INTRODUCTION: Thyroid antibodies are closely related to autoimmune thyroid disorders. To date, there
are no data on the prevalence of these antibodies among the Malaysian population. This study aimed to
determine the prevalence of thyroid antibodies; and the factors associated with thyroid antibodies in the
Malaysian adult population. MATERIALS AND METHODS: A cross-sectional study was performed in 5 preassigned regions in Peninsular Malaysia. Participants’ sociodemographic profile and medical history were
recorded. Physical examinations were done looking for abnormalities of the thyroid gland and signs of thyroid
dysfunctions. Fifteen mils of blood were withdrawn and analysed for thyroid function, anti-thyroperoxidase
(anti-TPO) and anti-thyroglobulin (anti-TG) antibodies at a central laboratory. RESULTS: Among the total of
2190 respondents, the overall prevalence of positive anti-TPO and anti-TG antibodies were 12.2% and 12.1%,
respectively; mainly found in urban and coastal areas. Only 7% to 9% of those with positive anti-TPO or antiTG antibodies had either hypo- or hyperthyroidism. The predictors for positive anti-TPO antibody were
female [adjusted OR 1.7 (95%CI: 1.2–2.4); p=0.001], Indian [adjusted OR 1.9 (95%CI: 1.1–3.1); p=0.020], and
having a goitre [adjusted OR 1.8 (95%CI: 1.2–2.8), p=0.004]. The predictors of positive anti-TG antibody was
female [adjusted OR 2.3 (95%CI: 1.6–3.3); p
Introduction: Long waiting time is a common issue complained by diabetic patients that came for an
early morning appointment in a health clinic. Therefore, an audit was conducted among diabetic patients in
a primary care clinic with the aim to assess the patients’ waiting time and to formulate strategies for
improvement. Methods: This audit was conducted for four weeks using a universal sampling method in
November 2017. All diabetic patients who attended the clinic during this period were included except those
who required longer period such as critically ill patients or those who came for repeat medication or
procedures. The arrival and departure time for each station was captured using the modified waiting time
slip, which is manually filled at every station. The waiting and consultation time for registration, screening,
laboratory investigation, diabetic educator, doctor and pharmacy were recorded. The data were entered into
the statistical software SPSS version 17 for analysis. Results: Results showed that all patients were registered
within 11.0 minutes (SD=2.52min). Average total waiting time to see a diabetic educator and a doctor was
20.9 minutes (SD=15.53min) and 33.23 minutes (SD=27.85min), respectively. Average waiting time for other
stations was less than 10 minutes. Average total time spend in the clinic for a diabetic patient was 107.58
minutes, which is comparable to a non-diabetic patient. The identified problems were due to the poor
tracing and filing system. Conclusion: Improvement strategies recommended include enforcing early file
tracing prior to appointment and providing a checklist for consultation by doctors and diabetic educators.
Introduction: Over the decades, organic arsenic has been thought to be less toxic than inorganic arsenic.
Monosodium methylarsonate (MSMA) is a potent organoarsenical herbicide that is still being used in most
Asian countries. Reported studies on the effects of organic arsenic are mainly to the gastrointestinal system,
however there are limited research on its impacts to the liver. Therefore, this study aimed to investigate the
effect of MSMA exposure on hepatocytes and liver sinusoidal endothelial cells (LSEC). Materials and Methods:
Fourteen Sprague Dawley rats (n=14) were divided equally into arsenic-exposed (n=7) and control (n=7)
groups. The rats in arsenic-exposed group were given MSMA at 63.20 mg/kg daily for 6 months through oral
gavage. While the rats in control group were given distilled water ad libitum. At the end of the duration,
they were euthanized and underwent liver perfusion for tissue preservation. Liver tissues were harvested and
processed for light microscopy, scanning and transmission electron microscopy. The findings were analysed
descriptively. Results: MSMA had caused necrotic and apoptotic changes to the liver. Normal organelles
morphology were loss in the hepatocytes while LSEC revealed defenestration. Conclusion: In this study,
chronic low dose organic arsenic exposure showed evidence of toxicity to hepatocytes. Interestingly, LSEC
demonstrated capillarization changes.
