INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES <p>International Journal of Allied Health Sciences, is a peer-reviewed, English-language scholarly online journal, published biannually by the Kulliyyah of Allied Health Sciences, International Islamic University Malaysia.</p> Kulliyyah of Allied Health Sciences, International Islamic University Malaysia en-US INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2600-8491 KNOWLEDGE AND ATTITUDE TOWARDS GERIATRIC AND ITS ASSOCIATED FACTORS AMONG FINAL YEAR MEDICAL STUDENTS OF INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA <p><strong>Background</strong>: The aging population is growing globally causing demographic changes and morbidity. Therefore, in order to improve the elderly's health and provide comprehensive health services, every healthcare personnel should have good knowledge and attitude. This research aims to measure the level of knowledge and attitude towards geriatric and to determine the associated factors among IIUM final year medical students.</p> <p><strong>Methodology</strong>: A cross – sectional study was conducted between May to June 2020 during the Movement Control Order (MCO) period among 116 consented students. Structured questionnaires consist of Geriatric Attitude Scale and Palmore Facts on Aging Quiz&nbsp; were completed via online Google Form. Data was analysed using IBM SPSS version 22.0. The association between the categorical variables were analysed using Mann Whitney U test and Kruskal–Wallis test.</p> <p><strong>Results</strong>: The data revealed that the overall total knowledge and attitude towards geriatrics among the students was at moderate level with median score of knowledge at 14.00(13.00) and mean score for attitude of 48.52(5.53). Place of residence (P=0.01) and presence of grandparents were the significant (P=0.04) factors that affected the knowledge of the students towards geriatrics.&nbsp; Number of siblings significantly (P=0.05) influenced attitudes of the students towards geriatrics.</p> <p><strong>Conclusion</strong>: It was concluded that there is need of improvement for the current geriatric curriculum with more refined implementation of gerontology course in the basic IIUM medical learning. Further research should be conducted to discover more on the factors that affecting knowledge and attitude towards geriatrics among medical students.</p> Shaiful Shalihin Syahirah Azmi Najwa Zin Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 2101 2101 ONE YEAR OUTCOME OF STRUCTURED DIABETES MELLITUS EDUCATIONAL PROGRAM (SDEP) ON THE MANAGEMENT OF DIABETES IN APRIMARY CARE CLINIC <p><strong>Introduction: </strong>Health education may empower the patient in term of reinforcing belief, medication adherence and initiating lifestyle changes. This study aims to examine the benefit of SDEP on the management of diabetes mellitus in a health clinic.</p> <p><strong>Materials and method: &nbsp;</strong>The SDEP are a program targeted at poorly controlled diabetic patients. It is a half day program with&nbsp; 5-6 participants, consisting of interactive and practical sessions by doctor, diabetes educator, nutritionist, occupational therapist, and pharmacist. Based on the diabetes record book of patients who had participated in 2017 and 2018, only 35 participants have a complete record, thus were included in this study. All relevant information pre and one-year post program were obtained and analysed with SPSS.</p> <p><strong>Results: </strong>All participants were Malay FELDA settlers with the mean age of 60<u>+</u>7. The mean HbA1c level at pre-program was 9.8%. There was a significant reduction in mean HbA1c level of 1.2% one-year post program. There were no new incidence of co-morbidities and diabetic complications or significant changes in other clinical parameters among this group. There was also no significant difference in total dose/day of diabetic treatment (OHAs, insulin) between pre and 1-year post-program.</p> <p><strong>Conclusion: </strong>Diabetic education program, which is targeted, structured, interactive and multi-disciplinary in nature has shown to be beneficial for diabetes mellitus management without the need for intensification of therapy.</p> <p>&nbsp;</p> K Nor Azam B Bustamanizan Z Asyikin P Hafizah Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 2102 2102 KNOWLEDGE, ATTITUDE AND PRACTICE ON BREAST CANCER AMONG STUDENTS OF IIUM <p><strong>Backgrounds:</strong> Breast cancer is among the most common cancers which lead to death among Malaysian. Despite the development of advanced screening tools for breast cancer in clinical settings, one should be able to understand and practice the knowledge gained. This study aims to emphasize on the importance of knowing the BC among IIUM Kuantan Campus students;&nbsp; the future health professionals. &nbsp;</p> <p><strong>&nbsp;</strong></p> <p><strong>Methods:</strong> A cross-sectional study was conducted at the Campus from July to August 2020 by snowball sampling method. A validated self-administered questionnaire via Google Form was distributed through Whatsapp groups. Data was analysed using Chi-square test, independent T test and multiple logistic regression analysis.</p> <p>&nbsp;</p> <p>R<strong>esults:</strong> A total of 357 students participated in this study. Among them 58.0% had good knowledge of breast self-examination, 49.% of clinical breast examination and 19.8% of mammography. Only 58.3% female students practice breast self-examination. Overall, most of the students had fair KAP of BC screening with 59.3%. The statistical analysis revealed that there was a significant (P&lt;0.05) relationship between overall KAP of BC screening with gender and Kulliyyah of study.</p> <p><strong>&nbsp;</strong></p> <p><strong>Conclusion:</strong> The KAP of BC was fair among undergraduate students of IIUM Kuantan. The efficacy and reliability of informers to convey the information may influence a better environment and understanding towards BC as well as&nbsp; help to reduce the mortality and morbidity rate from BC .</p> <p><strong>&nbsp;</strong></p> <p>&nbsp;</p> <p>&nbsp;</p> Shaiful Shalihin Kamilia Kamaruddin Izzatul Azmi Syafiqah Johar Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 2103 2103 A RARE CASE OF PATELLA ROTATIONAL DISLOCATION AND INCARCERATION IN FEMORAL CONDYLE FRACTURE <p>Patella dislocation around its longitudinal axis is rare and incarceration in femoral condyle fracture is even rarer. To date there are less than ten similar cases reported around the world. We report a 23 years old man who was involved in a road traffic accident and sustained left femur medial condyle partial articular fracture with his patella dislocated and incarcerated in the fracture site. Multiple attempts of closed reduction were unsuccessful, leading to emergency open reduction of patella. During surgery, his extensor mechanism was found to be relatively intact with only soft tissue defect over lateral aspect, of which the lateral condyle had buttonholed through it. Patella was externally rotated and incarcerated in the fracture. After disengaging the patella from fracture site, femur condyle was fixed with a locking plate and soft tissue defect was repaired. Patella tracking was restored. Six months after surgery, the fracture healed, and patient was able to fully bear weight and flex his knee up to 90 degree. Patient did not complaint of knee pain or recurrent patella dislocation.</p> Chang CW Osman Z Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 SUPRACUTANEOUS PLATING AS A METHOD TO SHORTEN EXTERNAL FIXATOR TIME IN BONE LENGTHENING AND BONE TRANSPORT – A CASE SERIES <p>Bone lengthening and bone transport are procedures that require long duration of wearing external fixator frame such as Ilizarov or monorail fixator. Prolonged time on frame (TOF) may result in patient discomfort and complications. In this study, four patients aged between 17 to 49 (average 30) years old, two femur lengthening, one tibia lengthening, and two tibia bone transport were carried out. All cases were met with problems during consolidation phase. We anticipated longer than usual TOF for these patients but by converting to supracutaneous plate, TOF became shortened significantly. After radiological union was achieved, plate was removed and duration of time on plate (TOP) was recorded. Average total healing time was 24.8 months, with 14.4 months of TOF and 10.4 months of TOP. Average length of bone gained was 7.6cm, and external fixator index (EFI) was shortened from 3.3months/cm to 1.9months/cm. During the time patients on plate, no screw tract infection was recorded, range of motion of adjacent joint and bone alignment remained unchanged. In view of good results in this study, we suggest supracutaneous plating as a method to shorten time on frame in bone lengthening and bone transport.</p> Chang CW Nazari Ahmad Tarmuzi Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 CUSTOMIZED HIP ABDUCTION BRACE MOLDED FROM USED PATIENT’S HIP SPICA <p>Following closed reduction in treating developmental hip dysplasia (DDH), the child is kept in the hip spica for three months, with one spica change under general anaesthesia in between. The understanding is that a concentric hip joint will encourage the acetabulum to remodel. There is no uniform guideline as to what happens after the spica is taken off. It is unpredictable as to whether the acetabulum will remain recalcitrant, and the femur head will remain enlocated. Some selected cases may benefit from wearing the fixed abduction brace for an extended period of time. Certain countries like Australia, UK, and USA practice weaning into an abduction brace following hip spica until satisfactory acetabular index improvement on follow-up radiographs. Unfortunately, the cost of these braces is steep in Malaysia, ranging from MYR 550 to 750 (USD 132 to 180). The Malaysian median household monthly income is MYR 5873 (USD 1412). We came up with the effort to produce an affordable option where we utilized the patient’s original spica as the template and designed a removable brace using medical fiberglass cast, cloth straps and metal rivets, commonly available in hardware stores. We used three rolls of fiberglass, 1.5 meters strap, rivets and foam tape; with the total cost of MYR 150 (USD 36).</p> <p><strong>Acknowledgement</strong>: Muhd. Luthfi B. Md. Zin, Biomechanical Lab Technician, NOCERAL</p> Wong M Saw A Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 A NEURO-FUZZY AND SEMANTIC CAUSAL REASONING APPROACH TO CLINICAL DECISION SUPPORT SYSTEM <p>Clinical Decision Support System (CDSS) is a health information system which is designed to facilitate physicians in decision-making process. However, it remains a challenge to successfully provide and implement CDSS in clinical practice. One of the issues is regarding the limited provisions of causal reasoning and evidences in existing CDSS. These are necessary for showing the relevance and reliability of system outcomes and help physicians in making proper decisions. This study has proposed a CDSS model that consists of two modules. The Neuro-Fuzzy Learning Module represents the use of Neuro-Fuzzy technique for making predictions, while the Semantic Causal Reasoning Module represents the use of ontology for integrating medical domain knowledge with causal reasoning, decision support, and supporting evidences. The proposed CDSS model was developed and evaluated based on clinical case of drug addict’s therapy (i.e. prediction of optimal methadone doses). The results demonstrated that our CDSS model is feasible as the obtained performances of Neuro-Fuzzy prediction model showed a good accuracy. Moreover, our ontology model contains good quality and the information represented by our ontology was generally accepted and acknowledged by medical experts. As a result, our CDSS model able to provide full support for provision of causal reasoning and evidences compared to other CDSS models, and hence these signify the contributions of this study.</p> Nur Raidah Rahim Sharifalillah Nordin Rosma Mohd Dom Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 LEVEL OF PHYSICAL ACTIVITY AND IT’S ASSOCIATED FACTORS AMONG PREGNANT WOMEN DURING PREGNANCY <p><strong>Background:</strong> Pregnancy is a normal physiologic event that is complicated by pathologic process, dangerous to health of mother and fetus. However, regular physical activity during pregnancy not only maintains maternal and fetal wellbeing also maintains physical fitness and derives varies health benefits. The objective of this study was to measure the level and factors contributing to physical activity among pregnant women during pregnancy.</p> <p><strong>Methods</strong>: This is a cross sectional study of normal pregnant women (age 18-35 years) receiving antenatal care (gestational age 12-35 weeks) in a primary health clinic in Kuantan, Pahang. Their socio-demographic characteristics were recorded, and two set of questionnaires were used; validated Malay version IPAQ (short-form) for assessing physical activity and DASS -21 Malay version for evaluating psychological symptoms. Chi-square test, Fishers exact test, Independent t-test and multiple logistic regression were applied using SPSS Version 25.0. Significant level was set at p value &lt;0.05.</p> <p><strong>Results</strong>: Among 168 respondents, 24.4% had moderate level of physical activity, but the majority (76.0%) had low level physical activity. Likewise, about 78.6% were physically inactive and only 22.0% physically active during pregnancy. We have not found any factors significantly associated with physical activity level.</p> <p><strong>Conclusion:</strong> Majority of the pregnant women have low physical activity level, thus contributed to high prevalence of physical inactivity.</p> <p><strong>Acknowledgement: </strong>We appreciate IIUM, Department of Community Medicine &amp; Indera Mahkota Health Clinic Kuantan, Pahang for supporting this study. Thanking Ministry of Health, Malaysia for their permission to conduct the study (NMRR: 19247048889).</p> Fatima Aslam Karimah Hanim Abd Aziz Nurjasmine Aida Jamani Razman Mohd Rus Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 NEW CLASS OF LEBESGUE QUADRATIC STOCHASTIC OPERATORS ON CONTINUAL STATE SPACE <p>The theory of quadratic stochastic operator (qso) has been developed significantly since it was introduced in the early of 20<sup>th</sup> century by Bernstein through his work on population genetics. In this research, we introduce a new construction of Lebesgue qso generated by 2measurable partition on the continual state space . The main aim of this research is to investigate the trajectory behaviour of such operators by reducing its variables into one-dimensional setting which correspond to the number of its measurable partition. The limit behaviour of such operators will be investigated computationally and analytically where the computational results conform to the analytical results. Measure and probability theory alongside the functional analysis will be employed to investigate the limit behaviour and characteristics of fixed points. The results showed that for measure of Lebesgue qso less than two parameters, one can find the behaviour of such operators either have fixed point or periodic point of period 2. These results suggest that the new Lebesgue qso generated by 2measurable partition can be regular or nonregular transformation depends on the given conditions.</p> <p><strong>Acknowledgement</strong>: This research was financially supported by FRGS grant by Minister of Education Malaysia, project code FRGS/1/2019/STG06/UIAM/03/1 with project ID FRGS19-122-0731.</p> Siti Nurlaili Karim Nur Zatul Akmar Hamzah Nasir Ganikhodjaev Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 DETECTION OF PORK IN USED COOKING OIL USING FOURIER TRANSFORM INFRARED SPECTROSCOPY <p>Fraudulent incorporation of cheaper materials such as used cooking oil into fresh cooking oil can become a problem for reasons related to religious, ethical, and legal requirement. Thus, the present study aimed to detect pork adulteration in the used cooking oil by using Fourier Transform Infrared (FTIR) Spectroscopy. Samples of frying oils from fried pork, fried fish, fried chicken and fried banana were analysed. Spiked samples were prepared by adding frying oil from fried pork ranging from 3% to 70% (v/v) to frying oils from fried fish, fried chicken and fried banana. The data obtained were further analysed with Principal Component Analysis (PCA) for better results feasible. In the evaluation of the spiked samples, this method was able to detect at least 3% of pork adulteration in used cooking oils. However, it unable to classify the samples based on their sources. This method would beneficial to ensure food integrity in the frying oils.</p> Nurul Azarima Mohd Ali Nur Azira Tukiran Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 ABNORMAL DETECTION OF CHEST X- RAY IMAGES USING FEDERATED LEARNING <p>Nowadays, data has become a valuable asset to the world. Even though the values of these data can help people to analyse information with accuracy and precision, it may lead to privacy concerns for sensitive information such as patient's chest X-rays (CXR) images. This study is focusing on maintaining the privacy of users by applying the Federated Learning system using the TensorFlow library as a method of developing machine learning algorithms that can detect any abnormalities in the CXR images without requiring any client to share their CXR images outside of the hospitals. This method showed a better score in the precision-recall curve graph compared to the conventional methods that used locally trained machine learning.</p> <p><strong>Acknowledgement</strong>: I would like to express my very great appreciation to my supervisor, Asst. Prof. Dr. Mohd Adli Bin Md. Ali and my co-supervisor, Assoc. Prof. Dr. Mohd. Zulfaezal Bin Che Azemin for guiding me in this research.</p> Hafidzul Abdullah Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 COMPARISON OF FUNCTIONAL OUTCOME BETWEEN CONSERVATIVE AND SURGICAL TREATMENT FOLLOWING FINGERTIP INJURY IN ADULT– A 3-MONTH LONGITUDINAL STUDY <p>Finger injury is the most common upper extremity injury and is commonly work related. Poor functional outcome following the injury is associated with financial burden mainly due to work limitation. The objective of this study is to measure functional outcome following fingertip injuries in a public tertiary hospital in Negeri Sembilan. A 3-month prospective longitudinal study was conducted involving 57 respondents from the orthopaedic clinic from May 2018 until May 2019. The functional outcomes from the fingertip injury were measured using the Michigan Hand Outcomes Questionnaire (MHQ), range of motion, and two-point discrimination test. The study recorded a 97.1% response rate. The mean MHQ score showed a significant improvement in a scale of 1 to 100 on the functional outcome with 49.35 (±11.79) and 58.54 (±10.95) at 1 and 3 months, respectively. The range of motion and two-point discrimination test also showed a significant improvement at 3 months post-injury. This study also found surgical treatment recorded lower functional outcome compared to conservative treatment at both 1- and 3-month postinjury.</p> <p>In conclusion, the functional outcomes of fingertip injury in public tertiary hospital recorded a satisfying level. However, lower outcomes were observed with surgical treatment that could be due to the complexity of the patient’s injury</p> Mohd Firdaus Zulkifly Kamarul Ariffin Khalid Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 EARLY PHYSICAL REHABILITATION FOR CHILDREN WITH ERB’S PALSY: A SYSTEMATIC REVIEW <p>Early physical therapy intervention has a significant impact on improving the impairments and disabilities of Erb’s Palsy patients. Proper early assessments and management by physical therapists can reduce physical complications and mental health problems, thus enhancing the child’s opportunities to return to their maximal activity daily living (ADL).