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Background/Aims@#Cirrhosis is the most important risk factor of hepatocellular carcinoma (HCC), and patients with cirrhosis are recommended to receive semiannual surveillance for early HCC detection. However, early cirrhosis is often asymptomatic and can go undiagnosed for years, leading to underuse of HCC surveillance in clinical practice. We characterized the frequency and associated factors of unrecognized cirrhosis in a national sample of patients with HCC from the United States. @*Methods@#HCC patients aged 68 years and older, diagnosed during 2011 to 2015 were included from the SEERMedicare Linked Database. If cirrhosis was diagnosed within 6 months immediately preceding HCC diagnosis or after HCC diagnosis, cases were categorized as unrecognized cirrhosis. Factors associated with unrecognized cirrhosis were identified using logistic regression analyses. Factors associated with overall survival were evaluated using Cox regression analyses. @*Results@#Among 5,098 HCC patients, 74.8% patients had cirrhosis. Among those with cirrhosis, 57.4% had unrecognized cirrhosis, with the highest proportion (76.3%) among those with NAFLD-related HCC. Male sex (aOR: 2.12, 95% CI: 1.83–2.46), non-Hispanic Black race (aOR: 1.93, 95% CI: 1.45–2.57), and NAFLD etiology (aOR: 4.46, 95% CI: 3.68–5.41) were associated with having unrecognized cirrhosis. Among NAFLD-related HCC patients, male sex (aOR: 2.32, 95% CI: 1.71–3.14) was associated with unrecognized cirrhosis. Unrecognized cirrhosis was independently associated with worse overall survival (aHR: 1.17, 95% CI: 1.08–1.27) compared to recognized cirrhosis. @*Conclusions@#Unrecognized cirrhosis is common in NAFLD-related HCC, particularly among male and Black patients, highlighting these groups as important intervention targets to improve HCC surveillance uptake and outcomes.
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@#Biliary atresia is one of the commonest causes of prolonged jaundice in neonate, whereas cystic biliary atresia is a rare form of biliary atresia with similar presentation, but a slightly different sonographic finding. Being able to differentiate them radiologically is important as the surgical management is different for these two diagnoses. An ultrasound examination was done for a 2-month-old baby girl with prolonged jaundice with the finding of a cyst along the portal triad, which raised the suspicion for cystic biliary atresia. The diagnosis was confirmed with intraoperative cholangiography (IOC) and Kasai procedure was done. The patient was well after the surgery with resolution of jaundice.
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@#Hepatobiliary iminodiacetic acid (HIDA) scintigraphy is a non-invasive, functional imaging of the hepatobiliary system that serves as an adjunct imaging modality for neonatal cholestasis work-up. In view of the urgency to diagnose biliary atresia and restore bile flow through surgery, HIDA scintigraphy could help to distinguish between neonatal cholestasis due to biliary atresia and neonatal hepatitis of various causes. We describe a full-term male infant with jaundice beyond the physiological period in which HIDA scintigraphy showed absent tracer excretion from the biliary system into the intestines up to 5 hours on follow-up imaging. The intraoperative diagnosis confirmed the diagnosis of biliary atresia. The prognosis of the patient with biliary atresia depends on early surgical planning and intervention. Therefore, non-invasive diagnostic tools play an important role in the evaluation of a child with neonatal cholestasis.
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@#Introduction: The culture of eating out among Malaysians has substantially increased in recent years due to the urbanisation of the society. Frequent eating out has been linked with reduced quality of diet, reduced intake of micronutrients, and increased weight gain. This study aims to explore specific factors on the perceptions and behaviours related to eating out from the perspective of parents. Methods: A qualitative study was carried out among 27 informants from various ethnicities and locations in Peninsular Malaysia. All sessions were audio-recorded, fully transcribed and analysed using thematic content analysis. Results: The main overarching theme that surfaced from this study was the role of parents in shaping the practice of eating out. Time constraints due to parents’ work commitments, the availability of various food outlets, increase in family bonding time and food preferences were recurring themes revealed by informants as facilitating factors to eating out. Other emerging themes, such as hygiene of food premises and cost of food, posed as barriers to eating out. Conclusion: These findings offered a better understanding on the eating out practices of a family from the parents’ perspective. Information as such could be incorporated in strategies to enhance the promotion of healthy eating and nutrition interventions that aim to inculcate healthy food choices while eating out.