Introduction: Traditionally, Mallotus paniculatus (Balik Angin) plant is used in the treatment of various
diseases in rural areas such as remedy after childbirth, wound healing and fever. In this present study, four
medicinal properties of the plant were investigated which included antibacterial, antifungal, anticancer and
antioxidant activities. Materials and Methods: Potential medicinal compounds were extracted from the plant
leaves by sonication with 3 different solvents namely ethanol, ethyl acetate and hexane respectively. The
antibacterial and antifungal properties were determined using disc diffusion agar and broth dilution assay,
the antioxidant activity by DPPH scavenging assay and the anticancer effect by MTT assay. Results: From the
screening of the medicinal properties, M. paniculatus leave extracts were shown to possess antibacterial,
antioxidant and anticancer properties but not antifungal properties. Ethanolic and ethyl acetate extracts of
the leave were active against gram positive bacteria (Staphylococcus aureus and Bacillus subtilis) but not
gram negative bacteria (Pseudomonas aeruginosa and Escherichia coli). The antioxidant activity of the
ethanolic crude extract was high; with IC50 of 30 μg/ml comparable with the positive controls; ascorbic acid
and butylated hydroxytoluene (BHT). Both ethanolic and ethyl acetate extracts were cytotoxic against breast
cancer (MCF7), colon cancer (HT-29), cervix cancer (Hela) cell lines. Conclusion: M. paniculatus leave
extract has many potential medicinal values for further studies.
Recreational noise exposure has become a major threat to the hearing system, and this
includes exposure to loud noise during group exercises such as Zumba Fitness, where loud music plays an
important role. This study aimed to assess the noise exposure and hearing threshold profile among Zumba
Fitness regulars in Kuantan, Malaysia. MATERIALS AND METHODS: Noise exposure and hearing profile
threshold were measured during Zumba Fitness sessions at a fitness studio in Kuantan, Malaysia from 24th
June 2014 to 12th August 2014. Noise exposure was measured using a noise dosimeter for one hour of Zumba
Fitness session with a total of nine sessions run by three different instructors while sound level pressure was
taken using a sound level meter during ambient, peak session and during cooling down. Thirty participants
answered questionnaires and underwent pure tone diagnostic audiometry test at a local clinic for hearing
threshold documentation. RESULTS: Some areas of the hall posed higher risks of causing noise-induced
hearing loss especially near the amplifiers. There were periods when the hearing level exceeded 115 dBA.
Early abnormal pattern could be observed in the hearing profiles of some of the participants to suggest
preliminary hearing problems. CONCLUSION: Zumba Fitness regulars have a risk of developing noise-induced
hearing loss and preventive steps should be properly addressed as NIHL is permanent and irreversible.
Fistula-in-ano is a benign anorectal disease which always poses a big dilemma to the surgeons
because of their significant recurrent rate following surgery. Materials and Methods: A cross-sectional study
involving 42 patients undergoing core out fistulectomy in the Hospital Tengku Ampuan Afzan, Kuantan,
Pahang, Malaysia were included in this study. Demographic data of patients were assessed. Endoanal
ultrasound (EAUS) was done prior to the surgery to determine types of fistula and classified using Park’s
classification. Follow up was made post-operatively at 4th week, 2nd month, 3rd month, 4th month, 5th month
and 6th month to look for the duration of healing or recurrence. Results: 5 out of 42 patients were lost to
follow up leaving 37 patients available for the analysis. Mean age of the patient was 38.4 (13.8) years old.
Transphincteric and intersphincteric type of fistula accounted for 54.5% and 40.1%, respectively. 62.2%
(n=23) of patients achieved primary healing after the procedure. The mean for healing duration was 3.7
(3.1) months. Recurrence of the disease was seen only in 37.8% (n=14) of the patients. Conclusions: Even
though we managed to achieve significant success rate cumulatively, recurrence of fistula still impose a
significant challenge toward patient’s management. Therefore, further prospective study with a bigger
sample size is recommended to look into this method to reduce recurrence of fistula.
