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1. Fulltext Clival Chordoma in an Adolescent: A Perspective from Primary Care

   Miptah HN, Badlishah-Sham SF, Hashim H, Ramli AS

   Korean J Fam Med, 2020 Nov;41(6):427-430.

   PMID: 32438537 DOI: 10.4082/kjfm.19.0004

   Abstract

   Clival chordoma is a rare malignant tumor of the brain that typically occurs in older adults. It has a high local recurrence rate and is hence associated with poor prognosis. Here, we report a case of an adolescent who presented with a 1-month history of worsening headache and blurring of vision, as well as a 6-month history of left-sided facial and body numbness. Clinical findings were consistent with left upper motor neuron lesion of the seventh cranial nerve with involvement of the fifth cranial nerve. He was also found to have a sixth cranial nerve palsy demonstrated by diplopia upon lateral gaze with no evidence of papilledema. Magnetic resonance imaging of the brain suggested clival chordoma. He was subsequently referred to the neurosurgical team, and he successfully underwent an endoscopic trans-sphenoidal surgery to excise the lesion. He recovered well, continued his follow-ups with the neurosurgical team, and showed good progress. He also attended regular follow-ups with his primary care physician to ensure ongoing psychosocial support and monitoring of his overall health status. This case demonstrates the importance of prompt identification and treatment of clival chordoma in an adolescent. Long-term follow-ups and shared care between primary and secondary care physicians are essential to monitor recurrence of tumor and to provide psychosocial support.
2. Fulltext Transforming ophthalmic education into virtual learning during COVID-19 pandemic: a global perspective

   Chatziralli I, Ventura CV, Touhami S, Reynolds R, Nassisi M, Weinberg T, et al.

   Eye (Lond), 2021 May;35(5):1459-1466.

   PMID: 32651545 DOI: 10.1038/s41433-020-1080-0

   Abstract

   OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has imposed measures of social distancing and barriers in delivery of "in person" education. Institutions, involved in training the next generation of ophthalmologists, are using alternative teaching methods to maintain the standard of education.

   METHODS: We conducted a worldwide survey among physicians, who are actively involved in Ophthalmology-related education, between 3 and 14 April 2020. The expert survey, developed on the basis of literature search and focus group discussions, comprised 23 questions addressing the use of e-learning in Ophthalmology during the COVID-19 pandemic.

   RESULTS: A total of 321 participants from both academic and non-academic institutions worldwide, with variable practice experience and expertise, completed the survey. Before the pandemic, the majority of participants used traditional training modalities, including lectures, grand rounds and journal clubs, and 48% did not use any e-learning. There was a statistically significant increase in the use of all e-learning alternatives during the pandemic (p 

   MeSH terms: Curriculum; Humans; Education, Distance*; Pandemics
3. Fulltext Unsuccessful Exclusive Breastfeeding and Associated Factors among the Healthcare Providers in East Coast, Malaysia

   Hashim S, Ishak A, Muhammad J

   Korean J Fam Med, 2020 Nov;41(6):416-421.

   PMID: 33242382 DOI: 10.4082/kjfm.19.0060

   Abstract

   BACKGROUND: Breastfeeding is widely recognized as the optimal and natural method of feeding infants. However, there are obstacles that can limit exclusive breastfeeding practices during the first 6 months of an infant's life. This study aimed to determine the prevalence of unsuccessful exclusive breastfeeding and its associated factors among mothers who work as healthcare providers at Universiti Sains Malaysia Hospital.

   METHODS: A cross-sectional study was conducted among 295 medical doctors and staff nurses from June to December 2015. Simple random sampling was applied. The data were collected using a self-administered questionnaire and analyzed using IBM SPSS ver. 22.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics and logistic regression analysis were performed.

   RESULTS: The prevalence of unsuccessful exclusive breastfeeding among the study participants was 58.3%. Mothers who preferred formula milk (odds ratio [OR], 4.40; 95% confidence interval [CI], 1.45-13.31) delivered via lower segment cesarean section (OR, 2.31; 95% CI, 1.07-4.98) and produced inadequate breast milk (OR, 4.06; 95% CI, 2.40- 6.89) were significantly associated with unsuccessful exclusive breastfeeding.

