University Kebangsaan Malaysia Medical Centre Research Articles

Estimating the Risk of Attention Deficit Hyperactivity Disorder (ADHD) in Parents of Children with ADHD and the Association with Their Children's Disease Severity and Adherence to Medication.

Attention deficit hyperactivity disorder (ADHD) is characterised by inattentiveness, hyperactivity, and impulsivity. Up to half of the affected children have a parent with ADHD. In this study, the risk of ADHD among parents of ADHD children was estimated. The associations between parental ADHD and child ADHD severity and medication adherence were determined. Parents of children and adolescents diagnosed with ADHD attending the University Kebangsaan Malaysia Medical Centre (UKMMC) were recruited between June to August 2022 and the administered Conners' Adult ADHD Rating Scale (CAARS) self-report short form, Vanderbilt ADHD Parent Rating Scale (performance section), and Medication Adherence Report Scale (MARS). Forty-five children with ADHD were recruited and 15 out of 45 (33%) parents were detected to have ADHD. ADHD severity was worse in children with ADHD parents for total severity (mean of 34.67 vs. 29.13, p = 0.047) and difficult behaviours at home (mean of 7.87 vs. 6.27, p = 0.036). The children's academic performance and behavioural challenges at home and school were positively correlated with the parental ADHD scores for 'inattention' and 'problems with self-care' subscales. A total of 33% of ADHD children had parents with ADHD. ADHD children with ADHD parents were more likely to have behavioural problems at home and more severe ADHD. However, no statistical significance was noted with medication adherence.

Alpha-amyrin as an anti-biofilm agent against methicillin-resistant and vancomycin-intermediate Staphylococcus aureus

Staphylococcus aureus has caused life-threatening infections and developed resistance against conventional antimicrobials, posing a significant threat to human health worldwide. Biofilms that surround the bacteria cells act as a protective layer, allowing cells inside the biofilm to be resistant to external stresses such as antimicrobials. Therefore, biofilms further complicate treatment available for infections caused by multi-drug resistant Staphylococcus aureus. A previous study on alpha-amyrin (AM), derived from ursane, was reported to significantly reduce the biomass and inhibit the metabolic activity of reference strain methicillin-resistant and methicillin-sensitive S. aureus (MRSA and MSSA, respectively). In this study, the antibiofilm activity of AM was extended to include clinical isolates of MSSA and MRSA, and laboratory-generated vancomycin-intermediate S. aureus (VISA) collected from University Kebangsaan Malaysia Medical Center (PPUKM) and Universiti Kebangsaan Malaysia Medical Molecular Biology Institute (UMBI). Pre-formed biofilms of biofilm-forming isolates identified from the Congo Red Agar (CRA) assay were then exposed to AM, vancomycin and oxacillin, and evaluated using the crystal violet and resazurin assays. The results showed that AM reduced the biofilm biomass of three isolates of MSSA, eight isolates of MRSA and four isolates of VISA but increased the metabolic activity in certain MSSA, MRSA and VISA isolates, indicating AM may possess biofilm reduction effects but not bactericidal effects. Based on these findings, AM could be further studied and developed as a potential therapeutic agent for chronic S. aureus infections.

The Accuracy of Surgeon-Performed Preoperative Parathyroid Ultrasound Localization for Renal Hyperparathyroidism Patient

