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> Spontaneous Rupture of Unscarred Uterus in Second Trimester Pregnancy Presented as Acute Appendicitis; An Unusual Obstetric Emergency and the Importance of Imaging in Suspected Acute Appendicitis in Pregnancy https://journals.iium.edu.my/kom/index.php/imjm/article/view/1516 <p>Spontaneous uterine rupture in an unscarred uterus in early trimester is very rare and difficult to diagnose. We reported a case of 28 years old lady at 15th week of gestation with three previous uneventful obstetrical history presented with one-day history of acute right iliac fossa pain and vomiting. She was subjected for an open appendectomy after an assessment by obstetric and surgical team which revealed ruptured of uterine fundal. She recovered well but she lost her pregnancy. Traditional management of acute appendicitis in pregnant patients is an early exploration. However recent studies showed that it was unpractical as the rate of pregnancies loss was two times with negative appendectomy compared to simple appendicitis; and almost as high as complicated appendicitis. All suspected appendicitis cases required ultrasound studies, and when the diagnosis is uncertain, further imaging such as computed tomography (CT) scan or magnetic resonance imaging is needed prior to surgery.</p> <p> </p> Fadya Nabiha A.S Ahmad Shariffuddin Nur Bazlaah Bahari Hirdayu Abu Bakar Khairuzi Salekan Fazlin Farhana Mohd Isam Syariz Ezuan Sulaiman Muhammad Amer Dad Dzulkifli Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1516 An Exophytic Hepatocellular Carcinoma in an Undiagnosed Cirrhotic Liver Mimicking an Intraperitoneal Soft Tissue Sarcoma https://journals.iium.edu.my/kom/index.php/imjm/article/view/1594 <p>Exophytic hepatocellular carcinoma is a rare type of hepatocellular carcinoma (HCC), which may present with a wide variation in clinical presentations and imaging findings. Thus it may cause diagnostic dilemma and may need a multidisciplinary approach management tailored to individual patient for a better outcome. Here we reported a case of a patient with exophytic hepatocellular carcinoma mimicking an intraperitoneal sarcoma.</p> <p> </p> Mohd Ezane Aziz Farahat Nadeem Ahmed Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1594 Bleed or Clot? Managing Bleeding in Post Thrombolysis Patient with Massive Pulmonary Embolism Who Underwent Recent Major Cancer Surgery https://journals.iium.edu.my/kom/index.php/imjm/article/view/1626 <p>51 years old female, with invasive left breast cancer stage T3N0M0 developed syncope, hypotension, chest pain, and ST elevation in anterior leads on the next day following Left Mastectomy. The initial diagnosis of AMI revised to massive pulmonary embolism after tranthoracic enchocardiogram. However, IV (intravenous) Metalyse was given as thrombolysis therapy and the patient showed a good initial response. Subsequently, the patient developed massive bleeding from the surgical site. Bleeding was successfully controlled with total of 11 units packed cells, 4 units fresh frozen plasma, 4 units of platelet, and 6 units of cryoprecipitate as well as prothrombin complex concentrate. Local compression bandage and continuous surgical site drainage were applied in this case. Following successful control in bleeding unfractionated heparin infusion was given for 2days followed by low molecular weight heparin for 2days and discharged with a direct oral anticoagulant. On follow up visit, the patient made an excellent recovery and planned for further treatment for breast cancer. Thrombolysis therapy and anticoagulant therapy in post-operative patients with high-risk bleeding posses great challenges. Careful evaluation of bleeding versus clotting is the key to good outcomes.</p> Sivasubramaniam Balakrishnan Mohd Zulkifli Mohamad Zahir Che Rosle Draman Wan Ahmad Syahril Rozli Wan Ali Ismail Ibrahim Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1626 Spinal Brucellosis Masquerading as Pyogenic Spondylodiscitis: A Rare Case https://journals.iium.edu.my/kom/index.php/imjm/article/view/1511 <p>Brucellosis is a zoonotic infection secondary to <em>Brucella spp</em>. Musculoskeletal system is the most affinity site to been affected by this disease and lumbar vertebrae the most favourite site of involvement. The disease can manifest as focal or diffuse. The dietary history is a main and good clinical clue towards the definite