Introduction: The causes of obesity is caloric intake that, over time, is greater than the caloric expenditure. Factors that are associated with this energy imbalance include genetic predisposition, behavioural dynamics, hormonal disturbances, and environmental circumstances. Results: Food Intake: Increased portion sizes, the energy density of today’s commonly eaten foods, and the trend in consuming meals outside the home contribute to the increase in calorie consumption. Satiety helps determine food intake and is partially determined by the volume and weight of the food consumed. Foods that are high in calorie content for a given volume, such as highly processed, low-fiber foods, can lead to excessive calorie intake. Many factors contribute to overeating, including stress, boredom, nutritional insufficiencies, emotional lability, access to food, and the changing of our diet to one that is highly processed. Movement and Physical Activity: In a recent review, Denham et al. (2013) summarized the ability of physical activity to influence epigenetic modifications of histones or DNA in the brain, skeletal muscle, and peripheral blood. Aerobic exercise over many weeks was the primary variable studied that led to activity-induced benefits. Several of the studies found benefits with 30 minutes of daily moderate activity. Yoga is an effective type of movement activity for improving weight and mental well-being. Sleep: There is an association between too little or too much sleep and overweight and obesity. In a survey of more than 54,000 U.S. adults age 45 years or older, sleeping too little (≤6 hours) and sleeping too much (≥10 hours) were significantly associated with obesity. Sleep deprivation is associated with elevated ghrelin, elevated cortisol, elevated insulin, decreased leptin, and increased hunger (Patel and Hu, 2008). Psychosocial Stress: In addition to the negative influences of physiological stress from poor nutrition, insufficient appropriate activity, and inadequate sleep, psychosocial stress can also contribute to excess weight. Psychosocial stress can arise from a wide variety of environmental stressors, such as change in routine, difficult decisions, depression, chronic health issues, lack of access to health care, economic challenges, inadequate social support, abusive relationships, illiteracy, job dissatisfaction, poor adjustment to life-cycle transitions such as retirement, and legal problems. This type of stress is often associated with weight gain, elevated BMI, and poor food choices. Increased cortisol levels can lead to weight gain around the abdominal region (central adiposity). Conclusion: It is important to screen for emotional stress with patients, identify how this stress may be negatively impacting their weight, and help them incorporate stress reduction programs to achieve their weight loss goals.
Introduction: Tuberculosis (TB) is one of the utmost serious infectious diseases worldwide. The emergence of multi- drug resistance demands the development of better or new putative drug targets for tuberculosis. Recent studies sug- gest Mycobacterium tuberculosis cytochrome P450 enzymes as promising drug targets and azole drugs as potential inhibitors. Methods: Various computational tools, like Expasy Protparam, Swiss model, RaptorX and Phyre2 were used to analyze 12 Mycobacterium tuberculosis P450 enzymes and determine their three-dimensional structure. The structural validation was done through a Ramachandran plot using RAMPAGE server. The docking of P450 enzymes with azole drugs was done with autodock ver 4.2.6. Results: Based on sub-cellular localization prediction using CEL- LO tool, P450 enzymes CYP123A1, CYP132A1, CYP135A1, CYP136A1, CYP140A1, and CYP143A1 were predicted to be in the cytoplasm. Through structure assessment by Ramachandran plot, the best homology modelled proteins were docked with azole drugs like clotrimazole, croconazole, econazole, fluconazole, itraconazole, itraconazole, ketaconazole and micronazole by using autodock. By docking method it is identified that ketaconazole drug has a high affinity towards most of the mycobacterium P450 enzymes followed by the itrconazole drug. CYP123A1 enzyme is preferable as a drug target due to high binding affinity towards ketoconazole followed by CYP135A1, CYP140A1 enzymes. Conclusion: This study would help in identifying putative novel drug targets in Mycobacterium tuberculosis, which can lead to promising candidates for the optimization and development of novel anti-mycobac- terial agents.
A 42-year-old gentleman presented with left eye pain after accidental contact with Euphorbia lactea sap while gar- dening. At presentation, left eye best-corrected visual acuity (BCVA) was 20/30. Ocular examination revealed left eye conjunctiva congestion and cornea abrasion. Eye symptoms and BCVA deteriorated over 12 hours. Cornea showed diffuse stromal oedema with presence of anterior uveitis. A diagnosis of toxic keratouveitis was made. He was treat- ed with intensive topical steroids, cycloplegics, lubricants, prophylactic antibiotics and oral non-steroidal anti-in- flammatory analgesic. Patient achieved complete resolution two weeks later. We aim to raise awareness among the ophthalmologists to detect and manage these injuries.
