IIUM Medical Journal Malaysia
https://journals.iium.edu.my/kom/index.php/imjm
<p>IIUM Medical Journal Malaysia (IMJM) formerly known as the International Medical Journal Malaysia (IMJM) is the official journal of the Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia. It serves primarily as a forum for education and intellectual discourse for health professionals namely in clinical medicine but covers diverse issues relating to medical ethics, professionalism as well as medical developments and research in basic medical sciences. It also serves the unique purpose of highlighting issues and research pertaining to the Muslim world. Contributions to the IMJM reflect its international and multidisciplinary readership and include current thinking across a range of specialties, ethnicities and societies.</p>IIUM Pressen-USIIUM Medical Journal Malaysia1823-4631<p>All material submitted for publication is assumed to be submitted exclusively to the IIUM Medical Journal Malaysia (IMJM) unless the contrary is stated. Manuscript decisions are based on a double-blinded peer review process. The Editor retains the right to determine the style and if necessary, edit and shorten any material accepted for publication.</p> <p>IMJM retain copyright to all the articles published in the journal. All final ‘proof’ submissions must be accompanied by a completed Copyright Assignment Form, duly signed by all authors. The author(s) or copyright owner(s) irrevocably grant(s) to any third party, in advance and in perpetuity, the right to use, reproduce or disseminate the research article in its entirety or in part, in any format or medium, provided that no substantive errors are introduced in the process, proper attribution of authorship and correct citation details are given, and that the bibliographic details are not changed. If the article is reproduced or disseminated in part, this must be clearly and unequivocally indicated.</p>Assessment Tools for Detecting Malnutrition among Elderly in Shelter Homes: A Systematic Review
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2237
<p>Assessing nutritional status in older people is essential to screen for malnutrition and identify the individuals requiring nutritional intervention for a better quality of life and longer life expectancy. This review aimed to investigate malnutrition and the role of nutritional assessment tools among older people in Malaysia. We systematically reviewed the publications from 2000 to 2019 using PubMed/MEDLINE and Scopus databases, recovering 15 original articles published until January 2022. This systematic review was conducted from May to September 2022. Two reviewers were involved in the process of the selection of articles and data extraction. Only research papers on malnutrition among older people in institutionalized settings in Malaysia were included. Four articles related to malnutrition in older people in old folk homes in Malaysia were included in this review. The tools with the most significant evidence were Mini Nutritional Assessment (MNA) and Nutritional Health Checklist (NHC) in residential care for the elderly. It was found that the incidence of malnutrition among the elderly in old folk homes in Malaysia ranged from 12.3% to 17.4%. Meanwhile, 40.4% to 57.7% of the population are documented to be at risk of malnutrition. NA and DETERMINE NHC were found to be most suitable for use in residential care due to their high sensitivity and specificity. A subsequent study is proposed to build and implement a scoring system to rate screening tools based on the validity, suitability, and practicability of the tools to help with malnutrition screening research and clinical practice in Malaysia and internationally.</p>Maisarah Abdul MutalibNoor Atiqah Aizan Abdul KadirAida Soraya ShamsuddinKhalisanni Khalid
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2237A Systematic Review on Multiple Purpose Solution of Contact Lens Ingredients: Benefits and Risks
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2249
<p>Since the past decades, the prevalence of microbial keratitis (MK) has risen notably among contact lens (CL) wearers. The main contributor to this infection is the use of an inefficient CL disinfecting solution. This paper highlights a systematic review of articles from journals on the multipurpose solution (MPS) of CL ingredients available currently in the market. This review emphasizes the compositions of MPS to evaluate their effectiveness and risks to lens wearers. A search for original articles published was conducted through Scopus, PubMed, and Google Scholar databases, focusing on the keywords contact lens ingredients and preservatives, MPS, polyquaternium, biguanides, and MK. A thorough review was conducted to extract the data on the subjects from the generated searches.The review revealed that hydrogen peroxide (H2O2), polyhexamethylene biguanide (PHMB), povidone-iodine (P-I), and polyquaternium-1 (PQ-1) are the preferred MPS formulations in the current industry of CLs. These chemical ingredients are effective against causative agents of keratitis for faster disinfection and lower risks of microbial infections in CL users. Thus, proper hygienic practices must follow the guidance from the respective product manufacturers to prevent harmful risks of ocular diseases.</p>Maizatul Akma IbrahimNor Hazwani Mohd HasaliNor Hafizah Zakaria Fadzilah Adibah Abdul MajidFatimah HashimSyed Ahmad Tajudin Tuan Johari
