Introduction:Obesity prevalence in Malaysian adults aged 18 and above has more than tripled over the past 20 years with 4.5% in 1996 to 17.7% in 2015. The alarming trend of the obesity epidemic in Malaysia requires im-mediate revision of public health policies. Thus this review was conducted to determine the effectiveness of latest weight reduction strategies. Methods: Literature search was conducted as guided by PICO Framework and using online databases PubMed on 22 June 2018. A total of 2,203 articles were found and screened. A total of 26 articles were reviewed. Results: Most weight loss achieved is through surgical intervention with weight reduction of 20.8 kg compared to 8.5 kg reduction in control group (95% CI, p < 0.001). Non-invasive procedures that produced greatest weight reduction include diet modification strategy consisting of isocaloric diet with large breakfast (700 kcal) which produced weight reduction of 8.7 ± 1.4 kg compared to large dinner (700 kcal) 3.6 ± 1.5 kg (95% CI, p < 0.0001, and special diet of adding 3g/day cumin supplementation into normal diet which produced weight reduction of 6.2 kg compared to 4.19 kg reduction in control group (95% CI, p < 0.05. Conclusion: In this review, most weight loss is achieved through surgical intervention. All patients should receive lifestyle therapy and additional consideration should be given for pharmacotherapy and bariatric surgery when indicated.
Introduction: In this study, Renal artery (RA) stenosis of Single Stenosed (SS) and Double Stenosed (DS) with the condition of Normal Blood Pressure (NBP) and High Blood Pressure (HBP) were investigated using the aid of Fluid Structure Interaction (FSI) approach. Methods: Numerical analysis of 3D model patient’s specific abdominal aorta with RA stenosis was conducted using FSI solver in software ANSYS 18. Results: The results of velocity profile, pres- sure drop, time average wall shear stress (TAWSS), Oscillatory shear index (OSI) and total deformation of SS and DS with the condition of NBP and HBP were compared in terms of blood flow and structural wall tissue behaviour. The results concluded SS-NBP produced the highest value of velocity profile, TAWSS and OSI parameter compared to the others. Meanwhile, SS-HBP indicates the highest value pressure drop. On the other hand, SS-HBP and DS-HBP have a higher distribution of deformation contour and also maximum VMS compared to SS-NBP and DS-HBP. Conclusion: With the aid of FSI approach, this studied has proven that the existence of SS at RA location has a higher impact on the velocity magnitude, higher pressure drop, higher TAWSS and OSI value compared to the DS case. This is due to a high concentration of pressure acting at the narrow blood vessel of SS compared to DS cases which most of the blood flow will pass to the lower part of abdominal aorta.
Prolonged standing has been identified as one of the risk factors which is associated with occupational injuries. Therefore, the primary aim for this study is to determine the association between prolonged standing and muscle dis- comfort among workers who have to stand for long periods of time. A total of 74 respondents were given and asked to complete a self-administered Borg’s Scale questionnaire. After that, the completed questionnaire was analysed using statistical analysis. This study highlighted the correlation between height, weight and age of the respondents with muscle discomfort following exposure to prolonged standing. Besides that, the association between prolonged standing and muscle discomfort also will be highlighted. In short, the prevalence of leg muscle discomfort was higher compared to the muscle discomfort experienced by the other body parts.
The repeatedly heating cooking oil in preparation of fried food has become a main dietary habit among Malaysian which can cause health impacts on humans. The peroxide value (PV) can be applied to identify cooking oil’s quality through the oxidative change that takes place in fats or oils. High peroxide value indicates bad quality of cooking oil. This research was conducted to identify the awareness and practice of repeatedly heating cooking oil among food premise operators and to determine the peroxide value in repeatedly heating cooking oil samples. Methods: A total of 124 food premise operators in Bukit Mertajam, Penang, participated in this research. A face-to-face interview was carried out by using the structured questionnaire for data collection to obtain socio-demographics information as well as awareness and practice of repeatedly heating cooking oil among respondents. The peroxide values analysis was performed on five samples of respondent’s most favourable brands of cooking oil by using iodometric titration method. Results: Majority of respondents had moderate awareness (53.2%) and practice (50.0%) level regarding repeatedly heating cooking oil. The PV analysis showed that the peroxide value begin to exceed the AOCS standard limit of 10 meqO2/kg following the 5th cycles of frying. Conclusion: Relevant actions need to be taken by the governmental food authorities to address this issue and ensure safe consumption of fried foods by consumers.
