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.

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.

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.

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.

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).

Job Satisfaction ; Motivation ; Primary Health Care ; Education, Graduate

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

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.

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.

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.