MASH Journal Volume 7 Issue I

March 2022
Dermatofibrosarcoma Protuberans With Fibrosarcomatous Transformation: A Case Report & An Overview
Eyrique G, Riham H and Arrazeen H

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma of the skin characterized by plaque like tumor derived from mesenchymal cell. Fibrosarcomatous transformation of DFSP (FS-DFSP) is an even rarer variant of which it is clinically indistinguishable from other DFSP variant - diagnosed by histopathological characteristics. As it is known to be more aggressive with higher risk of distant metastases, treatment should be carefully planned followed by strict post-op follow ups.


This is a case of a 57 years old man with a slow growing large tumor on his forearm following a minor trauma 10 years ago, presented to our institution for further management due sudden rapid enlargement and discomfort. The result of the lesion sent for histopathological examination is diagnosed as FS-DFSP without distant metastases (from a full body CT scan). On 3rd month of follow up, neither recurrence nor symptoms of distant metastases has been observed.


In conclusion DFSP needs a histopathological examination to distinguish its variant. This is important as FS-DFSP has higher risk of recurrence and metastasis. There are options of technique to ensure complete surgical resection of tumor. In cases of metastases and unresectable tumor, radiotherapy and pharmacological treatment is to be considered.  In our case, there is no signs of recurrent or distant metastases. However, long -term follow up is strictly recommended.

A 6 Step Approach In Initiating Essential Emergency Critical Care Services In A Resource Limited Emergency Department Setting.
Gurjeet Singh a/l Harvendhar Singh

The emergency departments of today no longer only cater for treatment of life threatening conditions as it also involves monitoring and lodging of critically ill patients pending admission to the wards in view of overcrowding and longer boarding times in the emergency. Application of critical care services will ensure that the patients who are critically ill and boarding in the emergency departments especially the red zones receive proper monitoring and ICU like care services. However, advanced emergency and critical care services require many resources which may not be possible in many resource limited facilities. This calls for the introduction of essential emergency critical care, a concept that provides the essentials of critical care in the emergency setting to ensure good monitoring and continuous critical care for lodging patients. In this article we introduce a 6 step method employed in a resource limited setting to implement essential emergency critical care services in the red zones of the emergency department.

A Brief on Exercises in Gym with Some Misconceptions
Ashraful Kabir


Ancient gymnasiums were the places for social interaction, recreation and leisure, but they were first and foremost educational institutions where the intellectual and athletic training of a military character was supposed to be accomplished. The Greek gymnasium was a popular recreational space for the members of the aristocratic class as it provided those with an opportunity to perform and enhance their outstanding persona and family [1]. Gyms are one of the most pursued leisure places in western societies and can be said to have established themselves as part of a white middle-class culture [2, 3, 4, 5, 6-8, 9]. Almost 13% of the UK population is registered as members of a private health and fitness gym or publicly-owned fitness facility, with London having the most registered users [10]. Depending on the size and target group, multi-purpose amenities encourage pre- or post-training activities, for example at their spas and beauty centers or they organize social activities at the weekend [11]. Indeed, gym membership usually starts with the diagnostic procedure of a health check where weight, height, body fat, blood pressure, body mass index, etc., are measured and compared to what has been established as a scientific norm so that goals for further training can be identified and changes noticed. Bodies can be sculpted and corrected by the right diet, exercise and cosmetic products. Advertisements suggest that individuals are personally responsible for monitoring and controlling their attractiveness and ambition [12]. Gym participants over 65 years old tend to come to the gym not only for physical training but also to form social bonds [13]. The medical condition might experience to come in a gym as a compulsory homework [14].

