Rheumatoid arthritis (RA) is a chronic, disabling autoimmune disease which affects about 5 in 1000 people in Malaysia. Patients with RA are at increased risk of developing comorbid conditions. This research aims at determining these relationships between demographic, duration of illness and comorbidity in RA via a multiple binary logistic (MBL) regression analysis based on the 102 patients’ information (23 males; 79 females) obtained from the rheumatoid clinic of the Queen Elizabeth Hospital in Kota Kinabalu. The relationship of the RA patients with comorbid conditions was studied with focus on the demographic and duration of illness. The variables obtained for analysis were the comorbid conditions namely, hypertension and hyperlipidemia, age, duration of illness, gender, ethnicity, household income and education level. From six independent variables, two were quantitative would be analyzed, while four were categorical, and would be transformed into dummy variables. Four phases in a model-building approach were executed where two models were formed where Model I predicted the probability of occurrence of hypertension with age of patients and first order interaction between duration of illness before diagnosis and household income of less than RM1000 had positive effects on the model, while Model II predicted the occurrence of hyperlipidemia among the RA patients with age of patients and first order interaction variable between gender(female) and age were the contributing factors.
Study site: Rheumatoid clinic, Queen Elizabeth Hospital (QEH), Kota Kinabalu, Sabah, Malaysia
Progression to AIDS is more rapid in HIV-infected children. Objective: Our study aimed to investigate the effect of HIV status disclosure in children in terms of their perception of the illness, knowledge on their disease and medications and the overall impact on their quality of life.
Methods: A qualitative study was conducted from 1st June 2017 till 8th September 2017 involving face-to-face interviews with HIV-positive children receiving combination anti-retroviral therapy (cART) under paediatric HIV clinic follow-up, Hospital Tuanku Fauziah, Kangar, Perlis. Transcribed interview dialogues were subsequently coded for analysis.
Results: Data were collected from 6 out of 8 HIV-positive children on cART in Hospital Tuanku Fauziah, Perlis. Participants’ mean age was 12.2 years (standard deviation [SD] 2.11); 3 with disease disclosure. Disease-disclosed participants with ironically poor knowledge on their disease emerged as the key theme in the study. Disease-disclosed participants were also noted to be more withdrawn with very few friends, if any. Disease disclosure status did not affect the patients’ knowledge and compliance to medication.
Conclusion: Assessment of patients’ understanding after disease-disclosure session is crucial to encourage therapy adherence and prevention of future transmission. Re-appraisal of the healthcare policy with regards to holistic management of children living with HIV is warranted to attain positive social and developmental goal throughout their lives.
Study site: paediatric HIV clinic follow-up, Hospital Tuanku Fauziah, Kangar, Perlis
Objectives: This is a retrospective study in which all neonates with confirmed dengue fever mother admitted to our special care nursery from March 2014 to March 2015 were recruited. This is to determine the percentage of positive dengue serology in the neonates of mother with confirmed dengue fever and to investigate the correlation between the duration of maternal illness with these neonatal seropositivity of dengue antibody and their presenting symptoms.
Method: A total of 22 neonates whose mother with confirmed dengue fever were recruited out of which 14 (63.6%) neonates of confirmed dengue fever mothers had positive dengue serology.
Results: Eight out of fourteen neonates were dengue seropositive when mother dengue illness was between day 1 to 5 of illness (acute phase) at the time of delivery. Thirteen out of twenty-two neonates (59%) were symptomatic, out of which 61.5% (8 out of 13) were delivered during maternal acute phase of illness.
Conclusion: From this study, we concluded that neonates were more likely to be dengue seropositive and symptomatic when mother presented in acute phase of illness during delivery. However, our sample size was small, only 22 neonates were recruited from a single centre, therefore a larger sample size from multicentre is required in future.
