IIUM Medical Journal Malaysia

Overview of the Prevalence and Contributing Factors for Occupational Noise-Induced Hearing Loss (NIHL) in Malaysia

2024-03-19T11:24:23+08:00

INTRODUCTION: This manuscript aims to provide a synopsis of the current situation surrounding noise exposure at work and the risk of noise-induced hearing loss (NIHL) in Malaysia. NIHL is an occupational illness that affects most many people and can be prevented in many countries in the world. The production and agriculture businesses and the extraction of natural resources and urban traffic all contribute to ambient noise levels. Working in a noisy environment is the main occupational risk factor for adult-onset hearing loss. In this study, we investigate the prevalence of NIHL across different industries, as well as research publication trends on NIHL. MATERIAL AND METHODS: Conducted thorough several online databases, like Science Direct, Web of Science, and Google Scholar, for related research that had already been published. The review phases were carried out according to the recommendations laid out by the preferred reporting items for systematic reviews. A set of criteria was developed for selecting relevant studies. RESULTS: The prevalence of NIHL among workers in Malaysia, varies across different industries and has been reported to range from 5.0% to 82.6%. NIHL has multiple contributing factors, including noise intensity, long-term exposure to daily noise, hearing protection devices and age. A review of these studies found varying percentages of individuals affected by each contributing factor. CONCLUSION: Occupational NIHL is a preventable health risk for workers across industries. Employers must adopt engineering and administrative controls (education and training) and provide personal hearing protectors to protect workers from noise.

Physicochemical and Sensory Attributes of Trihoney Blend (Trigona sp., Apis mellifera, and Apis dorsata) for Enhanced Antioxidant Optimization using Response Surface Methodology (RSM)

2024-03-11T09:04:01+08:00

INTRODUCTION: The therapeutic applications of honey products have been extensively studied, but the various combination of honeys as a high-antioxidant product has not been explored. This study aimed to develop an optimized three honey formulation (Trihoney) with maximal antioxidant potency and physicochemical characteristics, as well as favourable among panellists. MATERIALS AND METHODS: The three types of honey studied are; i) Trigona sp. honey (TH), ii) Apis mellifera honey (MH), and iii) Apis dorsata honey (DH). Response surface methodology (RSM) was employed to design optimal Trihoney formulation for i) total phenolic content (TPC), ii) ferric-reducing ability of plasma (FRAP), and iii) 2,2’-diphenyl-1 picrylhydrazyl (DPPH) radical scavenging activity. Proximate and nutrient analyses, such as moisture, protein, fibre, carbohydrate, sugar, and gross energy were also conducted. Additionally, sensory evaluation was carried out to support the findings. RESULTS: Based on RSM, three optimal Trihoney formulation were developed; i) Trihoney 1 (MH15:DH10:TH45), ii) Trihoney 2 (MH15:DH10:TH25), and iii) Trihoney 3 (MH15:DH10:TH15). Trihoney 1 was the most promising formulation, exhibiting the highest TPC (0.50 mg/GAE/g), remarkable values of FRAP (230.85 AAE/g) and DPPH (86.32%). Physicochemical and sugar analysis indicated that all values complied with permitted quality standards. MH received the highest overall acceptability scores based on sensory evaluation. CONCLUSION: These findings warrant further extensive investigation of Trihoney formulation in animal studies to support its efficacy as a valuable food supplement.

Association of Serum Programmed Cell Death Protein 1 (PD-1) and Gene Polymorphism with Some Valid Predictors for Systemic Lupus Erythematosus (SLE) Patients in Basra Province, Iraq

