Asian Journal of Medicine & Health Sciences
This free, open-access journal will cover epidemiological, fundamental, and clinical research related to health, ethical and social issues in the field of medicine, health sciences and health professions education. Broad Subject Term(s): Medicine, Health Sciences and Health Professions Education
UniKL Royal College of Medicine Perak (UniKL RCMP)
Journal of Engineering Technology (JET) is an open-access journal that follows the Creative Commons Attribution-Non-commercial 4.0 International License (CC BY-NC 4.0)
Antenatal Education in Reducing Risk of Anaemia in Pregnancy: A Scoping Review
Anaemia during pregnancy continues to be a major public health concern worldwide, affecting a substantial proportion of expectant mothers and contributing to adverse maternal and neonatal outcomes. This scoping review explores the role of antenatal education in reducing the risk of anemia by examining the types of educational strategies used, their reported outcomes, and existing gaps in current practice. The review was guided by the Arksey and O’Malley framework and reported in line with PRISMA-ScR recommendations. Relevant experimental studies published between 2000 and 2024 were identified from four electronic databases. Following a rigorous screening process, 11 studies were included. Overall, the findings suggest that antenatal education delivered through approaches such as community-based counseling, digital communication, visual or art-based methods, and home visits can improve maternal knowledge, increase adherence to iron and folic acid supplementation, and raise hemoglobin levels. However, the effectiveness of these interventions appears to vary depending on contextual factors, including cultural background, literacy levels, and the extent to which behavioural theories are applied. In conclusion, while antenatal education shows clear potential in reducing anaemia risk, future interventions should place greater emphasis on theory-driven design, cultural relevance, and long-term evaluation. Digital platforms, in particular, may offer practical opportunities to enhance accessibility and engagement, especially in resource-limited settings.
Anaemia in pregnancy, antenatal education, effectiveness, gestational anaemia, nutritional education
Nor Sufaradila Maizura Badrun Sufian@ Ahmad Zaki
Copyright (c) 2026 Asian Journal of Medicine & Health Sciences https://creativecommons.org/licenses/by-nc-sa/4.0
Epidemiology, Clinical Characteristics, and Outcomes of Carbapenem-Resistant Enterobacterales in a Specialist Hospital in Sabah, Malaysia: A Retrospective Cohort Study
Introduction: Carbapenem-resistant Enterobacterales (CRE) represent a growing global health threat associated with high mortality, limited treatment options, and substantial healthcare burden. In Malaysia, increasing carbapenem resistance among Enterobacterales has raised concerns, yet data from East Malaysia remain scarce. This study aimed to describe the epidemiology, clinical characteristics, microbiological profiles, and outcomes of patients with CRE in a major referral hospital in Sabah, Malaysia, and to identify factors associated with CRE infection. Methods: We conducted a single-centre retrospective cohort study at Hospital Queen Elizabeth II involving adult patients with at least one CRE-positive culture between January 2020 and December 2021. CRE was defined according to CDC criteria. Patients were classified as having CRE infection or colonisation based on clinical and laboratory findings. Demographic data, healthcare exposures, antimicrobial use, microbiological characteristics, and outcomes were extracted from medical records. The primary outcome was 30-day all-cause in-hospital mortality. Results: A total of 101 patients were included, of whom 40 (39.6%) had CRE infection and 61 (60.4%) had CRE colonisation. The median time to CRE detection was approximately two weeks of hospitalization. Klebsiella pneumoniae was the predominant organism (68.3%), with New Delhi metallo-β-lactamase (NDM) identified in 79.2% of isolates. Prior exposure to broad-spectrum antibiotics, invasive devices, ICU admission, and recent surgery were common. Thirty-day in-hospital mortality was significantly higher among patients with CRE infection compared with colonisation (52.5% vs 21.3%). Higher Charlson comorbidity index was associated with mortality, while delays in CRE identification were frequently observed. Conclusion: CRE colonisation and infection impose a substantial clinical burden in this tertiary hospital, with high mortality among infected patients and limited therapeutic options. Strengthened infection prevention measures, targeted surveillance, optimized antimicrobial stewardship, and improved access to effective anti-CRE therapies are urgently needed to mitigate CRE transmission and improve patient outcomes.
Hand, Foot and Mouth Disease (HFMD) Prevention: A Study of Parental Knowledge, Perception and Practice in Malaysia.
Introduction: Hand, foot, and mouth disease (HFMD) is a prevalent viral illness affecting primarily children under five years of age, with significant outbreaks in Asian countries, including Malaysia. This study aimed to evaluate the level of knowledge, perception, and practice (KPP) regarding HFMD among Malaysian parents. Methodology: A cross-sectional study was conducted in Malaysia using convenience and snowball sampling. A total of 390 parents from 13 states participated. Questionnaires were administered to collect socio-demographic data and assess the KPP on HFMD. Result: Knowledge was moderate (56.4%), and perception was neutral (49%). However, item-level analysis revealed critical gaps: 62.6% incorrectly believed HFMD only affects children, and 40-50% failed to recognise severe symptoms requiring urgent medical attention. Preventive practices among parents, with 60% (234/390) demonstrating good practice. Significant factors influencing knowledge included gender (p=0.046), race (p=0.038), education (p=0.038), state (p=0.010), and number of children (p=0.044), while age, marital status, and occupation were not significant. Perception was significantly associated with age (p=0.006), gender (p=0.046), state (p<0.001), and number of children (p<0.001), but not with race, marital status, education level, or occupation. Conclusion: The study revealed that Malaysian parents had moderate knowledge and a neutral perception of hand, foot, and mouth disease (HFMD), with good prevention practices. These findings underscore the necessity for targeted educational interventions to enhance knowledge, perception, and practices among parents, ultimately contributing to a safer environment for young children in Malaysia.
