INTRODUCTION: Glaucoma is a leading cause of permanent blindness, often going undetected in its early, asymptomatic stages, especially in older age groups. In Malaysia, glaucoma is a growing public health issue due to an increase in the ageing population. While screening is essential for early glaucoma detection, the most suitable strategy for Malaysia's healthcare system remains unclear. This study explored the perspectives of eye healthcare professionals on the most suitable glaucoma screening strategies for Malaysia. MATERIAL AND METHODS: This qualitative study used semi-structured interviews with 19 eye health professionals (ophthalmologists, optometrists, nurses, ophthalmic technicians, and assistant medical officers) practicing in the Klang Valley. The interviews were conducted face-to-face in their workplace or via a video conferencing platform. All interviews were recorded, transcribed, and analysed using thematic analysis. RESULTS: Six major themes were identified: types of glaucoma screening programmes, accessible screening locations, target screening population, instruments and use of digital technology, trained personnel, and referral criteria. Opportunistic case finding and population-based programmes were identified as the glaucoma screening programmes in which trained personnel conducted screening at accessible locations. Glaucoma screening for high-risk individuals was recommended, focusing on visual acuity testing, tonometry, anterior chamber angle assessment, funduscopy, perimetry, and retinal nerve fibre assessment. A lack of clear referral criteria due to low awareness and poor implementation of existing guidelines was observed. CONCLUSION: Further investigations are required to identify the best combination of components for glaucoma screening. This will enable policymakers to develop an effective glaucoma screening programme in Malaysia.

BACKGROUND: Postoperative pain is a common, distressing symptom following arthroscopic knee surgery. The aim of this study was to compare the potential analgesic effect of dexmedetomidine after intrathecal versus intra-articular administration following arthroscopic knee surgery. METHODS: Ninety patients undergoing unilateral elective arthroscopic knee surgery were randomly assigned into three groups in a double-blind placebo controlled study. The intrathecal dexmedetomidine group (IT) received an intrathecal block with intrathecal dexmedetomidine, the intra-articular group (IA) received an intrathecal block and intra-articular dexmedetomidine, and the control group received an intrathecal block and intra-articular saline. The primary outcome of our study was postoperative pain as assessed by the visual analogue scale of pain (VAS). Secondary outcomes included the effect of dexmedetomidine on total postoperative analgesic use and time to the first analgesic request, hemodynamics, sedation, postoperative nausea and vomiting, patient satisfaction, and postoperative C-reactive protein (CRP) levels. RESULTS: Dexmedetomidine administration decreased pain scores for 4 h in both the intrathecal and intra-articular groups, compared to only 2 h in the control patient group. Furthermore, there was a significant reduction in pain scores for 6 h in the intra-articular group. The time to the first postoperative analgesia request was longer in the intra-articular group compared to the intrathecal and control groups. The total meperidine requirement was significantly lower in the intra-articular and intrathecal groups than in the control group. CONCLUSIONS: Both intrathecal and intra-articular dexmedetomidine enhanced postoperative analgesia after arthroscopic knee surgery. Less total meperidine was required with intra-articular administration to extend postoperative analgesia to 6 h with hemodynamic stability.
Analgesia ; Arthroscopy* ; Bupivacaine* ; C-Reactive Protein ; Dexmedetomidine* ; Hemodynamics ; Humans ; Knee* ; Meperidine ; Pain, Postoperative* ; Patient Satisfaction ; Postoperative Nausea and Vomiting

Agriculture sector accounts significant numbers of injuries and fatalities in the workplace particularly related to pesticide management. Among three main pathways of pesticide exposure, dermal contact is the most common route, which exposure usually occurs during pesticide mixing/loading, application, harvesting and other farming activities. This review aims to present and discuss several vital components of pesticide dermal exposure among agriculture workers, as well as pesticide application in agriculture sector in Malaysia involving different commodity agriculture sub-sectors. Pesticide exposure was discussed from perspective of three pesticide management activities (i.e. preparation, application and cleaning) that contribute to the risk of exposure through three routes (i.e. emission, deposition, transfer). Moreover, this paper also discussed pesticide dermal exposure risk assessment methods which can be defined into exposure assessment and effect assessment. The exposure rate was affected by various factors such as application equipment, application rate and duration, type of pesticide formulation, pesticide management stage, usage of personal protective equipment, training and aptitude of the applicator as well as environmental factors (i.e. temperature, humidity, wind speed and direction). The factors mention earlier have been used to explain the exposure distribution over different parts of the body and support the fact that pesticide type was not a major factor in total exposure.
Pesticide ; dermal exposure ; exposure risk ; distribution

