Browse publications by year: 2023

  1. Ibrahim ZH, Al-Diwan JK
    Med J Malaysia, 2023 Nov;78(6):717-720.
    PMID: 38031212
    INTRODUCTION: Coronavirus disease 2019 (COVID-19) has high morbidity and mortality especially in preexisting risk groups. In atopic diseases the IgE and eosinophils are commonly elevated. This study aims to determine the potential association between COVID-19 and atopic diseases in Iraqi patients.

    MATERIALS AND METHODS: A cross-sectional study done in Baghdad on 112 patients who attended Al-Zahraa Allergic Center. Their demographic characteristics, total IgE, eosinophil counts and PCR result for COVID-19 were determined.

    RESULTS: The means for IgE and eosinophils were 245.7±260.1IU/ml and 444.5±117.1cells/microliter sequentially. Around 32.1% had high IgE level (i.e., atopic) and 11.6% had COVID-19. Among the atopic patients, 33.3%, 30.5% and 36.2% had atopic dermatitis, allergic rhinitis and asthma respectively. More than half (58.3%) of them were male, 55.5% aged <45 years, 36.2% were retired or had no job, 69.5% were graduated from secondary school or more and 88.8% lived in urban areas. There is no significant association in IgE level between those with and without COVID-19, which means that exposure to SARS Cov2 virus could not be a trigger or exacerbation for atopic diseases. Also, there was no association between atopic patients with COVID-19 and those without it regarding type of atopy, age, sex, occupation, education, type of living area.

    CONCLUSIONS: Atopy is not a risk factor for COVID-19.

    MeSH terms: Cross-Sectional Studies; Eosinophils; Female; Humans; Immunoglobulin E; Iraq/epidemiology; Male; Rhinitis, Allergic*
  2. Ang WS, Jamil TR, Kamaludin R, Mustafar R
    Med J Malaysia, 2023 Nov;78(6):721-732.
    PMID: 38031213
    INTRODUCTION: Chronic kidney disease (CKD) rapid progression is associated with higher risk of end-stage kidney disease and higher mortality rate. Monitoring and recognition of CKD rapid progression is still lacking, however interventions have been shown to improve this. Thus, this study aimed to evaluate the acceptability and feasibility of CKD-CHECK toolkit and preliminary measure the outcome of the CKD-CHECK toolkit in assisting primary care doctor to order further tests for CKD rapid progressors and trigger appropriate nephrology referral.

    MATERIALS AND METHODS: The CKD-CHECK (CKD-CHECK EGFR Chart in Kidney disease) is a toolkit that was developed to auto-generate patients' eGFR trend using a line graph, displaying the trend visually over a year. It identifies patients with rapid CKD progression, triggers the doctors to order appropriate tests (proteinuria quantification or renal imaging) and helps in decision making (continued monitoring at primary care level or referral to nephrologist). The toolkit was piloted among medical officers practising in a hospital-based primary care clinic treating patients with eGFR<60ml/min/1.73m2 using an interventional before-after study design from February to May 2022. In the preintervention period, the CKD patients were managed based on standard practice. The doctors then used the CKDCHECK toolkit on the same group of CKD patients during the intervention period. The feasibility and acceptability of the toolkit was assessed at the end of the study period using the Acceptability of Intervention Measure (AIM) and Feasibility of Intervention Measure (FIM) questionnaires. All patients' clinical data and referral rate were collected retrospectively through medical files and electronic data systems. Comparison between the pre- and post-intervention group were analysed using paired t-test and McNemar test, with statistical significance p value of <0.05.

    RESULTS: A total of 25 medical officers used the toolkit on 60 CKD patients. The medical officers found the CKD-CHECK toolkit to be highly acceptable and feasible in primary care setting. The baseline characteristics of the patients were a mean age of 72 years old, predominantly females and Chinese ethnicity. Majority of the CKD patients had diabetes mellitus, hypertension and dyslipidemia. The numbers of CKD rapid progressors was similar (26.7% in the preintervention group vs 33.3% in the post-intervention group). There were no significant differences in terms of proteinuria assessment and ultrasound kidney for CKD rapid progressors before and after the intervention. However, a significant number of CKD rapid progressors were referred to nephrologists after the use of CKD-CHECK toolkit (p=0.016).

    CONCLUSIONS: CKD-CHECK toolkit is acceptable and feasible to be used in primary care. Preliminary findings show that the CKD-CHECK toolkit improved the primary care doctor's referral of rapid CKD progressors to nephrologists.

    MeSH terms: Aged; Female; Glomerular Filtration Rate; Humans; Male; Pilot Projects; Primary Health Care; Proteinuria; Retrospective Studies; Disease Progression
  3. Goh CY, Visvanathan R, Leong CT, Hooi LS, Ch'ng CC, Yee SY, et al.
    Med J Malaysia, 2023 Nov;78(6):733-742.
    PMID: 38031214
    INTRODUCTION: The incidence of acute kidney injury (AKI) among hospitalised patients has not been well studied in Malaysia.

