Deep Neural Networks (DNN) has been successfully applied in a variety of medical image analysis. However, in building a good DNN model, it requires validated label from medical experts. The task of getting labels validated by the medical expert is quite a challenge due to the complexity of the image as well as large variability between the experts. Thus, this research investigates the effect of corrupted medical label on deep neural network for analysing diseases. Materials and method: In investigating this issue, a chest X-ray dataset comprising of 2560 images with 14 multilabel diseases from the National Institutes of Health (NIH) are examined. The DNN models that are explored are MobileNet, which is a base network that uses a depth-wise separable convolutional in building lightweight DNN and Xception, which is also utilised depth-wise separable convolutional with inception modules as an intermediate step in between regular convolutional and the depthwise convolutional. Different training and testing sizes are presented to the models with different ranges of corrupted labels from 10% to 50%. The training and validation accuracy is compared for each of the test cases together with other statistical analysis. Results: Based on the conducted experiments, it can be highlighted that both models can classify the diseases with the accuracy of more than 80% if the images have been previously trained by the model for different sizes of the corrupted labels. For the unseen or previously untrained images, the models can reach the accuracy of 70% and as the sizes of corrupted label increases, the accuracy will decreases as low as 50%. Conclusion: To conclude, corrupted labels have a critical effect on the DNN models. Thus, it is very essential to study the effect of the corrupted medical images label to ensure the reliability of the DNN models for medical imaging.
Axillary nerve supplies deltoid muscle long head of triceps and teres minor in the arm and supply regimental batch area over the inferior part of shoulder. Anterior dislocation of shoulder, latrogenic injury to the nerve during shouder injection and brachial plexus injury can cause axillary nerve injury. Case report: We report a rare case of isolated axillary nerve injury in a 20 year old lady. She was admitted following a low speed fall from motorcycle and sustain abrasion wound over the right side of the face and shoulder. There was no direct or tractional injury to the shoulder during the incidence.During admission she complaint of progressive right shoulder weakness with MRC power of 2 and sensory loss over regimental patch area. On examination there was no tenderness to the shoulder area or neck and she was unable to abduct her right shoulder with full passive range of motion. Patient was subjected to nerve conduction study four months later and revealed slower sensory conduction and deltoid muscle amplitude decreased compared the left side. At 7 months post trauma she is recovering with deltoid power of 4 after multiple physiotherapy session. Isolated axillary nerve injury following a blunt trauma is a rare condition with multiple reported cases showed poor recovery. One should wait for regeneration of nerves to complete before offering any surgical intervention to the patient. As in our case, patient showed remarkable improvement after seven months with conservative management thus avoiding the complication of surgery.
Colorectal cancer is the third most common cancer worldwide. Microsatellite instability (MSI) contributes to be one of the main mechanisms in colorectal cancer. Individuals with MSI tumors have loss of expression of one or more Mismatch Repair proteins. MSI tumors have better survival rate than microsatellite stable (MSS) tumors, poor response to 5FU-based adjuvant chemotherapy and relatively successful immunotherapy in metastatic MSI tumors. Immunohistochemistry recognizes altered gene by recognizing loss of its protein product. Based on the presence or absence of Mismatch repair proteins, groups are classified into Mismatch repair proficient (MMR-p) and Mismatch repair deficient (MMR-d). Aim: To investigate the immunohistochemical profile of Mismatch repair proteins namely: hMLH1, hMSH2, hMSH6, and hPMS2 in surgically resected colorectal cancer specimens. Materials and Method: A total of 76 cases were selected from the Histopathology Department of HTAA to determine MMR protein expression status. Cases were either MMR-p or MMR-d. Results: Of the specimens which were properly immunostained, seventeen out of seventy-six cases (22.37%) showed loss of one or more MMR proteins expression and thus were MMR-d. MLH1, MSH2, MSH6 and PMS2 protein expression was detected as 85.53% (65/76), 81.6% (62/76), 88.16% (67/76), and 76.32% (58/76), respectively. Conclusion: Mismatch repair proteins profile should be done using immunohistochemistry in local laboratories on these selected cases before referring for the expensive molecular test.
Endoscopic retrograde cholangiogram pancreatography (ERCP) and biliary stenting is a minimally invasive procedure widely utilised to relieve biliary obstruction. Although not common, it is related with several possible complications. Stent migration causing duodenal perforation is 1 of its rare complications as being described in several previous case reports. However up to date there is no case report on migrated stent with subsequent duodenal and distal ileal perforation as will be discussed here. Importance of radiological examinations and its related findings in diagnosing this very rare complication will be described in this article.
