HKL Research Day 2023

Advisor
Dr Marina Abdullah Sani
Deputy Director, Hospital Kuala Lumpur (HKL)
Organiser Co-organiser
Dr Saiful Safuan Md Sani
Head, Clinical Research Centre HKL
Dr (Mr) Iskandar Hailani
President, Postgraduate Society HKL
Event Manager Deputy Event Manager
Dr Duratul’ain Mohamad Nazri Dr Siti Zubaidah Othman
Speakers’ Invitation Abstract Submission, Oral &
Poster Competition
Dr Karina Koh
Dr Prem W.P Venugopal
Dr Mohd Azizuddin Amir Shariffuddin
Dr Hee Yew Ping
Dr Zubaidah Othman
Promotion, Program Book Registration, Correspondence,
Certificate
Dr Lee Jen Ven
MA Mastura binti Mohd Murad
Dr Aina Waheeda Mohamad
Dr Nazifa Nusral
Dr Nadiah Ismail
IT, Multimedia, Audiovisual,
Design
Finance, Sponsorship, Food &
Beverages
Dr Varaalakshmy Gokilavanan
MA Mohamad Ikram Zaki Jaafar
Dr Nik Nur Eliza Mohamed
Dr Duratul’ain Mohamad Nazri
Dr Siti Zubaidah Othman
Administration, Letters,
Logistics
Texts Preparation
Mdm Aribah Izni
Mr Mulyadi Ramli
Dr Karina Koh
Dr Lee Jen Ven
3
6th Hospital Kuala Lumpur Research Day 2023 l

Page
Message from Deputy Director General of Health
(Research & Technical Support) Ministry of Health
Malaysia
5
Message from Director of Hospital Kuala Lumpur (HKL) 6
Message from Head of Clinical Research Centre Hospital
Kuala Lumpur
7
Tentative Programme 8
Speaker’s Profile 9 – 13
Hospital Kuala Lumpur Hospital Research & Review
Committee 2023
14
Hospital Kuala Lumpur Research Coordinators 2023 15
HKL Research Publication Award 2022 16
Oral & Poster Presentation Competition 17
Abstracts – Oral Presentation 18 – 22
Abstracts – Poster Presentation 23 – 52
2022 HKL Research Day Gallery 53 – 54
Trainings & Workshops 2023/ CRCHKL Newsletter 55
CRCHKL Activities 2022-2023 56 – 57
Workflow for Conducting Research in HKL 58
4

I would like to congratulate Clinical Research Centre Hospital Kuala Lumpur for generously
hosting on the 6th annual Hospital Kuala Lumpur Research Day, a celebration of
innovation, curiosity, and the pursuit of knowledge.
With the theme ‘Research today for the best healthcare tomorrow’, today’s programme
serves as a testament to the power of human intellect, our insatiable quest for
understanding, and on our unwavering commitment to pushing the boundaries of
knowledge. It is a platform that amplifies the remarkable work being done across diverse
fields, ranging from medicine and technology to social sciences and the humanities.
Today, HKL is the National Referral Centre whereby multiple disciplinary subspecialities
are situated to offer the best services in the country.
On top of that, HKL has progressed to be the favourite site for clinical trials by major
pharmaceutical companies worldwide as being the largest hospital in the country with
the biggest pool of patients. This in fact is a significant contribution to the world’s
research database where our esteemed researchers and dedicated patients are being part
of it. Well done!
As we embark on this journey of intellectual exploration today, let us embrace the
excitement of discovery, the joy of learning, and the power of collaboration. May this
Research Day inspire us all to continue our quest for knowledge, to never stop asking
questions, and to keep pushing the boundaries of what we thought was possible.
Keep up the great work and let the exploration begin!
Datuk Dr Nor Fariza
Binti Ngah
Deputy Director-General of
Health (Research and Technical
Support), Ministry of Health,
Malaysia
5

I am honoured to write a few words regarding the 6th HKL Research Day 2023. This annual
event is organized by Clinical Research Centre Hospital Kuala Lumpur (CRC HKL). HKL is
the largest tertiary public hospital in the country. HKL has always had an impressive
record of achievements in health and medical research, thanks to the dedication and hard
work of its clinicians and allied health team, who have all worked hard to make significant
contributions to the local and international research community.
Every year, HKL staff members are encouraged to share and present their research
findings, fostering a love for research within the community. Their commitment,
dedication and devotion have been the driving force behind the advancement of clinical
research in HKL.
It brings me immense pride to see how research is thriving at HKL. Last year, in 2022,
there were 263 Investigator-Initiated Research projects, 88 Industry-Sponsored Research
Initiatives, 219 publications and 360 poster or oral presentations. These statistics are not
mere numbers, but rather they represent the effort and dedication that HKL have put in
to promote evidence-based medicine in the hospital.
Moreover, collaborative research with industry partners, universities and MOH facilities is
highly encouraged to further expand and grow research efforts at HKL. I am optimistic
that this annual event will inspire more HKL staff to engage in research and contribute to
improving healthcare in the future.
I extend my warmest congratulations the Clinical Research Centre Hospital Kuala Lumpur
for organizing the 6th HKL Research Day 2023.
Thank you.
Datin Paduka Dr Rohana
binti Johan
Director, Hospital Kuala Lumpur
6

On behalf of the organising team, it is my great pleasure to welcome everyone for joining
the 6th Hospital Kuala Lumpur Research Day 2023 with the theme “Research Today for the
Best Healthcare of Tomorrow”. We are proud to again host a physical event today. The
small dedicated team of CRCHKL is making progress in the field of research and
promoting research culture among new and ongoing researchers. Research consultations,
trainings and workshops are provided to nurture them along their research journey.
Hospital Kuala Lumpur Research Day brings together a wide spectrum of healthcare
professionals the opportunity to collaborate and update on the latest knowledge, clinical
skills as well as sharing of experiences. By practicing evidence-based medicine, we hope
to achieve an improved healthcare and better quality of life for the patients.
Healthcare is ever evolving from policies to patients and clinical research has a significant
influence on the development of health policy and delivery of patient-centered care. The
pandemic has further accelerated the adoption of digital technology in healthcare.
Therefore, we had eminent speakers on the agenda to address the power of Artificial
Intelligence on healthcare, how digital health is altering patient care, the importance of
translating research into policy, conducting meaningful research and the future of
decentralization clinical trials.
Finally, my heartfelt thanks to the main working committee for their well-coordinated
commitment in making this event a success. I would like to thank Deputy Director
General of Health (Research & Technical Support) Ministry of Health for officiating the
event, Director of Hospital Kuala Lumpur for the unwavering support, kind sponsorship
from Clinical Research Malaysia and Great Eastern and many individuals who had directly
or indirectly contributed towards this 6th Hospital Kuala Lumpur Research Day.
Thank you and best wishes!
Dr Saiful Safuan Bin Md Sani
Head, Clinical Research Centre
Hospital Kuala Lumpur
7

6th HOSPITAL KUALA LUMPUR RESEARCH DAY 2023
03 Aug 2023 (Thursday), 8.00 am – 5.00 pm l Main Auditorium, Hospital Kuala Lumpur
“Research Today for the Best Healthcare of Tomorrow”
Time Agenda
8.00am – 8.25am Registration
8.25am – 8.35am Arrival of Distinguished Guests & VIPs
8.35am – 8.45am Welcoming Address by Master of Ceremony
8.45am – 8.50am Prayer Recital
8.50am – 9.05am Welcoming Speech
Dr Saiful Safuan Bin Md Sani, Head of Clinical Research Centre, Hospital Kuala
Lumpur
9.05am – 9.25am Officiation of 6th Hospital Kuala Lumpur Research Day 2023
Datuk Dr. Nor Fariza Binti Ngah, Deputy Director - General of Health (Research &
Technical Support), Ministry of Health, Malaysia
9.25am – 9.30am Launching of 6th HKL Research Day 2023 Multimedia Presentation
9.30am – 9.50 am Presentation of Certificates of Appreciation to Hospital Research Review
Committee 2023
Datuk Dr. Nor Fariza Binti Ngah
HKL High Impact Factor (IF) Publication Award Giving Ceremony
Datin Dr. Sheamini Sivasampu, Director of Institute For Clinical Research,
National Institutes of Health
9.50am – 10.30am TEA BREAK & BOOTH VISIT (Main Lobby, Hospital Kuala Lumpur)
10.30am – 11.15am Advancing Precision Medicine: Harnessing the Power of AI
Prof Datuk Dr. A Rahman A Jamal, Founding Director of UKM Medical Molecular
Biology Institute (UMBI)
11.15am – 12.00pm Making Research Meaningful: Translating Research into Policy
Dato’ Dr. Amar Singh HSS, Consultant Paediatrician
12.00am – 1.15pm Oral Presentation Competition
1.15pm – 2.15pm LUNCH BREAK
BOOTH VISIT
2.15pm – 3.00pm Application of Digital Health in Patient Care
Mr William Law, Digital Health Research and Innovation Unit, Institute For
Clinical Research, National Institutes of Health
3.00pm – 3.45pm Patient-Centered Research: Maximizing the Benefits of Meaningful Research
Dr. Syazatul Syakirin Binti Sirol Aflah, Respiratory Physician, Institut Perubatan
Respiratori (IPR)
3.45pm – 4.30pm Decentralizing of Clinical Trials: Putting Patients First
Mdm Asha Thanabalan, Clinical Research Malaysia (CRM)
4.30pm – 5.00pm Prize Giving & Closing Ceremony
Datin Paduka Dr. Rohana binti Johan, Director of Hospital Kuala Lumpur
6th Hospital Kuala Lumpur Research Day 2023 l 8

Advancing Precision Medicine: Harnessing the Power of AI
Professor Datuk Dr. A. Rahman A. Jamal is the founding director of UKM Medical
Molecular Biology Institute (UMBI) and a professor of Paediatric Haematology, Oncology
and Molecular Biology. He has been helming the key research initiatives of UMBI since its
establishment in 2003. His vision for UMBI is to be the leader in precision medicine using
next generation sequencing technologies.
As an esteemed researcher, clinician and one of the key drivers of molecular medicine
research, he has more than 100 publications, awarded with numerous research grants
and supervised more than 50 postgraduate students.
He has a diverse research interest but his main focus is on cancers and blood disorders.
Together with his research team, they have discovered various important gene signatures
associated with the pathogenesis of colorectal cancer, glioma and leukaemia.
He sits in a good number of national key committees including being the Member and
Board of Directors of Clinical Research Malaysia Sdn Bhd, Melaka Biotechnology
Corporation and NanoMalaysia Sdn Bhd. He is also the Chairman of National Committee
for Ethics for Stem Cell Research and Therapy as well as Taskforce for Precision Medicine
under the Academy of Sciences Malaysia.
Professor Datuk Dr A.
Rahman bin A. Jamal
Founding Director of UKM
Medical Molecular Biology
Institute (UMBI)
9

Making Research Meaningful: Translating Research into Policy
Dato’ Dr Amar-Singh HSS, Cert Theology (Aust, Hons), MBBS (Mal), MRCP (UK), FRCP
(Glasg), MSc Community Paediatrics (Ldn, distinction), is a Consultant Paediatrician. He
served the Malaysian civil service for 35 years and led both a regional Paediatric
Department and a Clinical Research Centre.
He is still active in research, has published a number of books including one on research
and has numerous local and international research publications and reports. He is keen
on Health Systems Research, Community & Applied Research and in assisting others to
conduct research.
He has used research evidence extensively to change the health care services in the
country and to implement new programmes. He is an active child and disability advocate
and is the recipient of the “Outstanding Asian Paediatrician Award” 2012, the “SENIA
Advocacy Award” 2016 and the “Rehabilitation International Centennial Award for
Significant Contributions” 2023. He is also an honorary Senior Fellow at the Galen Centre
for Health and Social Policy.
10
Dato’ Dr Amar Singh HSS
Consultant Paediatrician

