IIUM Medical Journal Malaysia

Architecting Healthy Work in the Era of Occupational Health 5.0

David Koh Soo Quee — 2026-10-01

Primary Total Knee Arthroplasty with Tibial Tubercle Advancement Osteotomy in a Young Adult with Severe Deformity: A Case Report

Mohd Ariff Sharifudin — 2026-10-01

Total knee arthroplasty (TKA) in young patients with complex deformities and prior surgical interventions presents unique technical challenges. We report the case of a 32-year-old male with post-traumatic arthritis, fixed valgus deformity, patella baja, and limited motion secondary to previous femoral and patellar fractures with subsequent infection. He underwent primary TKA with tibial tubercle advancement (TTA) osteotomy. Intraoperative findings included severe scarring and patellar maltracking. A non-constrained implant was used with good intraoperative balance. The patient maintained good function at a five-year follow-up with no pain or instability. This case highlights the feasibility of non-constrained TKA with TTA in young patients when guided by thorough preoperative planning and soft tissue management.

Beyond the Lungs: Presumptive Tuberculous Dacryoadenitis Associated with Latent Tuberculosis Infection

Azhany Yaakub — 2026-10-01

We report a case of a 30-year-old woman working in a tuberculosis laboratory who presented with a two-week history of right periorbital swelling, pain, and redness. Examination revealed right eye dacryoadenitis with scleritis. Given her occupational exposure, strongly positive tuberculin skin test (TST) and positive Interferon-gamma Release Assay (IGRA) results, a presumptive diagnosis of orbital tuberculosis was made, despite the absence of microbiological or histopathological confirmation. The patient received anti-tuberculosis therapy, resulting in complete resolution of symptoms. This case highlights that dacryoadenitis with scleritis, though uncommon, should be considered in the differential diagnosis of atypical orbital presentations, particularly in endemic settings.

Scrotal Hernia or Castleman Disease? A Diagnostic Pitfall in an Unusual Presentation of a Rare Entity

Raudatul Janah — 2026-10-01

Castleman disease (CD) is a rare, non-neoplastic lymphoproliferative disorder with varied clinical presentations and uncertain etiology. It is classified into unicentric (UCD) and multicentric (MCD) forms, and histologically into hyaline vascular, plasma cell, or mixed subtypes. While CD typically affects the mediastinum or neck, scrotal involvement is exceedingly rare and can mimic more common conditions. We report a case of a 65-year-old man with a painless, enlarging scrotal mass initially diagnosed as a reducible hernia. Imaging and histopathology revealed a large lymphoid mass, diagnosed as UCD with mixed hyaline vascular and plasma cell subtypes. This case highlights the importance of including CD in the differential diagnosis of scrotal masses and underscores the critical role of histopathological examination in diagnosis and treatment planning. The patient had a favorable outcome after surgical excision, reinforcing that early recognition and proper management of UCD typically result in an excellent prognosis.

Fulminant Bacillus Cereus Endogenous Panophthalmitis and Flood Water: A Case Report and Literature Review

Muhammad Ashrof Abdullah — 2026-10-01

Bacillus cereus is a spore-forming Gram-positive bacillus found in soil and water that can cause severe ocular infections. This is a case of a 53-year-old woman with uncontrolled diabetes who developed sudden, painful vision loss in her left eye after flood exposure. Examination revealed no light perception, ophthalmoplegia, and elevated intraocular pressure (IOP) of 52 mmHg. Within eight hours, her condition worsened with severe proptosis, chemosis, and IOP rising to 87 mmHg, requiring emergency canthotomy and cantholysis. Blood cultures confirmed B. cereus, and blood tests showed leucocytosis and elevated C-reactive protein. Imaging revealed necrotizing infection with orbital gas. Despite intravenous antibiotics, the eye ruptured and evisceration was performed. She completed two weeks of antibiotics and recovered without systemic or intracranial spread. This case underscores the fulminant progression of B. cereus pan-ophthalmitis, the need for early intervention, and the importance of PPE during post-flood clean-up to prevent serious infections, particularly in vulnerable individuals.

