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 Press en-US IIUM Medical Journal Malaysia 1823-4631 <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&nbsp;Copyright Assignment Form, duly&nbsp;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> Religiosity and its Relationship with Smoking Cessation: A Systematic Review. https://journals.iium.edu.my/kom/index.php/imjm/article/view/1654 <p><strong>Objective:</strong> This study aims to systematically review the literature regarding the relationship between religiosity and smoking behaviour. <strong>Methods:</strong> Four electronic databases were used to identify the literatures including Scopus, Science Direct, ProQuest and PubMed. The search was limited to full text articles and in English or Malay only. Articles on smoking prevention and other nicotine delivering devices such as vape or electronic cigarette were excluded from the study. <strong>Results:</strong> Initially, 10,154 articles were retrieved and 12 met the inclusion criteria. Out of the 12 studies, five studies revealed a significant relationship between religious activities and cessation while the others showed inverse associations between religiosity and smoking. <strong>Conclusion:</strong> Religiosity played an important role in influencing smoking behaviour, making it an important vehicle to complement other existing tobacco control efforts. Limited studies were focusing on the Islamic religion despite the growing number of Muslim populations worldwide. Thus, further research on the integration of Islamic religion in smoking cessation program is highly recommended especially in a Muslim country like Malaysia.</p> Junainah Azmi Sharifah Munirah Mohd Said Nurumal Hanida Hani Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1654 Insight of Mechanism and Signaling Pathway in Pathogenesis of Diabetic Neuropathy: A Review https://journals.iium.edu.my/kom/index.php/imjm/article/view/1947 <p>Diabetic neuropathy (DN) is a common chronic microvascular complication of diabetes mellitus. The features of DN include allodynia, hyperalgesia, abnormal or loss of sensation of nerve fibers. The clinical features will contribute to poor quality of life, disrupt sleep, lead to depression, and increases mortality. Current drug treatments have been shown to alleviate the symptoms of DN but failed to treat the underlying causes of DN. Therefore, a better understanding of the molecular mechanisms underlying the development and progression of DN is needed for early diagnosis and intervention and understanding the failure of existing treatments. Identification of potential mechanisms is critical for better prediction of progression and for designing preventive therapies. DN's exact pathogenesis is incomplete, although it is understood that its multifunctional dysfunction involving many signaling pathways. This review summarized the common deterioration of signaling pathways and mechanisms involved in DN pathogenesis.&nbsp;</p> Norhamidar Ab Hamid Norsuhana Omar Che Aishah Nazariah Ismail Idris Long Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1947 Protracted Bacterial Bronchitis, it is a Myth? https://journals.iium.edu.my/kom/index.php/imjm/article/view/1858 <p>Protracted wet and productive chronic cough is a symptom that indicate there is an underlying cause and the possibility vary from a simple to serious medical conditions. If the cough is accompanied with specific pointers in signs and symptoms, the diagnosis is apparent. Nevertheless, the challenge is to identify the diagnosis in children who cough without specific pointers. Recently, protracted bacterial bronchitis is one of the conditions that was proposed and postulated to conceive this clinical presentation. Since then, the understanding of PBB has escalated and deepened. However, there is still no unanimous consensus in definition, pathophysiology, diagnostic, treatment, long term outcome and even the entity itself. Further research is required to refine understanding of this condition in several facets therefore patients can be treated accordingly.