Application of Digital Health in Patient Care
Mr William Law Kian Boon is an experienced researcher who wears many hats. He has
been serving in Ministry of Health Malaysia since 2007 after graduating with a Bachelor
of Pharmacy. After working several years as a clinical pharmacist in Hospital Sultan Ismail
and Hospital Kuala Lumpur, he joined Centre for Clinical Trial, Institute of Clinical Research
in 2010 before moving onto Digital Health Research and Innovation Unit, ICR in 2019.
He also holds a Masters in Science (Statistics) from University Malaya since 2017. Besides
that, he is equipped with various professional certificates such as; Professional Certificate
in Project Management, Diploma of Professional Translator from Malaysian Translator
Association Malaysia, Microsoft Training Specialist Certification and a Certificate in
Introduction to Mathematical Models of the Epidemiology and Control of Infectious
Diseases from The Imperial College of London.
Mr William’s main research interests are in statistical modeling and analysis,
mathematical modelling of infectious diseases, artificial intelligence modeling, clinical
epidemiology, clinical research management, health informatics, big data analytics and
digital health research & innovation. He has published more than 20 papers and is
currently involved in numerous research projects.
11
Mr William Law
Digital Health Research and
Innovation Unit, Institute For
Clinical Research, National
Institutes of Health (NIH)

Patient-Centered Research: Maximizing the Benefits
of Meaningful Research
Dr Syazatul Syakirin is a respiratory physician working at the Institute of Respiratory
Medicine (IPR), Kuala Lumpur. She is the Lead/ Head of the Special Interest Group
for Interstitial Lung Disease within the Malaysian Thoracic Society (MTS). She
graduated from the National University of Malaysia (UKM) in 2003 and obtained
her membership of Royal College Physician (MRCP) United Kingdom in the year
2010. She pursued respiratory sub-speciality training in Malaysia with further
training in Interstitial Lung Disease (ILD) in Forli, Italy.
She is a member of Malaysia Thoracic Society (MTS), Malaysia Association
Bronchology Intervention Pulmunology (MABIP), World Association Bronchology
Intervention Pulmunology (WABIP), Asia Pacific Society of Respirology (APSR),
International Association for the study of Lung Cancer (IASLC) and World
Association Sarcoidosis and other granulomatous disorders.
She is active in research and participates in presenting oral and poster in local and
international congresses. Recently, Dr. Syazatul Syakirin and her team in IPR
became the first Asia Pacific (APAC) recruiter for an Idiopathic Pulmonary Fibrosis
(IPF) study.
12
Dr Syazatul Syakirin Binti
Sirol Aflah
Respiratory Physician
Institut Perubatan Respiratori (IPR)

Decentralizing of Clinical Trials: Putting Patients First
Mdm Asha Thanabalan is a senior business development manager in Clinical Research
Malaysia (CRM). She has abundance of existing knowledge on the workings of healthcare,
especially in clinical research (Malaysian GCP certified) and expertise in managing
campaigns and promotional programs. Her strengths in communication skill, and frequent
engagement with existing and new stakeholders are keys to her success.
She Graduated with Bachelor’s Degree in Health Sciences (Biomedicine), University of
Science Malaysia (Health Campus) in 2005 and started her career as a research assistant
in University Malaya. Her key responsibilities include assisting in molecular parasitology
research projects involving Brugia pahangi. She then served as senior technical officer at
Brain Research Institute, Monash University for 3 years before joining CRM as assistant
manager, Medical Research & Ethics Committee.
Her current job is to strategies and contribute to Business Development operations in
accordance with company's key strategies and play an active role in networking and
searching for new business opportunities through identifying new markets/potential
clients.
13
Mdm Asha Thanabalan
Clinical Research Malaysia (CRM)

14
Dr Subasri Armon
(Pathologist)
Ms (Dr) Farah Hani Hassan
(Otorhinolaryngologist)
Dr Ahmad Zaid Zanial
(Nuclear Medicine Physician)
Ms (Dr) Buvanes Chelliah
(Obstetrician & Gynaecologist)
Mdm Hayati Alwani Yahaya
(Clinical Pharmacist)
Ms A’in Syirah Mazlan
(Environmental Health
Officer)
Ms (Dr) Siti Hawa Tahir
(Orthopaedic Surgeon)
Dr Kartikasalwah Abd Latif
(Neuroradiologist)
Mr (Dr) Lee Chee Wei
(Oral Maxillofacial Surgeon)
Dr Muthukkumaran Thiagarajan
(Oncologist)
Mdm Tay Chan Yen
Mdm Norsuhaila Sha’ari
(Dietitian)
Dr Julaina Terimo
(Rehabilitation Physician)
Mr (Dr) Koh Khai Luen
(Plastic & Reconstructive Surgeon)
Dr Narul Aida Salleh
(Family Medicine Specialist)
Dr Wan Hazlina Wan Mohamad
(Nephrologist)
Dr Rahela Ambaras Khan
Dr Khoo Lay See
(Forensic Officer)
Dr Zulaiha Muda
(Paediatrician)
Ms (Dr) Chan Li Yen
(Ophthalmologist)
Dr Mohd Hafiz Norzan
(Psychiatrist)
Mr Jivanraj Nagarajah
Dr Nabilah Solehah Ahmad Tamrin
(Physicist)
Dr Zaleha Abd Manaf
(Paediatric Radiologist)
CRCHKL
Dr Karina Koh
Dr Lee Jen Ven
Dr Nadiah Ismail
Dr Siti Zubaidah Othman
Dr Nik Nur Eliza Mohamed
Dr Prem A/L W.P. Venugopal
Dr Aina Waheeda Mohamad
Dr Nazifa Nusral
Dr Hee Yew Ping
Chairperson: Dr Ngu Lock Hock (Metabolic Geneticist)
Deputy Chairperson: Dr Saiful Safuan Md Sani (Acute Internal Physician)
Secretary: Dr Mohd Azizuddin Amir Shariffudin (Clinical Research Centre)
Dr Julaina Terimo
Dr Mohd Hafiz Norzan
Dr Farah Hani Hassan
Mdm Norsuhaila Sha’ari
Mdm Hayati Alwani Yahaya
Dr Mohd Azizuddin Amir Shariffuddin
Dr Zubaidah Othman
Dr Hee Yew Ping
Dr Nik Nur Eliza Nik Mohamad

15
Anaesthesia & Intensive Care Dr Arul Sakthi Aruminathan
Dermatology Dr Suganthy Robinson
Dietetics & Food Services Mdm Norsuhaila Sha’ari
Emergency & Trauma Dr Wan Nor Aida binti Wan Mohd Shukri
Engineering Ir. Akmal Arif bin Mohammed
General Medicine Dr Ng Yoke Mui
General Surgery Mr (Dr) Narasimman Sathiamurtrhy
Genetic Dr Kavitha A/P Rethanavelu
Health Education Mdm Jamaliah binti Abd. Rashid
Hospital Surpervisory Mr Rosdi bin Zainol
Kuala Lumpur Health Clinic Titiwangsa Dr Narul Aida binti Salleh
Medical Record/ Casemix Mdm Nur Syazwin binti Preshahdin
Medical Social Work Mdm Noor Syuhadah binti Mokhtar
National Blood Centre Dr Alvina Lau Voon Na
National Institute Forensic Medicine Dr Khoo Lay See
National Transplant Resource Centre Dr Zaidani Ekram Attamimi
Nephrology Dr Tan Min Hui
Neurology Dr Dhayalen Krishnan
Neurosurgery Ms (Dr) Priya Sharda A/P Jagdish Mitter
Nuclear Medicine Dr Mohd Fazrin bin Mohd Rohani
Nursing Matron Azliha Minai Rajab
Occupational Safety & Health SN Jheffany bin Yazid
Occupational Therapy Mr Muhammad Sulaiman bin Samat
Ophthalmology Ms (Dr) Chan Li Yen
Oral & Maxillofacial Surgery Mr (Dr) Jonathan A/L Rengarajoo
Orthopaedics & Traumatology Mr (Dr) Arshad bin Puji
Otorhinolaryngology Mr (Dr) Rohaizam bin Japar@Jaafar
Pathology Dr Subasri Armon
Pharmacy Mdm Jacqueline Wong Hui Yi
Physiotherapy Ms Ong Hai Choo
Plastic & Reconstructive Surgery Mr (Dr) Koh Khai Luen
Psychiatry & Mental Health Dr Chee Kok Yoon
Psychology Counselling Mr Mat Noor Kamarol bin Abdul Talib
Public Health Ms A’in Syirah bt Hj Mazlan
Quality Dr Nur Syafika Zazili
Radiology Dr Sarawana Chelwan Muniandy
Radiotherapy & Oncology Dr Muthukkumaran Thiagarajan
Rehabilitation Dr Masyitah binti Mohammad Khayat
Respiratory Medicine Institute Dr Syazatul Syakirin Sirol Aflah
Urology Mr (Dr) Lo Hwa Loon

16
Award for High
Impact Factor
Publication
(Case Report)
Autosomal recessive progeroid syndrome due to
homozygosity for a TOMM7 variant
The Journal of Clinical Investigation (IF: 5.53)
Abhimanyu Garg, Wee-Teik Keng, Zhenkang Chen,
Adwait Amod Sathe, Chao Xing, Pavithira Devi
Kailasam, Yanqiu Shao, Nicholas P Lesner, Claire B
Llamas, Anil K Agarwal, Prashant Mishra
Award for High
Impact Factor
Publication
(Research)
Time from last immunity event against infection
during Omicron-dominant period in Malaysia
International Journal of Infectious Diseases (IF: 2.43)
Su Lan Yang, Adiratna Mat Ripen, Jen Ven Lee, Karina
Koh, Chia How Yen, Avinash Kumar Chand, Nur Aisyah
Binti Abdul Rahim, Varaalakshmy Gokilavanan, Nik Nur
Eliza Binti Mohamed, Raj Kumar A/L Sevalingam, and
Kalaiarasu M. Peariasamy
Award for High
Impact Factor
Publication
(Research)
Kuala Lumpur train collision during the COVID-19
pandemic
World Journal of Emergency Surgery (IF: 1.74)
Alzamani M. Idrose, Fikri M. Abu-Zidan, Nurul Liana
Roslan, Khairul Izwan M. Hashim, Saiyidi Mohd Azizi
Mohd Adibi, Mahathar Abd. Wahab
Award for High
Impact Factor
Publication
(Support
Services)
Home parenteral nutrition during the COVID-19
pandemic: Experience in a tertiary referral
hospital in Malaysia
Clinical Nutrition (IF: 1.55)
Fun-Wee Hoo, Chee-Tao Chang, Mohd Haz Hairul
Amran
*Criteria for nomination:
- Top impact factor (IF) based on Scientific Journal Rankings 2022 in Hospital Kuala Lumpur (HKL).
- The first, second or third author is affiliated to Hospital Kuala Lumpur.