Assessment of Liver Fibrosis by FibroScan in Rheumatology Patients Treated with Conventional Synthetic Disease-Modifying Antirheumatic Drugs.
Background: Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) are widely used in the management of inflammatory rheumatic diseases. Long-term exposure, particularly methotrexate, raises concerns regarding hepatotoxicity and liver fibrosis. Objective: To determine the frequency of liver fibrosis among rheumatology patients treated with csDMARDs using transient elastography (FibroScan). Methods: This retrospective study included rheumatology patients receiving csDMARDs therapy (monotherapy or combination) who had undergone FibroScan assessment. Liver fibrosis was defined as METAVIR stage of F2 or higher. Results: Among 60 patients, liver fibrosis (F2–F4) was detected in 18 (30.0%), while 42 (70.0%) had no or mild fibrosis (F0–F1). Mean age did not differ significantly between groups; however, patients with fibrosis had a younger age at rheumatic disease diagnosis. Triglyceride levels were significantly lower in the fibrosis group. csDMARDs type, combination therapy, and cumulative drug doses did not differ significantly between groups. Multivariate logistic regression analysis identified no independent predictors of liver fibrosis. Conclusion: Liver fibrosis was detected in nearly one-third of rheumatology patients treated with csDMARDs using FibroScan. No significant associations were observed between liver fibrosis and csDMARDs type, combination therapy, or cumulative drug exposure. These findings suggest that liver fibrosis in csDMARD-treated patients may not be solely attributable to conventional clinical or treatment-related factors, underscoring the potential value of non-invasive liver assessment in routine rheumatology practice.
Conventional synthetic disease modifying antirheumatic drugs
Prevalence of Diabetic Peripheral Neuropathy and Its Association with Health Literacy among Patients with Type 2 Diabetes Mellitus in Kuantan Primary Health Clinics.
Introduction: Diabetic peripheral neuropathy (DPN) is a common microvascular complication of type 2 diabetes mellitus (T2DM), contributing to disability, foot ulceration, and reduced quality of life. Health literacy may influence patients’ self-care and early detection of complications, but evidence from Malaysian primary care is limited. This study aimed to determine the prevalence of DPN and its association with health literacy among patients with T2DM in primary health clinics in Kuantan. Methods: A cross-sectional study was conducted among 430 adults with T2DM selected using probability proportionate to size sampling across four primary health clinics in Kuantan. Simple random sampling was applied within clinics. DPN was assessed using monofilament and tuning fork tests, and health literacy using an interviewer-administered Health Literacy Short Form Instrument (HLS-SF12) questionnaire. Multiple logistic regression identified associated factors. Results: The prevalence of DPN was 23.3% (n = 100; 95% CI: 19.3–27.5). Increasing age (AOR 1.04, 95% CI: 1.02–1.07, p = 0.003) and HbA1c (AOR 1.20, 95% CI: 1.06–1.35, p = 0.003) were independently associated with higher odds of DPN. Participants with adequate health literacy had significantly lower odds of DPN compared to those with limited health literacy (AOR 0.48, 95% CI: 0.28–0.82, p = 0.008). Other sociodemographic and clinical factors were not significantly associated with DPN. Conclusion: Nearly one in four adults with T2DM attending primary care clinics in Kuantan had DPN. Adequate health literacy was independently associated with lower odds of DPN, highlighting the importance of routine screening and health literacy–focused interventions in primary care to reduce neuropathic complications.
Diabetic peripheral neuropathies; health literacy, type 2 diabetes mellitus
Involving Men in Women's Health: A Qualitative Study of Male Staff Perceptions of Cervical Cancer at a Private University in Malaysia.
Background: In Malaysia, cervical cancer is the fourth most common cancer affecting women, following breast, intestinal, and lung cancers. The Pap smear is essential for early detection, and yet uptake remains below the WHO-recommended target of 70%. Many studies have examined why women do not undergo screening; however, few studies have explored men’s perspectives, representing an important research gap. This study investigates men’s awareness, knowledge, and perceptions of cervical cancer and their roles in supporting its prevention. Methods: A qualitative design was employed, involving three focus group discussions (FGDs) with 13 male participants. Semi-structured interviews were conducted until thematic data saturation was reached. Results: Participants exhibited diverse levels of awareness, with only a few demonstrating accurate knowledge of cervical cancer risk factors and the causal link to human papillomavirus (HPV). Misconceptions were prevalent, with several attributing the disease to lifestyle, diet, or hygiene. Although cervical cancer was widely acknowledged as a serious women’s health issue, knowledge about prevention methods, including Pap smears and HPV vaccination, was inconsistent. While many men expressed willingness to support female family members emotionally, financially, and physically, cultural norms, religious beliefs, and socio-demographic factors posed significant barriers to open discussions and involvement. Conclusion: Health education strategies should shift toward inclusive approaches that actively engage men and couples. Strengthening men's awareness and involvement represents a crucial step toward increasing screening uptake and advancing cervical cancer elimination efforts in Malaysia.