</p> Ahmad Fadzil Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1858 A Review on the Relationship between Matrix Metalloproteinases (Mmps) and their Natural Inhibitors (Tissue Inhibitors Of Matrix Metalloproteinases [Timps]) and the Success of an Autologous Arteriovenous Fistula (Avf) https://journals.iium.edu.my/kom/index.php/imjm/article/view/1823 <p>Since its introduction by Brescia and Cimino in 1966, arteriovenous fistula has been regarded as the best vascular access for haemodialysis purpose. However, it’s not without any drawbacks which has cost over USD1 billion in the United States alone to rectify them. Intimal hyperplasia has been shown to be a major contributory factor to this development. Intimal hyperplasia is a complex molecular process resulting in unwarranted accumulation of contractile smooth muscle cells, myofibroblasts, fibroblasts, and macrophages. There is an increasing amount of evidence suggesting that matrix metalloproteinases (MMPs) and its natural inhibitors (tissue inhibitors of matrix metalloproteinases ([TIMPs]) play a pivotal role in the development of intimal hyperplasia. Our purpose of writing this review article is to examine these evidences and to suggest of what future research questions need to be answered to further strengthen and clarify this relationship.</p> Mohd Norhisham Azmi Abdul Rahman Ahmad Faidzal Othman Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1823 A Mini Review: Visual and Auditory Perception in Dyslexia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1616 <p>Dyslexia is a reading disorder defined as the consequences of sensory impairment which can be quite tricky in diagnosis, as many symptoms of dyslexia tend to overlap with learning disabilities such as specific language Impairment (SLI), dysgraphia, dyscalculia, and a few others. However, as research keeps on progressing, a consensus has been made suggesting that dyslexia is commonly attributed to the impairment of auditory and visual perception. This review paper intends to discuss the detailed progression of research focusing on auditory and visual perception among dyslexics.</p> Siti Atiyah Ali Nor Asyikin Fadzil Faruque Reza Faiz Mustafar Tahamina Begum Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1616 Textbook Writing in the Academic World - More than Meets the Eye https://journals.iium.edu.my/kom/index.php/imjm/article/view/2032 Assoc. Prof. Dr. Roslina Abdul Rahim Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.2032 Patients’ Perception towards General and Pelvic Examination by Male Medical Students: A Cross-sectional Study in a Multi-ethnic Population https://journals.iium.edu.my/kom/index.php/imjm/article/view/1680 <p><strong><u>Introduction</u></strong></p> <p>Male medical students globally have difficulty in obtaining consent to perform pelvic examination. We sought to identify independent factors influencing women consenting to male medical students performing general and pelvic examination under supervision.</p> <p><strong><u>Methods</u></strong></p> <p>This cross-sectional study conducted at a tertiary hospital and a public health care centre in Johor Bahru, Malaysia recruited 369 women above 18 years old who have had&nbsp; sexual intercourse before and no prior hysterectomy. A validated self-administered bilingual questionnaire was used to collect data on factors that influence them consenting to male medical students examining them and performing pelvic examination when indicated.</p> <p><strong><u>Results</u></strong></p> <p>The respondents were largely below 30 years old (52.9%), Malays (73.4%) and Muslims (75.3%). The consent rates for general and pelvic examination were 27.4% and 18.9%, respectively. Being a Muslim, having an occupation and being introduced by a male medical specialist increased the likelihood of women consenting to general examination. However, a history of being examined by male students decreased the likelihood by 64%. Believing that male doctors should have the skills to treat patients in women's health was the only independent factor that increased the likelihood for women to consent for pelvic examination to be conducted by male medical students.&nbsp;</p> <p><strong><u>Conclusion</u></strong></p> <p>Believing that male doctors should be skilled in treating women positively influences decision to consent. Explaining earnestly to women on how they aid in developing the skills of future doctors should be prioritised.