Introduction: Overweight and obesity has been emerging as one of the most common and preventable
nutritional problems worldwide. In 2016, 39% and 13% of the adult population worldwide was classified as
overweight and obese, respectively. Materials and Methods: We conducted a cross-sectional study at 12
selected health clinics in Perak, Malaysia, and we used multi-stage cluster random sampling to determine the
prevalence of overweight and obesity among the primary healthcare workers and the associate factors of
obesity indices. Each respondent was required to complete a self-administered questionnaire on their sociodemographic characteristics. In addition, we took anthropometric measurements, including height, weight,
BMI, waist circumference, and body fat percentage, of the participants. Results: We recruited 261 primary
healthcare workers. Overall, 49.9% of the healthcare workers were overweight or obese, 51.0% were at risk
of having abdominal obesity, and 79.6% had a high body fat percentages. Age and self-reported health status
were significantly associated with all the obesity indices. Educational level showed significant association
with BMI and waist circumference, while occupational status showed an association only with BMI. Older age
and professionals were predictors for high obesity indices. Conclusion: The prevalence of obesity among the
primary healthcare workers was higher than among the general population. An immediate intervention
programme is needed to reduce the prevalence of overweight and obesity among primary healthcare
workers.
Introduction: Trigona thoracica propolis is known to have antimicrobial properties, however its
antileptospiral properties and its synergistic effects with commonly prescribed antibiotics are scarcely
documented. This study aimed to evaluate the antileptospiral properties of Trigona thoracica against
pathogenic Leptospira species (spp.) and to study its synergistic effects with commonly prescribed
antibiotics. Materials and Methods: The tested Leptospira serovars were Australis, Bataviae, Canicola and
Javanica. Aqueous extract propolis (AEP) and ethanolic extracts propolis (EEP) were used. Broth dilution
methods were used to determine the Minimum Inhibitory Concentration (MIC), Minimum Bactericidal
Concentration (MBC) and the synergistic effects between the propolis and the tested antibiotics. The
synergistic effects was evaluated by using the fractional inhibitory concentration (FIC) index. Morphological
changes of the treated Leptospira were observed under a Scanning Electron Microscope (SEM). Results: The
AEP and EEP were found to have antileptospiral properties against the tested Leptospira spp. The synergy
result showed that only combination of AEP and penicillin G against serovar Australis has demonstrated
synergistic effect with the FIC index of 0.38. Morphological study using SEM showed significant structural
changes of the treated Leptospira spp. Conclusions: The result suggests that Trigona thoracica propolis could
potentially be used as either a complimentary or an alternative therapeutic agent against pathogenic
Leptospira spp.
Introduction: Based on the Theory of Planned Behaviour (TPB), sexual intention is determined by three main
socio-cognitive factors which are permissive attitudes, social-norms and self-efficacy in performing
premarital sexual activity. Premarital sex associated with increased risk of sexually transmitted diseases and
detrimental social implications. The aim of this study was to explore the correlation of the socio-cognitive
factors in predicting intention to engage in premarital sex amongst late adolescents in Kuantan government
secondary schools. Method: This cross-sectional study was conducted among 466 pre-university students aged
18-19 years from nine government secondary schools in Kuantan district. A self-administered validated Youth
Sexual Intention Questionnaire (YSI-Q) was used. Statistical analyses were done using IBM SPSS version 22.0.
Results: Permissive attitude (r=0.579, p
Introduction: Altered weather patterns and changes in precipitation, temperature and humidity resulting
from climate change could affect the distribution and incidence of cholera. This study is to quantify climateinduced increase in morbidity rates of cholera. Material and Methods: Monthly cholera cases and monthly
temperature, precipitation, and relative humidity data from 2004 to 2014 were obtained from the Malaysian
Ministry of Health and Malaysian Meteorological Department, respectively. Poisson generalized linear models
were developed to quantify the relationship between meteorological parameters and the number of reported
cholera cases. Results: The findings revealed that the total number of cholera cases in Malaysia during the 11
year study period was 3841 cases with 32 deaths. Out of these, 45.1% of the cases were among children below
12 years old and 75% of the cases were from Sabah. Temperature and precipitation gave significant impact on
the cholera cases in Sabah, (p
The incidence of rectal dissection is increasing with the rise of rectal cancer all over the world. This
technique has been used regularly to provide a reasonable quality of life for patients. The concern raised
was the functions of these neorectum to replace the original rectum. Several configurations have been
suggested namely the straight end-to-end coloanal anastomosis, side-to-end coloanal anastomosis, colonic Jpouch and the transverse coloplasty to suit the anatomy of the deep pelvis. Apparently, there was no
difference in terms of functional outcome among all these four types of reconstructions. However, these
configurations have seen the emergence of anterior resection syndrome or a pragmatic defaecatory
dysfunction as their complications. Furthermore, the neorectum functions are affected by many other
factors such as preoperative chemoradiotherapy, septic complications, and others more.