diagnosis. Plain radiograph may benefit in terms of focal disease, however MRI is the most sensitive and appropriate imaging to look for extension of the disease and spinal complications. We are reporting a case of spinal Brucellosis in a lady who was initially diagnosed as pyogenic and tuberculous spondylodiscitis. Patient’s initial presentation as well as the radiological investigation led towards the diagnosis of pyogenic spondylodiscitis, however the blood culture revealed <em>Brucella melitensis</em>. We would like to highlight the importance of clinical history and challenges in diagnosing spinal Brucellosis as radiographic manifestation is non-specific and the organism are almost forgotten nowadays.</p> Azizul Akram Salim Nadiah Nik Hassan Juhara Haron Joehaimey Johari Mohd Imran Yusof Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1511 Covid-19 Impasse: Time to Co-exist with the Pandemic https://journals.iium.edu.my/kom/index.php/imjm/article/view/2161 Assoc. Prof. Dr. Razman Mohd Rus Copyright (c) 2022 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.2161 Estimates Of Glomerular Filtration Rate in Critically Ill Patients With Sepsis: Comparisons of Different Equations https://journals.iium.edu.my/kom/index.php/imjm/article/view/1980 <p><strong>Introduction:</strong> Accurate assessment of glomerular filtration rate (GFR) is important in the critically ill. Kinetic estimate of GFR (keGFR) considers the changes of creatinine, creatinine production rate, and volume of distribution, hence postulated to be a more accurate estimate of GFR, where there are rapidly changing kidney functions. We evaluated the association of the estimated GFR by established equations and keGFR with creatinine clearance (CrCl) measurement. <strong>Materials and Methods:</strong> This is a prospective observational study of critically ill patients. Inclusion criteria were patients older than 18 years old with sepsis (clinical infection and increase in SOFA score&gt;2), and plasma procalcitonin&gt;0.5ng/ml. Plasma creatinine and Cystatin C (CysC) were measured on admission and 4 hours later, and the eGFR were calculated by the Cockcroft Gault (CG), MDRD, CKD-EPI and keGFR equations, and compared to the CrCl measurement. <strong>Results:</strong> A total of 70 patients were recruited. eGFR by all 4 equations strongly correlates with CrCl. keGFR had the least bias depicted by the mean differences nearest to zero (-18ml/min). Similarly, keGFR<sub>CysC</sub> had less bias than eGFR<sub>CysC</sub>, with mean difference of -21ml/min. eGFR<sub>CG </sub>had the greatest precision depicted by the narrower SD lines, however the precision of both keGFR were not much difference compared to those of eGFR<sub>CG</sub>. <strong>Conclusions:</strong> In critically ill patients with sepsis, keGFR<sub>Cr</sub> and keGFR<sub>CysC</sub> had the least bias and fair precision when compared to creatinine clearance measurement. In the absence of creatinine clearance measurement, keGFR calculations is useful as surrogate for kidney function.</p> Azrina Md Ralib Farah Nadia Mohd Hanafiah Iqbalmunawwir Abd Rashid Shahir Asraf Abd Rahim Mohd Basri Mat Nor Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1980 Differences in Attitude towards End-Of-Life Care among Haemodialysis Patients and their Family Members in Two Malaysian Hospitals https://journals.iium.edu.my/kom/index.php/imjm/article/view/1841 <p><strong>INTRODUCTION: </strong>End-of-life (EOL) care has become an important topic of discussion in those with chronic illness, especially in End Stage Renal Disease (ESRD) patients on dialysis. This study explored attitudes towards the EOL care among haemodialysis patients and compared them with the patients’ family members. <strong>MATERIALS AND METHODS</strong><strong>:</strong> The study was a cross-sectional descriptive study conducted in two tertiary hospitals in Malaysia. The data was collected by using a survey questionnaire from 164 participants which consisted of 82 pairs of patients and their relatives. <strong>RESULTS:</strong> ‘Patient’ and ‘family’ groups demonstrated differences in their preferences regarding EOL care options. Family members group favoured cardiopulmonary resuscitation (81.7% vs 41.4%) (p &lt;0.001), endotracheal intubation (80.5% vs 43.9%) (p = 0.989) and nasogastric tube feeding (87.8% vs 67%) (p = 0.001) more than patients themselves. The physician was the most nominated surrogate decision-maker by the patient (91.5%). Majority of the patients (57.3%) felt uncomfortable discussing EOL care options. There was significant correlation between duration of dialysis and patients’ EOL preferences where patients less than 5 years on haemodialysis favoured CPR (55.9% vs 31.3%; p = 0.026), intubation (55.9% vs 35.4%) and nasogastric tube feeding (82.3% vs 56.3%; p = 0.013) compared to patients who had been on haemodialysis for 5 years or longer. <strong>CONCLUSION:</strong> This study demonstrated significant differences between the attitudes of the patients and their relatives regarding EOL care preferences.