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Introduction: The number of elderly diabetes patients is rising all over the world. Therefore, the quality of life of older people as well as the factors that influence it are aimed to be evaluated in this study. Method: A cross-sectional study was carried out on 269 senior diabetes patients from government health clinic in Kuantan, Pahang. Their sociodemographic information was gathered, and the Diabetes Quality of Life Instrument (DQoL) was used to assess their quality of life. The connection between DQoL domains and covariates was determined by Mann-Whitney U test and the Kruskal-Wallis test. Linear regression analysis was used to find the predictors. Results: : The majority of patients in the B40 groups had at least a primary level of education (52.2%) and a source of income (97.3%).The majority of the clinics (61.3 %) were located in rural areas and did not have a family medicine specialist on staff (77.7 %). The majority of the patients had uncontrolled diabetes (71.7%), uncontrolled blood pressure (63.2%), uncontrolled cholesterol levels (74.0%), and abnormal abdominal circumferences (84.8%). Clinic location, diabetes control status, and old age were statistically significant in predicting the quality of life. Conclusion: Despite the perception of a significant risk of problems, this study found that decreasing the HbA1c goal further improved the quality of life of older patients. Those clinic headed by family medicine specialist gave the highest degree of patient quality of life. As a result, additional primary care physicians should be trained, as well as local treatment measures.

The COVID-19 pandemic forced the Deans’ Council of Public Malaysian Medical Faculties to tackle the issue of examinations in the face of movement control orders (MCO). A task force decided that final professional examination is necessary and three recommendations have been proposed. Online examination is among the best option with strict adherence to the Malaysian Medical Council guidelines. The majority of the universities used a Moodle-based Learning Management System; the examination will therefore mainly cover cognitive outcomes focusing on final professional exit examinations. It felt that cheating, although a real issue, is manageable and came up with several recommendations for the implementation based on likely outcomes of the MCO.

The coronavirus disease 2019 (COVID-19) pandemic has affected the socio-economic fabric of the society globally. Educational institutions, including medical schools are no exception. It has caused wide-spread disruption to teaching and learning (T&L) activities and may impact the future of medical education worldwide.

AbstractEstrogen (17β-estradiol or E2) is a crucial regulator of the synthesis and secretion of pituitary reproductive hormones luteinizing hormone, follicle-stimulating hormone, and prolactin. In this review, we summarize the role of estrogen receptors in nonfunctioning pituitary neuroendocrine tumors (NF-Pitnets), focusing on immunoexpression and gonadotroph cell proliferation and apoptosis. Gonadotroph tumors are the most common subtype of NF-Pitnets. Two major estrogen receptor (ER) isoforms expressed in the pituitary are estrogen receptor alpha (ERα) and estrogen receptor beta (ERβ). Overall, estrogen actions are mostly exerted through the ERα isoform on the pituitary. The G protein–coupled estrogen receptor (GPER) located at the plasma membrane may contribute to nongenomic effects of estrogen. Nuclear immunoreactivity for ERα and ERβ was highest among gonadotroph and null cell tumors. Silent corticotroph tumors are the least immunoreactive for both receptors. A significantly elevated ERα expression was observed in macroadenomas compared with microadenomas. ERα and ERβ may act in opposite directions to regulate the Slug-E-cadherin pathway and to affect invasiveness of NF-Pitnets. In the cellular pathway, ERs regulate estrogen-induced proliferation and differentiation and impact several signaling pathways including the MAPK and PI3K/Akt pathway. Estrogen was the first-discovered inducer of pituitary tumor transforming gene 1 that was abundantly expressed in NF-Pitnets. ERα can be a potential biomarker for predicting tumor size and invasiveness as well as therapeutic target for NF-Pitnets. Selective estrogen receptor modulators or antiestrogen may represent as an alternative choice for the treatment of NF-Pitnets.

