Inefficient metered-dose inhaler (MDI) technique results in poor drug delivery, suboptimal disease control a possibility of inhaled medication overuse. The MDI technique of 134 government hospital and clinic followed-up adult asthmatic patients followed-up in a government hospital and a heath clinic was pragmatically assessed based on the 3 obligatory steps of adequate lip seal, appropriate hand-breath coordination and sufficient breath holding after inhalation. The relationship between technique efficiency and frequency of daily short-acting beta2-agonist (SABA) use via the MDI and asthma exacerbations over a 12-month period was also assessed. Fifty-six patients (42%) had inefficient MDI technique. All demographic and asthma-related variables between the 'efficient' and 'inefficient' technique groups of patients were comparable except for significantly longer mean years of MDI use in the 'efficient' technique group [mean (SD): 10 (7) vs. 7 (5); p=0.003]. There were no significant differences between the two groups in relation to frequency of daily SABA use or asthma exacerbations over the past 12 months. Despite having been available in Malaysia for a considerable period of time, the MDI device is still poorly handled by a large proportion of adult asthmatic patients. Changing to other more user-friendly devices or use of spacer devices to facilitate delivery should be considered for these patients.
Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan; Klinik Kesihatan Seremban, Malaysia
A prospective clinical study of 181 patients with psoriasis seen in Seremban General Hospital showed the incidence of psoriasis among dermatology outpatients was 2.15%. A significantly higher proportion of male patients were affected, with a male to female ratio of 1.7:1. Within the racial groups; 63 were Malays, 37 Chinese, and 81 Indians. There was a significantly higher proportion of Indians affected as compared with the races. The mean age of patients in this study was 43.7 years old but the mean age of onset of psoriasis in these patients was 33.1 years old. Thirty-one (17.1%) patients gave a positive family history of psoriasis and the mean age of onset of psoriasis was lower (29.3 years old) for patients with a positive family history. Plaque psoriasis was the commonest type of clinical presentation with the scalp being the commonest site affected. Psoriatic arthropathy was seen in 35 (19.3%) patients. Ninety-five (52.5%) patients gave a positive history of factors exacerbating their pre-existing disease and stress was singled out as the most common exacerbating factor.
Study site: Skin clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia
The bioavailability of a generic diclofenac sodium sustained release tablet preparation (Zolterol, SR) was compared with the innovator product, Voltaren, SR. Twelve healthy adult male volunteers participated in the study, which was conducted according to a randomized, two-way crossover design with a wash out period of one week. The bioavailability of diclofenac was compared using the parameters area under the plasma concentration-time curve (AUC(0-infinity)), peak plasma concentration (Cmax) and time to reach peak plasma concentration (Tmax). No statistically significant difference was observed for both logarithmically transformed AUC(0-infinity), Cmax values and Tmax value of the two preparations.
Six children with Acute Disseminated Encephalomyelitis (ADEM) were seen at the Penang Hospital over a two year period (July 1999-June 2001). Diagnosis was based upon typical clinical features and characteristic findings on neuroimaging. Cerebrospinal fluid examination and other investigations were done, where appropriate, to rule out other causes of central nervous system disease. Three children had a prodromal illness. The most common presenting symptoms were fever, seizures, ataxia, focal neurological deficits and labile mood. Two children presented with status epilepticus. All children had an abnormal neurological examination. Brain magnetic resonance imaging revealed hyperintense signals on T2-weighted and FLAIR sequences in the subcortical and deep white matter regions of the frontal, parietal, and temporal lobes, as well as in the thalami, cerebellum and brainstem. One child had multiphasic disseminated encephalomyelitis (three episodes). The child with multiphasic disease had only one treated episode, and has suffered mild disability. Three children were treated with either methylprednisolone or immunoglobulins, and remain well. One child received both treatments but expired as a result of severe gastrointestinal bleeding from the use of methylprednisolone. The child who was not treated has severe disability.
