Leptospirosis is an endemic disease worldwide and its incidence is increasing with outbreaks and mortality. It is caused by Leptospires interrogans which are very thin,spiral-shaped, tightly coiled, gram-negative aerobic, spirochetes. It can cause several infection to human including organs such as the kidneys, liver, lungs, heart and the central nervous system. The organism can give rise to several ocular manifestations and when it affect the eyes, it causes Leptospirosisneuroretinitis. The present case illustrated a case of 9 year-old boy succumbed withleptospirosisinfection presenting as neuroretinitis. The unique of the case is that the boy had noobvious systemic manifestation of leptospirosis which caused a challenge to a physician to arrive at the diagnosis. Other important differentials had be entertained namely toxoplasmosis and ocular tuberculosis.,Further management had been discussed until the boy was discharged and being followed up as an outpatient. This is followed by the discussion on leptospirosis neuroretinitis.

Many COVID-19 vaccine candidates were clinically tested in response to the coronavirus pandemic. This study aims to determine the acceptance rate of, main concerns about and knowledge of COVID-19 vaccination among the Malaysian population based on different sociodemographic characteristics during the early stages of vaccine arrival in Malaysia. A cross-sectional online survey was performed between January 25, 2021 and February 1, 2021 using descriptive statistics, Likert scale analysis, hypothesis testing, correlation and regression. These statistics assessed the correlation between sociodemographic characteristics, exposure to COVID-19 vaccine information, as well as the perceived risk of infection and acceptance towards COVID-19 vaccines. There exist significant differences across sociodemographic variables. More than half of the respondents (58.85%) voted safety as their primary concern. Moreover, a medium correlation exists between knowledge and acceptance, r = 0.444, N = 2051, p<0.01. The linear regression equation of acceptance predicted by knowledge was Acceptance = 2.873 + 0.981 (Knowledge). This study’s findings can help the government design the best way to execute COVID-19 vaccination campaigns in Malaysia, for example, the National COVID-19 Immunisation Programme. It also demonstrates that online questionnaires are appropriate for assessing health literacy skills and attitudes towards vaccination during infectious disease epidemics. It can also aid in the adaptation of medical communication tactics to better comprehend vaccination values.

Higher education institutions with significant numbers of young adults may become centres of acute outbreaks during a pandemic. Due to the large number of young adults, universities have the potential to become outbreak centres. The aim of this research is to examine the knowledge, attitude and practice (KAP) of university students towards COVID-19 at Universiti Sains Islam Malaysia (USIM), in Nilai. A self-administered questionnaire with a sample size of 2061 Universiti Sains Islam Malaysia (USIM) students was distributed to collect the data and analyzed using SPSS software. To identify the levels of KAP among USIM students, we used descriptive statistics based Likert scale questionnaire. Results show that the sample of students have excellent awareness (85 per cent) and good attitude (73.8 per cent) towards COVID-19. However, levels for practice is significantly lower (44.9%) than the other two attributes. This is most likely due to the unpreparedness to face this pandemic's crucial situation. In other words, it can be said that although students have a fairly good level of knowledge on the subject, there is still much room for improvement in attitude and practice.

This study aimed to explore the socio-demographic characteristics, mental health status, and perceived causes of pandemic fatigue with COVID-19 pandemic fatigue among the general population of Malaysia. The data was collected online during the transition from the COVID-19 pandemic phase to the endemic phase in Malaysia from 1 to 30 April 2022. Sociodemographic data, Depression Anxiety Stress Scale-21 (DASS-21), perceived causes of pandemic fatigue, and the Fatigue Assessment Scale (FAS) were included in the survey. The chi-square test and a simplelogistic regression analysis were used to identify predictors of pandemic fatigue. The completed survey (N = 775) included individuals aged 18 years or above [mean 31.98 (SD = 12.16)] from all states in Malaysia. Pandemic fatigue prevalence was 54.2%. Severe to extremely severe depression, anxiety, and stress symptoms were detected in 11.2%, 14.9%, and 9.1% of the participants, respectively. Younger age, non-Malay ethnicity, living alone, and higher income categories were significantly higher in the fatigued group. Higher DASS-21 scores on all domains were associated with higher FAS scores. Meanwhile, high scores for perceived tiredness from complying with the COVID-19 Standard Operating Procedure (SOP), perceived risk of infection from COVID-19, perceived hardship due to the pandemic, perceived public complacency during the pandemic, and perceived changes due to the pandemic were associated with a higher FAS score. This study provides valuable information for policymakers and mental health professionals worldwide on pandemic fatigue and its associated factors, including mental health status in Malaysia.

