IIUM Medical Journal Malaysia

Knowledge and Confidence Level among Emergency Healthcare Workers in Airway Management and Resuscitation of Suspected Covid-19 Patients: A Cross-Sectional Study in Penang and Kelantan

Mon, 01 Apr 2024 00:00:00 +0800

INTRODUCTION: COVID-19 cases in Malaysia have followed a never-ending course of spike and fall since it was first detected. Though the prominent role of infection control standard precautions were strictly applied, cases among emergency healthcare workers (EHCW) contracting the disease continue to rise. Our study aims to evaluate the knowledge and confidence level and the factors that may influence the knowledge and confidence level among EHCW in airway management and resuscitation of suspected COVID-19 patients. MATERIALS AND METHODS: This was a cross-sectional study conducted in tertiary hospitals in Penang and Kelantan using a validated questionnaire. The territories evaluated include the possible method of transmission, proper steps during resuscitation, airway management and intubation, intensive care management, and etiquette of personal protective equipment. RESULTS: Out of 543 EHCW eligible for the study, only 300 participants responded to the questionnaire. Our study showed only 15.3% of respondents had good knowledge and 62.3% had high confidence in airway management and resuscitation of suspected COVID-19 patients. Significant associations were seen in knowledge and confidence level among respondents with previous experience attending continuing medical education (F=7.041, P=0.008 and F=19.398, P<0.001 respectively). Significant associations were also demonstrated in confidence level among respondents with previous simulation training experience (F=13.905, P<0.001). CONCLUSION: Our study revealed that most EHCW had poor knowledge and moderately adequate confidence in the airway management and resuscitation of suspected COVID-19 patients. A more comprehensive and strategized training program needs to be conducted to help in improvement of the knowledge and confidence level among EHCW.

Reappraisal of the Use of X-Rays in Acute Ankle and Midfoot Injuries. A Prospective Evaluation of the Ottawa Ankle Rules (OAR) in a Single Tertiary Trauma Centre

Mon, 01 Apr 2024 00:00:00 +0800

INTRODUCTION: Acute ankle and foot injuries commonly present to the emergency departments, often resulting in routine radiography referrals, despite the fact that less than 15% of cases exhibit clinically significant fractures. The OAR has been designed to reduce the number of unnecessary radiographs ordered for these patients. We evaluated the OAR for predicting ankle and midfoot fractures in a cohort of patients treated in a single tertiary trauma centre. MATERIALS AND METHOD: A prospective study was conducted in the emergency department and orthopaedic clinics of a tertiary trauma centre. 73 patients aged 18 years and older were recruited during a 12-month study period. Radiographs were performed for all patients after clinical evaluation findings were recorded. The main outcomes measured were sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios (positive and negative) of the OAR. RESULTS: 41 patients had ankle injuries, 21 around the midfoot, and 11 within both areas. In detecting ankle fractures, OAR had a sensitivity of 100%, a specificity of 73.68%, and a negative predictive value of 100% compared to the detection of midfoot fractures (100%, 84.61%, and 100%, respectively). The OAR had the potential of reducing radiographs by 42.47%. CONCLUSION: OAR is an accurate and highly sensitive tool to detect ankle and midfoot fractures. The implementation would lead to a significant reduction in the request for radiographs without missing any clinically significant fractures, thus, reducing costs, radiation exposures, and waiting times.

Understanding the Motives and Intention of Blood Donation during the Pandemic

Mon, 01 Apr 2024 00:00:00 +0800

INTRODUCTION: In every country, an adequate and reliable blood supply can be assured by a stable base of regular, voluntary, and unpaid blood donors. However, with the strike of COVID-19 around the world, fewer donors have come forward to donate blood since the government's movement control order. Therefore, to ensure the blood supply is always sufficient, this study discussed the Malaysians' motivation and intention to donate blood during the COVID-19. MATERIALS AND METHODS: The structural focus group discussion was conducted among nine informants. The informants are classified into four groups, which are non, first-time, regular, and lapsed (repeated/occasional) blood donors. RESULTS: It indicated that the regular and lapsed group of blood donors were motivated by the satisfaction of donating blood. Meanwhile, first-time donors are motivated to donate blood because of extrinsic rewards. However, the donors attested that the movement control order restricted their movement to go to the blood transfusion center. On the other hand, the non-donor group admitted that they do intend to donate blood. Still, several factors such as work commitment, location, and fear of being infected by COVID-19, hold them from doing so. CONCLUSIONS: These findings will serve as insights for future blood donation disruption remediation, especially during unexpected situations, as well as the success of the Malaysian blood campaign.

