This is a case of a 68-year-old man who was diagnosed late with Hashimoto’s thyroiditis
following a few admissions for symptomatic anaemia. Although hypothyroidism is common
among the elderly, the classic symptoms are less likely to be evident and anaemia can be the
first sign of hypothyroidism. This patient had multiple comorbidities including ischaemic heart
disease, diabetes and chronic kidney disease which might have contributed to the delay in
finding the underlying cause of his anaemia. He initially presented with symptomatic anaemia
and received blood transfusions and iron supplementation. On subsequent follow up, his
anaemia failed to improve. He was then referred to our primary care clinic. Hashimoto’s
thyroiditis was diagnosed based on his clinical features, thyroid function test results and antithyroid peroxidase level. This case highlights the importance of determining the cause of
anaemia as his haemoglobin level improved significantly after thyroxine was commenced. It
also serves as a reminder that hypothyroidism should be considered in patients with anaemia,
especially in those with uncertain aetiology.
Introduction: Low health literacy (HL) is one of the contributing factors that leads to negative diabetic outcome. Quality of life (QOL) is a state of complete physical, mental and social wellbeing. There is limited evidence on association of HL and QOL among type 2 diabetes mellitus (T2DM), therefore the objectives of this study were to identify the HL and QOL status, to determine the association between HL and QOL and factors associated with QOL among T2DM patients.
Methods: This was a cross sectional study involving patients with T2DM from two public primary care clinics. HL and QOL were measured using translated and validated HLS – Asia Q16 and DQoL-BCI questionnaires respectively among T2DM patients.
Results: The mean HL score was 12.39 (3.34), 17.7 % had “inadequate HL”, 25.7% had “problematic HL” and 56.6% had “sufficient HL”. The mean DQoL-BCI score was 32.09 (6.51). Lower QOL level was negatively associated with age (b -0.140; CI: -0.190, - 0.090; p<0.001), not obese (b -1.476; CI: -2.605, - 0.347; p<0.011), and HL level (b -0.425; CI: -0.59, - 0.259; p<0.001). Lower QOL level was positively associated with uncontrolled glycaemic status (HbA1c >6.5%) (b 1.308; CI: -0.042, 2.659; p<0.058), treatment with insulin (b 4.163; CI:1.538, 6.788; p<0.002) and combination treatment of insulin and oral hypoglycaemic agents (OHA) (b 2.450; CI:1.145, 3.756; p<0.001).
Conclusions: This study demonstrated that age, body mass index, HL, glycaemic control, treatment with OHA and insulin were significantly associated with QOL. This suggest the importance of identifying high risk patients with poor QOL for targeted intervention.
KEYWORDS: Health Literacy, Quality of Life, Type 2 Diabetes Mellitus, Primary Care, Malaysia
Study site: Two public primary care clinics (klinik kesihatan), Gombak district, Selangor, Malaysia
MeSH terms: Adult; Ambulatory Care Facilities; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Humans; Malaysia; Quality of Life*; Health Literacy*
Introduction: Sudden cardiac death is the most common medical cause of death in athletes.
The aim of this study was to identify the electrocardiogram (ECG) pattern changes and its
association with echocardiography among Malaysian footballers during a pre-participation
evaluation (PPE). Methods: A retrospective study was conducted on footballers attending a
PPE at a primary care centre. Secondary data collection was conducted and the proforma
included clinical history, physical examination, ECG, Echocardiogram and cardiovascular risk
factors assessment such as heart rate, blood pressure, lipid profile, fasting blood sugar and
creatinine. Data were extracted from the medical records, echocardiogram report and the
original ECG. The ECG patterns were analysed according to the International consensus for
ECG interpretation in athletes to determine physiological versus pathological changes. The
data was analysed using SPSS v24. Results: This study included 85 male Malaysian
footballers with a mean age of 20.1 ± 3.0 years. The mean resting heart rate was 55.2 ± 9.3
beats per minute. Abnormal ECG changes were found in 20% of the participants, which were
higher compared to that reported in other studies (14% – 17.3%). The normal ECG findings in
athletes were sinus bradycardia (76.5%), J-point elevation (68.2%), prolonged PR interval
(3.5%) and incomplete right bundle branch block (4.7%). The abnormal ECG changes were
multiple T wave inversions (5.9%), hypertrophy (2.4%), and deep Q-waves (8.2%). Four
abnormal ECGs were consistent with abnormal echocardiography findings and out of these,
two ECGs with hypertrophic changes were consistent with mild inter atrial septal bulging and
apical hypertrophy. Conclusions: Malaysian footballers have ECG changes that are
consistent with physiological changes in athlete’s heart. The positive association between ECG
and Echocardiogram findings are useful in confirming pathological ECG changes. Physicians
should be trained in PPE protocol and ECG interpretation in athletes in order to improve
identification of those at risk of sudden cardiac death.
