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Pattern of skin diseases among patients attending an outpatient dermatology clinic in a tertiary hospital in urban Malaysia

Kwan Z, Wong SM, Robinson S, Tan LL, Ismail R

Australas J Dermatol, 2017 Nov;58(4):e267-e268.
PMID: 28660702 DOI: 10.1111/ajd.12541
An ecological study of the relationship between urban built environment and cardiovascular hospital admissions (2004-2016) in an Asian developing country

Kwan SC, Ismail R, Ismail NH, Mohamed N

Soc Sci Med, 2021 05;276:113868.
PMID: 33799201 DOI: 10.1016/j.socscimed.2021.113868

This study aims to evaluate the relationship between urban built environment and hospital admissions from cardiovascular diseases in Kuala Lumpur, Malaysia. Hospital admission data from 2004 to 2016 for cardiovascular diseases were used with patient residential postcodes as the unit of analysis. Data was split into 2004-2009 (12,551 cases) and 2010-2016 (17,154 cases) periods corresponding to land use data. We used generalized linear mixed model to analyse population density, property value, entropy index, and the kernel density (800 m) of specific land use, bus and rail stations, and road junctions, with time period and postcodes as the random effects to generate incidence rate ratios (IRRs). Results indicated that entropy index and recreational area density were associated with fewer hypertensive disease and ischemic heart disease hospital admissions (IRR range: 0.49-0.68, 95%CI: 0.27, 0.97). Population density and property value were associated with fewer cerebrovascular disease hospital admissions (IRR range: 0.29-0.34, 95%CI: 0.11, 0.75). Contrarily, density of road junctions was associated with 2.5-6.3 times more hospital admissions for cardiovascular disease hospital admissions (IRR range: 2.53-6.34, 95%CI: 1.07,17.91). There were no significant association between hospital admission and density of residential area, undeveloped land, rail and bus stations. The shapes of relationships for all attributes were non-linear, and changed markedly at the third quartile except for recreational area density. The findings suggest that land use attributes have some protective effects on the cardiovascular disease admission cases as compared to the transport attributes. These findings have important merits for integrating health into urban planning.
The Malay Version of the Michigan Hand Outcomes Questionnaire: Cross-Cultural Adaptation, Validation and Reliability Testing

Lye JX, Kow RY, Ismail R, Khalid KA

J Hand Surg Asian Pac Vol, 2021 Jun;26(2):166-179.
PMID: 33928864 DOI: 10.1142/S2424835521500156

Background: The Michigan Hand Outcomes Questionnaire (MHQ), a self-reported questionnaire for patients with hand disorders, has been widely used globally. It has been cross-culturally adapted into different languages across all continents. Aims of this study were to translate the MHQ into Malay language and to evaluate its reliability and validity compared with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in a Malay-speaking population. Methods: The MHQ was cross-culturally adapted into a Malay version based on the guidelines. A pre-testing involving thirty patients with hand disorders was performed to assess whether it was comprehensible to the target population. One hundred patients with hand disorders were recruited in this study to answer the MHQ and DASH questionnaires. The MHQ was tested twice with an interval of two weeks in between. Statistical analysis was performed to assess the reproducibility and internal consistency via the test-retest method and Cronbach's alpha calculation, respectively. The association between MHQ and DASH questionnaire was assessed with Spearman's correlation calculation. Results: In the pre-testing, twenty-six patients (86.7%) understood all the questions in the Malay version of MHQ. The test-retest analysis showed a good reliability across the duration of two weeks with the intraclass correlation coefficient of all subscales ranging from 0.925 to 0.984. Cronbach's alpha values of the Malay version MHQ ranged from 0.82 to 0.97, indicating a good internal consistency. Spearman's correlation factor of the MHQ in comparison with DASH showed a fair to moderately strong correlation with the values ranging from 0.513 to 0.757. Conclusions: The Malay version of MHQ was successfully translated and culturally-adapted with excellent reliability (reproducibility and internal consistency) and good construct validity.
Anticipated delay in help-seeking for cancer symptoms: Findings from a nationwide study of Malaysian adults

