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.
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.
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.
Assisted Reproductive Technology (ART) is a suite of laboratory techniques designed to rescue infertile phenotypes. While ART has led to the birth of 5 million ART babies worldwide, success rates rarely exceed 40%. One potential factor for this could be iatrogenic (‘clinician-induced’) damage to critical sperm proteins, such as phospholipase C zeta (PLCζ) and protamine, which are fundamental for oocyte activation and sperm DNA integrity, respectively. This report describes how we have begun to investigate the adverse effects of ART techniques upon these key sperm proteins. We also describe the pathway taken by Miss Suseela Yelumalai to acquire a scholarship from the Malaysian Government and her postgraduate experience at the University of Oxford. We introduce the facilities and learning opportunities available at the Institute of Reproductive Sciences (IRS) which houses Dr Kevin Coward’s research laboratory, and finally, highlight the potential for collaborative development between the Universities of Oxford and Malaya.
Dengue is one of the highest occurring vector-borne diseases. It is caused by dengue viruses 1- 4. Currently, the disease is classified into dengue with or without warning signs and severe dengue based on WHO 2009 dengue classification. As of today, neither specific drugs nor commercial vaccine exist for dengue. The best treatment yet would be support, management and proper medical care. With no pathognomonic features that could differentiate it from other febrile illnesses, clinical diagnosis alone is insufficient. Yet, despite the current advances and existence of various laboratory diagnostic methods of dengue, a consensus singular method has not been established. There are several hypotheses or theories regarding the vaguely understood immunopathogenesis of dengue. Amongst these are the viral factors, host-immune factors and host-genetic factors. In addition to these, the occurrence of asymptomatic dengue has further complicated the disease. However, these individuals provide opportunities in the search for protective factors against dengue.
Organ shortage is a major concern in many countries. The objective of this paper was to investigate the factors that contribute to the low quantity of organ donation in Malaysia. The 1311 respondents in this survey came from the three main ethnic groups in Malaysia (Malay, Chinese and Indian). The survey was based on these components: The reason for not pledging to become a donor; the reason of refusing to become a donor; and whether non-fungible incentive would influence decision. The lack of information and trust were the factors that influenced the respondents to remain apathetic to organ donation. The results denote that people are unlikely to become a donor even if non-fungible incentive were provided to them. Thus, it is important for the government bodies to evaluate the programme and strategies of public education in relation to organ donation.
INTRODUCTION AND OBJECTIVE:
Most of important variables measured in medicine are in numerical forms or continuous in nature. New instruments and tests are constantly being developed for the purpose of measuring various variables, with the aim of providing cheaper, non-invasive, more convenient and safe methods. When a new method of measurement or instrument is invented, the quality of the instrument has to be assessed. Agreement and reliability are both important parameters in determining the quality of an instrument. This article will discuss some issues related to methods comparison study in medicine for the benefit of medical professional and researcher.
This is a narrative review and this article review the most common statistical methods used to assess agreement and reliability of medical instruments that measure the same continuous outcome. The two methods discussed in detail were the Bland-Altman Limits of Agreement, and Intra-class Correlation Coefficient (ICC). This article also discussed some issues related to method comparison studies including the application of inappropriate statistical methods, multiple statistical methods, and the strengths and weaknesses of each method. The importance of appropriate statistical method in the analysis of agreement and reliability in medicine is also highlighted in this article.
There is no single perfect method to assess agreement and reliability; however researchers should be aware of the inappropriate methods that they should avoid when analysing data in method comparison studies. Inappropriate analysis will lead to invalid conclusions and thus validated instrument might not be accurate or reliable. Consequently this will affect the quality of care given to a patient.
