Displaying publications 1 - 20 of 461 in total

  1. Norhalini Hamzah, Majdiah Syahirah Nasir, Mohd Basri Mat Nor, Azrina Md Ralib
    Introduction: There has been increasing evidence of detrimental effects of cumulative positive fluid
    balance in critically ill patients. The postulated mechanism of harm is the development of interstitial
    oedema, with resultant increase morbidity and mortality. We aim to assess the impact of positive fluid
    balance within the first 48 hours on mortality in our local ICU population. Methods: This was a secondary
    analysis of a single centre, prospective observational study. All ICU patients more than 18 years were
    screened for inclusion in the study. Admission of less than 48 hours, post-elective surgery and ICU
    readmission were excluded. Cumulative fluid balance either as volume or percentage of body weight from
    admission was calculated over 6, 24 and 48 hour period from ICU admission. Results: A total of 143 patients
    were recruited, of these 33 died. There were higher cumulative fluid balances at 6, 24 and 48 hours in nonsurvivors
    compared to survivors. However, after adjusted for severity of illness, APACHE II Score, they were
    not predictive of mortality. Sensitivity analysis on sub-cohort of patients with acute kidney injury (AKI)
    showed only an actual 48-hour cumulative fluid balance was independently predictive of mortality (1.21
    (1.03 to 1.42)). Conclusions: Cumulative fluid balance was not independently predictive of mortality in a
    heterogenous group of critically ill patients. However, in subcohort of patients with AKI, a 48-hour
    cumulative fluid balance was independently predictive of mortality. An additional tile is thus added to the
    mosaic of findings on the impact of fluid balance in a hetergenous group of critically ill patients, and in subcohort
    of AKI patients.
  2. Dalia, F.A., Hamizah, I., Zalina, N., Yong, S.L., Mokhtar, A.
    Introduction: To review the gestational age at diagnosis, method of diagnosis, pregnancy outcome and
    maternal complications of prenatally diagnosed lethal foetal anomalies. Methods: Retrospective review of 25
    women who had aborted or delivered foetuses with lethal anomalies in a tertiary hospital in 2011 based on
    patient medical records. Results: There were a total of 10,088 deliveries, in which 25 (0.24%) women were
    found to have conceived foetuses with lethal anomalies. All of them were diagnosed by prenatal ultrasound
    and only 7 (28.0%) had both prenatal ultrasound and genetic study done. The women’s mean age was 29.9
    years old. The mean gestational age at diagnosis of lethal foetal anomalies was 25.5 weeks (SD=12.5) and
    mean gestational age at termination of pregnancy (TOP) or delivery was 28.5 weeks (SD=12.5). Seven (28%)
    women had early counseling and TOP at the gestation of < 22 weeks. Beyond 22 weeks of gestation, eight
    (32%) women had TOP and ten (40%) women had spontaneous delivery. Twenty (80%) women delivered or
    aborted vaginally, three (12%) women with assisted breech delivery and two (8%) women with abdominal
    delivery which were performed due to transverse foetal lie in labour and a failed induction, leading to
    emergency hysterotomy complicated by hysterectomy due to intraoperative finding of ruptured uterus.
    Overall, the associated post-partum adverse events included post-partum haemorrhage (12%), retained
    placenta (12%), blood transfusion (8%), uterine rupture (4%) and endometritis (4%). Mean duration of hospital
    stay was 6.6 days (SD 3.7 days). Conclusion: Late diagnosis of lethal foetal anomalies leads to various
    maternal morbidities, in this case series , which could have been prevented if they were diagnosed and
    terminated at early trimester. A new direction is needed in our local practice.
  3. Joehaimey, J., M. Anwar Hau A., Kamil, M.K., Jaya Purany, S.P., Saadon, I., Chee Huan, P., et al.
    Introduction: The aim of this study is to determine the most common organisms isolated in diabetic foot
    infection and the most utilised antibiotic regimes as the first line of treatment. Methods: This is a
    retrospective record review of the National Orthopaedic Registry Malaysia among diabetes mellitus type 2
    patients who had foot infections. All identified cases admitted to 18 government hospitals in Malaysia from
    the 1st January 2008 until the 31st December, 2009 were included in the study. Results: A total of 416
    patients were included in the study. The most common organisms cultured were Proteus species (17.5%),
    Klebsiella species (17.1%) and Staphylococcus aureus (17.9%), while the most commonly used antibiotic was
    ampicillin/sulbactam (67.5%). None of the patients was appropriately treated with metronidazole,
    cefoperazone or fucidic acid. All patients were given appropriate antibiotics to treat Serratia infection.
