Maternal obesity is significantly associated with less intention to breastfeed, low breastfeeding self-efficacy, and poor breastfeeding outcomes. This cross sectional study investigates the determinants of breastfeeding self-efficacy among overweight and obese pregnant mothers using self-administered validated questionnaires. There were 44.9% of overweight and obese from 200 recruited mothers. They had low breastfeeding self-efficacy and less intended to breastfeed as compared to normal-weight mothers. Past breastfeeding experience and exclusive breastfeeding inten- tion are predictors of breastfeeding self-efficacy among overweight and obese pregnant mothers. Effective strategies should be conducted targeting this population with regards to low self-efficacy and intention to breastfeed.
Introduction:Stroke is a major public health concern and treating its complications is important for functional recov-ery. Heterotopic ossification (HO), a condition where bone is developed in non-skeletal tissue, is not an uncommon stroke-related complication with reported occurrence up to 12%. It typically presents with joint range of motion (ROM) limitation, pain and swelling. Detecting HO is important to prevent forceful joint manipulation during reha-bilitation that can cause pain and fracture. Two cases of diagnosing HO during the course of stroke rehabilitation are presented. Case description: First case was a subacute stroke in 25 year-old male with right-sided hemiparesis and right hip joint ROM limitation. He did not consent to have passive ROM exercise and refused to be seated due to severe right hip pain. Second case was a 41 year-old male with chronic right-sided hemiparetic stroke exhibiting ipsilateral lower limb neurological recovery but inability to perform bed mobility and walking despite regaining motor function. The right hip joint ROM was limited in the absence of pain. Radiographs demonstrated presence of HO in the affected hip of both patients. Gentle hip ROM exercise was prescribed and noted improvement in ROM with subsequent ability for sitting (first case) and short-distance ambulation (second case). Conclusion: HO should be considered as a differential diagnosis in stroke patients having limited ROM, hence the importance of thorough physical examination. Presence of HO would guide rehabilitation process by encouraging gentle ROM exercise in the attempt to reduce public health burden from halted functional recovery in stroke.
Introduction:Diabetes is high in the agenda of public health issues with significant prevalence of diabetic-related amputations. Prosthetic restoration post-amputation is imperative to reduce disability, but its success is influenced by several factors. This study analysed the practice, and the determining factors affecting prosthetic restoration among major lower limb amputees with diabetes in Sabah. Methods: Retrospective cross-sectional study among 65 major lower limb amputees with diabetes referred for rehabilitation medicine services at Queen Elizabeth Hospital from 1st January 2015 to 31st December 2017. Demographics data, pre-morbid diseases, levels of amputation and prac-tice on prosthetic restoration (suitability for restoration, duration from prosthetic application to restoration, funding issue) are primary evaluated factors. Results: Forty-nine, fifteen and one amputees had below knee amputation, above knee amputation and hip disarticulation respectively. Forty-three amputees (66.2%) were deemed suitable for prosthetic restoration but only 27 were prosthetically restored, with mean duration from prosthetic application to res-toration of 5.92±2.189 months. Having additional pre-morbid diseases did not reduced the likelihood of suitability for prosthetic restoration compared to those only with diabetes (p=0.082). Funding issue is the key factor affecting prosthetic restoration with higher likelihood for restoration among those eligible through governmental agencies funding (p=0.027). Conclusion: In Sabah, low rate of suitability for prosthetic restoration is observed among major lower limb amputees with diabetes. A larger study is warranted to investigate causes of such low rate of suitability for prosthetic restoration among this specific population in the effort to reduce public health burden from major lower limb amputation-related disability.
Introduction: : Ginseng is a type of traditional medicine that has been used for thousand years to treat various dis- eases and has been proven effective in treating cardiovascular diseases. Incorporation of polyaniline (PANI) which is a type of conductive polymer together with ginseng into poly(lactic-co-glycolic acid) (PLGA) microcapsules is neces- sary for the treatment of cardiovascular diseases as the polymer will control drug release and the electroconductivity of PANI is beneficial on myocardium cells. Methods: Therefore, this project involved the encapsulation of ginseng inside PLGA/PANI microcapsules. The encapsulation of ginseng inside the microcapsules was verified through the identification of chemical composition of ginseng, PLGA and PANI using attenuated total reflectance-Fourier trans- form infrared spectroscopy (ATR-FTIR). Results: The results of scanning electron microscope (SEM) showed the formation of microspheres where the microcapsule size was decreased from 3.14±1.87 μm to 1.98±1.30 μm as the concentration of PANI increased. The distribution of microcapsules size was more homogeneous in the high con- centration of PANI as been determined through the histogram analysis. In addition, the fluorescence analysis demon- strated the efficiency of ginseng encapsulation inside PLGA/PANI microcapsules through the appearance of stained ginseng inside the microcapsules. Conclusion: As a conclusion, the ginseng was successfully encapsulated within PLGA/PANI microcapsules that will be beneficial in drug delivery application, specifically in the cardiovascular area.
