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> en-US <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> imjm@iium.edu.my (Prof. Dr. Nasser Muhammad Amjad, nasser@iium.edu.my) noyu@iium.edu.my (Nurul Afifah Min Hussain, noyu@iium.edu.my) Thu, 01 Jul 2021 10:50:51 +0800 OJS 3.3.0.6 http://blogs.law.harvard.edu/tech/rss 60 Willingness to Pay for Cancer Genetic Testing in a Tertiary Healthcare Centre https://journals.iium.edu.my/kom/index.php/imjm/article/view/1953 <p>INTRODUCTION: Increasing use of predictive genetic testing to address hereditary cancer risk has been commonly assessed by cost sharing practices. Little is known about how demographics, knowledge, attitude and practices may influence these individuals’ willingness to pay for cancer genetic testing. The objective of this research was to determine factors associated with willingness to pay for cancer genetic testing. MATERIALS AND METHODS: A self-administered questionnaire was distributed to 175 respondents in the oncology and day care unit in one of tertiary healthcare centre. The respondents comprised cancer patients, their family members and the community. RESULTS: A total of 117 (66.9%) participants were willing to pay for cancer genetic testing. Ninety three (79.5%) of respondents were willing to pay from their own pocket with a mean of MYR1201.77 (SD976.72) and 95 (54.3%) respondents were willing to pay, shared with insurance. There were significant associations between willingness to pay with status of respondent as patients or family members or community, gender, race, educational level, income, knowledge and attitude. CONCLUSION: This is the first study to evaluate factors associated with willingness to pay not only among cancer patients but also their family members and the community. These findings reveal that majority of respondents believe there is valuable personal benefit based on genetic risk information and they are willing to pay for it.</p> Aizuddin AN, Syed Rusli SAS, Ramdzan AR, Syed Omar SA, Mahmud Z, Abdul Latiff Z, Shah SA, Amat S, Ismail F, Keng WT, Ch’ng GS, Rais H, Aljunid SM Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1953 Thu, 01 Jul 2021 00:00:00 +0800 Interobserver Variability and Distribution of Mammographic Breast Density in Patients with Invasive Breast Carcinoma using the Fifth Edition of BI-RADS Guidelines https://journals.iium.edu.my/kom/index.php/imjm/article/view/1520 <p>INTRODUCTION: Breast density is associated with an increased risk of developing breast cancer. The present study aims to determine the distribution and interobserver variability of mammographic breast density in patients with invasive breast carcinoma, using the fifth edition of BI-RADS guidelines. It is part of a larger study to ascertain the association between mammographic breast density and breast cancer characteristics. MATERIALS AND METHODS: Two radiologists independently assessed 122 mammograms of patients with histologically confirmed invasive breast carcinoma and assigned the breast density to categories A-D based on the fifth edition of BI-RADS guidelines. The interobserver variability was calculated using the weighted kappa coefficient and the level of agreement was determined using the Landis and Koch guidelines. RESULTS: In this study, 55.7% of patients with invasive breast carcinoma were assigned to category B, followed by category C with 36.1%. Only 4.1% of patients were assigned to categories A and D respectively. There was substantial agreement between the two readers’ judgement, k=0.610 (95% CI, 0.523-0.697), p &lt; 0.001 for specific BI-RADS categories. CONCLUSION: Among patients with invasive breast carcinoma, there were more patients with non-dense breasts than dense breasts. Overall, there is a substantial interobserver agreement when radiologists used the fifth edition of the BI-RADS guideline, which is in line with results found in the literature. This suggests that the BI-RADS density classification is an acceptable method and can be reliably used in clinical practice.</p> Siti Soraya Ab Rahman, Luqman Hakim Mohd Kamal, Farah Hani Ab Rahman, Rosliza Ghazali, Emelianah Saidil, Nadeeya Mohamad Nor Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1520 Thu, 01 Jul 2021 00:00:00 +0800 Correlates of Attempts to Quit Smoking: A Hierarchical Multiple Linear Regression Analysis https://journals.iium.edu.my/kom/index.php/imjm/article/view/1676 <p>Background: Smoking is a public health concern that contributes to non-communicable disease fatalities. Nearly five million Malaysians aged 15 years and above are estimated to be smokers. Quitting smoking is complicated and challenging for most smokers to attempt and succeed. Not everyone enjoys it, but some have decided and/or tried to stop smoking completely. This study aimed at identifying predictors of quit smoking attempts. Methods: The researchers designed a cross-sectional study conducted in Samarahan Division, Sarawak, Malaysia. Data from 777 smokers were collected via face-to-face interview using a validated structured questionnaire. A hierarchical multiple regression analysis was performed to determine the factors associated with quit smoking attempts by IBM SPSS version 22.0. A p-value of ≤.05 was considered statistically significant. Results: The average age of the smokers was 43.46 years old, with the male to female ratio of 8.96:1. The median age of starting and being regular smoking were 20 and 23 years, respectively. The hierarchical multiple linear regression analysis revealed that motivation (β=.220, p&lt;.001), intention to quit (β=.148, p&gt;&lt;.001), age at regular smoking (β=.131, p&gt;&lt;.01), gender (β=.088, p&gt;&lt;.01) appeared to be significant predictors of quit smoking attempt. Self-efficacy (β=-.101, p&gt;&lt;.05) had a negative effect on quit smoking. However, nicotine dependency and the age of respondents did not affect smoking cessation. Conclusion: Smoking cessation motivation, intention, and age of regular smokers were associated with quit attempts.Conclusion: Smoking cessation motivation, intention, and age of regular smokers were associated with quit attempts. Therefore, the aim of a future campaign should be to reinforce motivation, increase the level of intention and self-esteem for successful smoking cessation.