Introduction: Proper distribution of human resources is an important factor ensuring high-quality performance and sustained service quality. The aim of this study was determining the workload pressure among medical officers in health clinics (HCs) in Kelantan. Method: A record review survey was conducted between January and April 2019 using human resources data for 2018 involving HCs in Kelantan. It included all the HCs in Kelantan and excluded community clinics. Workload pressure was determined using a tool known as Workload Indicator of Staffing Needs, developed by World Health Organization. A high workload pressure was defined as a ratio between required and acquired medical officers of less than 1. The data were presented descriptively using as frequencies and percentages. Results: All 85 HCs in Kelantan were involved in the study; 90% (9/10) of the Kelantan districts recorded high work- load pressure. Moreover, 68.2% (58/85) HCs had high workload pressure. Tanah Merah, Tumpat, Pasir Mas, and Kota Bharu had the most HCs with high workload pressure, and most such HCs were found in areas with a high-den- sity population, requiring huge coverage. Conclusion: The Kelantan State Health Department should develop better human resource distribution strategies to ensure the sustainability of quality care in HCs.
Introduction: This multiple-subject fMRI study continue to further investigate brain activation within and effective connectivity between the significantly (p
A 31-year-old lady with normal physical characteristics was found to have persistent high FSH and LH and was suspected possible premature ovarian failure after reported to have not normal menstrual cycle. Leucocytes were collected from patient’s fresh peripheral blood sample and Giemsa banding (G-banding) was done. All metaphases were captured and analysed using Cytovision software 4.5 and the final analysis show 47,XXX.
Advanced parental age is a risk factor for chromosomal abnormalities in their offspring. Trisomy X or Triple X syn- drome has previously been reported with advanced maternal age. Here we report two (2) cases of Trisomy X with paternal age as risk factor. Generally, Trisomy X individuals show variable physical and psychological manifesta- tions. However, both cases reported here have advanced paternal age as a risk factor; 55 years old (46 years old at conception) for Case 1 with patient having right eye squint, beaked nose, Posterior Misalignment Type Ventricular Septal Defect (PMVSD) and small Patent Ductus Arteriosus (PDA) with failure to thrive and 49 years old (45 years old at conception) for Case 2 with speech delay and protruding tongue. In view of that, advanced paternal age could possibly contribute the accumulation of de novo mutations in germ line mosaicism.
Hamman’s syndrome by definition is spontaneous pneumomediastinum with the exclusion of thoracic trauma or iatrogenic cause. It is rare and is more common in adolescence male. Amongst the risk factors are underlying lung condition such as asthma and interstitial lung disease, drug inhalation and parturient woman. Patient usually pres- ents with sudden onset of shortness of breath and chest pain with subcutaneous emphysema on examination. The diagnosis is confirmed with chest radiograph. The prognosis of Hamman’s syndrome is excellent. Most cases are self-limiting and resolve spontaneously. However, Hamman’s syndrome is a poorly recognised disease due to its rarity. Therefore, the patient may be subjected to misdiagnosis and treatment. This is a case report of Hamman’s syn- drome misdiagnosed and treated as pneumothorax. The objective of this case report is to highlight the importance of differentiating this benign syndrome with life threatening differentials which may have similar clinical presentation. Thus, avoiding unnecessary costly investigation, treatment and invasive procedures.
Introduction: This study determined nitrate concentration and identify the classifying sources of nitrate pollution in the alluvial deposit aquifer system in Bachok, Kelantan. Materials and Methods: A total of 300 groundwater samples were collected in two different areas; agricultural area (150 samples) and non-agricultural area (150 samples). The samples were analyzed for nitrate and other parameters such as pH, EC, NH4+, TDS, turbidity and salinity. The multivariate analyses were used to identify factors that govern the groundwater quality and potential nitrate sources in the study area. Results: Samples in the agricultural area were slightly acidic (5.89 ± 0.67), contained high nitrate (15.10 ± 15.90 mg/L NO3-N), NH4+ (0.82 ± 1.24 mg/L) and turbidity (3.25 ± 2.78 NTU). The principal component analysis (PCA) have identified the groundwater quality in the study area was influenced by the natural processes and anthropogenic activities. Based on the hierarchal cluster analysis (HCA), Cluster II in the agricultural area was identified to be most heavily nitrate contamination, while Cluster III in the non-agricultural area was identified to be strongly affected by seawater intrusion. Conclusion: The findings of this study are useful for developing protection alternatives of private well waters to prevent further deterioration of groundwater quality by nitrate such as control of nitrogen fertilizer use, manure applications and other agricultural practices in the agricultural area. In order to reduce the health risk of nitrate, private well water users in this area should be advised to treat their water or find alternative sources for drinking.
