PURPOSE: TO DETERMINE: (i) the mammographic parenchymal patterns in Malaysian women and whether the breasts are dense on mammogram; (ii) the effect of age on breast density; (iii) the effect of parity on breast density; (iv) the difference in breast parenchymal patterns among the major races of women in Malaysia.
METHODS: This was a descriptive cross-sectional study of 1,784 patients (981 Malays, 571 Chinese, 214 Indians and 18 others) who had undergone mammography during the 1-year study period. Majority of women (41.7%) were aged between 51 and 60 years and majority (43%) had 3-4 children. The Tabar classification (Pattern I - V) was used to evaluate breast parenchymal patterns on mammogram. Tabar Pattern I was further divided into 3 sub-groups (Pattern IA, IB, and IC). The different patterns were then grouped into dense (IB, IC, IV, V) and not dense (IA, II, III) breasts. The SPSS package was used for statistical analysis.
RESULTS: Majority (59%) of Malaysian women had dense breasts (Pattern IB 29%, IC 20%, IV 5%, and V 5%) and 41% did not have dense breasts (Pattern IA 28%, II 6%, and III 7%). Age and parity were inversely related to breast density (p < 0.0001). Chinese women (65.7%) had the highest percentage of dense breasts (p = 0.69, odds ratio = 1.22), followed by the Indians (57.2%) and the Malays (50.5%).
CONCLUSION: Majority of women had dense breasts but Pattern IV, which has been associated with increased risk of breast cancer, was seen in only 5% of the women. The breast density reduced steadily with increasing age and parity. There was no statistically significant difference in breast density in the three main races.
KEYWORDS: Mammography; breast density; breast parenchymal patterns
OBJECTIVES: To compare the morbidity patterns in public and private primary care clinics; determine patients' reasons for encounter (RFE) and diagnoses using the ICPC-2, and compare ten commonest diagnoses and RFEs.
METHODS: A cross-sectional study on randomly selected clinics was conducted nationwide. Doctors completed the Patient Encounter Record (PER) for systematically selected encounters for a week.
RESULTS: Response rate was 82.0% (public clinic) and 33% (private clinic) with 4262 encounters and 7280 RFE. Overall, the three commonest disease categories encountered were respiratory (37.2%), general and unspecified (29.5%), and cardiovascular diseases (22.2%). Public and private clinics handled 27% versus 50% acute cases and 20.0% versus 3.1% chronic cases i.e. 33.7 and 5.6 chronic diseases per 100 RFE respectively.
CONCLUSION: Doctors in public clinics saw more chronic and complex diseases as well as pregnancy related complaints and follow-up cases while in private clinics more acute and minor illnesses were seen. Health services should be integrated and support given to co-manage chronic diseases in both sectors.
KEYWORDS: Malaysia; Primary practice; delivery of health care; morbidity pattern; reasons for encounter
In view of the alarming increase in the incidence of diabetes mellitus in Malaysia, we conducted a study to assess the awareness of complications of diabetes among the diabetics attending the peripheral clinics in Melaka. The study period was from January 2007 to December 2007. 351 patients were included in the study. 79.8% were aware of the complications of diabetes mellitus and 87.2% were aware that diabetes can affect the eyes. However, only 50% of the patients underwent an ophthalmological evaluation. Although awareness was good, the motivation to undergo the assessment was poor.
Study site: Klinik Kesihatan Peringgit, Klinik Kommunity Ayer Keroh, Melaka, Malaysia
The Malaysian National Cancer Registry (NCR) report for the period 2003-2005 shows an incidence of stomach cancer of 2.2 for Malay, 11.3 for Chinese and 11.9 for Indian males per 100,000 population. Malay (1.3), Chinese (7.2) and Indian (7.2) women have rates lower than men. Malays in Peninsular Malaysia have five times less stomach cancer than Chinese and Indians. This racial difference is more marked than that noted in the Singapore cancer registry. Regional data from Kelantan has an even lower rate for Malays there (1.5 for males and 0.9 for females per 100,000 population). The incidence of Helicobacter pylori infection, a known risk factor for stomach cancer, is low among Malays.
This case history illustrates the real life experience and dilemma of an 80-year-old woman in pursuit of medical care for her left shoulder pain. Points for discussion range from clinical features of Pancoast tumor, importance of pain management, good principles of Family Medicine and Palliative care to ethical issues of conspiracy of silence, limited treatment plan and palliative versus curative radiotherapy treatment without a known biopsy report. This paper provides opportunity for analysis of a real complex clinical situation, application of medical knowledge to problem solving in clinical practice and relevant topics for discussions. (For anonymity sake, the names of patient, doctors, general and private hospitals are not mentioned. The aim of this paper is solely for continuous medical education without any intention to ridicule any party).
AIM: This pilot study aimed to explore the perceptions of general medical practitioners (GPs) towards the professional training and roles of community pharmacists.