</p> Muhammad Siddiq, Md Mizanur Rahman, Mohd Faiz Gahamat Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1676 Thu, 01 Jul 2021 00:00:00 +0800 Correlation of E-cadherin Expression in Endometrial Carcinoma with Tumour Grade and Stage https://journals.iium.edu.my/kom/index.php/imjm/article/view/1737 <p>INTRODUCTION: Endometrial carcinoma (EC) is among the common malignancy in the female with adverse prognosis in the advanced stage. Prediction of its prognosis is important in stratifying EC patients to achieve optimum treatment and improve clinical outcomes. This study is aimed to evaluate the prognostic significance of E-cadherin expression in patients with EC. The present study also investigated the correlation of E-cadherin expression in EC with its tumour grade and stage. MATERIALS AND METHODS: A total of 70 cases of EC were included in the study within eleven years comprising 56 cases of endometrioid carcinoma, 2 cases of mucinous carcinoma, 10 cases of serous carcinoma and 2 cases of clear cell carcinoma. E-cadherin expression was immunohistochemically analysed and compared with clinicopathological parameters. RESULTS: E-cadherin loss of expression shows significant association with non endometrioid EC (p=0.003), high tumour grade (p&lt;0.001) and tumour with distant metastasis (p=0.028). Tumour grade is the main predictor of down-regulation of E-cadherin expression (Grade 3: aOR 8.400, 95%CI 2.534-27.842). There was no significant association found between E-cadherin expression with myometrial invasion, FIGO stage, lymph node status and lymphovascular invasion. CONCLUSION: E-cadherin loss of expression correlates with poor prognostic factors namely high grade and high stage (metastasis) EC. This may serve as a potential prognostic marker for EC&gt;&lt; 0.001) and tumour with distant metastasis (p=0.028). Tumour grade is the main predictor of down-regulation of E-cadherin expression (Grade 3: aOR 8.400, 95%CI 2.534-27.842). There was no significant association found between E-cadherin expression with myometrial invasion, FIGO stage, lymph node status and lymphovascular invasion.</p> Lizawati RH, Nur Maya Sabrina TL, Muhammad Fakhri MS, Nordashima AS, Azmawati MN Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1737 Thu, 01 Jul 2021 00:00:00 +0800 Surgeon Performed Ultrasound in Assessing Thyroid Nodule Using American College of Radiology Tirads and Total Malignancy Score (TMS): A Validation Cross Sectional Study https://journals.iium.edu.my/kom/index.php/imjm/article/view/1832 <p>INTRODUCTION: This study aims to evaluate the diagnostic reliability of the American College of Radiology Thyroid Imaging Report and Data System (ACR-TIRADS) and Total Malignancy Score (TMS) scoring system, in differentiating benign and malignant thyroid nodules. MATERIALS AND METHODS: This is a cross-sectional study involving patients with thyroid nodules treated at Hospital Canselor Tuanku Muhriz from October 2017 until October 2019. Ultrasound findings were scored according to the ACR[1]TIRADS and TMS scoring system. They were then correlated with the FNAC or histopathology report. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of both scoring system were calculated for analysis. RESULTS: A total of 150 patients with 223 thyroid nodules were included. 17% or 38 nodules were found to be malignant. The sensitivity, specificity, PPV, NPV and accuracy of ACR-TIRADS and TMS were 97.37% vs. 84.21 % , 52.97% vs. 62.70%, 29.84% vs. 31.68%, 98.99% vs. 95.08% and 61% vs. 66% respectively. According to the ACR-TIRADS, only hypoechoic nodules was a strong predictor of malignancy. Comparatively, in the TMS, strong predictors of malignancy include single nodule, hypoechogenicity, irregular margin, and nodules with peri and intranodular vascularity. CONCLUSION: Both ACR-TIRADS and TMS score had good diagnostic accuracy in predicting malignant thyroid nodule. TMS is comparable and not inferior to ACR[1]TIRADS however, the latter is more practical for use as growth and Doppler characteristic are not included in the assessment.</p> Adi Syazni Muhammed, Randeep Singh, Shahrun Niza Abdullah Suhaimi, Nani Harlina Muhammad Latar Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1832 Thu, 01 Jul 2021 00:00:00 +0800 Trajectory of Change in Erectile Dysfunction Symptoms Following Coronary Artery Bypass Surgery in Malaysian Population https://journals.iium.edu.my/kom/index.php/imjm/article/view/1554 <p>INTRODUCTION: Despite the advantages of Coronary artery bypass surgery (CABG), this procedure has been reported to have a significant impact on sexual activity. The study aims to assess the trajectory of change in erectile dysfunction (ED) symptoms following CABG.METHODS: 73 adult male participants were recruited. Participant primary data was measured using the International Index of Erectile Dysfunction (IIEF-5) at three-time points. RESULTS: Severe ED was most prevalent during 6 weeks following-operation (86.3%); however, the proportion of