Non-bacterial thrombotic endocarditis (NBTE) denotes the presence of sterile non-infective vegetation on structurally normal, or subtly degenerate cardiac valves and is often associated with advanced malignancies. In gynaecological cancer in particular, NBTE has been most commonly associated with ovarian cancer.1,2 Here we report a rare but interesting case of NBTE in a patient with locally advanced cervical adenocarcinoma.

Literature has documented that student nurses undergo stress in their academic and clinical setting. This raises concerns because stress during undergraduate training may result in psychological or emotional impairment during the nurses’ professional life and ultimately affect the quality of patient care. The Objective of the study was to study the prevalence of stress, and the association between sociodemographic factors, stressors and coping strategies with stress. This was a cross-sectional study on 96-year 1-3 nursing students from a government university done between 2015-2018. Bahasa Malaysia translated The General Health Questionnaire, Stressors in Nursing Student Scale Questionnaire and Brief COPE Questionnaire was used in this study. This study had Malay (95.9%) and female (91.7%) dominated population. The prevalence of stress in student nurses was 25%. No association was reported between sociodemographic factors and stress. Among the 4 stressors educational, clinical, confidence and financial, clinical stressor scored the highest mean 6.40 (SD±3.66). Confidence stressor (AOR=1.26 95% CI 1.04-1.53) was the only stressor associated with stress. The top 3 coping strategies practiced by the student nurses were religion (praying), acceptance and planning. Self-blame (AOR 8.18 95% CI 1.86-35.91) was the only coping strategy associated with stress. Stress management programmes, and workshops on stress and coping strategies should be conducted yearly to ensure a well-balanced environment for good learning experiences and prevent stress related health problems and improved academic performance.

In Malaysia, chronic respiratory disease including COPD is responsible for 7% of the total Disability-Adjusted Life Years (DALYs). Sleep disturbance in COPD patients is often underestimated and overlooked clinically. Respiratory symptoms caused by COPD often leads to poor sleep quality and insomnia. Poor sleep quality contributes to frequent episodes of exacerbation which directly increases mortality risk. This study aims to determine health-related quality of life and sleep quality among COPD patients and their associations with severity. In this cross-sectional study, 102 COPD patients classified according to Global Initiative for Chronic Obstructive Lung Disease were evaluated. EQ5D and Pittsburgh Sleep Quality Index (PSQI) questionnaires were used to assess health-related quality of life and sleep quality respectively. Results showed the severity of COPD is significantly associated (p<0.05) with all 5 dimensions of EQ5D among COPD patients in Kuala Lumpur. In this study, 71 patients (69.9%) were reported to be poor sleepers (PSQI>5) with a mean g l o b a l score of 6.93 ± 4.072. Sleep quality was also found to be significantly associated (p <0.05) with COPD severity, in which patients with lower severity showed better sleep quality. In this study, COPD severity was found to be significantly associated with health-related quality of life. As the disease severity progresses, both quality of life and sleep quality worsens gradually. Findings from this study highlight the importance to consider the quality of life and sleep quality as part of the management plan for COPD patients.

Introduction: Acne vulgaris is a chronic inflammatory dermatosis caused by Propionibacterium acnes. Clinicians are constantly attempting to discover the best antibiotic regimes in treating acne vulgaris. This study compares two regimens in terms of efficacy, tolerability, compliance and recurrence rate to make recommendation on which is the best regime. Methods: An open-labelled prospective randomized investigator-blinded interventional study was carried on moderate acne vulgaris patients. Patients were assigned to treatment arm at enrolment followed by follow-up and maintenance visits. Demographic data were collected at enrolment and questionnaire enquiring acne condition, general health and quality of life impairment were filled at every visit followed by blinded dermatologist assessment. Antibiotic tablets were provided based on assigned arm until follow-up 3. Results: 26 mild acne vulgaris patients aged 17 to 29 years were recruited. Physician assessment based on GAGS and photo assessment analysis showed an overall significant change (p<0.05) with decreasing trend indicating that the treatment is statistically effective. However, no significant differences (p>0.05) were found between regimens. Similarly, patient self-perceived assessment and CADI assessment also showed overall significant changes (p<0.05) with increasing trend indicating improvement in acne condition but no significant differences (p<0.05) between regimens. Conclusion: Neither regimen were significantly more efficacious than another. In view of cost, oral azithromycin 500mg daily for consecutive 4 days monthly is suggested as a better option.

Introduction: Consumption of Chinese Herbal Medicine (CHMs) have escalated globally. They are preferred treatment for minor diseases or disorders. In Malaysia, CHMs are common home remedies during pregnancy and postpartum. Angelica sinensis (Danggui) is a staple CHMs during postpartum for purpose of nourishing blood and resolving stasis. Concerns are raised over possible heavy metals toxicity. Objective: This study aims to (i) determine Danggui consumption among postpartum mothers, (ii) quantify its heavy metals level, namely Lead (Pb), Cadmium (Cd), Arsenic (As) and Chromium (Cr) and (iii) determine health risks of Danggui consumption among mothers. Methods: A cross-sectional study involving 112 postpartum mothers was carried out in Kuala Lumpur. Danggui samples were collected from nine districts in Kuala Lumpur (Segambut, Seputeh, Cheras, Kepong, Bandar Tun Razak, Titiwangsa, Setiawangsa, Batu and Lembah Pantai). Heavy metals were extracted using microwave digester and analysed using Inductively coupled plasma mass spectrometry (ICPMS). Hazard Quotient (HQ) was used to determine non-carcinogenic health risks for herbal medicine consumption. Results: Danggui was consumed by 19.6% of mothers (n=22). Among them, incidence of jaundice was 63.6% and need for phototherapy was 40.9%. Heavy metals contaminations were found in the decreasing order of Cr > As > Pb > Cd with median (interquartile) of 3996.3 (2805.6) μg/ kg, 128.3 (56.7), 98.6 (99.1) and 37.0 (35.0) respectively. No non-carcinogenic health risks were found for all four metals. Conclusion: Alarming concentrations of heavy metals were quantified in Danggui warranting for further investigation to safeguard health of postpartum mothers.

Introduction: In Malaysia, herbal medicines are used for variety of reasons including health promotion and home remedies during pregnancy and postpartum with Manjakani (Quercus infectoria) as one of the most commonly consumed herbs. Herbal medicines consumption had been linked to heavy metals contamination and transfer from mother to infant and may affect infant’s growth and development. This study aims to (i) determine Manjakani consumption among postpartum mothers, (ii) quantify its heavy metals level, namely lead, cadmium, arsenic and chromium, and (iii) determine health risk associated with its consumption. Methods: A cross-sectional study involving 106 postpartum mothers was carried out in Kuala Lumpur. Six samples of Manjakani were sampled and extracted using microwave digester and analysed using Inductively coupled plasma mass spectrometry (ICP-MS). Non-carcinogenic health risks for herbal medicine consumption were calculated using Hazard Quotient (HQ). Results: Manjakani was consumed by 16% of mothers (n=17). Highest level of the metals was shown by chromium with mean concentration of 4210 ± 1910 ug/kg, followed by lead (170.8 ± 193.2), arsenic (39.3 ± 27.1) and cadmium (7.7 ± 0.76). There were no significant non-carcinogenic health risks with lead, arsenic, chromium and cadmium contamination (HQ < 1). Conclusion: Manjakani is consumed by mothers during confinement period. Heavy metals were quantified in Manjakani although no significant association was observed with socio-demographic characteristics and birth outcomes.