&nbsp; This review aims to identify the early physical rehabilitation treatments for children with Erb’s Palsy. This objective is fulfilled by using the systematic review method following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. The search from Web of Sciences (WoS), PubMed, Science Direct, Scopus, PEDro and Google Scholar databases yielded 245 records. Twenty-nine full-text articles were assessed and six eligible articles were further reviewed. The study summarized that physical therapy treatments should be started as early as the condition being diagnosed. Treatment is found to be more effective when conventional physical therapy treatments are combined with advanced exercise consists of plyometric, modified constrained induced movement therapy (MCIMT) and virtual reality (VR). This review enables physical therapists in Malaysia to plan proper and suitable treatments for Erb’s palsy patients according to the injury’s level and severity.</p> Nurul Hafizah Dzulkifli Rozlin Abdul Rahman Noor Azliyana Azizan Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 GUTTAFLOW BIOSEAL AS MONOCONE OBTURATION TECHNIQUE IN CURVED ROOT CANALS. A SCANNING ELECTRON MICROSCOPY STUDY <p>The obturation with GuttaFlow Bioseal (GFB) in curved root canals is not clearly investigated due to the new generation of root filling material. This study compared the obturated surface area, extrusion of root filling material beyond the apical foramen and duration of obturation procedure in curved root canals using monocone obturation technique. Access cavity was prepared on twenty human mandibular molars. The root canal curvature of more than 10° determined according to Schneider’s method was included. Samples were prepared using Hyflex CM rotary files and divided into two groups (n=10). Group 1 [gutta-percha (GP) cone and GFB] and Group 2 [GP cone and RoekoSeal Automix root canal sealer]. The duration of obturation procedure was recorded and the obturation radiograph was taken. Samples were bisected and the mesial roots were sectioned horizontally to obtain 3 root segments; apical, middle and coronal. All resected roots were mounted on brass stubs, sputter-coated with thin platinum coating and observed under scanning electron microscope (SEM) at 70x magnification. The SEM images were transferred to the SketchAndCalc Area Calculator software. There were no statistically significant differences on the obturated surface area and extrusion of root filling material between Group 1 and 2 irrespective of the status of root canal curvature. The duration of obturation procedure in severe root canal curvature between Group 1 and 2 exhibited statistically significant difference. The obturated surface area and extrusion of root filling material were not affected by the status of root canal curvature. The duration of obturation procedure with GFB in severe root canal curvature was slightly longer. Neither root filling material was able to seal the curved root canal of mandibular molars completely. Both root filing materials in the present study can be opted depending on the clinical cases, material availability and clinician preference.</p> <p><strong>Acknowledgement: </strong>This research was supported by Research Initiative Grant Scheme 2017 from International Islamic University Malaysia (RIGS 2017-063-0638).</p> Musliana Mustaffa Hajar Ar Rahmah Nasri Insyirah Kamarulzaman Mohamad Shafiq Mohd Ibrahim Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 EFFECT OF TOCOTRIENOL-RICH FRACTION ON THE VISUAL-BEHAVIOUR RESPONSE OF RATS WITH STREPTOZOTOCIN-INDUCED DIABETIC RETINOPATHY <p>Diabetic retinopathy (DR) is the second leading diabetic complication, which impairs vision. Tocotrienol-rich fraction (TRF) has shown to protect against diabetes-induced retinal oxidative stress. Therefore, we investigate TRF effect on the visual-behaviour response in rats with streptozotocin (STZ)-induced DR. Male <em>Sprague-Dawley</em> rats (200-250 grams) were divided into diabetic received intraperitoneal 55mg/kg STZ and normal (N) rats received citrate buffer. Diabetic rats were subdivided to diabetic-vehicle (DV) and diabetic-TRF (DT). N and DV received vehicle, whereas DT received 100 mg/kg TRF orally for 12 weeks. The general behaviour in open field arena was assessed at week 12 followed by visual-behaviour response, a mirror and reversed mirror was added. &nbsp;Retinal tissues were collected for haematoxylin and eosin (H&amp;E) staining. In open field, N showed higher zone crossings (3.73-folds, p&lt;0.001), travelling (2.02-folds, p&lt;0.001), rearing (2.22-folds, p&lt;0.001) and grooming (4.33-folds, p&lt;0.01) with lower freezing (2.47-folds, p&lt;0.001) and faecal pellet (4.17-folds, p&lt;0.01) versus DV. Compared to DV, general behaviour in DT was similar to N.&nbsp; N spent more time with higher zone entries toward mirrored compared to non-mirrored and reversed mirror zones (p&lt;0.05 and p&lt;0.01 respectively).&nbsp; N also showed higher freezing within mirrored zone versus DV (2.00-folds, p&lt;0.05). Visual-behaviour response in DT was comparable to N.&nbsp; Retinal morphometry showed reduction in cell count in ganglion cell layer and layer thickness in DV versus N (p&lt;0.01). In DT these parameters were greater than DV (p&lt;0.05), which correlated with visual-behaviour response. Hence, orally administered TRF improves visual-behaviour response in DR rodent model associated with retinal morphology preservation.</p> <p><strong>Acknowledgement</strong>: This work was supported by Universiti Teknologi MARA (UiTM) grants (600-IRMI/DANA 5/3/BESTARI (P) (001/2018) and 600-IRMI/DANA 5/3/BESTARI (P) (012/2018)) and Ministry of Education (MOE), MY grant (600-IRMI/FRGS 5/3 (101/2019)).</p> Muhammad Zulfiqah Sadikan Nurul Alimah Abdul Nasir Igor Nikolayevich Iezhitsa Renu Agarwal Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 SURGICAL MANAGEMENT OF DISTALTIBIA FRACTURE: TOWARDS ANDOUTCOME-BASED TREATMENT ALGORITHM <p>Distal tibia fractures are frequently associated with extensive soft tissue injury which leads to higher risk of complications and poor outcome. The purpose of this study is to measure the outcome of distal tibia fractures treated with internal fixation(IF), external fixator(EF) or Ilizarov external fixator(IEF). We aim to propose an algorithm for management of distal tibia fractures. This study is a cross-sectional study of all distal tibia fractures treated surgically in Tengku Ampuan Rahimah Hospital, Klang from 1st January 2016 till 30th June 2018. Patient records were reviewed to analyse the outcomes and risk factors associated with it. Ninety-one patients were included. Thirty-eight patients (41.8%) were treated with IF, 27 patients (29.7%) were treated with IEF and 26 patients (28.6%) were treated with EF. Among open fractures cases, no significant finding can be concluded when comparing each surgical option and its outcome. Initial skeletal traction or temporary spanning external fixator in close fractures reduced the risk of mal-alignment (p value=0.001). IF is seen superior to IEF and EF in close fractures in term of articular surface reduction (p value=0.043) and risk of mal-alignment (p value=0.007). This proposed algorithm can help surgeons in deciding treatment strategies to reduce associated complications.</p> <p><strong>Acknowledgement</strong>: Department of Orthopaedic and CRC, Tengku Ampuan Rahimah, Hospital, Klang.</p> Rushdi I Che-Ahmad A Abdul-Ghani KAH Mohd-Rus R Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 HEALTH-RELATED QUALITY OF LIFE AMONG HEPATITIS C PATIENTS IN PAHANG STATE, MALAYSIA: A CROSS-SECTIONAL STUDY <p><strong>Background</strong>: Measurement of health-related quality of life (HRQOL) among hepatitis C patients is crucial in assisting health care providers to understand the complex psychosocial impact of disease on patients, thus facilitating a more patient-centred care. This study aims to measure the HRQOL among hepatitis C patients attending a tertiary hospital in Pahang, Malaysia.</p> <p><strong>Methods</strong>: This was a cross sectional study conducted among 195 hepatitis C patients attending Hospital Tengku Ampuan Afzan (HTAA), the main public tertiary hospital in Pahang. HRQOL was assessed using the 36-item short-form survey (SF-36v2).</p> <p><strong>Results</strong>: Respondents had lower scores in physical and mental health components of HRQOL than normal population. Those who completed treatment had higher scores in both physical and mental health component, compared to those who was not treated or on treatment. There was no significant association between HRQOL and gender, age, marital status, employment status and education level.</p> <p><strong>Conclusio</strong>n: Our findings showed that patients with hepatitis C, in general, have poor HRQOL in both physical and mental health components. Disease management should take into account patients’ quality of life as part of the inter-disciplinary approach.</p> <p><strong>Acknowledgement: </strong>The authors would like to thank all staff of gastroenterology and internal medicine department Hospital Tengku Ampuan Afzan, Kuantan. The study was approved by the National Medical Research Register (NMRR), Malaysia Research Ethics Committee (MREC) and the Clinical Research Centre (CRC) of HTAA (Ethics No: NMRR-18-3536-42688)</p> Ummu Afeera Z Muhammad Ateeq MJ Khairul Azhar J Raudah M Yunus Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 FLT3 AND NPM1 MUTATIONS IN PATIENTS WITH MYELOID NEOPLASMS <p><strong>Background:</strong> Acute myeloid leukemia (AML) and myeloproliferative neoplasms (MPN) are the most common entities of myeloid neoplasms. In AML, among the most frequent genetic alterations that carries both diagnostic and prognostic values are mutations in Nucleophosmin 1 <em>(NPM1)</em> and FMS-like tyrosine kinase 3 (<em>FLT3</em>) genes. Nevertheless, their frequencies among AML patients in Kuantan, Pahang have not been studied. Additionally, published literatures on both of these mutations in MPN are scarce although they have been shown to confer MPN in animal model.</p> <p><strong>Purpose: </strong>This cross-sectional study therefore aimed to determine the proportion of <em>FLT3-ITD, FLT3-D835</em> and <em>NPM1</em> mutations among patients diagnosed with AML and MPN in Hospital Tengku Ampuan Afzan (HTAA) of Kuantan, Pahang from the year 2016 to 2019.</p> <p><strong>Methodology:</strong> A total of 56 cases were studied, of which 43 cases were AML and 13 cases MPN. Molecular methods based on polymerase chain reaction were employed for mutation detection, from the retrieved trephine biopsy tissue blocks.</p> <p>&nbsp;<strong>Result: </strong>Six of the 43 cases (14.0%) of AML were positive for <em>FLT3-ITD </em>and a similar proportion (6/43, 14.0%) were also positive for <em>NPM1</em> mutations. <em>FLT3-D835</em> mutation was identified in three of the AML cases (7.0%) while concurrent mutations of <em>NPM1</em> and <em>FLT3-ITD </em>were seen in 2 cases (4.7%). Two of 13 (15.4%) MPN cases were positive for <em>FLT3-ITD</em>. None of the MPNs cases were positive for either <em>FLT-D835</em> or <em>NPM1</em> mutations.</p> <p><strong>Conclusion: </strong>The frequency of <em>FLT3</em> and <em>NPM1</em> mutations in the AML cases in our study were relatively lower as compared to other reports. The significance of <em>FLT3-ITD</em> mutation positivity found in our series of MPN remains to be elucidated.</p> <p><strong>Acknowledgement:</strong> We would like to express our heartfelt gratitude towards the Department of Pathology HTAA, Kulliyyah of Medicine, IIUM and SASMEC@IIUM for their support in undertaking this research.&nbsp;</p> Mohammad Naem Mansoor Naznin Muhammad Norlelawati A. Talib Asmah Hanim Hamdan Karimah Hanim Abd Aziz Ismail Ibrahim Rusmawati Ismail Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 MRI OF CORPUS CALLOSUM IN PATIENTS WITH AUTISM SPECTRUM DISORDER IN KUANTAN <p>The main objective is to study the integrity of the corpus callosum among autistic children population in Kuantan, Pahang, Malaysia. The integrity of the corpus callosum in this study is determined by diffusion tensor imaging (DTI) parameters, fractional anisotropy (FA) and radial diffusivity (RD) which represent the direction dependence of water molecules diffusion within the measured tissues. As corpus callosum is saturated with brain white matter tracts, the water molecules diffusion will be direction dependent. Several previous studies involving foreign populations have shown that there is some distortion in the brain’s white matter diffusion tensor parameters in autistic population indicative of microstructural distortion. If similar findings would be observed in our local autistic population remains a question which we aim to study. Other gross corpus callosum parameters such as its thickness, length and size are also studied. 28 randomly selected autistic children who are under the International Islamic University Malaysia Medical Centre (IIUMMC), Kuantan follow up are subjected to MRI scan. A weak negative correlation is found between the age and the DTI’s fractional anisotropy (FA) of the corpus callosum. Other parameters such as the thickness, length and size on the other hand show weak positive correlation with age. Although the correlation is weak, our study shows that there is evidence of distortion of corpus callosum white matter microstructure in children with autism spectrum disorder in Kuantan, Pahang.</p> Azian Abd Aziz Rajeev Shamsuddin Perisamy Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 SONOGRAPHIC RENAL LENGTH IN MALAYSIAN INFANT POPULATION: A HOSPITAL BASED CROSS-SECTIONAL STUDY <p>Neonatal stage is an important period of growth and development. Organ maturity takes place rapidly during this stage. Any insult could potentially result in impairment of the affected organs, for example the kidneys. Medical personnel have been reliant on renal ultrasonography to determine organ characteristics including renal lengths. However, the lack of local data means that we are dependent on overseas data, which may not be suitable locally. Our primary aim is to determine the range of normal sonographic renal length up to 1 year old in SASMEC@IIUM and HTAA in Kuantan. We also aim to investigate any renal lengths differences between the genders. Finally, &nbsp;&nbsp;we aim to propose simple mathematical equations to estimate the ideal length based on age. All children under the age of 1 who had normal renal ultrasonography were included in this study. Five age groups were formed based on previous studies. Data were mined from Radiology Information Systems, giving a total of 463 cases. Three important data were obtained – infant’s age, sonographic renal lengths for both kidneys and gender. Their sonographic renal lengths were tabulated according to age group, following which the mean and corresponding 95% confidence interval (C.I) were derived. We tabulated the means and 95% C.I for both right and left kidneys separately for each group. We found no significant difference in renal sonographic lengths comparing between the genders. Two separate linear regression equations were formulated for right and left kidneys respectively. We formulated tables of normal sonographic renal lengths according to age,&nbsp; useful in daily practice.</p> Azian Abd Aziz Aidi Aswadi Halim Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 PAIN RELIEF AFTER SACROILIAC JOINT INJECTION WITH ANAESTHETIC AND CORTICOSTEROID <p><strong>Introduction: </strong>The goal of sacroiliac joint injection is to provide pain relief, improve work status and early return to work or pre pain functional state, therefore, this study is aimed to investigate role of corticosteroid and anaesthetic mixture to provide short- and long-term pain relief in patients with sacroiliac joint pain.&nbsp; <strong>Objective:</strong> To determine the effectiveness and safety of administering combination of corticosteroid and anaesthetic in sacroiliac joint injection in the treatment of patients with sacroiliac joint dysfunction.</p> <p><strong>Methods: </strong>This is prospective observational single centre study included 27 patients with sacroiliac joint dysfunction who received combination of triamcinolone (40mg) and ropivacaine 1ml (0.2%) for sacroiliac joint injection (we include both intra and periarticular injection) which were followed with 4 scheduled visits i.e. baseline, 4 weeks, 8 weeks and 6 months. The primary outcome variable was the changes of Visual Analogue Scale (VAS), for pain assessment during each interval of follow up. The clinical efficacy measures the secondary interest; physician’s assessment on numbers of positive provocative tests and patients self-reported assessment using Rolland Morris questionnaire (RMQ) to evaluate their functional outcome. Clinical symptoms were assessed before each injection.</p> <p><strong>Results: </strong>At the 4 weeks and 8 weeks follow up evaluations, the VAS reduced from 5.85(±1.03) at baseline to 3.30(±1.77) at 4 weeks, 3.30(±1.86) at 8 weeks and 3.00(±1.86) at 6 months.&nbsp; At each interval, improvement in terms of clinical assessment using a series of provocative tests was seen with mean 1.37(±1.33), 1.63(±1.31) and 1.48(±1.05) at 4 weeks, 8 weeks and 6 months respectively. For the functional effectiveness parameters (RMQ), the SIJ injected with these drugs combination showed a greater improvement in symptoms and function at 4 weeks (9.04±3.33), at 8 weeks (9.07±4.13) and 6 months (8.26±4.92), compared to baseline (13.56±3.36). Using the one-way repeated measures ANOVA, the SIJ pain, provocative test and functional outcome were significantly improved throughout the study (P&lt;0.001).</p> <p><strong>Conclusion: </strong>Our findings support the long-term effectiveness and safety of combination of steroid and anaesthetic injections for patients with SIJ dysfunction who failed conservative treatment. No complication of the administration of these medications were noted.</p> Siti Nur Fudhlana Ab Aziz Aminudin Che Ahmad Mr Ahmad Sabri Omar Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 ESTIMATES OF GLOMERULAR FILTRATION RATE: COMPARISON OF DIFFERENT CREATININE BASED EQUATIONS <p><strong>Introduction:</strong> Kidney disease is a worldwide health concern with an increasing number of patients and associated mortality in the past 10 years. The Kidney Disease Improving Global Outcomes (KDIGO) guideline advocates the use of estimated glomerular filtration equation (eGFR) to estimate renal function. We evaluated the performance of Cokcroft Gault (CG), Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations for estimating GFR considering ethnicity, BMI and age group.</p> <p><strong>Materials and method:</strong> This is a cross sectional study. Inclusion criteria includes age more than 18 years old and not pregnant. Estimated GFR were calculated based on plasma creatinine and analysed in relation to the measured GFR by 99mTc-DTPA scan.</p> <p><strong>Result:</strong> A total of 126 patients’ data was collected. CKD-EPI had the highest correlation to measured GFR with correlation coefficient of 0.72 (p&lt;0.001). MDRD had the highest accuracy while CKD-EPI had the least bias and more precise compared to MDRD and CG.</p> <p><strong>Conclusion:</strong> By comparing estimated GFR to measured GFR, CKD-EPI gives the best estimation of GFR&nbsp; taking into account of the effect of BMI, age and different stages of Chronic Kidney Disease.