IIUM Medical Journal Malaysia (IMJM)
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Scissor-Induced Penetrating Brain Injury in a Child: A Case Report
Full text linkPenetrating brain injury (PBI) is a rare but severe form of traumatic brain injury, especially when caused by non-missile, low-velocity objects. We report a case involving a 12-year-old boy who sustained a penetrating frontal brain injury after falling with a scissor in hand during a school activity. The scissor penetrated the right orbital roof and entered the anterior cranial fossa, injuring the right frontal lobe and causing an intraparenchymal hematoma. Computed tomography (CT) confirmed the trajectory and extent of injury. The patient underwent emergency craniotomy and foreign body removal. Postoperatively, he recovered without neurological deficits, cerebrospinal fluid (CSF) leakage, or recurrent seizures. This case highlights the importance of timely imaging, careful surgical planning, and adherence to management principles to optimize outcomes in pediatric PBI
Evaluating the Resilience Level among Medical and Health Science Lecturers in Higher Education
Full text linkINTRODUCTION: The use of resilience in higher education involves recognizing and implementing adaptive mechanisms during periods of adversity or transition. The present study aims to conduct an evaluation of the resilience levels of lecturers and investigate the association between socio-demographic factors that are linked to resilience among medical and health science lecturers in Malaysia. MATERIALS AND METHODS: A cross-sectional online questionnaire was conducted between October and November 2023. This study employed the validated Medical Professionals Resilience Scale (MeRS) for all lecturers in medical and health science fields at Malaysian institutions, which consists of 37 items designed to assess the resilience level of the lecturers. Socio-demographic data were also collected to identify resilience characteristics. The independent sample T-test, Pearson correlation, and one-way ANOVA were used to analyze the data. RESULTS: The study encompassed a collective of 127 lecturers. A mean score of 123.66 and a standard deviation of 16.7 show that the lecturers have a high level of resilience. Resilience was observed more in lecturers with a non-clinical background compared to fellow clinical background (p=0.018). The other socio-demographic factors, including gender, age, marital status, years of experience as an educator, and designation of administration role, were not shown to have a significant impact. CONCLUSION: This study has the potential to yield valuable insights and may improve the effectiveness of university management frameworks in supporting lecturers during difficult times; this could be accomplished by advocating for leisure and sports activities and instituting healthy habits
Barriers to Physical Activity Among Stroke Survivors: A Scoping Review
Full text linkBarriers to physical activity (PA) experienced by stroke survivors may contribute to low PA participation. This review aims to update the existing review report on barriers to PA among stroke survivors. We conducted electronic searches across three databases (PubMed, Scopus, and Web of Science) between January 2011 and January 2023. Keywords related to barriers, physical activity, and stroke survivors were used to identify relevant studies. Eighteen studies were included. The identified barriers to PA among stroke survivors were physical impairments, fatigue, and issues with training venues and facilities. These barriers were categorized using the Theory Domain Framework, revealing nine domains, with environmental context and resources being the most common. Clinicians can develop individualized programs to address barriers, improving adherence to PA among stroke survivors and contributing to a better quality of life while reducing the risk of stroke recurrence
Silent Storm: Ventricular Standstill Masquerading as Seizure in Adams-Stokes Syndrome
Full text linkParoxysmal ventricular standstill is one of the rarest but life-threatening cause of Adams-Stokes (A-S) syndrome. We present the case of an elderly female who experienced recurrent episodes of convulsions, described as tonic movements of all limbs followed by brief loss of consciousness, due to paroxysmal ventricular standstill. The diagnosis was confirmed when an episode of convulsions coincided with an ECG strip showing ventricular standstill, and the convulsions stopped once the arrhythmia resolved, as observed on the cardiac monitor. The diagnosis was further supported by the absence of additional convulsive episodes after the insertion of a temporary transvenous pacemaker, which corrected the arrhythmia. Adams-Stokes syndrome refers to a lack of brain perfusion caused by inadequate or inefficient cardiac contractility due to a cardiac arrhythmia. This can result in abnormal brain activity, leading to convulsions or syncope
A Cross-Sectional Study on Solid Oral Dosage Form Modifications among Older Patients Admitted to A Malaysian Teaching Hospital
