Pain management with analgaesics employs a multidisciplinary approach of clinicians towards patients. Nevertheless, preventing drug abuse and misuse in pain management is also an important goal. Understanding patients’ behaviour in the usage of painkillers may facilitate more effective communication and to educate them on the appropriate choice of painkillers. This study aimed to assess patients’ knowledge, attitude and practice towards painkillers. This was a questionnaire-based cross-sectional study conducted from February to May 2016 among patients in Tawau Hospital. Respondents were selected via convenience sampling and interviewed based on a questionnaire to assess their knowledge, attitude and practice towards painkillers. A total of 193 questionnaires with complete responses were analysed. Most of the respondents
(60.1%) obtained their painkillers from public facilities. Generally, they were very satisfied with the painkillers that they had used (36.7%). However, most of them (75.0%) did not know the name of the ingredient of the painkillers that they had taken before. They were also not aware of the side effects (73.1%) and allergic reactions (64.8%) caused by painkillers. Most of the respondents (58.5%) had not been informed regarding the side effects of the painkillers by healthcare professionals. Only 25.0% of the respondents had been asked regarding their past medical history, past medication history and allergic history by healthcare professionals before a painkiller was recommended to them. This study highlights the need of continuous efforts by healthcare professionals to inform patients of the proper use and risks associated with painkillers to improve the quality use of painkillers.
Calcineurin inhibitors, cyclosporine and tacrolimus are increasingly becoming part of the standard immunosuppresant therapies for renaltransplanted patients in Malaysia. In this study, the clinical safety and efficacy of cyclosporine and tacrolimus in a Malaysian renal-transplanted population is compared. A fourteen-year retrospective review on all renal-transplanted patients (from September 1991 to September 2015) or patients being followed up at University Malaya Medical Centre (UMMC) on cyclosporine or tacrolimus regime was conducted. We collected the clinical and laboratory parameters at 3-month, 6-month, 7-month, 8-month, 9-month, 10-month, 11-month, 12- months, 2-year and 3-year following from transplantation for each drug. The mean cyclosporine and tacrolimus trough levels were within the recommended therapeutic ranges (189.16 ± 69.10 ng/ml and 7.84 ± 2.18 mg/day respectively). The mean low-density lipoprotein (LDL) was significantly higher at eleven months for tacrolimus compared to cyclosporine. Similarly, the mean total bilirubin level was significantly higher with cyclosporine as compared to tacrolimus between 3 – 9 months post transplantation but did not show any significant difference (p = 0.49). The overall monthly means of serum uric acid levels in patients were also similar, 380 ± 87 mg/dL (cyclosporine) and 390.96 ± 95.97 mg/dL (tacrolimus) (p = 0.49). The Kaplan-Meier survival rate is significantly longer (p = 0.03) with cyclosporine-based treatment as compared to tacrolimus. Overall, cyclosporine and tacrolimus did not show any significant difference in terms of safety and efficacy parameters among Malaysian renal-transplanted patients indicating that they may be used interchangeably.
Breast cancer is the number one malignancy in women worldwide. It tends to metastasize distantly via lymphatic and haematogenous route. Skeletal metastases are frequent with more than three quarter of cases in all malignant bone tumours. Breast cancer can infiltrate the axial bone especially spine, but rarely affect the temporomandibular joint. In view of its rarity and the significance of early detection, the diagnosis is always challenging and shall be considered in the differential diagnosis. We endeavour to highlight this unfortunate 37-year-old premenopausal lady who had just undergone left mastectomy and axillary dissection but was complicated with left temporomandibular joint metastasis.
The three plasmid borne alternative dihydropteroate synthetase (DHPS) genes namely sul1, sul2 and sul3 genes were heterologous in amino acid sequence and have about 40 – 50% identity. However, they have same DHPS activity with disc diffusion zone size of 6 mm with suphamethoxazole disc in our previous study. Sul1, sul2 and sul3 genes were observed in sulphamethoxazole resistant uropathogenic Escherichia coli (UPEC). In this study, all the three genes were cloned into E. coli host and minimum inhibitory concentration (MIC) was investigated for each sul gene to compare the activities of sul genes. The MIC values of E.coli containing sul2, sul1 and sul3 genes inserted recombinant plasmid were observed to have 18.5 mg/ml, 18 mg/ml and 17.5 mg/ml respectively as mean value of five experimental results. Although comparable MICs were obtained as a result, the MIC value was highest in E. coli carrying sul2 gene indicating that this DHPS enzyme activity of sul2 was strongest among three sul genes.
