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Although the Ministry of Health Malaysia has been encouraging the practice of Traditional and Complementary Medicine (T&CM)1, 2, 3, 4 but patients/clients has not been able to apply it for their need of medical treatments and sometimes it leads to negative outcomes due to lack of knowledge on T&CM and its safe applications5,6’7,8 Most of the western-trained physicians are ignorant of risk and benefits of T&CM9,10,11. This study was aimed to determine the gap between knowledge regarding T&CM and perception on education in T&CM among the medical staffs in five selected hospitals in Malaysia. A cross-sectional survey was done at five public hospitals among medical staff in Malaysia by using quantitative methods. A total of 477 medical staffs were involved in this study. The study showed that the overall knowledge of T&CM among the medical staffs were poor (61.2%). Having good knowledge regarding T&CM were significantly higher in Hospital Duchess of Kent (52%, p=0.001), among the non-Malays (44%, p=0.047) and pharmacists (47.2%, p=0.030). Positive perception on health education in T&CM among medical staffs were high (85.3%) especially among females (88.1%, p=0.002) and pharmacists (93.7%, p<0.001). The use of T&CM among the general population is relatively high in Malaysia and many patients increasingly seek the information on T&CM therapies from medical staffs. Knowledge regarding T&CM was poor in this study because most of the medical staffs have not been exposed to T&CM education. This interesting scenario between poor knowledge and high positive perception on health education in T&CM shows the demand of urgent intervention in educating the medical staffs. We recommend that medical staffs must have some basic education and knowledge about T&CM before they could offer advice to their patients. Doctors are of the utmost important in this regard because they play a very important role in patient care. Providing T&CM education to medical staff may help to integrate T&CM into the mainstream medicine.
Medicine, Traditional ; Complementary Therapies

Bone turnover markers (BTMs) are useful in the assessment of bone health status. However, the infl uence of age, ethnicity and body anthropometry on the level of BTMs in men remains understudied. This study aimed to determine the infl uence of these factors on the level of BTM, namely osteoclacin (OC) and C-terminal telopeptides of type 1 collagen (CTX-1) among Malay and Chinese men (N = 407) aged 20 years and above in Klang Valley. The subjects were recruited using purposive sampling method. Their height, body weight and body mass index were measured. Their blood was collected in the morning for serum OC and CTX-1 analysis using enzyme-linked immunoasorbent assays. Results showed that OC and CTX-1 levels were signifi cantly higher in Malay compared to Chinese men (p < 0.05). Highest levels of OC and CTX-1 were observed in men aged 20-29 years, while the lowest levels were found among men aged 30-39 years (p < 0.005). No signifi cant diff erences in the levels of both markers were found between the older men and those aged 30-39 years (p > 0.005). There were signifi cant and negative correlations between OC and body mass index and weight, which were signifi cant for men aged 20-39 years only (p < 0.05). Body anthropometry was not correlated with CTX-1 level in men (p > 0.05). As a conclusion, levels of BTMs in Malaysian men could be infl uenced by age, ethnicity and body anthropometry. Thus, these factors should be taken into consideration in the evaluation of bone health status of men using BTMs

Newborn screening (NBS) program is an important tool for the early diagnosis and preventive treatment of life-long impairments. NBS is one of the strategies recommended by the World Health Organization to promote the primary prevention of congenital anomalies and the health of children with these conditions. However, NBS initiation and implementation in developing countries, especially South-East Asian and North African regions, are slow and challenging. Expanded NBS is not mandatory and has not yet been incorporated into the public healthcare system in our country. Limited funding, manpower shortages, inadequate support services, low public awareness, and uncertain commitment from healthcare practitioners are the main challenges in establishing this program at the national level. Involvement and support from policy makers are very important to the success of the program and the benefit of the entire population.

