1.Managing chronic diseases in the Malaysian primary health care- a need for change
Malaysian Family Physician 2008;3(1):7-13
Chronic diseases are the major cause of death and disability in Malaysia, accounted for 71% of all deaths and 69% of the total burden of disease. The WHO in its report Preventing Chronic Disease: A Vital Investment has highlighted the inaction of most governments of the low and middle income countries in tackling the problem urgently, is clear and unacceptable. The
acute care paradigm is no longer adequate for the changing pattern of diseases in today’s and tomorrow’s world. An evolution of primary health care system beyond the acute care model to embrace the concept of caring for long term health problems is imperative in the wake of the rising epidemic of chronic diseases and its crushing burden resulting in escalating healthcare costs. Compelling evidence from around the world showed that there are innovative and cost-effective community-based
interventions to reduce the morbidity and mortality attributable to chronic diseases, but these are rarely translated into high quality population-wide chronic disease care. This paper describes the current situation of chronic disease management in the Malaysian primary care setting – to highlight the need for change, discuss the barriers to the implementation of effective
chronic disease management programmes in the community, and consider fundamental solutions needed to instigate the
change in our setting.
2.Concurrent Validity Of The Depression And Anxiety Components In The Bahasa Malaysia Version of The Depression Anxiety and Stress Scales (DASS)
Ramli Musa ; Roszaman Ramli ; Kartini Abdullah ; Rosnani Sarkarsi
ASEAN Journal of Psychiatry 2011;12(1):1-5
Scales 21-item (DASS-21) has been widely used ever since the establishment of its validity. To consolidate the evidence of the BM DASS-21 validity by examining its concurrent validity. Methods: The BM DASS was administered together with the Hospital Anxiety and Depressive Scale (HADS) to a total of 246 patients at International Islamic University Malaysia (IIUM) Infertility Centre. Results: The anxiety domain of BM DASS-21 had good correlation with anxiety domain in HADS (0.61) but for DASS depressive domain, it had modest correlation with its respective domain in HADS (0.49). Conclusions: The results of this study further ensconced the evidence that the BM DASS-21 had relatively satisfactory psychometric properties for clinical subjects in Malaysia.
3.Prevalence of Eosinophilic/Non Eosinophillic Nasal Polyps and Analysis of Their Presentation in Hospital Universiti Sains Malaysia Kelantan, Malaysia.
Ramiza Ramza Ramli ; Irfan Mohamad
The International Medical Journal Malaysia 2017;16(2):89-92
This study is aimed to examine the predominant inflammatory cells in nasal polyps (NP) in the
local community and its correlation to the clinical presentations. Materials and Methods: The study was
done retrospectively looking at patients who had undergone functional endoscopic sinus surgery (FESS) in
Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia with a histopathological diagnosis of nasal
polyposis (NP), between the years 2004 to 2008. Sixty two patients between the ages of 18 years to 60 years
old were selected and data relevant to the study were collected from the patient’s folders using a specially
created form prepared for the study. The NP histopathology report from each patient underwent FESS were
analysed and the patients were divided into eosinophilic and non eosinophilic dominant group. Clinical
presentations from each patient were also gathered and analysed according to the NP group. Results: In
HUSM, there were a higher number of eosinophilic types NP as compared to the neutrophilic type NP which
is contrary to other study conducted on Asian populations. The clinical symptom correlations between either
eosinophilic or non-eosinophilic type of NP have not shown any significant associations. Conclusion: The
study showed that the incidence of histological subtypes of nasal polyp in HUSM is almost the same as that
found in other parts of the world (Europe and North America) which will reduce the possibility of racial or
geographical influence on the pathogenesis of the nasal polyp. Clinical symptoms and presentation alone are
not enough to differentiate the type of the nasal polyp without the histological study.
4.White coat effect and white coat hypertension: one and the same?
Malaysian Family Physician 2008;3(3):158-161
White coat hypertension (WCHT) and white coat effect (WCE) are often thought to be of the same entity. They are in fact different conditions which carry distinctive definitions and prognostic significance. WCHT is diagnosed when office blood pressure (OBP) is ≥140/90 mmHg on at least 3 occasions, while the average daytime or 24-hour blood pressure is <135/85 mmHg. It is common with 15% prevalence in the general population and may account for over 30% of individuals in whom
hypertension is diagnosed. Although individuals with WCHT were reported to have a better cardiovascular (CV) prognosis when compared to those with sustained hypertension and masked hypertension; they were also shown to have a greater prevalence of target organ damage (TOD) and metabolic abnormalities than that of normotensive subjects. In contrast, WCE is defined as the transient elevation of OBP induced by the alerting response to a doctor or a nurse. WCE can occur in both
normotensive and hypertensive persons; and is not substantially influenced by reassurance and familiarisation. There is conflicting evidence with regards to prognostic significance of WCE, where most data indicated that it does not predict future
TOD, CV morbidity or mortality; with some studies showed otherwise. This case scenario aims to solve the diagnostic
perplexity with regards to WCHT and WCE, followed by an evidence-based commentary of how to best manage such
conditions.
