Background: Kangaroo mother care (KMC) in low birth weight newborns has been found to be beneficial, but
studies have shown that maternal factors might be of concern in the successful application of KMC.
Aim: To study the influence of maternal factors on growth parameters in low-birth-weight babies with KMC.
Methods: This is a prospective cohort study of 40 low birth weight newborns in our institutions. We randomly
assigned the newborns to the group which received KMC and to the group which received conventional care.
Maternal factors were recorded. We measured weight, length, and head circumferences of newborns daily
for thirty days. Data was processed by SPSS x22.0.
Results: A total of 40 newborns were recruited into the study. Weight parameters were significantly higher
in the KMC group than in the conventional group except for the Z scores. Regarding maternal characteristics,
only gestational age was found to influence the initial and the last head circumference (p=0.035). There were
no differences in maternal age, parity, maternal education, mode of delivery, fetal sex, and initial Apgar score
with any of the growth parameters.
Conclusion: There were no maternal and fetal differences in the growth parameters of the groups, except in
the delayed growth of head circumferences in preterm infants.
Keywords: Growth parameters, KMC method, low birth weight
Haemophagocytic lymphohistiocytosis (HLH) is a clinico-pathologic entity caused by increased proliferation
and activation of benign macrophages with haemophagocytosis throughout the reticulo-endothelial system.
Virus-associated HLH is a well-recognised entity. Although majority of parvovirus B19 associated HLH does not
require any specific treatment and carries good prognosis, outcome of children is worse than adults. We report
here a case of HLH associated with acute parvovirus B19 infection in a young healthy patient with underlying
hereditary spherocytosis, with bone marrow findings typical of parvovirus infection. Although this patient
had spontaneous recovery of cell counts, he succumbed due to complication from prolonged ventilation.
Unexpectedly, his immunoglobulin levels were inappropriately normal despite on-going ventilator associated
pneumonia, which reflects inadequate humoral immune response towards infection.
Familial hypercholesterolaemia (FH) is one of the most frequent inherited metabolic disorders that can lead
to a risk of premature cardiovascular disease. Publications on FH are mainly from western patients as there is
little research on Asians, including Malaysians. The aim of this review is to provide an up-to- date information
on Malaysian studies on FH genotyping and its relation to the phenotype of the affected patients.
A search was conducted for data from online databases on FH in Malaysia.
The mutation spectrum for FH among Malaysian patients was extremely broad. The gene variants were located
mainly in the low-density lipoprotein receptor (LDLR) and apolipoprotein B-100 (APOB-100) genes rather than
in the proprotein convertase subtilisin kexin type 9 (PCSK9) gene. The exon 9 and 14 were the hotspots in the
LDLR gene. The most frequent mutation was p.Cys255Ser, at 12.5%, followed by p.Arg471Gly, at 11%, and the
most common single nucleotide polymorphism (SNP) was c.1060+7 T>C at 11.7%. The LDLR gene variants were
more common compared to the APOB-100 gene variants, while variants in the PCSK9 gene were very few.
Phenotype-genotype associations were identified. Subjects with LDLR and APOB-100 genes mutations had a
higher frequency of cardiovascular disease, a family history of hyperlipidaemia and tendon xanthoma and a
higher low-density lipoprotein cholesterol (LDL-C) level than non-carriers.
Research on Malaysian familial hypercholesterolaemic patients by individual groups is encouraging. However,
more extensive molecular studies on FH on a national scale, with a screening of the disease-causing mutations
together with a comprehensive genotype-phenotype association study, can lead to a better outcome for
patients with the disease.
Glaucoma is a common eye disease that can cause irreversible damage if left undiagnosed and untreated. It is one of the most common neurodegenerative diseases causing blindness. Pre-clinical studies have been carried out on animal models of glaucoma for stem cell therapy. We carried out a systematic review to determine whether stem cell therapy had the potential to treat glaucoma. Nine studies were selected based on the predetermined inclusion and exclusion criteria. Of these nine studies, eight focused on neuroprotection conferred by stem cells, and the remaining one on neuroregeneration. Results from these studies showed that there was a potential in stem cell based therapy in treating glaucoma, especially regarding neuroprotection via neurotrophic factors. The studies revealed that a brain-derived neurotrophic factor expressed by stem cells promoted the survival of retinal ganglion cells in murine glaucoma models. The transplanted cells survived without any side effects. While these studies proved that stem cells provided neuroprotection in glaucoma, improvement of vision could not be determined. Clinical studies would be required to determine whether the protection of RGC correlated with improvement in visual function. Furthermore, these murine studies could not be translated into clinical therapy due to the heterogeneity of the experimental methods and the
use of different cell lines. In conclusion, the use of stem cells in the clinical therapy of glaucoma will be an important step in the future as it will transform present-day treatment with the hope of restoring sight to patients with glaucoma.
