- Department of Family Medicine
Level 14 Preclinical Block
Faculty of Medicine
Universiti Kebangsaan Malaysia
Jalan Yaacob Latif
56000 Cheras, Kuala Lumpur
Malaysia
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INTRODUCTION Stroke survivors are commonly at risk of functional decline, which increase their dependency in activities of daily living and eventually affects their motivation level, self-efficacy, and quality of life. Circuit exercise... more
INTRODUCTION Stroke survivors are commonly at risk of functional decline, which increase their dependency in activities of daily living and eventually affects their motivation level, self-efficacy, and quality of life. Circuit exercise has been shown to be useful in enhancing functional performance and quality of life of chronic stroke survivors. There is a need to review the existing "usual circuit exercise" and develop a better approach, such as game-based circuit exercise. Training in enriched and fun environment may possibly further promote neuroplasticity. However, evidence on inducing fun element in the existing circuit exercise among stroke survivors is limited. Also, no studies are available to date which report the benefit of circuit exercise on stroke survivors' self-efficacy and motivation level. Therefore, this study aims to assess the effectiveness of game-based circuit exercise in comparison to conventional circuit exercise on functional outcome (lower limb strength, postural stability and aerobic endurance), motivation level, self-efficacy and quality of life among stroke survivors. This study also aims to assess whether the outcomes gained from the 2 interventions could be sustained at week 12 and 24 post-trial. METHODS This is an assessor-blinded randomized control trial comparing 2 types of intervention which are game-based circuit exercise (experimental group) and conventional circuit exercise (control group). Based on sample size calculation using GPower, a total number of 82 participants will be recruited and allocated into either the experimental or the control group. Participants in the experimental group will receive a set of structured game-based exercise therapy which has the components of resistance, dynamic balance and aerobic exercises. While participants in the control group will receive a conventional circuit exercise as usually conducted by physiotherapists consisting of 6 exercise stations; cycling, repeated sit to stand, upper limb exercise, lower limb exercise, stepping up/down and walking over obstacles. Both groups will perform the given interventions for 2 times per week for 12 weeks under the supervision of 2 physiotherapists. Outcomes of the interventions will be measured using 30-second chair rise test (for lower limb strength), Dynamic Gait Index (for postural stability), 6-minute walk test (aerobic capacity), Intrinsic Motivation Inventory questionnaire (for motivation level), stroke self-efficacy questionnaire (for self-efficacy) and Short Form-36 quality of life questionnaire (for quality of life). All data will be analyzed using descriptive and inferential statistics. DISCUSSION This study will provide the information regarding the effectiveness of including game elements into circuit exercise training. Findings from this study will enable physiotherapists to design more innovative exercise therapy sessions to promote neuroplasticity and enhance functionality and quality of life among stroke survivors under their care. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN 12621001489886 (last updated 1/11/2021).
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Introduction: The clinical pathway (CP) is one of the most recommended tools for ensuring the best quality of care and has been proven to reduce the cost and time spent in hospital. The development of a CP for influenza is crucial,... more
Introduction: The clinical pathway (CP) is one of the most recommended tools for ensuring the best quality of care and has been proven to reduce the cost and time spent in hospital. The development of a CP for influenza is crucial, especially for the elderly, as they are vulnerable to influenza-related complications. The main aim of this study was to provide a comprehensive protocol for each component of influenza management among the elderly in Malaysia. Methods: An expert group meeting was conducted involving family medicine specialists, public health specialists, geriatricians, respiratory physicians and infectious disease physicians. The CP was designed following a 6-step protocol: 1) Selection of expert panel, 2) discussion and information gathering, 3) development of CP draft, 4) refinement of CP draft, 5) implementation of CP, and 6) finalisation of CP. The CP for influenza was designed based on service type and disease severity. Results: The panel described both outpatient a...