Introduction: Parathyroid surgery for renal hyperparathyroidism (RHPT) is indicated when patients have a progressive disease despite optimal medical therapy. The success of total parathyroidectomy in RHPT lies in accurate localization and excision of all PTGs. Recently, surgeon-performed ultrasound (SPU) has been increasingly used for the preoperative localization of PTGs in the intent of focused approach and reduce morbidity. Thus, we conducted a prospective observational single-center study to determine the accuracy of SPU for PTG localization in RHPT and the factors affecting its accuracy. Materials and Methods: This is a prospective, observational, single-center study conducted in University Kebangsaan Malaysia Medical Centre between March 2018 and March 2019. The patients’ preoperative demography, clinical data, and relevant blood laboratory results, including calcium, phosphate, alkaline phosphatase, and intact parathyroid hormone, were recorded. Preoperative USG and surgery were performed by the same endocrine surgery consultant. Results: SPU localization had an overall accuracy of 78.1%, sensitivity of 81.0%, and specificity of 30.0% with a positive predictive value of 94.8% and a negative predictive value of 10.5%. The SPU gland localization rate was significantly higher in patients without goiter (median=0.88, IQR=0.63–1.00) than in those with goiter (median=0.50, IQR=0.25–0.75) (p=0.028). Conclusions: SPU localization of the PTG in RHPT had an accuracy comparable with that in previous literature with the additional advantage of identifying concurrent unknown thyroid nodules. Considering the high prevalence of concomitant nodular thyroid disease in our RHPT population, we advocate the routine use of preoperative neck ultrasound for RHPT patients undergoing parathyroid surgery.

Significance of Endocan Expression in Various Types of Epithelial Ovarian Tumors.

Background & Objective:Ovarian cancer is associated with the highest mortality rate among gynecologic malignancies. Despite new therapeutic strategies, ovarian cancer still has a high risk of metastasis and mortality. Endocan is a newly identified endothelial cell activation marker, which is responsible for angiogenesis, tumor invasion, and aggressive behavior of tumors. The aim of this study was to assess Endocan expression in different types of ovarian tumors and to identify its relationship with clinicopathologic characteristics of ovarian tumors. Methods:This cross-sectional study was conducted on 183 tissue samples, including benign, borderline, and malignant ovarian tumors collected from the University Kebangsaan Malaysia Medical Center archive of Pathology during 2005-2015. Mouse monoclonal anti-human Endocan/ESM-1 Clone MEP08 was used at a dilution of 1:400 for immunohistochemical (IHC) staining. All the information was collected by a checklist, and the association between clinicopathological features and high or low levels of Endocan -MVD was evaluated using Pearson chi-square, Fischer's exact, or Monte Carlo tests.Results:The prevalence of Endocan positivity was significantly higher in malignant compared to borderline and benign ovarian tumors (P<0.001). There was also a significant association between type of tumor and Endocan status in malignant ovarian tumors (P=0.02), indicating that Endocan positivity was more likely in serous malignant ovarian tumors compared to other ovarian tumor types. However, the tumor stage was not significantly associated with Endocan status (P=0.31). Conclusion:This study showed that Endocan positivity may show the highest prevalence among malignant tumors suggesting that high Endocan expression would be negatively associated with ovarian tumor behavior.

Single Dose Gonadotropin-Releasing Hormone Agonist Luteal Support in Fresh Embryo Transfer: Variation in Timing, Type, and Dosage.

ObjectivesTo evaluate the effects of the addition of single-dose GnRH agonist to the routine progestogens use for luteal phase support on IVF outcome as compared to progestogens only.MethodsThis is a retrospective case-control study on selected patients who underwent IVF treatment with fresh embryo transfer (ET) under Medically Assisted Conception Unit, University Kebangsaan Malaysia Medical Center for the period of June 2015–June 2018. A higher dose of 0.2 mg subcutaneous Decapeptyl was administered 2 days before fresh ET concurrent with routine progestogen support. Patients with different luteal phase regimes, frozen embryo transfer and medical records with missing data were excluded. Their medical records were reviewed, and data analyzed. The pregnancy outcomes measured included biochemical pregnancy rates, clinical pregnancy rates, live birth rates and miscarriage rates.ResultsA total of 786 patients were analyzed. Four hundred forty-four patients were given luteal phase support with progestogens and GnRH agonist, whereas 342 patients served as control were given progestogens only. The study group showed higher biochemical pregnancy rate (47.7 vs. 44.4%,), clinical pregnancy rate (25.7 vs. 23.4%) and livebirth rate (24.3 vs. 22.2%), respectively but not statistically significant. The rate of miscarriage among the study group was lower (4.5% vs 9.4%) compared to the progestogen group alone. Nonetheless, the OHSS rate was slightly increased in the study group (4.5 vs. 3.5%) despite using a mild stimulation protocol.ConclusionsNew regime of GnRH agonist luteal support in addition to the standard progestogen support was found to be beneficial in overall IVF outcome.

