Respirable dust exposure impact on respiratory symptoms among cleaners in a Selangor Public University, Malaysia.

INTRODUCTION: Cleaners perform a vital role in environmental health by keeping the place clean, but they are also exposed to various hazards. Yet, there is a lack of effective and accessible occupational safety standard measures, thus making this to be difficult to monitor the long-term health effects of cleaners. This study aims to determine the respirable dust exposure on respiratory symptoms among cleaners in a public university in Selangor. MATERIALS AND METHODS: A cross-sectional study was carried out among 51 cleaners. The respondents' background information and respiratory symptoms were gathered using a series of standardised questionnaires validated by the American Thoracic Society (ATS-DLD-78-A). The 8- hour respirable dust exposure to cleaners was measured using an air sampling pump (Gillian & Sensodyne Gil Air 3). RESULTS: The mean of respirable dust was lower than permissible exposure limit with 0.63±0.57mg/m3. The respiratory symptoms among the cleaners showed no significant association between cough, phlegm, and breathing difficulties with working tenure. Meanwhile, wheezing and coughing with phlegm have an almost significant association with working tenure among cleaners with (Χ2=1.00, p=0.08) and (Χ2=1.00, p=0.07) respectively. Exposure to respirable dust has exhibited 6 times the prevalence of coughing with phlegm among cleaners (PR=6.28, 95% CI: 0.44, 89.38). CONCLUSION: The findings of this study demonstrated that the cleaners were significantly affected by the respirable dust. The cleaners' working environment has caused them to be exposed to respirable dust.

Iridium-palladium binary alloy as a counter electrode in dye-sensitized solar cells.

This study is concerned with the iridium-palladium (Ir-Pd) binary alloy as a counter electrode (CE) for DSSC. The CE was prepared using the liquid phase deposition (LPD) technique. The influence of the concentration of hydrogen hexachloroiridate(IV) hydrate (H2Cl6Ir·H2O) on the properties and the performance of the device was investigated. The source of iridium was H2Cl6Ir·H2O. XRD analysis confirmed that the dominant phase of Ir-Pd existed in the sample. The grain size of Ir-Pd increased with the increase in the concentration of H2Cl6Ir·H2O until an optimum concentration of 0.7 mM was reached. The % wt of Ir was found to increase with the concentration of H2Cl6Ir·H2O. The device utilizing Ir-Pd CE with 0.7 mM H2Cl6Ir·H2O demonstrated the highest power conversion efficiency (PCE) of 5.84%, beating that of the device with Pt CE having a PCE of 5.04%. This is because the device possesses the lowest charge transfer resistance (Rct), highest recombination resistance (Rcr), and longest carrier lifetime (τ), and the device possesses the highest reduction current (Jpc) and incident-photon conversion efficiency (IPCE). The PCE was significantly affected by Ir content in the binary alloy of Ir-Pd. According to the PCE result, Ir-Pd CE was found as a suitable substitution for Pt as CE for the device.

Mixed autoimmune haemolytic anaemia in a COVID-19 patient.

INTRODUCTION: Mixed warm and cold autoimmune haemolytic anaemia (AIHA) secondary to COVID-19 is rarely reported. CASE REPORT: We present a case of a 65-year-old Malay lady with no known medical illness, who was admitted for COVID-19 category 3 and mixed warm and cold AIHA. She presented with lethargy, productive cough and on and off fever. Blood investigations showed severe anaemia with spurious macrocytosis, increased lactate dehydrogenase (LDH) and total bilirubin with indirect bilirubin predominance. On full blood picture (FBP), there was normocytic normochromic anaemia with reticulocytosis, red blood cells clumping and NRBC's were seen. Both anti-IgG and anti-C3d were positive for monospecific Coombs test. For indirect Coombs test, auto-IgG and cold agglutinin were detected. DISCUSSION: These findings were consistent with mixed warm and cold AIHA. She was treated with intravenous methylprednisolone, before being changed to high dose oral prednisolone. A total of 3 units packed cells were transfused.

Self-efficacy, motivation and adolescent's adherence of a health protocol during pandemic COVID-19 in Indonesia.