17
Oral Presentation Judges
Dr Rahela Ambaras Khan
Head of Pharmacotherapy Services Hospital Kuala Lumpur
Prof Dato’ Dr Azizi Hj Omar
KPJ Healthcare Berhad Chairman/ Consultant Paediatrician/ Paediatric
Respiratory Physician KPJ Damansara Specialist Hospital
Prof Dr April Camilla Roslani
Senior Consultant Colorectal Surgeon/ Dean Faculty of Medicine, University
Malaya
Poster Competition Judges
AP Dr Wan Nur Nafisah Wan Yahya
Consultant Neurologist/ Head, Medical Department HCTM, UKM
Dr Nor Zam Azihan Mohd Hassan
Public Health Physician/ Head, Center for Health Economics Research IHSR, NIH
Dr Ngu Lock Hock
Senior Consultant/ Head, Genetics HKL
Mr (Dr) Koh Khai Luen
Plastic & Reconstructive Surgeon HKL
Prof Dr Nik Sherina Haidi Hanafi
Consultant FMS UMMC/ Deputy Chair MREC UMMC
Dr Chern Phei Ming
Consultant Rehabilitation Physician, Head, CRC Cheras Rehabilitation Hospital
Dr Ahmad Zaid Zanial
Nuclear Medicine Physician HKL
Mr Jivanraj Nagarajan
Clinical Pharmacist HKL
Prizes
Oral
Winner: RM400
2nd: RM300
3rd: RM200
Consolation: RM100 x2
Poster (Research)
Winner: RM300
2nd: RM200
3rd: RM150
Poster (Case Report)
Winner: RM200
2nd: RM150
3rd: RM100

–
18
Vaping Topography and Health Risk Assessment of Electronic Cigarettes Use
Najihah Zainol Abidin1, Emilia Zainal Abidin2, Aziemah Zulkifli1, Sharifah Norkhadijah
Syed Ismail2, Karmegam Karuppiah2, Amer Siddiq Amer Nordin3
1Department of Diagnostic and Allied Health Science, Faculty of Health and Life Sciences,
Management & Science University, 40100 Shah Alam, Selangor.
2Department of Environmental and Occupational Health, Faculty of Medicine and Health
Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor.
3Centre on Addiction Sciences (UMCAS), University of Malaya, 50603 Kuala Lumpur.
Department of Psychological Medicine, Faculty of Medicine, University of Malaya, 50603
Kuala Lumpur.
Introduction
Limited data on local vaping topography on the use of electronic cigarettes (EC) products
raises concerns and a challenge for a comprehensive health risk assessment to be done.
Objective: This study aimed to estimate the non-carcinogenic and carcinogenic health
risks due to the exposure to selected aldehydes and heavy metals present in the EC
vapours.
Methodology
Vaping topography data was gathered from a survey among 226 tobacco users. Chemical
analysis was done on EC vapours produced from the top ten locally manufactured e-
liquid. Using both data, health risk assessment was calculated.
Results
The EC vapours analysed showed mean concentrations of formaldehyde, acetaldehyde,
aluminium, chromium, iron, nickel, copper, cadmium and lead between 4.31-7.04 ppm,
3.34-5.88 ppm, 0.126-0.205 ppm, 0.0258-0.0323ppm, 0.646-1.51 ppm, 0.520-0.980
ppm, 0.118-0.0495 ppm, 0.00453-0.00311 ppm and 0.0288-0.0256 ppm respectively
when operated in low and high wattage settings. It was estimated that the
exposure to selected compounds in EC vapours may pose both non-carcinogenic and
carcinogenic risks to users where 1 and 2 in every 10,000 EC user’s population had the
potential of developing cancer in their lifetime.
Discussion/Conclusion
The continuous and prolonged exposures to these harmful substances may cause a
burden to the public health system. The growing trend of EC users’ population among
never-smokers and the rapid evolution of this product, continuous research focusing on
local EC products and users is necessary to provide more scientifically based evidence to
authorities for comprehensive regulations on EC products to be formulated and
implemented.

19
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Nutritional Status and Perception of Traditional and Complementary Medicine (T&CM)
Usage Among Cancer Patients in Institut Kanser Negara, Putrajaya and Hospital Kuala
Lumpur : A Descriptive Study
Norsuhaila Sha’ari1, Norshariza Jamhuri2
1Department of Dietetics and Food Service, Hospital Kuala Lumpur, Kuala Lumpur
2Department of Dietetics and Food Service, Institut Kanser Negara, Putrajaya
Introduction
Cancer patient often turns to T&CM as a part of cancer treatment. This study aimed to
determine the nutritional status and perception of T&CM usage among cancer patients
in Institut Kanser Negara and Hospital Kuala Lumpur.
Methodology
Validated questionnaire derived from the Malaysian Breast Cancer Survivorship Cohort
study was used in this cross-sectional study. Demographic and clinical data were
obtained from recent medical record. Subjects were followed up on after a month to
obtain anthropometric data and nutritional intake.
Results
This study enrolled 382 subjects, with median age 51.38±11.73 years and 34.8% used
T&CM. Subjects were mostly female (81.2%), Malay (89.5%) with secondary education
(57.1%). Breast cancer patients were the highest users of T&CM, 50.4% had
comorbidities and 38.3% at Stage 4. T&CM use was associated with ethnicity (p=0.001),
cancer type (p=0.04), working status (p=0.015), and family history (p=0.012). Ethnicity
has significant negative effect on T&CM use (OR:-1.140, p<0.001). Significant changes in
total BMI (p<0.001) but no differences in mean weight, BMI, calorie consumption, and
protein intake at pre-diagnosis, first visit, and follow-up. Subjects (61%) reported
improved health (35% reduced fatigue) after using T&CM, 65% believe that T&CM should
be more regulated than it is now. 66% disagree that T&CM should be integrated into
cancer patient management, and 79% would not recommend T&CM to other cancer
patients.
Majority of T&CM users believed T&CM may improve health. Most of T&CM information
been provided by family member. Therefore, patient education is crucial, and
practitioners must be knowledgeable on the usage and safety of T&CM.

20
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Severe vs Non-Severe Dengue: Is There Any Association with the Genes?
Norfarhana Khairul Fahmy1, Saiful Safuan Md Sani2, Tengku Nurainna Fatihah Tengku
Abdullah3, Jamiila Ismail1, Koay Bee Tee1, Muhammad Zhafri Md Zakariah1, Ching Yee
Ming3, Shuwahida Shuib3, Nurhanani Muhammad Nor3, Erina Faizati Kadri3, Masita Arip3,
Norhazlin Mustafa1
1Transplantation Immunology Unit, Allergy & Immunology Research Centre, Institute for
Medical Research, National Institutes of Health (NIH) Malaysia
2Hospital Kuala Lumpur
3Autoimmune Unit, Allergy & Immunology Research Centre, Institute for Medical
Research, National Institutes of Health (NIH) Malaysia
Introduction
Dengue is a hyperendemic disease in Malaysia whereby the incidence rate continues to
increase exponentially over the years. Pathogenic factors that determine differences in
clinical manifestations are still not well understood, but multiple studies have highlighted
the involvement of host genetics as one contributing factor towards dengue severity. This
study aimed to identify genes that are associated with dengue severity within the
Malaysian population.
Methodology
This is a case-control study that includes 86 patients with dengue fever (DF) and 102
patients with severe dengue (SD). Patients were recruited from Hospital Kuala Lumpur
from year 2018-2020. Classification of dengue severity was made based on the WHO
2009 classification. DNA extracted from whole blood samples, were genotyped using
Infinium™ Asian Screening Array. Single variant association analysis was performed
following stringent quality control checking.
Results
Our results showed two suggestive variants that can be associated with dengue severity.
Both variants rs9872672 and rs148681490 that showed the odds ratio of 3.683 x 10-6
and 4.703 x 10-6, respectively, stand above the suggestive threshold value of p<5x10-6.
Variant rs9872672 was identified at the intronic region of synaptoporin (SYNPR) gene
that is predicted to be an integral component of synaptic vesicle membrane. Variant
rs148681490 is predicted to encode for tetratricopeptide repeat domain 17 (TTC17)
protein, whose function is involved in the actin filament polymerization and cilium
organization. Although the potential roles of the suggestive variants are still uncertain,
the findings from this study support the notion that host genetic factor showed
association with disease pathogenicity of dengue severity.

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Prevalence of Hidradenitis Suppurativa in Kuala Lumpur, Malaysia: A Cross Sectional
Study
Moonyza Akmal Ahmad Kamil1, Azahirafairudi binti Abdul Rahim1, Lachoomii Piriya
Ganesan1
Introduction
Hidradenitis Suppurativa (HS) is a debilitating inflammatory skin disease affecting the
apocrine gland bearing regions, based on typical lesion, topography and chronicity of the
symptoms. HS is associated with emotional distress leading to reduced quality of life.
This study aims to provide the prevalence of HS via a validated screening questionnaire
among healthy adults in Hospital Kuala Lumpur (HKL).
Methodology
All healthy adults, including hospital staff and those accompanying patients undergoing
care in HKL, were approached to answer the HS screening questions from December
2022 to April 2023. The basic socio-demographic data were obtained. Those screened
positive, were seen by dermatologist to confirm the diagnosis and further management.
Statistical analysis on point prevalent and the factors associated with HS were
performed.
Results
Seven were diagnosed with HS, out of 500 consented subjects, making the prevalence of
1.4%. 71%(n=5) were HS Hurley stage 1 and 29%(n=2) stage 2. HS was more prevalent in
males(n=4) and Chinese(n=3), but not statistically significant between subjects of HS
compared to non-HS, based on their age, gender, ethnicity, education level, income, BMI,
or smoking status (p>0.05).
This questionnaire study yield a much higher prevalence rate compared to previous
studies as it actively screens for HS symptoms. Majority were in mild severity disease. No
significant difference in environmental and socio-demographic factors. In conclusion,
screening for HS enables early detection of HS and serve as a basis to a comprehensive
approach of diagnosis and treatment, thus preventing the complications due to the
diagnostic delay.

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A Retrospective Study on The Use of Continuous Clonidine Infusion for Sedation in
Critically Ill Paediatric Patients
Hooi Hoon Koay1, Jian Lynn Lee1, Mohd Makmor-Bakry2
1Pharmacy department, Hospital Tunku Azizah, Kuala Lumpur
2Faculty ot Pharmacy, Universiti Kebangsaan Malaysia, Perak
Introduction
The off-label use of clonidine as a sedative agent is gaining recognition as it has shown
favorable sedative and analgesic effect with lower risk of tolerance and dependence. This
study aimed to evaluate the effectiveness and safety of clonidine as an alternative
sedative agent in critically ill children and to identify factors for clonidine dose
requirements.
Methodology
A retrospective cohort study was conducted between June 2020 and April 2023 in the
paediatric intensive care unit (PICU) of Hospital Tunku Azizah.
Results
A total of 38 mechanically ventilated patients receiving continuous infusion of clonidine
for sedation were included. The median age of patients were 2.1 years (IQR 1.1 - 6.1).
Median dose of clonidine used was 0.58 mcg/kg/hr (IQR 0.39 - 0.79) at the first 24 hours
of infusion. There were significant reductions in the dose of midazolam (p=0.021) and
dexmedetomidine (p<0.001) with clonidine use. Patients who weigh less than 12kg were
9 times more likely to get a clonidine dose of 0.6 mcg/kg/hr at first 24 – hours of
continuous infusion (OR: 9.086; 95 % CI: 1.574 – 52.463; p=0.014). Whereas, patients
with longer PICU stay prior to the start of clonidine infusion were 13% less likely to
receive higher clonidine dose 0.6mcg/kg/hr) at the first 24 hours of infusion (OR:
0.874; 95% CI: 0.767 – 0.996; p=0.044).
Clonidine is an effective and safe sedative agent in critically ill children. Patients’ weight
and length of PICU stay prior to starting clonidine were significant factors that affect
clonidine dose for the first 24 hours of infusion.