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2249Brain Tumours and Inflammatory Markers: Mini-Review
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2313
<p>An inflammatory biomarker is an indicating substance that facilitates the process of cell injury and promotes the development of cancer cells. The brain structure naturally protects the extracellular matrix (ECM), which consists of microglia, astrocytes, and neurons, by separating them from harm with the blood–brain barrier (BBB). Yet, the inflammation process damages the brain cells, thus releasing inflammatory markers into the plasma. Chronic inflammation results from persistent inflammation, and any failure of control mechanisms within the brain tissues will promote the development of cancer cells. Previous studies showed that several proinflammatory biomarkers, which included interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), and C-reactive protein (CRP), were observably higher in patients with glioblastoma compared to those with healthy brain tissues. However, the relationship between proinflammatory factors and glioma development remains unclear. Against such background, this review discusses the potential association between inflammatory markers and a brain tumour, along with the importance of these parameters.</p>Ling Tiong Michelle HuiWan Norlina Wan AzmanAnani Aila Mat ZinZamzuri IdrisM. MaulidianiWan Nur Syuhaila Mat Desa
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2313Complicated Appendicitis-Shifting towards Early Appendectomy-A Comprehensive Review
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2372
<p>The management of complicated appendicitis has undergone a transformative shift in recent years, moving away from the traditional conservative approach followed by interval appendectomy towards early appendectomy. This review article explores the current landscape of complicated appendicitis management, investigating the roles of conservative treatment, interval appendectomy, and early appendectomy. With no definitive consensus in place, the choice of treatment largely depends on the individual surgeon. The emergence of laparoscopic appendectomy has played a pivotal role in this paradigm shift, further highlighting the need to reevaluate and understand the various management options available. A total of 43 articles, 24 from Asia, 12 from Europe, 5 from the USA and 1 from Africa were retrieved from PubMed, Google scholar and the Cochrane database of clinical reviews. This review synthesizes existing literature, shedding light on the advantages and considerations associated with each approach.</p>Kumar Hari RajahSomanathan Menon
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2372The Terror State of Israel: A Nation in Unity and Defiance on the Face of Global Disdain
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2494
<p>-</p>Prof. Dr. Mohammed Fauzi Abdul Rani
Copyright (c) 2024
2024-01-012024-01-012301Adrenal Cavernous Hemangioma: A Rare Incidental Finding from A Routine Ultrasound Assessment
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2117
<p>Cavernous hemangioma of the adrenal gland is a very rare benign vascular tumour. Its rarity and non-specific presentation pose a challenge to the radiologists and surgeons in making the correct diagnosis. We report a case of adrenal cavernous hemangioma in a 76 years old gentleman, in which a large heterogeneous mass was incidentally found at his left hypochondriac region during a routine KUB and prostate ultrasound assessment for benign prostatic hyperplasia. A multiphasic CT study performed and revealed a large mass with a maximum diameter of 18 cm occupying the left suprarenal area. Considering the large size of the left suprarenal mass with mass effect to the surrounding structures, the patient undergone left adrenalectomy. His final histopathological diagnosis revealed a cavernous hemangioma. This case highlighted literature review and role of imaging in this extremely rare benign tumour as one of the differential diagnosis of an adrenal incidentaloma.</p>Aisyah Khaulah MuslimRadhiana HassanNasser Mohammad AmjadAzliana Abd Fuaat
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2117Subcutaneous Panniculitis-like T-cell Lymphoma: A Case Report of A Solved Conundrum
https://journals.iium.edu.my/kom/index.php/imjm/article/view/1985
