Molecular epidemiology of dengue in Malaysia: 2015-2021.

Dengue has been one of the major public health problems in Malaysia for decades. Over 600,000 dengue cases and 1,200 associated fatalities have been reported in Malaysia from 2015 to 2021, which was 100% increase from the cumulative total of dengue cases reported during the preceding 07-year period from 2008 to 2014. However, studies that describe the molecular epidemiology of dengue in Malaysia in recent years are limited. In the present study, we describe the genetic composition and dispersal patterns of Dengue virus (DENV) by using 4,004 complete envelope gene sequences of all four serotypes (DENV-1 = 1,567, DENV-2 = 1,417, DENV-3 = 762 and DENV-4 = 258) collected across Malaysia from 2015 to 2021. The findings revealed that DENV populations in Malaysia were highly diverse, and the overall heterogeneity was maintained through repetitive turnover of genotypes. Phylogeography analyses suggested that DENV dispersal occurred through an extensive network, mainly among countries in South and East Asia and Malaysian states, as well as among different states, especially within Peninsular Malaysia. The results further suggested Selangor and Johor as major hubs of DENV emergence and spread in Malaysia.

Update to: Assessing the efficacy of male Wolbachia-infected mosquito deployments to reduce dengue incidence in Singapore.

BACKGROUND: This trial is a parallel, two-arm, non-blinded cluster randomised controlled trial that is under way in Singapore, with the aim of measuring the efficacy of male Wolbachia-infected Aedes aegypti deployments in reducing dengue incidence in an endemic setting with all four dengue serotypes in circulation. The trial commenced in July 2022 and is expected to conclude in September 2024. The original study protocol was published in December 2022. Here, we describe amendments that have been made to the study protocol since commencement of the trial. METHODS: The key protocol amendments are (1) addition of an explicit definition of Wolbachia exposure for residents residing in intervention sites based on the duration of Wolbachia exposure at point of testing, (2) incorporation of a high-dimensional set of anthropogenic and environmental characteristics in the analysis plan to adjust for baseline risk factors of dengue transmission, and (3) addition of alternative statistical analyses for endpoints to control for post hoc imbalance in cluster-based environmental and anthropogenic characteristics. DISCUSSION: The findings from this study will provide the first experimental evidence for the efficacy of releasing male-Wolbachia infected mosquitoes to reduce dengue incidence in a cluster-randomised controlled trial. The trial will conclude in 2024 and results will be reported shortly thereafter. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT05505682. Registered on 16 August 2022. Retrospectively registered. Last updated 11 November 2023.

Impact of vaccination on COVID-19 severity during the second wave in Brunei Darussalam, 2021.

Objective: Coronavirus disease (COVID-19) vaccinations have been shown to prevent infection with efficacies ranging from 50% to 95%. This study assesses the impact of vaccination on the clinical severity of COVID-19 during the second wave in Brunei Darussalam in 2021, which was due to the Delta variant. Methods: Patients included in this study were randomly selected from those who were admitted with COVID-19 to the National Isolation Centre between 7 August and 6 October 2021. Cases were categorized as asymptomatic, mild (symptomatic without pneumonia), moderate (pneumonia), severe (needing supplemental oxygen therapy) or critical (needing mechanical ventilation) but for statistical analysis purposes were dichotomized into asymptomatic/mild or moderate/severe/critical cases. Univariate and multivariable analyses were conducted to identify risk factors associated with moderate/severe/critical disease. Propensity score-matched analysis was also performed to evaluate the impact of vaccination on disease severity. Results: The study cohort of 788 cases (mean age: 42.1 ± 14.6 years; 400 males) comprised 471 (59.8%) asymptomatic/mild and 317 (40.2%) moderate/severe/critical cases. Multivariable logistic regression analysis showed older age group (≥ 45 years), diabetes mellitus, overweight/obesity and vaccination status to be associated with increased severity of disease. In propensity score-matched analysis, the relative risk of developing moderate/severe/critical COVID-19 for fully vaccinated (two doses) and partially vaccinated (one dose) cases was 0.33 (95% confidence interval [CI]: 0.16-0.69) and 0.62 (95% CI: 0.46-0.82), respectively, compared with a control group of non-vaccinated cases. The corresponding relative risk reduction (RRR) values were 66.5% and 38.4%, respectively. Vaccination was also protective against moderate/severe/critical disease in a subgroup of overweight/obese patients (RRR: 37.2%, P = 0.007). Discussion: Among those who contracted COVID-19, older age, having diabetes, being overweight/obese and being unvaccinated were significant risk factors for moderate/severe/critical disease. Vaccination, even partial, was protective against moderate/severe/critical disease.

