Aim: To provide the first case series analysis for psoriatic arthritis (PsA) in Malaysia.
Methods: Patient records were studied from rheumatology clinics in Universiti Kebangsaan Malaysia Hospital and Putrajaya Hospital in Malaysia.
Results: Thirty-one patients from two rheumatology centres were studied. Thirteen patients (41.9%) were male and 18 patients (58.1%) were female. Nineteen patients (61.3%) were Malays, four (12.9%) were Chinese, seven (22.6%) were Indians and one (3.2%) was a Sikh. The majority of patients were in the >.50 years age-group (11 [35.5%]) followed by the 41-50 years age-group (10 [32.3%]). Thirteen patients (41.9%) had the disease since 41-50 years of age. Twenty-three patients (77.4%) had no family history of PsA. Twenty-three patients (74.2%) had psoriasis first, seven (22.6%) had arthritis first and one (3.2%) developed psoriasis and arthritis at the same time. Twenty-four patients (77.4%) had positive activity correlation for skin and arthritis. The majority of patients had symmetrical arthritis (20 [64.5%]) and chronic plaque-like lesions (22 [71.0%]). These patients were on NSAIDS and methotrexate (14 [45.2%]). One patient (3.6%) needed surgery for joint replacement.
Conclusion: Patients who were diagnosed as having PsA were Malays, age group of more than 50, disease onset at 41-50 years of age, no family history, had symmetrical and chronic plaque lesions, had psoriasis first and needed NSAIDS and methotrexate.
Aims: To assess the association between non-steroidal anti-inflammatory drug (NSAID) use and upper gastrointestinal (GI) tract-related hospitalizations and to evaluate inpatient healthcare resource utilization associated with these complications in Malaysia.
Methods: A retrospective case control study was performed using medical records of patients admitted to two Malaysian hospitals during 1999 and 2000. Cases were identified based on mode of presentation at hospital admission. One control was identified for each case, matched by age, sex and admission date. NSAID exposure was determined by drug use during one year prior to admission. Conditional logistic regression analysis was used to determine the association between NSAID use and upper GI complications, adjusting for predictors.
Results: The 273 cases were significantly more likely to have used NSAIDs in the year prior to hospitalization than controls (27.8% vs. 6.2% of patients; P < 0.0001). Conditional logistic regression analysis adjusting for other predictors showed that the odds of being hospitalized for upper GI tract complications were 4.1 times higher among NSAID users than non-users (95% CI = 1.88-9.12). Other risk factors for GI-related hospitalizations were a history of upper GI tract complications (OR = 5.8, 95% CI = 1.28-26.53), use of gastroprotective agents (OR = 5.3, 95% CI = 1.67-16.79), and use of antacids (OR = 5.0, 95% CI = 2.10-11.91) in the previous year.
Conclusion: This study demonstrated that NSAID exposure was significantly higher among patients hospitalized for GI-related complications than for other reasons, indicating that NSAID use is an independent risk factor for upper GI tract complications in this Malaysian sample.
