Abstracts of 4th Scientific Research Conference, organised by the Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah.
Background: Malaysia has been ranked the fattest country in Southeast Asia. Overweight and obesity are the fifth leading risk factor for death globally in 2008. It may lead to increase of risk of non-communicable diseases such as cardiovascular diseases, diabetes, cancer and hypertension.
Objectives: This research aimed to determine the prevalence of overweight and association of overweight with sociodemography, lifestyle as well as its health related conditions of adults in Kampung Tiga Papan.
Methods: Cross-sectional analytical study was used to achieve our specific objectives. A total of 199 adults aged 18 years and above in Kampung Tiga Papan had been recruited by non-probability sampling method. Sociodemographic data and lifestyle adopted were obtained via validated questionnaire, the BMI status of respondents were calculated, blood pressure was measured and DASS-21 score was used to assess mental health of the respondents.
Results: There are 118 (59.3%) respondents categorized into overweight group (BMI>23 kg/m2) and 130 (65.3%) respondents are having abdominal obesity (Waist-hip ratio: male>0.9 and female>0.8). There are significant association between gender, household-income, alcohol status and preference of food and BMI status. Besides, there are significant association between gender, household income, alcohol and smoking status and significant increased risk of hypertension in overweight group.
Conclusion: Overweight is associated to some sociodemographic and lifestyle factors. It helps to target high risk population and community intervention can be done to reduce the prevalence of overweight
Introduction: Vision is an important requirement for learning and plays a critical role in the development of a child during the first three years of life. Little is known regarding the extent of visual impairment amongst preschool children in Sabah.
Objective: To determine visual status among preschool children in Kota Kinabalu and to determine prevalence of refractive error among children who were referred by the programme.
Methodology: A retrospective cohort study of clinical records was conducted at Department of Ophthalmology, Hospital Queen Elizabeth, Kota Kinabalu, Sabah from May to September 2017. Criteria for failed vision were VA 6/12 (0.3 LogMar) or worse. All records of referred children were selected for prevalence of refractive error. Data collected include basic demographic data, visual acuity and refractive error. Myopia was defined as spherical equivalent (SE) ≥−1.00 DS, hyperopia SE ≥+3.00 DS and astigmatism ≥−1.50 DC.
Results: A total of 192 children age 4 to 6 years old were screened, comprised of 102 (53.1%) male and 90 (46.9%) female (mean age: 5.81 ± 0.41 years). Of the 192 students, 39 (20.3%) of them failed vision screening. Among the 39 children, only 17 children came for further eye assessment. Twelve (70.6%) of them had a binocular visual impairment (VI) while 5 (29.4%) children had monocular VI. Six years old children were found to have VI more compared to other age groups (n= 14, 82.4%) and majority of this age group having binocular VI (n=10, 83.3%). Mean SE was −0.60 ± 0.94. Astigmatism is the commonest type of refractive error found with a prevalence of 41.4% followed by myopia, 27.6%.
Conclusion: This study was the first attempt to investigate the visual status among preschool in Kota Kinabalu. As most children were found with astigmatism, early detection of significant refractive error could help to minimize the effect of VI.
Prostate carcinoma is a common health issue that can metastasise in the spine. A 65-year-old male was diagnosed with prostate carcinoma and two years later he developed a progressive neurological deficit over the bilateral lower limb. He experienced severe back pain, became paraplegic and the quality of life was severely impaired. Radiographic investigations were done and revealed osteoblastic bone metastasis at thoracic vertebrae with spinal cord compression. The patient underwent surgical decompression surgery at the T9 level mainly for pain control. Six months post-surgery not only the pain was well controlled but patient able to ambulate with walking aid. It is a rare post-operative result as the neurological recovery in a patient with complete paralysis is less than 3%. This type of recovery is possible when the cause of the neurological deficit is mainly mechanical compression from tumour rather than cord ischaemia from traumatic injury.
The first case of COVID-19 in Malaysia was detected on 24 January 2020.1 As of 10 September 2020, when this editorial article is written, the total cases have increased to 9,628 cases, with active cases of 333 are being isolated and undergoing treatment, while 9,167 cases achieved recovery.2 The number of deaths in Malaysia due to COVID-19 is 128 people. Within the past few months, there has been increased in the number of clusters of infection in some states including Sabah. The number of cases in Sabah is currently at 592 cases.
