Prevalence, risk factors and treatment outcomes of syphilis among people living with human immunodeficiency virus at primary care clinics in Malaysia: A retrospective study.

Introduction: Syphilis and human immunodeficiency virus (HIV) coinfection is a common clinical problem with a significant rising trend worldwide. In Malaysia, the burden of care is shared between hospitals and primary care clinics. This study aimed to determine the prevalence of syphilis among people living with HIV (PLHIV) at primary care clinics in Malaysia and assess its association with sociodemographic characteristics, risk factors and treatment outcomes. Methods: This retrospective study included 750 PLHIV aged ≥18 years who attended primary care clinics in three different locations in Malaysia from 1 January 2017 to 31 December 2019. Data were obtained from the patients' clinical notes using a structured questionnaire evaluating the sociodemographic characteristics, history of sexual and lifestyle behaviours, diagnosis and management. Results: The patients' age ranged from 18 to 78 years (mean=34.7, standard deviation=10.2). The prevalence of syphilis among the PLHIV at the three primary care clinics was 33.8% (n=254). Syphilis was significantly associated with gender (P=0.038) as well as sexual activity (P<0.001), substance use (P=0.038), history of chemsex (P=0.001) and history of sexually transmitted infections (STIs) (P<0.001) within the past 12 months. The majority of the PLHIV with syphilis received treatment at the primary care clinics (n=248, 97.3%), and up to 96.1% (n=245) had completed such treatment. Conclusion: Syphilis is prevalent among PLHIV at primary care clinics, and most patients receive standard treatment. Therefore, primary care doctors must enhance their knowledge to effectively manage STIs, especially syphilis.

Jump dispersal drives the relationship between micro- and macroevolutionary dynamics in the Sicydiinae (Gobiiformes: Oxudercidae) of Sundaland and Wallacea.

Insular biodiversity hotspots of Southeast Asia are remarkable for their biodiverse faunas. With a marine larval phase lasting up to several months, the freshwater fish subfamily Sicydiinae has colonized most islands of these hotspots. However, Sicydiinae diversity is still poorly understood in Southeast Asia. With the objective to estimate intraspecific genetic diversity and infer past demography, we conducted the molecular inventory of Sicydiinae species in Sundaland and Wallacea using 652 bp of the mitochondrial cytochrome oxidase I gene, species delimitation methods and Bayesian Skyline plot reconstructions. In total, 24 Molecular Operational Taxonomic Units are delimited among the 603 sequences belonging to 27 species and five genera. Two cases of discordance between morphology and mitochondrial sequence are observed suggesting ongoing speciation and/or introgression in two genera. Multiple new occurrences are reported, either for a single biodiversity hotspot or both, some of which corresponding to observations of a few individuals far from the range distribution of their conspecifics. Among the ten species or species group whose intraspecific diversity was examined, high levels of genetic diversity and past population expansion are revealed by Tajima's D tests and Bayesian Skyline Plot reconstructions. Together these results indicate that long-distance dispersal is common and suggest that most endemic species originated through founder events followed by population expansion. Patterns of sexual dimorphism and males' coloration among diverging species pair seem to point to sexual selection as an important mechanism contributing to speciation in the Sicydiinae of Sundaland and Wallacea.

Usability and acceptability of oral fluid- and blood-based hepatitis C virus self-testing among the general population and men who have sex with men in Malaysia.

