Introduction: Early identification of patients at risk for severe multisystem inflammatory syndrome in children (MIS-C) is essential for favourable clinical outcomes. This study aims to identify the clinical characteristics, factors and outcomes associated with severe MIS-C. Materials and methods: In this retrospective cohort study involving 14 major hospitals in Malaysia, children <15 years who met the United States Centres for Disease Control and Prevention case definition for MIS-C were included. Severe MIS-C was defined as children who required inotropic support, ventilatory support (invasive or non-invasive ventilation), or left ventricular ejection fraction of <55%. The factors investigated for severe MIS-C were demographic characteristics, the presence of comorbidities, clinical characteristics, and laboratory measures. Multivariable logistic regression was used to compute the adjusted odds ratio (aORs) of factors associated with severe MIS-C. Results: Among the 155 patients, 91 (58.7%) presented with severe MIS-C. Severe MIS-C was more likely in patients aged ≥5 years old (aOR 2.13, 95% confidence interval [CI] 1.08-4.21), with dehydration (aOR 3.80, 95% CI 1.53-9.45), lethargy (aOR 2.02, 95% CI 0.97-4.18), tachycardia (aOR 8.33, 95% CI 3.27-21.22), albumin <30g/L (aOR 3.36, 95% CI 1.58-7.13), creatine kinase >200U/L (aOR 3.68, 95% CI 1.57-8.64), D-dimer >3.0µg/mL (aOR 2.11, 95% CI 1.08-4.13), ferritin >500ng/mL (aOR 3.77, 95% CI 1.88-7.55), prothrombin time >12.7 seconds (aOR 3.22, 95% CI 1.61-6.43), and urea >6mmol/L (aOR 5.09, 95% CI 2.04-12.71). Conclusion: Identification of these associated factors of severity in MIS-C could aid in early recognition and prompt escalation of care, leading to better outcomes.

Colorectal cancer (CRC) carries a significant burden in most world regions. However, its screening uptake remains low. This study aimed to explore awareness and perspectives on CRC screening program in a multiethnic population and their preference for CRC screening decision aid. In-depth interviews were conducted until data saturation was reached. All interviews were audiotaped, transcribed verbatim, translated to English and analysed thematically using hybrid inductive and deductive approaches. 17 informants from three main ethnic groups (Malay, Chinese and Indian) with various levels of risk for developing CRC were recruited. Awareness on CRC screening program was found to be low. Majority of informants never heard of CRC screening program. Among 11 eligible informants, only five experienced CRC screening uptake. Thematic analysis of the transcripts yielded six major themes; knowledge on CRC, screening process, authority’s role, curability, willingness to screening and preference for decision aid, and theywere mapped onto the Health Belief Model. Specific multiethnic perspectives found included preference for traditional medicine coming from all ethnics, and reliance in God coming from Malay informants. Majority preferred short videos as CRC screening decision aid, in the form of animation and live-action screenplay. Exploration of perspective of CRC screening helps in producing impactful decision aids. Future efforts should focus on developing short videos that incorporate population’s perspectives and can be disseminated through electronic media.

Introduction: Intensive care unit (ICU) patients are at the greatest risk of acquiring nosocomial infections, partly because of their serious underlying disease, but also by exposure to life-saving invasive procedures. Hospital-acquired infections increase patient morbidity, increase the length of hospital stay and hospital costs, and also increases mortality rate. The basic knowledge of organisms infecting ICU patients is very important to empirically select appropriate antibiotics, so that the most likely infecting organisms are addressed. Objective: The aim of the study was to find out the etiologic agents causing infection in medical intensive care unit patients. Results In our study of 289 patients, 180 (62.3%) showed a growth of organism during the stay in ICU. The most common site of infection was the respiratory tract in 138 patients (47.8%) with 60 patients (20.8%) showing Acinetobacter baumannii.
Cross Infection ; Intensive Care Units ; Acinetobacter baumannii ; Respiration, Artificial

