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 Apr 2021 12:01:52 +0800 OJS 3.3.0.6 http://blogs.law.harvard.edu/tech/rss 60 Scleral Tunnel Fixated Intraocular Lens in Complicated Cataract: A Case Series https://journals.iium.edu.my/kom/index.php/imjm/article/view/33 <p>When capsular support is inadequate in complicated cataract, scleral fixated IOL (SFIOL) has its advantage whereby it is nearer to physiological nodal point when compared to other types of IOL implantation. Scleral tunnel fixated intraocular lens (STFIOL) technique is gaining popularity due to its simplicity and ease of placement compared to sutured IOL. We report our experience with eight cases of STFIOL implantation from September 2016 to May 2018 in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). All patients had improvement of vision except one case who had unchanged vision. Mean post-operative BCVA was logMAR 0.57±1.13 (which is almost equivalent to 6/21) and improved to logMAR 0.37±0.43 (which is almost equivalent to 6/12) excluding one patient with chronic RRD with band keratopathy. Post-op complications include raised intraocular pressure, cystoid macular oedema, hyphaema, and wound leak. However, all complications were not severe and responded to topical eyedrops. In conclusion, STFIOL insertion technique is safe and works well to restore vision in majority of patients operated with this technique.</p> <p> </p> See Theng Lim, Mae-Lynn Catherine Bastion, Mushawiahti Mustapha, Wan Haslina Wan Abdul Halim, Meng Hsien Yong Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/33 Thu, 01 Apr 2021 00:00:00 +0800 The “Fountain of Death”: A Case Series on Tracheo-innominate Artery Fistula https://journals.iium.edu.my/kom/index.php/imjm/article/view/727 <p>Tracheo-innominate artery fistula (TIF) is a very rare complication related to tracheostomy and has been reported in 0.7% of patients, but certainly is one of the most life-threatening conditions. It is of paramount importance to maintain a high index of suspicion in evaluating patients with TIF and to anticipate occurrence of massive haemorrhage even during simple procedures related to tracheostomy such as tube change. We report 3 cases of TIF, each with a unique and unsuspecting history of the condition and review the emergency protocol in arresting the bleeding. We’ve also highlighted the potential role of permissive hypotension with sedation in improving survival outcomes of patients with TIF.</p> Jason Lo, Marina Mat Baki, Yeoh Xing Yi , Nik Hisyam Amirul , Zahirrudin Zakaria Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/727 Thu, 01 Apr 2021 00:00:00 +0800 Mesenteric Adenitis Caused by Salmonella Typhi: A Case Report https://journals.iium.edu.my/kom/index.php/imjm/article/view/1684 <p>Both mesenteric adenitis and acute appendicitis may present with fever and right lower quadrant pain. This presentation makes it challenging to provide a timely and accurate diagnosis to avoid unnecessary surgery. We report a case of an 8-year-old who was admitted with fever and right lower quadrant pain, loss of appetite, and diarrhoea. There were tenderness and rigidity in the right lower quadrant of the abdomen. Hepatomegaly was present. Full blood count showed pancytopenia, and serum transaminases were mildly elevated. The clinical features in typhoid fever are not specific, making it difficult to differentiate from other infectious causes such as malaria, dengue, or leptospirosis, common in the region. This report illustrates a rare case of mesenteric adenitis caused by Salmonella serotype Typhi. It also shows the benefit of doing an abdominal ultrasound to help the surgeon decide whether surgery is necessary.</p> Nik Haszroel Hysham Nik Hashim, Nur Ain Che Azmi Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1684 Thu, 01 Apr 2021 00:00:00 +0800 Unilateral Adrenal Hyperplasia: A Rare Cause of Primary Aldosteronism https://journals.iium.edu.my/kom/index.php/imjm/article/view/1449 <p>A 73-year-old gentleman with a background history of long-standing hypertension and hyperlipidaemia presented with one-year history of persistent asymptomatic hypokalaemia associated with metabolic alkalosis. Within a few months, the hypertension worsened, needing increasing dose of anti-hypertensive agents. Biochemical test showed an elevated aldosterone-renin ratio but the computerized tomography (CT) scan of adrenal did not show any adrenal mass. Arterial stimulation venous sampling (ASVS) lateralized the lesion to the left side. A left retroperitoneal adrenalectomy was performed with immediate reversal of hypokalaemia and improvement of blood pressure control to only single anti-hypertensive agent.</p> Noor Ezmas Mahno, M. Rohaizak, AS. Nordashima, Y. Yazmin Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1449 Thu, 01 Apr 2021 00:00:00 +0800 Achieving Self-reliance in Providing Vital Medical Service in the Current Turmoil: Corneal Transplantation https://journals.iium.edu.my/kom/index.php/imjm/article/view/1882 Assoc. Prof. Dr. Khairidzan Mohd Kamal Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1882 Thu, 01 Apr 2021 00:00:00 +0800 Association between Hs-CRP and other Cardiovascular Risk Factors with Blood Pressure in Young Adults https://journals.iium.edu.my/kom/index.php/imjm/article/view/1874 <p>INTRODUCTION: Hypertension remains the leading preventable risk factor for premature mortality and morbidity worldwide. The use of high-sensitivity C-reactive protein (hs-CRP) as the global risk prediction assessment for cardiovascular diseases (CVD) in asymptomatic individuals suggests the possibility that higher hs-CRP, or subclinical inflammation, maybe one of the causal factors contributing to an increased risk of CVD in young hypertensive patients. Most studies of hypertension and hs-CRP association were conducted regionally, whereby most of the participants were Caucasians with age beyond 40 years old. Studies of this association among young adults in Asian populations are lacking, therefore, a generalization of data might be limited to certain ages and populations only. MATERIALS AND METHOD: This comparative cross-sectional study analysed the association between hs-CRP and other cardiovascular risk factors with three different blood pressure statuses categorised into Normotensive (NT), Pre-hypertensive (PHT), and Hypertensive (HPT) groups among young adults in Kuantan, Pahang, Malaysia. RESULTS: Independently, the association was significant only in males and subjects with parental history of hypertension in the prehypertensive group. However, in the hypertensive group, the relationships were significant not only in males and individuals with parental histories of hypertension but also in obese subjects. Hs[1]CRP was not associated with blood pressure status in the present study. CONCLUSION: The hypothesis that hs[1]CRP has an independent association with blood pressure status was not demonstrated in the present study. However, the observed association between circulating hs-CRP and blood pressure status is likely to be driven by confounders namely age, gender, genetic factors, and BMI status.