</p> Farah Nadia Mohd Hanafiah Azrina Md Ralib Rozilah @ Abd Hadi Mohamed Nur Fariza Ramly Mohamad Shahrir Abd Rahim Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 A SURVEY OF END OF LIFE CARE PREFERENCES AMONG PATIENTS ON MAINTENANCE AEMODIALYSIS IN KUANTAN <p><strong>Introduction:</strong> There are growing evidences of the end of life care role for end stage renal disease (ESRD) patients who are associated with high morbidity and mortality rate despite being on dialysis therapy. However, the local data on the patients’ preferences is yet sparse.</p> <p><strong>Method:</strong> The study aimed to describe the end of life care preferences among patients on haemodialysis (HD) in Kuantan, Pahang. A cross-sectional study was conducted among 350 patients from 14 outpatient centres. Patients were recruited via convenient sampling and data collection began from March till June 2019. Participants completed the validated questionnaire in structured, interview-based surveys.</p> <p><strong>Results: </strong>The highest number of respondents preferred a plan of care that relieves pain or discomfort and improves quality of life as much as possible over prolonging life. Patients’ preference of being at home approaching end of life rather than receiving active interventions and treatments in the hospital was reported in most respondents. Majority were comfortable to discuss end of life issues with their nephrologists on a regular basis. However, the discussion rarely took place with 60% of them never engage in any discussion concerning their preferences on the end of life care choices in the past 1 year.</p> <p><strong>Conclusion: </strong>&nbsp;The study demonstrated that only a minority have engaged in the discussion on the end of life care choices and preferences with their treating health professionals despite their wish and comfortability to do so.</p> Nur Raziana Rozi Wan Ahmad Syahril Rozli Wan Ali Che Rosle Draman Hafizah Pasi Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 THE INCIDENCE AND THE PRACTICE OF DEPRESSION SCREENING AMONG PATIENT WITH DIABETES IN THE PRIMARY CARE CLINICIN KUANTAN, PAHANG <p>Diabetes is one of the illnesses that required continuing medical care and self-management behaviours by patients. The presence of diabetes seems to be positively associated with emotional problems that are an important threat to a good quality of life of patients. The study is aimed at determining the incidence of depression and the practice of depression screening among patient with diabetes. A mixed methods study was conducted among the patient with diabetes and the health care professional in Primary Care Clinic in Kuantan, Pahang. The DASS 21 was used to assess presence of depressive symptoms among patient with diabetes. Meanwhile the semi structure interview was used among the eight healthcare professionals. The overall prevalence of depression among patient with diabetes was 4.2% (14 out of 333 respondents).&nbsp; As the result, 2.4% had mild depression, and 1.8% had moderate depression. None had severe depression. Factors dependently associated with a diagnosis of depression were age (OR:0.98, p&lt;0.05), race (OR:0, p&lt;0.005), marital status(OR:10.34,p&lt;0.005), educational level (OR:0.0,p&lt;0.005), duration having diabetes(OR:1.03,p&lt;0.005), type of diabetes (OR:0, p&lt;0.005) and having other illness(OR:7.43, p&lt;0.005). Several factors involving the practice of depression screening such as limitation of time, standard of the procedure, and communication barrier. The risk factor of depressive symptoms in diabetes has been shown. A holistic approach that focuses on the identification and management of depression among patients with diabetes is recommended.</p> Sanisah Saidi Ainul Wahidah Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 CORRELATION BETWEEN SCATTERED-RADIATION DOSES TO THE EYES OF ANGIOGRAPHIC STAFF AT DIFFERENT HEIGHTS: A PHANTOM STUDY <p>The scattered-radiations that reached the eye lens of angiographic staff can cause radiation-induced cataract. This preliminary study aimed to find the correlation between scattered-radiation doses and heights which correspond to the eyes of angiographic staff at different positions in an angiography room. An anthropomorphic upper body phantom (Kyoto Kagaku PBU-31) which simulated a male patient was exposed in a posteroanterior projection (PA) using the Siemen’s Artis Q angiographic system. The phantom was exposed for 22 seconds in Digital Subtraction Angiography (DSA) acquisition with the technical factors for a percutaneous transhepatic biliary drainage (PTBD) procedure. The scattered-radiation doses were measured using the nanodot optically stimulated luminescence (OSL) dosimeters (Landauer, Inc., Glenwood, USA). A total of 96 nanodots were placed on twelve paper tubes which simulated twelve different positions in the angiography room. Three lines of four paper tubes each were placed at the side of examination table. The first line was 40cm from isocentre of exposure, and the second and third line was 0.3048 meter and 0.6096 meter away from the first line. On each paper tube, eight nanodots were placed to measure the scattered-radiation doses at eight different heights of 135, 140, 145, 150, 155, 160, 165 and 170 cm from the floor. Scattered-radiation doses recorded by the nanodots were read in the mGy units using the InLight microStar reader.&nbsp; Spearman’s rank order correlation was used as the radiation doses were not normally distributed. For overall scattered-radiation doses, the Spearman correlation showed that there is moderate inverse correlation between eye levels and scattered-radiation doses, r = -0.478 (<em>p-</em>value<em> &lt;</em> 0.001). This preliminary study found that scattered-radiation doses inversely correlated with the height of angiographic staff eyes especially when positioned near the patient.</p> Halimatussa’diah Ahmad Radzi Norhanna Sohaimi Ahmad Razali Md Ralib Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 DEVELOPMENT OF BIOLOGICAL HEALTH RISK ASSESSMENT TOOL FOR WORKERS EXPOSED TO KNOWN PATHOGEN <p>Health risk assessment is an approach used to assess and manage health risks at the workplace and the environment. Biological hazard is one of the hazards that need to be assessed at the workplace for preventive and control measures and workers protection. Until currently, there is no established standardized biological health risk assessment (BHRA) tool for the use at the workplace. This causes inconsistent risk assessment methodology; findings may vary and possible inappropriate risk management. Therefore, a standardized and validated BHRA tool has been developed for the use of occupational health practitioners to prevent work-related infectious disease in the workplace. The newly developed BHRA tool is using a qualitative risk assessment matrix in which risk rating is equal to the consequences time likelihood, also considering the modifying factors. Version 1 BHRA was developed after extensive literature reviews and in-depth interviews with the experts. Version 2 BHRA was developed after face and content validity assessment using qualitative method and validity index among the occupational health and microbiological practitioners and experts. The results of the content validity analysis showed that the Relevance = 1.00, Clarity = 0.98, Simplicity = 1.00, Ambiguity = 0.98. The BHRA required much improvement in the mode of transmission modifying factors. Version 3 BHRA has been completed after tested its used among the occupational health practitioners using simulation case studies. In conclusion, the newly developed BHRA tool has good standing but requires continuous improvement.</p> <p><strong>ACKNOWLEDGEMENT: </strong>This work was financially supported by the National Institute of Occupational Safety and Health (NIOSH)</p> Nur Aqilah Mohd Fauzy Niza Samsuddin Nor Azlina A.Rahman Ibrahim Adham Taib Noor Artika Hassan Norhanna Sohaimi Dewililah Sapriah Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 DEVELOPMENT OF IIUM KNOWLEDGE AND PRACTICES ON CHILDREN EYE CARE QUESTIONNAIRE (IIUM KPC-EYE Q). <p>In Malaysia, the main causes of visual impairment in children is uncorrected refractive error, which is treatable and preventable. Previous studies reported that, most parents did not bother to bring their children for eye examination, and they believed that routine eye exam is not necessary. It is important to identify the reasons why some parents seek care for their children and others do not. The purpose of this study is to develop a reliable and validated questionnaire that measures the parents’ knowledge and practices on children eye care in Malaysia, namely the IIUM Knowledge and Practices on Children Eye Care Questionnaire (IIUM KPC-EYE Q). Hopefully more information can be obtained regarding the role of perceptions, practices, and awareness in paediatric eye health among parents. The questionnaire is developed based on extensive literature review and it is a semi structured question consisting of 3 sections. Subsequently, face and content validity were obtained from the experts. A pilot study was then conducted to investigate its reliability (n=100). Internal consistency reliability was determined for knowledge and practice items of the questionnaire; Cronbach Alpha’s value is 0.7 and 0.8 respectively. This indicates good reliability of both instruments, and 75% of the respondents agreed the questionnaire are clear and easy to understand. The study (IIUM KPC-EYE Q) is currently in phase 1 out of 3 phases. It is a potentially useful tool in assessing parental knowledge and practices on children eye care among Malaysian parents.</p> Norsham Ahmad Dayang Balkis Fatiha Musa Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 ASSESSMENT OF CONCORDANCE BETWEEN IMMUNOHISTOCHEMISTRY AND MSI ANALYSIS AND THEIR ASSOCIATION WITH CLINICOPATHOLOGICAL FEATURES IN MALAYSIAN COLORECTAL CANCER PATIENTS <p><strong>Introduction</strong>: Colorectal cancer (CRC) is the second most common tumour in Malaysia. Universal screening for the identification of microsatellite instability/mismatch repair (MSI/MMR) status in CRC patients is recommended by several guidelines. The detection of MSI/MMR status in CRC patients is not only essential to identify Lynch Syndrome (LS), but it also has predictive and prognostic values. The study aimed to investigate the MMR and MSI status among CRC patients as well as to assess the concordance between immunohistochemistry (IHC) and MSI analysis.</p> <p><strong>Method</strong>: Formalin-fixed paraffin-embedded (FFPE) tissue blocks of 123 CRC patients were retrieved for the years 2017-2018. For IHC and MSI analysis, EnVision<sup>TM </sup>FLEX, Mini Kit, High PH, and MSI Analysis System 1.2 (Promega) were utilized, respectively. MSI analysis was performed on selected deficient mismatch repair (dMMR) and proficient mismatch repair (pMMR) cases.</p> <p><strong>Results</strong>: IHC detected 11.4% (14 out of 123) patients as dMMR and 88.6% (109 out of 123) as pMMR. MSI analysis identified 26% (13 out of 50) patients as MSI-H, 6% (3 out of 50) patients as MSI-L, and 64% (32 out of 50) patients as MSS. Both the IHC and MSI analysis showed perfect agreement (0.896, Kappa value) for the recognition of dMMR or MSI-H CRC patients while demonstrating only 4% (2 out of 50) discordant results. Almost all dMMR patients detected by IHC were recognized by MSI analysis as MSI-H except one.</p> <p><strong>Conclusion</strong>: The significant prevalence of dMMR in the current cohort supports the recommendation that the assessment of MSI/MMR status should be addressed in CRC patients. The selection of the choice method may be based on the availability of expertise and equipment. Since IHC is an affordable, reproducible, and readily available in most histopathological laboratories, it can be used as a primary screening test to detect MSI/MMR status in CRC patients.</p> Muhammad Ishaque Faizee Asmah Hanim Hamdan Nor Zamzila Abdullah Norlelawati A. Talib Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 HERLYN-WERNER -WUNDERLICH SYNDROME: A CASE PRESENTATION AND REVIEW <p>The Herlyn-Werner-Wunderlich syndrome (HWW syndrome), also known as obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) is a very rare congenital anomaly of urogenital tract characterized by a triad of uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis in the majority of the cases. We presented a case of a female adolescent recently post menarche with incidental findings of renal agenesis and bicornuate uterus diagnosed on ultrasound (US). Magnetic resonance imaging (MRI) finding suggested the diagnosis of OHVIRA. Although the presentation is atypical, the anatomical finding is classical. Review of literature and the role of imaging modalities pertaining to the diagnosis OHVIRA is also highlighted.</p> Fathihah Ahmad Ahmad Razali Md Ralib Sin Yeat Mah Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 A COMPARISON OF EARLY POST-OPERATIVE MOBILIZATION AND IMMOBILIZATION FOR BELOW KNEE AMPUTATION <p>Post-operative transtibial or below knee amputation (BKA) complication such as knee flexion contracture have become a burden because it will delay the time to prosthesis fitting for the patient. This study compares the postoperative clinical outcomes of the BKA patients in early mobilization and immobilization (U-slab application),&nbsp; specifically analyses the degree of affected knee flexion contracture before the operation, at day 2, day 14, and day 60 postoperation and also assesses the post-operative spontaneous stump pain. This is a randomized controlled trial study conducted in a single centre for one year by randomly selected the patient by the turn of surgery and the patient either putting on U-slab or not after BKA. 80 patients were recruited, the female was about 53%. Left-sided below knee amputation recorded about 51%. The study showed a significant difference in the degree of knee flexion contracture between pre-operation and post-operation with a p-value less than 0.05 while performing the unpaired T-test. The Pearson chi-square test showed no significant association between the VAS score for pain and with and without U-slab since a p-value more than 0.05. From this study, the immobilization of the affected stump with Uslab appears to be more superior. However, due to more complications arose after usage of U-slab, the early mobilization technique still advisable as a choice of the treatment.</p> Ahmad Firdaus Yusof Mohd Adham Shah Ayeop Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 RARE SUPPLY OF EXOPHYTIC HEPATOCELLULAR CARCINOMA FROM SPLENIC ARTERY COLLATERALS <p>Hepatocellular carcinoma (HCC) is the most common primary malignancy of liver and the sixth most common malignancy worldwide. Trans arterial chemoembolization (TACE) is one of the available treatment options. The splenic artery supply of hepatocellular carcinoma (HCC) is a rare occurrence. However, in patient who had repeated chemo embolization procedures, the collateral supply from this uncommon artery can be seen. This is a case of 70 years old gentlemen who underwent 9<sup>th</sup> TACE of a large exophytic HCC in segment IV of the liver. Multiple TACE were done previously to branches from gastroduodenal artery.&nbsp; The intraprocedural coeliac axis CT Angiography showed enlarging tumour. An extrahepatic feeder artery is seen arising from collateral of splenic artery branch which mainly supply the posterior inferior portion of the tumour. The branch was successfully cannulated, and chemo&nbsp; embolization was done. Rare collateral supply of HCC can be seen in patient who underwent multiple chemo embolization. Thus, evaluation of tumoral supply preembolization could give a better information of the feeder arteries.</p> Mohamad Aizuddin Mohd Nasr Anis Mahfudz Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 COMPARISON BETWEEN WEEKLY VS DAILY DOSING L-THYROXINE FOR THETREATMENT OF HYPOTHYROIDISM IN RAMADAN – A PILOT RANDOMIZED CONTROLLED TRIAL <p><strong>INTRODUCTION: </strong>Hypothyroid patients find it difficult to take L-thyroxine on empty stomach during <em>Sahur. &nbsp;</em></p> <p><strong>&nbsp;</strong></p> <p><strong>OBJECTIVE: </strong>To compare the efficacy, safety and patient’s preference of weekly vs daily dosing of L-thyroxine in Ramadan.</p> <p><strong>&nbsp;METHOD: </strong>This is a pilot randomized controlled trial among hypothyroid patients during Ramadan 2017-2018. Patients were randomized into weekly and daily arm. Weekly arm took 7x their usual Lthyroxine dose at least 30 minutes pre-<em>sahur</em> once a week while daily arm took their usual daily dose at least 2 hours after the last meal before bed<strong>. </strong>Thyroid hormones, cardiac parameters, cognitive and psychological function were assessed.</p> <p><strong>RESULTS:</strong> Eighteen patients were randomized into weekly and daily arm. Majority (66.7%) were hypothyroid secondary to radioiodine therapy. At the end of study, there were no significant change in thyroid hormones level for weekly arm (intervention arm) but significant increment of TSH was observed in daily arm [TSH w0 1.8(0.23,5.57) vs w4 3.65(0.45,16.1);p =0.011]. In terms of toxicity, there were no hyperthyroid or cardiac toxicity observed despite the significant increment of fT4 within 24hours of weekly dosing [fT4 w0 13.21(8.19,14.63) vs w2 17.43(12.38,22.55);p=0.011]. All patients were euthyroid with no side effects. Majority (83.3%)preferred weekly dosing during Ramadan.</p> <p>&nbsp;<strong>CONCLUSION: </strong>Weekly levothyroxine dosing during Ramadan appeared to be safe, efficient and the most preferred dosing method.</p> <p><strong>ACKNOWLEDGEMENT:</strong>&nbsp;&nbsp; IIUM Research Initiative Grant Scheme (RIGS)</p> Nurul Aulia Zakaria Mohammad Arif Shahar Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 A CASE REPORT: CHALLENGES IN DIAGNOSIS OF CEREBELLAR ABSCESS WITH ATYPICAL EATURES <p>Differentiation brain abscess and tumour in brain is important because both totally have different management. Even though brain infection and brain tumour has their own radiologic features, atypical imaging features can give us confusion to make correct diagnosis. Therefore, it is important to have good clinical history in addition with laboratory investigation in addition with imaging. We present a case of a young female with atypical features of cerebellar abscess. Although advanced MRI techniques provide valuable information for differentiating brain abscess, neoplastic lesion and haemorrhagic infarct; atypical findings must be taken into account. Thus, correlation with conventional MRI sequences and consideration of the clinical pictures are utmost importance in determining the adequate management plan and strategy.</p> Mohamad Akram Ruslan Radhiana Hassan Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 UNVEILING THE NEURONAL MECHANISM DURING LISTENING TO QURANIC RECITATION <p><strong>Introduction</strong>: Listening to Quranic recitation produces deep relaxation effects thus promotes cognitive capabilities. The brainwaves oscillatory responses were applied in psychotherapy and cognitive rehabilitation approaches. <strong>Objective: </strong>Emphasizing the alpha brainwave (frequency of 8 to 13Hz), we aimed to learn the neural mechanisms from the brain oscillations perspective evoked by the rhythmic acoustic of the Fatihah Chapter of the Holy Quran.</p> <p><strong>Methods: </strong>Twenty-eight healthy participants received three auditory stimulations of Fatihah Chapter, Arabic News, and Rest in random sequence in 5,8,6,6,10,8 and 20 seconds each, in a treated quiet room with dimmed light. Electrical activities were measured using the 128-electrode sensor net of EEG (Electrical Geodesics, Inc). The data was pre-processed by EGI Net Station and then analyzed by Fast Fourier Transform (FFT) using BESA Research 6.0, Germany to yield the power spectrum (amplitude squared, µV<sup>2</sup>). Event-Related Synchronization or Desynchronization (ERD/ERS) analysis was subsequently performed.