Jane, 11 years of age, presented to her general practitioner with fever, sore throat and painful ... more Jane, 11 years of age, presented to her general practitioner with fever, sore throat and painful ulcers on her lips. Two weeks earlier, she was admitted to the local hospital after having a second episode of afebrile seizure and was therefore started on carbamazepine CR 200 mg nocte. Magnetic resonance imaging (MRI) and electroencephalogram (EEG) were normal. For the following 8 days, she complained of fatigue and feeling slightly 'woozy' in the head. These symptoms resolved spontaneously and were believed to be side effects of carbamazepine. Three days after that, she complained of sore throat that was associated with low-grade fever. There was no rash on her trunk or limbs. Full blood count, liver function test and electrolytes were all within normal limits. Her fever increased progressively over the next 5 days and her lips became progressively red, swollen and painful.
The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing infl... more The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing inflammation and pain. Classical non-steroidal anti-inflammatory drugs (NSAID) inhibit the COX-2 enzyme that produces inflammatory prostaglandins as well as the COX-1 enzyme that produces gastric mucosa protecting prostaglandins. By specifically inhibiting only the COX-2 enzyme, coxibs thus reduce pain but do not damage the gastric mucosa. However, COX-2 at the vascular endothelium produces antithrombotic prostaglandins, and so by inhibiting COX-2 enzyme, the coxibs promote thrombosis. Rofecoxib and valdecoxib have been withdrawn because of the adverse cardiovascular events they induce. Amongst presently available coxibs cardiovascular risk is highest with enterocoxib and lowest with celecoxib. NSAIDS also increase cardiovascular events, the risk is highest with diclofenac and lowest with naproxen. Paracetamol and corticosteroids induce hypertension, while steroids also adversely affect the ...
The International Journal of Occupational and Environmental Medicine
Background: Despite its excellent psychometric properties, St George's Respiratory Questionna... more Background: Despite its excellent psychometric properties, St George's Respiratory Questionnaire (SGRQ) has not been previously used in measuring respiratory quality of life (RQoL) among traffic police and firefighters who are at risk of poor respiratory health by virtue of their occupations. Objective: To assess and compare the RQoL of the occupationally exposed (firefighters and traffic police) and the occupationally unexposed populations in Penang, Malaysia. Methods: We recruited male traffic police and firefighters from 5 districts of Penang by convenient sampling during June to September 2018. Participants completed the SGRQ. Scores (symptoms, activity, impacts, total) were derived using a scoring calculator. Higher scores indicate poorer RQoL. Univariate and multivariate linear regression models were fitted to explore the relationship of the independent predictive factors with participants' RQoL. Results: We recruited 706 participants—211 firefighters, 198 traffic poli...
Background: Despite its excellent psychometric properties, St George's Respiratory Questionna... more Background: Despite its excellent psychometric properties, St George's Respiratory Questionnaire (SGRQ) has not been previously used in measuring respiratory quality of life (RQoL) among traffic police and firefighters who are at risk of poor respiratory health by virtue of their occupations. Objective: To assess and compare the RQoL of the occupationally exposed (firefighters and traffic police) and the occupationally unexposed populations in Penang, Malaysia. Methods: We recruited male traffic police and firefighters from 5 districts of Penang by convenient sampling during June to September 2018. Participants completed the SGRQ. Scores (symptoms, activity, impacts, total) were derived using a scoring calculator. Higher scores indicate poorer RQoL. Univariate and multivariate linear regression models were fitted to explore the relationship of the independent predictive factors with participants' RQoL. Results: We recruited 706 participants—211 firefighters, 198 traffic poli...
Objectives This qualitative study aims to construct a model of the barriers to smoking cessation ... more Objectives This qualitative study aims to construct a model of the barriers to smoking cessation in the primary care setting. Design Individual in-depth, semistructured interviews were audio-taped, then verbatim transcribed and translated when necessary. The data were first independently coded and then collectively discussed for emergent themes using the Straussian grounded theory method. Participants and setting Fifty-seven current smokers were recruited from a previous smoking related study carried out in a primary care setting in Malaysia. Current smokers with at least one failed quit attempts were included. Results A five-theme model emerged from this grounded theory method. (1) Personal and lifestyle factors: participants were unable to resist the temptation to smoke; (2) Nicotine addiction: withdrawal symptoms could not be overcome; (3) Social cultural norms: participants identified accepting cigarettes from friends as a token of friendship to be problematic; (4) Misconception...
