Self-sampling in Human Papillomavirus screening during and post-COVID-19 pandemic.

INTRODUCTION: Cervical cancer is the third most common cancer among Malaysian women. Sarawak, the largest state in Malaysia has consistently recorded the highest cervical cancer rate in the country where nearly half of its population still live in the rural areas and is at increased risk of the disease due to inequitable access to healthcare. The countrywide lockdown due to the COVID-19 pandemic had halted the accessibility to cervical cancer screening programme. The aim of the study is to determine the feasibility of providing primary HPV DNA test using the selfsampling method to the hard-to-reach population in the interior of Sarawak during the COVID-19 pandemic. MATERIALS AND METHODS: This is a cross-sectional study where women aged between 20-80 years were recruited via convenient sampling from villages in Long Banga, Sarawak over a five-day outreach programme. Cervicovaginal selfsamples were obtained and screened for the presence of high-risk human papillomavirus DNA (HR-HPV) using the careHPVTM Test. A self-administered questionnaire was also administered to determine the sociodemographic and perception towards the self-sampling method. RESULTS: The 55 women recruited consist of ethnic backgrounds of Penan (58.18%), Kenyah (25.45%), Iban (5.45%), Saban (3.64%), Kelabit (3.64%), Malay (1.82%) and Chinese (1.82%). The prevalence of HR-HPV was 1.85% (n=1/55). Nearly 80% of the women were unemployed, and more than half have had attended primary education. Nine (16.4%) have heard about HPV, and seven (13%) knew HPV infection could cause cervical cancer. Three of them had HPV vaccination, and only one (1.85%) knew the brand of the HPV vaccine. Although 40% preferred self-sampling over clinician-collection, only ten (18.2%) women have completed the self-collection perception questionnaire. CONCLUSION: Primary HPV DNA screening using the selfsampling method can be carried out in the remote areas during the COVID-19 pandemic without compromising mobility restriction.

How well does Malaysia achieve value for money in public sector purchasing of medicines? Evidence from medicines procurement prices from 2010 to 2014.

BACKGROUND: Malaysia's public healthcare sector provides a greater volume of medicines at lower overall cost compared to the private sector, indicating its importance in providing access to medicines for Malaysians. However, the Ministry of Health (MOH) has concerns about the continuous increase in the public sector medicines budget, and achieving efficiencies in medicines procurement is an important goal. The objectives of this study were to assess the overall trend in public sector pharmaceutical procurement efficiency from 2010 to 2014, and determine if the three different ways in which MOH procures medicines influence efficiency. METHODS: We matched medicines from the public sector procurement report by medicine formulation to medicines with a Management Sciences for Health (MSH) International Reference Price (IRP) for each year. Price ratios were calculated, and utilizing the information on quantity and expenditure for each product, summary measures of procurement efficiency were reported as quantity- and expenditure-weighted average price ratios (WAPRs) for each year. Utilizing MOH procurement data to obtain information on procurement type, a multiple regression analysis, controlling for factors that can influence prices, assessed whether procured efficiency (relative to IRPs) differed by MOH procurement type. RESULTS: Malaysia's public sector purchased medicines at two to three times the IRP throughout the study period. However, procurement prices were relatively stable in terms of WAPRs each year (2.2 and 3.2 in 2010 to 1.9 and 2.9 in 2014 for quantity and expenditure WAPRs, respectively). Procurement efficiency did not vary between the three different methods of MOH procurement. Procurement efficiency of both imported originators and imported generics were significantly lower (P < 0.001 and P < 0.01) than local generic products, and medicine source and category influenced the procurement efficiency of each MOH procurement mechanism. CONCLUSION: The design of different medicines procurement mechanisms, along with the balance between ensuring competitive procurement prices and adhering to national industry and procurement policies, have not been able to achieve lower public sector medicines procurement prices (relative to IRP). Introducing pooled procurement options along with continuous monitoring of procurement efficiency and exploring ways to improve price competition among local and foreign suppliers is recommended.