</p> Asmak A.S., Aszrin A., Nor Zamzila A., Aida N.S M. S., Azarisman S.M.S. Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1874 Thu, 01 Apr 2021 00:00:00 +0800 Positive Correlation between Monocyte-to-Lymphocyte Ratio and C-Reactive Protein in Vitamin D Deficient Preterm Infants with Respiratory Distress Syndrome https://journals.iium.edu.my/kom/index.php/imjm/article/view/122 <p>INTRODUCTION: Respiratory distress syndrome (RDS) is one of the leading causes of preterm infant mortality. Vitamin D deficiency is known as a risk factor for RDS related to infants with immature lungs leading to inflammatory exacerbations. Therefore, early diagnosis is needed to prevent RDS. This study evaluated white blood cells (WBC) ratios and C-reactive protein (CRP) among vitamin D deficient preterm infants with RDS to identify simple and prompted inflammatory markers. MATERIALS AND METHODS: A cross-sectional study involving forty preterm infants (28 to 34-weeks gestational age) with low vitamin D levels (25(OH)D&lt;20 ng/dL) was conducted in a neonatal ward of a hospital in Bandung, Indonesia, from February to October 2018. Two consecutive blood collections (cord blood at birth and venous blood at first week) were performed to measure cord blood vitamin D (25(OH)D) levels, complete blood count (CBC), and CRP levels. White blood cell ratios (Monocyte-to-Lymphocyte ratio: MLR, Neutrophil-to-Lymphocyte ratio: NLR, and Platelet-to-Lymphocyte ratio: PLR) were calculated and analyzed. Association analysis was performed using Student’s t-test, Mann-Whitney U and Spearman correlation tests. RESULTS: The median of 25(OH)D levels were 9.96 (7.58-15.81) ng/dL. A significant positive correlation between MLR and CRP was found in the RDS group (r=0.576, p=0.004) and all the subjects (r=0.491, p=0.002); the WBC ratio and CRP levels showed insignificant higher trends when compared to the non[1]RDS group. CONCLUSION: There was a positive correlation between MLR and CRP among vitamin D deficient preterm infants with RDS.</p> Reni Ghrahani, Mohammad Ghozali, Adhi Kristianto Sugianli, Tetty Yuniati, Raden Tina Dewi Judistiani, Budi Setiabudiawan Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/122 Thu, 01 Apr 2021 00:00:00 +0800 Model-Based Insulin Sensitivity as a New Biomarker of Sepsis Diagnosis in the Intensive Care Unit https://journals.iium.edu.my/kom/index.php/imjm/article/view/1008 <p>INTRODUCTION: Currently, there is a lack of real-time biomarker to diagnose sepsis. Insulin sensitivity (SI) may be determined in real-time using mathematical glucose-insulin models, but its effectiveness as a diagnostic test of sepsis remains unexplored. We aimed to explore the diagnostic value of model-based SI as a new biomarker of sepsis in a mixed cohort of diabetic and non-diabetic patients newly admitted to the intensive care unit (ICU). MATERIALS AND METHODS: In this cross-sectional study, we analysed SI levels derived from the Intensive[1]Control-of-Insulin-Nutrition-Glucose model in septic (n=45) and non-septic (n = 41) patients upon their ICU admission. The diagnostic value of model-based SI for sepsis was determined through analysis of the area under the curve (AUC) of the receiver operating characteristic curve. RESULTS: Baseline SI levels were significantly lower in patients with sepsis than those without sepsis (0.560 (SD=0.676) vs. 1.097 (SD=1.473) x 10-4 L/mU/min, P = 0.037). However, the AUC of 0.588 revealed that model-based SI was a poor diagnostic test of sepsis in the mixed cohort of diabetics and non-diabetics. In a separate analysis among the non-diabetics (n=19), model-based SI predicted sepsis with clinically valid performance (AUC 0.911). CONCLUSION: Presence of sepsis significantly reduced SI in the critically ill patients but a low SI could predict sepsis only in the non-diabetic cohort.</p> Wan Fadzlina Wan Muhd Shukeri, Mohd Basri Mat-Nor, Azrina Md. Ralib, Ummu Kulthum Jamaludin Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1008 Thu, 01 Apr 2021 00:00:00 +0800 Risk Factors for Sexual Dysfunction among Postpartum Women in Kuantan, Pahang https://journals.iium.edu.my/kom/index.php/imjm/article/view/1440 <p>INTRODUCTION: Sexual dysfunction after childbirth is reported to be prevalent worldwide. The risk factors for sexual dysfunction is still underexplored. Thus, this study aims to determine the possible risk factors associated with sexual dysfunction among post-partum women. MATERIALS AND METHODS: This cross-sectional study was conducted in nine primary care clinics in Kuantan involving 420 women within six months postpartum. The respondents were conveniently sampled and completed the data collection forms comprising of their socio[1]demographic data, the Malay version Female Sexual Function Index (MVFSFI) Questionnaire to measure the sexual dysfunction score. Descriptive analysis, Chi-square test, and binary logistic regression were used for data analysis. RESULTS: Among the women sampled, those with higher education had a 72% increased risk of developing postpartum sexual dysfunction (aOR=1.72, 95%CI=1.01,2.81). Women who practised non-hormonal contraception were a 42% lower risk of getting postpartum sexual dysfunction as compared to those who consumed hormonal contraception (OR=0.58, 95%CI=0.35,0.95). CONCLUSION: Education level is associated with a higher risk of developing postpartum sexual dysfunction. Non-hormonal contraceptive methods were found as a protective factor for developing postpartum sexual dysfunction. Therefore, doctors can advise those postpartum women with sexual dysfunction and on hormonal contraception to change to non-hormonal methods.