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INTRODUCTION: Lesbian, Gay, Bisexual and Transgender (LGBT) patients continue to report discrimination in healthcare setting despite the efforts of the primary healthcare offering community friendly services in Malaysia. This qualitative study aimed to provide understanding of this current issue and to explore the challenges that family medicine specialists (FMSs) from East Coast of Peninsular Malaysia face when dealing with LGBT patients. MATERIALS AND METHODS: 30 FMSs working in East Coast Peninsular Malaysia were interviewed through a phenomenological framework using semi-structured indepth interviews of LGBT patients. The interviews were recorded in audio format, transcribed verbatim, and subjected to Braun and Clarke’s thematic analysis. We discerned common themes that can be elucidated through the lens of Leininger’s Theory of Culture Care (TCC) and the Sunrise Enabler Model (SEM). RESULTS: Three overlapping themes of the transcriptions were developed; (1) Multidimensional understanding of LGBT described how FMSs saw the LGBT community as diverging from societal norms, yet acknowledge their vulnerability as integral members of the society, (2) obstacles to providing culturally competent care stemmed from inadequate training, an unsupportive clinic environment, and the self-stigma experienced by patients, and (3) barriers to incorporating spiritual needs for holistic care arose in situations where there was insufficient spiritual health training or a preference to concentrate on physical and emotional well-being to uphold trust. CONCLUSION: The findings on this study reflect the need for proper training of healthcare personnel to deliver a holistic, culturally competent care for LGBT patients. A collaborative effort with relevant authorities is also needed to successfully overcome those challenges. [ABSTRACT FROM AUTHOR]

Hyponatraemia is the most commonly encountered electrolyte disturbance in neurological high dependency and intensive care units. Cerebral salt wasting (CSW) is the most elusive and challenging of the causes of hyponatraemia, and it is vital to distinguish it from the more familiar syndrome of inappropriate antidiuretic hormone (SIADH). Managing CSW requires correction of the intravascular volume depletion and hyponatraemia, as well as mitigation of on-going substantial sodium losses. Herein we describe a challenging case of CSW requiring large doses of hypertonic saline and the subsequent substantial benefit with the addition of fludrocortisone.

INTRODUCTION: Acute myocardial infarction (AMI) is the major cause of death worldwide. There is limited data on the characteristics of afflicted young adults. A recent increase in recreational drugs has been associated. No local studies have ever reliably attributed this to young adults. This study aims to study the characteristic of AMI cases among young adults and these associations. MATERIALS AND METHODS: This cross-sectional study was conducted at a tertiary referral centre for Cardiology services, Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang. It involved screening 818 patients presenting with AMI at the Emergency Department of HTAA over a one-year duration. Malaysian citizens aged 18 to 45 years newly diagnosed with AMI were included. Urinary samples were collected for recreational drug screening. RESULTS: The incidence of AMI cases among young adults in HTAA Kuantan, Pahang were 10.3 per 100 persons of total AMI cases in one year (95% Confidence Interval, 8.4%-12.6%). Fifty -eight patients who met the inclusion criteria were recruited, 1.7 % tested positive for amphetamines. Males made up 96.6% of the patients and the most common risk factor identified for young adults with AMI was smoking (N=45, 77.6%) followed by obesity (N=33, 56.9%). More than half (58.6%) of the patients had 3 cardiovascular disease risk factors or more. CONCLUSION: Recreational drug use at AMI presentation was negligible. Males made up the majority and smoking was the most prevalent risk factor. To date, this is the first study in Malaysia looking at the incidence of young adults with AMI and their preponderant characteristics. [ABSTRACT FROM AUTHOR]