Introduction: Leptospirosis is a re-emerging zoonotic disease caused by Leptospira bacteria. The clinical manifes-tations of leptospirosis include mild-fever to a severe or even fatal. Increased levels of inflammatory cytokines pro-duced in response to the Leptospira infection by the host immune system were hypothesized as among the causes of severity in leptospirosis. Besides the classical presentation with the triad of febrile, jaundice, and renal failure, patients with leptospirosis also can pose with predominant sign and symptoms of pulmonary involvement. This study aimed to compare the levels of TNF-α, IL-1b, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13, IL-17A, IL-18, and IL-22 In the plasma of samples of leptospirosis patients with and without pneumonia. Methods: Circulating cytokine levels in plasma were measured in seventeen patients hospitalized and diagnosed with leptospirosis in Malaysia (January 2016 – December 2017) and nineteen healthy individuals as controls. Patients were categorized into leptospirosis without pneumonia (n=12) and with pneumonia (n=5). Cytokine was measured using SimplePlexTM assays (San Jose, CA, USA). Measurement was performed in triplicate and statistical analysis was conducted using Graphpad® Prism v6 (San Diego, CA, USA). Results: Elevation of plasma TNF-α, IL-6, IL-8, IL-10, IL-18, and IL-22 levels were observed among leptospirosis patients with pneumonia compared to without, although no statistical differences were observed between these two groups. Conclusion: There are no significant differences observed between the levels of plasma TNF-α, IL-6, IL-8, IL-10, IL-18, and IL-22 in patients with pneumonia compared to without.
Introduction: Hajj is a unique religious mass gathering among Muslims hosted by Kingdom of Saudi Arabia (KSA) annually. It is a fifth pillar that is compulsory to be carried among muslim. Infections due to Neisseria meningitidis, Streptococcus Pneumoniae and Influenza virus are very high among Hajj pilgrims in KSA. Study shows knowledge and attitude towards vaccine preventable disease and vaccination which is very important for the prevention of these infectious diseases. This study aims to determine knowledge and attitude among the prospective Malaysian hajj pilgrims on vaccine preventable disease and vaccination. Method: A cross sectional study was conducted among prospective hajj pilgrims in June 2019. Self-administered questionnaires were given to the respondents through simple random sampling. The socio-demographic characteristics were described using descriptive analysis. Chi-square test was used to analyse the association between the socio-demographic and Malaysian hajj pilgrims’ knowledge and attitude towards the vaccine preventable diseases and vaccination. Results: A total of 135 respondents were recruited in the study. There were statistically significant associations between the knowledge and the highest education level (p=0.01), and also between the knowledge and the occupation (p=0.02) on vaccine preventable disease and vaccination. Conclusion: There is a lack of knowledge among the Malaysian hajj pilgrims about these vaccine preventable diseases and vaccination, especially those who have lower education level and also unemployed. Tabung Haji are highly advised to focus on these group and prepare a special course that focused on these vaccine preventable diseases so that Malaysian Hajj pilgrims will be protected.
Sporotrichosis is a relatively uncommon fungal infection in human as compared to other fungal infectiction such as tinea corporis or cruris. The fungus can be found in the environment and on plant matter. Sporotrichosis usually results from trauma to the skin followed by exposure to the fungus. It can also be spread by cat scratch or bite. Sporotrichosis usually presents as multiple skin nodules arranged in a linear fashion over the limbs, often with associated lymphadenopathy. This calls for importance of full physical examination and a high index of suspicion in order to diagnose this infection that can either involve the skin or the lymphatic channel or both. If misdiagnosed, treatment can be delayed and lead to prolonged suffering of the patient. This is an interesting case report about a 43-year-old woman who presented with left axillary swelling and decreased range of movement of the correspond- ing shoulder which was feared initially to be linked to breast cancer. However, good clinal acumen lead to the actual diagnosis of sporotrichosis.