From Intubation to Tracheal Resection: Navigating Severe Airway Complications in a Post-COVID-19 Patient with Comorbidities

Syarifah Nafisah Al-Yahya — 2026-10-01

Laryngotracheal stenosis (LTS) is a significant complication post-intubation in COVID-19 patients, with incidence rates between 12.7% and 40%, exacerbated by comorbidities like diabetes and obesity. We report a 44-year-old female with type II obesity (BMI=39.8 kg/m²), diabetes mellitus, and hypertension, who developed LTS after 8 days of intubation for severe COVID-19. Her condition rapidly progressed from grade 3 to grade 4 LTS, requiring emergency tracheostomy, Shian-Yann-Lee procedure, and tracheal resection with anastomosis (TRA). Complications included anastomotic dehiscence, sepsis, and deep venous thrombosis. Serial dilatations and intralesional steroid injections (SILSI) were needed to manage restenosis. This case highlights the complexity of LTS management in patients with significant comorbidities, emphasising the need for early intervention, tailored strategies, and meticulous postoperative care to prevent complications like Critical Illness Weakness (CIW) and thromboembolic events.

A Rare Case of Solobacterium moorei Bacteraemia Secondary to Necrotising Fasciitis in a Patient with Chronic Elephantiasis

Nurul Azira Mohd Shah — 2026-10-01

Solobacterium moorei is an anaerobic Gram-positive bacillus, part of the normal oral and intestinal microbiota, and is infrequently implicated in systemic infections. We report a rare case of S. moorei bacteraemia in a 64-year-old man with chronic right lower limb elephantiasis and multiple metabolic comorbidities. The patient presented with necrotising fasciitis of the right foot, necessitating urgent surgical intervention. Blood culture yielded S. moorei, while other significant cultures demonstrated mixed growth of aerobic and anaerobic organisms. The patient responded well to intravenous antibiotic therapy and was discharged in stable condition. This case underscores the potential pathogenicity of S. moorei in immunocompromised individuals and highlights the importance of considering rare anaerobic organisms in severe soft tissue infections.

Exploring the Increased Risk of Vector-Borne Diseases Driven by Climate Change and Proposing Strategic Solutions to Mitigate the Impact. A Narrative Review

Nur Adibah Mohidem — 2026-10-01

Since the middle of the 20th century, human activity has caused Earth's climate to change. The Intergovernmental Panel on Climate Change projects that global temperatures will continue rising in the coming decades, leading to significant environmental and health impacts. This traditional narrative review synthesises evidence from previously published literature to determine the epidemiology of vector-borne diseases caused by climate change, their environmental factors, and solutions to address the issues. The vector-borne diseases, such as West Nile virus, malaria, dengue, Chikungunya, and Zika virus, are related to changing climatic conditions that create favorable environments for the transmission of the disease. The climatic factors include rising temperatures, drought, hurricanes, floods, changes in rainfall patterns, higher relative humidity, and shifts in wind patterns. The findings indicate that climate change not only expands the geographical distribution of vectors such as mosquitoes, ticks, and rodents, but also enhances their breeding and survival rates, leading to increased transmission risks. To mitigate these impacts, this review proposes several strategic solutions, including improved surveillance, adaptation measures, disease risk assessments, mitigation, and public health education.

Research Gaps in the Relationship Between Serum Brain-derived Neurotrophic Factor (BDNF) and Trunk Control After Stroke: A Scoping Review of the Last Decade (2014–2024)

Abdulkareem Muhammad Umar — 2026-10-01

Brain-derived neurotrophic factor (BDNF) plays a crucial role in neuroprotection and neuroplasticity, positioning it as a key target for enhancing rehabilitation outcomes in stroke survivors. This scoping review aimed to explore the relevance of serum BDNF levels in improving trunk control and balance performance among this population. Using the PICO framework, the review focused on stroke patients (Population), undergoing rehabilitation (Intervention), compared to healthy individuals (Comparison), with outcomes including trunk control, balance, and serum BDNF levels (Outcome). A systematic search was conducted across five major databases: MEDLINE, PsycINFO, Embase, CINAHL Plus, and Cochrane Central, targeting full-text English studies published between 2014 and 2024. Studies meeting the inclusion criteria were analysed to identify patterns and research gaps. Five studies met the inclusion criteria. The findings suggest that serum BDNF levels increase following rehabilitation interventions and correlate with the duration of mobilisation. However, none of the included studies directly assessed trunk control, highlighting significant research gaps in understanding the direct impact of BDNF on trunk recovery after stroke. Further research is needed to elucidate how BDNF may facilitate trunk recovery, enhance early ambulation, and improve functional outcomes in individuals with stroke. This review highlights the absence of direct evidence linking serum BDNF to trunk-specific recovery and emphasises the need for targeted research in this area. Most research focuses on gait and balance, which serve as surrogate measures for trunk control, and emphasises spasticity in the extremities. Addressing these gaps through targeted research could optimize rehabilitation strategies and improve outcomes for stroke survivors

