Displaying publications 1 - 20 of 393 in total

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  1. Hafizuddin Awang, Tengku Alina Tengku Ismail
    JUMMEC, 2021;24(1):15-22.
    MyJurnal
    Evidence-based recommendations on intrapartum care are important to ensure the safety of mothers and neonates. The objective of this study was to compare two established guidelines for intrapartum care to provide clinicians with more comprehensive recommendations on intrapartum management. We carried out a descriptive analysis of guidelines from the Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines published by the World Health Organization, and the Perinatal Care Manual published by the Ministry of Health Malaysia, on intrapartum care to determine differences, if any, with regards to management. Latent, active and the second phase of labour are defined differently in both guidelines. Both guidelines showed high similarity in the steps of clinical management for all phases of labour but differed in foetal monitoring methods, indications for episiotomy, mood and behavior assessment, universal precautions, pain management, and placental disposal. Both guidelines had similar managements for most of the problems encountered during the intrapartum period except for preterm labour and multiple births which have substantial differences. Malaysian guidelines highlight additional systems such as the red alert system, and referral and retrieval system, which would enhance the quality of intrapartum management. The IMPAC guidelines emphasize supportive care, birth companionship, maternal care and monitoring up to one hour after placental delivery; and home birth management; these are inadequately explained or lacking in Malaysian guidelines. From the comparison, it was seen that substantial variation exists in intrapartum management between both guidelines that indicates the need for better evidences to synthesize a more comprehensive set of guidelines for the improvement in intrapartum care.
  2. Chan, Siaw Leng, Fonny, Dameaty Hutagalung, Lau, Poh Li
    JUMMEC, 2021;24(1):1-10.
    MyJurnal
    An alarming increase in the prevalence of depression has been found among Malaysian young adults which necessitates responsiveness. This study sought to better understand the subjective personal growth experience in terms of the processes among young adults recovering from major depressive disorder (MDD). A qualitative, transcendental phenomenological design was adopted by collecting data through in-depth, semi-structured interviews, audio recordings, interview transcripts and documents. Nine Malaysian young adults with MDD (Mean age=28) who reported being in recovery from MDD for at least one year were recruited from local mental health settings through purposive sampling. Data analysis involved Colaizzi’s eight-step method. The findings revealed eight personal growth processes themes: revealing the struggles, self-discovery and personal strength, personal responsibility, readiness for change, hope, redefining the meaning, forgiveness, and acceptance. Noticeably, each theme was interconnected to facilitate personal growth among major depressive young adults. The implications for mental health psychotherapy practice and future research were discussed.
  3. Seong, Lim Ghee, Buzayan, Muaiyed Mahmoud Ali, Elkezza, Aeman
    JUMMEC, 2021;24(1):23-29.
    MyJurnal
    Introduction: Flexible denture is an alternative treatment modality for removable partial denture (RPD) that aid the retention by ensuring seal around the entire border of the denture. It is also referred as hypoallergenic denture especially for those who are allergic towards conventional acrylic denture which is the poly-methylmethacrylate monomer (PMMA) and metal (cobalt chromium). The flexible material exhibits lower flexural modulus than conventional type of baseplate material denture that makes it nearly unbreakable. Nowadays, there are a handful of different flexible materials in the dental market for the general dental practitioners to choose but somehow the studies on the properties of these different types of flexible materials are sparse.

    Objectives: The present study is to study the development of the flexible materials, the different type of flexible materials and their physical properties.

    Methods: From the limited article journals available, the authors have summarized the history, development and constituents of different type of flexible materials used in fabricating denture. Besides that, the authors also discussed about the indications, contraindications, advantages and disadvantages of the materials in denture constructions based on all the published researches available on this topic using published materials available in the dental library, University of Malaya and the databases (Science Direct, PubMed).