    Conclusion: Significant number of patients with diabetic foot infections were not treated using appropriate
    antibiotics as the first line treatment.
  4. Md. Muziman Syah, M.M., Mutalib, H. A., Sharanjeet Kaur, M. S., Khairidzan, M. K.
    Introduction: The purpose of this study was to derive a modified equation for contact lens method (CLM) in
    calculating post myopic laser refractive surgery corneal power. Methods: A total of 93 subjects who
    underwent myopic laser refractive surgery at IIUM Eye Specialist Clinic were recruited. The accuracy of
    postoperative corneal power using the standard CLM and newly-derived contact lens modified method
    (CLMmod) were compared to the standard comparison method ; the historical method (HM). The CLMmod
    equation was derived by adjusting postoperative corneal power of CLM according to amount of refractive
    change. Results: The mean postoperative corneal power using standard CLM was significantly higher than
    HM (mean difference: -0.24 D, p < 0.001). Fifty seven percent (n = 53 eyes) of the standard CLM results were
    within ±0.50 D of HM results. The difference between postoperative corneal power using standard CLM and
    HM increased significantly with the amount of refractive change (r = 0.835; p < 0.001). The mean
    postoperative corneal power of CLMmod showed that there was no statistical significant difference compared
    to the HM results (mean difference: 0.00 D, p= 0.964). Eighty eight percent (n = 82 eyes) of the CLMmod
    results were within ±0.50 D of HM results with improvement of 31% from the standard CLM results.
    Conclusion: The CLMmod equation provides more accurate calculation in determining post myopic laser
    refractive surgery corneal power. In near future, this modified equation can be used as an alternative
    equation to calculate postoperative corneal power when the preoperative data is unavailable.
  5. Goh, K.L., Zamzuri, Z., Mohd Ariff, S., Mohamed Azril, M.A.
    Introduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable
    intertrochanteric fractures continues to raise concern related to risk of lag screw cut-out with or without
    subsequent damage to the acetabulum. Measurement of tip-apex distances (TAD) has been recommended to
    guide the optimal placement of lag screw and to predict subsequent risk of screw cut-out. In this study, the
    value of TAD was evaluated to verify its usefulness. Methods: This is a retrospective study of 33 consecutive
    patients with intertrochanteric fracture treated with DHS. Demographic data of the patients were traced
    from their case notes. Post-operative radiographs were reviewed by focusing on measurement of TAD on
    anteroposterior and lateral radiographs. Radiographs at one year follow-up were reviewed to depict any
    fixation-related failure or complication. Results: Fifty two percent of patients did not achieved the
    recommended TAD of ≤ 25mm. The mean post-operative TAD was 25.9mm and elderly patients were likely
    to achieve TAD of ≤ 25mm. The overall complication rate of 6% was attributed to screw cut-out in two
    cases. The unstable left-sided fracture was identified to be a potential risk for screw cut-out or migration.
    Conclusion: TAD is a valuable measurement to guide optimal placement of lag screw during DHS fixation of
    intertrochanteric fracture.
  6. Amjad, N.M., Karim, K.A., Naing Soe, Y.
    Introduction: The goal of palliative care is the provision of the best quality of life (QOL) for terminally ill
    and dying patients. Advances in medical treatment has seen an increase in overall survival of all stages of
    malignant diseases. This includes advanced and/or inoperable malignancies where management is mainly
    palliative involving different modalities. Methods: We designed a cross-sectional descriptive study of
    surgical patients in a palliative care unit in a 1000-bedded teaching hospital in Kuantan, Malaysia.
    Objectives of this study are: to study the demographic characteristics and indications for admission of
    surgical patients in palliative care unit, to study the options of treatment modalities and their
    complications, to identify the barriers in decision making in surgical treatment and finally to objectively
    assess the quality of life of these patients by utilizing QUALITY OF LIFE (WHOQOL) –BREF –questionnaire.
