METHODS: Item generation, item reduction, and pretesting were used to develop a questionnaire that served as a screening tool to detect severe post-COVID-19 complications. The questionnaire was validated by both internal and external reviewers, and the final version consisted of 11 items. Face validity was assessed through direct interviews with 11 athletes. Severe COVID-19 complications were identified for criterion validity and correlation analysis. A total score of 11 indicates that there is no risk of severe COVID-19 complications and gradual return to play is recommended; results <11 indicate a need for further evaluation by trained medical personnel. For reliability test, 50 respondents were chosen and asked to answer the questionnaires 7 days after their first responses.
RESULTS: Physical Activity Readiness Questionnaires for post-COVID-19 athletes (PAR-COVID-Q) demonstrated excellent internal consistency (r=1, P<0.05) and test-retest reliability (r=1, P<0.05). A total of 118 athletes scored 11, had normal health screening, normal electrocardiogram and chest X-ray, and successfully returned to sports without any reported complications (r=1, P<0.05). Two athletes scored <11 and underwent further medical evaluation.
CONCLUSION: The PAR-COVID-Q is a valid and reliable self-assessment tool with a low burden for athletes to return to sports following mild COVID-19.
MATERIALS AND METHODS: This study is a comparative, crosssectional and hospital-based study. We recruited 83 children with VKC and 83 healthy children as controls. All children underwent complete ocular examinations, CCT measurement using an ultrasound pachymeter and corneal topography using a Placido disc corneal analyser.
RESULTS: There was a statistically significant difference of means CCT and topographic indices in children with VKC compared to controls (p<0.05). The probability keratoconus reached 18% in children with VKC. The mean CCT was observed to be thinnest in the severe-to-very severe groups of VKC compared to the mild-to-moderate (p<0.05). The means simulated-K1 and -K2, apical keratometry, apical gradient curvature, superior-inferior index and keratoconus prediction index were significantly different in severe-tovery severe VKC compared to mild-to-moderate VKC and controls (p<0.05). However, there was no significant difference in mean cylinder value and percent probability keratoconus when comparing different groups of severity of VKC (p=0.912 and 0.070 respectively).
CONCLUSION: Children with VKC have thinner CCT and topographic indices changes compared to healthy children. Similar pattern was observed between groups with VKC. Degree of astigmatism and probability of keratoconus were similar in mild-to-moderate and severe-to-very severe groups.
MATERIALS AND METHODS: This study used a quasiexperimental on 84 participants with DM, which was randomised into intervention (n=42) and control (n=42) groups. The intervention group was provided with health education through booklets and cell phone-based telenursing for four sessions and four sessions of follow-up, while the control group was given health education according to standards from the health centre (Puskesmas). All respondents had their FBG levels checked before, one month, and two months follow-up. The data were analysed using paired sample t-tests, independent samples t-test, and repeated ANOVA.
RESULTS: The mean FBG measurements in the intervention group prior to treatment were 210.88mg/dL, decreased to 173.21mg/dL in the first month, and 177.48mg/dL in the second month (follow-up), while the control group started at 206.36mg/dL, decreased to 182.55mg/dL in the first month, and 191.64mg/dL in the second month. The difference between the two groups was not significant in both the intervention and control groups, p=0.181.
CONCLUSION: Health education through mobile phone-based telenursing and standard health centres both affect FBG levels of people with DM.
MATERIALS AND METHODS: This retrospective audit had two cycles - the first includes all IE patients in Sarawak Heart Centre, Malaysia from January 2020 to December 2022 with different parameters (blood culture, echocardiogram, the appropriateness of antibiotics and surgery) assessed against Malaysian Clinical Practice Guideline (CPG); and reaudit from July 2023 to December 2023. Interventions before re-audit include presentation at different hospital levels and continuing medical education.
RESULTS: Fifty patients were recruited (37 in the first cycle, 13 in the second cycle). The median age was 48.5 years with male predominance. Valve prosthesis (12.0%) and rheumatic heart disease (10.0%) were the commonest predisposing factors. Native mitral (44.0%) and aortic valves (28.0%) were most commonly involved. Twenty-eight (56.0%) patients were culture-positive. In the first cycle, most parameters (culture technique 0.0%, vegetation measured 54.1%, empirical 5.4%, culture-guided 29.7% antibiotics therapy, indicated surgery 0.0%) did not achieve the expected standard except timeliness of echocardiograms and blood culture incubation period. After initial interventions, all parameters showed statistically significant improvement (culture technique p<0.001, echocardiography p<0.001, empirical p<0.001, culture-guided p=0.021, surgery p<0.001) during the re-audit.