Posterior capsular rupture (PCR) is a common and serious complication of cataract surgery. It complicates the process of inserting posterior chamber intraocular lens and affects the visual outcome. This study is a review on visual acuity of patients that had PCR during cataract surgery in Hospital Melaka, risk factors of PCR, and factors that cause poor visual outcome. The record of all patients that had PCR during cataract surgery from 1 January 2014 till 31 March 2017 was traced using National Eye Database (NED) and the patients’ folders were reviewed retrospectively. Data collected was demographic data, type of cataract surgery, status of surgeon, underlying ocular diseases, risks factors for PCR, postoperative visual acuity, and factors that cause poor visual outcome. There were 238 eyes that had PCR during cataract surgery, from 126 (53%) female and 112 (47%) male patients. The mean age was 66.62 years old, ranging from 9 to 87 years old. Major risk factors identified were hard cataract, polar cataract, uncooperative patients, extended continuous capsulorhexis, subluxated lens, myopia, vitrectomised eyes, and poor pupil dilatation. From 153 cases that had no pre-existing ocular diseases, 119 (78%) cases had normal vision (best corrected visual acuity – BCVA) two months after surgery, 10 (7%) cases had moderate visual impairment, and four (2%) cases had severe visual impairment. Causes of BCVA poorer than 6/18 were high astigmatism, CMO, and prolonged inflammation. Cataract surgery, even complicated by PCR, is compatible with good visual outcome if the complications are managed promptly.
Alcohol misuse compromises the quality of life of individuals, families, communities and whole societies in a variety of ways. Malaysia acknowledges the problems, implementing policies and health promotion activities in line with the World Health Organization Global Strategy to reduce the harmful use of alcohol by 10% between 2010 and 2025. Sabah, one of two Malaysian states on the island of Borneo, has more than 30 different indigenous ethnic groups. Alcohol production and consumption have traditional and unique roles in the cultural practices of many of these groups, making one common programme difficult to implement. Preliminary research suggests that alcohol is a serious problem in indigenous communities in Sabah. It also shows lack of knowledge on recommended limits for alcohol consumption and understanding of alcohol-related harm. The objective of this action-research is to produce a toolkit that will transfer knowledge and empower communities to adopt safer drinking and reduce alcohol-related harm. It must be attractive, appropriate, easily understood and be able to be tailored to suit different communities. The alcohol tool-kit was developed by a group of academicians using evidence-based information. Qualitative research methods were used to evaluate the initial alcohol tool-kit. A purposive sample of 45 village representatives was selected and divided into 5 groups for focus group discussion. Their feedback was recorded and transcribed verbatim. The alcohol tool-kit was edited accordingly. All participants agreed the alcohol tool-kit was important and can empower communities to reduce alcohol-related harm directly improving their quality of life. The amended alcohol tool-kit will be recommended for health promotion material and evaluated from time to time.
Approximately 50% patients with psychotic illnesses on antipsychotic drugs have an increased risk of obesity. This study aimed to determine changes in body weight, body fat percentage and lipid profiles and to stress the importance of early nutrition intervention in the management of psychotic illness patient treated with antipsychotic drugs. This is a prospective longitudinal study conducted for 3 months in Hospital Mesra Bukit Padang, Kota Kinabalu, Sabah. A total of 150 patients with Diagnostic and Statistical Manual IV (DSM-IV) diagnosis of psychotic illness (either Olanzapine or Risperidone only at any dosage) first started or restarted after a treatment gap of at least 6 months were recruited. Weight, height and body fat percentage were measured using Bioelectrical Impedance Analysis (BIA) (Model Omron HBF-375) and blood fasting lipid test were taken from the point of starting medication for 12 weeks. Data were analysed using repeated measures of ANOVA for statistical method. All variables showed significant mean differences (p < 0.05) in increasing pattern throughout the 12 weeks of treatment. However, the total cholesterol of risperidone patients had no significant mean difference from initial to week 6 (p = 0.282). It was proven that there was increase in body weight, body fat percentage and lipid profiles among patients on olanzapine and risperidone. The limitation of this study might relate to the drugs’ dosage and method used in assessing the body composition. It is suggested that early nutrition intervention is needed to control unnecessary gain of weight, body fat and lipid profiles in the management of patient with psychotic illnesses.
