Parent's perception of digital device use among their preschool children and its associated factors in Kota Setar, Kedah.

INTRODUCTION: Digital devices are an integral part of children's lives, and its use is associated with both risks and benefits. The aim of this study was to determine parent's perception of digital device use among their preschool children. MATERIALS AND METHODS: A cross-sectional study was conducted among parents of 145 children in the year 2020. Participants were selected using multistage randomisation technique from 10 of the 75 registered government kindergartens in Kota Setar District, Kedah. Data were collected using a self-administered questionnaire. Analysis was done using descriptive statistics and the association between parent's demographic characteristics and the overall perception of digital media use by their preschool children was tested using Chi-square test. RESULTS: A total of 150 questionnaires were distributed, and 145 were returned (96.7% response rate) out of which 139 were complete. We found that parent's overall perception of their preschool children using digital devices was mixed, where about one-third of them perceived that digital device use was a risk, one-third perceived it as beneficial while onethird were unsure. The common perception of risk was that digital devices impaired children's physical (71.9-90.6%) and intellectual domains (71.9-86.3%) especially causing damage to eyesight (90.6%), causing addiction (86.3%) and exposed to radiation (81.3%). The perceived benefits of using digital device were mainly in the social domain, promoting technology awareness (64.8%), easily accessible and portable (63.3%) and entertaining (64.0%). They also perceived that digital devices promoted creative and interactive learning (62.6%). Parent's overall perception of digital media use was associated with their employment status (p=0.028). CONCLUSION: Parent's overall perception regarding digital device use among their preschool children was mixed. They perceived that digital devices commonly cause risk to the physical and intellectual aspects of their children while there are some benefits to the social aspects. There is an association between parent's overall perception and employment status.

Parental hesitancy and perception of the COVID-19 vaccine for children below 5 years in Cheras district, Kuala Lumpur.

INTRODUCTION: The use of the COVID-19 vaccine for all children below the age of 5 is expected to be available soon in Malaysia. Hence, this study aimed to assess parental hesitancy and perception of the vaccine. MATERIALS AND METHODS: A cross-sectional study was conducted among parents of children below 5 years of age, from July to September 2022 at two urban primary care clinics in the Cheras district of Kuala Lumpur. Hesitance and perception of the COVID-19 vaccine were assessed using a self-administered questionnaire. RESULTS: A total of 219 completed entries were analysed. The rate of COVID-19 vaccine hesitance for children below the age of 5 was 64.4% (n=141). Univariate analysis showed that vaccine hesitancy was associated with parental age and Muslim religion. The multivariate model showed that younger parents were more likely to be vaccine hesitant compared to older parents. A 1-year increase in parental age showed a 13% decrease in the odds of vaccine hesitancy (AOR 0.87, 95% CI 0.80-0.96). Muslim parents were also more likely to be vaccine hesitant compared to non-Muslim parents (AOR 2.46, 95% CI 1.26-4.79). Most parents perceived correctly that the vaccine can prevent complications and the spread of the disease. However, their main barriers to vaccination were concerns regarding side effects, safety and effectiveness of the vaccine. CONCLUSION: Our study found that parents have a high rate of COVID-19 vaccine hesitancy for children younger than 5 years of age. Vaccine hesitancy was associated with parents' age and religion. Most of them perceived that the vaccine could prevent complications and the spread of COVID-19. Their main barriers towards vaccination were regarding vaccine side effects, safety and effectiveness.

Adverse events following immunisation of COVID-19 vaccine among health care workers in the first phase of vaccination.