The Use of Breast Cancer Survivor Patients as Part of Patient-Centred Education in the Training of Breast Cancer Care Nurses

INTRODUCTION: Breast cancer is the most common cancer worldwide. Patients diagnosed with breast cancer face many psychological and social distress that might affect their quality of life and indirectly might affect the disease outcome. Patient-centred education has been found to have a positive influence on the quality of management and anxiety reduction. A one-day workshop involving breast cancer survivor patients was designed as a preliminary step to improve the quality of care provided by oncology nurses in University Kebangsaan Malaysia Medical Centre (UKMMC). The objectives of the workshop were to train the nurses in providing patient-centred education using breast cancer survivor patients and to implement the breast cancer Malaysian Clinical Practice Guidelines (CPG) recommendation. MATERIALS AND METHODS: One-day workshop was designed to meet specific learning outcomes. The patient education program was introduced with special emphasis on a patientcentred approach through the involvement of breast cancer survivor patients. Twenty-one staff nurses and two breast cancer survivor patients have participated in this workshop. The workshop was conducted by a breast cancer surgeon, oncologist, dietitian, family physician, and medical educators. RESULT: Overall, all participants found the workshop was very useful, particularly with the involvement of breast cancer survivor patients. Sixty – two percent of the participants agreed that the objectives of the workshop were met and 76 % of them found the workshop relevant to their work. CONCLUSION: The involvement of breast cancer survivor patients in this workshop was a valuable learning experience that enhanced the patient-centred approach in medical education.

Mental Health Status among Systemic Lupus Erythematosus (SLE) Patients at Tertiary Hospital in Malaysia

Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can affect and cause damage to several human organs such as the skin, kidneys, muscles, joints, lungs, heart and brain. Uncontrolled relapses in SLE patients can lead to death. SLE patients and their families also face difficulties due to lack of information about the disease. Therefore, studies focused on the psychological aspects such as symptoms of anxiety and depression among SLE patients is still needed in Malaysia. Thus, this study investigated the psychological status of SLE such as the occurrence of anxiety and depression in SLE patients and its associated factors. A cross sectional study using the purposive sampling was carried out at University Kebangsaan Malaysia Medical Centre (UKMMC). Hospital Anxiety and Depression Scale questionnaires were used to occurrence of anxiety and depression respectively. Out of 150 SLE patients participated, 46.6% had anxiety while another 33.3% experienced severe depression. Anxiety and depression were significantly correlated with socio demographic factors such as gender (p = 0.006, p = 0.003 respectively), level of education (p = 0.028, p = 0.003 respectively), and monthly income (p = 0.008, p = 0.001 respectively). Overall, socio demographic factors have important influence on the occurrence of anxiety and depression in patients with SLE. Mental health issue among SLE patient in Malaysia should be taken into consideration by health care provider especially by medical social worker.

Factors associated with prolonged cardiopulmonary resuscitation attempts in out-of-hospital cardiac arrest patients presenting to the emergency department

BackgroundThere is high variability among clinicians’ decision of appropriate cardiopulmonary resuscitation (CPR) duration before deciding for termination of resuscitation. This study attempted to investigate factors associated with the decision to prolong resuscitation attempts in cardiac arrest patients treated in an emergencydepartment (ED). MethodsA retrospective study that evaluated two years of mortality registry starting in 2015 was conducted in the ED of University Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia. Adult out-hospital cardiac arrest (OHCA) patients treated in the ED were included. Multivariate logistic regression analysis was utilized for the exploration of factors associated with prolonged CPR attempts (> 30min). ResultsThe median CPR duration was 24min (range 2–68min). Four variables were independently associated with prolonged CPR attempts: younger age (OR, 0.97; 95% CI, 0.95–0.99; p<0.001), pre-existing heart disease (OR, 1.97; 95% CI, 1.07–3.65; p=0.031), occurrence of transient return of spontaneous circulation (ROSC) (OR, 2.38; 95% CI, 1.05–5.36; p=0.037), and access to the ED by nonemergency medical services (EMS) transport (OR, 1.92; 95% CI, 1.09–3.37; p=0.024). ConclusionPatient-related and access-related factors were associated with prolonged CPR attempts among OHCA patients resuscitated in the ED.