Mental Health Evaluation Of Students In A Private University In Malaysia During The Pandemic.
Ching Xiu Wei, Lee Wei Jun, Tan Zi Tien, Muhammad Syahmi bin Nadzri, Humas Nasir, Philip George, John Pinto


Mental health disorders in Malaysia have been on the rise, especially among youth. The data from the National Health and Morbidity Survey, 2015 conducted by the Ministry of Health Malaysia recorded an increasing trend of mental health problems among adults, of age 16 years and above in Malaysia from the year 1996 (10.7%) to 2015 (29.2%). Changes in the learning environment due to the COVID-19 pandemic cause an increased burden on their mental health. This survey evaluates 118 students from a local private university using several scales such as the- DASS-21, Satisfaction with Life Scale (SWLS), and Brief Resilience Scale (BRS) to screen for mental health wellbeing. The results showed the prevalence of moderate to extremely severe depression symptoms at 33.9%, anxiety symptoms at 30.51%, and stress at 19.49%. About 31.3% of students have poor satisfaction with life and 29.7% of students have poor resilience. There seemed to be no significant association between different ethnicity, course of study, family income, and relationship status. However, there is a significant relationship between the age group of 15-24 years compared to 25-34 years in stress scores. Younger students seemed to record more stress symptoms.

Covid-19 Vaccination: The Prevalence And Influencing Factors For Vaccine Hesitancy Among Mbbs Students From International Medical University, Malaysia
Ganesha Grant, James Koh, Mariyam Nizha, Yap Cheng, Kwek Ser, Sheetel Kaur, Anis Ahmed


Vaccines have been the most effective and safe way to protect people from harmful diseases.  With the severity of the pandemic weighing on healthcare systems around the world, the development of COVID-19 vaccines has been prioritized by pharmaceutical companies around the world. Therefore, we decided to carry out research to determine the prevalence of vaccine-acceptance and vaccine-hesitancy attitudes among medical students, to identify factors influencing attitudes towards COVID-19vaccines among medical students, and to establish correlation among various variables toward COVID-19vaccination. This comparative cross-sectional study recruited medical students from semester 1 to 10, and data was collected by using a questionnaire adopted from a similar study in the local settings. A total of 397 students responded to this study. Overall, students of both phases had similar attitudes but the only significant difference regarding the trust in vaccines approved by the Ministry of Health with more agreeability in clinical phase students. This study is one of few studies that evaluate the vaccine hesitancy of medical students in Malaysia. Further studies should be carried out to compare these findings with undergraduates at various points of their education.

Outcome Of Reduction Of Subcondylar Fracture In Retromandibular Transparotid Approach
Mohammed Ayaz Ahmed


Among all mandibular fracture, 25 to 40% fractures are regarded as Condylar and Subcondylar fracture. Commonly, reduction of subcondylar fracture is done under general anaesthesia. Different approaches are found for the surgical treatment of condylar fractures besides intraoral approaches such as the pre-auricular, submandibular, rhytidectomy, retromandibular. To find out the outcome of retromandibular transparotid approach for subcondylar fracture treatment of mandible i.e to find out correction of occlusion and establishment of jaw function, infection, hematoma, salivary fistula, facial nerve damage, hematoma etc. complications. Surgical treatment of subcondylar fractures of 15 patients were done from January 2019 to December 2021 in retromandibular transparotid approach. The patients were evaluated for hematoma, infection, Frey’s syndrome, salivary fistula, facial nerve damage, occlusion, fracture site stability, chronic pain in the fracture site and temporomandibular joint movements in the postoperative period.  Facial nerve injury was not observed. Postoperative swelling of parotid region developed in first two patients. Single patient developed paresis in zygomatic branch of facial nerve causing left upper eyelid muscle weak and after two weeks of physiotherapy it became normal. Salivary fistula developed in three patients which were resolved spontaneously. Outcome of this approach like good anatomy and function was found in all cases. Good articular function was obtained in all the cases. By this retromandibular approach condylar fracture reduction, fixation and healing were managed comfortably. However, direct vision of facial nerve fibers has limited the risk of facial nerve injury.