This community-based, cross-sectional study aimed to identify the factors associated with
postpartum family planning use among a cohort of women with recent caesarean delivery in a state with the
lowest contraceptive use in Malaysia. Materials and Methods: A total of 281 women aged between 18-49
years old who had caesarean delivery in government tertiary centres in Kelantan from January until April
2017 were enrolled in this study. The study was conducted from January until April 2018. Women were
selected through stratified random sampling with probability proportional to size. Data were collected
through a validated structured questionnaire. The main outcome was binary (postpartum family planning use
or non-use). The factors included socio-demographic details, reproductive history, previous contraceptive
use, contraceptive health education received, knowledge, and social support. Simple and multiple logistic
regression were conducted to identify significant determinants of postpartum family planning use. Results:
The factors associated with postpartum family planning use included a secondary and below education level
of women (AOR= 2.37, 95% CI (1.05, 5.34)), previous contraceptive use (AOR= 9.82, 95% CI (4.81, 20.06)),
individual health education (AOR= 4.19, 95% CI (1.23, 14.30)), higher knowledge score (AOR= 1.12, 95% CI
(1.03, 1.23)), and higher social support score (AOR= 1.09, 95% CI (1.03, 1.16)). Conclusions: here remains a
need to enhance personalised contraceptive counselling in the primary care setting as well as to promote
longer acting reversible contraceptive methods.
Introduction: This prospective cross sectional study assessed surgical antibiotic prophylaxis (SAP) practice,
the incidence of surgical site infection (SSI) and its associated risks in Universiti Kebangsaan Malaysia Medical
Centre. Methods: Patients for elective colorectal, hepatobiliary, upper gastrointestinal, breast and
endocrine surgery, who received SAP were included and followed up until day-30 postoperatively. Types of
antibiotic, preoperative–dose timing, intraoperative re-dosing and its duration were recorded. The incidence
of SSI was calculated and its associated risks expressed in odds ratio. Results: Out of 166 patients recruited,
121 (72.89%) patients received SAP preoperatively, and 91 (75.21%) of them were prescribed the appropriate
antibiotic as per our institutional guideline. Three patients who continued to receive therapeutic antibiotic
postoperatively were excluded from statistical analysis. Eleven (9.10%) patients received SAP beyond the
preoperative–dose timing of 60 minutes (p=0.001), which was an independent risk factor for SSI (adjusted OR
4.527, 95% CI; 1.058-19.367, p=0.042). The risk of SSI also remained in patients who continued to receive
SAP beyond 24 hours (OR 4.667, 95% CI; 1.527-14.259, p=0.007). The overall rate of SSI was 17.18%.
Conclusion: We found that the choice of antibiotic prescribed for SAP was in accordance to institutional
guideline and the relatively high SSI incidence was similar to a recent local report. Although the number of
patients receiving preoperative dose-timing of > 60 minutes was low, it was nonetheless an independent risk
factor for SSI. The postoperative continuation of SAP for more than 24 hours showed no benefit in reducing
SSI.
Introduction: Hamstring tendon (HT) and bone patellar tendon bone (BPTB) are the commonly used
autograft in an anterior cruciate ligament reconstruction surgery. The BPTB is said to have more incidence of
anterior knee pain compared to HT. The study aimed to compare the severity of knee pain during Islamic
prayer kneeling. Methods: A cross sectional cohort analysis of patients undergoing ACL reconstruction surgery
using BPTB with HT autografts was conducted to determine differences in postoperative pain while kneeling
and ability to pray in normal position. Kneeling during prayer and the ability to sit while performing prayer
were assessed at 3rd, 4th, 5th and 6th month. Results: There were no significant differences in mean pain score
while kneeling at 3rd, 4th, 5th and 6th month. The mean difference of patient’s ability to perform normal
prayers for BPTB (3.56+1.16) and HT (3.30+1.05) was found insignificant. The average number of patients in
both groups was able to pray between 3 to 4 months post operatively as full range of motion of knee is
allowed within this period. Total 49 patients (BPTB 23, HT 26) out of 60 were able to pray normally within 4
months post-operation. Mostly delayed due to anterior knee pain. Conclusion: There is no different in term of
knee pain during kneeling while performing Islamic prayer between those who had their ACL reconstructed
either using BPTB or HT autograft.
