Introduction: Iron deficiency anaemia (IDA) is the most common cause of anaemia worldwide. Determination of body iron status is necessary to diagnose IDA. This can be measured using a biochemistry assessment of the serum/ plasma. Plasma/serum iron quantitation is also important in diagnosing iron overload disorders. However, iron studies are limited due to high cost and lack of access to biochemical analysers. Therefore, a cost- and technical-ef- fective method is needed to measure human plasma iron concentration. Plasma iron is mainly transferrin-bound and an acidic plasmic condition is necessary to release the iron. This study investigated various candidate acid salts to achieve the acidic condition needed for plasma iron release. Method: Ten powdered or crystallised acid salts were studied for their water solubility as well as their pH reduction capability in revised simulated body fluid (r-SBF) and commercially available human plasma without any change in colour or form. Results: Six acid salts studied were discontinued from further investigation because they were insoluble in water. Another two candidates were unsuitable as they precipitated in r-SBF and human plasma. Maleic acid formed a jelly-like texture after a certain amount of time in human plasma. Only citric acid met all the criteria of a suitable acid salt to be investigated further as part of the reagent for a spontaneous plasma iron measurement. Conclusion: Citric acid, which is a colourless and odourless acid salt, was selected to lower the human plasma pH to an acidic condition for transferrin-bound iron release.
Introduction: Chronic kidney disease is a public health problem in the world which is increasing every year. Hemo- dialysis is one of the methods commonly used for patients with end-stage chronic kidney disease. However, hemo- dialysis does not cure the disease and requires long term therapy. So, the patient's decision whether to undergo he- modialysis, is crucial. Methods: This study is aimed to identify the factors associated with decision making in patients with end-stage chronic kidney disease undergoing hemodialysis in the Bahteramas General Hospital of Southeast Sulawesi Province, Indonesia. This study is a descriptive-analytic study using a cross-sectional design to observe the relationship between patients' decision making for hemodialysis. Results: A total of 34 patients with end-stage chron- ic kidney disease were chosen by accidental sampling technique. Analysis of the data was done by the Chi-Square test. The results of this study showed that age, level of knowledge, and family support have a significant relationship with the patient's decision for hemodialysis. The distance of home and economic status showed no relationship with the patient's decision to undergo hemodialysis. Conclusion: Based on the results of this study it can be concluded that age, level of knowledge and family support is related to the patient's decision to hemodialysis in the Bahteramas General Hospital of Southeast Sulawesi Province.
Fat density lesions or masses arising from the mesentery are best imaged in Computed Tomography or Magnetic Res- onance Imaging scans. This a case of a 75 year old man who presented with intestinal obstructive symptoms. Urgent computed tomography scan was carried out which revealed a large mesenteric lipoma compressing the small bowel at the level of the jejunal loops. Small bowel obstruction can be due to intrinsic, extrinsic and intraluminal causes. Mesenteric lipomas are uncommon, thus torsion or twisting of the mesenteric lipoma causing intestinal obstruction is exceptionally rare.