<p>Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare primary cutaneous lymphoma which often be very complexed to be diagnosed. Here we reported a case of a 38-year-old lady with wax and wane course of left facial swelling associated with prolonged pyrexia of unknown origin, lethargy and prominent weight loss. Multiple investigations were conducted to reach to the conclusive diagnosis. Histopathological showed infiltration of neoplastic lymphoid cells within the adipocyte clusters with hyperchromatic nuclei, small nucleoli and scant cytoplasm. Immunohistochemical analysis were immunoreactive to CD3, CD8 & TIA and negative to CD20, CD4 & CD56. Based on clinical findings, histopathology report and immunohistochemical analysis, the patient diagnosed with SPTCL. Hence, any suspicious maxillofacial swelling without obvious sign of infection and trauma shall be investigated until a final diagnosis is reached.</p>Khairul Bariah Chi AdamNabilah Rashida JamaliNor Adilah HarunNor Aszlitah BurhanudinAsmah Hanim Hamdan
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.1985Peritoneal Tuberculosis Mimicking Ovarian Malignancy
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2178
<p>Peritoneal tuberculosis is an uncommon site of extrapulmonary infection caused by <em>Mycobacterium tuberculosis</em> (TB). It occurs mostly in immunocompromised patients such as malignancy, elderly or renal failure patients. We present a case of pelvic TB which appear to mimic an ovarian malignancy with acute onset of ascites. A 59 years old, para 3 presented with 2 weeks history of abdominal ascites with ovarian tumour. Ovarian cancer was suspected. Total abdominal bilateral salpingo-oophorectomy was performed. Histo pathology confirmed TB. She was started with an-TB therapy, she was improved after 2 weeks of therapy and she is well until now. Peritoneal TB is a rare condition which can mimick ovarian malignancy or peritoneal malignancy, especially in patient without pulmonary manifestation and negative TB investigations. This will cause dilemma in diagnosis hence delay in management.</p> <p> </p>Pek Sung Hoo Ahmad Amir Ismail Nik Rafiza Afendi Erinna Mohamad ZonMohd Pazudin IsmailRahimah RahimRahilah Ahmad Shukri Ahmad Zharif HusseinAhmad Akram Omar
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2178An Unusual Cause of Progressive Chest Deformity in A Child
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2067
<p>Inflammatory myofibroblastic tumour (IMT) is a rare tumour with intermediate malignant potential and unclear aetiology. In most cases, the clinical presentation is non-specific. The liver and lung are the most common location for IMT in children, and mediastinum is an uncommon place. Symptoms vary depending on the location of IMT, thus making a definitive diagnosis to be even more difficult. Until the histological investigation can rule out IMT, it should be considered in the differential diagnosis of individuals with localised masses. We report here a case of an 8-year-old boy with rightsided chest pain and deformity before the diagnosis of mediastinal IMT was made through tissue biopsy.</p>Muhammad Khairul Amri Yusoff Ahmad Fadzil AbdullahTaufiq Hidayat HasanAzian Abd AzizNorhafiza Ab. RahmanMohanaprakash K R Arasappan
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2067The Effect of Horticultural Therapy on Increased Self-Esteem for Mental Disorders in the Community
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2337
<p><strong>INTRODUCTION:</strong> The increasing number of mental disorders causes various problems, so treatment and rehabilitation programs are needed to increase adaptability and prevent recurrences in the community. M<strong>ATERIAL AND METHODS:</strong> This study used a quasi-experimental method with a pre-post test between the intervention and control groups. Effects of horticultural therapy on self-esteem were analysed using paired t-tests. <strong>RESULTS:</strong> The results showed a significant difference in the self-esteem scores of patients with mental disorders before and after treatment in the intervention group with horticultural therapy (p-value of 0.00). <strong>CONCLUSION:</strong> A significant difference exists in the self-esteem scores of patients with mental disorders before and after treatment in the intervention group given horticultural therapy marked. The participants in the study had various mental disorders, including schizophrenia and depression. Both schizophrenia and depression are associated with symptoms of low self-esteem. Horticultural therapy positively enhances self-esteem regardless of specific mental disorders.</p>Widyo SubagyoDyah Wahyuningsih
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2337Depression, Anxiety and Stress Levels During Covid-19 Pandemic among Frontliners of IIUM Hospital and Kuantan-Campus, and its Associated Factors
