Displaying publications 81 - 100 of 393 in total

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  1. Moy, F.M., Hoe, V.C.W., Tan, C.P.L., Rosmawati, M.
    JUMMEC, 2010;13(1):45-49.
    MyJurnal
    Night work and rotating shift work are found to be detrimental to the health of workers. A cross sectional analytical study was conducted among the employees of a public medical centre in Kuala Lumpur. A total of 380 employees participated in the health screening and questionnaire survey. The majority of the respondents were Malays, females, and with mean age of 49 years old. The shift workers persistently had higher but non-significant proportions of being overweight/obesity and unhealthy clinical indicators such as systolic and diastolic blood pressure, fasting blood glucose and lipid profile except waist circumferences and HDL-cholesterol. There were also slightly more shift workers diagnosed with diabetes mellitus, hypertension or coronary heart disease (p>0.05). Although the present study could not provide established evidence for a relationship between shift work and cardiovascular risks, this could serve as a pilot study for future studies in this area.
  2. Yaakob, Z.H., Syed Tamin, S., Nik Zainal, N.H., Chee, K.H., Chong, W.P., Hashim, N.E., et al.
    JUMMEC, 2009;12(2):57-62.
    MyJurnal
    Current selection guideline for CRT uses broad QRS duration (>120 ms) as a marker for ventricular dyssynchrony. However, more recent data supports mechanical marker specifically measured by Tissue Doppler Imaging (TDI) as a better criterion to predict response to CRT. Sixty seven patients with significant left ventricular dysfunction (EF less than 40%) and narrow QRS complex were prospectively enrolled. They underwent Tissue Doppler Imaging (TDI) study to evaluate intraventricular mechanical dyssynchrony. Dyssynchrony index which is defined as standard deviation of time to peak systolic velocity in twelve ventricular segments was measured. A value greater than 32.6 is taken to reflect significant ventricular dyssynchrony. Overall 38 patients (56.7%) demonstrated significant dyssynchrony. There was no significant correlation between QRS duration and the Ts-SD-12 (r = 0.14, p = 0.11). Ventricular mechanical dyssynchrony is common in patients with normal QRS duration. Therefore, QRS duration alone will miss a substantial proportion of suitable patients for CRT and therefore deny them this adjunct therapy. We propose echocardiographic parameters, specifically TDI, to be included in patient selection criteria for CRT.
  3. Loh, S.Y.
    JUMMEC, 2009;12(1):31-34.
    MyJurnal
    In a clinical controlled trial involving repeated measures of continuous outcomes such as quality of life, distress, pain, activity level at baseline and after treatment, the possibilities of analyzing these outcomes can be numerous with quite varied findings. This paper examined four methods of statistical analysis using data from an outcome study of a clinical controlled trial to contrast the statistical power on those with baseline adjustment. In this study, data from a CCT with women with breast cancer were utilized. The experiment (n=67) and control (n=74) were about equal ratio. Four method of analysis were utilized, two using ANOVA for repeated measures and two using ANCOVA. The multivariate between subjects of the combined dependents variables and the univariate between subjects test were examined to make a judgement of the statistical power of each method. The results showed that ANCOVA has the highest statistical power. ANOVA using raw data is the least power and is the worst method with no evidence of an intervention effect even when the treatment by time interaction is statistically significant. In conclusion, ANOVA using raw data is the worst method with the least power whilst ANCOVA using baseline as covariate has the highest statistical power to detect a treatment effect other than method. The second best method as shown in this study was in using change scores of the repeated measures.
  4. Chuah, U.C., Kamarul, T., Sara, T.
    JUMMEC, 2006;9(2):28-31.
    MyJurnal
    Squamous cell carcinoma of the tongue is a highly malignant condition and results in high mortality and morbidity in patients despite its early detection (1). Early surgical interventions have been found to reduce mortality but in many reports, tongue reconstructions using live grafts have been found to reduce normal tongue function of speech, swallow and taste. In contrast, our report using free radial forearm flap (FRFF) to reconstruct the defect left over after a radical tongue resection in a 38-year-old gentleman with oral cancer has shown promising results. This type of reconstruction has left the patient with a functional and cosmetically acceptable tongue with minimal alteration in recognizable speech.
  5. Ng, Christina
    JUMMEC, 2010;13(1):19-23.
