Centre In Malaysia Research Articles

Family dynamics and delinquency: understanding the experience of female adolescents with their families

PurposeThis study aims to explore the family experiences of delinquent adolescents and uses a descriptive phenomenological research design.Design/methodology/approachThe study explores the family experiences of delinquent adolescents and uses a descriptive phenomenological research design. Eight adolescents that were under detainment in a rehabilitation centre in Malaysia participated in the study. Data were gathered through semi-structured interviews and reflective journals.FindingsFive themes common to the participants’ experience were inductively identified from the analysis. These were: life without guidance, alienation and isolation, conflict on how the family is managed; I am still a little child and prisoners at home.Originality/valueDespite many studies on delinquent adolescents were conducted in Malaysia, no study has been conducted so far to explore and understand the experience of female adolescents in their families.

A five-year experience in endoscopic endonasal excision of juvenile nasopharyngeal angiofibroma

Introduction: Juvenile nasopharyngeal angiofibroma (JNA) is a histological benign but locally aggressive vascular tumour which can invade the base of skull. Aim: This is a retrospective study with the aim to examine the outcome of patients with JNA and endoscopic endonasal excision of tumour at a tertiary center in Malaysia. Material and methods: 9 patients were identified from the medical record office from 2015 to 2019. We review the data on patient demographics, clinical presentations, laboratory investigations, intraoperative blood loss and duration of hospital stay. Results and discussion: 8 patients were male, 1 was female. The average age of diagnosis was 15 (range 11 to 29) years. The commonest chief complaint was recurrent epistaxis, followed by nasal obstruction and nasal discharge. Three patients were at stage I, 4 patients at stage II, 1 patient at stage III and 1 patient at stage IV based on Fisch classification. All patients underwent primary endoscopic endonasal excision of tumour with no vascular, ophthalmological or neurological complication. Seven patients had preoperative embolization done. Average operation time was 137 minutes (range 60–360 minutes). Intraoperative blood lost varied from 500 mL to 1300 mL (mean 777.7 mL). All patients were discharged well with no recurrence. Conclusions: The management of JNA can be challenging. The current shift in management favouring endoscopic endonasal excision of JNA reduces postoperative morbidity. It is possible to be applied on all stages of tumour with good success rate.

Intraperitoneal ropivacaine for post-operative pain following laparoscopic tubal ligation: a randomised double-blind placebo-controlled trial

Background: Female sterilisation is the most common method of contraception worldwide and laparoscopic tubal sterilisation is increasingly considered as a day-surgery procedure. Therefore, pain following this procedure should be seriously addressed. Instillation of 200 to 300 mg of ropivacaine intraperitoneally has been proven effective in controlling pain after laparoscopic tubal ligation (LTL). However, extreme caution must be taken as potential serum toxicity has been reported with the instillation of 150 mg of intraperitoneal ropivacaine. In search of the lowest, most effective dose, this study aimed to evaluate the effectiveness of 112.5 mg of ropivacaine intraperitoneally in reducing post-operative pain after LTL. Methods: This double-blind, placebo-controlled randomised trial was conducted in an ambulatory care centre in Malaysia. Sixty-two patients scheduled for LTL were recruited. Two patients were excluded from the trial because of intraoperative complications. Sixty patients were randomised to either the placebo group (intraperitoneal normal saline, n = 30) or the ropivacaine group (intraperitoneal ropivacaine, n = 30). Pain scores (using a visual analogue score), and the need for additional analgesia were assessed at 15, 60, 120, and 240 minutes post-LTL. Results: We observed no significant differences in pain scores or the need for additional analgesia between the groups. Conclusion: 112.5 mg of ropivacaine administered intraperitoneally is not more effective than normal saline in decreasing post-operative pain after LTL.

Customer Loyalty: The Effect of Service Quality and Brand Image in Malaysias Automotive Industry

This paper aims to examine the relationship between customer loyalty, service quality and brand image after sales at national automotive service centers in Malaysia. The study used a quantitative method and was completed using a SERVQUAL model. The questionnaire was answered by 311 respondents. It was discovered that brand image and customer loyalty was determined by the customers’ perception of the service quality provided by the automotive service centers in terms of technical quality and customer service. The study found a strong correlation between customer loyalty, brand image, and the service quality which includes two elements such as technical quality and customer service. It was discovered that there is a significant relationship between customer loyalty, service quality and brand image. Customer loyalty was affected by service quality and brand image at the service centers by 87%. The study highlights the intangible dimensions of customer loyalty in relations between service quality and brand image.