</p> <p><strong>Result:</strong> Listening to the&nbsp; Fatihah Chapter recitation elicited ERD that pronounced as increased cortical excitability, reflecting the attentive behavior and memory consolidation in the listeners.</p> <p><strong>Conclusion:</strong> The highly rhythmic sound waveforms modulated the neuronal amplitudes as referred to the alpha ERD, which was produced during deep relaxation and could contribute to cognition enhancement.</p> Samhani Ismail Mohd Ariff Sharifudin Mohammed Faruque Reza Hafizan Juahir Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 COMPARISON OF DURAL PUNCTURE EPIDURAL TECHNIQUE (DPE) VERSUS LUMBAR EPIDURAL TECHNIQUE (LE) FOR LABOUR ANALGESIA <p>Neuraxial techniques are considered the gold standard for labour analgesia. Conventional lumbar epidural (LE) and Combined Spinal Epidural (CSE) are the most commonly used techniques for providing pain-free labour experience in current clinical practice. Although LE has minimal side effects, it has been associated with a slow onset and inadequate sacral spread that is crucial during the second stage of labour. CSE on the other hand, has a more rapid onset with excellent sacral spread but has been associated with maternal hypotension, pruritus and foetal bradycardia. Dural Puncture Epidural (DPE) is a novel technique that is a modification of the CSE technique where the only difference is that medication is not administered into the subarachnoid space. The dural puncture by the spinal needle serves as a mean or conduit for the translocation of medication from the epidural space into the subarachnoid space. We hypothesise that DPE has a faster onset to adequate analgesia with a better sacral spread when compared to LE for labour analgesia. A total of 80 parturients that requested for labour analgesia were randomly allocated to either DPE or LE groups. Initial bolus for DPE and LE comprised epidural 10 millilitres 0.05% Ropivacaine with Fentanyl 2 micrograms per millilitres over 10 minutes. Upon completion of the initial bolus, a blinded coinvestigator assessed the outcomes. The primary outcomes were time taken to Numerical Pain Rating Scale (NPRS) ? 1 analysed by using survival analysis and incidence of bilateral S2 dermatome blockade analysed by using Pearson Chi Square test. Secondary outcomes included, block quality, catheter failure rates, maternal adverse effects, modes of delivery and satisfaction score. DPE achieved NPRS ? 1 significantly faster than LE (median times [IQR] were 10 [7.9 – 12.0] minutes and 18 [16.3 – 19.7] minutes respectively; Log Rank test p-value 0.002). Compared with LE, DPE had significantly greater incidence of bilateral S2 dermatome blockade at 10 minutes (relative risk [RR] 2.12; 95% CI 1.42 – 3.17; p-value 0.000) and a higher mean maternal satisfaction score (mean [SD] 98.1 [6.7]; p-value 0.000). There were no reported incidence of hypotension, foetal bradycardia, nausea, vomiting, pruritus and post dural puncture headaches in both groups. There were also no statistically significant difference in the incidence of lower segment caesarean section and instrumental delivery between DPE and LE. The DPE technique had a significantly faster onset to adequate analgesia with better bilateral S2 spread without any significant adverse effects to the foetus or to the mother. DPE could benefit parturients with cardiovascular disease or hypertensive disorders where achieving rapid adequate pain relieve is extremely important to prevent unwanted complications from continuous sympathetic stimulations.</p> <p><strong>Acknowledgement:</strong> The findings are based on research conducted in the labour room of Hospital Tengku Ampuan Afzan, Kuantan.</p> Muhammad Ishaq Mohd Abd Rahman Mohd Nizamuddin Ismail Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 SQUAMOUS CELL CARCINOMA IN BURN SCARS: REPORT OF THREE CASES <p><strong>Introduction:</strong> Squamous cell carcinoma (SCC) is a malignant tumour of epidermal keratinocytes. SCC may arise in chronically inflamed lesions such as burn scars and chronic ulcers. Here, we report three cases of SCC arising from pre-existing burn scars. <br><br><strong>Cases presentation:</strong> <br><br>Case 1: A 63-year-old lady presented with a four-months duration of progressive skin tumour over right shoulder scar. She had burn injury over the right shoulder for more than 50 years. She underwent wide local excision of the mass and the histopathological examination (HPE) reported as well-differentiated SCC. <br><br>Case 2: A 53-yearold gentleman presented with a one-year history of skin growth over left shin. He had burn injury over left lower limb since the age of 10. He underwent left above-knee amputation (AKA) and HPE reported as welldifferentiated SCC. Case 3: A 31-year-old man presented with non-healing ulcers over bilateral ankles. He sustained burn injury over bilateral upper and lower limbs at the age of 11. He underwent right AKA and HPE reported as well differentiated SCC. <br><br><strong>Discussion:</strong> Malignant transformation from burn is usually slow. This type of SCC is aggressive and associated with poor prognosis. Conclusion: SCC can complicate long-standing burn scars; therefore, follow-up is recommended to look for malignant changes.</p> <p><strong>Acknowledgement:</strong> We thank Dr. Goh Kian Liang, former orthopaedic surgeon IIUM for his contribution in this case report.</p> Siti Nurhanisah Azmi Khairunisa Ahmad Affandi Azliana Abd. Fuaat Asmah Hanim Hamdan Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 ANTIOXIDANT ACTIVITY OF AQUEOUS EXTRACT OF TRIGONA SPP. PROPOLIS USING RESPONSE SURFACE METHODOLOGY <p>Trigona <em>spp. </em>propolis (Propolis Lebah Kelulut) previously has been reported as an antioxidant property, anti-fungal, anti-inflammatory and antiviral. Propolis or known as bee glue is a complex resinous substance and has gained many attentions recently due to its medicinal and health purposes and also high in price market value. In this study, the extraction of antioxidant activities was evaluated and Response Surface Methodology (RSM) with central composite design (CCD) was employed in determining the optimal conditions towards total phenolic content (<em>Y<sub>1 </sub></em>= TPC), ascorbic acid equivalent antioxidant content (<em>Y<sub>2 </sub></em>= AEAC) and ferric reducing ability power (<em>Y<sub>3 </sub></em>= FRAP). The optimization parameters tested were extraction temperature (<em>X<sub>1 </sub>= </em>30 - 60 °C) and time (<em>X<sub>2 </sub>= </em>24 - 72 hrs). The CCD generated eight experimental points and five replications at the centre points. A polynomial model developed a satisfactory fitting of the experimental data with respected to the TPC (R<sup>2</sup>= 0.8431, <em>p </em>= 0.0098), AEAC (R<sup>2 </sup>= 0.8976, <em>p </em>= 0.0024) and FRAP (R<sup>2 </sup>= 0.8780, <em>p = </em>0.0042). The optimum conditions of extraction temperature and time were obtained at 49.0 °C and 24.0 hrs with a maximum yield of antioxidant properties were achieved. In conclusion, the establishment of this model can provide a robust experimental foundation using RSM for optimizing the extraction temperature and time for aqueous extract of trigona <em>spp</em>. propolis.</p> <p><strong>Acknowledgment : </strong>The author received no funding for this research. The research team would like to thank the Kulliyyah of Allied Health Sciences, International Islamic University Malaysia (IIUM), and the Central Research and Animal Facility (CREAM, IIUM) for the laboratory facilities provided for the accomplishment of this present study.</p> Nurlisa Fatihah A.R. Muhammad I. Radiah A.G. Nuraniza A. Abdullah H. Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 METABOLIC SYNDROME AND HIGHSENSITIVE C-REACTIVE PROTEIN IN YOUNG HYPERTENSIVE AND PREHYPERTENSIVE ADULTS <p>Hypertension and prehypertension are reversible risk factors for coronary artery disease (CAD). However, CAD risk is usually inadequately assessed in young adults and underestimated. This study aimed to investigate metabolic syndrome criteria including high-sensitive C-reactive protein (hs-CRP) in young hypertensive and prehypertensive adults. This was a cross-sectional study involving 120 male young adults aged &lt; 45 years old; 40 subjects in control, prehypertensive and hypertensive group respectively. CAD risk factors; body mass index (BMI), waist circumference, lipid profiles, fasting blood glucose and hs-CRP levels were assessed in all subjects. Obesity and hypercholesterolemia were most prevalent in hypertensive, followed by prehypertensive and control group. Mean waist circumference was significantly higher in hypertension than the control (98.3±13.1 vs. 87.0±8.4 cm, p=0.018). Median hs-CRP was significantly higher in hypertension and prehypertension than the control (2.7 vs. 2.2±3.8 vs. 1.1±1.7 p&lt;0.001). The high prevalence of metabolic syndrome and elevation of hs-CRP in young adults with hypertension and prehypertension indicate the increase risk of CAD among these cohorts. Hence, apart from management of high blood pressure, holistic risk modifications strategies such as weight loss, low cholesterol diet and physical exercise are essential to prevent premature CAD.</p> <p><strong>Acknowledgement:</strong> (RIGS 15-076-0076), RMC IIUM.</p> Norbaiyah Mohamed Bakrim Aszrin Abdullah Aida Nur Sharini Mohd Shah Norlelawati A. Talib Wan Fatein Wan Omar Azarisman Shah Mohd Shah Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 CORRELATION BETWEEN ACROMIOHUMERAL DISTANCE AND ROTATOR CUFF TEAR <p>Rotator cuff tear causing narrowing of the subacromial space quantified as acromiohumeral distance, which can be measured from shoulder x - ray and MRI. This study, is to determine the mean acromiohumeral distance measurement of rotator cuff tear in local population and to correlate between x - ray and MRI. This is a retrospective study conducted in a single centre from 2014 - 2018. Mean value of measured&nbsp; acromiohumeral distance from x-ray and MRI were calculated. The presence of rotator cuff tear, muscle atrophy and fatty degeneration were analyzed. 100 patients’ X-Ray were recruited with mean age of 52 (±11.4). 59% of them were male. Half of the patient presented with complete tear of supraspinatus tendon. The mean acromiohumeral distance for complete tear based on x-ray measurement was 6.30mm(±0.96), while the MRI was 6.00mm(±0.88). There was positive correlation between the two factors(p=&lt;0.001). Out of 100 patients only 26% associated with muscle atrophy and 7% with fatty degeneration. The acromiohumeral distance does not correlate with muscle atrophy and fatty degeneration (P value 0.100 and 0.317). X-ray and MRI both give significant reading correlation, usage of MRI over x-ray is more superior because it can detect soft tissue injury with lesser radiation. Western study showed that from x-ray, distance below 7mm associated with complete tendon tear. From this study the mean acromiohumeral distance in Malaysian population for complete tear is lower and the distance has no correlation with muscle atrophy and fatty degeneration</p> Husni U.E Alyani NAA Tahir SH Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 EFFECT OF pH ON H&E STAINING IN SMALL AND LARGE INTESTINES OF RATS <p><strong>Background:</strong> An optimized hematoxylin and eosin (H&amp;E) histotechnique ensures reproducible and good staining quality. The common practice in determining when to discard the solutions depends largely on frequency and duration of usage. This practice suits labs with many active users, but not practical in less active labs. During this pandemic time, there is a substantial decrease in lab-based activities and replenishment of research materials. Hence, knowing the effect of pH of these solutions on staining quality could assist in deciding if they need to be replaced.</p> <p><strong>Purpose: </strong>To investigate the effect of hematoxylin pH on H&amp;E staining outcomes.</p> <p><strong>Method: T</strong>his is an experimental study performed on formalin-fixed paraffin embedded intestines of three healthy female Sprague-Dawley rats. The standard H&amp;E protocol was applied on 3 ?m tissue sections using hematoxylins of four serial pH (2.5, 2.75, 3.0 and 3.5). Eosin of pH 5.0 was used as the counterstain.</p> <p><strong>Results: </strong>At pH 2.5, the slides appeared acidic, and the epithelial lining was not distinctive. At pH 2.75, the hematoxylin dye was most prominent with good balance of staining, and ‘crisp’ epithelial lining was observed. At pH 3.0 or higher, although the lining was ‘crisp’, bluestaining mucin were observed.</p> <p><strong>Conclusion:</strong> The pH 2.75 appears to be the most optimal to achieve balance of coloration and definitive epithelial lining in H&amp;E staining and with increasing pH overstaining occurs.</p> Hazulin Mohd Radzuan Wan Fatein Nabeila Wan Omar Mohd Dhiyaulhaq Halim Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 REFINEMENT OF A PROTOCOL FOR THE CULTURE OF PRIMARY LUNG CANCER CELLS <p>Primary cancer cell culture act as an <em>in vitro</em> model to learn about the aspects of tumor biology. A refinement of protocol for the culture of primary lung cancer cells is important as different medium and coating substrates play significant roles in enabling the cells growth and proliferation. Cells were mechanically harvested from tumor biopsy of 21 patients suspected of primary lung cancer and cultured in Dulbecco’s Modified Eagle’s Medium (DMEM) and Airway Epithelial Medium (AEM). Each medium was supplemented with 10% fetal bovine serum and 1% penicillin-streptomycin. Collagen type 1 and poly-L-lysine (PLL) solutions were used as the coating substrates. Cells formed monolayer attachment and epithelial-like morphology following cultured in AEM after 14 days of incubation with collagen type 1 as the coating substrate. Cells incubated in PLL coated flasks had shown no growth when cultured in AEM and DMEM.&nbsp; Different culture medium and coating substrates for the had different effects on the growth, proliferation and survival of the cells with respect to the morphology and attachment ability. In this study, primary lung cancer cells were able to grow in AEM with collagen type 1 as the coating substrate.</p> <p><strong>Acknowledgement: </strong>This work is supported by MOSTI under the grant of e-Science Research Grant (06-01-08-SF0376).</p> Salmah Sedek Mardhiah Mohammad Anis Nurashikin Nordin Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 PHENOLIC COMPOUNDS AND ANTIOXIDANT ACTIVITY OPTIMIZATION OF TRIGONA HONEY AND PROPOLIS USING RESPONSE SURFACE METHODOLOGY <p>The optimum combination of honey and propolis for total phenolic content (TPC), total flavonoid content (TFC), and antioxidant activity were analysed for Trigona honey and Trigona propolis aqueous extract using response surface methodology and central composite design. The influence of honey (X1:15–16.5 g) and propolis (X2:13.5–15g) on TPC (Y1), TFC (Y2), DPPH (Y3), ABTS (Y4) and FRAP (Y5) were tested. The experimental results were adequately fitted into a second-order polynomial model regarding TPC (R2 = 0.9539, p =0.0002), TFC (R2 = 0.9209, p = 0.0010), DPPH (R2 = 0.9529, p =0.0002), ABTS (R2 = 0.9817, p &lt; 0.0001), and FRAP (R2 = 0.9363, p = 0.0005). The optimum percentage compositions of honey and propolis were 15.26g (50.43%) and 15g (49.57%), respectively. The predicted outcomes for&nbsp; TPC, TFC, DPPH(IC<sub>50</sub>), ABTS, and FRAP were 162.46 mg GAE /100g, 2.29 mg QE/g , 14.52 mg/ml,&nbsp; 564.27 µMTE/g, and 3.56 mMTE/g, respectively. The experimental results were close to predicted outcomes, 152.06 ±0.55 mg GAE/100g, 2.21± 0.05 mg QE/g , 13.85 ± 0.34 mg/ml, 555.22±36.84 µMTE/g, and 3.71± 0.02mMTE/g, respectively. Therefore, the optimum combination of honey and propolis with remarkable antioxidant properties could be applied as food additives, cosmetics and pharmacological applications.</p> Abdullah Hagar Muhammad Ibrahim Nurlisa Fatihah Abd Rani Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 DETERMINATION OF URINARY CALCULI COMPOSITION USING DUAL ENERGY CT <p>To assess the incidence of the various types of urinary calculi composition using dual energy CT . This study aims to determine the urinary calculi size, location, characteristics, and the radiation exposure for DECT KUB. It is a cross-sectional study performed from June 2018 until December 2019 at the Department of Radiology HTAA. A total of 170 patients were selected using a purposive sampling method. The research featured 67% of males and 33% of females. Among the patients, 131 were Malays, 32 were Chinese, and 7 were Indians. The mean age was about 54.5. A total of 44 (26%) of urinary calculi was in the form of uric acid. Out of the 126, (74%) were non-uric acid type; calcium oxalate and calcium hydroxyapatite formed 78 (46%), and cystine constituted the remaining 48 (28%) of the urinary calculi. Most of the urinary calculi, with a total of 71 (42%), were less than 5 mm in size, and 77 (45%) were located in the lower pole of the kidney. The mean average of radiation exposure for DECT KUB was 11.5 mGy. DECT KUB is not only highly sensitive and specific for urinary calculi diagnosis, but it can also characterize the urinary calculi chemical composition. This method could assist in medical intervention of urinary calculi (uric acid) that could be treated medically and may not require any surgery.</p> Wan Irfan W Mustapha Ahmad Razali Md Ralib Mohd Nazli Kamarulzaman Razman Mohd Rus Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 RAPID ANALYSIS OF ALPHA-GLUCOSIDASE INHIBITORY ACTIVITY OF PSYCHOTRIA MALAYANA JACK LEAF APPLYING INFRARED FINGERPRINTING <p><em>Psychotria malayana </em>Jack is the plant belongs to Rubiaceae family and known in Malaysia as “meroyan sakat/salung”. Despite its potential use as an antidiabetic agent, a rapid analytical approach for the quality control of this plant has not been developed. Thus, the objective of this study was to establish a validated analytical method for the prediction for the alpha-glucosidase inhibitory activity of the leaves of <em>P. malayana</em> through implementation of Fourier Transformation Infrared Spectroscopy-fingerprinting utilizing a multivariate statistical calculation, orthogonal partial least square. The dried extracts prepared with different solvents ratios of methanol-water (0, 25, 50, 75, and 100% v/v), were evaluated for the bio-activity and analyzed via infrared spectroscopy. Orthogonal partial least square was accomplished through correlating the bioactivity and infrared spectra of every extract. The 100% methanol extract possessed the highest inhibitory activity against the alpha-glucosidase (IC<sub>50</sub> 2.83 ± 0.32 ?g/mL). The loading plot from the statistical calculation revealed several functional groups, including hydroxyl (O-H), alkenyl (C=C), methylene (C-H), carbonyl (C=O), and secondary amine (N-H) groups, which actively induced the ?-glucosidase inhibitory activity. The established validated model can be utilized in predicting the inhibitory activity of new set of <em>P.</em><em> malayana</em> Jack leaves and can also be used as an assessment tool in the quality control of this plant.</p> <p><strong>Acknowledgments:</strong> Tanzina Sharmin Nipun would like to thank the Bangabandhu Science and Technology Fellowship Trust, Ministry of Science and Technology of Bangladesh for the granting of her Ph.D. fellowship. A. Khatib acknowledges the Malaysian Ministry of Education for the Fundamental Research Grant Scheme [FRGS-19-0880697].