Hepatitis C self-testing (HCVST) is emerging as an additional strategy that could help to expand access to HCV testing. We conducted a study to assess the usability and acceptability of two types of HCVST, oral fluid- and blood-based, among the general population and men who have sex with men (MSM) in Malaysia. An observational study was conducted in three primary care centres in Malaysia. Participants who were layman users performed the oral fluid- and blood-based HCVST sequentially. Usability was assessed by calculating the rate of errors observed, the rate of difficulties faced by participants as well as inter-reader (self-test interpreted by self-tester vs interpreted by trained user) and inter-operator concordances (self-test vs test performed by trained user). The acceptability of HCV self-testing was assessed using an interviewer-administered semi-structured questionnaire. Participants were also required to read contrived test results which included "positive", "negative", and "invalid". There was a total of 200 participants (100 general population, 100 MSM; mean age 33.6 ± 14.0 years). We found a high acceptability of oral fluid- and blood-based HCVST across both general population and MSM. User errors, related to timekeeping and reading within stipulated time, were common. However, the majority of the participants were still able to obtain and interpret results correctly, including that of contrived results, although there was substantial difficulty interpreting weak positive results. The high acceptability of HCVST among the participants did not appreciably change after they had experienced both tests, with 97.0% of all participants indicating they would be willing to use HCVST again and 98.5% of them indicating they would recommend it to people they knew. There was no significant difference between the general population and MSM in these aspects. Our study demonstrates that both oral fluid- and blood-based HCVST are highly acceptable among both the general population and MSM. Both populations also showed comparable ability to conduct the tests and interpret the results. Overall, this study suggests that HCVST could be introduced as an addition to existing HCV testing services in Malaysia. Further studies are needed to establish the optimal positioning of self-testing alongside facility-based testing to expand access to HCV diagnosis in the country.

Groundwater quality index development using the ANN model of Delhi Metropolitan City, India.

Groundwater is widely recognized as a vital source of fresh drinking water worldwide. However, the rapid, unregulated population growth and increased industrialization, coupled with a rise in human activities, have significantly harmed the quality of groundwater. Changes in the local topography and drainage systems in an area have negative impacts on both the quality and quantity of groundwater. This underscores the critical need to assess the susceptibility of groundwater to pollution and implement measures to mitigate these risks. The water quality index (WQI) is an approach that simulates the water quality at peculiar locations for a particular period of time. The artificial neural network (ANN) model approach is such an idealistic methodology that can be utilized for WQI development and provides better results for specific locations in optimum time. Therefore, the goal of the current study is to provide a unique way for using artificial neural networks (ANN) to characterize the groundwater quality of Delhi Metropolitan City, India. In order to make the water fit for residential and drinking use, the research also pinpoints the geographical variability and spots where the contaminated region has to be sufficiently cleaned. A minimum WQI of 41.51 was obtained at the Jagatpur location while a maximum value of 779.01 was at the Peeragarhi location. During the training phase, the results obtained using the ANN model were highly favorable, demonstrating a strong association with an R-value of 98.10%, thus highlighting the program's exceptional efficiency. However, in accordance with the correlation regression findings, the prediction outcomes of the ANN model in testing are observed to be an R-value of 99.99-100%. This study confirms the promise and advantages of employing advanced artificial intelligence in managing groundwater quality in the studied area.

Water Quality Index Assessment of River Ganga at Haridwar Stretch Using Multivariate Statistical Technique.

The Ganges (Ganga) river contributes significant water resources for the ecology and economy, but it frequently encounters severe deterioration due to cumulative impact from upstream natural and anthropogenic variables. Knowledge and understanding of the dynamic behavior of such networks remain a significant challenge, particularly in the context of rising environmental pressures, such as climate change and industrialization, as well as constraints in both process and data understanding across geographies. An interdisciplinary approach is required to be developed to investigate the hydrogeochemical dynamics and anthropogenic sources influencing water quality in major river systems. The present study has been carried out to evaluate the characterization of river water quality in terms of the physico-chemical & bacteriological parameters. Also, the development of a water quality index (WQI) for Domestic (drinking) and Spiritual (bathing) usage is a part of the study. The water quality index has been developed using the Canadian Council of Ministers of the Environmental Water Quality Index (CCME WQI). The river's water quality index score in the present study lies in the range of 38.32 to 79.82, indicating the quality of water from fair to poor for drinking purposes. The highest water quality index value of 79.82 has been observed at Guru Kashnik Ghat, while the lowest WQI value of 38.32 has been observed at Har ki Pauri for drinking purposes. However, the water quality score for bathing purposes ranged from 71.04 to 91.22 thus signifying the quality of the water from fair to good for bathing purposes. The highest water quality index value of 91.22 has been assessed at Guru Kashnik Ghat, while the lowest WQI value of 71.04 has been assessed at Bhimgoda Barrage. The developed water indices assessment in the present study will be beneficial for society to provide a benchmark for the control of water pollution in River Ganga. These findings will support policymakers and stakeholders in addressing water quality issues in a more efficient and effective manner. The study also emphasizes the requirement for ongoing water quality monitoring and evaluation in order to guarantee the long-term well-being of the river and its ecosystems.

