Prevalence of Burnout and Its Associated Factors among Medical Students in a Public University in Selangor, Malaysia: a CrossSectional Study

@#Introduction: Burnout is a growing trend among medical students worldwide. The aim of this study was to determine the prevalence and factors associated with burnout among medical students at a public university in Malaysia. Methods: A cross-sectional study was conducted among 1st through 5th year medical students at a public university using a simple random sampling method in recruiting participants. In this study, The Maslach Burnout Inventory-General Survey for Student (MBI-SS) was used and burnout is defined as severely emotionally exhausted and severely depersonalised. Results: A total of 328 medical students were recruited with a with response rate of 88.6%. The burnout prevalence was 10.1%. Based on multivariate logistic regression, presence of smartphone addiction with adjusted (odds ratio (OR) 7.37, 95% confidence interval (CI) = 1.67, 32.49), course choice not based on personal interest or due to family pressure (OR 2.72, 95% CI = 1.08, 6.85) and the presence of family relationship problems (OR = 3.58, 95% CI = 1.27, 10.04) are more likely to be associated with burnout among the medical students. Conclusion: Our study has shown that every tenth medical students suffers from burnout. Medical students who are addicted to smartphone, have chosen medical course against individual interest or because of family pressure and have family relationship problems are at risk of getting burnout. Intervention is required to address this issue for the future well-being of medical students.

Amplification of vWA, FGA, and TH01 loci of DNA Samples Isolated From Ring Stored at Room Temperature

@#Introduction: Acts of criminal behaviour that occur have various modes and motives. Also, criminals always try to hide or eliminate evidence at the crime scene. In most cases, police or forensic experts often find DNA on items at the crime scene. One of these items is a ring, which is an item that humans often wear. Methods: This study used 24 samples of rings that had been worn for 8 hours and were incubated at room temperature. All these 24 samples then were distinguished into 4 groups, in which each group was consisting of 6 samples and incubated for 0, 1, 3, and 7-days. DNA identification was then carried out using UV spectrometer for DNA quantification and DNAzol method for DNA extraction. Results: The mean result of DNA quantification on day 0 (control) was 1020,833 ± 0.28903 ng/μL, day 1 was 546 ± 0.093569 ng/μL, day 3 was 1066.333 ± 0.117372 ng/μL, and day 7 was 1054.083 ± 0.070733 ng/μL. PCR process used STR primers with loci vWA, FGA, and TH01 and visualization used the silver nitrate method. Conclusion: The final results showed that all samples could be amplified using 3 STR loci, namely vWA, FGA, and TH01.

Screen Media Dependency and Its Associated Factors Among Preschool Children in Kuala Lumpur

@#Introduction: Excessive screen time among young children is associated with screen dependency. At this moment, there is a lack of data on screen dependency among young children in Malaysia. This study aimed to measure the prevalence of screen dependency and its associated factors among preschool children in Kuala Lumpur. Methods: A cross-sectional study was carried out at registered preschools in Kuala Lumpur. 300 parents of preschool children aged 4 to 6 years old who fulfilled the inclusion and exclusion criteria were recruited via simple random sampling. The Screen Dependency Scale (SDS) were used to assess their dependency to screen media. Univariate and multivariate statistics were analysed using IBM SPSS version 27. Results: The prevalence of screen dependency among preschool children in Kuala Lumpur was 65.7%. Multivariate logistic regression analysis identified that using the screen to resolve children’s quarrels (aOR 2.855, 95% CI 1.187 - 6.868), children who use smartphones (aOR 2.735, 95% CI: 1.244 - 6.013), children’s screen time exceeds 2 hours over the weekend (aOR 2.261, 95% CI: 1.058 - 4.830) and having a television in the bedroom (aOR 5.562, 95% CI: 1.591 - 19.442) were predictors for screen dependency. While active co-use mediation (aOR 0.505, 95% CI: 0.302 - 0.845) were protective. Conclusion: The prevalence of screen dependency was high among preschool children in Kuala Lumpur. Active screening at health care clinics or in schools is essential to identify early children with risk factors for screen dependency.

