The p53 gene is a tumour suppressor gene that encodes a 393-amino-acid nuclear DNA-binding phosphoprotein. The significance of p53 detection is that p53 mutation is linked with chemo-resistance and transformation to more aggressive disease in a large number of tumour types and it was confirmed that mutant p53 is involved in neoplastic transformations. In addition, the expression of p53 has been closely correlated with clinicopathological findings. Since breast cancer has been reported as one of the most frequent malignancies in women in Malaysia, the expression of p53 was studied in 382 cases of invasive ductal carcinoma of the breast, obtained from three major hospitals in the North East States of Malaysia. The study utilized an enzyme immunohistochemistry assay for the detection of p53. It was found that p53 was expressed in 29.6% of all the study cases. Furthermore, its expression was significantly correlated with the age and the clinical grading of the disease. No significant statistical correlations were depicted with lymph node status, tumour size, side of tumour, and expression of estrogen and progesterone receptors. Nevertheless, knowledge of the p53 status may be valuable in making clinical decisions regarding diagnosis, prognosis and therapy.
This paper describes the pattern of diving accidents treated in a military hospital based recompression chamber facility in Peninsular Malaysia. A retrospective study was carried out to utilize secondary data from the respective hospital medical records from 1 January 1996 to 31 December 2004. A total of 179 cases categorized as diving accidents received treatment with an average of 20 cases per year. Out of 179 cases, 96.3% (n=173) received compression treatment. Majority were males (93.3%), civilians (87.2%) and non Malaysian citizens (59.2%). Commercial diving activities contributed the highest percentage of diving accidents (48.0%), followed by recreational (39.2%) and military (12.8%). Diving accidents due to commercial diving (n=86) were mainly contributed by underwater logging activities (87.2%). The most common cases sustained were decompression illness (DCI)(96.1%). Underwater logging and recreational diving activities which contribute to a significant number of diving accidents must be closely monitored. Notification, centralized data registration, medical surveillance as well as legislation related to diving activities in Malaysia are essential to ensure adequate monitoring of diving accidents in the future.
MeSH terms: Accidents; Decompression Sickness; Diving; Hospital Records; Hospitals, Military; Malaysia; Male; Medical Records; Military Personnel; Retrospective Studies; United States
We report a case of umbilical necrosis after a unilateral pedicled transverse rectus abdominis myocutaneous flap in a patient post mastectomy. This uncommon complication of breast reconstruction is highlighted.
We report a male patient of Graves Disease with bilateral exophthalmos who had undergone bilateral transnasal endoscopic orbital decompression with subsequent improvement of 3mm in orbital proptosis bilaterally without any complications. Transnasal endoscopic orbital decompression is recommended as an alternative to traditional decompression techniques especially for purely cosmetic reasons.
Rhinosporidiosis is a chronic granulomatous disease caused by an aquatic protistan parasite in the class of Mesomycetozoea, that is endemic in India and the subcontinent. This is a case report of a rhinosporidiosis presenting in an individual from Myanmar, whom had been working in Malaysia for the past four years. The disease is characterized by the appearance of polypoidal, friable growths that contain numerous spore filled cysts that stain with PAS staining. This disease is rarely seen in Malaysians due to the extensive urbanization in Kuala Lumpur, however the increasing numbers of migrant workers in Malaysia today necessitates an increasing awareness in clinicians of the possibility of these conditions.
The aim of this study was to determine the prevalence and association of speech disorders among operated cleft lip and palate children (CLP) in North East Malaysia. A comparative cross sectional study was performed on 98 operated CLP and 109 non cleft subjects that aged between 3-12 years old. Data collection was done clinically and also by recording speech samples of each subject from both groups using a portable cassette recorder. Results showed that the prevalence of speech abnormality was 61.2% (95% CI : 51.41-71.04) and the risk of having speech abnormality was 174.5 times (95% CI : 23.04, 1320.67; P value < 0.001) in CLP children compared to non cleft children. Therefore, it was found that children with appropriately repaired CLP in North East Malaysia failed to have normal speech.