Lupus with overlap syndrome is an uncommon autoimmune disease that typically affects teenage females. It can present as various symptoms affecting multiple organs. Delay in the diagnosis of lupus will lead to deleterious effects on the implicated adolescents’ health. The case report aims to describe the diagnostic challenge of a refractory skin disease leading to a delay in diagnosis and highlight its psychosocial impact. Here, we describe a case of a teenager who presented with poorly controlled chronic dermatitis. The chronic dermatitis was refractory to the first-line therapy of topical steroids and emollients. She was finally diagnosed with lupus and overlap syndrome, confirmed by a skin biopsy. In conclusion, any chronic refractory skin diseases warrant further referral and investigation at the tertiary centre. Assessment of psychosocial in managing chronic skin disease in adolescent is essential as it could implicate their mental health further.

Gender dysphoria describes the feeling of distress and discomfort experienced when the assigned gender does not match the person’s gender identity. In its severe form, it leads to anxiety, depression and even suicidal ideation or attempts. Unfortunately, this does not end as some transgenders faced significant pressure by cultural, religious, employment, financial and social during the transformation period, hence would de-transition back to their natal gender identity. Gender de-transition is a process through which a person discontinues some or all aspects of gender affirmation. During the de-transition, ambivalence, confusion, doubts about their ability to carry out the gender role and responsibilities are common. Gender dysphoria and gender de-transition requires professional help, but the stigma and discrimination hinders them from seeking help from health care providers (HCP). Although these gender-related identity problems are preferentially diagnosed by a specialised psychologist or psychiatrist, primary care physicians often play an important role in this aspect. This case illustrates the health and help-seeking behaviour of a transwoman who had experienced gender dysphoria in the early adolescence year. Long after that, he faced a difficult life, making him de-transition to his original gender. He eventually presented with trivial symptoms in primary care hoping to solve the crisis.

Idiopathic intracranial hypertension (IIH), also known as pseudotumour cerebri,has an estimated incidence of 1 to 2 in 100,000 people per year. IIH commonly affects obese young women, where its pathogenesis, however, is not clearly understood. Patients present to the emergency department with a wide array of presentations. In light of this, we present a case of isolated sixth cranial nerve palsy in a non-obese young woman due to IIH in which brain imaging studies showed no abnormality;however,lumbar puncture reveals an opening pressure of more than 50 cmH2O. This case would help to alert physicians to consider IIH as one of the differential diagnoses when encountering such cases, as an uncommon presentation in the non-obese patient, and prompt referral is important to avoid unnecessary delay in the treatment of IIH.