Improper self-treatment of vaginal discharge may result in various complications to the patient. We reported a case of a 24-year-old single and nulliparous lady with an oak gall stick lodged in her vagina during an attempt to treat her own vaginal discharge. During an examination under anaesthesia (EUA), her hymen was noted to be torn and a foreign body was identified and removed out from her vagina. Her upper vaginal swab cultures were negative for any pathogen. We concluded that this was a case of intravaginal foreign body complicated with vaginal injury secondary to self-medication for vaginal discharge by using a herbal stick. Hence, the public should be educated to seek proper medical treatment rather than performing self-treatment. [ABSTRACT FROM AUTHOR]

Living with morbid obesity is challenging since it affects various dimensions of life. Sustainable weight loss via bariatric surgery helps people suffering from morbid obesity to lead a healthy and meaningful life. This study highlights the challenges before bariatric surgery and the impact on one's life. A phenomenological approach was employed using in-depth interviews with 21 participants (15 females and 6 males) who had undergone surgery at least 6 months prior to the study with the mean age of 42.6 years. Due to excess body weight, the physical limitation had a serious negative impact on their social life, making them targets of bias and stigmatisation. Surgery was the best option for them to attain sustainable weight loss and to lead a new life. However, a few participants struggled with the side effects of surgery. Five themes were discovered, namely, (1) social restraint; (2) experiencing bias and stigmatisation; (3) bringing new life; (4) boosting self-esteem; and (5) facing the negative side of surgery. This study serves as a platform to explore the difficulties faced by people with morbid obesity and the changes that the participants experienced after the surgery for future intervention to curb the rising number of people with morbid obesity.

Poor sleep is related to type 2 diabetes and adversely influences a person’s quality of life. This study aimed to evaluate sleep quality in patients with type 2 diabetes (T2DM), its associated factors, and its relationship with quality of life. A cross-sectional study was conducted at a primary care clinic in a tertiary hospital on the east coast of Malaysia. This study included 350 participants (175 men and 175 women). Data were collected using the Malay version of the Pittsburgh Sleep Quality Index (PSQI-M) with a cut-off point of >5 as poor sleep, the Malay version of Diabetes Distress Scale (MDDS-17) and the revised Malay version of T2DM-related quality of life (Rv-DQOL). Statistical analysis was conducted using the SPSS software version 26.0. The respondents’ median (interquartile range (IQR)) age was 62.0 (11.0) years, and poor sleep was reported in 32% (95% confidence interval (CI) = 27.1, 36.9) of the participants. Multivariate logistic regression analysis revealed that poor sleep quality was significantly associated with nocturia (odds ratio (OR) = 2.04; 95% CI = 1.24, 3.35), restless legs syndrome (OR = 2.17; 95% CI = 1.32−3.56) and emotional burden (OR = 2.37; 95% CI = 1.41−3.98). However, no statistically significant association was observed between sleep quality and quality of life among our participants.

This study examined the perceptions of current smokers on electronic cigarette (EC) use, after exposure to information on EC use and its potential harms from various media and retail outlets. This cross-sectional study is a sub-analysis of the National Study of Electronic Cigarettes Prevalence (N = 4289) using the multi-stage stratified sampling method. Respondents were interviewed face-to-face by a trained data collector using a structured questionnaire printed in both Bahasa Malaysia and English. The analysis included 376 males who smoked conventional cigarettes and/or used ECs and reported ever seeing messages on ECs/vape in various platforms were analyzed using weighted simple and multiple logistic regression. Our findings showed different media types resulted in differing perceptions among smokers towards EC use especially between social media and conventional media. Those exposed to messages promoting EC in social media had higher odds of believing that ECs help people quit smoking (OR: 2.28), the urge to smoke is reduced by ECs (OR: 1.86), ECs are more effective than medication for quitting smoking (OR: 1.96), breathing is improved after using ECs (OR: 2.85), the smell of EC is better than a tobacco cigarette (OR: 2.73), and ECs should be regulated rather than banned completely (OR: 3.08). Vape shops, social, and conventional media provided very different perceptions among smokers towards EC use. Beyond using traditional communication channels, EC promoters have successfully utilized social media to promote ECs among smokers.