LPA Gene Copy Number Variation and APOE Gene Polymorphism in Young Acute Myocardial Infarction

Mon, 01 Apr 2024 00:00:00 +0800

INTRODUCTION: An early onset of acute myocardial infarction (AMI) and a strong family history suggest the possibility of its genetic predisposition. Lipoprotein(a) (LPA) and Apolipoprotein E (APOE) genes are known to be involved in lipid metabolism which may contribute to the development of atherosclerosis leading to AMI. This study aims to assess the association between LPA gene copy number variation (CNV) and APOE gene polymorphism in young AMI patients. MATERIALS AND METHODS: A total of 40 DNAs were extracted from the buffy coat. APOE genotyping and detection of LPA gene CNV were performed using multiplex PCR technique and digital PCR. After tabulation of the results of the current study, meta-analyses were performed from selected studies among Asian populations using the Comprehensive Meta-analysis version 3 software program. RESULTS: No significant association was found between CNV of the LPA gene and the polymorphism of the APOE gene with Young AMI patients in the current study. However, our meta-analysis confirmed that the E4 allele increased the risk for CAD with the E3/E4 genotype [p=0.000, OR= 1.60 (95% CI: 1.41-1.83) significantly increased risk of CAD and individuals with E3/E3 genotype [p=0.000, OR=0.73 (95% CI: 0.66-0.81) were protective against CAD. The gain of LPA CNV was higher in YAMI [n=5 (25%)] than in control [n=2 (10%)] but they are not significant. CONCLUSION: There is no association between the LPA gene CNV and the presence of APOE polymorphism in young AMI, but our meta-analysis confirmed that the E4 allele increased the risk for CAD.

Radiological and Clinical Outcome of Thoracolumbar Burst Fracture Following Short Segment and Long Segment Pedicle Screw Fixation

Mon, 01 Apr 2024 00:00:00 +0800

INTRODUCTION: The indications for operative treatment and type of stabilization procedures for the treatment of thoracolumbar fracture remains controversial. Long-segment pedicle screw fixation permits correction of kyphotic deformity while short-segment pedicle screw fixation preserves motion segments, reduces costs and time of surgery. Our aim is to study the correlation and comparison between clinical and radiological outcome of both fixations and identify factors that might contribute to the outcome. MATERIALS AND METHODS: 60 patients with thoracolumbar spine fracture from 2017 to 2022 were identified. Age, gender, mechanism of injury, classification of fracture, duration of hospital stays and one-year post-operative outcome of Visual Analogue (VAS) pain score, and Oswestry Disability Index (ODI) score were documented. Pre- and post-operative AP/Lateral radiographs measurements of local kyphotic angle, Cobb angle were measured. Signs of fixation failure were examined at follow-up. RESULTS: Subjects mean age is 42.4, male predominance (85%) and work-related. The highest incidence was at level of L1 (56.7 %) in the long-segment and 46.7 % in short-segment. Most common injury was burst fracture (AO classification A3 A4 group) due to fall from height. There is shorter hospital stay documented in the short-segment fixation. Radiological outcome measured in both groups were comparable with no signs of fixation failure. Short-segment fixation group also resulted in better clinical and functional outcome at one-year follow-up. CONCLUSION: There is no significant difference in radiologic outcome of Cobb and kyphotic angle in both fixation groups. Short-segment fixation has significantly better clinical and functional outcome post-operative and at 1-year follow up.