Cervical cancer prevention, male involvement, pap smear, men’s perception, health behaviour
Concurrent Reactivation of Varicella Zoster Virus and Herpes Simplex Virus with Hepatic Microabscesses after Anifrolumab Treatment in Systemic Lupus Erythematosus Patient - A Case Report.
This report describes a patient with long-standing, refractory systemic lupus erythematosus (SLE) who developed concurrent varicella zoster virus (VZV) and herpes simplex virus (HSV) reactivation following treatment with anifrolumab. Diagnosed with SLE at 18 years of age, she experienced multiple haematological flares and major organ involvement despite prolonged immunosuppressive therapy, including mycophenolate mofetil, cyclophosphamide, and rituximab. Ongoing disease activity led to initiation of intravenous anifrolumab. Six days after the third infusion, she presented with painful vesicular lesions involving the extremities and genital region, systemic inflammatory features, and gastrointestinal symptoms. Investigations confirmed simultaneous VZV and HSV infection, supported by positive serology and Tzanck smear findings, along with hepatic microabscesses on imaging. She was successfully treated with intravenous acyclovir, broad-spectrum antimicrobials, and intravenous immunoglobulin, with complete clinical and radiological resolution. This case highlights the risk of severe and atypical herpesvirus reactivation in heavily immunosuppressed SLE patients receiving anifrolumab and underscores the importance of early recognition and prompt antiviral therapy.
Effectiveness of Citrus hystrix Extracts in Antibacterial Therapy: A Systematic Review
Citrus hystrix is a tropical medicinal plant known for its rich essential oils and its potential as a natural antibacterial agent. In this systematic review, the antibacterial efficacy of Citrus hystrix extracts is critically evaluated in relation to its phytochemical composition, providing an integrated analysis that links bioactive constituents with antimicrobial activity using 12 eligible studies published between 2005 and 2025 from Scopus, PubMed, Web of Science, ScienceDirect, and Google Scholar. Most studies investigated the essential oils of the peel or leaves and reported citronellal, limonene, and β-pinene as the main constituents. The extracts inhibited Staphylococcus aureus, Escherichia coli, Streptococcus mutans, and methicillin-resistant S. aureus (MRSA), with MIC values ranging from 3.12 to 12.5 mg/mL. Synergistic effects with antibiotics were also observed. However, the heterogeneity of extraction methods, the limited number of phytochemical profiles, and the reliance on in vitro assays limits the comparison between studies. Future work should focus on standardized extraction, comprehensive phytochemical profiling, detailed cytotoxicity assessment, and robust in vivo and clinical validation to enable therapeutic application of Citrus hystrix extracts.
Physical and balance activity, mobility status and risk of falls among older people in Brunei Darussalam.
Background: Low levels of physical activity, balance exercises, and mobility are linked to an increased risk of falls in older people. In this study, physical activity components, mobility status, balance activity, and risk of falls among older individuals attending community centres in Brunei Darussalam were assessed. Methods: A cross-sectional survey was conducted regarding mobility status, balance activities, physical activity levels (using the Physical Activity Scale for Elderly, PASE), and risk of falls. Results: There were 92 participants. The mean PASE score was 156.3. Almost all participants were independent in mobility, and all engaged in walking activities. Only 52.2% engaged in physical activity ranging from light to strenuous intensity, while 81.5% did not perform balance exercises. Regarding fall risk, 51.1% reported worrying about falling, 59.8% were identified as being at risk of falls, and 19.6% had experienced falls within the past 12 months. Participants with secondary level education had a higher PASE score (p=0.031). Despite a non-significant association, physically active older people had a lower risk of falls and did not fall in the past 12 months. Conclusion: Although the participants were perceived as physically active as members of the community centres, there is a need to further increase activity levels and introduce balance exercises to reduce falls risk and maintain independence in the community.
Accidental falls, Exercise, Older adults, Physical activity, Postural balance.
Exercise and Physical Fitness Interventions in Stroke Rehabilitation: A Bibliometric and Thematic Review of Research Trends and Outcomes
Stroke is a leading cause of death and long-term disability worldwide, placing major physical, psychological, and socioeconomic burdens on patients, families, and healthcare systems. In this bibliometric review with thematic analysis, we examined the trends in research on exercise and physical fitness interventions for stroke rehabilitation. A literature search was conducted in the Web of Science Core Collection on 22 December 2025, including English-language articles and review articles published between 2015 and 2025. Title-based search terms combined stroke-related and physical fitness–related concepts. Publication output and citation patterns were analysed, and keyword co-occurrence analysis was performed to identify dominant research themes. The findings revealed a steady increase in publication volume over the past decade, with accelerated growth after 2020, indicating rising scholarly interest in exercise-based stroke rehabilitation. In contrast, citation counts declined in recent years, likely reflecting citation lag associated with newly published studies. Three major thematic clusters were identified: functional performance and mobility-oriented rehabilitation, physical activity and health-related quality of life, and cardiorespiratory fitness with an emphasis on exercise prescription and clinical translation. These findings indicate a shift from primarily function-focused research toward more comprehensive, health-oriented, and clinically translational approaches. While functional mobility remains a central research priority, increasing attention to quality of life and cardiorespiratory fitness reflects a broader conceptualisation of post-stroke recovery. This review highlights the need for standardised outcome measures, clearer exercise prescription parameters, and stronger integration of evidence into clinical practice to advance exercise-based stroke rehabilitation.