Carbon monoxide measurement is one of the biomedical risk assessments in smoking cessation. With the advancement in medical devices, risk assessment among smoker using carbon monoxide can be an effective intervention for quit smoking. A systematic review was conducted on the effectiveness of using carbon monoxide measurement in smoking cessation intervention. Material and methods: A systematic review and narrative synthesis were done using PRISMA guideline. A broad database search on English literature was conducted including Medline, PubMed, Scopus and Science Direct from 2008 till 2017. Additional studies were also searched through snowballing technique by searching the bibliographies of selected studies. Five studies met the criteria with two studies were done in clinical settings while the other was done at population settings. The studies were conducted in the United States of America, United Kingdom and South Korea. All study were two-arm randomized controlled trials with variation in the outcome measurement mainly intention to quit, quit attempt and smoking abstinence. There was also variation in the duration of follow up ranging from 1 week to 12 months. Results: Only three studies found statistically significant increased in motivation or intention to quit smoking but only at 1 month follow up. All five study found no significant difference in frequency of quit attempt or smoking abstinence. Most of the studies recruited participants based on voluntary participation thus limiting the generalizability of the results. Conclusions: The present review has found limited studies on the effect of carbon monoxide measurement intervention for quit smoking. It may only be beneficial at the motivational level and not translated into behavioural changes. However, the effect too was short term and not sustained in the long term.
Pediculosis capitis has been a worldwide concern among the vulnerable population of primary school children due to the physical, economical and psychological consequences that it brings to both the children and their caretakers. It is observed that there were only limited studies conducted in Malaysia and no previous study was done in Kuantan despite the health concern that it bears. Since both local and worldwide studies show that Pediculosis capitis is more prevalent among female as compared to male school children, thus, this study aims to investigate the prevalence and predictors of Pediculosis capitis among female primary school children in Kuantan. Materials and method: An analytical crosssectional study using cluster random sampling was carried out in Kuantan, Pahang, Malaysia. A self-administered validated questionnaire was used to collect the data among female primary school children from standard one to six. Hair and scalp examination was performed to identify presence of Pediculosis capitis infestation. Multivariate logistic regression was used to control for potential confounding and determine the predictors Results: 10 schools participated in the study with total number of 636 female students as respondents. The overall prevalence of Pediculosis capitis among female primary school children was 17.6% (n=112). Multivariate logistic regression analysis showed that Indian (OR=5.634, 95% CI= 3.157-10.055), history of contact with infested person (OR=2.822, 95% CI=1.6193.691) and those who had number of family members more than four (OR=0.065, 95% CI=0.008-0.550) were predictors for Pediculosis capitis Conclusion: The prevalence of Pediculosis capitis among female primary school children in Kuantan, Pahang is endemic (17.6%) and predictors are Indian, history of contact with infested person and having family members of more than 4. Hence, there is a need for health intervention to reduce the burden of Pediculosis capitis infestation.
Diabetes Mellitus is a major global health concern worldwide with increasing trend as reported in the National Health Morbidity Survey 2015. Due to the fact that diabetes mellitus is a life long chronic illness and incurable, it contributes to the increased tendency of seeking Traditional Complementary Medicine (TCM). The objective of this study is to measure the prevalence of CM use among diabetic patients and its association with diabetic control. Materials and Method: A cross-sectional study was performed at Hospital Tengku Ampuan Afzan, between July to August 2018. 136 Type II adult diabetic patients in medical ward and diabetic clinic were interviewed regarding the use of CM, and their blood investigations results were collected from patients' medical records. A data collection form was used as the study instrument. Descriptive statistic was used to measure the prevalence while Fisher exact test and Independent t-test were used to find associations between CM usage with study background and diabetic control. Results: Low prevalence of Traditional Complementary Medicine use (16.9%) was found with retired group of respondents was identified to be the predominant group (p-value=0.025). Majority of patients used CM as an additional treatment for diabetes (60.9%). Friends, family members and advertisement were the main influential factors in starting and using CM. A significant difference in eGFR value was reported between inpatient and outpatient CM users with a p-value of 0.001. No positive association was observed for HbA1c level. Conclusion: 1 in every 6 diabetic patients in HTAA, Kuantan were using Traditional Complementary Medicine along with conventional diabetic medications in which retirees were the major group identified. eGFR was the diabetic control parameter that had been found to have a significant association with diabetic inpatients and outpatient CM users in this study.