The effectiveness of pharmacist-led educational model in adult patients with allergic rhinitis: a single-center randomized control trial protocol (AR-PRISE RCT).

BACKGROUND: Allergic rhinitis is a chronic respiratory disorder that significantly impacts patients' quality of life (QoL) and work performance. Pharmacists are recognized as suitable professionals to provide patient education and pharmaceutical care for managing allergic rhinitis patients. However, local clinical practice guidelines, particularly regarding pharmaceutical care in public healthcare institutions, are lacking. This study protocol outlines a randomized controlled trial (RCT) designed to evaluate the effectiveness of a pharmacist-led educational model (AR-PRISE Model) in managing allergic rhinitis in adult patients compared to standard pharmaceutical care. The AR-PRISE model delivers patient educational material and a pharmaceutical care algorithm. METHOD: This is a 6-month, single-center, prospective, randomized, two-arm, and parallel-group controlled trial. The trial recruits patients attending the otorhinolaryngology clinics of a tertiary referral hospital. Participants are randomized into control or intervention groups in a 1:1 ratio using permuted block randomization. The total number of participants estimated is 154, with each group requiring 77 participants. The control group receives standard pharmaceutical care, while the intervention group receives pharmacist-led education according to the AR-PRISE model. Both groups are assessed for middle turbinate endoscopy findings, disease severity, knowledge level, symptom control, medication adherence, and QoL at baseline and the end-of-study follow-up (day 180 ± 7). Depending on feasibility, intermediate follow-ups are conducted on days 60 ± 7 and 120 ± 7, either virtually or face-to-face. During intermediate follow-ups, participants are assessed for symptom control, medication adherence, and QoL. The intention-to-treat analysis includes all participants assigned to each group. An independent T-test compares the mean difference in knowledge level between the two groups. A two-way repeated measures ANOVA analysis is employed to determine between-group differences for scores of symptom control, adherence rate, and QoL. A P-value < 0.05 is considered statistically significant. DISCUSSION: This study protocol will provide a framework for conducting a randomized controlled trial (RCT) to evaluate the effectiveness of pharmacist-led education intervention in managing allergic rhinitis within public healthcare settings. The parameters measured in this trial will quantify outcomes associated with improvements in symptoms and QoL. By systematically assessing these outcomes, we aim to contribute valuable insights into the role of pharmacist-led interventions in enhancing the management of allergic rhinitis in public healthcare settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT06027736 . Registered on 9 July 2023-retrospectively registered.

Predictors of chronic kidney disease survival in type 2 diabetes: a 12-year retrospective cohort study utilizing estimated glomerular filtration rate.

Predicting the course of kidney disease in individuals with both type 1 and type 2 diabetes mellitus (DM) is a significant clinical and policy challenge. In several regions, DM is now the leading cause of end-stage renal disease. The aim of this study to identify both modifiable and non-modifiable risk factors, along with clinical markers and coexisting conditions, that increase the likelihood of stage 3-5 chronic kidney disease (CKD) development in individuals with type 2 DM in the United Arab Emirates (UAE). This was a single-center retrospective cohort study based on data derived from electronic medical records of UAE patients with DM who were registered at outpatient clinics at Tawam Hospital in Al Ain, UAE, between January 2011 and December 2021. Type 2 DM patients aged ≥ 18 years who had serum HbA1c levels ≥ 6.5% were included in the study. Patients with type 1 DM, who had undergone permanent renal replacement therapy, who had under 1 year of follow-up, or who had missing or incomplete data were excluded from the study. Factors associated with diabetic patients developing stage 3-5 CKD were identified through Cox regression analysis and a fine and gray competing risk model to account for competing events that could potentially hinder the development of CKD. A total of 1003 patients were recruited for the study. The mean age of the study cohort at baseline was 70.6 ± 28.2 years. Several factors were found to increase the risk of developing stage 3-5 CKD: advancing age (HR 1.005, 95% CI 1.002-1.009, p = 0.026), a history of hypertension (HR 1.69, 95% CI 1.032-2.8, p = 0.037), a history of heart disease (HR 1.49, 95% CI 1.16-1.92, p = 0.002), elevated levels of serum creatinine (HR 1.006, 95% CI 1.002-1.010, p = 0.003), decreased levels of estimated glomerular filtration rate (eGFR) (HR 0.943, 95% CI, 0.938-0.947; p < 0.001), and the use of beta-blockers (HR 139, 95% CI 112-173, p = 0.003). Implementing preventative measures, initiating early interventions, and developing personalized care plans tailored to address specific risk factors are imperative for reducing the impact of CKD. Additionally, the unforeseen findings related to eGFR highlight the ongoing need for research to deepen our understanding of the complexities of kidney disease.

