DEPRESSION AND ITS ASSOCIATED FACTORS AMONG SECONDARY SCHOOL STUDENTS IN MALAYSIA.

Research in the field of factors associated with depression among adolescents is lacking in Malaysia. The aims of the present study were to assess the current prevalence of depression and its related factors among secondary school students in Pasir Gudang, South Malaysia. In this cross sectional study, 2,927 secondary school students (13-17 years old) from urban areas were screened for symptoms of mental disorder as well as demographic and risk behaviors using a validated Depression, Anxiety and Stress Scale (DASS) 12 questionnaire. The majority of the respondents (53.8%) were Malay, of which 53.1% were female. Symptoms of mild depression were found in 33.2% of the respondents, while the prevalence of the symptoms of moderate, severe, and extremely severe depression was 21.5%, 18.1%, and 3.0%, respectively. Logistic regression suggested that participants who were Chinese or had a lower average grade were three times more likely to have depression, while those who came from a single-parent family were twice as likely to have this condition. This study indicated that academic performance and risk behaviors along with the demographic characteristics are important contributors to adolescent depression.

Pharmacological management of dilated cardiomyopathy in Duchenne muscular dystrophy: A systematic review.

Duchenne muscular dystrophy is a fatal X-linked recessive disease affecting approximately 1 in 3500 births. It is characterized by a genetic lack of dystrophin, which is an essential protein for maintaining muscle integrity. The lack of dystrophin plays a pathophysiological role in the development of dilated cardiomyopathy in Duchenne muscular dystrophy. Currently, no consensus exists on specific pharmacological therapy guidelines for these patients; however, it centers around the guidelines for heart failure management. This systematic review investigated 12 randomized control trials dating back to 2005 in the pharmacotherapy of patients with dilated cardiomyopathy Duchenne muscular dystrophy. This review specifically included angiotensin-converting enzyme inhibitors, aldosterone receptor blockers, angiotensin receptor/neprilysin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists. Despite their limitations, these studies have shown promising effects in improving the overall heart function and prognosis in patients with this condition. However, to attain higher statistical significance, future studies should investigate larger populations and for longer periods.

Management of psychosis associated with a prolactinoma: case report and review of the literature.

BACKGROUND: Prolactinomas are the most common pituitary tumors; they are treated with dopamine agonists, which may cause psychotic symptoms as a side effect. Psychosis is treated with dopamine-receptor blockers that may result in elevated serum prolactin and symptomatic hyperprolactinemia. OBJECTIVE: The authors will review a case of a patient with a prolactinoma as well as schizophrenia and illustrate the management of psychosis in this case. METHOD: The review describes the management of prolactinoma, symptoms of hyperprolactinemia, and long-term effects of hyperprolactinemia. RESULTS: In the case presentation reviewed, the patient was finally discharged on risperidone long-acting injection and testosterone supplementation, with no growth of the adenoma after 3 years. DISCUSSION: This review provides recommendations and treatment strategy for management of prolactinoma in a patient with schizophrenia.

Harlequin Colour Change.

Harlequin colour change (HCC) is a rare, benign and transient colour change presenting in normal healthy neonates in initial days of life and resolves spontaneously. It is thought to be due to hypothalamic immaturity, leading to capillary bed dysregulation. Gravity might also play a role, as this is apparent on the dependent side. It is important for physicians to recognize this phenomenon so that they do not order any irrelevant investigations. Here, we present a case of a healthy neonate who had HCC, which was unilateral, well demarcated erythema, with patchy pallor. Baby was vitally stable at that time. This colour change was observed twice and each time resolved within 20 minutes of its appearance and was not observed again to date (after 20 days). Baby was discharged in a stable condition after 48 hours of life.

Legal, financial, and public health consequences of HIV contamination of blood and blood products in the 1980s and 1990s.

