METHODS: This is an assessor-blinded randomized control trial comparing 2 types of intervention which are HBT (experimental group) and usual practice (UP) (control group). Based on sample size calculation using GPower, a total number of 42 participants will be recruited and allocated into either the HBT or the UP group. Participants in HBT group will receive a set of structured exercise therapy consisting of progressive strengthening, balance and task-related exercises. While participants in UP group will receive a usual "intervention" practised by rehabilitation professional prior to discharging stroke patients from their care. Both groups are advised to perform the given interventions for 3 times per week for 12 weeks under the supervision of their caregiver. Outcomes of interventions will be measured using timed up and go test (for mobility), ten-meter walk test (for gait speed), stroke self-efficacy questionnaire (for self-efficacy) and hospital anxiety and depression scale (for anxiety level). All data will be analyzed using descriptive and inferential statistics.
DISCUSSION: This study will provide the information on the effectiveness of HBT in comparison to UP among stroke population who are discharged from rehabilitation. Findings from the study will enable rehabilitation professionals to design effective discharge care plan for stroke survivors in combating functional decline when no longer receiving hospital-based therapy.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12619001182189 (last updated 22/11/2019).
METHODOLOGY: A cross sectional study was conducted in two clinics at a university primary care centre. Patients aged ≥18 years with ≥1 risk factor for NAFLD or CVD were recruited. Participants with history of established liver disease or chronic alcohol use were excluded. Socio-demographics, clinical related data, anthropometric measurements and blood investigation results were recorded in a proforma. Diagnosis of NAFLD was made using abdominal ultrasound. The 10-year CVD risk was calculated using the general Framingham Risk Score (FRS). Multiple logistic regression (MLogR) was performed to identify independent factors associated with NAFLD.
RESULTS: A total of 263 participants were recruited. The mean age was 52.3 ± 14.7 years old. Male and female were equally distributed. Majority of the participants were Malays (79.8%). The overall prevalence of NAFLD was 54.4% (95%CI 48,60%). Participants in the high FRS category have higher prevalence of NAFLD (65.5%), followed by those in the moderate category (55.4%) and the low category (46.3%), p = 0.025. From MLogR, independent factors associated with NAFLD were being employed (OR = 2.44, 95%CI 1.26,4.70, p = 0.008), obesity with BMI ≥27.5 (OR = 2.89, 95%CI 1.21,6.91, p = 0.017), elevated fasting glucose ≥5.6 mmol/L (OR = 2.79, 95%CI 1.44,5.43, p = 0.002), ALT ≥34 U/L (OR = 3.70, 95%CI 1.85,7.44, p
OBJECTIVE: To evaluate the effectiveness of CBB on respiratory variables among NS-LBP patients.
STUDY DESIGN: pre- and post-experimental study.
PARTICIPANTS: Forty participants were assigned to an experimental group (EG) [n = 20] and control group (CG) [n = 20] based on the study criteria.
INTERVENTIONS: The EG received CBB together with routine physiotherapy and the CG received routine physiotherapy over a period of 8 weeks. Participants were instructed to carry out the exercises for 3 days per week. The training was evaluated once a week and the exercises progressed based on the level of pain.
OUTCOME MEASURES: Primary outcomes were maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and maximum voluntary ventilation (MVV). The secondary outcomes were measured in the numeric rating scale (NRS), total faulty breathing scale (TFBS), cloth tape measure (CTM) and lumbo-pelvic stability.
RESULTS: The MIP increased significantly among the EG when compared with that in the CG (p > 0.05).The EG showed a significant increase in MVV (p = 0.04) when compared to the CG (p = 0.0001). There was a significant reduction in pain for both groups. The MEP, TFBS, chest expansion and core stability showed no changes in either group.
CONCLUSION: CBB was effective in improving respiratory variables among NS-LBP patients.
METHODS: Consensus-driven approach between authors from the six selected countries was applied. Country specific policy documents, official government media statements, mainstream news portals, global statistics databases and latest published literature available between January-October 2020 were utilised for information retrieval. Situational and epidemiological trend analyses were conducted. Country-specific interventions and challenges were described. Based on evidence appraised, a descriptive framework was considered through a consensus. The authors subsequently outlined the lessons learned, challenges ahead and interventions that needs to be in place to control the pandemic.