Rheumatoid arthritis (RA) is a chronic inflammatory condition that can be associated with abnormal bone turnover and hence osteoporosis. Osteocalcin (OC) levels are increased in conditions with high bone turnover, including high RA disease activity. Thus, OC levels could possibly be used as a marker to assess bone health and disease activity in RA patients. As there have been no previous studies looking at serum OC levels in Malaysian RA patients, this study was performed to examine possible correlations between OC, bone mineral density (BMD) and disease activity in this population. A cross-sectional study of 75 female RA patients and 29 healthy controls was performed. Serum OC was measured using a Quantikine® ELISA kit. Dualenergy x-ray absorptiometry (DXA) was used to assess BMD. Serum OC levels were not significantly different between RA patients (median 14.44 ng/mL, interquartile range [IQR 12.99]) compared to healthy controls (median 11.04 ng/mL IQR 12.29) (p=0.198). Serum OC increased with age (Spearman’s rho r=0.230, p=0.047). There was no significant correlation between serum OC and body mass index (BMI), menopause status, BMD, DAS28, swollen or tender joint counts. Overall, there were 11 (14.7%) patients with osteoporosis and 27 (36.0%) with osteopenia. Menopause status was significantly associated with BMD at all sites (lumbar spine p=0.002, femoral neck p=0.004, total hip p=0.002). Serum OC were similar in RA patients compared to healthy controls. In RA patients, serum OC did not correlate with RA disease activity or BMD. Menopause status remains an important influence on BMD. Thus, measuring serum OC levels in Malaysian RA patients was not useful in identifying those at risk of low BMD.
Study site: Rheumatology clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, and Klinik Pakar Puchong, Kuala Lumpur, Malaysia
This study is to determine the prevalence and the associated factors of low-back pain (LBP), which has multifactorial causes, among ambulance workers in Kelantan, Malaysia. The cross-sectional study involved ambulance workers in the emergency department in all government hospitals in Kelantan. Those who did not consent, complete or return the questionnaire as well as having rheumatic diseases were excluded from the study. The participants were asked to answer a self-administered questionnaire in English. Descriptive analyses and Chi-square test were used. A total of 168 respondents had completed the questionnaires with a response rate of 85.0%. Questionnaires with more than 95.0% items completed were included in the analysis (n=143). The respondents had a higher proportion of male than female (63.6% versus 36.4%). Assistant Medical Officer comprised of 60.0% of all respondents and the rest were nurses. The respondents’ age ranged between 23 to 58 years old with a mean age of 38.27 and standard deviation (SD) of 7.27. The mean duration of involvement in ambulance service was 9.68 years (SD 6.97). The majority (98.5%) of the respondents were Malay. Gender, smoking status and hobbies were the associated factors of LBP among ambulance workers. The modifiable risk factors should be emphasized to the ambulance workers as a measure to prevent the development of LBP.
Foreign body ingestion among children is common and most usually pass through the gastrointestinal tract without requiring any intervention. Magnets, however, pose a greater threat especially when more than one are ingested. We report a case of multiple bowel perforation secondary to ingestion of magnetic beads in a 3-year-old.
Introduction: Little is known about how smokers respond cognitively and emotionally to the experience of "late" relapse after the acute withdrawal phase. This study assessed the kinds of thoughts and feelings that emerge in order to provide a basis for quantitative research assessing prevalence of different types of response and implications for future quit attempts. Methods: Face-to-face in-depth interviews were conducted among 14 people attending a quit smoking clinic in Malaysia who had relapsed after at least 6 weeks of abstinence. Transcripts were analyzed using thematic analysis to enable emergence of important aspects of the experience. Results: Following relapse, smokers often engaged in rationalizations and activities to minimize worry about the harmful effects of smoking by switching to a lower-tar cigarette, reducing the number of cigarette smoked, attempting to reduce cigarette smoke inhalation, comparing themselves with other smokers, and minimizing the health risks associated with smoking. In some cases, smokers retained a "non-smoker" identity despite having relapsed. Conclusion: Smoking relapsers rationalize their failure to quit and minimize their health risk in order to protect their image as non-smokers while it remains a source of identity conflict.