</p> <p> </p> Aizad Azahar Noor Airini Ibrahim Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1841 The Accuracy of Surgeon-Performed Preoperative Parathyroid Ultrasound Localization for Renal Hyperparathyroidism Patient https://journals.iium.edu.my/kom/index.php/imjm/article/view/1833 <p><strong>Introduction: </strong>Parathyroid surgery for renal hyperparathyroidism (RHPT) is indicated when patients have a progressive disease despite optimal medical therapy. The success of total parathyroidectomy in RHPT lies in accurate localization and excision of all PTGs. Recently, surgeon-performed ultrasound (SPU) has been increasingly used for the preoperative localization of PTGs in the intent of focused approach and reduce morbidity. Thus, we conducted a prospective observational single-center study to determine the accuracy of SPU for PTG localization in RHPT and the factors affecting its accuracy. <strong>Materials and Methods: </strong>This is a prospective, observational, single-center study conducted in University Kebangsaan Malaysia Medical Centre between March 2018 and March 2019. The patients’ preoperative demography, clinical data, and relevant blood laboratory results, including calcium, phosphate, alkaline phosphatase, and intact parathyroid hormone, were recorded. Preoperative USG and surgery were performed by the same endocrine surgery consultant. <strong>Results</strong>: SPU localization had an overall accuracy of 78.1%, sensitivity of 81.0%, and specificity of 30.0% with a positive predictive value of 94.8% and a negative predictive value of 10.5%. The SPU gland localization rate was significantly higher in patients without goiter (median=0.88, IQR=0.63–1.00) than in those with goiter (median=0.50, IQR=0.25–0.75) (p=0.028). <strong>Conclusions: </strong>SPU localization of the PTG in RHPT had an accuracy comparable with that in previous literature with the additional advantage of identifying concurrent unknown thyroid nodules. Considering the high prevalence of concomitant nodular thyroid disease in our RHPT population, we advocate the routine use of preoperative neck ultrasound for RHPT patients undergoing parathyroid surgery.</p> <p> </p> Noor Ezmas Mahno Shahrun Niza Abdullah Suhaimi Nani Harlina Md Latar Rohaizak Muhammad Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1833 Appropriateness of Proton-Pump Inhibitor Usage among Hospitalized Patients in a Johor Government Hospital https://journals.iium.edu.my/kom/index.php/imjm/article/view/1736 <p><strong>Introduction: </strong>Proton pump inhibitors (PPIs) are potent and effective acid suppressant agents. There are emerging concerns that PPI overuse leads to escalating healthcare costs, drug-drug interactions, and adverse clinical outcomes. Exploring the appropriateness of PPI therapy among hospitalised patients in Malaysia is crucial. Thus, this study aims to determine the appropriateness of proton pump inhibitors utilisation in Sultan Ismail Hospital, Malaysia. <strong>Materials and Methods</strong>: This single-center retrospective cross-sectional study was conducted at a public tertiary hospital situated in the Johore state of Malaysia. Patients recruited were 12 years and above who had received PPI in January 2017. Medical information was reviewed from electronic medical records. Patients were classified into three subgroups based on indications adopted from evidence-based guidelines. <strong>Results</strong>: 422 patients were enrolled, 47.4% (n=200) fulfilled the Food Drug Administration (FDA) approved indications, 25.4% (n=107) had borderline indications, and 27.2% (n=115) had inappropriate PPI usage. Improper PPI therapy was observed with a similar fraction of patients in medical (24.5%, n= 58 ) and non-medical disciplines (30.8 %, n=57). Stress ulcer prevention in low-risk subjects and individuals with no apparent indication were reasons for PPI overuse. <strong>Conclusion</strong>: PPI overuse is prevailing in hospitalised adult patients. Promoting the awareness of guideline-based indications and adverse clinical events of PPI among clinicians is imperative in improving PPI prescribing.