Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. A physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. This paper presents some information regarding medical ethics, including the values and principles of ethical conduct. Later the requirements of consent form is presented to guide the researchers before conducting a study.
Ethics, Medical ; Ethics

Introduction: Various studies in primary care and hospitalized patients have discouraged routine use of chest x-ray (CXR) in medical examination. Purpose: The study aims to determine the prevalence of abnormal routine CXR and cost of one CXR at a public health clinic and discuss the rationale of CXR in routine medical examination. Methodology: Data of patients who visited Klinik Kesihatan Bandar Kota Bharu (KKBKB), a public health clinic, from 1 January until 31 December 2010 were examined. The study used cross-sectional design. All patients who came for medical examination and CXR at KKBKB were included. Cost analysis was performed from the perspective of provider. Findings: About 63.1% of 8315 CXR films in KKBKB were produced as part of routine medical examination. Prevalence of abnormal CXR was 0.25%. The cost of producing one CXR ranges from RM15.87 to RM32.34. Discussion: Low yield from CXR screening and high cost of CXR are the main concern. CXR screening would also lead to unnecessary radiation; and false-positive screening resulting in physical risk, unwarranted anxiety and more expenditure. CXR screening is appropriately reserved for high-risk patients and those with relevant clinical findings.

Aims: Quantitative screening of phytochemical properties and antimicrobial activities were done on some plants of importance in human medicine as traditional herbs to treat fish diseases in Malaysia. Six extracts of Vitex trifolia, Aloe vera, Strobilanthes crispus, Clinacanthus nutans, Pereskia grandifolia and Peperomia pellucida were determined for phytochemical properties and their antibacterial activities against common freshwater pathogens i.e. Streptococcus agalactiae, Aeromonas hydrophila and Enterobacter cloacae. Methodology and results: Qualitative screening of phytochemical properties in herbs were determined using conversional method for flavonoids, tannins, saponin, alkaloids steroid and glycoside The results showed flavonoid was presence in all plant extracts. For the antimicrobial activity, the aqueous and methanolic extracts were tested by using disk diffusion method. Antimicrobial assay of methanolic crude extracts (25 to 100 mg/mL) showed effectiveness against the pathogenic bacteria. Comparatively, all aqueous extracts did not show any antimicrobial activity. Strong antibacterial activity was shown by the methanolic extracts of V. trifolia, A. vera and S. crispus while moderate antimicrobial activity was shown by C. nutans, P. grandifolia and P. pellucida. Conclusion, significance and impact study: The current results indicated that the studied plants might indeed be potential sources of natural antimicrobial agents to control fish diseases.
Plants, Medicinal

Recognising the epidemic of overweight and obesity among Malaysians, formulation of intervention programmes such as a weight management programme at workplace is essential. This study aimed to determine the effectiveness of a structured weight management programme at workplace among overweight and obese employees. In this quasi-experimental study, sixty-four of overweight and obese adults were recruited and divided into two groups (intervention group, n = 32 and control group, n = 32). Subjects in the intervention group received three months scheduled programme and the control group received a routine weight management consultation from dietitians. Significant group effect was found on waist circumference (WC) in men (p < 0.05) and Body Mass Index (BMI) in women (p < 0.05). Men from the intervention group had reduced their WC by 3.4% (-3.7 cm) as compared to controls of 0.7% (-0.8 cm). Women in the intervention group improved their BMI by 1.4% (-0.4 kg/m2) as compared to controls at 0.3% (-0.1 kg/m2). Total cholesterol and LDL-C reduced among women in both intervention and control group with significant time effect (p < 0.05). As a conclusion a structured weight management programme effectively improved WC in men and BMI in women, and appeared to be as effective as individual diet counselling by dietitians in improving lipid profiles in women.
Obesity

Smoking is one of the addiction problems that needs an effective intervention. Smoking cessation studies have shown the promising result, but the central issue was to prevent relapse. A retrospective cohort study was conducted at Quit Smoking Clinic in Klinik Kesihatan Tanglin, Kuala Lumpur to determine the outcome and predictors of smoking cessation. A cohort of 770 smokers attended the clinic between the year 2008 and 2015 was selected through simple random sampling. Smokers were defined as current smokers while smoking abstinence is defined as cessation for more than 6 months and relapse as any smoking episode even a puff since the quit date. The majority were Malays, Muslims and had at least secondary education. The mean age of smoking initiation was 17.6 years old. The majority of the respondent smokes between 11 to 20 sticks per day and had a higher nicotine dependence score (43.0%). The smoking cessation outcome was good with 52.5% of the respondent abstained from smoking at 6 months. The predictors for smoking cessation were numbered of the quit attempt (1 to 10 times) (AOR = 1.582, 95% CI = 1.012-2.472) and pharmacotherapy (aOR = 0.711, 95% CI=0.511-0.989). More frequent follow-up was essential during the first 6 month period to enhance not only medication compliance but also a motivational aspect to smokers to maintain cessation. Emphasis should also be made for smokers who make first quit attempt.