    Results: One hundred and one eligible patients (53%) male, (47%) female of mean age of 54yrs, majority
    Malay and Chinese patients were included in the study. All patients had malignancies and they were Breast
    (30%), Lower gastrointestinal (GI) (24%), (18%) upper GI, (15%) hepato-biliary, and (7%) pancreatic cancers.
    Thirty two percents of patients had emergency treatment while the rest had supportive treatment. Barriers
    to decision making were mainly due to patient factors in 71%, while 12% was due to the disease presenting
    at an advanced stage and 15% due to limitation of care. The final results of overall quality of life rating
    were shown as poor (1%), neither poor nor good (42%), good (52%) and very good (2%). Conclusions:
    Palliative care and end of life decision making from surgical point of view is a delicate issue. Like all other
    fields in medicine, palliative care must be evidence-based with specific goal directed therapy. Our study
    shows that we are able to positively impact the quality of life in more than two thirds of our patients. Our
    aim is to achieve 100% success. As such, it is imperative to inculcate the goal of palliative care to all grades
    of health care personnel. ‘To cure sometimes, To relieve often, To comfort always’ should not be mere
  7. Ramli, M., Mohd Aznan, M.A., Maliya. S., Muhamad Shaiful Lizam, M.A., Muhammad Salman, M.H., Mohamad Faqihuddin, H., et al.
    Introduction: Lack of knowledge and negative attitude towards HIV/AIDS may be the risk factors for HIV infection among transsexuals. Research on knowledge and attitude towards HIV infection in transsexual communities is very limited at both local and international levels. This study aimed to assess the knowledge and attitude towards HIV infection among the male-to-female transsexual community in Kuantan, Pahang.
    Methods: A cross-sectional study was carried out from July to August 2014 among 33 male-to-female transsexuals in Kuantan, Pahang. Convenience sampling was used. Participants who gave consent answered a self-administered questionnaire. Data obtained was analyzed with descriptive statistics, χ2-test, and independent sample t test.
    Results: The majority of the subjects in this study were 29 years and below (48.5%), Muslims (93.9%), and had completed up to secondary education (60.6%). Most of them were sex workers (60.6%), and had relatively low income (no income to RM 3000, mean of RM1528). A total of 87.9% of the subjects demonstrated good knowledge and also positive attitude towards HIV/AIDS. Level of education was significantly associated with scores in knowledge (p=0.01).
    Conclusions: Despite the positive outcome from this study, misconceptions towards HIV/AIDS still exist among transsexuals. Education and interventions from multiple directions on HIV/AIDS are essential to deliver the correct information to this population, so as to emphasize prevention, early detection, and holistic medical care. Transsexuals also require attention from religious bodies and non-governmental organizations to help them in employment, financial, spiritual, and psycho-social issues.
  8. Kamaluddin, M.R., Hassan, S.K., Dharmalingam, T. K.
    Introduction: Despite general acknowledgement of the importance in assessing family needs in critical care
    patients, there is no psychometric instrument to measure the family needs within Malaysian settings. This
    study aimed to perform factorial validation and establish psychometric properties of Malay translated
    Critical Care Family Need Inventory (CCFNI-M) for Malaysians. Methods: This study consisted of four
    protocols: Forward-Backward translation, validity, internal reliability and inter domain correlations phases.
    The factorial validation of the CCFNI-M was based on its administration to 109 family members of critical
    care patients admitted to the Intensive Care Unit of Hospital Universiti Sains Malaysia, Kelantan, Malaysia.
    At validity phase, factorial validation was performed using Exploratory Factor Analysis using Principal
    Component Analysis with Varimax rotation. The internal consistency and inter domain correlations were
    calculated using Cronbach’s alpha and Pearson correlation coefficient respectively. Results: Preliminary
    analyses reported the suitability of data for factorial validation. With reference to the original CCFNI, five
    factors were extracted which explained 49.4% of the total variance. After removal of several items for
    different reasons, the final items in CCFNI-M were 42. The internal consistency values for five dimensions
    ranged from 0.72 to 0.87 with inter domain correlation values (r) among the dimensions ranged between
    0.36 and 0.61. Conclusion: The high measures of factorial validity, internal consistency and inter domain
    correlations values of the CCFNI-M make it suitable measure for assessing the family needs of critical care
