Message from

Director-General of Health,
Ministry of Health Malaysia
YBhg Datuk Dr Muhammad Radzi
Bin Abu Hassan

I would like to thank the organisers for inviting me to the prestigious Melaka Re-
search Day 2023. The theme of this year's event "Benefitting Society by Translating
Research into Practice," emphasizes the crucial need to direct our research efforts
towards enhancing the health and well-being of our communities. It is imperative
that we not only generate knowledge but also find ways to apply it in real-world set-
tings to make a tangible difference in people's lives.

I am thrilled to witness the diverse range of research projects that will be presented
this year, and I hope to see more researchers engaging in meaningful research to
address the pressing health challenges facing our society.

I extend my heartfelt gratitude to all the researchers and students who have con-
tributed to this event, as well as the organisers and committee members for their
hard work and dedication in making this event a success.

Thank you, and congratulations to all the participants.

 Message from
Director of Health, Melaka
YBhg Datuk Dr Rusdi Bin
Abd Rahman

I am honoured to welcome you to the Melaka Research Day 2023 with the theme of
“Benefitting Society by Translating Research into Practice”.

Today, we gather to celebrate the transformative power of research and the ways in
which it can make a difference in our communities. At this event, we will have the
opportunity to showcase the innovative research being done here in Melaka and
explore how it can be applied in real-world settings to improve people’s lives.

As we all know, research is a critical component of our society’s progress. It is

through research that we gain new knowledge and understanding of the world
around us. It is through research that we develop new technologies, treatments,
and solutions to the problem we face.

However, research is only as valuable as its application. That is why the theme of
this year’s Melaka Research Day is so important. We want to highlight the im-
portance of translating research into practice and the positive impact it can have on
society.

On behalf of the organising committee, I want to express my gratitude to all the par-
ticipants and also not forgetting the committee members who organise this exciting
event.

So with this, let us all come together and celebrate the power of research, and let
us work together to translate it into practical solutions that benefit us all.

As we are still in the month of Syawal, let me take this opportunity to wish everyone
Selamat Hari Raya Aidilfitri and wishing all of you to have a fruitful and enjoyable
event.

Thank you.
 Message from
Director of Institute for Clinical Research,
National Institutes of Health, Malaysia

Datin Dr Sheamini Sivasampu

I am delighted to see the upcoming Melaka Research Day 2023 with the theme
“Benefitting Society by Translating Research into Practice”.

Research is a fundamental aspect of advancing knowledge and developing new

technologies. Clinical research, especially, plays a pivotal role in modern healthcare
with the end goal of improving patient care and outcomes. The theme for Melaka
Research Day is therefore a very befitting one, as it is not enough to simply con-
duct research and publish their findings. Even the most promising research findings
are only impactful if they can be translated into practice and applied to the real
world; in this context, our patients and the communities we live in.

During this Melaka Research Day, we will be witnessing many promising research-
ers sharing their latest research findings and discussing how these can be translat-
ed into practical solutions that can benefit our communities. Through this platform
too, we will acknowledge the researchers’ efforts, and we hope that this will moti-
vate them to scale to greater heights in the future. Remember, we owe it to our-
selves and to society to make sure that the research that we conduct is translated
into practice so that tangible benefits and real differences are made in the lives of
our patients and the health of our communities.

I also take this opportunity to express my gratitude to the organisers and committee
members for their hard work, and to all participants for your time and commitment.

I wish all of you a great and successful research day.

Thank you.
 Message from
Director of Hospital Melaka
Dr Zaharimah Binti Abdul Kadir

I am pleased to welcome all of you to our Melaka Research Day 2023- “Benefitting
Society by Translating Research into Practice”. This event is jointly organised by
Melaka State Health Department, Hospital Melaka, Clinical Research Centre Hospi-
tal Melaka, in collaboration with Clinical Research Malaysia and Pertubuhan Pen-
didikan Perubatan Lepasan Ijazah Hospital Melaka.

The purpose of this event is to showcase many excellent research that are being
conducted in Melaka and to promote the translation of research findings into prac-
tice, with the ultimate goal of improving patient care and benefiting society as a
whole. This event provides a great opportunity of sharing the wealth of knowledge
and expertise among colleagues with the wider community.

I look forward to seeing you at the Melaka Research Day, and I hope that this event
will inspire us all to continue working towards the goal of improving patient care and
benefiting society through research.

And to all delegates, organising committee members and participants, thank you for
making this event a memorable one.

Thank you.
 Message from
Head of Clinical Research Centre
Hospital Melaka
Dr Shalini Vijayasingham

It is my great pleasure to welcome all of you to Melaka Research Day 2023. We are
at this platform on 9 May 2023, with the theme “Benefitting Society by Translating
Research into Practice”, we bring together researchers from the medical, dental,
allied health and various related fields to share their knowledge and expertise, and
to engage in fruitful discussions on how we can collaborate to translate research
into practice. We also aim to inspire the next generation of researchers to pursue
their passions and make meaningful contributions to society.

For this wonderful event, we have received active participation of more than 60 for
both oral and poster presentations whereby pre-selected participants will be show-
casing their research in the coming sessions.

There is a significant increase on the number of research for both Investigator-

Initiated Research and Industry-Sponsored Research conducted here in Melaka for
the past years. It is instrumental for all research pertaining to Ministry of Health fa-
cilities to be conducted ethically in accordance to the newly updated NIH Guide-
lines For Conducting Research In Ministry of Health Institutions & Facilities 3rd Edi-
tion 2021. We do hope more and more researchers would register their research
through the national medical research registry nmrr.gov.my.

My sincere thank you to the YBhg Datuk Dr Nor Fariza Ngah on behalf of Director-
General of Health, Ministry of Health Malaysia, for kindly agreeing to officiate this
event, with the support and leadership from our State Director, Yg Brs Datuk Dr
Rusdi Abd Rahman and Director of Hospital Melaka Dr Zaharimah Abdul Kadir, and
also my gratitude to the representatives from Institute for Clinical Research and
Clinical Research Malaysia, and also to all committee members, delegates and par-
ticipants.

Thank you.
 SPEAKERS

Dr. Peter Tok Seah Keng

BMedSc (Melb), MD (UI), MPH
(UM), DrPH (UM)
Public Health Medicine Specialist
Institute for Clinical Research, NIH

Pn Nor Hafiza Johari

Bac. Sc (Hons) Biology (UPM)
Clinical Operations Manager
Clinical Research Malaysia (CRM)
 PROGRAM
Time Agenda

8.00-8.30am Registration of participants and Arrival of Guests

Arrivals of VIPs

8.30-9.15am National Anthem: ‘Negaraku’

Melaka State Anthem: ‘Melaka Maju Jaya’

Ministry of Health Song: ‘Kami Sedia Membantu’

Recital of Doa

Welcome Speech:
Head of CRC Hospital Melaka: Dr Shalini Vijayasingham

Opening Speech:
Director of Health Melaka: YBhg Datuk Rusdi bin Abd Rahman

Opening Ceremony by VIP and Opening Montage

9.15am-9.35am Speaker 1: Dr Peter Tok Seah Keng

(Institute for Clinical Research)

Topic: Benefitting Society by Translating Research into Practice

9.35am-9.45am Speaker 2: Puan Nor Hafiza Binti Johari

(Clinical Research Malaysia)

Topic: Industry-Sponsored Research: Real-Life Practices

9.45am-10.15am Tea Break

10.15am-1.00pm Oral Presentation

Professionals
Allied Health
Students

1.00pm-2.00pm Lunch Break

2.00pm-3.00pm Poster Presentation

Professionals
Allied Health
Students

3.00pm-3.30pm Judges’ Remarks

3.30pm-4.30pm Announcement of Oral & Poster Research Presentation winners

Prize Giving Ceremony
Presentation of Certificates
Closing ceremony
 Melaka State Health Director
Datuk Dr Rusdi bin Abd Rahman

Director of Hospital Melaka

Dr Zaharimah binti Abdul Kadir

Deputy Director I Hospital Melaka

Dr Sharifah binti Omar

Head of Clinical Research Centre Hospital Melaka

Dr Shalini Vijayasingham

Abstract Reviewers Judges

Dr Shalini Vijayasingham Dr. Peter Tok Seah Keng
Dr. Ng Khai Lip Mr. (Dr) Vijayaprakas Rao Ramanna
Dr. Muhamad Shariman Muhamad Shari Dr Nor Haliza Binti Mohd Ali
Dr. Mohd Syis Bin Zulkifli Dr. Latha R Selvarajah
Dr. Muhammad Yadiy Bin Abdullah Dr. Zaim Hazim bin Onn
Pn. Delarina Frimawati binti Othman Andu Dr. Dang Chee Chean
Pn. Noorazlinda Binti Yacob
 Committee

JKN Melaka
Dr. Muhamad Shariman Muhamad Shari
Dr. Nur Amalina Hani Binti Senin
Dr. Intan Azura Binti Mohd Din
Dr. Nor Diana binti Mohd Herman Cher
Dr. Amira Syafiqah binti Rosziman
En. Wan Mohd Nazri Bin Wan Mohd Iz-
zuddin
Pn. Syaziyah Binti Sharom CRC HOSPITAL MELAKA
Pn. Hazlinda Binti Abu Hassan Dr Shalini Vijayasingham
Pn. Delarina Frimawati binti Othman
HOSPITAL JASIN Andu

Dr. Muhammad Yadiy Bin Abdullah Dr. Aneeta Lakshimi Mohan

HOSPITAL ALOR GAJAH
Dr. Hafiz Bin Ahamat
PKD MELAKA TENGAH
Dr. Mohd Syis Bin Zulkifli
Matron Barbara Michael
Cik Raudhah Maisara Binti Hakbar
Cik Nur Izzah Binti Ibrahim
Pn. Nur Aizarina Asma Binti Awang
Cik Seri Rabiatul Nur Binti Abu Salim

PKD JASIN
Dr. Nur Aishah Bte Buang

PKD ALOR GAJAH

Dr. Nur Syazwani Binti Jaafar Sidek
 Committee
HOSPITAL MELAKA
Dr. Fatin Rabi’ah Binti Othman
Dr. Haslizan Bin Hassan
Dr. Hemaarubeni A/P Murugan
Dr. Ilmi Akmaludin Bin Mohamad
Dr. Joan Yau Yee Chin
Dr. Kumaresan A/L Ramasamy
Dr. Lee Shi Zhen
Dr. Mahfida Mahat
Dr. Mahnon Suria Binti Mokhy
Dr. Muhesh Rao
Dr. Nadia Binti Jamaludin
Dr. Nadzirah Yahya
Dr. Natalia Hanum Binti Hassim
Dr. Ng Khai Lip
Dr. Nor Fadhilah Binti Madon
Dr. Nor Izana Binti Isa
Dr. Nor Syahira Binti Shariffudin
Dr. Nur Aina Mardhiah Bte Mohamad Johar
Dr. Nur Sufiah Binti Nordin
Dr. Nurul Fateha Binti Abd Rahman
Dr. Nyin Li Yuen
Dr. Padma Rani A/P Kumar
Dr. Raiwathy Krishnasamy
Dr. Shaliza Binti Nawawi
Dr. Suzy Faradiah Binti Samsudin
Dr. Syed Omar Farouk Bin Syed Alwi
Dr. Tay Qin Le
Mr. (Dr) Lai Jun Han
Mr. (Dr) Vijayaprakas Rao Ramanna
Pn. Lina Binti Isnin
Pn. Masita Binti Adam
Pn. Noorazlinda Binti Yacob
Pn. Nurul Asnida Binti Abdul Wahab
Pn. Siti Norliza Binti Md Arif
Pn. Suriya Binti Hassan
En. Masnizar Bin Jamian
En. Mohd Nazri Bin Mohd Zali
En. Muhamad Salehudin Bin Ramli
En. Muhammad Faisal Bin Sarwan
En. Thevandran A/L Thangevelu
ORAL
OA : Oral - Allied Health Category
OMD : Oral-Medical/Dental Category
OS : Oral -Student Category

Category Presenting Author & Institutions Title

OA1 NUR SYAHIDA AZREEN BINTI FOOT CARE PRACTICES AMONG DIABETES MELLITUS PATIENTS
ZAINAL, IN MEDICAL WARD OF HOSPITAL ALOR GAJAH MELAKA
HOSPITAL ALOR GAJAH, MELAKA
OA2 HERMIZAN BIN HALIHANAFIAH, MAGNETIC RESONANCE ANGIOGRAPHY (MRA) STUDY ON ANA-
ILKKM SG BULOH, SELANGOR TOMICAL VARIATIONS OF THE CIRCLE OF WILLIS (COW) IN KUA-
LA LUMPUR HOSPITAL
OA3 ANG BEE XIAN, NUTRITIONAL SUPPORT IN IMPROVING PHASE ANGLE AND
HOSPITAL MELAKA SKELETAL MUSCLE MASS FOR LOW RECTAL ADENOCARCINO-
MA- A CASE STUDY
OA4 LINA BINTI ISNIN, ADEQUACY OF EARLY ENTERAL NUTRITION AMONG COVID-19
HOSPITAL MELAKA PATIENTS IN INTENSIVE CARE UNIT, HOSPITAL MELAKA – A
RETROSPECTIVE STUDY
OA5 SIAW SZE HOONG, INCIDENCE OF ADVERSE DRUG REACTION (ADR) TOWARDS
PEJABAT KLINIK DAERAH JASIN NIRMATRELVIR/ RITONAVIR (PAXLOVID®) AMONG OUTPA-
TIENT ADULT PATIENTS IN PRIMARY HEALTHCARE SETTING IN
MELAKA
OA6 POONCHOLAI A/P POOSARY, HOS- EFFECT OF ASPIRIN ON THE INTERNATIONAL NORMALIZED RA-
PITAL TUANKU AMPUAN NAJIHAH, TIO IN ELDERLY PATIENTS WITH ATRIAL FIBRILLATION ON CON-
NEGERI SEMBILAN CURRENT WARFARIN THERAPY
OA7 MOHD AZAM ABDUL HALIM, ILKKM THE FACE AND CONTENT VALIDITY OF AID FOR DECISION MAK-
SG BULOH, SELANGOR ING IN OCCUPATION CHOICE FOR HAND (ADOC-H) MALAY VER-
SION (MV): A TRANSLATION STUDY
OA8 ANG MEI FEN, KNOWLEDGE, ATTITUDE & PRACTICE ON MEDICATION WAST-
KLINIK KESIHATAN AYER KEROH AGE AND DISPOSAL AMONG MALAYSIANS: A SYSTEMATIC RE-
VIEW
OMD1 CHARLOTTE JANE JOSEPH, HOSPI- AUDIT ON THE DIAGNOSTIC ASSESSMENT OF AUTISM SPEC-
TAL TUNKU AZIZAH, KUALA LUM- TRUM DISORDER AND PROFILING OF THE CHILD AT THE INITIAL
PUR ASSESSMENT AT HOSPITAL TUNKU AZIZAH, KUALA LUMPUR.

OMD3 SRINEVASARAO RAMANAIDU, UM VIEWS AND EXPERIENCES ON HIV PRE-EXPOSURE PROPHYLAXIS

OMD4 JANARISA BINTI MUSTAR MAY,
KLINIK KESIHATAN MASJID TANAH
OMD5 KAMALESH A/P PUNIAMURTHY,
KLINIK KESIHATAN MASJID TANAH
OMD6 NUR AMALINA HANI SENIN, KLINIK
PERGIGIAN ALOR GAJAH, MELAKA
OMD7 S PONNALAGI SUBRAMANIAM,
HOSPITAL MELAKA
OMD8 MARCUS GABRIEL A/L PITCHAI JO-
SEPH, HOSPITAL MELAKA
OMD9 LOH AI YUN,
HOSPITAL SULTAN ISMAIL
(PREP) AMONG FAMILY MEDICINE SPECIALISTS IN KLANG VAL-
LEY.
OUTCOME OF PARENTERAL IRON THERAPY AMONG PREG-
NANT WOMEN WITH ANEMIA IN KLINIK KESIHATAN MASJID
TANAH.
THE EFFECTIVENESS OF (DAILYCALM©) APP IN REDUCING THE
LEVEL OF STRESS AMONG SECONDARY SCHOOL STUDENTS IN
MELAKA TENGAH DISTRICT: A RANDOMIZED CONTROLLED TRI-
AL
ORAL HEALTH IN TODDLER: EMPOWERMENT OF GENERASIKU
HARAPANKU (GKHK) PROGRAMME IN ALOR GAJAH DISTRICT
ALTERATIONS IN BLOOD GROUP STATUS IN ACUTE MYELOID
LEUKEMIA
A RARE CASE OF SMALL BOWEL DIVERTICULITIS – A CASE RE-
PORT IN HOSPITAL MELAKA
NON TYPHOIDAL SALMONELLA BACTERAEMIA WITH NE-
CROTIZING CAVITATINGPNEUMONIA, MIMICKING PULMO-
NARY TUBERCULOSIS: A CASE REPORT
ORAL
OA : Oral - Allied Health Category
OMD : Oral-Medical/Dental Category
OS : Oral -Student Category

Category Presenting Author & Institutions Title

OS1 YEW QIAN YI, MUCM UNDERGRADUATE MEDICAL STUDENTS’ SELF-PERCEIVED

KNOWLEDGE AND ATTITUDE TOWARDS HEALTH DISPARITIES

OS2 KHOO JIA XIAN ETHAN, MUCM COMPARISON OF LEARNING WITH AUDIOVISUAL MNEMONIC AND
TEXT REDING IN ENHANCING MEMORY RETENTION AMONG MEDI-
CAL STUDENTS: A RANDOMIZED CONTROL TRIAL.

OS4 DANIEL YAP CHOON LIANG, THE LEVEL OF COMPREHENSION OF MEDICAL INFORMATION PRE-
MUCM SENTED IN FLOWCHART VERSUS STANDARDISED TEXT: A RANDOM-
ISED CONTROL TRIAL
OS6 PRANEETHA NAIR A/P MUKUNDA POSTVACCINATION BREAKTHROUGH COVID-19 INFECTIONS AMONG
KUMAR, MUCM ADULTS IN MALAYSIA AND ATTITUDES TOWARDS FUTURE VACCINA-
TION
OS7 CHARLOTTE PATRICK ARJUNAN, EFFECT OF IMMUNE RESPONSE AFTER DIFFERENT COVID 19 BOOST-
MUCM ER VACCINATIONS IN MALACCA, MALAYSIA.

OS8 DELISHA KAUR BOPARAI, MUCM DOES THE APPEARANCE AND MANNERISM OF DOCTORS AFFECT THE
DOCTOR-PATIENT RELATIONSHIP? A CROSS-SECTIONAL STUDY
AMONG THE GENERAL POPULATION IN MALAYSIA

OS9 GAYATHRIE KRISHNASAMY, PERCEPTIONS TOWARDS THE TRANSITION FROM PRE-CLINICAL TO

MUCM CLINICAL PHASE AMONG UNDERGRADUATE MEDICAL STUDENTS: A
CROSS SECTIONAL STUDY

OS10 CHIN YAN YU MICHELLE, MUCM ASSOCIATION BETWEEN SOCIO-ECONOMIC FACTORS, LIFESTYLE,
WORKING CONDITIONS AND MIGRAINE AMONG ADULT POPULA-
TION IN MALAYSIA

OS11 CHAN KER XIN, MUCM EFFECT OF BLACKCURRANT JUICE ON PERCEIVED STRESS AND
MOOD AMONG MEDICAL STUDENTS - A RANDOMIZED CONTROL
TRIAL

OS12 PRITHIVA SERENA FERNANDO,

MUCM THE KNOWLEDGE, ATTITUDE AND AWARENESS OF STEM CELLS AND
STEM CELL RESEARCH AMONG MEDICAL AND DENTAL STUDENTS: A
CROSS SECTIONAL STUDY IN MALAYSIA
 Abstract Title Foot Care Practices Among Diabetes Mellitus
Patients in Medical Ward of Hospital Alor Gajah
OA 1
Melaka
Author and Nur Syahida Azreen Binti Zainal1, Dr. Siti Fatimah
Co-Researchers Binti Md Shariff1
1
Medical Ward of Hospital Alor Gajah Melaka

NMRR ID NMRR ID-22-00445-JVI

Introduction
Diabetes Mellitus (DM) is a metabolic disorder that is generally caused by hyperglycaemia and is
expanding worldwide. Individuals with DM are at high risk for complications including neuropathy. The
majority of DM patients will experience ulcers in the legs sooner or later depending on the blood sugar
control. A large number of these patients need hospital treatment over a long period of time and are at
risk of other various complications as well as amputation and neuropathy. This study aims to evaluate
the level of foot care practice among Diabetes Mellitus (DM) patients in the Medical Ward of Hospital
Alor Gajah Melaka.

Methodology
This was a cross – sectional quantitative study conducted on 120 respondents who were selected
through the method of purposive sampling, consisted of DM patients who admitted to the Medical Ward
of Hospital Alor Gajah Melaka between March to July 2022. Four sections were used to obtain data;
socio demographic, foot care practices, knowledge and attitude of DM patients regarding foot care. Data
were collected and analysed using SPSS version 26.

Result
The results of the study showed that the majority of respondents have a high knowledge of foot care
practices. In addition, they also strongly agreed that it is important to exercise and practice a balanced
diet as a factor that influenced the disease control. Therefore, the was no significant difference ( t-test
showed .146; while p-value > 0.05 ) between knowledge and foot care practice. Therefore, the
hypothesis is rejected.

Conclusion
Respondents have a good knowledge, practice and attitude in Diabetes Mellitus foot care. A good level
of socio-demography becomes a major role to ensure foot care practice can be effective in order to
reduce complications.

Keyword: Practice, Knowledge, Attitude, Foot Care, Diabetes Mellitus Patients.

 Abstract Title Magnetic Resonance Angiography (MRA)
Study On Anatomical Variations Of The
OA 2
Circle Of Willis (COW) In Kuala Lumpur
Hospital
Author and Hermizan Bin Halihanafiah1
Co-Researchers Dr Nurul Hafidzah Binti Rahim2
1
Institut Latihan Kementerian Kesihatan
Malaysia (Sungai Buloh)
2
Jabatan Radiologi, Hospital Kuala Lumpur

NMRR ID NMRR-21-819-59425

Introduction
The morphology and diameters of the circle of Willis (COW) arteries are thought to be important in
determining the optimal blood distribution and collateral potential of the COW. This study aimed to look
into the variations in COW morphology and their prevalence in Malaysian populations.

Methodology
This retrospective study was carried out at Kuala Lumpur Hospital on 152 patients, including 92 males
and 60 females. The patients' average age was 43.8 years. These patients were drawn from the three
major ethnic groups: Malay, Chinese, and Indian. The variations in COW morphology were assessed
using three-dimensional Time-of-Flight Magnetic Resonance Angiography (3D-TOF MRA). The COW's
completeness and variants were investigated.

Result
Complete, partially complete, and incomplete configurations of the COW were observed in 16.4%,
48.7%, and 34.9% of cases, respectively. In comparison to their group, the prevalence of entirely
complete configuration was high in younger, female, and Chinese patients. The anterior part of the COW
had a complete configuration in 56.58 % of cases, with types A, G, and H being the most common
variants. Only 25% of cases had a complete configuration in the COW's posterior part, with types E, A,
D, F, and H becoming the most common variants.

Conclusion
Understanding the normal pattern and the variations the COW arteries is critical for explaining various
neurological symptoms and completing neurovascular surgery successfully. These variations must also
be considered during radiological interpretation and interventional radiology. These findings should be
included in the most recent anatomy textbook and discussed in anatomy classes.

Keyword: Circle of Willis, Magnetic Resonance Angiography, Anatomical Variation

 Abstract Title Nutritional Support in Improving Phase Angle OA 3
and Skeletal Muscle Mass for Low Rectal
Adenocarcinoma- A Case Study

Author and Ang Bee Xian1, Lina Isnin1

1
Co-Researchers Dietetic and Food Services Department,
Hospital Melaka

NMRR ID

Introduction
Malnutrition can adversely affect treatment responses and surgical outcomes in rectal cancer patients.
The phase angle, which is measured via bioelectrical impedance analysis (BIA), is a clinically
bioimpedance parameter used for nutritional assessment and evaluating the risk of diseases. Reducing
muscle mass in cancer patients causes poor prognosis.

Methodology
A 61 years old Malay lady with underlying low rectal adenocarcinoma and dyslipidemia was referred to
Dietitian for Perioperative Nutrition Optimization (PNO). Patient had history of transverse colostomy and
completed concurrent chemoradiotherapy (CCRT) prior to surgical intervention. During first visit with
Dietitian, patient BMI was 24.7 kg/m2 presented with suboptimal oral intake (energy 20kcal/kg/day;
protein 0.7g/kg/day). BIA result showed low phase angle (4.5°) and skeletal muscle mass (12.3kg). She
was prescribed with oral nutritional supplement and high protein diet for two weeks prior to operation.
The BIA result showed an improvement in phase angle (5°) upon admission to the ward prior to surgery.
Patient was reviewed again on day two postoperatively, and BIA results showed a significant reduction
in phase angle (from 5° to 4°) and loss of skeletal muscle mass for 1.1kg. Nutrition intervention given
was oral nutritional supplement three times per day with high calorie, high protein diet postoperatively.

