Introduction: Children with visual impairment are reported to be at higher risk of poor oral health. They faced dif- ficulties in basic skills including oral care. For this reason, they may develop dental caries and periodontal disease. The aim of this study was to assess the oral health status of a group of visually impaired school children in Kuala Lumpur. Methods: A cross-sectional study was carried out on students from a Special Education School in Kuala Lumpur. Oral examination was conducted to determine caries experience and oral hygiene status. Caries was mea- sured using DMFT index and simplified oral hygiene index (OHI-S) for oral hygiene status. Oral examination was based on modified World Health Organization (WHO) oral health assessment criteria for children. Chi-square test was used to determine associations between demographic variables and oral health status. Results: A total of 91 visually impaired students (41 blind, 50 low vision) within the age group of 13 to 17 years old participated in this study. The mean OHI-S score was 1.68 (SD 0.87) with majority of students had fair oral hygiene (39.6%) and 29.7% with poor and very poor oral hygiene. The mean DMFT score of total students were 0.80 (SD 1.62). Male students demonstrated significantly better oral health status than female in relation to prevalence and mean score of dental caries. Conclusion: Most of the visually impaired children in this study showed fair oral health status. Regular oral health education is recommended to improve the oral hygiene especially in the totally blind group.
Nurul Salwana Abu Bakar, Jabrullah Abdul Hamid, Sharifah Zawani Syed Ahmad Yunus, Nurul Syarbani Eliana Musa, Roslinda Abu Sapian, Nur Hidayati Abdul Halim, et al.
Introduction: Electronic medical records from hospital information system (HIS) offer a major potential for secondary data analysis which can improve the efficiency of healthcare delivery. This study describes an initiative to use HIS data to explore the level of diabetic care in patients with T2DM in a hospital-based outpatient clinic, the advantages and challenges in utilising HIS data. Methods: Patients age of 18 and above who received any diabetes medication in 2013 were retrospectively identified from HIS of Serdang Hospital. Demographic characteristics, anti-diabetic agent (ADA) dispensed, and glycaemic measures were quantified. Data was extracted using structured query lan- guage (SQL) and descriptive statistical analyses were conducted using Stata Version 12. Results: Prevalence of T2DM patients in the hospital was 7.5%. Male had slightly higher prevalence and patient at age of 61-70 years old. About 62% of patients were prescribed with metformin and 5% of newer combination of oral hypoglycemic agent. In pre- scribing pattern, stratification by age group, showed that patient age 41 to 70 years received mostly monotherapy, whilst 61.1% continue their regime for the year. Only 18% obtained good glycaemic control. Conclusion: Hospital Information system is a critical instrument in providing data as a platform in diabetic care in an outpatient care. Moving forward, steps to improve HIS should be taken to seize its potential as a tool to increase the efficiency of healthcare delivery.
MeSH terms: Aged; Ambulatory Care; Ambulatory Care Facilities; Biometry; Blood Glucose; Delivery of Health Care; Diabetes Mellitus, Type 2; Hospital Information Systems; Hospitals; Humans; Hypoglycemic Agents; Male; Metformin; Middle Aged; Retrospective Studies; Prevalence; Electronic Health Records
Preschool children are one of the major target groups of the Oral Health Program, Ministry of Health Malaysia. However, caries prevalence of preschool children due to unmet treatment needs remains high. Thus, it is imperative for preschool children to receive dental treatment to maintain or restore function and aesthetics, prevent premature tooth loss and improve their quality of life. We aimed to increase the percentage of preschool children receiving dental treatment at kindergartens from 9.8% to 30% in a year. A cross-sectional study was conducted in January 2015 to March 2015 to identify factors contributing to low percentage of preschool children receiving dental treatment using a structured questionnaire modified and adapted from literatures. Ten kindergartens in Machang District were randomly selected, and a total of 200 preschool children, 180 parents and 13 dental therapists in Machang District were recruited for this study. Remedial measures were implemented in April 2015 until September 2015, followed by a post-remedial evaluation in October 2015 to December 2019. The factors contributing to low percentage included inconvenient visit schedule, lack of monitoring system, preschool children at kindergartens refusing dental treatment, and lack of oral health knowledge and awareness among parents. A series of interventions were introduced including improvement of care process, systematic planned visits, and formation of a dedicated team for kindergartens. Oral Health Education and seminars were given to parents. Supportive environment and innovations were created, including colorful attire, cartoon accessories and Benzo Kids’ eye-wear tools. The Benzo Kids functioned as a smart phone holder for a child to watch their favourite video during treatment to divert the child’s attention and reduce anxiety. The percentage of preschool children receiving dental treatment at kindergartens increased from 9.8% (2014) to 55.9% (2019), which exceeded the initial target of 30%. This study has had a significant impact on the number of deciduous teeth with dental caries of these preschool children when they progress to primary one. The HMIS data showed a decreasing trend of dental caries per 100 children from 80(2013) to 58(2019).