Introduction: Initially, studies showed that graphic warning signs (GWSs) on cigarette packages encouraged smok- ing cessation. However, there have been recent concerns over the effectiveness of GWSs to change smoker percep- tions and behavior over time. Our goals were to assess the latest perceptions of GWSs among smokers in Kelantan and to determine the factors associated with them. Methods: This cross-sectional study was conducted among re- spondents who attended outpatient clinics in a teaching hospital in Kelantan. Their perceptions were analyzed with a validated Malay questionnaire containing four domains: fear, influence, credibility, and picture content. Results: The average smoking age was 17 (3.04) years old. The mean smoking time was 11 (7.49) years. The average daily cigarettes smoked was 8 (6.26). Most respondents perceived low levels of fear (83%), poor picture content (65.5%), low influence (87.6%), and low levels of credibility (70.1%) in GWSs. Those with low levels of education were significantly associated with poor perceptions of GWSs. Conclusion: Despite vigorous efforts by the government to discourage smoking in Kelantan, smokers still poorly perceive GWSs. More effective health-promotion strategies are essential to influence smokers in this area.
Introduction: Children with visual impairment are reported to be at higher risk of poor oral health. They faced dif- ficulties in basic skills including oral care. For this reason, they may develop dental caries and periodontal disease. The aim of this study was to assess the oral health status of a group of visually impaired school children in Kuala Lumpur. Methods: A cross-sectional study was carried out on students from a Special Education School in Kuala Lumpur. Oral examination was conducted to determine caries experience and oral hygiene status. Caries was mea- sured using DMFT index and simplified oral hygiene index (OHI-S) for oral hygiene status. Oral examination was based on modified World Health Organization (WHO) oral health assessment criteria for children. Chi-square test was used to determine associations between demographic variables and oral health status. Results: A total of 91 visually impaired students (41 blind, 50 low vision) within the age group of 13 to 17 years old participated in this study. The mean OHI-S score was 1.68 (SD 0.87) with majority of students had fair oral hygiene (39.6%) and 29.7% with poor and very poor oral hygiene. The mean DMFT score of total students were 0.80 (SD 1.62). Male students demonstrated significantly better oral health status than female in relation to prevalence and mean score of dental caries. Conclusion: Most of the visually impaired children in this study showed fair oral health status. Regular oral health education is recommended to improve the oral hygiene especially in the totally blind group.
CAD accounts for 25% of mortality in Malaysia public hospitals. CABG is one of treatment for patients with CAD, but requires RBC transfusion, which is associated with morbidity and mortality. This study was to evaluate the association between RBC transfusion and morbidity and mortality in CABG patients at the National Heart Centre, Malaysia (IJN). Methods: Retrospective cross-sectional study performed using data from 434 patients who underwent CABG in 2013 and 2014. Subjects had systematic random sampling every fifth subject of the patients in the sequence of dates of the year. Data related to the relationship between RBC transfusion with mortality and morbidity, and the predicting factors captured. Results: 64.3% of CABG patients (n = 279) received RBC transfusion perioperatively. Age, gender, BMI, and EF, were factors that contributed for RBC transfusion. RBC transfusion was a contributor to longer intensive care unit length of stay (ICULOS) and hospital length of stay (HLOS). Multiple logistic regression revealed, for every 1 year increase of age, there is 3.5% higher chance of transfusion. Whereas an increase of 1 kg/m2 of BMI and 1% of EF reduced the odds of RBC transfusion by 13.0% and 3.0% respectively. Conclusions: Age, gender, BMI, and EF determine the probability of needing RBC transfusion during CABG, and RBC transfusion will result in longer ICULOS, and HLOS. Probability of RBC transfusion will be higher in older patients and reduced in those with higher BMI and EF.