Efficacy of Wolbachia-mediated sterility to reduce the incidence of dengue: a synthetic control study in Singapore.

BACKGROUND: Due to the absence of available therapeutics and good vaccines, vector control solutions are needed to mitigate the spread of dengue. Matings between male Aedes aegypti mosquitoes infected with the wAlbB strain of Wolbachia and wildtype females yield non-viable eggs. We evaluated the efficacy of releasing wAlbB-infected A aegypti male mosquitoes to suppress dengue incidence. METHODS: In this synthetic control study, we conducted large-scale field trials in Singapore involving release of wAlbB-infected A aegypti male mosquitoes for dengue control via vector population suppression, from epidemiological week (EW) 27, 2018, to EW 26, 2022. We selected two large towns (Yishun and Tampines) to adopt an expanding release strategy and two smaller towns (Bukit Batok and Choa Chu Kang) to adopt a targeted-release approach. Releases were conducted two times a week in high-rise public housing estates. All intervention and control locations practised the same baseline dengue control protocol. The main outcome was weekly dengue incidence rate caused by any dengue virus serotype. We used incidence data collected by the Singapore Ministry of Health to assess the efficacy of the interventions. To compare interventions, we used the synthetic control method to generate appropriate counterfactuals for the intervention towns using a weighted combination of 30 control towns between EW 1, 2014 and EW 26, 2022. FINDINGS: Our study comprised an at-risk population of 607 872 individuals living in intervention sites and 3 894 544 individuals living in control sites. Interventions demonstrated up to 77·28% (121/156, 95% CI 75·81-78·58) intervention efficacy despite incomplete coverage across all towns until EW 26, 2022. Intervention efficacies increased as release coverage increased across all intervention sites. Releases led to 2242 (95% CI 2092-2391) fewer cases per 100 000 people in intervention sites during the study period. Secondary analysis showed that these intervention effects were replicated across all age groups and both sexes for intervention sites. INTERPRETATION: Our results demonstrated the potential of Wolbachia-mediated incompatible insect technique for strengthening dengue control in tropical cities, where dengue burden is the greatest. FUNDING: Singapore Ministry of Finance, Ministry of Sustainability, and the National Environment Agency, and the Singapore National Robotics Program.

Characteristics of Children with Newly Diagnosed Type 1 Diabetes Mellitus in Brunei Darussalam.

Objective: This study aims to characterize the presentation, biochemical status of children with T1DM at diagnosis, the type of subcutaneous insulin regimens initiated, and to determine the incidence of T1DM in Bruneian children aged 18 years and younger. Methodology: A retrospective electronic and paper medical chart review was performed on patients aged 18 years and younger diagnosed with T1DM from 2013 to 2018 in Brunei Darussalam. Results: A total of 31 children with a mean age of 10.2 ± 3.6 years old were diagnosed with T1DM, of which 66.7% presented with diabetic ketoacidosis (DKA), a majority in severe DKA with an intercurrent illness (p = 0.021). The mean HbA1c was 13.6 ± 2.7% with a mean serum glucose of 37.0 ± 14.9 mmol/L at diagnosis. In the majority of the children (67.7%), multiple daily injections of subcutaneous insulin were initiated. The incidence of T1DM in children aged 18 years and younger was 4.9 per 100,000 for the year 2018. Conclusions: The majority of the patients in this study presented with severe DKA with an intercurrent illness. This highlights the importance of childhood T1DM awareness among the public and healthcare providers. The incidence of childhood T1DM in Brunei Darussalam is similar to other countries in the Asian region, being relatively low, compared to the rest of the world.