severe ED symptoms reduced after 4 months following-operatively (42.5%). There was a statistically significant difference in ED symptoms between pre-operatively and 6 weeks post- operatively (p&lt; 0.001). At 4 months, there was a marginally significant improvement in ED symptoms compared to baseline pre-operatively post CABG (p = 0.064). Age significantly increases the chance in odds of having abnormal ED symptoms by 22% at 4 months postoperatively (aOR=1.22, 95% CI=1.06, 1.41, p&lt;0.05). Other risk factors for abnormal ED symptoms following CABG, which include normal creatinine clearance, being a smoker, and having moderate to good LV function was not statistically significant. CONCLUSION: The present study has demonstrated a high prevalence of ED following CABG and the procedure caused a negative impact on the ED symptoms. However, there was a significant improvement in ED symptoms as the time from surgery increases and patients recovered. Further studies with larger sample size and longer recovery time are needed to assess the trajectory of recovery in ED symptoms in this population.&gt;&lt; 0.05). Other risk factors for abnormal ED symptoms following CABG, which include normal creatinine clearance, being a smoker, and having moderate to good LV function was not statistically significant. CONCLUSION: The present study has demonstrated a high prevalence of ED following CABG and the procedure caused a negative impact on the ED symptoms. </p> Katijjahbe Mohd Ali, Nur Ayub, Suriati Mohamed Sani, Muhammad Ishamuddin Ismail, Hairulfaizi Haron, Fahmi Pramaditto Azmi, Mohamad Arif Muhammad Nor, Mohd Ramzisham Abdul Rahman, Mohd Rizal Abdul Manaf Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1554 Thu, 01 Jul 2021 00:00:00 +0800 Parental Experiences in the Management of Children with Syndromic Craniofacial Diagnoses in Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1625 <p>INTRODUCTION: Patients with syndromic craniofacial diagnoses (SCD) require coordinated overall management and remain a parental challenge. This study assessed the parental experience and psychological outcome, as well as the evaluation of professional and community support, received in Malaysia. MATERIAL AND METHODS: The Craniofacial Experiences Questionnaire (CFEQ) was used to assess parents of SCD children registered with the Combined Oro-Craniomaxillofacial Clinic in University Malaya Medical Centre, Kuala Lumpur. RESULTS: Thirty parents participated in this study with their children’s age ranged from 2 months to 14 years old diagnosed with Apert, Crouzon, and Pfeiffer syndromes, as well as other SCD such as Goldenhar, Pierre Robin, and Nager. The majority of parents felt anxious whenever their child underwent an operation despite having positive perceptions of the outcome. Most respondents did not see the condition as handicap although 6.7% of parents were embarrassed by their child’s appearance. The majority of the respondents were worried about the financial implication, had to be occasionally absent from work due to their child’s regular appointments, and felt depressed while only a quarter of respondents socialised less and struggled to meet parenting needs. Most respondents received positive comments, were treated with respect, and obtained adequate support from both health professionals and the community with regards to their childcare. CONCLUSIONS: Although most parents were concerned about their children’s condition, only minimal social stigmatisation was noted. Parents were satisfied with the emotional and physical support received from healthcare professionals and the community. Understanding parental experience may contribute to the improvement of multidisciplinary syndromic craniofacial management.</p> Khairul Bariah Chi Adam, Firdaus Hariri, Norintan Ab Murat, Loh Meii Yin, Muhammad NurHalim Amran Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1625 Thu, 01 Jul 2021 00:00:00 +0800 Undergraduate Students’ Perception on Assessment Experience in a Malaysian Medical School: Comparison among Gender, Ethnicity and Phase of Study https://journals.iium.edu.my/kom/index.php/imjm/article/view/1647 <p style="margin: 0cm; margin-bottom: .0001pt; text-align: justify; background: white;"><span style="font-size: 10.5pt; font-family: 'Segoe UI',sans-serif;">INTRODUCTION: It is a well-known fact that assessment influences learning and study behaviour. Assessment affects what and how students learn, either positive or negative learning behaviour. This study was aimed to determine students’ perceived assessment experience and the comparison among different gender, ethnicity, and phase of the study. MATERIALS AND METHODS: This is a cross-sectional study. Assessment Experience Questionnaire (AEQ) version 3.3 was distributed to 324 undergraduate medical students of Universiti Putra Malaysia. The AEQ score among different gender, ethnicity, and phase of the study was compared using independent t-test and one-way ANOVA. RESULTS: Female students were found to develop a surface approach to learning, learn new things from the assessment, and be satisfied more with the teaching compared to males. Chinese students tended to put higher effort into learning compared to Malay. Clinical students valued more the feedback received and had clearer goals and expectations for their work than preclinical students. However, preclinical students tended to put a higher quantity of effort, learn wider coverage of syllabus and develop a surface approach of learning than clinical students. The respondents commented that feedback is lacking and suggested having more feedback sessions with their teachers after assessment. CONCLUSION: There were different assessment experiences and learning found among different gender, race, and phase of the study. These may affect their academic performance and are probably due to the curriculum setting. Understanding student assessment experience and its impact helps the faculty to improve the assessment structure for a conducive assessment environment and meaningful learning experience for the students.