Full text linkINTRODUCTION: Older adults often require multiple medications, increasing their risk of polypharmacy and drug-related problems (DRPs). Solid oral dosage forms (SODFs) are the most common medication formulation used by patients. However, administering SODFs to older adults can be challenging, especially for those with swallowing difficulties, leading to practices such as crushing, splitting tablets, or opening capsules. These modifications can affect medication efficacy and safety. This study aims to examine the prevalence of SODF modification among hospitalized older adults, the methods used, the reasons for modification, and the appropriateness of these practices. MATERIALS AND METHOD: This cross-sectional study included patients aged 60 years and above admitted to the general medical ward of a tertiary teaching hospital. Eligible participants were identified through the hospital's electronic registration system. Sociodemographic and clinical data were collected using a standardized form. Participants were interviewed about their SODF modification practices, and swallowing difficulties were assessed using the PILL-5 questionnaire. RESULTS: Of 122 participants, 54.1% were aged 60–69, and 9.8% reported dysphagia. SODF modification was practiced by 55.7%. Swallowing problems and pill dysphagia are significantly associated with SODF modification. Among those modifying SODFs, 47.1% incorrectly believed all medications could be safely altered. Splitting tablets was the most common practice (92.6%). CONCLUSION: Both dysphagia and pill dysphagia are significantly associated with SODF modification practices among older patients. Healthcare providers should be vigilant about these practices in older patients with swallowing difficulties. Proper education and assistance in medication handling are essential for this population
Knowledge, Attitude, and Practice towards Disaster Preparedness among Medical Personnel in Emergency Departments in Malaysia
Full text linkINTRODUCTION: Disasters are incidents that can cause damage to properties and loss of lives. Disaster preparedness is a set of measures undertaken in planning for disaster situations. The objectives of this study were to determine the level of knowledge, attitude, and practice (KAP) towards disaster preparedness and its associated factors among emergency department (ED) medical personnel. MATERIALS AND METHODS: This study was conducted in 12 hospitals in Malaysia. A validated questionnaire was used and 427 participants were involved. This study was carried out from March 2019 to March 2020. RESULTS: This study showed that ED medical personnel in Malaysia had adequate KAP towards disaster preparedness, which scored 91.6%, 78.2%, and 61.1%, respectively. An increased level of knowledge was related to experience and training in disaster response, whereby the increased level of practice was associated with duration of working experience. However, there was no association between the level of attitude and disaster preparedness. CONCLUSION: Continuous education and training on disaster preparedness for ED medical personnel are necessary to prepare staff in the event of disaster and to improve the healthcare syste
Determinants of Road Traffic Accident Among Elderly in Malaysia: A Scoping Review
Full text linkMalaysia is transitioning into an aged nation, with 15% of its population projected to be 60 years or older by 2030. This demographic shift is expected to increase the number of elderly road users, yet road conditions remain inadequate for their needs, and preventive measures for road traffic accidents (RTAs) are still underdeveloped. There is limited understanding of how physiological, cognitive, and environmental factors contribute to RTAs among the elderly in Malaysia. This scoping review aims to explore existing literature on the factors influencing RTAs in this demographic. The review follows the PRISMA-ScR reporting guidelines and includes peer-reviewed studies published in English from 2012 to 2022. A total of 15 studies were identified, and the findings are categorized into four domains: medical conditions, physical capability, driving nature, and environmental factors. Key determinants include cognitive impairment, medical illnesses, visual impairment, depression, and adverse medication effects (medical conditions); poor physical strength and flexibility, and fatigability (physical capability); long driving hours or distance, driving alone, and poor ergonomics (driving nature); and poor road condition and visibility, road complexity, reckless behaviour of other road users, and poorly maintained or old vehicles (environmental factors). These determinants are crucial in informing RTAs prevention strategies and guiding public health interventions for the elderly. However, the limited number of studies highlights the need for further research in this area to better support the safety of elderly road users