Background: Lack of awareness, poor knowledge and attitude regarding cancer have been identified as possible reasons accounting for the late presentation which lead to the poor survival of cancer patients in Malaysia. Method: A cross sectional study was conducted in three traditional Malay villages in Negeri Sembilan among adult males. Those who were already diagnosed with prostate cancer or Non malaysians were excluded from the study. Data was collected using self-administered questionnaires which consist of several sections namely socio-demographic, awareness about prostate cancer, sources of information, family history of prostate cancer, lifestyle associated with risk of cancer, knowledge and attitude towards prostate cancer. Data was analysed using SPSS version 22.0. Chisquare test was used to determine associations. Level of significance was set at p
Introduction: The prevalence of stress among Malaysian police is high in which 38.8% polices have severe stress related to work resources and workplace environment. Psychosocial safety climate is one of the indicators that can be used to avoid psychosocial health problems. Objective: This study was conducted to determine the risk factors of psychosocial safety climate and to measure the effectiveness of a customised safety website in improving the safety climate. Methodology: This study involved 105 police officers who were randomly selected from nine different departments in PDRM Bukit Aman. A survey adapted from previous study was used to determine the psychosocial safety climate levels among respondents. Then, occupational safety website was introduced to the respondents and being used for two weeks. Lastly, post survey was done to see the difference of psychosocial safety climate before and after the use of the website. Results and Discussion: Findings showed that team psychological safety (r=0.381, p= , p=
Introduction: Dengue fever currently remains as one of the major public health issues in Malaysia. Dengue inci-dence in Malaysia has been increasing in the last 20 years. Dengue fever has been causing an economic burden to the country each year. Vector control is one of the preventions and control activities to reduce its incidence. Vector control activities, especially fogging is a resource-intensive activity. It uses most of the allocated budget of a district health office (33%). The major cost components of the prevention and control activities were human resources and pesticides with 60.7% were for human resources and 13.6% of the costs were for pesticides. Therefore, it is important to know, cost of each fogging activity and the factors that contribute to that cost. The objective of this study was to determine the costs of fogging activities carried out by Hulu Langat Health District Office, Selangor, Malaysia. Meth-ods: This study was a retrospective descriptive and analytical study using data from the Hulu Langat District Health Office for the year 2018. Cost analysis of fogging activities was carried out using the activity-based costing method-ology. The factors associated with, and predictors of, the costs of fogging activities were determined using chi-square and multiple linear regression. Results: In 2018, Hulu Langat District Health Office carried out total of 2,063 fogging activities. The average cost of each fogging activity was estimated as RM 1,579. Types of insecticides was statistically significant associated and predictive factor of the cost of fogging activity. Conclusion: The present study showed that the estimated average cost per fogging activity is RM 1,579 and water-based insecticide was found to be the cheaper option compared to oil-based insecticide. However, as this study did not determine the effectiveness of these insec-ticides, recommendations cannot be made as to which insecticide should be used.
Workplace violence become a global concern and perceived as a very serious safety and health hazard especially in healthcare setting. The aim of this study was to determine the prevalence of workplace violence and its associated risk factors among healthcare workers in public hospital. Methods: This was a cross-sectional study which involved 136 randomly selected respondents among doctors and nurses in a public hospital in Kuala Lumpur. Data was gathered through a self-administered questionnaire consisted of two standardized questionnaire; Workplace Violence (WPV) and Job Content Questionnaire (JCQ-27). Results: The response rate was 91%. The prevalence of reported WPV was 71.3% where nurses (73.2%) had slightly higher prevalence than doctors (69.2%). The most common forms of WPV was verbal abuse (70.6%), followed by bullying/mobbing (29.4%), physical violence (11.0%), and sexual harassment (6.6%). The perpetrators were mostly among relatives of patients and visitors followed by the patients. Multiple logistic regression shows that respondents working in Accident and Emergency (A&E) Department was 17 times more likely to report workplace violence than those working in Pediatric Department. Also, for every 1 year younger, respondents were 5 times more likely to experience workplace violence controlling for other factors. Conclusion: The prevalence of workplace violent among respondents were high and most common among young workers, especially nurses and those working in A&E Department. Hence, further assessment should be carried out to reduce the identified risk factors and to find ways of solving this issue.