Effect of Static Stretching and Eccentric Exercise on Improving Hamstring Flexibility in University Students.
Hamstring tightness is prevalent among sedentary young adults and is associated with altered pelvic alignment, reduced lumbar lordosis, and increased risk of musculoskeletal injury. While static stretching and eccentric exercise are frequently used to improve hamstring flexibility, evidence comparing their effectiveness in non-athletic student populations is limited. This study aimed to evaluate and compare the effects of a four-week static stretching and eccentric exercise programme on hamstring flexibility. An experimental study was conducted with 36 university students (aged 18 to 25 years) not involved in structured exercise programmes. Participants were randomly allocated to a static stretching group (n=18) or an eccentric exercise group (n=18). Interventions were performed three times per week for four weeks. Hamstring flexibility was assessed using the Active Knee Extension Test (AKET) and hip flexion active range of motion (AROM) pre- and post-intervention. Data were analysed using paired and independent t-tests, with significance set at p<0.05. Both groups demonstrated significant improvements in AKET and hip flexion AROM following the intervention (p=0.001). However, no significant difference was found between the two groups in post-intervention outcomes (p>0.05). In conclusion, static stretching and eccentric exercise are comparably effective in improving hamstring flexibility among sedentary university students. These findings support the use of either modality for enhancing flexibility in this population.
Active knee extension test, eccentric exercise, hamstring flexibility, static stretching
Malay Translation and Reliability Testing of Return to Work Self-Efficacy (RTWSE-19) Scale among Patients with Work-Related Musculoskeletal Injuries.
Introduction: The Return to Work Self-Efficacy Scale (RTWSE-19) is a widely used tool designed to assess individuals' confidence in their ability to return to work following injury or illness. This study aimed to translate, cross-culturally adapt, and preliminarily validate the RTWSE-19 into Malay among patients with work-related musculoskeletal injuries in a rehabilitation setting in Malaysia. Method: The translation process followed established guidelines, including forward and backward translation, expert committee review, and pilot testing. Pre-testing was conducted among 30 patients at Pusat Rehabilitasi PERKESO Tun Abdul Razak (PRPTAR), Melaka, and was followed by reliability testing in a separate validation sample (n=23). The validity was determined by the content and face validity index and test-retest reliability was assessed using the Intraclass Correlation Coefficient (ICC) between day 0 (admission) and day 7. Results: Content validity was evaluated using the Content Validity Index (S-CVI/Ave=0.98) and Face Validity Index (S-FVI/Ave=0.95), demonstrating excellent clarity and relevance. Internal consistency for the three subscales - (i) “Meeting Job Demands” (α = 0.88), (ii) “Modifying Job Tasks” (α = 0.86), and (iii) “Communicating Needs to Others” (α = 0.90) showed good reliability. Test-retest reliability demonstrated strong stability (ICC = 0.89, 0.84, and 0.89, respectively). Conclusion: The Malay RTWSE-19 shows promising reliability in this pilot sample. Given the small sample size and absence of construct validation, findings should be interpreted with caution. Further studies with larger populations are needed to establish full psychometric properties, including construct and predictive validity.
Malaysia, return-to-work, rehabilitation, self-efficacy, validation.
Mechanisms, Clinical Applications, and Future Directions of Transcutaneous Spinal Cord Stimulation on Spinal Cord Injury Recovery: A Narrative Review
Transcutaneous spinal cord stimulation (TSCS) is an emerging non-invasive approach for spinal cord injury (SCI) rehabilitation. This narrative review synthesizes current evidence on its neurophysiological mechanisms and clinical applications while identifying limitations to its clinical integration. A comprehensive literature search reveals that TSCS can transiently modulate spinal excitability, facilitating improvements in motor control, autonomic regulation, and neuropathic pain. When paired with task-specific physiotherapy, TSCS appears to enhance neuroplasticity and functional recovery. However, the field is hampered by heterogeneity in patient populations, stimulation protocols, and outcome measures, leading to inconsistent therapeutic outcomes. The absence of standardized protocols and robust longitudinal data remains a major barrier. To accelerate clinical adoption, future efforts should focus on multicenter randomized controlled trials, protocol harmonization, and the development of accessible, portable TSCS systems suitable for home and community-based rehabilitation.
Cardiovascular regulation, motor recovery, neuropathic pain, transcutaneous spinal cord stimulation, spinal cord injury (SCI)
Knowledge, Attitude, and Readiness towards Basic Life Support among Healthcare Workers, Medical Students, and the Public in Malaysia.
Introduction: Basic Life Support (BLS) is a vital emergency procedure that improves survival outcomes following sudden cardiac arrest. Methods: This cross-sectional study evaluated knowledge, attitude, and readiness to perform BLS among healthcare workers, medical students, and the public in Malaysia. A total of 297 respondents (128 healthcare workers, 100 medical students, 69 members of the public) were recruited via convenience sampling from Ampang Hospital and Universiti Kuala Lumpur Royal College of Medicine Perak. All participants were aware of BLS and completed a structured self-administered questionnaire. Data were analyzed using SPSS with chi-square and Fisher’s exact tests. Results: Healthcare workers demonstrated significantly higher knowledge scores (82.8% high knowledge) compared to medical students (49.0%) and the public (7.2%) (p<0.001). Attitudes toward BLS were positive across all groups 89.6% demonstrating a high attitude level. However, readiness to perform cardiopulmonary resuscitation (CPR) was critically low among the public, with 100% classified as having low readiness. Prior training, perceived competence, and frequency of practice influenced readiness levels. Despite positive attitudes, lack of hands-on experience, particularly among non-healthcare respondents, emerged as a key barrier. Conclusion: Targeted BLS education and practical training programs are urgently needed. To improve community responsiveness in emergencies, it is recommended that BLS training be incorporated into educational curricula, workplace training, and community program.
