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Does Overnight Culture of Cleaved Embryos Improve Pregnancy Rate in Vitrified-Warmed Embryo Transfer Programme?

Azam Agha-Rahimi ; Marjan Omidi ; Fatemeh Akyash ; Azita Faramarzi ; Forough Alsadat Farshchi

Malaysian Journal of Medical Sciences.2019;26(2):52-58. doi:10.21315/mjms2019.26.2.6

Background: Vitrification is a routine procedure in assisted reproductive technique (ART) lab. However, there is widespread variability between protocols of different centres. The aim of this study was to compare the chemical pregnancy, clinical pregnancy and live birth rates between one-day embryo culture and immediate transfer for frozen-thawed embryo transfer (FET) cycles. Methods: In this cohort retrospective study, 366 FET cycles were divided into two groups: Group A, the embryos were warmed one day before transfer, and were cultured overnight; Group B, the embryos were warmed on the same day of transfer, at least were cultured 1 h before embryo transfer (ET). Chemical and clinical pregnancy and live birth rates were compared between two groups. Results: The chemical pregnancy was higher in group A than B (37.9% versus 28.9%), but this difference was not significant (P = 0.07). Clinical pregnancy (30.8% versus 24.1%) and live birth (19.8% versus 22.05%) were similar in group A and B, (P = 0.15), and (P = 0.8). Conclusion: In conclusion, overnight culture and confirmation of mitosis resumption was not essential for FET cycles in vitrification method.

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Serum Ferritin Levels: A Potential Biomarker to Represent Child-Turcotte-Pugh Score among Decompensated Liver Cirrhosis Patients

Taufik Sungkar ; Muhammad Fakhrur Rozi ; Leo Basa Dairi ; Lukman Hakim Zain

Malaysian Journal of Medical Sciences.2019;26(2):59-65. doi:10.21315/mjms2019.26.2.7

Background: Liver cirrhosis and the child-Turcotte-Pugh (CTP) score are inseparable entities in liver disease. CTP score is largely known as the mortality and prognosis predictor. Nevertheless, ferritin emerges as a simple biomarker related to prognosis. The study aimed to determine whether there was a significant correlation between serum ferritin levels and CTP score. Methods: The study analysed 54 decompensated liver cirrhotic patients including 17 females and 37 males between May 2016 and May 2017 at the Haji Adam Malik General Hospital, Medan, Indonesia. Ferritin levels were, then, divided into trichotomous cut-off value (< 200 ng/ mL, n = 22; 200–400 ng/mL, n = 5; and > 400 ng/mL, n = 27). Data was analysed using SPSS version 12.0 (continuous variables were assessed by the Kruskal-Wallis test and Chi-square test was used for categorical variables). In addition, Spearman correlation test was used to determine any significant correlation between ferritin levels and CTP score. Results: Based on data analysis, gender and CTP score were related to higher ferritin levels (P = 0.002 and P = 0.018, respectively). Furthermore, a significant correlation between serum ferritin levels and CTP score was obtained in to moderate degree (P = 0.000; r = 0.487). Conclusions: There might be a significant role of serum ferritin levels in predicting mortality and prognosis among decompensated liver cirrhosis patients but it still needs further attention.

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Laboratory Study on Injection Force Measurement on Syringe and Needle Combinations

Theddeus Octavianus Hari Prasetyono ; Prasasta Adhistana

Malaysian Journal of Medical Sciences.2019;26(2):66-76. doi:10.21315/mjms2019.26.2.8

Background: This study aimed to measure the least initial and maintenance forces of syringe and needle combinations to provide a reference for local anesthetic injection. Methods: An experimental study was conducted in our Physics Laboratory during September 2015. A series of syringes sized 1 mL, 3 mL, 5 mL, 10 mL and 20 mL were paired with the original needles, 27G, 27G spinal and 30G. Each combination was tested three times using a compression testing Instron 5940 Series to measure initial and maintenance forces. Statistical analysis was performed using One-way ANOVA. Results: The lowest initial force was shown by the combination of 1 mL syringe and 27G spinal needle. However, the 1 mL syringe showed no significant difference across the needles [F(3, 8) = 3.545; P < 0.068]. The original and 27G needle showed mean difference 0.28 (95%CI: −0.19, 0.75; P = 0.420). The lowest maintenance force was measured in the combination of 1 mL syringe and its original 26G needle. On the contrary, both the highest initial and maintenance forces were shown by the combination of 10 mL syringe and 30G needle. Conclusion: The 1 mL syringe with original 26G needle shows the best combination.

