Defatted dabai peel contains a high amount of anthocyanin. Anthocyanins are known to prevent several
types of disease, including cardiovascular-related complications. This study aimed to describe the
effects of different doses of defatted dabai peel extract by histopathological analyses on lesions in the
liver, kidney, heart and aorta. Histopathology methods were applied to determine the protective effects
of defatted dabai peel extracts against hypercholesterolemia-induced oxidative damages to animal
organs. Haematoxylin and eosin staining was applied for histopathology examination for liver, kidney,
heart and aorta. Data showed that a high dose of defatted dabai extract (3000 mg per day) applied to
hypercholesterolemic rabbits for eight weeks had mild protective effect, especially reducing the severity
of hepatic fibrosis and steatosis of the renal medulla. The high dose of extract supplementation also
reduced inflammation of aorta and formation of atherosclerosis plaque in the cell wall of right ventricle
of the heart. The high dose of defatted dabai peel extract could be a protective agent against oxidative
stress.
Introduction: With the increasing number of institutions implementing competency-based education which demands to provide feedback to students at regular intervals, there is an increase in the frequency of assessments. For this purpose, the written examinations using multiple choice questions (MCQs) are the most feasible form of assessment. However, constructing MCQs is an arduous task and significantly adds to the work-load of the academ- ic staff members. To ease this burden, the institutions may consider to develop banks of valid and reliable MCQs. Methods: Based and built on our experience and literature review, the steps – relating to the process of constructing valid and reliable questions and development of question banks (QBs) – are the actions needed to develop new QBs or improve on the existing ones. Results: We have described ten practical steps for developing and banking of MCQs. The first five steps relate to the development of quality items and the remaining steps relate to the development of QBs, their maintenance, growth and safety and security. We have also established the criteria for selection and the frequency of reuse of questions. Conclusion: Using QBs will alleviate some of the burden of constructing novel quality questions needed for frequent assessments of students using 21st century teaching/learning approaches. The use of banked questions with known psychometric properties would allow the authorities to take charge and control of items’ quality and overall examination standards.
Mid-aortic syndrome (MAS) is a rare clinical entity that is
characterized by coarctation involving the distal thoracic and/or
abdominal aorta and its major branches accounting for 0.5–2%
of all cases of coarctation of the aorta (1). Renovascular
hypertension can be a significant sequelae - it is the main
symptomatic presentation of this disease among children and
adolescents. We describe a 9-year-old girl who presents with
recurrent abdominal pain and symptomatic hypertension. Due to
significant left ventricular systolic dysfunction and uncontrolled
hypertension, percutaneous balloon angioplasty was performed
to treat the coarctation. To our knowledge, this is the first
reported case of MAS in Malaysia. This case report highlights
the clinical presentation, the role of computed tomography
angiogram (CTA) in the diagnosis and current options in the
management of MAS.
Introduction: Glucose-6-phosphate dehydrogenase (G6PD) deficiency causes red blood cell destruction due to oxi- dative stress. G6PD is essential for NADPH conversion; which is critical for glutathione reductase to prevent damage to cellular structures. In Malaysia, blood donors are not routinely screened for G6PD deficiency. We hypothesise that G6PD-deficient red blood cells are more likely to haemolyse during storage due to increased oxidative molecules. The objectives of this study were to determine the prevalence of G6PD deficiency among blood donors, describe their characteristics and to evaluate the effects of storage on G6PD-deficient donated blood. Methods: This study was conducted at selected mobile donation centres in Terengganu. Consented blood donors were screened for G6PD sta- tus using fluorescent spot tests (FST). G6PD enzyme activities were measured for donors who were G6PD deficient. Effects of storage on haemolysis from G6PD-deficient donors were compared with non G6PD-deficient group. Sixty ml of blood was collected from blood unit to transfer pouch for estimation of haemoglobin (Hb), plasma Hb, per- centage of haemolysis and plasma potassium. Serial sampling with a 7-day interval was done from Day 1 to Day 35. Statistical analysis was considered significant if p 0.05. Results: A total of 440 blood donors were screened and 12 male donors were found to be G6PD deficient by FST. Enzymatic activities were measured in 11 donors as one donor sample failed to be sent to the centre due to logistic problem. Their enzymatic activities ranged from 1.66-2.93 U/g Hb whereby 6 have severe deficiency and the other 5 were categorised as partial deficiency. Donors were asymp- tomatic for haemolytic episode. Serial sampling showed there was no significant difference of haemolytic parameters in blood units of G6PD-deficient donors as compared to control (p>0.05). Conclusion: Prevalence of G6PD blood donors in Terengganu mobile centres was 2.7%. G6PD enzyme activities did not correlate with clinical symptoms. Haemolytic parameters were not affected in blood units which were G6PD-deficient.
