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Fulltext Factors associated with falls among the elderly attending a government clinic in Kuala Lumpur

Leong Joyce W.S, Intan Nadia Mohd Zukri, Siew Mooi Ching, Navin Kumar Devaraj

Malaysian Journal of Medicine and Health Sciences, 2020;16(1):183-190.
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Introduction: Falls among the elderly can be associated with serious complications such as fractures, injuries and death. This study aims to ascertain the factors associated with falls among the elderly patients attending a government clinic located in Kuala Lumpur. Method: This was a cross-sectional study using a convenience sampling method. Data collection in 2017 from 322 elderly who attended the above clinic. A modified assisted self-administered ques- tionnaire was used that contained the socio-demographic data, falls profile as well as extrinsic and intrinsic factors associated with falls. Analysis was done with SPSS v20.0. Results: 120 (37.27%) elderly reported falls in the past one year. The majority who had falls were females (n=76, 41.8%) and between the age of 80-89 years old (n=29, 44.6%). Malay ethnicity group, reported more falls compared to other ethnicities (n=93,44.5%). Significant associations were found between age, ethnicity and history of falls with falling (p
Fulltext A clinical audit of the process of care for women with gestational diabetes mellitus in a Malaysian public polyclinic

Faezah Hassan, Siew, Mooi Ching, Poh, Cheng Ling, NurHidayah Jaffar, Kai, Wei Lee

Malaysian Journal of Medicine and Health Sciences, 2019;15(2):69-76.
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Introduction: Proper gestational diabetes mellitus (GDM) care is essential for optimal control and thus prevents adverse perinatal outcomes. This audit aimed to determine the quality of GDM care provided by a public polyclinic.
Methods: The audit was performed on the clinic-based medical record of GDM patients who had undergone at least
three prenatal follow-ups and one postnatal follow-up between January and November 2012. Patients with pre-existing diabetes mellitus were excluded. Results: A total of 74 medical records were audited and it showed that 94.6%
of patients were of age 25 and above, 91.9% were Malays, 71.6% were multigravida and 98.6% had risk factors of
GDM. 54.1% of diagnoses were made during the second trimester, while 25.7% and 20.2% of cases were detected
during the first and third trimester respectively. All of the GDM patients had their weight and blood pressure monitored, 85.1% had their fundal height checked as scheduled and 85.1% were referred for diet counselling. 81.9% and
100% of GDM patients who were not on treatment and on treatment correspondingly had their blood sugar profile
monitoring done as recommended. Only 13.5% of GDM patients were given prenatal family planning counselling
and 35.1% were given a six weeks’ postnatal oral glucose tolerance test appointment. Monthly ultrasound screening
and HbA1c monitoring was done in merely 51.4% and 58.1% of the GDM patients respectively. Conclusion: The
GDM care process in this public polyclinic could be improved further to achieve the standard recommendations.
Fulltext Septic shock as a differential diagnosis of severe dengue fever in a child in Malaysia - a case report

Navin Kumar Devaraj, Mokshashri Naidu Ragubathi, Sin, Yee Er, Siew, Mooi Ching

Malaysian Journal of Medicine and Health Sciences, 2019;15(2):154-156.
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Dengue fever infection is common in many parts of the world and may result in serious complications such as den- gue haemorrhagic fever, dengue shock syndrome, pleural effusion, pericardial effusion and multi-organ failure if not diagnosed early or treated adequately. This is more so in the so called susceptible group that includes children, pregnant mother, elderly patients, patients with heart, liver or kidney co-morbidity, obese patients as well as immu- nocompromised patient such as those with transplanted organs or human immune-deficiency infection. However in certain cases, severe dengue fever may mimic the presentation of septic shock which needs urgent and decisive man- agement actions to be taken. This case report will look at a 7-year-old child who survived despite developing septic shock which was thought to be initially dengue fever with warning signs. Early referral and aggressive treatment in hospital prevented a direr consequence for this child.
Effects of gestational diabetes mellitus on the quality and quantity of blood hematopoietic stem cells: a case-control study

