IIUM Medical Journal Malaysia (IMJM)
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Navigating the Diagnostic Maze of Psoriatic Arthritis sine Psoriasis in Primary Care
Get PDFPsoriatic arthritis, a seronegative spondyloarthropathy is an autoimmune inflammatory joint disease. However, the diagnosis is often delayed due to the absence of specific biomarkers and a lack of awareness among primary care providers, who may be unable to recognize the key features of the condition. We present a case of a 30-year-old woman with a 9-month history of lower back pain and multiple joint pain. Despite elevated inflammatory markers like C-reactive protein and erythrocyte sedimentation rate, other initial tests including rheumatoid factor and antinuclear antibody tests were all negative. The appearance of new skin lesions in the 10th month prompted further evaluation and resulted in a diagnosis of psoriatic arthritis. Treatment with Celecoxib and Methotrexate led to significant improvement in her condition. This case underscores the crucial role of primary care providers in the early detection and management of spondyloarthropathy, helping to prevent joint damage and enhance patient outcomes
Prevalence of Diabetes Mellitus and its Associated Factors among Adults in Malaysia: Findings from the National Health and Morbidity Survey 2019
Get PDFINTRODUCTION: Diabetes mellitus (DM) is a major non-communicable health problem in both developed and developing countries, including Malaysia. This study aimed to determine the prevalence of DM and identify associated factors among adults in Malaysia. MATERIALS AND METHODS: A nationwide cross-sectional study was conducted in 2019 involving 10,464 respondents. A two-stage stratified sampling design was employed to select a representative sample of adults aged ≥18 years. Data was collected using structured and validated questionnaires administered through face-to-face interviews. Finger-prick fasting blood glucose tests were performed on respondents without a known DM diagnosis. All analyses were weighted to represent the Malaysian adult population. Chi-square tests and multiple logistic regression analyses were used to determine the associations between DM and the associated factors, with a significance level set at 0.05. RESULTS: The overall weighted prevalence of DM was 18.3% (n=2629). Higher prevalence was observed among individuals aged ≥60 years (41.5%), of Indian ethnicity (31.4%), physically inactive individuals (22.5%), obese individuals (27.1%), those with hypertension (36.0%), and those with high cholesterol levels (30.4%). Logistic regression identified age, ethnicity, obesity, hypertension, and cholesterol levels as significant factors associated with DM. CONCLUSION: The prevalence of DM among Malaysian adults remains high. Targeted strategies focusing on high-risk groups, particularly older adults, individuals of Indian ethnicity, those with obesity, hypertension, and dyslipidaemia, are important to reduce the national diabetes burden.
The Avoidance Practice and Its Association with Self-Efficacy, Knowledge and Attitude among Mothers with Children under 6 Years Old on Environmental Tobacco Smoke Exposure to Their Children in Selangor
Get PDFINTRODUCTION: Environmental tobacco smoke (ETS) poses significant health risks globally, particularly for children. This study aimed to determine levels of self-efficacy, knowledge, attitude, and avoidance practices regarding ETS exposure among mothers with children under six and identify factors associated with avoidance practices. MATERIALS AND METHODS: A cross-sectional study was conducted using the validated Malay SE-KAP-ETS questionnaire among 321 mothers. Higher scores indicated better self-efficacy, knowledge, attitude, and avoidance practices. Multiple linear regression (MLR) analysis was performed to determine associations. RESULTS: Participants had a mean age of 33.4(±5.57), and 67.9% had tertiary education. Mean scores were: self-efficacy 36.41(±9.7), knowledge 38.26(±3.76), attitude 48.58(±3.75), and avoidance practices 28.33(±3.27). MLR revealed that no smokers at home [B=0.700, 95%CI: 0.304, 1.462; p=0.003], higher self-efficacy [B=0.058, 95% CI: 0.028, 0.088; p<0.001], and positive attitudes [B=0.414, 95%CI: 0.336, 0.491; p<0.001] were positively associated with avoidance practices. Conversely, primary and secondary education [B=-0.750, 95% CI: -1.449, -0.051; p<0.035] and self-employment [B=-1.517, 95%CI: -2.584, -0.450; p=0.005] were negative predictors. CONCLUSION: Findings indicate that although ETS knowledge is high among mothers of young children in Selangor, it does not predict avoidance practices. Instead; self-efficacy, attitude, and smoke-free homes are critical determinants, underscoring the need for empowerment-focused interventions, particularly for mothers with primary and secondary education
Study on the Effectiveness of Integrating Religious Approaches in Health Interventions for Transgender Individuals in Malaysia
Get PDFINTRODUCTION: Transgender women (mak nyahs) are biological males who self-identify as females and often face discrimination in education, employment, and healthcare. Economic marginalisation frequently pushes them into sex work, heightening risks of HIV infection, depression, anxiety, and substance abuse. While interventions for Muslim transgender communities exist, their effectiveness is underexplored. This study evaluated a health program integrating Islamic elements to reduce HIV-related risk behaviours among mak nyahs. MATERIALS AND METHOD: A cross-sectional study was conducted among 50 participants recruited via respondent-driven sampling. A validated, self-administered questionnaire assessed religiosity and HIV-related risk behaviours. The intervention, delivered in a 3-day, 2-night motivational camp (Mukhayyam), incorporated Islamic talks, tazkirah (religious reminders), songs, videos, slides, and quizzes. Participants completed questionnaires at baseline (Day 1) and post-intervention (Day 3). RESULTS: The mean age of respondents was 39.9 years (SD=9.46). One-fifth reported sex work, and only one-third reported no HIV-related sexual risk behaviours. The intervention significantly improved knowledge and attitudes related to ibadah (z=-2.317, p=0.021) and akhlak (z=-2.900, p=0.004), with an overall increase in Islamic religiosity scores (z=-3.038, p=0.002). Health knowledge also improved, particularly on the negative effects of cosmetic procedures (z=-2.848, p=0.004). CONCLUSION: The Mukhayyam-based intervention incorporating Islamic teachings enhanced religious knowledge and showed potential in reducing HIV-related risks among Muslim transgender women. Longitudinal studies and controlled trials are warranted to evaluate sustainability and scalability.