</p> Karimah Hanim Abd Aziz, Nurjasmine Aida Jamani, Nur Nadrah DrKhalid, Nani Draman Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1440 Thu, 01 Apr 2021 00:00:00 +0800 Validation of a Malay Version of the Patient-Rated Wrist Hand Evaluation (PRWHE-MV) https://journals.iium.edu.my/kom/index.php/imjm/article/view/1545 <p>INTRODUCTION: The Patient-Rated Wrist Hand Evaluation (PRWHE) is a widely used measure of patient[1]reported disability, pain and appearance related to both hand and wrist disorders. It has been adapted cross[1]culturally worldwide but not in Malaysia. We performed a translation and cross-cultural adaptation of the PRWHE into a Malay version (PRWHE-MV) with assessed reliability and validity in patients presented with hand and/or wrist disorders. MATERIAL AND METHODS: PRWHE-MV was developed via translation and resolution of cultural discrepancies. A total of 83 patients (38 men, 45 women) with the mean age of 38 (SD 14) years and hand and/or wrist disorders completed both PRWHE-MV and the Malay version of Quick DASH during their first orthopaedic hand clinic follow up, and a second PRWHE-MV at 48 hours later. Intraclass Correlation Coefficient (ICC) was used to assess test-retest reliability of the PRWHE-MV while Cronbach’s alpha was calculated to assess the internal consistency. We tested the validity of PRWHE-MV against the Malay version of Quick DASH by calculating the nonparametric Spearman’s correlation coefficient between these two measures. RESULTS: There was no major cultural problems during the forward and backward translation of PRWHE, except for a minor change owing to cultural discrepancy in toilet hygiene. The Cronbach alpha PRWHE-MV was 0.978 (SEM = 5.5) at baseline and 0.979 (SEM = 5.35) at the second assessment. For the test-retest reliability, ICC was 0.99. There was a strong direct correlation between the scores for the PRWHE-MV and the Quick DASH (r = 0.916, p&lt; 0.001). A majority of patients considered hand appearance somewhat important and were bothered in the past week. Their main concerns were gaining back normal hand function and subsequently returning to work. CONCLUSION: The PRWHE-MV showed high internal consistency, test-retest reliability and good validity in patients with hand and/or wrist disorders.</p> Teh KH, Mohamed Saaid F, Arumugam M, Rosli MRI Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1545 Thu, 01 Apr 2021 00:00:00 +0800 Knowledge, Attitude and Practice on Electronic Cigarette and their Associated Factors among Undergraduate Students in a Public University https://journals.iium.edu.my/kom/index.php/imjm/article/view/1883 <p>INTRODUCTION: Smoking tobacco has been a longstanding issue worldwide, but the trend of smoking electronic cigarette (e-cigarette) is now on the rise. Many people assume that smoking e-cigarette is safer and less harmful than conventional cigarette smoking, which is worrying. Adolescents and young adults are easily influenced by advertisements on e-cigarette. Thus, this study was conducted to determine the knowledge, attitude and practice on e-cigarette among university students. MATERIALS AND METHODS: A cross-sectional study using self-administered questionnaire was carried out among 484 university students in a public university in Negeri Sembilan, Malaysia. RESULTS: Respondents were between 19- 25 year-old undergraduates, with the majority being female. 6.6% of the respondents were smokers, with nine having tried e-cigarette, where only one is a regular user. Bivariate analysis was carried out to analyse knowledge, attitude and practice scores on e-cigarette. There was significant association between gender with attitude and practice scores (p&lt;0.001) on e-cigarettes, household income with attitude and practice scores (p=0.013 and p=0.001 respectively) on e-cigarette, as well as smoking status (p&gt;&lt;0.001). Multivariate analysis revealed that being female and non-smoker were associated with higher attitude and practice scores on e-cigarette. CONCLUSION: In conclusion, the knowledge, attitude and practice on e-cigarette needs to be improved among young adults and a more holistic intervention strategy should be implemented to prevent the rise of e-cigarette smoking. &gt;&lt;0.001) on e-cigarettes, household income with attitude and practice scores (p=0.013 and p=0.001 respectively) on e-cigarette, as well as smoking status (p&lt;0.001). Multivariate analysis revealed that being female and non-smoker were associated with higher attitude and practice scores on e-cigarette. CONCLUSION: In conclusion, the knowledge, attitude and practice on e-cigarette needs to be improved among young adults and a more holistic intervention strategy should be implemented to prevent the rise of e-cigarette smoking. &gt;&lt;&lt;0.001). Multivariate analysis revealed that being female and non-smoker were associated with higher attitude and practice scores on e-cigarette. CONCLUSION: In conclusion, the knowledge, attitude and practice on e-cigarette needs to be improved among young adults and a more holistic intervention strategy should be implemented to prevent the rise of e-cigarette smoking.