Objective: To evaluate the long-term efficacy, retention rate and tolerability of ketogenic diet treatment (KD) for children with medically refractory epilepsies from a single tertiary centre in Malaysia. Methods: Children who were treated with ketogenic diet since 2006 and had at least 2 years follow up after initiation of the KD were evaluated retrospectively using intention-to-treat principle. Response is defined at seizure reduction of > 50%. Efficacy was assessed as percentage of patients who had seizure reduction by >50%, >90% and seizure freedom and retention rate was the proportion of patients who remained on ketogenic diet. Result: A total of thirty children were included. The median duration of treatment was 8 months (range: 7 days to 6 years). Retention rates at 3, 6, 12 and 24 months were 80%, 70%, 50% and 40% and responder rates were 70%, 63%, 47% and 37% respectively. The common adverse effects were constipation (43%), hunger (23%), excessive weight gain or loss (20%), vomiting (10%), hyperuricaemia(30%), hypocalcaemia (20%) and renal calculi (13%). The common reasons for stopping were because the diet was too restrictive (33%), infrequent seizure or seizure freedom (23%), not effective (17%) but none was due to the adverse effects. Conclusion: Ketogenic diet treatment is effective and well-tolerated by Malaysian children in general.
Ketogenic Diet ; Epilepsy

The type of specific learning needs of women with breast cancer using the Information Needs Questionnaire (INQ) had been identified prior to developing a breast cancer education package. It is also important to determine the types of patient factors such as demographic and clinical factors that influence women’s specific learning needs on breast cancer. This study thus reports the findings on what type of patient factors influence women’s specific learning needs related to the types of INQ. A total of 140 women with breast cancer who sought treatment at Universiti Kebangsaan Malaysia Medical Centre participated in this cross sectional study. Age showed a significant relationship with specific learning needs on sexual attractiveness (p=0.001) and self-care (p=0.048). Duration of illness was related to information on spread of breast cancer (p=0.040) and self-care (p=0.047). Education level showed a significant relationship with cure (p=0.001), sexual attractiveness (p=0.007) and spread of breast cancer (p=0.003). Occupation showed a significant relationship with specific learning needs on sexual attractiveness (p=0.005), chemotherapy (p=0.043), radiotherapy (p=0.039) and hormonal therapy (p=0.043). On treatment received, a significant relationship was noted with sexual attractiveness (p=0.009), radiotherapy (p=0.029), hormonal therapy (p=0.038) and targeted therapy (p=0.047). Ethnicity and Marital status showed no significant relationship with all the specific learning needs. Findings of this study concluded that certain patient factors had significant relationship with certain specific learning needs. All the patient factors studied and their influence on the specific learning needs were taken into consideration prior to developing the breast cancer education package.

Aim: Nanotechnology is an increasingly growing field with its current application in Science and Technology for the purpose of manufacture of novel materials at the nanoscale level. Silver-Titania nanoparticles (AgTiO2-NPs) have been known to have inhibitory and bactericidal effects. Methodology and Results: In the present study, stable silver-titania nanoparticles coated metallic blocks were prepared for testing their efficacy against selected bacterial pathogens like Escherichia coli and Staphylococcus aureus. In the experimental part, the bacterial pathogens were inoculated on silver-titania nanoparticle coated blocks and the treatment was carried out in „0‟ time and „24‟ h interval and were enumerated. Conclusion, significance and impact of study:The results were compared with the control (uncoated metallic blocks) and analyzed by using Japanese Industrial Standard (JIS Z2801:2000) method. From this study, it was concluded that silver-titania nanoparticles has inhibitory effect on bacterial pathogen tested.

As cognition declines with age, cognitive impairment rates are expected to increase ranging from 100% to 300% in this region. It could be higher among elderly who had any chronic diseases. The aim of the present work was to determine the prevalence and associated factors of cognitive impairment among elderly with hypertension. A clinic-based, cross-sectional study was conducted at several community clinics in Sabak Bernam and Hilir Perak districts from July to December 2015. A total of 480 patients were recruited. The prevalence of cognitive impairment was 13.13% (95%CI: 13.11, 13.15). Factors associated with cognitive impairment among elderly hypertensive were no formal educational level [OR: 3.95 (95%CI: 1.80, 8.67)]; history of high cholesterol [OR: 3.24 (95%CI: 1.15, 9.16)]; underweight [adj. OR: 4.88 (95%CI: 1.34, 17.67)]; and increasing age [OR: 1.03 (95%CI: 1.01, 1.06)]. Public health policy makers and geriatric practitioners should emphasise on early cognitive function assessment among elderlies who are hypertensive, unemployed, poor educational background, males, high cholesterol level and underweight to enhance the quality of geriatric services. Earlier establishment of diagnosis may prevent from greater rate of decline in cognitive functioning among this vulnerable group.