    MATERIALS AND METHODS: We conducted a prospective, multicentre study in seven hospitals in West Malaysia. All the adults admitted in March 2017 fulfilling Kidney Disease Improving Global Outcomes (KDIGO) criteria for AKI were included.

    RESULTS: Of the 34,204 patients screened, 2,457 developed AKI (7.18%), 13.1% of which occurred in intensive care unit (ICU). There were 60.2% males with a mean age of 57.8 (±17.5) years. The most common comorbidities were hypertension (55.0%), diabetes (46.6%), ischaemic heart disease (15.1%) and chronic kidney disease (12.0%). The commonest causes of AKI were sepsis (41.7%), pre-renal (24.2%) and cardiorenal syndrome (10.8%). Nephrotoxin exposure was reported in 31%. At diagnosis, the proportion of AKI stages 1, 2 and 3 were 79.1%, 9.7%, 11.2%, respectively. Referral to nephrologists was reported in 16.5%. Dialysis was required in 176 (7.2%) patients and 55.6% were performed in the ICU. Acidosis (46.2%), uraemia (31.6%) and electrolyte disturbance (11.1%) were the commonest indications. Continuous renal replacement therapy (CRRT) was required in 14%. The average length of hospital stay was 9.5 days. In-hospital mortality was 16.4%. Among survivors, full and partial renal recovery was seen in 74.7% and 16.4% respectively while 8.9% failed to recover. After a mean follow-up of 13.7 months, 593 (30.2%) of survivors died and 38 (1.9%) initiated chronic dialysis. Mortality was highest among those with malignancies (Hazard Ratio, HR 2.14), chronic liver disease (HR 2.13), neurological disease (HR 1.56) and cardiovascular disease (HR 1.17).

    CONCLUSION: AKI is common in hospitalised patients and is with associated high mortality during and after hospitalisation.

    MeSH terms: Adult; Aged; Female; Humans; Kidney; Malaysia/epidemiology; Male; Middle Aged; Prospective Studies; Retrospective Studies; Risk Factors; Incidence
  4. Ho YH, Lim CT, Chua CZF, Chow HB, Chua HH, Fong AYY
    Med J Malaysia, 2023 Nov;78(6):743-750.
    PMID: 38031215
    INTRODUCTION: Despite recent advancements in the diagnosis and management of infective endocarditis (IE), it is associated with substantial morbidity and mortality. Our study objective is to determine the factors associated with in-hospital mortality in IE patients among the local population.

    MATERIALS AND METHODS: All IE patients who were diagnosed with definite or possible IE and were treated at Sarawak Heart Centre from 1st January 2020 to 31st December 2022 were recruited. We examined the demographic features of the subjects and the factors that contributed to in-hospital mortality. Multivariate logistic regression was used to analyse the associated factors and in-hospital mortality.

    RESULTS: Our study population comprised a total of 37 patients with a mean age of 46.4 years and male predominance. The in-hospital mortality rate of IE in this study was 44.4%. Haemodynamic instability and anaemia were found to be strong predictors of IE survival outcome, with an odds ratio of 51.5 and 35.7 respectively. Patients with vascular phenomenon and heart failure were at 10.5- and 6.0-times higher odds of dying, however, these two associations were found to be not statistically significant.

    CONCLUSION: The in-hospital mortality due to IE in our study was among the highest in developing countries. Factors of hypotension and optimal response to individual hemodynamic parameters may confer lower mortality. While anaemia is demonstrable as a risk factor for inpatient mortality, a target has yet to be reasonably established.

    MeSH terms: Anemia*; Endocarditis*; Endocarditis, Bacterial*; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Hospital Mortality
  5. Ismail IN, Alaga A
    Med J Malaysia, 2023 Nov;78(6):751-755.
    PMID: 38031216
    INTRODUCTION: Ultrasound guided lung biopsy (USLB) is a minimally invasive diagnostic tool with short examination time and real-time monitoring conducted bedside for accurate diagnosis in order to provide the best treatment. However, it is not widely performed by pulmonologists. We aim to explicate the efficacy and safety of USLB led by pulmonologists. The objective of this study is to assess safety and efficacy of USLB performed by pulmonologists in an outpatient setting.

    MATERIALS AND METHODS: We retrospectively enrolled patients who underwent the procedure from January 2018 to April 2022. Under real time ultrasound (Hitachi Medical ProSound F37), thoracic lesions adjacent to the chest wall were sampled with a full-core biopsy needle (CT Core Single Action Biopsy Device, 18G × 15 cm, Vigeo, Italy). Chest x-ray was performed 30 minutes post procedure ruling out pneumothorax. Patients were discharged home 1-2 hours post biopsy. Data was analysed using Microsoft Excel 2010 and Statistical Package for Social Science (SPSS) Version 26.