Human adipose tissue has been recognized as an alternative source of adult stem cells. The abundance and ease of harvest of adipose tissue has made it suitable for use in regenerative medicine and tissue engineering. Adipose-derived stem cells isolated from human adipose tissue are able to differentiate into several mesenchymal lineages and secrete growth factors that exhibit therapeutic potential. Protein profiles have been established using various isolation methods, which has expanded researchers’ understanding of adipose-derived stem cells in clinical applications. This review highlights the properties, isolation methods, immunophenotype and clinical applications of adipose-derived stem cells.
Autologous chondrocyte implantation (ACI) is a widely accepted procedure for the treatment of large, fullthickness chondral defects involving various joints, but its use in developing countries is limited because of high cost and failure rates due to limited resources and support systems. Five patients (age
The biocompatibility and similarity of hydroxyapatite (HA) to the mineral composition of the bone has made HA a potential candidate in bone tissue engineering (BTE). Over the past few decades, its application as bone graft in combination with stem cells has gained much importance. The use of bone marrow-derived mesenchymal stromal cells (MSCs) will enhance the rate and quality of defect repair. However, application of hydroxyapatite as a material to develop a 3-dimension scaffold or carrier to support MSCs in vitro is still in its infant stage. This review will discuss the source, manufacturing methods and advantages of using HA scaffolds in bone tissue engineering applications.
Antimicrobial peptides (AMPs) have gained increasing attention as a potential candidate in the development of novel antimicrobial agent. Designing AMPs with enhanced antimicrobial activity while reducing the cell toxicity level is desired especially against the antibiotic-resistant microbes. Various approaches towards the design of AMPs have been described and physicochemical properties of AMPs represent the primary factors determining the antimicrobial potency of AMPs. The most common parameters include net charge and hydrophobicity, which greatly influence the antimicrobial activity of AMPs. Moreover, certain amino acids would have critical importance in affecting the antimicrobial activity as well as cell cytotoxicity of AMPS. In this review, net charge, hydrophobicity, and specific amino acid residues were discussed as factors contributing to the antimicrobial activity of AMPs.
Initiation of Highly Active Anti-Retroviral Therapy (HAART) depends on clinical or immunological criteria. Clinical criteria include the presence of opportunistic infections, categorized by the WHO as stage 3 and 4. Immunological criteria are based on CD4 cell count. The WHO guidelines have changed frequently. All patients with CD4 cell count less than 200 cells/µl and symptomatic HIV or late disease or severe recurrent HIV illnesses or patients with AIDS or tumor at any CD4 count, should start therapy. WHO guidelines in 2013 recommended initiating HAART at CD4 counts less than 500 cells/µl. HAART is usually initiated when CD4 is less than 200 cell/µl because HIV infected patients present at a late stage. Research on factors responsible for this is sorely needed so that interventions can be targeted at this group.
This was a cross-sectional study which attempts to assess the effectiveness of the 18-hour lactation management course organised by Klang District Health Office for its health staff. The course was conducted for three days from 19 to 21 September, 2006 with a total of 18 hours, comprising 15 hours of lectures and three hours of supervised clinical experience. There were a total of 46 participants for the course. The pre- and post-test scores of the participants from the course were used for analysis. This study showed that the mean pre-test versus mean post-test scores were 12.63 and 19.87. The difference in the mean score was statistically significant (p < 0.001, 95%CI -8.285, -6.193). The difference was significant for the staff nurse, community nurse and assistant nurse but not for doctors. In conclusion, the 18-hour duration lactation management course was effective at improving the knowledge and skills on breastfeeding management for the health staff.
