Haemoglobin Bart's hydrops foetalis syndrome (--SEA/--SEA) is not compatible with life and contributes to a majority of the hydropic foetuses in the Malaysian Chinese alpha-thalassaemia carriers who possess the 2-alpha-gene deletion in cis (--SEA/alphaalpha). A duplex-PCR which simultaneously amplifies a normal 136 bp sequence between the psialpha-alpha2-globin genes and a 730 bp Southeast Asian deletion-specific sequence (--SEA) between the psialpha2-theta1-globin genes was established. The duplex-PCR which detects the --SEA deletion in both chromosomes serves as a rapid and cost-effective confirmatory test in the antenatal diagnosis of Haemoglobin Bart's hydrops foetalis syndrome in Malaysia. In addition, the duplex-PCR is simple to perform as both the normal and deletion-specific alpha-globin gene sequences are amplified in the same PCR reaction.
The genetic property of subclinical eating behaviour (SEB) and the link between SEB and polycystic ovary syndrome (PCOS) has been studied before but the role of leptin within this connection has never been investigated. The objective of this study was 1). to study the genetic property of SEB. 2). To find a link between leptin, SEB and PCOS. One hundred and fifty four (77 pairs) female-female Iranian twins including 96 MZ individuals (48 pairs) and 58 DZ individuals (29 pairs) participated in the study. Clinical, biochemical and ultrasound tools were used to diagnose polycystic ovary syndrome. BITE questionnaire was filled out for subjects. Eight percent of subjects were diagnosed for subclinical eating disorder. No significant difference was found between intraclass correlation of MZ and DZ (z = 0.57, P = 0.569). Serum leptin level correlated significantly with bulimia score (P < 0.007). The mean (+/-SD) value for bulimia score was found to be higher among PCOS(positive) subjects (3.27 +/- 5.51) in comparison with PCOS(negative) subjects (2.06 +/- 4.48) (P < 0.001). The genetic property of subclinical eating disorder was not confirmed as shared environment might have played a major role in likeliness of DZ twins as well as MZ. Leptin is linked with both subclinical eating disorder and PCOS.
Human amniotic membrane as a homograft material was compared to temporalis fascia to close tympanic membrane perforations in 50 patients with chronic otitis media. Human amniotic membrane was used in 20 patients while temporalis fascia was used in the remaining 30. Anatomical closure of the perforation and reduction of the air-bone gap was measured. The graft uptake showed a 65% success rate for the amniotic membrane and 56.7% for the temporalis fascia at 3 months post-operatively. Significant closure of air-bone gap was observed in the human amniotic group. These results indicate comparable outcomes between human amniotic membrane and the temporalis fascia graft.
A cross-sectional study was conducted among 517 patients with diabetes mellitus at all health centres in Melaka Tengah District to examine whether these patients and their associated cardiovascular risk factors were managed according to current guidelines. All patients had Type 2 diabetes mellitus with mean age of 57.9 +/- 10.5 years and the mean duration of diabetes was 7.2 +/- 6.0 years. The glycaemic control was poor with 53.6% of the patients having HbAlc above 8% (mean = 8.5%) and 24% of them had microalbuminuria. Among these patients with poor glycaemic control, about 47.6% of them were on monotherapy. Three hundred and fifty (67.7%) patients had hypertension but only 11 (3.1%) achieved target blood pressure of less than 130/80 mmHg. Only 18.3% of the diabetics with hypertension were prescribed angiotensin converting enzyme inhibitors and 0.3% with angiotensin receptor blockers. Nearly two-third of them had low-density lipoprotein cholesterol greater than 2.6 mmol/l (mean = 3.4 mmol/l) but only 6.8% were prescribed lipid-lowering agents. Aspirin was prescribed to 8.2% of diabetics aged above 40 years. Sixteen percent of the patients smoked, 53% did not do any exercise, and the mean BMI was 26.8 kg/mn. The management of diabetes mellitus and its associated cardiovascular risk factors was suboptimal on the basis of current clinical guidelines. A greater effort in educating doctors in the health centres about these management and adherence to the guidelines is important in reducing patients' risk of cardiovascular disease and its associated morbidity and mortality.
