The objective of this case-control study was to determine the association between herbal medicine use during pregnancy and perinatal mortality in Tumpat District, Kelantan, Malaysia. Cases were mothers who gave birth from June 2002 to June 2005 with a history of perinatal mortality, while controls were those without a history of perinatal infant mortality. A total of 316 mothers (106 cases and 210 controls) were interviewed. The use of unidentified herbs prepared by traditional midwives and other types of herbal medicines during the first trimester of pregnancy were positively associated with perinatal mortality (OR = 5.24, 95% CI = 1.13; 24.23 and OR = 8.90, 95%, CI = 1.35; 58.53, respectively). The use of unidentified "Orang Asli" herbs and coconut oil during the third trimester of pregnancy were negatively associated with perinatal mortality in Tumpat (OR = 0.10, 95% CI = 0.02; 0.59 and OR = 0.48, 95% CI = 0.25; 0.92, respectively). These findings suggest the use of unidentified "Orang Asli" herbs and coconut oil in late pregnancy are protective against perinatal mortality, while the use of unidentified herbs prepared by traditional midwives and other types of herbal medicines in early pregnancy has an increased risk of perinatal infant mortality. Pharmacological studies to confirm and identify the compounds in these herbs and their effects on the fetus should be conducted in the future.
The phytotoxic risk of ambient air pollution to local vegetation was assessed in Selangor State, Malaysia. The AOT40 value was calculated by means of the continuously monitored daily maximum concentration and the local diurnal pattern of O3. Together with minor risks associated with the levels of NO2 and SO2, the study found that the monthly AOT40 values in these peri-urban sites were consistently over 1.0 ppm.h, which is well in exceedance of the given European critical level. Linking the O3 level to actual agricultural crop production in Selangor State also indicated that the extent of yield losses could have ranged from 1.6 to 5.0% (by weight) in 2000. Despite a number of uncertainties, the study showed a simple but useful methodological framework for phytotoxic risk assessment with a limited data set, which could contribute to appropriate policy discussion and countermeasures in countries under similar conditions.
Pancreatic carcinoid tumours are rare, particularly within the paediatric population. The clinical presentation is largely dependent on the functionality of the tumour. Although the tumour is generally slow-growing, surgical resection is still the mainstay of curative treatment. Morbidity is, however, significantly contributed by secretion of excess hormones; in view of this, biotherapy is an important treatment strategy. Octreotide, a somatostatin analogue, has been shown to be successful in both symptomatic control and stability of tumour progression. We report a 12-year-old girl, who presented with hypertensive crisis, and showed good response to a combination of chemotherapy and octreotide.
The processing of amang, or tin tailings, for valuable minerals has been shown to technologically enhance NORM and this has stirred significant radiological safety and health concerns among Malaysia's regulatory authority. A growing radiological concern is now focused on the amang effluent containing NORM in recycling ponds, since these ponds may be reclaimed for future residential developments. A study was carried out to assess the radiological risk associated with amang processing and the accumulated effluent in the recycling ponds. Twenty-six sediment samples from the recycling ponds of two amang plants in the states of Selangor and Perak, Malaysia, were collected and analyzed. The maximum activity concentrations of (238)U, (226)Ra, (232)Th and (40)K recorded in sediments from these ponds were higher than Malaysia's and the world's natural highest. Correspondingly, the mean radium equivalent activity concentration indices, Ra(eq), and gamma radiation representative level index, I(gammar), were higher than the world's average. The enhancement of NORM in effluent sediments as a consequence of amang processing, and the use of a closed water management recycling system created Effective Dose Rates, E (nSv h(-1)), that signal potential environmental radiological risks in these ponds, should they be reclaimed for future land use.
This paper discusses the advantage of certification process in the quality assurance of individual dose monitoring in Malaysia. The demand by customers and the regulatory authority for a higher degree of quality service requires a switch in emphasis from a technically focused quality assurance program to a comprehensive quality management for service provision. Achieving the ISO 9001:2000 certification by an accredited third party demonstrates acceptable recognition and documents the fact that the methods used are capable of generating results that satisfy the performance criteria of the certification program. It also offers a proof of the commitment to quality and, as a benchmark, allows measurement of the progress for continual improvement of service performance.