</span></p> Siti Khadijah Adam, Nur Atiqah Mazlan, Shivaprakash Selvakumar, Xian Hui Teh, Faridah Idris Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1647 Thu, 01 Jul 2021 00:00:00 +0800 Sentinel Lymph Node Biopsy in Early Breast Cancer Using the Indocyanine Green Fluorescence Technique: A Validation Study https://journals.iium.edu.my/kom/index.php/imjm/article/view/1751 <p>INTRODUCTION: Introduction: Sentinel lymph node biopsy (SLNB) is now recognized as the standard of care for early breast cancer patients with negative axillary lymph nodes. Various approaches for Sentinel Lymph Node (SLN) identification using either the blue dye method or scintigraphy alone or their combination have been proposed. However, this method is costly and may not be applicable in certain developing countries. SLNB involving the use of indocyanine green (ICG) offers several advantages, and it is valid and safe when in direct comparison with the blue dye method and scintigraphy. Hence, we performed SLNB using this method in early breast cancer as the first center that involves the use of ICG in Malaysia. We performed validation study on this method with the aims to determine its sensitivity and safety profile. MATERIALS AND METHODS: This is a validation and non-randomised prospective observational study involving 20 patients underwent SLNB wherein ICG is used for localisation. The patients were recruited according to the recommendations stipulated in the Malaysia Clinical Practice Guideline. RESULT: The average number of SLNs removed per patient was 4.0 (range, 3–6) with sentinel lymph nodes detection rate at 98.75% (79/80). The false negative rate is at 5%. No adverse events were observed in all cases. CONCLUSION: The ICG fluorescence method is simple, reliable and safe. Moreover, it demonstrates a high SLN detection rate with a low false-negative rate, and it does not require a special instrument for radioisotope use.</p> Loh Soon Khang, Suraya Baharudin, Juliana Abdul Latiff, Siti Aishah Mahamad Dom, Shahrun Niza Suhaimi Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1751 Thu, 01 Jul 2021 00:00:00 +0800 Serum Vitamin D and Immunoglobulin E Levels In Patients With Seasonal Allergic Conjunctivitis https://journals.iium.edu.my/kom/index.php/imjm/article/view/1756 <p>INTRODUCTION: Seasonal allergic conjunctivitis (SAC) is a mild but common immunoglobulin E (IgE) mediated ocular allergy. Low serum vitamin D levels have been related to some allergic disorders but such data in the clinical context of SAC are missing. Our study investigated serum IgE and vitamin D levels in SAC patients. MATERIALS AND METHODS: A cross-sectional case-controlled study was conducted at University of Hafr Al-Batin, Saudi Arabia involving patients with established diagnosis of SAC and age[1]matched healthy control subjects. Standard patient evaluation of eye dryness (SPEED) questionnaire was scored for the frequency and severity of symptoms. Blood samples were taken to quantify serum IgE and vitamin D levels. Mean +- SD were calculated and independent sample t-test was applied for comparison between groups. RESULT: A total of 52 subjects were recruited into the study in which 26 subjects were patients aged between 20-60 years with an established diagnosis of SAC and another 26 subjects were age-matched healthy controls without any allergy. Mean serum IgE, vitamin D level and SPEED scores were significantly higher in SAC patients than in healthy control (2181.09 IU/ml +- 1062.33 vs 54.83 IU/ml +- 26.67; 38.96 ng/ml +- 11.37 vs. 29.47 ng/ml+- 11.73; 19.42 +- 4.81 vs. 2.19 +- 1.49) with p-value 0.001, 0.005, and 0.001 respectively. Mean vitamin D levels in both groups were within normal range. CONCLUSION: Higher serum vitamin D levels may be linked with SAC, but further research is needed to eliminate irregularities in the existing evidence on the influence of vitamin D in SAC.</p> Farhan Khashim Al-Swailmi, Syed Imran Ali Shah, Ghassab Mohammad Al-Mazaideh, Mirza Zeeshan Sikandar Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1756 Thu, 01 Jul 2021 00:00:00 +0800 Optimized Preparation of Urine Samples from Acute Melioidosis Patients for In-Solution Proteomic Studies using LCMS QTOF or MALDI TOF MS https://journals.iium.edu.my/kom/index.php/imjm/article/view/1844 <p><strong>Introduction:</strong> Investigation of urine proteome in patients with acute melioidosis may reveal potential disease markers, from either bacterial or human proteins. We used an in-solution gel-free method instead of 2-DE to detect human and <em>Burkholderia pseudomallei</em> proteins in urine of patients with acute melioidosis. Here, we propose a simpler, economical method for preparing urine samples directly from melioidosis patients, for in-solution proteomic analysis using LCMS-QTOF MS/MS or MALDI-TOF MS/MS. <strong>Material and Methods: </strong>We adapted an acetone-TCA based protein precipitation method with LCMS-QTOF MS to detect the <em>B. pseudomallei</em> proteins directly from urine of acute melioidosis patients (culture positive and negative). This process involves protein precipitation, desalting, trypsin digestion, and optimization for the mass spectrometry. <strong>Results</strong>: A total of 3,866 human peptides were detected across 11 urine samples from clinically suspected acute melioidosis patients. Among them were three <em>Burkholderia</em> specific proteins detected in 75% of culture positive samples. Large amounts of acute phase proteins, cell mediated immunity proteins, complement pathway proteins and inflammatory mediators were seen upon gene ontology (GO) annotation and GO enrichment analysis. <strong>Conclusions</strong>: This simple in-solution sample preparation method can be replicated easily for LCMS/MS-QTOF and MALDI-TOF proteomic analyses, avoiding tedious optimization steps in 2-DE. This method is cost effective and can be done in centres without specialized 2-DE or MS equipment and elutes can be easily transported for analysis and bioinformatics. This is the first study to analyse urine samples directly for <em>B. pseudomallei</em> proteins. Discovery of the entire proteome as a whole is important in leading to biomarker discovery.</p> Aniza Pakeer, Mohammed Imad A. Mustafa Mahmud, Nosrihah Ismail, Vanitha Mariappan Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1844 Thu, 01 Jul 2021 00:00:00 +0800 Preliminary Findings on a Newly Developed Malaysian Multilingual Sentence Repetition Task for Multilingual Chinese Children in Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1704 <p>INTRODUCTION: Even though multilingualism is the basic fabric of linguistic diversity of mainstream communities in Malaysia, there is generally a lack of assessment tool to assess the language abilities of multilingual children at risk of language impairment. This study is aimed at developing a Malaysian Multilingual Sentence Repetition (MMSR) task which can be used to assess the morphosyntactic abilities of multilingual Chinese children speaking three languages i.e., English-Mandarin-Malay. MATERIALS AND METHOD: 10 typically developing Chinese children within the ages of 4 years until 6 years and 11 months old were recruited. Each child was presented with sentences auditorily using a laptop with a microphone headset. The child was then asked to repeat verbatim the sentences they just heard. RESULTS: Findings showed that the subjects performed equally well in English and Mandarin but lower in Malay (p &lt; 0.01). Correlation analyses revealed that the older children performed better for English (p &lt; 0.05) and Mandarin (p &lt; 0.01) sentence repetitions (SRs). Performance on SR tasks decreased with the increase in sentence length and complexity. CONCLUSION: The newly developed multilingual SR task proved reliable and valid as a tool and has the potential to be developed into a standardized test to assess multilingual Malaysian children at risk of language impairment.</p> Rogayah Bt Razak, Cho Kai Shuo Cho, Norsofiah Abu Bakar Abu Bakar Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1704 Thu, 01 Jul 2021 00:00:00 +0800 Mutational Analysis of Quinolone-Resistant Determining Region gyrA and parC Genes in Quinolone-Resistant ESBL-Producing E. Coli https://journals.iium.edu.my/kom/index.php/imjm/article/view/1825 <p>Introduction: Co-resistance to quinolones among extended spectrum β[1]lactamase (ESBL)-producing E. coli commonly occurs in clinical settings. Quinolones act on DNA gyrase and DNA topoisomerase enzymes, which are coded by gyrA and parC genes, thus any mutation to the genes may affect the drug effectiveness. The objective of the study was to characterize gyrA and parC genes in quinolone-resistant E. coli isolates and correlated the mutations with their phenotypic resistance. Materials and Methods: Thirty-two quinolone-resistant (QR) and six quinolone-sensitive (QS) ESBL-E. coli isolates were identified by antibiotic susceptibility and minimum inhibitory concentration tests. Bioinformatics analysis were conducted to study any mutations occurred in the genes and generate their codon compositions. Results: All the QR ESBL-E. coli isolates were identified as multidrug-resistant bacteria. A single point mutation in the quinolone resistance-determining region (QRDR) of gyrA, at codon 83, caused the substitution amino acid Ser83Leu. It is associated with a high level of resistance to nalidixic acid. However, double mutations Ser83Leu and Asp87Asn in the same region were significantly linked to higher levels of resistance to ciprofloxacin. Cumulative point mutations in gyrA and/or in parC were also correlated significantly (p&lt;0.05) to increased resistance to ciprofloxacin. Conclusion: Together, the findings showed that the mutations in gyrA and parC genes handled the institution of intrinsic quinolone resistance in the ESBL-E. coli isolates. Thus, vigilant monitoring for emergence of new mutation in resistance genes may give an insight into dissemination of QR ESBL-E. coli in a particular region.