Context: Electronic cigarettes have been used as a harm reduction method toward tobacco cessation. Malaysian government has enforced a strict policy to regulate the sale of electronic cigarette products because its liquid contains nicotine., Aims: This study aimed to explore the general public's perception toward electronic cigarette use. Public support toward electronic cigarette regulation was also examined., Settings and Design: This was a Malaysian population-based survey., Materials and Methods: Data were obtained from the National E-Cigarette Survey (NECS) 2016, which used a multistage stratified cluster sampling household survey representing all Malaysian adults aged 18 years old. A cross-sectional survey was conducted among a total of 4288 adults., Statistical Analysis Used: Descriptive and logistic regression analysis., Results: Majority were aged 25-44 years old (44%), completed at least secondary education (69%), of Malay ethnicity (73%), and married (68%). Majority (88.1%) have never used electronic cigarette. A quarter (25.5%) perceived electronic cigarette helps people quit cigarette smoking, whereas 20.3% perceived electronic cigarette helps people to maintain cigarette abstinence. Approximately 85% believed that electronic cigarette use does not help in improving breathing and coughing. Majority (91.8%) disagreed that electronic cigarettes should be allowed in places where tobacco smoking is banned. Thus, 63.4% agreed that electronic cigarette should be banned completely rather than regulated., Conclusion: Majority of general public had negative perception about electronic cigarette use., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Pharmacy and Bioallied Sciences.)

Introduction: Practice of dispensing paracetamol (PCM) in post infants' vaccination remains debatable in Malaysia as the administration of PCM postvaccination in infants was found to cause the vaccine to be less effective, thus requiring appropriate regulation measures., Objective: This research aimed to investigate the prevalence of adverse events following immunization (AEFI) with/without PCM to be prescribed post infants' vaccination in Malaysia (possible associated factors: age, types and stages of vaccination, concomitant vaccines and drugs, and/vitamins)., Materials and Methods: A retrospective cross-sectional study was conducted from 2011 to 2017. The AEFI was extracted from Quests 2, 3, and 3+ System of National Pharmaceutical Regulatory Agency (NPRA). The population of vaccinated infants was obtained from the Ministry of Health (MOH) Malaysia official website. The AEFI data were further categorized into (i) AEFI with possibility for PCM to be prescribed, and (ii) AEFI with no possibility for PCM to be prescribed. The data were analyzed using Microsoft Excel 2013, Portland, USA simple and multiple logistic regression tests, Statistical Package for the Social Sciences (SPSS) software programme, version 22.0 (IBM), New York, USA., Result: Various AEFI cases (359 infants) were reported. DTaP/Hib/IPV and measles-mumps-rubella (MMR) showed higher prevalence of AEFI with/without PCM to be prescribed post infants' vaccination cases per 100,000 population (2.07 and 2.21, respectively) than other types of vaccinations. DTaP/Hib/IPV (2 months) vaccination showed the highest value (3.00) among other age groups. Backward elimination presented DTaP/Hib/IPV (3-4 months) (95%CI; 0.231, 0.899%; P = 0.023) was the possible associated factor. Hepatitis B (1-5 months), DTaP/Hib/IPV (3-4 months), DTaP/Hib/IPV (5-12 months), concomitant vaccines as well as concomitant drugs and/ vitamins were the identified potential cofounders., Conclusion: Prescribing and dispensing of PCM post infants' vaccination may be confined to DTaP/Hib/IPV (2-4 months) and 12 months MMR groups., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Pharmacy and Bioallied Sciences.)

