Medical Journal of Malaysia最新文献

Introduction: Breast cancer ranks as the most common cancer among women in Malaysia with its incidence rate steadily rising over the years. Mammograms are crucial for early detection, yet their usage remains low in Malaysia, especially in Terengganu where the services are scarce. This study seeks to explore the factors influencing mammogram uptake among women visiting public primary care clinics in Terengganu.

Materials and methods: A cross-sectional study was conducted at six public primary care clinics in Terengganu, selected using cluster random sampling from both urban and rural areas. A total of 739 women participated, of whom 231 met the eligibility criteria for mammogram screening according to Ministry of Health guidelines. A validated questionnaire was utilized to gather information on sociodemographic factors, knowledge and attitudes towards breast cancer and screening behaviours. Both univariable and multivariable logistic regression analyses were conducted to examine the relationships between independent variables and mammogram uptake.

Results: Only 16.5% of the eligible participants reported having undergone a mammogram at some point. The multivariable analysis indicated that age and education level significantly predicted mammogram uptake. Women with higher education levels exhibited 2.6 times greater odds (95% CI: 1.22, 5.43) of having undergone mammography, and each additional year of age increased the probability of screening by 7% (aOR: 1.07, 95% CI: 1.01, 1.13).

Conclusion: The uptake of mammograms among women in Terengganu is alarmingly low and mirrors national trends. Women who possess higher education and are older were more likely to participate in mammography, proving the critical role of health literacy in screening behaviour. Addressing access and awareness are vital challenges in areas where mammogram services are limited. Implementing targeted educational initiatives and enhancing healthcare access, particularly in rural settings is crucial for improving breast cancer screening rates.

No abstract available.

Introduction: Diabetes mellitus is a metabolic disorder which is characterized by chronic hyperglycemia condition and this condition can cause some complications such as diabetic ulcers. Secretome from UC-MSC is an alternative treatment that being developed for accelerating wound healing of diabetic ulcers. The aim of this research is to study the effect of UC-MSC secretome for wound healing of diabetic ulcers in Nicotinamide-Streptozotocin (NA-STZ) induced Wistar rats and the mechanism through mRNA CCL22 and CXCL12 expression study.

Materials and methods: Fifteen male Wistar rats were divided into the diabetes group and the normal group. The diabetes group consists of the diabetes control group given by 0.02 ml MEM-α, the secretome group 0.004 ml, the secretome group 0.02 ml, and the secretome group 0.4 ml, and the normal group. Wounds are created on the back of the hyperglycemia rats and given the treatment intradermally. Wounded skin was collected for RNA extraction. RNA total yield used for cDNA synthesis. cDNA used as a template for Polymerase Chain Reaction (PCR) and using Agarose electrophoresis to view mRNA CCL22 and CXCL12 expression. Gene expression was normalized using mRNA GAPDH. Online software Targetscan and miRTarbase are used for selection of miRNA which have potentially targeted CCL22 and CXCL12 mRNA.

Results: NA-STZ affect increasing blood glucose. Injection of 0.02 ml UC-MSC secretome showed a better impact on wound healing than the diabetes control group. Lower expression of mRNA CCL22 and CXCL12 showed in male Wistar rats induced NA-STZ with UC-MSC secretome treatments.

Conclusion: UC-MSC secretomes have potential therapy as anti-ulcer on hyperglycemia male Wistar rats induced NASTZ with probability via hsa-23a-3p in nuclear factor-kappa β (NF-κβ) pathway via inflammation mechanism.

Introduction: Genetic factors are increasingly recognized as crucial contributors to both familial and sporadic forms of Parkinson's disease (PD), including mutations in LRRK2 (Leucine-rich Repeat Kinase 2). Previous studies have indicated that the G2019S variant results in more favorable motor outcomes post-deep brain stimulation (DBS) compared to the R1441G variant. This study was aimed at investigating whether different LRRK2 variants in Parkinson's disease patients with LRRK2 mutations (LRRK2 PD) produce distinct motor responses following DBS.

Materials and methods: A literature search was conducted across three databases using keywords related to Parkinson's disease, deep brain stimulation, and LRRK2. The inclusion criteria involved studies focusing on LRRK2 PD with DBS intervention, specifically comparing LRRK2 variants, and measuring motor responses pre- and post- DBS using the UPDRS III. A meta-analysis was performed to compare motor responses using a random effects model.

Results: Out of 325 search results, eleven articles were included in the review. Three LRRK2 PD variants-G2019S, R1441G, and G2385R-were associated with DBS intervention. The overall effect of DBS in LRRK2 PD compared to idiopathic PD was not statistically significant, with a mean difference (MD) of -3.00 (-8.52; 2.52). High overall heterogeneity was observed (I ² = 63.1%; P < 0.05). Subgroup analysis revealed significant differences (P < 0.05), suggesting that different LRRK2 variants may result in varying motor outcomes post-DBS.

