Health impact related to smoking is a critical public health predicament especially in pregnancy. However there is not much data available to describe the magnitude of the problem. Hence this study was conducted to determine the prevalence of smoking and its socioeconomic factors among antenatal mother and their opinion related to tobacco control measures. A cross sectional study was carried out involving newly registered antenatal mothers attending all government health clinics in Penang. Prevalence of ever smoking among antenatal mother is 1.4%, of which 42.4% is still smoking at first antenatal visit. It was found that single mothers are more likely to smoke (OR, 14.23: C12.52-53.27). It was also noted that spouse smoking (OR, 5,14: CI 1.95-17.09), primigravida (OR, 2.7: C1 1.3-5.62), age group less than 30 years old (OR, 2.41; CI 1.03-6.09) and living in urban area (OR, 2.33; CI 1.01 — 6.47) have a higher risk to indulge in smoking behaviour. Muslim OR 0.29; C1 0.14 - 0.60) and Malay (OR 0.22; CI 0.10 - 0.47) pregnant mothers are noted to be less likely to smoke as compared to non Muslim and non Malay. More than 85% of them agreed with the tobacco control measures regardless of their smoking status. Most of respondents agreed the influential people in community L;11T · such as medical personnel, teachers and parents should not smoke.
Henoch-Schonlein purpura or anaphylactoid purpura is a systemic vasculitis of unknown cause that affects small vessels and mainly involves the skin, joints, gastrointestinal tract and kidneys. Gastrointestinal involvement occurs in more than half of patients and is thought to be related to edema and intramural haemorrhage. Radiologically the gastrointestinal findings are mainly those of bowel ischemia with thumbprinting and bowel wall oedema. Although this disease is usually treated conservatively, aggressive intervention is occasionally performed because of acute abdominal symptoms due to complications, such as perforation, intussusception and obstruction. This report illustrates a case of Henoch-Schonlein purpura with acute abdominal symptoms due to intussusception.
Introduction: The common cold is the commonest reason for primary care encounters worldwide. This paper aims to describe the reasons that influence patients to seek medical consultation for the common cold.
Methods: This was a cross-sectional survey conducted among adult patients of an urban teaching primary care clinic. An adapted bilingual survey form was administered by the researchers to obtain data regarding their decision to seek medical consultation for a cold and the reasons for their decision. Quantitative analyses were done to describe the close-ended responses. Open-ended responses were analysed using a qualitative approach and
the frequencies of the themes were reported. Results: A total of 320 respondents participated in this study, with a response rate of 91.4%. They were predominantly females (59.4%), Malay (70.9%), and had tertiary education (65.9%). More than half of the patients (52.5%) said they would seek consultation for cold symptoms. Fever was the commonest symptom (57-61%) which compelled them to seek consultation. The commonest reason for seeking consultation was to get medications (41.7%), whereas the commonest reason not to seek consultation was the practice of self-medication (44.2%). Ethnicity was found to be significantly associated with the decision to seek doctor’s consultation.
Conclusion: Colds are usually self-limiting and do not result in complications. Empowering
patients by providing appropriate self-care knowledge can help to reduce the burden of primary care services.
Patients should be taught about red flag symptoms as well as drug safety for medications commonly taken for
colds.
Keywords: Upper respiratory tract infections, patient acceptance of health care, primary health care.
The case history, treatment and follow-up of a thirteen-year-old girl with obsessive-compulsive neurosis of six months duration are reported. Results show that behaviour modification techniques were effective though a second course of treatment was required. Her illness and its treatment by behaviour therapy in relation to the Malaysian Chinese culture is discussed.
Introduction: Febuxostat is a non-purine-selective oral xanthine oxidase inhibitor drug, and is an alternative to Allopurinol to lower serum uric acid in gout patients. It is probably more effective than Allopurinol, however, its use is limited because of its cost and availability. Allopurinol has been the mainstay treatment for gout for about 50 years. However, its use has been associated with allergic reactions especially in patients with renal impairment.The objective of this study was to describe HTAA Rheumatology Unit experiences with Febuxostat in the management of gout.