Relationship of metabolic syndrome defined by IDF or revised NCEP ATP III with glycemic control among Malaysians with Type 2 Diabetes

BackgroundThe chronic complications of Type 2 Diabetes (T2D) such as macrovascular disease is amplified with the increase in the number of metabolic syndrome (MetS) risk factors. This research aims to study the relationship of MetS, diagnosed by the International Diabetes Federation (IDF) or revised National Cholesterol Education Programs Adult Treatment Panel III (NCEP ATP III) criteria, with glycemic control, fasting blood glucose (FBG), glycated hemoglobin (HbA1c), C-peptide, and insulin resistance in T2D patients.MethodsThe study is a cross-sectional observational study which, involved 485 T2D patients who are receiving treatment at the University Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia. The MetS among the T2D patients was diagnosed based on IDF and revised NCEP ATP III criteria. C-peptide and HbA1c levels were determined by an automated quantitative immunoassay analyzer and high-performance liquid chromatography, respectively. The MetS factors; FBG, triglyceride, and high-density lipoprotein cholesterol were measured by spectrophotometer.ResultsApplication of the IDF and revised NCEP ATP III criteria respectively resulted in 73% and 85% of the T2D subjects being diagnosed with MetS. The concordance of these criteria in diagnosing MetS among T2D patients was low (κ = 0.33, P < 0.001). Both IDF and revised NCEP ATP III criteria indicated that T2D patients with 5 MetS factors had higher insulin resistance (P = 2.1 × 10−13; 1.4 × 10−11), C-peptide (P = 1.21 × 10−13; 4.1 × 10−11), FBG (P = 0.01; 0.021), and HbA1c (P = 0.039; 0.018) than those T2D patients without MetS, respectively.ConclusionAlthough there is a low concordance between IDF and revised NCEP ATP III criteria in the diagnosis of MetS among T2D patients, both criteria showed that T2D patients with 5 MetS factors had higher insulin resistance, C-peptide, FBG, and HbA1c.

Cost Centric Data Mining for Radiology Procedures at Teaching Hospital in Malaysia

This study explored radiology procedure cost across available units in the Radiology’s Department UKMMC (University Kebangsaan Malaysia Medical Centre). In 2011, the total number of radiology procedures carried out in this department was 121,221. Nevertheless, the estimating expenses of offering these procedures are not known. An economic evaluation study was employed and cost centric data mining based on costing activity method was used to determine the charge of the procedure in every centre. Information on seven cost parameters was collected for each procedure: human resources, consumables, equipment, reagents, administration, maintenance and utilities. The results of the study show that the highest percentage of cost parameter for the human resource was Radiology (Mobile) 57.5%, the highest percentage of cost parameter for consumables and reagent was EIR (Endovascular International Radiology) Unit 75.8% and Medical Nuclear Unit 68.1% was the highest percentage of cost parameter for reagent. The MRI (Magnetic Resonance Imaging) Unit 81.4% was the highest cost parameter for equipment. The most top mean cost procedures were EIR MYR4330 and it was revealed that procedures with the highest difference ratio were procedures in EIR (18.50). Finding of this study is very useful to UKMMC management since it helps to enhance the efficiency of services and reduce unnecessary radiology procedures in patient’s management.

Economic burden of hypoglycemia for type II diabetes mellitus patients in Malaysia.