Exploring the Role of The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diet on Psychological Disorders in Adults: A Scoping Review

Muhamad Mustaqim M Zapawi — 2026-10-01

Psychological disorders are a major global health concern, affecting millions of adults worldwide. The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet has emerged as a potential dietary approach for reducing the risk of psychological disorders. This scoping review aimed to map and synthesize the existing evidence on the association between MIND diet adherence and psychological disorders among adults. This review followed the Arksey and O’Malley (2005)’s framework and the PRISMA-ScR 2020 guidelines. Four databases (Scopus, Web of Science, PubMed, and the Cochrane Library) were searched. Of 236 records identified, 17 studies met the inclusion criteria (eight cross-sectional, five cohort, one case-control, and three randomized controlled trials (RCTs)). Most studies were conducted in Asia, particularly Iran, China and Pakistan. Three cross-sectional studies reported higher MIND diet adherence was associated with lower depression and anxiety, while one study demonstrated significant reductions in depression, anxiety and stress. However, other studies found no significant association with stress. Cohort study findings were inconsistent, with most reporting weak or non-significant associations, although two studies observed reduced depressive symptoms with higher MIND diet adherence. Two RCTs found no significant effects on psychological outcomes, whereas one reported significant improvements in depression and anxiety. The case-control study demonstrated an inverse association between MIND diet adherence and anxiety disorders. Although current evidence suggests that MIND diet adherence may improve psychological health, findings remain inconsistent across study designs. Further high-quality longitudinal studies and well-designed RCTs are needed to establish its effectiveness in preventing and managing psychological disorders in adults

Mapping the Research Landscape of Ambulatory Blood Pressure Monitoring in Pregnancy (2000-2025): A Bibliometric Study

Hidayatul Radziah Ismawi — 2026-10-01

Ambulatory blood pressure monitoring (ABPM) has gained recognition as a valuable tool for diagnosing and managing hypertensive disorders during pregnancy. However, the research landscape and emerging trends in this field have not been comprehensively mapped. This study aimed to conduct a bibliometric analysis to evaluate global research trends, scientific productivity, collaboration patterns, and thematic developments related to ABPM in pregnancy. Publications were retrieved from the Scopus database and analysed using bibliometric mapping and visualisation tools. Bibliometric indicators included publication output, citation patterns, co-authorship networks, and keyword co-occurrence analyses to identify research themes and emerging trends. The analysis revealed 148 original articles and 26 reviews from 2020-2025. Research productivity increased steadily over the past two decades, with the United States, United Kingdom, Spain, and Australia emerging as the most influential contributors. Collaboration networks revealed strong regional clusters, particularly across Europe, with the United States serving as a central hub for international partnerships. Keyword analysis identified five thematic clusters: clinical aspects of ABPM, pregnancy complications and outcomes, cardiovascular and metabolic risk factors, maternal–foetal characteristics, and methodological and interventional studies. Term co-occurrence analysis highlighted interconnected themes spanning maternal outcomes, cardiovascular risk predictors, and clinical management. Research on ABPM in pregnancy has expanded in scope and depth, reflecting its growing clinical importance. Nonetheless, contributions remain concentrated in high-income countries, with limited representation from low- and middle-income regions. Future research should emphasise broader international collaboration, standardisation of ABPM protocols, and investigation into long-term maternal and offspring cardiovascular outcomes

Corpus Callosum Morphometric Analysis in Paediatric Epilepsy: A Retrospective MRI Study