Schliemann D, Ismail R, Donnelly M, Su TT

Cancer Epidemiol, 2021 04;71(Pt A):101882.
PMID: 33433363 DOI: 10.1016/j.canep.2020.101882

BACKGROUND: To investigate the relationship between anticipated delay in help-seeking and cancer symptom recognition and the extent to which this relationship varied according to socio-demographic and health-related characteristics.
METHODS: A cross-sectional telephone survey was conducted of 1895 adults aged ≥40 years who were randomly selected across Malaysia and interviewed using the Awareness and Beliefs about Cancer questionnaire, which was previously validated and culturally adapted by the research team. Logistic regression analysis was used to test the associations between anticipated delay for help seeking >2 weeks and socio-demographic and health-related variables.
RESULTS: Anticipated delay in help-seeking was reported for persistent cough (19.3 %), rectal bleeding (6.1 %) and breast changes (2.5 %). Difficulty in accessing a doctor was associated with anticipated delayed help-seeking for breast changes and rectal bleeding (adjusted ORs 7.58; 95 % CI 1.98, 28.94 and 2.37; 95 % CI 1.21, 4.66, respectively); not recognising the symptom 'unexplained bleeding' as a colorectal cancer warning sign was associated with anticipated delayed help-seeking for rectal bleeding (adjusted OR 1.54; 95 % CI 1.03, 2.31); and ethnicity was associated with anticipated delay for rectal bleeding and persistent cough.
CONCLUSIONS: Generally, anticipated delay to help-seeking for cancer symptoms in Malaysia (a middle-income country) appeared to be a less significant problem compared to other countries including high-income countries. There appeared to be a significant association between social variation indicators in Malaysia and anticipated delay in help-seeking.
Inhibition of Human Cytochrome P450 2c8-catalyzed Amodiaquine N-desethylation: Effect of Five Traditionally and Commonly Used Herbs

Muthiah YD, Ong CE, Sulaiman SA, Ismail R

Pharmacognosy Res, 2016 Oct-Dec;8(4):292-297.
PMID: 27695271

In Southeast Asia and many parts of the world, herbal products are increasingly used in parallel with modern medicine.
Fulltext Factors associated with tuberculosis disease among children who are household contacts of tuberculosis cases in an urban setting in Malaysia

Azit NA, Ismail A, Ahmad N, Ismail R, Ishak S

BMC Public Health, 2019 Nov 01;19(1):1432.
PMID: 31675946 DOI: 10.1186/s12889-019-7814-x

BACKGROUND: With the rise in prevalence of childhood tuberculosis (TB) globally, contact tracing should be a powerful strategy for early diagnosis and management, especially in children who are household contacts of active TB cases. Here, we aimed to determine the prevalence and factors associated with TB disease in children who are household contacts of TB cases.
METHODS: We used a cross-sectional study with data from the Malaysian TB Information System (TBIS) recorded from 1 January 2014 to 31 December 2017. All children aged 0-14 years who were registered in the TBIS with at least one household contact of TB cases were included in the study. Multiple logistic regression analysis was performed to calculate the adjusted odds ratio (adj. OR) and for adjusting the confounding factors.
RESULTS: A total of 2793 children were included in the study. The prevalence of active TB was 1.5% (95% confidence interval [CI]: 1.31, 1.77%). Children aged 6 weeks [adj. OR 7.48 (95% CI: 2.88, 19.43), p
Efficacy and safety of single versus multiple daily doses of glibenclamide in type 2 diabetes mellitus

Wan Mohamad WB, Tun Fizi A, Ismail RB, Mafauzy M

Diabetes Res Clin Pract, 2000 Aug;49(2-3):93-9.
PMID: 10963819 DOI: 10.1016/s0168-8227(00)00138-8