Conclusion: LRRK2 PD exhibited diverse motor outcomes depending on the specific mutation variant when subjected to DBS. Patients with LRRK2 variants G2019S and G2385R demonstrated clinically significant improvements in motor responses, while those with the R1441G variant showed inadequate motor response.

Introduction: Preparing and stabilising various types of nanoparticles using herbal extract has proven to be an intriguing prospective environmentally beneficial technology. Magnesium oxide nanoparticles (MgONPs) are finding a broad range of applications in the environmental and medical sciences due to their impressive antioxidant, anticancer, and antibacterial activity. The traditional uses of Equisetum arvense included wound and ulcer healing, renal issues, tuberculosis treatment, and bleeding control. This work intended to synthesise magnesium oxide nanoparticles in an environmentally friendly manner utilising E. arvense, with potential uses in biomedicine.

Materials and methods: Using a green fabrication technique, E. arvense extract was used to create magnesium oxide nanoparticles (MgONPs). The antibacterial activity of the resulting MgO NPs against wound infections was evaluated. The ABTS, Nitric Oxide, DPPH, FRAP, and H2O2 assays were used to measure antioxidant activity. Utilising zebrafish survivability during MgONPs treatment, cytotoxicity was evaluated.

Results: The green-produced MgONPs showed good antibacterial activities against wound infectious microbes, compared to the E. arvense control. It also demonstrated outstanding biocompatibility and antioxidant activity.

Discussion: The potential application of plants mediated NPs as antibacterial, and an antioxidant agent is the primary conclusion of the research.

Pierre Robin Sequence (PRS) is a congenital condition characterized by micrognathia, glossoptosis, and airway obstruction, often accompanied by a cleft palate. Severe cases pose additional challenges in surgical management due to anatomical abnormalities. A 3-year-old male with severe PRS underwent a cleft palate repair procedure, which was a multidisciplinary approach, and the successful repair of the cleft palate and uneventful postoperative recovery were attributed to the team's collaborative efforts. This case also highlights the importance of genetic evaluation and testing in managing PRS cases. This case highlights the importance of thorough preoperative assessment, advanced airway management skills, and genetic evaluation for better patient outcomes. Future research should explore innovative techniques and strategies to improve the outcomes of patients with PRS and other complex congenital conditions.

Introduction: Sodium plays a crucial role in regulating blood volume and osmotic balance; however, excessive intake can lead to fluid retention and increased blood pressure. Assessing knowledge, attitudes, and practices (KAP) related to salt consumption is a fundamental step in developing effective public health strategies to reduce excessive salt intake.

Materials and methods: This cross-sectional study was conducted among 1,001 adults in Kuala Terengganu using a snowball sampling method to assess salt-related KAP and the factors associated with good dietary salt intake practices. Eligible participants were aged 18 years and above, proficient in Bahasa Malaysia, and had access to a smartphone with internet connectivity. Data were collected through a structured, pre-tested questionnaire administered via Google Forms and analysed using multiple logistic regression to identify factors associated with good dietary salt intake practices.

Results: Among the total respondents, 28.8% (95% CI: 26.0% - 31.6%) demonstrated good dietary salt intake practices. The study revealed a disconnect between knowledge and practice, indicating that awareness alone did not translate into healthier dietary behaviours. Multiple logistic regression analysis identified employment status (adjusted OR: 1.541, 95% CI: 1.166 - 2.038; p<0.001) and higher attitude scores (adjusted OR: 1.138, 95% CI: 1.065 - 1.215; p<0.001) as significant positive predictors of good dietary salt intake practices.

Conclusion: The findings provide valuable insights into salt consumption behaviours and associated factors among the self-selected adults in Kuala Terengganu. The results underscore the importance of targeted public health interventions, particularly those promoting positive attitudes and addressing employed populations, to encourage healthier dietary salt intake practices.

Introduction: Synechiae formation is a common and undesired complication after functional endoscopic sinus surgery. Mitomycin-c, known for its anti-proliferative and anti-fibroblastic properties holds potential for reducing synechiae and scar tissue formation following endoscopic sinus surgery. This study aims to evaluate the efficacy of topically applied mitomycin-c postoperatively in minimising adhesions and nasal obstruction symptoms using the Lund- Kennedy Endoscopic Scoring and Nasal Obstruction Symptom Evaluation (NOSE) scores.

Materials and methods: This double-blind randomised study assessed topical mitomycin-c's efficacy in reducing adhesions post-FESS in 50 chronic rhino-sinusitis patients. Participants who were selected based on Lund-Mackay CT scores underwent functional endoscopic sinus surgery (FESS). The mitomycin-c and saline-soaked nasal packs were placed in middle meatuses either of one in each nasal cavity. Postoperative care included antibiotics, analgesics and saline douching. Outcomes were evaluated at 1, 4 and 12 weeks using the NOSE (nasal obstruction symptom evaluation) questionnaire and Lund-Kennedy scoring to determine mitomycin-c's impact on nasal obstruction and synechiae formation.