In the wake of COVID-19 infection in the world, it is
more devastating when a developing country is
affected. Fortunately, due to coordinated infection
control measures in Malaysia, the national morbidity
and mortality rate is kept low. As of May 6th 2020,
22 patients required intensive care and the mortality
rate was 1.66%.1
The majority of patients contracted
a milder form of the disease.
INTRODUCTION: One of the most important and debilitating complication of diabetes mellitus is foot
problem such as ulcers, infections and amputations. However, these complications are preventable by simple
intervention such as regular foot care practice. This study aims to assess the foot care practice and its
associated factors among type 2 diabetes mellitus patients attending primary health clinics in Kuantan.
MATERIALS AND METHODS: This was a cross-sectional study conducted at four primary health clinics in
Kuantan involving 450 study participants who were selected by using universal sampling method. Level of
awareness and practice toward diabetic foot care was assessed using validated self-administered
questionnaire. Multiple logistic regressions were performed to identify factors associated with poor foot care
practice among the respondents. RESULTS: About 59.6% of respondents had poor foot care practice and
50.9% had poor awareness level. Multivariate logistic regression analysis identified that, increasing age
(OR 0.97, 95% CI: 0.955-0.993) and good awareness towards foot problem (OR 0.43, 95%CI: 0.289-0.643)
were less likely to have poor foot care practice. However, Malay ethnicity (OR 1.81, 95% CI: 1.002-3.271) and
obesity (OR 1.9, 95% CI: 1.225-2.976) were associated with poor foot care practice after controlling other
variables. CONCLUSION: Majority of the respondents had poor foot care practice and poor awareness.
Respondents who are older and have better awareness are less likely to have poor foot care practice.
Diabetic patients who are Malays and/or obese are predicted to have poor diabetic foot practice and hence
must be prioritized for a sustainable patient education and compliance towards foot care practice at primary
care level.
Obstructive sleep apnoea (OSA) is a sleep related breathing disorder with recurrent episodes of apnoea or hypopnoea occurring during sleep. It is associated with increased risk of cardiovascular disease and prone to accidents. However, there is no applicable study that assess the risk for OSA at the primary care level. Objective: This study aims to assess the prevalence of risk for OSA and OSA symptoms and its associated risk factors among adults attending primary care clinics. Materials and method: This cross-sectional study was conducted among 252 adults attending four Klinik Kesihatan in Kuantan, Pahang. The inclusion criteria was adults age 30 years old and above. The exclusion criteria were a known case of Hypothyroidism, Depression and pregnancy. A self-administered validated Malay version of Berlin Questionnaire(BQ) was used to screen for high risk of OSA. The statistical analyses were done using IBM SPSS version 23.0. Results: Majority of the respondents were male (54%), Malay (87.7%), and married (79.4%). The prevalence of High Risk for OSA was 32.9%. Among these, 94% of them presented with snoring and 16.9% presented with excessive daytime sleepiness. Among male, Malay and married; 48%, 32.6% and 36.5% respectively was shown to be High Risk for OSA. The risk factors that were found significantly associated with High Risk of OSA includes younger age (AOR=0.951 CI=0.923-0.980); higher BMI classification with obese type 1 (AOR=2.604 CI=1.278-5.308), obese type 2 (AOR=3.882 CI=1.078-13.975) and obese type 3 (AOR=6.800 CI=1.164-39.717); higher neck circumference (AOR=1.109 CI=1.007-1.221); hypertension (AOR=2.297 CI=1.122-4.702); and hypercholestrolaemia (AOR=2.040 CI=1.050-3.965). Conclusions: This study shows that nearly one third of the adults attending primary health clinic are at High Risk for OSA and nearly 17% of them presented with excessive daytime sleepiness. Further study need to be carry out particularly among those of younger age, higher BMI classification, and with co-morbidities.