To assess the likelihood of an introduction of foot-and-mouth disease (FMD) into the Malaysia-Thailand-Myanmar (MTM) peninsula through terrestrial movement of livestock.
The long history of safety has contributed to the acceptance of probiotics as a safe food adjunct. Consequently, many probiotic products and their applications have been granted GRAS (generally regarded as safe) status. However, this classification has been frequently generalized for all probiotic strains regardless of their application. Cases of probiotics from the genera Lactobacillus, Leuconostoc, Pediococcus, Enterococcus, and Bifidobacterium have been isolated from infection sites, leading to the postulation that these probiotics can translocate. Probiotic translocation is difficult to induce in healthy humans, and even if it does occur, detrimental effects are rare. Despite this, various reports have documented health-damaging effects of probiotic translocation in immunocompromised patients. Due to probiotics' high degree of safety and their morphological confusion with other pathogenic bacteria, they are often overlooked as contaminants and are least suspected as pathogens. However, the antibiotic resistance of some strains has increased the complexity of their eradication. Probiotic translocation and infection deserve further investigation and should become a facet of safety assessment so the negative effects of probiotics do not outweigh the benefits.
Anticoagulation and antiplatelet medications may potentiate GI bleeding, and their use may lead to an increased need for a GI endoscopy. We hypothesized that there might be different practice patterns among international endoscopists.
Health care workers (HCW) are at high risk of acquiring blood-borne diseases. This study compared the risk of infection among HCW in different hospital units and also between HCW and students in medical fields. This cross-sectional study involved pre-tested questionnaires that were completed by 625 HCW and undergraduate students undergoing clinical attachments from February to August 2001. The respondents were separated into two groups: i) HCW from Hospital Kuala Lumpur, HKL (n=241) and Hospital Universiti Kebangsaan Malaysia, HUKM (n=153) ii) Medical students from Universiti Kebangsaan Malaysia, UKM (n=171) and HUKM student nurses (n=60). The results obtained showed that the risk of transmission of blood-borne infections varied significantly according to professional ranks (p<0.05) and to hospital units (p<0.05). The medical intensive care (ICU), haemodialysis, and nephrology and urology units had the highest scores for the risk of infection while the diagnostic laboratory had the lowest risk of infection (p<0.05). Preventive measures taken by the subjects in this study were not satisfactory especially with reference to the use of personal protective equipment and the practice of universal precautions.
To evaluate the influences of mode of immediate preceding delivery and number of prior vaginal births on the risk of repeat cesarean and neonatal admission at attempted vaginal birth after cesarean.
Breast cancer is the commonest cancer affecting females in Malaysia, contributing 31% of all newly diagnosed cases amongst Malaysian women. The present retrospective cohort study evaluated the relationship between cerbB- 2 onco-protein overexpression with various tumour characteristics and survival rate of breast cancer patients treated at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between 1996-2000. CerbB- 2 oncoprotein overexpression was determined by immunohistochemistry (IHC) and tumors showing 2+ positivity were verified by Fluorescence In Situ Hybridization (FISH). One hundred and seventy two patients were eligible for the study with a short-term follow-up (median) of 5.1 years. C-erbB-2 oncoprotein overexpression correlated with lymph node positivity, oestrogen receptor (ER) and progesterone receptor (PR) negativity. Univariate analyses showed shorter disease free survival (DFS) and overall survival (OS) in patients with cerbB- 2 oncoprotein overexpression, Malay ethnicity, higher tumour grade, lymph node positivity, ER and PR negativity. In a subgroup of patients with c-erbB-2 oncoprotein overexpression, a shorter OS was observed in those with lymph node positivity, ER and PR negativity. In multivariate prognostic analysis, lymph node status, ER status and tumour grading were the strongest independent prognostic factors for both OS and DFS. However, c-erbB-2 status was not a significantly independent prognostic factor, even in subsets with lymph node positive or negative group. C-erbB-2 oncoprotein overexpression correlated well with lymph node status, ER and PR. Shorter OS and DFS were significantly observed in patients with c-erbB-2 oncoprotein overexpression. Lymph node status, ER status and tumour grading were the only three independent prognostic factors for OS and DFS in this study. Although c-erbB-2 expression is obviously important from a biological standpoint, multivariate analysis showed that it is not an independent prognostic indicator in breast carcinoma in the local population.
