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An ear infection (EI) is one of the most common pediatric illnesses. This study aimed to assess parental knowledge, care-seeking practices, and factors associated with them. A cross-sectional study involved a sample of parents attending hospitals in three selected cities in Iraq. Data were collected with a questionnaire composed of three parts: i) Sociodemographic characteristics, ii) Questions related to knowledge of symptoms, risk factors, and complications of an EI, and iii) Questions related to care-seeking practices. The mean age of respondents was 34.99 (±9.85) years. Females made up 58.90% of the sample. More than half reported holding tertiary education. Most participants showed satisfactory knowledge of EI symptoms (88.10%) and proper practices of seeking medical attention from a doctor or other medic (95.80%). Respondents with tertiary education had higher odds of having satisfactory knowledge (OR 4.63, 95% CI 1.18-18.19) and proper care-seeking practices (OR 14.96, 95% CI 1.12-28.80) than those with primary education and below. Current smokers had higher odds of having unsatisfactory knowledge (OR 0.12, 95% CI 0.02-0.70) than non-smokers. In conclusion, respondents had sufficient knowledge and care-seeking practices. Educational level was associated with adequate knowledge and care-seeking practices, and former smoking status was associated with unsatisfactory knowledge.

Background: Self-medication of drugs to alleviate symptoms is a common global behavior, helping relieve burdens on health services, but many drugs eg, antibiotics are prescription-only. Self-medication of antibiotics (SMA) is an irrational use of drugs, contributing to microbial resistance increasing health care costs and higher mortality and morbidity. This study aimed to assess SMA among university students. Methods: This was a cross-sectional study conducted among medical and non-medical students of the National Defence University of Malaysia. A validated instrument was used to gather data. Ethics approval was obtained. Random and universal sampling was adopted, and SPSS 21 was used for data analysis. Results: A total of 649 students participated in the study: 48.5% male and 51.5% female, 39.3% reported self-medicating with antibiotics. Penicillin, doxycycline, clarithromycin were the antibiotics most used with the majority reporting no adverse drug reactions. Cost savings and convenience were the principal reasons for SMA which were mainly obtained from local retail pharmacies. Despite medical students (particularly the more senior) having better knowledge of antibiotic use than non-medical students, 89% of all research participants responded that practicing SMA was a good/acceptable practice. Conclusion: SMA is common amongst Malaysian students and, despite understanding why SMA is unwise, even medical students self-medicate.

Background Considerable overlap exists between case-based learning (CBL) and problem-based learning (PBL) and differentiating between the two can be difficult for a lot of the academicians. Aims This study gauged the ability of members of medical school, familiar with a problem-based learning (PBL) curriculum, to differentiate between case-based learning (CBL) and PBL after a two-day workshop on CBL. Methods A questionnaire was distributed to all participants, attending the introductory course on CBL. It was designed to document the basic characteristics of the respondents, their preference for either CBL or PBL, their ability to recognize differences between CBL and PBL, and their overall perception of the course. Results Of the total workshop participants, 80.5 per cent returned the completed questionnaire. The mean age of the respondents was 44.12±12.31 years and women made up a slight majority. Majority favoured CBL over PBL and felt it was more clinical, emphasizes on self-directed learning, provides more opportunities for learning, permits in-depth exploration of cases, has structured environment and encourages the use of all learning resources. On the respondents’ ability to discriminate CBL from PBL, a weighted score of 39.9 per cent indicated a failure on the part of the respondents to correctly identify differences between CBL and PBL. Less than half opined that CBL was a worthwhile progression from PBL and about third would recommend CBL over PBL. Conclusion It seems that majority of the respondents failed to adequately differentiate between CBL and PBL and didn’t favour CBL over PBL.

Haque M, Rahman NAA, McKimm J, et al. Infect DrugResist. 2019;12:1333–1351.On review of the published paper, the authors have noticedan error on page 1336, in the first sentence of theechniques of data collection section, where “Appendix I”has been cited in error. There is no appendix for this papernd the appendix citation should be disregarded. Theauthors confirm that this correction has no impact on theindings of the study. Read the original article