Antenatal (AN) care is vital for all pregnant women and for reduction of maternal mortality and morbidity. AN care knowledge and specific AN care practices are some of the crucial components of what determines effective AN care. In developing nations, the health of pregnant women can be even more sensitive to these factors. Objectives of this study was to assess the antenatal (AN) care practice and pregnancy outcome of ever-married women aged 18 to 49 years old having at least one pregnancy experience ,residing in kampongs of Sikuati area, Kudat between March to December 2015. Cross–sectional descriptive study, non-probability convenient sampling method was used and 150 eligible participants were interviewed through face to face by trained interviewers using a semi-structured questionnaire and their knowledge of AN care, their AN care practices and outcomes and complications of their pregnancies were recorded. 99% of all the women received AN care, and 64% of the women received essential AN care practice (AN visit of minimum 4 times). The study revealed that overall knowledge amongst the women with good knowledge was 48% and low knowledge was 52%. Despite this, it was found that low knowledge of AN care was associated with essential AN care practice. Additionally, AN care practices, assessed through timing of first AN care visit and frequency of visits, was not significantly associated with pregnancy complications. Despite these results, outcomes were good and all complications were properly and successfully addressed. This may reflect the effectiveness of current programs in place promoting importance of AN care and delivery practices. Maintenance of current programs with targeted interventions to address low knowledge level and the low level of compliance with essential AN care completed are recommended..
PHC services particularly the ambulance call is traditionally a hospital-based system. Within the Kota Kinabalu area, there are 3 tertiary hospitals that provide the ambulance call service; and also provide the interfacility transfer, disaster management and medical team standby. How about the health clinics? Health clinics play a major role for primary healthcare and the interfacility transfer of patient from the health clinics to the hospital.
Irrational use of drugs could be detrimental issues in the practices of healthcare communities. This problem arises either because of the wrong prescription or inappropriate self-medication. Faulty prescribing practices and incorrect self-medication will lead to an ineffective treatment regime. Still, they can also be unsafe as these may exacerbate or prolong the illness and distress the patients. In turn, these will incur unnecessary treatment costs. The most typical issues in the irrational use of drugs are the patient’s lack of information about the medicine and inadequate proper consultation from physicians. Lack of regulation in the appropriate use and supply of drugs by the relevant enforcement agencies could also be the problem in the irrational use of drugs. Ulceration and inflammation due to the irrational use of NSAIDs, antibiotics, and unhealthy lifestyle may contribute to the novel therapeutic strategy challenges. The ability to purchase the drugs without a doctor’s prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) was also the landmark event that became the most widely used medications for the anti-inflammatory, analgesic, and antipyretic effects. Inadequate knowledge from both drug providers and patients may contribute to the most recognized influential factors in the irrational use of drugs in various countries. The recommendation should introduce an appropriate educational intervention that can be designed to promote rational prescribing. Proper regulation on prescription practices by policymakers and physicians could be the way to ensure the standard of rational usage of drugs have compliant with the healthcare communities.
Skeletal metastasis is a frequent complication of cancer resulting in significant morbidity as well as mortality. We highlight a case of a 73-year old gentleman with metastatic squamous cell carcinoma of the sternum. He denied dysphagia, shortness of breath, goitre, and presence of chronic non-healing ulcer. He was anaemic and carcinoembryonic antigen (CEA) was 18.7. Chest radiograph on lateral view showed a suspicious cortical irregularity. Computed tomography (CT) scan of thorax revealed an aggressive sternal lesion with soft tissue component. Ultrasound guided biopsy was performed and the biopsy was consistent with metastatic squamous cell carcinoma. Squamous cell carcinoma has a predilection to metastasize via haematogenous spread, but direct extension of tumour into the bone is not frequently seen. Finding the primary cause is utmost importance either via imaging modalities or invasive procedures. Isolated secondary lesion is extremely rare but unfortunate among defaulters. We discuss its diagnostic work-up and treatment options conserved to manage this condition.
