SARS-CoV-2 S-RBD IgG & Neutralizing antibodies among different categories of health care workers post third dose BNT162b2 mRNA COVID-19 vaccine.

Neutralizing antibodies (NTAb) play a significant role in preventing and protecting against SARS-CoV-2 virus infection. Identifying NTAb is undoubtedly imperative in understanding the immunity toward COVID-19 better. However, it is interesting to note that the production of NTAb varies among individuals, especially among healthcare workers (HCWs), as they are exposed to the virus daily. Hence, we would like to investigate factors affecting the production of S-RBD IgG and NTAb among different categories of HCWs, particularly after receiving the third dose of the BNT162b2 mRNA COVID-19 Vaccine. A total of 361 HCWs from our hospital were prospectively enrolled and had their S-RBD IgG and NTAb titers measured. They were studied in relation to the degree of exposure to COVID-19, breakthrough infections, gender, age, race, household income, housing type, household number, and education levels. HCWs with the highest risk of exposure to COVID-19, breakthrough infections, and male gender displayed the highest median titers of both S-RBD IgG and NTAb, and the differences were statistically significant (p < .05). Age, race, household income, housing type, household number, and education levels were revealed to be insignificant. We concluded that the degree of exposure to COVID-19, breakthrough infections, and male gender are significant factors in NTAb production among HCWs.

Utility of PIVKA-II and AFP in Differentiating Hepatocellular Carcinoma from Non-Malignant High-Risk Patients.

Background and Objectives: We aim to compare the diagnostic performance of Protein induced by vitamin K absence-II (PIVKA-II), a biomarker for hepatocellular carcinoma (HCC), and alpha-fetoprotein (AFP) in differentiating HCC and non-malignant high-risk (NMHR) groups and to determine their cut-off values. Materials and Methods: A total of 163 patients, including 40 with HCC and 123 with NMHR (100 with liver cirrhosis and 23 with non-cirrhotic high-risk patients) were prospectively enrolled. The levels of AFP and PIVKA-II were measured, and their cut-off values were determined. We calculated and compared the areas under the receiver operating characteristic (AUROC) curves of PIVKA-II, AFP, and their combination. Results: The levels of PIVKA-II and AFP were found to be significantly higher in the HCC compared to NMHR patients (p < 0.0001). For the differentiation of HCC from NMHR, the optimal cutoff values for PIVKA-II and AFP were 36.7 mAU/mL (90% sensitivity; 82.1% specificity) and 14.2 ng/mL (75% sensitivity; 93.5% specificity), respectively. The AUROC of PIVKA-II (0.905, p < 0.0001) was higher compared to AFP (0.869, p < 0.0001), but the combination of PIVKA−II and AFP gave the highest AUROC value (0.911, p < 0.0001). However, their differences were not statistically significant (AFP vs. PIVKA; p = 0.4775, AFP vs. Combination; p = 0.3808, PIVKA vs. Combination; p = 0.2268). Conclusions: PIVKA-II and AFP showed equal performance in detecting HCC in high-risk patients. AFP as a screening marker for HCC may be adequate, and replacing or adding the PIVKA-II test in current clinical practice may be of little value.

Correlation of Dengue Warning Signs during Febrile Phase with Rotational Thromboelastometry, Cortisol and Feritin.

Dengue mortality remains high despite monitoring against warning signs (WS). The associations of WS at febrile phase (FP) and hemorrhage at defervescence with the levels and kinetics of ROTEM, platelet count, cortisol, and ferritin were analyzed. Patients with confirmed dengue serology and WS in two centers were screened (n = 275) and 62 eligible patients were recruited prospectively over 9 months. "Vomiting" was the commonest WS (62.9%), with shortened clotting time (CT) INTEM (p = 0.01). "Hematocrit increase" showed significant prolonged CT INTEM, EXTEM, and FIBTEM (p < 0.05). "Platelet decrease" showed reduced platelet function and reduced clot amplitude at 10 min (A10) and maximum clot firmness (MCF) in INTEM and EXTEM (p < 0.001). The kinetics were reduced in platelet count, CT EXTEM, and cortisol (p < 0.05) but increased in CT INTEM (p = 0.03). At FP, "vomiting", "hematocrit increase", and "platelet decrease" demonstrated impaired CT, clot strengths A10/MCF and platelet functions. Majority (60/62, 96.7%) had non-severe outcomes, consistent with increase in cortisol kinetics. In conclusion, "vomiting", "hematocrit increase" and "platelet decrease" at FP correlated with ROTEM. No conclusion could be made further regarding ferritin and cortisol. Larger study is required to study "hematocrit increase" with ROTEM as a potential marker for hemorrhage.

