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Fulltext Thyroid Function Test as First-line Investigation of Hyponatremia: Is It Necessary?

Huzairi Sani, Nada Syazana, Zahir Izuan Azhar

Asian Journal of Medicine and Biomedicine, 2020;4(1):12-18.
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Non-severe hypothyroidism has no strong association with hyponatremia. However, thyroid function tests (TFT) continue to be ordered as a first-line investigation. The objective of this study was to establish the prevalence of inpatient hyponatremia and to reiterate the association between thyroid disorders and hyponatremia based on study findings and current literature. A cross-sectional study on 3,478 in-patients adults of both gender admitted to a Malaysian tertiary hospital was carried out. Age, gender, sodium levels, thyroid stimulating hormone (TSH), free thyroxine (fT4) and clinical notes between 1/11/17-31/12/17 were extracted from the hospital’s information system. Bivariate analysis was performed using Mann-Whitney U, Chi-square and Spearman correlation tests. 21.9% of inpatients had hyponatremia of which 52% were mild. 359 (69%) of hyponatremic patients had a TFT sent where 71.9% were euthyroid. Sodium level is significantly correlated with age (R=-0.257, P
Fulltext Neighbourhood factors on mental health questionnaire: development, validity, and reliability among Malaysian adolescents

Zahir Izuan Azhar, Shamsul Azhar Shah, Tan, Susan, M.K., Syed Sharizman Syed Abdul Rahim

Int J Public Health Res, 2016;6(1):713-718.
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Introduction The risk factors associated with mental health among adolescents are usually
described by researchers at an individual level. Neighbourhood factors and
health have opened a new insight into the field of epidemiology. The aim of
this study was to assess the reliability and validity of a newly developed
Neighbourhood Factors on Mental Health Questionnaire among Malaysian
adolescents.

Methods A cross-sectional study was conducted in four secondary schools in Kuala
Lumpur, Malaysia using a newly developed questionnaire which comprised
of two main domains and seven items. Exploratory factor analysis and
Cronbach‟s alpha were used to measure the instrument‟s construct validity
and reliability.

Results A total of 106 adolescents participated in this research. The majority of
adolescents were 13 years old (40.6%), female (55.7%), Malays (68.9%),
have parents who only studied until secondary school (66.0%) and lived in
flats (32.1%). Bartlett‟s Test of Sphericity was significant (Chi-square =
258.361, p
Fulltext Spatial clustering of cholera in Sabah, Malaysia

Syed Sharizman Syed Abdul Rahim, Shamsul Azhar Shah, Zahir Izuan Azhar, Mohammad Saffree Jeffree, Mohd Rohaizat Hassan, Nazarudin Safian

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):54-54.
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Introduction: Cholera epidemics can produce devastating public health outcomes. Cholera distribution is influenced by temperature, precipitation, elevation, distance to the coastline and oceanic environmental factors such as sea surface temperature, sea surface height and ocean chlorophyll concentration. The purpose of this study is to describe the spatial epidemiology of cholera in the four districts of Sabah. Methods: This is a retrospective review of 4 years (2011 to 2014) data from the districts of Kota Kinabalu, Penampang, Putatan and Papar, Sabah. All reported cases of cholera from those areas are included. Coordinates for locations of the cases are based on home addresses. SPSS v20, ArcGIS v10 and CrimeStat IV were used for data analysis and mapping. Results: Cholera showed several clustering of cases, such as in 2011 and 2014 in Kota Kinabalu. In the year 2011 and 2013, Penampang and Papar districts had the nearest neighbour index of less than 1, but p value was not significant, meaning the pattern did not appear to be significant. Nearest neighbour hierarchical clustering analysis further revealed cholera had 7 clusters, of those 6 were first order and 1 was a second order cluster. Conclusion: Cholera shows disease clustering which could mean it is due to its common point source or localised human to human transmission. Using GIS as a tool may help in surveillance and control of cholera infections.
Fulltext COVID-19 review: an epidemiological perspective and Malaysian scenario in handling the pandemic (January – May 2020)

Zahir Izuan Azhar, Chen Xin Wee, Mariam Mohamad, Mohd Shahril Ahmad Saman, Mohamad Rodi Isa, Nurhuda Ismail