This study mainly aims to identify the direct cost and economic burden of hypoglycemia for patients with type II diabetes mellitus in Malaysia. A cross-sectional study explored the cost incurred for hypoglycemia among patients admitted to University Kebangsaan Malaysia Medical Centre (UKMMC). The study covered patients aged 20–79 years hospitalized with a primary diagnosis of ICD-10 hypoglycemia and discharged between January 2010 and September 2015 according to the casemix database. A costing analysis was done through a step-down approach from the perspective of health providers. Cost data were collected for three levels of cost centers with the help of a hospital-costing template. The costing data from UKMMC were used to estimate the national burden of hypoglycemia among type II diabetics for the whole country. Of 244 diabetes patients admitted primarily for hypoglycemia to UKMMC, 52% were female and 88% were over 50 years old. The cost increased with severity. Managing a hypoglycemic case requires five days (median) of inpatient stay on average, with a range of 2–26 days, and costs RM 8,949 (USD 2,289). Of the total cost, 30% related to ward (final cost center), 16% to ICU, and 15% to pharmacy (secondary-level cost center) services. Considering that 3.2% of all admissions were hypoglycemia related, the total annual cost of hypoglycemia care for adult diabetics in Malaysia is estimated at RM 117.4 (USD 30.0) million, which translates to 0.5% of the Ministry of Health budget. Hypoglycemia imposes a substantial economic impact even without the direct and indirect cost incurred by patients and other cost of complications. Diabetic management needs to include proper diabetic care and health education to reduce episodes of hypoglycemia.

The association between serum prolactin levels and interleukin-6 and systemic lupus erythematosus activity.

Based on the recent evidence of association between hyperprolactinemia and systemic lupus erythematosus disease activity (SLEDAI), a study was conducted to analyze the association of hyperprolactinemia with lupus nephritis disease activity. In this cross-sectional study, the analysis was conducted on SLE patients who visited the University Kebangsaan Malaysia Medical Centre (UKMMC) Nephrology Clinic from August 2015 till February 2016. The disease activity was measured using the SLEDAI score, with more than 4 indicating active lupus nephritis. Basal resting prolactin level was analyzed in 43 patients with lupus nephritis, in 27.9% of them had raised serum prolactin. The median of serum prolactin level at 0 minutes was 19.91 ng/mL (IQR: 15.95-22.65 ng/ mL) for active lupus nephritis, which was significantly higher compared to the median of serum prolactin level of 14.34 ng/mL (IQR: 11.09-18.70 ng/mL) for patients in remission (p=0.014). The serum prolactin level positively correlated with SLEDAI (rhos: 0.449, p=0.003) and the UPCI level in lupus nephritis patients (rhos: 0.241, p=0.032). The results were reproduced when the serum prolactin was repeated after 30 minutes. However, the serum prolactin levels at 0 minutes were higher than those taken after 30 minutes (p=0.001). An assessment of serum IL-6 levels found that the active lupus nephritis patients had a higher median level of 65.91 pg/ mL (IQR: 21.96-146.14 pg/mL) compared to the in-remission level of 15.84 pg/mL (IQR: 8.38-92.84 pg/mL), (p=0.039). Further correlation analysis revealed that there was no statistical correlation between the interleukin (IL)-6 levels with serum prolactin, SLEDAI and other lupus nephritis parameters. An ROC curve analysis of serum prolactin at 0 minutes and serum prolactin after 30 minutes and IL-6 levels for prediction of SLE disease activity provided the cutoff value of serum prolactin at 0 minutes, which was 14.63 ng/mL with a sensitivity of 91.7% and specificity of 58.1% and AUC of 0.74 (p=0.015). This study concurred with the previous findings that stated that hyperprolactinemia is prevalent in SLE patients and correlated with clinical disease activity and UPCI level. The baseline of the fasting serum prolactin level was found to be a sensitive biomarker for the evaluation of lupus nephritis disease activity.

