Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are a group of uncommon diseases. Given its rarity and multisystem clinical presentation which are usually serious and potentially fatal, prompt recognition and early treatment are of utmost importance. We report a case of AAV that presented with digital infarcts, cutaneous vasculitis, rapidly progressive glomerulonephritis, mononeuritis multiplex, eosinophilia and positive myeloperoxidase (MPO)-ANCA antibody. Apart from renal damage, there was complete recovery in other systems following intravenous cyclophosphamide and high-dose glucocorticoids albeit the response was delayed. This response obviates the need for second-line therapy with newer agent such as rituximab (anti-CD20 monoclonal antibody). We would also like to highlight that this is the first case of AAV that is associated with autoimmune thyroid disease to be reported from Malaysia.
Langerhans Cell Histiocytosis (LCH) is an uncommon neoplastic disorder characterized by accumulation of histiocytes in various tissues. The clinical manifestation is highly variable, ranging from an isolated skin rash or a single bony lesion, to fatal multi-organ failure. Due to its rarity and systemic involvement, the epidemiology of LCH is still not fully understood and most studies focus on the paediatric population. The extent of clinical involvement has important prognostic implications. Treatment options may be local or systemic depending on disease extent. Here we describe a rare case of adult onset LCH who presented with recurrent pneumothoraces, diabetes insipidus and papules and plaques over the scalp and forehead.
This is a retrospective study examining the outcome of paediatric patients with subglottic stenosis who underwent partial cricotracheal resection (PCTR) as a primary open procedure from 2004 to 2012. There were 5 patients identified aged from 3 to 18 years old. All the subglottic stenosis were acquired type. All of them were secondary to prolonged intubation. Three patients were classified as Myer-Cotton grade III and the other two were Myer-Cotton grade IV. Two of the patients had concomitant bilateral vocal cord immobility. All patients underwent two staged PCTR . All patients underwent two staged PCTR, and one patient underwent posterior cordectomy apart from partial CTR at different setting. All patients were successfully decannulated at various durations postoperatively. Although this is an early experience in our institution, PCTR
has shown to be effective and safe procedure in patients with subglottic stenosis especially those with Myer-Cotton
grade III and IV.
Introduction: Cervical cancer is the third most common cancer in women worldwide. The HPV-16/18 AS04-
adjuvanted vaccine (Cervarix®) has previously been shown to be highly immunogenic with a clinically acceptable safety profile. This phase IIIb, double-blind, randomized (1:1) and placebo controlled trial (NCT00345878) was designed to evaluate the vaccine immunogenicity against HPV-16 and HPV-18 as well as its safety and reactogenicity in Malaysian women.
Methods: Healthy women aged 18–35 years received intramuscularly three doses of either the vaccine (HPV
group) or aluminium hydroxide (ALU group) at 0, 1, and 6 months. Antibody titers were measured by an enzyme-linked immunosorbent assay (ELISA). Results: A total of 271 eligible subjects were enrolled and
266 subjects completed the study. Initially seronegative subjects in the HPV group showed 100% seroconversion one month post-dose-3 for anti HPV-16 and anti-HPV-18 antibodies with geometric mean titers of 11107.5 (95% CI: 9727.3–12683.4) EL.U/mL and 4273.5 (95% CI: 3771.8–4841.9) EL.U/mL, respectively. Over 96% of subjects in both groups received all three vaccine doses. Solicited local (pain) and general symptoms (myalgia, fatigue, arthralgia and headache) were commonly reported in both HPV and ALU groups. Eight serious adverse events were reported throughout the study (five in the HPV group; three in the ALU group), all considered by investigators to be unrelated to vaccination.
Conclusion: The HPV-16/18 AS04-adjuvanted vaccine was immunogenic and generally well tolerated in Malaysian women aged 18-35 years.