Trauma is a major health problem in Malaysia. An understanding of the trauma epidemiology is important in developing a reliable trauma service. The aim of this study is to understand the pattern of trauma in our institution and to highlight the need for a dedicated trauma service. In this database, 142 cases were included. Majority were males (127, 89.4%). Most common injury types are motor vehicle accidents (87.3%) followed by falls (7.7%) and stabs (3.5%). Most Injury Severity Score (ISS) falls under moderate score with 38.7%. Mean Abbreviated Injury Score (AIS) was 3 with most involving the chest and 90% of the patients have injuries involving at least 2 regions. Average hospital length of stay (LOS) was 11.4 days ±11.5 SD; with most patients (71.8%) were discharged without permanent disability. The mortality rate was 9.2% with all having ISS>16. ISS found to be strongly related to longer hospital stay and worse outcome (0.59, p < 0.0001, 0.4, p < 0.0001). This data is equivalent to the compared registries from 4 different trauma centres. However, steps need to be taken to improve this database. In conclusion, this university hospital receives a reasonable load of trauma cases yearly which is equivalent with other trauma centres. The increasing trauma cases will benefit from an implementation of a dedicated trauma service. This trauma database needs more depth in its elements and better data handling to ensure a quality and complete registry.
Malaysia has high prevalence of general and central obesity which can be signified by measurements of BMI and waist circumference respectively. Both parameters are established risk factors and predictors for non-communicable diseases including diabetes and hypertension. A health screening programme was conducted in a rural district of Sabah, Malaysia where a total of 42 participants were examined for weight, height, BMI, waist circumference, systolic and diastolic blood pressure, pulse rate and capillary blood glucose. Mean age of the participants was 52.4 ± 14.9 years old. General obesity based on BMI was 42.9% while central obesity based on waist circumference was 26.2%. Proportion for hypertension and hyperglycaemia were equal at 33.3%. BMI was strongly correlated to waist circumference (r = 0.873, p < 0.001). Moreover, both BMI and waist circumference were independently correlated with systolic blood pressure (r = 0.418, p = 0.006 and r = 0.383, p = 0.012 respectively). Finally, systolic blood pressure was directly correlated with weight of the participants (r = 0.350, p = 0.023). These findings were found to be closely similar and comparable to currently available epidemiological data.
Oxidative stress is an imbalance in redox coupling
in the body. Lack of antioxidants to scavenge the
reactive oxygen species produces adverse effects
on health. The causes for an imbalance in redox
coupling are multi-factorial. Though, reactive
oxygen species are beneficial in the body, excessive
generation and lack of proper scavenging may
pose a threat. Both internal and external factors
may elevate the level. Environmental pollution is
a major contributor. Man-made chemicals such as
pesticides, heavy metals, and carbon combustion
products are blamed. Chronic exposures lead to
disease processes through oxidative stress. They
mediate pro-inflammatory cytokines and produce
free radicals. Pro-oxidant to antioxidant mismatch
leads to the adverse effects. Nrf2 activates a number
of genes that encode the antioxidants. Glutamate
cysteine ligase is activated in response to Nrf2
and it is a key enzyme for GSH production. Nrf2
functionality protects the cells from environmental
pollutants. Nrf2 mediates the antioxidant response
due to chemical insults, translocated in the cell
nucleus. Oxidative stress is known to induce a
number of diseases such as genetic abnormalities,
carcinogenesis, cardiovascular and respiratory
diseases, neuro-degeneration - Parkinson’s and
Alzheimer’s diseases. Pesticides are the major
pollutants. Studies confirm oxidative stress and
environmental pollution need to be addressed for
public welfare.
