Background: Urinary incontinence is a common problem among older women. The objective of this study was to determine the prevalence of urinary incontinence among older women aged 55 years and over in the Klang valley, the most densely populated urban area in Malaysia, and to determine any potential ethnic differences.
Methods: This study used cross-sectional data from the Malaysian Elders Longitudinal Research (MELoR) study. A total of 863 participants were included, with a mean age of 67.97 ± 7.50 (S.D.). They were selected by simple random sampling from the electoral rolls of three parliamentary constituencies.
Results: The prevalence of urinary incontinence was 30.8%. Mixed urinary incontinence (UI) was present in 44.7%, stress UI in 39.1% and urge UI in 16.2%. Ethnic Malays (38%) were more likely than ethnic Indians (32.3%) and Chinese (29.7%) to have UI. Ethnic Malays were also more likely to have stress UI and Indians were more likely to have urge UI .
Conclusion: The prevalence of UI in this study was comparable to other Asian and worldwide studies. The significant association between ethnicity and UI, however, has not been reported in any previous studies. Further studies should identify factors which may determine these ethnic differences in UI.
The aim of this review is to critically analyse the available literature and to propose a rational, safe and cost-effective clinical pathway to provide nutritional support in acute pancreatitis. This pathway is proposed based on assessment of peer reviewed literature and existing generally accepted knowledge. Acute pancreatitis is a heterogeneous disease and the outcome is variable. The role of nutritional support is controversial. Acute mild pancreatitis (80%) usually does not require nutritional support unless the pre-existing nutritional is poor or complications occur. Contrary to this acute severe pancreatitis is associated with severe catabolism and a high complication rate. Nutritional depletion rapidly occurs. It is logical to support the nutrition once the patient is haemodynamically stable. Although enteral nutrition should be administered whenever feasible, it is not always possible or advisable. Aggressive, hypercaloric parenteral nutrition administered via central venous line is not recommended. A combination of initial peripheral parenteral nutrition with fat in appropriate amount, and gradually switching over to enteral feedings is safer and cost-effective. It also avoids central line associated sepsis. The roles of newer specific therapeutic diets to enhance the immune status in patients with acute pancreatitis are not well established. KEYWORDS: Acute pancreatitis, Enteral nutrition, Parenteral nutrition, Immunonutrition.
The objectives of this study were: (1) to detect group B streptococcus (GBS) carriers among antenatal patients during pregnancy ( 35 to 37 weeks) in the University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia, and (2) to give antibiotic prophylaxis during the intrapartum period for the GBS carrier patients. The aim is to prevent early onset of GBS infection in newborn. This pilot study was carried out from 1st July 2005 to 31st August 2005. It is a prospective study involving 56 pregnant women who were seen at the antenatal clinic in the UMMC between 35 to 37 weeks gestation. High vaginal swab and low vaginal together with endoanal swab were taken for culture and sensitivity. The antibiotic prophylaxis was started early in the intrapartum period for patients with positive culture for GBS. GBS was detected in 18 patients which contributes to about 32% of the study population. The proper choice of antibiotic is important in successful disease prevention.
Study site: Obstretic and gynaecological clinic, University Malaya Medical Centre (UMMC)
MRI can be a distressing and traumatic experience in many patients, especially in those with underlying anxiety and/or claustrophobia. We conducted a study to determine if dexmedetomidine as a sedative agent can alleviate these symptoms. Dexmedetomidine is a potent and highly selective α-2 adrenergic receptor agonist which has sedative and analgesic properties. Eleven adult patients (n=11) with a histroy of anxiety and/or claustrophobia undergoing MRI who expressed their desire for sedation were recruited. Dexmedetomidine was infused at 0.5 to 1.0 μg/kg over 10 minutes prior to scanning. Eight patients (n=8) were able to complete the MRI scan comfortably. The findings suggest that dexmedetomidine provides adequate sedation that can allow patients with anxiety and/or claustrophobia to undergo MRI scanning succesfully in a large poproption of the population with anxiety. This result however is still preliminary and will need to be validated in a more robust clinical study.
