Malaysian Journal of Medicine and Health Sciences
The Malaysian Journal of Medicine and Health Sciences (MJMHS) diterbitkan oleh Fakulti Perubatan dan Sains Kesihatan Universiti Putra Malaysia. Matlamat utama MJMHS adalah menjadi jurnal utama mengenai semua aspek perubatan dan sains kesihatan di Malaysia dan di peringkat antarabangsa. Tumpuan MJMHS akan menjadi hasil penyelidikan dan pembangunan saintifik yang asal, isu-isu baru dan analisis dasar yang berkaitan dengan sains perubatan, bioperubatan dan klinikal. The Malaysian Journal of Medicine and Health Sciences kini diindeks dalam pangkalan data berikut: Scopus, EBSCOhost, ISC, dan Rubriq. pISSN: 1675-8544 eISSN: 2636-9346
The Struggle of Neural Progenitors in Down Syndrome Brain: The Need for Neuromodulation Beyond Symptomatic Mitigations
Copyright (c) 2024 Malaysian Journal of Medicine and Health Sciences
Study Protocol of a Mixed-Methods Study to Develop and Validate the Malaysian Anti-Hypertensive Agents Non-Adherence Scale in Hypertensive Patients
Introduction: Domains of adherence and non-adherence to hypertensive medications have not been extensively documented in Malaysia due to the absence of theoretically driven and culturally appropriate measurement tools, leading to a poor understanding of the adherence and underlying factors. We aim to identify these domains in Malaysian hypertensive patients and subsequently apply the findings to develop and validate the Malaysian Anti-Hypertensive Agents Non-Adherence Scale (MAANS). Methods: This study has an exploratory mixed-methods design. In Phase 1, we will recruit hypertensive patients from two health clinics to participate in a semi-structured interview. Recruitment of participants will terminate once thematic saturation is achieved. Coding and thematic analyses will be performed to identify the domains of adherence and non-adherence to anti-hypertensive medications. In Phase 2, based on the domains generated from Phase 1, we will develop the Malaysian Anti-Hypertensive Agents Non-Adherence Scale (MAANS). Four hundred hypertensive patients will be randomly selected. Data from 200 participants (serving as the calibration sample) will be subjected to exploratory factor analysis while data from additional 200 participants (serving as the validation sample) will be subjected to confirmatory factor analysis. Factor structure, predictive validity, and reliability of the MAANS will be statistically tested. Discussion: With the presence of the MAANS, health care providers can gather crucial information regarding barriers and facilitators to hypertensive treatment adherence and design effective health promotion programmes to reduce complications of uncontrolled hypertension. Trial registration: Ethical approval is granted by the Medical Research Ethics Committee, Ministry of Health, Malaysia (NMRR-18-3251-44694).
Sodium and Potassium Urinary Excretion Among Malaysian Adults Claiming to Practice Salt-control: Findings from the Malaysian Community Salt Survey (MyCoSS)
Introduction: Raised blood pressure is associated with diet high in sodium and low in potassium. According to the Malaysian Community Salt Survey (MyCoSS), Malaysian adults consume a high sodium diet, despite half claiming that they control their salt intake. The objective of this study was to investigate the association of sodium and potas- sium with salt-control claims among adults from the MyCoSS study based on 24-h urinary excretion. Methods: Data of 1,047 respondents aged 18 years and above who completed the knowledge, attitude, and practice (KAP) question- naire were used in this study. Face-to-face interviews were conducted to acquire information on sociodemographic, medical reports and KAP on salt intake. Sodium and potassium level were assessed from 24-hr urine specimen, an- thropometric measurements were done using WHO criteria, while blood pressure was measured using validated dig- ital blood pressure monitor. Descriptive and analysis of variance (ANOVA) were used to determine the associations between urinary sodium and potassium with salt-control claims and practices. Results: The consumption of sodium was higher than recommended, while potassium was lower among respondents who claimed to control their salt intake. Significant associations were found between sodium intake with marital status, ethnicity, education level and employment status. Meanwhile, significant associations were found between potassium intake with ethnicity and employment status. Conclusion: Sodium intake was high, and potassium intake was low among respondents who claimed they control their salt intake. Further study with detailed intervention on specific target group is required to improve sodium and potassium intakes among Malaysian adults.
An Exploration of Family Members’ Roles in the Context of Breast Cancer: A Narrative Study in Malaysia
Introduction: Breast cancer is a significant health problem that affects patients and their family members. Family members are often key to supporting the patient. However, there is an inadequate understanding of the role of female breast cancer patients’ family members in Malaysia. This study aimed to explore the roles of family members of female breast cancer patients from symptom appraisal until the patient treatment commences. Methods: Snowball sampling was applied and 14 participants were recruited through the nomination of the female breast cancer patients. The participants took part in in-depth, face-to-face, and audio-recorded one-time interviews. All of the interviews were subsequently transcribed verbatim and analysed using narrative analysis. Results: Five themes were identified with regard to the roles of family members: 1) confirming breast changes; 2) managing personal emotions; 3) seeking the information; 4) seeking alternative forms of treatment; and 5) advocating for conventional treatment. Conclusion: This study discovered that family members play an important role in the journey of women with breast cancer from the time an abnormality is discovered to the time the patient receives treatment. During this time, many of them suppressed their emotions in order to focus on the women suffering from breast cancer. Healthcare professionals working with breast cancer should recognise and support the key role of family members in supporting women to get treatment. It is important to take a proactive approach in recognising the early signs of stress for family members and, when appropriate, offering them additional sources of support.
Peripheral Blood Smear Atypical Lymphocytes Association With Covid-19 Mortality
Introduction: COVID-19 disease is currently pandemic, and its prevalence in Saudi Arabia is concerning. The SARS-CoV-2 virus primarily affects the lungs, but it also affects the haematopoietic system. The atypical lymphocytes on peripheral blood film that have a distinct morphological appearance were of particular interest in this study. Our goal was to see a link between atypical lymphocytes and COVID-19 patient mortality. Methods: This four-month single-centered prospective descriptive study was conducted in Makkah, Saudi Arabia. COVID-19 patients of both genders were randomly selected based on inclusion criteria. The data from the patient’s electronic medical record was extracted. All patients’ peripheral blood film parameters were recorded on days 3, 7, and 14 after admission. The statistical data was analysed using SPSS version 23. The Fisher’s exact test was used to determine the relationship with mortality. A p value of 0.05 was considered significant. Results: The total number of cases enrolled in the study was 226. The patients’ average age was 58 years (SD 0.5289). On the third day of admission, 88.2 % of patients with COVID-19 had atypical lymphocytes, with a mean of 2.35 ± 0.927. A significant correlation (p < 0.001) exists between atypical lymphocytes decreasing percentage number on the 3rd, 7th, and 14th days of admission and death. Conclusion: The decrease in the number of atypical lymphocytes on peripheral blood film has a significant association with the patients’ mortality. This fact can be used to develop a tailored management strategy based on the observation of peripheral blood film.
Knowledge of Breast Cancer Among Urban Women in the South of Peninsular Malaysia
Introduction: : Breast cancer (BC) is the most commonly diagnosed cancer globally and it is the leading cause of cancer mortality in Malaysian women. Increasing women knowledge of BC and breast self-examination (BSE) leads to increased compliance in early diagnosis and treatment. This study aims to determine the level of knowledge on BC and its association with socio-demographic characteristics among urban women. Methods: A cross-sectional study was conducted among 270 urban women in the South of Peninsular Malaysia using the adapted Breast Cancer Awareness Measure. Data were analyzed through SPSS software version 26.0. Results: Of the participants, 53.7% (n=145) had poor knowledge of BC warning signs, 50.7% (n=137) of BSE and 55.6% (n=150) of risk factors. High education was associated with better BC knowledge on warning signs (p=0.006) and risk factors (p=0.048). Chinese women have poor BC knowledge on warning signs (p=0.005) and BSE (p<0.001) than other ethnicities. Age (p=0.024) and marital status (p=0.028) were statistically significant with BC knowledge on breast self-examination (BSE) while family history of BC (p=0.019) and duration of seeking medical advice (p=0.041) were associated with BC knowledge on the risk factor. Conclusion: The findings of this study may give insight into effective health education strategies for urban women concerning breast cancer awareness.