Emergence of multidrug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB) is one of the reasons why tuberculosis (TB) continues to cause great mortality and morbidity in less-developed countries. The development of rapid diagnostic methods targeting genetic mutations associated with resistance to the anti-tuberculous drugs is essential to fight this deadly pathogen. Isoniazid (INH) has been included in the multidrug regimens for the treatment of drug-susceptible TB for the decades. In the worldwide setting, isoniazid resistance was highly prevalent and was observed in one of every seven TB cases. Since katG315 mutation is highly prevalent, the common mutation in the enzyme essential for the activation of the INH concerned with the mechanism of drug resistance and associated with high level resistance to INH, katG315 mutation was necessary to be identified by molecular method as a molecular determinant of INH resistant Mycobacterium tuberculosis. The prevalence of katG315 mutation in various countries was discussed in this report and a new molecular method for the detection of the mutation was proposed.
Primary pleural melanoma is a very rare condition
and highly aggressive tumour. A patient presented
with productive cough, haemoptysis, pluritic chest
pain and breathlessness. On investigation, she was
diagnosed as left-sided lung mass with pleural
effusion. Pleural biopsy confirmed malignant
melanoma of pleura and she was subsequently
referred to the oncology team for palliative
chemotherapy. In conclusion, primary pleural
melanoma remains a rare disease with no proven
effective treatment regime available.
Trigeminal schwannoma is a rare cause of
cerebellopontine angle tumour. This case report
of a 65-year-old lady presented with ipsilateral
facial numbness and instability. She was finally
diagnosed to have trigeminal schwannoma after
seeking multiple medical consultations with her
doctors. This case report highlights a rare cause
of cerebellopontine angle tumour.
Aging population will be an inevitable phenomenon around the globe. This study aimed to
assess the quality of life and its associated factors among the elderly population in rural areas of
Kudat, Sabah. A community based cross-sectional study was conducted among elderly aged 60 and
above living in Tambuluran Area of Kudat. Quality of life was assessed using WHOQOL-BREF
questionnaires. Socio-demographic data of the elderly, perceived morbidities and utilization of health
services were collected. Independent sample t-test was used for data analysis. A total of 165
respondents participated in this study with a mean age of 71.42±6.50. The mean WHOQOL-BREF
score was 65.20 ±11.49. Mean scores for physical and psychological domains were lower than
average. Age, marital status, educational level and perceived morbidity were associated significantly
with QOL. In conclusion, QOL was generally average among elderly in rural areas of Kudat.
Therefore, interventions should place emphasis on physical and psychological aspects of life among
these aged population.
Obesity is a prevailing health issue and has been recognized as a threat in public health worldwide.
Rural setting is no longer a barrier to the epidemic of obesity as previously thought. This crosssectional
study aimed to determine the risk factors and associated co-morbidities of obesity among
adults aged 18 and above in rural community of Kudat, Sabah. 28.2% of respondents were found to be
obese with female predominance (54.9%). Older age, formally educated, ever-drinkers and high
systolic blood pressure were associated with obesity. Various forms of interventions should also
involve the rural area to close the disparity of health.
Myasthenia gravis, the most common autoimmune
neuromuscular disorder, is characterised by
muscle weakness and fatigability. A 23-yearold-lady
with background history of breathing
and swallowing difficulty for six months was
presented with respiratory distress to the hospital
which is without an in-house neurology service.
Her diagnosis remained a challenge as patient
presented as an emergency without detailed
medical history. She was subjected to bedside ice
pack testing and subsequently managed along the
diagnosis of myasthenia crisis. She responded to
the treatment and survived the critical period. So,
diagnosis of myasthenia gravis by ice pack test
and managing a case of myasthenic crisis would
be possible in limited heath care setting.