CONCLUSION: Compliance with clinical practice guidelines (CPG) on IE management was suboptimal during the first audit but improved after interventions. Hence, regular continuing medical education (CME) is essential, and a written hospital protocol may be useful. Regular audits alongside multidisciplinary teamwork are crucial efforts.
MATERIALS AND METHODS: A total of 34 house officers were enrolled in the study on joining the paediatric unit of Hospital Kulim. They were given the "Textbook of NRP" to prepare for the theory paper that consisted of 30 multiplechoice questions (MCQs). Two to four weeks later they went through a day of training on the resuscitation of the newborn using low-fidelity simulation manikins. They were taught to recognise a newborn who needed resuscitation after delivery, prepared the equipment for resuscitation and learned the skills of resuscitation. The skills included the initial steps, bag valve mask ventilation, intubation, cardiac massage, umbilical vein cannulation and use of medications. They were also taught the performance of objective structured clinical examination (OSCE) A and B. They were evaluated at 3, 6, and 9 months after the completion of their training using the MCQs and the performance checklist in the NRP textbook.
RESULTS: The results showed that there was a significant reduction in their knowledge retention as shown by their performance in multiple choice questions. Similarly, there was a significant loss of competency in their skills and competency in resuscitation using bag mask ventilation, intubation and performance of OSCE A and OSCE B. However, their performance at initial steps showed no significant reduction.
CONCLUSION: In view of the observed deterioration a refresher course in NRP before transferring out to the districts is recommended to improve their overall performance.
MATERIALS AND METHODS: The cross-sectional study was conducted through cloud-data-based digital questionnaires completed by randomly selected residents in the Johor River Basin (n=647). Data was analysed with descriptive statistics using SPSS 27 (IBM®) Software. Comparisons between indigenous and non-indigenous communities were performed using Chi square analysis.
RESULTS: Respondents in this study consisted of indigenous people (n=79) and non-indigenous people (n=568). Indigenous respondents generally perceived more frequent occurrence of extreme weather events in the next 20 years, even for the phenomena unfamiliar in Malaysian settings. All respondents showed similar concerns for health impacts of global warming, although the non-indigenous respondents perceived the risk further into the future (25 years) compared to the indigenous respondents who perceived current or imminent (<10 years) risks. Intense concerns for self, children, family members and community were shown by nearly all indigenous respondents (97-99%), while the non-indigenous people in this study expressed stronger concerns at country level and for future generations. During the last haze episode, most indigenous respondents (85%) did not notice any change in air quality nor discomfort among family members, in contrast 70% of the nonindigenous respondents claimed to have suffered from breathing problems themselves as well as others in the family. All respondents were concerned about air quality in their surroundings, indigenous people were concerned for the near future (<10 years), and non-indigenous people were concerned for the next 25 years.
CONCLUSION: In this study, respondents were generally concerned about the health impacts of unimpeded global warming. There was significant difference in perceptions between indigenous and non-indigenous respondents. The findings were useful, complemented with further studies, to improve understanding of public awareness and to help develop relevant education programmes accessible for wider audience.
MATERIALS AND METHODS: This retrospective cross-sectional study involved children aged 6 months to 6 years who were hospitalised for febrile seizures in Hospital Tuanku Ja'afar Seremban (HTJS) from January 2021 to June 2022. Descriptive statistics were used to summarise the differences in demographics and clinical presentations. Logistic regression analyses were performed to identify factors associated with COVID-19 and non-COVID-19 febrile seizures.
RESULTS: Of the 345 patients (median age 22 months, IQR 15- 32; 59.7% were males) included in the study, 130 (37.7%) tested positive for COVID-19, while 215 (62.3%) tested negative. There were no significant differences between both groups based on age, comorbidities, history of febrile seizures, seizure types, temperature on arrival, cough and rhinorrhoea. Multivariate analysis revealed that a family history of febrile seizures and leucocytosis were associated with increased odds of non-COVID-19 febrile seizures. In contrast, lymphopenia was associated with decreased odds.
CONCLUSION: The clinical presentation of COVID-19 and non- COVID-19 febrile seizures are remarkably similar, highlighting the importance of including COVID-19 screening in febrile seizures workup. Full blood count readings may be potentially useful for differentiating between these conditions.
MATERIALS AND METHODS: cCMV-infected neonates aged ≤3 weeks old were recruited and underwent clinical and laboratory tests to detect viremia and symptomatic infection, hearing examinations at three and six months of age, and radiological imaging of brain auditory pathways using diffusion tensor imaging.
