Women with gestational diabetes mellitus (GDM) during their pregnancy have a greater risk of developing overt diabetes mellitus and dysglycemia (prediabetes, impaired glucose tolerance or impaired fasting glucose) later in future, compared to mothers with normal pregnancy. Postpartum screening is crucial for early identification of type 2 diabetes (T2DM) in women with GDM. Nevertheless, despite various strategies, its rate remains low. A systematic review using databases of PubMed/Medline, Science Direct and CINAHL from 2008 to 2018, was conducted to iden- tify the factors influencing the attendance of postpartum diabetes screening. Open access English articles, focusing on observational studies were reviewed. Primary screening of titles and abstracts of 91 articles were done, secondary screening of 31 articles resulted in 6 articles, included in this manuscript. Various factors identified to be associated with the attendance to postpartum diabetes screening, which are age, education, ethnicity, some obstetric factors like multiparty, and history of insulin usage previously. Many women fail to be screened for diabetes during the postpar- tum period, and this delays T2DM diagnosis, which in turn gives rise to various complications. Further research that considers these factors is necessary for developing interventions to improve postpartum T2DM screening for mothers with GDM during their pregnancy.
Utilization is an important indicator for health service planning and can be determined through the count of actual usage of health services. There are also several determinants to health care utilization. This systematic review aims to explore the technical components from spatial analysis in primary health care utilization, the determinants frequently discussed, and the gap in the spatial analysis from these studies. Two databases were searched according to search strategy. A total of 15 articles were eligible. Each study was different in terms of analysis unit, spatial analysis, and utilization outcome. Spatial accessibility, sociodemographic, and geographical aspect were the frequent determi- nants discussed among the study of spatial utilization in this review. Several studies found the association between the determinants with utilization. However, spatial analysis in primary health care utilization studies still subjected to several limitation in term of their unit of analysis and source of data.
Introduction: Exposure of PM2.5 and PM10 released from combustion of biomass activity caused respiratory health among children. Objective: This study aims to determine the association between exposure of PM2.5 and PM10 with DNA damage in primary school children living nearby palm oil combustion activity at Semenyih. Methods: A cross sectional comparative study were conducted among Malay primary school children in school A located 2.7km from palm oil activity (N=82) and school B located about 40km away from the palm oil area (N=85). A standardized ques- tionnaire were distributed to respondent’s parents. Concentrations of PM2.5 and PM10 were measured by using Dust Trak DRX Aerosol Monitor Model 8534 and Escort LC Personal Sampling Pump. Measurement of indoor and outdoor air pollutants were conducted in schools and home. Buccal cells were collected, which then followed by micronu- cleus assay. Results: Concentration of PM10 and PM2.5 at home of studied group were significantly higher compared to comparative group with p value (p=0.007) and (p=0.018) respectively. PM10 and PM2.5 of studied schools were significantly higher compared to comparative schools with p value (p=0.014) and (p=0.04) respectively. MN fre- quencies of studied group were significantly higher compared to comparative group (p=0.001). Significant difference of respiratory symptoms were found between two groups which are cough, phlegm, wheezing and chest tightness (p=0.001). There were significant correlation between PM10 with MN frequency of studied group and comparative group with r= 0.562; p=0.001. Conclusion: This study indicated that the exposure of PM10 and PM2.5 would increase the risk of having respiratory health symptoms and might induce the micronuclei formation among children who lived near palm oil activity area.
