Validity of self-reported weight and height: a cross-sectional study among Malaysian adolescents.

BACKGROUND: Self-reported weight and height are commonly used in lieu of direct measurements of weight and height in large epidemiological surveys due to inevitable constraints such as budget and human resource. However, the validity of self-reported weight and height, particularly among adolescents, needs to be verified as misreporting could lead to misclassification of body mass index and therefore overestimation or underestimation of the burden of BMI-related diseases. The objective of this study was to determine the validity of self-reported weight and height among Malaysian secondary school children. METHODS: Both self-reported and directly measured weight and height of a subgroup of 663 apparently healthy schoolchildren from the Malaysian Adolescent Health Risk Behaviour (MyAHRB) survey 2013/2014 were analysed. Respondents were required to report their current body weight and height via a self-administrative questionnaire before they were measured by investigators. The validity of self-reported against directly measured weight and height was examined using intraclass correlation coefficient (ICC), the Bland-Altman plot and weighted Kappa statistics. RESULTS: There was very good intraclass correlation between self-reported and directly measured weight [r = 0.96, 95% confidence interval (CI): 0.93, 0.97] and height (r = 0.94, 95% CI: 0.90, 0.96). In addition the Bland-Altman plots indicated that the mean difference between self-reported and direct measurement was relatively small. The mean difference (self-reported minus direct measurements) was, for boys: weight, -2.1 kg; height, -1.6 cm; BMI, -0.44 kg/m2 and girls: weight, -1.2 kg; height, -0.9 cm; BMI, -0.3 kg/m2. However, 95% limits of agreement were wide which indicated substantial discrepancies between self-reported and direct measurements method at the individual level. Nonetheless, the weighted Kappa statistics demonstrated a substantial agreement between BMI status categorised based on self-reported weight and height and the direct measurements (kappa = 0.76, 95% CI: 0.67, 0.84). CONCLUSION: Our results show that the self-reported weight and height were consistent with direct measurements and therefore can be used in assessing the nutritional status of Malaysian school children from the age of 13 to 17 years old in epidemiological studies and for surveillance purposes when direct measurements are not feasible, but not for assessing nutritional status at the individual level.

Prevalence of smoking and its associated factors with smoking among elderly smokers in Malaysia: findings from a nationwide population-based study.

BACKGROUND: The determination of smoking prevalence and its associated factors among the elderly could provide evidence-based findings to guide the planning and implementation of policy in order to will help in reducing the morbidity and mortality of smoking-related diseases, thus increase their quality of life. This paper describes the rate of smoking and identifies the factor(s) associated with smoking among the elderly in Malaysia. METHODS: A representative sample of 2674 respondents was obtained via a two-stage sampling method in proportion to population size. Face-to-face interviews were conducted using a set of standardized validated questionnaire. Data was weighted by taking into consideration the complex sampling design and non-response rate prior to data analysis. Univariable and multivariable logistic regression were used to determine the factor/s associated with smoking. RESULTS: The prevalence of non-smokers, ex-smokers and current smokers among Malaysians aged 60 years and above were 36.3 % (95 % CI = 32.7-39.8), 24.4 % (95 % CI = 21.2-27.5) and 11.9 % (95 % CI = 9.5-14.3), respectively. Current smokers were significantly more prevalent in men (28.1 %) than in women (2.9 %), but the prevalence declined with advancing age, higher educational attainment, and among respondents with known diabetes, hypertension and hypercholesterolemia. Multivariable analysis revealed that males (aOR, 18.6, 95 % CI 10.9-31.9) and other Bumiputras (aOR 2.58, 95 % CI 1.29-5.15) were more likely to smoke. in addition, elderly with lower educational attainment (aOR, 1.70, 95 % CI 1.24-7.41) and those without/unknown hypertension also reported higher likelihood to be current smokers (aOR 1.98, 95 % CI 1.35-2.83). However, there were no significant associations between respondents with no/unknown diabetes or hypercholesterolemia with smoking. CONCLUSIONS: In short, smoking is common among elderly men in Malaysia. Therefore, intervention programs should integrate the present findings to reduce the smoking rate and increase the smoking cessation rate among the elderly in Malaysia and subsequently to reduce the burden of smoking-related disease.

The prevalence of physical activity and its associated factors among Malaysian adults: findings from the National Health and Morbidity Survey 2011.

