Objective. A hospital-based cross-sectional descriptive study documenting the common clinical manifestations of systemic lupus erythematosus (SLE) in a tertiary rheumatology center in the state of Perak in Malaysia. Method. The 1997 American College of Rheumatology classification revised criteria and the 2012 Systemic Lupus International Collaborating Clinic criteria were used and all patients attending the rheumatology clinic at a tertiary referral centre were included. The demographics and other clinical information were retrieved from patients’ outpatient clinical records.
Results. One-hundred SLE patients were included in this cross-sectional study, the majority of whom were of the Malay ethnic group (47%) followed by Chinese (41%) and Indians (12%). Almost 91% of the patients in our study were females. Mean age was 34.94 years (SD = 12.7; 95% confidence interval, 32.42 – 37.46), almost 79% were in the 20-50 years age group. Anti-nuclear antibody (ANA) was positive in 70% of patients while only 28% were positive for anti-double-stranded deoxyribonucleic antibody (dsDNA). Major clinical manifestations were hematological disorders (53%) followed by a malar rash (41%), photosensitivity (30%) and oral ulcers (27%).
Conclusion. Clinical phenotypes, demographics of SLE patients in this study shows no significant difference across age, gender, and ethnic groups. The current data, though limited, shows a high frequency of hematological and mucocutaneous manifestation in these patients.
Background: A systematic review reported a high prevalence of complementary and alternative medicine (CAM) practice during pregnancy. Earlier Malaysian studies related to it were based on Malay predominant populations.
Objectives: The study objectives were to determine prevalence, types, aims, and associated factors of CAM use during pregnancy and the postnatal period among women who gave birth in a Malaysian tertiary hospital.
Methods: A cross sectional study was conducted among women who were admitted to the postnatal wards of “Hospital Raja Permaisuri Bainun, Ipoh, Perak state, Malaysia” using a structured questionnaire, designed to collect data on the participants’ demography, details of CAM practice and their attitude towards its use.
Results: The prevalence of CAM use among 134 respondents was 87.3%. The most commonly used method was naturopathy using abdominal hot stone application or massage as reported by 72% respondents. It was rated highly effective in improving circulation or recuperation by 90% of users. Herbal usage was reported by 36% and the commonest type was Indonesian traditional herbal medicine “Jamu”. The use of CAM was significantly low among Chinese respondents (P
Background: Haemodialysis has been known to affect the patient’s quality of life (QOL). The procedure may affect the social life and economic status of the sufferer.
Aim: To determine the quality of life among haemodialysis patient at Northern Region of Sarawak.
Methodology: The cross-sectional study was conducted among 100 chronic renal failure patients registered at the haemodialysis centre at Miri Red Crescent Dialysis Centre in Northern Region of Sarawak. Their quality of life (QOL) was measured using Kidney Disease Quality of Life-Short Form (KDQOL-SF) instrument, which measures the disease, physical and mental components of QOL.
Results: Overall score for three components of the KDQOL-SF was 69.1. The score of each component were 66.3, 52.6, and 39.4 respectively. There were statistically significant association between marital status and physical health component (P=0.046); age and physical health component (P=0.026); educational level and mental health component (P=0.006).
Conclusion: In general, QOL of patients on dialysis in this centre was good. Most of the patients had better quality of life in the kidney disease component, and mental health component, despite of having poor quality of life in the physical health component. QOL of patients will be better if they got encouragement from dialysis staff in the Centre, getting strong social support from the family and if they actively involved in social function.
Background: Young adults in Malaysia are vulnerable to sexual health problems and unwanted pregnancies as sexual health issues are still a taboo subject in Malaysia. This study examines the knowledge and attitudes regarding sexual health among the undergraduates.
Methods: Data were obtained from a cross-sectional survey of 300 undergraduates in Ipoh, Perak. Their demographic data, sexual knowledge and attitudes were evaluated.
Results: The mean sexual knowledge mark was 29.68 ±5.6 out of total mark of 38 based on 15 questions, with HIV/AIDS being the most well-known STDs. Eighty two percent of the undergraduates obtained information of sexual health through the internet. Higher level economic status of the undergraduates had greater sexual knowledge.
Conclusion: There was adequate grasp of knowledge on sexual health among undergraduate especially health sciences students and students with higher income parents and the youths were very much aware of the importance of education on sexual health.