Stress Indicators Among 21st Century University Students
Introduction: Pursuing higher education has always been considered to be stressful as students need to adapt to new social and academic environment. Higher education in recent years has shifted from teacher centred authoritarian approach to student centred learning with amicable learning environment. In this changing scenario, this study aims to identify the indicators of stress and stress levels among 21st century university students and fathom the demographic factors influencing it. Method: A cross-sectional survey was conducted on students attending a private university in Malaysia using Stress Indicators Questionnaire. The data was analysed with descriptive and inferential statistical tests. Results: A total of 1050 university students aged between 18-30 years from different faculties voluntarily participated in the study. All respondents reported stress varying from very low to dangerous levels. Among the indicators of stress, sleep and emotional indicators were at dangerous levels, physical indicators and personal habits were at high level and behaviour indicators were perceived at medium level. A significant difference in total stress score between students of different age groups and ethnicity were observed, while no significant difference was noted with regards to gender. Conclusion: This study reveals that various indicators of stress are prevalent among the present-day university students. It may help guide policy makers and teachers in early identification of stress among their pupils and plan effective strategies aimed at balancing a good quality of life and academic achievement for the learners in institutions of higher learning.
Would You Have Your Future Children Vaccinated? A Study Among Foundation Program Students in a Malaysian Public University
Introduction: There are a growing number of parents who hesitate to vaccinate their children. Therefore, the current study was conducted to assess future parents-to-be intention to vaccinate their children, as well as to investigate contributing factors of vaccination intention and to identify sources of information on childhood vaccination. Method: A cross-sectional study was conducted among Foundation Program students at a public university for five months, from April to August 2019. Factors studied included sociodemographic characteristics, knowledge and attitudes toward childhood immunization, and religiosity. Data were collected using a validated self-completed questionnaire. Simple random sampling was conducted, with a total of 371 students were recruited as respondents. Multiple logistic regression was performed to determine the predictors. The significance level is set at alpha less than 5%. Results: Approximately 95% of respondents indicated an intention to vaccinate their future. The mean age of respondents was 19 ± 0.37 years old. A motive to vaccinate their future children was high among females (AOR: 4.20, 95% CI: 1.59, 11.08, p: 0.004), having sufficient knowledge about childhood vaccination (AOR: 3.92, 95% CI: 1.23, 12.45, p: 0.021), and having a positive attitude toward childhood vaccination (AOR: 9.56, 95% CI: 2.15, 42.46, p: 0.003). There was no significant association between intention to have their future children vaccinated and religiosity. The sources of information about childhood vaccination were mainly the Internet (72%), mass media (68.2%), and social media (61.7%). Conclusion: Readiness of foundation program students was satisfactory. However, policymakers and program planners should target improving knowledge and attitudes of young people about childhood immunization especially among young men as they will head the household. This effort may sustain the readiness of young people to vaccinate their future children. The approach should include the Internet, mass media, and social media.
Evaluation of Comprehensive Management Protocol for Reduction of the Risk of Fragility Fractures Among Osteoporosis Individuals, Visiting Teaching Hospital, Kolkata
Introduction: Fragility fracture from osteoporosis is a major challenging health problem in aging population in developing countries. In order to reduce the risk of development of osteoporotic fragility fractures authors made a study with high risk individuals, divided into two groups and a comprehensive management protocol had been offered in one group where as conventional management protocol had been offered in other to see the efficacy of such comprehensive management protocol to reduce the risk of occurring fragility fracture over at least three months period among the patients, attended in orthopaedic out patient department of state medical college, West Bengal. Methods: The authors selected 30 diagnosed osteoporosis clients of 50 to 90 years age as per inclusion and exclusion criteria, who attended in orthopaedic OPD in SSKM Hospital, Kolkata, West Bengal, India from 2021April to July2021, carrying highest risk factors of developing osteoporosis. Results: In experimental group, mean post test BMD score is higher than the mean pre test BMD, which is statistically significant as calculated t value is 3.666 at 14 df at 0.05 (p<0.05) level of significances. It indicates that comprehensive management protocol is effective to increase the bone strength. Conclusion: The study of comparison of mean difference values of two groups conclude that comprehensive management protocol can reduce the risk of osteoporotic fracture much efficiently in compared to standard pharmaceutical treatment in a short span of time which is applicable for long term management of osteoporosis.
Effectiveness of an integrated-Weight Management Programme (i-WMP) in Reducing Body Weight among Noncommunicable Disease Patients in Malaysian Government Primary Care Clinics: A Randomised Controlled Trial
Introduction: Obesity is a global issue called as “globesity”. Overweight and obesity may lead to many noncommunicable diseases (NCDs). Primary care is the first centre to monitor and follow-up the progress of NCD patients. Therefore, the objective of this study was to determine the effectiveness of an integrated-Weight Management Programme (i-WMP) to reduce body weight among NCD patients from two Government primary care clinics from Hulu Langat District. Methods: This study was single-blinded randomised controlled trial by design. There were 244 eligible patients were randomised into intervention (n = 122) or wait-list control group (n = 122). The i-WMP was developed based on the behaviour change wheel through the operationalization of behaviour change techniques. The duration of this intervention programme was four weeks. Data collected at week 0, week 4, and week 12. The software IBM SPSS was used to analyse the data. Generalized linear mixed model analysis with intention-to-treat principle was applied. Results: The retention rate was 74.2%. Findings showed that the i-WMP was significantly effective in reducing not only body weight as primary outcome but also secondary outcomes such as waist-to-height ratio, waist circumference, body mass index, and total sitting time. It also improved effectively other secondary outcomes such as participants’ knowledge, attitude, and practice towards dietary and towards physical activity. However, no significant changes were reported for body fat percentage and total physical activity metabolic equivalent of task-minutes/week. Conclusion: Implications surrounding the implementation of i-WMP in the primary care clinics are recommended.
Point-of-Care Procalcitonin to Guide the Discontinuation of Antibiotic Treatment in the Intensive Care Unit: A Malaysian Randomised Controlled Trial
Introduction: This work aims to establish the practicality of simple point-of-care (POC) measurements of procalcitonin (PCT) coupled with the standard PCT-guided antibiotic treatment discontinuation algorithm to guide the cessation of antibiotic treatment in intensive care unit (ICU). Methods: In this randomised-controlled trial, 80 adult patients with suspected bacterial infections were randomised to either the POC PCT-guided arm (n = 40) or the standard-of-care arm (n = 40). The decision to discontinue antibiotic treatment in the POC PCT-guided arm was based on the POC PCT-guided antibiotic-treatment discontinuation strategy, which states that discontinuation is urged once the PCT concentration has reduced by ≥ 80% or to < 0.5 ng/mL. In the standard-of-care arm, the antibiotic-treatment duration followed the local guidelines. Results: The median duration of antibiotic treatment was 6.5 [IQR = 5.0-7.0] days in the POC PCT-guided antibiotic-treatment arm versus 7.5 [IQR = 5.0-14.0] days in the standard-of-care arm (p = 0.010). The mean antibiotic-free days in the first 30 days after study inclusion was 20.7 (SD = 5.3) days in the POC PCT-guided antibiotic-treatment arm versus 16.4 (SD = 7.4) days in the standard-of-care arm (p = 0.004). The number of patients who took an antibiotic for more than 10 days was 2 (5%) in the POC PCT-guided antibiotic-treatment arm versus 13 (32.5%) in the standard-of-care arm (p = 0.002). Conclusion: Antibiotic use in patients with symptoms of bacterial infections in the ICU was substantially minimised with the installation of a POC PCT-guided antibiotic-treatment cessation.
Exploring Perception and Role of Nurses during COVID-19 Pandemic: Experiences of Frontline Workers in East Java, Indonesia
Introduction: Humanity is increasingly faced with the constant threat of natural and man-made disasters. Nurses need to have preparedness because they are at the forefront of disaster management. However, few studies have explored the perception of nurses during the COVID-19 pandemic in Indonesia. This study explored nurses’ perceptions in caring for patients with COVID-19. Methods: The study used a qualitative approach at two referral hospitals for COVID-19 in East Java, Indonesia, from June 10 to 30, 2021. Twenty-five nurses who worked closely with COVID-19 patients were recruited through convenience sampling. They underwent a face-to-face interview, through an online platform, using semi-structured interview. The data were analyzed thematically. The NVivo version 12 was used to organize data to improve analysis. Results: Three main themes emerged from the analysis including 1) lack of preparation in facing a pandemic situation, 2) ready to face all the tremendous challenges–fighting with nurse duties, and 3) working together as a transdisciplinary team. Conclusion: The study showed that during caring for patients with COVID-19, nurses perceived the lack of PPE, unstable working emotions, burning shift schedule, and working collaboration. Enhancing the role of nurses to deal with any pandemic or microbiological attack needs to be highlighted.
