IIUM Medical Journal Malaysia

Malay Language Translation and Validation of the Seven-item Eustachian Tube Dysfunction Questionnaire [ETDQ-7(M)]

Heng Yao Tan, Asma Abdullah, Ahmad Nordin Afandi , Noor Dina Hashim — Sat, 01 Jul 2023 00:00:00 +0800

INTRODUCTION: Eustachian tube dysfunction (ETD) is commonly left unidentified, and clinicians often had to deal with its consequences. Hence, ETD symptoms should be routinely explored to unmask the diagnosis. The seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) is a user-friendly and disease-specific instrument introduced by McCoul et al. to assess the severity of ETD symptoms and treatment effectiveness. However, there is no Malay version of ETDQ-7 [ETDQ-7(M)] available for local population. This study aims to translate and validate the ETDQ-7 in Malay language. MATERIALS AND METHODS: The ETDQ-7 was translated and culturally adapted into Malay language. 68 adult patients with ETD and 68 healthy patients who served as control completed ETDQ-7(M). It was repeated on patients with ETD after two weeks. Statistical analysis was performed to determine the psychometric properties of ETDQ-7(M). RESULTS: ETDQ-7(M) displayed excellent internal consistency (Cronbach’s α = 0.93) which is comparable to the original questionnaire. There was excellent test-retest reliability (r= 0.86 – 0.99). No significant difference in total scores was observed between the first and second evaluations. The mean total score for patients with ETD and control group was 25.8 and 8.4 respectively. Discrimination between ETD and control group using a cut-off point of 13.5, yielded sensitivity and specificity of 100% respectively (area under curve=100%). CONCLUSION: ETDQ-7(M) is a validated questionnaire recommended for use in the management of ETD as a diagnostic tool and in treatment monitoring with excellent reliability and validity.

Patterns of Breastfeeding Practices among Mothers in Two Urban Cities in Vietnam

Sat, 01 Jul 2023 00:00:00 +0800

INTRODUCTION: Breastfeeding is associated with lower risk of child morbidity and mortality and foster overall child development. However, suboptimal breastfeeding practices have been reported in many countries. This study aims to describe patterns of breastfeeding from birth to 24 months in Vietnam and examine factors associated with the maintenance of breastfeeding at 12 months. MATERIALS AND METHODS: 573 mothers whose infants aged from 12 to 24 months in a multi-centre cross-sectional study were recruited. RESULTS: The prevalence of initiation of breastfeeding within the first hour post-partum was 52.9%, between 1 to 24 hours was 21.9%, after the 24 hours was 25.2% and none not initiated by the 7th day after birth. The prevalence of delayed initiation of breastfeeding was significantly higher in caesarean section than in vaginal births (p=0.0001). Prevalence of infants ever breastfed was 100%; exclusively breastfed at 6 months was 19.7%, continued breastfeeding at 12 months was 92.5%, and continued breastfeeding at 20-24 months was 43.5%. There were 16.4% of mothers had breastfeeding problems. Correctly describing the recommended duration of exclusive breastfeeding and not using a bottle to give expressed milk to the infants were factors associated with the higher prevalence of breastfeeding maintenance for 12 months. CONCLUSION: Early initiation of breastfeeding and exclusive breastfeeding prevalence at 6 months in our study earn rating of “good” and “fair” respectively according to World Health Organization (WHO) recommendation. Improving mothers’ knowledge of exclusive breastfeeding recommendations and educating about breast milk expression may improve the prevalence of breastfeeding maintenance at 12 months.

Knowledge and Attitude on COVID-19 Appropriate Behavior among Frontline Healthcare Workers in a Tertiary Care Hospital: A Cross Sectional Study

Alka Gore, Randhir Dhobale, Vivek Behere, Sanjay Quraishi, Girish Dhumale — Sat, 01 Jul 2023 00:00:00 +0800