</p> Nuurain Amirah MR, Tengku Amatullah Madeehah TM, Nadeeya ‘Ayn MN, Dzulkhairi MR, Mohamed Fakhri AB, Shalinawati R, Zairina AR, Nooriah MS, Jaafar H Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1883 Thu, 01 Apr 2021 00:00:00 +0800 Immunohistochemical Analysis of Mismatch Repair Deficiency in Colorectal Cancer Patients in Kuantan, Pahang https://journals.iium.edu.my/kom/index.php/imjm/article/view/965 <p>INTRODUCTION: The deficient mismatch repair (dMMR) status of colorectal cancer (CRC) is the hallmark of a defective DNA mismatch repair (MMR) system. Immunohistochemistry (IHC) indirectly detects the affected gene by the loss of its protein product. This study aimed to assess the frequency of different types of dMMR status and associate them with the clinicopathological characteristics of CRC patients diagnosed at Hospital Tengku Ampuan Afzan (HTAA) and the Sultan Ahmad Shah Medical Centre (SASMEC) using an immunohistochemical method. MATERIAL AND METHODS: Formalin-fixed paraffin-embedded (FFPE) tissue blocks of 123 CRC cases were retrieved from the Pathology Department of HTAA and SASMEC for patients diagnosed between 1 January 2017 and 31 December 2018. IHC was performed manually using an Envision Flex Polymer detection kit (Dako) along with four primary anti-mouse antibodies (MLH1, PMS2, MSH2, and MSH6) for the MMR proteins to assess dMMR status. RESULTS: Out of 123 cases, 21 (17.07%) showed the loss of one or more MMR protein expression and were dMMR. There was no statistically significant association between pMMR (proficient Mismatch repair) and dMMR cases with regards to clinicopathological factors (age, sex, race, site of the tumour, TNM (Tumour Node Metastasis) staging, bowel wall invasion, lymph node metastasis, lymphovascular invasion, histological type, and tumour differentiation). CONCLUSION: IHC is the preferred method and most reproducible test for assessing dMMR status in CRC patients in the histopathology diagnostic laboratory.</p> <p> </p> Muhammad Ishaque F., Asmah Hanim H., Norlelawati A.T., Nor Zamzila A, Feisal E., Arfahiza S. Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/965 Thu, 01 Apr 2021 00:00:00 +0800 End-Of-Life Care in Dementia among Asian, A Scoping Review https://journals.iium.edu.my/kom/index.php/imjm/article/view/1794 <p>INTRODUCTION: Dementia is a neurocognitive disease characterised by a progressive deterioration of brain cognitive function. Dementia in the advanced stage should be treated as other terminal diseases. However, there is still a lack of acknowledgement regarding the end-of-life (EOL) care of people with dementia in Asian populations. This study aims to elucidate the components of EOL care in advanced dementia from the Asian perspective. MATERIAL AND METHODS: Arksey and O’Malley’s scoping review methodology framework was used to guide and conduct this scoping review. Databases of Pubmed, EBSCOhost, and Ovid Scholars were systematically searched using MeSH heading of end-of-life, palliative, dementia, and individual name of Asian countries. RESULT: Fourteen articles met the inclusion criteria. The majority of the studies involved interviews or questionnaires to the caregivers, the patients, and the healthcare professionals. The studies were done mostly in Taiwan and Japan and one from Indonesia. The studies reported themes that were categorised into life sustenance treatments and medications, advanced directives, the burden of the caretakers, and the knowledge, attitude, and practice of the healthcare providers or the family members. CONCLUSION: Major barriers in delivering EOL care to advanced dementia patients include knowledge, skills, communication, attitude, and beliefs, especially among developing countries in Asia. More education and awareness are needed amongst the healthcare providers and the public regarding this matter to ensure proper EOL care in advanced dementia patients.</p> Firzanah Adabiah Zulkernain, Hana Maizuliana Solehan, Nor Safiqah Sharil, Abdul Aziz Marwan, Ummu Aiman Faisal, Ummi Affah Mahamad Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1794 Thu, 01 Apr 2021 00:00:00 +0800 Serum Vitamin D and Cardiometabolic Markers: A Comparative Study in Adult Men Based on Body Mass Index https://journals.iium.edu.my/kom/index.php/imjm/article/view/1640 <p>INTRODUCTION: Deficiency of vitamin D has been implicated in several disorders, including skeletal, immune, neural, metabolic, and cardiovascular diseases (CVDs). The impact of vitamin D deficiency on CVDs is potentially through derangement of cardiometabolic profile. The present work assessed the relationship between serum vitamin D levels and cardiometabolic markers in adult men. MATERIALS AND METHODS: A cross-sectional analytical study (n=160) was conducted on adult men between the ages 35-50 years without a history of CVDs and/or diabetes, liver, or kidney disorders. Serum vitamin D, lipid profile (cholesterol, triacylglycerol; TAG, low[1]density lipoprotein; LDL, high-density lipoprotein; HDL), and renal function tests (urea, creatinine) were measured using enzyme‑linked immunosorbent assays (ELISA). Pearson’s correlation was used for assessing correlations between the studied parameters. Participants were further grouped as underweight, normal weight, overweight, and obese based on their BMI values, and one-way ANOVA and post-hoc Tukey’s tests were done to observe group mean differences. RESULTS: Vitamin D and HDL were positively correlated (r=0.395, p=0.000) while negative correlation of serum vitamin D levels was seen with TAG (r=-0.539, p=0.000), cholesterol (r=-0.325, p=0.000), LDL (r=-0.541, p=0.000) and urea (r=-0.514, p=0.000). Levels of serum vitamin D (p=0.000) and HDL (p=0.000) were lower while levels of TAG (p=0.000), cholesterol (p=0.000), LDL (p=0.000) and urea (p=0.000) were higher in the overweight and obese groups. CONCLUSION: Inadequate serum vitamin D status is associated with dyslipidaemia in adult men. Moreover, obese and overweight men have lower serum vitamin D levels with pronounced dyslipidaemia, thus highlighting vitamin D as a potential cardiometabolic risk factor.</p> Syed Imran Ali Shah, Sabiha Iqbal, Mirza Zeeshan Sikandar, Umair Yaqub Qazi, Inamul Haq Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1640 Thu, 01 Apr 2021 00:00:00 +0800 Metal Release of Standard and Fake Orthodontic Braces: An In Vitro Study https://journals.iium.edu.my/kom/index.php/imjm/article/view/1707 <p>INTRODUCTION: The growing demand for orthodontic braces among Malaysians has led to the development of fake braces. These fake braces services are illegal and their brackets are reported to be of inferior quality. Fake braces are constantly being exposed to the saliva intraorally, hence they are susceptible to corrosion. This study was conducted to investigate the release of metal ions as a result of corrosion from standard and fake orthodontic braces immersed in artificial saliva of different pH. MATERIALS AND METHODS: A total of six different types of brackets (three from standard and three from fake braces) were immersed in containers containing 5 mL of artificial saliva of pH 4.9 and pH 7.8. The samples were collected for analysis on day 1, day 14, and day 28 using Inductively-Coupled Plasma Mass Spectrometry (ICPMS) to evaluate the amount of metal ion released. Statistical analysis was performed to isolate the significant difference of metal ions released between two types of braces in different pH solutions. RESULTS: The release of aluminum, nickel, chromium, manganese and copper were observed and analyzed. Fake braces released the highest concentration of chromium, manganese, and nickel ions in both artificial saliva as compared to standard braces. Brackets immersed in pH 4.9 released a higher number of ions compared to pH 7.8. CONCLUSION: This study showed that fake braces released the highest concentration of metal ions as compared to standard braces. Both time and pH influenced the release of metal ions from orthodontic brackets.