Although long acting, glibenclamide is frequently given in split doses for type 2 diabetes mellitus. This may discourage compliance. It is thus appropriate to consider dosing it less frequently. We therefore studied glibenclamide effects when used once daily and when used in split doses. Our objective was to assess the feasibility of using once daily dosing as a regimen of choice. We measured plasma glucose, insulin, glibenclamide, lipids, HbAl and body mass index associated with the regimens. We also compared the number of hypoglycemic episodes occurring with them. Thirty type 2 diabetics on multiple daily glibenclamide were enrolled. Their regimens were changed over to once daily. Blood for glucose, insulin, lipids, HbAl and glibenclamide and body weight measurements were determined before and after the crossover period. We found no major difference in the sugar and insulin profiles with the two regimens. Fasting total cholesterol and triglyceride were also similar and so were plasma glibenclamide. The HbAl levels and body mass index and number of minor and major hypoglycemic episodes and hospital admissions for hypoglycemia also did not differ. We conclude that single daily dosing of glibenclamide was equivalent to multiple daily dose regimens. It can be used to an advantage to improve patient's compliance.
Sleep quality in opioid-naive and opioid-dependent patientson methadone maintenance therapy in Malaysia

Zahari Z, Inrahim MA, Tan SC, Mohamad N, Ismail R

Turk J Med Sci, 2016 Dec 20;46(6):1743-1748.
PMID: 28081321 DOI: 10.3906/sag-1507-132

BACKGROUND/AIM: Sleep disturbances may contribute to poor treatment outcomes in opioid-dependent patients. The extent to which the sleep profiles of opioid-dependent patients differ from those of the general Malaysian population is not documented. This study compared opioid-naive subjects and opioid-dependent patients on methadone maintenance therapy (MMT) in terms of their sleep quality.
MATERIALS AND METHODS: Participants comprised Malay male opioid-naive subjects (n = 159) and opioid-dependent patients (n = 160) from MMT clinics in Kelantan, Malaysia, between March and October 2013. Sleep quality was evaluated using the translated and validated Malay version of the Pittsburgh Sleep Quality Index (PSQI).
RESULTS: The opioid-dependent patients exhibited higher global PSQI scores [adjusted mean (95% CI) = 5.46 (5.02, 5.90)] than the opioid-naive group [4.71 (4.26, 5.15)] [F (1, 313) = 4.77, P = 0.030].
CONCLUSION: This study confirmed the poorer sleep quality among opioid-dependent patients on MMT, as manifested by their higher global PSQI scores. The sleep complaints in this patient population are a factor to consider and, when necessary, sleep evaluation and treatment should be undertaken to improve MMT patients' quality of sleep and overall treatment outcome.
A simple method for the detection of CYP2C9 polymorphisms: nested allele-specific multiplex polymerase chain reaction

Zainuddin Z, Teh LK, Suhaimi AW, Salleh MZ, Ismail R

Clin Chim Acta, 2003 Oct;336(1-2):97-102.
PMID: 14500040 DOI: 10.1016/s0009-8981(03)00319-x

BACKGROUND: Cytochrome P4502C9 (CYP2C9), a principle drug-metabolizing enzyme is polymorphic in humans and is responsible for important pharmacokinetic and pharmacodynamic variations of CYP2C9 substrates. We developed an allele-specific multiplex polymerase chain reaction (PCR) method for the detection of common CYP2C9 alleles.
METHOD: Genomic DNA was extracted from blood obtained from 40 unrelated healthy Malaysian Indian volunteers. The DNA was subjected to a first PCR that was used to amplify both exons 3 and 7 simultaneously in one reaction tube and a second PCR that was used to detect the polymorphic sites of CYP2C9 alleles using allele-specific primers. Sequencing was performed to validate the test results.
RESULTS: We were successful in amplifying the fragments of interest from the DNA samples. The method was also reproducible and specific. The amplified sequences showed 100% homology to CYP2C9 sequence.
CONCLUSION: This is the first nested allele-specific multiplex PCR method reported to allow for the simultaneously detection of five CYP2C9 alleles.
Standard CYP2D6 genotyping procedures fail for the CYP2D6*5 and duplication alleles when hair roots are used as a source of DNA

Gan SH, Ismail R, Wan Adnan WA, Wan Z

Clin Chim Acta, 2003 Mar;329(1-2):61-8.
PMID: 12589966 DOI: 10.1016/s0009-8981(03)00019-6

BACKGROUND: Hair roots provide a useful alternative to blood as a source of DNA for genotyping. Besides simple and non-invasive collections, the DNA extraction step is also easy to perform and is fast. The aim of our study is to determine if hair roots can be used to genotype all of the common CYP2D6 alleles for routine screening purposes.