Result
After 6 weeks post-op, patient’s latest BMI was 23.5 kg/m2. BIA results showed there was improvement
in phase angle (from 4° to 4.6°) and increasing skeletal muscle mass (from 11.24kg to 12.38kg). She
achieved energy intake of 30kcal/kg/day and protein intake 1.2g/kg/day throughout Dietitian’s outpatient
clinic follow-up.

Conclusion
Nutritional support is essential for optimising nutrition outcomes in surgical patients. Improving phase
angle and skeletal muscle mass postoperatively indicates improved cell health and recovery.

Keyword: Nutritional support, phase angle, surgical outcomes

 Abstract Title Adequacy Of Early Enteral Nutrition Among
Covid-19 Patients In Intensive Care Unit,
OA 4
Hospital Melaka – A Retrospective Study
Author and Lina Binti Isnin1, Ang Bee Xian1
1
Co-Researchers Dietetic and Food Services Department,
Hospital Melaka

NMRR ID NMRR 22-00506-PDU

Introduction
Early Enteral Nutrition initiation in the first 24-48 hours after ICU admission or within 12 hours after
mechanical ventilation is indicated for COVID-19 patient in ICU to make sure patients get adequate
energy and protein intake. This study is aim to evaluate the adequacy of energy and protein intake of
COVID-19 patients in intensive care unit Hospital Melaka in the first five (5) days after initiation of enteral
feeding.

Methodology
A retrospective study with purposive sampling method was conducted by involving COVID-19 patients in
ICU Hybrid, Hospital Melaka between July to October 2021. Criteria for inclusion were ages 18 and
above, stable patients who were on enteral nutrition. The exclusion criteria was patients who were on
oral, parenteral, started non-liquid diet within 5 day before achieving more than 75% of energy
requirement and patients who died / discharged before achieving more than 75% of energy
requirement.

Result
A total of 40 subjects was involved in this study. Only 75% of patients achieved energy intake with
32.5% via bolus feeding, 30% via continuous feeding and 12.5% via combination of bolus and
continuous feeding. There is a significant different in energy intake between mode of feeding regardless
day of feeding F(2,35) = 6.04, p<0.01, partial Eta Squared = 0.57. As for protein intake, only 57.5%
patients achieved. There is a significant different in protein intake between mode of feeding regardless
day of feeding F(2,35) = 4.498, p = 0.018, partial Eta Squared = 0.018. There also had significant
different in energy intake between feeding barrier regardless day of feeding F(4,33) = 11.13, p<0.01,
partial Eta Squared = 0.57.

Conclusion
As conclusion 75% of patient achieved adequate energy intake and 57.5% of patient achieved adequate
protein intake.

Keyword: Early Enteral Nutrition, adequacy of energy and protein intake

 Abstract Title Incidence of Adverse Drug Reaction (ADR) towards
OA 5
Nirmatrelvir/ Ritonavir (Paxlovid®) among outpatient
adult patients in primary healthcare setting in Melaka
Author and Noorazlinda bt Yacob1,
Co-Researchers Nur Huzaimah bintI Noh@Seth2, Siaw Sze Hoong2,
Anis Arina Jasmin Binti Md Ramli2, Azura Kasim3,
Faisal Iskandar bin Mohd Faisal Farish3,
Nur Faiqah Aisyah bt Mohd Ali3,
Brenda Brenjah Anak Hinly4, Noor Syazanani binti Amran4,
Nur Izzah Binti Bahrudin4, Kuan Hsieng Yew5
1
Hospital Melaka
2
Pejabat Kesihatan Daerah Alor Gajah, Melaka
3
Pejabat Kesihatan Daerah Jasin, Melaka
4
Pejabat Kesihatan Daerah Melaka Tengah, Melaka
5
Bahagian Perkhidmatan Farmasi, Melaka
NMRR ID NMRR ID-23-00027-EXB

Introduction
Since early pandemic, several existing drug treatments have been recommended for the outpatient
setting and home care management of COVID-19. The newly oral antiviral agent, Paxlovid has been
introduced to treat mild-to-moderate COVID-19 in high-risk adults. Since the drug is relatively new to the
market, information about its safety and effectiveness is limited. This study was aimed to establish the
occurrence rate of ADR towards Paxlovid.

Methodology
A cross sectional study was conducted in COVID-19 Assessment Centres (CAC) in health clinics across
three districts in Melaka. Patients list who were dispensed with Paxlovid from 1 st May 2022 to 31st
December 2022 were used as our sampling frame. A proportionate stratified random sampling was
applied in order to obtain a sample population that best represents the entire population being studied.
Briefing was done to all investigators and relevant data was entered into a specified data collection form.
Descriptive statistic and Pearson Chi Square test was conducted using IBM 22.0 software.

Result
Out of 536 patients included in our study, about 415 (77.4%) of them developed ADR. Bitter taste was
the main ADR (361; 67.4%), followed by diarrhoea (100; 18.7%), vomiting (26, 4.9%), dizziness (16; 3%)
and muscle pain (12, 2.2%). Other minor ADR were also reported. The onset of ADR reported by
patients can be as soon as few minutes after taking the first dose Paxlovid. Only age was significantly
associated with risk of developing Paxlovid ADR (Pearson Chi Square test (df): 4.236(1); P=0.027).

Conclusion
ADR following Paxlovid treatment is minor and self-resolving in nature. Patient education was crucial to
ensure compliance with the medication. To encourage ADR reporting among public, a user-friendly
interface should be integrated into the MySejahtera application.

Keyword: adverse drug reaction, side effect, Paxlovid, Nirmatrelvir/ Ritonavir

 OA 6
Abstract Title Effect of Aspirin on the International
Normalized Ratio in elderly patients with
atrial fibrillation on concurrent warfarin
1
Author and Pooncholai Poosary
2
Co-Researchers Tan Hung Kun
3
Teo Kui Yuan
4
Ahmad Ridza Ahmad Nizam

1
Pharmacy Department, Hospital Tuanku Ampu-
an Najihah
2
Pharmacy Department, Klinik Kesihatan Salak
Selatan
3
Pharmacy Department, Hospital Tuanku Ampu-
an Najihah
4
Pharmacy Department, Hospital Tuanku Ja’afar

NMRR ID NMRR-20-2635-57429

Introduction
Initiation of aspirin in elderly patients with atrial fibrillation (AF) on warfarin therapy might influence the
International Normalized Ratio (INR). The aim of the study is to determine the distribution of INR and the
changes in INR before and after aspirin initiation in elderly patients with AF on warfarin therapy.

Methodology
A cross-sectional study was conducted in the Anticoagulant Medication Therapy Adherence Clinic (AC-
MTAC) in Hospital Tuanku Ampuan Najihah (HTAN) from January 2021 to March 2021. A total of 350
patients with AF were screened for eligibility and we included 81 of them. A data collection form was
used to collect their demographic data and INR before and after aspirin initiation. Descriptive statistics
summarised the respondent’s demographics and INR distribution. Paired t-test was used to assess the
differences in INR before and after aspirin initiation.

Result
Most of the patients were female (n=44,54.3%), Malay (n=74, 91.4%), with a mean age of 74.94 years
old (SD=8.14) used aspirin and warfarin concurrently for four weeks. 33 respondent’s INR (40.7%) fall
less than 2.0 and 32 respondent’s INR (39.5%) fall within target INR range (2.0 to 3.0) before aspirin
initiation. INR rose in 58 (71.6%) respondents after aspirin initiation. Moreover, INR>3 increased in 49
(60.5%) respondents after aspirin use. There was a significant difference in the INR before and after
aspirin initiation, 2.27±0.79 and 3.59±0.70 respectively, P<0.001.

Conclusion
This study showed that aspirin initiation increased the INR significantly in elderly patients with AF on
warfarin therapy. Thus, health care professionals should monitor INR closely when aspirin is prescribed
concurrently with warfarin in elderly patients with AF and make improvements in patient counselling
points checklist, to ensure optimal health outcomes in elderly patients and prevent potential bleeding
incidence.

Keywords: atrial fibrillation, initiation of aspirin, International Normalized Ratio

 OA 7
Abstract Title The Face and Content Validity of Aid for
Decision Making in Occupation Choice for
Hand (ADOC-H) Malay Version (MV): A
Translation Study
Author and Mohd Azam Abdul Halim 1,2, Ahmad Zamir Che
Co-Researchers Daud 2, Kounosuke Tomori 3,
Ahmad Rashdeen Fazwi Muhammad Nawawi 4

1
Occupational Therapy Programme, Institut Lati-
han Kementerian Kesihatan Malaysia (ILKKM)
Sungai Buloh
2
Centre for Occupational Therapy Studies, Fac-
ulty of Health Sciences Universiti Teknokogi Ma-
ra (UiTM) Puncak Alam Campus, Puncak Alam
3
Department of Occupational Therapy, Schools
of Health Sciences, Tokyo University of Technol-
ogy, 1404-1 Katakuramachi, Hachioji City, Tokyo
192-0982, Japan,
4
Hand & Microsurgery, Orthopedic & Traumatol-
ogy Department Hospital Selayang

NMRR ID MRR ID-19-2870-50611 (IIR)

Introduction
Aid for Decision Making in Occupation Choice for Hand (ADOC-H) English version was developed to
promote the use of injured hand in real life setting. However, there is a need for culturally translating and
validating that are accepted by the native speaker before it can be used. Therefore, this study aimed to
cross cultural translate and validate the ADOC-H into Malay version (MV).
Methodology
A cross-sectional study was done by employing cross-cultural translation standard guidelines. A
purposive sampling was employed to select the respondents based on inclusions and exclusions criteria.
The sample size was 50 participants. This study was conducted at two government hospitals in
Malaysia. Ethical approval was obtained from ethics committee from both organisations and consents
sought from participants prior to conduct this study.
Result
The majority of experts expressed high agreement on the content of the translated scale as it is relevant,
clear, simple, and no ambiguity in the content's intent and meaning. The I-CVI has shown 0.91 scores,
and universal agreement has shown 0.8 in terms of scale. There are five items need to be added for
Malaysian culture and population based on illustrations includes eating using hand, bathing using dipper,
driving a motorcycle and car and ride a bicycle.
Conclusion
The advantage of ADOC-H when compared to other client-centred methods such as Canadian
Occupational Performance Measure (COPM) because the illustrations and pictures are related to
activities and participation, which are accessible, available on iPads and paper version. ADOC-H Malay
version will provide clients whose primary language is Malay the opportunity to share decision-making
with their clinicians about the problems and their main goal. To conclude, the Malay paper version of the
ADOC-H is a valid and reliable to be used in Malaysian culture and population.

Keyword: ADOC-H; Activity; Participation; Decision Making

 Abstract Title Knowledge, Attitude & Practice on
Medication Wastage And Disposal Among
OA 8
Malaysians: A Systematic Review
Author and Khairunnisa Binti Zulkarnain1, Ang Mei Fen2
Co-Researchers
1
Unit Farmasi Klinik Kesihatan Tengkera
2
Unit Farmasi Klinik Kesihatan Ayer Keroh

NMRR ID NMRR ID-23-00381-LFD

Introduction
Pharmaceuticals are vital in treating disease, relieving symptoms, and ameliorating quality of life.
However, it was found that Malaysia has recorded high prevalence in medication wastage and improper
drug disposal. There are several factors that may contribute to this issue which are mainly related to lack
of knowledge, attitude and practice. Therefore, this study reviews the evidences of knowledge, attitudes
and practices among Malaysians towards this issue.

Methodology
Systematic review. Data sources: Google Scholar, PubMed and SpringerLink were searched from 10
November 2022 to 25 January 2023. Methods: Databases were searched for the predefined keywords of
"knowledge", "attitudes", "practices", "medication wastage” and “drug disposal". The inclusion criteria
were limited to time range (year 2010-2022), language and study types and nature. Duplicated records
were removed using Mendeley. An Appraisal tool for cross-sectional studies known as Appraisal tool for
Cross-sectional Studies (AXIS) tool was used to assess the risk of bias in those articles.

Result
A total of 12 studies are included for the data extraction. Most population are generally unaware of the
proper disposal of unused and expired medications, as well as the Medicine Return Programme by
Ministry of Health. Some of the reasons of having unused medications at home reported by several
studies are changed treatment, passed expiry date, medical condition resolved, excess quantity
supplied, side effects, medicine labels had unclear instructions, unsure why medicine was prescribed,
inconvenience or difficulty following instruction, and patient deceased. Majority respondents from the
studies shows inappropriate disposal practice of unused or expired medications.

Conclusion
The degree of knowledge, attitude and practice of medication disposal among Malaysians is
unsatisfactory. More cross-sectional studies are required to address the research gap between the
public's knowledge, attitude and practice towards medication wastage and proper disposal.

Keyword: knowledge, attitude, practice, medication wastage, medication disposal, Malaysians.

 Abstract Title Audit on the diagnostic assessment of Autism OMD 1
Spectrum Disorder and profiling of the child at
the initial assessment at Hospital Tunku
Azizah, Kuala Lumpur.

Author and Charlotte Jane Joseph 1, Keng Yee Lee2,

Co-Researchers Gabriel Whitlingum 3

1
Hospital Tunku Azizah, Kuala Lumpur.
2
National Institute of Health, Selangor.
3
Royal Hampshire County Hospital, Winchester,
UK.
NMRR ID NMRR ID: NMRR -20-1761-55941

Introduction
Autism Spectrum Disorder (ASD) is the most prevalent development disorder worldwide with an
estimate of 1 in 160. Recommended standard of assessment is based on DSM-5, WHO ICD 10 and
NICE Guidelines. As per our knowledge this is the first audit in Malaysia pertaining to this topic.

Primary objective is auditing the clinical notes of children diagnosed with ASD attending Child
Development Clinic (CDC) and determine diagnostic assessment pathway. Secondary objective is
evaluating comorbidities in these children carry out appropriate assessments and referrals.

Methodology
Source of the data were electronic medical records of patients diagnosed with ASD from 15 th August
2020 to 31st July 2021. Feedback to staff given and re-audit was done.

Result
100 electronic records were accessed in pre and reaudit. Children were mostly male and
Malays. Reauditing showed improvement in diagnostic assessment within 3 months. History taking in
the audit and re-audit was consistent in more than 90%. Assessment through interaction and
development in pre and reaudit was about 99%-100%. Information sharing with parents and follow-up
within 6 weeks was below the expected. Comorbidities identified patients were not built into the profile.

Conclusion
Standards were not met based on the guidelines in relation to history taking, physical examination,
information giving and diagnosis. Problem list is inadequate, profiling of the child does not meet the
standards. Almost all the child strengths, skills, impairment was not established. Recommended that
education of staff and implementation of changes to be continued. Conduct qualitative analysis can be
done to further explore reason (s) of not using tool kit for ASD diagnosis via focus group discussion. In-
depth interview should be done to understand the root cause for more effective implementation in near
future.

Keywords: Autism Spectrum Disorder, Child Development Clinic

 OMD 3
Abstract Title Views And Experiences On HIV Pre-Exposure
Prophylaxis (Prep) Among Family Medicine
Specialists In Klang Valley.
Author and Dr.Srinevasarao Ramanaidu,
Co-Researchers Associate Prof Dr.Nur Amani@Natasha Bt
Ahmad Tajuddin,
Associate Prof. Dr. Liew Su-May

Department of Primary care, University of

Malaya, Kuala Lumpur
NMRR ID NMRR-21-1284-60351 (IIR)

Introduction
The Human Immunodeficiency Virus (HIV) is one of the world's most serious health threats. The
increased number of new HIV cases, as well as the shift in HIV transmission from injecting drugs to
sexual behaviour, highlights the importance of pre-exposure prophylaxis, particularly for individuals in
high-risk populations. In identifying the facilitators and barriers, this study aims to explore the views and
experiences of primary care physicians in the practice of HIV pre-exposure prophylaxis.

Methodology
To participate in this study, primary care physicians were chosen at random from government health
clinics in the Klang Valley. Individual in-depth interviews were conducted. The audio-recordings were
transcribed verbatim and analysed thematically. A total of 15 participants from diverse races, religions,
and durations of working experience were recruited.

Result
Four main themes emerged from the findings: (i) Physicians' knowledge and client-associated factors
that motivate PrEP prescription (ii) Physicians' religious beliefs and ethical stance in the prescription of
PrEP (iii) Resource and other limitations; and (iv) Lack of standardized policies, guidelines and training.

Conclusion
This study garnered a variety of responses. Some physicians are influenced by their religious beliefs and
ethical attitude while deciding whether or not to give PrEP. These findings highlight the importance of
implementing training programmes, better policies, and a gradual acceptance of PrEP medication
provision in overcoming the identified issues. Higher levels of healthcare management and politicians
must be involved in order for these policy changes to be possible.

Keywords: Human Immunodeficiency Virus, pre-exposure prophylaxis

 OMD 4

Abstract Title Outcome Of Parenteral Iron Therapy Among

Pregnant Women With Anemia In Klinik
Kesihatan Masjid Tanah
Author and Janarisa M, Rosnani S, Goh SL, Lena N,
Co-Researchers Norsiah A

Klinik Kesihatan Masjid Tanah, Melaka

NMRR ID RSCH ID-23-00931-H0F

Introduction
Anaemia in pregnancy is an important risk factor for adverse obstetric outcome. The prevalence of
anemia among antenatal mothers in Melaka is still high despite the use of parenteral iron to treat anemia
among pregnant mothers in Melaka since 2016. The objective of this study is to determine outcome of
parenteral iron therapy among pregnant mothers with anemia in pregnancy in Klinik Kesihatan Masjid
Tanah (KKMT).

Methodology
Retrospective chart review of antenatal cards of mothers with anemia in pregnancy who had received
parenteral iron in KKMT from January to December 2022. Data was analyzed using SPSS version 20.

Result
A total of 66 pregnant mothers were identified but only 62 cards were included in the study (Response
rate: 93.9%). They were mainly Malays (95.5%) with median age of 28 years old (IQR 10). Almost half
(42.3%) completed tertiary education. Their mean income was RM3553 (min = RM900, max =
RM17000). About 24.2% were primigravida and 25.8% had poor spacing. The mean pre-treatment
haemoglobin was 10.33 g/dl (SD 0.67) while median gestational age for parenteral iron administration
was 29 weeks (IQR 6). The median usage of parenteral iron was 9 vials (IQR 2). A total of 609 vials
were used for 62 mothers and 83% were successfully treated. Multiple regression analysis found that
pre-treatment hemoglobin level was the only factor that was independently associated with successful
treatment outcome (adjusted OR 114.11 [95%CI 1.13-11545.99], p=0.04).

Conclusion
Success rate of parenteral iron treatment among antenatal mothers with anaemia in KKMT was
83%. Pre-treatment hemoglobin level was the only factor that was independently associated with
successful treatment.

Keyword: Iron-deficiency anemia, anemia in pregnancy, parenteral iron

 Abstract Title The Effectiveness of (DailyCalm©) App in Re- OMD 5
ducing the Level of Stress among Secondary
School Students in Melaka Tengah District: A
Randomized Controlled Trial
Author and AP Dr Noor Azimah bt Muhammad1
Co-Researchers Dr Kamalesh a/p Puniamurthy2
AP Dr Hizlinda Tohid3
Dr Nur Fazidah Elias4
Roseliza Murni Ab Rahman5
Siti Fadzilah Mat Noor6

1
Department of Family Medicine, Faculty of Medi-
cine, Universiti Kebangsaan Malaysia.
2
Alor Gajah Health Clinic, Alor Gajah, Melaka
3
Department of Family Medicine, Faculty of Medi-
cine, Universiti Kebangsaan Malaysia.
4
Faculty of Information Science and Technology,
Universiti Kebangsaan Malaysia.
5
Faculty of Social Sciences and Humanities,
Universiti Kebangsaan Malaysia.
6
Faculty of Information Science and Technology,
Universiti Kebangsaan Malaysia.

NMRR ID NMRR 20-930-54922

Introduction
Stress is common among adolescents that impairs their well-being. This randomized controlled trial
study aimed at determining the effectiveness of a newly developed mobile app, DailyCalm in reducing
stress compared to standard of care among secondary school students in Melaka Tengah, Malaysia.

Methodology
For intervention group, students were given accessed to the DailyCalm app that contained videos
teaching on breathing and relaxation techniques. Both groups received virtual talk on stress
management.

Result
A total of 146 students in intervention and 152 students in control groups completed the study. The
median age for both groups were 14.00 (3.00) years with no difference in their socio-demographic
profiles (p-value=0.079 to 0.736). The mean frequency of the videos used over 8 weeks was 9.63 times
(SD=13.04). For intervention group, there was a reduction in the mean score of stress from 13.60
(SD=5.60) at Week 1 to 11.34 (SD=5.31) at Week 8 (p-value<0.001). There was no significant reduction
in the control group (p-value >0.05). There was also a significant reduction in the number of students
with high stress in the intervention group (p-value <0.001).

Conclusion
DailyCalm had proved to be effective in reducing the stress level among secondary school students and
potentially can be used among Malaysian adolescents.

Keyword: adolescent; effectiveness; mobile phone application; stress

 OMD 6

Abstract Title Oral Health In Toddler: Empowerment Of

Generasiku Harapanku (GKHK) Programme In
Alor Gajah District
Author and Nur Amalina Hani Senin1,
Co-Researchers Raja Zarith Najwa Raja Zakaria1, Nur ‘Aqilah Norudin1,
Hani Wajihah Mohd Hanif1, Hasni Md Zain2

1
Alor Gajah Dental Clinic, Melaka
2
Oral Health Division, State Health Department, Johor

NMRR ID NMRR-20-2710-56824

Introduction
Generasiku Harapanku (GKHK) is a programme that focuses on toddlers’ early oral health care through
Lift the Lip technique and fluoride varnish application. The objectives were to identify the dietary, oral
hygiene and risk habits that were practiced by toddlers’ and to determine the association between
dietary, oral hygiene and risk habits in relation to oral health status in the GKHK Programme in Alor
Gajah District.

Methodology
This study was conducted among toddlers enrolled in the GKHK Programme in Alor Gajah District that
involved secondary data collection of 708 Anticipatory Guidance (AG) form.

Result
It was found that under dietary habits, bottle feeding had the highest frequency 572, 80.79%. For
hygiene habits, 495 (69.9%) of the participants were found to brush at least two times daily with
fluoridated toothpaste. 152 (21.47%) were found in the risk habits where parents have tasted the food
before feeding them to their toddlers. The relationship between dietary habits and oral health status
showed that intake of sugary food after main meals and bottle feeding in bed were statistically significant
with presence of plaque, gingivitis, and white spot lesions. For the relationship between risk habits and
oral health status, only parents that tasted food before feeding them to their toddlers was statistically
significant with presence of gingivitis.

Conclusion
The study findings enabled dental health education for toddlers’ parents in the right designation for each
habit to achieve better oral health among toddlers.

Keyword: toddlers, oral health education, dietary habits, oral hygiene habits, risks habits
 OMD 7

Abstract Title Alterations In Blood Group Status In Acute

Myeloid Leukemia

Author and S Ponnalagi Subramaniam1, Nor Amiza Mat Amin1,

Co-Researchers Norazlina Hamzah1, Nadzirah Yahya1, Norazwin
Yahya1

1
Transfusion Medicine Department, Hospital Melaka

NMRR ID NMRR ID: RSCH ID-23-01804-MVO

Introduction
The ABO blood group antigens are highly significant in clinical settings due to their high immunogenicity.
Since red blood cell antigens are inherited traits, they typically remain constant throughout an
individual's lifespan. The loss or weak expression of ABH antigens is a rare phenomenon but have been
observed mainly in myeloid malignancy. Our case series depicts the weak expression of A antigen
among patients with acute myeloid leukemia.

Methodology
This is a descriptive study that follows three patients with acute myeloid leukemia, who had Group II
ABO discrepancies. The blood grouping results for these patients showed either no agglutination or
mixed-field reaction with Anti-A in forward typing. Further immunohematological workup, review of
patient's previous blood group records, and re-check of blood group after the commencement of
chemotherapy led to the conclusion that one patient had blood group A and the other two had blood
group AB.

Result
In these cases, the ABO discrepancies were caused by a reduction in the expression of A antigens on
the surface of red blood cells, which was secondary to the underlying leukemia. However, after
treatment, the expression of A antigens gradually restored.

Conclusion
Integrating laboratory results with clinical details and patient history is crucial in resolving blood group
discrepancies and determining the appropriate transfusion support for various blood components.
Furthermore, the detection of loss or weak expression of ABO antigens should prompt an investigation
for underlying hematological malignancies. Variations in ABO antigens may also provide insight into the
status of malignancy.