OBJECTIVES -To examine the effect of nicotine (Ni) on bone socket healing treated with Ellagic acid (EA) after tooth extraction in rat. MATERIALS AND METHODS Thirty-Two Sprague Dawley (SD) male rats were divided into four groups. The group 1 was administrated with distilled water intragastrically and injected sterile saline subcutaneously. The group 2 was administrated with EA orally and injected with sterile saline subcutaneously. The groups 3 & 4 were subcutaneously exposed to Ni for 4 weeks twice daily before tooth extraction procedure, and maintained Ni injection until the animals were sacrificed. After one month Ni exposure, the group 4 was fed with EA while continuing Ni injection. All the groups were anesthetized, and the upper left incisor was extracted. Four rats from each group were sacrificed on 14(th) and 28(th) days. Tumour necrosis factor alpha (TNFα), Interleukin-1 beta (IL-1β) and Interleukin-6 (IL-6) were applied to assess in serum rat at 14th and 28(th) days. Superoxide dismutase (SOD) and Thiobarbituric acid reactive substances (TBRAS) levels were assessed to evaluate the antioxidant status and lipid peroxidation accordingly after tooth extraction in homogenized gingival maxilla tissue of rat at 14(th) and 28(th) days. The socket hard tissue was stained by eosin and hematoxylin (HE immunohistochemical technique was used to assess the healing process by Osteocalcin (OCN) and Alkaline Phosphatase (ALP) biomarkers. RESULTS Ni-induced rats administered with EA compound (Group 4) dropped the elevated concentration of pro-inflammatory cytokines significantly when compared to Ni-induced rats (Group 3) (p

A number of methods have been used for the detection of the presence of microsarcocysts in animals, but little information exists on the value between the various methods. This study therefore examined for Sarcocystis spp. using three different methods in 105 samples of skeletal muscle collected from goats slaughtered in an abattoir in Selangor, Malaysia from January to February 2014. Three methods were used, direct light microscopy of squashed fresh muscle tissues; histological examination of fixed, sectioned, and hematoxylin and eosin (HE)-stained samples of muscle; and molecular identification by polymerase chain reaction (PCR). Of the 105 tissue samples, 55 (52.38 %) were positive by light microscopy (LM), 46 (43.8 %) by histology, and 95 (90.48 %) by PCR. Only 29 (27.6 %) and 5 (4.76 %) samples were positive and negative, respectively, by all three methods. The cysts were elongated to a spindle shape with a mean size of 393.30 × 81.6 μm and containing banana-shaped bradyzoites of size 12.32 × 2.08 μm. The wall of the cyst was radially striated with a thickness of 2.83 μm. Samples were tested for the presence of Sarcocystis-specific 18S rRNA and were identified as Sarcocystis capracanis. Of the three methods used, the PCR test appears to be the most useful method for the diagnosis of sarcocystosis especially for species identification.

Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not invasive procedure and can be done on outpatient basis without anesthesia and with few complications which is most probably temporary and treatable. The objective of this study is to evaluate the efficiency and safety of ESWL in treatment of ureteric stone in Iraq. Materials and Methods: A total of 112 Iraqi patients with ureteric stones were participated in this prospective observational study in which patients scheduled for ESWL treatment for a period of 6 months. Patients were divided into 2 groups: 1) Group 1: 52 patients with proximal ureteric stone; 2) Group 2: including 60 patients with distal ureteric stone. Preoperatively all patient underwent bowel preparation and were asked to fast for 8 hours before the procedure. Results: The age ranged between 22 and 55 with mean of 42 (SD = 5) years. Around 46% had proximal ureteric stone and the rest were in distal ureter. Around 44% needed one session and 40% needed two sessions to be stone-free respectively. In regards to associated symptoms, 74% had ureteric colic, 3% haematuria, 43% microhematuria and 12% UTI. Mild hydronephrosis was found in 90% of the cases and 30 reported had previous intervention. Success rate was 90%. Conclusions: ESWL is safe and effective in treatment of ureteric stone with few complications and must be regarded first choice after conservative treatment in a patient with uncomplicated ureteric stone.

Background: Health promotion (HP) is getting recognition in most medical school curricula. The aim of this study is to assess students’ perception of learning outcomes and the main factors affecting these outcomes . Methods: This was a prospective cross-sectional which involved all year four medical students who completed the population health posting for two successive academic sessions 2011-2012 and 2012-2013. Self-administered questionnaire was used to assess course characteristics, teaching environment and acquired knowledge, skills and attitude. Response to each survey question was described. Structural Equation Modelling was used to test the relation between course characteristics, teaching environment and knowledge, skills and attitude. Path coefficients with corresponding significance test were presented. Results: Three hundred and thirty students with mean age of 22.6 years returned the completed questionnaire. There were about 69.1 % female students and 30.9 % males. Most respondents gave positive feedback regarding course characteristics. However, around 47% were not sure about clarity of the objectives. Students provided favourable responses to the statement evaluating lecturer performance and the class environment including opportunities for learning. Majority of respondents showed favourable response to statement assessing the defined attitude, skills and attitude. Lower higher ratings were observed for statements reflecting respondent autonomy, ability to work in difficult situation and managerial abilities. Path model showed that teaching environment impacted knowledge, skills and attitude, while course characteristic impacted the gained attitude only . Conclusions: Health promotion program is perceived to be sufficient to prepare students for professional life. Teaching environment had more impact on learning outcomes.