The proper use of contraceptive has significantly
improved health-related outcomes among the
mothers and infants.1,2 Each pregnancy and
childbirth places a health risk for the mother and the
risk is magnified if she is at high risk or with preexisting
chronic medical conditions.3 Family
planning programme has been implemented free or
at affordable charges in Malaysia Healthcare System;
however, it was underutilized or not being fully
utilized.4 Based on the health records and returns
from January till December 2016 in one local
maternal-child health clinic, as high as 62.5% of
registered high risk mothers were reluctant to
practice family planning Code 1 (hormonal methods
of contraceptive). High risk pregnancy cause
complications for both mother and infant; also
affecting the whole family system. Literatures
suggest that health education has positive impacts in
changing individual’s health behavior; also
empowering the clients to take charge of their own
health decisions and behavior
Introduction: Myocardial infarction (MI), a common cause of mortality and morbidity, needs early and reliable diagnosis. We determined the validity of rapid troponin T (rTropT) in the diagnosis of MI in our local population to know if it can be used as a single diagnostic test.
Method: This was a case control study conducted in patients admitted to ICU/CCU/medical ward in a teaching hospital towards north of Pakistan over a period of six months. Fifty patients were included in study group and 50 in control group, depending on the presence or absence of MI respectively. Patients in control group were age and sex matched. WHO criteria was used for the diagnosis of acute MI. Rapid TropT was performed in study group after establishing the diagnosis of MI and in control group after excluding the diagnosis of acute MI. CK, SGOT, LDH and rTropT were done by Humazyn M test kit Germany, Granutest Merck Germany, monokinetic method and Boehringer Mannheim Germany respectively.
Results: In the study group, 34 (68%) patients were male. Age range was 55-65 years. Overall sensitivity, specificity, positive predictive value and negative predictive value of Rapid troponin T were 92% (CI 80.8-97.8), 100% (CI 92.89-100.0), 100% and 92.6% (CI 83.0-96.9) respectively.
Conclusion. Rapid trop T was a reliable marker for the diagnosis of MI in our patients over a prolonged window period of 7 days after MI. So it can be used as a single diagnostic test in our local population avoiding the need to do many other tests.
This report is a case of a 24-year-old immunocompetent lady treated with anti-tuberculous drug for disseminated tuberculosis diagnosed by bone marrow finding. She presented with concurrent intracranial and intramedullary tuberculoma associated with tuberculous spondylodiscitis evidenced by serial magnetic resonance imaging (MRI) screening after a month of anti-tuberculous therapy. These complications are thought to be paradoxical effects of anti-tuberculous therapy. Symptoms resolved with continuation of anti-tuberculous treatment and a course of corticosteroid.
Sporotrichosis is a fungal infection caused by Sporothrix schenckii, a dimorphic fungus. Transmission of this infection is usually through contact with infected soil, decaying vegetation and plants as well as zoonotic inoculation such as cat scratches. We present an uncommon case of lymphocutaneous sporotrichosis accompanied by reactive arthritis in a 51-year-old woman due to a cat scratch in Malaysia.
Introduction: Congenital talipes equinovarus (CTEV), commonly known as the ‘club foot’ is a developmental disorder of the lower limb that is related with socioeconomic difficulties. Ponseti method is considered as the most popular and successful method of treatment for CTEV children. This study was aimed to evaluate the severity and monitoring the progress of initial treatment of CTEV children.
Materials and methods: Forty two patients with 58 idiopathic CTEV feet treated at a hospital outpatient clinic from January 2017 to February 2018 were included in the study. Ponseti method and Pirani score system were used and the results were calculated after wearing brace for three months duration at the end of serial casting.
Results: The patients in the study were in the age range of 14 days to 12 months. The mean number of changing of casting was 7.2 times. Casts were changed 1.9 times more in the severe cases than mild cases. Thirty six (85.7%) cases needed percutaneous tenotomy. There was no need to perform tenotomy for the mild cases. The initial achievement rate was 90.5 % and there were 9.5 % relapsed cases because of incorrect wearing of the brace. Statistically significant score differences were seen before and after treatment (P-value
Background: Sex determination can be done by the detection of drumstick-shaped nuclear appendage that is present in neutrophil leukocytes from peripheral blood smear of female subjects. Objectives: This study was conducted to identify a drumstick-shaped nuclear appendage on neutrophil leucocytes from peripheral blood smear and to analyse the sensitivity, specificity, positive predictive value and negative predictive value of the test in gender determination. Materials and Methods: A total of 110 randomly selected blood smears (from 40 male and 70 female subjects) with age range from 19-22 years, were stained with Jenner-Giemsa stain. At least 100 well-stained neutrophils per slide were double-blindly studied by the observers.
Results: Sixty-six out of 70 female subjects and 36 out of 40 male subjects were correctly identified. There was 4 false positive result on the male subjects and 4 false negative results on the female subjects in the detection of nuclear appendage. A 94.28% sensitivity, 90% specificity, 94.28% positive predictive value and 90% negative predictive value for the study was calculated. Conclusions: The identification and detection of nuclear appendage from neutrophil leukocyte is an easily applicable method that is useful as a screening method in sex determination. Overall, the method also has a high sensitivity, specificity and predictive values.