Attitude, basic life support (BLS), CPR, knowledge, readiness.
Positive Deviants among MBBS Clinical Students: Study Habits, Lifestyle Choices and Social Dynamics at UniKL RCMP.
The MBBS program is renowned for its academic intensity, which often challenges students' ability to maintain personal well-being and a balanced lifestyle. However, a distinct group of students, termed "positive deviants," consistently excel academically while also thriving personally. This study investigates the unique study habits, lifestyle choices, and social dynamics of these high-performing MBBS clinical students at UniKL RCMP. Using a mixed-methods sequential explanatory design, 150 Year 4 students completed a quantitative survey, from which 13 positive deviants (scoring in the 90th percentile across all domains) were identified for in-depth focus group discussion. The findings reveal that positive deviants employ intentional, replicable strategies, including structured study routines with active recall, disciplined time management, consistent wellness practices (regular exercise and adequate sleep), and proactive cultivation of emotionally supportive peer networks. These students succeed not through innate talent but through deliberate, sustainable behaviours. The study concludes that these strategies offer a valuable framework for institutional interventions, suggesting that integrating such practices into student support programs could enhance academic performance and well-being across the wider student population.
Clinical medical students, lifestyle choices, positive deviant, social dynamics, study habits
Population Pharmacokinetic Modelling of Vancomycin in Asian Neonates: A Narrative Review to Optimise Dosing Strategies
Vancomycin exhibits highly variable pharmacokinetics (PK) in neonates, making standard dosing strategies often inadequate. This narrative review evaluates the current landscape of population pharmacokinetic (PopPK) modeling in Asian neonates to optimise dosing strategies. A comprehensive literature search was conducted across PubMed to locate English-language studies published between 2010 and 2025. Studies were selected if they utilised nonlinear mixed-effects modelling to describe vancomycin PK in Asian neonatal cohorts. Data regarding model structure, significant covariates, and validation methods were extracted from 11 identified studies, encompassing 1,359 neonates across six countries, and synthesised narratively. Findings indicate that body weight is the universal predictor for clearance (CL) and volume of distribution (Vd), while renal maturation markers (serum creatinine and postmenstrual age) significantly influence CL. Dynamic NICU factors, including daily fluid intake, diuretics, and vasoactive agents, were also found to critically impact drug disposition. While traditional efficacy targets use an AUC24/MIC≥400, evidence suggests a neonatal-specific target of 240–480 may be safer for this population. Nephrotoxicity risk was notably increased at an AUC24 threshold ≥ 485 mg·h/L. Collectively, these models demonstrate that trough-only monitoring is an inaccurate surrogate for total exposure. The review advocates for the adoption of Bayesian-derived pharmacokinetics estimates for AUC monitoring and the development of localised PopPK models to ensure precision dosing and therapeutic safety in Asian neonatal subpopulations.
Dosing regimen, neonates, modelling/modeling, neonates, vancomycin
From Knowledge to Practice: Strengthening Medication Error Reporting Practices Among Community Pharmacists in Malaysia
As per the authors' guideline, an abstract is not required for letters to the Editor.
Exploring Time Banking and Community Integration: A Pilot Study with Malaysia's Ageing Population.
Background: Malaysia's ageing population is expected to grow significantly, making the country an "ageing nation" by 2030. Time banking is a system in which participants earn time credits for providing services within the community, fostering mutual support, and enhancing social interactions. Methods: A mixed-methods research approach was used to investigate the interest and feasibility of time banking among elderly individuals in Bagan Serai, Perak. Surveys and focus group discussions were conducted with 34 elderly individuals aged 60 and above, covering demographics, healthcare needs, social needs, perceptions of time banking, and participation preferences. Results: No participants had prior knowledge of time banking; however, after receiving an explanation, 82.4% expressed willingness to participate. Key barriers included limited digital literacy (58.8% lacked the necessary skills), privacy concerns (41.2% feared misuse of personal information), and financial or transportation constraints limiting healthcare access. Notably, 44.1% of participants who encountered healthcare barriers took no action to address them. While most participants engaged in structured communal activities (gotong-royong, 47.1%), 35.3% disagreed that they enjoyed recreational socializing, indicating heterogeneity in social preferences. Participants expressed interest in time-banking services related to safety, health, daily living needs, and transportation. Recommended strategies include comprehensive education, user-friendly platforms, and personalized instruction. Conclusion: This pilot study provides preliminary insights into time banking’s potential for elderly healthcare and social needs. Successful implementation requires culturally tailored education, trust-building measures to address privacy concerns, and hybrid models combining digital tools with human facilitation. Future research using larger, more representative samples and controlled designs is needed. Collaboration between community organizations and healthcare providers can help create a more inclusive environment for the elderly in Perak.