Introduction: Human leukocyte antigens (HLA) are a group of unique transmembrane glycoproteins that are ex-pressed on the surface of virtually all types of cells within the human body. These molecules are encoded by a set of highly polymorphic gene sequences known also as the major histocompatibility complex (MHC) and play an essential role in the presentation of antigenic peptides to immune cells for recognition and response. In recent years, various HLA alleles have been found to be associated with different autoimmune and inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus (SLE) and allergic rhinitis. Identification of these alleles via HLA typing is necessary for initial screening and diagnosis purposes. Besides that, HLA typing is also used to determine compatibility matching between a donor and a recipient for tissue/organ transplantations in order to prevent graft rejection. Therefore, good quality and quantity of genomic DNA is required. In most scenarios, peripheral blood is chosen as the most reliable source of DNA for analysis, however this approach is seen as invasive and may cause pain and anxiety among the patients, particularly young children and weak subjects. Hence, derivation of genomic DNA from buccal cells as an alternative source material is becoming increasingly popular, especially in PCR-based genetic assays. Some of the most commonly described methods to collect buccal cells include using oral swabs, cytological brushes, mouthwashes and treated cards. Each technique yields varying quantities of DNA with diverse purity levels. In this study, we aim to evaluate the amount and purity of genomic DNA extracted from buccal swabs and brushes as well as blood for screening of selected HLA class II alleles. Methods: Cheek cell samples were col-lected using sterile foam tipped buccal swabs (Whatman) and buccal collection brushes (Gentra Puregene) whereas peripheral blood samples were withdrawn following routine venipuncture techniques. All samples were subjected to DNA extraction according to modified commercial kit protocols. Screening of selected HLA-DRB1 alleles was con-ducted via PCR with sequence-specific primers as established by Bunce et al. 1995. Results: There was no significant difference (p > 0.05) in the total DNA yield obtained from blood and buccal swab samples, which were 17.57μg (± 8.66) and 13.28μg (± 4.81), respectively. All samples exhibited similar 260/280 ratios of about ~1.80 (p > 0.05). However, buccal brush samples contributed the least amount of DNA (0.29μg, ± 0.12) compared to other sources (p < 0.05). The pure genomic DNA isolated from both blood and buccal swab samples were successfully typed for low resolution HLA-DRB1 alleles. Conclusion: Buccal swabs provide good quantity and quality of DNA for screening of HLA alleles with high accuracy and thus can be utilized as a non-invasive substitute for venipuncture.
Introduction: Alzheimer disease (AD) is the most widely recognised neurodegenerative disorder in the ageing population, characterised by progressive neuronal loss. The enhanced level of acetylcholine (ACh) in the human brain is another measure of identifying the progression of the disease. Increased acetylcholinesterase (AChE) level plays a fundamental role in the hydrolysis of Ach which worsens the cognitive function. Though there are several medications or drugs currently used in treating AD, their clinical implications remains debatable due to its adverse effects. Methods: In this study, the combined nutraceutical effect of natural plant compounds, piperine and curcumin were evaluated for acetylcholinesterase inhibitory assay using Ellman colourimetric method. Results: Results obtained from the study revealed that combined effects of natural plant compounds showed promising acetylcholinesterase inhibition activity with an IC50 of 104.1 ± 0.08 µg/mL compared to individually treated compounds, i.e., IC50 of curcumin = 134.5 ± 0.05 µg/mL and IC50 of piperine = 62.81 ± 0.00 µg/mL. Conclusion: The results suggest that the natural plant compounds taken in combination act as natural acetylcholinesterase inhibitors, and could be beneficial in the treatment of AD.
Introduction: Psychological problems like anxiety, depression and stress significantly exacerbate the pressure on stu- dents to perform better. These factors collectively hamper their performance leading to low academic achievement especially among postgraduate students who majority of them are working and married. This study aims to identify the level of depression, anxiety and stress among postgraduate students, and to investigate the correlation between depression, anxiety and stress based on gender, marital status and age. Methods: The study was a quantitative survey and correlational research design using a clustered random sampling, selected from all postgraduate students (179) in Faculty of Education. The DASS-21 was used as measuring tools for depression, anxiety and stress among post- graduate students. Results: Findings of the study revealed that majority of the respondents are having moderate level of depression, anxiety and stress. Meanwhile, there were strong correlations between depression, anxiety and stress. However, there were no significant differences for level of depression, anxiety and stress based on demographic factors (gender, marital status and age). Conclusion: Based on the findings, it can be concluded that depression, anx- iety and stress are strongly correlated. This study can give some insight to the educators, universities administration as well as students’ family to develop common intervention on how to curb depression, anxiety and stress among postgraduate students.
