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Fulltext Staggering the dose of sugammadex lowers risks for severe emergence cough: a randomized control trial

P S L, Miskan MM, Y Z C, Zaki RA

BMC Anesthesiol, 2017 Oct 11;17(1):137.
PMID: 29020936 DOI: 10.1186/s12871-017-0430-3

BACKGROUND: Cough on emergence has been reported as a common adverse reaction with sugammadex reversal. We investigated if staggering the dose of sugammadex will reduce emergence cough in a single-center, randomized, double-blinded study.
METHODS: A hundred and twenty ASA 1-3 adults were randomly reversed with 1 mg/kg sugammadex prior to extubation followed by another 1 mg/kg immediately after extubation (staggered group), single dose of 2 mg/kg sugammadex (single bolus group) or neostigmine 0.02 mg/kg with glycopyrrolate (neostigmine group).
RESULTS: We found 70% of patients (n = 28) reversed with single boluses of sugammadex had Grade 3 emergence cough compared to 12.5% (n = 5) in the staggered sugammadex group and 17.5% (n = 7) in the neostigmine group (p
Fulltext Prescribing of antihypertensive agents in public primary care clinics - is it in accordance with current evidence?

Ramli AS, Miskan M, Ng K, Ambigga D, Nafiza M, Mazapuspavina M, et al.

Malays Fam Physician, 2010;5(1):36-40.
PMID: 25606184

Large population surveys in Malaysia have consistently shown minimal improvement of blood pressure control rates over the last 10 years. Poor adherence to antihypertensive medication has been recognized as a major reason for poor control of hypertension. This study aimed to describe the prescribing pattern of antihypertensive agents in 2 public primary care clinics and assess its appropriateness in relation to current evidence and guidelines.
Fulltext Are medical students confident in taking a sexual history? An assessment on attitude and skills from an upper middle income country

Ariffin F, Chin KL, Ng C, Miskan M, Lee VK, Isa MR

BMC Res Notes, 2015;8:248.
PMID: 26082003 DOI: 10.1186/s13104-015-1220-y

BACKGROUND: Sexual history training during undergraduate education is essential for preparing future doctors to handle patients' sexual health concerns. The purpose of this study was to assess the attitudes and perceptions of final-year medical students in Malaysia toward sexual history taking and the training they receive from their medical schools.
METHODS: The study used a cross-sectional survey of 379 final-year medical students from three medical schools in Malaysia. Students were asked to rate their attitudes and perceptions regarding training on taking sexual histories using a newly developed questionnaire with good internal consistency (Cronbach's alpha = 0.73). Ethics approval was obtained from the relevant medical schools, and the statistical analysis was conducted using SPSS, Version 20.0.
RESULTS: The mean age of participants was 23.58 ± 0.65 SD. Participants reported high interest in sexual health and felt it was important for doctors to know how to take a sexual history (95%). Among the participants, only half felt comfortable in taking sexual histories from patients. The participants identified cultural and religious differences between the doctor and the patient as a potential barrier for discussing sexual health. Participants were aware of their own practice and ability, as well as their limitations, in taking sexual histories. Less than half (46%) felt that the training they received adequately prepared them to take sexual histories.
CONCLUSIONS: This study identified gaps in sexual health training among medical schools in Malaysia. The delivery of sexual health education program should incorporate confidence building and to make students feel comfortable to take sexual histories from patients. The barrier caused by differences in culture or religion between a doctor and a patient may be overcome through cross cultural and cultural competency training. This is important for multi-faith, multi cultural societies such as Malaysia and other similar countries.
Anxiety, Depression, and Fear of COVID-19 and Its Association With Psychosocial Factors Among the Employees of a Malaysian Public University During Movement Control Order

Mahmud AA, Mohamad Rom FZ, Suain Bon R, Miskan M, Haque M

Cureus, 2024 Nov;16(11):e73676.
PMID: 39559433 DOI: 10.7759/cureus.73676

BACKGROUND: This cross-sectional study among the employees of the National Defense University of Malaysia (NDUM) assessed the levels of depression, anxiety, and fear related to COVID-19 and its association with psychosocial factors. It was conducted during the strict lockdown period imposed by the Malaysian government due to the COVID-19 pandemic.
METHODS: A stratified sampling method was used, and 277 employees were randomly selected to participate in the study. Generalized anxiety disorder (GAD-7) was used to measure anxiety symptoms. Patient health questionnaire (PHQ-9) was utilized to assess depression. The fear of COVID-19 (FOC) was calculated using the Fear of COVID-19 Scale (FCV), while the psychosocial factors affecting psychological impact were measured using a self-generated questionnaire.
RESULTS: The study obtained a response rate of 46.2% (n=128). Most respondents were female, married, permanent employees, and from the non-academic group. Depressive and anxiety symptoms were reported by 47% (n=55) and 32.5% (n=38) of the respondents, respectively. Statistically, a higher level of fear related to COVID-19 was found among non-academic employees (p=0.015) and those with permanent employment status (p=0.030). Anxiety was significantly correlated with depression (r=0.70, p≤0.001), while no correlations were found between these factors and fear related to COVID-19. Taking over school lessons was the most troubling factor that affected the respondents' level of distress, followed by working from home and worrying about their family member's health.
CONCLUSIONS: This study identified significant psychological effects of the pandemic on university employees, with anxiety and depression being notably correlated. While the generalizability of the findings is limited due to a low response rate, several key psychosocial distress factors were identified. These findings emphasize the necessity of addressing psychosocial factors to mitigate the mental health impact of pandemics. Further research with a higher response rate is required to confirm these findings and to design targeted interventions to support affected employees.
Fulltext Physical Activity in Malaysia: Are We Doing Enough? Findings from the REDISCOVER Study