The prevalence and predictors of poor sleep quality and excessive daytime sleepiness in epilepsy: A single tertiary centre experience in Malaysia.

BACKGROUND AND OBJECTIVE: People with epilepsy frequently encounter sleep disruptions that can stem from a variety of complex factors. Epilepsy-related sleep disturbance can lead to reduced quality of life and excessive daytime hypersomnolence. Identification of sleep disturbances may help in the overall management of epilepsy patients. This study was conducted to determine the prevalence and predictors of poor sleep quality and daytime sleepiness in epilepsy. METHODS: A cross-sectional study on 284 epilepsy patients was performed in a local tertiary centre. The demographic and clinical epilepsy data were collected. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaires were utilised to determine the quality of life and daytime hypersomnolence of epilepsy patients, respectively. RESULTS: Poor sleep quality was reported in 78 (27.5%) patients while daytime hypersomnolence was present in 17 (6%) patients. The predictors of poor sleep quality include structural causes (OR = 2.749; 95% CI: 1.436, 5.264, p = 0.002), generalised seizures (OR = 1.959, 95% CI: 1.04, 3.689, p = 0.037), and antiseizure medications such as Carbamazepine (OR = 2.34; 95% CI: 1.095, 5.001, p = 0.028) and Topiramate (OR 2.487; 95% CI: 1.028, 6.014, p = 0.043). Females are 3.797 times more likely score higher in ESS assessment (OR 3.797; 95% CI: 1.064, 13.555 p = 0.04). DISCUSSION: Sleep disturbances frequently coexist with epilepsy. Patients should be actively evaluated using the PSQI and ESS questionnaires. It is imperative to identify the key factors that lead to reduced sleep quality and heightened daytime sleepiness in patients with epilepsy, as this is essential to properly manage their condition.

Static-99R Norms and Cross-Cultural Validity for Australian Aboriginal and Non-Aboriginal Men Convicted of Sexual Offences.

This study examined Static-99R normative data and cross-cultural validity in a sample of 811 Aboriginal and 3257 non-Aboriginal Australian men (N = 4068) serving custodial orders for sexual offences in New South Wales (NSW), Australia. Aboriginal men scored significantly higher on the Static-99R than non-Aboriginal men (M = 4.39 vs. 2.61) and were more likely to be represented in higher categories of risk. The Static-99R showed good discrimination performance for the total sample (AUC = .76; 95% CI = [.73-.80]) and acceptable calibration to expected reoffending rates for routine samples, with slight tendencies towards overestimation. Discrimination accuracy was lower for Aboriginal men (AUC = .68; 95% CI = [.60-77]) than non-Aboriginal men (AUC = .78; 95% CI = [.74-83]) although was significantly better than chance for both groups. Additional analyses indicated that cross-cultural differences in discrimination were partly associated with variance in sample composition between groups. This is the first Australian study to find evidence for significant predictive validity of the Static-99R with Aboriginal men, and while further research is needed, the results provide initial support for cross-cultural applications of the measure in local criminal justice settings.

A Cantonese Audio-Visual Emotional Speech (CAVES) dataset.

We present a Cantonese emotional speech dataset that is suitable for use in research investigating the auditory and visual expression of emotion in tonal languages. This unique dataset consists of auditory and visual recordings of ten native speakers of Cantonese uttering 50 sentences each in the six basic emotions plus neutral (angry, happy, sad, surprise, fear, and disgust). The visual recordings have a full HD resolution of 1920 × 1080 pixels and were recorded at 50 fps. The important features of the dataset are outlined along with the factors considered when compiling the dataset. A validation study of the recorded emotion expressions was conducted in which 15 native Cantonese perceivers completed a forced-choice emotion identification task. The variability of the speakers and the sentences was examined by testing the degree of concordance between the intended and the perceived emotion. We compared these results with those of other emotion perception and evaluation studies that have tested spoken emotions in languages other than Cantonese. The dataset is freely available for research purposes.