The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing infl... more The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing inflammation and pain. Classical non-steroidal anti-inflammatory drugs (NSAID) inhibit the COX-2 enzyme that produces inflammatory prostaglandins as well as the COX-1 enzyme that produces gastric mucosa protecting prostaglandins. By specifically inhibiting only the COX-2 enzyme, coxibs thus reduce pain but do not damage the gastric mucosa. However, COX-2 at the vascular endothelium produces antithrombotic prostaglandins, and so by inhibiting COX-2 enzyme, the coxibs promote thrombosis. Rofecoxib and valdecoxib have been withdrawn because of the adverse cardiovascular events they induce. Amongst presently available coxibs cardiovascular risk is highest with enterocoxib and lowest with celecoxib. NSAIDS also increase cardiovascular events, the risk is highest with diclofenac and lowest with naproxen. Paracetamol and corticosteroids induce hypertension, while steroids also adversely affect the ...
Background Improvement in medical management has enabled transfusion dependent thalassaemia (TDT)... more Background Improvement in medical management has enabled transfusion dependent thalassaemia (TDT) patients to survive beyond childhood, building families, and contributing to the labour force and society. Knowledge about their adult life would provide guidance on how to support their needs. This study aims to explore the general well-being of adults with TDT, their employment status and challenges. Methods We contacted all regional Thalassaemia societies in Malaysia to invite TDT members aged 18 or over to participate. Participants were also recruited from the two participating hospitals. A self-administered questionnaire including ‘CDC Healthy-days’, WHOQOL-BREF and employment measurements was used. Multiple linear regression models were fitted with associations adjusted for several potential confounders. Results Of the 196 participants, almost half (45%) had comorbidities and 20% suffered multiple types: bone-related (13%), hormonal (12%), cardiac (3%) and infections (2%), resulti...
The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing infl... more The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing inflammation and pain. Classical non-steroidal anti-inflammatory drugs (NSAID) inhibit the COX-2 enzyme that produces inflammatory prostaglandins as well as the COX-1 enzyme that produces gastric mucosa protecting prostaglandins. By specifically inhibiting only the COX-2 enzyme, coxibs thus reduce pain but do not damage the gastric mucosa. However, COX-2 at the vascular endothelium produces antithrombotic prostaglandins, and so by inhibiting COX-2 enzyme, the coxibs promote thrombosis. Rofecoxib and valdecoxib have been withdrawn because of the adverse cardiovascular events they induce. Amongst presently available coxibs cardiovascular risk is highest with enterocoxib and lowest with celecoxib. NSAIDS also increase cardiovascular events, the risk is highest with diclofenac and lowest with naproxen. Paracetamol and corticosteroids induce hypertension, while steroids also adversely affect the ...
Objectives: “Using the CAT assessment tool, what differences and similarities exist between tutor... more Objectives: “Using the CAT assessment tool, what differences and similarities exist between tutors’ scores and students’ self-assessment scores, and between tutors’ scores and simulated patient’s scores, in a communication role-play scenario?” Methods: Two cohorts of medical students, 3rd year and 5th year, 245 in total, 4 tutors of Penang Medical College, and 1 simulated patient assessed independently a communication skills role-play session during a Family Medicine posting. The 14-item 5-point- rating CAT was used. Comparison of tutors’ scores and students’ self-assessment scores, and tutors’ scores and simulated patient’s scores were made. Results: Based on the similarities and differences between students’ self-assessment scores and the tutors’ scores, the students’ communication skills performance can grouped into 4 – those skills where both tutors and students agree the students were competent [CAT2, CAT6] – both of us agree you did well; those skills where students did better...
The International Journal of Occupational and Environmental Medicine
Background: Despite its excellent psychometric properties, St George's Respiratory Questionna... more Background: Despite its excellent psychometric properties, St George's Respiratory Questionnaire (SGRQ) has not been previously used in measuring respiratory quality of life (RQoL) among traffic police and firefighters who are at risk of poor respiratory health by virtue of their occupations. Objective: To assess and compare the RQoL of the occupationally exposed (firefighters and traffic police) and the occupationally unexposed populations in Penang, Malaysia. Methods: We recruited male traffic police and firefighters from 5 districts of Penang by convenient sampling during June to September 2018. Participants completed the SGRQ. Scores (symptoms, activity, impacts, total) were derived using a scoring calculator. Higher scores indicate poorer RQoL. Univariate and multivariate linear regression models were fitted to explore the relationship of the independent predictive factors with participants' RQoL. Results: We recruited 706 participants—211 firefighters, 198 traffic poli...