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RD1.
Magnetic Resonance Angiography (MRA) Study On Anatomical Variations Of The Circle Of Willis (COW)
In Kuala Lumpur Hospital
Hermizan Bin Halihanafiah1, Nurul Hafidzah Binti Rahim2
1Institut Latihan Kementerian Kesihatan Malaysia, Sg Buloh, 2Kuala Lumpur Hospital
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. 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 are assessed using three-dimensional
Time-of-Flight Magnetic Resonance Angiography (3D-TOF MRA). The COW's completeness and variants
were investigated. 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 higher 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. 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.
RD2.
Geometric Morphometric Analysis based on Sacrum Landmarks among Malaysian Population
Lai Poh Soon1, Mohamad Helmee Mohamad Noor2,,Nurliza Abdullah1
1National Institute of Forensic Medicine, 2Radiology Department, Kuala Lumpur Hospital
Biological profiling in the anthropological approach comprises of sex, ancestry, stature and skeletal age
estimation. The 3D digitisation includes computed tomography (CT) scan has been applied for 3D
geometric morphometrics (GMM) in concurrent with statistical analysis. This study aims to conduct a
GMM analysis to explore the shape variations on sacrum within the Malaysian population. A total of 320
subjects were collected at Kuala Lumpur Hospital according to sex, ancestry and age among three main
ethnicities. The segmented sacral bones from CT images using Mimics Research 17.0 software were
marked with 19 raw points via IDAV Landmark 3.0 software. Their coordinates were being extracted into
Notepad++ 7.6.3 software and analysed with MorphoJ 1.06d software. GMM analysis showed that the
utmost degree of variations was observed on the transverse diameter of the S1 body, alae dimensions
and auricular surfaces. Sex discrimination function with cross validation success rate was between
84.47% up to 92.45%. Discrimination functions with cross validation success rate between Chinese and
Indian ranged from 64.22% up to 83.02%. Elderly individuals had bigger S1 body dimensions, alae antero-
posterior dimension and shorter sacral height compared to adolescents with varies cross validation
success rate up to 84.78%. Males had relatively more curved sacrum, longer sacral height and auricular
length, bigger S1 body dimensions but narrower alae compared to females. Chinese had generally higher
sacral basal width and sacral height compared to Malay and Indian. This population-specific study is
valuable for Malaysian experts in analysing the sacrum for biological profiling.

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RD3.
Volumetric Assessment of Canines using Post-Mortem Computed Tomography (PMCT) for Sex
Estimation in Malaysia Population
Mohd Hafizal bin Harudin1, Norhayati Jaffar1,Mohamad Helmee bin Mohamad Noor1,
Mohamad Azaini bin Ibrahim1
1Kuala Lumpur Hospital
Recent research has explored volumetric assessment in three-dimensional (3D) imaging procedures for
sexual dimorphism. The 3D techniques have enabled a more realistic, accurate and non-invasive
visualisation of sex-related anatomical parameters, such as the size and shape of human teeth. To
perform sexual dimorphism based on dental tissue volumes of left permanent maxillary and mandibular
canines in a Malaysian population. A cross-sectional study was carried out on 220 Post-Mortem
Computed Tomography (PMCT) scans of Malaysian subjects (114 males and 106 females) aged between
18 and 40 years old. The left permanent maxillary and mandibular canines were analysed based on their
volume of I) enamel cap, II) coronal dentine, and III) root, as well as the combination between the three
dental tissue volumes (DTV). 3D Slicer version 4.10.2 computer software was used to perform a semi-
automated segmentation of the anatomic regions of interest of each tooth. The DTV of left permanent
maxillary and mandibular canines showed sexual dimorphism as the males presented larger DTV than
females (p< 0.05). After binary logistic regression, the DTV revealed an overall sex classification rate of
60% to 74.1%. The DTV of the left permanent mandibular canine had more discriminant power to
correctly classify males and females compared to the left maxillary canine. Volumetric assessment of
dental tissue of left permanent maxillary and mandibular canines could discriminate sex in the Malaysian
population. Given the limited classification rate, this approach could act solely as a supplementary tool to
existing sex estimation methods.
RD4.
Gender Differences in the Prevalence of Cardiovascular Disease (CVD) Risk Factors Among Working-age
Population in Malaysia: Findings from the National Health and Morbidity Survey (NHMS) 2019
S Maria Awaluddin1, Noor Syaqilah Shawaluddin1, Tuan Mohd Amin Tuan Lah1, Thamil Arasu
Saminathan1, Nurhamizah Nasaruddin1, Nazirah Alias1, Lim Kuang Kuay1
1Institute for Public Health
There are gender differences in the prevalence of CVDs risk factors, however, data on the national
representative samples were inadequate. This article aims to determine the gender differences across
the prevalence of common CVD risk factors among working-age population in Malaysia. Data from the
national survey in 2019 was used in this study. A validated questionnaire was used, and clinical
procedures were conducted to measure the body mass index, blood pressure, and capillary blood for
glucose and cholesterol readings. The prevalence of eight CVD risk factors were calculated using IBM
SPSS version 25 and the gender differences were tested via chi-square test. A total of 3694 male and
4423 female respondents’ data were analysed. Female respondents had a significantly higher prevalence
of abdominal obesity (40.3% vs 29.0%), BMI of 25 kg/m2 and above (62.5% vs 39.8%) and being
physically inactive (25.4% vs 18.6%). In contrast, male respondents significantly showed a higher
prevalence of current tobacco smoking (45.3 vs 1.3%) and current alcohol drinking (18.2 vs 7.1%). The
prevalence of those with more than three CVD risk factors was significantly higher among males than
females (7.4 vs 4.7%). Gender differences were observed in the prevalence of abdominal obesity, BMI of
25 kg/m2 and above, physical inactivity, smoking and alcohol drinking. Thus, targeted interventions
according to gender, such as correcting the maladaptive behaviours of smoking and alcohol abuse among
males and increasing awareness among females to be more physically active and have an ideal BMI are
recommended.

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RD5.
Knowledge, Application and Practice of “Stop and mock Before You Block” among Anaesthetic Doctors
in Hospital Kuala Lumpur
Ng Jo Sheng1, Azrin Mohd Azidin1, Mohd Azizuddin Amir Shariffudin1
Safe practice during regional anaesthesia is important to ensure avoidance of morbidity and mortality.
The Stop and Mock Before You Block is a safety initiative that is developed to prevent wrong sided and
site regional blocks. The study aims to identify the incidences of wrong side or site blocks and identify the
knowledge, application, and practice of anaesthetic doctors in Hospital Kuala Lumpur. This is an
observational descriptive study, where a questionnaire in the format of Google Form is distributed
among Anaesthetic doctors via Whatsapp. The data was then collected and analysed using SPSS to
generate frequencies and mean of responses. It was also used to analyse the relationship between the
variables and demographics using Fisher’s exact test. A total of 143 Anaesthetic doctors responded with
an incidence of 8 wrongly performed blocks. The respondents generally had poor knowledge (59.4%),
and moderate application (64.3%) and practice (79.6%) of the “Stop and Mock Before You Block” safety
initiative. There is significant correlation between years of practice with knowledge (p = 0.003) and
application (p = 0.005) component. There is also significant correlation between doctor’s grade to the
knowledge (p = 0.001) component. The study has identified 8 occurrences of wrong side or site block
that has occurred among the anaesthetic doctors in Hospital Kuala Lumpur. Based on the results of the
study, majority of the anaesthetic doctors had moderate to poor knowledge, application, and practice of
the Stop and Mock Before You Block safety initiative.
RD6.
Psychosocial Impact of Dental Aesthetics on Adolescent Patients in Klinik Pergigian Lanang
Loon Han Tan1,2, Shih Chia Pua1, Siong Ting Wong3
1Lanang Dental Clinic, Sarawak, 2Orthodontic Unit, Cahaya Suria Dental Clinic, Wilayah Persekutuan Kuala
Lumpur, 3Dental Public Health Specialist Unit, Jalan Oya Dental Clinic, Sarawak, Ministry of Health,
Malaysia
Malocclusion affects a person’s appearance and psychosocial well-being. Patient’s perspective should be
considered while assessing orthodontic treatment need. The research aims to study the psychosocial
impact of dental aesthetics (PIDA) on adolescent patients attending Klinik Pergigian Lanang (KPL), and
determine its relationship with self-perceived need of orthodontic treatment, gender, age and race. The
overall prevalence of PIDA was 95.2%. Prevalence was highest in dental self-confidence (DSC) domain,
followed by psychological impact (PI), social impact (SI) and aesthetic concern (AC). The prevalence in
DSC, SI, AC domains were significantly higher in subjects with self-perceived malocclusion. Those with
self-perceived malocclusion had significantly higher severity of impacts. Up to 34.7% of subjects reported
significant impact in all domains. Higher mean total PIDA score in older adolescents was not statistically
significant. Female subjects obtained significantly higher mean total PIDA scores. The effect of race on
PIDA was not significant. The prevalence, severity and extent of PIDA among adolescents were high.
Adolescents with selfperceived malocclusion had significantly higher severity of impacts.

26
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RD7. Renal Function Outcomes among Non-Valvular Atrial Fibrillation Patients on Warfarin and Non-
Vitamin K Oral Anticoagulants: Interim Analysis of a Multicenter, Propensity-Matched Retrospective
Analysis
Hock Peng Koh1, Jivanraj R. Nagarajah1, Szu Lynn Tay1, Jiaa Yinn Tang1, Yee Yin Hoo2, Sahimi Mohamed2,
Chelfi Zhi Fei Chua3, Sze Ling Tan4, Shi Jing Ong5, Shantini a/p Radhakrishnan6, Norzahidah Zamani7,
Pradeep Kumar Nair Arumugam8
1Pharmacy, Hospital Kuala Lumpur, 2Pharmacy, Hospital Serdang, 3Pharmacy, Pusat Jantung Sarawak,
4Pharmacy, Hospital Queen Elizabeth II, 5Pharmacy, Hospital Queen Elizabeth, 6Pharmacy, Hospital Tunku
Jaafar, 7Pharmacy, Hospital Tengku Ampuan Afzan, 8Medical, Hospital Kuala Lumpur
Evidence suggests that certain oral anticoagulant (OAC) may exert favorable renal outcomes in non-
valvular atrial fibrillation (NVAF) patients. We aimed to compare the renal function progression in NVAF
patients treated with warfarin and non-vitamin K OAC (NOAC). This multicenter retrospective study
analyzed NVAF patients initiated on OAC from 2013 to 2022 in eight tertiary hospitals in Malaysia.
Convenience sampling was used in this study. Based on propensity-score matching, 222 patients
receiving warfarin were matched against 222 patients receiving NOAC [apixaban (n=81), rivaroxaban
(n=67), and dabigatran (n=74)] by incorporating 13 variables that potentially affect the renal function.
Clinically significant (>30%) estimated glomerular filtration rate (eGFR) decline after OAC initiation was
the primary outcome measure. Secondary outcome measures include the incidence of ischemic
stroke/transient ischemic attack (TIA) and major bleeding. There was no significant difference in clinically
significant eGFR decline between the warfarin (n=33, 14.9%) and NOAC (n=28, 12.6%) groups (p=0.491).
The incidences of ischemic stroke/TIA [warfarin (n=8, 3.6%) versus NOAC (n=5, 2.3%), p=0.398] were
comparable between the two groups. The incidence of major bleeding was significantly higher in the
warfarin arm (p<0.030). Clinically significant eGFR decline is common among Malaysian NVAF patients on
OAC but not affected by choice of OAC.
RD8. Incidence and Predictors of Clinically Significant Renal Function Decline among Non-Valvular
Atrial Fibrillation Patients on Warfarin: A Retrospective, Multicenter Study
Sze Ling Tan3, Shi Jing Ong4, Shantini a/p Radhakrishnan5, Norzahidah Zamani6, Pradeep Kumar Nair
Arumugam7
1Pharmacy, Hospital Kuala Lumpur, 2Pharmacy, Hospital Serdang, 3Pharmacy, Hospital Queen Elizabeth II,
4Pharmacy, Hospital Queen Elizabeth, 5Pharmacy, Hospital Tunku Jaafar, 6Pharmacy, Hospital Tengku
Ampuan Afzan, 7Medical, Hospital Kuala Lumpur
Literature had reported worsening renal function with warfarin use. This study aimed to assess the
incidence of clinically significant renal function decline among non-valvular atrial fibrillation (NVAF)
patients on warfarin treatment and identify its predictors. This multicenter retrospective study analyzed
data on NVAF patients initiated on warfarin from 2013 to 2022 in six tertiary hospitals in Malaysia.
Convenience sampling was used in this study. Clinically significant (>30%) estimated glomerular filtration
rate (eGFR) decline after warfarin initiation was the primary outcome measure. Secondary outcome
measures include the incidence of ischemic stroke/ transient ischemic attack (TIA) and major bleeding.
Logistic regression analyses were used to assess independent predictors of clinically significant eGFR
decline. We analyzed 292 patients with a mean age of 67.7±10.2 years and predominantly male (n=155,
53.1%). Most (n=191, 65.4%) patients have underlying chronic kidney disease during warfarin initiation.
Clinically significant eGFR decline occurred in 74 (25.3%) patients. Nine (3.1%) patients developed
ischemic stroke/TIA. Major bleeding occurred in 8 (3.2%) patients. Overall, treatment duration (in years)
(aOR 1.260, p=0.037), time in therapeutic range (TTR) 60% (aOR 0.414, p=0.011), and insulin use (in
diabetic patients) (aOR 3.403, p=0.004) were the predictors of clinically significant eGFR decline in NVAF
patients on warfarin treatment. Lastly, clinically significant eGFR decline was not associated with ischemic
stroke/TIA (p=0.170), but significantly associated with major bleeding (p=0.015). Clinically significant
eGFR decline is common among Malaysian NVAF patients on warfarin treatment and was associated with
the treatment duration, TTR and diabetis on insulin therapy.