Perceived Symptoms of Depression, Anxiety and Stress amongst Staff in a Malaysian Public University: A Workers Survey.

Mental health conditions are a major part of workers' health that predisposes to poor self-motivation for sustaining productivity. This study was aimed to determine the prevalence of depression, anxiety, and stress among staff in a Malaysian public university and its associated factors. A cross-sectional study was conducted among 459 staff from the Universiti Kebangsaan Malaysia (UKM) between April and June 2019. A questionnaire that consisted of items on socio-demographic and socioeconomic characteristics, employment description, lifestyle risk behaviors, personal medical history, and symptoms of depression, anxiety, and stress was administered to participants. Descriptive and inferential statistics were conducted using SPSS version 22.0. The prevalence of perceived symptoms of depression, anxiety, and stress among the respondents was 28.7%, 50.1%, and 14.8%, respectively. Over one-quarter (26.5%) of the participants presented symptoms of two or more mental disorders. Women, those aged less than 40 years old, and non-academic professionals were more likely to exhibit depressive symptoms, while those with medical conditions that required hospitalizations sustained anxiety symptoms. Perceived stress was more likely to be prevalent among staff with secondary education or less and smokers. Proactive support for staff needs to be offered in sustaining their emotional well-being.

Factors Associated with Health-Related Quality of Life amongst Employees in a Malaysian Public University.

The current academic landscape has overwhelmed faculties and with demands to adopt tech-savvy teaching modes and accelerate scholarly works, administrative duties, and outreach programs. Such demands have deteriorated the health-related quality of life (HRQoL) among university employees. This study aimed to determine the factors associated with HRQoL among university employees in a Malaysian public university. This cross-sectional study was conducted among 397 employees from the Universiti Kebangsaan Malaysia (UKM) between April and June 2019. A self-administered questionnaire that consisted of socio-demographic items, risky health behaviors, health-related information, and validated scales for measuring employees' physical inactivity, psychological states, and HRQoL was utilized. Descriptive and inferential statistics were calculated using SPSS version 23.0. Hierarchical multiple linear regression models were yielded to determine the factors associated with different domains of HRQoL. Mediation analysis was conducted using PROCESS MACRO (Model 4). Statistical significance was set to p < 0.05. Physical HRQoL scored the highest, while environmental HRQoL had the lowest score among the employees. Physical HRQoL was influenced by age, service duration, comorbid conditions, BMI, chronic diseases, and anxiety. Factors associated with psychological HRQoL were age, service duration, depression, and stress. Age, service duration, and chronic diseases affected employees' social relationship HRQoL, while environmental HRQoL was associated with age, occupation type, chronic diseases, and depression. Socio-demographics, risky health behaviors, health profiles, and psychological attributes were significantly associated with employees' HRQoL. Age was the only positively correlated factor across all HRQoL domains, while other factors deteriorated employees' HRQoL.

Prevalence of metabolic syndrome and its associated risk factors among staffs in a Malaysian public university.