Aims: The aim of this study was to determine the depth of knowledge about osteoporosis (OP) among the public in Malaysia. Methods: A self-administered questionnaire was distributed to attendees of selected health-related public forums in the Klang Valley and Seremban between the months of May to October 2005. Results: 483 questionnaires were returned from 600 given out (80.5%). There were 139 (28.8%) male, 338 (70%) female respondents and 6 (1.2%) not stated. 87.1% respondents had heard of OP. Significantly more women than men had heard of OP (p = 0.015). Mean age was 50.15 ± 14.6 years, 56.7% in the range of 45-64 years. There was no significant difference in the ages of those who had heard of OP and those who had not. 180/338 (53.3%) were postmenopausal females. Those with >10 years of schooling were more likely to have heard of OP (p RM 1000/month (US$270) were more likely to have heard of OP (p =0.022). 22.6% had a positive family history of OP. 63.1% exercised regularly at an average of 4.26 ± 2.78 hours/week. 4.8% were smokers with a median of 10 cigarettes/day. 24.4% drank alcohol with a median of 1 drink/week. However, 70.9% of respondents said that OP led to falls. 89.6% were concerned about osteoporosis. 90.7% agreed that osteoporosis would make daily activities more difficult. The majority obtained their information about osteoporosis from the printed word; newspapers 55.7%, magazines 46.4%, posters/brochures 30.2%, followed by public talks 30%, relatives 29.6%, television 22.8%, medical clinic 22.6% and internet 11.4%. The majority would ask for more information on osteoporosis from their general practitioner 30.6%, followed by other medical specialists such as orthopaedic surgeons 28.4%, hospital specialists 23.8%, rheumatologists 22.4%, followed by friends 15.9%, relatives 14.3% and pharmacists 11.4%. In this self-selected population, knowledge of OP was better among women, the better educated and those earning a higher level of income. Almost 90% of respondents were concerned about getting OP. Their knowledge of OP was obtained from the printed word, which is an important consideration when considering health promotion activities. General practitioners and orthopaedic surgeons need to have a good knowledge of OP.
Objective: To determine the epidemiological, clinical and laboratory features of the patients with gout, on follow up in Rheumatology Outpatient Clinic, Hospital Seremban.
Methods: This was a retrospective study. Case notes of all our existing gout patients were reviewed, and data on demography, clinical features, associated conditions, and laboratory findings were noted.
Results: 54 patients were studied, 48 (89%) were male and 6 (11%) were female at the ratio of M : F = 8:1, 30 (57%) of them had the onset of symptoms at their 3rd and 4th decades of life. The majority were the Malays 39 (72%), followed by the Indians 11 (20%) and the Chinese 4 (8%). Commonly associated conditions were hypertension in 37 (68.5%), obesity (BMI of 30 and above) in 36 (66.7%) and hyperlipidaemia in 36 (66.7%) of them. Mixed hyperlipidaemia (High TG and LDL cholesterol) were found in 19 (53%). Underlying history of diabetes mellitus 7 (13%), alcohol consumption 8 (15%), smoking habits 22 (40%) and family history of gout 18 (33%). Half of our patients 27 (50%) had at least 2 or more joints involvement. 28 (52%) of them had tophaceous gout. Among those with tophaceous gout, 18 (64%) had renal impairment with serum creatinine of .150mmol/l. 6 (31.5%) of the patients with renal impairment found to have renal calculi on ultrasonography.
Conclusion: There was male predominance in our group of patients which was consistent with other reported epidemiological studies. Hypertension, mixed hyperlipidaemia and obesity were common associated conditions while diabetes mellitus, smoking and family history of gout were not. The majority of gout patients in our clinic were Malays and due to religious reasons, alcohol was not a common associated factor. Half of our patients had multiple joints involvement and more than half also had tophaceous gout. There was high incidence of renal impairment seen in patients with tophaceous gout. These could be due to delay in seeking medical treatment, present of renal calculi and possibly contributed by associated hypertension and diabetes mellitus.