Introduction: Workplace violence (WPV) among healthcare workers (HCW) remains a significant public health issue in Malaysia. This study aimed to determine the prevalence and associated factors of WPV among HCW in Emergency Departments of public hospitals in Melaka. Methods: A cross-sectional study was conducted among 231 HCW who were selected in Emergency Departments (ED) from three public hospitals in Melaka through proportionate stratified random sampling method. Data was collected using self-administered questionnaire which consists of three parts (personal and workplace data, workplace violence, and psychosocial workplace environment factors). The period of workplace violence studied was any occurrence of it within six months prior to this study. The data were anal-ysed using Statistical Package for Social Sciences (SPSS) software version 24. Results: The prevalence of WPV was found to be 38%, of which 88.9% were psychological violence, and were mostly perpetrated by combinations of type of perpetrators (51.9%). Multiple logistic regression shows that those aged 40 years and below have 5.4 times more likely to experience workplace violence compared to other age group, respondents with low job support has 2.9 times more likely to experience workplace violence compared to its counterpart, and respondents who work in secondary hospital have 2.7 times more likely to experience workplace violence compared to those who work in tertiary hospital. Conclusion: Preventive measures to prevent this issue should be in placed to tackle WPV especially among the at risk groups.
Introduction: Association studies between single nucleotide polymorphisms (SNPs) and type 2 diabetes mellitus (T2DM) have been abundant. However, there are limited reports on copy number variations (CNVs) of beta-defen- sins (DEFB) gene in relation to T2DM. In this study, DEFB copy numbers were quantified in T2DM with nephropathy, T2DM without nephropathy and non-diabetic control groups to investigate its influence in chronic inflammation in Malaysian individuals. Methods: DEFB copy number in Malaysian individuals were quantified by using paralogue ratio tests (PRT) which allow direct quantification of gene copy number by using PRT107A and HSPD21 PRT primers. The copy number generated was then validated from insertion/deletion ratio measurement 5DEL (rs5889219) and two microsatellite analyses (EPEV-1 and EPEV-3). Results: DEFB copy number was found extending from 2 to 8 cop- ies in the non-diabetic group (n=146), while in T2DM group (n=392), copy numbers were more extensive, ranging between 1 and 12 copies; with 1, 10 and 12 copies detected in T2DM with nephropathy group (n=202). Statistically, there is no significant difference in DEFB copy number between T2DM and the non-diabetic group (p=0.209) as well as between diabetic nephropathy and without nephropathy of the T2DM group (p=0.522). However, significant white blood cell (WBC) count was found between T2DM groups with and without diabetic nephropathy (p=0.000). Conclusion: Extreme DEFB copy numbers in T2DM with nephropathy group suggest future studies with bigger sam- ple size are necessary to elucidate the true impact of CNVs of DEFB gene in promoting early onset of nephropathy in T2DM.
Glutathione s-transferases (GSTs) are the vital enzymes involved in Phase II metabolism to detoxify a wide range of carcinogenic metabolites in the body. GST class mu-1 (GSTM1) and GST class theta-1 (GSTT1) are the genes encoding for the GST isoenzymes. Nevertheless, both genes were frequently reported absent (null) in most of the populations at different frequencies. Null polymorphism will affect the production of GSTs and impair the ability to eliminate carcinogenic compounds which had been shown to expose null individuals to high risk of several cancers such as gastric and lung cancer. Thus, this review will briefly summarize on the GSTM1 and GSTT1 polymorphisms, frequencies of null variants in populations worldwide, including Malaysian, and their relevancy to the underlying basis of toxicological response to xenobiotics. Additionally, the genotyping assays used in GST studies will also be discussed.
C-C motif Chemokine Ligand 3 Like 1 (CCL3L1) is characterized as a gene with copy number variable (CNV) and clustered at the segmental duplication on chromosome 17q12. CCL3L1 is responsible for the production of mac- rophage inflammatory protein (MIP) 1α that plays an important function in the immune system and host defense. Various copies range of CCL3L1 have been reported and associated with the diseases in different populations. Thus, this review aimed to summarise the distribution of CCL3L1 copy number from different populations according to the geographical region and highlighted the lacking of data from Malaysian population, which is one of the multi-ethnic countries due to the impacts of CCL3L1 copies on various diseases. Besides, we also outlined the methodologies available for the copy number typing. In overall, this review could provide significant information on the role of CCL3L1 copies in disease association and as well as providing evidence on the population diversity.