Suppurative BCG lymphadenitis can easily be overlooked, as it mimics other diseases such as tuberculous lymphadenitis. A case of a three-month old female infant who received the BCG vaccination at birth presented with isolated left axillary mass at two months of age. She was initially treated as lymph node abscess but was referred to the hospital due to the increasing size of the swelling. Needle aspiration was done and the microbiology analysis came out positive for acid-fast bacilli. She was planned for syrup isoniazid; however, the management team withheld treatment until they were certain of the identity of the bacteria. The bacteria was confirmed by the molecular method to be Mycobacterium bovis BCG strain. The case report highlights the importance of the microbiology investigations for appropriate management in this case.
Pneumonia is a common lung infection. Common bacterial cause of this serious lung infection includes Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae. Haemophilus parahaemolyticus pneumonia is an uncommon cause of bacterial pneumonia, occurring mainly as an opportunistic pathogen in immunocompromised patients as in this case, diabetes mellitus. Therefore, this case report will look at a case of 49-year-old man who was diagnosed with this uncommon pathogen which was successfully eradicated with antibiotics. This case report will look at a case of 49 years old who was diagnosed with this uncommon pathogen which was successfully eradicated with antibiotics.
Introduction: Production of nitric oxide (NO) is one of the main responses elicited by a variety of
immune cells such as macrophages (e.g. microglia, resident macrophages of brain), during inflammation. Evaluation of NO levels in the inflammatory milieu is considered important to the understanding of the intensity of an immune response; and has been performed using different methods including the Griess assay. To assay NO in culture, an appropriate number of cells are stimulated into an inflammatory phenotype. Common stimuli include lipopolysaccharide (LPS), IFN-γ and TNF-α. However, overt stimulation could cause cell cytotoxicity therefore an ideal concentration of LPS should be used. Objective: To set-up a model of BV-2 cell activation that allows the assay of detectable levels of NO. Optimization of BV-2 microglia cell density and LPS concentrations after stimulation by bacterial lipopolysaccharide (LPS) for the Griess assay is demonstrated in this study. Methods: BV-2 microglia were cultured at different cell densities, and treated with LPS at three concentrations (1, 5, 10 μg/ml). NO production in culture supernatants were then measured at 18, 24, 48 and 72 hours. Moreover, methyl tetrazolium assay (MTT) was also performed to ensure that NO measurement is performed at no-cytotoxic concentrations of LPS. Results and Conclusions: NO production follows a temporal pattern. The density of 25000 cells/ well was the ideal seeding density for NO evaluation in BV-2 cells. BV-2 stimulation by LPS is dose dependent, and NO levels are increased proportional to the LPS concentration up to 1.0μg/ml, whereas the higher LPS concentrations are associated with decreased cell viability may be caused by the high toxic levels of LPS or NO. Although Griess assay has been commonly used by the scientists, however, optimization of its parameters on BV-2 cells will be useful for the experiments which will be performed on this particular cell line. The optimized pattern of Griess assay on BV-2 cells was achieved in this study, hence easier and more practical for the future scientists to perform Griess assay on BV-2 cells.
Introduction: Challenge arises for medical undergraduates as the subject of medicine is intricate and extensive. Although students come from the same pool of excellent academic background, the medical undergraduates are still prone to failure in exams, resulting in them repeating the year of study or even having the thought of changing to other courses. In order to cope with the programme, students may adopt learning approaches that would help them to go through the programme. Therefore, it would be interesting to explore the learning approaches of medical students in Universiti Putra Malaysia. Methods: The purposes of this study were to determine the learning approach of medical undergraduates of Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (FMHS, UPM) together with its associated factors, which were socio-demographic characteristics and learning environment. This research was a cross-sectional study where the sample size calculated was 554. Self-administered questionnaires were given to the respondents chosen by simple random sampling. The socio-demographic characteristics were analysed using descriptive statistics such as frequency and percentage. Chi-square test was used to analyse the association between the variables. Results: The response rate was 83% (460 respondents agreed to participate). The majority of the respondents were females (73.7%), Malay (67%), and in their clinical years of study (58.7%). Overall, most students preferred deep approach (DA) of learning (49.6%), followed by strategic approach (29.1%) and surface apathetic approach (21.3%) of learning. There were statistically significant associations between learning approach and gender (p=0.005), as well as between learning approach and year of study (p=0.037). Conclusion: Our study showed an association between learning approaches and year of study and gender. DA of learning was the preferred learning approach in medical students at FMHS, UPM. This approach of learning, where students learn to understand the subject matter, may result in students become effective learners. Their understanding about the subject matter will be applicable to their clinical practice in the future.