Development and validation of a pharmacist-led education model in allergic rhinitis management: a multi-phase study.

BACKGROUND: Patient education is identified as one of the core and fundamental management strategies in the management of allergic rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines developed guidance for the management of allergic respiratory disease, and the guidelines are applicable to the international context. The ARIA guidelines for the pharmacy have specifically encouraged the creation of local pharmacist-led intervention in allergic rhinitis management. This study aims to develop a pharmacist-led educational model using a multi-phase study approach. METHOD: In phase one, we conducted a literature review using four databases to extract relevant articles and clinical practice guidelines published between 2017 and 2022. The information was structured into a questionnaire consisting of patient education material (10 domains with 130 items) and pharmacist counseling scopes (15 domains with 43 items), with each item having a rating scale ranging from 1 (lowest) to 9 (highest) level of agreement. Fifty-two panellists, including otorhinolaryngologists and pharmacists, were invited to complete the questionnaire. A consensus agreement was considered when at least 70% of panellists scored 7 to 9 (critically important). A two-round survey was conducted, and descriptive analysis, inter-rater reliability (≥ 0.5-1 indicate moderate to excellent reliability), variation in the relative interquartile (VRIR < 0.3 indicate good stability), and variation in the coefficient of variation (VCV < 40% considered consensus achieved) were performed. In phase two, patient education material was developed into audio-visual format, and in phase three, patients rated its understandability and actionability using a validated Patient Education Materials Assessment Tool. RESULTS: In the round one Delphi survey, 43 panellists responded, with 171 out of 173 items achieving "consensus agreement" (75.4-100%). In the second survey, 32 out of 43 panellists responded, with most items (171 out of 173 items) stable across rounds and all items had acceptable internal consistency (VCV: - 12.21-15.81). Two items did not achieve "consensus agreement" (64%) but improved in round two (92.9%), however, instability was observed (VRIR: 0.36). These two items were retained in the model due to achieving the minimum level of agreement and internal consistency (VCV = 15.81). Inter-rater reliability was 0.608 and 0.970 in the respective rounds. Patients rated the educational material as understandable (81.8-100%) and actionable (100%). CONCLUSION: The validated pharmacist-led education model, with its educational materials tested on end-users, provides structured patient education and pharmaceutical care in assisting patients with allergic rhinitis. The educational material allows the delivery of standardized information by the healthcare providers to the patients. Further research on the effectiveness of this model in improving patients' symptom control and quality of life is warranted.

Imaging evaluation of a proposed 3D generative model for MRI to CT translation in the lumbar spine.

BACKGROUND CONTEXT: A computed tomography (CT) and magnetic resonance imaging (MRI) are used routinely in the radiologic evaluation and surgical planning of patients with lumbar spine pathology, with the modalities being complimentary. We have developed a deep learning algorithm which can produce 3D lumbar spine CT images from MRI data alone. This has the potential to reduce radiation to the patient as well as burden on the health care system. PURPOSE: The purpose of this study is to evaluate the accuracy of the synthetic lumbar spine CT images produced using our deep learning model. STUDY DESIGN: A training set of 400 unpaired CTs and 400 unpaired MRI scans of the lumbar spine was used to train a supervised 3D cycle-Gan model. Evaluators performed a set of clinically relevant measurements on 20 matched synthetic CTs and true CTs. These measurements were then compared to assess the accuracy of the synthetic CTs. PATIENT SAMPLE: The evaluation data set consisted of 20 patients who had CT and MRI scans performed within a 30-day period of each other. All patient data was deidentified. Notable exclusions included artefact from patient motion, metallic implants or any intervention performed in the 30 day intervening period. OUTCOME MEASURES: The outcome measured was the mean difference in measurements performed by the group of evaluators between real CT and synthetic CTs in terms of absolute and relative error. METHODS: Data from the 20 MRI scans was supplied to our deep learning model which produced 20 "synthetic CT" scans. This formed the evaluation data set. Four clinical evaluators consisting of neurosurgeons and radiologists performed a set of 24 clinically relevant measurements on matched synthetic CT and true CTs in 20 patients. A test set of measurements were performed prior to commencing data collection to identify any significant interobserver variation in measurement technique. RESULTS: The measurements performed in the sagittal plane were all within 10% relative error with the majority within 5% relative error. The pedicle measurements performed in the axial plane were considerably less accurate with a relative error of up to 34%. CONCLUSIONS: The computer generated synthetic CTs demonstrated a high level of accuracy for the measurements performed in-plane to the original MRIs used for synthesis. The measurements performed on the axial reconstructed images were less accurate, attributable to the images being synthesized from nonvolumetric routine sagittal T1-weighted MRI sequences. It is hypothesized that if axial sequences or volumetric data were input into the algorithm these measurements would have improved accuracy.

