Acral melanoma of the extremities_a study of 33 cases Sarawakian patients

cral melanoma involve the non-pigmented palmoplantar and subungual areas and are commonly seen among Asians. Patients commonly display advanced stage of disease at presentation. It may appear unnoticed and mimic benign lesions. Methods: Data for this retrospective study was retrieved from Histopathology Unit, Sarawak General Hospital, Malaysia archive from 2003 to 2009. Result: 62.3% cases of malignant melanoma were acral melanoma. The mean age of diagnosis was 64.3±12.1. The involved sites were the heel (39.4%), middle and frontal plantar area (24.2%), toe (24.2%) and web spaces (9.1%). The clinical presentations were; an enlarging mass (60.6%), nonhealing ulcer (24.2%) and abnormal pigmented lesion (15.2%). Most cases exhibited Breslow thickness >4.00 mm (87.9%) and Clark’s levels V (50%). The majority showed moderate (non brisk) tumour infiltrating lymphocytes (57.6%). Ulceration (84.8%) and lymphovascular involvement were seen (24.2%). Conclusion: Acral melanoma is the commonest malignant melanoma in this Sarawakian cohort. Most of the cases presented with advanced stage disease

Prevalence of dementia in elderly population in Sarawak using the Early Dementia Questionnaire (EDQ)

Introduction: The number of elderlies in Malaysia is increasing similar with the rise in ageing population worldwide. This leads to increase in the prevalence of dementia. This study was done to screen the elderly population in health clinics in Sarawak for dementia using the validated Early Dementia Questionnaire (EDQ). EDQ is a screening tool based on symptoms of dementia. Methods: A cross sectional study was done on the elderly patients aged 60 years and above attending health clinics in Kuching, Sibu and Miri, Sarawak using systematic sampling. Patients with depression were excluded from the study using the Geriatric Depression Scale (GDS). Eligible patients were then assessed for dementia using the validated Early Dementia Questionnaire (EDQ) with the cut-off score of 10. Their informants were also interviewed to complete the questionnaire. Results: The prevalence of dementia among 455 elderly patients was 42.4% (CI 1.180, 2.534). After controlling for confounding factors, dementia was independently associated with advanced age (adjusted OR: 7.3; 95% CI: 1.561, 34.202; P=0.012) and no formal education (adjusted OR: 3.3; 95% CI: 0.198, 0.453; P<0.001). Concentration (75.6%) was the most common symptom presented. Other symptoms were memory symptoms (48.2%), physical and emotional symptoms (57.2%) and symptoms on sleep and environment (50.7%). Conclusion: The prevalence of dementia in Sarawak based on EDQ was 42.2%. Apart from memory problems which are often associated with dementia, patients with concentration problems should also alert the health professionals on the possibility of dementia

Experience of hormone replacement therapy among women of Sarawak, Malaysia

Objectives To determine the usage of hormone replacement therapy (HRT) and knowledge about HRT among women of Sarawak in Malaysia. Methods A prospective study using a face-to-face interview was conducted on 356 randomly selected Sarawakian women aged between 40 and 65 years. Results The mean age of respondents was 50.83+6.30 years and the mean age of menopause was 51.28+2.28 years. Twenty-three percent of women were premenopausal, 39.6% perimenopausal and 37.4% postmenopausal. Only 36% of the respondents were aware of the existence of HRT; this is especially among those who were younger women, better educated and working. The main sources of information on HRT were friends and relatives (92.2%), newspapers/magazines (89.1%) and television/radio (64.1%). HRT usage among respondents was low (8.1%), mainly for relief of menopausal symptoms such as night sweats (100%), mood swings (93.1%), irritability (93.1%), and hot flushes (86.2%); only 24.1% used it for the prevention of osteoporosis. All women on HRT had taken HRT for less than 3 years. The main reason given for not being on HRT was that it was not recommended by their doctors (56.6%); only 8.3% worried about the side-effects and 4.3% were on other forms of treatment. Conclusions The use of and knowledge about HRT among women of Sarawak were found to be low in our study. The main sources of information about HRT are from friends/relatives and the mass media. Health-care providers should play an important role in promoting, counseling and health education regarding HRT needs to rectify these problems

