Psychiatric manifestations in orthopedic patients on Celecoxib therapy

Introduction: The Cyclooxygenase-2 (COX-2) enzyme is responsible for the synthesis of prostaglandin which is responsible for inflammation and pain. Celecoxib a cyclooxygenase-2 inhibitor was first used as a non-steroidal anti-inflammatory drug in 1999. Celecoxib is as effective as NSAJDs but causes less ulceration of the gastrointestinal tract, hence it is commonly used. It has been widely used in patients with osteoarthritis and rheumatoid arthritis. We present 3 cases of temporary psychiatric disorders associated with consumption of celecoxib, two of the patients presented with auditory hallucinations while one was diagnosed to be having depression. None had pre-existing psychiatric disorders or consumed alcohol or substance of abuse. All 3 patients recovered from their temporary psychiatric disorders after stopping celecoxib. Discussion: It is important to be aware of the psychiatric side effects when prescribing the drug for prolonged periods

Effect of taking chicken essence on cognitive functioning of normal stressed human volunteers

Objective: This study evaluates the effect of a commercial brand of chicken essence (BEC) on the various parameters related to stress and cognition of human volunteers. BEC is produced by a hot-water extraction process from chicken meat under high pressure conditions. It contains concentrated amounts of proteins, amino acids and peptides such as carnosine compared to homemade traditional chicken soup. Due to the unique extraction process, it has been postulated that readily absorbed amino acids and bioactive peptides are present in BEC. Methods: In this study, we evaluated the effect BEC in comparison with a placebo on a group of distressed medical students. Students were randomly divided into two groups and given either BEC or a placebo drink daily for two weeks.Before and after the two weeks, the students were given a series of tests to asses their level of cognitive functioning and perceived stress level while being monitored for EEG recording. The combination of these tests, namely Digit span, Arithmetic and Letter-number sequencing, generally assessed the student's attention and working memory. Results: The working memory performance of student's who ingested essence of chicken was found to be significantly better than those who consumed placebo when data comparing baseline and after two weeks consumption were compared. Conclusion: This study seems to suggest that essence of chicken has positive effects on the subjects' cognitive functions

Prevalence, awareness, treatment and control of hypertension in Malaysia: A national study of 16,440 subjects.

Study design: A cross-sectional study was conducted in all states of Malaysia to determine the prevalence, awareness, treatment and control of hypertension. A stratified two-stage cluster sampling design with proportional allocation was used. Methods: Trained nurses obtained two blood pressure measurements from each subject. Hypertension was defined as mean systolic blood pressure 4140 mmHg, diastolic blood pressure490 mmHg, or a self-reported diagnosis of hypertension and taking antihypertensive medication. All data were analysed using Stata 9.2 software and took the complex survey design into account. A two-sided P-value of o0.05 was considered to be statistically significant. Results: The overall prevalence of hypertension for subjects aged X15 years was 27.8% (95% confidence interval (CI) 26.9–28.8). The prevalence of hypertension was significantly higher in males (29.6%, 95% CI 28.3–31.0) compared with females (26.0%, 95% CI 25.0–27.1). Multivariate logistic regression showed that the odds of having hypertension increased with increasing age, in males, in subjects with a family history of hypertension, with increasing body mass index, in non-smokers and with decreasing levels of education. Only 34.6% of the subjects with hypertension were aware of their hypertensive status, and 32.4 were taking antihypertensive medication. Amongst the latter group, only 26.8% had their blood pressure under control. The prevalence of hypertension amongst those aged X30 years has increased from 32.9% in 1996 to 40.5% in 2004. Conclusion: In Malaysia, the prevalence of hypertension is high, but levels of awareness, treatment and control are low. There is an urgent need for a comprehensive integrated population-based intervention programme to ameliorate the growing problem of hypertension in Malaysians

Needle stick and sharps injuries and factors associated among health care workers in a Malaysian hospital.