Erien Pradyta — 2026-10-01

INTRODUCTION: The corpus callosum (CC) plays a central role in interhemispheric communication and seizure propagation. Structural alteration of the CC in paediatric epilepsy has been inconsistently reported, highlighting the need for further comparative morphometric analysis during this critical neurodevelopmental period. This study aimed to evaluate differences in CC morphometry between epileptic and non-epileptic children aged 6-17 years. MATERIALS AND METHODS: This retrospective case-control study analysed brain magnetic resonance imaging (MRI) scans acquired between July 2023 and October 2024 at a single tertiary hospital, including 50 epileptic and 42 non-epileptic children. CC morphometry, including anterior-posterior diameter, total length, and thickness of genu, body, isthmus, and splenium, was measured on mid-sagittal T2-weighted images. Statistical analyses were performed using the independent t-tests and Mann-Whitney tests as appropriate. RESULT: No significant overall differences were found in CC morphometry between epileptic and non-epileptic groups. However, subgroup analysis revealed significantly reduced body thickness in epileptic children aged 12-14 years and shorter total CC length among epileptic females. In contrast, epileptic children without extra-callosal abnormalities showed greater genu thickness compared to non-epileptic controls. These findings were associated with a moderate-to-large effect size (Hedges’ g>0.6), suggesting subtle deviations in callosal maturation patterns. CONCLUSION: Epilepsy may be associated with region-specific and sex-related variation in CC morphometry during critical stages of brain maturation. Although these differences are subtle and not evident on conventional MRI, quantitative CC morphometry may serve as a complementary, hypothesis-generating approach to investigating neurodevelopmental alterations in paediatric epilepsy

Detection of High-Risk Pathogenic Alleles for Young-Onset Myocardial Infarction in a Malaysian Cohort: A Pilot Study

Huzairi Sani — 2026-10-01

INTRODUCTION: Identifying pathogenic genetic variants associated with young-onset myocardial infarction (YOMI) may facilitate early risk stratification and enable timely preventive intervention. This pilot study aimed to compare the genetic profiles of patients with YOMI with healthy controls to identify high-risk genetic variants and evaluate the utility of polygenic risk scores (PRS) in differentiating genetic susceptibility between the two groups. MATERIALS AND METHODS: Genomic DNA was extracted from patients with YOMI (n=30; mean age = 37.47 ± 3.29 years) and healthy controls (n=12; mean age =34.67 ± 2.71 years). Samples were genotyped using the Asian Screening Array (Infinium®, Illumina). Genetic variants associated with cardiovascular risk were identified through annotation against the Genome-Wide Association Studies (GWAS) database. Polygenic risk scores were calculated and compared between the two groups. RESULTS: Thirty-seven single nucleotide polymorphisms (SNPs) with odds ratios greater than 2 were identified, including variants associated with coronary heart disease, venous thromboembolism, and atrial fibrillation. The rs13082914 variant in KCNAB1 showed a strong association with young-onset myocardial infarction (OR=8.63; P<0.05). Polygenic risk score analysis revealed higher risk loads in YOMI patients for Brugada syndrome, myocardial infarction in CAD, peripheral artery disease, and non-BMPR2 pulmonary arterial hypertension. CONCLUSION: This pilot study demonstrated the potential value of genetic screening to identify individuals at risk of developing YOMI. However, larger prospective studies are required to validate these findings and to determine their clinical utility in risk prediction and preventive cardiovascular care.

The Relationship Between Social Support and Religious Coping Strategies Towards Quality of Life of Muslim Retirees in The East Coast Region in Malaysia

Noor'ain Mohamad Yunus — 2026-10-01

INTRODUCTION: Quality of Life (QoL) is a multidimensional concept crucial for older adults, particularly as they experience physical decline, chronic diseases, and reduced social participation. This study examines the relationship between social support, religious coping, and QoL among older Muslims in the East Coast Region of Malaysia. MATERIALS AND METHODS: A positivist approach was employed, utilising an online survey distributed to Muslim retirees aged 60 and above. A self-administered questionnaire assessed demographic data, social support, religious coping strategies, and QoL. RESULTS: 150 responses were analysed using SPSS Statistics 29.0 and Smart PLS 4.0. Most respondents (97.3%) belonged to the young-old category. The findings revealed that religious coping was positively associated with quality of life (QoL) (β=0.209, t=2.365, p<0.01), and social support was also positively associated with QoL (β=0.502, t=4.181, p<0.01). CONCLUSION: These findings highlight the importance of social and religious support in enhancing older adults' well-being. Future research should explore qualitative approaches to gain deeper insights into the lived experiences of older Muslims. Understanding these factors can inform policymakers and healthcare providers in developing effective ageing interventions that promote healthy ageing, social participation, and autonomy