METHOD: The study complies with the Declaration of Helsinki. After obtaining informed consents, both blood and hair samples were collected from 92 patients for genotyping of the CYP2D6 gene. PCR was used to detect the following mutations: CYP2D6*1, *3, *4, *5, *9, *10, *17 and duplication gene. The results were compared where hair roots and blood were used as templates for DNA respectively.

RESULTS: When blood was used as a source of DNA for genotyping, all of the investigated CYP2D6 alleles were successfully amplified. However, with hair roots, the genes with the larger fragment sizes: CYP2D6*5 and the duplication gene could not be amplified and the bands of other alleles investigated were faint when visualized under UV light.

CONCLUSIONS: DNA extraction from hair roots and leucocytes yielded similar results but the DNA extracted from hair roots did not allow successful amplification of the longer genes such as the CYP2D6*5 and the duplication gene.
Fulltext Antibiotic Resistance during COVID-19: A Systematic Review

Sulayyim HJA, Ismail R, Hamid AA, Ghafar NA

Int J Environ Res Public Health, 2022 Sep 21;19(19).
PMID: 36231256 DOI: 10.3390/ijerph191911931

One of the public health issues faced worldwide is antibiotic resistance (AR). During the novel coronavirus (COVID-19) pandemic, AR has increased. Since some studies have stated AR has increased during the COVID-19 pandemic, and others have stated otherwise, this study aimed to explore this impact. Seven databases-PubMed, MEDLINE, EMBASE, Scopus, Cochrane, Web of Science, and CINAHL-were searched using related keywords to identify studies relevant to AR during COVID-19 published from December 2019 to May 2022, according to PRISMA guidelines. Twenty-three studies were included in this review, and the evidence showed that AR has increased during the COVID-19 pandemic. The most commonly reported resistant Gram-negative bacteria was Acinetobacterbaumannii, followed by Klebsiella pneumonia, Escherichia coli, and Pseudomonas aeruginosa. A. baumannii and K. pneumonia were highly resistant to tested antibiotics compared with E. coli and P. aeruginosa. Moreover, K. pneumonia showed high resistance to colistin. Commonly reported Gram-positive bacteria were Staphylococcus aureus and Enterococcus faecium. The resistance of E. faecium to ampicillin, erythromycin, and Ciprofloxacin was high. Self-antibiotic medication, empirical antibiotic administration, and antibiotics prescribed by general practitioners were the risk factors of high levels of AR during COVID-19. Antibiotics' prescription should be strictly implemented, relying on the Antimicrobial Stewardship Program (ASP) and guidelines from the World Health Organization (WHO) or Ministry of Health (MOH).
Linearity study on detection and quantification limits for the determination of avermectins using linear regression

Ismail R, Lee HY, Mahyudin NA, Abu Bakar F

J Food Drug Anal, 2014 Dec;22(4):407-412.
PMID: 28911453 DOI: 10.1016/j.jfda.2014.01.026

In this study, linear relationships between response and concentration were used to estimate the detection limit (DL) and quantification limit (QL) for five avermectins: emamectin, abamectin, doramectin, moxidectin, and ivermectin. Estimation of DL and QL was based on the standard deviation of residual and y-intercept of the regression line at low concentrations of avermectins, using the dispersive solid-phase extraction procedure. Avermectin extracts were analyzed using liquid chromatography tandem mass spectrometry. Based on the regression slope, DL and QL were higher at concentrations of 0.3-0.4 μg/kg and 1 μg/kg, respectively, for all avermectin compounds. Linearity assessment was performed by linear regression, which incorporated a regression model, outlier rejection, and evaluation of the assumption with a significant test. For all avermectins, there is a significant correlation between response and concentration in the range 1-15 μg/kg, and the y-intercept passes through origin (zero).
Method development and validation of a high-performance liquid chromatographic method for tramadol in human plasma using liquid-liquid extraction

