Scimitar syndrome is a rare congenital heart defect occurring in 1 to 3 per 100,000 live births. This is a case of a 26 years old lady presenting with episodic fainting spells since the age of 18 years old. She was initially diagnosed with epilepsy until a referral to our centre found a soft splitting of the second heart sound and multiple premature ventricular complexes on ECG. The computed tomography of the pulmonary artery confirmed the diagnosis if Scim- itar syndrome in the presence of anomalous single right pulmonary vein draining into infra-diaphragmatic systemic venous circulation. A corrective open-heart surgery to re-implant the pulmonary vein was performed with excellent clinical outcomes. Therefore, it is crucial for clinicians to embody high index of suspicion of congenital anomaly even in adults presenting with indefinite clinical symptoms. This report also represents the first published case of adult Scimitar syndrome from Malaysia.
Subclinical hypothyroidism (SHT) is a biochemical diagnosis, defined as an elevated Thyroid Stimulating Hormone (TSH) with normal free thyroxine (FT4). It affects 4-10% of the adult population and is more prevalent in elderly women. Its commonest cause is autoimmune thyroiditis, detected by anti- thyroid peroxidase antibody (TPO-Ab). About 2-5% of SHT patients progress to overt hypothyroidism annually. The SHT prevalence among depressed patients ranges between 3% and 17%. This study aimed to determine the prevalence of SHT and TPO-Ab positivity among patients diagnosed with depressive disorders. It was a cross-sectional study carried out in the Universiti Kebangsaan Malaysia Medical Centre over a 12 months period. Serum TSH, FT4 and TPO-Ab were measured. Results showed that 82% of depressed patients were euthyroid, 4% had SHT, 11% had subclinical hyperthyroidism and 2% had discordant thyroid function. TPO-Ab positivity among the subjects was 7%, one of whom had SHT. In conclusion, the prevalence of SHT and TPO-Ab positivity in the study population, at 4% and 7%, respectively, were comparable to previous findings.
With advancement in genetic studies, familial phaeochromocytoma (PCC) and paraganglioma (PGL)
are increasingly being recognized. Characteristically, correlations exist between genotypes and clinical
and biochemical phenotypes. We report a phaeochromocytoma in a young patient with intriguing family
histories, raising the possibility of his being a familial case.
Introduction: Diabetes Mellitus (DM), characterised by chronic
hyperglycaemia, exposes patients to acute and chronic
complications, such as hypoglycaemia and vascular
complications, respectively. The latter is associated with the
degree of glycaemic control. Glycated haemoglobin (HbA1c)
indicates long-term glycaemic control of the preceding 2-3
months. The practice of self-monitoring blood glucose (SMBG)
is essential for insulin-treated diabetic patients to achieve
optimum glycaemic control and prevent hypoglycaemia. Aim:
The study aimed to determine the SMBG practice and frequency
and its association with HbA1c and factors in insulin-treated
diabetic patients. Methods: This was a cross-sectional study of
insulin-treated diabetic patients attending follow-up at the
diabetic clinic of Hospital Serdang from April 2015 to August
2015. Consented eligible patients completed validated selfadministered
questionnaires. Patients’ HbA1c results were
obtained from the hospital information system. Results: Ninetyone
of 137 (66%) patients practiced SMBG and 46 (34%) did
not. Although 82% had seen diabetic nurses, 54% of patients did
not alter their treatment accordingly. Neither the practice nor the
frequency of SMBG was significantly associated with
differences in HbA1c levels (p=0.334 and p=0.116 respectively).
Ethnicity and household income significantly affected SMBG
practice. The presence and frequency of hypoglycaemia
significantly increased the likelihood of SMBG practice
(p
Free light chains (FLCs) are tumour markers of monoclonal gammopathies. Detection of urinary FLC or also known as Bence-Jones protein through urinary protein and its immunofixation electrophoreses (UPE and uIFE, respectively) have been considered the gold standard for its biochemical diagnosis. This is mainly due to their superior detection limits compared to their counterpart investigations in serum. However, urinalysis is limited in many ways. The emergence of serum FLC assay with markedly improved detection limit circumvents many of these problems and has gained much importance in biochemical investigations of monoclonal gammopathies. Nevertheless, they are not without limitations. This review discusses the advantages and limitations of serum and urinary FLC assays.