Introduction: Anaemia is a significant public health problem among adolescents globally but there is limited data in many countries, including Malaysia. This study aims to investigate the 5-years incidence of anemia among Malaysian adolescents by gender, ethnicity, locality of schools, Body Mass Index, stature and diet intake. Methods: A secondary analysis of existing data from MyHeART study was conducted within a closed cohort of 528 adolescents (aged 13 years) attended 15 public secondary schools from Kuala Lumpur, Selangor and Perak. The adolescents who were followed up at 15 and 17 years old had completed haemoglobin assessment, anthropometric measurements and -days diet history. The data was cleaned and missingness was handled accordingly with multiple imputation. SPSS Software version 21 was used to analyse the data, with Generalised Estimating Equation (GEE) showing the effect of time on the trajectory of prevalence of anaemia over the 5 years. Results: The prevalence or incidence? of anaemia in 2012, 2014 and 2016 was 7.9% (95%CI: 5.0-12.3), 13.9% (95%CI: 10.0-19.0) and 15.8% (95%CI:11.3-21.7). In females, anaemia increased from 11.1% (95%CI:6.7-18.7) to 15.7% (11.4-21.3) and 23.1%(95%CI: 16.8-31.0); the change was significant from 13 to 15 years old. Similar trend was noticed in those who are stunted, overweight/obese, in both urban/rural schools and didn’t meet their daily recommended nutrient intake for total calorie, protein and iron. Conclusion: Anaemia is increasing in trend among the adolescents over the years and deems attention from the relevant stakeholders to create a robust anemia prevention program.
Introduction: Family plays an important role in the development of an adolescent. Several theories postulate in-fluences of bully behaviours within family context. Persistent act of school bullying may lead to violence and eventually disruption of a normal adolescence mental health. This study was done to address whether family factors were associated with school bully perpetrator. Methods: This was a cross sectional study conducted among Form One students from twenty-five schools in Selangor. Parental and respondents’ consents were obtained prior to this research. Data was collected using a self-administered questionnaire comprising of sociodemographic data of the respondents, their family characteristics and parenting style. Cronbach alpha ranged from 0.70- 0.89. Data was analysed using SPSS v25. Ethical approval was obtained from the Ethics Committee for Research Involving Human Subject of Universiti Putra Malaysia (UPM). Results: Response rate was 92.7% with 1221 respondents. Majority of the respondents were females (62%), Malays (82.8%) and lived with married parents (91.2%). Prevalence of bully perpetrator was 12.8%. Parental marital status (p < 0.05), presence of substance abuse among family member (p < 0.05), presence of violence act among family member (p < 0.05), witnessing violence at home (p < 0.05), sibling violence (p < 0.05), presence of family hostility (p < 0.05) and permissive maternal parenting style ( p < 0.05) were associated with school bully perpetrators. Conclusion: This study showed the association between family factors and the development of school bully perpetrators. It is a strong message for parents, educators, policy makers and health providers to collaborate and redesign prevention programmes in an effort to contracept the birth of a school bully.
Introduction: Regular physical activity and VO2 max are correlated directly. Physical anthropometry physical ac-tivity, lung function and cardiac parameters such as systolic, diastolic blood pressure and resting heart rate are the important baseline parameters in relation to the a healthy life. In this study, a comprehensive determination of these parameters were planned among the common ethnicities of Sabah. This study in turn aims at making the sedentary people to make physically active and implicate a possible relationship between cardio-respiratory parameters with the physical activity levels. Methods: A total of 385 young adult Sabah, Malaysia college students with n=148 males and n= 237 females were randomly selected from the different colleges in Kota Kinabalu. Ethical clearance was received from Faculty of Medicine & Health Sciences UMS, and the participants were briefed on the procedures with their voluntary consent. IPAQ-Score/Met-Min/Week, BMI, resting heart rate, blood pressure, lung function parameters – forced vital capacity, peak expiratory flow rate etc were estimated by standard techniques. Data was analyzed, a regression analysis and ANOVA was performed to assess the relationship between independent and dependent variables. Results: Physical activity level has a significant correlation with the dependent variables of this study. VO2max is significantly and inversely related to body weight, BMI, blood pressure and pulse rate, whereas physical activity level is directly correlated. A weak positive correlation for VO2 max with lung function parameters.Conclusion: Physical activity, VO2 max and cardio-respiratory parameters; interdependently correlated and regular activity contributed to the rate of oxygen consumption.