Journal of Clinical and Health Sciences, 2020;5(1):26-41.
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The pandemic of Coronavirus Disease 2019 (COVID-19) has brought much fear and anxiety
worldwide due to the rapid transmission rate and mortality. The exponential surge of COVID19 cases need to be addressed aggressively to flatten the epidemic curve. This review aims to
describe the COVID-19 disease epidemiology and disease transmission, response actions
taken by the authorities to control this pandemic and risk communication strategies in Malaysia.
A literature search via the ScienceDirect and Google Scholar databases of published articles
and official statements from the Ministry of Health, Malaysia from December 2019 to May 2020
was conducted. The first wave of COVID-19 outbreak in Malaysia started in late January
involving 22 cases but the second wave involved more cases due to the massive religious
gathering that occurred in late February. Malaysia implemented the Movement Control Order
(MCO) on 18th March 2020 and other well-coordinated response action plans to prevent
community transmission. The reproduction number (R0) was successfully reduced from 3.6 to
0.3 due to the MCO. Malaysia’s risk communication strategies that include daily press
conference by the Director General of Health and dissemination of information through national
television and social media, played a crucial role in dealing with the COVID-19 outbreak. In
conclusion, effective response actions and mitigation plans, should be the main priorities to
combat this pandemic. The immediate direction will need to be focused on development of
vaccines for COVID-19. Future research should study the origin of the virus in animals and the
role of comorbidities contributing to poorer prognosis.
Fulltext A review on climate change and Malaysia’s actions

Narinderjeet Kaur, Syed Sharizman Syed Abdul Rahim, Zahir Izuan Azhar, Mohd Yusof Ibrahim, Mohammad Saffree Jeffree, Mohd Rohaizat Hassan

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):72-72.
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Introduction: One of the biggest global health threats of the 21st century is climate change It is so catastrophic that the climate action has been given a platform as it is the 13th goal of the 17 United Nations Sustainable developmen-tal goals (SDG). This review seeks to understand the factors causing climate change, followed by understanding the impact it has on individual and population health. We also identify the strategies to control and prevent further cli-mate change. Methods: Reviews of local and international articles from the past ten years was conducted. The focus of the review was the causes, health effects as well as strategies. Data base used was Pro Quest. Results: This re-view identified that the main contributor to climate change are man-made activities such as fossil fuels combustion, livestock farming, and deforestation. This change in climate has many repercussions from mass migrations, increase communicable diseases as well as an increase in extreme weather events and natural disasters. All this eventually leads to the deterioration of individual and population health. Strengthening adaptivity to climate-related hazard, climate change integration into national policies, education, awareness-raising, impact reduction and early warning are actions that are present in Malaysia to manage this crisis. Conclusion: Climate change is occurring globally, and its presence can no longer be denied. Actions have been put forth, but only when its importance and impact is taken seriously will the positive changes be sustainable.
Fulltext Complications of Melioidosis: a systematic review

Marilyn Charlene Montini Maluda, Michelle May D. Goroh, Tan, Eric Chee How, Syed Sharizman Syed Abdul Rahim, Richard Avoi, Mohammad Saffree Jeffree, et al.

Borneo Epidemiology Journal, 2020;1(1):5-15.
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Introduction: Melioidosis, also known as Whitmore disease, is caused by the gram-negative bacillus, Burkholderia pseudomallei and remains a public health concern in Southeast Asia and northern parts of Australia. This study attempts to identify all possible complications of melioidosis and its outcomes.
Methods: Literature search was conducted from databases such as PubMed, Science Direct and Scopus from 1st January 2000 to 31st August 2019. Medical Subject Headings (MeSH) search strategy was used with the terms ‘Melioidosis’ or ‘Burkholderia pseudomallei’ and ‘Complications’.
Results: A total of 162 titles were identified and 22 articles were included in the review. Findings showed that among the 22 articles, the ratio of male to female melioidosis incidence was 2.3 to 1, with most cases (86.4%) aged older than 14 years old and showed a mean age of 46 years old. A third (7/22) of the papers reported the involvement of the nervous system as a complication of melioidosis followed by cardiovascular complications. Among the 23 cases reported, 13 had underlying medical conditions with most of them (84.6%) having diabetes mellitus or newly diagnosed with diabetes mellitus. Overall, only one case (4.3%) had resulted in mortality, while 17.4% developed complications and 78.3% managed a full recovery after undergoing treatment for melioidosis.
Conclusion: The most commonly found complication of melioidosis involved the nervous system but patient outcomes were favourable. Rare complications included mycotic aneurysm that can be fatal. Melioidosis can affect almost any organ leading to various complications.
Fulltext Acceptance factors of pneumococcal vaccination among adult population: a systematic review

Siti Nor Mat, Norzaher Ismail, Syafiq Taib, Hasanain Faisal Ghazi, Zahir Izuan Azhar, Mohammad Saffree Jeffre, et al.

