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Fulltext Pilot study on depression among secondary school students in Selangor

Adlina S, Suthahar A, Ramli M, Edariah AB, Soe SA, Mohd Ariff F, et al.

Med J Malaysia, 2007 Aug;62(3):218-22.
PMID: 18246911 MyJurnal

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 role of acute internal medicine service in handling burden of medical access block in a tertiary hospital, Hospital Melaka experience

Adznan NUH, Gan CL

Med J Malaysia, 2021 Jan;76(1):68-72.
PMID: 33510112

INTRODUCTION: Access block is a major problem faced by most hospitals. It has led to congestions in emergency departments (ED) leading to sub-optimal or delayed treatment. Inevitably the spotlight falls on medical department, being accountable for the highest proportion of access block in ED.
MATERIALS AND METHODS: This is a retrospective study looking at data collected during office hours on 79 working days, excluding weekends and public holidays in Hospital Melaka, Malaysia. Details on all medical access block cases that were reviewed were recorded including their locations, diagnosis, disposition decisions and if they received specialist input at the time of their initial assessment by the medical team in ED. The aim is to revolutionise patient admission flow by offering early specialist care with rapid assessment, investigation and treatment. Hence, improving the overall treatment efficiency and reduce medical access block.
RESULTS: There were 1321 admissions. A total of 82% of the patients were admitted to the medical wards while 13% of them were given acute treatment in ED and discharged home with appropriate follow ups. We managed to resolve 18% of medical access block by re-triaging our cases and offering timely acute medical treatment. Nearly 90% of patients received first hand medical specialist input during the initial assessment by the Acute Internal Medicine (AIM) team in ED.
CONCLUSION: The significant resolution in medical access block with active screening, re-triaging and management of patients by the AIM team allows a more optimal hospital bed management. Patients also receive timely access to medical intervention with specialist care and stable patients can benefit from early supported discharge.
Fulltext Prevalence of smoking and drinking habits among Form Six students in Petaling District, Selangor

Afiah MZ, Hejar AR, Kulanthayan KC, Fadhilah J, Law TH

Med J Malaysia, 2006 Mar;61(1):41-7.
PMID: 16708733 MyJurnal

Smoking and alcohol intake patterns may persist from adolescence to adulthood. The aims of this study are to determine the prevalence and factors associated with smoking and drinking habits among Form Six students. This was a cross-sectional study conducted in January 2003 among Form Six students from government schools in the Petaling District, Selangor. A hundred and thirty six self-administered questionnaires were distributed to students selected through multistage stratified sampling. Response rate in this study was 90.1% (136/151). The respondents were mainly Chinese 60 (44.1%) and female 88 (64.7%). The prevalence of smoking was 22.8%, whereas the prevalence of alcohol intake was 47.8%. Only 33.1% of the respondents practiced undetermined activities and 1.5% have undetermined characters. There were significant associations between smoking and males (Adjusted OR 2.56, 95% CI 1.02-6.43) and smoking and alcohol intake (Adjusted OR 2.74, 95% CI 1.11-6.78). Alcohol intake has significant negative association with Malays (Adjusted OR 0.83, 95% CI 0.03-0.27). Smoking habits among adolescents were associated with males and alcohol intake. However, only alcohol intake was negatively associated with Malays. Program interventions to reduce behavioral problems, particularly smoking and alcohol intake should be emphasized.
Fulltext Diagnosis of thanatophoric dwarfism in utero

Afzal M, Singh J, Ong SK

Med J Malaysia, 1983 Mar;38(1):47-50.
PMID: 6633336

Thanatophoric dwarfism is a severe form of neonatal shortlimbed skeletal dysplasia. Most infants are stillborn or die soon after birth. This disorder has well defined radiological features which distinguish it from the other forms of neonatal dwarfism. We report two cases where short limbs were detected on sonography and a diagnosis was made on antenatal radiographs and fetography.
Fulltext Lethal neonatal dwarfism: a case of achondrogenesis

Afzal MK, Choo KE

Med J Malaysia, 1980 Sep;35(1):64-7.
PMID: 7254002

Achondrogenesis is a lethal neonatal chondrodysplasia with extreme micromelia and marked discrepancy between the relatively large head and the decreased trunk length. The affected neonates are usually delivered prematurely, and are stillborn or die soon after birth. Polyhydramnios is frequently present. It is an inherited autosomal recessive disease. The radiographic features are diagnostic.
Fulltext Deaths in visceral leishmaniasis (Kala-azar) during treatment

