aerobic to anaerobic transition intensity is one of the most significant physiological variable in endurance sports. Scientists have explained the term in various ways, like, Lactate Threshold, Ventilatory Anaerobic Threshold, Onset of Blood Lactate Accumulation, Onset of Plasma Lactate Accumulation, Heart Rate Deflection Point and Maximum Lactate Steady State. But all of these have great role both in monitoring training schedule and in determining sports performance. Individuals endowed with the possibility to obtain a high oxygen uptake need to complement with rigorous training program in order to achieve maximal performance. If they engage in endurance events, they must also develop the ability to sustain a high fractional utilization of their maximal oxygen uptake (%VO(2) max) and become physiologically efficient in performing their activity. Anaerobic threshold is highly correlated to the distance running performance as compared to maximum aerobic capacity or VO(2) max, because sustaining a high fractional utilization of the VO(2) max for a long time delays the metabolic acidosis. Training at or little above the anaerobic threshold intensity improves both the aerobic capacity and anaerobic threshold level. Anaerobic Threshold can also be determined from the speed-heart rate relationship in the field situation, without undergoing sophisticated laboratory techniques. However, controversies also exist among scientists regarding its role in high performance sports.
In practice, asthmatic patients whose metered-dose inhaler (MDI) technique is inefficient are either corrected or changed to dry powder breath-actuated or spacer device that is easier to handle. Based on 'real life clinic circumstances', we studied 15 symptomatic asthmatic patients whose MDI techniques were inefficient that either received correction in their technique (n=9) or were changed to turbohaler (n=6). For comparison, we also studied a similar group of symptomatic asthmatic patients (n=6) with appropriate MDI techniques that were treated by doubling of inhaled corticosteroid (ICS) dose. After 4 weeks, FEV(1) and symptom scores in the turbohaler group was significantly improved from baseline but not in the corrected MDI group. The group whose ICS dose was doubled also showed significant improvement in symptom scores but not in FEV(1). We question the benefit gained by correcting MDI technique in some asthmatic patients compared to that of switching over to more user-friendly devices such as turbohaler. In our study, the improvement observed with turbohaler appears to be more than a mere doubling of drug delivery to the lungs and may relate to the recognized greater consistency of drug delivery by turbohaler compared to MDI device.
Rheumatic mitral stenosis is prevalent in this part of the world and it gives rise to wide array of manifestations. However, hoarseness of voice secondary to recurrent laryngeal nerve paralysis (Ortner's syndrome) is an uncommon manifestation. This case illustrates an uncommon presentation in a common disease. A 29-year-old lady presented with a 2-year history of hoarseness of voice. Physical examination revealed a mid-diastolic murmur and left vocal cord paralysis. Echocardiography confirmed mitral stenosis with pulmonary hypertension. She underwent percutaneous mitral balloon valvotomy in 1991 with return of normal speech after a few months. The recurrent laryngeal nerve paralysis is mainly due to the compression by an enlarged pulmonary artery as initially thought. This complication is rarely seen nowadays due to greater awareness of the disease and earlier intervention. With the advent of percutaneous transvenous mitral valvotomy in the nineties, effective non-surgical intervention is plausible.
Our purpose is to report on the epidemiological variables and their association with the results of the exercise tolerance test (ETT) in the series of patients referred for standard diagnostic ETT at Seremban Hospital during the year 2001. ETT is widely performed, but, in Malaysia, an analysis of the associations between the epidemiological data and the results of the ETT has not been presented. All patients referred for ETT at Seremban Hospital who underwent exercise treadmill tests for the year 2001 were taken as the study population. Demographic details and patients with established heart disease (i.e. prior coronary bypass surgery, myocardial infarction, or congestive heart failure) were noted. Clinical and ETT variables were collected retrospectively from the hospital records. Testing and data management were performed in a standardized fashion with a computer-assisted protocol. This study showed that there was no significant predictive epidemiological variable on the results of the ETT. However, it was found that there was statistically significant difference between the peak exercise time of males and females undergoing the ETT.