RESULTS: The total number of people infected with COVID-19 between 1 January and 16 November 2020 had reached 48,520 in Malaysia, 58,124 in Singapore, 3,875 in Thailand, 470,648 in Indonesia, 409,574 in Philippines and 70,161 in Myanmar. The total number of people infected with COVID- 19 in the six countries from January to 31 October 2020 were 936,866 cases and the mortality rate was 2.42%. Indonesia had 410,088 cases with a mortality rate of 3.38%, Philippines had 380,729 cases with a mortality rate of 1.90%, Myanmar had 52,706 cases with a mortality rate of 2.34%, Thailand had 3,780 cases with a mortality rate of 1.56%, Malaysia had 31,548 cases with a mortality rate of 0.79%, and Singapore had 58,015 cases with a mortality rate of 0.05% over the 10- month period. Each country response varied depending on its real-time situations based on the number of active cases and economic situation of the country.
CONCLUSION: The number of COVID-19 cases in these countries waxed and waned over the 10-month period, the number of cases may be coming down in one country, and vice versa in another. Each country, if acting alone, will not be able to control this pandemic. Sharing of information and resources across nations is the key to successful control of the pandemic. There is a need to reflect on how the pandemic affects individuals, families and the community as a whole. There are many people who cannot afford to be isolated from their families and daily wage workers who cannot afford to miss work. Are we as a medical community, only empathising with our patients or are we doing our utmost to uphold them during this time of crisis? Are there any other avenues which can curb the epidemic while reducing its impact on the health and socio-economic condition of the individual, community and the nation?
METHODS: This is a quasi-experimental research with prepost test design with control group involving 81 participants per group from two health clinics in Sepang. The primary outcome was a change in the haemoglobin levels following educational intervention. Secondary outcomes include knowledge on anaemia, Health Belief Model (HBM) constructs, dietary iron intake and compliance towards iron supplementation. The intervention group received a HBMbased education intervention programme.
RESULTS: The response rate in the intervention and control group were 83.9% and 82.7% respectively. Generalised estimating equations analysis showed that the intervention was effective in improving the mean haemoglobin level (β=0.75, 95%CI=0.52, 0.99, p<0.001), the knowledge score (β=1.42, 95%CI=0.36, 2.49, p=0.009), perceived severity score (β=2.2, 95%CI= 1.02, 3.39, p<0.001) and increased proportion of high compliance level (AOR=4.59, 95%CI=1.58, 13.35, p=0.005).
CONCLUSION: HBM-based health education programme has proven to be effective in improving the haemoglobin levels, knowledge scores, perceived severity scores and compliance level of participants. The study results emphasized on the effectiveness of such an approach, therefore it is recommended that future educational interventions which aim at increasing preventive healthy behaviours in pregnant women may benefit from the application of this model in primary health care settings.
METHODS: This prospective cohort study was conducted at Hospital Universiti Sains Malaysia (USM) from 1st October 2016 to 30th November 2017. Serial bedside ultrasound procedures were performed for 83 patients who were diagnosed as having dengue fever without warning signs and were initially treated as outpatients. Ultrasonography evidence of plasma leakage either pleural effusion, thickened gallbladder wall, ascites or pericardial effusion were compared with clinical findings and laboratory parameters for plasma leakage.
RESULTS: Of the 83 dengue patients, eventually 72.3% had dengue fever with warning signs and 6.0% had severe dengue fever. There were 38 patients who had subclinical plasma leakage at initial presentation, 84.2% and 7.9% of them then progressed to dengue fever with warning signs and severe dengue respectively. There was a minimal agreement between serial bedside ultrasound and haematocrit level in the detection of plasma leakage (observed kappa 0.135).
CONCLUSIONS: Serial bedside ultrasound is an adjunct procedure to physical examination and may detect plasma leakage earlier compared to haemoconcentration. The early usage of serial ultrasound is of paramount importance in detecting dengue patients who are at risk of progressing to severe dengue.
METHODS: We enrolled all patients referred for SCI rehabilitation from 2012 to 2015 that fulfilled our study criteria. Data that were retrospectively reviewed included demographic and clinical characteristic data; and US KUB surveillance studies.