Nik-Nasir NM, Md-Yasin M, Ariffin F, Mat-Nasir N, Miskan M, Abu-Bakar N, et al.

Int J Environ Res Public Health, 2022 Dec 15;19(24).
PMID: 36554769 DOI: 10.3390/ijerph192416888

Physical activity (PA) in the form of structured or unstructured exercise is beneficial for health. This paper aims to study PA levels across four domains according to the International Physical Activity Questionnaire (IPAQ) and its associated factors. A total of 7479 Malaysian adult participants between 18 to 90 years old from the REDISCOVER study who completed the IPAQ were analyzed. PA was calculated as MET-min per week and were categorized according to insufficiently active, sufficiently active and very active. Multinomial regression was used to determine the association between sociodemographic, clinical factors and the level of PA. The mean age of the participants was 51.68 (±9.5 SD). The total reported physical activity in median (IQR) was 1584.0 (0-5637.3) MET-min per week. The highest total for PA was in the domestic domain which is 490 (0-2400) MET-min per week. Factors associated with sufficiently active or very active PA include Malay ethnicity, no formal education, elementary occupation, current smokers and high HDL. Whereas low income, male and normal BMI are less likely to participate in sufficiently active or very active PA. Intervention to encourage higher PA levels in all domains is important to achieve recommended PA targets.
Fulltext Depressive symptoms among adults: Baseline findings of PURE Malaysia cohort study

Mohd Tamil A, Ismail NH, Jaafar MH, Md Isa Z, Ismail R, Mat Nasir N, et al.

Heliyon, 2024 Jan 15;10(1):e23042.
PMID: 38192831 DOI: 10.1016/j.heliyon.2023.e23042

INTRODUCTION: In Malaysia, the prevalence of depression has increased from 1.8 % to 2.3 % within a decade. Thus, this study was performed to identify depressive symptoms and its associated factors among Malaysian adults.
METHODS: A cross-sectional study was conducted among the adult population aged 35-70 residing in rural and urban areas in Malaysia. Depressive symptoms were assessed using the short form Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Composite International Diagnostic Interview (CIDI) questionnaire. Logistic regression models were fitted to identify the associated factors related to depressive symptoms.
RESULTS: About 3.7 % (95 % CI: 2.33-4.83) of the respondents reported having depressive symptoms. Younger adults aged 35-40 years old (AOR: 3.087; 95 % CI: 2.021-4.717), females (AOR: 2.318; 95 % CI: 1.669-3.219), widows and divorcees (AOR: 2.294; 95 % CI: 1.085-4.848), smokers (AOR: 1.843; 95 % CI: 1.334-2.545) and alcohol consumers (AOR: 1.843; 95 % CI: 1.264-2.688) showed a higher odds compared to their other counterparts. Underweight individuals (AOR: 1.899; 95 % CI: 1.177-3.065) and those diagnosed either with hypertension (AOR: 1.442; 95 % CI: 1.11-1.873), diabetes (AOR: 1.554; 95 % CI: 1.133-2.13), angina (AOR: 2.73; 95 % CI: 1.596-4.67), COPD (AOR: 4.187; 95 % CI: 1.528-11.472) or asthma (AOR: 1.906; 95 % CI: 1.309-2.774) were more likely to have depressive symptoms. Additionally, individuals with difficulty trusting people (AOR: 1.477; 95 % CI: 1.024-2.13) and those reported to experience either home or work-related stress (AOR: 2.584; 95 % CI: 2.003-3.331) were more prone to have depressive symptoms.
CONCLUSION: In this broad population-based study, about 3.7 % (95 % CI: 2.33-4.83) of respondents reported having depressive symptoms. Timely and well targeted collaborative intervention on the identified risk factors by the relevant authorities, would mitigate their effect on the quality of life and retard the progression into depression, especially among younger adults.
Fulltext JIS definition identified more Malaysian adults with metabolic syndrome compared to the NCEP-ATP III and IDF criteria

Ramli AS, Daher AM, Nor-Ashikin MN, Mat-Nasir N, Ng KK, Miskan M, et al.