Cleft palate has been recorded for many cenhuies. Until the 16th century attempts at closure were by covering or filling the clefts using artificial materials. By the 18th century sutures were used to close the palate after cauterization. By the 19th century lateral relaxing incisions were used to close the cleft at mid line. In 1861 Von Langenbeck (9,22) introduced his technique for dosing the palate. Veau(9) recommended his technique to elongate the palate and to narrow the velopharyngeal space. Many specialties are involved in rectifying this problem. They comprise maxillofacial, orthodontic. ENT surgeons, as well as speech therapists.(9) However, none of these methods succeeded to provide a satisfactory solution for the problem of complete deft palate. In this study, 618 cases of cleft palate of varying degrees were operated during the period from January 1992 to July 2001. From these 618 cases, 48 cases (7.07%) had complete cleft lip and palate. Only 18 cases (37.5%) had bilateral complete cleft lip and palate, and 30 cases (62.5%), had unilateral complete deft lip and palate. The results of the corrective surgical procedures were very promising. In this series of 618 cases only six cases developed residual fistula. The used technique was simple and similar to the Von Langenbeck technique but differs in some steps. The timing of the surgical intervention was a very important factor which influenced the outcome of the closure. KEYWORDS; New technique and tinling for treating complete cleft palate.
During the period from January 1992 up to the end of July 2001, the Burns Unit in King Khalid C Hospital treated 1735 cases of burns. The burns cases were of varying causes, age groups, degree, depth and extent. The formula used in lTeating these burns patients was a modification of Parkland fonnula. The fluid used was Ringer lactate solution. This fluid was administered for the first 3 days post burn until the general condilion of the palient was sfabilized. Early oral intake was encouraged in aU patients and was started as early as the second or the third day. Colloids were given by the end of the third or even the fourth day and according to the individual patients' needs. The results of this treatment regime significantly avoided renal complications and ensured patient rehydration. KEYWORDS; Major burns, fluids resuscitation
INTRODUCTION AND OBJECTIVE:
Most of important variables measured in medicine are in numerical forms or continuous in nature. New instruments and tests are constantly being developed for the purpose of measuring various variables, with the aim of providing cheaper, non-invasive, more convenient and safe methods. When a new method of measurement or instrument is invented, the quality of the instrument has to be assessed. Agreement and reliability are both important parameters in determining the quality of an instrument. This article will discuss some issues related to methods comparison study in medicine for the benefit of medical professional and researcher.
METHOD:
This is a narrative review and this article review the most common statistical methods used to assess agreement and reliability of medical instruments that measure the same continuous outcome. The two methods discussed in detail were the Bland-Altman Limits of Agreement, and Intra-class Correlation Coefficient (ICC). This article also discussed some issues related to method comparison studies including the application of inappropriate statistical methods, multiple statistical methods, and the strengths and weaknesses of each method. The importance of appropriate statistical method in the analysis of agreement and reliability in medicine is also highlighted in this article.
CONCLUSION:
There is no single perfect method to assess agreement and reliability; however researchers should be aware of the inappropriate methods that they should avoid when analysing data in method comparison studies. Inappropriate analysis will lead to invalid conclusions and thus validated instrument might not be accurate or reliable. Consequently this will affect the quality of care given to a patient.
100 consecutivnee wly diagnosed patients with nasopharyngeal carcinoma (NPC) since January 1994 were the subjects for studying various factors related to the delay in the confirmation of the diagnosis. 79 of them were ttlales and the peak age of incidence was the 5th decade. 92% of them were Chinese, 7% Malay and 1% Indian. 76% were agriculture worker or labourers with 66% having either no formal education (16%) or only primary level education (50%). For 50% of patients neck swelling was the first symptom, 26% had nasal symptoms, 12% ear symptoms and 11% hads symptoms due to intracranial extension of tumour. As many as 80% were at UICC Stage IV at the time of diagnosis. While the median delay, on the part of patients, in consulting a doctor was 2.5 days, the median delay on the part of the doctors to confirm the diagnosis of NPC was as long as 127 days, which was particularly worse when the patients presented with ear symptoms (266 days) followed by those with neck swelling (94 days). For those patients who were required to undergo more than one nasopharyngoscopy and biopsy the median doctor's delay was 144 days. Since 82% of patients had consulted general practitioners who remained the first-line health-service provider, it is suggested that their level of awareness with regards to NPC be significantly raised so that the delay on their part be greatly minimized. KEYWORDS: Nasopharyngeal carciuotna, delay in diagnosis, patient's delay, doctor's delay.
Purpose: The object of this study was to identify patients with diagnosed dengue infection, who were positive
for both dengue-specific NS1 antigen and IgM antibody.
Method: From January 2013 to December 2016, in Central Kolkata in West Bengal in India, patients with
symptoms of dengue infection, were sent to the laboratory by the physicians for confirmatory diagnosis of
dengue infection. A total of 4762 patients were seen, and serum samples tested and distributed into seven
panels, according to the investigations requested. 1436 patients were tested positive.
