Acceptance and effectiveness of the Healthier Choice Logo (HCL) among food industries in Malaysia

@#Introduction: The Healthier Choice Logo (HCL) was introduced in 2017 by the Ministry of Health Malaysia. This paper analysed acceptance of HCL, effectiveness of HCL in encouraging healthier product reformulation, and factors affecting reformulation among food industries. Methods: An online self-administered questionnaire consisting of four sections utilising multiple choice and 5-point Likert scale questions was distributed to food industries in Malaysia. Sample size calculation yielded 100 respondents. Results: Food industries had a higher acceptance of the processes and requirements involved in HCL implementation. HCL was highly effective in encouraging product reformulation among food industries in Malaysia. Meeting consumer demand, improving brand image, public health, more awareness around nutrition labelling, logo and national nutrition target, more technical knowledge and budget were found to motivate healthier product reformulation. However, product suitability, consumer acceptability, difficulties maintaining taste and shelf life, and limited budget were the challenges faced in product reformulation. There was no correlation between HCL acceptance and factors encouraging or inhibiting reformulation. Conclusion: These findings are expected to help relevant authorities or stakeholders make changes, if necessary, towards processes and requirements involved in HCL application to ensure wider HCL implementation. Future research should identify the relationship between HCL implementation and public health improvement among the Malaysian population.

Relationship between Parental Emotional Styles and Family Values to Anxiety Level among Primary School Children

@#Introduction: Childhood anxiety is one of the common mental health problems in children. Untreated childhood anxiety will lead to a higher risk of developing mental health problems in adulthood. Thus, this study aimed to investigate the relationship between parental emotional styles and family values to anxiety level among primary school children. Methods: A cross-sectional study was conducted in a selected primary school in Kelantan, Malaysia. A set of questionnaires consisted of the Revised Child Anxiety and Depression Scale–Parents’ Report (RCADS-P 25), the Parental Emotional Style Questionnaire (PESQ), and the Asian Family Characteristics Scale (AFCS) was used for assessing anxiety, parental emotional styles, and family values, respectively. Data were collected via an online survey using Google Form, and were analysed using Multiple Linear Regression (MLR) to determine the factors associated with childhood anxiety. The significance value was set at p < 0.05. Results: A total of 150 parents of primary school children from the selected school was involved in this study. The majority of respondents were females (82.0%), married (94.7%), hold a degree (66.7%), and were working in the government sector (60.0%). Most of the respondents’ child were twelve years old (20.7%) and males (62%). Based on the MLR, emotional dismissing parental style (p = 0.025) and family values (p = 0.016) were significantly associated with anxiety in these children. Conclusion: Emotional dismissing parental style and family values were significant predictors of anxiety in primary school children. Future intervention research on childhood anxiety is needed.

Probabilistic Tractography Between Nucleus Accumbens and Other Reward-related Brain Areas in Malay Female Adolescents

@#Introduction: Studies show that adolescents are more reward sensitive compared to other age groups. The nucleus accumbens (NAcc) has been identified as a key brain area involved in reward through its connectivity to other reward-related brain areas. Our study aimed to characterise the white matter structural connectivity of nucleus accumbens with brain areas that are most often associated with reward in female adolescents. Methods: Fifteen healthy female Malay adolescents were recruited and underwent diffusion-weighted brain scanning. Two behaviour scales were also given to verify typical reward responsiveness. Then, probabilistic tractography and NAcc segmentation were performed on the data using FMRIB Software Library (FSL). Probabilistic tractography was performed to determine the relative connection probability of nucleus accumbens (NAcc) to areas shown to be associated with reward, namely amygdala, anterior cingulate cortex (ACC), medial orbitofrontal cortex (mOFC), hippocampus, ventrolateral prefrontal cortex (vlPFC) and dorsolateral prefrontal cortex (dlPFC). Connectivity-based segmentation of NAcc was performed to determine the spatial distribution of its connectivity with the target brain areas according to the highest connection probability. Results: The highest relative connection probability was found between NAcc to mOFC, while the NAcc parcellation showed the widest distribution of connection to mOFC compared to the other five targets on both sides of the brain. Conclusion: Our findings demonstrated the strongest structural connectivity and widest distribution between NAcc and mOFC compared with other brain areas related to reward. This study’s findings could be used as baseline to compare with people with atypical reward circuit problems.