Isolated Gastrointestinal Symptoms as Initial Presentation in Systemic Lupus Erythematosus and Its Differential Diagnosis

@#Initial clinical presentation of Systemic Lupus Erythematosus (SLE) is varied as it affects various organs in the body. While the typical presentation of SLE is mucocutaneous, musculoskeletal and haematological manifestation, gastrointestinal (GI) manifestation is a rare initial presentation of SLE. We discuss the case of a 13-year-old girl who was diagnosed with SLE after she presented with isolated gastrointestinal symptoms. She presented with vomiting, diarrhoea, mild colicky abdominal pain and bilateral ankle oedema; and was treated as acute gastroenteritis. She returned after one week with worsening symptoms. Her full blood count showed bicytopenia; urinalysis had proteinuria and haematuria, and renal profile revealed acute on chronic kidney injury which triggered suspicions of a more serious disease rather than simple viral gastroenteritis. Further investigations of positive anti-nuclear antibody, low complements and positive Coombs’s test supported the diagnosis of SLE. The diagnosis of SLE was confirmed when her renal biopsy reported crescentic lupus nephritis ISN/RPS Class IV. Additional investigation to investigate the cause of her gastrointestinal symptoms included an ultrasound abdomen which showed minimal ascites and bilateral renal parenchymal disease. She was planned for colonoscopy but due to the unavailability of paediatric endoscopy, colonoscopy was postponed. However, her symptoms markedly improved with intravenous Cyclophosphamide which supported the diagnosis of GI SLE. This case report is to highlight that a patient with symptoms of simple viral gastroenteritis might have a more serious underlying disease. Even though rare, SLE can present with gastroenteritis symptoms and is one of the differential diagnoses that should be considered.

Tools to Assess Screen-related Dependency in Children: a Narrative Review of Validated Questionnaires

@#Children are using digital screen media at an even younger age as they use it for a wide range of activities such as watching videos, playing games, and educational purposes. Due to its accessibility and portability, children also spend a significant amount of time on screen. Excessive screen time in children is associated with many consequences, including language delay, hyperactivity, impulsivity, visual problems, and lower psychological well-being. With the emergence of behaviour addictions related to technologies such as addiction towards online games, the internet, and the mobile phone, researchers are looking into these incidences among children. However, a validated and reliable tool is important to detect the problem early, especially for young children at increased risk. To date, many tools have been developed to detect screen-related dependencies for adolescents and adults but lacking among children. This review aims to elicit tools available specifically for children below 10 years of age, to analyse its psychometric properties and validation process as well as to compare between them.

Spatial and Temporal Distributions Pattern of Dengue Fever Cases: A Ten Years Trends in Kuantan, Pahang

@#Introduction: Dengue fever (DF) is a prominent vector-borne disease spread by mosquitos of the Aedes genus (mainly Aedes aegypti, and even Aedes albopictus), a tropical regions vector. The purpose of this research was to establish the spatial and temporal distribution patterns of DF cases in the study area between 2010 and 2020. Methods: The correlation between the Kuantan sub-district and dengue haemorrhagic fever (DHF) incidence is examined in this study using spatial analysis. The correlation was calculated using spatial autocorrelation, Moran’s Index (Moran’s I) and Spatial Autocorrelation of Local Indicators (LISA). Moran’s index is a worldwide indicator used to determine whether or not disease transmission has geographical autocorrelation in disease transmission. Results: The results indicated that between 2011 and 2020, the monthly Moran’s I of dengue transmission in Kuantan was estimated to range between -0.685 and 0.338. The lowest reading of Moran’s index was -0.685 in May 2015, whereas the highest reading was 0.338 in May 2019. This reflects the strong spatial autocorrelation of dengue transmission in Kuantan over the last decade. The LISA analysis revealed significant spatial autocorrelations on DF cases in Kuantan for three (3) out of six (6) sub-districts (50%) with a significance level of 2%. This suggests that there are spatial autocorrelations in Kuala Kuantan, Beserah and Penor sub-district that influence the distribution of DHF transmission. Conclusion: The results reveal that the spatial autocorrelation analysis method can be a tool for relevant researchers to understand the pattern of DF transmission study and establish the direction for further study.

Recurrent Retrobulbar Optic Neuritis in Seronegative Rheumatoid Arthritis

@#Rheumatoid arthritis (RA) is a multisystemic autoimmune disease which can be associated with visual threatening ocular manifestations. Common ocular associations with RA include necrotising scleritis and peripheral ulcerative keratitis (PUK). Optic nerve involvement otherwise is uncommon, especially as a presenting feature of RA. We report a rare case of recurrent bilateral retrobulbar optic neuritis (ON) with progressive visual deterioration as an early manifestation of seronegative RA. This case posed diagnostic and management challenges due to its unusual presentation and initially inconclusive investigations. The patient was diagnosed with seronegative RA three years after the first eye presentation. Her RA disease activity score (DAS-28) improved after treatment with a disease-modifying anti-rheumatic drugs (DMARDs), and her ON attacks have been controlled since then. However, her visual acuity, visual field and colour vision remained poor after multiple ON attacks. Multidisciplinary care is key to managing such a patient’s condition and its potential disease complications.