Accurate corneal wavefront aberration measurements are essential in determining patient’s suitability, vision outcomes and patient satisfaction in laser refractive surgeries. This study aimed to evaluate the reliability measurement of higher-order aberration (HOA) using corneal videokeratograph Atlas 9000. Materials and method: 38 eyes of 19 participants were recruited in this study. Comprehensive eye examination was done to ensure all participants eligibility, and any conditions in which obstruct the central cornea were excluded. Corneal wavefront aberrations were measured based on Zernike polynomials. In assessing repeatability, three repetitive measurements in five minutes in a single session were taken by 2 experience examiners. For reproducibility measurement, similar approach was done with the time-interval between measurements was set at one week. Bland-Altman, limits of agreement (LoA) and intraclass correlation coefficients (ICCs) were used to evaluate the reliability measurement. Results: Bland-Altman and LoA findings revealed no significant differences for both repeatability and reproducibility measurement. For repeatability testing, the mean differences for vertical trefoil, oblique trefoil and spherical aberration were -0.096 ± 0.493, 0.001 ± 0.048, 0.008 ± 0.035, 0.004 ± 0.029, 0.010 ± 0.053 with LoA of 1.930, 0.188, 0.138, 0.114, and 0.208 respectively. Intraclass correlation coefficient (ICC) excellent reliability of 0.841 for all parameters. Likewise, reproducibility testing showed similar findings with the mean difference were -0.018 ± 0.091, 0.016 ± 0.061, -0.0004 ± 0.036, -0.002 ± 0.042, 0.003 ± 0.026, with LoA of 0.356, 0.24, 0.141,0.164, and 0.102 respectively. Intraclass correlation coefficient (ICC) shows excellent reliability of more than 0.9 for all parameters. LoA of less than 1.0 were observed in all measurements (except for repeatability of vertical trefoil) indicates high consistency of the measurements. Conclusions: Corneal videokeratograph Atlas 9000 provides excellent HOA measurement reliability.
Colorectal cancer (CRC) is the second most common cancer in Malaysia. In general, patients aged > 65 years comprise the majority of the population with CRC. However, recent reports indicate its increasing incidence in younger populations. We describe 4 cases of early onset colorectal cancer in Kuantan. Materials and method: This is a descriptive study of a small series of patients. Data between 2018 and 2019 were obtained from medical charts. Results: We diagnosed four patients under the age of 50 with colon cancer (75% male), the median age was 36 (23-47), with no comorbidities. None of the patient had family history of colorectal cancer. The majority of our patients presented with complication of tumour (2 perforation, 1 obstruction) required emergency surgeries. Only one patient presented with with rectal bleeding and was found to have tumor of the rectosigmoid junction. Two patients had tumor at descending colon and one at the splenic flexure. From this case series, we found there were one patient for every stage of colorectal cancer. Carcinoembryonic (CEA) levels were elevated at baseline in only two patients. Conclusion: Incidence of colon cancer rises among young patients in Kuantan. Further studies are needed to clarify the clinical and biological characteristics of colon cancer, improve its treatment strategies, and promote better outcomes in young patients.
Dental caries has remained a major oral health problem worldwide. Streptococcus mutans is considered as a vital cariogenic agent in the oral cavity. It can synthesise soluble and insoluble glucans from sucrose by glucosyltransferases enzymes and develops stable biofilm on the tooth surface. In the previous study, the fatty acids profile of activated virgin coconut oil (AVCO) have been described, and it includes the excellent antimicrobial activity of the oil. The current study aims to evaluate the antibiofilm effect of AVCO against the Streptococcus mutans ATCC 2157 biofilm in vitro. Materials and method: The minimum biofilm inhibition concentration (MBIC) and the minimum biofilm eradication concentration (MBEC) for antibiofilm activity were determined by serial dilution method, and biofilm thickness on S. mutans was quantified by confocal laser scanning microscopy (CLSM). Results: At the concentra-tion of 15.63 mg/ml of AVCO, it successfully inhibits the development of S. mutans ATCC 21575 biofilm and AVCO (62.52 mg/ml) eradicate biofilm that was formed by the bacteria. The z-stack images obtained from CLSM allows the construction of 3-D biofilm structure and a significant difference in the thickness of S. mutans ATCC 21575 biofilm pre and post-treatment with AVCO were observed. Conclusion: AVCO showed good potential as anticaries where it possesses the ability to inhibits and eradicate S. mutans ATCC 21575 biofilm. A future study to evaluates the interaction of individuals fatty acids present in AVCO against proteins that relate to biofilm formation of S. mutans can be performed utilising the molecular docking tools.