Literature data on association between physical activity (PA) and health related quality of life (HRQoL) in non-clinical adults population are still limited. Thereby, the objective of this study was to evaluate the association between PA and HRQoL among the non-academic staff serving the Faculty of Health Sciences (FSK), Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur (KL). In this cross sectional study, 105 non-academic staffs aged between 18 to 60 years were recruited. Self-administered questionnaires (Malay version of the International Physical Activity Questionnaire and World Health Organisation Quality of Life-Brief Version) were administered among the participants. Mann Whitney test and Spearman’s rho correlation were employed for the statistical analysis using SPSS version 22.0 Majority of participants (72.4%) demonstrated high PA scores of ≥ 3000 MET-minutes/week. PA scores between genders was not statistically significant (p = 0.137). However, total PA score of support staffs (median = 9039.0, IQR = 15811.00) was significantly higher compared to staffs in management and professional group (median = 4329.0, IQR = 4189.00). The mean(SD) self-perceived HRQoL score was 3.4 (0.76). There were no significant correlation between PA and all domains of HRQoL such as physical health, psychological, social relationship and environmental domains (Correlation coefficient, ρ = -0.108, 0.003, -0.023, 0.026 respectively) with p = 0.273, 0.978, 0.818, 0.794 respectively. Majority of non-academic staffs of FSK, UKM engaged in high physical activity. The PA levels of support staffs were significantly higher than management and professional staffs. However, there was no statistically significant correlation observed between PA and domains of HRQoL.
Life Style

Ketamine can be abused as a recreational drug, and there has been a recent surge in its usage. The effects of ketamine on the urinary system were unknown until the recent publication of a few case reports. Many doctors are still unaware of this new clinical entity, termed ketamineassociated ulcerative cystitis. We report a case that we encountered and discuss the diagnosis and disease management in addition to a review of the literature.

Purpose: Perianal fistula is one of the most common anorectal diseases in adult patients, especially men. A relationship between pyogenic perianal abscess and fistula formation is established in multiple domains. This is the first exploration of such association among patients in the country as no related study has been published in Bahrain. We expect this study to be a foundation for future protocols and evidence-based practice. Methods: A retrospective study was conducted in Salmaniya Medical Complex of Bahrain. A total of 109 patients with a diagnosis of anal abscess were included between 2015 and 2018. Data were collected from the electronic files database used in Salmaniya Medical Complex (iSeha) as well as phone calls to the patients. Collected data were analyzed using statistical software. Results: The most predominant presentation of perianal abscess was pain. Over 50% of abscesses were classified as perianal (56.9%) and among those, left-sided abscesses were more common, followed by right-, posterior-, and anterior-sited, respectively. No recurrence of abscess was recorded among 80% of patients. A fistula developed following abscess drainage in 33.9% of patients. Most fistulas (37.8%) were diagnosed within 6 months or less from abscess drainage. Posterior fistulas were the most common, followed by anterior and left-sided fistulas. Conclusion The incidence of anal fistula in Bahrain after perianal abscess was 33.9%. Most of the patients who developed a fistula following pyogenic abscess drainage were males and above the age of 40 years. The most common site for fistula was posterior.