A life-threatening condition—ruptured ectopic pregnancy with negative urine pregnancy test: A case report

@#Ectopic pregnancy is an extra-uterine pregnancy and is a potentially life-threatening condition that can lead to death from intra-peritoneal hemorrhage. This case reports a rare occurrence of ruptured tubal pregnancy in which the patient presented early with abdominal pain and a negative urine pregnancy test but subsequently presented again with evidence of intra-peritoneal hemorrhage. A negative urine pregnancy test is often used to rule out pregnancy, but it is not 100% sensitive. Complete assessment is critical in this important diagnosis in order to plan for the appropriate emergency management.

Exploring women’s perceptions and experiences of menopause among East Coast Malaysian women

@#Background: Menopause signifies the beginning of a non-reproductive phase from the reproductive period. Although it is considered a natural life transition, recent studies have indicated that a woman’s menopausal experience may impact her quality of life. While studies have examined Malaysian women’s knowledge and awareness of menopause, they have focused on the prevalence of menopausal symptoms and sociocultural aspects. These investigations also used a quantitative design that may have limited the information regarding the nature and experience of menopause. Objectives: This study explores women’s perceptions and understanding of their menopausal experience. Methods: A total of 20 menopausal women were recruited using purposive sampling through social media in the state of Pahang, Malaysia. In-depth semi-structured interviews were used to explore how they perceived their menopausal experience. The data were then analyzed using thematic analysis. Results: Three themes that emerged from the findings included perceptions of menopause, biopsychosocial changes and help-seeking behavior. For many Muslim women, menopause was perceived as a time for them to engage in religious commitment more than they had before. Conclusion: The study findings uncovered a knowledge gap and a lack of support for women impacted by menopause. Muslim women regarded their menopause phase as a time for them to engage in religious duty fully. These results indicate the need for a psychosocial intervention and educational program to ensure women a better transition throughout their menopausal phase

Disparities among pediatric hospital admissions according to gender

Background:The objective of the study was to determine the pattern of disparities among paediatric hospital admissions according to gender.Methods:This retrospective observational study was done at pediatric ward of Al-Tibri Medical College and Hospital Karachi from June 2018 to May 2019. Pediatric patients below 12 years of age admitted to the pediatric ward of the hospital were included while patients who were admitted for less than 24 hours, refused for consent by parent/guardian, surgical or ICU pediatric patients were excluded. SPSS was used for data analysis. Quantitative data included age, gender, diagnosis and seasonal variation, expressed as frequency in percentages and chi-square test was applied to test for significance.Results:Among 734 pediatric hospital admissions, 423 (58%) were males and 311 (42%) females. Highest percentages of pediatric admission in both genders were infants afterwhich second most patients were from the 1-4 years group in both genders (p=0.01). 215 patients of acute gastroenteritis were male while 142 females. Among patients admitted with respiratory disease, 56 were males while 48 were females. 52 male patients were admitted with viral fever while 34 patients admitted were females (p=0.01).Conclusions:Our study reported a significant difference among gender variances in pediatric hospital admissions. Overall, not only males were predominant in admission to pediatric wards, they were also found to be predominant in disease categorization. Further studies set to determine the reasons behind such gender differences would help in determining plans accordingly to improve outcome of diseases

An infant with kwashiorkor: The forgotten disease

@#Undernutrition remains a major public health concern, especially in developing countries. Despite being rich in resources, Malaysia is still home to children sufering from severe undernutrition. Tis paper presents the case of a 5-month-old boy with kwashiorkor stemming from improper weaning which was overlooked. Tis case highlights the importance of recognizing the early signs of kwashiorkor to allow for early referrals for proper management and prevent its possible complications.

The implication of stigma on people living with HIV and the role of social support – A case report

@#Despite the advancements made in the knowledge and treatment of the human immunodeficiency virus (HIV) since it was first discovered, people living with HIV (PLWH) continue to be stigmatized. This paper presents the case of an HIV-infected patient who delayed the necessary treatment due to stigma and ultimately presented with AIDS. Through social support, however, he was able to overcome his internalized stigma; he was finally willing to start on antiretroviral treatment (ART). This case report addresses the effect of stigma on and the role of social support in the management of an individual with HIV.