OBJECTIVES: Despite the health-enhancing benefits of physical activity, a large segment of the Malaysian population does not engage in regular physical activity at the recommended level. This study aimed to determine physical activity patterns and the associated sociodemographic correlates of physical activity. STUDY DESIGN: Data on physical activity were obtained from the National Health and Morbidity Survey (NHMS) 2011, a nationally representative, population-based cross-sectional study. A two-stage stratified sampling method was used to select a representative sample of Malaysian adults aged 16 years and above. METHODS: A total of 19,145 adults aged 16 years and above were recruited, and face-to-face interviews were conducted using the International Physical Activity Questionnaire (IPAQ), short version. The correlates for physical activity were identified using multivariate analysis. RESULTS: In this study, 64.3% (95%CI: 63.1-65.5) of Malaysian adults aged 16 and above were physically active, but overall physical activity levels decreased with advancing age. Men, rural residents, 'other' ethnic groups, and married women were more likely to demonstrate higher levels of physical activity. CONCLUSION: Approximately 65% of Malaysian adults were physically active. However, it is recommended that health promotions for active lifestyles should be targeted to the least active segments, which constitute more than a quarter of the Malaysian population.

In vitro antibacterial activity and physicochemical properties of a crude methanol extract of the larvae of the blow fly Lucilia cuprina.

The emergence of multidrug-resistant bacterial strains has prompted the reintroduction of maggot therapy in the treatment of chronic, infected wounds. Many previous studies have demonstrated the potent antibacterial activity of larval excretions/secretions of the blowfly Lucilia sericata (Meigen) (Diptera:Calliphoridae) against bacteria. However, the antibacterial activity of its sibling species, Lucilia cuprina (Wiedemann) (Diptera:Calliphoridae) against a wide range of pathogenic bacteria has never been determined. The aim of this study was to develop a new procedure to produce whole body extract of larvae of L. cuprina via methanol extraction as well as to demonstrate the in vitro antibacterial activity of this extract against seven selected wound pathogens (Staphylococcus aureus, methicillin-resistant S. aureus, S. epidermidis, Streptococcus pyogenes, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli). The turbidimetric assay demonstrated that L. cuprina larval extract was significantly potent against all bacteria tested (P < 0.001). Additionally, colony-forming unit (CFU), agar well diffusion and minimum inhibitory concentration assays have confirmed the apparent potency of larval extract against P. aeruginosa. The reconstituted larval extract was highly robust and thermally stable. These observations substantiated the feasibility of the methanol extraction method in the production of larval extract.

Eleven novel polymorphic microsatellite DNA markers from the green-lipped mussel Perna viridis.

We report on the characterization of 11 polymorphic microsatellite loci in P. viridis, the first set of such markers developed and characterized for this species. The number of alleles per locus ranged from 2 to 7, whereas the observed heterozygosity ranged from 0.0447 to 0.4837. These markers should prove useful as powerful genetic markers for this species.

Patterns of rapd markers and heavy metal concentrations in Perna viridis (L.), collected from metal-contaminated and uncontaminated coastal waters: are they correlated with each other?

Genetic variation due to heavy metal contamination has always been an interesting topic of study. Because of the numerous contaminants being found in coastal and intertidal waters, there is always much discussion and argument as to which contaminant(s) caused the variations in the genetic structures of biomonitors. This study used a Single Primer Amplification Reaction (SPAR) technique namely Random Amplified Polymorphic DNA (RAPD) to determine the genetic diversity of the populations of the green-lipped mussel Perna viridis collected from a metal-contaminated site at Kg. Pasir Puteh and those from four relatively' uncontaminated sites (reference sites). Heavy metal levels (Cd, Cu, Pb and Zn) were also measured in the soft tissues and byssus of the mussels from all the sites. Cluster analyses employing UPGMA done based on the RAPD makers grouped the populations into two major clusters; the Bagan Tiang, Pantai Lido, Pontian and Kg. Pasir Puteh populations were in one cluster, while the Sg. Belungkor population clustered by itself. This indicated that the genetic diversity based on bands resulting from the use of all four RAPD primers on P. viridis did not indicate its potential use as a biomarker of heavy metal pollution in coastal waters. However, based on a correlation analysis between a particular metal and a band resulting from a specific RAPD primer revealed some significant (P < 0.01) correlations between the primers and the heavy metal concentrations in the byssus and soft tissues. Thus, the correlation between a particular metal and the bands resulting from the use of a specific RAPD primer on P. viridis could be used as biomonitoring tool of heavy metal pollution.

Management delays for early gastric cancer in a country without mass screening.

