A forty-four year old wife of an alcoholic husband with irregular employment sought repeated medical care for her headache, bodyache, chest pain and alleged falls at home. The family backgrounds of the battered wife and the violent husband, his alcoholism and their financial problems all contributed to the violence in marriage. Their six children had lived in fear and two of them had behaviour problems. Awareness of the multiple problems associated with a battered wife should prompt cooperation between medical, social and other workers involved in the management.
Study site: medical outpatients clinic of
T.H. Woon
M.B., B.S., M.D., M.R.A.N.Z.C.P.
Associate Professor and Head
Department of Psychological Medicine
Faculty of Medicine
University of Malaya
Kuala Lumpur, 22-11
and
Shirley George
M.B., B.S., M.P.M.
Psychiatrist
Psychiatric Unit
General Hospital, Seremban.
Running Title:
Battered wife - psychodynamics and social background of a
Malaysian family - alcoholic husband - medical symptoms -
multidisciplinary management.
University Hospital to the psychiatric Walk- inClinic
The value of tuberculin skin testing in the diagnosis of active tuberculosis remains uncertain. Interpretation of tuberculin tests would be easier if the tuberculin test profiles in different communities were accurately known. We reviewed 468 Mantoux test reactions in patients coming to Hospital Universiti Sains Malaysia with suspected tuberculosis. Eighty six percent of patients with active tuberculosis had a positive Mantoux test. Forty two percent of the cases of positive Mantoux test did not have evidence of active tuberculosis. Most of these cases had evidence of past infection with tuberculosis. We conclude that Mantoux test is a sensitive but a non-specific test in the diagnosis of active tuberculosis.
Study site: outpatients, inpatients; Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
This paper discusses the spectrum of rheumatic diseases seen over a 24-month period from January 1986 to December 1987. Rheumatoid arthritis was the commonest rheumatic disorder seen, comprising of 47.1 % of all cases and ankylosing spondylitis was among the least frequent (0.9%). Most of the rheumatic diseases reported in the West are also seen in Malaysia. However, results of this study which is based on the hospital population may not be representative of the spectrum of rheumatic diseases in the our population.
Key words: Epidemiology, occurence, rheumatic diseases, Malaysia
Study site: Rheumatology clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
One hundred and forty-five diabetic patients attending diabetic clinic over a four week period were fully examined in an adjacent eye clinic. The fundi were examined with a Halogen light direct ophthalmoscope and the Binocular Indirect Ophthalmoscope after mydriasis to assess the presence of retinopathy. 44.1 percent of patients examined had Opbthalmoscopicaliy detectable retinopathy while 11 percent were found to have 'serious diabetic eye disease'. The prevalence of diabetic retinopathy in Malaysia is comparable to those of Western countries and Japan.
Study site: Diabetic clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
A retrospective review of all bronchoscopy cases for investigation of lung cancer between January 1997 and December 1999 was done. The cases were included if endobronchial mass was visible (Group A) or when there was an abnormal mucosa and/or bronchial narrowing in the absence of a mass (Group B). All patients in Group A (n = 177) underwent endobronchial biopsy (EB) bronchial brushings (BB) and bronchial washings (BW). All cases in Group B underwent transbronchial biopsy (TBB), BB and BW. Only a small increase in the positive results for cancer was seen when cytology specimens (BB and BW) were added to EB (85.3% vs 88.1%, McNemar's P = 0.06) in Group A but there was a significant increase in Group B (37.3% vs 54.2%. McNemar's, P = 0.001). Therefore although cytology specimens did not significantly add to overall yield of positive results when endobronchial lesions were visible, when mass lesions were not visible, cytology specimens increased the yield by 16.9%.
Study site: Chest clinic, Hospital Sultanah Aminah (HSA), Johor Bahru, Johor, Malaysia
Introduction A study was conducted to determine the level of mothers' perception on children with cleft deformity and its associated factors
Methods This was a cross sectional study involving 110 mothers with children attending the Plastic And Reconstructive Surgery Clinic. Data was gathered from a face to face interview based on a questionnaire that assesses the level of perception and its associated factors. The level of perception was evaluated from a scoring method and divided into four domains namely psychosocial, care management, treatment and education.
Results The level of perception was high in all four domains ranged from 62% for treatment and 80% for education. Factors that were significantly associated with the level of perception were ethnicity, religion, type of cleft deformity and level of information.