RESULTS: From 26 eligible infants (52 ears), we detected symptomatic infection in nine (34.6%), viremia in 14 (14/25; 56.0%) and sensorineural hearing loss (SNHL) in 14 infants (53.8%). We observed 40 ears (76.9%) with unstable hearing thresholds, 17 (42.5%) of which fluctuated. Hearing fluctuation and progressivity were more common in symptomatic infection (66.7% vs. 14.7%, p<0.001; and 38.9% vs. 2.9%, p=0.002; respectively). A substantial proportion of ears had reduced fractional anisotropy (FA) in the medial geniculate body (59.1%), superior olivary nucleus (45.5%), trapezoid body (40.9%), auditory radiation (36.4%) and inferior colliculus (31.8%). Symptomatic infection was associated with an increased FA in the medial geniculate body (mean difference, MD: 0.12; 95% Confidence Intervals, 95%CI: 0.03, 0.22) and viremia in the inferior colliculus (MD: 0.09; 95%CI: 0.02, 0.16). An FA in the inferior colliculus of ≥0.404 had a sensitivity and specificity of 68.8% and 83.3% in predicting viremia (area under the curve 0.823; 95%CI: 0.633, 1.000, p=0.022).
CONCLUSION: SNHL along with its fluctuation and progression are common in cCMV-infected infants. cCMV infection may induce structural changes in the central auditory pathway.
MATERIALS AND METHODS: A randomised controlled trial (RCT) study involving 111 undergraduate medical students was conducted where the competency of skills was assessed by objective structured clinical examination (OSCE) in the first, fourth and seventh/eighth weeks. A cohort of 12-14 students was enrolled for each session. The randomisation of the participants into control (VAL-based teaching) and intervention (HFS-based teaching) groups was achieved by implementing the computer-based random sequence generation method. VAL-based teaching module was a fully interactive face-to-face teaching session where a prerecorded video clip was used. The video clip detailed the diagnosis of tension pneumothorax in an acute medical emergency and its management by performing needle decompression on a high-fidelity patient simulator (METIman). HFS-based teaching module was delivered as a fully interactive hands-on training session conducted on the same METIman to demonstrate the diagnosis of tension pneumothorax in an acute medical emergency and its management by performing needle decompression. OSCE scores were compared as the denominator of learning (enhancement and retention of skills) between two groups who underwent training with either VAL-based or HFS-based teachings. The OSCE assessments were used to evaluate the participants' performance as a group. These scores were used to compare the enhancement and medium-term retention of skills between the groups. The outcome was measured with the mean and standard deviation (SD) for the total OSCE scores for skills assessments. We used General Linear Model two-way mixed ANOVA to ascertain the difference of OSCE marks over assessment time points between the control and the intervention groups. ANCOVA and two-way mixed ANOVA were used to calculate the effect size and the partial Eta squared. p value less than 0.05 was taken to be statistically significant.
RESULTS: The two-way mixed ANOVA showed no statistically significant difference in mean OSCE scores between intervention and control groups (p=0.890), although the mean score of the intervention group was better than the control group.
CONCLUSION: Our study demonstrated that HFS was not significantly effective over VAL-based education in enhancing skills and consolidating retention among undergraduate medical students. Further research is needed to determine its suitability for inclusion in the course curriculum considering the cost-effectiveness of implementing HFS that may supplement traditional teaching methods.
MATERIALS AND METHODS: This cross-sectional study is conducted at the Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) clinic of Hospital Universiti Sains Malaysia. The forward and backward translation of the OSA- 18 questionnaire into the Malay language (Malay OSA-18) was performed and tested for content and face validity. The questionnaire's internal validity and reliability were tested using Pearson's correlation, Cronbach α and inter-reliability coefficient tests. The psychometric properties (validity, reliability and reproducibility) were assessed.
RESULTS: We observed 84 patients ranging from six months up to 12 years of age. The mean age was 8 years old, and 63.1% were male patients. Among the samples, 96.4% presented with palatine tonsillar enlargement, and 84.5% presented with adenoid tonsillar enlargement. Based on the questionnaire the patient's caregiver answered, Pearson's correlation demonstrated that all the symptom scales correlate and measure the same things. The Cronbach's α coefficient value for each symptom scale was acceptable, within 0.6-0.8. The total Cronbach's α coefficient value was 0.89. The test-retest evaluation was excellent, with the value of intraclass correlation (ICC) more than 0.90.
CONCLUSION: The Malay version of the OSA-18 questionnaire is equivalent to the original English version. It is an effective tool to assess the paediatric OSA patient's symptoms and quality of life based on the obtained validity, reliability and reproducibility values. Therefore, it is recommended to be a screening tool in daily practice.