Keyword: ABO discrepancy, acute myeloid leukemia, weak expression of A antigen

 Abstract Title A Rare Case of Small Bowel Diverticulitis OMD 8
– A Case Report in Hospital Melaka

Author and G Marcus, JH Lai

Co-Researchers Department of Surgery, Hospital Melaka

NMRR ID

Introduction
Small intestine diverticular disease is much less common than colonic diverticular disease. Its etiology is
unknown; it is believed that diverticula develop as a result of abnormalities in intestinal peristalsis,
intestinal dyskinesis and very high intraluminal pressure, such as in the colon. Intraluminal and Meckel
diverticula are congenital, while extraluminal diverticula can be found at many anatomical sites and are
denominated duodenal, jejunal, ileal or jejunoileal. The prevalence of small intestinal diverticula ranges
from 0.06% to 1.3%. Diverticular disease is more common in the proximal jejunum (75%), followed by
the distal jejunum (20%) and the ileum (5%).
Result
A 48-year-old gentleman with comorbids of hypertension presented to Hospital. She complained of
abdominal pain for 3 days at right lower quadrant associated with anorexia. Blood parameters show
elevated white blood cell with other parametres being unremarkable. Preoperatively patient was co-
managed by gynaecology team for left ovarian cyst and general surgery treating as acute appendicits. A
laproscopic converted to a lower midline laparotomy, initial assessment shows ruptured left
endometrioma with multiple endometriotic spots, adhesion over right lower quadrant. Post adhesiolysis
noted multiple large outpouchings of terminal ileum covered with slough, proceeded with a limited right
hemicolectomy and primary anastomosis, gynaecology team was called on table ovarian cyst aspiration
and wall biopsy was done.

Conclusion
At this moment, there is no consensus concerning its treatment, although laparotomies are common in
the acute setting, The goal of treatment is based on reducing intestinal spasms; consumption of a diet
rich in fiber (vegetables, fruits and cereals) is the best solution for reducing these. Diverticulosis does not
require surgical intervention. Mortality is influenced by the age of the patient, the nature of the
complications and the time that has elapsed before the intervention, and nearly all patients with
diverticulitis require hospitalization; initial intervention includes bed rest, fasting, placement of
nasogastric tube, administration of intravenous solutions as well as wide-spectrum antibiotics and
evaluation by a specialist.

Conclusion
Diverticular disease is usually asymptomatic, detected with the presence of one or more of the several
complications described previously, and many cases are diagnosed incidentally during the treatment of
these. The clinical case presented is a good example of this situation because, as previously mentioned,
the patient had peritoneal irritation data and admittance to the Hospital with a pre-operative diagnosis of
appendicitis with ovarian cyst. Indicative of diverticular disease, macroscopic lesions were detected
during surgery and were subsequently noted by histopathology findings.

Keywords: Diverticular disease, small intestine

 OMD 9
Abstract Title Non typhoidal salmonella bacteraemia with
necrotizing cavitating pneumonia, mimicking
pulmonary tuberculosis: A case report
Author and Dr Loh Ai Yun, MBBS, MRCP (UK)1, Dr Lee
Co-Researchers Weng Hoong, MD, MRCP (UK)1

1
Medical department, Hospital Sultan Ismail Jo-
hor Bahru (HSIJB)

NMRR ID

Introduction
Nontyphoidal Salmonella (NTS) serotypes infection can present with diverse clinical manifestations.
Extra-intestinal infections were recorded such as bacteraemia, septic arthritis, osteomyelitis, nephritis,
endocarditis, cholecystitis, and meningitis. Rare pulmonary involvement occurs in the form of
bronchopneumonia, necrotizing pneumonia, lung abscess, and empyema.
Methodology
This is a case of Non typhoidal Salmonella bacteraemia with cavitating lung lesion and necrotizing
pneumonia, that can mimic pulmonary tuberculosis in initial presentation.
Case
A 42 years old man presented to HSIJB with history of productive cough for 2 weeks, associated with
LOA and LOW. Denied PTB contact. He had underlying poorly controlled DM with Hba1c of 11.0%.
Upon arrival to ED, patient had required NP3L/min and CXR noted consolidation over left upper zone
with cavitating lung lesion (Fig 1). He was admitted to ward with impression sepsis secondary to CAP
TRO PTB, uncontrolled DM. He became hypotensive in ward and required inotropic support. Screening
test of HIV, Hepatitis B, Hepatitis C were negative. PTB workout sent, noted sputum AFB x 3 negative.
Subsequently blood culture came back as Salmonella species (not typhi and paratyphi) isolated. Sputum
culture also showed same findings. Antibiotic was changed to IV Ceftriaxone 1g BD based on the culture
sensitivity.
Impression revised to Non typhoidal salmonella bacteremia with cavitating lung lesion TRO necrotizing
pneumonia, with resolved septic shock. Echo done, noted no vegetation. CT thorax done, overall
findings are suggestive of right lung necrotizing cavitating pneumonia, predominantly in right upper lobe
with right hilar, mediastinal and left supraclavicular lymphadenopathies. (Fig 4,5,6,7). In view of some of
the cavities are communicating with airway, case consulted with surgical team and patient was
counselled for lobectomy but patient had refused, opted for continue IV antibiotic. Repeated serial CXR
(Fig 2, 3) showed significant improvement. Blood parameter improving. Chest consultation done,
planned for total duration of antibiotic for four to six weeks.
He was then discharge well with oralised antibiotic (ciprofloxacin) and TCA medical clinic for review CXR
post completion of antibiotic.

Keyword: Nontyphoidal Salmonella

 Abstract Title Undergraduate Medical Students’ Self- OS 1
Perceived Knowledge and Attitude Towards
Health Disparities
Author and Yew Qian Yi, Aashika Binti Amber, Hema Dhaar-
Co-Researchers sinii, Ruhan Dev Ravichandran, Kareena Kaur
Parmar

Faculty of Medicine, Manipal University College

Malaysia, Manipal Academy of Higher Education
(MAHE), Melaka, Malaysia.

NMRR ID RSCH ID-23-02080-1D8

Introduction
Good health and well-being for all is the third sustainable development goal established by the United
Nations which aims to ensure healthy lives and promote well-being for everyone at all ages. The basic
idea is to achieve universal health coverage (UHC) as well as access to quality health care. However,
health disparities are a rampant yet often neglected issue in many nations across the world. Race,
gender, disability and socioeconomic status are the factors which contribute to an individuals’ ability to
achieve good health. We aimed to determine medical students self-perceived knowledge and attitude
towards health disparities as well as the association between gender, ethnicity and family income and
health disparities.

Methodology
A cross-sectional study was conducted among medical students of Manipal University College Malaysia.
A google form questionnaire was distributed and a total of 123 responses were collected. The data was
statistically analysed using Epi Info version 7.2. Chi-Squared test was used to analyse the data.

Result
Findings revealed that 41.4% of medical students agreed that doctors like all individuals have
prejudices. 60.97% agreed and strongly agreed that they would be able to demonstrate empathy
towards multiple difficulties faced by patients from underserved populations. The highest percentage of
self-perceived area of knowledge was an assessment of health literacy of the patient with a positive
response of 60.9%. The most significant association obtained was between family income and comfort
of addressing health issues in six underserved populations mainly in immigrants and refugees (P value =
0.003), the LGBTQ community (P value =0.001), the homeless (P value =0.009), incarcerated
individuals (P value =0.003), those who are mentally ill or those with substance abuse (P value = 0.001)
and veterans (P value =0.029).

Conclusion
In summary, most students seemed to have adequate knowledge, positive attitudes and a good holistic
self-perception towards health disparities.

Keyword: Health Disparities, Self-Perceived Knowledge, Attitude, Perceptions, Medical Student, Cross-
Sectional Study, Malaysia
 Abstract Title Comparison of Learning with Audio-visual OS 2
Mnemonic and Text Reding in Enhancing
Memory Retention among Medical Students:
A Randomized Control Trial

Author and Dayasni Ratneswaren, Khoo Jia Xian Ethan,

Co-Researchers Narthana V. Vengadeshwaran, Sasika Sumodh
Dias, Mila Nu Nu Htay, Soe Moe, Nan Nitra
Than,
Htoo Htoo Kway Soe.

Faculty of Medicine, Manipal University College

Malaysia.
NMRR ID

Introduction
The combination of audio-visual and mnemonic learning methods has been found to be more effective in
retaining knowledge compared to text reading alone.

Methodology
A randomized controlled trial was conducted among medical students at Manipal University College
Malaysia to compare audio-visual mnemonic learning and text reading in terms of memory retention,
satisfaction and engagement with the learning method. We recruited 64 students who were randomized
into 32 control and 32 intervention groups. The students in the intervention group are shown an Audio-
visual Mnemonic video while the control group were asked to read printed text copies of a textbook. The
topics were case control, cohort and cross-sectional.

Result
The results showed that there was no significant difference in memory retention between audio-visual
mnemonic learning group and text reading group. However, memory retention was found to be
statistically significant among the audio-visual mnemonic groups in pre-test and immediate post-test, pre
-test and 7-day post intervention, pre-test and 14-day post intervention. Based on the satisfaction
survey, audio-visual mnemonic group had better satisfaction and engagement with their learning method
compared to text reading group. Complex information were easily retained in the memory and students
look forward to study with this method for their future tests.

Conclusion
The study recommends using audio-visual mnemonic learning method among medical students as it
helps in building long term memory and enhances memory retention of students.

Keywords: audio-visual and mnemonic learning, memory retention

 Abstract Title The Level of Comprehension of Medical OS 4
information presented in Flowchart versus
Standardised Text: A Randomised Control
Trial
1
Author and Shaamila Ramesh, 1Akila Vinudha Goone-
Co-Researchers singhe , 1Amelia Azalea binti Muhammad Ih-
san, 1Daniel Yap Choon Liang, 2Htoo Htoo Kyaw
Soe, 2Soe Moe, 2Thin Mon Kyaw, 2Mila Nu Nu
Htay

1
Faculty of Medicine, Manipal University College
Malaysia, Melaka
2
Department of Community Medicine, Faculty of
Medicine, Manipal University College Malaysia,
Melaka, Malaysia

NMRR ID RSCH ID – 23 – 02086 – 3MI

Introduction
Medical professionals are expected to rapidly assess and make accurate decisions during emergency
medical scenarios. Therefore, presentation of medical management protocols should be concise,
illustrative and user-friendly. The objective of this study was to determine the level of comprehension of
medical information and time taken to make accurate decisions during medical emergency scenarios
when presented in a flowchart in comparison to standardised text format among undergraduate medical
students.
Methodology
A single blinded pilot parallel randomised control trial was conducted among medical students at
Manipal University College Malaysia (MUCM). 60 students were randomized equally into intervention
(flowchart) and control (standardized text) groups. Flowchart and standardised text versions of
“Immediate Management of Diabetic Ketoacidosis (DKA)” were given followed by a case-based scenario
questionnaire. The data collected was analysed using Epi-Info Software version 7.2.5.0. T-test, Chi-
square test and Fisher's Exact test were used.
Result
Based on the grading system, the level of comprehension was statistically significant among the groups
(p=0.043). 33.33% of the intervention group scored “Very Good” (86% - 100% scoring interval) as
compared to 20% of the control group. The time taken for correct answers among the two groups was
not statistically significant (p=0.089). Based on the feedback form, medical students chose flowchart as
their preferred mode of medical information presentation as it is user friendly (p=0.001), easier to
understand (p=0.001) and make fast decisions (p<0.001).
Conclusion
The study determined that the flowchart group has a higher level of comprehension as they were able to
make accurate decisions for the provided emergency medical scenarios. Therefore, we recommend the
use of flowchart for future medical publications to improve comprehension and decision-making
accuracy.

Keyword: Level of comprehension, medical information, flowchart, standardized text

 Abstract Title Postvaccination Breakthrough COVID-19 In- OS 6
fections Among Adults In Malaysia And Atti-
tudes Towards Future Vaccination

Author and 1
Praneetha Nair A/P Mukunda Kumar, 1Koh Kai
Co-Researchers Ern ,1Christine Yvonne Bede, 1Lee Ai Ren Nata-
sha ,1Mevuni Dinethma Mahanama, 3Thin Mon
Kyaw, 3Htoo Htoo Kyaw Soe, 3Soe Moe,2Kazi
Majidur Rahaman, 3Mila Nu Nu Htay

1
Faculty of Medicine, Manipal University College
Malaysia
2
Department of Medicine, Faculty of Medicine,
Manipal University College Malaysia
3
Department of Community Medicine, Faculty of
Medicine, Manipal University College Malaysia
NMRR ID RSCH-ID-2302066-6SD

Introduction
Mass vaccination against COVID-19 brings the hope to end the pandemic, while breakthrough infections
raised another challenge to overcome. This study aimed to determine the frequency and severity of
these breakthrough infections, and its associated factors in Malaysia.

Methodology
This cross-sectional study was conducted among adult population in Malaysia who had completed at
least one dose of vaccination. The content validated online questionnaire was used for data collection
between December 2022 to February 2023. The data was collected using convenient sampling method
and was analysed using descriptive statistics, and logistic regression using SPSS (Version 27).
Qualitative data from open-ended questions were analysed as thematic analysis by using R-based
Qualitative Data Analysis (RQDA) software.

Result
A total of 525 participants responded to the survey. 77.5% of them completed three doses of COVID-19
vaccination. Breakthrough infection after vaccination was reported in 57.3% of the participants. Age 18
to 29 years (AOR 2.33, 95% CI 1.01, 5.32) and other ethnicity (AOR 2.00, 95% CI 1.02, 3.93) were
found to have a significant association with the occurrence of the breakthrough infections. 35.5% of
participants were not willing to take another booster dose in the future provided their attitudes towards
fear of long-term side effects, untrust to vaccine, less susceptibility to severe infection, belief in natural
immunity and myths change.

Conclusion
Future public health policies and interventions should disseminate accurate and timely information about
safety of booster dose(s) and management of side effects.

Keyword: COVID-19; SARS CoV-2, breakthrough infection; vaccine, Malaysia

 OS 7
Abstract Title Effect of immune response after different
Covid 19 Booster Vaccinations in Malacca,
Malaysia

Author and Charlotte Patrick Arjunan1, Sumandeep Kaur1,

Co-Researchers Debban A/L Ramesh1, Ashwathy Varadarajan1,
Sabyasachi Das1

1
Faculty of Medicine, Manipal University College
Malaysia

NMRR ID NMRR ID-23-01308-SPU

Introduction
The SARS CoV-2 virus, which gave rise to Covid-19, had a devastating impact on death and morbidity
all across the world. Like all other nations Malaysia has also introduced different vaccines (Comirnaty-
BNT162b2, Vaxzevria-AZD1222, CoronaVac) in 2021 followed by different booster to protect the civilian
from the deadly virus. Different combinations of vaccine (1-2-dose) and booster (Pfizer-Pfizer, AZ-Pfizer,
AZ-AZ, Sinovac-Pfizer, Sinovac-Sinovac) were randomly administered to civilians. Therefore, the novel
objective of our study is to assess the precise protective immune response after booster in Malaysia.

Methodology
Volunteers (110) from different ethnic groups who have received two doses of vaccine followed by a
booster were included in the study. One millilitre of venous blood was collected at week 0,2,4,8,12,16
and 24 after booster. Serum was isolated followed by estimation of neutralizing Covid-S-protein specific
IgG through ELISA. Blood cells are separated through gradient centrifugation, and different populations
of lymphocytes and monocytes are counted through microscopy. Data was analysed through mixed-
ANOVA, and logistic regression.

Result
Irrespective of ethnicity serum Covid-S-IgG levels were drastically reduced to negative mark by week 16
(P<0.01) in Sinovac-Sinovac group while in AZ-AZ and AZ-Pfizer combination, IgG antibody was
decreased significantly in week 24 (P<0.05) but not to the negative mark. Significantly higher serum
Covid-S-IgG level after week 24 was observed in Sinovac-Pfizer (P<0.005) and followed by the Pfizer-
Pfizer group. Plasma B-cell (Large lymphocyte) maturation is significantly higher in week 4, week 8 in
Sinovac-Pfizer, and Az-Pfizer group when in compared to Sinovac-sinovac or Az-Az or Pfizer-Pfizer
group (p<0.01). Irrespective of vaccine combination, category-2 overweight and obese individuals have
significantly low large lymphocytes as well as low serum antibody level.

Conclusion
Immune-response after vaccination is depending on level of serum antibody and proportion of plasma B-
cell population. Mixed vaccine booster provides better immunity in comparison to single vaccine group.

Keyword: Covid vaccination, mixed vaccination, booster, Covid-S- IgG, Plasma cells, lymphocytes
 Abstract Title Does the appearance and mannerism of doc- OS 8
tors affect the doctor-patient relationship? A
cross-sectional study among the general
population in Malaysia

1
Author and Delisha Kaur Boparai, 1Keeran Ramesh
1
Co-Researchers Ama Thathsarani Rajapura,1Dushan Uvindu
Gunawardana, 2Thin Mon Kyaw , 2Htoo Htoo
Kyaw Soe, 2Soe Moe, 3Nivedita Nadarajah, 2Mila
Nu Nu Htay

1
Faculty of Medicine, Manipal University College
Malaysia,
2
Department of Community Medicine, Faculty of
Medicine, Manipal University College Malaysia,
3
Department of Medicine, Faculty of Medicine,
Manipal University College Malaysia

NMRR ID RSCH ID-23-02075-A93

Introduction
A good doctor-patient relationship is essential for ensuring our patients’ overall well-being. This study
aimed to determine the community’s perception toward doctors’ physical appearance, mannerisms, and
association with the doctor-patient relationship in Malaysia.

Methodology
This cross-sectional study was conducted among the general population in Malaysia between January to
February 2023. The data was collected via online Google form questionnaire. Multinomial logistic
regression analysis was conducted.

Result
A total of 389 respondents participated in this study. Among them, 55.53% reported that professional
attire with a white coat is important, and 90.75% said that they preferred the doctors to wear the name
tag. It was more likely that respondents paid more attention to mannerisms if they were younger age
group (18-30 years) rather than the older age group (50 years and above) (Exp(B) 4.64, 95% CI: 1.90,
11.36). While the respondents with higher education levels (Postgraduate) were more attentive to
mannerisms compared to respondents with SPM level (Exp(B) 6.77, 95%CI: 1.26, 36.53).

Conclusion
The respondents demonstrated increased trust with doctors dressed in formal attire with white coat and
name tags. The majority preferred doctors with ear piercings, natural hair colours, and short nails. Most
respondents felt that both the physical appearance and mannerisms of doctors are crucial to form a
good doctor-patient relationship. Mannerism was considered more important for the doctor-patient
relationship among younger aged and higher educated people.

Keyword: Attire, Physical Appearance, Mannerism, Doctor-patient relationship, Malaysia

 OS 9
Abstract Title Perceptions towards the transition from
pre-clinical to clinical phase among
undergraduate medical students: A cross
sectional study

Author and Tharinya Bamunusinghe1, Gayathrie Krish-

Co-Researchers nasamy1, Saminu Nimsara Edirisinghe1, Ruben
Raj, Thin Mon Kyaw1, Anita Devi Krishnan Than-
try1, Mila Nu Nu Htay1, Soe Moe1, Htoo Htoo Ky-
aw Soe1

1
Faculty of Medicine, Manipal University College
Malaysia
NMRR ID RSCH ID -23 – 02076 - BSJ

Introduction
The transition from preclinical to clinical training in medical education is a complex and challenging
process that involves both positive and negative aspects for students. Students may experience stress,
workload, and uncertainty, but also gain satisfaction, confidence, and a sense of professional identity.
We investigated how the medical students' perception was in regard to five domains: transition and
professional socialization; workload; patient contact; knowledge, knowledge application and skills; and
learning and education during this transition period. We also aimed to find the association between
gender, ethnicity, enrolment status, presence of health professionals in the family and students’
perception regards to five domains.

Methodology
A cross sectional study was conducted among medical students of Manipal University College Malaysia
who were attending fifth, sixth, and seventh semesters. Online questionnaire was distributed. The
student’s perception was evaluated using a 5-point Likert scale. A total of 105 students participated.
Multiple linear regression was calculated.

Result
It was observed that the medical students were neutral about transition and professional socialization,
and knowledge, knowledge application and skills during transition period. They had positive perception
towards patient contact, and learning and education, but the students showed negative perception
towards workload in the clinical year. There was no significant association between demographics
variables and five domains of perception. However, there was significant association between gender
and two domains such as workload, and knowledge, knowledge application, and skills.

Conclusion
Our research demonstrated that the medical students had difficulty transitioning from the preclinical
phase to the clinical phase. Effective support and guidance from educators, mentors, and peers can help
students navigate this transition and optimize their learning and well-being.

Keywords: preclinical training, clinical training, medical education

 OS 10
Abstract Title Association between Socio-economic
factors, Lifestyle, Working Conditions and
Migraine among Adult Population in Malaysia

Author and Chin Yan Yu Michelle1, Ayswaraya Devi Ramu1,

Co-Researchers Ramanayake Pathirennahelage Sahan Nimsara
Ramanayake1, Wickramarachchi Appuhamilage
Nimasha Chathurangi Wickramarachchi1,
Nivedita Nadarajah1, Calvin Chu Jia Yung1, Thin
Mon Kyaw1, Mila Nu Nu Htay1, Soe Moe1, Htoo
Htoo Kyaw Soe1

1
Faculty of Medicine, Manipal University College
Malaysia

NMRR ID RSCH ID – 23 – 02254 – ZH4

Introduction
Migraine is a neurological disorder that affects approximately 1 billion people worldwide. It is
characterized by recurring attacks of moderate to severe headache, often accompanied by other
symptoms such as nausea, vomiting, and sensitivity to light and sound. Given the limited research on life
style and environmental factors on migraines, we aimed to examine the links between socioeconomic
factors, lifestyle, and working conditions with migraines.
Methodology
A cross-sectional study was carried out in Malaysia to investigate migraine in adults over 18 years old.
The survey used an online questionnaire and convenience sampling. To evaluate migraine, a Malay
version of the Structured Migraine Interview (SMI-M) was employed. The questionnaire also included
questions about socioeconomic status, lifestyle, and working conditions. The study had 514 participants,
and multiple logistic regression was used to analyze the results.
Result
26.8% of participants had migraines. Gender, ethnicity, and education level were significantly associated
with migraines. Emotional belittlement was also a significant risk factor for migraines, while lifestyle
factors were not significantly associated. High noise levels that required participants to raise their voice
were significantly associated with a higher odd of experiencing migraines.
Conclusion
Our study highlighted the importance of considering various factors such as gender, ethnicity, education
level, emotional well-being, and environmental factors for the managing and treating migraine. More
research is required to comprehend the complex interplay between these factors related to migraine and
to develop improved strategies for preventing and treating the condition.

Keywords: Migraine, severe headache, ethnicity

 OS 11
Abstract Title Effect of blackcurrant juice on perceived
stress and mood among medical students – a
Randomized control trial

Author and Chean Ker Xin1, Deveshwar a/l Raja Mohan1,

Co-Researchers Dharishini a/p Parameswaren1,Lithma Thamadhi
De Silva1, Prof Dr. Htoo Htoo Kyaw Soe1, Asso-
ciate Prof Dr.Kazi Majidur Rahaman1

1
Faculty of Medicine, Manipal University College
Malaysia
NMRR ID

Introduction
The high levels of polyphenols found in blackcurrants are the key factor that makes them beneficial for
improving mood and reducing perceived stress, even though they also possess other properties such as
antibacterial and anti-inflammatory effects. Although some randomized controlled trials have indicated
that blackcurrant juice has a positive impact on mood, there is currently no evidence suggesting that it
can reduce perceived stress.
Methodology
To investigate the effects of blackcurrant juice on mood and perceived stress, a pilot study was
conducted using a randomized, single-blind, and placebo-controlled design. The study involved 65
medical students, who were randomly assigned to either the intervention group (n=32), which received
blackcurrant juice for three consecutive days, or the control group (n=33), which received a placebo for
the same duration. After three days, mood and perceived stress were assessed using the Bond and
Lader Visual Analogue Scale, Positive and Negative Affect Schedule (PANAS) for mood, and Perceived
Stress Scale (PSS) for perceived stress.
Result
The results showed that there was no significant difference in post-intervention subjective mood and
perceived stress between the blackcurrant juice and placebo groups, except for the calmness factor in
the Bond Lader Visual Analogue Scale, which showed a statistically significant difference. However, a
comparison of the baseline and post-intervention data revealed a significant difference in mood and
perceived stress among participants in the blackcurrant juice group, based on the Bond and Lader
Visual Analogue Scale, but not on the PANAS scale's positive and negative affect score.
Conclusion
Overall, our study suggests that blackcurrant juice has a positive effect on mood and perceived stress,
and can be an effective tool for reducing stress among medical students.

