Factors in determining seizure control in pediatric patients on antiepileptic medication: a review of the literature

Introduction Pediatric epilepsy is one of the common illness in children. Pediatric epilepsy has significant impact not only to the patient, but also to the care takers. Furthermore, the disease could potentially cause strain in the limited resources of the healthcare system which is preventable. Methods A search was conducted to review relevant published studies on factors affecting seizure control using PubMed/MEDLINE, Google Scholar and also Science Direct searching engines databases using keywords: paediatric seizure, seizure control, side effects, antiepileptic, adherence and quality of life. Results In this review, we found that many factors contribute to the pediatric epilepsy, namely; compliance, genetic, age, socioeconomic factors, parental health literacy and numbers and side effects of the medications. Furthermore, there is certain factors that need to be explored in the future, such as unaddressed parental concern on treatment/medication, denial of disease and drug-drug interactions. Conclusions Factors that had been identified can be used in the prevention and control programs, while factors which is less studied should be further studied in the future

The association of knowledge, attitude and practice with 24 hours urinary sodium excretion among Malay healthcare staff in Malaysia

Introduction The most effective and affordable public health strategy to prevent hypertension, stroke and renal disease is by reducing daily salt consumption. Therefore, this study aims to determine the association of knowledge, attitude and practice on salt diet intake and to identify foods contributing to high sodium intake. Methods Secondary data analysis was performed on MySalt 2016 data. It was conducted from November 2015 until January 2016 which involving Ministry of Health Staff worked at 16 study sites in Malaysia. Salt intake was measured using 24 hours urinary sodium excretion. Food frequency questionnaire was used to determine the sodium sources. Knowledge, attitude and practice of salt intake were assessed using a validated questionnaire adapted from WHO. Demographic data and anthropometric measures also were collected. Sodium levels of more than 2400mg/day was categorised as high sodium intake. Data were analysed using SPSS software version 21. Results The mean sodium intake estimated by 24 hours urinary sodium excretion was 2853.23 + 1275.8 mg/day. Food groups namely rice/noodles (33.8%), sauces/seasoning (20.6%), meat and poultry (12.6%) and fish/seafoods (9.3%) were the major contributors of dietary sodium. In multiple logistic regression analysis, being a male (aOR=2.83, 95% CI 2.02 – 3.96) and obese (aOR=6.78, 95% CI 1.98 – 23.18) were significantly associated with high urinary sodium excretions. In addition, those who were unsure that high salt intake can cause hypertension (aOR=1.24, 95% CI 0.65 – 2.36), those who think that they consumed too much salt (aOR=2.10, 95% CI 1.13 – 3.87) and those who only use salt rather than other spices for cooking (aOR=2.07, 95% CI 1.29 – 3.30) were significantly associated with high urinary sodium excretion. Conclusions This study showed that the main sources of sodium among Malay healthcare staff is cooked food. Poor knowledge and practice towards reducing salt consumption among them contributes to the high sodium consumption. The practice of healthy eating among them together with continuous awareness campaign is essential in order to educate them to minimize sodium consumption and to practice healthy eating

Risk factors and predictors of levodopa-induced dyskinesia among multiethnic Malaysians with Parkinson's disease

Chronic pulsatile levodopa therapy for Parkinson's disease (PD) leads to the development of motor fluctuations and dyskinesia. We studied the prevalence and predictors of levodopa-induced dyskinesia among multiethnic Malaysian patients with PD. Methods: This is a cross-sectional study involving 95 patients with PD on uninterrupted levodopa therapy for at least 6 months. The instrument used was the UPDRS questionnaires. The predictors of dyskinesia were determined using multivariate logistic regression analysis. Results: The mean age was 65.6 ± 8.5 years. The mean onset age was 58.5 ± 9.8 years. The median disease duration was 6 (7) years. Dyskinesia was present in 44% (n = 42) with median levodopa therapy of 3 years. There were 64.3% Chinese, 31% Malays, and 3.7% Indians and other ethnic groups. Eighty-one percent of patients with dyskinesia had clinical fluctuations. Patients with dyskinesia had lower onset age ( p < 0.001), longer duration of levodopa therapy ( p < 0.001), longer disease duration ( p < 0.001), higher total daily levodopa dose ( p < 0.001), and higher total UPDRS scores ( p = 0.005) than patients without dyskinesia. The three significant predictors of dyskinesia were duration of levodopa therapy, onset age, and total daily levodopa dose. Conclusions: The prevalence of levodopa-induced dyskinesia in our patients was 44%. The most significant predictors were duration of levodopa therapy, total daily levodopa dose, and onset age

