Characteristics Of HIV-Infected Tuberculosis Patients In Kota Bharu Hospital, Kelantan From 1998 To 2001.

To characterize the demographic profiles, clinical features, radiological patterns and outcomes of treatment of HIV-infected TB patients, a descriptive study was carried out on 149 HIV infected TB cases diagnosed from 1998 through 2001 at Kota Bharu Hospital, Kelantan, Malaysia

A study on the influence of hiv infection in pulmonary tuberculosis patients on the se condary transmission of pljlmonary tuberculosis to household contacts

Introduction: The Human Immunodefiency Virus (HIV) epidemic has had a profound influence on the transmission of tuberculosis (TB). The potential for HIV -associated TB cases to transmit M.tuberculosis and to produce a secondary increase in TB morbidity is unknown. Objectives: To compare the prevalence of M.tuberculosis infection among household contacts of HIV-positive and HIV-negative pulmonary TB (PTB) patients, and to identify potential variables that associated with the transmission. Materials and Methods: A cross-sectional study was carried out to review records of tuberculin (Mantoux) tests administered during routine contact investigations at the Chest Clinic, Kota Bharu Hospital, Kelantan from 1999 through 2000. HIV status of patients was based on the result of ELISA tests while information on household contacts were recorded during house visit. Results: One hundred and sixty eight contacts to 67 HIV -negative patients and 62 contacts to 22 cases of HIV -positive PTB patients were included. Thirty-two percents (20/62) of contacts of HIVpositive PTB had a positive tuberculin compared with 49.4 % (83/168) of contacts to HIVnegative patients (crude Odds Ratio (OR) = 0.48 95% Confidence Interval (el) 0.26 - 0.90, p = O. 020). HIV -infected PTB patients in this study had a less severe form of pulmonary lesion without cavitations. The difference in tuberculin response among the household contacts of each group was still significant after performing multivariate logistic regression analysis to adjust for the severity of PTB and other potential variables associated with infectiousness of TB (adjusted OR = 0.43, 95% CI 0.18 - 0.95 P = 0.04). Adult contacts, crowding of house, longer duration of stay with index. cases, presence of sputum positive and cavitations on chest X-ray in index cases showed higher odds of being tuberculin positive among household contacts but the differences were not significant. Conclusion: The study has shown that HIV -infected PTB were less infectious to their household contacts than HIVnegative patients. The study suggests that the more advanced HIV -associated immunosuppresion among the PTB index cases, the less infectious is the PTB. The transmissibility of TB may depend on the stage of HIV infection i.e patients who are immunosuppressed are less likely to cavitate and have milder pulmonary lesions, and therefore are less infectious than those patients who are at an early stage of HIV infection. The presence of HIV in the community may not necessitate a change in the current policy in the management of contacts in the general population

Health and safety: enhancing community-based Education modulers of preparedness for floodrelated communicable diseases in Kelantan

