Cobra bite envenomation is one of the commonest causes of snake related injuries in Malaysia. Local tissue injury following a cobra bite is a complex sequalae of envenomation that is attributed to various peptides and enzymes including cytotoxin, metalloproteases, phospholipase A2 and hyaluronidase. This case involves a young construction worker who was bitten by an unidentified snake on the dorsum of his left foot. He presented with typical features of local and systemic envenomation of a Naja species. Remote Envenomation Consultancy Services was consulted and the appropriate antivenom was administered. The patient underwent wound debridement and subsequent skin grafting. Follow up at outpatient clinic showed good skin graft uptake and recovery. Managing a significant Naja species bite envenomation can be a lengthy process requiring expertise from various subspecialties. Timely and seamless multidisciplinary approach in managing a Naja species envenomation ensures a favorable outcome with minimal complication..

Introduction: Aquilaria malaccensis, also known as “Pokok Karas” in Malaysia, is widely used in Southeast Asian countries for the treatment of joint pain, diarrhoea and inflammatory diseases, and has shown beneficial effects as an anticancer agent. The aim of this study was to investigate the effect of ethanol leaf extracts of A. malaccensis on MCF-7 cells. Methods: MTT-based cytotoxic and antiproliferative assay was used to determine the outcome of ethanolic extract toward MCF-7 cells. The mode of cell death was determined by the AO/PI double staining assay and the depolarisation of the mitochondria membrane potential. Results: IC50 value of the extract against MCF-7 cells treated for 72 hours was 4.1 ± 2.08 µg/mL, while the IC50 value for doxorubicin was 2.92 ± 0.12 µg/mL. The extract showed a lower cytotoxic effect against the NIH/3T3 cells and inhibited the growth of MCF-7 cells in a dose dependent manner. AO/PI double stain showed that the ethanolic extract of A. malaccensis leaves induced MCF-7 cells into apoptotic cell death. The present study showed that the ethanolic extract of A. malaccensis induced apoptosis through mitochondrial pathway as indicated by its ability to take up JC-1. Conclusion: The study found that ethanolic extract obtained from A. malaccensis leaves is cytotoxic on MCF-7 cells, resulting to apoptotic cell death of the cells.

Introduction: The COVID-19 pandemic has forced revolutionary changes in the delivery of medical education and imposed much stress on medical students and academicians. This study aimed at evaluating the level of exposure to COVID-19, COVID-related functional difficulties and concerns experienced by medical students, approximately one year after COVID-19 became significant health and socio-economic issues in Malaysia. Methods: A cross-sectional study using self-administered online questionnaire, was conducted among the undergraduate medical students of a private university in Malaysia. Results: A total of 243 medical students participated. They reported low level of exposure to COVID-19 infection. Majority of them demonstrate moderate level of difficulties in learning (median score of 3, highest score = 4) and high levels of COVID-related concerns (median scores of 4 to 5, highest score = 5). Lowest household income category was a significant predictor of high level of functional difficulties (OR = 3.878, 95%CI: 1.651, 9.110); whilst female gender was a significant predictor of high level of COVID-related concerns (OR = 7.400, 95%CI: 1.920, 28.514). Conclusion: One year following the onset of COVID-19 pandemic in Malaysia, medical students still reported significant functional difficulties in learning and demonstrated high levels of COVID-related concern. Collaborative efforts to mitigate the problems need to be intensified with emphasis on the delivery of online medical education and special attention to female and lower socio-economic group students to prevent detrimental consequences to medical students and medical education. Multi-center and longitudinal studies are recommended.

Introduction: Type 2 diabetes mellitus is a chronic disease which is highly prevalent in Malaysia. In managing diabetes, the American Diabetes Association (ADA) and the International Diabetes Federation (IDF) have advocated self-management to be the basic component of diabetes care. However, an ongoing discussion, education and assessment of the patient’s diabetic knowledge should be implemented in the patient’s empowerment process. There are various assessment tools available worldwide but very few are available in the Malay language. This study is aimed to perform the Malay translation of the Simplified Diabetes Knowledge Test (DKT) questionnaire and validate it. Methods: Forward-backward translation procedure was used to translate the simplified version of the DKT questionnaire. A total of 120 respondents with type 2 diabetes mellitus from a selected government health clinic were recruited to answer the questionnaire which consists of socio-demographic, diabetes characteristics and the 20-item Malay version of simplified DKT questionnaire. Reliability and construct validity were tested with Cronbach’s alpha coefficient and Exploratory Factor Analysis. Results: Factor analysis with Varimax rotation identified five meaningful domains for the final 18 items. The Cronbach’s alpha for the overall scale of the translated questionnaire was 0.573 with values of each five significant domain’s Cronbach’s alpha ranged from 0.370 to 0.564. Conclusion: The Malay version of simplified DKT is valid and reliable to be used as a brief assessment of knowledge among Malaysian diabetic patients.