Gan SH, Ismail R, Wan Adnan WA, Wan Z

J Chromatogr B Analyt Technol Biomed Life Sci, 2002 May 25;772(1):123-9.
PMID: 12016023

An HPLC system using a simple liquid-liquid extraction and HPLC with UV detection has been validated to determine tramadol concentration in human plasma. The method developed was selective and linear for concentrations ranging from 10 to 2000 ng/ml with average recovery of 98.63%. The limit of quantitation (LOQ) was 10 ng/ml and the percentage recovery of the internal standard phenacetin was 76.51%. The intra-day accuracy ranged from 87.55 to 105.99% and the inter-day accuracy, 93.44 to 98.43% for tramadol. Good precision (5.32 and 6.67% for intra- and inter-day, respectively) was obtained at LOQ. The method has been applied to determine tramadol concentrations in human plasma samples for a pharmacokinetic study.
Fulltext Knowledge, attitude and practice of healthcare workers towards antibiotic resistance during the COVID-19 pandemic

Al Sulayyim H, Ismail R, Hamid AA, Ghafar NA

JAC Antimicrob Resist, 2023 Jun;5(3):dlad068.
PMID: 37288079 DOI: 10.1093/jacamr/dlad068

BACKGROUND: During the novel Coronavirus 2019 (COVID-19) outbreak, there was an overuse of antibiotics in hospitals. The improper use of antibiotics during COVID-19 has increased antibiotic resistance (AR), which has been reported in multiple studies.
OBJECTIVES: To assess the healthcare workers' (HCWs) knowledge, attitude and practice (KAP) in relation to AR during the era of COVID-19, and identify the associated factors with good knowledge, positive attitude and good practice.
METHODS: A cross-sectional design was used to assess the KAP of HCWs in Najran, Kingdom of Saudi Arabia (KSA). A validated questionnaire was used to collect participants' data, which consisted of the following information; socio-demographics, knowledge, attitude and items for practice. Data were presented as percentages and median (IQR). Mann-Whitney and Kruskal Wallis tests were used to compare them. Logistic regression was used to identify the associated factors linked to KAP.
RESULTS: The study included 406 HCWs. Their median (IQR) knowledge score was 72.73% (27.27%-81.82%), attitude score was 71.43% (28.57%-71.43%) and practice score was 50% (0%-66.67%). About 58.1% of the HCWs stated that antibiotics could be used to treat COVID-19 infection; 19.2% of the participants strongly agreed and 20.7% agreed that during the COVID-19 pandemic, antibiotics were overused at their healthcare institutions. Only 18.5% strongly agreed and 15.5% agreed when asked whether antibiotics used properly for the right indication and duration can still result in AR. The significantly associated factors with good knowledge were nationality, cadre and qualification. A positive attitude was significantly associated with age, nationality and qualification. Good practice was significantly associated with age, cadre, qualification and working place.
CONCLUSION: Although the HCWs had a positive attitude regarding AR during COVID-19, their knowledge and practice need significant improvement. Implementation of effective educational and training programmes are urgently needed. In addition, further prospective and clinical trial studies are needed to better inform these programmes.
Barriers to effective implementation of end-of-life vehicle management in Indonesia

Sitinjak C, Simic V, Ismail R, Bacanin N, Musselwhite C

Environ Sci Pollut Res Int, 2023 Aug;30(37):87286-87299.
PMID: 37422560 DOI: 10.1007/s11356-023-28554-1

Effective end-of-life vehicle (ELV) management is crucial for minimizing the environmental and health impacts of Indonesia's growing automotive industry. However, proper ELV management has received limited attention. To bridge this gap, we conducted a qualitative study to identify barriers to effective ELV management in Indonesia's automotive sector. Through in-depth interviews with key stakeholders and a strengths, weaknesses, opportunities, and threats analysis, we identified internal and external factors influencing ELV management. Our findings reveal major barriers, including inadequate government regulation and enforcement, insufficient infrastructure and technology, low education and awareness, and a lack of financial incentives. We also identified internal factors such as limited infrastructure, inadequate strategic planning, and challenges in waste management and cost collection methods. Based on these findings, we recommend a comprehensive and integrated approach to ELV management involving enhanced coordination among government, industry, and stakeholders. The government should enforce regulations and provide financial incentives to encourage proper ELV management practices. Industry players should invest in technology and infrastructure to support effective ELV treatment. By addressing these barriers and implementing our recommendations, policymakers can develop sustainable ELV management policies and decisions in Indonesia's fast-paced automotive sector. Our study contributes valuable insights to guide the development of effective strategies for ELV management and sustainability in Indonesia.
Fulltext The effect of calcium silicate and ground magnesium limestone (GML) on the chemical characteristics of acid sulfate soil