Chronic Obstructive Pulmonary Disease (COPD) is a growing health problem worldwide and in Malaysia. Until recently, research on COPD has been slow and difficult, partly due to the huge heterogeneity of this disease, and its variable and imprecise definitions. To perform a descriptive study on a convenient sample of local patients with COPD treated in a state hospital in Malaysia. Fifty-two patients [mean (95% CI) age: 67 (63-70) years; 86% male: 38% Malays, 36% Chinese, 25% Indians; mean (95% CI) PEFR: 45 (40-51) % predicted normal] were interviewed. Clinico-demographic data was collected using a structured questionnaire and health-related quality of life was scored using St George's Respiratory Questionnaire (SGRQ). For analysis, patients were also divided into moderate (n=17) [PEFR 50% to 80%] and severe (n=35) [PEFR < 50%] disease groups. Except for education and total family income, demographic and comorbidity variables were comparable between the two groups of COPD severity. All except 9% of patients were current or ex-smokers. Breathlessness, not chronic bronchitis (i.e. cough and sputum), was the first ranking respiratory symptom in over 70% of the patients, whether currently or at early disease manifestation. Between 5 and 15% of the patients denied any symptom of chronic bronchitis as current or early stage symptoms. Duration of symptoms prior to the diagnosis varied considerably with about 9% having symptoms for over 10 years. Over 80% of the patients smoked for over 15 years before the onset of symptoms. Quality of life in patients with COPI) was generally poor and similar between both COPD severity groups. About one fifth of the patients had exacerbations more than 12 times a year. While many features described in our local patients are well recognized in COPD, the finding that 'chronic bronchitis' is not a prominent symptom in the current or past history may have important implications in the diagnosis of at risk individuals and patients with early disease requiring attention. More research is required to confirm and to understand this.
Post Arthroscopic intra-articular analgesia is a better method to avoid post-operative pain after arthroscopic surgery, thus avoiding the adverse effects of systemic analgesics. In this prospective randomized double blind study conducted on 90 patients, 30 patients in group A received 20 ml of intra-articular saline, 30 patients in Group B received 10 ml of intra-articular saline and 10 ml of 0.25% bupivacaine and 30 patients in Group C received 10 ml of 0.25% bupivacaine, 1 ml (30 mg) of ketorolac and 9 ml of saline intra-articularly. Ambulatory status, duration of analgesia and requirement for supplemented analgesia were compared in these three groups. Patients receiving this intra-articular analgesic combination of bupivacaine and ketorolac required significantly less supplemental postoperative analgesics. This combination significantly prolonged the duration of analgesia. Patients receiving this combination of drugs for intra-articular analgesia ambulated earlier.
Stroke is a leading cause of death and disability in most developed countries and developing nations. Majority of the stroke survivors are left with significant physical and cognitive impairments. In addition to the improved acute stroke care, they often benefit from rehabilitation in improving their function. This was the first study done to document function for post stroke patients in Malaysia. It was prospective study conducted to document functional status of acute stroke patients upon admission, discharge and at 3 months post stroke. Assessment of functional status for these patients are based on their activities of daily living and ambulation i.e. self-care, sphincter control, mobility, locomotion, communication and social cognition. It is also aimed to describe their demographic and clinical characteristics. Correlation of functional status at 3 months post stroke with the initial severity of stroke was also explored. A total of fifty-one patients with acute stroke in University Malaya Medical Centre (UMMC) were recruited. The patient's age ranged from 38 to 83 years with a mean of 60.2 years. Thirty-six patients (71%) were first stroke sufferers and fifteen patients (29%) had recurrent stroke. At discharge from acute stay, 13% of patients were able to ambulate with aids and 87% needed assistance for ambulation in varying degrees. Eighty-two percent of patients showed improvement in overall function (both motor and cognition) at 3 months post stroke. Sixty percent of patients were independent in ambulation and 40% required assistance. Significant correlation was seen between the initial severity of stroke and functional status at 3 months post stroke. Functional status of patients with stroke has improved at 3 months post stroke. A comprehensive rehabilitation medicine programme should be incorporated into management of stroke patients to expedite functional recovery and improve patient's independence.