    MyJurnal
    The clinical experience of the novel drug temsirolimus on eight patients with metastatic renal cell carcinoma and who were refractory to other forms of treatment is reported. Although none of the patients showed complete or partial response, three patients had stable disease. One patient was prematurely withdrawn due to pneumonitis. Five patients died during the period of observation of twenty months and the median survival time from start of treatment was ten months. Three patients showed no evidence of adverse events (AE). Five patients showed dyslipidemia and two had pneumonitis for which, the drug had to be withdrawn in one of them. None had significant leucopenia. We conclude that temsirolimus has activity even in heavily pretreated patients in advanced renal cell carcinoma and in addition, has the benefits of ease of administration and good tolerability.
  6. Loh, S.Y.
    JUMMEC, 2010;13(1):33-37.
    MyJurnal
    As women with breast cancer are living longer, issues beyond survivorship like the much neglected sexual functioning and issue of quality of life have become increasingly important. Experiences of significant alterations in sexual functioning need to be addressed. However, these sexual issues are often not acknowledged in our traditional medical model of health care delivery. This paper briefly reviews the changes in sexual functioning after a diagnosis of breast cancer, with implication for clinical practice and medical curicula.
  7. Rosmawati Mohamed, Low, Wah Yun
    JUMMEC, 2006;9(2):1-2.
    MyJurnal
    The year 2005 marked the rebirth of JUMMEC when the Editorial Board took over from its previous Editor with modest but realistic expectations. One year on, we have successfully achieved our initial expectation, that is, to encourage greater participation from our junior academics to write and publish in our very own journal, JUMMEC. As we head towards the end of 2006 and prepare to usher in 2007, we see JUMMEC consolidating and gaining in strength. Let us reflect on its past achievements and our expectations for the future.(Copied from article).
  8. How, S.H., Azlin, S., Pang, Y.K., Liam, C.K.
    JUMMEC, 2006;9(2):35-38.
    MyJurnal
    Lymphangioleiomyomatosis (LAM) is a rare disease. The reported prevalence is around one per million in the West but the exact prevalence in Asia is unknown. It affects primarily young women of reproductive age, with a mean age of onset at 34 years. The disease is characterised by an abnormal proliferation of smooth muscle-like cells that grow over a course of time to obstruct airways, lymphatic and blood vessels. We report a case of LAM in a young woman who presented with a spontaneous pneumothorax. Computed tomography scan of the thorax and abdomen showed homogenous thin-walled cystic lesions with normal intervening lung parenchyma and multiple lesions in her kidneys with Hounsfield units similar to that of fat.
  9. Sia, S.F., Dublin, N.
    JUMMEC, 2006;9(2):22-23.
    MyJurnal
    Anomalies of the genitourinary tract occur in approximately 10% of the population and account for about one third of all congenital malformations in children (1). Congenital malformations involving the genitourinary system are major therapeutic challenges faced by the practising urologist.
  10. Sia, S.F., Fong, E.P.
    JUMMEC, 2006;9(2):24-27.
    MyJurnal
    The treatment of large ulcers is a problem. Closure with flaps and even skin grafts in compromised patients is often fraught with risks. Dressing these large wounds is also a problem, as they are often heavily exudative. We report our experience using the vacuum-assisted closure technique in managing difficult ulcers in four patients. A modification of the technique using cheap, easily available materials is described. The vacuum-assisted suction is an effective treatment for large ulcers in compromised patients. It facilitates considerable contraction of the wound, and in smaller wounds; the vacuum-assisted closure allows sufficient contracture to enable delayed primary closure. We recommend the use of this method of wound dressing and closure in large wounds particularly, in high-risk patients where extensive flap coverage or even split skin graft would incur considerable risk.
  11. Tengku Kamalden, T.A., Choo, M.M., Fauzi, A.
    JUMMEC, 2006;9(2):32-34.
    MyJurnal
    Malignant hypertension affects less than 1% of people with high blood pressure, and is a hypertensive emergency. It is rare for patients to present initially with this form of elevated blood pressure, which is almost always associated with acute target organ damage, which can manifest in many forms including ocular, neurological, cardiac and renal. This treatable condition is associated with a high rate of morbidity and mortality therefore, early detection and immediate management is of paramount importance.
  12. Nor Zuraida, Z., Ng, C.G.
    JUMMEC, 2010;13(1):12-18.
    MyJurnal
    Distress has become a major issue in cancer population. Patients may suffer from either physical,psychological distress or both. Cancer patients who are undergoing chemotherapy are more likely to experience psychological distress. This could be due to the negative effects of chemotherapy agents, the uncertainty of post-treatment, and the occurrence of psychosocial problems. As a result, the patient may experience a normal reaction such as sadness or may develop common psychiatric disorders such as depression and anxiety.
  13. Nazatul, S.B., Ruby, H.
    JUMMEC, 2009;12(2):70-73.