</p> Siti Hajjar Nasir, Muhammad Syahmi Mohamad Amran, Muhammad Muaz Abidin Mustaffar Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1707 Thu, 01 Apr 2021 00:00:00 +0800 Validation of Bahasa Malaysia Version of Psychological Mindedness in a University Population https://journals.iium.edu.my/kom/index.php/imjm/article/view/1718 <p>INTRODUCTION: Psychological mindedness concept is widely accepted to be significantly correlated to psychological strength and mental health. There are multiple scales that attempted to measure psychological mindedness objectively, with the most recent one being Balanced Index of Psychological Mindedness (BIPM). Psychological mindedness is an area of interest in psychiatry and psychology in Malaysia. Hence, this study aims to validate the Bahasa Malaysia Version of Balanced Index of Psychological Mindedness (BIPM-M). MATERIALS AND METHODS: The 14-items scale was translated according to World Health Organization guidelines. 141 participants were recruited from the university population. Participants were required to fill the basic demographic information, as well as Bahasa Malaysia version of Balanced Index of Psychological Mindedness, and two other scales, namely Mindful Awareness Attention Scale (MAAS), and Acceptance and Action Questionnaire-II Scale (AAQ-II). RESULTS: BIPM-M showed excellent internal consistency with Cronbach α of 0.87. As per the original BIPM, the Bahasa Malaysia version also suggested two factor structures in this scale. BIPM-M was significantly correlated with AAQ-II. Conclusion: BIPM-M is a psychometrically sound instrument that can be utilized to assess the psychological mindedness among Malaysians, and certainly enhance the array of psychological assessments available as Malaysia faces the mental health after-effect of COVID-19.</p> Mohd Amiruddin M.K., Nicholas Pang T.P, Wendy D.S, Mathias Wen L.T, Ervina Abbylen M., Yin Xin Yeoh Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1718 Thu, 01 Apr 2021 00:00:00 +0800 Evaluating Frozen Strawberries as a Strategy for Thirst Management in Patients with Congestive Heart Failure (CHF) https://journals.iium.edu.my/kom/index.php/imjm/article/view/1637 <p>INTRODUCTION: Thirst sensation in Congestive Heart Failure (CHF) patients is caused by diuretic administration and fluid consumption limitation. Unhandled thirst sensation leads to a disobedient patient in fluid consumption limitation that causes the patient condition to worsen. This research aimed to analyse the frozen strawberries administration's effects on the thirst sensation in a patient with CHF . MATERIAL AND METHOD: The method used was a quasi-experiment with a pre-test and post-test control group design. The number of respondents was 34 patients divided into two groups: 17 respondents in the intervention group and 17 respondents in the control group. The sampling technique was stratified random sampling based on NYHA classification in the respondents. Frozen strawberries were given to the intervention group, while ice cubes were given to the control group. All the data were analyzed using a t-test.RESULT:The results showed that the mean score of the thirst intensity of the intervention and control group was 4.44 and 2.35, respectively. The independent t-test of the mean difference of thirst intensity pre and post-test between the intervention and control groups was p=0.001. According to the paired t-test analysis, the thirst intensity score between pre-test and post-test was p&lt;0.001, from moderate to low thirst intensity. CONCLUSION:Frozen strawberries were statistically effective in reducing the thirst intensity in a patient with CHF.</p> Dian Hudiyawati, D. L. Suswardany Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1637 Thu, 01 Apr 2021 00:00:00 +0800 Revisiting the Pedicled Gastrocnemius Flap for Orthoplastic Limb Reconstruction https://journals.iium.edu.my/kom/index.php/imjm/article/view/174 <p>INTRODUCTION: Gastrocnemius muscle flap is performed in a combined approach of the orthopaedic and plastic team for limb reconstruction in the developed countries. However, this practice is not readily available in Malaysia because of the smaller numbers of plastic surgery services in government hospitals. This study reviews the outcome of the gastrocnemius flap performed by the orthopaedic team. MATERIALS AND METHODS: Thirty-two patients underwent gastrocnemius flap surgery with a mean age of 35.3 years (range 13-82). The flaps were done to cover the upper third (22), upper half (4), knee (2), distal femur (2) and the popliteal fossa (1). The initial problems were open fracture (21), infection following plating (5), necrotising fasciitis (3), degloving injury (1), pin site infection (1) and melioidosis (1). Five patients were having underlying Diabetes mellitus, 3 Hepatitis B, 2 HIV and 1 Hepatitis C infections. RESULTS: There was no flap necrosis. Complications include persistence infection in 3 patients which required advancement of the flap (1) and additional fasciocutaneous flap (2) to cover the wound breakdown. All fractures achieved union but one patient with infection following double plating for tibial plateau fracture developed chronic osteomyelitis. One patient develops transient peroneal nerve palsy following the lateral gastrocnemius transfer. Both patients who had patella ligament reconstruction with gastrocnemius flap develop knee stiffness. CONCLUSIONS: Gastrocnemius flap is a reliable and safe procedure in salvaging the leg from amputation related to open fractures and infections in orthopaedic surgery. It should be one of the options for the operative procedure taught during the orthopaedic training.