To determine the relationship between socio-demography, knowledge and attitude regarding prostatism among male in-patients in Teluk Intan Hospital. Two hundred respondents were recruited. Questionnaires that consist of demographic data such as age, ethnicity and religion and some question that pertaining knowledge and awareness were used. The questions eliciting symptoms of prostatism were based on the International Prostate Symptom Score (IPSS). 76.0% of the respondents were symptomatic as they presented with prostatic symptoms. The prevalence of asymptomatic cases is higher (6.7%) among the adults whereas the percentage in elderly respondents is higher than the adults in moderate to severe cases (p < 0.001). Only 10% of respondents have heard about prostatism and mass media is ranked highest as the most preferred source of information regarding this matter with 66.7% preference. About 85.70% of respondents who had a severe score and 18.5% who had a moderate score were dissatisfied with their quality of life due to prostatic symptoms. This study provides a deeper understanding on the prevalence and severity of the prostatic symptoms and its association with the quality of life. It also illustrates low awareness, poor health seeking behaviour and poor knowledge pertaining to prostatism among the study population.
Sinusitis is an important cause of morbidity and one of the major sources of income loss. Anatomical variations of the nose have been reported to predispose to sinusitis. These variations include concha bullosa, nasal septal deviation and oversized bulla. The aim of this study was to determine the proportion and the distribution of concha bullosa in patients with chronic sinusitis and to determine the relationship between concha bullosa and age, sex, ethnicity. A cross-sectional study was conducted at the Department of Ear, Nose and Throat in Kuala Lumpur Hospital (HKL). Data was collected retrospectively using a pretested proforma. All patients who underwent Sino nasal surgery between January 1999 and December 2000 and whose preoperative CT scans were available were included in the study. The CT scans were reviewed. Analysis was carried out using Statistical Package for Social Sciences. Out of 146 patients who underwent sinonasal surgery between January 1999 and December 2000, 101 (69.2% preoperative CT scans of these patients were available and these were reviewed. The proportion of patients with concha bullosa was 49.5%. The results showed that there was significant relationship between presence of concha bullosa and age and sex. The overall mean age of patient with concha bullosa was 35.7 years (95% CI 12.1-39.3) and ranged from 11-years to 56-years. The mean age of respondents with concha bullosa was significantly lower than patients without concha bullosa 41.98 (95% CI 37.6-46.3; t-test = 2.221; df=99; p < 0.05). Concha bullosa was significantly more in females (66.0%) compared to males (chi2 = 4.465, df=1, p < 0.05). There was no significant relationship between presence of concha bullosa and ethnicity.
To determine the immunisation status of hospitalised infants and to examine the potential risk factors associated with incomplete immunisation. Prospective study of infants admitted to a paediatric hospital in Kuala Lumpur, conducted by interviewing carers. Twenty-two percent of infants had incomplete immunisation. The most significant factor that was associated with incomplete immunisation was the carer's lack of knowledge on the timing of the next immunisation (p = 0.005). Other factors that had significant association were the presence of a previous admission to hospital (p = 0.03) and the infant's age of more than 6 months (p = 0.025). The rate of incomplete immunisation in the study population was 22%. An admission to hospital of an infant should be taken as an opportunity to update their immunisation in order to improve the rate of uptake.
The use of 'spare part' tissue from an amputated segment to cover a stump with soft tissue deficiency is a viable option for augmenting the shape of the stump and preserving functional length of the stump without additional donor morbidity. The procedure requires no microsurgical skill if the tissues are used as pedicle fillet flaps transfer. This concept of fillet flap makes the amputation distal to an unfavourable definitive amputation site such as in congenital constriction band possible. We report herein a case of amputation distal to constriction ring to illustrate the application of fillet flap in reconstruction surgery.
Double dislocations of joints of the thumb are uncommon injuries. We report an unusual case of simultaneous dislocation of the metacarpophalangeal (MCP) and subluxation of the carpometacarpal (CMC) joints of the thumb in a child to illustrate problems related to their treatment.