MeSH terms: Seroconversion; Aluminum Hydroxide; Uterine Cervical Neoplasms; Double-Blind Method; Enzyme-Linked Immunosorbent Assay; Female; Headache; Humans; Research Personnel; Vaccination; Arthralgia; Human papillomavirus 18; Human papillomavirus 16; Papillomavirus Vaccines; Myalgia
Introduction: Depression is the most common psychological sequelae in cancer patients. It is challenging to diagnose depression in cancer patients. Furthermore, the presentation is influenced by the patients’ cultural background. Objectives: This literature review aims to determine the prevalence of depression in cancer patients across regions of different cultural background. Methods: A literature search was undertaken by using Pubmed electronic database. Studies were included in this review if they (a) examined the prevalence of depression in cancer patients and (b) published in English peer-review journal between 2000 and 2009. Results: A total of 59 studies from 21 countries were reviewed and summarised. The prevalence of depression in cancer patients ranged from 3% to 72%. Studies from Asia reported the lowest prevalence (3-39%) and Europe reported the highest prevalence (7-72%). Conclusion: Cultural influence may play a role in the prevalent difference of depression in cancer patients. Somatization and stigmatization are suggested as the possible reasons of lower prevalence of depression in Asia region. The biopsychiatric model of mental illness and western psychologization explain the higher prevalence in Western region. Future research on the cross-cultural variability in the presentation of depression in cancer patients is recommended.
Although comorbidity of obsessive compulsive disorder (OCD) with schizophrenia is well-established, the occurrence of psychotic symptoms especially hallucinations with OCD still requires further studies. We report a case of a child with OCD who experienced auditory hallucination with the recurrence of his OCD symptoms and the management involved. We discussed the possible differentials when auditory hallucinations occur in the context of OCD.
This case series reports four patients who used religion and spirituality to relieve symptoms of post traumatic stress disorder (PTSD) following motor vehicle accidents. Their symptoms subsided after a few weeks and the recovery is sustained after one month. This demonstrates that in a country where psychological help is still scarce and religion is central to its culture, intervention based on spirituality and religion can be used as an alternative early intervention to relieve symptoms of PTSD and hence protects them from developing the condition.
MeSH terms: Accidents, Traffic; Humans; Stress Disorders, Post-Traumatic; Early Intervention (Education); Motor Vehicles; Spirituality; Biological Processes; Physiological Processes
Evidence linking cannabis use and depression remains inconsistent. Variations of clinical features were observed in those with history of cannabis use presented with affective symptoms. We report a case of a 19-year-old male college student with a history of heavy cannabis use for at least seven months. A month after stopping cannabis, he presented with severe persistent depressive symptoms. He had no withdrawal symptoms prior to this. He had severe depressive symptoms with melancholic features and progressed to multiple and serious suicidal attempts. While the use of cannabis is implicated in neither the patient’s diagnosis nor management, its use has a significant role in influencing the clinical features and course of the illness. This case suggests that depression can start long after cessation of cannabis use with the history of cannabis remained as a significant risk factor.
The objective of this study is to evaluate the depression and coping strategies used by postnatal mothers during the postpartum period.This study used cross-sectional design and was conducted at the University Malaya Medical Centre from November 2013 to January 2014. This study involved 150 respondents (postnatal mothers) and used instrumentation adopted from the Malay version of Edinburgh Postnatal Depression Scale (EPDS) and the Malay version of Brief COPE. The results showed 32 (21.3%) postnatal mothers have had severe depression. Emotional coping strategies were reported to be the most used by postnatal mothers (mean = 4.77 ± 0.70). There was a significant association between problem-focused coping strategies and race (p=0.045) where it was mostly used by Malay participants (mean = 3.39±0.46). There was a mild negative relation between EPDS and problem focus (r=-0.168, p=0.04). On the other hand, there was a mild positive relation between depression level and avoidant emotion (r= 0.162, p= 0.047). The psychological support from nurses and family was needed to improve depression and coping strategies used so that it can improve health outcome among postnatal mothers.