Malaysia’s multiracial society has its cultural heritage of exercising for the health of its practitioners. In Chinese culture, for example, there is Tai Chi, while in Indian culture, Yoga is practiced for general health. Furthermore, in Malay culture, exercise has always been associated with the martial arts called ‘Silat Melayu’ with one of them being Senaman Tua Melayu (ST), which is developed from Silat Melayu Keris Lok 9. The Ministry of Health Malaysia has recognized traditional medicine as an alternative treatment. Senaman Tua Melayu (ST) belongs to this category. Unfortunately, there are no scientific studies to prove the effectiveness of ST for its users. Therefore, this study aims to analyze the effectiveness of ST from the users' perspective upon completing 16 sessions of ST training. The quantitative approach, i.e. questionnaire instrument, is used to carry out this study. It also used the qualitative method, where interviews with all participants were conducted for data triangulation. The results show that ST is significantly effective in improving participants' general health and musculoskeletal systems. Findings also showed that participants are strongly interested in continuing the practice of ST to improve their general health. It is hoped that this research may spread the good effects of doing routine physical activity. Further research can be done to explore the benefits of ST in a specific disease apart from general health.   Abstrak: Masyarakat Malaysia yang berbilang kaum mempunyai warisan budaya bersenam yang tersendiri untuk kesihatan pengamalnya. Dalam budaya Cina misalnya, terdapat Tai Chi, manakala dalam budaya India pula Yogadiamalkan secara umum untuk kesihatan. Dalam budaya Melayu, senaman lazimnya dikaitkan dengan seni mempertahankan diri yang dipanggil ‘Silat Melayu’, salah satunya ialah Senaman Tua Melayu (ST) yang telah dikembangkan daripada Silat Melayu Keris Lok 9. Kementerian Kesihatan Malaysia mengiktiraf perubatan tradisional sebagai rawatan alternatif. Senaman Tua Melayu (ST) tergolong dalam kategori ini. Walau bagaimanapun, belum ada kajian saintifik yang membuktikan keberkesanan ST kepada pengamalnya. Oleh itu, kajian ini bertujuan untuk menganalisis keberkesanan ST dari perspektif pengamal atau peserta setelah mereka menamatkan latihan ST sebanyak 16 sesi. Pendekatan kuantitatif iaitu instrumen soal selidik digunakan dalam kajian ini. Dalam masa yang sama, kaedah kualitatif turut digunakan dengan menjalankan temu bual terhadap semua peserta untuk tujuan triangulasi data. Dapatan kajian menunjukkan bahawa ST amat berkesan dalam meningkatkan kesihatan am dan sistem muskuloskeletal peserta. Dapatan kajian juga menunjukkan bahawa peserta amat berminat untuk meneruskan amalan ST bagi meningkatkan kesihatan mereka. Kajian ini diharapkan dapat memberi manfaat atau kesan baik melakukan aktiviti bersenam sebagai rutin harian. Kajian selanjut boleh dilakukan untuk meneroka manfaat ST dalam menyembuhkan penyakit tertentu selain daripada kesihatan am.

Higher educational centres with significant numbers of young people will become acute disease hubs during a pandemic. Owing to the sizeable population of young adults, more direct social interaction, and unrestricted boundaries, universities have the capacity to become volatile, centrifugal outbreak hubs. This research examines the university student’s knowledge, attitude, and practice towards the COVID-19 pandemic in Universiti Sains Islam Malaysia (USIM), Nilai. A self-administered questionnaire was distributed to obtain the data and analysed utilising SPSS software with a sample size of 2061 USIM students. Descriptive statistics, Likert scale analysis, multiple linear regression, as well as Pearson correlation, were used to identify the relationship between KAP. It was discovered that most of the USIM’s students have an excellent knowledge (85%) and attitude (73.8%) towards COVID-19. However, they moderately practice the right steps to prevent themselves from virus infection. This is very likely due to unpreparedness in responding to a critical situation such as this pandemic. In other words, it can be said that although students have a pretty good knowledge on the matter, still, attitude and practice have much room for improvement. The study finds significant relationship between practice and both knowledge and attitude.

Leg cramps (LCs) are common in pregnancy and may affect pregnant mothers’ quality of life (QoL). However, studies to show this impact are still lacking. Thus, this study aimed to evaluate the association of LCs with QoL among pregnant mothers. The magnitude and characteristics of LCs were assessed too. A cross-sectional study was conducted at a government health clinic in Hulu Langat, Selangor involving 99 mothers in their second or third trimesters, recruited through convenience sampling between March and April 2018. This study used a developed bilingual (Bahasa Malaysia and English) self-administered questionnaire on leg cramps proϐile, as well as the bilingual self-administered SF-12v2, to assess their QoL. About 71.7% experienced LCs during this pregnancy. About half experienced LCs once to twice a week and 63.4% had moderately painful LCs. Only 26.7% had severely painful LCs and 12.7% had the next-day soreness in all or most of the time. Gestational age (P=0.001) and booking Body Mass Index (BMI) (p=0.022) were signiϐicantly associated with LCs, but not their QoL (p=0.712 for PCS and p=0.118 for MCS). Generally, LCs were common among these pregnant mothers. However, LCs appear to be brief, infrequent, and mild which did not signiϐicantly affect their QoL. Nevertheless, LCs should not be disregarded, as a subgroup of them experienced severe LCs with the next day soreness who may need further assessment and treatment.