Introduction: Smartphone has become an essential Smart-tool for IT-based learning among university students. How- ever, excessive use of smartphones can be addictive leading to psychological distress, poor academic performance, social isolation and depression. In the context of University Malaysia Sabah (UMS), the issue of contention is whether smartphone addiction is a problem among nursing undergraduate students and thus the justification for this study. This study evaluated the pattern of usage smartphone and addiction among nursing students in UMS. Methods: The study deployed a cross-sectional survey design involving 100 (N) respondents selected through clustered convenient sampling from year 1(n=35), year 2 (n=35) and year 3 (n=30) nursing students who are currently pursuing their di- ploma study in UMS. Ethical approval was obtained from the Research Ethics Committee of UMS as well-informed consent from respondents. The study tool consisted of a well-establish validated questionnaire benchmarked from a previous study (reliability Cronbach α= 0.78) which captured respondents’ socio-demographics, smartphone us- age characteristic proforma and Smart Addiction Scale (SAS). Results: Among 100 nursing students in this study, 78% (n=78) of them had high smartphone usageaveraging 4.3 hours daily. The overall prevalence of smartphone addiction among nursing students in this study was 25% (n=25). Male student nurses significantly had higher smart- phone addiction scores compared to female students (p=0.01). Likewise, year 3 students had higher addiction scores compared to their peers in year 2 or year 1 (p=0.002). Conclusion: findings from this study imply that smartphone addiction affects 1 in 4 nursing students in UMS and there is a need to develop ‘digital detox” strategies to address the issue.
Introduction: Atopic dermatitis (AD) and its severity has been inconsistently associated with lower vitamin D levels as multiple other factors that influence vitamin D status were not always assessed. Methods: A case control study involving AD patients and controls 18 years old was performed. Exclusion criteria were systemic immunosuppres- sion 4 weeks prior to recruitment, renal or hepatic impairment, parathyroid diseases and vitamin D or calcium supplementation. Healthy controls were matched for age, gender, ethnicity, Fitzpatrick skin type and body mass index (BMI). Sun exposure, a 3-day, 24-hour dietary recall and serum 25-hydroxyvitamin D were measured. Re- sults: 38 AD patients and 38 controls participated. Majority had Fitzpatrick skin type IV. Vitamin D was lower in AD [15.9(9.9-24.0)ng/ml] than controls [17.3(14.4-27.2)ng/ml], p= 0.028. It was sufficient in 16(42.1%) AD and 15(39.5%) controls, insufficient in 7(18.4%) AD and 22(57.9%) controls and deficient in 15(39.5%) AD compared to 1(2.6%) control. Sun exposure was similar in both groups. AD had significantly higher dietary vitamin D intake [1.5(0.6-3.1) vs 0.6 (0.3-1.0)µg]. AD was an independant risk for vitamin D deficiency with OR 17.52; 95%CI:1.4-
212.7 and vitamin D insufficiency OR 0.26;95%CI:0.07-0.95. Vitamin D levels did not correlate with AD severity. Conclusion: AD is a risk for vitamin D deficiency despite higher dietary intake and similar skin type, BMI and sun exposure as controls.
Introduction: The problem in patients who are intubated with endotracheal tube is the occurrence of accumulation of secretions. One of the actions to reduce the secretion is closed suction. This research monitors the patient's oxy- gensaturation and also reveals the effect of closed suction on oxygen and AaDO2 saturation (alveolar-arterial oxygen difference) in patients who were mechanically ventilated in the Intensive Care Unit (ICU) of Dr. Kariadi Hospital. The design of this study uses pre experiment. Methods: The research process has been carried out on April 2, 2019 until May 26, 2019 in the Intensive Care Unit with a total sampling technique, on 15 respondents. Result: The results of the study showed that there was effect of closed suction technique on the value of oxygen saturation in patients with mechanical ventilation (p-value = 0.010). Conclusion: Closed suction can lead to decrease of air volume in the lungs up to 1200 ml. So hyperoxygenation must be done before closed suction as it can reduces the incidence of hypox- emia by 49%. Before closing the suction, it is recommended to do hyperoxygenation.
Introduction: Urbanisation is a key determinant of population health. Malaysia’s exemplary economic growth in the early 1990s and the consequent development and urbanisation led to significant changes in health, lifestyle and quality of life. Rising expectations, changing demographics and nutrition and disease transitions were challenges synonymous to an increasingly urban Malaysia. As the Government targets optimal population health, this paper aims to explore one of the many challenges of urbanisation, namely the prevalence of non-communicable diseases or NCDs. For the purpose of this paper, NCD is proxied by Diabetes Mellitus. Methods: This study is based the 2015 National Health and Morbidity Survey, which is a cross-sectional population-based survey, involving 30,000 re- spondents. Given the binomial nature of the survey variables, the multinomial Probit model was employed using the STATA statistical software. Results: Generally, age, gender and race are significant in determining health outcomes. Socioeconomically, all three variables of income, education and employment are significant. For lifestyle factors, findings show that only the weight and physically active status have a role in determining health outcomes. Finally, the urban variable is also positive and significant. Conclusion: Findings show that the prevalence of Diabetes Melli- tus, is rising along with urbanisation and that there is a health penalty for the urban population and also for those who do not embrace healthy lifestyles. Additionally, other factors are equally important as urban health determinants, encompassing both the demographic and socioeconomic factors.