Molecular epidemiology of piliated pneumococcal isolates at a major tertiary hospital in the Klang Valley, Malaysia

Objective: To characterise a collection of pili-carrying and none pili-carrying pneumococcal isolates of clinical origin for serotypes, antibiotic resistance and genotype. Methods: In total, 42 clinical isolates were collected between October 2017 and December 2019. Those isolates were analysed for antimicrobial susceptibility, serotype distribution, detection of pneumococcal virulence and pilus genes. Multilocus sequence typing was performed only for piliated isolates, followed by phylogenetic analysis. Results: The common isolation sites among the pneumococcal isolates were tracheal aspirate (28.6%), blood (26.2%), and sputum (23.8%). Fifty percent isolates were resistant to erythromycin, tetracycline (50.0%) and trimethoprim-sulfamethoxazole (43.0%). The most frequent were serotypes 19F (28.6%), 6A/B (23.8%) and 19A (14.3%). Piliated isolates were detected in a small proportion (33.3%); 64.3% were multidrug-resistant. ST320 was the prevalent sequence type among the piliated isolates and genetically related to the Pneumococcal Molecular Epidemiology Network clones Taiwan 19F -14 (CC271). In the phylogenetic analysis, some piliated isolates showed a close association having similar ST320, carrying serotype 19A and both pilus genes indicating their clonal spread. Conclusions: Pneumococcal lineages of piliated isolates have been globally disseminated and pili could have played a role in the spread of antibiotic resistant clones.

Assessments of Aphasia: Practices and Challenges faced by Malaysian SpeechLanguage Therapists (Penilaian Aphasia: Amalan dan Cabaran yang dihadapi oleh Jurupulih Pertuturan-Bahasa Malaysia) / Jurnal Sains Kesihatan Malaysia

@#Aphasia assessment is crucial in diagnosing aphasia, determining the extent of language impairment, and identifying factors that may support or restrict aphasia recovery to design an appropriate plan of care for people with aphasia. Speech-language therapists (SLTs) play a major role in conducting aphasia assessments. Little is known about the practices of SLTs in assessing aphasia in low-resource regions. The present study aims to identify aphasia assessment practices among Malaysian SLTs and related challenges, as well as strategies for improving aphasia assessments from SLTs’ perspectives. A total of 32 SLT participants who have been practicing in Malaysia completed an online survey to gather their background information, data pertaining to practices and challenges in conducting aphasia assessments, and suggestions for improving aphasia assessments. Descriptive analyses were conducted for all numerical data. Suggestions for improving aphasia assessment practices were analysed qualitatively using the thematic content analysis approach. SLT practices in aphasia assessment were found to be consistent in certain aspects, but not all. Two major challenges were identified: (a) linguistic barriers between clinicians and clients/caregivers, and (b) a lack of standardized assessment tools for aphasia evaluations. Participants suggested “Internal Strategies” and “External Strategies” for improving aphasia assessment practices.

Management of Tricuspid Valve Regurgitation During Surgical Ventricular Restoration for Ischemic Cardiomyopathy

ABSTRACT Introduction: We studied the effect of tricuspid valve (TV) surgery combined with surgical ventricular restoration (SVR) on operative outcomes, rehospitalization, recurrent tricuspid regurgitation, and survival of patients with ischemic cardiomyopathy. Additionally, surgery was compared to conservative management in patients with mild or moderate tricuspid regurgitation. To the best of our knowledge, the advantage of combining TV surgery with SVR in patients with ischemic cardiomyopathy had not been investigated before. Methods: This retrospective cohort study included 137 SVR patients who were recruited from 2009 to 2020. Patients were divided into two groups - those with no concomitant TV surgery (n=74) and those with concomitant TV repair or replacement (n=63). Results: Extracorporeal membrane oxygenation use was higher in SVR patients without TV surgery (P=0.015). Re-exploration and blood transfusion were significantly higher in those with TV surgery (P=0.048 and P=0.037, respectively). Hospital mortality occurred in eight (10.81%) patients with no TV surgery vs. five (7.94%) in the TV surgery group (P=0.771). Neither rehospitalization (log-rank P=0.749) nor survival (log-rank P=0.515) differed in patients with mild and moderate tricuspid regurgitation in both groups. Freedom from recurrent tricuspid regurgitation was non-significantly higher in mild and moderate tricuspid regurgitation patients with no TV surgery (P=0.059). Conservative management predicted the recurrence of tricuspid regurgitation. Conclusion: TV surgery concomitant with SVR could reduce the recurrence of tricuspid regurgitation; however, its effect on the clinical outcomes of rehospitalization and survival was not evident. The same effects were observed in patients with mild and moderate tricuspid regurgitation.