The purpose of this study was to integrate the available data published to date on susuk or charm needles into a com- prehensive analysis of their clinical/radiological features. An electronic search was undertaken in September 2019. Eligibility criteria included publications having enough clinical and radiological to confirm a definite diagnosis. The initial literature search resulted in 48 publications. Ten publications were excluded for duplicates, and another 17 excluded after a screening of the abstract. Besides, the screening of the abstract shows that five publications were not meeting the inclusion criteria, resulting in a total of 14 publications of susuk that were included in the systematic review. Bias analysis was conducted according to Oxford Center for Evidence-Based Medicine. The resulting total of 78 cases from the selected publications were analysed, showing a wide age range with different distribution among gender and ethnicity. Three cases reported in the literature having symptoms related to susuk. Susuk can be seen as an incidental finding during a routine radiographic assessment, and clinicians should be able to differentiate it from other radiopaque foreign bodies. The practice is not limited to South East Asian population and can be seen in wide racial profiles.
Introduction: The Environment of Care (EoC) is less being the highlight as one of the important components in hospi-tal administration. The EoC is the interface between the patient and the organisation and it provides both a practical and safe area in which to provide patient care. The study aims to determine the correlation between the environment of care, patient satisfaction and willingness to recommend. Methods: This was a cross-sectional study conducted in one of the teaching hospitals in Malaysia. A Malay validated Hospital Consumer Assessment of Healthcare Provider and System (HCAHPS) questionnaire was used. The multistage sampling was applied. 13 wards represent medical, surgical and O&G based wards were selected randomly. Systematic random sampling method was used for pa-tient selection. Number of samples for each ward was calculated proportionately based on the average number of discharge patient monthly. The global rating item in HCAHPS was used to determine satisfaction level. Data was collected and analysed using SPSS version 22.0. Results: 547 respondents were involved in the study with 61.6% of them were female. Majority of respondents were young adult less than 60 years old. 36.9% of the respondents had positive experience with cleanliness of the ward meanwhile 26.7% had positive experience with quietness of the ward. 57.6% of the respondents were satisfied with the services and 64.5% were willing to recommend the hos-pital to others. There was a significant correlation between environment of care, satisfaction level and willingness to recommend. Conclusion: The healthcare facility needs to concentrate on creating a positive experience on EoC component as this can influence satisfaction level and willingness to recommend the hospital.
Introduction: Primary health care plays an important role in healthcare systems. In Malaysia, One (1) Malaysia Clinic (now known as Community Clinic since 2018) was established in 2010 aims to increase healthcare services accessibility within the poor urban population. The aim was to look at the effectiveness of One (1) Malaysia Clinic as a new form of public primary health clinic by looking at expectations and perceptions of the quality of the provided services by the patients. Method: It applied a cross sectional study involving nine clinics in of the busiest district in Kelantan namely, Kota Bharu district. 386 respondents which were Malaysian citizen, 18 years old and above were involved in this study. The survey used Malay validated SERVQUAL questionnaire. The Service Quality (SQ) gap was calculated. Result: The empathy dimension obtained the highest expectation and perception score, while the tangi- ble dimension has the lowest expectation and perception score. In all SERVQUAL dimension, the expectations and perceptions of the service provided was significantly different with P < 0.001. The most critical dimension identified was tangible dimension as it has the largest negative SQ gap score. Conclusion: Negative gaps for all SERVQUAL dimensions and individual items indicated that provided services at One (1) Malaysia Clinic still could not fulfilled the patient’s expectation. A continuous improvement program is needed especially on tangible dimension in deliv- ering a quality healthcare services.
Spontaneous pneumothorax and pneumomediastinum is defined as presence of free air or gas in the pleural cav- ity and mediastinal structures respectively. Spontaneous pneumothorax seems to be associated with anatomical abnormalities such as subpleural blebs or bullae, however not for spontaneous pneumomediastinum which may developed without an apparent precipitating cause. Both usually may occur in young healthy adults without serious underlying lung disease. We report a case of spontaneous pneumothorax and pneumomediastinum after a trivial injury. He was initially presented with dyspnea after two weeks of initial trivial trauma. Chest radiograph showed left apical pneumothorax with pneumomediastinum with no evidence of rib fracture. His condition was deemed non-traumatic by surgical colleague, thus admitted to medical ward for observation and eventually discharged well.