Malaria and dengue are among the most important public health threats in Malaysia. These two-arthropod borne diseases have overlapping mosquito biotopes and clinical manifestations, and co-infections have been associated with increased severity notably on the haematological abnormalities. Dengue caused by four dengue virus (DENV) serotypes has been highly endemic in Malaysia. However, malaria due to Plasmodium ovale (P. ovale) has been rarely reported among Malaysian population. Nonetheless, climate change and increased influx of international travellers and migrants have shifted the parasite boundaries to non-endemic countries. Thus, diagnosis and management of imported malarial infections should rely on the geographical knowledge on the origin of potential Plasmodium species, prompt laboratory testing and public health intervention. Moreover, it would be difficult to clinically differentiate dengue fever (DF) with a potential relapse or partially treat- ed case of P. ovale, and there is absolutely no transmission of this Plasmodium species in our country. Hence, we believed that this case deserved to be reported.
Poor mental health can affect a person’s quality of life and well-being, impacting cognitive, emotional, social, and physical functioning. Mental health difficulties have been found commonly in parents of children with autism spec- trum disorder (ASD), who often struggle to cope with a range of challenges. These parents tend to have reduced over- all wellbeing. This review study targeted an under-researched area, aiming to review mental health studies on the coping strategies used by Muslim parents of children with ASD in Malaysia, focusing on psychospiritual strategies. Journal articles were searched via Google Scholar, Science Direct, and Mendeley software online databases using relevant keywords. This narrative review identified 5 studies that examined parental coping, but only 4 reported the inclusion of Muslims. This review identified a gap in published knowledge regarding coping from a spiritual per- spective in Muslim families of children with ASD in Malaysia and recommended future research from a biopsycho- social-spiritual perspective.
Protein kinases (PKs) are regulators of protein phosphorylation in many infectious diseases, including malaria. How- ever, the cellular functions of majority of PKs in Plasmodium falciparum remain unknown. The mechanisms involved in P. falciparum cell cycle progress are not fully understood. The activation of cyclin-dependent kinases (CDKs), which constitute a PK family that includes crucial regulators of cell cycle progression in eukaryotes, is strictly being coordinated by the interaction with specific cyclins at well-defined points within the cell cycle. These cyclin/CDK complexes are very well characterised in humans, but little is known in P. falciparum. This review expand our un- derstanding of the characteristic of CDKs and cyclins in P. falciparum, and paves the way for further investigations on the precise molecular role of these crucial regulatory proteins in mosquito and human. This represents a valuable step towards the elucidation of cell cycle control mechanisms in malaria parasites.
Introduction: Rapid ongoing industrialisation particularly in developing countries has triggered an
increased risk of occupational noise-related disease occurrence. Machinery and work tasks in metal fabrication
processes may produce high noise levels that can be harmful to hearing. This study aimed to investigate the
workers’ exposure to noise at a fabrication plant and their perceptions toward hearing loss symptoms and its association.
Methods: This study was conducted at a Heating, Ventilating and Air Conditioning fabrication plant in Johor.
With a 31% response rate, 50 respondents who were selected using purposive sampling answered a
questionnaire regarding demographic background, noise exposure and perceived hearing loss symptoms. Noise
measurements were also conducted among 30 of them based on the concept of sampling the maximum
risky workers. The noise was measured using a sound level meter IEC 60651 Class 2. Minimum (Lmin)
and maximum (Lmax) sound pressure levels were measured for 5-minute and repeated for three exposure
periods (morning, afternoon, evening). Results: 68% and 32% of the workers were 20-30 years old and had
been employed for 3-5 years, respectively. Average noise exposure level observed was 63.3-101.5 dBA. 25%
of the workers reported that they were sometimes experienced the symptoms of hearing loss. These include
difficulty in understanding conversation and ringing in the ear. However, noise exposure and hearing loss
symptoms were not significantly associated. Conclusion: The study findings suggest that the workers have a risk
of developing hearing loss. Intervention programme and enforcement on hearing protection of the workforce
are highly recommended.