  9. Zalina, N., Ruqaiyah, B. R., Hamizah, I., Roszaman, R., Mokhtar, A., Rozihan, I., et al.
    Objective: Lower Urinary Tract Symptoms (LUTS) is a highly prevalent disease which varies by geography
    and culture. It influences the quality of life and has social implication. The objectives of this study are to
    estimate the prevalence of LUTS among women attending our gynaecology clinic, the associated risk factors
    and their quality of life. Method: This is a cross sectional study on women attending gynaecology clinic in a
    tertiary centre. Participants were given 3 sets of validated self-answered questionnaire, UDI-6, IIQ-7 and
    OAB V8. Results: the prevalence of luts is 50.6% which is common among Malay women. Forty nine percent
    is due to stress urinary incontinence (SUI). The risk of LUTS is significantly associated with obesity (AOR =
    12.14 95% CI = 1.21 to 121.99, p – value = 0.034), higher parity (AOR = 1.68 95% CI = 1.26 to 2.24, p – value =
  10. Rathor MY, Azarisman Shah MS, Hasmoni MH
    The practice of contemporary medicine has been tremendously influenced by western ideas and it is assumed by many that autonomy is a universal value of human existence. In the World Health Report 2000, the World Health Organization (WHO) considered autonomy a “universal” value of human life against which every health system in the world should be judged. Further in Western bioethics, patient autonomy and self -determination prevails in all sectors of social and personal life, a concept unacceptable to some cultures. In principle, there are challenges to the universal validity of autonomy, individualism and secularism, as most non-Western cultures are proud of their communal relations and spiritualistic ethos and, thereby imposing Western beliefs and practices as aforementioned can have deleterious consequences. Religion lies at the heart of most cultures which influences the practice patterns of medical professionals in both visible and unconscious ways. However, religion is mostly viewed by scientists as mystical and without scientific proof. Herein lies the dilemma, whether medical professionals should respect the cultural and religious beliefs of their patients? In this paper we aim to discuss some of the limitations of patient's autonomy by comparing the process of reasoning in western medical ethics and Islamic medical ethics, in order to examine the possibility and desirability of arriving at a single, unitary and universally acceptable notion of medical ethics. We propose a more flexible viewpoint that accommodates different cultural and religious values in interpreting autonomy and applying it in an increasingly multilingual and multicultural, contemporaneous society in order to provide the highest level of care possible.
  11. Shamini Arasalingam, Hatta Sidi, Ng Chong Guan, Srijit Das, Marhani Midin, Ramli Musa
    Introduction: Both premature ejaculation(PE) and erectile dysfunction(ED) are prevalent sexual health
    disorders that have been inadequately investigated in Malaysia, a multiethnic and conservative nation.The
    objective of the study was to study the relationship between PE and ED, and other common mental health
    issues, i.e. anxiety and depression in Malaysian urban population. Methods: The diagnosis for PE was
    established by clinical diagnosis using DSM-5 and ISSM definition criteria for PE, whereas a diagnosis of ED
    was established by the International Index of Erectile Function (IIEF) questionnaire. Anxiety and depression
    levels were detected from the Hospital Anxiety and Depression Scale (HADS). Results: Based on DSM-V and
    ISSM clinical diagnosis for PE, the prevalence of PE was found to be 25%. Erectile dysfunction (p = 0.035, OR
    = 3.315, 95% CI 1.088, 10.103) and severe anxiety (p = 0.020, OR = 7.656, 95% CI 1.383, 42.396) significantly
    predicted presence of PE. Conclusion: There was a strong association between PE and ED and between PE
    and anxiety. Routine examination for PE in male patients should address the issue and the management of
    both ED and anxiety among PE patients, especially in an urban Malaysian clinical and medical care setting.
    Introduction: Both premature ejaculation(PE) and erectile dysfunction(ED) are prevalent sexual health
    disorders that have been inadequately investigated in Malaysia, a multiethnic and conservative nation.The
    objective of the study was to study the relationship between PE and ED, and other common mental health
    issues, i.e. anxiety and depression in Malaysian urban population. Methods: The diagnosis for PE was
    established by clinical diagnosis using DSM-5 and ISSM definition criteria for PE, whereas a diagnosis of ED
    was established by the International Index of Erectile Function (IIEF) questionnaire. Anxiety and depression
    levels were detected from the Hospital Anxiety and Depression Scale (HADS). Results: Based on DSM-V and
    ISSM clinical diagnosis for PE, the prevalence of PE was found to be 25%. Erectile dysfunction (p = 0.035, OR
    = 3.315, 95% CI 1.088, 10.103) and severe anxiety (p = 0.020, OR = 7.656, 95% CI 1.383, 42.396) significantly
    predicted presence of PE. Conclusion: There was a strong association between PE and ED and between PE
    and anxiety. Routine examination for PE in male patients should address the issue and the management of
    both ED and anxiety among PE patients, especially in an urban Malaysian clinical and medical care setting.