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Background The practice of referring diabetic patients for dental intervention has been poor despite awareness and knowledge on the systemic effects of periodontal disease. Similarly, dentists are rarely updated on the glycaemic status of... more
Background The practice of referring diabetic patients for dental intervention has been poor despite awareness and knowledge on the systemic effects of periodontal disease. Similarly, dentists are rarely updated on the glycaemic status of patients receiving treatment for diabetes. The rising incidence of diabetes among individuals who are unaware of their glycaemic status warrants screening among those presenting with complications of diabetes i.e. periodontitis. Objectives This study aimed to provide a standardised care pathway which will initiate screening for diabetes from dental clinics and link patients with primary care to receive optimised care for glycaemic control. Methods Modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices to screen for diabetes among patients attending dental clinics for periodontitis. Expert panel members were recruited using snowball technique and comprised of Family Medicine Specialists (5), Periodontologists (6), Endocrinologists (3) and Clinical Pharmacists (4) who are involved in management of patients with diabetes at public and private healthcare facilities. Care algorithms were designed based on existing public healthcare services. Results CODAPT© panel recommended referral to primary care for further evaluation of glycaemic status if patients diagnosed with periodontitis record fasting capillary blood glucose levels ≥ 5.6 mmol/L. Intervention treatment options for prediabetes are listed, and emphasis on feedback to dental healthcare team is outlined specifically. Conclusion CODAPT© care pathway has potential to link dental clinics with primary care to diagnose and/or optimise treatment of prediabetes/diabetes among patients receiving periodontitis treatment
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Background Satisfaction with post stroke services would assist stakeholders in addressing gaps in service delivery. Tools used to evaluate satisfaction with stroke care services need to be validated to match healthcare services provided... more
Background Satisfaction with post stroke services would assist stakeholders in addressing gaps in service delivery. Tools used to evaluate satisfaction with stroke care services need to be validated to match healthcare services provided in each country. Studies on satisfaction with post discharge stroke care delivery in low- and middle-income countries (LMIC) are scarce, despite knowledge that post stroke care delivery is fragmented and poorly coordinated. This study aims to modify and validate the HomeSat subscale of the Dutch Satisfaction with Stroke Care-19 (SASC-19) questionnaire for use in Malaysia and in countries with similar public healthcare services in the region. Methods The HomeSat subscale of the Dutch SASC-19 questionnaire (11 items) underwent back-to-back translation to produce a Malay language version. Content validation was done by Family Medicine Specialists involved in community post-stroke care. Community social support services in the original questionnaire were...
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Research Interests: Rehabilitation, Long Term Care, Focus Groups, Malaysia, Developing Countries, and 15 moreMedicine, Library and Information Studies, Humans, Human Resources for Health, Female, Male, Focus Group, Aged, Middle Aged, Adult, Public health systems and services research, Continuity of Patient Care, attitude to health, Health Services Accessibility, and Health Resources
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Data on post stroke outcomes in developing countries are scarce due to uncoordinated healthcare delivery systems. In Malaysia, the national stroke clinical practice guideline does not address transfer of care and longer term post stroke... more
Data on post stroke outcomes in developing countries are scarce due to uncoordinated healthcare delivery systems. In Malaysia, the national stroke clinical practice guideline does not address transfer of care and longer term post stroke care beyond tertiary care. Hence, post stroke care delivery may be delivered at either tertiary or primary care facilities. This study aimed at describing patients’ characteristics and outcomes of post stroke care delivered by the primary care teams at public primary care healthcentres across Peninsular Malaysia. Multi staged sampling was done to select public primary care health centres to recruit post stroke patients. At each health centre, convenience sampling was done to recruit adult patients (≥18 years) who received post stroke care between July-December 2012. Baseline measurements were recorded at recruitment and retrospective medical record review was done simultaneously, for details on medical and / or rehabilitation treatment at health cent...