Survival and Prognostic Factors of HIV-positive Patients after Antiretroviral Therapy Initiation at a Malaysian Referral Hospital.

Background:Antiretroviral therapy (ART) has transformed the management of human immunodeficiency virus (HIV) infection and significantly improved survival rates, but there is lack of such survival data from Malaysia.Objective:The objective was to determine the survival rates and prognostic factors of survival in HIV-infected adults treated with ART in Malaysia.Materials and Methods:This retrospective cohort study considered all HIV-positive adult patients registered in Sungai Buloh Hospital, a major referral center in Malaysia, between January 1, 2007 and December 31, 2016. Then, patients were selected through a systematic sampling method. Demographic, clinical, and treatment data were extracted from electronic medical records. Person–years at risk and incidence of mortality rate per 100 person–years were calculated. The Kaplan–Meier survival curve and log-rank test were used to compare the overall survival rates. Cox proportional hazards regression was applied to determine the prognostic factors for survival.Results:A total of 339 patients were included. The estimated overall survival rates were 93.8%, 90.4%, 84.9%, and 72.8% at 1, 3, 5, and 10 years, respectively, from ART initiation. The results of multiple Cox proportional hazard regression indicated that anemic patients were at a 3.76 times higher risk of mortality (95% confidence interval [CI]: 1.97–7.18; P < 0.001). The hazard risk was 2.09 times higher for HIV patients co-infected with tuberculosis (95% CI: 1.10, 3.96; P = 0.024).Conclusion:The overall survival rates among HIV-infected adults in this study are higher than that from low-income countries but lower than that from high-income countries. Low baseline hemoglobin levels of <11 g/dL and tuberculosis co-infection were strong prognostic factors for survival.

Incidence of Post Tuberculosis Chronic Obstructive Pulmonary Disease in a Tertiary Centre In Malaysia

Pulmonary tuberculosis (PTB) and chronic obstructive pulmonary disease (COPD) are important causes of mortality and morbidity in Malaysia. The number of tuberculosis (TB) cases in Malaysia appears to be increasing and there were 500,000 Malaysians diagnosed with COPD in 2016. A substantial number of PTB patients go on to develop post tubular airway disease. Past infection with TB has been shown to contribute to the aetiology of COPD. We conducted a one year cross-sectional study in outpatient setting involving adult subjects in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) with a history of pulmonary tuberculosis three years prior to the study. We excluded subjects with bronchial asthma, COPD, interstitial lung disease and bronchiectasis. Airflow obstruction was defined as FEV1: FVC ratio &lt;0.70. The COPD Assessment Test (CAT) questionnaire was used. Eighty-two subjects were recruited with a median age of 52.5 years (IQR 36-62). Male predominance (56.1%) with 29 (35.4%) smokers. Eighteen (22%) subjects had airflow obstruction. Six (33%) out of these subjects were smokers. Fourteen(17%) had restrictive pattern and 50 (61%) had normal spirometry results. Five subjects (22.22%) had mild obstruction, 7 (44.44%) moderate obstruction, and 6 (33.33%) had severe obstruction. There was a positive correlation between chest X-ray abnormalities and age with airflow obstruction (P&lt;0.05). Abnormal spirometry pattern was found in 39% of subjects. Post TB-COPD incidence was 22% in those who completed TB treatment. There appeared to be an association between abnormal chest radiograph findings with airflow obstruction in subjects with history of PTB.

التدخل اللغوي لدى طلبة المدارس الثانوية الماليزية في مسابقة صناعة الأفلام القصيرة الناطقة بالعربية

ISESCO Educational Centre in Malaysia (ISESCO Malaysia), in collaboration with the Islamic Education Department of Ministry of Education, Malaysia, offers various annual language activities to improve the level of Arabic language usage among secondary school students in Malaysia. One of the languages activities organised by ISESCO Malaysia annually, is an Arabic Short Film Competition. It is noticeable that there are variety of Arabic language usage errors appeared in the videos presented, including those resulting from language interference effect. Some of these errors are often repeated by students, believing that it is a sound of Arabic language. This study therefore, conducted to examine the errors of language interference effect and its causes among Arabic learners in Malaysia’s secondary school. The study has followed the descriptive approach to analyse these errors. The study found that linguistic errors among Arabic students in Malaysian secondary schools resulted from language interference effect of their mother tongue; by literally translating it, following the culture and rules, as well as lack of knowledge of the rules of the language and culture of the Arabic language. This study proposed an appropriate action to solve the problems using educational approach.