Speech and language skills are among the crucial components in determining cochlear implant habilitation outcomes. The purpose of this study was to investigate speech and language skills of Malay cochlear implant children using a developmental scale questionnaire and to identify the demographic factors that contribute to their performance. This study involved 26 children recruited from the National Cochlear Implant Program under the Malaysian Ministry of Health with chronological ages between 33 to 99 months (mean=72, SD=18.9), implant ages between 18 to 71 months (mean=40, SD=13.5) and hearing ages between 13 to 48 months (mean=30, SD=10.5). The instrument used was The Integrated Scale of Development-Malay version 2 (ISD-Mv2). The questionnaires were given to the parents or caregivers followed with by a phone call interview later. Results from the study showed that only 9 subjects (35%) were able score on the ISD-Mv2 equally or higher than their hearing age. From the six components in the ISD-Mv2, cognitive was scored the highest with 96.79% meanwhile expressive language was the lowest with 76.21%. Pearson correlation test revealed strong positive correlation between audition-receptive language (r=0.554, p<0.05) and cognitive–social communication/ pragmatic (r= 0.625, p<0.05). Speech and language performance of children with demographic factors did not show significant differences. The findings suggests that majority of the Malay cochlear implant children demonstrated delayed speech and language performance as compared to normal hearing children.

Introduction: Prevalence of malnourished children in Putrajaya was unexpectedly high in 2016. This paper describes the study protocol for a case-control study conducted to identify the associated factors of malnutrition among children under 5 years old in Putrajaya. Methods: This study involved two phases. Phase I was ‘screening’ where all children aged 6-59 months in 118 preschools and four government health clinics were measured for their weight and height. The World Health Organization Anthro software was used to determine the nutritional status of these children. Phase II was the ‘interview’ where children from screening were sampled into four pairs of case and control. The optimum sample size for the case of stunted, wasted, underweight, and overweight were 380, 335, 318, and 308, respectively. The same number of controls were recruited. Parents/caregivers of selected children were approached to obtain data on parental factors, children factors, food intake factors, and environmental factors that contributed to malnutrition. Data analysis was performed by multiple logistic regression in SPSS version 26. Results: Screening phase successfully measured 8,261 (50.1%) children from an estimated 16,500 children under 5 years old in Putrajaya. The number of children who were stunted, wasted, underweight, and overweight were 2,105 (25.5%), 512 (6.2%), 1,516 (18.4%), and 248 (3.0%), respectively. As overweight was undersampled, the number of controls for overweight was doubled to increase the power of the study. Parents/caregivers of selected cases and controls were interviewed in their household or any other venues at their convenience. Conclusion: This protocol promises beneficial outputs to stakeholders and policy makers that can be used for combating malnutrition in children.

Purpose: To compare single-step transepithelial photorefractive keratectomy (TPRK) to conventional alcohol assisted epithelial removal then photorefractive keratectomy (AAPRK) regarding pain, epithelial healing, visual acuity, corneal haze measured subjectively and objectively, higher order aberrations changes, contrast sensitivity and vector analysis of astigmatic correction with one year follow-up.
Methods: A prospective double-blind randomized study of 29 subjects (58 eyes) who underwent myopic aberration-free laser correction by smart pulse technology using Schwind Amaris 1050 Hz with 1-year follow-up. Right eye was randomly treated by AAPRK or TPRK. Postoperative assessment was performed on day 1 and 3, at 1st week, and 1st, 3rd, 6th, and 12th months. Patients were assessed for pain, epithelial healing, visual acuity, corneal haze, astigmatic correction, higher order aberrations and contrast sensitivity.
Results: Epithelial healing was complete by the 3rd day in 62.1% of AAPRK eyes and in 89.7% of TPRK eyes. First day postoperative pain was higher in TPRK group (p = 0.0134). The decimal uncorrected visual acuity at 12 months was 1.47 ± 0.39 and 1.57 ± 0.38 in the AAPRK and TPRK groups respectively (p = 0.3719). Post-photorefractive keratectomy haze reached a final level of 0.04 ± 0.14 and 0.02 ± 0.1 in AAPRK and TPRK groups respectively (p = 0.5607). Contrast sensitivity was comparable in low and high frequency cycles per degree. Vector analysis of astigmatic correction showed correction index at one year of 0.99 and 1.05 for AAPRK and TPRK groups respectively.
Conclusions Alcohol assisted and transepithelial photorefractive keratectomy have comparable results regarding safety and efficacy.

