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1.  Determination of Sample Size 
There is a particular importance of determining a basic minimum required ‘n’ size of the sample to recognize a particular measurement of a particular population. This article has highlighted the determination of an appropriate size to estimate population parameters.
PMCID: PMC3561892  PMID: 23386802
determonation; sample size; population parameters
2.  Factors Related to Smoking Habits of Male Adolescents 
Tobacco Induced Diseases  2004;2(3):133-140.
A cross-sectional study was conducted to identify the factors related to smoking habits of adolescents among secondary school boys in Kelantan state, Malaysia. A total of 451 upper secondary male students from day, boarding and vocational schools were investigated using a structured questionnaire. Cluster sampling was applied to achieve the required sample size. The significant findings included: 1) the highest prevalence of smoking was found among schoolboys from the vocational school; 2) mean duration of smoking was 2.5 years; 3) there were significant associations between smoking status and parents' smoking history, academic performance, perception of the health hazards of smoking, and type of school attended. Peer influence was the major reason students gave for taking up the habit. Religion was most often indicated by non-smokers as their reason for not smoking. Approximately 3/5 of the smokers had considered quitting and 45% of them had tried at least once to stop smoking. Mass media was indicated as the best information source for the students to acquire knowledge about negative aspects of the smoking habit. The authors believe an epidemic of tobacco use is imminent if drastic action is not taken, and recommend that anti-smoking campaigns with an emphasis on the religious aspect should start as early as in primary school. Intervention programs to encourage behavior modification of adolescents are also recommended.
doi:10.1186/1617-9625-2-3-133
PMCID: PMC2671541  PMID: 19570279
3.  Factors Related to Smoking Habits of Male Adolescents 
Tobacco Induced Diseases  2004;2(1):13.
A cross-sectional study was conducted to identify the factors related to smoking habits of adolescents among secondary school boys in Kelantan state, Malaysia. A total of 451 upper secondary male students from day, boarding and vocational schools were investigated using a structured questionnaire. Cluster sampling was applied to achieve the required sample size. The significant findings included: 1) the highest prevalence of smoking was found among schoolboys from the vocational school; 2) mean duration of smoking was 2.5 years; 3) there were significant associations between smoking status and parents' smoking history, academic performance, perception of the health hazards of smoking, and type of school attended. Peer influence was the major reason students gave for taking up the habit. Religion was most often indicated by non-smokers as their reason for not smoking. Approximately 3/5 of the smokers had considered quitting and 45% of them had tried at least once to stop smoking. Mass media was indicated as the best information source for the students to acquire knowledge about negative aspects of the smoking habit. The authors believe an epidemic of tobacco use is imminent if drastic action is not taken, and recommend that anti-smoking campaigns with an emphasis on the religious aspect should start as early as in primary school. Intervention programs to encourage behavior modification of adolescents are also recommended.
doi:10.1186/1617-9625-2-13
PMCID: PMC2669457
4.  Correction: Central Corneal Thickness and Intraocular Pressure in Malay Children 
PLoS ONE  2011;6(12):10.1371/annotation/627b0a20-6623-4d46-970a-2f1f2ad0d002.
doi:10.1371/annotation/627b0a20-6623-4d46-970a-2f1f2ad0d002
PMCID: PMC3248572
5.  Central Corneal Thickness and Intraocular Pressure in Malay Children 
PLoS ONE  2011;6(10):e25208.
Background
To determine the mean values for central corneal thickness (CCT) and intraocular pressure (IOP) and the relationship between these values, in healthy Malay children to serve as reference values in diagnosis and treatment.
Design
A cross-sectional study.
Methodology/Principal Findings
One hundred and eight eyes (54 subjects) of Malay children without diagnosis of ocular abnormality or disease meeting our inclusion and exclusion criteria were selected. The CCT and IOP were measured by specular microscopy and non-contact air-puff tonometry respectively, for analysis and comparison with the values obtained in previous studies. Mean CCT and IOP was found to be 530.87±30.79 µm and 15.65±3.05 mm Hg respectively. CCT was found not to vary with age. A positive relationship was found between CCT and IOP; specifically, with every 100-µm increase in CCT, IOP increased by 3.5 mm Hg.
Conclusions/Significance
CCT and IOP are strongly related in healthy Malay children aged 8 to 16. The mean CCT of Malay children is lower than that of majority children of other ethnic groups, supporting the existence of CCT variation among different populations and that ethnicity should be a key consideration when applying CCT data to the general pediatric population.
doi:10.1371/journal.pone.0025208
PMCID: PMC3187772  PMID: 21998644
6.  Effect of rosiglitazone and ramipril on macrovasculopathy in patients with type 2 diabetes: needs longer treatment and/or higher doses? 