Gelam honey was reported to exhibit anti-oxidative, anti-tumour and anti-inflammatory properties against many types of cancer. The main aim of the present study was to evaluate the effect of Gelam honey on the oxidative stress level of human lung cancer cells. IC50 of Gelam honey was identified by treating A549 cells with different doses of honey (50-200 mg/ml). The cells were divided into four groups and induced with stress using hydrogen peroxide (H2O2) accordingly: control, H2O2, Gelam honey, H2O2 + Gelam honey. After 24 hrs of treatment, oxidative stress markers such as malondialdehyde (MDA) and protein carbonyl, were determined. Induction of oxidative stress significantly increased the levels of MDA (p<0.05) but had no effect on protein carbonyl levels. Treatment with Gelam honey was found to reduce MDA levels (p<0.05) in A549 cells exposed to H2O2 but had no effect on the level of protein carbonyl. Interestingly, Gelam honey treatment alone had no effects on the levels of MDA and protein carbonyl. In conclusion, Gelam honey reduces lipid peroxidation but not protein oxidation in human lung cancer cells subjected to oxidative stress.

The information of biomechanical properties is crucial in the study of biological tissue and its clinical relevance. 3mm x 3mm free gingival human tissues was taken using disposable punch biopsy (Accu sharp blade, India) and stored in 0°C Freezer. The sample was sectioned to a thickness of 10μm using high profile microtome blade (Leica 818, Germany) and cryostat (Leica CM1850UV, United Kingdom). The sample was analysed using Atomic Force Microscope (Nanowizard® 3, JPK Instruments, Germany) at room atmosphere. The collagen fibrils of the free gingival tissues appeared to be stacked in basket weave like structure. The mean value of free gingival collagen fibrils width and the length of D-band were 106.71±11.18nm and 65.82 ± 3.04nm respectively. The Young’s modulus of collagen fibrils for human free gingival tissue at overlap region was 212.88 ± 242.58 MPa, whereas at the gap region was 207.00 ± 230.71 MPa. Within the limitation of the study, the collagen fibrils appeared to be stacked in basket weave-like structure. The length and width of the collagen fibril were similar to the values investigated using other techniques. There was significant linear relationship between Young’s modulus of overlap and gap regions.

Angiography is the gold standard for the diagnosis and treatment of vascular and related diseases. However, the challenges and peculiarities of the procedure may result in increased fluoroscopy time and number of acquired images, which increased personnel and patients‟ radiation exposure. This study determines the dose area product readings following diagnostic and interventional angiographic procedures in an attempt to establish reference values for patient radiation dose optimization. This retrospective study reviewed the cases of 25 patients that were managed at the teaching hospital. Types of angiographic procedure, exposure parameters as well as radiation dose parameters were documented. Fluoroscopy time, number of frames acquired for each examination, fluoroscopy and frame radiation doses were equally recorded. Of the 25 patients, 6 were for 4-vessel cerebral Digital Subtraction Angiography (DSA), 3 for both lower limbs DSA, 4 for both lower limbs DSA and angioplasty, 3 for Inferior Vena Cava (IVC) filter placement, 2 for pulmonary arteriography, 2 for renal artery embolisation, and 5 for unilateral lower limb DSA and angioplasty. Renal artery embolization had the highest fluoroscopy and frame radiation doses (73764 cGy.cm2 and 4090 mGy) compared to others. Measured Dose Area Product (DAP) doses were above the Diagnostic Reference levels (DRLs) available in the literature thereby necessitating the need for radiation dose optimization through, continuous dose management.

Patients who self-discharge against medical advice (DAMA) are susceptible to life-threatening consequences. By understanding the factors associated with DAMA, healthcare centres can build strategies to assist patients to receive optimal medical care and prevent unfavourable outcome. The objective of this study was to determine the factors associated with DAMA from the Emergency Department (ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a prospective unmatched case control study conducted over a 4-month period. For every DAMA episode, two patients who were admitted on the same day were randomly selected as control. Following patient consent, data was collected using a standardized questionnaire. Patients were contacted by the investigator for information regarding hospitalization within two weeks of DAMA. Ninety three patients were recruited; 31 DAMA patients and 62 admitted patients. Payment method was significantly associated with DAMA (OR 3.17 95% CI 1.29-7.98; p=0.01). The likelihood of self-paying patients to take DAMA was three times higher than those who had a guarantor letter from their employer or insurance provider. Other factors which influence DAMA were family obligations (OR 4.08 95% CI 1.09- 15.26; p = 0.03) and work problems (OR 3.83 95% CI 1.13-12.94; p=0.03). A total of 19.4% of DAMA patients left following symptomatic pain relief. A total of 80.6% DAMA patients were admitted to hospital within two weeks of the DAMA episode. Payment method significantly influences DAMA. Payment planning, social welfare services, non-governmental organization funds and the introduction of a national health policy scheme may aid hospital payment, alleviate financial limitation of patients and reduce DAMA episodes.
Patient Discharge