Prevalence and factors of adherence to post exposure follow-up among sharps-injured healthcare workers in a government hospital

Adherence to post-exposure follow-up protocol reflects the continuity of care in managing sharps injuries among healthcare workers (HCWs). This study aimed to determine the prevalence of adherence to post-exposure follow-up and its associated factors in a public hospital. This cross-sectional study was conducted at Hospital Melaka, Malaysia. All 250 reported sharps injury cases among HCWs were conveniently sampled throughout the period of five years between 2013 to 2017. Data from the Infectious Disease Clinic were extracted and analysed descriptively via multivariate binary logistic regression using IBM SPSS version 22 software. Sharps-injured HCWs were predominantly female (64.4%) with a median age of 26 (IQR 24 to 28) years old, had two years or more of experience (36.8%), status was negative for HIV/HBV/HCV (68.4%) and non-paramedics (84.4%). The prevalence of adherence to follow-up was 36.8%. Paramedics were more adhere to follow-up (56.4%) than the non-paramedics group. The factors that were significantly associated with follow-up adherence were the type of device (p=0.049) and occupation category (p=0.006). Paramedics had 2.66 times the odds of adherence to post-exposure follow-up compared to non-paramedics (95%CI: 1.32, 5.36; p = 0.006) when adjusted for type of devices. Based on our study, paramedics showed a good example of HCWs with a higher prevalence of adherence as compared to non-paramedics. However, the overall prevalence of adherence was still low. Hence, further research on finding the determinants of adherence in a local setting is undoubtedly needed

A tale of two construct validation analysis: Rasch model and exploratory factor analysis approach for Three-Factor Eating Questionnaire (TFEQ-R21) among Malaysian male workers

Introduction: This study aims for construct validation using two approaches, i.e., exploratory factor analysis and Rasch Model. Methods: A cross sectional of 313 male workers from multiple worksites had completed self-administered Malay translated version of Three-Factor Eating Questionnaire- R21. Data quality was assessed by misfit person criteria, dimensionality, summary statistic, item measure and rating (partial credit) scale followed by exploratory factor analysis and internal consistency reliability assessment. Results: The dual approaches of construct validation analysis were complement to each other. Rasch analysis supported the theoretical constructs of three eating behaviour dimensions among respondents. In contrary to exploratory factor analysis, it did show presence of a newfound factor (α=0.04) came up from the separation of the cognitive restrain and uncontrolled eating however, the correlation between the two respective sub-factors were fair (r=0.39) and weak (r= −0.08). Both analyses had detected three problematic items but those items were psychometrically fit for used for current study setting. The data had adequate psychometric properties. Cronbach’s alpha for cognitive restraint, uncontrolled eating and emotional eating were 0.66, 0.79 and 0.87 respectively. Rating scale quality was conformed to standard criteria. Conclusion: Malay version TFEQ-R21 with promising psychometric properties and valid measures for eating behaviour dimensions among male workers aged between 20 to 60 years old is now available. Further development should focus on the items in relation to Malaysian cultural adaptation before its use for daily practice in future setting

Transcriptome profiling of stevia rebaudiana ms007 revealed genes involved in flowedevelopment