Chronic disability in children imposes great strains on a family. The responsibility of mothering disabled children may be detrimental to the well-being of mothers. This study aims to assess the different types of coping styles of mothers with disabled children and its influencing factors. It is a cross-sectional study using Coping Inventory Stressful Situation (CISS) scale to determine the mothers' coping styles. A sample of 81 mothers with disabled children attending two rural Community Rehabilitation Centres, were included in the study. Overall, the mothers were using a mixture of coping strategies. However, they scored more in the task-oriented (mean T score = 52.88) and emotion-oriented (mean T score = 50.52) coping styles, while the other subscales of coping styles, namely avoidance, distraction and social diversion were below average (mean T score < 50). Divorced mothers (p=0.04) and those with low educational level (p=0.00) were more inclined to use emotion-oriented coping strategies while mothers with younger children (< 5 years old) used more avoidance coping strategies (p=0.01). There were no significant difference of coping styles in association with the mothers' age, ethnicity, duration of marriage, number of siblings, child's birth order or gender. By understanding the mothers' coping styles, health care workers would be able to educate the mothers with effective coping strategies and consequently reduce their psychological distress.
This study reviewed the trabeculectomies (TEs) carried out in University Malaya Medical Center between 1994 to 1998. One hundred and nine of 132 eyes operated were in the primary glaucoma group of which 63 (47.7%) were of the open angle type and 46 (34.8%) were of the angle closure type. Twenty-three eyes belong to the secondary glaucoma group. Sixty-five eyes had plain or non-augmented trabeculectomy (TE) while 20 were augmented with mitomycin C (MMC) and 11 with 5 flourouracil (5FU). In 31 eyes the plain TEs were combined with extracapsular cataract extraction (ECCE) and 4 with phacoemusification. One case had combined ECCE and augmented trabeculectomy with mitomycin-C. The patients were followed up at 1 month, 6 months, 1 year and 2 years. Ninety-four of 132 (71.2%) eyes had successful surgery with intraocular pressure (IOP) of less than 21 mmHg (tonometric success) at the end of 2 years. Four of these patients needed topical medication for the IOP control. More failures were seen in patients with cystic blebs than those with diffuse blebs. Complications include hypotony, shallow anterior chamber, cataracts and hyphaema. The majority of cases (53%) had no complications.
A rare case of partially thrombosed giant serpentine right middle cerebral artery aneurysm presented. A 26 year old man initially presented with headache and 3 months later developed neurological deficit. Various stages of clot with patent residual lumen seen on neuroimaging, led to the diagnosis. Catheter angiography is the investigation of choice for evaluating the location, flow dynamics and extent of the serpentine aneurysm. The patient had embolisation done for the giant serpentine aneurysm.
We conducted a prospective study in order to audit our experience of repairing cranial defects using Methyl methacrylate. This included a total of 49 patients undergoing cranioplasty using methyl methacrylate, of which 45 were males and 4 females. The age of patients at the time of surgery ranged from 16 to 40 years old, with an average of 24 years. Malays were the majority (67%), followed by Chinese (23%) and Indian (10%). Cranial defects were mainly caused by motor vehicle accident (94%), while gunshot wounds, industrial accidents and tumours, each contribute 2%. Bone flaps were commonly removed during previous surgery related to traumatic subdural haemorrhage (33%), contusion (21%) and intracerebral haemorrhage (14%). The size of cranial defects ranged from 28 cm2 to 440 cm2, with an average of 201 cm2. Most had right sided (55%) and lateral defects [temporoparietal (52%) followed by temporal (16%), frontal (16%), frontotemporal (14%) and occipital (2%)]. Duration of surgery ranged from 70 to 275 minutes, with an average of 135 minutes. Nine of 12 patients (75%) with neurological disability had some improvement while 85% of symptomatic patients had symptoms improvement after cranioplasty. The infection rate in this series was 4%.
Systemic Lupus Erythematosus (SLE) is a disease with multiorgan involvement and multiple autoantibody production including antineutrophil cytoplasmic antibodies (ANCA). Despite its reported prevalence in more than one third of SLE patients, the role of ANCA in the pathogenesis or otherwise in SLE remains unresolved. 131 SLE patients had been previously studied for various serologic parameters of disease activity. Their cumulative organ involvement in the course of their disease had also been determined and the Lupus Activity Index (LAI) calculated. Their stored sera were then screened for the presence of ANCA by two methods viz Indirect immunofluorescence (IIF) and also enzyme-linked immunosorbent assay (ELISA). ANCA was present in 24.8% of these SLE patients. The atypical ANCA pattern was predominant and accounted for an overall of 20.6%. Anti-MPO and anti-PR3 were detected in 1.5% of patients respectively. No association was found between ANCA positivity and disease activity. There was also no association of ANCA with specific organ involvement. Despite the high prevalence of ANCA especially the atypical variant in SLE, they probably represent only one of the wide repertoire of autoantibodies found in this disease. Routine testing for ANCA in lupus patients is therefore not recommended.