  12. Jinadu LO, Salmiah M S, Azuhairi AA
    Introduction: According to the Youth Behaviour Risk Factor Surveillance (YBRFSS, 2011) in Malaysia, the prevalence of smokers nationally among Form 1, 2 and 4 students government secondary school students was 9.1% (ever smokers) and 8.7% (current smokers). However, there is limited information on the prevalence of smoking among religious secondary school students and self-esteem as risk factor. Thus, this study was conducted to determine the prevalence and factors associated with smoking among the religious secondary school students in Petaling district, Selangor.
    Methods: A cross-sectional study was conducted among 899 students. The schools were selected using cluster sampling and self-administered questionnaire was used. Data was analyzed using chi-square test and multivariate logistic regression to identify the independent factors for smoking.
    Results: The response rate was 94%. The prevalence of ever smoking was 10.1%; 3.9% among female and 18.6% among male. The median age (interquartile range) of smoking initiation was 12.00 (4.01) years. The results showed that independent factors for smoking were: males (OR= 5.47); age group 14-15 years (OR=2.82) and 16-17 years (OR=3.63) and having low self -esteem (OR=6.24).
    Conclusion: prevalence of ever smokers is higher when compared to YBRFSS, (2011) and it was revealed that most of the smokers started smoking even before secondary school. The results also revealed the importance of promoting self-esteem. Efforts in smoking prevention should therefore be focused on curbing the initiation of the acts and improving students’ self-worth.
  13. Ahmad Nabil, M.R., Saini, S.M., Sharip, S., Nasrin, N., Bahari, R.
    Introduction: The mainstay of treatment of depression relies on pharmacological and psychological treatments. On top of that, evidence also recognizes the vital role of spirituality for human wellness which leads to growing interest in its utilization to treat depression. However, research on spirituality among Muslims in relation to depression is relatively scarce. The aim of this study is to explore the understanding of spirituality among Muslim patients with depression, and to explore their spiritual needs.
    Methods: This is a qualitative study conducted on 10 depressed Muslim patients at the UKM Medical Centre. Purposive sampling was done to ensure diversity of subjects. Individual in-depth interviews were conducted using semi-structured questionnaire guidelines. The data were transcribed verbatim and analysed using a thematic approach.
    Result: Out of 10 patients, almost all of them expressed spiritual needs. Two major themes emerged in relation to the spiritual needs which are (i) religious needs; need for worship, religious knowledge and guidance, religious reminders, and (ii) existential needs; need for calmness, sensitivity and empathy, self-discipline, certainty, hope , physical help, ventilate and meaning of illness. These needs are essential for patients during the time of crisis.
    Conclusion: The majority of patients expressed spiritual needs which are required during the process of recovery and this provides an opportunity to incorporate spiritual approaches in the treatment of depression. However, more studies are needed to demonstrate its scientific basis and to design an effective psycho-spiritual treatment modality so that the ‘holistic’ or ‘biopsychosocial-spiritual’ treatment can be integrated by health care professionals to those in need.
    Study site: hospital database at the department of psychiatry (in-patient and outpatient), Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
  14. Norzila, A.B., Wong, M.P.K.
    Malignant pedunculated (exophytic) hepatocellular carcinoma (P-HCC) is a rare entity of hepatocellular
    carcinoma. Due to its unique characteristics, it gives a different spectrum of clinical findings, radiological
    presentation and different management approach with reported better outcome to the patients. We
    present a case report of a lady diagnosed with malignant pedunculated hepatocellular carcinoma.