Managing Early Childhood Care And Education: A Comparison of Government and Private Childcare Centres in Malaysia

Managing Early Childhood Care And Education: A Comparison of Government and Private Childcare Centres in Malaysia

The Incidence of Thyroid Gland Invasion in Patients with Carcinoma of the Larynx who Underwent Total Laryngectomy

Introduction: Total thyroidectomy or at least hemithyroidectomy is routinely performed alongside total laryngectomy in patients with advanced carcinoma of the larynx. Life-threatening hypocalcaemia and hypothyroidism are common sequelae especially with adjuvant radiation. The study aims to determine the incidence of microscopic thyroid gland invasion and challenge the idea of routine thyroidectomy in advanced carcinoma of the larynx. Materials and Methods: This study was a retrospective observational study. It was done in two tertiary centres in Malaysia between 2003 and 2013 for a total duration of 11 years. A total of 72 patients were included in this study. Data from medical records, operative notes, and histopathological reports were collected and analysed. Results: Three patients (4.2%) had the presence of microscopic thyroid gland invasion. There were no significant associations between microscopic thyroid gland invasion and tumour subsites, histological types of a tumour nor T staging (p&gt;0.05) Conclusion: The incidence of microscopic thyroid gland invasion in advance carcinoma of the larynx is low, disavowing routine thyroidectomy. Limitations: Some factors such as cartilage invasion on CT imaging and central lymph node treatment were not considered due to limitations in case documentation.

The clinical spectrum of ocular bartonellosis: a retrospective study at a tertiary centre in Malaysia

BackgroundCat scratch disease (CSD) is a systemic illness caused by the gram-negative bacillus, Bartonella henselea, which can occasionally involve the ocular structures. The objective of this study is to evaluate the various clinical presentations of ocular bartonellosis at our institution. A retrospective review of the clinical records of 13 patients (23 eyes) with ocular manifestations of Bartonella infections over a 3-year period between January 2016 to December 2018 was undertaken at our institution.ResultsThe diagnosis was made based on clinical findings and in addition, with the support of the evidence of Bartonella hensalae IgG and/or IgM. Small retinal white lesions were the most common ocular findings in this series of patients (82.6% of eyes, 76.9% of patients). Neuroretinitis was the second most common finding (47.8% of eyes, 69.2% of patients), followed by exudative retinal detachment involving the macula (34.8% of eyes, 53.8% of patients) and Parinaud’s oculoglandular syndrome (17.4% of eyes, 23.1% of patients). Other findings like isolated optic disc oedema without macular star (8.7% of eyes, 15.4% of patients) and vitritis (4.3% of eyes, 7.7% of patients) were also observed. Ten patients (76.9%) had bilateral ocular involvement. Most of the patients were young, immunocompetent and had systemic symptoms like fever prior to their ocular symptoms. The visual acuity (VA) at initial presentation ranged from 6/6 to hand movement (mean, 6/20), and at final visit 6/6 to 6/60, (mean, 6/9). 91.7% of patients were treated with antibiotics. Only 2 patients received oral corticosteroids together with antibiotics due to very poor vision on presentation. The visual prognosis of ocular bartonellosis is generally good with 16 (88.9%) of 23 eyes having VA of 6/12 or better at final follow-up visit.ConclusionSmall foci of retinal white lesions were the most common manifestation of ocular bartonellosis in this series, followed by neuroretinitis, though an array of other ocular findings may also occur. Therefore, we should consider bartonella infection as a possible differential diagnosis in those patients.

