bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of Venom and Venom-Derived Products in Medicine and Cosmetics: the Ethical Issues From Islamic Perspective
Authors: Ahmad Rusmil Muhamad Rusdi , Othman Iekhsan , Che Mohamad Che Anuar
Published: January 2021

Venom is a mixture of biologically active toxins that affect normal physiological functions. With the advance in technology, the complexity and functions of venom and its toxins are slowly being revealed. It has become important source for therapeutic, diagnostic and cosmetic agents. However, there is concern among the Muslim community pertaining to halal and safety issues on the venom and venom-derived product usage. There are few studies that discuss the Islamic views in the usage of venom and venom-based product in medicine and cosmetic applications. There is a need for Muslim scientists and scholars to seriously identify the potential ethical and safety issues in the usage of venom and venom-derived products in view of the widespread application in medicine and cosmetic, which subsequently forming the basis for relevant and reliable shariah ruling. This is an attempt to review the relevant articles based on the following keywords: venom and Islamic ruling, venom-based product, venom and medicine, venom and cosmetic, antivenom, venom toxin, snake poison and venom diagnostics. It will also attempt to clarify and elaborate the implication of the “halal” status for venom-based product. Finaly the current available shariah rulings on the usage of venom and venom-based product both in medical and cosmetic area and the related principle of fiqh involved will be analyzed. The findings from this review, particularly the current available ruling will allow various parties to be well informed on the current ruling and related issues on the usage of this products.
Towards a Shariah Compliance Model for Healthcare Centres with reference to Spiritual Healers: Issues and Challenges
Authors: Wan Muhammad Ramizah
Published: January 2021

Generally, a good healthcare centre comprises of qualified manpower, right policies and right procedures in providing primary care, secondary care and tertiary care for the patients as well as in public health. Other than manpower, healthcare centres must also look at social, religious and cultural factors affecting the recipients of the healthcare services given by the healthcare centres. In this paper, the author will look at some pertinent issues such as the need to have spiritual healers in any healthcare centre to help the patients in dealing with fatal illness. The spiritual healer is to help the patient and give him motivation so that he could have a positive mind throughout his journey in battling with his illness. Sometimes we have patients who refused to listen to the doctor's advice. Thus, the role of the spiritual healer would be important in assisting the healthcare centres and its management to convince him. Another issue is the privacy, respect and trust between patients and doctors as well as with the management of the healthcare centres. One of the duties of the healthcare centres’ management and doctors is, to respect the patient's religion and his faith. These three issues are amongst the important issues which every healthcare centre must look upon. Definitely there are a lot of challenges in addressing the above mentioned issues such as the procedures, methods on how to execute these issues and most importantly the perception of the public. In Islam, health care is one of the five important elements in which the Prophet SAW has mentioned in one hadith to be taken care of. A study has shown that a nation-building efforts has no meaningwithout the best public health and healthcare delivery system to the people.
Comparison of Bacterial Loads from the Lift Buttons of a Kulliyyah and a Library at IIUM Kuantan and Identification of the Bacteria from Selected Buildings
Authors: Mohd Danial Nur Izzatul Husna , Alias Norsyuhada , Mohd Fauzi Fadhlin Sakina
Published: January 2021

Introduction: Lift buttons are among the potential fomites in transmitting infectious microorganism to the community. The daily use of lift buttons by different people with various hygiene practices can contribute to the colonization of microorganism on the touched surfaces. There is a little published research on microbial colonization on lift buttons in Malaysia, especially in the campus setting. Hence, this study aimed to identify and compare the bacterial load on lift buttons from a kulliyyah (faculty) and the library at IIUM Kuantan. Materials and Methods: A total of 42 swab samples were collected aseptically from the lift buttons and cultured on nutrient, mannitol salt and MacConkey agar for bacterial enumeration and isolation. Gram staining, microscopy examination and molecular amplification of the 16S rDNA gene by polymerase chain reaction were performed for further characterization of the bacteria. Results: Out of 42 swab samples collected (kulliyyah: n = 25, library: n = 17), 88.4% of the samples confirmed the presence of bacteria with the lift buttons in the kulliyyah showed a higher percentage of bacterial isolation (92%) compared to the library (84%). Grampositive cocci clustered bacteria dominated the isolates followed by Gram-positive bacilli, Gram-positive cocci tetrads and Gram-negative coccobacilli. Based on culture growth, Gram-staining features and 16S rDNA gene sequencing, isolated bacteria were identified as Staphylococcus sp., Staphylococcus kloosii, Bacillus cereus, Kocuria palustris, Yersinia mollaretii, Bacillus sp., Micrococcus sp., and other Gram-positive cocci. Conclusion: The results revealed a high bacterial load on lift buttons which can be a source of bacterial transmission.
Early Experience with Local Custom Made Synthetic Bone Construct for the Treatment of Bone Defect
Authors: Mohd Yusof Nazri , Singh Harkeerat
Published: January 2021

