Acanthamoeba is a free-living protozoa which causes serious ocular problem. Acanthamoeba keratitis is becoming more prevalent amongst contact lens wearers and it can cause loss of vision and blindness if not treated properly. The objective of this research is to determine the effectiveness of gentamicin against six Acanthamoeba spp. isolates, of which three were clinical isolates (HS 6, HKL 95, HTH 73) and three environmental isolates (SMAL 7, SMAL 8, TTT 9). Cyst suspension from the chosen isolates were exposed to gentamicin. After 48 hours of incubation at temperature of 30°C and 37oC, each mixture was filtered and filtration membrane was put onto non-nutrient agar laid with Escherichia coli. The agar plates were incubated for three days at 30oC and 37oC and the plates were examined daily until day 14 to look for the presence of Acanthamoeba trophozoites under inverted microscope. The presence of trophozoites indicated the ineffectiveness of gentamicin. Gentamicin was found to be effective against Acanthamoeba cysts from all the test strains at both incubation temperatures. The minimum cysticidal concentration (MCC) mean value of gentamicin was 0.193 mg/mL at 30oC and 0.229 mg/mL at 37oC. So, we concluded that gentamicin has cysticidal potential towards Acanthamoeba.
Beta (β)- thalassaemia is a public health problem in Malaysia. The carrier rate is estimated to be 4.5% by micro-mapping studies particularly among Malays who comprise 53.5% of the population in Malaysia. The common diagnostic method in Malaysia for mutation detection is by amplification refractory mutation system (ARMS). It allows single mutation detection in each reaction but is labour intensive and time consuming when many mutations need to be identified. The purpose of this study was to develop a diagnostic tool for effective mutation detection of beta thalassaemia in Malay patients and compare its efficacy with ARMS-PCR, the current method in use. Methods: Reverse dot blot hybridization (RDBH) technique was incorporated in the development of two strip assays [RDBH-Strip M(6) and RDBH-Strip C(6)] to identify common beta thalassaemia mutations in the Malays. The panels of selected mutations were based on the mutation frequencies in Malaysia reported in previous studies. RDBH-Strip M(6) was applied as step 1 and RDBH-Strip C(6) was applied as step 2 for unidentified mutations. The strips were validated with the gold standard method, ARMS- PCR. Results: One hundred and thirty seven Malay patients with 274 alleles were studied. In Step 1 mutation detection, 238 alleles (86.9%) were identified in 119 of patients by RDBH-Strip M(6). Step 2 resulted in a further detection of 20 alleles in another 10 patients by RDBH-Strip C(6). The combination of both strips resulted in the identification of 258 alleles in 129 (94.6%) of 137 Malay patients. The strip assays were 100% sensitive and specific when compared with ARMS-PCR method. Conclusion: Two strip assays utilising the RDBH technique were developed to identify common β-thalassaemia mutations in Malays. The RDBH Strip M(6) identified 86.9% of the mutations and the RDBH-Strip C (6) detected further 7.3% alleles. This two step strategy was found to be rapid and cost effective for the direct diagnosis of β-thalassaemia mutations in the Malays. The remaining unidentified mutations would require DNA sequencing. It can serve as a specific molecular diagnostic tool for effective diagnosis of
β-thalassaemia mutations in this ethnic group.
There are many inherent challenges in the evaluation and management of children with laryngotracheal disorders, and it differs widely from one institution to another. The main challenges include access to suitable equipment, fully trained surgeon and, cooperation with the anesthetist and pediatrician. Material & Methods: The aim of the study was to analyze the pediatric laryngotracheal cases undergoing endoscopic examination in Hospital Universiti Sains Malaysia. A retrospective review of 73 cases undergoing microlaryngoscopy and bronchoscopy from 2004 to 2008 was done. Results: Laryngomalacia was the commonest diagnosis. The majority of the cases (45.2 %) were referred because of noisy respiration. Other reasons for referral were foreign body inhalation, unresolved lung disease, failed extubation, examination prior to decannulation and hoarseness. Conclusion: Management of pediatric laryngotracheal cases were varied and tailored to each problem. The endoscopic examination must be meticulous. The management include observation, medical treatment, closed (endoscopic)
techniques and open surgery.