Despite it being culturally forbidden, youth are voluntarily engaging in premarital sex which could lead to poor sexual behaviour in adult life. This nationwide study aimed to determine the prevalence of permissive attitude towards premarital sex among young university students and its associated factors. Methods: A cross-sectional study was conducted from June 2021 to December 2021 among students attending higher education institutions in Malaysia using stratified random sampling. A self-administered online questionnaire was used that captured participants’ sociodemographic characteristics, knowledge of sexual health, childhood abuse, and attitudes toward premarital sex. Data were analysed using SPSS 27. Results: Out of 1171 respondents, 42.4% have demonstrated permissive attitude towards premarital sex. Half had adequate knowledge on sexual health (50.2%). Among the four types of childhood abuse, only emotional abuse (p=0.02) was found more likely (AOR: 2.01; 95% CI: 1.30-3.12, p=0.02) to have permissive attitude towards premarital sex. Being a Muslim (p<.001) and living in urban area (p=0.03) were protective factors against having permissive attitude towards premarital sex. Participants who have and adequate knowledge on sexual health (p<.001), smoke or vape (p=0.05) and consume alcohol (p<0.001) were more likely tohave permissive attitude towards premarital sex. Conclusion: Childhood abuse, especially emotional abuse, should not be underestimated. Permissiveness regarding premarital sex is of great concern. Permissiveness can lead to risky sexual behaviour. Preventive measures should be taken to promote positive attitudes toward premarital sex and to raise awareness about childhood abuse.

The emergence of COVID-19 has affected people worldwide from all angles, from the aspects of health, wealth, emotional and also human interactions. This study aimed to look at the attributes such as positive behaviour, awareness, preparedness and relationships among Malaysians during the implementation of movement control order (MCO), and the predictors of preparedness in facing the COVID-19 pandemic. A cross-sectional study was conducted online involving 317 respondents above the age of 18 years old. A self-administered questionnaire was developed in both Malay and English languages to assess the level of positive behaviour, awareness, preparedness and relationships, as well as their main source of information retrieval regarding COVID-19. Overall, the measured attributes in this study showed the highest level in behaviour (84.2%), followed by awareness (73.5%), preparedness (62.5%) and relationships (60.6%). Multiple regression on preparedness revealed that all variables (behaviour, awareness, and relationships) are significant (p<0.05), while gender is not. The top two sources of information the respondents refer to during the MCO are social and broadcast media. This marks the influence of social and broadcast media in an Industrial Revolution 4.0 era. Despite having good awareness and positive behaviour, the MCO may also have caused relationship issues as well as lower preparation levels in facing a deadly pandemic. It is suggested that future research to look into whether this would have any association with the mental health of Malaysians facing the pandemic. By understanding the attributes related to the MCO during the COVID-19 pandemic, it would help the government in the implementation of policies and procedures in any future pandemic.

Post-infectious bronchiolitis obliterans (PIBO) is a chronic lung disease involving fibrosis and obstruction of the terminal bronchioles. Possible infective aetiologies are commonly adenovirus, respiratory syncytial virus (RSV), influenza, and parainfluenza virus. A 25-year-old student was diagnosed with this condition in infancy and is dependent on 24-hour oxygen for the last 12 years. He was planning on pursuing a law degree in a local public institution. Due to the rarity of this chronic and debilitating illness, the physician attending his check-up must decide on the factors that could affect his academic survival or performance. However, this was overcome with careful risk-benefit considerations and support from family, peers, and physicians. This case highlights the psychosocial aspect to be considered that could impact the academic survival of such a case.