The Relationship Between Knowledge and Attitudes of Malaysian Undergraduate Students Towards Dementia
Introduction: Providing care for vulnerable people, including older adults with dementia, that is safe and efficient is a significant factor in improving their health. This study aims to determine the knowledge and attitudes of undergraduate nursing students regarding dementia in older adults. Methods: This is a cross-sectional study conducted among 126 undergraduate students at a Malaysian university using purposive sampling. The respondents’ knowledge of dementia was measured using the Alzheimer’s Disease Knowledge Scale (ADKS), and their attitudes towards dementia were measured using the Adolescent Attitudes towards Dementia. The scale of P<0.05 was statistically significant, and the data was analyzed using the Statistical Package for the Social Sciences (SPSS) Statistics 26.0 for Windows. Results: The results showed that 78.6% of undergraduate nursing students had higher knowledge of dementia than 92.9% had positive attitudes toward dementia. There is a significant relationship between years of study and knowledge of dementia among UKM nursing students (χ2= 14.93, p = 0.001). Conclusion: Most undergraduate students have higher knowledge of and positive attitudes towards dementia. A better understanding of the disease process improves the quality of life for people with dementia and their caregivers. Longitudinal and comparative studies were suggested for further research.
Public’s Preferences for Community Pharmacy Attributes and Their Perceptions Towards Pharmacist-led Minor Ailment Services in Malaysia
Introduction: The prospect of public accessing community pharmacies for minor ailment advice or treatment highly depends on the pharmacy attributes and their staff. This study aimed to investigate the extent to which community pharmacies are used as a source of minor illness management and the public’s relative preferences for pharmacy features. Methods: A cross-sectional survey among the public in Malaysia was carried out between August and December 2020. The validated self-administered questionnaires were distributed at several pharmacies and shared via email, Whatsapp group, and Facebook. Results: A total of 141 from 153 public respondents completed the survey. From the descriptive and inferential analysis, it was found that about a third of the public goes to a pharmacy for advice or treatment for minor illnesses. The vast majority of respondents had positive perceptions that community pharmacists are knowledgeable and qualified to offer advice or treatment for minor diseases. A significant positive relationship was observed between pharmacy characteristics’ scores and pharmacy staff and pharmacy services’ scores (p<0.001). The increase in pharmacy staff score significantly increased the pharmacy services’ score (p<0.001). Conclusion: The implications of the public acknowledging specific attributes were crucial in further supporting community pharmacists’ services, especially in the private practice setting.
A Statistical Analysis and Comparison of the spread of Swine Flu and COVID-19 in India
Introduction: The world is currently experiencing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [COVID-19], however, this is not a new phenomenon; it occurred in 2009-2010 in the form of novel influenza A. (H1N1). The H1N1 virus primarily afflicted people between the ages of 26 and 50, but SARS-CoV-2 primarily afflicted those over the age of 60, increasing the number of deaths owing to their weakened immunity. The report provides a case study of the impact of H1N1 and SARS-CoV-2 in India. Methods: Data is obtained from The Hindustan Times newspaper, GoI press releases and World Health Organization (WHO) reports. Results: The incidence rate was initially low and it was only by the 10-15th week that it started increasing. There is an initial upward trend before levelling out followed by a second wave and third wave. COVID-19 exhibited a steeper growth, where the steps taken by the Government were ineffective leading to higher death cases. Kerala was affected due to the travellers returning from the Middle East, while Maharashtra and Delhi saw large incidence rates due to the migrant influx and communal gathering. Conclusion: The most effective and practical approach is to test the symptomatic patients and aggressive testing to contain the transmission. Awareness campaigns to educate the public about social distancing and personal hygiene is more practical. There is still scope of improvement with regards to the public health care support, preparedness and response. Lockdown measures could have been avoided if the initial screening was conducted properly.
Coping Strategies Among Indonesian College Students During The Covid-19 Pandemic
Introduction: Several steps have been taken to reduce opportunities for spreading diseases COVID-19. Coping strategies are the main tool individuals use to minimize situations that are considered dangerous. College students cannot use coping strategies that are typically done outside, due to the limitations of lockdown in their respective areas. The aim of this study was to identify differences in coping strategies used by students during the pandemic in West Kalimantan, Indonesia. Method: A cross-sectional survey approach was conducted among Indonesian college students. The data for the study were collected from students acquiring education at public/private Universities/Academies/Institutes spread throughout West Kalimantan Province in Indonesia. The sample size was 663 students, and the sampling strategies used a snowball technique. The Brief-COPE inventory was used to measure coping strategies. Results: The majority of the 663 students used adaptive coping (41.94 ±8.641). The mean score was highest for emotional support (6.44 ± 1.430) and active coping (6.10 ± 1.467), followed by religion (6.00 ± 1.394), with the lowest score for substance use (4.24 ± 1.368). We did not found significant differences between the sociodemographic subgroups except gender on subscales for religion, active cope, emotional support, and substance. Conclusion: Adaptive coping is more widely used by students in maintaining mental health than maladaptive coping. There were high scores on the subscales measuring the use of emotional support, active coping, and religion. Although many students use positive coping, students who use maladaptive coping need intervention from the campus, such as by providing online counseling services.
Stroke Code Implementation in A Physician-Led District Hospital in Malaysia
Introduction: The past few years have shown a marked improvement in acute ischaemic stroke (AIS) thrombolysis therapy in Malaysia. We analysed our data on stroke code activation performed in a non-neurologist hospital. Methods: Data of all stroke code activated patients from September 2019 to September 2020 was collected. Demographic, clinical characteristics and outcomes of these patients were analysed and reviewed with published data in Malaysia. Results: Seventy cases were stroke code activated. Majority of the stroke cases (80%) were ischaemic in nature with the highest subgroups of lacunar infarct at 60.7%. Hypertension is the most prevalent risk factor followed by dyslipidaemia and diabetes. The median time for onset-to-door was 95minutes, door-to-CT was 24minutes, door-to-decision was 46.5 minutes and door-to-needle was 80minutes. There was a sequential reduction in median door-to-CT and door-to-needle time to 16.5 and 65.5minutes respectively. Fifteen patients (21.4%) were given thrombolysis therapy. The median NIHSS score was 7.5 on arrival and 6 upon discharge. They had an improvement of mRS from a median of 4 upon discharge to 1 at six months follow-up. There were no haemorrhage incidences post thrombolysis. The outcome of LACI strokes versus non-LACI strokes was similar at 3 and 6-months follow-up despite non-LACI strokes having a more severe presentation upon admission. Conclusion: With AIS thrombolysis therapy, non-LACI strokes may have similar functional outcomes as LACI strokes. With backup support from hospitals with neurologists and neurosurgeons, physician-led AIS thrombolysis therapy is implementable in a non-neurologist centre. Strong adherence to protocol is pertinent to ensure success.
Copyright (c) 2025 Malaysian Journal of Medicine and Health Sciences
Handgrip Strength Assessment and Its Associated Factors among Hospitalized Elderly in Klang Valley Hospitals
Introduction: Handgrip strength is a crucial biomarker of aging. Poor handgrip strength among hospitalized elderly increases the risk of health complications leading to a higher risk of hospital readmissions and mortality. This study aimed to determine handgrip strength among hospitalized elderly in Klang Valley hospitals alongside its associated factors. Methods: A total of 57 subjects were recruited for this study. Face-to-face interviews and physical assessments were conducted to obtain data on sociodemographic factors, medical background, anthropometry assessments and biochemical markers level. Dietary intake was obtained through two days of 24-hour dietary recall while tools such as Global Oral Health Assessment Index (GOHAI) and Mini Nutrition Assessment- Short Form (MNA-SF) were used to assess perception towards oral health and malnutrition risk, respectively. Reference value from the Asian Working Group of Sarcopenia (2014) was used to compare handgrip strength. Results: 94.7% of the subjects were found to have low handgrip strength with a mean value of 8.28 + 6.92 kg/force. Factors including age (r=-0.370, p=0.005), educational level (r=0.471, p=<0.0005), perception towards oral health (r=0.370, p=0.005) and energy intake (r=0.367, p=0.005) were significantly associated with handgrip strength. Meanwhile, other variables were not significantly associated. Conclusion: The majority of the subjects had poor handgrip strength. Factors such as age, educational level, perception towards oral health and energy intake were significantly associated with handgrip strength while the rest were non-significantly associated. Thus, more research and intervention strategies should be done to improve handgrip strength among hospitalized elderly to achieve a healthy aging nation.