Introduction: The incidence of dengue has risen dramatically high over the last few decades worldwide. Some three billion people are at risk of getting infected with dengue. In Malaysia the total number of dengue cases has been rising annually. In Perak, the number of cases for dengue fever and hemorrhagic dengue fever increased from 421 cases per 100000 population in 2012 to 1024 cases per 100000 in 2013 accounting for an increase of 143.2%. This study aimed to assess the knowledge, practice of preventive measures and effectiveness of health promotion related to dengue among residents of a village in Ipoh.
Methodology: This cross sectional study was conducted in 2015. Simple random sampling was applied to choose the samples.
Results and discussion: Out of a total of 408 respondents, 61.3% and 74% obtained good scores in knowledge and preventive practice measures respectively. The highest misconceptions occurred on behavior aspects of the Aedes mosquitoes (46.6%) and availability of vaccinations for dengue (40.7%) while 65% of respondents allow fogging activities to be conducted at 2pm (noon). Significant associations were shown between types of occupation and knowledge (p=0.017), level of education and practice (p=0.022), previous exposure among family members and practice (p=0.016), and between knowledge and practice (p=0.011). In conclusion, despite having good knowledge about dengue and potential breeding sites of the Aedes mosquito, the number of dengue cases rising could be due to a quarter of population having poor preventive practices.
Second year medical students were presented with six scenarios, each representing a dilemma in ethics. All of these scenarios were linked to five options, each of which could represent a possible response to the dilemma, and the students were required to choose which one of these they most favoured. A computerized audience response system was used to individualize the procedure and to ensure participation of all students. Subsequently more information was given about the circumstances of each dilemma, and the same set of options was displayed, allowing another round of voting, whereby the students could change their minds if they wished. Then more information was given, and the voting repeated. The aim was to ascertain if providing information in three stages can aid the students in selecting the (undisclosed) responses favoured by the authors. The results indicated that, on the whole, provision of further information within an ethical dilemma does not enhance the students’ ability to discern what is right and proper and that in this group at least more effort must be put into the ethics instruction.
Helicobacter pylori has been established as the pathogen responsible for various upper gastrointestinal conditions ranging from peptic ulcer disease to malignancies such as gastric adenocarcinoma and mucosa associated lymphoid tissue lymphoma. In this study the prevalence of this organism among patients undergoing oesophago-gastro-duodenoscopy as outpatients was investigated utilizing the rapid urease test of endoscopic gastric biopsies. Out of 278 respondents, we discovered that the prevalence was 40.3% with a slight female preponderance. Ethnic differences were also noted with a much higher (>40%) percentage of Indians and Chinese testing positive for the organism compared with the Malays (23.8%). A larger proportion of the respondents who had the organism were found to have positive OGDS findings compared with those who did not have the organism.
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.
Focal myositis presents as an acute and localized inflammation of the muscle without systemic involvement. The etiology is unknown. Several case reports in the literature have described different presentations of the condition, the majority affecting the limbs with a spectrum of clinical progression, laboratory, and radiological findings.
It is often confused with infection, muscle tumor such as sarcoma, paraneoplastic syndrome or even immune-mediated polymyositis. Delay in diagnosis and inappropriate treatment may lead to recurrence of the condition.
We report a case of recurrent focal myositis of the left thigh in a man in whom optimal treatment commenced six months after the onset led to regression of his symptoms and signs.
Urinary retention rarely affects women. In obstructive retention the source must be determined and treated to allow the patient to void normally. A common anatomic cause of urinary retention is extrinsic compression due to a pelvic mass. In addition, obstruction can also be seen in women with pelvic organ prolapse. Haematocolpos and uterine fibroids have also been documented as causes of acute urinary retention.
The following cases of female urinary retention highlight the need to consider haematocolpos in the adolescent girl who has not attained menarche and fibroids in the older female.
Breast cancer is a major global health problem and the leading cause of death among women of
all ethnic backgrounds. In Malaysia the incidence of breast cancer among women is 1: 19. Around
5,000 Malaysian women are diagnosed with breast cancer every year, most of them aged between
30 and 60 years where, nearly half of those affected are under 50-years of age. In Malaysia,
screening for breast cancer is mainly based on clinical examination, mammogram and ultrasound
studies for most of the population. Based on radiological investigations the patients are then
referred for Fine Needle Aspiration Cytology (FNAC) /or biopsy for final diagnosis. Most women
over 40 years of age undergo mammogram screening so there has been early detection of cancer
of breast in the older age group. Mammogram is not advised in younger age groups as lesions will
be difficult to identify in dense breasts. We did a cross sectional study among 139 rural women in
Perak. The participants were chosen randomly from the rural areas of different villages. We used
a pretested self-administered questionnaire. The questionnaire comprised of eight questions based
on knowledge of breast cancer and few more questions related to imaging of breast. The
questionnaire was distributed to women between the ages 20- 60 years of all three major ethnic
groups in Malaysia, namely Malays, Chinese and Indians. The mean age of the participants was
