Solitary plasmacytoma (SPC) account for only 5% of plasma cell neoplasms, and the literature hardly reports spinal SPC with a neurological deficit. Furthermore, spinal surgical intervention during pregnancy is rarely encountered and often requires multidisciplinary collaboration and management. The objective of this case report is to highlight this near-miss diagnosis and spinal surgical intervention during pregnancy. A 31-year-old woman with 24 weeks gestation presented with sudden paralysis and incontinence, with an underlying history of chronic backpain over a twomonth period. Initially, she was treated for musculoskeletal back pain by obstetric colleagues during an antenatal visit, and no radiograph was performed. A non-contrasted spinal MRI was eventually requested when she started to show bilateral lower limb weakness, numbness and incontinence. The MRI highlighted thoracic vertebrae T11 vertebra plana with kyphotic deformity and a paraspinal soft tissue mass compressing the spinal cord causing spinal cord oedema. Our initial working diagnosis was spinal tuberculosis (TB), considering TB is highly endemic in Malaysia. However, TB workup was negative, and we proceeded with spinal surgery and transpedicular biopsy. Neurology improved significantly after surgery. Eventually, serum protein electrophoresis reported plasma dyscrasia, and HPE confirmed plasmacytoma. The patient was referred to a haematologist for steroidal and chemotherapy treatment.

Violence among adolescents is a significant public health issue. The focus was on school-going adolescents because of the life-long negative impact at an individual level both for the perpetrator and victim. Besides, it increases the costs to provide health, welfare, and criminal justice as well as decreases general productivity at the community level. The study aims to determine the prevalence of violence-related behavior, characteristics of both victims and perpetrators, in addition to inter and intrapersonal factors associated with violence-related behaviors. A study was carried out in 2013, which involved all upper secondary school students (aged 16 to 17 years). It was a part of the Malaysian Adolescent Health Risk Behavior (MyAHRB) study, which was conducted in 11 states in Peninsular Malaysia. Standardized, validated questionnaires were used for data collection. The prevalence of violence-related behaviors was 22.4%, and this was higher among male students as compared to females (29.1% vs. 16.3%). Multivariable analysis revealed that the odds of violence-related behaviour increased among males, Malay race, drug use, smoking, had exposure to sex, which sometimes and always felt lonely and had attempted suicide. Agreeable to ensure that their lifestyles do not transgress religious limit and belief was significantly protective. This study provides evidence for a targeted approach to combat violence-related behaviors among adolescents.

INTRODUCTION: Chronic thromboembolic pulmonary hypertension (CTEPH) is a known sequela after acute pulmonary embolism (PE). It is a debilitating disease, and potentially fatal if left untreated. This review provides a clinically relevant overview of the disease and discusses the usefulness and limitations of the various investigational and treatment options. METHODS: A PubMed search on articles relevant to PE, pulmonary hypertension, CTEPH, pulmonary endarterectomy, and balloon pulmonary angioplasty were performed. A total of 68 articles were found to be relevant and were reviewed. RESULTS: CTEPH occurs as a result of non-resolution of thrombotic material, with subsequent fibrosis and scarring of the pulmonary arteries. Risk factors have been identified, but the underlying mechanisms have yet to be fully elucidated. The cardinal symptom of CTEPH is dyspnoea on exertion, but the diagnosis is often challenging due to lack of awareness. The ventilation/perfusion scan is recommended for screening for CTEPH, with other modalities (eg. dual energy computed tomography pulmonary angiography) also being utilised in expert centres. Conventional pulmonary angiography with right heart catheterisation is important in the final diagnosis of CTEPH. CONCLUSION Operability assessment by a multidisciplinary team is crucial for the management of CTEPH, as pulmonary endarterectomy (PEA) remains the guideline recommended treatment and has the best chance of cure. For inoperable patients or those with residual disease post-PEA, medical therapy or balloon pulmonary angioplasty are potential treatment options.