BACKGROUND: In Malaysia, acute leukemia is the most common cancer among children below the age of 15. A case-control study was here conducted for cases from the Klang Valley, Malaysia, who received treatment at the National University of Malaysia Hospital (HUKM) and Kuala Lumpur General Hospital (GHKL). The main objective was to determine any association with environmental factors.
METHODS: Case subjects were children aged below 15 years and diagnosed with acute leukemia in HUKM and GHKL between January 1, 2001 and May 30, 2007. Control subjects were children aged below 15 years who were diagnosed with any non-cancerous acute illnesses in these hospitals. A total of 128 case subjects and 128 control subjects were enrolled in this study. The information was collected using a structured questionnaire and a global positioning system (GPS) device. All factors were analyzed using unmatched logistic regression.
RESULTS: The analysis showed that the occurrence of acute leukemia among children was strongly determined by the following factors: family income (odds ratio (OR) 0.19, 95% confidence interval (CI): 0.09-0.42), father with higher social contact (OR 7.61, 95% CI: 3.78-15.4), number of elder siblings (OR 0.36, 95% CI: 0.18-0.77), father who smokes (OR 2.78, 95% CI: 1.49-5.16), and the distance of the house from a power line (OR 2.30, 95% CI: 1.18-4.49).
CONCLUSIONS: Some socioeconomic, demographic, and environmental factors are strong predictors of the occurrence of acute leukemia among children in Klang Valley, Malaysia. In terms of environmental factors, it is recommended that future housing areas should be developed at least 200 m away from power lines.
The differentiation between cervical intraepithelial neoplasia 3 (CIN 3) and early squamous cell carcinoma (SCC) of the cervix may be difficult in certain situations. Identification of invasion beyond the basement membrane is the gold standard for the diagnosis of the latter. The objective of this study was to determine whether the use of Ki-67 and p53 could help in solving the above dilemma. This was a retrospective study on 61 cases of cervical neoplasms comprising of 25 cases of CIN 3 and 36 SCC. All cases were evaluated by immunohistochemistry using Ki-67 and p53 monoclonal antibodies. Results showed that the differences of Ki-67 and p53 expression between CIN 3 and SCC were statistically significant. In conclusion, Ki-67 and p53 may serve as helpful adjuncts to routinely-stained histological sections in differentiating between CIN 3 and SCC.
The association between fetal sex and outcome of pregnancy and labor has been well documented in western populations. However, no studies in Malaysia or other developing countries have examined the effect of fetal sex on such outcomes.The main objective of this study was to determine the influence of fetal sex on the outcome of labor at term in a cohort of Malaysian nulliparae.A retrospective observational study was designed using data from 4644 Malaysian nulliparae who gave birth consecutively to singleton male babies at Hospital Sultanah Aminah, Johor Bahru, after normal full-term pregnancies.The results of this study indicate that mothers giving birth to male infants have a greater risk of requiring cesarean delivery because male babies are heavier and have statistically significantly greater head circumference (P < .001). These findings concur with those obtained in western populations and suggest that the differences in outcome observed are biological, not dictated by race, ethnicity, or environmental conditions. Such information could help in the antenatal assessment of Malaysian patients and stimulate more comprehensive studies of the mechanisms involved in this sex-based difference in outcomes. Reasons for such differences are proposed.
This study presents a new approach to determine the significant prognosis factors in dengue patients utilizing the self-organizing map (SOM). SOM was used to visualize and determine the significant factors that can differentiate between the dengue patients and the healthy subjects. Bioimpedance analysis (BIA) parameters and symptoms/signs obtained from the 210 dengue patients during their hospitalization were used in this study. Database comprised of 329 sample (210 dengue patients and 119 healthy subjects) were used in the study. Accordingly, two maps were constructed. A total of 35 predictors (17 BIA parameters, 18 symptoms/signs) were investigated on the day of defervescence of fever. The first map was constructed based on BIA parameters while the second map utilized the symptoms and signs. The visualized results indicated that, the significant BIA prognosis factors for differentiating the dengue patients from the healthy subjects are reactance, intracellular water, ratio of the extracellular water and intracellular water, and ratio of the extracellular mass and body cell mass.
