Background: Central nervous system arteriovenous malformation (AVM) is a vascular malformation of the brain and involves entanglement of veins and arteries without an intervening capillary bed. Affecting predominantly young male patients, AVM presents with different clinical manifestations namely headache, seizures, neurological deficit and intracranial haemorrhage. The patients who present acutely with intracranial bleeding have a significant morbidity and mortality. The aim is to study the angioarchitecture of brain AVM (BAVM) and determine the risk factors for intracranial bleeding. Ultimately, the goal of the study is to look for the association between volume of haematoma and architecture of BAVM. Methods: A cross-sectional study of 58 patients was conducted at the Hospital Universiti Sains Malaysia. Data were collected over a period of seven years (2000 to 2007) to look for the association between the angioarchitecture of brain arteriovenous malformations (BAVM), haemodynamics and the natural history and risk of intracranial haemorrhage. Results: BAVM was predominantly found in young male patients in 65.5%. Small nidal size (P-value=0.004), deep location (P-value=0.003) and deep venous drainage (P-value=0.006) were found to be significant factors contributing to intracranial haemorrhage. All patients with coexisting intranidal or prenidal aneurysms presented with intracranial haematoma. Conclusion: The angioarchitecture of BAVM like nidal size, deep location and deep venous drainage can predict the risk of intracranial bleeding and can help in the management of high risk patients without any delay. Small sized and deep seated lesions have a diffuse type of intracranial bleed which eventually need more attention to the managing team as diffuse haematoma indicates more insult to brain.

A repeat Computer Tomographic (CT) brain after 24 -48 hours from the 1st scanning is usually practiced in most hospitals in South East Asia where intracranial pressure monitoring (ICP) is routinely not done. This interval for repeat CT would be shortened if there was a deterioration in Glasgow Coma Scale (GCS). Most of the time the prognosis of any intervention may be too late especially in hospitals with high patient-to-doctor ratio causing high mortality and morbidity. The purpose of this study was to determine the important predictors for early detection of Delayed Traumatic Intracranial Haemorrhage (DTICH) and Progressive Traumatic Brain Injury (PTBI) before deterioration of GCS occurred, as well as the most ideal timing of repeated CT brain for patients admitted in Malaysian hospitals. A total of 81 patients were included in this study over a period of six months. The CT scan brain was studied by comparing the first and second CT brain to diagnose the presence of DTICH/PTBI. The predictors tested were categorised into patient factors, CT brain findings and laboratory investigations. The mean age was 33.1 ± 15.7 years with a male preponderance of 6.36:1. Among them, 81.5% were patients from road traffic accidents with Glasgow Coma Scale ranging from 4 – 15 (median of 12) upon admission. The mean time interval delay between trauma and first CT brain was 179.8 ± 121.3 minutes for the PTBI group. The DTICH group, 9.9% of the patients were found to have new intracranial clots. Significant predictors detected were different referral hospitals (p=0.02), total GCS status (p=0.026), motor component of GCS (p=0.043), haemoglobin level (p<0.001), platelet count (p=0.011) and time interval between trauma and first CT brain (p=0.022). In the PTBI group, 42.0% of the patients were found to have new changes (new clot occurrence, old clot expansion and oedema) in the repeat CT brain. Univariate statistical analysis revealed that age (p=0.03), race (p=0.035), types of admission (p=0.024), GCS status (p=0.02), pupillary changes (p=0.014), number of intracranial lesion (p=0.004), haemoglobin level (p=0.038), prothrombin time (p=0.016) as the best predictors of early detection of changes. Multiple logistics regression analysis indicated that age, severity, GCS status (motor component) and GCS during admission were significantly associated with second CT scan with changes. This study showed that 9.9% of the total patients seen in the period of study had DTICH and 42% had PTBI. In the early period after traumatic head injury, the initial CT brain did not reveal the full extent of haemorrhagic injury and associated cerebral oedema. Different referral hospitals of different trauma level, GCS status, motor component of the GCS, haemoglobin level, platelet count and time interval between trauma and the first CT brain were the significant predictors for DTICH. Whereas the key determinants of PTBI were age, race, types of admission, GCS status, pupillary changes, number of intracranial bleed, haemoglobin level, prothrombin time and of course time interval between trauma and first CT brain. Any patients who had traumatic head injury in hospitals with no protocol of repeat CT scan or intracranial pressure monitoring especially in developing countries are advised to have to repeat CT brain at the appropriate quickest time .