Stigma and discriminatory attitudes (SDAs) have a negative impact on human immunodeficiency virus (HIV) prevention, testing, and treatment as well as on family and social networks. There is a lack of understanding about HIV-related SDAs among people living outside large cities. This study is aimed to determine the level of HIV-related SDAs among a semi-urban population in Malaysia and to compare the SDA results among people with different sociodemographic characteristics.A sample of 106 respondents was generated by convenience sampling during the screening campaign in Alor Gajah, Malaysia. Data collection was carried out based on a pre-tested questionnaire via face-to-face interviews.More than half of the respondents (62.3%) thought that an HIV-positive teacher should not be allowed to continue teaching at school; 81.1% were unsure or were unwilling to care for their family member with AIDS at home; 81.2% thought children with HIV/AIDS should not continue to be raised in families; and 77.3% thought they would not reveal if a family member had HIV/AIDS.Priority should be given to evidence-based interventions to reduce HIV-related SDAs. This study did not reveal any significant relationship between sociodemographic profiles and HIV-related SDAs. Therefore, further research with a larger sample size is needed to investigate the underlying causes of HIV-related SDAs.

Background The scarcity of data about coping styles with a biochemical marker namely lipid profile, potentially associated with cardiovascular risk factors is most striking among professionals working in public university. Hence, this research aimed to investigate the relationship between coping styles and lipid profile comprising total cholesterol (TC), triglyceride (TG), HDL-cholesterol (high density lipoprotein-cholesterol) and LDL-cholesterol (Low density lipoprotein-cholesterol) among this group of professionals. Methods A cross sectional survey was conducted among staff from a tertiary education centre. Subjects were contacted to ascertain their medical history. A total of 320 subjects were interviewed and 195 subjects were eligible and subsequently recruited on a suitable date for taking blood and administration of the questionnaires. The subjects completed questionnaires pertaining to demographic details and coping styles. Pearson’s correlation coefficient was used to measure the strength of association between lipid profile and coping styles. Results Majority of the subjects were non-academic staff (60.0%), female (67.2%), Malay (91.8%), married (52.3%) and educated until Diploma level (34.9%). Academic staff scored significantly higher mean scores in task-oriented coping styles (Mean = 64.12). Non-academic staff scored significantly higher mean scores in emotion (Mean = 48.05) and avoidance-oriented coping styles (Mean = 57.61). Malay subjects had significantly higher mean scores in emotion (Mean = 47.14) and avoidance-oriented coping styles (Mean = 55.23). Non-malay subjects (Mean = 66.00) attained significantly higher mean scores in task-oriented coping styles. Single/divorced/widowed individuals scored significantly higher mean scores in emotion (Mean = 48.13) and avoidance-oriented coping styles (Mean = 56.86). There was a significant negative correlation between TC (r = −0.162) and LDL (r = −0.168) with avoidance-oriented coping styles (p = 0.023, p = 0.019 respectively). Conclusion Avoidance-oriented coping style was more likely to engender favourable lipid profile. Hence, assessment of coping styles would certainly assist health care practitioners in predicting subjects who would be at a greater risk of developing cardiovascular diseases.

To assess the relationship between glycaemic control and quality of life (QoL) among a sample of Malaysians with type 2 diabetes mellitus. This study is a cross-sectional hospital-based study involving 256 patients from three major ethnic groups in Malaysia. Data about QoL were collected with the 18-item Audit of Diabetes Dependent QoL questionnaire. Other data about putative predictors of QoL including personal characteristics and disease-related factors were also collected. Hierarchical multiple linear regression was used to determine factors associated with QoL and to control for confounding variables. The mean age of participants was 56.79 years. Participants were mostly women, employed and married and had attained secondary education. More than a third of the patients had a disease duration of more than 10 years, and about two-thirds had HbA1c ≥ 6.5 %. Those with desired glycaemic control had poorer QoL than those with less than desired glycaemic control moderated by the use of insulin. Hierarchical multiple linear regression showed that desired glycaemic control (HbA1c), diabetes worry, use of insulin, more than 10 years’ duration of diabetes, neuropathy and retinopathy were associated with poor QoL, whereas being satisfied with waiting time for consultation was associated with better QoL. The results of this study show that diabetes was associated with negative impact on quality of life. The use of insulin to achieve desired glycaemic control was particularly associated with negative impact on QoL.

