Knowledge and attitude regarding cervical cancer and its prevention among young female adults in Kuantan, Malaysia.

BACKGROUND: Cervical cancer is the second-most common female cancer in Malaysia after breast cancer. This study intended to investigate the knowledge and attitude regarding cervical cancer and its prevention and its associated factors among young female adults in Kuantan, Malaysia, to gauge the community's understanding and idea about this issue. MATERIALS AND METHODS: The study was conducted in attractive places in Kuantan, Malaysia, such as shopping malls and Urban Transformation Centre, using a cross-sectional study design and convenience sampling method. Data on the respondents' knowledge and attitude regarding cervical cancer and its prevention were collected using a questionnaire. Kruskal-Wallis, Independent t-, and Pearson correlation tests were used to investigate the study variables' association using SPSS software. RESULTS: From the total of 142 respondents, almost half of them aged between 20 and 24 years old with the majority were Malays (85.9%) and single (74.6%). The internet (78.1%) was identified as the main medium to gain information regarding cervical cancer. The results show that levels of education, races, and occupation types were statistically significantly associated with the respondents' knowledge and attitude scores in this study. Age was found to be associated with knowledge scores only, while marital status was only significantly associated with the attitude scores regarding cervical cancer and its prevention. Knowledge scores were also found to be positively associated with attitude scores. CONCLUSION: Several socio-demographic factors were significantly associated with the knowledge and attitude regarding cervical cancer and its prevention. In view of the positive association between knowledge and attitude scores, suitable health promotion activities can be designed and planned to increase young female adults' knowledge and attitudes toward cervical cancer and its prevention.

Tocilizumab in COVID-19: a study of adverse drug events reported in the WHO database.

BACKGROUND: Elevated inflammatory cytokines in Coronavirus disease 2019 (COVID-19) affect the lungs leading to pneumonitis with a poor prognosis. Tocilizumab, a type of humanized monoclonal antibody antagonizing interleukin-6 receptors, is currently utilized to treat COVID-19. The present study reviews tocilizumab adverse drug events (ADEs) reported in the World Health Organization (WHO) pharmacovigilance database. RESEARCH DESIGN AND METHODS: All suspected ADEs associated with tocilizumab between April to August 2020 were analyzed based on COVID-19 patients' demographic and clinical variables, and severity of involvement of organ system. RESULTS: A total of 1005 ADEs were reported among 513 recipients. The majority of the ADEs (46.26%) were reported from 18-64 years, were males and reported spontaneously. Around 80%, 20%, and 64% were serious, fatal, and administered intravenously, respectively. 'Injury, Poisoning, and Procedural Complications' remain as highest (35%) among categorized ADEs. Neutropenia, hypofibrinogenemia were common hematological ADEs. The above 64 years was found to have significantly lower odds than of below 45 years. In comparison, those in the European Region have substantially higher odds compared to the Region of Americas. CONCLUSION: Neutropenia, superinfections, reactivation of latent infections, hepatitis, and cardiac abnormalities were common ADEs observed that necessitate proper monitoring and reporting.

Detection of mobile colistin-resistance gene variants (mcr-1 and mcr-2) in urinary tract pathogens in Bangladesh: the last resort of infectious disease management colistin efficacy is under threat.