</p> <p> </p> Tiong Chan Lee Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1736 Understanding the Healthcare Practitioners’ Experience in Managing Women with Postnatal Depression: A Qualitative Study in Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1993 <p><strong>INTRODUCTION: </strong>Postnatal depression is largely underdiagnosed in many low-and middle-income countries, including Malaysia. Healthcare practitioners’ perceptions towards postnatal depression were identified as one of the main barriers to seeking help. Objective: This study aimed to explore the perceptions of healthcare practitioners about postnatal depression, and their experience in managing women with postnatal depression in Malaysia. <strong>Materials and methods</strong>: Eighteen healthcare practitioners (5 head nurses, 9 nurses, and 4 doctors) working in maternal and child health clinics and a female psychiatric ward in Kuala Lumpur were individually interviewed following a generic qualitative research design. Interview data were transcribed verbatim, and the transcripts were analyzed using framework analysis. <strong>Results</strong>: Healthcare practitioners reported that their management of women with postnatal depression was limited by the absence of a specific screening tool, and presence of stigma associated with postnatal depression. <strong>Discussion and conclusion</strong>: Healthcare practitioners were found to be aware of poor maternal mental health provision within their clinical setting and are ready to contribute to developing protocols to improve maternal mental health. As its diagnosis and treatments vary from general depression, there should be a specific direction addressed in the policy to assist in actions for managing postnatal depression. Professional training and continuous education on postnatal depression are a fundamental component in fostering quality of care, and public awareness as well as improving stigma within the Malaysian healthcare system.</p> <p> </p> Siti Roshadai Mohd Arifin Khadijah Hasanah Abang Abdullah Nurul Ain Hidayah Abas Rohayah Husain Mohamad Che Man Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1993 Translation and Validation of Computer Vision Syndrome Scale 17 (CVSS 17) – The Malay Version https://journals.iium.edu.my/kom/index.php/imjm/article/view/1963 <p><strong>Introduction: </strong>Computer Vision Syndrome Scale 17 (CVSS17) is a questionnaire to measure computer-related visual and ocular symptoms among video display terminal workers. This study aimed to translate CVSS17 into Malay languag and determine its psychometric properties among video display terminal workers. <strong>Materials and Methods</strong>: This was a cross-sectional validation study involving 206 workers in Universiti Teknologi MARA UiTM Selayang and Sungai Buloh Campus. The English version of the CVSS17 questionnaire is a 17-item scale measuring two key factors, which are internal symptom factors (11 items) and external symptom factors (6 items). The CVSS17 underwent forward-backward translation, face validation, and field testing to produce the Malay version. Validity of the items assessing psychometric properties was performed using exploratory factor analysis. The reliability testing was performed using internal consistency and test-retest reliability. <strong>Results</strong>: The validated CVSS17-Malay version retained all 17 items with acceptable factor loadings. There were 13 items in the external, and 4 items in the internal symptom factors domain. In comparison to the original version, 4 items (A2, A22, A28, A30) were swapped from internal to external symptom factors and 2 items (C16 and C23) swapped from external to internal symptom factors. The changes of these items into different domains were discussed. The overall Cronbach’s α was 0.867 and the intraclass correlation coefficient was 0.866. The Kaiser-Meyer-Olkin was 0.928, and Bartlett’s test of sphericity was p-value &lt;0.001. <strong>Conclusion</strong>: The CVSS17 Malay version is valid, reliable, and stable over time, to be used in measuring computer vision syndrome among Malay-speaking workers.