IIUM Medical Journal Malaysia

Contextual, Radiological Anatomy (RA) Learning needs Evaluation for Curricular Improvement

Reshma Mohamed Ansari — 2023-04-01

INTRODUCTION: As a part of the MBBS curriculum review exercise, University of Cyberjaya (UoC), Malaysia had come up with a study to investigate the feedback and learning needs pertaining to radiological anatomy (RA) in pre-clinical teaching. MATERIALS AND METHODS: A single-institutional survey of all five-year medical students was done using an adapted instrument which had both open and close-ended questions on the radiological anatomy teaching received so far and the perception on the teaching methods and content. 405 respondents out of 503 (80%) (year 1=115, year 2= 78, year 3=79, year 4=78, year 5=55) replied. There were totally 136 male and 269 female respondents. RESULTS: Though the overall student learning time (SLT) was adequate, year 3 students (62%) reported inadequate radiological anatomy SLT. Pre[1]clinical students (57.5%) reported more of formal radiological anatomy teaching while clinical students indicated informal teaching (Informal: 15.1 %, Even mix of formal and informal: 56.6 %). Female students reported higher response of adequate SLT (69.1%) and formal teaching (46.9%) compared to males. Small group learning such as gross anatomy practical sessions, problem-based learning, clinical skills teaching, and clinical correlates sessions were recommended. Abdomen and thorax were the most preferred regions where radiological anatomy could be explored further. X-ray followed by CT and MRI were the most favoured radiological modalities to learn topographical anatomy. CONCLUSION: The study provided sound feedback on the existing radiological anatomy teaching practices. Data shows stark contrast between the needs of the students and the current practices indicating that it is quite substantial for curriculum review.

Evaluation of Learning Approaches among First-Year Medical and Dental Students of a Private University, in Malaysia

Sherly Deborah George — 2023-04-01

INTRODUCTION: Every learner has a way of interacting with the knowledge they have acquired, and this interaction is called a learning approach. Knowing the student's favorite learning methods will facilitate them with directions tailored to their unique needs. This study aims to measure the differences in learning approaches among first-year medical and dental students of a private university, in Malaysia. MATERIALS AND METHODS: A three-month analytical cross-sectional study was undertaken among the interested students. The self-administered, validated ASSIST questionnaire was used to measure students’ preferred learning approaches. The Pearson correlation and independent sample t-test were used to analyze the data with SPSS software. The p-value was set at less than 0.05 to indsicate a significant level. RESULTS: A total of 225 students participated, out of which 150 (66.7%) respondents were medical students, and 75 (33.3%) were dental students. Medical students reported a favoured considerably deep learning approach over dental students (t=2.874, p=0.004), and preferred the strategic approach to learning (t=2.051, p=0.041). There was a weak and no significant correlation between the concept of learning (learning as reproducing knowledge [RK] p=0.377, learning involving personal understanding [PU] p=0.269), self-rating (p=0.824), and the surface learning approach. Both medical and dental students have no significant difference in surface learning approach with t =0.556 and p=0.579. CONCLUSION: Medical students favoured deep and strategic learning over dental students. While there was no significant difference in the surface learning approach, the deep and strategic learning approaches were substantially connected with the notion of learning, types of courses/teaching, and self-rating. The knowledge of learning approaches will assist educators in making efforts to address students through successful teaching strategies. Once teachers understand the need to accommodate individual strengths and needs, they will devise appropriate new teaching methods.

The Impact of Pre-surgical Orthopedics Appliances (PSOAs) in Bilateral Cleft Lip and Palate (BCLP) Patients

Nurul Syazana Mohamad Shah — 2023-04-01

INTRODUCTION: Acceptable maxillary growth in bilateral cleft lip and palate (BCLP) is difficult to achieve. Pre-surgical orthopedic treatment aims at the reduction of cleft size by guiding growth and functional rehabilitation. The objective of this study was to evaluate the impact of Pre-surgical Orthopedics Appliances (PSOAs) on facial growth in BCLP. MATERIALS AND METHODS: Consented subjects were patients who were treated in Hospital Universiti Sains, Malaysia, and Hospital Raja Perempuan Zainab II. Ages of patients ranged from 7 to 21 years of age with non-syndromic cleft and no associated anomalies. A lateral cephalogram was taken and data collected was analyzed to compare the facial growth of BCLP with and without PSOA and between active and passive PSOA. RESULTS: The study sample comprised of 52 BCLP patients with 26 having PSOA and 26 did not having PSOA. Among these patients, those who had PSOA had significant shorter length of PNS-ANS (3.69 mm; p= 0.04) and Co-A (8.38 mm; p=0.04) compared to those who did not have PSOA. However, there were no significant difference in the length measurements between passive and active PSOA users. CONCLUSION: The usage of PSOA gives a shorter maxillary length in the facial growth of bilateral cleft patients. This study proved the effectiveness of PSOA on facial growth of cleft patients in local population.

