Objective: This study aims to determine: the safety and efficacy of risperidone on treatment naive first episode schizophrenia for first episode schizophrenia; and the social and occupational outcome of these patients. Methodology: This trial was an open clinical study using oral risperidone for 8 weeks, in treatment naive first episode schizophrenia in Malaysia. All first episode schizophrenic patients from 3 general hospitals in Northern Johor that fulfilled the entry criteria were included in this study. They were assessed by using PANNS, CGI, HoNos, AIMS and Adverse rating scale. They were seen at week 0, 1, 2, 4, and 8 weeks. In the first week, risperidone was given given at 1mg per day and subsequently adjusted by no more than 1mg per week up to maximum of 8mg/day. Results: During the 9 month trial, 44 patients were diagnosed to have first episode schizophrenia, but only consented to be in the study. Nine patients had to dropped out because they required parentheral antipsychotic treatment. Thirty-one patients completed this 8 week trial. Using 20% reduction of PANSS score, 27 patients (87.1%) improved at 8 weeks. Using 50% reduction of PANSS initial score and CGI-S score of 1 or 2, 16 patients (51.6%) improved at 8 weeks.Adverse effects were reported in 8 of the patients (25.8%). The mean dose required was 2.69 mg/day, with maximum dose of 8 mg/day. Conclusion: Risperidone is an effective and safe antipsychotic for first episode schizophrenia in Malaysia. The doses required are substantially less than usually needed for chronic schizophrenia.
Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; SCHIZOPHRENIA ; RISPERIDONE ; CLINICAL TRIAL

The Malaysian Medical Council (MMC) operates under the Medical Act of 1971, which defines its core functions related to (a) the registration and practice of medical practitioners (b) the period of compulsory service (c) provisions to be enacted for purposes of (a) and (b). In the early years the MMC used the list of recognised colleges or Universities that appeared in the list of degrees recognised by the General Medical Council of United Kingdom (GMC). Over the years the MMC has undertaken the role of granting recognition to other medical schools in the country and overseas, and added the name of these schools to the existing register of recognised medical degrees in the second schedule of the Act. For the purpose of recognition of medical schools the MMC endorsed a guideline on standards and procedures on accreditation developed in 1996, which was later realigned with international and regional guidelines, in 2000 and 2001. It is recommended that the MMC establishes an active functional 'Education Committee' and that the role of MMC in medical education should be clearly and explicitly stated in the Act. An amendment to the Act would require the MMC to be responsible not only for undergraduate medical education but medical education in its entire phase.
Mitomycin ; Medical ; Education, Medical ; Role ; MALAYSIAN

Introduction: H. pylori BabA is an outer membrane protein that mediates bacterial adherence to the gastric epithelium, triggers several pathways during the course of infection, and thus contributes to the disease development. Considering the variability in the presence of BabA coding gene (babA2) among H. pylori clinical strains, the aim of this study was to assess the relationship between the genotype status of H. pylori babA2 and the severity of clinical and histopathological outcomes. Methods: Gastric mucosal biopsy specimens were collected from 30 CLO test-positive patients, 16 with gastritis and 14 with peptic ulcer disease. Polymerase chain reaction was carried out to detect the presence of H. pylori-specific glmM gene and BabA coding gene (babA2). Histopathological examination was performed to evaluate the severity of H. pylori-associated gastric disease according to the Updated Sydney Classification System. Results: The glmM and babA2 genes were present in 100% and 86.7% of the tested H. pylori strains, respectively. Although higher degrees of inflammatory activity and H. pylori density were noted in babA2-positive biopsy specimens, there was no statistically significant association between babA2 genotype status and the severity of gastric disease. Conclusion: The babA2 genotype status of H. pylori may not be considered as a sole marker for determining the infection outcomes.

Filariasis, a parasitic infection endemic in parts of India, Myanmar, islands of the South Pacific, West and East Africa and Saudi Arabia can be diagnosed from various types of cytopathological specimens. This case documents the detection of filarial infection from hydrocele fluid cytology in a 30-year-old Myanmar migrant worker in Malaysia.
Liquid substance ; Cellular aspects of ; Infection as complication of medical care ; Microfilaria ; Myanmar

Introduction: The increasing trend of extensively drugresistant gram negative bacteria responsible for nosocomial infections has prompted resurgence colistin usage. Colistin-induced nephrotoxicity is a concern with disparity in the reported rates between previous studies. This study aims to evaluate colistin-induced nephrotoxicity among Malaysian population. Methods: The medical records of ICU patients receiving colistin therapy in Hospital Serdang and Hospital Sungai Buloh from 2010 to 2012 were retrospectively reviewed. Demographics data, treatment characteristic as well as culture result and creatinine level were documented. Nephrotoxicity was determined based on RIFLE criteria. Results: A total of 100 patients were included. Median daily dose, cumulative dose and duration of colistin therapy were 3.0 MIU (IQR: 4, range 1-12), 17.8 MIU (IQR: 31.5, range 2-180) and seven days (IQR: 4, range 1-30). Nephrotoxicity was found in 23% of the study population. All cases were reversible but marginally associated with higher mortality. No statistical association exist between age, gender and race as well as administration routes with nephrotoxicity by univariable analysis. The association of dose and duration with nephrotoxicity was also not significant by univariable analysis. After adjustment for confounders, statistical association between the independent variables and dependent variable remains not significant. Conclusion: Lower dose and shorter duration in local settings contribute to lack of association between colistin therapy and nephrotoxicity in this study. Higher dosing regimen with loading dose application has been introduced in the latest National Antibiotic Guideline. Further evaluation of colistin-induced nephrotoxicity and potential risk factors is therefore warranted.
Colistin ; Intensive Care Units

OBJECTIVETo examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma, who show loss of cervical lordosis and neck pain.