    Conclusion: Each flexible material has its pros and cons. Therefore, careful selection of material and understanding of the flexible dentures’ indications and contraindications are utmost importance to make sure the best treatment outcome. Hence, patients’ best interest and quality of life can be upheld.
  4. Farahnaz Amini, Hou, Wong Fu, Chye, Edmond Ng Siah, Roslina Omar, Shafinaz Mohd Rejab, Izyan Wajiha Mohd Noor, et al.
    JUMMEC, 2021;24(1):37-44.
    MyJurnal
    Background: Breast cancer (BC) is the most common cancer in women globally. In low- and middle-income countries, the use of appropriate breast cancer genetics services for screening and personalized treatments is severely lacking. This review is aimed to assess and summarize the reported mutation profiles of Malaysian BC patients.

    Methods: A literature search was performed in PubMed and Google Scholar from 2002 to 2019 using a set of keywords and MESH terms.

    Results: Data from 14 eligible studies are presented here. A total of 28 genes were studied in Malaysian BC patients in which 445 genetic alterations (229 deleterious, 209 variants with unknown clinical significance (VUC), and seven protective variants) have been reported, with 73 being novel (16% novel). The frequency ranged from 0.2% to 76% for VUC and 2.1 to 15% for deleterious variations. Only BRCA1, BRCA2, PALB2, APOBEC3B, and P53 have been associated with BC risk in Malaysian patients. Nine of these studies were conducted using the overlapped source of patients, which may limit the generalizability of the findings to the whole population of Malaysia.

    Conclusion: Information on the genetic basis of BC in the Malaysian population is scant. Multidisciplinary efforts with appropriate sample selection techniques and study design with multicenter collaboration are needed to address this issue. Out of thirteen high- and moderated-penetrance pathogenic mutations for BC, only five have been linked to Malaysians’ BC susceptibility. The findings from this review is valuable for decision-makers, researchers, and physicians, to enhance the research plans and utility of genetic services for screening and prevention.
  5. Lip, Henry Tan Chor, Huei, Tan Jih, Vellusamy, V Muthualhagi
    JUMMEC, 2021;24(1):11-14.
    MyJurnal
    In Malaysia, incidence of Wilms’ Tumor (WT) is rare, with only 8 cases reported over four years according to the Malaysia Cancer Registry Report (2012-2016). Reports of spontaneous rupture of WT are scarce and the commonest presentation of this entity is a palpable mass in the abdomen. Herein, we report on the unusual presentation of an 11-year-old boy with typical symptoms of acute appendicitis. The child was subjected to an initial open appendicectomy and diagnosed intra-operatively with a right sided ruptured renal mass. Subsequent investigation leading to the diagnosis of a ruptured Wilms’ tumor and its treatment is discussed in this case presentation.
  6. Lip, Henry Tan Chor, Huei, Tan Jih, Kannan, Ballan
    JUMMEC, 2021;24(1):50-52.
    MyJurnal
    Inferior vena cava agenesis (IVCA) is an uncommon congenital anomaly which was first described in the seventeenth century. The detection of such an anomaly is often incidental and patients are asymptomatic until the third to fourth decade of life. Due to the scarcity of these cases, there is no consensus on the subsequent treatment and surveillance of incidental asymptomatic IVC anomalies. Herein, we report on a young male with incidental findings of suprarenal IVC agenesis identified on contrast enhanced computed tomography (CT) scan of the abdomen in the course of treatment for acute appendicitis.
  7. Sundus, Ahlam, Tan, Maw Pin, Sellappans, Renukha
    JUMMEC, 2021;24(1):63-69.
    MyJurnal
    Introduction: The population of Malaysia is ageing rapidly. Due to the relatively greater incidence of noncommunicable diseases among older adults, polypharmacy is highly prevalent in this population. This polypharmacy along with other age-related factors increases the risk of drug-related problems to several folds. Currently, no study in Malaysia or even Asia has determined the type and nature of drug-related problems among non-institutionalised older adults. Therefore, this study aims to highlight common drug-related problems among community-dwelling older persons (≥ 65 years) with polypharmacy.

    Materials and Methods: A cross-sectional exploratory study was carried out where in-depth home medication reviews were carried out by two pharmacists. Participants were recruited from geriatric and fall clinics of the University of Malaya Medical Centre located in the urban area of the Federal Territory of Malaysia. The total numbers of drug-related problems were classified using the Pharmaceutical Care Network Europe (PCNE) classification V9.0. Recommendations and referral letters were provided based on the pharmaceutical care issues identified.