Effects of Stromal Vascular Fraction and Platelet-Rich Plasma Treatment on Capillary Histopathology During Anal Trauma Healing in Rats: An in Vivo Study

Darwin - — 2023-04-01

INTRODUCTION: Anal traumas, such as blunt and penetrating injuries to the perineum, can disrupt the anal sphincter and cause considerable morbidity. Non-invasive anal trauma therapies have been widely developed, including growth factors administered as platelet-rich plasma (PRP) and stromal vascular fraction (SVFs) containing adipose[1]derived stem cells (ASCs) and limited growth factor. This study aimed to assess PRP and SVF effects on capillary histopathology in the anal trauma Wistar rat model. MATERIALS AND METHODS: This experimental study used a rat model. Rats were divided into three groups: Group A (n=12) was treated with PRP and SVFs; Group B (n=12) was treated with normal saline (placebo); Group C (n=4) was sacrificed on day 0 to obtain baseline capillary counts. Groups A and B were further divided into three subgroups, sacrificed on days 1, 7, and 14 post-treatment. RESULTS: Capillary counts significantly showed higher density between Groups A and B (p=0.037, analysis of variance). On day 7, there was a significant difference between Groups A and B (p=0.001). CONCLUSION: Mean capillary density significantly improved in anal trauma treated with a combination of PRP and SVFs compared to control. Our findings support the use of PRP and SVFs to aid recovery of patients with anal trauma.

Effectiveness of a Dietitian-led Healthy Lifestyle Education Package in Improving Health Behaviours of Stroke Survivors in Malaysia: A Pilot Study

Hui Jie Wong — 2023-04-01

INTRODUCTION: Despite a higher risk of a recurrent cerebrovascular event, many stroke survivors failed to achieve their targeted treatment goals. This study aimed to examine the effectiveness of a dietitian-led healthy lifestyle educational package targeted at improving stroke risk factors and lifestyle practices among stroke survivors. MATERIALS AND METHODS: A quasi-experimental pilot study was undertaken in general medical wards of two public hospitals in Malaysia. Patients were allocated into either intervention or control groups based on the week of screening. Adults aged more than 18 years old, with first-ever stroke, and the willingness of caregivers to participate were included. The intervention group (patient-caregiver dyad) received three dietitian-led healthy lifestyle education sessions underpinned with Health Belief Model and Reflection and Refractive theories and was followed up for three months. The control group received the usual stroke care. Outcome variables included blood pressure, body mass index, waist circumference, dietary intake, physical activity levels, smoking status, alcohol consumption, malnutrition risk, and health-related quality of life. McNemar, Chi-square, and repeated measures Analysis of Covariance tests were conducted to examine the within - and between-group differences. RESULTS: A total of 54 participants (27 in each group) were included in this study. The intervention group had a significantly lower intake of sugar (P=0.002, effect size=0.50) and sodium (P=0.044, effect size=0.31), a lower proportion of active smokers (7% versus 33%, P=0.039), lesser sitting time (P=0.012, effect size=0.37), and lower proportion having pain/discomfort issues (22% versus 63%, P=0.005) than the control group. CONCLUSION: Early dietitian-led lifestyle modification sessions underpinned with behavioural change theories paired with the involvement of family members appear to be beneficial among stroke survivors.

In vitro and In vivo Assessments on Nutraceutical and Safety of Herb-Fruit Based Drink on Female Wistar Rats

