Youth sexuality is a great concern for many. Sexual health issues facing our youths are: premarital sexual intercourse, sexually transmitted diseases, unwanted and unsafe pregnancies and abortions, sexual diversity, HIV/AIDS, and cybersex. Various factors lead to risky sexual and reproductive health behavior, particularly among those unmarried youths: lack of sexual and reproductive health information and skills in negotiating sexual relationships and the inaccessibility of youth-friendly sexual and reproductive health services. Growing peer pressure of pre-marital sex plays a major role in sexual and reproductive health related decision-making among youths. Another factor is the issue of sexuality education which is still considered a sensitive topic and thus impinging on its implementation, due to cultural and religious constraints. Misunderstanding and a lack of information on sexual diversity have caused a concern for many, as there is a tendency for judgments, stereotypes, discriminations and prejudices towards homosexuality in the society. Online sexual activities or cybersex have become the next sexual revolution. Negative consequences are shown for those hooked on cybersex. Healthy youths are fundamental to the prevention initiatives. Promoting the sexual and reproductive needs and rights of our youths is warranted.
Following craniotomy for an atypical rhabdoid tumour of the posterior cranial fossa, a fourteen-month-old boy developed a ventriculitis with methicillin resistant Staphylococcus epidermidis (MRSE) which is associated with the use of a ventriculoperitoneal shunt. Treatment with intravenous vancomycin resulted in a severe allergic skin reaction. Substitution with intravenous teicoplanin resulted in negative blood culture and MRSE ventriculitis was successfully eradicated with concomitant use of intraventricular teicoplanin. No signs of recurrent infection or adverse events occurred. Intraventricular teicoplanin is safe and effective for the treatment of staphylococcal neurosurgical shunt infections.
Renal angiomyolipoma, once considered a rare benign renal tumour, is relatively common these days. They account for 0.3-3.0% of all renal masses. Histologically, it is composed of adipose tissue, smooth muscles and blood vessels. Here, we wish to highlight five cases of renal angiomyolipomas which were presented to the University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia, over a two-year period between June 2005 and June 2007. This study wish to illustrate its varied clinical presentation and the management undertaken for each underlying condition. These cases were presented in the form of spontaneous perirenal haemorrhage, a large asymptomatic renal mass, a small asymptomatic renal mass, a symptomatic renal angiomyolipoma and a case of renal angiomyolipoma mimicking a renal tumour. Each of these cases varied in its clinical presentation; thus, management has become very challenging to clinicians ranging from conservative management to active intervention, be it operatively or non-operatively.
Dengue virus infection has been endemic in Malaysia and in the region for decades and the disease caused by the virus has led to increased morbidity and mortality each year. Dengue is now endemic in more than 110 countries worldwide with two-fifths of the world's population at risk. Dengue fever is a flu-like illness and clinical features vary with the age of the patient. Dengue haemorrhagic fever on the other hand, is characterized by high fever, haemorrhagic phenomena and in severe cases, circulatory failure. There is no specific treatment for dengue fever but careful clinical management frequently saves the lives of these patients. Vaccine development has been difficult as protection against one or two dengue viruses could actually increase the risk of more serious diseases. At present, the only method of preventing dengue is to combat the vector mosquitoes. Dengue is diagnosed by viral isolation and or serology. Current methods, some in-house and others commercial, are far from satisfactory. My laboratory has developed, evaluated and validated tests for dengue that now enable detection on the first day of illness in most cases. At the same time an important aspect of dengue prevention is protection. To this end, we have been investigating the various immune parameters such as T-cells, cytokines and antibody neutralizing activities to show that specific immune responses do occur in a selected Malaysian population which are HLA restricted, cytokine mediated and directed specifically at certain regions of the virus.
The state of Selangor, Malaysia, is facing a significant rise in the number of malaria cases with the incidence varying from 20 to 90 per 100,000 persons in a population. A study was carried out to describe the distribution of malaria cases in relation to the growing number of foreign workers in Selangor. Data were reviewed using the return forms "PBV (M) 101", a summary of malaria cases in Selangor for 2006 and Annual Reports of Vector-Borne Disease Control Unit, Selangor State Department for 2001- 2005. The malaria cases in Selangor varied between 172 cases in 2001 and 90 cases in 2006. Most of the cases were contributed by foreign workers, who were predominantly male of economically active age group and came from malaria endemic countries. Most of these cases were concentrated in the urban districts. Malaria is still endemic in Selangor. Malarial infection has the potential of contributing to an urban outbreak of malaria.