BACKGROUND/AIMS: To examine the symptoms of early gastric cancer and the time scale of management delays in a country without a mass screening program. METHODOLOGY: Retrospective review of 44 patients with early gastric cancer. RESULTS: Epigastric pain (63.3%) and gastrointestinal hemorrhage (27.3%) were the main symptoms found. Total delay was made up of patient delay (48.6%), doctor delay (25.5%) and treatment delay (25.9%). Median patient delay (from symptom onset to medical consult) was 30 days (inter-quartile range 2 to 365). Patient delay of more than 6 months was associated with patients aged 50 and younger (P = 0.04) and those presenting with pain (P = 0.05). Median doctor delay (consult to diagnosis) was 21 days (1 to 35) and median treatment delay (diagnosis to surgery) was 8 days (2 to 21). Doctor delay of more than 6 months was associated with a negative gastroscopy or barium meal in the previous 12 months (P = 0.03). CONCLUSIONS: The detection of early gastric cancer at the symptomatic-detectable stage is possible and this potential window for diagnosis can be more than 1 year for up to one third of cases. Efforts to reduce management delays should be aimed at public education and improving the quality and accessibility of endoscopic evaluation.

Laparoscopic fenestration of a simple hepatic cyst.

Hepatic cysts are usually asymptomatic, most being detected incidentally during imaging. Distinction has to be made between a simple hepatic cyst from more sinister types such as a parasitic cyst and a cyst occurring as part of a neoplastic process. Intervention in a simple hepatic cyst is only indicated when they become symptomatic or when they grow at a rapid rate. Surgery is the mainstay of treatment, with laparoscopic intervention becoming more and more widely accepted. We present here the first case of laparoscopic fenestration of liver cyst performed in our hospital and also review the literature on this modality of treatment.

Post-operative pain in needlescopic versus conventional laparoscopic cholecystectomy: a prospective randomised trial.

BACKGROUND: Needlescopic cholecystectomy (NC) utilises instruments and ports smaller than 3 mm in diameter compared with the 5 mm ones used in conventional laparoscopic cholecystectomy (LC). Post-operative pain control and recovery has been thought to be superior in NC, when compared with historical controls with LC, but has not been proven in a prospective fashion. PATIENTS AND METHODS: A prospective randomised trial of NC versus LC for patients with symptomatic gallstone disease, with standardisation of post-operative analgesia and daily assessment of post-operative pain, using a 5-point visual analogue scale. RESULTS: There were 64 eligible patients randomised into NC (28) and LC (36). Four patients who had NC were converted to LC due to technical problems. Another three and six patients from the NC and LC groups, respectively, had conversion to open surgery. Post-operative pain scores were low in both groups. Mean pain scores for those with successful NC and LC were: 1.24 versus 1.43 for the day of operation (P = 0.49), 0.86 versus 0.83 for the first day post-operatively (P = 0.92) and 0.75 versus 0.81 for the second post-operative day (P = 0.87). The mean number of intra-muscular analgesic injections required were 0.76 versus 0.83 after NC and LC, respectively (P = 0.93). There were no significant differences between the two groups in the time taken to return to feeding, eating a normal diet and discharge from hospital. CONCLUSION: There is no advantage of NC over LC in terms of post-operative pain or recovery. Nevertheless, NC can be performed safely and expediently and has an excellent cosmetic outcome and high patient acceptability.

Removal of a dinner fork from the stomach by double-snare endoscopic extraction.

Long and pointed foreign objects in the stomach are difficult to remove by endoscopy, and they can cause complications such as perforation and impaction. The endoscopic removal of long and pointed objects involves the following principles: (1) presenting the blunt end cephalad to prevent perforation or impaction during extraction; (2) orienting the long axis of the object in the line of extraction; and (3) applying traction to the foreign body without losing grip. Currently practised methods of extraction, which use a protector hood or an overtube, do not address these three principles. We report on a case in which an ingested metal dinner fork was removed from the stomach by using a double wire-loop snare technique. This method uses two snares to hold the object and allows the endoscopist to change the presentation, orient the axis, and maintain traction to allow the safe removal of long and pointed objects.

Duodeno-ureteric fistula secondary to chronic duodenal ulceration.

Renoalimentary fistulae are rare. When they occur, they are usually between the right renal pelvis and the duodenum. The primary pathology often resides in the kidney, and nephrectomy is often necessary in the management of such fistulae. We describe a case of an elderly man who presented with non-specific abdominal pains. He had a history of peptic ulcer which was treated with H2 antagonist. He was well for the past few years until recently when he experienced upper abdominal pains. Subsequent investigations showed a duodeno-ureteric fistula secondary to a chronic duodenal ulcer. The kidney was normal. Polya gastrectomy was performed and the patient recovered with complete resolution of his symptoms.

Perforated leiomyosarcoma of Meckel's diverticulum.