Siti Noorwanie Abdul Hamid — 2023-04-01

INTRODUCTION: The study aimed to assess the safety and nutraceutical properties of ALLURA^TM related to women’s health and skin beautification. MATERIALS AND METHODS: Determinations of total phenolic (TPC) and flavonoid contents (TFC) were done using the colorimetric method, followed by the identification of gallic acid via highperformance liquid chromatography (HPLC). Antioxidant activity was analyzed using 2,2 -diphenyl-2-picrylhydrazyl (DPPH) and 2,2’-azino-bis(3-ethylbenzthiazoline-6-sulphonic acid (ABTS) radicals while its anti-inflammatory activity was measured using enzymelinked immunosorbent assay (ELISA). Anti-aging and whitening effects were determined by porcine elastase and mushroom tyrosinase activities, respectively. Skin cell growth promotion and rejuvenation were evaluated using in vitro scratch assay. Cytotoxicity assay was done using HSF1184 and 3T3 BALB/c cell lines. While, acute toxicity test was done on two groups (control and treatment) of six Wistar rats each. The nutraceutical properties were evaluated based on proximate analysis. RESULTS: ALLURA^TM exhibited DPPH-IC50 values of 180.40 µg/mL and ABTS-IC50 value of 174.40 µg/mL. TPC and TFC were 67.31 mg GAE/g extract and 43.21 mg CE/g extract, respectively while 10.98 mg/g of gallic acid were quantified. ALLURA^TM reduced pro-inflammatory cytokines of TNF-α and IL-6 and showed anti-aging (IC50-162.40 µg/mL) and whitening effects (IC50- 167.70 µg/mL). ALLURA™ also increased the proliferation of HSF1184 (≤ 1000 µg/ mL), producing significant secretion of epidermal growth factor (EGF) and shown to be non-cytotoxic. No mortality was observed at the highest dose of 2000 mg/kg b.w.t. nor the behavioral and morphological changes in rats. The proximate analysis resulted in high content of moisture and low calories. CONCLUSION: These findings provided preliminary reports for the first time on the functionality of ALLURA™ for its anti-inflammatory, antioxidant, and nutraceutical properties.

Nutritional Status, Vitamin D and Lifestyle of Adults with and without Type 2 Diabetes in Baghdad, Iraq: A Comparative Cross-Sectional Study

Sumayah Mahmood — 2023-04-01

INTRODUCTION: Understanding the status of diabetes is important to predict the
variables that affect risks due to diabetes or can be used to prevent diabetes. This study
aimed to compare the socio-demographic characteristics, nutritional status, vitamin D
(VitD) levels, and lifestyles of diabetic versus non-diabetic adults in Baghdad, Iraq.
MATERIALS AND METHODS: A comparative cross-sectional study was carried out from
October to December 2019, and data were collected from adults aged 20 to 65 years.
Logistic regression analysis was used to identify factors that contributed to the
development of Type 2 Diabetes Mellitus (T2DM). Data was analyzed using SPSS
Version 22. RESULTS: One-hundred seventy subjects were divided into two groups of
85 respondents in non-diabetic and diabetic groups, respectively. Educational level, vitD
level and daily consumption of red meat, pizza, pastries, nut and bread were significantly
higher in the non-diabetic than in the diabetic group (p<0.05). On the other hand,
respondents with T2DM had higher family history of T2DM, waist-to-hip ratio (WHR),
body fat percentage (BF%), fasting blood glucose (FBG) and daily consumption of brown
bread (p<0.05). Multiple logistic regression showed that the only significant factors
contributing to the status of diabetes were educational attainment and FBG (p<0.05).
CONCLUSION: Higher educational level and decreasing one unit of FBS reduced the risk
of T2DM by 10% and 67%, respectively. Future Interventions on fostering educational
level, normal BMI, healthier diet and vitamin D intake are recommended for T2DM
prevention and control in Iraqi adults.

Risk Perception Survey on Developing Diabetes Questionnaire: Translation and Validation of the Malay Version

Fatin Aina Abu Bakar — 2023-04-01

INTRODUCTION: The Risk Perception Survey on Developing Diabetes questionnaire identifies how women with gestational diabetes mellitus (GDM) perceived the risk of developing diabetes after their pregnancy has ended. The objective of this study was to translate and validate an English questionnaire into Malay. MATERIALS AND METHODS: A cross-sectional study was conducted from February 2019 to July 2019 among 200 women with GDM who attended public health clinics in Johor Bahru, Malaysia. The original author of the questionnaire granted us permission to use for this study. The translation of the questionnaire, content, and face validation was performed. It was followed by confirmatory factor analysis using R version 3.5.3 and item analysis for the knowledge domain. The composite reliability and internal consistency reliability using Cronbach alpha were also computed. RESULTS: The Malay version consists of 20 items in five domains; personal control (2 items), optimistic bias (2 items), knowledge of diabetes risk factors (11 items), benefits and barriers of preventive behaviour (3 items), and risk perception (2 items). Confirmatory factor analysis confirmed the structure of the model. The goodness-of-fit values were adequate [comparative fit index=0.994, Tucker-Lewis Index=0.990, standardized root mean square residual=0.038, root mean square of approximation=0.021 (90% CI: 0.000,0.064)]. The four domains had composite reliability values between 0.60 and 0.88. The Cronbach alpha value for knowledge of diabetes risk factors domain was 0.843. CONCLUSION: The translated Malay questionnaire is valid and reliable to assess the perception of women with GDM towards their future risk of getting diabetes.