MeSH terms: Smartphone; Anxiety; Anxiety Disorders; Attention; Child, Preschool; Cross-Sectional Studies; Dental Caries; Esthetics; Health Education, Dental; Humans; Malaysia; Oral Health; Parents; Quality of Life; Surveys and Questionnaires; Tooth, Deciduous; Prevalence; Tooth Loss
Lukman Nul Hakim Md Khairi, Farah Syakirah Ahmad, Nur Liyana Mohd Fozi, Aimi Shazana Muhammad Anuar, Wan Najiah W. Mokhtar @ W. Moxtor, Maznuraini Zainuddin
Bedside dispensing (BD) is one of the clinical services offered by the Pharmacy Department to patients prior to their hospital discharge. Increment in number of BD may improve the patients’ discharge process, patients’ satisfaction and their medication knowledge. This project aimed at increasing the percentage of BD in adult medical wards of Hospital Sultanah Nur Zahirah (HSNZ). The proposed standard of BD percentage was at least 30% within four months of intervention. The project was conducted from November 2016 to December 2019. The monthly report of pharmacy BD record was analysed to assess the achievement of BD. A pre-interventional retrospective BD data review of discharge prescriptions received throughout 2016 showed that only 8.1% of discharge prescriptions were dispensed at the bedside. A closed-ended questionnaire to evaluate knowledge, experience and perceived contributing factors to the low percentage of BD was distributed to nurses, inpatient pharmacists and ward pharmacists. The main contributing factors identified included time constraint, poor understanding of BD workflow, inadequate staff awareness and lack of cooperation among healthcare providers. Institutional BD workflow was implemented involving the introduction of discharge prescriptions pick-up points at medical wards, and a scheduled timing for prescriptions collection and dispensing during office hours. Three face-to-face educational sessions on overview of BD and its latest workflow were given to staff nurses, inpatient pharmacists at discharge pharmacy unit and ward pharmacists. In 2017, the percentage of BD increased from 8.1% to 28.0% after the implementation of interventions, and subsequently to 60.0% in the latest maintenance phase of January until December 2019. The sustainable implementation of this BD program could be shared and implemented at other facilities with inpatient discharge services to improve healthcare delivery.
Lukman Nul Hakim Md Khairi, Farah Syakirah Ahmad, Aimi Shazana Muhammad Anuar, Nurul Ain Wan Omar, Nurul Najmi Muhammad, Nurulhayati Abd. Jamal, et al.