Khairunisar-E-Rashim Mohammed Yusufirashim
Interleukin-27 Disrupts the Crosstalk of Apoptotic Activities between 4T1 Breast Cancer Cells and M2 Macrophages
Introduction: Cytokine immunotherapy such as Interleukin-27 (IL-27) has been foreseen as a promising alternative anti-cancer treatment. Thus, this study aimed to investigate whether IL-27 gene therapy regulates crosstalk between breast cancer cells and macrophages in the sense of pro-apoptotic activities. Methods: This study has led to the development of recombinant pcDNA3.4-IL27. The recombinant pcDNA3.4-IL27 was transfected into 4T1 murine mammary carcinoma cells alone and co-culture of 4T1 with M2 macrophages. The successful expression of IL-27 in the cells were determine through the immunofluorescence staining and detection of CD206, M2 macrophages marker. Apoptotic effects of pcDNA3.4-IL27 were assessed through MTT assay, Annexin V flow cytometer analysis, and AO/PI dual staining. Results: Our findings shows that pcDNA3.4-IL27 has the ability to induce apoptosis in both of the cell group and performs better in the co-culture of 4T1 with M2 macrophages compared to 4T1 cells alone. PcDNA3.4-IL27 induced apoptosis through the altered cell morphology and reduction in the number of viable cells. Conclusion: These data demonstrate that pcDNA3.4-IL27 has the ability to induce apoptosis in both 4T1 cell alone and co-cultured 4T1 with M2 macrophages. Thus, could serve as a potential anti cancer candidate against breast cancer.
Hordeum vulgare (Barley grass) Scavenge Free Radical and Inhibits Formation of Advanced Glycation End Products Formation.
Introduction: Advanced glycation end products (AGEs) formation is due to glycation of lipids, proteins, and nucleic acids. AGEs play a vital role in Diabetes Mellitus (DM) and cardiovascular complications and is enhanced by oxidative stress. Hordeum vulgare (Barley Grass) is a cereal plant of grass family poaceae and has been reported to exhibit antidiabetic and antioxidant characteristics and prevention of cardiovascular disease. Current experiment focused on the evaluation of antioxidant and anti-advanced glycation end products formation effect of Hordeum vulgare water extract. Methods: Free radical scavenging ability of Hordeum vulgare water extract, was evaluated using DPPH, nitric oxide, hydrogen peroxide, lipid peroxidation, FRAP and metal ion chelating. Total phenolic content of Hordeum vulgare was also analysed. In-vitro antiglycation activity was done using BSA-MGO, BSA-Glu. Phytochemical screening was performed to detect the presence of flavonoids, saponins, tannins, steroids and terpenoids. Results: The results showed Hordeum vulgare water extract ameliorated the formation of AGE and scavenge free radical from DPPH, Nitric oxide, hydrogen peroxide, Lipid peroxidation, FRAP and Metal ion chelating. Phytochemicals such as saponins, tannins, flavonoids, steroids and terpenoids were detected in Hordeum vulgare water extract. Conclusion: Hordeum vulgare water extract reveals antiglycation and free scavenging properties.
Development and Validation of a Comprehensive Tool for Assessing Postgraduate Students’ Oral Presentations: Importance of the Role of Ergonomics
Introduction: The aim of this exploratory sequential mixed methods study was to develop an oral presentations assessment tool for postgraduate students’ oral presentations. Methods: First, a literature review and the ideas of 319 experienced professors were used to identify domains and potential items to develop the desired tool. Then the psychometric properties of the preliminary tool were measured using face and content validity, inter-rater agreement and test-retest reliability. Results: The qualitative phase indicated there should be four domains in the developed Oral Presentations Assessment Tool: subject knowledge, delivery, content and organization, and ergonomics, and that items in the developed tool should be weighted according to importance for the efficacy of a presentation. The final version included 19 items across four domains. Mean content validity index and content validity ratio scores were 0.93 and 0.76, respectively. Spearman’s rank correlation coefficient for the two evaluation periods was 0.92. The intra-class correlation coefficient was 0.78. Conclusion: The Oral Presentations Assessment Tool has appropriate psychometric properties and can be used as a valid and applicable instrument to assess postgraduate students’ oral presentations. Important cognitive factors in oral presentations in the form of an ergonomic domain was included for the first time, as part of this new comprehensive tool.
Cultural, Belief, And Lifeway Factors in Diabetes Patients: An Ethnonursing Study
Introduction: The people of Sumba prefer traditional medication from shamans as they believe that diabetes they suffer from the Marapu, hence uncurable by modern medical means. This study aimed to derive a picture regarding diabetes patients’ cultural values, beliefs, and lifeways in the East Sumba ethnic of Indonesia. Methods: This study uses a qualitative design with an ethnographic approach which was conducted in 2018. The main participants in the study were seven diabetic patients, were determined purposively. Focused discussions were held with the person in charge of the non-communicable disease program from seven Public Health Centers. Data were collected from interviews, focus group discussions, field notes and observation sheets. All data were analyzed by content analysis method corresponding to the 4 phases in ethnonursing. Results: Five themes were generated in this study with details of three themes describing the cultural values of diabetic patients (subthemes traditional ceremonies, chewing happa, and traditional medicine), one theme describing the beliefs of diabetic patients (subthemes perceptions about diabetes) and one theme describing the lifestyle of diabetic patients (subthemes eating/drinking patterns, spiritual values, rest/sleep habits, and daily activities). The culture of diabetics depicted in adat ceremonies, happa or betel nut chewing, and traditional medication, which is still thick in East Sumba and their beliefs on the disease they suffer from, exert influence on their daily lives, including their eating or drinking patterns, spiritual values, resting or sleeping patterns, and daily activities. Conclusion: This finding can be helpful for the effort to improve nursing for diabetes patients by cultural approaches.
Indoor Air Quality Level at Medical Clinics, University Hospital in Klang Valley, Malaysia
Introduction: Patient health can be influenced by indoor air quality (IAQ) level, where the risks of IAQ pollution are proportionate with the occupant number in the clinic. This research aims to determine the level of IAQ in Medical Clinic 1 and 2 of University Hospital in Klang Valley, Malaysia. Methods: The indoor exposure to physical (temperature, relative humidity and air movement), chemical (formaldehyde, CO2 , CO, TVOC and PM10) and biological (bacterial and fungal count) parameters following Industry Code of Practice (ICOP) IAQ (2010) were assessed in the morning and afternoon using relevant equipment. Data was analysed with One-Sample T Test and Independent T Test using SPSS Version 25. Results: No statistically significant mean difference (p>0.05) of IAQ parameters between both Medical Clinics (morning & afternoon) except for Rh and CO by Independent T Test analysis. In contrast, the One-Sample T Test showed there was statistically significant mean difference (p<0.01) of all parameters as compared to the ICOP (2010) standard in both Medical Clinics (morning and afternoon). There was a positive correlation of CO2, CO and formaldehyde with bacterial counts (TBC) for both Medical Clinics. Meanwhile, CH2O concentration was slightly higher in the morning due to the usage of cleaning products which may have released CH2O gas killing the bacteria, thus lower the rate of bacterial growth in the afternoon. Fungal counts showed no significant impact. Conclusion: All measured parameters were complied with the ICOP (2010) standard except air movement and CO2 in both Medical Clinics.
Assessment of the Reliability and Validity of the Alberta Infant Motor Scale and Peabody Development Motor Scale in Highrisk Infants
Introduction: The aim of this study was to investigate the correlation between Alberta Infant Motor Scale (AIMS) scores at 8 months and Peabody Developmental Motor Scale-2 (PDMS-2) and Peabody Developmental Gross Motor Scale-2 (PDMS-GM-2) scores at 18 months and 3 years in high-risk infants. Methods: This retrospective study included 105 high-risk infants at a Saudi Arabian tertiary care facility. Pearson correlation analysis was used for comparing scores. Additional subgroup analyses were performed for participants diagnosed with cerebral palsy at 18 months and for those who received physiotherapy. Result: AIMS scores at 18 months showed stronger correlations with PDMS-GM-2 scores than with PDMS-2 total scores, while these correlations decreased at 3 years. For the cerebral palsy subgroup, correlation with PDMS-2 scores at 18 months was relatively stronger than at 3 years. For the physiotherapy intervention subgroup, correlations with PDMS-GM-2 scores PDMS-2 total scores were similar at 18 months and 3 years. Conclusion: The AIMS predictive validity was lowest at 3 years in high-risk infants. A correlation was higher in participants with physiotherapy intervention and highest in participants with cerebral palsy. Outcome measures and treatment results should be cautiously reported during the first 3 years to prevent over-treating high-risk infants and decrease rehabilitation costs.