Thoughts on Snake Species, Their Bites As Well As Management
Ashraful Kabir, Walid Fathy


Snakes are medically recognized creature all over the world. Snakebite is a much-neglected issue, but its management is urgent to the victims. Recently, Chittagong Medical College of Bangladesh has inaugurated a research section on the venom of snakes. This composition based on various reports, articles and books has been done for the multidisciplinary people. The review report suggested flood season is vulnerable to all sorts of people, and villagers are more prone to snakebite. The villagers do not get proper medications due to a lack of knowledge of first aid, and they are used to the treatment by traditional snake charmers.

Influence Of Academic Strain, Remoteness From School, And Fear Of Infection In Medical Students’ Stress And Health During The Covid-19 Pandemic
AR Denisha Ravichandran, Shiv Eswar Adrian Anantha Raja, Syacynthia Lynn Ravindran, Seow Jiin Terng , Mila Nu Nu Htay, Sujata Khobragade, Soe Moe and Htoo Htoo Kyaw Soe


The emergence of the COVID-19 has greatly affected the world and caused many unprecedented changes in our lives. For many, it has generated a significant amount of stress, anxiety, worries about health, social isolation, unemployment as well as financial problems. Just like the rest, the pandemic has really taken a toll on students’ well-being all around the world. They have a lot on their plates, especially dealing with academic strains, remoteness from school and fear of infection during this time of crisis. Therefore, a cross-sectional study was conducted to explore how and if these three stressors have an impact on the medical students’ stress and health during the pandemic. The analysis included mean, frequency, correlation, unpaired T-test & ANOVA.  Out of 159 students, we have found that Hindu religion has a higher stress level (mean =24.4). Female gender (mean = 25.6) and those who have underlying mental health issues (mean=30.3) have a higher physical and psychological impairment. There is a positive significant association between academic strain (r= 0.245, p=0.001), remoteness from school (r=0.223, p=0.003) with perceived stress. There is also a positive significant correlation between academic strain (r=0.283, p=0.000), remoteness from school (r=0.387, p=0.000), perceived stress (r=0.583, p=0.000) with impairment of physical and psychological health. Thus, with this information we can conclude that we have found that there is a positive significant association between academic strain, remoteness from school with perceived stress, physical and psychological health.

What Are The Most Important Attributes Of A ‘Good’ Doctor Among Clinical Phase MBBS Students In Malaysia?
Andrew Jacob Solomon, Nor Rafidah Bt Ibrahim, Daniel Win, Goh Ju Huan , Sujata Khobragade, Mila Nu Nu Htay, Soe Moe, Htoo Htoo Kyaw Soe


Non-academic attributes are not taught in medical school and mostly learned from home and the upbringing of certain people. Theories and clinical learning are taught in medical schools by experienced professors. A survey and study were done in the United Kingdom with 10 specialists and asked the doctors to rank the most important attributes needed in a good doctor. A cross sectional study was conducted on medical students in a private medical university in Malaysia in April 2021 to study the relationship between demographic profile and the most important factor attributes of a ‘good’ doctor among clinical phase MBBS students. Purposive non-probability sampling method was used, and data was collected through a questionnaire via Google form. Epi info v7.2.4 was used to analyse the data and mean, standard deviation and range was calculated. Based on our results, certain demographic details such as gender, academic performance, race, academic performance, parent monthly income, parent highest education, family members work in medical field had significant association with certain attributes. In conclusion, we were able to understand that certain demographic details had an impact on how medical students in the clinical phase ranks the most important attributes needed in a good doctor.

Unusual Spontaneous Passing Of Large Renal Calculi
Jesper Leonard Vun Kien Fung , Kartik Saxena


Urolithiasis is among the most common urological diseases encountered in this modern time. This report recounts a case of a 65-year-old Chinese Malaysian gentleman, presenting with left sided flank pain and symptoms suggestive of benign prostatic hyperplasia and recurrent urinary tract infection for 2 years. His pain worsened over the last 2 weeks with a newly developed bladder outlet obstruction. On the 14th day, he passed a stone measuring 10mm x 6mm. Three days later, he passed a second stone measuring 14mm x 9mm x 5mm, followed by haematuria and transient urinary incontinence. Most surgical literature and guidelines draw the cut-off point for spontaneous passing of calculi at 5mm in diameter. This unusual case of spontaneous passage of large urinary calculi serves as another excellent reminder that there are no absolutes in medicine.