Materials and method: Case records belonging to 6 patients who had been started on Febuxostat between January 2012 and January 2017 were analysed.
Results: The majority of patients on Febuxostat were males (83.3%) as well as Malays (83.3%). About 66.7% of patients had already developed mild to moderate chronic kidney disease (GFR between 30-89 mL/min) due to multifactorial causes by the time they were started on Febuxostat. Also 33% of patients had mild liver impairment (ALT & AST < 1.5 ULN) due to fatty liver prior to Febuxostat. All patients had been started on Febuxostat due to allergic reactions to Allopurinol. All patients were on Febuxostat 40 mg once a day. Following Febuxostat, a significant decrease in the uric acid levels much closer to the target level i.e. less than 360 µmol/L were achieved in all patients. Only 1 patient (16.7%) developed a side effect i.e. ALT > 1.5 ULN while the rest tolerated the drug very well.
Conclusion: Although the number of patients analysed was small, Febuxostat was shown to be very effective and safe for use in patients with gout even with concomitant mild to moderate renal impairment. Serum uric acid levels reduced significantly while on the lowest dose of 40 mg once a day.
Stroke is a causal factor that commonly caused physical impairments and activity limitations among patients to perform daily activities until at certain level stroke patients will experience disability. The aim of this study is to examine the relationship of each demographic and clinical factors that is believed to associate with physical functioning of patients
those who experienced stroke. This present study also try to compare physical functioning of patients with associated factors and then examine the correlation between those factors with physical functioning. A total of 147 respondents that pass for cognitive screening test involved in this study. Barthel Index (ADL) was administered to the respondents after 6 weeks of stroke attack in order to measure their physical functioning status. Results found that there was a significant difference [F(3, 143) = 4.06; p < 0.01] between level of educations with physical functioning of patients. With respect to clinical factors also showed a significant difference (p < 0.01) was higher in physical functioning when stroke attack
occurred at right hemisphere of brain. There was a significant difference (p < 0.01) in physical functioning with respect to belief of recovery. Furthermore, number of stroke attack also showed a significant difference [F(1, 145) = 11.19; [p < 0.01] in physical functioning of patients. Correlation test that was carried out found a positive significant correlation
(r = 0.24; p < 0.01) between physical functioning with respect to the affected lesion side. In conclusion, demographic and clinical factors also played the roles to determine level of physical functioning among stroke patients and thus these factors should be considered in any studies that intended to enhance physical functioning of patients in future.
Keywords: stroke; physical functioning; disability; physical impairment
INTRODUCTION: Children who develop any hypersensitivity reaction to eggs are routinely referred to hospital for Measles-Mumps-Rubella (MMR) vaccination as inpatients to prevent anaphylaxis. We aimed to study the association between hypersensitivity reactions after egg exposure and similar reactions after MMR immunisation; and examine the necessity of hospital admission for vaccination.
METHODS: A prospective observational study was conducted in Paediatric Department in Bukit Mertajam Hospital, Penang, between March and December 2014. Children referred from local polyclinics for inpatient MMR vaccination because of a history of egg allergy were recruited. The children were observed in the ward for post vaccination allergic reactions. Concurrently, a group of children without egg allergy was recruited from those admitted for other illnesses but had recent MMR vaccination at polyclinics. Parents of these children were interviewed and asked if they had observed any reactions post vaccination. In both groups, sociodemographics, medical history and family history of atopy were collected.
RESULTS: Eighty-seven subjects were recruited in this study. Fifty-four infants with egg allergy had previous mild allergic reactions after exposure to eggs or egg-related products. They were associated with a family history of egg hypersensitivity, personal history of acute gastroenteritis and upper respiratory tract infections. Two of them developed cutaneous rashes post vaccination during observation, but none developed anaphylactic or anaphylactoid reactions. Two infants among those without egg allergy had post vaccination fever. There was no association between egg allergy and hypersensitivity reactions to MMR vaccine (p=0.632).