Subclinical hypothyroidism (SHT) is a biochemical diagnosis, defined as an elevated Thyroid Stimulating Hormone (TSH) with normal free thyroxine (FT4). It affects 4-10% of the adult population and is more prevalent in elderly women. Its commonest cause is autoimmune thyroiditis, detected by antithyroid peroxidase antibody (TPO-Ab). About 2-5% of SHT patients progress to overt hypothyroidism annually. The SHT prevalence among depressed patients ranges between 3% and 17%. This study aimed to determine the prevalence of SHT and TPO-Ab positivity among patients diagnosed with depressive disorders. It was a cross-sectional study carried out in the Universiti Kebangsaan Malaysia Medical Centre over a 12 months period. Serum TSH, FT4 and TPO-Ab were measured. Results showed that 82% of depressed patients were euthyroid, 4% had SHT, 11% had subclinical hyperthyroidism and 2% had discordant thyroid function. TPO-Ab positivity among the subjects was 7%, one of whom had SHT. In conclusion, the prevalence of SHT and TPO-Ab positivity in the study population, at 4% and 7%, respectively, were comparable to previous findings.
Depression

Intrduction: Obesity and chronic diseases have been increasing since the last few decades alongside rapid economic development in developed and developing countries. The alarming increase in the prevalence of childhood obesity had been shown by many epidemiological studies worldwide. The aims of this study were to determine the prevalence of overweight and obesity among Chinese school children in Kota Bharu, Kelantan, and to map the association between dietary practices and their nutritional status. Methods: A cross-sectional study was conducted on 278 school children aged 10 to 12 years old (144 boys and 134 girls) studying in a Chinese primary school in Kota Bharu. Results: The survey revealed that while only 1.4% (n=4) were overweight, 23.4% (n=65) of the children were obese. A total of 67.7% (n=44) of the obese children were boys. The overweight and obese children (n=70) were compared with a randomly selected group of normal weight children (n=70). Dietary assessment showed that protein, fat and total calorie intake were significantly higher among the overweight group (p<0.05). A significantly higher proportion of the normal weight children (85.7%) took breakfast daily or at least 4 days per week compared to the overweight groups (59.4%) (p<0.05). Conclusion: The prevalence of obesity among school children in the study is a matter of concern. These findings may be useful in targeting programmes and strategies for prevention and intervention of childhood obesity.

Background: The idea of launching an internet-based self-management program for patients with diabetes led us to do a cross-sectional study to find out about the willingness, interest, equipment, and level of usage of computer and internet in a medium- to low-social class area and to find the feasibility of using e-telemonitoring systems for these patients. Methods: A total of 180 patients with type 2 diabetes participated in this study and fulfilled the self-administered questionnaire in Diabetes Clinic of Primary Medical Center of University Kebangsaan Malaysia Medical Centre; the response rate was 84%. We used the universal sampling method and assessed three groups of factors including sociodemographic, information and communication technology (ICT), willingness and interest, and disease factors. Results: Our results showed that 56% of the patients with diabetes were interested to use such programs; majority of the patients were Malay, and patients in the age group of 51–60 years formed the largest group. Majority of these patients studied up to secondary level of education. Age, education, income, and money spent for checkup were significantly associated with the interest of patients with diabetes to the internet-based programs. ICT-related factors such as computer ownership, computer knowledge, access to the internet, frequency of using the internet and reasons of internet usage had a positive effect on patients’ interest. Conclusion: Our results show that among low to intermediate social class of Malaysian patients with type 2 diabetes, more than 50% of them can and wanted to use the internet-based self-management programs. Furthermore, we also show that patients equipped with more ICT-related factors had more interest toward these programs. Therefore, we propose making ICT more affordable and integrating it into the health care system at primary care level and then extending it nationwide.

Obesity is a risk factor for chronic diseases which can affect work productivity and physical function of employees particularly among those in security sector. The study aimed to determine the association between obesity with total days of sick leave and health related quality of life (HRQoL) among Malay male security officers. A cross-sectional study was conducted among Malay male security officers working in a Malaysian higher learning institution. Subjects were evaluated using anthropometric measurements, quality of life and number of sick leave taken within two months prior to the study. A total of 194 subjects (mean age 40.12 ± 11.41 years) were recruited. A total of 30.4% were obese, 39.7% were pre-obese and only 29.9% had normal body weight or underweight. Central obesity was observed in 57.7% of them and 87.1% shown excessive body fat percentage. Number of sick leave days was positively correlated with Body Mass Index (BMI) (r = 0.162, p = 0.024) and waist circumference (r = 0.181, p = 0.012). Score of the general health component was negatively correlated with BMI (r = -0.161, p = 0.025), waist circumference (r = -0.194, p = 0.007) and body fat percentage (r = -0.191, p = 0.008). Physical functioning score was lowest in obese subjects than normal and pre-obese subjects (p = 0.046). Score of the bodily pain component was positively correlated with waist circumference (r = 0.156, p = 0.030). Obesity is associated with number of sick leave days and quality of life in the studied group. Hence, body weight of the security staff should be monitored and appropriate intervention should be conducted to improve their work attendance and quality of life.
Obesity

Human papillomavirus (HPV) plays an important role in the pathogenesis of cervical cancer. HPV has been found in 99.7% of cervical cancers worldwide. In Malaysia, it is the second most common cancer among women in all major ethnic groups. The main purpose of this study was to establish the method of SyBrGreen Real-Time PCR and apply it for identification of multiple infections of the two high risk HPV subtypes. In this study, 57 positive samples for HPV 16 and HPV 18 were used to establish a simple and sensitive method to detect and identify HPV infection in the cervical neoplasia at different stages of the disease by using real-time ABICycler SyBrGreen 1 technology. The results showed 67 HPV genomes in 57 samples. HPV 16 genome was detected in 55/67 (82%) cases while HPV 18 was detected in 8/67 (12%) cases with 4 cases showing multiple infections of HPV 16 and HPV 18. HPV 16 was the most prevalent followed by HPV 18. Using SyBr Green Real-Time PCR techniques, the results showed that DNA melting curve for HPV 16 had a peak around 80.2ºC and Ct value of 20 cycles whereas the DNA melting curve for HPV 18 around 79.2ºC and Ct INTRODUCTION value of 22 cycles. In conclusion, a SyBr Green Real-Time PCR method has the potential for clinical usage in detection and identification of HPV infection in cervical neoplasia at different stages of the disease.