   CONCLUSION: The prevalence of unsuccessful exclusive breastfeeding among the study participants was high. Maternal characteristics such as preference towards formula milk, mode of delivery and adequacy of breast milk must be assessed to prevent unsuccessful exclusive breastfeeding among healthcare providers.
4. Resilience in Iranian adolescents during the COVID-19 pandemic: Psychometric Evaluation of the Connor-Davidson Resilience Scale

   Sharif-Nia H, She L, Froelicher ES, Arslan G, Hejazi S, Fomani FK, et al.

   J Child Adolesc Ment Health, 2021;33(1-3):111-122.

   PMID: 38041437 DOI: 10.2989/17280583.2023.2274339

   Abstract

   Background: Resilience is a measure of the ability to cope with stress and the accurate measurement of it is critical. This study aimed to translate and evaluate the psychometric properties of the Connor-Davidson Resilience Scale in Iranian adolescents during the Coronavirus Disease (COVID-19) pandemic.Methods: In this cross-sectional study, after the scale translation, the content and construct validity were assessed using exploratory and confirmatory factor analysis. Moreover, internal consistency, composite reliability, and invariance measurement were evaluated.Results: The content validity ratio was greater than 0.49, and the modified kappa coefficient for all items was higher than 0.6. With exploratory factor analysis, two factors were extracted consisting of 16 items and explaining 43% of the total variance. The results of confirmatory factor analysis indicated a good fit for the model. Cronbach's alpha and composite reliability for both factors were greater than 0.7. Although there is no significant difference (p = 0.09) in the average resilience of adolescents in different provinces, boys (42.64 ± 10.90) had a significantly (p < 0.001) higher resilience score than girls (40.10 ± 11.92).Conclusion: The study results showed that the Persian 16-item version of the Connor-Davidson Resilience Scale has acceptable reliability and validity in the Iranian adolescent population.
5. Fulltext Managing COVID-19 Pandemic in the Community: A Primary Health Clinic Experience

   Yusof NA, Juhari SN, Daud N, Pauzi MF, Ngah ND

   Korean J Fam Med, 2022 Jul;43(4):220-224.

   PMID: 35615872 DOI: 10.4082/kjfm.21.0062

   Abstract

   The coronavirus disease 2019 (COVID-19) pandemic has affected several countries worldwide, including Malaysia, with the first reported case occurring in January 2020. Terengganu, a state on the east coast of Malaysia, is finding it challenging to contain the disease by aggressively instituting all public health measures to reduce the number of COVID-19 cases and community transmission. Our primary health clinic, which is situated in a semi-rural district in Terengganu, is also involved in the implementation of containment measures, community risk measurement, and the initial management of COVID-19 cases. The health clinic changed the clinic system for the delivery of healthcare services to avoid overcrowding of patients and adapted innovative ways of providing medical services, such as telemedicine and "drive-through" pharmacy. It also provided continuous health education and awareness regarding COVID-19 to both patients and clinic attendees. The essential element of combating the infection is the effective control of infection in a small, isolated clinic in which space and adequate facilities are known challenges. This study aimed to highlight the flow of COVID-19 management starting from screening, triaging, and management based on protocol, implementation of infection control measures, and training of healthcare workers in our health clinic. The mental health of these workers was managed by the Mental Health and Psychosocial Support Unit, as recommended by the Ministry of Health Malaysia. The role of primary care clinics in the ongoing pandemic is currently increasing. Hence, higher authority and the government must increase the number of facilities, human resources, and financial budget to ensure that all initiatives can be implemented effectively.
6. Lipid profiles and lifestyle habits of stroke survivors in the east coast region of peninsular Malaysia: Preliminary findings

   Wong HJ, Harith S, Lua PL, Ibrahim KA

   Nutr Health, 2023 Dec;29(4):695-705.