Conclusions Information regarding cleft deformity must be tailored toward mothers’ personal characteristics and type of cleft deformity to improve mothers' perception on this problem.
Study site: Plastic And Reconstructive Surgery Clinic, Hospital Kuala Lumpur, Malaysia
Objective: The assay for anti-cyclic citrullinated peptide (anti-CCP) antibody is a recent test of interest due to low diagnostic specificity of rheumatoid factor in the diagnosis of rheumatoid arthritis. To determine the sensitivity and specificity of anti-CCP antibodies in rheumatoid arthritis patients using American College of Rheumatology (ACR) criteria as a gold standard.
Design: A cross sectional study was conducted from January 2008 to December 2008 on 100 patients with rheumatoid arthritis and 153 patients with arthritis or arthralgia but not fulfilling ACR criteria for rheumatoid arthritis.
Materials and Methods: Serum from each subject was tested for anti-CCP antibodies and IgM rheumatoid factor (IgM RF) by an enzyme linked immunosorbent assay (ELISA). Sensitivity and specificity of the tests were evaluated using the ACR criteria as the gold standard. Data was analyzed using SPSS version 12.0 software. The association between the two categorical variables were tested using chi-square test. The differences between the two groups were tested using independent t-test. Results: The sensitivity of anti-CCP antibodies was 71% with 94.8% of specificity. For rheumatoid factor the sensitivity was 85% and the specificity was 74.5%. Positive predictive value for anti-CCP antibodies was 89.9% whereas for rheumatoid factor it was 68.5%. The sensitivity of ACR criteria with inclusion of anti- CCP antibodies was 100% and specificity of 94.8% (95%CI: 91.3%, 98.2%).
Conclusion: Anti-CCP antibody has a higher diagnostic accuracy compared to the RF. Anti-CCP antibody is a useful laboratory marker to support the diagnosis of rheumatoid arthritis and to differentiate patients with rheumatoid arthritis from rheumatoid arthritis-like symptoms. Therefore, it is suggested that anti-CCP antibodies should be included as another laboratory supportive criterium besides RF test in ACR criteria in the diagnosis of RA.
Study site: family medicine clinic, rheumatology clinic and immunology laboratory of Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian, Kelantan, Malaysia
Objectives: To evaluate the frequency of HLA Class II antigens in Malays with SLE in order to determine their role in disease susceptibility and association with clinical manifestations.
Design: Cross-sectional study
Methods: Fifty-four SLE patients from Malay ethnic attending Physician Clinic at Hospital Universiti Sains Malaysia were enrolled into the study. Demographic and clinical findings were obtained from medical records. HLA typing of class II antigens were carried out using MicroSSP Class II generic (DRB/ DQB) from One Lambda Inc. Controls were from ethnically matched healthy individuals.
Results: A univariate analysis confirmed the association between HLA-DR15 with SLE compared to healthy control group; and was maintained using multiple logistic regression model (P corr = 0.002, adjusted OR = 5.513). There was a weak decrease of HLA-DR4 which was not significant after corrections for multiple comparisons made. DR7 was found to be significantly increased in patients with malar rash. There was positive association of DR15 with arthritis in patients compare to those without.
Conclusion: Our data support the role of HLA Class II genes in conferring SLE susceptibility.
Study site: Physician Clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Background: Rheumatoid arthritis (RA) is an inflammatory disease. Predictors of disease activity include presence of joint inflammation, blood investigations such as erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP). ESR is said to be imprecise as it is affected by aging, female sex, obesity, pregnancy, anaemia and polycythaemia. But it is inexpensive and easy to perform. CRP is produced as an acute phase reactant by the liver in response to interleukin 6 and other cytokines. CRP is more specific but costs more than ESR. Both tests are done in the rheumatology clinic of Hospital Seremban. Objective: To compare the usefulness of ESR and CRP as a predictor of disease activity in rheumatoid arthritis (RA) patients. Method: This was a retrospective study. The medical records of 248 RA patients who attended the rheumatology clinic, Hospital Seremban between 1 January 2004 and 31 Dec 2004 were reviewed. The following data were obtained: joint swelling and tenderness, other clinical features which indicate inflammation secondary to infection or trauma and inflammation of soft tissue, ESR, CRP, FBC and UFEME. Results: Data was analysed and the results showed that a total number of 248 patients were seen. There were 13 defaulters. Of the 248 patients there were 929 patients' visits. Of the total number of patients' visits where patients clinically had active disease, 80.2% had raised ESR while 88.8% had raised CRP. As for visits where patients had quiescent disease clinically, 57.3% had normal ESR and 36.5% had normal CRP. Conclusion: CRP is more sensitive but less specific than ESR. This suggests that we still should use both tests as they complement each other. ESR can serve as a countercheck for CRP and vice versa.
