Browse publications by year: 2003

Incidental, delayed diagnosis of gastric foreign body in a 15-year-old boy

Al-Busairi WA, Ali FE

CMAJ, 2003 Jun 10;168(12):1568-9.
PMID: 12796339
MeSH terms: Adolescent; Gastroscopy; Humans; Male; Radiography
Unilateral exophthalmos caused by an extramedullary plasmacytoma: a case report

Ashraf M, Abdullah J, Ariff A, Biswal BM, Mokhtar I, Othman N

Malays J Med Sci, 2003 Jan;10(1):95-9.
PMID: 23365508

Solitary plasmacytoma of the head and neck is a rare disease entity. Its description in the literature consist of some case reports. Solitary plasmacytoma presenting with exophthalmos are rare. We report a case of intracranial solitary plasmacytoma in an elderly lady with involvement of the right orbitocranial region presenting with severe exophthalmos. The tumour was debulked and radiotherapy was given.
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)

MeSH terms: Adult; Ambulatory Care Facilities; Attitude; Body Weight; Cross-Sectional Studies; Diabetes Mellitus; Diet; Humans; Health Knowledge, Attitudes, Practice; Malaysia; Primary Health Care; Blood Glucose Self-Monitoring; Exercise; Knowledge
Fulltext Educational bridges between Ireland and Malaysia: Initial student responses to the Penang Medical College project

Bury G, Cullen W, Khoo SB

Asia Pac Fam Med, 2003;2(4):200-205.

Background: Penang Medical College is a joint Ireland-Malaysia project in which Malaysian students spend their initial 3 years in Ireland and complete their clinical training in Penang and receive Irish qualifications and registration. The educational foundations for such a program, particularly in general practice/primary care, are complex. Objectives: To explore the experiences of current students undertaking clinical training at Penang. Methods: All students were invited to complete an anonymous, confidential questionnaire dealing with foundation course availability and participation, the perceived value of such courses and suggestions for change. Results: Two thirds of all students responded. Attendance at foundation courses varied greatly as did the perceived value of such courses for clinical training. Early patient contact and communications skills courses scored most highly. More 'hands-on' clinical skills training was requested. No student raised ethical, legal or economic issues although these areas include very significant differences between the countries. Discussion: Educational bridges which link the learning and healthcare environments in which students work are crucial in this novel undergraduate setting. Conventional educational structures have value for students but access and relevance can be improved. Students are highly conscious of the differences between these environments but prize familiar themes such as clinical skills training over less tangible areas such as ethical or social structures.

MeSH terms: Cross-Sectional Studies; Education, Medical, Undergraduate; Family Practice; Humans; Ireland; Malaysia; Primary Health Care; Students; Students, Medical; Universities; Young Adult
Fulltext Developing an integrated data management system for general practice

Doshi HK

Asia Pac Fam Med, 2003;2(4):193-195.

Developing a software program to manage data in a general practice setting is complicated. Vision Integrated Medical System is an example of a integrated management system that was developed by general practitioners, within a general practice, to offer a user friendly system with multi tasking capabilities. The present report highlights the reasons behind the development of this system and how it can assist day to day practice.

MeSH terms: Malaysia; Software
Fulltext Facts and fallacies in palliative care

Khoo SB

Asia Pac Fam Med, 2003;2(3):143-147.

The concept of palliative care is still quite new in Malaysia. Through the experience of delivering palliative care in both the hospital and community settings, the author has realized that there are many false beliefs among the medical and nursing professionals, as well as patients and their caregivers. By exploring and providing factual explanations to these beliefs, the present article highlights the differences in approach between acute and palliative management and the importance of good communication skills, as well as correcting the myths of patients and their caregivers, with the aim of improving the understanding of palliative care., (C) 2003 Blackwell Science Ltd

MeSH terms: Death; Malaysia; Morphine; Nursing; Palliative Care; Primary Health Care; Caregivers
Fulltext Meditation for physical, mental and spiritual health

Loh KY

Asia Pac Fam Med, 2003;2(4):239-239.