Introduction: Doppler mode ultrasound is widely used in prenatal scanning and known to produce a higher acoustic
output which later leads to higher heat energy conversion compared to other ultrasound modes. It has been reported
that the use of Doppler imaging might increase the temperature of tissues, thus, when Doppler is used in combination with 2D ultrasound, the risks of bioeffects tend to increase more. It is also known that prolonged exposure to
ultrasound during pregnancy can cause irreversible biological destructions to the fetus. Despite the benefits of using
Doppler ultrasound, its potential adverse effects have received scant attention in the research literature. Therefore,
this study aimed to examine a correlation between gestational stages (GS) and newborn rabbit’s body weight at different prenatal Doppler ultrasound exposure durations. Methods: Twelve pregnant New Zealand white rabbits (NZWR)
were exposed once using three different Doppler ultrasound exposure durations (30, 60, 90 minutes exposure) at
three different GSs (1st, 2nd, and 3rd GS). After delivery, the mean weights of the 62 newborns were statistically analysed. Results: Strong negative and positive correlation between newborn’s body weight at different GSs and Doppler
ultrasound exposure durations with a significant result found in 60 minutes exposure (p =
Introduction: Delivering oral hygiene instruction is one of the integral parts of orthodontic treatment. However, there is scarce information regarding the impact of audiovisual method on knowledge retention among orthodontic patients. This study aimed to assess knowledge retention of the patient after instruction delivered in audiovisual (AV) method and compare it to the standard written and verbal (WV) method. Methods: This prospective clinical trial was conducted on 60 patients aged 13 to 40 years. They were randomized into the audiovisual group (n=30) and written & verbal group (n=30). Patients’ knowledge retention was measured using a self-administered questionnaire in Google form, immediately after instruction given as short-term retention and long-term retention for three time- point, i.e., 1-month, 3-month, and 6-month. Results: There was a significant improvement in knowledge for both AV and WV methods at immediate and 1-month assessment and the knowledge retained until 6-month follow up. The AV method demonstrated a significantly higher increase in knowledge retention at immediate and 1-month than the WV method. Conclusion: The AV method was significantly more effective in improving patient's knowledge reten- tion compared to the written & verbal methods. Repetition of instruction also influence the retention of knowledge.
ABSTRACTS FOR THE 1ST INTERNATIONAL BORNEO HEALTHCARE AND PUBLIC HEALTH CONFERENCE AND 4TH BORNEO TROPICAL MEDICINE AND INFECTIOUS DISEASE CONGRESS. New Frontiers in Health: Expecting the Unexpected. Held at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia. 3rd-5th September 2019
Introduction: Rice is classified as waxy, very low, low, intermediate and high based on its amylose content (AC). Most people prefer to consume intermediate AC rice because of its texture which tends to appear in between low (moist and sticky) and high (dry and less tender). Although rice with high AC appears dry and less tender, it usually possesses a low glycemic index (GI) i.e. a slower increase in blood glucose level after the consumption of food. Consequently, people with diabetes are recommended to eat low and intermediate GI foods. Although, rice is generally categorised as a high GI staple food there are some exceptions to it. For example, the premium Basmati aromatic rice possesses a low GI and is recommended for diabetic patients. The study aimed to identify Sabah’s traditional rice germplasm with low GI via AC that may be used as a replacement to commercial rice varieties.
Methods: A total of 110 traditional rice samples were obtained from rice fields located in the Tuaran and Kota Belud districts of Sabah. The AC in each sample was determined via I:KI method (ISO AACC-6647).