Exploring the facet of elderly care centre in multiethnic Malaysia

Purpose Malaysia is considered to be a relatively young country as compared to other older countries such as Japan, China and Australia in terms of the ageing population. However, until 2035, Malaysia will be in the ageing group countries as 15% of the entire population will be above 60 years of age. This situation is quite alarming as more and more ageing care centres will be required to fulfill the ongoing demands of the ageing population. The elderly care centres in Malaysia are categorised as public (sponsored by the government), private, and charity based that comes under religious centres. Currently, there are about 365 registered elderly care centres working in the main states of Malaysia, including Sabah and Sarawak, two states of the East Malaysia. Due to the importance of ageing population issues, the present study is conducted to explore the demographics facet of Malaysian’s elderly care centres. The main reason behind that lies on the fact that many of these centres are still labelled as being not well equipped and lacking behind in trained staff, equipment and also suffering from severe financial constraints but some still capable of working on a sustainability basis. Design/methodology/approach Qualitative Research Strategy has been adopted, and 28 centres throughout Malaysia are included in this study. About 18 Operators from different centres and 15 caregivers were interviewed to get the holistic view of ageing care and facilities in their respective centres. Findings The results highlight that the majority of centres are not receiving any financial help from the government, and few centres are doing small business such as supplying consumable medical and non-medical items and providing renting and rehabilitation centres facilities to sustain. The caregivers are facing issues such as excess workload, less salary, peer conflicts and non-cooperative centre leadership. Originality/value The present study may help to provide useful information to the policymakers, which enables them to formulate the strategies for ageing care centres in Malaysia. As this study provides insight of components that have an impact on the overall wellbeing of elderly care centres, hence, it could help the care services providers to act as a rising star for Malaysian’s social life comfort.

Prevalence Rates of Chlamydia Trachomatis and Other Sexually Transmitted Organisms in Infertile Couples Attending a Tertiary Medical Centre in Malaysia

INTRODUCTION: Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG) infections are well recognized and prevalent sexually transmitted infections (STIs). The role of Mycoplasma spp and Ureaplasma spp are still controversial as some are commensals of genitourinary tract. OBJECTIVES: To estimate the prevalence rate of 7 organisms: Chlamydia trachomatis, Neisseria gonorrhoea, Mycoplasma genitalium, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP) in infertile married couples during infertility evaluation. MATERIALS &amp; METHODS: A total of 274 samples from all of the 137 couples who attended the reproductive center from June to December 2014 were collected. Detection of the organisms was performed using multiplex polymerase chain reaction. RESULTS: STI-associated organisms were detected in 35.4% (97/274) of subjects. The prevalence rates of CT, MG, TV, UU, MH were 7.3%,1.1%, 0.4%,5.4% and 5.1% respectively. Twenty-one (7.7%) subjects were positive for more than one organism. 24/274 (8.8%) of subjects had history of urogenital tract-related symptoms and 50% (12/24) were tested positive to one or more organisms. The presence of symptoms in both male and female subjects were found to be 10% (2/20) in CT infection, 10% (7/67) in UP, 14% (2/14) in MH and 13% (2/15) in UU infections. CONCLUSION: Sexually transmitted organisms were detected in one third of subjects planning for fertility evaluation. The absence of symptom in most subjects particularly in CT infection emphasizes the need for microbiological screening during infertility evaluation. The presence of genital ureaplasmas and mycoplasmas in infertile couples should not be neglected. There is a growing need to clarify whether their roles are simply colonizers or pathogens implicated in infertility.

A retrospective analysis of the care cascades for non-communicable disease and mental health among people living with HIV at a tertiary-care centre in Malaysia: opportunities to identify gaps and optimize care.