Ahasan HA, Chowdhury MA, Azhar MA, Rafiqueuddin AK, Azad KA

Med J Malaysia, 1996 Mar;51(1):29-32.
PMID: 10967976

Twenty-seven out of five hundred and fifty three patients hospitalized for visceral leishmaniasis (Kala-azar) died during treatment with sodium antimony gluconate. Data from these patients were evaluated to find out the cause of death. Eight patients had associated diseases such as pulmonary tuberculosis (3), severe malnutrition (1), acute gastroenteritis (1), spleenic infarction (1), acute renal failure (1) and atrial septal defect (1) which could be attributed to death. Twelve patients developed spontaneous haemorrhages from nose, gums and gastrointestinal tract and died, despite of adequate supportive measures. Seven other patients who were improving slowly with antimony therapy died unexpectedly. Though, cause of death could be explained in some patients with associated disease conditions, it could not be explained in others as significant clinical manifestations, haematological, biochemical and electrocardiographic alterations were not evident prior to death. Our impression is that mortality in Kala-azar patients during standard antimonial therapy is more related to the drug rather than the disease process.
Fibroadenoma of vulva

Ahluwalia HS, Gopinath A, Kumaradeva S

Med J Malaysia, 1978 Mar;32(3):215-6.
PMID: 683045
Squamous cell carcinoma of the larynx with sarcoma like stroma

Ahluwalia HS, Kandiah S, Kaur H

Med J Malaysia, 1977 Dec;32(2):172-4.
PMID: 614488
Endodermal sinus tumour of Teilum

Ahluwalia HS, Sharma DC

Med J Malaysia, 1973 Mar;27(3):223-4.
PMID: 4268930
Fulltext Knowledge of diabetes and lifestyle behaviour amongst indigenous population in Peninsular Malaysia

Ahmad B, Khalid BA, Quek KF, Anuar Z, Phipps ME

Med J Malaysia, 2013 Aug;68(4):309-14.
PMID: 24145258 MyJurnal

A cross-sectional study involving seven Orang Asli
settlements located in three different states in Peninsular
Malaysia; Johor, Selangor and Perak.
Fulltext The development and validation of diabetes knowledge questionnaire for the Indigenous population in Malaysia

Ahmad B, Ramadas A, Quek KF

Med J Malaysia, 2010 Dec;65(4):273-6.
PMID: 21901944 MyJurnal

The study's aim was to construct and validate a diabetes mellitus knowledge questionnaire in Bahasa Malaysia for Orang Asli (OA-DKQ). The questionnaire was administered to; case (Orang Asli) and control (administrative staff) groups at baseline and retested two weeks later. The Cronbach's Alpha was used to determine internal consistency and intraclass correlation coefficient (ICC) was used to determine test-retest reliability. The OA-DKQ has an internal consistency of 0.806. These findings suggest the OA-DKQ is an acceptable instrument to assess knowledge and preventive behaviour in Orang Asli (86 words).
Fulltext Fentanyl pre-treatment alleviates pain during injection of propofol-lipuro premixed with lignocaine

Ahmad N, Zanariah Y, Balan S

Med J Malaysia, 2008 Dec;63(5):431-3.
PMID: 19803312

We studied the effect of fentanyl pretreatment on alleviating pain during the injection of Propofol-Lipuro. One hundred and seventy patients were randomly allocated to receive either 100 mcg of intravenous fentanyl or normal saline (placebo) followed by intravenous Propofol-Lipuro premixed with 20 mg lignocaine. The incidence of injection pain was 32% and 13% in the placebo and fentanyl groups, respectively. We found a statistically significant reduction in incidence of injection pain in the fentanyl group when compared with the placebo group (p<0.003). The number needed to treat was 6 (3.2< 95% CI <15.1). In conclusion, fentanyl pretreatment is effective in alleviating pain during injection of Propofol-Lipuro.
Fulltext The current practice of sedation and analgesia in intensive care units in Malaysian public hospitals