Using pulmonary tuberculosis (pTB) as an example of a vaccine-preventable disease (VPD), we aimed to gather evidence on the economic impact of treating a case or managing an outbreak of a VPD. A scoping review was con- ducted. Online databases (MEDLINE and Google Scholar) were used to collate published studies from the year 2015 to 2019 on the management cost of one case or an outbreak of pTB. Keywords used were cost, treatment, outbreak, pulmonary tuberculosis, tuberculosis, economic, economic evaluation. A total of 29 studies were analysed. The costs of pTB treatment for individual patient were higher in high-income countries compared to middle-income and low-income countries. A case of pTB can result in household catastrophic health expenditure; while an outbreak can overwhelm the health system’s capacity, and disrupts the economy of a country. Therefore, accessibility of vaccines especially in low-income countries must be ensured. Also, vaccine-hesitant individuals must reconsider their stance on vaccination.
Introduction: The compatibility of denture cleanser is crucial in the prevention of failure of adhesion between silicone soft liner and acrylic denture base, thus ensuring the durability of the prosthesis. This scanning electron microscope (SEM) study was to determine the mode of failure and measured the gap formation between silicone soft liners and Polymethylmethacrylate (PMMA) denture base after immersion in denture cleansers. Methods: A total of 135 specimens of PMMA denture base lined with three different silicone soft liners (GC Reline Soft, Mollosil and Tokuyama Sofreliner Tough) were immersed into denture cleansers (Polident® and Stearadent) daily and stored in distilled water at 37±1°C. Specimens were examined and sectioned at 2.5mm and 5.0mm from the margin after 1 day, 30 days and 90 days before analyzed. Results: No significant difference detected in the mode of failure and gap formation after one-day immersion. Adhesive failure was the commonest failure at the margin after 30 days (71.11%) and after 90 days (95.56%). However, 33.33% of specimens showed mixed failure at 5.0mm sectioned after 90 days. A significant difference of gap formation was demonstrated from Mollosil in Steradent at the margin and at 2.5 mm sectioned after 30 days and after 90 days (p
Introduction: This is open label randomised control trial, aimed to identify whether an early (commenced at the time of diagnosis) and intensive nutrition intervention (INI) (individualised dietary counselling, oral nutritional sup- plements [ONS], telephone, and home visit) can improve weight and dietary intake of gynaecological cancer (GC) patients preoperatively. Methods: Selected GC patients planned for surgery were randomly grouped into control group (CG) (n = 35) and intervention group (IG) (n = 34). Malnutrition screening tool (MST) was used as a screening tool, while Patient-Generated Subjective Global Assessment (PG-SGA) was used as a nutrition assessment tool. IG received an intensive individualised dietary counselling with the supply of ONS at baseline (Day 1). This continued with telephone and home visit follow-up by research dietitian (Day 3 and Day 6). Meanwhile, CG only received general nutritional counselling without supply of ONS. Final assessment was conducted on Day 14. The primary outcomes included weight changes measured using TANITA and dietary intake assessment using 24-hour diet recall. Results: Mean duration of INI was 14 days. At the end of the treatment period, there was a significant weight change between groups (p < 0.001), with 0.14% weight gain in IG and 1.3% weight reduction in CG. Mean energy and protein intake of IG were higher compared to CG by +329 kcal/day and +12.2 g/day, respectively. Conclusion: This study showed that INI that incorporated individualised dietary counselling, ONS, telephone counselling, and home visit can increase energy and protein intake of GC patients, resulting in weight gain.
Introduction: Arterial and venous thromboses contribute to significant morbidity and mortality rate, thus an anti- thrombotic agent is needed for prevention and treatment of thrombosis. Ajwa dates (Phoenix dactylifera L.) report- edly contain a high level of salicylic acid which is a compound responsible for anticoagulation via antagonism of vitamin K. The present study was designed to assess coagulation activities in human plasma treated with Ajwa date extracts in vitro. Methods: Platelet-poor plasma samples from 27 donors were treated with ethanol crude date extract (ET) or aqueous crude date extract (AQ) of Ajwa dates at different concentrations to generate the following seven test groups from each donor: control (normal saline), ET-I (0.1 g/mL), ET-II (0.5 g/mL), ET-III (1.0 g/mL), AQ-I (0.1 g/ mL), AQ-II (0.5 g/mL) and AQ-III (1.0 g/mL). In vitro coagulation activities of Ajwa dates were assessed based on prothrombin time (PT, an assessment of extrinsic coagulation pathway), activated partial thromboplastin time (APTT, an assessment of the intrinsic coagulation pathway), and thrombin time (TT, an evaluation of level and function of fibrinogen). Results: A very significant prolongation of PT, APTT and TT were observed for the ET-II and ET-III groups and very significant prolongation of PT and TT was observed for the AQ-II and AQ-III groups. Significant prolonga- tion of TT was observed in the AQ-I group. Conclusion: In conclusion, Ajwa date extracts had an anticoagulation effect on human plasma.
