Background: Prevalence of diabetes is escalating both globally as well as in Malaysia. With the epidemic of diabetes and its related morbidities and mortalities, health care professionals are facing an unprecedented challenges in controlling the disease. Objective: To determine the metabolic control and the cardiovascular risk factors among type 2 diabetic patients in a primary care setting. Method: This was a cross sectional study conducted in a primary care clinic in Selangor, Malaysia. Inclusion criteria were all type 2 diabetic patients aged 18 and above and were being followed-up for more than six months prior to the recruiting period in May 2009. The demographic data were obtained through faceto- face interview. Height, weight and blood pressure of the patients were taken during the day of data collection. The co-morbidities and laboratory results were obtained from the medical records. Results: Two-hundred patients were recruited. The mean age was 58.6 (SD=10.5) with 79.0% of the patients aged more than 50 years old. The majority of the patients were female (62.5%). One-tenth (11.5%) were smokers. More than half of the patients (64.0%) had co-morbid of hypertension and half of them (50.5%) had dyslipidaemia. A total of 72.5% of the patients had 3 or more cardiovascular risk factors. Less than one fifth of the patients had achieved the target of control for glycaemia, blood pressure, LDL and BMI. Those age 60 and above had significantly higher proportion of patients achieving fasting blood glucose control (p=0.033). Conclusion: The majority of type 2 diabetic patients had multiple cardiovascular risk factors (3 or more risk factors) and had not achieved the recommended goals in metabolic control.

This is a case of a 65 year old lady who presented with Cushing’s syndrome secondary to ingestion of a complementary and alternative medicine that has been adulterated with exogenous glucocorticoids. In a clinical consultation, it is important to include assessment of complementary and alternative medicine use for a comprehensive care.

Reactive arthritis and erythema are uncommon presentations of tuberculosis (TB). Reactive arthritis in tuberculosis (TB) is known as Poncet’s disease, a rare aseptic form of arthritis observed in patients with active TB. We report a case of Poncet’s disease in a 20-year old man whose reactive arthritis overshadowed other clinical symptoms of TB resulting in delayed diagnosis and treatment. Although a conclusive diagnosis of Poncet’s disease is not possible, reactive immunologic reactions such as reactive arthritis and erythema nodosum even without respiratory symptoms should raise suspicion on possible TB. Thus, taking a thorough medical history as well as performing relevant examinations and investigations for possible TB will help expedite the diagnostic process.
Arthritis, Reactive ; Tuberculosis ; Rheumatology

Leaves of Thottea dependens have been used as folk medicine in Malaysia for the treatment of several conditions involving pain and inflammation with accompanying pyrexia. However, there is no scientific evidence for its effectiveness to treat fever. Hence, the purpose of this study was to evaluate the anti-pyretic activity of methanol (MeOH) and aqueous (Aq) extracts of T. dependens leaves in albino mice (ICR strain). Methods: Thirty-six albino mice of both sexes, randomized into six groups (n=6) were used. Group I served as the control and received only the vehicle, normal saline. Group II received paracetamol 150 mg/kg body weight (b.w.) orally, groups III and IV received 100 and 200 mg/kg b.w. of the MeOH extract while groups V and VI received 100 and 200 mg/kg b.w. of the Aq extract orally. Pyrexia was induced by a subcutaneous injection of 10 mL/kg b.w. of 15% (w/v) yeast suspended in 0.5% (w/v) methylcellulose solution. LD50 of both extracts were determined according to the method of Organisation for Economic Co-operation and Development guidelines. Phytochemical screening was carried out qualitatively for the presence of different class of biologically active compounds. Results: LD50 values for both extracts were found to be greater than 1000 mg/kg b.w. indicating the wide margin of safety of T. dependens leaves. The MeOH extract at 200 mg/kg b.w. showed statistically significant (P<0.01) dose dependent reduction of brewer’s yeast induced pyrexia in albino mice. Flavonoids, saponins and phenolic compounds were found to be major biologically active phytoconstituents in MeOH extract. Conclusion: The study showed that T. dependens leaves possess significant anti-pyretic activity, thus justifying its ethnomedicinal use in Malaysia to treat fever.