The Invisible Struggles: A Qualitative Study in Understanding Mothers’ Perceptions and Experiences in Nurturing Small for Gestational Age Infants
Introduction: Small for gestational age (SGA) infants have been linked to poor growth trends and nutritional status. SGA infants that do not reach their full growth potential must be supervised by a multidisciplinary medical team. Parents devote more time, energy, and money for raising of the SGA infants. The objective of this present study is to explore the perceptions and the experiences of the mother in nurturing the small for gestational age infants in their first year of life. Method: A qualitative exploratory descriptive study via in-depth interview was conducted in the primary health clinics in urban areas in Malaysia to explore the mothers’ perceptions and experiences in SGA infant’s care. 13 SGA infant’s mothers participated in the study after the children achieved the age of one year old. Thematic analysis was conducted using software ATLAS.ti version 8. Results: The average mothers’ age in this study were 33 years old, majority was Malay ethnicity. Only one mother was a housewife and others were working mother. Four out of 13 SGA infants were born prematurely. This study found that homogenous experiences throughout the pregnancy and baby nurturing phase, perceptions on husband involvement and external supports in infant care, infant health status and health services provided, were highlighted as important contributor to infant survival. Conclusion: The importance of monitoring SGA infant growth and nutritional status have been highlighted. Maternal psychological support needs to be enhanced to ease the burden in SGA infant care. Targeted program intervention for family and community social support during postnatal and empowering mothers in nurturing their infants are crucial.
In Vitro Antioxidant Properties and Methylglyoxal (MGO) Scavenging Effects of Centella asiatica Leaves in Water Extract
Introduction: Advanced glycation end product (AGE) is formed by the non-enzymatic glycation, leading to free radicals’ production and high oxidative stress. Accumulation of AGEs is associated with chronic diseases which are correlated with diabetes mellitus. Centella asiatica is a traditional medicinal herb used in Asia with numerous pharmacological effects such as antioxidant, wound healing, neuroprotective, and gastrointestinal treatment. This research was aim to evaluate the antioxidant, antiglycation, and phytochemical analysis of C. asiatica leaves (L.) water extract. Methods: The antioxidant activity of the plant extract was evaluated through 2,2-diphenyl-1-picrylhydrazyl (DPPH), hydroxyl (OH) radicals, nitric oxide (NO), and chelating capacity assays. Total phenolic content (TPC) was performed to determine the presence of bioactive compounds, such as saponins, which have been extensively reported in previous studies. Butylated hydroxytoluene (BHT) and ethylenediaminetetraacetic acid (EDTA) were used as positive control in the antioxidant assays, while quercetin was used in the antiglycation assays. Antiglycation effects of C. asiatica L. were evaluated through Bovine serum albumin (BSA)-MGO, BSA-glucose, and MGO scavenging assay. The data was expressed in terms of IC50. Result: The plant extract possessed significantly (p < 0.001) lower IC50 value compared to the BHT in DPPH and NO radical scavenging assay. It also showed stronger antiglycative effect with lower IC50 value compared to the quercetin in BSA-glucose and BSA-MGO assay. The TPC of C. asiatica L. was 3.20 mg/GAE/g at 100μg/ml. Conclusion: The antiglycation effects of C. asiaitca L. include the reduction of Amadori products formation, trapping α-dicarbonyl intermediates, and free radical scavenging. It is suggested that the antiglycation effects of C. asiatica L. maybe attributed by the presence of saponins and other phytochemicals.
Prescribing Pattern of Benzodiazepine Receptor Agonists (BZRA) and Factors Associated With Duration of BZRA Use in a Malaysian Psychiatry Outpatient Clinic
Introduction: Benzodiazepine receptor agonist (BZRA) are among the most frequently used psychotropic medications worldwide. We aim to understand the pattern of prescription of BZRA in the government healthcare facilities and identify factors affecting the likelihood of BZRA prescription and duration of use. Method: This is a retrospective study. Data was obtained from record of outpatient clinical notes. Medications studied were midazolam, alprazolam, lorazepam, bromazepam, clonazepam, diazepam and zolpidem. Mean duration per prescription, mean dosage perprescription and duration per patient per year were calculated for each sedative hypnotic. The likelihood of factors affecting duration of prescription were also analysed. Results: The prevalence of sedative hypnotic use in psychiatry outpatient clinic was 12.16%. Clonazepam was found to have the longest duration per patient per year (306.5 days). Insomnia and anxiety are the two most common reasons for sedative hypnotic prescription. Factors found to affect duration of prescription were unemployment, borderline personality disorder, alcohol and substance use disorders. Conclusion: Implementation of effective monitoring system on sedative hypnotic prescribing and increase use of non-pharmacological interventions for insomnia and anxiety are necessary to curb prolonged use of sedative hypnotic.
Worker’s Perceptions and Attitudes of Coal-dust Exposure and Health Hazards: Case of a Coal-fired Power Station in Southern Africa
Introduction: Exposure to coal dust is one of the major health hazards that result in respiratory problems in the coal industry. Literature on workers’ perceptions of coal dust exposure and its health effects is limited. This study aimed to establish workers’ perceptions and attitudes about coal dust exposure and health hazards. Methods: The study used a descriptive cross-sectional design and stratified sampling approach to select 152 workers from a coal-fired power station. Quantitative data was collected using a structured interviewer-administered questionnaire to solicit information on age, gender, work experience, knowledge and perception, with Chi-square tests used for inferential analysis. The study was conducted at Bulawayo Power Station, Zimbabwe. Results: Respondents between 18 to 39 years were the majority. 72.4% had worked at the coal-fired power station for more than a year. Most respondents were aware of the sources of coal dust, its exposure routes, the frequency of exposure that may result in respiratory problems, health effects and methods of prevention. Most respondents perceived they were exposed to coal dust, which they identified as a significant health hazard; they were at risk of having respiratory difficulties and could be protected from its exposure. There was no correlation between workers’ perception of coal dust exposure and their work experience. Conclusion: Workers were knowledgeable of the health hazards associated with coal dust. Coal dust was perceived as the main health hazard resulting in respiratory complications. The perception was the same among workers with different work experiences
Effect of Alcohol Prevention Program on Subject Well-being Scale, Alcohol Abstinence Self-Efficacy Scale and Alcohol Decisional Balance Scale of Alcohol Related Prisoners in Correctional Institutions in Korea
Introduction: This research intends to determine the intervening effect of alcohol prevention education programs on subjective well-being, alcohol abstinence self-efficacy, and alcohol decisional balance of alcohol-related prisoners. Methods: The subjects of the research were 25 alcohol-related prisoners who were detained in S district prisons in South Korea. The program was organized into less than 10 subjects for each session and carried out in three rounds from June 1 to July 2, 2019. A total of eight sessions programs were provided for four weeks, two times a week for each session. The collected data were analyzed with frequency, percentage, and paired t-test using the SPSS/WIN 21.0 program. Results: After the alcohol prevention training program, there was significant difference in subjective well-being scores (t=3.05, p= .005) and alcohol decisional balance score (t=2.16, p=.041). However, there was no significant difference in the abstinence self-efficacy score (t=-1.17, p=.254). Conclusion: Implementing the program will not only enriches the quality of life of alcohol-related prisoners by improving inherent positive emotions but also contribute to re-socialization and reduction of recidivism by making them aware of shortcomings rather than the benefits of alcohol.