METHODS: A self-administered questionnaire was distributed to all private clinics (n=160) run by GPs in a northern state of Malaysia. The instrument contained questions to evaluate the practitioners' level of agreement using a 5-point Likert-type scale.
RESULTS: Of 160 GPs, 80 returned the questionnaire (response rate 50%). The respondents agreed that: GPs should consider the community pharmacists' recommendations whenever there is/are any problem(s) with the prescriptions given by them (46.3%); community pharmacists are the best healthcare professionals to educate patients about safe and appropriate use of medications (52.5%); the pharmacy profession had undergone a major metamorphosis from a product-oriented profession to a more patient-centred and outcome-oriented one (61.3%); if dispensing separation is implemented, they will work closely with the community pharmacists in monitoring patients' pharmacotherapeutic outcomes (77.5%).
CONCLUSION: The current findings suggest that GPs would support an extension of the role of the community pharmacists in number of activities of patient care activities such as medication counselling. Thus, suggesting potential collaborative care between GPs and community pharmacists towards patient care and the needs to develop and incorporate topics on inter-professional relationship in the current medical and pharmaceutical education curriculums.
KEYWORDS: Community pharmacists; general practitioners; perceptions; roles; training
This is a cross-sectional study investigating the profile of children with disability registered with the primary health care clinics in Malaysia. The purpose of the study was to assess the developmental stage of children with disability. Secondary data from the pilot project conducted by the Family Health Development Division, Ministry of Health Malaysia was used in this study. The study period was for six months from 1st August 2004 until 31st January 2005. A total of 900 disabled children were selected in this study. Schedule of Growing Scale (SGS) II was used for analysis. Results showed more boys than girls were affected with a ratio of 6:4. The mean total SGS score increases as the age of the child increased. The score was highest in delayed speech cases and lowest in cerebral palsy cases. The performance among children with delayed speech was the highest while children with cerebral palsy were the lowest. There was a statistically significant difference between the major ethnic groups in delayed speech and attention deficit hyperactive disorder.
Questionnaire: Denver Developmental Assessment Test II chart; DSST; Schedule of Growing Scale II; SGS
Identifying clinical features that differentiate acute febrile thrombocytopaenia from acute febrile illness without thrombocytopaenia can help primary care physician to decide whether to order a full blood count (FBC). This is important because thrombocytopaenia in viral fever may signify more serious underlying aetiology like dengue infection.
OBJECTIVE: The natural history of asymptomatic (silent) gallstones has been inadequately studied. Existing information derives from studies based on oral cholecystography or relatively small sample sizes. We planned a retrospective cohort study in subjects with gallstones to determine conversion rates from asymptomatic to symptomatic.
METHODS: We extracted data from computerised databases of one government hospital and two private clinics in Malaysia. Files were scrutinised to ensure that criteria for asymptomatic gallstones were fulfilled. Patients were called on telephone, further questioned to confirm that the gallstones at detection were truly asymptomatic, and asked about symptoms that were consistent with previously defined criteria for biliary colic. Appropriate ethical clearances were taken.
RESULTS: 213 (112 males) patients fulfilled the criteria for asymptomatic gallstones and could be contacted. 23 (10.8%) developed pain after an average follow up interval of 4.02 years (range 0.1-11 years). Conversion rates from asymptomatic to symptomatic gallstones were high in the first two years of follow up, averaging 4.03±0.965 per year. Over time the conversion rates slowed, and by year 10 the annual conversion rate averaged only 1.38±0.29. Conversion rates were much higher for females compared to males (F:M hazard ratio 3.23, SE 1.54, p>z 0.014). The lifetime risks for conversion approached 6.15% for males, and 22.1% for females.
CONCLUSION: In conclusion, asymptomatic gallstones are much more likely to convert to symptomatic in females than in males. Males in whom asymptomatic stones are discovered should be advised conservative treatment. Surgery may be preferable to conservative management if the subject is a young female.
m radiology records of Hospital
Study site: Computerised database, Hospital Selayang, Selangor; private clinics, Kuala Lumpur, Malaysia
Many patients have erroneous views with regard to depression and its management, and it was noted that these attitudes and beliefs significantly affected their adherence rates.
Primary sinonasal clear cell carcinoma is a rare neoplasm classified under malignant epithelial tumours of salivary gland - type carcinomas under World Health Organization (WHO) classification. We report a case which occurred on a 69 year old gentleman presented with epistaxis and nasal endoscopy examination showed tumour arising from the right ethmoid cells. Endoscopic excision of the tumour was done and histopathological examination revealed clear cell carcinoma. In addition, other secondary or primary sites of the lesion were excluded by clinical, immunohistochemical and radiological examinations. 10 months into the postoperative period, patient remains well without recurrence of the tumour.