Studies on excised aldosterone-producing lesions have found somatic mutations in five genes (KCNJ5, CACNA1D, ATP1A1, ATP2B3, and CTNNB1) commonly causes the excess aldosterone production. Interestingly, Oriental cohorts had the highest frequency of KCNJ5 mutations whereas CACNA1D mutations were most common in Black African Caribbean patients, suggesting that genetic background affects the prevalence and distribution of aldosterone-driving somatic mutation. We therefore aimed to identify the common germline variants that associates with excess aldosterone production through performing a pilot genome wide association study (GWAS) on primary aldosteronism (PA) patients. GWAS was performed using the Human Infinium OmniExpressExome-8 v1.4 BeadChip containing 960,919 markers to compare gDNA of 154 PA patients with 78 healthy controls. Samples were checked for sex discordance, heterozygosity rate, missing rate and the degree of recent shared ancestry for each pair of individuals using the PLINK program and Genome Studio (Illumina). In total, 150 patients and 75 controls (112 males and 113 females) were included in the downstream analysis. 630,749 markers that passed quality control steps (missing call rate 1%) were used to perform association analysis using the Chi-square Test which was then subjected to multiple testing corrections (Bonferroni correction). As expected with a pilot sample size, no variants passed the suggestive significant threshold of Bonferroni corrected P-value < 5 x 10-6 (-log10 P = 5.3). However, 27 SNPs had the uncorrected P-value2, and differences of frequencies in cases compared to control >0.1 or References aChu et al., Int J Clin Exp Pathol 2017;10(9):10009-10018. bTanaka et al., Hypertens Res 2019;42(2):165-173. cNogueira et al., Mol Cell Endocrinol 2009; 302(2): 230–236. dGTEx Analysis Release V7 (dbGaP Accession phs000424.v7.p2) Acknowledgements This research was supported by the Malaysian Ministry of Higher Education Grant (FRGS/1/2015/SKK08/UKM/02/3), The National University of Malaysia (UKM) University Grant (GUP-2016-083), and The UKM Medical Center Fundamental Grant (FF-2016-302).

Objective : Patients beliefs determine their response to an illness and its management especially if it is chronic. Studies assessing patient’s knowledge of their epilepsy are scarce. We report the first objective study evaluating knowledge, attitude and practices of epilepsy patients referred to a tertiary care centre in East Coast of Malaysia. Materials and Methods : A cross sectional study using pre-tested, semi-structured questionnaire among consenting epilepsy patients. Results : The demographic details and responses to a questionnaire assessing their insight towards epilepsy were recorded. Among 132 respondents, 51.5% were male and 48.5 % were female. Their age ranged from 14 to 70 years (mean = 31.63 ± 13.41). Majority (53.8%) of them aged equal or less than 30 years. The median number of years they had epilepsy was 8.0 (4.0, 18.8) years and average duration of seizure prior to seeking medical attention was 1.0 (0.3, 4.5) years. The average number of years they were receiving treatment from a hospital was 5.50 ± 5.84. Most (90.9%) did not know the cause of epilepsy; however 93.9 % were aware that it can be treated with modern drugs. While only 22.7 % believed that faith healers can treat epilepsy, 74.2% had tried other forms of treatment. Negative attitude was reflected in the belief that epilepsy is due to supernatural powers (1.5%) and that epilepsy is contagious (17.4 %). Positive attitude included that PWE can take a job (66.7%), allowing a child with epilepsy to study (80%), not objecting children to play with a child with epilepsy (54.5%), marry (65.9%) and having children (58.3%). Conclusions : Patients with epilepsy are not knowledgeable about their disorder. This is true regardless of age, educational background, or number of years with epilepsy. The results suggest that there is a critical need to enhance epilepsy education and improve attitudes towards epilepsy beyond seizure control. Bangladesh Journal of Medical Science Vol.16(4) 2017 p.545-553

Introduction: Despite advances in the management of diabetes, the rate of control of diabetes in the population remains modest. Perception of diabetes control is a key to patient empowerment. The aim of this study was to describe the perception of diabetes control among patient with poorly controlled diabetes. Materials and method: A cross sectional study was done involving 276 patients with type 2 diabetes mellitus in the out-patient settings. After obtaining an informed consent, the socio-demography and medical history of each patient was recorded. Their most recent available blood investigations were documented. Patients were then asked on their perception of diabetes control whether it was excellent, moderate or poor. Analyses were descriptive and exploratory. Results: The median age of subjects was 56.0 (48.0,62.0) years old, with a median duration of diabetes of 8 (4,13) years. The median HbA1C was 9.5 (8.3,11.4)% with a fasting blood sugar of 9.7 (7.1,13.8) mmol/L. Despite having poor HbA1C, 28.4% of patients perceived that their diabetes control was excellent; 58.9% perceived moderate and only 12.7% accurately perceived poor control. The reverse relationship between perception of disease and education may indicate that other factors such as effective communication might need to be considered. The absence of association between perception and duration of diabetes may suggest that information given to patient over the years had poor impact on their understanding of disease control. Conclusion: This study demonstrated that there was presence of discordance between perception of diabetes control and HbA1C. Identifying the discordance between perception of diabetes control and HbA1C should be the first step in delivering a personalized diabetes education for patient.