Agreement between body weight perception and body weight status among late adolescents in Kuantan, Malaysia

@#Objectives: Body weight perception may determine the practice of proper weight management. The objective of this study was to measure the agreement between body weight perception and actual body weight status and its associated factors among late adolescents in Kuantan, Malaysia. Methods: A cross-sectional study was conducted from April to October 2018 among 479 adolescents aged 17-19 years old from seven institutions of higher learning in Kuantan. Body weight status was described as body mass index (BMI). Weight and height were measured, and BMI was calculated. Validated, self-administered Figure Rating Scale (FRS) questionnaires were used. Agreement between BMI and body weight perception was calculated using Kappa statistics. Logistic regression was employed to examine the association between body weight perception and sociodemographic variables. Results: More than one-third (35.3%) of the respondents misjudged their own body weight. More than one third of the respondents (38.7%) who were underweight, misperceived themselves as having normal weight whilst 31.7% of obese respondents identified themselves as overweight. The agreement between body weight perception and body mass index was moderate (k0.46, p<0.01). Conclusion: Body weight perception was in moderate agreement with actual weight in late adolescents. Accurate body weight perception is an important factor in late adolescent’s weight management behaviour. Hence, health education related to body weight management should be emphasized among this age group.

A Presentation of Penile Siliconoma in Primary Care after a Dubious Implant Injection: A Case Report

Abstract@#Cases of penile siliconoma are unusual and less commonly present to medical practitioners. The siliconoma is a subsequence of injecting high viscous solution into the penis; commonly sillicone with the aim to enhance its size and performance. This case will look at a patient who developed penile siliconoma after a dubious penile implant injection gone wrong. It will also look at what surgical options are available to the unfortunate patients to ease their suffering. Physician should have a high index of suspicion on the use of such substances to enhance sexual performances in patients presenting with atypical penile swelling.

Post mortem computed tomography (PMCT) guided lung biopsy: A preliminary case report

@#Tuberculosis (TB) is a highly infectious disease on the rise caused by the organism Mycobacterium tuberculosis and health care workers working in emergency departments, medical wards and autopsy rooms are in danger of contacting this disease. We present a case of a 42 year old man found dead under a pedestrian bridge with no medical history available. Post mortem computed tomography showed multiple cavities involving upper lobes of both lungs and areas of consolidation in both lung fields raising the suspicion of pulmonary tuberculosis. This was followed by a computed tomography guided lung biopsy and a limited conventional autopsy done in situ in a special high risk autopsy suite with appropriate ventilation. This case highlights the importance of cross sectional imaging which can be coupled with image guided biopsy in cases of infectious disease to reduce the risk of transmission to health care workers.

Topical corticosteroids in clinical practice

@#Topical corticosteroids are common medications prescribed for skin problems encountered in the primary care or dermatology clinic settings. As skin conditions comprise of around 20% of cases seen in primary care, this article written to guide readers, especially non-dermatologists on the appropriate potency of topical corticosteroids to be chosen for skin problems of patients and to list the side effects both local and systemic

The Effects of 4-Hydroxybenzoic Acid Identified from Bamboo (Dendrocalamus asper) Shoots on Kv1.4 Channel

Background: Bamboo shoot has been used as a treatment for epilepsy in traditional Chinese medicine for generations to treat neuronal disorders such as convulsive, dizziness and headaches. 4-hydroxybenzoic acid (4-hba) is a non-flavonoid phenol found abundantly in Dendrocalamus asper shoots (bamboo), fruits (strawberries and apples) and flowers. Kv1.4 is a rapidly inactivating Shaker-related member of the voltage-gated potassium channels with two inactivation mechanisms; the fast N-type and slow C-type. It plays vital roles in repolarisation, hyperpolarisation and signaling the restoration of resting membrane potential through the regulation of the movement of K+ across the cellular membrane. Methods: Chemical compounds from Dendrocalamus asper bamboo shoots were purified and identified as major palmitic acids mixed with other minor fatty acids, palmitic acid, 4-hydroxybenzaldehyde, lauric acid, 4-hydroxybenzoic acid and cholest-4-ene-3-one. The response of synthetic 4-hydroxybenzoic acid was tested on Kv1.4 potassium channel which was injected into viable oocytes that was extracted from Xenopus laevis. The current were detected by the two-microelectrode voltage clamp, holding potential starting from −80 mV with 20 mV stepup until +80 mV. Readings of treatments with 0.1% DMSO, 4-hba concentrations and K channel blockers were taken at +60 mV. The ratio of tail/peak amplitude is the index of the activity of the Kv1.4 channels with n ≥ 6 (number of oocytes tested). The decreases of the ratios of five different concentrations (1 μM, 10 μM, 100 μM, 1 mM and 2.5 mM) were compared with 0.1% DMSO as the control. Results: All concentration showed statistically significant results with P < 0.05 except for 100 μM. The normalised current of the 4-hba concentrations were compared with potassium channel blockers (TEA and 4-AP) and all groups showed statistically significant results. This study also showed that time taken for each concentration to affect Kv1.4 does not play any significant roles. Conclusion: 4-hydroxybenzoic acid was found to be able to enhance the inactivation of Kv1.4 by lowering the membrane potential so that the abnormal neuronal firing can be inhibited. With IC50 slightly higher than 10 μM, increasing concentrations (100 μM, 1 mM and 2.5 mM) had shown to exhibit toxicity effects. The best concentration from this study is 10 μM with Hill slope of 0.1799.