Therapeutic drug monitoring (TDM) is a valuable clinical tool in optimisation of drug regimens. However, improper utilisation of TDM may lead to significant resource wastage and expose patients to avoidable trauma, toxicity, therapeutic failure and prolonged hospitalisation. This study aimed to reduce the percentage of inappropriate TDM sampling to our proposed standard of less than 20% within a four-month intervention period. A cross-sectional study was undertaken from January to December 2015 at the inpatient setting of Hospital Sultanah Nur Zahirah. Gentamicin and Vancomycin analytes were studied because these analytes accounted for 69.2% of total samples received in 2014. TDM Monitoring Form was used to collect sampling and dosage information to assess sampling appropriateness. A closed-ended self-administered questionnaire was distributed to a group of medical doctors to assess their knowledge on appropriate Gentamicin and Vancomycin TDM sampling method pre- and post-intervention. Prior to the intervention phase in October to December 2014, 79.4% of TDM were inappropriately sampled. The main contributing factors were inadequate knowledge among medical doctors, lack of sampling reminders for new TDM requests, and misunderstanding on sampling information for repeated TDM requests. 60-minute face-to-face educational sessions on TDM sampling method were conducted specifically for staff at the General Medical and Paediatric Departments, and two continuing medical education (CME) slots were held at the hospital level. Guidelines on TDM sampling was initiated and laminated copies were distributed to all wards. Implementation of TDM Alert System which consisted of digital reminders and physical stickers was also introduced. The interventions were able to reduce the inappropriate sampling percentage from 79.4% to 41.8% post-intervention, and to 19.1% in the recent monitoring phase of January until June 2019. Continuous close monitoring and sustainable implementation of the measures are vital as TDM sampling appropriateness may affect clinical interpretation of the results.
The Department of Oral & Maxillofacial Surgery at Hospital Sultanah Aminah, Johor Bahru started managing patients who lost their eyeballs with ocular prosthesis in 2013. Unfortunately, there was an increasing trend of failed ocular prosthesis from 2013-2015. The failure rate went from 28.6% in 2013 to 40% in 2014 and increased to 44.4% in 2015. Failed ocular prosthesis not only leads to dissatisfied patients but also an increase in cost due to redoing of prosthesis. The objective of this project was to reduce the incidence rate of failed ocular prosthesis. A failed case is when the prosthesis does not pass the issue stage and has to be redone from the beginning. The standard failure rate is 0%, as the average number of cases per year is only about 10 cases. We determined the contributing factors of failed ocular prosthesis by analysing retrospective data from patients’ dental and lab records. This was followed by a self-administered questionnaire on reasons for failed cases which was distributed among the dentists and lab technicians in our department. The contributing factors that were identified included insufficient knowledge or skill of dentist and lab technicians in the construction of the ocular prosthesis, as well as improper screening of new cases which was the main factor of all the failed cases. The strategies for change included improving the process of care by creating a checklist for proper screening of new patients, mentoring of new staff, and continuous training on construction of ocular prosthesis, Fabricated Iris Mould innovation technique and early referral for insertion of eye conformer. The interventions that were implemented reduced the failure rate to 20% in 2016 followed by 0% in 2017, 2018 and 2019. Ongoing efforts are being done to replicate this project in other Oral & Maxillofacial Surgery clinics in Johor.
Neonates in Special Care Nursery (SCN) are constantly exposed to routine procedures that are painful. Repetitive painful exposures in neonates are known to have long-term deleterious effects that may surpass adulthood. A quality improvement project was designed to reduce the pain experienced by neonates during routine minor procedures in SCN unit of Hospital Tuanku Fauziah (HTF), a tertiary state hospital in Perlis, Malaysia. The Neonatal Infant Pain Scale (NIPS) was used as a pain assessment tool in neonates throughout the study. Several factors contributing to neonatal painful experience during routine procedures were identified, including poor awareness on neonatal pain perception, poor procedural etiquette among paediatric house officers, and lack of non-pharmacological pain relief used during the procedures. Interventional measures included adjunctive use of non-nutritive sucking via orthodontic Avent® pacifier, use of adjustable swaddling blanket via SwaddleMe® size S, and introduction of a clinical training module for the house officers. There were 159 neonates recruited in the pre-intervention period and 163 neonates evaluated in the post-intervention period. Our study revealed a significant decrease in neonatal painful experience during routine procedures, from 49.7% to 17.8% (p
