Reactive arthritis in tuberculosis : a case of Poncet's disease

Reactive arthritis and erythema are uncommon presentations of tuberculosis (TB). Reactive arthritis in tuberculosis (TB) is known as Poncet's disease, a rare aseptic form of arthritis observed in patients with active TB. We report a case of Poncet's disease in a 20-year old man whose reactive arthritis overshadowed other clinical symptoms of TB resulting in delayed diagnosis and treatment. Although a conclusive diagnosis of Poncet's disease is not possible, reactive immunologic reactions such as reactive arthritis and erythema nodosum even without respiratory symptoms should raise suspicion on possible TB. Thus, taking a thorough medical history as well as performing relevant examinations and investigations for possible TB will help expedite the diagnostic process

Glycemic control among insulin-treated Type 2 diabetes in Kelantan

Objective: To determine the prevalence of good glycemic control and its associated factors that contribute to good glycemic control among insulin-treated Type 2 diabetes mellitus. Design: Cross sectional study. Materials and Methods: The study was conducted on 236 insulin-treated T2DM at Diabetic Clinic, Hospital Universiti Sains Malaysia using systematic random sampling. A set of case report form (CRF) was used. Data was entered and analyzed by SPSS 12.0 using descriptive and Multiple Logistic Regression analyses. Results: The percentage of good glycemic control (HbA1C less than7.0%) was 21.2 percent. The factors that contribute to good glycemic control were female gender (Adjusted OR 5.06; 95%CI 1.64, 15.59), high education (Adjusted OR 16.44; 95%CI 3.68, 73.58), combination of insulin and oral anti-diabetic drugs regime (Adjusted OR 3.11; 95%CI 1.01, 9.55), basal bolus insulin (Adjusted OR 5.18; 95%CI 1.61, 16.70) and fasting plasma glucose less than 6.1mmol/l (Adjusted OR 8.30; 95%CI 3.24, 21.27). Conclusion: Majority of our patients did not achieve the target of HbA1C less than 7.0% as recommended by the American Diabetes Association. Physicians should be aware of the associated factors that may influence the glycemic control among insulin treated type 2 diabetic patients. Future studies are needed to explore the patient's skills and knowledge on how to adjust the insulin dose during the treatment

A preliminary study of job satisfaction and motivation among the Malaysian primary healthcare professionals

Aim: This study aimed to examine the relationship between personal or work-based characteristics and job satisfaction and motivation in Malaysian primary healthcare professionals. Methods: This was a cross-sectional survey conducted during the 15th Family Medicine Scientific Conference in June 2011 using the Warr-Cook-Wall scales. The questionnaires included demography and work-related items and were self-distributed and returned at the end of the conference. Independent risk factors were identified using multiple linear regressions. Results: A total of 149 conference participants completed the survey, with a response rate of 33.1%. They were mainly females (85.2%), Malay (83.2%), and married (83.9%) in almost equal proportions of practice location (urban 57.8% and rural 42.2%). Majority of them were working at community-based health clinics (74.0%) and in public sectors (94.4%). The respondents were mainly doctors (91.4%). The mean age of the participants was 39.1 years (SD 8.0), with a mean duration of service of 9 years (SD 6.9). Family medicine specialty (FMSt) residents had lower job satisfaction (B = -8.0, 95% CI -14.61 to -1.40, p = 0.02). Family medicine specialists (FMSs) had higher satisfaction with working conditions (B = 1.95, 95% CI 0.50 to 3.41, p = 0.01). A male worker had on average 2.8 (95% CI -4.7 to -0.9, p = 0.005) lower points in the total intrinsic job motivation scale. There was a positive relationship between the duration of working and job motivation (B = 0.10, 95% CI 0.004 to 0.2, p = 0.04). Conclusion: FMSt residents might have the least job satisfaction, but FMSs were generally satisfied with their working conditions regardless of the location of their clinics. Men and those who were novice in primary healthcare may need more support for motivation

Knowledge on breast cancer and practice of breast self examination among selected female university students in Malaysia.