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RD9.
Clinical Profile and Predictors of Stroke and Major Bleeding among Non-Valvular Atrial Fibrillation
Patients on Anticoagulant Therapy: An Asian Real-world Multicentre Study
Chelfi Zhi Fei Chua3, Sze Ling Tan4, Shi Jing Ong5, Shantini a/p Radhakrishnan6, Norzahidah Zamani7,
Pradeep Kumar Nair Arumugam8
1Pharmacy, Hospital Kuala Lumpur, 2Pharmacy, Hospital Serdang, 3Pharmacy, Pusat Jantung Sarawak,
4Pharmacy, Hospital Queen Elizabeth II, 5Pharmacy, Hospital Queen Elizabeth, 6Pharmacy, Hospital Tunku
Jaafar, 7Pharmacy, Hospital Tengku Ampuan Afzan, 8Medical, Hospital Kuala Lumpur
Managing non-valvular atrial fibrillation (NVAF) remains challenging to balance between preventing
thromboembolism and bleeding. This study aimed to assess the clinical profile and identify predictors
affecting stroke and major bleeding among NVAF patients on oral anticoagulant (OAC) therapy. This
multicenter retrospective study analyzed data on NVAF patients initiated on OAC from 2013 to 2022 in
eight public tertiary hospitals in Malaysia. The primary outcome measures were ischemic
stroke/transient ischemic stroke (TIA) and major bleeding. Convenience sampling was used in this study.
Logistic regression analyses were used to assess independent predictors of primary outcomes. We
analyzed 601 patients with a mean age of 70.0±10.3 years and were predominantly male (n=337, 56.1%).
Most patients were on warfarin (n=292, 48.6%), followed by apixaban (n=118, 19.6%), dabigatran
(n=113, 18.8%), and rivaroxaban (n=78, 13.0%). Ninety (15.0%) patients had a history of ischemic
stroke/TIA before OAC therapy. The incidence of ischemic stroke/TIA and major bleeding were 2.5%
(n=15) and 2.8% (n=17), respectively. History of ischemic stroke/TIA (aOR=6.605, p=0.007) was the only
predictor for ischemic stroke/TIA occurrence after OAC initiation. Non-vitamin K OAC (aOR=0.231,
p=0.023) and antiplatelet(s) (aOR=3.302, p=0.028) use were the predictors for major bleeding after OAC
initiation. Identified predictors of stroke/TIA and major bleeding allow clinicians to manage NVAF
patients better. In stroke prevention among NVAF patients, anticoagulant treatment with non-Vitamin K
OAC has a similar stroke/TIA risk and lower major bleeding risk than warfarin. The concurrent use of
antiplatelet(s) this population needs to be cautious.
RD10.
Inhaler Technique and Predictors of Inhaler Adherence among Asthma and Chronic Obstructive
Pulmonary Disease Patients Who Presented with Acute Exacerbation to the Public Outpatient
Emergency Department
Hock Peng Koh1, Paula Suen Suen Teoh1, Hui Yin Chin1, Nurul Liana Roslan2
1Pharmacy, Hospital Kuala Lumpur, 2Emergency and Trauma, Hospital Kuala Lumpur
Understanding the barriers to optimal inhaler use and adherence is essential in achieving the treatment
goal for asthma and chronic obstructive pulmonary disease (COPD). This study aimed to assess the
inhaler technique and identify the predictors of inhaler adherence among asthma and COPD patients
who presented to the outpatient emergency department (ED). This prospective study recruited patients
who presented to Asthma Bay ED Hospital Kuala Lumpur for mild-moderate exacerbation from March
2022 to February 2023. Convenience sampling was used in this study. The inhaler techniques of all
subjects were evaluated. Regression analysis was used to identify predictors of inhaler adherence. We
recruited 120 subjects with a mean age of 47.8±16.0 and were predominantly asthma patients (n=85,
70.8%). The majority were on proper follow-up (n=72, 60.0%) and adhered to their inhaler(s) (n=86,
71.7%). However, less than half of the subjects use their inhaler(s) correctly (n=45, 37.5%). Three
predictors of inhaler adherence were identified: proper follow-up (aOR 2.072, p=0.041), correct inhaler
technique (aOR 3.071, p=0.039), and ability to explain inhalers’ mode of action (aOR 10.906, p=0.031).
The rate of wrong inhaler techniques among asthma and COPD patients is worrisome. The above-
identified predictors of inhaler adherence should be targeted when managing this group of patients. In
Asthma Bay, exacerbation treatment alone is inadequate and should include inhaler technique
evaluation and counseling to improve patients’ knowledge. The presence of pharmacists and trained
medical assistants in the ED Asthma Bay could be the solution.

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RD11.
Factors Associated with Poor Glycemic Control Among Malaysian Diabetes Population: Results from
National Health Morbidity Survey (NHMS) Malaysia 2019
Jayvikramjit Singh1, Shubash Shander A/L Ganapathy2, Lye Sing Ie1, Noor Adibah Md Noor1, Zamtira
Seman2
1Hospital Kuala Lumpur, 2National Institutes of Health, Setia Alam
Diabetes is a serious health problem that affects the whole life of people. Thus good glycemic control is
important to control the complications related to diabetes. Therefore, this study aimed to determine
factors associated with poor glycemic control among Malaysian adult’s population. Data was obtained
from National Health and Morbidity Survey (NHMS) 2019. This study used data from NHMS 2019, and
conducted a cross-sectional design by applying two-stage stratified cluster sampling. Descriptive statistics
such as the percentage of each variable were done. Factors associated with poor glycemic control were
determined at both univariate and multivariable levels using simple logistic regression and multiple
logistic regression. The data were presented as standard values for each analysis and adjusted odds ratios
with 95% CI with p values (<0.05). Factors associated with poor glycemic control based on multivariate
analysis were having hypertension (AOR=1.46,95% CI (1.12-1.90)), hypercholesterolemia (AOR=1.54,95%
CI (1.24-1.92)), being obese (AOR=1.68, 95%CI (1.22-2.31)) and having high waist circumference
(AOR=1.33,95% CI (1.03-1.73)). Sociodemographic data that were associated were age 34 years and
above with Malay and Chinese ethnicity. No association was found between exercise, smoking, fruits and
vegetables intake. Our study further strengthens that co-morbidities and having unhealthy nutritional
status are associated with poor glycemic control. These findings highlight the importance of having a
healthy Body Mass Index (BMI), waist circumference and controlled co-morbidities for better glycemic
control. Hence, these measures will lessen the negative impact of diabetes on patient’s quality of life and
reduce the complications of uncontrolled diabetes.
RD12.
Acceptance of Advance Care Planning (ACP) among the Malaysian Public
Zaikiah Binti Mohd. Zin1, Sheikh Shafizal Sheikh Ilman1, Abu Bakar Rahman1, Nadia Hani Jahaya1, Mariatul
Umeera Muhammad Dahaban1
1Institute For Health Behavioural Research, Selangor, Malaysia
Advance Care Planning (ACP) is a process that expresses the preference of an individual via verbal or
written communication that helps prepare for healthcare decision-making. Currently, there is no
legislation for ACP in Malaysia, and thus, the choice to use medical intervention to extend lives rests with
the doctors or the next of kin. This cross-sectional study evaluates the public’s acceptance of ACP in
Malaysia. A self-administered questionnaire was designed with Google Form, shared with various social
media groups, and emailed to the Employees Provident Fund (EPF) and Social Security Organisation
(SOCSO) so that these organisations could share it with others in their databases. According to 89.4% of
participants, discussing their treatment preferences in advance will be preferable if they can no longer
make decisions. The main justification was they did not want to burden their family members with
medical treatment decisions (93.8%) and were aware that they might lose their decision-making capacity
due to illness or future injury (93.8%). On the other hand, among the main objection to stating treatment
choices were they did not want to see themselves in those situations (45.4%) and did not want to think
that they would eventually die or lose their memory (40.9%). From the result of the study, acceptance of
ACP is high in Malaysia. The situation might be due to respondents’ sociodemographic background, such
as marital status, employment status and educational level. Therefore, promoting ACP to other
sociodemographic groups is necessary so everyone knows its significance in future healthcare decision-
making.

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RD13.
Perception, Acceptance, and Barrier of Telehealth Services among Physiotherapists in Public Hospitals
Chong Pui Kei1, Ong Hai Choo1, Sugaashini A/P Muniandy1, Loi Phoebe1
1Jabatan Fisioterapi Hospital, Kuala Lumpur
Telehealth has shown positive impressions and high satisfaction rates among clinicians and healthcare
providers. Locally, telehealth application in physical therapy remains unpopular. This study aims to
identify the perception, acceptance, and barriers among physiotherapists in public hospitals. This
multicenter cross-sectional survey study recruited physiotherapists who work in public hospitals.
Convenience sampling and technology acceptance model (TAM) questionnaires were used in this study.
The correlation between TAM components were analysed with linear regression analyses. In total, 181
physiotherapists completed the survey (age range 24 to 59 years, 77% female), giving a response rate of
62%. There is a significant linear relationship between perceived ease of use (PEOU) and behavioral
intention (BI) with actual use (ATU). PEOU ad BI can explain 82.1% of the variation in ATU according to
the linear regression model (r2=82.1). Besides, a significant linear relationship exists between ATU and
user satisfaction (p<0.001). The majority of responders cited a lack of user-friendly software (69.1%),
technical difficulties (63.5%), and lack of suitable training to practice telehealth (60.2%) as barriers to the
adoption of telehealth. Physiotherapists show overall positive perceptions and acceptance of telehealth
services. There are several barriers to practicing telehealth. Addressing the barriers might increase the
physiotherapists’ perceptions and acceptance of telehealth services.
RD14.
Knowledge, Attitude and Oral Health Practice (K.A.P) and Awareness towards Periodontal Health
among Healthcare Workers
Mabel Mun Yen Chi1
1Klinik Pergigian Hospital Bahagia Ulu Kinta, Perak
Periodontal disease is common disease existing within Malaysians. Objective are accessing Knowledge,
Attitude, Practice (K.A.P) and Awareness of periodontal health among healthcare workers. Total 24
questions adopted and then go through validation by two experts. Clustered, cross-sectional and self-
administered and 24 questions’ questionnaire was delivered to the participants. Questionnaires are
distributed to 209 participants from 14 investigating sites situated in the state of Perlis. The data
collected uses IBM SPSS 23 and analyzed using frequencies mode. 93.3% (195/209) of the participants’
ages ranged from 20-44 years old. Highlighted findings in our study, included: accessed self-awareness,
11% (23/209) for loose teeth; 10% (21/209) have gum disease Accessed knowledge, 62.2% (130/209)
informed dental plaque is hard deposit on teeth; 19.2% (41/209) informed do not know relationships in
periodontal disease to diabetes; 55.5% (116/209) do not know that periodontal disease suffers from
pregnant mother likely to have preterm low birth weight baby delivery. Accessed attitude, 52.6%
(101/209) do not visit the dentist due to have no time. Accessed practices, 48.3% (101/209) informed
brushing their teeth less than 2 mins; 79.5% (166/209) informed do not perform interdental cleaning
once a day. K.A.P and awareness in periodontal health among healthcare workers need to improve.
Collaboration with medicine and dental department to achieve a better outcome in periodontal health.
Additionally, healthcare workers acquired to develop these practices, such as brushing teeth in two mins,
twice a day with fluoridated toothpaste and interdental cleaning at least once a day, then imply this
habits to the communities.