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The Use of Medicines with Anti-cholinergic Properties and Their Health Impacts among Hospitalised Malaysian Geriatric Patients

Izyan A Wahab ; Bakht Akbar ; Zainol Akbar Zainal ; Mohd Farizh Che Pa ; Basariah Naina

Malaysian Journal of Medical Sciences.2019;26(2):77-87. doi:10.21315/mjms2019.26.2.9

Background: Studies have shown that the use of medicines with anti-cholinergic (Ach) properties can increase elderly patients’ risk of experiencing falls, confusion, and longer hospital stays (LOS). These adverse effects are preventable with appropriate intervention. Little is known about the use of medicines with Ach properties and their impact on Malaysian elderly patients. This study aimed to investigate the use of medicines with Ach properties and their impact on fall risk, confusion, and longer LOS among hospitalised elderly patients. Methods: This study utilised a cross-sectional design and was conducted at a single centre where convenience sampling was employed to collect data from elderly patients (> 60 years) admitted to geriatric and medical wards at Hospital Tuanku Ja’afar during a 2-month period (July 2017–August 2017). Patients were excluded from this study if their hospital admission was planned for an elective procedure or if neurocognitive and hepatic impairment were diagnosed prior to the hospital admission. Medicines with Ach properties were identified and classified according to the anti-cholinergic drug scale (ADS). Univariate and multiple logistic regression statistical analyses were performed to assess its impacts on falls, confusion, and LOS. Results: A total of 145 elderly patients with a mean age of 71.59 years old (SD = 8.02) were included in the study. Fifty-two percent of the participants were female, and the average hospital stay was 6 days (SD = 2.09). Medicines with Ach properties were administered in 62% (n = 90) of the cases. The most commonly prescribed medicine with Ach properties was furosemide (n = 59), followed by ranitidine (n = 44), warfarin (n = 23), and methylprednisolone (n = 22). Compared to patients who did not receive medicines with Ach properties, patients who received them had a significantly higher risk of falls [odds ratios (OR) = 2.61; 95%CI: 1.18, 5.78; P = 0.018], confusion (OR = 3.60; 95%CI: 1.55, 8.36; P = 0.003), and LOS (OR = 4.83; 95%CI: 2.13, 10.94; P < 0.001). Multiple comorbidities also showed a significantly increased risk of falls (OR = 3.03; 95%CI: 1.29, 7.07; P = 0.010). Conclusion: Medicines with Ach properties had a significant impact on elderly patients’ health. Strategies for rationally prescribing medicines with Ach properties to Malaysian elderly patients need to be improved and be recognised as an important public health priority.

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Stressors and Coping Strategies during Clinical Practice among Diploma Nursing Students

Rusnani Ab Latif ; Mohd Zarawi Mat Nor

Malaysian Journal of Medical Sciences.2019;26(2):88-98. doi:10.21315/mjms2019.26.2.10

Introduction: Consistent with the significant of the stress issue in education, this study aimed to survey type of stressors and identifies the coping strategies used by diploma nursing students during clinical practices. Methods: A descriptive cross-sectional study was carried out at the Kubang Kerian Nursing College, Kelantan which involved 346 respondents using simple random sampling method. The inclusion criteria were year one, two and three of nursing students who have clinical posting and voluntarily joining the study. Perceived Stress Scale (PSS) and Brief COPE inventory were utilised in the data collection. Higher mean score indicates higher degree of stress. Results: Clinical assignments and workload were the main stressor (mean = 3.19, SD = 1.09). Religion approach was the most coping strategy applied (mean = 3.30, SD = 0.71). Pearson’s correlation coefficient test found that six domains of stressors during clinical practices (taking care of patients; clinical educators/instructors and ward staff; clinical assignments and workload; peers and nursing students from other college; lack of professional knowledge and skills and clinical environment) were statistically significant correlation with coping strategies, where P-value < 0.05. Conclusion: Clinical assignment was the main stressor among nursing students; therefore, successful activities should be promoted to help them in managing clinical assignment and enhancing knowledge in religion.

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Confirmatory Factor Analysis of the Malay-Language Transtheoretical Model of Physical Activity among Malaysian Primary School Children

Hussein Rizal ; Mawar Siti Hajar1, ; Yee Cheng Kueh ; Ayu Suzailiana Muhamad ; Garry Kuan

Malaysian Journal of Medical Sciences.2019;26(2):99-113. doi:10.21315/mjms2019.26.2.11

Introduction: The transtheoretical model (TTM) is an integrative model of intentional change consisting of stages of change, processes of change, decisional balance and self-efficacy. This study aimed at validating the TTM questionnaires on physical activity for Malaysian children using confirmatory factor analysis. Methods: The participants were 381 Malay students (188 male; 193 female), aged 10–12 years old, with a mean age of 10.94 (SD = 0.81). The original version of the TTM was translated into the Malay language using forward and backward translation. Certain phrases were adapted based on the local culture and vocabulary suitable for primary school students. Results: The final measurement models and their fit indices were: processes of change (CFI = 0.939, TLI = 0.925, SRMR = 0.040, RMSEA = 0.030); decisional balance (CFI = 0.897, TLI = 0.864, SRMR = 0.045, RMSEA = 0.038); and self-efficacy (CFI = 0.934, TLI = 0.915, SRMR = 0.042, RMSEA = 0.032). Conclusion: Care must be taken when using the TTM with children, as it has been prevalently validated with adults. The final version of the TTM questionnaire for Malay primary school children had 24 items for process of changes, 13 items for self-efficacy and 10 items for decisional balance.