Introduction: Malaysian traffic police are always working on the public roads to alleviate traffic congestion and therefore exposed them to the polluted air every day. In particular, polluted air containing PM2.5 is dangerous to their respiratory health as they can penetrate deep into the lungs, leading to bronchitis, lung cancer and many more. Hence, this research examined the relationship of personal exposure level to PM2.5 with respiratory symptoms among traffic policemen in Kuala Lumpur and Johor Bahru. Methods: 134 participants among traffic policemen were agreed to participate in this study. They were requested to complete a questionnaire regarding the sociodemographic back- ground and respiratory health information. The questionnaire was adopted from International Union Against Tuber- culosis Lung Diseases (1986). Personal exposure level of PM2.5 was measured using an air pump with 5.0µm pore size PVC filter. Results: The mean exposure level of PM2.5 among traffic policemen was 28.69 µg/m3. It was found that some of them possess respiratory symptoms (Coughing 33.6%, Phlegm 25.4%, Wheezing 14.9% and Shortness of breath 32.1%). There was significant association detected at p-value < 0.05 in coughing. Despite, there was no significant association in other symptoms such as phlegm, wheezing and shortness of breath. Conclusions: Traffic police were exposed to a relatively high level of PM2.5 (12.4 µg/m3 to 55.3 µg/m3) and showed symptoms of respi- ratory effects. Therefore, recognition of the risks connected with occupational lung disease and exposure monitoring must be a high priority. This baseline data can serve as a reference to the top management of traffic police officers in order to develop an occupational safety and health guideline for police officers as required by Occupational Safety and Health Act (OSHA, Act 514 1994).
Introduction: School environment represents an important microenvironment for students who spend 6-8 hours in classrooms. Indoor air quality is linked to several respiratory diseases in the school age group. This research aims to study indoor air quality of schools at different environmental characteristic and assess its health risks to students. Methods: This research measured air quality (PM2.5, PM10, CO2 , and HCHO) in three junior high schools and followed by health risk assessment. Results: This research found that the mean or median level of indoor PM2.5 and PM10 in all three schools exceeded the standard value with health risks (HQ> 1) for PM2.5 in all three schools and PM10 in two schools. Whereas carbon dioxide and formaldehyde concentrations were still safe and did not inflict health risks (HQ < 1). The scenario for managing the health risk of PM2.5 and PM10 exposure was to control the exposure at a safe threshold of PM2.5 0.035 mg/m3 ; 0.043 mg/m3 and PM10 0.144 mg/m3 for most of the population at normal school time. Conclusion: It was concluded that the level of indoor particulate matters indicates poor indoor air quality in all three schools at different environmental characteristic and inflicts health risk on students so that the health risk management is required.
Introduction: The increased use of mobile phones has increased the mobile base stations (MBS) deployment. While understanding of radiation protection is growing among the public, questions regarding early-life exposure to ra- diofrequency radiation (RFR) from MBS in children are of importance as to whether it will raise the chances of developing chronic diseases during adulthood. Taking into account the sitting location of MBS, the purpose of this study is to evaluate the chromosomal DNA damage in buccal mucosal cells between school children exposed to RFR emitted from base station antennas. Method: This is a comparative cross-sectional study in which two group of school children were sampled i.e. exposed groups are children whose school located near MBS (200 meters); un- exposed groups are children whose school located distant far from the MBS (>200 meters). Digital RF Analyzer was used to measure RFR at the school surrounding. Buccal mucosa cells from the oral cavity were sampled to examine the level of micronuclei (MN) frequencies. Results: This study found that the densities of the RFR energy differed in range. Although all measurements showed the RFR reading below the acceptable exposure level, there were still sig- nificant variations at each location assessed. Statistically, the MN frequency is significantly different when compared to the exposed and non-exposed group. Conclusion: To understand the mechanism of health effects from exposure to low-level RFR emited from MBS, further study should consider environmental factors influencing MBS sitting on RFR emission, as well as examining the health effects into molecular levels.