CONCLUSIONS: MMR vaccine can be safely administered to children with mild egg allergy, hence admission for vaccination in the hospital is not warranted. Risk stratification is required to ensure only infants with severe reactions will be admitted for vaccination.
In Malaysia, breastfeeding was dominantly practiced among Malay whose deeply believe in Islam and any decision should abide by Islamic teachings. Existing literature appear to have limited evidence on Malay mothers’ interpretation and construction of this practice. The decision to breastfeed was believed to be influenced by social and cultural context. Therefore, in order to explore life experience of breastfeeding mothers on their beliefs related to religious and sociocultural, qualitative study design was used. A minimal guidance of phenomenological approach adopted as the methodological framework. Semi structured interviews were carried out among 15 mothers whose were recruited from four Maternal and Child Health Clinic in Kuantan using purposive sampling. The experience of researchers thorough out their journey will be shared in terms of challenges; barriers and solution to overcome the concerned that exist while conducting in-depth interview session.
Tumoral calcinosis is an uncommon condition which has been described to exist in primary and secondary forms. A lack of awareness of this entity can lead to unnecessary procedures and incorrect management. We report a case of a patient on peritoneal dialysis who presented with multiple painful joint swellings to the orthopaedic department. An initial diagnosis of septic arthritis was made, then revised to chronic tophaceous gout and referred to the rheumatology unit.
Exhibitionism is a distressing condition which may have a link with the increasing availability and usage of online sexual activities (OSA). We highlight a 42-year-old man who presented with a constant craving for OSA to achieve his sexual satisfaction which included exposing his genitalia to virtual partners, unsuspected strangers, and colleagues in public areas. His sexual behaviours were further reinforced by an online video chatting with genitalia exposure, which ended commonly with an exchange of masturbatory acts. He denied any problem with his erection and able to achieve orgasm via common sexual acts. There was no past psychiatric history nor family history of mental disorder. He volunteered to seek psychiatric help and subsequently given a psycho education on his illness and how to cope with the distress associated with his sexual acts. He was scheduled for an intensive psychotherapy to instil insight and hope to deal with his sexual difficulties.
The non-structural protein 1 (NS1) of the dengue viral genome has been found useful for diagnosis of acute dengue infections, being detected from one day and up to 18 days post onset of symptoms (1). Rapid Dengue NS1 antigen test was made available in commercial test kits for private clinics in Perak in 2014. This study aimed to determine the use usefulness of dengue NS1 test kits in suspected dengue cases in a general practice clinic in Perak and the period in which positive test results were obtained after the onset of symptoms. Clinic records of all suspected dengue cases seen in the ten months from October 2014 to July 2015 were traced. Patients’ demographic characteristics, presenting symptoms and the use of One Step Dengue NS1 Antigen test (Avo Diagnostics) were analyzed using SPSS version 17. Seventy one suspected dengue fever cases were seen in the study period, the highest number in July 2015 (25%). Majority were Chinese (80%), female (63%), and aged 40 years and above (51%). Most patients presented with fever (99%), body-ache (51%), gastrointestinal symptoms (51%) and headache (44%). Dengue NS1 antigen test was done in 94% of the suspected cases with 61% testing positive. The majority of the cases presenting one day to five days after onset of symptoms tested positive i.e. 59% (1 day), 90% (2 days), 54% (3-4 days) and 89% (5 days). Using dengue NS1 antigen test, positive results can be obtained as early as one day after the onset of symptoms. This test is a useful tool to aid primary care physicians detect dengue fever early.