The Trend of the Burden of Allergic Rhinitis Pre- and Post-COVID-19 Pandemic in the Urban Population of Perak, Malaysia.

Aims: This study aims to determine the trend of allergic rhinitis (AR) prevalence in a tertiary hospital between 2017 and 2022, and to compare its prevalence pre- and post-COVID-19 pandemic. Methods: This was a cross-sectional study involving the extraction of all Malaysian patients' medical records who were diagnosed with AR and attended the otorhinolaryngology outpatient clinic of a government-funded tertiary hospital in Malaysia between 2017 and 2022. Results: 3,744 cases out of the 57,968 first-encounter outpatient visits to the otorhinolaryngology clinic were extracted for analysis. Overall, the prevalence of AR cases ranged from 1.83 to 9.23% between 2017 and 2022. There was a significant drop of 21.38 to 70.22% between the pre- and post-COVID-19 pandemic (p < 0.001). Males (0.34 to 1.60%) were more prevalent in the 6 to 18 year old than females (0.09 to 1.23%). The trend shifted with age, whereby females (0.50 to 2.45%) experienced a higher prevalence than males (0.21 to 1.77%) as they aged from 19 to 59. The Malay (1.01 to 4.59%) demonstrated a two-time higher prevalence than the Chinese (0.30 to 2.01%) and Indian (0.40 to 2.14%) ethnicities. After stratifying by gender and ethnicity, Indian women (0.17 to 1.09%) had a higher rate of AR than their Chinese counterparts (0.12 to 0.99%) across all years. Conclusion: The AR prevalence consistently ranged from 8.14 to 9.23% pre-pandemic. A remarkable drop was observed post-pandemic, ranging from 1.83 to 6.40%. A gender shift from male to female predominance as age progressed. The Malay had the highest prevalence of AR.

Post-COVID-19 health-care utilization: one year after the 2020 first wave in Brunei Darussalam.

Objective: Patients who recover from coronavirus disease (COVID-19) infection are at risk of long-term health disorders and may require prolonged health care. This retrospective observational study assesses the number of health-care visits before and after COVID-19 infection in Brunei Darussalam. Methods: COVID-19 cases from the first wave with 12 months of follow-up were included. Health-care utilization was defined as health-care visits for consultations or investigations. Post-COVID condition was defined using the World Health Organization definition. Results: There were 132 cases; 59.1% were male and the mean age was 37.1 years. The mean number of health-care visits 12 months after recovery from COVID-19 (123 cases, 93.2%; mean 5.0 ± 5.2) was significantly higher than the prior 12 months (87 cases, 65.9%, P < 0.001; mean 3.2 ± 5.7, P < 0.001). There was no significant difference when scheduled COVID-19 visits were excluded (3.6 ± 4.9, P = 0.149). All 22 cases with moderate to critical disease recovered without additional health-care visits apart from planned post-COVID-19 visits. Six patients had symptoms of post-COVID condition, but none met the criteria for diagnosis or had alternative diagnoses. Discussion: There were significantly more health-care visits following recovery from COVID-19. However, this was due to scheduled post-COVID-19 visits as per the national management protocol. This protocol was amended before the second wave to omit post-COVID-19 follow-up, except for complicated cases or cases with no documented radiological resolution of COVID-19 pneumonia. This will reduce unnecessary health-care visits and conserve precious resources that were stretched to the limit during the pandemic.

Assessing the efficacy of male Wolbachia-infected mosquito deployments to reduce dengue incidence in Singapore: study protocol for a cluster-randomized controlled trial.