Physical inactivity is strongly associated with obesity and an increased risk of cardiovascular disease in children and adolescents. A cross-sectional study using multistage random sampling was conducted to determine associations between demographic characteristics, sedentary behaviours and physical activity among adolescents. Data were collected from 785 (414 males and 371 females) Form four students attending 15 schools in Petaling District, Selangor using an adapted self-administered questionnaire. Results showed that more females (50.1%) were physically inactive compared to males (39.6%) (Adjusted odds ratio (OR): 1.55, 95% confidence interval (CI): 1.12-2.15). Physically inactive adolescents were less likely to participate in intramural/house league sports (OR: 1.71, 95% CI: 1.19-2.44), school team sports (OR: 1.45, 95% CI: 1.03-2.04) and individual physical activities outside school (OR: 1.53, 95% CI: 1.11-2.12) compared to their physically active counterparts. Physically inactive adolescents were also less engaged in sedentary activities, such as television watching (OR: 0.69, 95% CI: 0.50-0.94), playing computer/video game (OR: 0.44, 95% CI: 0.28-0.72), talking on the telephone/mobile phone text messaging (OR: 0.47, 95% CI: 0.32-0.69) and reading (OR:0.45, 95% CI: 0.24-0.86) compared to those who were physically active. In this study, physical activity coexists with sedentary behaviour in adolescents. Sedentary activities may not necessarily displace physical activity among youth. In addition, these data suggest that promoting organised sports in school and outside the school among youths may be a potential strategy for increasing physical activity in this population.
Introduction: The electronic cigarette (EC) usage has raised public health concerns; whether its advantages to smok- ers as a potential smoking cessation aid have outweighed its negative health impacts among EC users. This study aims to estimate health risks associated with chemical exposures to nicotine, propylene glycol (PG) and selected To- bacco-Specific Nitrosamines (TSNAs) namely 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and N’-nitro- sonornicotine (NNN) in e-liquids locally-manufactured in Malaysia. Methods: The health risk assessment (HRA) was performed using established guideline by the Environmental Protection Agency (EPA). The average daily dose (ADD) and lifetime average daily dose (LADD) were calculated using previously published data on chemical concentration of selected compounds and local EC usage topography data. Next, the non-carcinogenic risk (nicotine and PG) and carcinogenic risk (NNK and NNN) were calculated and denoted as total hazard quotient (HQT) and total lifetime cancer risk (LCRT) value, respectively. Results: For non-carcinogenic risk, the mean of HQT was 78.9 which falls un- der “unacceptable” risk as demonstrated by HQT value of more than 1. While for carcinogenic risk, the mean of total LCRT value was 1.54E-04 which may place EC users at risk of developing cancer resulted from exposure to selected TSNAs. Conclusion: Comprehensive HRA using currently available data of local EC usage topography and chemical evaluation of Malaysian-made e-liquids have revealed that the exposure to nicotine, PG and selected TSNAs are expected to be a significant health concern for local EC users. This finding supports the local health authority to issue a stringent health policy in considering EC as a tool for smoking cessation among heavy smokers.
Introduction: Under 5 mortality is a leading indicator of the level of child health and overall development of a coun-try. In Malaysia, progressive reduction has been observed from 1990 however since 2000 progress has been static. Further understanding about this trend is crucial. The objective of this study was to identify causes of mortality for better policy development in order to further reduce this rate. Methods: Analysis of mortality trends was done using data from Department of Statistics and causes of mortality using data collected through the Stillbirth and Under 5 Mortality Reporting System (SU5MR) in 2016. Results: The trend for Under 5 mortality rate between 2006 till 2016 is still plateaued and hovered between 8 to 9 per 1000 live births at the national level. High percentage of death is seen among the neonatal group (51%), followed by children 28 days to 1year (31%) and toddlers 1-4 years (18%). Percentage of preventable deaths increased with age i.e. 21% among neonates, 41% among children 28 days to 1year and 48% among toddlers. The leading causes of death are conditions from perinatal period (34.4%), congen-ital malformation (30%), injuries and external causes (6.4%), respiratory (5.6%) and certain infectious and parasitic disease (5.1%). Conclusion: To further reduce under -5 mortality focus needs to be on preventable deaths; to reduce neonatal deaths will require political commitment to ensure adequate resources; interagency collaboration is needed to reduce toddler mortality and family and community awareness on prevention of injury and infection.
Retinoblastoma is a rare intraocular malignant tumour more commonly seen in children below five years of age. We presented a rare case of retinoblastoma in an older child. A nine-year-old girl noticed that she had loss of vision OS following a fall at home. Her vision was 6/6 OD and only light perception OS. Examination of the left eye revealed an extensive exudative retinal detachment. Her right eye examination was unremarkable. CT scan showed a left eye intraocular mass with calcification. EUA revealed a mixed endophytic and exophytic mass with extensive exudative retinal detachment. Family members consented to left eye enucleation and histopathological report confirmed the diagnosis of retinoblastoma. Post enucleation, patient is doing well with a prosthetic eye. In conclusion, any unexplained visual loss in children regardless of age warrants a full ophthalmological examination as the possibility of retinoblastoma cannot be ruled out.
