Peripartum cardiomyopathy (PPCM) is a life-threatening cardiomyopathy of an unknown cause that occurs in the peripartum period in previously healthy women and this article discusses the challenges that lie in diagnosing and managing this rare yet lethal disease.
Nasopharyngeal carcinoma (NPC) is a non-lymphomatous, squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx, an area that shows varying degrees of differentiation. Although relatively rare worldwide, NPC has substantial incidence and mortality in populations in Southeast Asia and in people with Southern Chinese ancestry. In Malaysia, NPC is a leading cancer type. In the clinic, NPC presents on a very wide spectrum. Therefore, a high degree of suspicion on the part of the clinician and an increased awareness by the patient is essential for the recognition of an early lesion. Early detection of the cancer is important as it affects the patient's prognosis and the mode of treatment. Managing patients with NPC is very challenging as patients usually present late when the cancer is already in an advanced stage. Here, we review the challenges in the management of NPC.
Fungal infection of the nail is a common condition that causes much concern because of its disfiguring appearance. Although specific treatment is available for this condition, treatment outcome is variable and persistent nail dystrophy post-treatment may cause distress to both the patient and the physician. This article describes the current available treatment options for onychomycosis, management approach and the expected treatment outcome to enhance primary care physicians' confidence in managing this condition. Oral antifungal agents such as terbinafine and itraconazole are good treatment options for onychomycosis. Combination therapy using oral antifungal agents with topical lacquer preparations may provide added benefits. Evaluation of patient's expectations, providing information on treatment outcome, clinical cure and recurrence rates are essential in the management of onychomycosis. This article is intended to guide primary care physicians to achieve realistic treatment goals and for a satisfactory experience in the overall management of this challenging condition.
This short research note describes and summarizes several recent peer-reviewed and non-peer-reviewed studies on the concept of flattening-the-curve (FTC) in the context of the COVID-19 pandemic. This note also highlights contradictory findings of these studies in terms of the effect of FTC on the total number of infections (the final epidemic size), and poses a research problem for future studies.
1) A variety of surgical lesions can occur in infants and children. 2) The first step in the management is to arrive at an accurate diagnosis. Most lesions can be diagnosed or suspected through "pattern recognition" 3) Some lesions can be treated by the general practitioners / family physicians for e.g. umbilical granuloma. 4) Lesions that can be observed over time for spontaneous resolutions are umbilical hernia, congenital hydrocele and haemangioma. 5) Lesions or conditions that require prompt referral are undescended testis, inguinal hernia, neonatal jaundice and large cystic hygJ1Qmas 6) Thyroglossal cyst, hypospadias and small cystic hygromas can be referred to a specialist at a time convenient for the family. 7) Phimosis may require an expert consultation 8) Expert consultation should be sought when in doubt; for example when difficulty is encountered in differentiating a retractile testis from an undescended testis. 9) As a general rule, all skin and subcutaneous swellings, except a hemangioma should be referred to a specialist, as soft tissue malignancy is a possibility even in infants. 10) Family physicians should be aware of the potential long-term problems of some conditions such as undescended testis and biliary atresia.
Rapid and marked socioeconomic advancements in Malaysia for the past two decades have brought about significant changes in the lifestyles of communities. These include significant changes in the dietary patterns of Malaysians, eg the increase in consumption of fats and oils and refined carbohydrates and a decreased intake of complex carbohydrates. This resulted in a decline in the proportion of energy from carbohydrates, while an increase in the percentage contribution of fat has been observed. Changes in meal patterns are also evident: more families eat out, busy executives skip meals, the younger generation miss breakfasts and rely too much on fast foods. Many Malaysians have the mistaken belief that the taking of vitamin and mineral supplements can make up for the lack of these nutrients in their daily diets. In addition, communities have become generally more sedentary. All these changes have brought about undesirable effects with significant proportions of the affluent segments of the population being afflicted with various non-communicable diseases associated with overnutrition, namely obesity, hypertension, coronary heart disease and cancers. Nutrition activities and programmes are now being directed to tackle this increasing trend, whilst still attempting to eliminate the undernutrition problems. The ultimate strategy towards achieving a healthy nation is the promotion of a healthy lifestyle, including inculcating a culture of healthy eating. Comprehensive long term programmes, including a series of Healthy Lifestyle (HLS) Programmes have been carried out by the government. Launched in 1991 for six consecutive years, the first phase of the Programme comprised one thematic campaign each year, commencing with coronary heart disease and ending with diabetes mellitus. To further strengthen this long-term strategy, another series of activities to be carried out under the second phase of the HLS programme from 1997 to 2002 was launched within the framework of the National Plan of Action on Nutrition (NPAN) for Malaysia. The implementation of these programmes is, however, a challenge to health and nutrition workers. There is a need to examine the strategies for nutrition education to ensure more effective dissemination of information. The challenge is to determine how best to promote healthy eating within the present scenerio of rapid urbanisation, "western" dietary pattern influence, a whole barrage of convenience and "health" foods and nutrition misinformation. Malaysia continues to march ahead with its development plans to elevate the nation and its people to an even higher level of socio-economic status. The crucial question is: are we able to arrest the increase in these diet-related chronic diseases ? Or are we heading towards further deterioration in dietary pattern and increase in these diseases ? It will be a difficult and challenging journey ahead, requiring the concerted effort of all in the country. It is hoped that through this conference of sharing experiences with other Asian countries, a better understanding and improved strategies could be arrived at.
A review of the questionnaire was carried out basically to assess the relevance of the questions to the objectives of the study, to identify weaknesses of the questions particularly in terms of the wording in order to make them as clear as possible to the respondents and to minimize ambiguity and thus the problems of getting the questions across to the respondents. Based on the review a new set of questionnaire would be proposed. The review thus focuses on two major aspects namely the structure and the content of the questionnaire. From the structural aspects each question was reviewed in terms of the language, wording, sequencing and continuity between one another. Basically, not much problems have been identified except in certain cases of ambiguity largely due to language and words used and some cases lack of continuity due to improper sequencing of the questions In terms of the content, for each questions, the purpose of asking, and what is expected of the questions was thoroughly examined and then the relevance assessed. Based on the analysis, three group of questions were identified i.e., the irrelevant questions, the partially relevant and most inlportant non-existence of many relevant questions. It is recommended that the irrelevant questions be omitted, those partially relevant to be modified and new questions added.
Meta-analysis is a method of review that summarises the results of previous research of the same particular issue in a systematic and quantitative way. A meta-analysis that properly combines results from different studies will average out differences caused by random variation and produce a more precise estimate of the true effect. It may also detect and investigate heterogeneity among studies thus providing a deeper understanding of clinical dilemmas and guidance on resolving them, in this way a meta-analysis will be a better guide to practice than an individual study. Meta-analysis also has its limitations as it is largely dependent on the quality of published data and requires careful planning and execution of a valid protocol, together with cautious interpretation of the results. KEYW'ORDS: Quantitative Review, CritinJ Appraisal, Overall Effect, Publintion Bias.
The Malaysian Journal of Medical Sciences (MJMS) would like to present a brief report of its progress in 2018 with a purpose to provide a clear picture of how it has performed so far. This report may considered as a helpful information, especially, to future authors who wish to submit their articles to MJMS. This report summarised the information of the total of original manuscripts received based on manuscript type, authors' country of origin and total of original manuscripts received by month. It also reveals the statistics of the final decisions made based on manuscript type, the accept-reject ratio by the editor and the time taken from submission to decision for all manuscripts submitted throughout 2018.