INTRODUCTION: The new COVID-19 vaccine was met with worldwide overwhelming uncertainties pertaining to its safety profile, effectiveness, and potential adverse reactions when it was first introduced. This led to vaccine refusal and delay in vaccine uptake in many countries including Malaysia. The objective of this study was to determine the Adverse Events Following Immunization (AEFI) to the COVID-19 vaccine. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted among healthcare workers who received the COVID-19 vaccine during the first phase of immunisation from eight public primary clinics in Johor Bahru district. Data were collected between May and September 2021 using a self-administered questionnaire. RESULTS: A total of 240 healthcare workers participated and all of them received the Pfizer Messenger RNA vaccine. Our study found that a large majority of vaccine recipients (87.5%, n=210) experienced AEFI to COVID-19 vaccine for either the first, second, or both doses. More than 80% of them experienced more than one type of AEFI. The most common AEFI reported during the first and second dose was localised symptom such as pain at injection site (60-68%), pain on the injected arm (52-61%), and swelling at injection site (32-33%). Common systemic symptoms were fever (22- 57%), myalgia (20-45%), and dizziness (24-26%). Although a large majority experienced AEFI, these reactions were mostly of mild to moderate severity (47.3-73.6%). The mean duration of AEFI onset was within 30 minutes to about 1 day (0.33-22.5 hours) of injection and lasted between 30 minutes and 2.5 days. There was no association between demographic characteristic of participants and severity of AEFI to COVID-19 vaccine. Mean duration of fever was significantly (p=0.005) longer after the second dose (34.2 hours) of vaccine compared to first (20.6 hours) CONCLUSION: This study shows that a large majority of COVID-19 vaccine recipients experienced AEFI; however, these reactions were mostly of mild to moderate severity and lasted between 30 minutes and 2.5 days. A large majority experienced more than one type of AEFI. The most common AEFI was localised reactions consisting of pain and swelling at the injection site and pain on the injected arm. The most common systemic reactions were fever, myalgia, and dizziness. Duration of fever was significantly longer after the second dose.

Sexual characteristics, knowledge on human papillomavirus-related diseases and its associated factors among high-risk men.

INTRODUCTION: Human papillomavirus (HPV) infection is sexually transmitted and responsible for anogenital warts and malignancies. HPV-related disease awareness among high-risk men in Malaysia remains unknown. The objective of this study was to assess sexual characteristics and HPV knowledge among high-risk men. MATERIALS AND METHODS: A total of 194 men between ages 18 and 45 years from the HIV and STD clinics of a tertiary hospital and six Health Clinics in Perak participated in this study. Knowledge of HPV was assessed using a selfadministered questionnaire. RESULTS: Majority of participants were Malays (47.4%) and had tertiary education (54.1%). Most of them (76.5%) were homosexual and practiced the versatile sexual role (69.9%). Majority engaged in oral (72.2%) and anal sex (58.2%). Only one-third of them (30.8%) used condom consistently. Only 14.4% of the study participants had adequate knowledge of HPV. Men who practiced oral sex and had previous STD had adequate knowledge of HPV. Those who practiced oral sex were 3.9 times more likely to have adequate knowledge of HPV. CONCLUSION: Our study shows that most participants have high-risk sexual behaviour. These men also have poor knowledge of HPV-related diseases. This may be a barrier to implement preventive strategies and reduce HPV-related disease and malignancies among them. Counselling regarding HPV, for men attending the HIV and STD clinics may improve patient's awareness and knowledge on HPVrelated diseases and promote HPV vaccination uptake.

Lymphocutaneous sporotrichosis of the abdominal wall: A lesson in lymphatic drainage.

Cutaneous sporotrichosis (CS) presents as asymptomatic lesions of varied morphology. The most common variant is the lymphocutaneous type which typically progresses from a papule to an ulcer and then forms nodules along the superficial lymphatic channels. Diagnosis CS may be challenging when the lesion presents at an uncommon site where the superficial lymphatic drainage is unfamiliar. We present here a case of sporotrichosis of the abdominal wall which was initially misdiagnosed as an abscess but later confirmed by culture and managed successfully.

Risk perception and knowledge regarding diabetes among offspring of type 2 diabetics at a tertiary institution.