We determine the familial aggregation and determinants of post challenge blood glucose (BG) in four ethnic populations. A national health survey was conducted in Malaysia in 1996. 18,372 subjects aged 30 years or older had post challenge BG measurements and another 846 subjects were pre-diagnosed to have diabetes on drug treatment. We imputed the BG of diagnosed diabetics by randomly selecting a value from the BG distribution of undiagnosed diabetics. Covariates of interest include ethnicity, gender, age, urban-rural residence, body mass index (BMI), physical activity, education, and household income. Ethnic and gender differences in mean BG persisted after adjustment for other covariates. Age and BMI were the only two factors with strong, positive and consistent effects on mean BG in all ethnic-sex groups. Family resemblance for BG as measured by intraclass correlation was small and homogenous across all ethnic groups and did not differ from resemblance in BG between spouses. In conclusion, BMI was the only consistent modifiable predictor of BG in all ethnic-sex groups. Environmental factors are probably more important than genetic factors as determinant of BG in the four ethnic populations studied.
Rhinosinusitis is a common disorder with various etiological factors. In our clinical practice allergy seems to be a predominant cause followed by other less common causes like infection, drugs and aspirin hypersensitivity. We present a case of chronic rhinosinusitis secondary to hypothyroidism. Although hormonal causes like hypothyroidism have been proven to cause nasal congestion and rhinosinusitis, this is the first reported case of chronic rhinosinusitis in Hashimoto's thyroiditis in our center. This is a diagnosis of exclusion for chronic rhinosinusitis not responding to optimal medical therapy.
Haemangiopericytoma (HPC) is a rare tumour with a predilection for the central nervous system. Though previously thought to originate from the meninges and ventricular walls, HPC's are currently accepted as distinct mesenchymal neoplasms unrelated to meningiomas. Haemangiopericytomas have been previously reported to be associated with the production of insulin like growth factor II (IGF-II) and hypoglycaemia. A case of a 61-year-old poorly controlled diabetic lady with a rare presentation of an abdominal haemangiopericytoma is discussed. A laparoscopic assisted resection of the massive lobulated tumour arising from the parietal peritoneum with dense attachment to the diaphragm and the liver was performed with an uncomplicated postoperative recovery. Control of the patient's diabetes improved dramatically following surgery and the rare association of hyperglycaemia and HPC, which has not been previously described, is elaborated upon in this report.
A cross sectional study was conducted to assess the level of awareness and knowledge of common eye diseases (cataract, glaucoma, diabetic retinopathy and refractive errors) among 473 academic staff (non-medical faculties) of University Malaya. The awareness of cataract was in 88.2%, diabetic retinopathy in 83.5%, refractive errors in 75.3% and glaucoma in 71.5% of the study population. The knowledge about all the above common eye diseases was moderate, except presbyopia which was poor. Multivariate analysis revealed that females, older people, and those having family history of eye diseases were significantly more aware and more knowledgeable about the eye diseases. Health education about eye diseases would be beneficial to seek early treatment and prevent visual impairment in the society.
Water-based cooling towers and their water supply at two hospitals in Johor were surveyed for the presence Legionella pneumophila. L. pneumophila were grown from 19 (76%) out of 25 collected water samples. One hospital cooling tower was contaminated with L. pneumophila serogroup 1.
Malnutrition including vitamin A and iron deficiency and parasitic diseases have a strikingly similar geographical distribution with the same people experiencing both insults together for much of their lives. Parasitic infections are thought to contribute to child malnutrition and micronutrient deficiency through subtle reduction in digestion and absorption, chronic inflammation and loss of nutrients. Parasites may affect the intake of food; it's subsequent digestion and absorption, metabolism and the maintenance of nutrient pools. The most important parasites related to nutritional status are intestinal parasites especially soil transmitted helminthes, Giardia duodenalis, Entamoeba histolytica, followed by other parasites such as the coccidia, Schistosoma sp. and malarial parasites.
A patient who underwent emergency laparotomy for rectal prolapse developed repeated abdominal wound dehiscence and subsequently an enteric fistula. The management of abdominal wound dehiscence is discussed, specifically with regards to the Bogota bag. Use of Bogota bag has been reported worldwide but this may be the first report here.