Introduction: In the present scenario there are many qualified nursing human resources with flawless emotional personality but with errors in job accomplishment, lack of accuracy and delays in working completion, low working motivation, as well as careless and insincere working. The qualified nursing human resources must consist of nurses with a passion for work and with creativity. They must be proactive, with great deal of warmth and smiles. Based on the required nursing competences, it is found that the on-duty nurses should acquire several vital proficiencies such as leadership qualities, proper working procedures, interpersonal/soft skills, and environmental control. Soft skills may be developed and improved through various ways like trainings, modification of the environment, and with appropri- ate nursing education. Methods: The research population consists of 18 master's degree nursing students of a hospital divided into a control and experimental group (total sampling), and 47 on-duty nurses who are collected through a random sampling technique. Results: The results of the present study show that the implementation of transformation- al leadership model is effective to improve nurses' soft skills in terms of self-assurance, communication, compliance, teamwork, precision, discipline and problem solving. There were also noteworthy changes after the model imple- mentations based on 1st month and 2nd month and then on those at 1st month and 3rd month. Conclusion: The Soft Skills-Based Transformational leadership model is highly applicable in nursing care units of all hospitals to meet the challenges of the world in improving human resources by means of improvement of performance. With respect to soft skills and intrapersonal skills as well as the frequently neglected nurses' daily activities and portfolio worksheets are highly effective in dealing with the model applications.
Introduction: Computer usage has become an indispensable tool in the official set up of all the workplaces in the current era. Predominance of musculoskeletal disorders (MSDs) in relation to habitual posture during work is the utmost problem of modern society. Teaching staff stand out amongst a group of workers exposed to occupational MSDs. The objective of this study was to identify the prevalence and risk factors of musculoskeletal disorders in relation to posture and computer ergonomics at workplace among the college and university staff in Petaling Jaya, Malaysia. Methods: This cross-sectional quantitative study was conducted from August 2019-October 2019, among 419 volunteers by using a self-administered survey questionnaire. Descriptive and bivariate statistics were used for the analyses of multiple variables. The association between demographic characteristics, computer ergonomics and prevalence of musculoskeletal pains were analyzed through Chi-square test. Results: 55.8 % respondents (n=234) reported neck pain (NP), (n=196) 46.8% shoulder pain (SP) and (n=308) 73.5% low back pain (LBP) respectively. A significant relationship between desktop computer usage and musculoskeletal pains in LBP (P=0.036) and SP (P=0.023) was observed. Significant association of head posture was found with NP (P=0.002), SP (P=0.042) and LBP (P=0.001), correspondingly. Discussion: Habitual postures were significantly associated with musculoskeletal pains while using computer. Conclusion: This study proved with precession that higher prevalence rate of musculo- skeletal disorders was undoubtedly influenced by prolonged sitting, awkward postures at workstation, and repetitive movements of shoulders and hands. Further synchronous studies are vital to limit the modern era of musculoskeletal disorders.
Acute epiglottitis though relatively common in pediatric patients as compared to adults, present with almost similar clinical presentations. They include voice change, difficulty or painful swallowing and sometimes with upper airway obstruction. Physical finding of swollen epiglottis is difficult to be obtained owing to the danger of introducing laryngeal mirror into the oropharynx as to avoid contact spasm. The diagnostic thumb sign appearance on lateral neck radiograph is considered pathognomonic of epiglottitis. We report a case of an adult with clinical features and radiological finding of an acute epiglottitis, which did not resolve with antibiotic treatment. Subsequent imaging confirmed the presence of an abscess in the epiglottic mucosa.
Introduction: Psychological consequences of traumatic events are often overlooked by both medical professionals and patients themselves. Post-traumatic stress disorder (PTSD) is the most serious condition in the spectrum of trau- ma- and stressor-related disorders. Left untreated, it may result in physical and mental illnesses as well as social and occupational dysfunction. In the Malaysian Muslim population, stigma against mental illnesses frequently deter in- dividuals suffering from psychological trauma from presenting to mental health services. These people prefer the use of spiritual and religious healing approaches to manage their post-traumatic stress symptoms. The objective of this study was to describe the Islamic cognitive restructuring techniques employed by motor vehicle accident victims for post-traumatic stress. Methods: An exploratory qualitative study involving 9 Muslim motor vehicle accidents victims was conducted from May to September 2015. Subjects were interviewed in-depth using semi-structured interview schedules. These interviews were recorded, transcribed verbatim and analysed with the aid of Atlas.ti software. Re- sults: Psychological intervention such as cognitive restructuring is an effective technique to overcome post-traumatic stress. In this study, our subjects employ cognitive restructuring techniques with predominantly Islamic content. Al- most half of the subjects believe that God will not create hardship but some good will come out of it. Other subjects approach cognitive restructuring by being thankful for the small tests of hardships and compared their situation with others of worse fate. Conclusion: Islamic cognitive restructuring is a useful technique to manage posttraumatic stress symptoms. Further research is needed to determine the effectiveness of this approach.