OBJECTIVE: Compliance with the 5M health protocols of washing hands, wearing masks, keeping a distance of at least one meter, avoiding crowds, and reducing mobility is the best effort to prevent COVID-19. Adolescents are non-compliant in implementing health protocols during the pandemic. Therefore, this study aimed to investigate the level of compliance with the 5M health protocols. It also examines the relationship between self-efficacy, motivation, and compliance with health protocols. MATERIALS AND METHODS: Data analysis was conducted on a cross-sectional survey of 978 adolescents in Surabaya, Indonesia. Multiple logistic regression was performed to analyze the relationship between the three. Furthermore, adolescent self-efficacy was measured using the General Self Efficacy Scale (GSES), while motivation scale and sociodemographic questionnaire were measured to assess the motivation and characteristics of the respondents. RESULTS: Adolescent self-efficacy in compliance with health protocols is around (92.0%) with an average GSES score of 25.52 + 4.64. The analysis showed that adolescents with high self-efficacy and motivation had a high level of adherence (OR 2.804, 95% CI 2.008, 3.915) and high motivation (OR 2.926, 95% CI 2.087, 4.102), compared to those with low self-efficacy and motivation. CONCLUSIONS: The results suggested that initial identification of self-efficacy and motivation should be addressed to ensure compliance with health protocols to prevent the pandemic.

Cross-sectional survey on primary care medical doctors' practices on oral health care in pregnancy and its association with knowledge and attitude.

INTRODUCTION: Oral health care is an important indicator of the overall wellbeing of pregnant women. Optimizing the utilisation of dental care during pregnancy goes a long way in ensuring an improved and optimal pregnancy outcome. OBJECTIVE: This study aimed to assess the practices of primary care doctors on oral health care in pregnancy and its association with the level of knowledge and attitude. MATERIALS AND METHODS: This cross-sectional study was conducted among primary care doctors in nine public health clinics in Petaling District. A self-administered questionnaire consisting of socio-demographic characteristics, knowledge, attitude, and practices related to oral health care in pregnancy was used. RESULTS: A total of 138 primary care doctors participated in this study with a response rate of 98.0%. Most primary care doctors frequently advised patients not to delay dental visits until after pregnancy (84.8%), advised patients to see dentists (69.7%), and referred patients to dentists during pregnancy (63.6%). However, only 18.9% perform assessments routinely to detect oral health issues. The median (IQR) score for knowledge was 17(4) (range score: 0-23) and attitude was 23(3) (range score: 6-30). Knowledge median score (p:0.026) and practices of referring patients to dentists (p:0.017) were significantly associated. There was a positive correlation between overall practices of primary care doctors and their age, years of experience, and knowledge. CONCLUSION: Most primary care doctors frequently advise and refer pregnant patients to see dentist. Primary care doctors with higher knowledge score, who were older and had more experience, had better overall practices on oral health care in pregnancy.

Gastrointestinal parasitic infections of buffaloes (Bubalus bubalis) in Sarawak Borneo: Prevalence, risk factors, and farming practices.

The objectives of this study were to investigate the prevalence and associated risk factors for gastrointestinal (GI) parasites in buffaloes from various areas of Sarawak, and to assess current management practices of GI parasites among farmers. Faecal samples were collected from 15 farms and 129 animals, as well as data on farm and animal-based characteristics. A total of 129 faecal samples were examined for GI parasites using a modified McMaster and sedimentation. Association between potential risk factors and the prevalence of GI parasites was investigated using Chi-square statistic. The prevalence of Paramphistomum sp., strongyles, and coccidia were 75.2% (95% CI±7.5), 52.7% (95% CI±8.6) and 48.1% (95% CI±8.6), respectively. Farms which had a grazing area less than 50 acres in size had significantly higher prevalence of strongyles (70.5%, χ2 = 8.34, P = 0.004) and paramphistomes (88.6%, χ2 = 6.46, P = 0.01) relative to farms with a larger grazing area (43.5% and 68.2%, respectively). Prevalence of strongyles was lower in farms that did not implement a cut- and-carry system (45.6%, χ2 = 4.17, P = 0.04) in comparison to those that did (64%). The prevalence of paramphistomes was higher on farms with more than 40 animals (80.6%, χ2 = 3.18, P = 0.05) relative to farms with fewer animals. The majority of farmers surveyed (67.9%) showed awareness of GI parasite infection and reported that they recognized the associated symptoms. Most farmers practised deworming, and ivermectin was the most commonly used anthelminthic (60.4%); only 1.9% of farmers used albendazole. Overall this study revealed a high prevalence of GI parasites in buffalo in Sarawak. Although farmers report they are aware of parasitic diseases, further education is still required. This could include how they can successfully implement on-farm changes to reduce the prevalence of GI parasites in their herds.

