Displaying publications 1 - 20 of 464 in total

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  1. Ahmad Faizal S, Sidi H, Wahab S, Lenny SS, Mat Zin N, Baharuddin N
    Introduction: Marital satisfaction is vital to the wellbeing and functioning of the individual and family. Marital dissatisfaction can lead to detrimental effects on mental, physical and family health. The study aimed to determine the proportion of marital dissatisfaction in outpatient setting and its association with sexual functioning and psychiatric morbidity in Kuala Lumpur, Malaysia.
    Materials & Methods: A cross-sectional study was conducted in selected primary care using purposive sampling. Data collection was done using socio-demographic questionnaire and several validated Malay version of self-administered questionnaires. Marital satisfaction was measured by the Malay version of Golombok-Rust Inventory of Marital State (Mal-GRIMS).
    Results: The prevalence of marriage dissatisfaction in sample population was about 37.3% with almost equal prevalence in both, 36.5% (male) and 37.8% (female). Using a regression analysis, the significant factors that affect marital dissatisfaction were respondent's age group between 31- 40 years old (Adjusted Odds Ratio, AOR. =11.4, 95% Confidence Interval, CI. =1.2-110.9), spouse's salary of RM1000-RM2000 (lower income category) (AOR=7.3, 95% CI= 1.9-28.1), anxiety case (AOR= 4.8, 95% CI=1.1- 21.5), depression case (AOR= 4.8, 95% CI=1.0-22.8), female sexual dysfunction in term of arousal function (AOR= 0.01, 95% CI=0.0-0.7), satisfaction dysfunction (AOR= 9.4, 95% CI= 1.5-58) and pain function (AOR=43.7, 95% CI=1.28 - 1489.2).
    Conclusion: Marital dissatisfaction can be influenced by financial factor, sexual dysfunction and presence of psychiatric morbidity. Hence, in management of marital discord, thorough screening of these factors should be prioritized in clinical setting.
  2. Nursazila Asikin MA, Siti Norhani S, Nur Arzuar AR, Azam OE
    Introduction: Edinburgh Postpartum Depression Scale (EPDS) is a tool used to assess the risk of postpartum depression (PPD). In this study we determined the reliability and validity of the Malay version of EPDS when administered at two different time points in the postpartum period.
    Materials and Methods: This cross-sectional study design was carried out between May and September 2017 at three government primary healthcare clinics located in Batang Padang district, a suburban area of Perak state in Peninsular Malaysia. We recruited a total of 89 women; 41 women were in the early postpartum period (1-30 days) and 48 women were in the late postpartum period (31-120 days). Cronbach's alpha coefficient, inter-item correlation, and corrected item-total correlation were used to assess the internal consistency. The concurrent validity was assessed using Spearman's correlation. The data were analyzed using SPSS version 20 and R 3.4.2.
    Results: The Cronbach's alpha for the first and second group was 0.78 and 0.62, respectively, which indicated satisfactory reliability. At both time periods, removing Item 2 from the scale resulted in a significant increase in Cronbach's alpha (to 0.847 and 0.709, respectively). As expected, the EPDS scores correlated moderately with the BDI-II scores (1-30 days: Spearman's rho = 0.65, p < 0.01; 31-120 days: Spearman's rho = 0.73, p < 0.01).
    Conclusion: The Malay version of the EPDS is a reliable screening instrument for detecting postpartum depression. It showed reasonability and feasibility and can be used in postpartum clinical settings or for assessing intervention effects in research studies. Furthermore, as our results indicated, removing Item 2 from the Malay version would increase the internal consistency of the EPDS. © 2019 Default.
    Study site: Klinik Kesihatan, Perak, Malaysia
  3. Karimah Hanim, A.A., Razman, M.R., Jamalludin, A.R., Nasreen, E.H., Htike Myat Phyu, SweSwe, L., et al.
    MyJurnal
    Background: With increasing number of dengue cases in Malaysia, it’s of utmost importance that immediate
    action be taken to limit the epidemic. Since dengue control is a behavioral problem, the knowledge,
    attitude and practice in population needs to be studied in order to control the disease. Hence, the aim of
    this study is to assess knowledge, attitude and practice regarding dengue and its associated factors among
    adult residents of Felda Sungai Panching Timur (SPT), Kuantan, Pahang, 2014.

