Digital mammography has been progressively introduced in screening centers and the concern is to achieve an image of diagnostic value which would be able to detect early changes in the breast tissue. The aim of this study was to evaluate the image quality of mammograms using quantitative and qualitative methods of two FFDM systems with variations in breast thickness and anode/filter combination. This study was done from January to April 2008 with two FFDM systems; Siemens Mammomat NovationDR at Diagnostic Imaging Department, Hospital Kuala Lumpur and Hologic Lorad Selenia at Breast Clinic, National Cancer Society. A CIRS012A tissue equivalent breast phantom (4, 5 and 6 cm) thickness was used to obtain images in the craniocaudal plane with 26-32 kVp and a combination of molybdenum/molybdenum (Mo/Mo) and molybdenum/rhodium (Mo/Rh) anode/filter. For the qualitative evaluation, two independent radiologist with a minimum of five years experience was used to score the images. Wilcoxon Sign Rank Test showed that there are no significant differences (p > 0.05) in image quality between both the FFDM systems. Kappa analysis had a poor agreement between the scores given by the two radiologists. The quantitative analysis using Mann-Whitney test showed that there are significant differences (p < 0.05) between the SNR values of both FFDM systems. Although the qualitative evaluation was similar, the study showed that Lorad Selenia had a significantly superior SNR value, hence would be a better tool to detect early changes in the breast tissue. This study also demonstrated that a lower kVp is more suitable with molybdenum filter and as the breast thickness is increased rhodium filter with higher kVp displayed better quality images.

Introduction: Leptospirosis is endemic to tropical regions of the world and is re-emerging as a new danger to public health in Malaysia. the purpose of this particular study was to determine the common leptospiral serovars present in human communities living around wildlife reserves/disturbed forest habitats. the objective of this study was to estimate the seroprevalence of leptospirosis and finding infecting serovars in villages surrounded habitats where wildlife lives in Sarawak, Malaysia. Methods: A cross-sectional serological survey of 198 humans was conducted in four villages around Kuching, Sarawak between January 2011 and March 2012. results: A seroprevalence of 35.9% (95%cI 29.2-43.0) to the MAt was detected in the tested humans. Antibodies to serovar Lepto 175 Sarawak were most commonly detected (31.3%; 95%cI 24.9-38.3) and were detected in individuals at all four locations. the presence of skin wounds (Or 3.1), farm animals (Or 2.5) and rats (Or 11.2) were all significantly associated with seropositivity in a multivariable logistic regression model. conclusions: the results of the current study are important as wildlife may act as reservoirs of leptospires for humans. Health authorities should expand disease control measures to minimise the spill-over from wildlife to humans visiting, living or working in the sampled locations. the pathogenic status of serovar Lepto 175 Sarawak also requires further investigation.
Leptospirosis

Aims: Arbuscular mycorrhizal is an obligate mutualistic symbiosis fungus which survives by forming endomycorrhizal on plant roots. The arbuscular mycorrhizal fungi are not host-specific, allowing them to form a mutualistic symbiosis with a wide range of host plants including oil palm. In Malaysia, the arbuscular mycorrhizal fungi are used as a growth enhancer for the oil palm: Elaeis guineensis. The arbuscular mycorrhizal fungi are introduced only during transplantation to the field when the ages of the seedlings are approximately one year old. As such, this study is designed to investigate the ability of the arbuscular mycorrhizal fungi to form colonisation with pre-nursery oil palm seedlings. Methodology and results: Here, the arbuscular mycorrhizal fungi were introduced at the pre-nursery stage oil palm seedlings. After inoculation, the seedlings were harvested on different days, i.e. on day-3, day-7, day-14, day-21, day-40 and day-60 to determine the colonisation of arbuscular mycorrhizal fungi. We found that the arbuscular mycorrhizal fungi are able to form a mycorrhizal association with the oil palm seedling at the pre-nursery stage after 40 days of inoculation, and the arbuscular mycorrhizal fungi that formed the association are Glomus sp. and Scutellospora sp. Conclusion, significance and impact of study This study suggested that the oil palm seedling can be made into a mycorrhizal plant as early as the nursery stage before transplanting them into the plantation.

Enhancement of physical function had been shown in older adults who actively participate in physical activities,particularly in the form of aerobic training with addition of progressive resistance training (PRT). However, it is quitechallenging and risky for most older adults to exercise in standing position without any support. Chair Based Exercise(CBE) is an alternative mode of exercise for older adult to facilitate exercise participation and increase safety. Its effectwhen combined with resistance training is unknown to date. Therefore, the aim of this study was to evaluate the outcomeof CBE with PRT on physical performances among older adults. A total of 18 older adults (13 females (72%)) and 5 males(28%)), aged 60 to 83 years with mean age (SD) 72.67 (6.17) years completed the study. All subjects performed CBE withPRT intervention twice weekly for 8 weeks, with individually-tailored exercise progressions. Pre and post measurementsof physical performance were performed using Six MinutesWalk Test (6MWT), Five Times Sit to Stand (FTSTS) and HandGrip Strength (HGS) test. Significant improvement in 6MWT (p < .001), HGS Right hand (p = .043), HGS Left hand (p <.001), FTSTS (p < .001) was shown after the eight-week intervention. Adding PRT into seated exercises results in furtherimprovement in physical performance of older adults. CBE-PRT may be recommended as an exercise routine for olderadults living in the community.