Introduction: Segmental bone defect can be treated with autologous bone graft and bone transport. Synthetic bone graft has successfully been used for the treatment of metaphyseal fracture or bone cyst. However, their use for the treatment of segmental bone defect has not been establish. Recently, a local company has produced a biodegradable custom made synthetic bone construct phosphate-based materials that is used to treat fractures and bone defect. Materials and Methods: After getting approval from Medical Device Agency, we used SBC to treat segmental bone defect in our patients. A case series review was conducted in these cases. Results: Three patients underwent surgery using SBC as a spacer to fill the defect at the docking site to prevent soft tissue collapse in one patient and as a replacement for bone autologous bone grafting in two patients. In our observation granules resorbtion ranged from 40-80% by 6 months with no radiological evidence of new bone formation. SBC mixed with bone marrow aspirate failed to harden into a palette. Although no new bone formation was seen at the docking site, insertion of SBC prevents soft tissue invagination and reduced the need of a second surgery to remove other conventional spacers. Conclusion: SBC may be used as a spacer to prevent soft tissue interposition and skin invagination in bone transport. However mixing it with bone marrow aspirate resulted in failure to form beads and does not form bone.
Existence of Occult Hepatitis C virus Infection in Local Haemodialysis Setting
Authors: Abdul Rahman Siti Nurul Fazlin , Hamzah Hairul Aini , Mustafa Mohammed Imad
Published: January 2021

Introduction: Among chronic hepatitis C patients, the viral agent is well known to replicate in the hepatocytes and extrahepatic cells. Previous studies have demonstrated a new form of hepatitis C called 'Occult HCV Infection' (OCI). It is defined as the presence of HCV RNA in the hepatocytes but undetectable HCV RNA in the serum or plasma. The exact natural history, epidemiology, pathogenesis and clinical importance of OCI are unknown. Several studies have been carried out worldwide, but none from Malaysia. This studyÂ investigated OCI among local patients undergoing routine hemodialysis at a referral hospital in Pahang, Malaysia. Materials and Methods: Blood was collected from both anti-HCV positive (n=10) and anti-HCV negative (n=18) patients. Inclusion criteria for the seronegative patients included elevated liver enzymes. Results: 10 chronic hepatitis C patients were recruited in this study. All had viral RNA detected in both serum and peripheral blood mononuclear cells (PBMC). Viral quasispecies was common in this group of patients. Meanwhile, out of 18 seronegative patients, 3 patients (16%) showed active viral replication in PBMC. Conclusion: This study proved the existence of OCI in local haemodialysis setting. Further investigation is needed to get the actual prevalence of OCI.
Functional Outcome of Neurotization to The Musculocutaneous Nerve in Traumatic Brachial Plexus Injury
Authors: Abdul Rashid Mohammad Azrul Bin , Khalid Kamarul Ariffin , Ismail Raffael
Published: January 2021

Introduction:  Neurotization procedures to the elbow flexors are commonly done in traumatic brachial plexus injury (BPI). The objective of this study was to evaluate the recovery of elbow flexors in patients who underwent neurotization procedure to musculocutaneous nerve in the panplexus and upper trunk BPI. Materials and Methods: This was a cross sectional study involving 70 patients who underwent neurotization to elbow flexor. A total of 31 patients (44%) had panplexus injury and 39 (56%) had upper trunk BPI. Elbow flexor motor power and post-operative Disabilities of the Arm, Shoulder and Hand (DASH) score were evaluated. Results:  The mean age of the patients was 22.7 years. Patients with panplexus BPI underwent neurotization to the elbow flexor using spinal accessory nerve as a donor and patients with upper trunk BPI used either ulnar or median nerve as a donor. The results of elbow flexors recovery in panplexus BPI were good (MRC grade 4 and 5) in 11 patients (35.5%) and poor in 20 patients (64.5%). Conversely, the recovery of elbow flexors in upper trunk BPI were better with 28 patients (71.8%). Good post-operative DASH score (score <50 points) were noted in 29 patients (74.4%) with upper trunk BPI. Only seven patients (22.6%) with panplexus BPI showed good post-operative DASH score. Majority of patients with panplexus BPI demonstrated poor recovery of elbow flexor and post-operative DASH score as compare to upper trunk BPI (p= 0.002). Conclusion:  Overall, this study showed significantly better functional outcome of neurotization procedure to elbow flexor in upper trunk BPI than in panplexus BPI.
Idiopathic Thrombocytopenic Purpura & Total Knee Arthroplasty: How Low Can You Go
Authors: Singh Harkeerat , Ganthel Kunalan
Published: January 2021

Idiopathic thrombocytopenic purpura or ITP is  an autoimmune disorder with a reduction in circulating platelets, it subjects patients to spontaneous torrential bleeding even with trivial trauma. In this case report we share our experience conducting a TKR in a patient with refractory ITP. A 64-year-old patient with ITP complicated with history of ICB in 2001 presented with bilateral knee pain. Her platelet counts were 60x109 /L despite previous steroidal and immunoglobulin therapy. After discussion haematologist a manual platelet count under microscopy had 15-20/hpf large platelets with estimated counts to be 100x109 /L. She underwent a cemented right TKR under general anaesthesia. No femoral/sciatic block was performed nor was a tourniquet applied fearing an intramuscular haematoma/ecchymosis. Two grams of intravenous tranexemic acid was given prior to the surgery and four units of platelets were transfused intraoperatively. Despite no tourniquet, she clotted very well and blood loss was minimal. Thereafter, ITP is an immune disorder where patients form antibodies towards their own platelets resulting in increased platelet destruction and a decrease in platelet formation. Remaining circulating platelets are bigger than usual platelets, however, their function are not impaired. ITP guidelines by the British Journal Of Haematology dictate a minimal platelet count of 50x109 /L for minor surgical procedures and 80x109 /L for major surgical procedures. It is still safe to perform TKR in ITP patients. However a combined approach with haematology is advocated as manual platelet counts give a better representation of the actual number of circulating platelets compared to routine blood counts.
Knowledge, Attitude and Practice of Doctors Regarding Perioperative Tobacco Smoking Intervention in Surgical Based Discipline in IIUM Medical Centre
Authors: Nanyan Suhaila Binti , Tengku Shaiful Bahril Tengku Syaifa Izzura Binti , Mohd Ikhsan Amiratul Athirah Binti , Ismail Nor Hazira Binti
Published: January 2021