Introduction: The incidence of diabetes mellitus (DM) is increasing globally and it is associated with significant morbidity and mortality. The importance of a better quality of diabetes care is increasingly acknowledged. Objective: This clinical audit was conducted to assess the quality of care given to type 2 DM patients in public primary care clinics. Methods: A clinical audit was conducted in two selected urban public primary care clinics, between April and June of 2005. The indicators and criteria of quality care were based on the current Malaysian clinical practice guidelines for type 2 DM. A structured pro forma was used to collect data. Results: A total of 396 medical records of patients with type 2 DM were included in this audit. Most of the patients had measurements of fasting blood glucose and blood pressure recorded in more than 90% of the visits over the previous one year.Twenty-seven percent of the patients had glycosylated haemoglobin (HbA1c) done every 6 months with a mean of 8.3%. Only 15.6% had HbA1c values less than 6.5%. Fifty percent had blood pressure controlled at 130/80 mmHg and below; and 13.0% had low density lipoprotein cholesterol values of 2.6mmol/L or less. The majority of the patients were overweight or obese. Conclusions: The quality of diabetes care in this study was found to be suboptimal. There is a gap between guidelines and clinical practice. Certain measures to improve the quality of diabetes care need to be implemented with more rigour

Introduction The total number of patients, especially the non-urgent cases (Priority 3) attending the Accident and Emergency Department (AED) of the RIPAS Hospital have increased from 1996 to 2003. This questionnaire study looked at the reasons for attending the AED of RIPAS Hospital instead of the outpatient peripheral clinics or health centres. Materials and Methods The study was conducted using prepared survey questions (17 questions) from 15th May to 15th June 2004 (32 days) on patients/care-givers/accompanying persons (Priority 3 - non-urgent/not serious cases) who attended the AED for various reasons. A total of 398 respondents participated in the study. Results Most of the respondenta were Bruneian (88.9%) with the rest consisting of permanent residents 4.6% and expatriates (7.2%). The majority of respondents were in the age group between 16 to 45 years (32.8%). Reasons for going the AED RIPAS hospital included complete facilities (Radiology, Laboratory and etc, 87.7%), provision of a 24 hours service (89.8%), patients' perception of their illnesses being serious (81.9%), more comprehensive check-ups (66%) and less traffic leading to the AED at certain times of the day (61.2%). Interestingly, some were unaware of available specified health services in their area and that extended services were available in Ong Sum Ping Health Centre. Conclusion A majority of responders attended the AED for various reasons. Patient education is important to increase awareness so that priority 3 cases can be directed to peripheral clinics to reduce congestions at the AED RIPAS Hospital.

Aims: The objectives of this study were to evaluate the inhibitory activity of the cell-free supernatants (CFS) of lactic acid bacteria (LAB) isolates and determine the effect of pH, enzymes and heat treatment on the antifungal activity against Candida species. Methodology and results: A total of 25 strains of LAB were isolated from honey samples from Malaysia, Libya, Saudi Arabia, and Yemen. Four from twenty-five LAB isolates showed antifungal activity against Candida spp. and were identified as Lactobacillus plantarum (HS), L. curvatus (HH), Pediococcus acid lactic (HC), and P. pentosaceus (HM) using 16S rDNA sequence. The CFS of these isolates were evaluated for their antifungal activity using microtiter plate assay. The antifungal activity showed significant inhibitory activity against all Candida spp. especially growth of C. glabrata ATCC 2001 was significant (p < 0.001) completely inhibited by CFS of HH and HM at pH 3. Similarly, growth of C. glabrata ATCC2001 was significantly inhibited (p < 0.001) when treated with previously heated CFS of L. curvatus HH and P. pentosaceus HM at 90 °C and 121 °C. While, the growth of C. krusei ATCC 6258 was completely inhibited by CFS of L. curvatus HH at 121 °C. Treatment the CFS of LAB isolates with proteinase K and RNase II increased the antifungal activity against C. krusei and C. glabrata, whereas the activity of CFS produced by P. acidilactici was lost when treated with RNase II, especially against C. krusei. Conclusion, significance and impact of study: This study demonstrated that treated supernatant of LAB isolates with heating, adjusted pH and enzymes can be used to inhibit the growth of pathogenic Candida spp.