</p> <p> </p> Mazapuspavina Md-Yasin Nor Shazatul Salwana Din Zahirah Tharek Nor Azimah Abd Aziz Mariam Mohamad Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1963 Balance Disorders: A Review of Patients at a Specialized Vestibular Clinic https://journals.iium.edu.my/kom/index.php/imjm/article/view/1905 <p><strong>Introduction: </strong>With recent advancements in vestibular assessments, new ancillary tests can assist clinicians to better understand underlying cause of a balance problem. The recently established specialized vestibular clinic in Sultan Ahmad Shah Medical Centre @IIUM is equipped with these tests. This study aimed to determine the prevalence of the different diagnoses of balance disorders in a specialized vestibular clinic in Kuantan, Malaysia. <strong>Materials and Methods</strong>: This is a retrospective review of 121 walk-in patients over an 18-month period at a specialized Vestibular Clinic in Sultan Ahmad Shah Medical Centre @IIUM. The variables analysed in this review include the age, gender, ethnicity, diagnoses, and total number of visits before diagnoses were achieved. <strong>Results</strong>: Meticulous history taking, focused otorhinolaryngological examination and detailed vestibular assessment through the specialized vestibular clinic helped us in reaching a conclusive diagnosis. The most common cause of balance disorders in our review was Benign Paroxysmal Positional Vertigo (BPPV), constituting 41.3% of the cases. Among the canals, the posterior canal is the most affected (70%) and is usually treated with Epley manoeuvre. Other common diagnoses include Vestibular Migraine, Meniere’s Disease and Vestibular Neuritis. <strong>Conclusion: </strong>Vestibular clinics play a vital role in helping to pinpoint the accurate diagnosis of patients with balance disorders.</p> Kim Yew Richard Wong Muhammad Hosni Zainal Abidin Saiful Adli Jamaluddin Shamim Rahman S.M.A Abdul Rasheed Yahia Faik Hussein Al-Hadeethi Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1905 Knowledge and Practices of Episiotomy amongst House Officers, Student Midwives and Experienced Midwives in Low-Risk Obstetrics Practice – A Cross-Sectional Study in a Tertiary Hospital in Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1743 <p><strong>Introduction</strong>: Episiotomy rates differ widely internationally. There are few studies that explore gaps in knowledge and practices amongst clinicians performing episiotomy, yet limited amongst the obstetrics frontliners attending to low-risk births in Malaysia. This study aims to assess knowledge and practices amongst house officers, student midwives and experienced midwives, to determine if those gaps are narrower in this era of evidence-based practice. <strong>Materials and methods</strong>: A previously validated questionnaire was administered to three groups of respondents: house officers, student midwives and experienced midwives working in the obstetrics department and labour room. One section of the questionnaire explored the participants' knowledge of episiotomy based on a single best answer. The other section explored the participants' practices regarding episiotomy. Each response was classified as "correct" or "other", resulting in a 3x2 table for each item, and a chi-squared test was used to compare groups. <strong>Results</strong>:128 respondents from three groups completed the questionnaire. 95.3% of all respondents preferred the mediolateral approach. House officers were the most knowledgeable in anatomy and episiotomy complications. More than 60% respondents of all three groups performed episiotomies on nulliparous women. Medical officers had a significant (p:&lt;0.001) impact on influencing the decision to perform episiotomy amongst house officers. <strong>Conclusions</strong>: Despite knowledge levels and influence by seniors, practice of episiotomy is far from ideal amongst our obstetrics frontline staff. Evidence-based education and workshops with interprofessional education may be the way forward.