Keywords: blackcurrant juice, polyphenols, improving mood, reducing perceived stress

 Abstract Title The Knowledge, Attitude and Awareness of OS 12
Stem Cells and Stem Cell Research among
Medical and Dental students:
A Cross Sectional Study in Malaysia

Author and Ngo Ping May1, Prithiva Serena Fernando1, Mir-

Co-Researchers za Ariffin bin Bany Ariffin1, A.Sharveshramanaa
a/l Arujunan1, Diduni Miriam George1, Prof Dr
Htoo Htoo Kyaw Soe1, Prof Dr Kazi Majidur Ra-
haman1

1
Faculty of Medicine, Manipal University College
Malaysia

NMRR ID

Introduction
In recent years, the use of stem cells in the treatment of various diseases has become increasingly
popular. It is important for healthcare providers to be knowledgeable about stem cells in order to provide
patients with more treatment options. The purpose of our study was to assess the level of knowledge,
attitude, and awareness of stem cells and stem cell research among medical and dental students at
Manipal University College Malaysia.

Methodology
Between November and December 2022, we conducted a cross-sectional study using an online
questionnaire distributed to 302 participants, consisting of first to fifth year medical and dental students
who were purposefully sampled. The questionnaire included true/false questions to test knowledge and
a 5-point Likert scale to assess attitude.

Result
Our results showed that 69.5% of participants had poor knowledge, while 30.5% had moderate
knowledge, but an overwhelming majority (98.7%) had high awareness and positive attitudes (Mean,
SD: 40.9, 6.5) toward stem cells and stem cell research. Additionally, 89.4% of respondents expressed
interest in attending courses or conferences to improve their knowledge.
We also found a significant relationship between gender, religion, and family income with knowledge of
stem cells, while attitude was significantly associated with gender, ethnicity, religion, and family income.

Conclusion
Our study suggests a need for more accurate information about stem cells to be provided to students, as
they are enthusiastic about learning and developing an interest in stem cell research.

Keywords: stem cells, awareness

 POSTER
PA : Poster- Allied Health Category
PMD : Poster-Medical/Dental Category
PS : Poster-Student Category

Category Presenting Author & Institutions Title

PA2 LIM KUANG HOCK, IMR DETERMINATION OF THE CONSTRUCT VALIDITY AND RELIABILITY OF
THE MALAY VERSION OF THE ROSENBERG SELF ESTEEM SCALE (RSES-
M) AMONG SECONDARY SCHOOL STUDENTS USING CONFIRMATORY
FACTOR ANALYSIS

PA3 QUAK CHYI ING, VANCOMYCIN DOSING ADJUSTMENT: COMPARISON BETWEEN

HOSPITAL MELAKA TROUGH AND AUC

PA4 MUHAMMAD AMIR BIN HAMDAN, STUDY OF PRESCRIBING PATTERN IN TYPE 2 DIABETES MELLITUS PA-
HOSPITAL ALOR GAJAH TIENTS IN HOSPITAL ALOR GAJAH

PA5 AINA FATINI AHMAD FISAL, HOSPI- STUDY ON THE ASSOCIATION BETWEEN PHOSPHATE BINDERS PILL
TAL JASIN BURDEN, MEDICATION ADHERENCE AND BONE DISEASE MARKERS
AMONG HAEMODIALYSIS PATIENTS IN HOSPITAL JASIN

PA6 NUR NADRAH BINTI MAT SUPRI, THROMBOEMBOLIC DISEASE AMONG PREGNANT WOMEN WITH
KLINIK KESIHATAN JASIN COVID-19: PREVALENCE, RISK FACTORS, AND IN-HOSPITAL MORTALITY
PA7 NOOR SYAZANANI BINTI AMRAN, PRACTICE AND PERCEPTION OF PATIENTS IN KLINIK KESIHATAN PER-
KLINIK KESIHATAN PERINGGIT INGGIT (KKP) TOWARDS PHARMACY INVENTORY SYSTEM (PhIS) MEDI-
CATION LABELLING
PA8 MUHAMMAD HAMZIHADI BIN NURSING CARE DURING PRONE POSITION IN ACUTE RESPIRATORY
HAMRAH, DISEASE SYNDROME (ARDS): OUR PRAGMATIC APPROACH
HOSPITAL PORT DICKSON
PA9 MAHNON SURIA, UPPER ARM LENGTH AS A PREDICTOR FOR ESTIMATING THE HEIGHT
HOSPITAL MELAKA OF CHILDREN WITH CEREBRAL PALSY IN MALAYSIA
PA10 MOHD AZAM BIN ABDUL HALIM, AID FOR DECISION MAKING IN OCCUPATION CHOICE (ADOC) AS A
ILKKM SG BULOH TOOL TO ADDRESS ACTIVITIES AND PARTICIPATION: A SCOPING RE-
VIEW
PMD1 TOO XIAO QING, LAPAROSCOPIC RADICAL CYSTECTOMY: AN INITIAL EXPERIENCE IN A
HOSPITAL MELAKA NON-UROLOGY CENTRE
PMD2 TOO XIAO QING, POST-SPLENECTOMY PORTAL VENOUS SYSTEM THROMBOSIS - A CASE
HOSPITAL MELAKA REPORT IN HOSPITAL MELAKA
PMD3 NUR ARINA NAFISAH BINTI MOHD IT’S RUNNING ‘BENIGNANT’!” A CASE REPORT OF PATHOLOGICAL
AZNAN, PREMATURE VENTRICULAR COMPLEXES (PVCS) THAT LEADS TO MA-
HOSPITAL MELAKA LIGNANT ARRHYTHMIAS.
PMD4 SITI HAWA BINTI ADNAN, HOSPITAL PURPLE URINE BAG SYNDROME: EARLY RECOGNITION BY HEALTHCARE
MELAKA PROVIDER AND ANTIBIOTIC ADMINISTRATION
PMD5 NOORUL NADIAH BT NOOR ZAMRY, ORAL HEALTH EDUCATION IN THE PREVENTION OF EARLY CHILDHOOD
BAHAGIAN KESIHATAN PERGIGIAN CARIES: A SYSTEMATIC REVIEW AND META-ANALYSIS
NEGERI MELAKA
PMD6 NOOR HUDA BINTI ABD HAMID, COLLAGENOMA – A SKIN MANIFESTATION OF MULTIPLE ENDOCRINE
HOSPITAL MELAKA NEOPLASIA TYPE 1
PMD7 NOOR HAFIZAH BINTI AB HAMID, AN EXPLOSION OF ENDOCRINOPATHIES-A COMPLEX CASE OF MEN 1
HOSPITAL MELAKA
PMD8 PUSPADEVI ARMUGHAM, HOSPITAL THE PROZONE PHENOMENON WITH SYPHILIS AND HIV-1 CO-
SELAYANG INFECTION
PMD9 PANGIE ANAK BAKIT, IHM IMPROVISING SELECTION CRITERIA FOR HEALTHCARE LEADERSHIP
TRAINING UNDER TALENT GROOMING PROGRAMME (TGP)
 POSTER
PA : Poster- Allied Health Category
PMD : Poster-Medical/Dental Category
PS : Poster-Student Category
Category Presenting Author & Institutions
PMD10 NOREHAN BINTI JINAH, IHM
PMD11 SHALIZA BINTI NAWAWI, HOSPITAL
MELAKA
PMD12 LAILA SYAKIRAH BINTI 'EZUDDIN,
HOSPITAL ENCHE' BESAR HAJJAH
KALSOM, JOHOR
PMD13 MUHAMMAD ZULHILMI BIN IS-
MAIL, HOSPITAL MELAKA
PMD14 NOOR HAFIS BIN MD TOB, HOSPI-
TAL MELAKA
PMD15 MOHD AIZUDDIN BIN MOHD ZU-
LASTRI, HOSPITAL MELAKA
PMD16 ASMA' BINTI ABDUL AZIZ, Klinik
Kesihatan Batu Berendam
PMD17 ROSNANI BINTI SAMSUDIN, KLINIK
KESIHATAN MASJID TANAH
PMD18 MUHAMMAD HUZAIFAH BIN HAS-
SAN, HOSPITAL MELAKA
PS1 ANGELA LOW HUI QI, MUCM
PS2 BRYAN CHEE EE PINN, MUCM
PS3 CHONG GUANG WEN, MUCM
Title
WHAT TRIGGERS THE STRIKE BY HARTAL DOKTOR KONTRAK? A QUALI-
TATIVE CONTENT ANALYSIS FROM THE PERSPECTIVE OF MEDICAL FRA-
TERNITIES
PRIMARY CUTANEOUS ANAPLASTIC LARGE CELL LYMPHOMA : A CASE
REPORT IN HOSPITAL MELAKA
CASE REPORT: DELICACY THAT COSTS A LIFE
DOES ALL LBBB IS STEMI EQUIVALENT?
ISOLATED ACTH DEFICIENCY WITH PITUITARY INCIDENTALOMA POST
CORECTION (1)
HOUSE OFFICER’S EXPERIENCE AND PERCEPTION OF MEDICAL POST-
ING: A RETROSPECTIVE SINGLE CENTRE STUDY
LEVEL OF PHYSICAL ACTIVITY AND ITS BARRIERS AMONG OVER-
WEIGHT AND OBESE PATIENTS ATTENDING 3 PRIMARY CARE CLINICS
IN MELAKA
THE PERCEPTION OF PRIMARY CARE POSTGRADUATE TRAINEES ON
ASSESSMENT OF ERECTILE DYSFUNCTION IN THEIR PATIENTS
A CASE OF THYROID STORM IN ASTHMATIC PATIENT WITH ATRIAL
FIBRILLATION IN RAPID VENTRICULAR RESPONSE : CHALLENGES IN
DIAGNOSIS AND PHARMACOLOGICAL TREATMENT
IMPACT OF SLEEP QUALITY ASSOCIATED WITH STRESS AMONG MEDI-
CAL STUDENTS IN MANIPAL UNIVERSITY COLLEGE MALAYSIA (MUCM).
IN VITRO EVALUATION OF ALPHA-AMYLASE AND ALPHA-GLUCOSIDASE
INHIBITORY POTENTIAL AND ANTIOXIDANT ACTIVITY OF ANTHRAQUI-
NONE DERIVATIVES
CORRELATION BETWEEN HEALTH BELIEFS, AND LIFESTYLE AMONG
MEDICAL STUDENTS IN MALAYSIA: A CROSS-SECTIONAL STUDY
 Abstract Title Determination of the construct validity and PA 2
reliability of the Malay version of the
Rosenberg Self Esteem Scale (RSES-M)
among secondary school students using
confirmatory factor analysis

Author and Lim Kuang Hock1, Cheong Yoon Ling 1, Lim

Co-Researchers Hui Li2, Kee CC3, Mohd Hazilas MH1, Ali
Aman M1, Cheah YK4, Lim JH5, Sumarni MG1

1
Institute for Medical Research
2
Hospital Sultan Ismail
3
Department of Biostatistics and Data Reposi-
tory, NIH
4
School of Economics, Finance and Banking,
UUM
5
Pharmacy Department, Hospital Putrajaya
NMRR ID NMRR-12-1210-12399

Introduction
The Rosenberg Self-Esteem Scale is widely used to measure self-esteem among adults and youth. This
study aims to determine the construct validity and reliability of a Malay language version of the RSES
(RSES-M) among Malaysian youth using confirmatory factor analysis.

Methodology
We administered the RSES-M to 378 students selected through multistage sampling in Kota Tinggi
district. We compared three measurement models with the best relative fit: a single domain model and
two two-domain models.

Result
Results: The findings indicate that the best model of the RSES-M was a two-domain model with one
domain containing all the positively-worded items, and the other domain containing all the negatively-
worded items. Model fit was good with Chi-Square/df 0.967, goodness-of-fit (GFI) 3.341, comparative fit
index (CFI) 0.905, incremental fit index (IFI) 0.906, and root mean square error of approximation
(RMSEA) of 0.079. The reliability of RSES-M using this model was substantial, Cronbach’s alpha of
domain one (positively-worded) was 0.765 and domain two (negatively-worded) was 0.648.

Conclusion
The study indicates that the RSES-M can be used to assess self-esteem among adolescents in
Malaysia.

Keyword:
Rosenberg self-esteem Scale Malay (RSES-M), Malaysian Youth,
Construct validity, Reliability VIEW POSTER >
 Abstract Title Vancomycin Dosing Adjustment: Compari-
son between Trough and AUC
PA 3
Author and Chew Soo Piing1, Quak Chyi Ing1
Co-Researchers
1
Pharmacy Department, Hospital Melaka

NMRR ID NMRR-20-263-53121

Introduction
Trough-based dosing adjustment method for Vancomycin has been postulated to increase incidence of
Vancomycin-induced-nephrotoxicity (VIN) due to overexposure of Vancomycin. Hence AUC24-based
method (with lower therapeutic range for trough level) has been reintroduced to replace trough-based
method to reduce unnecessary overexposure of Vancomycin. The objectives of the study were to
compare the incidence of VIN, resolution of infection, duration of treatment, and total daily dose of
Vancomycin between the trough-based and AUC24-based Vancomycin dosing adjustment methods.

Methodology
A combination of retrospective (trough-based) and prospective (AUC24-based) study involving patients
with normal renal function initiated on Vancomycin for indicated infection. There will only be one method
of dosing adjustment at one time throughout the study time frame. For trough-based method, patients
had their Vancomycin dose adjusted based on trough level to achieve the therapeutic range of 15-20 µg/
mL. As for AUC24-based method, patients had their Vancomycin dose adjusted based on AUC24
method to achieve a therapeutic range of 400-600 and trough level of 10-20 µg/mL. Data on duration of
Vancomycin treatment, resolution of infection, and average total daily dose to achieve therapeutic range,
were collected and analysed for both arms.

Result
A total of 152 patients were included, with 70 patients in trough-based arm and 82 patients in AUC24-
based arm. The indication of Vancomycin mainly for bone MRSA (30, 19.7%), swab MRSA (24, 15.8%)
and tissue MRSA (19, 12.5%). There was no significant difference in term of VIN between both arms
[Trough: n=6, 54.5%, AUC24: n=5, 45.5% (p=0.557)]. AUC24 has significant lower trough level
compared to trough-based [AUC24: 11.93 µg/mL; Trough: 15.25 µg/mL (p=0.032)]. There was no
significant difference in total vancomycin dose in both arms [Trough: 1757mg; AUC24: 2125mg
(p=0.35)). AUC24 was not inferior to trough-based in term of resolution of infection [Trough: n=7 (70%);
AUC24: n=3 (30%) p=0.116] and duration of treatment [Trough: 13.96 day; AUC24: 13.39 day
(p=0.661)].

Conclusion
This study found no reduced incidence of VIN with AUC24 based methods. Total daily dose, duration of
treatment, and rate of resolution of infection were the same between both arms.

Keyword: Vancomycin, trough-based, AUC24-based, nephrotoxicity, exposure

VIEW POSTER >

 Abstract Title Study of Prescribing Pattern in Type 2 PA 4
Diabetes Mellitus Patients in Hospital Alor
Gajah

Author and Heng Jia Shen1, Khairunisa binti Rumaizi1, Nik

Co-Researchers Nur Zuhairah binti Niknazman1, Nurul Athirah
binti Riduan1, Muhammad Amir bin Hamdan1

1
Pharmacy Unit, Hospital Alor Gajah

NMRR ID NMRR ID-22-00720-IXE

Introduction
Diabetes is a chronic illness that has a major impact on the lives and well-being of people around the
world which usually affects adults. In Malaysia, majority of diabetes patients are prescribed with more
than two oral glucose-lowering drugs (OGLDs) instead of monotherapy, while others additionally
received insulin as part of the regimen. Metformin is the most extensively used medication in the therapy
of Type 2 Diabetes Mellitus (T2DM) patients, followed by sulfonylurea (SU). The study aims to examine
the pattern of prescribing for Type 2 Diabetes Mellitus patients in outpatient settings in Hospital Alor
Gajah.

Methodology
This retrospective study involved 385 patients’ prescription that was collected for a period of 6 months
from June 2021 to December 2021 in medical outpatient clinic Hospital Alor Gajah, Melaka. Patients
who have T2DM aged of 18 and above with a history or known use of OGLDs were included in the
study. Data was entered into Microsoft Excel. Quantitative variables were expressed as mean ± SD and
descriptive statistics were used to express the data in the form of percentage and bar chart.

Result
From the study, females have slightly higher prevalence of T2DM compared to males and generally fall
in the older population group between ages of 61-70. Malay showed the highest percentage of diabetic
prevalence, followed by Indian, Chinese and other race. Majority of them (46%) were prescribed with
dual therapy followed by monotherapy (36.3%) and triple therapy (17.7%).

Conclusion
Metformin was the most frequently prescribed OGLD by healthcare practitioners. Majority of patients
were on combination therapy, with most of them receiving a combination of metformin and sulfonylureas
(dual therapy). Meanwhile, combination of metformin, sulfonylurea and vildagliptin was the most
common triple therapy prescribed.

Keyword: Prescribing pattern, Type 2 Diabetes Mellitus, oral glucose-lowering drugs

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 Abstract Title Study On the Association Between PA 5
Phosphate Binders Pill Burden, Medication
Adherence and Bone Disease Markers
Among Haemodialysis Patients in Hospital
Jasin
Author and Fadzilah Shafie1, Ng Shy Pyng1, Nur Izzati Ah-
Co-Researchers mad1, Aina Fatini Ahmad Fisal1

1
Pharmacy Unit, Hospital Jasin

NMRR ID NNMR-19-2984-50468

Introduction
Phosphate binder medications account for approximately half the daily pill of dialysis patients. However,
the prevalence of non-adherence to phosphate binder medications is 22-74%. The objective of this study
was to investigate the association between phosphate binders (PB) pill burden, medication adherence
and mineral bone disease markers among patients undergoing haemodialysis (HD) in Hospital Jasin.
Methodology
This cross-sectional study included all 44 patients in Haemodialysis Centre in Hospital Jasin aged 18
years old above using phosphate binders. Adherence was assessed using the validated 12-item of
Adherence to Refills and Medications Scale (ARMS) which was translated from English into Malay. The
result was analysed using Pearson Correlation.
Result
There are 65.9% male patients as compared to female (34.1%) in this study. The dialysis vintage of the
patient was 1-25 years with mean of 5.41 years and ±SD of 6.40. The majority of patients took calcium-
based phosphate binders with 88.6% and only 5 patients took non-calcium-based phosphate binder
which are lanthanum (6.8%) and sevelamer (4.5%). The total number of pills daily ranged from 4-33
pills, with overall mean ± SD of 16.45 ± 6.4. The result divided the patients into two groups where 50%
got <16 ARMS scoring whereas the other 50% got more than 16 ARMS score. In our study, only 5
patients have an ARMS score of 12 with 11.36% of the total patients. The other 72.72% were non-
adherent towards the regime. The PB pill burden did not have influence with the ARMS score.
Adherence also showed no correlation with the serum phosphate, serum calcium and serum parathyroid
hormone (PTH). There was no relationship between PB pill burden with mineral bone disease markers.
Conclusion
There is no correlation between PB pill burden, medication adherence and bone disease markers
among HD patients in Hospital Jasin.

Keyword: phosphate binders pill burden, ARMS score, adherence, mineral bone disease marker,
haemodialysis.

VIEW POSTER >

 Abstract Title Thromboembolic Disease Among Pregnant PA 6
Women with COVID-19: Prevalence, Risk
Factors, And In-Hospital Mortality
Author and Nur Nadrah Mat Supri1, Dr Hanis Hanum
Co-Researchers Zulkifly2,Dr Mohamad Rodi Isa2, Cik Izzati Abdul
Halim Zaki2, Dr Tharmini Ravi3

1
Unit Farmasi Klinik Kesihatan Jasin,
2
Fakulti Farmasi UiTM, Hospital UiTM,
3
CRC Hospital Sungai Buloh

NMRR ID NMRR ID-22-00988-KE4

Introduction
Quantifying the prevalence and identifying the risk factors for thromboembolic (TE) disease associated
with COVID-19 in the pregnant population is the key to planning and providing the best clinical care. The
main objective of this study was to investigate the prevalence of TE disease among pregnant women
with COVID-19.
Methodology
This cohort study was conducted retrospectively in Hospital Sungai Buloh, which includes all pregnant
women with COVID-19 who were admitted from the 1st of January until 31st of December 2021.
Result
From this cohort (N=132), 90 patients (68.2%) developed TE disease. The mean age was 31 years old
(SD: 5.298). Majority (97.7%) were Malaysian. Most of them were Malay (90.9%), while the rest were
Chinese, Indian and other races (9%). Less than half of them had maternal obesity (38.6%). All subjects
had a median gestational age of 29.5 weeks (IQR: 25.3 – 34.0). More than half (54.5%) of them had
underlying diabetes mellitus (44, 33.3%), hypertension (6, 4.5%) and respiratory diseases (6, 4.5%). The
median baseline D-dimer value was 2.5 times the upper reference limit (1228.5 ng/mL; IQR: 791.5 –
1934.5) whereas the median CRP value was elevated to 3.0 mg/dL (IQR: 0.53 – 5.8). The risk factors
associated with TE disease on multivariate regression analysis were baseline D-dimer values (OR:
1.002; CI: 1.001, 1.003; p<0.001) and CRP values (OR: 1.23; CI: 1.059 – 1.428; p=0.007). Nine deaths
occurred (6.8%); six cases (66.7%) were those who developed TE, which was pulmonary embolism
(PE).
Conclusion
The prevalence of TE disease among pregnant women with COVID-19 was high in this cohort (68.2%),
with an overall mortality of 4.5% due to TE disease. The main predictors of TE events were higher-than-
normal baseline D-dimer values (NV <500 ng/mL) and CRP values (NV <1.0 mg/dL).

Keywords:thromboembolic (TE) disease, pregnant women

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 PA 7

Abstract Title Practice and Perception of Patients in Klinik

Kesihatan Peringgit (KKP) Towards Pharmacy
Inventory System (PhIS) Medication Labelling

Author and Noor Syazanani Amran1, Melissa Ong

Co-Researchers Ee Lynn1

1
Farmasi Klinik Kesihatan Peringgit

NMRR ID NMRR 22-00684-U3L

Introduction
Medication label is important to provide health information to the patients about their medications. The
label should provide clear, readable and comprehensive information for patients to understand and
follow the instructions displayed. However, the problem in understanding and reading medication labels
had been linked to poor health literacy among patients. The main objective of this study was to evaluate
the practice and perception of patients in Klinik Kesihatan Peringgit (KKP) towards the current PhIS
medication label.

Methodology
A prospective, cross-sectional study was conducted using self-designed questionnaire, involving
patients that currently seeking treatment in KKP. Data collected from the questionnaire were further
analyzed using Statistical Package for Social Science (SPSS) software. Chi-square analysis was used
to analyse the association between social demographics and health information with the practice and
perception variables. A p-value of less than 0.05 was considered statistically significant.

Result
There were 328 eligible respondents in this study. Most of the respondents (74.4%; n: 244) possessed
good practice towards their medication label. There were significant associations between practice level
and age group (p:0.000), educational level (p: 0.000), monthly income (p: 0.031), employment status (p:
0.002), and medication management (p: 0.025). Majority of the respondents (92.1%; n: 302) showed
positive perceptions towards the current label design and suggestions proposed to improve the
medication label. There was significant association between perception level and medication
management (p: 0.016).
Conclusion
Majority of the patients showed good practice and perception towards current PhIS label, proving that
the current label design was perceived well by the consumers. Additionally, all suggestions proposed for
the improvement of medication label received positive response from most of the patients.

Keywords: Medication label, practice and perception

VIEW POSTER >

 PA 8

Abstract Title Nursing Care During Prone Position in Acute

Respiratory Disease Syndrome (ARDS): Our
Pragmatic Approach

Author and Muhammad Hamzihadi Hamrah1, Hema Malini A/

Co-Researchers P Manogharan1

1
Intensive Care Unit, Anaesthesiology depart-
ment, Hospital Port Dickson

NMRR ID NMRR-16-2901-31919

Introduction
The fatality rate associated with acute respiratory distress syndrome (ARDS) is very significant. The use
of the prone position has been proposed as a way to increase survival. To ensure that oxygenation
delivery is optimal during the treatment, continued nursing care is crucial to improve oxygenation
however it can cause pressure injury. Nursing care for prone positioning has been discussed in
advanced countries but no documentation of nursing care on prone position has been discussed in
Malaysia. Therefore, this case study is looking into nursing care on prone position for those patients’
diagnosed ARDS.

Methodology
Three cases have been identified and treated as severe ARDS in different period of time in 2017 and
2018. Eight hours in prop up supine position nursing care implement as usual while 16 hours nursing
care of prone position has been implemented and documented. Arterial blood gases (ABG) were taken
frequently to monitor oxygenation level in blood. Close method suction applied to minimize losing
oxygenation during suction. Positioning Head, hands and leg in swimming position and changed every
two hours. Monitor regularly on CBD tubing or ECG lead to avoid pressure injury. Eyes is closed with
eyes shield and frequently inspect eyes.