This is a retrospective case control study conducted between 1 January 2005 and 30 June 2006 at the Hospital Tuanku Jaafar, Seremban, Malaysia. The objective was to study the maternal sociodemographics and foetal characteristics associated with premature delivery. There were 387 cases selected universally and 387 controls selected by using systematic random sampling involving every 13 cases. The patients were women who had delivered their babies before 37 completed weeks, while the control were women who had term deliveries during the same period. Data were collected using structured questionnaire through secondary data. Results showed that having multiple pregnancies (OR=8.33, 95% CI: 2.91, 23.84), congenital abnormality (OR=4.6, 95% CI: 0.98, 21.84) and intrauterine growth retardation (OR=15.59, 95% CI: 3.69, 65.82) were the risk factors of premature delivery. Being an ethnic Indian also raised the odds (OR=1.67, 95% CI: 1.14, 2.43) but this was not significant in the multivariate analysis. Other sociodemographic characteristics did not contribute significantly to the risk factors for premature delivery in this sample. In conclusion, foetal characteristics were found to be significantly associated with premature delivery after adjustment for other confounding factors.
It is important to provide effective postoperative analgesia following a Caesarean section because mothers wish to be pain-free, mobile and alert while caring for their babies. The role of regular oral diclofenac as postoperative analgesia was evaluated in a randomized controlled study and it was compared to the established method of parenteral pethidine. Forty healthy women scheduled for elective Caesarean section under spinal anaesthesia with 2-2.5 mg of heavy bupivacaine 0.5% were randomized to receive either 75 mg of oral diclofenac twice daily or 1 mg/kg of subcutaneous pethidine every 8 hourly. Efficacy of pain relief (visual analogue score), patients' satisfaction and side effects such as sedation, nausea and vomiting were recorded for three days. The demographic variables were similar in both groups. Pain relief was adequate and comparable in both groups with similar mean visual analogue score during the second and third day of the study period. However, on the first postoperative day, 60% of the diclofenac group population required rescuemedication consisting of subcutaneous pethidine in order to achieve the same pain scores as those in the pethidine group who did not require any rescue medications. Women who received oral diclofenac reported lower sedation and higher overall satisfaction. The incidence of nausea and vomiting was similar in both groups. This concluded that although oral diclofenac 75mg twice daily may not be superior to the traditional method of subcutaneous pethidine for pain relief following caesarean section, it can still be used alone as an alternative, as it has other benefits of a non-opioid analgesia.
Achieving and maintaining good glycaemic control remains an important goal in the management of this common and prevalent disorder. Recent evidence from important megatrials, ACCORD, ADVANCE, VADT, UKPDS-10 year follow-up as well as the STENO-2 follow-up study, have cleared doubts concerning the benefits of targeting good glycaemic control. For the first time, we have the reassurance that macrovascular benefits can be realised from good glycaemic control. The legacy effect of prior good glucose control from the UKPDS-10 year follow-up, reinforces the results seen from the DCCT-EDIC (for Type 1 diabetes). The Intervention Phase of the UKPDS revealed benefits for reduction of microvascular complications, while it was only at the end of the Post-Trial Monitoring Phase where significant improvements in both micro and macrovascular outcomes were seen. The other three Trials assessing the effect of glycaemic control on cardiovascular outcomes, although largely negative for CV benefit, give valuable insight towards appropriate patient characteristics for which aggressive glucose control can and should be instituted. Individualising glycaemic targets, which has been the approach that many clinicians have been practising, has received new impetus albeit with clearer details. Getting to glycaemic goal early in the course of T2DM and Doing to Safely (Avoiding hypoglycaemia)are the key ingredients to successful management. The legacy of the memory of initial good metabolic/glycaemic control is investment in good health with benefits of reductions in both micro and more importantly, macrovascular disease, years later. Multifactorial interventions that include blood pressure, lipid lowering in addition to glucose control in these individuals with the Metabolic Syndrome result in more immediate beneficial additive effects on cardiovascular outcomes.