</p> <p> </p> Nisha Angela Dominic Glenn Jing Yan Lye SA Gunaravi S Sandrasagran VJT Arasoo R Jeganathan M Sood Copyright (c) 2021 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 Understanding How Malaysian Women Appraise their Breast Cancer Symptoms: A Narrative Approach https://journals.iium.edu.my/kom/index.php/imjm/article/view/1712 <p><strong>INTRODUCTION: </strong>Awareness of breast cancer symptoms has made a positive impact on recognition and screening, however there is little research describing how women interpret their bodily changes. This study was conducted to explore how Malaysian women with breast cancer appraise their symptoms and how their interpretation of the symptoms had been shaped by the social norms, knowledge and previous experiences. <strong>Materials and Methods: </strong>14 women with breast cancer were recruited using purposeful sampling. The participants took part in in-depth, one-time, face-to-face, and audio-recorded interviews. All the interviews were subsequently transcribed verbatim and analysed using structure and content of a narrative approach. <strong>Results</strong>: Women interpreted their symptoms based on the physical presentation of the symptoms, previous experiences, and societal norms and beliefs. Some women immediately understood the potential meaning of their breast changes and sought medical opinion, while others waited from one week up to until one year to observe symptoms or normalised them in terms of previous and current experiences. The use of narrative enabled these women to recapitulate particular experiences that had special meaning in order to make sense of their action. <strong>Conclusions: </strong>The way women interpreted their symptoms reflected their understanding on the significant meaning of the symptoms. Acknowledging this symptom appraisal information may assist healthcare professionals in providing appropriate information that can challenge misconceptions, myths, and negative beliefs about breast cancer to improve breast cancer awareness and early detection among the community.</p> <p> </p> Wan Hasliza Wan Mamat Susi Lund Nikki Jarrett Nur Aishah Mohd Taib Sue Duke Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1712 Hypertension among Diabetes Population in Malaysia and its Associated Risk Factors; Findings from National Health and Morbidity Survey 2015 https://journals.iium.edu.my/kom/index.php/imjm/article/view/1639 <p>The prevalence of hypertension and diabetes continue to rise globally. This study aims to examine the national prevalence of hypertension among diabetes population in Malaysia and its associated risk factors. A sub-analysis of data from National Health Morbidity Survey (NHMS) 2015 was conducted among 4229 respondents with diabetes. This data was obtained from respondents aged 18 years and above. Diabetes was defined as those who self-reported to have diabetes or who had fasting capillary blood glucose of ≥6.1 mmol/L or non-fasting blood glucose of &gt;11.1 mmol/L. Hypertension was defined as one who has systolic and diastolic blood pressure of ≥140 and ≥ 90, respectively. The prevalence of hypertension among respondents with diabetes was 57.9% (95%CI: 55.8,60.0). The prevalence of hypertension among diabetes was higher among females (58.7%), ≥60 years old (80.1 %), Chinese (61.1%), those with primary education (69.6%), widow/widower/divorce (75.4%), not working (67.7%), rural residents (60.6%), non-smokers (60.1%), non-drinkers (58.1%), those who were obese (66.0%) and with abnormal cholesterol level (63.5%). Multiple logistic regression analyses revealed that age group, working status, obesity and cholesterol were associated with hypertension among respondents with diabetes. Early detection of hypertension should be an integral part of diabetes management.</p> Hasimah Ismail Thamil Arasu Saminathan Mohd Azahadi Omar Halizah Mat Rifin Tania Gayle Robert Lourdes Wan Shakira Rodzlan Hasani Jane Ling Miaw Yn Nur Liana Ab Majid Ahzairin Ahmad Muhammad Fadhli Mohd Yusoff Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 Risk Evaluation on Security Personnel Managing Illegal Detainees in a Makeshift Covid-19 Low Risk Quarantine and Treatment Centre https://journals.iium.edu.my/kom/index.php/imjm/article/view/1818 <p><strong>Background:</strong>&nbsp; The COVID-19 pandemic situation in Malaysia has resulted in a whole country approach where a newly built makeshift low risk Covid-19 treatment centre was chosen to house all COVID-19 positive illegal immigrants.&nbsp; In view of the desperate situation the detained illegal immigrants were in as the risks of them behaving aggressively, taking hostage, running away and escaping from the treatment centre were high this is the first time ever other governmental, non-governmental and security agencies worked alongside healthcare personnel in a biological hazard treatment centre while the clinical management was of no different than any other clinical setup in the country.