Background: Those with increased dynamic knee valgus are vulnerable to increased risk of non-contact knee
injuries. However, studies on the top down kinetic chain of lower limb mechanics during dynamic motions
such as single leg squat (SLS) among trained males were scarce.
Objective: The objective of the study was to evaluate the relationship between isokinetic hip and knee strength
and frontal plane projection angle (FPPA) of the knee joint during SLS.
Methods: Thirty-two male junior athletes (twelve cyclists, ten runners and ten squash players) were screened
for excessive dynamic knee valgus (DKV) prior to participation. Only those within the normal value of DKV were
included. Their hip and knee isokinetic strength in sagittal plane were evaluated at 60º/s of angular velocity
for both legs using dynamometer. Two dimensional knee FPPA was evaluated during SLS at 60º of knee flexion.
Pearson correlation was evaluated between knee FPPA during SLS and isokinetic leg strength.
Results: Correlations between knee FPPA and hip and knee isokinetic strength were not statistically significant
except between knee flexion peak torque/body weight (r = -0.35, p = 0.05) and hamstring to quadriceps ratio
(r = -0.39, p = 0.03) of non-dominant leg.
Conclusions: Isokinetic hip and knee strength and knee FPPA during SLS was correlated only for non-dominant
leg during SLS among male junior athletes. DKV during SLS may be reduced through strengthening the muscles
around hip and knee joints.
Background: The cytokine cascade in the immunopathogenesis of malaria infection had been widely studied.
However, their specific association with survival and severe infection remained obscure.
Methods: The study investigated the cytokine profiles and histopathological features of malaria in the severe
infection and survival models by using male ICR mice and male Sprague Dawley rats respectively.
Results: The severe model, the infected ICR mice, exhibited a high parasitemia with 100% mortality after
peak parasitemia at day 5 post-infection. The survival model, the infected Sprague Dawley rats, showed
mild parasitemia with full recovery by day 14 of infection. Both severe and survival models showed similar
histopathological severity during peak parasitemia. The severe model produced highly elevated levels of proinflammatory
cytokines, TNF-α and IL-1α, and low levels of the anti-inflammatory cytokine, IL-4; while the
survival model showed low levels of TNF-α and IL-1α with high levels of IL-4.
Conclusion: There were differences in the pathogenesis of the severe and survival models of malaria infection.
These could be a basis for immunotherapy of malaria in the future.
Background: Astrocytic gliomas are the most common primary brain tumors that developed from glial origin.
The angiogenic cell population from brain tumor enhances the recruitment of circulating cancer stem cells
homing towards tumor site.
Objectives: This study aimed to investigate the tumor angiogenic cell population that stained with CD133+
and VEGFA+ markers and its association with circulating cancer stem cell (CD133+/VEGFR2-) population in the
peripheral blood mononuclear cells (PBMCs) of astrocytic glioma patients.
Methods: A total of 22 astrocytic glioma patients from Hospital Universiti Sains Malaysia who consented to
the study were included. Tumors (n=22) were sliced and stained with CD133+ and VEGFA+ angiogenic markers
and counter stained with DAPI. The circulating cancer stem cells (CD133+/VEGFR2-) in PBMCs (n=22) were
quantified using FACS based on the expression of CD133 and VEGFR2 markers. The paired t-test and Pearson
correlation were used for the data analysis.
Results: The percentage of angiogenic cell population was significantly higher in brain tumor compared to
adjacent normal brain tissue (1.25 ± 0.96% vs. 0.74 ± 0.68%; paired t-test=2.855; df=21, p = 0.009). Positive
correlation was found between the angiogenic cells of brain tumor tissue and adjacent normal brain tissue
(Pearson correlation, r = 0.53, p = 0.011). Significant positive correlation was found between angiogenic cells
in glioma tumor and cancer stem cells in peripheral circulating systems of astrocytic glioma patients (Pearson
correlation, r = 0.42, p = 0.049).
Conclusion: Angiogenic cells in the brain tumor resident promote the recruitment of circulating cancer stem cells
homing to the tumor site and induce the proliferation and growth of the tumor in astrocytic glioma patients.