ObjectivesThis qualitative study aims to construct a model of the barriers to smoking cessation i... more ObjectivesThis qualitative study aims to construct a model of the barriers to smoking cessation in the primary care setting.DesignIndividual in-depth, semistructured interviews were audio-taped, then verbatim transcribed and translated when necessary. The data were first independently coded and then collectively discussed for emergent themes using the Straussian grounded theory method.Participants and settingFifty-seven current smokers were recruited from a previous smoking related study carried out in a primary care setting in Malaysia. Current smokers with at least one failed quit attempts were included.ResultsA five-theme model emerged from this grounded theory method. (1) Personal and lifestyle factors: participants were unable to resist the temptation to smoke; (2) Nicotine addiction: withdrawal symptoms could not be overcome; (3) Social cultural norms: participants identified accepting cigarettes from friends as a token of friendship to be problematic; (4) Misconception: perce...
The International Journal of Occupational and Environmental Medicine
Background: Despite its excellent psychometric properties, St George's Respiratory Questionna... more Background: Despite its excellent psychometric properties, St George's Respiratory Questionnaire (SGRQ) has not been previously used in measuring respiratory quality of life (RQoL) among traffic police and firefighters who are at risk of poor respiratory health by virtue of their occupations. Objective: To assess and compare the RQoL of the occupationally exposed (firefighters and traffic police) and the occupationally unexposed populations in Penang, Malaysia. Methods: We recruited male traffic police and firefighters from 5 districts of Penang by convenient sampling during June to September 2018. Participants completed the SGRQ. Scores (symptoms, activity, impacts, total) were derived using a scoring calculator. Higher scores indicate poorer RQoL. Univariate and multivariate linear regression models were fitted to explore the relationship of the independent predictive factors with participants' RQoL. Results: We recruited 706 participants—211 firefighters, 198 traffic poli...
Jane, 11 years of age, presented to her general practitioner with fever, sore throat and painful ... more Jane, 11 years of age, presented to her general practitioner with fever, sore throat and painful ulcers on her lips. Two weeks earlier, she was admitted to the local hospital after having a second episode of afebrile seizure and was therefore started on carbamazepine CR 200 mg nocte. Magnetic resonance imaging (MRI) and electroencephalogram (EEG) were normal. For the following 8 days, she complained of fatigue and feeling slightly 'woozy' in the head. These symptoms resolved spontaneously and were believed to be side effects of carbamazepine. Three days after that, she complained of sore throat that was associated with low-grade fever. There was no rash on her trunk or limbs. Full blood count, liver function test and electrolytes were all within normal limits. Her fever increased progressively over the next 5 days and her lips became progressively red, swollen and painful.
The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing infl... more The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing inflammation and pain. Classical non-steroidal anti-inflammatory drugs (NSAID) inhibit the COX-2 enzyme that produces inflammatory prostaglandins as well as the COX-1 enzyme that produces gastric mucosa protecting prostaglandins. By specifically inhibiting only the COX-2 enzyme, coxibs thus reduce pain but do not damage the gastric mucosa. However, COX-2 at the vascular endothelium produces antithrombotic prostaglandins, and so by inhibiting COX-2 enzyme, the coxibs promote thrombosis. Rofecoxib and valdecoxib have been withdrawn because of the adverse cardiovascular events they induce. Amongst presently available coxibs cardiovascular risk is highest with enterocoxib and lowest with celecoxib. NSAIDS also increase cardiovascular events, the risk is highest with diclofenac and lowest with naproxen. Paracetamol and corticosteroids induce hypertension, while steroids also adversely affect the ...