Medical students’ experiences of online learning during the COVID-19 pandemic: A phenomenological study / The Health Sciences Journal

INTRODUCTION@#The COVID-19 pandemic forced Philippine medical schools to adapt their curriculum design to fit an online setup. This study aimed to analyze and interpret the lived experiences of medical students who experienced online learning during the COVID-19 pandemic and to explore the adaptations to online learning.@*METHODS@#This is an interpretive phenomenological study using purposive sampling. Participants were 1st to 3rd year medical students enrolled for Academic Year 2020-2021. Participants were interviewed online by a psychologist who was not part of the research team using a 13-question guide. The interviews were recorded and transcribed. Interview data were analyzed and interpreted using interpretative phenomenological analysis (IPA).@*RESULTS@#Nine medical students were interviewed. The IPA identified six superordinate themes: 1) positive adaptations through positive reframing; 2) resulting mental health concerns; 3) intrinsic and extrinsic concerns encountered; 4) self-awareness as a first step towards adjustment; 5) dual role of family; and 6) perceptions on systemic response. @*CONCLUSION@#Online medical education during the pandemic resulted in problems and mental health concerns among participants, and many developed self-awareness and positive adaptations specific to the online setup. Participants’ families helped some adjust, while others posed an additional challenge. Both positive and negative perceptions of the systemic response of the school also arose.

Preemptive pregabalin for postoperative analgesia during minimally invasive hysterectomy: a systematic review and meta-analysis of randomized controlled trials

We aimed to perform a systematic review and meta-analysis of all randomized placebo-controlled trials (RCTs) that examined the analgesic benefits of preemptive pregabalin among patients undergoing minimally invasive hysterectomy. Five major databases were systematically screened from inception until August 29, 2021 Relevant studies were evaluated for risk of bias. Endpoints were analyzed using the random-effects model and pooled as the mean difference or risk ratio with a 95% confidence interval. Four studies with seven treatment arms met the inclusion criteria. The total sample size was 304 patients: 193 and 111 patients were allocated to the pregabalin and placebo groups, respectively. Overall, the included studies revealed a low risk of bias. The summary results revealed that the mean postoperative pain scores at rest were significantly lower in the pregabalin group than in the control group at 0, 2, 4, 6, 12, and 24 hours. Moreover, the mean postoperative pain scores on movement/coughing were significantly lower in the pregabalin group than in the control group at 12 and 24 hours. The rate of patients who were opioid-free postoperatively was significantly higher in the pregabalin group than in the control group. There was no significant difference between the groups in terms of the mean postoperative time to first rescue analgesic and the rates of adverse events. Compared with placebo, preemptive pregabalin was largely safe, and was correlated with superior analgesic effects in terms of lower postoperative pain scores and higher opioid-sparing effects. Additional RCTs are needed to confirm these findings.

Low-cost 3D modeling software for generating patient-specific drill guide templates for cervical pedicle screw insertion: An in vitro study