Demographic study of brain tumour in a neurosurgical department in Terengganu, Malaysia.

INTRODUCTION: Brain tumour (BT) is a tremendous burden on patients, families as well as the surrounding communities, especially the healthcare services. It can be classified into either a benign slow growing tumour (non-cancerous) and malignant tumour (cancerous). The purpose of this study was to determine the incidence and pattern of brain tumour admitted to the Neurosurgery Department in Hospital Sultanah Nurzahirah (HSNZ), Terengganu, Malaysia. METHODS: This is a retrospective study of incidence and pattern of BT admitted to the Neurosurgery Department in HSNZ. Data was collected from the yearly census of BT registered from 2013 to 2018. RESULTS: A total number of 386 new cases of primary BT were registered. The number of cases of BT was found to be lowest among children (0 to 10 years old) with only 4.4% but at peak among elderly aged between 51 to 60 years old (26.2%). As for gender, males constituted about 44.5% (n=172) whereas females accounted for 55.5% (n= 214) of the cases. In total, meningioma was found to have the highest incidence (27.2%) followed by metastases brain tumour (18.1%) and glioma (17.4%). CONCLUSIONS: This study has shown that the incidence of BT was led by meningioma which had a high prevalence among the elderly population, followed by metastasis BT and gliomas.

Membrane distillation of saline and oily water using nearly superhydrophobic PVDF membrane incorporated with SiO2 nanoparticles.

Fat, oil and grease in wastewater generated from household kitchens, restaurants and food processing plants affect sewer systems, water resources and environment adversely. Hence, membrane distillation of saline and oily water was studied using a nearly superhydrophobic membrane developed in this work. Polyvinylidene fluoride (PVDF) membrane incorporated SiO2 nanoparticles was synthesized via phase inversion with dual baths and modified using hexadecyltrimethoxy silane. The volume ratio of silane to ethanol was varied between 1:200 to 1:25. The membrane characteristics were examined using a goniometer, a porometer, scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR). The PVDF-SiO2 membrane modified using the volume ratio of 1:50 achieved the highest water contact angle of 141.6° and LEP of 2.642 bar. This membrane was further tested in membrane distillation to observe the permeate flux of distilled water, saline solution (1 M NaCl) as well as saline and oily solution (1 M NaCl; 1,000 ppm of palm oil). The modified PVDF/SiO2 showed high permeate flux which is nearly four times of the permeate flux of neat PVDF membrane, but still susceptible of salt and oil fouling as shown in SEM images.

High Sensitivity pH Sensor Based on Porous Silicon (PSi) Extended Gate Field-Effect Transistor.

In this study, porous silicon (PSi) was prepared and tested as an extended gate field-effect transistor (EGFET) for pH sensing. The prepared PSi has pore sizes in the range of 500 to 750 nm with a depth of approximately 42 µm. The results of testing PSi for hydrogen ion sensing in different pH buffer solutions reveal that the PSi has a sensitivity value of 66 mV/pH that is considered a super Nernstian value. The sensor considers stability to be in the pH range of 2 to 12. The hysteresis values of the prepared PSi sensor were approximately 8.2 and 10.5 mV in the low and high pH loop, respectively. The result of this study reveals a promising application of PSi in the field for detecting hydrogen ions in different solutions.

Physical properties of cobia (Rachycentron canadum) surimi: effect of washing cycle at different salt concentrations.