Introduction: Needle stick and sharps injuries (NSSIs) have been recognized as one of the occupational hazards among health care workers (HCWs). They increase risk of spread of diseases like HIV, Hepatitis B and Hepatitis C. The objective of this study was to determine the prevalence and factors associated with needle stick and sharps injuries. Methods: This cross sectional study was conducted in Serdang Hospital Malaysia using a self-administered validated questionnaire. The respondents consisted of 345 HCWs namely medical assistant officer, staff nurses, medical laboratory technician and community nurse. Data was analysed using SPSS version 17. Results: Results showed that the overall mean age of the 345 respondents was 29.7years and it ranged from 22 years to 45 years with a median of 29 years. The mean age for the males (28.9 years) did not differ significantly from the females (29.9 years). The overall prevalence of needle stick or sharps injuries was 23.5%. Staff nurses had the highest prevalence (27.9%). The causes of NSSI in 58% of cases were hypodermic needle and 27.2% cases were recapping. Medical ward reported the highest NSSIs (51.9%). Knowledge on body fluid transmitted by HIV/AIDS and blood products was high (99.1%). Majority stated that they throw needles or sharps immediately after use in sharp bins (92.7%), do not separate needles from syringes prior to disposal (98.0%) and do not dissemble needles or sharps with hand (98.5%) and do not recap needles after use (94.3%). Majority also stated that they were aware about universal precaution guideline (96.5%) and needle stick and sharps injury needs to be reported (99.1%). However, out of those health care workers (23.5%) who had NSSI, only 30.9% had reported the incident of needlestick and sharps injuries indicating that there were gaps between knowledge and practice among the HCWs. There was a statistically significant association between NSSIs and age (p=0.01) of respondent, working experience (p=0.001) and job categories (p=0.03). Conclusions: The prevalence of NSSI was 23.5%. Although the knowledge on Universal Precautions is good, the prevalence of NSSIs is still high and there are gaps between knowledge and practice related to HIV prevention. NSSIs continue to pose a serious occupational problem

Assessment of depression and anxiety in hematological cancer patients and their relationship with quality of life.

OBJECTIVES:To determine the relationship between major depressive disorder, anxiety disorders and the quality of life of haematological cancer patients. METHODS: This cross-sectional study was conducted at Ampang Hospital Kuala Lumpur, Malaysia, a tertiary referral centre hospital for haematological cancer. The Mini-International Neuropsychiatric Interview was used for the diagnosis of major depressive disorder and anxiety disorders. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was utilised to measure patients' quality of life. RESULTS: A total of 105 haematological cancer patients were included in the study with response rate of 100%. Major depressive disorder correlated with almost all domains of the quality of life, except the pain scores. Logistic regression showed that insomnia and financial difficulties were related to major depressive disorder. Different anxiety disorders also correlated with quality of life in specific domains. The leading anxiety disorders that correlated mostly with quality-of-life scales were generalised anxiety disorder, followed by obsessive-compulsive disorder, social anxiety disorder, as well as post-traumatic stress disorder and panic disorder with agoraphobia (p<0.05). CONCLUSIONS: Psychological treatment along with medication and intervention should be implemented to improve the overall quality of life and psychiatric disorder symptoms among the haematological cancer patients

Depression and quality of life among patients with hematological cancer in a Malaysian hospital

Objective: To determine the prevalence of major depressive disorder (MDD) in hematological cancer patients and to investigate MDD with quality of life. Methods: The research, which uses a cross sectional design, has been carried out at Ampang Hospital, Kuala Lumpur. The hospital is a tertiary referral center for cancer cases that include non-Hodgkin lymphoma, acute myelogenous leukemia, acute lymphoblastic leukemia, Hodgkin lymphoma and other hematological cancers. In total, 105 patients with hematological malignancies were included in the study. This study employed the MINI International Neuropsychiatric Interview for diagnosis of MDD, the Patient Health Questionnaire (PHQ-9) for symptom severity of depression and the European Organisation for Research and Treatment of Cancer Quality Of Life questionnaire (EORTC QLQ-C30) to assess the quality of life of the respondents. Result: The response rate was 83.3%. The prevalence of MDD was 24.8% (n=26) with the majority of cases classified as moderately severe depression (38.5%). About 92.3% (n=24) of depressed hematological cancer patients were diagnosed with a current episode of MDD. The depressed patients also had significantly reduced quality of life in physical, role, emotional, cognitive and social domains (p<0.05). They also had significantly more symptoms of fatigue, nausea and vomiting, dyspnea, insomnia, appetite loss, constipation and diarrhea in addition to having financial difficulties and poor global health statuses (p<0.05). Conclusion: The prevalence of depression among the hematological cancer patients was high and the depressed patients had reduced qualities of life. Special attention in psychotherapy would help to improve both depression level and the quality of life in these patients