Ageing population, elderly care, healthcare needs, social needs, time banking
Vancomycin Dosing and Pharmacokinetics in Adults Undergoing Continuous Renal Replacement Therapy: A Narrative Review
Vancomycin is a cornerstone therapy for severe Gram-positive infections, but dosing in critically ill patients on continuous renal replacement therapy (CRRT) is challenging due to significant pharmacokinetic variability. This narrative review synthesizes current evidence on vancomycin pharmacokinetics, dosing strategies, and therapeutic drug monitoring. Twelve articles were included, encompassing 398 adult patients receiving vancomycin across different CRRT modalities, including continuous veno-venous hemofiltration (CVVH), hemodialysis (CVVHD), and hemodiafiltration (CVVHDF). Vancomycin pharmacokinetics during CRRT are influenced by CRRT modality, effluent flow rate, filter integrity, residual renal function, and patient-specific factors such as expanded volume of distribution. Clearance estimates range from 0.7 to 2.6 L/h, with CVVHDF achieving the highest removal (up to 76% of total body clearance). An initial loading dose of 20 to 25 mg/kg is consistently recommended, followed by maintenance dosing of 5-7.5mg/kg every 12 hours, adjusted according to the CRRT intensity. Continuous infusion strategies may offer more stable concentrations but require close monitoring. TDM is essential, with a clear evolution from trough-based monitoring (target 15–20 mg/L) toward AUC₂₄/MIC-guided dosing (target 400–600 mg·h/L), consistent with current guidelines. This review highlights the critical interplay between CRRT parameters and vancomycin clearance, emphasizing the need for individualized, TDM-guided therapy to optimize efficacy and minimize toxicity in this complex patient population.
Continuous renal replacement therapy, pharmacokinetics, vancomycin
Determinants of Diabetes Knowledge among Patients with Type 2 Diabetes Mellitus in a Malaysian Primary Care Setting: A Cross-sectional study at Kangar Health Clinic.
Introduction: Type 2 Diabetes Mellitus (T2DM) requires ongoing self-management to reduce the risk of complications, with patient knowledge playing a pivotal role in making informed decisions about diet, medication adherence, and lifestyle modifications. A better understanding of diabetes enables patients to manage their condition effectively and prevent complications. Objectives: This study aimed to assess the level of diabetes knowledge and its associated factors among T2DM patients at Kangar Health Clinic, Perlis. Methods: A cross-sectional study was conducted at Kangar Health Clinic. Participants were eligible for inclusion if they were aged 18 years or older and had been diagnosed with T2DM. A self-administered questionnaire comprising 35 items, which included sociodemographic information, diabetes-related characteristics, and the validated Malay-translated Simplified Diabetes Knowledge Test (DKT), was used for data collection. Multiple linear regression was performed to identify factors associated with diabetes knowledge. Results: A total of 298 participants were included, with a mean age of 64.0 years (SD = 10.6). The majority were male (62.4%) and Malay (91.3%). Most respondents (69.8%) demonstrated a poor level of knowledge. After multivariable analysis, higher knowledge was significantly associated with being female (p = 0.003), being married (p = 0.020), and having higher education levels (p < 0.05). Additionally, having hypertension (p = 0.004) or dyslipidemia (p = 0.001), and being a former smoker (p = 0.015) were associated with higher scores, while current smokers were associated with significantly lower knowledge (p = 0.003). Conclusion: Participants demonstrated a poor level of diabetes knowledge. Tailored educational interventions targeting males, individuals with lower education levels, and current smokers are recommended to improve self-management and health outcomes.
Diabetes knowledge, health literacy, patient education, self-management, type 2 diabetes mellitus
Kikuchi-Fujimoto Disease Triggered by Mycoplasma pneumoniae Infection: A Case Report.
Kikuchi-Fujimoto disease (KFD) is a rare inflammatory disorder which typically presents with cervical lymphadenopathy and pyrexia. It is frequently misdiagnosed as other more common medical conditions which share similar clinical manifestations. The diagnosis of KFD is often established only after a lymph node biopsy and histopathology evaluation that demonstrates the characteristic features of histiocytic necrotizing lymphadenitis. While the aetiology of KFD remains poorly-understood, certain microbial agents have been implicated as triggering factors. Here, we highlight a case of a young Asian woman who developed prolonged fever and cervical lymphadenopathy. She was initially being investigated for possible lymphoma, but was subsequently found to have KFD, alongside a Mycoplasma pneumoniae infection. She recovered well following the treatment with azithromycin.
Azithromycin, Kikuchi-Fujimoto disease, Mycoplasma pneumoniae.
Copyright (c) 2025 Asian Journal of Medicine & Health Sciences https://creativecommons.org/licenses/by-nc-sa/4.0
Evaluation of Fitness Levels and Associated Factors among Public Health Pharmacy Staff in Perlis.
Background: Maintaining good fitness levels is vital for healthcare workers due to the physical and mental demands of their roles. This study assessed the fitness levels of pharmacy staff at public health clinics in Perlis and explored associated factors. Methods: A cross-sectional study was conducted from April to June 2024 among pharmacy staff in 13 public health facilities in Perlis. Data on sociodemographic characteristics, fitness levels (cardiovascular endurance, muscle strength, and muscle endurance), and mental health symptoms were collected using an English-language questionnaire and analysed with SPSS version 25.0. Results: Of the 72 participants (mean age 36.3 years, SD=7.04), most were Malay (95.8%), female (77.8%), and married (70.8%). Obesity (BMI ≥30 kg/m²) was present in 11 participants (15.3%). Cardiovascular endurance was rated average or above in 87.5% of participants, muscle strength in 55.6%, and muscle endurance in 73.6%. Overall, 37.5% were classified as physically fit. Exercising four to five times per week significantly increased the likelihood of being physically fit compared to those who did not exercise (AOR=17.29, p=0.030). Conclusion: A considerable proportion of pharmacy staff were not classified as physically fit, highlighting the need for targeted interventions. Regular exercise, particularly four to five times per week, was strongly associated with improved fitness levels.