Lung cancer is by far the most lethal cancer, causing approximately 1.4 million deaths in 2008. Meanwhile, tuberculosis (TB) presents a global threat. Various research and studies had been reported in correlation of pulmonary tuberculosis and lung carcinoma. These cause diagnostic challenges from the multi-faceted presentations and lesions in radiograph mimicking each other.
Introduction: Critically-ill patients are commonly fed with EN via open system (OS) or closed system (CS). Several studies showed that patients on CS had received greater volume of EN compared to OS.
Objective: As there was no study conducted in Malaysia, hence this study is conducted to compare the energy and protein adequacy of both systems.
Methodology: This cohort prospective study was conducted in GICU (OS) and NICU/NHDW (CS) in Hospital Kuala Lumpur. Patients aged ≥18 years and fed by feeding pump in OS were included. Patients who were moribund or not given EN were excluded. Patients’ demographic data and disease severity score were collected on day 1 in ICU and followed for 5 days until decease or discharge. Adequacy was determined by percentage of energy/protein received from requirements.
Results: Fifty-five patients were included (25 OS and 30 CS) with mean aged 45.41±17.46 years old, 78.2% male and 65.5% Malay. The mean SAPS II, SOFA score and ICU LOS were 46.47±10.65, 8.60±3.64 and 9.24±7.91 days respectively. The ICU mortality was 20%. EN was started about 2.56±2.89 days after ICU admission and the mean adequacy of energy was 74.56±32.23%, while protein adequacy was and 69.15±35.78%. Compared with the CS, OS were significantly older than CS (51 years old vs 42.5 years old; p=0.035) and had a higher SOFA score (10 vs 7.5; p= 0.014). No difference in ICU LOS and mortality between group were found. Energy (45.64% vs 96.71%; p<0.001) and protein adequacy (38.78% vs 94.12%; p<0.001) were significantly higher in the CS than the OS.
Conclusion: CS as compared with OS may improve nutritional adequacy as CS delivered more 108% energy and 141% protein than OS. The difference in adequacy might be attributed to these factors; feeding method used in the system, patients’ characteristics and condition rather than the feeding system itself.
Keywords: enteral nutrition, critically-ill patients, open system, closed system, adequacy
The Emergency Department (ED) provides treatment for acutely ill patients in need of urgent medical attention. Despite the availability of the primary care unit ‘Klinik Kesihatan’, where non urgent patients should be treated, Malaysia’s public hospitals still need to deal with overcrowding of non-urgent patients in ED. The main aim of the study was to assess the willingness of non-urgent patients to be redirected to Klinik Kesihatan. This was a cross-sectional study conducted at Hospital Tuaran Emergency Department, Sabah. Non-urgent patients were interviewed using a questionnaire, to find out the purpose of their visit to Emergency Department. A total of 318 non-urgent patients out of 457 patients were interviewed during the study duration. 41 respondents (12.9%) were willing to be redirected towards a Klinik Kesihatan. No associated factors were found when compared with the unwilling to be redirected group. Among 277 respondents who rejected redirection to Klinik Kesihatan, 70.4% agreed to pay a surcharge to be treated in the Emergency Department and there was no association found with the employment status (p= 0.391). Most patients were not willing to accept redirection to a Klinik Kesihatan and would prefer to visit the Emergency Department despite knowing that their condition or illness is one that does not require emergency treatment. Social media, advertisements and pamphlets must be made available to educate patients on the proper use of the Emergency Department.
Many studies on postural photogrammetry had reported various intra-class correlation coefficients (ICC) across postural variable measurements, however no conclusive solution was given. This reliability and cross-sectional study was done in June 2016 at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah. A total of 24 male adult subjects with mean age 28.5 years (± 4.8 years), body mass 24.97 kg (± 3.85 kg) and height 166.6 cm (± 6 cm) were evaluated for standing postural photogrammetry. Four sets of manually digitized posture image files (by 4 raters) were measured and statistically analyzed for interrater agreement as well as the influence of image resolution and camera height from the floor on various postural variable measurements. The ICC between 4 raters for all postural variables was excellent (the lowest ICC was 0.940 for Q Angle of the Right Knee measurements). Two-Way ANOVA showed that postural variable measurements were not affected by either image resolution or camera height from the floor. Scrupulous attempts done on standing postural photogrammetry amplified the potential for standing postural evaluation in clinical settings.
