Search

Little is known about the perceptions of harm and benefit associated with the use of e-cigarettes in Malaysia. This was a cross-sectional analysis of a nationally representative sample comprising 1987 males (≥18 years of age). Current, former, and never users of conventional cigarettes and/or e-cigarettes participated in a questionnaire study conducted via face-to-face interviews. The relationship between participant characteristics and perceptions of harm and benefit of e-cigarettes were determined with multivariable logistic regression. There were 950 current, 377 former, and 660 never users of e-cigarettes. Government employees (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.29-2.66, P = .001), private sector employees (OR = 1.67, 95% CI = 1.27-2.18, P = .001), and the self-employed people (OR = 1.68, 95% CI = 1.31-2.17, P = .001) were more likely to perceive e-cigarettes as more harmful than conventional cigarettes compared with respondents who were not wage earners. All current users in the form of e-cigarette users (OR = 7.87, 95% CI = 3.23-19.18), conventional cigarette smokers (OR = 1.80, 95% CI = 1.39-2.33), and dual users (OR = 8.59, 95% CI = 4.76-15.52) were more likely to perceive e-cigarettes as useful in quitting conventional cigarette smoking compared with former and never users. Our findings constitute an important snapshot into the perceptions of e-cigarette harms and benefits, which could inform targeted public health messaging strategies.

The public health burden of dengue is most likely under reported. Current dengue control measures only considered symptomatic dengue transmission. Hence, there is a paucity of information on the epidemiology of inapparent dengue. This study reports that many people have been unknowingly exposed to dengue infection. Almost 10% and 70% of individuals without any history of dengue infection and living in a dengue hotspot, in Selangor, Malaysia, were dengue IgM and IgG positive respectively. When dengue-positive mosquitoes were detected in the hotspot, 11 (6.3%) of the 174 individuals tested were found to have dengue viremia, of which 10 were asymptomatic. Besides, upon detection of a dengue-infected mosquito, transmission was already widespread. In a clinical setting, it appears that people living with dengue patients have been exposed to dengue, whether asymptomatic or symptomatic. They can either have circulating viral RNA and/or presence of NS1 antigen. It is also possible that they are dengue seropositive. Collectively, the results indicate that actions taken to control dengue transmission after the first report of dengue cases may be already too late. The current study also revealed challenges in diagnosing clinically inapparent dengue in hyperendemic settings. There is no one best method for diagnosing inapparent dengue. This study demonstrates empirical evidence of inapparent dengue in different settings. Early dengue surveillance in the mosquito population and active serological/virological surveillance in humans can go hand in hand. More studies are required to investigate the epidemiology, seroprevalence, diagnostics, and control of inapparent dengue. It is also crucial to educate the public, health staff and medical professionals on asymptomatic dengue and to propagate awareness, which is important for controlling transmission.

The elbow is composed of three bones namely humerus, ulna and radius which their movements are provided by three separate joints: ulnohumeral joint, radioulnar joint and radiohumeral joint. Rheumatoid arthritis is one of the most common causes of elbow arthritis. Three major events, i.e., proliferative synovitis, destruction of articulation cartilage and destruction of medial and lateral collateral ligament complexes are observed during the progression of this disease. Finite element analysis method has been shown to be a reliable tool for investigative purposes. The aim of the present study was to determine the disease progression of rheumatoid arthritis disease involving the elbow. An elbow affected by rheumatoid arthritis was simulated incorporating the three previously described characteristics. Three dimensional of healthy and rheumatoid arthritis elbow bones were constructed. The models were analyzed using computational software. Bones, ligaments and cartilages were considered linear and therefore were categorized as isotropic materials. The distal humerus was fixed while the values of muscle force used in this study were obtained from previous experiments. Result showed changes in the biomechanical behavior of rheumatoid elbow as compared to healthy elbow. In both elbow models, the stress distribution was in the region of the proximal ulna: an average of 17.5 Mpa in the rheumatoid elbow and 2.5 Mpa in the healthy elbow. However in the cancellous bones, rheumatoid elbow experienced stress distribution of 4 Mpa on average, while in the healthy elbow the magnitude of stress was on average 3 Mpa. CONCLUSION: The present study demonstrates that the rheumatoid elbow joint model is subjected to higher stresses as compared to healthy elbow joint.

