Child ; Codon, Nonsense ; Female ; Hamartoma Syndrome, Multiple ; diagnosis ; genetics ; Humans ; PTEN Phosphohydrolase ; genetics

Central corneal thickness plays a major role in the management of many types of glaucoma. Therefore, our aim is to determine the relationship between the severity of glaucoma measured by optical coherence tomography (OCT) and central corneal thickness (CCT) among normal tension and high tension glaucoma patients. This is an observational cross sectional study on 190 patients carried out in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Three groups of patients were identified; 60 normal tension glaucoma (NTG), 61 primary open angle glaucoma (POAG) and 69 control. Patients were identified based on the glaucomatous visual field changes and previous record of intraocular pressure before treatment. Visual acuity and intraocular pressure measurements were recorded. Specular microscope was used to measure the CCT and the severity of glaucoma was evaluated objectively based on the retinal nerve fibre layer (RNFL) thickness using optical coherence tomography. Results showed NTG patients had significantly thinner cornea, 503.07±32.27μm compared to the control group, 517.45±31.74 μm (p=0.012). However, there was no significant difference between the CCT of POAG and NTG groups (p=0.386).Retinal nerve fibre layer (RNFL) thickness was significantly different between the glaucoma and the control groups (p<0.05 in all quadrant). However, correlation between CCT and severity of RNFL thinning was only found for the POAG group but not for the NTG group. (mean RNFL and superior quadrant RNFL; r=0.251,0.401) . This study demonstrated the correlation between CCT and severity of glaucoma in POAG patients but not for the NTG group. Therefore, CCT is related to the severity of POAG-related visual loss.

Drug administration is an integral part of nurses role in nursing practice. In relation to their diverse roles, nurses are required to have adequate knowledge and good practice. The purpose of this study is to examine the level of knowledge, attitude and practice of nurses in the medical wards administering oral medication and to assess whether nurse’s knowledge, attitude and practice is associated with working experience and professional education (post basic training). A cross-sectional study was conducted on forty (40) nurses working in the Medical wards in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Questionnaires were used to measure the level of knowledge and attitude of nurses and a direct observation technique with checklist to record the practice of nurses. The mean score for knowledge (13.8), attitude (16.4) and practice (10.7) were all within average distribution. No significant difference was found between knowledge and practice of nurses with working experience and post basic training. However, the influence of working experience on attitude of nurses in serving oral medication was found to be significant (p= 0.045). Nurses in medical ward, Universiti Kebangsaan Malaysia Medical Centre, were found to possess an average level of knowledge and attitude in administering oral medication. In addition, this study suggest that work experience of nurses has no influence on knowledge gain and good practice in administering oral medication.

Parenting stress is the stress level experienced within the role of a parent (HoekstraWeebers et al. 1998). The source of stressors is variable and dependent on the phase of disease and chemotherapy (Sawyer et al. 2000). Failure to cope with these stressors may in turn affect the child’s emotional and social adjustment towards the diagnosis of cancer in addition to poor medical treatment adherence behaviour(Sawyer et al. 1993). The objectives of this study are to determine the level of parenting stress, the risk factors contributing to high parenting stress, and the coping mechanisms used to handle the stress. This single centred, cross-sectional study was done amongst 117 parents at the Paediatric Haematology and Oncology Unit, Universiti Kebangsaan Malaysia Medical Centre (UKMMC) over two years duration. Self-administered questionnaires comprising the Parenting Stress Index/Short Form (PSI/SF) and Coping Inventory for Stressful Situation (CISS) were distributed to parents of children who were 12 years old and below. The mean total parenting stress score amongst parents of children diagnosed with acute leukaemia was 91.5±21.1(95%CI). A total of 27.3% of parents experienced a high total parenting stress score(defined as total PSI score ≥ 75th centile, ie ≥ 103). Task-oriented coping mechanism was used by the majority of parents. Emotion-oriented coping mechanism was the only identifiable risk factor for high parenting stress score following multiple logistic regression analysis. A parent who used emotion-oriented coping mechanism was 7.1 times (95% Confidence Interval 1.2 to 41.4) more likely to have a high parenting stress score compared to a parent who used other coping mechanisms. By identifying these at-risk parents, appropriate counselling and psychological support may be offered early to alleviate the stress as well as assist in the coping and adjustment mechanisms of these parents.