Background: Currently, colistin-resistant pathogens emerged has become a global health concern. This study assessed the distribution of mcr-1 to mcr-5 variants with the phenotypic colistin-resistance in bacterial isolates from urinary tract infection (UTI) patients in Bangladesh.Methods: A cross-sectional study was conducted between April 2017 and March 2018 to enroll uncomplicated UTI patients, and 142 urine samples were analyzed. Uropathogens were identified using the API-20E biochemical panel and 16s rRNA gene sequencing. Polymerase chain reactions detected the mcr gene variants in the UTI isolates. The phenotypic colistin-susceptibility was determined by the Kirby-Bauer disc-diffusion method and the minimal inhibitory concentration (MIC) measurement.Results: The combined carriage of mcr-1 and mcr-2 genes in 11.4% (14/123) of urinary tract pathogens. The mcr-positive pathogens include five Escherichia coli, three Klebsiella pneumoniae, three Pseudomonas putida, two Enterobacter cloacae, and one Enterobacter hormaechei. The mcr-positive variant showed significantly higher phenotypic colistin resistance with MIC between >16 µg/mL and >128 µg/mL (p< 0.001). Over 85% of colistin-resistant isolates showed MDR phenomena.Conclusions: The emergence of the clinical MDR pathogens with resistance to a highly selective drug may lead to a lack of treatment options for the infectious diseases and spread of infection to the unaffected cohorts.

The Incidence of Nasopharyngeal Carcinoma in Pahang State of Malaysia from 2012 to 2017.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is the fifth most common cancer among Malaysians. While several studies have reported the trend of NPC in other states in Malaysia, no studies have reported the trend of NPC in Pahang state. This study was designed to report the number and distribution of newly diagnosed NPC cases in Pahang. METHODS: NPC cases that were diagnosed between 2012 and 2017 in two referral hospitals in Pahang were traced. The crude incidence rate (CR) and age-standardised rate (ASR) were calculated to investigate the NPC incidence. RESULTS: There were 143 new cases of NPC reported from the two hospitals. The mean age at diagnosis was 52.0 ± 13.7 years old. The majority of cases involved males (74.1%) with a male to female ratio of 2.9:1. Chinese males were found to have the highest incidence with a mean ASR of 4.7 per 100,000 population. Overall, the mean ASR for Pahang was 2.4 per 100,000 population for males and 0.9 per 100,000 population for females. CONCLUSION: The total number of NPC cases reveals an increasing trend from 2012 to 2014 and then a slightly decreasing trend from 2015 to 2017. The incidence of NPC in Pahang was intermediate in males and low in females.

Type-2 Diabetes Mellitus Individuals Carry Different Periodontal Bacteria

ABSTRACT Objective: To identify etiologic microbiota associated periodontal diseases among diabetes patients and the factors related to the most commonly identified bacteria species. Material and Methods: Periodontal plaque samples from 11 diabetic participants and 13 non-diabetic controls were collected to assess their aerobic and anaerobic bacterial growth. Different distinct colonies were identified by microscopic and 16srDNA sequencing. Pearson's chi-square tests were conducted to examine any association between categorical variables. Results: The diabetic subjects revealed a more intense plaque formation with a mean plaque index of 2.4 compared to 1.8 in non-diabetics. A total of 86 bacteria were isolated from 24 plaque samples, 44 were aerobic, and 42 were anaerobic. Only aerobic isolates, 22 from diabetic patients and 22 from non-diabetic patients, were evaluated in these analyses. Bacillus spp. (B. cereus mainly) and Klebsiella spp. (K. pneumoniae, K. aerogenes, K. oxytoca) were detected markedly higher in non-diabetic individuals than in diabetic subjects (p=0.026 and p=0.021, respectively). Some bacteria were only identified in the dental plaque of diabetic individuals, namely, Bacillus mojavensis, Enterobacter cloacae, Proteus mirabilis, Staphylococcus epidermidis, Staphylococcus hominis, Staphylococcus pasteuri, Streptococcus mutans, and Streptococcus pasteurianus. The presence of acid reflux and jaundice were significantly associated with the most common bacterial isolate, namely Bacillus spp., with the p-values of 0.007 and 0.001, respectively. Conclusion: Type-2 diabetes mellitus is associated with a higher amount of dental plaques. Periodontal plaque samples from diabetic and non-diabetic subjects possess differential microbial communities. Diabetic plaques contain more versatile microbes predominated by gram-positive streptococci and staphylococci.

Microbial Resistance Movements: An Overview of Global Public Health Threats Posed by Antimicrobial Resistance, and How Best to Counter.