    Method: A cross sectional
    study was carried out involving 265 adult respondents. A face to face interview questionnaire which was
    divided into 2 parts (Part A: Sociodemoghraphic; Part B: Knowledge, Attitude and Practice) was used. Data
    was analyzed using descriptive statistics, simple and multiple logistic regression.

    Results: 53.2% of the
    respondents had good knowledge about dengue and it was found that the main source of information from
    mass media (76.6%). However, only 43.4% were found to have good attitude towards dengue. Multiple
    Logistic Regression analysis showed there was no association between sociodemographic characteristics with
    the level of knowledge and attitude towards dengue. There was also no association found between
    knowledge of dengue and the attitude of the respondents towards dengue. Descriptive analysis on the
    practice of dengue showed majority of the respondents who had possible breeding site for Aedes mosquitos
    (water container, drains/gutter roof/flower pots/tires) in their compound practiced good habit in
    preventing the Aedes mosquitoes from breed.

    Conclusion: Although knowledge and practice towards dengue
    is good, their attitude require improvement.
  4. Puteri Nemie, J.K., Ariff Osman, H.O., Ramizah, W.M.
    MyJurnal
    The increasing awareness amongst the society on medico-legal issues as well as the growth of consumerist
    attitude towards the provision of medical services has caused the medical profession to be subjected to
    vociferous criticism if they do not meet rising expectations of the society. Substandard services have not
    been well tolerated and paternalistic approaches in medical treatment are considered to be outmoded and
    inappropriate. Any dissatisfaction on the part of the patient towards medical services provided nowadays
    may easily trigger claims in the court of law. This changing trend has also fundamentally changed the
    behaviour of the courts towards the medical profession. Judicial and legislative interventions in medical
    practice have created more and more rights for the patients and consequently, corresponding legal duties
    for the medical profession to uphold. In the present healthcare setting, the medical profession will not be
    able to provide infallible services without knowledge of the legal standards which they have to adhere.
    Thus, educating future medical professionals with the fundamentals of law and ethics would ensure greater
    accountability, knowledge and personal commitment in providing medical services to the society as the
    ideals of professionalism not only require them to have the necessary expertise, dedication, respect,
    compassion, empathy, honesty, altruism, responsibility, integrity, self-improvement and accountability but
    also adherence to the demands of law and highest ethical standards.
  5. Ismail, K., Ghazali@Suhaimi, S.S., Abu Bakar, N., Mokhtar, K.I., Kharuddin, A.F.
    MyJurnal
    Introduction: Malocclusion is one of the most common dental problems observed. Limited data is currently
    available regarding the demographics of malocclusion observed locally.

    Materials And Methods: This is a
    retrospective study where 770 patients were recruited from May 2009 till December 2014. 560 orthodontic
    study models that met the inclusion criteria were examined and the malocclusions were classified according
    to the British Standard Institute (BSI) incisor classification. Demographic pattern and their relationship were
    analysed by structural equation modelling using SPSS (version 23.0).

    Results: From 560 study models
    analysed, 72% were female. The age of the patients ranges from 7-12 years old (17.1%), 13-17 years old
    (55.9%) and >18 years old (27.0%). Majority of the patients were Malay followed by Chinese (5.7%), Indian
    (1.8%) and other races (1.8%) Treatments received were fixed appliances (FA) (60.0%), removable appliances
    (RA) (12.5%), functional appliances (FnA) (1.1%), combination of RA and FA (16.1%), combination of FnA and
    FA (2.1%) and consultation (8.2%). Types of malocclusions observed were Class I (25.7%), Class II/1(32.7%),
    Class II/2 (7.5%) and Class III (34.1%). There was significant association (p
  6. Suhaily, M.H., Ismail, A.A., Najib, M.Y.
    MyJurnal
    Introduction: Dyslipidaemia is one of the risk factors contributing to the pathogenesis of cardiovascular
    diseases (CVDs). This study was conducted to investigate the effect of wet cupping on lipid profile.