    RESULTS: A total of 18 patients (14 males, 4 females) underwent USLB for lung tumours. Biopsies were histologically deemed adequate with an overall diagnostic yield of 77.8% (14/18). A total of 57% were positive for thoracic malignancy (21% squamous cell carcinoma, 21% adenocarcinoma, 15% small cell carcinoma) and another 43% were positive for extra thoracic malignancy (1 hepatocellular carcinoma, 2 DLBCL, 1 Hodgkin's lymphoma, 1 seminoma, 1 thymoma). Four patients had inconclusive results but managed to get positive results from surgical or lymph node biopsy (thymoma and adenocarcinoma). Statistical analysis showed more than two passes are needed to achieve a positive HPE yield (p value<0.05). There were nil complications to all the cases done.

    CONCLUSIONS: USLB can safely and effectively be performed by trained pulmonologists with excellent accuracy and low complication rate in outpatients.

    MeSH terms: Female; Humans; Lung/pathology; Malaysia; Male; Retrospective Studies; Thoracic Neoplasms*; Tomography, X-Ray Computed; Ultrasonography, Interventional; Image-Guided Biopsy/adverse effects; Image-Guided Biopsy/methods; Pulmonologists
  6. Nor AM, Jagdeesh K, Mohd FAS, Kamraul AK, Yusmadi A, Noraslawati R, et al.
    Med J Malaysia, 2023 Nov;78(6):756-762.
    PMID: 38031217
    INTRODUCTION: The study aims to evaluate and report on the clinical characteristics, incidence, risk factors and associated complications of emergency and planned peripartum hysterectomy in a single training and research tertiary health care centre in Malaysia.

    MATERIALS AND METHODS: We conducted a 6-year retrospective cross-sectional study from the 1st January 2016 until 31st December 2021. Clinical, demographic characteristics, perioperative parameters, operative indications, blood loss, maternal/neonatal outcomes and complications were analysed. Patients were subdivided, analysed and studied in two subgroups- emergency hysterectomy (EH) and planned hysterectomy (PH).

    RESULTS: There were 65 cases of peripartum hysterectomy out of total 100,567 deliveries, with a prevalence rate of 0.06%. Overall, the majority of patients were multiparous (96.9%), having previous caesarean scar (73.8%) or diagnosed with placenta praevia (75.4%). More than half of the total patients (61.5%) have both previous caesarean scar and concomitant placenta praevia. EH was carried out in 39(60%) patients while 26(40%) patients underwent PH. The only indication for surgery in the PH group (100%) was abnormal placentation while the most common indication for surgery in the EH group (53.8%) was postpartum haemorrhage related to abnormal placentation. Patients who underwent EH were more likely to have massive blood loss (p=0.001), require ICU admissions (p=0.001), have DIVC cycles transfused (mean [SD] regime: 1.35 [0.95] vs 0.54 [0.99]; p=0.002), have lower postoperative haemoglobin level (mean [standard deviation, SD] haemoglobin: 9.23g/l [SD1.8] vs. 10.8 g/l [SD1.86]; p=0.001) and have higher difference between pre/post operative haemoglobin level (mean [SD] haemoglobin difference: 1.78g/l [SD6.34] vs 0.32g/l [SD1.7]; p=0.008) compared to patients with PH. Red blood cell transfusion, operating time, length of stay, weight of babies and Apgar score between two groups showed no significant differences. A significant reduction of blood loss between the first and the second half duration of the study (mean [SD] blood loss: 6978 ml [SD 4999.45] vs. 4100ml [SD2569.48]; p=0.004) was also observed. In the emergency group, 'non-placental cause' EH required significantly more red blood cell transfusion than 'placental cause' (p<0.05) while in the PH group, no significant difference was observed between the occlusive internal iliac artery 'balloon' and 'no balloon' subgroup in terms of operating time, total blood loss or blood transfusion. Overall complications showed more cases of post operative fever and relaparotomy in the EH group (18.4% vs. 7.6%) while urinary tract injuries including injuries to bladder and ureter occurred only in the PH group (9.4% vs. 0%).

    CONCLUSION: The majority of peripartum hysterectomy cases are due to placenta accreta spectrum disorders. Planned peripartum hysterectomies have a lower morbidity rate compared to emergency hysterectomies. Therefore, early identification of placenta accreta spectrum disorders and timely planning for elective procedures are crucial to minimise the need for emergency surgery.

    MeSH terms: Cesarean Section/adverse effects; Cicatrix/complications; Cross-Sectional Studies; Female; Hemoglobins; Humans; Hysterectomy/adverse effects; Hysterectomy/methods; Infant, Newborn; Placenta; Placenta Accreta*; Pregnancy; Retrospective Studies; Peripartum Period; Tertiary Care Centers
  7. Tanusha N, Leelavathi M, Azimah NM
    Med J Malaysia, 2023 Nov;78(6):763-767.
    PMID: 38031218
    INTRODUCTION: Digital devices are an integral part of children's lives, and its use is associated with both risks and benefits. The aim of this study was to determine parent's perception of digital device use among their preschool children.