Antibiotics changed medical practice by significantly decreasing the morbidity and mortality associated with bacterial infection. However, infectious diseases remain the leading cause of death in the world. There is global concern about the rise in antimicrobial resistance (AMR), which affects both developed and developing countries. AMR is a public health challenge with extensive health, economic, and societal implications. This paper sets AMR in context, starting with the history of antibiotics, including the discovery of penicillin and the golden era of antibiotics, before exploring the problems and challenges we now face due to AMR. Among the factors discussed is the low level of development of new antimicrobials and the irrational prescribing of antibiotics in developed and developing countries. A fundamental problem is the knowledge, attitude, and practice (KAP) regarding antibiotics among medical practitioners, and we explore this aspect in some depth, including a discussion on the KAP among medical students. We conclude with suggestions on how to address this public health threat, including recommendations on training medical students about antibiotics, and strategies to overcome the problems of irrational antibiotic prescribing and AMR.

Genotypic to Phenotypic Resistance Discrepancies Identified Involving ß-Lactamase Genes, blaKPC, blaIMP, blaNDM-1, and blaVIM in Uropathogenic Klebsiella pneumoniae.

INTRODUCTION: Klebsiella pneumoniae carbapenemase (KPC) belongs to the Group-A ß-lactamases that incorporate serine at their active site and hydrolyze various penicillins, cephalosporins, and carbapenems. Metallo-beta-lactamases (MBLs) are group-B enzymes that contain one or two essential zinc ions in the active sites and hydrolyze almost all clinically available ß-lactam antibiotics. Klebsiella pneumoniae remains the pathogen with the most antimicrobial resistance to KPC and MBLs. METHODS: This research investigated the blaKPC, and MBL genes, namely, blaIMP, blaVIM, and blaNDM-1 and their phenotypic resistance to K. pneumoniae isolated from urinary tract infections (UTI) in Bangladesh. Isolated UTI K. pneumoniae were identified by API-20E and 16s rDNA gene analysis. Their phenotypic antimicrobial resistance was examined by the Kirby-Bauer disc diffusion method, followed by minimal inhibitory concentration (MIC) determination. blaKPC, blaIMP, blaNDM-1, and blaVIM genes were evaluated by polymerase chain reactions (PCR) and confirmed by sequencing. RESULTS: Fifty-eight K. pneumoniae were identified from 142 acute UTI cases. Their phenotypic resistance to amoxycillin-clavulanic acid, cephalexin, cefuroxime, ceftriaxone, and imipenem were 98.3%, 100%, 96.5%, 91.4%, 75.1%, respectively. Over half (31/58) of the isolates contained either blaKPC or one of the MBL genes. Individual prevalence of blaKPC, blaIMP, blaNDM-1, and blaVIM were 15.5% (9), 10.3% (6), 22.4% (13), and 19% (11), respectively. Of these, eight isolates (25.8%, 8/31) were found to have two genes in four different combinations. The co-existence of the ESBL genes generated more resistance than each one individually. Some isolates appeared phenotypically susceptible to imipenem in the presence of blaKPC, blaIMP, blaVIM, and blaNDM-1 genes, singly or in combination. CONCLUSION: The discrepancy of genotype and phenotype resistance has significant consequences for clinical bacteriology, precision in diagnosis, the prudent selection of antimicrobials, and rational prescribing. Heterogeneous phenotypes of antimicrobial susceptibility testing should be taken seriously to avoid inappropriate diagnostic and therapeutic decisions.

Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries.