Electronic cigarettes (e-cigarettes) are a new method for the consumption of nicotine. A nationwide survey among 4288 Malaysian adults was conducted in 2016 to measure the prevalence and to describe the population characteristics of e-cigarette users. A complex sampling design was used, and data were collected using a face-to-face questionnaire. The overall prevalence of current, ever, former, and dual users of e-cigarettes in Malaysia were 3.2% (95% confidence interval [CI] = 2.5-4.1), 11.9% (95% CI = 10.5-13.5), 8.6% (95% CI = 7.5-9.8), and 2.3% (95% CI = 1.8-3.1), respectively. The prevalence of all type of e-cigarette use was higher in urban than in rural areas. Current e-cigarette users were likely to be younger, males, and with higher education level. Among current e-cigarette users, 74% (95% CI = 64-82) also smoked conventional cigarettes (dual user). E-cigarette use is prevalent in Malaysia. It is common among younger adults, males, and cigarette smokers.

Smoking cessation significantly reduces risk of smoking-related diseases and mortality. This study aims to determine the prevalence and factors associated with attempts to quit and smoking cessation among adult current smokers in Malaysia. Data from the National E-Cigarette Survey 2016 were analyzed. Forty nine percent of current smokers had attempted to quit at least once in the past 12 months and 31.4% of the respondents were former smokers. Multivariable analysis revealed that current smokers with low nicotine addiction and aged below 45 years were more likely to attempt to quit smoking. Being married, older age group, and having tertiary education were significantly associated with smoking cessation. Only half of the current smokers ever attempted to quit smoking and only a third of smokers quit. Stronger tobacco control policies are needed in Malaysia to encourage more smokers to quit smoking. Improved access to cessation support for underprivileged smokers is also needed.

Little is known about the perceptions of harm and benefit associated with the use of e-cigarettes in Malaysia. This was a cross-sectional analysis of a nationally representative sample comprising 1987 males (≥18 years of age). Current, former, and never users of conventional cigarettes and/or e-cigarettes participated in a questionnaire study conducted via face-to-face interviews. The relationship between participant characteristics and perceptions of harm and benefit of e-cigarettes were determined with multivariable logistic regression. There were 950 current, 377 former, and 660 never users of e-cigarettes. Government employees (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.29-2.66, P = .001), private sector employees (OR = 1.67, 95% CI = 1.27-2.18, P = .001), and the self-employed people (OR = 1.68, 95% CI = 1.31-2.17, P = .001) were more likely to perceive e-cigarettes as more harmful than conventional cigarettes compared with respondents who were not wage earners. All current users in the form of e-cigarette users (OR = 7.87, 95% CI = 3.23-19.18), conventional cigarette smokers (OR = 1.80, 95% CI = 1.39-2.33), and dual users (OR = 8.59, 95% CI = 4.76-15.52) were more likely to perceive e-cigarettes as useful in quitting conventional cigarette smoking compared with former and never users. Our findings constitute an important snapshot into the perceptions of e-cigarette harms and benefits, which could inform targeted public health messaging strategies.

Purpose: Baccaurea angulata (common names: belimbing dayak or belimbing hutan) is a Malaysian underutilized fruit. The preliminary work on B. angulata fruit juice showed that it possesses antioxidant properties. Therefore, further work is needed to confirm the efficacy and proper dosage of B. angulata as a potential natural antioxidant. The present study was thus carried out to compare the effects of three different B. angulata whole fruit (WF) juice doses administered at nutritional doses of 0.50, 1.00 and 1.50 ml/kg/day on plasma, aorta and liver malondialdehyde (MDA) levels, antioxidant enzymes (superoxide dismutase, glutathione peroxidase and catalase) as well as total antioxidant capacity in rabbits fed high-cholesterol diet., Methods: Thirty-five male rabbits of New Zealand strain were randomly assigned to seven groups. For 12 weeks, group CH was fed 1% cholesterol diet only; group C1 was fed 1% cholesterol diet and 0.50 ml/kg/day B. angulata WF juice; group C2 was fed 1% cholesterol diet and 1.00 ml/kg/day B. angulata WF juice; group C3 was fed 1% cholesterol diet and 1.50 ml/kg/day B. angulata WF juice; group N was fed standard pellet only; group N1 was fed standard pellet and 0.50 ml/kg/day B. angulata WF juice; and group N2 was fed standard pellet and 1.00 ml/kg/day B. angulata WF juice., Results: The three doses reduced the formation of MDA and enhanced the expression of endogenous antioxidant enzymes. The highest dose used (1.50 ml/kg/day) was, however, seen as the most potent., Conclusion: Higher doses of B. angulata juice exerted better antioxidant activity.