INTRODUCTION: The rapid increase in Type 2 Diabetes Mellitus (T2DM) among the younger age groups is a growing concern worldwide. Thus, assessing the perception of risk and knowledge among those at risk may provide an opportunity for early intervention, delay or even prevent the onset. OBJECTIVE: The aim of this study was to determine the perceived risk of developing T2DM and its knowledge among the offspring of diabetic patients. METHODS: A cross sectional study using a self-administered questionnaire was conducted among university students whose parents had type 2 diabetes to determine their perceived risk and knowledge on T2DM. RESULTS: A total of 336 university students participated in this study and 56.5% of them correctly identified themselves at risk of developing T2DM. About half of them (52.7%) had higher knowledge of T2DM. Male students appeared to have better risk perception (p=0.024) compared to females while those with mothers affected by T2DM appear to have higher knowledge regarding diabetes (p=0.007). Most of their information regarding T2DM was obtained from the internet (87.5%) and other family members (77.9%). CONCLUSION: The students whose mothers had T2DM appear to have better knowledge and information regarding T2DM and this was mostly obtained from the internet and family members. Awareness regarding diabetes and healthy lifestyles advice through primary patients may be beneficial for their offspring.

Characteristics and Factors Associated with Adverse Cutaneous Drug Reactions Caused by Traditional, Complementary and Conventional Medicine in Malaysia

@#Traditional and Complimentary Medicines (TCMs) can potentially cause Adverse Cutaneous Drug Reactions (ACDRs). The aim of this study was to describe the characteristics of ACDRs due to TCMs and compare with those due to conventional medicine. This was a retrospective study with 134 cases being diagnosed with ACDR at the Dermatology Clinic of a tertiary hospital in Kuala Lumpur. Most (82.1%) ACDRs were caused by conventional drugs, while 17.9% were due to TCMs. Majority (70-75%) of the ACDRs were of mild to moderate severity. The most common ACDR to TCM was Exfoliative Dermatitis (ED) and Acute Generalized Exanthematous Pustulosis (AGEP) (both 16.7%) while maculopapular rash was the most common reaction for conventional medications (25.5%). The onset of adverse reaction to TCM was about 4 weeks (60.2%) while reactions due to conventional medication was earlier (1 to 6 days, 65.4%; p<0.05). The odds of developing delayed ACDR was 14 times more with TCM compared to conventional medicine (p<0.05). This study showed that ED and AGEP were the most common ACDR manifestations of TCM while macuplopapular rash was the most common manifestation of conventional medications. However, most of these reactions were of mild to moderate severity. ACDR due to TCM may manifest long after the initiation of these products and hence its use should be routinely inquired when patients present with skin problems. All suspected cases of ADRs to TCM should be reported to the Malaysian Adverse Drug Reactions Advisory Committee (MADRAC) for continuous pharmacovigilance of these products.

Knowledge of obesity related pregnancy risks among expectant mothers and its associated factors.

BACKGROUND: Obesity in pregnancy causes both maternal and foetal complications hence adequate knowledge of obesity related pregnancy risks would ensure better outcomes. This study aims to determine the knowledge of obesity related pregnancy risks among pregnant women. METHODS: A cross-sectional study was conducted among pregnant women from four antenatal clinics in Seremban, between February and May 2015. Knowledge on pregnancy risks was assessed using questionnaire. Women were defined as having broad knowledge on obesity related pregnancy risks if they correctly identified that women who are very obese, are at higher risk of obesity related pregnancy complications and weight loss prior to pregnancy is associated with lower risk of obesity related pregnancy complications. Descriptive statistics and regression tests were used in the analysis. RESULTS: A total of 315 women participated in this study. Their mean age is 29.3 (SD±4.8) years and majority were Malay (72.4%). More than half of them were overweight and obese (60.6%). About 63.2% participants had broad knowledge on obesity related pregnancy risk. Education is a significant predictor of broad knowledge as women with tertiary education had higher odds of having broad knowledge compared to those with only school education (OR 2.1; 95%CI: 1.28 to 3.59). CONCLUSIONS: This study found that more than half of the participants had knowledge of obesity related pregnancy risks and that education is a significant predictor for knowledge. Pre-pregnancy care education programmes can help identify barriers, introduce simple weight management strategies to overcome obesity, to ensure better maternal and foetal outcome.