Introduction: Low job satisfaction among healthcare workers may lead to high turnover intention, poor job perfor-mance, high absenteeism, and low patient satisfaction. Global and local needs for health workforce are increasing in trend to meet current health demands. Addressing job satisfaction of the healthcare workers is a practical way to uti-lise the available human resources optimally. The main aim of this study is to determine job satisfaction level and its associated factors among healthcare workers in health clinics under the Petaling District Health Office jurisdiction in Selangor, Malaysia. Methods: A cross-sectional study was conducted among healthcare workers in ten health clinics in Petaling District from April until May 2019. Simple random sampling method proportionate to the number of staffs from each health clinics was done. A structured self-administered questionnaire was used. Results: The response rate was 93%. Majority of the respondent were female (83%), married (82%), diploma holder (41%), nurses (33%) and working in health clinics with specialists (93%). The job satisfaction mean score for the studied population was 4.46 (SD = 0.72). Self-rated physical health and mental stress status were significantly associated with job satisfaction (p < 0.001). Conclusion: The job satisfaction level of the studied population was comparable to other local studies and higher than studies from Iran, Ethiopia and China. Extra attention should be given to healthcare workers with poor physical health and poor mental stress. More objective study on physical health and mental stress is required.
Introduction: About 18% of Malaysian Armed Forces (MAF) personnel are diagnosed with either hypertension, diabetes or coronary artery disease, while another 8% are obese. The rising prevalence necessitates intervention.
Methods: This is a single blinded randomized controlled trial among overweight and obese MAF personnel attending medical checkup in MAF hospital in Kuala Lumpur. An intervention module was developed to increase their physical activity level. Short version of International Physical Activity Questionnaire was used to assess physical activity in metabolic equivalent of task score (METs score), while blood pressure, body mass index (BMI), blood lipid profile and fasting blood sugar measurements were also obtained. These parameters were measured at baseline and again at 6 months. Generalized estimating equations (GEE) statistical test were applied to evaluate the effect of the intervention.
Results: Response rate was 100%. Most of participants were aged above 40 years, male, from Malay ethnic group, completed secondary education and had monthly income above RM 4000. Most of the respondents were obese and had moderate level of physical activity at baseline. All variables compared between groups at baseline showed no significant difference. At six months, after controlling for covariates, the significant difference was only in METs score. The odds of having high METs score in the intervention group after receiving intervention was nearly 3 times higher than those in the control group, after adjusting for interaction between time and group as well as other covari- ates (AOR = 2.908, 95% CI 1.323 – 6.391, P=0.008).
Conclusion: Intervention was effective in increasing physical activity among overweight and obese military personnel.
Study site: Malaysian Armed Forces Hospital, Kuala Lumpur, Malaysia
Simulated/ standardized patients (SPs) have become one of the significant components in today’s medical education and students’ assessment. Some differences exist in the training method of SPs for psychiatry examinations compared to other medical disciplines. This brief report highlights the challenges encountered in the training process and methods to overcome those challenges. A wellstructured, intensive training remains as one of the most important factors in ensuring standardization of SPs for psychiatric examinations.