    MATERIALS AND METHODS: A cross-sectional study was conducted among parents of 145 children in the year 2020. Participants were selected using multistage randomisation technique from 10 of the 75 registered government kindergartens in Kota Setar District, Kedah. Data were collected using a self-administered questionnaire. Analysis was done using descriptive statistics and the association between parent's demographic characteristics and the overall perception of digital media use by their preschool children was tested using Chi-square test.

    RESULTS: A total of 150 questionnaires were distributed, and 145 were returned (96.7% response rate) out of which 139 were complete. We found that parent's overall perception of their preschool children using digital devices was mixed, where about one-third of them perceived that digital device use was a risk, one-third perceived it as beneficial while onethird were unsure. The common perception of risk was that digital devices impaired children's physical (71.9-90.6%) and intellectual domains (71.9-86.3%) especially causing damage to eyesight (90.6%), causing addiction (86.3%) and exposed to radiation (81.3%). The perceived benefits of using digital device were mainly in the social domain, promoting technology awareness (64.8%), easily accessible and portable (63.3%) and entertaining (64.0%). They also perceived that digital devices promoted creative and interactive learning (62.6%). Parent's overall perception of digital media use was associated with their employment status (p=0.028).

    CONCLUSION: Parent's overall perception regarding digital device use among their preschool children was mixed. They perceived that digital devices commonly cause risk to the physical and intellectual aspects of their children while there are some benefits to the social aspects. There is an association between parent's overall perception and employment status.

    MeSH terms: Child, Preschool; Cross-Sectional Studies; Humans; Parents*; Perception; Surveys and Questionnaires; Internet*
  8. Abdullah B, Idris S, Md Jaafar SA, Ghazali NLA, Mat Liki NS, Aminuddin AA
    Med J Malaysia, 2023 Nov;78(6):768-773.
    PMID: 38031219
    INTRODUCTION: The aim of this study is to determine the level of awareness of pelvic organ prolapse (POP) and factors that influence the attitude towards the treatment of POP among Malaysian women.

    MATERIALS AND METHODS: This was a cross-sectional study of 400 women from registered non-government organisations (NGOs) in Malaysia who voluntarily answered questionnaires distributed through Google form via emails. Data were analysed using descriptive statistics, independent t-test and one-way ANOVA test.

    RESULTS: Four hundred respondents participated in this study. The mean age was 40.42 years old (SD=12.566). The mean score for the studied population was 4.96 (SEM 0.124). Only 58 (14.5%) respondents obtained a score of eight or more, and 235 (58.8%) respondents scored between 4 and 7. The rest of 107 (26.7%) respondents scored 3 and less. There were statistically significant differences in the mean score for level of awareness between marital statuses, menopausal status, number of children and occupation. There were only 273 (68%) respondents who will seek treatment if they experience symptoms of POP. The most frequent reasons for not seeking treatment were unawareness of the availability of medical treatment for POP (69 %).

    CONCLUSION: Majority of the respondents have an inadequate level of awareness on POP. Although more than half of the respondents will seek treatment if they experience symptoms of POP, concerns raised by those who chose not to seek treatment should be addressed by a more effective public awareness programme. This includes the unawareness of the availability of medical treatment and the embarrassment to see medical practitioners.

    MeSH terms: Adult; Child; Cross-Sectional Studies; Female; Humans; Malaysia; Surveys and Questionnaires
  9. Zulkifle AF, Siti Soraya AR, Hamzaini AH
    Med J Malaysia, 2023 Nov;78(6):774-779.
    PMID: 38031220
    INTRODUCTION: We aimed to compare the degree of bowel distension and image quality between pineapple juice and different mannitol concentrations, as well as patients' acceptance and side effects of these different magnetic resonant enterography (MRE) oral contrast agents.

    MATERIALS AND METHODS: Seventy-five participants underwent MRE as an initial investigation or follow-up for inflammatory bowel disease. A systematic sampling method was used to divide the participants into three different groups: group 1 received 6.7% mannitol concentration, group 2 received 3.3% mannitol concentration and group 3 received pineapple juice as an oral contrast agent during their MRE examination. The degree of bowel distension on MRE images was assessed by a radiologist by measuring the bowel diameter from inner wall to inner wall at specified levels, while qualitative analysis was evaluated based on the presence of artefacts. All patients were asked to score their acceptance of the oral contrast and were asked about side effects such as diarrhoea, abdominal discomfort and vomiting.

    RESULTS: All patients were able to completely ingest 1.5L of oral contrast. The mean diameter of bowel distension was 2.1cm in patients who received 6.7% mannitol concentration, 2.0cm in patients who received 3.3% mannitol concentration and 1.6 cm in patients who received pineapple juice. Twothirds of patients who received 6.7% mannitol and 3.3% mannitol solutions had good-quality MRE images, but 68% of patients who received pineapple juice had poor-quality MRE images. Twenty-four patients (96%) who received pineapple juice rated it as slightly acceptable and acceptable but only 12 patients (48%) who received 6.7% mannitol solution rated it as slightly acceptable and acceptable. Eighty-eight percent of patients who received 6.7% mannitol solution experienced at least one form of side effect as compared to 44% of patients who received 3.3% mannitol solution and 18% of patients who received pineapple juice.

