Since 2004, malaria with a "fifth" plasmodium, Plasmodium knowlesi (common in macaque monkeys), has been diagnosed in a number of people in Southeast Asia. This article gives a short overview of the epidemiology, clinical picture, diagnostics and treatment of P. knowlesi infection.
The Asia-Pacific region has at least 50% of its population at risk for malaria. In Malaysia, indigenous malaria is largely concentrated among the Orang Asli in Peninsular Malaysia. A cross-sectional study was conducted in an Orang Asli community in the district of Raub, Pahang, to determine the predictors of malaria. Age, seldom/never wearing protective clothing while in the jungle, going out at night, ever staying in another village, and living in bamboo-walled homes were found to be associated with malaria (crude odds ratio = 1.8-4.5; 95% confidence interval [CI] = 1.1-9.1) After adjusting for confounding, major predictors of malaria were age < or =12 years (adjusted odds ratio [aOR] = 4.3;95% CI = 2.2-8.4),), never/seldom wearing protective clothing while in the jungle (aOR = 3.8; 95% CI = 1.8-8.0), and going out at night (aOR = 2.5; 95% CI = 1.4-4.8). The findings lend support for intensifying behaviour modification in this population.
The Malaysian Psoriasis Registry, established in 1998, is the first skin disease clinical registry in Malaysia. It aims to provide useful data on various aspects of psoriasis. Following an extensive revision of the registry form in 2007, a total of 509 psoriasis patients from 10 government dermatologic centres were reviewed in a three month pilot study. The onset of psoriasis was during the second to fourth decade of life in the majority of patients. There was no sexual and ethnic predilection. A positive family history was present in 21.2%, and more common in patients with younger disease onset. The main aggravating factors of psoriasis were stress, sunlight and infection. Plaque psoriasis was the commonest clinical type (80.9%). Joint disease was present in 17.3% of patients, among which mono-/oligoarticular type being the commonest. Nail changes occurred in 68%. More psoriasis patients were overweight and obese compared to the normal population. The mean Dermatologic Life Quality Index (DLQI) score was 8.08 +/- 6.29, and changes during subsequent follow-up may reflect therapeutic effectiveness. This study enabled evaluation of the revised registry form and helped in identifying shortcomings in the implementation of the registry.
Anthropometric wrist measurement ratios were examined for an association with idiopathic carpal tunnel syndrome (CTS). Wrist measurements were recorded in 67 patients with CTS and in a matched control group of 67 healthy volunteers. The Wrist Ratio (WR) (wrist anterior to posterior dimension/wrist medial-lateral dimension) and the Wrist Palm Ratio (wrist anterior to posterior dimension/palm length) were calculated for each case. We found that a WR of > or =0.70 and a Wrist Palm Ratio of >0.342 were significantly associated with idiopathic CTS.
The clinical outcome of bacteraemic patients is influenced by many factors. It is vital to know one's own local hospital epidemiological data so as to provide optimal care to the affected patients. This was a prospective, observational study carried out in the said patient population over a period of four months in the year 2005. One hundred and ninety one patients presented with bacteraemia over the study period. Fifty-two (27%) of the patients died. Mechanical ventilation, inappropriate empirical antibiotic usage, Chinese ethnicity and low serum albumin levels independently affected prognosis. These factors should alert physicians to those patients who require more intensive monitoring and care.
KEY WORDS:
Bacteraemia, Blood Culture Positive, Outcome, Risk factors, Kuala Lumpur, Malaysia
The incidence of osteoporosis is increasing worldwide. It has great impact on the life of the elderly population. The most significant medical consequence of osteoporosis is fragility fracture which without proper treatment will cause severe medical and psychosocial complications. The overall cost in managing osteoporosis and its related fractures is escalating. Using bone densitometry to measure bone mineral density is useful in the diagnosis of osteoporosis but it is costly and not feasible in the community. Drugs such as estrogen replacement, raloxifene and calcitonin are effective in prevention and treatment of osteoporosis but they are also expensive. Identifying modifiable risk factors such as smoking, lack of exercise, low dietary calcium and vitamin D intake and healthy life style remain strategy in the primary prevention of osteoporosis in the community.
