Introduction: The lack of evidence that proves the benefit of traditional and complementary medicines (T&CM) in treating chronic medical conditions does not deter its usage among patients worldwide. Prevalence of usage among post-stroke patients in Malaysia especially is unknown. This study aims to determine the prevalence, practice and perception of T&CM use among stroke survivors attending an outpatient rehabilitation program in a teaching hospital. Methods: A cross-sectional study was conducted among 104 post stroke patients attending an outpatient rehabilitation program. A structured self-administered questionnaire was used to collect data on sociodemographic and clinical profile of patients, as well as types of therapy used and perception on T&CM usage. Descriptive analysis was done, and bivariate analysis was used to determine associations between categorical data. Results: Mean age of patients was 62 years (SD 12.2), 54% were Chinese and 75% of the patients had ischaemic stroke. Mean age of T&CM users was younger compared to nonT&CM users (61 years vs. 66 years, p=0.04). Two-thirds (66%) of patients admitted to concurrent T&CM usage while attending conventional post stroke rehabilitation. Acupuncture (40.4%), massage (40.4%) and traditional Chinese medicine (11.5%) were the most common T&CM used. Positive perception was recorded in terms of ability of T&CM usage to relieve post stroke symptoms (68%), and it was safe to use because it was made from ‘natural sources'. Negative perception recorded: T&CM caused significant adverse effects (57.6%) and was not safe to be used in combination with other conventional medicines (62.5%). Conclusions: Concurrent T&CM usage among post-stroke patients attending structured outpatient rehabilitation program is widely practised especially acupuncture, massage and traditional Chinese medici
Complementary Therapies, Stroke

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.

Syzygium polyanthum is traditionally used as anti-hypertensive agent. However, the nephroprotective effects of S. polyanthum against hypertensive induced chronic kidney disease has yet to be elucidated. This study was conducted to determine the antioxidant properties and nephroprotective effects of aqueous extract of S. polyanthum (AESP) in the spontaneous hypertensive rat model (SHR). The phytochemical constituent was identified using the phytochemical screening and HPLC methods. The in vitro antioxidant activities were determined by DPPH radical scavenging and ferric reducing antioxidant power (FRAP) assays. Fifty male SHR were equally divided into 5 groups, (n=10/group); Untreated-SHR, 20 mg/kg Losartan-treated SHR, 1500 mg/kg AESP treated SHR, 1750 mg/kg AESP treated SHR and 2250 mg/kg AESP treated SHR, while 10 male Wistar Kyoto rats (WKY) were used as control. Losartan and AESP were administered by oral gavage. Rats were sacrificed after 12 weeks of experiment. The phytochemicals include phenolics, flavonoids and alkaloids were identified. AESP has high antioxidant activity as shown by antioxidant assays. AESP normalised systolic blood pressure (p<0.05) and significantly improved renal function (p<0.05). AESP also significantly reduced malondialdehyde (MDA) (p<0.05) and increased superoxide dismutase (SOD) levels in the serum as compared to untreated-SHR group (p<0.05). Ultrastructure of renal damage improved by supplementation of AESP. Conclusively, S. polyanthum is potential to alleviate hypertensive induced chronic kidney disease through its antioxidant properties.

INTRODUCTION: Uncontrolled asthma may cause an increase in healthcare utilisation, hospital admission and productivity loss. With the increasing burden of asthma in Malaysia, strategies aimed at reducing cost of care should be explored. OBJECTIVE: This study aims to determine if a clinical pathway (CPW) for inpatient paediatric asthma would reduce average length of stay (ALOS), improve asthma management and decrease cost. METHODS: A quasi-experimental, pre-post study was used to evaluate the CPW effectiveness. Paediatric inpatients aged 5-18 years old, admitted for acute asthma exacerbation from September 2015 to April 2016 were prospectively recruited. Data from patients admitted from January-July 2015 were used as control. CPW training was carried out in August 2015 using standardised modules. Direct admission cost from the provider's prospective was calculated. Outcomes compared were differences in ALOS, discharge medication, readmission within 28 days of discharge and cost. RESULTS: ALOS is 26 hours lower in the CPW group for severe exacerbations and underlying uncontrolled asthma (19.2 hours) which is clinically significant as patients have shorter hospital stay. More newly-diagnosed intermittent asthmatics were discharged with relievers in the CPW group (p-value 0.006). None of the patients in the CPW group had readmissions (p-value 0.16). Mean treatment cost for patients in the intervention group is higher at RM843.39 (SD ±48.99, versus RM779.21 SD±44.33). CONCLUSION: This study found that management using a CPW may benefit asthmatic patients with uncontrolled asthma admitted with severe exacerbation. Further studies will be needed to explore CPW's impact on asthma management starting from the emergency department.

Introduction: Cardiovascular disease is the leading cause of death worldwide. Despite the proven benefit of secondary prevention medications (SPMs), their utilisation remains suboptimal in many countries. This study aimed to assess the use of SPMs in a Malaysian primary care clinic and factors associated with it. Methods: A retrospective review of electronic medical records was conducted to assess the prescription of SPMs among patients with coronary artery disease who attended the clinic between 1st January 2018 and 31st December 2018. Prescriptions of SPMs were documented in numbers and percentages. Multiple logistic regressions were used to analyse factors associated with the prescription of SPMs. Results: Of the 662 patients included in the study, 99.1% were prescribed statins, 97% antiplatelets, 81.7% angiotensin-converting enzyme (ACE)-inhibitors or angiotensin Ⅱ receptor blockers (ARBs), and 78.7% beta-blockers. Male patients were more likely to be prescribed statins (OR = 8.584, 95% CI: 1.431 – 51.510) and antiplatelets (OR = 6.818, 95% CI: 2.294 – 20.257). Another significant factor for antiplatelets prescription was having diabetes (OR = 3.318, 95% CI: 1.148 – 9.590). Having hypertension was associated with ACE-inhibitors or ARBs prescription (OR = 4.008, 95% CI: 2.522 – 6.370). Conclusion: Although the majority of patients received SPMs, there were significant disparities for some SPMs prescriptions among female patients. As these medications are widely available in the Malaysian primary care setting, steps should be taken to ensure that these medications are prescribed equally for all eligible patients.