Factors Associated with Intention to Report Child Abuse among Early Childcare Providers in North-eastern Preschools, Malaysia

Siti Mariam Ja’afar , Wan Nor Arifin, Azriani Rahman — Mon, 01 Apr 2024 00:00:00 +0800

INTRODUCTION: Despite the rising number of child abuse in Malaysia, there are only few studies documenting early childcare providers' (ECPs') intention to report child abuse. ECPs play a vital impact because they closely interact with the children and nearly daily observe them. They should take the lead in ending the cycle of abuse in order to safeguard the children. The aim of our study was to determine the factors that influence ECPs' intentions to report child abuse. MATERIALS AND METHOD: 457 ECPs working in preschools registered under the Community Development Department in Kelantan, the North-eastern part of peninsular Malaysia participated in a cross-sectional study utilising the Early Childhood Educators Child Abuse Questionnaire (ECECAQ) in Malay, which has been validated. RESULTS: Increasing knowledge was significantly associated with the intention to report to the authorities as revealed by multiple logistic regression. CONCLUSION: Our findings justify the need for a comprehensive module and integrated standardized training on child abuse for ECPs in Malaysia to improve their knowledge, thus empowering them to report any child abuse case.

Dual Method P6 Acupressure Therapy for Nausea and Vomiting during Early Pregnancy in Indonesia: A Mixed Method Study

Tuti Meihartati, Zatul Akmar Ahmad, Leny Suzana Suddin — Mon, 01 Apr 2024 00:00:00 +0800

INTRODUCTION: Nausea and vomiting during pregnancy (NVP) are not only considered to be a sign of discomfort both culturally and clinically but also seen as potential safety risks for mothers and their unborn children. One of the non-pharmacological complementary therapies was the use of acupressure. The purpose of this study was to assess the effectiveness, safety, and satisfaction of the dual method of P6 acupressure as an intervention in affected pregnant women to reduce NVP and explore the method P6 acupressure perception as the intervention of choice in the treatment of nausea and vomiting in pregnancy. MATERIALS AND METHOD: A mixed-methods sequential explanatory study was conducted which consisted of two phases: quantitative followed by qualitative. The first phase involved the recruitment of 120 pregnant women with moderate to severe NVP symptoms. Six participants were in the intervention group qualitative phase. RESULTS: The Pregnancy-Unique Quantification of Emesis (PUQE) scores of participants in the intervention group were lower compared to that of the control group after the intervention period (p=<0.01). The PUQE score was found to be reduced in the intervention group of having severe into having mild symptoms. There were no adverse effects reported after the intervention. Majority of the participants were satisfied after using the dual P6 acupressure method (Z=1830, p<0.01).Meanwhile, during the qualitative phase, six themes emerged. CONCLUSION: A dual method of P6 acupressure therapy could be effective, safe, and satisfactory in relieving NVP. Therefore, maternity care providers may consider using this method as a therapeutic alternative for the management of NVP.

Psychosocial Factors Affecting Mental Well-Being of Dental Students: A Qualitative Study

Shea Lim, Salizar Mohamed Ludin, Noraini Abu Bakar, Nadzirah Ahmad Basri — Mon, 01 Apr 2024 00:00:00 +0800

INTRODUCTION: Dental students often faced high levels of mental distress which contributed to lower mental well-being. This has a negative impact on their health and academic performance. Many previous studies focused on students who were already in a 'diseased' state with little focus on students who are well but at risk of developing poor mental well-being. A better understanding of the factors affecting the mental well-being dental students is needed. This study was aimed to explore the factors associated with mental well-being of dental students and to identify steps to promote their mental well-being. MATERIALS & METHODS: In this qualitative study, individual interviews were conducted among undergraduate dental students using semi-structured interview guide. The interviews were recorded, transcribed via verbatim and analyzed using thematic analysis. RESULTS: The analysis revealed three main themes; i) Impression of dentistry, ii) Stressors and iii) Mental health experience. CONCLUSION: Undergraduate dental students often experienced low mental well-being due to the stressors they faced. Identifying the factors that influenced the mental well-being of dental students would allow for early intervention and fostering of mental well-being among dental students.