Muhammad Hassan Fikry Saiful Hilmi Hadad
The Intersection of Islam and Nursing: A New Perspective on Cleanliness and Care.
Introduction: Cleanliness is a key pillar of health, vital for infection prevention, patient safety, and overall well-being. In both nursing and Islamic teachings, cleanliness is essential to health and ethical responsibility. Nursing focuses on clinical hygiene and sanitation, while Islamic jurisprudence (Fiqh) provides a broader framework encompassing physical, spiritual, and moral dimensions. This study explores cleanliness from both perspectives, identifying similarities and potential integration into nursing practice. Objective: This article examines cleanliness in nursing and Islamic teachings, highlighting similarities and differences. It also discusses integrating Islamic principles of cleanliness into nursing to enhance culturally and religiously competent care. Methodology: A qualitative content analysis approach was used, drawing from nursing literature and Islamic sources, including the Qur’an, Hadith, and scholarly interpretations. Hygiene frameworks and infection control guidelines were analysed alongside Islamic purification concepts to develop an integrated understanding. Results: Both nursing and Islamic teachings emphasise cleanliness for disease prevention and patient care. Nursing focuses on hygiene protocols and infection control, while Islamic jurisprudence extends cleanliness to ritual purity, spiritual well-being, and ethical conduct. Integrating Islamic principles can enhance patient-centred care, address Muslim patients’ religious needs, and foster ethical cleanliness in healthcare settings. Conclusion: Integrating Islamic cleanliness principles into nursing bridges clinical hygiene with spiritual and ethical care. This integration can improve cultural sensitivity, patient satisfaction, and holistic well-being. Future research should assess its impact on nursing education, healthcare policy, and patient outcomes to promote inclusive healthcare practices.
Mohamad Firdaus Mohamad Ismail Mohamad Ismail
The Return of a Forgotten Disease: Paediatric Scurvy in the Modern Era – A Case-Based Review.
Scurvy, a disease resulting from severe vitamin C deficiency, is considered a disease of the past. We encountered a case of paediatric scurvy in a previously healthy child from an affluent family, presented with gradually worsening bilateral knee and hip pain over 6 months, with inability to walk for the past 2 months without a history of trauma or falls. The clinical presentation of joint pain and muscle wasting mimicked several other conditions, particularly neurological and rheumatological disorders, leading to extensive blood investigations and imaging to determine the cause. High clinical suspicion of scurvy arose when all investigations and imaging were normal except mild hypochromic microcytic anaemia and poor diet history. This case report highlights the clinical presentation and challenges for early diagnosis and treatment in a low-risk population. It underscores the importance of a thorough dietary history and consideration of nutritional deficiencies among children with unexplained musculoskeletal symptoms.
Dietary history, musculoskeletal, scurvy, vitamin C deficiency.
Comparison of Rosuvastatin and Atorvastatin Regimens in the Achievement of LDL-C Goals: A Malaysian Real-World Cohort Study.
Background: Despite potent lipid-lowering therapies (LLT), achieving low-density lipoprotein cholesterol (LDL-C) targets remains challenging, especially in high-risk populations. This study evaluated the comparative efficacy of atorvastatin and rosuvastatin regimens and goal attainment within a Malaysian public tertiary care setting. Methodology: We conducted a retrospective cohort study of adults treated with atorvastatin or rosuvastatin (as monotherapy or combined with ezetimibe) at Hospital Taiping. Patients with continuous treatment (≥12 months) and paired lipid profiles (baseline 2022; follow-up 2023) were included. The primary outcome was 2019 ESC/EAS guideline target achievement. The secondary outcome was the mean reduction in LDL-C levels. Results: A total of 255 patients were included. Overall, only 19.2% (49/255) achieved their risk-stratified LDL-C targets. Goal attainment was notably poor in the high- and very-high-risk subgroups, with 85.8% failing to reach targets. Rosuvastatin plus ezetimibe demonstrated the greatest mean LDL-C reduction, significantly outperforming atorvastatin monotherapy (mean difference (MD) 0.65 mmol/L, p=0.045) and atorvastatin plus ezetimibe (MD 0.59 mmol/L, p=0.013). Analysis of treatment gaps revealed that 46.6% (96/206) of patients who failed to reach targets had not been titrated to the maximum tolerated statin dose. Conclusion: While rosuvastatin plus ezetimibe emerged as the most effective regimen, overall goal attainment remained suboptimal. Clinical inertia was a primary barrier, evidenced by the high proportion of uncontrolled patients remaining on sub-maximal doses. To bridge this gap, institutional strategies in the public health setting must prioritize earlier initiation of combination therapy and automated prompts for dose intensification in high-risk individuals.
Atorvastatin, cardiovascular risk, ezetimibe, LDL, rosuvastatin
Phacoanaphylactic Endophthalmitis: A Rare Cause of Postoperative Intraocular Inflammation.