The prevalence of smartphone addiction among university students has raised concerns about its potential implications on their mental health, academic performance, and interpersonal relationships. This review aims to address the existing gap in the literature and shed light on the psychosocial impact of smartphone addiction in this crucial phase of young adults’ lives. A systematic approach was employed to identify and analyse relevant studies from reputable databases. The selection criteria encompassed studies published between January 2009 and December 2022, in university students. The review synthesises findings from 32 selected studies to present a comprehensive analysis of the psychosocial impacts of smartphone addiction. The results indicated significant associations between excessive smartphone use and adverse mental health outcomes, including increased levels of anxiety, depression, and stress among university students. Furthermore, smartphone addiction negatively influences academic performance, decreasing face-to-face communication and social isolation.

During the coronavirus disease 2019 (COVID-19) pandemic, the worldwide medical education system was affected tremendously due to the suspension of clinical activities and lockdown to prevent the spread of the disease. The delivery of clinical training was modified to alternative methods including online classrooms, recorded video, use of simulated patients and hybrid teaching. Several institutions worldwide chose to postpone their scheduled examination, which requires physical attendance or opted for virtual examination. Malaysian centralised postgraduate orthopaedic exit examination was postponed in 2020 and later recommenced in 2021 with three different centres across the country: north, east and central Malaysia. This article describes the preparation and challenges faced in conducting a face-to-face clinical exit examination for postgraduate orthopaedic candidates in Universiti Putra Malaysia in May 2021, during the Conditional Movement Control Order phase. The examination was a success, and no outbreak of COVID-19 was reported from the event.

Introduction: Premarital sexual is a sexual and reproductive health concern among adolescents in Malaysia. Guided by the constructs of the Social Cognitive Theory (SCT), this study aimed to determine the moderating role of gender on premarital sexual practices among the late adolescents in Kuantan, Pahang. Methods: Probability sampling was utilized to sample the late adolescents from tertiary educational centres. Confirmatory factor analysis (CFA) was conducted to verify the factor structure of the observed variables, with the interrelationship between variables were studied using structural equation modelling (SEM). Moderation analysis was completed via multigroup analysis (MGA). Results: A response rate of 72.2% was obtained, with 390 adolescents aged 18 to 19 years old participated in the study. The total mean for premarital sexual practices was 1.14 ± 0.47, with highest mean observed for masturbation (1.33 ± 0.83). Attitude (β = -0.111, p = 0.021), religiosity (β = -0.014, p = 0.032) and high-risk activities (β = 0.999, p < 0.001) illustrated significant relationships with premarital sexual practices. A moderated regression analysis showed significant interactive effects between gender and premarital sexual practices, with negative association between attitude and religiosity with premarital sexual practices were found among male respondents. Conclusion: This empirical study demonstrated significant moderation effect of gender between attitude and religiosity with premarital sexual practices among targeted late adolescents’ population in Pahang, Malaysia. Any efforts to tackle issue related to premarital sexual practices among similar population should be directed towards male adolescents with lower religiosity score.

A three-year-old female with a history of recurrent tonsillitis was investigated for failure to thrive and global developmental delay. Clinically, she had a triangular face with low-set ears and intermittent tachycardia. She had growth failure with her weight under the third centile while her height was within normal limits. Other systemic examinations were unremarkable. The presence of an elevated free T4 (FT4) with an inappropriately high thyroid stimulating hormone (TSH) in this patient raised the clinical suspicion of Thyroid Hormone Resistance Syndrome. DNA sequencing confirmed the diagnosis, which showed R243W gene mutation in Thyroid Hormone Receptor-Beta1 (THRB1).
Receptors, Thyroid Hormone ; Thyroid Hormone Resistance Syndrome ; Goiter

