Introduction: Attention deficit hyperactivity disorder (ADHD) is a frequently encountered clinical condition in children. Based on DSM IV-TR criteria it can be sub-classified into three distinct types namely hyperactiveimpulsive, inattentive and combined. Materials and Methods: In the present study, salivary antioxidant activity (AOA) in children with ADHD was compared with age-matched normal control subjects, both as a whole and also with regard to the three subtypes. Additionally, the effect of therapy on the altered AOA levels was investigated following short term (
Choriocarcinoma is a malignant proliferation of syncytial trophoblast cells that do not form placental villi. It is a relatively rare and highly malignant variant of gestational trophoblastic disease. Although choriocarcinoma is mostly observed after a molar pregnancy, it may be preceded by any gestational event. It has been shown that even a partial mole can transform into choricarcinoma. Incidence rates of choriocarcinoma differ widely throughout the world. In Europe and North America, choriocarcinoma is reported to affect one in every 30,000 to 40,000 pregnancies, and one in 40 molar pregnancies. In South East Asia, choriocarcinoma is reported to affect one in every 500-3000 pregnancies. Following livebirth, choriocarcinoma with metastatic disease are important sequele (31%)(Tidy et al 1995). In the same study the reported median interval between antecedent pregnancy and choriocarcinoma is five months. Multi agent chemotherapy is required in the majority of patients (82%) for the high risk group. The prognosis for choriocarcinoma after a normal gestation is poorer. The mortality rate is also significantly higher than non-molar abortion (21%). Effective treatment with oral Methotrexate in metastatic choriocarcinoma to the lung confirmed the highly sensitive nature of this tumour to chemotherapy agent.
Pelvic inflammatory disease (PID) is a common cause of morbidity and accounts for 1 in 60 GP consultations by women under the age of 45 in the UK. Pelvic inflammatory disease encompases a broad category of disease including endometritis, salphingitis, salphingo-oopheritis, tuboovarian abscess and pelvic peritonitis. It most commonly occurs as a result of Chlamydia trachomatis or Nesseria gonorrhea 1,2 infection of the endocervix that eventually spread into the upper genital tract. Direct spread from a nearby infection such as appendicitis and diverticulitis is not that common. Hematogenous spread is rare except in cases of tuberculous pelvic inflammatory disease. This case illustrates atypical presentation of pelvic inflammatory disease in a previously healthy single unmarried lady. The presence of ascites, bilateral ovarian mass and constitutional symptoms closely mimics that of malignant ovarian tumour. This was preceded by empyema which grew E coli.
Vaginal agenesis is a rare event occurring at a frequency of 1 case per 4000-10 000 female lives born. The most common etiology of vaginal agenesis is congenital absence of the uterus and vagina called mullerian agenesis (Mayer-Rokitansky-Hauser Syndrome). Although most patients with mullerian agenesis have small rudimentary 2 ‘mullerian bulbs’ without any endometrial activity, 7-8% of these cases possibly have a functioning uterus 3. In vaginal agenesis, genetic females are thought to have persistence of mullerian inhibiting factor MIF, resulting in failure of the vagina and uterus to develop 4. The ovaries, given their separate embryonic source, are normal in structure and function. This condition usually goes undetected until these patients reach puberty, when they start to experience cyclic pelvic pain due to the accumulation of menstrual blood.
Thanatophoric dysplasia (TD) was reported earlier in the previous publication. It is one of the most common lethal human skletal dysplasia characterized by severe dwarfism. It occurs in 3 to 4 per 100,000 live births1 and is due to autosomal dominant sporadic de novo mutations in the fibroblast growth factor receptor 3 (FGFR3) gene3 which codes for the FGFR3 transmembrane receptor expressed largely by skeletal and brain tissues in the developing fetus where it is involved with growth regulation. The FGFR3 mutation in TD leads to generalized defects and lack of endochondral ossification, with membranous ossification being less impaired1. Male and female fetuses are equally affected. Two thanatophoric case of this extremely rare occurance are reported and discussed.
Objectives: To evaluate the cost-effectiveness of the new oxytocin regimes in the augmentation of labour and the effect on the maternal and fetal outcome. Design: Randomized controlled trial. Setting: Labour ward of Hospital Tengku Ampuan Afzan, Kuantan. Participants: 230 pregnant women in labour at term with obstetric indications for labour augmentation. Methods: The women were randomly assigned to receive new oxytocin regime of 5 units in 500 cc of D/Saline at titration of 5 dpm with increments of 5 dpm to a maximum of 60 dpm. Or, old oxytocin regime of 1/2/4 units with titration of 20/40/60 dpm for primips and half the dosage for multips.