Background: The emergence of COVID-19 as a pandemic has resulted in the need for urgent development of vaccines and drugs and the conduction of clinical trials to fight the outbreak. Because of the time constraints associated with the development of vaccines and effective drugs, drug repurposing and other alternative treatment methods have been used to treat patients that have been infected by the SARS-CoV-2 virus and have acquired COVID-19. Objective: The objective of this systematic scoping review is to provide an overview of the molecular mechanism of action of repurposed drugs or alternative treatment medicines used to attenuate COVID-19 disease. Method: The research articles or gray literature, including theses, government reports, and official news online, were identified from four databases and one search engine. The full content of a total of 160 articles that fulfilled our inclusion criteria was analyzed and information about six drugs (ritonavir, lopinavir, oseltamivir, remdesivir, favipiravir, and chloroquine) and four Traditional Chinese Medicines (Shuang Huang Lian Kou Fu Ye, TCM combination of Bu Huan Jin Zheng Qi San and Da Yuan Yin, Xue Bi Jing Injection, and Qing Fei Pai Du Tang) was extracted. Results: All of the repurposed drugs and complementary medicine that have been used for the treatment of COVID-19 depend on the ability of the drug to inhibit the proliferation of the SARS-CoV-2 virus by binding to enzyme active sites, viral chain termination, or triggering of the molecular pathway, whereas Traditional Chinese Medicine plays a pivotal role in triggering the inflammation pathway, such as the neuraminidase blocker, to fight the SARS-CoV-2 virus.
The majority of infantile hemangiomas are benign and will resolve on their own. We report a 4-month-old infant with an ulcerated giant segmental infantile hemangioma involving the left upper limb who developed a contracture of the left elbow despite treatment with oral propranolol, proper wound care, and regular intense physiotherapy. To our knowledge, contracture resulting from an infantile hemangioma has not been reported previously.
Objectives: We report the first use of a biorestorative valved conduit (Xeltis pulmonary valve-XPV) in children. Based on early follow-up data the valve design was modified; we report on the comparative performance of the two designs at 12 months post-implantation. Methods: Twelve children (six male) median age 5 (2 to 12) years and weight 17 (10 to 43) kg, had implantation of the first XPV valve design (XPV-1, group 1; 16 mm (n = 5), and 18 mm (n = 7). All had had previous surgery. Based on XPV performance at 12 months, the leaflet design was modified and an additional six children (five male) with complex malformations, median age 5 (3 to 9) years, and weight 21 (14 to 29) kg underwent implantation of the new XPV (XPV-2, group 2; 18 mm in all). For both subgroups, the 12 month clinical and echocardiographic outcomes were compared. Results: All patients in both groups have completed 12 months of follow-up. All are in NYHA functional class I. Seventeen of the 18 conduits have shown no evidence of progressive stenosis, dilation or aneurysm formation. Residual gradients of >40 mm Hg were observed in three patients in group 1 due to kinking of the conduit (n = 1), and peripheral stenosis of the branch pulmonary arteries (n = 2). In group 2, one patient developed rapidly progressive stenosis of the proximal conduit anastomosis, requiring conduit replacement. Five patients in group 1 developed severe pulmonary valve regurgitation (PI) due to prolapse of valve leaflet. In contrast, only one patient in group 2 developed more than mild PI at 12 months, which was not related to leaflet prolapse. Conclusions: The XPV, a biorestorative valved conduit, demonstrated promising early clinical outcomes in humans with 17 of 18 patients being free of reintervention at 1 year. Early onset PI seen in the XPV-1 version seems to have been corrected in the XPV-2, which has led to the approval of an FDA clinical trial. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02700100 and NCT03022708.
Shrimp aquaculture has great potential for providing income and employment opportunities to farmers. Shrimp production can also contribute to economic growth given its high value and demand in Malaysia. However, it is often said that players in the marketing channel extract high margins for themselves. This study intends to verify this claim by examining a case study based on white leg shrimp (Litopenaeus vannamei) aquaculture in Kedah. The data for this study was obtained from a detailed study involving a shrimp retailer in Kedah. The marketing margins were calculated from the interviews of the farmer and the retailer. The results showed that the marketing channel was quite efficient because there was no large gap in the prices between the marketing channels. The difference between retail price and farm price is only RM7 per kilogram for the white shrimp which accounts for 43.75 percent of total farm price and represents the cost of bringing shrimps from the farm to the retail market.