A Synopsis on the Kinds and Functions of Human Hormones
Ashraful Kabir


Based on the classification of human hormones, there is no solid idea in most books. In this view, this article could exemplify a concrete solution, especially for medical and university students. Hormones have many life-saving roles in the human body. With the deficiency of hormones, our body might fall into lots of severe problems. Data analyses of much information from books, articles, as well as online supplements provided different ideas on the total hormones. The result suggested that some hormones were secreted from the same glands. Out of 110 hormones (when the same hormone produced from different sources), different types of hormones were 88. Analyzed hormones consisted of four major groups- amine (4 hormones), eicosanoid (4), steroid (15), and peptide (65) out of 88 endocrine chemicals. The endocrine and reproductive system (56) jointly secreted most of the hormones, and secondly gastrointestinal tract (26 hormones). Besides the organ system or glands, some were secreted from the cell, tissue, tissue system, and placenta. This paper also mentioned that many sex hormones were found both in males and females. In future, it is needed to enhance more research on the classification of the hormones in human body.

Application of Gagne’s Theory of Instructional Design in Training Statistics to Medical Students
Mila Nu Nu Htay, Htay Lwin, Htoo Htoo Kyaw Soe, Soe Moe, Adinegara Lutfi Abas


Research methodology and statistical training are relevant to both undergraduate and postgraduate healthcare students. Medical educators play a crucial role to provide well-planned, effective training on statistics, which should be student-centered to equip the skill in data analysis and interpretation. In order to deliver effective teaching or training, educators use the instructional design models and integrate them into the curriculum. In this article, Gagne’s theory of nine-step instructional model design is applied to the biostatistics training of undergraduate medical students. It will provide a sample framework for future statistical training programmes.

Emergency Medicine Department Continuous Medical Education (CME) 6-step Transformation
Gurjeet Singh a/l Harvendhar Singh, Nur Hayat binti Khairul Shamsudin, Kogilanivashini Sevarash, Syed Jamal Fikri bin syed yusoff fadzil


Continuous medical education (CME) is an effort by a medical department to implement teachings of a particular specialty to improve the knowledge of the staffs within a department that will translate to better clinical practice. Traditional CME modules have always involved gathering of medical officers with a preset of topics that are rotate at a regular basis with or without supervision by a specialist sees many rooms for improvements. A more flexible CME module with emphasis placed on newer topics, without constant rotations, supervision from even before the beginning of the CME and inter departmental or hospital involvement can be fostered to ensure a continuous and longer lasting seasonal CME module. In this article we introduce a 6 step transformation that was done to improve the CME module.

Cross-sectional Study of Perception on Mobile Phone Health Hazard and Behavioral Risk among Undergraduate Medical Students
Ting Pei Erl, Lok Ren Hao, Vinod Iswaran a/l Vivekananda M, Tashmeetadev Kaur Thind a/p Sukhdeve Singh, Mila Nu Nu Htay, Sujata Khobragade, Soe Moe, Htoo Htoo Kyaw Soe