Inverted pappilomas (IPs), although histologically benign, are aggressive lesions that may recur after excision. They usually present as unilateral firm, bulky, red and vascular masses. The objective of this case series is to discuss the surgical treatment options for IPs and to review the literature with a special emphasis on our experience with endoscopic medial maxillectomy. A retrospective review of the data of patients with IP treated by endoscopic medial maxillectomy was performed. This report describes the surgical experience with five patients with IP arising from various sites on the lateral nasal wall. Data points collected included age, sex, location(s) and histopathological diagnosis (benign IP vs. IP with dysplasia or carcinoma). The surgical treatment strategy, need for adjunct approaches, complications, recurrence rates and length of follow up were determined. The average age was 51.2 years (range, 35-62 years), with four males and one female. All cases were managed with endoscopic medial maxillectomy as the primary surgical modality. Adjunctive approaches included endoscopic dacryocystorhinostomy (EDCR) in two patients who presented with epiphora post operatively. Intra operative frozen section was performed in all cases to ensure complete tumor removal. No intra operative complications were encountered. No recurrences were noted in these patients, with a mean follow up period of 23 months.
Hand assisted laparoscopic nephrectomy (HAL-N) and nephroureterectomy (HAL-NU) were introduced to bridge the gap between open and laparoscopic surgery. This newer technique has the benefits of both laparoscopic and open surgical approaches but has a shorter learning curve and decreased operative time compared to laparoscopic surgery. A review of our 2 year experience showed that for the seventeen cases of HAL-N that was performed, the mean operative time was 187.8 minutes while the mean length of hospital stay was 4.1 days. For the two HALNU cases, the mean operative time was 415 minutes while the mean length of hospital stay was 5.5 days. Only one complication occurred and it was an incisional hernia at the hand port site. There was no recurrence for the carcinoma cases. Our experience shows that this technique is feasible and safe.
The nasal profile and skin thickness in the Caucasian Indian vary from the Oriental Chinese or Malay noses. Reduction rhinoplasty is more common in the Caucasian Indian noses whereas augmentation rhinoplasty is more common in the Oriental Chinese or Malay noses. Graft selection remains the greatest challenge for surgeons performing rhinoplasty. However, the preferred choice as far as possible for nasal reconstruction would be autografts as compared to allografts due to their lower rate of infection, extrusion and they do not induce an immune response. We have evaluated 40 patients and compared our experience with the grafts available over a period of 46 months.
MeSH terms: Humans; Nose; Rhinoplasty; Transplantation, Autologous; European Continental Ancestry Group; Asian Continental Ancestry Group; Allografts; Autografts; Surgeons
Self esteem is an important determinant of psychological well being that is particularly problematic during adolescent life stage. There is a correlation between low self esteem and other social problems among today’s adolescents. This study was conducted to determine the mean self esteem score and to determine the association between self esteem and age, sex, race, religion, number of siblings, ranking among siblings, family function, parental marital status and smoking among adolescents aged 12 to 20 years old. A cross sectional study design using random cluster sampling method was done. Four out of a total of 35 secondary schools in Klang District, Selangor were selected. Respondents consisted of individual students in selected classes from the four selected schools. Data was collected using a self administered, structured, pre tested questionnaire and was analyzed using the SPSS version 12.0. Out of 1,089 respondents, 793 completed the questionnaire (response rate 73.82%). The overall mean self esteem score was 27.65. The mean self esteem score for males (27.99) was slightly higher than females (27.31). The differences in the mean scores by race were statistically significant. There was a statistically relationship between mean self esteem scores and sex, age, race, religion, number of siblings, smoking and family function. There was no statistically significant difference between mean self esteem score with parental marital status and with ranking among siblings. The overall mean self esteem score was 27.65. Self esteem was associated with sex, age, race, religion, number of siblings, smoking and family function.
With improvements in health care, disability and developmental problems in childhood have become more important health problems. Global developmental delay, cerebral palsy, intellectual impairment, hearing impairment, vision impairment, autism, ADHD, mental health problems, etc. have become more important concerns in recent years. It is important to detect these early as data suggests that, early detection and intervention offer better long term outcomes and better family well being.
MeSH terms: Attention Deficit Disorder with Hyperactivity; Autistic Disorder; Cerebral Palsy; Developmental Disabilities; Hearing; Hearing Tests; Mental Health; Hearing Loss
Summary of Paper: This study aimed to assess the knowledge on basic sciences and clinical psychiatry (psychopathology and clinical syndromes) of the part I candidates on the mock MCQ paper. Methodology and results: The study is a descriptive and cross-sectional study and was carried out in a group of postgraduate students in psychiatry from Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM) and Faculty of Medicine, Universiti Malaya (UM) attending a series of revision course organized by the Department of Psychiatry, UKM. Revision course in psychiatry is an annual intensive course organized by the Department of Psychiatry, UKM to help young candidates preparing postgraduate psychiatry examination to refresh and consolidate their knowledge on basic sciences and clinical psychiatry. Candidates from various universities sitting for part 1 exam and completed their lectures and training in area of basic sciences are invited to attend this course which is held in The Department of Psychiatry, Hospital UKM.