Validation of instruments is essential when assessing physical activity (PA). The aim of this study was to validate a Malay language version of the International Physical Activity Questionnaire (IPAQ-M) against Actical accelerometer and to determine its reliability and validity. A total of 90 Malay adults aged 35-65 years old participating in The Malaysian Cohort project were recruited for this study. The IPAQ-M is comprised of 12 items, covering vigorous, moderate, walking, sitting and sleeping activities, and was administered on two occasions (Day 1 and Day 9) by interviewing the participants. Participants wore the Actical accelerometer for seven consecutive days between the two interview sessions. Validity tests showed that time spent in moderate-vigorous physical activity (MVPA) (min wk-1) from IPAQ-M was significantly correlated with MVPA from accelerometer (ρ=0.32, p<0.01). Time spent in vigorous activity (ρ=0.44) and total activity (ρ=0.36) from IPAQ-M were significantly correlated (p<0.01) with that measured by accelerometer, but no correlation was observed for sedentary behaviour. Reliability tests revealed significant correlations between the two interview sessions for all intensities of PA (=ρ0.55 to 0.71, p<0.01). Bland-Altman plots showed that time spent in MVPA for IPAQ-M was significantly different from that measured by accelerometer (mean difference: 98.02 min wk-1; 95% limits of agreement: -785.33 to 1317.83 min wk-1; p<0.01). When classifying people into meeting PA recommendation, the agreement between the two instruments was fair (κ=0.22). The IPAQ-M has acceptable validity for MVPA, vigorous and total physical activity, and was reliable for assessing the physical activity of Malay adults.​

Percutaneous coronary intervention (PCI) is an invasive diagnostic investigation that may result in high level of anxiety and "fear of the unknown" among cardiac patients. An increment of anxiety among PCI patients will augment the level of stress and this extreme stress level will then aggravate depression. The objective of this study was to determine the incidence of anxiety and depression before and after PCI. This was a cross-sectional descriptive study. The Hospital Anxiety and Depression Scale (HADS) was used. It measured two elements, namely the anxiety and depression levels of patients before and after PCI.This study was conducted in the cardiology wards Anggerik and Dahlia, and Day Care of the National Heart Institute, from January to February 2006. A sample of 61 patients before and after PCI who fulfilled the inclusion criteria were recruited in this study. Of these, 40 and 38 patients before and after PCI respectively , had low anxiety levels; while 47 and 46 patients before and after PCI had low depression levels.Anxiety and depression levels before and after PCI were not significantly correlated to socio demographic status. However a significant correlation (p<0.05) was found between anxiety and depression levels before and after PCI. The low levels of anxiety and depression seen among patients before and after PCI at National Heart Institute could possibly due to the adequate facilities and health education program provided by the physician, nurses and cardiac technician.

Breast self-examination (BSE) is recommended globally as one of the methods in early detection of breast cancer. Little is known about nurses screening behavior related to BSE. A cross-sectional study was conducted to examine the knowledge, attitude and practice of Breast Self Examination (BSE) among nurses. A self-administered questionnaire was sent to a total of 114 nurses working in Obstetrics & Gynaecology wards and clinics of two tertiary hospitals. Among the 114 participants, 111(97.4%) practiced BSE. The mean age of the participants was 34.97(±9.104) years. The mean score of knowledge was 11.07(±1.020) and 81.1% had high knowledge of BSE. Majority (98.2%) of respondents showed good attitude towards BSE. Barriers was found to be a significant predictor and self confidence proved to be an influencing factor on BSE performance. Despite practicing BSE, the number of nurses that examined their breast monthly was only 35.1%. Age, working experience and marital status showed no significant relationship with knowledge and practice of BSE. However, BSE taught during their undergraduate programme was found to have a significant relationship with practice of BSE. Majority of nurses in this study were not complying with MOH recommendation for BSE in terms of frequency. Thus, intervention strategies should focus on educating nurses on performing BSE monthly, in accordance with the Ministry of Health guidelines. This is important as nurses play a primary role in promoting health behaviors in BSE practice and breast cancer awareness among women in this country.