Diabetic foot disease research in gulf cooperation council countries

Objectives: Countries in the Gulf Cooperation Council [GCC] have some of the highest prevalence rates of diabetes mellitus [DM] in the world; however, DM-related research activity in this region is limited. This study aimed to examine trends in published diabetic foot disease [DFD] research undertaken in GCC countries

Methods: This bibliometric study was conducted in December 2016. Standardised criteria were used to search the MEDLINE database [National Library of Medicine, Bethesda, Maryland, USA] for DFD-related publications authored by GCC researchers between January 1990 and December 2015. Various details such as the type of publication, journal impact factor and number of article citations were analysed

Results: A total of 96 research articles were identified. The number of publications per year significantly increased from nil prior to 1991 to 15 in 2015 [P <0.01]. Basic/clinical research articles accounted for 96.9% of publications, with three randomised controlled trials and no systematic reviews/meta-analyses. When adjusted for population size, Kuwait had the highest number of published papers per year, followed by Bahrain and Qatar. The number of authors per publication significantly increased during the study period [P = 0.02]. However, 16 articles [16.7%] had no citations. The median journal impact factor was 0.15 +/- 1.19 [range: 0-6.04]

Conclusion: The number of publications authored by GCC researchers has risen in recent years. Increasing research funding and promoting collaboration between local and international researchers and institutes are recommended to bolster research regarding DFD prevention and management in GCC countries

Management of pain in the intensive care unit

Background: Pain assessment in ICU patients turns out to be a daily challenge for the attending teams, particularly in those patients who are intubated endotracheally; on mechanical ventilation or analgosedated as such patients are unable to self-assess existence and intensity of pain. Guidelines to identify pain in these patients are crucial for physicians for effective management

Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1994, through March 2017. The following search terms were used: pain management in ICU, pain in ICU, pain assessment by behavior, pain assessment in intubated patients

Aim: Our aim in this study was to understand how to assess and manage pain in an intensive care unit patient, particularly those patients who are unable to self-report or assess

Conclusion: Physical clues given by comatose or intubated patients in critical care unit must be used as a method to identify existence of pain, and must be managed effectively to decrease discomfort and prevent short and long term adverse effects

Left atrium volume as a surrogate marker of left ventricular diastolic dysfunction

Objective: To determine correlation between left atrial volume and left ventricular diastolic dysfunction

Methodology: This was a single center observational study conducted at Lady Reading Hospital, Peshawar. Patients above 18 years of both genders, who were in sinus rhythm and having no significant systolic dysfunction or significant mitral insufficiency on echocardiography, were included in the study, using purposive non-probability sampling technique. A total 339 patients underwent transthoracic echocardiography from July 2013 to June 2014. Detailed cardiac echocardiography was performed to determine left atrial volume, ejection fraction, E and A velocities, deceleration time and e've-locity, E/e

Results: A total of 339 patients were studied. Male were 61.9%. Mean age of study population was 58.42 +/- 10.48 years. Baseline characteristics of patients having some degree of diastolic dysfunction were; mean age 65.5 +/- 12.3, mean body mass index 25.2 +/- 2.5 kg/m2, mean ejection fraction 55.1 +/- 7.5%, hypertension 48.6%, diabetes mellitus 10.1% and left ventricular hypertrophy 38.6%. Echocardiographic findings in diastolic dysfunction patients were as follow: mean left atrial volume was 65.3 +/-10.1 ml, E/A 1.4 +/- 0.6, TDI e' was 6.7 +/-1.3 m/sec and TDI E/e' was 12.7 +/- 2.1. Increasing left atrial volume was well correlated with increasing severity of left ventricular diastolic dysfunction [y = +0.8, Spearman rank correlation]

Conclusion: Increase in left atrial volume is directly correlated with severity of diastolic dysfunction. Severity of diastolic dysfunction increases with increased left atrial volume