This study aimed to determine the effects of 2-5 wash cycles and the addition of tetrasodium pyrophosphate (TSPP) (0 %, 0.05 Surimi% and 0.1 % w/w)-with or without the addition of 0.4 % calcium chloride (CaCl2)-on the physical properties such as texture, colour, expressible moisture and microstructure of Cobia (Rachycentron canadum) surimi gel. The highest breaking force (484.85 g) was obtained with the addition 0.1 % TSPP alone on the fifth wash. However, a combination of 0.1 and 0.4 % CaCl2 in surimi gels at wash cycle 5 resulted in the highest degree of whiteness (86.8 %), as well as total expressible moisture (2.785 %) and deformation (17.11 mm). The highest surimi gel strength (6,923 g.mm) was obtained after three wash cycles with the addition of 0.1 % TSPP +0.4 % CaCl2. The physical properties of Cobia fish surimi gels were affected by the number of wash cycles and treatments with TSPP and CaCl2.

Implementation Status and Challenges Associated With Implementation of the Targeted Medication Safety Best Practices in a Tertiary Hospital.

Background The Institute for Safe Medication Practices (ISMP) is a well-known non-profit organization dedicated to preventing medication errors. Every two years they publish best practices that can reduce the occurrence of medication errors. This study aims to evaluate the implementation status of these best practices and to understand barriers associated with non-implementation at a tertiary hospital in Saudi Arabia. Methodology This was a two-phase qualitative study. First, a survey consisting of the ISMP best practices was sent to employees (mainly heads of departments) to fill out the implementation rate for each best practice. Then an interview or a focus group was conducted to further validate their answers and understand why some best practices were not implemented. Results Our study found that the highest implemented best practices were having strategies to improve safety with high-alert medications (best practice #19, 85.7%), having antidotes and reversal agents readily available (best practice #9, 75%), independent verification of sterile preparation (best practice #11, 75%), and limiting the number of removable medications from the automated dispensing unit by override (best practice #16, 75%). The least implemented best practices were ensuring that oral liquid medications are dispensed in a syringe (best practice #4, 12.5%), maximizing use of barcode verification (best practice #18, 12.5%), purchasing oral liquid dosing devices that display metric scale (best practice #5, 25%), eliminating glacial acetic acid from all areas of the hospital (best practice #6, 28.6%), and eliminating all 1,000 mL of sterile water from all areas outside of the pharmacy (best practice #10, 28.6%). Challenges associated with implementation were related to knowledge, motivation, and opportunity in the environment, with the latter being the highest barrier associated with non-implementation. Conclusions Healthcare providers need to have knowledge about the best practices and the rationale behind them, the motivation to perform them, and the necessary resources to implement the best practices in their hospital.

Describing Self-Reported Penicillin Allergy Using a Penicillin Allergy Risk Tool (PEN-FAST) in an Outpatient Setting at a Tertiary Hospital in Saudi Arabia.

Introduction Penicillin is a widely used antibiotic and is frequently reported as a cause of allergic reactions. However, many individuals reporting penicillin allergies are later found to be tolerant. This study, conducted in an outpatient setting at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia, aimed to assess the prevalence of self-reported penicillin allergy and to evaluate further the risk of a positive penicillin allergy test using the PEN-FAST tool. Methods A cross-sectional study was conducted via in-person questionnaires with patients in the waiting area at the outpatient clinics of KAUH in Jeddah, Saudi Arabia. Results Among 140 participants, 4% reported a penicillin allergy, with most identifying their allergies based on symptoms. None of these allergies resulted in severe reactions. Notably, 50% reported nausea and itching as symptoms. The PEN-FAST tool categorized 33.3% as moderate risk and 50% as low to very low risk for a positive penicillin skin test. One participant was confirmed to be allergic via a skin prick test. Discussion and conclusion The prevalence of reported penicillin allergy was lower in our study than that previously reported. Evaluation of the PEN-FAST score demonstrated that this prevalence is even lower at 2%. While this single-center study offers valuable insights, further research in diverse healthcare settings is required to validate these findings and refine our understanding of penicillin allergies.

Optimisation of topical antibacterial preparation from Malaysian kelulut honey by using xanthan gum as polymeric agent.