Main outcome measures: Cost analysis, duration of labour, duration of augmentation, complication of labour, post partum hemorrhage (PPH), mode of delivery and perinatal outcome.
Results: There was no significant difference in the mean duration of labour (6.8 h vs 6.7 h ; p = 0.45) and mean augmentation time (3.86 h vs 4.0 h; p = 0.9) between the regimes studied There seemed to be higher incidence of caesarean section in the old oxytocin group (6.5% vs 24.7%; p = 0.001). There was no significant influence on the neonatal morbidity and mortality (p = 0.07). A moderate reduction of annual cost for augmentation of labour was noted (RM 962.34).
Conclusion: The results showed that the new oxytocin regime was more cost-effective without apparent increased in the maternal and fetal mortality and morbidity.
Introduction: Internet addiction is an increasingly worrying phenomena affecting people globally especially the youths. This study aimed to determine the prevalence of internet addiction among undergraduate students in a Malaysian public university and its associated factors. Materials and Methods: A cross-sectional study involving 322 undergraduate students, identified through cluster sampling was conducted using a pretested, self-administered questionnaire. The questionnaire includes socio-demography, use of information technology gadgets and internet usage. Internet Addiction test (IAT) was used to identify internet addiction. Data was analysed using SPSS version 22. Results: From 322 respondents, 25 (7.8%) were categorised as addictive internet users, while 182 (56.5%) were problematic internet users. The commonest online activity includes social networking (86.6%), entertainment (77.3%) and educational purposes (77.0%). From multivariate analysis, problematic and addictive internet use was significantly more common among male students (AOR=2.47, 95% CI [1.43, 4.26]), those who received study loan (AOR=1.93, 95% CI [1.10, 3.39]) and other types of funding (AOR=3.95, 95% CI [1.59, 9.80]) compared to those on scholarships, and those who spent between four to ten hours a day accessing the Internet (AOR=2.43, 95% CI [1.13, 5.23]) compared to those using the Internet for two hours or less a day. Conclusion: The prevalence of problematic and addictive internet use among respondents were higher compared to previous researches among Malaysian adolescents. It is recommended that an awareness programme on responsible use of the internet be conducted to prevent students from becoming addicted which may impact negatively on their educational performance and social life.
Introduction: Introduction: The paper explores turnover intention and job satisfaction among healthcare employees of Ministry of Health (MOH) Malaysia. Methods: A nationwide study was carried out in order to identify dimensions of job satisfaction and turnover intention among public healthcare employees. Data was collected by means of self-administered questionnaire and distributed based on quota sampling. Results: The study shows that public healthcare workforce is generally satisfied with their work (mean 3.45). In addition, medical specialists and assistant medical officers were found to be significantly more satisfied than other job designations. However, intention to resign was high among medical specialists, pharmacists and dentists. A high proportion of medical specialists also had received job offers from the private sector. Conclusion: The findings showed that employee turnover may not necessarily be due to job dissatisfaction, but rather due to demand from the private sector. Findings from the study would assist policy-makers with respect to talent management in public healthcare service.
Vector control is still the principal method to control dengue and chemical insecticides, especially the
pyrethroids such as permethrin are the forerunners of mosquito control agent. Intensive and extensive use
of pyrethroids often result in resistance, thereby hampering control efforts. The present study was
conducted to evaluate the susceptible status of Aedes aegypti, the primary vector of dengue against
permethrin. A nationwide mosquito sampling via ovitrapping was conducted in 12 dengue hotspots across 5
states in Peninsular Malaysia. Field collected Aedes eggs were hatched and reared until L3 larval and further
identified it species. Adult F0 Aedes aegypti were reared until F1 progeny and the female were used in
adult assay, performed according to World Health Organization (WHO) protocol as to determine the
resistance level. The laboratory strain maintained for more than 1000 generations that were susceptible to
permethrin served as the control strain. Evaluation of resistance ratio was assessed by comparing the
knockdown rate with laboratory susceptible strain. In this present study, 70% ofAe. aegypti population from
dengue hotspots was highly resistance to permethrin. The study clearly demonstrated that widespread of
permethrin resistant Ae. aegypti in Malaysian mosquito’s population, indicating the need of implementing
an efficient pyrethroid resistance management.