Phacoanaphylactic endophthalmitis (PE) is an uncommon and rare immune response to retained lens material after cataract surgery. This case involves a 71-year-old diabetic man who developed PE following a complicated cataract surgery with posterior capsule rupture (PCR) and retained lens fragments. The patient initially presented with mild postoperative inflammation, but eventually developed granulomatous uveitis, vitritis, and vasculitis. The diagnosis was made based on clinical findings and intraoperative evidence of retained lens material during pars plana vitrectomy (PPV) and anterior chamber washout, which led to resolution of inflammation and improvement in vision, though anterior chamber and vitreous chamber tap were not performed. Early recognition and timely surgical intervention are crucial in managing PE, especially in diabetic patients prone to postoperative complications.
diabetes mellitus, cataract surgery, phacoanaphylactic endophthalmitis, lensectomy, vitrectomy surgery
Exploring Balance as a Determinant of High-Level Mobility After Traumatic Brain Injury.
Traumatic brain injury (TBI) remains a major cause of long-term disability. Individuals with moderate to severe TBI often experience lasting difficulties in balance and mobility. High-level mobility, which includes tasks such as running, stair climbing, and quick directional changes, is frequently impaired in this population and poses significant barriers to independence and community reintegration. Despite the known importance of balance in rehabilitation, its precise contribution to the high-level mobility critical for independence remains poorly understood. This study aimed to determine the relationship between balance performance and high-level mobility in individuals with moderate to severe TBI. A total of 86 participants were assessed using the High-Level Mobility Assessment Tool (HiMAT), the Sensory Organization Test (SOT), and the Limits of Stability (LOS) test. The analysis demonstrated moderate to strong positive correlations between high-level mobility and both SOT and LOS measures, with maximum excursion (MXE) (r = 0.603) showing the strongest association. These results advocate for incorporating dynamic balance challenges (e.g., perturbed walking, reactive stepping) into rehabilitation to maximise mobility recovery. By highlighting balance as a modifiable and measurable contributor to mobility, this study offers practical insights for designing more effective rehabilitation strategies that support recovery and independence after TBI.
Therapeutic Drug Monitoring in Peritoneal Dialysis: A Case of Klebsiella pneumoniae Peritonitis Treated with Gentamicin.
Peritonitis is a common complication of peritoneal dialysis. Prompt initiation of antibiotic therapy is consistently associated with improved outcomes. Antibiotics for peritonitis may be delivered via the intraperitoneal or systemic route. The pharmacokinetics of gentamicin in patients on continuous ambulatory peritoneal dialysis (CAPD) are highly variable, complicating dosing decisions to balance between efficacy and avoid toxicity. The implementation of therapeutic drug monitoring is important in adjusting gentamicin serum concentrations in patients receiving CAPD.
Continuous ambulatory peritoneal dialysis, gentamicin, peritonitis, therapeutic drug monitoring,
Understanding and Improving Workplace Violence Prevention Practices among Nursing Students: A Cross-Sectional Study in a Private College, Malaysia.
Background: Workplace violence (WPV) is a growing concern in healthcare settings, with nursing students at heightened risk due to their frontline roles during clinical placements. Although several studies have explored WPV among healthcare workers, research focusing on prevention practices among nursing students in Malaysia remains limited. This study aimed to assess nursing students’ perception and practice of WPV prevention and identify associated factors. Methods: A cross-sectional survey was conducted among 245 nursing students enrolled at a private nursing college in Perak, Malaysia. Data were collected using a validated structured questionnaire assessing WPV perception and practice across multiple domains. Descriptive and inferential analyses were performed using chi-square tests and logistic regression to determine predictors of good perception and practice. Results: Most participants demonstrated moderate perception and high practice of WPV prevention. Binary logistic regression revealed that bachelor-level students (aOR = 114.5, p = 0.03) and those with ≥ 6 months of clinical experience (aOR = 1.89, p = 0.046) were more likely to exhibit good perception towards WPV prevention. Multinomial regression confirmed these associations, indicating that educational level and clinical experience independently predicted good perception. No significant predictors were found for practice outcomes. Conclusion: Academic preparation and clinical exposure play crucial roles in shaping nursing students’ perception of WPV prevention. Integrating structured WPV prevention training into the nursing curriculum and strengthening institutional support mechanisms are essential to enhance awareness, preparedness, and safety culture among future nurses.
Erythema Induratum in a Young Woman with Latent Tuberculosis: A Case Report.
Erythema induratum of Bazin (EIB) is a rare, immune-mediated panniculitis historically associated with Mycobacterium tuberculosis infection. Reports linking erythema induratum to latent tuberculosis (TB), particularly without active pulmonary disease, remain limited. We describe a 24-year-old Malaysian woman with multiple nodules on both lower legs. She had a significant family history of tuberculosis, as her father had been treated for pulmonary TB more than 10 years ago. Histopathology revealed lobular granulomatous panniculitis with vasculitis and fat necrosis. The Mantoux test was positive, but chest imaging ruled out active TB. Based on clinical and histological findings, she was treated for latent TB infection (LTBI) with antituberculosis therapy, which resulted in no further new lesions, while existing lesions showed crusting within two months. This case highlights the importance of considering latent TB in patients presenting with erythema induratum, particularly in TB-endemic regions, even in the absence of clinical or radiological evidence of active disease.