A cross sectional descriptive study of 2048 subjects was conducted to determine the prevalence of depression and factors influencing depression among students in secondary school from urban and rural areas in the state of Selangor, Malaysia. The children's depression inventory (CDI) developed by Maria Kovacs was used in this study. Students who participated in this study come from two urban schools and three rural schools. It was found that in the yield for scores for five factors were 9.2% have negative mood, 5% have interpersonal problems, 8.3% have ineffectiveness, 9.8% have anhedonia and 10.6% have negative self esteem. Following the interpretive guidelines for the T-scores, it was found that 10.3% of the students were much above average in the depression scale. This study also found that: 1% of students were smoking, 1.6% of students were gum sniffling, 0.9% took drugs, 4.1% took alcohol and 9.9% took things from other people. Females were more depressed than males. The Chinese students were more depressed compared to Indian students. Students whose parents had no formal education or had only primary education were more depressed than students whose parents had secondary, college or university education. Depression increased with increasing number of siblings. Depression contributed to the habit of drug abuse, gum sniffing and stealing but not to smoking and alcohol abuse. Suicidal tendencies were more likely among the depressed students. It is imperative that not only caregivers but also teachers have to be equipped with the knowledge, attitude and skills to assist secondary school children cope with their emotions, handle conflicts and manage stress early so that a more productive society will develop in the future.
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.
The subset of data on southern Thai InterAsia study conducted in 2000 was revisited in order to document gender and ethnic breakdown of prevalence of risk factors for cardiovascular diseases (CVD). Three hundred and seventy-five men and 630 women with overall mean +/- SD age of 53.2 +/- 11.7 years were recruited. Combined gender prevalences were: 21.1% for smoking, 15.5% for drinking, 21.8% for hypertension (systemic blood pressure > or = 140/90 mmHg), 49.8% for impaired fasting plasma glucose (FPG 110-125 mg/dl), 9.9% for diabetes mellitus (FPG > or = 126 mg/dl), 10% for body mass index > or = 30 kg/m2, 43.5% for large waist circumference (WC > or = 90 cm in men and > or = 80 in women), 62.8% for total serum cholesterol (TC), > 200 mg/dl, 38.5% for TC divided by high density lipoprotein cholesterol (HDL-C) > or = 5 and 61.6% for low-density-lipoprotein cholesterol (LDL-C), > or = 130 mg/dl. After using logistic regression, adjusting the effects of age and community of residence, women were less likely than men to be smokers, drinkers, or showed impaired FPG but significantly more likely to have large WC, TC > or = 200 mg/dl and LDL-C > or = 130 mg/dl. Muslims showed significantly lower risk for drinking and large WC but higher risk for low HDL-C. The differences require further research. In conclusion, gender and age have stronger association with various risk factors than ethnicity in this selected population.
The purpose of this study was to investigate the association between pregnancy-induced hypertension and low birth weight. A population-based case control study was conducted. Antenatal mothers who attended the government health centers in the district of Kuala Muda, Kedah, Malaysia from June 2003 to May 2004 were recruited. Cases were 312 mothers who delivered low birth weight babies, and controls were 312 mothers who delivered normal birth weight babies. Face-to-face interviews using a structured questionnaire and a review of medical records were carried out. After controlling for important confounders such as gestational age at delivery, maternal age, ethnicity, education, parity, and previous history of abortion, pregnancy-induced hypertension was found to be an independent risk factor (adjusted odds ratio = 5.06; 95% confidence interval: 2.63, 9.71) for low birth weight. There was a significant association of pregnancy-induced hypertension with low birth weight. Women who delivered low birth weight babies were 5 times more likely to have had pregnancy-induced hypertension.
This study was conducted to measure the prevalence of cigarette smoking and to determine the individual, family, and environmental factors associated with smoking among young urban women. A cross-sectional study through self-administered questionnaire was conducted on female students enrolled in private higher learning institutions in Kuala Lumpur and Selangor, Malaysia, between July and October 2005. Analysis on 408 respondents showed that current smoker prevalence rate was 18.6%. Adjusted analyses showed significant association between smoking and individual factors, which are the importance of slim image, average monthly allowance, and car ownership. For family factors, analyses showed significant association between smoking and parental marital status and smoking status of male siblings. Strong associations were seen between female smoking and environmental factors, such as having more smoker friends, having smokers as best friends, keeping cigarette-brand items, being offered free cigarette, and perceiving female smoking as normal. The identified risk factors could be used to develop more effective prevention programs to overcome smoking among young urban women.
A household survey was carried out in Peninsular Malaysia to determine the prevalence rate of depressive symptoms in middle-aged women and to explore its associated factors. Women aged 45 to 60 years were assessed on sociodemographic profiles, menopausal status, depressive symptoms, marital dissatisfaction, and coping strategies. A total of 3934 women participated, and the mean age was 51 years. The prevalence rate of depressive symptoms was 54.2%. Of the married women, 38.4% had poor to very severe problems in their marriage. Depressive symptoms were significantly associated with marital status (P < .001), ethnicity (P < .001), educational levels (P < .001), occupational status ( P < .001), domicile (P < .001), and menopausal status ( P < .05). Depressive symptoms were correlated with marital dissatisfaction scores. Women who consulted professionals, shared with relatives, kept problems to themselves, or consulted parents/siblings had higher mean scores on depressive symptoms compared with those who did not use these coping strategies.