BACKGROUND@#Instrumented posterior cervical spine surgery (IPCSS) can be conducted using screws inserted through the pedicles of the vertebra. A safe IPCSS method uses 3D-printing to produce templates that will serve as drill guides for screw placement.@*OBJECTIVES@#This study describes the generation of 3D-printed drill guides using low-cost general purpose 3D modeling software and the comparison of screw insertion accuracy scores against the traditional landmark method and guides created using commercial grade software.@*METHODS@#Twenty-five (25) subaxial pedicles of five cadaveric spines were selected and scanned using computed tomography (CT). A digital reconstruction of the five cadaveric spines were created based on the CT DICOM data. A low-cost 3D modeling software, Rhinoceros 3D, was utilized for trajectory planning and generation of a patientspecific drill template using the digital reconstruction. The templates were then fabricated in ABS plastic using a fused deposition modeling (FDM) 3D printer. Insertion of cervical pedicle screws on the cadaveric spines was done by an orthopedic resident using the 3D printed guides. Postoperative CT scans were obtained, and placement accuracy of the screws were scored by two assessors utilizing a four-point rating system. Screws in correct placement were scored Grade 0 while misplaced screws with neurovascular damage were given a score of Grade 3.@*RESULTS@#Accuracy scores for the 3D-printed drill guides were 52% for assessor 1 and 44% for assessor 2. For assessor 1, screw placement in C3, C6, and C7 received the highest scores. For assessor 2, the highest scores were achieved in C3 and C7. The hybrid method of Bundoc et al. achieved scores of 94% while 3D printed guides utilizing commercial software like Materialise Mimics, Geomagic Freeform, or UG Imageware achieved scores of 80-100%. The traditional landmark method had scores ranging from 12% to 94% depending on the skill of the surgeon.@*CONCLUSION@#Commercial medical 3D image-based engineering software has high acquisition costs that might be beyond the reach of most institutions. A sub-$1000 general purpose 3D modeling software can be used to create drill templates. Several factors were identified in the design and fabrication of the template that can be addressed to increase accuracy. Trajectory planning can also be improved by automating the process. The researchers recommend further studies in these areas specially in the context of developing 3D printing as a support service for surgical operations in the Philippines.

Burnout and Stressor Related Factors among Nurses Caring For Children in Hospital Universiti Sains Malaysia

@#Introduction: The aim of the study is to determine the prevalence of burnout and correlation between burnout score and stressor domain score and to determine the association between sociodemographic and occupational related factors with overall burnout among nurses caring for children in Hospital Universiti Sains Malaysia (Hospital USM). Methods: This was a cross-sectional study using bilingual validated questionnaire; the General Stressor Questionnaire (GSQ) and Copenhagen Burnout Inventory (CBI) conducted among nurses providing medical service for children in Hospital USM particularly in wards and clinics. All 159 eligible nurses were recruited and 157 completed questionnaires were analysed. Pearson’s correlation analysis was applied to study the correlation while simple logistic regression and multiple logistic regressions were applied to study the association. Results: The prevalence of burnout among nurses caring for children in Hospital USM was 28.7% (95% CI = 21.6, 35.7) with the majority of them experienced personal burnout (49.7%, 95% CI = 41.9, 57.5). There was a significant moderate positive correlation between different stressor domain score with overall burnout score with p-value < 0.05. Work placement and bureaucratic constraints were identified as the main contributory factor leading to overall burnout. Conclusion: Burnout among nurses providing medical services for children in Hospital USM is of concern especially involving personal burnout. The main stressor related factors of burnout were work placement and bureaucratic constraints. Therefore, burnout among nurses providing care for children must be addressed in order to enhance their psychological well-being.

Comparison of nutrient-rich and limited media in the production of biosurfactant by Achromobacter xylosoxidans BP(1)5

Aims@#This study aims to produce Achromobacter biosurfactant in nutrient-rich and nutrient-limited media.@*Methodology and results@#This study conducted fermentation on nutrient-rich and nutrient-limited media using a minimal salt medium (MSM). Dextrose and sodium citrate were used as sole carbon supplemented with 0.5% yeast extract for nutrient-rich media, while nutrient-limited media used molasses and rice straw hydrolysate (RSH) at variations of concentrations of 100 ppm and 200 ppm. The research was performed over 120 h and evaluated from growth response, surface tension and emulsification activity. The study revealed that the best surface tension value was when 2% (w/v) sodium citrate was used as C-source and 0.5% (w/v) yeast extract as N-source, after 72 h upon incubation at 30 °C/120 rpm having 45.45 ± 2.19 mN/m with emulsification activity 24.54 ± 3.42%. Whereas the best result of the nutrient-limited medium was obtained by RSH at a concentration of 200 ppm having 48.86 ± 5.36 mN/m.@*Conclusion, significance and impact of study@#The experiment showed that nutrient-limited medium from rice straw hydrolysate could compete with the nutrient-rich medium. The use of rice straw will contribute to the reduction of biosurfactant production costs and valorisation of agricultural waste.