Malaysia, with a population of 28.25 million, consists of Peninsular Malaysia and the Borneo states of Sarawak and Sabah. Substance abuse has been prevalent in Malaysia since the 19th century. In the early 20th century, the main drug of abuse was opium, which was primarily restricted to Chinese and Indian immigrant laborers who were introduced by British colonialists to work in Malaya (Noorzurani et al., 2008). However, the pattern of consumption changed in the 1970s when heroin became the abused substance of choice and Malays were the main ethnic group involved in heroin abuse compared to other ethnic groups, namely the Chinese and Indians (Noorzurani et al., 2008; Rusdi et al., 2008). By the 1980s, heroin use among Malaysian youth reached national crisis proportions (Navaratnam, 1988; Chawarski et al., 2006). A total of 194,897 drug dependents were registered by the National Anti-Drug Agency (NADA) in 1988; however, at the end of 2004, the numbers of drug dependents were estimated to be between 202,075 and 607,647 (Mahmood et al., 2005). By 2009, the cumulative number of confirmed drug addicts exceeded 300,000 (Sangeeth et al., 2009; Narayanan et al., 2011).

Background: The transition of drug policy from prohibition to harm reduction has never been easy. The deeply entrenched belief in prohibition shared by policy makers and religious leaders provided little room for alternatives, and change came only slowly. The non-governmental organisations (NGOs) in Malaysia played a pivotal role in effecting such a change. Understanding how they did so may be instructive for other similarly placed countries. Methods: Data collected via reviews of published secondary sources, media reports and in-depth interviews with pioneers of harm reduction drawn from NGOs, medical practitioners and the police were analysed to construct the paper. Results: The policy change was the outcome of competition between three groups in the drug policy subsystem - the state, the Muslim religious lobby and the NGOs. Developments such as the poor outcomes from the prohibition programmes and the outbreak of HIV/AIDS did not change policy but did lead to a rethink of core beliefs in the state alliance and spawned a state-NGO partnership. The subsequent failure to meet the Millennium Development Goal with respect to HIV/AIDS in 2005 - was seen as a failure of the Health Ministry which then led the final charge for a policy change arguing that a health crisis was imminent. The NGOs played a pivotal role in this process by educating their partners in the state coalition, by drawing academics and medical practitioners into advocacy and by engaging the religious lobby (albeit with varying success). They were also frontline players in implementing harm reduction programmes and successfully deflected criticisms from unconvinced Islamic groups away from the state. Conclusion: Given their central role in the needle-syringe exchange programme, the NGOs are well positioned to convince injecting drug users to opt for voluntary medical treatment. This can potentially reduce both the harm from drug use and the prevalence of it. (C) 2011 Elsevier B.V. All rights reserved. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.

Background: The transition of drug policy from prohibition to harm reduction has never been easy. The deeply entrenched belief in prohibition shared by policy makers and religious leaders provided little room for alternatives, and change came only slowly. The non-governmental organisations (NGOs) in Malaysia played a pivotal role in effecting such a change. Understanding how they did so may be instructive for other similarly placed countries. Methods: Data collected via reviews of published secondary sources, media reports and in-depth interviews with pioneers of harm reduction drawn from NGOs, medical practitioners and the police were analysed to construct the paper. Results: The policy change was the outcome of competition between three groups in the drug policy subsystem - the state, the Muslim religious lobby and the NGOs. Developments such as the poor outcomes from the prohibition programmes and the outbreak of HIV/AIDS did not change policy but did lead to a rethink of core beliefs in the state alliance and spawned a state-NGO partnership. The subsequent failure to meet the Millennium Development Goal with respect to HIV/AIDS in 2005 - was seen as a failure of the Health Ministry which then led the final charge for a policy change arguing that a health crisis was imminent. The NGOs played a pivotal role in this process by educating their partners in the state coalition, by drawing academics and medical practitioners into advocacy and by engaging the religious lobby (albeit with varying success). They were also frontline players in implementing harm reduction programmes and successfully deflected criticisms from unconvinced Islamic groups away from the state. Conclusion: Given their central role in the needle-syringe exchange programme, the NGOs are well positioned to convince injecting drug users to opt for voluntary medical treatment. This can potentially reduce both the harm from drug use and the prevalence of it.