This paper investigates the antenatal care (ANC) services utilization in currently pregnant women during their visits to maternal and child health (MCH) clinics of rural (Kinabatangan) and urban (Sandakan), Sabah. A community clinic based, cross-sectional descriptive study was performed. In total, 800 currently pregnant women attending two MCH clinics, from April to September 2012, were participated using tested set questionnaires. Descriptive analysis was used for background characteristics and chi-square analysis was applied to identify the rural-urban differences among the variables.In both study areas, previous births delivered by skilled birth personnel were same. In pregnant women from rural, less income, more grand-multiparity, earlier antenatal care booking, more frequent post-natal care, more use of contraception compared to those in urban. In comparison, urban pregnant women had more anti-tetanus toxoid injection in their previous pregnancies, past history of antenatal care for at least four times, increase in household members. As this study found the differences in ANC services utilization at Rural and Urban, further study is needed to explore concrete reasons for above findings. By delivering services according to the needs of all clients, irrespective of their place of residence, it will improve ANC services utilization in both areas of Sabah and hence will improve more on existing health status of the Nation.

Atrial ectopic rhythm is one of the most common fetal arrhythmias that can present during the prenatal period. Detection of fetal arrhythmia can be made by auscultating fetal heart rate and rhythm using a fetal handheld Doppler, and this can be done even in a resource-limited setting. Te fnding of an abnormal fetal heart rate and rhythm should prompt early referral to a pediatric cardiologist, as this may improve clinical outcomes. We present a case of atrial ectopic rhythm detected in utero using a handheld Doppler.

The role of lactic acid bacteria (LAB) in honey as antifungal activity has received little attention and their mechanism of inhibitory of fungi is not fully understood. In this study, LAB were isolated from honey samples from Malaysia, Libya, Saudi Arabia, and Yemen. Twenty-five isolates were confirmed LAB by catalase test and Gram staining, and were screened for antifungal activity. Four LAB showed inhibitory activity against Candida spp. using the dual agar overlay method. And they were identified as Lactobacillus plantarum HS isolated from Al-Seder honey, Lactobacillus curvatus HH isolated from Al-Hanon honey, Pediococcus acidilactici HC isolated from Tualang honey and Pediococcus pentosaceus HM isolated from Al-Maray honey by the 16S rDNA sequence. The growth of Candida glabrata ATCC 2001 was strongly inhibited (>15.0 mm) and (10~15 mm) by the isolates of L. curvatus HH and P. pentosaceus HM, respectively. The antifungal activity of the crude supernatant (cell free supernatant, CFS) was evaluated using well diffusion method. The CFS showed high antifungal activity against Candida spp. especially The CFS of L. curvatus HH was significantly (p < 0.05) inhibited growth of C. glabrata ATCC 2001, C. parapsilosis ATCC 2201, and C. tropicalis ATCC 750 with inhibitory zone 22.0, 15.6, and 14.7 mm, respectively. While CFS of P. pentosaceus HM was significantly (p < 0.05) effective against C. krusei, C. glabrata, and C. albicans with inhibition zone 17.2, 16.0, and 13.3 mm, respectively. The results indicated that LAB isolated from honey produced compounds which can be used to inhibit the growth of the pathogenic Candida species.
Agar ; Bacteria* ; Candida glabrata ; Candida* ; Catalase ; Diffusion ; DNA, Ribosomal ; Fungi ; Honey* ; Lactic Acid* ; Lactobacillus ; Lactobacillus plantarum ; Libya ; Malaysia ; Methods ; Pediococcus ; Saudi Arabia ; Yemen