Tusimin M, Ahmed SME, Wei Lee K, Siew Mooi C, Md Noor S, Nordin N

Croat Med J, 2021 Dec 31;62(6):590-597.
PMID: 34981691

AIM: To evaluate the effects of gestational diabetes mellitus (GDM) on the quantity and quality of hematopoietic stem cells (HSC).
METHODS: In this case-control study, HSC were isolated from umbilical cord blood (UCB) procured at delivery from 63 mothers with GDM and 67 healthy mothers. Total nucleated cells (TNC) and CD34+ cells were quantified using BD FACSCalibur flow cytometer. The quantity and quality of stem cells were determined.
RESULTS: The GDM group had lower total cord blood volume and lower number of nucleated HSC compared with healthy mothers. Regarding stem cell quantity parameters, they had significantly lower UCB volume (P=0.041), TNC count (P=0.022), total viable NC count (P=0.014), and CD34+ percentage (P=0.014). Regarding the quality of stem cells, they had significantly lower viable TNC percentage (P=0.015). The predictors for total TNC count were longer labor duration (adjusted B coefficient [p]: 0.031 [0.046]), greater estimated blood loss (0.089 [0.005]), female neonates (12.322 [0.049]), and higher placenta weight (0.080 [0.033]). The predictors of total viable NC count were greater estimated blood loss (0.092 [0.003]), female neonates (13.16 [0.035]), and greater placenta weight (0.083 [0.026]).
CONCLUSION: The GDM group had much lower quantity and quality of UCB stem cells. Our results should be taken into consideration when drawing cord blood for unrelated stem cell banking in an obstetric unit to ensure the obtaining of optimal cord blood samples and to avoid unnecessary expenses.
Fulltext High-frequency repetitive transcranial magnetic stimulation at dorsolateral prefrontal cortex for migraine prevention: A protocol for a systematic review of controlled trials

Mohamad Safiai NI, Mohamad NA, Basri H, Inche Mat LN, Hoo FK, Abdul Rashid AM, et al.

PLoS One, 2021;16(6):e0251528.
PMID: 34138860 DOI: 10.1371/journal.pone.0251528

BACKGROUND: Migraine may lead to a negative impact on the patients' quality of life with a subsequent substantial burden to society. Therapy options for treatment and prevention of migraine have progressed over the years and repetitive transcranial magnetic stimulation (rTMS) is one of the promising non-pharmacological options. It induces and alters electric current in the brain via repetitive non-invasive brain stimulation in high frequency. In migraine patients, two common stimulation sites are the M1 cortex and dorsolateral prefrontal cortex (DLPFC). The mechanism on how rTMS exerts therapeutic effects on migraine is not fully established, but the main postulation is that the neuromodulation via high-frequency rTMS (hf-rTMS) might inhibit pain perception. However, evidence from studies has been conflicting, thus the usefulness of hf-rTMS as migraine preventive treatment is still uncertain at this moment.
METHODS: This is a systematic review protocol describing essential reporting items based on the PRISMA for systematic review protocols (PRISMA-P) (Registration number: CRD42020220636). We aim to review the effectiveness, tolerability, and safety of hf-rTMS at DLPFC in randomised controlled trials (RCTs) as migraine prophylactic treatment. We will search Scopus, Cumulative Index to Nursing and Allied Health Literature Plus, PubMed, Cochrane Central Register of Controlled Trials and Biomed Central for relevant articles from randomised controlled clinical trials that used hf-rTMS applied at DLPFC for the treatment of migraine. The risk of bias will be assessed using the version 2 "Risk of bias" tool from Cochrane Handbook for Systematic Reviews of Interventions Version 6.1. We will investigate the evidence on efficacy, tolerability and safety and we will compare the outcomes between the hf-rTMS intervention and sham groups.
DISCUSSION: This systematic review will further determine the efficacy, safety, and tolerability of hf-rTMS applied at DLPFC for migraine prophylaxis. It will provide additional data for health practitioners and policymakers about the usefulness of hf-rTMS for migraine preventive treatment.