Study site: Quit Smoking Clinic, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia
Patient radiation dose and image quality are primary issues in the conduct of nuclear medicine (NM) procedures. A range of protocols are currently used in image acquisition and analysis of quality control (QC) tests, with National Electrical Manufacturers Association (NEMA) methods and protocols widely accepted in providing an accurate description, measurement and report of γ-camera performance parameters. However, no standard software is available for image analysis. Present study compares vendor QC software analysis and three types of software freely downloadable from the internet: NMQC, NM Toolkit and ImageJ-NM Toolkit software. These were used for image analysis of QC tests of γ-cameras based on NEMA protocols including non-uniformity evaluation. Ten non-uniformity QC images were obtained using a dual head γ-camera installed in Trieste General Hospital and then analyzed. Excel analysis was used as the baseline calculation for the non-uniformity test according to NEMA procedures. The results of non-uniformity analysis showed good agreement between the independent types of software and Excel calculations (the average differences were 0.3%, 2.9%, 1.3% and 1.6% for the Useful Field of View (UFOV) integral, UFOV differential, Central Field of View (CFOV) integral and CFOV differential, respectively), while significant differences were detected following analysis using the company QC software when compared with Excel analysis (the average differences were 14.6%, 20.7%, 25.7% and 31.9% for the UFOV integral, UFOV differential, CFOV integral and CFOV differential, respectively). Compared to use of Excel calculations use of NMQC software was found to be in close accord. Variation in results obtained using the three types of software and γ-camera QC software was due to the use of different pixel sizes. It is important to conduct independent analyses tests in addition to using the vendor QC software in order to determine the differences between values.
This study explored health-care workers' perception of patients' suicide intention and their understanding of factors leading to particular interpretations. Semistructured face-to-face in-depth interviews were conducted with 32 health-care workers from a general hospital in Klang Valley, Malaysia. Interview data were transcribed verbatim and analyzed using the interpretative phenomenological analysis. The health-care workers were found to have four types of perceptions: to end life, not to end life, ambivalence about intention, and an evolving understanding of intention. Factors leading to their perceptions of patients' suicide intention were patient demographics, health status, severity of ideation/attempt, suicide method, history of treatment, moral character, communication of suicide intention, affective/cognitive status, availability of social support, and health-care workers' limited knowledge of patients' condition/situation. Insufficient knowledge and negative attitudes toward suicidal patients led to risk minimization and empathic failure, although most health-care workers used the correct parameters in determining suicide intention.
Background: Standard Precaution (SP) is a very important health issue that has not been well-emphasized. The outcome of not following the SP is a serious problem that can lead to the blood-borne infection.
Methods: A set of self-administered anonymous questionnaire were given to all healthcare personnel in 4 selected Emergency Department (ED), hospital in Kelantan to assess the knowledge and practice of standard precaution.
Results: Almost half of the healthcare personnel were having a good knowledge 115 (57.8%) and good practice 156 (78.4%) towards SP. For those who did not comply with SP, complained oflackoftime as the main reason (38.5%) followed by interference with their work (29.2% ). There was no significant difference between presence of Emergency Physician or not in ED with the compliance towards SP.
Conclusion: Though majority of the healthcare personnel in ED possessed a good level of knowledge and practice towards SP, the staff compliance should be revised regularly wherever necessary to improve the precautions.
Keywords: Standard precaution, Emergency Department, Malaysian Nurse
A study was conducted at the Outpatient Department (OPD) of Ipoh Hospital, an urban public primary healthcare facility, over a weekend, to determine the profile of patients attending the clinic, the reasons for encounter and the reasons for choosing after hours medical care. The data from this study would be useful in determining the need for and formulating a policy for after hours medical care at urban primary health care facilities in the country. The study showed there was a low proportion of acute illness in the weekend clinic. A total of 17% of the patients had an acute illness and a further 8% had aggravation of an existing illness. This group of patients requires access to weekend medical services. The main reason for choosing after hours care was social, that is the convenience of an off-day from work or school. Several options can be explored to provide after hours care, including volunteer government doctors or private general practitioners running the service. Another option is to direct public patients during the weekends to private general practitioners in their locality who will be subsidized. The cost of providing after hours care is expected to be higher. Misuse of services may have to be considered as the study showed 5 % of the patients were not ill during the encounter.