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2406
<p><strong>INTRODUCTION:</strong> Psychological burden of frontliners increased during the COVID-19 pandemic, leading to psychiatric illnesses reducing productivity. Assessing their mental health status is vital in providing effective care. Our aim was to investigate the levels of depression, anxiety, stress, and associated factors among frontlines of International Islamic University Malaysia (IIUM), Sultan Ahmad Shah Medical Centre (SASMEC) and Kuantan-Campus during the recent COVID-19 pandemic. <strong>MATERIALS AND METHODS: </strong>Cross-sectional study among 261 SASMEC@IIUM and 125 Kuantan-campus IIUM frontliners from March 2021 to June 2022 using self administered validated DASS-21 questionnaire. Descriptive statistics, Chi-Square and Fisher’s Exact tests were used for data analysis. Frontliners with severe and very severe DASS scores were offered psychoeducational counselling for intervention.<strong> RESULTS:</strong> Out of 386 respondents, 82.1% were clinical frontliners, 65.8% were female, and 65.8% were married. The prevalence was 15.8%, 29.5% and 9.3% for depression, anxiety and stress, respectively. This study showed no statistical differences between the clinical and non-clinical, and between SASMEC@IIUM and Kuantan-campus frontliners on depression, anxiety and stress levels. Those with post-traumatic events had significant association with depression (p<0.001) and anxiety (p<0.001), while anxiety significantly associated with chronic diseases (p=0.034). <strong>CONCLUSION:</strong> Over one-fourth of frontline staff suffered from anxiety during the COVID-19 pandemic, whereas 9-15% experienced depression and stress. Frontliners with post-traumatic events or chronic diseases required additional support in coping with their mental health burden. No significant difference was found in anxiety, depression and stress levels between clinical and non clinical or between hospitalbased and on-campus frontliners, suggesting a comprehensive mental health screening and timely intervention to all frontliners regardless of their post or area of service.</p> <p> </p>Fa'iza AbdulllahNor Azlina A RahmanNik Nur Fatnoon Nik Ahmad Suhaiza Samsudin Nadzirah Ahmad Basri Mohd Aznan Md. Aris Mohd Basri Mat Nor
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2406Protective Mechanism Pathway of Cinnamomum zeylanicum at High Dosage against Liver and Renal Damage in STZ-Induced Diabetic Rats
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2359
<p><strong>INTRODUCTION:</strong> <em>Cinnamon zeylanicum</em> (CZ) bark is widely used as supplement for diabetic management, there are concerns about its safety and potential toxicity at high doses, and limited evidence to support its efficacy. To investigate this further, this study examines the effects of <em>Cinnamon zeylanicum</em> aqueous extract (CZAE) on various factors in diabetic rats, including body weight, blood glucose level, biochemical parameters, histological changes, and gene expression. <strong>MATERIALS AND METHODS:</strong> In the study, 30 male Sprague Dawley rats were divided into five groups of six animals each. Type 2 diabetes mellitus (T2DM) was induced in all groups except the negative control by a single intraperitoneal injection of streptozotocin (STZ). The rats in the intervention groups (Groups C, D, and E) were given CZAE at 1000, 1500, and 2000 mg/kg, dose respectively, for 28 days. The body weight and fasting blood glucose were monitored weekly, and their liver and renal profiles were analyzed. Histology was assessed with hematoxylin and eosin stain, and apoptotic gene expression was examined in liver and renal tissues. <strong>RESULTS:</strong> The body weight of rats in intervention groups increased compared to the control group. There was a significant decrease (P<0.001) in blood glucose levels. The extract significantly reduced (P<0.05) liver biochemical markers in the intervention groups compared to the control group. The histology of the liver & kidney improved (p<0.001) with upregulated Bcl-2 and down-regulated BAX genes in preventing apoptosis in the intervention groups. <strong>CONCLUSIONS:</strong> High doses of CZAE are safe and effective for T2DM.</p>Maisarah Abdul MutalibSakina Ruhi Mohamad Halim Mohamad ShariffWin Win MayDhani Ramachandran
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2359The Effect of Doxycycline on Matrix Metalloproteinase-9 Levels in the Colon of Wistar Rats with Obstructive Ileus
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2370