Introduction: One of the most common aetiology of opportunistic fungal infections in humans is Candida species. The virulence of Candida species is due to repertoire of factors, specifically, the ability to form biofilms. Medical devices such as intravenous catheters, prosthetic heart valves and surgical interventions provide pathogenic microorganisms with a surface to adhere to form biofilm. Fungi present as biofilms are often resistant to antifungal treatment because these biofilms offer a protective barrier that prohibits the drugs to get to the active site of the fungi. The objective of this study is to investigate the biofilm architecture of Candida rugosa (C.rugosa) at different developmental phases and to identify Sessile Minimum Inhibition Concentrations (SMICs) of amphotericin B, caspofungin, fluconazole, and voriconazole for the biofilm of C. rugosa. Methods: Confocal scanning laser microscopy (CSLM) and scanning electron microscopy (SEM) were used to visualize C. rugosa biofilms at different developmental phases. The antifungal susceptibility test was performed using serial doubling dilution. The growth kinetics of Candida biofilms was quantified using XTT reduction assay and crystal violet assay. Results: From the antifungal susceptibility test, the biofilms had SMIC of >16μg/mL for amphotericin B, 6µg/mL for caspofungin, >64μg/mL for fluconazole and >16μg/ mL for voriconazole. From the SEM micrographs, C. rugosa biofilm have a structure composed of an adherent yeast cells and blastopores with hyphal elements. There were significant alterations in the morphology after exposure to antifungal agents. The quantitative measurement of the matrix thickness of embedded yeast cells were obtained from CLSM micrographs. Conclusion: In conclusion, the ability of C. rugosa to form biofilms may attribute to one of the virulence factors that causes reduced susceptibility to antifungal agents.
Introduction: The incidence of antimicrobial resistance (AMR) has increased worldwide including Malaysia, which may be attributed partly to inappropriate prescribing of antimicrobials. Antimicrobial prescribing form has been introduced to mandate appropriate antimicrobial prescription including documented indication as a key standard of antimicrobial stewardship practice. Hence, this current study aimed to determine the usage and completeness of the designated antimicrobial prescribing form that had been implemented in the General Intensive Care Unit (GICU), Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Methods: This prospective observational study was carried out in GICU UKMMC from 30 August 2018 to 30 November 2018 by convenience sampling. The information that was recorded in the antimicrobial prescribing form was collected by using the designated data collection form. A total of 68 patients were included and 205 antimicrobial prescribing forms were evaluated. Results: There were 100% usage of antimicrobial prescribing forms found in this study. However, only 81 ± 8 % of these forms were completely filled. Indication for the antimicrobial prescription was not filled in 47% of the forms. Almost two thirds of the antimicrobial prescriptions were empirically indicated and one percent de-escalation of antimicrobial therapy was filled in the forms. These prescriptions comprised of 91.7% antibiotics, 7.8% antifungals and 0.5% antivirals. The suspected site of infections were primarily from the lungs (27%), gastrointestinal (16%), blood (16%) and central nervous system (14%). Piperacillin/Tazobactam was the most frequent antibiotic prescribed (21%), followed by third and fourth generation cephalosporins (20%). Conclusion: This study provided an overview of the uptake of the antimicrobial prescribing form implementation and highlighted the requirement for supplementary efforts to maximize the compliance of this form.
Introduction: Polymyxins are used as the “last-line therapy” for multi drug resistant (MDR) Gram-negative bacterial infections. However, the development of nephrotoxicity is a major concern. The objectives of this study were to determine the incidence and severity of acute kidney injury (AKI) and to identify risk factors associated with AKI and mortality rate in Malaysian patients on polymyxin B (PMB) for MDR Gram-negative bacterial infections. Methods: A retrospective study was conducted in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Medical and
medication charts were reviewed for all intensive care unit (ICU) patients who received intravenous (IV) PMB from 1st May 2008 to 1st May 2018. Simple and multiple logistic regression were performed to identify risk factors of PMB induced nephrotoxicity. Results: Among the total 572 patients identified, only 31 patients were eligible to be included. The incidence rate of AKI was 45.2% (14 of 31 patients). Univariate analysis showed that age was a significant risk factor of PMB associated nephrotoxicity [OR 1.074; 95% CI 1.002-1.151; P=0.045]. Other four variables (P
Introduction: Polymyxin B (PMB) is one of the remaining antibiotics that is effective against multidrug resistant (MDR) Gram-negative bacteria. However, PMB monotherapy is not able to achieve sustained killing hence, combination with other antibiotics are usually employed. Besides antibiotics, studies are now moving towards non-antibiotic alternatives such as metabolite feeding against MDR pathogens. This study aimed to investigate the susceptibility
and bacterial killing of PMB in combination with metabolite phenylpyruvate against Klebsiella pneumoniae isolates. Methods: Broth microdilution was used to determine PMB minimum inhibitory concentration (MIC) alone and with phenylpyruvate against two Klebsiella pneumoniae isolates. Time kill studies were performed over 24 h (initial inoculum: ~106 CFU/mL), using PMB 2 mg/L and phenylpyruvate 2 mmol/L, alone and in combination, against the
PMB-resistant isolate. Microbiological responses were examined using the log-change method. Results: The MIC of PMB was reduced by phenylpyruvate in both isolates. In the time kill studies, during the first hour, PMB monotherapy demonstrated the highest bacterial killing activity even compared to the combination. Phenylpyruvate monotherapy showed negligible activity against K. pneumoniae. A significant reduction in bacterial burden was seen at 1 h following PMB monotherapy and combination therapy but an equally rapid regrowth was seen at 4 h. Notably at 24 h, the regrowth following combination therapy was >1-log10 CFU/mL less than PMB monotherapy. Conclusion: Our results suggest that phenylpyruvate increased PMB susceptibility in K. pneumoniae and may minimise the emergence of resistance to PMB. Future studies investigating phenylpyruvate at higher concentrations against more isolates are
warranted.