Cytomegalovirus (CMV) is frequently isolated from neonates. Symptomatic infection is only apparent in 10% of affected babies with particular predilection for the reticuloendothelial and central nervous system. Isolated respiratory system involvement is rarely encountered. We report a case of a premature 32 weeks infant who required prolonged oxygen dependency and treated for bronchopulmonary dysplasia. The diagnosis of CMV pneumonitis was only discovered after detection of CMV DNA in the bronchoalveolar lavage. A high level of clinical awareness is crucial as a definite diagnosis and treatment will significantly alter the morbidity and the cost of therapy.
Introduction: This preliminary cross-sectional study aimed to investigate the prevalence of toxoplasmosis among blood donors in Kelantan, Malaysia. Methods: A total of 56 blood donors were screened by an enzyme-linked immu- nosorbent assay (ELISA) for anti-T. gondii Immunoglobulin G (IgG) and Immunoglobulin M (IgM) antibodies. Positive
T. gondii IgG and IgM were further tested for IgG avidity ELISA. All extracted deoxyribonucleic acids (DNAs) from whole blood samples were analyzed for the presence of the Toxoplasma B1 gene and the ITS1 region by polymerase chain reaction (PCR). The socio-demographic data of donors was assessed using a data collection form. Results: Out of 56 blood donors, 24 (42.86%) donors were IgG+/IgM-, and 2 (3.57%) donors were IgG+/IgM+ with one of them having a high avidity index indicating as past infection for more than 20 weeks and the other with a low avidity index indicating as recent infection within 20 weeks. None of the samples tested positive for the presence of the Toxoplasma B1 gene and the ITS1 region. A univariate analysis showed that only employment status was significantly associated with Toxoplasma seropositivity. Conclusion: The seroprevalence of toxoplasmosis among blood donors in Kelantan, Malaysia, was 46.43%. Nevertheless, direct detection by PCR showed that this parasite was absent in the blood. These results highlight that the blood donors in this study had previously been exposed to T. gondii infection. The parasite may still remain in certain tissues but does not freely circulate in the blood.
Introduction: A parallel design randomized clinical trial was conducted to compare dentoalveolar and skeletal changes in two groups of patients who had completed twin block therapy; one group had a three-month night-time retention period whereas the other group had no retention period, after twin block therapy but before fixed applianc- es. Methods: 26 participants of Malay ethnicity aged 10 to 15 years were included in the trial and had an overjet of 5mm or greater, molar relationship greater than half cusp Class II on a skeletal Class II base which had been corrected to a Class I molar relationship following twin block therapy. Following randomization, the 26 were divided into two groups of 13. Group A had fixed appliances bonded immediately whereas group B continued wearing twin block at night for three months, after which fixed appliances were bonded. Lateral cephalograms assessed were those taken before randomization, upon twin block therapy completion (T1) and six months after bond-up of fixed appliances (T2). Results: Paired t-test showed several statistically significant dentoalveolar and skeletal changes in group A. In contrast, only condylar head position exhibited a statistically significant change in group B. Despite a statistical sig- nificance, changes measured in both groups were minimal at less than 2mm and therefore clinically insignificant. Independent t-test showed no statistically significant difference between the changes recorded in both groups. Con- clusion: The results suggest that a three-month night-time retention period after twin block therapy does not lead to any changes that may be considered clinically beneficial.
Introduction: Severe labour pain and dissatisfaction towards supports received from midwives during labour are common experiencesamong parturient mothers. Thesenegative emotional experiences need to be given attention as they are associated with higher acute stress reactions and postpartum depressive symptoms. Therefore, this study examinedthe labour pain and satisfaction toward labour support and their influential factors. Methods: A total of 136 parturient mothersregistered for a labour in the UniversitiKebangsaan Malaysia Medical Centre were included in this studyusing simple random sampling. The mothers had met the eligibility criteria; live and singleton pregnancy, able to communicate in English, Malay or Mandarin. Visual anologue scale and Bryanton Adaptation of the Nursing Support in Labor Questionnaire (BASILIQ) which contained both quantitative and qualitative questions were used to measure the pain and satisfaction level respectively. Descriptive statistics, Spearman correlation, Mann-Whitney and Kruskal-Wallis tests and also content analysis wereutilised to analyse the data. Results: Labour pain was low (Mean=2.24, SD=2.20) and satisfaction toward the labour support was high (Mean=76.9, SD=8.75). Both the pain and satisfaction were not significantly related to each other and also to any of the mothers’ demographic (p > 0.05) and obstetrical data (p > 0.05). However, 32.9% (n=25) out of 76 subjectswho responded to the qualitative questions had highlighted the need of havingfriendly and helpful nurses during their labour.In addition, 56% (n=14) out of 25 subjects who provided additional comments had suggested to include theemotional support to reduce their labour pain, fear and anxiety. Conclusion: Friendly and helpful nurses are part of the emotional support for labour. There- fore, it is recommended that a structured emotional laboursupport should be made availableto parturient mothers. Further research examining the effectiveness of the emotional support on the pain and satisfaction, nevertheless, is warranted.