    Methods: This randomized controlled trial was conducted in 2012 at the School of Medical Sciences,
    Universiti Sains Malaysia, Malaysia. Sixty-two healthy volunteers ranging from 30 to 60 years old were
    randomized into control and intervention groups. Subjects in the intervention group were assigned to two
    sessions of wet cupping at the beginning of the study and at the third month; individuals in the control group
    did not undergo any cupping procedure. Venous blood sample was collected for serum lipid profile: Total
    Cholesterol (TC), High Density Lipoprotein Cholesterol (HDL-C), Low Density Lipoprotein Cholesterol (LDL-C),
    and triglycerides; measured at baseline, first, third and fourth month.

    Results: Subjects in the cupping
    group had significant improvements from baseline to third and fourth month for TC (MD=-0.56, P=0.004),
    HDL-C (MD=-0.22, P
  7. Loo, L.Y., Mawaddah, A., Shahrul, H., Khairullah, A.
    MyJurnal
    The upper airway is a crucial structure. It becomes a grave problem should it be narrowed. Several methods
    of treatment were rendered for patients with laryngotracheal stenosis. We share our experience with the
    combination total intravenous anaesthesia and apneic pause technique with or without steroid injection.
    Four cases of laryngotracheal stenosis were observed in Hospital Ampang: two adult and two paediatric
    cases. Age, gender, causative factor, stenosis segment length, grade or severity were observed before and
    after dilatation, number of dilatation were observed and compared. The outcome measures are
    decannulation and avoidance of tracheostomy. All cases had improvement of symptoms. Half or 50% of the
    patient required repeated balloon dilatations. The paediatric cases successfully avoided tracheostomy while
    the adult cases successfully decannulated with no complication from the procedure. Balloon dilatation by
    total intravenous anaesthesia coupled with apneic method is a safe and effective method of treatment for
    the narrowed airway.
  8. Saidi S
    MyJurnal
    Introduction: A survey in 2011 reported that the prevalence of diabetes in Malaysia is 20.8% (2.8 million people) and 88% have uncontrolled diabetes. Diabetic foot ulcer (DFU) is one of the common diabetes complications in Malaysia that leads to other devastated situation including infection, amputation and death. In Pahang, 95% of the patients have uncontrolled diabetes and 50% of them suffered from DFU. Self-wound management is an important element in reducing the risk of further complications of DFU. However, little is known on the patients' understanding of diabetes and their practice of self wound management. This study aimed to understand the knowledge, attitude and practice of self-wound management among patients with diabetic ulcer in Pahang.
    Materials and method: A quantitative, cross-sectional study was conducted in a tertiary hospital in Pahang involving 100 participants. Participants were recruited using purposive sampling from April 2017 until May 2017. Participants' knowledge, attitude and practice of self-wound management were measured using self-administered questionnaires. Additionally, the data on socio-demographic was gathered. The data was computed into SPSS and analyzed using descriptive and inferential statistics.
    Results: Out of 100 participants, 95% of them had good knowledge on diabetes and DFU, 84% had a positive attitude towards self-wound management and 56% perceived good practices of self-wound management. However, a chi-square test between knowledge on diabetes and DFU and practice of self-wound management found no significant interaction (p > 0.05). Meanwhile, there was a significant interaction between attitude and practice of self-wound management (p < 0.05).
    Conclusion: Good knowledge on diabetes and DFU do not determine the patients’ practice of self-wound management. However, positive attitude towards self-wound management would contribute to the practice and willingness of the patients to selfmanage their foot ulcer wound at home.
  9. Nour El Huda Abd Rahim, Mohd Nabil Fikri Rahim, Norsidah Ku Zaifah, Hanisah Mohd Noor, Kartini Abdullah, Norlelawati A. Talib
    MyJurnal
    The dopamine hypothesis has earlier dominated the theories for the
    development of schizophrenia based on the early pharmacologic evidence. The
    antipsychotic drugs, among others, is thought to interfere with the function of the
    dopamine D2 receptor (DRD2) resulting in clinical improvement. Accumulating evidence
    suggest the role of epigenetic mechanisms in the pathophysiology of schizophrenia.
    Despite this, specific evidence linking the DRD2 DNA methylation with schizophrenia is
    insufficient mainly due to the poor accessibility and limited brain samples. Of late, new
    data has suggested the global impact of DNA methylation in the development of
    schizophrenia, thus methylation in the peripheral blood could infer changes in the brain.
    The aim of this study was to assess the DRD2 DNA methylation in the peripheral blood of
    schizophrenia.