OBJECTIVE: To determine the trend of cancer cases in one major hospital in Kelantan over a 20 year period from 1987 to 2007 and to speculate the change in trend due to the socio-economic and other health status in the state.
METHODOLOGY: All data on clinically diagnosed cancer cases in Hospital Universiti Sains Malaysia [HUSM] were retrieved from the hospital medical records. The cancers were classified according to ICD10 and scrutinized to avoid duplicate or more entries. The increment in cancer incidence was calculated based on total numbers of cancer cases per each 5-6 year period.
RESULTS: A total of 12,228 solid cancers were diagnosed during the period. There is an increment of 20.1% for 1991-1996 from 1987-1990 period, 67.4% for 1997-2001 from 1991-1996 period and 305.9% for 2002-2007 from the 1997-2001 period. The rise was steep in the last 5-6 years. After excluding referred cases from states outside Kelantan, the increments were 20.1%, 67.4% and 143.6% for the consecutive 5-6 year periods. The predominant rising trends were seen for cancers of the female organs, digestive tract and endocrine organs.
CONCLUSION: Cancer cases in HUSM are showing a rising trend, associated with increasing prevalence of smoking, obesity and diabetes in the community served by the hospital. Since HUSM is the only hospital managing cancer in the state of Kelantan, to reduce cancer incidence in the state, life-style issues need to be addressed.
INTRODUCTION: CA15-3 is a well-known tumour marker for breast cancer. Currently it is not recommended for screening or diagnosis of breast cancer and its main application is in monitoring response to treatment in women with metastatic breast cancer. The aim of this study was to correlate serum CA15-3 at presentation with the stage of disease and overall survival in women with breast cancer in the University Malaya Medical Centre.
METHODS: This is a retrospective study of 437 women who had CA15-3 levels determined at initial presentation of breast cancer to UMMC between Jan 1999 and Oct 2003.
RESULTS: Of those patients who were adequately staged, CA15-3 was found to be elevated (defined as >51 U/ml) in 0% of Stage 1, 7.9% of Stage 2, 36.7% of Stage 3 and 68.6% of Stage 4 cases. In a subset of 331 patients with survival data, patients with normal CA15-3 had a 85% five year overall survival rate compared to 38% in their counterparts with elevation of the tumor marker. The level of elevation was also significantly related to survival; patients with values more than 200 U/ml exhibited only a 28% five year survival. The association of elevated CA15-3 at initial presentation with poor outcome was maintained over univariate and multivariate analyses.
CONCLUSION: Estimation of CA15-3 at presentation of breast cancer is important as it is an independent prognostic indicator and may prompt the physician to investigate for metastases if elevated.
INTRODUCTION: Mastectomy is an essential but disfiguring operation in cancer treatment. The negative impact on body image can however be prevented by immediate reconstruction.
AIM: The aim of this study was to determine the reasons why patients choose to have or not to have immediate breast reconstruction.
METHODOLOGY: This is a cross sectional descriptive study of breast cancer patients post-mastectomy who had and had not undergone immediate breast reconstruction. The patients were asked a series of questions to ascertain the reasons why they chose or did not choose immediate breast reconstruction.
RESULTS: 136 patients in total were interviewed of which 23 had undergone immediate breast reconstruction. 36.8% of the patients had been offered reconstruction. In the non-reconstructed group, the main reason for not having reconstruction were fear of additional surgery. In the group that had reconstruction done, the main reason was to feel whole again. Low on the list were reasons such as trying to improve marital or sexual relations.
CONCLUSION: Only a third of patients undergoing mastectomy were offered immediate reconstruction. In public hospitals in developing countries, limited operating time and availability of plastic surgery services are major barriers to more women being offered the option.
We were presented with a teenage female who developed superior ophthalmic vein thrombosis and cavernous sinus thrombophlebitis after a 1-week history of a single acne-like lesion or furuncle at the anterior tip of the nose. She was managed aggressively with heparin and intravenous antibiotic. Signs and symptoms improved after 2 weeks of treatment, and she was discharged with an anticoagulant.