Background: Atherosclerosis is the most common disease of large and medium-sized arteries linked to oxidative stress, dyslipidemia as well as chronic inflammation. The aim of this study was to evaluate the potential health benefits of Baccaurea angulata (BA) fruit juice on the aorta of diet-induced hypercholesterolemic rabbits, to detect an accumulation of fatty streak and evaluate the percentage of atherosclerotic lesion accrued., Methods: Thirty-five healthy male adults New Zealand White rabbits were assigned to seven different groups. Four groups were fed 1% cholesterol diet and 0, 0.5, 1.0, and 1.5 mL of BA fruit juice per kg of rabbit daily (atherogenic groups), while the other three groups were fed commercial rabbit pellet and 0, 0.5, and 1.0 mL of juice per kg of rabbit daily (normocholesterolemic groups) for 90 days. The thoracic and abdominal aorta between the heart origin and bifurcation into iliac arteries of all the rabbits were carefully removed and analyzed accordingly., Results: The supplementation of the high-cholesterol diet of hypercholesterolemic rabbits with only 0.5 mL BA/kg rabbit per day significantly (p < 0.001) improved aortic lipid profile, attenuated aortic fatty streak development and reduced intima thickening. Higher BA doses used (1.0 and 1.5 mL/kg rabbit per day) also significantly (p < 0.001) decreased further the development of aortic fatty streaks, reduced the thickening of the tunica intima layer and preserved endothelial healing following arterial injury., Conclusion: Therefore, BA fruit is a potential novel functional food with effective anti-inflammatory, anti-atherogenic and hypocholesterolemic activities.

Purpose: The consequence of the increased demand due to the population expansion has put tremendous pressure on the natural supply of fruits. Hence, there is an unprecedented growing interest in the exploration of the potentials of underutilized fruits as alternatives to the commercially available fruits. Baccaurea angulata is an underutilized fruit widely distributed in Borneo Island of Malaysia. The present study was conducted to investigate the effects of B. angulata whole fruit (WF), skin (SK) and pulp (PL) juices on malondialdehyde (MDA) levels and antioxidant enzymes in rabbits fed high-cholesterol diet., Methods: Thirty-six male rabbits of New Zealand strain were randomly assigned to six groups. Rabbits were fed either a standard pellet (group NC) or a high-cholesterol diet (groups HC, PC, WF, SK and PL). Groups WF, SK and PL were also given 1 ml/kg/day B. angulata WF, SK and PL juices, respectively., Results: Baccaurea angulata had high antioxidant activities. The administration of the various juices significantly reduced (p < 0.05) the concentration of induced plasma MDA. The decrease in the SOD, GPx, CAT and TAC levels caused by cholesterol feeding was also ameliorated with B. angulata., Conclusion: Our results show that B. angulata fruit is beneficial in positively influencing and managing oxidative damage.

The loss of the ability for learning and memory is a prominent feature of dementia, which affects millions of individuals all over the world, due to either neurodegenerative diseases or brain injury. Although a lot of information is known about the pathology involved, treatment remains elusive at best. The Black Seed of Nigella sativa has been historically and religiously used for thousands of years for preventing and treating many different kinds of diseases. This review article looks at Nigella sativa and its potential role in facilitating learning and memory. The possible use of this seed's extract or compounds isolated from it, such as thymoquinone, for treating damaged brain neural tissue is discussed. The evidence presented in this paper appears to be supporting the hypothesis that this plant and/or its bioactive constituents can enhance learning and memory in health and disease in animals and humans.