Self-Perceived Stigma and its Effect on Quality of Life among Malaysians Living with Human Immunodeficiency Virus

Human Immunodeficiency Virus (HIV) epidemic remains a significant burden in Malaysia. Stigma related to HIV and its effect on the quality of life (QOL) of persons living with HIV (PLHIV) remains under-reported. The aim of the present study was to assess self-perceived stigma amongst PLHIV attending an urban community clinic and its influence on their QOL. Data was collected using HIV Stigma Scale and WHO-QOL HIV BREF Scale. The overall stigma experienced by PLHIV in this community was higher than previous studies (mean ± SD; 103.37 ±18.14). Majority participants had fear disclosing their disease status, while personalized stigma or the experience of prejudice and rejection was the least experienced. The overall QOL was low and was significantly impaired in social relationship domain (mean ± SD; 12.72 ± 3.59). However, their ability to perform daily activities was not affected by the illness (mean ± SD; 14.48 ± 2.91). PLHIV with higher spiritual values demonstrate lower perception of negative self-image and inferiority (r= -0.54). This finding was unique to PLHIV in this study and suggested the importance of spirituality and personal beliefs on their self-esteem. In conclusion, stigma remains as a significant problem among PLHIV in this community. Primary care offers the best platform to promote a holistic management of PLHIV, where the integration between counselors, religious experts, family and non-governmental associations could come together. The management of PLHIV is unique in every community, hence individualized approach based on cultural norms and beliefs could assist in the overall management of

Dermatological Diseases Among Octogenarians In A Tertiary Center

Introduction: Our country is fast becoming a developed country with improved life expectancy. The healthcare system should be prepared to manage medical conditions which are prevalent in the older age group. Skin diseases are commonly observed in the geriatric population. We seek to characterize the dermatological conditions affecting patients at the extremes of age. Methods: To determine the types of dermatological diseases affecting patients over 80 years of age, and to determine their clinical characteristics and comorbidities. Objectives: Subjects with photodamage were older, and had lower education and employment rates compared to subjects without photodamage. There was no significant difference in knowledge on the harmful effects of sun exposure and on sun protection or in sun avoidance behaviour (other than use of protective sunglasses) between the two groups, though more patients with photodamage felt that they take adequate sun protection measures. Of note, only a low percentage of subjects in both groups (24.5% of subjects with photodamage and 23.1% of subjects without photodamage) practise regular use of sunscreen. Methods: This was a retrospective study conducted at the Dermatology Unit, University Kebangsaan Malaysia Medical Center (UKMMC). All patients aged ≥80 years who attended the Dermatology Clinic UKMMC in 2015 were identified from the clinic database. Their clinical notes were reviewed. Demography, clinical characteristics and dermatological diagnosis were recorded and analyzed using SPSS Version 22. Results: One hundred and three octogenarians were included in the study. Fifty one (49.5%) were females, and 52 (50.5%) were males. The age ranged from 80 to 89 years. The majority were Chinese, 76 (73.8%), 16 (15.5%) were Malays, 6 (5.8%) were Indians and remaining 5 (4.9%) were of other ethnicities. The most commonly seen diseases were endogenous eczema 46 (44.7%), cutaneous malignancy 10 (9.7%), psoriasis 8 (7.8%), bullous pemphigoid 7 (6.8%) and fungal infection 6 (5.8%). More than half of patients [25 (24.3%)] with endogenous eczema had unclassified eczema. Other conditions were seborrheic keratosis 5 (4.9%), adverse drug eruption 5 (4.9%), viral infections 4 (3.9%) and lichen amyloidosis 3 (2.9%). Comorbidities of the patients were 48 (46.6%) hypertension, 29 (28.2%) diabetes, 25 (24.3%) atherosclerosis related disease, 22 (21.4%) dyslipidemia, 9 (8.7%) chronic lung disease and 9 (8.7%) non-skin malignancy.Conclusions: Eczema is very common in elderly patients. In the majority of patients the clinical features of eczema are often not typical of endogenous eczema subtypes. We propose the term senectus eczema as a diagnosis, however its clinical characteristics has yet to be clearly delineated. Skin cancers, psoriasis, bullous pemphigoid, fungal infections, drug eruption and viral infection are other conditions which should not be missed in assessing these patients.