Introduction: The spread of multidrug-resistant malaria parasite – Plasmodium sp. to commercially available antimalarial drugs, i.e. artemisinin-based combination therapies (ACTs) and chloroquine (CQ), has become a global treat to eliminate malaria. To limit the impact of antimalarial drug resistance, a new potent and affordable alternative is urgently needed. A number of metal-based compounds (metallodrugs) have been found active against Plasmodium falciparum, the species that causes potentially fatal cerebral malaria, as they are ease in ligand grafting of multi-functional groups. Ferroquine (FQ) is one of the metalloantimalarial drugs that is currently undergoing clinical trials. Methods: In this study, a series of ternary copper(II) and zinc(II) complexes – Cu(phen)(edda) 1, Zn(phen)(edda) 2, [Cu(phen)(cdmg)] NO3 3 and [Zn(phen)(c-dmg)]NO3 4 were synthesized and characterized by the following tests: Fourier transformed infrared (FTIR), CHN elemental analysis, UV-Vis spectroscopy, molar conductivity and magnetic susceptibility measurements. Results: In vitro hemolytic and antimalarial assays using SYBR Green I dye were done to determine the biological properties of these complexes. Preliminary biological evaluation demonstrated that all the complexes 1, 2, 3 and 4 exhibit toxicity against the sensitive blood-stage Plasmodium falciparum 3D7 with IC50 in μM range. Conclusion: Thus, metal complex is a potentially viable candidate as antimalarial drug to overcome the emergence of drug resistance.
Introduction:Alcohol is a major factor that can affect many aspects of life. The prevalence of current drinker in Malaysia aged 13 years old and above was 7.7% as reported by NHMS 2015. Sabah was ranked the third in highest consumption of alcohol in Malaysia, at 18.4% after Kuala Lumpur 20.3% and Sarawak 19.7%. The aim of the study is to investigate prevalence of different types of drinkers and identify demographic characteristic of drinkers in Kota Kinabalu (KK). This study also aims to investigate the effectiveness of screening and brief intervention in reduction of alcohol consumption and risky drinking in KK. Methods: A cross-sectional study was done where the data were col-lected from seven different areas in KK, selected by stratified and simple randomized sampling. Alcohol Use Disorder Identification Test (AUDIT) questionnaire translated and validated in Malay version by Unit Terjemahan Universiti Malaya was used. AUDIT score was calculated and brief intervention was given accordingly and scoring was then repeated after three months. The intervention applied was based on Guideline on Risk Assessment and Primary In-tervention in Alcohol Harm, published by Ministry of Health Malaysia in 2010. Results: The age range of population studied is from 13 to 85 years old with 243 males and 230 females. Out of the 473 participants, 13.1% adolescent, 37.6% young adulthood, 36.4% middle adulthood and 12.9% in late adulthood. We observed that the male mean weight was 68.27±12.72kg versus 58.86±12.45kg mean weight in female. The prevalence of drinkers – 3.6% depen-dent drinkers, 22.2% high risk drinkers, 36.2% low risk drinker while the remaining 38.1% are abstainers. Majority of consumers were practicing low-risk drinking pattern which highlighted the need for prevention and harm minimiza-tion programme. Paired sample t-test shows that the decrease in AUDIT three months after intervention is statistically significant. Conclusion: This study conducted in KK suggests that screening coupled with brief intervention can help reduce alcohol misuse and risky drinking and should be practiced in all primary healthcare facilities.