  10. Masnizahani Jamil, Radiah Abdul Ghani, Adzly Hairee Sahabudin, How, Fiona Ni Fong
    MyJurnal
    Over accumulation of polyamines is one of the causes of cancer because
    polyamines could promote the cancer cells growth. Due to the lack of specificity and
    increased reports of side effects in the current cancer treatment, one of the strategies
    to overcome the challenges is by utilizing polyamines as vectors of known cytotoxic
    compounds to target the cancer cells. Therefore, this study was aimed to investigate
    the cytotoxicity effect of Spermidine Sulphur Analogues Type 1 and Type 2 (SSA-1 and
    SSA-2) against human lung adenocarcinoma cells (A549), human colorectal
    adenocarcinoma cells (HCT-8) and human breast adenocarcinoma cell (MCF-7). (Copied from article).
  11. Aisyah Mohamed Rehan, Mohammad Izwan Enche Othman, Nor Munirah Mohd Amin, Intan Azura Shahdan, Hanani Ahmad Yusof@Hanafi
    MyJurnal
    Streptococcus pneumoniae (S. pneumoniae) is a gram-positive diplococci belonging to the genus Streptococcus and it is a well-studied pathogenic bacterium. Pneumococcal diseases such as otitis media, pneumonia, sepsis and meningitis caused by pathogenic strains of S. pneumoniae still brought significant mortality and morbidity worldwide. The pathogenicity of S. pneumoniae is exerted by various virulence factors and one of it is the enzyme hyaluronate lyase. Hyaluronate lyase plays a major role in
    the invasive capability of S. pneumoniae. Its mechanism of action and crystallographic
    structure have been determinedbut its regulatory mechanism is still poorly understood.
    Drawing connections between the nutritional behaviour and invasive property of S.
    pneumoniae, CodY regulator is hypothesized as a potential hyaluronate lyase regulator.
    This work was aimed to construct CodY deficient mutant of S. pneumoniae to form
    foundational work for the study of CodY regulatory effect on hyaluronate lyase.
  12. Azrina Md Ralib, Iqbalmunawwir Ab Rashid, Nur Aisyah Ishak, Suhaila Nanyan, Nur Fariza Ramly, Mohd Basri Mat Nor
    MyJurnal
    Plasma Cystatin C (CysC) is as an early functional marker for acute kidney
    injury. Estimates of glomerular filtration rate using CysC (eGFRCysC) has been used in
    some clinical setting. We evaluated the utility of CysC and eGFRCysC in diagnosing acute
    kidney injury (AKI) and predicting death in critically ill patients with sepsis. (Copied from article).
  13. Iqbal Jamaludin, Mohd Zulfaezal Che Azemin, Abdul Halim Sapuan, Radhiana Hassan
    MyJurnal
    The brain is the most complex organ in the human body. Robust and vigorous daily activities may cause changes to the brain structure. Huffaz, individuals who memorise the Quran undergo intensive memorization training which may lead to structural changes in specific regions of the brain.
  14. Norsuhana Halim, Radiah Abdul Ghani, Adzly Hairee Sahabudin, How, Fiona Ni Fong
    MyJurnal
    Cancer is one of the global health problems that has a detrimental effect
    to a person's life. However, chemotherapeutic agents success are subject to the side
    effects due to lack of specificity in the drug delivery system to cancer cells and an
    increase risk of systemic toxicity to the normal cells. Polyamine transport system (PTS)
    is one of the potential pathways for transporting anticancer agent into specific cancer
    cells. This is due to the upregulation of PTS in cancer cells compared to normal cells for
    the proliferation activity. The aim of this study was to investigate the cytotoxicity effect
    of putrescine-sulphur analogues type 1 (PSA-1) and type 2 (PSA-2) on human lung
    adenocarcinoma cells (A549), human colorectal adenocarcinoma cells (HCT-8) and
    human breast adenocarcinoma cell (MCF-7).