</p> Tanzina Sharmin Nipun Alfi Khatib Qamar Uddin Ahmed Irna Elina Redzwan Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 CLINICAL OUTCOME OF INFECTED TIBIAL NONUNION TREATED WITH ILIZAROV EXTERNAL FIXATOR: TWO-CENTER EXPERIENCE <p><strong>Introduction:</strong> Common complication for tibia fractures due to infection is delayed union or non-union. The Ilizarov external fixator application is preferred because it is minimally invasive,&nbsp; correct the deformities and able to close the bone defect. The objective of this study is to evaluate the clinical and functional outcome in tibial non-union treated with Ilizarov external fixator.</p> <p><strong>Materials and Methods:</strong> A retrospective cross-sectional study was carried out from October 2015 to October 2019. Total of forty patients with tibial non-union associated with infection who treated with the Ilizarov fixator were included in the study. Patient records and radiographs were reviewed for union of bone, functional outcomes and complications. The functional outcome of the affected limb was assessed using LEFS scoring and ASAMI grading system.<strong>&nbsp;</strong></p> <p><strong>Results:</strong>&nbsp; All patients had achieved union except two. Thirty-six (83.0%) patients had excellent and good score for bone and functional results respectively. In terms of employment, 33(82.5%) patients were able to return to their work.&nbsp; The most common complication noted was pin track infections which occurred in 12 (30%) patients.</p> <p><strong>Conclusion: </strong>Ilizarov bone transport technique is an effective salvage tool in obtaining union among patients with infected tibial non-union associated with bone loss. The functional outcome is good and most of our patients (82.5%) are able to perform their daily activity after completion of their treatment.</p> Ramesh Muthu Nazri Mohd Yusof Ahmad Fadzli Sulong Ahmad Hafiz Zulkifly Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 THE IMPACT OF INDIRECT CALORIMETRY GUIDED FEEDING PROTOCOL ON CLINICAL OUTCOMES IN CRITICALLY ILL PATIENTS: A RANDOMIZED CONTROLLED TRIAL (THE IC STUDY <p><strong>Background: </strong>International guidelines recommend the use of indirect calorimetry (IC) to measure energy requirements in critically ill patients. This study aimed to assess the effects of IC-guided nutrition vs standard-nutrition care on clinical outcomes in critically ill patients</p> <p><strong>&nbsp;</strong></p> <p><strong>Methods:</strong> Sixty mechanically ventilated patients expected to stay in intensive care unit (ICU) more than 3 days were randomized into a group in which energy needs were determined by IC (IC-group) and a group prescribed with 25kcal/kg/day reflecting standard care (SC-group). The primary outcome was the ICU length of stay(LOS). Secondary outcomes included change in quadriceps muscle layer thickness (QMLT, ultrasound) during the first 10 days of ICU admission, hospital-LOS, duration of mechanical ventilation, ICU mortality and 28-day-in hospital mortality.</p> <p><strong>&nbsp;</strong></p> <p><strong>Results: </strong>Mean energy requirement was similar in both groups. The IC group received 85.63%, whereas the SC group received 76.83% of their energy goals (P=0.002). The protein intake was higher in the IC group (89.58% vs 77.66%, p=0.007). Both groups had a median of 8.0 days ICU-LOS (p=0.424). QMLT was decreased in both groups by 21.9% vs. 25.3% at day10 (p &lt; 0.001), respectively. However, there were no significant differences observed in muscle mass changes and other secondary clinical outcomes between the groups.</p> <p><strong>Conclusion:</strong> IC-guided nutrition did not appear to affect significantly any clinical outcomes compared to the SC group due to the limitation in Sample identifier no. <strong>NCT04479254</strong></p> <p><strong>Acknowledgement: </strong>The authors wish to thank the medical staff at the IIUM-Medical Centre Intensive Care Unit.</p> Samiullah saeed Mohd Basri Mat Nor Azrina Md. Ralib Adre Mohammad Aidid Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 DETERMINING THE BEST PREDICTIVE EQUATION FOR RESTING ENERGY EXPENDITURE AMONG MECHANICALLY VENTILATED CRITICALLY ILL PATIENTS IN A MALAYSIAN TERTIARY HOSPITAL <p><strong>Introduction:</strong> Measurement of resting energy expenditure(REE) using indirect calorimetry(IC) in ICU’s patient is the gold standard. Unfortunately, technical difficulties and high cost prevent its widespread adoption. Predictive equations are largely used instead. We aim to validate commonly used predictive equation at different period of acute phase of critical illness.</p> <p><strong>Methods:</strong> Patients hospitalized in ICU of SASMEC, who had been ventilated were included. Measurement was done from day 1 to day 7. 18 equations performance were assessed. Accuracy was defined as a measurement within 90-110% of measured REE by IC.</p> <p><strong>Results:</strong> 49 patients&nbsp; were recruited. The mean of REE as measured by IC was 1176±332 kcal during early acute phase and 1222±321 kcal during late acute phase. During acute phase, Mifflin-St. Jeor have the highest accuracy (33.33%) but no agreement with IC. In the late acute phase, WHO predictive equation shows the highest accuracy but poor agreement while Mifflin-St. Jeor shows the second highest accuracy and moderate agreement.</p> <p><strong>Conclusions:</strong> No predictive equation can be recommended during early acute phase of critical illness. The Mifflin-St. Jeor can be recommended to be used in late acute phase of critically ill patients. Incorporation of dynamic variables such as maximum temperature, minute ventilation does not increase the accuracy of predictive. Recommendations cannot be concluded due to lack of sample size.</p> <p><strong>Acknowledgement</strong>: I would like to thank Prof Basri Mat Nor for guiding me through this research.</p> Khairul Anam Mansor Basri Mat Nor Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 HISTOMORPHOLOGIC ASSESEMENT OF TUMOUR BUDDING AND POORLY DIRFFFERENTIATED CLUSTER IN COLORECTAL CANCER <p><strong>Introduction: </strong>Tumor budding (TB) and poorly differentiated cluster (PDC) are independent prognostic factors for colorectal cancer (CRC), which may allow for stratification of patients into more meaningful risk categories than TNM staging. However, these parameters are not routinely incorporated as part of the histopathological assessment.&nbsp; Therefore, we aimed to evaluate the TB and PDC in our CRC cases and assess their associations with the prognostic clinicopathological parameters.</p> <p><strong>Methodology: </strong>Haematoxylin and eosin-stained slides prepared from tissue blocks of 129 CRC cases diagnosed from 1<sup>st</sup> January 2017 to 31<sup>st </sup>December 2018, in Hospital Tengku Ampuan Afzan (HTAA) and Sultan Ahmad Shah Medical Centre @ IIUM, Kuantan Pahang were analysed. The PDC, and TB according to the International tumor budding consensus conference (ITBCC) criteria were scored.</p> <p><strong>Results: </strong>For TB, of the 129 cases studied, 93, 25, and 11 cases were classified as budding 1, budding 2, and budding 3, respectively. As for PDC, 93, 25, and 11 cases were classified as grade 1, grade 2, and grade 3, respectively. High TB and PDC grades were significantly associated with lympho-vascular invasion (p&lt;0.05), nodal metastasis (p&lt;0.05) and high pTNM stage (p&lt; 0.05).</p> <p><strong>Conclusion:</strong> Based on the results of the study it is suggested that TB and PDC be included as histomorphologic parameters for assessment of CRC.</p> <p><strong>Acknowledgement: </strong>Pathology Department (HTAA), and SASMEC @ IIUM for their support in undertaking this research.</p> Haroon Firooz Azliana Abd Fuaat Naznin Muhammad Norlelawati A. Talib Azmi Md Nor Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 A REVIEW OF ANTIMICROBIAL STEWARDSHIP PROGRAMS IN THE HOSPITAL WARDS BASED ON THE INTERVENTIONS AND THE PATIENTS’ OUTCOMES <p>The overuse of antibiotics has led to various healthcare problems such as the emergence of resistance in infectious microbes and mortality due to antibiotic resistant nosocomial infections. An antimicrobial stewardship (AMS) program is the set of interventions used worldwide to rationalize the antimicrobial practice for the hospitalized patients. The objective of this review is to describe the characteristics of the implemented AMS programs in various hospitals of the world, mainly to highlight the AMS interventions and the resultant patients’ outcomes determined through various study designs. The literature about AMS programs was searched through various databases such as PubMed, Google Scholar, Science Direct, Cochrane Library, Ovid (Medline), Web of Science and Scopus. In this review the literature pertaining to the AMS programs for hospitalized patients is sorted on the basis of various interventions that are categorized as formulary restriction (pre-authorization), guideline development, clinical pathway development, educative interventions and prospective audit. Moreover, a clear emphasis is laid on the patient outcomes obtained as a result of these interventions namely the infection control, decline of readmission rate (RR), mortality control, resistance control and the control of an overall cost of antibiotic treatment obtained mainly by curbing the overuse of antibiotics within the hospital wards. AMS program is an efficient strategy of pharmacovigilence to rationalize the antimicrobial practice for hospitalized patients as it prevents the irrational use of antibiotics, which ultimately retards the health threatening effects of various antibiotics.</p> <p><strong>Acknowledgement:</strong> This research project was funded by the Fundamental Research Grant Scheme (FRGS) of the Ministry of Education (MOE), Malaysia for the Research Acculturation of Early Career Researchers (RACER) having the project identification number mentioned as RACER19-025-0025.</p> Ovais Ullah Shirazi Norny Syafinaz Ab Rahman Che Suraya Zin Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 LEVELS OF DEPRESSION, ANXIETY, AND STRESS AND THEIR ASSOCIATION WITHTHE CLINICAL TRAINING PHASE AMONGST UNDERGRADUATE DENTAL STUDENTS <p>The purpose of this study is to assess the levels of depression, anxiety and stress and their association with the clinical training phase amongst undergraduate dental students. Method : All dental students in the 2019/2020 academic year at IIUM were included in the cross-sectional survey via voluntary sampling. Data was collected by using a self-administered questionnaire which consisted of demographic background (age, gender, year of study) and Depression, Anxiety and Stress Scales (DASS-21) to collect data on the students’ levels of depression, anxiety and stress. Data collected was then analysed with SPSS. Results: A response rate of 83.2% (n=238) was obtained, where the respondents' age ranged from 19 to 26 years old. It is worrying to note that 46.2% of the students had depression, 60.9% had anxiety and 29.4% were stressed. There were no significant differences in the levels of depression, anxiety, and stress between the clinical phase and preclinical phase of studies amongst dental undergraduate students although this study found that there was a significant difference in the levels of depression between the Year 1 students and the Year 5 students and between the Year 1 students and the Year 2 students. There were no differences in levels of depression, anxiety and stress between male and female students. Conclusion: High report on depression, anxiety and stress amongst undergraduate dental students warrant prevention modalities and treatment strategies to help students better manage the stressors they have to face and to have a healthier professional future.</p> <p><strong>Acknowledgement</strong>: Ahmad Azmie Musa and Abu Hurairah Mohamad, for their contribution in data collection, Dr Mohamad Shafiq Mohd Ibrahim for his guidance on statistical analysis.</p> Lim Shea Lee Noraini Abu Bakar Nadzirah Ahmad Basri Salizar Mohamed Ludin Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 A CROSS- SECTIONAL STUDY ON PATIENT SATISFACTION AT IIUM FAMILY HEALTH CLINIC, KUANTAN, PAHANG <p><strong>Background</strong>: Patient satisfaction may be defined as a representation of attitude, emotion and perception towards health services provided. It may be measured using tools such as patient satisfaction surveys thereby allowing healthcare provider to improve their quality of service. <strong>Objective</strong>: To measure the level of patient satisfaction towards International Islamic University Malaysia (IIUM) Family Health Clinic, Kuantan Pahang.</p> <p><strong>Methodology</strong>: A cross-sectional study was conducted among 200 patients attending IIUM Family Health Clinic selected through convenient sampling. A set of self-administered validated questionnaire which includes the Patient Satisfaction Questionnaire 18 (PSQ-18) were given to the respondents. Descriptive analysis was used to describe socio-demographic and socioeconomic factors of respondents as well as the score of patient satisfaction. Relation between sociodemographic and patient satisfaction were analysed using Kruskal Wallis test.</p> <p><strong>Result</strong>: Majority of the respondents were from the age group 30 to 49 years-old (57.7%), female (63.9%), Malay (96.4%) Muslim (98.5%), live in urban residence (84.0%), married (68.0%), have tertiary level education (87.6%). working (67.0%) and have a household income of more than RM3000. The overall satisfaction score was 70.75 (78.6%). Highest satisfaction was in interpersonal manner, and the lowest was in time spent with doctors. There were significant association between overall satisfaction with marital status, general satisfaction with education background, interpersonal manner with ethnic and marital status, financial aspect with age group, working status and marital status, and time spent with doctor with age group of patients.</p> <p><strong>Conclusion</strong>: Mean score and percentage of the patient satisfaction was high in IIUM Family Health Clinic. However, there are areas that are still concerning and require improvement such as the time spent with doctor. By doing so, the quality of care and overall patient satisfaction may be improved.</p> <p><strong>Acknowledgement</strong>: We would like to thank all staff of IIUM Family Health Clinic, Kuantan who assisted throughout this study.</p> Mohammad CM Muhammad Zubir Y Amsyareezmi J Amira Sofiyah A Fakhri Syahmi K Shahidah CA Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 NON-THROMBOTIC PULMONARY EMBOLISM FOLLOWING HYALURONIC ACID BREAST FILLER INJECTION – A CASE REPORT <p>Hyaluronic acid is a commonly used injectable breast enhancement material. In the right set of hands, it is usually a safe injectable material. We present a case of a 35-year-old female who underwent hyaluronic acid injection by an unlicensed practitioner, presenting 2 weeks later with acutely worsening 4 days history of shortness of breath and pleuritic chest pain. She had low grade pyrexia at 37.8°C. She was tachycardiac and tachypnoeic, with her oxygen saturation around 85% on air during presentation. Her serum white cell count was normal. She underwent an emergent CT pulmonary angiogram on day 1 of admission, which revealed no pulmonary artery clots but extensive bilateral peripherally located wedge-shaped ground glass opacities with no lobar predisposition. Given her recent history of breast filler injection, she was treated as non-thrombotic pulmonary embolism (NTPE). She was started on deep vein thrombosis prophylaxis, commenced on corticosteroids therapy and started on antibiotics. She continued to have supplementary oxygen and was discharged with temporary oxygen supplement at home. Follow-up CT done a few months later demonstrated practically complete resolution of the initial changes. In our poster, we briefly outlined some literature review of NTPE including its aetiology, imaging characteristics and management.</p> Mohd Radhwan Abidin Aidi Aswadi Halim Lim Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 THE ROLE OF miRNAs IN ACUTE MYOCARDIAL INFARCTION OF YOUNG ADULTS <p>Acute myocardial infarction (AMI) is the leading cause of death worldwide. In Malaysia, people are getting AMI at younger age compared to well-developed countries.&nbsp; The role of microRNA (miRNA) in pathogenesis of AMI is not well elucidated and its involvement in young population has not been studied. miRNAs possibly affect the atherogenesis, a precursor for AMI by affecting the genes that regulate endothelial stability, atherosclerotic plaque destabilization, fibrogenesis and heart remodelling post infarction. Understanding the pathogenesis of AMI in this young population is important in providing accurate diagnosis and prompt management of the disease.&nbsp; The aim of our study is to investigate how miRNAs contribute to the pathogenesis of AMI by profiling specific miRNAs that are dysregulated following an AMI in young group and to determine whether these miRNAs lead to the dysregulation of their target mRNA. Blood sample will be taken from the control, young and mature AMI groups and divided into 2 aliquots for the miRNA profiling analysis and mRNA analysis.&nbsp; The gene expressions will be analysed using the Bio-Rad CFX96&nbsp; software.&nbsp; The significance of miRNA and mRNA expressions will be assessed using appropriate statistical analysis.&nbsp; The discovery of miRNAs involved in the AMI pathogenesis in this study could lead to potential usage as novel biomarkers for detection of early cardiac injury, prognosis and therapeutic intervention.</p> NURUL ASHIKIN MUHAMMAD MUSA NOR ZAMZILA ABDULLAH NORLELAWATI A. TALIB ASZRIN ABDULLAH AZARISMAN SHAH MOHD SHAH Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 VALSARTAN INDUCEDEX ANTHEMATOUS MACULAR SKIN LESIONS <p>Valsartan is one of the antihypertensive agents under angiotensin II receptor blocker (ARB) group that commonly used in treating hypertensive patient with underlying heart failure, chronic kidney disease and angiotensin converting enzyme inhibitor (ACE-i) drug’s intolerance. We report a case of Valsartan induced exanthematous macular skin lesions. This case illustrates a rare adverse cutaneous effect of Valsartan with skin manifestation that mimicking other common skin diseases. Clinicians should consider Valsartan as one of the triggering factors for exanthematous skin manifestation.</p> Mohammad CM Shahidah CA Nurul HA Arifin SRM Salman A Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 DIFFERENCES BETWEEN ALAR LIGAMENT OF MALE AND FEMALE: MRI PERSPECTIVES <p><strong>Background:</strong> Road traffic accidents have caused serious public health concerns; which include whiplash-associated disorders involving cervical spine. MRI is often required to supplant diagnosis of this condition. Nevertheless, alar ligament of the cervical spine may show variability in MR appearance; most profoundly signal hyperintensity easily mistaken as injury.</p> <p>&nbsp;</p> <p><strong>Purpose:</strong> The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female in terms of its course, shape, orientation and signal homogeneity, despite determining the association between the heights of respondents with alar ligament dimensions.</p> <p><strong>Methodology:</strong> 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured.</p> <p><strong>Results:</strong> Male respondents were 70% more likely to exhibit alar ligament signal inhomogeneity which is statistically significant (p = 0.02). No significant difference in alar ligament shape, size and orientation was seen between both genders. However positive correlation between height and the craniocaudal diameter of the alar ligament as well as the anteroposterior diameter, regardless of gender; which were statistically significant (r = 0.25, n = 100, p = 0.01 and r = 0.201, n = 100, p = 0.045 respectively).