Borneo Journal of Medical Sciences (BJMS)

Anaemia in Pregnancy in Sabah, Malaysia: A Challenge.

2025-08-11T16:02:14+08:00

Anaemia during pregnancy represents a critical public health concern in Malaysia, especially in the state of Sabah where challenges such as limited access to healthcare, poor socioeconomic conditions, and geographic isolation intensify the burden. This article reviews the epidemiological patterns, contributing factors, health consequences, and strategic responses to anaemia in pregnancy among Sabah’s diverse communities. Contributing factors include inadequate nutrition, early and repeated pregnancies, poverty, and cultural dietary restrictions. The condition increases risks of complications for both mother and baby, such as preterm birth, low birth weight, and maternal mortality. National and local health policies have incorporated interventions such as routine haemoglobin assessments, iron-folic acid supplementation, and nutrition education. Promising results from case studies, like the decline in anaemia cases at Klink Kesihatan Penampang, reflect the importance of tailored interventions. The article concludes with actionable recommendations focused on expanding antenatal care access, enhancing diagnostics, and promoting culturally sensitive health education to reduce anaemia in pregnancy and improve maternal and child outcomes in Sabah.

Artificial Intelligence in Medical Education: Preparing Future Physicians for an AI-Driven Healthcare System

2026-08-12T09:08:53+08:00

Artificial intelligence (AI) is a transition from an old speculative idea to a new comprehensive idea that is a vital element for healthcare and medical education. AI is either generative or assistive, strengthening the field of study. The most popular generative AI platform, ChatGPT, along with other language models, has been widely used by medical students to access information, solve problems, develop clinical reasoning, and prepare for examinations. On the other hand, educators are searching for AI-assisted technologies for assessment and evaluation design, feedback generation, curriculum development, teaching methods and strategies, and various research. This notable evolution presents huge opportunities while also raising concerns about ethical practice, data privacy, learners' professionalism and dependency, writing individuality, academic integrity, and professional accountability.

An Unexpected Site: Pleomorphic Adenoma In The Nasal Septum

2025-07-08T19:33:45+08:00

Pleomorphic adenoma is the most common benign tumour of the major salivary glands, but it may also arise in the minor salivary glands, particularly those located in the hard and soft palate. Its occurrence in the nasal cavity is rare, with approximately 80% of intranasal cases originating from the nasal septum and the remainder from the lateral wall or turbinates. We report the case of a 49-year-old woman who experienced left-sided epistaxis for one year, along with progressive nasal obstruction and a painless swelling over the left lateral alar region for six months. Rigid nasoendoscopy revealed a large polypoid mass occupying the left anterior nasal cavity. Histopathological examination of a biopsy specimen suggested pleomorphic adenoma. Computed tomography of the paranasal sinuses demonstrated an enhancing soft tissue lesion at the proximal left nasal meatus. The mass was excised endoscopically, and the patient has remained disease-free on follow-up. This case underscores the importance of recognising intranasal pleomorphic adenoma as a rare differential diagnosis and highlights the value of early identification and surgical intervention.

Severe Bickerstaff Brainstem Encephalitis in a Young Adult Male: Delayed Recovery Despite Early Immunotherapy

2025-07-14T11:28:22+08:00

Bickerstaff brainstem encephalitis (BBE) is a rare post-infectious autoimmune disorder within the anti-GQ1b antibody spectrum, commonly presenting with ophthalmoplegia, ataxia, and impaired consciousness. Diagnosis is typically delayed because early symptoms are non-specific, and initial imaging often appears normal. We report a case of a 19-year-old male who initially presented with fever, limb weakness, and slurred speech. Within days, he deteriorated rapidly, requiring intubation. Initial imaging and cerebrospinal fluid analysis (CSF) were inconclusive. However, later serological studies revealed the presence of anti-GQ1b antibodies. Although MRI results were normal, the clinical picture was consistent with BBE. He underwent plasma exchange in the third week of illness. His recovery was complicated by hospital-acquired infection and barotrauma. His neurological recovery was slow. At the time plasma exchange was initiated (Day 21 of admission), the patient remained unresponsive with a Glasgow Coma Scale (GCS) of E1VTM1. By the sixth week of admission, his GCS had improved to E4V5M6, reflecting significant neurological recovery. With multidisciplinary rehabilitation, he eventually regained the ability to ambulate independently within 6 months. This case highlights the importance of considering BBE early in young patients presenting with acute brainstem dysfunction, even when initial imaging is unremarkable.

Healthcare Utilisation Inequality and the Hidden Burden of Out-of-Pocket Expenditures in Sabah

2025-07-03T13:05:26+08:00

Malaysia has made significant progress in reducing financial hardship from out-of-pocket (OOP) health expenditures, aligning with Sustainable Development Goal 3.8.2 on universal health coverage. However, persistent income inequality, particularly in Sabah where nearly 20% of individuals live below the poverty line, continues to hinder equitable access to healthcare. This study draws on data from the National Health and Morbidity Surveys (NHMS, 1996 to 2023) and the Household Income and Expenditure Surveys (HIES, 2014 to 2022) to assess income-related inequalities in healthcare utilisation and financial protection. Analyses were conducted using STATA 18. NHMS data were used to evaluate disparities in service use across income groups, while HIES data captured catastrophic and impoverishing health expenditures. Catastrophic expenditure was defined as health spending exceeding 40% of a household’s capacity to pay, and impoverishment as OOP payments that pushed households below the basic needs threshold. In 2023, inpatient care remained concentrated in the public sector, while outpatient services were more evenly utilised across sectors. Nevertheless, concentration indexes indicated rising pro-rich inequalities. Between 2.41% and 3.10% of households experienced catastrophic payments. An additional 2.0% to 3.8% were impoverished. Targeted and inclusive financial protection strategies are essential to close these gaps and achieve equitable health coverage.