We aimed to establish a method for quantitative analysis of mixed haematopoietic chimerism based on microchip electrophoresis of selected molecular markers following PCR amplification for accurate monitoring of graft status post-transplantation. A 12-year-old girl with relapsed acute lymphoblastic leukaemia who underwent allogeneic bone marrow transplantation had qualitative chimerism analysis using short tandem repeat markers at three time points following the procedure. Her archived DNA samples were then used to test the ability to correlate her clinical course with changes in the quantity of donor chimerism at the different time points. Quantitative chimerism analysis was performed on the Agilent 2100 bioanalyser and donor-recipient ratios were calculated from generated electropherograms. Complete donor chimerism (98%) was demonstrated three weeks post- transplantation. Decreasing amount of donor chimerism to 24% was shown after three months and this concurred with clinical relapse. Following a second transplant, full donor chimerism was reestablished where donor chimerism rose to 100%. High resolution microchip electrophoresis could be useful in predicting the occurrence of increasing recipient chimerism which may herald impending relapse in patients while the disease burden is still low. This investigational approach may provide useful information for clinicians to select appropriate intervention strategies to ensure successful transplantation.
Rehabilitation Medicine is dedicated to optimise patients function and health in the most comprehensive manner. ICF, the latest International Classification by World Health Organization (WHO) is a conceptual framework for the assessment of functioning, disability and health. The purpose of this paper is to describe the applications of ICF in Rehabilitation Medicine practice in the Medical Rehabilitation Unit, University of Malaya Medical Centre (UMMC), Kuala Lumpur. Issues: ICF consists of body function, structure, activity, participation and environmental factor. ICF categories are exhaustive, but are not practical to be used entirely and not applicable in clinical practice on their own. How is ICF used from the clinical perspective? It has to be adapted to make it usable. In Rehabilitation Medicine settings, the following are ways ICF is applied in clinical practice: research in terms of validating the use of available ICF Core Sets and development of new ICF Core Set; clinical practice based on the ICF-based sheet; and educational tools. Conclusion: The practice of Rehabilitation Medicine is in line and compatible with the concept of ICF and can serve as a new important language that can improve the practice of Rehabilitation Medicine. It can be a universal language in functioning, disability and health and can improve understanding in addressing issues on disability within the medical community, improve multi professionals’ communication among patients, healthcare providers and stakeholders.
Primary parotid lymphoma is uncommon and rarely suspected. In most cases, the disease would have disseminated at the time of diagnosis. We describe a case of primary non-Hodgkin’s lymphoma of the parotid gland which progressed to the central nervous system. Clinical history is of limited value in identifying this condition. Diagnostic imaging studies (CT or MRI) may indicate whether or not the mass is salivary in origin but do not help to confirm the diagnosis. In this case, it was deemed that FNA alone is incapable of determining the precise histological subtype for lymphoma, whilst a tru-cut biopsy demonstrated a more sensitive method of determining the diagnosis. The lessons learned from this case would prove useful for other health care providers to make an early diagnosis and hopefully manage more effectively if similar conditions appear in their practice. Performing the appropriate measures can help to not only improve the prognosis but may even avert the prospect of unnecessary surgery.
Presence of a hypofunctioning pigmented adenoma are commonly asymptomatic and is usually only found during an autopsy. In contrast, hyperfunctioning pigmented adenoma is a rare clinical entity and in the majority of cases results in Cushing's syndrome. In this case study, we report a 66-year-old male who presented instead with the clinical and biochemical features of Conn's syndrome. On laparoscopic adrenalectomy, it was found that the tumour had a functioning black adenoma which does not usually present with Conn's syndrome but rather to that of a Cushing's. The intraoperative changes and histopathological findings are discussed.
Leadership style has been shown to be an important determinant of organisational success. The aim of this preliminary study was to develop an understanding of leadership style of three employees with leadership responsibility in a hospital. All the participants were interviewed using a structured questionnaire around a framework on leadership behaviours followed by self administered T-P leadership questionnaire and voluntary completion of a leadership perception survey by each of the participant’s colleagues. The results suggest that whilst individuals are aspiring to be transformational in style, key barriers such as organisational culture, inter-professional dynamics and lack of leadership development meant responses more characteristic of a transactional style were encountered. There is a need to have joint responsibility between developing the individual leadership style and the organisation that facilitates such development for their leaders. The author concludes that a more analytical approach to leadership and mentorship opportunities for developments is required.