Effect of symbiotic bee fungus on survival of stingless bee Heterotrigona itama larvae

Aims@#Symbiotic bee fungus associated with the stingless bee larval food has been revealed to play a major role in performing a mutual relationship with the host. The fungus is believed capable to produce crucial nutrients that are required for larval pupation. However, detailed information on the fungus identification isolated from the larval food of our native Indo-Malaya stingless bee, Heterotrigona itama (Hymenoptera: Apidae), is poorly understood. Hence, this study was conducted to determine the effect of fungus isolated from the stingless bee larval food on the survival of H. itama larvae and identify the isolated fungus using both morphological and molecular analyses.@*Methodology and results@#Elisa plates designed with F-bottom type were used as artificial brood cells in a controlled condition. The eggs transferred to Elisa plates were kept in the incubator with 75%-100% humidity and 25 ± 2.5 °C of temperature. This study carried out in three different treatments: (1) microbes-free larval food, (2) fresh larval food and (3) microbes-free larval food with fungus supplement. Results showed that the survival of H. itama larvae depends on the presence of beneficial fungus with the highest survival rate (Treatment 2 = 85.71%). The absence of the beneficial fungus in the fluid food of H. itama showed the lowest survival rate (Treatment 1 = 37.14%). Microscopy analysis showed that the fungus had various forms, including unconjugated asci, round-shaped ascospore and pseudohyphae. The molecular characterisation of the isolated fungi was performed using 23S rRNA gene sequencing using universal primers ITS1 and ITS4. DNA barcoding of three isolated fungi confirmed all isolated fungi matched Panus lecomtei (Basidiomycetes; Poriales; Polyporaceae) with 99.70% of similarity.@*Conclusion, significance and impact of study@#This study provides information on the importance of whitish fungus in appearance that existed in the brood cell, which is proposed to be the crucial component of in-vitro stingless bee queen rearing protocol.

Challenges to paediatric tuberculosis care as perceived by health workers in Kano, North-western Nigeria

uberculosis (TB) remains the world's deadliest infectious disease that affects a third of the world's population and newly infected an estimated 10 million people in 2018. The number of TB infected Nigerians ranks sixth in the world and first in Africa. Kano State has the highest Nigerian TB prevalence. I aimed to identify Paediatric TB care challenges as perceived by Kano Medical and DOT health care providers. The study design was prospective, descriptive and cross sectional involving structured questionnaire interviews of 43 healthcare providers, during TB supervision visits of 10 Health facilities in Kano. Generated data was entered, validated and analysed using the STATA 13 statistical software package. The sample size was convenient, since it is the number of all the health providers working in the facilities assigned to the author for supervision under a supervision contract with KNCV in 2017. Of the 43 respondents, there were 26 males, with a M: F ratio of 1.5: 1. Those health workers aged from 30 and 40 years constituted 58% of respondents. The staff cadre of respondents comprised of Community Health Extension Workers [CHEW] (40%), doctors (30%) and nurses (3%). Up to 51% of respondents had over 10 years health worker experience and greater than 36 months Child TB DOT care provision. The most commonly identified challenges to paediatric TB care included poor health knowledge (97.7%), poor health seeking behaviour (95.4%), poverty (95.4%), the inability of children to cough up sputum 95.4%, late presentation (90.7%), contact tracing logistics (90.7 %), patient and community factors of stigma and discrimination (86%) and poor health worker paediatric TB knowledge (70%). Perceived health worker challenges to effective Paediatric TB care were the adult orientation of the TB programme and its contact tracing logistic challenges, inadequate health worker Paediatric TB knowledge, children's inability to cough up sputum, poverty, poor patient TB health knowledge, community stigma and discrimination, poor health seeking behaviour and late presentation.