Breast cancer is the most common cancer affecting women in most parts of the world including Malaysia. Even though breast self examination (BSE) is not seen as a relevant cancer screening tool anymore, it still plays an important role in the breast health awareness programme. Aim of the study to determine the knowledge of respondents on breast cancer regarding the risk factors, symptoms, and to determine respondents’ practice of breast self-examination. A cross sectional study was carried out in University Putra Malaysia, data were collected using validated questionnaire developed for this study. Among respondents 197(83.1%) were single, 100 were Malay (42.3%) and 49(20.7%) of the respondents reported having a family history of breast cancer. eighty-seven respondents (36.7%) claimed they had practice BSE. There were statistically significant differences between those who practice and did not practice BSE in term of knowledge regarding risk factors, symptoms of breast cancer, total knowledge of breast cancer and knowledge score of BSE (p-value <0.05). The findings showed that knowledge of breast cancer and the practice of BSE is inadequate among young Malaysian female

Effects of EPA/DHA from yellow-stripe scad and salmon on platelet-related cytokines of healthy overweight Malaysians

Introduction: Overweight currently has become a major global burden. Salmon is one of the major sources for fish oil to treat inflammatory related cardiovascular diseases. Yellow-stripe scad (YSS) on the other hand, is a local Malaysian fish which can be a good substitute for salmon; however, the therapeutic effects of YSS is still unclear. Objective: Therefore, this study compared the nutritional values EPA+DHA of YSS and salmon on body mass index (BMI), leptin and activation markers for both platelet and endothelial cell. Methods: Healthy overweight Malaysian adults (n=45), aged 21-55 years old, were recruited for 6-months cross-over trial study. They were randomised equally to receive eight weeks of either steamed whole YSS fish or salmon fillet, for three days per week, obtaining approximately 7000 mg EPA+DHA weekly. The diets were switched after an eight-week washout period. Baseline dietary fish intakes were similar in the two groups. Results: Significant differences observed in serum leptin for YSS-baseline group I and salmon-baseline group II (p0.05). Significant decreased were also observed in serum vWF and VCAM-I in salmon/baseline group II (p0.05). However, there was no significant differences between YSS and salmon (P>0.05) on time and treatment in all variable after 16 week, but there was a significant effect of treatment on sCD40L from YSS and vWF from salmon (p<0.05) Conclusion: Both YSS and salmon could harmonized EPA+DHA into leptin, platelet and endothelial phospholipid membrane to decreased platelet and endothelial cell activation markers which may contribute to the cardioprotective effect of EPA +DHA. Thus, the health benefits of YSS fish “ikan selar” and salmon on leptin and prothrombotic parameter on healthy overweight adults may be similar

Effects of consuming yellowstripe scad versus salmon on lipid profile, fasting glucose, body weight status and blood pressure among healthy overweight Malaysian adults

Introduction: This is a preliminary result of an on-going randomised cross-over trial to compare the effects of consuming yellowstripe scad (YSS) and salmon, both rich in omega-3 fatty acids, on lipid profile, fasting glucose, body weight status, and blood pressure among healthy overweight adults. Methods: Fifty healthy overweight Malaysians aged 21-55 years were recruited voluntarily through advertisements. During the first period of intervention, subjects were randomised equally to receive eight weeks of either steamed whole YSS fish (YSS group) or salmon fillet (salmon group), three days per week, obtaining approximately 7000 mg EPA+DHA per week. The diets were switched after an eight-week washout period. Lipid profile, fasting glucose, body mass index, and blood pressure were evaluated before and after each intervention period. Results: The mean ages of YSS group (n=25) and salmon (n=25) group were 30.6±9.1 and 27.9±7.1 years respectively. Both groups had no statistically significant differences on socio-demographic characteristics (p>0.05). After the first intervention period, there was a significant increase in total cholesterol within the YSS group (p0.05). Both YSS and salmon groups had significantly higher HDL-cholesterol levels after 8 weeks compared to baseline(p<0.05). There was no significant between-group difference in all the variables after eight weeks (time x group interaction, p>0.05). However, there was a significant effect of time on diastolic blood pressure (p<0.05). Conclusion: These preliminary findings indicate that YSS and salmon may have similar beneficial effects on HDL-cholesterol level among healthy overweight adults. The second intervention period is on-going to confirm these findings

An overview of patient involvement in healthcare decision-making: a situational analysis of the Malaysian context

Background: Involving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients’ desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia. Methods: In this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation. Results: There are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient’ programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan. Conclusion: In summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia

A Protocol of Process Evaluations of Interventions for the Prevention of Type 2 Diabetes in Women With Gestational Diabetes Mellitus: A Systematic Review