Public health systems are concerned with the commensurate rise of metabolic syndrome (MetS) incidence across populations worldwide, due to its tendency to amplify greater risk of diabetes and cardiovascular diseases within communities. This study aimed to determine the prevalence of MetS and its associated risk factors among staffs in a Malaysian public university. A cross-sectional study was conducted among 538 staffs from the Universiti Kebangsaan Malaysia (UKM) between April and June 2019. MetS was defined according to JIS "Harmonized" criteria. A questionnaire that consisted of items on socio-demographics, lifestyle risk behaviors and personal medical history information was administered to participants. Subsequently, a series of physical examination and biochemical assessment was conducted at the hall or foyer of selected faculties in the university. Descriptive and inferential statistics were conducted using SPSS version 22.0. Multivariate models were yielded to determine the risk factors associated with MetS. Statistical significance was set at P < 0.05. The overall prevalence of MetS was 20.6%, with men having greater prevalence than women (24.9% vs. 18.3%). Prevalence of MetS increased with age. Factors contributed to MetS in the overall sample were BMI, hypertension, diabetes and physical activity of moderate intensity. Diabetes and hypertension were significantly associated with MetS in men, whereas BMI, diabetes and hyperlipidemia were significantly associated with MetS in women. Lifestyle behaviors and cardio-metabolic risk factors were associated with MetS for the overall sample, and across genders.

COVID-19 in Malaysia: exposure assessment and prevention practices among healthcare workers at a teaching hospital.

INTRODUCTION: During the second wave of the coronavirus disease 19 (COVID-19) pandemic, Malaysia reported several COVID-19 clusters related to healthcare workers. Thus, addressing and understanding the risk of exposure in healthcare workers is important to prevent future infection and reduce secondary COVID-19 transmission within the healthcare settings. In this study, we aim to assess exposure and prevention practices against COVID-19 among healthcare workers at the Hospital Canselor Tuanku Muhriz, a university teaching hospital based in Kuala Lumpur, Malaysia. METHODOLOGY: A total of 571 healthcare workers at COVID-19 and non-COVID-19 wards as well as the emergency department and laboratory staff at COVID-19 testing labs were recruited. The presence of novel human coronavirus (SARS-CoV-2) and IgM/IgG antibodies were confirmed in all healthcare workers. The healthcare workers responded to an online Google Forms questionnaire that evaluates demographic information and comorbidities, exposure and adherence to infection prevention and control measures against COVID-19. Descriptive analysis was performed using Statistical Package for the Social Sciences 24.0. RESULTS: Three healthcare workers (0.5%) tested positive for SARS-CoV-2, while the remaining 568 (99.5%) were negative. All were negative for IgM and IgG antibodies during recruitment (day 1) and follow-up (day 15). More than 90% of the healthcare workers followed infection prevention and control practices recommendations regardless of whether they have been exposed to occupational risk for COVID-19. CONCLUSIONS: The healthcare workers' high level of adherence to infection prevention practices at this hospital helped reduce and minimize their occupational exposure to COVID-19.

Effects of CST3 Gene G73A Polymorphism on Cystatin C in a Prospective Multiethnic Cohort Study.

BACKGROUND/AIMS: G73A polymorphism in the CST3 gene of cystatin C has been associated with Alzheimer's disease, age-related macular degeneration, and cardiovascular disease. However, studies investigating the influence of this genetic variability on serum cystatin C and cystatin-based renal function estimate are limited. Therefore, the aim of this study is to investigate the possible association of single-nucleotide polymorphism (rs1064039) of the CST3 gene on the serum cystatin C level and cystatin C-based estimated glomerular filtration rate (eGFR). METHODS: Study subjects include patients with various levels of renal function recruited from the nephrology clinic and wards of a tertiary hospital. The blood samples collected were analyzed for serum cystatin C and creatinine levels by particle-enhanced turbidimetric immunoassay and kinetic alkaline picrate method, respectively. DNA was extracted using a commercially available kit. -Polymerase chain reaction results were confirmed by direct DNA Sanger sequencing. RESULTS: The genotype percentage (G/G = 73%, G/A = 24.1%, and A/A = 2.9%) adhere to the Hardy-Weinberg equilibrium. The dominant allele found in our population was CST3 73G allele (85%). The regression lines' slope of serum cystatin C against creatinine and cystatin C-based eGFR against creatinine-based eGFR, between G and A allele groups, showed a statistically significant difference (z-score = 3.457, p < 0.001 and z-score = 2.158, p = 0.015, respectively). Patients with A allele had a lower serum cystatin C level when the values were extrapolated at a fixed serum creatinine value, suggesting the influence of genetic factor. CONCLUSION: Presence of CST3 gene G73A polymorphism affects serum cystatin C levels.