Smoking cessation programmes have been available for almost 2 decades in Malaysia. However the programmes have mainly focussed on outpatient primary care settings. More attention is needed to address and treat smokers presenting to hospitals with acute and chronic medical illness as hospitals provide good settings to implement smoking cessation intervention. For instance, a tobacco related medical illness may boosts a smoker\'s motivation to stop, especially when the smoker perceives smoking as the cause of his illness and understands the gains achieved by smoking cessation. Besides bringing a smoker in contact with health personnel who may offer assistance to a smoker to help him stop smoking, a hospital stay also provide an opportunity for the health carer to initiate and practice the government policy of no smoking in the hospitals. This article addresses the importance of having a hospital-based smoking cessation programme for the Malaysian hospitals.
MeSH terms: Health Personnel; Health Promotion; Humans; Malaysia; Male; Outpatients; Primary Health Care; Smoking; Tobacco; Tobacco Use Disorder; Smoking Cessation
Substance misuse, in particular heroin addiction contributes to health and social problems. Although effective medical treatment was available, earlier efforts confined the treatment of heroin addicts to in-house rehabilitation which required them to be estranged from the community and their families for 2 years. The in-house rehabilitative programme, implemented for at least three decades has produced low abstinence rates. On the other hand, being ‘away’ meant that many heroin addicts faced employment problems and family relationship difficulties upon completing the in-house rehabilitation. However, recently, the concerted efforts by various government and non-government organisations, and the acknowledgement that heroin addiction is a medical illness has resulted in a revamp to approaching treatment of heroin addiction. At present, methadone substitution programmes have been offered as part of treatment programme for heroin addicts in Malaysia. This new programme has been shown to be effective in treating heroin addiction and would need support and cooperation from all groups involved.
MeSH terms: Heroin; Employment; Family Relations; Government; Heroin Dependence; Malaysia; Methadone; Residence Characteristics; Social Problems; Treatment Outcome
Pathological laughing or crying (PLC) were recognized after the occurrence of stroke, with a prevalence of 15% to 18%. There is no apparent triggering stimulus, and is often misdiagnosed as a mood disorder as it is a disorder of emotional expression rather than a primary disturbance of feeling. We reported a case of a 32 year old lady, who presented with giddiness and altered consciousness progressing to fever and neck stiffness, who’s CT showed a massive left cerebellar infarct. No risk factors were identified. Psychiatrically, she developed sudden crying spells after one month and a diagnosis of Major Depressive Disorder was made with subsequent commencement of anti-depressants. A week later, she developed continuous inappropriate laughter without the feeling of elation, which was beyond her control. There were no symptoms of mania or psychosis.
Introduction: Women are exposed to stress such as working full time while still being responsible for the family and house.
Objective: The objective of this study was to determine the prevalence of depressive symptoms among adult women in Selangor, and to determine the potential risk factors associated with depression.
Method: A community based cross sectional study was conducted in all districts of Selangor state, Malaysia in July 2004. Multi stage stratified proportionate to size sampling method was used to collect data. The Patient Health Questionnaire (PHQ-9) was used to determine the presence or absence of depressive symptoms among the respondents. All respondents aged 20 to 59 years old in the selected households were interviewed.
Results: Out of 1032 women, 972 agreed to participate in this study, giving a response rate of 94.2%. The mean age of the respondents was 37.91 ± 10.91. Majority were Malays (54.9%), married (83.8%) and had secondary education (54.5%). The results showed that the prevalence of depressive symptoms was 8.3% in Selangor. Race, religion, education level, history of having a miscarriage within the last 6 months and history of difficulty in getting pregnant were significantly associated with depressive symptoms (p<0.05). Women with history of a miscarriage within the last 6 months and absence of formal education were potential risk factors for depressive symptoms (OR, CI = 2.576 (1.165-5.696), p<0.01 and OR, CI = 5.766 (1.949-17.053), p < 0.01).
Conclusion: Depressive symptoms among adult women in Selangor was 8.3% and was associated with race, religion, education, history of miscarriage and difficulty in getting pregnant. The main potential risk factors were having a miscarriage within the last 6 months and absence of formal education.