Pregnancy is perceived by many pregnant mothers as a period of happiness in anticipation of motherhood. Not all pregnant mothers experience cheerfulness as some may experience a high anxiety and depression level for unknown reasons. The purpose of this study was to determine the level of anxiety and depression among high risk pregnant women and the factors that contribute to their level of anxiety and depression. A descriptive cross-sectional study was conducted on 38 high risk mothers whose stay in hospital exceeded more than three days in the obstetric ward of Hospital Universiti Kebangsaan Malaysia. A self assessment questionaire "Hospital Anxiety Depression Scale"was used to measure the level of anxiety and depression among high risk pregnant women. Of the 38 participants, 16 (42.1%) women experienced a mild level of anxiety and 22 (57.9%) experienced a severe level of anxiety. Seventeen (44.7%) women was classified as having mild depression and 21 (55.3%) severe depression. The factors contributing to the level of anxiety and depression, include those related with "lack of information on disease", "family matters" and "finance". High risk pregnant women in this study experienced a significant level of anxiety and depression during their stay in hospital. It is therefore important for nurses and doctors to be aware and sensitive to the influencing factors that cause anxiety and depression as to enable high risk pregnant mothers to enjoy their pregnancy and childbirth.

Anti-vascular endothelial growth factor (VEGF) reduces choroidal thickness by choroidal hypoperfusion in diabetic macula oedema (DME) patients. Indirect effect of anti-VEGF towards outer retinal layers (ORL) which supplied by choroidal circulation has not been well described. We evaluate the ORL thickness between retinal pigment epithelium (RPE) with inner-segment-outer-segment photoreceptor junction (IS/OS) and RPE with external limiting membrane (ELM) in pre- and post-intravitreal Ranibizumab (IVR) treated eyes with central foveal diabetic macula edema. A total of 60 eyes (40 patients) were analysed. ORL thickness measured with optical coherence tomography at pre- and post-injection day 1, week 4 and week 6. Mean thickness of RPE-IS/OS was statistically significant over time (p=0.023) but not for RPE-ELM (p=0.216). Thickness ratio between RPE-IS/OS and RPE-ELM and central subfoveal thickness (CST) both showed statistically significant result over time with p=0.038 and p=0.000, respectively. We observed an initial reduction of ORL thickness at day 1 followed by increased in thickness at week 4 with subsequent reduction at week 6 was observed. ORL is an aspect that can be explore and emphasized further in patients considered for IVR injections. The long-term effects of IVR to the ORL however could not be concluded due to short follow up period.

Introduction: Parental knowledge on nephrotic syndrome and disease relapse is important for early recognition and treatment of relapse to prevent the complications. Parental knowledge on nephrotic syndrome was reported to be inadequate from published studies. To date, there is no study on parental knowledge on childhood nephrotic syndrome in Malaysia. This study is thus aimed at to determine the level of knowledge on NS and disease relapse among parents of children with nephrotic syndrome and determine factors that influence knowledge on nephrotic syndrome and disease relapse. Study Design and Methods: This was a cross-sectional study conducted in Paediatric Nephrology Clinic, Hospital Selayang from November 2016 to November 2017. Seventy-eight parents were recruited based on universal sampling. Selfadministered questionnaire in Bahasa Malaysia and English was designed through focus group discussion with five subject matter experts and validated through content validity. Data was analysed using IBM SPSS Statistics 23.0. Results: Majority of parents or guardians (91%) were able to answer more than 50% of the questions correctly. Of these, 56% were able to answer more than 75% of the questions correctly. A 'cut-off' of 75% was defined as good knowledge. Parents of children with frequent relapses had higher parental knowledge and this was statistically significant (p=0.025). Conclusion: Parental knowledge on nephrotic syndrome and disease relapse was still inadequate as only 56% parents had good knowledge. The main areas of deficit in parental knowledge were related to medications, infections, home urine dipstick monitoring, and recognition of warning signs during relapse.