There is major concern about the hazards that electromagnetic waves emitted by mobile phones may pose to human health. We aimed to assess the perception of undergraduate medical students regarding mobile phone health hazards and behavioral risk, side effects that mobile phone hazards cause, behaviors affected due to mobile phone hazards, and whether mobile phone hazards may affect classroom habits. A cross-sectional study was conducted among pre-clinical and clinical year MBBS students in a private medical university in Malaysia. An online questionnaire was distributed and a total of 120 responses were collected. Epi info V7.0 was used to analyze the data. Findings revealed our participants perceived mobile phone usage could contribute to occurrence of fatigue, sleep disturbances, headache, and loss of mental attention. As for behavior risk associated with mobile phone usage, our participants thought that there were high behavioral risks such as to sleep all night with a turned-on mobile phone resting on the bedside and to stop a conversation to answer the mobile phone. With regards to side effects, the result reveals sleep disturbances as the side effects after mobile phone usage, concentration problems and blurred vision are experienced by the most. The results of how mobile phone hazards affect classroom habits shows that participants use mobile phone internet less than 7 hours a day, receive or send text messages during class but do not play games nor make or receive calls in class. In summary, the perceived mobile phone hazards among MBBS students were 62%. This study reveals the presence of a higher percentage of perceived mobile phone hazards among undergraduate medical students.

Pulmonary Complications and Peri-Operative Outcomes of Open Renal Surgery in HSAJB During COVID-19 Pandemic
Jin Rong Tan, Shamsuddin Bin Omar


Perioperative Covid-19 infection is associated with high risk of pulmonary complications and death. This study aimed to describe the pulmonary complications and peri-operative outcomes of open renal surgery done and to identify the possible associated factors for development of postoperative pulmonary complications. This is a clinical audit of all non COVID-19 patients underwent open renal surgery in Hospital Sultanah Aminah, Johor Bahru from January 2020 to January 2022. Socio-demographic data and factors associated with development of pulmonary complication were collected. Intraoperative outcome and post-operative pulmonary complications and outcomes were described. Bivariate analysis was performed to determine the association of the factors with the development of pulmonary complications. A total of 30 patients were included. 22 open radical nephrectomies, 7 open radical nephro-ureterectomies with bladder cuff excision and 1 open pyeloplasty were done. The mean operation time was 200±58.5 min (100-335 min) and blood loss was 1578±1930ml (200-8000 ml). The pulmonary complication rate was 10%. The mean hospital stay was 13±8.8days (6-45days). Thirty days mortality rate was 3.3%. ASA grades were found to be significant association with the development of pulmonary complications. Open renal surgery is safe to be done in Covid-19 treating hospital during COVID-19 pandemic.

MASH Journal Volume 7 Issue II

July 2022
Parasites: Major Attacks, Ways Of Transmission And Preventive Measures
Ashraful Kabir

Helminths infection is a class one neglected problem nowadays, particularly in Asia and very common in economically poverty-stricken families. To build up a healthy nation, circulate a real message with this review. A literature survey suggested that only individual and family hygiene through provocation are the only ways to avoid parasitic attacks in the human community.

Perception Of Telemedicine Visits During The Coronavirus Disease 2019 Pandemic: A Cross-Sectional Study Among Medical Students
Lai Yong Liang, Delveena a/p Dhass, Lim Chang Yen, Harvind Kumar a/l Suparamaniyam, Ashwin Sekar, Sujata Khobragade , Mila Nu Nu Htay, Soe Moe, Htoo Htoo Kyaw Soe

Telemedicine is described as healing at a distance together with the utilization of electronic information and telecommunication technology to improve patient’s outcome by enabling better access to care and medical information of an individual's needs. During COVID-19 pandemic, telemedicine could be a vital tool in providing care to patients while maintaining social distancing. The aim of this research is to determine the perception of telemedicine visits during this COVID-19 pandemic among medical students in a private medical university in Malaysia. A cross-sectional study was conducted from May 2021 to June 2021 and purposive sampling was used to enrol students for this study. Data collection was done by distribution of a google link consisting of the questionnaires to the students. The questionnaire was divided into three parts which were the sociodemographic information, preference of telemedicine, and experience with telemedicine. The data was analysed by Epi Info software version 7.2. The analysis included frequency tables, percentages, odd ratios, and chi-square test. A total of 150 students had participated in this study. The majority (74.67%) prefer to visit their regular doctor in person compared to those opting for telemedicine visits (25.33%). During this COVID-19 pandemic, it is seen that the percentage of medical students who prefer to see their doctor in person has fallen to 48.67% while 51.33% prefer telemedicine visits. After social distancing ends, only 4.66% prefer telemedicine visits. Telemedicine visits are not popular among the medical students because the concept is still new in Malaysia, and it is underdeveloped. Further studies and publicity on telemedicine visits in Malaysia might encourage them to have more enthusiasm for telemedicine.