Seagrasses provide a range of marine ecosystem services. These include coastal protection, biodiversity, provision of food for various organisms, breeding and nursery habitats for many marine species, and carbon storage. Increasing anthropogenic pressures have contributed to the decline of seagrass habitats. Transplantation is one of the solutions to increase seagrass coverage and resilience. What is often overlooked, however, is the ability of this tropical ecosystem to attract and support faunal assemblages that may impinge on the success of the transplantation. A pilot study on seagrass transplantation at Gaya Island (Kota Kinabalu, Sabah) was intended for observing its stability and species of fauna that develop association with this vegetation. The study covered the southwest and northeast monsoons. Mixed seagrass species were planted on approximately 50% of 30 m 2 transplantation areas. Monitoring of the planted seagrass was carried out in five phases (T1-T5) from September 2016 to April 2018. Weekly observations were made by SCUBA diving. Identification of associated fauna was done on the spot and was based on morphological characteristics. During the T1 (September to December 2016) the seagrass coverage was reduced to 41% due to strong waves generated by the northeast monsoon. However, the seagrass coverage increased ( 66 %) during the southwest monsoon (T2 - T4) in 2017. In early 2018 (T5), the seagrass coverage again reduced (about 18%) due to strong waves but recovered again at the end of the monitoring period (April 2018). A total of 30 species of fauna that were identified consisted of 9 resident and 21 non-resident species. Physical structure of transplanted seagrass created a microhabitat, and increased the food availability and abundance, which attracted many species of different trophic levels.
A comparison of zooplankton abundance and community in the seagrass and non-seagrass areas of Limau-limauan and Bak- Bak waters within the newly established Tun Mustapha Marine Park was made during 15-17 May 2017. Samples were collected via horizontal tow of a 140 μm plankton net. Environmental variables (temperature, salinity, DO, pH, turbidity) showed no significant differences among the study sites. However, zooplankton showed increasing abundance from non-seagrass, seagrass edge, to seagrass areas at Limau-limauan, while abundance values were comparable among the stations at Bak-bak. Overall zooplankton abundance was significantly higher at the seagrass areas relative to the non-seagrass station at Limau-limauan (p < 0.005), while no statistical difference was found at Bak-Bak (p < 0.21). Mean canopy height was 3-fold higher (p < 0.001) at Limau-limauan than Bak-Bak, suggesting the importance of seagrass bed structural complexity in habitat preference for zooplankton. Cluster analysis revealed the zooplankton community from the seagrass area at Limau-limauan was different from that at seagrass edge and non-seagrass areas, which may be attributed to the influence of seagrass meadows in forming characteristic zooplankton compositions. Marked differences in zooplankton composition and abundance even in close vicinity of sites suggest the importance of local small-scale variations in seagrass habitats in shaping the zooplankton community.
Johor Bahru with its rapid development where pollution is an issue that needs to be considered because it has contributed to the number of asthma cases in this area. Therefore, the goal of this study is to investigate the behaviour of asthma disease in Johor Bahru by count analysis approach namely; Poisson Integer Generalized Autoregressive Conditional Heteroscedasticity (Poisson-INGARCH) and Negative Binomial INGARCH (NB-INGARCH) with identity and log link function. Intervention analysis was conducted since the outbreak in the asthma data for the period of July 2012 to July 2013. This occurs perhaps due to the extremely bad haze in Johor Bahru from Indonesian fires. The estimation of the parameter will be done by quasi-maximum likelihood estimation. Model assessment was evaluated from the Pearson residuals, cumulative periodogram, the probability integral transform (PIT) histogram, log-likelihood value, Akaike’s Information Criterion (AIC) and Bayesian information criterion (BIC). Our result shows that NB-INGARCH with identity and log link function is adequate in representing the asthma data with uncorrelated Pearson residuals, higher in log likelihood, the PIT exhibits normality yet the lowest AIC and BIC. However, in terms of forecasting accuracy, NB-INGARCH with identity link function performed better with the smaller RMSE (8.54) for the sample data. Therefore, NB-INGARCH with identity link function can be applied as the prediction model for asthma disease in Johor Bahru. Ideally, this outcome can assist the Department of Health in executing counteractive action and early planning to curb asthma diseases in Johor Bahru.