Background: Anti-cyclic citrullinated peptide autoantibodies (anti-CCP) is a new serological test for the diagnosis of rheumatoid arthritis (RA). It is an enzyme immunoassay (EIA) for the detection of antibodies directed toward citrullinated peptides. Studies show this test has an improved diagnostic value compared to rheumatoid factor (RF). Objective: To determine the sensitivity and specificity of anti-CCP in patients with rheumatoid arthritis and other rheumatic diseases. Method: 227 serum samples for rheumatology clinics (Putrajaya, Taiping, and Ipoh Hospital) were tested for the presence of anti-CCP and rheumatoid factor (RF). These included 171 patients diagnosed with RA and 56 from other rheumatic diseases. Patient demographic data, clinical diagnosis, radiographic information and other laboratory data were obtained from the patients' clinical notes. Results: Anti-CCP antibodies were detected in 76.6% (131/171) patients with RA and 17.9% (10/56) patients with other arthritis. The sensitivity and specificity of anti-CCP reactivity at the optimal cut off values were 66.1% and 87.5% respectively. The sensitivity of anti-CCP was higher than that for RF (41.8%). However, the presence of either anti-CCP or RF improved the sensitivity to 76.2%. Conclusion: The detection of anti-CCP alone maybe useful in the diagnosis of RA. However, when used concomitantly with RF, it can improve the diagnostic ability significantly.
Background: Medication therapy management (MTM) service provides set of clinical activities to optimize therapeutic outcomes for patients. It requires the collaboration between patient, pharmacist and other healthcare providers to ensure safe and effective use of medicines. The objective of the current study was to assess Hospital Pulau Pinang pharmacists' knowledge, attitude and practice on MTM service.
Methods: A self-administrated validated survey was carried out among all pharmacists working at Hospital Pulau Pinang.
Results: A total of 93 pharmacists out of 130 (71.5%) were included in the study (61.3% between the age of 20-30 years old, 74.2% female, 68.8% Chinese, 88.2% holding bachelor's degree and 48.4% working in medication therapy adherence clinic and outpatient pharmacy). Majority of pharmacists had a high level of knowledge and positive attitudes regarding MTM service. All pharmacists agreed that MTM service could improve the quality of health services and most pharmacists were interested in providing MTM service (92.5%). Moreover, 95.7% were interested in acquiring more information about MTM service. About the barriers that might affect MTM service implementation, the most common barriers identified by pharmacists were lack of training (88.2%), need of high budget to implement MTM service (51.6%) and lack of time (46.2%).
Conclusions: Overall, the research findings provide some insights about the Hospital Pulau Pinang pharmacists' knowledge, attitude and practice regarding MTM service. Majority of pharmacists agreed and showed their interest towards the implementation of MTM service.
Study site: pharmacists working at Hospital Pulau Pinang.