Background Transmission of infectious diseases is a recognized complication of blood transfusion and blood products. Nucleic acid testing (NAT) may contribute to improved efficiency of blood screening and thereby increase the safety margin for transfused blood. Methods Unscreened blood samples from 1388 randomized donors were selected for this study at the Transfusion Medicine Unit of Hospital Universiti Sains Malaysia (HUSM). Informed consent was obtained from all donors and blood samples were tested for HIV, HBV and HCV serologically and by NAT assay. Results Of the 1,388 tested samples, 1,360 were non-reactive for both assays. Four samples (0.29%) were both serologically and NAT reactive. The remaining twenty-four samples were divided into two groups. Of these, five samples (0.366%) were NAT reactive and nineteen samples (1.37%) were serologically reactive. However, serology confirmation tests run on the latter nineteen samples were non-reactive. Conclusions Hence, NAT adds benefit of detecting “false positive” reactions via standard serology, the cost of administering NAT also need further consideration and study.

Background Hypertension is the leading cardiovascular risk factor globally as well as in Malaysia. This study aimed to estimate the prevalence, awareness, treatment, control and the socio demographic determinants of hypertension among Malaysian adults. Method The analytic sample consisted of 11,288 adults aged ≥ 30 years recruited at baseline in 2007–2011 from the REDISCOVER Study which is an ongoing, prospective cohort study involving 18 urban and 22 rural communities in Malaysia. Socio-demographics, anti-hypertensive treatment details and an average of at least two blood pressure measurements were obtained. Results The age-adjusted prevalence was 42.0 % (CI: 40.9–43.2) and was higher in men [43.5 % (CI: 41.2–45.0)] than women [41.0 % (CI: 39.8–42.3)]. Participants from rural areas (APR: 1.12, CI: 1.04–1.20); aged at least 40–49 years (APR: 1.86, CI: 1.62–2.14); who were overweight (APR: 1.24, CI: 1.15–1.34) and obese (APR: 1.54, CI: 1.43–1.6) were more likely to have hypertension. The Indigenous ethnic group was less likely to be aware (APR: 0.81, CI: 0.69–0.92) and to be on treatment (APR: 0.66, CI: 0.55–0.79). Those in rural areas were less likely to have their hypertension controlled (APR: 0.61, CI: 0.49–0.75). On the other hand, control was more likely in females (APR: 1.25, CI: 1.01–1.54) and Indigenous group (APR: 1.64, CI: 1.19–2.25). Conclusion Hypertension is common in the Malaysian adults. The control of hypertension has increased over the years but is still quite low. Public health measures, as well as individual interventions in primary care are crucial to reduce their risk of developing complications.

Introduction Diabetes Mellitus (DM) is notorious for its metabolic effect, acute and chronic complications and impact on Quality of Life (QoL). Successful intervention to improve QoL necessitates a valid and reliable measurement tool to identify areas of concern to patients with diabetes. Objectives To (1) assess the factor structure of the Malay Audit of Diabetes Dependent Quality of Life-18 (ADDQoL-18) questionnaire; (2) determine the impact of DM on QoL; and (3) identify areas of concern to patients with type 2 DM from three major ethnic groups in Malaysia. Methods Data was obtained from a cross sectional study involving 256 patients with type 2 DM attending the diabetes clinic of the National University of Malaysia Medical Centre. The Malay version of ADDQoL-18 survey was translated from its English version according to standard guidelines and administered by a trained research assistant. Exploratory Factor Analysis (EFA) with oblimin rotation was used to determine factor structure of the data. Confirmatory Factor Analysis (CFA) was used to confirm the factor structure. Hierarchical liner regression was used to determine factors associated with QoL. Results Unforced factor solution yielded two factors for the whole sample. Forced one factor solution was ascertained for the whole sample and for each ethnic group. Loadings ranged between 0.588 and 0.949. Reliability coefficients were all higher than 0.955. CFA showed that the two factor model had better fit statistics. QoL was associated with the use of insulin and desired glycaemic control, longer diabetes duration, worry about diabetes, and diabetes complications. Conclusions The Malay ADDQoL-18 is a valid tool to be used among patients with diabetes from different ethnic groups in Malaysia. The use of insulin to achieve desired glycaemic control had more negative impact on QoL than the use of tablets and/or dietary changes.

Background: Providing healthcare services to travelers has become very diffiult especially when there is an urgent need to access their health records. During the pilgrim season, in Makkah, Madinah and Jeddah, the hospitals are having great diffiulties in providing healthcare services to all the pilgrims. This paper discusses the current situation of pilgrim health record management in Malaysia and probe challenges and needs for implementing electronic medical records sharing framework Methods: A number of studies are scrutinized to establish the issues involved in creating, archiving, accessing, updating and sharing electronic patient health records. These issues include technical barriers,data integrity and security, individual privacy and confientiality, and trust in the receiver and its environment to correctly implement policies and vice-versa.A structured interview survey was conducted to gather data on the current practice of health record management by TabungHaji. Findings: After analyzing the fidings, several possible approaches are suggested for TabungHajitotake towards collaboration with the global health system. Conclusions: Benefis may include increased EHR adoption, interoperable medical records, and improved healthcare for Malaysian Hajjj pilgrims.