Introduction: Smartphone addiction is a hotly debated public health issue and it affects every generation especially the youth and younger generation nowadays (Generation Z / i-Generation) and contributes to the poor mental health status like stress, anxiety and depression. This study is carried out to determine the prevalence of smartphone addic-tion and its association with stress, anxiety and depression among the undergraduate students in Unitversity Malaysia Sabah. Methods: A cross-sectional study was conducted among the undergraduate students in Universiti Malaysia Sabah. A total number of 456 undergraduate students in Universiti Malaysia Sabah with at least a smartphone device were enrolled in the study by stratified random sampling. A self-administered questionnaire, Smartphone Addiction Scale Malay Version (SAS-M) and The Depression, Anxiety and Stress Scale – 21 Items (DASS-21) Malay Version were used for data collection. The prevalence of smartphone addiction, stress, anxiety and depression among un-dergraduate students of Universiti Malaysia Sabah were determined. Simple linear regression was used to determine the effect of smartphone addiction to stress, anxiety and depression. Results: Prevalence of smartphone addiction among undergraduate students in Universiti Malaysia Sabah is 61.2% (95% CI : 56.5%, 65.7%). The prevalence of stress, anxiety and depression among undergraduate students in Universiti Malaysia Sabah are 34.9%, 58.6% and 42.5% respectively. The univariate analysis shows that smartphone addiction is significantly associated with stress (Regression Coeeficient = 0.774, 95% CI 0.54, 1.01 ; P-value
There are many inherent challenges in the evaluation and management of children with laryngotracheal disorders, and it differs widely from one institution to another. The main challenges include access to suitable equipment, fully trained surgeon and, cooperation with the anesthetist and pediatrician. Material & Methods: The aim of the study was to analyze the pediatric laryngotracheal cases undergoing endoscopic examination in Hospital Universiti Sains Malaysia. A retrospective review of 73 cases undergoing microlaryngoscopy and bronchoscopy from 2004 to 2008 was done. Results: Laryngomalacia was the commonest diagnosis. The majority of the cases (45.2 %) were referred because of noisy respiration. Other reasons for referral were foreign body inhalation, unresolved lung disease, failed extubation, examination prior to decannulation and hoarseness. Conclusion: Management of pediatric laryngotracheal cases were varied and tailored to each problem. The endoscopic examination must be meticulous. The management include observation, medical treatment, closed (endoscopic)
techniques and open surgery.
Introduction: Oxidative damage is an important factor contributing to ageing and many degenerative dis- eases. It can be detected by the DNA base damage, which is formation of 8-oxo-7,8-dihydro-2’deoxygua- nosine (8-oxodG). The 8-oxodG is an important indicator of oxidative stress and has been competent- ly specified as a recognized initiator of the carcinogenic process and premutagenic injury in mammalian cells. Aims: In this preliminary study, we investigated the possible association of oxidative DNA damage in hepa- tocellular carcinoma (HCC) patients in comparison with Malaysian healthy controls taking into account the dif- ferent races and genders in both groups. Method: DNA of peripheral white blood cells was isolated from 91 HCC patients and 304 controls. The level of oxidative DNA damage was determined by ELISA procedure. Results: Quantitative measurement of 8-oxodG was higher in HCC patients at mean value of 3.30 ± 2.32 ng/ml. In controls, the average value is 1.57 ± 1.92 ng/ml. Comparison between gender showed that there was a significant difference observed in the level of 8-oxodG between male and female in controls, where p = 0.003. The level of 8-oxodG was higher in male than in female controls. There was a significant difference in the average value of 8-ox- odG level between the controls and HCC patients where p
Data from the Malaysian National Drugs Agency December 2013 Report, showed that among 7864 drug users, 632 were abusing Amphetamine Type Stimulant. Rates of admission due to Methamphetamine abuse in pregnancy are higher compared with men and non- pregnant lady in the United States.1 A number of issues may complicate the management of pregnant women who abused methamphetamine such as the low motivation for them to come forward voluntarily for treatment, the high rates of fetal and maternal complications due to methamphetamine abuse,2,3 and the inavailabiliy of effective treatment for methamphetamine dependence.
Cervico-aural [collaural fistula] fistula is rare and it accounts for less than 5% of branchial cleft anomalies. In this paper, we report one such case of a 9 year old girl who was presented to us with two discharging cutaneous openings on the right side; one in the floor of the external auditory canal and another in the neck at the junction of the upper 2/3rd and lower third of the sternomastoid muscle along its anterior border.