A LESS INVASIVE METHOD OF REDUCING THE INCIDENCE OF POST-ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY PANCREATITIS: INTRAVENOUS DICLOFENAC SODIUM VERSUS PLACEBO

Objective: The purpose of this study is to reduce the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) by the administration of intravenous (IV) diclofenac sodium.Methods: This is a prospective, randomized, double-blinded control study. This study was performed in the hepatobiliary unit of general surgery department in University Kebangsaan Malaysia Medical Centre (UKMMC) from May 2015 to May 2016. A total of 128 patients were enrolled in this study. 59 patients were randomized into the treatment arm, while 63 were randomized into the control group. Patients were randomized by envelope system, and patients in the treatment arm received 75 mg of diclofenac sodium intravenously, within 30 min of ERCP commencement. Both groups were observed for PEP post-ERCP and their pain score recorded. Patients’ demographic data were also observed.Results: A total of 122 patients were included in the study, with 59 patients randomized into the treatment arm and 63 into the placebo arm. There was an increase of 7.6% PEP rates in the placebo group (12.7% vs. 5.1% in the treatment arm). However, this was not statistically significant (p=0.142)Conclusion: This study shows that IV diclofenac sodium can decrease PEP but is not statistically significant.

A Validity Study of Malay-translated Version of the Modified Caregivers Strain Index Questionnaire (M-CSI-M)

The diversity of the population of the world suggests a great need for validated cross-cultural survey instruments or scales. Health care professionals should have access to reliable sources and valid concepts of interest in their own cultures and languages to provide quality patient care. Therefore, the aims of this study were to translate the Modified Caregiver Strain Index (M-CSI) in the national language of Malaysia. Also to evaluate the validity and reliability of the Malay-translated version of Modified Caregiver Strain Index (M-CSI-M). Instrument was translated forward and rearward through the translation strategy, reconciled by a panel, and verified by the Malaysian Institute of Translation &amp; books as experts of content. After methodological approaches for the translation, adaptation and transcultural validation of Modified Caregiver Strain Index (M-CSI). The latest version of Malaysia was administered to 50 informal care providers of dependent elderly with the Parkinson's disease, at the Association of Parkinson Malaysia (MPDA) and University Kebangsaan Malaysia (UKM) Medical Centre in May 2017. The Malaysians Modified Caregiver Strain Index (M-CSIM) has good face validity and content, as well as inner consistency (Cronbach's alpha 0.75). In conclusion, the M-CSI-M is a reliable tool for the evaluation of caregiving strain levels experienced by informal care providers in Malaysia. M-CSI-M is recommended as a brief and valid measurement that can be used by doctors, counselors, social workers and psychologists to locate the caregiving strain levels of the informal care providers of dependent elderly in Malaysia

Knowledge of Osteoporosis among Men Attending Primary Care Clinic and the Associated Factors

Introduction: Osteoporosis has frequently been regards as a disease of women only. However, men are also at risk of developing osteoporosis. We aimed to evaluate the knowledge of osteoporosis among men and its associated factors. Materials and method: A cross-sectional study of 245 male patients aged 50 and above was conducted in the primary care clinic, University Kebangsaan Malaysia Medical Centre. The research instrument used in this study was a validated self-administered questionnaire which consists of socio-demographic data and 16 items of knowledge of osteoporosis among men. Results: The mean score for knowledge was 7.78± 3.32 out of 16 points. Most of the subjects (83 percent) knew the definition of osteoporosis but were not aware that osteoporosis was a silent disease. Only a quarter of subjects (38 percent) recognized family history as a risk factors for osteoporosis. Despite 78 percent of subjects answer correctly regarding importance of calcium intake in their diet however only 7 percent of them knew the recommended dosage of daily calcium intake. Knowledge of osteoporosis was found to be significantly associated with education and total monthly household income. Conclusion: Findings indicate limited knowledge of osteoporosis among the subjects. Public education of osteoporosis among men is important to increase their knowledge. Meanwhile, primary care doctors should also emphasize and educate men regarding osteoporosis to enhance their knowledge of the disease.