Artocarpus altilis (breadfruit) pulp, peel and whole fruit were extracted with various solvents such as hexane, dichloromethane (DCM) and methanol. The antioxidant activity of these extracts were examined using the stable 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging test. IC50 was 55 ± 5.89 μg/ml for the pulp part of methanol extract. In the β-carotene bleaching assay, the antioxidant activity was 90.02 ± 1.51 % for the positive control (Trolox) and 88.34 ± 1.31 % for the pulp part of the fruit methanol extract. The total phenolic content of the crude extracts was determined using the Folin-Ciocalteu procedure; methanol pulp part demonstrated the highest phenol content value of 781 ± 52.97 mg GAE/g of dry sample. While the total flavonoid content was determined using the aluminium chloride colorimetric assay, the highest value of 6213.33 ± 142.22 mg QE/g was indicated by pulp part of the fruit methanol extract. The antimicrobial activity of the crude extracts was tested using disc diffusion method against pathogenic microorganisms: Staphylococcus aureus, Staphylococcus epidermidis, Bacillus cereus, Salmonella typhimurium, Escherichia coli, Klebsiella pneumonia and Candida albicans. Methanol extract of pulp part was recorded to have the highest zone of inhibition against Gram-positive and Gram-negative bacteria. The minimum inhibitory concentration (MIC) and MBC/minimal fungicidal concentration (MFC) for the extracts were also determined using the microdilution method ranging from 4000 to 63 μg/ml against pathogenic microbes. The MBC/MFC values varied from 250 to 4000 μg/ml. A correlation between antioxidant activity assays, antimicrobial activity and phenolic content was established. The results shows that the various parts of A. altilis fruit extracts promising antioxidant activities have potential bioactivities due to high content of phenolic compounds.

Objective: In 2004, the province of Aceh, Indonesia was rocked by tsunami and in September 2009, West Sumatra, Indonesia was hit by an earthquake. The aim of this study was to determine the long-term psychological impact on the residents inhabiting these regions and to identify factors associated with it., Methods: A cross-sectional study was conducted among the residents. The Depression, Anxiety and Stress Scale (DASS) was used to measure their psychological well-being., Results: Out of 200 respondents, 1 in 5 (19%) was found to suffer from a high level of depression, 1 in 2 (51%) had anxiety and 1 in 5 (22%) experienced stress. Factors found to be significantly associated with depression, anxiety and stress were female, young age, unemployed, and single (p<0.05)., Conclusion: The psychological impact following the tsunami persisted in the population after many years post-disaster. It is recommended that the psychological profile of the population be evaluated for the vulnerable group following any natural disaster., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Introduction. This study aims to evaluate the effectiveness of Tualang honey on sperm parameters, erectile function, and hormonal and safety profiles. Methodology. A randomized control trial was done using Tualang honey (20 grams) and Tribestan (750 mg) over a period of 12 weeks. Sperm parameters including sperm concentration, motility, and morphology were analyzed and erectile function was assessed using IIEF-5 questionnaire. Hormonal profiles of testosterone, FSH, and LH were studied. The volunteers were randomized into two groups and the outcomes were analyzed using SPSS version 18. Results. A total of 66 participants were involved. A significant increment of mean sperm concentration (P < 0.001), motility (P = 0.015) and morphology (P = 0.008) was seen in Tualang honey group. In Tribestan group, a significant increment of mean sperm concentration (P = 0.007), and morphology (P = 0.009) was seen. No significant differences of sperm concentration, motility, and morphology were seen between Tualang honey and Tribestan group and similar results were also seen in erectile function and hormonal profile. All safety profiles were normal and no adverse event was reported. Conclusion. Tualang honey effect among oligospermic males was comparable with Tribestan in improving sperm concentration, motility, and morphology. The usage of Tualang honey was also safe with no reported adverse event.