Living donation is an important source for organs transplantation in Malaysia. This study aims to investigate
the Malaysian living donors’ follow-up attendance, their preferences on medical-institutional facilities, and
the financial circumstances pertaining to the follow-up costs
Materials and Methods:
Primary data were collected through a survey of 80 living donors who made their donation at the University
of Malaya Medical Center (UMMC) between 1991 and 2012.
Out total of 178 donors, only 111 were reachable and 80 of them participated in the survey (72%). The findings
revealed that most of the donors (71.2%) attend the follow-up regularly. Nevertheless, donors seem to neglect
the importance of follow-up as they consider themselves healthy (28.9%) or consider the follow-up as being
troublesome (28.9%). Most donors (67.5%) are not in favour of being treated as patients, but prefer to be
monitored under donor registry (88.8%) and getting their health service in special clinics for donors (80%).
The majority of the donors fund the follow-up costs themselves (32.4%), while 25% of the donors’ follow-up
costs were funded by family members. Among those donors without income and those of low-income (84.8%
of respondents), 60.3% believe that the follow-up costs should be borne by the government.
Based on the findings, it is therefore suggested that the government provides all living donors with proper
free health service through donor registry and donor clinics. Adequate care has to be given to the donors to
pre-empt any unforeseen health complications due to the organ donation surgical procedures.
Despite being the major cause of cancer-related death in Malaysian women,local data on patterns of breast cancer relapse and their long term outcomes are still scarce. We conducted a retrospective study on all patients treated for non-metastatic invasive breast cancer in 1999-2000 at the University of Malaya Medical Centre (UMMC), who subsequently developed relapse. We sought to analyse the patterns of relapse, their associated clinicopathological features and the overall survival ratefollowing the relapses. Univariate and multivariate analyses were used to analyse demographics and clinicopathological factors. Survival was analysed using the Kaplan and Meier method and compared by the log rank test. A total of 268 patients with a mean age of 50, were identified for the study. At a median follow-up of 50 months, 73 patients (27.2%) had relapsed. Local, regional and distant relapse rates were 5.5%, 1.9% and 19.8% respectively, whereas, the 5-year survival rates were 61%, 40% and 21% respectively (p < 0.01). Most relapses occurred within the first five years of diagnosis. Patients with long disease-free interval had better survival. The most common distant relapse site was the lungs while bone was the distant relapse site with the best prognosis. Disease stage, nodal status and oestrogen receptor status were found to have correlation with the risk of relapse. We concluded that the survival of patients with relapsed breast cancer was associated with the site(s) of first relapse and the disease free interval and clinicopathological factors can be used to predict the risk of relapse.
Prescribing medication is not without its adverse effects. Complications due to drug therapy are on the rise in Malaysia, especially when antibiotics are used indiscriminately. We reviewed cases admitted to the Acute Medical Ward of University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia, over a two-month period from March to April 2009. The authors found that Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) were the most common severe adverse cutaneous reactions due to ingestion or parenteral use of drugs. In this report, is a brief description of the two conditions and ways to manage them. The authors have come to a conclusion that judicious use of medications with adequate patient education is important in order to avoid these adverse effects.
Malignant tumours of the scrotum are very rare. Several type of occupations have been identified as high risk for the development of SCC of scrotum e.g paraffin and shale oil workers (1), textile workers (2) etc. We report a rare case of SCC of scrotum. Search of our records in the Urology and Pathology departments of our Centre showed that this is the only case of SCC of the scrotum in the last 10 years.