Translation and Content Validation of the Dementia Communication Difficulties Scale (DCDS) in Bahasa Melayu

Nichahlini Sounderajan — 2026-10-01

INTRODUCTION: The impact of communication challenges on dementia patients’ quality of life is profound and multifaceted. Originally designed in the English language, the Dementia Communication Difficulties Scale (DCDS) required translation and content validation to suit the diverse linguistic and cultural landscape of Malaysia, where culturally appropriate assessment tools are essential. MATERIALS AND METHODS: The translation of DCDS into Bahasa Melayu was done using a careful, methodical approach consisting of five stages: (1) forward translation, (2) synthesis, (3) backward translation, (4) expert review, and (5) cognitive debriefing. Cultural adaptation was done by a multidisciplinary team of professionals. The Content Validity Index (CVI) and Content Validity Ratio (CVR) were used by medical professionals to confirm and measure the content validity. RESULTS: The translated DCDS is evidenced to have excellent content validity by achieving an I-CVI score of 0.95 and 0.96 on relevance and clarity, respectively. The translation and its linguistic and cultural updates ensured the DCDS is suitable in a clinical setting and appropriately relevant for the multicultural Malaysian population. CONCLUSION: The DCDS in Bahasa Melayu has content validity in assessing communication problems among dementia patients in Malaysia. The DCDS has the potential to improve the quality of care and outcomes for patients, yet its clinical applicability is limited, and more psychometric assessments (reliability and construct validity) are needed to establish its true value.

A CT-Based Comparative Analysis of Mandibular Morphology Across Dentofacial Classification

Izzati Nabilah Ismail — 2026-10-01

INTRODUCTION: Anatomical variations of the posterior mandible have been an ongoing dialogue because of the importance of ensuring the safety of a vital structure that has a risk of damage in mandibular surgeries. Hence, this study aims to analyse the morphology of posterior mandibles across different dentofacial relationships. MATERIAL AND METHODS: A cross-sectional study was conducted utilizing CT scans of the head and neck. The recruitment of samples adhered to specified criteria, which were then categorised according to their skeletal pattern. The CT measurements include height of ramus (R), distance from lingula to sigmoid notch (LS), distance from lingula to inferior border (LI), vertical position of lingula in relation to occlusal plane (L-OP), ramus thickness at the crestal level (RT-C), and ramus thickness midway between sigmoid notch and lingula (RT-M). RESULTS: A total of 60 CT scans were evaluated and classified into Class I, II, and III. The LI and RT-C displayed noteworthy differences (p<0.05) when compared across groups. Other variables showed no significant difference. Nonetheless, a marginal difference was observed in the ramus height (p=0.055). Upon additional post hoc analysis for LI and RT-C, significant differences exist between Class II and III (p=0.019, p=0.023, respectively). CONCLUSION: Significant differences exist in the critical landmarks of the posterior mandible of different dentofacial patterns, where Class II mandibles portrayed a thicker ramus at the crestal level and a shorter distance from the lingula to the inferior border. These findings are crucial information in ensuring safe surgical practice involving the posterior mandible.

Associated Factors of Parental Stress: Child Repetitive Behaviour and Cognitive Emotional Regulation in Parents of Children with Autism Spectrum Disorder in Kelantan