Gastrointestinal parasitic infections of buffaloes (Bubalus bubalis) in Sarawak Borneo: Prevalence, risk factors, and farming practices

@#The objectives of this study were to investigate the prevalence and associated risk factors for gastrointestinal (GI) parasites in buffaloes from various areas of Sarawak, and to assess current management practices of GI parasites among farmers. Faecal samples were collected from 15 farms and 129 animals, as well as data on farm and animal-based characteristics. A total of 129 faecal samples were examined for GI parasites using a modified McMaster and sedimentation. Association between potential risk factors and the prevalence of GI parasites was investigated using Chi-square statistic. The prevalence of Paramphistomum sp., strongyles, and coccidia were 75.2% (95% CI±7.5), 52.7% (95% CI±8.6) and 48.1% (95% CI±8.6), respectively. Farms which had a grazing area less than 50 acres in size had significantly higher prevalence of strongyles (70.5%, χ² = 8.34, P = 0.004) and paramphistomes (88.6%, χ² = 6.46, P = 0.01) relative to farms with a larger grazing area (43.5% and 68.2%, respectively). Prevalence of strongyles was lower in farms that did not implement a cut- and-carry system (45.6%, χ² = 4.17, P = 0.04) in comparison to those that did (64%). The prevalence of paramphistomes was higher on farms with more than 40 animals (80.6%, χ² = 3.18, P = 0.05) relative to farms with fewer animals. The majority of farmers surveyed (67.9%) showed awareness of GI parasite infection and reported that they recognized the associated symptoms. Most farmers practised deworming, and ivermectin was the most commonly used anthelminthic (60.4%); only 1.9% of farmers used albendazole. Overall this study revealed a high prevalence of GI parasites in buffalo in Sarawak. Although farmers report they are aware of parasitic diseases, further education is still required. This could include how they can successfully implement on-farm changes to reduce the prevalence of GI parasites in their herds.

The Unmet Needs of Stroke Survivors and Stroke Caregivers: A Systematic Narrative Review.

INTRODUCTION: Facilitating stroke survivors and their caregivers to lead a fulfilling life after stroke requires service providers to think about their different needs. Poor post stroke care may lead to unmet needs in stroke survivors and stroke caregivers. This may compromise them in leading their lives optimally after stroke. OBJECTIVES & METHODOLOGY: This systematic narrative review examines articles published from 1990 to 2017, generated from Ovid, MEDLINE, CINAHL, and PubMed. The search was also supplemented by an examination of reference lists for related articles via Scopus. We included 105 articles. FINDINGS: We found that the type of unmet needs in stroke survivors and the contributing factors were substantially different from their caregivers. The unmet needs in stroke survivors ranged from health-related needs to re-integration into the community; while the unmet needs in stroke caregivers ranged from information needs to support in caring for the stroke survivors and caring for themselves. Additionally, the unmet needs in both groups were associated with different factors. CONCLUSION: More research is required to understand the unmet needs of stroke survivors and stroke caregivers to improve the overall post-stroke care services.

Safety and effectiveness of a biosimilar biphasic insulin in the management of diabetes mellitus during routine clinical practice in Asian patients.