<p><strong>INTRODUCTION:</strong> Obstructive ileus after colonic anastomosis resection can increase leakage up to 2.5-fold. One possibility could be the extracellular matrix degradation, where matrix metalloproteinase-9 (MMP-9) negatively influences anastomotic healing. This study aimed to determine the effect of doxycycline on MMP-9 levels in the colon of experimental rats with obstructive ileus. <strong>MATERIALS AND METHODS:</strong> In this study, 28 male Wistar rats were selected randomly in a post-test control-group design comprising: Group A - control group, Group B - group without obstructive ileus given doxycycline, Group C - group with obstructive ileus not given doxycycline, and Group D - group with obstructive ileus given doxycycline. Doxycycline was given at a dose of 30 mg/kg. Groups C and D underwent anastomotic resection 24 hours following obstructive ileus procedure. Groups A and B underwent anastomotic resection at the same time as Groups C and D. Colonic tissue was collected to examine MMP-9 levels using an enzyme-linked immunosorbent assay (ELISA). Data were compared using Shapiro–Wilk tests, ANOVA, and Mann–Whitney U tests, and p<0.05 was considered significant. <strong>RESULTS:</strong> The results showed that the average MMP-9 levels increased with doxycycline treatment, [Group C (4.294 ± 0.226)], with significantly higher MMP-9 levels than Group A (1.017 ± 1.569, p<0.001). Group B did not differ significantly from Group A (p=0.848). MMP-9 levels differed significantly between Groups B and D (p<0.001), and between Groups C and D (p<0.001). <strong>CONCLUSION:</strong> Oral administration of doxycycline can attenuate increasing MMP-9 levels in Wistar rats with obstructive ileus</p>Devby UlfandiIbrahim LabedaErwin SyarifuddinAndi Alfian ZainuddinMuhammad Faruk
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2370A Comparative Study of the Tolerance to Stress Response Under Spinal Anaesthesia in Diabetic Versus Non-Diabetic Patients
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2195
<p class="s9"><strong>INTRODUCTION:</strong> Activation of sympathetic nervous system, increase of catabolic hormone release and pituitary gland suppression are responses to surgical stress. Neural blockade via epidural or spinal anesthesia, intravenous administration of high-dose of strong opioid analgesics, and infusion of anabolic hormones such as insulin are three main methods for balancing stress responses to surgery. However, there are conflicting reports about the extent of autonomic disturbances occurring after inducing spinal anesthesia in diabetic patients due to underlying autonomic neuropathy. <strong>METHODOLOGY:</strong> An observational cohort study was conducted in an operative room of a tertiary health care center involving 25 diabetic patients and 25 non-diabetic patients to evaluate the tolerance to stress. The diabetic patients undergone an exercise tolerance test to evaluate for postural hypotension which would indicate presence of autonomic neuropathy. Stress parameters such as heart rate, mean blood pressure, blood glucose level, and temperature were measured at regular intervals pre, peri- and post-operatively.<strong> RESULTS:</strong> Intraoperative heart rate, mean blood pressure, and blood glucose level were high in diabetic patients with autonomic neuropathy (p≤0.05). Temperature was higher in diabetic patients with autonomic neuropathy initially (p≤0.05) and had a higher fall peri-and post-operatively (T=15 minutes, T=20 minutes, and T=after surgery). A significant differences in the parameters of stress response were observed in diabetic patients with autonomic neuropathy. <strong>CONCLUSION:</strong> By understanding the correlation between stress-response in diabetic patients with autonomic neuropathy peri-operatively will help the anesthetist to provide customized services to every patient</p>Prince SahaBhavini Bhushan ShahSubha Jose VazhakalayilAishwarya Thakur
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2195Patient Satisfaction with the Quality of Healthcare Services at Selected Major Outpatient Clinics at Sultan Ahmad Shah Medical Centre Kuantan Pahang
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2335
<p><strong>INTRODUCTION:</strong> Patient satisfaction is a key factor in determining any gaps or inadequacies in the healthcare provider's services. This study aimed to measure the level of patient satisfaction and its associated factors towards the healthcare service of outpatient clinics in Sultan Ahmad Shah Medical Centre (SASMEC), IIUM, Kuantan, Pahang. <strong>MATERIALS AND METHODS:</strong> A total of 1050 patients were recruited from internal medicine, paediatrics, surgery, obstetrics and gynaecology, orthopaedics, and psychiatry clinics between February 2021 and February 2022. A questionnaire was administered which consists of two parts: one that covers patients’ sociodemographic data and the other that assesses the patients’ level of satisfaction with the healthcare services using the Malay-validated Short-Form Patient Satisfaction Questionnaire (PSQ-18). <strong>RESULTS:</strong> The mean overall satisfaction level was 3.94 ± 0.46, with the highest mean scores in the interpersonal manners (4.2 ± 0.64) and