Results: 1053 cases were tested for both NS1 and Ig M antibody, 835 for dengue-specific NS1 antigen, IgM and
IgG antibodies and 218 for NS1 dengue-specific antigen and IgM antibody. Of these, dengue was confirmed in
34.3 %, with 16.6% positive for both NS1 antigen and IgM antibody. Eleven were diagnosed, with late dengue
infection, thirty-nine with late primary infections and ten with late secondary dengue infection.
Conclusions: Many of the patients were reactive for both NS1 antigen and IgM antibody, and they required
proper attention and strict vigilance with effective monitoring and treatment, not of early dengue infection,
but of late dengue infection. Unless the serological tests for Ig M and IgG antibodies, and the dengue specific
viral antigen NS1 are performed simultaneously, these types of cases would not all be detected.
The COVID-19 pandemic resulted in 5 consecutive Movement Control Orders (MCOs) in Malaysia in an attempt to flatten the epidemiological curve, with a reduction of cases. This study aims to use statistical analysis to assess whether the decisive public health interventions in the MCO were efficacious. Three statistical tests were employed: Mann-Kendall trend analysis; one way between groups ANOVA; and Pearson correlation test. Results demonstrated significant differences between the second block, MCO 3-5, compared to MCO 1-2. Johor and Selangor states experienced significant increase in early MCO, whereas Sarawak and Selangor states experienced significant decrease by MCO 3-5. The northern border states of Kedah, Perlis and Kelantan, had caseloads stabilised to zero by MCO 4/MCO 5. This study demonstrates that the MCO was effective within the target of twice the two-week incubation period of COVID-19, with cases from community transmission and importation through the air and southern land borders. Selangor and Sarawak had higher cases in early MCO due to situational factors. In conclusion, MCO has been efficacious, with different states attaining different levels of case reduction due to individualised reasons.
Salivary gland swelling is a rare complication of upper endoscopy with less than twelve cases reported in the literature. The swelling is usually transient in nature, with complete resolution in a few hours .While all the major paired salivary glands have been implicated, the exact aetiology remains obscure. In this case report, a sixty one year old female presents with unilateral swelling of the right parotid gland immediately following an upper endoscopy. There was complete resolution of the pneumoparotid with no neurological sequelae.
Senescent-decliue in the nervous-system functions is very frequently atbibuted to age-related neurone-loss. Processes and mechanisms involved in neuro- degeneration form part of the structural frame-work for interpreting the functional consequences. The literature concerning this matter are confusing and contradicting. The behaviour of cranial nerve ganglia was studied using neuro-histological techniques. On the evidence available in the present study, the dark cells are considered as active ones; the light cells are considered as those which have failed to establish functional projections, inactive, dying, dead or degenerating ones. Probably it is during the me- dium-sized stage of cell growth, the peripheral and central processes (of axons) begin to grow from the cell body and attempt to get established in their projection fields. The light cells have appeared among the very-small cells just on the day of hatching. This probably signifies the possible attempt to elinlinate the growing cells since they are no longer needed to replace larger categories of cells which have already well- developed neuronat connections at this stage. It is assumed that the time of appear- ance of light cells might be indirectly related to the onset of establishment of active functional connections of neurones and to the functional importance of the organs which it supplies. KEYWORDS: Neurone-Loss and Ageing, Dark and Light Neurones, Sensory and Autonomic Ganglia
The requirement of the medical graduate, tabled in the objectives of undergraduate medical education, as envisaged by the Malaysian Medical Council, call for the all round basic doctor to be able to handle any medical emergency, as well as meet the requirements of law in examining, documenting and reporting on the common offences of the Penal Code, where medical documentation is required of law for the purposes of dispensing justice. However, in tabling the amended requirements of the undergraduate syllabus on the lines of those followed in sollie of the more developed nations, we seem to have lost this perspective. The authors discuss, based on his previous experience from another former colonial country viz. India, where the objectives of the undergraduate training is the same, and the influences 011 the legal profession bear a common origin and governance, the relevance of some of these topics, coming under the antbit of Forensic Medicine and Toxicology as an undergraduate subject, in the day-to-day practise of medicine in and out of government service. While this issue has been the frequent topic of discussion in international confereilces and symposia, where the decline in the standards of medico-legal work in the coulltries attending have been blanled on the fall in the standard of undergraduate teaching, due recognition of the pitfalls of the deletion or whittling down of the course content, independent of the overall overhauling of the syllabi of medical schools, to keep up to the trends of overseas universities, has not been accorded in the planing of the coursc revisions, resulting in a deletion of a vital aspect of daily practise of medicine. KEYWORDS: Medico-legal; Undergraduates