There have been concerns about the growing number of children living in residential homes in Malaysia. The objective of this study was to determine the presence of depression and its association with the socio-demographic, personal characteristics and coping skills of adolescents residing in fourteen residential homes in Kinta Valley, Perak. A total of 235 adolescents participated in the study. They completed a self-report questionnaire gathering socio-demographic and personal factors, the Adolescent Coping Scale (ACS) and were assessed for presence of depression using The Mini International Neuropsychiatric Interview for children and adolescents (MINI Kid). The prevalence of depression was found to be 9.8 %, with 43% of the participants had history of being abused. Emotional abuse (OR=25.95, CI=4.51-149.43) and maintaining contact with parents (OR=0.02, CI=0.003- 0.10) were significant factors associated with being depressed. Depression is common among adolescents living in the residential homes. Detecting depression and understanding factors associated with depression allows appropriate management and intervention strategies.
Background: The General Health Questionnaire is a widely used scale to measure psychological distress. This scale is available in many languages. The original version comprised of 60 items. It is available in 30-items, 28- items, 20-items and 12-items. The shorter version is as good as the longer version of the scale. Objective: The aim of this investigation was to determine the sensitivity, specificity and reliability of the 12-item. General Health Questionnaire (GHQ-12) among university students. Method: A total of 280 undergraduate students were selected using convenient sampling. Result: The results of this study showed that the GHQ-12 is multidimensional and contains three factor structures. It has a high internal consistency and a useful instrument to measure the psychological wellbeing of university students in Malaysia Previous authors have suggested that the cut-off point is determined by the mean. Findings from this study, based on sensitivity and specificity, suggests that mean may not be a good option. This study recommends the best cut-off point is determined by the ROC. Conclusion: This study shows that the GHQ-12 is a valid and reliable instrument to detect psychological distress among university students. The optimum cut-off point
of the GHQ-12 score to detect psychological distress was 15/16.
MeSH terms: Language; Malaysia; Psychometrics; Surveys and Questionnaires; Sensitivity and Specificity; Stress, Psychological; Students; Universities; Reproducibility of Results
Introduction: Alcohol is a major risk factor for various non-communicable diseases (NCDs) such as cardiovascular related illnesses, liver cirrhosis and cancer. Despite the dangers of alcohol use, there is limited local research available to assist policy and advocacy. This commentary attempts to highlight what is presently available and suggestions to move forward in this field of research and services provision. Methods: A brief report of recent updates is provided for this article. Results and Conclusion: A number of recommendations are provided to assist in deliberating discussions to shape future policies which will improve current available practice and clinical service in the field of alcohol addiction.
Objective: to review the field of epigenetics, and present basic and recent material that may be of interest to clinical psychiatrists. We include basic molecular mechanism, a consideration of findings related to mental disorders, evidence of sustained effects, and the evidence for and implications of transgenerational epigenetic modifications. Method: we examined all the available papers for the last five years identified by PubMed using the words ‘epigenetics’ and ‘epigenetics psychiatry’, and the available leading specialized textbooks. Results: we report on molecular mechanisms including DNA and histone modifications, and non-coding RNAs. While some modifications are short-lived, others are life-long. Depression, suicide, schizophrenia, PTSD, borderline personality disorder and drug addiction are among the conditions for which epigenetic involvement has been proposed. Transgenerational epigenetics enables the environmental experience of one generation to be non-genetically inherited by subsequent generations. This has been molecularly demonstrated in laboratory animals and epidemically suggested in humans. Conclusions: epigenetics provides a new way of understanding human behavior and points to potential therapies for mental disorders. Should it transpire that transgenerational epigenetic modifications apply with force in humans as they do to laboratory animals, this will emphasize the need for cultural shift, safe societies with ample opportunities.