This study was done to determine the prevalence of dental anomalies and facial profile abnormality and its association with the non-syndromic cleft lip and palate (CLP) as compared to the non-cleft children. A comparative cross sectional study was conducted where the case group consist of 98 non-syndromic CLP children-unilateral (UCLP) and bilateral (BCLP) who attended the Combined Clinic at Kota Bharu Dental Clinic (KBDC) while the comparison group comprised of 109 non-cleft children who attended the outpatient clinic at KBDC. Their ages were between 3 to 12 years old. Clinical oral and facial profile examinations were carried out to look for dental anomalies (morphology, number and alignment of teeth) and facial profile abnormality. The prevalence of anomalies in morphology of teeth in CLP (24.5%) and non-cleft (10.1%), number of teeth in CLP (44.9%) and non-cleft (7.3%), mal-alignment in CLP (79.6%) and non-cleft (27.5%) and facial profile abnormality in CLP (26.5%) and non-cleft (9.1 %). There was a significant association between CLP and anomalies in morphology, number, mal-alignment and abnormality in facial profile; (p < 0.05). Therefore, there was a high prevalence and risk of dental anomalies and facial profile abnormality in the CLP children compared to the non-cleft children.
Children with bronchiolitis from Hospitals Universiti Sains Malaysia (HUSM) and Hospital Kota Bharu (HKB) were student using the Kristjansson Respiratory Score and the Wang Respiratory Score respectively. Saturation of oxygen (S(a)O(2)) was measured with a pulse-oximeter while the child is breathing room-air. Two observers assessed the respiratory scores in all children independently. The correlation between respiratory scores and S(a)O(2) was assessed using Spearman's Rho, and the inter-rater reliability of respiratory scores determined using intraclasscorelation coefficient. There were 29 children in HUSM and 25 from HKB with a median age of 8 months (IQR 4.5 months) and 9 months(IQR 7 months) respectively. In HUSM, the median Kristjansson Respiratory Score for both observers was 4 (IQR 2), and the median S(a)O(2) was 96% (IQR 3%). The correlation coefficient between the Kristjansson Respiratory Score and S(a)O(2) for the first observer was - 0.75 (p <0.001), and for the second observer -0.73 (p <0.001). In HKB, the median Wang Respiratory Score was also similar for both observers (median 4 IQR 4.5), and the median (IQR) for S(a)O(2) was 96% (2%). The correlation coefficient between the Wang Respiratory Score and S(a)O(2) for the first observer was -0.41 (p = 0.04) and for the second observer -0.43 (p = 0.03). The inter-rater reliability between the first and second observer was high for both the Kristjansson Respiratory (ICC 0.89) and the Wang Respiratory Scores (ICC 0.99). In conclusion the validity of the Kristjansson Respiratory Score was high whereas the validity of the Wang Respiratory Score was moderate in the assessment of the severity of acute bronchiolitis. Both respiratory scores and physical signs showed high agreement between observers. The Kristjansson Respiratory Score should be considered for use by medical personnel in the assessment of the severity of acute bronchiolitis in children.
The Malay version of the Medical Outcome Study (MOS) Social Support Survey was validated among a sample of postpartum Malay women attending selected health centers in Kedah, North West of Peninsular Malaysia. 215 women between 4 to 12 weeks postpartum were recruited for the validation study. They were given questionnaires on socio-demography, the Malay-versions of the MOS Social Support Survey, Edinburgh Postnatal Depression Scale (EPDS) and the 21-items Beck Depression Inventory-II (BDI-II). 30 of the women, who were bilingual, were also given the original English version of the instrument. A week later, these women were again given the Malay version of the MOS Social Support Survey. The scale displayed good internal consistency (Cronbach's alpha = 0.93), parallel form reliability (0.98) and test-retest reliability (0.97) (Spearman's rho; p<0.01). The negative correlations of the overall support index (total social support measure) with the Malay versions of EPDS and BDI-II confirmed its validity. Extraction method of the 19 items (item 2 to item 20) from the MOS Social Support Survey using principle axis factoring with direct oblimin rotation converged into 3 dimensions of functional social support (informational, affectionate / positive social interaction and instrumental support) with reliability coefficients of 0.91, 0.83 and 0.75 respectively. The overall support index also displayed low but significant correlations with item 1 which represents a single measure of structural social support in the instrument (p <0.01). The Malay version of the MOS Social Support Survey demonstrated good psychometric properties in measuring social support among a sample of Malay postpartum Malay women attending selected health centers in Kedah, North West of Peninsular Malaysia and it could be used as a simple instrument in primary care settings.
Increased international collaboration in clinical trials has created a need for cross culturally valid instruments to assess the quality of life and behavioural disorders. Cross cultural studies of depressive symptomatology, in particular, must be preceded by an exhaustive study of the psychometric properties of the instruments to ensure the validity of the comparison. In this article, we examined the validity, reliability and factor structure of the Malay version of the Beck Depression Inventory II (BDI-II) among Malay postpartum women attending selected health centres in Kedah, North West of Peninsular Malaysia. Our findings indicated that the current version of the BDI-II is psychometrically strong and appropriate for use in assessing depressive symptomatology among this group of women.