Introduction: Frontline healthcare workers (HCWs) are at higher risk of Covid-19 infection compared to general population. Adherence to COVID-19 preventive measure is an important factor in reducing the risk of exposure to the HCWs. Thus, we conducted a study to evaluate the knowledge and attitude toward COVID-19’s preventive measure among the HCWs. Material and Methods: We performed a cross-sectional study among HCWs in COVID care center of Bharati Hospital, Sangli, between June 2021 to December 2021, A validated self-questionnaire on the knowledge of hand-washing and donning-doffing, as well as the attitude towards covid-19 appropriate behavior was administered to the HCWs. A statistical analysis was performed using a Microsoft Office 365 and SPSS-22. Results: Evaluation of knowledge on hand-washing and donning-doffing shown that majority of study participants had an average knowledge (77.12%), whereas only 7.7% had good knowledge and another 14.9% had poor knowledge. Knowledge of HCWs were significantly associated with donning-doffing training (p <0.05). Majority of study participants (94.29%) demonstrated an appropriate behavior to COVID-19. Conclusion: As the study demonstrated an average knowledge on Covid-19 appropriate behavior after receiving a training, a periodic training on infection control and prevention in a healthcare setting and orientation programs related to COVID-19 appropriate behavior is indicated.

The Perception of Doctor Bullying by Patients and Relatives at Malaysian Emergency Departments in Regional Referral Hospitals

Kavita-Jetly ., Arvinder-Singh HS, Amar-Singh HSS — Sat, 01 Jul 2023 00:00:00 +0800

INTRODUCTION: Bullying can occur in terms of physical, verbal, mental, sexual, and/or litigation. The main objective of this study was to determine the prevalence of Emergency Department (ED) doctors being bullied by patients and/or relatives, the types of bullying faced and the Post-Traumatic Stress Disorder (PTSD) it may have caused them. MATERIALS AND METHODS: This was a cross-sectional study conducted in all 14 Malaysian state-tertiary government EDs. EDs were chosen as they encountered the maximum number of patients in hospitals. Data was obtained electronically among doctors randomized in each hospital. A validated questionnaire (POPAS-NZ) was used to determine the act of bullying and the impact of the most distressing event (IES-R scale) to detect PTSD. RESULTS: In total, 316 doctors participated in this study and the majority (98.7%) experienced some kind of bullying (98.1% faced verbal abuse). Among those bullied, 83.7% of doctors reported verbal abuse to be the most distressing event. Most of the preparators of the distressing incident were by accompanying relatives of patients (62.1%). Sexual abuse caused PTSD of concern- high enough to suppress the immune system. The final factors that were deemed to be significant to the mental abuse were age (p=0.03) and gender (p ≤ 0.001). Ladies had 2.69 times the odds (AOR 95% CI:1.57;4.60) to be mentally abused compared to men. Ladies had 5.50 times the odds (AOR 95% CI:1.88;16.11) to be sexually abused compared to men. CONCLUSION: Most doctors who worked in the ED faced bullying- commonest being verbal abuse. Sexual abuse caused the most distressing PTSD

Sleep Disturbances and Sensory Processing among Autism Spectrum Disorder Children

Sat, 01 Jul 2023 00:00:00 +0800

INTRODUCTION: Research on sleep disturbances and sensory processing disorder (SPD) among children with autism spectrum disorder (ASD) has received little attention. Identification of sensory components that cause sleep disturbances among ASD children will guide the therapists to select the best intervention for the condition. This study aims to identify the pattern of sensory processing that is responsible for sleep disturbance among ASD children. MATERIALS AND METHODS: A cross-sectional study was conducted among 55 ASD children between three and 18 years old who participated in the study. SPD was analyzed using Short Sensory Profile (SSP) while sleep disturbances utilized the Sleep Disturbance Scale for Children (SDSC). RESULTS: The subscale of SPD showed a strong correlation with the score for overall sleep disturbances. The subscales SPD are movements sensitivity with a positive association and auditory filtering with a negative correlation association (p<0.05). However, no significant association between total SPD and sleep disturbances (p>0.05) were noted. CONCLUSION: This finding may therefore shed light that SPD and sleep disturbances need to be addressed reciprocally. Increasing the number of participants and battery of tests are required to accurately determine the relationship between SPD and sleep disturbances.