Background Process evaluations of randomised controlled trials (RCTs) can provide insight and inform us on the intervention implementation, the causal mechanisms and the contextual factors. This will inform about interventions’ success or failure due to their implementation or the interventions themselves. We aim to consolidate the methodology from previous process evaluations of complex interventions upon their findings on facilitators and barriers to address the prevention of type 2 diabetes mellitus among women with gestational diabetes mellitus (GDM). Methods Comprehensive search will be conducted on electronic databases and reference lists of recent reviews for RCTs of complex interventions which address process evaluations of diabetes prevention intervention (DPI) for women with GDM in healthcare settings. There is no restriction on the language of the papers and year of publication until December 2020. Data from each study will be extracted by two reviewers independently using standardised forms. Data extracted include descriptive items on the study design and the outcomes of process evaluations from the three dimensions: (1) implementation; (2) mechanism of impact and (3) context. The quality of the studies will be assessed using mixed methods appraisal tool which is designed for the appraisal of mixed studies in systematic reviews. A narrative and framework analysis of the findings will be presented to inform the contents of a new DPI for women with GDM. Discussion The findings from this process evaluation findings are valuable in determining whether a complex intervention should be scaled up or modified for other contexts in future plan. It will give deeper understanding of potential challenges and solutions to aid in the implementation of effective DPIs for GDM in Malaysia

Anxiety, depression and stress among medical students in Malaysia during COVID-19: a cross-sectional study

Introduction: This study aimed to determine the prevalence and factors associated with psychological distress following the COVID-19 pandemic among medical students at one of the public universities in Malaysia. Method: From August to October 2020, a web-based cross-sectional study was conducted among undergraduate medical students at a public university. DASS-21, Brief Resilience Scale and WHOQOL-Bref questionnaires were used in this study. Results: The prevalence of depression was 40.5%, anxiety 46.0% and stress 30.9%. Based on multivariate logistic regression, a higher quality of life score is associated with a lower likelihood of depression (AOR=0.583, p<0.001), anxiety (AOR=0.726, p<0.001), and stress, (AOR=0.702, p<0.001) respectively. Likewise, a higher resilience score is less likely to be associated with depression (AOR=0.880, p=0.002), anxiety (AOR=0.880, p=0.002), and stress (AOR=0.850, p<0.001). Older age (OR=0.700, p=0.020) was associated with less stress and being on campus (OR=3.436, p=0.021) was at risk of stress during the COVID-19 pandemic. Conclusion: Our results suggest that medical students with higher quality of life and resilience scores had less depression, anxiety and stress. Older age was associated with less stress, and during the COVID-19 pandemic, being on campus was at risk of stress. Various stakeholders need to keep these findings in mind and identify those who are at risk for developing depression, anxiety, and stress in order to take further action to improve their quality of life and resilience

A mobile phone app for the prevention of type 2 diabetes in Malaysian women with gestational diabetes mellitus: Protocol for a feasibility randomized controlled trial

Background: Over 50% of women with a history of gestational diabetes mellitus (GDM) will develop type 2 diabetes (T2D) in later life. Asian women experience a disproportionate risk of both GDM and T2D compared to women from other ethnic backgrounds. Lifestyle interventions and behavior change can delay or even prevent the onset of T2D. We have developed a digitalized diabetes prevention intervention for the prevention of T2D in Malaysian women with GDM. Objective: The protocol describes a randomized controlled trial (RCT) to test the feasibility of undertaking a definitive trial of a diabetes prevention intervention, including a smartphone app and group support. Secondary aims are to summarize anthropometric, biomedical, psychological, and lifestyle outcomes overall and by allocation group, and to undertake a process evaluation. Methods: This is a two-arm parallel feasibility RCT. A total of 60 Malaysian women with GDM will be randomized in the antenatal period to receive the intervention or standard care until 12 months post partum. The intervention is a diabetes prevention intervention delivered via a smartphone app developed based on the Information-Motivation-Behavioral Skills model of behavior change and group support using motivational interviewing. The intervention provides women with tailored information and support to encourage weight loss through adapted dietary intake and physical activity. Women in the control arm will receive standard care. The Malaysian Ministry of Health’s Medical Research and Ethics Committee has approved the trial (NMRR-21-1667-60212). Results: Recruitment and enrollment began in February 2022. Future outcomes will be published in peer-reviewed health-related research journals and presented at national, regional, or state professional meetings and conferences. This publication is based on protocol version 2, January 19, 2022. Conclusions: To our knowledge, this will be the first study in Malaysia that aims to determine the feasibility of a digital intervention in T2D prevention among women with GDM. Findings from this feasibility study will inform the design of a full-scale RCT in the future