Background: Treating patients with multidrug-resistant tuberculosis (MDR-TB) strains is more complicated, complex, toxic, expensive, than treating patients with susceptible TB strains. This study aims to compare the treatment outcomes and potential factors associated between patients with MDR-TB and non MDR TB infections in peninsular Malaysia. Methods: This study was a retrospective cohort study. Data were collected from the medical records of all registered MDR-TB patients and Non-MDR-TB patients at five TB hospitals in peninsular Malaysia from January 2010 to January 2014. Results: A total of 314 subjects were studied, including 105 MDR-TB cases and 209 non-MDRTB. After TB treatment, 24.8% of the MDR-TB patients and 17.7% of non MDR TB relapsed; 17.1% of the MDR-TB patients and 16.3% of non MDR TB defaulted from TB treatment. A significant difference seen in treatment success rate 17.1% for MDR-TB; 63.1% for non MDR TB (P < 0.001)). Mortality rate were 8.9% for MDR-TB; 13.2% for non MDR TB. Multivariable analysis showed the potential factors associated with poor treatment outcomes were presence of HIV infection (AOR, 1.09; 95%CI: 1.05, 1.75; P = 0.001) and previous TB treatment (AOR, 4.87; 95%CI: 2.84, 8.38; P = 0.001). Conclusion: This study revealed that the treatment success rate in patients with non MDR TB infection was higher than MDR-TB. Unsuccessful treatment was seen in MDR-TB associated with potential factors such as history of TB treatment, and presence of HIV infection.

Paediatric subdural empyema is frequently seen in developing Asean countries secondary to rinosinusogenic origins. A cross-sectional analysis on the surgical treatment of intracranial subdural empyema in Hospital Kuala Lumpur (HKL), a major referral center, was done in 2004. A total number of 44 children who fulfilled the inclusion criteria were included into this study. The methods of first surgery, volume of empyema on contrasted CT brain, improvement of neurological status, re-surgery, mortality and morbidity, as well as the demographic data such as age, gender, sex, duration of illness, clinical presentation, probable origin of empyema, cultures and follow-up were studied. Chi-square test was performed to determine the association between surgical methods and the survival of the patients, neurological improvement, clearance of empyema on CT brain, re-surgery and long morbidity among the survivors. If the 20% or more of the cells were having expected frequency less than five, then Fisher’s Exact test was applied. The level of significance was set at 0.05. SPSS version 12.0 was used for data entry and data analysis. There were 44 patients who were less than 18 years. Their mean age was 5.90 ± 6.01 years. There were 30 males (68.2%) and 14 females (31.8%) involved in the study. Malays were majority with 28 (63.6%) followed by Indian 8 (18.2%), Chinese 5 (11.4%) and others 3 (6.8%). The variables which were under interest were gender, race, headache, vomiting, seizures, sign of meningism, cranial nerve palsy, thickness site of abscess, first surgical treatment, improvement in neurological deficit, clearance of CT and whether re-surgery was necessary. All variables were found not to be associated with Henk W Mauser Score for PISDE grading. Comparison between this urban study and a rural setting study by the same corresponding author in the same period on subdural empyema was done. Common parameters were compared and it was found out that seizures were more prevalent in urban study where the patients are more than one year old (p=0.005). Mortality was much higher in urban study than the rural one (p=0.040). The larger proportion of urban group had volume of abscess less than or equal to 50 ml (p=< 0.001).