Background: Most postpartum women are prescribed at least one medication; so the safety of the medication
is a major concern. In 2017, 11% of 815 questions received by the Pharmacy Drug Information Services at seven
clinics in Dungun is related to medication use in breastfeeding. Thus, this study was carried out to evaluate
the attitudes of healthcare providers (HCPs) and to investigate the effect of knowledge about medication use
in breastfeeding among HCPs; pre- and post-educational intervention.
Methods: An interventional study was carried out among medical officers, assistant medical officers,
pharmacists and pharmacist assistants from seven clinics in the district of Dungun, Malaysia. The questionnaires
were distributed during pre- and post-intervention period. The interventions in this study included continuous
medical education (CME) and the use of a booklet regarding medication use for breastfeeding women. The
data collected were analyzed using Statistical Package for Social Studies (SPSS) and presented as frequencies,
means, and standard deviations.
Results: Fifty HCPs were enrolled in this study and over 20% of them advised mothers to discontinue
breastfeeding whenever they are prescribed any medication. The knowledge of HCPs about medication use in
breastfeeding women was significantly improved (Z= -5.917, p
Background: Despite regularly participating in international and national level multisport events, there is still
limited data on the pattern of injuries and illnesses and factors associated with injuries and illnesses in Malaysia.
Such information is crucial to instil preventive measures because sustaining injuries during competition could
hamper the athlete’s performance.
Methods: This cross-sectional study investigated the incidence, patterns and risk factors of injuries and illnesses
among athletes throughout SUKIPT 2018, from the 2nd to the 10th of February 2018. All injuries and illnesses
treated by tournament medical personnel were reported using a standardised online injury reporting form.
This form was adapted from the injury surveillance form used by the International Olympic Committee.
Results: A total of 6071 athletes from 80 contingents took part in SUKIPT 2018. During the nine days of
competition 323 injuries and 48 illnesses were reported, resulting in an incidence of 5.3 injuries and 0.8 illness
per 100 athletes. Approximately 6% of the athletes sustained at least one injury or illness.
Conclusion: In summary, the incidence of injuries and illnesses among athletes during SUKIPT was 5.3 and
0.8 per 100 athletes, respectively. Muscle strain/rupture/tear was the most common pattern of injury while
collision with another athlete was the most frequent mechanism of injury. Meanwhile, the respiratory system
was the most commonly affected by illness and infection was the most prevalent cause of illness.
Cryptococcus neoformans is an encapsulated fungal pathogen that causes severe disease primarily in
immunocompromised patients. Adherence and internalisation of microbial pathogens into host cells often
begin with engagement of microbes to the surface receptors of host. However, the mechanisms involved
remain poorly understood. In this study, we investigated the association of cell surface determinants of C.
neoformans with mammalian cells. Our results showed that treatment with trypsin, but not paraformaldehyde
or heat killing, could reduce host-cryptococci interaction, suggesting the involvement of cell surface proteins
(CSPs) of C. neoformans in the interaction. We extended our investigations to determine the roles of CSPs
during cryptococci-host cells interaction by extracting and conjugating CSPs of C. neoformans to latex beads.
Conjugation of CSPs with both encapsulated and acapsular C. neoformans increased the association of latex
beads with mammalian alveolar epithelial cells, alveolar macrophages and monocyte-derived macrophages.
Further examination on the actin organisation of the host cells implied the involvement of actin-dependent
phagocytosis in the internalisation of C. neoformans in CSP-conjugated latex beads. We hypothesised that
CSPs present on the cell wall of C. neoformans mediate the adherence and actin-dependent phagocytosis
of cryptococci by mammalian cells. Our results warrant further studies on the exact role of CSPs in the
pathogenesis of cryptococcosis.
Background: Studies on the anthropometric, physical and physiological characteristics among Malaysian Paralympic powerlifters are limited. This study examined the sociodemographic, clinical information and anthropometric physical parameters of Paralympic powerlifters in Malaysia.
Methods: A cross-sectional study was conducted during a Powerlifting Workshop and National Championship in 2016. A structured questionnaire was used to collect data on powerlifters’ sociodemographic, sports participation history and medical information. All participants underwent a structured physical medical examination and anthropometric assessments.