Prevalence of Antibiotic Use in Hospitalized COVID-19 Patients: An Observational Study in Secondary Healthcare Hospitals in Kosovo

Ilir Tolaj, Hajrullah Fejza, Fitim Alidema, Lirim Mustafa — Mon, 01 Apr 2024 00:00:00 +0800

INTRODUCTION: Globally, the high use of antibiotics among hospitalized patients diagnosed with COVID-19 has been reported despite evidence that bacterial coinfections are uncommon. This issue raised our concerns, as there was a report on high frequency of antibiotic resistant bacterial infections in COVID-19 patients admitted to the intensive care unit. Thus, we conducted a study to determine the prevalence of antibiotic use for hospitalized acute COVID-19 infection in secondary healthcare hospitals in Kosovo. MATERIALS AND METHODS: A cross sectional study was conducted among patients with acute COVID-19 admitted to secondary healthcare hospitals in Kosovo. A modified Infectious Diseases International Research Initiative (ID-IRI) questionnaire was used to collect information in 460 COVID-19 PCR positive patients. RESULTS: All studied patients (100%) were treated with antibiotics. An empirical antibiotics were used to cover Methicillin-resistant Staphylococcus aureus (MRSA) infections in 136 cases (29.6%), methicillin-susceptible Staphylococcus aureus (MSSA) infections in 86 cases (18.7%), atypical pathogen in 174 cases (37.8%), and Pseudomonas infections in 48 cases (10.4%). The most frequently used antibiotics were ceftriaxone/cefotaxime plus macrolide (149 cases; 31%), ceftriaxone/cefotaxime plus quinolone (85 cases; 17.7%), and co-amoxiclav plus fluoroquinolone (78 cases; 16.3%). Imipenem was most frequently used in the ICU (64 cases; 13.3%). CONCLUSION: Despite the antibiotic guidelines clearly stated that antibiotics should only be used in confirmed case of secondary bacterial infections including the COVID-19 patients, our study revealed that the overused of antibiotics remained unchanged. As the misused and overused of antibacterial has been shown to accelerate the emergence and spread of antibacterial resistant, the inappropriate practice should be changed.

Implementation of Video Modeling Animation on Toilet Training Ability in Autism Spectrum Disorders

Septian Andriyani, Suci Tuty Putri — Mon, 01 Apr 2024 00:00:00 +0800

INTRODUCTION: Toilet training is critical for the quality of life of individuals with autism spectrum disorders (ASD) and other developmental disabilities. This is essential because an individual with ASD is often late to acquire these skills or fails to do so. This study aims to identify and analyze the implementation of animation video modeling (AVM) to improve toilet training abilities in children with autism spectrum disorders. MATERIALS AND METHODS: The research uses a quantitative descriptive approach with an experimental research design using One Group Pretest Posttest Design. The pretest was carried out before the intervention, and the posttest was carried out after the AVM gave toilet training intervention. The sampling technique was in the form of total sampling, namely 50 children(43 boys and 7 girls) with autism. The research instrument was a checklist of statements. Data analysis using the Wilcoxon Sign Rank Test. RESULTS: The results showed that almost half of the ability levels of children with autism before being given AVM toilet training were in a suitable category, nearly half of the children with autism after being given treatment were in a good type with a p-value 0.011; there was a significant difference in the level of ability before and after given an AVM. CONCLUSION: AVM is one of the effective interventions to improve toilet training abilities in children with ASD. AVM can help children in the elimination process that can be done independently in improving the quality of life in children with autism.