    CONCLUSION: Optimum small bowel distension and good image quality can be achieved using 3.3% mannitol concentration as an oral contrast agent. Increase in mannitol concentration does not result in significant improvement of small bowel distension or image quality but is instead related to poorer patient acceptance and increased side effects. Pineapple juice is more palatable than mannitol and produces satisfactory small bowel distension. However, the small bowel distension is less uniform when using pineapple juice with a considerable presence of artefacts. Mannitol, 3.3% concentration, is therefore recommended as an endoluminal contrast agent for bowel in MRE.

    MeSH terms: Administration, Oral; Contrast Media; Humans; Intestine, Small; Magnetic Resonance Imaging/methods; Mannitol*; Magnetic Resonance Spectroscopy; Ananas*
  10. Lai CCK, Yaacub YJ, Siow YC, Baharum N
    Med J Malaysia, 2023 Nov;78(6):780-786.
    PMID: 38031221
    INTRODUCTION: Prolonged grief disorder (PGD) is a diagnosis characterised by severe, persistent and disabling grief beyond 6 months post-death of a loved one. The new text revision of DSM-5 (DSM-5-TR) approved a new diagnosis PGD on March 2022. In Malaysia, PGD is not routinely screened in healthcare settings and hence goes untreated. The aim of this study is to identify prevalence and factors related to PGD among bereaved relatives whose loved ones had access to PCU services.

    MATERIALS AND METHODS: A cross-sectional study involving bereaved individuals in Palliative Care Unit Hospital Selayang. Participants (n=175) were recruited through telephone, and a validated tool Prolonged Grief Disorder Scale (PG-13) was asked to identify PGD. Further data collected were concomitant stressors in life and support system in the bereaved individual.

    RESULTS: Prevalence of PGD was 2.9% (n=5), and subthreshold PGD was 4% (n=7). A model of multiple logistic regression calculated most of the traditional risk factors were not significant except having an increased responsibility as a single parent after passing of a spouse or loved one, had 10 times increased odds of PGD (Odds Ratios: 10.93; 95% Confidence Interval: 2.937, 40.661). Otherwise, immediate family support (80%), religion (60%) and community (40%) support were the top three coping mechanisms of our PGD cohort, although they were not significant in a multiple logistic regression model.

    CONCLUSION: Our PGD percentage may not be as high as those of other countries, but nonetheless they exist and their needs are just as important. The authors hope that this paper may create an awareness among the healthcare clinicians about PGD in our society, for a greater access of service to understand them and better public awareness.

    MeSH terms: Bereavement*; Cross-Sectional Studies; Female; Humans; Malaysia/epidemiology; Palliative Care; Pregnancy; Prevalence; Preimplantation Diagnosis*
  11. Zaleha MI, Noor Hassim I, Azmi MT, Hasni MJ, Rosnah I, Abdul-Hamid H, et al.
    Med J Malaysia, 2023 Nov;78(6):787-792.
    PMID: 38031222
    INTRODUCTION: In Malaysia, studies on self-reported bone fractures are scarce. Due to the fact that bone fractures may serve as an indicator of osteoporosis in the community, this study aimed to identify the factors associated with their occurrence among adults in Malaysia.

    MATERIALS AND METHODS: Epidemiological data for selfreported bone fractures were obtained through direct interviews using a validated questionnaire from the Prospective Urban and Rural Epidemiology (PURE) study.

    RESULTS: Of 15,378 respondents, 6.63% (n=1019) reported bone fractures, with a higher proportion of men (65.8%, n=671) than women (34.2%, n=348). Higher odds of selfreporting bone fractures were seen in males (aOR, 2.12; 95%CI: 1.69, 2.65), those with a history of injury (aOR 5.01; 95%CI: 3.10, 6.32) and those who were obese (aOR: 1.46; 95% CI: 1.13, 1.89), highly active (aOR 1.25; 95%CI: 1.02, 1.53), smokers (aOR 1.35; 95%CI: 1.11, 1.65) and alcohol consumers (aOR 1.67; 95%CI: 1.20,2.32).

    CONCLUSION: Adopting a healthier lifestyle that includes a balanced diet and moderate physical activity is critical for weight loss, increased muscle and bone mass and better stability, which reduces the likelihood of fractures following a fall.

    MeSH terms: Adult; Female; Humans; Malaysia/epidemiology; Male; Prospective Studies; Risk Factors; Cohort Studies; Self Report
  12. Nurhani MA, Farah HMS, Ili NMA, Zahidah AR, Rahimah B, Nabilah HK, et al.
    Med J Malaysia, 2023 Nov;78(6):803-807.
    PMID: 38031224
    INTRODUCTION: The COVID-19 pandemic has prompted a global drive for vaccination, including children. Despite the urgency, understanding the safety and side effects remains crucial. Our study aimed to evaluate the safety of the Pfizer- BioNTech (BNT162b2) vaccine in children by determining the proportion of vaccinated children who experienced side effects and identifying factors associated with postvaccination side effects.