The study aims to formulate and optimise topical antibacterial preparation by using Malaysian kelulut honey as the active ingredient and xanthan gum as the polymeric agent. Response surface methodology was used to optimise the preparation. The acidity, honey concentration and xanthan gum concentration were the independent variables. The zone of inhibitions on S. aureus ATCC6538 and E. coli ATCC8739 were the response variables. The optimal preparation was evaluated on its physicochemical properties, viscosity, antibacterial efficacy and stability. The antibacterial efficacy of the optimal preparation was compared to the commercially antibacterial gel (MediHoney™, Comvita). The optimal preparation was formulated at pH of 3.5, honey concentration of 90% (w/v) and xanthan gum concentration of 1.5% (w/v) with the inhibition zones measured on S. aureus ATCC6538 was 16.2 mm and E. coli ATCC8739 was 15.8 mm respectively. The factors of acidity and honey concentration have significantly influenced the inhibition zone on S. aureus ATCC6538 and E. coli ATCC8739. The utilisation of xanthan gum as the polymeric agent was fit for the preparation which showed by adequate physicochemical properties and retained of the antibacterial effects. This was supported by constant viscosity and efficacy of the preparation within the six months of stability study indicating stable and reliable preparation. Xanthan gum is a potential polymeric agent due to its effective use in preparing stable preparation with effective antibacterial properties.

Ridge regression and its applications in genetic studies.

With the advancement of technology, analysis of large-scale data of gene expression is feasible and has become very popular in the era of machine learning. This paper develops an improved ridge approach for the genome regression modeling. When multicollinearity exists in the data set with outliers, we consider a robust ridge estimator, namely the rank ridge regression estimator, for parameter estimation and prediction. On the other hand, the efficiency of the rank ridge regression estimator is highly dependent on the ridge parameter. In general, it is difficult to provide a satisfactory answer about the selection for the ridge parameter. Because of the good properties of generalized cross validation (GCV) and its simplicity, we use it to choose the optimum value of the ridge parameter. The GCV function creates a balance between the precision of the estimators and the bias caused by the ridge estimation. It behaves like an improved estimator of risk and can be used when the number of explanatory variables is larger than the sample size in high-dimensional problems. Finally, some numerical illustrations are given to support our findings.

Cerebral white matter microstructural changes in isolated maxillofacial trauma and associated neuropsychological outcomes.

Isolated traumatic maxillofacial injury without concomitant brain injury may cause delayed post-concussive symptoms. Early identification allows optimal diagnosis, prognostication, and therapeutic intervention. The aim of this prospective observational study was to investigate longitudinal microstructural changes of the white matter (WM) tracts based on diffusion tensor imaging (DTI) indices in patients with isolated maxillofacial injuries, immediately and 6 months post-trauma, and to correlate these DTI indices with neuropsychological changes observed. Twenty-one patients with isolated maxillofacial injuries and 21 age-matched controls were recruited. DTI was performed and indices were calculated for 50 WM tracts. The neuropsychological evaluation was done using the screening module of the Neuropsychological Assessment Battery. Patients were subjected to repeat DTI and neuropsychological evaluation at 6 months post-trauma. Reduced fractional anisotropy (FA) and increased median (MD) and radial diffusivity (RD) in the acute phase were seen in major association, projection, and commissural fibre bundles, indicative of vasogenic oedema. These changes correlated with attention and executive function deficits in the acute phase, as well as improvement in memory and visuospatial function in the chronic phase. Isolated maxillofacial trauma patients develop WM microstructural damage, which may impair cognitive performance acutely and over time. DTI indices can serve as predictive imaging biomarkers for long-term cognitive deficits in isolated maxillofacial injuries.

Haemostasis in oral surgical procedures involving patients with a ventricular assist device.