BACKGROUND: Dengue is a severe environmental public health challenge in tropical and subtropical regions. In Singapore, decreasing seroprevalence and herd immunity due to successful vector control has paradoxically led to increased transmission potential of the dengue virus. We have previously demonstrated that incompatible insect technique coupled with sterile insect technique (IIT-SIT), which involves the release of X-ray-irradiated male Wolbachia-infected mosquitoes, reduced the Aedes aegypti population by 98% and dengue incidence by 88%. This novel vector control tool is expected to be able to complement current vector control to mitigate the increasing threat of dengue on a larger scale. We propose a multi-site protocol to study the efficacy of IIT-SIT at reducing dengue incidence. METHODS/DESIGN: The study is designed as a parallel, two-arm, non-blinded cluster-randomized (CR) controlled trial to be conducted in high-rise public housing estates in Singapore, an equatorial city-state. The aim is to determine whether large-scale deployment of male Wolbachia-infected Ae. aegypti mosquitoes can significantly reduce dengue incidence in intervention clusters. We will use the CR design, with the study area comprising 15 clusters with a total area of 10.9 km2, covering approximately 722,204 residents in 1713 apartment blocks. Eight clusters will be randomly selected to receive the intervention, while the other seven will serve as non-intervention clusters. Intervention efficacy will be estimated through two primary endpoints: (1) odds ratio of Wolbachia exposure distribution (i.e., probability of living in an intervention cluster) among laboratory-confirmed reported dengue cases compared to test-negative controls and (2) laboratory-confirmed reported dengue counts normalized by population size in intervention versus non-intervention clusters. DISCUSSION: This study will provide evidence from a multi-site, randomized controlled trial for the efficacy of IIT-SIT in reducing dengue incidence. The trial will provide valuable information to estimate intervention efficacy for this novel vector control approach and guide plans for integration into national vector control programs in dengue-endemic settings. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT05505682 . Registered on 16 August 2022. Retrospectively registered.

The management of allergic rhinitis by pharmacists in public services: a proposed PhaRmacISt-led Education Model (AR-PRISE).

Allergic rhinitis has been identified as a major respiratory disease that places a significant burden on patients and the healthcare system. Nevertheless, the management of allergic rhinitis is challenging for both patients and practitioners. Pharmacists have been recognised as strategic in providing advice for allergic avoidance, disease information, and pharmacological care for allergic rhinitis management. This role has been underutilised in the public health service sector in Malaysia due to variation in practice, regulation, and health system structures when compared to the international guidelines. This article proposed a PhaRmacISt-led Education Model (AR-PRISE) that includes explicit patient education materials and an algorithm for structured counselling by pharmacists in the management of patients with allergic rhinitis.

Standardization of the FAO/IAEA Flight Test for Quality Control of Sterile Mosquitoes.

Successful implementation of the sterile insect technique (SIT) against Aedes aegypti and Aedes albopictus relies on maintaining a consistent release of high-quality sterile males. Affordable, rapid, practical quality control tools based on the male's flight ability (ability to escape from a flight device) may contribute to meeting this requirement. Therefore, this study aims to standardize the use of the original FAO/IAEA rapid quality control flight test device (FTD) (version 1.0), while improving handling conditions and reducing the device's overall cost by assessing factors that could impact the subsequent flight ability of Aedes mosquitoes. The new FTD (version 1.1) is easier to use. The most important factors affecting escape rates were found to be tube color (or "shade"), the combined use of a lure and fan, mosquito species, and mosquito age and density (25; 50; 75; 100 males). Other factors measured but found to be less important were the duration of the test (30, 60, 90, 120 min), fan speed (normal 3000 rpm vs. high 6000 rpm), and mosquito strain origin. In addition, a cheaper version of the FTD (version 2.0) that holds eight individual tubes instead of 40 was designed and successfully validated against the new FTD (version 1.1). It was sensitive enough to distinguish between the effects of cold stress and high irradiation dose. Therefore, the eight-tube FTD may be used to assess Aedes' flight ability. This study demonstrated that the new designs (versions 1.1 and 2.0) of the FTD could be used for standard routine quality assessments of Aedes mosquitoes required for an SIT and other male release-based programs.