Int J Public Health Res, 2018;8(2):1006-1014.
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Introduction Pneumococcal disease causes considerable morbidity and mortality,
including among adults. Adult pneumococcal vaccines help to prevent these
burdens, yet, they are underutilized. Our objective is to systematically collect
and summarize the available evidence on the potential factors that lead to
pneumococcal vaccination acceptance among of adult community.
Methods A systematic literature search was conducted involving studies published
from January 1999 to December 2015. The studies were identified by
searching electronic resources (PubMed/MEDLINE and Pro Quest database)
and manual searches of references. The keywords “vaccine/ immunization”,
“uptake/ coverage”, “determinant/ factor”, and “Streptococcus pneumoniae/
pneumococcus/ pneumococcal” were used. Final studies result and data were
reviewed by two independent authors. Disagreement was resolved through
discussion and consensus.
Results A total of 171 studies were identified, only 17 studies were included in final
discussion with 10 domains identified in the paper. 7 studies (41%) had
reported that the provider domain, patients’ perception and
socio-demographic factor have had the most effect on the pneumococcal
vaccination acceptance rate. In addition, only 18% (3) of reviewed papers had
highlighted that socio-economic was a factor influenced the pneumococcal
vaccination acceptance while 24% (4 studies) were attributed to the comorbid
domains.
Conclusions Healthcare provider and patients’ perception about pneumococcal vaccination
for adult population are significant domains which influence the acceptance
towards vaccination. Strong recommendations from healthcare provider for
pneumococcal vaccination would be an important step to increase vaccination
acceptance among the population.
Fulltext Improvement of Blue Ribbon certification by including humanistic value (TFI Buddies)

Siti Munira Yasin, Harizah Mad Hisma, Mazlifah Omar, Nurhuda Ismail, Zahir Izuan Azhar, Zalina Omar, et al.

Jurnal Inovasi Malaysia, 2020;4(1):61-78.
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Cigarette smoke produces more than 4,000 toxic chemicals and 53 of these chemicals can cause cancer. Smoking increases your health risks such as lung cancer, heart attack and stroke. In Malaysia, between 10% and 12% of causes of death are caused by smoking and this results in over 10,000 deaths a year. According to the National Health Morbidity Survey (NHMS) in 2015, the number of smokers aged 15 and above in Malaysia is estimated to be more than 5 million (22.8%). This alarming amount will lead to increased health costs. Smoking can also lead to a reduction in worker productivity and air pollution and the pollution due to cigarette smoke. Therefore, smokers need to be aware of the effects of smoking habits and the importance of maintaining a tobacco-free environment for the health and well-being of their families, friends and the community around them. To address this, Smoke Busters have created an innovation called Blue Ribbon Star Certification with an additional component of humanization into the TFI Buddies existing Blue Ribbon Certification. The main goal of this innovation is to make University of Technology MARA (UiTM) campuses 100% tobacco free. The first project at the Sungai Buloh Campus resulted in a decrease in the percentage of ‘hotspots’, whereby the number of cigarette butts was found to be greatly reduced. In addition, the percentage of staff with good knowledge and attitude on the effects of cigarettes increased. Feedback from users comprising staff and students also showed a very positive response. The direct impact on faculty and campuses include cost savings in terms of medical expenses and increase in staff productivity. The long-term effects include enhancing UiTM’s image nationally and internationally. From a social point of view, this in addition creates a more caring and responsible generation of colleagues and the environment.
Neighbourhood influences and its association with the mental health of adolescents in Kuala Lumpur, Malaysia

Zahir Izuan A, Shamsul Azhar S, Tan MKS, Syed-Sharizman SAR

Asian J Psychiatr, 2018 Dec;38:35-41.
PMID: 30408711 DOI: 10.1016/j.ajp.2018.10.018

BACKGROUND: Mental health problems are affecting more children and adolescents worldwide. Individual, family and school factors are often linked with mental health problems among adolescents.
AIM: To determine the neighbourhood factors influencing the prevalence of abnormal mental health status among adolescents in an urban population.
METHOD: A cross-sectional study was conducted among adolescents aged 13, 14 and 16 years old from thirteen secondary schools in Kuala Lumpur using validated questionnaires. A total of 567 adolescents participated in this study.
RESULTS: The prevalence of abnormal mental health status in this study was 4.4%. In multivariable analysis, female (OR = 1.79, 95%CI: 1.11-2.89), having divorced parents (OR = 3.53, 95%CI: 1.96-6.36), high educational stress (OR = 8.18, 95%CI: 4.25-15.75), medium educational stress (OR = 2.99, 95%CI: 1.53-5.83), whose house has been broken in before (OR = 2.02, 95%CI: 1.11-3.68) and living in a neighbourhood with low socioeconomic status (OR = 2.09, 95%CI: 1.23-3.56) were more likely to have abnormal mental health status.
CONCLUSIONS: Neighbourhood factors were found to be significant in determining adolescents' mental health status. The findings emphasize the importance of those in the public health sector to highlight these significant neighbourhood factors to the Ministry of Housing and Local Government. Swift action needs to be taken by the Ministry to provide solutions related to the neighbourhood factors and this can contribute to improvement in the adolescents' mental health.