P53 DOWNREGULATION IN NON-MELANOMA SKIN CANCER TREATED WITH CITRUS LIMON (CL) ESSENTIAL OIL

2025-08-11T15:31:50+08:00

Background: Citrus limon essential oil (CLEO) is rich in bioactive compounds which exhibit various therapeutic properties, including anticancer potential. Non-melanoma skin cancer, such as squamous cell carcinoma, is commonly associated with TP53gene mutations, leading to uncontrolled cell proliferation. Objectives: This study investigates the cytotoxic effects of CL EO on normal human foreskin fibroblast cells (HFF1) and human squamous carcinoma cells (A431) by analysing morphological changes, p53 protein secretion, and TP53 gene expression. Methods: HFF1 and A431 cells were treated with CLEO at concentrations of 125, 250, and 500 µg/mL for 24 hours. Morphological changes were observed using an inverted light microscope, while p53 protein secretion was analysed via Western blot. TP53 gene expression was assessed using quantitative real-time PCR. Results: There is mild structural changes in HFF1 cells at higher CLEO concentrations (250 and 500 µg/mL), whereas A431 cells exhibited significant membrane blebbing and detachment at all concentrations (125, 250, and 500 µg/mL). p53 protein secretion increased in HFF1 cells following CLEO treatment, while A431 cells exhibited a dose-dependent reduction in p53 secretion. Additionally, TP53 gene expression was significantly downregulated in A431 cells at 125 and 500 µg/mL CLEO concentrations, suggesting alternative mechanisms of cytotoxicity. Conclusion: CLEO exerts cytotoxic effects on A431 skin cancer cells than normal HFF1 cells. The modulation of p53 protein secretion and TP53 gene expression indicates its action through p53-dependent and independent mechanisms. Further studies are necessary to explore its precise molecular pathways and optimise its potential as a complementary therapy for skin cancer.

Bridging the Theory-Practice Gap in Cardiopulmonary Resuscitation Training: Knowledge and Readiness Among Healthcare Trainees in Malaysia

2025-12-05T12:15:58+08:00

Cardiopulmonary resuscitation (CPR) is a critical life-saving skill formally embedded within the curriculum of healthcare training programmes in Malaysia. At the Training Institute Ministry of Health Malaysia Kota Kinabalu (ILKKM KK), CPR instruction is a mandatory component of both the Diploma in Medical and Health Sciences (DMHS) and Diploma in Nursing (DPNS) programmes. Although theoretical content is consistently delivered, concerns remain regarding the extent to which trainees are practically ready to perform CPR in real-life emergencies. This study aimed to assess the levels of CPR knowledge and practical readiness among ILKKM KK trainees and to examine the relationship between these two domains. A cross-sectional study was conducted involving 120 trainees (stratified random sampling) who had completed the CPR module. Data collection was carried out using a structured questionnaire administered through Google Forms. The instrument assessed knowledge using multiple-choice questions and practical readiness through self-reported behavioural indicators on a three-point frequency scale. Descriptive statistics summarised participants’ performance, while chi-square and independent t-tests were used to determine associations and group differences. The findings showed that (63 out of 120 trainees) 52.5 % of trainees demonstrated high levels of CPR knowledge (M = 13.5, SD = 0.8), while 42 out of 120 trainees (35.0 %) reported high readiness to perform the procedure (M = 25.5, SD = 3.2). A statistically significant association was identified between knowledge and readiness levels, χ²(4, N = 120) = 12.58, p = .013, Cramér’s V = .29, indicating a moderate relationship. However, there were no significant differences in knowledge or readiness between DMHS and DPNS programmes.These results highlight a critical disconnect between theoretical knowledge and applied readiness, despite the mandatory inclusion of CPR in the academic syllabus. Strengthening CPR education through structured simulations, continuous reinforcement, and psychological preparedness may help ensure that trainees are not only knowledgeable but capable of responding confidently and competently in emergencies.

Prevalence of Psychotropics Used and Occurrence of Falls Among Older Patients with Parkinson’s Disease

2025-08-13T22:15:55+08:00

Older patients diagnosed with Parkinson's disease (PD) often experience a range of both motor and non-motor symptoms, including psychiatric issues. Managing these patients effectively typically requires a combination of medications, which raises concerns about potential side effects, such as an increased risk of falls. This study aims to explore the prevalence of psychotropic medication use and the occurrence of falls among PD patients aged 65 years and older at a quaternary care center in Malaysia. This retrospective cohort study included all idiopathic PD patients aged 65 years and above who were under follow-up at the interdisciplinary geriatric unit in Hospital Kuala Lumpur from 1^st January to 31^st December 2023. A total of 42 patients were eligible in this study. We collected baseline demographic data, information on psychiatric conditions (e.g., duration, management, and types of psychotropic medications prescribed), and the incidence of falls during the study period. The median age of participants was 75 years (IQR 10), with slightly more males (52%). The median duration of PD was 6 years (SD 5), and 59% of patients were in stages 1 to 3 of the Hoehn and Yahr scale. All participants had comorbidities and were on polypharmacy. Sixty-two percent were diagnosed with a psychiatric disorder, and 77% were prescribed psychotropic medications. The most common psychotropic medications were antidepressants (75%), followed by antipsychotics (15%), anxiolytics (5%), and hypnotics (5%). None had psychotropic polypharmacy. This study highlights the high prevalence of psychiatric disorders, psychotropic medication use, and fall incidents in this population. Regular medication reviews and fall assessments should be integral to the comprehensive geriatric evaluation for PD patients.