IIUM Medical Journal Malaysia (IMJM)
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Interobserver Variability and Distribution of Mammographic Breast Density in Patients with Invasive Breast Carcinoma using the Fifth Edition of BI-RADS Guidelines
Get PDFINTRODUCTION: 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 < 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
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
Get PDFINTRODUCTION: 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<0.01). However, RWD-exposed students scored significantly lower than the RWD-unexposed < 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
Validation of Bahasa Malaysia Version of Psychological Mindedness in a University Population
Get PDFINTRODUCTION: 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
Smoking in Malaysia: Main issues and ways to overcome
No full textSmoking 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.  
Situational Analysis of Leptospirosis in Sik, Kedah, Malaysia: 2014 - 2017
Get PDFINTRODUCTION: Leptospirosis is endemic in Malaysia. Over the past decade, there have been an increased in the number of leptospirosis cases and outbreaks. Previous leptospirosis studies examined the incidence rate, disease burden and risk factors for leptospirosis in Malaysia, but not at district or state level. Very little is known about the leptospirosis situation at district or state level. Therefore, we conducted a study to find out about leptospirosis situation in Sik district. MATERIALS AND METHODS: We conducted a cross-sectional study from January 2014 till December 2017 in Sik District, Kedah. Information on cases admitted to Sik hospital was obtained from the health office of Sik district. Socio-demographic data and laboratory results were obtained from the patient's hospital records. We performed a descriptive analysis, followed by univariate and multivariate analysis. RESULT: From January 2014 until December 2017, 286 suspected cases of leptospirosis were admitted to Sik Hospital. Of the 286 cases, 150 were confirmed cases of leptospirosis and 136 probable cases. In our study, teenager (11-20 years of age) and older adults (aged 51-60 years) were more prone to infection with leptospirosis. Fever, vomiting, anorexia, cough, and myalgia were common symptoms. Laboratory findings in 108 confirmed leptospirosis cases showed a high white blood cell count of more than 10 X 109/L in half of the patients (50.0%), a serum aspartate aminotransferase (AST) of more than 50 U/L in 41 cases (38.0%), a platelets count of less than 150 X 109/L in 39 cases (36.1%), a serum creatinine kinase more than 308 U/L in 39 cases (36.1%) and serum alanine aminotransferase (ALT) less than 50 U/L in 33 cases (30.6%). Multivariate analysis showed leptospirosis infection was associated with cough (p=0.02. 95% CI=0.28-0.91) and abdominal pain (p=0.03, 95%CI =1.07-4.93). In our study, a higher number of leptospirosis cases were due to household infection compared to recreational activities. CONCLUSION: Teenagers and the elderly were more prone to leptospirosis infection, and the trend of household infection is increasing compared to recreational activities. Therefore, by knowing the current situation, the causes and the source of infection will help in the development of better control and prevention measures for leptospirosis
Optimized Preparation of Urine Samples from Acute Melioidosis Patients for In-Solution Proteomic Studies using LCMS QTOF or MALDI TOF MS
Get PDFIntroduction: 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 Burkholderia pseudomallei 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. Material and Methods: We adapted an acetone-TCA based protein precipitation method with LCMS-QTOF MS to detect the B. pseudomallei 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. Results: A total of 3,866 human peptides were detected across 11 urine samples from clinically suspected acute melioidosis patients. Among them were three Burkholderia 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. Conclusions: 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 B. pseudomallei proteins. Discovery of the entire proteome as a whole is important in leading to biomarker discovery
Association between Hs-CRP and other Cardiovascular Risk Factors with Blood Pressure in Young Adults
Get PDFINTRODUCTION: 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
Willingness to Pay for Cancer Genetic Testing in a Tertiary Healthcare Centre
Get PDFINTRODUCTION: 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
Changes in Corneal Endothelial Cells Morphology Due to Different Cataract Surgery Procedures: A Retrospective Study From November 2014 to November 2016
Get PDFIntroduction: The corneal endothelium is made up of an extremely thin layer of non -regenerating cells essential in keeping the cornea clear. The purpose of this study was to quantify the corneal endothelial cells morphology, visual acuity (VA) and refractive error in patients having femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS). Methods: Clinical data from 56 eyes were included in this study. 28 eyes had FLACS surgery and another 28 eyes had CPS. Distance VA, refractive error, corneal thickness and endothelial cells morphology were evaluated pre-operatively and at 1 month follow up. Refractive error was determined subjectively and VA was taken using Snellen chart. Specular microscope was used to measure endothelial cells morphology and central corneal thickness. Mann Whitney test and Spearman correlation analysis were used to analyse the results. Results: There were no statistically significant difference in the mean endothelial cell density (p=0.24), mean central corneal thickness (p=0.68), mean coefficient of variance (p=0.19), mean hexagonality (p=0.44), VA (p=0.72) and postoperative refractive outcome (p=0.66) between both groups. The duration of surgery was noted to have no statistically significant difference between both groups (p=0.08), while the cumulative dissipated energy and torsional time showed a significant difference between groups (p=0.01 and p<0.01 respectively). Conclusion: This study concluded that there was no significant difference in the endothelial cells morphology in patients undergoing both cataract surgeries. Both surgeries presented similar outcomes in the patients’ eyes
Effectiveness of Smartphone Application in Improving Knowledge on Under-Five Childhood Immunization Schedule amongst Parents in Selected Nurseries
Get PDFIntroduction: Knowledge on under-five childhood immunization has been identified as a key factor in determining understanding and compliance to the schedule. Understanding the current levels of knowledge and introducing a health intervention to improve the level will benefit the population to be healthier and reduce morbidity. Materials and Method: A quasi-experimental study was conducted in nurseries in Putrajaya and Cyberjaya, Malaysia from January 2016 to January 2018. 98 respondents from Putrajaya were given the technology based intervention and 98 from Cyberjaya were the wait-listed control group. Respondents answered a validated, self-administered questionnaire at baseline, immediate post-intervention and 3 months post-intervention that were specifically targeted to examine their levels of knowledge on under five childhood intervention. Results: Data was analysed using Statistical Package for Social Science (SPSS) Version 23. The level of knowledge at baseline was 58.9% for the intervention group and 61.7% for the control group with no significant difference between both groups (p=0.651). Immediate post intervention showed a significant difference (p<0.001) between the intervention group (97.7%) and control group (54.9%). As for 3 months post-intervention the intervention group was 95.5% and the control was at 85.1% (p<0.001). Conclusion: The level of knowledge improved after receiving the health intervention module and was effective in the increasing of knowledge among the respondents. However, there are still gaps in research that must be addressed in future studies to help further improve knowledge on under-five childhood immunization schedule