Point-of-care ultrasound (POCUS) protocol for systematic assessment of the crashing neonate-expert consensus statement of the international crashing neonate working group.

Sudden unexpected clinical deterioration or cardiorespiratory instability is common in neonates and is often referred as a "crashing" neonate. The established resuscitation guidelines provide an excellent framework to stabilize and evaluate these infants, but it is primarily based upon clinical assessment only. However, clinical assessment in sick neonates is limited in identifying underlying pathophysiology. The Crashing Neonate Protocol (CNP), utilizing point-of-care ultrasound (POCUS), is specifically designed for use in neonatal emergencies. It can be applied both in term and pre-term neonates in the neonatal intensive care unit (NICU). The proposed protocol involves a stepwise systematic assessment with basic ultrasound views which can be easily learnt and reproduced with focused structured training on the use of portable ultrasonography (similar to the FAST and BLUE protocols in adult clinical practice). We conducted a literature review of the evidence-based use of POCUS in neonatal practice. We then applied stepwise voting process with a modified DELPHI strategy (electronic voting) utilizing an international expert group to prioritize recommendations. We also conducted an international survey among a group of neonatologists practicing POCUS. The lead expert authors identified a specific list of recommendations to be included in the proposed CNP. This protocol involves pre-defined steps focused on identifying the underlying etiology of clinical instability and assessing the response to intervention.Conclusion: To conclude, the newly proposed POCUS-based CNP should be used as an adjunct to the current recommendations for neonatal resuscitation and not replace them, especially in infants unresponsive to standard resuscitation steps, or where the underlying cause of deterioration remains unclear. What is known? • Point-of-care ultrasound (POCUS) is helpful in evaluation of the underlying pathophysiologic mechanisms in sick infants. What is new? • The Crashing Neonate Protocol (CNP) is proposed as an adjunct to the current recommendations for neonatal resuscitation, with pre-defined steps focused on gaining information regarding the underlying pathophysiology in unexplained "crashing" neonates. • The proposed CNP can help in targeting specific and early therapy based upon the underlying pathophysiology, and it allows assessment of the response to intervention(s) in a timely fashion.

Challenges experienced in establishing clinical indication based diagnostic reference levels: Pilot study.

PURPOSE: The objective of this study is to establish clinical-indication based Diagnostic Reference Levels (DRLs) for the Computed Tomography (CT) examinations of Head, Abdomen & Pelvis + Contrast, and Kidney Ureter Bladder (KUB). Further, is to investigate the cases that register high-end doses to enable dose optimization. MATERIAL AND METHODS: Dose length product total (tDLPs) and scan acquisition parameters of a total of 715 patients who underwent CT Head, CT Abdomen & Pelvis + Contrast, and CT KUB studies were obtained and retrospectively examined. An electronic patient radiation dose monitoring system DOSE-TQM linked with the existing PACS was used to randomly generate patient dose information. Patient's demographics, clinical indications and scan acquisitions were also collected. ANOVA and Tukey's multiple comparison tests were used to check statistical differences between tDLPs per clinical indications. RESULTS: The data exhibited 341 CT Head, 109 patients for CT Abdomen & Pelvis + Contrast, and 265 CT KUB examinations. The DRLs proposed using total DLP (mGy.cm) for clinical indications; abdominal pain for both CT Abdomen & Pelvis + Contrast and CT KUB (441 and 311 mGy.cm, respectively), appendicitis /acute appendicitis (484 mGy.cm), head trauma (544 mGy.cm), stroke (544 mGy.cm) and renal colic (308 mGy.cm). These values were concluded to be below or in close proximity with the total DLP based indication reported internationally. Patient weight is a significant dose contributor. CONCLUSION: DLP differences exists not only between the same anatomical based CT studies but also across the same clinical indications. DLPs based on clinical indications provide a tool for CT dose optimisation that is better adapted to clinical practices and to the variability of patient's morphology.