MeSH terms: Malaysia; Meditation
Fulltext Prevalence of depression with chronic illness among the elderly in a rural community in Malaysia

Mohd Sidik S, Mohd Zulkefli NA, Mustaqim A

Asia Pac Fam Med, 2003;2(4):196-199.

Introduction: Depression is the most common psychiatric disorder among the elderly. The hallmark of depression in the elderly is its comorbidity with medical illness. Aim: To determine the prevalence of depression and its association with chronic illness among the elderly in a rural community setting. Methods: A cross sectional study design was used. A 30-item Geriatric Depression Scale questionnaire was used as a screening instrument. Results: The prevalence of depression was higher among elderly with chronic illness (9.0%) compared to elderly without chronic illness (5.6%). Depression among the elderly was signi.cantly associated with ischemic heart disease. Conclusion: The prevalence of depression among the elderly with chronic illness in the community is high. Primary care providers need to be vigilant when treating elderly patients in their care as depression is commonly found in this group.

MeSH terms: Aged; Mental Disorders; Chronic Disease; Coronary Disease; Cross-Sectional Studies; Depression; Health Surveys; Humans; Malaysia; Mass Screening; Primary Health Care; Rural Population; Comorbidity; Prevalence
Fulltext Factors associated with depression among elderly patients in a primary health care clinic in Malaysia

Mohd Sidik S, Mohd Zulkefli NA, Shah SA

Asia Pac Fam Med, 2003;2(3):148-152.

Aim: To identify the factors associated with depression among elderly patients attending a primary health care clinic in Malaysia. Methods: A cross sectional study was conducted on patients aged 60 years and above in Klinik Kesihatan Butterworth, Seberang Perai Utara, Pulau Pinang, Malaysia from April to September 1999. The Geriatric Depression Scale questionnaire was used as a screening instrument. Results: The response rate was 99.0%. A total of 18% of the patients were found to have depression. The associated factors were females (odds ratio (OR) = 2.87, 95% confidence interval (CI) = 1.37-6.02), those who were unmarried (OR = 3.46, 95% CI = 1.66-7.21), without formal education (OR = 8.0, 95% CI = 2.97-21.48), low total family income (OR = 7.97, 95% CI = 2.71-23.46) and urban residence (OR = 2.23, 95% CI = 1.09-4.58). Conclusion: Depression is very common among the elderly. As this is an important problem in primary care practice, primary care doctors should be aware of this problem so that early detection and management can be implemented., (C) 2003 Blackwell Science Ltd

MeSH terms: Aged; Ambulatory Care Facilities; Mental Disorders; Cross-Sectional Studies; Depression; Female; Humans; Malaysia; Mass Screening; Primary Health Care; Odds Ratio
Fulltext Prevalence of emotional disorders among medical students in a Malaysian university

Mohd Sidik S, Rampal L, Kaneson N

Asia Pac Fam Med, 2003;2(4):213-217.

Background: Emotional disorder, one of the common human emotional states is defined as feelings of sadness and tiredness in response to life events, such as disappointments. It is one of the major problems among students and although it consists of more than half of all mental disorders, it is often left untreated each year worldwide. Aim: To determine the prevalence of emotional disorders among medical students at a university in Malaysia.
Methods: A cross sectional study design was used. All medical students at a local university in Malaysia were included in the study. A questionnaire similar to the General Health Questionnaire (GHQ-12) was used as a screening instrument.
Results: A total of 41.9% of the medical students were found to have emotional disorders. Factors found to have a significant association with emotional disorders were relationship of the respondents with their parents (chi-square=6.02, d.f.=1, p<0.05), siblings (chi-square=6.94, d.f.=1, p<0.05) and lecturers (chi-square=4.80, d.f.=1, p<0.05), as well as pressure prior to exams (chi-square=10.30, d.f.=1, p<0.05).
Conclusion: The prevalence of emotional disorders among medical students was high. There was significant association between emotional disorders and respondents' relationship with their parents, siblings and lecturers, as well as level of pressure prior to exam. Early detection of this condition is important to prevent psychological morbidity and its unwanted effects on medical students and young doctors.

