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Chronic wounds are associated with significant clinical, economic and quality‐of‐life burden. Despite the variety of wound imaging systems available in the market for wound assessment and surveillance, few are clinically validated among patients of Asian ethnicity. We aimed to clinically validate the accuracy of a smartphone wound application (Tissue Analytics [TA], Net Health Systems Inc, Florida, USA), versus conventional wound measurements (visual approximation and paper rulers), in patients of Asian ethnicity with venous leg ulcers (VLU). A prospective cohort study of patients presenting with VLU to a specialist wound nurse clinic over a 5‐week duration was conducted. Each patient received seven wound measurements: one by a trained wound nurse clinician, and three separate wound measurements using TA on each of the iOS and Android operating systems. Inter‐rater and intra‐rater reliability between clinical and TA‐based measurements were analysed using intra‐class correlation statistics, with values of <0.5, 0.5 to 0.75, 0.75 to 0.9, and >0.9 indicating poor, moderate, good and excellent reliability, respectively. 82 patients (51% males), with a mean age at 65.8 years, completed the 5‐week study duration. 25 (30%) had underlying diabetes mellitus. Chinese, Malay and Indian ethnicity comprised 68%, 12% and 11%, respectively. The VLU healed in 26 (32%) of patients within the study period. In total, 358 wound episodes with 2334 wound images were analysed. Inter‐rater reliability for length, width and area between wound nurse measurements and TA application measurements was good (range 0.799‐0.919, P < 0.001). Separate measurements of intra‐rater reliability for length, width and area within the iOS or Android systems were excellent (range 0.967‐0.985 and range 0.977‐0.984 respectively, P < 0.001). Inter‐rater reliability between TA used on the iOS and Android systems was also excellent (0.987‐0.989, P < 0.001). Tissue Analytics, a smartphone wound application, is a useful adjunct for wound assessment and surveillance in VLU patients of Asian ethnicity. [ABSTRACT FROM AUTHOR]

Current suicide risk assessments for predicting suicide attempts are time consuming, of low predictive value and have inadequate reliability. This paper aims to develop a predictive model for suicide attempts among patients with depression using machine learning algorithms as well as presents a comparative study on single predictive models with ensemble predictive models for differentiating depressed patients with suicide attempts from non-suicide attempters. We applied and trained eight different machine learning algorithms using a dataset that consists of 75 patients diagnosed with a depressive disorder. A recursive feature elimination was used to reduce the features via three-fold cross validation. An ensemble predictive models outperformed the single predictive models. Voting and bagging revealed the highest accuracy of 92% compared to other machine learning algorithms. Our findings indicate that history of suicide attempt, religion, race, suicide ideation and severity of clinical depression are useful factors for prediction of suicide attempts. [ABSTRACT FROM AUTHOR]

Background: Self-management support has been recognized as one of the most essential elements of the Chronic Care Model (CCM). Inspired by the CCM, the EMPOWER-SUSTAIN Global Cardiovascular Risks Self-Management Booklet© was developed to aid and sustain self-management among patients with metabolic syndrome (MetS) in primary care to prevent cardiovascular complications. However, the usability of this booklet among these patients is not known. Therefore, this study aimed to evaluate the usability of this self-management booklet and identify the factors associated with its usability among patients with MetS in primary care. Methods: This cross-sectional study was conducted among patients with MetS attending a university primary care clinic in Selangor, Malaysia. The usability score was measured using a previously translated and validated EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) with a score of > 68 indicating good usability. Multiple logistic regressions determined the factors associated with its usability. Results: A total of 391 patients participated in this study. More than half (61.4%) had a good usability score of > 68, with a mean (± SD) usability score of 72.8 (± 16.1). Participants with high education levels [secondary education (AOR 2.46, 95% CI 1.04, 5.83) and tertiary education (AOR 2.49, 95% CI 1.04, 5.96)], those who used the booklet at home weekly (AOR 2.94, 95% CI 1.63, 5.33) or daily (AOR 2.73, 95% CI 1.09, 6.85), and those who had social support to use the booklet (AOR 1.64, 95% CI 1.02, 2.64) were significantly associated with good usability of the booklet. Conclusions: The usability of the EMPOWER-SUSTAIN Global Cardiovascular Risks Self-Management Booklet© was good among patients with MetS in this primary care clinic, which supports its widespread use as a patient empowerment tool. The findings of this study also suggest that it is vital to encourage daily or weekly use of this booklet at home, with the support of family members. The focus should also be given to those with lower education to improve the usability of this booklet for this group of patients. [ABSTRACT FROM AUTHOR]

