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 Disease-disclosed participants were also noted to be more withdrawn with very few friends, if any.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
Irreducible dislocation of the interphalangeal joint (IPJ) big toe is a rare injury Hitori et al. (2006) . We report a case of the right big toe IPJ dislocation following a trauma. The problem was diagnosed and managed at other medical centers with standard treatment of closed manual reduction and splint. The right big toe was splinted accordingly and the patient was referred to our orthopedic outpatient clinic. At the clinic, a repeat plain radiograph was ordered due to high suspicion of the irreducible IPJ.
Study site: orthopedic clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Positive emotion is often neglected in the depressed patients due to the lack of assessment tool. Positive Emotion Rating Scale (PERS) is a newly invented self-report questionnaire, nevertheless has an impressive psychometric properties.
Objective: The aim of this study was to study the psychometric properties of the Malay version PERS (PERS-M), in order to facilitate its use in the local setting.
Method: In this cross-sectional study convenient sampling, total of 43 depressed subjects and 85 non-depressed subjects who were presented to the outpatient clinic of HBUK were recruited. Both groups were assessed with PERS-M, original PERS, Dispositional Positive Emotion Scale (DPES), Malay version of Snaith-Hamilton Pleasure Scale (SHAPS-M) and Malay version of Center for Epidemiological Studies Depression CESDM).
Results: PERS-M displayed good internal consistency (Cronbach’s α = 0.89), parallel reliability (intraclasss coefficient = 0.95, p<0.001) and concurrent validity with the DPES (r=0.32, p<0.05) and SHAPS-M (r=0.77, p<0.01). The PERS-M was negatively correlated with CESD-M (r= -0.61, p<0.01). The optimal cut-off value was 32, with sensitivity = 0.68 and specificity = 0.63, positive predictive value of 0.49 and negative predictive value of 0.79. The area under the curve (AUC) for receiver operating characteristic (ROC) was 0.71 (95% CI = 0.604 - 0.813).
Conclusion: the PERS-M is a brief and easy to administer tool to measure positive emotion in depressed subjects, with demonstrable satisfactory psychometric properties.
Keywords: Positive Emotion, Depression, Psychometric Properties, Instrument
Study site: Psychiatric clinic, Hospital Bahagia Ulu Kinta, Perak, Malaysia
This article aims at exploring the trust establishment among patients with depression during their journey to psychiatric patient-hood. This study was undertaken in government hospital involving 29 psychiatric outpatient users in Kedah and Pulau Pinang respectively using phenomenological study and gender lens. Semi-structured in-depth interview and non-participant observation were the tools used in data collection. The data explicated with the aid of a qualitative data analysis tool, Atlas.ti., version 7.5. Through the findings, the study identified “Trust” appears critical in the accounts of the patients in shaping the doctor-patient relationship. Five interlocking subthemes describing the health professional’s characteristic while giving the service include doctor’s integrity, concern, competencies, empathy, and autonomy enabler. The findings had highlighted that both female and male physicians had different approach to their patients, where the female physician had better chances in getting the mandate of trust. This research is useful to health professionals and governance of mental health care to fulfil the patients’ needs based on their genders.
Study site: government hospital involving 29 psychiatric outpatient users
in Kedah and Pulau Pinang
Objective: Lead toxicity constitutes a major environmental risk to health in both animals and humans of all ages. It is more severe in young children than adults. Blood transfusion is an important source of lead exposure and may predispose premature infants to lead toxicity. Thalassaemia is common in Malaysia and majority of patients require frequent blood transfusion. The objective of this study was to determine whether regular blood transfusion contributed to high blood lead levels in paediatric thalassaemic patients.
Method: This was a cross sectional study conducted at the Paediatric Thalassaemia Day Care Unit, General Paediatric Ward and Paediatric Clinic in Hospital Universiti Sains Malaysia (HUSM). A total of 90 patients were included, 45 were thalassaemic transfusion dependant patients and the other 45 were control, who were of the same age and sex with patients group and had never been transfused. The blood samples were taken preand post-transfusion for thalassaemic and control groups. Blood lead levels were analyzed using standard Atomic Absorption Spectrometer (AAS) analysis.