The Effectiveness of Diabetes Conversation Map™ among Insulin Refusal Type 2 Diabetes Mellitus Patients

Rosnani Zakaria, Nur Sharharni Mohd Tahir, Maryam Mohd Zulkifli, Nani Draman — Sat, 01 Jul 2023 00:00:00 +0800

INTRODUCTION: Majority of patients with type 2 diabetes mellitus (T2DM) will eventually need insulin therapy to optimise their blood glucose level. However, there is difficulties in initiating an insulin therapy due to high refusal rate among these patients. Diabetes Conversation Maps (DCM), a tool designed to educate patients with diabetes and their family members is available in Malay language since 2008. Although DCM has been used in certain centres in Malaysia, their effectiveness has not been evaluated. Thus, we have conducted a study to assess effectiveness of DCM compared to standard counselling therapy in T2DM patients who initially refused insulin therapy by assessing acceptance rate post intervention. MATERIALS AND METHODS: A randomized control study was conducted on 88 adults T2DM patients who initially refused insulin therapy in primary care clinics in Johor. A total of 44 patients received group based education using a Malay version DCM whereas another 44 patients received standard individual education. Results were analysed using a Chi-square analysis and the significant result was set at p value of < 0.05. RESULTS: The response rate was 97.7% and there was a significant difference in insulin acceptance between these two groups. Eighty-six percent of T2DM patients in the intervention group education eventually accepted insulin initiation compared to only 11% in the control group (p < 0.001).CONCLUSION: Group education using Malay Diabetes Conversation Map on insulin initiation is effective in increasing acceptance among patients who initially refuse insulin treatment in primary care. We recommend using DCM as part of educational module to improve patient diabetic management.

Psychological Status among the Young Muslim Community in Yogyakarta Province, Indonesia, during the COVID-19 Pandemic

Naufal Arif Ismail, Muhammad Farid Adnan, Ika Fidianingsih — Sat, 01 Jul 2023 00:00:00 +0800

INTRODUCTION: Since the COVID-19 pandemic, psychological well-being has become a growing concern. Coping strategies, including religious activities, are needed to deal with psychological distress. This study aimed to evaluate the prevalence of psychological status and its relationship with religious activities among young Muslims in Yogyakarta province, Indonesia, during the COVID-19 pandemic. MATERIALS AND METHODS: Our cross-sectional study was conducted during the second and third waves of the COVID-19 pandemic in Indonesia. A total of 268 young Muslim from Islamic boarding schools in Yogyakarta province, Indonesia, were included in the study. A selfreported questionnaire containing sociodemographic information, religious activity, and Depression, Anxiety, and Stress Scales-21 (DASS-21) was filled up by the study participants. A descriptive and bivariate analysis was performed accordingly. RESULTS: Out of 312 people screened, a total of 268 participants were included in this study. The majority of participants were male (64.6%), aged between 14 to 18 years (55.2%), studying in high school (53.0%), memorised 1 to 10 juz (section) (79.1%), recited the Al-Quran 1 to 3 hours/day (59.3%), and fasted every Monday and Thursday (47.4%). The prevalence of depression, anxiety, and stress were 24.6%, 46.6%, and 29.1%, respectively. Young Muslims with high religious activities were noted to be less suffering from depression, anxiety, and stress, but it was not statistically significant (p=0.57). CONCLUSIONS: This study reported a high prevalence of depression, anxiety, and stress (from mild to extremely severe) among the young Muslim community in Yogyakarta, Indonesia. Our findings should raise awareness of the educational institutions, government, and public and trigger them to prepare appropriate preventive strategies for psychological distress in the young population.

Development and Validation of an Educational Module on Intimate Partner Violence for Young Adults

Sat, 01 Jul 2023 00:00:00 +0800

INTRODUCTION: Intimate partner violence may occur among young adults. It is influenced by their perceptions and attitudes concerning this violence. This study aims to develop and validate an educational module on intimate partner violence among young adults in Kelantan, Malaysia. MATERIALS AND METHOD: The study was conducted in three phases consisting of needs assessment, development of the educational module, and content and face validation. Face-to-face interviews were conducted with 10 young adults to identify the needs for this module. The module content was based on several guidelines, relevant literatures, and findings from needs assessment. Content validation was done by six experts and content validity index was calculated. Face validation was evaluated by 30 young adults. The percentage of agreement was calculated for each item. RESULT: The educational module contains five units covering the forms, causes, impacts, and supports in preventing intimate partner violence as well as rejecting it and willingness to disclose. The content validity was good, rated as relevant by all the experts. The percentages of participants in face validation who strongly agreed with the items assessed for all the materials ranged between 70% to 93.3%. Additional comments given by the participants were considered and the module was modified accordingly. CONCLUSION: The module has good content and face validity. It can be used to improve perceptions and attitudes toward intimate partner violence among young adults.