  15. Aszrin A, Azarisman SM, Jamaluddin RA, Tariq RA, Noriah NM
    Introduction: Prehypertension precedes overt hypertension and has been acknowledged by many guidelines. Hypertension is an important risk factor for cardiovascular disease in Malaysia. Hypertension prevalence is at 42.6% and population-based control is poor at 26.8%. The objective of the study is to ascertain the cardiovascular risk profile of prehypertensive and mildly hypertensive young adults against age-matched controls in rural Malaysia. Methods: 484 (four hundred and eighty four) subjects attending primary care clinic were screened. 91 (Ninety one) young adults with pre/mild hypertension and normotensive, agematched controls were enrolled. The blood pressure and biochemical profiles for both groups were assessed and compared. Results: Fifty-four subjects and 37 controls were enrolled. Amongst subjects, 46.3% had prehypertension and 53.7% had mild hypertension. Mean values compared to age-matched controls for MAP were 102.68 ± 7.48 vs 83.25 ± 6.08 mmHg (p< 0.001), LDL 3.75 ± 0.95 vs 3.32 ± 0.93 mmol/L (p=0.03), FBG 4.65 ± 0.54 vs 4.33 ± 0.42 mmol/L (p=0.03), BMI 28.81 ± 5.16 vs 24.12 ± 4.91 (p< 0.001). The mean BP was significantly associated with BMI, FBG, triglycerides, HDL and the TC/HDL ratio. Conclusions: Greater BMI, FBG, HDL, triglyceride levels and TC/HDL ratio characterised the young adults with pre/mild hypertension. The data suggests that hypertension in young adults is secondary to metabolic syndrome. © 2018, International Islamic University Malaysia.
  16. Haydar, A.
    MyJurnal
    Candida organisms are opportunistic fungal pathogens that have become a major cause of nosocomial infections worldwide. We investigated the clinical characteristics and outcomes of hospitalized patients with candidaemia caused by Candida albicans and non-albicans Candida spp at HUSM. Materials and Methods: We retrospectively evaluated all hospitalized patients with candidaemia from January 2010 till December 2014 based on inpatient hospital records and laboratory data. Results: A total of 134 patients with candidaemia were enrolled. Candida albicans and non-albicans Candida spp were responsible for 20% (27/134) and 80% (107/134) of candidaemia cases, respectively. Hospitalized patients with diabetes mellitus, surgical conditions, or concomitant septicaemia and those who received instrumentations such as CVC or CBD, and those admitted under medical settings were prone to develop candidaemia caused by either C. albicans or non-albicans Candida spp. All isolates were susceptible to Fluconazole except for C. krusei isolates. All-cause mortality within 30 days post diagnosis of candidaemia was 59%. Factors associated with mortality were solid tumor (p =0.014), surgical illness (p=0.128), central venous catheterization (p= 0.096) and leucocytosis (p=0.116). Only solid tumor was an independent contributory factor for mortality among patients with C. albicans candidaemia in the multivariate analyses (OR 5.09, 95% CI 1.38,18.74, p=0.014). Conclusions: The patients’ clinical characteristics were fairly comparable between Candida albicans and non-albicans candidaemia. The changing epidemiology of candidaemia at this centre was in fact alarming. The outcome associated with candidaemia was poor.
  17. Che Nor Zarida Che Seman, Zamzuri Zakaria
    MyJurnal
    Critical size defects (CSD) in the long bones of New Zealand White rabbits (Oryctolagus cuniculus) have been used for years as an experimental model for investigation of the effectiveness of a new bone substitute material. There are varieties of protocols available in the literature. This technical note attempts to present an alternative surgical technique of a CSD in the New Zealand white rabbit tibia. Methods: Thirty-nine New Zealand White rabbits were used in this study. A CSD of approximately 4.5 mm (width) X 9.0 mm (length) was surgically drilled at the proximal tibial metaphysis, approximately 1 cm from the knee joint. The surrounding of soft tissue was repositioned and sutured layer by layer with bioabsorbable surgical suture. Two x-rays of anteroposterior and lateral were taken before assessed under computed tomography scan at 6, 12 and 24 weeks. Results: This alternative method created CSD with less bleeding from the muscle observed. No mortality or other surgical complications observed within 6 weeks, 12 weeks and 24 weeks following surgery. Conclusion: A simple and safe method for performing CSD was demonstrated and recommended as an alternative approach for surgery on New Zealand White rabbits.