Introduction
The aim of the study is to investigate whether standard doses of rosiglitazone (4 mg/daily) and ramipril (5 mg/daily) can reverse pre-clinical macrovasculopathy in newly diagnosed never treated type 2 diabetes (T2DM) patients.
Methods
In this randomized, double-blind, placebo-controlled study, 33 T2DM patients were randomized to rosiglitazone (4 mg/daily) or ramipril (5 mg/daily) or placebo for 1 year. Hemodynamic variables were measured at 3 treatment phases and pulse wave velocity (PWV) and augmentation index (AI) were measured throughout the treatment period.
Result
In diabetic patients, PWV (P = 0.037) and AI (P = 0.005) with ramipril and AI (P < 0.001) with rosiglitazone were significantly reduced during overall treatment period from the baseline; however, these differences were not significant in comparison to placebo.
Discussion and conclusion
The present study showed that treatment with standard doses of rosiglitazone and ramipril are not adequate to reverse pre-clinical vasculopathy in T2DM. The lack of benefit in newly diagnosed T2DM may be because of the relatively short-term intervention and/or the use of lower doses of rosiglitazone/ramipril. Further trials are needed for a longer period of time, possibly with higher doses, to show whether rosiglitazone/ramipril can reverse pre-clinical vasculopathy in T2DM (ClinicalTrials.gov number, NCT00489229).
PMCID: PMC3262381  PMID: 22291490
rosiglitazone; ramipril; diabetic vasculopathy
7.  Angioarchitecture of Brain Arteriovenous Malformations and the Risk of Bleeding: An Analysis of Patients in Northeastern Malaysia 
Background:
Central nervous system arteriovenous malformation (AVM) is a vascular malformation of the brain and involves entanglement of veins and arteries without an intervening capillary bed. Affecting predominantly young male patients, AVM presents with different clinical manifestations namely headache, seizures, neurological deficit and intracranial haemorrhage. The patients who present acutely with intracranial bleeding have a significant morbidity and mortality. The aim is to study the angioarchitecture of brain AVM (BAVM) and determine the risk factors for intracranial bleeding. Ultimately, the goal of the study is to look for the association between volume of haematoma and architecture of BAVM.
Methods:
A cross-sectional study of 58 patients was conducted at the Hospital Universiti Sains Malaysia. Data were collected over a period of seven years (2000 to 2007) to look for the association between the angioarchitecture of brain arteriovenous malformations (BAVM), haemodynamics and the natural history and risk of intracranial haemorrhage.
Results:
BAVM was predominantly found in young male patients in 65.5%. Small nidal size (P-value=0.004), deep location (P-value=0.003) and deep venous drainage (P-value=0.006) were found to be significant factors contributing to intracranial haemorrhage. All patients with coexisting intranidal or prenidal aneurysms presented with intracranial haematoma.
Conclusion:
The angioarchitecture of BAVM like nidal size, deep location and deep venous drainage can predict the risk of intracranial bleeding and can help in the management of high risk patients without any delay. Small sized and deep seated lesions have a diffuse type of intracranial bleed which eventually need more attention to the managing team as diffuse haematoma indicates more insult to brain.
PMCID: PMC3216150  PMID: 22135525
angioarchitecture; brain arteriovenous malformation; intracranial haemorrhage; stroke; neurosciences; neuroradiology
8.  Correlations Between Subdural Empyema and Paraclinical as well as Clinical Parameters amongst Urban Malay Paediatric Patients 
Paediatric subdural empyema is frequently seen in developing Asean countries secondary to rinosinusogenic origins. A cross-sectional analysis on the surgical treatment of intracranial subdural empyema in Hospital Kuala Lumpur (HKL), a major referral center, was done in 2004. A total number of 44 children who fulfilled the inclusion criteria were included into this study. The methods of first surgery, volume of empyema on contrasted CT brain, improvement of neurological status, re-surgery, mortality and morbidity, as well as the demographic data such as age, gender, sex, duration of illness, clinical presentation, probable origin of empyema, cultures and follow-up were studied. Chi-square test was performed to determine the association between surgical methods and the survival of the patients, neurological improvement, clearance of empyema on CT brain, re-surgery and long morbidity among the survivors. If the 20% or more of the cells were having expected frequency less than five, then Fisher’s Exact test was applied. The level of significance was set at 0.05. SPSS version 12.0 was used for data entry and data analysis. There were 44 patients who were less than 18 years. Their mean age was 5.90 ± 6.01 years. There were 30 males (68.2%) and 14 females (31.8%) involved in the study. Malays were majority with 28 (63.6%) followed by Indian 8 (18.2%), Chinese 5 (11.4%) and others 3 (6.8%). The variables which were under interest were gender, race, headache, vomiting, seizures, sign of meningism, cranial nerve palsy, thickness site of abscess, first surgical treatment, improvement in neurological deficit, clearance of CT and whether re-surgery was necessary. All variables were found not to be associated with Henk W Mauser Score for PISDE grading. Comparison between this urban study and a rural setting study by the same corresponding author in the same period on subdural empyema was done. Common parameters were compared and it was found out that seizures were more prevalent in urban study where the patients are more than one year old (p=0.005). Mortality was much higher in urban study than the rural one (p=0.040). The larger proportion of urban group had volume of abscess less than or equal to 50 ml (p=< 0.001).