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@#Introduction: This paper discussed the effectiveness of “Healthy Kids Programme (HKP)”, specifically in improving the body weight status as well as knowledge, attitude and practice (KAP) of the children. Methods: In this longitudinal intervention study, a total of 12 primary schools in Klang Valley were randomly selected and divided into intervention and control groups. There were 386 standard three children participated at baseline. All children in the intervention group participated in the HKP that was conducted by nutritionists. The evaluations included the pre- and post-Immediate Impact survey (IIS) (every topic), and changes in nutrition KAP survey and anthropometric assessment of the children at the beginning and end of every year for three years. Results: School children in intervention group reported with an increased in the IIS score for each topic and achieved a significantly higher mean nutrition knowledge score than those in the control group over time. There were no significant differences in mean attitude and practice scores between two groups after the intervention. Children in the intervention group had lower rates of overweight and obesity (pre-test: 27.3%; post-test: 32.5%) than their counterpart (pre-test: 26.6%; post-test: 44.0%). Conclusions: The HKP is effective in improving nutrition knowledge of the children. A lower rate of overweight and obesity was observed in intervention group than control group. This approach will contribute towards inculcating healthy eating and active lifestyle habits among Malaysian children that bring about long-term health benefits.
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@#Introduction: Increasing numbers of limb amputation are performed globally and in Malaysia due to the rise of complications because of Diabetes Mellitus (DM). Limb amputation influences many aspects of an individual’s life, and prosthesis restoration is one of the primary rehabilitation goals to help amputees resume daily activities. As limited information is available in Malaysia, this study aims to determine the socio-demographic, clinical characteristics and prosthesis usage among the amputees. Methods: A cross-sectional study using self-developed survey form was conducted at 13 Medical Rehabilitation Clinics in Malaysia among 541 upper and lower limb amputees of any duration and cause. Results: The study population had a mean age of 54 years. Majority were males, Malays, married and had completed secondary school. About 70% of amputations were performed due to DM complications and at transtibial level. Fifty-eight percent of unilateral lower limb amputees were using prosthesis with a mean (standard deviation) of 6.48 (±4.55) hours per day. Time since amputation was the true factor associated with prosthesis usage. Longer hours of prosthesis use per day was positively correlated with longer interval after prosthesis restoration (r=0.467). Conclusion: Higher aetiology of DM and lower prosthesis usage among amputees may be because of high prevalence of DM in Malaysia. The prosthesis usage and hours of use per day were low compared to the international reports, which may be influenced by sampling location and time since amputation. Nevertheless, this is a novel multicentre study on the characteristics and prosthesis usage of amputees. Hopefully, this research will assist to support, facilitate and promote prosthesis rehabilitation in Malaysia.
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Hookah or waterpipe smoking or use is an emerging trend in the US population, especially among the youth. The misperception of hookah being less harmful than cigarettes and the availability of different but "appealing" flavors are considered among the main reasons for this trend. Hookah users however are exposed to many of the same toxic compounds/by-products as cigarette users, but at dramatically higher levels, which might lead to more severe negative health effects. In fact, hookah users are at risks of infections, cancers, lung disease, and other medical conditions. Moreover, because of the overlapping toxicant/chemical profile to conventional cigarettes, hookah smoke effects on the cardiovascular system are thought to be comparable to those of conventional cigarettes. A major source of tobacco addiction is nicotine, whose levels in hookah are extremely variable as they depend on the type of tobacco used. Taken together, in this review of literature, we will provide insights on the negative health effects of hookah in general, with a focus on what is known regarding its impact on the cardiovascular system.