Designing and Validating a New Youth and Adolescent Sexual Knowledge Scale

Hijaz Ridzwan — 2023-04-01

INTRODUCTION: There is an increasing trend of premarital sexual experience and teenage pregnancies in Malaysia, coupled with a paucity of data regarding sexual practices amongst adolescents. Current available sexual knowledge scales that were reviewed were found unsuitable to be applied to the Malaysian population, due to a multitude of factors such cultural and religious sensitivity; explicit nature and contents; targeting specific populations; non-comprehensiveness. MATERIALS AND METHODS: The development of a new scale, Youth and Adolescent Sexual Knowledge Scale (YASKS) is divided into qualitative and quantitative stages. The qualitative stage involved extensive literature review of currently available and related scales and expert interviews (qualitative content validity) to identify the domains for sexual knowledge; item identification for each domain and language review. In the quantitative stage, the pretest of the pre-final version, and validation study were conducted among students from International Islamic University Malaysia, in Kuantan. RESULTS: Initial Exploratory Factor Analysis (EFA) revealed 11 factors with overall Cronbach alpha of 0.3, 95% CI (0.251,0.422) EFA was then repeated with two factors resulting in deletion of 19 items. Cronbach alpha significantly improved to 0.695% CI (0.548, 0.643), while the alpha for the two domains were 0.68, CI (0.637, 0.724) and 0.5, 95% CI (0.455,0.589). CONCLUSION: This study revealed a two-factor model with 12 items of the YASKS with acceptable psychometric properties. This scale is valid and reliable to measure sexual knowledge among youth and adolescents in Kuantan.

Reliability and Validity Study on Work Safety Culture Questionnaire (WSCQ) among Government Office Worker using Information Motivation and Behavior (IMB) Model

Josiah Oluwaseun Odu — 2023-04-01

INTRODUCTION: The Workplace Safety Culture Questionnaire (WSCQ) was developed to assess the level of knowledge, attitudes and practices on Workplace Safety Culture (WSC) among public sector office workers in Nigeria. The main objective of this study was to determine the validity and reliability of the new Workplace Safety Culture Questionnaire (WSCQ) using the Information Motivation and Behavior (IMB) model. MATERIALS AND METHODS: The WSCQ questionnaire was completed twice by the respondents themselves, with an interval of ten days between sessions, to assess the accuracy of the initial results with the retest. This study involved 44 participants. RESULTS: Cronbach's alpha showed significant item consistency for each construct in the second pilot study. The information construct (Cronbach's α=0.929 and minimum corrected item-total correlation (CITC)=0.399). The motivation construct (Cronbach's α=0.932 and minimum corrected item-total correlation (CITC)=0.450). The behavior construct (Cronbach's α=0.812 and minimum corrected item-total correlation (CITC)= 0.401). In test-retest reliability, Cohen's kappa coefficient for construct of information for all items was almost 70% between (kappa k=0.689-1000, p<0.001). The intraclass correlation coefficient (ICC) for the construct of motivation for all items is 90% between (ICC=0.810-1000, p><0.001) and (kappa k=0.944-1000, p><0.001) for the construct of behavior was 71% for all items. CONCLUSION: This study introduces the WSCQ using the IMB model among public sector office workers as the first official validation of the WSCQ.>

Effects of Combined L-Carnitine Supplementation and Moderate-Intensity Exercises on Oxidative Stress, Antioxidant, and Anti-Inflammatory Responses in Overweight and Obese Individuals: A Randomized Controlled Trial