Introduction: The COVID-19 pandemic significantly impacted the global teaching and learning process (TnL). Unfortunately, to date, not many qualitative studies have been published specifically on the impact of COVID-19 on the Family Medicine course, particularly in Malaysia. Hence, this study aimed to explore the impact of COVID-19 pandemic on the teaching and learning experience of undergraduate students undergoing their Family Medicine course at a local university. Methods: A qualitative study using focused group discussion (FGD), was conducted among undergraduate students during the lockdown period. A semi-structured interview guide was used to interview 20 students, in their fifth undergraduate year, undertaking their fourth to fifth week of a total six-week course. They were selected using purposive snowball sampling method. There were four focus group discussions (FGD) with five students in a group. All interviews were audio-taped, transcribed verbatim, and the contents were analysed using the standard content analysis framework. Subsequently, thematic content analysis was conducted, and three major themes were produced. Results: The three major themes were (1) facilitators to learning, (2) barriers to learning, and (3) rooms for improvement. Conclusion: Although COVID-19 pandemic had significant impact on TnL of Family Medicine course among undergraduates, the students remained optimistic and proposed some improvement from their point of view. However, a creative, realistic, effective, and impactful way of TnL, particularly in clinical aspects should be developed and experimented. Technological progress and advancement should permit this idea to be achievable and implemented in near future.

Introduction: Mental health disorders (MHDs) are a global health burden with an increasing prevalence. During the COVID-19 pandemic, depression was the commonest MHD, followed by anxiety and stress. This nationwide study aimed to determine the prevalence and associated factors of depression, anxiety and stress among Malaysian students attending higher educational institutions. Methods: A cross-sectional study was conducted from June to December 2021. Institutions were selected via stratified random sampling and students via convenience sampling. A self-administered questionnaire comprising questions on socio-demographic characteristics, academic background, substance abuse, childhood abuse, religiosity and the Depression Anxiety Stress Scale-21 was used. Data were analysed using SPSS version 27; descriptive, point-biserial correlation, chi-square and multiple binary logistic regression analyses were conducted. Results: Sex and adverse childhood experiences significantly predicted all three MHDs (P<0.05). The students from public institutions (odds ratio [OR]=0.71, 95% confidence interval [CI]=0.56–0.90, P=0.004) had a lower risk of depression than those from private institutions. The smokers/vapers (OR=1.43, 95% CI=1.02–2.02, P=0.041) a higher risk of depression than the non-smokers/non-vapers. The social science students (OR=1.29, 95% CI=1.01–1.65, P=0.039) had a higher risk of anxiety than the science students. The students who highly engaged in organisational religious activity (OR=0.91, 95% CI=0.84–0.98, P=0.015) had a lower risk of anxiety than their counterparts. Conclusion: Anxiety is the commonest MHD among Malaysian youth, followed by depression and stress. Childhood abuse is a crucial related factor requiring further attention. Screening, surveillance, preventive measures and comprehensive interventions for MHDs should be initiated among youth.

Mental health conditions (MHC) have been found to have a negative effect on the outcome of respiratory diseases. MHC may increase readmissions and prolonged hospital stay for non-psychiatric hospitalisations. The study aimed to look at the depression, anxiety, and stress (DAS) levels of the Malaysian public in response to the pandemic and movement control order (MCO), using the Depression, Anxiety and Stress Scale 21 (DASS-21) questionnaire at different MCO stages. A cross-sectional survey was conducted using a non-probability and snowballing sampling method involving 317 respondents above 18 years of age in Malaysia. Descriptive statistics and t-tests were used to analyse the data to identify the DAS levels during the early phase MCO compared to the recovery phase MCO. Results demonstrate the stress level to be higher during the early phase in comparison to the recovery phase; however, for anxiety and depression, these levels are identical in both phases. Additionally, ttest results exhibit similar findings, where significant differences (at 5%) are found for stress levels between the early and recovery phases. Meanwhile, for anxiety levels, a significant difference is only found at the 10% level of significance. Interestingly, for depression, no significant difference is found between the two phases. The decrease in stress levels can be explained by the adaptation of the public response to the COVID-19 pandemic. Nevertheless, to a certain extent, anxiety was still present and postulated due to apprehension and uncertainties about the COVID-19 pandemic progression with time. Future research should further assess the public response toward the latest COVID-19 pandemic dynamics, and reasons for the anxiety component can be established.