    MyJurnal
    The exclusive breastfeeding rate in Malaysia is very low. However in recent years the awareness of breastfeeding among mothers has increased. A preliminary qualitative research was carried out on these motivated mothers. The objective of this study was to understand the challenges encountered by breastfeeding mothers and to explore the support and motivation received by them. Information from the motivated mothers was obtained from focus group discussion. Some obstacles faced by the mothers were lack of knowledge on breastfeeding and lack of support from health professionals, parents and siblings. Facilities to express breast milk while at work were not readily available. The main motivation to breastfeed came from the mother herself and support from the husband. A holistic approach must be used to help mothers to continue breastfeeding. This includes breastfeeding promotion and education, setting up more Baby Friendly Hospitals, availability of breastfeeding support groups and provision of enough breastfeeding facilities at work and public places.
  14. Parameswaran, M, Sivaprakasam, S., Dublin, N., Razack, A.H., Thun, T.H., Chua, C.B., et al.
    JUMMEC, 2009;12(2):74-82.
    MyJurnal
    The aim of this study was to validate the translation of the Overactive Bladder (OAB) Screener (OAB V8) to the Malay language. It was to assess the reliability of the screener in the context of a Malaysian population. The original screener consists of eight symptoms indicative of OAB that has been proven to be highly sensitive and reliable. Translation was done with a modification of the Brislin Method using back translation and a panel of experts as a final review panel. The pilot study had two groups; a symptomatic (n=19 patients) and an asymptomatic group (n=18 patients). All patients performed the test twice at two week intervals once at the clinic and subsequently at home. Test-retest method was used for reliability and Cronbach's alpha for internal consistency. The translated questionnaire demonstrated good internal consistency in both groups of patients for all eight items individually and for the total score. Cronbach's alphas ranged from 0.972 to 0.981 for the symptomatic group and from 0.750 to 0.976 for the asymptomatic group. Testretest correlation for all items was highly significant. Intraclass orrelation (ICC) was high for both the asymptomatic (ICC ranging from 0.600 to 0.953) and the symptomatic group (ranging from 0.944 to 0.989).The Malay OAB V8 showed itself to be suitable for use, reliable in distinguishing symptomatic and asymptomatic patients and a valid instrument.
  15. Mamat, M., Chan, L.
    JUMMEC, 2009;12(2):83-91.
    MyJurnal
    Patient safety is a serious global healthcare issue. Harm can be caused by a range of errors or adverse events. Therefore, it is vital that the commissioning of a new operating theatre should comply to the highest standard before it is allowed to function. This paper accounts our experience in the commissioning of the University Malaya Medical Centre (UMMC) trauma centre operating theatre(OT) complex in July 2008. We highlighted the problems we faced in adhering to the international standard guidelines. Unanticipated events were handled professionally and solved. With this experience, we hope that the identified problems would provide suggestions for commissioning an operating theatre in the local setting in the future.
  16. Marzida, M.
    JUMMEC, 2009;12(2):63-69.
    MyJurnal
    It is important to provide effective postoperative analgesia following a Caesarean section because mothers wish to be pain-free, mobile and alert while caring for their babies. The role of regular oral diclofenac as postoperative analgesia was evaluated in a randomized controlled study and it was compared to the established method of parenteral pethidine. Forty healthy women scheduled for elective Caesarean section under spinal anaesthesia with 2-2.5 mg of heavy bupivacaine 0.5% were randomized to receive either 75 mg of oral diclofenac twice daily or 1 mg/kg of subcutaneous pethidine every 8 hourly. Efficacy of pain relief (visual analogue score), patients' satisfaction and side effects such as sedation, nausea and vomiting were recorded for three days. The demographic variables were similar in both groups. Pain relief was adequate and comparable in both groups with similar mean visual analogue score during the second and third day of the study period. However, on the first postoperative day, 60% of the diclofenac group population required rescuemedication consisting of subcutaneous pethidine in order to achieve the same pain scores as those in the pethidine group who did not require any rescue medications. Women who received oral diclofenac reported lower sedation and higher overall satisfaction. The incidence of nausea and vomiting was similar in both groups. This concluded that although oral diclofenac 75mg twice daily may not be superior to the traditional method of subcutaneous pethidine for pain relief following caesarean section, it can still be used alone as an alternative, as it has other benefits of a non-opioid analgesia.
  17. Vijay AP, Chan SP
    JUMMEC, 2009;12(2):47-56.