Psychosocial consequences and reasons for illicit drug use among police officers in a northern Nigerian city: A mixed-method study

Harmful use of drugs is one of the principal risk factors affecting population health worldwide. Chronic use has been linked to medical, psychological and socioeconomic consequences. This study assessed the psychosocial consequences and reasons for illicit drug use among police officers in Kano, Nigeria. Using a mixed method of data collection, quantitative data was obtained from a cross-section of 275 officers using the Shortened Inventory of Problems-Drug Use (SIP­DU) and a pretested adapted questionnaire. In-depth interviews with 10 officers who used illicit drugs provided additional information. Almost half of the respondents (46.5%, n=128) were in their fourth decade of life with a mean age (±SD) of 35.1 ± 7.7 years. Over a quarter of the respondents (n=75) reported ever using illicit drugs, out of which 14.9% (n=41) were current users. Among the current drug users, 80.5% (n=33) attested to having money problems, 61.0% (n=25) agreed that they had spent too much money, and 56.1% (n=23) failed to do what was expected of them as a result of drug use and have hurt their family. Helping to stay awake and improving confidence were the major reasons (100%, n=41) for drug use mentioned by the respondents. The Nigerian Police Force should look into easing shifts and introducing stress-relieving activities. There is also the need to strengthen substance education and counselling and support officers with confidence issues, sleep disorders, and treat those with mood disorders.

Assessing the racial differences in Q angle measurements in relevance to articular cartilage of the femoral condyle: a retrospective ultrasound study / Evaluación de las diferencias raciales en las mediciones del ángulo Q en relación con el cartílago articular del cóndilo femoral: un estudio ecográfico retrospectivo

SUMMARY: The Q-angle is defined as the acute angle formed by the vectors for combined pull of the quadriceps femoris muscle and the patellar tendon. This study aimed to investigate the variations in Q angle with respect to race. Moreover, this study performed ultrasound to evaluate of the thickness of articular cartilage covering the medial and lateral femoral condyle in volunteers with an increased Q angle. The study included 487 Jordanian and 402 Malaysians with age range 18-23 years. Moreover, the study included 30 participants aged between 18 and 22 years, with a total of 15 volunteers with Q >14° and 15 patients with Q ≤14°. Both Q angle and condylar distance were measured by well-trained medical practitioners according to a well-established protocol. The thickness of articular cartilage covering the medial and lateral femoral condyle of the femoral bone was measured using ultrasound. Regardless of race, Q angle was greater in females. Furthermore, Q angle was significantly greater in Arab volunteers compared to Malay volunteers. Q angle significantly increase with increasing condylar distance in both races. Finally, the statistical analysis showed a significantly reduced thickness of articular cartilage on both medial and lateral femoral condyle (P = 0.05) in the Q >14° group. Multiple factors including race and condylar distance and even the articular cartilage of femoral condyle should be considered during the examination and management of knee fractures and condylar diseases.

RESUMEN: El ángulo Q se define como el ángulo agudo formado por los vectores de tracción combinada del músculo cuádriceps femoral y el tendón patelar. Este estudio tuvo como objetivo investigar las variaciones en el ángulo Q con respecto a la raza. Además, se realizó una ecografía para evaluar el grosor del cartílago articular que cubre los cóndilos femorales medial y lateral en voluntarios con un ángulo Q aumentado. El estudio incluyó a 487 jordanos y 402 malayos con un rango de edad de 18 a 23 años. Además, el estudio incluyó a 30 participantes con edades comprendidas entre 18 y 22 años, 15 voluntarios con Q> 14 ° y 15 pacientes con Q ≤ 14 °. Tanto el ángulo Q como la distancia condilar fueron medidos por médicos bien entrenados de acuerdo con un protocolo establecido. El grosor del cartílago articular que cubre los cóndilos femorales medial y lateral del fémur se midió mediante ecografía. Independientemente del grupo racial, el ángulo Q fue mayor en las mujeres. Además, el ángulo Q fue significativamente mayor en los voluntarios árabes en comparación con los voluntarios malayos. El ángulo Q se aumenta significativamente al incrementarse la distancia condilar en ambas grupos raciales. Finalmente, el análisis estadístico mostró una reducción significativa del grosor del cartílago articular en los cóndilos femorales medial y lateral (P = 0,05) en el grupo Q> 14. Durante la exploración y el tratamiento de las fracturas de rodilla y de las enfermedades condilares, se deben considerar múltiples factores, incluida la raza y la distancia condilar e incluso el cartílago articular del cóndilo femoral.