Hip dislocation in pregnancy is an uncommon injury. We report a case of traumatic hip dislocation in the third trimester of pregnancy to highlight potential problems associated with its treatment. The rationale for choosing the preferred treatment options is discussed.
In many developed countries, the incidence of rubella and congenital rubella syndrome (CRS) is considered to be negligible due to the availability of an effective vaccine. However, in Malaysia, several CRS cases are seen every year. This casts doubt on the effectiveness of the rubella vaccination programme. Very few seroprevalence studies were done over the years, making it difficult to discuss the effectiveness of the vaccination programme. The objective of this study is to determine the prevalence of rubella immunity among pregnant women attending antenatal clinics in a local teaching hospital. The hospital database on rubella immunity was assessed retrospectively from August 2001 to June 2002. A cross-sectional study of interviewed method as well as determination of rubella immunity by laboratory tests were carried out in July 2002. A total of 414 women were included, of whom 134 women were interviewed. The rubella immunity status was 92.3%. Based on this figure, rubella vaccination programme in Malaysia is a success despite the presence of CRS cases. Malaysia must ensure rubella vaccine coverage among target groups is high in order to minimise CRS cases.
Study site: Antenatal clinic, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
A quality assurance study was carried out prospectively in two phases at the Neonatal Intensive Care Unit (NICU) of Hospital Universiti Kebangsaan Malaysia. The objectives of the study were to determine the turn-around-time (TAT) of radiographs requested for infants undergoing intensive care treatment in the NICU and the effects of a standard operating procedure introduced based on initial findings of first phase of the study on subsequent TAT. The TAT was defined as the time taken for the radiograph to be ready for viewing after the attending doctor had requested for it to be done on an infant. During phase one of the study, none of the requested radiographs was ready to be viewed by the doctors within the standard TAT of 45 minutes. The problems identified were ward staffs delay in sending request forms to the radiology department, radiographers' delay in shooting and processing the films, and delay by NICU porter in collecting the processed films. Based on these findings, a standard operating procedure (SOP) was drawn up jointly by the staff of NICU and Department of Radiology. During phase two of the study conducted at one month after implementation of the SOP, there was a reduction of TAT by 50%. However, only 3 (4.3%) of the radiographs achieved the standard TAT. The main problems identified during phase two were delay in sending request forms and in collecting processed radiographs by the porter system. The dismal TAT of radiographs in NICU was related primarily to human behaviour. Besides continuous staff education, replacement of the porter system with electronic system may improve the TAT.
Keywords: Turn-around time, radiographs, neonatal intensive care unit, standard operating procedure, Kuala Lumpur
Stigmatising attitudes towards mental illness may improve with clinical exposure during medical school training. Attitudes of 48 fourth year medical students in Universiti Kebangsaan Malaysia were assessed before and after their compulsory attachment in Psychiatry, using the Attitude Towards Psychiatry-30 (ATP) and the Attitude towards Mental Illness (AMI) questionnaires. ATP scores improved significantly with training (104.8 and 114.4, pre- and post-attachment respectively) as did AMI scores (63.4 and 68.1 respectively). Both improvements were statistically significant. (ATP: z = 4.55, p < 0.0005) (AMI: z = 3.75, p < 0.0005). Attitudes towards mental illness appeared to have become more favourable with clinical training in psychiatry.
Aplastic anemia is a relatively uncommon disease and conventional management options include immunosuppressive drugs and/or haematopoeitic stem cell transplantation. It is now known that the pathogenesis of aplastic anemia is immune mediated. Mycophenolate mofetil is a common immunosuppressive drug now used mainly in prophylaxis of graft rejection in organ transplant and also for prevention/treatment for graft versus host disease in haemtopoeitic stem cell transplantation. It is thought that mycophenolate mofetil may be useful in this group of patients. In this short report, mycophenolate mofetil was tried in 6 patients who had severe aplastic anemia with variable doses for a minimum duration of 9 months. The result has however not been encouraging.