Malay Version of Moral Identity Scale: A Cross-Cultural Validation In Malaysian Youth

Introduction: The Moral Identity Scale (MIS) measures the construct of moral identity – internalization and symbolization. This study aims to translate and validate the original English version of MIS to the Malay language version. Methods: The 10 items of MIS (five items of symbolization and five items of internalization) were translated to the Malay language through forward and backward procedures. A total of 388 youth-aged participants were involved in this online survey. Participants’ age ranged from 18-24 years old. More than half were females. Results: The construct of moral identity was maintained with the re-modeling of internalization. The final model suggested retaining the three internalization items and five symbolization items. Discriminant validity and the construct reliability of the two factors were satisfactory (symbolization=0.81, internalization=0.69). Internal consistencies indicated acceptable Cronbach’s alpha values for both symbolization (0.85) and internalization (0.81). Test-retest Intraclass Correlation Coefficient (ICC) was good and satisfactory (internalization=0.79 and symbolization=0.81). Conclusion: The Malay version of MIS is a reliable tool and free from cultural bias which is useful to be applied in a public health-related program.

Factors Contributing to Red Blood Cells Crossmatch and Transfusion among Obstetrics Patients in a Single Tertiary Hospital

INTRODUCTION: Transfusion of blood and blood components among obstetrics patients is a common practice but they are not without risks. This study aims to determine crossmatch to transfusion ratio (C:T ratio) and to assess the factors that influence red blood cells (RBC) transfusion among obstetrics patients in a single tertiary hospital. MATERIAL AND METHODS: This was a retrospective cohort study of RBC crossmatch requests with data collected from 350 obstetrics patients. The patients were grouped into either received RBC transfusion or did not receive transfusion. Demographics and clinical characteristics were analyzed using descriptive and multivariate analysis. RESULTS: The mean C:T ratio was 3.1. Of 350 patients, 149 (42.6%) patients did receive RBC transfusion. Patients with underlying hemoglobinopathy (75.9%), history of postpartum hemorrhage (63.6%), underwent instrumental assisted delivery (64.3%), and with hemoglobin level of < 70 g/L upon crossmatch requests (90.5%) did receive RBC transfusion. Cesarean section (p=0.011), hemoglobin level < 99 g/L (p<0.001), estimated blood loss > 1000 mL (p<0.001), and symptomatic anemia (p=0.029) were the significant factors associated with RBC transfusion. CONCLUSION: The mean C:T ratio in our study was high. Identifying the factors contributing to RBC transfusion among obstetrics patients are important to reduce unnecessary crossmatch and subsequently improve blood inventory management, and thus further reduce the risks associated with allogeneic transfusion.

Uric Acid: Friend or Foe?

Introduction. Adverse Pregnancy outcomes (APO) continue to trouble physicians worldwide, and uric acid has become a marker of interest in its prediction. Despite this, the correlation of uric acid in the third trimester is rarely studied, and the reference value for normal uric acid levels in pregnancy has yet to be established. This study was done to evaluate the association of uric acid levels in the third trimester of pregnancy and the development of APO, specifically gestational hypertension (GH), pre-eclampsia (PE), gestational diabetes mellitus (GDM), small for gestational age (SGA) and to determine a cut-off value of serum uric acid levels for screening of the APO. Materials and methods. A retrospective observational study was conducted among 374 women who delivered at Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) and developed the APO of interest and had serum uric acid levels taken during the third trimester of pregnancy. A cut off value of 309 µmol/L was used to assess the sensitivity and specificity in predicting the APO. Results. Associations are observed between 309 µmol/L and the development of GH (p<0.0005), PE (p<0.0005), GDM (p<0.0005), SGA (p=0.0264). Plotted ROC curves with cutoff point of 309 µmol/L demonstrated moderate predictive value of serum uric acid and the development of GH (AUC 0.639), PE (AUC 0.713), SGA (AUC 0.649) and low predictive value for GDM (AUC 0.4). Conclusion. Serum uric acid level of 309 µmol/L in the third trimester of pregnancy is a moderate predictor of GH, PE, SGA and a poor predictor of GDM. KEYWORDS: Uric acid; pregnancy trimester, third; pregnancy outcome

Patient Satisfaction with Doctor-Patient Interaction using SKIP-11 and Its Associated Factors among Type 2 Diabetics in Primary Care.