Multiple concurrent primary extramammary Paget's disease.

Extramammary Paget's disease (EMPD) is a rare malignant disorder of the skin, which was described in as early as the nineteenth century. EMPD usually occurs as a single lesion in the apocrine sweat gland-bearing skin with abundant hair follicles. Here, we present an elderly man who suffered from a non-resolving chronic genital pruritus for 8 months. Initially, he was managed for recurrent fungal infection and eczema. Later, a diagnosis of the rare condition multiple primary EMPD was made based on the histopathology findings and appropriate treatment was given.

Onychomycosis nailed.

Fungal infection of the nail is a common condition that causes much concern because of its disfiguring appearance. Although specific treatment is available for this condition, treatment outcome is variable and persistent nail dystrophy post-treatment may cause distress to both the patient and the physician. This article describes the current available treatment options for onychomycosis, management approach and the expected treatment outcome to enhance primary care physicians' confidence in managing this condition. Oral antifungal agents such as terbinafine and itraconazole are good treatment options for onychomycosis. Combination therapy using oral antifungal agents with topical lacquer preparations may provide added benefits. Evaluation of patient's expectations, providing information on treatment outcome, clinical cure and recurrence rates are essential in the management of onychomycosis. This article is intended to guide primary care physicians to achieve realistic treatment goals and for a satisfactory experience in the overall management of this challenging condition.

Prevalence of toenail onychomycosis among diabetics at a primary care facility in Malaysia.

Onychomycosis increases the risk of developing secondary bacterial infection and cellulitis if left untreated. The aim of this study was to determine the prevalence of onychomycosis among diabetics and its associated factors. A cross sectional study using universal sampling of all type 1 and 2 diabetic patients attending a primary care facility of the Universiti Kebangsaan Malaysia (UKM) from January to March 2011 was conducted. Samples were taken from clinically abnormal nails and from the first right toenail in the absence of nail abnormalities and cultured for fungal elements. A total of 151 diabetics participated in the study. The mean patient age was 60.7 +/- 9.1 years. A total of 123 nail samples (81.5%) were culture positive for fungal elements. A positive correlation was found between onychomycosis and increasing age (p = 0.011) and clinically abnormal nails (p < 0.05). There were no significant correlations with gender, ethnic group, duration of diabetes, types of diabetes or glycemic control. The prevalence of onychomycosis among diabetics in our study was high.

Mismanagement of cat bite wound: lessons to learn.

Animal inflicted wounds, left untreated may result in chronic bacterial or fungal infection. Clinical features of these infections may overlap leading to a delay in diagnosis and treatment. We report a case of chronic non-healing cat bite wound treated with several antibiotics without improvement. Later patient developed the classical "sporotrichoid spread" and a presumptive diagnosis of sporotrichosis was made. Laboratory investigation for fungal culture and skin biopsy failed to identify the underlying pathogen. A trial of oral antifungal agent resulted in complete recovery of the lesions implicating fungus as the causative pathogen. Physicians should have a high index of suspicion for fungal infections when managing animal inflicted wounds.

Pisa syndrome secondary to rivastigmine: a case report.

Pisa syndrome or pleurothotonus is the persistent flexion of the body and head to one side giving the appearance of the leaning tower of Pisa. It is most commonly caused by typical and atypical antipsychotic drugs. We report a case of Pisa Syndrome caused by prolonged use of high dose cholinesterase inhibitor, rivastigmine. Symptoms subsided when rivastigmine was withdrawn and did not reappear when a different cholinesterase inhibitor, donepezil was introduced. Physicians should be aware of Pisa syndrome and should alert patient of this possibility when starting and stepping up medications. The purpose of reporting this case is to create awareness among general practitioners as it is a reversible condition which responds to removal of the offending drug.

Parental concerns and control in feeding of 9 to 12-year-old children in a primary school in Kuala Lumpur, Malaysia.