Two cases of perforated leiomyosarcoma of Meckel's diverticulum are presented. There are only 59 cases reported in current literature, including 4 perforations. Although the condition is rare, leiomyosarcoma is the commonest tumour of Meckel's diverticulum. Its clinical presentation include abdominal pain, intestinal bleeding, abdominal mass, intestinal obstruction and less commonly, acute perforations. Both our cases presented with perforations which is unusual. Despite this late presentations both were resectable and both had no distant or local metastasis. One of our patients was 89 years old at presentation and has been disease-free 3 years after resection. The other patient was 69 years old and has also been disease-free.

Laparoscopic Nissen fundoplication for hiatus hernia: a case report.

Laparoscopic Nissen fundoplication has rapidly become an established technique in the management of severe or complicated reflux oesophagitis. We describe our initial experience with laparoscopic Nissen fundoplication in a 54-year-old man with intractable severe haemorrhagic oesophagitis and a large sliding hiatus hernia. The Rossetti modification of Nissen fundoplication was used as this is a surgical procedure eminently suited for the laparoscopic approach since minimal dissection is needed. The operative time taken was 260 minutes, there was minimal blood loss, minimal postoperative analgesia requirement and early return of bowel function.

Gastric carcinoid: a rare form of gastrointestinal carcinoids. A report on three cases.

The stomach is an uncommon site for carcinoid tumors, the incidence of which is about 2% of all carcinoids. During a five-year period, from 1988 to 1992, three patients with gastric carcinoid tumors were diagnosed at the Tan Tock Seng Hospital, Singapore. Their ages ranged from 59 to 68 years, and all were male. Two patients were referred for investigation of anemia, and one patient presented with massive hematemesis and an advanced ulcerated tumor requiring emergency total gastrectomy. Of the other two patients, one had pernicious anemia with multiple carcinoid polyps, and the other had sessile carcinoid nodules. None of the patients had carcinoid syndrome. Two patients underwent gastrectomy, while the patient with polyps had an endoscopic polypectomy. Follow-up ranged from one to three years. Two patients remained well, but the patient who presented with an advanced tumor with serosal invasion and nodal involvement had hepatic recurrence and died two years after the diagnosis of recurrence.

Clinical and social problems in young women with breast carcinoma.

Studies have noted that Asian women tend to have invasive breast cancer at a younger age compared with their Western counterparts. This is a rising trend among women in Singapore. This study compares 46 women less than or equal to 35 years with 313 women greater than 35 years who were treated in a teaching hospital between January 1983 and December 1989. Despite better education, the younger women (less than or equal to 35 years) were no different from their older counterparts in delaying medical consultation for more than 3 months after self-detection (39 vs 38.6%) though a higher percentage of older women procrastinated for over a year (16.6 vs 6.5%). As a result, 28% of younger women and 21.6% of older women presented with late disease (TNM Stage III and IV). Primary healthcare physicians contributed towards further delay among 65% of women less than or equal to 35 years. They were more suspicious when breast lumps were detected in women greater than 35 years and only 8% had delayed referrals. Failure in advising early biopsy added further delay (greater than 3 months) in 27.6% of younger patients whereas it was seldom delayed for the other older group (0.3%). Eight patients less than or equal to 35 years were initially reluctant to undergo definitive surgery. These cumulative delays resulted in progression of disease in seven patients of the 11 patients whose therapy was delayed more than 6 months.

Exclusion probabilities of red cell antigen systems for Chinese.

Little data are available in the literature for Chinese people, regarding genotype frequencies of red cell antigen systems. Furthermore, no recommendations for proper selection of red cell antigen systems for paternity testing have been established for a Chinese population. Consequently, calculating a paternity index is impossible. Blood typing of 336-1919 samples of Taiwanese Chinese was undertaken to determine various red blood cell antigens. Gene frequencies and probabilities of exclusion (PE) for the red cell antigen systems were then analyzed. The distributions of the red cell antigens were quite homogeneous. The incidence of D, s, k, Fya and Lub antigens was high, 99.6%, 99.7%, 100%, 99.8% and 99.4%, respectively. On the contrary, that for the K antigen was very low. The PE for the ABO, Rh, MNSs, Kell, Duffy, Kidd, P, and Lutheran systems was 0.1910, 0.1961, 0.2237, 0.0003, 0.0444, 0.1870, 0.0806, and 0, respectively. The cumulative PE (CPE) using ABO, Rh, MNSs, Kell, Duffy, Kidd, P and Lutheran systems was 0.6394, while CPE for ABO, Rh, MNSs, Duffy, Kidd, and P systems was 0.6394. Thus, it appears that the Kell and Lutheran systems are not suitable for paternity testing because of their low probability of exclusions. Duffy system may also be excluded for its low PE. The CPE for ABO, Rh, MNSs, Kidd and P systems was 0.6226.