Endocan expression in placenta of women with hypertension.

AIM: The aim of our study was to determine the endocan-1 expression in placenta of hypertensive women, and its association with maternal and fetal outcomes. METHODS: This was a cross-sectional study consisted of 21 pregnant women with hypertension and 23 without hypertension. The gestational age ranged from 28 to 39 weeks (hypertensive) and 32 to 40 weeks (normotensive). The paraffin embedded formalin fixed placenta tissue blocks were retrieved from the pathology archives. Endocan immunohistochemistry was performed on tissue sections of full thickness and maternal surface of the placenta. The endocan expression was determined in fetal endothelial cells, maternal endothelial cells, cytotrophoblasts, syncytiotrophoblasts and decidual cells. The differences in endocan expression in placenta between hypertensive and normotensive subjects were evaluated by Pearson chi-square test and t-test were used in the statistical analysis. RESULTS: The endocan expression was significantly higher in fetal endothelial cells (P < 0.001), maternal endothelial cells (P = 0.003) and decidual cells (P < 0.001) in the placenta of women with hypertension. When comparing positive and negative endocan expression in maternal outcomes, endocan was associated with the development of pre-eclampsia (P = 0.03). Also, a positive endocan expression was associated with low birthweight (P = 0.001) and prematurity (P = 0.005) in the fetal outcomes. CONCLUSION: This study showed endocan is highly expressed in fetal endothelial cells, maternal endothelial cells and decidual cells in placenta of hypertensive women. In addition, its expression was associated with poorer maternal and fetal outcomes. These findings suggest endocan may play an important role in the progression of hypertension in pregnancy.

Vitamin D deficiency in pregnancy at term: risk factors and pregnancy outcomes.

Background Vitamin D deficiency during pregnancy is a worldwide epidemic. The aim of this study was to determine the prevalence of vitamin D deficiency, its predictive factors and the association with pregnancy outcomes. Materials and methods This was a prospective observational study in a tertiary teaching hospital over 2-years' duration from August 2013 to August 2015. A total of 680 women who completed 37 weeks of pregnancy were recruited. Results Five hundred and seventy-five patients were enrolled in the final analysis for pregnancy outcomes (response rate of 84.6%). There were 71.7% patients who exhibited vitamin D deficiency, 21.0% vitamin D insufficiency and only 7.3% who had adequate levels of 25-hydroxyvitamin D (25-OH-vit D) of more than 30 ng/mL. There was no statistically significant association between vitamin D status with maternal (parity, gestational diabetes mellitus, hypertension, preeclampsia, intrauterine growth restriction, preterm labor, antenatal infection, bacterial vaginosis and anemia) and neonatal outcomes (low birth weight baby and neonatal intensive care unit admission) among the three groups. Conclusion A high prevalence of low vitamin D level among pregnant women at term was seen in this study, however, there was no significant finding observed between vitamin D status and both maternal and neonatal outcomes.

Comparison of 25-hydroxyvitamin D and metabolic parameters between women with and without polycystic ovarian syndrome.

Background There is increasing evidence that supports the contribution of vitamin D deficiency in metabolic disturbances among women with polycystic ovarian syndrome (PCOS). The aim of this study was to compare 25-hydroxyvitamin D level and the prevalence of metabolic syndrome in the PCOS and normal women. Materials and methods A case-controlled study was conducted in a teaching hospital over a 6-month duration from June 2015 to January 2016. A total of 90 women, who consisted of 45 women with PCOS (study group) and 45 women without PCOS (control group), were recruited. Results The final analysis was of 80 women only and the prevalence of vitamin D deficiency (<20 ng/mL) was high between both groups, i.e. 93.7% but there was no significant difference (p = 0.874). Nevertheless, the prevalence of metabolic syndrome was significantly higher in the study group as compared to the control group (27.5% vs. 5.0%, p = 0.013). There was no statistically significant correlation between vitamin D level with clinical [age, weight, body mass index (BMI), waist and hip circumference, systolic and diastolic blood pressure (SBP and DPB, respectively)] and metabolic parameters (fasting glucose, triglycerides, cholesterol, high-density lipoprotein and low-density lipoprotein) among women with PCOS. However, height was positively correlated (r = 0.338, p = 0.033) and the contrary waist-hip ratio was negatively correlated with vitamin D level (r = -0.605, p = 0.048). Conclusion The prevalence of vitamin D deficiency was high in our study population. Nevertheless, the prevalence of metabolic syndrome was higher among women with PCOS as compared to women without PCOS.