RESULTS: Out of 136 electronic medical records reviewed, 110 fulfilled the study criteria. The prevalence of NB in our study population was 80.9%. We found 22(20%) of the patients showed evidence of US diagnosed NB complications with the mean detection of 9.61±7.91 months following initial SCI. The reported NB complications were specific morphological changes in the bladder wall 8(36.4%); followed by unilateral/bilateral hydronephrosis 7(31.8%); bladder and/or renal calculi 5(22.7%); and mixed complication 2(9.1%) respectively. Half of the patients with NB complications had urodynamic diagnosis of neurogenic detrusor overactivity with/without evidence of detrusor sphincter dyssynergia. We found co-existing neurogenic bowel, presence of spasticity and mode of bladder management were significantly associated factors with US diagnosed NB complications (p<0.05), while spasticity was its predictor with adjusted Odds Ratio value of 3.93 (1.14, 13.56).
CONCLUSION: NB is a common secondary medical impairment in our SCI population. A proportion of them had US diagnosed NB complications. Co-existing neurogenic bowel, presence of spasticity and mode of bladder management were its associated factors; while spasticity was its predictor.
METHODS: This was a primary school-based cross-sectional study using multistage cluster sampling, conducted at Bau district in Sarawak, Malaysia in 40 primary schools. A questionnaire was used to collect information of usage pattern in insufficient lighting, timing and position. The physical and behavioural complaints were traced. Data analysis was performed using SPSS version 22. A p-value < 0.05 with 95% CI was considered as statistically significant.
RESULTS: About 52.8% of the 569 students used digital devices in a bright room, 69.8% in the day time and 54.4% in sitting position. The physical complaints were headache (32.9%), neck, shoulder and back pain (32.9%) followed by by eye strain (31.8%). Regarding behavioural problems, 25.7% of the students had loss of interest in study and outdoor activities (20.7%), skipped meals (19.0%) and arguments/disagreements with parents (17.9%). After logistic regression analysis, the lying position (OR=1.71, 95% CI: 1.096, 2.688) and darkroom lighting (OR=2.323 95% CI: 1.138, 4.744) appeared to be potential predictors of the complaint.
CONCLUSION: One-quarter of the students studied experienced physical complaints, and one-fifth had behavioural problems associated with the use of electronic devices. Lying position and darkroom lighting are the potential predictors of complaints. Therefore, we suggest that the children should use electronic devices in the sitting position with adequate room lighting.
METHODS: This is a prospective observational cohort study conducted in Sarawak General Hospital, Malaysia. Patients 12 years of age and older with mild to severe TBI who had a brain computed tomography (CT) done within eight hours of injury were enrolled in the study. A total of 334 patients were recruited from the 5th of August 2016 until the 8th of March 2018 in Sarawak General Hospital. In all 167 of them were administered with TXA and another 167 of the patients were not. The primary outcome expected is the number of good outcomes in isolated TBI patients given TXA. Good outcome is defined by Glasgow Outcome Score-Extended (GOSE) of five and above. Secondary outcome was clot expansion of an intracranial bleed seen on the first scan that had expanded by 25% or more on any dimension on the second scan.
RESULTS: The TXA did not show significant trend of good outcome in terms of GOSE (p=0.763). However, for moderate and severe acute subdural haemorrhage (SDH) subgroups, there was a significant difference (p=0.042). Clot expansion was present in 14 patients (12.7%) with TXA given and in 54 patients (38.8%) without TXA. The difference was statistically significant (p<0.001). Of the patients who received TXA, there was one case (0.6%) of deep vein thrombosis. Apart from that, TXA showed non-significant trend in reducing mortality (p=0.474).
CONCLUSIONS: Tranexamic acid reduces the rate of clot expansion in TBI by 26.1% (38.8-12.7%) without significantly increasing the risk of a thrombotic event. It can also improve the outcome of moderate and severe TBI patients with acute SDH.
METHODS: In this series, we looked into nine cases of CM with syringomyelia from clinical and radiological perspective before and after surgery. The radiological parameters were herniated tonsillar length, syrinx: cord ratio, syrinx length and diameter. Flow velocity and morphologic changes in Chiari were illustrated.
RESULTS: Seven patients showed either reduction in syrinx length, syrinx: cord ratio or both postoperatively. Clinical recovery somewhat varied in motor and sensory symptoms. Four patients gained better functional grade in modified Rankin scale (MRS) while the rest remained similar. The study highlighted the advantage of CSF flow dynamics information over MR anatomical radiographic improvement in addressing the neurologic and functional recovery. We also discussed the practicality of cine sequence in preoperative patient selection, syrinx analysis and postoperative flow evaluation in anticipation of clinical outcome.