Raishan Shafini Bakar — 2026-10-01

INTRODUCTION: Restricted and Repetitive behaviour (RRB) is one of the main features in autism spectrum disorder (ASD). This behaviour may disrupt children’s routines and adaptability, contributing to significant parental stress. Good coping strategies are important for parents in handling this stress. This study aims to study the parents' stress levels, children’s restricted and repetitive behaviour, and cognitive-emotional regulation among parents of ASD children in Kelantan and its associations. MATERIALS & METHODS: A cross-sectional study was conducted from December 2023 to May 2024, involving 177 parents, selected through purposive sampling. Data were collected using the Malay versions of the Perceived Stress Scale, Repetitive Behaviour Scale-Revised, and Cognitive Emotional Regulation Questionnaire. Descriptive statistics and linear regression analyses were performed using SPSS to identify significant predictors. RESULTS: Among the respondents, 80.2% were mothers. The mean perceived stress score was slightly high at 16.86 (6.26). Positive Reappraisal had the highest cognitive strategy score with a mean 15.30 (3.89). The most common RRB was Sameness with a mean 7.95 (6.38). Factors significantly associated with parental stress included being a mother, having mental illness, Rumination, Positive Refocusing, Positive Reappraisal, Stereotyped, and Sameness behaviour (all p<0.05). CONCLUSION: Parental stress was moderately high among those with ASD children in Kelantan. Major stressors included being a mother, having mental illness, rumination, and children's stereotyped and sameness behaviours, while positive refocusing and reappraisal acted as protective factors. These findings highlight the need to promote effective cognitive emotional regulation strategies to alleviate stress in parents of children with ASD.

Attitude, Educational Needs, and Challenges Faced by Physicians in Managing End-of-Life Care for Critically Ill COVID-19 Patients in Critical Care Settings During the COVID-19 Pandemic

Woon Wee Ng — 2026-10-01

INTRODUCTION: End-of-life (EOL) decision-making is particularly sensitive and complex, especially during the COVID-19 pandemic. This study aimed to assess the attitudes, educational needs, and challenges faced by doctors working in critical care settings in providing EOL care for critically ill COVID-19 patients during the pandemic. MATERIALS AND METHODS: A structured questionnaire comprising four sections was utilized to assess the attitudes of critical care unit doctors at the Hospital Universiti Sains Malaysia and Hospital Selayang, Malaysia. The questionnaire captured responses related to the attitudes, educational needs, and challenges of the physicians in the management of critically ill COVID-19 patients. RESULTS: The respondents generally agreed that EOL care is an essential clinical competency during the pandemic, with a mean score of 3.44 ± 0.87. There was strong recognition of diverse educational needs related to EOL care, encompassing both clinical and ethical aspects, with average mean scores exceeding 3 across relevant items. The physicians also identified several significant barriers to delivering effective EOL care, including the absence of standardized protocols or dedicated services (p=0.001), insufficient training (p=0.006), and time constraints (p=0.007). CONCLUSION: Overall, doctors in critical care settings demonstrated a positive attitude toward the role of EOL care for critically ill COVID-19 patients during the pandemic. A clearer understanding of their attitudes, challenges, and educational needs can help inform strategies to enhance the development and integration of EOL care in critical care settings moving forward.

The Prevalence and Risk Association of Cardiovascular Disease Among Offshore Male Workers in Peninsular Malaysia

Amin Hamzah Mustafha — 2026-10-01

INTRODUCTION: Offshore workers are exposed to occupational and lifestyle factors that may increase cardiovascular disease (CVD) risk. Limited data are available regarding cardiovascular risk profiles among offshore personnel in Malaysia. This study aimed to determine the prevalence of cardiovascular disease risk levels and associated factors among offshore male workers in Peninsular Malaysia. MATERIAL AND METHODS: A cross-sectional study was conducted among 241 offshore male workers between January and February 2025. Data were collected using structured questionnaires and clinical assessments, including body mass index, blood pressure, and lipid profiles. Participants were categorized into low, moderate, and severe CVD risk groups using Malaysian CVD risk scoring guidelines. Chi-square tests and binary logistic regression were performed to identify associated factors. RESULTS: Among the participants, 22.4% were classified as low risk, 47.3% as moderate risk, and 30.4% as severe risk. Overall, 77.7% fell within the moderate-to-severe CVD risk categories. Significant predictors of elevated risk included increasing age (OR=1.046, p=0.003), higher BMI (OR=1.094, p=0.001), smoking (OR=3.320, p=0.008), shift work (OR=2.663, p=0.017), high job stress (OR=4.530, p=0.003), hypertension (OR=5.930, p=0.011), and dyslipidaemia (OR=3.860, p=0.011). CONCLUSION: A high prevalence of moderate-to-severe cardiovascular risk was observed among offshore workers. Occupational health interventions, regular screening, and lifestyle modification programs are recommended to reduce cardiovascular risk in this population.