Nur Syamsina Ahmad — 2023-04-01

INTRODUCTION: Obesity has been associated to persistent oxidative stress and inflammation that could lead to chronic diseases. MATERIALS AND METHODS: Sixty[1]eight overweight and obese participants aged 29.03 ± 6.02 years old were randomly assigned, with 17 participants per group, into sedentary control (C), L-carnitine supplement alone (S), exercise alone (E), and combined L-carnitine supplementation and exercise (SE) groups. The participants in S and SE groups took one tablet of 1000 mg of L-carnitine every day. The E and SE groups performed brisk walking exercise for 30 minutes at 50% HRmax followed by Tabata exercise for 10 to 20 minutes per session, 3 sessions per week. During pre- and post-tests, blood markers of participants were assessed to determine their reactive oxygen species (ROS), malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), and interleukin-6 (IL-6) levels. All the observed parameters were analysed using two-way mixed ANOVA for repeated measures to determine significant differences within and between the groups and comparisons of mean differences were performed using one way ANOVA. RESULTS: Results showed that there were significant decreases in ROS and MDA in the S, E, and SE groups at post-test after 12 weeks of intervention. The greatest reduction of these parameters were observed in SE group among all groups. At the post-test, both CAT and SOD levels increased in the S, E, and SE groups. Regarding IL-6, it was found to be increased in C and E groups. In contrast, there were significant decreases in S and SE groups following the intervention. CONCLUSION: Twelve weeks of L-carnitine supplementation and engagement in brisk walking and Tabata exercise had significant improvement on oxidative stress, antioxidant, and anti-inflammatory responses in overweight and obese individuals.

A Teenage Girl with Large Lung Mass

Gloria Liaw Ann Pyn — 2023-04-01

Extraskeletal Ewing Sarcoma is rarely reported. A fifteen-year-old girl presented with the right-sided pleuritic chest pain, shortness of breath, and productive cough with whitish sputum associated with poor oral intake. She subsequently underwent contrast-enhanced Computerized Tomography thorax, which showed lobulated heterogenous hypodensity occupying the entrance of the right superior pulmonary vein, extending to the left atrium.

Holistic Approach of Periodontitis Patient with Diabetes Mellitus: A Case Report

Farha Ariffin — 2023-04-01

Diabetes mellitus (DM) is a common risk factor for patients with periodontal disease. Periodontitis patients with poor glycaemic control present with severe and advanced periodontal tissue destruction. A multidisciplinary approach between the periodontist and medical practitioner is clinically proven to maintain the patient's periodontal health and general well-being. This case report aims to raise the awareness and provide a basic guideline for medical and dental practitioners in identifying and managing periodontitis patients with undiagnosed DM particularly if patient is presented with recurrent periodontal abscess. A 34-year-old Malay lady presented with recurrent periodontal abscess and diagnosed with Periodontitis Stage III Grade C was treated holistically by the periodontist and a medical practitioner. The patient's compliance towards the periodontal treatment, routine medical check-ups, and medications has helped the patient achieved better periodontal health and controlled glycaemic level. Following her sixth periodontal re-evaluation in two years improvement in oral hygiene, resolution of gingival swelling and bleeding were seen after sequences of non-surgical, surgical periodontal treatment and patient’s compliance towards her medications and follow-up.

Is Cognitive Behaviour Therapy Effective for Borderline Personality Disorder : A Case Report and Review of Literature

Gurpreet Kaur Autar Singh — 2023-04-01

Managing people with borderline personality disorder (BPD) is an arduous task due to the complexity of the condition. This paper describes the role of Cognitive Behaviour Therapy (CBT) in a patient diagnosed with BPD who has undergone a modified DBT skill group training. Despite receiving multiple interventions in the past, this patient had her bouts of struggles living with this illness which required a new approach to facilitate her recovery. A trial of a short-term, 12 session-ed treatment of mindfulness-based CBT was commenced. In this case report we describe the challenges and modifications which surpass during this session and literature review on the role of CBT on BPD.

A Rare Case of Diabetic Papillopathy Presenting with Pseudo-Foster Kennsedy Syndrome

Xiao Wei Ting — 2023-04-01

Pseudo-Foster Kennedy syndrome (PFKS) is defined as unilateral disc oedema with contralateral optic nerve pallor, in the absence of intracranial pathologies. Diabetic papillopathy is a rare ocular manifestation of diabetes mellitus (DM). We report a rare case of PFKS secondary to diabetic papillopathy in a young patient with type 2 DM who had poor glucose control. There was optic disc swelling over the right eye and optic disc pallor over the left eye. His visual field assessment showed right inferior field defect and general depression in the left. Optical coherence tomography retinal nerve fibre layer showed normal thickness over the right eye and generalized thinning over the left eye. Neuroimaging and other laboratory investigations were unremarkable. With good glycemic control, the optic disc swelling over the right eye resolved. Visual field defect remained the same but retinal nerve fiber layer showed thinning in areas where the edema had resolved.