INTRODUCTION: An important risk factor for developing breast cancer is a positive family history of breast cancer. In Malaysia, there is no population-based breast screening programme, but the clinical practice guidelines suggest increased surveillance for those with a positive family history ie mammography for those 40 years old and above, breast self-examination and clinical breast examination yearly.
OBJECTIVE: To determine if women with a family history of breast cancer present with earlier stages of disease.
METHODOLOGY: From Jan 2001 to Dec 2006, 1553 women with breast cancer presenting to the University Malaya, where family history was recorded, were eligible for this study. Women with a first or second degree relative with breast cancer were compared with those who have no family history with regard to their race, age, stage, size and duration of symptoms. The Chi Square test of significance was used for analysis.
RESULTS: Out of 1553 patients, 252 (16.2%) were found to have a relative with breast cancer out of which 174 (11.2%) had at least one affected first degree relative. There were no significant difference in the incidence of positive family history between the Malays, Chinese and Indians. 20% below the age of 40 years old had a positive family history compared with 12.6% in women with no family history. (p<0.05). There was no significant difference in stage at diagnosis between those with and without family history, ie 24.2% late stages (Stage 3 and 4) in the group with no family history compared with 21.8% in the group with family history. (p>0.05). The mean size in the group with no family history was 4.4 cm compared to 4.1 cm in the group with family history. There was a significant difference in screen-detected cancers in the women with family history, 10.7% compared with 5.1% of screen-detected cancers in the group without a family history. However there was no difference in the duration of symptoms between the 2 groups--25.8% in the women without a family history presented after 1 year of symptoms compared with 22.4% in the group with a family history (p>0.05).
CONCLUSION: Having a family history of breast cancer does not appear to have much impact on the health-seeking behavior of women. Even though there were more screen detected cancers, these comprised only 10% of the group with family history. Public education should target women at risk ie with family history to encourage these women to present earlier and to undergo screening for breast cancer.
Anthropozoonotic (human to nonhuman animal) transmission of infectious disease poses a significant threat to wildlife. A large proportion of travelers to tropical regions are not protected against vaccine-preventable illnesses, and a majority of these travelers demonstrate poor recall of actual vaccination status. Here we characterize self-perceived vaccination status among a large sample of ecotourists at the Sepilok Orangutan Rehabilitation Centre, Sabah, Malaysia. Despite their recognized travel itinerary to view endangered animals, tourists at wildlife sanctuaries are not adequately protected against vaccine-preventable illnesses. Of 633 surveys, over half reported being currently vaccinated against tuberculosis, hepatitis A, hepatitis B, polio, and measles. Fewer participants reported current vaccination status for influenza, rabies, and chickenpox. Despite the fact that the majority of visitors to Sepilok are from temperate regions where influenza is relatively more prevalent, 67.1% of those surveyed with medical-related occupations reported not being currently vaccinated for influenza. Ecotourists concerned about environmental protection are themselves largely unaware of their potential contribution to the spread of diseases to animals. The risks of negatively affecting animal populations must be communicated to all concerned parties, and this may begin by urging travelers to examine their actual vaccination status, particularly as the ecotourism industry continues its rapid expansion, and is seen increasingly as a possible tool to save great ape populations from extinction.
A prospective cohort study was conducted to determine the incidence of progressive encephalopathy (PE) and its associated clinical manifestations amongst a cohort of HIV infected children attending the HIV/AIDS clinic of the Pediatric Institute, Kuala Lumpur Hospital, Malaysia. Neurological and neurobehavioral assessments were performed in 55 children with HIV over a 24-month study period. Parameters assessed were physical and neurological assessments, CD4 counts, CD4 percentages, RNA viral loads and an IQ assessment at four monthly intervals. PE was diagnosed when patient developed at least one of the definitive criteria for PE based on the Consensus of Pediatric Neurology/Psychology Working Group, AIDS Clinical Trial 1996. The incidence of encephalopathy was 18.2% (n = 10) in 2002. All the patients had hepatosplenomegaly, lymphadenopathy, abnormal deep tendon reflexes and five had impairment in brain growth. The CD4 counts and CD4 percentages were more likely to be associated with PE compared to the non-PE group.