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Electroencephalography (EEG) monitoring is known to be technically feasible and possibly clinically relevant to determine patients with acute ischemic hemispheric stroke. The EEG is very useful tool in understanding neurological... more
Electroencephalography (EEG) monitoring is known to be technically feasible and possibly clinically relevant to determine patients with acute ischemic hemispheric stroke. The EEG is very useful tool in understanding neurological dysfunction of stroke plausible improving the treatment and rehabilitation. Most of the existing techniques to diagnose stroke from the EEG signal is mainly based on Fourier Transform (FT). For instance, the Brain Symmetry Index (BSI) employed Fast Fourier Transform (FFT) as coefficients to measure symmetrical of blood flow between left and right brain hemisphere. The symmetrical index ranges between zero and one where one indicates the highest asymmetrical of blood flow. It is known that the conventional FFT has limitation in analyzing non-linear and non-stationary signal. Therefore, the existing BSI and its variations may also suffer from this transformation properties. In this study, we propose BSI based on Hilbert Huang Transform (HHT) which defined as BSI-HHT. HHT is a way to decompose a signal into so-called intrinsic mode functions (IMF) along with a trend, and obtain instantaneous frequency data. The HHT will be used as coefficients instead off FFT in calculating the BSI index. An experiment to validate the performance of BSI-HHT is conducted in this study as to compare with the existing BSI technique. The EEG signal of Middle Cerebral Artery (MCA) subjects and healthy subjects are used for this investigation. The proposed BSI-HHT has offered better interpretation as it correlates to the stimulation procedure on the gathered data especially at specific frequency band. Also, through the analysis, the HHT coefficient is able to capture the non-stationary and non-linear of the interest electrode.
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This study explores the opinions of Malaysian clinical specialists on the antibiotic prophylaxis against infective endocarditis (IE) as described in the 2008 National Institute for Health and Care Excellence (NICE) guideline. This... more
This study explores the opinions of Malaysian clinical specialists on the antibiotic prophylaxis against infective endocarditis (IE) as described in the 2008 National Institute for Health and Care Excellence (NICE) guideline. This cross-sectional study was performed from September 2017 to March 2019. The self-administered questionnaire comprised two sections: background information of the specialists and their opinions on the NICE guideline. The questionnaire was distributed to 794 potential participants, and 277 responded (response rate of 34.9%). In general, 49.8% of the respondents believed that clinicians should adhere to the guideline, although the majority of oral and maxillofacial surgeons (54.5%) actually disagreed with this view. The dental procedures that were perceived as presented moderate-to-high risk for IE were minor surgery for an impacted tooth with a recent episode of infection, dental implant surgery, periodontal surgery and dental extraction in patients with poor...
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Background and objectives Risk of readmissions is an important quality indicator for stroke care. Such information is limited among low- and middle-income countries. We assessed the trends for 28-day readmissions after a stroke in... more
Background and objectives Risk of readmissions is an important quality indicator for stroke care. Such information is limited among low- and middle-income countries. We assessed the trends for 28-day readmissions after a stroke in Malaysia from 2008 to 2015 and evaluated the causes and factors associated with readmissions in 2015. Methods Using the national hospital admission records database, we included all stroke patients who were discharged alive between 2008 and 2015 for this secondary data analysis. The risk of readmissions was described in proportion and trends. Reasons were coded according to the International Classification of Diseases, 10th Edition. Multivariable logistic regression was performed to identify factors associated with readmissions. Results Among 151729 patients, 11 to 13% were readmitted within 28 days post-discharge from their stroke events each year. The trend was constant for ischemic stroke but decreasing for hemorrhagic stroke. The leading causes for rea...
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Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post... more
Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stroke care providers to help overcome fragmented post stroke care in areas where access is limited or lacking. Expert panel discussions comprising Family Medicine Specialists, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from Ministry of Health and acadaemia were conducted. In Phase One, experts chartered current care processes in public healthcare facilities, from acute stroke till discharge and also patients who presented late with stroke symptoms to public primary care health centres. In Phase Two, modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practic...
Research Interests: Nursing, Primary Health Care, Health Care, Malaysia, Public Health, and 15 moreHealth Administration, Medicine, Critical Care, Nursing Research, Library and Information Studies, Humans, Psychological Intervention, Checklist, Family Health, Patient Care Team, Public health systems and services research, Multidisciplinary Approach, Delphi Technique, Health Personnel, and Health Services Accessibility
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Background: This paper describes a study to evaluate the readability scores of Malaysian newspaper articles meant to create awareness of diabetes among the public. In contrast to patient-specific sources of information, mass media may... more
Background: This paper describes a study to evaluate the readability scores of Malaysian newspaper articles meant to create awareness of diabetes among the public. In contrast to patient-specific sources of information, mass media may potentially reach healthy people and help them avoid becoming part of the diabetes statistics. The study selected relevant samples from the Malaysian Diabetes Corpus and used an online tool to score and display their readability using Flesch Kinkaid Reading Ease (FKRE) as the main indicator. Result: The average readability for the materials is low at 49.6 FKRE, which may impede the uptake of information contained in the articles. Trend analysis reveals that there is not much variability in the years covered by the corpus with the articles from 2016 scoring better than other years. Feature analysis of articles with the best and worst readability indicates that medical practitioners may not be the best spokesperson to reach the public. It also indicates ...
