Acrodermatitis continua of Hallopeau

An analytical cross-sectional study was conducted in a public university in Kuala Lumpur among a random sample of 2665 undergraduates. The objective was to study the prevalence of breakfast skipping and its associated factors. Data collection was conducted via a self-administered pre-tested questionnaire. There were 43.5% male respondents, with Malays being the majority (58.3%). The prevalence of breakfast skipping was 29.2 (95% CI: 27.3 – 30.3) %. The factors significantly associated with breakfast skipping (p<0.05) were age, race, accommodation, faculty and skipping dinner. As the respondents’ age increased, their risk of breakfast skipping was lower (OR: 0.95; 0.89 – 0.99). Malays (OR: 1.94; 1.48 – 2.54), Indians (OR: 1.70; 1.08 – 2.66), and students from the Sabah and Sarawak indigenous communities (OR: 2.13; 1.37 – 3.33) were more likely to skip breakfast compared to their Chinese counterparts. Respondents who stayed in their own houses were also less likely to skip breakfast compared to those staying in hostel with meals catered (OR: 2.32; 1.39 – 3.84), hostel with cafeteria (OR: 2.92; 1.74 – 4.91) or in rented houses (OR: 2.08; 1.25 – 3.46). Respondents majoring in Arts & Economics had 1.40 (1.07 – 1.82) times risk of breakfast skipping compared to those majoring in Life Sciences. Those who skipped dinner too had twice the odds (1.47 – 2.77) of breakfast skipping. In conclusion the prevalence of breakfast skipping among the undergraduates of this university was moderately high. Health awareness campaigns or introduction of healthy eating guidelines should be initiated for the undergraduates as well as food caterers in campus. The policy and pricing of catered food in campus should also be reviewed.

Patients who self-discharge against medical advice (DAMA) are susceptible to life-threatening consequences. By understanding the factors associated with DAMA, healthcare centres can build strategies to assist patients to receive optimal medical care and prevent unfavourable outcome. The objective of this study was to determine the factors associated with DAMA from the Emergency Department (ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a prospective unmatched case control study conducted over a 4-month period. For every DAMA episode, two patients who were admitted on the same day were randomly selected as control. Following patient consent, data was collected using a standardized questionnaire. Patients were contacted by the investigator for information regarding hospitalization within two weeks of DAMA. Ninety three patients were recruited; 31 DAMA patients and 62 admitted patients. Payment method was significantly associated with DAMA (OR 3.17 95% CI 1.29-7.98; p=0.01). The likelihood of self-paying patients to take DAMA was three times higher than those who had a guarantor letter from their employer or insurance provider. Other factors which influence DAMA were family obligations (OR 4.08 95% CI 1.09- 15.26; p = 0.03) and work problems (OR 3.83 95% CI 1.13-12.94; p=0.03). A total of 19.4% of DAMA patients left following symptomatic pain relief. A total of 80.6% DAMA patients were admitted to hospital within two weeks of the DAMA episode. Payment method significantly influences DAMA. Payment planning, social welfare services, non-governmental organization funds and the introduction of a national health policy scheme may aid hospital payment, alleviate financial limitation of patients and reduce DAMA episodes.
Patient Discharge