The trend of dengue incidence in the regions and many countries has shown an increasing trend for the past few decades. The World Health Organization (WHO) reported that the incidence increased dramatically over the last 50 years and that dengue virus infections expanded to new countries, and from urban to rural settings. Malaysia is one of the countries that experience similar situation. The trend of dengue incidence in Malaysia has continued to increase since 2001 until 2014. In 2001, the dengue incidence rate (IR) was 72 cases in 100,000 population and progressively increased to 361 cases in 100,000 populations in 2014. There were temporary decrease of the incidence rate in 2011 and 2012 to 69.9 and 76 cases per 100,000 populations. Despite the close monitoring and continuous efforts from the Ministry of Health and Municipals to conduct the prevention and control activities, the number of dengue cases continues to increase due to multiple uncontrolled factors. There are at least five major factors that influence the transmission of dengue disease which include the dengue virus, the human as the host, the environmental condition such as cleanliness, the vectors and its behavior and the climate change. Due to these multiple factors that influence the disease pathophysiology and transmission of dengue virus, the control of mosquito-borne viral infection is very challenging and different from managing other infectious diseases. In addition, the rapid urbanization, population growth and human behavior together with international travel, making the control of dengue transmission even more difficult. Based on the circumstances, Ministry of Health Malaysia has implemented the intergrated strategy for dengue prevention and control program in the National Dengue Strategic Plan (NDSP) since 2011. There are seven strategies included in the NDSP which is strengthening of the dengue surveillance, practicing intergrated vector management, emphasizing on the dengue case management, social and community mobilization towards the prevention activity, ensuring rapid response in managing the dengue outbreak and developing new innovative method through dengue research. Most of the factors that contribute to the occurrence of dengue cases are difficult to be controlled and these leave with only manipulation and intervention with the environment, vector control and changing the human behavior for the prevention and control of dengue.
Background: Thyroid swelling or goitre is a common condition, either asymptomatic or symptomatic. The
diagnosis is usually established by ultrasound or fine needle aspiration cytology (FNAC) as a gold standard.
The sensitivity of the test is inversely related to increasing size of the nodule. The objective of this study is
to evaluate the accuracy of FNAC especially in cases of large goitre.
Material and methods: This is a
retrospective study on patients who underwent thyroidectomy between January 2000 to December 2007 for
solitary or dominant nodular goitre. The analysis was made only on those patients with complete data on
FNAC and histology.
Result: There were 235 patients, but only 161 patients were analysed after excluding
the suspicious and inadequate sample. The patients’ mean age was 42.1 year old (21 to 60). The size of the
thyroid nodule ranged from 2.1 to 5.0 cm (mean = 3.9 cm). The overall sensitivity was 67.4% and the overall
accuracy was 86.3%. The accuracy of FNAC according to the sizes above and below the value were as
follows; 2 cm (72.2% vs. 88.1%); 3 cm (88.0% vs. 87.4%) ; 4 cm (86.6% vs. 84.4%) ; 5 cm (87.3% vs. 78.8%).
This was most obvious in the sensitivity of the FNA which also showed reducing trend as the nodules
increased in size.
Conclusion: FNAC is an essential diagnostic tool in the management of nodular goitre.
Our study showed that the accuracy of FNAC decreased as the size of the nodule getting bigger. Cautious
approach should be taken in the management of large goitre and decision should not be based only on the
result of FNAC.
Individuals with Diabetes Mellitus (DM) are at increased risk for developing
diabetic ocular complications. This study was carried out to determine factors
influencing eye screening among Diabetes Mellitus patients. The descriptive findings of
participants’ sociodemographic data will be discussed. (Copied from article).
Hydroxychavicol (HC) is a phenolic compound of betel leaf (Piper betle). It has been reported to have antifungal properties against dermatophytes including T. rubrum. The aim of this study was to identify the effects of the HC against T. rubrum. Broth dilution method was used to determine the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of the HC. Microscopic study of the treated fungus was done by transmission electron microscope (TEM). Cytotoxicity study using pre-adipocyte (3T3-L1) cell line was performed by means of MTT cell proliferation assay. The MIC and MFC results of the HC were both 0.49 µg/ml. Microscopic study revealed the destruction of the fungal cell wall and organelles. Cytotoxicity study showed HC to be non-toxic to the tested human cell line. In conclusion, HC may potentially be used as an alternative therapeutic agent against T. rubrum infections.