IntroductionThe rapidly growing epidemic of non‐communicable diseases (NCDs) including mental health among aging people living with HIV (PLWH) has put a significant strain on the provision of health services in many HIV clinics globally. We constructed care cascades for specific NCDs and mental health among PLWH attending our centre to identify potential areas for programmatic improvement.MethodsThis was a follow‐up study of participants recruited in the Malaysian HIV & Aging study (MHIVA) from 2014 to 2016 at the University Malaya Medical Centre (n = 336). PLWH on suppressive antiretroviral therapy (ART) for a minimum of 12 months were invited to participate. At study entry, all participants underwent screening for diabetes (DM), hypertension (HTN) and dyslipidaemia; and completed assessments using the depression, anxiety and stress scale (DASS‐21). Screening results were recorded in medical charts and clinical management provided as per standard of care. A subsequent review of medical records was performed at 24 months following study completion among participants who remained on active follow‐up. Treatment pathways for NCD treatment and psychiatric referrals were assessed based on local practice guidelines to construct the care cascade.ResultsA total of 329 participants (median age = 43 years, 83% male, 100% on ART) completed follow‐up at 24 months. The prevalence of diabetes was 13%, dyslipidaemia 88% and hypertension 44%, whereas 23% presented with severe/extremely severe symptoms of depression, anxiety and/or stress. More than 50% of participants with dyslipidaemia and hypertension were not diagnosed until study screening, whereas over 80% with prevalent psychiatric symptoms were not previously recognized clinically. Suboptimal control of fasting lipids, sugar and blood pressure were found in the majority of participants despite optimal HIV treatment outcomes maintained over this same period. Only 32% of participants with severe/extremely severe mental health symptoms received psychiatric referrals and 83% of these attended their psychiatry clinic appointments.ConclusionsSystematic screening must be introduced to identify NCDs and mental health issues among PLWH followed by proper linkage and referrals for management of screen‐positive cases. Assessment of factors associated with attrition at each step of the care cascade is critically needed to improve health outcomes in our aging patients.

The Relationship between Physical Activity, Body Mass Index and Body Composition among Students at a Pre-University Centre in Malaysia

INTRODUCTION: Physical activity is an essential element in our daily life that leads to long-term health benefits. Physical activity refers to movement of the body that requires energy. Body mass index (BMI) indicates a ratio of body weight to squared height, which is a useful health indicator. On the contrary, body composition describes the body by measuring percentages of fat and muscle in human bodies. MATERIALS AND METHODS: This cross-sectional study aimed to determine the relationship between physical activities, BMI and body composition among pre-university students from one of the universities in Selangor, Malaysia. Stratified random sampling was employed to recruit 70 pre-university students into this study. RESULTS: From the study, 50% of the respondents are categorized as minimally active. In addition, there is significant difference between the physical activity levels of male and female respondents. The relationship between physical activity and BMI indicates a very weak negative correlation. Similarly, the correlation between physical activity and fat mass is a weak negative relationship. Meanwhile, there is a weak positive correlation between physical activity and muscle mass. CONCLUSION: Therefore, it can be concluded that when physical activity increases, BMI and body fat mass will decrease, while muscle mass will increase. Moreover, it was shown that there was a significant relationship between physical activity and body composition.

Pelvic exenteration for locally advanced and local recurrent primary rectal cancer: a 5 years Asian retrospective cohort study and lessons to learn

Background: Locally advanced rectal cancer (LARC) and local recurrent rectal cancer (LRRC) were deemed incurable, but with surgical advancement, pelvic exenteration has emerged as a curative option. Although colorectal cancer cases are common, pelvic exenterations are limited to several centres in Malaysia. The study aimed to determine the outcomes of pelvic exenteration from the centre in terms of complete resection, local recurrence rate, mortality rate and complications rate.Methods: Retrospective data collection was done for pelvic exenteration surgeries of LARC and LRRC from year 2014 till 2018 in a Malaysian tertiary referral centre. Demographic data, types of pelvic exenteration, postoperative complications, postoperative histopathology for complete resection (R0) and local recurrence were collected from the hospital medical records.Results: From 2014 till 2018, 51 cases of pelvic exenteration were done, with a mean age of 55.8±12.4 years and predominance of male gender (55%). Thirty-four cases (66.7%) completed the exenteration. A mere 24 cases (47.1%) had complete preoperative imaging of computed tomography (CT scan), pelvic magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET/CT) scan. R0 resection was achieved in 23 cases (67.6%). Complications were found in 44.8% of patients including anastomotic leak, collection, surgical site infection or cardiac/lung complications. The 30-days postoperative mortality rate is 3.9%. The six-months local recurrence rate was 5.8% and one-year local recurrence rate was 7.8%.Conclusion: Pelvic MRI and PET-CT scan is suggested to be compulsory for all pelvic exenteration candidates to ensure a good outcome. Multidisciplinary team approach is needed preoperatively to discuss the feasibility of pelvic exenteration to optimise the outcomes of this surgery.