PURPOSE: This study aimed to determine the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among infants with neonatal indirect hyperbilirubinemia (NIH); compare G6PD-deficient and G6PD-normal patients regarding hyperbilirubinemia and need for exchange transfusions (ET); and assess risk factors for ET and kernicterus. METHODS: This is a case-control retrospective study. Medical records of NIH patients admitted to the Pediatric Department, Salmaniya Medical Complex, Bahrain, between January 2007 and June 2010 were reviewed. Data on sex, age at presentation, hospitalization duration, need for ET, hemoglobin (Hb) level, reticulocyte count, direct Coombs test, serum total and indirect bilirubin levels, thyroid function, blood and urine cultures, G6PD status, and blood groups were collected and compared between the G6PD-deficent and G6PD-normal patients. RESULTS: Of 1,159 NIH patients admitted, 1,129 were included, of whom 646 (57%) were male. Among 1,046 patients tested, 442 (42%) were G6PD deficient, 49 (4%) needed ET, and 11 (1%) had suspected Kernicterus. The G6PD-deficient patients were mainly male (P<0.0001), and had lower Hb levels (P<0.0001) and higher maximum bilirubin levels (P=0.001). More G6PD-deficient patients needed ET (P<0.0001). G6PD deficiency (P=0.006), lower Hb level (P=0.002), lower hematocrit count (P=0.02), higher bilirubin level (P<0.0001), higher maximal bilirubin level (P<0.0001), and positive blood culture result (P<0.0001) were significant risk factors for ET. Maximal bilirubin level was a significant risk factor for kernicterus (P=0.021) and independently related to ET (P=0.03). CONCLUSION: G6PD deficiency is an important risk factor for severe NIH. In G6PD-deficent neonates, management of NIH should be hastened to avoid irreversible neurological complications.
Bahrain ; Bilirubin ; Blood Group Antigens ; Case-Control Studies ; Coombs Test ; Glucose-6-Phosphate* ; Glucosephosphate Dehydrogenase Deficiency* ; Glucosephosphate Dehydrogenase* ; Hematocrit ; Hospitalization ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal* ; Infant ; Infant, Newborn ; Kernicterus ; Male ; Medical Records ; Prevalence ; Reticulocyte Count ; Retrospective Studies ; Risk Factors ; Thyroid Gland

The multiracial population in Malaysia has lived together for almost a century, however, the risk ofgastric cancer among them varies. This study aimed to determine the distribution of different gastricadenocarcinoma subtypes and Helicobacter pylori infection status among gastric adenocarcinomapatients. Patients with gastric adenocarcinoma were enrolled from November 2013 to June 2015.Blood samples were collected for detection of H. pylori using ELISA method. Gastric adenocarcinomacases were more prevalent in the Chinese (52.8%), followed by the Malays (41.7%) and leastprevalent in the Indians (5.6%). Gastric adenocarcinoma located in the cardia was significantly moreprevalent in the Malays (66.7%) compared to the Chinese (26.3%), whereas non-cardia cancer wasdiagnosed more in the Chinese (73.7%) compared to the Malays (33.3%) [P = 0.019; OR = 5.6, 95CI: 1.27 to 24.64]. The Malays also had significantly higher prevalence of gastric tumour locatedat the cardia or fundus than other gastric sites compared to the Chinese (P = 0.002; OR: 11.2, 95%CI: 2.2 to 56.9). Among the cardia gastric cancer patients, 55.6% of the Malays showed intestinalhistological subtype, whereas all the Chinese had the diffuse subtype. More than half of the patients(55.3%) with gastric adenocarcinoma were positive for H. pylori infection and among them, 66.7%were Chinese patients. The risk of gastric adenocarcinoma in our population is different amongethnicities. Further studies on host factors are needed as it might play an important role in gastriccancer susceptibility in our population.

Chrysomya megacephala (Fabricius) and Chrysomya rufifacies (Macquart) are two important species of blow flies that could be utilised as indicators to estimate the Post Mortem Interval (PMI) of corpses in forensic science. Determination of PMI of corpses is based on the larva size and its development stages. Development studies of eggs, larvae and pupae of Ch. megacephala and Ch. rufifacies at 27ºC, 30ºC and 33ºC were carried out using an insect growth chamber. Data from these studies were used to construct growth curves and Accumulated Degree Hours (ADH) for both species. Ch. megacephala needs 9.15 days to complete one life cycle at 27ºC, 8.54 days at 30ºC and 6.76 days at 33ºC. Development for Ch. rufifacies is slower than Ch. megacephala and takes 9.92 day at 27ºC, 9.13 days at 30ºC and 7.44 days at 33ºC. Eggs of the two species hatch faster at 33ºC compared to the two other temperatures. Low value of ADH shows shorter life cycle of that particular species. This study’s findings are useful in estimating PMI of the corpses found under various environmental temperatures.