Study site: Outpatient Department (OPD) of Hospital Ipoh
Creatinine clearance is calculated from 24 hour urine creatinine excretion. This method of measuring creatinine clearance is cumbersome. Many formulae have been proposed as an alternative method of obtaining predicted creatinine clearance and they have all shown satisfactory results. From our study using 4 formulae, the correlation coefficient using these formulae rangedfrom 0.71 - 0.75. The correlation clearance was even better at > 0.90. We therefore advocate the routine use of these formulae for predicting creatinine clearance by clinicians.
Study site: Nephrology clinic, Universiti Kebangsaan Malaysia unit at Hospital Kuala Lumpur, Malaysia
A retrospective study of 100 patients with acute right upper quadrant pain was performed in order to indicate the diagnostic role of ultrasound including the diagnostic role of ultrasound including guided percutaneous procedures in the evaluation of such cases at the General Hospital Kota Bharu (GH, KB). In the majority of these patients the leading clinical consideration was acute cholecystitis. In all the patients the initial sonographic diagnoses were compared with the final diagnoses. In 35 patients (35%) biliary pathology was diagnosed. In this group the conographic correlation was good. In 65 patients (65%) the symptoms were due to non-biliary pathology. In this group ultrasound detected the actual site of pathology in 28%. Ultrasonography which can image multiple organs rapidly is a useful initial screening procedure in patients presenting with acute right upper quadrant pain because it can detect the actual size of pathology in about two-thirds of the cases.
Introduction: Maternal psychological well-being determines early mother-infant relationship and babys health. Paying attention on this aspect is essential particularly in early postpartum period. This study aimed to determine early psychological reactions toward socioeconomic profi les, delivery methods and delivery outcomes among postpartum mothers in Kuala Lumpur Hospital. Materials and Methods: A total of 150 two week-postpartum mothers participated in this cross sectional study and their psychological perspective was measured by using the Depressive, Anxiety and Stress Scale (DASS). Results: 4%, 16% and 4.7% of respondents had significant depressive, anxiety and stress levels respectively. Conclusion: Socioeconomic variables such household income, level of education and presence of medical illness were statistically signifi cant to determine early postpartum psychological reactions but not the modes or outcomes of delivery.
BACKGROUND/AIM: Multiple asthma guidelines have been developed to reduce asthma mortality, morbidity, and cost associated with asthma worldwide. In Malaysia, within this context, it is relatively unknown to what extent doctors adhere to the asthma guidelines. This study aimed to assess guideline adherence and calculate the cost of adhered and nonadhered prescriptions by medical doctors in a public tertiary health care facility.
MATERIALS AND METHODS: A cross-sectional study was carried out at Hospital Pulau Pinang, Malaysia. One hundred and eighty patients, a total of 30 patients per doctor, were enrolled to assess guideline adherence. The patients were followed for a second visit to assess their lung function. The costs of adhered and nonadhered prescriptions were calculated.
RESULTS: One hundred and forty-three patients (79%) received guideline (Global Initiative for Asthma 2011)-adhering pharmacotherapy. In the majority of patients (n = 133, 73.9%) asthma control was classified as partially controlled. There was no significant association observed between patient asthma control and patient demographics; however, there was a significant difference (P < 0.001) between lung function values from the first and second visits. The cost of adhered prescription was higher (70.1 Malaysian ringgit) than that of nonadhered prescription (13.74 Malaysian ringgit).
CONCLUSION: Fair levels of guideline adherence were observed. Emphasis should be placed on identifying appropriate cost-effective medication regimens based on patient asthma control and constant feedback from patients.