patients, families as well as the surrounding communities,especially the healthcare services. It can be classified intoeither a benign slow growing tumour (non-cancerous) andmalignant tumour (cancerous). The purpose of this studywas to determine the incidence and pattern of brain tumouradmitted to the Neurosurgery Department in HospitalSultanah Nurzahirah (HSNZ), Terengganu, Malaysia.Methods: This is a retrospective study of incidence andpattern of BT admitted to the Neurosurgery Department inHSNZ. Data was collected from the yearly census of BTregistered from 2013 to 2018.Results: A total number of 386 new cases of primary BT wereregistered. The number of cases of BT was found to belowest among children (0 to 10 years old) with only 4.4% butat peak among elderly aged between 51 to 60 years old(26.2%). As for gender, males constituted about 44.5%(n=172) whereas females accounted for 55.5% (n= 214) of thecases. In total, meningioma was found to have the highestincidence (27.2%) followed by metastases brain tumour(18.1%) and glioma (17.4%). Conclusions: This study has shown that the incidence of BTwas led by meningioma which had a high prevalence amongthe elderly population, followed by metastasis BT andgliomas.

Objective: To identify the predictors of mortality among in-hospital melioidosis patients. Methods: A total of 453 patients in Hospital Sultanah Bahiyah, Kedah, and Hospital Tuanku Fauziah, Perlis with culture-confirmed melioidosis were retrospectively included in the study. Advanced multiple logistic regression was used to obtain the final model of predictors of mortality from melioidosis. The analysis was performed using STATA/SE 14.0. Results: A total of 50.11% (227/453) of the patients died at the hospital, and a majority (86.75%, 393/453) of cases were bacteremic. The logistic regression estimated that the bacteremic type of melioidosis, low platelet count, abnormal white blood cell counts, and increased urea value were predictors of mortality. The results showed that bacteremic melioidosis increased the risk of death by 4.39 times (OR 4.39, 95% CI 1.83-10.55, P=0.001) compared to non-bacteremic melioidosis. Based on laboratory test, the adjusted ORs from the final model showed that all three blood investigations were included as the associated factors of mortality for the disease [high white blood cell (>10×109/L): OR 2.43, 95% CI 1.41-4.17, P<0.001; low white blood cell (<4×109/L): OR 3.82, 95% CI 1.09-13.34, P=0.036; low platelet (<100×109/L): OR 4.19, 95% CI 1.89-9.30, P<0.001; high urea (>7 800 μmol/L): OR 5.53, 95% CI 2.50-12.30, P<0.001; and low level of urea (<2 500 μmol/L): OR 3.52, 95% CI 1.71-7.23, P=0.001). Conclusions: Routine blood investigations during a hospital admission can early identify predictors of mortality in melioidosis patients.

Objective: To compare the prognostic factors of mortality among melioidosis patients between lognormal accelerated failure time (AFT), Cox proportional hazards (PH), and Cox PH with timevarying coefficient (TVC) models. Methods: A retrospective study was conducted from 2014 to 2019 among 453 patients who were admitted to Hospital Sultanah Bahiyah, Kedah and Hospital Tuanku Fauziah, Perlis in Northern Malaysia due to confirmed-cultured melioidosis. The prognostic factors of mortality from melioidosis were obtained from AFT survival analysis, and Cox s models and the findings were compared by using the goodness of fit methods. The analyses were done by using Stata SE version 14.0. Results: A total of 242 patients (53.4%) survived. In this study, the median survival time of melioidosis patients was 30.0 days (95% CI 0.0-60.9). Six significant prognostic factors were identified in the Cox PH model and Cox PH-TVC model. In AFT survival analysis, a total of seven significant prognostic factors were identified. The results were found to be only a slight difference between the identified prognostic factors among the models. AFT survival showed better results compared to Cox's models, with the lowest Akaike information criteria and best fitted Cox-snell residuals. Conclusions: AFT survival analysis provides more reliable results and can be used as an alternative statistical analysis for determining the prognostic factors of mortality in melioidosis patients in certain situations.