Results: Fifty-two powerlifters participated in this study. Mean age of participants was 24.50±SD8.25 year. The majority of the participants were men (82.7%) and most had spinal cord injury (34.6%) or amputation of the lower limb (26.9%). Most of the powerlifters competed at district and state level championships and 42.3% had represented Malaysia at international competitions. Women powerlifters had a significantly higher amount of body fat compared to men (35.61% vs 19.80%; p=0.003). Male power-lifters had significantly longer arm and forearm length (30.10±IQR3.00 cm vs 23.00±IQR2.13 cm; p=0.020). A significantly positive relationship was found between age, experience, weight, BMI, LBM, arm circumferences (relaxed and tensed) and the powerlifter’s best lift. Age, experience, body weight, BMI, lean body mass, body fat, hip circumference and arm circumferences (relaxed and tensed) met the criteria for inclusion in a multivariate model. Years of experience and non-dominant arm circumference (tensed) were significant predictors of best lifts among powerlifters.
Conclusion: In conclusion, assessment of anthropometric measures could be useful in monitoring athletes’ progress with training and have a role in the talent identification program for Paralympic powerlifters.
Objectives: Pancreatic cancer is an aggressive silent killer with a median survival of a few months. It is the
fourth leading cause of cancer death in the United States. The aim of this study was to evaluate the prognostic
factors affecting the survival of patients with adenocarcinoma of the pancreas in Malaysia.
Methods: This retrospective study examined 107 patients with adenocarcinoma of the pancreas from 2002
to 2012 at University Malaya Medical Centre. The factors evaluated were age, sex, race, smoking habits,
performance status, the presence of jaundice, pre-treatment CA 19.9 serum level, the location of a primary
tumour, tumour grade, tumour staging and intent of treatment.
Results: The median survival for the overall study population was 7.0 months (95% CI 5.1-8.8 months) with
1, 3, and 5-year survival rates of 30.8%, 8.4% and 3.7% respectively. The survival was 16.1 months (95% CI
7.7-24.4 months) for stage 1, 15.5 months (95% CI 8.1-22.8 months) for stage 2, 8.4 months (95% CI 6.1-10.8
months) for stage 3, and 3.8 months (95% CI 2.9-4.7 months) for stage 4. In multivariate analysis, independent
and unfavourable prognostic factors which retained significance were performance status, tumour stage and
treatment intent.
Conclusions: The biological characteristics are important as predictors of survival in patients with pancreatic
cancer. Longer survival is possible if the disease is identified in its early stages with good performance status.
Further development and evaluation of novel screening strategies need to be established to improve early
detection of this disease.
Background: Hepatitis C Virus (HCV) is a major public health problem worldwide. About 130- 200 million people
are infected with HCV worldwide leading to 500,000 deaths annually (WHO 2014). Healthcare workers (HCWs)
have played an important role in the transmission of HCV infection, either as victims or as sources of infection.
Objectives: To determine the prevalence of HCV, antibodies (Abs) RNA and genotypes among the female HCWs
in Baghdad and to identify whether HCWs were infective or only infected.
Subjects and Methods: A cross-sectional study involving 1001 women attending 17 health care centres in
Baghdad, Iraq, was carried out. Information on type and duration of their occupation was obtained. HCV Abs
(anti-HCV) were tested using a third generation enzyme immunoassay (EIA-3) and immunoblot assay (Lia
Tek-111). Molecular analysis using RT-PCR and DNA enzyme immunoassay (DEIA) for HCV-RNA and genotype
detections were carried out for 63 serum samples.
Results: Only 160/1001 (15.98%) were HCWs. Anti-HCV and HCV- RNA seroprevalence were significantly higher
(6.37%, p=0.0057, 88.83%, p= 0.011 respectively) among HCWs than non HCWs. HCWs were at a significantly
higher risk of exposure to HCV infection (OR=2.75, 95% C.I. =1.31-5.79). There was no significant association
between HCV genotypes and the HCWs. HCV-4 showed higher expression (62.5%) among HCWs.
Conclusion: Female HCWs were infective and infected with HCV, thus there is a need for medical equipment
to be sterilized and cleaned thoroughly.