    Results: Thirty participants were recruited, among whom 178 drug-related problems were identified with a median value of six [range 1-11] drug-related problems per participant. The majority of problems were related to the effectiveness of prescribed treatment (69.1 %), followed by the possibility of adverse effects (28.7 %).

    Conclusion: Home medication review identifies numerous medication-related issues and allows for patient education and detailed counselling in an informal and patient-friendly manner. Future studies to determine the longitudinal effect of home medication review on patient outcome, cost implications, and overall healthcare utilization are now indicated.
  8. Bouzaboul, Mounir, Abidli, Zakaria, Amri, Abdeslam, Rabea, Ziri, Ahami, Ahmed Omar Touhami
    JUMMEC, 2021;24(1):76-82.
    MyJurnal
    Introduction: Attention is one of many cognitive functions; it plays a central role in the learning process. For this reason, our study aims to determine the impact of attentional abilities on academic performance among middle school learners in Middle Atlas of Morocco.

    Methods: Data were collected from a sample of 137 middle school learners. For the assessment of attentional abilities, we performed the Trail Making Test (TMT) to estimate mental flexibility. Evaluation of selective attention was done through the Stroop Test and the measurement of sustained attention was achieved via the d2-R test.

    Results: Our results revealed that the attentional abilities of learners in our samples are positively correlated with their academic performance and vice versa.

    Conclusion: At the end of this study, it is important to establish a thorough diagnosis of attentional disorders to identify learners with attention problems in order to implement a remedial program so as to avoid the detrimental effects of these disorders on the academic performance of learners.
  9. Nik Nadirah Nik Azis, Samihah Abdul Karim, Mariam Mohamad, Nadia Mohd Mustafah
    JUMMEC, 2021;24(1):70-75.
    MyJurnal
    Objective: The aim of this study was to investigate scuba diving induced exercise response in novice divers as required in open water scuba diving certification.

    Methods: Maximal cardiopulmonary exercise test (CPET) was performed in 30 novice divers before and within 24 hours after a standard scuba diving open water certification diving protocol of four open water dives.

    Results: A significant increase in maximal oxygen consumption (VO2max) in mL·kg-1·min-1 after scuba diving training [25.84 (6.0) vs. 27.04 (7.0)] (p
  10. Tan, Jin Rong, Dayang Azzyati Awang Dahlan
    JUMMEC, 2021;24(1):91-97.
    MyJurnal
    Introduction: Ureteric obstruction commonly presents as a urological emergency requiring urgent intervention with urinary diversion. Double J stenting (DJS) is the preferred option to relieve ureteric tract obstruction in our centre.

    Objective: Our study aims to determine the feasibility and outcomes of DJS by general surgeons and medical officers in a hospital without a resident urologist and to identify the possible predictive factors for successful DJS.

    Methods: This is a clinical audit of all patients scheduled for DJS in Hospital Bintulu, Sarawak, from January 2017 to March 2020. A total of 57 patients were included. Socio-demographic data and factors predicting success rate, i.e., level of ureteric obstruction and its causes (intrinsic or extrinsic), diagnosis, size and nature of stone(s), degree of hydronephrosis and pre-operative renal profile, were collected. Success rate and postoperative outcomes for all successful cases were evaluated. Bivariate statistical analyses were used to investigate the association of predictive factors with the success rate of DJS.

    Results: Double J stenting was successful in 63.2% (36 cases) of our total samples of 57 cases. Out of 36 successful cases, 82.1% of the cases were able to return to baseline renal profile within 14 days and 83.3% did not develop fever within 3 days post-operative. The post-operative mean length of stay was 3.16 days and post-operative day 1 mean pain score was 0.72. Causes of obstruction by intrinsic factors, urolithiasis, pre-operative normal serum creatinine (
  11. Pal, Bikramjit, Chong, Sook Vui, Thein, Aung Win, Tay, Ava Gwak Mui, Soe, Htoo Htoo Kyaw, Pal, Sudipta
    JUMMEC, 2021;24(1):83-90.
    MyJurnal
    Introduction: Medical simulation is a technique that allows interactive and immersive activity by recreating all or part of a clinical experience without exposing the patients to the antecedent risks. High-fidelity patient simulation-based teaching is an innovative and efficient method to address increasing student enrolment, faculty shortages and restricted clinical sites.