Prevalence and risk factors for respiratory symptoms among children at child care centers in Malaysia

Many studies have been conducted to assess the effects of indoor air quality (IAQ) on human health. However, there is still a lack of studies available about the adverse health effects on children’s respiratory health at Child Care Centers (CCC). The aim of this paper was to investigate the risk factors for respiratory symptoms and identify the root cause of IAQ problems at CCCs in Malaysia. The Modified American Thoracic Society and the Division of Lung Diseases (ATS-DLD-82) questionnaire was used to gather information from parents regarding their children’s respiratory symptoms. The IAQ parameters measured were for air temperature, humidity, carbon dioxide, carbon monoxide, respirable particles (PM2.5), viable bacteria and fungi count while the information on CCC characteristics and potential surrounding air pollutants were collected via a combination of area monitoring, inspection and interviews. Factors found to be significantly associated with persistent cough and/or cold were age, type of ventilation, location of CCC, floor area per child (<3.5 m2) and temperature. Children attending CCCs supplied by ACMV had the highest risk for prevalence of persistent productive cough [5.56 (CI: 2.20; 14.00)]. This study provided the baseline data on IAQ and possible factors that influenced indoor air contaminants, which could aid policy makers in formulating guidelines on IAQ for CCC in Malaysia.

Positive Impacts of Islamic Inabah Substance Abuse Rehabilitation Program on Health-related Quality-of-Life Profiles and Religiousness

Introduction: Inabah program is psychospiritual rehabilitative approach which holistically incorporates Islamic concepts and religious practices in its module encompassing of prayers, zikir, and hydrotherapy. Objectives: This study attempts to (1) determine the impact of Inabah on health-related quality of life (HRQoL) profiles and religiousness and (2) explore the relationships between HRQoL and religiousness pre-Inabah and post-Inabah. Methods: A prospective preintervention and postintervention study was conducted at 3 Inabah centers in Malaysia, recruiting new inmates aged 18 years and above who were cognitively stable and have undergone detoxification. The Malay WHOQOL-BREF (higher score=better HRQoL) and Psychological Measure of Islamic Religiousness (PMIR) (higher score=better profiles) were administered before and after Inabah intervention (minimum 2 mo). Results: One hundred fifteen all-male inmates of 144 eligible participants (79.9%) completed the program (age=30.5±7.8 y; intervention duration ≤2.5 mo=60.9%; The Sijil Pelajaran Malaysia qualification=47.0%). Significant positive changes in Overall HRQoL, General Health, Psychological, and Islamic Obligations and Implementation issues were detected after Inabah (P<0.05; effect size=0.27 to 0.39). Pre-Inabah, Life Satisfaction (in PMIR) correlated significantly with all HRQoL domains (P<0.001) while Islamic Obligations and Implementation only significantly correlated with Psychological domain (P<0.05). Majority of other PMIR versus HRQoL relationships were also significant. Post-Inabah however, dramatic increases were observed in Islamic Obligations and Implementation domain which linked significantly with all (except 1) HRQoL aspects. Conclusions: The positive impacts of the noninvasive Inabah program on HRQoL and religiousness among substance abusers were evident.

Resilience in adolescent refugees living in Malaysia: The association with religiosity and religious coping.

Until now, there is scarcity of information regarding resilience, religiosity and religious coping among adolescent refugees. Currently, most researches emphasize on the physical, psychological and social distresses experienced by refugees while overlooking these crucial aspects, that is, resilience and coping. The study aimed to examine resilience and its association with religiosity and religious coping among adolescent refugees living in Malaysia. This is a cross-sectional study conducted in five community-based learning centres in Malaysia from July 2019 till December 2019. A total of 152 refugees, aged 13 to 19-years-old, were recruited. The study gauged resilience using the 14-Item Resilience Scale (RS-14), the Duke University Religion Index (DUREL) for religiosity and the Brief Religious Coping Scale (Brief RCOPE) for religious coping. The majority of adolescent refugees portrayed moderate levels of resilience (43.5%). The study highlighted the interconnectedness between resilience and intrinsic religiosity (IR) (p < .001), as well as, positive (p < .001) and negative (p = .010) religious coping. Additionally, the results demonstrated that certain sociodemographic factors could potentially confound resilience, namely, countries of origin (p < .001), religion (p < .001), education centre (p < .001) and refugee status (p = .018). With knowledge from this study, mental health professionals can initiate or improve liaison with religious-based services in working together to provide resources for adolescent refugees. Incorporating information regarding mental health with religious teachings may help increase resilience in young refugees and, in turn, alleviate their psychological distress.