Objective: A baseline functional magnetic resonance imaging (fMRI) study was carried out on a healthy right-handed male subject to attain further insights into the basic neuronal control mechanisms of bimanual and unimanual movements of hand fingers, an area that is still not fully understood. Methods : The study used the basic unimanual and bimanual movements of the left- and right-hand fingers to stimulate neuronal activity in the cerebral cortices. The subject was instructed to sequentially press his fingers either unimanually (UNI) or bimanually (BIM), against the thumb in a consistent alternative manner during the functional scans. The data were analysed using the MATLAB and SPM2 software packages. Results : Brain activations obtained via the F-test indicate a larger activation area as compared to that obtained from the T-test. The results showed that, the activated brain regions due to the self-paced finger movements are the precentral and postcentral gyrii covering the primary motor, premotor and somatosensory primer areas. The activestate signal intensity was found to be significantly (p < 0.05) higher than that of the resting-state. For UNI, brain activation showed contra-laterality with a larger activation area and a higher signal intensity at the point of maximum intensity for the left-hand finger
movement (UNIleft) compared to the right-hand finger movement (UNIright). Small ipsilateral activations were observed during UNIright and UNIleft. For BIM, the activation was observed in both hemispheres with the right hemisphere showing a higher signal intensity and coverage. The results support the fact that for a right-handed person performing either UNI or BIM type of movement, the activated motor area on the right hemisphere of the brain (movement of the left hand fingers) experience a higher intensity and larger coverage of hemodynamic response compared to the left hemisphere of the brain (movement of the right hand fingers). Analyses performed on the activated regions of interest (ROI) by
comparing the unimanual and bimanual types of activations revealed that during BIM, there are voxels in the left hemisphere controlling the movement of the left hand fingers (BIMleft) and voxels in the right hemisphere controlling the movement of the right hand fingers (BIMright). The interactions observed in this study resemble the existence of interhemispheric connection between both hemispheres during BIM. Conclusion : Although this is a single subject study, the hemodynamic response and the neuronal control mechanism in the cerebral cortices based on the BOLD mechanism can be studied and evaluated using fMRI and SPM.
Objective: This study investigates functional specialisation in, and effective connectivity between the
precentral gyrus (PCG) and supplementary motor area (SMA) in seven right handed female subjects.
Methods: Unimanual (UNIright and UNIleft) and bimanual (BIM) self-paced tapping of hand fingers were
performed by the subjects to activate PCG and SMA. Brain activations and effective connectivity were
analysed using statistical parametric mapping (SPM), dynamic causal modeling (DCM) and Bayesian
model selection (BMS) and were reported based on group fixed (FFX) and random (RFX) effects
analyses. Results: Group results showed that the observed brain activation for UNIright and UNIleft fulfill contralateral behavior of motor coordination with a larger activation area for UNIright. The activation for BIM occurs in both hemispheres with BIMright showing higher extent of activation as compared to BIMleft. Region of interest (ROI) analyses reveal that the number of activated voxel (NOV) and percentage of signal change (PSC) on average is higher in PCG than SMA for all tapping conditions. However, comparing between hemispheres for both UNI and BIM, higher PSC is observed in the right PCG and the left SMA. DCM and BMS results indicate that most subjects prefer PCG as the intrinsic input for UNIright and UNIleft. The input was later found to be bi-directionally connected to SMA for UNIright. The bi-directional model was then used for BIM in the left and right hemispheres. The model was in favour of six out of seven subjects. DCM results for BIM indicate the existence of interhemispheric connectivity between the right and left hemisphere PCG. Conclusion: The findings strongly support the existence of functional specialisation and integration i.e. effective connectivity in human brain during finger tapping and can be used as baselines in determining the probable motor coordination pathways and their connection strength in a population of subjects.
Introduction: Since 1978, Rohingya refugees have fled from their native nation, Myanmar to escape ethnic prose- cution. They comprise of the Muslim minority ethnic group originating from the Rakhine state in Myanmar. In many host countries, they may have difficulty to access health care services. The Islamic Association of Malaysia (IMAM) Response and Relief Team (IMARET) have taken many initiatives to provide healthcare services to the refugees through their volunteer-led mobile clinics. Therefore, this study aims to evaluate the utilisation of drugs among type 2 diabetes mellitus (T2DM) patients visiting this clinic. Methods: This was a cross-sectional study among Rohingya refugees with T2DM that visited the IMARET mobile clinics from August until November 2017. Convenient sampling method was used. Data were collected through patient’s interview, review of the patient’s prescriptions and their HbA1c readings. Results: A total of 29 T2DM patients were included in this study. The majority were female (75.9%) and aged below 65 years old (75.9%). The most commonly prescribed anti-diabetic agent was metformin (72.2%), followed by glibenclamide (22.2%) and gliclazide (5.6%). Metformin as a monotherapy (31%) was the most frequent treatment prescribed. More patients had controlled T2DM (62.1%) compared to those with uncontrolled DM. We found 90.9% of patients who were treated according to the recommended DM guidelines achieved a good blood glucose control (p=0.02). Conclusion: In Rohingya refugees having T2DM who were treated in the IMARET mobile clinic, the percentage having good control DM status is higher in those whose treatment regimen adheres to the clinical practice guidelines.