    Objective: To assess the effectiveness of high-fidelity patient simulation (HFPS) as compared to video-assisted lecture-based teaching method (VALB) among undergraduate medical students.

    Methods: The study was a Randomized Controlled Trial which involved 56 final year undergraduate medical students. The effectiveness of teaching based on HFPS (intervention group) and VALB (control group), on acquisition of knowledge, was assessed by multiple choice questions (MCQs) in the first and fourth week. Similarly, the skills competency was assessed by objective structured clinical examination (OSCE) in the second and fourth week. Mean and standard deviation (SD) for total score of knowledge and skills assessments were used as outcome measures. P value < 0.05 was considered to be statistically significant.

    Results: In both groups, students had significant higher mean MCQ scores at Post-tests. The intervention group had higher mean change score of MCQ marks than the control group but the difference was not statistically significant. In both the first and second skills assessments, mean OSCE scores for intervention group were higher than control group but this difference was not statistically significant.

    Conclusion: There was significant gain in knowledge in both methods of teaching but did not reach statistical difference in terms of skills enhancement in the intervention group as compared to the control group.
  12. Aik, Chuah Peng, Mohtaram Rabbani, Mansour Amini
    JUMMEC, 2020;23(1):1-5.
    MyJurnal
    Social anxiety is explained as noticeable anxiety or fear in one or more social situations where the individual is exposed to possible analysis by others. This research is aimed to determine the association between perfectionism and social anxiety among adolescents in Selangor, Malaysia. A final sample of 327 participants, between 13 to 18 years old, was collected. Data collection was conducted in two public secondary schools and two private high schools in Selangor. This survey included three instruments of analysis: The Child-Adolescent Perfectionism Scale, Kutcher Generalized Social Anxiety Disorder Scale for Adolescents and Demographic Questionnaire. The results showed that there is a significant positive association between perfectionism and social anxiety. This study has proved the positive association between perfectionism and social anxiety among adolescents in Selangor, Malaysia. Therefore, it is important to identify those students with these issues and guide them in an effective way to overcome the issues.
  13. Chew, Wei Zhuen, Jong,Wei Loong, Zulaikha Jamaluddin, Haiza Fasha Zakaraiah, Atiqah Kadri, Mohamad Afandi Azman, et al.
    JUMMEC, 2020;23(1):6-10.
    MyJurnal
    Background: Set-up errors are errors which are inevitable in radiotherapy. However, they should be kept to a minimum to achieve the maximum radiation dose to a tumour as to maximise treatment efficacy. This study aims to quantify those errors and assess if they remain within the tolerance limit of 5 mm in all directions. This study will also determine the adequacy of the margins for set up error for 3DCRT of rectal cancers at University of Malaya Medical Centre (UMMC).
    Methods: A total of 20 rectal cancer patients (July 2018 to May 2019) who were treated with radiotherapy amounting to a total of 119 CBCT images were included in the study. Population systematic errors and random setup errors were calculated.
    Results: Population systematic errors and random setup errors in the vertical, longitudinal and lateral direction were tabulated in Table 1. There is a large deviation (>5 mm) noted in some patients’ setup between the first 3 days and the next successive day of imaging. Clinical target volume (CTV) to planning target volume (PTV) margin were calculated using Van Herk’s margin recipe (M=2.5Σ+0.7σ). The margins were 5.0 mm, 6.2 mm, and 4.0 mm for vertical, longitudinal and lateral directions, respectively. The systematic error for the population was 1.1 mm, 0.9 mm, 0.9 mm in the vertical, longitudinal and lateral directions respectively, while the random error is 3.2 mm, 5.7 mm and 2.5 mm in the vertical, longitudinal and lateral directions respectively.
    Conclusion: All of the patients involved in the study were within tolerance limits at some point in their treatment. The results demonstrated that a larger margin is needed in the longitudinal direction. Weekly CBCT is also necessary after the initial 3-day imaging to ensure that patients are kept within the tolerance limits.
  14. Teoh, Gaik Kin, Haslee Sharil Abdullah, Lau, Poh Li, Chong, Mei Chan, Tan, Maw Pin
    JUMMEC, 2020;23(1):29-38.
    MyJurnal
    Migration is a widespread phenomenon throughout the world and it has been under way since time immemorial. While studies have focused on the causes of migration and the impact of migrants, studies focusing on the emotional experience of the left-behind older persons’ adjustments in their twilight years after the departure of their adult children, are few and far between. Thus, the perspectives of these left-behind older parents/persons are less understood. This paper aims to contribute to the literature by addressing the gap which will be filled through the experiences of left-behind Malaysian older persons. Drawing on in-depth interviews extracted from a qualitative study that focused on the strength of long-term marriages among Malaysian Chinese couples, this paper captures four older couples’ experiences that depict their feelings about their adult children’s migration. Analysis suggests that the children’s migration was induced by a lack of support and resources, followed by unequal educational opportunities. To deal with the gap left by their children, these older urban parents depend on kinship connection and community support in times of need. Government initiatives may also be able to empower the community in innovating and implementing plans which are tailored to the needs of the older parents left behind by children who have migrated. The living arrangements and recent bereavement experiences captured from the older couples can serve as cues for healthcare professionals and social support providers to assess the risks of social isolation and suicide among these left-behind older parents.
  15. Ramasandran, Gayaithiri, Yen, Khong Su, Sumaiyah Mat, Shahrul Bahyah Kamaruzzaman, Vyrn, Chin Ai, Aik, Ong Teng, et al.
    JUMMEC, 2020;23(1):18-22.
    MyJurnal
    Background: Urinary incontinence is a common problem among older women. The objective of this study was to determine the prevalence of urinary incontinence among older women aged 55 years and over in the Klang valley, the most densely populated urban area in Malaysia, and to determine any potential ethnic differences.