Introduction: Surgery provides an exceptional chance for smoking cessation and apparently surgeons can play an important role in tobacco control. Tobacco intervention in surgical patients benefited them both in the short-term and longterm health outcome. Unfortunately, little is known about the knowledge, attitudes and practices of Malaysian surgeon regarding peri-operative tobacco smoking interventions which triggers this study. Materials and Methods: A survey of written questionnaires was conducted on medical doctors in the surgical based discipline at the International Islamic University Malaysia Medical Centre. Results: The survey response rate was 100%, and 6.7% of respondents themselves were current smoker, 23.3% were former smoker. A high proportion of respondents had accurate perceptions of peri-operative and long-term health risks of smoking. However, most of them also knew how to counsel about smoking or help patients get the help they needed to quit. Majority (93.3%) of them frequently or almost always asked about smoking status; 56.7% advised about the health risk of tobacco use; 80.0% advised patients to stop smoking peri-operatively and 60.0% advised patients to quit smoking permanently. Compared with non-smokers, smokers were significantly less likely to advice about the health risks of smoking and quitting. Not only that, most of the respondents were willing to learn about peri-operative interventions and spend an extra 5 min to help patients quit smoking. Conclusions: Majority of the respondents poised adequate knowledge of health risks of smoking, strong perception of responsibilities, and willingness to participate in tobacco control, IIUM Medical Centre doctors actually play a significant role in tobacco control in which could improve peri-operative outcomes and promote long-term health.
Knowledge, Attitude and Practice on Smoking Cessation Guideline among Medical Doctors attending Family Medicine Scientific Conference 2016
Authors: Shalihin Mohd Shaiful Ehsan Bin , Md Aris Mohd Aznan , Nik Mohamed Mohamad Haniki , Mohd Rus Razman Bin , Jamani Nurjasmine Aida Bt
Published: January 2021

Introduction:  Prevalence of active smokers in Malaysia remains high despite the availability of stop-smoking services. Rather than focussing on patients’ demotivating factors, possible poor performance from providers should be evaluated. Thus, knowledge, attitude and practice of the healthcare professional on smoking cessation intervention needs to be assessed, especially among primary care doctors.  Materials and Methods:  A cross-sectional study was conducted among primary care medical doctors attending the 19th Family Medicine Scientific Conference 2016 held at the Grand Dorsett, Subang on the 10th to the 13th August 2016. Validated questionnaire of Knowledge, Attitude and Practice (KAP) of Medical Doctors on Smoking Cessation Guidelines consisting 17 questions were used to determine the KAP score. The difference between the median KAP scores between age, gender, ethnicity, religion, profession, location of clinic, availability of specialist in clinic, numbers of smokers seen and presence of smoking cessation training were assessed using Mann-Whitney U Test and Kruskal Wallis H Test. Results:  A total of 145 primary care doctors involved in the study. Majority were female (84.1%), Malay (73.1%) and haven’t undergone any kind of smoking cessation training (47.6%). The KAP score were statistically associated with presence of specialist, type of profession, history of attending training program, ethnicity and religion (p<0.05). Conclusion: Majority of the involved primary care doctors had low KAP score. Being a family medicine specialist, in charge of stop smoking clinic and having attended smoking cessation training program were significantly associated with high KAP score. Therefore, more smoking cessation training should be provided to the primary care doctors.
Localized Erythematous Pappular Rash: A Rare Presentation Of Essential Thrombocythemia
Authors: Shalihin Mohd Shaiful Ehsan , Harun Zulkifli , Osman Iskandar Firzada
Published: January 2021

Essential thrombocythemia (ET) is one of the myeloproliferative neoplasms which typically presents with thrombotic vasomotor symptoms or bleeding tendencies. Papular rash is a rare manifestation of ET and may cause delay in making the diagnosis and hence institution of the treatment. We report a case of ET in a 50- year-old gentleman, who presented with nonspecific localized erythematous papular rash over his right thigh associated with recurrent mild pain in the affected thigh for one year. He was not any drugs prior to the onset of the rash. He had no history suggestive of haematological disorder such as bleeding tendencies, recurrent fever or anaemic symptoms. He also had no constitutional symptoms or any palpable masses. He was managed conservatively initially at primary care clinic but the problem persisted. A full blood count was subsequently performed which revealed an isolated thrombocytosis of 880 x 109 /L. He was referred to the haematology team for the further management and a diagnosis of ET was then made. Both the platelet counts and the lesion improved with hydroxyurea treatment. This case report illustrates a rare chronic manifestation of myeloproliferative neoplasm detected at a primary care clinic.
Magnetic Resonance Imaging Procedure for Ventilated Intensive Care Patient in the International Islamic University Malaysia Medical Centre: Issues and Challenges
Authors: Ghazali Nazhan Afeef Mohd. Ariff @ , Ab Rashid Iqbalmunauwir
Published: January 2021