Study site: Respiratory clinic, Hospital Pulau Pinang, Pulau Pinang, Malaysia
Introduction: Rheumatic Heart Disease (RHD) has been thought as a disease of poor socioeconomic status. It is more prevalent in underdeveloped and developing countries than in developed countries. It is also common among the population with multiple social issues such as overcrowded dwellings, undernutrition, poor sanitation and suboptimal medical care. This study was done to review the socio demographic profiles of RHD patients in Hospital Queen Elizabeth (HQE) II, Kota Kinabalu, Sabah.
Methods: A secondary data review of all patients registered under the RHD registry in HQE II for one- year starting from July 2013 to June 2014.
Results: 204 RHD patients were included. Nearly three quarter (74.0%) were female. The mean age was 40.43 (14.75) years old. 61.1% has completed secondary
education. 42.7% were housewives. The mean monthly income was RM 1363.83 (1297.05) which was categorized under the vulnerable income group. When they were categorized under the poverty level and the vulnerable income group, 42.6% and 76.5% of them fell under those categories respectively. The nearest health facilities to their houses were district hospitals (33.3%) with the mean distance of 9.17 km and health clinics (30.8%) with the mean distance of 4.27 km. Only 11.5% of them lived near the specialist hospitals with the mean distance of 21.32 km.
Conclusions: Results from this review suggested that majority of RHD patients were in the low socioeconomic group with less access to health care facilities with specialist care. They are the most vulnerable groups and need to be prioritized in the specialized care program. .
An effective sharps injury prevention program includes several components that must work in concert to prevent healthcare personnel from suffering needlesticks and other sharp related injuries. Sharp injury management program in Kementerian Kesihatan Malaysia (KKM) is currently at surveillance state outlined in the Manual of Sharp Injury Manual Surveillance 2007. Latest data showed that as much as 1405 cases reported in Kementerian Kesihatan Malaysia facilities in 2011. In Hospital Melaka, high sharp injury prevalence was recorded with 25 per 1000 healthcare worker being affected each year. However, according to World Health Organization, surveillance data tend to underestimate the true rate of sharp injuries between 18% and 70%. Although reasons for sharp injury underreporting are well documented in many studies, less in known on what motivates healthcare personnel to report their injury. In order to encourage healthcare workers engagement to prevention program, these motivators need to be determined. Various factors affecting reporting behavior can be divided into organizational factors and health belief. The objective of the study is 1) to determine the level of awareness and compliance on sharp injury reporting among healthcare workers in Melaka, 2) To identify the relationship between awareness of reporting, organizational factors and health belief with sharp injury-reporting behavior among healthcare workers, 3) To determine the impact of awareness on reporting, organizational factors and health belief with sharp injury reporting behavior among healthcare workers, 4) To suggest improvements in sharp injury prevention program. Healthcare workers who reported sharp injury between 2011 and 2015 were invited to answers questionnaires pertaining these factors. Descriptive statistics, mean scores and multiple logistic regression were used for the analysis. Results and recommendation are discussed.
Hyperalgesia is a common clinical phenomenon among opioid dependent patients on methadone maintenance therapy (MMT) and it may be associated with undertreated pain and/or therapeutic failure. This study aimed to investigate association between serum methadone concentration (SMC) and cold pressor pain responses. Cold pressor pain responses in 147 opioid dependent patients on MMT were assessed using cold pressor test (CPT) at 0 h and at 2, 4, 8, 12, and 24 h after the dose intake. Blood samples were collected at 24 h after the dose. Serum methadone concentrations were measured using the Methadone ELISA kit and classified into two categories: < 400 ng/mL and ≥ 400 ng/mL. Eighty-eight patients (59.9%) had trough concentrations of < 400 ng/mL and 40.1% had trough concentrations of ≥ 400 ng/mL. There were significant effects of SMC on the cold pressor pain threshold (p = 0.019). Patients with concentrations < 400 ng/mL had significantly higher (almost 60% higher) cold pressor pain threshold (adjusted mean (95% CI) = 30.15 (24.29, 36.01) s) compared to those with concentrations of ≥ 400 ng/mL (18.93 (11.77, 26.08) seconds). There was also a 20% difference in pain tolerance, and 6% difference in cold pressor pain intensity score, neither of which were significant statistically (p > 0.05). Our results suggest an association of trough methadone concentration with the cold pressor pain threshold among opioid dependent patients on MMT. It would be useful to study the mechanisms underlying this association to help managing pain in such a population.