   PMID: 35763460 DOI: 10.1177/02601060221097459

   Abstract

   Background: Stroke survivors are at high risk for recurrent cardiovascular events if no prevention strategies are undertaken. Aim: This study aimed to investigate the fasting serum lipid profiles and lifestyle habits in stroke survivors, and the factors associated with suboptimal lipid profiles. Methods: A cross-sectional retrospective study was conducted in three public hospitals in Malaysia. Stroke survivors' data regarding the socio-demographic characteristics, clinical profiles, fasting serum lipid profiles, dietary adherence, and physical activity levels were acquired. Binary logistic regression was used to examine the factors associated with suboptimal lipid goals. Results: A total of 104 stroke survivors were recruited from patients attending the neurology and rehabilitation departments. Only 22% of the stroke survivors attained the targeted low-density lipoprotein cholesterol level (LDL-C < 1.8 mmol/L). Meanwhile, more than two thirds of patients achieved the targeted total cholesterol, triglyceride, and high-density lipoprotein cholesterol goals. Patients with a longer stroke duration (Adjusted odds ratio, AOR 3.33, 95% confidence intervals, CI: 1.09, 10.13, p  =  0.034), elevated blood pressure (AOR 4.74, 95% CI: 1.65, 13.62, p  =  0.004), chronic kidney disease (AOR 3.30, 95% CI: 1.05, 10.34, p  =  0.041), abdominal obesity (AOR 3.14, 95% CI: 1.20, 8.21, p  =  0.020), excessive energy intake (AOR 2.72, 95% CI: 1.07, 6.91, p  =  0.036), and excessive saturated fatty acids intake (AOR 2.85, 95% CI: 1.02, 7.93, p  =  0.045) were significantly associated with suboptimal lipid profiles. Conclusion: The lipid goals attainment was low, particularly the LDL-C levels among Malaysian stroke survivors. Greater efforts are warranted to fully utilise the lipid-lowering therapy and the lifestyle changes in these high-risk patients.
7. Fulltext Soil CO2 and CH4 fluxes from different forest types in tropical peat swamp forest

   Busman NA, Melling L, Goh KJ, Imran Y, Sangok FE, Watanabe A

   Sci Total Environ, 2023 Feb 01;858(Pt 2):159973.

   PMID: 36347298 DOI: 10.1016/j.scitotenv.2022.159973

   Abstract

   Information on temporal and spatial variations in soil greenhouse gas (GHG) fluxes from tropical peat forests is essential to predict the influence of climate change and estimate the effects of land use on global warming and the carbon (C) cycle. To obtain such basic information, soil carbon dioxide (CO2) and methane (CH4) fluxes, together with soil physicochemical properties and environmental variables, were measured at three major forest types in the Maludam National Park, Sarawak, Malaysia, for eight years, and their relationships were analyzed. Annual soil CO2 fluxes ranged from 860 to 1450 g C m⁻2 yr⁻1 without overall significant differences between the three forest sites, while soil CH4 fluxes, 1.2-10.8 g C m⁻2 yr⁻1, differed. Differences in GHG fluxes between dry and rainy seasons were not necessarily significant, corresponding to the extent of seasonal variation in groundwater level (GWL). The lack of significant differences in soil CO2 fluxes between the three sites could be attributed to set-off between the negative and positive effects of the decomposability of soil organic matter as estimated by pyrophosphate solubility index (PSI) and GWL. The impact of El-Niño on annual CO2 flux also varied between the sites. The variation in soil CH4 fluxes from the three sites was enhanced by variations in temperature, GWL, PSI, and soil iron (Fe) content. A positive correlation was observed between the annual CH4 flux and GWL at only one site, and the influence of soil properties was more pronounced at the site with the lowest GWL and the highest PSI. Variation in annual CH4 fluxes was controlled more strongly by temperature where GWL was the highest and GWL and plant growth fluctuations were the least. Inter-annual variations in soil CO2 and CH4 fluxes confirmed the importance of long-term monitoring of these at multiple sites supporting different forest types.

   MeSH terms: Carbon Dioxide/analysis; Methane/analysis; Nitrous Oxide/analysis; Wetlands; Forests
8. Fulltext The risk of mortality and severe illness in patients infected with the omicron variant relative to delta variant of SARS-CoV-2: a systematic review and meta-analysis

   Kow CS, Ramachandram DS, Hasan SS

   Ir J Med Sci, 2023 Dec;192(6):2897-2904.