SARS-CoV-2 virus is more severe in the elderly and contributes to most death cases. This is postulated due to the presence of multiple comorbidities and age-related immunological changes like immunosenescence and inflammaging. Immunosenescence causes impaired viral clearance, while inflammaging causes exaggerated response inappropriate to stimuli that triggers life-threatening cytokine storm. Hence, home-isolation prevents infection among the elderly and this limits their physical activity. Sedentary lifestyle eventually worsens pre-existing chronic disease and increases the risk of acquiring a new one. Tai Chi is one of the exercises recommended for the elderly during home-isolation. This literature review aims to provide information regarding the groups suggested for Tai Chi, its benefits, as an exercise to be practiced by elderly to maintain general health during COVID-19 and adverse effects. Tai Chi is for those aged 50 years and above or individuals with certain chronic, degenerative or psychological conditions. The systemic benefits are reduction in blood pressure, improves lipid profile, reduction in bone loss and musculoskeletal improvements; whereas neurologically, it reduces cortical shrinkage and improves depression, anxiety and insomnia. Moreover, it induces immune-regulation, which leads to enhancement of the immune system and inhibition of age-related chronic inflammatory condition, inflammaging. These may be protective against severe COVID-19 illness yet further studies are warranted. The adverse effect includes minor musculoskeletal pain and aches. In conclusion, Tai Chi is an ideal exercise for the elderly to maintain health during this challenging pandemic. However, the elderly need to be guided for the proper technique to perform this exercise at home.

Clinical reasoning is a vital medical education skill, yet its nuances in undergraduate primary care settings remain debated. This systematic review explores clinical reasoning teaching and learning intricacies within primary care. We redefine clinical reasoning as dynamically assimilating and prioritising synthesised patient, significant other, or healthcare professional information for diagnoses or non-diagnoses. This focused meta-synthesis applies transformative learning theory to primary care clinical reasoning education. A comprehensive analysis of 29 selected studies encompassing various designs made insights into clinical reasoning learning dimensions visible. Primary care placements in varying duration and settings foster diverse instructional methods like bedside teaching, clinical consultations, simulated clinics, virtual case libraries, and more. This review highlights the interplay between disease-oriented and patient-centred orientations in clinical reasoning learning. Transformative learning theory provides an innovative lens, revealing stages of initiation, persistence, time and space, and competence and confidence in students’ clinical reasoning evolution. Clinical teachers guide this transformation, adopting roles as fortifiers, connoisseurs, mediators, and monitors. Patient engagement spans passive to active involvement, co-constructing clinical reasoning. The review underscores theoretical underpinnings’ significance in shaping clinical reasoning pedagogy, advocating broader diversity. Intentional student guidance amid primary care complexities is vital. Utilising transformative learning, interventions bridging cognitive boundaries enhance meaningful clinical reasoning learning experiences. This study contributes insights for refining pedagogy, encouraging diverse research, and fostering holistic clinical reasoning development.

The introduction of the COVID-19 vaccines has led to an immense sense of relief for the global population. However, since the introduction of these vaccines, there have been several reports related to the side effects. A young woman presented to her primary care doctor with a vesicular rash three days after the BNT162b2 messenger RNA (mRNA) Pfizer-BioNTech vaccine, which was preceded by a low-grade fever for one day. Our case report highlights the challenges in diagnosing a vesicular rash post the BNT162b2 mRNA vaccine. Identifying the cause of a vesicular rash following vaccination has remained a challenge among primary care practitioners.

Waqf or religious endowment is of a benevolence instrument emerged to help reduce the burden of the disadvantaged people. As the cost for medical expenses are exorbitant, the availability of waqf should contribute to the improvement of the community health. The establishment of Universiti Sains Islam Malaysia (USIM) Specialist healthcare clinic was founded by the idea of waqf through healthcare for the less fortunate. With collaboration from many agencies the establishment of the clinic has served community in need to access better health care. The primary aim of waqf clinic establishment is to continually uphold the Islamic aspects in its establishment and management for betterment of health among disadvantaged people.