In this paper, the combined influences of biotic interactions, environmental components and harvesting strategy on the spread of Hantavirus are investigated. By employing a multi-species model consisting of (susceptible and infected) rodents and alien species, we show that interspecific competition from alien species has an effect in reducing the spread of infection, and this species could be employed as a potential biocontrol agent. Our analysis using numerical continuation and simulation also reveals the conditions under which Hantavirus infection occurs and disappears as the environmental conditions and the intensity of harvesting change. Without harvesting, infection emerges when environments are conducive. Inclusion of moderate harvesting in favourable environments can lead to disappearance of infection among rodent species. However, as the intensity of harvesting increases, this situation can cause extinction of all rodents species and consequently, jeopardise biodiversity. Overall, our results demonstrate how the interplay of different factors can combine to determine the spread of infectious diseases.
The removal of methyl orange (MO) dye has been studied using TiO2/chitosan-montmorillonite (TiO2/Cs-MT) bilayer photocatalyst which also functions as an adsorbent. The dye removal experiments were conducted in the dark and under UV-Vis light irradiation via adsorption and photocatalysis-adsorption processes, respectively. The adsorption modelings were employed on the dark experimental data and compared with the immobilized and suspended Cs-Mt counterparts. It was found that the bilayer photocatalyst closely followed the adsorption properties of immobilized Cs-Mt which obeyed the pseudo-second-order kinetic and film diffusion models. Fluorescent analysis revealed that the charge separation was enhanced in the presence of Cs-Mt as a sub-layer of TiO2. Under light irradiation, the photocatalytic activity of TiO2/Cs-MT corresponded to its adsorption counterpart trend and was optimized at pH 6.5 and 20 mg L-1 of MO dye solution. High removal efficiency and synergism of MO by TiO2/Cs-MT over TiO2 single layer were observed throughout the 10 cycles of application due to contribution of adsorption of Cs-Mt sub-layer and photocatalysis by TiO2 top layer.
In this research, a protein nanofiber membrane (P-COOH-CEW) was developed to treat the dye waste. Initially, polyacrylonitrile nanofiber membrane (PAN) was prepared by electrospinning, followed by heat treatment, alkaline treatment, and neutralization to obtain weak cation exchange nanofiber membrane (P-COOH). The P-COOH membrane was chemically coated with chicken egg white (CEW) proteins to obtain a 3D structure of complex protein nanofiber membrane (P-COOH-CEW). The composite prepared was characterized with Fourier Transform Infrared analysis (FTIR), Scanning Electron Microscopy (SEM), and thermogravimetric analysis (TGA). Further, the composite was evaluated by investigating the removal of Toluidine Blue O (TBO) from aqueous solutions in batch conditions. Different operating parameters - coupling of CEW, shaking rate, initial pH, contact time, temperature, and dye concentration were studied. From the results, maximum removal capacity and equilibrium association constant was determined to be 546.24 mg/g and 10.18 mg/mg, respectively at pH 10 and 298 K. The experimental data were well fitted to pseudo-second order model. Furthermore, desorption studies revealed that the adsorbed TBO can be completely eluted by using 50% ethanol or 50% glycerol in 1 M NaCl solution. Additionally, the reuse of P-COOH-CEW membrane reported to have 97.32% of removal efficiency after five consecutive adsorption/desorption cycles.