Result
Combination of three guidelines from United Kingdom had been implemented and had produced positive
result where no pressure injury seen since post procedure. ABG result shows improvement after 2 days
with 16 hours each day and then no prone position done. Suction done regularly with close suction had
shown significant improvement in oxygen saturation and PO2 reading.

Conclusion
Nursing care guideline on prone position should be proposed for in order to standardize in Malaysia
since the nursing guideline is not available in Malaysia practices currently.

Keywords: acute respiratory distress syndrome, prone position, nursing care

 PA 9
Abstract Title Upper Arm Length as a predictor for
estimating the height of children with
Cerebral Palsy in Malaysia

Author and Mahnon Suria Mokhy1,2, Rosita Jamaluddin1

Co-Researchers Abd Rasyid Ismail1 Norhasmah Sulaiman1,
Siti Nur ‘Asyura Adznam1, Intan Hakimah Ismai-
l1,Malina Osman1

1
Department of Nutrition and Dietetics, Faculty of
Medicine and Health Sciences, Universiti Putra
Malaysia, Serdang, Selangor.
2
Jabatan Dietetik dan Sajian, Hospital Melaka

NMRR ID NMRR-17-3373-35721

Introduction
Children with cerebral palsy (CP) usually suffer from congenital deformities, which prevents them from
standing correctly, and measuring height accurately. Upper arm length (UAL) is one of the segmental
body parts that can be used to measure height, especially when the lower parts of the body are affected.
This study aimed to develop prediction equations based on UAL for CP children in Malaysia to estimate
actual height across all five levels of gross motor functions (GMFCS I – V).
Methodology
The participants in this study were CP children (with GMFCS I – V) aged two to 18 years. A total of 177
participants were recruited from six outpatient paediatric clinics. All participants were sampled from the
central and southern regions of Malaysia. The height of the subjects we measured according to standard
protocol. A flexible Seca measuring tape was used to measure the UAL of all participants. Prediction
equations to estimate actual height from UAL anthropometric measurements have been developed
using linear regression analysis. Two models have been developed which, in Model1, a regression
prediction equation has been developed using UAL alone. On the other hand, in Model 2, age in years
(A) was included as an additional covariate in the equation. The Intra Correlation Coefficient (ICC) was
conducted to demonstrate the relationship between the actual height and the upper arm length
measurements.
Result
The UAL-based regression equations were Model 1, Height= 20.469 + (3.83 × UAL), R2=0.801 and
Model 2, Height= 33.15 + (2.771 × UAL) + (1.55×Age), R2=0.837. Both predictive equation models
showed a high degree of agreement, with ICCs for Models 1 and 2, respectively at 0.913 and 0.920.
Conclusion
Our findings suggest that predictive equations using upper arm length can accurately determine the
stature and actual height of children with CP children aged two to 18 years in the Malaysian population.
This predictive equation can be used for nutritional assessment which contributes to general clinical
benefit. Based on these findings, the nutritional status of the children with CP may be determined.
Keyword: Actual height; age; cerebral palsy; estimated height; upper arm length

VIEW POSTER >

 Abstract Title Aid for Decision Making in Occupation PA 10
Choice (ADOC) as a Tool to Address
Activities and Participation: A Scoping

Author and Mohd Azam Abdul Halim 1,2, Ahmad Zamir Che
Co-Researchers Daud 2, Kounosuke Tomori 3 & Ahmad
Rashdeen Fazwi Muhammad Nawawi 4

1
Occupational Therapy Programme, Institut Lati-
han Kementerian Kesihatan Malaysia (ILKKM)
Sungai Buloh, Selangor, Malaysia,
2
Centre for Occupational Therapy Studies, Fac-
ulty of Health Sciences Universiti Teknokogi
Mara (UiTM) Puncak Alam Campus, Puncak
Alam, Selangor, Malaysia,
3
Department of Occupational Therapy, Schools
of Health Sciences, Tokyo University of Technol-
ogy, 1404-1 Katakuramachi, Hachioji City, Tokyo
192-0982, Japan,
4
Hand & Microsurgery, Orthopedic & Traumatolo-
gy Department Hospital Selayang, Selayang -
Kepong Hwy Batu Caves, Selangor, Malaysia.

NMRR ID NMRR ID0-506-19-28711 (IIR)

Introduction
Aid for Decision-Making in Occupation Choice (ADOC) was designed to promote shared decision-
making and collaborative goal in daily living activities. This scoping review aimed to review and
synthesise research literature regarding ADOC and to identify any existing knowledge gap related to
ADOC
Methodology
The PRISMA-Scoping review was used as a guide. A literature search was retrieved from the January
2011 until December 2021 based on four databases; Scopus, Google Scholar, PubMed and CINAHL.
Result
A total of nine articles (N=9) were included in this review. The findings were arranged in five themes; i)
clinical purpose, ii) validity and reliability, iii) target population, iv) practicality of ADOC and v) ADOC with
the ICF. ADOC provides a client-centred and collaborative approach, highlighting meaningful
occupations in daily living and the use of technology in rehabilitation.
Conclusion
This review suggests the need for cross-cultural translation and validation of ADOC into the native
language before it can be used.

Keyword: ADOC, Activity, Participation, Decision Making, Occupation

VIEW POSTER >

 PMD 1

Abstract Title Laparoscopic Radical Cystectomy:

An Initial experience in a non-urology centre

Author and Too XQ, Sivapragasam. V, Noor Ashani M.Y.

Co-Researchers
Department of Surgery, Hospital Melaka

NMRR ID RSCH ID-23-01955-H78

Introduction
Radical cystectomy remains the gold standard for the treatment of localised muscle invasive and high-
risk urothelial cancers of the bladder. Since the introduction of minimally invasive surgery, laparoscopic
approach and even robotic-assisted technique have been adopted to enhance recovery of patients after
surgery,while reducing morbidity of open surgery. Hospital Melaka, being a tertiary referral centre with
visiting urologist on a monthly basis, has recently started performing laparoscopic radical cystectomy,
with the support of general surgical team.

Methodology
A total of six cases had been performed in the centre from December 2021 to August 2022. All patients
were male, with age ranging from 30 to 72 years old. Among these patients, 4 patients underwent
laparoscopic surgery completely while the other 2 patients had to be converted to open surgery due to
locally advanced nature of the disease.

Result
The average operating time was 6 hours 13 minutes (ranging from 4 hours 58 minutes to 7 hours 33
minutes) with an average blood loss of 500ml. The average length of postoperative hospital stay was
9.25 days (ranging from 6 to 12 days). Other than transient ileus, none of the cases had major
postoperative complication.

Conclusion
The outcome of our patients post laparoscopic radical cystectomy were promising with no major
complications. Therefore, we conclude that with appropriate patient selection and support from general
surgery, laparoscopic radical cystectomy is technically feasible in a non-urology centre.

Keywords: laparoscopic radical cystectomy, general surgery

VIEW POSTER >

 PMD 2

Abstract Title Post-Splenectomy Portal Venous System Throm-

bosis - A Case Report in Hospital Melaka
Author and XQ Too, JH Lai, SL Lim
Co-Researchers
Department of Surgery, Hospital Melaka

NMRR ID RSCH ID-23-01754-D33

Introduction
The indications for splenectomy are commonly attributed to traumatic injury and followed by hematologic
disorder. The most widely recognized complication of post-splenectomy is overwhelming bacterial
infection. More recently, thrombosis has become recognised as another potential complication.
Prospective cohort studies reveal that the incidence of thrombosis involving the portal venous system
after splenectomy ranges from 5% to 37%, all occurring within 2 months, and the majority within 2 weeks
of the surgery.
Methodology

We here reported a patient with beta-thalassemia who underwent splenectomy evolved with superior
mesenteric vein, splenic vein and right portal vein thrombosis, treated with systemic anticoagulation in
Hospital Melaka.
Result

A 28-year-old gentleman with beta thalassemia major underwent elective open splenectomy after being
evaluated by medical specialty. Preoperative ultrasound showed splenic size of 20.5cm and portal vein
of 1.4cm in diameter. Blood tests showed haemoglobin 10.6g/dL and platelet 159K/uL. Intraoperatively
the operating time lasted 1 hour 40 minutes with estimated blood loss of 100ml, no blood transfusion
was required. The spleen specimen weighed 830g. Postoperatively blood tests showed haemoglobin
10.0g/dL and platelet 487K/uL. No anticoagulant or antiplatelet was initiated and the patient was
discharged home on day 5.
He was readmitted on day 8 presented with abdominal pain and vomiting. Computed tomography
arteriography showed partial superior mesenteric vein thrombosis, splenic vein thrombosis and right
portal vein thrombosis. Blood tests showed haemoglobin 9.7g/dL and platelet 1845K/uL. Patient was
treated conservatively with anticoagulant and antiplatelet. After one month in hospital monitoring he was
discharged home well.
Conclusion
Portal venous thrombosis is a relatively common complication of splenectomy. A high index of suspicion,
early diagnosis by contrast-enhanced computed tomography, and prompt anticoagulation are key to a
successful outcome.

Keywords:splenectomy, portal venous thrombosis,

VIEW POSTER >
 PMD 3

Abstract Title ”It’s Running ‘Benignant’!” A case report of

pathological premature ventricular complexes
(PVCs) that leads to malignant arrhythmias.
Author and Nur Arina Nafisah Mohd Aznan1, Fareesya Hanum
Co-Researchers Mohd Fauzi1, Mohd Hilmi Che Aun1, Ammirul Fahmi
bin Othman1, Mohammad Fadhly Yahya1

1
Emergency and Trauma Department Hospital
Melaka, Melaka

NMRR ID

Introduction
Premature ventricular complexes (PVCs) often thought to be benign when it appeared occasionally on
electrocardiogram. There are specific morphologies of PVCs to distinguish between normal and
pathological PVC which give clues to catastrophic arrhythmia that may occur. Few characteristics that
pertinent to pathological PVC including coupling interval (CI), short ratio of CI and QT interval (CI/QT
ratio) and R on T phenomenon. These abnormal PVCs if recognized, may contribute to 5-10% of
reversible in and out of hospital cardiac arrest.

Methodology
An elderly gentleman with multiple co-morbid presented with an episode of syncope at home. Upon
presentation, he appeared tachypneic with elevated blood pressure. Generalized crepitations heard
upon lung auscultation and treated for acute pulmonary edema. Initial electrocardiogram showed left
ventricular strain pattern. Serial electrocardiogram revealed occasional PVCs which appeared to have
short-coupled interval. Shortly after, he developed fast atrial fibrillation with aberrancy followed by
monomorphic ventricular tachycardia. In view of multiple episodes of unstable tachyarrhythmias, patient
required multiple synchronized cardioversions in emergency department and ward. Pharmacological
therapy of intravenous Amiodarone and Lignocaine initiated as well.

We noticed subtle differences of PVCs morphology that give clues patient may develop malignant
arrhythmias. Cardiac monitoring was emphasized due to risks of sudden cardiac arrest. Initial
electrocardiogram showed left ventricular strain pattern followed by abnormal PVCs evidenced by short
CI (280 milliseconds) and CI/QT interval of 0.7. As predicted, patient developed episodes of
tachyarrhythmias which aborted after few attempts of synchronized cardioversions and pharmacological
treatment. Few studies showed that CI of less than 400 milliseconds and CI/QT interval less than 1
almost 100% specific and sensitive to predict malignant arrhythmias that may occur.

Conclusion
Occasional PVCs on electrocardiogram should not be overlooked. Other than estimation burden of
PVCs, the morphology of the PVCs should be analyzed as well to predict the catastrophic event of
malignant arrhythmia. Failure to capture the subtle changes of the morphology may lead to delay in
preventing the reversible sudden cardiac arrest.

Keyword:Premature ventricular complexes, arrhythmia VIEW POSTER >

 PMD 4

Abstract Title Purple urine bag syndrome : Early

recognition by healthcare provider and
antibiotic administration
Author and Siti Hawa Binti Adnan¹, Norhuwaina Binti Is-
Co-Researchers nazli¹, Mohd Hilmi Bin Che Aun¹, Mohammad
Fadhly Yahya¹

Emergency And Trauma Department Hospital

Melaka, Melaka.
NMRR ID RSCH ID 23-02565-JDC

Introduction
Urinary tract infection can occur in all age groups and produce a wide range of clinical syndromes.
Purple urine bag syndrome (PUBS) is rare and first reported in 1978. (1) Patient with Purple urine bag
syndrome may not come in with classical signs of urinary tract infection (UTI) . This purple hue urine is
an alarming sign and as an indicator of urinary tract infection patients with various comorbidities.

Methodology
A 43 years old Chinese man, with an underlying spinal cord injury with neurogenic bladder since 3 years
ago and schizophrenia. He had been an SPC dependent for the past 2 years for his neurogenic bladder.
His last change of SPC was on 22/2/2023. He presented to the emergency department of GHM for
hematuria, cough and fever. His father also reported he had a history of chronic constipation for 1 month
which was resolved after given ravin enema and syrup lactulose by a GP. Otherwise, he does not have
gastrointestinal losses, no abdominal pain and tolerating orally well. Upon presentation to the
emergency department, patient was alert, GCS E4V4M6, good pulse volume, crt <2s, not tachypneic,
not septic looking. Upon auscultation, lungs clear, CVS was dual rhythm no murmur. Upon palpation of
the abdomen, it was soft and nontender. Renal punch was negative. In the CBD bag, the urine is purple
in colour, in tubing the urine is clear, no hematuria. SPC site is clean.

Result
Investigation for URTI was sent. His urine biochemistry showed UTI features in which leukocyte is 3+,
nitrite positive with pH of 8. His full blood count showed increased white blood cell: 13.68, platelet 232
and hemoglobin of 14.4. His c-reactive protein increased to 44.6. His renal profile is normal with urea
5.9, creatinine 100. He was started on IV cefuroxime 1.5g STAT and regular dose of 750mg TDS and
his urine catheter and urine bag were changed. Upon following up the patient on the next day, his urine
has changed colour into yellowish with mild sediment.

Conclusion
Early detection and management of PUBS may save life of patients. Family, nursing home workers and
healthcare providers should be able to detect and provide necessary actions to patients with purple urine
bag syndrome, thus primary healthcare providers should provide standard guidelines to treat this unique
phenomenon in order to minimize morbidity and mortality outcomes in PUBS patients. Preventions such
as changing of urinary catheter and bags on a regular basis may help to prevent the discolouration of
urine. Hence, more attention should be given especially to patients who need special care and are
immunocompromised.

Keywords: Purple urine bag syndrome, URTI

VIEW POSTER >

 Abstract Title Oral Health Education In The Prevention Of PMD 5
Early Childhood Caries: A Systematic Review
And Meta-Analysis
Author and Dr. Noorul Nadiah Bt Noor Zamry1,, Assoc. Prof.
Co-Researchers Dr. Norkhafizah Saddki2,,Dr. Zuliani Mahmood2,
Dr. Nur Aishah Che Roos3

1
Oral Health Division, Melaka State
2
School of Dental Sciences, Universiti Sains Ma-
laysia, Kelantan
3
Faculty of Medicine and Defence Health, Uni-
versiti Pertahanan Nasional Malaysia,
Kuala Lumpur

NMRR ID NMRR 20-2952-52649

Introduction
This review systematically summarized the evidence and quantified on the effects of oral health
education (OHE) among pregnant women and/or caregivers of children less than 48 months in reducing
risk and severity of early childhood caries (ECC).
Methodology
A systematic electronic search of four databases using validated search strings along with manual
searches were performed to find eligible studies. Studies considered eligible if interventions include OHE
only on pregnant women and/or caregivers of children under 48 months of age, caries is measured in
children under 72 months of age, and involved randomized controlled trials. Further, only studies
published in English within 2011-2021 were included.
Two review authors independently assessed trial eligibility and extracted data with Covidence software
and evaluate the risk of bias adhering using the Cochrane Risk of Bias tool. Meta-analysis done to
quantify the pooled effect estimate using the RevMan 5.4 software. The quality of the evidence was
graded by three reviewers using Grading of Recommendations, Assessment, Development and
Evaluations (GRADE) approach.

Result
There were 3425 studies retrieved from both electronic and manual searches which then resulted with
three eligible studies. Meta-analysis resulted with lower mean dmfs score of young children whose
parents received OHE only compared to the control group (MD: -1.13, 95%CI: -1.73, -0.53, 3 studies;
762 participants). The evidence was downgraded due to the risk of attrition bias hence had moderate-
certainty.

Conclusion
Provision of OHE alone to the caregivers is effective in reducing the severity of caries at the surface
level among young children. As communication evolves, the way OHE is communicated could be
geared toward interactivity between the source (educator) and the receiver (caregiver). Interactive
communication could provide better engagement and participation of people which in turn lead to the
better health outcome.

Keyword: oral health education, early childhood caries, systematic

review VIEW POSTER >
 Abstract Title Collagenoma – A skin Manifestation of PMD 6
Multiple Endocrine Neoplasia Type 1
Author and Noor Huda Binti Abd Hamid, Hospital Melaka
Co-Researchers
NMRR ID RSCH ID-23-01827-GKQ

Introduction
Multiple endocrine neoplasia type 1 (MEN1) is a hereditary condition associated with tumors of the
endocrine (hormone producing) glands. The most common tumors seen in MEN1 involve the parathyroid
gland, islet cells of the pancreas, and pituitary gland. Non-endocrine tumors are also seen in MEN1 such
as facial angiofibroma, collagenoma, lipoma, leiomyoma, meningioma and ependydoma.

These tumors can also cause problems by producing high amounts of hormones leading to a wide
variety of symptoms. These include increased production of prolactin, growth hormone,
adrenocorticotropic hormone, gastrin, glucagon, vasoactive intestinal peptide, parathyroid hormone. We
present a case of clinical MEN1 with unusual dermatology symptoms.

Result
A 35 year woman with underlying repaired patent ductus arteriosus and hepatitis B carrier was referred
for asymptomatic hypercalcaemia which is corrected Ca of 2.63 mmol/L (2.12-2.52mmol/L) Her calcium
level was screened following her mother’s diagnosis of MEN1. She was also noted to have brown,
painless nodules over her arms and thighs and was referred to dermatology. Skin biopsy confirmed the
lesion to be collagenoma. An elevated parathyroid hormone of 30.40 pmol/l confirmed diagnosis of
primary hyperparathyroidism. Ultrasound neck showed two hypoechoic lesions at inferior posterior to the
right thyroid gland (1.3 x0.4x 2.1 cm, 0.8 x0.3 x 0.9 cm) and another hypoechoic lesions at inferior to left
thyroid gland, 0.6 x 0.7 x 1.4 cm). Imaging with sestamibi scan localized her lesion at the inferior pole of
left thyroid lobe.Focused left inferior parathyroidectomy was performed. HPE showed benign features in
favor of parathyroid adenoma.Computed tomography scan of pancreas showed 3 pancreatic nodules
which is being work up.

Conclusion
High clinical suspicion for MEN1 should lead to endocrinology evaluation with appropriate laboratory
workup and targeted imaging evaluation of the typical endocrine organs especially in patient with family
history of MEN 1 illness. Collagenoma is one of the many dermatological presentation of MEN1.

Keywords: Multiple endocrine neoplasia type 1, Non-endocrine tumors

VIEW POSTER >

 PMD 7
Abstract Title An Explosion of Endocrinopathies-a complex
case of MEN 1
Author and Noor Hafizah Binti Ab Hamid, Hospital Melaka
Co-Researchers
NMRR ID RSCH ID-23-01859-NNK

Introduction
To describe a lady with multiple concurrent endocrinopathies associated with MEN 1.
Methodology
Patient’s records were reviewed for her clinical findings, laboratory investigations and clinical course.
Result
A 62 years old lady with history of transsphenoidal surgery in her 20’s for prolactinoma presented with
headache, dizziness and vertigo. She has no bitemporal hemianopia and any other visual disturbances.
MRI pituitary showed tiny focus lesion in the left lobe measures 3.0x5.8mm in size suggestive of residual
pituitary microadenoma. Her hormonal screening revealed high serum prolactin, high intact parathyroid
hormone and calcium level .In view of her elevated prolactin and MRI findings, other anterior pituitary
hormones were checked. She had high adrenocorticotropic hormone and insulin-like growth factor 1
levels. Both prolonged Oral Glucose tolerance test (OGTT) and overnight dexamethasone suppression
test were not suppressed, confirming growth hormone and cortisol excess. At this point, patient started
to experience symptoms of hypoglycemia. Prolonged 72 hour fasting showed inappropriately normal c
peptide and insulin level during hypoglycemia, confirming endogenous hyperinsulinemia hypoglycemia.
CT pancreatic protocol showed multiple insulinomas and bilateral adrenal nodules. FNAC from both left
adrenal and pancreatic tail lesion during endoscopic ultrasound showed NET (neuroendocrine tumor)
grade 1. Patient was started on T diazoxide 100mg ON for her hypoglycemia and T cabergoline 0.25mg
2x/week for prolactinoma and planned for PET scan while awaiting her decision regarding surgery for
removal of tumor. Meanwhile, patient’s niece residing in another country had a genetic testing confirming
diagnosis of MEN 1.

Conclusion

This case illustrates the complex presentation and management of a patient with MEN1, who after
defaulting for 30 years presented with concurrent multiple endocrinopathies. Careful follow up of all
patients with MEN is crucial to avoid such presentation.

Keywords: endocrinopathies, Multiple endocrine neoplasia type 1

VIEW POSTER >

 PMD 8

Abstract Title The prozone phenomenon with syphilis and

HIV-1 co-infection

Author and Puspadevi A1, Amelia Lim lay Suan1, Prof.

Co-Researchers Madya Dr. Wan Haslina Wan Abdul Halim 1

1
Hospital Selayang, Hospital Universiti Kebang-
saan Malaysia
NMRR ID RSCH ID-23-01978-ZJ0

Introduction
Syphilis is often known as a great mimicker in uveitic conditions due to its wide spectrum of clinical
manifestations. Diagnosing ocular syphilis could be difficult and challenging at times. Clinicians mainly
depend on laboratory investigations to diagnose syphilis; however, the sensitivity and specificity of these
tests can be varied in different stages of syphilis.

Methodology
We describe a case of ocular syphilis with HIV-1 co-infection who presented to us with a bilateral
blurring of vision and floaters in the eyes. A 40-year-old man presented to us with visual acuity of the
right eye was 6/36 with a pinhole 6/18, while the left eye was 6/36 with a pinhole 6/36. He is an ex-
intravenous drug user with positive retroviral status currently taking highly active antiretroviral therapy
(HAART). On examination noted patient has intermediate uveitis with hyperreflective lesions at the
macula in an optical coherence tomography scan (OCT). The initial serum non-treponemal assays were
negative.

Result
Nevertheless, based on clinical suspicion of ocular syphilis, diluted samples of non-treponemal assays
were requested which were later on found to be positive with high titer. A confirmatory test of syphilis,
treponemal pallidum Hema-agglutination (TPHA) proceeded and turned out to be positive. The patient
was treated with intravenous G-penicillin for 14 days. He responded well with significant visual recovery.

Conclusion
In a case of high clinical suspicion of ocular syphilis, prozone phenomenon should be considered before
ruling out syphilis.

Keywords: syphilis, ocular syphilis

VIEW POSTER >

 Abstract Title Improvising Selection Criteria for PMD 9
Healthcare Leadership Training under
Talent Grooming Programme (TGP)

Author and Pangie Anak Bakit1, Norehan Jinah1, Lee Kun

Co-Researchers Yun1

1
Institute for Health Management, National In-
stitutes of Health, Ministry of Health Malaysia
NMRR ID NMRR-19-668-47660

Introduction
Selecting suitable candidates for Talent Grooming Programme (TGP) among MOH technical healthcare
professionals with different job schemes and positions can be challenging. In view of the limited training
spots, appropriate candidates should be recruited to ensure optimum training outcomes. This study
aimed to evaluate existing TGP selection criteria based on TGP completion rate and talents’ feedback to
enhance the selection process.

Methodology
This mixed method study was conducted in 2020, seven years after TGP establishment. Secondary data
analysis of TGP talents from cohort 1 to 7 was performed to determine the completion rate, followed by
focus group discussions (FGD) and in-depth interviews (IDI) with 57 talents and supervisors until data
saturation was achieved. All interviews were audio-recorded and transcribed verbatim. NVivo 12
software was used for data analysis.

Result
Out of the 104 talents, the majority were 35-45 years (57.7%, n=60) and predominantly females (60.6%,
n=63). 77.9% (n=81) successfully completed the programme, but only half (55.6%, n=45) managed to
do so within three years. Based on the qualitative findings, years of experience, duration of services in
MOH, and experience in leadership positions were quoted as positive influences on talents’ acceptance
of the knowledge and skills during TGP training. Senior talents reported having more familiarity with the
leadership domains than junior talents without experience in leadership positions.