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RD15.
Metastatic Mimickers and Recent Decade of Experience in SPECT/CT Utilisation for Evaluating
Indeterminate Skeletal Lesions
Mohd Fazrin Mohd Rohani1, Ahmad Zaid Zanial1, Subapriya Suppiah2, Farahnaz Mohamed Aslum Khan1,
Siti Zarina Amir Hassan1, Sobhan Vinjamuri
1Department of Nuclear Medicine, Hospital Kuala Lumpur, 2Department of Radiology, Faculty of Medicine
and Health Sciences, Universiti Putra Malaysia, 3Department of Nuclear Medicine, Royal Liverpool
University Hospital, Liverpool United Kingdom
Bone scan is widely used to evaluate skeletal lesions and disease staging in oncology. Degenerative or
other benign bony changes may give rise to indeterminate lesions imitating metastasis in some patients.
Single photon emission computed tomography/computed tomography (SPECT/CT) can be used to
improve characterisation of these lesions and help to resolve the diagnostic conundrum. We present a
systematic review to objectively appraise diagnostic capabilities of SPECT/CT in this matter. Systematic
review of relevant electronic databases done for articles published in English between January 2011 and
August 2020. Outcomes of interest included reporting of SPECT/CT to identify benign, indeterminate and
malignant lesions, calculation of sensitivity and specificity of index test based on histology or clinical with
imaging follow-up as reference standard. After the bias risk and eligibility assessment, 12 articles were
identified and synthesised in our meta-analysis. Total of 1511 patients with 2008 bony lesions were
analysed in the qualitative synthesis. Study subjects involved patients with breast cancer (n=830),
prostate cancer (n=463), lung cancer (n=92) and other malignancies (n=126). About half of indeterminate
lesions were in the vertebrae. Overall pooled sensitivity and specificity of SPECT/CT was 93.0% (95% CI:
0.91–0.95) and 96.0% (95% CI: 0.94–0.97) for identifying suspicious bony lesions. Heterogeneity of
articles noted due to varying imaging protocols, follow-up period and interpretation scoring methods that
may influence accurate assessment of true diagnostic capability of SPECT/CT. SPECT/CT improves
specificity of diagnosing bone metastases, but efforts needed to standardise research methodologies,
thresholds for SPECT/CT and harmonising the reporting criteria.
RD16.
Review of PSMA PET-CT in Relation to Patient Care Pathways for Biochemically Recurrent Prostate
Cancer in Tertiary Setting
Vineet Pant1, Sobhan Vinjamuri1, Ahmad Zaid Zanial2, Faisal Naeem1
Department of Nuclear Medicine, Royal Liverpool University Hospital, Liverpool United Kingdom,
2Department of Nuclear Medicine, Hospital Kuala Lumpur
Prostate specific membrane antigen positron emission computed tomography-computed tomography
(PSMA PET-CT) has been recommended in prostate cancer. Publications mainly have focused on
diagnostic performance of this modality rather than the outcome related to patient care pathways.
Radical prostatectomy or radiotherapy is offered to patients with intermediate risk localised prostate
cancer. We aimed to evaluate PSMA PET-CT utilisation in biochemically recurrent prostate cancers, their
prior treatment and PET-CT scan findings. Clinical audit and retrospective analysis of 295 PSMA PET-CT
scans done between 2020 and 2022 at a tertiary centre for North-West England. Imaging performed
using standard acquisition protocol following PSMA radiotracer injection. PET-CT studies were reviewed
by two experienced nuclear medicine physicians and classified as positive for recurrence/metastasis,
indeterminate and negative. Clinical information including prostate specific antigen (PSA) level at the
time of scan request and treatment history were obtained. There were 179 positive, 66 negative and 50
indeterminate scans noted. In positive category, 67 patients had radical prostatectomy and PSMA-avid
lesions were mostly in pelvic lymph nodes. However, 112 patients with positive scans had no prior
prostatectomy and 75% (n=84) demonstrated recurrence in prostate bed or gland. PSA 0.5 ng/ml was
associated with higher number of PSMA avid lesions (p<0.05). Subsequent follow-up PSMA PET-CT was
helpful in patients with initial indeterminate findings whereby PSA rise of 0.7 ng/ml in 6 months can
result in a positive scan. Higher disease recurrence in prostate gland/bed noted among patients who did
not undergo prostatectomy. Follow-up PSMA PET-CT was helpful for indeterminate findings.

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RD17.
Developing Malaysian Healthy Lifestyle Index Instrument
Khairulnissa Abdul Kadir1, Logeswary Krisnan Kaundan1
1Institutes for Health Behavioural Research, MOH
The goal of the Malaysian Healthy Lifestyle Index is to provide Malaysian with an easy-to-use health
behavior assessment tool. Involved in six stages; conceptualization, item generation, assessment of
comprehensibility or pre-testing, index calculation, pilot testing, and data analysis. A 136-item
questionnaire was developed and evaluated for content validity by an expert panel and then
administered to respondents. Validity and reliability results show that the overall questionnaire was
adequate. For face validity, in general, the respondents agreed that the MHLI covered relevant aspects of
a healthy lifestyle. Following experts’ evaluation calculation of the content validity index revealed an
average of 89% for all items. The instrument was developed with the aim of providing Malaysians with a
Healthy Lifestyle Index under the five domains of health behavior which are physical activity, smoking
behavior, alcohol intake, mental health, and eating behavior. Items were designed or chosen either for
their relevance to a healthy lifestyle or for their assessment of practicing a healthy lifestyle in general,
focusing on links between lifestyle and health.
RD18.
Attitude and Behavior towards Lean Healthcare Sustainability: A Scoping Review
Muniamal Krishnan1, Lum Kah Yee1, Zalina binti Libasin1, Ku Anis Shazura binti Indera Putera1, Nur Nadia
Renu binti Abdullah1, Intan Syafinaz binti Saimy1
1National Institutes of Health
Lean healthcare in Malaysia was first initiated in 2012 as part of an effort to reduce waiting time at MOH
hospitals. The Ministry of Health (MOH) is interested in expanding the accreditation of lean healthcare to
other MOH hospitals and empowering them to sustain lean implementations in the hospitals. This
presentation to address the attitude and behavior towards Lean healthcare sustainability in the MOH. A
scoping review of all types of research on the factors impacting lean sustainability in healthcare was
conducted for this review. Emerald Insight, Ovid Medline, Pubmed, and Google Scholar were the
databases used, along with backward citation searching. Thematic analysis was used to analyze the
obtained articles. There were forty publications found about what makes lean in healthcare sustainable.
The scoping review revealed eleven key topics, "Attitudes and behaviors" being one of them. This
presentation will concentrate on this theme. Subsequently, nine subthemes were discovered: (i) talent
recognition (ii) active participation (iii) adaptability (iv) commitment (v) support (vi) accountability (vii)
respect (viii) staff empowerment, and (ix) flexible work. The degree of Attitude and Behavior of
healthcare workers on implementation had a ripple effect on sustainability. This scoping review
emphasizes how crucial attitude and behavior are to maintaining lean in healthcare. This review may help
MOH to empower state health departments in Malaysia to sustain lean implementations in the hospitals
under their administration.

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RD19.
Identification of Prognostic Gene Set Associated with Platelet Activation Pathway That are Predictive of
Severe Dengue
Jeyanthi Suppiah1, Saiful Safuan Md Sani2, Safiah Sabrina Hassan1,3,, Nur Iman Fasohah Nadzar1, Nor
Abidah Mohd Narawi2, Rozainanee Mohd Zain1, Ravindran Thayan1
1Institute for Medical Research, 2Hospital Kuala Lumpur, 3Clinical Research Malaysia
Thrombocytopenia is a hallmark in dengue virus (DENV) infection. Breakthrough studies have shown that
DENV binds to platelet receptors and hijacks their translational machinery to replicate but lacks in
demonstrating the impact to the platelets at the transcriptome level. This study aims to determine the
gene expression profile linked to the platelet activation pathway in dengue- infected patients. High-
throughput-RNA-sequencing was performed on total RNA and host platelet transcriptome profile was
successfully generated in 16 dengue patients recruited from Hospital Kuala Lumpur. Differentially
expressed genes (DEGs) and pathway enrichment data were filtered for identification of upregulated and
downregulated genes in the platelet activation pathway and compared them between healthy
individuals, non-severe dengue, and severe dengue patients. Ten genes related to platelet activation
were found to be expressed differently in individuals with dengue compared to healthy controls,
including MYLK2, MAPK12, CENPO, UQCC2, FAM98B, ADCY3, PLCG2, PRKCI, PIK3CG, and BTK. Among
these, the MYLK2 and BTK showed significant predictive values for severe dengue with five-fold
upregulation and -0.84-fold downregulation respectively, compared to non-severe cases. MYLK2 is a
myosin kinase exclusively expressed in adult skeletal muscle and prerequisite for ADP-induced platelet
aggregation. This clarifies the high expression in severe dengue cases manifested with bleeding.
Meanwhile, the downregulation of BTK may serve as a protective mechanism to reduce DENV binding to
platelets since it is crucial in signalling via the collagen receptor glycoprotein-VI. These genes could be
used as biomarkers to predict severe dengue and advance for point-of-care testing.
RD20.
Practice of Dietary Supplements and Its Influence Towards Treatment Adherence Among Diabetes
Mellitus Patients
Nor Hidayah Mohd Kamarulbhrin1, Anida Daud2, Noornazli Zahirah Abdullah2, Jamuna Sannassy3, Boey Yik
Ming3, Nabilah Mohamad4, Nurhazira Alang1
1Pejabat Kesihatan Putrajaya, 2Klinik Kesihatan Putrajaya Presint 9, 3Klinik Kesihatan Putrajaya Presint 18,
4Klinik Kesihatan Putrajaya Presint 14
Diabetes mellitus (DM) is a chronic disease that greatly impacts morbidity and mortality. Many patients
seek dietary supplements or other complementary and alternative medicine to improve their health and
treatment outcomes. Increasing awareness about the role of supplements has resulted in the extensive
development of supplements and their consumption. Patients may underuse prescribed medication,
leading to issues with treatment adherence. The aim of this study was to explore the practice of dietary
supplements and its influence towards treatment adherence among patients with DM in Putrajaya Health
Clinics. The questionnaire used for this study consisted of 31 items that addressed three main areas:
social demographic characteristics, knowledge and attitude on dietary supplements and treatment
adherence. The questionnaire was distributed among 360 DM patients who received their medication at
the outpatient pharmacy under Putrajaya Health Clinics. Descriptive analysis was used for patients’
demographic background and statistical tests, including chi-square, t-test and Pearson’s correlation
coefficient, were used to explore relatedness between the studied variables. More than half of the
respondents preferred taking single supplement (n=247, 68.6%) rather than a combination of
supplements (n=113, 31.4%). Treatment adherence was not found to be associated with knowledge and
attitude towards supplements (p=0.248). However, there was a significant association between dietary
supplement intake and treatment adherence. Patients who took supplements, either single or
combination, showed lower treatment adherence (p=0.040). In conclusion, the practice of routine dietary
supplement intake may influence treatment adherence among DM patients in Putrajaya Health Clinics
and should be addressed during medication counselling sessions.

