Introduction: Gallstones disease is a common disorder and symptomatic disease is usually managed with surgery while those with common bile duct stones are usually managed with endoscopic intervention before proceeding to surgery. This study was intended to assess the rate of cholecystectomy among patients who had undergone ERC interventions, the reasons for not proceeding to cholecystectomy and related complications. Materials and Methods: Patients who had intact gallbladder and had undergone ERC for stones related complications over a two year period were retrospectively identified from the Endoscopic Unit Registry. Detailed case note reviews were conducted. Results: The overall cholecystectomy rate post-ERC interventions was 36.9% (48/130). Cholecystectomy was offered to 59.2% (n=77) and the uptake was only 58.4% (n=45/77). Among those who agreed for cholecystectomy, 11.1% (n=5/45) failed to turn up for their scheduled surgery. Three patients (6.7%) had symptoms recurrence before their scheduled surgery: two subsequently underwent cholecystectomy without ERC intervention and one who was pregnant was managed conservatively with holecystectomy. Among the patients who had declined cholecystectomy, 18.8% (n=6/32) had symptoms recurrence. Four patients required repeat ERC interventions and eventually all had cholecystectomy subsequently. The most common reason for declining cholecystectomy was 'not keen' and already asymptomatic (46.9%, n=15/32). Among patients who were not offerred cholecystectomy (n=53/130), symptoms recurrence occurred in 15.2% (n=7/53). Four patients required repeat ERC interventions and three subsequently underwent cholecystectomy. Conclusions: The cholecystectomy rate remains low after ERC interventions. Recurrence of symptoms necessating re-interventions occurred in patients offerred and not offerred cholecystectomy. The uptake rate should be improved and delay to cholecystectomy should be reduced to avoid symptoms recurrence. Patients not undergoing interventions should be advised regarding symptoms recurrence and should be monitored.
Choledocholithiasis ; Cholecystectomy ; Cholangiopancreatography, Endoscopic Retrograde ; CHOLELITHIASIS

The purpose of this study was to determine the sawmill workers’ knowledge, attitude and practice (KAP) in relation to noise-induced hearing loss (NIHL). A cross-sectional study was conducted involving 83 workers from 3 factories in Kota Bharu, Kelantan. Questionnaires were distributed to obtain the socio-demography, knowledge, attitude and practice level in relation to noise-induced hearing loss (NIHL). The weak areas identified in the knowledge section were treatment aspects (15.5%), signs and symptoms of NIHL (20.2%) and risk factors (31%). As for attitude; the prevention aspects were the lowest (25.3%), followed by risk taking attitude (26.2%), and causes of hearing loss (42.1%). Overall, the practice was not encouraging at all. It is important to have an education program to raise workers’ awareness and to improve their attitude and practices towards noise-induced hearing loss.

This study assesses inter-examiner reproducibility in recording various malocclusion parameters and Index of Orthodontic Treatment Need (IOTN) grade during patient examination by utilising the kappa statistic. Five previously calibrated orthodontists clinically examined 233 non-orthodontically treated schoolchildren aged 14-17 years for recording various malocclusion parameters. The examination was repeated twice, thirty days apart and precluded the use of study-models or radiographs. Although good inter-examiner reproducibility was observed in recording incisor class, IOTN dental health grade, type of posterior crossbite, and excellent for parameters with absolute criteria like erupted supernumeraries, etc, substantial examiner variation resulted in only fair reproducibility for recording IOTN esthetic category, canine class, overbite category, traumatic overbite and upper centre-line shift of two millimetres or more from the facial midline. Reproducibility for detecting occlusal displacement in the presence of crossbite was poor, and kappa statistic was incalculable for recording openbite and number of upper incisors rotated 30° or more. Kappa was also incalculable for recording IOTN dental health subcategory due to the creation of asymmetric tables caused by rarely chosen subcategory options. Despite prior agreement between previously calibrated examiners on evaluation criteria, detection of certain malocclusion parameters during an epidemiological examination can prove to be challenging. Epidemiological studies that report on prevalence of malocclusion in the population should always report on the kappa reproducibility, especially if the study is carried out by multiple examiners.
Malocclusion ; Orthodontics ; Epidemiologic Studies

Dental caries is an important community dental health problem with limited studies in the mixed dentition stage. The aim of this study was to determine the caries prevalence and treatment needs among 7- 9 year old school children in Kelantan which is situated in North East Malaysia. A retrospective dental record review of fully documented dental records belonging to primary school children attending a paediatric dental clinic was conducted. Dental caries was recorded using dmft index and DMFT index for deciduous teeth and permanent teeth respectively. Three hundred and nineteen dental records of 175 (54.9%) boys’ and 144 (45.1%) girls’ were selected and subjected to a ‘dental record study’. The prevalence of dental caries was 93% (95% CI : 89,97) in primary dentition and 50.5% (95% CI : 42.2, 58.8) in permanent teeth. Mean dmft and DMFT was 6.2(SD 3.39) and 1.04(SD 1.34) respectively. Regarding treatment needs in the primary dentition, 35.4% of teeth needed one surface filling, 34.7% needed extraction, 24.5% needed two or more surfaces filling and 5.6% needed pulp care. In the permanent dentition, 54.7% required sealants and 21.9% required one surface restoration. The caries prevalence and treatment needs were high among this study population in the mixed dentition stage, particularly showing the early involvement of newly erupted permanent teeth. It appears that high caries prevalence in the primary dentition is a risk factor for caries in newly erupted permanent teeth. Oral health promotions programmes are required in the mixed dentition stage and may reduce the risk of caries in permanent dentition.