Hiding In Plain Sight - An Incidental Finding Of Crowned Dens Syndrome
Jeremy V., Aishah N, Victor N, Eyrique G1.

Crowned dens syndrome (CDS) is a rare condition in which there is an abnormal deposition of calcium pyrophosphate dihydrate (CPPD) or hydroxyapatite crystals in the ligaments surrounding the odontoid process forming a crown or “halo-like” configuration. It is often misdiagnosed. In this case, we had a patient that had been admitted in view of trauma, however on an incidental finding from the CT scan showed the diagnosis of “Crowned Dens Syndrome”. The aim of this report is to raise awareness to the existence of this condition thus preventing submitting patients to inaccurate treatment and unnecessary investigations.

Nutritional Knowledge, Eating Habits, and Health Attitudes of Clinical Year Medical Students in A Private University in Malaysia
Clarissa Seow Xin Ni, Nurul Nabila binti Ahmad Masmi, Mahaletchummi a/p S Kanan, Goh Kai Sheng, Kabiram M. Seenivasagam a/l Karunananthan, Htoo Htoo Kyaw Soe, Soe Moe, Nivedita Nadarajah, Mila Nu Nu Htay

The nutritional knowledge, health attitude, and dietary habits of medical students in their clinical year are important as adequate knowledge of nutrition is a positive influence on the healthcare of the community. Nutritional knowledge has a direct impact on the choice of food, health attitude, and beliefs towards health. This study aimed to assess the nutritional knowledge, eating habits, health attitudes, and factors affecting food choices among clinical year medical students in a private university in Malaysia. A cross-sectional study was conducted among clinical year medical students from May 2022 to July 2022.  The respondents were recruited by purposive sampling and data was collected by using an online questionnaire. Data was analyzed by using Epi info software (version, and descriptive and inferential analyses were conducted using mean, standard deviation, Chi-square test, and Fisher’s Exact test. A total of 139 students participated in this study. Among the respondents, 47.48%, 44.60%, and 62.59% had an adequate knowledge of nutrition, good eating habits, and good nutritional attitudes respectively. There is no significant association between age, gender, study year, body mass index (BMI), and a monthly allowance towards nutritional knowledge, eating habits, and health attitudes. However, data recorded shows that female respondents have better nutritional knowledge, eating habits, and health attitudes compared to males. Health promotion among medical students should be carried out as it will encourage healthier lifestyle practices, which will be implemented in their careers as doctors in the future.

Effect of Laughter Therapy on Physiological and Psychological Functions Among Medical Students: A Randomized Controlled Trial
Lim Tian Kui , Pooja Renyshah A/P Thangaganesh, Thaarini A/P Vijayandran, Vethasri A/P Maheswaran, Htoo Htoo Kyaw Soe, Soe Moe, Minoo Pothen , Mila Nu Nu Htay

Laughter therapy is highly recommended to have positive impacts on physiological, psychological, and biological function, especially in producing serotonin and helping to inhibit the stress hormone. An open labelled, randomized control trial, the effect of laughter therapy on physiological and psychological functions among undergraduate medical students was conducted in a private medical university in Malaysia. While the control group carried on, as usual, the intervention group underwent laughter therapy, which included paper and pillow fights and comedy shows during three days of intervention. It was necessary to monitor both groups' blood pressure, heart rate, and stress level in assessing the laughter therapy. Assessment of perceived stress was conducted through Google form questionnaire of Perceived Stress Scale while the digital blood pressure equipment was used to measure the blood pressure and heart rate throughout the session. Heart rate and blood pressure were recorded, and perceived stress scale was administered before and after the intervention. However, there was no significant difference in perceived stress between the intervention and control groups after the intervention. These facts imply that neither the pre-intervention nor post-intervention results of this study was able to demonstrate appreciable modifications in the blood pressure, heart rate, or stress level.