A Malay Version of the Dementia Attitude Scale (DAS-M) Questionnaire: Its Adaptation, Validation, and Reliability among Malaysian Informal Dementia Caregivers

Nurulizzah Mahfar — 2026-10-01

INTRODUCTION: Dementia is an increasing public health concern globally and in Malaysia, where informal caregivers, mainly family members, provide most care. Caregivers’ attitudes may influence the quality of care and outcomes of people living with dementia (PLwD). However, no validated Malay questionnaire is available to assess dementia-related attitudes. This study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of the Malay Dementia Attitude Scale (DAS-M) among Malaysian informal dementia caregivers. MATERIALS AND METHODS: This cross-sectional study involved 355 informal caregivers recruited from geriatric clinics at Hospital Kuala Lumpur and Universiti Malaya Medical Centre between March and July 2025. The DAS underwent forward–backward translation, expert content validation, and pilot testing for face validity. Construct validity was evaluated using exploratory factor analysis (EFA) with principal axis factoring and Promax rotation. Internal consistency and test–retest reliability were assessed using Cronbach’s alpha and the intraclass correlation coefficient, respectively. RESULTS: The DAS-M demonstrated excellent content validity (I-CVI=1.00; S-CVI/Ave=1.00) and strong face validity (S-FVI/Ave=0.995). EFA supported a two-factor structure comprising Social Comfort and Knowledge, which explained 40.2% of the total variance. Three items were removed due to low factor loadings and communalities, resulting in a 17-item scale. The final scale showed good internal consistency (Cronbach’s α=0.825) and moderate-to-good test–retest reliability. CONCLUSION: The DAS-M demonstrated acceptable validity and reliability for assessing dementia-related attitudes among Malaysian informal caregivers. These findings support its potential use in research, caregiver training programmes, and public health interventions in Malaysia.

Warning Signs and Communication Effects: The Influence of Pictorial Health Warnings on Smoking-Related Knowledge, Attitudes, and Practices among Student Athletes

Nur-Hasanah Ruslan — 2026-10-01

INTRODUCTION: Pictorial health warnings (PHWs) on cigarette packaging are a widely recognised tobacco control strategy that aims to increase awareness of smoking-related health risks and discourage tobacco use. Although PHWs have demonstrated effectiveness in the general population, evidence regarding their impact on athletic populations remains limited. This study examined the relationship between responses to pictorial health warnings on cigarette boxes (PHWCB) and smoking-related knowledge, attitudes, and practices (KAP) among university student athletes. MATERIALS AND METHODS: A cross-sectional study was conducted among 68 university student athletes selected through convenience sampling. Data were collected using a self-administered online questionnaire assessing participants' cognitive and emotional responses to PHWCB and their smoking-related KAP. Descriptive statistics and Spearman's rank correlation were used to analyse the associations between PHWCB responses and KAP. RESULTS: Significant positive correlations were found between PHWCB responses and smoking-related knowledge (p<0.05) and attitudes (p<0.05), indicating that stronger responses to PHWCB were associated with greater awareness of smoking hazards and more negative attitudes toward smoking. However, no significant association was observed between PHWCB responses and smoking practices (p>0.05). PHWCB effectively enhanced knowledge and influenced attitudes toward smoking but did not significantly affect smoking practices among student athletes. This intention–behaviour gap may be explained by factors beyond awareness, including social influences, nicotine dependence, and athlete-specific motivations. CONCLUSION: PHWCB improves smoking-related knowledge and attitudes but has limited influence on smoking behaviour among university student athletes. Athlete-specific tobacco control interventions emphasising the immediate effects of smoking on physical performance are recommended.

Ethical and Shariah Considerations in Contemporary Genetic Practices: Where Should the Limits Be? A Thematic Analysis

Nik Norliza Nik Hassan — 2026-10-01

INTRODUCTION: Rapid advances in genetic technology have improved the diagnosis and treatment of genetic diseases but also raise ethical and Shariah concerns, particularly regarding human intervention in fitrah, genetic manipulation, and unclear fiqh guidance. This study explored the ethical and Shariah considerations in contemporary genetic practices based on the views and experiences of respondents involved in genetic issues within the context of Muslims in Malaysia. MATERIALS AND METHODS: A qualitative approach using semi-structured interviews was employed, with data analysed through inductive thematic analysis. RESULTS: Three themes were identified: Shariah limits in genetic technology, ethical concerns regarding genetic manipulation, and the need for contemporary fiqh guidelines. Acceptance of genetic practices was influenced by legal clarity, concerns about exceeding human fitrah, uncertainty regarding long-term consequences, and the potential misuse of genetic technology. CONCLUSION: The findings highlight the need for greater integration of genetic science, ethics, and Shariah in addressing contemporary genetic issues. This study provides empirical insight into gaps in practical fiqh guidance and offers a foundation for developing context-sensitive ethical and Shariah frameworks aligned with ongoing scientific developments.