Schizophrenia is a complex biological disorder with multifactorial mode of transmission where non-genetic determinants are also play important role. It is now clear that it involves combined effect of many genes, each conferring a small increase in liability to the illness. Thus no causal disease genes or single gene of major effects, only susceptible genes are operating. Given this complexity, it comes as no surprise of the difficulty to find susceptible genes. However, schizophrenia genes have been found at last. Recent studies on molecular genetics of schizophrenia which focused on positional and functional candidate genes postulated to be associated with schizophrenia are beginning to produce findings of great interest. These include neuregulin (NRG-1, 8p12-21), dysbindin, (DTNBP1,6p22.3), G72 (13q34) / D-amino acid oxidase (DAAO,12q24), proline dehydrogenase (PRODH-2, 22q11.21), catechol-O-methyltransferase (COMT, 22q11.21), regulator of G protein signaling (RGS-4), 5HT2A and dopamine D3 receptor (DRD3). Applications of microarrays methods were able to locate positional candidate genes related to dopaminergic, serotonergic and glutamatergic neurotransmission. New genome scan project, seen in the light of previous scans, provide support for schizophrenia candidate region on chromosome 1q, 2q, 5q, 6p, 8p, 10p, 13q,15q and 22q. Other reports described including the application of LD mapping and positional cloning technique, microarray technology and efforts to develop quantitative phenotype. More exciting finding is expected in near future with the completion of Hap Map project.
Many published studies that examined the effect of lead exposure on neurobehavioral performances were conducted in confined manufacturing environment with low to moderate blood lead levels as a marker of exposure. This study was conducted in a general environmental setting with very low exposure intensity and blood lead levels. The objective of the study was to determine the effect of very low blood lead levels (below 10 μg/dl) on the neurobehavioral performances of policemen in Kota Bharu, Kelantan. The study, conducted between August 25(th) and October 20(th) 2001, was cross-sectional in design and comprised of 89 policemen working in Kota Bharu district. The lead concentration of venous blood was determined using graphite furnace absorption spectrometer. We assessed neurobehavioral performances using the WHO Neurobehavioral Core Test Battery (NCTB). The mean blood lead concentration was 2.5 + 1.0 mg/dl. Among the seven tests performed, the positive effect of blood lead on Benton visual retention was not significant after controlling for the confounding effect of smoke-dose. This study suggested that very low blood lead levels have no significant effects on the neurobehavioral performances. Therefore, more studies with blood lead levels below the recommended environmental limit of 10 mg/dl, as recommended by Centers for Disease Control (CDC), be conducted in order to justify that limit.
The main aim of this study was to determine the medication errors among geriatrics at the outpatient pharmacy in a teaching hospital in Kelantan and the strategies to minimize the prevalence. A retrospective study was conducted that involved screening of prescription for a one-month period (March 2001). Only 15.35% (1601 prescription) of a total 10,429 prescriptions were for geriatrics. The prescriptions that were found to have medication errors was 403. Therefore, the prevalence of medication errors per day was approximately 20 cases. Generally, the errors between both genders were found to be comparable and to be the highest for Malays and at the age of 60-64 years old. Administrative errors was recorded to be the highest which included patient's particulars and validity of the prescriptions (70.22%) and drugs that available in HUSM (16.13%). Whereas the total of prescribing errors were low. Under prescribing errors were pharmaceutical error (0.99%) and clinical error (8.68%). Sixteen cases or 3.98% had more than 1 error. The highest prevalence went to geriatrics who received more than nine drugs (32.16%), geriatrics with more than 3 clinical diagnosis (10.06%), geriatrics who visited specialist clinics (37.52%) and treated by the specialists (31.07%). The estimated cost for the 403 medication errors in March was RM9,327 or RM301 per day that included the cost of drugs and humanistic cost. The projected cost of medication errors per year was RM 111,924. In conclusion, it is very clear that the role of pharmacist is very great in preventing and minimizing the medication errors beside the needs of correct prescription writing and other strategies by all of the heath care components.