</p> <p><strong>Keywords</strong>: patients’ perception; male medical students; pelvic examination</p> Valliammai Jayanthi Thirunavuk Arasoo Nisha Angela Dominic Vanassa Ratnasingam Md Inzamum Ul Islam Erin Ziyi Lee Jasmine Jia Min Wong Florence Wan Yiin Kong Walimuni Devage Rashmi Himashi Pemasiri Ravichandran Jeganathan Amutha Ramadas Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1680 Prevalence of Depression and its Associated Factors among Medical Students in International Islamic University Malaysia (IIUM) https://journals.iium.edu.my/kom/index.php/imjm/article/view/1854 <p><strong>Introduction: </strong>Globally, depression is one of the serious problems reported among medical students. Various studies reported that the prevalence of depression among medical students was high due to multiple risk factors. Therefore, this study aimed to measure the prevalence of depression and its associated factors among medical students in International Islamic University Malaysia (IIUM). <strong>Materials and Methods: </strong>A cross-sectional study was conducted among 500 medical students in IIUM Kuantan. A validated self-reported questionnaire using Depression Anxiety Stress Score 21 was distributed during the second semester of the 2018/2019 session. Descriptive statistics were used to measure the prevalence of depression. Chi-square test, Fisher’s exact test, independent sample T-test, and multiple logistic regression were used to determine the association between risk factors and depression. <strong>Result:</strong> The prevalence of depression was 39% with 10.5% of them were having severe and extremely severe level of depression. Multiple logistic regression analysis showed regular physical activity (AOR=0.64, 95% CI: 0.42-0.98) and Tahajjud prayer practice (AOR: 0.76, 95% CI 0.66-0.88) are two protective factors against depression among medical students. <strong>Conclusion: </strong>About two out of every five IIUM medical students had depression. Regular physical activity and Tahajjud prayer practised may reduce the risk of depression and should be encouraged.</p> Abdul Hadi Said Muhammad Addin Nur Hakim Azmi Haziqah Mohd Hanapiah Anis Wardati Abdullah Mohd Shaiful Ehsan Shalihin Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1854 Does Personality and Anxiety Symptomatology Matter in the Diabetes Mellitus Treatment Adherence? A Cross-Sectional Study Among Women with Diabetes Mellitus. https://journals.iium.edu.my/kom/index.php/imjm/article/view/1911 <p><strong>Abstract</strong></p> <p><strong>Purpose:</strong> Anxiety is prevalent among women with diabetes mellitus. Women also tend to have higher levels of neuroticism and anxiety. These symptoms can have an impact on social functioning and diabetes care. The main aim of the present study was to determine the relationship between neuroticism and anxiety symptoms, and other clinical and psychosocial variables, among women with diabetes mellitus (DM).</p> <p><strong>Patients and methods:</strong> This was a cross-sectional study conducted on women with diabetes mellitus. Sociodemographic and clinical variables were acquired, including perceptions on religious practice, social support, and diabetic self-care. Study subjects completed the Generalized Anxiety Disorder 7-item (GAD-7) and the Big-Five Inventory (BFI). The neuroticism subscale of the BFI was used for analysis.</p> <p><strong>Results:</strong> The study included 141 subjects (Median age: 64.0 years, IQR: 52.5–71.0 years) with a median duration of diabetes of 12.0 years (IQR: 6.0–20.0 years). Neuroticism scores correlated positively with the GAD-7 scores (Spearman’s rho: 0.406; <em>p</em>&lt;0.001). In the bivariate analysis, neuroticism also had significant association with employment status (<em>p</em>=0.023), religious practice (<em>p</em>=0.006), perceived social support (<em>p</em>=0.001), and perceived ability of diabetic self-management (<em>p</em>&lt;0.001). In the regression analysis, after controlling for employment, religious practice, and social support, neuroticism remained associated with anxiety (<em>p</em>&lt;0.001) and diabetic self-management (<em>p</em>=0.001).</p> <p><strong>Conclusions:</strong> Neuroticism was related to poorer subjective sense of diabetic management and a greater level of anxiety among women with DM. Improving self-efficacy in managing diabetes may help patients coping up with anxiety symptoms among those with neuroticism traits. This may also contribute to a better understanding of features and effective treatment of women with DM.