</p> Hairul Aini Hamzah, Rahmatullah Sirat , Mohammed Imad A. Mustafa Mahmud, Roesnita Baharudin Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1825 Thu, 01 Jul 2021 00:00:00 +0800 A Survey Of Perceived Barriers And Motivators Towards Exercise Among People With Parkinson’s Disease In Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1645 <p>INTRODUCTION: Considerable amount of evidence supports that exercise plays a vital role in maintaining and slowing Parkinson's disease (PD) progression. However, some people with PD have remained sedentary for undefined reasons. Therefore, the perceived barriers and motivators towards exercise among people with PD among Malaysian were investigated. METHODS: A cross-sectional survey was conducted using a self-developed and validated questionnaire distributed to forty-seven people with PD in a non[1]governmental organisation to determine exercise barriers and motivators. RESULTS: The exercise motivators in the study were having an exercise instructor (83.0%), exercise makes them feel healthier and more energetic (83.0%), and constant encouragement from family and friends (80.9%). The exercise barriers reported in this study were fatigue (40.4%) fear of falling (34%), bad weather (38.2%), and lack of transportation (31.9%). CONCLUSION: The study concluded that people with PD exercised because it makes them feel healthier and more energetic. Besides that, having an exercise instructor and being encouraged by family and friends reported being exercise motivators among the people in this study. The exercise barriers reported in this study were fatigue, bad weather, fear of falling, and lack of transportation. These findings should be taken into consideration when developing strategies and health interventions to improve exercise participation for people with PD.</p> Rajkumar Krishnan Vasanthi, Alfonsa Choo Kher Ying Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1645 Thu, 01 Jul 2021 00:00:00 +0800 Virulence-genes Rib and Bca in Serotypes of Group B Streptococcus (GBS) Isolated from Symptomatic Pregnant Women in East Coast Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1633 <p>INTRODUCTION: Group B streptococcus (GBS) is a leading cause of maternally-acquired invasive infections in neonates. Nowadays maternal immunization is of utmost demand for prevention of these infections. We undertook capsular serotyping and virulence factor genes identification for local GBS isolates as a pilot study, to identify potential candidates to propagate vaccine development. MATERIALS AND METHODS: This is a descriptive lab -based study to determine GBS serotypes and presence of genes coding virulence factors bca and rib in isolates obtained from symptomatic pregnant women in Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia. Sixty-two GBS isolates from high vaginal swabs were collected. Latex agglutination test was performed to determine GBS serotypes. Real-time PCR was done to determine the presence of virulence genes. RESULTS: Of the 62 GBS isolates, 77.4% were serologically typeable, and 22.6% were non -typeable. Serotypes Ia and Ib (16.1% each) were the most common capsular types, followed by II, V, and VII (9.7% each), III (8.1%), VI (6.5%), and VIII (1.6 %). Furthermore, 67.7% of the isolates harboured the rib gene while 98.4% possessed the bca gene. CONCLUSION: The five known prevalent serotypes worldwide, do not match the CPS distribution in symptomatic pregnant women in Kuantan. However, the frequency of virulence genes rib and bca is high among our isolates, which if confirmed by further bigger and wider studies makes the proteinaceous vaccine, N-terminal domains of Rib and AlpC a suitable candidate for GBS prevention in this geographical area.</p> Ayesha Bahez, Mohammed Imad Al-Deen Mustafa Mahmud, Hairul Aini Hamzah, Hanan Hamimi Wahid Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1633 Thu, 01 Jul 2021 00:00:00 +0800 Burkholderia Pseudomallei Short-Chain Dehydrogenase/ Oxidoreductase: Potential Urine Biomarker Candidate for Acute Melioidosis https://journals.iium.edu.my/kom/index.php/imjm/article/view/1699 <p>INTRODUCTION: In the current climate of urgency in identifying biomarkers for the development of rapid diagnostic kits, the use of urine samples to diagnose acute melioidosis was evaluated, comparing urine samples from Burkholderia pseudomallei culture-positive and culture-negative patients, and comparing pneumonic and septicemic melioidosis. MATERIAL AND METHODS: Eleven urine samples from clinically suspected melioidosis patients from a tertiary referral center, Hospital Tengku Ampuan Afzan, Pahang was used. An in-solution method for the detection of bacterial proteins using liquid chromatography-mass spectrometry quadrupole time-of-flight (LCMS QTOF) was used. RESULTS: Three bacterial proteins were consistently detected among all the culture[1]positive and PCR-positive cases tested, namely SDR family NAD(P)-dependent oxidoreductase protein (32kDa), 3-hydroxyacyl-CoA dehydrogenase Burkholderia sp. (32kDa), and NAD(P)-dependent dehydrogenase (short-subunit alcohol dehydrogenase family) Burkholderia sp. (33kDa). CONCLUSIONS: Short-chain dehydrogenase (SDO) proteins could potentially be a urine biomarker candidate as these have shown to aid in the ability of Burkholderia spp. to invade host cells as this action is important for the initial intracellular survival of the organism.</p> Aniza Pakeer, Vanitha Mariappan, How Soon Hin, Mohammed Imad A. Mustafa Mahmud Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1699 Thu, 01 Jul 2021 00:00:00 +0800 Sociodemographic Impact and Acquaintance on Antibiotic Resistance Among Outpatients in Specialist Hospital, Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1518 <p>INTRODUCTION: Awareness on antibiotics resistance among outpatients in hospital settings is reasonably explored and this study aimed to investigate the sociodemographic impact and the level of acquaintance towards antibiotics practice and resistance. MATERIALS AND METHODS: This cross-sectional study was conducted on 270 patients from the outpatient department of KPJ Seremban Specialist Hospital (KPJSSH), Malaysia. A pre-validated questionnaire was used to collect the data on the demographics of the patients, their knowledge, attitude, and usage of antibiotics. The study was approved by the KPJUC ethics committee (KPJUC/RMC/BPH/EC/2017/104). RESULTS: The mean age of the respondents was 36 ± 11.07 years and 