The purpose of this study was to determine whether tooth extraction for patients with ventricular assist devices (VADs) could be performed without interruption of anticoagulant and/or antiplatelet therapy and whether treatment with von Willebrand factor concentrates and desmopressin is required. The study consisted of three groups of patients undergoing oral surgery. The two experimental groups comprised patients with VADs, while the third group included cardiovascular patients without VADs who served as controls. All patients were treated intraoperatively with topical haemostatic agents (oxidized cellulose or collagen). The first group was additionally treated with fibrin glue. All 75 oral surgical procedures were performed under local anaesthesia without sedation. Three of 40 patients in the experimental groups and two of 20 patients in the control group suffered a haemorrhage, with no significant difference in the incidence of haemorrhage between the groups. The findings suggest that dental extraction can be performed without modification of oral anticoagulation or antiplatelet treatments, providing that INR is less than 3.5 on the day of the operation. It can further be hypothesized that an acquired coagulopathy in VAD patients does not influence the bleeding risk in dental extractions, and so the administration of desmopressin and/or von Willebrand factor concentrates is not required.

Heightened transmission of stable malaria in an isolated population in the highlands of Irian Jaya, Indonesia.

Malaria at an elevation of 1,500 meters is uncommon and is usually unstable when it occurs. To confirm reports of a recent increase in transmission of stable malaria in the Oksibil Valley, which is at an elevation of 1,250-1,500 meters in the Jayawijaya Mountains of Irian Jaya, Indonesia, five malariometric surveys were conducted in four villages between May 1990 and July 1991. A total of 3,380 blood smears, representative of 1,949 persons, was examined. Prevalence rates over the survey period were consistent in each of the four villages, averaging 10% for infants, 50% for children 1-4 years of age, 35% for those 5-9 years old, 28% for those 10-14 years old, and 16% for adults (greater than 15 years old). The spleen rate for the those less than five years old was 96%, with an average enlarged spleen score of 2.32. Plasmodium falciparum accounted for 55% of the infections in the valley, but P. vivax was the predominant species in those less than 10 years old. In the village of Kutdol at an elevation of 1,500 meters, P. malariae was identified in 43% of the positive smears. Four cases were diagnosed as P. ovale. Infection with P. falciparum without obvious clinical symptoms was common in both adults and children. Entomologic and epidemiologic data suggested that the recent upsurge in transmission coincided with the replacement of traditional village huts with the more modern social housing. This replacement required the extensive construction of drainage ditches, which inadvertently also served as additional vector breeding sites. We suspect that this manipulation of the environment, in an effort to improve the quality of life, created conditions conductive for heightened transmission of stable malaria.

PIP: Malaria at an elevation of 1500 meters is uncommon and is usually unstable when it occurs. To confirm reports of a recent increase in the transmission of stable malaria in the Oksibil Valley, at an elevation of 1250-1500 meters in the Jayawijaya Mountains of Irian Jaya, Indonesia, 5 malariometric surveys were conducted in 4 villages between May 1990 and July 1991. A total of 3380 blood smears from 1949 people was examined. Prevalence rates over the survey period were consistent in each of the 4 villages,with averages of 10% for infants, 50% for children 1-4 years old, 35% for those 5-9 years old, 28% for those 10-14 years old, and 16% for adults (over 15 years of age). The spleen rate for those less than 5 years old was 96%, with an average enlarged spleen score of 2.32. Plasmodium falciparum accounted for 55% of the infections in the valley, but P. vivax was the predominant species in those less than 10 years old. In the village of Kutdol, at an elevation of 1500 meters, P. Malariae was identified in 43% of the positive smears. 4 cases were diagnosed as P. ovale. Infection with P. falciparum without obvious clinical symptoms was common in both adults and children. Entomologic and epidemiologic data suggested that the recent upsurge in transmission coincided with the replacement of traditional village huts with more modern social housing. This replacement required the extensive construction of drainage ditches, which inadvertently also served as additional vector breeding sites. The authors suspect that this manipulation of the environment, while attempting to improve the quality of life, created conditions which were conducive for the increased transmission of stable malaria.

Insecticide susceptibility status of Anopheles koliensis (Diptera: Culicidae) in northeastern Irian Jaya, Indonesia.