INTRODUCTION: Biosimilar insulins have the potential to increase access to treatment among patients with diabetes mellitus (DM), reduce treatment costs, and expand market competition. There are no published studies evaluating the performance of biosimilar insulins in routine clinical practice in Asia. This study assessed the safety and effectiveness of biphasic isophane insulin injection in Malaysian DM patients. MATERIALS AND METHODS: In this open label, single-arm, observational, post marketing study, patients received biphasic isophane insulin injection as per the Prescribing Information; and were assessed for safety (adverse events including hypoglycaemia), effectiveness (glycosylated haemoglobin [HbA1c]; fasting blood sugar, [FBS]; and patient's condition by patient and physician) over a period of 24 weeks. RESULTS: Adult male and female diabetes patients (N=119; type 2 DM, n=117) with a mean (SD) diabetes duration of 13 years were included. No new safety signals have been identified. Significant reduction in HbA1c was observed at weeks 12 and 24 (mean [SD] - baseline: 9.6% [1.9]; Week 12: 9.0% [1.7] and at Week 24: 9.1% [1.7]; p < 0.001). There were 10 serious and 9 non-serious adverse events reported in the study. Expected mild events included hypoglycaemia and injection site pruritus. However, the majority of the adverse events were non-study drug related events. No deaths were reported during the study. DISCUSSION: Biphasic isophane insulin injection was well tolerated with no new safety concerns. It was found effective in post- marketing studies conducted in routine clinical settings when administered in DM patients in this study.

Genetic Modifiers of Fetal Haemoglobin (HbF) and Phenotypic Severity in ß-Thalassemia Patients.

BACKGROUND: The phenotypic severity of ß-thalassemia is highly modulated by three genetic modifiers: ß-globin (HBB) mutations, co-inheritance of α-thalassemia and polymorphisms in the genes associated with fetal haemoglobin (HbF) production. This study was aimed to evaluate the effect of HbF related polymorphisms mainly in the HBB cluster, BCL11A (B-cell CLL/lymphoma 11A) and HBS1L-MYB (HBS1-like translational GTPase-MYB protooncogene, transcription factor) with regards to clinical severity. METHODS: A total of 149 patients were included in the study. HBA and HBB mutations were characterised using multiplex PCR, Sanger sequencing and multiplex ligationdependent probe amplification. In addition, 35 HbF polymorphisms were genotyped using mass spectrometry and PCR-restriction fragment length polymorphism (PCRRFLP). The genotype-phenotype association was analysed using SPSS version 22. RESULTS: Twenty-one HBB mutations were identified in the study population. Patients with HBB mutations had heterogeneous phenotypic severity due to the presence of other secondary modifiers. Co-inheritance of α-thalassemia (n = 12) alleviated disease severity of ß-thalassemia. In addition, three polymorphisms (HBS1LMYB, rs4895441 [P = 0.008, odds ratio (OR) = 0.38 (0.18, 0.78)], rs9376092 [P = 0.030, OR = 0.36 (0.14, 0.90)]; and olfactory receptor [OR51B2] rs6578605 [P = 0.018, OR = 0.52 (0.31, 0.89)]) were associated with phenotypic severity. Secondary analysis of the association between single-nucleotide polymorphisms with HbF levels revealed three nominally significant SNPs: rs6934903, rs9376095 and rs9494149 in HBS1L-MYB. CONCLUSION: This study revealed 3 types of HbF polymorphisms that play an important role in ameliorating disease severity of ß-thalassemia patients which may be useful as a predictive marker in clinical management.

Subconjunctival Dirofilaria repens infection in a dog resident in the UK.

Dirofilaria repens infection was diagnosed in a 5-year-old female German shepherd crossbreed, originally from Romania but brought into the UK in February 2014. The dog presented with conjunctivitis in March 2014 and then again 2 months later with additional ocular and nasal mucopurulent discharge. Bacterial cultures from the nasolacrimal duct were negative for bacterial growth. The case was referred in August 2014 for ophthalmic examination, which revealed abnormalities in both eyes, especially the left. They included mild palpebral conjunctival hyperaemia and marked follicular conjunctivitis, as well as a dorsonasal bulbar conjunctival mass. Serum biochemistry was unremarkable and a conjunctival biopsy taken from the dorsonasal bulbar conjunctival mass revealed eosinophilic/lymphoplasmacytic conjunctivitis. At re-examination, nematodes were found in the area of the previous biopsy site and in the ventral palpebral conjunctival fornix. Polymerase chain reaction and sequencing confirmed these to be D. repens. Treatment with 10% imidacloprid and 2·5% moxidectin (Advocate Spot-On) was successful, and clinical signs resolved over a 6-week period. This case report indicates that D. repens infection should be considered as a possible aetiological cause of ocular lesions in dogs in the UK, especially those with a history of foreign travel. Implications for establishment and spread of D. repens in the UK are discussed.