PMCID: PMC3341917  PMID: 22589634
Subdural empyema; paediatric; urban; rural; management
9.  Delayed Traumatic Intracranial Haemorrhage and Progressive Traumatic Brain Injury in a Major Referral Centre Based in a Developing Country 
A repeat Computer Tomographic (CT) brain after 24–48 hours from the 1st scanning is usually practiced in most hospitals in South East Asia where intracranial pressure monitoring (ICP) is routinely not done. This interval for repeat CT would be shortened if there was a deterioration in Glasgow Coma Scale (GCS). Most of the time the prognosis of any intervention may be too late especially in hospitals with high patient-to-doctor ratio causing high mortality and morbidity. The purpose of this study was to determine the important predictors for early detection of Delayed Traumatic Intracranial Haemorrhage (DTICH) and Progressive Traumatic Brain Injury (PTBI) before deterioration of GCS occurred, as well as the most ideal timing of repeated CT brain for patients admitted in Malaysian hospitals. A total of 81 patients were included in this study over a period of six months. The CT scan brain was studied by comparing the first and second CT brain to diagnose the presence of DTICH/PTBI. The predictors tested were categorised into patient factors, CT brain findings and laboratory investigations. The mean age was 33.1 ± 15.7 years with a male preponderance of 6.36:1. Among them, 81.5% were patients from road traffic accidents with Glasgow Coma Scale ranging from 4 – 15 (median of 12) upon admission. The mean time interval delay between trauma and first CT brain was 179.8 ± 121.3 minutes for the PTBI group. The DTICH group, 9.9% of the patients were found to have new intracranial clots. Significant predictors detected were different referral hospitals (p=0.02), total GCS status (p=0.026), motor component of GCS (p=0.043), haemoglobin level (p<0.001), platelet count (p=0.011) and time interval between trauma and first CT brain (p=0.022). In the PTBI group, 42.0% of the patients were found to have new changes (new clot occurrence, old clot expansion and oedema) in the repeat CT brain. Univariate statistical analysis revealed that age (p=0.03), race (p=0.035), types of admission (p=0.024), GCS status (p=0.02), pupillary changes (p=0.014), number of intracranial lesion (p=0.004), haemoglobin level (p=0.038), prothrombin time (p=0.016) as the best predictors of early detection of changes. Multiple logistics regression analysis indicated that age, severity, GCS status (motor component) and GCS during admission were significantly associated with second CT scan with changes. This study showed that 9.9% of the total patients seen in the period of study had DTICH and 42% had PTBI. In the early period after traumatic head injury, the initial CT brain did not reveal the full extent of haemorrhagic injury and associated cerebral oedema. Different referral hospitals of different trauma level, GCS status, motor component of the GCS, haemoglobin level, platelet count and time interval between trauma and the first CT brain were the significant predictors for DTICH. Whereas the key determinants of PTBI were age, race, types of admission, GCS status, pupillary changes, number of intracranial bleed, haemoglobin level, prothrombin time and of course time interval between trauma and first CT brain. Any patients who had traumatic head injury in hospitals with no protocol of repeat CT scan or intracranial pressure monitoring especially in developing countries are advised to have to repeat CT brain at the appropriate quickest time .
PMCID: PMC3341922  PMID: 22589639
delayed; intracranial; haemorrhage; progressive brain injury; computer tomographic scan
10.  Prevalence and Ethnic Distribution of Helicobacter Pylori Infection Among Endoscoped Patients in North Eastern Peninsular Malaysia 
Objective:
The objective of this study was to determine the prevalence and ethnic distribution of Helicobacter pylori infection in an endoscoped population in North Eastern Peninsular Malaysia.