An elderly community may continue to serve their services to other jobs after retirement particularly in light works in accordance to their ability which can support the household income in such a challenging world. One of the professions that they could alternatively get involved is by being a taxi driver. Hence, the characteristic of elderly taxi driver is crucial to understand, primarily due to the ageing process which makes them more vulnerable towards injury. Sitting which is the working posture of a taxi driver should be properly done to avoid injuries among the elders. Improper seating posture is potentially unhealthy and considered as one of the major contributing factors for several musculoskeletal disorders (MSD) such as pain in the lower back part and shoulder. Due to increased exposures to seating posture inside the car, the proper sitting adjustment has become an important issue that demands adequate ergonomic interventions. A cross-sectional study was conducted with elderly taxi drivers using a self-administered questionnaire. It included questions on social-demographic data, Rapid Upper Limb Assessment (RULA) and Quick Exposure Check (QEC). Purposive method sampling is used according to these inclusive criteria; age 60 years old and above, self-driving taxi more than 1 year, no disabilities and registered with Ministry of Transport (MOT). Total of 443 respondents participated in the study. SPSS software version 20.0 to analyze data and RULA and QEC form was used. More than half elderly taxi driver used budget car (57.6%) type of taxi and most of elderly taxi drivers were smoking (66.0%). More than half respondents (70.0%) having felt back pain for the past 12 months and 75.4% feeling back pain the last seven days. 94.8% elderly taxi drivers complained of feeling low back pain. QEC showed higher score - neck (20.8%) and back body part (6.5%) and other factors at high score - driving (86.4%) and vibration (45.6%). RULA analysis body score at value score 7 (23.5%)- required immediate improvement and value score 5/6 (61.9%) - required investigation and needed to improve soon. Inappropriate seating posture among elderly taxi drivers may cause discomfort towards developing MSD. The implication of low awareness on ergonomics education could reflect quality lifestyle and health among elderly taxi drivers in Malaysia.

Life expectancy from birth is increasing dramatically. Due to this increase, the population of elderly people will increase. Consequently, geriatric related illnesses will increase leading to increased necessity to build up comprehensive and coordinated cost effective health care services appropriate for elderly people. Frailty is not a disease, but rather considered as a syndrome requiring comprehensive and multidisciplinary care approach. It is a prevalent reversible pathological transitional stage between healthy aging and disability. Frailty is associated significantly with increased health care utilization, mortality, and comorbidities such falls, hospitalizations, physical dependence, and poor perception of health. The aim of this review is to compile existing literature on the economic cost of frailty syndrome among elderly people in the recent years. Search queries were constructed to look for articles related to the economic cost of frailty in the electronic databases available at the National University of Malaysia library for articles published between the years 2011 and 2019. The accessed electronic database included New England journal of medicine, Science Direct, SCOPUS, BMJ, Cochrane, and Wiley Online Library. Articles included in this review when they were original research, participants were defined as frail elderly, manuscripts written in English language, and involved clearly described measures of frailty cost. Among the literature, twenty one articles were found to satisfy the inclusion criteria of the review process. The cost of care for frail elderly was ranging from US $ 8,620 to 29,910 per patient per year. The cost of health care was ranging from US $ 2,540 to 221,400. The health care cost was accounting for 40% to 76% of the total care cost. Hospitalization cost was the highest, it was ranging from US $ 806 to 152,726. Outpatient cost was ranging from US $ 200 to 18,000. Medications cost was ranging from US $ 7 to 3,434 per frail elderly patient per year. Home help cost was ranging from US $ 804 to 19,728 per frail elderly patient per year. In conclusion, frailty is a costly syndrome. It can be considered as a cost effective target for health promoting interventions to contain future elderly cost.

Damage Control Resuscitation and Surgery is the concept of controlled hypotension, haemostatic resuscitation and abbreviated surgical procedures following severe trauma; the practice of which has resulted in improved mortality and morbidity. We describe a rare case of thoraco-abdominal impalement successfully managed based on the concept of Damage Control Resuscitation.
Hypotension

The determination of HIV drug resistance mutations (DRMs) towards antiretroviral (ARV) drugs among HIV-1 treated patients with virological failure is crucial for further management of the patient. This study aimed to assess the most common genomic mutation and to analyse subtypes among the HIV-1 patients with viral load level > 1,000 copies/mL. A total of 101 virological failure HIV-1 patients from four different regions of Peninsular Malaysia with a viral load measurement facility were included in the study. Majority of patients (89.1%) have at least 1 mutation associated with clinical resistance to either protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) or nonnucleoside reverse transcriptase inhibitors (NNRTIs). Major resistance mutations among the patients towards NRTIs and NNRTIs were 70.3% and 18.8%, respectively. The most common mutation for NRTIs was M184V while K103N mutation was detected in the majority of patients who were treated with NNRTIs. The most commonly observed mutations for major PI and minor PI seen among the study population were V82A/T and L10V, respectively. In HIV-1 subtype analysis, CRF33_01B was the most predominant HIV-1 subtype in this study group. The vast detection of DRMs in this study emphasized the importance of genotypic resistance test in the management of HIV patients as DRMs can alter patient’s susceptibility towards ARV drugs. Further study on larger number of samples is essential for the development of a database on HIV-1 DRMs among patients that experience virological failure in Malaysia.