The International Journal of Occupational and Environmental Medicine
Background: Despite its excellent psychometric properties, St George's Respiratory Questionna... more Background: Despite its excellent psychometric properties, St George's Respiratory Questionnaire (SGRQ) has not been previously used in measuring respiratory quality of life (RQoL) among traffic police and firefighters who are at risk of poor respiratory health by virtue of their occupations. Objective: To assess and compare the RQoL of the occupationally exposed (firefighters and traffic police) and the occupationally unexposed populations in Penang, Malaysia. Methods: We recruited male traffic police and firefighters from 5 districts of Penang by convenient sampling during June to September 2018. Participants completed the SGRQ. Scores (symptoms, activity, impacts, total) were derived using a scoring calculator. Higher scores indicate poorer RQoL. Univariate and multivariate linear regression models were fitted to explore the relationship of the independent predictive factors with participants' RQoL. Results: We recruited 706 participants—211 firefighters, 198 traffic poli...
Background: Despite its excellent psychometric properties, St George's Respiratory Questionna... more Background: Despite its excellent psychometric properties, St George's Respiratory Questionnaire (SGRQ) has not been previously used in measuring respiratory quality of life (RQoL) among traffic police and firefighters who are at risk of poor respiratory health by virtue of their occupations. Objective: To assess and compare the RQoL of the occupationally exposed (firefighters and traffic police) and the occupationally unexposed populations in Penang, Malaysia. Methods: We recruited male traffic police and firefighters from 5 districts of Penang by convenient sampling during June to September 2018. Participants completed the SGRQ. Scores (symptoms, activity, impacts, total) were derived using a scoring calculator. Higher scores indicate poorer RQoL. Univariate and multivariate linear regression models were fitted to explore the relationship of the independent predictive factors with participants' RQoL. Results: We recruited 706 participants—211 firefighters, 198 traffic poli...
Objectives This qualitative study aims to construct a model of the barriers to smoking cessation ... more Objectives This qualitative study aims to construct a model of the barriers to smoking cessation in the primary care setting. Design Individual in-depth, semistructured interviews were audio-taped, then verbatim transcribed and translated when necessary. The data were first independently coded and then collectively discussed for emergent themes using the Straussian grounded theory method. Participants and setting Fifty-seven current smokers were recruited from a previous smoking related study carried out in a primary care setting in Malaysia. Current smokers with at least one failed quit attempts were included. Results A five-theme model emerged from this grounded theory method. (1) Personal and lifestyle factors: participants were unable to resist the temptation to smoke; (2) Nicotine addiction: withdrawal symptoms could not be overcome; (3) Social cultural norms: participants identified accepting cigarettes from friends as a token of friendship to be problematic; (4) Misconception...
The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing infl... more The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing inflammation and pain. Classical non-steroidal anti-inflammatory drugs (NSAID) inhibit the COX-2 enzyme that produces inflammatory prostaglandins as well as the COX-1 enzyme that produces gastric mucosa protecting prostaglandins. By specifically inhibiting only the COX-2 enzyme, coxibs thus reduce pain but do not damage the gastric mucosa. However, COX-2 at the vascular endothelium produces antithrombotic prostaglandins, and so by inhibiting COX-2 enzyme, the coxibs promote thrombosis. Rofecoxib and valdecoxib have been withdrawn because of the adverse cardiovascular events they induce. Amongst presently available coxibs cardiovascular risk is highest with enterocoxib and lowest with celecoxib. NSAIDS also increase cardiovascular events, the risk is highest with diclofenac and lowest with naproxen. Paracetamol and corticosteroids induce hypertension, while steroids also adversely affect the ...
Background Improvement in medical management has enabled transfusion dependent thalassaemia (TDT)... more Background Improvement in medical management has enabled transfusion dependent thalassaemia (TDT) patients to survive beyond childhood, building families, and contributing to the labour force and society. Knowledge about their adult life would provide guidance on how to support their needs. This study aims to explore the general well-being of adults with TDT, their employment status and challenges. Methods We contacted all regional Thalassaemia societies in Malaysia to invite TDT members aged 18 or over to participate. Participants were also recruited from the two participating hospitals. A self-administered questionnaire including ‘CDC Healthy-days’, WHOQOL-BREF and employment measurements was used. Multiple linear regression models were fitted with associations adjusted for several potential confounders. Results Of the 196 participants, almost half (45%) had comorbidities and 20% suffered multiple types: bone-related (13%), hormonal (12%), cardiac (3%) and infections (2%), resulti...