We report a 38-year-old gentleman who presented with painless haematuria for 6-months duration. Contrast-enhanced CT renal revealed a large, calcified intrapelvic mass with calyceal extension confined within the right kidney with moderate pelvicalyceal dilatation but no evidence of synchronous lesion elsewhere. Histopathological analysis showed high grade urothelial carcinoma of the renal pelvis with invasion of the renal parenchyma. Upper tract urothelial carcinoma (UTUC) which was once thought similar to urothelial carcinoma of the bladder (UCB), is increasingly being recognized as a different entity. However, heterogenous array of imaging manifestations of UTUC is also increasingly being encountered and pose diagnostic challenges though UTUC is not as prevalent as UCB which is easier to diagnose. Despite distinctive features against renal cell carcinoma (RCC), UTUC may mimic numerous other renal pathology especially the benign ones hence imaging plays a pivotal role to ascertain the diagnosis. This disease is usually treated with radical nephroureterectomy with superadded neoadjuvant chemotherapy for high risk cases. Less invasive endoscopic resection is also offered in certain cases but stringent surveillance of the whole urinary tract as well as post-operative follow-up are mandatory.
Majority of the traumatic spine injuries are located at the thoracolumbar region. They can be compression fractures, burst fractures, flexionextension injuries (Chance fractures), dislocations, or any of the combination. Surgery is indicated for patients with thoracolumbar injury classification scoring (TLICS) of 4 or more. Traditionally, surgical approaches for thoracolumbar spinal injuries involve open surgery, instrumentation with/without decompression. In our previous study, open surgery for traumatic thoracolumbar injuries and history of blood transfusion have been found to be associated with higher risk of deep surgical site infection requiring surgical debridement. With the advent of modern implants and equipments, minimally invasive surgery (MIS) has been made possible for spine surgeries. We report our two-year experience in utilizing MIS to treat traumatic thoracolumbar spinal injuries. Materials and method: Patients who underwent spinal surgeries at Hospital Tengku Ampuan Afzan, Kuantan from July 2017 to July 2019 were screened for suitability to be included in this study. Only patients who underwent spinal minimally invasive surgeries have been included in this study. Patients who underwent open spinal surgeries were excluded. Results: A total of 8 patients were included in this study. There were 3 burst fractures and 5 chance fractures. All patients underwent a minimum of 4-level posterior spinal instrumented fusion with MIS techniques and 2 patients had laminectomy at the injured level for decompression. All but one patient did not require blood transfusion and there was no incidence of surgical site infection among these patients. Conclusion: Minimally invasive surgery (MIS) is a better option compared to open surgery in treating traumatic thoracolumbar spinal injuries. By minimizing the surgical incision, we are able to reduce blood loss and avoid deep surgical site infection.
Solat or prayer, as one of the five pillars of Islam, and it is associated with bio-psycho-social benefits in Muslim patients. Â Many Muslim patients neglected solat while being hospitalized as they are unaware of the convenience (rukhsoh) available for them. Ibadah Friendly Hospital Courses have been conducted in different states of Malaysia to impart knowledge to the hospital staff who can in turn educate their patients. This study aims to construct a content-validated assessment tool and to assess the effectiveness of a state-level Hospital Mesra Ibadah course. Materials and methods: A self-administered questionnaire was constructed and content-validated by a panel of three experts (two religious teachers and one consultant spine surgeon). All 15 questions achieved item-level content validity index (I-CVI) of 1.00 after two rounds of validation. The questionnaires were distributed to participants of a state-level Hospital Mesra Ibadah course to compare the participants’ pre-course test score and post-course test score. Results: A total of 88 participants (48.9%) were included in this study. There was a significant difference in the pre-course test mean score and post-course test mean score among the participants. There was also a significant reduction of unsure answer after the course. There was no significant association found between the gender, place of working and occupations with the pre-post test score difference. Conclusion: This study demonstrates that the Hospital Mesra Ibadah course is effective in imparting as well as consolidating the knowledge among participants, hence it should be routinely organized to benefit more participants.