Knowledge of Ventilator Care Bundles among Registered Nurses in the Intensive Care Unit at Sarawak General Hospital, Malaysia

Sat, 01 Jul 2023 00:00:00 +0800

INTRODUCTION: Ventilator Care Bundles (VCB) is a group of evidence-based highimpact interventions for mechanically ventilated patients. The study aims to identify the knowledge of VCB among Intensive Care Unit (ICU) nurses at the local hospital in Sarawak, Malaysia. MATERIALS AND METHODS: A quantitative cross-sectional survey was conducted among 30 nurses who worked in the ICU at Sarawak General Hospital, Malaysia. A modified questionnaire with 20 items was used to measure the level of knowledge. Data analysis was performed using the Statistical Package for the Social Sciences Statistics 26.0 for Windows with p< 0.05 was considered statistically significant. RESULTS: The results revealed that 86.7% (n=30) of respondents had a high-level knowledge of the VCB. There is a significant relationship between the level of knowledge of VCB and qualification as a Registered Nurse (p=0.03), ICU post-basic qualification (p=0.02), and level of nursing education (p<0.001). The level of knowledge was significantly related to the level of education (r=0.71; p<0.001), the number of years qualified as a registered nurse (r=0.38; p=0.03), and post-basic qualification (r=0.42; p=0.02). CONCLUSION: The good level of knowledge regarding VCB implementation among registered nurses indicates that they are well-equipped with the proper knowledge for caring for mechanically ventilated patients.

Glyphosate Suppresses the Ability of PON1 to Hydrolyse Oxidized-LDL in the Exposed Farm Workers in Pahang, Malaysia

Sat, 01 Jul 2023 00:00:00 +0800

INTRODUCTION: Paraoxonase 1 (PON1) is a high-density lipoprotein (HDL)-associated enzyme which is known to hydrolyse most pesticides including organophosphates (OPs) and prevent atherosclerosis by inhibiting oxidative modification of low-density lipoprotein (LDL). Glyphosate is one of the common organophosphate pesticides used in agriculture in many developing countries including Malaysia. The aim of this study to is to assess the PON1 ability to hydrolyse oxidized LDL in glyphosate exposed farm workers. MATERIALS AND METHODS: In this cross-sectional comparative study, a total of 103 subjects (53 Glyphosate-exposed and 50 non-exposed) were recruited. Fasting serum samples were analysed for PON1 activities towards substrates paraoxon, phenylacetate, and diazoxon, as well as for lipid profiles and oxidized-LDL (ox-LDL). RESULTS: The results showed lower basal paraoxonase activity [156.96 (58.87) vs 177.06 (66.78)], arylesterase activity [90.06 (17.14) vs 96.92 (23.87)] and diazoxonase activity [850.93 (206.75) vs 990.48 (248.73)] in glyphosate-exposed compared to non-exposed, however, only diazoxonase activity was statistically significant (p<0.05). PON1 activity is not significantly different with different length of period of exposure except for arylesterase. There was also significantly higher (p<0.05) ox-LDL in the exposed group but no significant differences in lipid profiles (p>0.05) between the two groups. The PON1 to ox-LDL ratio which probably reflects the ability of PON1 to hydrolyse ox-LDL were also significantly lower (p<0.05) among the glyphosate-exposed group. CONCLUSION: The results suggested that the decreased PON1 activity in glyphosate-exposed individuals could predispose them to the development of atherosclerosis and coronary artery disease through decreased PON1 ability to hydrolyse ox-LDL.