Interpretation of thyroid function test (TFT) is often straightforward but in certain scenarios, discordance between the clinical impression and the laboratory results exists. A 50-year-old woman with a ten years history of hypothyroidism on levothyroxine presented with a recent notable change in TFT [elevated free thyroxine (FT4) and thyroid-stimulat- ing hormone (TSH)], in an otherwise clinically euthyroid and previously stable TFT, leading to levothyroxine being withheld. This case report highlights the possibility of assay interference as a cause of discordant TFT. It also draws the importance of close collaboration between clinicians and the laboratory to avoid unnecessary investigations and inappropriate management of such a case.
Introduction: Statins have several pleiotropic effects including its primary effect of lipid lowering that is important to prevent cardiovascular disease (CVD). Subjects often have heterogeneous responses to statin. This study aims to determine the biochemical effects of statins on lipid parameters among newly diagnosed dyslipidaemia subjects.
Methods: This was a prospective observational study involving 118 newly diagnosed adults with dyslipidaemia from three government health clinics in Selangor, Malaysia. Biochemical analyses including fasting lipid profile [triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)] and apolipoproteins (apoA1, apoB) were taken at baseline and follow-up after a month on statin.
Results: Majority of subjects (61.9%) were prescribed with lovastatin, with the rest on simvastatin. At baseline, the median values for all lipid profile parameters (TC, LDL-C, HDL-C) and non-conventional lipid parameters (LDL-C:HDL-C ratio, non-HDL-C, TC:HDL-C ratio, apoB:apoA1 ratio) were deranged except for TG and apoA1. On follow up, all parameters showed median values within the reference range except for HDL-C, non-HDL-C and TC:HDL-C ratio. There was significant difference in the effect of statins on lipid parameters including predictors of cardiovascular risk, simvastatin having better effects.
Conclusions: Different statins have varying effects on lipid parameters. Simvastatin showed significantly better effects compared to lovastatin. Non-HDL value should be included in the standard lipid profile report given its ease of use and implementation as it’s both a marker of coronary artery disease (CAD) risk stratification as well as an established determinant of goal attainment during therapy.
Osteolytic disease of the bones have a myriad range of aetiology. One rare cause is Gorham’s disease
or disappearing bone disease. This disease is a diagnosis by exclusion using correlation made with
clinical presentation, radiological findings and histopathological confirmation. Although many different
therapies have been advocated, none have been successful in fully controlling this disease. We present a
case that was detected in a Chinese lady using diagnostic imaging, confirmed with computed tomography
guided biopsy and successfully treated with joint reconstruction using endoprosthesis.
Introduction: Internet addiction disorder (IAD) particularly the internet gaming disorder (IGD) is recognized as a type of addiction similar to substance abuse. This addiction carries similar social impact as the latter, as it can cause serious impairment of interpersonal relationship, and even deterioration of academic or occupational performances. Functional magnetic resonance imaging (fMRI) is able to act as a non-invasive objective biomarker to detect functional neuronal connectivity in areas of the brain affected by IAD by utilizing blood oxygenation level dependent (BOLD) imaging. Methods: A systematic review was conducted from original articles published from January 2014 to January 2017 that had the keywords “internet addiction” and fMRI. Results: Initial data collection had 170 articles, however after applying the inclusion and exclusion criteria, there were 34 articles in the final analysis (17 resting-state fMRI studies and 18 task-based fMRI studies). The striatal nucleus and dopaminergic system demonstrated impaired functioning in subjects with IAD. Conclusion: Task-based and resting-state fMRI are able to detect areas of the brain that are activated in subjects with internet addiction, similar to those observed in subjects with substance abuse and other addictions. This review also introduces a newly arising subtype which is smartphone addiction disorder.
Blunt traumatic aortic injury (BTAI) is a crucial diagnosis to be made early in the management of trauma patients with aims to improve survival outcome. The objective of this case report is to highlight and explore the role of imaging especially Computed Tomography Angiography (CTA) thorax to diagnose a focal traumatic aortic isthmus pseudoan- eurysm in a young gentleman sustaining high impact thoracic trauma.