COVID-19 vaccination for children in Malaysia - A position statement by the College of Paediatrics, Academy of Medicine of Malaysia.

The availability of COVID-19 vaccines and mass vaccination programmes in adults have significantly reduced the case attack rates and disease burden. COVID-19 vaccination successfully decreases the population at risk of infection, allowing for the safer re-opening of economies and reducing the pandemic's crippling impact on healthcare systems. However, the rapidly mutating severe acute respiratory syndrome-coronavirus-2 poses challenges in diminishing vaccine-induced immunity and vaccinating a significant proportion of adults to achieve herd immunity. These challenges necessitated adolescent vaccination. With the recent emergence of the highly transmissible Omicron variant and the increasing COVID-19 hospitalisation rates of children below 12 years old, many countries opted to also vaccinate younger children. Phase II/III clinical trials and real-world experience demonstrate that COVID-19 vaccinations are effective and safe for younger children and adolescents. Before Malaysia introduced its national COVID-19 vaccination programme for children 5-11 years old (which ran between March and June 2022), an expert advisory statement was issued by the College of Paediatrics, Academy of Medicine of Malaysia, to highlight the benefits and importance of vaccinating children. The advisory statement included clarifications about vaccine-related side effects such as post-vaccination myocarditis and allergic reactions to encourage informed decision making by healthcare providers and parents. This paper, which was prepared based on the critical appraisal of the current evidence, evaluation of the international experiences and the positive impact of COVID-19 vaccination in children, collectively sums up the rationale to support and ensure the success of the nationwide vaccination programme for children. Hence, the College recommends COVID-19 vaccination for children in Malaysia.

Hypertensive retinopathy and sensorineural hearing loss.

OBJECTIVE: To determine the correlation between hypertensive retinopathy (which is the end-organ damage of the vessels due to chronic hypertension) with sensorineural hearing loss. METHODS: Pure tone hearing threshold of 56 hypertensive patients were compared with 56 normal age and sex matched control. Comparisons of pure tone hearing threshold are made among different group (grade) of hypertensive retinopathy patients and control (non-hypertensive patients). RESULTS: The mean hearing thresholds were higher (worse) in all the frequencies on both sides in the hypertensive study group compared with normal subjects. However it was found to be statistically significant when tested using independent sample test (p < 0.05) on right ear at 2,000 Hz, 4,000 Hz and 8,000 Hz only. The mean hearing threshold is higher in all frequencies in the presence of retinopathy compared to control. However, the difference was found to be only statistically significant in the mean hearing threshold between grade I and control at 4,000 Hz and 8,000 Hz on both sides and at 1,000 Hz and 2,000 Hz on right ear. Hypertensive patient with grade I retinopathy had higher pure tone hearing thresholds at 4,000 Hz and 8,000 Hz compared to hypertensive without retinopathy and normal control. CONCLUSIONS: Hypertensive retinopathy appears to be associated with high frequency sensor neural hearing loss.

Relationship between reproductive exposures and age-related cataract in women.

The objective of this study is to evaluate the relationship between reproductive exposures and age-related cataract among women. This was a hospital based case-control study. The study population included female patients, aged 50 years and above who attended the Eye clinic at the University of Malaya Medical Centre. The outcome measurement was based on ophthalmologic examination by an ophthalmologist. The data on exposure was obtained from face to face interview using a structured questionnaire. In order to reduce the recall bias, patients' medical records were used to substantiate the exposure status. Multiple logistic regression was used to assess the association of age-related cataract with exogenous estrogen usage (HRT and OCP) and duration of menses. Important confounders such as age, history of diabetes, cigarette smoking and steroids usage were controlled for in the analysis. Females with 29 years or less of endogenous estrogen exposure of, have almost three times the risk of developing age related cataract (adjusted OR 3.42: 95% CI: 1.28, 9.16), similarly among those with exposure of 30-32 years (adjusted OR 3.64: 95% CI: 1.08, 12.26). Hormone Replacement Therapy used for more than three years was found to be a protective factor of age-related cataract. There is evidence that reproductive exposure may play a role in reducing the occurrence of age-related cataract among Malaysian women.

The association between body mass index and age related cataract.

This study was carried out to determine the association between body mass index and age related cataract among patients attending eye clinic. We conducted a case control study. The outcome of clinical eye assessment determined the patient's status. Mean body mass index among the cases was shown to be higher (25.4 +/- 4.5) than the control group (24.4 +/- 3.9) (p < 0.01). Crude analysis showed that only obese respondents were 2.4 times more likely to develop age related cataract, however this association was not seen in the multivariate analysis after adjusting for other determinants (aOR 1.81; 95% CI 0.91 - 3.62). We conclude that there is no association between body mass index and age related cataract.

Changing habits and attitudes towards smoking among future physicians.

This study was conducted to asses the future physicians' habits, knowledge and attitude towards smoking. These factors influence the credibility of future Malaysian physicians as advocators and treatment providers. A cross sectional study was carried out among medical students at the Medical Faculty, University Malaya. Knowledge on smoking was evaluated on the total scores for knowledge questions, with one point and zero for each correct and incorrect answer respectively, to a maximum of six potential points. Attitude towards smoking was measured by summation of scores on attitude items; each item was scored from five points for "against smoking" and one point for "favourable to smoking". The possible score ranged from 10 to 50. The response rate was 79.4%. Prevalence of overall smokers was 4.4%. The mean knowledge score among smokers (4.30 +/- 2.17) was significantly lower than nonsmokers (5.19 +/- 1.28). The mean attitude score was higher among non-smokers (44.30 +/- 6.54) than smokers (39.86 +/- 10.93). The result from this study showed that smoking prevalence was lower compared to previous studies done in Malaysia.