Introduction: The distribution of Staphylococcus aureus and Staphylococcus epidermidis
among Malaysian healthy adults and their capability to produce enzyme hyaluronidase are less
reported. Hyaluronidase degrade hyaluronic acid in animal connective tissue and facilitate
bacterial spreading in host body. This study aims to identify the distribution of both
Staphylococci species in healthy subject, the hyaluronidase producer among the isolates and
the association of the latter with site of isolation (palm skin and anterior nares) and gender of
the host. Methods: A total of 108 swab samples were collected from anterior nares and palm
of 54 healthy subjects. The bacteria were identified through microscopic and biochemical tests,
before screened for hyaluronidase production using hyaluronic acid diffusion rapid plate
method. Results: Total of 139 bacterial isolates were identified; 68 isolates are S. aureus, 63
S. epidermidis and 8 other bacterial species. Staphylococcus aureus was highly isolated from
palm (57%) than anterior nares (47%). On the contrary for S. epidermidis was highly isolated
from anterior nares (53%) than from palm skin (43%). Equal proportion was found for both
species in male and female subject. A total of 77 (59%) isolates produced hyaluronidase; 55%
are S. aureus and 45% are S. epidermidis. Hyaluronidase-producer isolates are equally found
between anterior nares (56%) and palm skin (61%) or male (57%) and female subject (60%)
regardless of Staphylococcal species. No significant value was recorded for any analysis.
Conclusion: Capability of commensal S. aureus and S. epidermidis isolated from healthy
subject to produce hyaluronidase may indicate their potential as opportunistic pathogen
whenever the opportunity arises in any way.
The pandemic of Coronavirus Disease 2019 (COVID-19) has brought much fear and anxiety
worldwide due to the rapid transmission rate and mortality. The exponential surge of COVID19 cases need to be addressed aggressively to flatten the epidemic curve. This review aims to
describe the COVID-19 disease epidemiology and disease transmission, response actions
taken by the authorities to control this pandemic and risk communication strategies in Malaysia.
A literature search via the ScienceDirect and Google Scholar databases of published articles
and official statements from the Ministry of Health, Malaysia from December 2019 to May 2020
was conducted. The first wave of COVID-19 outbreak in Malaysia started in late January
involving 22 cases but the second wave involved more cases due to the massive religious
gathering that occurred in late February. Malaysia implemented the Movement Control Order
(MCO) on 18th March 2020 and other well-coordinated response action plans to prevent
community transmission. The reproduction number (R0) was successfully reduced from 3.6 to
0.3 due to the MCO. Malaysia’s risk communication strategies that include daily press
conference by the Director General of Health and dissemination of information through national
television and social media, played a crucial role in dealing with the COVID-19 outbreak. In
conclusion, effective response actions and mitigation plans, should be the main priorities to
combat this pandemic. The immediate direction will need to be focused on development of
vaccines for COVID-19. Future research should study the origin of the virus in animals and the
role of comorbidities contributing to poorer prognosis.