MeSH terms: Mental Disorders; Cross-Sectional Studies; Humans; Malaysia; Mass Screening; Morbidity; Parents; Students; Students, Medical; Universities; Prevalence; Young Adult
Fulltext Prevalence of menopausal symptoms among female teachers in Seremban, Negeri Sembilan

Mohd Zulkefli NA, Mohd Sidik S

Asia Pac Fam Med, 2003;2(4):235-238.

Background: Menopause is a condition that every woman faces in later life and can have many associated effects which might disrupt the quality of life.
Aim: To determine both the prevalence of menopause and menopausal symptoms in a group of employed Malaysian women and to determine their sources of information regarding menopause.
Methods: A cross sectional study was conducted among female teachers aged 35 and above in Seremban, Negeri Sembilan, Malaysia between 1 June and 31 December 2000. A total of 550 self administered questionnaires were distributed to teachers selected through simple random sampling of selected schools.
Results: The response rate was 78.9%. The prevalence of menopause was 21.9%. There was a high prevalence of skin dryness (44.2%), hot flushes (43.2%), fatigue (41.0%) and excessive sweating (34.7%) among the menopausal respondents and there was a significant difference between menopausal and non menopausal symptoms of respondents (p<0.05).
Conclusion: The prevalence of menopause and each menopausal symptom are high in the present group of women. Improved health care programs about the menopause might help give women a better quality of life.

MeSH terms: Cross-Sectional Studies; Faculty; Female; Humans; Malaysia; Menopause; Women; Prevalence
Fulltext Continuity of care of diabetic patients in a family practice clinic: How important is it?

Hanafi NS, Teng CL, Yasin S

Asia Pac Fam Med, 2003;2(1):10-15.

Aim: To assess the importance of continuity of care among diabetic patients attending a primary care clinic and to correlate degree of continuity of care with diabetic control. Methods: A cross sectional survey was carried out among diabetic patients (n = 166) attending follow-up consultations in a family practice clinic of a teaching hospital. Face-to-face interviews were carried out on patients' perception of continuity of care and various aspects related to diabetes. Diabetic control was assessed by glycosylated hemoglobin. Retrospective chart audits of each patient over the previous 28 months were done to assess the degree of continuity of care, measured with the Usual Provider Continuity Index (UPCI). Results: The UPCI ranged from 0.18 to 1.00 with a mean value of 0.60. The average number of visits per patient over the 28-month period was 11.7 visits. The majority of patients saw five different doctors for all their visits. There were no statistically significant associations between the degree of provider continuity with diabetic control (r = 0.054) and diabetic self-care behavior (r = 0.065). The majority of patients (89%) felt that it was important to have a regular doctor. The main reason given was that a regular doctor would know the patient's problems. Conclusions: Continuity of care was highly valued by diabetic patients attending a hospital-based family practice clinic. Even though the degree of continuity was not associated with the degree of diabetic control, patients felt that it was important to have doctors who are aware of their problems.

MeSH terms: Ambulatory Care Facilities; Continuity of Patient Care; Cross-Sectional Studies; Diabetes Mellitus; Family Practice; Hemoglobin A, Glycosylated; Hospitals; Humans; Malaysia; Medical Audit; Outpatients; Physicians, Family; Self Care
Fulltext Accuracy of urinalysis in detection of urinary tract infection in a primary care setting

Othman S, Chia YC, Ng CJ

Asia Pac Fam Med, 2003;2(4):206-212.