2024-02-22T14:50:24+08:00

INTRODUCTION: Systemic Lupus Erythematosus (SLE) is a systematic autoimmune disorder characterized by the production of autoantibodies against nuclear antigens and inflammation initiation. We aimed to examine the correlation between IL-18, IL-37, and PD-1, and the potential link between polymorphisms in the PD-1 gene located in intron-4 and the susceptibility to SLE. MATERIALS AND METHODS: This cross-sectional study included 43 SLE and 53 healthy individuals. Blood samples were obtained and underwent biochemical examination. The polymorphisms were screened by amplifying the intron-4 of the PD-1 gene using particular primers and then verified through sequencing. RESULTS: Our findings demonstrated statistically significant positive correlations between IL-18, IL-37, and PD-1, while the AUC of the ROC curve is 0.985, 0.968, and 0.940, and cut-off concentration is ≥132.87, ≥62.98, and ≥169.02, respectively. Moreover, two separate SNPs (rs6705653 and rs41386349) were discovered within intron-4 of the PD-1 gene. The genotype AA of the +7499 (G/A) SNP was significantly related with an increased risk of SLE (OR=3.11, 95%CI=1.52–5.94, p-value=0.031). Additionally, the A allele was identified as a risk allele (OR=1.59, 95%CI=1.09–2.31, p-value=0.043). Nevertheless, our study didn’t find any noteworthy connection between the allele and genotype of the +7209 (C/T) polymorphism region of the PD-1 gene frequencies and the susceptibility to SLE. CONCLUSION: IL-18, IL-37, and PD-1 may play significant roles in SLE immune responses and processes. Furthermore, the sequencing examination of intron-4 within the PD-1 gene demonstrated a noteworthy correlation between the A allele and the AA genotypes of PD-1 +7499 (G/A) SNP presence with the increased SLE susceptibility.

Experiences of Family Medicine Specialists in Providing Health Care for Lesbian, Gay, Bisexual and Transgender Patients: A Qualitative Study in East Coast Peninsular Malaysia

2024-03-14T15:38:03+08:00

INTRODUCTION: Lesbian, Gay, Bisexual and Transgender (LGBT) patients continue to report discrimination in healthcare setting despite the efforts of the primary healthcare offering community friendly services in Malaysia. This qualitative study aimed to provide understanding of this current issue and to explore the challenges that family medicine specialists (FMSs) from East Coast of Peninsular Malaysia face when dealing with LGBT patients. MATERIALS AND METHODS: 30 FMSs working in East Coast Peninsular Malaysia were interviewed through a phenomenological framework using semi-structured in-depth interviews of LGBT patients. The interviews were recorded in audio format, transcribed verbatim, and subjected to Braun and Clarke’s thematic analysis. We discerned common themes that can be elucidated through the lens of Leininger’s Theory of Culture Care (TCC) and the Sunrise Enabler Model (SEM). RESULTS: Three overlapping themes of the transcriptions were developed; (1) Multidimensional understanding of LGBT described how FMSs saw the LGBT community as diverging from societal norms, yet acknowledge their vulnerability as integral members of the society, (2) obstacles to providing culturally competent care stemmed from inadequate training, an unsupportive clinic environment, and the self-stigma experienced by patients, and (3) barriers to incorporating spiritual needs for holistic care arose in situations where there was insufficient spiritual health training or a preference to concentrate on physical and emotional well-being to uphold trust. CONCLUSION: The findings on this study reflect the need for proper training of healthcare personnel to deliver a holistic, culturally competent care for LGBT patients. A collaborative effort with relevant authorities is also needed to successfully overcome those challenges.

Post-traumatic, Depression, Anxiety, and Stress Symptoms among Malaysian Firefighters

2024-04-26T16:15:31+08:00

INTRODUCTION: Emergency responders, including firefighters are frequently exposed to life-threatening situations in their daily lives causing an increased risk for occupational stress, anxiety, depression and post-traumatic stress symptoms (PTSS). Hence, this study aimed to determine the prevalence, and correlation of PTSS with stress, anxiety, and depression among Malaysian firefighters. MATERIALS AND METHODS: A cross-sectional study was conducted among firefighters stationed in 20 fire and rescue stations in Penang, Malaysia using self-administered online survey through a purposive sampling. Information collected were sociodemographic data, measurement of severity of PTSS via Post-Traumatic Checklist-5 (PCL-5), and assessment of depression, anxiety, and stress via Depression, Anxiety, and Stress Scale (DASS-21). A descriptive analysis and Pearson's correlation coefficient analyses were employed in study analysis. RESULTS: Out of 562 firefighters participated in the study, the prevalence of PTSS, stress, anxiety, and depression was 5.0%, 2.1%, 13.0%, and 8.5%, respectively. Among those with PTSS, 28.6%, 78.6%, and 67.9% suffered from stress, anxiety, and depression, respectively. Hence, anxiety was highly coexisted with PTSS. There was significant positive correlation between PTSS score and the score of stress (r=0.656, P< 0.001), anxiety (r=0.699, P< 0.001), and depression (r=0.700, P< 0.001). CONCLUSION: Our study findings suggested that stress, anxiety, and depression can co-occur with PTSS. Hence, firefighters should have regular mental health assessments as the concurrent effect of multiple medical conditions may require comprehensive treatment to address the various aspects of each condition.