Background: Patients’ satisfaction with their nursing care is an important issue in assessing the quality
of nursing care. In Iran, cancer patients’ satisfaction at teaching hospitals of Tehran City has not been
investigated. Aim: A cross sectional study was conducted to determine the level and identify factors that contributed to patients’ satisfaction in nursing care provided at selected teaching hospitals in Tehran City, Islamic Republic of Iran. Method: A proportional stratified sampling method was used and data were collected via face-to-face interview based on a validated Patient Satisfaction Questionnaire (PSQ). A total of 384 cancer patients aged 14 years and above were selected. Result: The majority of respondents were males (201, 52.4%), age group 45-54 years (102, 26.4%); employed (202, 52.6%) and with a family monthly income of US$200-500 (234, 60.9%).The majority (314, 81.8%) of respondents were hospitalized between 2 to 5 days, and most (204, 54.0%) of them were admitted to teaching hospital B of The University of Medical Science.1 A majority of the respondents (318, 82.8%) was satisfied with the nursing care provided, while the others (66, 17.2%) were not. Generally, most of the respondents were satisfied with the amount of information given by the nurses (294, 76.6%), technical quality (295, 76.8%), interpersonal relationship (371, 96.6%), and physical environment (267, 69.5%). There was a positive significant relationship between patients’ satisfaction and type of hospital ( 2=4.985; df=1; p=0.026, n=384). Using the University’s hospital type was found to be the best predictor for level of satisfaction. Conclusion: Most of the respondents were satisfied with the nursing care. However, the respondents suggested several improvements such as increasing the number of doctors, improving socioenvironment factors in terms of privacy and interpersonal relationship, and improving on the existing facilities. Further research is needed to study in depth the socio-cultural and environment parameters which are relevant to patients’ satisfaction with nursing care.
Introduction: An arteriovenous malformation (AVM) is an abnormal collection of blood vessels in which arterial blood flows directly into the draining vein without the normal interposed capillaries. The Spetzler-Martin grading system has been widely accepted worldwide to estimate the pretreatment risks and predict the outcome of patients with intracranial AVM. In Malaysia, we still do not have the baseline data of this grading system. Methods: A total of 33 patients from a tertiary referral hospital diagnosed with intracranial AVM based on neuroimaging findings over a 4-year period were studied. Medical
records were traced and neuroimaging findings were analysed. The AVMs were graded according to the Spetzler-Martin grading system and Fisher’s exact test was used to assess statistical difference between the grades of the AVM and management plan for the patients. Results: Four patients were graded as Grade 1, 9 patients as Grade II, 10 patients as Grade III, 6 patients as Grade IV and 4 patients as Grade V. Ten patients were treated conservatively; six patients underwent surgery and embolisation respectively. Four patients underwent radiosurgery and a combination of embolisation while surgery and radiosurgery were given to 5 patients and 2 patients respectively. Statistically significant difference (p=0.016) was found between the Spetzler-Martin grading system and the management of intracranial AVMs. Conclusion: The management decision was not made based on the
grading of the AVMs. It is recommended that all AVM patients be routinely graded according to this system prior to treatment.
Work-Related Hand Injuries (WRHIs) may result in disability and diminished productivity and cause economic impacts not only to the individual, worker’s families and industries, but to the local community as well.
Objectives: To determine the prevalence of severe Work-Related Hand Injuries (WRHIs) and factors associated at a tertiary hospital.
Methods: A pre-tested validated questionnaire was used to obtain data. All patients 18 years and above with WRHIs seen at a tertiary hospital between January 2010 and June 2010 were included in the study. Data was analysed using SPSS version 18.