Food Insecurity During COVID-19: A Neglected Priority?

Muhammad Zulfahmi Haron — 2023-04-01

The COVID-19 pandemic is a public health and global problem threatening the food security and nutrition of millions of people. While considerable public health resources have focused on combating the COVID-19 pandemic, food and nutrition have received less attention. By 2030, Sustainable Development Goal 2 aims to eradicate hunger and ensure that all people, especially the poor and vulnerable, have year-round access to safe, nutritious, and enough food. Regrettably, the world is falling short of its 2030 target of attaining Zero Hunger, mainly due to this pandemic. We reviewed the prevalence of food insecurity during COVID-19 ranging from 23% to 80% and its consequences including the measures presented in the previous studies to address the issue. Food insecurity has many negative consequences during COVID-19, including disruption of food chains, increased food prices, malnutrition and health consequences, growing social inequities, and bad economic outcomes. We highlighted the need for two main strategies: nutritionsensitive social protection, and food system reform and innovation to address this problem further to build a more robust and resilient food system for the sake of future generations.

Stress Monitoring Device and its Future Direction

Azura Amid — 2023-04-01

Stress and mental health have become a global concern as a result of the COVID-19 pandemic. This review highlights the technologies applied to stress monitoring with up-to -date literature on psychological and behavioural evaluation for stress detection. The working principle and potential of these stress identifiers, particularly physiological signals are explored. Researchers have been directing their interest in producing reliable and wearable devices to detect and prevent stress and panic attacks. The breakthrough of biochemical-near-infrared stress monitoring devices will facilitate medical practitioners in the early detection of stress and panic attacks. The review seeks to explore the types of methods used to detect stress as well as the pros and cons of the available technology while providing a new solution for future implications of stress monitoring detection devices.

Preventive Interventions to Reduce Second-Hand Smoke Exposure Among Non-Smoking Pregnant Women: A Systematic Review

Siti Hajar Mohamed Zain — 2023-04-01

The alarming number of smokers have increased public health concerns regarding the effects of second-hand smoke (SHS) on non-smokers, especially amongst pregnant women and unborn babies. This paper aims to review the existing interventions used to reduce SHS exposure amongst non-smoking pregnant women. This review was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) review method. Published articles were identified through three databases: ProQuest, Science Direct, and Scopus within the 2010–2021 timeframe. Articles related to the intervention to reduce SHS exposure among non-smoking pregnant women were included. Nine studies were identified and reviewed. Most of the preventive interventions primarily focused on pregnant women as the target group, whereas a few interventions directly focused on changing the smoking behaviour of their spouses. This review suggests that using theories as a foundation in designing the intervention effectively reduces exposure to SHS among non-smoking pregnant women. The main limitation as reported by most studies was the lack of biochemical verification. Thus, future intervention should consider both pregnant women and their smoking spouses as the target group and include relevant theories in clinical intervention.

Systems Thinking Approach on Foetal Abnormalities Due to Alpha-Fetoprotein Level

Nur Sakinah Nong Nong — 2023-04-01

Foetal complications due to abnormal Alpha-Fetoprotein (AFP) levels are becoming a serious matter. The risk of adverse pregnancy outcomes (APOs) is substantially greater in the raised maternal serum-alpha fetoprotein (MS-AFP) group than in the normal MS-AFP groups. The top three APOs in terms of occurrence rate in the increased MS-AFP group were structural foetal abnormalities, spontaneous abortion, and premature delivery. Low levels of AFP in the maternal may indicate a risk of Down syndrome. This is a critical matter that needs to be investigated and dealt with seriously, based on the systems thinking approach. This research aims to investigate screening methods on AFP foetal based on system thinking approach. The main purpose of the study is to provide an analytical and integrated approach to deal with foetal complications due to AFP level. This integrated approach comprises various analytical aspects, including conceptual framework, data analysis, evaluation of the screening methods. How systems thinking can contribute to improve all these aspects of foetal complications will be investigated. The methodology will enable to conduct a detailed explanation to the major problems of AFP in the form of a causal loop diagram based on the holistic view of the systems thinking approach. It is expected that the application of a systems approach could provide an effective method of analysis for understanding and managing the foetal abnormalities by considering all aspects in a holistic manner and clearer methods of intervention to reduce the cases.

Revolutionizing Medical Education with Artificial Intelligence (AI) – The New Norm

Asst. Prof. Dr. Faidzal Othman — 2023-04-01