Biomed Res Int, 2013;2013:760963.
PMID: 24175300 DOI: 10.1155/2013/760963

Metabolic syndrome (MetS) is a steering force for the cardiovascular diseases epidemic in Asia. This study aimed to compare the prevalence of MetS in Malaysian adults using NCEP-ATP III, IDF, and JIS definitions, identify the demographic factors associated with MetS, and determine the level of agreement between these definitions. The analytic sample consisted of 8,836 adults aged ≥30 years recruited at baseline in 2007-2011 from the Cardiovascular Risk Prevention Study (CRisPS), an ongoing, prospective cohort study involving 18 urban and 22 rural communities in Malaysia. JIS definition gave the highest overall prevalence (43.4%) compared to NCEP-ATP III (26.5%) and IDF (37.4%), P < 0.001. Indians had significantly higher age-adjusted prevalence compared to other ethnic groups across all MetS definitions (30.1% by NCEP-ATP III, 50.8% by IDF, and 56.5% by JIS). The likelihood of having MetS amongst the rural and urban populations was similar across all definitions. A high level of agreement between the IDF and JIS was observed (Kappa index = 0.867), while there was a lower level of agreement between the IDF and NCEP-ATP III (Kappa index = 0.580). JIS definition identified more Malaysian adults with MetS and therefore should be recommended as the preferred diagnostic criterion.
Fulltext Prevalence, awareness, treatment, control and socio demographic determinants of hypertension in Malaysian adults

Abdul-Razak S, Daher AM, Ramli AS, Ariffin F, Mazapuspavina MY, Ambigga KS, et al.

BMC Public Health, 2016;16(1):351.
PMID: 27097542 DOI: 10.1186/s12889-016-3008-y

Hypertension is the leading cardiovascular risk factor globally as well as in Malaysia. This study aimed to estimate the prevalence, awareness, treatment, control and the socio demographic determinants of hypertension among Malaysian adults.
Fulltext Relationship between coping styles and lipid profile among public university staff

Ariaratnam S, Krishnapillai AD, Daher AM, Fadzil MA, Razali S, Omar SA, et al.

Lipids Health Dis, 2017 Feb 28;16(1):50.
PMID: 28245847 DOI: 10.1186/s12944-017-0438-1

BACKGROUND: The scarcity of data about coping styles with a biochemical marker namely lipid profile, potentially associated with cardiovascular risk factors is most striking among professionals working in public university. Hence, this research aimed to investigate the relationship between coping styles and lipid profile comprising total cholesterol (TC), triglyceride (TG), HDL-cholesterol (high density lipoprotein-cholesterol) and LDL-cholesterol (Low density lipoprotein-cholesterol) among this group of professionals.
METHODS: A cross sectional survey was conducted among staff from a tertiary education centre. Subjects were contacted to ascertain their medical history. A total of 320 subjects were interviewed and 195 subjects were eligible and subsequently recruited on a suitable date for taking blood and administration of the questionnaires. The subjects completed questionnaires pertaining to demographic details and coping styles. Pearson's correlation coefficient was used to measure the strength of association between lipid profile and coping styles.
RESULTS: Majority of the subjects were non-academic staff (60.0%), female (67.2%), Malay (91.8%), married (52.3%) and educated until Diploma level (34.9%). Academic staff scored significantly higher mean scores in task-oriented coping styles (Mean = 64.12). Non-academic staff scored significantly higher mean scores in emotion (Mean = 48.05) and avoidance-oriented coping styles (Mean = 57.61). Malay subjects had significantly higher mean scores in emotion (Mean = 47.14) and avoidance-oriented coping styles (Mean = 55.23). Non-malay subjects (Mean = 66.00) attained significantly higher mean scores in task-oriented coping styles. Single/divorced/widowed individuals scored significantly higher mean scores in emotion (Mean = 48.13) and avoidance-oriented coping styles (Mean = 56.86). There was a significant negative correlation between TC (r = -0.162) and LDL (r = -0.168) with avoidance-oriented coping styles (p = 0.023, p = 0.019 respectively).
CONCLUSION: Avoidance-oriented coping style was more likely to engender favourable lipid profile. Hence, assessment of coping styles would certainly assist health care practitioners in predicting subjects who would be at a greater risk of developing cardiovascular diseases.
Fulltext Study protocol of EMPOWER participatory action research (EMPOWER-PAR): a pragmatic cluster randomised controlled trial of multifaceted chronic disease management strategies to improve diabetes and hypertension outcomes in primary care

Ramli AS, Lakshmanan S, Haniff J, Selvarajah S, Tong SF, Bujang MA, et al.

BMC Fam Pract, 2014;15:151.
PMID: 25218689 DOI: 10.1186/1471-2296-15-151

Chronic disease management presents enormous challenges to the primary care workforce because of the rising epidemic of cardiovascular risk factors. The chronic care model was proven effective in improving chronic disease outcomes in developed countries, but there is little evidence of its effectiveness in developing countries. The aim of this study was to evaluate the effectiveness of the EMPOWER-PAR intervention (multifaceted chronic disease management strategies based on the chronic care model) in improving outcomes for type 2 diabetes mellitus and hypertension using readily available resources in the Malaysian public primary care setting. This paper presents the study protocol.