50.37% of them have moderate knowledge on antibiotics. The knowledge and attitude on antibiotics usage exhibited a significant difference (p=0.001) amongst these patients in association with literacy. The results showed that the literate respondents have significant knowledge on the identification of antibiotics (p=0.021), their roles, and adverse effects (p=0.004). The attitude of the respondents towards following the prescription was significantly associated with their literacy (p=0.004). CONCLUSION: This study reveals that respondents have the least knowledge on antibiotic course compliance and termination of therapy, which could lead to antimicrobial resistance. In conclusion, inculcating the knowledge of antimicrobial resistance, adverse effects, and course compliance among the patients may help overcome the national and global issues on multi-drug-resistant diseases.</p> Hanish Singh Jayasingh Chellammal, Mohamed Mansor Manan, Thayashini Kupusamy, Long Chiau Ming, Shafeeq Mohd Faizal Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1518 Thu, 01 Jul 2021 00:00:00 +0800 Vagus Nerve Injury during Continuous Intraoperative Neuromonitoring (cIONM) for Thyroid Surgery: Assessment of Severity https://journals.iium.edu.my/kom/index.php/imjm/article/view/1614 <p><strong>Introduction</strong>: Vocal cord palsy is one of the biggest concern in thyroid surgery especially among the professional voice user. Continuous intra-operative nerve monitoring allows real time of the nerve function during surgery that will reduce risk of injury. The procedure involve is not without complication but meticulous usage and following standard operating procedure is utmost important. This study was aimed looking at the potential morbidity of the procedure.</p> <p><strong>Methodology</strong>: A prospective observational study was conducted on 20 patients who underwent routine thyroid surgery using c-IONM. The procedure of c-IONM follows the standard guidelines. Measurements of vagal stimulation were taken proximal(V3) and distal(V2) to APS electrode to document any injury to the vagus nerve. The blood pressure and pulse rate were also documented through-out surgery, looking at the physiological effect of the stimulation. The function of the vocal cord was assessed by pre and post-operative laryngoscopy</p> <p><strong>Result:</strong> 18 patients with 29 nerves at risk were included as in two patients, the vagal stimulation did not achieve the acceptable amplitude (400 µV). There were drops of amplitude between V3 and V2 in 14 nerve at risks but there was clinical evidence of palsy on laryngoscopy. There were also fluctuation of mean arterial pressure and pulse rate but not significant enough to warrant intervention.</p> <p><strong>Conclusion:</strong> The use of c-IONM during thyroidectomy do exert minimal effect on the vagus nerve and its function but not significant enough to abandoned the procedure. It is safe and able to help the surgeon to identify and preserve the nerve function especially in difficult thyroidectomy</p> Rohaizak Muhammad, Shahrun Niza Abdullah Suhaimi, Nor Faezan Abdul Rashid, Suraya Othman Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1614 Thu, 01 Jul 2021 00:00:00 +0800 Disseminated Cutaneous Mycobacterium Fortuitum-Chelonae Complex Infection in a Young, Immunocompetent Patient: A Case Report https://journals.iium.edu.my/kom/index.php/imjm/article/view/985 <p>Mycobacteria fortuitum and chelonae are a group of Rapidly Growing Mycobacteria (RGM) that can cause skin infections, most commonly in immunocompromised patients. RGM can also infect immunocompetent patients, but the disease is usually localized. Immunocompetent patients infected by RGM usually had a predisposing condition leading to the skin infection. We present a case of an immunocompetent patient with no predisposing factors, who presented with a chronic lesion on his neck that disseminated to his axilla. Culture and species identification from the skin biopsy revealed Mycobacterium fortuitum-chelonae complex. The patient was treated with a combination of surgery and multi-drug therapy. This case report highlights the rarity of cutaneous RGM infections encountered in ENT setting and the diagnostic dilemma due to the non-typical characteristics of skin lesion in RGM infections.</p> Atikah Rozhan, Kahairi Abdullah, Zamzil Amin Asha'ari Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/985 Thu, 01 Jul 2021 00:00:00 +0800 Acute Abdomen caused by Perforated Jejunal Diverticulitis https://journals.iium.edu.my/kom/index.php/imjm/article/view/1445 <p>Jejunal diverticulum accounts for only 25% of small bowel diverticula, and approximately 7% of these will present as complicated jejunal diverticulitis or perforation. Here, we described a case of jejunal diverticular perforation presented as acute abdominal peritonitis. The computed tomography of the abdomen suggested small bowel perforation and therefore, emergency surgical exploration was performed. Intraoperatively, multiple jejunal diverticulae were found with one forming a localised diverticular abscess. Segmental resection of the diseased segment with primary anastomosis was performed. The patient made an uneventful post-operative recovery. Although complicated jejunal diverticulitis is rare, emergency surgery is often warranted if perforation occurs. Computed tomography is valuable in the diagnosis and preoperative planning especially in an emergency surgical conundrum when there is equivocal clinical peritonitis or perforation.