The current era of globalization has seen a pandemic rise in the number of patients with chronic diseases including end-stage renal disease (ESRD). This led to the study of various factors that affect patients’ health-related quality of life (HRQoL). One of the factors that is getting attention lately is the role of religious coping strategies and how it affects the quality of life of patients with chronic patients. Therefore, the present study examined the role of religious coping strategies (RCS) as a mediator between depression and HRQoL of ESRD patients. It was a cross sectional study, involved 274 ESRD patients who is undergoing dialysis treatment at dialysis centre in the Selangor, Kuala Lumpur and Johor. Instruments used were the Short Form-36 (SF-36), Beck Depression Inventory II (BDI II), and Religious Coping Strategies (RCS). Results showed that there were significant correlations between depression and RCS with HRQoL (Physical component summary PCS] and Mental Component Summary MCS]). Meanwhile, religious coping was a partial mediator between depression with PCS and MCS. The results of this study will facilitate health practitioners in developing appropriate interventions that take into account the role of religion to improve patient quality of life towards a more positive and effective manner.
A retrospective study of the incidence of Giant Papillary Conjunctivitis (GPC) seen in the Optometry clinic in Universiti Kebangsaan Malaysia from 1989 to 1994 was carried out. In the period of the 6 years, 37 contact wearers were diagnosed to have GPC. Of the 37 patients, 21 were Malays (57%), 12 were Chinese (32%) and the remaining 4 patients were Indians (11%). 18 or 48% of those with GPC were soft lens wearers, 46% of the wearers (17 patients) were rigid gas permeable lens wearers and 1 of the patients seen was a hard (PMMA) wearer (3%) and the other one was a disposable lens wearer (3%). Thirty patients were female (81%) and 7 (19%) were male. The age range of those with GPC were between 9 to 60 years old.
Study site: Optometry clinic, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
Aim: To investigate cigarette consumption patterns exhibited by non-smokers, occasional smokers, and daily smokers in Malaysia.
Subjects and methods: A sample of 4204 individuals from the 2011 Malaysian Global Adult Tobacco Survey is analyzed. A zero-inflated ordered probit model is used to accommodate the ordinal nature of smoking outcomes with excessive zero observations of non-smokers.
Results: Socio-demographic characteristics are closely associated with consumption patterns of non-smokers, occasional smokers, and daily smokers. Specifically, urbanites, government employees, and Malays exhibit greater tendencies to be daily smokers and lower propensities to be non-smokers than others. Education is a deterring factor in cigarette smoking as higher education up to the tertiary level raises the propensity of being a non-smoker by 8.16 percentage points. The role of ethnicity is highlighted as individuals of Malay and other ethnic backgrounds are more likely to smoke daily, while exhibiting lower propensities of being non-smokers. Males are more likely to engage in occasional or daily smoking than females. Employment in government or non-government sectors increases the probability of daily smoking.
Conclusions: Our results suggest the need to include measures to cope with internal or external cues among smokers with specific socio-demographic characteristics. Cessation interventions should focus on daily smokers in urban surroundings with low education levels and those of Malay ethnic origins. Anti-smoking measures in line with occasional smoking may include ameliorating the male attitude toward smoking and policies to prohibit workplace indulgence.
Study name: Global Adults Tobacco Survey (GATS-2011)
Patient’s appointment compliance refers to the willingness and ability of a patient to attend to their scheduled clinical appointment. Failure to do so have various consequences, especially so for a teaching clinic such as the Optometry Clinic, Universiti Kebangsaan Malaysia (UKM). The percentage of appoinment compliance at the Optometry Clinic was analysed from September to December 2015. Compliance rate was categorised based on clinic type and session, and on patient’s gender and ethnicity. Attendance compliance was around 60% for the Primary Care Clinic. It increased to 70% for patients with vision problems who where referred to specialty clinics i.e. Low Vision and Paediatric Clinics. Clinic day and session did not influence compliance significanly (p > 0.05). Patient’s gender and ethnicity did not influence compliance significantly as well but those of Indian ethnicity consistently showed the lowest appointment compliance rates. A protocol should be developed to increase the rate of patients’ appoinment compliance. This would then maximise productivity of students and clinic staff and optimise the clinic’s resources. The cost of each clinical session could be informed to the patients, even when the cost is not borne by them.
Keywords: Appointment compliance; Optometry Clinic; appointments; clinical teaching and learning; public health
Study site: Optometry clinic, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia