This is a cross-sectional study on 218 pregnant mothers in an urban government Hospital. The study aimed to assess knowledge, attitudes and sources of information on breastfeeding. The results could be utilised to promote breastfeeding. Almost all the respondents (96.8%) intended to breastfeed their newborns. Most of them (74.8%) were knowledgeable about breastfeeding i.e. colostrum and breast milk was the best food, good for resistance against disease and allergy, filling up stomach easily, helpful in teeth development and maternal recovery after birth, increased bonding, was easy and economical. The two main misconceptions were mothers would stop breastfeeding when infant or mother was sick, and giving clear fluid to the exclusively breastfed infants to prevent dehydration. Most mothers (83.9%) responded positively towards breastfeeding i.e. it was easier than infant formula, had no negative effect on marital relationship or family care, would commence breastfeeding straight after delivery, agreeable to the banning of bottles and teats in hospital and they would not stop breastfeeding even if husband discouraged them. Only 56.9% of the mothers believed they could breastfeed their babies with modesty anywhere. The main sources of information were attained from the mass media (34.9%), antenatal class (32.1%) and other mothers with breastfeeding experiences.

INTRODUCTIONDiabetes mellitus is a rising non-communicable disease in Malaysia. Insulin therapy refusal is a great challenge for healthcare providers, as it results in delayed insulin initiation. This study was conducted to determine the prevalence of insulin therapy refusal and its associated factors.

METHODSThis cross sectional study was conducted at seven public health clinics in Kubang Pasu district, Malaysia, from March to October 2012. A newly developed and validated questionnaire was used and participants were selected via systematic random sampling. Only patients diagnosed with type II diabetes mellitus (T2DM) and under the public health clinic care in Kubang Pasu were included in the study. Multiple logistic regressions were used to study the association between insulin therapy refusal and its associated factors.

RESULTSThere were 461 respondents and the response rate was 100%. Among these 461 patients with T2DM, 74.2% refused insulin therapy. The most common reason given for refusal was a lack of confidence in insulin injection (85.4%). Multiple logistic regression revealed that respondents who had secondary education were 55.0% less likely to refuse insulin therapy than those who had primary or no formal education (p = 0.009, adjusted odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.25-0.82). There was also a significant inverse association between glycated haemoglobin (HbA1c) and insulin therapy refusal (p = 0.047, adjusted OR = 0.87, 95% CI = 0.76-1.00).

CONCLUSIONInsulin therapy refusal is common in Kubang Pasu. Education status and HbA1c should be taken into consideration when counselling patients on insulin therapy initiation.

Adult ; Aged ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; blood ; drug therapy ; epidemiology ; Female ; Follow-Up Studies ; Glycated Hemoglobin A ; metabolism ; Humans ; Hypoglycemic Agents ; therapeutic use ; Insulin ; therapeutic use ; Malaysia ; epidemiology ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Surveys and Questionnaires ; Young Adult

Background: Antibiotic resistance is a rising problem in Malaysia. For instance, high antibiotic prescribing rate for upper respiratory tract infection and inappropriate choice of antibiotic is a significant healthcare concern in Malaysia. Our main objective was to study knowledge, attitude and practice of antibiotic prescribing among medical officers in Kedah, Malaysia. Methods: A cross sectional study was conducted in outpatient departments of health clinics and hospitals in Kedah from June 2013 until December 2013. Sample size was 118 and systematic sampling was conducted. Research tool used was a validated questionnaire from studies conducted in Congo and Peru. Results: Response rate was 84.8%. Majority of our respondents were female doctors (71.0%), local graduates (63.0%), and practiced for 4 years or less (61.0%). 52.0% of the respondents prescribed antibiotics more than once daily. Mean knowledge score on antibiotics was 5.31 ±1.19 (95% CI: 5.06; 5.54). More than half (62.0%) of our respondents were confident in antibiotic prescribing and there were merely 18.0% of them consulted any colleagues prior to prescription. There was a significant difference in frequency of antibiotic prescribing between junior doctors and senior doctors (P-value: 0.036). In addition, there was also a significant association between frequency of antibiotic prescribing and awareness of antibiotic resistance in their daily practice. (P-value: 0.002). Conclusion: Knowledge on antibiotic was moderate among our medical officers and antibiotic prescribing was frequent. Training and courses on appropriate antibiotic prescribing should be emphasized to ensure the best practice in antibiotic prescription.
Drug Prescriptions ; Drug Resistance, Microbial

Introduction: Jellyfish stings are the most frequently reported marine animal envenomation worldwide. However, data on jellyfish sting from Malaysia remains obscure due to inadequate research. Methods: We investigated the epidemiology, clinical features and treatment of patients presenting at the emergency department of Langkawi Hospital between January 2012 and December 2014. Secondary data on the nature of the incident, patient demographics, clinical presentation, and treatment were retrieved from the patients’ medical records. Descriptive statistics were presented for all patient variables. Results: A total of 759 patients presented with jellyfish stings during the 3-year study period, with highest number of visits in July, October, November, and December. The mean patient age was 26.7 years (SD: 12.14), 59.4% were men, 68.1% were foreigners or international tourists, and 40.4% were stung between 12.00 p.m. and 6:59 p.m. At least 90 patients presented with mild Irukandji or Irukandji-like syndromes. Most of the jellyfish stings occurred at Chenang Beach (590 reported cases), followed by Tengah Beach and Kok Beach. Most patients were treated symptomatically, and no deaths following a jellyfish sting was reported during the study period. Conclusion: There is a need for public health interventions for both local and international tourists who visit Langkawi Island. Preventive steps and education on initial treatment at the incident site could elevate public awareness and decrease the adverse effects of jellyfish stings.
Cnidaria ; Cnidarian Venoms

OBJECTIVES: This study explored the demographic characteristics of hepatitis C patients in the Kota Setar (KS) district, Kedah, Malaysia, the prevalence of intravenous drug use (IVDU) as a risk factor among these patients, and the associations between IVDU and demographic characteristics. METHODS: Retrospective data pertaining to 713 patients from January 2009 to December 2013 were retrieved from hospital and disease notification records for analysis. The risk factors for hepatitis C virus (HCV) infection were grouped into IVDU and non-IVDU risk factors for analysis using multiple logistic regression. RESULTS: Of the hepatitis C patients included in this study, the most common age group was 31 to 40 years (30.2%), and male patients (91.2%) made up the overwhelming majority. Ethnic Malays constituted approximately 80.4% of the patients, and IVDU was the main risk factor (77.8%) for HCV infection. Multiple logistic regression showed that male patients were 59 times more likely to have IVDU as a risk factor for HCV infection. Single patients were 2.5 times more likely to have IVDU as a risk factor. Patients aged > or =71 years were much less likely than patients aged < or =30 years to have IVDU as a risk factor for HCV infection. CONCLUSIONS: IVDU was found to be an important risk factor for HCV infection among patients in the KS district. The factors associated with IVDU included age, sex, and marital status. Appropriate preventive measures should be developed to target the groups in which IVDU is most likely to be a risk factor for HCV infection.
Disease Notification ; Hepacivirus ; Hepatitis C* ; Hepatitis* ; Humans ; Logistic Models ; Malaysia* ; Male ; Marital Status ; Prevalence ; Retrospective Studies ; Risk Factors

Adult ; Diagnosis, Differential ; Exanthema ; etiology ; Histiocytic Necrotizing Lymphadenitis ; complications ; diagnosis ; Humans ; Lymphatic Diseases ; etiology ; Male

OBJECTIVES: The goal of this study was to assess the relationship between intestinal obstruction and the prognosis of colorectal carcinoma. METHODS: Data pertaining to 4,501 colorectal carcinoma patients were extracted from the national colorectal registry and analysed. Survival analysis was performed using the Kaplan-Meier method. The log-rank test was used to compare the survival rate between patients with intestinal obstruction and those without intestinal obstruction. The p-values<0.05 were considered to indicate statistical significance. Simple Cox proportional hazards regression analysis was used to estimate the crude hazard ratio of mortality from colorectal cancer. RESULTS: Intestinal obstruction was reported in more than 13% of patients. The 3-year survival rate after treatment was 48.3% (95% confidence interval [CI], 43.9 to 52.8) for patients with intestinal obstruction (n=593) and 54.9% (95% CI, 53.1 to 56.6) for patients without intestinal obstruction (n=3,908). The 5-year survival rate for patients with intestinal obstruction was 37.3% (95% CI, 31.9 to 42.8), which was lower than that of patients without intestinal obstruction (45.6%; 95% CI, 43.5 to 47.7). After adjusting the hazard ratio for other prognostic variables, intestinal obstruction had a statistically significant negative correlation with the survival rate of colorectal cancer patients, with an adjusted hazard ratio of 1.22 (p=0.008). CONCLUSIONS: The presence of intestinal obstruction is associated with a lower survival rate among colorectal cancer patients.
Colorectal Neoplasms* ; Humans ; Intestinal Obstruction* ; Mortality ; Prognosis* ; Survival Rate

Purpose: Endoscopic total mastectomy (ETM) is predominantly performed with reconstruction using prostheses, lipofilling, omental flaps, latissimus dorsi flaps, or a combination of these techniques. Common approaches include minimal incisions, e.g., periareolar, inframammary, axillary, or mid-axillary line, which limit the technical ability to perform autologous flap insets and microvascular anastomoses, as such the ETM with free abdominal-based perforator flap reconstruction has not been robustly explored. Methods: We studied female patients with breast cancer who underwent ETM and abdominal-based flap reconstruction. Clinical-radiological-pathological characteristics, surgery, complications, recurrence rates, and aesthetic outcomes were reviewed. Results: Twelve patients underwent ETM with abdominal-based flap reconstruction. The mean age was 53.4 years (range 36–65). Of the patients, 33.3% were surgically treated for stage I, 58.4% for stage II, and 8.3% for stage III cancer. Mean tumor size was 35.4 mm (range 1–67). Mean specimen weight was 458.75 g (range 242–800). Of the patients, 92.3% successfully received endoscopic nipple-sparing mastectomy and 7.7% underwent intraoperative conversion to skin-sparing mastectomy after carcinoma was reported on frozen section of the nipple base. Mean operative time for ETM was 139 minutes (92–198), and the average ischemic time was 37.3 minutes (range 22–50). Fifty percent of patients underwent deep inferior epigastric perforator, 33.4% underwent MS-2 transverse rectus abdominis musculocutaneous (TRAM), 8.3% underwent MS-1 TRAM, and 8.3% underwent pedicled TRAM flap reconstruction. No cases required re-exploration, no flap failure occurred, margins were clear, and no skin or nippleareolar complex ischemiaecrosis developed. In the aesthetic outcome evaluation, 16.7% were excellent, 75% good, 8.3% fair, and none were unsatisfactory. No recurrences were observed. Conclusion ETM through a minimal-access inferior mammary or mid-axillary line approach, followed by immediate pedicled TRAM or free abdominal-based perforator flap reconstruction, can be a safe means of achieving an “aesthetically scarless” mastectomy and reconstruction through minimal incisions.

Methicillin-resistant Staphylococcus aureus (MRSA) is a serious threat to the global healthcare system. Ineffective and resistance to antibiotic treatments have increased morbidity and mortality rates worldwide.New and effective antibiotics are needed to combat against bacterial resistance. Endophytic fungi are crucial reservoirs of novel bioactive metabolites. In particular, the secondary metabolites show promising therapeutic potential, notably, antibacterial. This review discussed the emerging potential of endophytic fungi as anti-MRSA agents. The ecological sources of endophytic fungi were discussed with the synthesis of bioactive metabolites.The mode of antibacterial actions was elucidated to give a better understanding of the mechanisms involved. This review may serve as an important reference for future discovery and developments of anti-MRSA agents from endophytic fungi.