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Validity and Reliability of the Wii Balance Board for Static Balance Assessment in Healthy Young Adults

Kitchana Kaewkaen1,4 ; Suraphong Uthama ; Worasak Ruengsirarak ; Rungthip Puntumetakul

Malaysian Journal of Medical Sciences.2019;26(2):114-121. doi:10.21315/mjms2019.26.2.12

Introduction: The Wii Balance Board (WBB) is a commonly used tool for balance assessment, however the inconsistency in the reported validity for the WBB when used for the assessment of healthy young adults needs to be clarified. Aim: To investigate the concurrent validity and reliability of the WBB for balance assessment in healthy young adults. Methods: Thirty-two young adults participated in this study. Their ability to balance was tested while standing on a WBB and a laboratory-grade force platform, under three conditions: feet together with eyes open, feet together with eyes closed and semi-tandem standing with eyes open. They had 10 min resting period between tests. The agreement between the WBB and the laboratory-grade force platform was investigated, and the reliability of the WBB was determined. Results: A poor agreement between the WBB and the laboratory-grade force platform was found for all standing conditions [intraclass correlation coefficient (ICC) = 0.03 to 0.07]. A moderate to high reliability was found for the WBB for balance assessment in healthy young adults (ICC = 0.66 to 0.76). Conclusion: The WBB was found to be a reliable tool for static balance assessment in healthy young adults. However, it had poor validity compared to the laboratory-grade force platform.

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Mohammad Heidari ; Mansureh Ghodusi Borujeni ; Parvin Rezaei ; Shokouh Kabirian Abyaneh

Malaysian Journal of Medical Sciences.2019;26(2):122-130. doi:10.21315/mjms2019.26.2.13

Background: Work-related musculoskeletal disorders (WMSDs) in nursing are regarded as an important factor for creating tension since they may often cause discontent, leave profession, and provide incorrect services to their clients. The present study aimed to determine WMSDs and their related factors among the nursing staff in university hospitals affiliated to Shiraz University of Medical Sciences (SUMS). Methods: In the present descriptive cross-sectional study, 300 nurses in SUMS were selected based on systematic random sampling. To this aim, demographic information, and Nordic musculoskeletal disorder questionnaires were used for data collection. The data were analysed by descriptive and analytical tests (mean, standard deviation, independent t-test, and ANOVA) by SPSS/21 software. Results: Based on the findings of WMSDs, low back disorders (88.33%) were more prevalent. In addition, a significant relationship was observed between WMSDs in different areas of the body with age, sex, and work experience and hours (P < 0.05). Conclusion: Regarding the high prevalence of WMSDs among nurses, it is recommended to adopt interventional program for preventing WMSDs by reducing working hours and physical pressure control.

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Neurosciences at Universiti Sains Malaysia Represent Malaysia to Support Global Precision Brain Health

Jafri Malin Abdullah

Malaysian Journal of Medical Sciences.2019;26(3):1-23. doi:10.21315/mjms2019.26.3.1

The combined effort of the neuroscience and psychology cluster at the Universiti Sains Malaysia (USM)—fundamental, applied and clinical—has moved the institution to the number two position in the country, behind Universiti Malaya. The strategy to join the Global Brain Consortium (GBC) and put Malaysia on the map to address the GBC mission, vision, focus areas and outcomes began recently, in May 2019.

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Treatments for Anxiety Disorders in Malaysia

Jamilah Hanum Abdul Khaiyom ; Firdaus Mukhtar ; Oei Tian Po

Malaysian Journal of Medical Sciences.2019;26(3):24-36. doi:10.21315/mjms2019.26.3.2

This current study aims to systematically review the treatments for anxiety disorders in Malaysia. PsycINFO, MEDLINE databases, and 28 local journals were used to search published papers in this area. Eight articles were subjected to review after excluding 273 papers that did not meet the inclusion criteria. A total of 598 participants with various types of anxiety disorders were included in the review. Based on the findings, the combination of pharmacotherapy and psychotherapy provided better treatment outcomes if compared to psychotherapy or pharmacotherapy alone. The combination of selective serotonin reuptake inhibitors and cognitive behaviour therapy was considered as one of the most effective treatment to treat patients with anxiety disorders in Malaysia. This is in line with the clinical practice guidelines from the Ministry of Health Singapore and Canada. Even though there were some limitations in the methodology and reporting of the results, it can be concluded that efforts have been taken to conduct studies related to treatments for patients with anxiety disorders in Malaysia. Future studies are suggested to make conscious efforts to overcome these limitations.

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