Anopheles koliensis, an important malaria vector in the interior region of Irian Jaya, Indonesia, was evaluated for susceptibility to three different insecticide compounds using the standard World Health Organization diagnostic test kit and pretreated impregnated papers. A series of tests were conducted in Arso PIR I, a transmigrant settlement 60 km south of Jayapura, from January 1988 to May 1989. All compounds were tested at the recommended diagnostic dosage and exposure time. An. koliensis were susceptible to 1.0% fenitrothion at two hour exposure (N = 358) and 5.0% malathion at one hour exposure (N = 371) after the 24-hour holding period. Significant resistance to DDT was observed in both the An. koliensis and Culex quinquefasciatus populations. Approximately 30% of the An. koliensis population (N = 468) was resistant to 4% DDT at both one and two hour exposures. These findings indicate that routine use of DDT in Arso PIR I for indoor residual house spraying may be of limited effectiveness, in part, because of physiological resistance. However, use of an alternative insecticide will be more expensive and might prove equally ineffective because of the exophilic behavior of the species. This is the first confirmed report from repeated observations of DDT resistance in An. koliensis from Indonesia.

Optimisation of topical antibacterial preparation from Malaysian kelulut honey by using xanthan gum as polymeric agent

@#The study aims to formulate and optimise topical antibacterial preparation by using Malaysian kelulut honey as the active ingredient and xanthan gum as the polymeric agent. Response surface methodology was used to optimise the preparation. The acidity, honey concentration and xanthan gum concentration were the independent variables. The zone of inhibitions on S. aureus ATCC6538 and E. coli ATCC8739 were the response variables. The optimal preparation was evaluated on its physicochemical properties, viscosity, antibacterial efficacy and stability. The antibacterial efficacy of the optimal preparation was compared to the commercially antibacterial gel (MediHoney™, Comvita). The optimal preparation was formulated at pH of 3.5, honey concentration of 90% (w/v) and xanthan gum concentration of 1.5% (w/v) with the inhibition zones measured on S. aureus ATCC6538 was 16.2 mm and E. coli ATCC8739 was 15.8 mm respectively. The factors of acidity and honey concentration have significantly influenced the inhibition zone on S. aureus ATCC6538 and E. coli ATCC8739. The utilisation of xanthan gum as the polymeric agent was fit for the preparation which showed by adequate physicochemical properties and retained of the antibacterial effects. This was supported by constant viscosity and efficacy of the preparation within the six months of stability study indicating stable and reliable preparation. Xanthan gum is a potential polymeric agent due to its effective use in preparing stable preparation with effective antibacterial properties.

Insecticide susceptibility status of Anopheles koliensis (Diptera: Culicidae) in northeastern Irian Jaya, Indonesia.

Anopheles koliensis, an important malaria vector in the interior region of Irian Jaya, Indonesia, was evaluated for susceptibility to three different insecticide compounds using the standard World Health Organization diagnostic test kit and pretreated impregnated papers. A series of tests were conducted in Arso PIR I, a transmigrant settlement 60 km south of Jayapura, from January 1988 to May 1989. All compounds were tested at the recommended diagnostic dosage and exposure time. An. koliensis were susceptible to 1.0% fenitrothion at two hour exposure (N = 358) and 5.0% malathion at one hour exposure (N = 371) after the 24-hour holding period. Significant resistance to DDT was observed in both the An. koliensis and Culex quinquefasciatus populations. Approximately 30% of the An. koliensis population (N = 468) was resistant to 4% DDT at both one and two hour exposures. These findings indicate that routine use of DDT in Arso PIR I for indoor residual house spraying may be of limited effectiveness, in part, because of physiological resistance. However, use of an alternative insecticide will be more expensive and might prove equally ineffective because of the exophilic behavior of the species. This is the first confirmed report from repeated observations of DDT resistance in An. koliensis from Indonesia.