Introduction: Strongyloidiasis is endemic in the tropical and subtropical regions. Clinical manifestations of the dis-ease can range from asymptomatic eosinophilia in an immunocompetent host to a wide range of presentations in immunocompromised patients. Failure to consider the diagnosis of strongyloides infection, especially Strongyloides hyperinfection syndrome, is a major contributor of high mortality rate in such cases. Case Description: We report a case of 60 years old gentleman who was admitted to Sarawak General Hospital for a left subtrochanteric femur pathological fracture and the diagnosis of multiple myeloma was made in the same setting. He was started on treat-ment for multiple myeloma which includes high dose steroids. During his course of admission, he was diagnosed with hospital-acquired pneumonia was subsequently initiated with broad-spectrum antibiotics. Despite being exten-sively treated with multiple courses of broad-spectrum antibiotics, he deteriorated clinically, with eventual respirato-ry failure requiring ventilator support and ICU admission. A diagnosis of strongyloides hyperinfection syndrome was made after an incidental discovery of larvae in his sputum, which was later confirmed with stool sample. He was given a one-week course of albendazole 400mg twice daily and clinical improvement was observed. A repeated stool sample also demonstrated clearance of the parasites. Conclusion: This case highlights the need for clinical sus-picion of strongyloides hyperinfection syndrome in cases of unresolved pneumonia, especially for patients with risk factors of underlying immune-deficiency state. Preventive steps such early detection and eradication of strongyloides infection should be undertaken prior to initiation of immuno-suppressive therapy.
Introduction: Elimination of viral hepatitis as a major public health threat by 2030 was announced by the Global Health Sector Strategy (GHSS) on viral hepatitis in 2016. Hepatitis C is one of the major causes of liver cirrhosis and liver cancer. Complications as a results of hepatitis C infection can be prevented as hepatitis C infection is now con-sidered as a curable disease with the availability of Direct Acting Agents (DAAs). However, the main barrier towards treating and curing all HCV infected patients is a high cost of DAAs. The treatment regime of hepatitis C infection in Malaysia is sofosbuvir and daclastavir, an NS5A inhibitor. Daclastavir was reported as inherently resistant to HCV GT 3. Thus, this study aimed to develop an assay to detect the resistance associated substitution (RAS) towards the NS5A inhibitor among HCV GT 3 infected patients. Methods: Samples for the study were obtained from various hospitals in Malaysia. The samples were collected from DAAs naïve HCV GT 3 infected patients. From the literature review, a specific assay was chosen with different sets of primers were selected for the study. The DNA sequences of NS5A region of HCV genome were submitted to the geno2pheno [HCV] resistance database by Max Planck Institut (MPI) Informatics to yield RAS. Results: Suitable primers were identified based on generated amplicons produced for the samples which NS5A region were successfully sequenced. Results were obtained based on the 213 codon generated from the population based Sanger sequencing. RAS/ RASs towards Daclastavir were produced and the susceptibility result towards the drug was generated. Conclusion: The assay was successfully optimised and able to generate drug resistance results towards Daclastavir which might have impacts on the duration of treatment and/or inclusion of ribavirin in managing HCV infected patients in Malaysia.