Managing a ventilated patient in the Intensive Care Unit (ICU) for Magnetic Resonance Imaging (MRI) procedure requires precise planning. Vigilant anesthetist with adequate MRI compatible monitoring of a critically ill patient and in preparation of any crisis event during transport to MRI suite, during MRI and return journey to ICU is essential. Problems in transporting ICU patient are usually equipment related, deterioration in gas exchange and increased rate of ventilator associated pneumonia. Preparation includes clinical reassessment for swift and systematic transport, airway management, optimum sedation and record keeping close to the patient. This is a case report of a 64 year-old gentleman who presented to International Islamic University Malaysia Medical Centre with right sided headache for one week associated with high intracranial pressure symptoms. His initial Glasgow Coma Scale (GCS) was 15/15 and Computed Tomography (CT) scan of his brain showed bilateral acute-on-chronic subdural haemorrhage, uncal herniation and minimal midline shift. His GCS dropped to 6/15 (E1V1M4) in the ward and proceeded with right craniectomy, evacuation of clot and duraplasty. Post operatively, his GCS improved to 15/15 in ICU and was extubated. On Day 2 post extubation, his GCS dropped to 6/15 (E1V1M4) and intubation was performed. Repeat CT Brain in ICU showed no evidence of new bleeding or mass effect. MRI was performed and it showed acute infarctions at right pons and right occipital region. Tracheostomy was done and the patient was sent to the general ward on fixed performance mask.
Normal Saccadic Responses Using Video Head Impulse Test In Healthy Young Adults
Authors: Omar Nurul Amira , Jamaluddin Saiful Adli bin
Published: January 2021

Introduction: Vertigo and dizziness are common symptoms reported in audiology and ENT clinics. One of the objective assessments includes the video head impulse test (vHIT) where gain & amp; velocity responses of eye movements relative to the head movements are recorded using an infrared camera. Materials and Methods: Thirty normal hearing subjects age between 18 to 25 years old participated in this study. Exclusion factors include those with the history of head or neck injury and vertigo. At least ten lateral, left anterior right posterior (LARP), and right anterior left posterior (RALP) responses were recorded for each participant by making small unpredictable head movements. Results: The average velocity gain for lateral responses at 40 ms, 60 ms and 80 ms were 1.05 ± 0.003, 1.03 ± 0.002 and 1.01 ± 0.003 respectively. The LARP and RALP average velocity regression were 1.01 ± 0.24 for left anterior and 1.05 ± 0.25 for right posterior, 1.08±0.31 for right anterior and 1.12 ± 0.30 for left posterior. One sample T-test was conducted to compare lateral responses to a previous study by Mossman et al. 2015. There were significant differences in velocity gain at 60 ms and 80 ms where, t (59) = 5.56, p < 0.01 and t (59) = 2.86, p < 0.01, respectively. Conclusion: This indicates the importance of establishing norms for clinics as various factors could affect the results such as techniques used and equipment differences. A follow-up study on subjects with vestibular disorders is required to validate this data as a normative reference.
Pedobarography Study Among Malay Population In The District Of Kuantan, Pahang: A Preliminary Report
Authors: Nasuruddin Muhammad Haidar bin , Che Ahmad Aminudin bin , Ayeop Mohd Adham Syah bin , Nik Mohd. Najmi Nik Mohd. Fatmy Bin
Published: January 2021

Introduction: Plantar foot pressure has been widely used in managing foot-related disease in developed countries for the past 2 decades. However, in Malaysia, it is still at its infancy. Studies showed that the normal values are not affected by gender and body mass index (BMI), but vary between one race to another. Currently, to the best of author’s review, there is no standard value available for Malaysian or Southeast Asia population. This study is designed to measure pressure values observed in the normal foot of Malay population in Kuantan and its difference between different gender and BMI. Materials and Methods: Measurements were taken from 184 healthy subjects, 79 males and 105 females. Age and BMI were identified. Plantar pressures were measured using Emed-q100 pedobarography platform device with its emed/E (Expert) software Results: The median plantar pressure was 480kPa (IQR 205). There was no significant difference between genders (p=0.483) and BMI (p=0.076) Conclusion: This result is not meant to represent the whole Malay population but rather to be used as an early reference for plantar pressure studies among Malay population. More studies are needed to more accurately describe the value of the population.
Perceptions Among Muslims in Malaysia Towards Dental Procedures During Fasting Month
Authors: Said Abdul Hadi , Mohd Farah Natashah
Published: January 2021

Introduction: A few studies reported that there is reduced in dental attendance among Muslim patients during fasting month. This study aims to assess the perceptions among Muslims in Malaysia on common dental procedures during fasting. Materials and Methods: A structured questionnaire was used to assess the perception about common dental procedures and dental attendance during fasting on 377 Muslim adults in Kuantan, Malaysia. The total cumulative score derived from the perception section was categorized into good and poor perception based on the median score, where a score less than the median score was categorized as poor perception and a score equal to or more than the median score was categorized as good perception. We further examined the association between perception score with sociodemographic data and dental attendance. Results: Majority respondents perceived that most of the dental procedures will not nullify their fast with 50.9% of them categorized as having a good perception based on median score. There was a significant association between perception with education level (p=0.04) and Islamic education level (p<0.001). There was also a significant association between their perception and dental attendance during fasting month (p=0.04). It also showed that dental attendance during fasting month was poor across both groups with poor and good perception. Conclusion: The majority of the Muslims perceived that most dental procedures did not nullify their fast. However, their willingness to come for dental treatment during fasting was poor regardless of the perceptions. Hence, further research is necessary to explore the reason behind this.
Periodic Assessment Of Antenatal And Post Natal Serum Endothelin1 and Nitric Oxide Levels In Hypertensive Disorders Of Pregnancy
Authors: Ismawi Hidayatul Radziah , Abdul Razaq Tariq , Mohd. Zainudin Maizura , Jamani Nur Jasmine Aida
Published: January 2021