Wegener’s granulomatosis (WG) is a necrotizing
granulomatous inflammation. A 40-year-old lady
of Malay descent presented with unresolving
bilateral painful red eyes for three weeks. Clinical
examination revealed that best corrected vision
acuity of 6/9 for both eyes. Slit lamp examination
revealed diffuse scleritis. Other Investigations
result like UFEME blood cell: 2+, C-reactive
protein 70.06 mg/L and ESR of 125 mm/h
suggestive on acute inflammations. Connective
tissue screening revealed cytoplasmic ANCA
was positive and was supported by Anti-Serine
Protease3 (PR3) 68. All the investigation results
revealed that she had Wegener’s granulomatosis
with ophthalmology manifestation in the
form scleritis. Patient was treated with guttae
Maxidex QID to reduce cells that present in
anterior chamber and oral ibuprofen 400 mg
thrice daily. Subsequently, oral prednisolone
and oral cyclophosphamide with oral Bactrim
were commenced. Patient responded well and
redness resolved. There are many differential
diagnoses for chronic conjunctivitis but to rule
out connective tissue disease should be one of the
primary differential diagnoses in young female.
Oral immunosuppressive and Trimethoprim/
Sufmethoxazole (Bactrim) were been found
beneficial and symptoms were resolved. Wegener’s
granulomatosis is a great mimicker as exemplified
in this case. This disease can be misdiagnosed and
maltreated as conjunctivitis. Thus, the authors
wish to emphasize that WG is one the differential
diagnoses that need to be considered in a person
with bilateral scleritis.
Trimethoprim-Sulfamethoxazole (TMP-SMX)
or Co-Trimazole is the treatment of choice for
meliodosis. A 52-year-old man presented with
generalized body weakness with reduced appetite.
He had bradycardia on examination. After
investigations, he was diagnosed as hyperkalaemia.
He had life-threatening hyperkalaemia treated
with Trimethoprim-Sulfamethoxazole (TMPSMX)
as part of the eradication therapy for
Meliodosis. Urgent haemodialysis was done. There
were changes done for his meliodosis treatment.
This case wished to highlight the importance of
considering hyperkalemia in patient treated with
Trimethoprim-Sulfamethoxazole especially when
risk factor for hyperkalaemia is present.
An Objective Structured Clinical Examination (OSCE) is a tool of assessing the clinical school often used
in the education system of the healthcare system. Traditional Oral Examination (TOE) is also a clinical
examination where students are being tested by an examiner panel (1 or 2 members) on their clinical
activities and knowledge. It is designed to objectively test competence in skills such as history taking,
clinical examination, communication and clinical procedures. The Faculty of Medicine and Health Sciences
of Universiti Malaysia Sabah (UMS) also use OSCE for assessing clinical students. The aim of this study
was to compare the performance between the traditional oral examination (TOE) and OSCE among
undergraduate medical students. Study populations were the 3rd year MBBS students of the Faculty of
Medicine and Health Sciences of Universiti Malaysia Sabah (UMS). Number of students was 87. All
students underwent traditional oral examination after finishing a 2 months module. The same students
participated in the OSCE on the same day evening. Scores of each student were collected. Mean of the
scores were calculated. P value was measured by Student’s t test to evaluate the significant difference
between both the variables (traditional examination mean and OSCE mean) at 5% confidence interval (CI).
P-value was 0.00015 in 5% confidence level in two tailed hypotheses. As the value was less than 0.05 so
null hypothesis was rejected and alternate hypothesis was accepted. There was significant difference between the means of both the examinations. So it could be concluded that students’ performance was
significantly better in the OSCE over the traditional oral examination.
Calcification of costal cartilage increases with age and it is rare before the age of thirty years. Early
onset of costochondral calcification can be associated several endocrine and metabolic diseases,
following a trauma, infections, malignancies or due to genetic factors and very rarely idiopathic. Our
case exemplifies premature calcification of costal cartilages. The patient was a 20-year-old lady,
referred to endocrine clinic in UMS polyclinic, Kingfisher, University Malaysia Sabah for evaluation
of metabolic and endocrine causes of premature costochondral calcification. Physical examination
findings were normal except mild tenderness over the left lower lateral part of the chest. Investigation
results were inconclusive to detect any underlying endocrine, metabolic or inflammatory conditions.
Chest X-Ray revealed bilateral calcification of the 10th, 11th and 12th costal cartilages and was diagnosed
as idiopathic calcification of costal cartilage. Only analgesics were given as treatment and the pain
subsided after few days.