Clozapine is an atypical antipsychotic medication, used primarily as the drug of choice in treatment resistant schizophrenia. Despite its considerable advantages, clozapine’s licence is restricted because of its potential to induce agranulocytosis. Hence, white blood cell count monitoring is mandatory in patients receiving clozapine treatment. A side effect of clozapine that has received relatively less attention is constipation, which is caused by the drug’s anticholinergic effect. This potentially serious problem can result in life- threatening bowel obstruction, ischemia, necrosis, perforation, and pulmonary aspiration. Despite this evidence, routine inquiry about constipation in clozapine treated patients is not emphasised in current clinical guidance. We report a case to highlight constipation as both a potentially serious side effect and as a factor, insufficiently recognised, in non-adherence to clozapine.
Wolfram syndrome (WFS) is a rare neurodegerative disorder which is characterized by presentation of diabetes insipidus, juvenile diabetes mellitus, optic atrophy and deafness. We describe a case of WFS with presentation of psychosis. A 17-year-old female presented with psychiatric manifestations, namely inappropriate behaviour and second person auditory hallucination since the age of 16 years. The patient was diagnosed with type 1 diabetes mellitus at the age of 10 years old and subsequently progressive hearing and visual loss a year later. Her ophthalmic evaluation revealed total blindness due to optic atrophy. However she did not have renal dysfunction and diabetes insipidus which are also features of the syndrome. There is scarce literature to describe on psychiatric presentation in WFS. In the past, the psychiatric manifestation which was reported most of times was mood and suicidal behaviour. Hardly any article reported about psychosis (hallucination). We believe, her psychiatric manifestations were related to sensory deprivation due to blindness and deafness caused by the progression of WFS.
Objective: To evaluate the health-related quality of life (HRQOL) of patients with chronic depression. Methods: The study involved patients with chronic depression being followed-up at an outpatient clinic at a local hospital in Malaysia. HRQOL was assessed using the Sheehan Disability Scale (SDS); while symptom severity was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS). Results: 104 patients of Malay, Chinese and Indian ethnic groups met the selection criteria. Mean total SDS and MADRS scores was 9.36 ± 7.92 and 13.99 ± 11.58 respectively. There were no significant differences of HRQOL scores between the different ethnicities and between males and females. Symptom severity significantly influenced total and component HRQOL scores. Conclusions: The HRQOL of patients with chronic depression was found to be significantly influenced by symptom severity. Data obtained in this study can be used in the design and implementation of therapeutic and preventive interventions.
Living with epilepsy is equally demanding for both patients and their caregivers. The caregivers’ tasks are not limited to caring for the patients only but also the need to improve their awareness, knowledge and attitude (AKA) level as lack of understanding has a major impact on health-related quality of life (HRQoL). Little is known about the influence of AKA on family caregivers’ HRQoL. Objective: Therefore, this study aimed to assess and relate the AKA and HRQoL profiles of epilepsy carers. Methods: This prospective, cross-sectional study included a sample of 32 epilepsy family caregivers who were recruited from the Neurology and Paediatric Clinics of Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu. Results: Majority were Muslims (93.8%), married (65.6%), housewives (31.2%), who earning monthly income of not more than RM 1000 (34.4%) and was the patients’ mothers (40.6%). The Total AKA score was generally good (mean=123.4±16.8, median 122.5) with awareness being good, knowledge moderate and attitude positive whereas HRQoL score for Disruptiveness was the highest (good) compared to other domains. There were significantly higher scores for Sexual Functioning (p = 0.039) among Poor AKA group and Pain Management (p = 0.040) among Good AKA. Conclusion: The overall outcomes signified that family caregivers with Good AKA experienced better well-being compared to those with Poor AKA while carrying out their roles as caregivers. Consequently, carers clearly require constant epilepsy education to enhance skill-building in order to understand and keep updates with the disease, thus indirectly sustaining their desired HRQoL status from time to time.