Neck dissection for head and neck malignancies: A Malaysian 13 years review

Introduction and Objective: Neck dissection (ND) is a surgical procedure performed in treating head and neck cancer patients with cervical neck metastasis. The aim of neck dissection is to achieveloco-regional control thus optimizing the cancer’s cure rate. Various complications may potentially occur following this surgery. The main objective of this study is to evaluate the incidence of complications following neck dissection.Materials &amp; Methods: This is a 13 years retrospective descriptive case notes analysis conducted in UKMMC (University Kebangsaan Malaysia Medical Centre), a tertiary centre in Malaysia. Neck dissection surgeries that were performed between January 2000tillDecember 2012 were recruited for data analyses.Results: A total of 233 neck dissections were performed in our centre over 13 years period from January 2000 until December 2012. Of these, 27 cases were excluded due to unavailability of data and therefore a total of 206 cases were recruited for data analyses.The types of neck dissection performed include Extended Radical ND (n=7), Radical ND (n=40), Modified Radical ND (n=88) and Selective ND (n=71). Majority of neck dissection was performed for malignant oral cavity tumours (47.1%). Out of 206 cases, 57 (27.7%) developed wound complications, 48 (23.3%) cases had nerve complications with marginal mandibular nerve was most commonly injured (13%) and 20 (9.7%) cases had vascular and lymphatic complications mainly involving the thoracic duct (5.3%). The incidence of residual or recurrent neck disease was observed in 41 cases (20%). Pre-operative clinical assesment of cervical neck node metastatic status has a high sensivity of 89.7% but low specificity of 47.5%.Conclusion: Various complications may potentially occur following neck dissection. Awareness of these possible complications could minimize the incidence of complication following this surgery. This current study observed a strong association between the type of neck dissection performed with the incidence of wound, nerve and vascularcomplications following neck dissection surgery.Bangladesh Journal of Medical Science Vol.16(3) 2017 p.384-396

Anxiety and Depression among Breast Cancer Patients in an Urban Setting in Malaysia

Breast cancer is one of the most feared diseases among women and it could induce the development of psychological disorders like anxiety and depression. An assessment was here performed of the status and to determine contributory factors. A cross-sectional study was conducted among breast cancer patients at University Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur. A total of 205 patients who were diagnosed between 2007 until 2010 were interviewed using the questionnaires of Hospital Anxiety and Depression (HADS). The associated factors investigated concerned socio-demographics, socio economic background and the cancer status. Descriptive analysis, chi-squared tests and logistic regression were used for the statistical test analysis. The prevalence of anxiety was 31.7% (n=65 ) and of depression was 22.0% (n=45) among the breast cancer patients. Age group (p= 0.032), monthly income (p=0.015) and number of visits per month (p=0.007) were significantly associated with anxiety. For depression, marital status (p=0.012), accompanying person (p=0.041), financial support (p-0.007) and felt burden (p=0.038) were significantly associated. In binary logistic regression, those in the younger age group were low monthly income were 2 times more likely to be associated with anxiety. Having less financial support and being single were 3 and 4 times more likely to be associated with depression. In management of breast cancer patients, more care or support should be given to the young and low socio economic status as they are at high risk of anxiety and depression.

Development of MY-DRG casemix pharmacy service weights in UKM Medical Centre in Malaysia.

BackgroundThe service weight is among several issues and challenges in the implementation of case-mix in developing countries, including Malaysia. The aim of this study is to develop the Malaysian Diagnosis Related Group (MY-DRG) case-mix pharmacy service weight in University Kebangsaan Malaysia-Medical Center (UKMMC) by identifying the actual cost of pharmacy services by MY-DRG groups in the hospital.MethodsAll patients admitted to UKMMC in 2011 were recruited in this study. Combination of Step-down and Bottom-up costing methodology has been used in this study. The drug and supplies cost; the cost of staff; the overhead cost; and the equipment cost make up the four components of pharmacy. Direct costing approach has been employed to calculate Drugs and supplies cost from electronic-prescription system; and the inpatient pharmacy staff cost, while the overhead cost and the pharmacy equipments cost have been calculated indirectly from MY-DRG data base. The total pharmacy cost was obtained by summing the four pharmacy components’ cost per each MY-DRG. The Pharmacy service weight of a MY-DRG was estimated by dividing the average pharmacy cost of the investigated MY-DRG on the average of a specified MY-DRG (which usually the average pharmacy cost of all MY-DRGs).ResultsDrugs and supplies were the main component (86.0%) of pharmacy cost compared o overhead cost centers (7.3%), staff cost (6.5%) and pharmacy equipments (0.2%) respectively. Out of 789 inpatient MY-DRGs case-mix groups, 450 (57.0%) groups were utilized by the UKMMC. Pharmacy service weight has been calculated for each of these 450 MY-DRGs groups. MY-DRG case-mix group of Lymphoma & Chronic Leukemia group with severity level three (C-4-11-III) has the highest pharmacy service weight of 11.8 equivalents to average pharmacy cost of RM 5383.90. While the MY-DRG case-mix group for Circumcision with severity level one (V-1-15-I) has the lowest pharmacy service weight of 0.04 equivalents to average pharmacy cost of RM 17.83.ConclusionA mixed approach which is based partly on top-down and partly on bottom up costing methodology has been recruited to develop MY-DRG case-mix pharmacy service weight for 450 groups utilized by the UKMMC in 2011.