Azman EA, Ismail R, Ninomiya S, Jusop S, Tongkaemkaew U

PLoS One, 2023;18(9):e0290703.
PMID: 37713375 DOI: 10.1371/journal.pone.0290703

Acid sulfate soil characterized by pyrite (FeS2) which produces high acidity (soil pH < 3.5) and release high amount of Al3+ and Fe2+. Application of 4 t ha-1 Ground Magnesium Limestone (GML), is a common rate used for acid sulfate soil by the rice farmers in Malaysia. Therefore, this study was conducted to evaluate the integral effect of ground magnesium limestone (GML) and calcium silicate and to determine the optimal combination on acid sulfate soils in Malaysia. The acid sulfate soils were incubated under the submerged condition for 120 days with GML (0, 2, 4, 6 t ha-1) in combination with calcium silicate (0, 1, 2, 3 t ha-1) arranged in a Completely Randomized Design (CRD). The soil was sampled after 30, 60, 90 and 120 days of incubation and analyzed for soil pH, exchangeable Al, Ca, Mg, K and available Si. A total of 2 out of 16 combinations met the desired soil requirement for rice cultivation. The desired chemical soil characteristics for rice cultivation are soil pH > 4, exchangeable Al < 2 cmolc Kg-1, exchangeable Ca > 2 cmolc kg-1, exchangeable Mg > 1 cmolc kg-1 and Si content > 43 mg kg-1. The combinations are i) 2 t ha-1 calcium silicate + 2 t ha-1 GML, and ii) 3 t ha-1 calcium silicate + 2 t ha-1 GML, respectively. These combination rates met the desired requirement of soil chemical characteristics for rice cultivation. Soil acidity was reduced by a gradual release of Ca2+ and SiO32- from calcium silicate continuously filling the exchange sites and reducing the potential of extra (free) H+ availability in the soil system. Combination of calcium silicate and GML, shows the ameliorative effect with; i) release of Ca, ii) binding of Al3+ making it inert Al-hydroxides and, iii) bind H+ to produce water molecules.
Tumefactive demyelinating lesion and bilateral optic neuritis in a paediatric myelin oligodendrocyte glycoprotein antibody-associated disease

Siti Aeisyah A, Ain Masnon N, Ismail R, Mohamed AR

BMJ Case Rep, 2023 Dec 16;16(12).
PMID: 38103908 DOI: 10.1136/bcr-2023-255679
Fulltext Healthcare commissioners' experience with antibiotic resistance during the COVID-19 pandemic in Saudi Arabia: a qualitative study

Sulayyim HJA, Ismail R, Hamid AA, Abdul Ghafar N

J Pharm Policy Pract, 2024;17(1):2290671.
PMID: 38205192 DOI: 10.1080/20523211.2023.2290671

