Mohd Hasni Jaafar

Serum selenium level and other risk factors for breast cancer among patients in a Malaysian hospital

ObjectiveThe aim of this study is to investigate the association between breast cancer and serum selenium level as well as other risk factors for breast cancer.MethodsA matched case-control study was conducted in a hospital in Malaysia from July 2000 to January 2001 and from May 2001 to June 2001. Sixty-two newly diagnosed breast cancer patients were selected as the cases. Each control, selected from the same hospital population was matched to each case according to age, ethnic group, and menopausal status.ResultsThe mean selenium concentration among the cases was significantly lower than that among the control. There was a significant association (p<0.05) between breast cancer and low selenium serum level, nulliparity (OR=5.5,95% CI=1.22 to 24.81), exposure to cigarette smoke (OR=2.2, 95% CI=1.04 to 4.65) and use of oral contraceptives (OR=3.0, 95% CI=1.09 to 8.25) as determined by the McNemar test. Multivariate analysis showed that nulliparity (OR=10.08, 95% CI=1.48 to 68.52) and use of oral contraceptives (OR=3.66, 95% CI=1.36 to 9.87) were associated with increased breast cancer risk. An increased selenium concentration contributes to a reduced risk of breast cancer (OR=0.89, 95% CI=0.84 to 0.94).ConclusionThe results suggest that use of oral contraceptive pills, being nulliparous, and a low serum selenium level are associated with breast cancer.

Effectiveness of influenza vaccine in preventing influenza-like illness among Faculty of Dentistry staff and students in Universiti Kebangsaan Malaysia

Abstract Influenza is a highly contagious respiratory disease and potentially hazardous for patients and dental personnel in dental clinics. The objective of this study was to evaluate the effectiveness and safety of influenza vaccine among the staff and students of the Faculty of Dentistry, Universiti Kebangsaan Malaysia. The project was conducted from Mayto September 2005. Atotal of 346 participants volunteered for the study and were assigned randomly to a vaccination (170) and control group (176). Participants in the vaccination group were given influenza vaccine for the southern hemisphere season 2005. Demographic data of the participants, data on adverse effects after vaccination and occurrence of influenza-like illness (ILI) were obtained through questionnaires. Results showed that vaccination significantly reduced ILI prevalence by 52.6% ( P =0.002). Frequency of recurrence of the ILI episode, absenteeism and visits to doctors among the vaccinated group were 77.0% ( P =0.031), 76.1% ( P =0.001) and 52.7% ( P =0.004), respectively. Vaccination also provided indirect protection to family members or housemates of the vaccinated participants, with 71.6% effectiveness ( P =0.026). The most common adverse event reported by vaccinated individuals was pain at the site of injection. In conclusion, influenza vaccine is safe and beneficial for dental staff and students. Annual influenza vaccination of dental staff, students and other healthcare workers who have direct contact with patients should be encouraged.

Leptospirosis Outbreak After the 2014 Major Flooding Event in Kelantan, Malaysia: A Spatial-Temporal Analysis

Severe floods increase the risk of leptospirosis outbreaks in endemic areas. This study determines the spatial-temporal distribution of leptospirosis in relation to environmental factors after a major flooding event in Kelantan, Malaysia. We conducted an observational ecological study involving incident leptospirosis cases, from the 3 months before, during, and three months after flood, in reference to the severe 2014 Kelantan flooding event. Geographical information system was used to determine the spatial distribution while climatic factors that influenced the cases were also analyzed. A total of 1,229 leptospirosis cases were notified within the three study periods where incidence doubled in the postflood period. Twelve of 66 subdistricts recorded incidence rates of over 100 per 100,000 population in the postflood period, in comparison with only four subdistricts in the preflooding period. Average nearest neighborhood analysis indicated that the cases were more clustered in the postflood period as compared with the preflood period, with observed mean distance of 1,139 meters and 1,666 meters, respectively (both at P < 0.01). Global Morans I was higher in the postflood period (0.19; P < 0.01) as compared with the preflood period (0.06; P < 0.01). Geographic weighted regression showed that living close to water bodies increased the risk of contracting the disease. Postflooding hotspots were concentrated in areas where garbage cleanup occurred and the incidence was significantly associated with temperature, humidity, rainfall, and river levels. Postflooding leptospirosis outbreak was associated with several factors. Understanding the spatial distribution and associated factors of leptospirosis can help improve future disease outbreak management after the floods.