ABSTRACT Introduction: The quality of diabetes care is widely suboptimal, and most of the interventions depend on the active involvement and participation of patients. Understanding and determining patient related factors can help primary care providers pay more attention and give greater care to those patients. This will improve patient satisfaction, which further enhances compliance with or adherence to diabetic treatment. Therefore, this study aims to determine patient satisfaction with doctor-patient interaction and its associated factors among patients with type 2 diabetes mellitus. Materials and Methods: This cross-sectional study was performed among adults who had had diabetes for at least six months. Participants were selected by systemic random sampling in the outpatient clinic of the University Hospital. Patient satisfaction with doctor-patient interaction was measured using 11- items with a three-domain version of the “Skala Kepuasan Interaksi Perubatan-11” questionnaire. The total scores ranged from 11 to 55, and those who scored 44 and above (> 80%) were considered satisfied. Results: A total of 417 patients were recruited in the study. 60% were satisfied with their doctor-patient interactions. Among the subtypes in the satisfied group, the domain of rapport had the highest percentage of satisfaction at 77.7%. HbA1c was found to be significant associated with patient satisfaction with doctor-patient interaction (95% CI: 0.81, 0.97; p = 0.008) Conclusion: 60% of the participants clearly illustrated positive feedback and were more satisfied with their doctor-patient interactions. HbA1c was found to be significantly associated with patient satisfaction concerning doctor-patient interaction

Patients’ Perception towards General and Pelvic Examination by Male Medical Students: A Cross-sectional Study in a Multi-ethnic Population

Introduction Male medical students globally have difficulty in obtaining consent to perform pelvic examination. We sought to identify independent factors influencing women consenting to male medical students performing general and pelvic examination under supervision. Methods This cross-sectional study conducted at a tertiary hospital and a public health care centre in Johor Bahru, Malaysia recruited 369 women above 18 years old who have had sexual intercourse before and no prior hysterectomy. A validated self-administered bilingual questionnaire was used to collect data on factors that influence them consenting to male medical students examining them and performing pelvic examination when indicated. Results The respondents were largely below 30 years old (52.9%), Malays (73.4%) and Muslims (75.3%). The consent rates for general and pelvic examination were 27.4% and 18.9%, respectively. Being a Muslim, having an occupation and being introduced by a male medical specialist increased the likelihood of women consenting to general examination. However, a history of being examined by male students decreased the likelihood by 64%. Believing that male doctors should have the skills to treat patients in women's health was the only independent factor that increased the likelihood for women to consent for pelvic examination to be conducted by male medical students. Conclusion Believing that male doctors should be skilled in treating women positively influences decision to consent. Explaining earnestly to women on how they aid in developing the skills of future doctors should be prioritised. Keywords: patients’ perception; male medical students; pelvic examination

Measurement of Inflammation-Related Biomarkers in Different Chronic Kidney Diseases in Humans: Role of Aging and Gender?

INTRODUCTION: Chronic kidney disease (CKD) is a worldwide health problem which becomes a substantial emerging cause of morbidity. The inflammation can be resulted via different mechanisms in different kidney diseases including the imbalance of proinflammatory/anti-inflammatory biomarkers levels. This study aimed to measure the level of physiological bioactive substances as inflammation-related biomarkers in different CKD and to investigate whether gender or aging is critical in these measurements. MATERIALS AND METHODS: 84 persons (19 healthy, 29 chronic glomerulonephritis, 26 diabetic nephropathy, 6 benign nephrosclerosis, 4 lupus nephritis) were enrolled in this study. The inflammation progression degree in CKD was estimated by measuring the plasma level of neutrophil gelatinase-associated lipocalin (NGAL), monocyte chemoattractant protein 1 (MCP1), and clusterin (CLU) using ELISA. Serum total protein, urea and creatinine were measured using an automatic analyzer. RESULTS: Plasma level of urea and creatinine was increased while total protein level was decreased in all the patients compared to control participants. The level of NGAL, MCP1 and CLU was significantly increased in all the kidney diseases compared to controls. In addition, there were no differences in the level of inflammation-related markers between women and men. Moreover, the levels of inflammatory markers were increased in the kidney diseases regardless of the age difference. CONCLUSIONS: This study showed that the physiological bioactive substances NGAL, MCP1 and CLU can be increased in renal pathologies and considered as good indicators of progression of inflammation in chronic kidney diseases, with no role of gender and age in their increment plasma levels.