Introduction: The Hedgehog (Hh) signalling pathway is a developmental signalling pathway involved in normal mammalian developmental and homeostasis of adult renewable tissues. In most adult tissues, this pathway remains silent and previous studies have shown that constitutive activation of Hedgehog signalling pathway leads to various types of malignancies including medulloblastomas, basal cell carcinoma, gastrointestinal, breast and prostate cancer. The purpose of this study was to investigate the immunohistochemical expression of Hedgehog pathway proteins in Diffuse Large B-cell Lymphoma and determine their association with overall survival (OS). Methods: Positive control using normal tonsils were included in each batch of immunohistochemical staining procedure. Results: PTCH1 proteins were highly expressed in DLBCL and showed strong staining intensity in 107 (100%) cases and SMO proteins were expressed in 105 (98.1%) cases. PTCH1 proteins were localised in the nucleus of tumour cells, whereas SMO proteins were mainly localised in the cytoplasm of tumour cells. Positive expression of PTCH1 and SMO proteins and overall survival of DLBCL patients were correlated with age, gender, race and tumour location. There was no significant correlation between the expression of these two proteins with any of the parameters. PTCH1 expression showed significant association with SMO expression (P=0.03). Conclusions: Our findings suggest that high expression of both PTCH1 and SMO may be important in the pathogenesis of DLBCL. However, additional mechanisms that may contribute to the activation of HH signalling in DLBCL needs to be further explored.
Introduction: Previous studies have found that unwed pregnant teenagers have a variety of psychological issues such as loss of self-confidence, emotional stress, fear, worry, anxiety, depression, and suicidal thoughts. In addition, the society’s negative perception has made these teenagers to be alienated and mocked by the community and also by their own family members. Thus, this research aims to identify the mental health state and also to deeply explore on these teenagers’ emotional and psychological conditions. Methods: This research adopts qualitative phenomeno- logical research design. Four residents of a Protection Centre in Johor Bahru have been selected through purposive sampling method. Semi-structured interviews were conducted and the data has been transcribed and analysed using thematic content analysis method. Results: Results obtained show that the teenagers’ mental health symptoms are at moderate to severe states. They also show signs of emotional disturbance such as depression, seclusion, difficulty in sleeping, lips dry, easy to sweat, uncontrolled emotion, no appetite, headache, anxiety or worry, negative thoughts and not energetic. Apart from these, they also experience unstable emotional and psychological situations such as sadness, anger, fear, shock, stress and guilt due to shaming their families. Conclusion: This study is expected to pro- vide an early explanation on mental health among Muslim unwed pregnant teenagers. Therefore, the appropriate methods to use in addressing their emotional and psychological states need to be explored.
Introduction: The demand for commercial gluten-free food products are increasing due to rising prevalence of lifestyle-related diseases. The market growth is forecasted to increase in numbers. However, to date nutritional com- parison of gluten-free and gluten-containing food products is not done extensively in Malaysia. Therefore, this study aimed to investigate the nutritional composition and cost per 100 g between gluten-free and gluten-containing food products in selected grocery stores in Kuala Lumpur. Methods: A total of 106 food products comprising of gluten-free food products (n=41) and gluten-containing food products (n=65) were determined and compared for its nutritional composition and cost per 100 g. The products were obtained from 4 main grocery stores in Kuala Lumpur that supply gluten-free food products. The differences in nutritional composition and cost between both products were analysed by using independent samples t-test. Results: The results showed no difference in energy content between both prod- ucts. Across the food products, 15 % of gluten-free food products showed higher carbohydrate content compared to its counterparts. Protein content in gluten-free products was 63 % lower than gluten-containing products. Among all gluten-free food products included in this study, only lasagne sheet has lower content of dietary fibre compared to its counterparts. The cost for majority of gluten-free food products was significantly higher, which was two- to four- fold higher compared to gluten-containing products. Conclusion: This study indicated that gluten-free food products showed no nutritional advantage especially in its macronutrients, hence, avoidance of gluten for healthy population may not be beneficial and rather costly.