Introduction: Hypertensive Disorder of Pregnancy (HDP) is an independent risk factor of cardiovascular (CVS) disease with persistent endothelial dysfunction, that occurs after the initial insult during pregnancy and persists post partum postulated to be the pathophysiology. Endothelin-1 (ET-1), a potent vasoconstrictor, has been identified as a pivotal mediator in both essential hypertension and HDP. Disturbances in Nitric Oxide (NO) bioavailability found in endothelial dysfunction may increase susceptibility to cardiovascular diseases such as hypertension. Materials and Methods: Thirty six pregnant women at 30-36 weeks period of gestation from the following categories (i) pregnancy induced hypertension (PIH) (ii) chronic hypertension during pregnancy (CH) and (iii) normal pregnant women (Control). Blood pressure indices measurements and sample collection was done at antepartum (30-36 weeks), post partum (8 weeks and 12 weeks). Endothelin-1 was measured using the Human ET-1 (Endothelin-1) ELISA Kit and serum NO was measured using the Nitric Oxide (total) detection kit. Results: All blood pressure indices were significantly higher in HDP patients compared to control during antenatal and post partum periods. Serum ET-1 was significantly higher in patients with HDP compared to control during antenatal until 3 months post partum. This was accompanied by significantly lower levels of serum NO in HDP patients. Conclusion: ET-1 levels in patients with history of HDP irrespective of post partum blood pressure contributes to persistent endothelial dysfunction.
Phantom Pain in Major Lower Limb Amputation: Primary Ligation Cauterization vs Traction Neurectomy
Authors: Arshad Ahmad Redzuan , Mohd Yusoff Nazri
Published: January 2021

Introduction: Phantom Limb Pain (PLP) is haunting amputees in silent. Neuroma hyperexcitability is one of the popular peripheral theories which can be addressed during primary amputation by orthopaedic surgeons. There was no study comparing type of neurectomy association with PLP. The objective was to compare the occurrence of PLP between conventional and alternative techniques of neurectomy in major lower limb amputations. Materials and Methods: A prospective, randomized, interventional study was conducted involving 98 patients in Hospital Kuala Lumpur requiring major lower limb amputation due to diabetic complication, tumor and trauma from October 2016 to June 2017. Patients were evenly randomized into two groups; Group A: conventional traction neurectomy (CTN) and Group B: ligation and cauterization neurectomy (LCN). End point of the study was the outcome of PLP which was assessed clinically at post-operative day 3, 14 and 6-month. Results were analyzed using univariate and multivariate simple logistic regression. Results: There were have 47 and 46 patients in Group A and B respectively. Of these, 70.2% in Group A (n=33) and 28.3% in Group B (n=13) end up with PLP (p<0.001). Sixty nine percent of patients who underwent amputation above knee level (n=20) suffered from PLP (p<0.05). Group B patients had higher mean PLP pain score (3.31 and 2.94) but it was not statistically significant. 69.6% of patients with pre-operative pain (n=32) and 43.5% with peripheral vascular disease (n=20) developed PLP (p<0.05). Conclusion: LCN has 0.1 chance to develop PLP compared to CTN. Other significant factors in those who developed PLP include levels of amputation, pre-operative pain and peripheral vascular disease. LCN should be considered in primary amputation.
Point-of-care Procalcitonin Guidance to Reduce Antibiotic Use in Critically Ill Patients: A Randomized Controlled Trial
Authors: Wan Muhd Shukeri Wan Fadzlina , Md. Ralib Azrina , Mat-Nor Mohd Basri
Published: January 2021

Introduction: Antibiotic therapy is of great importance in sepsis but prolonged duration can add to the emergence of antibiotic resistance. We aimed to examine whether point-of-care (POC) procalcitonin (PCT) guidance can safely reduce the duration of antibiotic use in infected critically ill patients. Materials and Methods: Eighty adult patients admitted to or acquired sepsis in the intensive care unit (ICU) were enrolled in this randomized controlled trial. Patients were allocated to either POC PCT-guided intervention arm (n=40) or the control arm, in which antibiotic therapy followed local guidelines (n=40). In the PCT-guided arm, antibiotic treatment was discontinued if clinical signs of infection improved and the PCT concentration decreased by >80% of its peak value, or when it reaches a value of <0·5 g/L. Results: The mean duration of antibiotic use for PCT arm was 6.4 (SD 2.3) days compared to 9 (SD 4.3) days in the control arm (p=0.004). In the first 30 days after being assigned to a group, the proportion of patients who received a repeated course of systemic antibiotics was 33% in the PCT arm vs 38.1% in the control arm (p=0.757). Mean length of stay in the ICU was 8.4 (SD 5.3) days in the PCT arm vs 10.4 (SD 12.3) days in the control arm (p=0.404). Mortality at 30 days was 22.5% in the PCT-arm vs 25% in the control arm (p<0.0001). Conclusion: POC PCT guidance stimulates reduction of duration of antibiotic use in ICU, accompanied by a significant decrease in mortality.
Predicting Sexual Intention to Engage In Premarital Sex among Late Adolescent in Kuantan Government Secondary Schools: An Application Of The Theory Of Planned Behavior
Authors: Abdullah Faiza , Draman Samsul , Abd Aziz Karimah Hanim , Zainuddin Nurul Akmanidar , Muhammad Noor Azimah
Published: January 2021