Introduction:Obesity or overweight and its consequences are important public health problems globally resulting in a significant cause of morbidity such as hypertension, Diabetes Mellitus, hypercholesterolaemia, coronary artery disease, stroke, sleep apnoea, cancers and mortality which also render distressing financial burden on everyone. It is imperative to intervene in momentous strategies for early detection to prevent the weight-related epidemic. Methods:It was a health survey conducted in June 2019 to detect the prevalence of obesity and overweight problems and the resultant detrimental health conditions among the year 1 and year 2 medical students of the University Malaysia Sa-bah. The survey was done on 145 students aged between 19-23 years. The height, weight, BMI, waist circumference, blood pressure and capillary random blood glucose were measured. Pearson correlation and Chi-square tests were done to find an association between BMI and probable factors using SPSS. Results: The prevalence of obesity was 8.2%. High blood pressure was recorded in 23.45% participants where both systolic and diastolic blood pressure was high in 18.6%, only systolic blood pressure was high in 37.2% and only diastolic blood pressure was high in 28.3% among 145 students. There was no impaired glucose tolerance among the participants. There was a positive correlation between BMI and systolic (r=0.518, p
Introduction: Artemether and lumefantrine was registered as Riamet in Switzerland in 1999 and is commonly used in Keningau Hospital for managing uncomplicated malaria. Riamet works at the food vacoule of the malarial parasite, where they interfere with the conversion of heme into haemozoin. Case description: We report a case of Riamet induced prolonged corrected QT interval (QTc) in a 37 year old gentleman admitted for severe malaria (hypotension) with normal QTc of 420msc on presentation. Upon starting Riamet, he developed bradycardia and ECG showed sinus bradycardia with prolonged QTc of 551msec and no arrythmias. Echocardiography showed no structural heart abnormalities. All electrolytes were within normal range. He was monitored in cardiac care unit with decision to complete 6 doses of Riamet. Patient was started on Dopamine infusion which maintained his blood pressure and heart rate within normal range. 5 days post Riamet completion, his heart rate improved and dopamine infusion was tapered off and QTc normalized to 407msc. Discussion: The most common mechanism of drugs causing QT inter-val prolongation is by blocking the human ether-à-go-go related gene (hERG) potassium channel. Blockage of the hEGR channel lengthens ventricular re-polarization and duration of ventricular action potential which is reflected in ECG as prolonged QT interval. In the in-vitro whole cell patch clamp study, lumefantrine and its metabolite desbu-tyl-lumefantrine showed a concentration-dependent inhibition of the hERG current. The period of QTc prolongation was 3.5 to 4 days after the last dose of the standard 6 dose regimen. Conclusion: Riamet induced prolonged QTc is a very rare complication. A baseline electrocardiography is therefore imminent for every patient prior to initiation of this medication to avoid cardiac arrythmias.
Introduction: Dengue is caused by dengue virus (DENV) which is a member of the genus Flavivirus of the family Flaviviridae. The prevalence of dengue has been increasing all over the world especially in Southeast Asia and Western Pacific regions. In 2016 - 2017 dengue outbreaks were reported in Sandakan and Kudat of Sabah, Malay-sia. The aim of this study was to determine the serotypes of dengue viruses circulating in these two sites during the outbreaks. Methods: A total of 200 dengue patients’ sera tested positive with NS1 and IgM & IgG rapid test (PanBio) were collected from Hospital Duchess of Kent Sandakan and Hospital Kudat between June 2016 and December 2017. PCR was done at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah. One-Step Reverse transcriptase PCR (RT-PCR) and nested PCR was performed using C-prM amplimers designed by Lanciotti et al and later redesigned by Chien et al, followed by sequencing some of the PCR products. Results: Out of 200 sera tested 128 were PCR positive. All the four dengue serotypes were detected with PCR products with specific sizes in gel electrophoresis. However, in four samples, no serotype-specific band was amplified by the nested PCR, while they were dengue-positive in RT-PCR showing 511 base pair amplicon. Sequencing results revealed all four samples were found to belong to DENV4. The sequences of these samples were aligned with that of DENV 4 reverse primer rTS4. The DENV4 specific primer rTS4 was found to have four mismatched nucleotides to the DENV4 sequences. Conclusion: There was a co-circulation of DENV1 to 4 in Sandakan and Kudat in the study period. DENV1 was the predominant serotype. DENV4 specific C-prM primer rTS4 should be redesigned for the local DENV4 strain in Sabah in future research.