Impact of Chronic Low Back Pain (CLBP) On Quality of Life (QOL) of Parents with Physically Handicapped Children

Ida Hasni Shaari — 2026-10-01

INTRODUCTION: Parents of physically disabled children are susceptible to chronic low back pain (CLBP) due to sustained physical demands and psychosocial stress associated with caregiving. However, data on the prevalence of CLBP and its impact on quality of life (QOL) among parental caregivers in Malaysia remain limited. This study aimed to determine the prevalence of CLBP among parents of physically disabled children and to examine its relationship with children’s functional level and parental QOL. MATERIALS AND METHODS: A retrospective analysis of data from a cross-sectional survey was conducted among 94 parents of physically disabled children aged 2-14 years in Bandar Puncak Alam, Selangor. Participants were primary caregivers aged 18 years and above who lived with the child and reported low back pain (LBP) lasting more than three months. Data collected included demographic characteristics, children’s functional level, pain-related disability, and QOL. Descriptive and inferential analyses were performed to examine prevalence and associations. RESULT: CLBP was reported by 70% of parents (n=66). No significant association was found between children’s functional level and the prevalence of CLBP (χ²=3.47, p=0.48). Pain-related disability showed significant negative correlations with QOL domains, including role limitations due to physical health (p=0.002), fatigue (p=0.001), pain (p=0.002), general health (p=0.001), and perceived health change (p=0.004). CONCLUSION: Our findings reveal a high prevalent of CLBP among parents of physically disabled children and are associated with substantial impairments in QOL.

Reduced Urinary Endothelin-1 Levels Are Associated with Elevated Blood Pressure in Young Adults: A Cross-Sectional Study

Kit Yee Yan — 2026-10-01

INTRODUCTION: Urinary biomarkers offer practical and non-invasive advantages for clinical screening, including early cardiovascular risk assessment. While endothelin-1 (ET-1) is a recognised serum biomarker for hypertension, its role in urine, particularly among young adults, has not been fully explored. Therefore, this study aimed to evaluate the association between urinary ET-1 levels and elevated blood pressure (BP) among young adults. MATERIALS AND METHODS: In this cross-sectional study, 117 adults aged 18-45 years were recruited: normotensive (n=44; systolic blood pressure (SBP) <120 and diastolic blood pressure (DBP) <80 mmHg), prehypertensive (n=40; SBP 120-139 and/or DBP 80-89 mmHg), and newly diagnosed hypertensive (n=33; SBP≥140 and/or DBP≥90 mmHg). Pregnant women, individuals who were receiving antihypertensive therapy, or those diagnosed with underlying renal disease were excluded from the study. Plasma and urinary ET-1 levels were measured via enzyme-linked immunosorbent assay (ELISA). Urinary ET-1 was normalised to urinary creatinine to adjust for hydration status. RESULTS: Creatinine-normalised urinary ET-1 concentrations decreased progressively across the normotensive, prehypertensive, and hypertensive groups; median (25^th-75^th percentile) 26.39 (22.19-48.82) pg/mmol, 20.61 (14.72-38.55) pg/mmol and 13.49 (9.69-27.27) pg/mmol, respectively (p=0.002). Hypertensive participants exhibited significantly lower normalised urinary ET-1 levels compared to normotensive controls (p=0.001). In contrast, plasma ET-1 levels showed neither significant intergroup differences nor a significant correlation with urinary ET-1 levels. CONCLUSION: Reduced urinary ET-1 levels are significantly associated with elevated BP in young adults. However, prospective longitudinal studies are required to establish causality and clarify its mechanistic role in the development of young-onset hypertension.

Presbyacusis: A Lazy Diagnosis

Ailin Razali — 2026-10-01