Interaction of CT’s x-ray beams with patient resulted in attenuation process and there are
various factors affecting CT attenuation values. The aim of this review is to examine the existed
literatures regarding the concept of attenuation in CT and its relationship with body dimension,
gender and age in Malay population. Guided by primary question, literature searches were
conducted using the established online database; SCOPUS and PubMed. The time frame for
literatures was from 2000 to 2019 and only literatures in English language were selected. The
size of body dimension has affected the CT attenuation value but it also depending on the type
of tissue presence within the region of interest (ROI) such as muscle and fat tissues. Due to
larger body framework and higher amount of skeletal muscle mass theoretically males would
have higher CT attenuation value than female. CT attenuation value reduces with aging
process. Asians including Malay population have smaller body dimension than Caucasians
and the mean attenuation value of abdominal region in Asians could differ from 20 HU. Thus,
there is a need for future research to investigate the interrelatedness of attenuation in CT (HU)
and body dimension within Malay population and close this gap of knowledge.
Leaders should be competent in managing disaster situations to minimize the damage of the
events. However, when disaster strikes these leadership competencies may not always come
into play. This paper aims to identify the incongruence between what leaders should do and
what leaders do when managing real disasters and what can be learned from it. This paper
reviews the Aceh Earthquake and Tsunami disaster in 2004 and the Fukushima Nuclear
Disaster in 2011, as case studies. Published and grey literatures relating to these events were
searched from online sources. Two major mismatches between leadership theory and reality
were noted: effective communication and ability to co-ordinate resources at all levels. To
improve leadership in disaster management, mitigation measures, preparedness and skills in
crisis communication must be top-notch, communication disruption must be overcomed as
soon as possible; and all entities involved in disaster management must know their roles.
Maximum k Satisfiability logical rule (MAX-kSAT) is a language that bridges real life application to neural network optimization. MAX-kSAT is an interesting paradigm because the outcome of this logical rule is always negative/false. Hopfield Neural Network (HNN) is a type of neural network that finds the solution based on energy minimization. Interesting intelligent behavior has been observed when the logical rule is embedded in HNN. Increasing the storage capacity during the learning phase of HNN has been a challenging problem for most neural network researchers. Development of Metaheuristics algorithms has been crucial in optimizing the learning phase of Neural Network. The most celebrated metaheuristics model is Genetic Algorithm (GA). GA consists of several important operators that emphasize on solution improvement. Although GA has been reported to optimize logic programming in HNN, the learning complexity increases as the number of clauses increases. GA is more likely to be trapped in suboptimal fitness as the number of clauses increases. In this paper, metaheuristic algorithm namely Artificial Bee Colony (ABC) were proposed in learning MAX-kSAT programming. ABC is swarm-based metaheuristics that capitalized the capability of Employed Bee, Onlooker Bee, and Scout Bee. To this end, all the learning models were tested in a new restricted learning environment. Experimental results obtained from the computer simulation demonstrate the effectiveness of ABC in modelling MAX-kSAT.
Previous studies have indicated that the pipe-surface-mounted helical strakes effectively reduce vortex-induced vibration (VIV) under a uniform flow application, particularly during the lock-in region. Since VIV experiments are time-consuming, observation is generated with an interval helical strakes parameter in pitch and height to lessen tedious procedures and repetitive post-processing analyses. The aforementioned result subset is insufficient for helical strakes design optimisation because the trade-off between the helical strakes dimension, lock-in region and flow velocity are non-trivial. Thus, a parametric model based on an improved recursive least squares (RLS) parameter estimation technique is proposed to define the statistical relationship between input, or strakes and pipe dimension, and output, or VIV amplitude ratio. As results suggested, revised RLS estimated VIV model demonstrated an optimal prediction with the highest coefficient of determination and lowest Integral Absolute Error. The feasibility of VIV parametric model was validated by embed into Genetic Algorithm (GA) as the fitness function to acquire a desirable helical strakes dimension with minimum VIV amplitude. The rapid generation of optimal helical strakes dimension which returned the highest VIV suppression implied a superior simulation method compared to the experimental outcome.