Results: The overall mean plasma lead levels (2.13 + 1.72µg/dL) were lower than those of standard CDC recommendations. The independent t-test showed that plasma lead levels in thalassaemic group were significantly (p < 0.05) lower than the levels in controls. However, the ANCOVA analysis revealed the plasma lead levels were not significantly (p > 0.05) different between the two groups. Thus, suggesting that the reduced plasma lead level in thalassaemic group was due to the administration of iron chelators. Increased frequency of blood transfusion also did not significantly (p > 0.05) increase plasma ferritin or lead levels in thalassaemic patients.
Conclusion: This study shows that transfusion dependent thalassaemic infants have comparable plasma lead levels to those of age- and sex-matched controls, after taking into consideration the administration of iron chelators.
Study site: Paediatric Thalassaemia Day Care Unit, General Paediatric Ward and Paediatric Clinic in Hospital Universiti Sains Malaysia (HUSM)
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
Objective: The psychological impact of care giving responsibility for dementia patients is significant regardless of the cultural background. Most of the current advanced caregivers’ interventions, originating from developed western countries, do not necessarily apply to local settings. Hence, there is a need for an effective culturally competent psychological intervention for these caregivers. The aim of the study is to assess the effectiveness of the cultural-based support group for Malay caregivers of dementia patients in Kelantan towards their burden, anxiety and depression level, and quality of life.
Methods: This was an experimental study, without control, investigating pre and post support group intervention effectiveness in reducing caregiver burden, anxiety and depression, and improving the quality of life. Sixteen caregivers completed the program, which involved seven fortnightly support group sessions with duration of 2 hours each, conducted over twelve weeks. Caregivers’ burden was assessed using Caregiver Strain Index (CSI) while their psychological well-being was objectively assessed using Hospital Anxiety and Depression Scale (HADS). WHO Quality of Life questionnaire (WHOQOL-BREF) was used to measure the quality of life. The validated Malay versions of the questionnaires were used.
Results: There was a statistically significant reduction in the level of caregiver burden (p = or < 0.001). Measurement of both scores of anxiety and depression comparing pre and post intervention also showed improvement, but statistically were not significant. Assessment of caregivers’ quality of life showed statistically significant improvement in the domains of social, psychological and physical (all with the p-value <0.05). Discussion: Our cultural-based support group is an effective intervention to improve burden, psychological well-being and quality of life among local caregivers of dementia patients.
Keyword: Dementia Caregivers, Support Group, Malay, Burden, Quality of Life
Study site: Memory clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Background: The prevalence of asthma among children is common. In Malaysia, the clinical observations have demonstrated that many children with asthma were not properly assessed and did not get proper treatment. Hence, poor asthma control could cause disruption to the child's ability to get enough sleep, to pay attention, to participate in school activities and thus affecting their quality of life.nagement
Aim: The objective was to determine the effect of PAEP to change the quality of life of children, parents' mapractice and parents' technique of using an inhaler for their asthmatic children.
Methods: The study design was a one group pre-test-post-test intervention study. The respondents consisted of 78 parents with asthmatic children, aged between 8 to 12 years old. Parents were required to answer the Paediatric Quality of Life Inventory Questionnaire, Management Behaviour Survey for Familial Caregivers and skills of inhaler technique using the checklist at the Paediatric Clinic Hospital USM. Following that were given a date to attend PAEP and were assessed two months later for postintervention. The analysis for PedsQL, Management Behaviour Survey for Familial Caregivers and skill of inhaler technique was done by using paired t-test. A total of 70 parents completed the study.
Results: The study showed that the mean age for children with asthma was 9.31 years. PedsQL pre-intervention scores were 75.8%, and post-intervention 82.8%. The Mean of Management Behaviour Surveyfor Familial Caregivers scores increased from 53.16 to 62.33 pre-intervention and post-intervention, respectively. While the mean skill scores for inhaler user had increased from 3.43 to 7.13 for the MDI with a spacer. The findings showed statistical significance with P-values (<0.001) for PedsQL, Management Behaviour Survey for Familial Caregivers and skill scores for inhaler use.
Conclusion: The PAEP had improved the children's quality of life, parents management practice andinhaler skills among parents with asthmatic children.