Correlação entre níveis de sindecano 1, escore PELOD-2 e mortalidade em sepse pediátrica / Correlation between syndecan-1 level and PELOD-2 score and mortality in pediatric sepsis

RESUMO Objetivo: Analisar a correlação entre a lesão do glicocálix medida pelo nível sérico de sindecano 1 e as disfunções de órgãos avaliadas com o escore PELOD-2, assim como avaliar sua associação com a mortalidade em sepse pediátrica. Métodos: Realizou-se um estudo prospectivo observacional em um hospital terciário público. Sessenta e oito pacientes pediátricos, com diagnóstico de sepse segundo os critérios da International Pediatric Sepsis Consensus Conference, foram consecutivamente recrutados. Nos dias 1 e 5, realizaram-se dosagens dos níveis séricos de sindecano 1 e avaliação dos componentes do escore PELOD-2. Os pacientes foram seguidos por até 28 dias após o diagnóstico de sepse. Resultados: Em geral, o nível de sindecano 1 estava aumentado em todos os participantes, com nível significantemente mais elevado nos pacientes em choque (p = 0,01). O nível de sindecano 1 no dia 1 teve correlação positiva com o escore PELOD-2 no dia 1 e coeficiente de correlação de 0,35 (p = 0,003). Nos primeiros 5 dias após o diagnóstico de sepse, as alterações nos níveis de sindecano 1 tiveram correlação positiva com modificações no escore PELOD-2, com coeficiente de correlação de 0,499 (p < 0,001). Com utilização de um ponto de corte dos níveis de sindecano 1 no dia 1 ≥ 430ng/mL, a disfunção de órgãos (escore PELOD-2 ≥ 8) pôde ser predita com área sob a curva de 74,3%, sensibilidade de 78,6% e especificidade de 68,5% (p = 0,001). Conclusão: O nível de sindecano 1 no dia 1 teve correlação com o escore PELOD-2 no dia 1, porém não se associou com a mortalidade aos 28 dias. A disfunção de órgãos (PELOD-2 ≥ 8) pôde ser predita pelo nível de sindecano 1 nas primeiras 24 horas de sepse, sugerindo seu significante envolvimento na fisiopatologia da disfunção de órgãos associada à sepse.

ABSTRACT Objective: To analyze the correlation between glycocalyx disruption measured via the serum syndecan-1 level and organ dysfunctions assessed by the PELOD-2 score and to evaluate its association with mortality in pediatric sepsis. Methods: We performed a prospective observational study in a tertiary public hospital. Sixty-eight pediatric patients diagnosed with sepsis according to International Pediatric Sepsis Consensus Conference criteria were consecutively recruited. We performed measurements of day 1 and day 5 serum syndecan-1 levels and PELOD-2 score components. Patients were followed up to 28 days following sepsis diagnosis. Results: Overall, the syndecan-1 level was increased in all subjects, with a significantly higher level among septic shock patients (p = 0.01). The day 1 syndecan-1 level was positively correlated with the day 1 PELOD-2 score with a correlation coefficient of 0.35 (p = 0.003). Changes in syndecan-1 were positively correlated with changes in the PELOD-2 score, with a correlation coefficient of 0.499 (p < 0.001) during the first five days. Using the cutoff point of day 1 syndecan-1 ≥ 430ng/mL, organ dysfunction (PELOD-2 score of ≥ 8) could be predicted with an AUC of 74.3%, sensitivity of 78.6%, and specificity of 68.5% (p = 0.001). Conclusion: The day 1 syndecan-1 level was correlated with the day 1 PELOD-2 score but not 28-day mortality. Organ dysfunction (PELOD-2 ≥ 8) could be predicted by the syndecan-1 level in the first 24 hours of sepsis, suggesting its significant pathophysiological involvement in sepsis-associated organ dysfunction.

Clinical audit of management of smear positive adult pulmonary tuberculosis in PR1 tuberculosis clinic, KK Bandar Miri