</p> <p><strong>Conclusion:</strong> Presence of gender variability of alar ligament MR signal intensity as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury.</p> <p><strong>Acknowledgement:</strong> Radiology Department, Sultan Ahmad Shah Medical Centre (SASMEC)</p> Raihanah Haroon Siti Kamariah Che Mohamed Karimah Hanim Abd. Aziz Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 ADAMANTINOMATOUS CRANIOPHARYNGIOMA MISTAKEN AS RATHKE’S CLEFT CYST: A CASE REPORT <p>When a suprasellar mass is encountered, the differential diagnosis is crucial in order for the operating surgeon to determine further management and surgical approach.&nbsp; However, it is not always easy if the mass exhibits mixed solid cystic or entirely cystic features. The author presents a case of a 19-year-old lady who initially presented with left facial weakness, subsequently has been followed up several years for Rathke’s cleft cyst (RCC) in view of its MR appearance. But recently the patient complained of eye symptoms, occipital headache and amenorrhea. Repeat MRI showed increasing size of the suprasellar mass and local mass effect unto the optic chiasm. Patient underwent deroofing of the cyst with the histopathological examination which revealed adamantinomatous craniopharyngioma. Nevertheless, possible transformation of RCC into craniopharyngioma is not known in view of no tissue diagnosis was obtained earlier on. Review of MR appearances of these two entities in previous literature as well as the radiopathological correlation and differentiating features are presented.</p> <p><strong>Acknowledgement:</strong>&nbsp;Radiology Department, Sultan Ahmad Shah Medical Centre (SASMEC)</p> Raihanah Haroon Radhiana Hassan Siti Kamariah Che Mohamed Siti Nor Suzeana Mustfar Intan Bazilah Abu Bakar Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 METABOLIC SYNDROME AMONG TEMIAR SUBTRIBE IN KUALA BETIS, GUA MUSANG, KELANTAN <p>Metabolic syndrome (MetS) is a predictor for cardiovascular disease, characterized by visceral obesity, high triglycerides, blood pressure, blood glucose and low high-density lipoprotein cholesterol. Its staggering prevalence has also affected endangered Orang Asli (OA) tribes. Relocation program has exposed OA tribes to obesogenic environment. Obesogenic environment combined with genetic predisposition factors are menace to overall wellbeing, subsequently predispose individuals to develop MetS. Temiar subtribe in suburban settlements is readily adapted to lifestyles alteration provides an excellent opportunity to investigate diseases related with complex gene-environment interactions like MetS. This study was designed to determine prevalence of MetS and other risk factors; and to investigate risk of MetS susceptibility with genetic variants of <em>ADIPOQ</em> (+45T&gt;G and +276G&gt;T), <em>RETN</em> -420C&gt;G and <em>FTO</em> rs9939609 among the Temiar subtribe. A cross-sectional study was conducted among 123 consented Temiar volunteers. MetS was diagnosed using modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Anthropometric measurements, biochemical analysis, DNA extraction, Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) were performed. Statistical analysis was done using independent <em>t</em>-test, chi-square, logistic regression and odds ratios (ORs). The prevalence of MetS was 39.8%. Increasing age, body mass index, blood pressures, high serum resistin, and low serum adiponectin were recognized as MetS risk factors among the Temiar subtribe. All investigated genetic polymorphisms are significantly associated with risk of MetS susceptibility among the Temiar subtribe. The present findings provides an insight to design primary prevention strategies in reducing the risk and delays morbidity and mortality associated with MetS.</p> <p><strong>Acknowledgement:</strong> A token of appreciation to all Temiar community that participated in this study, the Department of Orang Asli Development (JKOA) Kelantan, i-SIHAT UniSZA, research teams, laboratory staffs at UniSZA Medical Campus, and UniSZA Medical Center (UMC) Gong Badak staffs, and postgraduate colleagues for their kind cooperation, and not to forget the Ministry of Higher Education (MoHE) for the research funding</p> Nur Sakinah Harun Mohd Nizam Zahary Rosliza Yahaya Nik Ahmad Shaifuddin Nik Him Mohd Adzim Khalili Rohin Mimie Noratiqah Jumli Nur Haslinda Ridzwan Aniza Abdul Aziz Azizul Fadzli Wan Jusoh Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 PRELIMINARY STUDY ON THE EFFECT OF TUALANG HONEY AND ITS SILVER NANOPARTICLES ON KAINIC ACID-INDUCED MEMORY DEFICITS AND OXIDATIVE DAMAGE IN RAT HIPPOCAMPUS. <p>Kainic acid (KA) mediated excitotoxicity has been shown to cause memory impairment and oxidative stress in rats brain. The aim of this study was to investigate the effect of Tualang honey (TH) and its silver nanoparticles (THSN) on the KA-induced memory deficits and oxidative damage in rats’ hippocampus. Twenty-four adult male Sprague-Dawley rats were randomized into eight groups: (i) control, (ii) THSN (10mg/kg), (iii) THSN (50mg/kg), (iv) KA only, (v) KA+TH, (vi) KA+THSN (10mg/kg), (vii) KA+THSN (50mg/kg), and (viii) KA+Topiramate. Based on their respective groups, rats were pretreated orally with either distilled water, THSN (10 or 50 mg/kg body weight), Tualang honey (1.0 g/kg body weight), or Topiramate (40 mg/kg body weight), five times at 12 hours intervals. Saline or KA (15 mg/kg body weight) were injected subcutaneously 30 min after last oral treatment. Novel object recognition test (NORT) was performed for memory assessment. The rats were sacrificed 24 hours post KA induction and hippocampus was harvested. Malondialdehyde (MDA) and superoxide dismutase (SOD) were measured using commercially available ELISA kits. The results showed that there was a trend of decreased in MDA level in both TH and THSN groups, however there were no significance difference. There was significantly increased level in SOD following pretreatment with TH and THSN groups compared to KA only group. Interestingly, these pretreatment groups also demonstrated enhanced memory as evidenced by significant increase in recognition index in NORT when compared to KA only group. In conclusion, this preliminary finding suggests that the pretreatment with TH and THSN might have potential role to improve the memory and ameliorate oxidative stress in the KA-induced exitotoxicity rats. However, further study needs to be carried out to understand the precise mechanism.</p> Hidani Hasim Sirajudeen Kuttulebbai Naina Mohamed Salam Pasupuleti Visweswara Rao Sangu Muthuraju Muzaimi Mustapha Mohd Asnizam Asari Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 PRELIMINARY STUDY ON INDOOR CLIMATE IN A NAVAL SHIP <p>The main issue of ventilation in ships is in controlling the heat and humidity. The high heat and humidity reduce cabin crews’ productivity and may cause failures of the equipment onboards. This study aimed to determine the indoor climatic conditions inside a naval ship. The indoor climate parameters (temperature, relative humidity, and air movement) were measured by using real-time instruments at the selected eight sampling points. From the assessment, all the sampling points were not compliant with the Industry Code of Practice on Indoor Air Quality 2010 (ICOP on IAQ 2010) for all the indoor climate parameters. Therefore, the ship management especially the maintenance division is encouraged to conduct inspections of the MVAC systems to resolve the poor indoor climatic issues identified during the study.</p> <p><strong>Acknowledgement</strong>: We thank Royal Malaysian Navy for the support in carrying out this project.</p> Arman Ariffin Amirul Faiz Kamaruddin Maryam Zahaba Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 ADULT ILEOCOLIC INTUSSUSCEPTION IN CAECAL ADENOCARCINOMA – AN INFREQUENT PHENOMENON <p>Intussusception&nbsp;is a common condition which radiologists come across on a day-to-day basis. However, this entity is uncommonly encountered in the adult population, causes of which most often attributed to a lead point. The growing use of CT has enabled radiologists to make timely diagnosis in order to prevent complications of acute abdomen. The author reports a case of a 56-year-old lady who had a previous history of blood transfusion for anemia, presented with chronic right sided and epigastric pain. These are associated with constipation, diarrhoea, tenesmus and constitutional symptoms. Clinical examination revealed mild pallor, palpable epigastric mass. CT showed a large sausage-shaped mass with features suggestive of intussusception of the caecum and terminal ileum into the ascending colon along with small bowel faeces sign. A focal enhancing mass simulating segmental bowel thickening is seen as a lead point. Open right hemicolectomy and ileocolic anastomosis were undertaken with the histopathological examination yielding a poorly differentiated caecal adenocarcinoma. Review of the radiopathological correlation of this entity is also outlined.</p> <p><strong>Acknowledgement:</strong>&nbsp;Radiology Department, Sultan Ahmad Shah Medical Centre (SASMEC)</p> Raihanah Haroon Mohd Radhwan Abidi Siti Kamariah Che Mohamed Aisyah Khaulah Muslim Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 A METHOD REVIEW OF SURGICALLY INDUCED HYPERTENSION IN PREGNANT RATS MODEL: MODIFIED REDUCED UTERINE PERFUSION PRESSURE (RUPP) <p><strong>Background: </strong>There are various animal models used in the study of pregnancy-associated hypertensive disorders. RUPP is one of the methods used to induce hypertension via surgical procedure by clipping both ovarian and uterine arteries with specified internal diameter of silver clip. In this study, we modified the method by using a surgical suture instead of clip.</p> <p><strong>Purpose: </strong>The objective of this study is to establish hypertension in a pregnant rat model by using a modified method of RUPP.</p> <p><strong>Methodology: </strong>Three female Sprague-Dawley rats were used. One of them was non-pregnant rat (C) and the other two rats (R1 &amp; R2) were mated. The establishment of pregnancy were confirmed with the visualization of sperm and it was recorded as D0 of gestation. On D14 of gestation, both uterine and ovarian arteries were tied in R1 by using a suture while in R2, only uterine arteries were tied. Blood pressure was measured via tail-cuff method at D20 of gestation.</p> <p><strong>Result:</strong> Complete fetal resorption occurred in R1 and R2 died post-operatively due to infection.&nbsp;</p> <p><strong>Conclusion: </strong>This method caused high morbidity and mortality and we could not establish hypertension in pregnant animal model. The alternative methods for induction of hypertension in pregnant animal model are by using a drug that inhibit Nitric Oxide synthase (L-NAME) or by genetic manipulation.</p> <p><strong>Acknowledgement: </strong>IIUM Research Acculturation Grant Scheme (IRAGS)</p> Khodijah Zulkiflee Maizura Mohd. Zainudin Fadhilah Zainal Abidin Hidayatul Radziah Ismawi Yusoff Sharizal Yusoff Azmi Merican Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 COMPARISON OF NEW TECHNIQUE OF APICAL SUPPORT USING MODIFIED UTEROSACRAL LIGAMENT FIXATION (MEUSL) VERSUS SACROSPINOUS LIGAMENT FIXATION (SSF) <p><strong>Background:</strong> Prevention of apical prolapse during vaginal hysterectomy is crucial in order to ensure good outcome of the surgery. The choice of the best method for apical support remains debatable. This study compared a new technique of apical support done during vaginal hysterectomy: Modified Extraperitoneal Uterosacral Ligament fixation (MEUSL) versus Sacrospinous Ligament fixation (SSF).</p> <p><strong>Method:</strong> This is a retrospective study involving 48 patients with stage 3 and 4 uterovaginal prolapse, looking into the outcome of lower urinary tract symptoms, operative complications, symptom recurrence, and surgical failure.</p> <p><strong>Results:</strong> Surgical failure at 6 months is significantly higher in the SSF group (p=0.043). There was no difference in terms of lower urinary tract symptoms. However, MEUSL had a significantly higher blood loss as compared to SSF group<em>. </em></p> <p><strong>Conclusion:</strong> MEUSL is an effective technique for the treatment of apical prolapse as it has lower risk of surgical failure with minimal complication. A future study regarding long term outcome between the two procedure is recommended to guide surgeons to choose the best treatment option.</p> Zalina Nusee Nurul Hikmah MN Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 ANALYSIS OF ANATOMICAL VARIANT OF NORMAL POSTERIOR CRUCIATE LIGAMENT FOOTPRINTS USING MRI STUDIES <p><strong>Introduction:</strong> The anatomy of normal PCL is not extensively studied. In recent years, MRI can provide surgeon with accurate and detail parameters of the ligament to guide in preparing near-anatomical graft for reconstruction of injured PCL.</p> <p><strong>Objective</strong>: To study the anatomical variant of PCL footprints from MRI by measuring the length, thickness, and width of PCL tibial and femoral footprints. Methodology: This is a single centre observational cross-sectional study which analyse the anatomy of normal PCL from MRI of the knee done for sports injury between January 2013 until January 2017. The measurements of the length, thickness, and width of PCL tibial and femoral footprints were taken and the mean values and comparison between genders and age were made.</p> <p><strong>Result:</strong> 240 MRIs were recruited with mean age of 26.7. 71.3% are of males and 28.7% are females.196 images are from male subjects and 44 from female subjects. The age ranges from 17 to 45 with mean age of 26.7. The reported normal PCL mean length is 38.79mm (± 1.69), thickness 4.25mm (± 0.41), width at femoral attachment 10.57mm (± 0.80), width at tibial attachment 10.76mm (± 0.53). The length and width at tibial attachment showed greater value in males than female (p=&lt;0.001). However, when compared between young and middle age groups within each gender, there was no significant difference (p&gt;0.05).</p> <p><strong>Conclusion:</strong> The measurement of length, width, and footprints of normal PCL from MRI has significant difference among genders but no significant difference among young and middle-aged subjects in Malaysian population.</p> Laila Maisarah A. Rahman Khairul Nizam Siron@Baharom Elinah Ali Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 LIPID PROFILES CHANGES IN 12% HIGH CHOLESTEROL DIET INDUCED NONALCOHOLIC TEATOHEPATITIS ANIMAL MODEL FOLLOWING SUPPLEMENTATION OF TUALANG HONEY AND DIET MODIFICATIONS <p>Non-alcoholic steatohepatitis (NASH) is associated with hypercholesterolaemia and hypertriglyceridaemia. The main recommendation for NASH management is a diet prescription to reduce body weight. Tualang honey (TH) has been suggested to improve lipid profiles and hence, may help combat NASH. This study aimed to investigate the effects of TH supplementation coupled with diet modification on lipid profiles of rats given a 12% high cholesterol diet (HCD). Fifteen Sprague Dawley rats were fed with HCD for 16 weeks. They were then divided into 3 groups. Group A rats were not treated and continued HCD (control). Group B rats were supplemented with TH (3.0g/kg) and continued HCD, while group C was given TH (3.0g/kg) but was changed to a normal diet for 4 weeks. Compared to the control (A), group C showed a significantly reduced total cholesterol (2.92 ± 0.78 vs 1.68 ± 0.16 mmol/L, p&lt;0.005), and triglycerides (3.30 ± 0.49 vs 0.98 ± 0.36 mmol/L, p&lt;0.001). Whilst group B only showed a significant reduction in triglyceride (3.30 ± 0.49 vs 2.04 ± 0.80 mmol/L, p&lt;0.003) but no significant changes in total cholesterol. Diet modification in addition to TH supplementation may further enhance the lipid profile modifications of HCD rats as compared to TH alone.</p> <p><strong>Acknowledgement</strong>: Fundamental Research Grant Scheme (FRGS/1/2018/SKK08/UIAM/11).</p> Mohd Afzal Alias Roslina Abdul Rahim Nor Zamzila Abdullah Naznin Muhammad Norlelawati A. Talib Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 THE PREVALENCE, RISK FACTORS AND OUTCOMES OF FRAILTY IN ELDERLY CRITICALLY ILL PATIENTS <p><strong>&nbsp;Introduction: </strong>Frailty is a multidimensional syndrome of loss of physiologic and cognitive reserves resulting in increased vulnerability to adverse outcomes. This research sought to determine the prevalence, risk factors, outcomes of frailty in the ICUs. This study’s purpose is to assess the applicability of frailty screening tools in guiding ICU admission of elderly patients.&nbsp;</p> <p><strong>Methods:</strong> This is a two centre, prospective observational study. Inclusion criteria were ICU patients &gt; 60 years old, and patients admitted &gt; 24 hours in ICU. Patients with Clinical Frailty Score (CFS) of greater than 5 were classified as frail.</p> <p><strong>Results: </strong>30 of 58 (51.7%) of our patients were frail. Modified Frailty Index (MFI) was significantly higher in frail patients. No significant risk factors and outcomes of frailty were detected. Mechanically ventilated patients were 7.735 times more likely to be frail and patients with nosocomial infection were 6.685 times more likely to be frail compared to patients who were not inflicted with the corresponding outcomes. Other outcomes were not associated with frailty.</p> <p><strong>Conclusion:</strong> Around half of the elderly critically ill patients were frail and significant association between the CFS and MFI was established. Mechanical ventilation and nosocomial infection were significantly associated with frailty.</p> Nur Khairunnisa Abdul Aziz Azrina Md Ralib Basri Mat Nor Foong Kit Weng Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 SYSTEMATIC REVIEW ON ROLE OF miRNAs IN ACUTE MYOCARDIAL INFARCTION OF YOUNG ADULTS <p>Acute myocardial infarction (AMI) is the leading cause of death worldwide. In Malaysia, people are getting AMI at younger age compared to well-developed countries.&nbsp; The role of microRNA (miRNA) in pathogenesis of AMI is not well elucidated and its involvement in young population has not been studied.&nbsp; The systematic review performed using available electronic databases and also previous reviews.&nbsp; The databases were broad search and began with the generic terms to identify search terms that were relevant.&nbsp; Databases including PubMed, Science Direct and Medline were searched between January 2010 and December 2020 for this systematic review.&nbsp; A total of 97 articles found. Only 1 article showed that the research was done in young AMI population.&nbsp; 13 miRNAs were found to be upregulated and 16 downregulated in young acute coronary syndrome (ACS) patient, which included both ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI).&nbsp; miRNA 183-5p was significantly upregulated in ACS patients with NSTEMI whereas miRNA 134-5p, miRNA 15a-5p and let 7i-5p were significantly downregulated in patients with STEMI compared to healthy control.&nbsp; Plasma miRNA 183-5p, miRNA 134-5p, miRNA 15a-5p and let 7i-5p were dysregulated in STEMI and NSTEMI where they can potentially be used to discriminate the two ACS forms in future study.</p> Nurul Ashikin Muhammad Musa Nor Zamzila Abdullah Norlelawati A. Talib Azliana Abd Fuaat Aszrin Abdullah Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 ESTIMATES OF GLOMERULAR FILTRATION RATE BASED ON CREATININE AND CYSTATIN C EQUATIONS IN CRITICALLY ILL PATIENTS <p><strong>Introduction and Aim</strong>: Accurate assessment of renal function in the critically ill is a complex task. Estimated glomerular filtration rate (eGFR) is the best indicator to help physicians estimate kidney function and determine different stages of kidney disease. eGFR can be calculated using serum Creatinine (S<sub>Cr</sub>), or serum Cystatin C (S<sub>CysC</sub>), age, body size, race and gender using different equations. We evaluated eGFR based on S<sub>Cr</sub> and S<sub>CysC</sub> equations in critically ill patients to find an accurate, precise, and less biased equation for GFR estimation.