A community-based study on the prevalence and factors affecting smoking in Terengganu state, Malaysia, 2004

Introduction: It is estimated that 4.9 million people worldwide died in 2000 as a result of their addiction to nicotine, about half of them prematurely. This huge death toll is rising rapidly, especially in low and middle income countries where most of the world’s 1.2 billion tobacco users live. Objectives: This study aimed to determine (i) the prevalence of smoking among the community aged 18 and above in Terengganu state, and (ii) the relationship between smoking and age, sex, educational level, family and peer influence. Methods: A cross-sectional study design was used in this study and data was collected using a standardised pre-tested structured questionnaire. Results: The overall mean age of the respondents was 38.9 (95% CI= 37.7 – 40.2) years. The majority of the respondents were Malays (99.1%). Of the 653 respondents, 32.2% and 23.6% were ever and current smokers respectively. Of this, 211 ever smokers, 199 (94.3%) were males and only 12 (5.7%) were females. The prevalence of ever and current smokers for males was 73.2% and 53.7% respectively compared to the females (3.1% and 2.1% respectively). There was a significant association between smoking status and sex (p<0.001). The prevalence of ever smokers was lowest amongst respondents with college or university educational level. However, for current smokers, those with college or university education had the highest prevalence. The overall mean initiation age of ever smokers was 19.7 years (95% CI = 18.8 – 20.7). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001). The mean duration of smoking for the current smokers was 21.6 (95% CI= 19.1 – 24) years. There was also no significant difference in the mean duration of current smoking for males compared to the females (p = 0.5). The majority (93.4%) of the ever smokers started either because their friends asked them to try or they were trying for fun. The quit ratio was 27%. Conclusion : The prevalence of ever and current smokers in males is very high (73.2% and 53.7% respectively) compared with the females (3.1% and 2.1% respectively). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001)

The socio-demographic and clinical factors associated with quality of life among patients with haematological cancer in a large government hospital in Malaysia.

Background: The paper examined the quality of life of haematological cancer patients according to their socio-demographic profiles and clinical diagnoses. Methods: This cross-sectional study was conducted at the tertiary referral centre of Ampang Hospital, Kuala Lumpur, involving 105 patients. The European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) questionnaire was used to measure their quality of life. Results: The study involved patients diagnosed with all types of haematological cancer, including non-Hodgkin lymphoma (NHL), acute myelogenous leukaemia (AML), acute lymphoblastic leukaemia (ALL), Hodgkin lymphoma (HL), and multiple myeloma (MM), with a response rate of 83.3%. The patients with ALL, HL, without NHL, and without MM were younger than other patients. There were significant differences in quality of life scores in different socio-demographic groups and types of cancer diagnosis. The global quality of life of the female patients was much better than that of the male patients. Patients who were 40 years old or younger had a better global quality of life and physical functioning, as well as fewer symptoms of constipation, nausea, and vomiting. Employed patients were in less pain but showed greater impairments of cognitive function than did unemployed patients. Patients who earned a monthly wage of RM1000 or less had reduced physical function, more symptoms of pain, and more financial difficulties compared with patients who earned more. Patients with AML tended to have better physical functioning than did patients with MM, whose physical functioning was impaired. Comparatively, more symptoms of dyspnoea were found in ALL and HL patients than in other types of lymphoma. Compared with other patients, those with ALL had a greater loss of appetite, and other lymphoma patients had fewer symptoms of pain. Patients with NHL had impaired role functioning and more constipation compared with other patients. The results were all statistically significant (P < 0.05). Conclusion: The quality of life of haematological cancer patients is affected by sociodemographic factors and clinical diagnoses. Efforts should be made to improve the overall quality of life of these patients