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@#Primitive neuroectodermal tumours (PNETs) occurring directly from the lung parenchyma without involvement of the chest wall or pleura are particularly unusual. We describe a 16-year-old male who presented with severe chest and back pain following a fall during high jump competition. Incidental finding of an opacity at the right lung upper lobe was seen on his chest radiograph. Computed tomography of the thorax demonstrated a lobulated hypodense lesion in the anterior segment of right upper lobe and subsequent biopsy confirmed the diagnosis of Ewing Sarcoma/ PNET following histologic and immunohistochemical examination. Whole-body positron emission computed tomography/computed tomography (PET/CT) revealed mild, homogenous F18-fluorodeoxyglucose (FDG) uptake in the lung lesion with no evidence of metastasis. He eventually underwent right thoracotomy and right upper lobectomy. Indeed, F18-FDG PET/CT is a valuable imaging method in demonstrating active focus of glucose metabolism in lung parenchymal lesion, for preoperative evaluation and as baseline scan for patient’s monitoring.
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@#Introduction: Transfusion Medicine is an evolving filed which integrates multidisciplinary science in providing safe blood and blood products for patients. With an increasing demand for Transfusion Medicine training in Malaysia, a formal survey is needed to evaluate the postgraduate Transfusion Medicine programme offered by Advanced Medical and Dental Institute, Universiti Sains Malaysia to identify areas of deficiency based on the alumni experiences. Methods: An English language survey form was developed specifically to assess the programme contents (overall contents, learning experience in each year, and support in research), the alumni perception on soft-skills gained during the study, and the outcome of the programme. The survey forms were distributed to all alumni between March 2018 and October 2018 via e-mail or hand-delivered. Results: The survey response rate was 79% (37 of 47). A majority (97%) of the transfusion medicine specialists (TMS) in this study reported that the course offered in the program was relevant to their current job. The learning experience which includes course content, student’s placement, facilities, and support in research) were rated between satisfactory and good. Communicating effectively through speaking was the highest reported soft-skill gained during the programme, whereas communicating effectively in writing was the lowest soft-skill gained. On the programme outcome, all TMS agreed that this programme will produce qualified and well trained specialists for current working market. Conclusion: Some improvement in the programme contents and teaching activities are needed to equip the future TMS for the nation.
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@# Breast cancer is globally known to be the commonest cause of cancer-related deaths among women. Screening tools which include breast-self examination (BSE), clinical breast examination and mammography are well-recognised to aid the detection of breast cancer among high risk women. Thus, our study was aimed to evaluate breast cancer and BSE awareness and practice, and to perform mammography screening among women who attended community breast cancer awareness and screening programme. Methods: Data was collected cross-sectionally from 2,021 women during community services from September 2013 until December 2015. Results: Majority of the women had previously attended health education on breast cancer (56.3%) and had been taught BSE techniques (61.4%), but only 38.6% performed BSE monthly. Factors associated with regular BSE practice were older age, higher education level, being married, higher monthly income, had attended health education on breast cancer, and had been taught BSE techniques. A subset of 130 high-risk women had underwent mammography screening and majority had heterogenously dense and normal mammogram findings. Conclusion: These findings suggested that regular breast cancer awareness campaigns is needed to strengthen breast cancer knowledge and to emphasise BSE techniques. Such campaigns should target younger women and those with low socioeconomic status.
