Dementia secondary to a potentially treatable cause - role of GPs

Dementia is tragic mind-wrecking disease, defined as a multifaceted decline in cognitive function severe enough to interfere with activities of daily life. We present herein two patients who presented with loss of memory and altered behaviour. The purpose of these case reports is to alert the health professionals, especially general practitioners, in detection of “potentially treatable " cases of dementia that can be treated effectively to restore normal or nearly normal intellectual function

Social and HIV/AIDS risk behaviours in a fishing community

Background: This study was to explore the pattern and depth of social and health risk problems that may address the social drivers of HIV/AIDS in a fishing community in the East Coast of Peninsular Malaysia. Methods: Five focus group discussions were held among selected villagers to gain their experiences and perception on social problems and HIV/AIDS risk behaviours in their community. Results: Many participants discussed on early involvement in substance use disorders and high risk sexual behaviours. Participants were frustrated with the poor parental supervision and lack of social support in the community which exposed them to social problems and subsequently to risk of HIV/AIDS infections. Conclusion: Poor parental supervision and lack of social support from the community are factors need to be considered when designing structural intervention programme. Further research needs to be done among more specific target groups in villages like youths, parents and school children, in order to identify the causal chains of deeper structure of HIV/AIDS risk for proximal and distal risk factors intervention

Hospitalised patients' awareness of their rights: a cross-sectional survey from a tertiary care hospital on the east coast of Peninsular Malaysia

INTRODUCTION: Optimal patient care varies considerably from place to place and is influenced by scientific as well as social developments. The purpose of this study was to investigate awareness and pertinent issues regarding informed consent among hospitalised patients and to determine lapses, in order to improve the standard of care. METHODS: A questionnaire-based cross-sectional survey was conducted among inpatients at a tertiary care level hospital. RESULTS: 90 percent of patients were aware of their rights, and 85 percent had enough information regarding their illness and modality of treatment. However, treatment options were discussed with 45 percent of cases only, and 65 percent of patients were informed of their duration of treatment. Most of the patients from the surgical group, haemodialysis unit and those with minor ailments were very satisfied with the doctors (92 percent, 86 percent and 96 percent, respectively), as opposed to only 36 percent of cancer patients and 70 percent of acquired immunodeficiency syndrome (AIDS) patients (p-value is less than 0.0001). Almost all patients (99 percent) said that their religious beliefs were respected by the staff and they had no problems in accessing them in times of need. Informed consent was obtained by the doctor in 98 percent of cases and by the nurse in two percent. 98 percent of the patients mentioned that their treatments/examinations were conducted in an atmosphere of privacy and that their personal information was kept confidential by their doctors. CONCLUSION: Patients were reasonably informed about their illness. Their privacy and religious beliefs were duly respected. Treatment options and the duration of treatment were not discussed with all patients. Cancer and AIDS patients were less satisfied with the attending staff. The results suggest that there is a need for periodic surveys of patient satisfaction with the quality of care

Religious and spiritual beliefs and practices in medicine: an evaluation in a tertiary care hospital in Malaysia

In recent years there has been growing awareness regarding the role of religion and spirituality (R/S) in the practice of clinical medicine. Despite hundreds of articles in professional journals on the subject, little is known about physician beliefs regarding the influence of religion on health. We aim to assess the beliefs and observations of physicians regarding the role of R/S and patient’s health and whether they address such issues in their clinical practice. Concomitantly, we aim to assess the beliefs of our patients and whether they like to address such issues. Questionnaire was based on a cross sectional survey among hospitalized patients and their treating physicians. Nearly all patients and physicians reported a high prevalence of religiosity. Patients also acknowledged that their R/S was respected by the staff, and that physicians inquired R/S about half of the time. R/S was described as beneficial as it enabled patients to cope better with their illness and gave them a positive state of mind. Religion is important to many patients and physicians, but half of the physicians ignore it in their clinical practice. Physicians need to be attentive to patients R/S issues and address them in specific clinical situations

Prevalence of cardiovascular risk factors in a selected community at Kuantan, Pahang, Malaysia

Hypertension and obesity are established and independent risk factors for cardiovascular diseases. There are important inter-relationships between these two factors that may explain the aetiology of cardiovascular diseases. To determine the prevalence of hypertension and obesity in a rural community setting in Malaysia, and to identify their associated risk factors, a cross-sectional study was conducted among residents aged of 18 years and above at a Kampung, Kuantan, Pahang Darul Makmur, Malaysia from 2007 to 2008. Sample size was 219. Prevalence of hypertension was 35.6% (78), with the highest prevalence among those aged of 45 years and above (50.0%). The prevalence of hypertension was notably higher in males compared to females, (38.9 versus 34.0%). In addition, the prevalence of obesity was 54.8%, with the highest prevalence among those aged 55 to 64 years (66.7%). The obese respondents were at higher risk to be hypertensive (OR = 1.4, 95% CI = 0.744, 2.277). The prevalence of hypertension and obesity in this study was high which herald the need for prevention programs for these risk factors in such rural communities at Kuantan, Pahang Darul Makmur, Malaysia