Antibacterial activity of different types of P. odorata leaf extracts was evaluated in combination with
standard antibiotics. Persicaria. odorata leaves were extracted with n-hexane (n-hex), dichloromethane
(DCM) and methanol (MeOH). Each extract was applied on vancomycin (30µg), erythromycin (15µg) and
gentamicin (10µg) discs, respectively. Disk diffusion method was used to evaluate the synergistic activity of
each combination on Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes,
Streptococcus pneumoniae, Pseudomonas aeruginosa, Salmonella typhi, and Escherichia coli. Minimum
inhibitory concentration (MIC) and gas chromatography mass spectrometry (GCMS) analysis was performed on
the active extract. Synergistic effects seen were mainly from the n-hex+antibiotics combinations, mainly on
the Gram-positive bacteria (7 additive, 5 antagonistic), with MIC range from 50 µg/ml to 100 µg/ml, as well
as Gram-negative bacteria (2 additive, 2 indifferent, 5 antagonistic). In particular, synergism showed by the
combination of n-hex+van were all additive against the susceptible bacteria. DCM extract combination
showed synergistic effects on three Gram-positive species (S. aureus, S. epidermidis, S. pyogenes).
Meanwhile, MeOH+antibiotics combination showed significant additive synergistic effects (p
Trichophyton rubrum is a common pathogenic fungal species that is responsible for causing infection on
human skin, hair and nail. The antifungal-resistant strains complicate the treatment regime.
Hydroxychavicol (HC) is one of the main compounds from Piper betel leaf that have antifungal potential and
its mechanism of action has not been studied yet. The objective of this preliminary study to determine the
antifungal properties of HC against T. rubrum using transmission electron microscope (TEM) on gross and
ultrastructure of T. rubrum hypha. T. rubrum was treated with HC and miconazole (MI) at concentrations of
1.25, 2.5, 5 and 10 mg/mL for 1, 3, 5 and 7 days continuously. Generally, fungi structures became more
severely damaged at increasing treatment duration. Microscopically, the fungi’s cell wall treated with HC
showed a rough surface, shrinkage and demolition similar to the MI treated group. The fungi organelles were
also demolished and disorganized. This study revealed that HC has the ability to inhibit T. rubrum growth
and has potential to be an antifungal agent for skin infections.
Introduction: This study aimed to explore the associated factors related to causes of stress and coping strategies among university students. Materials and Methods: As a focus group discussion, it was universal sampling, conducted among 39 of Medical Science and Biomedicine students on their second semester from Management and Science University (MSU), Shah Alam, Malaysia. Three issues were discussed: firstly, how they define the stress; secondly, what the most important causes of stress in their life are; and thirdly, how they cope with stress. Verbal consent was obtained from all participants. Due to the small sample size, the data was analyzed manually. Results: Total of participants were 39 students, their age ranged from 21 to 26 years. Seventeen (43.6%) of the students were 21 years old and the majority were female 31 (79.5%). The
most important causes of stress reported by the students were financial, lack of sleep, and family problems. In terms of coping with stress, the students were able to describe a variety of strategies to cope with their stressful situations. These included counseling services, doing meditation, sharing of problems, getting adequate sleep, and going out with friends. Conclusion: Most of the students defined stress as “a mental condition”. Lack of sleep, financial, and family problems were the most causes of stress among students. The students were able to identify some strategies to cope with stress.
Introduction: Each year, more than 20 million people are injured and 1.17 million are killed due to road
traffi c accidents. Developing countries account for over 85% of the deaths, and close to 90% of the disability caused by road traffi c crashes worldwide. The objectives of this study were to determine the knowledge, attitudes and practice and the factors infl uencing university students in Malaysia concerning road traffic accident. Materials and Methods: This study was conducted among the students of Management and Science University, Malaysia. The questionnaire was distributed randomly to the students of the Faculty of Health and Life Sciences. Data was analyzed using SPSS version 13, T-test and ANOVA. Results: The total number of 109 students with the mean age of 20.94±1.89 years participated in this study. Approximately 39 (35.7%) of the participant had been involved in one or more than one road traffi c accident. About 93.6% of them were very strongly/strongly convinced of seat belts importance. Multivariate analysis using the multiple linear regression method showed that age and attitude were signifi cantly associated with the exposure to the accident. Conclusion: The study participants had moderate knowledge about road traffic regulations and most of them mentioned that high speed, drivers’ lack of awareness about traffi c regulation and laws, and drivers’ non-compliance with traffi c rules and regulation were the most important cause of road traffic accidents. Almost all students were very strongly/strongly convinced of seatbelts importance. Age and attitude were signifi cantly associated with the exposure to the accident.