Ahmad N, Tan CC, Balan S

Med J Malaysia, 2007 Jun;62(2):122-6.
PMID: 18705443 MyJurnal

We sought to review the current practice of sedation and analgesia in intensive care units (ICUs) in Malaysian public hospitals. A questionnaire survey was designed and sent by mail to 40 public hospitals with ICU facility in Malaysia. The anaesthesiologists in charge of ICU were asked to complete the questionnaire. Thirty seven questionnaires were returned (92.5% response rate). Only 35% respondents routinely assess the degree of sedation. The Ramsay scale was used prevalently. A written protocol for sedation was available in only 14 centers (38%). Although 36 centers (95%) routinely adjust the degree of sedation according to patient's clinical progress, only 10 centers (14%) interrupt sedation on a daily basis. Most respondents agreed that the selection of agents for sedation depends on familiarity (97%), pharmacology (97%), the expected duration for sedation (92%), patient's clinical diagnosis (89%) and cost (73%). Midazolam (89%) and morphine (86%) were the most commonly used agents for sedation and analgesia, respectively. Only 14% respondents still frequently use neuromuscular blocking agents, mostly in head injury patients. Our survey showed similarity in the choice of sedative and analgesic agents in ICUs in Malaysian public hospitals comparable to international practice. Nevertheless, the standard of practice could still be improved by implementing the practice of sedation score assessment and daily interruption of sedative infusion as well as having a written protocol for sedation and analgesia.
Fulltext Disease impact and patient insight--a study on a local population of asthmatics

Ahmad NS, Chan MY, Hiew FL, Sharif SA, Vijayasingham P, Thayaparan T, et al.

Med J Malaysia, 2003 Oct;58(4):526-32.
PMID: 15190628

The cornerstone of asthma management is achieving adequate symptom control and patient education. We studied in our local population of asthmatic patients how well their symptoms were controlled with currently prescribed treatment and their insight into the disease and its management. Over a 6-month period, 93 asthmatics recruited from two local government health clinics and a state hospital were interviewed using a standard questionnaire. Patients were classified into 4 groups based on the treatment they were on according to Global Initiative for Asthma (GINA) treatment guidelines. The number of patients in Step 1 (rescue medication alone), Step 2 (1 controller medication), Step 3 (2 controller medications) and Step 4 (at least 3 controller medications) were 8, 39, 34 and 12, respectively. Except for day symptoms in Step 1 group, fewer than 50% achieved minimum day or night symptoms and no restriction of daily activities. Questions on patient insight were only available for 50 patients. Weather change (74%), air pollution (66%) and physical stress (46%) were the three highest ranked common asthma triggers. More than half correctly recognized the important symptoms of a serious asthma attack but fewer than 15% were familiar with the peak flow meter and its use or with the asthma self-management plan. Most patients perceived that their treatment had helped reduce disease severity and exacerbations. We conclude that symptom control and some aspect of patient education are still lacking in our local asthmatics.
Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan; Klinik Kesihatan Seremban; Klinik Kesihatan Ampangan, Malaysia
Fulltext Posterior mediastinal abscess secondary to esophageal perforation following fish bone ingestion

Ahmad R, Ishlah W, Shaharudin MH, Sathananthar KS, Norie A

Med J Malaysia, 2008 Jun;63(2):162-3.
PMID: 18942310 MyJurnal

Accidental swallowing of fish bone, which arrested in esophagus, is fairly common. However the incidence of esophageal perforation due to fish bone swallowing is low. Delayed posterior mediastinal abscess as a result of the esophageal perforation is a rare manifestation and may lead to fatal outcome. Two cases of delayed formation of posterior mediastinal abscess following esophageal perforation due to accidental fish bone ingestion are described here. In these cases patients presented with interscapular back pain. In one of the cases the patient died because of the presentation was misdiagnosed hence leading to delay in the intervention. Radiological findings and surgical management namely esophagoscopy and neck exploration are briefly described.
Fulltext Endonasal endoscopic resection of intranasal haemangioma

Ahmad R, Norie A

Med J Malaysia, 2006 Dec;61(5):644-6.
PMID: 17623972 MyJurnal

Intranasal haemangioma is quite rare. This tumor may be confused with other intranasal vascular tumor such as juvenile nasopharyngeal angiofibroma (JNA), glomus tumors as well as other tumor such as angiosarcoma and leiomyoma. Juvenile nasopharyngeal angiofibroma is the most common vascular tumor encountered in nasal cavity. A definitive histology diagnosis pre-operatively is difficult to be obtained as the biopsy may lead into severe uncontrolled bleeding. The final diagnosis very much depends on histology after the tumor excision. Complete surgical resection of the tumor is the standard approach. In this report we describe our surgical management in approaching intranasal haemangioma endoscopically and this pathology can be considered as one of differential diagnosis for unilateral nasal mass.
Fulltext Cochlear implantation in congenital cochlear abnormalities