    Methods: This study used cross-sectional data from the Malaysian Elders Longitudinal Research (MELoR) study. A total of 863 participants were included, with a mean age of 67.97 ± 7.50 (S.D.). They were selected by simple random sampling from the electoral rolls of three parliamentary constituencies.

    Results: The prevalence of urinary incontinence was 30.8%. Mixed urinary incontinence (UI) was present in 44.7%, stress UI in 39.1% and urge UI in 16.2%. Ethnic Malays (38%) were more likely than ethnic Indians (32.3%) and Chinese (29.7%) to have UI. Ethnic Malays were also more likely to have stress UI and Indians were more likely to have urge UI .

    Conclusion: The prevalence of UI in this study was comparable to other Asian and worldwide studies. The significant association between ethnicity and UI, however, has not been reported in any previous studies. Further studies should identify factors which may determine these ethnic differences in UI.
  16. Cong, Chin Wen, Ling, Wu Shin
    JUMMEC, 2020;23(1):60-66.
    MyJurnal
    Background: In Malaysia, the prevalence of adolescents’ suicidal ideation has increased over the years. Therefore, it is crucial to investigate the predictors of suicidal ideation among adolescents. Hence, the aim of this study was to examine the predicting effects of depression and self-esteem on suicidal ideation among Malaysian adolescents. In addition, the relationships between depression, self-esteem, and adolescents’ suicidal ideation were explored as well.


    Methods: By using a multistage cluster sampling method, a cross-sectional study was conducted in secondary schools in Kuala Lumpur, Malaysia. The participants were comprised of 852 adolescents (51% males and 49% females) aged 13-17 years old who completed self-administered questionnaires. Pearson’s Correlation analysis was used to analyse the relationships among depression, self-esteem, and adolescents’ suicidal ideation, while Standard Multiple Regression analysis was used to examine the predicting effects of depression and self-esteem on adolescents’ suicidal ideation.


    Results: Depression had a positive correlation with adolescents’ suicidal ideation (r = .290, p < .001), while self-esteem had a negative correlation with adolescents’ suicidal ideation (r = -.283, p < .001). Results also showed that both depression (β = .200, p < .001) and self-esteem (β = -.186, p < .001) significantly predicted adolescents’ suicidal ideation.