Correlations of Estimated Serum Small Dense Low-Density Lipoprotein and Isoprostane with Metabolic Syndrome Criteria between Metabolic Syndrome and Non-Metabolic Syndrome Subjects in Selangor

Sat, 01 Jul 2023 00:00:00 +0800

Introduction: Metabolic syndrome (MetS) is a global healthcare burden associated with increased risk of atherosclerosis (ATH). The relationship between atherogenic lipoprotein and oxidative stress biomarkers with clinical risk factors of MetS have not been fully explored. Therefore, the objective of this study is to determine the correlation between small dense low-density lipoprotein (sdLDL-c) and isoprostane (ISP) with MetS criteria and comparing these biomarkers between MetS and non-MetS. Materials and Methods: This was a cross sectional study involving 67 MetS and 43 non-MetS diagnosed by JIS criteria 2009. Demographic details and anthropometric measurements were recorded. Blood samples were collected to analyse serum plasma glucose, direct LDL, calculated sdLDL-c and ISP. Results: Mean serum sdLDL-c and ISP levels were significantly higher among those with MetS compared to non-MetS (1.14+0.44 mmol/L vs 0.87±0.38 mmol/L respectively, p=0.005). Similarly, mean serum ISP concentration was higher among MetS compared to non-MetS (884.40+602.69 ng/L vs 657.89±616.42 ng/L respectively, p= 0.054). sdLDL-c was positively correlated with TG in the MetS (Pearson correlation 0.501, p<.001) whilst HDL-c was positively correlated with sdLDL-c among the non-MetS (Pearson Correlation 0.422, p<.005). Conclusion: This study highlights the correlation between sdLDL-c and TG in among MetS, emphasizing the need to closely monitor and manage TG among this cohort to reduce the risk of ATH. It was also noted that HDL-c showed positive correlation with sdLDL-c among non-MetS. This discordant finding suggests that HDL-c itself may not be causally associated with cardiovascular benefits and that perhaps HDL-c subfractions may be a better approach to determine cardioprotective effects of HDL-c.

Bibliometric Analysis of Global Research on Long-Acting Reversible Contraception and Healthcare Workers

Nur Nabila Jusoh, Tengku Alina Tengku Ismail — Sat, 01 Jul 2023 00:00:00 +0800

INTRODUCTION: Long-acting reversible contraception (LARC) is a feasible solution to reduce unintended pregnancy and abortion rates. Nonetheless, the worldwide prevalence of LARC remains low. The LARC uptake depends heavily on healthcare workers because every LARC insertion requires a clinician’s visit, and they are a trusted source of contraceptive information. The study is aimed to explore the trend and distributions of global publications related to LARC and healthcare workers. MATERIALS AND METHODS: Articles related to LARC and healthcare workers were retrieved from the Scopus database. Eligible publications were limited to research articles, reviews, and conference papers published in the English language with no date restriction. The bibliometric data was analysed using Biblioshiny to obtain distributions in terms of the number of publications, journals, countries, institutions, citations, and keywords. RESULTS: A total of 681 eligible publications related to LARC and healthcare workers were retrieved from the Scopus database between 1967 to 2022. The number of publications was low for the first four decades but increased steadily from 2010 onwards. The leading country in this research area was the United States of America and the majority of the most productive institutions were from this country. Half of the frequently cited publications highlighted healthcare workers’ bias, attitude, and practice on LARC provision to clients. CONCLUSION: This bibliometric analysis can guide scholars to understand the global overview of research about LARC and healthcare workers. It may be useful for health practitioners and researchers who are interested in exploring this research area.

The Difference in Brain Processing Between Animate and Inanimate Beings in Moral Violation: An Electrophysiological Evidence

Chun Ming Chin, Nasir Yusoff — Sat, 01 Jul 2023 00:00:00 +0800

INTRODUCTION: Moral violation is known to elicit negative moral emotions and is associated with the electroencephalography (EEG)-derived P300 wave. However, the neural basis of moral categorisation (immoral behaviors towards animate beings or inanimate beings) has yet to be explored in moral psychology, which may increase knowledge and further understanding of brain function for the rehabilitation process. Thus our study aims to investigate the difference in brain processes between animate and inanimate moral violations. MATERIALS AND METHODS: Twenty-six participants (mean age of 24 years old) were involved in the experimental observation that was held in the Neuroscience Laboratory. In the event-related potential (ERP) session, EEG-derived P300 data were recorded while participants viewed a random series of 200 trials of visual stimuli that were distributed according to the odd-ball paradigm. The trials consisted of three image categories (15% of immoral behaviour toward animate beings, 15% of immoral behaviour to non-animate beings, and 70% of neutral images). Participants also pressed the buttons numbered ‘1’ or ‘2’ while responding to animate beings and inanimate beings, respectively. RESULTS: When compared to neutral images and nonanimate objects, the brain regions that were activated with immoral behavior toward animate beings had the biggest P300 amplitude with stronger neural activation in the temporal and occipital regions. CONCLUSION: Immoral behaviour towards animate beings is associated with greater neural cognition, as reflected by the activation in most brain regions. This discovery contributes to a better understanding of the moral foundation. It could be applied in determining the abnormal pattern of brain function and as a baseline reference to be used in the medical rehabilitation field.