Objective: To determine the number of RA cases and to evaluate the demographic patterns in all 4 Rheumatology Referral Centers under the Ministry of Health Malaysia. Materials and methods: One thousand and eighty-four rheumatoid arthritis patients from all 4 centers i.e. Hospital Selayang, Putra Jaya, Seremban and Taiping which are situated in the west coast of West Malaysia, using rheumatoid arthritis database comprising of basic clinical and patient questionnaire, until the end of year 2004 were analysed. Results: At the time of documentation, 88.6% were female at all range of ages especially between age of 25 and 54 years (77.6%) with female to male ratio 8 :1. 52.1% were housewives. Mean age of onset of RA was 49.6 ± 11.8 SD with female 49.3 ± 11.7 SD and male 52.0 ± 12.0 SD (p < 0.05). Indian was the predominant ethnic group (54.5%), followed by Malay (31.4%), Chinese (11.6%) and others (27%). Majority had their education up to secondary level (50.8%), followed by primary (32.6%), and tertiary (6.3%) levels while 10.3% of cases had not received any formal education in their lives. 74.4% were seropositive and 87.3% fulfilled at least 4 out of 7 American College of Rheumatology (ACR) revised criteria for rheumatoid arthritis. 74% were diagnosed RA within 2 years after the onset of arthritis. Seropositivity was not significantly related to gender. Positive rheumatoid factor was dominated by Indian followed by Malay and Chinese. 83.3% were married. 23.3% female and 33.9% male between age group 25-54 were employed. 7.4% had achieved their retirement at time of entry whilst 8.9% were unemployed. Employment status was statistically significant across gender (p < 0.001). The cases differed between rheumatology centers as well as individual practices. Conclusion: There are increasing numbers of RA cases in Malaysia. Results from this study did not reflect the true prevalence of RA in Malaysia. Hence, a larger and more comprehensive database on RA with collaboration of all Government and Private Hospitals in the whole nation will provide better information about the patient case mix in different healthcare settings, treatment practice as well as disease complications. The implementation of rheumatology centers with better regional cooperation, will lead to better treatment and outcome in terms of identification of early as well as established RA cases. Early referral to the centers will be made possible for proper treatment institution and rehabilitation. Hence, improve quality of life including socio-economic status especially among those within the productive age.
Background: Rheumatoid arthritis (RA) is an inflammatory disease. Predictors of disease activity include presence of joint inflammation, blood investigations such as erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP). ESR is said to be imprecise as it is affected by aging, female sex, obesity, pregnancy, anaemia and polycythaemia. But it is inexpensive and easy to perform. CRP is produced as an acute phase reactant by the liver in response to interleukin 6 and other cytokines. CRP is more specific but costs more than ESR. Both tests are done in the rheumatology clinic of Hospital Seremban. Objective: To compare the usefulness of ESR and CRP as a predictor of disease activity in rheumatoid arthritis (RA) patients. Method: This was a retrospective study. The medical records of 248 RA patients who attended the rheumatology clinic, Hospital Seremban between 1 January 2004 and 31 Dec 2004 were reviewed. The following data were obtained: joint swelling and tenderness, other clinical features which indicate inflammation secondary to infection or trauma and inflammation of soft tissue, ESR, CRP, FBC and UFEME. Results: Data was analysed and the results showed that a total number of 248 patients were seen. There were 13 defaulters. Of the 248 patients there were 929 patients' visits. Of the total number of patients' visits where patients clinically had active disease, 80.2% had raised ESR while 88.8% had raised CRP. As for visits where patients had quiescent disease clinically, 57.3% had normal ESR and 36.5% had normal CRP. Conclusion: CRP is more sensitive but less specific than ESR. This suggests that we still should use both tests as they complement each other. ESR can serve as a countercheck for CRP and vice versa.
Introduction: Gout is a clinical syndrome resulting from the deposition of monosodium urate monohydrate crystals. Recent studies have shown gout to be a significant metabolic disorder. However, there has been insufficient information on the clinical spectrum in the Malaysian population.
Objective: This study is conducted to review the clinical characteristics of patients with gout.