Objectives As is true for other chronic illnesses, perception of disease control is pivotal to patient empowerment in diabetes care. This study aimed to describe the perception of diabetes control by patients with poor glycated hemoglobin (A1C) levels so as to explore the relationship between perception and various sociodemographic and disease characteristics and to measure the patients' knowledge, attitudes and practices in diabetes care. Methods A cross-sectional study was made involving 276 patients with type 2 diabetes mellitus. After obtaining informed consent, their sociodemographics, medical histories and most recent available blood investigations were documented. Patients were asked about their perceptions of diabetes control—whether it was excellent, moderate or poor. A Malay-language knowledge, attitudes and practice questionnaire was administered to respondents. Analyses were descriptive and exploratory. Results The median age of the subjects and the durations of diabetes were 56 (interquartile range, 48–62) years and 8 (interquartile range, 4–13) years, respectively. The median A1C level was 9.5% (interquartile range, 8.3%–11.4%). Despite having poor A1C levels, 28.4% of patients perceived that their diabetes control was excellent; 58.9% perceived it as moderate, and only 12.7% accurately perceived it as poor. A significant number of those with higher education had wrong perceptions, indicating that other factors, such as effective communication, need to be considered. The absence of an association between perception and duration of diabetes suggests that information given over the years did not contribute to patients' understanding of disease control. Younger patients had better knowledge scores. Those with higher education levels had higher quartiles of knowledge and attitude but not practice scores. Conclusions This study demonstrated discordance between perceived diabetes control and actual A1C levels, which may hinder effective diabetes care.

Introduction: Due to globalization and changes in the health care delivery system, there has been a gradual change in the attitude of the medical community as well as the lay public toward greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As euthanasia has gained world-wide prominence, the objectives of our study therefore were to explore the attitude of physicians and chronically ill patients toward euthanasia and related issues. Concomitantly, we wanted to ascertain the frequency of requests for assistance in active euthanasia. Materials and Methods: Questionnaire based survey among consenting patients and physicians. Results: The majority of our physicians and patients did not support active euthanasia or physician-assisted suicide (EAS), no matter what the circumstances may be P < 0.001. Both opposed to its legalization P < 0.001. Just 15% of physicians reported that they were asked by patients for assistance in dying. Both physicians 29.2% and patients 61.5% were in favor of withdrawing or withholding life-sustaining treatment to a patient with no chances of survival. Among patients no significant differences were observed for age, marital status, or underlying health status. Conclusions: A significant percentage of surveyed respondents were against EAS or its legalization. Patient views were primarily determined by religious beliefs rather than the disease severity. More debates on the matter are crucial in the ever-evolving world of clinical medicine.

Fasting during the month of Ramadan is one of the five pillars of Islam, a recurring annual ritual, which is passionately practiced by most Muslims across the world. It is obligatory on every healthy Muslim; however, the Qur’an and Islamic teachings specifically exempt people with acute or chronic illnesses from this duty, especially if it might have harmful consequences. Muslims with diabetes are exempted from fasting, but many of them still fast during Ramadan, for their personal convictions as revealed by EPIDIAR study which showed that 43% of patients with type 1 diabetes and 79% with type 2 diabetes fasted during Ramadan. Muslims constitute about a quarter of the world’s population who are spread all over the globe. It is inevitable that health care issues peculiar to them will be encountered worldwide and health care providers will have to counsel them regarding medications and whether it is safe to undertake the fast. This paper is an update on the management of Ramadan fasting based on current evidence from published literature and expert opinions.

DOI: http://dx.doi.org/10.5915/43-1-6396 Informed consent is now accepted as a cornerstone of medical practice. It is a derivative of the four fundamental principles of medical ethics, which are patient autonomy, nonmaleficence, beneficence, and justice. Islam upholds the underlying virtue of these four basic principles, but diversity arises in their interpretation and practical applications. In the World Health Report 2000, the World Health Organization opined that the expectation for autonomy was "universal," while acknowledging cultural differences in its interpretation and implementation. The concept of autonomy applies well in securing the rights of patients against paternalistic infringement and in cases of malpractice. However, in this paper we argue that strict adherence to the Western grounded philosophy of medical ethics and autonomy is insufficient to solve ethical dilemmas in modern medicine, as it denies the role of faith in a supernatural being. Most non-Western cultures are still proud of their communal relations and spiritualistic ethos. In Western bioethics, patient autonomy prevails in choices involving all sectors of social and personal life, a concept unacceptable in many other cultures. In Islamic bioethics, the rights of God, the community, as well as the individual do feature in consideration. Islam emphasizes health promotion and disease prevention, making it obligatory for a Muslim physician to dissuade practices that undermine individual and collective health. Islam encourages individuals to get involved in such research, which has a public benefit and justifies the risks of participation. We propose a more flexible viewpoint that accommodates cultural values in interpreting autonomy and applying it in an increasingly multilingual and multicultural, contemporaneous society.