Aim: To determine the accuracy of urinalysis in the detection of urinary tract infection (UTI) in symptomatic patients at primary care level. Methods: A cross sectional study was undertaken on 100 patients with symptoms of UTI presenting at the Primary Care Clinic of University Malaya Medical Center, Kuala Lumpur, Malaysia during the months of August to November 1999. Their urine samples were tested simultaneously using urine dipstick, urine microscopy and urine culture. Urine culture was used as the gold standard and UTI was diagnosed when the urine culture showed a bacteria count of >= 105 organisms per mL. The sensitivity and specificity of each test was calculated. Results: The prevalence of UTI was 25% in symptomatic patients. The urine dipstick for leukocyte esterase, nitrite and red blood cell had sensitivities of 76, 56 and 76%, respectively. Their specificities were 60, 81 and 61%, respectively. Urine microscopy for leukocytes, red blood cells and bacterial count had sensitivities of 80, 52 and 84%, while their specificities were 76, 80 and 54%, respectively. Conclusion: The prevalence of UTI in the present study was low despite reported symptoms of UTI. Urinalysis is needed to support the diagnosis of UTI. In the present study, while there is accuracy in the urinalysis (as the sensitivities and specificities of various tests are comparable with other studies); lack of precision in each test because of the wide range of 95% confidence interval make it less reliable. Caution should be made in interpreting each test.

MeSH terms: Ambulatory Care Facilities; Cross-Sectional Studies; Diagnosis; Family Practice; Hospitals; Humans; Malaysia; Outpatients; Primary Health Care; Sensitivity and Specificity; Urinary Tract Infections; Prevalence; Urinalysis
Fulltext Health beliefs, concerns and expectations of patients presenting with non-acute pain: A preliminary study from a government health clinic in Malaysia

Teng CL, Mohd Jamin Z, Mohd Kamaruddin NI, Idris SA

Asia Pac Fam Med, 2003;2(1):23-26.

Aim: This study explored the health beliefs, concerns and expectations of primary care patients presenting with abdominal pain, headache and chest pain. Methods: Over a 6-week period, 107 adult patients with symptoms of pain were interviewed using a semistructured questionnaire. Results: The presenting symptoms of these patients were: abdominal pain, 41; headache, 35; and chest pain, 31. Females made up 53.3%; the ethnic groups were Malay (35.5%), Chinese (18.7%) and Indian (45.8%); and 71.8% of the patients had primary or secondary education. The patients' attributions of their symptoms were predominantly non-medical in all three ethnic groups. The non-medical causes mentioned include food, trauma, stress, weather changes and winds ('angin'). Only two fifths of the patients mentioned disease-specific concerns. Three quarters of these patients expected either medications or wanted the doctor to look for serious causes. Very few patients specifically wanted referral or special tests. Conclusions: The patients in the study had health beliefs and concerns, in view of their non-medical focus, that was at variance with those of the health care providers. However, having decided to consult the health clinic, they were mainly looking for symptomatic relief or evaluation for serious pathology.

MeSH terms: Adult; Ambulatory Care Facilities; Chest Pain; Cross-Sectional Studies; Culture; Ethnic Groups; Female; Food; Headache; Humans; Malaysia; Pain; Primary Health Care; Referral and Consultation; Abdominal Pain; Patient Preference
Risk of postnatal depression after emergency delivery

Koo V, Lynch J, Cooper S

J Obstet Gynaecol Res, 2003 Aug;29(4):246-50.
PMID: 12959147

AIM: To identify whether women having emergency delivery are at increased risk of developing postnatal depression (PND).
METHODS: This is a retrospective comparative cohort study design. Two hundred and fifty Malaysian women were part of a previous study examining the prevalence of PND in a multiracial country and the effects of postnatal rituals. All women were at least 6 weeks post-partum when asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic and birth data were obtained.
RESULTS: Data collected were divided into two groups: 55 emergency delivery and 191 non-emergency delivery. There were four missing data. There was no significant difference in the mean age, parity, gestational period, baby birthweight, 5 min baby Apgar score and EPDS scores of the two groups. However, the analysis of PND indicated that women with emergency delivery had a relative risk of 1.81 compared with women with non-emergency delivery. The comparison of the two groups using chi2 indicated a significant (chi2 = 3.94, d.f. = 1, P = 0.04) increase in the presence of PND in the emergency delivery.
CONCLUSION: When compared with women having non-emergency delivery, women having emergency delivery had about twice the risk of developing PND. Special attention to this group appears warranted.