Introduction: The Theory of Planned Behavior (TPB) states that behaviour is determined by four main domains of social-cognitive factors; attitudes, social norms, self-efficacy and sexual intention. The aim of this study was to explore the correlation of the socio-cognitive factors predicting sexual intention to engage in premarital sex amongst late adolescent in Kuantan government secondary schools. Materials and Methods: This cross-sectional study was conducted among 466 single students aged 18 to 19 years in nine government secondary schools in Kuantan district. A self-administered validated Youth Sexual Intention Questionnaire (YSI-Q) that measured permissive attitude, perception of social norms, perceived selfefficacy and sexual intention towards premarital sex activity has been used. Statistical analyses were done using IBM SPSS version 22.0. Results: There was a significant difference of sexual intention between male (35.6%) and female (64.4%) students with a mean(SD) of 10.54(3.8) and 7.3(2.9) respectively. Permissive attitude, perception of social norms (peer pressure) and perceived self-efficacy have significant positive correlation on sexual intention towards premarital sex with the value of (r=0.579, p<0.001), (r=0.513, p<0.001) and (r=0.253, p<0.001) respectively. Thus, the higher permissive attitude, social norms and perceived self-efficacy led to higher sexual intention. In addition, a student with premarital sex experience (1.5%) has significant higher sexual intention than student without premarital sex experience given by mean(SD); 14.43(2.5) vs. 8.25(3.6). Conclusion: The Theory of Planned Behavior has a positive correlation towards premarital sex among late adolescent. It might successfully guide the development of sexual abstinence intervention-based theory to reduce unsafe sexual behavior among adolescents.
Pulmonary Tuberculosis: Treatment Outcomes and Factors Associated with Poor Treatment Outcome in Pahang, Malaysia
Authors: Zulkipli Zafirah Amalina binti , Mohd Salleh Muhammad Amir Hafiz bin , Ahmed Musaab Nassereldeen
Published: January 2021

Introduction: Tuberculosis (TB) remains a formidable public health concern in Malaysia. Malaysia’s national treatment success rate is still below the ideal 90% positive outcome recommended by the End TB Strategy (2015-2035). In this study, we evaluated the treatment outcomes and associated predictors of smear or culture positive pulmonary tuberculosis (PTB) patients. Materials and Methods: This is a retrospective cohort study conducted in chest clinic of Hospital Tengku Ampuan Afzan (HTAA), Pahang from January 2012 to December 2016. PTB cases in HTAA were crosschecked with TB registry and patients who fulfilled the inclusion criteria were selected. Data was collected using a standardized clinical report form and analyzed using multiple logistic regression. Results: There were a total of 342 patients recruited. Majority were Malaysian (94.2%), male (67.8%) and Malay (80.0%). The treatment success rate was 55.26%, with a cure rate of 42.98%. The high portion of defaulters (21.05%) in our study population was amongst the most striking findings. Multiple logistic regression analysis revealed that the factors associated with unfavourable treatment outcome were time in treatment, case after treatment interruption or failure and poor compliance. Univariate analysis revealed that male, hepatitis, smoking and intravenous drug user were found to be significant factors associated with poorer treatment outcomes. Conclusion: Achieving a higher patient retention rate is a significant factor in increasing effectiveness of treatment services. Thus, our study recommends stricter Directly Observed Treatment, Short Course (DOTS) and an enhanced understanding of the real barriers to patients’ treatment regimen adherence in order to overcome them.
Soil Transmitted Helminth Infections Among Children Admitted to Hospital Tengku Ampuan Afzan, Kuantan, Pahang
Authors: Asady Abdullah , Oothuman Pakeer , Ismail Soraya , Abdul Jalil Marsitah
Published: January 2021

Introduction: Soil-transmitted helminth (STH) infections by Ascaris lumbricoides, Trichuris trichiura and hookworms still persist in poor communities in rural and urban areas. Recent studies in Malaysia focused on Orang Asli communities and few in hospital settings. This study determines the prevalence and risk factors for STH among children admitted to Paediatric ward of Hospital Tengku Ampuan Afzan (HTAA). Materials and Methods: This study was conducted among 133 (77 males, 56 females) paediatric patients in Hospital Tengku Ampuan Afzan from Dec 2017 to May 2018. Faecal samples were examined using wet smear, Kato-Katz, Harada-Mori and sedimentation techniques. Demographic data and hygiene practice information were collected using a pre-tested questionnaire. Results: The overall prevalence of STHs was 6% (A.lumbricoides 5.3%, T.trichiura 0.8%, and hookworms 0.8%). Prevalence among males was 3.9% and females 8.9%. Majority (94.7%) were Malays. There were two Orang Asli children and both were infected, one of whom had a mixed infection. Chi square analysis showed that the important risk factors for STH infections are education level of mother (p<0.05) and father (p<0.05), the source of drinking water (p<0.05), and the method of trash disposal (p<0.05). Conclusion: This study shows that the prevalence of STH infections is low in children due to better socio-economy and good hygiene practice. Differences in individual lifestyles and humid weather condition are probable reasons for sporadic infection to still exist.
The Correlation of Surgical Margins and Outcome Of Soft Tissue Sarcomas of The Extremities and Trunk in Hospital Sultan Ismail, Johor Bahru
Authors: Zainudin Muhamad Firdaus bin
Published: January 2021