    MATERIALS AND METHODS: A cross-sectional study was conducted among children who received the COVID-19 vaccine between 3 February and 8 May 2022. Data were collected using a self-administered questionnaire filled out by the parent or legal guardian.

    RESULTS: The mean age of the study participants was 9 years old and 43.1% were males. Out of the 195 participants in the study, 62 (31.8%) reported side effects after vaccination. The most frequently reported side effects were pain at the injection site (29.7%, n=58), fever (15.9%, n=31), localised inflammation (10.8%, n=21) and arthralgia/myalgia (9.2%, n=18). There were no reported severe adverse events such as anaphylaxis or myocarditis. Most side effects occurred within the first two days post-vaccination. There was a higher proportion of side effects among children with underlying co-morbidities. No significant differences were observed based on age, weight, ethnicity and the presence of allergies, or the use of premedication.

    CONCLUSION: The BNT162b2 vaccine was generally welltolerated in children, with most side effects being mild and self-limiting. These findings support the safety of the COVID-19 vaccine and would guide healthcare professionals, parents and policy-makers in making informed decisions about COVID-19 vaccination, especially among high-risk groups.

    MeSH terms: Child; Child, Preschool; Cross-Sectional Studies; Female; Humans; Male; Pandemics; Myalgia
  13. Maharani ND, Fuadi A, Halimi RA
    Med J Malaysia, 2023 Nov;78(6):808-814.
    PMID: 38031225
    INTRODUCTION: Craniotomy tumour is brain surgery that can induce a stress response. The stress response can be measured using haemodynamic parameters and plasma cortisol concentration. The stress response that occurs can affect an increase in sympathetic response, such as blood pressure and heart rate, which can lead to an increase in intracranial pressure. Scalp block can reduce the stress response to surgery and post-operative craniotomy tumour pain. The local anaesthetic drug bupivacaine 0.25% is effective in reducing post-operative pain and stress in the form of reducing plasma cortisol levels. The adjuvant addition of clonidine 2 μg/kg or dexamethasone may be beneficial.

    MATERIALS AND METHODS: A randomised control clinical trial was conducted at the Central Surgery Installation and Hasan Sadikin General Hospital Bandung and Dr. Mohammad Husein Hospital Palembang from December 2022 to June 2023. A total of 40 participants were divided into two groups using block randomisation. Group I receives bupivacaine 0.25% and clonidine 2 μg/kg, and group II receives bupivacaine 0.25% and dexamethasone 8 mg. The plasma cortisol levels of the patient will be assessed at (T0, T1 and T2). All the patient were intubated under general anesthaesia and received the drug for scalp block based on the group being randomised. Haemodynamic monitoring was carried out.

    RESULTS: There was a significant difference in administering bupivacaine 0.25% and clonidine 2μg/kg compared to administering bupivacaine 0.25% and dexamethasone 8 mg/kg as analgesia for scalp block in tumour craniotomy patients on cortisol levels at 12 hours post-operatively (T1) (p=0.048) and 24 hours post-surgery (T2) (p=0.027), while post-intubation cortisol levels (T0) found no significant difference (p=0.756). There is a significant difference in Numeric Rating Scale (NRS) at post-intubation (T0) (p=0.003), 12 hours post-operatively (T1) (p=0.002) and 24 hours post-surgery (T2) (p=0.004), There were no postprocedure scalp block side effects in both groups.

    CONCLUSION: The study found that scalp block with 0.25% bupivacaine and 2μg/kg clonidine is more effective in reducing NRS scores and cortisol levels compared bupivacaine 0.25% and dexamethasone 8mg in tumour craniotomy patients.

    MeSH terms: Analgesia*; Anesthetics, Local/pharmacology; Anesthetics, Local/therapeutic use; Bupivacaine/pharmacology; Bupivacaine/therapeutic use; Clonidine/pharmacology; Clonidine/therapeutic use; Craniotomy/adverse effects; Craniotomy/methods; Dexamethasone; Humans; Hydrocortisone/therapeutic use; Neoplasms*; Pain, Postoperative/drug therapy; Scalp/surgery
  14. Rajesh R, Moganadass M, Choo CY
    Med J Malaysia, 2023 Nov;78(6):815-820.
    PMID: 38031226
    INTRODUCTION: This study examined the prevalence of posterolateral tibial bone bruising in isolated anterior cruciate ligament (ACL) injuries, prevalence of meniscal injuries in ACL injuries, as well as the association between posterolateral tibial bone bruising and lateral meniscal tears among those with ACL injury undergoing Primary ACL Reconstruction.

    MATERIALS AND METHODS: Retrospective data on 130 patients who underwent primary ACL reconstructions was analysed. Their preoperative magnetic resonance images (MRI) were reviewed for the presence of posterolateral tibial bone bruise. The presence of meniscal injuries was recorded based on the arthroscopic findings from the operative records.