Gamelan in general is categorized as a group of gongs. This traditional Malay gamelan ensemble is in a slendro scale i.e. five notes per octave. The rhythms, pitch, duration and loudness classify the various groups of gongs such as bonang, kenong, gender, peking and gambang. The cast bronze peking, kenong and bonang were chosen from a range of Malay gamelan ensemble from Universiti Malaysia Sarawak (UNIMAS), Universiti Putra Malaysia (UPM), Universiti Kebangsaan Malaysia (UKM) and Universiti Teknologi Mara (UiTM). The sounds were recorded by PicoScope Oscilloscope. The PicoScope software displays waveform and spectrum in time and frequency domain respectively. The peking lowest and highest frequencies from UiTM were 293 Hz and 1867 Hz, from UPM were 644 Hz and 1369 Hz, from UKM were 1064 Hz and 2131 Hz and from UNIMAS were 1072 Hz and 2105 Hz respectively. The kenong lowest and highest frequencies from UiTM were 259 Hz and 463 Hz, from UPM were 294 Hz and 543 Hz, from UKM were 300 Hz and 540 Hz and from UNIMAS were 293 Hz and 519 Hz respectively. The fundamental frequencies of bonang from UPM were higher than that of UKM, UiTM and UNIMAS. The harmonics were not successive but interrupted by another frequency. The harmonics of each bonang was similar except for gamelan from UKM.
The tone of peking 1, 2, 3, 5, 6, 1’ was investigated using time-frequency analysis (TFA). The frequencies were measured using PicoScope oscilloscope, Melda analyzer in Cubase version 9 and Adobe version 3. Three different approaches for time-frequency analysis were used: Fourier spectra (using PicoScope), spectromorphology (using Melda analyzer) and spectrograms (using Adobe). Fourier spectra only identify intensity-frequency within entire signals, while spectromorphology identify the changes of intensity-frequency spectrum at fixed time and Adobe spectrograms identify the frequency with time. PicoScope reading produces the spectra of the fundamental and overtone frequencies in the entire sound. These overtones are non-harmonic since they are non-integral multiples of the fundamental. The fundamental frequencies of peking 1, 2, 3, 5, 6 were 1066Hz (C6), 1178Hz (D6), 1342Hz (E6), 1599Hz (G6) and 1793Hz (A6) respectively while peking 1’was 2123Hz (C7) i.e. one octave higher than peking 1. Melda analyzer reading proved that all peking sustained the initial fundamental frequency and overtone at t=0 until 2s. TFA from Adobe reading provides a description of the sound in the time-frequency plane. From TFA, peking 1, 2 and 6 exhibited a much gentler attack and more rapid decay than peking 3, 5 and 1’.
Introduction: Mental health problem is an important public health issue which causes deterioration in quality of life, function and financial capabilities. According to the National Health and Morbidity Survey (NHMS) 1996, the prevalence of mental problem among adults in Malaysia was 10.7% and this has increased to 29.2% in NHMS 2015. The aim of this study was to evaluate the burden of depression, anxiety and stress among adults in a city in Klang Valley, Malaysia including its associated factors.
Methods: A cross-sectional study was conducted by analysing secondary data obtained from screening program performed in six primary health clinics in the city throughout 2016. There were 576 adults participated in the screening program which consisted of mental health screening using Depression, Anxiety, Stress 21 (DASS-21) questionnaire and health status screening using Health Status Screening Form.
Results: The prevalence of depression was 20.5%, anxiety was 44.5%, while stress was 10.1%. By using logistic regression, history of being abused was the only significant protective factor associated with depression, anxiety and stress with OR of 0.062 (95% CI 0.007; 0.563, p=0.004), OR of 0.001 (95% CI 0.000; -, p=0.001) and OR of 0.026 (95% CI 0.003; 0.238, p<0.001) respectively. Other independent variables were not statistically significant.
Conclusions: As conclusions, surprisingly the risk of depression, anxiety and stress were not increased among participants who reported history of being abused. This was probably due to good coping mechanism among them. Nevertheless, early intervention needs to be emphasized to prevent mental disorders among this group of people in community.
