanced the cytotoxicity of
tamoxifen on MCF-7 cells through apoptosis by downregulation of MEK1/2 genes. Our research may provide a
rational basis for further in vivo studies to verify the efficacy of a combination of aloe emodin and tamoxifen
on the viability of ERa-positive-breast cancer cells.
Background:
Prevention of hypothermia in patients undergoing major posterior approach spinal surgery can be difficult, as a
large body surface is exposed to the cold environment of the operating theatre. We compared the efficacy of a
new under-body forced-air warming blanket with that of a resistive heating blanket in preventing hypothermia.
Methods:
Sixty patients undergoing major posterior approach spinal surgery lasting for more than 2 hours were randomly
assigned to warming with a full under-body forced-air warming blanket or three segments of resistive heating
blankets, both set at 42°C. The ambient temperature was kept near 20°C. Nasopharyngeal, rectal and axillary
temperatures were measured at regular intervals. Changes in core temperature (average of nasopharyngeal
and rectal) over time were compared by the independent t-test.
Results:
The characteristics of the patients were comparable. The baseline core temperature was 36.36 ±0.38°C in the
forced-air group and 36.27 ± 0.46°C in the resistive heating group. During the first hour, the core temperature
decreased similarly from baseline in both groups. From 100 minutes after induction until the end of the surgery,
core temperature rose in both groups. At the end of surgery, the core temperature was increased by 0.08
± 0.09°C from baseline in the forced-air group but decreased by 0.40 ±0.04°C from baseline in the resistive
heating group. The difference in the change of the core temperature, at the end of the surgery, between the
two groups is statistically significant (P
Typhoid fever is a systemic infection caused by Salmonella typhi, which may be associated with extra-intestinal
complications. Neurological manifestations, particularly Parkinsonism, are rarely reported. We report a
17-year-old patient with relapsed culture-proven Salmonella typhi infection who developed septic shock and
subsequently Parkinsonism. Lumbar puncture revealed acellular cerebrospinal fluid with raised protein level.
Magnetic resonance imaging revealed cerebral petechial haemorrhages resulted from small vessels vasculitis.
His symptoms resolved spontaneously after 3 months.
Background: Kangaroo mother care (KMC) in low birth weight newborns has been found to be beneficial, but
studies have shown that maternal factors might be of concern in the successful application of KMC.
Aim: To study the influence of maternal factors on growth parameters in low-birth-weight babies with KMC.
Methods: This is a prospective cohort study of 40 low birth weight newborns in our institutions. We randomly
assigned the newborns to the group which received KMC and to the group which received conventional care.
Maternal factors were recorded. We measured weight, length, and head circumferences of newborns daily
for thirty days. Data was processed by SPSS x22.0.
Results: A total of 40 newborns were recruited into the study. Weight parameters were significantly higher
in the KMC group than in the conventional group except for the Z scores. Regarding maternal characteristics,
only gestational age was found to influence the initial and the last head circumference (p=0.035). There were
no differences in maternal age, parity, maternal education, mode of delivery, fetal sex, and initial Apgar score
with any of the growth parameters.
Conclusion: There were no maternal and fetal differences in the growth parameters of the groups, except in
the delayed growth of head circumferences in preterm infants.
Keywords: Growth parameters, KMC method, low birth weight
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.
Background:
Familial hypercholesterolaemia (FH) is one of the most frequent inherited metabolic disorders that can lead
to a risk of premature cardiovascular disease. Publications on FH are mainly from western patients as there is
little research on Asians, including Malaysians. The aim of this review is to provide an up-to- date information
on Malaysian studies on FH genotyping and its relation to the phenotype of the affected patients.
Method:
A search was conducted for data from online databases on FH in Malaysia.
Results:
The mutation spectrum for FH among Malaysian patients was extremely broad. The gene variants were located
mainly in the low-density lipoprotein receptor (LDLR) and apolipoprotein B-100 (APOB-100) genes rather than
in the proprotein convertase subtilisin kexin type 9 (PCSK9) gene. The exon 9 and 14 were the hotspots in the
LDLR gene. The most frequent mutation was p.Cys255Ser, at 12.5%, followed by p.Arg471Gly, at 11%, and the
most common single nucleotide polymorphism (SNP) was c.1060+7 T>C at 11.7%. The LDLR gene variants were
more common compared to the APOB-100 gene variants, while variants in the PCSK9 gene were very few.
Phenotype-genotype associations were identified. Subjects with LDLR and APOB-100 genes mutations had a
higher frequency of cardiovascular disease, a family history of hyperlipidaemia and tendon xanthoma and a
higher low-density lipoprotein cholesterol (LDL-C) level than non-carriers.
Conclusion:
Research on Malaysian familial hypercholesterolaemic patients by individual groups is encouraging. However,
more extensive molecular studies on FH on a national scale, with a screening of the disease-causing mutations
together with a comprehensive genotype-phenotype association study, can lead to a better outcome for
patients with the disease.
Glaucoma is a common eye disease that can cause irreversible damage if left undiagnosed and untreated. It is one of the most common neurodegenerative diseases causing blindness. Pre-clinical studies have been carried out on animal models of glaucoma for stem cell therapy. We carried out a systematic review to determine whether stem cell therapy had the potential to treat glaucoma. Nine studies were selected based on the predetermined inclusion and exclusion criteria. Of these nine studies, eight focused on neuroprotection conferred by stem cells, and the remaining one on neuroregeneration. Results from these studies showed that there was a potential in stem cell based therapy in treating glaucoma, especially regarding neuroprotection via neurotrophic factors. The studies revealed that a brain-derived neurotrophic factor expressed by stem cells promoted the survival of retinal ganglion cells in murine glaucoma models. The transplanted cells survived without any side effects. While these studies proved that stem cells provided neuroprotection in glaucoma, improvement of vision could not be determined. Clinical studies would be required to determine whether the protection of RGC correlated with improvement in visual function. Furthermore, these murine studies could not be translated into clinical therapy due to the heterogeneity of the experimental methods and the
use of different cell lines. In conclusion, the use of stem cells in the clinical therapy of glaucoma will be an important step in the future as it will transform present-day treatment with the hope of restoring sight to patients with glaucoma.
Introduction:
Living donation is an important source for organs transplantation in Malaysia. This study aims to investigate
the Malaysian living donors’ follow-up attendance, their preferences on medical-institutional facilities, and
the financial circumstances pertaining to the follow-up costs
Materials and Methods:
Primary data were collected through a survey of 80 living donors who made their donation at the University
of Malaya Medical Center (UMMC) between 1991 and 2012.
Results:
Out total of 178 donors, only 111 were reachable and 80 of them participated in the survey (72%). The findings
revealed that most of the donors (71.2%) attend the follow-up regularly. Nevertheless, donors seem to neglect
the importance of follow-up as they consider themselves healthy (28.9%) or consider the follow-up as being
troublesome (28.9%). Most donors (67.5%) are not in favour of being treated as patients, but prefer to be
monitored under donor registry (88.8%) and getting their health service in special clinics for donors (80%).
The majority of the donors fund the follow-up costs themselves (32.4%), while 25% of the donors’ follow-up
costs were funded by family members. Among those donors without income and those of low-income (84.8%
of respondents), 60.3% believe that the follow-up costs should be borne by the government.
Conclusions:
Based on the findings, it is therefore suggested that the government provides all living donors with proper
free health service through donor registry and donor clinics. Adequate care has to be given to the donors to
pre-empt any unforeseen health complications due to the organ donation surgical procedures.