Left ventricular non-compaction cardiomyopathy (LVNC) is a rare congenital cardiomyopathy, which is
characterized by hypertrabeculations and deep recesses of the left ventricle. A patient could be
asymptomatic or presented with common manifestations, including reduced systolic function, arrhythmia,
thromboembolic events and heart failure. The rarity of the condition as well as lack of proper assessment
has probably led to this condition to be largely underdiagnosed or unrecognized. A 23-year-old lady had
collapsed at home thirty one days after delivering her first child. She had a history of goitre diagnosed a
year ago and noted to be fairly well throughout the pregnancy. Post mortem findings showed increased
trabeculations of the left ventricle. Further history was obtained after the procedure, revealing symptoms
such as syncopal attacks and bilateral lower limb weakness dated back as far as five years prior to her
sudden demise. These features were in keeping with hypotension hypoperfusion effects resulted from
reduced systolic function and decreased ejection fraction, as a result of left ventricular dysfunction. While
LVNC remains a rare type of disease, we would like to highlight the importance of a good anamnesis. It may
help to uncover some uncommon pathology such as this heart disease, thus warranting an appropriate
cardiac imaging to be engaged to clinch the primary diagnosis.
Cardiovascular diseases (CVD) are the leading cause of mortality in Malaysia as well as in other countries. It is associated with many risk factors, such as increasing age, hypertension, diabetes, dyslipidemia, oxidative stress and autonomic dysfunction and arterial stiffness. The objectives of this study were to measure the prevalence of arterial stiffness and to assess its association with dyslipidemia. Methods: A cross sectional study was conducted in a rural community in Malaysia involving 146 subjects. Data were collected using an interviewer administered questionnaire which included three sections – sociodemographic characteristics, personal profile, and past medical history. In addition, Seca Body Meter (Seca 220) was used to measure height and weight. Sphygmomanometer (OMRON Automatic Blood Pressure Monitor HEM 907) and SphygmoCor-AtCor MM3 SERIAL/RS-232 were used for blood pressure and augmentation index (AIx) measurement. Data were analysed using the SPSS for Windows, Version 18.0. Results: The mean age of respondents was 49.5 years, SD±15.6. The prevalence of arterial stiffness was 23.3% (95% Confidence Interval (CI): 16.44 – 30.16). The prevalence of dyslipidemia was 82.9% (95% CI: 76.79 – 89.01). Multivariate logistic regression revealed that total cholesterol was significantly associated with arterial stiffness (OR=4.56, CI 1.10-18.90). Conclusion: The prevalence of dyslipidemia was high. Despite an insignificant association between dyslipidemia and AIx, there is a significant association between TC level and AIx.
Introduction: Exposure to excessive noise is the major avoidable cause of permanent hearing impairment. Sawmill is one of the workplaces where workers are exposed to hazardous noise level. This study was conducted to determine the reliability and validity of noise-induced hearing loss questionnaire among sawmill workers. Materials and Methods: This cross sectional study was conducted in March 2007 among 35 consented sawmill workers. A total of 40 items; 10 items for knowledge (8 areas), 20 items for attitude (7 areas) and 10 items for practice (2 areas) were assessed. Statistical analysis for reliability analysis was test by internal consistency and construct validity by exploratory factor analysis using principal components and Varimax rotation method. Results: Cronbach’s alpha coeffi cients were acceptable for attitude (0.90) and practice
(0.75). However, it was low for knowledge (0.67). Exploratory factor analysis showed three meaningful exploratory factors that could explain the three dimensions in the questionnaire. Conclusion: The results of the validation study suggested that the noise-induced hearing loss questionnaire is reliable and valid tool for assessing knowledge, attitude and practice among sawmill workers.