Conclusion
Based on the evaluation, important factors influencing the training acceptability and programme
completion of TGP were taken into consideration under the new selection process. An Application
Ranking System (ARS) was developed by incorporating applicant’s age, length of service, and
leadership experience and other criteria to ensure a compatible match between the talents and the TGP
outcomes. ARS was officially implemented for the selection of TGP Cohort 13 talents in January
2023. (289 Words)

Keyword: talent grooming programme, selection criteria, leadership experience

VIEW POSTER >

 Abstract Title What Triggers the Strike by Hartal Doktor PMD
Kontrak? A Qualitative Content Analysis
from the Perspective of Medical 10
Author and Norehan Jinah1, Pangie Bakit1, Lee Kun Yun1,
Co-Researchers Norhaniza Zakaria1, Nursyahda Zakaria1,
Shazwani Mahmod1, Munirah Ismail2

1
Institute for Health Management, National In-
stitutes of Health, Ministry of Health Malaysia
2
Clinical Research Centre, Hospital Sultan Is-
mail, Ministry of Health Malaysia

NMRR ID NMRR ID-22-00850-MTS

Introduction
On 26th July 2021, contract doctors went on a nationwide strike known as Hartal Doktor Kontrak (HDK)
to voice their dissatisfaction with the contract appointment policy. It created widespread interest among
the general public due to extensive media coverage, especially among the medical fraternity. We sought
to explore the precipitating factors of the contract doctors' strike from the perspective of medical
fraternity members.

Methodology
A qualitative content analysis was conducted using Facebook posts related to the HDK strike between
1st June 2021 and 28th February 2022. 160 posts were extracted from the Facebook pages of four
medical fraternity groups and seven medical key opinion personnels. Inductive coding was applied to
identify the pertinent themes in NVivo 12.
Result
Three themes emerged regarding triggering factors of the strike as perceived by the medical fraternity: i.
unequal treatment perceived by contract officers, ii. frustration with the lack of long-term solutions, and
iii. aggravation by the COVID-19 pandemic. Many parties expressed disappointment about the
differential treatment given to contract doctors, especially compared to their predecessors who received
various perks associated with permanent positions. This policy was interpreted unfavourably by the
medical fraternity as there is little guarantee of career stability and advancement for contract doctors.
Their frustration worsened after numerous discussions with stakeholders leading to only short-term
solutions. As the COVID-19 waves grew, drastic changes in workload and staffing became the last straw
that triggered the strike.

Conclusion
Our findings aligned with the literature in which healthcare worker strikes are frequently caused by
dissatisfaction with salary and workload. Even though these medical fraternity members are not directly
affected by the contract appointment policy, they were understanding and supportive of the HDK.
Further analysis is recommended to determine if the support from the medical fraternity was helpful for
the cause of HDK.

Keyword: contract doctor, hartal, HDK, strike

VIEW POSTER >

 Abstract Title Primary cutaneous anaplastic large cell PMD
lymphoma: a case report in Hospital Melaka
11
Author and Shaliza Nawawi1, Adv MDerm (UKM)
Co-Researchers
1
Department of Dermatology, Hospital Melaka,
Melaka, Malaysia

NMRR ID RSCH ID – 23 – 02446 – CMF

Introduction
Cutaneous anaplastic large cell lymphoma (C-ALCL ) is part of the malignant end of CD30+ Cutaneous
T-cell lymphoma (CTCL) spectrum. Clinically, patient with C-ALCL can present with solitary or multifocal
localized nodules or tumour that ulcerated. Some C-ALCL, which is up to 40% can spontaneously
regress without any treatment and extensive lymph node involvement is rare (2).

Methodology
Here we illustrated a case of a 64 year old male presented with 6 months history of lesion over face and
bilateral thigh which were gradually increasing in size. No other significant associated symptom. On
clinical examination, there were multiple diffuse, ulcerated plaques over the philtrum, chin and bilateral
thigh.

Result
Skin biopsy at both area showed hallmark atypical lymphoid-type cells which appeared round-to oval
with irregular nuclei (horseshoe-shaped). Immunohistochemistry stains were positive for CD30 more
than 75%. Diagnosis of Primary C-ALCL was made after details CT scan showed no other organ
involvements.

Conclusion
He was started on chemotherapy regime and up until now showed good improvement.

Keyword: cutaneous anaplastic large cell lymphoma, CD30+, ulcerated plaque

VIEW POSTER >

 PMD
Abstract Title Case Report: Delicacy That Costs a Life
12
Author and Laila Syakirah binti ‘Ezuddin1, Nur Syafiqah binti
Co-Researchers Ab Samat, Aini Safira binti Che Abdul Rahim,
Ngazraini Abdul Maei, Nurul Erida binti Ismail

Anaesthesiology Department, Hospital Enche’

Besar Hajjah Khalsom, Kluang

NMRR ID

Introduction
Pufferfish, also known as fugu is an exotic Asian delicacy that can be lethal as it contains tetrodotoxin, a
potent neurotoxin which cause respiratory and cardiovascular failure in severe toxicity. We report a case
involving a couple with severe tetrodotoxin toxicity in Kluang.

Methodology
An 83-year-old man with hypertension, chronic kidney disease and bronchiectasis presented with
perioral and limbs numbness three hours after consumed pufferfish for lunch. He was intubated upon
presentation and admitted to the intensive care unit where he developed cardiac arrhythmia and acute
kidney injury which resolved throughout his stay. After ten days he was successfully extubated following
good muscle recovery and discharged to the ward. His wife who presented to the hospital with him
following similar ingestion unfortunately deteriorated rapidly and succumbed to the toxicity.

Result
Serum, blood and urine tetrodotoxin levels can be measured following pufferfish ingestion however such
assays were not available in our local settings. Samples of the remaining pufferfish were sent to a Food
Quality and Safety Laboratory revealed high levels of tetrodotoxin. As there are no specific antidotes for
tetrodotoxin, treatments were mainly supportive.

Conclusion
Symptoms of tetrodotoxin toxicity may manifest within 30 minutes after ingestion and mortality rate can
be as high as 30% however patients who survived for more than 24 hours are thought to have higher
chance of recovery. In our case report, we emphasize the high severity but potentially reversible nature
of tetrodotoxin poisoning, concluding that prompt diagnosis and early supportive management had been
crucial in improving our patient’s outcome.

Keyword: pufferfish, tetrodotoxin

VIEW POSTER >

 PMD
13
Abstract Title Does all LBBB is STEMI equivalent?
Author and Muhammad Zulhilmi Bin Ismail, Hospital Melaka
Co-Researchers
NMRR ID 20186

Introduction
ST elevation Myocardial Infarction (STEMI) is one of the common presentations to ED and remains the
highest cause of mortality in adult. The diagnosis of STEMI still remains challenging to ED personnel
especially with atypical type i.e., STEMI equivalent which means STEMI in? non-STE ECG. Failure to
diagnose STEMI can have deleterious impacts to patient.

Methodology
We presented a case of STEMI with left bundle branch block (LBBB) pattern type of ECG; with atypical
symptoms. Various criteria have been used to diagnose STEMI in LBBB that includes Sgarbossa,
Modified Sgarbossa and Barcelona; and we were able to identify specific signs/features of STEMI in
LBBB.

Result
This patient has been started on antiplatelets and anticoagulants, admitted to CCU and referred to
cardiac centre

Conclusion
We discussed on evidence based as well as pathway/algorithm to scrutinize STEMI in LBBB in
systematic way.

Keyword: ST elevation Myocardial Infarction, left bundle branch block

VIEW POSTER >

 Abstract Title Isolated ACTH Deficiency with Pituitary PMD
Incidentaloma Post Correction
14
Author and Noor Hafis Md Tob1, Chin Voon Tong1, Jen
Co-Researchers Hoong Oon1, Melissa Vergis1, Lee Siow Ping1

1
Medical department, Hospital Melaka

NMRR ID RSCRSCH ID-23-02053-YVQ

Introduction
Isolated adrenocorticotropic hormone (ACTH) deficiency is a rare condition characterized by secondary
adrenal insufficiency resulting from corticotroph loss. It is frequently associated with autoimmune
disorders, empty sellar syndrome, and hypophysitis. However, the coexistence of pituitary
microadenoma in isolated ACTH deficiency has not been previously reported.

Methodology
We present a detailed case of isolated ACTH deficiency, including the results of biochemical laboratory
tests and magnetic resonance imaging (MRI) study.

Result
A 39-year-old female was admitted for recurrent seizure episodes and loss of consciousness. She also
presented with symptoms of hypothyroidism. On presentation, her random blood glucose was low, and
her serum cortisol was less than 13.8 nmol/L, with serum ACTH < 1.11 pmol/L. Her thyroid function tests
showed a primary hypothyroid picture, with thyroid stimulating hormone (TSH) of 10.0 miu/L and free T4
10.18 pmol/L, despite negative thyroid autoantibodies. MRI of the pituitary gland revealed a left pituitary
microadenoma measuring 5.6 mm x 6.0 mm x 5.0 mm. Her symptoms markedly improved with steroid
and thyroxine replacement, without further episodes of hypoglycemia. On serial imaging, the size of the
pituitary microadenoma remained stable.

Conclusion
Isolated ACTH deficiency can present with neuroglycopenic symptoms, as observed in this case.
Although the majority of patients with pituitary microadenoma are asymptomatic, the presence of ACTH
deficiency mandates steroid replacement to prevent catastrophic adrenal crisis. In this case, the primary
hypothyroidism had negative autoantibodies, despite the common association with autoimmunity.

This is a case of isolated ACTH deficiency complicated by primary hypothyroidism and pituitary
incidentaloma. The findings suggests that, despite the possible heterogeneity of etiology, a direct local
effect of the lesion could be the cause of isolated ACTH deficiency. It also highlights the importance of
glucocorticoid therapy to prevent life-threatening crisis and normalization of thyroid status.

Keywords: Isolated adrenocorticotropic hormone, autoimmune disorders, empty sellar syndrome, and
hypophysitis

VIEW POSTER >

 PMD
Abstract Title House officer’s experience and perception of
medical posting: a retrospective single
15
centre study

Author and Dr Mohd Aizuddin1, Dr Chai Shuk Ching1,

Co-Researchers Dr Tong Chin Voon1

1
Medical Department, Hospital Melaka

NMRR ID RSCH ID-23-01825-XUR

Introduction
Medical posting is one of the core rotations during housemanship in Malaysia. It is the responsibility of
the department to provide optimum exposure for the housemen during the rotation. Our study aimed to
assess what is the perception and satisfaction level of the House Officers (HO) during their medical
rotation in General Hospital Malacca (GHM).

Methodology
All medical HOs rotated in Medical Department GHM from April 2018 to June 2022 were invited to
answer a questionnaire via “Google Form” when they completed their posting. This questionnaire
explored information on demographic parameters, HOs’ perceptions and level of satisfaction towards the
department. This was a retrospective, cross-sectional review of the results from the survey.

Result
236 HOs participated in this survey. Mean age was 26.3 years. About half of the respondents (54.7%)
were first and second posters. 2/3 graduated from local universities. There were more female (66.9%)
compared to male respondents. Of the HOs who participated in the survey, majority of them had good
impression and level of satisfaction during their medical rotation in GHM. Unconducive facilities,
problems with nursing/supporting staff and feeling of inadequate learning opportunities were among the
top causes of the dissatisfaction. Majority (94.9%) did not experience any physical or verbal abuse while
in the rotation. 87.1% felt that their welfare, overall was being well taken care of.

Conclusion
Ample efforts should be taken by all staffs to maintain the high standards and good perception towards
the department. However, the factors contributing to the dissatisfaction of the housemen should be
address promptly for effective working environment and improve the working atmosphere.

Keyword: Housemen, perception, satisfaction

VIEW POSTER >

 PMD
16
Abstract Title Level of Physical Activity and its Barriers
among Overweight and Obese Patients At-
tending 3 Primary care Clinics in Melaka

Author and Aziz AA, Daramaraju VP, Heetesh PS, Norsiah

Co-Researchers A
Health Clinic Batu Berendam, Melaka

NMRR ID NMRR-19-3657-52171

Introduction
The prevalence of obesity has significantly risen globally across all races ethnicity and social economic
status. Among the risk factors linked to obesity is physical inactivity. This study aims to assess physical
inactivity among obese and overweight patients attending 3 primary care health clinics in Melaka and the
barriers associated with it.

Methodology
A multi-centred cross-sectional descriptive quantitative study was conducted among 390 respondents
using interview based questionnaire which consists of social demographic data, Global Physical Activity
Questionnaire (GPAQ) and barriers to physical activity.

Result
Among the respondents, 65% were found to be sufficiently active and 35% were inactive with less than
600 MET minutes per day. Male and female respondents were almost equally active at 63.2% and 66%
respectively. The level of physical activity was found to be significantly declining with age (p 0.010, CI). It
was also found that people who were above poverty level to be more sufficiently active compared to
those below. Barriers studied was divided to internal and external with the commonest external barrier
being “no time"," no companion" and "causes pain". “Tired”, “lazy” and “active enough” were cited as the
top 3 internal barriers.

Conclusion
This study found that 65% of the obese and overweight patients at the 3 primary health care clinic was
sufficiently active. Age, ethnicity, religion and income were found to be significantly associated with
physical activity level. Despite being sufficiently active most respondents perceive to have barriers in
carrying out physical activities. Majority of the respondents appeared to have barriers in prioritizing the
need for and the benefit of physical activity.

Keyword: Physical activity, overweight, obesity, barriers

VIEW POSTER >

 Abstract Title The Perception of Primary Care PMD
Postgraduate Trainees on Assessment of
Erectile Dysfunction in Their Patients 17
Author and Rosnani S1, Ong AJ2, Jeyashella A3,
Co-Researchers Logeswari N4, Mages S5, Mohana K6, Na-
gammaiT7

1
Klinik Kesihatan Masjid Tanah,
2
Klinik Desa Sri Hartamas,
3
Klinik Kesihatan Taman Selasih, Kedah,
4
Klinik Kesihatan Kulim, Kedah
5
Klinik Kesihatan Merbau Pulas, Kedah
6
Clinic Medi Genesis, Kedah,
7
Klinik Kesihatan Kuala Lumpur

NMRR ID NMRR-18-1614-42333

Introduction
Erectile dysfunction (ED) is becoming more common globally. In primary care setting in Malaysia, the
estimated prevalence of ED was 64.5%. This study aimed to evaluate postgraduate primary care
trainees on their perception towards initiating inquiry into erectile dysfunction (ED) among patients
presenting to primary care clinics.
Methodology
This is a cross-sectional study conducted among postgraduate trainees in family medicine using specific
questionnaire from January to March 2019 during a teaching workshop in Kuala Lumpur.
Result
A total of 350 doctors took part in the study. The leading barriers in men’s health assessment were time
constraint 262 (74.9%), interruptions during consultations 238 (68.0%), lack of clinic staff 235 (67.1%),
frustration in sharing room 205 (58.6%), longer waiting hours 170 (48.6%), and unable to cope with clinic
load 160 (45.7%). The majority of the respondents 238 (68.0%) perceived that men were embarrassed if
enquire on ED. Generally, the respondents were comfortable 178 (50.9%) and were rather confident 148
(42.3%) talking about sexual health. In general, respondents thought that men will feel offended if sexual
issues were discussed during clinical encounter for acute minor complaints 200 (57.1%), however not
offended during follow up visit 167(47.7%) or wellness check-up 199(56.8%).
Conclusion
The perception of primary care doctors towards initiating inquiry into erectile dysfunction (ED) among
patients presenting to primary care clinics may not be truly reflective of their patients’ actual
thoughts. There is a need for training on skills to enhance sexual health communication among primary
care doctors. Time constraints tend to inhibit doctors’ enquiry on ED. Good quality of care to patients
can be better assured if the doctor are given adequate time to screen patients.
Keyword: ED, barriers and perception.

VIEW POSTER >

 PMD
Abstract Title A Case of Thyroid Storm In Asthmatic Patient
With Atrial Fibrillation In Rapid Ventricular
18
Response: Challenges In Diagnosis And
Pharmacological Treatment

Author and Muhammad Huzaifah bin Hassan1, Norhuwaina

Co-Researchers binti Isnazli1, Mohd Hilmi Che Aun1, Mohammad
Fadhly Yahya1

1
Emergency and Trauma Department, Hospital
Melaka
NMRR ID

Introduction
Thyroid storm is a life-threatening endocrine emergency of hyperthyroidism state. Establishment of
diagnosis of previously undiagnosed hyperthyroidism is more difficult as there is no objective laboratory
confirmation test. Current scoring system like Burch-Wartovsky score (BWTS) and Japanese Thyroid
Association (JTA) score is merely almost clinical scoring except JTA pre-requisitely need thyroid
hormone level (TFT).

Methodology
A 50-year-old female with past medical history of bronchial asthma on MDI Salbutamol 2 puff PRN
presented to the emergency department with chief complains of fever, cough, and shortness of breath
for one day that is not resolved by inhaler. Vital signs: temperature 37.4oc, heart rate 90 bpm, respiratory
rate 22 breaths per minute with 98% saturation on room air. Lung auscultation reveals occasional
rhonchi with prolonged expiratory phase. She was then triaged to green zone and given nebulizer
salbutamol. Patient complains of palpitation post nebulization with pulse rate of 200 bpm to 230 bpm on
vital signs monitor. She was then uptriage to Respi Red Zone. ECG stat showed Atrial Fibrillation (AF)
with rapid ventricular response in aberrancy; most likely secondary to beta 2-agonist. She was given
hydration and put under close observation; however, there is no improvement. Physical examination
reveals that patient is having neck mass, which is oblivious to patient before.

Result
New diagnosis of hyperthyroidism in impending thyroid storm ruled out by Burch Wartofsky Scoring
(BWS) is made. Urgent thyroid function test (TFT) was taken. Patient was started anti-thyroid (Oral
Carbimazole 40mg), parenteral steroids and intravenous loading dose of digoxin 0.5mg together with IV
magnesium sulfate for the Afib with rapid ventricular response. Lugol’s iodine given 1 hour after
carbimazole. Despite improvement in clinical signs and symptoms; she’s still having tachyarrhythmias of
heart rate between 160 to 180bpm. It was resolved after the administration of IV verapamil 2.5mg. she
was admitted to ward and treated as thyroid storm and discharged after several days with Endocrine
Clinic follow up.

Conclusion
Thyroid storm is one of endocrine emergency that may result in fatality. Despite multiple guidelines,
clinician should have a good critical thinking in selection of drugs to suppress thyrotoxicosis especially
when it comes with other medical condition.

Keyword: Thyroid storm, thyrotoxicosis, atrial fibrillation, exacerbation of asthma

VIEW POSTER >

 PS1

Abstract Title Impact of sleep quality associated with

stress among medical students in Manipal
University College Malaysia (MUCM)

Author and Rusdiah Ruzanna Jusoh 1,Angela Low

Co-Researchers Hui Qi1, Tejaswini A/P Jeya Sankar1, Navvinna
Anne A/P Kathirasan1

1
Faculty of Medicine, Manipal University College
Malaysia.
NMRR ID RSCH ID-23-02078-MP2

Introduction
During sleep, the mind and body finally receive well-deserved rest. Medical students are constantly
compromising on their sleep to fit in their growing workload, course requirements, social obligations, and
use of technology for communication and entertainment. They may also experience stressful
circumstances like social obligations, demanding academic curriculum, language obstacles, and
parental expectations. Aim: To determine the association between sleep quality and stress among
medical students in MUCM.

Methodology
A cross-sectional study was conducted among 215 medical students in MUCM. The questionnaire
consists of 3 sections, section A is about the demographic, section B is about sleep quality, and section
C assesses the stress scale. Data were analysed using Microsoft Excel and SPSS version 28.

Result
The prevalence of sleep quality is found that 36.3% of students get good sleep, 45.6% of students get
average sleep quality and 18.1% of students get poor sleep. During the weekdays around 145 students
(67.4%) sleep 5 to 8 hours, 69 (32.1%) students sleep less than 5 hours and only 1 student (0.5%)
reported that he/she sleeps for 9 to 11 hours. The most common factors affecting sleep quality are
stress (54.9%) and waking up without a reason (40.9%). The most common activity done by students
before going to sleep is checking social media (82.8%) and the least common activity is drinking alcohol
or smoking (0.9%). The majority of the students (96.3%) never take the sleeping pill to fall asleep, 6
students (2.8%) rarely take it and only 2 students sometimes take sleeping pills. The majority of students
have moderate stress levels and the factor with the highest score is academic/coursework demands and
procrastination. Whereas, the factor that has the lowest score is language/culture.
Conclusion
There was a statistically significant association between sleep quality and stress (p&lt;0.005). A
suggestion for medical college management is to establish academic counselling centres to help
students improve their study skills and cope with their stressful environment.

Keyword: Sleep, stress, medical students, sleep hour, academic

VIEW POSTER >

 Abstract Title In vitro evaluation of alpha-amylase and alpha- PS2
glucosidase inhibitory potential and antioxidant
activity of anthraquinone derivatives
Author and Bryan Chee Ee Pinn1, Harshini Velayudaraja1,
Co-Researchers Ahmed Darwish Samal1, Sabrina Teo Muham-
mad Teo1,Chee Chin Fei2, Theebaa Anasamy1

1
Faculty of Medicine, Manipal University
College Malaysia
2
Nanotechnology Catalysis Research
Centre, University of Malaya

NMRR ID RSCH ID-23-02070-587

Introduction
Oxidative stress which involves the production of reactive oxygen species had been linked to the
development of type 2 diabetes mellitus (T2DM), while inhibition of α-amylase and α-glucosidase
enzymes suppress carbohydrate digestion, delay glucose uptake and consequently, reduce blood sugar
levels. The bioactivity multiplicities of anthraquinones are dependent on their chemical structures, be it
the number of anthraquinone rings or the substituents. Taking this into consideration, five
anthraquinones namely 1-(methylamino) anthraquinone (1), 1,5-dichloroanthraquinone (2), 1-
chloroanthraquinone (3), 2-chloroanthraquinone (4), 1,8-dichloroanthraquinone (5) were tested for their
antioxidant and antidiabetic activities to discover compounds that could be clinically useful in the
treatment of T2DM.
Methodology
The antioxidant activity of anthraquinones was determined using the 2,2-diphenyl-1-picrylhydrazyl
(DPPH) assay. Antidiabetic activities were assessed by α-amylase and α-glucosidase enzyme inhibition
assays. Statistical analysis was done using One-Way ANOVA with Tukey’s post hoc test.
Result
Among the anthraquinones tested, compound 1 exhibited the strongest antioxidant activity (IC50: 31.8 ±
4.3 μM). The antioxidant activity of the compounds decreases in the following order: Ascorbic acid > 1 >
2 > 4 > 5 > 3. Compound 1 also exhibited the most potent and statistically significant (p<0.05) inhibition
against α-amylase (% relative inhibition: 25 ± 2.4%) and α-glucosidase enzyme (% relative inhibition: 32
± 4.3%), compared to vehicle control.
Conclusion
The potent antioxidant activity of compound 1 is most likely due to the substitution of the amino (–NH2)
group. This substitution contributes to an excellent electron-donating ability that helps in neutralizing the
free radicals. Furthermore, compound 1 exhibited potent inhibitory towards both α-amylase and α-
glucosidase enzymes. These findings may perhaps provide valuable guidance to further optimize and
evaluate new structures of anthraquinone for the treatment of T2DM.

Keyword: anthraquinones, ROS, α-amylase, α-glucosidase, T2DM

VIEW POSTER >

 Abstract Title Correlation between health beliefs, and lifestyle PS3
among medical students in Malaysia: A
cross-sectional study

Author and Bhargavi a/p Visualingam1, Chong Guang Wen1,

Co-Researchers Tharani R Mohan1, Abhiraami Sathasivam1,
Hansika Gamage1, Htoo Htoo Kyaw Soe1, Soe
Moe1, Khatijah Taharah Mohamed Shah1, Mila
Nu Nu Htay1.

1
Manipal University College Malaysia

NMRR ID RSCH ID-23-02088-KOA

Introduction
Physical activity, dietary pattern, stress and screen time are intertwined in achieving a healthy lifestyle.
Therefore, this study aimed to investigate the health beliefs, lifestyle, and dietary habits among medical
students.

Methodology
This cross-sectional study was conducted by recruiting medical students from a private medical
university with purposive sampling. Demographic characteristics, health belief model and lifestyle
information were collected by using Google form. Data was analyzed by descriptive statistics, unpaired t-
test, one-way ANOVA by using Epi info software (Version 7).