Prevalence and Perinatal Outcomes of Group B Streptococcus Positive Mothers in a University Hospital in Pahang, Malaysia
Get PDFINTRODUCTION: Group B streptococcus (GBS) is a leading cause of early neonatal infection and is related to various maternal infections. This study aims to determine the prevalence of GBS-positive mothers and their pregnancy outcomes in a University Hospital in Pahang, Malaysia. MATERIALS AND METHODS: A comparative cross-sectional study was conducted from October 2021-May 2022, involving 230 pregnant women between 35-38 weeks follow-up at this hospital. Rectovaginal swab (RVS), high vaginal swab (HVS), and midstream urine (MSU) cultures were sent for GBS screening in asymptomatic mother, and positive mothers received intrapartum antibiotic prophylaxis (IAP) as per protocol. Maternal outcome analysed were preterm pre-labour rupture of membrane (PPROM), preterm labour, maternal pyrexia, and puerperal infection. Whereas, neonatal outcomes include prematurity, low Apgar score, requirements of NICU/SCN admission and antibiotic; and diagnosis of neonatal early-onset GBS (EOGBS) disease. RESULTS: 58.6% of participants were tested GBS-positive based on either RVS, HVS, or MSU culture. There was no significant association between maternal GBS status, sociodemographic, and clinical background except for being overweight (mean BMI 26.3 kg/m2, p= 0.047). Maternal and neonatal outcomes were not significantly different between GBS-positive and GBS-negative mothers. CONCLUSION: The prevalence of GBS colonisation (58.6%) was higher compared to reports worldwide. However, the implementation of GBS screening and IAP had successfully prevented the development of EOGBS disease and complication for both mothers and neonates. Therefore, screening for asymptomatic mother is important and effective for GBS infection
The Relationship between Psychological Well-Being and Self-Directed Learning in Medical Students
Get PDFIntroduction: Student well-being plays a crucial role in influencing self-directed learning (SDL), particularly among medical students who face intense academic demands. This study aimed to assess the levels of psychological well-being and SDL among undergraduate students at the Faculty of Medicine, Universitas Islam Indonesia (FM UII), and to examine the relationship between the two variables. Materials and Methods: An observational, cross-sectional study design was employed, involving 317 undergraduate medical students from FM UII. Data collection utilized the Indonesian versions of Ryff’s Psychological Well-Being Scale and the Self-Directed Learning Readiness Scale. Univariate and bivariate analyses were conducted to evaluate the data and determine correlations. Results: Findings revealed that most students demonstrated moderate to high psychological well-being. SDL levels were predominantly high, with 74.8% of respondents reporting a high level of SDL, 25.2% reporting a moderate level, and none reporting low SDL. A statistically significant positive correlation was identified between psychological well-being and SDL (p=0.000; r=0.352), indicating a moderate relationship. Conclusion: The results suggest that most medical students at FM UII possess good psychological well-being and strong SDL readiness. A positive correlation between psychological well-being and SDL indicates that students with higher well-being are more likely to be confident and proactive in managing their own learning. These findings highlight the importance of fostering a supportive academic environment that prioritizes student mental health to enhance SDL capabilities. Faculty and educators should therefore integrate strategies that promote psychological well-being to improve learning outcome
Scoping Review of Community-Based Interventions to Improve Diabetes Control in Malaysian Adults
Get PDFType 2 diabetes mellitus (T2DM) is a major non-communicable disease globally including Malaysia. Despite a huge amounts of funds spent for the management of T2DM including community-based interventions (CBIs), the national statistics on the prevalence, treatment outcomes and summary measures of these population health have not improved. Thus we conducted a scoping review to map the details of CBI used for diabetes control among adult T2DM in Malaysia. A scoping review that followed the standard PRISMA guideline in conducting and reporting a scoping review was conducted. A search for relevant journal articles were conducted on four electronic databases (PubMed, SCOPUS, Cochrane Library, and Google Scholar). The titles and abstract of the search results were screened to select eligible papers for full text retrieval. Eligible papers were those reporting CBI studies of adults diagnosed with Type 2 diabetes mellitus in Malaysia. Only studies using intervention designs were included. Thirteen studies were reviewed and had individually-oriented or group-based interventions, or a combination of both. There was limited adoption of behavioural theories in guiding these diabetes interventions. Outcomes of the interventions were inconsistent. Most studies yielded significant positive results on HbA1c, diabetes knowledge, blood pressure, blood sugar, and foot care practices; few demonstrated positive outcomes on self-efficacy, body mass index, physical activity; self-monitoring of blood glucose, medication adherence, smoking and alcohol consumption. Studies varied in their approaches and yield mixed effects on diabetes control. Nevertheless, most interventions demonstrated reductions of HbA1c, which is the main clinical outcomemeasured following the CBIs