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@#Malignant intrathoracic disease is the commonest cause of superior vena cava (SVC) obstruction. Life threatening SVC obstruction with intense dyspnoea requires urgent treatment. SVC stenting has been developed in recent years which results in rapid relief of the obstruction. The Yconfiguration technique has been reported to provide support for all three limbs of the bifurcation to prevent restenosis. At present, there are limited reports on the use of Y-configuration stent in stent techniques for endovascular stenting in malignant SVC obstruction. We share our clinical experience of two patients who received balloon-mounted stents using this technique
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BACKGROUND: As the field of Emergency Medicine grows worldwide, the importance of an Emergency Department Crash Cart (EDCC) has long been recognized. Yet, there is paucity of relevant peer-reviewed literature specificaly discussing EDCCs or proposing detailed features for an EDCC suitable for both adult and pediatric patients. METHODS: The authors performed a systematic review of EDCC-specific literature indexed in Pubmed and Embase on December 20, 2016. In addition, the authors reviewed the 2015 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, the 2015 European Resuscitation Council (ERC) guidelines for resuscitation, and the 2013 American College of Surgeons (ACS) Advanced Trauma Life Support (ATLS) 9th edition. RESULTS: There were a total of 277 results, with 192 unique results and 85 duplicates. After careful review by two independent reviewers, all but four references were excluded. None of the four included articles described comprehensive contents of equipment and medications for both the adult and pediatric populations. This article describes in detail the final four articles specific to EDCC, and proposes a set of suggested contents for the EDCC. CONCLUSION: Our systematic review shows the striking paucity of such a high impact indispensable item in the ED. We hope that our EDCC content suggestions help enhance the level of response of EDs in the resuscitation of adult and pediatric populations, and encourage the implementation of and adherence to the latest evidence-based resuscitation guidelines.
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Primary osteosarcoma of the spine is indeed rare and onlyseveral sporadic cases have been reported. It tends to occurin a slightly older age group than those with appendicularskeleton tumours. We present here an unusual case ofaggressive lumbosacral osteosarcoma in a young teenagercomplicated by extensive dural spread, skip lesions andintravascular extension. Although a histopathologicalexamination is mandatory to establish the diagnosis, thiscase emphasises the need of imaging to ascertain the fullextent of disease spread especially in deciding the type oftreatment to be instituted and to evaluate the response tothe treatment.
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@#Introduction: The Penan people are largely settled in rural and remote areas of Sarawak with high rates of undernutrition among the children. The study aimed to determine the nutritional status and infant and young child feeding (IYCF) practices of Penan children. Methods: Subjects consisted of 121 children, aged between 0-23 months, from 15 Penan longhouses in Belaga district. Malnutrition was assessed using anthropometric measurements of children and categorised according to the World Health Organization (WHO) Growth Standards (2006). Feeding practices were assessed using questionnaires based on WHO IYCF Indicators (2008). Results: The prevalence of underweight was 29.8%; stunting 43.0% and wasting 5.8%. Prevalence of exclusive breastfeeding under 6 months was 44.4%. About 86% of infants aged 6-8 months were already given solid, semi-solid and soft foods. The proportion of children aged 6-23 months achieving minimum dietary diversity (MDD) was 76.6%, while minimum meal frequency (MMF) was 83.0% (breastfed and non-breastfed). Among the children who achieved MDD, 64.9% of their meals were derived from 4-5 food groups. More than half (55.3%) of all subjects (breastfed and non-breastfed) received minimum acceptable diet (MAD). Achievement of iron-rich foods (IRF) indicator was 77.7%. There was no significant association between the IYCF indicators of MDD, MMF and MAD and underweight, stunting and wasting. Conclusion: A high prevalence of poor nutritional status was recorded among the Penan children. While the IYCF indicators apparently showed satisfactory complementary feeding practices, future studies should assess quantitatively the intake of complementary food among Penan infants and young children.
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@#Ectasia or abnormal dilatation of a vessel may affect any vein within the body including the neck region. Internal jugular vein (IJV) ectasia commonly presents as a painless, soft swelling on the neck which appears to be prominent with increased intrapleural pressure such as during Valsalva manoeuvre. To the best of our knowledge, the occurrence of venous ectasia is infrequent with limited number of reports on this anomaly available. However with the advancement of technology especially in imaging modalities, there is improvement in detecting this condition. We describe here an incidental finding of focal IJV ectasia in an elderly lady following a cervical spine magnetic resonance imaging (MRI) for bilateral hand numbness, and discuss the management of this rare presentation.