Background: School children are at great risk of nutrition-related chronic diseases. Their eating pattern in
school is influenced by the availability of food served within the school environment. The purpose of this
paper was to determine the effectiveness of a canteen-based food nutrition intervention, designed according
to the theory of planned behaviour, on the knowledge, perception and choices of healthy food among primary
schoolchildren.
Methods: This was a prospective intervention study using a two-group design. Six school canteens from the
ninety-eight primary schools were randomly allocated to an intervention group or a control group. All the
food handlers in the intervention group were given a twelve-week training course in food nutrition. On the
completion of the course, 293 Standard Six students from these schools, were interviewed with a nutritional
questionnaire on food in their school canteens. The training programme for the intervention group and the
questionnaire for the students were developed and validated for the study, and a power calculation made for
the sample size of students.
Results: The students in both groups were homogeneous in gender and body mass. The mean body mass
index (BMI) was 19.26 (SD: 0.38) and 19.47 (SD: 0.39) for the intervention and the control group respectively.
There were more schoolchildren in the intervention group who purchased foods in school canteens (p 0.0036)
of milk and milk products (p 0.034), and white rice (p
Introduction: Providing adequate and equal access to healthcare is a key goal towards achieving universal health coverage. However, social and demographic inequalities in accessing health care services exist in both developed and developing countries. This study examined the demographic and socio-economic factors associated with the lack of access to public clinics in the Greater Kuala Lumpur area.
Materials and Methods: The study employed a survey involving 1032 participants. Data were collected using self- administered questionnaires distributed between October and December 2015 in the Greater Kuala Lumpur area.
Results: Of the 1032 participants, 535 were public clinic users. A quarter (25.8%) of the users stated that they did not have access to public clinics in their residential area. A multiple logistic analysis showed that the elderly, the women, those from ethnic minority groups, those of lower family income, and the private sector workers were more likely not to have access to public clinics than their counterparts.
Conclusions: The existing level of accessibility to public clinics could be improved by increasing the number of clinics. Clinics should be established to focus more on reaching the elderly, the women, the ethnic minority groups, the poorer families, and the private sector employees.
Introduction: Studying in a university can be stressful for any undergraduate student, and the excessive
stress is associated with physical and mental health problems. The purpose of the study was to examine the prevalence and determinants of perceived stress among undergraduate students in a Malaysian university.
Methods: 456 undergraduate students participated in this study. The Perceived Stress Scale and the Student Stress Survey (SSS) were implemented as indicators; PSS as a global measure of perceived stress, and the SSS for the identification of the sources of stress.
Results: The prevalence rate of perceived stress among the undergraduate students was 37.7%. The overall PSS mean score was 27.5 ( SD 4.763), with a cut-off value of perceived stress at 28. Multivariate logistic regression model identified that the female student (OR 1.995, 95% CI 1.313-3.031) and the first year student (OR = 2.383, 95% CI 1.047-5.422) perceived more stress than the others.
Conclusion: The present study demonstrated a high prevalence rate of perceived stress among undergraduate students in general, and the female and the first year undergraduate students in particular. There is a need for further studies on the borderline stress of the undergraduate students and the sources of stress.
The study aimed at government efforts in making maternal and child healthcare services more available to
rural women, many of whom who still seek care from traditional practitioners during the postpartum period
after childbirth. In this research, we explored the role of traditional practitioners, such as Traditional Birth
Attendants (TBAs), herbalists and spiritualists, in traditional maternity care and the implications for the health
of the expectant mother, foetus or baby. This qualitative inquiry used purposive sampling and snowballing to
select the respondents in their various localities. It was observed that the traditional practitioners performed
both spiritual and medical roles during pregnancy and childbirth.
In the study, we discovered that both mothers and babies were exposed to health risks, as administration
of the herbal medicines and assistance at deliveries were carried out under unhygienic conditions. The
techniques used in labour management were not in compliance with the recommendations of the World
Health Organisation. The stages of maternity were characterised with the application of herbal concoctions
with spirituality attached.