Study period: 1 February 2008 till 1 August 2008
Study participants: 110 type 2 diabetes patients, 40% male, 96% malay
Study design: Cross-sectional study
Questionnaire: Beck depression inventory II (BDI-II) in Malay version
Prevalence of depression: 22%
Study site: Outpatient clinic, Hospital Sik, Kedah, Malaysia
Audit has improved certain aspects of management of typhoid fever detected through Klinik Perubatan Masyarakat at Hospital Universiti Sains Malaysia. We audited records of clinic patients who were blood culture positive for Salmonella typhi. For August to October 1992, we found 10 out of 31 cases (32%) were not admitted. Some of these were patients who defaulted, while some were managed as outpatients but not notified. We took action to educate the medical officers. For November 1992 - March 1993 we found 8 out of 24 cases (33%) were not admitted. Although the admission rate was no better, there was a non significant improvement in rate of notification by doctors. Defaulters were now the main problem, and so we took action to improve their follow-up, by using the clinic staff nurse. For April - August 1993, only 1 out of 16 cases (6%) was not admitted. This was a significant improvement (p=0.03)
Study site: Klinik Perubatan Masyarakat at Hospital Universiti Sains Malaysia
The compulsive behaviour of observing an unsuspecting person undressing or being naked in voyeurism may be related to Obsessive-Compulsive spectrum disorder. The aim of this paper is to report a case that reiterates a unique psychopathology of a Malaysian male voyeur with an obsession on female body parts. This 35 year-old voyeur man who attended psychiatric outpatient clinic in an academic medical centre presented to a psychiatrist for taking photos of his sisters' naked bodies and collected nails and hairs from their body, coded them with intend for masturbation. His voyeuristic thoughts and urges which came repeatedly and intrusively, involving attempts to resist them and was associated with an inner tension for the urges to be fulfilled. He responded both to Paroxetine and behaviour therapy. The possibility that voyeurism, a paraphilia can manifest itself as a subtype of OCD is discussed. Keywords: Malaysian voyeur, obsession-compulsive spectrum disorder, body parts
The aims of this study were to translate the Michigan Diabetes Knowledge Test (MDKT) into the Malaysian language, and to examine the psychometric properties of the Malaysian version. A standard translation procedure was used to create the Malaysian version of the MDKT from the original English version. A convenience sample of 307 outpatients with type 2 diabetes was identified between May and October 2009. All data were collected from the Penang General Hospital, Penang, Malaysia. Instruments consisted of the Malaysian version of the MDKT and a socio-demographic questionnaire. Medical records were reviewed for haemoglobin A1c (HbA1c) levels and other clinical data. Reliability was tested for internal consistency using Cronbach’s alpha coefficient. Employing the recommended scoring method, the mean±SD of MDKT scores was 7.88±3.01. Good internal consistency was found (Cronbach’s alpha = 0.702); the test-retest reliability value was 0.894 (p<0.001). For known group validity, a significant relationship between MDKT categories and HbA1c categories (chi-square = 21.626; p≥0.001) was found. The findings of this validation study indicate that the Malaysian version of the MDKT is a reliable and valid measure of diabetes knowledge which can now be used in clinical and research practice.
KEY WORDS: diabetes knowledge; validation; Michigan test; translation
Study site: Diabetes Clinic, Hospital Pulau Pinang, Pulau Pinang, Malaysia.
This quasi-experimental study was carried out to evaluate the effectiveness of an eight-week multi-disciplinary pulmonary rehabilitation programme in improving nutritional and functional status and quality of life of COPD out patients at Hospital Universiti Kebangsaan Malaysia. A total of 9 COPD outpatients aged 40 years and above (6 men and 3 women) completed at least 50% of 16 sessions of an eight-week pulmonary rehabilitation programme. Their nutritional and functional status and rating of quality of life were measured at baseline (0 day) and after 8 weeks and these were compared to those of the control group matched for age, comprising 13 subjects (11 men and 2 women). Nutritional status was determined using anthropometry, body composition (Bioelectrical Impedance Analysis) and three-day food record. Assessment of appetite for food was also carried out using the Simplified Nutritional Assessment Questionnaire (SNAQ). Functional status was assessed using the Pulmonary Functional Status and Dyspnea Questionnaire-modified version(PFSDQ-M). The handgrip strength was also measured using handgrip dynamometer. The SF36 questionnaire was used to measure the quality of life of the subjects. There was a reduction in dyspnea (-49.0%, p<0.05) and fatigue (-47.8%, p<0.05) in men after the intervention programme, as compared to their controls (dyspnea -2.9% and fatigue 8.9%). Quality of life in this group was also significantly improved by 31.8% (p<0.05) as compared to their controls (-3.0%,p>0.05). Similar trends were noted for the women, although the difference was not significant. No significant changes were seen in nutritional status assessed by anthropometry, dietary intake and appetite. However, there was a trend of increased nutrient intake and SNAQ score in the intervention group as compared to control. An eight-week pulmonary rehabilitation programme was effective in improving the functional status particularly in men, by reducing dyspnea and fatigue; and also improving their quality of life, but was not effective in changing the nutritional status.