The prevalence of long-term (chronic) non-communicable diseases (NCDs) is increasing globally due to an ageing global population, urbanization, changes in lifestyles, and inequitable access to healthcare. Although previously more common in high- and upper-middle-income countries, lower-middle-income countries (LMICs) are more affected, with NCDs in LMICs currently accounting for 85-90% of premature deaths among 30-69 years old. NCDs have both high morbidity and mortality and high treatment costs, not only for the diseases themselves but also for their complications. Primary health care (PHC) services are a vital component in the prevention and control of long-term NCDs, particularly in LMICs, where the health infrastructure and hospital services may be under strain. Drawing from published studies, this review analyses how PHC services can be utilized and strengthened to help prevent and control long-term NCDs in LMICs. The review finds that a PHC service approach, which deals with health in a comprehensive way, including the promotion, prevention, and control of diseases, can be useful in both high and low resource settings. Further, a PHC based approach also provides opportunities for communities to better access appropriate healthcare, which ensures more significant equity, efficiency, effectiveness, safety, and timeliness, empowers service users, and helps healthcare providers to achieve better health outcomes at lower costs.

Antibiotic resistance and sensitivity pattern of Metallo-ß-Lactamase Producing Gram-Negative Bacilli in ventilator-associated pneumonia in the intensive care unit of a public medical school hospital in Bangladesh.

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICU), accounting for 25% of all ICU infections. Antimicrobial resistance is increasing and becoming a significant health problem worldwide, increasing hospital length of stay, mortality and costs. Identifying antibiotic resistance patterns in VAP is important as this can cause outbreaks in ICUs. To date, there have been limited studies assessing this in Bangladesh. Consequently, the primary objective of this research was to study the species of bacterial growth and to determine the antibiotic resistance patterns of Metallo-ß-Lactamase (MBL) producing gram-negative bacilli among ICU patients with VAP in a public medical school hospital, Bangladesh. In addition, identify the factors associated with a positive culture to provide future guidance. METHOD: Cross-sectional study performed in the Chattogram Medical College Hospital, Bangladesh. Mueller Hinton agar plates were used for antibiotic sensitivity testing by the Kirby-Buer disc diffusion test. RESULTS: Among 105 clinically suspected VAP cases, qualitative cultures were positive in 95 (90%) of them. The most common bacteria identified were Acinetobacter spp. (43.2%), Klebsiella spp. (20%) and Pseudomonas spp. (18.9%). A positive culture was not associated with patients' age or gender. Among 41 isolated Acinetobacter spp., 38 (92.7%) were resistant to gentamicin followed by 36 (87.8%) to ceftriaxone. Among 24 isolated Klebsiella spp., 22 (83.3%) were resistant to ceftriaxone. Among 18 isolated Pseudomonas spp., 16 (88.8%) were resistant to ciprofloxacin, and 13 (72.2%) were resistant to ceftriaxone. Among nine isolated E. coli, all were resistant to ceftriaxone and ciprofloxacin. All four Proteus spp. (100%) isolated were resistant to ciprofloxacin. Additionally, phenotype MBL producing was 65.22% and genotype was 45.65% among imipenem resistant pathogens. Imipenem resistant pathogens were sensitive to amoxyclav, amikacin¸ azithromycin, ceftazidime, ceftriaxone, colistin and gentamycin. CONCLUSION: A positive culture was detected in 90% of VAP patients, but it was not associated with the patients' age and gender. The most common bacteria identified were Acinetobacter spp., Klebsiella spp. and Pseudomonas spp., where the majority of these were resistant to ceftriaxone. The results are being used to provide future guidance on the empiric management of VAP in this hospital.

Knowledge, Attitude and Practice Regarding Pertussis among a Public University Students in Malaysia

Abstract Objective: To study the knowledge, attitude, and practice (KAP) regarding pertussis among students in a public university in Malaysia. Material and Methods: This study was a cross-sectional study using convenience sampling to recruit 171 respondents. The data was collected using a self-administered questionnaire comprised of four different parts: the socio-demographic data, the knowledge, the attitude and the practice towards the prevention of pertussis. The data were analyzed using correlation, independent t-test, and ANOVA according to the different study objectives and types of data. Results: More than half of the respondents (67.8%) indicated that they had heard about pertussis. The school or university (59.6%) was the most common source of information, followed by Internet (46.2%). The most of the respondents (43.9%) possessed moderate knowledge regarding pertussis and knew that Bordetella pertussis is the causative agent of pertussis (76.0%). A significant positive correlation between knowledge regarding pertussis with age (p=0.023) was observed, however, there was no association between age with attitude and practice (p=0.272 and 0.131, respectively). Gender and marital status did not influence the KAP regarding pertussis; nevertheless, significantly different between different faculties. Conclusion: Students from the Faculty of Medicine had the highest knowledge scores, while the students from the Faculty of Nursing had the most top attitude and practice scores compared to students from another faculty. The students from the public university generally had a good level of KAP regarding pertussis.