Results: We found that 46 (41.8%), 51 (46.4%), 7 (6.4%) and 6 (5.5%) Sabah’s traditional rice samples possess high, intermediate, low and very low AC, respectively. The intermediate AC type is predominant in Sabah’s traditional rice germplasm as it is the preferred rice texture by the general population. We have identified 46 rice germplasm with high AC type (i.e. with low GI value). The AC content in these is comparable to the Basmati rice and may be suitable candidates for diabetic patients.
Conclusion: The present study showed Sabah’s traditional rice germplasm has the potential to be promoted as a low GI rice cultivar based on AC for diabetic patients in order to prevent spikes in blood glucose levels while still enjoying the staple food
Introduction: Worm infection is one of the major global public health problems especially among rural communities.
Objectives: to determine the prevalence of intestinal worm infection and factors associated among Semai Aboriginal
children aged between 6 to 13 years in Tapah, Malaysia. Methods: A cross-sectional study design was used in this
study. The estimated sample size was 508. Data was collected using a validated pretested questionnaire. Faecal
samples were also examined. Data was analysed using SPSS version 22. Results: The response rate was 80.9%.
The overall mean age of the 411 respondents was 10.1 years(95% CI = 9.89, 10.22). Majority (71.5%) were poor.
Prevalence of intestinal worm infections was 60.8% and 57.2% had multiple infections. The multiple logistic
regression analysis showed that those with poor hygiene practices were 2.18 times the odds of worm infection
when compared with children with good hygiene practices (95% CI = 1.4, 3.4). Similarly, poor attitudes towards
prevention of worm infection increased the odds of having worm infection by 1.62 times among Orang Asli children.
Children living without toilets had 2.45 times higher odds as compared with those who had proper toilets. Absence
of river near by these areas where there is no safe water supply also increases the risk of worm infection among
children by 1.84 times among Orang Asli children. Conclusions: the prevalence of worm infection is still very
high among rural Aboriginal community. Current control measures should be reassessed to enable introduction of
effective measures to reduce the worm infection among Orang Asli children.
Introduction: Scarcity of data found in regard to association of vitamin D level with bone mineral density (BMD). Our study aimed to determine the correlation of vitamin D with BMD and intact parathyroid hormone (iPTH) among healthy Malay adult. Methods: This cross-sectional study recruited 126 healthy Malay volunteers (aged 21–45 years old) from Kota Bharu, Malaysia. Serum total calcium, albumin, phosphorus, 25-hydroxyvitamin D (25(OH)D), and iPTH were measured. BMD was assessed with dual energy X-ray absorptiometry (DXA) scan over left hip (right hip in case of problem with left hip) and lumbar spine (L1 – L4 vertebrae). Results: The mean serum 25(OH)D was 38.91
± 14.07 nmol/L. Out of 126 study subjects, 104 subjects (82.5%) had insufficient level of vitamin D (< 50 nmol/L). Mean hip and lumbar BMD were 0.952 ± 0.145 g/cm2 and 1.006 ± 0.133 g/cm2 respectively. According to T-score, 93 subjects (73.8%) had normal T-score of -1, 33 subjects (26.2%) had osteopenia (T-score -2.5 to -1) and none had osteoporosis (T-score -2.5). Significant positive correlation between serum 25(OH)D and hip BMD (r = 0.234, p = 0.009) was observed, but no correlation was found between serum 25(OH)D and lumbar BMD. Meanwhile, significant inverse correlation between serum 25(OH)D and iPTH was observed (r = -0.324, p < 0.001). Conclusion: High prevalence of vitamin D insufficiency was observed among healthy Malay population, but majority had normal bone density. Nonetheless, serum 25(OH)D was positively correlated with BMD and inversely correlated with iPTH. Our findings support the role of vitamin D for maintaining bone health.