@#Introduction: Malaysian tuberculosis (TB) clinical practice guideline (CPG) standardises the management of TB to improve the quality of care for TB patients. Not all primary care providers adhere to this guideline, however. This audit aims to improve the management of smear positive adult pulmonary TB by identifying areas of concern and developing action plans. Methods: Data for the audit were gathered from August 2018 to August 2019 from medical records of diagnosed smear positive pulmonary TB patients. Patients were included based on inclusion and exclusion criteria. Results: Forty-eight smear positive pulmonary TB patients were recruited. The majority of patients were male (54.2%) and Malay (33.2%). TB symptoms were assessed for 29.2% of patients at two weeks and then in 81.3% at one month, 97.9% at two months, 16.7% at three months, 95.8% at four months, 22.9% at five months and 95.8% at six months. Medication side effects were assessed at two weeks for only 2.1% of patients, then for 8.3% of patients at one month, 2.1% at two months and 0% at subsequent months. At diagnosis, 25% and 4.2% of patients had their visual acuity and colour vision, respectively, assessed. Only 6.3% of patients were referred to pre-pregnancy counselling. Weights were recorded for 87.5% of patients at diagnosis, then for 27.1% at two weeks, 81.3% at one month, 91.7% at two months, 77.1% at three months, 97.9% at four months, 79.2% at five months and 93.8% at six months. Baseline investigations and Mycobacterium tuberculosis culture and sensitivity were conducted for all patients, but only 81.3% of patients were traced. No patients were referred to pharmacy for medication counselling. Conclusion: This audit shows that there is a difference between current practice and the national guideline. There are some downfalls in management and proper documentation, so interventions should be carried out to improve those aspects.

Morphological and molecular identification of Fusarium spp. and Colletotrichum spp. isolated from infected vanilla orchid

Aims@#This study aimed to isolate and identify fungi involved in causing diseases to Vanilla planifolia as well as to study their pathogenicity level in causing disease.@*Methodology and results@#The diseased parts of vanilla plants were collected from vanilla farms located in Pahang and Sabah, Malaysia from May 2015 to May 2016. Diseases tissue transplantation was adopted to isolate the fungi for morphology identification prior to the polymerase chain reaction (PCR) amplification of internal transcribed spacer (ITS) regions using universal primers for fungi, ITS1 and ITS4. After being isolated, the fungi pathogenicity was tested on detached fresh and mature vanilla leaves. A total of 22 fungal isolates were identified, Fusarium fujikuroi and F. oxysporum were the two most recovered species, followed by Colletotrichum gloeosporioides, Fusarium sp., F. proliferatum and F. solani. Pathogenicity test revealed a significantly high pathogenicity of F. oxysporum and C. gloeosporiodes (p<0.01) on detached vanilla leaf, with high level of damage. @*Conclusion, significance and impact of study@#This study provides valuable information on fungi-associated diseases on vanilla plants grown in Malaysia and can be used for future development in disease management.

Price Elasticity Of Demand And The Impact Of Taxing Sugar-Sweetened Beverages In Malaysia

@#The Malaysian government implemented an excise tax of MYR 0.40 per L on sugar-sweetened beverages in July 2019. Excise tax is imposed on sweetened drinks containing more than 5 g of sugar per 100 ml, flavoured Ultra High Temperature milk-based drinks, and fruit juices with more than 7 g and 12 g of sugar per 100 ml, respectively. We analysed the impact of excise tax on the consumption of SSBs by developing a demand model for SSBs to estimate the elasticity of demand using a two-way fixed-effect model. The tax increased the price of 1 L SSBs by 8.33%, and we estimated it to decrease the consumption of SSBs by 9.25%. The estimated own-price elasticity of demand for SSBs was −1.11 (95% CI: −1.97 to −0.25). Price of SSB is a determinant for SSB demand, but income or the price of milk are not. The estimated excise revenue calculated was MYR 357.61 million. However, industry responses via product reformulation and pass-through rates could reduce revenue and enhance or reduce health impacts.

Lower eyelid fornix deepening: A new indication for the facial artery myomucosal flap

Eye socket contracture is a well-known late complication of enucleation surgery, and the additional insult of radiotherapy at an early age causes even further fibrosis and scarring of the socket. Management of the contracted socket is challenging, and several methods have been proposed. We report a case of eye socket contracture after enucleation and radiotherapy in which multiple reconstructive procedures failed. The recurrent contracture caused difficulty in housing and retaining the eye prosthesis. We reconstructed the lower eyelid with a facial artery myomucosal flap and nasolabial flap, and the upper eyelid with a Fricke flap following reconstruction of the orbital rims (supraorbital and infraorbital rims with a calvarial bone graft, and further augmentation of the infraorbital rim with a rib bone graft). Cosmesis post-reconstruction was acceptable and the prosthesis was retained very well.