Introduction: Global health awareness is sorely lacking in medical curricula and the general public, leading to increasing apathy and decreased levels of volunteerism. Much knowledge about pertinent global health issues is sequestered with academicians and researchers, with little public trickle down. The aim of the study was to increase awareness among Sabahan public about global health issues and promote discussion. Methods: A global health film club was established at community level and discussions about issues and potential individual action points was conducted. Films were screened every month in both UMS and Palliative Care Center Sabah. Global health issues ranging from First World manipulation of HIV/AIDS medication prices, deregulation of medical devices industries, heroin addiction, ADHD drug abuse, and stigma in psychiatry were covered. Public participants’ responses were collected qualitatively. Results: The films largely were well received by participants, with most participants prefer-ring the expose-type films over the more narrative approaches. Films spurred discussion about how foreign or global issues were related to local level, for example unscrupulous sale of medical devices in Malaysian populations and abuse of sleeping medications from local health providers. Also each film screening vastly increased participants’ awareness of pertinent issues, and spurred them to evangelise about said issues to others and take small actions. Conclusion: Global health is a somewhat neglected part of medical and community curricula. Lack of awareness about global health issues reduces the public’s capacity for collective action in exerting pressure on stakeholders, governments, and civil society in taking action. It is hoped such regular global health film screenings at local level brings literacy on urgent public health issues to the people for whom it matters most – the communities where ad-verse global health consequences eventually arise.
Introduction: Rectal schwannoma is a rare gastrointestinal mesenchymal tumour with only a few numbers of cases has been reported. It is predominant in the stomach and small bowel, but uncommon in the colon and rectum. Case description: A 74-year-old man presented with features masquerading as low rectal malignancy with a malignant looking pedunculated polyp measuring 10 x 8 cm on colonoscopy. Punch biopsy revealed a diagnosis of benign tumour of schwannoma. After failure of multiple attempts of endoscopic resection, a decision of transanal excision was made. The histopathological assessment was consistent with the preoperative diagnosis and supported by immu-nohistochemistry of S-100 protein. His postoperative recovery was uneventful as he was discharged on the following day. There is no evidence of tumour recurrence on follow up. Conclusion: A huge tumour of the rectum is not always malignant. However, patient with features of low rectal tumour warrants an immediate referral to the surgical team as this non-communicable disease is a public health concern. Preoperative diagnosis is paramount for a necessary surgical intervention.
Introduction:The objectives of this study were to measure the status of glycaemic control and identify factors asso-ciated with good glycaemic control among diabetic patients treated at primary health clinics. Methods: All diabetic patients registered and under follow up of Ministry of Health facilities were monitored for their glycaemic controls through HbA1c levels. Data obtained from line listing of diabetic patients that received treatment from four health clinics at Hulu Terengganu in 2019. All of patients’ data including socio demographic characteristics, latest labo-ratory investigations and treatment modalities were recorded in the line listing. In this study, 350 active patients were randomly selected systematically. Logistic regression analysis was done to predict factors associated with good glycaemic control which is defined as having HbA1c less or equal to 6.5%. Results: In this study, the proportion of patients with good glycaemic control was lower than other published studies. It is found that 99 patients (28.3%) have good glycaemic control while 251 patients (71.7%) have poor glycemic control. Factors significantly associ-ated with good glycaemic control included age (odds ratio 0.965; 95% confidence interval 0.940-0.991), presence of comorbidity (odds ratio 0.326; 95% confidence interval 0.107- 0.995) and type of treatment (odds ratio 0.302; confidence interval 0.171-0.533). Those who were not on insulin were more likely to have good glycaemic control. Older patients were also tend to have good glycaemic control. Conclusion: Multi-disciplinary approaches and great-er efforts by healthcare providers at primary health clinics are needed in order to help more patients to achieve good glycaemic control. Younger patients and those who do not have comorbidities yet should be closely monitored as they are prone to have poor glycaemic control. Extra cautions is warranted in patients with insulin in order to achieve glycaemic target thus reducing complications and making the treatment more cost-effective.