In Phase 1 (between August and October 2015, situational analysis were done in assessing and exploring baseline knowledge, attitude and preventive practices (KAP) of the affected communities with regards to communicable diseases related to flood. Baseline community surveys were conducted using a pre-validated KAP questionnaire through g_uided interviewed-based technique among 300 villagers. Raw total scores from each section of KAP were converted to percentage scales for analysis while four focus group discussions (FGD) were performed to explore their coping and experiences in the flood disaster. In Phase 2 (between November 2015 and February 2016), health education materials were developed through series of workshop and then were evaluated through a community intervention. These involved revising existing health education materials, creating new materials tailored to the community and getting feedback from stakeholders. Customized modules that focusing on major flood-related communicable diseases and comprising of printed materials and audio-visual information kits were eventually developed which included 2 series of health education flip charts, 2 series of PowerPoint slides for health talk, 3 series of health education flyers, 10-minute video with captions on flood-health hazards, diseases and prevention messages and other complementary public health information. A non-randomized community-controlled trial was then conducted to determine effectiveness of the community-based health education modules. The delivery channels of the health modules were conducted at least two weeks before the forecasted flood seasons in that year. Two strategies were applied: targeted small group health education sessions which comprised 20-25 persons each, and mass dissemination of public information health education materials. Results Three hundreds repondents were interviewed with a mean age of 45.1 years old (SD=17.34) and mainly those with secondary school education (n=166, 55.3%). Taking mean scores below 60% as unsatisfactory, all knowledge domains, attitude and selected pratices (drinking water and protective habit) need further concern. Between 90. 7 to 96.3% agreed that they were more likely to practice preventive measures if given proper information and personal protective tools (e.g soap, hand sanitizer, face mask etc). Between 72.2 - 95.3% agreed that current materials of health education on flood related diseases were useful but interactive small group discussions and demonstrations were also suggested by them. There were 129 and 101 respondents within the intervention community who were participated in the repeated surveys at 1-week and 1-month post intervention KAP assessments respectively while another 125 in the controlled group. Table 1 shows there were statistically significant improvements in all knowledge components (type of diseases, common symptoms, methods of transmission, susceptible and risk factors, and danger signs) from 9.4% to 52.6% (P<0.001) while there was a 10% increment (P<0.001) in attitude scores toward preventing behaviours on flood-related communicable diseases among the intervention community. There was a slight reduction in most domains at 1-month post intervention; however all mean scores were still higher than at the baseline pre intervention stage. When compared to control community at post-1 month, statistically significant difference in knowledge scores were shown between 15.4% and 35.4% (P<0.001) on types of diseases, common symptoms and susceptible/ risk factors domains. There were siQnificant improvements on the practice domains at post 1-month in the practice of drinkinQ safe water and protective habits (P<0.001 and P<0.006 respectively) but no changes in the hand-washing and sanitation practice. Conclusion The study findings show that: 1. the community-based health education has been evaluated to be effective in enhancing existing level of relevant knowledge and attitude as part of their preparedness toward communicable diseases related to flood 2. this research furthers contribute by providing customized and comprehensive community-based health education modules in preventing potential communicable disease outbreaks in affected flood-prone communities 3. this will reduce the costs associated with the diseases and reduce the vulnerabillties of communities exposed to flood

Challenges and Opportunities to Improve Tuberculosis Screening among Immigrant Plantation Workers in Sabah, Malaysia

Tuberculosis (TB) among immigrants has substantial contribution to the TB epidemiology in Sabah. This study aimed to determine the yield of screening for TB disease among immigrant plantation workers in Sabah, Malaysia. This was a prospective cohort study involving 482 legal immigrant workers aged 18 years and above, consented and available at study sites during the study period. Workers with previous history of TB or currently on TB treatment were excluded from participation. Symptom based questionnaire was administered along with both chest radiograph and sputum samples collection for symptomatics participants. Out of 482 plantation workers creened, there was no case of active TB detected among the 44 (9.1%) symptomatics participants. Finding of low TB yield in this study was rather unexpected but this indicates the real challenges for the local health authority to come out with more cost effective screening programs, including reducing stigma, in active TB screening among migrant population

Study on Knowledge, Decision Making and Acceptance of Human Papilloma Virus Vaccination among Parents of Primary School Students in Kota Bharu

NTRODUCTION: Cervical cancer is the third most common cancer in women and fifth most common cancer in the entire general population in Malaysia 1. The primary prevention, HPV vaccine is only approved for use in females in Malaysia2. Children rely on parents not only for the consent even for the guidance and information about the vaccines3. OBJECTIVES: The study to determine the level of parental knowledge, decision making and acceptance of HPV vaccination, and association between knowledge and acceptance. METHODS: This cross sectional study was conducted among 280 parents of primary school students in Kota Bharu for 12 months duration. Systemic random sampling and a validated self administered questionnaire was used to assess knowledge of HPV vaccination. Data was analysed using SPSS ver 22. RESULTS: Parents with good knowledge in Kota Bharu was 38% and 62% was poor. Most decision regarding vaccination was a shared decision, 72%. The proportion of acceptance of HPV vaccine for girls was 63%. Level of knowledge (good) has significant association with acceptance of HPV vaccine (95% CI 7.319,36.403, p<0.001). CONCLUSION :Parent’s level of knowledge is low despite the implementation of the HPV vaccine since 2010. Vaccine acceptance is dependent on the level of knowledge. Parents play an important role in determining the success of HPV vaccine program4. The trend of decision making has changed in Malaysian family as most couples make joint decisions in allowing vaccinations on their child as compared to traditionally decision making by father5. KEYWORDS: HPV vaccine, knowledge, decision making, acceptance, parent

A Preliminary Study Of The Influence Of HIV Infection In The Transmission Of Tuberculosis.