5.A Comparison between Home Based and Hospital-Based Pulmonary Rehabilitation Programmes Among COPD Patients in Improving Lung Functional Status
Ayiesah Ramli ; Roslina Abdul Manap ; Leonard Joseph
Malaysian Journal of Health Sciences 2008;6(1):95-108
This study was aimed at identifying the effectiveness of hospital-based pulmonary rehabilitation programme as compared to home-based pulmonary programme in improving the condition of the chronic obstructive pulmonary
disease (COPD) patients of Universiti Kebangsaan Malaysia Hospital. A total of 35 patients aging between 17 to 78 years old were randomised either to hospital (48.6%, n = 20) or home (43%, n = 15) -based pulmonary
rehabilitation by the Physiotherapists. For the hospital-based rehabilitation programme, the patients were scheduled to come to the hospital twice a week
for eight weeks. For home-based rehabilitation programme, subjects were scheduled to come to the Physiotherapy Department twice to learn on the exercises that need to be carried out before they are allowed to do on their own
at home. Each subject was given a diary to record the exercises that have been done. A telephone call is made once a week for monitoring purpose. Assessment
of lung function, six-minute-walk test and Borg score were carried out before and after the eight-week rehabilitation is conducted. The Results showed that there was no significant change in lung function for both groups before and after rehabilitation. There is a significant different (p < 0.05) in 6MWT before and after rehabilitation for hospital-based pulmonary rehabilitation patients.
However, the difference is not significant (p > 0.05) for home-base pulmonary rehabilitation patients. The results also show that there exist no significant
correlation between lung function and 6MWT even though there is an increase in walking distance at baseline or the eighth week. In conclusion, hospitalbased
pulmonary rehabilitation is more effective than the home-based pulmonary rehabilitation in improving the exercise endurance which would helps in reduce dyspnoea among COPD patients.
6.Translation, validation and psychometric properties of Bahasa Malaysia version of the depressive anxiety and stress scales (DASS)
Ramli Musa ; Mohd Ariff Fadzil ; Zaini Zain
ASEAN Journal of Psychiatry 2007;8(2):82-89
Background: Up to date, there are handful questionnaires that have been validated in Bahasa
Malaysia (BM). This study aimed to translate the Depression Anxiety Stress Scales 21-item
(DASS-21) and measure its psychometric properties. Objectives: To determine the construct
validity and acceptability of the DASS, BM. Methods: Two forward and backward translations
were done in BM in accordance to guideline, and its validation was determined by using
confirmatory factor analysis. A total of 263 subjects were selected by systematic random
sampling to represent Malaysian population for reliability and validity purposes. Results: The
BM DASS-21 had very good Cronbach’s alpha values of .84, .74 and .79, respectively, for
depression, anxiety and stress. In addition, it had good factor loading values for most items
(.39 to .73). Correlations among scales were between .54 and .68. Conclusions: BM DASS-21
is correctly and adequately translated to Bahasa Malaysia with high psychometric properties.
Further studies are required to support these findings.
7.Imaging findings of an isolated deep cerebral venous thrombosis in the absence of superficial sinus thrombosis
Sabrilhakim Sidek ; Kartini Rahmat ; Norlisah Ramli
Neurology Asia 2015;20(2):191-195
Thrombosis of the deep cerebral venous system in the absence of superficial sinus thrombosis is a very
rare disease. The clinical and radiological findings can be diagnostically challenging due to the subtle
appearances on computed tomography (CT) scan. Magnetic resonance imaging (MRI) examination is
a preferred imaging modality to complement the CT findings for an accurate diagnosis of venous sinus
thrombosis. We present a case of this unusual condition which present as unilateral thalamic lesion
on CT scan and the role of contrast enhanced MRI with fast spoiled gradient echo (FSPGR) sequence
and 3D reconstruction which led to the diagnosis of thrombosis in the deep cerebral venous system.
Thrombosis
8.Tolosa-Hunt syndrome following recurrent facial palsies
Nortina Shahrizaila ; Norlisah Ramli ; Chong Tin Tan
Neurology Asia 2010;15(1):97-99
Tolosa-Hunt syndrome is typically associated with an infl ammatory lesion in the cavernous sinus or orbital
fi ssure, often requiring steroids for symptom resolution. In this report, we describe a case of Tolosa-Hunt
syndrome preceded by several years’ history of idiopathic recurrent facial palsies. The spontaneous
resolution of THS in our case as well as prior facial nerve involvement supports the hypothesis that
Tolosa-Hunt syndrome is part of a spectrum of idiopathic recurrent cranial neuropathy.
10.Ptosis due to cavernous sinus syndrome as a rare presentation of advanced breast metastasis in a patient with delayed diagnosis
Malaysian Family Physician 2012;7(1):31-33
Complications of breast cancer metastasis may be the first manifestation of the disease. We report a rare case of left eye ptosis secondary to cavernous sinus syndrome in a 34-year-old lady due to refusal of proper medical treatment for metastatic breast cancer. The delay in seeking medical treatment was attributed to her use of Traditional Chinese Medicine (TCM).