Large normal-range TBP and ATXN7 CAG repeat lengths are associated with increased lifetime risk of depression.

Depression is one of the most prevalent and debilitating psychiatric disorders worldwide. Recently, we showed that both relatively short and relatively long cytosine-adenine-guanine (CAG) repeats in the huntingtin gene (HTT) are associated with an increased risk of lifetime depression. However, to what extent the variations in CAG repeat length in the other eight polyglutamine disease-associated genes (PDAGs) are associated with depression is still unknown. We determined the CAG repeat sizes of ATXN1, ATXN2, ATXN3, CACNA1A, ATXN7, TBP, ATN1 and AR in two well-characterized Dutch cohorts-the Netherlands Study of Depression and Anxiety and the Netherlands Study of Depression in Older Persons-including 2165 depressed and 1058 non-depressed individuals-aged 18-93 years. The association between PDAG CAG repeat size and the risk for depression was assessed via binary logistic regression. We found that the odds ratio (OR) for lifetime depression was significantly higher for individuals with >10, compared with subjects with ≤10, CAG repeats in both ATXN7 alleles (OR=1.90, confidence interval (CI) 1.26-2.85). For TBP we found a similar association: A CAG repeat length exceeding the median in both alleles was associated with an increased risk for lifetime depression (OR=1.33, CI 1.00-1.76). In conclusion, we observed that carriers of either ATXN7 or TBP alleles with relatively large CAG repeat sizes in both alleles had a substantially increased risk of lifetime depression. Our findings provide critical evidence for the notion that repeat polymorphisms can act as complex genetic modifiers of depression.

Understanding stroke survivors' and informal carers' experiences of and need for primary care and community health services--a systematic review of the qualitative literature: protocol.

INTRODUCTION: Despite the rising prevalence of stroke, no comprehensive model of postacute stroke care exists. Research on stroke has focused on acute care and early supported discharge, with less attention dedicated to longer term support in the community. Likewise, relatively little research has focused on long-term support for informal carers. This review aims to synthesise and appraise extant qualitative evidence on: (1) long-term healthcare needs of stroke survivors and informal carers, and (2) their experiences of primary care and community health services. The review will inform the development of a primary care model for stroke survivors and informal carers. METHODS AND ANALYSIS: We will systematically search 4 databases: MEDLINE, EMBASE, PsycINFO and CINAHL for published qualitative evidence on the needs and experiences of stroke survivors and informal carers of postacute care delivered by primary care and community health services. Additional searches of reference lists and citation indices will be conducted. The quality of articles will be assessed by 2 independent reviewers using a Critical Appraisal Skills Programme (CASP) checklist. Disagreements will be resolved through discussion or third party adjudication. Meta-ethnography will be used to synthesise the literature based on first-order, second-order and third-order constructs. We will construct a theoretical model of stroke survivors' and informal carers' experiences of primary care and community health services. ETHICS AND DISSEMINATION: The results of the systematic review will be disseminated via publication in a peer-reviewed journal and presented at a relevant conference. The study does not require ethical approval as no patient identifiable data will be used.

Functional limitation and health-related quality of life, and associated factors among long term stroke survivors in a Malaysian community.

PURPOSE: this study aimed to evaluate function and quality of life (QoL) and associated factors among long term stroke survivors in the Malaysian community. METHODS: A cross-sectional study was conducted involving stroke survivors living in the community at two or more years post-stroke. Eligible participants with the diagnosis of stroke were identified from 2005-2010 case mix database of a tertiary hospital. the patients' medical records were analysed and data on demographic and clinical profiles were collected. telephone interviews were conducted to assess existing stroke-related impairments, comorbidities, stroke recurrences, current level of function and QoL, with the usage of rivermead mobility index (rMI), barthel index (bI) and stroke specific quality of life scale (ssQOL). RESULTS: A total of 203 stroke survivors; mean age 64.5 (standard Deviation(sD) 12.2) years, 45.3% males, stroke duration 44.7 (sD 13.8) months completed the interviews. Mean rMI was 11.7 (sD 3.4) and bI was 89.8 (sD 19.8). Forty three percent and 99% had difficulty in ascending/descending stairs and fast walking, respectively. Up to 20% had limitations in most of the bI subsets. Mean ssQOL was 207.6 (sD 37.2), with domains mostly affected were 'energy' and 'social role'. Function and QOL were both influenced by age (p<0.01) and stroke related impairments (p<0.05), but not by co-morbidities or stroke recurrence. QoL and function (both mobility and ADL) were strongly positively correlated with each other (p<0.01). CONCLUSIONS: It was observed that functional limitations especially mobility, remains post-stroke major problem and were attributed mainly to stroke-related impairments.