Minocycline Protects Against LPS-induced Neuronal Death and Memory Impairment in the Rat
Introduction: Minocycline has been demonstrated to have potent effects on neurologic structures and functions in several animal models. However, its neuroprotective properties following a single injection of lipopolysaccharide (LPS) in an adult rat model have not been clearly elucidated. This study investigated minocycline’s neuroprotective effects in the LPS-induced neuroinflammation rat model. Methods: Fifty adult male Sprague Dawley rats were split into five groups at random: (i) control, (ii) distilled water-treated LPS, (iii) 25 mg/kg minocycline-treated LPS, (iv) 50 mg/kg minocycline-treated LPS, and (v) 10 mg/kg memantine-treated LPS. On day 5, LPS (5 mg/kg) was given intraperitoneally once, whereas minocycline and memantine were given once daily for 14 days. Results: LPS was found to significantly induce β-amyloid peptide deposition and neuronal damage, and impair recognition memory, while administration of minocycline dose-dependently reversed these effects. These data suggest that LPS-induced recognition memory impairment by inducing β-amyloid peptide deposition and neuronal damage in the cortical and hippocampal areas. Furthermore, we compared minocycline with memantine administration, and these data suggested better effects in minocycline (50 mg/kg) and comparable effects between minocycline (25 mg/kg) and memantine (10 mg/kg) treatments in reducing β-amyloid peptide deposition, neuronal damage and recognition memory impairment induced by LPS. Conclusion: Minocycline may be a strong contender as an effective preventive-therapeutic drug for neuroinflammatory diseases such as Alzheimer’s disease (AD) based on these findings.
Changing Undergraduate Medical Students’ Perception of Online Learning and Assessment During the Covid-19 Pandemic: a One Year Follow-up Study
Introduction: Like most educational institutions, our medical school transitioned to online learning during the COVID-19 pandemic in March 2020. An initial survey of 192 undergraduate medical students conducted in June 2020 revealed a low acceptance of online assessments, lack of work-readiness, perception of online discussions as being inferior to face-to-face, and prevalent anxiety. Following this, we implemented pedagogic changes to encourage independent learning, improve patient contact, and increase social interactions between students. Methods: A follow-up study was conducted 12 months later in the same student population, excluding those who had graduated. The same 14-item anonymized survey questionnaire was administered, and comparisons were made between the follow-up and initial responses. Results: At follow-up, 45.6% of participants felt that online assessments can adequately and fairly assess students’ performance compared to the initial study (26.2%, p = 0.002). Participants at follow-up were generally more agreeable that discussion using an online learning platform was as effective as face-to-face learning compared to before (p = 0.017). Subgroup analysis showed that this was only true for Year 2 – 4 students. Year 5 students perceived online learning as less effective then face-to-face, reported lower confidence in their ability to apply their knowledge, and an increased in anxiety compared to before. Conclusion: While perception of online learning and assessment had improved at follow-up, the ramifications from restrictions to medical education over the past two years are now being felt most severely by the current final year students, emphasizing the importance of anticipating and addressing these concerns much earlier.
An In Vitro Evaluation of the Remineralizing Efficacy of Two concentrations of Silica Doped Nanohydroxyapatite on Bleached Enamel
Introduction: Vital bleaching of teeth is associated with mineral loss and surface roughness leading to hypersensitivity. Aesthetic restorations are recommended after one week. Search is on for a suitable remineralizing material, which helps in instant adhesive bonding. Hence objective of the study is to evaluate the remineralizing efficacy of two concentrations of Silica doped Nanohydroxyapatite on bleached enamel. Methods: Enamel surfaces of 30 extracted human central incisors were divided into Part A: Unbleached enamel, Part B: Bleached enamel, Part C: Remineralized enamel. The samples were randomly divided into, Group 1: MI Paste Plus (Recaldent, USA), Group 2 and 3 for application of Dentin bonding agents (Tetric- n-bond, Ivoclar, Vivadent) mixed 0.2% and 0.8% Silica doped Nanohydroxyapatite (Sigma Aldrich, Bangalore, India). Post bleaching remineralizing agents were applied on part C. Surface roughness was evaluated with contact stylus profilometer and mineral content was evaluated with Energy dispersive X-Ray spectroscopy for three parts. Data were analysed using ANOVA and Post Hoc Tukey test with p ≤ 0.05. Results: Surface roughness values (Ra) were increased, and mineral loss (Ca:P) was observed after bleaching. After application of remineralizing agents, surface roughness was decreased with no significant value (p > 0.05) and a significant increase in mineral content of all three groups with a p < 0.05 was observed. Conclusion: Application of dentin bonding agent mixed with Silica doped Nanohydroxyapatite decreased surface roughness and improved remineralization of bleached enamel.
Laplace-Based Interpolation Method in Reduction of Metal Artifact in Computed Tomography Imaging
Introduction: Metal artifacts can degrade the image quality of computed tomography (CT) images which lead to errors in diagnosis. This study aims to evaluate the performance of Laplace interpolation (LI) method for metal artifacts reduction (MAR) in CT images in comparison with cubic spline (CS) interpolation. Methods: In this study, the proposed MAR algorithm was developed using MATLAB platform. Firstly, the virtual sinogram was acquired from CT image using Radon transform function. Then, dual-adaptive thresholding detected and segmented the metal part within the CT sinogram. Performance of the two interpolation methods to replace the missing part of segmented sinogram were evaluated. The interpolated sinogram was reconstructed, prior to image fusion to obtain the final corrected image. The qualitative and quantitative evaluations were performed on the corrected CT images (both phantom and clinical images) to evaluate the effectiveness of the proposed MAR technique. Results: From the findings, LI method had successfully replaced the missing data on both simple and complex thresholded sinogram as compared to CS method (p-value = 0.17). The artifact index was significantly reduced by LI method (p-value = 0.02). For qualitative analysis, the mean scores by radiologists for LI-corrected images were higher than original image and CS-corrected images. Conclusion: In conclusion, LI method for MAR produced better results as compared to CS interpolation method, as it worked more effective by successfully interpolated all the missing data within sinogram in most of the CT images.
Embracing Online Learning: The Readiness and Perceived Challenges among Health Sciences Distance Learners
Introduction: The shifting of conventional to online learning is prominent in our millennial era. The online pedagogy is dynamic in creating knowledge and simultaneously engaging learners with experts beyond boundaries. Our study aims to determine the readiness of distance learners in embracing online learning and their perceived challenge in accomplishing their academic journey. Methods: We employed the quantitative study design with a cross-sectional survey and this study was conducted in a public university. The health sciences learners who are currently undertaking their distance learning program were recruited by convenience sampling (N=128). The Online Learning Readiness Scale (OLRS) was adopted with its internal consistency ranging from 0.77 to 0.95 for five dimensions of measure. Results: Our results indicate a high level of online learning readiness. In addition, the highest level of readiness in the dimension of computer/internet self-efficacy whereas the least level was the learners’ control. Sixty-eight percent of learners reported poor internet connectivity as the main challenge in online learning. Moreover, we found that gender, age, and the learners’ program were not the significant factors affecting learners’ online learning readiness (p>.05). Conclusion: Our study revealed a high extent of online learning readiness among distance learners that display constructive embracing of current educational technology. Nevertheless, considering the poor internet connection, communication infrastructure needs to be further developed to bridge the gap between millennial learners and the Internet of Things (IoT).
Predictors of Coronary Heart Disease (CHD) among Malaysian Adults: Findings from MyDiet-CHD Study
Introduction: This study aimed to determine the risk factors of CHD among the Malaysian adult population. Methods: Using a cross- sectional observational study design, this study involved 365 adult patients aged between 30-64 years, attending clinics from eight government hospitals and four health clinics in Terengganu, Pahang, Selangor, Putrajaya, Penang, Kedah, Johor and Sabah from February 2018 until September 2020. Sociodemographic characteristics, clinical and dietary data, physical activity and stress level were recorded using a structured questionnaire. Multiple logistic regression was used to analyse CHD risk factors. Results: The overall response rate was 99.2%. The adjusted odds ratio of CHD was greater for age (AOR; [%95 CI]) (1.043;[ 1.009,1.078]); waist circumference (1.033;[1.009, 1.057]); total fat intake (1.035;[1.021, 1.050]); full cream dairy products intake (1.004;[1.001, 1.008]); smokers vs non-smokers (4.691;[2.399, 9.176]); individual with family history of CHD vs without family history (2.705;[ 1.496, 4.891]); married vs single (0.434;[ 0.217,0.867]); and lower for HDL cholesterol (0.185;[0.052, 0.662]); Chinese vs Malays (10.619;[ 2.255, 49.995]); and third lowest income (0.197;[ 0.073, 0.532]) and forth lowest income (0.167;[ 0.056, 0.499]) vs lowest income. Conclusion: Age, race, income, smoking and marital status, family history of CHD, waist circumference, HDL cholesterol, total fat intake, full cream dairy products intake were significantly associated with CHD among this population. This finding is particularly important to the primary health carers to identify at-risk CHD individuals thus appropriate intervention could be provided.