There has been a significant decline in maternal mortality in Malaysia since independence. The issue of measuring maternal mortality accurately is a problem in all countries. Another major problem is whether we can reduce the mortality further. The definition of maternal mortality includes two major components, which are causation of death and the time of death. To improve data collection on maternal deaths, we need to collect all data on maternal deaths, which are omitted or misclassified. Deaths from accidental causes that are not normally used in the calculations of maternal mortality need to be carefully reexamined to be excluded. The time of death means that in maternal mortality calculations, it includes up to six weeks after delivery, but recent World Health Organization (WHO) publication (ICD-10) suggests that the collection of maternal deaths even after six weeks should be reviewed because there are many maternal deaths which occur after six weeks. Measuring maternal mortality rate should be encouraged rather than maternal mortality ratio. Another measurement of maternal mortality is the lifetime risk of the women. The lifetime risk is the measure of maternal mortality that takes into account the probability of becoming pregnant and the probability of dying as a result of pregnancy. Many countries have started reporting the lifetime risk, which is considered to be better indicator to measure maternal health.
A cross-sectional study of 109 patients with Pseudomonas aeruginosa bacteremia from the University of Malaya Medical Centre (UMMC) in the years 2000 and 2001 was conducted to describe epidemiological features, underlying diseases, possible source of infection, early mortality among patients as well as the antibiotic susceptibility pattern of patients' isolates. Further analysis of the 87 patient records that were available revealed that the mean age was 48.5 years (SD ± 25.1). Fifty-two per cent of cases were male and 48% female. Seventy-nine per cent of infections were nosocomially acquired, 33% of bacteremias were polymicrobial, 47% of patients had a continuous bladder drainage catheter (CBD) in situ, 33% had a central venous catheter (CVL) present at the time of bacteremia and 30% were ventilated. Sixty-eight per cent of patients had an underlying immunosuppressed state and 26% had undergone surgery involving general anesthesia in the week prior to isolating P. aeruginosa. Among the 23 patients with early mortality, 61% were on inappropriate antimicrobials. Most of the patients' isolates were sensitive to imipenem (86%), ciprofloxacin (81%), ceftazidime (79%), gentamicin (78%) and cefoperazone (77%). Among the community acquired strains, however, there was 100% sensitivity to imipenem, ceftazidime, cefoperazone and ciprofloxacin.
Antithyroid drugs have been used for more than 50 years for the management of hyperthyroidism. Most patients tolerate treatment well, but some may develop rare life threatening side effects such as agranulocytosis and aplastic anaemia. Clinical experience with the latter condition is extremely limited. We report on a case of carbimazole-induced aplastic anaemia caused by hypocellular bone marrow and associated plasmacytosis in a thyrotoxic patient chronically treated with carbimazole. This resolved after substitution with propylthiouracil. The clinical course was complicated by neutropaenic septicaemia and atrial fibrillation.
Study site: University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
In the last three centuries, medicine has focused predominantly on the physical body as the source of disease, placing very little importance on the mind. However, the significance of mind-body interactions in medicine is now increasingly being recognised. True health must include both the physical body and the mind. This article traces our concepts of the relationship between mind and body since primitive times and explores its relevance to the maintenance of health.
Steroids remain an important component of maintenance immunosuppression after renal transplantation. Their anti-inflammatory action is partly due to the sequestration of CD4+ lymphocytes in the reticuloendothelial system. Steroids bind to intracellular receptors and the resulting steroid-receptor complex alters the transcription of cytokines by binding to glucocorticoid response elements on DNA. Transcription factors whose actions are altered by glucocorticoids include activating protein-1 (AP-1) and nuclear factor-B (NF-B). The main cytokines whose production by antigen-presenting cells is inhibited by steroids are interleukin-1 (IL-1), required for helper T-cell activation, and IL-6, required for B-cell activation. Other pro-inflammatory cytokines such as interferon gamma and tumour necrosis factor are also inhibited. This multiplicity of immunosuppressive actions is not fully replicated by other immunosuppressants. However, there are concerns about the long-term side effects of steroids. This review will examine the attempts at steroid withdrawal or steroid avoidance in renal transplant patients.