Comparative Study of Microwave Oven-Assisted Tissue Processing with Isopropanol and Mineral Oil Mixture and Propylene Glycol Methyl Ether on Morphological Quality of Tissue Sections

Background: Over several years, xylene has been traditionally utilised as the clearing agent of choice in tissue-processing due to effectiveness in rapidly clearing tissue, facilitating the paraffin infiltration process. However, xylene use adversely impacts the health of personnel with long term exposure due to toxicity. In order to overcome these effects and replace it with a safer alternative agent, the present study aims to compare quality of tissue sections processed using an isopropanol and mineral oil mixture and propylene glycol methyl ether (PGME) as xylene substitutes. Methods: Rat skeletal muscle tissue samples (n=20) were prepared for each processing protocol with xylene substitutes. Tissue specimens were processed according to the proposed microwave protocol. The clearing steps were performed using isopropanol and mineral oil mixture, and PGME, replacing xylene. From each paraffin-embedded block, one section of 4-5µm thickness tissue was obtained and conventionally-stained with Haematoxylin and Eosin (H&E). The histological sections were microscopically assessed and scored by a pathologist. A qualitative analysis was performed with the results obtained. Results: The overall score obtained for xylene processed tissue was 100% with a score of 2 for all the 3 parameters assessed. However, the outcome for tissue processed with isopropanol and mineral oil mixture was 28.6% unsatisfactory, 28.6% satisfactory and 42.8% good. In PGME-treated tissues, 14.3% were unsatisfactory sections, 71.4% were satisfactory and 14.3% produced good quality sections. Overall, tissues processed using both substitutes exhibited sufficient staining quality in terms of the aforementioned parameters as compared to xylene-processed tissues, though significant difference in scores were observed. Conclusion: Despite several challenges faced in the study, isopropanol and mineral oil mixture and PGME can be suggested as alternative clearing agents to xylene, provided having access to a more sophisticated microwave oven with precise temperature control for complete tissue-processing.

Prevalence of Depression and its Associated Factors among Medical Students in International Islamic University Malaysia (IIUM)

Introduction: Globally, depression is one of the serious problems reported among medical students. Various studies reported that the prevalence of depression among medical students was high due to multiple risk factors. Therefore, this study aimed to measure the prevalence of depression and its associated factors among medical students in International Islamic University Malaysia (IIUM). Materials and Methods: A cross-sectional study was conducted among 500 medical students in IIUM Kuantan. A validated self-reported questionnaire using Depression Anxiety Stress Score 21 was distributed during the second semester of the 2018/2019 session. Descriptive statistics were used to measure the prevalence of depression. Chi-square test, Fisher’s exact test, independent sample T-test, and multiple logistic regression were used to determine the association between risk factors and depression. Result: The prevalence of depression was 39% with 10.5% of them were having severe and extremely severe level of depression. Multiple logistic regression analysis showed regular physical activity (AOR=0.64, 95% CI: 0.42-0.98) and Tahajjud prayer practice (AOR: 0.76, 95% CI 0.66-0.88) are two protective factors against depression among medical students. Conclusion: About two out of every five IIUM medical students had depression. Regular physical activity and Tahajjud prayer practised may reduce the risk of depression and should be encouraged.

Protracted Bacterial Bronchitis, it is a myth?

Protracted wet and productive chronic cough is a symptom that indicate there is an underlying cause and the possibility vary from a simple to serious medical conditions. If the cough is accompanied with specific pointers in signs and symptoms, the diagnosis is apparent. Nevertheless, the challenge is to identify the diagnosis in children who cough without specific pointers. Recently, protracted bacterial bronchitis is one of the conditions that was proposed and postulated to conceive this clinical presentation. Since then, the understanding of PBB has escalated and deepened. However, there is still no unanimous consensus in definition, pathophysiology, diagnostic, treatment, long term outcome and even the entity itself. Further research is required to refine understanding of this condition in several facets therefore patients can be treated accordingly.