MATERIALS AND METHODS: A case-control study involving 160 children that attended six health clinics in Kuantan from August to October 2021 with a ratio of 1 case: 3 controls. Data were collected from mothers using a questionnaire consisting of sociodemographic and feeding assessment adapted from a validated World Health Organization (WHO) integrated management of childhood illness (IMCI) assessment form. The data was analysed using IBM SPSS version 26.0. Binary logistic regression analysis was used to identify factors associated with stunting. The odds ratio was used to measure the strength of the association between outcome and predictor variables. The significance value was set at p<0.05.
RESULTS: Children with identified feeding problems have more than four-time significantly higher risk of becoming stunted (Odds Ratios, OR: 4.2; 95% Confidence Intervals, 95%CI: 1.4, 12.8) as compared to children with no feeding problems. Specifically, children with inadequacy in feeding components; amount, variety and frequency of meal each have significantly six-time higher risk (OR: 6.2; 95%CI: 2.7, 14.5), four-time higher risk (OR: 4.2; 95%CI: 1.4, 12.3), and three-time higher risk (OR: 2.8; 95%CI: 1.1, 6.9), of becoming stunted as compared to children with adequate feeding. Additionally, with a decrease of one week in delivery week, one kilogram in birth weight and one centimetre in maternal height, there is a respectively significant 40.0% (OR: 0.6; 95%CI: 0.4, 0.9), 80.0% (OR: 0.2; 95%CI: 0.1, 0.7) and 11.0% (OR: 0.89; 95%CI: 0.82, 0.98) increase in the risk of become stunted among children.
CONCLUSION: Feeding problems specifically inadequate food amount, food variety and meal frequency not following the recommendation contribute to stunting in young children. Other factors identified are lower maternal height and children with lower birth weight and delivery week. This highlights the need for more excellent detection and intervention of nutritional concerns and risk factors to prevent stunting.
MATERIALS AND METHODS: We conducted a cross-sectional study of epilepsy patients from the neurology clinic, Hospital Canselor Tuanku Muhriz, Kuala Lumpur. The dental assessment included the decayed, missing and filled teeth (DMFT) criteria, as well as the plaque and periodontal status by dentists.
RESULTS: A total of 151 patients were recruited. The median age of onset of epilepsy was 16 (IQR 7-30) years, with generalised seizures at 59.6% and focal seizures in 40.4% of patients. Fair or poor oral health was present in 59 (39.1%) and gingivitis was seen in 65 (43%). The median DMFT decayed (D), missing (M) and filled teeth (FT) was 3 (IQR 1- 7). The median age of patients with fair or poor oral health was older (40 years, IQR 31-51) than the patients with excellent or good oral health (33 years, IQR 26-45), (p=0.014). Multivariate logistic regression analysis showed that carbamazepine (Odds Ratios, OR: 3.694; 95% Confidence Intervals, 95%CI: 1.314, 10.384) and hypertension (OR 6.484; 95%CI: 1.011, 41.594) are the risk factors for fair or poor oral health. Phenytoin use is 4.271 times more likely to develop gingivitis (OR 4.271; 95% CI: 1.252, 14.573).
CONCLUSION: Factors that contribute to fair or poor oral health include age, antiseizure medications like phenytoin and carbamazepine, and hypertension. Effective preventive strategies should be implemented to maintain oral health in epilepsy patients.
MATERIALS AND METHODS: Data from the National Eye Database (Malaysia) for cataract surgery performed at Hospital Taiping, Perak, between January 2019 and December 2020 were reviewed. The medical records of patients with LIG were retrieved to obtain demographic data, clinical profiles and visual outcomes.
RESULTS: Of 3233 patients who underwent cataract surgery at Hospital Taiping, Perak, between 2019 and 2020, 25 underwent emergency surgery for LIG. However, only 24 patients fulfilling the diagnostic criteria for LIG were included in the study: 14 (58.33%) patients with phacomorphic and 10 (41.6%) patients with phacolytic glaucoma. The mean age of the patients was 66±12 years. Women and men were equally affected. Most patients were Malay (75%), followed by Chinese (16.67%) and Indian (8.33%). The anterior chamber depth (ACD) was significantly shallow with a mean value of 2.72 mm. Nineteen (79.1%) patients presented with visual acuity of worse than counting fingers. The mean intraocular pressure (IOP) at presentation was 47.5±13.66mmHg, which improved to 15.08±8.09mmHg postoperatively. A best-corrected visual acuity of 6/15 and better was achieved in 20 patients (83.33%) despite glaucomatous optic neuropathy being present in 41.67% of the cases. The majority (58.3%) of surgeries were performed via extracapsular cataract extraction, while six (25%) of our patients underwent successful phacoemulsification. Seven (29.17%) patients had intraocular complications: five with zonular dialysis and two with posterior capsule rupture. Of these seven cases, four ended up with intracapsular cataract extraction, leaving two of them aphakic.