communications (4.26 ± 0.56) domains. From the multivariate analysis, it was found that those patients in the lower income group (B40) were more satisfied with the quality of the healthcare services (B=0.172, 95% CI=0.08, 0.263) compared to the middle-income group. Being a student (B=- 0.202, 95% CI=- 0.296, -0.108) and having a follow-up treatment visit (B=-0.082, 95% CI=-0.156, -0.008), were significantly associated with lower satisfaction levels as compared to their counterparts. <strong>CONCLUSION:</strong> Overall, patients who attended SASMEC were satisfied with the service provided. Continuous service improvement aimed at patients’ household income, occupation and purpose of visit may help SASMEC enhance its service in the future</p>Mohamad Che' ManShahidah Che AlhadiMuhammad Zubir YusofSiti Roshaidai Mohd ArifinMohd Zhafri Md. RazibSalman Amiruddin
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2335Surgical outcome of Acoustic Neuroma Surgery in a Malaysian Tertiary Hospital
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2236
<p style="font-weight: 400;"><strong>INTRODUCTION:</strong> Acoustic neuroma (AN) or vestibular schwannoma, is a benign, slow-growing tumour that arises from the Schwann cell of the vestibular branch of the vestibulocochlear nerve. Treatment options are mainly conservative or surgical excision. The aim of this study is to describe the clinical characteristics of AN and the surgical outcomes in a Malaysian tertiary hospital. <strong>MATERIALS AND METHOD:</strong> Records of 73 patients who were diagnosed with AN from January 2008 until December 2019 were retrieved. All patients were analyzed for demographic data and clinical characteristics. In all 52 patients underwent AN surgery and had normal preoperative facial nerve function. A descriptive analysis was used for the surgical outcomes of each patient. <strong>RESULTS:</strong> The median age of patients was 51.5 (15.8 SD). Hearing levels pre-operatively were severe to profound in 74.0% of the patients, followed by moderate to severe in 15.1%, mild to moderate in 6.8%, and mild hearing loss in 2.7%. Retrosigmoid (48.1%) was the most common surgical approach used, followed by translabyrinthine (44.2%) and middle cranial fossa (MCF) (7.7%). The translabyrinthine approach is associated with the least incidence of facial nerve paresis postoperatively (21.2%) when compared to the retrosigmoid and middle cranial fossa approaches (40.4%). However, there was no significant association between surgical approaches and facial nerve outcome (p=0.07). <strong>CONCLUSION:</strong> AN surgery is a safe procedure, regardless of the surgical approach used. There was a significant relationship between tumour size and facial nerve outcome.</p>Siti Sarah RazakAsma AbdullahNoor Dina HashimAzizi Abu BakarRosnah SutanAbdullah Sani
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2236Unaltered Long-Term Maternal Endothelin System in a Gestational Hypertensive Rat Model
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2388
<p><strong>INTRODUCTION:</strong> Cardiovascular diseases (CVDs) are two to four times more likely to affect women with a history of hypertensive disorders of pregnancy (HDPs). One of the etiologies of CVDs is endothelial dysfunction, which results from an imbalance in the production of endothelin-1 (ET-1) and nitric oxide (NO). Although blood pressure (BP) is normalized postpartum, we hypothesize that a transient increase in BP during HDPs may cause ongoing endothelial dysfunction. We aimed to discover the impact of HDPs in the development of cardiovascular diseases after long-term postpartum changes in endothelin-A receptor (ETAR) and endothelin-B receptor (ETBR) expression and the concentration of ET-1 and NO. <strong>MATERIALS AND METHOD:</strong> Twenty-four female Sprague-Dawley (SD) rats were assigned into four groups (n = 6), including two treatment and two control groups. All rats were sacrificed on Day 30 postpartum. The NO and ET-1 concentrations were determined by ELISA and the ETAR and ETBR expression of the mesenteric arteries were measured by immunohistochemistry studies. <strong>RESULTS:</strong> The mean concentrations of ET-1 and NO were not significantly different in all groups. There was no significant difference in the mean immunoreactivity of ETAR and ETBR percentages area in the tunica intima and media in all groups. <strong>CONCLUSION:</strong> No evidence demonstrates significant changes in the endothelin system of the resistance arteries at the proteomic level in the long-term duration following HDP. Further investigation of its potential chronic effect warrants a deeper analysis at the molecular and ultrastructural levels.</p>Khodijah ZulkifleeYusoff Sharizal Yusoff Azmi MericanMaizura Mohd. ZainudinHidayatul Radziah IsmawiFadhilah Zainal AbidinAzliana Abd. Fuaat