Phytochemical studies on rhizome of Etlingera elatior have resulted in the isolation of 1,7-bis(4-hydroxyphenyl)-2,4,6-heptatrienone (1), demethoxycurcumin (2), 1,7-bis(4-hydroxyphenyl)-1,4,6-heptatrien-3-one (3), 16-hydroxylabda-8(17),11,13-trien-16,15-olide (4), stigmast-4-en-3-one (5), stigmast-4-ene-3,6-dione (6), stigmast-4-en-6b-ol-3-one (7), 5α,8α-epidioxyergosta-6,22-dien-3β-ol (8). 1 and 4 were new compounds. Compounds 5 and 7 displayed high antitumour-promoting activity. Ethyl acetate extract showed a very significant cytotoxic activity against CEM-SS and MCF-7 cell lines (4 μg/ml and 6.25 μg/ml respectively). The antitumour-promoting activity was determined by EBV-EA assay and cytotoxic activity was determined by MTT assay.
Perceived breathlessness played an important role in guiding treatment in asthma. We developed a simple, user-friendly method of scoring perception of dyspnoea (POD) using an incentive spirometer, Triflo II (Tyco Healthcare, Mansfield, USA) by means of repetitive inspiratory efforts achieved within three minutes in 175 normal healthy subjects and 158 asthmatic patients of mild (n=26), moderate (n=78) and severe (n=54). Severity was stratified according to GINA guideline. The mean POD index in normal subjects, and asthmatic patients of mild, moderate and severe severity were: 6 (4-7) 16 (9-23), 25 (14-37), and 57 (14-100) respectively (p<0.001 One-Way ANOVA). Based on 17 asthmatic and 20 normal healthy subjects, intraclass correlation coefficients for POD index within subjects were high. In 14 asthmatic patients randomized to receiving nebulised b(2)-agonist or saline in a crossover, double-blind study, % FEV(1) change correlated with % changes in POD index [r(s) -0.46, p=0.012]. Finally, when compared with 6-minutes walking test (6MWT) in an open label study, respiratory POD index correlated with walking POD index in 21 asthmatic patients [r(s)= 0.58 (0.17 to 0.81) (p=0.007] and 26 normal subjects [0.50 (0.13 to 0.75) (p=0.008)]. We concluded that this test is discriminative between asthmatic patients of varying severity and from normal subjects, is reproducible, responsive to bronchodilator effect, and comparable with 6MWT. Taken together, it has the potential to score disability and POD in asthma effectively and simply.
A 40-year-old man presented with floaters and painless progressive blurring of vision in the right eye for one month duration. Visual acuity in the right eye was 6/24. There was mild anterior chamber reaction and vitritis. The optic disc was swollen and elevated with presence of granulomatous lesion in the optic disc head. Blood investigations were unremarkable. Serum angiotensin converting enzyme (ACE) was normal and conjunctival biopsy showed presence of inflammatory cells. B-Scan ultrasound revealed an echo-dense lesion in the optic nerve head. There was increased uptake of the right lacrimal gland and presence of 'Panda sign' with Gallium scan. A diagnosis of right ocular sarcoidosis was made base on the clinical features and Gallium scan.
Stress tends to worsen the prognosis of patients with coronary heart disease. The aim of the study is to determine the relationship between stress related psychosocial factors like anxiety, depression and life events and temporally cardiac events specified as acute myocardial infarction and unstable angina 65 subjects with confirmed myocardial infarction or unstable angina were interviewed using 2 sets of questionnaire, the Hospital Anxiety and Depression Scale (HADS) and Life Changes Stress Test, a segment of the Rahe's Stress and Coping Inventory first at time of occurrence of their cardiac event and the second time was 6 months later. Anxiety, depression and life events scores were calculated for both and recurrence of cardiac event for the 6 month duration was also recorded. Patients who had significant levels of depression and or life events were ten times more likely to have recurrence of cardiac events as compared to those without risk for either of these psychological symptoms. Anxiety, depression and stress levels are significantly increased after the onset of ischemic heart disease and could be contributing or predisposing factors for the recurrence of cardiac events for these patients.
Even though extensive studies have been conducted on the effect of noise exposure on hearing apparatus / auditory system, information on the effect of noise on the other body functions is sparse. The present study examined the effect of exposure of albino rats to acute and chronic noise stress on two important interlaced endocrine levels. In acute experiments the animals were exposed to 120 dB noise for a duration of 1, 2, 3 hrs. In chronic experiments the animals were exposed to noise for one hour daily for 30, 60 and 90 days. Plasma corticosterone and leptin levels were measured in these animals. There was significant elevation in the levels of corticosterone and leptin after exposure to noise stress. The elevation in corticosterone level after noise stress is in agreement with earlier reports. So noise acts like a stressor and elevates the secretion of the corticosterone, the stress hormone and leptin, the product of the ob gene there is an elevation in leptin levels after noise stress.