INTRODUCTION: The occurrence of antibiotic resistance (AR) has become a critical issue during the Novel coronavirus disease 2019 (COVID-19) pandemic. This study explores the experiences of healthcare commissioners with AR during the COVID-19 pandemic, identifies challenges, and provides recommendations for combating AR during pandemics.
METHODS: This qualitative study was multi-centered and used a phenomenological approach. Semi-structured interviews were conducted between December 2022 and January 2023 among 11 health commissioners using video calls.
RESULTS: Seven themes emerged from the data, including knowledge of AR and its consequences, the antibiotic prescription system, the future of AR and potential contributory factors, the impact of COVID-19 on AR and their relationship, the experience of AR during the COVID-19 pandemic in healthcare facilities, barriers that prevent the misuse of antibiotics during pandemics, and recommendations regarding antibiotic resistance during pandemics.
CONCLUSION: The findings of this study could be used to inform policy and practice for government healthcare workers (HCWs) and the public. Furthermore, this study identified the main challenges of AR during the pandemic, and the recommendations of health commissioners were provided accordingly. Such recommendations could be beneficial on a national and international scale to reduce the impact of future pandemics on AR.
ABBREVIATIONS: COVID-19: Novel coronavirus disease 2019; AR: Antibiotic Resistance; IPC: Infection prevention and control; MDRO: multi-drug resistant organism; ASP: Antimicrobial Stewardship Program; HCW: Healthcare worker; KSA: Kingdom of Saudi Arabia; WHO: World Health Organization; MOH: Ministry of Health; MOEWA: Ministry of Environment, Water, and Agriculture; AMR: Antimicrobial Resistance; PHCC: Primary Healthcare Center.
Fulltext Cancer symptom and risk factor awareness in Malaysia: findings from a nationwide cross-sectional study

Schliemann D, Ismail R, Donnelly M, Cardwell CR, Su TT

BMC Public Health, 2020 Apr 06;20(1):464.
PMID: 32252721 DOI: 10.1186/s12889-020-08581-0

BACKGROUND: Cancer incidence in Malaysia is expected to double by 2040. Understanding cancer awareness is important in order to tailor preventative efforts and reduce the cancer burden. The objective of this research was to assess nationwide awareness about the signs and symptoms as well as risk factors for various cancers in Malaysia and identify socio-demographic factors associated with awareness.
METHODS: This cross-sectional study was conducted from March-November 2014 in the form of a telephone survey. Participants aged 40 years and above were randomly selected across Malaysia and interviewed using the validated Awareness Beliefs about Cancer (ABC) measurement tool. Linear regression was conducted to test the association between symptom and risk factor recognition and socio-demographic variables.
RESULTS: A sample of 1895 participants completed the survey. On average, participants recognised 5.8 (SD 3.2) out of 11 symptoms and 7.5 (SD 2.7) out of 12 risk factors. The most commonly recognised symptom was 'lump or swelling' (74.5%) and the most commonly recognised risk factor was 'smoking' (88.7%). Factors associated with prompted awareness were age, ethnicity, education and smoking status.
CONCLUSION: Recognition of symptom and risk factors for most cancers was relatively low across Malaysia compared to previous studies in high-income countries and to studies conducted in Malaysia. There is a need to conduct regular public health campaigns and interventions designed to improve cancer awareness and knowledge as a first step towards increasing the early detection of cancer.
Fulltext Return to flying after coronary artery disease: A case series among Malaysian pilots

Mohammad Z, Ismail R, Mohamed Rus MR, Haron MH

J Occup Health, 2021 Jan;63(1):e12241.
PMID: 34155722 DOI: 10.1002/1348-9585.12241

OBJECTIVES: Pilots with coronary artery disease (CAD) are at increased risk of myocardial infarction, stroke, and possibly death. Return to flying duties may be considered after a detailed risk assessment. The aim of this retrospective case series is to describe the return to flying duty process.
METHODS: We conducted a retrospective case review of pilots diagnosed with CAD at the Institute of Aviation Medicine (IAM), Royal Malaysian Air Force (RMAF) in October 2020.
RESULTS: Thirteen cases of CAD were included in the review. Ten pilots were diagnosed after developing acute coronary syndrome; the remaining three pilots were diagnosed during a routine medical examination via an exercise stress test. Twelve pilots required a revascularization procedure. A total of 11 pilots (84.6%) were recertified for flying duties, while another two were disqualified. The duration to recertification for these 11 pilots was between three months and one year.
CONCLUSIONS: The risk assessment was initiated with initial risk-stratification using population-appropriate risk calculator combined with the 4 × 4 aeromedical risk matrix. The reassessment of return to flying after coronary artery disease must be carried out no sooner than six months after the event. Pilots must be hemodynamically stable with no evidence of significant inducible ischemic left and a minimum 50% of ventricular ejection fraction (LVEF). A follow-up is recommended at the initial six months after recertification and then annually with a routine noninvasive cardiac assessment.

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