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Objective: To determine the association between histological grade of tumour and estrogen progesterone receptors (ER/PR) expression in unselected invasive carcinoma of breast in Malaysian patients., Study Design: An observational study., Place and Duration of Study: Advanced Medical and Dental Institute and Hospital, Kepala Batas, from year 2002 to 2007., Methodology: Ethical approval from Ministry of Health of Malaysia was obtained. Retrospective case records of patients presented between 2002- 2007 were reviewed for obtaining information on grade of tumour and expression of ER/PR in unselected carcinoma of breast patients. Records with missing data were discarded., Results: Out of 195 cases evaluated, 42 cases of grade-I tumour were recorded of which 08 (19%) tested positive for ER and 34 (81%) tested negative, 86 cases represented grade-II tumour of which 33 (38%) tested positive for ER and 53 (62%) were negative for ER, while out of 67 grade-III tumours 22 (33%) were positive for ER receptors while 45 (67%) were negative, (chi2 statistic (df) 4.831, p=0.089). For PR, 192 cases were evaluated and data was missing for 3 cases on PR status. Grade-I tumour consisted of 39 cases of which PR +ve represented 07 (17.94%) and 32 (82.05) cases PR -ve; 86 cases were of grade-II of which 31 (36.04%) were PR +ve and 55 (63.95%) PR -ve. Sixty seven cases of grade-III tumour of which 19 (28.35%) were PR +ve and 48 (71.64) were PR -ve (chi2 statistic (df): 4.297; p=0.117)., Conclusion: ER/PR positivity trend was highest for grade-II tumours compared to grade-I and grade-III tumours. In general ER positivity was more with grade-II and grade-III tumours compared to grade I tumours. Although results did not reach statistical significance but there was a trend towards ER/PR positivity in grade-II and III tumours. So far, studies from South East Asia reported ER/PR expression more with low grade tumours.

Background: Breast cancer is the commonest cancer affecting women world wide. Breast cancer is a leading cause of cancer related mortality in Asian countries. Management of breast cancer depends on several tumour-related and patient related factors. HER-2/neu over-expression has been associated with a poor prognosis in breast cancer. We assessed HER-2/neu over expression pattern in unselected breast cancer cases in terms of clinico-pathologic parameters to identify any associations between them., Methods: Two hundred cases of breast cancer were evaluated at Advanced Medical and Dental Institute and Hospital Kepala Batas from 2002 to 2007. HER-2/neu status was confirmed in breast cancer tissues by immunohistochemistry. Immunohistochemical expression of HER-2/neu was evaluated according to the published scoring guidelines of the 'Hercep Test' (Dako, Carpinteria, CA). Data were analysed to identify any association between HER-2/neu and clinico-pathologic parameters., Results: HER-2/neu over expression was found in 63 (31.5%) tumours out of 200. When assessed for various age groups no significant association was found. However, a high percentage (75%) of over-expression was noted in the 81-85 years age group. No association was found with different racial groups (Malay, Chinese and Indians), with lymph node status or with grade of tumour. However a positive association was observed with oestrogen receptor and progesterone receptor expression., Conclusion: There was no association between HER-2/neu over expression and age, race, lymph node status or tumor grade. However a positive association was found with oestrogen and progesterone receptor status.

In Malaysia, it is a common belief among health care workers that females and Indians have lower pain threshold. This experience, although based on anecdotal experience in the healthcare setting, does not allow differentiation between pain tolerance, and pain expression. To determine whether there is a difference in the tolerance to pain between the three main ethnic groups, namely the Malays, Chinese and Indians as well as between males and females. This was a prospective study, using a laboratory pain model (ischaemic pain tolerance) to determine the pain tolerance of 152 IMU medical students. The mean age of the students was 21.8 years (range 18-29 years). All of them were unmarried. The median of ischaemic pain tolerance for Malays, Chinese and Indians were 639s, 695s and 613s respectively (p = 0.779). However, statistically significant difference in ischaemic pain tolerance for males and females Indian students were observed. Possible ethnic difference in pain tolerance in casual observation is not verified by this laboratory pain model. Difference in pain tolerance between genders is shown only for Indians.

The prevalence of pain complaints as a reason for patient-doctor encounters in the local primary care setting is unknown. We performed a cross-sectional survey of such encounters in one public primary care clinic (KK) and 17 general practice clinics (GP), from the city of Seremban, Negeri Sembilan, Malaysia. Reasons for visits were recorded by doctors in KK and medical students in GP using a structured questionnaire. Morbidity data was coded using the International Classification of Primary Care (ICPC-2). A total of 2234 encounters were recorded (80.9% from KK, 19.1% from GP). The overall prevalence of pain complaints was 31.9% with a significant difference between the two cohorts (KK 28.7% and GP 45.2%, p<0.001). Musculoskeletal pain complaints were more common in KK than GP (40.9% versus 29.7%, p<0.05). Of the 3 main ethnic groups in Malaysia (Malay, Chinese and Indian) the Indian patients at KK had the highest prevalence of pain complaints and the Chinese at the GP had the lowest. Thus pain was a common complaint in the two different primary care settings studied. Some of the differences observed are probably due to the differences in the healthcare seeking behaviour of patients consulting at these two settings as well as differences in the payment systems.

Background: Understanding the sociocultural dimension of a patient's health beliefs is critical to a successful clinical encounter. Malaysia with its multi-ethnic population of Malay, Chinese and Indian still uses many forms of traditional health care in spite of a remarkably modern rural health service., Objective: The objective of this paper is discuss traditional health care in the context of some of the cultural aspects of health beliefs, perceptions and practices in the different ethnic groups of the author's rural family practices. This helps to promote communication and cooperation between doctors and patients, improves clinical diagnosis and management, avoids cultural blind spots and unnecessary medical testing and leads to better adherence to treatment by patients., Discussion: Includes traditional practices of 'hot and cold', notions of Yin-Yang and Ayurveda, cultural healing, alternative medicine, cultural perception of body structures and cultural practices in the context of women's health. Modern and traditional medical systems are potentially complementary rather than antagonistic. Ethnic and cultural considerations can be integrated further into the modern health delivery system to improve care and health outcomes.