</p> Nazri Mohd Yusof, Akmal Azim Ahmad Alwi Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/174 Thu, 01 Apr 2021 00:00:00 +0800 Knowledge, Attitudes And Practices Towards COVID-19 among Medical Students in International Islamic University Malaysia: An Online Cross-Sectional Study https://journals.iium.edu.my/kom/index.php/imjm/article/view/1686 <p>INTRODUCTION: COVID-19 pandemic has caused a major impact to global public health including one of the high risk groups which is the medical students. This study was intended to assess knowledge, attitudes and practices (KAP) towards COVID-19 among medical students in International Islamic University Malaysia (IIUM). MATERIAL AND METHOD: An online cross-sectional study was conducted among 438 medical students of IIUM from 6th July 2020 to 9th July 2020. KAP towards COVID-19 was measured using a structured Malay and English version questionnaire consisting of 13 items on knowledge, 3 items on attitudes and 3 items on practices. RESULTS: The average correct response rate on knowledge was 85.4%. Only 12.1% of the students had correct knowledge on all items, and 1 in every 4 and 5 students had misconceptions on the clinical features and transmission of COVID-19. In term of attitudes towards COVID-19, majority of the respondents believed that COVID-19 would be effectively controlled (85%) and had faith that Malaysia could overcome the war against COVID-19 (99%). Most of the respondents practiced good towards COVID-19 in avoiding crowded places (90%), wearing face masks (95%) and practicing hand hygiene (91.6%). CONCLUSION: Although the results are positive towards KAP, only 1 in every 10 students responded correctly to all knowledge questions, and few proportions had misconceptions on the disease and did not maintain adequate practices. Policies aimed at appropriate health promotion activities may ensure empowering the medical students with adequate knowledge on all aspects of COVID-19, and practice properly following the standard operating procedure implemented by the government.</p> Ikhlas Solehah Abd Rahim, Muhammad Badrul Nizam Roslan, Nur Najihah Mohamad Zaini, Nur Syazwani Kasim, Muhammad Izz Hilmi Mohd Yazid, Hafizah Pasi, Hashima E Nasreen Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1686 Thu, 01 Apr 2021 00:00:00 +0800 Depression Among Non-Cancer Chronic Pain Patients at a Tertiary Hospital in Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/748 <p>INTRODUCTION: Pain is as important public health concern. Chronic pain patients most frequently present with depression, and this needed to be treated. The aim of the study was to find the prevalence of depression among non-cancer chronic pain patients attending a Pain Clinic in Malaysia, and discuss possible treatment methods to help these patients. MATERIAL AND METHODS: Inclusion criteria were all non- cancer chronic pain patients who visited the Pain Clinic of Queen Elizabeth Hospital (QEH), Kota Kinabalu, Sabah from 2013 till 2017. All patients were required to fill a PainDetect form and a Patient Health Questionnaire-9 (PHQ-9). RESULTS: Two hundred and fifty-four patient’s case notes were analysed. The results show that 29.6 % patients had mild depression, with 34.4% of patients had moderate to severe depression. There was a significant correlation between pain scores and depression. There was also a significant correlation between PainDetect scores and depression. CONCLUSION: There is a high prevalence of depression among non-cancer chronic pain patients. This study shows that psychological treatment for all chronic pain patients is needed.</p> Rajesh Kumar Muniandy, T Kumaravadivel Dharmalingam Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/748 Thu, 01 Apr 2021 00:00:00 +0800 Adaptation and Validation of the Muslim Medical Students Questionnaire (MMSQ) in the Indonesian Language https://journals.iium.edu.my/kom/index.php/imjm/article/view/1720 <p>INTRODUCTION: The Muslim Medical Students Questionnaire (MMSQ) is a self-assessment tool that was designed to measure student’s Islamic competency in line with the implementation of the Islamic medical curriculum. For it to be applicable in Indonesia, this questionnaire needed to be translated and validated in the Indonesian language (Bahasa Indonesia). This study aimed to collect validity evidence of the Bahasa Indonesia version of MMSQ (BI-MMSQ). MATERIALS AND METHODS: The research process consisted of four stages: Forward and backward translation; Harmonization of the BI-MMSQ resulting from the initial stage; Pre-test of the BI-MMSQ among 30 clinical students, and finally construct validation among 225 clinical students. The completed questionnaires of 213 students were then analysed for their reliability and validity using exploratory factor analysis (EFA). RESULTS: The study showed that the scale had sufficient validity evidence; content, response process, and internal structure. The evidence of the internal structure of the tool is derived from the internal consistency (Cronbach’s Alpha is 0.85) and also from the factor analysis. Most of the items had a factor loading value of &gt; 0.3, but it was suggested that some of those with a value of &lt; 0.3 should be rephrased to increase their quality. The Practice domain was the most stable sub-scale since most of the items contained high factor loadings. CONCLUSION: The BI-MMSQ had sufficient validity evidence and the internal structure may be improved by alteration of a few items.