Study methods: In this cross-sectional study 52 patients with gout were recruited. The records of 13 patients from National University of Malaysia Hospital and 39 patients from Putrajaya Hospital, attending the rheumatology clinic between October and December 2005 were reviewed. Results: Gout was found predominantly among ethnic Malays 83%, and Chinese 17% in these centers. The male to female ratio was 12 :1. The peak age of onset of the disease was less than 40 years in 46% of the subjects. Primary gout in females was seen after menopause. 37% cases had a definitive hereditary incidence. At the first presentation 83% had acute monoarthritis and 17% acute polyarticular arthritis. Podagra was seen in 62%. Peripheral joints involvement was seen in 81% patients. Tophaceous gout was seen in 42%. In 85% cases the disease had a chronic polyarticular course, whereas in 15% the disease remained only at a single joint. In 10% cases, there was associated sero-negative arthritis. Associated disorders included hypertension (65%), diabetes mellitus (33%), dyslipidemia (56%), ischemic heart disease (23%), urate nephropathy (39%), uric acid nephrolithiasis (2%). In 88% of cases, there was associated hyperuricaemia. Most of the patients were overweight with body mass index 25-29 (39%) and obese with body mass index 30-70 (36%). Conclusions: Gout is not an unusual disorder in our centre. The age of onset of gout occurred much earlier with forty-six per cent of patients having their first attack of gout before the age of 40. Primary gout in females was seen after menopause. Majority of patients first presented with acute monoarthritis, of which sixty-two per cent presented with podagra. The incidence of tophi was high. Patients with gout should be screened for other associated disorders like diabetes mellitus, hypertension, dyslipidemia and obesity.
Molecular alterations in KRAS, BRAF, PIK3CA, and PTEN have been implicated in designing targeted therapy for colorectal cancer (CRC). The present study aimed to determine the status of these molecular alterations in Malaysian CRCs as such data are not available in the literature. We investigated the mutations of KRAS, BRAF, and PTEN, the gene amplification of PIK3CA, and the protein expression of PTEN and phosphatidylinositol 3-kinase (PI3K) catalytic subunit (p110α) by direct DNA sequencing, quantitative real-time PCR, and immunohistochemistry, respectively, in 49 CRC samples. The frequency of KRAS (codons 12, 13, and 61), BRAF (V600E), and PTEN mutations, and PIK3CA amplification was 25.0% (11/44), 2.3% (1/43), 0.0% (0/43), and 76.7% (33/43), respectively. Immunohistochemical staining demonstrated loss of PTEN protein in 54.5% (24/44) of CRCs and no significant difference in PI3K p110α expression between CRCs and the adjacent normal colonic mucosa (p = 0.380). PIK3CA amplification was not associated with PI3K p110α expression level, but associated with male cases (100% of male cases vs 56% of female cases harbored amplified PIK3CA, p = 0.002). PI3K p110α expression was significantly higher (p = 0.041) in poorly/moderately differentiated carcinoma compared with well-differentiated carcinoma. KRAS mutation, PIK3CA amplification, PTEN loss, and PI3K p110α expression did not correlate with Akt phosphorylation or Ki-67 expression. KRAS mutation, PIK3CA amplification, and PTEN loss were not mutually exclusive. This is the first report on CRC in Malaysia showing comparable frequency of KRAS mutation and PTEN loss, lower BRAF mutation rate, higher PIK3CA amplification frequency, and rare PTEN mutation, as compared with published reports.
In the present study, we evaluated the association between the TP53BP1 Glu353Asp and T-885G polymorphisms and breast cancer risk as well as with the clinicopathological characteristics of the patients. Genotyping of these polymorphisms was performed on 387 breast cancer patients and 252 normal and healthy women who had no history of any malignancy using PCR-RFLP method in a hospital-based Malaysian population. Breast cancer risk was not observed among women who were heterozygous (OR(adj) = 0.887; 95% CI, 0.632-1.245) or homozygous (OR(adj) = 1.083; 95% CI, 0.595-1.969) for Asp allele, and those carriers of Asp allele (OR(adj) = 0.979; 95% CI, 0.771-1.243). Similarly, women who were TG heterozygotes (OR(adj) = 1.181; 95% CI, 0.842-1.658) or GG homozygotes (OR(adj) = 1.362; 95% CI, 0.746-2.486) and carriers of G allele (OR(adj) = 1.147; 95% CI, 0.903-1.458) were not associated with increased risk of breast cancer. Asp allele genotype was significantly associated with ER negativity (p = 0.0015) and poorly differentiated tumours (p = 0.008), but G allele genotype was not associated with the clinicopathological characteristics. In conclusion, Glu353Asp and T-885G polymorphic variants might not have an influence on breast cancer risk, thus might not be potential candidates for cancer susceptibility. Glu353Asp variant might be associated with tumour aggressiveness as defined by its association with ER negativity and poorly differentiated tumours.