Human herpesvirus-6 (HHV-6) levels have been considered as markers for various diseases. The aim of this study was to evaluate the prevalence of HHV-6 infection in healthy adults in Malaysia. Methods: The level of HHV-6 in saliva was investigated in 36 healthy adults, age 19 to 23 years, at Kuala Lumpur, Malaysia using variant-specific TaqmanTM quantitative real-time PCR (qPCR). Results: The amount of HHV-6 DNA in the saliva of healthy adults ranged from negative to 10,000 HHV-6 genomes/ml of saliva (median, 360 genomes/ml of saliva). Of the 36 samples tested, 30 (83%) contained HHV-6 DNA. HHV-6B was the only variant detected in the saliva of all the positive cases. Conclusions: The detection of HHV-6 DNA in saliva by real-time PCR assay provides a sensitive and specific quantitation of HHV-6. Our pilot study suggests the wide prevalence of HHV-6 in saliva from
healthy adults.
We reported a young patient with myelodysplastic syndrome (MDS) with eosinophilia, in which her chromosomal analysis revealed the presence of trisomy X and a marker chromosome at chromosome 11. The technique used to detect the chromosomal abnormalities is a multicoloured –fluorescent in situ hybridization technique (M-FISH). Our observation suggested that these underlying chromosomal abnormalities were probably responsible for her development of MDS with eosinophilia.
Myelodysplastic syndrome (MDS) is a condition whereby there is ineffective production of haematopoietic stem cells and poor quality of cells produced. The cause can either be a primary bone marrow problem, de novo or therapy related. Most MDS cases are secondary rather than primary. Many chromosomal abnormalities have been found in cases of myelodysplastic syndrome. We described a case of MDS with eosinophilia in association with presence of trisomy X and a marker chromosome in chromosome 11.
A fish bone (foreign body) in the throat is a common presentation in an otolaryngology practice. Commonly the fish bone can be visualized and removed in a clinic setting. More distal foreign body impaction such as at the cricopharyngeus level will need direct laryngoscopy and removal under general anesthesia. It is not uncommon to have patient presented with residual symptom of post foreign body ingestion. Findings such as traumatized mucosa and embedded bone with slough on the mucosal surface are commonly encountered. We report a case of post foreign body ingestion presented with odynophagia and laryngoscopy showed a partially swollen epiglottis. The symptom recovered with conservative management.
Lightning strikes have been known to cause fatal injuries. However, these cases have not been adequately highlighted in Malaysia. This paper reports on three cases of military personnel who lost their lives after being struck by lightning while on operational duties. It is extremely important to implement adequate safety measures and ensure that all military personnel are adequately trained on emergency procedures, such as Cardio Pulmonary Resuscitation (CPR) to prevent casualties of lightning strikes in future. This paper addresses several issues to avoid similar occurrences; the importance of taking extra safety precautions and recognizing signs of lightning strikes, as well as the immediate administration of CPR on victims.
The objective of the study was to determine the proportion of sound HIV knowledge and common misconceptions about HIV among university students. A set of pre tested and validated questionnaire assessing sound HIV knowledge and common misconceptions about HIV was used in this cross sectional study. HIV knowledge was defined as sound when one was able to identify correctly two ways of preventing the sexual transmission of HIV and reject three major misconceptions about HIV. Out of 300 respondents, 298 completed the questionnaire giving a response rate of 99.3%. A total of 40.9% of university students have sound HIV knowledge. The majority of those who lacked sound HIV knowledge were young (60.2%) and female (60.4%). A significant proportion still believed that HIV can be transmitted via social contact (13.8%), by sneezing or coughing (11.4%) and mosquito bites (10.1%). About 6.7% were believed wrongly that HIV can be treated by vaccine and healthy-looking people cannot have HIV.