Introduction: Adventure tourism has become one of Malaysia’s most attractive tourism demands, and mountain climbing is rapidly becoming a popular recreational sport. Exploring mountain adventures offers a dynamic experience, preserving this fascinating activity, yet the climbers are exposed to the risk of altitude sickness, such as Acute Mountain Sickness (AMS). This study aimed to evaluate the prevalence of AMS and investigate the effects of high-altitude sickness on the climber profile associated with climbing at Mount Kinabalu, Malaysia. Methods:. The Lake Louise acute mountain sickness LLS score questionnaire collected 95 climber’s data at four different altitudes. SPO2 and Pulse rate was (PR) measured using a finger pulse oximeter. In a cohort study, AMS was measured on day one at 1866m (1st station), 3622m (2nd station), and day two at 3810m (3rd station), and 4095m (4th station). Results: At the altitude of 1866 (Timpohon Gate), the prevalence of AMS was 0%, 30% at 3622m (Laban Rata), 34.7% at 3810m (Sayat-Sayat), and 37.9% at 4095m (Low’s Peak). The overall prevalence of AMS was 37.9% and the majority of AMS cases were moderate in severity and the LLS score is significant with Pulse Rate and peripheral capillary oxygen saturation (SPO2). Conclusion: Concisely, this finding has triggered a need for consideration from multi agencies to enhance mountaineering guidance, especially for beginners or inexperienced hikers, for a suitable package for climbing attempts to reduce the incidence of AMS among Mount Kinabalu climbers.

Introduction: Exploring potential optimization strategies and developing evident practices is critical. Previous studies show that radiation dose can be reduced by increasing the source-image distance (SID). Although most studies use digital radiography, many hospitals in underdeveloped countries still use computed radiography (CR). Therefore, research will investigate the relationship between SID and Entrance surface dose (ESD) using the CR. Methods: This study involved the measurement of radiation dose and image quality of a radiological procedure performed at a reference SID; 100cm and the tested SIDs; 110cm, 120cm, and 130cm, using constant technical factors (70kVp, 25mAs, grid). A LiF; Mg Ti thermoluminescence dosimeter (TLD-100) chip was placed in the center of the radiation field of the OF10° skull radiography examination to measure ESD. Image quality was assessed using the European Commission guidelines and graded using relative visual assessment analysis (VGA). Results: Significant ESD reduction from 21% and 45% when SID was increased from 100cm to 130cm (p <0.001), where SID was negatively correlated with ESD (r= - 0.98). The VGA scores showed no statistical difference in the image quality of the OF10° skull radiography examination for the tested and reference images (p=0.21). VGA scores for 120cm images showed the highest image quality among the SIDs tested with a dose reduction of 37%. Conclusion: ESD was statically reduced when SID was increased from 100cm to 130cm, while image quality was diagnostically acceptable. The study suggests that 120cm is the optimal SID when both dose and image quality are considered.

Introduction: Among adolescents, asthma is an important public health burden that is associated with high morbidity and mortality. Poor asthma control is likely in this age group. Our aim was to identify the predictors of well controlled asthma among adolescents with persistent asthma in Northwest of Libya. Methods: A sample of 92 adolescents with persistent asthma were recruited from the respiratory clinic in Sabratha Teaching Hospital, and completed questionnaires measuring demographic and clinical characteristics, asthma knowledge, self-efficacy, and asthma control. Logistic regression analysis was carried out, taking the asthma control as the dependent variable. Results: Twenty-four percent of participants had well controlled asthma. In a bivariate analysis, well controlled asthma was significantly associated with adolescents having mild persistent asthma, not having allergic rhinitis, using preventive inhalers regularly, reporting higher level asthma knowledge, and higher self-efficacy. However, in multiple logistic model, only self-efficacy was an independent predictor of asthma control, with higher self-efficacy associated with well-controlled asthma (Adjusted OR= 1.107, 95% CI: 1.012 – 1.210, p= 0.026). Conclusion: Identifying and targeting modifiable predictors of well controlled asthma could improve asthma control. In adolescents with asthma, enhancing self-confidence of adolescents to undertake health behaviour modification seems to be an important step toward a better asthma control.