  15. Nurul ‘Izzati, A.H., Nor Azlina, A.R., Nor Iza, A.R., Mainul, H.
    Smoking is an issue that has spread around the world throughout the years. The majority of smokers have the intention to quit smoking, but due to some factors, it may prevent their intention. Research and interventions have been done in many countries to decrease the smoking prevalence. This cross-sectional study aimed to find out the associations of knowledge, attitude and practice (KAP) towards smoking and to identify the factors associated with knowledge and attitude towards smoking, in priority to sociodemographic factors among the International Islamic University Malaysia Kuantan (IIUMK) communities, including between students and workers. One hundred fifteen respondents of students and workers from IIUMK were investigated with a self-administered questionnaire starting from 10-01-2014 to 10-02-2014. The data were analysed using SPSS software.Respondents had good knowledge and practice, and moderate attitude towards smoking. There was weak positive correlation between knowledge with attitude (r=+0.193, p=0.038) and practice (r=+0.206, p=0.028), also moderate correlation between attitude and practice towards smoking (r=+0.626, p<0.001). There was no factor found to be associated with knowledge, but significant association was found between attitude towards smoking with gender (p<0.001), education level (p=0.016) and smoking status (p<0.001). Although, the mean values of KAP levels were higher for workers, but it was not statistically significant as compared to the students. These study findings suggested that the main obligation are more for students to improve their KAP level towards smoking as they are fresh generation who will educate and lead the upcoming generation of Malaysia.
    KEYWORDS: Health Knowledge, Attitudes, Practice, Smoking, Students, Workers.
  16. Drama, S., Maliya, S., Liyana, A., Farhani, S., Jannah, R., Razman., M.R.
    Introduction: Transsexuals face discriminations and rejections from the Malaysian society. The number of
    studies done on understanding the phenomenology, experiences, and problems faced by transsexuals is still
    few in Malaysia. This research aims to document their psycho-social and spiritual backgrounds and the
    relevant experiences, and to explore their perceptions and needs as male-to-female transsexuals in the
    context of Persatuan Insaf Pahang, Malaysia. Materials and Methods: A qualitative research was carried out
    in July and August 2015 among eight male-to-female transsexual adults in Kuantan, Pahang. Snowball
    sampling was used. Participants who gave consent were interviewed in two focus groups. Data obtained was
    transcribed and used as the primary data source. Results: Subjects in this study reported confusions over
    their gender identity since childhood. They struggled against conflicts regarding their transsexuality in
    adolescence, and eventually many quit their studies. As adults, they were discriminated against in
    employment and religious settings. They provided positive feedbacks on religious authorities who could
    understand problems unique to transsexuals and empathise with the transsexual community. Conclusion: The
    psycho-sexual phenomenology is the same in transsexuals all over the world. Misunderstanding and
    discrimination from the society remain heavy towards this community. Transsexuals should learn to adapt to
    meeting expectations from the society as well, so they could be accepted in public. They will need religious
    guidance and spiritual support for better quality of life. Dedicated efforts are still needed in training
    professionals in the educational, medical, and religious fields to attend to the specific needs of transsexuals
    in this country.
  17. Muhammad, Z.R., Norra, H., Suhaila, A., Norlelawati, A.T., Naznin, M.C.
    Introduction: Gastrointestinal stromal tumour (GIST) is relatively rare. The clinical behaviour of GIST ranges
    from benign to frank sarcoma. The diagnosis is established through histopathological examination and
    immunohistochemistry profile. In Malaysia, the number of publications related to GIST is relatively rare. This
    study was therefore conducted to examine the demographic, histopathological and immunohistochemical
    features of GIST cases diagnosed in the Department of Pathology, Hospital Tengku Ampuan Afzan, Kuantan,
    Pahang from 2009 until 2014. Methods: Past histopathological records were reviewed. Demographic and
    histopathological and immunohistochemical data of patients diagnosed were collected. Results: There were
    28 cases (14 males and 14 females) diagnosed as GIST. Mean age was 56.4 years, and the majority were
    above 40 years of age (85.7%). Stomach was the most common location (42.9%), followed by small intestine
    (28.6%). In 23 cases (82%), the tumours exhibited spindle cell morphology, while epithelioid cell and mixed
    cell types were seen in 3 cases (11%) and 2 cases (7%), respectively. Five cases were categorised as very low
    risk to low risk behaviour, while 18 cases were intermediate to high. None of the histological parameters
    analysed which include tumour morphology, necrosis, haemorrhage, nuclear atypia and mean number of
    mitoses showed significance difference between the different risk behaviour groups. Positivity with KIT
    (CD117), considered to be the defining immunohistochemistry feature, was negative in 2 cases. Conclusion:
    Although this study is a retrospective study, the findings contribute to the knowledge on GISTS in Malaysia.