The Malaysian government's ongoing movement control order (MCO) to prevent coronavirus disease 2019 (COVID-19) spread, has disrupted the teaching and learning (T&L) activities of higher education institutions in the country. This paper seeks to outline the steps taken by the Department of Family Medicine of the International Medical University (IMU), Malaysia, to adapt its online teaching and learning activities. The five tips are: i) understand how to use online T&L platforms; ii) teachers should create multiple communication channels; iii) ensure attendance is captured; iv) enhance the online T&L experience and v) conduct online formative assessments. [ABSTRACT FROM AUTHOR]

Introduction. Triglycerides are lipids composed of fatty acids that provide energy to the cell. These compounds are delivered to the body's cells via lipoproteins found in the bloodstream. Increased blood triglyceride levels have been associated with high-fat or high-carbohydrate diets. Generally, increased triglyceride levels occur in conjunction with other symptoms that are difficult to notice and recognize. Objectives. The study's goal was to develop and predict the model that could be used to explain the relationship between triglycerides and waist circumference, high-density lipoprotein (HDL), and hypertension status by determining the relationship between triglycerides and waist circumference, HDL, and hypertension status. This model was developed using qualitative predictor variables and incorporated data bootstrapping multilayer perceptron neural networks and fuzzy linear regression. Materials and procedures. This was a public health study that combined retrospective data analysis with methodology development. The medical records of patients who attended outpatient clinics at Hospital Universiti Sains Malaysia (USM) were collected and analyzed. This was to provide a more extensive illustration of the methods developed. Screening and selection of patient data were necessary following the inclusion and exclusion criteria. The patient's medical record was used to obtain triglycerides, high-density lipoprotein (HDL), waist circumference, and hypertension status. Due to the critical nature of the variable, it was chosen to aid the clinical expert. The R-Studio software was used to develop the associated syntax for the hybrid model, which would define the association between the examined variables. The purpose of this study is to create a technique for the clinical trial design that utilizes bootstrapping, Qualitative Predictor Variables (QPV), Multiple Linear Regression (MLR), Artificial Neural Networks (ANNs), and Fuzzy Regression (FR). All analyses were performed using the newly introduced R syntax. The research developed a fuzzy linear model that increased modelling performance by incorporating clinically significant factors and validated variables via Multilayer Perceptron (MLP). Conclusion. The proposed technique for modelling and prediction appeared to be the ideal combination of bootstrap, Multilayer Feed Forward (MLFF) neural network, and fuzzy linear regression. The created syntax is currently being evaluated and validated clinically. For modelling and prediction, the proposed technique looked to be the best, as it incorporated bootstrap, MLFF neural network, and fuzzy linear regression. The established syntax is now being utilized in the clinic to evaluate and validate the outcome. In terms of variable selection, modelling, and model validation, this strategy was superior to earlier approaches for fuzzy regression modelling. [ABSTRACT FROM AUTHOR]

Background. The CYP2C19*2 allele may be associated with a reduced antiplatelet effect for clopidogrel. Here, we assessed whether CYP2C19*2 alleles correlate with clopidogrel responsiveness following the administration of clopidogrel in healthy Malaysian volunteers. Methods. Ninety volunteers were genotyped for CYP2C19*2 and CYP2C19*3 alleles. Forty-five of 90 volunteers were included in the clopidogrel response studies and triaged into three genotypes, namely, CYP2C19*1/*1 (n = 17) CYP2C19*1/*2 (n = 21) and CYP2C19*2/*2 (n = 17). All subjects received 300 mg of clopidogrel, and platelet reactivity was assessed after a four-hour loading utilizing the VerifyNow-P2Y12 assay. Platelet activity was reported using P2Y12 reaction units (PRUs), and nonresponder status was prespecified at PRU = 230. Results. Following clopidogrel intake, CYP2C19*2/*2 carriers had a significantly higher mean PRU compared to the CYP2C19*1/*2 and CYP2C19*1/*1 (291.0 ± 62.1 versus 232.5 ± 81.4 versus 147.4 ± 87.2 PRU, P < 0.0001) carriers. Almost half of the participants (46.7%) were found to be nonresponders (3 were CYP2C19*1/*1, 11 were CYP2C19*1/*2, and 7 were CYP2C19*2/*2). Conclusion. In healthy Malaysian volunteers, CYP2C19*2 allele was associated with a decrease in platelet responsiveness to clopidogrel. However, clopidogrel nonresponders can be found not only in the carriers of CYP2C19*2/*2, but also in the carriers of CYP2C19*1/*2 and CYP2C19*1/*1. The present paper demonstrated that genotype information does not correlate with clopidogrel response, and genotyping may represent a less robust approach compared to platelet activity testing in guiding clopidogrel therapy. [ABSTRACT FROM AUTHOR]