An integrated DEMATEL-MMDE-ISM approach for analyzing environmental sustainability indicators in MSMEs.

The Micro, Small and Medium Enterprises (MSMEs) face numerous environmental challenges encompassing resource and energy conservation; waste generation and disposal; water and air pollution; and so on. As a result, it becomes critical to implement policies, strategies, and technologies that can help in reducing the adverse impacts of manufacturing activities on the environment. In this context, the current study identified 15 critical environmental sustainability indicators to assess the impact of manufacturing activities on the environment by taking a case study of lock manufacturing MSMEs. To understand the interdependence among the selected indicators, the study further utilizes an integrated DEMATEL-MMDE-ISM approach to analyze the inputs of industry professionals. The results of the study highlighted that green product design, which facilitates the product to be disassembled, reused, or recycled and are free from hazardous materials, plays a significant role in enhancing the environmental sustainability of the concerned industry. Green product design significantly affects 12 other indicators out of 15 under consideration; thus, incorporating green practices in the design and development of a product leads to significant improvement in environmental sustainability. The study is expected to aid decision-makers (industry practitioners and academic researchers) to identify strategic areas in order to achieve higher environmental sustainability in manufacturing organizations.

May Measurement Month 2019: an analysis of blood pressure screening results from Malaysia.

Despite hypertension remaining the leading cause of death worldwide, awareness of hypertension and its control rate is still suboptimal in Malaysia. This study aims to determine the proportion of both diagnosed and undiagnosed hypertension, awareness and its control rate during the yearly May Measurement Month (MMM) campaign that has been coordinated by the International Society of Hypertension. Participants aged ≥18 years were recruited at various screening sites namely universities, health facilities, shopping malls, and other sites. Participant's socio-demographic, environmental, and lifestyle data were captured using a questionnaire. Three blood pressure (BP) readings as well as anthropometric measurements were obtained from all participants. The mean of the second and third BP readings was used in analyses. Hypertension was defined as a systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or taking antihypertensive medication. A total of 3062 participants were recruited. The proportion with hypertension in our study was 18.7% (n = 572). The proportion who were aware of their BP status was 63.2%. More than half (57.2%) of the hypertensives were on antihypertensive medication and 70.3% of those treated were controlled. In conclusion, in this BP screening campaign, one in five were hypertensive with almost two thirds aware of their hypertensive status. BP control among those who are taking medications was high at 70% but under 60% of hypertensives were on treatment. Hypertension screening programmes are important to promote awareness and control of hypertension as well as to reduce the devastating complications associated with this disorder.

Relationship of an adherence score with blood pressure control status among patients with hypertension and their determinants: Findings from a nationwide blood pressure screening program.

This study aimed to examine the relationship of adherence with blood pressure (BP) control and its associated factors in hypertensive patients. This cross-sectional nationwide BP screening study was conducted in Malaysia from May to October 2018. Participants with self-declared hypertension completed the Hill-Bone Compliance to High Blood Pressure Therapy Scale (Hill-Bone CHBPTS) which assesses three important domains of patient behavior to hypertension management namely medication taking, appointment keeping and reduced salt intake. Lower scores indicate better compliance while higher scores indicate otherwise. Participant's body mass index and seated BP were measured based on standard measurement protocol. Determinants of adherence to treatment were analyzed using multiple linear regression. Out of 5167 screened subjects, 1705 were known hypertensives. Of these, 927 (54.4%) answered the Hill-Bone CHBPTS and were entered into analysis. The mean age was 59.0 ± 13.2 years, 55.6% were female and 42.2% were Malays. The mean Hill-Bone CHBPTS score was 20.4 ± 4.4 (range 14-47), and 52.1% had good adherence. The mean systolic BP and diastolic BP were 136.4 ± 17.9 and 80.6 ± 11.6 mmHg, respectively. BP was controlled in 58.3% of those with good adherence compared to 50.2% in those with poor adherence (p = .014). Based on multiple linear regression analysis, female gender (ß = -0.72, 95% confidence interval [CI] -1.30, -0.15, p = .014), older age (ß = -0.05, 95% CI -0.07, -0.03, p < .001), and individuals with primary or lower educational level (ß = -0.91, 95% CI -1.59, -0.23, p = .009) had better adherence to BP management. Interventional programs targeted at the less adherent groups are needed in order to improve their adherence and BP control.