  18. Mohd Nor NA, Repen MC, Zakaria Z, Ab-Murat N, Saub R, Abdul Razak I
    MyJurnal
    This study assesses dental students’ and patients’ perceptions on the role of dental students as smoking cessation counsellors as well as the patient’s quit rate at the University of XX. Materials and methods: Self-administered questionnaires were distributed to all senior dental students (n=154) in XX University and telephone call interviews were conducted on their patients (n=169) who received smoking cessation counselling from September 2010 to June 2013. Results: Response rates for dental students and patients were 68.2% and 67.3% respectively. Most of the dental students in this study were females (72.3%) whereas the majority of patients were males (97.6%). An average of six months follow up indicated that 22.5% of patients had quit smoking, 65.3% reduced the number of cigarettes smoked and 6.5% had relapsed. About a third of patients surveyed (33.1%) believed that smoking cessation counselling was extremely helpful compared to what students perceived (5.7%, p
  19. Ranjit, S., Carol, P., Kellie, C., Pauline, M., Renuka, S.
    MyJurnal
    Objective: The aim of this study is to evaluate the outcome of pregnancy in prenatal and postnatal period of pregnancy complicated with thick nuchal translucency but normal karyotype. Methods: This is a retrospective study of 119 singleton pregnancies with increased NT (NT > 2.5mm) but a normal karyotype over a 3 year period. The records of ultrasound at 18-20 and 25-26 weeks’, antenatal and postnatal details were reviewed. The developmental and health outcomes of the surviving children were obtained through telephone conversation with the family. Adverse outcome such as miscarriages, termination of pregnancy, intrauterine death, structural anomalies and neurodevelopment delay were analysed. Results: Out of 119 foetuses with increased NT but normal karyotype, 11.8% of pregnancies ended with miscarriages, termination of pregnancy and intrauterine death. 89.9% foetuses were structurally normal. 12.9% presented with structural anomalies in the second-trimester ultrasound scan. 81.8% showed major malformations, out of which 44% consisted of heart defects. 1% of foetuses were syndromic and 1.9% had developmental delay. 96.8% of foetuses with NT equal to or greater than the 95th percentile (3.4mm) and 80% with NT equal to or greater than the 99 percentile (5.5mm) had a normal outcome. 50% of foetuses with thickened nuchal fold had a poor outcome. Postnatal follow-up was established for all infants and toddlers, and abnormalities were observed in 5.6% of them. Chances of having a live and healthy infant decreases with increased NT, corresponding to 80% for NT equal to or greater than 5.5mm. Conclusion: We have provided data that may help in the counselling of parents and increasing their confidence on a favourable pregnancy outcome. In cases with increased nuchal translucency but normal karyotype, the chances of normal pregnancy success rate is 89.9%. Parents can be reassured that thickened nuchal translucency with a normal karyotype and normal targeted ultrasound between 20-22 weeks gestation, the risk of adverse perinatal outcome and postnatal developmental delay is not increased in comparison with that of the general population. This seems to be the case for all degrees of increased nuchal translucency.
  20. Draman, S., Maliya, S., Farhan, A., Syazwan, S., Nur ‘Atikah A., Abd Aziz, K.H.
    MyJurnal
    Introduction: Mak nyahs (male-to-female transgenders) often consume feminizing hormones to achieve and maintain the female physical appearance. They do it without professional prescription/advise, and often take excessive doses. This renders them at risk of developing complications of hormone consumption. This paper provides some quantitative data on hormone consumption among mak nyahs in Kuantan, Pahang, in Malaysia. Materials and Methods: A cross-sectional study was carried out from July to August in 2015 among 35 mak nyahs. Convenience sampling was used. Participants who gave consent answered an interview-guided questionnaire which documents socio-demographic profile, hormone usage, and morbidities as a result of hormone consumption. Data was analysed using SPSS, Version 16.0. (version 16). Results: Majority of the subjects were Malays (91.4%) and Muslims (97.1%), their median (IQR) age being 31 (±17) years, more than half (57.1%) were between 20 to 40 years old. Most (80.0%) of them are sex workers. Oral hormone was most commonly used (88.6%), while more than half (67.7%) of them added hormone injections. Almost all subjects purchased hormones over the counter from local pharmacies (94.2%). However, many received information on hormone from non-professional sources. Possible adverse effects of hormones reported among subjects were hypertension, ischemic heart disease, diabetes mellitus, and venous thrombo-embolism. Conclusion: Hormone consumption was very common among the subjects in this study, and may be associated with certain medical problems. Medical personnel must pay more attention in educating the mak nyahs on adverse effects of hormones consumption. Mak nyahs should also be screened for complications every time they seek medical attention.
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