Clinical and genetic risk factors for new-onset diabetes mellitus after transplantation (NODAT) in major transplant centres in Malaysia

BackgroundNew-onset diabetes after transplantation (NODAT) is associated with reduced patient and graft survival. This study examined the clinical and selected genetic factors associated with NODAT among renal-transplanted Malaysian patients.MethodsThis study included 168 non-diabetic patients (58% males, 69% of Chinese ethnicity) who received renal transplantation between 1st January 1994 to 31st December 2014, and were followed up in two major renal transplant centres in Malaysia. Fasting blood glucose levels were used to diagnose NODAT in patients who received renal transplantation within 1 year. Two single nucleotide polymorphisms (SNPs), namely; rs1494558 (interleukin-7 receptor, IL-7R) and rs2232365 (mannose-binding leptin-2, MBL2) were selected and genotyped using Sequenom MassArray platform. Cox proportional hazard regression analyses were used to examine the risk of developing NODAT according to the different demographics and clinical covariates, utilizing four time-points (one-month, three-months, six-months, one-year) post-transplant.ResultsSeventeen per cent of patients (n = 29, 55% males, 69% Chinese) were found to have developed NODAT within one-year of renal transplantation based on their fasting blood glucose levels. NODAT patients had renal transplantation at an older age compared to non-NODAT (39.3 ± 13.4 vs 33.9 ± 11.8 years, p = 0.03). In multivariate analysis, renal-transplanted patients who received a higher daily dose of cyclosporine (mg) were associated with increased risk of NODAT (Hazard ratio (HR) =1.01 per mg increase in dose, 95% confidence interval (CI) 1.00–1.01, p = 0.002). Other demographic (gender, ethnicities, age at transplant) and clinical factors (primary kidney disease, type of donor, place of transplant, type of calcineurin inhibitors, duration of dialysis pre-transplant, BMI, creatinine levels, and daily doses of tacrolimus and prednisolone) were not found to be significantly associated with risk of NODAT. GA genotype of rs1494558 (HR = 3.15 95% CI 1.26, 7.86) and AG genotype of rs2232365 (HR = 2.57 95% CI 1.07, 6.18) were associated with increased risk of NODAT as compared to AA genotypes.ConclusionThe daily dose of cyclosporine and SNPs of IL-7R (rs1494558) and MBL2 (rs2232365) genes are significantly associated with the development of NODAT in the Malaysian renal transplant population.

Paediatric Adenotonsillectomy: Its Safety and Outcome in a Malaysian Tertiary Medical Center.

Adenotonsillectomy is the commonest otorhinolaryngology surgery for paediatrics. The purpose of this study was to determine the safety and outcome of adenotonsillectomy in a tertiary center in Malaysia. This was achieved by studying the demographics, indications, co-morbidities of patients and its association with the complications of the procedure. This retrospective study was conducted from November 2011 until October 2016. Medical records of patients aged 2-12years old who had adenotonsillectomy done in our center were retrieved for data collection. A total of 143 patients who fulfilled the inclusion and exclusion criteria were recruited. Median age was 7.52 (± 2.98 SD) years old. Allergic rhinitis was the commonest co-morbidity (40%). Recurrent tonsillitis was the main indication (60%), followed by sleep disordered breathing (SDB) without apnea (29%), obstructive sleep apnea (OSA) (7%) and other indications (4%). Post-operative paediatric intensive care unit (PICU) admission was very low (1.4%) and was reserved for those with severe OSA with complications. None of the patients admitted to PICU post-operative had respiratory complications. The prevalence of post-tonsillectomy bleeding was only 2.1%. There was no significant association between patient's co-morbidity with operative complications (p = 0.269). Adenotonsillectomy is indicated for children with recurrent tonsillitis and paediatric SDB. The two most severe complications, namely post-tonsillectomy haemorrhage and respiratory complications occurred but incidence was low. Criteria of post-operative PICU or paediatric high dependency unit admission for paediatric SDB has to be based on multiple clinical and logistics factors and not only patients co-morbidity and indication of surgery.