The Association Between Marital Satisfaction, Depression, and Sexual Dysfunction Scores among Women at Six Months Postpartum in Kelantan, Malaysia
Get PDFINTRODUCTION: Female sexual dysfunction (FSD) can significantly impact the quality of sexual relationships, potentially leading to marital dissatisfaction and depression if it occurs postnatally. However, there is limited research investigating FSD, marital satisfaction, and postnatal depression (PND) in Malaysia. This study aimed to determine the association between FSD scores with marital satisfaction scores and depression scores among postpartum women in Kota Bharu, Kelantan. MATERIALS AND METHODS: A cross sectional study was conducted among 429 women at 6 months postpartum in four primary healthcare clinics in Kota Bharu district. They were required to answer the Malay Version of the Female Sexual Function Index-6 (MVFSFI-6), Golombok Rust Inventory of Marital State (MV-GRIMS), and the Edinburgh Postnatal Depression Scale (MV-EDPS). The data was analysed using multiple linear regression. RESULTS: At six months postpartum, 52.5% were at risk of sexual dysfunction, 55.0% at risk of marital dissatisfaction, and 18.2% at risk of PND. The associations between FSD scores and marital dissatisfaction scores, as well as FSD scores and PND scores, were significant. CONCLUSION: The frequency of FSD could heighten the risks of marital dissatisfaction and depression in postpartum women. Thus, healthcare providers should holistically assess sexual issues in postpartum women and refer them for early diagnosis and treatment to prevent adverse outcomes
Stroke Chameleon: Acute Bilateral Middle Cerebral Artery Infarct Complicated with Acute Pulmonary Oedema
Get PDFAcute bilateral middle cerebral artery (MCA) infarctions are an extremely rare event. However, it can cause disruption of bilateral corticothalamic networks leading to coma. Detection of this condition is challenging as the early ischemic signs found on the non-contrast CT (NCCT) is depending on comparison between infarcted region and its normal counterpart. We report a case of 60-year-old man presented with acute comatose state and pulmonary oedema secondary to hypertensive emergency. His NCCT brain showed acute infarction of bilateral MCA territories. His acute pulmonary oedema subsequently resolved with the treatment. However, he succumbed to his illness and its complications on day 7 of admission. In this case report, we explore the strategy to improve detection of bilateral infarction on NCCT and navigating the differential diagnosis of comatose state and acute pulmonary oedema brought about by the hypertensive emergency
Ameliorative Effects of Olea europaea Oil on Morphine Withdrawal: Behavioural, Biochemical and Histological Evidence in Rats
Get PDFINTRODUCTION: Prolonged morphine use can trigger dependence and addiction leading to severe withdrawal symptoms upon cessation. Oxidative stress is a key factor in its pathogenesis. Olea europaea (olive) oil, rich in polyphenols and oleuropein, exhibits antioxidant, anti-inflammatory and neuroprotective properties. Thus, this study aimed to evaluate the effects of Olea europaea oil in alleviating morphine withdrawal symptoms in morphine-dependent rats. MATERIALS AND METHODS: A total of eighteen rats were randomly divided into three groups. The control group received normal saline, while the positive control group received intraperitoneal injections of morphine sulphate (2.5 mg/kg to 50 mg/kg) for seven days. The treatment group received the same morphine doses followed by oral administration of 250 mg/kg Olea Europaea oil for twenty-one days during morphine withdrawal period. Spontaneous morphine withdrawal behaviours of rats were observed. Subsequently the rats were sacrificed and the brain tissue was stained with H&E for histological markers. Blood serum and brain tissue were collected for Glutathione (GSH) level measurement using an ELISA kit. The findings were analysed using GraphPad Prism. RESULTS: The administration of Olea Europaea oil significantly reduced (p<0.05) spontaneous withdrawal symptoms. Findings show that Olea Europaea oil ameliorated histological brain signs of morphine toxicity and GSH levels in the brain tissue of the treated group were significantly higher (p<0.05) compared to the no treatment group. CONCLUSION: This study demonstrates that Olea Europaea oil supplementation significantly alleviates morphine withdrawal symptoms and restores antioxidant capacity likely due to its potent antioxidant and neuroprotective properties