Objective: This study is a preliminary work to develop a Malay version questionnaire named ‘Inventori Persepsi bagi Muslim yang Memiliki Masalah Pendengaran (IPM3P)’ to assess the perception on Islamic understanding and practice among Muslim adults with hearing impairment. Methods: The scale development involved three phases: i) generation of domains based on the literature, ii) generation of sub-domains based on literature review and Islamic panel survey, and iii) generation of items. Results: Preliminary version of IPM3P consists of 59 items was produced, representing three domains: Obligation (18 items), Practice (21 items), and Difficulty (20 items), and seven sub-domains (‘Ibadah’, ‘Aqidah’, ‘Muamalat’, ‘Tasawwuf’, ‘Akhlak’,‘Da’wah’, and ‘Sirah’). Conclusion: The preliminary version of IPM3P needs to be psychometrically tested. This pioneering study may become an impetus towards more research pertaining to understanding the effect of hearing loss towards religious life in the future in Malaysia.

Introduction: Human teeth tend to stain from intrinsic and extrinsic factors with time. The study was aimed to assess colour change of stained enamel after the use of bleaching agents. Methods: 63 extracted human teeth were selected and soaked in the coffee solution for 7 days to stain the teeth. Then they were randomly divided into 3 groups (n = 21). The groups were divided as the control group (distilled water), group using 6% carbamide peroxide (CP6) and group using 9% carbamide peroxide (CP9). The groups of CP6 and CP9 were bleached with 0.2 ml of bleaching agent for 5 minutes daily until 14 days. Colour changes were visually recorded by using VITA Toothguide 3D-MASTER and Ocean Optics Spectrometer instrument. Results: CP6 started to show shade reduction on Day 3 (score 5), followed by a steady reduction until Day 10. Day 12 to 14 showed another steady reduction of CP6. CP9 had a larger shade reduction (scores of 2-5) from Day 1 to Day 4, followed by a steady reduction until Day 14. Spectrometer analysis shows that CP9 samples had lower absorbance unit compared to CP6 samples for both second-day and sixth-day groups. However, most changes can be observed on the CP9 samples from control to the second-day and sixth-day. Conclusion: Bleaching agent with low concentration can approach the efficacy of high concentration of bleaching agent with an extended treatment time.

Purpose: To compare single-step transepithelial photorefractive keratectomy (TPRK) to conventional alcohol assisted epithelial removal then photorefractive keratectomy (AAPRK) regarding pain, epithelial healing, visual acuity, corneal haze measured subjectively and objectively, higher order aberrations changes, contrast sensitivity and vector analysis of astigmatic correction with one year follow-up.
Methods: A prospective double-blind randomized study of 29 subjects (58 eyes) who underwent myopic aberration-free laser correction by smart pulse technology using Schwind Amaris 1050 Hz with 1-year follow-up. Right eye was randomly treated by AAPRK or TPRK. Postoperative assessment was performed on day 1 and 3, at 1st week, and 1st, 3rd, 6th, and 12th months. Patients were assessed for pain, epithelial healing, visual acuity, corneal haze, astigmatic correction, higher order aberrations and contrast sensitivity.
Results: Epithelial healing was complete by the 3rd day in 62.1% of AAPRK eyes and in 89.7% of TPRK eyes. First day postoperative pain was higher in TPRK group (p = 0.0134). The decimal uncorrected visual acuity at 12 months was 1.47 ± 0.39 and 1.57 ± 0.38 in the AAPRK and TPRK groups respectively (p = 0.3719). Post-photorefractive keratectomy haze reached a final level of 0.04 ± 0.14 and 0.02 ± 0.1 in AAPRK and TPRK groups respectively (p = 0.5607). Contrast sensitivity was comparable in low and high frequency cycles per degree. Vector analysis of astigmatic correction showed correction index at one year of 0.99 and 1.05 for AAPRK and TPRK groups respectively.
Conclusions Alcohol assisted and transepithelial photorefractive keratectomy have comparable results regarding safety and efficacy.