Study site: Universiti Putra Malaysia (UPM), Malaysia
Vitamin D plays an important role in maintaining the physical health as well as the performance of athletes. This cross-sectional analytical study was conducted to determine vitamin D intake, sun exposure and skin types of both indoor and outdoor Malaysian athletes in the National Sports Institute, Bukit Jalil. Method: A total of 28 indoor (badminton, shooting, wushu and fencing) and 36 outdoor (athletics, football and hockey) athletes were recruited for this study. The dietary vitamin D intake was estimated using Vitamin D-specific Food Frequency Questionnaire (FFQ). The Sun Exposure Index (SEI) was calculated from Seven-day Sun Exposure Record while the skin types of athletes were determined using Fitzpatrick Skin Typing Questionnaire. Results: The mean age of the athletes was 21.02±4.11 years and their mean Body Mass Index (BMI) was 22.20±2.22 kg/m2. The mean body fat percentage of outdoor athletes was significantly lower than indoor athletes (p
Globally, one person dies every six seconds as a result of tobacco use. This makes tobacco use the cause of every one out of 10 deaths in adults and the single largest and leading cause of preventable death in the world. The objective of this study was to determine the prevalence of smoking among staff of Universiti Putra Malaysia. For the purpose of this study an analytical cross sectional study design was used and a standardized, pre-tested, while a validated well-structured questionnaire was used for data collection. The prevalence of smoking was found to be 10.0% (26.5% among males and 0.5% among females). In addition, significant associations were found between smoking and gender, religion, marital status, highest educational level, occupation, and family income (p < 0.05). In particular, gender and educational level were significant predictors of smoking. In conclusion, the prevalence of smoking among university staff was shown to be considerably lower than that stated for the national level. However, the University could aim at achieving zero prevalence in the years to come.
Major Depressive Disorder (MDD) in gynaecological cancer patients is a disabling illness with significant mental and physical suffering. Determining the risk factors of MDD in cancer patients enables us to pay more attention to those who are vulnerable and to device effective strategies for prevention, early detection, and treatment. The objective of the study is to determine the prevalence of MDD and its associated risk factors in gynaecological cancer patients at Hospital Sultanah Bahiyah, Alor Star. This is a hospital-based cross-sectional descriptive study of 120 gynaecological cancer patients in Gynae-Oncology Unit in Hospital Sultanah Bahiyah, Alor Star. Mini International Neuropsychiatry Interview (MINI) was used for diagnosis of MDD. Socio-demographic data and clinical variables were collected. MVFSFI (Malay version Female Sexual Function Index) was used to determine sexual dysfunction, and WHOQOL-BREF (World Health Organization – Quality of Life-26) was performed to assess quality of life. The prevalence of MDD in gynaecological cancer patients in the study was 18%. The variables found to be significantly associated with MDD were lack of perceived social support, greater physical pain perception, presence of past psychiatric history, and poorer quality of life. Meanwhile, sexual dysfunction was not associated with MDD. Logistic regression analysis revealed that only the psychological health domain of QOL was significantly associated with MDD, and contributed to 60% of the variation in MDD. The prevalence of MDD in gynaecological cancer patients is higher than those in the general population. In view that MDD can compromise cancer prognosis and patient’s well-being, psychosocial intervention is recommended as a part of multi- disciplinary and comprehensive management of gynaecological cancer.
Clinical vampirism in psychiatric practice is very rare and usually associated with schizophrenia, antisocial personality disorder or paraphilia. An Asian case of clinical vampirism is described. It is about a 24-year-old Malay female, paramedic student, who craved for blood since childhood. She injured her sister and herself so that she could access and drink blood. There was no associated psychosis or medical problems. The craving for blood may represent her underlying craving for parental love and attention.