IN CONCLUSION: We report a rare case of primary sinonasal clear cell carcinoma in addition to the limited literature available and emphasize the differentials with other probable tumour through meticulous microscopic examination and use of special immunostains.
Keywords: Melaka
A study on infant feeding practices was conducted during the implementation of the Baby Friendly Hospital Initiative (BFHI) in a district hospital. The aim was to identify which population subgroups had lower breastfeeding rates at 4 months and the effect of attendance of antenatal breastfeeding education on breastfeeding practices. All infants delivered in May 1996 were followed-up. 204 respondents were analyzed. This study demonstrated a higher exclusive and any breastfeeding rates at 4 months than some other studies. (48% and 76% respectively). It was found that the Malays were more likely to be breastfeeding exclusively at 4 months (72%) than the Indians (32%) and the Chinese (4%). (P < 0.01). There were more non-working mothers breastfeeding exclusively at 4 months than working mothers. (60% versus 26%) P < 0.01. Antenatal breastfeeding education in the form that was given appeared to improve breastfeeding rates at 4 months. Future efforts to promote breastfeeding should target the Chinese mothers and the working mothers.
A cross-sectional study on a normal clinical myopic population reveals that there is a difference in the pattern of myopic progression between Malays and Chinese in Malaysia. It shows that while myopia in Malays stays relatively constant throughout 10 to 50 years of age, myopia in Chinese progresses rapidly from 10 to 20 years of age, after which it starts to show hyperopic shift, reaching a level of myopia similar to that of Malays at around 35 years of age. In view of the above finding it is postulated that the difference in myopia between the two races may be due to excessive accommodation in Chinese, causing a temporary increase in crystalline lens power and hence an increase in myopia. Because the magnitude of myopia for both races for 10 +/- 1 years age group is relatively high, i.e. about -2.00 D, it is postulated that myopia in these ethnic groups may start much earlier than 10 years of age.
Eight cases of dermatomyositis were seen in the Skin Department, Hospital Besar Kuala Lumpur between 1989 and 1993. There was one case of juvenile dermatomyositis. There was a majority of Chinese patients (87.5%). There were three patients (37.5%) with underlying malignancies, two of which (66.7%) were nasopharyngeal carcinomas; all were under the age of fifty years. It is important to screen all adult patients for underlying malignancies, even those in the younger age group.
Thirty consecutive patients from peninsular Malaysia with clinically definite multiple sclerosis were studied; 80% were ethnic Chinese, with a female-male ratio of 5:1. The average age at onset was 29.7 years, with one relapse average every 1.9 years. Optic-spinal recurrence was the most common clinical pattern of the disease, accounting for 63.3% (19/30) of the cases. All the patients had spinal cord involvement sometime during the course of the illness. The mortality was high at 36.7% (11/30), with an average duration of symptoms of 7.6 years. There was characteristic severe residual visual and motor disability. At the time of the last examination, 12 patients had bilateral optic atrophy with blindness or severe visual acuity impairment. Sixteen patients were bedridden or confined to a wheelchair. The severe motor disability reflected the severe spinal cord involvement. It was the main factor that accounted for the high mortality. The cerebral, cerebellar, and brain-stem involvements were, however, generally transient. None of the patients' had a family history of similar illness despite the average sibling size of six. There was no example of Devic's disease. The clinical pattern was closest to those patients who presented from Taiwan.
Following the opening of the University Hospital of the University of Malaya in 1967, over 126,000 patients (excluding obstetric patients) have been admitted. A retrospective review, run concurrently with a prospective study, of over 200 patients thought to have suffered from systemic lupus erythematosus (SLE) revealed that, up until the 31st December 1975, 175 patients fulfilled the criteria for the diagnosis of SLE. There was a highly significant increase in the diagnosis of SLE over this period among Chinese patients compared to all other races, and no significant differencein the diagnosis of SLE among Indian and Malay patients. A review of the literature revealed that SLE appears to be a worldwide disease, reported frequently from Chinese communities but infrequently from tropical Africa. It is concluded that SLE is more common in the Chinese from Peninsular Malaysia than the other races, and that a careful study of geographical and racial factors in SLE may contribute to further understanding of its pathogenesis.
Serum ferritin and haemoglobin estimates were carried out on 78 first time blood donors with a view to determining iron store status. Of these 30 were Malays, 20 were Chinese and 28 were Indians. The ferritin level in Malay donors ranged from 16-160 mg/ml (mean 83 +/- 49.4 mg/ml in chinese donors is ranged from 36-500 mg/ml (mean 242.8 +/- 132 mg/ml), and in the Indian donors it ranged from 5 - 270 mg/ml (mean 94.6 +/- 67.9 mg/ml). The haemoglobin concentration for the whole group was 14.9 +/- 1.49 g/dl. There was no correlation of haemoglobin concentration with serum ferritin levels.