Keywords : Prevalence, asthma, quality of life
Study site: Paediatric clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
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
Objectives: Studies have shown that periodontal disease and Rheumatoid Arthritis (RA) shared similar pathogenesis. Anti-Cyclic Citrullinated Peptide anibodies (anti-CCP) has recently been used for diagnosis of RA. Thus, this study aimed to assess the levels of anti-CCP antibodies and periodontal status in RA patients.
Methods: Forty four RA patients were included in this study. The blood samples were analysed for anti-CCP levels. Plaque Score (PS), Gingivitis Score (GS), Probing Pocket Depth (PPD) and Clinical Attachment Loss (CAL) were recorded for assessment of periodontal status. Relevant clinical information was obtained from medical records.
Results: Mean anti-CCP level was 180.8 ± 290.3 Unit/ml. The results showed that 27.3% patients had poor oral hygiene (PS >60%; mean anti-CCP 84.22 ± 167.51 Unit/ml), 52.3% had generalized gingivitis (mean anti-CCP 145.07 ± 269.17 Unit/ml), and 20.5% had mean CAL of >3mm (mean anti-CCP 56.81 ± 119.02 Unit/ml). None of patients presented with deep PPD > 4mm. The levels of anti-CCP showed no significant association with periodontal status (p=0.27).
Conclusion: Most RA patients were positive for anti-CCP antibodies and presented with generalized gingivitis. Oral hygiene education should be reinforced in RA patients to prevent further progression of periodontal disease. Nevertheless, studies with larger sample size should be carried out to obtain more conclusive findings.
Study site: Rheumatology Clinic and Dental Clinic of Hospital Universiti Sains Malaysia (USM), Kubang Kerian, Kelantan, Malaysia
Introduction: Hyperuricemia is associated with chronic kidney disease (CKD) progression and poor cardiovascular outcomes. We studied the effect of febuxostat on estimated glomerular filtration rate (eGFR), proteinuria and monitored the safety profile of the medication.
Material and Methods: This is a prospective open-label, randomized study in CKD stage 3 and 4 patients with diabetic nephropathy and asymptomatic hyperuricemia. Patients were randomized into febuxostat 40 mg daily and no treatment group using block randomization method and were followed up for 6 months. Their usual care for diabetes mellitus, hypertension and dyslipidemia were continued in the study. Blood and urine investigations were monitored at baseline, 3 months and 6 months.
Results: The eGFR in febuxostat group was stabilized at 6 months with no significant reduction [26.2 (IQR 14.30) at baseline to 26.3 (IQR 15.2) ml/min/1.73 m2]. Whereas, there was a significant reduction of the eGFR in no treatment group from 28.2 (IQR 17.9) to 27.6 (IQR 19.3) ml/min/1.73 m2 (p value < 0.01). We found the HbA1c (glycosylated hemoglobin) was significantly increased in febuxostat group from 7.2 ± 0.5 % at baseline to 7.6 ± 1.4 at 6 months (p value 0.04) but no significant change of HbA1c in the no treatment group. Proteinuria level was unchanged in both groups. The commonest adverse event was joint pain.
Conclusions: Febuxostat was able to preserve eGFR in CKD patients with diabetic nephropathy and this effect was beyond glycemic control. Increment of HbA1c level in febuxostat group needs further larger trials.
Study site: Chronic kidney disease clinic, Hospital Canselor Tuanku Muhriz, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Introduction Parkinson’s disease (PD) is the second most common neurodegenerative disease after Alzheimer’s disease (AD) and the most frequent sub-cortical degenerative disease, characterized by universal progressive disorder of the
nervous system that affects movement. This cross sectional study aimed to determine the prevalence and correlates of PD among elderly attending the neurology clinic in Serdang Hospital.
Methods A total of 150 records of patients attended the clinic from January to December 2016 were randomly selected. Data was collected using a proforma form seeking information related to age, gender, race, locality, and presence of comorbidity particularly diabetes mellitus. The data was analysed using the Statistical Package for Social Science (IBM SPSS) version 22.0.
Results The prevalence of PD among the elderly involved in the study was 34%. Majority of the respondents were aged 60 to 70 years old (54.7%), male (53.3%), Chinese (56.7%), from urban locality (93.0%) and were not diabetic (69.3%). The inferential statistics showed no significant association between all the factors with PD. However, the associations between age and diabetes mellitus with PD were almost significant with p values of 0.07 and 0.08 respectively.