The determination of HIV drug resistance mutations (DRMs) towards antiretroviral (ARV) drugs among HIV-1 treated patients with virological failure is crucial for further management of the patient. This study aimed to assess the most common genomic mutation and to analyse subtypes among the HIV-1 patients with viral load level > 1,000 copies/mL. A total of 101 virological failure HIV-1 patients from four different regions of Peninsular Malaysia with a viral load measurement facility were included in the study. Majority of patients (89.1%) have at least 1 mutation associated with clinical resistance to either protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) or nonnucleoside reverse transcriptase inhibitors (NNRTIs). Major resistance mutations among the patients towards NRTIs and NNRTIs were 70.3% and 18.8%, respectively. The most common mutation for NRTIs was M184V while K103N mutation was detected in the majority of patients who were treated with NNRTIs. The most commonly observed mutations for major PI and minor PI seen among the study population were V82A/T and L10V, respectively. In HIV-1 subtype analysis, CRF33_01B was the most predominant HIV-1 subtype in this study group. The vast detection of DRMs in this study emphasized the importance of genotypic resistance test in the management of HIV patients as DRMs can alter patient’s susceptibility towards ARV drugs. Further study on larger number of samples is essential for the development of a database on HIV-1 DRMs among patients that experience virological failure in Malaysia.

OBJECTIVETo study the antidiabetic activity of Gynura procumbens (G. procumbens) used in the traditional management of diabetes in Southern Asia.

METHODSG. procumbens leaves were extracted sequentially with graded percentage of ethanol in water (95%, 75%, 50%, 25% and 0%), and the extracts were tested for antidiabetic activity using acute (7 h), subcutaneous glucose tolerance test and sub-chronic (14 d) test in non-diabetic and streptozotocin-induced diabetic rats. The extracts were further subjected to phytochemical studies.

RESULTSIn acute dose (1 g/kg), the extracts significantly lowered fasting blood glucose (FBG) in streptozotocin-induced diabetic rats (P<0.05). However, the FBG-lowering effect of the 25% extract compared to the other extracts, was rapid (47% after 2 h) and the highest: 53%, 53% and 60% in the 3rd, 5th, and 7th h, respectively (P<0.05), comparable only to the effect of metformin. Furthermore, the extracts suppressed peak FBG in subcutaneous glucose tolerance test, but only the 0% and 25% extracts, and metformin sustained the decrease until the 90th min (P<0.05). Moreover, in the 14 days study, the 25% extract exerted the highest FBG-lowering effect, namely 49.38% and 65.43% on days 7 and 14, respectively (P<0.05), similar to the effect of metformin (46.26% and 65.42%). Total flavanoid and phenolic contents in the extracts were found to decrease with increase in polarity of extraction solvents. The composition of reference compounds (chlorogenic acid, rutin, astragalin and kaempferol-3-O-rutinoside) followed a similar trend.

CONCLUSIONSG. procumbens contains antidiabetic principles, most extracted in 25% ethanol. Interaction among active components appears to determine the antidiabetic efficacy, achieved likely by a metformin-like mechanism.

Animals ; Asteraceae ; chemistry ; Blood Glucose ; drug effects ; Body Weight ; drug effects ; Diabetes Mellitus, Experimental ; chemically induced ; drug therapy ; Flavonoids ; chemistry ; Glucose Tolerance Test ; Hypoglycemic Agents ; administration & dosage ; chemistry ; pharmacology ; Metformin ; administration & dosage ; pharmacology ; Phenols ; chemistry ; Phytochemicals ; chemistry ; Plant Extracts ; administration & dosage ; chemistry ; pharmacology ; Plant Leaves ; chemistry ; Rats

Most of important variables measured in medicine are in numerical forms or continuous in nature. New instruments and tests are constantly being developed for the purpose of measuring various variables, with the aim of providing cheaper, non-invasive, more convenient and safe methods. When a new method of measurement or instrument is invented, the quality of the instrument has to be assessed. Agreement and reliability are both important parameters in determining the quality of an instrument. This article will discuss some issues related to methods comparison study in medicine for the benefit of medical professional and researcher. METHOD: This is a narrative review and this article review the most common statistical methods used to assess agreement and reliability of medical instruments that measure the same continuous outcome. The two methods discussed in detail were the Bland-Altman Limits of Agreement, and Intra-class Correlation Coefficient (ICC). This article also discussed some issues related to method comparison studies including the application of inappropriate statistical methods, multiple statistical methods, and the strengths and weaknesses of each method. The importance of appropriate statistical method in the analysis of agreement and reliability in medicine is also highlighted in this article. CONCLUSION: There is no single perfect method to assess agreement and reliability; however researchers should be aware of the inappropriate methods that they should avoid when analysing data in method comparison studies. Inappropriate analysis will lead to invalid conclusions and thus validated instrument might not be accurate or reliable. Consequently this will affect the quality of care given to a patient.
Costs and Cost Analysis