The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing infl... more The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing inflammation and pain. Classical non-steroidal anti-inflammatory drugs (NSAID) inhibit the COX-2 enzyme that produces inflammatory prostaglandins as well as the COX-1 enzyme that produces gastric mucosa protecting prostaglandins. By specifically inhibiting only the COX-2 enzyme, coxibs thus reduce pain but do not damage the gastric mucosa. However, COX-2 at the vascular endothelium produces antithrombotic prostaglandins, and so by inhibiting COX-2 enzyme, the coxibs promote thrombosis. Rofecoxib and valdecoxib have been withdrawn because of the adverse cardiovascular events they induce. Amongst presently available coxibs cardiovascular risk is highest with enterocoxib and lowest with celecoxib. NSAIDS also increase cardiovascular events, the risk is highest with diclofenac and lowest with naproxen. Paracetamol and corticosteroids induce hypertension, while steroids also adversely affect the ...
Objectives: “Using the CAT assessment tool, what differences and similarities exist between tutor... more Objectives: “Using the CAT assessment tool, what differences and similarities exist between tutors’ scores and students’ self-assessment scores, and between tutors’ scores and simulated patient’s scores, in a communication role-play scenario?” Methods: Two cohorts of medical students, 3rd year and 5th year, 245 in total, 4 tutors of Penang Medical College, and 1 simulated patient assessed independently a communication skills role-play session during a Family Medicine posting. The 14-item 5-point- rating CAT was used. Comparison of tutors’ scores and students’ self-assessment scores, and tutors’ scores and simulated patient’s scores were made. Results: Based on the similarities and differences between students’ self-assessment scores and the tutors’ scores, the students’ communication skills performance can grouped into 4 – those skills where both tutors and students agree the students were competent [CAT2, CAT6] – both of us agree you did well; those skills where students did better...
The International Journal of Occupational and Environmental Medicine
Background: Despite its excellent psychometric properties, St George's Respiratory Questionna... more Background: Despite its excellent psychometric properties, St George's Respiratory Questionnaire (SGRQ) has not been previously used in measuring respiratory quality of life (RQoL) among traffic police and firefighters who are at risk of poor respiratory health by virtue of their occupations. Objective: To assess and compare the RQoL of the occupationally exposed (firefighters and traffic police) and the occupationally unexposed populations in Penang, Malaysia. Methods: We recruited male traffic police and firefighters from 5 districts of Penang by convenient sampling during June to September 2018. Participants completed the SGRQ. Scores (symptoms, activity, impacts, total) were derived using a scoring calculator. Higher scores indicate poorer RQoL. Univariate and multivariate linear regression models were fitted to explore the relationship of the independent predictive factors with participants' RQoL. Results: We recruited 706 participants—211 firefighters, 198 traffic poli...
ObjectivesThis qualitative study aims to construct a model of the barriers to smoking cessation i... more ObjectivesThis qualitative study aims to construct a model of the barriers to smoking cessation in the primary care setting.DesignIndividual in-depth, semistructured interviews were audio-taped, then verbatim transcribed and translated when necessary. The data were first independently coded and then collectively discussed for emergent themes using the Straussian grounded theory method.Participants and settingFifty-seven current smokers were recruited from a previous smoking related study carried out in a primary care setting in Malaysia. Current smokers with at least one failed quit attempts were included.ResultsA five-theme model emerged from this grounded theory method. (1) Personal and lifestyle factors: participants were unable to resist the temptation to smoke; (2) Nicotine addiction: withdrawal symptoms could not be overcome; (3) Social cultural norms: participants identified accepting cigarettes from friends as a token of friendship to be problematic; (4) Misconception: perce...
The International Journal of Occupational and Environmental Medicine
Background: Despite its excellent psychometric properties, St George's Respiratory Questionna... more Background: Despite its excellent psychometric properties, St George's Respiratory Questionnaire (SGRQ) has not been previously used in measuring respiratory quality of life (RQoL) among traffic police and firefighters who are at risk of poor respiratory health by virtue of their occupations. Objective: To assess and compare the RQoL of the occupationally exposed (firefighters and traffic police) and the occupationally unexposed populations in Penang, Malaysia. Methods: We recruited male traffic police and firefighters from 5 districts of Penang by convenient sampling during June to September 2018. Participants completed the SGRQ. Scores (symptoms, activity, impacts, total) were derived using a scoring calculator. Higher scores indicate poorer RQoL. Univariate and multivariate linear regression models were fitted to explore the relationship of the independent predictive factors with participants' RQoL. Results: We recruited 706 participants—211 firefighters, 198 traffic poli...
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