Maternal thyroid function in women undergoing controlled ovarian hyperstimulation during in-vitro fertilization and its relation to reproductive outcome.

BACKGROUND: We conducted a study to evaluate the changes in thyroid function during controlled ovarian hyperstimulation (COH) and its association with the outcome of assisted reproductive technique (ART). METHODS: This is a prospective cohort study done in University Hospital Fertility Clinic for one year duration. A total of 88 euthyroid women who underwent COH as part of planned in-vitro fertilization (IVF) were invited to participate in this study. Serum thyroid function of each women will be monitored before stimulation (T1), day 10-13 of cycle (T2), during oocyte retrieval (T3), one week following embryo transfer (T4), and at four weeks after embryo transfer (T5). Reproductive outcome of IVF will be observed and documented. RESULTS: Nine women had ongoing singleton pregnancy, seven suffered from miscarriage, while the rest had implantation failure. Serum thyroid-stimulating hormone (TSH) and free thyroxine (fT4) increased throughout stimulation, peaking at 32-36 hours after hCG administration compared to baseline (1.250 vs. 1.740 mIU/L and 13.94 vs. 15.25 pmol/L). It remains elevated until one week following embryo transfer. The increment of serum TSH exceeded the upper limit, acceptable for first trimester (<1.60 mIU/L). However, the evolution of serum TSH and fT4 did not significantly differ with pregnancy outcome. CONCLUSIONS: In euthyroid women, thyroid function changed significantly during COH, but these changes were not different between the three reproductive outcomes. Thus, we do not suggest continuous thyroid function monitoring during COH.

Cohort Profile: The Malaysian Cohort (TMC) project: a prospective study of non-communicable diseases in a multi-ethnic population.

The Malaysian Cohort study was initiated in 2005 by the Malaysian government. The top-down approach to this population-based cohort study ensured the allocation of sufficient funding for the project which aimed to recruit 100,000 individuals aged 35-70 years. Participants were recruited from rural and urban areas as well as from various socioeconomic groups. The main objectives of the study were to identify risk factors, to study gene-environment interaction and to discover biomarkers for the early detection of cancers and other diseases. At recruitment, a questionnaire-based interview was conducted, biophysical measurements were performed and biospecimens were collected, processed and stored. Baseline investigations included fasting blood sugar, fasting lipid profile, renal profile and full blood count. From April 2006 to the end of September 2012 we recruited a total of 106,527 participants. The baseline prevalence data showed 16.6% participants with diabetes, 46.5% with hypertension, 44.9% with hypercholesterolaemia and 17.7% with obesity. The follow-up phase commenced in June 2013. This is the most comprehensive and biggest cohort study in Malaysia, and has become a valuable resource for epidemiological and biological research. For information on collaboration and also data access, investigators can contact the project leader at (rahmanj@ppukm.ukm.edu.my).

A case of hyperosmolar hyperglycaemic state with involuntary movements - diagnostic dilemma and clinical considerations.

Hyperosmolar hyperglycaemic state (HHS) is a medical emergency which needs immediate medical intervention. A 37-year-old Chinese woman with a history of hypertension attended the Emergency Department. She had a two-day history of involuntary movement, i.e. chorea of the upper limbs, preceded by a one-week history of upper respiratory tract infection. She also had polyuria and polydipsia, although she was never diagnosed as diabetic. The main aim of reporting the present case was to highlight the importance of biochemical investigations involved in the diagnosis of involuntary movements.