Background: Percutaneous Transvenous Mitral Commissurotomy (PTMC) is a procedure of choice for the treatment of severe mitral stenosis. We aimed to describe our experiences on management of rheumatic heart disease with PTMC in Malaysia. Methods: Patients who underwent PTMC were traced through the electronic medical record of University Malaya Medical Centre. The patients detailed echocardiogram parameter pre-procedure, post-procedure and outcome were documented. Statistical analysis was performed using SPSS version on 18 for windows. Results: 11 patients were treated with PTMC in our centre with 90.9% (n=10) success rate. Subjects underwent PTMC were statistically significant associated with improved echocardiogram parameters as following: increase in mitral valve size (p=0.0058) from 0.89 ± 0.2 cm2 (pre) to 1.4 ± 0.4 cm2 (post); reduction in mean pressure gradient across mitral valve (p=0.0283) from 11.5 ± 4.9 mmHg (pre) to 6.9 ± 3.5 mmHg (post); and reduction (p=0.0019) in elevated pulmonary artery systolic pressure from 65.7 ± 21.4 mmHg (pre) to 45.6 ± 10.0 mmHg (post). More than half (62.5%, n=5) of the subjects with favourable Wilkin score 8 or less achieved good outcome defined as post-PTMC mitral valve size ≥ 1.5 cm2 . All subjects with unfavourable Wilkin score of more than 8 only achieved sub-optimal post-PTMC mitral valve size ≤ 1.5 cm2 . Conclusion Given the minimally invasive nature of PTMC with comparable excellent haemodynamic outcome to invasive vascular repair, PTMC should be the recommended first line therapy in mitral valve stenosis.
Mitral Valve Stenosis

Insulin oedema is a rare condition that may occur after the initiation or rapid intensification of insulin therapy in patients with long-standing hyperglycaemia, commonly with type 1 diabetes mellitus (DM). We reported a case of insulin oedema in a patient with type 2 DM who presented with swelling of the extremities and weight gain of 3 kg 1 week after insulin initiation. A course of furosemide was administered, but no significant immediate improvement was observed; however, the lower limb swelling resolved spontaneously after 3 months of follow-up. The patient also achieved adequate diabetic control with insulin, as shown by the reduction of her HbA1c from 10.7% to 6.9% over 6 months. Insulin oedema is a diagnosis of exclusion after ruling out other differential diagnoses, such as cardiac, renal, or liver failure. Although insulin oedema carries with it a good prognosis, physicians should be aware of the condition to avoid misdiagnosis.
Insulin ; Edema ; Diabetes Mellitus, Type 2

Introduction: Smartphone addiction is becoming a global concern affecting every part of society, including healthcare professionals. This study aimed to identify the prevalence of risk of smartphone addiction and its associated factors among medical and dental students in a public university in Malaysia. Methods: This cross-sectional study was conducted among pre-clinical medical and dental students using convenience sampling. Questions regarding sociodemographic profile and responses to the Smartphone Addiction Scale Short Version (SAS-SV) and Depression, Anxiety and Stress Score questionnaire (DASS-21) were collected. Multiple logistic regression testing was used to analyse the factors associated with smartphone addiction. Results: We invited 409 pre-clinical medical and dental students to participate voluntarily, resulting in a response rate of 80.2%. The prevalence of high-risk smartphone addiction among the participants was 47.9%. Male participants, participants who used smartphones mainly for social media, and participants with depressive symptoms were more likely to have a high risk of smartphone addiction. Medical students, participants who spent less than 3 hours per day on a smartphone, and participants who used smartphones for education-related activities were less likely to have a high risk of smartphone addiction. Conclusion Smartphone addiction prevalence among pre-clinical medical and dental students was high. Therefore, the authorities should overcome this problem by implementing early measures.
Internet Addiction Disorder ; Students, Medical ; Students, Dental

Flood disaster is the commonest natural disaster with huge impact on healthcare services in Malaysia. TheFloodDMQ-BM©questionnairewasdeveloped as a tool to assess the knowledge, attitude, and practice of healthcare providers regarding patient management during a flood disaster. We aimto further validate the FloodDMQ-BM©questionnaire by using Confirmatory Factor Analysis (CFA) and Item Response Theory (IRT).Thiscross-sectional studyinvolved doctors, nurses and paramedics workingin the Emergency Department of Hospital Universiti Sains Malaysia, Hospital Raja Perempuan Zainab II and Hospital Kuala Krai. Respondents were required to complete the FloodDMQ-BM©questionnaire. The responseswereanalysed by using CFA and IRT to establish its validity and reliability. A total of 215respondents participatedin this study. CFA analysiswith Maximum Likelihood Robust as the estimation method, on the attitude and practice components resulted in good factor loadings (>0.5) in nearly all items and excellent modelfit indices values (CFI = 0.96-0.98, TLI = 0.95-0.96, SRMR = 0.04-0.05, RMSEA = 0.07).Meanwhile, IRT analysis on the knowledge section showed a good two-way marginal fit based on S-X2, and a good model fit with RMSEA of 0.08. Based on the 2PL model by using the IRT assessment of the knowledge section, one item in the knowledge section (K3) was removed (chi-squared residual >4) resulting in improved model fit. The included items had well-standardized loadings (>0.3) and marginal reliability of 0. 651.Ourresults confirmed that the FloodDMQ-BM©questionnaire displayed valid and reliable psychometric properties.

Objectives: Body weight perception may determine the practice of proper weight management. The objective of this study was to measure the agreement between body weight perception and actual body weight status and its associated factors among late adolescents in Kuantan, Malaysia. Methods: A cross-sectional study was conducted from April to October 2018 among 479 adolescents aged 17-19 years old from seven institutions of higher learning in Kuantan. Body weight status was described as body mass index (BMI). Weight and height were measured, and BMI was calculated. Validated, self-administered Figure Rating Scale (FRS) questionnaires were used. Agreement between BMI and body weight perception was calculated using Kappa statistics. Logistic regression was employed to examine the association between body weight perception and sociodemographic variables. Results: More than one-third (35.3%) of the respondents misjudged their own body weight. More than one third of the respondents (38.7%) who were underweight, misperceived themselves as having normal weight whilst 31.7% of obese respondents identified themselves as overweight. The agreement between body weight perception and body mass index was moderate (k0.46, p<0.01). Conclusion: Body weight perception was in moderate agreement with actual weight in late adolescents. Accurate body weight perception is an important factor in late adolescent’s weight management behaviour. Hence, health education related to body weight management should be emphasized among this age group.

Undernutrition remains a major public health concern, especially in developing countries. Despite being rich in resources, Malaysia is still home to children sufering from severe undernutrition. Tis paper presents the case of a 5-month-old boy with kwashiorkor stemming from improper weaning which was overlooked. Tis case highlights the importance of recognizing the early signs of kwashiorkor to allow for early referrals for proper management and prevent its possible complications.