Introduction: Female Genital Cutting (FGC) is a sensitive issue as this topic is always associated with religion and culture in Malaysia. In the past, FGC is performed by the traditional midwives. However, this practice has been med-icalized nowadays. This study aimed to understand the reasons of performing FGC, the decision making, the practice and the future of FGC among rural community in Northern Malaysia. Methods: Focus group discussions (FGD) were conducted on three groups of young women aged 18-45, older women aged 45 and above and a group of married adult men. All of them were Malay Muslims who were conveniently selected from a rural village in Northern Malay-sia. A semi-structured interview guide was used to conduct the FGD focusing on the reasons, decision making, the practice and the future of FGC. Data was collected until saturation of information was achieved. These participants were chosen based on their willingness to take part in the discussion and also based on their personality of being talkative and able to give feedback to the questions. Results: The result of the interviews revealed that religion is the reason of practicing FGC. All of the participants from each FGD prefer to go to the doctor in the clinic compared to the traditional midwives. The men in this FGD mentioned that they rarely involved in the decision making of the FGC and only the mother or the grandmother to take the responsibility to decide. Conclusion: Generally, majority Malay Muslims community from the rural areas in Northern Malaysia believed that FGC is compulsory in Islam and they prefer to go to the doctors to perform FGC.
Introduction: Based on World Health Organization (WHO) incidence of musculoskeletal diseases is estimated to reach 60.4% of all occupational illness. Research conducted in the UK and Hongkong on nurses reported lower stage pain of 38% and 39% and some neck pain 34% and 31% respectively. Musculoskeletal disorders are basically complaints of pain in parts of our body that include muscles, joints, ligaments, skeletons, and nerves. Work posture is one of the factors that influence the increase in musculoskeletal disorders. The objective of the research is to identify correlation between posture at job with musculoskeletal disorders complaints in the emergency department among nurses. Methods: The Method of the research was a quantitative research using cross sectional methods with Spear- men Rho correlation statistic test and the sampling method used total sampling. The sample size in this study was 40 nurses in the Emergency Department. Data collection was conducted by using Nordic Body Maps questionnaire to assess Musculoskeletal Disorder and posture of job assessment was carried out by Rapid Entire Body Assessment (REBA). Results: The results from this study showed that half of respondents (50%) were 26-30 years old, more than half (67%) of respondents are male, more than half (60%) have very high risks due to posture of job, and more than half (55%) had heavy complaints. Conclusion: There was a correlation between job posture with musculoskeletal disorders.
Introduction: Evaluation of mental health literacy is important in assisting the development of intervention and policies toward preventing mental health problems. This study aims to explore mental health literacy and its socio- demographic predictors in a group of housewives living in low-cost apartments in Selangor, Malaysia. Methods: A Malay version of the self-administered Mental Health Literacy Scale (MHLS) was used in this cross-sectional study. Age, ethnicity, religion, educational level and family income were tested using one-way ANOVA and independent t-test. Result: A total of 103 eligible respondents participated in the study. Most respondents were from the age group of 30 and above, from the Malay ethnic group, Muslims, had formal education up to secondary level with a monthly family income below RM4000 (USD980). The overall mean (sd) mental health literacy score was low 106.65 (11.21) and was significantly associated with ethnicity, religion, educational level and family income (p>0.05). Conclusion: Mental health literacy scores were low and showed variations within sociodemographic groups.
Introduction: cAMP Response Element Binding (CREB) and Brain Derived Neurotrophic Factor (BDNF) protein levels tend to be a critical mediator for the beneficial effects of diet on neurogenesis and cognitive function. Increased fruit intake has been associated with improved cognitive function. However, in Malaysia, most adolescents still haven't met the recommended intake of fruits and far less is known on how their adequacy of fruit intake can be affected to their protein levels of CREB and BDNF. Methods: A cross sectional study was done on 352 students aged 14 and 16 years old involving 11 secondary schools in Kuala Terengganu, Marang and Hulu Terengganu Districts. A validated MyUM adolescent FFQ was used for fruit intake assessment. Blood sample to determine the level of CREB and BDNF proteins. Results: A total of 53.7% of adolescents consumed an adequate intake ( 2 servings/day) of fruits. Serum level BDNF was significantly (p
Introduction: Nutritional requirements increase during lactation. However, maternal dietary intakes of Malaysian
mothers are subjected to restrictions commonly included in traditional postpartum practices. This study aimed to
assess the maternal dietary intake status during the recommended six month exclusive breastfeeding (part of which
included the traditional confinement) period. Methods: Thirty-two Malay mothers aged 18-35 years, who had delivered full-term (at ≥37 weeks) singleton babies and were exclusively breastfeeding, were included in the study.