Haemophilia A is an inherited bleeding disorder, commonly involve soft tissues and joints. Gastrointestinal tract
bleeding, are not uncommon but seldom highlighted. A 23-year-old male with underlying severe haemophilia A was
presented with a generalised abdominal pain for 2 days, abdominal distension, diarrhoea and vomiting. He did not
have any trauma to the abdomen. Abdominal examination revealed generalized tenderness with sign of guarding
on palpation. Laboratory investigations revealed isolated, prolonged activated partial thromboplastin time (APTT)
with normal total white blood cell count and haemoglobin level. In view of acute abdomen, which was not resolved
by conservative treatment, an emergency laparotomy was done with FVIII concentrate and recombinant factor VII
(rFVII) coverage. Intraoperative findings noted patchy gangrenous spots of about 30 cm in length in the small bowel.
Histopathology examination revealed an evidence of haemorrhage within the submucosal and intramuscularis layer
from the resected specimen. This case highlighted the possibility of gastrointestinal bleeding without prior trauma,
which can be presented as acute abdomen in severe haemophilia patient.
Necrotizing fasciitis (NF) is a deadly soft tissue infection causing a significant morbidity and mortality. Abdominal and chest wall NF are unusual. We describe a 49-year-old male with anterior abdominal wall NF secondary to per- forated gastric ulcer (PGU). He was admitted in septic shock presenting an abdominal wall NF with severe metabolic acidosis requiring dialysis and admission to the intensive care unit. There was a patch of gangrene with surrounding skin discoloration at lower quadrant of the abdominal wall. Local debridement was done without a preoperative computed tomography that was performed after surgery. Adequate source control was not achieved after the second surgery and the patient had worsened resulting to death. We describe this rare presentation of NF and discuss the issues learnt from this unfortunate event.
Penetrating injury to the abdominal viscera is not uncommon unless when it is caused by marine life. We present a 39-year-old fisherman from a tropical country who had sustained a penetrating injury from a stab wound to the abdomen due to needlefish impalement. He sustained a small perforation of the sigmoid colon during exploratory laparotomy and primary repair was done. Although this incident is rare, there are cases involving seawater activities either for leisure, sport or diving for fishing. We highlight this rare incident and discuss the management plan.
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: 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.
Clinical vampirism in psychiatric practice is very rare and usually associated with schizophrenia, antisocial personality disorder or paraphilia. An Asian case of clinical vampirism is described. It is about a 24-year-old Malay female, paramedic student, who craved for blood since childhood. She injured her sister and herself so that she could access and drink blood. There was no associated psychosis or medical problems. The craving for blood may represent her underlying craving for parental love and attention.
Introduction: Aedes albopictus is known for its aggressiveness towards human and recently expanded to more coun- tries outside the native regions. Thus, the demographic parameters of Aedes albopictus are important to determine the characteristics of this species mosquitoes in terms of the reproduction rates and dispersal distance. Materials and Methods: This study, was performed using a Shah Alam strain of Aedes albopictus originally collected in twenty district areas of the central zone of Shah Alam. This research applies field work-study with a cross-sectional design to investigate the demographic parameters of Aedes albopictus. The demographic evaluation of Aedes albopictus was conducted under the control environment in insectarium. Results: Investigation on the demographic parameters of Aedes albopictus clearly showed that there is a significance different observed in the total number of mosquito eggs produced in both high and low incidence rate IR areas (p=0.03). In contrast, other parameters showed insignificant value between high and low IR areas. Conclusion: The key to control the mosquito vectors population is by tracking the vector’s life cycle including its survival. Therefore, the outcome of this study may provide as a baseline to esti- mate the dengue outbreak in the current episystem.
Introduction: Banana is a perishable fruit and rapidly overripe which can cause food waste problems to
occur if not used to prepare other foods. Drying would be useful to overcome this problem by converting
the overripe banana into a value-added product. Therefore, this study aims to evaluate the effect of different
temperatures for foam mat drying on overripe banana puree. Besides, the sensory attributes and acceptability of banana cakes produced will be evaluated. Methods: The overripe banana puree was subjected to
foam mat drying and the dried powder was subjected to banana cake production. Physical analysis,
chemical analysis, and sensory evaluation were carried out for the banana cakes. Results: A significant
different (p