The growing use of illicit ketamine among young adults poses a public health concern in Malaysia. In contrast to medical use of ketamine, illicit use has been reported to produce adverse effects on the urinary tract and, in particular the bladder. This case report describes a young Malay woman who developed severe bladder symptoms (urinary frequency) after consuming illicit ketamine. A history of illicit ketamine use was initially missed, and she was consequently diagnosed and treated for a urinary tract infection. Her symptoms persisted despite several courses of antibiotics. The patient was subsequently referred to an urologist where cystoscopic examination and biopsy of the bladder found changes consistent with interstitial cystitis. This was despite the absence of haematuria. Renal function was normal. The patient's ketamine use was the most likely cause for the urinary symptoms and bladder changes. Illicit ketamine use may lead to severe urinary tract problems that can be irreversible even after ketamine has ceased. Early diagnosis is critical although difficult when ketamine use is not divulged during the consultation with the physician. Physician consideration of this new clinical entity is important, particularly in cases where the symptoms do not resolve with usual treatment.

Issues. Methadone, a pharmacological agent used to treat heroin dependence is relatively safe, but may cause cardiac arrhythmias in the concurrent presence of other risk factors. Approach and Key Findings. This case report highlights the risk of Torsade de Pointes, a life-threatening cardiac arrhythmia, in a heroin-dependent patient receiving methadone substitution therapy who was prescribed itraconazole for vaginal thrush. The patient presented to the accident and emergency department for chest discomfort and an episode of syncope following two doses of itraconazole (200 mg). Electrocardiogram monitoring at the accident and emergency department showed prolonged rate-corrected QT interval leading to Torsade de Pointes. The patient was admitted for cardiac monitoring, and electrocardiogram returned to normal upon discontinuation of methadone. Implication. This cardiac arrhythmia was most likely as a result of a drug interaction between methadone and itraconazole because the patient presented with no other risk factors. Conclusion. Given the benefits of methadone as a substitution treatment for heroin-dependent individuals, the association between methadone and cardiac arrhythmias is of great concern. Physicians treating heroin-dependent patients on methadone substitution therapy should therefore be cautious of the potential risk of drug interactions that may lead to fatal cardiac arrhythmias.

Despite being a common skin dermatosis in the tropics, physicians in the tropics may miss the diagnosis of cutaneous larva migrans for other pruritic skin manifestation. This is especially in those who live in urban housing with no history of travel. Cutaneous larva migrans, an intensely pruritic skin pathology is mainly contracted by people with history of beach holiday or contact with moist soft sand which had been contaminated with dog or cat faeces. This article reports a patient who presented with intensely itchy papular spots over the dorsum of his foot after walking barefooted in an urban toilet soiled with cat faeces. The patient had initially seen an urban general practitioner who diagnosed the papular skin lesion as an allergic reaction, and prescribed antihistamines. The patient subsequently developed creeping skin lesions and was seen by the author who prescribed albendazole 400 mg twice daily for three days. The patient reported reduction in itching after two days of albendazole treatment and a follow up at ten days revealed a healed infection.

There is a growing trend of methamphetamines use in Asia-Pacific region. This has affected many new drug users. There are closed link between methamphetamine use and mental illness. Dual diagnosis among users are very common. It is a common encounter in clinical practices patients who took methamphetamines presented with psychotic disorders. Persecutory delusions and tactiles hallucination are common phenomena in this group of patients. These have contributed increase in aggressiveness among methamphetamines users too. In addition to psychotic, mood symptoms may also be parts of its presentation. Reduced sleep and high risk behaviour are among the known effects of methamphetamines use. In the case of methamphetamines dependence, there are users who experience dysphoric mood. This experiences may mimic the presentation in major depressive disorders. In this presentation, more details of these linkage between methamphetamines use are described.In conclusion the complexity of mental illness and methamphetamines use would need comprehensive assessment among methamphetamines users. Challenges in effective management of methamphetamines include to address both mental illness and methamphetamines abuse.