Prevalence of obesity in Malaysia has been steadily rising over the last two decades. Therefore, the efforts towards curbing this problem is becoming increasingly necessary. The main objective of this cross-sectional study was to evaluate the effectiveness of obesity projects conducted by the NGOs funded by the Malaysian Health Promotion Board (MHPB). In this study, the secondary data from the final reports of 22 obesity projects were analyzed to evaluate its effectiveness. All the information in the final report was transferred into the formative evaluation forms prepared by MHPB. The effectiveness of obesity projects was determined through the level of achievement of health literacy by using 21 indicators validated data extraction tool based on the RE-AIM Model. Projects which achieved 15 to 21 marks are considered to be of high quality, 8 to 14 marks are considered to be of moderate quality and 0 to 7 marks are categorized as low quality. Using the Cohen’s Kappa test to assess the inter-rater reliability towards 21 indicators validated data extraction tool based on the RE-AIM Model, it was found that there was very high level of inter-rater agreement (K = 0.868). From the 22 obesity projects studied, none was considered to be of high quality, 21 projects were found to have a moderate quality and 1 project was found to be of low quality. There was no significant difference on the percentage achievement of health literacy between different duration of project undertaken (p > 0.05). Based on the health screening of 1982 project participants, 333 (16.8%) are overweight and 354 (17.9%) are obese. In conclusion, although majority of the projects were successfully carried out by the NGOs. A follow-up study is needed to monitor lifestyles change which may eventually lead to reduction in the prevalence of obesity in the community where the projects were executed

The Medical Faculty of Universiti Sains Islam Malaysia (USIM) aims to produce good Muslim doctors (GMD) who are able to practise medicine that is integrated with Islamic values. Islamic courses and Medical Ethics are integrated into the curriculum in its effort to provide adequate Islamic knowledge and nurturing professionalism as a process of personal and professional development (PPD) within the framework of Islamic teaching. The objective of the study was to evaluate the perception of graduates and students of characteristics of a GMD. Method: A self-administered questionnaire was distributed to the participants. The respondents were asked to rate their level of agreement or disagreement on the statements that represent the characteristics of a GMD. Statistical analysis of the data was carried out using SPSS version 18.0. The mean, median and inter quartile ranges of the characteristics were determined and differences between the groups were analysed using Mann-Whitney U test. Results: Results showed significant difference between gender for the item “Conscious of professional ethics” (p=0.021). Significant differences were seen in the median scores between the graduates and the final year students in four out of six items for personal characteristic. Conclusion: Islamic input in the medical curriculum and the teaching of professionalism has an impact on graduate perception of characteristics of a GMD. Further improvement in the teaching of professionalism among undergraduates is necessary in order to promote greater impact on the understanding and internalization of characteristics of a GMD. The Islamic input in the medical curriculum can thus be regarded as the blueprint for PPD of medical undergraduates to become a GMD.

Midazolam is one of the most commonly used drugs for sedation in Emergency Department (ED). This was a retrospective study conducted on 380 patients from December 2012 to May 2014 in ED of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The objective was to elicit the frequency of side effects and correlation to various factors i.e. socio-demography, co-morbidities, age groups and underlying illnesses. Out of 380 patients, 35 patients experienced side effects (20 patients with midazolam alone, 15 patients with combination of drugs). The average age was 42 years and the average dose of midazolam was 3.5mg. The most common other drug combined was fentanyl. The overall complication rate for midazolam was 5.3%. The most common side effect recorded was excessive somnolence (1.6%). Other side effects included local skin reactions (1.1%), vomiting (0.8%), headache (0.8%) and hypotension (0.5%). There was no significant association between the socio-demographic factors and drugs combination with the side effects of midazolam on patients. It was concluded that midazolam was a safe drug due to absence of any life-threatening side effects. There are possibilities that most side effects recorded could be caused by other comfounding factors e.g. underlying injuries or disease and combination with other drugs.
Midazolam