</p> <p>&nbsp;</p> <p>&nbsp;</p> Luke Woon Gurpreet Kaur Autar Singh Hatta Sidi Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1911 Quality Characteristics, Antioxidant and Anticancer Potential of Stingless Bee Honey and Honeybee Honey from Similar Environmental Conditions https://journals.iium.edu.my/kom/index.php/imjm/article/view/1753 <p><strong>Introduction:</strong> The composition of the honey depends on the intrinsic and extrinsic factors, including place of origin, the floral types, the season and the storage conditions. This study compared the anticancer potential, quality, antioxidant and phytochemical between unprocessed stingless bee honey (SBH) and honeybee honey (HBH) from the same environmental factors including place of nest, floral type (Acacia), harvesting month (August) and storage conditions (&lt;5°C). <strong>Materials and methods:</strong> To measure quality, 5-hydroxymethylfurfural (HMF) and diastase activity were determined, followed by total phenolic content (TPC) and total flavonoid content (TFC) for phytochemicals. Antioxidant activity was assessed via 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay. Cytotoxicity towards cervical cancer cell line (HeLa) was measured using a 2-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay (IC<sub>50</sub>). <strong>Results:</strong> The results indicated that HBH exhibited significantly higher diastase activity (2.17 ± 0.07 DN), TPC (338.95 ± 3.49 mg GAE/kg), DPPH scavenging activity EC<sub>50</sub> (80.06 mg/ml) and MTT activity IC<sub>50</sub> (64.80 mg/ml) towards HeLa as compared to SBH with absence of diastase activity, TPC (250.60 ± 3.98 mg GAE/kg), DPPH scavenging activity EC<sub>50</sub> (165.80 mg/ml) and MTT activity IC<sub>50</sub> (75.76 mg/ml). However, there were no significant differences in HMF and TFC between HBH and SBH. <strong>Conclusion:</strong> Therefore, the present study found that HBH demonstrates better antioxidant capacity, anticancer potential and phenolic content as compared to SBH.</p> Hayati Yusof Ahmad Khusairy Zulpa Nur Suaidah Mohd Isa Fauziah Tufail Ahmad Murni Nur Islamiah Kassim Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1753 Measurement of Inflammation-Related Biomarkers in Different Chronic Kidney Diseases in Humans: Role of Aging and Gender? https://journals.iium.edu.my/kom/index.php/imjm/article/view/1827 <p>INTRODUCTION: Chronic kidney disease (CKD) is a worldwide health problem which becomes a substantial emerging cause of morbidity. The inflammation can be resulted via different mechanisms in different kidney diseases including the imbalance of proinflammatory/anti-inflammatory biomarkers levels. This study aimed to measure the level of physiological bioactive substances as inflammation-related biomarkers in different CKD and to investigate whether gender or aging is critical in these measurements. MATERIALS AND METHODS: 84 persons (19 healthy, 29 chronic glomerulonephritis, 26 diabetic nephropathy, 6 benign nephrosclerosis, 4 lupus nephritis) were enrolled in this study. The inflammation progression degree in CKD was estimated by measuring the plasma level of neutrophil gelatinase-associated lipocalin (NGAL), monocyte chemoattractant protein 1 (MCP1), and clusterin (CLU) using ELISA. Serum total protein, urea and creatinine were measured using an automatic analyzer. RESULTS: Plasma level of urea and creatinine was increased while total protein level was decreased in all the patients compared to control participants. The level of NGAL, MCP1 and CLU was significantly increased in all the kidney diseases compared to controls. In addition, there were no differences in the level of inflammation-related markers between women and men. Moreover, the levels of inflammatory markers were increased in the kidney diseases regardless of the age difference. CONCLUSIONS: This study showed that the physiological bioactive substances NGAL, MCP1 and CLU can be increased in renal pathologies and considered as good indicators of progression of inflammation in chronic kidney diseases, with no role of gender and age in their increment plasma levels.</p> Abdulla Ahmad Mohammed Ajeel Karam Aldabbagh Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1827 Metabolic and Pancreatic Derangement in type 2 Diabetic Rat https://journals.iium.edu.my/kom/index.php/imjm/article/view/1917 <p><strong>Introduction:</strong> The prevalence of diabetes mellitus is increasing globally, despite the best current therapies available. A large diversity of animal models has been developed for better understanding the pathogenesis of diabetes mellitus. This study aimed to develop a rat model that mimics the metabolic characteristics of human type 2 diabetes mellitus. <strong>Methods:</strong> Twenty-four male Sprague–Dawley rats (200–250 g) were divided into two groups and fed either a commercially available standard pellet diet (n=8) or a self-prepared high-fat diet (HFD) (n=16) for 6 weeks. HFD-fed rats were significantly obese compared to standard-fed rats. Eight of the obese rats were injected a single low dose of streptozotocin (STZ) at 35 mg/kg intraperitoneally to induce type 2 diabetic rat (T2DR) and were monitored for 6 weeks. <strong>Results:</strong> The weekly fasting blood glucose levels (FBG) in T2DR remained consistently high throughout the 6 weeks. The T2DR group exhibits decreased body weight, increased water intake, increased 24-hour urine volume with microalbuminuria, hyperlipidemia, altered liver and kidney functions, and structural changes of the islet of Langerhans. <strong>Conclusion:</strong> This model simulates the natural disease progression and metabolic characteristics of type 2 diabetic patients. This model mimics the human syndrome that can be maintained at a reasonable cost, and easy to develop.