Keywords: Depressive symptoms, Prevalence and Risk Factors, Selangor Women
MeSH terms: Abortion, Spontaneous; Adult; Cross-Sectional Studies; Depression; Depressive Disorder; Family Characteristics; Female; Health Surveys; Humans; Malaysia; Marriage; Pregnancy; Surveys and Questionnaires; Risk Factors; Prevalence
Introduction: As eating disorders such as anorexia nervosa and others are generally becoming more prevalent, it is essential to have a culturally accepted and locally validated questionnaire that is able to detect abnormal eating habits. Objective: To translate the Eating Disorders Examination Questionnaire (EDE-Q) into Bahasa Malaysia (BM) and to determine the construct validity, reliability and other psychometric properties of the BM version. Method: Two parallel forward and backward translations were done in BM in accordance to guideline. Its validation was determined by using confirmatory factor analysis among 298 secondary school children. Results: The BM EDE-Q had very good internal consistency with global Cronbach’s alpha value of 0.879. For construct validity, majority of the items managed to produce values of more than 0.4 for confirmatory factor analysis with four unforced distinct factors detected. Conclusions: Analyses of reliability and validity of this BM version of EDE-Q yielded satisfactory results. The BM version produced in this study had good psychometric properties and it is applicable to the Malaysian population. Findings indicated that cultural factors in eating habits certainly influences the effort to adapt the questionnaire within a Malaysian setting.
MeSH terms: Anorexia Nervosa; Feeding and Eating Disorders; Child; Factor Analysis, Statistical; Habits; Humans; Malaysia; Psychometrics; Surveys and Questionnaires; Translating; Translations; Reproducibility of Results; Prevalence
Objective: This study assesses the impact of prescribed undergraduate psychiatry training program on medical students’ attitudes to psychiatry. It is hypothesized that training may cause positive attitude changes towards the discipline and status perceptions of the profession of psychiatry. Methods: A 23 item questionnaire was administered to 89 medical students before and after prescribed training in psychiatry as per the medical curriculum. Results: Participation in psychiatry training enhanced students’ belief that it is a rapidly expanding frontier of medicine and that psychiatry can be viewed as precise and scientific. Psychiatric referrals were seen as useful to medical and surgical patients. However there was less agreement that psychiatric treatment is helpful to most people. Support for choice of psychiatry as a career was less as students were more negatively influenced by family. Poor income prospects and perceived low status among other medical disciplines were also endorsed following the completion of training.Conclusion: There is a pressing need to revise the psychiatric training for medical students. A total attitude change is difficult to achieve and hence, the curriculum has to identify focal areas for emphasis. A multidisciplinary, bio-psychosocial model through liaison with other disciplines like medicine and surgery is a definite option. Psychiatrists have to be role models to alter the image of psychiatry among other medical professionals.
MeSH terms: Attitude; Cross-Sectional Studies; Curriculum; Humans; Malaysia; Psychiatry; Surveys and Questionnaires; Referral and Consultation; Students, Medical; Universities
Objective: The objectives of this study were to asses body mass index, fasting blood sugar , serum cholesterol levels and prevalence of Diabetes Mellitus among outpatients attending the Clozapine clinic at University Malaya Medical Center. Method: 36 patients had their height and weight taken at the start of the study. Their BMI (body mass index) was calculated. Fasting blood sugar, (FBS) and Fasting Serum Lipid (FSL) were performed. Result: The mean body mass index was 24.63. The prevalence of obesity was 13.89%. The prevalence of overweight was 27.8 % and the prevalence of underweight was 5.55%. The prevalence of Diabetes Mellitus was 2.78 %. Serum triglyceride levels appear to be elevated in those receiving Clozapine.Conclusion: It appears that Clozapine may predispose one to obesity. From our study we cannot conclude if Clozapine causes Diabetes Mellitus. However treatment with Clozapine may be associated with elevated levels of serum triglycerides.
Study site: Clozapine clinic at University Malaya Medical Center
107 secondary school teachers were surveyed to find out about their observations of children with learning disorders at schools. The respondents reported that the most commonly observed disorders involved difficulty paying attention, difficulty learning a second language, being fidgety and having difficulty sitting still, and having poor comprehension. They also indicated that whilst some children made fun of their classmates with learning disorder, others tried to assist their classmates. The most common reaction of parents was to send the child for lots of tuition, and to be very frustrated with the child. In addition, some parents neglected their children’s learning disorder, and many did not seem to realise how serious the problem was. When it came to the needs of teachers, the most common need that the teachers reported was to have the parents cooperate with them and to have support from the education authorities. The paper discusses the implications of these findings and proposes suggestions for dealing with the training needs of teachers working in the area of learning disorders.
MeSH terms: Adult; Child; China/ethnology; Cross-Sectional Studies; Female; Humans; India/ethnology; Health Knowledge, Attitudes, Practice*; Learning Disorders; Malaysia; Malaysia/ethnology; Male; Surveys and Questionnaires; Schools; School Teachers*