The objectives of this study is to evaluate the suitability of full cup test (FCT), numeric pain rating scale (NPRS), and visual analogue scale (VAS) to assess pain after surgical removal of lower third molar and to identify which of these three pain scales is the easiest to use. A total of 50 patients, age between 18 to 30 years who underwent minor oral surgery for removal of impacted third molar were sampled in Faculty of Dentistry, University of Malaya. The patients were provided with forms containing three pain scales and they were required to mark each pain scales – FCT, NPRS and VAS daily for three consecutive post-operative days. The forms were collected a week later when patients came back for review. The validity between NPRS with VAS, FCT with NPRS and FCT with VAS were tested using Spearman rank correlation coefficient. Results showed that the correlation coefficient values for each pair were very high and significant. The findings when comparing Day 1, Day 2 and Day 3 and the combination for those three days showed no significant differences. No evidences indicated that the findings for Day 1 were more superior in comparison with other days. In conclusion, FCT was as valid as NPRS and VAS. The pain scale which was claimed to be the easiest to use by patients was NPRS, followed by FCT and VAS. However, further studies are needed to investigate the reliability and sensitivity of FCT.

Hypercholesterolemia is an important modifiable risk factor for coronary heart disease. Lifestyle changes in diet and physical activity can improve cholesterol levels. This study aimed to compare the fruits and vegetables (FV) intake and physical activity (PA) between hypercholesterolemic adults and nonhypercholesterolemic adults in Malaysia, and to investigate factors associated with meeting the recommended levels of FV intake and PA in a hypercholesterolemic population. Methods: This study was based on 17,988 participants (response rate 98.7%) aged 18 years and above who responded to the hypercholesterolemia questionnaire in the 2011 Malaysian National Health and Morbidity Survey (NHMS), a cross-sectional study with two-stage stratified sampling design. Data were obtained by trained enumerators via face-to-face interviews and were analysed by descriptive analysis, chi-square test, and univariable and multivariable logistic regression. Results: Out of the total population assessed, 39.0% had hypercholesterolemia. The prevalence of consuming five or more servings of FV per day is low (7.8%) while 36.0% were physically inactive among the hypercholesterolemic adults. No significant differences were observed in FV intake and PA between hypercholesterolemic and non-hypercholesterolemic populations. Gender, age and educational levels were associated with FV intake and PA among hypercholesterolemic adults. Hypercholesterolemic adults who were underweight or obese were less likely to consume FV, while those who were former smokers and those who had diabetes and heart disease were less likely to be physically active. Conclusion: These findings are relevant for future health promotion strategies, suggesting that more intensive interventions are needed to increase FV intake and PA level in hypercholesterolemic population and in the general population.
Hypercholesterolemia ; Fruit ; Vegetables ; Eating ; Motor Activity

Diabetes mellitus is an important cardiovascular risk factor. The objective of this study was to provide population-based estimates on the prevalence, awareness, treatment and control rate of diabetes among the older persons in Malaysia. Analysis of secondary data from a cross-sectional national population-based survey was done, which was conducted in 2011 throughout Malaysia. A total of 2764 respondents (15.5%) were older persons. The overall prevalence of diabetes among older persons was 34.4% in which 65.2% were aware of their diabetes status. Out of those who were aware, 87.5% had been treated. Only 21.8% of those treated had their diabetes controlled. The results of multiple logistic regression showed that the factors associated with higher awareness rates were women, Indians and higher income groups; factors associated with higher treatment rates were urban residents and those who were married and widow/widower/ divorcee. There was a high overall prevalence, awareness and treatment rate of diabetes among older persons in Malaysia but with suboptimal control rate.
Diabetes Mellitus ; Aged ; prevention & control ; Therapeutics

Introduction: Consumers are advised to read the nutrition labeling when purchasing packaged food. To what extent consumers read nutrition labeling and understand what they read is not well established among Malaysian older persons. Methods: Data from the National Health and Morbidity Survey III (NHMS III) undertaken in 2006 was analysed to determine the use and understanding of nutrition labeling and its associated factors among free living elderly men and women aged >60 years. Descriptive analysis and binary Logistic Regression were used to analyse the data. Results: A total of 4,898 respondents provided self-reported information on their use and understanding of nutrition labeling when they bought or received food. Use of nutrition labeling was higher among elderly men [61.9% (95% CI: 59.6-64.1)] than for women [36.6% (95% CI: 34.5-38.8)]. Nutrition labeling use was significantly associated with age, formal education, higher household income levels and marital status among both elderly men and women. Understanding of nutrition labeling among elderly men and women was 91.8% (95% CI: 90.1-93.2) and 89.7% (95% CI: 87.4- 91.7) respectively and was significantly associated with formal education for both elderly men and women. Conclusion: Overall, the reading of nutrition labeling among Malaysian elderly is moderate. Elderly men and women with formal education were more likely to understand nutrition labeling. The importance of reading nutrition labels should be inculcated in consumers including older persons so that they choose foods that are nutritious and safe.