The Efficacy of Patient Controlled Analgesia for Acute Non Traumatic Abdominal Pain in Emergency Department

Nik Hisamuddin Nik Ab Rahman, Kogulan Kanesan — Sat, 01 Jul 2023 00:00:00 +0800

INTRODUCTION: Patient-Controlled Analgesia (PCA) is an intravenous selfadministration of small doses of opioids (such as morphine) using a programmable pump, The goal of PCA is to efficiently reduce patients’ pain at patient's preferred dose and schedule. Thus, we conducted a study to compare patient PCA morphine with intravenous bolus morphine for acute abdominal pain of non-traumatic origin in the emergency department (ED). MATERIALS AND METHODS: A randomised, non-blinded clinical trial was conducted in patients presented with severe acute non traumatic abdominal pain of less than 24 hours requiring opioid analgesic based on numerical pain score of more than seven at triage. The primary outcome was visual analogue pain score (VAS) recorded at 0, 30th, 60th and 120th minutes during the management in the ED and after admission to wards, and the secondary outcomes were total dosage of morphine used and degree of patient satisfaction. RESULTS: A total of 62 participants who fulfilled study criteria were randomized into PCA morphine group or bolus morphine group. The average amount of analgesic used for bolus morphine group was lower compared to PCA morphine (4.23 mg)(s.d 1.89 vs 5.29 mg)(s.d 2.16) (p=0.027). Despite of significant VAS score changes within group analysis, between group repeated measure ANOVA (RMA) VAS score analysis was not statistically significant. [Bolus group (6.7+2.03) compared to PCA group (5.83 + 2.38)](p=0.089). Patient satisfaction was statistically significant for the PCA group [PCA (1.65+0.709) compared to bolus group (2.23+0.920)](p=0.007). CONCLUSIONS: There was no significant difference in pain score reduction between PCA and intravenous bolus of morphine for the management of severe acute non traumatic abdominal pain in ED. However, PCA provided more patient satisfaction and should be considered as an alternative modality of acute pain management in ED.

Adult Moyamoya Syndrome as A Manifestation of Varicella-Associated Cerebral Vasculopathy: A Case Report

Sat, 01 Jul 2023 00:00:00 +0800

Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive large intracranial artery narrowing and development of small vessel collaterals. Moyamoya syndrome (MMS) refers to the angiographic findings of MMD with predisposing medical conditions. Varicella-associated cerebral vasculopathy (VACV) is a severe complication of varicella zoster virus (VZV) infection and its association with MMS is rare in adult. We report on a case of a 55-year-old lady who presented with progressively worsening dysphasia and left lower limb weakness following a week of right herpes zoster ophthalmicus infection. The initial Magnetic Resonance Imaging (MRI) of brain demonstrated features of encephalitis with micro abscesses. Her serial repeated MRI brain imagings subsequently demonstrated worsening of cerebral infarctions with right internal carotid artery stenosis and basal ganglia collaterals suggestive of Moyamoya vasculopathy. This case highlights the rare association of VACV with MMS and should be considered as a potential serious complication in patients with VZV infection.

Management of Deep Neck Infection with Descending Mediastinitis using Video-Assisted Thoracoscopic Surgery

Hui Jean Yap, Irfan Mohamad, Ahmad Zuhdi Mamat — Sat, 01 Jul 2023 00:00:00 +0800

Descending mediastinitis is defined as the spread of oropharyngeal or odontogenic infection into the mediastinum. It occurs uncommonly and has a high mortality rate. Prompt commencement of broad-spectrum antibiotics combined with surgical drainage is crucial to limit further spread of infection. We report a case of extensive deep neck infection in a 66-year-old female which rapidly progressed to the contralateral neck complicated by descending anterior mediastinitis. She underwent a combined transcervical and video-assisted thoracoscopic surgery (VATS) for drainage of abscess and was put on 3 weeks of intravenous antibiotics coupled with another 3 weeks of oral antibiotics. Deep neck infection with descending mediastinitis can be successfully treated with antibiotics and early surgical drainage via a combined transcervical and VATS approach.

