Peripheral, predominantly motor polyneuropathy is associated with a plethora of possible aetiologies and the investigative procedures to rule them out are extensive. A 31 year old lady presented with progressive lower limb weakness over a period of 2 years. Examination revealed symmetrical weakness (3+/5) of all distal muscle groups in the lower limbs with absent ankle jerk. There was no sensory loss. The nerve conduction study revealed a predominantly axonal motor neuropathy. Cerebrospinal fluid examination and other investigations to rule out potential causes of predominantly motor peripheral neuropathy were normal. The only positive findings were multiple qualitative assays for porphobilinogen in her urine.
Introduction: Epilepsy remains a stigmatised disease across geographical and temporal boundaries. Very little is known about epileptic stigma (ES) in cross-cultural settings. The aim of this study was to assess the prevalence of perceived stigma and factors associated with it, among patients with epilepsy (PWE) at a tertiary care referral hospital in East Coast of Malaysia. Methods: A cross sectional survey among 132 consenting PWE using pre-tested, semi-structured questionnaire in Malay/English language to assess their knowledge, attitude and practices (KAPs). Results: Among 132 respondents, 51.5% were male and 48.5 % were female. Their age ranged from 14 to 70 years (mean=31.6±13.41). Majority (53.8%) of them were aged 30 years or younger. The median number of years they had epilepsy was 8.0 (IQR 4.0-18.8) years and average duration of seizure prior to seeking medical attention was 1.0 (IQR 0.3 - 4.5) year. Most of them (90.9%) did not know the cause of epilepsy; however nearly all (91.7%) believed that it was a disease of the
brain. Higher education level respondents possessed significantly higher KAP scores compared to lower education level respondents (p
Introduction: Hypertension is one of the most important risk factors for cardiovascular disease in Malaysia. The prevalence of hypertension nearly doubled over a ten-year period (1986 – 1996). This has resulted in a significant rise in its attendant cost. We aim to review the institutional anti-hypertensive use, the cost incurred and the implications on management in our local setting. Materials and Methods: A retrospective review of the annual cost (2006) of anti-hypertensive medications was undertaken at the Department of Pharmacy, Hospital Tengku Ampuan Afzan, a 600-bed major regional hospital on the east-coast of Malaysia. The total number of prescriptions given out and the total cost per drug is then factored to give the annual cost per drug per person in a percentage of the total annual expenditure.Results: The majority of patients were on either 2 (46.5%) or 3 (25.9%) anti-hypertensives. The most frequently prescribed medications were ACE Inhibitors (33.45%), Calcium channel blockers (29.63%), diuretics (16.67%) and β-blockers (13.64%). In terms of cost however, the Calcium channel blockers constituted the greatest percentage of the annual anti-hypertensive budget (63.67%) compared to ACE Inhibitors at just 20.04% of the annual expenditure. The least costly group of drugs is the diuretic making up 16.67% of the total annual prescriptions but only constituting 1.23% of the annual cost. Conclusion: The majority of patients were on ACE Inhibitors and/or Calcium channel blockers. This has huge monetary implications as they represent a large proportion of the annual antihypertensive allocation. There may be a need to reverse the trend in the developing world due to cost restrictions.
Hypertension is the most prevalent risk factor of cardiovascular diseases in Malaysia. 17.3% of hypertension cases in Malaysia is attributed to adults aged 18 to 39 years. Psychosocial distress is a possible risk factor for elevated blood pressure in young adults, and cortisol could be the mediating factor. The aim of this study is to evaluate the mediating role of cortisol in hypertension and psychosocial distress in young adults. Methods and materials:A comparative cross-sectional study was conducted in 240 young adults aged 18 to 45 years. The body mass index, waist circumference and blood pressure parameters were recorded. Serum cortisol, creatinine, fasting blood glucose and lipid profile were measured following acute mental stress test. Psychosocial distress was assessed using the DASS-21 questionnaire. Results:Mean (standard deviation) values for SBP, DBP, MAP were 126.0(16.3), 84.1(12.2) and 98.1(13.1) mmHg respectively. Anxiety was significantly associated with systolic blood pressure (β=0.644), diastolic blood pressure (β=0.454) and mean arterial pressure (β=0.516) after adjusting for sex, age and cortisol. However, it was not mediated by cortisol. Depression and stress were not found to have any effect on blood pressure of the young adults studied. Conclusion:The data suggest that there is no elevated risk for psychosocial distress and hypertension that cortisol poses in young adults.