Comparative Study of CDST & Multiplex PCR to Detect MBL Producing Gram-Negative Bacilli among VAP Patients Admitted in a Public Medical College Hospital of Bangladesh.

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICU), which accounts for 25% of all ICU infection. Documenting carbapenem-resistant gram-negative bacilli is very important as these strains may often cause outbreaks in the ICU setting and are responsible for the increased mortality and morbidity or limiting therapeutic options. The classical phenotypic method cannot provide an efficient means of diagnosis of the metallo-ß-lactamases (MBLs) producer. Polymerase chain reaction (PCR) assays have lessened the importance of the phenotypic approach by detecting metallo-ß-lactamase resistance genes such as New Delhi metallo-ß-lactamase (NDM), Imipenemase (IMP), Verona integron-encoded metallo-ß-lactamase (VIM), Sao Paulo metallo-ß-lactamase (SPM), Germany Imipenemase (GIM). OBJECTIVE: To compare the results of the Combined Disc Synergy Test (CDST) with that of the multiplex PCR to detect MBL-producing gram-negative bacilli. MATERIALS AND METHOD: A total of 105 endotracheal aspirates (ETA) samples were collected from the ICU of a public school in Bangladesh. This cross-sectional study was carried out in the Department of Microbiology, Chittagong for quantitative culture, CDST test, and multiplex PCR for blaIMP, blaVIM, blaNDM genes of MBL producers. RESULTS: Among the 105 clinically suspected VAP cases, the quantitative culture was positive in 95 (90%) and among 95 g-negative bacilli isolated from VAP patients, 46 (48.42%) were imipenem resistant, 30 (65.22%) were MBL producers by CDST, 21 (45.65%) were identified as MBL producers by multiplex PCR. CONCLUSION: PCR was highly sensitive and specific for the detection of MBL producers.

Antibiotic Use: A Cross-Sectional Study Evaluating the Understanding, Usage and Perspectives of Medical Students and Pathfinders of a Public Defence University in Malaysia.

Background: Antimicrobial prescribing behaviors are often influenced by the local culture and prescribing appropriateness of medical doctors and other health care professionals. Globally, antimicrobial utilization practices have a profound impact on antimicrobial resistance and are a tremendous public health concern. The aim of this survey was to explore the knowledge and attitudes of medical students from the National Defence University of Malaysia regarding antimicrobial usage and antimicrobial resistance. Research design and methods: This was a cross-sectional study. The study population consisted of undergraduate medical students in each year group from the National Defence University of Malaysia. Students receive limited formal training on the use of antibiotics in their curriculum, and most of this learning is opportunistic whilst on clinical placement. Universal sampling was used as the study population was small. Data were collected utilizing a previously validated instrument regarding antibiotic use. Simple descriptive statistics were used to generate frequencies and percentages with SPSS V21. This research was approved by the Centre for Research and Innovation Management, National Defence University of Malaysia. Results: 206 questionnaires were distributed with a response rate of 99.03%, 54% (110) male, and 46% (94) female. Out of the respondents, 65% (132) had used antibiotics in the last year. Respondents displayed a moderate level of knowledge about antibiotics. Conclusions: This study revealed that the older the student was, or when the year of study and total knowledge score was higher, the students were less likely to stop antimicrobials when they felt better or use leftover antibiotics without consulting a doctor. Therefore, the nearer the students were to graduation, the better their knowledge and skills were, and this translated into their own behaviors regarding use of antimicrobials. This finding has clear implications for curriculum design and the inclusion of formal teaching throughout the medical program on antimicrobial use and antimicrobial resistance (AMR). However, more research is needed on this topic, including the prescribing habits and antibiotic use of practicing doctors.