Stevia rebaudiana is a medicinal plant recommended to diabetic or obese patients as an alternative sweetener owing to its low-calorie property. Previous studies have found that the stevioside level is highest at the time of flower bud formation and lowest at the time of preceding and following flower bud formation. Hence, this study aims to identify the genes involved in the flowering of local S. rebaudiana accession MS007 by investigating the transcriptomic data of two stages of growth, before flowering (BF) and after flowering (AF) that were deposited under accession number SRX6362785 and SRX6362784 at the NCBI SRA database. The transcriptomic study managed to annotate 108299 unigenes of S. rebaudiana with 8871 and 9832 genes that were differentially expressed in BF and AF samples, respectively. These genes involved in various metabolic pathways related to flower development, response to stimulus as well as photosynthesis. Pheophorbide A oxygenase (PAO), eukaryotic translation initiation factor 3 subunit E (TIF3E1), and jasmonate ZIM domain-containing protein 1 (JAZ1) were found to be involved in the flower development. The outcome of this study will help further research in the manipulation of the flowering process, especially in the breeding programme to develop photo-insensitive Stevia plant

Mastoid surgery outcomes in two tertiary Malaysian hospitals

Objective: Mastoidectomy is a surgical procedure of exenterating the mastoid air cell. The goal of this surgery is to create a dry, safe ear, to preserve or restore functional hearing as much as possible and to prevent complications. There are two types of mastoidectomy, each with their own indications, advantages, and disadvantages. It can be divided into canal wall up mastoidectomy (CWUM) and canal wall down mastoidectomy (CWDM). The objective of this study is to determine the outcome of both types of mastoidectomy in term of audiological and ear status for patients with chronic active otitis media (OM) with cholesteatoma, chronic mastoiditis or chronic active OM with cholesteatoma and mastoiditis managed at our tertiary centres; Universiti Kebangsaan Malaysia Medical Centre (UKMMC) and Kuala Lumpur General Hospital (KLGH). Design: A retrospective 10-year study was conducted at UKMMC and KLGH. Materials & Methods: All patients who were diagnosed with CSOM with / without cholesteatoma and/ or chronic mastoiditis and underwent surgical intervention during the study periods were included in this study. The age, gender, presenting symptoms, complications, diagnosis, surgical procedures and the surgical findings were retrieved from clinical notes. The postoperative pure tone audiometric (PTA) thresholds were evaluated on the follow-up visit within six months to one year after surgery. Results: There were 253 patients recruited with 260 ears as study samples. 103 cases underwent CWUM and 157 cases underwent CWDM. At surgery, cholesteatoma was detected in 68% of the patients. We found 58.3% of ears in the CWUM group showed improvement in hearing threshold whereas only 44.6% showed improvement in the CWDM group. Post-operatively, mean PTA in CWUM (49.7dB) is significantly better than CWDM (59.2dB) with p value of 0.003. In CWUM, the mean air bone gap (ABG) is 24.05dB, which is significantly better than in CWDM (31.03dB). From all patients who underwent CWUM, 42% had post-operative ABG less than 20dB and this only occurred in 20.6% of the CWDM group. For ear status, 85% of patients who underwent CWUM had a dry ear postoperatively, which is significant compared to CWDM which was 69%. Conclusion: CWUM provides a better hearing outcome based on average air conduction (AC) threshold, AC gain and mean ABG. It also has a higher chance of obtaining a safe, dry ear

Missed Appointments at a Child Development Centre and Barriers to Access Special Needs Services for Children in Klang Valley, Malaysia: A Mixed Methods Study

Attending appointments is vital for children with special needs, as such appointments involve long-term interdisciplinary care to ensure continuity of care and improve health and well-being. This study was performed to determine the prevalence of missed clinic appointments and identify the factors among those who have ever missed appointments and barriers of access to children&rsquo;s special needs services at the Child Development Centre (CDC) at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Moreover, suggestions for improvement from the caregivers&rsquo; perspectives were explored. This is an explanatory sequential mixed methods study among caregivers of children with developmental disabilities aged up to 17 years old. Of 197 caregivers, 62 (31.5%) had missed clinic appointments. Forgetfulness was the most frequently cited reason. The bi-variable analysis showed significant differences in missed appointment rates by gender of caregivers and duration of follow-up. The final logistic regression model demonstrated that, when combined with the effect of being a male caregiver as an independent variable, follow-up duration of more than 6 years increased 2.67 times the risk of missing an appointment. Caregivers&rsquo; perceived barriers were transportation, caregiver, child and healthcare services factors. Policies and strategic plans should be focused on key findings from these factors to improve appointment adherence and accessibility to services for children with special needs