Introduction: Patients with soft tissue sarcoma are treated following the standardized guidelines, however it is not guaranteed patient will remain free from local recurrence (LR) and metastasis. This study was conducted to determine the association between microscopic marginal status with local recurrence, metastasis and the survival of the patient. Materials and Methods: This retrospective study was conducted from January 2015 to December 2017 in Hospital Sultan Ismail, Johor Bahru. All patients underwent complete standadized resection of the tumour and had been follow up for 5 years. An operating and follow-up records of 70 cases who fulfill the inclusion and exclusion criteria were collected and analysed using Pearson chi square test and Kaplan-Meier curves. Results: Of the 70 patients, 52 were males and 18 were females. The age of the patients were between 16 and 73 years with the means age of 48.8 years old. Sixty eight patients underwent limb salvage surgery and 2 had amputation. 42 of them had positive post-operative microscopic surgical margin (PMSM) while 28 were negative. Local recurrence was noted in 28 and metastasis in 30 patients. Patient who had PMSM has higher risk to get local recurrence and metastasis compared to patient with negative margin (p-value <0.001). The overall median survival was 23 months. Overall survival rates for 3 years was 80% and for 5 years was 65%. Conclusion: In our study, patient with positive post-operative microscopic surgical margin had higher possibility to develop local recurrence, metastases and decrease overall survival rate.
The Diagnostic and Predictive Value of Plasma Cystatin C in Acute Kidney Injury Secondary to Sepsis in The Intensive Care Unit
Authors: Ab Rashid Iqbalmunauwir bin , Md Ralib Azrina , Mat Nor Mohd Basri , Mohamed Abdul Hadi bin
Published: January 2021

Introduction: Plasma Cystatin C (pCysC) is one of the functional biomarker for AKI. This study evaluates the utility of pCysC in diagnosing AKI, predicting death and its correlation with eGFR in septic critically ill patients. Materials and Methods: This is a two centre, prospective observational study of septic critically ill patients. The inclusion criteria were patients older than 18 years old with sepsis, SOFA score of≥2 and procalcitonin level ≥ 0.5 ng/ml. Serum Creatinine (sCr) and pCysC were measured at 0, 4, 24, 28, 48, and 52 hours. AKI was defined based on creatinine criteria of the KDIGO guideline. Results: Seventy patients were recruited into this study, of which 32 (45.7%) had AKI and 15 (21.4%) died. pCysC diagnosed AKI in all six time intervals with AUC of 0.859, 0.858, 0.876, 0.918, 0.887, and 0.879 for 0 hour, 4, 24, 28, 48, and 52 hours, respectively (p <0.0001). It did not predict death at any time interval, with an AUC range of 0.053 to 0.608 (p>0.1). pCysC showed strong negative correlation with all estimates of GFR, with the best profile recorded at 28 hours. Correlation coefficient for eGFRCG, eGFRMDRD, eGFRCKD-EPI and keGFR were -0.778, -0.763, -0.808, and -0.781, respectively (p <0.0001). There is no correlation between cardiac output and pCysC, and eGFR. Correlation coefficient were between -0.208 to 0.267 (p >0.1). Conclusion: pCysC diagnosed AKI in septic critically ill patients and strongly correlated with all estimates of GFR. However, pCysC did not predict death, nor correlate with cardiac output.
A Practical Journey in Implementing a Shari’ah Compliant Hospital: An Nur Specialist Hospital’s Experience
Authors: Md Shariff Shaharom , Mohtar Shahimi , Jamaludin Roslan
Published: January 2021

Research on Islamic products and services has been receiving great attention over the past years. This has attributed to the increasing awareness among Muslims to consume Halal products or served with Shari’ah compliant services. In responding to this development, An Nur Specialist Hospital has initiated to be the first private Shari’ah Compliant Hospital (SCH), through the award of the MS 1900:2014 in April 2015. MS1900:2014 provides guidelines for an organization to be accredited as a Shari’ah compliant organization. The Ministry of Health, Malaysia has introduced ‘ībādah friendly hospital’ in 2010. However, there is lack of research on the characteristics and implementation of SCH in the healthcare industry. Therefore, the purpose of this paper is to understand the implementation of SCH at An Nur Specialist Hospital. A qualitative case study is utilised to investigate the issues and implementation of SCH. The case study uses in-depth, open-ended interview with the hospital senior management. The interview was recorded, transcribed, and evaluated based on thematic analysis to understand the practice. The study found major outcomes in implementing SCH, such as the important role of the Shari’ah Advisory Council in ensuring all the Standard Operating Procedures are in line with Shari’ah principles, continuous staff development programs in providing the Shari’ah understanding and latest fatwā on Fiqh Medic. The other outcome is the positive response from patients who have been frequently visiting the hospital due to the status of An Nur as a SCH.
A Secondary Research on Human Endocrine Physiology in the Al-Qur’an and the Ahadith
Authors: Abdul Ghani Radiah , Ikmal Hisham Ahmad Irfan , Ahmad Rosli Athirah Nur
Published: January 2021