   PMID: 36754948 DOI: 10.1007/s11845-022-03266-6

   Abstract

   We summarized through systematic review and meta-analysis of observational studies the risk of mortality as well as severe illness of COVID-19 caused by omicron variant relative to delta variant of SARS-CoV-2. A total of twelve studies were included. Our results showed significantly reduced odds of mortality (pooled OR = 0.33; 95% CI: 0.16-0.67) and significantly reduced odds of severe illness (pooled OR = 0.24; 95% CI: 0.21-0.28) in patients infected with the omicron variant of SARS-CoV-2 relative to their counterparts infected with the delta variant. Findings of lower disease severity following infection with the omicron variant of SARS-CoV-2 than the delta variant are encouraging during the ongoing transition from the pandemic phase into the endemic phase of COVID-19.
9. Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period-a cross-sequential study based on COVAD surveys

   Jagtap K, Naveen R, Day J, Sen P, Vaidya B, Nune A, et al.

   Rheumatology (Oxford), 2023 Dec 01;62(12):3838-3848.

   PMID: 36961331 DOI: 10.1093/rheumatology/kead144

   Abstract

   OBJECTIVE: Flares of autoimmune rheumatic diseases (AIRDs) following COVID-19 vaccination are a particular concern in vaccine-hesitant individuals. Therefore, we investigated the incidence, predictors and patterns of flares following vaccination in individuals living with AIRDs, using global COVID-19 Vaccination in Autoimmune Diseases (COVAD) surveys.

   METHODS: The COVAD surveys were used to extract data on flare demographics, comorbidities, COVID-19 history, and vaccination details for patients with AIRDs. Flares following vaccination were identified as patient-reported (a), increased immunosuppression (b), clinical exacerbations (c) and worsening of PROMIS scores (d). We studied flare characteristics and used regression models to differentiate flares among various AIRDs.

   RESULTS: Of 15 165 total responses, the incidence of flares in 3453 patients with AIRDs was 11.3%, 14.8%, 9.5% and 26.7% by definitions a-d, respectively. There was moderate agreement between patient-reported and immunosuppression-defined flares (K = 0.403, P = 0.022). Arthritis (61.6%) and fatigue (58.8%) were the most commonly reported symptoms. Self-reported flares were associated with higher comorbidities (P = 0.013), mental health disorders (MHDs) (P 
10. Prevention of mother-to-child transmission of hepatitis B virus: An observation of routine practice in a tertiary liver centre before and after the introduction of the global health sector strategy on viral hepatitis

    Hoo CZ, Wan Abdullah WZ, Omar H, Tan SS

    Med J Malaysia, 2023 Mar;78(2):234-240.

    PMID: 36988536

    Abstract

    INTRODUCTION: Worldwide, around 296 million people have hepatitis B virus (HBV) infection, most commonly transmitted from mother-to-child. Global Health Sector Strategy on Viral Hepatitis (GHSSVH) was introduced in May 2016, calling for elimination of viral hepatitis by 2030. This study aims to compare practice in a tertiary liver centre before and after GHSSVH introduction for prevention of mother-to-child transmission (MTCT).

    MATERIALS AND METHODS: This retrospective cohort study was performed in a tertiary referral liver centre in Malaysia, using data from electronic medical record from January 2015 to December 2019. A total of 1457 medical records of female with HBV infection were screened. The inclusion criteria of the study were pregnant women with HBsAg positive or known to have HBV infection during the study period. We excluded patients with co-infections of other types of viral hepatitis or human immunodeficiency virus, concurrent liver diseases (e.g.: autoimmune hepatitis, Wilson’s disease), previous organ transplant and malignancy—except for hepatocellular carcinoma (HCC).

    RESULTS: This study included 117 pregnancies and 21/117 (17.9%) were on antiviral therapy (AVT) for HBV. In 2017– 2019, 13/18 (72.2%) of those with HBV DNA >200,000IU/ml were on AVT, compared to 5/9 (55.6%) for 2015–2016, indicating 58% (95% CI −63% to 568%) higher odds of being on AVT in post GHSSVH group after accounting for HBV DNA.

    CONCLUSION: Uptake of maternal AVT for the prevention of MTCT shows an increased trend since the introduction of GHSSVH, with room for improvement.

    MeSH terms: Female; Fixatives/pharmacology; Formaldehyde/pharmacology; Hepatitis B virus*; Hepatitis, Viral, Human*; Humans; Global Health; Infectious Disease Transmission, Vertical