A Systematic Review of Prevalence and Risk Factors of Latent Tuberculosis Infection Among Medical and Nursing Students
Introduction: Clinical training may expose medical and nursing students to workplace hazards comparable to those encountered by healthcare workers (HCWs). This study was designed to investigate the prevalence of latent tuberculosis infection (LTBI) and associated risk factors among medical and nursing students. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a systematic review was conducted utilising four electronic databases to appraise and synthesise the literature on LTBI which used the tuberculin skin test (TST) and the blood interferon-gamma release assay (IGRA). Results: Original articles published in the English language between 2010 and 2020 were included, yielding 14 relevant articles. The average prevalence of LTBI in high-burden countries was 38.2% for TST and 20.6% for the IGRA test. According to TST and IGRA findings, the average prevalence of LTBI in nations with an intermediate burden was 16.7% and 4.7 %, respectively. The average prevalence was 2.8% and 1.1% from the TST and IGRA tests for low-burden countries, respectively. A greater risk of LTBI was shown to be related with an increase in age among postgraduate medical school students, a history of Bacillus Calmette-Guerin (BCG) vaccination, origin from high-risk tuberculosis (TB) countries, increased hours of hospital exposure, a history of contact with TB cases, a high body mass index, older age group students, and a lower TB knowledge score. Conclusion: The available evidence from this review emphasised the importance of developing and implementing efficient and cost-effective TB infection-control programmes, particularly in high-burden countries and amongst students at risk.
In What Way Does Music Improve Learning in Medical Education? A Systematic Review
Introduction: Music has been widely used in teaching and learning due to its observed positive effects. This review aimed to identify the beneficial impacts of music utilization in medical education. Methods: Using four established databases; Scopus, ScienceDirect, JSTOR and PubMed, exhaustive searched of related articles were performed for articles published between January 2010 and January 2020 using combination of keywords. Screening of titles and abstracts were conducted, with removal of duplicates. Results: Five full text articles were finally reviewed, of which one cross-sectional, three intervention and a qualitative studies. Consensus between authors had successfully identified three themes, which were positive effect of music on the well-being and performance of the medical students, as well as improved patient-doctor communication skills. Conclusion: The findings of the review confirmed the positive effects of music utilization on the well-being and performance of medical students, as well as on patient-doctor communication skills.
The Health and Wellness Benefits of Traditional Postnatal Practice (TPC) on Postnatal Mothers: A Systematic Review
Introduction: Postnatal is a transition process for the mother back to her non-pregnancy state and involves the changes in hormones level. During the postnatal period, many health issues need to be addressed for both mother and newborn. One of the upsetting health issues for the mother due to the increasing trend is postnatal depression and if it is not identified and treated early, it may cause further complicated problems not only to the mother but also to the baby, family, and local community. With this issue, the Ministry of Health Malaysia has taken a few initiatives to encourage the postnatal mother to also practice the non-medical approaches or traditional postnatal care (TPC) as a self-care for the prevention of postnatal depression. Aim: To systematically identify and review studies examining the influence of TPC on postnatal mothers. Design & Data Sources: A systematic search strategy on the research trend for the period between the years 2013 to 2020 through the Scopus database, Science Direct, and PubMed database. Methods: This review has identified 7 journal articles based on the preferred reporting items for the systematic reviews (PRISMA) framework. Results: There are many methods of TPC, such as traditional postnatal body massage, herbal consumption, herbal bath, body steaming, and body wrapping based on own culture and beliefs. Besides the TPC preparation and techniques, some studies also describe the effects of TPC on a mother’s health and wellness. Conclusion: TPC shows encouraging health trends, and it helps to enhance the well-being and good health of postpartum mothers.
Parental Intervention Strategies to Reduce Screen Time Among Preschool-aged Children: A Systematic Review
Aims: Children below five years have been the target of screen time guidelines. The adverse health outcomes associated with it require focusing on prime strategies for reducing screen time. The current study reviews parental intervention strategies to reduce screen time among preschool-aged children. Design: Systematic review. Data sources: A total of five databases of the Cochrane register of controlled trials, CINAHL, Medline PubMed, and Scopus databases were searched from May 1 to 31, 2020. Review Methods: The keywords of “screen time”, “television”, “video”, “computer”, “mobile device”, “hand phone”, “media use”, “preschool-aged children”, “interventions”, and “strategies” used for search. The inclusion criteria are limited to specific study populations, intervention, comparison and outcomes (PICOs), language, and published study types. The quality of articles was assessed using the Cochrane Risk of Bias (RoB) tool. Results: A total of six studies that met the inclusion criteria were further analysed. It showed that besides providing knowledge and awareness regarding screen time, restrictive practices, offering alternative activities to parents and removing the screen from the child’s bedroom were the most common strategies used by successful studies. The duration of intervention between 6-8weeks was sufficient to observe screen time reduction, while face-to-face methods dominated the mode of delivery. Increasing parental self-efficacy, listing outcome expectations, and reinforcement strategies targeting both the parents and their home environment were beneficial in reducing screen time. Conclusion: Future screen time reduction studies could benefit from incorporating the above approaches for screen time reduction intervention among preschool children.
High Titer Inhibitor-Acquired Hemophilia A Treated With Human FVIII Concentrate in Limited Resource: A Case Report
Acquired hemophilia A (AHA) is a rare condition that affects one in a million people each year, and there are not many diagnostics or therapeutic agents available for treatment due to its rarity. This is a case report of a 61-year-old woman who presented with a spontaneous subcutaneous hematoma and multiple extensive bruises in her extremities. There was no prior history of bleeding disorders, and the laboratory results showed an isolated aPTT prolongation with no correction after mixing studies, and a reduction in FVIII activity level along with a high FVIII inhibitor titer (928BU). Furthermore, the diagnosis of idiopathic AHA was made after other secondary causes had been ruled out, and the patient received human FVIII concentrate instead of bypassing agents due to its availability. The patient still experienced clinical improvement despite using this alternative. AHA is currently managed using both hemostasis agents and inhibitor eradication, and they come with several limitations. Human FVIII concentrate therapy is still an option in situations with limited resources, even though it is not recommended in patients with high inhibitor titer levels.
Dengue Encephalopathy or Japanese Encephalitis? Co-Infection or Serologic Cross- Reactivity?
Dengue infection has a wide clinical spectrum ranging from asymptomatic presentation to life-threatening severe dengue with multiorgan failure, and increasingly recognized neurological presentation in the past decade. Japanese encephalitis on the other hand is another common mosquitoes-borne flavivirus infection endemic in Southeast Asia, which share some similar clinical features. We report a case of a 38-year-old male patient who presented to us with complaints of fever and acute encephalitis syndrome with positive dengue NS1 antigen, and positive cerebrospinal fluid serologies for both dengue and JE immunoglobulins. Magnetic Resonance Imaging findings were suggestive of encephalitic changes. Co-infection and serology cross-reactivity of these two flaviviruses is not uncommon in countries where both dengue and Japanese encephalitis are endemic, and thus, the treating clinician should have a high index of suspicion if clinical and serological evidence are present whilst treating the patient.
Snare Guiding Technique in Bifurcated Endovascular Repair of Abdominal Aortic Aneurysm with Severely Tortuous Iliac Artery Access: A Case Report
Endovascular aneurysm repair (EVAR) has gained acceptance as a viable alternative to open surgical treatment for abdominal aortic aneurysm (AAA). We report the use of snare guiding wire in bifurcated EVAR case with severely tortuous femoral access. A 63-year-old man referred to the hospital from another facility with complaints of pulsating mass in right iliac and umbilical region for the last 2 years. He was then admitted to the cardiac catheterization lab for EVAR under general anaesthetic. Endovascular aneurysm repair (EVAR), also known as an endoprosthesis, is a stent-graft device-guided therapy for a AAA. This procedure is a safer choice for individuals who are elderly or have pulmonary, cardiac, or renal problems. Tortuous iliac arteries might obstruct device delivery during EVAR. The Snare Guiding Wire approach might be an alternate method for EVAR to treat AAA if conventional cannulation is difficult or impossible in individuals with highly tortuous iliac access.