Ahmad RL, Lokman S

Med J Malaysia, 2005 Aug;60(3):379-82.
PMID: 16379199

Many children have benefited from cochlear implant device including those with congenital malformation of the inner ear. The results reported in children with malformed cochlea are very encouraging. We describe 2 cases of Mondini's malformation with severe sensorineural hearing loss. Cochlear implantation was performed and both of them underwent post-implantation speech rehabilitation. Post-implantation, both of them were noted to respond to external sound. But the second case developed facial twitching a few months after the device was switched on. It is important to evaluate the severity of the inner ear deformity and the other associated anomalies in pre-implantation radiological assessment in order to identify the problem that may complicate the surgery and subsequent patient management.
We're making it work! UKM'S Speech Sciences Programs' teleclinic experience in the time of COVID-19

Ahmad Rusli Y, Hassan FH, Haris SM, Mohd Azraai H, Md Almi SN

Med J Malaysia, 2021 08;76(Suppl 4):52-54.
PMID: 34558561

This paper highlights issues, challenges, and lessons learnt from implementing a speech-language therapy teleclinic service delivery model by the Speech Sciences Program, Universiti Kebangsaan Malaysia (UKM) during the wake of the recent COVID-19 pandemic. The teleclinic service provision was initially started to help our student cohorts attain and complete the required direct contact speechlanguage therapy clinical hours for graduation during the pandemic. It has since evolved to be an integral part of the clinical practicum curriculum and a service delivery model that is here to stay. Although far from perfect, the program hopes to systematically continue our endeavours in telerehabilitation as one of our niche areas, realising the wealth of benefits that this service delivery model has to offer.
The uptake of Mammogram screening in Malaysia and its associated factors: A systematic review

Aidalina M, Syed Mohamed ASJ

Med J Malaysia, 2018 08;73(4):202-211.
PMID: 30121682 MyJurnal

INTRODUCTION: This review aimed to summarise the trend of mammogram screening uptake published in local studies between years 2006 and 2015 among the Malaysian women aged 40 years and above, and identify the associated factors and barriers, as well as discuss limitations of the studies and research gaps.
METHODS: A systematic review was conducted on breast cancer screening studies among Malaysian women, published between January 2006 and December 2015. Online databases were searched using keywords: "mammogram", "mammography", "uptake", "breast cancer screening" and "Malaysia".
RESULTS: Thirteen original articles were reviewed. The rate of mammography uptake ranged between 3.6% and 30.9% among the general population, and 80.3% among personnel of a tertiary hospital. Factors associated with mammogram screening were clinical breast examination, age, income, knowledge on breast cancer and mammogram, perceived susceptibility to breast cancer, ethnicity and education level. Barriers to mammogram screening were lack of knowledge, embarrassment, fear of cancer diagnosis, perception that breast screening was unnecessary, lack of coping skills and pain during procedure. However, almost all of the studies could not be generalised beyond the study sample because of the limited number of sites and respondents; and most data were self-reported with no objective measures of the responses.
CONCLUSION: Mammogram screening uptake among women in selected communities were generally low. Further studies involving the general population are essential. Future studies should also explore the availability, affordability and accessibility of this service especially in the pursuit of achieving universal health coverage in breast cancer management.
COVID-19 vaccination: a systematic review of vaccination strategies based on economic evaluation studies

Aidalina M, Khalsom S

Med J Malaysia, 2023 May;78(3):411-420.
PMID: 37271852

INTRODUCTION: Countries must employ the most efficient way to vaccinate their population with the COVID-19 vaccines, given the vaccines' low availability compared to its demand. This review aims to identify and compare the different COVID-19 vaccine delivery strategies employed internationally in the recent year based on the economic evaluation findings and subsequently to recommend the most cost-effective strategy among them.
MATERIAL AND METHODS: A systematic review was conducted by examining online databases (Scopus, MEDLINE and Science Direct) to identify health economic evaluation studies of COVID-19 vaccines. Critical appraisal of studies was conducted using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).
RESULTS: A total of nine studies were selected for analysis. Results show two strategies that were cost-effective compared to its comparators: mass vaccination program compared to no vaccination and universal vaccination approach compared to a risk-stratified vaccination approach. Several other strategies were found to increase the cost-consequences in the COVID-19 vaccination program: higher vaccine effectiveness, higher vaccination pace, increased vaccination coverage, and vaccine prioritisation for an at-risk population. The study findings were restricted to analysis based on the current available data.
CONCLUSION: COVID-19 vaccination policies should aim for increased vaccine production as well as a rapid and extensive vaccine delivery system to ensure the maximal value of vaccination strategies. These results can aid policymakers in opting for the most efficient approach to vaccinating the population during this COVID-19 pandemic and future pandemic.

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