The study recommends re-examination of mediating socio-cultural factors to professional health care. There
is a need for the Ghana Health Service to ensure the efficacy and safety of herbal drugs as well as to monitor
the production and application of such medicines.
Background: The rise in substance-use-related problems among Malaysian adolescents called for a study to
assess the efficacy of an anti-drug educational program to improve the knowledge, attitude and perception
(KAP) of Malaysian students regarding substance use.
Methods: This study involved 573 students from four Malaysian Chinese schools in Malacca. Each student
filled out a Likert-scale mandarin translated questionnaire (KAP-C) on substance use ( Pre-test). Following an
educational program on substance use, the KAP-C questionnaire was given again to the students, immediately
following the program (PT 1), and after a month (PT 2) and two months (PT3) of the programme.
Results: The students showed improvement in knowledge of the types of substance use in PT 1 (p
Long-distance running has gathered some momentum among health-conscious participants. However, some
studies have revealed association between long-distance running and development of acute kidney injury.
Although the impact usually lasts only for a few days after the event, some participants have been admitted for
severe acute kidney injury, the minority of which require dialysis treatment. The mechanisms underlying the
injury may include dehydration, development of rhabdomyolysis, heat stroke and concomitant use of NSAIDS.
Unfortunately, there is no long-term follow-up study to determine the long-term effect on kidney function.
Acute hyponatremia may develop in a significant proportion of long-distance runners. Majority of them were
asymptomatic but a few fatal cases which were supposedly due to cerebral oedema have been reported.
Excessive intake of hypotonic drinks, excessive sweating and secretion of non-osmotic antidiuretic hormone
have been postulated to be the causes of hyponatremia. This mini review will discuss the pathophysiology of
the development of acute kidney injury and hyponatremia. It will also discuss the prevention and treatment
of both conditions.
Purpose: The object of this study was to identify patients with diagnosed dengue infection, who were positive
for both dengue-specific NS1 antigen and IgM antibody.
Method: From January 2013 to December 2016, in Central Kolkata in West Bengal in India, patients with
symptoms of dengue infection, were sent to the laboratory by the physicians for confirmatory diagnosis of
dengue infection. A total of 4762 patients were seen, and serum samples tested and distributed into seven
panels, according to the investigations requested. 1436 patients were tested positive.
Results: 1053 cases were tested for both NS1 and Ig M antibody, 835 for dengue-specific NS1 antigen, IgM and
IgG antibodies and 218 for NS1 dengue-specific antigen and IgM antibody. Of these, dengue was confirmed in
34.3 %, with 16.6% positive for both NS1 antigen and IgM antibody. Eleven were diagnosed, with late dengue
infection, thirty-nine with late primary infections and ten with late secondary dengue infection.
Conclusions: Many of the patients were reactive for both NS1 antigen and IgM antibody, and they required
proper attention and strict vigilance with effective monitoring and treatment, not of early dengue infection,
but of late dengue infection. Unless the serological tests for Ig M and IgG antibodies, and the dengue specific
viral antigen NS1 are performed simultaneously, these types of cases would not all be detected.
congenital deformity among paediatric patients. The outcome of starting clubfoot treatment early is very
promising. Patient retention throughout the treatment programme is challenging in Sarawak. In this study,
we explored the barriers that parents/caregivers face when seeking clubfoot treatment in Sarawak, Northwest
Borneo. A better understanding of the barriers will provide us with the information to formulate effective
programmes for clubfoot treatment in this region.
Methods: We conducted a questionnaire-based quantitative cross-sectional descriptive survey. We adapted
a set of closed-ended questionnaires originally designed by Kazibwe and Struthers in a study done in Uganda
in the year 2006.
Results: A total of 53 parents/caregivers of children with idiopathic clubfoot were recruited in this study, with
16 defaulter cases and 37 non-defaulter cases. We found 2 statistically significant barriers to clubfoot treatment
in Sarawak, with p-value < 0.05, namely the geographical factor (p = 0.019) and logistic factor (p = 0.017).