    Conclusion: The study found that depression is a risk factor, while self-esteem is a protective factor of adolescents’ suicidal ideation.
  17. Gan, Syang Pyng, Yap, Sheau Huey, Ch'ng, Shereen Suyin, Hazlyna Baharuddin
    JUMMEC, 2020;23(1):23-25.
    MyJurnal
    A 71-year-old lady with rheumatoid arthritis developed painful peripheral vasculitic neuropathy of the lower limbs and was treated with high dose steroid and cyclophosphamide. Eight months later, she presented with left hip and back pain for a week, with minimal relief from regular analgesia. Although the initial pelvic radiograph was normal, a repeat film performed two weeks later showed a destructive lytic lesion in the left pubic bone, confirmed as osteomyelitis with intramuscular collection by MRI. Cloxacillin was started empirically, and when the blood culture isolated methicillin-sensitive Staphylococcus aureus (MSSA), it was planned to be given for six weeks via a peripherally inserted central catheter. Despite an initial response, she became febrile on the fifth week of antibiotic therapy. Subsequent blood culture isolated Trichosporon asahii. Her condition deteriorated, and she succumbed on the fourth day of antifungal therapy. In conclusion, the diagnosis of osteomyelitis pubis, a rare complication of MSSA bacteremia, could be delayed in an atypical presentation.
  18. Lenny Suryani Safri, Kumar, Krishna, Huei, Tan Jih, Lip, Henry Tan Chor, Rozman Zakaria, Mohamad Azim Md Idris, et al.
    JUMMEC, 2020;23(1):26-28.
    MyJurnal
    Venous malformations (VM) of vulva, perineum and pelvis are uncommon condition which may present with cutaneous varices or aesthetically disabling swelling of external genitalia. Herein, we report a young woman who presented with a large left vulva bluish tinged swelling, progressively increasing in size since birth. Computed tomography of the pelvis and lower limbs confirmed the diagnosis of extensive VM of pelvis and perineum. She underwent selective angiogram which revealed venous malformations of left vulva and gluteal region with no arterial supply to the lesion. Surgical excision was performed but complicated with bleeding which necessitate multimodal hemostatic procedures and blood transfusion. There is no recurrent swelling after 5 years follow up. Surgical excision of vulvar venous malformation offer good cosmetic outcome. However, appropriate planning with axial scan, angiogram and operative technique including multimodal hemostatic measure are important steps to achieve good result with no recurrence. We discussed on challenges on management of this case in relation to the currently available literature.
  19. Hafizuddin Awang, Md Hanif Md Arif
    JUMMEC, 2020;23(1):39-43.
    MyJurnal
    Scrub typhus is an acute febrile illness caused by the bacteria Orientia tsutsugamushi, which can be transmitted to humans through the bite of infected trombiculid chigger mites. Besides the typical clinical features of fever and eschar formation, the central nervous system has been reported to be involved as evidenced of reported cases ranging from meningitis to meningoencephalitis. Here, we describe an atypical presentation of scrub typhus case that occurred in a 34-year-old Malay male who presented with quadriplegia following an insect bite at the back of his neck. Our case displayed unusual findings of this rare condition in a non-aboriginal Malaysian population. Based on previous literature, we emphasized the importance of prompt diagnosis of scrub typhus in order to reduce the mortality and morbidity and to improve the quality of life for patients with complications of this disease.
  20. Yookarajah, Uma Devi, Lydia Abdul Latiff
    JUMMEC, 2020;23(1):11-17.
    MyJurnal
    Depression is a frequent companion of stroke. It is associated with a degree of functional impairment that might adversely affect rehabilitation. A study was carried out to determine the rate of self-reported depression at admission and after six months, and the associated factors, in patients with stroke who were referred for rehabilitation. A multiple binary logistic regression was used to determine the associated factors at six months. Depression was recorded in 45% of patients at admission and in 39% at six months after the stroke. Patients who were employed, those who were depressed at admission, those who did not return to work and those who did not return to driving six months after stroke, were significantly associated with depression.
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