MeSH terms: Adult; Cesarean Section/psychology*; Emergency Medical Services; Female; Humans; Pregnancy; Retrospective Studies; Risk Factors; Depression, Postpartum/etiology; Depression, Postpartum/epidemiology*
Fulltext Prevalence of hypogonadism in the aging male and male erectile dysfunction in Asia-Pacific countries

Chew KK

Asian J Androl, 2003;5:171-172.

MeSH terms: Adult; Aged; Asia; Australia; China; Humans; Hypogonadism; Erectile Dysfunction; Japan; Korea; Malaysia; Male; Singapore; Testosterone; Thailand; Prevalence
Meliternatin: a feeding deterrent and larvicidal polyoxygenated flavone from Melicope subunifoliolata

Hung Ho S, Wang J, Sim KY, Ee GC, Imiyabir Z, Yap KF, et al.

Phytochemistry, 2003 Apr;62(7):1121-4.
PMID: 12591266

We screened more than 60 Malaysian plants against two species of insects and found that Melicope subunifoliolata (Stapf) T.G. Hartley (Rutaceae) showed strong feeding deterrent activity against Sitophilus zeamais Motsch. (Curculionidae) and very good larvicidal activity against Aedes aegypti L. (Diptera). One anti-insect compound, meliternatin (3,5-dimethoxy-3',4',6,7-bismethylendioxyflavone) (6) and six other minor polyoxygenated flavones were isolated from M. subunifoliolata.

MeSH terms: Aedes/growth & development; Animals; Beetles/growth & development; Eating/drug effects; Flavonoids/isolation & purification; Flavonoids/pharmacology*; Flavonoids/chemistry*; Insecticides/isolation & purification; Insecticides/pharmacology*; Insecticides/chemistry*; Larva/growth & development; Lethal Dose 50; Nuclear Magnetic Resonance, Biomolecular; Rutaceae/chemistry*
Defining and measuring trophic role similarity in food webs using regular equivalence

Luczkovich JJ, Borgatti SP, Johnson JC, Everett MG

J Theor Biol, 2003 Feb 07;220(3):303-21.
PMID: 12468282

We present a graph theoretic model of analysing food web structure called regular equivalence. Regular equivalence is a method for partitioning the species in a food web into "isotrophic classes" that play the same structural roles, even if they are not directly consuming the same prey or if they do not share the same predators. We contrast regular equivalence models, in which two species are members of the same trophic group if they have trophic links to the same set of other trophic groups, with structural equivalence models, in which species are equivalent if they are connected to the exact same other species. Here, the regular equivalence approach is applied to two published food webs: (1) a topological web (Malaysian pitcher plant insect food web) and (2) a carbon-flow web (St. Marks, Florida seagrass ecosystem food web). Regular equivalence produced a more satisfactory set of classes than did the structural approach, grouping basal taxa with other basal taxa and not with top predators. Regular equivalence models provide a way to mathematically formalize trophic position, trophic group and trophic niche. These models are part of a family of models that includes structural models used extensively by ecologists now. Regular equivalence models uncover similarities in trophic roles at a higher level of organization than do the structural models. The approach outlined is useful for measuring the trophic roles of species in food web models, measuring similarity in trophic relations of two or more species, comparing food webs over time and across geographic regions, and aggregating taxa into trophic groups that reduce the complexity of ecosystem feeding relations without obscuring network relationships. In addition, we hope the approach will prove useful in predicting the outcome of predator-prey interactions in experimental studies.