Analysis of myocardial infarction signals using optical technique

Abstract The risk of heart attack or myocardial infarction (MI) may lead to serious consequences in mortality and morbidity. Current MI management in the triage includes non-invasive heart monitoring using an electrocardiogram (ECG) and the cardic biomarker test. This study is designed to explore the potential of photoplethysmography (PPG) as a simple non-invasive device as an alternative method to screen the MI subjects. This study emphasises the usage of second derivative photoplethysmography (SDPPG) intervals as the extracted features to classify the MI subjects. The statistical analysis shows the potential of “a-c” interval and the corrected “a-cC” interval to classify the subject. The sensitivity of the predicted model using “a-c” and “a-cC” is 90.6% and 81.2% and the specificity is 87.5% and 84.4%, respectively.

Utilization of second derivative photoplethysmographic features for myocardial infarction classification

Abstract Myocardial infarction (MI) is a common disease that causes morbidity and mortality. The current tools for diagnosing this disease are improving, but still have some limitations. This study utilised the second derivative of photoplethysmography (SDPPG) features to distinguish MI patients from healthy control subjects. The features include amplitude-derived SDPPG features (pulse height, ratio, jerk) and interval-derived SDPPG features (intervals and relative crest time (RCT)). We evaluated 32 MI patients at Pusat Perubatan Universiti Kebangsaan Malaysia and 32 control subjects (all ages 37–87 years). Statistical analysis revealed that the mean amplitude-derived SDPPG features were higher in MI patients than in control subjects. In contrast, the mean interval-derived SDPPG features were lower in MI patients than in the controls. The classifier model of binary logistic regression (Model 7), showed that the combination of SDPPG features that include the pulse height (d-wave), the intervals of “ab”, “ad”, “bc”, “bd”, and “be”, and the RCT of “ad/aa” could be used to classify MI patients with 90.6% accuracy, 93.9% sensitivity and 87.5% specificity at a cut-off value of 0.5 compared with the single features model.

360 STOKING THE FIRE- LOW SECONDARY PREVENTION MEDICATIONS AMONG HIGH RISK PATIENTS IN MALAYSIA

Background and Objective: Beta-blockers, antiplatelets, ACE inhibitors / Angiotensin Receptor Blockers (ACE-i/ARB) and statins are well established secondary prevention drugs for high risk patients, especially those with coronary heart disease (CHD) or stroke. However, often these are not widely used. The objective of this study is to determine their use in Malaysia. Methodology: The Prospective Urban Rural Epidemiology (PURE) study is a community-based world-wide research collaboration involving 154,000 adults (15,617 from Malaysia) to evaluate the impact of urbanization on cardiovascular disease. Demographic, anthropometric, blood pressure and fasting glucose and lipids were obtained using validated questionnaires and standard laboratory methods. Results: PURE involves 6891 rural and 8726 urban dwellers with a mean age 51.13+9.9 years; 55.9% are females. Hypertension, diabetes, overweight (BMI 25-30), obesity (BMI>30), and smokers make up 44.1%, 15.7%, 38.2%, 21.3% and 23.1% respectively. Beta-blockers, antiplatelets, ACE-i/ARB and statins are used in 2.9%, 1.3%, 2.5% and 2.5% respectively. Among CHD or stroke participants, their use is 11.1%, 13.6%, 10.9% and 13.9% respectively; urban dwellers using more Beta-blockers and antiplatelets (14.0% vs 13.4% and 12.9% vs 9.9% respectively) and rural dwellers using more ACEi/ARB and statins (11.5% vs 10.1% and 14.1% vs 13.5% respectively) and their use is more in males than females. Conclusion: Although the Malaysian public health system provides these drugs free, their actual use is abysmally low even among high risk individuals. Improving patient awareness, health education, professional commitment and health delivery system may alter the scenario.