</p> Umatul Khoiriyah, Diani Puspa Wijaya, Ramli Musa Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1720 Thu, 01 Apr 2021 00:00:00 +0800 Reflection-based Whole-batch Discussion (RWD) as a Tool for Learning Proficiency Enhancement at Faculty of Medicine, Universiti Sultan Zainal Abidin in Malaysia: Toward Curriculum Development https://journals.iium.edu.my/kom/index.php/imjm/article/view/1585 <p>INTRODUCTION: Different approaches have been endeavoured by medical educationists to produce high[1]standard graduates from medical school, including collaborative group discussions and reflective practice (RP) assignments. The current study aimed to evaluate the outcome of teacher-led whole batch discussion following RP tasks given to the students. The overall teaching approach is referred to as “Reflection-based whole-batch discussion (RWD)”. MATERIALS AND METHODS: One hundred twenty-two medical students who attended the haematology course at the University Sultan Zainal Abidin were recruited into this study over 2 academic years. The first batch of students (n=61) was unexposed to the RWD intervention (RWD-unexposed) while the second batch from the following academic year (n=61) was exposed (RWD-exposed) to the intervention. Students adhered to the guidelines given by the instructor pertaining to the reflective practice (RP) before the sessions. A weekly RWD session was conducted where the instructor-led a dually interactive forum to discuss students’ mistakes and misunderstandings as reflected within their write-ups. Exam results from both RWD-exposed and the RWD[1]unexposed students were compared using the student t-test. RESULTS: The mean scores of students’ results were significantly higher among RWD-exposed students compared to RWD-unexposed students in their essay questions and objective structured practical exam questions (p&lt;0.01). However, RWD-exposed students scored significantly lower than the RWD-unexposed &lt; 0.01). However, RWD-exposed students scored significantly lower than the RWD-unexposed student's group in multiple true and false (MTF) questions. CONCLUSION: Implementing RWD is a promising teaching strategy in improving the academic achievement of medical students especially in answering essay questions. MTF questions format may be an incompetent tool for evaluating the impacts of new teaching strategies and therefore medical educationists recommended efficient alternative assessment tools such as OBA and EMQ for the sake of curriculum development in medical institutes.</p> Uday Younis HA, Marwan SA, Haitham MJ, Rana Abdulrahman HAM, Nor Iza AR, Nordin S Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1585 Thu, 01 Apr 2021 00:00:00 +0800 Relationship of Psychosocial Factors towards Medication Adherence among Hypertension Patients in A Tertiary Hospital https://journals.iium.edu.my/kom/index.php/imjm/article/view/1236 <p>INTRODUCTION: Hypertension is one of the invisible diseases causing heart failure and stroke, and responsible for death. This study aimed to determine the level of medication adherence and psychosocial factors among patients with hypertension, relationship between socio demographic and medication adherence, and relationship between psychosocial factors and medication adherence among patients with hypertension. MATERIALS AND METHODS: A cross-sectional descriptive study was performed at the Primary Health Clinic and Medical Clinic in one of the tertiary hospitals. There were 123 patients with hypertension who volunteered to participate using a validated adapted and modified questionnaire to assess the compliance and psychosocial factors. The data collected was analysed using IBM SPSS Statistics version 23. RESULTS: A hundred and twenty respondents were adherents to medication (97.6%) while respondents with non-adherence to medication were 3 (2.4%) with a mean adherence score of 42.2764 with SD ± 2.67134. Some of the psychosocial variables had good understanding, good emotional state, positive attitude, higher motivation, higher perception of severity, lower perception of susceptibility and less barrier to compliance. Emotional state was the only thing reported for the psychosocial factors as being statistically significant. The level of emotional state was found statistically significant differences with scores p=0.008 (p&lt; 0.05). CONCLUSION: The level of medication adherence was good which reflected the patients’ compliance towards medication taking. This study showed a good medication adherence and compliance among hypertension patients.</p> Jalina Karim, Hazwani Ramli, Siti Zuraida Mohd Razi, Nor Haty Hassan Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1236 Thu, 01 Apr 2021 00:00:00 +0800 Postnatal Depression in Malaysia: Perspectives of Stakeholder on Awareness Medium https://journals.iium.edu.my/kom/index.php/imjm/article/view/1696 <p>INTRODUCTION: Postnatal depression is a highly prevailing illness, yet underdiagnosed. Untreated, it carries a transgenerational impact, and therefore promoting awareness for it has to be of high priority. This research explored the elements of an educational tool to develop awareness for postnatal depression as preferred by stakeholders. MATERIALS AND METHOD: A descriptive qualitative approach using semi-structured face-to-face interviews were conducted, where nine participants were recruited via purposive sampling from a university hospital in Malaysia. Interviews with each participant were audio-recorded and transcribed to verbatims. Emergent themes were identified during the analysis. RESULTS: Four consistent themes regarding elements for an educational tool were derived as follows: Foundations of the tool, Illness circumstances, Support bases, and Matters of perspective. CONCLUSION: An educational video within the local setting should involve the usage of a short emotionally driven video, highlighting illness- and treatment-related content, and addressing the preference and concerns of women within the religious and cultural context. The use of edutainment as an educational tool is replicable and has a high outreach even to those who are illiterate. The findings can be used in the tailored development of an educational video on postnatal depression which will benefit local women by creating awareness and encouraging early help-seeking.