Conclusion: Barriers to clubfoot treatment that influence the compliance to treatment identified in this study
are long distance travel, logistics limitations, uncooperative patients during treatment, parents/caregivers
having other commitments, unsupportive family members, lack of understanding regarding clubfoot and its
treatment, inadequate specialists in clubfoot, traditional socio-cultural beliefs and practices and economic
constraints. Enhanced understanding in this matter will guide us in devising culturally admissible ways to
increase awareness in parents/caregivers regarding clubfoot and its treatment. A sustainable national clubfoot
program will be very beneficial in providing a holistic approach to tackle barriers to treatment in our country.
Objective: The study was designed to determine the risk perception of the public population in Kota Kinabalu towards childhood immunisation.
Methodology: This was a cross-sectional study where self-administered questionnaires were distributed to the public in Kota Kinabalu. The respondents who consented were 18 years old and older. The illiterate persons and the foreigners were excluded. The calculated sample size was 400. Only 313 samples collected were suitable for analysis using SPSS v21.0.
Results: Fever, pain swelling and allergic reaction were correctly identified as risks of immunisation. Autism, mental retardation and even death could also result from vaccination. Of the total respondents, 76.7% agreed with the practice of childhood vaccination, 70.0% thought that childhood vaccinations were safe and effective and 58.1% felt that its benefit outweighed the risk. Other than that, 32.0% refused childhood vaccination from fear of its risks, and this fear was the main reason for the refusal of childhood vaccination. Age, marital status, race and income were the factors which influenced parental willingness to vaccinate their children (p<0.05).
Conclusions: Most participants understood the risks of childhood vaccination, but few agreed to the practice of childhood immunisation for herd immunity. Public health campaigns are needed, to increase the understanding and acceptance of childhood vaccination especially in the rural community.
Keywords: Childhood Immunisation, Parental Risk, Perception, Public Acceptance
Graft-versus-host Disease (GVHD) is the main cause of morbidity and mortality after allogeneic hematopoietic
stem cell transplantation (alloHSCT). In spite of immune-suppressive prophylaxis, most survivors suffer from
acute and chronic GVHD (aGVHD and cGVHD). The outcome of alloHSCT may be affected by the presence of
single nucleotide polymorphism (SNP) in non-HLA genes including those involved in innate immune responses.
This study aimed to evaluate the impact of cytotoxic T-lymphocyte antigen-4 (CTLA-4) and caspase recruitment
domain 15 (NOD2/CARD15) gene polymorphisms on the incidence and severity of aGVHD and cGVHD following
alloHSCT. A structured literature review was carried out using various keywords and MESH terms such as
stem cell transplantation, allogenic haematopoietic stem cell transplantation, GVHD, and non-HLA gene
polymorphism, in PubMed, Google Scholar and Cochrane Database. A total of 8 studies that met inclusion
criteria (English publications from 2006 to 2017) were included. Ten SNPs in CTLA-4 gene and three SNPs in
NOD2/CARD15 gene were tested in patients with underlying haematological malignancies. Four studies tested
the SNPs of CTLA-4 gene and two were found to have an association with CTLA-4 SNPs (rs3087243, rs231775)
and increased incidence of aGVHD. The other four studies tested the SNPs of NOD2/CARD15 gene and one
found an association between SNP13 and increased incidence of aGVHD. None of these eight studies found
any effect on severity of GVHD. In conclusion, two SNPs in CTLA-4 and one SNP in NOD2/CARD15 increased
the incidence of aGVHD but not its severity. The higher incidence of aGVHD in studies with larger sample size
could support the impact of SNPs in the outcome of alloHSCT. However, due to the heterogeneity of studies in
regard to the age of patients and donor, and conditioning regimen, it is difficult to draw a definite conclusion.
Locked pubic symphysis is a rare form of pelvic injury that usually occurs after a lateral compression injury to
the pelvis, where the intact pubis is trapped behind the contralateral pubis. To the best of our knowledge, there
were 25 similar cases reported in the English literature since it was first described in 1952. We present a case
of locked pubic symphysis with a left iliac wing fracture and a left femur shaft fracture requiring open reduction
and internal fixation. We also reviewed previous reported cases of locked pubic symphysis and analysed the
pattern of presentation and guide to management of such injuries. We propose a classification system for
grading overlapping pubic symphysis that will provide a better guide to the management of such injuries.