Actinomyces naeslundii is an oral microbiome that has been suggested to involve in actinomycosis particularly in immunocompromised patients. However, studies have also shown that the bacterium can inhibit the colonisation of Candida albicans and cariogenic bacterium, Streptococcus mutans. Even though various studies have been conducted to characterise A. naeslundii, however, the role of the bacterium in the oral cavity either to induce pathogenicity or to improve oral health remain unclear. The objective of this study is to determine the role of A. naeslundii in the oral cavity using bioinformatic tools with the hypothesis that A. naeslundii possesses genome similarity to oral probiotics. Materials and method: The study was conducted by data mining of the genomic sequences of A. naeslundii NCTC10301 from GenBank. Following that, genomic comparison was performed with 25 species of well-known probiotics. MAUVE version 2.3.1 was used to find similarities between A. naeslundii with the known probiotics through identification of potential relevance probiotic properties in A. naeslundii. Phylogenetic tree was constructed using PHYLIP package to identify evolutionary relationship of A. naeslundii with the known probiotics. The 16s rRNA sequences of A. naeslundii and known probiotics were harvested from GenBank using BLAST. Finally, the functions of all A. naeslundii genes that shared similarity with known probiotics were identified using INTERPRO. Result: Genome comparison analysis of the present study showed that A. naeslundii genome exhibited high similarity to Bifidobacterium species such as B. animalis subsp. lactis, B. bifidum, B. longum and B. breve. In addition, phylogenetic tree analysis showed that Bacillus species, B. subtilis and B. cereus , appeared to clade together with A. naeslundii, with bootstrap value of 98%. Conclusion: A. naeslundii had high similarity with probiotic Bifidobacterium species thus supported the hypothesis of the present study that A. naeslundii possesses genome similarity to oral probiotic.
Breast cancer is the commonest malignancy in Malaysian women. Cancer recurrence has been a detrimental factor towards survival with peak of recurrence recorded in first 2 years of diagnoses. Identifying the prognostic factors towards recurrence is important to management and prolonging survival. Materials and method: We have retrospectively analyzed 179 patients women with breast cancer based on 5 years single centre database with minimum follow up of 2 years. The demographic and clinicopathological characteristics were determined using descriptive statistics. Survival were calculated based on Kaplan- Meier method and multivariate analysis by Cox proportional hazards was performed to evaluate the potential factors affecting breast cancer recurrence. Results: Mean follow up was 42 months, with mean age 52 years and 60.9% presented in Stage II disease. Overall recurrence was 41.9% with local recurrence 2.1%, regional recurrence 12.3% and distant recurrence 27.4%. 50% of our patients developed recurrence at 25 months. In univariate analysis, time to first presentation was significantly correlated with recurrence. However, in multivariate analysis; tumor size, lymph node positivity and lymphovascular invasion were independently associated with recurrence. Conclusion: Even though local data on breast cancer recurrence is sparse, it does correlate with the international data. Thus, optimizing our care in breast cancer.
Sacral chordomas are rare, low-grade and slow growing malignant bone tumours arising from the sacral bone. They are locally aggressive with the tendency to metastasize to the lungs. Surgical resection remains the mainstay of treatment of sacral chordomas. However, most patients presented late with large tumours and intra-abdominal extension making en bloc resection highly challenging. Besides that, surgical resection poses risk of injury to the surrounding structures such as major blood vessels, bladder, ureters and rectum due to their proximity to the tumour. Therefore, multidisciplinary team approach is vital in ancipitating possible complications and preventing surgical morbidity. We present a case of advanced sacral chordoma which has been successfully resected with the assistance of pre-operative selective arterial embolization as a pre-emptive therapy. Case report: A 58-year-old lady presented with a large sacral chordoma (17.17 cm x 27.3 cm x 30.5 cm) with sacral erosion, infiltration to gluteus maximus, medius and minimus muscles and lung metastasis. A decision to perform a surgical resection was made to alleviate the pain secondary to sacral nerve compression. Anticipating massive bleeding intra-operatively, pre-operative arterial embolization was performed involving one branch of right internal iliac artery as well as five branches of left internal and external iliac arteries using endovascular coils. The tumour was resected with partial sacrectomy from S2 and below. Intra-operatively, 6 pints of packed cells were transfused with estimated blood loss of 4 litres. The patient recovered well after the surgery. She was pain-free post-operatively with no lower limb neurological deficit. Conclusion: Surgical resection remains the treatment of choice for sacral chordoma. Pre-operative selective arterial embolization can reduce intra-operative bleeding and avoid a potentially convoluted surgery.