Introduction: In the present scenario there are many qualified nursing human resources with flawless emotional personality but with errors in job accomplishment, lack of accuracy and delays in working completion, low working motivation, as well as careless and insincere working. The qualified nursing human resources must consist of nurses with a passion for work and with creativity. They must be proactive, with great deal of warmth and smiles. Based on the required nursing competences, it is found that the on-duty nurses should acquire several vital proficiencies such as leadership qualities, proper working procedures, interpersonal/soft skills, and environmental control. Soft skills may be developed and improved through various ways like trainings, modification of the environment, and with appropri- ate nursing education. Methods: The research population consists of 18 master's degree nursing students of a hospital divided into a control and experimental group (total sampling), and 47 on-duty nurses who are collected through a random sampling technique. Results: The results of the present study show that the implementation of transformation- al leadership model is effective to improve nurses' soft skills in terms of self-assurance, communication, compliance, teamwork, precision, discipline and problem solving. There were also noteworthy changes after the model imple- mentations based on 1st month and 2nd month and then on those at 1st month and 3rd month. Conclusion: The Soft Skills-Based Transformational leadership model is highly applicable in nursing care units of all hospitals to meet the challenges of the world in improving human resources by means of improvement of performance. With respect to soft skills and intrapersonal skills as well as the frequently neglected nurses' daily activities and portfolio worksheets are highly effective in dealing with the model applications.
Introduction: Diabetic foot ulcer (DFU) is the most distressing complication of diabetes mellitus and often associated with risk of non-traumatic lower extremity amputations. Available formulations and wound dressings for DFU treatment are unfortunately less effective both on controlling and healing DFU. Issues commonly found are associated with providing an optimum environment which facilitates healing process; moist environment, effective oxygen exchange, preventing infection, controlling exudate and also patients compliance. The challenge is therefore to develop a novel drug delivery which address this unmet medical need for better wound treatment of chronic and slow healing DFU. This study aimed to develop a biomaterial based nanofibrous wound dressing formulation containing deferoxamine (DFO), which reported as a potential therapeutic approach to improve wound healing. Deferoxamine regulates the expression and increase stability of hypoxia-inducible factor-1α (HIF-1 α), growthfactor that crucial in wound repair, and thus increase neovascularization. Preparation and characterization of chosen polymers; chitosan/ alginate/polyvinyl alcohol (PVA) for nanofiber formulation will be carried out. Such biodegradable polymer nanofiber is a great benefit for drug delivery owing to its high surface area to volume ratio and high porosity which creates ideal environment to aid in wound healing. Methods: Nanofibers loaded DFO will be fabricated by electrospinning
method that utilizes electrostatic force to produce fine fibers from the polymeric solution. Results: Various polymers concentrations and ratios are investigated to obtain the desired fibers characteristics. The selected optimized DFO nanofibers will be studied for its efficacy in wound healing through in-vivo animal studies. Conclusion: The proposed formulation would be an ideal low cost novel wound dressing with improved healing potential for efficient treatment
of diabetic foot ulcer.
Introduction: Lean healthcare outcome is usually measured with multiple key performance metrics but there is a lack of tools that enabled efficiency assessment. This research aimed to assess the efficiency among lean public emergen- cy departments (ED) through Slack-Based Measure Data Envelopment Analysis (SBM-DEA) and evaluate the impact of lean on the efficiency in public emergency departments. Methods: A retrospective observational study design using data on the number of support staff, number of doctors, number of discharge, arrival to consultant and length of stay. Efficiency scores of 20 Malaysian public EDs were computed using SBM-DEA modelling and compared be- tween before and after lean implementation. Results: A total of 13 out of 20 public EDs exhibited improvement in ar- rival to consultant and length of stay upon lean implementation. However, only 9 out of the 13 public EDs have had an improvement in efficiency score. Conclusion: Lean healthcare demonstrated a positive impact on the efficiency level of some public EDs. The SBM-DEA model offers the benchmarking capability and slack elimination information that may complement the lean continuous improvement philosophy.
