At the Heart of the Community: Implementation of Echocardiographic Screening for Rheumatic Heart Disease in Primary Care Facilities of Northern Borneo Island.

BACKGROUND: Rheumatic heart disease (RHD) is a potentially life-threatening condition that causes long-standing public health concerns. Echocardiography is a reliable diagnostic and screening technique for many cardiovascular conditions, including RHD. It is commonly used in tertiary care facilities worldwide but less so in the community setting. The primary aim of this study was to introduce and elaborate on the echocardiographic screening for RHD that was implemented by a Malaysian primary care clinic in Penampang district, Sabah. We also set out to present the uptake of the service in its initial years of establishment, as well as the challenges faced. METHODS: In the first part of this study, document reviews were conducted to compile relevant information about the conceptualization and implementation of this service. Following that, we also obtained secondary data on the echocardiographic screening service from its first implementation in April 2020 until May 2021 to examine the uptake and the patient profile. RESULTS: From April 2020 to May 2021, a total of 189 echocardiographic screening was conducted by primary care doctors using handheld ultrasound. Of the 189 children screened, 19 (10.1%) were found to have cardiac anomalies and were referred for a formal echocardiogram. Upon follow-up, 8 were detected with mild mitral regurgitation and referred to the nearest tertiary hospital for further management. CONCLUSION: Based on our review, the echocardiographic screening for RHD among children conducted by the Penampang Health Clinic was deemed successful. Echocardiogram service provided by primary care centers located in suburban and rural areas is highly beneficial for patients with poor access to specialized health care services because they stay far away from tertiary care facilities. Tapping into family medicine physicians located closer to communities to conduct echocardiographic screening and review the results can improve the detection of cardiac anomalies requiring further investigation. With the success of this project, echocardiographic services in the primary healthcare setting can be expanded by garnering the necessary collaborative efforts and consistent support from various stakeholders.

Biometric indices and population parameters of three polynemid fishes from Batang Lassa Estuary of East Malaysia.

The length-weight relationships (LWRs), condition factor (Kn), growth, mortality and exploitation status of three polynemid fishes, i.e., Filimanus xanthonema (Valenciennes, 1831), Polynemus melanochir (Valenciennes, 1831) and Polynemus paradiseus (Linnaeus, 1758) from Batang Lassa River estuary were estimated. Fish samples were caught during April 2019 to September 2020 using the ESBN (locally called Gnian) having 1.25 to 4.00 cm mesh size. The total length (TL) and body weight of each individual fish was measured to the nearest 0.1 cm and 0.01 g respectively. The growth coefficients (b) for F. xanthonema, P. melanochir and P. paradiseus, were 2.880, 2.717 and 2.724 with the R 2 values 0.956, 0.972 and 0.936 respectively. Estimated growth coefficients indicated a negative allometric growth pattern for all three threadfin fishes. To date, information regarding length-weight relationships for F. xanthonema and P. melanochir is insufficient whereas the information is available for P. paradiseus. About 40-48% of fishes exhibited flat or thin body shape (Kn < 1), 48-50% were rounded or fat (Kn > 1) and only 1-3% of fishes showed proportional body shape (Kn = 1). The growth parameters L∞ , K and ϕ' were estimated at 15.75 cm, 0.95 yr-1 and 2.37 for F. xanthonema; 27.61 cm 0.87 yr-1 and 2.82 for P. melanochir; and 27.30 cm, 0.58 yr-1 and 2.64 for P. paradiseus; respectively. The estimated natural mortality (M) included 2.10, 1.69 and 1.30 yr-1; the fishing mortality (F) 0.57, 0.67 and 0.60 yr-1; and exploitation ratio (E) 0.21, 0.28 and 0.31 for F. xanthonema, P. melanochir and P. paradiseus respectively. The study concluded that the stocks are still under exploitation (E < 0.5) condition. However, the studied Batang Lassa estuary could be a potential nursery ground considering the minimum lengths of 5.0, 3.8 and 4.0 cm for F. xanthonema, P. melanochir and P. paradiseus respectively. Therefore, management initiatives are needed to escape juvenile catches.

Spatially varying correlation between environmental conditions and human leptospirosis in Sarawak, Malaysia

@#The spatial distribution of environmental conditions may influence the dynamics of vectorborne diseases like leptospirosis. This study aims to investigate the global and localised relationships between leptospirosis with selected environmental variables. The association between environmental variables and the spatial density of geocoded leptospirosis cases was determined using global Poisson regression (GPR) and geographically weighted Poisson regression (GWPR). A higher prevalence of leptospirosis was detected in areas with higher water vapour pressure (exp(â): 1.12; 95% CI: 1.02 - 1.25) and annual precipitation (exp(â): 1.15; 95% CI: 1.02 - 1.31), with lower precipitation in the driest month (exp(â): 0.85; 95% CI: 0.75 – 0.96) and the wettest quarter (exp(â): 0.88; 95% CI: 0.77 – 1.00). Water vapor pressure (WVP) varied the most in the hotspot regions with a standard deviation of 0.62 (LQ: 0.15; UQ; 0.99) while the least variation was observed in annual precipitation (ANNP) with a standard deviation of 0.14 (LQ: 0.11; UQ; 0.30). The reduction in AICc value from 519.73 to 443.49 indicates that the GWPR model is able to identify the spatially varying correlation between leptospirosis and selected environmental variables. The results of the localised relationships in this study could be used to formulate spatially targeted interventions. This would be particularly useful in localities with a strong environmental or socio-demographical determinants for the transmission of leptospirosis.

A new cembrane-type diterpenoid from Bornean liverwort Chandonanthus hirtellus.

A new compound, chandonanol (1), along with four known compounds, chandonanthone (2), iso-chandonanthone (3), anastreptene (4), and (6R,7S)-sesquiphellandrene (5), was isolated from the MeOH extract of Bornean liverwort Chandonanthus hirtellus. The structure of the new metabolite was established by analyses of the spectroscopic data (1D NMR, 2D NMR, HRESIMS, and IR). These compounds were tested for their activity against antibiotic-resistant clinical strains. Chandonanol (1) exhibited potent bactericidal activity against Staphylococcus aureus and Escherichia coli.