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Background The elderly population in Malaysia are projected to reach almost one third of the total population by 2040. The absence of a National Dementia Strategy (NDS) in preparing the healthcare services for the ageing population is... more
Background The elderly population in Malaysia are projected to reach almost one third of the total population by 2040. The absence of a National Dementia Strategy (NDS) in preparing the healthcare services for the ageing population is compounded by the lack of assessment of preparedness of future healthcare workers to manage complications related to ageing i.e., dementia. Studies in countries with NDS demonstrated lack of dementia knowledge among medical undergraduates. Hence, this study aimed to assess the knowledge on dementia among final year medical undergraduates in Malaysia and its associated factors, using the Dementia Knowledge Assessment Scale (DKAS). Methods This cross-sectional study, employed multistage sampling method to recruit final year medical undergraduates from eleven selected public and private medical institutions across Malaysia. Online self-administered measures were delivered to final year medical undergraduates through representatives of medical students’ so...
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Introduction: Dementia is a global challenge for healthcare systems, including Malaysia. Despite evidence-based Clinical Practice Guidelines (CPG) for dementia management in primary care, detection is poor. Improving detection rates... more
Introduction: Dementia is a global challenge for healthcare systems, including Malaysia. Despite evidence-based Clinical Practice Guidelines (CPG) for dementia management in primary care, detection is poor. Improving detection rates requires understanding current practice and influencing factors. This study aims to assess the practice of cognitive evaluation among primary care practitioners (PCPs) and its associated factors, as well as its correlation with their knowledge and attitudes towards early dementia diagnosis. Materials and Methods: A cross-sectional study conducted online, using Google Form TM recruited 207 Medical Officers from 14 public primary health centres, with a response rate of 74%. The Knowledge, Attitude and Practice Questionnaire for Family Physicians (KAPQFP) was used to assess PCPs' knowledge, attitude and practice in dementia care. Items in each domain were scored on a 4-point Likert scale, with scores ranging from 1 to 4. Each domain's mean score was divided by 4 and converted to a scale of 100, with higher scores indicating better knowledge, attitude and practice. Bivariate analyses were conducted to determine the factors associated with cognitive evaluation practice. Results: The overall mean practice score was 3.53±0.52 (88.3%), which is substantially higher than the mean score for perceived competency and knowledge of 2.46±0.51 (61.5%). The mean score for attitude towards dementia and collaboration with nurses and other healthcare professionals was 3.36±0.49 (84.0%) and 3.43±0.71 (85.8%), respectively. PCPs with prior dementia training showed better practice (p=0.006), as did PCPs with longer primary care work experience (p=0.038). A significant positive association was found between knowledge-practice ((rs=0.207, p=0.003), attitude towards dementia practice ((rs=0.478, p<0.001), and attitude towards collaboration with other healthcare professionals-practice (rs= 0.427, p<0.001). Limited time and inadequate knowledge regarding dementia diagnosis and cognitive evaluation tools were among the reasons cognitive evaluations were not performed. Conclusion: PCPs demonstrated better practice of cognitive evaluation, as compared to their knowledge and attitude. Given that their perceived competency and knowledge on dementia diagnosis is low and is positively associated with their practice, it is crucial to implement a comprehensive dementia training to enhance their knowledge and confidence on early detection of cognitive decline and cognitive evaluation in order to achieve better dementia detection in primary care.