    Future research related to GISTs in Malaysia should focus on molecular analyses for KIT and PDGFRA
    mutations for diagnostic confirmation especially in KIT-negative cases and also for the purpose of
    therapeutic response correlations.
  18. Jamalludin, A.R., Razman, M.R., Niza, S.
    Background: Peer assessment has been shown to complement both formative and summative evaluations in education and used in some medical programmes. The study was aimed to find correlation between group work peer assessment score and final examination mark among four batches of International Islamic University Malaysia (IIUM) first year MBBS students.
    Method: A set of four questions was constructed and tested to assess students’ overall role in their group research project. The difference in distribution according to years was tested by using one-way ANOVA or Kruskal-Wallis, depending on the data distribution. Pearson correlation coefficient test was done to test the linear association between peer score and final examination mark. Partial correlation test was used to adjust the correlation for four academic years.
    Results: From the analysed data of 502 students, there was moderate, significant positive correlation (0.366) between peer assessment score and the final examination mark (P < 0.001). Adjustment to the academic years resulted in correlation coefficient of 0.371.
    Conclusion: The results provide an important insight on the influence of peers’ perception in predicting the medical student academic performance.
  19. Hafiz J., Dzulkhairi, M.R., Shamsir, M.A., Abu, N.
    Introduction: Islamic prayers involve certain physical movements and positions. These positions may be
    difficult to achieve in Muslim patients who suffer from any illness that limit their physical movements.
    Therefore, Islam introduced the concept of Rukhsah or exemptions. The objective of this study was to
    assess the knowledge, attitudes and practices of healthcare workers related to performing prayers during
    illness. Materials and Methods: A cross sectional study was conducted among 121 healthcare workers in
    Hospital Langkawi, between 22nd to 24th April 2014. Simple random sampling method was used to select the
    participants among healthcare workers in Hospital Langkawi to attend a workshop on Rukhsah Ibadah. The
    participants were given a set of questionnaire to answer and all the data were collected just before the talk
    began. Results: The majority of the participants 108 (89.3%) were female and more than half of them 74
    (61.2%) were staff nurses. The mean age for the participants was 32.4 (SD: 9.42) years. About 73 (60.3%) of
    the participants have good knowledge, 62 (51.2%) have good attitude and 73 (60.3%) have good practice
    towards religious obligations and Rukhsah. Bivariate analysis shows no correlation between age and
    knowledge, attitude and practice score. There was also no correlation seen between knowledge, attitude
    and practice score. Conclusion: Almost half of the participants have good knowledge, attitude and practice
    on performing prayers during illness. By conducting proper training and coaching, it is hoped that their level
    of understanding towards Rukhsah can be improved.
  20. Mohd Sayuti, R., Raja Ahmad, R.L.A., Wan Ishlah, L., Kahairi, A., Asha’ari, Z.A., Norie Azilah, K.
    Introduction: External laryngotracheal (ELT) trauma is rarely encountered in clinical practice. In most
    circumstances, this injury is overlooked by the primary attending team. Surgical management of ELT trauma
    is complicated, because there is no established management approach for this potentially life-altering, high
    morbidity injury. It is important for this injury to be identified early, as any delay in surgical intervention
    may result in poor airway and phonatory outcomes. The aim of surgical reconstruction is to minimise the
    above debilitating morbidities by restoring the main laryngeal functions as much as possible. Methods: We
    reviewed the outcomes of six surgical interventions for ELT trauma at Tengku Ampuan Afzan Hospital from
    June 2007 to June 2014. Clinical presentations, computed tomography (CT) scans features, intraoperative
    findings, and postoperative outcomes were evaluated. Results: All patients made a good recovery in terms of
    phonation except for one patient who had reduced speech function. After one year, one patient was still
    dependent on a fenestrated tracheostomy. This article describes the surgical reconstruction techniques used
    to achieve these positive outcomes. Stenting is helpful to aid healing and re-epithelialisation. Conclusion:
    Prompt recognition and non-traumatised airway control are essential for addressing laryngotracheal trauma.
    Subcutaneous emphysema is an important hallmark that should alert the attending physician to the
    possibility of ELT trauma. Immediate surgical intervention using appropriate techniques can produce
    favorable patient outcomes.
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