Design and Usability Testing of a Web-Based Intervention Module for Obesity: CoPT Nutri Trail

2024-04-16T10:04:53+08:00

INTRODUCTION: Online interventions have emerged as innovative solutions to address health issues, notably obesity, while minimizing the necessity for in-person interactions during the recent COVID-19 pandemic. There is urgency in designing and developing an appropriate online intervention module within a web-based application. This study aims to describe the design process and usability of the online Canteen Operators, Parents, and Teachers (CoPT Nutri Trail) module for an upcoming school-based obesity intervention. MATERIALS AND METHODS: The design methodology consists of four phases: content development, design, web app development, and usability testing. The web application was designed to personalize usage for teachers, parents, and canteen operators to foster healthy environments for children. Thirteen experts, including teachers, nutritionists, and IT professionals, participated in the usability testing. RESULTS: All experts agreed that the design of the web application met the requirements of target users, requiring slight improvements in graphic design, language, and information elements. The web application tool was found acceptable, as the usability of alpha scores for all interface elements ranged from 68.2% to 86.6%, falling between good and very good scores. The content validation indices indicate good levels of validity (ranging from 0.83 to 1.00). CONCLUSION: The CoPT Nutri Trail web application is ready to be launched as a school-based intervention for obesity.

The Impact of Symptomatic Chronic Venous Insufficiency (CVI) on Health-Related Quality of Life (HR Qol) in A Multi-Ethnics Society in a Developing Nation

2024-02-22T13:48:51+08:00

INTRODUCTION: Chronic venous insufficiency (CVI) is a common condition especially among those of advance age that is often neglected. As the disease severity progresses, it increases the healthcare cost and resources required, while diminishing the quality of life of the persons. Health-related Quality of Life (HRQoL) among CVI patients begins to decline once the symptom starts to appear, and reduces it further as the symptoms worsens. MATERIALS AND METHODS: This is a prospective, multi-centred, cross-sectional study on consenting symptomatic CVI patients who presented to the International Islamic University of Malaysia (IIUM) teaching hospital in Pahang, Malaysia. The diagnosis of CVI was confirmed on duplex imaging. Clinical grading was performed using Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification. Patients completed generic validated Malay language Short Form 36 (SF36) HRQoL instrument. RESULTS: One hundred and ten patients (62% male) with a mean age of 57 years, Malays (60%), Chinese (25%) and Indian (15%) were recruited. The most frequent CVD symptoms reported were pain (42%). The clinical, aetiological, anatomical, and pathophysiological (CEAP) classification placed most patients in the C2 class (34%). Apart from partaking in social functions, all other elements of mental and physical health component of SF 36 showed a marked deterioration as the disease progressed. CONCLUSIONS: We found a significant decline in the HRQoL among symptomatic CVI patients presenting to IIUM hospital in a multi-ethnic developing country.

Incidence of Fall and its Associated Factor: A Single Centre Experience

2024-03-19T11:19:06+08:00

INTRODUCTION: Patient falls during hospitalisation can cause catastrophic injuries and remain one of the major patient-safety issues faced by hospitals. This study was designed to determine the inpatient falls rate and the association between fall-related injury and sociodemographic variables. MATERIALS AND METHODS: A retrospective record review was conducted for a one-time inpatient fall in a single centre between January 2017 and December 2019. Pearson chi-square or Fisher's exact test were performed to assess association between the categorical variables. RESULTS: There were 44 inpatient falls who fell one time between January 2017 and December 2019. The inpatients fall rate was 3.0 per 10000 patient-days from 2017 to 2019. Overall, the patients who fell experienced an injury (n=24, 55%). There was no significant difference between age group, gender, time of fall, assisted type, history of fall, fall risk assessment, mental status, the department involved, and injurious fall outcome. CONCLUSION: Our study showed a low incidence of fall rate per 10000 patient-days for 2017-2019. More than half of the fallers experienced an injurious fall. The highest fall rate was noted in the surgical based departments. However, there was no significant difference between injurious fall outcomes and sociodemographic variables. Risk assessments and management strategies should focus on education, particularly bed safety.