Stevioside from Stevia rebaudiana has been reported to exert antihyperglycemic effects in both rat and human subjects. There have been few studies on these effects in vitro. In this paper, radioactive glucose uptake assay was implemented in order to assess improvements in insulin sensitivity in 3T3-L1 cells by elevation of glucose uptake following treatment with stevioside. Oil Red-O staining and MTT assay were utilized to confirm adipocyte differentiation and cell viability, respectively. Findings from this research showed a significant increase in absorbance values in mature adipocytes following Oil Red-O staining, confirming the differentiation process. Stevioside was noncytotoxic to 3T3-L1 cells as cell viability was reduced by a maximum of 17%, making it impossible to determine its IC50. Stevioside increased glucose uptake activities by 2.1 times (p < 0.001) in normal conditions and up to 4.4 times (p < 0.001) in insulin-resistant states. At times, this increase was higher than that seen in positive control group treated with rosiglitazone maleate, an antidiabetic agent. Expressions of pY20 and p-IRSl which were measured via Western blot were improved by stevioside treatment. In conclusion, stevioside has direct effects on 3T3-L1 insulin sensitivity via increase in glucose uptake and enhanced expression of proteins involved in insulin-signalling pathway. [ABSTRACT FROM AUTHOR]

Background: The paper examined the quality of life of haematological cancer patients according to their socio-demographic profiles and clinical diagnoses. Methods: This cross-sectional study was conducted at the tertiary referral centre of Ampang Hospital, Kuala Lumpur, involving 105 patients. The European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) questionnaire was used to measure their quality of life. Results: The study involved patients diagnosed with all types of haematological cancer, including non-Hodgkin lymphoma (NHL), acute myelogenous leukaemia (AML), acute lymphoblastic leukaemia (ALL), Hodgkin lymphoma (HL), and multiple myeloma (MM), with a response rate of 83.3%. The patients with ALL, HL, without NHL, and without MM were younger than other patients. There were significant differences in quality of life scores in different socio-demographic groups and types of cancer diagnosis. The global quality of life of the female patients was much better than that of the male patients. Patients who were 40 years old or younger had a better global quality of life and physical functioning, as well as fewer symptoms of constipation, nausea, and vomiting. Employed patients were in less pain but showed greater impairments of cognitive function than did unemployed patients. Patients who earned a monthly wage of RM1000 or less had reduced physical function, more symptoms of pain, and more financial difficulties compared with patients who earned more. Patients with AML tended to have better physical functioning than did patients with MM, whose physical functioning was impaired. Comparatively, more symptoms of dyspnoea were found in ALL and HL patients than in other types of lymphoma. Compared with other patients, those with ALL had a greater loss of appetite, and other lymphoma patients had fewer symptoms of pain. Patients with NHL had impaired role functioning and more constipation compared with other patients. The results were all statistically significant (P < 0.05). Conclusion: The quality of life of haematological cancer patients is affected by sociodemographic factors and clinical diagnoses. Efforts should be made to improve the overall quality of life of these patients. [ABSTRACT FROM AUTHOR]

Background: Medication use process in the emergency department (ED) can be challenging and the risk for medication error (ME) to occur is high. In Malaysia, several studies on ME have been conducted in various hospital settings. However, little is known about the prevalence of ME in emergency department (ED) in these hospitals. The objective of this study was to determine the prevalence and characteristics of ME at an ED of a teaching hospital in Malaysia.Methods: A cross-sectional study was conducted over the period of 9 weeks in patients who visited the ED of Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia. Data on patient medication orders and demographic information was collected from the doctor's clerking sheet. Observations were made on nursing activities and these were documented in the data collection form. Other information related to the administration of medications were obtained from the nursing care records.Results: Observations and data collections were made for 547 patients who fulfilled the study criteria. From these, 311 patient data were randomly selected for analysis. Ninety-five patients had at least one ME. The prevalence of ME was calculated to be 30.5%. The most common types of ME were wrong time error (46.9%), unauthorized drug error (25.4%), omission error (18.5%) and dose error (9.2%). The most frequently drug associated with ME was analgesics. No adverse event was observed.Conclusions: The prevalence of ME in our ED setting was moderately high. However, the majority of them did not result in any adverse event. Intervention measures are needed to prevent further occurrence. [ABSTRACT FROM AUTHOR]