CONCLUSION: Phase-contrast cine MRI is a useful tool dictated by resource availability. We recommend its routine use in preoperative analysis and subsequent observational follow-up after surgery.
MATERIALS AND METHODS: In this retrospective review, data collected during 2006-2015 from the medical charts of patients with evidence of infection, caused by any Salmonella serogroup or clinical form, were examined. We aimed to assess the clinical manifestations, antibiotic susceptibility, and antibiotic use in children with Salmonella gastroenteritis over the ten years' period.
RESULTS: A total of 419 patients had non-typhoidal Salmonella infection. Four-hundred (95.5%) patients were diagnosed with acute gastroenteritis, which was common in children aged <12 months (72.3%). The clinical features of patients with gastroenteritis included fever (74.5%), diarrhoea with bloody mucus (60.5%), watery diarrhoea (39.5%), and vomiting (19.8%). Serogroup B was most commonly detected in the stool specimens. The susceptibility of non-typhoidal Salmonella to ampicillin, norfloxacin, and co-trimoxazole was 36.3%, 98.0%, and 80.5%, respectively. Serogroup B was the most resistant strain, which was sensitive to ampicillin in only 21.6% of specimens, while it showed high susceptibility to norfloxacin and co-trimoxazole (98.1 and 84.0%, respectively). Third-generation cephalosporin and fluoroquinolone were most commonly prescribed.
CONCLUSIONS: Acute gastroenteritis is the most common form of Salmonella infection. Gastroenteritis caused by serogroup B is still the most common infection, which mostly occurs among infants under one year of age. The majority of stool specimens were still susceptible to antimicrobial agents, especially fluoroquinolone and cotrimoxazole; however, there was an overuse of antibiotics without proper indications.
MATERIALS AND METHODS: The ethanolic extract was used to synthesise copper nanoparticles. The copper nanoparticles were successfully synthesised from copper sulphate solution which was identified by the colour change from dark green colour of the extract. Thus the B.oleracea var acephala is a good source to synthesis copper nanoparticles. The synthesised copper nanoparticles were characterised using Scanning Electron Microscope (SEM) analysis. The SEM image displayed the high-density nanoparticles synthesised by leaf extracts and that the nanoparticles were crystals in shape.
RESULTS: The copper nanoparticles (CNP) bind to the leaf extract. B.oleracea var acephala also has shown the antimicrobial and antioxidant activity. A comparative study was done between ethanolic its crude extract and nanoparticles. Both extracts exhibited zone of inhibition and better antioxidant potential but the CuNPs shows major zone of inhibition and showed more antioxidant activity. Anticancer activity of B.oleracea var acephala against Cervical HeLa cell line was confirmed using ethanolic crude extract and CNP. The results showed that HeLa cells proliferation was inhibited with increasing concentration of ethanolic crude extract and copper nanoparticles. From the results, it was seen that percentage viability of the cancer cells decreased with increased concentration of the samples whereas cytotoxicity against HeLa cell lines increased with the increased concentration of the samples.
CONCLUSION: Thus B.oleracea var acephala possesses anticancer activity against HeLa cell lines.
METHODS: A simple visual acuity test algorithm in the form of a single letter E display was designed as the optotype for development of a mobile application. The standardised optotype is presented at random to test visual acuity for corresponding level of 3/60, 6/60, 6/18, and 6/12. The final result is auto-generated based on the classification of the WHO for visual impairment and blindness. The Snellen chart was used as the gold standard to determine its validity while five different users were involved to determine its inter-rater reliability. A pilot study was performed between April till November 2019, in the Universiti Sultan Zainal Abidin Medical Centre (UMC) at Kuala Nerus and Mooris Optometrist Centre at Marang, Terengganu. A total of 279 participants aged four years old and above were involved in this study.
RESULTS: The highest sensitivity was found at the vision level cut-off point of 6/12 with the percentage of 92.7% and 86.8% for the right and left eye, respectively. The specificity was more than 89% for all vision levels in both eyes. The Krippendorff's alpha value for the inter-rater reliability was 0.87 and 0.83.
CONCLUSION: The relatively high level of validity and reliability obtained indicate the feasibility of using the designed optotype to develop a valid and reliable mobile app for vision test. The app can be used to screen vision by nonmedical persons, at anytime and anywhere to help improve public awareness and capability to correctly determine their visual status.