Keywords: Depression, Anxiety, Stress, Adults, Urban
MeSH terms: Adult; Anxiety; Anxiety Disorders; Cross-Sectional Studies; Depression; Humans; Malaysia; Mass Screening; Mental Health; Public Health; Quality of Life; Surveys and Questionnaires; Prevalence; Logistic Models; Protective Factors
Introduction: This study examines the psychometric characteristics of a translated version of the Beck Depression Inventory II (BDI – II) among Malaysian school students. Methods: The sample consisted of 257 boys and 302 girls. This study employed WINSTEPS 3.74 to provide statistics and other information from Rasch Model analysis, namely, the fit statistics, dimensionality analysis, rating scale analysis, reliability and separation indices, differential item func- tioning analysis, and distribution of items difficulty and students’ ability. Results: Rating scale analysis showed that category 2 and category 3 of the ratings were not different. Meanwhile, Item 19 did not fit the model’s expectations; and thus, it was omitted from further analyses. The scale demonstrated a high person reliability and a high person separation index. There were no items demonstrating gender DIF. The school students endorsed feeling guilty as the least severe symptom of depression, while committing suicide as the most serious symptom. Conclusion: In general, the BDI-II demonstrated acceptable properties in measuring depression symptoms among school students.
Introduction: Poor hygiene practice is an important factor that lead to morbidity and mortality among young chil- dren which are common among the indigenous population due to the lack of access to health services and their unique beliefs and practices. This study aimed to identify the socio-demographic determinants of hygiene practices among the indigenous (known as Orang Asli in Malaysia) primary caregivers of children under the age of three in Malaysia. Methods: A cross-sectional study was conducted among 166 primary caregivers of Orang Asli children of below three years old in Kuala Langat District. Data was collected using a validated and pre-tested questionnaire via face-to-face interviews with individual respondents. The questionnaire consisted of two main sections: sociodemo- graphics and hygiene practice. Results: A majority of the Orang Asli primary caregivers had good hygiene practices (78.9%). The number of children under five years old living at home was significantly associated with hygiene prac- tice and it was the only significant determinant or predictor of good hygiene practice among the Orang Asli primary caregivers. Conclusion: The number of children under five years old living at home is an important factor to ensure good hygiene practices among the primary caregivers of Orang Asli children. This factor need to be taken into con- sideration in monitoring children health status by the health staff by emphasizing the importance of hygiene practice in the prevention of infectious diseases and malnutrition among Orang Asli children.
MeSH terms: Child; Child, Preschool; Communicable Diseases; Cross-Sectional Studies; Ethnic Groups; Health Services Accessibility; Health Status; Humans; Hygiene; Malaysia; Morbidity; Surveys and Questionnaires; Caregivers; Malnutrition; Population Groups
Introduction: The daily life problems of patients with schizophrenia as well as their symptoms are challenging sit- uations that may interfere with their psychological well-being. The purpose of this study is to investigate the factors affecting the psychological well-being of patients with schizophrenia and factors affecting it. Methods: A cross sec- tional study was conducted to examine the socio-demographic factors, health level, social support and self-esteem of patients with schizophrenia. A total of 255 respondents consisting of patients on follow-up from specialist clinics at three Psychiatric Hospitals in this country were selected to answer the questionnaire. The questionnaires used were the Affect Balance Scale, the Multidimensional Scale of Perceived Social Support Scale and the Rosenberg Self-Esteem Scale for the measurement of the psychological well-being, social support and self-esteem respectively. The data was analysed using Chi-Square and Mann-Whitney U test. Results: A total of 62% of the respondents had positive psychological wellbeing. Socio demographic factors, namely occupation (p=0.007), overall social support (p=0.023), family support (p=0.040), significant others’ support (p=0.046), and self-esteem (p < 0.001), were associ- ated with positive psychological well-being. Conclusion: This study has proven that patients with schizophrenia who regularly received treatment can achieve positive psychological well-being when they have high self-esteem, strong support from their family members as well as people around them and are stable occupation.