The exclusive breastfeeding rate in Malaysia is very low. However in recent years the awareness of breastfeeding among mothers has increased. A preliminary qualitative research was carried out on these motivated mothers. The objective of this study was to understand the challenges encountered by breastfeeding mothers and to explore the support and motivation received by them. Information from the motivated mothers was obtained from focus group discussion. Some obstacles faced by the mothers were lack of knowledge on breastfeeding and lack of support from health professionals, parents and siblings. Facilities to express breast milk while at work were not readily available. The main motivation to breastfeed came from the mother herself and support from the husband. A holistic approach must be used to help mothers to continue breastfeeding. This includes breastfeeding promotion and education, setting up more Baby Friendly Hospitals, availability of breastfeeding support groups and provision of enough breastfeeding facilities at work and public places.
The aim of this study was to validate the translation of the Overactive Bladder (OAB) Screener (OAB V8) to the Malay language. It was to assess the reliability of the screener in the context of a Malaysian population. The original screener consists of eight symptoms indicative of OAB that has been proven to be highly sensitive and reliable. Translation was done with a modification of the Brislin Method using back translation and a panel of experts as a final review panel. The pilot study had two groups; a symptomatic (n=19 patients) and an asymptomatic group (n=18 patients). All patients performed the test twice at two week intervals once at the clinic and subsequently at home. Test-retest method was used for reliability and Cronbach's alpha for internal consistency. The translated questionnaire demonstrated good internal consistency in both groups of patients for all eight items individually and for the total score. Cronbach's alphas ranged from 0.972 to 0.981 for the symptomatic group and from 0.750 to 0.976 for the asymptomatic group. Testretest correlation for all items was highly significant. Intraclass orrelation (ICC) was high for both the asymptomatic (ICC ranging from 0.600 to 0.953) and the symptomatic group (ranging from 0.944 to 0.989).The Malay OAB V8 showed itself to be suitable for use, reliable in distinguishing symptomatic and asymptomatic patients and a valid instrument.
The aim of the research is to compare the physical profile between Malaysian women basketball players and netball players. The physical profile measures were height, body mass, and body fat. The subjects were divided into two groups based on their playing performance and positions. The playing performance consisted of elite/senior, junior, and reserve players. Meanwhile, the playing positions consisted of forward/attack, centre, and guard/defence. The percentage of body fat was determined by means of skinfold measurement at seven different locations. Results showed that there were significant differences in body fat percentage between basketball player and netball players (p < 0.01). The elite/senior basketball players were reported to have the lowest body fat percentage as compared to other basketball or netball players. While for the playing position, guard/defence position basketball players were reported to be the shortest and have the lowest body fat percentage as compared to other playing positions. In conclusion, Malaysian basketball players were found to have better physical or bodily advantaged in terms of playing contact sports as compared to the Malaysian netball players.
The objectives of this study were: (1) to detect group B streptococcus (GBS) carriers among antenatal patients during pregnancy ( 35 to 37 weeks) in the University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia, and (2) to give antibiotic prophylaxis during the intrapartum period for the GBS carrier patients. The aim is to prevent early onset of GBS infection in newborn. This pilot study was carried out from 1st July 2005 to 31st August 2005. It is a prospective study involving 56 pregnant women who were seen at the antenatal clinic in the UMMC between 35 to 37 weeks gestation. High vaginal swab and low vaginal together with endoanal swab were taken for culture and sensitivity. The antibiotic prophylaxis was started early in the intrapartum period for patients with positive culture for GBS. GBS was detected in 18 patients which contributes to about 32% of the study population. The proper choice of antibiotic is important in successful disease prevention.