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2388Mapping Out Factors that Undermining Vaccine Uptake in Malaysia: A Multiple Perspective
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2334
<p><strong>INTRODUCTION:</strong> Malaysia has recorded a sporadic increase in vaccine-preventable diseases in many different states such as Johor, Perak, Selangor, and Sabah, to name a few. What is more worrying was the drastic drop in vaccination for children especially the measles, mumps, and rubella (MMR) vaccination during the early period of COVID19 pandemic in 2020. On this basis, this paper is intended to interrogate why vaccine uptake has decreased over the years. When vaccination became a global concern with the surge of COVID-19 cases in the first quarter of 2020, further questions were posed to understand the reality behind vaccine rejections and refusals. <strong>MATERIALS AND METHODS:</strong> This study employs a focus group discussion and in-depth interviews to explore the vaccine refusal phenomenon in Malaysia. Theoretical sampling led to the recruitment of participants from health institution, media organisation, and vaccine refusal individuals as they are useful to provide different yet connected insights into the phenomenon under study. <strong>RESULTS:</strong> Under the constructivist-interpretivist paradigm, grounded theory revealed that micro and macro factors jointly contribute to vaccination refusals. <strong>CONCLUSIONS:</strong> Considering these factors, this study suggests the importance of health literacy and synergised policies to protect, educate, and guide society on vaccine-related matters.</p>Mohd Helmi YusohWan Norshira Wan Mohd GhazaliKamaruzzaman Abdul MananShafizan Mohamed Nur Shakira Mohd NasirSaifullah MohamadHamidah Idris
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2334Plasma Haptoglobin as A Potential Biomarker for Coronary Artery Disease in Young Hypertensive Adults
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2371
<p><strong>INTRODUCTION:</strong> Uncontrolled hypertension is one of the recognized risk factors for coronary artery disease (CAD) in young adults, commonly underestimated owing to the young age. A novel biomarker to improve CAD risk assessment and hypertension management should be identified for this cohort. Thus, we had conducted a study to investigate plasma concentration and the role of haptoglobin in young hypertensive adults in the establishment of premature acute myocardial infarction (AMI). <strong>MATERIALS AND METHODS:</strong> A total of 120 male adults aged between 18 to 45 years enrolled into this cross-sectional study, divided into control, hypertensive, and acute myocardial infarction (AMI) groups. Blood samples were collected from all subjects, plasma concentrations of haptoglobin measured using enzyme-linked immunosorbent assays, and other CAD risk factors including high sensitivity C-reactive protein (hs-CRP) levels were analyzed. <strong>RESULTS:</strong> Plasma concentration of haptoglobin in the AMI group was the highest compared to hypertensive and control group (290.63±99.90 vs. 208.47±112.93 vs. 170.02±108.11 ng/ml, p<0.006). There was a significant association between AMI and plasma haptoglobin concentration in hypertensive subjects independent of other known CAD risk factors (OR: 0.985, 95% CI 0.973-0.997, p=0.017). There was positive correlation between plasma haptoglobin and hs-CRP (r=0.0370, p<0.001). <strong>CONCLUSION:</strong> Plasma haptoglobin is a potential biomarker to identify young hypertensive adults who are at risk of developing CAD.</p>Norbaiyah Mohamed Bakrim Wan Fatein Nabeila Wan Omar Aszrin AbdullahNurul Nadiah Hamidon Suhaila Abdul Muid Aisyah Badrulhisham
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2371Prevalence and Factors Determining Adolescents Risk Taking Behaviours in Sarawak, Malaysia
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2425
<p><strong>INTRODUCTION:</strong> During adolescence, significant physical, emotional, and social changes influence growth. This phase exposes adolescents to risky situations. Understanding adolescent risk-taking is crucial. This study aims to determine the extent of risk-taking behaviour among Malaysian adolescents and identify associated factors. <strong>MATERIALS AND METHODS:</strong> In a community-based study, we surveyed 1,344 Malaysian adolescents aged 10-19 across 22 districts in Sarawak using multi-stage cluster sampling and face-to-face interviews. Data analysis was performed with IBM SPSS v28.0. <strong>RESULTS:</strong> Analysis found that 43.7% of adolescents engaged in risky behaviours, with a higher incidence in males (50.1%) compared to females (37.4%). Multinomial logistic regression analysis identified for low-medium risk behaviours were being aged 15-19 (AOR=1.52; CI:1.14-2.02), infrequent religious practice (AOR=1.70; CI:1.01-<br />2.84), poor parent-child relations (AOR=2.02; CI:1.07-3.83) and