</p> Liza Noordin Nor Asiah Muhamad Nor Nor Hidayah Abu Bakar Wan Amir Nizam Wan Ahmad Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1917 Comparative Study of Microwave Oven-Assisted Tissue Processing with Isopropanol and Mineral Oil Mixture and Propylene Glycol Methyl Ether on Morphological Quality of Tissue Sections https://journals.iium.edu.my/kom/index.php/imjm/article/view/1724 <p><strong>Background: </strong></p> <p>Over several years, xylene has been traditionally utilised as the clearing agent of choice in tissue-processing due to effectiveness in rapidly clearing tissue, facilitating the paraffin infiltration process. However, xylene use adversely impacts the health of personnel with long term exposure due to toxicity. In order to overcome these effects and replace it with a safer alternative agent, the present study aims to compare quality of tissue sections processed using an isopropanol and mineral oil mixture and propylene glycol methyl ether (PGME) as xylene substitutes.</p> <p>&nbsp;</p> <p><strong>Methods: </strong></p> <p>Rat skeletal muscle tissue samples (n=20) were prepared for each processing protocol with xylene substitutes. Tissue specimens were processed according to the proposed microwave protocol. The clearing steps were performed using isopropanol and mineral oil mixture, and PGME, replacing xylene. From each paraffin-embedded block, one section of 4-5µm thickness tissue was obtained and conventionally-stained with Haematoxylin and Eosin (H&amp;E). The histological sections were microscopically assessed and scored by a pathologist. A qualitative analysis was performed with the results obtained.</p> <p><strong>&nbsp;</strong></p> <p><strong>Results: </strong></p> <p>The overall score obtained for xylene processed tissue was 100% with a score of 2 for all the 3 parameters assessed. However, the outcome for tissue processed with isopropanol and mineral oil mixture was 28.6% unsatisfactory, 28.6% satisfactory and 42.8% good. In PGME-treated tissues, 14.3% were unsatisfactory sections, 71.4% were satisfactory and 14.3% produced good quality sections. Overall, tissues processed using both substitutes exhibited sufficient staining quality in terms of the aforementioned parameters as compared to xylene-processed tissues, though significant difference in scores were observed.</p> <p>&nbsp;</p> <p><strong>Conclusion:</strong></p> <p>Despite several challenges faced in the study, isopropanol and mineral oil mixture and PGME can be suggested as alternative clearing agents to xylene, provided having access to a more sophisticated microwave oven with precise temperature control for complete tissue-processing.</p> Sri Darsheny Saint Nway Aye Purushotham Krishnappa Rashindra Ravindran Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1724 Evaluating Effect of Prophylactic Intravenous Dexamethasone in Post Spinal Shivering: A Single Centre Randomised Controlled Study https://journals.iium.edu.my/kom/index.php/imjm/article/view/1693 <p><strong>Introduction:</strong> Shivering is a common side effect of central neuraxial anaesthesia. Intravenous pethidine is commonly used in reducing shivering but has been associated with significant opioid side effects. Dexamethasone as a powerful anti-inflammatory and analgesia agent is postulated to inhibit inflammatory mediators’ release thus inhibiting central thermoregulatory centre, potentially attenuating post spinal shivering.&nbsp; This double-blinded randomised controlled study was to determine the ability of intravenous dexamethasone in decreasing the incidence, severity and the need for treatment for post spinal shivering.</p> <p><strong>Methods: </strong>We recruited 72 patients requiring spinal anaesthesia and randomised them to receive either dexamethasone 0.1 mg/kg (up to 8 mg) or normal saline (placebo). We observed their tympanic membrane temperatures, mean arterial pressures and shivering scores at regular intervals up to 2 hours post-spinal or till end of surgery (minimum 30 minutes post spinal).