Pharmacology teaching during preclinical years is important for medical students to make rational choices in choosing suitable treatment for patients in future. Therefore, the present study determined the adequacy and effectiveness of pharmacology teaching in the undergraduate medical program at the Universiti Kebangsaan Malaysia Medical Center (UKMMC). Suggestions for improvement of the curriculum were also identified. An online questionnaire on the perceptions of pharmacology teaching methodology was distributed to a total of 459 medical students in 4th and 5th year at UKMMC. The questionnaire covered demographics, perceptions about pharmacology teaching, the ideal teaching learning methodology for learning pharmacology, pharmacology topics which are useful for future clinical practice, the pharmacology topic which was most interesting and recommendations for improvement. The response rate was 46.4% and majority of the participants were females (65.7%). Most of the students agreed that interactive learning was more helpful than didactic lectures (88.0%). Seventy percent of the students reported that pharmacology lectures in the preclinical years were helpful during the clinical years. Percentage of students who agreed that pharmacology teaching in their preclinical was adequate for their clinical practice was 47.0%. There was no association between demographic variables (gender, race, year of study and medical family background) and interest in pharmacology (p>0.05). In conclusion, the pharmacology teaching during preclinical years was perceived to be effective and useful for students’ clinical practice. More pharmacology teaching sessions in clinical years was suggested which may improve adequacy of pharmacology teaching.

The Malaysian Adults Nutrition Survey (MANS) was carried out between October 2002 and July 2003, involving 6,775 men and 3,441 women aged 18 – 59 years. Anthropometric assessment showed that the overall mean body weight and BMI were 62.65 kg (CI: 62.20, 63.09) and 24.37 kg/m2 (CI: 24.21, 24.53) respectively. Based on the WHO (1998) classification of BMI, 12.15% (CI: 11.26, 13.10) were obese (BMI > 30 kg/m2), and 26.71% (CI: 25.50, 27.96) overweight (BMI > 25 - 29.9 kg/m2). Significantly, more women were obese [14.66% (CI: 13.37, 16.04)] while significantly more men were overweight [28.55% (CI: 26.77, 30.40)]. Ethnicitywise, prevalence of obesity was highest among the Malays [15.28% (CI: 13.91, 16.77)] while overweight was highest for the Indians [31.01% (CI: 26.64, 35.76)]. Both obesity and overweight were highest among those aged 40 - 49 years. Obesity was highest for those whose household income was between RM1,500 - 3,500 while overweight was more prevalent for those whose household income exceeded RM3,500. The prevalence of overweight was highest for those with primary education [31.90% (CI: 29.21, 34.72)]. There was no significant urbanrural differential in both obesity and overweight. The study found 9.02% (CI: 8.82, 10.61) with chronic energy deficiency (CED) (BMI < 18.5 kg/m2). The prevalence of CED was relatively higher in the indigenous population (Orang Asli) [14.53% (CI: 5.14, 34.77)], subjects aged 18-19 years [26.24% (CI: 21.12, 32.09)], and with monthly household income of < RM1,500 [10.85% (CI: 9.63, 12.20)]. The prevalence of CED was not significantly different among the geographical zones and educational levels, and between urban/rural areas and sexes. The results call for priority action to address the serious problem of overweight and obesity among Malaysian adults as it poses a grave burden to the country’s resources and development.

Turner syndrome is one of the most common chromosomal abnormalities affecting newborn females. More than half of patients with Turner syndrome have a 45X karyotype. The rest of the patients may have structurally abnormal sex chromosomes or are mosaics with normal or abnormal sex chromosomes. Mosaicism with a second X sex chromosome is not usually of clinical significance. However, Turner syndrome patients having a second Y chromosome or Y chromosomal material are at risk of developing gonadoblastoma later in life. The aim of this study is to compare the results of conventional (karyotyping) and molecular cytogenetics (FISH), and discuss the advantages and limitations in the diagnosis of Turner syndrome. We also aim to compare the degree of mosaicism identified using conventional cytogenetics and FISH techniques. Conventional cytogenetics and FISH analyses were performed on eight peripheral blood samples of patients with Turner syndrome collected between 2004 and 2006. From this study, two out of eight patients with Turner syndrome were found to have the sex determining region on the Y chromosome (SRY) gene by FISH analysis. Our results showed that the rate of detection of mosaic cases in Turner syndrome was also increased to 88% after using the FISH technique. We concluded that FISH is more superior to conventional cytogenetics in the detection of the Y chromosomal material. FISH is also a quick and cost effective method in diagnosing Turner syndrome and assessing the degree of mosaicism.

