Published Scholarly Output

Background Migraine may lead to a negative impact on the patients’ quality of life with a subsequent substantial burden to society. Therapy options for treatment and prevention of migraine have progressed over the years and repetitive transcranial magnetic stimulation (rTMS) is one of the promising non-pharmacological options. It induces and alters electric current in the brain via repetitive non-invasive brain stimulation in high frequency. In migraine patients, two common stimulation sites are the M1 cortex and dorsolateral prefrontal cortex (DLPFC). The mechanism on how rTMS exerts therapeutic effects on migraine is not fully established, but the main postulation is that the neuromodulation via high-frequency rTMS (hf-rTMS) might inhibit pain perception. However, evidence from studies has been conflicting, thus the usefulness of hf-rTMS as migraine preventive treatment is still uncertain at this moment. Methods This is a systematic review protocol describing essential reporting items based on the PRISMA for systematic review protocols (PRISMA-P) (Registration number: CRD42020220636). We aim to review the effectiveness, tolerability, and safety of hf-rTMS at DLPFC in randomised controlled trials (RCTs) as migraine prophylactic treatment. We will search Scopus, Cumulative Index to Nursing and Allied Health Literature Plus, PubMed, Cochrane Central Register of Controlled Trials and Biomed Central for relevant articles from randomised controlled clinical trials that used hf-rTMS applied at DLPFC for the treatment of migraine. The risk of bias will be assessed using the version 2 “Risk of bias” tool from Cochrane Handbook for Systematic Reviews of Interventions Version 6.1. We will investigate the evidence on efficacy, tolerability and safety and we will compare the outcomes between the hf-rTMS intervention and sham groups. Discussion This systematic review will further determine the efficacy, safety, and tolerability of hf-rTMS applied at DLPFC for migraine prophylaxis. It will provide additional data for health practitioners and policymakers about the usefulness of hf-rTMS for migraine preventive treatment.

Objective To evaluate the efficacy of high-frequency repetitive transcranial magnetic stimulation over dorsolateral prefrontal cortex as a migraine prevention by conducting a systematic review and meta-analysis. Background The efficacy of high-frequency repetitive transcranial magnetic stimulation over dorsolateral prefrontal cortex as preventive migraine treatment remains debatable. Methods PubMed, Scopus, CINAHL, CENTRAL, and BioMed Central databases were searched from their inception until December 2020. Randomised trials comparing high-frequency repetitive transcranial magnetic stimulation over dorsolateral prefrontal cortex with sham for migraine prevention were included. The risk of bias was assessed using the Cochrane guidelines. Headache days, pain intensity, acute medication intake, and disability were extracted as study outcomes and the mean difference with a random-effects model was used to determine the effect size. Results Meta-analysis revealed that high-frequency repetitive transcranial magnetic stimulation over dorsolateral prefrontal cortex significantly reduced acute medication intake (Mean Difference = 9.78, p = 0.02, 95%CI: 1.60, 17.96, p = 0.02) and functional disability (Mean Difference = 8.00, p < 0.05, 95%CI: 4.21, 11.79). However, no differences were found in headache days and pain intensity reduction, although there was a slight trend favouring high-frequency repetitive transcranial magnetic stimulation. Conclusion High-frequency repetitive transcranial magnetic stimulation over dorsolateral prefrontal cortex may be effective in reducing acute medication intake and disability. However, more studies are needed to strengthen this preliminary evidence.

Introduction: As future healthcare providers, it is vital for medical students to be well-versed in home blood pressure monitoring (HBPM), which plays a crucial role in hypertension management. This study aimed to assess the level of knowledge on HBPM among medical students and factors associated with good knowledge. Method: A cross-sectional study was conducted among Year One to Five medical students in a Malaysian public university using universal sampling. Data was gathered via an online questionnaire on HBPM knowledge. The analysis of the data was performed using SPSS v26. Multiple logistic regression identified the determinants of good HBPM knowledge after adjusting for confounding. Results: A total of 370 medical students were recruited. The median age was 22 (2) years old, and 73.2% were female. 63.2% of them were from clinical years. The proportion of medical students with good HBPM knowledge was 55.7% (28.7% from preclinical students and 46% from clinical-year students). Multiple logistic regression revealed that clinical-year students were more likely to have good knowledge about HBPM than preclinical-year students. (OR=2.96; 95% CI=1.91-4.58, p<0.001). Conclusion: This study showed that preclinical-year students possess a poorer knowledge of HBPM. However, less than half of clinical year students exhibited good knowledge, despite greater patient exposure suggesting current clinical teaching may not impart comprehensive HBPM understanding. Medical schools should strengthen the curriculum by incorporating more practical HBPM learning during clerkships and rotations. This can better equip future physicians to effectively utilize HBPM for diagnosing and managing hypertension.

Peripheral neuropathy is a common cause for neurological consultation, especially among those with diabetes mellitus. However, research on peripheral neuropathy among the general population is lacking in Malaysia. This study aimed to determine the prevalence and factors associated with peripheral neuropathy in a setting of retail pharmacies. This cross-sectional study of 1283 participants was conducted at retail pharmacies in Selangor. Peripheral neuropathy was defined as the final score in the mild to severe category in the severity rating scale using a biothesiometer. SPSS version 26 was used to perform the analysis. Multiple logistic regressions were used to determine the factors associated with peripheral neuropathy. The prevalence of peripheral neuropathy based on the biothesiometer was 26.5%. According to multiple logistic regression, the predictors of peripheral neuropathy were those who have diabetes (AOR = 3.901), aged more than 50 years (AOR = 3.376), have secondary education or below (AOR = 2.330), are male (AOR = 1.816), and have underlying hypertension (AOR = 1.662). Peripheral neuropathy is a reasonably prevalent condition, affecting a quarter of the general population, and often goes undiagnosed. It is crucial for healthcare providers to proactively screen for peripheral neuropathy, particularly in high-risk populations, to prevent potential complications.