Infection with Toxoplasma gondii is widespread and important in humans, especially pregnant women and immunosuppressed patients. A panel of tests is usually required for diagnosis toxoplasmosis. Excretory secretory antigen (ESA) is highly immunogenic, and thus it is a good candidate for investigation into new infection markers. ESA was prepared from tachyzoites of RH strain of T. gondii by mice intraperitoneal infection. Sera were obtained from several categories of individuals who differed in their status of anti-Toxoplasma IgM, IgG and IgG avidity antibodies. The ESA was subjected to SDS-PAGE, two-dimensional gel electrophoresis and Western blot analysis. Antigenic bands of approximate molecular weights of 12, 20 and 30 kDa, when probed with anti-human IgM-HRP and IgA-HRP, showed good potential as infection markers. The highest sensitivity of the bands was 98.7% with combination of IgM and IgA blots with sera of patients with anti-Toxoplasma IgM+ IgG+. The specificities were 84% and 70% with sera from other infections and healthy controls in IgM blots and IgA blots respectively. By mass spectrometry, the 12 kDa protein was identified as thioredoxin. The two top proteins identified for 20 kDa molecule were microneme protein 10 and dense granule protein 7; whereas that for 30 kDa were phosphoglycerate mutase 1 and phosphoglycerate mutase.
Toxoplasma gondii is an important human pathogen with a worldwide distribution. It is primarily of medical importance for pregnant women and immunocompromised patients. Primary infection of the former is often associated with fetal infection, which can lead to abortion or severe neonatal malformation. Immunocompromised patients are at risk of contracting the severe form of the disease that may be fatal. Thus, detection of T. gondii infection with high sensitivity and specificity is crucial in the management of the disease. Toxoplasmosis is generally diagnosed by demonstrating specific immunoglobulin M (IgM) and IgG antibodies to toxoplasma antigens in the patient's serum sample. Most of the commercially available tests use T. gondii native antigens and display wide variations in test accuracy. Recombinant antigens have great potential as diagnostic reagents for use in assays to detect toxoplasmosis. Thus in this review, we address recent advances in the use of Toxoplasma recombinant proteins for serodiagnosis of toxoplasmosis.
This experiment evaluated Panduratin A (PA), a chalcone isolated from Boesenbergia rotunda rhizomes, for its hepatoprotectivity. Rats were subjected to liver damage induced by intra-peritoneal injection of thioacetamide (TAA). PA was tested first for its acute toxicity and then administered by oral gavage at doses 5, 10, and 50 mg/kg to rats. At the end of the 8th week, livers from all rats were excised and evaluated ex vivo. Measurements included alkaline phosphatase (AP), alanine transaminase (ALT), aspartate transaminase (AST) and gamma-glutamyl transferase (GGT), serum platelet-derived growth factor (PDGF) and transforming growth factor (TGF-β1), and hepatic metalloproteinase enzyme (MMP-2) and its inhibitor extracellular matrix protein (TIMP-1). Oxidative stress was measured by liver malondialdehyde (MDA) and nitrotyrosine levels, urinary 8-hydroxy 2- deoxyguanosine (8-OH-dG), and hepatic antioxidant enzyme activities. The immunohistochemistry of TGF-β1 was additionally performed. PA revealed safe dose of 250 mg/kg on experimental rats and positive effect on the liver. The results suggested reduced hepatic stellate cells (HSCs) activity as verified from the attenuation of serum PDGF and TGF-β1, hepatic MMP-2 and TIMP-1, and oxidative stress. The extensive data altogether conclude that PA treatment could protect the liver from the progression of cirrhosis through a possible mechanism inhibiting HSCs activity.