    RESULTS: 95 patients were recruited into the study. The prevalence of posterolateral bone bruise in this study was 41%. There was a statistically significant difference when comparing the prevalence of bone bruising to the time of injury to MRI (p<0.001). The prevalence of an injury to at least one meniscus at the time of ACLR surgery was 83.2%. The prevalence of lateral meniscus injuries in patients with bone bruise was found to be 53.9%. The crude odds ratio of a patient having a lateral meniscal tear in the presence of bone bruising was 1.56 (0.68, 3.54). This figure was even higher when it was adjusted for time to MRI and was 2.06 (0.77, 5.46).

    CONCLUSION: Prevalence of posterolateral tibial bone bruising in our study was 41%, and the prevalence of meniscal injury to either meniscus at the point of surgery was 83.2%, out of which the lateral meniscus tears were identified during ACLR surgery in 47.3% of the patients. We found there was no association between posterolateral tibial bone bruising to sex, age and mode of injury, but was sensitive to the interval between time of injury and MRI. The overall prevalence of lateral meniscal tears was higher in patients with posterolateral bone bruising but was not statistically significant with a P value of 0.31; however, the Crude odd ratio was 1.56 (0.68, 3.54) and was higher when adjusted to time of injury to MRI 2.06 (0.77, 5.46). We suggest for MRI to be done as soon as possible after injury in regard to bone bruising identification. We should be vigilant to look for lateral meniscal tears and anticipate for its repair in ACL injuries, especially so when we identify posterolateral tibial bruising on the preoperative MRI.

    MeSH terms: Hematoma; Humans; Magnetic Resonance Imaging; Menisci, Tibial/surgery; Retrospective Studies; Anterior Cruciate Ligament/surgery
  15. Priasmoro DP, Dradjat RS, Zuhriyah L, Lestari R, Subagiyono
    Med J Malaysia, 2023 Nov;78(6):821-829.
    PMID: 38031227
    INTRODUCTION: Managing severe mental disorders at home by family members as caregivers is considered the most efficient option compared to hospital care. However, on the other hand, it can lead to the emergence of physical and psychological burdens on the caregiver. To improve their role optimally in caregiving, families will undergo psychological adaptation, reaching the highest level of acceptance. Other factors, such as stigma, social support, social norms, caregiving experience and personal characteristics, influence family acceptance. This study aims to determine a family acceptance model to enhance the role of the family.

    MATERIALS AND METHODS: The research instruments used included The McMaster Family Assessment Device Adaptation, IEXPAC, and S.N.Q. 22, F.Q., P.S.Q., Social Support Questionnaire shortened version, The Family Focused Mental Health Practice Questionnaire and extraversion personality questionnaire. The questionnaire was distributed to caregivers with a population of 175 individuals. The sample size of this study was 133 individuals selected through proportional random sampling. The data were analysed using Structural Equation Modeling Partial Least Square (SEM-PLS) with Amos software v.26.0.

    RESULTS: The phase one research showed that intention and satisfaction are the leading indicators of family acceptance that can influence family roles. At the same time, family acceptance is influenced by personal character (p≤0.001), care experience (p≤0.001), social support (p≤0.001), social norms (p=0.004), symptom severity (p≤0.001), and stigma (p≤0.001). Additionally, family acceptance significantly impacted the family's caregiving role (CR=6.573, p≤0.001).

    CONCLUSION: It was found that the family acceptance model to improve the family's role in the care of patients with severe mental disorders focuses on the acceptance that the family has to be able to carry out its role well in patients. To improve family acceptance, families still lack the personal character expected in caring for patients with severe mental disorders at home. It is necessary to increase commitment to care and positive values in life.

    MeSH terms: Family/psychology; Humans; Mental Health; Surveys and Questionnaires; Caregivers*
  16. Shalihin MSE, Suhaimi NAN, Hamzah HA, Abidin S, Aidid ME, Musa R
    Med J Malaysia, 2023 Nov;78(6):830-844.
    PMID: 38031228
    INTRODUCTION: Mounting evidence has shown the significant correlation between periodontitis and the development of other comorbidities, such as cardiovascular disease due to periodontopathogenic bacterial migration and colonisation. As the main etiologic agent of periodontitis, the role of Porphyromonas gingivalis (P. gingivalis) has been widely explored as the main culprit and its early detection is crucial to control the exacerbation of diseases. This review aims to identify and summarise all clinical diseases that potentially developed due to the presence of P. gingivalis and discover all its detection methods that have been developed.

    MATERIALS AND METHODS: Full-text articles of case report, case control, cohort and cross-sectional studies that were published from 1st January 2012 until 30th June 2022, were searched using PubMed, CINAHL and Scopus. Periodontal related diseases were excluded in this review due to its wellknown associated disease with P. gingivalis. A comparison studies of detection methods were also excluded in this review.

    RESULTS: Out of 612 articles that were screened, only 106 met the eligibility criteria to be selected for further review. Risk of bias was performed using FEAT principles and reviewers' discussion. A total of 21 final articles that were reviewed showed significant correlation with P. gingivalis and were classified into several clinical domains. Twelve out of 13 detection methods showed high sensitivity and specificity with short duration analysis.