Results: Out of the 297 industrial accidents, 74 (24.9%) were WRHIs. Among those with WRHIs, (47.3%) of them had severe hand injuries. The overall mean age of the respondents was 30.36 (± 9.54 SD) years. Majority (82.5%) of the injuries occurred between Mondays to Friday. Majority (70.1%) of hand injuries were caused by machine and 48.6% of the hand injuries occurred when the hand was caught in the operating part of the machine. Majority (62.1%) of the respondents had fingers’ injuries and 32.4% had open fracture. Bivariate analysis showed that there was significant association between severity of WRHIs and locations of injury, mechanisms of injury, sources of injury and sectors of industry (p < 0.05). Logistic regression analysis showed that WRHIs was significantly associated with source of injury and sector of industry. Respondents with hand injury resulted while operating on mechanical machine was 26 times more likely to report severe WRHIs than those with other sources of their hand injury like (sharp tool, heavy door, and wet floor). Respondents working in metal-machinery industries were eight times more likely to report severe WRHIs than those who working in other sectors of industry like (wood-furniture, constriction, food preparing, service and automotive).
Conclusions: WRHIs contributed to 24.9% of all industrial accidents seen at the emergency department and orthopaedic clinic and 47.3% of the respondents with WRHIs had severe hand injuries. Severity of WRHIs was significantly associated with sources of injury and sectors of industry.
Study site: emergency room, orthopaedic ward, general surgery ward and the orthopaedic outpatient clinic of a tertiary hospital
Tobacco use among females is a rising public health issue. Further insight into the smoking epidemic can be gained from studying a specific subgroup of interest within the population. Determining predictors of each tobacco smoking type is necessary for planning tobacco specific intervention programmes. The aim of this study was to determine the prevalence of ever tobacco use and its associated socio-demographic factors among Saudi female adolescents aged 12 to 19 in Jeddah. A cross-sectional analytical study was conducted among female students from intermediate and high secondary schools in Jeddah during the academic year 2012-2013. Sampling with probability proportionate to size was used to select a sample of 5,150 students from 40 schools. The data were collected using validated self-administrated questionnaire that required information on tobacco use behaviours and selected socio-demographic characteristics. A total of 5,073 students participated in this study of whom 51.6% were from intermediate grades, and 83.1% from public schools. The prevalence of ever tobacco use was 44.2% (36.2% water pipe and 30.9% cigarettes). The significant predictors of ever tobacco use were student’s age, mother’s education, family structure, residence location and monthly student’s allowance. In conclusion, ever tobacco used is highly prevalent among female adolescents in Jeddah. Designing intervention programmes aimed at preventing Saudi female adolescents from smoking should include all forms of tobacco use.
Although the transformation towards adopting an Outcome-based Education (OBE) is gathering momentum globally, several medical schools are finding it hard to implement the change. Based and built on authors’ experience and cues from the literature, the tips – relating to the process of identification, description and dissemination of learning outcomes (LOs); usage of LOs to ascertain the curricular contents, the teaching/learning and assessment methods; implementing, monitoring and reviewing the curriculum – are the actions that the institutions of higher learning need to perform to transform the existing curriculum or to develop an altogether a new curriculum according to OBE approach. The development of the faculty through dialogues, discussions and training sessions should be an initial and essential step in this process. It is hoped that these tips will alley some of the fears and facilitate the adoption of OBE curriculum in new as well as in existing established institutions.
Introduction: : Ginseng is a type of traditional medicine that has been used for thousand years to treat various dis- eases and has been proven effective in treating cardiovascular diseases. Incorporation of polyaniline (PANI) which is a type of conductive polymer together with ginseng into poly(lactic-co-glycolic acid) (PLGA) microcapsules is neces- sary for the treatment of cardiovascular diseases as the polymer will control drug release and the electroconductivity of PANI is beneficial on myocardium cells. Methods: Therefore, this project involved the encapsulation of ginseng inside PLGA/PANI microcapsules. The encapsulation of ginseng inside the microcapsules was verified through the identification of chemical composition of ginseng, PLGA and PANI using attenuated total reflectance-Fourier trans- form infrared spectroscopy (ATR-FTIR). Results: The results of scanning electron microscope (SEM) showed the formation of microspheres where the microcapsule size was decreased from 3.14±1.87 μm to 1.98±1.30 μm as the concentration of PANI increased. The distribution of microcapsules size was more homogeneous in the high con- centration of PANI as been determined through the histogram analysis. In addition, the fluorescence analysis demon- strated the efficiency of ginseng encapsulation inside PLGA/PANI microcapsules through the appearance of stained ginseng inside the microcapsules. Conclusion: As a conclusion, the ginseng was successfully encapsulated within PLGA/PANI microcapsules that will be beneficial in drug delivery application, specifically in the cardiovascular area.