</p> Aishah Siddiqah Alimuddin, Tuti Iryani Mohd Daud, Umi Adzlin Silim, Mohd Abdul Wahab Fatoni Mohd Balwi, Ani Amelia Zainuddin, Marhani Midin, Hazli Zakaria Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1696 Thu, 01 Apr 2021 00:00:00 +0800 Utilisation and Perception of Complementary and Alternative Therapies (CATs) among Obese and Overweight Individuals in a Malaysian Public University https://journals.iium.edu.my/kom/index.php/imjm/article/view/1358 <p><strong>Introduction:</strong> Obesity and overweight are among the most serious public health issues that can threaten the well-being of individuals. Its increasing prevalence in Malaysia has inevitably caused many to additionally seek complementary and alternative therapies (CATs) to lose weight. This study intends to 1) assess the utilization and perception toward CATs among obese and overweight participants and 2) assess applicability, practicality, reliability and validity of the UPCATs-Malay. <strong>Materials and methods:</strong> It was conducted cross-sectionally on 30 students and staff. Responses were analyzed using SPSS (v21). <strong>Results:</strong> Among the participants (age = 26.17±8.23 years; female = 66.7%; students = 63.3%), 40.0% were overweight and 60.0% were obese. Overall, 23.3% of the participants had previously used some types of CATs to lose weight, with herbal or dietary supplements (20.0%) being the most common. Participants’ attitudes towards CATs were mostly influenced by the internet (93.3%). Most believed that CATs modalities were safe (53.3%) and not a threat to public health (70.0%). The majority of participants (53.3%) were also considering joining any CATs-based weight management programmes. Additionally, the questionnaire was considered clear, comprehensive and not difficult to complete (&lt; 5 minutes). The overall reliability was 0.711 (domain range = 0.641-0.881). Majority of individual items in UPCATs-Malay correlated better with their domains compared to other domains supporting validity. <strong>Conclusion:</strong> Overall, positive perceptions towards CATs were apparent and the questionnaire was reliable and valid. Further approaches should be taken especially on the identification of safe, viable CATs modalities and their role in weight management.</p> Pei Lin Lua, Nurul Afiedia Roslim, Aryati Ahmad, Mardiana Mansor, Myat Moe Thwe Aung, Farrahdilla Hamzah Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1358 Thu, 01 Apr 2021 00:00:00 +0800 The Three-Level Model (3LM): A Conceptual Framework for the Integration of Naqli and Aqli Knowledge In Medicine https://journals.iium.edu.my/kom/index.php/imjm/article/view/1877 Razrim R, Mohd Faisal M, Affirul Chairil A, Mohd Rushdan MJ Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1877 Thu, 01 Apr 2021 00:00:00 +0800 The Role of Apolipoproteins in Dengue Infection: A Review https://journals.iium.edu.my/kom/index.php/imjm/article/view/130 <p>The re-emergence of the dengue virus in recent decades has significantly increased with almost 40%-50% of the world’s population being at risk. Meanwhile, cholesterol and its components, apolipoproteins, were found to play a vital role in dengue infectivity and the development of severe dengue. This review attempts to address the functional importance of cholesterol and related apolipoproteins in dengue virus pathogenesis and to identify the potential utilisation of this relationship in future diagnosis and management of dengue. The literature search was conducted using a computer-based electronic search on dengue infection with cholesterol and human lipoproteins from September 2017 to June 2019 through three main search engines: MEDLINE (OVID), PubMed, and Science Direct using the keywords including Flaviviruses, characteristics of dengue virus, the pathogenesis of dengue, enhancement of dengue, metabolism of cholesterol, cholesterol pathway and human lipoproteins in association with dengue. Dengue virus manipulates lipid raft integrity and utilizes cholesterol components and apolipoproteins for virus internalisation through LDLr and SR-BI receptors. Infectivity of the dengue virus correlated with a decrease in the cholesterol content of the virions. High cholesterol levels in the endoplasmic reticulum promote replication complexes formation of dengue virus. Cholesterol is needed for NS1 secretion which is essential in viral replication, dengue pathogenesis, and host immune evasion. Levels of cholesterol and its related components contributed to the development of severe dengue. The interplay between cholesterol and cellular proteins lead to significant effect in all aspects of the dengue virus replication cycle from viral entry to release.</p> Radzi Ikhsan Ahmad, Fadzilah Mohd Nor, Wang Seok Mui, Thuhairah Hasrah Abdul Rahman Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/130 Thu, 01 Apr 2021 00:00:00 +0800 Using Mathematical and Statistical Model to Forecast the Path of Infection by Covid-19 in the Kingdom of Saudi Arabia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1683 <p>Saudi Arabia, like any other part of the earthly globe, has been exposed to the Covid-19 pandemic. The first case appeared on March 3, 2020, followed by an increase in the number of infections until it reached thousands with the numbers on the rise. Therefore, adopting clear strategies to deal with the pandemic according to specific data on its size is necessary. In this study, the time series of the number of infections and deaths were analyzed to study the behavior of the pandemic over time. The cumulative curve of the phenomenon was analyzed to show the extent of the pandemic's decline or spread. On the other hand, the time curve of the number of cases of the pandemic was fitted based on a set of mathematical and statistical models, which were divided into three sections [nonlinear growth model, Susceptible, Exposed, Infectious, Recovered (SEIR) model, regression model] to attain the best possible fitting of the relationship curve. The results show that the Weibull model and Polynomial model at (n = 4) are the best models for fitting the relationship at short run and the SEIR model gives better relationship fitting at long run. In conclusion, there is a tendency for the disease to decline during the short period, while expecting other waves of the epidemic that will recede in the long term with the emergence of a suitable vaccine.</p> Tarek Omara, Khaled A. Harby Copyright (c) 2021 IIUM Medical Journal Malaysia https://journals.iium.edu.my/kom/index.php/imjm/article/view/1683 Thu, 01 Apr 2021 00:00:00 +0800