having a history of mental abuse (AOR=3.02; CI:1.37-6.62). However, a larger family size appeared to be a protective factor (AOR=0.39; CI: 0.18-0.89). High-risk behaviours were more prevalent in older (AOR=2.65; CI:1.91, 3.68) male adolescents (AOR=2.75; CI: 2.02, 3.75) and low religious value (AOR=3.55; CI: 1.32-9.52), larger families (AOR=2.03; CI: 1.38-3.00), lower school grades (AOR=1.74; CI: 1.27-2.38), physical ailments (AOR=2.63; CI:1.60-4.32), and a history of mental abuse (AOR=3.85; CI:1.78-8.31). <strong>CONCLUSION:</strong> Adolescents aged 15-19 with weak family ties, low religious engagement, and a history of mental abuse tend to exhibit low to medium risk behaviours. Older male adolescents with health issues are more likely to engage in high-risk behaviours, whereas those from larger families show fewer such tendencies. These insights are crucial for shaping <br />targeted interventions and policies.</p>Wong Khung Ying Mizanur Rahman Andrew Kiyu
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2425Toxicity Effects of Clitoria Ternatea L. Extract in Liver and Kidney Histopathological Examination in Mus Musculus
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2318
<p><strong>INTRODUCTION:</strong> Clitoria ternatea L. or butterfly pea is more increasingly being consumed as traditional medicine though it contains secondary metabolites, which can be nonbeneficial to its consumer. LD50 and histopathological examination are used frequently in toxicity studies. Thus we aimed to determine the toxicity level of Clitoria ternatea L. flower extract and its effects on the liver and kidney in mice. <strong>MATERIALS AND </strong><strong>METHOD:</strong> We carried out this analytical experimental study with from August 2021 to June 2022. Mice were categorised into five dose groups. They were treated with aquades, paracetamol-induced, and flower extract at 500, 1000, and 2000 mg/kg BW orally for 14 consecutive days. <strong>RESULTS:</strong> C.ternatea flower was classified as having very low toxicity (LD50>2000 mg/kg BW). We detected toxicity signs in mice such as lethargy and tremor in the group treated with more than 1000 mg/kg BW. Histopathological examinations showed leucocytes, vacuolation, and necrosis in the liver and kidneys of mice. There were significant differences in liver and kidney histopathological scores between the five study groups (p<0.05).<strong> CONCLUSION:</strong> C.ternatea flowers are safe to consume at a dosage of 500 and 1000 mg/kg BW since no mice died after being treated for 14 days. Liver and kidney damage appeared at 2000 mg/kg BW dosage in histopathological examination. Hence, its consumption at this dosage should be limited.</p>Aulia KhatibTofrizal -Dessy Arisanty
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2318Characterisation of Human-Wildlife Conflict and Casualties Caused by Wildlife Attacks in Peninsular Malaysia
https://journals.iium.edu.my/kom/index.php/imjm/article/view/2283
<p><strong>INTRODUCTION:</strong> This study examines human-wildlife conflict (HWC) in Peninsular Malaysia, a consequence of human population expansion, natural resource demand, deforestation, resettlement, infrastructure development, urbanization, and agricultural land growth. We analyze HWC incidents and human casualty statistics from wildlife attacks recorded by the Department of Wildlife and National Parks, Peninsular Malaysia, between 2011-2018 and 2008-2019, respectively. <strong>MATERIALS AND METHODS:</strong> Data were collected on HWC cases reported to the Department of Wildlife and National Parks, Peninsular Malaysia (locally known as PERHILITAN), from 2011 to 2018. This data underwent processing, analysis, and presentation in tables and bar charts. <strong>RESULTS:</strong> There was an increasing trend in reported HWC cases from 2012 to 2018 (5,602 to 7,967 cases). The majority of these incidents in Peninsular Malaysia involved mammalian species such as the long-tailed macaque (Macaca fascicularis), wild boar (Sus scrofa), elephant (Elephas maximus), civets (Viverridae family), and pig-tailed macaque (Macaca nemestrina), totaling 33,198, 6,614, 3,797, 3,219, and 2,232 cases respectively. Notably, snakes accounted for over 80% of fatalities and injuries. <strong>CONCLUSION:</strong> This report is the first to provide a comprehensive overview of HWC cases and casualties due to wildlife attacks in Peninsular Malaysia. Our findings highlight the urgent need for policy evaluation and improved inter-agency coordination for effective HWC management, wildlife conservation, and reduction of wildlife attack casualties</p>Lim Qiu XinSiti Nor Assyuhada Mat GhaniNur Syahmina RasudinNoraini Abdul GhafarNur Haslindawaty Abd RashidDennis Choon Yung TenSalman SaabanHisham Atan EdinurMohd Tajuddin Abdullah
Copyright (c) 2023 IIUM Medical Journal Malaysia
2024-01-012024-01-01230110.31436/imjm.v23i01.2283