Study site: Neurology and Paediatric Clinics of Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu
Objective: The aim of this study is to determine the risk factors for sex offenders. Methods: This is a cross sectional study comparing two groups using a combination of survey methodology and personal interviews. The data was collected over a period of six months from January 2004 until June 2004. All convicted sex offenders in respective prisons who are available until July 2004 was included in the study. A control group of non-sex offenders were chosen from the same prisons. The non-sex offenders were matched to the sex offenders group in term of the length of their sentence. Data was gathered using the self generated questionnaire, Structured Clinical Interview for DSM III-R, SCID and Personality Diagnostic Questionnaires. Results: Religion, education level, history of physical abuse and no history of substance abuse and dependence towards sex offenders. Conclusion: Offenders who only committed sexual offences have some characteristics which differ from other sex offenders who committed non sexual offences as well. Low or no formal education, had history of physical abuse were associated with sex offenders. No history of substance abuse and dependence were associated with no sex offenders.
MeSH terms: Physical Abuse; Cross-Sectional Studies; Personality; Personality Disorders; Prisons; Surveys and Questionnaires; Risk Factors; Sex Offenses; Substance-Related Disorders; Control Groups; Diagnostic and Statistical Manual of Mental Disorders; Criminals
Owing to reduced inpatient stays, people with mental illness (PMI) were often discharged from the hospital in ‘acute’ conditions. During this transition period of fragility, the relocation of care from hospital to home has tremendous impact on every aspect of a family’s life as they need to face a challenging task of caring especially when they are ‘not ready’ and ‘ignorant’ about the chronicity and severity of the illness. Furthermore, where economic and psychological support is concerned, those who are undertaking this task may require significant professional guidance. Aims: This study examines the experiences of 100 families in caring for people with mental illness in the community. Methods: Qualitative interviews were conducted in their homes within three Malaysian states of Sabah, Sarawak and Johor in year 2013. Results: Three themes emerged from the findings of ‘care demands related concerns’ of these families. These include theme (1): care provision related concerns of families which were related to the needs of people with mental illness for continuing care provision, their non-compliance with medication and relapse, altered sleep pattern, limited self-care ability, behavioral problems and also social isolation. Theme (2): perceived availability of resources of service provision/support which were related to activities planned for the families before the discharge of the people with mental illness and theme (3): family members perceived service needs whereby they informed of their needs such as continual health care through home visit, provision of financial aid, job coach service, centre for care provision of PMI and rehabilitative programs.
MeSH terms: Problem Behavior; Chronic Disease; Family; Family Relations; House Calls; Humans; Inpatients; Malaysia; Recurrence; Self Care; Social Isolation; Mentally Ill Persons
A review of the criminological literature indicates that some personality traits appear to develop and shape violent criminal behaviour. With this in mind, the present study was aimed to examine the personality profiles of Malaysian male murderers utilising the Alternative Five Factor Model (AFFM) constituting five personality traits: Activity, Sociability, Aggressiveness-Hostility, Impulsive Sensation Seeking, and Neuroticism- Anxiety. Methods: The present study was an observational cross-sectional study using a guided self-administered questionnaire. Items representing the five personality traits were assessed through the Malay version of Zuckerman-Kuhlman Personality Questionnaire-40-Cross Cultural Questionnaire (ZKPQ-M-40-CC). 71 male prisoners convicted of murder who are incarcerated in 11 Malaysian prisons were recruited. Descriptive item analyses were carried out to elicit the level of responses for each item in the ZKPQ-M-40-CC. Furthermore, the descriptive personality profiles using mean scores were performed. Results: The results indicated that the mean score of Activity (29.35, SD = 5.66) was higher than other personality traits. The mean score of Impulsive Sensation Seeking (21.65, SD = 6.48) and Aggressiveness-Hostility (21.65, SD = 6.48) were higher than the mean score of Neuroticism-Anxiety (17.96, SD = 5.51). Among the participants, 56.3% of them scored above the mean score (M = 26.54) for Sociability personality traits, which was the highest compared to other personality traits. 53.5% of the murderers scored equal or above the mean score (M = 6.48). Correlations among the five personality traits indicated several significant associations. Conclusion: In conclusion, the present study successfully identified the personality profiles of Malaysian male prisoners convicted of murder.