Methods:
Pathology records of 400 consecutive gastric biopsies received at the pathology laboratory in a university hospital were reviewed. Demographic data of patients including their ethnic groups were documented. Evidence of gastritis and H. pylori infection were ascertained by routine histology and Warthin Starry stain. Univariate and multivariate analysis were applied to determine the prevalence of H. pylori infection in the sampled population and the difference in prevalence among the ethnic groups.
Results:
The overall H. pylori infection prevalence rate was unusually low at 13.5% (54 of 400) in this region. The prevalence among the races were as follows: Malay 6.6% (17/256), Chinese 24.1% (27/112) and Indian 28.6% (6/21). Gender and age were not significant associated factors for H. pylori infection. However there was an increased risk of H. pylori infection in Chinese (OR= 4.46, 95%CI, 2.3–8.6) and Indians (OR=5.6, 95%CI, 1.9–16.3) compared to Malays.
Conclusion:
The difference in prevalence of H. pylori infection between the three major ethnic groups concurs with other studies done in Malaysia. The reason for this interesting finding is uncertain and is suspected to be due to different environmental, genetic and socio-cultural practices in the various races.
PMCID: PMC3561889  PMID: 23386799
low H. pylori prevalence; ethnic difference; Malaysia
11.  Adolescent’s Attitudes Towards Health Warning Message on Cigarette Packs 
A total of 190 secondary four male school students from three schools in Kota Bharu were surveyed on their smoking habits and their attitudes towards the health warning messages on cigarette packs. There were 57 (30.0%) students who were current smokers, 45 (23.7%) students who were ex-smokers and 88 (46.3%) students who have never smoked cigarettes. Nearly all current and ex-smokers (95.1%) as well as non-smokers (94.3%) knew the wording of the health warning message currently displayed on cigarette packs. Almost all the students (95.3%) also knew where the warning message was placed. There were more ex-smokers and non-smokers (70.5%) compared to current smokers (50.0%) who felt that there should be different health warning messages and each should be displayed concurrently on different cigarette packs. The students felt that the current health message was not effective to motivate smokers to quit (score=2.25). Alternative messages which the students felt may be more effective were ‘Smoking is dangerous for pregnancy’ (score = 3.3), ‘Cigarette smoke is dangerous for your child’ (score=3.11) and ‘Smoking can kill you’ (score=3.08). The current health message “Smoking is dangerous for your health’ is eighth with a score of only 2.64. The students felt that the least effective message was ‘Cigarettes are drugs’ (score=2.22). Most of the students (80.0%) felt that the health warning message should be placed at the front instead of on the side of the cigarette pack to be more effective.
PMCID: PMC3433959  PMID: 22973151
smoking; health messages; adolescents; Kota Bharu
12.  Absence of Ras, c-myc and Epidermal Growth Factor Receptor (EGFR) Mutations in Human Gliomas and its Clinical Factors Associated with Pathological Grading After Six Years of Diagnosis in North East Malaysian Patients 
Neoplastic transformation appears to be a multi-step process in which the normal controls of cell proliferation and cell-cell interaction are lost, thus transforming normal cells into cancer. The tumorigenic process involves the interplay between oncogenes and tumour suppressor genes. In this study, we have selected the ras family, c-myc and epidermal growth factor receptor (EGFR) genes to detect whether their abnormalities are associated with the expression and progression of glioma cases in Malay patients. We have used the polymerase chain reaction-single stranded conformation polymorphism followed by direct sequencing for the study. For the ras gene family, we screened the point mutations in codons 12 and 61 of the H-, K-, and N-ras gene; for EGFR and c-myc, we analyzed only the exon 1 in glioma samples. In mutational screening analyses of the ras family, c-myc and EGFR gene, there was no mobility shift observed in any tumour analyzed. All patterns of single stranded conformation polymorphism (SSCP) band observed in tumour samples were normal compared to those in normal samples. The DNA sequencing results in all high-grade tumours showed that all base sequences were normal. All 48 patients survived after five years of treatment. In simple logistic regression analysis, variables which were found to be significant were hemiplegia (p=0.047) and response radiotherapy (p=0.003). Hemiplegics were 25 times more likely to have high pathological grade compared to those without. Patients with vascular involvement were 5.5 times more likely to have higher pathological grade. However, these findings were not significant in multivariate analysis. Patients who had radiotherapy were nearly 14 times more likely to have higher pathological grade. Multivariate analysis revealed that patients with hemiplegia were more likely to have higher pathological grade (p= 0.008). Those with higher pathological grading were 80 times more likely to have radiotherapy (p=0.004).
PMCID: PMC3349398  PMID: 22605955
Ras gene; c-myc; EGFR; Gliomas; Malaysia

Results 1-12 (12)