    CONCLUSION: Due to asymptomatic periodontal disease and the high prevalence of P. gingivalis-associated clinical diseases, this review suggests the need for oral public health awareness and early screening for the bacterium detection especially among elderly groups to maintain their quality of life.

    MeSH terms: Aged; Cross-Sectional Studies; Humans; Quality of Life; Porphyromonas gingivalis*
  17. Chew KS
    Med J Malaysia, 2023 Nov;78(6):845-846.
    PMID: 38031229
    Clinical toxinology is an essential subject that should be included in undergraduate medical curricula. By equipping students with the knowledge and skills to identify and treat venomous animals and use antivenom appropriately reduces the risk of medical negligence and delays in treating and transporting these patients. Unfortunately, given the packed curriculum of undergraduate medical programs, it is important to focus on providing students with essential knowledge and skills to function as competent house officers. Student-centered learning approaches, such as gamification and community service projects, can be effective in enhancing learning and promoting awareness of appropriate toxin-related public measures.
    MeSH terms: Curriculum; Education, Medical, Undergraduate*; Humans; Learning; Schools, Medical; Students, Medical*
  18. Sachithanandan A
    Med J Malaysia, 2023 Nov;78(6):847-848.
    PMID: 38031230
    No abstract available.
    MeSH terms: Humans; Mass Screening; Early Detection of Cancer
  19. Krishnan R, Shamsher S, Adzura S
    Med J Malaysia, 2023 Nov;78(6):849-851.
    PMID: 38031231
    We describe a potential cause of eye injury, its concerns and ways to prevent it. The first author underwent a left cataract operation and was prescribed eye drops postoperatively. While applying one of the eye drops, he felt an object hitting the lower eyelid. A serrated plastic piece had fallen off the bottle. Had it fallen on the operated site, it might have caused serious untoward complications. Nurses, carers and patients need to be educated to remove the serrated piece from the bottle before applying eye drops. Manufacturers of eye drops should design safer bottles without such serrated pieces to prevent such eye injuries.
    MeSH terms: Cataract*; Eyelids; Humans; Male; Ophthalmic Solutions
  20. Khoo E, Roslee R, Zakaria Z, Ahmad NI
    J Vet Sci, 2023 Nov;24(6):e82.
    PMID: 38031519 DOI: 10.4142/jvs.23053
    BACKGROUND: The current conventional serotyping based on antigen-antisera agglutination could not provide a better understanding of the potential pathogenicity of Salmonella enterica subsp. enterica serovar Brancaster. Surveillance data from Malaysian poultry farms indicated an increase in its presence over the years.

    OBJECTIVE: This study aims to investigate the virulence determinants and antimicrobial resistance in S. Brancaster isolated from chickens in Malaysia.

    METHODS: One hundred strains of archived S. Brancaster isolated from chicken cloacal swabs and raw chicken meat from 2017 to 2022 were studied. Two sets of multiplex polymerase chain reaction (PCR) were conducted to identify eight virulence genes associated with pathogenicity in Salmonella (invasion protein gene [invA], Salmonella invasion protein gene [sipB], Salmonella-induced filament gene [sifA], cytolethal-distending toxin B gene [cdtB], Salmonella iron transporter gene [sitC], Salmonella pathogenicity islands gene [spiA], Salmonella plasmid virulence gene [spvB], and inositol phosphate phosphatase gene [sopB]). Antimicrobial susceptibility assessment was conducted by disc diffusion method on nine selected antibiotics for the S. Brancaster isolates. S. Brancaster, with the phenotypic ACSSuT-resistance pattern (ampicillin, chloramphenicol, streptomycin, sulphonamides, and tetracycline), was subjected to PCR to detect the corresponding resistance gene(s).

    RESULTS: Virulence genes detected in S. Brancaster in this study were invA, sitC, spiA, sipB, sopB, sifA, cdtB, and spvB. A total of 36 antibiogram patterns of S. Brancaster with a high level of multidrug resistance were observed, with ampicillin exhibiting the highest resistance. Over a third of the isolates displayed ACSSuT-resistance, and seven resistance genes (β-lactamase temoneira [blaTEM], florfenicol/chloramphenicol resistance gene [floR], streptomycin resistance gene [strA], aminoglycoside nucleotidyltransferase gene [ant(3″)-Ia], sulfonamides resistance gene [sul-1, sul-2], and tetracycline resistance gene [tetA]) were detected.

    CONCLUSION: Multidrug-resistant S. Brancaster from chickens harbored an array of virulence-associated genes similar to other clinically significant and invasive non-typhoidal Salmonella serovars, placing it as another significant foodborne zoonosis.

    MeSH terms: Ampicillin; Animals; Anti-Bacterial Agents/pharmacology; Chloramphenicol; Microbial Sensitivity Tests/veterinary; Salmonella/genetics; Streptomycin; Tetracycline; Virulence/genetics; Drug Resistance, Multiple, Bacterial; Multiplex Polymerase Chain Reaction/veterinary
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