</p> Praveena Prithvi Raj, Chin Wee Ang, Hiong Chin Lim, Michael Pak-Kai Wong Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1445 Thu, 01 Jul 2021 00:00:00 +0800 Serum Magnesium: A Forgotten Electrolyte after Total Thyroidectomy https://journals.iium.edu.my/kom/index.php/imjm/article/view/1700 <p>Hypocalcemia is a common complication after total thyroidectomy; however, hypomagnesemia is also frequently detected, and its role is often disregarded. We report a 72-year-old woman who underwent total thyroidectomy with neck dissection and subsequently developed atrial fibrillation due to hypocalcemia and hypomagnesemia. The pathophysiology of hypomagnesemia after total thyroidectomy and its significance in calcium homeostasis is described.</p> Adi Syazni Muhammed, Shahrun Niza Abdullah Suhaimi, Qi Zheng Lee Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1700 Thu, 01 Jul 2021 00:00:00 +0800 Cytomegalovirus (CMV) Infection in Infants: Two Case Reports and Review of Literature https://journals.iium.edu.my/kom/index.php/imjm/article/view/1523 <p> </p> <p>Cytomegalovirus (CMV) is a virus under the Herpesviridae family. We describe two case reports on different manifestations of infants with CMV infection presented with neonatal jaundice, small for gestational age (SGA) and congenital cataract. Congenital CMV (cCMV) was diagnosed in a neonate presented with jaundice and SGA. cCMV cannot be excluded in another case as no CMV PCR done within 3 weeks of life. Only one cCMV infection was treated with 6 weeks of ganciclovir anti-viral therapy, which presented with neonatal jaundice, SGA with a very high CMV viral load. All cases were under multidisciplinary follow[1]up, including pediatric for developmental assessments, audiologist for hearing assessment, and ophthalmology for vision assessment. These case reports describe the importance of thorough clinical examination and early screening of CMV infection in infants to rule out cCMV as CMV is the commonest congenital treatable viral infection in Malaysia. Early treatment and intervention can be planned for child wellbeing.</p> Zeti Norfidiyati Salmuna, Norjihan Abdul Hamid, Nabilah Awang@Ismail, Alwi Muhd Besari, Mohd Zulfakar Mazlan, Suharni Mohamad Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1523 Thu, 01 Jul 2021 00:00:00 +0800 Clinical Significance of Caseating Granulomas Detected on Transrectal Ultrasound Biopsy of Prostate Gland: The Recommended Management https://journals.iium.edu.my/kom/index.php/imjm/article/view/30 <p>Introduction: The histopathological examination (HPE) findings of caseating granulomas from the transrectal ultrasound (TRUS) of prostate biopsy are rare. A high index of suspicion is necessary to diagnose a tuberculosis infection. Here, we present the clinical outcomes of patients and the practical management steps when encounter these findings. Methods: We conducted a retrospective analysis of three cases in a tertiary care centre and reviewed the available literature on the topic. Results: All patients were aged less than 55 years and were considered young adults. One patient presented with neurogenic systemic symptoms, and two patients presented with lower urinary tract symptoms. All patients had abnormal digital rectal examination findings that warranted a TRUS biopsy of the prostate. All biopsies reported caseating granuloma with multinucleated giant cells. Additional investigations led to the diagnosis of tuberculosis infections in two patients, and one patient was diagnosed as having non-specific granulomatous prostatitis. All patients were treated according to their specific diagnosis and recovered fully. Conclusion: The detection of caseating granuloma on prostate biopsy may lead to diagnoses of several conditions, either infective or non-infective in origin. Further investigation is mandatory to provide appropriate treatment.</p> Syahril Anuar Salauddin, J.R Sathiyananthan, Rohan Malek Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/30 Thu, 01 Jul 2021 00:00:00 +0800 Smoking in Malaysia: Main issues and ways to overcome https://journals.iium.edu.my/kom/index.php/imjm/article/view/1727 <p>Smoking is a public health problem worldwide and in Malaysia. According to serial Malaysian data, the age of initiation of smoking are at a younger age and the prevalence of smoking in Malaysia among adults and adolescents have not reduced much over the years. Smoking has a detrimental heath effect to smokers as well as those passively smoking. Younger age of smoking is linked to increased dependence of nicotine and many other high-risk behaviours. The two main issues which is addressed here is younger age of initiation of smoking and smoking bans in Malaysia. The factors which contribute to younger age of smoking initiation is tobacco factors, school factors, family factors and social factors. Challenges to smoking bans in Malaysia includes poor enforcement and innovation of tobacco products in Malaysia. A comprehensive approach including the mPOWER strategy should be carried out to address this problem towards achieving Tobacco Endgame. &nbsp;</p> Azmawati Mohammed Nawi, Kavita Jetly, Nur Suhada Ramli Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1727 Thu, 01 Jul 2021 00:00:00 +0800 Malaysia’s COVID-19 Saga: Dire Need for A Robust Vaccination Roll Out https://journals.iium.edu.my/kom/index.php/imjm/article/view/1954 Prof. Dr. Jamalludin Ab. Rahman Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1954 Thu, 01 Jul 2021 00:00:00 +0800 Stress and Sexual Dysfunctions During COVID-19: Things to Ponder https://journals.iium.edu.my/kom/index.php/imjm/article/view/1952 Prof. Dr. Hatta Sidi, Dr. Srijit Das Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1952 Thu, 01 Jul 2021 00:00:00 +0800