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RD21.
The association between warning signs and symptoms with severe dengue in adult patients
Muhammad Zhafri Bin Md Zakariah1, Saiful Safuan2, Norfarhana Binti Khairul Fahmy1, Ching Yee Ming1,
Shuwahida Binti Shuib1, Koay Bee Tee1, Jamiila Ismail1, Masita Binti Arip1, Norhazlin Binti Mustafa1
1Institute for Medical Research (IMR), NIH, 2Hospital Kuala Lumpur.
In Malaysia, dengue is a hyperendemic infectious disease. The difficulty in accurately identifying dengue
patients who may experience severe sickness is one of the difficulties in providing patient care. In this
study, we aim to investigate the association between severe dengue patients with the warning sign and
symptoms. The study involved 103 cases of severe dengue and 101 controls with non-severe dengue at
Hospital Kuala Lumpur. The data were analysed using statistical tests, and six warning signs and five
symptoms were identified in the study group. These included persistent vomiting or diarrhea, abdominal
pain, lethargy or confusion, tender liver, bleeding tendencies, high hematocrit levels with a rapid drop in
platelets, fever, body aches, nausea or vomiting, rashes, and low white blood cell count. In our study,
severe dengue patients generally had prolonged vomiting or diarrhoea (59.2%), abdominal discomfort
(33.0%), and elevated hematocrit with fast reduction in platelet (33.0%), though none of them were
statistically significant in association with severity of dengue. Fever is the most common symptom among
severe dengue patients (100%), followed by body pains (72.8%) and nausea or vomiting (65.0%),
however there is no significant differences were identified between the two groups (p > 0.05). In contrast
with other studies, our data demonstrate there is lack of correlation between warning signs and
symptoms in predicting severe dengue. Hence there is an additional value incorporating laboratory
diagnostics in overall management of severe dengue patients.
RD22.
Clinical Characteristics and Risk Factors of Progression to Severe Covid-19 Disease Among Patients
Admitted to Covid-19 Quarantine and Low-Risk Treatment Centre at the Malaysia Agro Exposition Park
Serdang (MAEPS) 2.0
Marzilawati Abd Rahman1, Ong Siaw Yen1, Yvonne Lim Poh Yoke2, Nurakmal Binti Baharum3, Poonam
Devi A/P Anoop Kumar4, Tunku Mahzuz bin Tunku Mutasim5, Muhamad Akmal bin Rosli6, Shaarwin
Rajaratnam7, Nurul Aishah Eliza Versluis binti Nurul Taufiq Anthonie1, Sarah Shaikh Abdul Karim6
1Hospital Kuala Lumpur, 2Klinik Aurora Bukit Jalil, 3Centre for Coordination Clinical Research Network,
4Hospital Serdang, 5Klinik Kesihatan Cheras, 6Hospital Sungai Buloh, 7Hospital Shah Alam
COVID-19 Quarantine and Low-Risk Treatment Centre MAEPS 2.0 was an effort by the Malaysian Ministry
of Health to accommodate the increasing number of COVID-19 cases. This study aims to identify clinical
characteristics and risk factors of progression to severe COVID-19 disease among patients initially
diagnosed with low-risk COVID-19 disease. This was a retrospective study involving patients above 12
years old admitted to our centre between October 1 till November 30, 2021. Patients' outcomes were
classified as those who did or did not progress to Category 4 COVID-19. A total of 8,419 patients' records
were analysed. Median age was 37 years. There were 8007 patients (95.1%) who received two doses of
vaccine. There were 7843 (93.1%) patients with Category 3 Covid-19, while 74 (0.9%) patients were
Category 4. There were 458 (5.4%) patients who progressed to Category 4 Covid-19. Unvaccinated
patients had sixfold higher risk (adjusted odds ratio (aOR) 6.23, P<0.001) compared to patients who
received two doses of Pfizer-BioNTech vaccine (aOR 1.09, P<0.001). Patients who received two doses of
Sinovac-CoronaVac vaccine had twofold risk of progression to Category 4 (aOR 2.44, P<0.001), compared
to two doses of Oxford-AstraZeneca vaccine which yielded similar risk as two doses of Pfizer-BioNTech
2 (aOR 2.53, P<0.001), presence of
respiratory symptoms (aOR 1.54, P<0.001), hypertension (aOR 1.41, P=0.007), diabetes mellitus (aOR
1.56, P=0.001), cardiovascular disease (aOR 1.62, P=0.037), increasing age and CRP level (P<0.001). The
findings in this study were comparable with other regional studies in Asia.

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RD23.
Outcomes of Methylprednisolone Use in Hospitalised COVID-19 Patients: A Retrospective Study
Nur Fatin Najwa Azemi1, Farida Hanim Islahudin2, Rahela Ambaras Khan1, Leong Chee Loon1
1Kuala Lumpur Hospital, 2Universiti Kebangsaan Malaysia
Recent trials have demonstrated benefits of corticosteroids including methylprednisolone in treatment of
coronavirus disease 2019 (COVID-19). However, data on optimal dose, duration and timing of
administration is limited. Retrospective cohort study on hospitalised, adult COVID-19 patients admitted
between June to August 2021 in general COVID-19 wards, treated with methylprednisolone. Clinical
outcomes evaluated include in-hospital mortality, thirty-day mortality, timing of initiation, trends of c-
reactive protein, total white blood cells and oxygen requirement at day-five and day-ten as well as
adverse events of methylprednisolone. Of 278 patients, 1 (0.4%) received weight-based dosing of
1mg/kg/day, 101 (36.3%) received weight-based dosing of 2mg/kg/day, 130 (46.8%) received fixed dosing
methylprednisolone 250mg/day and 46 (16.5%) received fixed dosing methylprednisolone 500mg/day.
There was a significant difference in in-hospital mortality rates following different methylprednisolone
doses (p = 0.023). In patients who received weight-based dose of either 1 or 2 mg/kg/day
methylprednisolone, 23 (22.5%) patients had in-hospital mortality. In those receiving fixed dose
250mg/day methylprednisolone, 42 (32.3%) patients had in-hospital mortality. In-hospital death and
discharge were the same in patients receiving fixed dose methylprednisolone of 500mg/day (n=18,
39.1%, respectively). On the other hand, there was no significant difference in 30-day mortality between
the three groups (p>0.05). The mean (SD) of timing of initiation of methylprednisolone was similar
between groups, 8.43 days (3.232). Clinical efficacy and safety were similar between the groups (p>0.05).
In hospitalised COVID-19 patients receiving methylprednisolone, the use of methylprednisolone up to
250mg/day is associated with lower in-hospital mortality without significant adverse effects.
RD24.
Effect of Aspirin on the International Normalized Ratio in Elderly Patients with Atrial Fibrillation on
Concurrent Warfarin Therapy
Pooncholai Poosary1, Tan Hung Kun2, Teo Kui Yuan1, Ahmad Riza Ahmad Nizam3
1Pharmacy, Hospital Tuanku Ampuan Najihah, 2Pharmacy Department, Klinik Kesihatan Salak Selatan,,
Pharmacy, Hospital Tuanku Ja’afar, Ministry of Health Malaysia
The 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 changes in INR and the
prevalence of INR adherence before and after aspirin initiation in elderly patients with AF on warfarin
therapy. A cross-sectional study was conducted in the Anticoagulant Medication Therapy Adherence
Clinic in Hospital Tuanku Ampuan Najihah from January 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
demographics and INR distribution. Paired t-test was used to assess the differences in INR before and
after aspirin initiation. Most of the patients were female (n=44, 54.3%), Malay (n=74, 91.4%), with a mean
age of 74.94±8.14 years old. 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. Thirty-two patients (39.5%) achieved their
targeted INR range of 2.0 to 3.0, whereas more patients achieved subtherapeutic INR (40.7%) before
aspirin initiation. INR rose in 58 (71.6%) warfarin users after aspirin initiation. Moreover, INR increased
above 3.0 in 49 patients (60.5%) after aspirin use. This study showed that aspirin initiation increased the
INR significantly in elderly patients with AF on warfarin therapy. Thus, healthcare professionals should
monitor INR closely and make improvements in the patient counselling points checklist, to ensure optimal
health outcomes in elderly patients and prevent potential bleeding incidence.

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RD25.
Changes of Facial Features After Bariatric Surgery: A Systematic Review
Pavitra Ramasamy1, Zhen Yu Wong2, Koen J A O Ingels3, Chetan Parmar4, Wah Yang5, Sjaak Pouwels6, 7
1Department of General Surgery, Hospital Selayang, Kuala Lumpur, Malaysia, 2Department of General
Surgery, Nottingham City Hospital, Nottingham, UK, 3Department of Otorhinolaryngology, Head & Neck
Surgery, Radboudumc, Nijmegen, Netherlands,4Department of Surgery, Whittington Hospital, London, UK,
5Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University,
Guangzhou, China, 6Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital,
Hilvarenbeekseweg, Tilburg, Netherlands,7Department of General, Abdominal and Minimally Invasive
Surgery, Helios Klinikum, Krefeld, NRW, Germany
This study aims to provide an overview of the facial features and structure after bariatric surgery in the
existing literature. A systematic literature search was performed in electronic databases until 15th
February 2022. Four cohort studies including 129 patients from 3 countries were included between time
period 2011 and 2020. Overall, bariatric surgery would promote massive weight loss associated with
positive effects on facial aging. Analysis revealed a proportional relationship between body mass index
(BMI) and faster facial aging and more attractive. Undergoing bariatric surgery would result in facial skin
sagging and a favorable effect on the upper airway. Bariatric surgery was found to have a significant
impact on changes in facial features but the current evidence remains inconclusive and further studies
are required to illustrate facial changes post-bariatric surgery.
RD26.
Adverse Event Following Immunization (AEFI) Associated With COVID-19 Vaccine Reported In A
Tertiary Hospital In Malaysia: A Retrospective Cross-Sectional Study
Marilyn Tan May Yeen1, Teh Hwei Lin1, Wan Nor Aida Wan Mohd Shukri1, Tuan Mazlelaa Binti Tuan
Mahmood2, Adliah Mhd Ali2
1Kuala Lumpur Hospital, 2Universiti Kebangsaan Malaysia
The safety profile of different type of COVID-19 vaccine is lacking despite it is widely administered to the
nation. The aim of the study is to investigate AEFI associated with COVID-19 vaccines among adult
patients visiting Hospital Kuala Lumpur (HKL). The specific objectives of the study are to identify the type
and severity of AEFI, determine the common management of AEFI and identify the predictive factors that
affect the severity of AEFI. This study is a single centre, retrospective cross-sectional study by using
secondary data obtained from AEFI reporting form. This study was conducted in HKL and stratified
random sampling method was used in this study. Logistic regression analyses were used to assess
independent predictors that may affect the severity of AEFI. In this study, most patient were presented
with systemic reaction (60%) and only 40% of patients presented with local reactions like pain and
redness on injection site. Majority of the patients developed minor reaction (86.7%) following COVID-19
vaccination. Multiple logistic regression analysis found that the significant predictive factors that may
affect the severity of AEFI are mRNA type of COVID-19 vaccine (OR 0.117, 95% CI 0.031-0.448, p-value
0.002) and age less than 55 years old (OR 0.181, 95% CI 0.069-0.476, p-value 0.001). This study
concluded that the three types of COVID-19 vaccine that are available in Malaysia currently are safe as
none of the vaccines is associated with elevated risk of severe AEFI outcome or mortality rate
significantly.