</p> <p><strong>Methods: </strong>This is a single cantered, cross-sectional observational study in critically ill patients older than 18 years staying for over 24-hours in intensive care units. Urinary Creatinine, S<sub>Cr</sub>, and S<sub>CysC</sub> were measured at 8, 24, and 72-hour intervals. Acute kidney injury (AKI) was defined at admission using the Creatinine definition of the Kidney Disease Improving Global Outcome (KDIGO) guideline. After estimating GFR from Creatinine (eGFR<sub>Cr</sub>), Cystatin C (eGFR<sub>CysC</sub>), and combining Creatinine and Cystatin C (eGFR<sub>Cr-CysC</sub>), results were compared with measured Creatinine clearance (Cr<sub>CL</sub>). Cr<sub>CL</sub> was defined based on urinary Creatinine, S<sub>Cr</sub>, and urinary volume in a 24-hour period.</p> <p><strong>Results: </strong>Forty-three patients were recruited, of which 6 died and 37 alive. eGFR<sub>Cr-24hrs </sub>had the highest correlation to measured Cr<sub>CL-24hrs</sub>, with correlation coefficient of 0.81 (p&lt;0.001). eGFR<sub>Cr-72hrs</sub> had the highest accuracy at 30% and 50% of measured Cr<sub>CL</sub> between 57.69% and 69.23% respectively. However, the eGFR<sub>CysC-24hrs</sub> equation was more precise with the lowest bias of 0.94. Logisticregression-analysis reveals that p values for eGFRCr-24hrs, CrCL-24hrs, eGFRCr-CysC-24hrs, eGFRCr-72hrs, eGFR<sub>Cr-CysC-72hrs </sub>equations were ? 0.05, which helps diagnose AKI. Logistic regression was &gt;0.05 for in- hospital-mortality prediction, addressing none of the equations led to death prediction.</p> <p><strong>Conclusions:</strong> eGFR<sub>Cr-24hrs </sub>had the highest correlation to measured Cr<sub>CL-24hrs</sub>, with correlation coefficient of 0.81 (p&lt;0.001). The most accurate equation was eGFR<sub>Cr-72hrs </sub>However, eGFR<sub>CysC-24hrs</sub> equation had the lowest bias and was relatively more precise (60.0?ml/min). Using logistic regression, most of the equations contributed to diagnosing AKI. However, none of the equation predicted in-hospital-mortality.</p> <p><strong>Acknowledgement</strong>: I would first like to express my heartfelt thanks to my supervisor Associate Professor Dr Azrina Md Ralib. A more supportive and considerate supervisor I could not have asked for. Secondly, I want to express my immense gratitude to the Afghan Government, my sponsor (HEDP) for allocating 100% sponsorship for my Master degree, and many thanks to everyone who assisted directly (family members) and indirectly in this whole journey.&nbsp;</p> Sohaila Kakar Azrina Md Ralib Mohd Basri Mat Nor Edre b Mohammad Aidid Shahir Asraf Abdul Rahim Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 PERCUTANEOUS TENDON ACHILLES LENGTHENING: A CADAVERIC STUDY <p><strong>Background</strong>: Ankle equines are the most prevalent foot deformity in children and in the adult diabetic population. Untreated equines will indirectly damage the adjacent structures and lead to inefficient gait.&nbsp;</p> <p><strong>Purpose</strong>: This study aims to determine the efficacy and safety of the percutaneous Tendon Achilles (TA) technique.</p> <p><strong>Methodology</strong>: Six fresh frozen cadaver leg specimens were used in this study and divided into three groups namely 1.5cm,2cm, and 2.5 hemisection groups. Forces were measured during the lengthening process. Soft tissue was dissected and using a measurement caliper the gap at the hemisection site, amount of overlapping tendon, and depth of blade in relation to adjacent neurovascular bundle were measured</p> <p><strong>Results</strong>: Tendon excursion distance: 2.5 cm hemisection distance yielded the highest excursion distance. Tendon Overlap: 2.5 cm or higher hemisection distance carry less risk of near or total tendon rupture when compared to the lower hemisection distance group Forces Vs ROM: The forces needed to increase 1degree range of motion (ROM) in the 2.5cm hemisection group is comparatively higher compared to 2cm and 1.5 cm group. The margin of Safety: No significant difference in each group, to prevent complications it is advisable not to extend the blade beyond the margin of safety at each hemisection cut by 0.74cm, 0.97cm, and 1.55cm at the proximal middle and distal hemisection respectively.</p> <p><strong>Conclusions</strong>: 2.5cm and higher hemisection distance provide more tendon lengthening, lesser risk of tendon rupture, and have a more protective effect in the earlier phases of rehabilitation.</p> Muhammad Wafiuddin Ahmad Aminudin Che Ahmad Shukrimi Awang Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 A NOVEL TECHNIQUE OF ISOLATED GASTROCNEMIUS RECESSION: A CADAVERIC COMPARISON WITH STRAYER PROCEDURE <p>Strayer’s gastrocnemius recession is a common technique in treating ankle equinus of gastrocnemius origin. Nevertheless, this technique is associated with a few flaws. We aim to introduce a novel technique of isolated gastrocnemius recession and perform a cadaveric study to evaluate its safety, at the same time compare this novel technique with the existing Strayer procedure biomechanically. Eight fresh cadaveric models of gastrocnemius tightness were established by isolated traction of the gastrocnemius muscles. Gastrocnemius recession was performed on all eight models with Strayer method and the novel method randomised equally. The safety of both the techniques was evaluated by identifying any iatrogenic injury to the surrounding structures. The lengthening and improvement of the ankle dorsiflexion was measured and compared between the two techniques. There was no iatrogenic sural nerve or saphenous vein injury in all eight models. There was no significant difference between the two techniques in terms of lengthening (24.25 mm vs 21.00 mm; p=0.838) and improvement of ankle dorsiflexion (26.5-degree vs 26 degree; p=0.829). Both Strayer technique and the novel technique of gastrocnemius recession lengthened the gastrocnemius and improved the ankle dorsiflexion in this cadaver trial. Both procedures were safe with proper techniques and there was no significant difference in efficacy between them. The cadaveric study of the novel technique of gastrocnemius recession show that it is safe and effective in the treatment of conditions associated with isolated gastrocnemius tightness.</p> <p><strong>Acknowledgement:</strong> The authors would like to thank Universiti Malaysia Sabah for the research grant (UMS/PPI1.3.2/800-4/8/452) to carry out this study.</p> Kow Ren Yi Aminudin Che Ahmad Mohd Adham Shah Ayeop Muhammad Wafiuddin Ahmad Shahril Yusof Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 CHARACTERISTICS AND MICROBIOLOGY PROFILE OF PATIENTS WITH DIABETIC FOOT INFECTIONS IN KUANTAN, PAHANG <p>The number of people suffering from diabetic foot infection (DFI) has increased precipitously over the years in Malaysia, owing to increased population, urbanization, the surge of number of people with obesity and physical inactivity. As one of the most dreaded complications of diabetes mellitus, DFI is associated with high morbidity and mortality. We aim to study the microbiological profile of patients with DFI at a university hospital in Kuantan, Pahang. This retrospective study is carried out at International Islamic University Malaysia Medical Center to study patients admitted from 1<sup>st</sup> of January 2018 to 30<sup>th</sup> April 2019. Patients’ demographic data, types of infection and surgical intervention, and the microbiological profile are obtained from the medical records. A total of 142 causative pathogens are cultured from 130 tissue samples, with an average of 1.09 pathogens per lesion. Majority of the pathogens are gram-negative pathogens (52.8%). <em>Staphylococcus sp.</em> is the most common pathogen isolated (22.5%). This is followed by <em>Streptococcus sp</em>. (10.6%), <em>Pseudomonas sp</em>. (9.2%), <em>Morganella sp</em>. (5.6%), <em>Klebsiella sp</em>. (4.9%), <em>Enterobacter sp</em>. (4.9%), and others. Among the 142 pathogens, there are 9 multidrug-resistant strains observed. Most of the antibiotics are effective against the gram-positive pathogens except benzylpenicillin, tetracyclin, fusidic acid and ciprofloxacin. Meanwhile, cefotaxime, amoxicillin and ampicillin-sulbactam are also not suitable against gram-negative pathogens. Oxacillin and sulfamethoxazole/trimethoprim can be used as empirical antibiotics against gram-positive pathogens, while vancomycin should be reserved for patients with septic shock or suspected multi-drug resistant strain infection. Piperacillin/tazobactam and ceftazidime can be used as empirical antibiotics against gram-negative pathogens. Early initiation of empirical antibiotic(s) is paramount to stymie the infection from getting worse while waiting for the identification of causative pathogens in the management of DFI. This study provides a guide for treating physicians to initiate the most appropriate empirical antibiotic in DFI.</p> Kow Ren Yi Low Chooi Leng Mohd Adham Shah Ayeop Aminudin Che Ahmad Mohd Shukrimi Awang Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 A RARE CASE OF TRAUMATIC PERONEAL TENDONS RUPTURE IN ATHELETE <p><strong>Introduction:</strong> Ankle sprain is one of the most common injury among athletes. 80% of lateral ankle ligaments are typically injured during inversion injury in ankle sprain. Very rarely this injury involves the peroneal tendons.</p> <p><strong>Case Report: &nbsp;</strong>A 47-year-old former athlete and coach came with complaint of pain and swelling of his right ankle after a history of fall with inverted right foot while walking on uneven ground four months prior to hospital visit. Clinically tenderness was elicited at the anterolateral and posterolateral aspect of the ankle and Anterior Drawer’s test was positive. His MRI revealed peroneal longus and brevis tendon rupture and chronic complete rupture of the lateral ankle ligaments. He was then subjected for exploration, peroneal tendons repair, anatomical repair of ATFL and retinaculoplasty under general anaesthesia. Operative findings are like the reported MRI.</p> <p><strong>Discussion: </strong>25-77% of patients with chronic lateral ankle instability had some type of injury to the peroneal tendons in form of tendinitis, subluxation, tendon tears or combination of any. These tendons act as dynamic stabilizer of the ankle joint. Apart from inversion injury to the ankle, peroneal tendons rupture can be attributed to their anatomical variation of the bony and soft tissues around the ankle. Treatment of peroneal tendon injury depends on the magnitude of the injury varying from as simple as debridement to tendon repair to tendon transfer or grafting.</p> <p><strong>Conclusion: </strong>Peroneal tendon disorder is an important cause of lateral ankle instability and may affect athletic performance among athletes.</p> Laila Maisarah A. Rahman Aminudn Che Ahmad Mohd Adham Shah Ayeop Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 OUTCOMES OF LOCKED INTRAMEDULLARY NAIL PROCEDURE IN CLOSED DIAPHYSEAL FEMUR FRACTURE IN RELATION TO TIMING OF SURGERY <p><strong><u>Introduction:</u></strong> Diaphyseal femur fracture is one of the commonest fractures following blunt trauma. The gold standard for managing such injury is intramedullary nailing which provides good union rate, early mobilization and able to address comminuted fractures. Many literatures have advocated that fixation should be done early within 24 hours to reduce risk of respiratory complications for stable cases. However, performing intramedullary fixation for all diaphyseal femur fractures within 24 hours are not possible for all centers due to limited availability of operating theatre time and resources.</p> <p><strong><u>Method:</u></strong> In this study, we compared the outcomes of closed diaphyseal femur fracture fixation with locked intramedullary nail procedure done within 1 week to those done after 1 week. This is a retrospective single centre study which was done by reviewing the patient’s record who had closed diaphyseal femur fracture treated with locked intramedullary nail procedure at Hospital Tengku Ampuan Rahimah, Klang, Selangor from January 2017 till May 2019. A total of 221 patients were selected with the mean age of 29 years old.</p> <p><strong><u>Result and conclusion:</u></strong> There is no statistically significant difference between closed diaphyseal femur fracture treated with locked intramedullary nail done between 24 hours till 1 week compared to cases done after 1 week except for the total length of hospital stays which is longer for cases done after 1 week.&nbsp;Although there is no significant difference between the 2 groups aside from total length of hospital stays, measures should be taken to improve the timing of surgery as prolong hospital stays impose significant cost to both patients and medical institutions.</p> Ng MG Zamzuri Zakaria Karupiah RK Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 ASSESSMENT OF SHOULDER BALANCE IN A SURGICALLY TREATED PATIENTS WITH THORACIC ADOLESCENT IDIOPATHIC SCOLIOSIS : A RADIOLOGICAL AND CLINICAL CORRELATION <p>Scoliosis is an apparent lateral curvature deformity of the spine that is greater than 10 degree with vertebral rotation. It can be treated conservatively or surgically. Post-operative shoulder imbalance has become one of the major concerns for patients and it may lead to psychological distress in adolescent females. This study was implemented to assess the correlation between radiological and clinical findings of shoulder balance in thoracic adolescent idiopathic scoliosis (AIS) patients treated with posterior spinal instrumentation &amp; fusion (PSIF) surgery. This is a cross sectional study involving 30 subjects. All AIS patients with thoracic component who have been treated surgically in HSIJB and IIUM Medical Centre Kuantan with PSIF from January 2007 until May 2019 were selected in this study. Mode of assessment are radiological and clinical. We assessed the correlation between post-operative radiographic &amp; clinical parameters of shoulder balance. We also&nbsp; compared pre and post-operative radiographic parameters between two groups of shoulder balance and identified the radiological factors related to shoulder balance after PSIF. There was no significant correlation exists between post-operative radiological and clinical parameters. Comparison of mean shows none of the radiographic parameters had statistically significant difference in mean between both posterior shoulder imbalance groups. Results also showed that none of the radiographic factors was related to Postoperative Shoulder Imbalance (PSI). In conclusion,&nbsp; there was no radiographic parameter that has a strong correlation with postoperative shoulder balance. Surgeons should pay more attention to&nbsp; clinical shoulder balance parameters during assessment to prevent this complication among adolescents.</p> Mohd Azreen Ezainy Mohmad Sallih T. Jayamalar Sa’adon Ibrahim Rajandra Kumar Karupiah Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 THE RELATIONSHIP BETWEEN SALIVARY LEPTIN LEVELS AND FACIAL SKELETAL PATTERN: A PREFATORY <p><strong>Background: </strong>Leptin hormone is a key regulator of several physiological pathways including inflammation, bone metabolism and the metabolism of fat and energy stores. It has been concluded that leptin plays a significant role in bone formation through the activation of osteoblasts. There is however an apparent gap in the literature regarding leptin role and its association with the facial skeletal pattern that is heavily related to the dynamic of growth, bone deposition and bone resorption. This pilot study hopes to provide initial information on leptin in this aspect.</p> <p><strong>Objective: </strong>The aim of this study was to assess and compare the salivary leptin hormone levels between different classes of facial skeletal pattern (Class I, II and III).</p> <p><strong>Methodology: </strong>A sample of 62 patients were selected prior to the orthodontic treatment from a population that attended the International Islamic University Malaysia (IIUM) Specialist Orthodontic Clinic. Based on the analysis lateral cephalometric analysis, the subjects were grouped into Class I, Class II and Class III facial skeletal patterns, according to Eastman and Wits appraisal. Subsequently, unstimulated saliva samples were taken and purified to undergo leptin enzyme-linked immunosorbent assay (ELISA) analysis to determine the levels of leptin hormone.</p> <p><strong>Results: </strong>The results showed that there was a significant difference between the levels of salivary leptin hormone between the different classes of facial skeletal pattern. There was a significant difference between the levels of leptin hormone between Class I and Class II skeletal patterns(p=0.004); and between Class I and Class III facial skeletal patterns(p=0.003). No statistical difference was noted between the levels of leptin of Class II and Class III facial skeletal patterns(p=0.681).</p> <p><strong>Conclusion:</strong> Leptin hormone levels are higher in patients with Class II and Class III facial skeletal patterns compared to Class I.</p> Danusha Siva Dharma Noraini Abu Bakar Basma Ezzat Mustafa Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 A STUDY OF LONG BONE INJURIES AMONGST CHILDREN INVOLVED IN ROAD TRAFFIC ACCIDENTS IN KLANG POPULATION <p>Road traffic injuries are the leading cause of morbidity, disability and mortality worldwide amongst the young and the most vulnerable road traffic users are pedestrians, motorcycle riders and bicyclists. This retrospective study reviewed the epidemiological data of long bone injury cases amongst children who were admitted to orthopedic ward in a tertiary hospital at the central region of Malaysia following road traffic accident to analyze the pattern of injury and morbidity outcome to predict the effect of their injuries to their school attendance and academic performance. A total of 281 patients were included in the study with a mean age of 14.36 years (SD: 2.57 years). There was a male predominance in all age groups. The most common vehicle involved was motorcycles with a significant prevalence of underage motorcycle riders. Humerus fracture was more common amongst the younger age groups, whereas forearm fractures and lower limb fractures involving the femur, tibia and fibula were more prevalent amongst the adolescents. The mean hospital stay was 6.98 days (SD: 7.09 days) and mean medical leave issued was 111.39 days (SD: 71.36 days). The patients had an average of 5 clinic visits after discharge (SD: 2.75 days). 4.6% of all patients had suffered permanent physical impairment with 8 of them having physical impairment directly related to long bone injury.&nbsp; Linear regression test showed no significant association between the length of school absence to academic performance in school-going children with long bone injury. In conclusion, there is a variation in pattern and severity of pediatric trauma across the age groups. The high prevalence of underage motorcycle riders suggests that a concerted effort should be undertaken to improve public awareness about road safety to implement primary injury prevention and to promote pediatric safety measures in all motor vehicles.</p> Aida Adlina Anuar Avthar Singh Mohd Shukrimi Awang Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 FORMULATION OF METRONIDAZOLE LOADED CHITOSAN NANOPARTICLES FOR PERIODONTAL TREATMENT <p>Local drug delivery of antimicrobials is one of the methods in controlling and treating periodontal disease.