The human immunodeficiency virus (HIV) epidemic has had a profound influence on the epidemiology of tuberculosis (TB). The potential for HIV-associated TB cases to transmit M. tuberculosis and to produce a secondary increase in TB morbidity is unknown

Mood and Memory Function in Ovariectomised Rats Exposed to Social Instability Stress

This study aims to compare the effects of social instability stress on memory and anxiety- and depressive-like behaviour between sham-operated controls and ovariectomised (OVX) rats. Forty adult female Sprague-Dawley rats (8 weeks old) were randomly divided into four groups,

Isolated Cerebellar Stroke Masquerades as Depression

Objective: There are numerous reports on neurological conditions masquerading as psychiatric disorders. However, cerebellar stroke is not established as one of it. The 2 case reports will highlight that this masquerade is possible and the physician's high index of suspicion is the key to accurate diagnosis. Results: The case reports illustrated how a cerebellar stroke could be misdiagnosed as a depression due to its presenting symptoms of vertigo. The rarity of cerebellar stroke itself already posed a challenge for the physician to detect it but the mimicking of depression was the ultimate obstacle. Conclusion: The acute onset strongly suggests an organic cause. It is important to ascertain depression through depressive mood, and not by behavioral changes alone. Correct diagnosis of cerebellar stroke is of paramount importance so that early intervention can be delivered to the patient

Ni endoscopic classification for Storz Professional Image Enhancement System (SPIES) endoscopy in the detection of upper aerodigestive tract (UADT) tumours

The diagnostic procedure for upper aerodigestive tract (UADT) tumours is by white light endoscopy (WLE) combined with biopsy. However, WLE has difficulty identifying minute epithelial changes which hinders early diagnosis. Storz Professional Image Enhancement System (SPIES) is designed to enhance the visualization of microvasculature on the mucosal surface and detect any epithelial changes. In this study, we aimed to evaluate the use of Ni endoscopic classification with SPIES endoscopy in the detection of UADT tumours. Fifty-nine patients with suspected UADT tumours underwent WLE followed by SPIES endoscopy. All the tumours were biopsied and sent for histopathological examination (HPE). The kappa index (kappa) was used to evaluate the agreement between the methods. The level of agreement between SPIES using Ni classification and HPE showed almost perfect agreement as compared to moderate agreement between WLE and HPE. The sensitivity and specificity for WLE and HPE were 77.5% and 84.2% respectively with positive predictive value (PPV) of 91.2% and negative predictive value (NPV) of 64%. The sensitivity and specificity for SPIES endoscopy using Ni classification and HPE were 97.5% and 94.7% respectively with PPV of 97.5% and NPV of 94.7%. SPIES endoscopy using Ni classification is a valid tool for earlier tumour detection

The Effect of Labisia pumila var. alata on Postmenopausal Women: A Pilot Study

This is a randomized, double-blind, placebo-controlled study comparing the effects of a water extract of Labisia pumila var. alata at 280 mg/day with placebo, given for 6 months in postmenopausal Malay women. There were 29 patients treated with Labisia pumila and 34 patients in the placebo group. Menopausal symptoms were assessed at baseline and at 6 months. The blood pressure, body mass index, waist circumference, fasting blood sugar, lipid profile, and hormonal profile (follicle stimulating hormone/luteinizing hormone/estradiol) were measured during visits every two months. ANCOVA model analysis showed significantly lower triglycerides levels in LP subjects at 6 months after treatment as compared to placebo (1.4 versus 1.9 mmol/L; adj. mean difference 0.5, 95% CI: 0.02, 0.89 after adjusted for the baseline values, age, BMI, and duration of menopause placebo). Other parameters in both groups did not differ significantly. In conclusion, daily intake of Labisia pumila at 280 mg/day for six months was found to provide benefit in reducing the triglyceride (TG) values