IntroductionIn Malaysia, MMT started with low regulated model since year 2002 to address increasing prevalence of HIV/AIDS among intravenous drug users. However, fear of widespread diversion and overdose death forced the government to implement high regulated MMT model. Universiti Malaya conducted both model among self-sponsored(low supervision) and government-sponsored(high supervison) program.ObjectivesTo investigate the biodemographic profiles, psychosocial correlates, pattern of substance use, methadone dosing and client satisfaction level among the two groups.MethodsWe conducted a cross sectional study involving 50 clients from each model. The inclusion criteria inludes opiates dependents age > 18 years and above with written consent using convenience sampling from October to December 2008. Semistructured questionare for demographic and pattern of substance use interview, MINI Neuropsychiatric interview for psychiatric morbidity and CSQ-8 for client satisfaction measurement. Analysis was done using SPSS version 16.ResultsAll the participants are males with the mean age of 40 years. 61% are married and 90% are employed during the interview. 80% received MMT more than one year and 65% achieved maintenance dose more than 50mg daily. 68% used substance more than 10 years prior to the MMT and 73% starts using heroin below age of 20 years old. 57% have comorbid psychiatric illness(anti-social personality, major depression and psychotic disorders) and 33% have medical illness(HIV+, Hepatitis B/C and tuberculosis). There were no significance difference in demographic profiles, pattern of substance use, psychiatric/medical comorbidities and clients satisfasfaction level between the two groups.ConclusionBoth group are similar from the clients satisfaction perpectives.

The history of substance abuse in Malaysia can be divided into pre- and post-independent era. In preindependence, the main drug of abuse was opium which was initially consumed by immigrants from China who were introduced by the British colonialist to work in Malaya. The post-independence era began in the 1960s when young adults were influenced by the “Hippy” subculture. At this time, consumption patterns changed where more Malays were involved in drug abuse compared to other ethnic groups (1, 2).By the early 1980s, the prevalence of drug addiction increased and this increasing trend made the Malaysian government consider heroin addiction as a national threat. The national anti-drug task force was formed to control trafficking and to rehabilitate addicts who were involved in heroin addiction (3). Legislation was introduced where mandatory death sentence was implemented for those who smuggled more than 15 grams of heroin. Drug addicts found to be positive for heroin were forced to undergo compulsory rehabilitation for two years (4). Nationwide, up to 28 government drug rehabilitation centers were established, and at any particular period, each center accommodated up to 500 inmates. Approximately RM50 million a year was spent to run these centers (5). The centers were initially managed on a total abstinence philosophy; however this approach produced poor results. The latest survey showed that 85% of drug addicts relapsed after completing their rehabilitation at these centers (4, 6). In view of the poor results, substitute treatment with methadone was introduced recently to these centers (7).One of the visions of the Malaysian government was to create a drug addiction free nation by the year 2015. However, the increasing number of drug addicts has caused a surge in demand for rehabilitation centers, resulting in the inability of these centers to cope. For example, the number of drug addicts increased by 1% from year 2001 to 2002, but the number of drug addicts detected in year 2003 was 36,996, a 16% jump from the previous year (31,893). Furthermore, the National Drug Agency reported that 45% of the cases were repeat addicts. As for distribution of new cases, by ethnic group the Malays constituted 71%, Chinese 10.6% and Indian 8.2%. The majority (70%) were in the socially and economically most productive age group (20-39 years) and almost 98% of the addicts who occupied these rehabilitation centers were male. Currently, the number of drug users in the country is estimated to be 250,000 but the number is predicted to reach half a million by year 2015 (3, 8-10). The resulting economic, human resource and social loss is not quantifiable as the vacuum left by these people in various employment sectors are currently being filled by migrant workers. Thus, it is evident that the increasing trend in drug addiction poses a threat to the future of the nation (1, 6, 9).