Tooth wear is the non-carious loss of tooth tissue, which results from three processes namely attrition, erosion and abrasion. These can occur in isolation or simultaneously. Very mild tooth wear is a physiological effect of aging. This study aims to estimate the prevalence of tooth wear among 16-year old Malay school children and determine a feasible sample size for further study. Fifty-five subjects were examined clinically, followed by the completion of self-administered questionnaires. Questionnaires consisted of socio-demographic and associated variables for tooth wear obtained from the literature. The Smith and Knight tooth wear index was used to chart tooth wear. Other oral findings were recorded using the WHO criteria. A software programme was used to determine pathological tooth wear. About equal ratio of male to female were involved. It was found that 18.2% of subjects have no tooth wear, 63.6% had very mild tooth wear, 10.9% mild tooth wear, 5.5% moderate tooth wear and 1.8 % severe tooth wear. In conclusion 18.2% of subjects were deemed to have pathological tooth wear (mild, moderate & severe). Exploration with all associated variables gave a sample size ranging from 560 – 1715. The final sample size for further study greatly depends on available time and resources.

PURPOSE: Little evidence estimated the exposure of psychosocial work stressors, work-related fatigue, and musculoskeletal disorders for nurses working in South-East Asian region, and research on this subject is almost nonexistent in Brunei. The main aim of our study was to provide a comprehensive exploration and estimate exposure of the study variables amongst emergency (ER) and critical care (CC) nurses in Brunei. The study also aims to compare whether experiences of ER nurses differ from those of CC nurses. METHODS: This cross-sectional study was implemented in the ER and CC departments across Brunei public hospitals from February to April 2016 by using Copenhagen Psychosocial Questionnaire II, Occupational Fatigue Exhaustion Recovery scale, and Cornell Musculoskeletal Discomfort Questionnaire. RESULTS: In total, 201 ER and CC nurses (82.0% response rate) participated in the study. Quantitative demands of CC nurses were significantly higher than ER nurses. Even so, ER nurses were 4.0 times more likely [95% confidence interval (2.21, 7.35)] to experience threats of violence, and 2.8 times more likely [95% confidence interval: (1.50, 5.29)] to experience chronic fatigue. The results revealed that nurses experienced high quantitative demands, work pace, stress, and burnout. High prevalence of chronic and persistent fatigue, threats of violence and bullying, and musculoskeletal pain at the neck, shoulder, upper and lower back, and foot region, was also reported. CONCLUSION: This study has provided good estimates for the exposure rate of psychosocial work stressors, work-related fatigue, and musculoskeletal disorders among nurses in Brunei. It provided important initial insight for nursing management and policymakers to make informed decisions on current and future planning to provide nurses with a conducive work environment.
Asian Continental Ancestry Group ; Brunei* ; Bullying ; Critical Care Nursing ; Critical Care* ; Cross-Sectional Studies ; Emergencies* ; Emergency Nursing ; Fatigue* ; Foot ; Hospitals, Public* ; Humans ; Musculoskeletal Pain ; Neck ; Nursing ; Occupational Health ; Prevalence ; Shoulder ; Social Support ; Violence

Statistical editors of the Malaysian Journal of Medical Sciences (MJMS) must go through many submitted manuscripts, focusing on the statistical aspect of the manuscripts. However, the editors notice myriad styles of reporting the statistical results, which are not standardised among the authors. This could be due to the lack of clear written instructions on reporting statistics in the guidelines for authors. The aim of this editorial is to briefly outline reporting methods for several important and common statistical results. It will also address a number of common mistakes made by the authors. The editorial will serve as a guideline for authors aiming to publish in the MJMS as well as in other medical journals.

Antibodies, Bacterial ; COVID-19/prevention & control* ; Humans ; Injection Site Reaction ; RNA, Messenger ; Vaccination/adverse effects*

INTRODUCTION: Drug allergies are often self-reported but of unknown accuracy. We carried out a prospective study to examine the utility and safety of formal allergology evaluation, and to identify factors associated with accurate drug allergy labels. METHOD: All patients who underwent drug allergy evaluation in our clinic during the study period were recruited. Baseline demographics, characteristics of index hypersensitivity reaction and outcomes of evaluation were recorded. RESULTS: A total of 331 patients from March 2019 to June 2021 completed drug allergy evaluation to index drugs of concern. There were 123 (37%) male patients, and the mean age was 49 years (standard deviation 17). There were 170 beta-lactam antibiotics, 53 peri-operative drugs, 43 others, 38 non steroidal anti-inflammatory drugs, and 27 non-beta-lactam antibiotic evaluations. Index reaction occurred within 5 years in 165 (50%) patients, with latency of less than 4 hours in 125 (38%) patients. The most common index reactions were rash, angioedema and urticaria. There were 57 (17%) evaluations stratified as low risk, 222 (67%) moderate risk, and 52 (16%) high risk based on multidisciplinary consensus. Allergy label was found to be false (negative drug evaluation) in 248 (75%) patients, while 16/237 (7%) skin tests, 44/331 (13%) in-clinic graded challenge, and 23/134 (17%) home prolonged challenges were positive (true drug allergy). The most common evaluation reactions were rash and urticaria. No cases of anaphylaxis were elicited. CONCLUSION Seventy-five percent of drug allergy labels are inaccurate. Risk-stratified, protocolised allergy evaluation is safe. Prolonged drug challenge increases the sensitivity of drug allergy evaluation and should therefore be performed when indicated.
Humans ; Male ; Middle Aged ; Female ; Prospective Studies ; Drug Hypersensitivity/epidemiology* ; Exanthema ; Urticaria ; Monobactams