Self-medication of antibiotics: investigating practice among university students at the Malaysian National Defence University.

Background: Self-medication of drugs to alleviate symptoms is a common global behavior, helping relieve burdens on health services, but many drugs eg, antibiotics are prescription-only. Self-medication of antibiotics (SMA) is an irrational use of drugs, contributing to microbial resistance increasing health care costs and higher mortality and morbidity. This study aimed to assess SMA among university students. Methods: This was a cross-sectional study conducted among medical and non-medical students of the National Defence University of Malaysia. A validated instrument was used to gather data. Ethics approval was obtained. Random and universal sampling was adopted, and SPSS 21 was used for data analysis. Results: A total of 649 students participated in the study: 48.5% male and 51.5% female, 39.3% reported self-medicating with antibiotics. Penicillin, doxycycline, clarithromycin were the antibiotics most used with the majority reporting no adverse drug reactions. Cost savings and convenience were the principal reasons for SMA which were mainly obtained from local retail pharmacies. Despite medical students (particularly the more senior) having better knowledge of antibiotic use than non-medical students, 89% of all research participants responded that practicing SMA was a good/acceptable practice. Conclusion: SMA is common amongst Malaysian students and, despite understanding why SMA is unwise, even medical students self-medicate.

Knowledge, attitude and practice regarding hypertension among residents in a housing area in Selangor, Malaysia.

BACKGROUND AND AIMS: Hypertension is becoming a global epidemic and threat to the world population. This cross-sectional study was carried out at a housing area in Selangor, Malaysia to study the knowledge, attitude and practice (KAP) regarding hypertension among the residents. METHODS: A total of 110 respondents aged 18 years old and above were selected by convenience sampling. Data was collected using a structured interviewer-guided questionnaire with Likert-scale choices of answers. RESULTS: All respondents were Malay with the mean age of 41 years [Standard Deviation (SD)=11.828]. The total mean and SD of knowledge, attitude and practice scores were 74.33 (SD=6.25), 44.22 (SD=5.05) and 27.55 (SD=2.86), respectively. There were significant positive correlations between knowledge with attitude (r=+0.393; p<0.001) and practice (r=+0.378; p<0.001). However, there was no significant correlation between attitude and practice (r=+0.120; p=0.212). There were significant fair positive correlations between age with knowledge (r=+0.402; p<0.001), attitude (r=+0.265; p=0.005) and practice (r=+0.337; p<0.001) regarding hypertension. Meanwhile, gender, educational level, employment status and family history had no significant association with knowledge, attitude and practice regarding hypertension. CONCLUSION: This study revealed that KAP regarding hypertension were associated with age, but not with other socio-demographic characteristics studied. The awareness, prevention and control programs of hypertension in their community should be increased, so that the residents could enjoy and maintain the healthy lifestyle.

A cross-sectional study evaluating the knowledge and beliefs about, and the use of antibiotics amongst Malaysian university students.

BACKGROUND: The introduction of antibiotics into modern medicine has changed clinical care by saving millions of lives. However, misuse of antibiotics has led to their benefits being overshadowed by the development of antimicrobial resistance. AIMS OF STUDY: This study aimed to assess university students' knowledge and beliefs about and their use of antibiotics. METHODS: This cross-sectional study was conducted among 674 medical and non-medical students of the National Defence University of Malaysia, using universal and convenience sampling methods. The data was collected using a validated questionnaire and analyzed using IBM SPSS 24, and the MANOVA test and Logistic Regression were used to explore the associated factors. RESULTS: More than half of the respondents' knowledge was low and their health beliefs outdated. Age, race and program were significantly associated with up-to-date knowledge and beliefs about antibiotic use, factors associated with finishing a course of antibiotics were studying medicine, personal health, and ethnicity. The significant factors associated with antibiotic self-prescribing were beliefs having been prescribed antibiotics during the last one year, and trusting the doctors who did not prescribe antibiotics. CONCLUSION: This study has identified a concerning low knowledge about antibiotics amongst some Malaysian university students, reflected in use of un-prescribed antibiotics and a lack of adherence to treatment. There is a need for educational interventions for students regarding antibiotic usage and resistance issues.