The objective of this study was to compare in-patient drug use patterns, costs, and outcomes associated with risperidone or olanzapine in a naturalistic clinical setting. Retrospective chart reviews of 92 patients with psychotic disorders were conducted at the University of Malaya Medical Centre (UMMC). Data was collected from patients who were hospitalized and for whom risperidone or olanzapine was the drug of first choice for long-term pharmacologic treatment. Proportion of patients for whom efficacy of the studied treatment could be established (as rated by the treating physician) was higher, but not significantly, with risperidone compared to olanzapine (p = 0.46). The average dose of the studied medication was 2.9 ± 1.0 mg/day for risperidone and 9.7 ± 2.4 mg/day for olanzapine. The total cost was significantly higher (p
A cross-sectional survey of commercial vehicle drivers who were renewing their own licences was conducted at the Selangor Road Transport Department office in Padang Jawa between 1 February 2002 and 28 February 2002, using questionnaire and medical examination. The objective was to determine the prevalence of myopia, colour vision deficiency and visual field defect among the commercial vehicle drivers. The respondents that reported visual defect at the time of interview was compared with those detected by the author through medical examination. Out of the 223 respondents, 21 (9.4%) reported to have myopia by the questionnaire survey. Through the visual examination there were 63 (28.3%) with myopia (visual acuity worse than 6/12),six (2.6%) had a visual field defect and 14 (6.3%) had red-green colour deficiency. The visual defect detected during the study among the commercial vehicle drivers, which were missed at the time of the routine medical examination were significant. The process of the statutory medical examination should be reviewed.
Squamous cell carcinoma of the tongue is a highly malignant condition and results in high mortality and morbidity in patients despite its early detection (1). Early surgical interventions have been found to reduce mortality but in many reports, tongue reconstructions using live grafts have been found to reduce normal tongue function of speech, swallow and taste. In contrast, our report using free radial forearm flap (FRFF) to reconstruct the defect left over after a radical tongue resection in a 38-year-old gentleman with oral cancer has shown promising results. This type of reconstruction has left the patient with a functional and cosmetically acceptable tongue with minimal alteration in recognizable speech.
The year 2005 marked the rebirth of JUMMEC when the Editorial Board took over from its previous Editor with modest but realistic expectations. One year on, we have successfully achieved our initial expectation, that is, to encourage greater participation from our junior academics to write and publish in our very own journal, JUMMEC. As we head towards the end of 2006 and prepare to usher in 2007, we see JUMMEC consolidating and gaining in strength. Let us reflect on its past achievements and our expectations for the future.(Copied from article).
Lymphangioleiomyomatosis (LAM) is a rare disease. The reported prevalence is around one per million in the West but the exact prevalence in Asia is unknown. It affects primarily young women of reproductive age, with a mean age of onset at 34 years. The disease is characterised by an abnormal proliferation of smooth muscle-like cells that grow over a course of time to obstruct airways, lymphatic and blood vessels. We report a case of LAM in a young woman who presented with a spontaneous pneumothorax. Computed tomography scan of the thorax and abdomen showed homogenous thin-walled cystic lesions with normal intervening lung parenchyma and multiple lesions in her kidneys with Hounsfield units similar to that of fat.
Evidence suggests that breast cancer is taking the form of a chronic illness. This will add on to the present burden of managing chronic diseases in the healthcare delivery system. The burden of breast cancer being a chronic illness, calls for greater efforts to address the many neglected, physical-psycho-social and occupational functioning consequences. Timely efforts are needed to identify and implement interventions that are aim at improving the quality of life of women with breast cancer. At present, research evidence is highlighting that chronic diseases may best be managed using a self-management approach, and best treated by a balance of traditional medical care and the day-to-day practice of self-management skills. This paper presents the perspective of breast cancer as a chronic illness and its implication for rehabilitation and medical education. It is imperative that health professionals be made aware of these survivorship issues through medical education. The goals are to reduce the many disability risks, encourage patient-health provider communication and enhance partnership in care, within a timely, holistic therapeutic program to improve the quality of life of women with breast cancer.
Six groups of adult Sprague-Dawley rats were orally administered with a variety of treatments to elucidate their cytoprotective effects. Absolute ethanol combined with HCl was used to induce gastric lesions in rats. Aqueous and ethanol extracts of Chromolaena odorata, a famous folk herb for treating skin wounds were evaluated to determine their protective effect on gastric mucosa. In this study, aqueous extract and ethanol extract of C. odorata were combined with honey. In addition, honey alone and honey combined with cimetidine were also evaluated. Rat stomachs were examined grossly and histologically. Results were expressed as inhibition percentage. The honey and aqueous extract combination showed the highest inhibition percentage (72.67%) followed by honey and ethanol extract (58.92%), honey and cimetidine (56.55%) and the lowest was honey alone (46.74%). However, there were no significant differences between the effects of aqueous and ethanol extracts of C. odorata and honey in promoting cytoprotective effects and this may be due to the small sample size. Nevertheless, these results suggest that C. odorata and honey may be beneficial in treating induced gastric mucosal injury.