RESUMO
BACKGROUND: Leptospirosis, commonly known as rat-urine disease, is a global but endemic zoonotic disease in the tropics. Despite the historical report of leptospirosis in Malaysia, the information on human-infecting species is limited. Determining the circulating species is important to understand its epidemiology, thereby to strategize appropriate control measures through public health interventions, diagnostics, therapeutics and vaccine development. METHODOLOGY/PRINCIPLE FINDINGS: We investigated the human-infecting Leptospira species in blood and serum samples collected from clinically suspected leptospirosis patients admitted to three tertiary care hospitals in Malaysia. From a total of 165 patients, 92 (56%) were confirmed cases of leptospirosis through Microscopic Agglutination Test (MAT) (n = 43; 47%), Polymerase Chain Reaction (PCR) (n = 63; 68%) or both MAT and PCR (n = 14; 15%). The infecting Leptospira spp., determined by partial 16S rDNA (rrs) gene sequencing revealed two pathogenic species namely Leptospira interrogans (n = 44, 70%) and Leptospira kirschneri (n = 17, 27%) and one intermediate species Leptospira wolffii (n = 2, 3%). Multilocus sequence typing (MLST) identified an isolate of L. interrogans as a novel sequence type (ST 265), suggesting that this human-infecting strain has a unique genetic profile different from similar species isolated from rodents so far. CONCLUSIONS/SIGNIFICANCE: Leptospira interrogans and Leptospira kirschneri were identified as the dominant Leptospira species causing human leptospirosis in Central Malaysia. The existence of novel clinically important ST 265 (infecting human), that is different from rodent L. interrogans strains cautions reservoir(s) of these Leptospira lineages are yet to be identified.
Assuntos
Leptospira interrogans/isolamento & purificação , Leptospira/classificação , Leptospira/isolamento & purificação , Leptospirose/epidemiologia , Leptospirose/microbiologia , Adulto , Testes de Aglutinação , Animais , Feminino , Genes Bacterianos/genética , Humanos , Leptospira/genética , Leptospira/patogenicidade , Leptospira interrogans/genética , Leptospira interrogans/patogenicidade , Leptospirose/sangue , Leptospirose/urina , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Tipagem de Sequências Multilocus , Reação em Cadeia da Polimerase , RNA Ribossômico 16S/genética , Doenças dos Roedores , Roedores , Análise de Sequência de DNA , Testes Sorológicos , Adulto Jovem , ZoonosesRESUMO
BACKGROUND: The dawn of m-Health facilitates new horizons of professional communication through WhatsApp, allowing health professionals to interact fast and efficiently for effective patient management. This preliminary study aimed to investigate perceived benefits, if any, of WhatsApp use across general medical and emergency teams during clinical practice in Malaysia. METHODS: A cross-sectional study was conducted in a universal sample of 307 health professionals comprising of nurses, medical assistants, medical residents, medical officers and physicians across medical and casualty departments in a Malaysian public hospital. The self-administered questionnaire consisted of items on socio-demographics, WhatsApp usage characteristics and the type of communication events during clinical practice. RESULTS: The majority of respondents (68.4%) perceived WhatsApp as beneficial during clinical practice. In multivariate analysis, perceived benefits was significantly higher amongst the clinical management group (aOR=2.6, 95% CI 1.5-4.6, p=0.001), those using WhatsApp for >12months (aOR=1.7, 95% CI 1.0-3.0, p=0.047), those receiving response ≤15min to a new communication (aOR=1.9, 95% CI 1.1-3.2, p=0.017), and frequent information giving events (aOR=2.4, 95% CI 1.2-4.8, p=0.016). CONCLUSION: Perceived benefits of WhatsApp use in clinical practice was significantly associated with usage characteristics and type of communication events. This study lays the foundation for quality improvement innovations in patient management delivered through m-Health technology.
Assuntos
Pessoal de Saúde/psicologia , Informática Médica , Aplicativos Móveis , Atenção Primária à Saúde , Tecnologia sem Fio , Adulto , Comunicação , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Malásia , Masculino , Médicos , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: To determine the prevalence and factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia. DESIGN: Descriptive, cross-sectional single-centre study with universal sampling of all patients with type 2 diabetes. SETTING: Endocrinology clinic of medical outpatient department in a Malaysian public hospital. PARTICIPANTS: All 169 patients with type 2 diabetes (men, n=99; women, n=70) aged between 18 and 90 years who acquired follow-up treatment from the endocrinology clinic in the month of September 2013. MAIN OUTCOME MEASURES: The validated Hospital Anxiety and Depression Scale (HADS), sociodemographic characteristics and clinical health information from patient records. RESULTS: Of the total 169 patients surveyed, anxiety and depression were found in 53 (31.4%) and 68 (40.3%), respectively. In multivariate analysis, age, ethnicity and ischaemic heart disease were significantly associated with anxiety, while age, ethnicity and monthly household income were significantly associated with depression. CONCLUSIONS: Sociodemographics and clinical health factors were important correlates of anxiety and depression among patients with diabetes. Integrated psychological and medical care to boost self-determination and confidence in the management of diabetes would catalyse optimal health outcomes among patients with diabetes.