Translation and Validation of the Malay Version of Modified Vaccine Hesitancy Scale (MVHS-M) for Assessment of Parental Vaccine Hesitancy

Mon, 01 Apr 2024 00:00:00 +0800

INTRODUCTION: Parental hesitancy towards routine childhood vaccines has been recognized as one of the public health threats. Since the uptake of child vaccination remains inconsistent, there is a need for a reliable and validated tool to measure this phenomenon. MATERIALS AND METHODS: A cross-sectional study was conducted at government health clinics in Kelantan between April 2023 to July 2023. A permission to use the original version of Modified Vaccine Hesitancy Scale (MVHS) was obtained and translated into the Malay version (MVHS-M) based on established guidelines. Parents who have at least one child aged 7 years or less were recruited by using systematic random sampling to validate the MVHS-M. A confirmatory factor analysis (CFA) was used to confirm the latent domain, while reliability was measured by composite reliability and test-retest. The data were analysed using IBM SPSS Version 26 and Mplus version 8. RESULTS: A total of 270 parents who fulfilled the study criteria were selected and completed the survey. The CFA showed a good fit index: RMSEA = 0.057 (90% CI 0.031, 0.082), CFI = 0.970, TLI = 0.957, and SRMR = 0.031. The composite reliability for the domain "lack of confidence" was 0.93 (95% CI 0.91, 0.94), while the domain "risk" showed a reliability of 0.74 (95% CI 0.69, 0.79). The test-retest reliability, as measured by the Intra-class Correlation Coefficient (ICC), was 0.77 (95% CI 0.59, 0.87), indicating good stability. CONCLUSION: MVHS-M is a valid and reliable tool that will be useful in identifying parental vaccine hesitancy in Malaysia.

In Vivo Studies of Lepidium meyenii or Maca in Animal Models of Diabetes Mellitus and Other Metabolic Syndrome-Related Diseases- A Scoping Review

Mon, 01 Apr 2024 00:00:00 +0800

Lepidium meyenii or Maca is a Peruvian plant that belongs to the Brassicaceae family. Maca has various attributed health benefits due to the diversity of its bioactive compounds. Studies reveal that Maca is effective for many purposes including in the treatment of diabetes mellitus (DM) and other metabolic syndrome-related diseases. This review aims to uncover previously identified underlying anti-diabetic effects of Maca as well as its potential in the treatment of other conditions linked to metabolic syndrome in animal models in vivo. A scoping review of the literature was conducted using a protocol by Arksey and O’Malley. The protocol centred on the identification of research questions, identification and selection of relevant studies, data charting and collating, summarizing, and reporting the findings. Searches were conducted using Semantic Scholar, Scopus, PubMed Central, and ScienceDirect. Six studies were included in the review. The studies varied in terms of purpose, methodology, and detail of findings. They include the administration of Maca in different types of animal models and its effect on several biochemical parameters. There is fundamental scientific evidence from this review that supports the anti-diabetic properties of Maca in animal models of DM and other metabolic syndrome-related diseases. However, the scarcity of reports indicates the need for more rigorous studies in the future.

The Association between Religiosity and Hba1c Level in Patients with Type 2 Diabetes Mellitus: A Systematic Review

Muhammad Luthfi Adnan, Riana Rahmawati — Mon, 01 Apr 2024 00:00:00 +0800

Glycemic control poses a challenge in the management of type 2 diabetes mellitus (T2DM). Religiosity can influence a patient’s coping strategies with the disease. However, the relationship between patient religiosity and glycemic control has not been thoroughly explored. In this systematic review, we assessed the relationship between religiosity and glycemic control in patients with T2DM. Using PubMed and Google Scholar, we included articles published in English from 2011 onwards that quantitatively examined religiosity and its relationship with glycemic control based on the glycated hemoglobin (HbA1c) levels. Four studies from four different countries were included, employing varying measurement tools to assess religiosity. The HbA1c level was significantly related to the Diabetes Fatalism Index (p<0.05) and with general gratitude and gratitude to God, as assessed using the Multidimensional Measurement of Religiousness. Religiosity may alleviate stress-related diseases and enhance diabetes care. One study showed a relationship between the HbA1c levels and the Beliefs and Values score amongst Muslims only. Two studies reported a significant correlation between religiosity and HbA1c levels. Reducing fatalistic beliefs and improving gratitude to God could be a viable strategy for helping patients manage T2DM. Further studies are needed to promote such an approach in T2DM management.

Postgraduate Clinical Specialist Training in Malaysia: At A Crossroads

Prof. Dr. Nasser Muhammad Amjad — Mon, 01 Apr 2024 00:00:00 +0800