Little new evidence on the prevalence of injury to the anterior teeth of children has been reported in the past five years and, in South Africa, trauma to the teeth of children in different ethnic groups has not been compared respectively. The purpose of this investigation was to determine the prevalence of dental trauma using well-defined criteria and to sample a specific age-group. Five regions were chosen and 1035 children in the eleven-year age-group were examined. No statistical significance was found between the ethnic groups related to the amount of injury sustained. For all groups, boys received more injuries than girls. The most common injury was fracture of the enamel of the maxillary central incisor. With 15 percent of the children receiving some level of trauma by age eleven years, this is one of the main dental treatment needs for South African children.
Objective: This study explored the stress and coping strategies among retired people in Malaysia. Methods: In-depth interviews were conducted with 36 elderly Malaysian subjects. This protocol was approved by the Ethics Committee of the Management and Science University. The data obtained were sorted into various categories. Results: A total number of 36 retired elderly people participated in this study. The majority of them were in the age group of 55-59 years old, females, Malay and married. The majority defined stress as pressure or tension. Financial difficulties, family and work problems were the main causes of stress in the majority. Also, the majority of respondents mentioned that they coped with stress by sharing problems with others, by resting and relaxing, and/or by doing housework during their free time. A few of them coped with stress by hanging out with friends, going shopping,
doing photography, travelling, going fishing, and doing sports. Conclusion: Financial difficulties, family and work problems were the main causes of stress among elderly people. They coped with stress by sharing problems with others, resting and relaxing, and/or doing housework during their free time.
Objective: This interventional study was aimed to investigate the effects of dark chocolate
consumption on anxiety, depression, and stress (ADS) among trainee nurses. Methods: A
parallel and open-label experimental study was conducted. Of the 128 nurses enrolled, only 47 participated in the intervention study (mean age = 20.32 years; ranging from 19 to 22 years old). They were randomly assigned to an intervention group (IG, n = 25) or a control group (CG, n = 22). The IG consumed dark chocolate and CG ingested mineral water for 3 consecutive days. The validated Malay Hospital Anxiety and Depression Scale (HADS) and Depression, Anxiety and Stress Scale (DASS-21) were utilised for measuring ADS levels. Data were analysed descriptively and score comparisons were conducted using non-parametric tests. Results: No significant differences between IG and CG in ADS scores were detected at baseline (all p > 0.05). At post-consumption, ADS score were significantly reduced in IG (all p < 0.01) compared with CG (all p < 0.05). Larger effect sizes among these respondents had also revealed that there were mood-elevating effects of dark chocolate consumption. Conclusion: This study has discovered that 3-day consumption of dark chocolate may alleviate ADS status among trainee nurses suggesting that dark chocolate may have a more prominent role in improving emotional and mood generally. Further investigations are however warranted to confirm this finding.
Objective: The aim of the study is to examine the prevalence and factors influencing PTSD among a sample of help-seeking women experiencing domestic violence. Methods: This was a cross-sectional survey study of 40 women in two shelters in Malaysia from 2007 to 2008. Measures include the Detailed Assessment of Posttraumatic Stress; the Measure of Wife Abuse; the Posttraumatic Cognitions Inventory; the Coping Scale for Adults; and the Provision of Social Relations. Results: Results showed that 60% of subjects
exhibited patterns of symptoms consistent with the diagnosis of PTSD. The most prominent posttraumatic symptoms reported were re-experience, avoidance, dissociative responses, and symptoms of increased arousal. Both negative appraisals about themselves and self blame for the abusive situations were positively associated with increased tendency to develop PTSD. The greater use of optimism coping style and the higher quality social
support appeared to lead to a significantly reduced tendency of developing PTSD. Negative appraisals about themselves were found to be the strongest positive predictor of PTSD [R² = 0.32, F(1,38)=17.67, p