</p> <p><strong>Results:</strong> Both groups showed consistent and comparable drop in tympanic membrane temperatures and mean arterial pressures after spinal anaesthesia, except at 15 minutes in which patients of dexamethasone group demonstrated significantly higher temperatures than saline group (<em>p</em>=0.04). There were also significantly less patients in the dexamethasone group reporting incidence of visible shivering as compared to the placebo group (<em>p</em>=0.003). No significant difference was seen in severity of shivering or usage of pethidine.</p> <p><strong>Conclusion:</strong> Dexamethasone has the potential to mitigate the reduction in core body temperature, especially at 15 minutes post spinal. It can reduce the incidence of clinically significant visible grade of shivering post spinal.</p> Dr Chih Nie Yeoh Dr Billy Voon Datin Dr Siti Nidzwani Mohamad Mahdi Dr Syarifah Noor Nazihah Sayed Masri Associate Professor Dr Azarinah Izaham Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1693 Heart Rate Variability and Muscle Strength in Young Adults with Sedentary Behaviour https://journals.iium.edu.my/kom/index.php/imjm/article/view/1643 <p><strong>Introduction:</strong> Sedentary behaviour or physical inactivity has been relatively prevalent among young adults globally. Multiple studies pointed out that Malaysia has been listed as one of the Asian countries with high prevalence of inactivity. <strong>Objective</strong>: This study aimed to examine the heart rate variability (HRV) and muscle strength among young adults in order to identify the early impact of this behaviour on their physiological and physical health. <strong>Method:</strong> This cross-sectional study involved 185 healthy male adults aged 18-25 years old. Participants’ height and body compositions were measured and their level of physical activities were obtained using Short Questionnaire to Assess Health (SQuASH). Those with less than 150 minutes per week of physical activity engagement were classified as sedentary. Their HRV was analysed as a determinant for early physiological change that was influenced by the sedentary behaviour. Muscle strength of upper and lower body was assessed via handheld dynamometer to identify the physical fitness associated to the behaviour. <strong>Results:</strong> Among the participants that volunteered in this study, approximately 44% were classified as sedentary. Analyses revealed that those with sedentary behaviour had lower variability of their HRV and lower muscle strength as compared to those who engaged with at least 150 minutes per week of physical activities. <strong>Conclusion</strong>: The highlighted evidence of the difference on parameters of HRV and muscle strength with this behaviour suggested that these parameters were suitable parameters to be utilised in determining subclinical improvement on health with any intervention to curb sedentary behaviour.</p> Norsham Juliana Mohd Azrul Anuar Zolkafi Sahar Azmani Izuddin Fahmy Abu Noor Aein Mon Sarip Noor Anisah Abu Yazit Nur Islami Mohd Fahmi Teng Srijit Das Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1643 Patient Satisfaction with Doctor-Patient Interaction using SKIP-11 and Its Associated Factors among Type 2 Diabetics in Primary Care. https://journals.iium.edu.my/kom/index.php/imjm/article/view/1530 <p><strong>ABSTRACT </strong></p> <p><strong>Introduction: </strong>The quality of diabetes care is widely suboptimal, and most of the interventions depend on the active involvement and participation of patients. Understanding and determining patient related factors can help primary care providers pay more attention and give greater care to those patients. This will improve patient satisfaction, which further enhances compliance with or adherence to diabetic treatment. Therefore, this study aims to determine patient satisfaction with doctor-patient interaction and its associated factors among patients with type 2 diabetes mellitus.</p> <p><strong>Materials and Methods: </strong>This cross-sectional study was performed among adults who had had diabetes for at least six months. Participants were selected by systemic random sampling in the outpatient clinic of the University Hospital. Patient satisfaction with doctor-patient interaction was measured using 11- items with a three-domain version of the “Skala Kepuasan Interaksi Perubatan-11” questionnaire. The total scores ranged from 11 to 55, and those who scored 44 and above (&gt; 80%) were considered satisfied.