There has been an increasing awareness on the end of life care for end stage renal disease (ESRD) patients and patients’ factors have been identified as pivotal elements in directing its implementation. Questionnaire has been a useful tool by researchers to assess on patients’ knowledge, perceptions and preferences on end of life care. However, up to date, there is no validated questionnaire developed in Malaysia for such purposes. Thus, this study aims to develop and validate questionnaires on end of life care knowledge, perceptions and preferences among ESRD patients in Kuantan. Materials and method: A cross-sectional study among haemodialysis (HD) patients aged 18 and above from 14 out-patient HD centres was performed. This study was divided into 4 phases i) developing the questionnaire involving related specialists and pre testing, ii) improving and editing the questionnaire and redistribution to 50 respondents for the pilot study, iii) factor analysis and iv) internal consistency reliability testing of the questionnaire. Results: The result of Factor analysis with Varimax rotation performed identified 3 domains for the 41 items, with 10 to 20 items in each domain. All the 41 analyzed items had a good factor loading of more than 0.4 with the lowest value of 0.421 and were nicely fit into 3 respective domains; knowledge, perception and preference. Internal consistency reliability analysis performed indicates that Cronbach’s α was between 0.5 to 0.7 for all factors which were higher than the level set for this study which is 0.5. Conclusion: The questionnaire is successfully validated and considered as a useful tool to be used. Nonetheless, improvement will still be necessary from time to time to ensure its relevance especially if it is to be used by different populations or countries of different background than Malaysia.
Oral cancer is the sixth most common cancer worldwide with Candida albicans infection being one of the aetiological factors for the disease. Meanwhile, Streptococcus salivarius K12 is an oral probiotic that is beneficial to the oral cavity. The objective of the present study is to determine the effect of S. salivarius K12 on C. albicans biofilm-forming ability with the hypothesis that S. salivarius K12 inhibits biofilm formation of C. albicans Materials and method: To assess the effect of S. salivarius K12 on C. albicans biofilm formation, S. salivarius K12, lab strain C. albicans MYA-4901 and clinical isolates from oral cancer, ALC2 and ALC3 were grown in both nutrient broth (NB) and RPMI. In a mono-species biofilm, 105 of C. albicans cells and 106 of S. salivarius K12 cells were grown separately in a 96-well plate. In contrast, both microorganisms were combined for polymicrobial biofilms with similar cell numbers as in mono-species. The biofilms were incubated for 72 hours at 37°C and the media were replenished every 24 hours. Finally, the crystal violet assay was conducted, and the optical density was measured at OD620nm. Results: Polymicrobial biofilms of C. albicans (MYA-4901 and ALC3) with S. salivarius K12 when grown in NB, exhibited a decrease by 64.5 ± 25.8% and 83.7 ± 5.4%, respectively when compared to the expected biofilms which were predominated by yeast form. Furthermore, polymicrobial biofilms of C. albicans (ALC2 and ALC3) with S. salivarius K12 showed a decrease by 62.5 ± 25.6% and 55.9 ± 17.1 %, respectively when compared to the expected biofilms when grown in RPMI that were predominated by hyphal form. Conclusion: S. salivarius K12 inhibited polymicrobial biofilms formation of C. albicans yeast and hyphal forms, thus supported the hypothesis that S. salivarius K12 inhibits biofilm formation of C. albicans.
Proper knowledge of oral diseases is crucial in medical practice because periodontal disease is associated with multiple systemic conditions. A large number of systemic diseases and drugs have oral manifestations as well as adverse reactions. The aim of this study is to assess periodontal awareness, knowledge and attitude among medical students of International Islamic University Malaysia (IIUM). Materials and method: This cross-sectional study utilized questionnaires which were distributed to fourth and final year medical students of IIUM Kuantan. Each participant’s consent was obtained before being recruited into the survey. Questions pertaining to oral health, periodontal disease and its relation with systemic conditions were given. Based on the answers, respondents’ awareness, knowledge and attitude were assessed.The data was analyzed by using Statistical Package for Social Sciences (SPSS) version 21. Results: A total of 93 students completed the survey questionnaires. 3% of them have awareness that periodontal disease is related to gingiva. 10% respondents agreed that the dental plaque is the primary cause of periodontal disease.80% respondents have knowledge of associations between periodontal disease and systemic conditions. 4% of them were able to identify drugs causing gingival enlargement. 97% of respondents showed positive attitude for referral to dentist in the future. Conclusions: The participants have superficial awareness and knowledge about periodontal disease and its relation to systemic conditions. However, they have positive attitude for future practice towards their patients. Hopefully, this research may provide direct suggestion to incorporate basic periodontal knowledge in their medical syllabus.