47.9. The Indians comprised of (59.7%) of participants. Malays (25.2%) and Chinese (15.1 %).
Just below half of the participants were of secondary educational level (44 .6%) Most of them
were married (63.3%). Almost half of them were employed (48.9%). The percentage of women
who had a family history of breast cancer accounted for 11.5%. Among the three major races the
Chinese had more screening done compared to the Malays and Indians (P value 0.003). 51.1% of
women showed poor knowledge of breast cancer and 19.4 % had no knowledge of cause of breast
cancer. Among the several reasons given for not having a mammogram, 40.8 % of participants
said that it was not advised. The major source of information was (TV, Magazines, papers) 63.4 %
and (Friends / Relatives) 30.6%.
Introduction: The Royal College of Medicine Perak under Universiti Kuala Lumpur started its own undergraduate medical degree programme in 2007. As part of the review and evaluation of communication skills (CS) training, the performance of the two pioneer batches of final year students in CS Objective Structured Clinical Examinations (OSCEs) stations in the 2012 and 2013 were analysed.
Methods: The CS OSCE stations were analysed based on the percentage of students obtaining a satisfactory performance in each CS component. Overall performance in each CS component was considered satisfactory, if ≥ 50% of students achieved satisfactory performance or unsatisfactory, if < 50% of students achieved satisfactory performance. The two cohorts were compared for any significant statistical difference (p < 0.05) in their performance.
Results: Satisfactory performance was obtained in basic CS (courtesy, appropriate non-verbal and verbal CS), stating intention of session, recognizing patient’s cues, checking and addressing patient’s perceptions and concerns, checking patient’s understanding, breaking bad news and maintaining a professional attitude. The performance was unsatisfactory in assessing prior knowledge, discussing patient management and checking patient’s coping skills. Both the two cohorts’ performance did not differ significantly.
Conclusion: Overall the students’ performance was satisfactory except for assessing prior knowledge, discussing management and checking patients’ coping skills.
A teacher’s perspective about what makes an effective medical teacher is changing. Medical
teachers are not data-banks of facts and experience, imparting knowledge passively. It was
decided to see what our faculty (Malaysian and non-Malaysian) thought were attributes of an
effective medical teacher.
This was a cross-sectional study in a private medical school in Malaysia. We obtained Ethics’
Committee approval. The estimated sample size was 73. Faculty willing to participate after
verbal informed consent were included. Thirty attributes were rated on a 5-point Likert scale.
Attributes were grouped into four categories: “teaching-related”, “personal traits” “interaction
with students”, and “teacher as a doctor”.
One hundred and four faculty completed the questionnaire (63.5% male, 36.5% female, 20.2%
preclinical, 25% surgical, 25% medical, 10.6% public health-family medicine and 19.2% general
Top ranking attributes selected from the percentage of faculty who rated each strongly were
“enabled to understand basic principles and enthusiastic” (77.9%), “made subject meaningful to
practice”, and “encouraged students to participate” (76%), “ethical” (73.1%), “presented
logically” (69.2%), “motivated students” (68.3%), “spoke loudly and clearly” (67.3%),
“passionate” (65.4%), “showed concern for students” (64.4%), “no bias” (63.5%), “punctual”
and “gave feedback”(61.5%).
Overall ranking for grouped attributes in descending order was “personal traits”, “teachingrelated”,
“interaction with students” and “teacher as a doctor”.
Conclusions and take home message:
Teachers in this study, did not rank knowledge among the top 10 attributes overall. Awareness of
perspectives of teachers will help administrators to organize appropriate staff development
Background: Dementia is known as a serious disorder that commonly appears in aged individuals. The cognitive impairment of the individuals creates difficulties in performing daily activities and tends them to depend on a caregiver to guide and help them to complete their chores. The level of dependency predicts the self-esteem of the dementia people. Objective: The aim of the study was to find the relationship between dependency and self-esteem of the PWD (People with dementia) in Dementia Day Care Centre.
Methods: The study was done on 40 PWDs aged 50 years and above with mild to moderate dementia in the Dementia Day Care Centre. Rosenberg Self-esteem Scale was given to the PWD to assess their level of self-esteem and Care Dependency Scale was given to their respective caregivers to assess the dependency level of the dementia people. The study variables were gender, ethnicity, age and educational level, stage of dementia, total of dependency score and total of self-esteem score.
Results: The total number of PWD participated in this study was 40. More than half (60%) of the PWD were female and 40% were male. Chinese were the majority among the patients. Most of them were aged 70 and above. 85% of the patients were educated. There is a significant positive relationship between dependency and self-esteem with the p-value of .034, where p