Management of Beta (β)-thalassaemia intermedia in contrast to β-thalassaemia major patients has no clear guidelines as to indicators of adequate transfusion. Regular blood transfusion suppresses bone marrow erythropoietic activity. Serum soluble transferrin receptor (sTfR) concentration is a marker for erythropoietic activity, with increased sTfR being associated with functional iron deficiency and increased erythropoietic activity. This study aimed to determine the use of sTfR as an indicator of adequate transfusion in adult β-thalassaemia intermedia patients. A cross-sectional study was conducted at Hospital Ampang, Malaysia, for six months. Patient group included six β-thalassaemia intermedia and 34 HbE-β-thalassaemia transfused patients. None of the patients were on regular monthly blood transfusions as in β-thalassaemia major. The control group comprised of 16 healthy subjects with normal haematological parameters. Haemoglobin (Hb) analysis, sTfR and ferritin assays were performed. Hb and HbA percentages (%) were found to be significantly lower in patients compared to the controls, while HbE%, HbF%, sTfR and ferritin were significantly higher in patients. An inverse relationship was found in the controls between HbF% with Hb (r = -0.515, p < 0.05) and HbA% (r = -0.534, p < 0.05). In patients, sTfR showed an inverse relationship with HbA% (r = -0.618, p = 0.000) and a positive correlation with HbE% (r = 0.418, p = 0.007) and HbF% (r = 0.469, p = 0.002). Multivariate analysis showed that HbA% (r = 2.875, p = 0.048), HbE% (r = 2.872, p = 0.020) and HbF% (r = 2.436, p = 0.013) best predicted sTfR independently in patients. Thus, sTfR is a useful marker for erythropoiesis. The elevated sTfR in these patients indicate that the transfusion regimen used was inadequate to suppress ineffective erythropoiesis. Hb levels may not be the best target for monitoring transfusion treatment in β-thalassaemia intermedia patients, but the use of sTfR is helpful in individualising transfusion regimens.
Cancer pain is a complex experience and is one of the most common and distressing symptom of breast cancer which affects patients’ functioning in daily activities, their quality of life (QOL), and mood. Yet, there is a great lack of data on breast cancer and pain in Malaysia.
Methods: A cross-sectional study using the Breast Cancer Patient Version of Quality of Life (QOL) Instrument (translated into Malay) and Depression Anxiety and Stress Scale (DASS) were conducted on 87 female breast cancer patients to investigate the impact of pain interference level on their quality of life and depressive level.
Results: The patients were divided into 4 groups based on their rating of how pain and aches have been a problem to them (i.e not a problem [n=18 (20.7%)], mild[n=29 (33.3%)], moderate [n=18 (20.7%)] and severe [n=22(25.3%). Pain and aches ware reported to be the most severe interference problems in QOL physical domain by patients (mean=5.8, SD=2.8), followed by fatigue (mean=6.0, SD=3.1) and sleep changes (mean=6.2, SD=3.5). Patients who reported that pain and aches had severely affected them showed significantly lower score on many aspects of quality of life (Fs > 5, p < 0.005; p < 0.0001) and patients reported pain was not a problem at all demonstrated highest score on all aspects of QOL. Patients with most severe pain interference level showed highest depressive score [F (3, 84) =3, p < 0.05].
Conclusion: The study underscores the impact of pain interference on patients’ quality of life and depressive level. The pain assessment deserves significant attention and therefore a comprehensive biopsychosocial assessment of pain to rule out any related underlying issues is warranted in the management of breast cancer to ensure appropriate intervention given to the patients.
As the sugar intake of Malaysians is one of the highest in the Asia Pacific region, we wanted to investigate how this high prevalence of ‘sweet tooth’ is influenced by biological determinants like age, gender, ethnicity and Body Mass Index (BMI). Therefore, this study was to determine the demographic and BMI differences of preference, intake frequency and craving of a list of sweet beverages and food among Malaysian subjects. Convenience sampling was performed around Kuala Lumpur, with informed consents, involving 367 multi-ethnic subjects (163 males, 204 females; 83 Malays, 201 Chinese, 83 Indians; 209 lean, 158 overweight). Demographics and anthropometric measurements were taken and questionnaire on the preference/frequency/craving of a list of 22 sweet food and beverages with a 7 point hedonic scale (from 1= very unpleasant/never/never crave to 7 = very pleasant/at least once a day/ always crave) was performed. Females significantly preferred more, took less frequently but had equal craving of sweet foods compared to males. Lean subjects and those
The National Health and Morbidity Survey 2011 was a nationally representative household survey of non-institutionalized Malaysian population who were residing in Malaysia for at least 2 weeks prior to data collection. The aim of the survey was to provide health related community–based data and information to support Ministry of Health, Malaysia, in reviewing health priorities, programme strategies and activities, and planning for allocation of resources. There were twelve research scopes included in the survey. The sample size was calculated based on the requirement for each scope. A two-stage stratified sampling was adopted in the survey. The methods for data collection were via the questionnaire, clinical examination, and biochemical analysis. Quality controls were also instituted to ensure collection of high quality data. The National Health and Morbidity Survey 2011 (NHMS 2011) adopted an appropriate methodology for a population survey and all the necessary steps were taken to ensure valid and reliable findings.