Hypolipidaemic and Cardioprotective Effects of Bee Bread Harvested from Stingless Bee (Heterotrigona Itama) in High-Fat Diet-Induced Obese Animal Model
Full text linkINTRODUCTION: Bee bread has reached its research interest because of its high antioxidant and nutritional values. Our study aimed to characterize hypolipidaemic and cardioprotective effects of high-fat (F) diet-induced obese rats co-administered with bee bread. MATERIALS AND METHODS: Male Sprague-Dawley rats were randomly assigned as N group (rats fed with normal diet), F group (rats fed with F diet), FB group (rats fed with F diet and 0.5 g/kg/day bee bread), and FO group (rats fed with F diet and 10 mg/kg/day orlistat for 6 weeks). RESULTS: The FB group significantly had decreased levels of Lee obesity index, total fat pad, total cholesterol and low-density lipoprotein, and significantly had increased cardiac superoxide dismutase, glutathione peroxidase and catalase activities compared to the F group. Furthermore, the FB group demonstrated significant decreases in the levels of cardiac lipid peroxidation marker and fatty acid synthase activity with improvement in histological findings of heart and adipose tissues. CONCLUSION: These findings suggested that bee bread exerted hypolipidaemic and cardioprotective effects owing to its modulatory action on de novo synthesis of fatty acid
The Clinical Characteristics and Outcomes of JAK2/ CALR/MPL Mutation Related Myeloproliferative Neoplasms - A Single Centre Study from Malaysia
Full text linkINTRODUCTION: The pathogenesis of classical myeloproliferative neoplasm (MPN) driven by JAK2, CALR and MPL gene mutations affects the clinical course and survival. This study aimed to determine the prevalence of driver mutations in MPN patients and their association with clinical presentations and outcomes. MATERIALS AND METHODS: We conducted a retrospective study involving patients with classical MPN diagnosed from 2002 to 2019. The patient's clinical and laboratory information, as well as outcomes, were collected and reviewed. RESULTS: 267 patients with classical MPN were recruited into the study. Majority of these patients were Chinese (46.5%), followed by Malay (40.1%) and Indian (12.7%). Most of the patients had essential lthrombocythaemia (ET) (57.3%), followed by polycythaemia vera (PV) (30.0%) and primary myelofibrosis (PMF) (12.7%). JAK2V617F mutation was detected in PV (87.5%), ET (68.0%), and PMF (67.6%) patients whereas CALR mutation was present in 15.0% of ET and 8.8% of PMF patients and MPL mutation was present in 0.7% and 5.9% of ET and PMF patients respectively. CALR-mutated ET patients were less likely to develop vascular events compared to JAK2V617F mutated patients (Odds ratio 0.301, 95% confidence interval 0.097–0.939, p=0.039). As for clinical outcomes, triple negative PMF patients had shorter median overall survival than those with JAK2V617F mutation (24.0 months vs. 161.0 months, p=0.017). CONCLUSION: Majority of classical MPN patients were Chinese with ET being the most common MPN subtype. The mutation profiles, clinical features, and survival outcomes were comparable to previous reports. Mutation studies are therefore important for prognostication and should be performed routinely
Diagnostic Accuracy of Fine Needle Aspiration Cytology of Thyroid in Hospital Sultanah Nur Zahirah, Malaysia
Full text linkINTRODUCTION: Fine Needle Aspiration Cytology (FNAC) is widely used as an initial screening method in the preoperative examination of thyroid lesions. However, diagnostic cytology interpretation remains inconsistent among reporting pathologists worldwide. This study aimed to determine the diagnostic accuracy of FNAC of thyroid lesions at Hospital Sultanah Nur Zahirah (HSNZ), a tertiary hospital in Kuala Terengganu, Malaysia. MATERIAL AND METHODS: We conducted a retrospective cross-sectional study at the Department of Pathology, HSNZ, from January 2017 to December 2019. Data of patients were collected from the Laboratory Information System (LIS) and Hospital Information System (HIS). The study included patients with thyroid lesions who underwent both FNAC and subsequent histopathological examination (HPE). RESULT: A total of 389 cases of thyroid lesions underwent FNAC, with 162 cases proceeding to surgical resection. The median age of the patients was 43.3 years, with a male to female ratio of 1:5.3. FNAC diagnoses were categorized as follows: 85 cases (52.5%) were benign, 23 (14.2%) as atypia or follicular lesion of undetermined significance, 9 (5.6%) as follicular neoplasm, 21 (13%) as suspicious for malignancy, and 12 (7.4%) as malignant and unsatisfactory. The diagnostic accuracy of FNAC was 85.8%, with sensitivity of 66.7% and specificity of 96.2%. The positive predictive value was 90.5%, and the negative predictive value was 84.2%. CONCLUSION: FNAC has proven to be an accurate diagnostic method for screening thyroid lesions. However, continuous improvement in sampling and preparation techniques and cytopathologist training is necessary to enhance its reliability further