Quality of Life among Female Breast Cancer Patients in a University Hospital in Malaysia

Aims: To assess the Quality of Life (QOL) among female breast cancer patients in a university hospital in Malaysia. Study Design: The study was designed as a cross-sectional study. Place and Duration of Study: The study was conducted at the Surgery and Oncology Clinic in University Kebangsaan Malaysia Medical Centre (UKMMC) between 22nd May 2014 and 27th June 2014. Methodology: A total of 133 female breast cancer patients were selected by universal sampling, out of which 117 patients responded. The QOL was measured both by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and breast cancer specific supplementary module (QLQ-BR23). Results: The global health status/QOL mean score was 67.81 (SD±18.92). Mean age of the respondent was 54 years (SD±18.39). Nearly half of the Malay breast cancer patients (45.6%) diagnosed at the stage of III & IV. In the functional scales, the highest mean score was observed for cognitive functioning 83.19 (SD±22.26); whereas emotional functioning had the lowest mean score 62.96 (SD±26.39). The respondents were satisfied with their body image with a mean score Original Research Article Edib and Kumarasamy; BJMMR, 6(5): 453-462, 2015; Article no.BJMMR.2015.221 454 of 81.34 (SD±24.26) but greatly affected by sexual functioning with a mean score of 31.48 (SD±26.96). Most prevalent general symptoms reported in this study were fatigue, insomnia, pain, appetite loss and financial difficulties; and most prevalent breast cancer specific symptom was found upset by hair loss. Conclusion: Specific measures should be taken for the routine breast cancer screening, awareness and education programmes to promote early detection and diagnosis of the breast cancer. The planned rehabilitation protocol should be addressed by health care professionals to further improve the QOL among breast cancer patients.

Association between nutrient adequacy and psychosocial factors with overall rate of weight loss after bariatric surgery.

This was a cross-sectional study that investigated the relationship between nutrient intake and psychosocial factors with the overall rate of weight loss after bariatric surgery among patients who had undergone sleeve gastrectomy in University Kebangsaan Malaysia Medical Centre (UKMMC). Forty-three subjects (15 men and 28 women) were recruited for this study. Subjects completed assessment questionnaires including the Binge Eating Scale (BES), Beck Depression Inventory (BECK), Family Support Questionnaires, and the Index of Peer Relation (IPR). Results showed that the median overall rate of weight loss was 4.3±5.5 kg/month, which was lower when compared to the rate of weight loss at three months which was 5.0±5.6 kg/month. Pre-operative weight was the predictor of overall rate of weight loss (p<0.05, R²=0.52). Binge eating disorder (BED) and depression were also closely associated with each other after bariatric surgery (p<0.001, R²=0.46). Subjects with good compliance to dietary advice had lower scores on the binge eating scale. The mean caloric and protein intake was very low, only 562±310 kcal/day and 29.6±16.1 g/day. The intake of vitamin A, B-1, B-2, B-3, B-12, C, folate, and iron met the Malaysian Recommended Nutrient Intake (RNI). However, the RNI for calcium, zinc, selenium, vitamin D, and vitamin E was not met. In conclusion, although bariatric surgery had many health benefits, several factors hindered weight loss after bariatric surgery. Health care professionals should closely monitor patients after bariatric surgery.