Nutritional Rickets in Three Toddlers during Covid-19 Pandemic Lockdown

Yee Lin Lee, Nor Azyati Yusoff, Tzer Hwu Ting — Sat, 01 Jul 2023 00:00:00 +0800

Nutritional rickets is a worldwide problem which has been increasingly reported globally. Three toddlers aged 1-2 years presented in March to April 2021 with bony deformities following one year of national Covid-19 pandemic lockdown since March 2020. All three
patients were breastfed till presentation without formula milk supplementation. Weaning occurred at 4-6 months of age but without proper complementary food intake. All three patients and their nursing mothers were mostly confined indoors during the pandemic
lockdown. Bone metabolic profile and radiological imaging confirmed vitamin D deficiency rickets. All three patients responded well to vitamin D3 treatment and calcium supplementation for 3-6 months duration. Vitamin D deficiency rickets appears to be an
increasing problem in breastfed toddlers following the prolonged movement control order, particularly amongst picky eaters and young children on restrictive diets. Sun exposure and early vitamin D supplementation are crucial to prevent the development of nutritional rickets.

A Case Series of RT-QuIC Positive Sporadic Creutzfeldt-Jakob Disease-First Two Cases from Malaysia

Sat, 01 Jul 2023 00:00:00 +0800

Creutzfeldt-Jakob disease (CJD) is invariably a fatal neurodegenerative disorder that presents rapidly progressive dementia with multifaceted involvement of the nervous system. In this case series, we present case reports of two elderly patients diagnosed with sporadic CJD who presented with rapid progression of cognitive decline and myoclonus. Supportive findings on further investigations included cortical ribboning on diffusion-weighted MRI brain; generalised periodic complexes on electroencephalogram with positive cerebrospinal fluid 14-3-3 and pathogenic prion protein (PrPSc) detection on RT QuIC confirming the diagnosis of sporadic CJD in both cases to a great extent.

The Evolving Management Approach to Musculoskeletal Infection

Prof. Dr. Nazri Mohd Yusof — Sat, 01 Jul 2023 00:00:00 +0800

Construction of Sexual and Gender Minority Identity among Malay-Muslim Natal Females: A Meta-Synthesis

Sat, 01 Jul 2023 00:00:00 +0800

Malay-Muslim identity is the regular norm among Malays in Malaysia; however, this identity has been challenged with the emergence of sexual-and-gender minority (SGM). Even though Malay cultural values and Islamic teachings prohibit same-sex orientation and cross-gender, a SGM group has evolved among Malay-Muslim natal females. This meta-synthesis was conducted to explore the psychosocial factors involved in the construction of SGM and its consequences among Malay natal females in Malaysia using the Sandelowski-Barroso approach. A systematic search of articles was done in the selected databases by using identified keywords between October to December 2020. Twelve full articles were included after proper screening and in-depth reviews. The quality of these articles was assessed independently by two researchers. The articles were then analysed using ATLAS.ti 8 software to group the data into subthemes and themes. Lastly, the effect sizes of each subtheme were calculated. Three main themes were identified: affection seeking, hurtful experience and nurturing influences. Malay natal females also shared consequences following construction of SGM identity which include acceptance from community, continuous conflicts in life and mental health consequences. This meta-synthesis revealed the influences that shape the construction of Malay SGM women. Thus, interventions shall be planned to aid them according to cultural and psychosocial factors.