The health status of Orang Asli (OA) in Malaysia often lag behind other races with under-nutrition and communicable diseases remain significant. While there is an upward trend of non-communicable diseases (NCD) in this country due to modernisation of lifestyle, how this change affecting OA is a public health interest. Materials and method: A community based survey was conducted involving 225 OA from Jakun tribe aged above 18 years living in three villages around Tasik Chini, Pahang in 2017. Results: There were low prevalence of overweight and high blood pressure (18.8% and 14.2%). Random blood sugar 5.6 mmol/L was found in 23.4% but only five villagers (0.02%) were eventually diagnosed with diabetes mellitus. Majority (63.7%) of OA in the three villages smoke products of tobacco. Conclusion: The NCD risk among this fringe OA community is still insignificant as shown by low prevalence of overweight, high blood pressure, and diabetes even when compared to national figures for other Bumiputera in Malaysia (30%, 18.6%, and 10.7% respectively). However, the prevalence of smoking was strikingly higher than 2015 national figure for other Bumiputera (25.8%). This is contributed by high rate of smoking among women and established cultural practice. The findings highlighted the need for customization in smoking intervention for OA.
Neonates refers to the first 28 days of life, they are vulnerable to physiological changes. About 15% of neonates get admitted to NICU and a significant number of them end up in ventilation. This study assessed the beneficial role of non- pharmacological modalities on recovery with a better outcome of ventilated babies in NICU. Material and Methods: The study is a quantitative cross-sectional study for 9 months of NICU at IIUMMC. The study will include top conditions warranting neonatal intensive care unit (NICU) admissions and ventilation as preterm, respiratory distress, neonatal sepsis, HIE, and others. They are divided into two (2) groups; the first group will keep the standard practice and assigned as a control group. The second group will afford all or most of a package of non-pharmacological and sensory stimuli like a kangaroo, feeding, non-nutritive sucking, swaddling, skinto-skin contact, sensory saturation, soft massage, away irritant odour, Normal visual experience during daytime and dime light at night-time. decrease sound pollution, and voice stimulation assessing soft music or recitation of the Qur’an according to family preference. We will assess stabilizing vital signs, behavioural assessment, extubating timing, Short term outcome. Results: Adding non-pharmacological modalities could reduce the dose requirements for sedation and analgesics and has a positive effect on the neurodevelopmental outcome. Conclusion: nonpharmacological strategies besides other modalities improved short-term outcomes and the recovery of ventilated babies. The importance of coming back to nature, the effect of special senses and sensory stimulation on neonatal recovery, and ease extubation.
Productivity in medical field has inherent value in terms of improving our lives, which can expand our economies. Productivity in medicine has many aspects including improving clinical diagnostic skills, safety, and quality and quantity care. This study will assess whether early exposure to structured clinical reasoning coaching tools would improve their clinical decision making and productivity. Research question: Does clinical reasoning coaching tools Increase neonatal healthcare productivity? Materials and method: Medical practitioners recently joined neonatal units will participate over 2 years in an innovative series of clinical reasoning coaching sessions blended with virtual patients. Practitioners will be exposed to many teaching methods during the neonatal training that includes lectures, bedside teaching sessions and small group discussions beside website continuous contact for learning and chairing skills. Teaching series scope should cover resuscitating sick neonates, handling ventilators either conventional or high frequency, practicing common neonatal procedures, dealing with common neonatal scenarios, infection control policy and, effective communication skills The evaluation sessions will be introduced at the beginning of their training, during the course and at the end of the clerkship to assess their improving productivity, using diagnostic thinking inventory(DTI). Selection of the medical practitioners will be based on either on stratified random sampling or cohort control depending on the funding and logistic. All items will be analysed advanced statistical analysis methods. Results: The coaching tool may yield dramatic impact, allowing the innovators to be more productive. Suggesting widely utilize it for nurses, undergraduate and postgraduate medical Subspecialty. Conclusion: The research hypothesis is assuming that DTI scores and productivity will be higher after the coaching sessions as rated by the candidate’s performance.