Study site: Obstretic and gynaecological clinic, University Malaya Medical Centre (UMMC)
The objective of this study was to determine the prevalence of sleep disturbance with work characteristics among nurses in the Melaka Hospital, Malacca, Malaysia. This was a cross sectional study conducted in Melaka Hospital. Universal sampling was conducted and a Malay version of the Pittsburgh Sleep Quality Index (PSQI) questionnaire was used in data collection. Socio-demographic characteristics such as age, marital status, number of children and work characteristics such as type of work schedule and duration were also enquired. Factors associated with poor sleep quality were compared between those nurses with good sleep quality by using logistic regression. There were 607 nurses who completed the questionnaire with a response rate of 73.1%. There was a moderate prevalence (57.8%) of poor sleep quality (PSQI > 5) in all study subjects. The prevalence of sleep disturbance was more widespread among nurses who worked shifts (62.0%) compared to non-shift working nurses (41.5%) p
The aim of this study was to determine whether the home environment was a risk factor for falls occurring at home among the elderly in the Masjid Tanah community, Malaysia. An analytical cross-sectional study conducted from early June 2006 until May 2007 in six randomly selected villages in Masjid Tanah Province. A total of 516 participants were included in this study. Overall prevalence of falls among the study participants was 27.3%. Home falls accounted for 66.7% of the total falls. In conclusion, there was no association between home environment and home fall in this study. Logistic regression analysis showed that having a depressive mood was the main determinant for home falls among the elderly in this study.
Male factor infertility which accounts for 30-50% of infertility is a major problem faced by married couples. Congenital absence of the vas deferens, though uncommon, remains the most common abnormality seen in extratesticular ductal and ejaculatory system, accounting for 1-2% of male infertility. It may be unilateral or bilateral. Association with renal abnormality has also been reported with congenital absence of vas deferens (1). The patients are asymptomatic and the congenital abnormality is usually detected when investigation for infertility is carried out. We present a case of an unusual presentation of congenital bilateral absence of vas deferens (CBAVD).
A case-control study was conducted between November 2005 and May 2007 in the University of Malaya Medical Centre (UMMC), University of Malaya, Kuala Lumpur, Malaysia. The objective of this study was to identify specific socio-demographic and lifestyle factors which were associated with foot ulcer in Type 1 and Type 2 diabetes patients. There were 125 cases and 250 controls by using universal sampling. Diabetic foot ulcer was defined as "the full thickness skin break at least to Grade 1 Wagner Stage, occurring distal to malleoli". The case was defined as the diabetic patient who was newly diagnosed or who has a known case of diabetic foot ulcer and the control was defined as the diabetic patient without active foot ulcer. Data was collected via face-to-face interview using a structured questionnaire. Results showed that diabetic patients at younger age group, 44 years old and less (OR 5.90 95% CI 2.31, 15.10), Indian (OR 3.24 95% CI 1.66, 6.30), and smoker (OR 3.85 95% CI 1.77, 8.35) were the independent risk factor for diabetic foot ulcer.
Malaysia is a country consisting of people of Malay, Chinese and Indian ethnic origin and also of some Indonesian and Thai population. In this study of acute pancreatitis, the age group, sex incidence, clinical
features, complications and treatment were compared between different ethnic groups. A total of fifty-four consecutive patients admitted in Sungai Petani Hospital, Kedah, Malaysia with acute pancreatitis from 2002 to 2004 were taken for this study. There were 29 males and 25 females. The 40–60 years age group was more commonly involved. The common factors associated with acute pancreatitis were alcohol intake in males and biliary disease in females. Two females suffered from acute pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). One of the 54 cases died due to multi-organ failure.
The crux of the current health problem is the alarming increase of dengue cases in the country. Dengue fever is endemic in Southeast Asia with Malaysia seeing dengue cases surge since 2003. The Health Minister of Malaysia has reported that the acute increase in dengue cases is worrying and could hit the country's productivity, tourism industry and economy.(Copied from article).
A 65-year-old lady with cholelithiasis underwent an elective laparoscopic cholecystectomy (LC) and was discharged on post-operative day 2. She was re-admitted after five days with right hypochondriac pain and fever. Investigations revealed a drop in hemoglobin. Computed tomography showed a large intrahepatic subcapsular collection without intra-abdominal collection. She was treated with intravenous antibiotics. Percutaneous aspiration of intrahepatic subcapsular collection under ultrasound guidance revealed old blood. Hence diagnosis of intrahepatic subcapsular hematoma (ISH) was made. She improved and was discharged after a two weeks' hospital stay. Follow-up ultrasonography examination two months later revealed complete resolution of the hematoma. We report this case due to its rarity and review the previously documented cases of this complication.
Intrapulmonary bronchogenic cyst is a rare congenital lesion originating from abnormal budding of the embryonic foregut. It is less common than mediastinal bronchogenic cyst. We describe a case of intrapulmonary bronchogenic cyst and discuss the treatment of this condition.