May Measurement Month 2018: an analysis of blood pressure screening results from Malaysia.

Hypertension continues to be the top global killer, contributing to over 10 million deaths annually. As prevalence and unawareness of hypertension remain high in Malaysia, this study was aimed to screen more individuals to identify those with undiagnosed hypertension. Respondents aged ≥18 years were recruited through opportunistic sampling at various screening sites including health clinics, hospitals, student health centres, universities, community halls, shopping malls, as well as through other health screening campaigns. Each respondent completed a questionnaire on socio-demographic, environmental, and lifestyle data. Anthropometric measurements as well as three blood pressure (BP) measurements were obtained from all participants. Hypertension was defined as a systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or taking antihypertensive medication. The total number of participants was 4866. The mean age of the participants was 39.8 (17.6) years with 61.1% female participants. Of the 4866 participants, 1405 (28.9%) had hypertension. The proportion of those aware of their hypertension status was 76.3% (1073/1405). The proportion of those with hypertension on medication was 71% (998/1405). Of those receiving antihypertensive treatment, 62.4% (623/998) had controlled BP. The proportion of hypertension in this study was 28.9%. The awareness rate of 76.3% compares favourably to a previously reported national level of 43.2%. Hence, BP screening programmes may be effective at increasing awareness and should be conducted annually.

High continuous positive airway pressure in neonates: A physiological study.

OBJECTIVE: We sought to evaluate physiological cardiorespiratory implications of high pressures (>8 cmH2 O) on continuous positive airway pressure (CPAP) in preterm neonates. METHODS: Fifteen preterm neonates at postmenstrual age ≥32 weeks on CPAP 5 cmH2 O were enrolled. Pressures were increased by 2 cmH 2 O increments until 13 cmH 2 O. At each increment, cardiac output, electrical diaphragmatic (Edi) activity, and clinical cardiorespiratory parameters were measured. Predefined cut-off values for changes in cardiorespiratory parameters were used as termination criteria. Data, presented as mean (SD), were compared using repeated measures analysis of variance. RESULTS: The mean GA, age at study, and weight of subjects were 27.4 (2.6) weeks, 58.5 (35.5) days, and 2.3 (0.6) kg, respectively. The median (IQR) time at each CPAP increment was 10 (5, 20) min. Cardiac output (mL/kg/min) at 5, 7, 9, 11, and 13 cmH 2 O were not different at 295 (75), 290 (66), 281 (69), 286 (73), and 292 (58), respectively (P = 0.99). Edi values demonstrated a trend towards decline at 9 cmH 2 O before rising again. No other cardiorespiratory parameter was different across CPAP levels; no subject met termination criteria. CONCLUSION: High CPAP levels were well tolerated for short durations. Further physiological and clinical research is required on safety/efficacy in neonates with more severe lung disease, as well as its impact over longer durations.

Introduction of microsystems in a level 3 neonatal intensive care unit-an interprofessional approach.

BACKGROUND: Growth of neonatal intensive care units in number and size has raised questions towards ability to maintain continuity and quality of care. Structural organization of intensive care units is known as a key element for maintaining the quality of care of these fragile patients. The reconstruction of megaunits of intensive care to smaller care units within a single operational service might help with provision of safe and effective care. METHODS/DESIGN: The clinical team and patient distribution lay out, admission and discharge criteria and interdisciplinary round model was reorganized to follow the microstructure philosophy. A working group met weekly to formulate the implementation planning, to review the adaptation and adjustment process and to ascertain the quality of implementation following the initiation of the microsystem model. DISCUSSION: In depth examination of microsystem model of care in this study, provides systematic evaluation of this model on variable aspects of health care. The individual projects of this trial can be source of solid evidence for guidance of future decisions on optimized model of care for the critically ill newborns. TRIAL REGISTRATION: ClinicalTrial.gov, NCT02912780 . Retrospectively registered on 22 September 2016.