CONCLUSION: Prompt cataract surgery is paramount in all LIG cases to reduce IOP and achieve better visual outcomes. Despite the promising prognosis associated with early surgical intervention, patients should be counselled about the potential for a guarded visual prognosis from complicated surgery and its long-term complications.
MATERIALS AND METHODS: A case-control study design involving 132 subjects (88 subjects of hypertension patients for case group and 44 subjects for control group) aged 18 to 40 years old of both genders was conducted at HUSM primary care clinic and physician clinic from May 2020 to May 2021. Blood samples were collected from each of the case and control subjects and analysed for serum uric acid, urea, creatinine, total cholesterol, triglycerides, LDL and HDL on chemical analyser Architect c8000. The data were analysed by using SPSS Statistics 26.0 version.
RESULTS: The proportion of subjects with hyperuricaemia in the case group was 48.9%. A significant difference in the uric acid levels between the case group (390.64±92.65μmol/L) and control group (352.09±86.07μmol/L), (p<0.05) was observed. There was no significant difference in the serum uric acid mean ± SD based on the duration of hypertension (<5 years and ≥5 years), (p=0.331) and stages of hypertension (p>0.05). In case group, significant correlations were established between uric acid and triglycerides (r=0.255, p<0.05), uric acid and HDL (r= -0.223, p<0.05), uric acid and urea (r=0.299, p<0.05), uric acid and creatinine (r=0.486, p<0.01). No correlation among uric acid and total cholesterol levels (p>0.05), uric acid and LDL (p>0.05). Serum uric acid was a vital variable in developing hypertension (p<0.05) but not when adapted for age and body mass index (BMI) (p>0.05).
CONCLUSION: Serum uric acid was significantly elevated in essential hypertension. The significant associations were established between uric acid and triglycerides, HDL, urea and creatinine in essential hypertension. Serum uric acid was a vital variable to develop hypertension, but the association was weakened by other co-founders as age and BMI. A large-scale population-based study is required to truly conclude the association between serum uric acid levels and essential hypertension in our population.
MATERIALS AND METHODS: Parents of 30 children with ASD with ages ranging from 8 to 12 years attending Child Development Clinic, Hospital Pulau Pinang (CDC HPP) were recruited. Parents attended two-hour virtual parent sexual health training and educational materials were provided to be utilised at home. Follow-up via phone consultation were done at three and six months to ensure training was carried out. Both structured interview and Vineland adaptive behaviour scales (VABS-3) were done at recruitment and at eight months via phone consultation. Wilcoxon-signed rank test was used to analyse differences between pre- and postintervention outcome measures.
RESULTS: Statistically significant increase in number of sexual health topics taught by parents and appropriate socio-sexual behaviours of children were found. Intellectual function of children with ASD influenced the study outcomes.
CONCLUSION: Parent sexual health training can be done to empower parents to educate children with ASD and promote appropriate socio-sexual behaviours.
MATERIALS AND METHODS: This scoping review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework developed by the Joanna Briggs Institute (JBI). A total of 10 studies were identified as eligible from the title and abstract review. The mixed method quality appraisal tool (MMAT) version 2018 was used to assess the quality of the included quantitative studies.
RESULTS: The results showed that poverty, unemployment, low education levels, migrant status, community support, male gender, substance abuse, and regional disparities significantly impact the occurrence of TB LTFU in Southeast Asia.
CONCLUSION: The findings have significant implications for public health in Southeast Asia. Addressing these socioeconomic barriers through community-based strategies, educational initiatives, and policy reforms is vital for improving treatment outcomes and overall public health.
MATERIALS AND METHODS: Adjust to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020; this study met all the requirements and was up-todate. The search approach was online publications between 2013 and 2023 in Pubmed and SagePub. It was decided not to consider review pieces that had already been published and half done. The STATA 18th version was used for metaanalysis.
RESULTS: Our search results included 370 PubMed and 149 SagePub articles. Since 2013, 134 PubMed and nine SagePub articles have been obtained, and seven studies have met the criteria.
CONCLUSION: Disorders of intestinal motility in the aganglionic segment and accumulation of faeces disrupt the balanced microbiota population, which are factors of preoperative HAEC. Major congenital anomalies and low birth weight worsen pre-operative HAEC. Pre-operative HAEC can continue and affect the post-operative. Constipation and fecal incontinence are still the main challenges after HSCR surgery.