Result
A total of 160 students responded to this study. Age of the respondents was significantly associated with
nutritional confidence (P=0.033) and barrier (P=0.032) domains of health belief. While gender was
significantly associated with barriers (P=0.041) and behavioral intention to do physical activity (P=0.018).
Academic year was found to be associated with susceptibility domain (P=0.013) of health belief. Gender
was significantly associated with the physical health and exercise (P<0.001) and psychological health
(P=0.012) domains. Age was significantly associated with accident prevention domain (P=0.013). While
BMI was significantly associated with physical health and exercises (P=0.001). Academic year was
significantly associated with social concern (P=0.028) and sense of purpose (P=0.009) domains. Health
beliefs among respondents were correlated with the nutritional and physical activity in their daily lifestyle.
Especially having nutritional confidence, knowing the benefits of a healthy diet, behavioral intention to
eat healthy food and to do physical activity were significantly correlated with the respondent’s nutrition
intake and physical activities.

Conclusion
Educational interventions and activities such as talks related to adopting healthy lifestyles could help
medical students in attaining better lifestyle habits.

Keyword: Health Belief Model, Lifestyle, Medical Student, Malaysia, Nutrition.

VIEW POSTER >

 Construct validity and Reliability of Malay version
Rosenberg Self Esteem Scale (RSES) among secondary
school students: A confirmatory factor analysis
Lim KH1, Cheong YL1, Lim HL2, Kee CC3, Mohd Hazilas MH1, Ali Aman M1, Cheah YK4, Lim JH5, Sumarni MG1
1Institutefor Medical Research, Ministry of Health Malaysia, Jalan Pahang, 50588, Kuala Lumpur, Malaysia.
2HospitalSultan Ismail, Ministry of Health Malaysia, Taman Mount Austin, 81100, Johor, Malaysia.
3Department of Biostatistics and Data Repository, National Institutes of Health, Shah Alam, Malaysia.
4School of Economics, Finance and Banking, Universiti Utara Malaysia, Sintok, Malaysia.
5Pharmacy Department, Hospital Putrajaya, Putrajaya, Malaysia.
NMRR-12-1210-12399

INTRODUCTION Response rate was 96.9%

INTRODUCTION
The Rosenberg Self-Esteem Scale (RSES) is
45.2% 54.8% Urban Rural
widely used to measure self-esteem among
adults and youth1. There is one item in RSES 40.2% 59.8%
that is often confused, namely "I wish I could
respect myself more.“, negative in its original
instrument, is found positive in its translation
into other languages. Others
Malay Chinese Indian
OBJECTIVE RESULTS 80.2% 11.6% 7.9% 0.3%
Fig. 1 Social-demographic characteristic of respondents
To determine the construct
validity and reliability of the
RSES-M among Malaysian
youth using the Confirmatory
Factor Analysis.

METHODOLOGY
Malay Language Rosenberg
Self-Esteem Scale (RSES)
to 378 Form Four students
in Kota Tinggi District,
multistage sampling was
administered.

3 models of the RSES-: one

Fig. 1 Unidimensional model of RSES-M Fig. 2 Two domains of RSES-M according to
uni-dimensional model and
Rizwan 20172
two different two-domain
models.

CFA model fit

- Relative Chi-square < 5
- Comparative Fit Index (CFI
≥0.090)
- RMSEA≤ 0.080
- Incremental Fit Index
(IFI≥0.090≤)

RESULTS
The findings indicate that the
best model of the RSES-M
was a two-domain model (Fig.
3), wherein domain one
represented positive self-
esteem.
Fig. 3 Two domains of RSES-M according to Gnambs et al. 20183
DISCUSSION

Our investigation demonstrated that the RSES-10 M's items had good validity and supported the
model's two-domain structure.

This study advances knowledge of the RSES's applicability in various sociocultural contexts.

The reliability of the first factor/positive self-esteem (0.77) and the second factor (0.629) as
demonstrated from the present study were slightly lower than described by Rosenberg (1965)1

REFERENCES PA2
1. Rosenberg M. Society and the adolescent self-image. Princeton University Pres; 1965.
2. Rizwan M, Malik S, Malik NJ, Siddiqui RS. Urdu rosenberg self-esteem scale: an analysis of reliability and validity in Pakistan. Sociol Int J.
2017;1(2):00010. doi:10.15406/sij.2017.01.00010
3. Gnambs T, Scharl A, Schroeders U. The structure of the rosenberg self-esteem scale: a cross-cultural meta-analysis. Z. für Psychol. 2018;226: 14-
29. doi: 10.1027/2151-2604/a000317

We would like to thank the Director General of Health Malaysia and the director, Institute for Medical Research (IMR) for their permission to present this research
PA3
PA4
 STUDY ON THE ASSOCIATION BETWEEN PHOSPHATE BINDERS PILL BURDEN,
MEDICATION ADHERENCE AND BONE DISEASE MARKERS AMONG
HEMODIALYSIS PATIENTS IN HOSPITAL JASIN
Ng Shy Pyng, Fadzilah Shafie, Nur Izzati Ahmad, Aina Fatini Ahmad Fisal
Department of Pharmacy, Hospital Jasin, Melaka NNMR-19-2984-50468

Introduction Result Results DiscussionDiscussion

• Phosphate binder (PB) medication adherence is required to maintain optimal • Total patient recruited was 44. • Only half of HD patient adhere to PB medications. Thus,
phosphate level and minimize bone disease in end stage renal disease (ESRD). • Descriptive of sample: healthcare professional should also pay attention to this group.
• Usage of daily PB medications accounted almost half of the daily pill among ESRD
➢ Male 65.9% and female 34.1%. • Older age showed more adherence to medications as that they
patient. However adherence to PB medications is questionable.
• The prevalence of nonadherence to PB medications is numerous between 22- ➢ Age range 19-80 years (mean= 55.34, SD =16.75). had more social support compared to younger age. 2
74%.1 ➢ Dialysis Vintage, range 1-25 years (mean= 5.41, SD= 5.52). • PB pill burden is not the only factors affecting adherence. Other
• ➢ Total number of daily pills range 4-33 (mean =16.45, factors should be considered including fear of drug interaction,
Objective
SD = 6.40). pill size and doubt of real efficacy of the drug. 3
1. To assess the prevalence of adherence to PB medications among dialysis patients
• Prevalence of adherence is 50%. • High pill burden demonstrated no relationship with mineral bone
and the contributing factors.
• Statistical Analysis: disease markers. Previous study showed that phosphate level
2. To examine correlation of PB pill burden and adherence.
Table 1: Factor contributing to adherence are also affected by a patient's dietary intake. 4
3. To examine correlation of PB and mineral bone disease markers.
Variables Pearson P-value Limitation
Methodology Correlation
• Study was conducted using small sample size in a single
Study Design Age -0.193 0.046
facility, thus result may not be generalized to other facilities.
• Cross sectional involved face-to-face interview and medication abstracting record. Dialysis Vintage 0.099 0.524 • Adherence is affected by individual living habits and social life
• A specific questionnaire developed to obtain demographic and adherence. Pill Burden -0.247 0.106 which is not accounted for in this study.
• • 18
Adherence assessed years
using old andto above
Adherence Refills and Medication Scale (ARMS)
Serum Phosphate 0.095 0.541
• ARMS questionnaires was never validated in HD patients
• treatment1: in
Follow-up Subscale
ARMS contains 2• subscales; Medication behavior, Subscale 2: specifically.
Serum Calcium 0.112 0.476
Medication Refills. HDU HJ References
Serum PTH 0.163 0.291
• Maximum ARMS score is 36. Score < 16 = nonadherence, >16 = adherence. 1. De Brito Ashurst, I., & Dobbie, H. (2003). A randomized controlled trial of an educational
Table 2: Association between PB pill burden and adherence intervention to improve phosphate levels in hemodialysis patients. Journal of renal
Study Population nutrition, 13(4), 267-274.
• All hemodialysis (HD) patients in Hemodialysis Unit (HDU) HJ. Variables Pearson P-value 2. Smilowitz, S., Aftab, A., Aebi, M., Levin, J., Tatsuoka, C., & Sajatovic, M. (2020). Age-
Correlation related differences in medication adherence, symptoms, and stigma in poorly adherent
• Inclusion criteria: Adult patients aged 18 years old and above. adults with bipolar disorder. Journal of geriatric psychiatry and neurology, 33(5), 250-255.
PB Pill Burden 0.046 0.765 3. Burnier, M., Pruijm, M., Wuerzner, G., & Santschi, V. (2015). Drug adherence in chronic
• Exclusion criteria: acute renal failure, pregnant women, transferred out to another kidney diseases and dialysis. Nephrology, dialysis, transplantation : official publication of
facility, peritoneal dialysis. Table 3: Correlation of PB and mineral bone disease markers the European Dialysis and Transplant Association - European Renal Association, 30(1),
39–44.
Variables Pearson P-Value 4. Chiu, Y. W., Teitelbaum, I., Misra, M., de Leon, E. M., Adzize, T., & Mehrotra, R. (2009).
Sample Size Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis
Correlation
• Minimum 40 respondents (95% confidence level and + 5% margin). patients. Clinical Journal of the American Society of Nephrology, 4(6), 1089-1096.
Serum Calcium -0.30 0.846
Statistical Analysis References
Serum Phosphate 0.096 0.537
Acknowledgement
The authors wish to thank Puan Noorazlinda binti Yacob, head of Pharmacy Department of
• SPSS version 26.0 Serum PTH 0.239 0.118 Hospital Melaka for helping us with analyzing the data using SPSS as well as valuable input
• Pearson correlation to measure the correlation of variables. in completing this research.

PA5
PA6
PA7
PA9
 Aid for Decision Making in Occupation Choice (ADOC) as a
Tool to Address Activities and Participation: A Scoping Review
Mohd Azam Abdul Halim, Ahmad Zamir Che Daud , Kounosuke Tomori & Ahmad Rashdeen
Fazwi Muhammad Nawawi
Occupational Therapy Programme, Institut Latihan Kementerian Kesihatan Malaysia
(ILKKM) Sungai Buloh, Selangor, Malaysia, Centre for Occupational Therapy Studies, Faculty
of Health Sciences Universiti Teknokogi Mara (UiTM) Puncak Alam Campus, Puncak Alam,
Selangor, Malaysia, Department of Occupational Therapy, Schools of Health Sciences, Tokyo NMRR ID-19-
University of Technology, 1404-1 Katakuramachi, Hachioji City, Tokyo 192-0982, Japan, 2870-50611
Hand & Microsurgery, Orthopedic & Traumatology Department Hospital Selayang, Selayang (IIR)
- Kepong HwyBatu Caves, Selangor, Malaysia

INTRODUCTION:
Aid for Decision-Making in Occupation Choice (ADOC) was designed to promote shared decision-making and
collaborative goal in daily living activities.
OBJECTIVES:
This scoping review aimed to review and synthesise research literature regarding ADOC and to identify any existing
knowledge gap related to ADOC.
METHODOLOGY:

The PRISMA-Scoping review was used as a guide. A literature search was retrieved from the January 2011 until
December 2021 based on four databases; Scopus, Google Scholar, PubMed and CINAHL. Inclusion criteria as
stated: 1) Peer-reviewed articles or papers that have been published from January 2011 to December
2021,
2) Focusing on ADOC
3) Discussing decision making in meaningful occupations.
RESULTS:

A total of 235 suitable articles were found through a comprehensive search of the electronic databases. Only nine
articles (n=9) were included in this study after duplicates were removed and screening were done according to the
inclusion and exclusion criteria

The findings were arranged in five themes; i)clinical purpose, ii) validity and reliability, iii) target population, iv)
practicality of ADOC and v) ADOC with the ICF.
DISCUSSIONS & CONCLUSIONS:
• Interestingly, ADOC can be used in different conditions and settings and is also applicable in paper printed
versions
• ADOC provides a client-centred and collaborative approach, highlighting meaningful daily occupation and the
use of current technology in rehabilitation.
• The strength and advantage of ADOC when compared to other client-centred methods such as COPM
because the illustrations and pictures are related to activities and participation, which are accessible, useful
and available on iPads (Ohno et al., 2017)
• Future studies should expand the search in more databases and warrant a systematic review provided
more studies are required to be done on ADOC. Knowledge gap have been recognized to explore more
on ADOC tool especially into the native language by conducted translation and validation studies.
ACKNOWLEDGMENTS: CITE THIS ARTICLE:
• Graduate Excellence Programme (GrEP) 2018 Majlis
Abdul Halim, M. A. Tomori, K., Wan Zohdi, W.N., Muhammad
Amanah Rakyat (MARA) Nawawi, R.F., Che Daud, A.Z. (2022). Aid for Decision Making in
• ILKKM SB- Director and Head of OT Programme Occupation (ADOC) as a Tool to address activities and PA10
Occupational Therapy Programme participation: A Scoping Review. Malaysian Journal of Medicine
and Health Sciences (MJMHS), 18(Supp15), 359-366.
 Laparoscopic Radical Cystectomy -
An Initial experience in a non-urology Poster ID.:
centre
Authors : Too XQ, Sivapragasam. V, Noor Ashani M.Y.
Affiliations : Department of Surgery, Hospital Melaka, Malaysia
NMRR : RSCH ID-23-01955-H78

Introduction
Radical cystectomy remains the gold standard for the treatment of localised muscle invasive and
high-risk urothelial cancers of the bladder. Since the introduction of minimally invasive surgery,
laparoscopic approach and even robotic-assisted technique have been adopted to enhance recovery
of patients after surgery ,while reducing morbidity of open surgery. Hospital Melaka, being a tertiary
referral centre with visiting urologist on a monthly basis, has recently started performing
laparoscopic radical cystectomy, with the support of general surgical team.

Methodology
A total of six cases had been performed in the centre from December 2021 to August 2022. All
patients were male, with age ranging from 30 to 72 years old. Among these patients, 4 patients
underwent laparoscopic surgery completely while the other 2 patients had to be converted to open
surgery due to locally advanced nature of the disease.

Results
Operating Complications
No Age Gender EBL Discharge Histopathology Note
Time *

Anterior abdominal wall Unresectable.

3 hours metastatic carcinoma Palliative care.
1 60 Male Minimal Day 7
3 mins Uneventful favour urinary bladder Refused other
primary. therapy.
Invasive urothelial
6 hours carcinoma
2 30 Male 500 ml Day 7
17 mins Uneventful (high grade)
p T2b N0
Invasive urothelial
6 hours
3 72 Male 500 ml Day 6 carcinoma (high grade)
4 mins Uneventful
p T2a N0
Invasive urothelial
4 hours
4 63 Male 500 ml Grade 1 Day 12 carcinoma (high grade)
58 mins
p T3a N0

6 hours Signet ring cell carcinoma

5 63 Male 1400 ml Grade 1 Day 15 Converted to open
47 mins p T4a N1

Invasive urothelial
7 hours
6 61 Male 500 ml Grade 1 Day 12 carcinoma (high grade)
33 mins
p T2b N2
* According to Clavien-Dindo classification exemplified in radical cystectomy

The average operating time was 6 hours 13 minutes (ranging from 4 hours 58 minutes to 7 hours 33
minutes) with an average blood loss of 500ml. The average length of postoperative hospital stay was
9.25 days (ranging from 6 to 12 days). Other than transient ileus, none of the cases had major
postoperative complication.

Discussion
Bladder cancer is the ninth most common cancer among men in Malaysia. The incidence of bladder
cancer dramatically increases after 65 years old. It is expected to rise with the ageing population.
Malaysia is projected to have 14.5% of the population aged 65 years old and above in 2040. With the
few number of urologist in Malaysia we anticipate outreaching services to non-urology centre with
the support from general surgery lead by urology team.

Conclusion
The outcome of our patients post laparoscopic radical cystectomy were promising with no major
complications. Therefore, we conclude that with appropriate patient selection and support from
general surgery, laparoscopic radical cystectomy is technically feasible in a non-urology centre. PMD
1
 Post-Splenectomy Portal Venous System Poster
Thrombosis - A Case Report in Hospital ID
Melaka
Authors : Too XQ, LAI JH, LIM SL
Affiliations : Department of Surgery, Hospital Melaka

NMRR (RSCH ID-23-01754-D33)

Introduction
The indications for splenectomy are commonly for splenic injury and certain hematologic disorders.
The most widely recognized complication post splenectomy is overwhelming bacterial infection.
More recently, mesenteric and portal venous thrombosis has increasingly been recognized as a
potential complication. We here reported a patient with beta-thalassemia major who underwent
splenectomy and developed superior mesenteric and right portal venous thrombosis.

Case presentation
A 28-year-old gentleman with beta thalassemia major underwent elective open splenectomy for
hypersplenism with increasing transfusion requirement. Preoperative ultrasound showed splenic size
of 20.5cm and portal vein of 1.4cm in diameter. Blood tests showed haemoglobin 10.6g/dL (post
transfusion) and platelet 159K/uL. Intraoperatively the operating time lasted 1 hour 40 minutes with
estimated blood loss of 100ml, no blood transfusion was required. The spleen specimen weighed
830g. Postoperatively blood tests showed haemoglobin 10.0g/dL and platelet 487K/uL. No
anticoagulant or antiplatelet was initiated and the patient was discharged home on day 5.

He was readmitted on day 8 presented with abdominal pain and vomiting. Computed tomography
showed partial superior mesenteric vein and right portal vein thrombosis. Blood tests showed
haemoglobin 9.7g/dL and platelet 1845K/uL. Patient was treated conservatively with anticoagulant
and antiplatelet. After one month in hospital monitoring he was discharged home.

Fig.1 CT abdomen taken upon presentation. Fig.2 CT abdomen taken 1 month later.
Arrow showing filling defect of right portal Arrow showing resolution of right portal
vein indicating thrombosis. vein thrombosis.

Discussion
Prospective cohort studies reveal that the incidence of thrombosis involving the portal venous
system after splenectomy ranges from 5% to 37%, all occurring within 2 months, with the majority
within 2 weeks of the surgery [1]. The majority of patients with portal venous thrombosis remain
asymptomatic, but it can present with a wide variation of symptoms such as fever, abdominal pain,
nausea, diarrhoea, ileus, ascites and bleeding from esophageal varices [2]. If left untreated it can
progress and finally result in liver function deterioration, intestinal infarction and even intestinal
necrosis, making the mortality rate even up to 10% [3].

Conclusion
Portal venous thrombosis is a relatively common complication of splenectomy. A high index of
suspicion, early diagnosis by contrast-enhanced computed tomography, and prompt anticoagulation
are key to a successful outcome.

References
1. Crary SE, Buchanan GR. Vascular complications after splenectomy for hematologic disorders. Blood. 2009 Oct
1;114(14):2861-8. doi: 10.1182/blood-2009-04-210112. Epub 2009 Jul 27. PMID: 19636061; PMCID: PMC2756197.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756197/#B7
1. Tsamalaidze L, Stauffer JA, Brigham T, Asbun HJ, Postsplenectomy Thrombosis of Splenic, Mesenteric, and Portal vein (PST-
SMPv): A single institutional series, comprehensive systematic review of a literature and suggested classification, The
American Journal of Surgery (2018) doi:10.1016/j.amjsurg.2018.01.073
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756197/ PMD
1. Yang Zl, Guo T, Zhu DL, Zheng S, Han DD, Chen Y. Risk factors of portal vein thrombosis after splenectomy in patients with
liver cirrhosis. Hepatoma Research. 2020; 6:37. http://dx.doi.org/10.20517/2394-5079.2020.09
https://hrjournal.net/article/view/3534#Cite_This_Article
2
PMD
3
PMD
4
 ORAL HEALTH EDUCATION IN PREVENTING EARLY CHILDHOOD CARIES: A Poster ID
SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED font size

CONTROLLED TRIALS (28)

Noorul Nadiah Noor Zamry1, Norkhafizah Saddki2, Zuliani Mahmood2, Nur Aishah Che Roos3
1. Oral Health Division, Melaka State, 2. School of Dental Sciences, USM, Kelantan.
3. National Defence University, Kuala Lumpur
NMRR (font size 14)

INTRODUCTION

Early childhood caries (ECC) remains prevalent affecting nearly half of the children worldwide1 (48%). The early
toddlers years is seen as captive period to engage caregivers with oral health education (OHE). However, no
review ever reported on the effectiveness of OHE on caregivers of children less than 48 months in preventing
ECC. The evidence will act as a reference to the clinicians and dental fraternities in designing appropriate
strategies in reducing ECC among young children.

METHODOLOGY

Phase 1 Identification 3425 Phase 1 Reviewers

1. NZ 2. ZM
3

Phase 2 Data extraction2 Phase 2 Reviewers

1. NZ 2. ZM 3. NKS

Phase 3 Assessment of risk of bias 3 Phase 3 Reviewers

1. NZ 2. NA

Phase 4 Meta-Analysis 4 Phase 4 Reviewers

1. NZ 2. ZM 3. NKS

Assessment of GRADE 5 ★ risk of bias ★ indirectness

★ inconsistency ★ imprecision

RESULTS

Three randomized controlled trials included in

meta-analysis involving 762 participants6,7,8
The evidence was downgraded due to unclear risk
of attrition bias of a study weights 70.4%, hence
resulting with moderate-certainty evidence.
MD: -1.13 (95%CI: -1.73, -0.53; 3 trials; 762
participants; moderate-certainty evidence)

DISCUSSION / CONCLUSION

• The current evidence found having higher effect estimate compared to another meta-analysis of OHE
alone on caregivers of children less than 7 years old9: (SMD -0.2, 95% CI: -0.43 to 0.03), however the
quality of evidence was not assessed.
• All of the trials in the meta-analysis had given motivational interviewing (MI) to the participants in the
intervention groups as opposed to the conventional method of oral health education which used printed
materials and other standard activity in the study settings
• Advantage of MI in preventing ECC is consistent with the evidence from recent systematic reviews and
meta-analysis on the effectiveness of MI in ECC prevention10

This review suggests that provision of OHE alone to caregivers of children less than 48 months is effective in
reducing the severity of caries at surface level.