MeSH terms: Family; Follow-Up Studies; Health Status; Hospitals, Psychiatric; Humans; Occupations; Surveys and Questionnaires; Schizophrenia; Self Concept; Social Support; Statistics, Nonparametric
Introduction: Compression of the median nerve in pregnancy is thought to be due to fluid retention within the carpal tunnel space. We aim to discover the cause of carpal tunnel syndrome (CTS) in pregnancy using high resonance ul- trasonography. Methods: This is a cross-sectional study where obstetric patients were screened for CTS and subjected to a non invasive ultrasonic imaging. Results: A total of 63 patients were seen with 25 diagnosed to have CTS (39.7%) and 38 patients had none (60.3%) based on a screening tool. Age ranged from 20-42 years old with the highest range in the 28-30 year old group (34.9%). In patients with CTS, the cross sectional area of the median nerve inside the tunnel was a mean of 0.908 cm ie larger, while non-CTS patients had a mean of 0.797 cm inside the tunnel. The transverse carpal ligament (TCL) measured a mean of 0.0988 cm in the CTS group (ie thinner) and 0.1058 cm in the non-CTS group. Median nerve mobility at equal to or less than one tendon width was 80% in pregnant women with CTS and 92.1% for those without. No fluid was present within the carpal tunnel of all patients. The results were sta- tistically not significant. Conclusion: Ultrasonographic evidence in pregnant women with CTS shows a larger median nerve, a more mobile median nerve and a less thick transverse carpal ligament. There is absence of fluid retention and synovitis ruling out extrinsic compression of the median nerve as cause of CTS in pregnancy.
Introduction: Falls among the elderly can be associated with serious complications such as fractures, injuries and death. This study aims to ascertain the factors associated with falls among the elderly patients attending a government clinic located in Kuala Lumpur. Method: This was a cross-sectional study using a convenience sampling method. Data collection in 2017 from 322 elderly who attended the above clinic. A modified assisted self-administered ques- tionnaire was used that contained the socio-demographic data, falls profile as well as extrinsic and intrinsic factors associated with falls. Analysis was done with SPSS v20.0. Results: 120 (37.27%) elderly reported falls in the past one year. The majority who had falls were females (n=76, 41.8%) and between the age of 80-89 years old (n=29, 44.6%). Malay ethnicity group, reported more falls compared to other ethnicities (n=93,44.5%). Significant associations were found between age, ethnicity and history of falls with falling (p
MeSH terms: Accidental Falls; Aged; Aged, 80 and over; Cross-Sectional Studies; Data Collection; Ethnic Groups; Female; Gait; Government; Humans; Malaysia; Research Design; Fractures, Bone
Citation: National Health and Morbidity Survey 2019. Shah Alam: Institute for Public Health, Ministry of Health, Malaysia; 2020
Fact sheet: http://www.iku.gov.my/images/IKU/Document/REPORT/NHMS2019/FactSheet_BI_AUG2020.pdf
Infographics (key findings): http://www.iku.gov.my/images/IKU/Document/REPORT/NHMS2019/Infographic_Booklet_NHMS_2019-English.pdf
Technical Report Volume 1: http://www.iku.gov.my/images/IKU/Document/REPORT/NHMS2019/Report_NHMS2019-NCD_v2.pdf
Technical Report Volume 2: http://www.iku.gov.my/images/IKU/Document/REPORT/NHMS2019/Report_NHMS2019-HCD-eBook_p.pdf
Study name: National Health and Morbidity Survey (NHMS-2019)
MeSH terms: Health Surveys; Humans; Malaysia; Health Literacy
Deep eutectic solvents (DESs) are green solvents developed as an alternative to conventional organic solvents and ionic liquids to extract nitrogen compounds from fuel oil. DESs based on p-toluenesulfonic acid (PTSA) are a new solvent class still under investigation for extraction/separation. This study investigated a new DES formed from a combination of tetrabutylphosphonium bromide (TBPBr) and PTSA at a 1:1 molar ratio. Two sets of ternary liquid-liquid equilibrium experiments were performed with different feed concentrations of nitrogen compounds ranging up to 20 mol% in gasoline and diesel model fuel oils. More than 99% of quinoline was extracted from heptane and pentadecane using the DES, leaving the minutest amount of the contaminant. Selectivity was up to 11,000 for the heptane system and up to 24,000 for the pentadecane system at room temperature. The raffinate phase's proton nuclear magnetic resonance (1H-NMR) spectroscopy and GC analysis identified a significantly small amount of quinoline. The selectivity toward quinoline was significantly high at low solute concentrations. The root-mean-square deviation between experimental data and the non-random two-liquid (NRTL) model was 1.12% and 0.31% with heptane and pentadecane, respectively. The results showed that the TBPBr/PTSADES is considerably efficient in eliminating nitrogen compounds from fuel oil.