Background/Aim. Epidemiology of maxillofacial fractures (MFF) varies between populations. This study investigated the epidemiology of MFF treated at the Oral and Maxillofacial Surgery (OMFS) Unit, Hospital Universiti Sains Malaysia (USM). Methods. A retrospective review of 473 medical records of patients with MFF treated from June 2013 to December 2015 was conducted. Information on demographic characteristics of patients, aetiology of injury, types of MFF, and treatment was obtained. Descriptive analysis, Pearson's chi-squared test, and multiple logistic regression analysis were conducted. The level of significance was set at 0.05. Results. Most patients treated for MFF were males (82.2%), aged 30 and below (63.1%), and from Malay ethnic (97.4%). Road traffic accident was the most common cause of MFF (83.1%), with motorcycle accident accounting for most injuries (73.6%). Orbital wall fracture was the most frequent MFF type (51.2%). About half of MFF patients (51.4%) were treated conservatively. Patients aged more than 20 years old were at higher odds of sustaining orbital wall fracture (AOR= 1.76; 95% CI: 1.214-2.558; P= 0.003) but were at lower odds of sustaining mandibular fracture (AOR= 0.47; 95% CI: 0.315-0.695; P= 0.001) than patients who are 20 years old and younger. Helmet use among motorcyclists was significantly associated with the nasal, orbital wall, and maxillary sinus wall fractures (P= 0.006, 0.010, and 0.004, respectively). Conclusion. Motorcycle accident was the most common cause of MFF in Kelantan, Malaysia. Ages of patient and helmet use were associated with the type of MFF sustained. This study provides important information to facilitate the planning of MFF prevention strategies among motorcyclists and emphasizes the importance of using a helmet when riding a motorcycle. [ABSTRACT FROM AUTHOR]

Background. Mental illness is a pertinent risk factor related to suicide. However, research indicates there might be underdiagnosis of mental illness in Asian suicide attempters; this phenomenon is concerning. This study explored prediction of diagnosis of mental illness in suicide attempters in Singapore using available variables. Methods. Three years of medical records related to suicide attempters (N = 462) who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to analysis. Of the sample, 25% were diagnosed with mental illness; 70.6% were females and 29.4% were males; 62.6% were Chinese, 15.4% Malays, and 16.0% Indians. Their age ranged from 12 to 86 (M = 29.37, SD = 12.89). All available variables were subjected to regression analyses. Findings. The full model was significant in predicting cases with and without diagnosis of mental illness and accurately classified 79% of suicide attempters with diagnosis of mental illness. Conclusions. The findings were discussed in regard to clinical implications in diagnosis and primary prevention. [ABSTRACT FROM AUTHOR]

Background. Toxoplasmosis is caused by infection from a ubiquitous obligate intracellular parasite known as Toxoplasma gondii, which can infect both human and warm-blooded animals. This infection is commonly prevalent in developing country. Objectives. The purpose of this study is to report on a 7-year review of ocular toxoplasmosis patients that presented to the Universiti Sains Malaysia Hospital. Material and methods. This is a retrospective review of cases. The demographic data, ocular manifestations, clinical and laboratory profiles, treatment and disease outcome were collected from the patients' medical records from January 2010 to December 2016. Results. A total of 16 patients with a diagnosis of ocular toxoplasmosis were identified. The mean age was 43.2, with standard deviation ± 15.4 years old. The percentage was 62.5% (10 patients) females and 37.5% (6 patients) male. The majority of patients were Malay (93.4%, 15 patients). The most common classification of uveitis was panuveitis (56.3%, 9 patients), followed by posterior uveitis (25%, 4 patients), anterior uveitis (12.5%, 2 patients) and intermediate uveitis (6.2%, 1 patient). Keratic precipitate (75%, 12 patients) and vitritis (75%, 12 patients) were the most common ocular manifestation of ocular toxoplasmosis. A serological test for toxoplasmosis found only 1 patient with positive serum immunoglobulin M, while all patients displayed non-reactive serum immunoglobulin G (except 1 missing data). All ocular toxoplasmosis patients were treated with oral Azithromycin 500 mg daily for 6 weeks, 81.3% (13 patients) were given an instillation of a steroid eye drop, while 25% (4 patients) required administration of an oral steroid. All of the patients responded well to treatment, but 25% (4 patients) suffered from recurrence, which required a second course of treatment. Conclusions. Ocular toxoplasmosis is a serious and depilating disease that can cause serious ocular morbidities. This review shows a diverse presentation of ocular toxoplasmosis as a result of toxoplasmosis infection. [ABSTRACT FROM AUTHOR]

The article presents research on the effect of emotional stability on the social adjustment of working men in Mangalore, Karnataka, India. Results of the study show the association between the emotional stability of the workers' coping, life and life situations in the context of their social adjustments at work.