Simultaneous Appearance of Arteritic Anterior Ischemic Optic Neuropathy and Central Retinal Artery Occlusion in Giant Cell Arteritis
Giant cell arteritis (GCA) is uncommon among Asian population. It is frequently associated with sight threatening complications. Simultaneous bilateral ocular involvement with different pathology is uncommon. We would like to highlight a rare case of GCA that was presented with transient visual loss over the right eye with simultaneous onset of central retinal artery occlusion as well as arteritic anterior ischemic optic neuropathy in both eyes. High dose intravenous methylprednisolone then subsequently maintenance dose of oral steroid and oral aspirin were given. His visual acuity remained the same after treatment. Early diagnosis and treatment of GCA is crucial. Visual outcome can be devastating if treatment is delayed.
Superior mesenteric artery (SMA) syndrome is rare with the common presentation of megaduodenum from entrapment of the third part of the duodenum (D3) by the SMA. We present a case report of a thin, fit 16-year-old boy, active smoker complaining of generalized colicky abdominal pain associated with persistent postprandial vomiting. Small bowel study demonstrated partial duodenal obstruction from compression of the third part of the duodenum by the SMA. Computed tomography of the abdomen shows an aorto-mesenteric angle of 13 degrees with aorto-mesenteric distance of 0.32 cm, indicating SMA syndrome. His symptoms resolved spontaneously with watchful waiting and nutritional care plan. The success was contributed to restoring the fat cushion around the SMA, hence, widening the aorto-mesenteric angle. In conclusion, watchful waiting with a nutritional care plan is a feasible initial strategy in the approach to SMA syndrome. However, should this strategy be unsuccessful, the choice of surgical treatment is duodenojejunostomy.
Post-traumatic Pseudoaneurysm of a Branch of Facial Artery
Pseudoaneurysm which is also known as a false aneurysm is caused by extravasation of blood from the injured vessel wall which is contained by the surrounding soft tissue. It does not contain any layer of the vessel wall and can expand as more and more blood collects. We are reporting a case of an 18-year-old Indian gentleman who presented with complaint of left neck swelling after being involved in a motor vehicle accident. Examination showed a softly pulsating swelling at the angle of the left mandible. CT angiogram revealed a pseudoaneurysm of a branch of the left facial artery. The pseudoaneurysm was embolized by using histoacryl glue. Pseudoaneurysm should be considered as a differential diagnosis in patients with a pulsatile mass after trauma.
Sternal Cleft With Coarctation of Aorta and Vascular Anomalies - Learning Point in Young Stroke
Sternal cleft is a rare congenital anomaly that is known to be associated with other congenital abnormalities in particular coarctation of aorta and vascular anomalies. We present a case of a young teacher who presented with recurrent episodes of ischemic stroke. During the workup to look for the cause of stroke, it was discovered that this patient had complete midline sternal cleft with underlying coarctation of aorta and left subclavian artery aneurysm. We wish to highlight the relation between the presence of sternal cleft and coarctation of aorta as well as vascular anomalies as one of the rare cause of young stroke.
Handling The Identification of Burn Victims in A Traffic Accident: A DVI Case Report
The role of the forensic pathologist in a mass disaster is to identify the victims. The procedure refers to Interpol’s Disaster Victim Identification (DVI) guidelines. DVI consists of 4 stages namely Scene Examination, Post-Mortem Examination, Ante-Mortem Examination, and Reconciliation. Post-Mortem (PM) and Ante-Mortem (AM) data collected include fingerprints, dental records, DNA as Primary Identifiers, medical records, and property as Secondary Identifiers. At the reconciliation stage, at least there must be a match between one Primary Identifier or two Secondary Identifiers. Theoretically, 4-phase DVI should be performed according to the DVI standard in every disaster case. In fact, the implementation of DVI encountered many obstacles in the field. This article discusses the various obstacles and problems faced when conducting DVI in the case of a car accident with a truck on the Madiun-Ngawi toll road at KM 631 A to the Madiun – Nganjuk toll road. The chronology of this incident began when the elf’s vehicle hit a truck and a concrete barrier and then caught fire. Three victims were found in a burned condition leaving only the skeleton, thigh and psoas muscle. This of course does not allow fingerprints to be checked. The identification process is carried out only by comparing primary and secondary data as an identification guide given the condition of the bodies that are only slightly left. Then DNA examination was not carried out in this identification process. Tests for CO levels showed that the three victims indicated CO poisoning before they died.
The Miracle Weight Loss in Primary Care?
This case report illustrates how a primary care physician managed a 60-year-old woman with severe obesity, uncontrolled diabetes mellitus, and low self-esteem for many years. Through a primary care physician, bariatric surgery is recommended for patients with severe obesity, which is then co-managed in a tertiary hospital through a multidisciplinary team. Primary care physicians are on the front lines when treating patients with severe obesity. A number of studies have shown that primary care physicians have low success rates in counselling and managing patients with severe obesity.(1,2) There is also a debate about bariatric surgery being unsuitable for the elderly age. It is crucial to intervene early to prevent obesity progression and its complications. Clinical inertia is one factor that hinders patients with severe obesity. Therefore, it is essential to address the problem of severe obesity early and should not miss the opportunity to counsel the treatment options and refer these patients to bariatric surgery if indicated. Primary care physicians are also crucial in providing continuity of care after bariatric surgery.
Addressing the Double Burden of Malnutrition using the Life Course Perspective
The double burden of malnutrition refers to the coexistence of undernutrition which is typically characterised by stunting and wasting, alongside overnutrition at all levels of the population. The objective of this article is to review the current issues in addressing the double burden of malnutrition using the life course approach. Studies addressing life course approach in DBM were identified through PubMed & EMBASE databases. Relevant studies were critically appraised. The challenges, opportunities and way forward in addressing DBM through the life course concept were discussed. The review showed that the DBM dilemma could be addressed via a holistic perspective through a life course concept as nutrition plays an important role in influencing health from pre-conception to old age. The life course concept proposes that environmental exposures, including biological, physical, social, and behavioral factors, including life experiences, throughout life, influence health outcomes in current generations and their offspring.
A Narrative Review of Alveolar Bone Analysis and CBCT Classification related to Immediate Implant Placement in The Anterior Maxilla
Immediate implant placement into fresh extraction sockets has gained a lot of attention in implant dentistry. Besides proper risk assessment, the evaluation of tooth anatomy aids the clinicians to select the finest treatment protocol. Cone Beam Computed Tomography (CBCT) imaging was frequently used for alveolar bone analysis prior to tooth extraction in immediate implant placement. As an ideal position is required to prevent a buccally tilted implant or too palatal implant placement, various authors have proposed the treatment guidelines for immediate implant placement in the anterior maxilla. Although insightful, the previous classification was lacking anatomic variant and key anatomical features of alveolar bone and tooth angulation. Furthermore, there is no standardization method of measuring the specific degree of tooth angulation in CBCT scans that could possibly be used in clinical setting for appropriate treatment protocol. Thus, it is essential for the clinician to have adequate knowledge on the role of facial alveolar bone, palatal alveolar bone and tooth angulation related to immediate implant before selecting the appropriate treatment guidelines based on the classification reviewed. In this review, the previous quantitative measurements were categorized, and the previous classification was listed for the sake of familiarity by the dental practitioner with the major updates on implant placement strategy, patient selection and to reduce the rate of surgical complications
Peri-implant Bone Healing: Its Basic Osteogenesis and Biomarkers
The continuous sequence of bone healing phases starts off with osteoconduction to the implant surface, depending on the migration of osteogenic cells. Osteoneogenesis ensues resulting in a mineralised interfacial matrix and is followed by bone remodelling to the implant interface at discrete sites. Dental implant drilling procedure and placement produce osseous defect which is filled by blood. Within seconds, blood proteins are adsorbed onto the implant surface and platelets are activated resulting in the release of cytokines and growth factors. Further platelet aggregation initiates osteoconduction to the surface, followed by osteoneogenesis, forming an extracellular matrix. Subsequently, remodelling creates a bone to implant interface which can be explained through distance and contact osteogenesis. The dental implant surface has been shown to influence osteoconduction by modifying protein properties and adsorption around the implant. Salivary biomarkers may be considered as a specific and sensitive diagnostic tool to detect these changes in protein expressions after implant placement. Thus, the purpose of this narrative review is to provide a detailed account of the bone healing mechanism associated with dental implant placement, as well as how the implant surface architecture and protein release play a role in bone healing, and the potential use of saliva to detect these biomarkers.