Results: The results indicated statistically significant variation between mitomycin-c and control sides in terms of symptoms and endoscopic findings in the first week postoperatively. By the fourth week, the clinical pictures of both sides were nearly identical.

Discussion: Data suggested that low-dose mitomycin-c significantly reduces adhesions and improves nasal symptoms in the early postoperative period for chronic rhinosinusitis patients. These results align with previous research, supporting mitomycin-c as a valuable adjunctive therapy in sinus surgery. Future studies are recommended to explore varying dosages and application methods for potential differences in outcomes.

Introduction: Accidental oesophageal intubation is a significant cause of death or neurological injury during anaesthesia in the perioperative period, making it crucial to confirm the correct placement of the tracheal tube immediately. In the operating room, anaesthesiologists typically use indirect methods to verify tracheal tube positioning. Ultrasonography (USG) can be employed to confirm whether the endotracheal tube (ETT) is correctly placed in the trachea. This study evaluates the use of USG in supervising a trainee during intubation and also examines the time it takes for USG to identify the tube's entry into the trachea or oesophagus in real-time.

Materials and methods: The study included 90 patients with ASA physical status 1 and 2 who were scheduled for elective surgeries under general anaesthesia. Preoperative data were collected on patient characteristics, airway measurements, and baseline haemodynamic parameters. Anaesthetic management was kept consistent across all participants. The 90 patients were divided into three groups of 30 each, with intubation performed by either an intern, resident, or faculty member, assigned through computergenerated randomisation. A high-frequency linear ultrasound probe (9-14MHz) was placed at the suprasternal notch and slightly moved to the left. In this view, at the level of the suprasternal notch, the oesophagus appears posterolateral to the trachea. During laryngoscopy, the Cormack-Lehane grade was recorded. The anaesthesiologist performing the ultrasound simultaneously measured the time taken to confirm endotracheal intubation. In cases of oesophageal intubation, the "double track" sign was used for identification, and the time required to make this identification was recorded. The times for confirming intubation into the trachea and oesophagus were documented for all three groups. SPSS Version 20.0 software was used for statistical analysis. The study employed mean, standard deviation, chi-square test, ANOVA, and Duncan Multiple Range Test (DMRT) for data analysis.

Results: The patient characteristics and demographic data showed no significant statistical differences. Oesophageal intubation was detected as quickly as 2 seconds, and the average time in seconds to confirm endotracheal tube placement was recorded for each group as follows: Faculty < Resident < Intern (Mean time: 17.5 < 26.8 < 53.6 seconds). The ANOVA test indicated statistically significant differences in tracheal intubation times among the three groups. Further analysis with the Duncan Multiple Range Test (DMRT) confirmed that the timing differences between the groups were statistically significant.

Discussion: Ultrasound is a valuable tool in training scenarios where a physician supervises less experienced practitioners. It provides a fast and reliable method for confirming correct endotracheal intubation.

Introduction: The COVID-19 pandemic has highlighted the importance of vaccination, with booster doses now integral to public health strategies. However, there is a lack of validated tools to assess vaccine intention for booster doses, despite the Health Belief Model (HBM) being widely used for primary doses. This study aims to address this gap by validating a Malay version of the HBM-based COVID-19 booster dose vaccine intention scale to measure factors influencing booster vaccination decisions in Malaysia.

Materials and methods: The study was conducted in three phases. Phase 1 involved translation, content, and face validity. The translation process employed a forwardbackward method, utilising two bilingual translators and an independent back-translator. Content validity was assessed by five experts from psychology, public health, and medicine, and face validity was evaluated through a pre-test with 40 laypersons. Phase 2 used Exploratory Factor Analysis (EFA) with 160 participants to identify the tool's underlying factor structure. Phase 3 employed Confirmatory Factor Analysis (CFA) with 556 participants to assess construct validity and reliability. Internal consistency was measured using Cronbach's alpha and Composite Reliability (CR). Participants aged 18 and above were recruited via online platforms, with eligibility determined by receipt of primary doses of the COVID-19 vaccine.

Results: The translation process resulted in a 16-item Malay COVID-19 HBM-Booster Dose Intention Scale (HBM-BDIS). Phase 1 confirmed content and face validity, with the Content Validity Index (CVI) for all items exceeding 3.0, and a satisfactory Face Validity Index (FVI). EFA in Phase 2 revealed a clear factor structure with factor loadings meeting the 0.33 threshold, and internal consistency was confirmed with Cronbach's alpha of 0.82. CFA in Phase 3 confirmed the scale's construct validity, with improved fit indices after revision (CFI = 0.926, TLI = 0.909, RMSEA = 0.084). The final model showed strong internal consistency, with CR values above 0.80 for all factors.

Conclusion: The 16-item Malay COVID-19 HBM-BDIS is a valid and reliable measure for assessing COVID-19 booster dose vaccination intention in Malaysia, providing a solid foundation for future research and public health interventions.