Dementia, Islamic indication and scientific evidence

Background: The increasing prevalence of dementia has dramatic effects on lives of millions of people across the regions and on public health costs. This is a commonly elderly health health problem as indicated in the Holy Qur’an. Although there is no cure yet but much can be done to improve the quality of life of people with dementia. Methods: An extensive review of the literature, including the Holy Qur’an, in several pertinent areas of inquiry that may deleniate the prevalence, potential risk factors related to dementia was under taken. Results: The overall prevalence of dementia for males and females doubled for every five years increase in age after the age of 65. It is largely a disease of older people. Results highlight a number risk factors associated with dementia. Inter alia, these include physical activities, education, occupation, stress, cholesterol and APOE gene. A number risk factors associated with dementia are modifiable. Conclusion: The prevalence of dementia rises as the people ages. The modifiable risk factors may have potential as strategies useful in preventing or delaying dementia among elderly subjects

Dementia : prevalence and risk factors

The increasing prevalence of dementia already has dramatic effects on lives of millions of people across the regions and on public health costs. There is no cure yet but much can be done to improve the quality of life of people with dementia and the families who care for them. An extensive review of the literature in several pertinent areas of inquiry that may determine and delineate the prevalence, potential risk factors related to dementia was undertaken. The overall prevalence for males and females doubled for every five years increase in age after the age of 65. It is largely a disease of older people, but 2% of those affected were under 65 years of age. Results highlight a number of risk factors associated with dementia. Inter alia, these include physical activities, education, occupation, stress, cholesterol and APOE gene. Dementia is increased in certain population and the trend is on the rise. A number of risk factors associated with dementia are modifiable and may have potential as strategies useful in preventing or delaying dementia among elderly subjects. Further research is needed to determine the validity and strength of associations of risk factors of dementia including ascertainment of its causality

Genetic and bio-chemical determinants of dementia

As the neurodegenerative disease (NDD), dementia, is emerging as a silent epidemic for rapidly developing countries like Malaysia, locally investigation of its prevalence including genetic, biochemical and behavioural determinants were the focused objective of this study. For clinical epidemiological investigation of dementia, the commonest NND, an initial descriptive study to assess the magnitude of dementia followed by a case-control study were conducted in collaboration with other higher educational institutions both overseas and in Malaysia. This study revealed many facts locally unexplored previously. Data were collected from a statistical sound sample size (197 study subjects initially for the descriptive phase; 63 dementia cases and 103 age matched controls for analytic phase) using a questionnaire for personal profile and other related factors. The standard protocols were followed to measure the selected biochemical determinants such as adiponectin, glucose levels, lipid profile and alleles of apolipoprotein E gene (APOE). The statistical analyses were performed using standard statistical software, the SPSS (Statistical Package for the Social Sciences) for Windows, Version 17. In addition to descriptive statistics, pertinent inferential statistical analyses were performed. It appears from the initial descriptive study that dementia was the leading diseases (72.1%) of the identified neurodegenerative diseases among study subjects. In investigation of genetic determinant, as in other areas of inquiry, one-fifth (19.7%) of the identified cases revealed the positive family history reflecting the putative role for inherited susceptibility. About one-third of them were smokers (29.4%). Among the known co-morbidities, type 2 diabetes mellitus, hyperlipidemia and hypertension were remarkable (43.7%, 11.3% and 65.5% respectively). The evident of high percentages of patients were suffering from different co-morbidities in combinations suggested the potential scope for further investigations of selected biochemical and genetic determinants such as, serum adiponectin level, lipid profile and glycaemic status and alleles (ApoE-ε2 Apo ApoE-ε3 and E-ε4) of APOE to explore the respective etiological role. ApoE-ε4 was statistically significantly associated with dementia (¬2 (df = 1) = 10.8, p<0.01) and might be an important determinant for the dementia cases. The proportion of dementia cases among neurodegenerative diseases in this study was alarmingly high. Type 2 diabetes mellitus was the most common co-morbidity and ApoE-ε4 appears to be a genetic determinant of dementia

Antimicrobial use and factors influencing prescribing in medical wards of a tertiary care hospital in Malaysia

Abstract: To ascertain the pattern of antimicrobial use and to analyze the selected core drug use indicators – prescribing indicators – a prospective study was conducted in 2008 in medical wards of a tertiary care hospital in Malaysia. Every patient in the medical wards of the selected hospital who was being treated with antimicrobial(s) during the data collection period was considered a potential study subject for this study. The treatment charts of 209 admitted patients were reviewed. Pneumonia was the leading diseases among them (26.3%). The most commonly used antimicrobials were amoxicillin with clavulanate (augmentin), erythromycin, cefuroxime, ceftriaxone and ampicillin sodium with sulbactam sodium (unasyn). The level of generic prescribing of antimicrobials was just above the half of all prescribed courses (54.3%) and the intravenous route was the preferred method of administration (57.3%). The mean number antimicrobials received by the studied patients were 1.8 (± 0.9). The majority of them (53.6%) received two or more antimicrobials for their treatments. The evident of high percentages of patients received antimicrobial treatment in combinations reflected the potential of higher proportion of inappropriate treatment of different diseases and suggested the ample scope for intervention to improve antimicrobial use in the hospital