Periodic Medical Examination: A Systematic Review

Fayiza Manzoor Ahmed, Azimatun Noor Aizuddin, Nor Farah Bakhtiar, Azizan Ali — Sat, 01 Jul 2023 00:00:00 +0800

A periodic medical examination is also referred to as a health screening, an annual health checkup, a preventive health check or a general health checkup. This study aimed to conduct a systematic review in order to identify the techniques, their origin, and conceptual foundation, as well as the instruments or items that were utilised in evaluating views about periodic medical examinations. Three databases were searched using the PRISMA checklist for publication searches from inception to April 2019. Some of the PICO (population, intervention, comparison, outcome) acronym selection criteria that were looked for included: focusing on general health check-ups and involving adults; and is published in peer-reviewed journals from inception to April 2019, with full-text papers available in English. Of the 2,445 articles identified, 340 were examined, and only 15 were finally included in this review. One study used a mixed method and another two qualitative methods, while the rest were quantitative in nature. The Mixed Method Appraisal Tool (MMAT) was used to evaluate the overall quality of each item that was kept. A multi-factorial impact on periodic medical examination is seen in the practice of periodic medical examination. Lack of awareness, self-practice, and compliance with suggestions from healthcare experts might be responsible. As a medical examination is the initial step of a healthcare intervention, action taken at this stage may help in management later, thus maximising the advantages of health check-ups. In order to get the full benefits of periodic health checks, a wide variety of techniques will be required.

The Integration of Islamic Values in Daily Clinical Practice among Healthcare Professionals: A Scoping Review

Muhammad Anas Mahmood, Nazri Mohd Yusof, Sanisah Saidi, Aminudin Che Ahmad — Sat, 01 Jul 2023 00:00:00 +0800

Islam is a major world religion that has a universal system encompassing every aspect of daily human activities. In this regard, Islam also provides principles and values related to the practice of medicine. However, it is not known how much of the practices have been practiced in daily clinical settings. Therefore, this paper aims to chart the overview of the studies and publications that have been done related to the integration of Islamic principles and values being incorporated in clinical practice. This paper is a scoping review. Databases like PubMed, PLOS, BMJ, Cochrane, EBSCo, Emerald, ProQuest, ScienceDirect, Scopus, and ACI were used to conduct the literature search. MeSH terms like “Islam," “religion and medicine,” and “attitude of medical staff” are among the keywords used, along with synonyms like “Islam," “Islamic," “Muslim," “medicine," “clinical," “practise," “healthcare," “professionals," “Islamic medical practise," “doctor," “nurse,” and “healthcare professionals.” The Boolean operators “AND” and “OR” were applied during the search. In addition to databases, manual internet searches were conducted to find relevant papers. The review has found that Islamic concepts and ideals have been sporadically incorporated into medical practice worldwide, whether by Muslim or non-Muslim healthcare professionals. The three key themes related to Islamic practice in medicine: are (a) attitude and character of healthcare professionals, (b) clinical decisionmaking, and (c) holistic spiritual care. There is still a big gap and differences in integrating Islamic values into clinical practice. Further work on defining and constructing a framework for a holistic Islamic medical practice is warranted.

Childhood Vaccine Hesitancy in selected Islamic and Muslim-majority Countries : Result Synthesis from a Scoping Review

Khalsom Samsudin, Rosliza Abdul Manaf, Aidalina Mahmud — Sat, 01 Jul 2023 00:00:00 +0800

Vaccine hesitancy and refusal were linked to various religious beliefs, including Islam. Regardless, there were limited studies which offer insights into the role of religious affiliations and related misconceptions in childhood vaccination refusal and hesitancy in Islamic and Muslim Majority countries (MMC). Therefore, this review identifies the prevalence of childhood vaccine hesitancy and its contributory factors while determining the role of religious beliefs in childhood vaccine hesitancy in Islamic states and MMC. We examined four electronic databases for published studies related to childhood vaccine hesitancy and refusal in Islamic countries or MMC from 2011 to 2021. Results revealed that the prevalence of vaccine hesitancy and vaccine refusal range from 8.0% to 21.0% and 1.0% to 58%, respectively, which was comparable to other countries. Parental reasons contributing towards vaccine hesitancy and refusal include concerns related to vaccine safety, side effects and effectiveness, preference for alternative measure to prevent disease, prior bad experiences, and healthcare system distrust. Religious reasons instigating vaccine hesitancy include concerns that vaccine consists of haram ingredients, beliefs that vaccine is against God’s will, perceptions of vaccine being harmful, influences from religious leaders, and distrust towards religious authorities supporting vaccination. In brief, various factors induce vaccine hesitancy and refusal in Islamic states and MMC. Further studies could provide better insights into the role of religious factors in childhood vaccine hesitancy within local contexts in order to formulate effective interventions to address this issue.