Study site: Psychiatric Clinic, Hospital Universiti Sains Malaysia (HUSM); Psychiatric Clinic, Hospital Raja Perempuan Zainab II; and eight other government MMT clinics in Kelantan, Malaysia
Objectives. The study was conducted to determine the correlation of ICAM-1, VCAM-1, and anti-C1q antibody levels with SLE disease activity index (SLEDAI) and standard SLE disease activity immunological markers (anti-dsDNA and sera C3 and C4). Study Design. This was a cross-sectional study. Materials and Methods. Blood samples were obtained from 95 SLE patients (45 active SLE and 50 nonactive SLE) and 50 controls. The subjects were assessed using SLEDAI and score of more than five is determined as having active SLE. The sera were tested for serum ICAM-1, VCAM-1, and anti-C1q (ELISA), anti-dsDNA (CLIFT), serum C3, and serum C4 (immunonephelometry). Results. Anti-dsDNA and anti-C1q antibody showed good positive correlations with SLEDAI (r = 0.529, P < 0.001 and r = 0.559, P < 0.001, resp.). VCAM-1 and sera C3 and C4 showed fair correlation with SLEDAI (r = 0.294, P = 0.004; r = -0.312, P = 0.002; and r = -0.382, P < 0.001, resp.). ICAM-1 level showed no significant correlation with SLEDAI (P = 0.062). There were significant correlations of VCAM-1 and anti-C1q antibody with anti-dsDNA (r = 0.226, P = 0.006 and r = 0.511, P < 0.001, resp.). VCAM-1 showed poor inverse correlation with serum C3 (r = -0.183, P = 0.028) and fair inverse correlation with serum C4 (r = -0.251, P = 0.002). Anti-C1q antibody demonstrated fair inverse correlation with both sera C3 and C4 (r = -0.420, P ≤ 0.001 and r = -0.398, P < 0.001, resp.). However, ICAM-1 showed no significant correlation with anti-dsDNA and sera C3 and C4 (P = 0.259, P = 0.626 and P = 0.338, resp.). Conclusions. The serum levels of anti-C1q antibody in SLE patients showed the best correlation with the SLEDAI and standard immunological tests for SLE disease activity. These data support that anti-C1q antibody is a useful marker for monitoring SLE global disease activity. The potential of VCAM-1 needs further confirmation.
Study site: Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian, and Hospital Raja Perempuan Zainab II (HRPZ II), Kota Bharu, Kelantan, Malaysia
The present study was conducted primarily to determine the occurrence of polypharmacy in patients with schizophrenia on risperidone. The secondary aim was to ascertain the incidence of inappropriate prescribing with anticholinergics. A retrospective review of the medical records of all patients who were being followed up at the out-patient clinic of a tertiary-care hospital in Malaysia was conducted. Only patients who were being prescribed risperidone between 1 June 2008 and 31 December 2008 were included in the study. Demographic data such as patient's age, gender and race were obtained from the patient's medical records. In total, 113 patients met the selection criteria. Polypharmacy was found to occur in 34 patients (30.09%), with the majority (76.47%) being on two antipsychotics. In total, 27 patients (34.18%) on monotherapy with risperidone were prescribed an anticholinergic on scheduled dosing, while 19 patients (24.05%) were prescribed it on an as-needed basis. Of the patients on polypharmacy, 26 (76.47%) were on scheduled dosing of anticholinergics, while three (8.82%) were taking the medication on an as-needed basis. Polypharmacy should be avoided, and the use of anticholinergics should be closely reviewed. By adopting more efficient prescribing practices, costs can be reduced and financial resources can instead be channelled towards more beneficial areas for the patients.
Study site: Psychiatric clinic, tertiary hospital, Malaysia