Maternal dietary intake was assessed using multiple-pass diet recall on Days 10, 30, 60, 90, 120, 150, and 180,
postpartum. The average total energy and macronutrient intakes were compared against recommended values. Results: The findings of this study demonstrated that maternal intakes of total energy ranged from 1,500-2,000kcal/day,
carbohydrate 189-272g/day, protein 58-72g/day, and total fat 32-70g/day. Total calorie intake was the lowest during
confinement period (Days 10 and 30) compared to the rest of the exclusive breastfeeding period. This is similar with
total fat consumption. On the other hand, protein intake was the highest during confinement period whereas carbohydrate intake was consistent throughout the six-month period. Despite the increased requirements, intakes of total
calories, protein, total fat, dietary fibre, and water, did not meet the recommended values throughout the exclusive
breastfeeding period. Conclusion: Mothers’ inability to fulfil their nutritional requirements during exclusive breastfeeding period may be associated with traditional postpartum dietary practices. Dietary advice with consideration
for cultural food taboos practiced by local mothers during confinement may help to improve maternal nutritional
intakes during this crucial time.
Leptospirosis is an infectious and zoonotic disease caused by pathogenic bacteria called leptospires which can be transmitted through the exposure to the urine or excretion of infected animals, and also water or soil that being contaminated with secretion of the infected animals. Leptospirosis remains a concern in Malaysia, as the number of cases had steadily increased. This study aims to determine the knowledge, attitude and practice (KAP) among final year students of selected programmes in Universiti Putra Malaysia (UPM). Methods: A cross sectional study was conducted among students of Environmental and Occupational Health (ENVOCH) (57 students), Nursing (22 students) and Veterinary Medicine (97 students). Thus, the total sample sizes were 170, however the response rate were 81.76%. Questionnaire was used as the study instrumentation. Results: There was a significant association between race and knowledge, also gender and attitude with p
Introduction: This study reported the concentration of bacterial and fungal bioaerosol at an animal house and hospi- tal laboratories with the aim to compare the concentration levels at library and administrative offices. The bioaerosol levels between mid-shift (afternoon) were also compared to the concentration measured during pre-shift (morning). Methods: The NIOSH 0800 method utilising microbiological air sampler collecting airborne bacterial and fungal samples via impaction technique on Nutrient agar (NA) and Sabouraud Dextrouse agar (SDA) as culture medium, respectively. Sampling was done twice daily; before (pre-shift) and during working (mid-shift) hour. Results: The highest bacteria and fungi concentration was recorded at the animal house with median concentration of 2477 CFU/ m3 (IQR=121-2477) and 791 CFU/m3 (IQR = 379-2081), respectively. Higher-risked workplaces such as animal house and hospital laboratories have significantly higher bioaerosol concentrations compared to control workplaces such as library and administrative offices (p
Introduction: Child abuse is an epidemic and in Malaysia, the numbers are rising. Statistic showed that 60% of the victims were below seven years old. Since most of them goes to preschool at this age, the role of childcare providers (CPs) in addressing this issue is crucial. However, previous data showed that referrals made by them to the author-ities was less than 1%. The objective of this study was to determine the knowledge and attitude of CPs in KEMAS preschools towards child abuse. Methods: This is a cross-sectional study involving CPs working in the KEMAS pre-schools in Kota Bharu and Tumpat, Kelantan, Malaysia, from April to June 2019. Results: From 218 respondents, 78% and 83% of them had good awareness on signs of neglect and physical abuse respectively compared to sexual abuse (64.6%). In terms of knowledge, 80% answered correctly about signs of abuse. However, only 18.8% an-swered correctly about sexual abuse. Moreover, 86.7% of CPs believed that they should be responsible to lodge a report, while only 6% of them objected. Although 76.1% were correct about the information to be prepared for reporting, only 4.6% of them realised that suspicions about a case would suffice to lodge a report. There were 94.5%, and 65.1% of CPs who correctly answered about the protection of the reporter under the law and its penalty respectively. But, only 26.6% of the CPs were correct about the category of mandated reporters according to the law. Conclusion: Although majority of CPs had good knowledge and awareness, there was still 26.6% who did not realise that they were mandated to report suspected cases. Therefore, educational programs need to be planned to increase awareness and knowledge on abuse and its legal aspects among CPs.