REFERENCES
6. Batliner, Tiwari, T., Henderson, W. G., Wilson, A. R., Gregorich, S. E., Fehringer, K. A., … Albino, J. (2018). Randomized Trial of
1. Uribe, S. E., Innes, N., & Maldupa, I. (2021). The global prevalence of early childhood caries: A systematic review with Motivational Interviewing to Prevent Early Childhood Caries in American Indian Children. JDR Clinical & Translational Research,
meta-analysis using the WHO diagnostic criteria. International Journal of Paediatric Dentistry, 31(6), 817–830. 3(4), 366–375. doi:10.1177/2380084418787785

PMD
doi:10.1111/IPD.12783 7. Colvara, Faustino-Silva, D. D., Meyer, E., Hugo, F. N., Hilgert, J. B., & Celeste, R. K. (2018). Motivational Interviewing in
2. Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (2020). Cochrane Handbook for Preventing Early Childhood Caries in Primary Healthcare: A Community-based Randomized Cluster Trial. Journal of Pediatrics,
Systematic Reviews of Interventions. Cochrane Handbook for Systematic Reviews of Interventions (Version 6.). Cochrane. 201, 190-195. doi:10.1016/j.jpeds.2018.05.016
doi:10.1002/9781119536604 8. Faustino-Silva, Colvara, B. C., Meyer, E., Hugo, F. N., Celeste, R. K., & Hilgert, J. B. (2019). Motivational interviewing effects on
3. Higgins, J. (2011). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1 (updated March 2011). (The caries prevention in children differ by income: A Randomized Cluster Trial. Community Dentistry & Oral Epidemiology, 47(6),

4.
Cochrane Collaboration, Ed.), The Cochrane Collaboration (Version 5.). [updated March 2011]. Retrieved from
https://ci.nii.ac.jp/naid/20000796633
RevMan. (2020). Review Manager (RevMan). The Cochrane Collaboration
9.
477-484. doi:10.1111/cdoe.1248
Faisal, M. R., Mishu, M. P., Jahangir, F., Younes, S., Dogar, O., Siddiqi, K., & Torgerson, D. J. (2022). The effectiveness of
behaviour change interventions delivered by non-dental health workers in promoting children’s oral health: A systematic
5
5. Ryan, R., & Hill, S. (2016, July 25). How to GRADE the quality of evidence. doi:10.26181/5B57D95632A review and meta-analysis. PLOS ONE, 17(1), e0262118. doi:10.1371/JOURNAL.PONE.0262118

Collagenoma - A Skin Manifestation of
Multiple Endocrine Neoplasia Type 1
Noor Huda Ab Hamid, Chin Voon, Tong
Endocrine Unit, Department of Medicine
INTRODUCTION
Multiple endocrine neoplasia type 1 (MEN1)
is a hereditary condition associated with
tumors of the endocrine (hormone
producing) glands. The most common
tumors seen in MEN1 involve the
parathyroid gland, islet cells of the pancreas,
and pituitary gland. Non-endocrine tumors
are also seen in MEN1 such as facial
angiofibroma, collagenoma, lipoma,
leiomyoma, meningioma and ependydoma.
(1) These tumors can also cause problems
by producing high amounts of hormones
leading to a wide variety of symptoms.
These include excess production of
prolactin, growth hormone ,
adrenocorticotropic hormone, gastrin,
glucagon, vasoactive intestinal peptide,
parathyroid hormone.
CASE REPORT
A 35-year woman with underlying repaired
patent ductus arteriosus and hepatitis B
carrier was initially referred for asymptomatic
hypercalcaemia with corrected calcium of
2.63 mmol/L (2.12-2.52mmol/L) Her calcium
level was screened following her mother’s
recent diagnosis of MEN1. She was also
noted to have brown, painless nodules over
her arms and thighs and was referred to
dermatology
Skin biopsy confirmed the lesion to be
collagenoma. (Figure). An elevated
parathyroid hormone of 30.40 pmol/l
confirmed diagnosis of primary
hyperparathyroidism.
Ultrasound neck done showed two
hypoechoic lesions at inferior posterior to the
right thyroid gland (1.3 x0.4x 2.1 cm, 0.8
x0.3 x 0.9 cm) and another hypoechoic
lesions at inferior to left thyroid gland, 0.6 x
0.7 x 1.4 cm). Sestamibi scan localized her
lesion at the inferior pole of left thyroid lobe.
Focused left inferior parathyroidectomy was
performed and histopathology examination
(HPE) showed benign features in favor of
parathyroid adenoma.
Computed tomography scan of
pancreas showed 3 pancreatic nodules
which is currently being worked up. She did
not have any symptoms of pancreatic
hormones hypersercretion. She has 3
maternal cousins currently diagnosed with
MEN 1.
Poster ID
RSCH ID-23-01827-GKQ
FIGURE
Histopathology from skin biopsy showed skin
tissue lined by stratified squamous
epithelium with mild papillomatosis of the
epidermis . The dermis is thick with broad,
haphazard collagen distribution. Minimal
perivascular lymphocytes infiltrate is seen in
the upper dermis. No evidence of
malignancy. Skin biopsy is consistent with
collagenoma.
DISCUSSION
This is a case presenting with unusual skin
lesion related to MEN type 1.The presence
of multiple angiofibromas and collagenomas
should arouse suspicion of MEN1. Other
cutaneous features include café au lait
macules, lipomas, hypopigmented macules,
and gingival papules which can be easily
overlooked because of their subtle
appearance. (2)
CONCLUSION
High clinical suspicion of MEN1 should lead
to endocrinology evaluation with appropriate
laboratory workup and targeted imaging
evaluation of the typical endocrine organs
especially in patient with family history of
MEN 1 illness. Collagenoma is one of the
many dermatological presentation of MEN 1
REFERENCES
1. Giusti F, Marini F, Brandi ML. Multiple Endocrine Neoplasia
Type 1. 2005 Aug 31 [Updated 2022 Mar 10].
2. Vidal A, Iglesias MJ, Fernández B, Fonseca E, Cordido F.
Cutaneous lesions associated to multiple endocrine neoplasia
syndrome type 1. J Eur Acad Dermatol Venereol. 2008
Jul;22(7):835-8.
ACKNOWELEDGEMENT
We would like to extend our gratitude to the Pathology Department
for providing the HPE figures and the patient, for allowing her case
to be shared.
PMD
6
 Poster ID
An Explosion of Endocrinopathies:
A Complex Case of MEN 1
ID:RSCH ID-23-01859-NNK
Noor Hafizah binti Ab Hamid, Chin Voon Tong
Endocrine Unit, Department of Medicine

INTRODUCTION TABLE: Summary of hormonal parameters and

Multiple endocrine neoplasia, type 1 (MEN 1),is a dynamic tests.
rare disorder that causes tumors in the endocrine
glands and parts of the small intestine and stomach.
It is an autosomal dominant disease. Multiple HORMONE RESULTS
endocrine neoplasia type 1 (MEN1) is caused by LEVELS/DYNAMIC TESTS
inactivating mutations of the MEN1 tumor
suppressor gene at the 11q13 locus. (1) In MEN 1, PROLACTIN 557.1uIU/ml ↑
the endocrine glands, usually the parathyroids,
pancreas and pituitary grow tumors and release CALCIUM ↑3.04mmol/l
excessive amounts of hormones that can cause a
wide variety of signs and symptoms. However, the PARATHYROID HORMONE 28.18 pmol/l↑
tumors are usually noncancerous (benign). We
present here, a patient with MEN 1 who manifested IGF-1 231.4ng/ml↑
with multiple tumors and endocrinopathies at the
same setting. GROWTH HORMONE POST NON
ORAL GLUCOSE SUPPRESSED
TOLERANCE TEST
METHODOLOGY ACTH 4.6 pmol/l
Patient’s records were reviewed for her clinical CORTISOL POST 164.6nmol/l↑
findings, laboratory investigations and clinical
course. DEXAMETHASONE
SUPRESSION TEST
CORTISOL LOW DOSE 131.6nmol/l↑
CASE REPORT DEXAMETHASONE
A 62 years old lady with history of transsphenoidal SUPPRESSION TEST
surgery in her 20’s for prolactinoma presented with CPEPTIDE LEVEL (DURING 753pmol/l
headache, dizziness and vertigo. She has no
bitemporal hemianopia and any other visual HYPOGLYCEMIA)
disturbances. Clinically she does not have overt INSULIN LEVEL (DURING 53.4pmol/l
features of Cushing’s syndrome or acromegaly.
HYPOGLYCEMIA)
MRI pituitary showed tiny focus lesion in
the left lobe measures 3.0x5.8mm in size suggestive FIGURE :CT pancreatic protocol showing
of residual pituitary microadenoma. Her hormonal multiple insulinomas.
screening revealed high serum prolactin, high intact
parathyroid hormone and calcium level .In view of
her elevated prolactin and MRI findings, other
anterior pituitary hormones were assessed. She had
high insulin-like growth factor 1 level. Both
prolonged Oral Glucose tolerance test (OGTT) and
overnight dexamethasone suppression test showed
insufficient suppression, consistent with Growth
Hormone and cortisol excess. ACTH
(Adrenocorticotropic hormone) was not suppressed,
confirming an ACTH dependant Cushing’s. At this
point, patient started to experience symptoms of
hypoglycemia. Prolonged 72 hour fasting showed DISCUSSION
inappropriately normal C peptide and insulin level Our patient has multiple endocrinopathies as a
during hypoglycemia, confirming endogenous result of MEN 1. She has primary
hyperinsulinemia hypoglycemia. (Table). CT
pancreatic protocol showed multiple insulinomas hyperparathyroidism, a pituitary adenoma co-
and bilateral adrenal nodules. (Figure) FNAC from secreting prolactin, ACTH and GH, insulinoma
both left adrenal and pancreatic tail lesion during and bilateral adenomas which had been detected
endoscopic ultrasound showed NET(neuroendocrine in a short period of time. Almost all endocrine
tumor) grade 1. organs were affected in her. Patients with
Patient was started on T diazoxide untreated MEN 1 have reduced life expectancy;
100mg ON for her hypoglycemia and T cabergoline most commonly due to malignant pancreatic NET
0.25mg 2x/week for acromegaly and planned for and thymic carcinoids. (2) Our patient would
Gallium PET scan while awaiting her decision require multi-disciplinary team approach to
regarding surgery for removal of tumors. Apart from address all her endocrinopathies thoroughly.
surgery, somatostatin receptor ligands can be
considered, to provide systemic effects. Meanwhile, CONCLUSION
patient’s niece residing in another country had a
genetic testing confirming diagnosis of MEN 1. This case illustrates the complex presentation and
Patient’s own daughter and a nephew had been management of a patient with MEN1, who after
detected to have hypercalcemia during screening. defaulting for 30 years presented with concurrent
multiple endocrinopathies. Careful follow up of all
patients and screening of family members with MEN
is crucial to avoid such presentation.
REFERENCES
1. Thakker RV, Newey PJ, Walls GV, Bilezikian J, Dralle H, Ebeling PR, Melmed S, Sakurai A, Tonelli F, Brandi ML; Endocrine Society. Clinical practice guidelines for multiple endocrine neoplasia type 1
(MEN1). J Clin Endocrinol Metab. 2012 Sep;97(9):2990-3011
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2. Gaztambide S, Vazquez F, Castaño L. Diagnosis and treatment of multiple endocrine neoplasia type 1 (MEN1). Minerva Endocrinol. 2013 Mar;38(1):17-28..
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 The prozone phenomenon with syphilis and HIV-1
co-infection
Puspadevi Armugham 1,2, Amelia Lim lay Suan1, Prof. Madya Dr. Wan Haslina Wan Abdul Halim2
1.Department of Ophthalmology, Selayang Hospital
2.Department of Ophthalmology, Universiti Kebangsaan Malaysia
INTRODUCTION
Syphilis is often considered a great mimicker of uveitis
because of its range of clinical manifestations.It can be difficult
and challenging to diagnose ocular syphilis at times. Syphilis is
mainly diagnosed by laboratory investigations, but its sensitivity
and specificity can vary depending on the stage of the disease.
PURPOSE
To report case of Prozone Phenomenon in ocular Syphilis
METHOD
Case report
RESULTS
We describe a case of ocular syphilis with HIV-1 co-infection
presented to us with a bilateral blurring of vision and floaters in the
eyes. A 40-year-old man presented to us with visual acuity of 6/36
with a pinhole 6/18 in the right eye, and 6/36 with a pinhole 6/36 in
the left eye. As an ex-intravenous drug user with positive retroviral
status, he is currently taking highly active antiretroviral therapy
(HAART). On examination, the patient had intermediate uveitis
with hyperreflective lesions at the macula on optical coherence
tomography (OCT). The initial serum non-treponemal assays were
negative.
Nevertheless, based on clinical suspicion of ocular syphilis, diluted
samples of non-treponemal assays were requested which were
later confirmed to be positive with a high titer. A confirmatory test
for syphilis, treponemal pallidum hema-agglutination (TPHA), was
performed and was positive. The patient was treated with
intravenous G-penicillin for 14 days. He responded well with a
significant visual recovery.
(b)
(a)
(C) (d)
Figure 1 : Optical coherence tomography (OCT) macula of right eye (a)
and left eye (b) showed bilateral mild macular oedema with
hyperreflective lesions and loss of ORL. OCT macula of the right eye (c)
and left eye (d) macula showed resolution of hyperreflective lesions and
restoration of ORL after treatment.
Poster ID
font size
(28)
NMRR: RSCH ID-23-01978-ZJ0
DISCUSSION
HIV-1 (HIV) coinfections have increased since the
resurgence of syphilis in sex with men (MSM). [1,2]
According to the Center for Disease Control and
Prevention (CDC), 7.5 cases of primary and secondary
syphilis were reported per 100,000 people in 2015, of
which 54% occurred in men who had contact with other
men. HIV coinfection with syphilis ranges from 20% to
70%. [3,4]
Patients with HIV-related syphilis and ocular symptoms
often have a 10% prevalence of ocular syphilis. [5]
In any uveitic case with highly suggestive ocular syphilis,
the prozone phenomenon should be considered. About 0.2
to 2.0% of patients with secondary syphilis showed non-
reactive non-treponemal laboratory results. [6]The Prozone
phenomenon is believed to be higher in secondary Syphilis
and Human Immunodeficiency Virus (HIV) co-infection. [6]
It refers to false-negative responses resulting from high
antibody titers in the serum. As a result of a strong clinical
suspicion of ocular syphilis, quantitative non-treponemal
assays were requested in this case, which were positive.
The most effective method for detecting syphilis is to
observe the spirochetes by dark-field microscopy and
collect samples of non-treponemal and treponemal
serologic antibodies. Tests such as rapid plasma reagin
(RPR) and Venereal Disease Research Laboratory (VDRL)
are more sensitive than treponemal tests for initial
screening. The confirmation is then done with specific
treponemal tests such as fluorescent treponemal antibody
absorption test (FTA-ABS) and TPHA. [7]
The non-Treponemal tests like VDRL or the RPR test
measure the hosts' response to lipoprotein-like material
released from the Treponema also as well as non-
treponemal antigens like lecithin and cardiolipin released
from the damaged host cells. These tests are generally
considered sensitive to early syphilis. However, these tests
lack sensitivity and falsely produce inaccurate results,
especially at a late stage of syphilitic infection resulting in
the prozone phenomenon.[8] False-negative results
happen as a result of zones of excess antibodies
("prozone") or antigens ("postzone"), which result in false
negative results. [9] Reassessment of non-treponemal
assays with dilution is crucial if clinical suspicion of ocular
syphilis is high.
CONCLUSION
In a case of high clinical suspicion of ocular syphilis,
prozone phenomenon should be considered before ruling
out syphilis.
REFERENCES
1. Cronin M, Domegan L, et al. The epidemiology of infectious syphilis in the
Republic of Ireland. Euro Surveill. 2004;9(12):14–7.
2. Jakopanec I, et al. Syphilis epidemiology in Norway, 1992–2008:
resurgence among men who have sex with men. BMC Infect Dis. 2010;
10:105.
3. Parthopratim Dutta Majumder, et al. (2017): Ocular Syphilis: An Update,
Ocular Immunology and Inflammation.
4. Tsuboi M, Nishijima T, Yashiro S, et al. Prognosis of ocular syphilis in
patients infected with HIV in the antiretroviral therapy era. Sex Transm
Infect. 2016;92(8):605–610.
5. Zetola NM, Engelman Jet al. Syphilis in the United States: An Update for
clinicians with an emphasis on HIV coinfection. Mayo Clin Proc.
2007;82(9):1091–1102
6. Musher DM, Hamill RJ, Baughn RE (1990) Effect of (HIV) infection on the
course of syphilis and on the response to treatment. Ann Intern Med 113:
872-881.
7. Smith G, Holman RP. The prozone phenomenon with syphilis and HIV-1
co-infection. South Med J. 2004 Apr;97(4):379-82.
8. Naidu NK, Bharucha ZS, et al. Comparative study of Treponemal and
non-Treponemal test for screening of blood donated at a blood center.
Asian J Transfus Sci. 2012 Jan;6(1):32-5.
9. Berkowitz K, Baxi L, Fox HE. False-negative syphilis screening: The
prozone phenomenon, non-immune hydrops, and the diagnosis of syphilis
during pregnancy. Am J Obstet Gynecol 1990; 163:975–977.
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 Isolated ACTH Deficiency with pituitary
LOGO
incidentaloma and primary Poster ID

hypothyroid
RSCH ID-23-02053-YVQ

Noor Hafis Md Tob, Chin Voon Tong, Jen Hoong Oon, Melissa Vergis, Siow Ping Lee

INTRODUCTION HORMONAL AND BIOCHEMICAL RESULT

Isolated adrenocorticotropic hormone (ACTH)
deficiency is a rare condition characterized
by secondary adrenal insufficiency resulting
from corticotroph loss. It is frequently
associated with autoimmune disorders,
empty sellar syndrome, and hypophysitis1.
However, the coexistence of pituitary
microadenoma in isolated ACTH deficiency
and primary hypothyroid has not been
previously reported.

METHODOLOGY
We review a detailed case of isolated ACTH
deficiency, including the results of MRI PITUITARY
biochemical laboratory tests and magnetic
resonance imaging (MRI) study.

CASE REPORT
A 39-year-old lady was admitted for recurrent
seizure episodes and loss of consciousness.
She also has chronic lethargy necessitating
the consumption of frequent sugary drink.
She reported regular menstrual cycles and
was a mother of three children. On
assessment, her random blood glucose was
low. She regained back consciousness after
reversal of hypoglycaemia. Blood pressure
was 108/74 mmHg and heart rate was 79
beats per minutes. She was afebrile. No skin
or mucosal pigmentation was observed, and
there was no goiter palpable. Her visual
confrontation test was intact. No mass
palpable on per abdomen examination. Blood
tests revealed that both her serum cortisol
and serum ACTH were below the detection
level, which was suggestive of secondary
adrenal insufficiency. In contrast, her thyroid
function test indicated primary
hypothyroidism, although her thyroid
peroxidase (TPO) antibody was negative.
Her other pituitary axes were intact, and the
remaining biochemical investigations were
unremarkable. Anti Pituitary Antibody testing
was not available locally, therefore the test
was not performed. MRI pituitary in 2019
revealed a left pituitary microadenoma
measuring 5.6 x 6.0 x 5.0 mm. A repeat MRI
in 2020 showed that the microadenoma had
a stable size, measuring 3.0 x 4.0 x 4.2 mm.
Her overall symptoms markedly improved
with the administration of oral hydrocortisone
10mg BD and L-thyroxine 50mcg daily.
Further assessment showed that she was
clinically and biochemically eucortisol and
euthyroid while on hormonal replacement.
DISCUSSION
Isolated ACTH deficiency can present with
neuroglycopenic symptoms, as observed in
our case and other previous case series2-3.
Even though, most of pituitary microadenoma
are asymptomatic, the presence of adrenal
insufficiency mandates steroid replacement.
There may be an autoimmune component in
some reported cases, but the etiologies are
likely to be heterogenous, including structural
abnormalities of the pituitary gland4-5. She
need frequent monitoring for asssessment of
the adequacy of hormonal replacement.
CONCLUSION
We here illustrate the first case report of
isolated ACTH deficiency and primary
hypothyroid complicated with pituitary
incidentaloma. It also highlist the importance
of glucocorticoid therapy to prevent life
threatening adrenal crisis and normalization
of thyroid status.
REFERENCES
1. Yamamoto, Toshihide. Isolated ACTH Deficiency. The Endocrinologist (Baltimore, Md.).
2009;19(3),108–113.
2. Alabdrabalnabi FM, Al Saeed ZA, Elamin YA. Hypoglycaemia as initial presentation in
patient with isolated ACTH deficiency. AACE Clin Case Rep. 2020;6(6):e338-e341
3. Hannon AM, Hunter S, Smith D, et al. Clinical features and autoimmune associations in
patients presenting with Idiopathic Isolated ACTH deficiency. Clin Endocrinol (Oxf).
2018;88(3):491-497.
4. Stacpoole PW, Interlandi JW, Nicholson WE, Rabin D. Isolated ACTH deficiency: a
heterogeneous disorder. Critical review and report of four new cases. Medicine.
1982;61:13-24.
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5. Karavitaki N, Wass J, Henderson Slater JD, Wade D. A case of post-traumatic isolated
ACTH deficiency with spontaneous recovery 9 months after the event. J Neurol Neurosurg
Psychiatry. 2006;77:276-277 14
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Company or
University Logo
Introduction
During sleep, the mind and body finally receive
well-deserved rest. Medical students are constantly
compromising on their sleep to fit in their growing
workload, course requirements, social obligations,
and use of technology for communication and
entertainment. Medical students may also
experience stressful circumstances like social
obligations, demanding academic curriculum,
language obstacles, and parental expectations
(Bharti et al. 2021).
Objectives
1. To assess sleep quality among medical students
in MUCM.
2. To assess stress levels among medical students
in MUCM
3. To determine the association between sleep
quality and stress among medical students in
MUCM.
Materials and Methods
A cross-sectional study was conducted among 215
medical students in MUCM. The questionnaire
consists of 3 sections, section A is about the
demographic, section B is about sleep quality, and
section C assesses the stress scale. The
questionnaires were created in Google Forms and
the link was shared with the students. The online
questionnaires were validated and pre-tested. Data
were analysed using Microsoft Excel and SPSS
version 28. Chi-square was used to measure the
association between sleeping quality and stress
score in MUCM medical students
Impact of sleep quality associated with stress among medical students in Manipal
University College Malaysia (MUCM).
Rusdiah Ruzanna Jusoh, Angela Low Hui Qi, Navvinna Anne a/p Kathirasan, Tejaswini a/p Jeya Sankar.
Manipal University College Malaysia
Results Discussion
Sample size Gender Nationality -Half of the surveyed students rate their quality of
sleep just on average. 32.1% sleep less than 5 hours.
Medical students tend to reduce their sleep, to adjust
and cope with their workload.
215 participants 66% 34% 78.6%
Figure 1 : Demographic data -3.7% had used sleeping pills to assist them to sleep.
This requires early intervention before complications
start to develop, such as medication dependence.
Figure 5: Factors affecting Sleep Quality
-82.8% used their devices to check social media
before sleep. Electromagnetic radiation emitted by
mobile phones 30 minutes before sleeping was found
Figure 2 : Quality of Sleep to delay the onset of melatonin production which in
turn might affect sleep (Wood et al., 2006).
-Moderate stress level. Academic is one of the highest
factors of stress. There are associations between sleep
Figure 6: Activities done before going to sleep
quality and stress. Medicine is one of the most
stressful fields of education, which may be why poor
Figure 3 : Average hours slept during weekdays
sleep quality and stress are common.
Conclusions
There was a statistically significant association
between sleep quality and stress (p < 0.005).
A suggestion for medical college management is to
establish academic counseling centres to help students
Figure 4 : Usage of Sleeping pills Figure 7: University Stress Score
improve their study skills and cope with their stressful
environment.
Not at all Sometimes Frequently Constantly
References
1. Bharti, Aakanksha & Kapoor, Richa & Maheswari, Supriya & Rathi, Dr & Sharma, Dr &
Ka, Mogan & Goyal, Dr. (2021).
2. Merenheimo, H. (2018). A Study About Students' Sleeping Habits. Bachelor’s thesis,
School of Health Care and Social Services: Lapland University of Applied Sciences.
3. Stallman, H. M., & Hurst, C. P. (2016). The University
Stress Scale: Measuring domains and extent of stress in university students. Australian
Psychologist, 51(2), 128-134.
Academic Procrastination Uni environment Finance problem Health problem Friendship Parental expectation Language/culture 4. Wood, A.W., Loughran, S.P. and Stough, C., 2006. Does evening exposure to mobile phone
radiation affect subsequent melatonin production?. International journal of radiation
Figure 8: University Stress Scale biology, 82(2), pp.69-76.
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 Correlation between health beliefs, and lifestyle among medical
students in Malaysia: A cross-sectional study
Chong Guang Wen
Bhargavi a/p Visualingam, Tharani R Mohan, Abhiraami Sathasivam, Hansika Gamage, Htoo Htoo Kyaw
Soe, Soe Moe, Khatijah Taharah Mohamed Shah, Mila Nu Nu Htay. RSCH ID-23-02088-KOA
Introduction Total: 160 students Results Discussion
Male: 39.38%, Female: • Age: Nutritional confidence (P=0.033) • Age, gender, and academic years
Physical activity, dietary pattern, 60.63%
stress and screen time are • Academic year: Susceptibility (P=0.013) were significantly associated
Malay: 5.63%, Chinese: • Gender: Barriers (P=0.041), Behavioural with health beliefs. Kim et al:
intertwined to healthy lifestyle. 30.63%, Indian: 43.75%, intention to do physical activity health beliefs differences in age
Others: 20% (P=0.018) and gender categories [1]
Aim 30.00
To investigate the health beliefs, 7.50%
25.00 • Positive correlation of health
5.00% 20.00
lifestyle, and dietary habits among 15.00
knowledge, beliefs and
medical students.
29.38%
58.13%
10.00 improving diet pattern [1,3].
5.00
0.00 Nutritional Susceptibility
Behavioral Behavioral
Healthy Overweight 1 2 3 4 5 6
Conclusion
Benefit Barriers intention to eat intention to do
confidence
healthy food physical activity

Methods Obese Underweight Series1 12.74 13.66 24.18 18.29 10.47 11.08
Educational interventions and
Figure 1. Body Mass Index of respondents Figure 2. Mean scores of Health Belief Domains
• Cross-sectional study activities such as talks related to
Table 1. Correlation between health belief, nutritional lifestyle, and physical activity among
• Sample size - 157 (Epi-info) medical students (n=150)
adopting healthy lifestyles could
• Demographic characteristics, Health Belief domains Nutrition Physical activity help medical students in attaining
health belief model [1] and
Pearson
correlation
P Pearson P
correlation healthier lifestyle habits.
Nutritional confidence 0.26 0.001 0.41 <0.001
lifestyle information [2] -Online Susceptibility 0.10 0.274 0.14 0.078 References
data collection Severity 0.00 0.457 0.00 0.474 1. Kim H-S, Ahn J, No J-K. Applying the Health Belief Model to college students’
Benefit 0.30 <0.001 0.47 <0.001 health behaviour. Nutrition Research and Practice [Internet]. 2012;6(6):551.
• Descriptive, unpaired-t test, Barrier 0.00 0.453 0.10 0.269 2.
Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3542446/.
Dinzeo TJ, Thayasivam U, Sledjeski EM. The Development of the Lifestyle and
Habits Questionnaire-Brief Version: Relationship to Quality of Life and Stress in
ANOVA and correlation analysis Behavioral intention to eat healthy food 0.46 <0.001 0.58 <0.001
3.
College Students. Prevention Science. 2013 Feb 19;15(1):103–14.
Carroll S, Dudfield M. What is the Relationship Between Exercise and Metabolic
Behavioral intention to do physical 0.46 0.001 0.60 <0.001
(Epi info version 7) activity
Abnormalities? Sports Medicine. 2004;34(6):371–418

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