Physiology is one of the remarkable branches in medical field which allows an appreciation of the anatomy as well as the functions of being; which then gives an idea on the purpose of a creation and a better understanding of the purpose of humans themselves. However, modern physiology taught in many Westernised textbooks lack the link and reflection to the worldview of Islam. As a result of this divorce between the modern physiology and the religious worldview, physiology as a subject is lacking “spiritual” connection and thus, produces students with lack of connection with the Tawhidic (Oneness) and admirableness to Allah, much to the dismay of the Islamic teaching. Thus, this paper is aimed to review the relevant scientific knowledge in endocrine physiology and relate it with the Qur’anic verses and Hadith. The roles of melatonin and cortisol that changes between day and night, the role of touch and the release of oxytocin are explained from the Islamic perspective based on the relevant Qur’anic verses and/or the Ahadith. Future research in integrating the physiology with the evidence from the Qur’an and the Ahadith should be attempted by medical and biomedical scientists alike, to further enhance and develop the concept of physiology as a subject in medical schools, not limited to the physical sciences per se, but also the spiritual and metaphysical dimensions.
Assessment of Dental Development in Children with Hypodontia and Hyperdontia: A Case Control Study
Authors: Ardini Yunita Dewi , Abu Bakar Noraini , Kamalul’lail Nabila Farhana , Mohd Rasdi Noor Syazwani
Published: January 2021

The aim is to investigate the dental development (DD) in children with hypodontia and hyperdontia compared to age, gender, and race matched controls.A match-pair case control study was conducted among children aged 5 to 14-year-old, attending the Dental Polyclinic, IIUM, from December 2011 until September 2014. Willem’s method was used to analyze the dental age (DA) using panoramic radiograph. The difference between dental age of hypodontia/hyperdontia children and the controlswas analyzed using analysis of covariance (ANCOVA). The differences between dental and chronological ages (CA) and the differences in DA and CA with the numbers of missing teeth were analyzed using t-test. Intra-class correlation coefficient between examiners ranged from 0.98-0.99. The result is that27 hypodontia and 12 hyperdontia samples were recruited and compared to a total of 78 matched controls. Both male (n=12) and female (n=15) hypodontia children had statistically significant delay in DD (p=0.000). There was no significant difference in the DD of male (n=7, p=0.811) and female (n=5, p=0.235) in hyperdontia children compared to the matched controls. No differences were observed between DA and CA with the number of missing teeth. Unlike hyperdontia children, hypodontia children showed delayed DD in comparison to age, gender, and race matched controls. There was no association between magnitudes of dental development delay in hypodontia children with the number of missing teeth. This study provides valuable baseline information for provision of better treatment planning for those hypodontia and hyperdontia children that may involve inter-disciplinary management.
Depression, Anxiety and Stress among Dental Undergraduate Students: Prevalence, Stressors and Relieving Factors
Authors: Yaacob Munirah , Harun Nor Asilah , Ramli Farizah , Abdul Razak Hannah , Sajuni Noor Aisyah
Published: January 2021

Aim: To investigate the depression, anxiety and stress, stressors and relieving factors among dental students at Kulliyyah of Dentistry (KOD). Materials and methods:  A cross-sectional study was conducted among 222 dental students. Their socio-demographic data, self-reported depression, anxiety and stress (DASS-21) scores, causes and relieving factors were collected using validated semi-structured pre-tested questionnaires. The data was analysed using percentages, chi-square test and Binary logistic regression tests with SPSS version 24. Results: The prevalence of depression, anxiety and stress was 41%, 68.9% and 34.2% respectively. Cross analysis showed that academic-related and laboratory or clinical related reasons were significantly associated with the depressive symptoms [(X2= 15.86, p<0.0001) and (X2= 10.45, p=0.001) respectively] and stress symptoms [(X2= 19.95, p<0.0001) and (X2= 6.11, p<0.05) respectively] among dental student. Furthermore, the item ‘examination’ being the highest factor chosen in academic-related stressors. The response for stress-relieving factors was high for Islamic ritual prayer/spiritual activities (94.6%), sleeping (86.5%) and doing exercise/playing sports (76.1%), while ‘seeking professional help’ (19.8%) was the least. Conclusion: This study shows that depressive, anxiety and stress symptoms are prevalent among dental students. Islamic ritual prayer and involvement in spiritual related activities was found to be the most preferred way for students to relief stress. Hence, it is vital that the university continually evaluates the psychological health of the students, tailor preventive measures and spiritual related programs to help students to cope with stress.
Development and Validation of a new Multidimensional Questionnaire called Muslim Medical Student Questionnaire (MMSQ) among Malaysian Undergraduates
Authors: Musa Ramli , Abdul Rani M. Fauzi , Che A. Aminudin , Draman Samsul
Published: January 2021

Introduction: A handful of medical schools have implemented the Islamic input in medical program into their medical curricula. However we are facing a setback as there is no validated standard assessment tool to measure the effectiveness of this academic input for undergraduate medical programme. Therefore the objective of this study is to design a scale that is able to gauge the impact of the Islamic input among medical undergraduates. Materials and Methods: The construction of a new scale is based on the 5 stages of standard questionnaire design. To validate the newly designed scale, it was administered to all the medical students who granted their consent. Results: A total of 520 students from all academic years of a medical school were enrolled in the validation stage. Bartlet’s KMO value is 0.9. From 46 items, 67% had good factor loading (>0.4). Cronbach’s alpha values of 0.78, 0.85 and 0.13 were obtained for Attitude, Practice and Knowledge domains respectively. We identified the 3 domains by using exploratory factor analysis. Conclusion: The scale has good psychometric values for both reliability and validity.