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: 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: During the COVID-19 pandemic, healthcare providers have been in great fear due to the high risk of contracting COVID-19 infection at any time. This study aimed to determine the mediating role of resilience on the relationship between fear of COVID-19 and burnout in primary care healthcare providers in Malaysia. Methods: This was an online cross-sectional study involving 1280 healthcare providers aged 18 years and older from 30 government primary care clinics in Malaysia. We used the COVID-19 Fear Scale, the Copenhagen Burnout Inventory Scale, and the Short Brief Resilience Scale to collect data from the respondents. Smart-PLS was used to perform mediation analysis. Results: The mean age of the respondents was 36 years old and mean duration of working experience was 11 years. The majority of the respondents were female (82.4%) and Malays (82.3%). The study population consisted of nurses (47.4%), doctors (26%), medical assistants (11.9), healthcare assistant (7.1%), medical laboratory technicians (6.4%) and drivers(1.3).The results show that fear of COVID-19 positively predicts burnout. According to the results, resilience mediates the relationship between fear of COVID-19 and all the three burnout domains, namely personal burnout (β=0.175,p<0.001), work-related burnout (β=0.175,p<0.001) and client-related burnout (β=0.172,p<0.001). Additionally, resilience reduces the impact of COVID-19 fear on the three domains of burnout. Conclusion: Our study has reported a mediating effect of resilience on the relationship between fear of COVID-19 and burnout.

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..

Background: Vitamin D may enhance immune system function and provide a protective effect against infections. Feto-maternal circulation plays an important role in supplying the developing fetus with nutrients and antibodies for its development and health during pregnancy and for its early years of life after birth. This meta-analysis aimed to determine the effectiveness of maternal vitamin D supplementation in preventing respiratory tract infections (RTIs) in children. Methods: We searched the Central and MEDLINE databases and went through all the reference lists in the related articles. We also searched for ongoing trials at http://www.who.int/ictrp/en/ and www.clinicaltrials.gov. Randomized controlled trials comparing vitamin D supplementation with a placebo or no treatment in pregnant women published in the English language up to March 2019 were included. Two reviewers extracted data independently using a predefined protocol and assessed the risk of bias using the Cochrane risk of bias tool, with differences agreed upon by consensus. The predefined primary outcome was the number of offspring who had RTIs. The secondary outcome was the presence of measurable serum immunoglobulin E levels. Results: Three trials involving 3,224 participants (mother–child pairs) met the inclusion criteria and were included in this review. The present analysis reported that maternal supplementation with vitamin D had no effect on RTIs among children (n=1,486 offspring; risk ratio, 0.95; 95% confidence interval, 0.82–1.11; random effects; I2 statistics, 0%). Conclusion Maternal vitamin D supplementation had no effect on RTIs in children. Therefore, consideration of other prevention methods in this regard is recommended.

Among the three subtypes of neurofibromatosis are type 1 and 2 neurofibromatosis and schwannomatosis, von Recklinghausen disease also known as type 1 neurofibromatosis has an autosomal dominant inheritance. It is the commonest form as and presents with numerous café-au-lait macules and neurofibromas. Giant congenital melanocytic nevus (CGMN) on the other hand is characterized by a melanocytic proliferation that present at birth. CGMN develops due to a defective embryonic pigment cell (melanocyte) precursors development and are often present at birth. Giant congenital melanocytic nevus (CGMN) and type 1 neurofibromatosis may occur together rarely. Clinicians should be aware of the rare presentation of both CGMN and type 1 neurofibromatosis in a patient.

Introduction: Anaemia is common during pregnancy and can lead to miscarriage, intrauterine growth retardation, premature labour and antepartum haemorrhage. Anaemia in pregnancy is defined as a haemoglobin (Hb) level of <11 g/dL. Methods: This retrospective review included 407 antenatal mothers diagnosed with anaemia at 36±1 weeks of gestation at all 10 health clinics in Alor Gajah between January and December 2018. Results: According to the district annual returns, 2,407 antenatal mothers (36 weeks of gestation) were registered in the health clinics in Alor Gajah in 2018. Among them, the prevalence of anaemia was 18.6% (n=448). However, there were only 407 cards found. Most participants were Malays (89.4%), aged 20–40 years (93.6%) and married (96.3%). Almost all anaemia cases (96.5%) were mild (Hb level of 9–10.9 g/dL). Approximately 34.4% of the mothers were already anaemic at booking; 77.6% belonged to the B40 income group; and 31.6% had poor pregnancy spacing of <2 years. Iron deficiency anaemia was the most common type of anaemia (51.0%), followed by dilutional anaemia (34.0%), which did not normalise at 36 weeks of gestation. Anaemia was associated with lower educational (P<0.05) and Hb levels at booking (P<0.001). Conclusion Having normal maternal Hb levels in early pregnancy especially at booking is crucial, as it may reduce the possibility of anaemia during pregnancy. Early screening and supplementation of at-risk pregnancies may be applied as a preventive strategy. Suitable methods of iron treatment and investigation need further exploration.