Knowledge, Attitude and Perception on Traffic Noise Pollution among Undergraduate Medical Students in Malaysia: A Cross-Sectional Study
Jayshrie a/p Murugan, Avenashini a/p Anpalakan, Sri Dania Shreida, MohanKumar a/l Kanniaseelan, Htoo Htoo Kyaw Soe , Soe Moe, Htay Lwin, Mila Nu Nu Htay

Noise is a persistent environmental hazard in our current world, and it arises from a diverse number of sources, and it is not taken as seriously as other sources of pollution. However, noise pollution can be regarded as the third most harmful factor in major cities. This study was conducted to assess the effects of noise pollution on undergraduate medical students in Malaysia as well as due to the limited amount of research on this topic. Therefore, a cross-sectional study was conducted from July 2022 to August 2022 among undergraduate medical students in a private medical university in Malaysia. A purposeful sampling method was utilized to enlist students and a questionnaire was used to collect data. The analysis is explained using frequency tables, percentages, standard deviations, unpaired t-test, and one-way ANOVA test. The effect of noise pollution on human health respondents, the highest number correctly answered was 95.9% for irritation and the lowest number was 30.6% for increased heart rate respectively. The next question was whether reflection levels of high-rise buildings were a factor in raising the level of noise pollution, 83.7% answered correctly and the third question was whether trees reduce noise pollution, 80.6% answered correctly. 73.5% answered correctly that retaining walls were effective to reduce traffic noise pollution and 68.4% correctly answered vegetation density was effective in reducing noise. A total of 51.0% answered creating walls was more effective in reducing noise pollution than using dirt hills next to highways, 87.8% were familiar with the suitable plant species for reducing sound, and 71.4% familiar with the suitable materials of the highway walls to reduce noise. And for the final questions, 57.1%, 80.6%, and 76.5% answered correctly on the knowledge level of students about the effects of noise pollution on human health. The mean score obtained was 14.5, whereby 56% had good knowledge regarding the effects of noise pollution on human health.

Correlation Between Eating Habits and Exam Stress Among Medical Students in Malaysia: A Cross-sectional Study
J. B. Sathmi S. De Silva , Fathima Safna Tuan Fareed, Mah Yin Chang, Keishini a/p T. Alagarajah, Sujata Khobragade , Htoo Htoo Kyaw Soe, Soe Moe, Mila Nu Nu Htay

Stress is thought to influence human eating behaviour. Usually, it has a negative impact on human health. Medical students could feel stress during their studies contributed by the nature of their study. As a result, their appetite can be affected by skipping meals or eating fast food. The aim of this study was to assess the pattern of eating habits and its association with stress among medical students. This cross-sectional study was conducted among the undergraduate medical students in a private medical university college in Malaysia. Researchers used questionnaires consisting of questions on sociodemographic, stress and eating habits, which was distributed online. The data was statistically analysed using Epi Info version Correlation test, unpaired T-test, one-way ANOVA, and general linear model were used to analyze the data. A total of 109 students participated in the study. The mean age was 22.2     years and 70.6% were female students. Findings revealed that 40% of students showed to be having poor eating habits, that was positively associated with the exam stress (r= 0.69, p value= 0.004). A significant positive association was established between gender and exam stress faced by the medical students that have participated in the study (p value= 0.01). This study demonstrated that exam stress and eating habits are critical issues for a medical student’s life and their future. Therefore, undergraduate medical students need support and guidance on healthy eating habits and strategies to cope up with exam stress especially when they are preparing for important exams and also right after the exams.