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<p><b>INTRODUCTION</b>This study aimed to develop and validate a food frequency questionnaire (FFQ) to assess habitual diets of multi-ethnic Malaysian children aged 7-12 years.</p><p><b>METHODS</b>A total of 236 primary school children participated in the development of the FFQ and 209 subjects participated in the validation study, with a subsample of 30 subjects participating in the reproducibility study. The FFQ, consisting of 94 food items from 12 food groups, was compared with a three-day dietary record (3DR) as the reference method. The reproducibility of the FFQ was assessed through repeat administration (FFQ2), seven days after the first administration (FFQ1).</p><p><b>RESULTS</b>The results of the validation study demonstrated good acceptance of the FFQ. Mean intake of macronutrients in FFQ1 and 3DR correlated well, although the FFQ intake data tended to be higher. Cross-classification of nutrient intake between the two methods showed that < 7% of subjects were grossly misclassified. Moderate correlations noted between the two methods ranged from r = 0.310 (p < 0.001) for fat to r = 0.497 (p < 0.001) for energy. The reproducibility of the FFQ, as assessed by Cronbach's alpha, ranged from 0.61 (protein) to 0.70 (energy, carbohydrates and fat). Spearman's correlations between FFQ1 and FFQ2 ranged from rho = 0.333 (p = 0.072) for protein to rho = 0.479 (p < 0.01) for fat.</p><p><b>CONCLUSION</b>These findings indicate that the FFQ is valid and reliable for measuring the average intake of energy and macronutrients in a population of multi-ethnic children aged 7-12 years in Malaysia.</p>
Subject(s)
Child , Female , Humans , Male , Diet , Diet Records , Energy Intake , Ethnicity , Food , Malaysia , Reference Values , Reproducibility of Results , Schools , Surveys and QuestionnairesABSTRACT
An increase in physical activity is a key component for effective weight loss. It helps to control weight loss by using excess calories as well as boosting metabolism and lowering insulin levels. Physical activity also helps prevent many chronic diseases and improve the overall human health. The objective of this study was to assess weight loss practice using physical activity strategies among working women in Kuala Lumpur, Malaysia. A total of 639 adult Malaysian working women were screened and 120 respondents were identified based on their experience of losing at least 10% of their highest lifetime body weight, which is a criterion for successful weight-loss. Self-administered questionnaire was used to collect information from 120 successful weight loss respondents. Physical activity was measured by using International Physical Activity Questionnaire (IPAQ) short version. Results showed that 35.8% of women had low physical activity level; slightly above than one third of women (38.3%) had moderate activity level, while 25.8% women had high physical activity level.The most common physical activity monitoring strategies implemented were exercise at least 30 minutes per day (22.5%) and incorporate physical activity into daily life (21.7%). A total of 70.8% women regained weight after significant weight loss. A total of 40.0% who regained weight as compared to 25.7% of those who did not regain weight were physically inactive (p=0.138). There was no statistically significant different in daily sitting time between the two groups (p=0.627). As a conclusion, government working women in Kuala Lumpur have low to moderate physical activity levels. Majority women regained weight after significant weight loss. Common strategies to lose weight are exercise at least 30 minutes per day and incorporate physical activity into daily life. More education and promotion regarding the importance of physical activity should be done to all community members especially to the government working women.