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Background: The elderly population in Malaysia are projected to reach almost one third of the total population by 2040. The absence of a National Dementia Strategy (NDS) in preparing the healthcare services for the ageing population is... more
Background: The elderly population in Malaysia are projected to reach almost one third of the total population by 2040. The absence of a National Dementia Strategy (NDS) in preparing the healthcare services for the ageing population is compounded by the lack of assessment of preparedness of future healthcare workers to manage complications related to ageing i.e., dementia. Studies in countries with NDS demonstrated lack of dementia knowledge among medical undergraduates. Hence, this study aimed to assess the knowledge on dementia among final year medical undergraduates in Malaysia and its associated factors, using the Dementia Knowledge Assessment Scale (DKAS). Methods: This cross-sectional study, employed multistage sampling method to recruit final year medical undergraduates from eleven selected public and private medical institutions across Malaysia. Online self-administered measures were delivered to final year medical undergraduates through representatives of medical students' society after approval from Deanery and institutional ethics board of participating universities. The measure collected demographic information, previous dementia exposure (i.e., formal or informal) and the 25-item Likert scale DKAS. Bivariate analysis and linear regression were conducted to confirm factors influencing dementia knowledge components. Results: A total of 464 respondents from 7 universities participated in this study. Overall dementia knowledge among respondents with and without exposure, was low, with average score of 29.60 ± 6.97 and 28.22 ± 6.98, respectively. DKAS subscales analysis revealed respondents scored highest in care consideration subscale (9.49 ± 2.37) and lowest in communication and behaviour subscale (4.38 ± 2.39). However, only causes and characteristic subscale recorded significantly higher knowledge score among respondents with previous exposure (7.88 ± 2.58) (p =0.015). Higher knowledge of dementia was associated with previous formal dementia education (p=0.037) and informal occupational/working experience in caring for dementia patients (p = 0.001). Informal occupational/working experience (B = 4.141, 95% CI 1.748-6.535, p = 0.001) had greater effect than formal education (i.e. lectures/workshops) (B = 1.393, 95% CI 0.086-2.700, p = 0.037) to influence respondents' knowledge on dementia.
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Context: Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care‑driven health service is an option to ensure optimal care to poststroke patients residing at... more
Context: Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care‑driven health service is an option to ensure optimal care to poststroke patients residing at home in the community. Aims: We assessed outcomes of a pilot long‑term stroke care clinic which combined secondary prevention and rehabilitation at community level. Settings and Design: A prospective observational study of stroke patients treated between 2008 and 2010 at a primary care teaching facility. Subjects and Methods: Analysis of patients was done at initial contact and at 1‑year post treatment. Clinical outcomes included stroke risk factor(s) control, depression according to Patient Health Questionnaire (PHQ9), and level of independence using Barthel Index (BI). Statistical Analysis Used: Differences in means between baseline and post treatment were compared using paired t‑tests or Wilcoxon‑signed rank test. Significance level was set at 0.0...
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Context: Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care‑driven health service is an option to ensure optimal care to poststroke patients residing at... more
Context: Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care‑driven health service is an option to ensure optimal care to poststroke patients residing at home in the community. Aims: We assessed outcomes of a pilot long‑term stroke care clinic which combined secondary prevention and rehabilitation at community level. Settings and Design: A prospective observational study of stroke patients treated between 2008 and 2010 at a primary care teaching facility. Subjects and Methods: Analysis of patients was done at initial contact and at 1‑year post treatment. Clinical outcomes included stroke risk factor(s) control, depression according to Patient Health Questionnaire (PHQ9), and level of independence using Barthel Index (BI). Statistical Analysis Used: Differences in means between baseline and post treatment were compared using paired t‑tests or Wilcoxon‑signed rank test. Significance level was set at 0.0...
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The majority of caregivers for stroke patients in Malaysia are informal caregivers, although there are no valid tools to measure their knowledge regarding caregiving. Therefore, this study validated the Caregiving Knowledge Questionnaire... more
The majority of caregivers for stroke patients in Malaysia are informal caregivers, although there are no valid tools to measure their knowledge regarding caregiving. Therefore, this study validated the Caregiving Knowledge Questionnaire (CKQ-My) as an assessment of Malaysian stroke caregivers' knowledge regarding patient positioning and feeding. Back-to-back translation was used to produce a bilingual version of the questionnaire. Hand drawings were used to replace photographs from the original questionnaire. Face validity and content validity were assessed, and construct validity was determined by comparing responses from informal caregivers, medical students, and primary care doctors. Finally, the internal consistencies of the subscales were determined. Pretesting showed that the translated version was sufficiently easy to understand. Internal consistency for the positioning subscale (28 items, Cronbach's α = 0.70) and feeding subscale (15 items, Cronbach's α = 0.70) ...