Renal cell carcinoma (RCC) is the most common renal malignancies. In advanced stage, it is highly resistant to systemic therapies. RCC is a highly vascular tumour and angiogenesis pathway has been postulated in its carcinogenesis. Novel drug targeting Vascular Endothelial Growth Factor (VEGF) and advanced surgical interventions have shown to increase the overall patients’ survival. In this study, we evaluated the VEGF expression of RCC using immunohistochemistry technique and its potential correlation with the tumour grades. Methods: 40 RCC cases that underwent nephrectomy were selected. The archived samples of formalin fixed, paraffin-embedded (FFPE) were retrieved. The tumour tissue blocks were carefully chosen, sectioned and stained with VEGF using immunohistochemistry technique. The intensity of VEGF expression was scored as 0 (negative), 1+ (weak), 2+ (moderate) or 3+ (strong). Results: Majority of the RCC cases were male, with male to female ratio of 2.1:1. Mean patient age was 56.2 years (age ranged between 16 to 74 years). Most of the cases were Malays (42.5 %). VEGF was expressed in 36 (90%) of RCC cases. Among the 36 cases that were immunopositive, 8 (16.7%) were grade 1, 20 (55.6%) grade 2 and 8 (16.7%) grade 3. There was no significant association between VEGF expressions score and grades of RCC (p=0.39). Conclusion: VEGF was expressed in majority of RCC cases although there was no significant association with tumour grades.
Agriculture activity in Cameron Highland is one of the sources of river water pollution. This study evaluates the phys- icochemical properties and heavy metals contamination (Cu, Cd, Zn, Cr, Pb) in Bertam River. The results indicate the river water pH was slightly acidic. Based on the Malaysia National Drinking Water Quality Standard (NDWQS), the river water is not suitable for drinking as it has exceeded the safe value for turbidity, chemical oxygen demand COD and lead (Pb). Spatial distribution of heavy metals showed that Cr, Cu and Pb were concentrated at the downstream area.
Introduction: Family planning allows couples to have their desired number of children and optimum birth spacing. While the contraceptive prevalence rate (CPR) in Malaysia was reported as 52.2% in 2014, little is known regard- ing the practice of family planning among marginalised groups such as the Orang Asli women. This study aims to determine family planning practice among married Orang Asli women in Sepang district and its associated factors. Methods: A cross sectional study using a pretested questionnaire was conducted in five Orang Asli settlements in Sepang using cluster sampling. Chi-square test and simple logistic regression were used in bivariate analysis, where- as binary logistic regression was used to determine the predictors of family planning practice. Results: 212 (58.4%) participants were current users of family planning, with 68.3% of the users reported using oral contraceptive pills. In the logistic regression models, family planning practice was significantly more common among women who had children (AOR= 43.659, 95% CI: 5.788, 329.323), being housewives (AOR=1.973, 95% CI: 1.205, 3.230) and had higher attitude score (AOR=1.113, 95% CI: 1.006, 1.232). Conclusion: The CPR of current study was about the same as the national CPR in 2014. The predictors of family planning practice among Orang Asli women were having chil- dren, being a housewife and having a better attitude towards family planning. Future intervention to increase the CPR should focus on improving women’s attitude regarding family planning.
Introduction: Pap smear screening may increase the quality of women’s health through early detection of cervical cancer thus providing a better prognosis for women with cervical cancer. While the benefit of Pap smear screening is well documented, the screening uptake among Malaysian women in general was unsatisfactory with only 47.3% being screened. This study aimed to determine the prevalence of Pap smear uptake and its associated factors among Orang Asli women who lives in rural areas in Selangor. Methods: A cross sectional study was conducted in Hulu Langat and Kuala Langat districts from April to July 2017. Through cluster sampling, five Orang Asli settlements in the two districts were chosen. All women in the selected village aged between 18 to 65 years were invited to participate and interviewed using a structured, pretested questionnaire. Data were analysed using SPSS Version 22. Univariate and bivariate analysis were conducted to identify factors associated with Pap smear uptake among the participants. All hypotheses tests were two-sided and level of significance was set at 0.05. Results: Out of the 147 respondents, 114 (77.6%) had undergone Pap smear for at least once in the past. Women aged more than 35 years (p=0.013) were shown to be significantly more likely to take Pap smear compared to women who were 35 years old and less. There were significant associations between marital status (p