MeSH terms: Animals; Insects; Models, Biological*; Plants; Predatory Behavior; Ecosystem; Food Chain*
An extensive study of human IgE cross-reactivity of Blo t 5 and Der p 5

Kuo IC, Cheong N, Trakultivakorn M, Lee BW, Chua KY

J Allergy Clin Immunol, 2003 Mar;111(3):603-9.
PMID: 12642844

BACKGROUND: Dual sensitization by Blomia tropicalis and Dermatophagoides pteronyssinus mites is common in tropical and subtropical countries. The human IgE cross-reactivity between clinical important group 5 allergens, Blo t 5 and Der p 5, remains controversial.
OBJECTIVE: This study was undertaken to assess the levels of the IgE cross-reactivity between Blo t 5 and Der p 5 by using sera from a large cohort of asthmatic children in subtropical and tropical countries.
METHODS: Purified recombinant Blo t 5 and Der p 5 were produced in Pichia pastoris and tested against sera from 195 asthmatic children. The IgE cross-reactivity was examined by direct, inhibitory and competitive human IgE enzyme-linked immunosorbent assay as well as skin prick tests.
RESULTS: The Blo t 5 IgE responses were 91.8% (134 of 146) and 73.5% (36 of 49) for Taiwanese and Malaysian sera, respectively. The Blo t 5 specific IgE titers were significantly higher than those of Der p 5 (P

MeSH terms: Adolescent; Adult; Allergens/biosynthesis; Allergens/immunology*; Asthma/immunology*; Child; Cross Reactions; Dose-Response Relationship, Immunologic; Enzyme-Linked Immunosorbent Assay/methods; Humans; Immunoglobulin E/blood*; Pichia/immunology; Recombinant Proteins/immunology; Skin Tests; Cohort Studies; Antigens, Dermatophagoides/biosynthesis; Antigens, Dermatophagoides/immunology*; Antigens, Plant; Arthropod Proteins
Effects of iridoids on lipoxygenase and hyaluronidase activities and their activation by beta-glucosidase in the presence of amino acids

Ling SK, Tanaka T, Kouno I

Biol Pharm Bull, 2003 Mar;26(3):352-6.
PMID: 12612446

Enzyme inhibitory activities of 14 iridoids previously obtained from two Malaysian medicinal plants, Saprosma scortechinii and Rothmannia macrophylla, were evaluated in vitro using soybean lipoxygenase and bovine testis hyaluronidase. Most of the iridoids, including asperulosidic acid, paederosidic acid, and an epimeric mixture of gardenogenins A and B, did not show any effect on the enzyme activities, except for the bis-iridoids, which inhibited the lipoxygenase activity with their IC(50) values of approximately 1.3 times that of a known inhibitor, fisetin. Structural modification of asperulosidic acid and paederosidic acid through enzymatic hydrolysis by beta-glucosidase resulted in their inhibition towards the enzyme activities, and these activities were enhanced by the presence of some amino acids (lysine, leucine or glutamic acid) or ammonium acetate. Mixtures of gardenogenins A and B; isomers of non-glucosidic iridoids, incubated with amino acid or ammonium acetate did not show any inhibitory effect on the enzyme activities during the 6 h incubation period, except for lysine where spontaneous reaction between the iridoids and amino acid resulted in the inhibition of lipoxygenase activity. The results from these biomimetic reactions suggested that the iridoid aglycons and the intermediates formed by these reactive species could inhibit the enzyme activities, and thus substantiate previous reports that the formation of iridoidal aglycons is a prerequisite for the iridoid glycosides to demonstrate some of the biological activities. In addition, the results also indicated that it is worthwhile to further explore these intermediates as potential anti-inflammatory agents.

MeSH terms: Amino Acids/pharmacology*; Animals; beta-Glucosidase/metabolism*; Cattle; Drug Interactions; Enzyme Activation/drug effects; Hyaluronoglucosaminidase/metabolism*; Lipoxygenase/metabolism*; Male; Plant Extracts/pharmacology; Plant Extracts/chemistry; Structure-Activity Relationship; Testis/drug effects*; Testis/enzymology; Time Factors; Inhibitory Concentration 50; Iridoids/classification; Iridoids/pharmacology*; Iridoids/chemistry

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