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Anxiety, depression and quality of life of medical students in Malaysia

Gan GG, Yuen Ling H

Med J Malaysia, 2019 02;74(1):57-61.
PMID: 30846664

BACKGROUND: Medical education is known to be highly stressful and challenging. Many medical students suffer from psychological stress which may lead to burnout and poor academic performances. Quality of life (QOL) of medical students is also affected. In this study, we aim to determine the prevalence of anxiety and depression of the senior medical students and to assess their QOL.
METHODS: This is a cross-sectional study which involved medical students in their final two years of study at a public university in Malaysia. Self-administered Hospital Anxiety and Depression scale (HADS) and World Health Organisation QOL questionnaire (WHOQOL-BREF) were used to assess their psychological symptoms and QOL.
RESULTS: A total 149 students participated. The prevalence rates of anxiety and depression were 33% and 11% respectively. Malay students had significantly more anxiety compared to the other ethnic groups, P<0.05. Female students had significantly lower psychological score compared to male; 70.73 vs 66.32(P<0.05). Anxiety and depression were associated with significantly poorer QOL. Students with depression symptoms were associated with lower physical, psychological and environmental domain score whereas those with anxiety had lower psychological, social and environmental scores, P<0.05. Overall QOL score was significantly lower in Chinese students (P<0.05) and those with depression (P<0.001).
CONCLUSION: QOL of medical students are significantly affected by the presence of anxiety and depression. It is recommended that medical schools implement measures which can identify students at risk and to offer comprehensive intervention and preventive programmes to improve the students' wellbeing.
Fulltext A knowledge, attitude and practice (KAP) study of diabetes mellitus among patients attending Klinik Kesihatan Seri Manjung

Ambigapathy R, Ambigapathy S, Ling HM

NCD Malaysia, 2003;2(2):6-16.

This cross sectional study describes the knowledge, attitude and practice (KAP) among 100 patients attending the diabetic clinic at Klinik Kesihatan Seri Manjung from December 2002 until January 2003. A face-to-face interview using a structured questionnaire was carried out for data collection. The results revealed that 87% of the respondents were able to answer 50% or more questions on knowledge correclty, while 98% of them had 50% or more score for the attitude questions. Ninety-nine percent of them reported 50% or more score for the questions on practice. However, only 56% of them practice all 4 of the practices that were asked - regular exercise, healthy diet, monitoring blood glucose level, and monitoring body weight. There was a significant positive correlation between knowledge and attitude (r=0.536, p<0.01), but there was no significant correlation found between attitude and practice. The results indicate that an increase in knowledge will increase the attitude, however this is not necessarily the same between attitude and practice. A better structured educational programme on diabetes and preventive measures should be conducted for all especially those with diabetes to improve their practice towards diabetes. Keywords: Diabetes Mellitus, Knowledge, Attitude and Practice (KAP)
Curative lung metastectomy and complete pathological response after neo-adjuvant GEMOX chemotherapy for relapse fibrolamellar hepatocellular carcinoma

Eng JY, Soon SY, Winnie Ling HY

Med J Malaysia, 2018 02;73(1):46-48.
PMID: 29531203 MyJurnal

Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare variant of hepatocellular carcinoma. It is commonly reported in the younger population with no underlying chronic liver disease and free of viral Hepatitis B and C. Local recurrence and distant metastasis are common despite better prognosis compared to conventional hepatocellular carcinoma. Complete surgical resection is associated with higher median survival and is the mainstay treatment option for localized FL-HCC. Multi-modality therapies such as TACE can be used to downstage upfront unresectable FL-HCC. Complete response with GEMOX chemotherapy has been reported in advanced metastatic FL-HCC and should be considered in upfront unresectable or metastatic disease. We present a case of biopsied proven relapse FL-HCC with oligo- left lung metastasis who successfully underwent a left lung lobectomy after neo-adjuvant GEMOX chemotherapy, and is disease free at 24 months follow up.
Career adapt-ability scale -short form: Validation among early career stage of Chinese university graduates

Song C, Hashim SB, Xu X, Ling H

Front Psychol, 2023;14:1110287.
PMID: 36777202 DOI: 10.3389/fpsyg.2023.1110287

The Career Adapt-Ability Scale (CAAS) is the favored method among researchers for measuring career adaptability. The 12-item version of CAAS-SF, which was made by Maggiori, Rossier, and Savickas based on a change to CAAS, has been slowly used by different groups in different countries and regions. As samples for the validation of the scale in this study, 571 Chinese university graduates in the early stages of their professions were chosen. Principal component analysis and confirmatory factor analysis suggest that CAAS-SF and CAAS have very similar psychological measurement features and factor structures. And the internal consistency of each subscale and total scale are equivalent to or greater than that of the CAAS assessment. These findings indicate that the CAAS-SF is a valid and reliable instrument for evaluating China's career adaptability. In addition, limitations, issues for further research, and suggestions are emphasized.
A profile of gout patients in Sarawak