Introduction: Dengue is caused by dengue virus (DENV) which is a member of the genus Flavivirus of the family Flaviviridae. The prevalence of dengue has been increasing all over the world especially in Southeast Asia and Western Pacific regions. In 2016 - 2017 dengue outbreaks were reported in Sandakan and Kudat of Sabah, Malay-sia. The aim of this study was to determine the serotypes of dengue viruses circulating in these two sites during the outbreaks. Methods: A total of 200 dengue patients’ sera tested positive with NS1 and IgM & IgG rapid test (PanBio) were collected from Hospital Duchess of Kent Sandakan and Hospital Kudat between June 2016 and December 2017. PCR was done at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah. One-Step Reverse transcriptase PCR (RT-PCR) and nested PCR was performed using C-prM amplimers designed by Lanciotti et al and later redesigned by Chien et al, followed by sequencing some of the PCR products. Results: Out of 200 sera tested 128 were PCR positive. All the four dengue serotypes were detected with PCR products with specific sizes in gel electrophoresis. However, in four samples, no serotype-specific band was amplified by the nested PCR, while they were dengue-positive in RT-PCR showing 511 base pair amplicon. Sequencing results revealed all four samples were found to belong to DENV4. The sequences of these samples were aligned with that of DENV 4 reverse primer rTS4. The DENV4 specific primer rTS4 was found to have four mismatched nucleotides to the DENV4 sequences. Conclusion: There was a co-circulation of DENV1 to 4 in Sandakan and Kudat in the study period. DENV1 was the predominant serotype. DENV4 specific C-prM primer rTS4 should be redesigned for the local DENV4 strain in Sabah in future research.
Leptospirosis has a wide range of presentation which ranges from mild flu-like symptoms, to severe form including renal failure, liver failure, and hemorrhage. Pulmonary involvement can progress from subtle clinical features to life threatening pulmonary hemorrhage and acute respiratory distress syndrome. Although benefits of corticosteroids in adult respiratory distress syndrome have been proven and accepted, evidence for use of corticosteroids in pulmonary leptospirosis is still limited. Given the vasculitic nature of severe leptospirosis, it has been proposed that addition of intravenous corticosteroid therapy, particularly in cases of pulmonary involvement is beneficial. We report a case of leptospirosis with suspected pulmonary hemorrhage which deteriorates after a few days of admission in our tertiary hospital. We have demonstrated that the prescription of a lower dose of corticosteroid than what was widely reported in the literature can equally led to a satisfactory recovery of the pulmonary hemorrhage.
A clinical descriptive study was done to determine the sociodemographic, laboratory and clinical characteristics of patients with congenital adrenal hyperplasia (CAH) referred to Hospital Putrajaya, a tertiary endocrine centre in Malaysia. Electronic laboratory data of 51 CAH patients were obtained. The demographics and clinical details of the study population were acquired from a questionnaire completed by parents of participants. There were 25 males (49%) and 26 females (51%), of which, 58.8% were Malays. Median age of participants was 4 years whilst median age at diagnosis of CAH was two years. Parental consanguinity was documented in three patients (5.9%). Patients originated from Johor (19.6%), Selangor (19.6%), Negeri Sembilan (17.6%) and Kedah (13.7%). Majority of patients were diagnosed after one week of life (80.4%) although more females were diagnosed under the age of one week compared to males (p=0.041). Most females presented with ambiguous genitalia (42.3%) [p=0.001] whereas 72% of males presented with salt wasting (p=0.003). No significant associations between race and all other variables, though interestingly three Malay patients presented with ambiguous genitalia and hypertension. Equal gender distribution noted as expected in an autosomal recessive condition, although not in keeping with other Asian countries. Early diagnosis in females attributed to obvious genital ambiguity at birth. Varied clinical presentation, although in minority, necessitates genetic studies for prompt diagnosis and treatment. Considering that majority of patients presented with salt wasting and the age at diagnosis was delayed, the introduction of a neonatal screening programme is essential in Malaysia.