Introduction: Despite advancement of treatment modalities, Tuberculosis (TB) treatment interruption rate has glob- ally accelerating, calling for greater framework shifting towards psychosocial intervention. Similarly, Selangor state had reported the perturbing TB treatment interruption rate, which was figured persistently above 10% in the interval year of 2014 to 2018, thus signifies an empirical assessment on Information-Motivation-Behavioural skills (IMB) determinants of TB intensive phase treatment. This study aims to determine the time to intensive phase TB treatment interruption and its prognostic factors among newly diagnosed pulmonary Tuberculosis (PTB) smear positive patients in urban district Selangor. Methods: A multi-centric prospective cohort study will recruit 695 newly diagnosed PTB smear positive patients at treatment centres in urban districts, Selangor. This study will utilize validated self-admin- istered questionnaire and standardised data collection form (PROFORMA). At baseline, we will elicit information on IMB models constructs, additionally on socio-demographics, health service factors and clinical characteristics. Meanwhile, four points follow up will be executed to retrieve information on treatment status and time varying effects of body weight, treatment side effects, symptoms improvement and internalised stigma. Finally, survival analysis will be computed to identify the time to intensive phase treatment interruption and its prognostic factors. Conclusion: This study will enlighten IMB model determinants of intensive phase treatment interruption, hence to endeavour psychosocial elements in designing time relevant public health strategies in TB case management.
MeSH terms: Antitubercular Agents; Body Weight; Demography; Follow-Up Studies; Health Services; Humans; Motivation; Prognosis; Prospective Studies; Public Health; Surveys and Questionnaires; Tuberculosis, Pulmonary; Survival Analysis; Case Management
Fistula-in-ano is a benign anorectal disease which always poses a big dilemma to the surgeons
because of their significant recurrent rate following surgery. Materials and Methods: A cross-sectional study
involving 42 patients undergoing core out fistulectomy in the Hospital Tengku Ampuan Afzan, Kuantan,
Pahang, Malaysia were included in this study. Demographic data of patients were assessed. Endoanal
ultrasound (EAUS) was done prior to the surgery to determine types of fistula and classified using Park’s
classification. Follow up was made post-operatively at 4th week, 2nd month, 3rd month, 4th month, 5th month
and 6th month to look for the duration of healing or recurrence. Results: 5 out of 42 patients were lost to
follow up leaving 37 patients available for the analysis. Mean age of the patient was 38.4 (13.8) years old.
Transphincteric and intersphincteric type of fistula accounted for 54.5% and 40.1%, respectively. 62.2%
(n=23) of patients achieved primary healing after the procedure. The mean for healing duration was 3.7
(3.1) months. Recurrence of the disease was seen only in 37.8% (n=14) of the patients. Conclusions: Even
though we managed to achieve significant success rate cumulatively, recurrence of fistula still impose a
significant challenge toward patient’s management. Therefore, further prospective study with a bigger
sample size is recommended to look into this method to reduce recurrence of fistula.
Recreational noise exposure has become a major threat to the hearing system, and this
includes exposure to loud noise during group exercises such as Zumba Fitness, where loud music plays an
important role. This study aimed to assess the noise exposure and hearing threshold profile among Zumba
Fitness regulars in Kuantan, Malaysia. MATERIALS AND METHODS: Noise exposure and hearing profile
threshold were measured during Zumba Fitness sessions at a fitness studio in Kuantan, Malaysia from 24th
June 2014 to 12th August 2014. Noise exposure was measured using a noise dosimeter for one hour of Zumba
Fitness session with a total of nine sessions run by three different instructors while sound level pressure was
taken using a sound level meter during ambient, peak session and during cooling down. Thirty participants
answered questionnaires and underwent pure tone diagnostic audiometry test at a local clinic for hearing
threshold documentation. RESULTS: Some areas of the hall posed higher risks of causing noise-induced
hearing loss especially near the amplifiers. There were periods when the hearing level exceeded 115 dBA.
Early abnormal pattern could be observed in the hearing profiles of some of the participants to suggest
preliminary hearing problems. CONCLUSION: Zumba Fitness regulars have a risk of developing noise-induced
hearing loss and preventive steps should be properly addressed as NIHL is permanent and irreversible.