Introduction: A growing evidence supported that variation of sweet taste perception, mediated by TAS1Rs gene variants could lead to excess sweetened food and beverages intake and also obesity. However, obesity development may also alter individuals' taste sensitivity and perception. Thus, it is best to further investigate whether or not the individuals' sweet taste sensitivity and acceptance are associated with variation in TAS1R2 gene and Body Mass Index (BMI) status. Methods: This comparison cross sectional study comprised of 88 obese and 92 non-obese subjects aged 20-45. All the subjects were genotyped for TAS1R2 gene variant at rs12033832 using polymerase chain reaction – restriction fragment length polymorphism (PCR-RFLP). Suprathreshold sensitivity for sweet taste was assessed using general Labeled Magnitude Scales. Intensity rating and hedonic test were carried out on 2 food samples (tea drink and rose flavoured agar) to examine subject's intensity rating and liking at different sugar contents. Results: Our re- sults showed that rs12033832 of TAS1R2 gene is associated with sweet taste perception among obese and non-obese subjects. No interaction effect between BMI status and TAS1R2 gene variant (rs12022832) was found on sweet taste measures. Overall, non-obese subjects with AA genotype on rs12033832 had the highest sweet taste sensitivity and dislike high sugar content products the most. The effect was reverse among the obese subjects with GG homozygous. Conclusion: These findings suggest that TAS1R2 gene variation plays an important role in sweet taste perception among individuals and may have nutritional implications and obesity.
Introduction:Lymphatic filariasis (LF) is a neglected tropical disease that can cause significant morbidity. In Malay-sia, National Programme for the Elimination of Lymphatic Filariasis started in 2001 with the initial target of achiev-ing Lymphatic Filariasis elimination status by 2018 but it has been revised to year 2020. Mass Drug Administration (MDA) Programme was performed from 2004 to 2008 in all endemic areas (Red Implementation Unit, IU) in Malay-sia including Terengganu state to stop disease transmission. Transmission Assessment Surveys (TAS) were conducted later on and for Terengganu, they were done in 2011 (TAS 1), 2015 (TAS 2) and 2017 (TAS 3) and had passed all the surveys based on critical cut off (CCO) point given. Methods: A cross sectional analysis of 10-year Terengganu filariasis records (2009-2018) was initiated in June 2019 using data source from eVekpro and filariasis cases line-list-ing. Results: Majority of filariasis cases in Terengganu were among males (n=147, 76.6%) with the highest number among 30-39 year-old age group (n=35, 18.2%). Majority of cases were Malaysian citizens (n=162, 84.4%) with main filariasis species identified were Brugia Malayi (n=149, 77.6%). The number of cases diagnosed was slightly higher from Green Implementation Unit area (n=102, 53.1%) compared to Red Implementation Unit area. Conclu-sion: The number of lymphatic filariasis cases among Terengganu citizens was below critical cut off point after the accomplishment of MDA programme and in accordance with the aim of lymphatic filariasis elimination status in Malaysia by 2020.
Introduction: This study examines the psychometric characteristics of a translated version of the Beck Depression Inventory II (BDI – II) among Malaysian school students. Methods: The sample consisted of 257 boys and 302 girls. This study employed WINSTEPS 3.74 to provide statistics and other information from Rasch Model analysis, namely, the fit statistics, dimensionality analysis, rating scale analysis, reliability and separation indices, differential item func- tioning analysis, and distribution of items difficulty and students’ ability. Results: Rating scale analysis showed that category 2 and category 3 of the ratings were not different. Meanwhile, Item 19 did not fit the model’s expectations; and thus, it was omitted from further analyses. The scale demonstrated a high person reliability and a high person separation index. There were no items demonstrating gender DIF. The school students endorsed feeling guilty as the least severe symptom of depression, while committing suicide as the most serious symptom. Conclusion: In general, the BDI-II demonstrated acceptable properties in measuring depression symptoms among school students.