Molecular DNA identification of medicinal plants used by traditional healers in Malaysia.

Plants have been used throughout human history for food and medicine. However, many plants are toxic, and cannot easily be morphologically distinguished from non-toxic plants. DNA identification solves this problem and is widely used. Nonetheless, plant DNA barcode identification faces a number of challenges, and many studies have been conducted to find suitable barcodes. The present study was conducted to test the efficiency of commonly used primers, namely ITS2, rpoC1, and trnH-psbA, in order to find the best DNA barcode markers for the identification of medicinal plants in Malaysia. Fresh leaves from 12 medicinal plants that are commonly used by Malay traditional healers were collected from the Tropical Spice Garden, Pulau Pinang, and subjected to polymerase chain reaction amplification using ITS2, rpoC1, and trnH-psbA DNA markers. We found that trnH-psbA is the best DNA marker for the species-level identification of medicinal plants in Malaysia.

The correlation of Helicobacter Pylori with the development of cholelithiasis and cholecystitis: the results of a prospective clinical study in Saudi Arabia.

OBJECTIVE: Gallstone disease is a common surgical ailment. Helicobacter pylori has a role in upper gastrointestinal disorders, including gallstones. This study aimed to determine the association of H. pylori with gallstones, so developing a preventative strategy for gallstone formations. PATIENTS AND METHODS: A prospective study was conducted on 95 patients referred to the surgical clinic of Al-Meeqat General Hospital, Al-Madinah Al-Munawarah, with gallstone disease. Detection of H. pylori antibodies (IgG) in serum was done in all the patients who underwent cholecystectomy. H. pylori stool antigen (HPSA) using stool samples was done for IgG sero-positive patients prior to the cholecystectomy. The bile collected from the gall bladder during operation was examined for the presence of H. pylori by Gram stain, culture and HPSA assay. Gallbladder mucosa was examined for urease A gene by polymerase chain reaction (PCR) in patients proven to be positive for stool or bile serology. RESULTS: Of the 95 patients, 75 (79%) were positive for H. pylori antibodies. Twenty-six (34.7%) patients were positive with H. pylori antigens in bile and 21 (28%) with H. pylori antigens in the stool samples. Among these 47 patients, PCR was positive in 29 (62%) subjects. H. pylori couldn't be detected among the studied patients by using either Gram stain or culture. CONCLUSIONS: The presence of H. pylori in bile may indicate a significant risk for cholelithiasis. PCR is a rapid reliable method for the detection of H. pylori DNA in bile. This rapid molecular approach together with culture and immunological methods could help clinicians to effectively manage patients at high risk of developing gallstones at an earlier stage.

Cystathionine Levels in Patients With Huntington Disease.

BACKGROUND: Recently a profound depletion of cystathionine γ-lyase (CSE), the principal enzyme involved in the generation of cysteine from cystathionine, was shown in Huntington disease (HD) patients and several transgenic HD mouse models. We therefore hypothesized that blood and urine cystathionine levels may be increased in HD patients and that this increase might correlate with disease progression. METHODS: We measured concentrations of cystathionine as well as 22 other amino acids in fasting plasma and 24-h urine samples of nine early-stage HD patients and nine age, sex, and body mass index matched controls. RESULTS: There were no significant differences in the plasma or urine concentrations of cystathionine or any other amino acid between HD patients and controls. CONCLUSION: We found no evidence for changes in plasma or urine concentrations of cystathionine in early-stage HD patients. Therefore, cystathionine levels are unlikely to be useful as a state biomarker in HD.

Severe hypertriglyceridemia in a nondiabetic treated with low dose insulin infusion.

We report a case of a 54-year-old man with severe HTG which did not respond to conventional anti lipid therapies. He was treated with intravenous insulin and concurrent dextrose infusions which led to a dramatic reduction in serum triglyceride levels.