Study site: Physiotherapy Unit, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Introduction: Feeding difficulty and functional disability are common problems among patients with dementia but their influence on caregivers' burden has not been addressed comprehensively. Thus, this study aimed to determine the association between feeding problems, functional status and caregiver burden among patients with dementia who receive outpatient treatment at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in Kuala Lumpur, Malaysia, as compared to their non-demented counterparts. Methods: A cross-sectional comparative study was conducted among 30 patients with dementia (12 men, 18 women, mean age 75 ± 7 years old) and 60 subjects without dementia (25 men, 35 women, mean age 69 ± 7 years), as well as their caregivers. Subjects' functional status, feeding problems and also caregiver burden were assessed using Activities of Daily Livings (ADLs) and Instrumental Activities of Daily Living (IADL) questionnaire, The Edinburgh Feeding Evaluation in Dementia Questionnaire (EdFED-Q) and Zarit Burden Interview (ZBI), respectively. Subjects were also measured for height and weight. Results: Patients with dementia needed supervision (50%) and physical help during mealtime (40%). The mean functional status score of these patients was higher than the patients without dementia (p<0.05). Caregiver burden score was positively correlated with the EdFED-Q score (r=0.405, p<0.05) but negatively correlated with functional status score (r=0.475, p<0.01). Further, multiple regression analysis showed that after adjustment for age, EdFED-Q score and functional status remained correlated with caregiver burden at R2 of 0.210. Conclusion: Caregiver burden is associated with feeding problems and functional disability among patients with dementia. There is a need to educate the caregivers in order to improve the quality of life of both carers and the demented patients.
Key words: Caregiver burden, dementia, feeding problems, functional status, outpatient
Study site: Psychiatric and medical clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Introduction: Malnutrition is associated with poorer outcomes following treatment for colorectal cancer (CRC). This study evaluates the relationship between nutritional status using scored Patient Generated-Subjective Global Assessment (PG-SGA) with the validated European Organisation for Research and Treatment of Cancer questionnaire (EORTC-QLQ C30) which consists of five functional scales, three symptoms scales and one item of global health/quality of life (QOL).
Methods: A total of 42 CRC patients at oncology outpatient clinics from two hospitals in Malaysia participated in the study from March 2011 to March 2012. The participants were classified as either well-nourished (PG-SGA A) or malnourished (PG-SGA B and C).
Results: The majority of patients were Chinese, male, with a mean age of 57.1 ± 9.8 years and had been diagnosed with stage 2 CRC. Well-nourished patients had statistically significantly better QOL scores on symptom scales: fatigue (p<0.001), nausea and vomiting (p<0.05), and pain (p<0.001) compared to malnourished patients. PG-SGA was strongly correlated with the main domains of the QOL: global health status (r = -0.395, p<0.05), fatigue (r = 0.816, p<0.001), nausea and vomiting (r = 0.730, p<0.001) and pain (r= 0.629, p<0.001). The better the nutritional status (lower total mean score of PG-SGA), the higher the QOL (high mean score of global health status).
Conclusion: The scored PG-SGA is suitable for use as a nutrition assessment tool to identify malnutrition and it is associated
with QOL among this population.
Key words: Chemotherapy, colorectal cancer patient, malnutrition, nutritional status, PGSGA score, quality of life
Study site: Oncology clinics, Hospital Kuala Lumpur, Hospital Selayang, Kuala Lumpur, Malaysia
Self-care behaviour involves all activities type 2 diabetes patients engage in to care for their disease. In our local population, however, most patients do not manage their disease appropriately. This study aimed to determine the level of self-care behaviour and to examine the differences in self-care behaviour according to type 2 diabetes patients’ demographic data and health condition at University Malaya Medical Centre. Sample of this study comprised 388 patients (respondents) and data were collected from December 2010 to February 2011 using self-administered questionnaires. Results showed that the level of self-care behaviour was moderately high (mean = 38.94, SD=11.93). There were significant differences between self-care behaviour and ethnicity [Wilk’s Lambda = 0.92, F(12, 1008) = 2.70, p < 0.05], age group [Wilk’s Lambda = 0.96, F(4, 383) = 4.39, p < 0.05], education level [Wilk’s Lambda = 0.94, F(12, 1008) = 1.85, p < 0.05], type of treatment [Wilk’s Lambda = 0.92, F(12, 1008) = 2.84, p < 0.05], health education [Wilk’s Lambda = 0.97, F(4, 383) = 3.33, p< 0.05]. Respondents who are Indian, elderly, had lower level of education, on insulin treatment, had received health education on diabetes and not smoking had better self-care behaviour scores. It can be concluded that high risk type 2 diabetes patients should be taught individually so as to help them improve physical and psychological outcome.
Study site: diabetic clinic; medical, nephrology, orthopedic, and surgery wards, University Malaya Medical Centre (UMMC)