Study name: National Health and Morbidity Survey (NHMS-2011)
Maternal depression has been linked to the development of adolescents’ emotional and behavioural problems. The main objective of this study was to determine the association between maternal depressive disorders and externalizing and internalizing problems among their adolescent children. This was a cross-sectional, comparison study of 35 mothers with depression and their adolescents, matched with 35 healthy mothers and their adolescents as controls. The mothers completed Quick Inventory Depressive Symptomatology (QIDS) for assessment of current depression. The emotional and behavioural problems in the adolescents were assessed independently by the mothers and their adolescents off-springs using Child Behavioral Checklist (CBCL) and Youth Self-Report (YSR), respectively. SPSS version 12.0 was used for statistical analysis. The findings showed that adolescents who have mothers with depressive disorders had significantly higher scores of externalizing (mean difference = 4.686 + 10.887, p = 0.016) and total emotional and behavioural problems (mean difference = 10.171 + 23.007, p = 0.013) than controls. The cases also scored higher than the controls in the following CBCL syndrome scales: aggressive behaviour (mean difference = 3.200 + 6.773, p = 0.008), social problem (mean difference = 1.286 + 2.865, p = 0.012), and attention problem (mean difference = 1.543 + 4.435, p = 0.047). Mothers with depressive disorders reported that their adolescents have greater emotional and behavioural problems than the controls. The findings suggested a need for preventive strategies to curb problematic behaviour focusing on this vulnerable group.
Routine diagnosis of intestinal microsporidiosis in clinical diagnostic laboratories relies mostly on detection of microsporidial spores via special staining and microscopic techniques. This paper describes the comparative evaluation of Calcofluor White M2R method, with modified Gram-chromotrope Kinyoun method as the reference standard. One hundred and six stool samples were examined for the presence of microsporidial spores. Sensitivity, specificity, positive and negative predictive values of the Calcofluor White M2R method compared to the reference technique were 95.2%, 4.3%, 78.2% and 20.0%, respectively. The positive predictive value (PPV) was 78.2% and the negative predictive value (NPV) was 20.0%. Despite low specificity of the CFW method due to its ability to stain chitinous wall of microorganisms, the presence of distinct deep-blue horizontal or equitorial stripes in microsporidial spores in modified Gram-chromotrope Kinyoun would likely reduce the false positive results obtained in the Calcofluor White M2R. Hence, the simultaneous use of these two methods would give better performance and accuracy for the detection of microsporidial spores in patients with intestinal microsporidiosis.
In this paper, we report three cases of orbital rhabdomyosarcoma in different age groups with different histopathologic types. Case 1 is a 10-year old Malay boy who presented with painless proptosis of the left eye. Magnetic resonance imaging (MRI) showed soft tissue mass arising from the lateral rectus muscle. Tissue biopsy revealed rhabdomyosarcoma of embryonal type. Case 2 is a 32-year old Malay man who presented with a progressive left eye proptosis associated with pain and redness. Computed Tomography (CT) scan showed a retrobulbar mass extending medially in the left orbit. Meanwhile, biopsy showed rhabdomyosarcoma of pleomorphic type. Case 3 is a 67-year old Malay woman who presented with proptosis and fungating growth of left orbital region, epistaxis and nasal blockage. CT scan revealed an ill-defined mass filling up the left orbital cavity. Biopsy showed rhabdomyosarcoma of alveolar type. Rhabdomyosarcoma is the most common in childhood but it should be considered as a differential diagnosis of orbital tumours irrespective of age.
Cervico-aural [collaural fistula] fistula is rare and it accounts for less than 5% of branchial cleft anomalies. In this paper, we report one such case of a 9 year old girl who was presented to us with two discharging cutaneous openings on the right side; one in the floor of the external auditory canal and another in the neck at the junction of the upper 2/3rd and lower third of the sternomastoid muscle along its anterior border.