&nbsp;&nbsp;</p> <p><strong>Methodology:</strong>&nbsp; This is a semi-quantitative and integrated type of hazard identification, risk assessment and risk control (HIRARC) approach where it incorporates risk rating and severity rating to cover four elements, which are people, property, environment, and reputation.&nbsp; Total scores range from 1 to 25 and was further categorized into low, medium and high risk in a color-coded representation.&nbsp; The assessment was done for two weeks from 27<sup>th</sup> May 2020 till 11<sup>th</sup> June 2020.</p> <p><strong>Result &amp; Discussion:</strong> Four types of occupational and security hazards identified were physical, biological, psychological and ergonomics hazards.&nbsp; this evaluation serves as a good planning tool in optimizing the risk mitigation measures among security personnel working in a biological hazardous environment. Physical hazards with possible violence and riot scored the highest risk while ergonomic issues had the lowest rating.&nbsp;</p> <p><strong>Conclusion:</strong>&nbsp; The mapping combination of existing hazard, risk rating and control was able to facilitate organization to prioritise future planning.&nbsp; With the fluidity of the COVID-19 pandemic, periodical evaluation is recommended to meet dynamic changes such as demands for frontliner manpower strength, the number of existing detainee patients in ward and the evolution of the COVID-19 infection itself to maintain safety and security for all.&nbsp; &nbsp;</p> Mohammad Farhan Rusli Anita Abd Rahman Mohd Arshil Moideen Erlendawati Mohd Anuar Fuad Ridha Mahabot Wan Mohd Harith Wan Mustapha Md Anuar Abd Samad@Mahmood Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1818 Optimal dose of granisetron in reducing the incidence and severity of pruritus post intrathecal morphine for Caesarean deliveries https://journals.iium.edu.my/kom/index.php/imjm/article/view/1655 <p><strong>INTRODUCTION</strong>: Pruritus is one of the common side effects observed after intrathecal morphine (ITM) especially among parturients. Granisetron, a 5-HT<sub>3</sub> antagonist has been shown to reduce this side effect. <strong>MATERIAL AND METHODS</strong>: This prospective randomised double-blind control trial compared two different doses of granisetron for anti-pruritic efficacy. One hundred and twenty parturients with a singleton uncomplicated pregnancy undergoing Caesarean section received spinal anaesthesia with ITM 0.1 mg. After the delivery of baby, they were randomised to receive either granisetron 1 mg (Group 1) or 3 mg (Group 2). The severity of pruritus was assessed within 24 hours at different intervals and were graded. <strong>RESULTS:</strong> Patients demographic and clinical characteristics were comparable between the two groups. The incidence for pruritus between Group 1 and 2 was 63.3% and 65.0% respectively with p value of 0.849 with a proportion of difference of 1.7%. Similarly, the severity of pruritus at different intervals, the need for rescue treatment and patient satisfaction for both groups were not statistically significant. <strong>CONCLUSION:</strong> Granisetron 1mg is effective when given as prophylaxis in reducing the incidence, severity and the need for rescue treatment in ITM-induced pruritus among Caesarean delivery patients.</p> Chong Ling Tong Joanna Ooi Esa Kamaruzaman Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1655 Massive Open Online Course (MOOC) in Continuous Nursing Education (CNE): Contributions and Challenges: A Review https://journals.iium.edu.my/kom/index.php/imjm/article/view/1913 <p>becomes an important aspect of the health care system and the growth in quality of health care education process. Continuous nursing education (CNE) is a lifelong professional development to enhance the knowledge, skills and attitude of nurses for the development of nursing practice, education, administration and research. The development of massive open online course (MOOC) which is an e-learning platform, has changed the approach of continuous education. However, the pedagogy in MOOC CNE is still under-developed. Although numerous roles for MOOC have been proposed in both in and out campus for nursing programs, a clear rationale for