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Motor Activity , ExerciseABSTRACT
"Primum non nocere" [first do no harm]: Hippocrates [c. 460 BC-377 BC]. Wrong site surgery is the fourth commonest sentinel event after patient suicide, operative and post-operative complications, and medication errors. Misinterpretation of the clinic letters or radiology reports is the commonest reason for the wrong site being marked before surgery. We analyzed 50 cases each of operations carried out on the kidney, ureter, and the testis. The side mentioned on clinic letters, the consent form, and radiology reports lists were also studied. The results were analyzed in detail to determine where the potential pitfalls were likely to arise. A total of 803 clinic letters from 150 cases were reviewed. The side of disease was not documented in 8.71% and five patients had the wrong side mentioned in one of their clinic letters. In the radiology reports, the side was not mentioned in three cases and it was reported wrongly in two patients. No wrong side was ever consented for and no wrong side surgery was performed. The side of surgery was not always indicated in clinic letter, theatre list, or the consent form despite the procedure being carried on a bilateral organ. As misinterpretation is a major cause of wrong side surgery, it is prudent that the side is mentioned every time in every clinic letter, consent form, and on the theatre list. The WHO surgical safety checklist has already been very effective in minimizing the wrong site surgery in the National Health Service
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Humans , General Surgery , Patient Safety , World Health Organization , Checklist , Retrospective StudiesABSTRACT
To determine the association between carotid femoral pulse wave velocity PWV[CF] and augmentation index [AI] with future cardiovascular disease [CVD] risk, and to assess whether high sensitivity C-reactive protein [hs-CRP] is an important mediator towards these vascular changes, among young men. This cross-sectional study was conducted at Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia from July 2011 to December 2012. Two hundred and eleven young men were recruited. The PWV[CF] and AI were measured using Vicorder. High sensitivity C-reactive protein was measured by using immunological methods. The future CVD risk was assessed by Framingham risk score [FRS] and age adjusted FRS [A-FRS]. Data for analysis was conducted using the Statistical Package for Social Sciences Version 15 [SPSS Inc., Chicago, IL, USA]. The mean age of the subjects was 27.09 [95% confidence intervals [CI] 26.39-27.79] years old. Those with >/-2 risk factors had significantly higher AI [10.09 [95% CI: 9.06-11.12] versus 6.56 [95% CI: 5.54-7.57] [p=0.001], but not PWV[CF] 7.45 [95% CI: 7.29-7.61] m/s versus 7.29 [95% CI: 7.06-7.51] m/s, [p=0.90] when compared to the healthy subjects. High sensitivity C-reactive protein was not an independent determinant for PWVCF and AI. Only AI was significantly associated with FRS and A-FRS [p=0.0001]. To assess the impact of risk factors on vascular damage and for future assessment of CVD risk among the young men, AI may be a better marker than PWVCF. The increase in AI among these subjects was not related to hs-CRP
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The objective was to compare the fetal birth weight between anaemic and non anaemic pregnant women. This cross sectional, comparative study was conducted with a total of 200 pregnant women, 100 anaemic and 100 non anaemic, delivering in the labour ward of Abbasi Shaheed Hospital of Gynae unit 1. Study duration was one year from October 2005-September 2006. Pregnant women with singleton, term and gravidity up to 5 were included while twin, grand multi para, intrauterine growth retardation [IUGR], preterm and women with co-morbids were excluded. Data was recorded on a special form. Maternal blood was drawn for haemoglobin estimation and fetal birth weight was recorded after delivery. Results were analyzed by using SPSS 10 on computer. The mean fetal birth weight in anaemic pregnant women was 2338 +/- 266 gm and in non anaemic pregnant women it was 3081 +/- 307 gms with p-value 0.000. Out of 100 anaemic pregnant women 25% were mild, 65% were moderate and only 10% were severely anaemic. The mean birth weight of moderately anaemic was 2184 +/- 89 gms and of severely anaemic women was 1990 +/- 73 gms with p = 0.000. This study shows that anaemic pregnant women who have haemoglobin level of less than 11 gms/dl deliver low birth weight babies as compared to non anaemic pregnant women who have haemoglobin levels greater than or equal to 11 gms/dl