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RD27.
Pandemic Era Cross-Sectional Study on Impaired Work Productivity due to Sickness Among Security
Guards with Musculoskeletal Pain and Other Contributing Factors
Nur Faezah Che Mat1, Hanizah Mohd Yusoff2
1Klinik Kesihatan Putrajaya Presint 18, Jabatan Kesihatan Wilayah Persekutuan Kuala Lumpur dan
Putrajaya, 2Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia
Medical Centre, Kuala Lumpur
Impaired work productivity within the context of sickness absenteeism (absent from work) and
presenteeism (present but unwell) reflects employee’s wellbeing. In view of their working nature,
security guards are exposed to physical and ergonomic hazards. They are vulnerable to develop
musculoskeletal (MS) pain. Limited data available on this matter. We aimed to study the impaired work
productivity and associated contributing factors among local public university security guards with MS
pain. A cross-sectional study was conducted in three campuses of Universiti Kebangsaan Malaysia (UKM)
between March and October 2020 involving 83 security guards with MS pain. Validated set of self-
reporting questionnaires including Nordic Musculoskeletal Questionnaire; Depression, Anxiety and Stress
Scale; Stanford Presenteeism Scale-6; and Penilaian Keterukan Stress Kerja were adopted. Statistical
evaluations using descriptive, bivariate, and multiple logistic regression analyses were applied
accordingly. Prevalence of absenteeism and presenteeism among security guards with MS pain was
25.3% and 42.2% respectively. Majority had multiple area of body pain (68.7%). About 33.7% of
respondents required medication for pain relief and were found to have 9.561 higher odds of developing
absenteeism. Emotional stress observed in 25.3% of respondents which was a significant associated
factor. Odds of having absenteeism and presenteeism among security guards with stress were 5.035 and
3.904 times of that of non-stress security guards. Those who worked for >10 years had 0.291 lower odds
of developing presenteeism. Significant percentage of security guards with MS pain reported
absenteeism and presenteeism. Pain medication use, emotional stress and length of services were
important associated factors.
RD28.
Experience in Using Intravenous (IV) Iron: A Retrospective Study on Effectiveness of IV Iron in Medical
Ward Tertiary Hospital
Merina Aw Kar Ling1, Hayati Alwani Yahaya1, Loh Weng Khean2, Nurul Ain Mohd Tahir3, Chandini Menon
Premakumar3
1Kuala Lumpur Hospital, 2Ampang Hospital, 3University Kebangsaan Malaysia
Oral iron is the first-line treatment for Iron Deficiency Anaemia (IDA). Given the proven safety and
efficacy of intravenous (IV) iron in various studies, the current practice needs to be revised. This study
aimed to evaluate the effectiveness of IV iron used in IDA in a medical setting. A single-centre
retrospective study was conducted from January to December 2021. All adult patients receiving IV iron in
the medical wards of Hospital Kuala Lumpur (HKL) were conveniently sampled in this study. For efficacy
outcome, the Hb and MCV levels were increased significantly from 8.283 g/dL (± 1.124) to 10.532 g/dL (±
1.760) and 77.305 fL (± 10.66) to 82.189 fL (± 9.044), respectively. 49.2% of patients achieved the
increment of Hb 2 g/dL, and 13.3% of the patient’s achieved normalization of Hb. There are only 2.8% of
patients experience adverse events. There are four significant predictors that will affect the use of IV iron
to achieve an increment of Hb 2 g/dL which were baseline Hb (aOR 0.541; 95% CI 0.348 – 0.843),
baseline ferritin 30 µg/dL (aOR 3.059; 95% CI 1.136 – 8.240), diabetes mellitus (aOR 0.317; 95% CI 0.130
– 0.772) and blood disorder (aOR 5.195; 95% CI 1.024 – 26.358). IV iron significantly increases the Hb and
MCV levels without causing significant adverse events. The predictors for achieving increment Hb 2 g/dL
were lower baseline Hb, baseline ferritin 30 µg/dL and underlying blood disorder. IV iron is a safe and
effective option to treat IDA in medical patients.

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RD29.
A study to Evaluate Clinical Judgement among Nurses in Public Hospital, Malaysia using SBARe tool: A
Preliminary Research
Azliha Minai Rajab1, Jheffany Yazid2, Aisyahton Suhaimi1, Zahidah Idris1, Yuzana Muhd Yusop3
1Nursing Unit, Hospital Kuala Lumpur, Jheffany Yazid, Occupational Health and Safety unit, Hospital Kuala
Lumpur, 3University Sultan Zainal Abidin, Kuala Nerus, Terengganu
Communication failure is a leading cause of patient harm and complaints against healthcare
services. Aim: To evaluate clinical judgment among nurses using the SBARe tool, explore their
views or comments towards using it during report handovers, understand its applicability in their routine,
and recognize the level of communication, knowledge, and readiness among nurses in using SBARe. This
qualitative study utilized the narrative method and the purposive sampling technique. The sample
included 15 nurse leaders who communicated using SBARe in Malaysia's largest public hospital. In-depth
interviews were conducted, and data were analyzed using the Thematic Analysis approach and ATLAS ti
for coding and theme identification. The study found that nurses in Malaysian public hospitals using the
SBARe tool were effective and efficient in clinical decision-making. The tool improved their analysis of
patient information, prioritized care, and informed their decisions. Nurses believed SBARe was efficient,
time-saving, and practical, and could improve communication and preparedness during report
handovers. The tool's results were simple, accurate, and compact, ensuring essential information
exchange and minimizing errors. This study recommends that the SBARe tool should be implemented in
all hospitals and continuously trained for nurses. It can optimize resource utilization and improve patient
outcomes by improving clinical decision-making, reducing errors, and saving time during report
handovers. Nurses' reaction to SBARe is a recommendation that should be implemented. All nurses
should use it because it's simple and straightforward, rather than writing lengthy reports.
RD30.
Measure of Physician Workload in Hospital Setting: A Narrative Review
Karina Koh¹, Lee Jen Ven¹, Varaalakshmy Gokilavanan¹, Aina Waheeda Mohamed¹, Siti Zulfa Zulfikli²,
Azahirafairud Abdul Rahim², Saiful Safuan Md Sani¹², Cheah Wee Kooi3, Shaun Lee Wen Huey4.
1Clinical Research Centre, Hospital Kuala Lumpur; 2Department of Medicine, Hospital Kuala Lumpur,
3Medicine, Clinical Research Centre of Taiping Hospital, Perak, 4Faculty of Pharmacy, Monash University
Currently there is a maldistribution of doctors in Malaysia. There is a need to equally distribute doctors to
hospitals according to workload requirements. Currently there is no standard tool to measure physician
workload. This study aims to identify the methods used to determine physician workload in hospital
settings. Literature searches of Medline, Emerald and Proquest were conducted from January 1, 2000 to
22 November 2022. Inclusion criteria for this review are physicians working in non-surgical based
specialty, hospital setting, measuring physician workload, any study design and in English language.
Eligible studies provided both objective and subjective measurements of physician workload. This review
was conducted in accordance with the PRISMA guidelines. Eighty-two studies were included for full text
review. Majority (69%) of current literature uses physician related measures to measure workload. In this
subgroup, the most common measure used is mental workload and perceived workload of physicians
(42%), followed by number of hours worked (40%). Patient related measures were also used as a proxy of
physician workload and the most commonly used measure is patient volume (75%) which is rather
intuitive. A standard tool to measure physician workload is still lacking. The availability of different tools
gives users the flexibility to tailor suits the measurement according to their needs and resources. Even
though majority of studies utilizes objective measures, subjective measures of physician workload should
not be disregarded.

38
– POSTER PRESENTATION
RD31.
The Prevalence and Influencing Factors for Compassion Fatigue Among Nurses in Hospital Kuala
Lumpur: A Cross-Sectional Study
Tham Sin Wan1,2, Victor Hoe Chee Wai Bin Abdullah1, Mahmoud Danaee1
1University of Malaya, 2National Institutes of Health
Nursing is a caring profession where compassion is their core value. They may experience compassion
fatigue (CF) when providing patient care, which can affect their well-being and job performance. This
study aimed to determine the prevalence and factors associated with CF among nurses in Hospital Kuala
Lumpur (HKL). This research was a cross-sectional study among 174 nurses in HKL recruited via universal
sampling. Data were collected through an online survey which includes sociodemographic and the Malay
version of the Professional Quality of Life Scale (ProQOL-M). Data analysis consisted of descriptive
statistics, bivariate analysis, and linear regression at a 95% significance level using SPSS version 24. Of 174
nurses, the majority were female (93.1%), Malay (89.1%), married (76.4%), had work experience of more
than ten years (47.1%) and cared for COVID patients (67.2%). There were 37.9% of nurses experienced
moderate CF. The factors that associated with CF were age -.024, p = <0.001), work experience -
.140, p = 0.002), care for COVID patient -.276, p = 0.005), shift -.361, p = <0.001), position -.435,
p = 0.003) and traumatic event in past 12 month -.242, p = 0.010). One-third of nurses in HKL
experienced CF. Various factors contributed to CF. The hospital administrators need to explore and plan
strategies to create an excellent working atmosphere and safeguard the mental health of nurses in the
hospital. In turn, this can improve human resource management and achieve a sustainable quality of
patient care.
RD32.
Outcome And Safety of Shorter Versus Longer Regimen of Drug Resistant Tuberculosis Treatment in A
Tertiary Care Respiratory Center in Malaysia
Nager Devi Vampanan1, Shamala Balan2, Zamzurina Abu Bakar3, Lim Suat Yee3, Nurul Nabihah Hilmiyah3
1Kuala Lumpur Hospital, 2Tengku Ampuan Rahimah Hospital, 3National Respiratory Institute
Drug-resistant tuberculosis (DR-TB) remains a global threat in TB control. There is a scarcity of evidence
on the comparison of outcomes and safety between shorter and longer regimens for DR-TB treatment. A
retrospective cross-sectional study was conducted among adult DR-TB patients attending respiratory
clinic at the National Respiratory Centre from January 2017 to January 2021. Medical records were
screened for evaluation of DR-TB treatment outcome which were classified as successful outcomes and
unsuccessful outcomes. Safety profile was assessed from adverse drug reaction (ADR) reports. In total, 81
patients aged 18 to 68 years old (41.1±14.1) were included. The DR-TB treatment consists of 55.6%
(n=45) patients in longer and 44.4% (n=36) patients in shorter regimen. Overall, 24.7% (n=20) and 17.3%
(n=14) patients were categorised as having successful outcomes in the longer and shorter regimen,
respectively. About 79% (n=64) of patients experienced at least one ADR related to DR-TB treatment
resulting in 82 ADR cases. Most of the ADRs (53.1%, n=43) were reported among patients in the longer
regimen. Kanamycin was most commonly suspected to cause ADR. The causality assessments were
certain in 47.56% (n=39) cases, probable in 23.2% (n=19) cases and possible in 29.3% (n=24) cases.
Patients on the longer regimen of DR-TB treatment reported a greater rate of successful outcomes
despite experiencing a higher number of ADRs. Identification of risk factors associated with ADR among
patients on the longer regimen is essential in order to optimize the outcome and safety of DR-TB
treatment.

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