INTRODUCTION: Body weight of children is affected by many factors including food habits which are influenced by their parents. Studies in the West have shown that parents tend to control child feeding in response to their child's weight status. The aim of this study was to assess Malaysian parental concerns about child weight and the control they exert on child feeding. METHODS: This cross-sectional study was conducted on parents and their children aged 9 to 12 years from a primary school in Kuala Lumpur. The weight status of the children was classified according to the body mass index-for-age growth chart. Parental concerns about child weight and control in child feeding was assessed using the adapted Malay version of Child Feeding Questionnaire. RESULTS: A total of 204 parents participated in this study. The study found that being a female served as a protective factor against becoming overweight (OR: 0.28, CI: 0.13-0.62). Parents with overweight children were significantly older (OR: 1.08, CI: 1.01-1.15), concerned about their child's weight (OR: 2.77, CI: 1.49-5.12) and controlled their child's feeding by restricting food intake (OR: 2.70, CI: 1.30-5.60). They were less likely to pressure their children to eat (OR: 0.32, CI: 0.19-0.56). Parents from the low income group were more likely to have underweight children (OR: 4.15, CI: 1.28-13.47). CONCLUSION: There was significant difference in level of parental concern across differing child weight status. Parents with overweight children were likely to be more concerned about their child's weight, tending to control their feeding. In contrast, parents with underweight children did not exert control on their feeding.

Parental Concerns and Control in Feeding of 9 to 12-Year-Old Children in a Primary School in Kuala Lumpur, Malaysia

Introduction: Body weight of children is affected by many factors including food habits which are influenced by their parents. Studies in the West have shown that parents tend to control child feeding in response to their child’s weight status. The aim of this study was to assess Malaysian parental concerns about child weight and the control they exert on child feeding. Methods: This crosssectional study was conducted on parents and their children aged 9 to 12 years from a primary school in Kuala Lumpur. The weight status of the children was classified according to the body mass index-for-age growth chart. Parental concerns about child weight and control in child feeding was assessed using the adapted Malay version of Child Feeding Questionnaire. Results: A total of 204 parents participated in this study. The study found that being a female served as a protective factor against becoming overweight (OR:0.28, CI:0.13-0.62). Parents with overweight children were significantly older (OR:1.08, CI:1.01-1.15), concerned about their child’s weight (OR:2.77, CI:1.49-5.12) and controlled their child’s feeding by restricting food intake(OR:2.70, CI:1.30-5.60). They were less likely to pressure their children to eat (OR:0.32, CI:0.19-0.56). Parents from the low income group were more likely to have underweight children (OR: 4.15, CI:1.28-13.47). Conclusion: There was significant difference in level of parental concern across differing child weight status. Parents with overweight children were likely to be more concerned about their child’s weight, tending to control their feeding. In contrast, parents with underweight children did not exert control on their feeding.

Contact dermatitis presenting as non-healing wound: case report.

Topical antiseptics are commonly used in the management of minor wounds, burns, and infected skin. These agents are widely used by health professionals and are often self-prescribed by patients as they are easily available over-the-counter. This case illustrates a 73 year old man who presented with a non-healing wound on his right forearm for 4 weeks. The wound started from an insect bite and progressively enlarged with increasing pruritus and burning sensation. Clinically an ill-defined ulcer with surrounding erythema and erosion was noted. There was a yellow crust overlying the center of the ulcer and the periphery was scaly. Further inquiry revealed history of self treatment with a yellow solution to clean his wound for 3 weeks. Patient was provisionally diagnosed to have allergic contact dermatitis secondary to acriflavine. Topical acriflavine was stopped and the ulcer resolved after treatment with non-occlusive saline dressing. Skin patch test which is the gold standard for detection and confirmation of contact dermatitis showed a positive reaction (2+) to acriflavine. Acriflavine is widely used as a topical antiseptic agent in this part of the world. Hence, primary care physicians managing a large variety of poorly healing wounds should consider the possibility of contact allergy in recalcitrant cases, not responding to conventional treatment. Patient education is an important aspect of management as this would help curb the incidence of future contact allergies.