Effectiveness of Hypertonic Saline, Polidocanol, and Glycerol as Sclerosing Agent: An Experimental Study in Javan Rabbits (Lepus nigricollis)

2024-06-12T16:21:25+08:00

INTRODUCTION: Therapeutic approaches to varicose veins include sclerotherapy, laser ablation, and surgery. Using sclerosing agents such as hypertonic saline, polidocanol, and glycerol can be an option in cases of recurrent varicose veins. This study aimed to assess the effectiveness of hypertonic saline, polidocanol, and glycerol as sclerosant agents in an in vivo study. MATERIAL AND METHODS: This was an experimental study on 24 Javan rabbits, divided into three treatment groups: hypertonic saline (group I, n=8), polidocanol (group II, n=8), and glycerol (group III, n=8). All animals received treatment by injection into the vein behind the ear, then vein damming 10 minutes later. Punch tissue samples for standard histopathological examination were taken from blood vessels at 1 hour, 24 hours, 7 days, and 45 days post-treatment across all groups. The histopathology changes were scored based on inflammation, proliferation, luminal narrowing, and fibrosis. RESULT: No differences were observed in the degrees of inflammation, proliferation, luminal narrowing, or fibrosis at different observation intervals. However, a significant and positive correlation was found between inflammation, vascular proliferation, and fibrosis with all sclerosing agents (p<0.005). No significant correlation exists in the scoring of luminal narrowing among any sclerosing agent (p>0.005). CONCLUSION: Hypertonic saline, polidocanol, and glycerol demonstrated comparable efficacy as sclerosing agents in vivo concerning fibrosis, vascular proliferation, and inflammation.

“You Know How People Talk,” Reasons Behind Child Marriage among Female Youth in The North-Eastern State of West Malaysia

2024-06-23T13:44:00+08:00

INTRODUCTION: Over the past decade, Kelantan has consistently ranked among the top three states in Malaysia for the highest number of registered child marriages, garnering attention in local and international news. However, little is understood about the local factors influencing girls' decisions to marry young. This study aimed to explore these reasons from the perspective of young women involved in child marriages in Kelantan, Malaysia. MATERIALS AND METHODS: Fourteen women aged 16-30, married before 18, participated in semi-structured, in-depth interviews. The interviews were recorded, transcribed, and analysed using NVivo® software. Thematic analysis, drawing from phenomenology and socioecological theory, revealed three overlapping themes. RESULTS: Themes emerged were: (1) self-fulfilment, (2) marriage brings security, and (3) avoidance of public ridicule. CONCLUSION: The study underscores societal and familial pressures, alongside low socioeconomic status, and religious factors, as central to child marriage in Malaysia. By amplifying the voices of these women, efforts can focus on preventing the consequences and devising solutions to curb this practice in the future.

The Use of Virtual Reality in Stable Sitting Trunk Rehabilitation for Stroke Patients: A Pilot Study

2024-04-16T10:22:28+08:00

INTRODUCTION: Virtual reality (VR) holds promise for stroke rehabilitation. However, many existing VR systems requires users to stand while playing, posing a potential falling risk for stroke patients. This study investigated the effects of a custom-developed VR system that focus on trunk rehabilitation in stable sitting position on muscle activities, postural control, and physiological cost compared to conventional trunk exercises in stroke patients. MATERIALS AND METHODS: A cross-sectional observational pilot study was conducted involving 12 paretic stroke subjects performing four exercises: two Conventional Trunk Exercises (CTE) and two VR-based Trunk Exercises (VRTE) using customized Tilt-The-Maze (self-paced) or Catch-The-Mole (game-paced) games. Muscle activity was measured using electromyography (EMG). Postural control data in the Anterior-Posterior (AP) and Medio-Lateral (ML) axes was recorded using a force plate, while the physiological cost was measured via a heart rate sensor during the exercises. RESULTS: The results indicated low muscle activity and light-intensity cardiovascular responses in all CTE and VRTE exercises. Game-paced VRTE recorded slightly higher Center of Pressure (CoP) velocity in the AP and ML axes versus CTE (AP:4.40±1.80 vs. 4.02±1.20 cm/s; ML:6.40±2.54 vs. 5.42±2.21 cm/s). In contrast, the self-paced VRTE showed an insignificant impact on postural control than both CTE and game-paced VRTE. CONCLUSION: The game-paced VRTE induced comparable effects on muscular activation, postural control, and physiological cost to that of CTE in stroke patients. The findings suggest the stable-sitting VR system as a supplementary approach to the existing trunk rehabilitation protocols for stroke patients.