The menopausal experience among indigenous women of Sarawak, Malaysia

Objectives To document the common menopausal symptoms and quality of life in indigenous women of Sarawak in Malaysia. Methods A face-to-face interview using the Menopause-specific Quality of Life questionnaire was conducted with 276 indigenous Sarawakian women aged 40–65 years to determine the mean age of menopause and common symptoms (divided into vasomotor, psychosocial, physical and sexual domains) associated with menopause. Results The mean age at menopause of postmenopausal women was 50.78+2.47 years (range 47.3–58.2 years). The most common symptoms reported were aching in muscles and joints (82.6%), lack of energy (77.5%) and low backache (77.2%). The typical menopausal symptoms of hot flushes, night sweats, sweating and vaginal dryness were experienced by 42.4%, 34.8%, 29.7% and 49.3%, respectively of the women studied. Perimenopausal women (n¼114) experienced the most physical and psychosocial symptoms, while postmenopausal women (n¼102) experienced most sexual symptoms. Perimenopausal and postmenopausal women were reported to suffer more than premenopausal women (p50.001) within the four domains of symptoms (vasomotor, psychosocial, physical and sexual). Conclusions The menopausal symptoms in this study correspond to those in other studies on Asian women but the prevalence of typical and classical menopausal symptoms was lower compared to studies on Caucasian women. The perimenopausal women had the most significant decrease in quality of life, followed by postmenopausal women and premenopausal women. Vasomotor symptoms had a predominant influence on the quality of life

A survey on COVID-19 vaccine acceptance and concern among Malaysians

Background Vaccination is an effective way to curtail the burden of COVID-19 in which success depends on a high acceptance of the vaccine. However, addressing concerns among vaccine-hesitant individuals is essential to avoid failure of the immunisation programme. This study sought to assess the concerns and acceptance rates regarding the COVID-19 vaccine among Malaysians. Methods An online questionnaire was distributed to 1411 respondents via a snowball sampling method among Malaysians aged 18 years and above. Results The majority of the respondents were young adults (40.7%), female (62.8%), Malay (63.8%), Muslim (72.3%), married (52.9%), with tertiary education (86.8%) and without medical illness (85%). Social media (97.4%) was the primary source of information regarding COVID-19. The overall acceptance rate was high (83.3%), with the lowest rates among the elderly aged 60 years and above (63.4%) and pensioners (64.6%). Hesitance was caused by concerns regarding side effects (95.8%), safety (84.7%), lack of information (80.9%), effectiveness (63.6%) and religious (20.8%) and cultural factors related to the COVID-19 vaccine (6.8%). Respondents with diabetes mellitus (24.7%) and hypercholesterolemia (23%) were more hesitant to accept the COVID-19 vaccine, at 16.1 and 15.8%, respectively. Predictors of COVID-19 vaccine hesitance were age, religion, and current residence. Conclusions The results indicate a high rate of acceptance of the COVID-19 vaccine among Malaysians. Thus, the Malaysian government and other related agencies should increase their campaign and prepare to implement the COVID-19 mass immunisation programme among Malaysians. However, despite the high acceptance rate, it remains important to address concerns among hesitant individuals by building trust in vaccine safety and effectiveness through adequate information regarding the vaccine

Thyroid Associated Ophthalmopathy: A Review

Thyroid associated ophthalmopathy is an autoimmune disorder affecting the orbital and periorbital tissues. Hyperthyroidism is commonly associated with thyroid associated ophthalmopathy, however in 5% to 10% of cases it is euthyroid. Genetic, environmental and endogenous factors play a role in the initiation of the thyroid ophthalmopathy. Smoking has been identified as the strongest risk factor for the development of the disorder. The pathogenesis involves activation of both humoral and cell mediated immunity with subsequent production of gycoaminoglycans, hyaluronic acid resulting in oedema formation, increase extraocular mass and adipogenesis in the orbit. The natural history of the disease progresses from active to inactive fibrotic stage over a period of years. Diagnosis is mainly clinical and almost all patients with ophthalmopathy exhibit some form of thyroid abnormality on further testing. Treatment is based on the clinical severity of the disease. Non-severe cases are managed by supportive measures to reduce the symptomatology and severe cases are treated by either medical or surgical decompression. Rehabilitative surgery is done for quiescent disease to reduce diplopia and improve cosmesis

Diabetic retinopathy and the effect of pregnancy

Pregnancy is associated with increased risk of development and progression of diabetic retinopathy (DR). Although pregnancy does not have any long term effect on DR, progression of retinopathy changes occur in 50%-70% of cases. The greatest risk of worsening occurs during the second trimester and persists as long as 12 months postpartum. The other factors found to be associated with its progression include duration of the diabetes, severity of retinopathy at conception, hyperglycaemic control, anaemia and progression of coexisting hypertension. Because of the increased risk of progression of the disease in pregnancy, conception should be delayed till the ocular disease is treated and stabilized and laser photocoagulation should be promptly instituted in all cases of severe non-proliferative retinopathy and should not be delayed till the patient develops early proliferative changes. Good diabetic control before and during pregnancy can help prevent this increase in the progression and serious vision loss