The application of artificial intelligence (AI) is on the rise in the healthcare industry. However, the study on the physicians’ perspectives is still lacking. The study aimed to examine physicians’ attitudes, expectations, and concerns regarding the application of AI in medicine. A cross-sectional study was conducted in October 2019 among physicians in a tertiary teaching hospital in Malaysia. The survey used a validated questionnaire from the literature, which covered: (1) socio-demographic profile; (2) attitude towards the application of AI; (3) expected application in medicine; and (4) possible risks of using AI. Comparison of the mean score between the groups using a t-test or one-way analysis of variance (ANOVA). A total of 112 physicians participated in the study: 64.3% from the clinical departments; 35.7% from the non-clinical specialties. The physicians from non-clinical departments had significantly higher mean attitude score (mean = 14.94 ± 3.12) compared to the clinical (person-oriented) departments (mean = 14.13 ± 3.10) and clinical (technique-oriented) departments (mean = 13.06 ± 2.88) (p = 0.033). The tech-savvy participants had a significantly higher mean attitude score (mean = 14.72 ± 3.55) than the non–tech-savvy participants (mean = 13.21 ± 2.46) (p = 0.01). There are differences in the expectations among the respondents and some concerns exist especially on the legal aspect of AI application in medicine. Proper training and orientation should precede its implementation and must be appropriate to the physicians’ needs for its utilization and sustainability.

Background: Breastfeeding is recognized as the optimal form of nutrition for the physical and neurological development of infants and is considered the most significant way to prevent child mortality. This study aimed to assess the effectiveness of metoclopramide for enhancing milk production in lactating women. Methods: We searched the Cochrane Central Register of Controlled Trials and MEDLINE for randomized controlled trials comparing metoclopramide with a placebo, no treatment, or other galactagogue drugs. We included breastfeeding women with term or preterm infants. Results: We retrieved 164 records from our search of the electronic databases and 20 records from other sources. Eight trials involving 342 lactating women that used metoclopramide were included in this review after assessing the eligibility criteria. The meta-analysis of these trials revealed that metoclopramide did not increase the milk volume of the intervention groups compared to that of the control groups. There was a significant increase in the serum concentrations of prolactin when the mothers were administered metoclopramide. No significant adverse events were reported. Conclusion Metoclopramide did not improve milk production in lactating women. Therefore, we do not recommend using metoclopramide to increase milk production in lactating women.

Introduction: Association studies between single nucleotide polymorphisms (SNPs) and type 2 diabetes mellitus (T2DM) have been abundant. However, there are limited reports on copy number variations (CNVs) of beta-defensins (DEFB) gene in relation to T2DM. In this study, DEFB copy numbers were quantified in T2DM with nephropathy, T2DM without nephropathy and non-diabetic control groups to investigate its influence in chronic inflammation in Malaysian individuals. Methods: DEFB copy number in Malaysian individuals were quantified by using paralogue ratio tests (PRT) which allow direct quantification of gene copy number by using PRT107A and HSPD21 PRT primers. The copy number generated was then validated from insertion/deletion ratio measurement 5DEL (rs5889219) and two microsatellite analyses (EPEV-1 and EPEV-3). Results: DEFB copy number was found extending from 2 to 8 copies in the non-diabetic group (n=146), while in T2DM group (n=392), copy numbers were more extensive, ranging between 1 and 12 copies; with 1, 10 and 12 copies detected in T2DM with nephropathy group (n=202). Statistically, there is no significant difference in DEFB copy number between T2DM and the non-diabetic group (p=0.209) as well as between diabetic nephropathy and without nephropathy of the T2DM group (p=0.522). However, significant white blood cell (WBC) count was found between T2DM groups with and without diabetic nephropathy (p=0.000). Conclusion: Extreme DEFB copy numbers in T2DM with nephropathy group suggest future studies with bigger sample size are necessary to elucidate the true impact of CNVs of DEFB gene in promoting early onset of nephropathy in T2DM.