their effectiveness is still nascent. This review attempts to explore MOOC and its contributions and challenges in CNE. Literature search was conducted on articles published between 2010–2020 in Ovid MEDLINE, Embase Ovid, Ovid Emcare and CINAHL Plus databases, ScienceDirect, Web of Science, ProQuest and the Google Scholar whereby only English-language and peer-reviewed journal articles were included. Eight articles were selected for review and three aspects were extracted: i) history of MOOC, ii) characteristics of MOOC in health care, and iii) its contributions and challenges to lifelong learning as well as CNE. The findings provided valuable insights about MOOC based CNE as an inspiring approach that holds a great potential to offer credible, cost-effective and readily accessible contents to the health care providers</p> Khin Thandar Aung Noor Azizah Mohd Ali Muniyati Musa@Mohd Zaid Nurul Jannah Shaharzan Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1913 The Impact of Cognitive Intervention on the Cognition of Adults Over 50 with Mild Cognitive Impairment (MCI) in Asia: A Systematic Review https://journals.iium.edu.my/kom/index.php/imjm/article/view/1837 <p>The cognitive intervention for the ageing population is growing rapidly. This review aimed to explore the impact of cognitive intervention on the cognitive abilities among adults over 50 with mild cognitive impairment (MCI) in Asia. Articles on randomised controlled trials (RCT) studies published between 2010 and December 2020 in PubMed, Science Direct, Web of Science, and Scopus databases were searched. A total of 13 studies were included in this review for further analysis. The results showed that cognitive training can be effective in improving the cognitive function in adults with MCI in various aspects, including memory, attention, executive functioning, reducing subjective memory complaints, and improving daily living skills. The findings indicated that different modalities of cognitive intervention, namely single-domain, multi-domain, and multimodal modalities could be a promising intervention in improving the overall cognitive abilities of adults with MCI in Asia. The single-domain cognitive intervention was influenced by the far transfer effect that improved other untrained cognitive areas. Both multi-domain and multimodal cognitive interventions showed improvement in the global cognitive function and transfer effect on the non-cognitive areas such as daily activities and mood. Future review could explore the impact of intervention duration on cognitive abilities and the transfer effect for each modality to understand the ideal intervention package for adults over 50 with MCI in Asia.</p> Nor Afifah Aziz Ponnusamy Subramaniam Shazli Ezzat Ghazali Wani Amira Mustafa Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1837 Oral Health and Cardiac Rehabilitation: A Scoping Review https://journals.iium.edu.my/kom/index.php/imjm/article/view/1811 <p>This scoping review aimed to gain an insight into the oral health status, behaviour, knowledge, and risk among cardiovascular patients, as well as to explore challenges and to make a recommendation concerning oral health and cardiovascular patients. It focused on four key areas, namely oral health status, behaviour, knowledge, and associated risk factors. Relevant studies were searched using a combination of keywords and related search terms. Four available databases were used; EBSCOhost, Scopus, Proquest, and Pubmed to identify the relevant studies. A total of 789 papers were screened and duplicated papers were removed, 28 papers were retrieved for full-text review. It was found that most cardiovascular patients have poor oral health, while their oral health behaviour and knowledge were at a fair level. There are a limited number of studies assessing oral health conditions during cardiac rehabilitation. In general, protocol and guidelines about the importance of oral health care for cardiovascular patients are still lacking. Having good oral health has potential impacts in reducing the risk of CVD. Future research is warranted with potential intervention approaches to improve oral health conditions among cardiovascular patients, thus reducing the risk of CVD.</p> Normaliza Ab Malik Saari Mohamad Yatim Leonard Sheung Wai Li Asri Rangga Abdullah Ramaiah Copyright (c) 2022 IIUM Medical Journal Malaysia 2022-04-01 2022-04-01 21 2 10.31436/imjm.v21i2.1811