The number of active smokers in Malaysia is increasing despite the availability of stop smoking clinics and smoking cessation medications. Other than smokers’ level of motivation to quit smoking, competency of the healthcare professionals involved in providing smoking cessation intervention using evidence based guidelines needs to be considered. Hence, knowledge, attitude and practice (KAP) of the healthcare providers in relation to existing clinical practice guidelines on smoking cessation should be assessed. In this review, we look at the factors contributing to the KAP of medical personnel on the guidelines and also the previously available assessment tool, mainly in the form of a validated questionnaire, for the purpose of applying it to the context of the Malaysian healthcare providers.
Getting appropriate healthcare is a challenge to the citizens in Malaysia due to the limited facilities, healthcare providers, and cost of healthcare. Uberization of healthcare will help fill this gap. Uberization helps modify the market or economic model with the introduction of a cheaper and more effective alternative service by introducing a different way of buying or using it, with the use of mobile technology. With powerful artificial intelligence engines operating on cloud servers, mobile apps can provide a better healthcare experience for patients. With uberization application, the patient need not come to the hospital to see a doctor before a treatment can be planned. Once a request is made by the patient, the healthcare providers can come to see the patient at an agreed place. This article aims to explore the possible uberization of healthcare in Malaysia.
Slum children are at risk for serious mental health problems because of their economic and social
environments. Little is known about their mental health. This cross sectional study was carried out to
know the extent of mental health problems among slum-dweller children in Dhaka city, Bangladesh. One
hundred and twenty students of four different primary schools were selected. In the first stage of the study,
socio-demographic data as well as information about mental health problems were collected through
socio-demographic questionnaire and validated Bengali version of Rutter B2 scale respectively, from the
teachers of the schools. In the second stage, all the students were assessed again personally by the both
authors with the help of Diagnostic and Statistical Manual of Mental Disorders- fourth edition (DSMIV).
High prevalence of mental health problems was found among slum children (70.8%). Emotional,
conduct and undifferentiated disorders were detected in 14.17%, 45.83% and 10.83%, respectively.
Conduct disorder was 3.23 times more prevalent in the children than was emotional disorder. It was more
prevalent in boys than in girls (57.90% vs 34.90%). Significant relationships were found among gender
and emotional disorder (p < 0.030), father’s employment status and undifferentiated disorder (p < 0.010),
substance abuse by father and child’s emotional disorder(p
This systematic review was aimed to evaluate the effectiveness of technology-enhanced learning (TEL) used in medical teaching for undergraduate medical students. The objectives are to (a) identify various teaching modalities which are used to enhance TEL; (b) evaluate whether TEL is more effective than traditional learning (TL) in cognitive and affective learning domain outcome. The empirical studies were searched in the following databases: Google Scholar, MEDLINE, ERIC, ProQuest, Cochrane Library and Scopus. All papers published from 2008 to 2018 were included. From eligible studies, the study design, study field, study population, intervention methods, type of assessment and learning achievement were abstracted and summarized the information. The search results were independently reviewed by two authors. From a pool of 1384 articles, 43 eligible articles were identified, enrolling 7292 undergraduate medical students examining comparative study between TEL and traditional learning. The results showed that there was a high degree of heterogeneity seen amongst the included studies in terms of TEL modalities used. The majority of intervention studies favoured online resources, while the rest used various offline multimedia electronic devices, virtual simulations and blended modes. Overall findings showed promising data that TEL is better than TL with regards to knowledge gain and skill acquisition, as well as providing higher student satisfaction. In all, the findings present blended learning in a positive and promising light in time, particularly where systematic reviews on technology-enhanced learning in the field of the undergraduate medical programme have produced mixed result.REVIEW ARTICLEA Systematic Literature Review on Technology-Enhanced Learning in Medical EducationMay Honey Ohn1*, Bareth Ravindran2, Chan Zhi Wei3, Khin Maung Ohn4, Ng Pey Luen5Borneo Journal of Medical Sciences 14 (1) January, 2020: 3 – 171 Emergency Department, Sandwell & West Birmingham NHS Trust, United Kingdom2 Surgical Department, Hospital Tuanku Ja’afar Seremban, Kuala Lumpur, Malaysia3 Orthopaedics Department, Hospital Sungai Buloh, Kuala Lumpur, Malaysia4 Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia5 Radiology Department, Hospital Queen Elizabeth II, Sabah, Malaysia* Corresponding author’s email: mayhoney.ohn@gmail.com Received: 14 July 2019 Accepted: 5 November 2019Borneo Journal of Medical SciencesBJMSKeywords: blended learning, technology-enhanced learning, medical education, hybrid learning, undergraduate medical students