Conclusions Overall, the prevalence of PD among elderly who attended the neurology clinic in year 2016 was less than half with none of the factors under study were significantly associated with PD. However with bigger sample size, possible significant association may be obtained between age and diabetes mellitus.
This study looked into the rate and pattern of neuropsychological impairment in patients with traumatic brain injury patients at three months post injury. Forty patients attending the neurosurgery outpatient clinic were included in the study. Benton visual retention test (BVRT), rey auditory verbal learning test (RAVLT), digit span test, trail making test (TMT) and mini mental state examination (MMSE) were used for assessment. Forty five percent (n=18) sustained moderate to severe head injury. Twenty five percent (n=10) have abnormal MMSE result. Forty two and a half percent (n=17) have abnormal BVRT result. Seventy five percent (n=30) have abnormal RAVLT result while 35% (n=14) have abnormal digit span test result. Seventy seven and a half percent (n=31) have at least one neurological deficit. There was significant association between severity of head injury (GCS score) and neuropsychological deficit. This study highlights the point that in post head injury patients, there are high occurrences of cognitive dysfunction. MMSE and GCS play a significant and important role in assessing cognitive dysfunction. Severity of head injury as determined by GCS scores also influence the outcome in patients with head injury
The reasons for referral of 189 patients referred to the Primary Care Out-patient Clinics, University Hospital Kuala Lumpur, were studied. 55.6% of them were from private general practitioners. 51.0% of the referrals were for evaluation of symptoms and 46.5% were for management of diseases. The profile of the referrals helps in curriculum planning of Primary Care Medicine. Other applications of the results are discussed.
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
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
To determine the impact of the haze on asthma symptomatology in children with chronic asthma on inhaled prophylaxis. The study was prospective and collected information on asthma symptoms from children attending the asthma clinic. A comparison of peak expiratory flow rate (PEFR) measurements before and during the haze was performed for children above 7 years. A total of 97 children were included into the study. Forty (41%) children complained of an increase in nocturnal cough (55%) followed by nasal symptoms (40%), daytime cough (40%), nocturnal wheeze (25%) and daytime wheeze (18%). About half of the children who had increased symptomatology during the haze had to limit outdoor activities. In the 43 children in whom PEFR studies were available, 29 (67%) of them had a fall in the PEFR. However, children with no increase in asthma symptomatology showed a similar fall in PEFR measurement when compared to children with increased asthma symptomatology. The haze appeared to be detrimental to the well being of some children with chronic asthma despite being on inhaled prophylaxis.
Study site: Asthma clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Many studies have shown that failure in the control of hypertension with oral antihypertensives could be associated with noncompliance. The present study was conducted to assess the compliance rate to antihypertensive therapies and also to determine factors related to any noncompliance. The study was conducted in a teaching hospital in Kuala Lumpur. Data was collected from patients' medical records and via personal interview using a structured questionnaire. Out of a total of 175 respondents recruited in the study, 49.1% missed at least a dose of their antihypertensive agents during a one·month period. The most common reason given by respondents who were not compliant to their antihypertensive therapies was forgetfulness (91.8%), followed by too busy (20.0%) and insufficient medication supplied to them (18.8%). None of the factors analysed, including the demography of the respondents, their knowledge about hypertension and the types of antihypertensive therapies they were on, had any statistically significant influence on the compliance behaviour of the respondents to their antihypertensive therapies. However, more than 80% of the respondents kept their appointment to see their doctor and only this factor appeared to be related to the medication compliance behaviour although it still did not reach any statistical significance. KEYWORDS: Compliance, antihypertensive agent, blood pressure, knowledge
In multiethnic countries such as Malaysia more than six different languages are spoken by patients in publicly-funded clinics. Sometimes doctors are unable to speak the patient's language and there are no professional interpreters. Research on doctor-patient communication has rarely included the language variable and its impact on information exchange and patient outcome in consultations where the doctor does not speak the patient's language. The few studies carried out in linguistically plural societies show that doctors and patients can face language barriers and trained interpreters are not always available. This paper illustrates some of the problems of using untrained interpreters in a primary care setting. Consultations were audiotaped and the transcripts were used to show how messages underwent distortion, condensation, and omission in interpreter-mediated consultations. Research needs to be carried out based on a model of doctor-patient communication which reflects the realities of the multilingual consultation.