    MyJurnal
    Achieving and maintaining good glycaemic control remains an important goal in the management of this common and prevalent disorder. Recent evidence from important megatrials, ACCORD, ADVANCE, VADT, UKPDS-10 year follow-up as well as the STENO-2 follow-up study, have cleared doubts concerning the benefits of targeting good glycaemic control. For the first time, we have the reassurance that macrovascular benefits can be realised from good glycaemic control. The legacy effect of prior good glucose control from the UKPDS-10 year follow-up, reinforces the results seen from the DCCT-EDIC (for Type 1 diabetes). The Intervention Phase of the UKPDS revealed benefits for reduction of microvascular complications, while it was only at the end of the Post-Trial Monitoring Phase where significant improvements in both micro and macrovascular outcomes were seen. The other three Trials assessing the effect of glycaemic control on cardiovascular outcomes, although largely negative for CV benefit, give valuable insight towards appropriate patient characteristics for which aggressive glucose control can and should be instituted. Individualising glycaemic targets, which has been the approach that many clinicians have been practising, has received new impetus albeit with clearer details. Getting to glycaemic goal early in the course of T2DM and Doing to Safely (Avoiding hypoglycaemia)are the key ingredients to successful management. The legacy of the memory of initial good metabolic/glycaemic control is investment in good health with benefits of reductions in both micro and more importantly, macrovascular disease, years later. Multifactorial interventions that include blood pressure, lipid lowering in addition to glucose control in these individuals with the Metabolic Syndrome result in more immediate beneficial additive effects on cardiovascular outcomes.
  18. Hematram, Y.
    JUMMEC, 2006;9(1):30-34.
    MyJurnal
    There has been a significant decline in maternal mortality in Malaysia since independence. The issue of measuring maternal mortality accurately is a problem in all countries. Another major problem is whether we can reduce the mortality further. The definition of maternal mortality includes two major components, which are causation of death and the time of death. To improve data collection on maternal deaths, we need to collect all data on maternal deaths, which are omitted or misclassified. Deaths from accidental causes that are not normally used in the calculations of maternal mortality need to be carefully reexamined to be excluded. The time of death means that in maternal mortality calculations, it includes up to six weeks after delivery, but recent World Health Organization (WHO) publication (ICD-10) suggests that the collection of maternal deaths even after six weeks should be reviewed because there are many maternal deaths which occur after six weeks. Measuring maternal mortality rate should be encouraged rather than maternal mortality ratio. Another measurement of maternal mortality is the lifetime risk of the women. The lifetime risk is the measure of maternal mortality that takes into account the probability of becoming pregnant and the probability of dying as a result of pregnancy. Many countries have started reporting the lifetime risk, which is considered to be better indicator to measure maternal health.
  19. Nadeem, S.R., Rina, K., Hamimah, H., Savithri, D.P.
    JUMMEC, 2006;9(1):14-19.
    MyJurnal
    A cross-sectional study of 109 patients with Pseudomonas aeruginosa bacteremia from the University of Malaya Medical Centre (UMMC) in the years 2000 and 2001 was conducted to describe epidemiological features, underlying diseases, possible source of infection, early mortality among patients as well as the antibiotic susceptibility pattern of patients' isolates. Further analysis of the 87 patient records that were available revealed that the mean age was 48.5 years (SD ± 25.1). Fifty-two per cent of cases were male and 48% female. Seventy-nine per cent of infections were nosocomially acquired, 33% of bacteremias were polymicrobial, 47% of patients had a continuous bladder drainage catheter (CBD) in situ, 33% had a central venous catheter (CVL) present at the time of bacteremia and 30% were ventilated. Sixty-eight per cent of patients had an underlying immunosuppressed state and 26% had undergone surgery involving general anesthesia in the week prior to isolating P. aeruginosa. Among the 23 patients with early mortality, 61% were on inappropriate antimicrobials. Most of the patients' isolates were sensitive to imipenem (86%), ciprofloxacin (81%), ceftazidime (79%), gentamicin (78%) and cefoperazone (77%). Among the community acquired strains, however, there was 100% sensitivity to imipenem, ceftazidime, cefoperazone and ciprofloxacin.
  20. Vijay AP, Lim SS, Tan ATB, Rokiah P, Chan SP
    JUMMEC, 2009;12(2):92-95.
    MyJurnal
    Antithyroid drugs have been used for more than 50 years for the management of hyperthyroidism. Most patients tolerate treatment well, but some may develop rare life threatening side effects such as agranulocytosis and aplastic anaemia. Clinical experience with the latter condition is extremely limited. We report on a case of carbimazole-induced aplastic anaemia caused by hypocellular bone marrow and associated plasmacytosis in a thyrotoxic patient chronically treated with carbimazole. This resolved after substitution with propylthiouracil. The clinical course was complicated by neutropaenic septicaemia and atrial fibrillation.
    Study site: University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
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