Adolescents who overestimate the prevalence of smoking among their peers or other teens are at higher risk to take up smoking. The purpose of this study is to elucidate the factors which are related to adolescents’ overestimation of smoking. We surveyed form four (16 years old) students in Petaling District, Selangor. A sample was selected using two-stage stratified sampling, and data were collected using standardised, self-administered questionnaires. A response rate of 80.4% (n=1045/1298) was obtained, and a total of 943 students were included in the final analysis. About 73 percent (n=688/943) of the respondents overestimated the prevalence of smoking among their peers. The odds of overestimating increased as the number of close friends who smoke increased [Two close friends, OR=3.10(1.67-5.75), three close friends OR=10.81(4.44-26.3) and four-five close friends OR= 12.91(5.31-31.43)]. Those who had an elder brother who smoked (OR=1.95 (1.18-3.24)) and females [2.08(1.37-3.33) were more likely to overestimate peer smoking prevalence. Intervention programmes to correct the misperception of peer smoking prevalence are recommended, in addition to measures to modify the other factors that are amenable to intervention, so as to reduce the risk of smoking initiation among adolescents.

Many studies on adolescent smoking have been conducted in Malaysia, but very limited information is available on smoking amongst lower secondary school male students (Forms 1 and 2). We present data from a baseline study in Kota Tinggi District, Johor on the psychosocial factors, stages of smoking acquisition and susceptibility to smoking initiation and their relationship to adolescent smoking. The study is the first wave of a 3-year longitudinal study which was conducted from March 2007 to May 2009, aimed to describe the prevalence of smoking among students in the lower secondary classes. A three stage stratified sampling was performed to obtain a sample. The Bogus Pipeline Method was employed to confirm smoking status. Prevalence of smoking was 35.5%. Smoking prevalence among students of schools located in the Federal Land Development Authority (FELDA) settlement areas (42.9%) was two-fold higher than in the rural and town schools combined (20.29%). Using the Fagerstrom scale, 90% of current smokers had lower addiction to nicotine. Smoking was associated with peer smoking [OR, 4.19 (95% CI, 2.57-6.82)], having a brother smoking [2.17 (1.31-3.61)], parental smoking [1.73 (1.17-2.80)] and locality where respondents attend school [1.94(1.11-3.39)]. The study indicates that, the prevalence of smoking was high in all areas especially FELDA settlement areas. Measures such as teaching of skills to resist social pressure to smoke, establishment of peer support groups and involvement of parents in anti-smoking programs are recommended to curb the high prevalence of smoking among lower secondary school students in Kota Tinggi.

Analysis of count event data such as mortality cases, were often modelled using Poisson regression model. Maximum likelihood procedures were used by using SAS software to estimate the model parameters of a Poisson regression model. However, the Negative Binomial distribution has been widely suggested as the alternative to the Poisson when there is proof of overdispersion phenomenon. We modelled the mortality cases as the dependent variable using Poisson and Negative Binomial regression and compare both of the models. The procedures were done in SAS by using the function PROC GENMOD. The results showed that the mortality data in Poisson regression exhibit large ratio values between deviance to degree of freedom which indicate model misspecification or overdispersion. This large ratio was found to be reduced in Negative Binomial regression. The Normal probability plot of Pearson residual confirmed that the Negative Binomial regression is a better model than Poisson regression in modelling the mortality data. The objective of this study is to compare the goodness of fit of Poisson regression model and Negative Binomial regression model in the application of air pollution epidemiologic time series study by using SAS software.