Knowledge, Attitude, and Practice Regarding the Risk of Cardiovascular Diseases in Patients Attending Outpatient Clinic in Kuantan, Malaysia.

BACKGROUND: Cardiovascular disease (CVD) is a leading cause of death around the world including Malaysia. Ischemic heart disease (IHD) is the single largest cause of death in the developed countries and is one of the main contributors to the disease burden in developing countries. MATERIALS AND METHODS: This was a cross-sectional study conducted to determine knowledge, attitude, and practice (KAP) regarding the risk of CVD in patients attending an outpatient clinic in Kuantan, Malaysia. A total of 100 patients comprising 52 male and 48 female subjects were selected through convenient sampling method. RESULTS: Of the total subjects, 86% were Malays. The mean scores (standard deviation) for KAP were 60.75±4.823, 54.36±8.711, and 33.43±4.046, respectively, whereas the maximum scores obtained by the subjects for KAP were 71, 65, and 43, respectively. Regarding questions related to knowledge, 88% subjects knew irregular eating pattern can cause disease and the benefits of vegetable intake. Most subjects recognized that smoking and obesity were CVD risk factors. Regarding questions related to attitude, 96% agreed that exercise can prevent CVD. More than half of the subjects followed healthy lifestyle. There were statistically significant differences observed in knowledge level between sexes (P = 0.046) and races (P = 0.001). Nevertheless, there was no statistically significant difference observed in KAP across different education levels of the subjects regarding the risk of CVD (P-value = 0.332, 0.185, and 0.160, respectively). CONCLUSION: This study revealed that patients had good knowledge and attitude regarding CVD risk factors. Yet, the number of smokers is still quite high. Development of better public information system is essential for the well-being of the society.

Internet use and addiction among medical students of Universiti Sultan Zainal Abidin, Malaysia.

BACKGROUND: The use of Internet has now become indispensable, and the technology has revolutionized the medical education and practice worldwide. Currently, medical students and professionals have an enormous opportunity to keep them always updated with the exponential growth of knowledge because of potential progression of Internet throughout the world that enables them to become a lifelong learner. Internet addiction is a widespread phenomenon among students and academicians at universities in Malaysia. Students use the Internet for recreational purpose and personal and professional development. The Internet has become an integral part of day-to-day life of the university students, including medical students. The aim of the present study was to examine the Internet use and addiction among students of Universiti Sultan Zainal Abidin, Malaysia. METHODS: This was a cross-sectional study in which a questionnaire, Internet Addiction Diagnostic Questionnaire, developed by the Center for Internet Addiction, USA, was used. One hundred forty-nine medical students of Universiti Sultan Zainal Abidin participated in this study. Data were analyzed using Statistical Package for the Social Sciences software. RESULTS: The mean scores were 44.9±14.05 and 41.4±13.05 for male and female participants, respectively, which indicated that both the genders were suffering from mild Internet addiction. CONCLUSION: This study shows almost similar level of Internet usage among medical students irrespective of their socioeconomic background, with no statistically significant (p>0.05) differences, except among the years of study (p=0.007). Overall, from the research data and having worked with this cohort very closely, Universiti Sultan Zainal Abidin medical students can be labeled as wonted and recurring users of the Internet. Nevertheless, it is very difficult to define as Internet addicts or pathological users of the Internet because of small sample size and cross-sectional study.