Utilisation, satisfaction and opinion on telemedicine among undergraduate medical students: A cross-sectional study in Malaysia
Theophania Hor Zhi Zhen , Leong Weng Shen, Yugendran, Pawan Madusanka, Manasa Manivannan, Htoo Htoo Kyaw Soe, Mila Nu Nu Htay, Soe Moe, M Swamenathan

Covid-19 crisis in Malaysia has strengthened the foundation of the country's digital health care services. Currently, the idea on telemedicine is more prevalent among medical students which plays a vital role in their present and future life. This study was aimed at determining the utilization, satisfaction, opinion on telemedicine and their relationship among undergraduate medical students. This study was an analytical cross-sectional study conducted from July 2022 to August 2022, among the undergraduate medical students in a private medical university in Malaysia. We had recruited 158 participants by non-probability purposive sampling. Self-administered questionnaires were distributed online via Google forms to undergraduate students. The data was processed and analysed using Microsoft Excel and Epi Info version Statistical tests used was Chi square test, Fisher’s exact test, Unpaired t-test and Correlation. The frequency and percentage were analysed for qualitative data while mean, standard deviation and range for quantitative data. Level of significance was set at p<0.05 and odds ratio was calculated. Among the 158 participants, only 20.89% participants had self-utilized telemedicine, 24.68% participants utilized for family and friends and 17.09 % participants observed doctors utilizing telemedicine. Mean satisfaction score was 63.50 ± 12.11 and mean opinion score was 91.21± 15.87. Pearson correlation coefficient was 0.7 and it was statistically significant (p<0.001). There was significant, high, and positive linear correlation between satisfaction and opinion on telemedicine utilization. This study showed majority have heard and have some information about telemedicine, but few have utilized telemedicine. More participants responded positively in terms of future utilization of telemedicine There was significant association between utilization, satisfaction and opinion on telemedicine among the students. It is essential for medical students to integrate telemedicine in their future career in view of the rapid digitalisation of healthcare delivery system.

A Revision Exclusively on the Diseases of Female Reproductive Organs and Breasts
Ashraful Kabir

Based on human survival, females have innumerable impacts on this universe. They give birth for the continuity of generation through pregnancy. If mothers are housewives or service-holders, naturally, they spend most of their time, to nourish and care for children. Twenty-four references have helped to accumulate a clear conception of these female reproductive diseases. The review result suggested that out of 28 diseases, the incident of disease percentages was 28.57, 10.71, 25, 10.71, 25, 10.71, 17.86, and 3.57 in the uterus, cervix, ovary, fallopian tube, vagina, vulva, breast, and bone respectively. Females get affected with lactation-mediated osteoporosis and osteoporosis due to menopause. Amongst the menstrual problems, at the time before menopause or during the time of menopause (pre-, post-, and peri-menopausal symptoms), females received lots of life-threatening issues in their lives.

Endocarditis in Disseminated Melioidosis: A Case Report
TS Ng1, MA Wajidi

Melioidosis is a disease caused by Burkholderia pseudomallei and it is an endemic in Southeast Asia. We report a case of a 59 years-old gentleman who worked as plantation worker presented to hospital with symptoms of fever, cough, loss of weight and appetite for 1 week of duration. Examination reviewed unilateral left limb swelling. Investigations showed bicytopenia and high inflammatory marker. Chest x-ray noted left upper lobe cavitation and ultrasound showed left popliteal deep vein thrombosis (DVT). A diagnosis of community acquired pneumonia and left DVT was made. He was initially started on intravenous augmentin plus oral azithromycin and subcutaneous enoxaparin, however his clinical condition deteriorating with multiple spikes of temperature. Subsequently, CT thorax revealed a large left lung cavitation with splenic microabscesses. Echocardiogram showed vegetation over the non-coronary cusp of the aortic valve and repeated blood culture grew showed growth of Burkholderia pseudomallei. Diagnosis was revised to disseminated melioidosis with native valve infective endocarditis. Antibiotics were escalated to intravenous meropenem and oral bactrim. Unfortunately, patient succumbed on 4th week of hospitalization.