Ensuring the safety of the blood supply connects politics and science. The business and service sectors share responsibility for the collection and processing of blood donations, and government agencies perform regulatory and surveillance roles. The onset of the AIDS epidemic has challenged the interface among these systems, leading to widespread fears about compromised safety of the blood supply. Because of public concern about blood-supply decisions made in the 1980s, developed countries in the 1990s established reimbursement programs for persons with transfusion-acquired viral infections from blood or blood products, adopted diagnostic tests and procedures that improved the safety of the blood supply, and held criminal judicial investigations of government officials and industry leaders accused of delaying implementation of potential blood-safety measures. In contrast, developing countries continue to struggle with blood-supply safety issues. This paper summarizes the current status of these safety concerns in developed countries, where viral transmission from contaminated blood or blood products is extremely rare, and in developing countries, where up to 10% of HIV infections result from transfusion of blood or blood products.

Relationship between health insurance and medical care for patients hospitalized with human immunodeficiency virus-related Pneumocystis carinii pneumonia, 1995-1997: Medicaid, bronchoscopy, and survival.

In the late 1980s, Medicaid-insured human immunodeficiency virus (HIV)-infected patients with Pneumocystis carinii pneumonia (PCP) were 40% less likely to undergo diagnostic bronchoscopy and 75% more likely to die than were privately insured patients, whereas rates of use of other, less resource-intensive aspects of PCP care were similar. We reviewed 1395 medical records at 59 hospitals in 6 cities for the period 1995-1997 to examine the impact of insurance status on PCP-related care. Medicaid patients were only one-half as likely to undergo diagnostic bronchoscopy as were privately insured patients, yet we found no evidence that mortality was greater among patients who received empirical treatment. The bronchoscopy rates were primarily related to patients' personal insurance status. A weaker hospital-level effect was seen that was related to hospitals' Medicaid/private insurance case mix ratios. The situation has evolved from one in which Medicaid coverage was associated with underuse of bronchoscopy and poorer survival among empirically treated persons with HIV-related PCP to one in which empirical therapy is effective in treating this disease and expensive diagnostic procedures may be overused for privately insured patients.

HIV-related pneumonia care in older patients hospitalized in the early HAART era.

Age-related variations in care have been identified for HIV-associated Pneumocystis carinii pneumonia (PCP) in both the 1980s and 1990s. We evaluated if age-related variations affected all aspects of HIV-specific and non-HIV-specific care for HIV-infected individuals with PCP or community-acquired pneumonia (CAP), or whether age-related variations were primarily limited to HIV-specific aspects of care. Subjects were HIV-infected persons with PCP (n = 1855) or CAP (n = 1415) hospitalized in 8 cities from 1995 to 1997. Nine percent of our study patients had received protease inhibitors and 39% had received any type of antiretroviral therapy prior to hospitalization. Data were abstracted from medical records and included severity of illness, HIV-specific aspects of care (initiation of PCP medications), general measures of care [initiation of CAP medications, intubation, and intensive care units (ICU)], and inpatient mortality. Compared to younger patients, pneumonia patients 50 years of age or older were significantly more likely to: be severely ill (PCP, 20.4% vs. 10.4%; CAP, 27.5% vs. 14.9%; each p = 0.001), receive ICU care (PCP, 22.0% vs. 12.8%, p = 0.002; CAP: 15.1% vs. 9.4%; p = 0.02), and be intubated (PCP, 14.6% vs. 8.4%, p = 0.01; CAP, 9.9% vs. 5.6%, p = 0.03). Compared to younger patients, older patients (>/=50 years) had similar rates of timely medications for CAP (48.5% vs. 50.8%) but had lower rates of receiving anti-PCP medications (85.8% vs. 92.9%, p = 0.002). Differences by age in timely initiation of PCP medications, ICU use, and intubation were limited to the nonseverely ill patients. Older hospitalized patients were more likely to die (PCP, 18.3% vs. 10.4%; CAP, 13.4% vs. 8.5%; each p < 0.05). After adjustment for disease severity and timeliness of antibiotic use, mortality rates were similar for both age groups. Physicians should develop strategies that increase awareness of the possibility of HIV infection in older individuals.