METHODSAll patients who presented to our emergency department following blunt trauma were enrolled in this study, except those with schiwora, neurological deficits or fracture demonstrated on cross-table cervical spine X-rays, and those who were either obtunded or presented after cervical spine surgery. Adequacy of flexion and extension views was checked by the neurosurgery and radiology team members. All these patients underwent cross-table cervical spine view followed by flexion/extension views based on the loss of lordosis on cross-table imaging and the presence of neck pain.

RESULTSA total of 200 cases were reviewed, of whom 90 (45%) underwent repeat X-rays because of either inadequate exposure or limited motion. None of the patients with loss of lordosis on cross-table view had positive flexion and extension views of cervical spine for instability.

CONCLUSIONSOur results show that in patients who underwent acute radiographic evaluation of blunt cervical spine trauma, flexion and extension views of the cervical spine are unlikely to yield positive results in the presence of axial neck pain and/or loss of cervical lordosis. We can also hypothesize that performing flexion and extension views will be more useful once the acute neck pain has settled.

BACKGROUND:Vacuum sealing drainage is currently considered as a safe and effective for fasciotomy wounds in the treatment of compartment syndrome. But the wounds after treatment are often not self-closed, which needs skin grafts that can cause secondary injury. Studies have shown that shoelaces technology is useful for leg fasciotomy wounds in the surgical treatment of lower leg compartment syndrome, but so far there are few domestic reports. OBJECTIVE:To compare the vacuum sealing drainage and shoelace technique for treatment of leg fasciotomy wounds. METHODS:A total of 36 patients, with 46 leg fasciotomy wounds, were randomized into vacuum sealing drainage and shoelace technique groups, 23 wounds in each group. In the vacuum sealing drainage group, patients were subjected to vacuum sealing drainage after fasciotomy based on fracture reduction and external fixation;in the shoelace technique group, the fasciotomy wounds were covered with polyethylene/ethanol hydrated seaweed salt foam fol owed by shoelace technique. After 1 month, wound size, wound closure time, infection, further intervention and daily treatment cost were compared between the two groups. RESULTS AND CONCLUSION: Wound closure time was significantly higher in the vacuum sealing drainage group compared to the shoelace technique group (P < 0.05). Eight wounds in the vacuum sealing drainage group required skin grafts; while, no skin graft was necessary in the shoelace technique group. In the shoelace technique group, the vessel loops had to be replaced in five wounds. There was no wound infection, increased compartment pressure and skin flap necrosis postoperatively in both two groups. Both vacuum sealing drainage and the shoelace technique are safe, reliable and effective methods for closure of leg fasciotomy wounds. Vacuum sealing drainage requires longer time to definite wound closure and is far more expensive than the shoelace technique, especially when additional skin grafting is required.

Introduction: This review aimed to summarise the trend ofmammogram screening uptake published in local studiesbetween years 2006 and 2015 among the Malaysian womenaged 40 years and above, and identify the associated factorsand barriers, as well as discuss limitations of the studiesand research gaps.Methods: A systematic review was conducted on breastcancer screening studies among Malaysian women,published between January 2006 and December 2015.Online databases were searched using keywords:“mammogram”, “mammography”, “uptake”, “breast cancerscreening” and “Malaysia”.Results: Thirteen original articles were reviewed. The rate ofmammography uptake ranged between 3.6% and 30.9%among the general population, and 80.3% among personnelof a tertiary hospital. Factors associated with mammogramscreening were clinical breast examination, age, income,knowledge on breast cancer and mammogram, perceivedsusceptibility to breast cancer, ethnicity and education level.Barriers to mammogram screening were lack of knowledge,embarrassment, fear of cancer diagnosis, perception thatbreast screening was unnecessary, lack of coping skills andpain during procedure. However, almost all of the studiescould not be generalised beyond the study sample becauseof the limited number of sites and respondents; and mostdata were self-reported with no objective measures of theresponses.Conclusion: Mammogram screening uptake among womenin selected communities were generally low. Further studiesinvolving the general population are essential. Futurestudies should also explore the availability, affordability andaccessibility of this service especially in the pursuit ofachieving universal health coverage in breast cancermanagement.

Objective: To investigate and compare the resistance and sensitivity of Salmonella typhi samples to commonly used antibiotics in three major divisions of Bangladesh and to evaluate the gradually developing resistance pattern.
Methods:The antibiotic susceptibility of 70 clinical isolates collected from blood, sputum, urine and pus samples were identified by specific antisera and with standard biochemical tests. The patients were divided into 5 age groups. Susceptibility and resistance was also tested by Kirby-Bauer disc diffusion method using 12 regularly used antibiotics.
Results:Antibiotic susceptibility test demonstrated that 64.28% isolates of Salmonella typhi were multidrug resistant. Present study suggests that the clinical samples were mostly resistant against nalidixic acid with all age groups and in all three divisions with similar resistance pattern. Resistance is more common among adult people (30-40 years) and children (0-10 years).Salmonella typhi was mostly sensitive against gentamycin, chloramphenicol and ciprofloxacin.
Conclusions: Although the population density of Dhaka region is markedly higher than Rajshahi and Chittagong regions, no significant difference in resistance pattern was found. The rate of multidrug resistance is a matter of concern. Physicians should reconsider before prescribing nalidixic acid and cefixime. Further molecular study is needed to reveal the genomic and proteomic basis of resistance.