Post-operative complications are well known to impair the functional outcomes of total knee arthroplasty (TKA). Patella subluxations post-TKA is a grim complication rendering patients disable post-surgery. Howbeit, medial patella subluxation is a rarely recorded incident altogether. This case report describes a patient post successful TKA two years ago, who was incidentally diagnosed with a medial patellofemoral subluxation during a recent routine yearly follow up. This gentleman, however, had no complaints and the only evident clinical sign was anterior knee skin puckering. A radiograph of the knee confirmed our clinical suspicion of medial patella subluxation. The patient’s symptoms, his expectations, radiological findings, what went wrong during surgery and management of this rare entity were analysed. This rarely reported entity requires a high degree of suspicion especially if the patient complains of instability and peculiar anterior knee pain. Diagnosis is customarily clinical and revision surgery is almost invariably necessary.
As general population of obese patients in Malaysia rapidly increases, more obese patients are requiring anaesthesia for various operative procedures. Obesity is associated with anatomical and physiological differences and co-morbidities that influence on the choices of anaesthesia care. A surgical case with general anaesthesia is used as a basis of discussion. A 37-year-old female, history of untreated hypertension and gastrooesophageal reflux disease (GORD), BMI of 41 admitted for laparoscopic cholecystectomy for symptomatic cholelithiasis under general anaesthesia. She presented with pain at the upper right abdomen and associated with bloated abdomen, nausea and vomiting after intake of meals. General anaesthesia and right ultrasound-guided transversus abdominis plane (TAP) block for abdominal wall blocks via subcostal approach was performed. Operation was removal gallstones in the common bile duct via laparoscopic approach. Post-operation patient was extubated successfully. She was prescribed paracetamol 1g 4 hourly and started on fentanyl patient-controlled analgesia (PCA) for next 2 days. In this case report, there is the description of the application of TAP block which when used in obese abdominal surgical procedure, can provide excellent postoperative pain relief, early mobilization and recovery.
hildhood undernutrition while being a preventable condition remains a major public health issue because it contributes to the mortality and morbidity of children globally. Intervention to improve the nutritional status of children includes supplementary feeding, fortified foods, cash transfers and nutritional education.
Keywords:
Non-cirrhotic portal hypertension (NCPH) is clinically defined as the presence of portal hypertension in the background of non cirrhotic liver. It is diagnosed by the findings in ultrasound of the hepatobiliary system and also oesophagogastroduodenoscopy (OGDS) that consistent with that of a portal hypertension, but otherwise has a relatively normal liver function and echotexture. The treatment mainly focuses on primary and secondary prophylaxis of variceal bleeding both pharmacologically like non-selective beta-blockers and octreotide, and non-pharmacologically like endoscopic band ligation of varices and sclerotherapy. In advance cases, sometimes surgery such as Porto systemic shunt or splenectomy may be required especially in patients with uncontrolled variceal bleeding or with symptomatic hypersplenism. Here we report a case of a young man who presented with upper gastro-intestinal bleeding, which was initially thought from a bleeding ulcer but was found to be secondary to oesophageal and gastro-oesophageal varices. Apart from having mild ascites, he has no other features of portal hypertension. His liver biochemistry and echotexture were also normal. Unfortunately, the patient was lost to follow up while he was still in the early stage of investigating the condition. The purpose of this case report is to share an uncommon occurrence of NCPH in East Malaysia, where liver cirrhosis predominates the aetiology of portal hypertension. Also, to the best of our knowledge, there is a very limited reporting of a similar case in this region.