Holistic Management of Diabetic Foot: Redefining Strategy

2024-07-01T10:26:39+08:00

Unraveling the Complex Role of Zinc, Boron, Chromium, and Selenium in the Pathogenesis of Diabetes Mellitus: A Review

2024-02-08T15:54:03+08:00

Trace elements are micronutrient components that are only required in small amounts but are critical for the biological functions of many human body tissues. Studies in multiple settings found significant connections between diabetic mellitus (DM) and trace elements caused by disturbances of overlapping cellular metabolic systems. Zinc, boron, chromium, and selenium at either extremely high or low levels could elicit some alteration in cellular metabolism. These lead to the development of DM. The changes include 1) the disturbance in the efficient release of insulin secretory granules, 2) the production of proinflammatory cytokines and oxidative stress state, 3) the failure of insulin signalling pathway, and 4) the reduction of glucose tissue uptake secondary to the downregulation of glucose transporters. Both significantly high and low concentrations have been linked to the development of insulin resistance. Nevertheless, conflicting evidence makes their optimum nutritional levels difficult to establish. For example, lead at a trace concentration may accelerate the development of insulin resistance. The purpose of this review is to emphasise the metabolic role of the 4 trace elements and their influence on the pathogenesis of diabetes when body levels are below optimal. Understanding the consequences of these elements could pave the way for therapeutic possibilities and breakthroughs in personalised DM management.

Microbiome Dysbiosis in Depression: A Narrative Review

2024-03-10T21:23:13+08:00

The comprehensive exploration of the microbial composition of the gut and its role in depression underscores a complex interplay involving alterations in gut microbiome, immune pathways, and inflammatory control. Studies reveal potential biomarkers and therapeutic targets linked to depression, with particular bacterial genera correlated with the severity of depressive symptoms. The dysregulation extends to disruptions in metabolic pathways and functions of bacterial proteins within the gut, contributing to intestinal barrier dysfunction and increased gut permeability. Notably, alterations in microbial composition are observed in various depressive conditions, including major depressive disorder (MDD), post-stroke depression (PSD), and depression during neoadjuvant cancer treatment. The influence of the gut microbiome on the central nervous system and the bidirectional relationship between depression and microbial changes are highlighted. Regulatory interventions, including antidepressants and probiotics, show promise in modulating the gut microbiome and alleviating depressive symptoms. The combination of probiotics with antidepressants emerges as a potential strategy for inducing a balanced microbiome. However, a lack of consensus exists regarding specific bacterial taxa associated with depression, emphasizing the need for further research to refine the therapeutic approaches for managing depression and related mood disorders. This review aims to explore the relationship between microbiome dysbiosis and depression, highlighting the role of dysbiosis as a potential contributing factor to depressive symptoms.

Decoding the Future: Genomic Sequencing's Vital Role in Communicable Disease Prevention within Public Health Practice - A Scoping Review

2024-05-13T10:11:15+08:00

Precision public health using genomic sequencing is a new field that has gained interest from public health practitioners for prevention and control measures. This study aims to identify the various applications of genomic sequencing for the prevention of communicable diseases in public health practice. Articles containing relevant keywords were determined using a systematic search strategy applied in Medline, Scopus, and Springer electronic databases. Full text included in the study was retrieved and categorised. A total of 24 articles were included in the final review. The main themes regarding the application of genomic sequencing in the prevention of communicable disease that were found in the articles were describing transmission patterns, investigating outbreaks, diagnosing infection, developing and evaluating interventions including vaccines, outcomes response treatment, and monitoring antimicrobial resistance. In conclusion, genomic sequencing has the potential to enhance the prevention and control of communicable diseases globally.