&nbsp; However, low drug penetration and rapid drug release are the major challenges in formulating local drug delivery systems. Thus, various drug targeting mechanisms and nanocarrier fabrication were developed to efficiently deliver the sustained release drug deep into the mucosa lining. In addition, chitosan is commonly used as nanocarriers for pharmaceutical drugs due to its biocompatibility and biodegradable properties. It can act as nanocarriers for loading antibacterial drugs on targeted sites and enhancing the bioavailability.&nbsp; The suitability of nanocarrier formulations for local drug delivery depends on various parameters, including the average particle size and polydispersity index (PDI). Therefore, the aim of this study was to identify the particle size and PDI of metronidazole antibiotics loaded with chitosan nanoparticles using ionic gelation.&nbsp; Metronidazole (MNA) nanoparticle was obtained by crosslinking chitosan (0.2% w/v) in lyophilized solutions containing metronidazole with tripolyphosphate (TPP) (0.2% w/v).&nbsp;&nbsp; The particle size and PDI of MNA nanoparticle were found to be 303.86 ± 62.78 nm and 0.497 ± 0.08, respectively (n=3). In this analysis, the nanoparticle diameter with moderate size distribution is capable of delivering the drug into the deeper layers of oral mucosa and prolonging the release of metronidazole directly to periodontal infection. Further study is needed to identify their therapeutic efficiency before <em>in vivo</em> evaluation.</p> <p><strong>Acknowledgement</strong>: The authors would like to thank the financial support by grant FRGS19-146-0755</p> Nora Azirah Mohd Zayi Muhammad Lutfi Mohamed Halim Mohd Yusof Mohamad Ahmad Fahmi Harun Mohd Hafiz Arzmi Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 CLINICAL AND RADIOLOGICAL OUTCOME FOR NEGLECTED DEVELOPMENT DYSPLASIA OF THE HIP <p><strong>Purpose: </strong>The objectives of this current study is to evaluate radiological and clinical outcome for neglected development dysplasia of the hip. This study was conducted in older children aged more than six years old.</p> <p><strong>Materials and Methods: </strong>This is a retrospective analysis of 22 hips among 20 patients. All the patients had undergone an operation at a Hospital Pulau Pinang in Malaysia from 2013 to 2018.&nbsp; Severin's scoring and MacKay's scoring system was used for postoperative evaluation.&nbsp; Kalamchi &amp; Mac Ewen grading was used if patient complicated with avascular necrosis of femoral head.&nbsp;<strong>&nbsp;</strong></p> <p><strong>Results: </strong>This study revealed that the average age during surgery was 10.38±3.91 years. The Tönnis classification, show that there are 1(5%), 13(65.0%), and 6 (30.0%) hips in Grades II, III and IV. In this study, the surgical technique used was innominate osteotomy with pemberton osteotomy or shelf procedure (18 and 2 hips). Postoperatively, there were (30.0%), 13(65.0%), and 1 (30.0%) hips in Severin grade II, III and IV, respectively. In accordance to the McKay criteria of clinical evaluation, there were 6 hips (30.0%) in excellent condition whereas 14 (70.0%) is categorized as in good condition. The comparison of Pre-operative acetabular index and Postoperative acetabular index showed that patients below 8 years old is significant improving&nbsp; one patient’s postoperatively complicated with stable, painful hip with evidence of avascular necrosis of the femoral head.</p> <p><strong>Conclusion: </strong>With the results obtained in this present study, it was recommend for the single stage procedure of open reduction. This study also suggesting for femoral shortening and pelvic osteotomy for treatment of DDH in older children who is having a good to excellent radiological and functional outcomes.</p> WK Ng Ardilla Hanim Nik Alyani Mohd Shukrimi Ahmad Hafiz Zulkifly Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 SURGICAL TREATMENT OF HALLUX VALGUS; A CASE REPORT <p><strong>Introduction:</strong> Hallux valgus (HV) is associated with laterally deviated great toe, and prominent metatarsal head. This disease usually asymptomatic, however in some cases it can cause pain and may cause discomfort when wearing footwear. It also can be associated with callosity and ulcer formation as a result of pressure from footwear on the bony prominence. In this case, clinical, treatment by reconstruction of deformity correction of hallux valgus are described.</p> <p><strong>Case report:</strong> We reported a 23 years old female presented with a 6 years history of bilateral hallux valgus. Her deformity progressed throughout the years, causing severe pain on weight bearing activity. Clinically she has bilateral flat foot with hallux valgus deformity which is more severe on her left foot. On plain radiograph, her deformity was classified as severe (Hallux Valgus Angle (HVA); 44.7º, Intermetatarsal angle (IMA);18º and Distal Metatarsal Articular Angle (DMMA) of 9º). In view of severity of deformity and persistent pain despite receiving analgesic and splinting, she was planned for surgical correction. Post-surgical correction shows improvement both clinical and radiological parameters with no immediate complication observed. Currently she still undergoes follow up to monitor her progress.</p> <p><strong>Conclusion:</strong> HV usually is an asymptomatic disease. Treatment is aimed at reducing pain and irritation at medial prominence. Treatment option depend on the symptoms and severity of the disease. Numerous surgical procedures have been described with good outcome. This surgical procedure is reserved for those who failed conservative treatment, and aimed to correct deformity, and to elevates the symptoms.</p> Siti Nur Fudhlana Ab Aziz Aminudin Che Ahmad Mohd Adham Shah Ayeop Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 SPONTANEOUS SUBCAPSULAR LIVER HEMORRHAGE: A RARE COMPLICATION POST THROMBOLYSIS FOR STEMI <p>Spontaneous liver haemorrhage is an infrequent complication post ST elevation myocardial infarction (STEMI) thrombolysis. It is a serious and life-threatening condition that can occur after the treatment. This is a case of 63 years old gentlemen initially treated as acute posterior myocardial infarction (killip 4). Thrombolysis of posterior STEMI is successfully done 5 days prior and the patient is discharged well. Patient presented again with a complaint of epigastric pain for 1 day. The pain is described as colicky and pressing in nature and not resolved by sublingual glyceryl trinitrate (GTN). Otherwise, he denied blackish stool, hematemesis or hemoptysis as well as any history of trauma or fall. On examination, tenderness at right subcostal region and right renal angle is elicited. Haemoglobin is dropped from 9 to 6 g/dL. Ultrasound examination showed subcapsular organising haematoma with moderate intraperitoneal collection. CT Angiography of abdominal aorta showed large liver subcapsular haematoma with haemorrhagic free fluid. However, no evidence of active bleeding is detected. Patient was treated conservatively. As a conclusion, spontaneous subcapsular liver haematoma&nbsp; is a rare complication post thrombolysis therapy. Clinical suspicion supported with radiological findings can avoid catastrophic outcomes to the patient.</p> Mohamad Aizuddin Mohd Nasri Radhiana Hassan Siti Kamariah Che Mohamed Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 CLINICAL OUTCOME OF LUMBAR FACET JOINTS INJECTION IN PATIENTS WITH FACET JOINTS SYNDROME <p>Facet joints or known as zygapophysial joints is one of the common sources of chronic back pain. Facet joint injection with local anaesthesia with steroids is known to have optimistic results with this technique. Therefore, our study aimed to evaluate the efficacy of the treatment response for the patients who were clinically diagnosed with lumbar facet joints syndrome by using Oswestry Disability Index scoring (ODI) and pain score as the standard assessment tool. At the same time, we further look into the correlation between body mass index (BMI) and vitamin D status with the treatment outcome. This is a quasi-experimental one-group time-series study where all patients with a clinical diagnosis of lumbar facet joints syndrome were recruited from August 2018 till December 2019. Statistical analysis of parametric data will be performed by using descriptive analysis. Pearson correlation is used to determine the strength and direction between two continuous data. A paired T-test is used to compare between two-time point for the same patient (i.e., pre and post 6 months of lumbar facet joints injection for ODI percentage score). The inferential analysis will be done using one-way AOVA for the mean difference of ODI percentage score of pre and post 6 months of lumbar facet joints injection. P-value of &lt;0.05 is considered to indicate a statistically significant difference. Further analysis using post-hoc test will be used for the significant result under one-way ANOVA. We have a total of 36 patients to achieve the power of 80%, at 0.05 significance level. Patients’ rated outcomes were assessed using Oswestry disability index score (ODI) and pain score showed improvement after the treatment, Pearson correlation test showed that there was statistically significant correlation between these assessment tool (p-value = 0.001). We failed to demonstrate positive correlation between the body mass index (BMI) and the ODI scoring by using One-way ANOVA analysis (F (2.33) = 3.003, p-value = 0.063). However, we noticed a significant improvement based on ODI scoring for the patients with normal weight. There is a positive correlation between vitamin D status and ODI scoring by using One-way ANOVA analysis (F (2.33) – 3.294, p-value = 0.049). Dunnett T3 post-hoc test further exploited and revealed that the optimal category of vitamin D patients have shown to have good outcome after the treatment. In conclusion, patient diagnosed with lumbar facet joints syndrome with normal BMI and optimal vitamin D status has a good clinical outcome after lumbar facet joint injection.</p> Loh Li Loong Zamzuri Zakaria@Mohamad Rajandra Kumar Karupiah Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 PROGRESSIVE HEPATIC HISTOPATHOLOGICAL CHANGES IN HIGH CHOLESTEROL DIET INDUCED NON-ALCOHOLIC FATTY LIVER DISEASE MODEL <p>Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease.&nbsp; The disease ranging from simple hepatic steatosis to progressive steatohepatitis (NASH). Recently model of NASH was established following 12% cholesterol diet for six weeks. However, histopathological changes before developing NASH were not yet determined. This study aimed to ascertain NAFLD progression at four, five and six weeks. Twelve Sprague Dawley rats were divided into four groups. Control received normal diet, and another three were fed on 12% cholesterol diet for four, five and six weeks. Body and liver weight were measured. Liver tissues stained&nbsp; for haematoxylin and eosin staining. The percentage of steatosis was measured using Image J software. The differences between groups were analysed using One-way ANOVA. There were significant increase in body weight in five and six week groups compared to control, while liver weight was significantly raised in six weeks. Progressive hepatic changes were observed from four to six weeks. Four weeks showed simple steatosis, whereas ballooning degeneration and inflammation were more obvious in six than five weeks. In conclusion, this model demonstrated the histopathological progression of NAFLD.</p> <p><strong>Acknowledgement</strong>: Department of Basic Medical Sciences &amp; Department of Pathology &amp; Laboratory Medicine, Postgraduate Office, Postgraduate Office, KOM, IIUM.</p> Nawal Ahmed Zunariah Buyong Nor Zamzila Abdullah Asmah Hanim Hamdan Jamalludin Ab. Rahman Sirajudeen Kuttulebbai Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 VARDENAFIL MARKEDLY SUPPRESSES TUMOR GROWTH AND ENHANCES IDARUBICIN-INDUCED ANTITUMOR EFFECTS AGAINST GLIOMA IN VIVO <p>Idarubicin (IDA) is highly potent anticancer against glioma <em>in vitro</em> but not <em>in vivo</em>. Phosphodiesterase (PDE-5) hydrolyses cyclic guanosine monophosphate (cGMP), and is highly expressed in glioma. We proposed that increasing cGMP in the brain by the PDE-5 inhibitor vardenafil (VAR) augments IDA anti-glioma activity. We show that VAR (10 mg/kg) enhanced IDA (0.1mg/kg)-induced tumor growth-inhibitory activity and augmented IDAinduced improvement of survival against rat C6 glioma. Real time PCR results demonstrated that VAR inhibited mRNA expression of PDE-5 in the brains of animals treated with VAR, compared to control-treated group, implicating an important role for the inhibition of PDE-5 in VAR antitumor activity. Animals receiving either VAR alone or VAR+IDA improved survival when compared with control (PBS) or IDA groups.&nbsp; We examined the antiproliferative, pro-apoptotic and anti-invasive activities VAR <em>in vitro</em> and showed that VAR inhibited the growth and promoted apoptosis of rat C6 glioma cells. VAR also inhibited the migration and anchorage-independent growth of C6 cell. This suggests that the enhanced antitumor effect of VAR could be due to combined antiproliferative, pro-apoptotic and antiinvasive activities.</p> ASHOUR A.E. A. ALZAHRANI H. ABDEL-HAMIED K. ZOHEIR S. AHMAD S. ALREJAIE A. ABD-ALLAH Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 THE TRANSLATION AND VALIDATION OF THE RELATIONSHIP DYNAMIC SCALE (RDS-M) MALAY VERSION AMONG HEALTHY MARRIED MALAY WOMEN <p><strong>Background: </strong>Relationship Dynamic Scale (RDS) questionnaire is a marital fitness scale that measure marital conflict. The RDS has been translated into different languages and assessed in different populations. The validity and reliability of RDS varied depending on the ethnicity and culture of the respondents. This study aimed to establish a valid and reliable version of the RDS in Malay (RDS-M).</p> <p><strong>Methodology: </strong>A cross-sectional study using the translated and validated RDS questionnaire was conducted in married Malay women. Subjects were asked to complete the RDS-M that consists eight items. The concept, content, and construct validity and reliability of the RDS-M were assessed.&nbsp;</p> <p><strong>Results: </strong>150 subjects were involved in this study. The content validity index (CVI) for the RDS-M from three expert lecturers was 0.95, indicating satisfactory validity content. The final model confirmatory factor analysis (CFA) showed good model fit based on ?² p-value &gt; 0.001, SRMR = 0.038, RMSEA = 0.083, CFI = 0.970 and TLI = 0.930. The internal consistency for reliability confirmation indicated good reliability (Cronbach’s ? coefficient = 0.764).&nbsp;</p> <p><strong>Conclusion:</strong> Our results demonstrated good reliability and validity of the Malay version of the RDS as a measure of marital conflict in healthy married Malay women. This will fill an important gap in measuring the marital conflict for married women in research and community settings in Malaysia. The RDS-M can be used to help prioritize health-related concerns from the married women’s perspective.</p> <p><strong>Acknowledgement: </strong>Fundamental Research Grant Scheme 2015(203.PPSP.6171192)</p> Nurhazwani Hamid Rosediani Muhamad Yee Cheng Kueh Zalina Zahari Nurhayati Mohamad Nor Nurzulaikha Abdullah Mung Seong Wong Zheng Feei Ma Yeong Yeh Lee Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 CLINICAL AND FUNCTIONAL OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION OF SCAPULA FRACTURE IN ADVANCE TRAUMA CENTRE <p style="margin: 0cm; text-align: justify; text-justify: inter-ideograph;"><span lang="EN-MY" style="font-size: 10.0pt; font-family: 'Book Antiqua',serif;">Scapula fractures usually involving high impact trauma. The indications for operative management in scapula fracture is expanded. Using modified Judet’s approach, open reduction and internal fixation(ORIF) of scapula fracture was performed. The aims of surgery is early rehabilitation of affected limb. In this cross-sectional study, the data collected from January 2017 until June 2019, evaluating the clinical and functional outcomes of ORIF of scapula fracture. The reconstructed CT shoulder used to classify the fracture pattern.&nbsp; The clinical outcomes of this study include the range of motion, Disability of the Arm, Shoulder and Hand(DASH) score, Visual Analogue Score(VAS) and radiological outcome by assessment post operative. We recorded 35 patients sustained closed displaced fracture of scapula and underwent ORIF. Outcomes recorded during the 30months period. The mean ROM ranged from 82% to 100%. The mean DASH score was 12.1 at final follow-up. The mean decrease of VAS was 83% (6 to 1). The conclusion is operative treatment for displaced scapula fractures can yield good functional outcome.&nbsp;</span></p> Mokhtar NE Sulong AF Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 STEP BY STEP PREPARATION OF URINE SAMPLES FOR IN-SOLUTION, GEL-FREE PROTEOMIC STUDIES, SUITABLE FOR MALDI TOF MS AND LCMS QTOF MS <p>Two-dimensional electrophoresis is an established method for isolating and separating proteins for proteomic analysis and identification of proteins. However, it requires a lot of optimization and it suffers from some ongoing concerns regarding quantitative reproducibility and limitations on its ability to study certain class of proteins. We propose a simpler method in preparing urine samples from acute melioidosis patients for in-solution proteomics using liquid chromatography coupled with mass spectrometry quadrupole time of flight (LCMS-QTOF MS) or matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). This method is relatively easier than 2-dimensional electrophoresis, affordable, reproducible, can be performed in less equipped laboratories for transport to specialized centers for proteomic studies and bioinformatic analysis.</p> Aniza Pakeer M. Yusri Idorus Nosrihah Ismail Vanitha Mariappa Imad Mustafa al Deen Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1 ILLICIT CIGARETTE USE IN KUANTAN, PAHANG-A QUICK GLIMPSE <p><strong>Introduction:</strong> Cigarette usage maintains as a concerning global health issue, especially with the expanding illicit cigarette spread and consumption.</p> <p><strong>Aim and objectives:</strong> To investigate the characteristics of illicit cigarette smokers in Kuantan, to compare the smoking behaviour and associated factors between illicit and non-illicit cigarette use; and to investigate the most common illicit cigarette brands used in Kuantan.</p> <p><strong>Material and methods:</strong> A cross-sectional study was done in Kuantan, Pahang by recruiting 100 participants, comprising of 50 illicit and 50 non illicit smokers. Participants were selected through snowballing technique. A survey was conducted by distributing questionnaire modified and translated from Global Adult Tobacco Survey.</p> <p><strong>Results:</strong> Illicit cigarette smokers are characterized by not married, no medical illness, lower total household income and higher frequency of smoking as compared to non-illicit cigarette smokers. They were aware of using illicit cigarette and low price is the main reason to smoke. Friends were the main source of information to buy and spread illicit cigarette. The famous brands are tally with the top brands findings from the Illicit Cigarette Study in Malaysia, 2019.</p> <p><strong>Conclusion: </strong>Illicit cigarettes use has become popular among the population in Kuantan especially lower income group, as it is cheaper and accessible through social networking.</p> <p><strong>Acknowledgement</strong>: The authors would like to thankfully acknowledge the support of Kulliyyah of Dentistry</p> Zurainie Abllah Sarah Nadia Hunstad Sharifah Nurul Amirah Syed Ahmad Fauzi Copyright (c) 2021 INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES 2021-04-08 2021-04-08 5 1