Teh CL, Cheong YK, Ling HN, Chan PL, Chan T, Ling GR

Rheumatol Int, 2013 Apr;33(4):1079-82.
PMID: 22101556 DOI: 10.1007/s00296-011-2245-8

We performed a prospective study of all patients diagnosed with gout and who received treatment in Sarawak General Hospital from 1 July 2010 to 31 December 2010. There was a total of 138 patients in our study of which 92 (66.7%) were from the indigenous populations. They have a mean age of 56.5 ± 12.5 years with a mean duration of illness of 11.6 ± 8.7 years. The mean lag time between symptom onset to the diagnosis of gout was 2.8 ± 4.8 years and a mean lag time to appropriate treatment of gout of 8.8 ± 8.4 years. Sixty-six (47.8%) patients have family history of gout. The common complications of gout in our patients were tophi (47.1%), joint deformities (39.1%), kidney stones (16.7%), and uric acid nephropathy (0.7%). Hospitalization occurred in 93 (67.4%) patients. Gout is a serious medical problem in our centre. Gout affects middle-aged men, especially the indigenous populations. Almost half of our patients have a family history of gout and have tophi formations. Our gout patients have a significant delay in diagnosis and appropriate treatment, thus contributing to more complications and hospitalizations in our centre. There is an urgent need to educate both patients and healthcare workers on gout and its treatment to reduce the burden of chronic gout in Sarawak.
Fulltext Locking compression plate: a treatment option for diaphyseal nonunion of radius or ulna

Ling HT, Kwan MK, Chua YP, Deepak AS, Ahmad TS

Med J Malaysia, 2006 Dec;61 Suppl B:8-12.
PMID: 17600986

Treatment of radius or ulna nonunion requires both osteogenic environment and mechanical stability. We would like to report three radial and six ulnar diaphyseal nonunions treated with 3.5 mm locking compression plate (LCP) fixation. To assess the effectiveness of 3.5 mm LCP in treating diaphyseal nonunion of the forearm bones, we prospectively reviewed nine patients with the mean age of 33 years with diaphyseal nonunion of the radius or ulna. All patients were treated with 3.5 mm LCP. Bone grafting was only performed for atrophic nonunion. Surgical and functional outcome were evaluated. There were three atrophic nonunion of the radius, four atrophic nonunion of the ulna and two hypertrophic nonunion of the ulna. All nonunion united successfully with satisfactory functional outcome. 3.5 mm LCP is effective in the treatment of nonunion of ulna or radius.
Smartphone electrocardiogram for QT interval monitoring in Coronavirus Disease 2019 (COVID-19) patients treated with Hydroxychloroquine

Andy Ko TY, Chen LS, Pang IX, Ling HS, Wong TC, Sia Tonnii LL, et al.

Med J Malaysia, 2021 03;76(2):125-130.
PMID: 33742617

INTRODUCTION: The global pandemic of Corona Virus Disease 2019 (COVID-19) has led to the re-purposing of medications, such as hydroxychloroquine and lopinavir-ritonavir in the treatment of the earlier phase of COVID-19 before the recognized benefit of steroids and antiviral. We aim to explore the corrected QT (QTc) interval and 'torsadogenic' potential of hydroxychloroquine and lopinavir-ritonavir utilising a combination of smartphone electrocardiogram and 12-lead electrocardiogram monitoring.
MATERIALS AND METHODS: Between 16-April-2020 to 30-April- 2020, patients with suspected or confirmed for COVID-19 indicated for in-patient treatment with hydroxychloroquine with or without lopinavir-ritonavir to the Sarawak General Hospital were monitored with KardiaMobile smartphone electrocardiogram (AliveCor®, Mountain View, CA) or standard 12-lead electrocardiogram. The baseline and serial QTc intervals were monitored till the last dose of medications or until the normalization of the QTc interval.
RESULTS: Thirty patients were treated with hydroxychloroquine, and 20 (66.7%) patients received a combination of hydroxychloroquine and lopinavir-ritonavir therapy. The maximum QTc interval was significantly prolonged compared to baseline (434.6±28.2msec vs. 458.6±47.1msec, p=0.001). The maximum QTc interval (456.1±45.7msec vs. 464.6±45.2msec, p=0.635) and the delta QTc (32.6±38.5msec vs. 26.3±35.8msec, p=0.658) were not significantly different between patients on hydroxychloroquine or a combination of hydroxychloroquine and lopinavir-ritonavir. Five (16.7%) patients had QTc of 500msec or more. Four (13.3%) patients required discontinuation of hydroxychloroquine and 3 (10.0%) patients required discontinuation of lopinavirritonavir due to QTc prolongation. However, no torsade de pointes was observed.
CONCLUSIONS: QTc monitoring using smartphone electrocardiogram was feasible in COVID-19 patients treated with hydroxychloroquine with or without lopinavir-ritonavir. The usage of hydroxychloroquine and lopinavir-ritonavir resulted in QTc prolongation, but no torsade de pointes or arrhythmogenic death was observed.