algorithm for mobile application and perform a pilot study todetermine its validity and reliability as a tool for vision testin the community.Methods: A simple visual acuity test algorithm in the form ofa single letter E display was designed as the optotype fordevelopment of a mobile application. The standardisedoptotype is presented at random to test visual acuity forcorresponding level of 3/60, 6/60, 6/18, and 6/12. The finalresult is auto-generated based on the classification of theWHO for visual impairment and blindness. The Snellen chartwas used as the gold standard to determine its validity whilefive different users were involved to determine its inter-raterreliability. A pilot study was performed between April tillNovember 2019, in the Universiti Sultan Zainal AbidinMedical Centre (UMC) at Kuala Nerus and MoorisOptometrist Centre at Marang, Terengganu. A total of 279participants aged four years old and above were involved inthis study. Results: The highest sensitivity was found at the vision levelcut-off point of 6/12 with the percentage of 92.7% and 86.8%for the right and left eye, respectively. The specificity wasmore than 89% for all vision levels in both eyes. TheKrippendorff’s alpha value for the inter-rater reliability was0.87 and 0.83.Conclusion: The relatively high level of validity andreliability obtained indicate the feasibility of using thedesigned optotype to develop a valid and reliable mobile appfor vision test. The app can be used to screen vision by non-medical persons, at anytime and anywhere to help improvepublic awareness and capability to correctly determine theirvisual status.

Introduction: This study aimed to determine the risk factors of CHD among the Malaysian adult population. Methods: Using a cross- sectional observational study design, this study involved 365 adult patients aged between 30-64 years, attending clinics from eight government hospitals and four health clinics in Terengganu, Pahang, Selangor, Putrajaya, Penang, Kedah, Johor and Sabah from February 2018 until September 2020. Sociodemographic characteristics, clinical and dietary data, physical activity and stress level were recorded using a structured questionnaire. Multiple logistic regression was used to analyse CHD risk factors. Results: The overall response rate was 99.2%. The adjusted odds ratio of CHD was greater for age (AOR; [%95 CI]) (1.043;[ 1.009,1.078]); waist circumference (1.033;[1.009, 1.057]); total fat intake (1.035;[1.021, 1.050]); full cream dairy products intake (1.004;[1.001, 1.008]); smokers vs non-smokers (4.691;[2.399, 9.176]); individual with family history of CHD vs without family history (2.705;[ 1.496, 4.891]); married vs single (0.434;[ 0.217,0.867]); and lower for HDL cholesterol (0.185;[0.052, 0.662]); Chinese vs Malays (10.619;[ 2.255, 49.995]); and third lowest income (0.197;[ 0.073, 0.532]) and forth lowest income (0.167;[ 0.056, 0.499]) vs lowest income. Conclusion: Age, race, income, smoking and marital status, family history of CHD, waist circumference, HDL cholesterol, total fat intake, full cream dairy products intake were significantly associated with CHD among this population. This finding is particularly important to the primary health carers to identify at-risk CHD individuals thus appropriate intervention could be provided.

Introduction: General population across different countries have shown an overall support for anti-smoking measures that vary significantly by certain population parameters. However, characteristics of the public attitude in a community who has been exposed to prolonged awareness campaigns and smoke-free area legislation is unclear. Consequently, we investigate residents who reside next to Batu Buruk beach in Kuala Terengganu city which has been gazetted as a smoke-free area since 2017. Methods: The cross-sectional study involves self-administered validated questionnaires. Multiple linear regression with forward method was applied to identify significant factors associated with the attitude towards anti-smoking measures. Results: A total of 295 residents participated. Most of them were Malays (96.6%), married (64.4%), attained up to the secondary school level (45.4%) and employed (59.7%). The mean value of the total attitude scores was 181.86 (range: 70-200). Multivariate analyses revealed those having higher monthly income had a higher total attitude scores (adjusted b: 6.91, 95% CI: 2.15, 11.66), while current daily smokers had a lower total attitude scores towards anti-smoking measures than non-smokers (adjusted b: -23.30, 95% CI: -29.55, -17.05). These findings highlight comparatively stronger and more consistent support for anti-smoking measures that may vindicate high-stake investment and legislation against smoking. Conclusion: The novel evidence may also better-inform the strategy to expand the initiatives further through profiling the target population with heightened emphasis on the economic standing and prevalence of current daily smokers. Future research may adopt experimental design to establish causality relationship between predictors and outcomes revealed in this community.