</p> <p><strong>Results: </strong>A total of 417 patients were recruited in the study. 60% were satisfied with their doctor-patient interactions. Among the subtypes in the satisfied group, the domain of rapport had the highest percentage of satisfaction at 77.7%. HbA1c was found to be significant associated with patient satisfaction with doctor-patient interaction (95% CI: 0.81, 0.97;<em> p</em> = 0.008)</p> <p><strong>Conclusion:</strong> 60% of the participants clearly illustrated positive feedback and were more satisfied with their doctor-patient interactions. HbA1c was found to be significantly associated with patient satisfaction concerning doctor-patient interaction</p> <p>&nbsp;</p> Siti Suhaila Mohd Yusoff George Wong Pah Kiam Lili Husniati Yaacob Nani Draman Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1530 Endoscopic Management of Branchial Fistula: Diagnostic and Therapeutic. https://journals.iium.edu.my/kom/index.php/imjm/article/view/1688 <p>Recurrent neck abscess is a typical feature of branchial anomaly. Open surgical excision has been the primary treatment modality for past decades however several alternative treatment modalities such as endoscopic electrocauterization has recently gained popularity and acceptance universally. This series aims to introduce endoscopic assessment as the first line diagnostic and therapeutic management for branchial fistula.</p> <p>5 patients underwent examination under general anesthesia via direct laryngoscopy, endoscopic assessment and cauterization in our centre from 2016 to 2019. They were then followed up at our clinic to assess disease progression.</p> <p>Comparison between open neck surgery and endoscopic cauterization of internal sinus tract opening as the primary treatment has reported similar recurrence rate.</p> <p>Proposal of endoscopic assessment as the first line investigation and diagnostic tool &nbsp;with the aim of therapeutic cauterization at the same setting. MRI may be needed in scenarios such as failed endoscopic treatment or when open surgery is required.</p> Mark Paul Bee See Goh Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1688 Bilateral Internal Auditory Canal (IAC) Duplication with Congenital Sensorineural Hearing Loss (SNHL)-A Case Report https://journals.iium.edu.my/kom/index.php/imjm/article/view/1757 <p>Duplication of the internal auditory canal is a rare entity. It can be unilateral or bilateral involvement and usually found during an investigation of sensorineural hearing loss or facial nerve palsy. We report this image finding in a child with Down syndrome with bilateral profound sensorineural hearing loss. There was no facial nerve palsy. We highlight the rarity of this image finding and the importance of imaging for detection of middle and inner ear abnormality in a case of congenital sensorineural hearing loss as it helps in decision making for the suitable treatment.</p> <p><strong>Keywords:</strong> Duplicate IAC; Bilateral Duplicate IAC; sensorineural hearing loss; Down syndrome</p> Nik Adilah Nik Othman Nur Saadah Mohamad Ahmad Aizuddin Mohamad Jamali Mohd Shafie Abdullah Mohd Khairi Md Daud Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1757 Atypical Optic Neuritis in an Immunocompetent Patient with Orbital https://journals.iium.edu.my/kom/index.php/imjm/article/view/1729 <p>Aspergillosis infection in immunocompetent individuals is an uncommon entity. Non-specific presentation could delay in the diagnosis and management. We describe a case of orbital aspergillosis with cavernous sinus extension in a healthy lady. A 67-year-old lady presented with left eye decreased vision, preceded by non-specific headache for three weeks. Visual acuity deteriorated followed by ptosis and left ocular restrictions after corticosteroids therapy. Examination revealed poor left eye visual acuity with ptosis, anisocoria and total ophthalmoplegia. MRI orbit and brain demonstrated a heterogenous left orbital apex lesion extending to cavernous sinus. Transsphenoidal endoscopic biopsy revealed Aspergillus infection at the left retro-orbital space and the sphenoid sinus. Patient was treated with long duration of oral voriconazole. Ptosis and ophthalmoplegia resolved but left optic atrophy remained. In conclusion, orbital aspergillosis may carry a poor visual prognosis and intracranial spread does easily occur. Early treatment may lead to a better outcome in immunocompetent patients.</p> Nurul 'Ain Masnon Wan Hazabbah Wan Hitam Lakana Kumar Thavaratnam Maimunah Abd Munaaim Copyright (c) 2021 IIUM Medical Journal Malaysia 2021-10-01 2021-10-01 20 4 10.31436/imjm.v20i4.1729