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Diabetes mellitus is a major global public health problem. The rise in global prevalence is expected to reach 5.4% or 300 million worldwide by 2025, with developed countries carrying a larger burden (1). Malaysia is not spared from this... more
Diabetes mellitus is a major global public health problem. The rise in global prevalence is expected to reach 5.4% or 300 million worldwide by 2025, with developed countries carrying a larger burden (1). Malaysia is not spared from this phenomena, with an alarming rise in prevalence of Type 2 diabetes mellitus (T2DM) over the past fifteen years, from 8.3% (NHMS 1, 1996) to 20.8% (NHMS IV, 2011) (2). What is most worrying is the figure for undiagnosed diabetics, which recorded almost a ten-fold increase (from 1.8% to 10.1%) within the same period. The national economic burden for provision of ambulatory or outpatient care for diabetes patients alone was estimated to cost the Ministry of Health RM 836 million, which took up 2.2% of the nation’s total health expenditure for 2009 (3). The average provider cost per outpatient visit for diabetes treatment at primary care was RM393.24, compared to RM 2707.44 at Specialist diabetic clinics. Treatment at primary care health centres was also ...
This presentation disucsses the use of care pathways to coordinate post stroke care for patients residing at home in the Community. Designed to aid and empower the Primary care team to align and direct post stroke patients to receive... more
This presentation disucsses the use of care pathways to coordinate post stroke care for patients residing at home in the Community. Designed to aid and empower the Primary care team to align and direct post stroke patients to receive optimal care which combines medical and psycho social approach.
Colorectal cancer (CRC) is one of the major malignancies in the world. In Malaysia, CRC is fast becoming the commonest cause of cancer death. Its etiology is complex, involving both environmental and genetic factors. This study looked at... more
Colorectal cancer (CRC) is one of the major malignancies in the world. In Malaysia, CRC is fast becoming the commonest cause of cancer death. Its etiology is complex, involving both environmental and genetic factors. This study looked at the profile and outcome of five-year follow-up of patients with CRC. Retrospective case review study done on CRC patients at University Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia. Patientsandapos; socio-demographic characteristics, modalities of treatment, cancer characteristics and outcome at 5-year follow up were extracted from the case records. A total of 107 case records of patients were analyzed. Peak age of CRC presentation was 40-69 years (71.1%). Male to female ratio was 1.2:1 with Chinese predominance (52.3%). Anaemia and its related symptoms including per rectal bleeding was the commonest clinical presentation. The median duration of clinical presentation was 13 weeks (IQR 21.8). More than two-thirds presented as no...
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Abstract: Randomised controlled trials form the foundation for 'evidence-based-medicine,'but the results of such research can be relied upon only if it was conducted according to principles and standards collectively referred to... more
Abstract: Randomised controlled trials form the foundation for 'evidence-based-medicine,'but the results of such research can be relied upon only if it was conducted according to principles and standards collectively referred to as 'Good Clinical Practice'(GCP). The GCP was established as a basis both for the scientific and ethical integrity of research involving human subjects and for generating valid observations and sound documentation of research findings. It provides a framework for clinical investigators and pharmaceutical companies ...
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Introduction Erectile dysfunction (ED) is defined as the "inability to attain or maintain penile erection sufficient for satisfactory sexual performance". 1 The prevalence of ED is increasing, and it is estimated that 322... more
Introduction Erectile dysfunction (ED) is defined as the "inability to attain or maintain penile erection sufficient for satisfactory sexual performance". 1 The prevalence of ED is increasing, and it is estimated that 322 million men worldwide will be affected by 2025, with the largest projected increase occurring in developing countries. 2 The prevalence of ED varies from 6.4-70.1%, and the wide variation is mainly due to the difference in assessment tools used, and the populations studied. 3-8 Physiologically, normal erection is maintained by a complex interplay between vascular and neurological events. Any condition that affects the vascular supply or the neuronal pathways to the penis, whether medical or psychological in origin, may cause ED. 1,9,10 Studies have shown that the prevalence of ED is significantly associated with age, the presence of co-morbid conditions and smoking. 3,4,6 Millions of men are affected by ED, often suffering in silence, while experiencing s...