This article aims to review the scientific data on phytochemical and pharmacological studies of Artocarpus collected from Malaysia as well as to highlight their usage as ethnomedicine worldwide. About 55 Artocarpus species are distributed worldwide and 32 of the Artocarpus species can be found in Malaysia. Artocarpus species are well known worldwide for their edible fruits such as Artocarpus heterophyllus (jackfruit), Artocarpus integer (chempedak), and Artocarpus communis (breadfruit). Aside from its edible fruits, the timber is valued for light constructions, crates, large canoes, and boats. The literature for this review was searched using the term 'Artocarpus', 'Artocarpus Malaysia', 'Artocarpus extracts', 'Artocarpus traditional medicine' and 'Artocarpus ethnomedicine' from published books and scientific journals via various engines such as The Web of Science, PubMed, Science Direct, Scopus, Research Gate, and Google Scholar. The references cited from the retrieved articles were also scanned and cross-checked. All published studies on phytochemical and pharmacological activities of Malaysia's Artocarpus species up to January 2021 were included in this review. Articles on phytochemical studies of Malaysia's Artocarpus revealed the isolation of flavonoids as the major constituents. Research on pharmacological activities of the isolated phytochemicals showed that these compounds exhibited significant disease-linked-enzyme (tyrosinase, cholinesterase, glucosidase) inhibitors as well as antioxidant, anti-inflammatory, antimicrobial, and cytotoxic activities. The ethnomedicinal data gathered are useful to understand and prioritize Artocarpus species that can contribute to potent phytochemicals and possibly new drug leads. This review also provides valuable information for the future development of isolated compounds from Artocarpus species.

STUDY DESIGN: Prospective study. PURPOSE: To compare Patients' and parents’ perceptions of physical attributes (PAs) of adolescent idiopathic scoliosis (AIS) patients and to report any correlations between their perceptions and Scoliosis Research Society-22r (SRS-22r) scores. OVERVIEW OF LITERATURE: Few studies have looked into the differences between Patients' and parents’ perceptions of their appearance. METHODS: AIS patient–parent pairs (n=170) were recruited. The Patients' and parents’ perceptions of six PAs were evaluated: waist asymmetry (WA), rib hump (RH), shoulder asymmetry (SA), neck tilt, breast asymmetry (BrA), and chest prominence. These PAs were ranked, and an aggregate PA (Agg-PA) score was derived from a score assigned to the attribute (6 for the most important PA and 1 for the least important). The patients also completed the SRS-22r questionnaire. RESULTS: Ninety-nine patients (58.2%) and 71 patients (41.8%) had thoracic and lumbar major curves, respectively. WA was ranked first by 54 patients (31.8%) and 50 parents (29.4%), whereas RH was ranked first by 50 patients (29.4%) and 38 parents (22.4%). The overall Agg-PA scores were similar for patients and parents (p>0.05). However, for thoracic major curves (TMCs) >40°, a significant difference was noted between the Agg-PA scores of patients and parents for SA (3.5±1.6 vs. 4.2±1.6, p=0.041) and BrA (3.0±1.6 vs. 2.2±1.3, p=0.006). For TMCs <40°, a significant difference was found between the Agg-PA scores of patients and parents for WA (3.7±1.6 vs. 4.4±1.5, p=0.050). BrA was negatively correlated with total SRS-22r score. CONCLUSIONS: There were no significant differences between patients and parents in their ranking of the most important PAs. For TMCs >40°, there were significant differences in the Agg-PA for SA and BrA. Pa¬tients were more concerned about BrA and parents were more concerned about SA. Patients' perception of the six PAs had weak correlation with SRS-22r scores.
Adolescent ; Awards and Prizes ; Body, Physical Appearance ; Breast ; Humans ; Neck ; Parents ; Prospective Studies ; Ribs ; Scoliosis ; Shoulder ; Thorax

Methods: Forty AIS patients were recruited. Demographic, preoperative, and postoperative data were recorded. The magnitude and characteristics of postoperative pain were assessed using the painDETECT questionnaire through telephone enquiries at intervals of 2, 6, 12, and 24 weeks. Statistical analyses were followed by Pearson correlation test to determine the relationship between pain scores at 6, 12, and 24 weeks with the risk factors. Results: Based on the painDETECT questionnaire, 90% of the patients had nociceptive pain, and 10% had a possible neuropathic pain component at 2 weeks postoperatively as per a mean painDETECT score of 7.1±4.5. Assessments at 6, 12, and 24 weeks showed that no patients had neuropathic pain with painDETECT scores of 4.4±3.2, 2.9±2.9, and 1.5±2.0, respectively. There was a significant correlation between total postoperative morphine use during 48 hours after the surgery and a tendency to develop neuropathic pain (p=0.022). Conclusions Chronic neuropathic pain was uncommon in AIS patients who had undergone PSF surgery. Higher opioid consumption will increase the possibility of developing chronic neuropathic pain.