Introduction: A custom-made Perspex male pelvic phantom was developed to measure and to compare absorbed, surface and effective doses obtained from Single-Energy and Dual-Energy Computed Tomography (SECT & DECT). Methods: A customised Perspex pelvic phantom that mimicked male Asian reference size was scanned with SECT mode at 80 kV, 100 kV, 120 kV and 140 kV. In addition, the fabricated phantom was also scanned with DECT mode at 80/140 kV. Thermoluminescence dosimeters (TLD) were used to measure the charges and doses obtained from the TLD calibration curve. The absorbed dose, surface dose and effective dose obtained from SECT and DECT were measured and compared between these two modes. Results: The DECT showed 55.9 % dose reduction compared to SECT at 140 kV tube voltage. It shows that DECT can be used with radiation dose sparing, and it is in good agreement with routine CTDI phantom study. The effective dose of DECT of the abdominal imaging was within the acceptable effective dose limit of AAPM Report No. 96. This study also found that the surface dose was lower than values reported in previous studies for both modes. Conclusion: The fabricated Perspex phantom shows a great potential to be considered as an alternative phantom for the commercially existing phantom in CT dosimetry application.

Background: This study is aimed to analyse the availability, prices and affordability of medicines for ischaemic heart disease (IHD) in Bangi, Selangor, Malaysia. Methods: A quantitative research was carried out using the methodology developed by the World Health Organization and Health Action International (WHO/HAI). The prices were compared with international reference prices (IRPs) to obtain a median price ratio. The daily wage of the lowest paid unskilled government worker was used as the standard of the affordability for the medicines. In this study, ten medicines of the IHD were included. The data were collected from 10 private medicine outlets for both originator brand (OB) and lowest-priced generic brand (LPG) in Bangi, Selangor. Results: From the results, the mean availability of OB and LPG were 30% and 42%, respectively. Final patient prices for LPG and OB were about 10.77 and 24.09 times their IRPs, respectively. Medicines that consumes more than a day’s wage are considered unaffordable. Almost half of the IHD medications cost more than one day’s wage. For example, the lowest paid unskilled government worker would need 1.4 days’ wage for captopril, while 1.2 days’ wage to purchase enalapril for LPG. Meanwhile, for OB, the costs rise to 3.4 days’ wage for amlodipine and 3.3 days’ wage for simvastatin. Conclusion: The findings of this study emphasise the need of focusing and financing, particularly in the private sector, on making chronic disease medicines accessible. This requires multi-faceted interventions, as well as the review of policies and regulations.

Introduction: ABO blood group can be associated with chronic diseases, for example, cancer and coronary heart disease, however it is not proven in Type 2 Diabetes Mellitus (T2DM). The aim of this study was to identify the association between the ABO blood group and disease control among T2DM patients at Kepala Batas, Penang. Methods: Approximately two mL vials of fresh blood were collected and typed using the tube method from 129 T2DM and 132 non-diabetic (control) patients, who visited the specialist clinic. The sociodemographic characteristics of the T2DM patients was analysed using descriptive analysis. The proportions of A, B, AB, and O blood groups among the diabetic and control patients were compared using the chi-square test. Any association between the ABO blood group and disease control was identified using the bivariate correlation test. Results: No significant association was found between the ABO group and T2DM patients (p = 0.152) when compared with the control group. However, blood group B was the most frequent among T2DM patients (33.3%) compared to blood group O within the control group (36.4%). Negative associations were observed between the ABO blood group and BMI (r = 0.098, p = 0.268), as well as the HbA1C value (r = -0.065, p = 0.464). Conclusion: No association was found between the ABO blood group and the associated risk factors (BMI and HbA1C). However, individuals with blood group B and risk factors, such as older age group, obesity, and high HbA1C value (more than 7.0%), should be monitored.

Introduction: Various phantom with varied materials has been proposed to replace the human body. Besides, there is always a demand to use the local material as a phantom material, which is readily available and inexpensive. Wood is usually preferred because it is multifunction, environmentally friendly, low in toxic, inexpensive, as well as easy to use and prepare. Previous studies have found that Rhizophora spp. is a suitable natural source material and has been suggested due to its comparable dosimetric properties to commercial phantom. Methods: In this study, fabricated Rhizophora spp. particleboards phantom was opted as a solid-equivalent phantom medium at low energy photon beams using Gafchromic film x-ray quality assurance 2 (XRQA2). Additionally, the characteristics of XRQA2 film in the diagnostic energy range were generated. Results: Interestingly, the density of the fabricated Rhizophora spp particleboards was observed to have the same density with the water equivalent material (ρ= 1.00 g.cm-3) and has shown to have loosened agreement with PDD of water phantom at approximately 25% of the dose error. Also, further analysis using XRQA 2 film showed that energy was independent at different ranges. Conclusion: The analysis of fabricated Rhizophora spp particleboards undertaken here has extended our knowledge of the possibility of manufacturing cost-effective water equivalent phantom by using binder-less particleboard from Rhizophora spp. Therefore, a definite need for smaller interspacing particles should be considered to elevate the potential of Rhizophora spp particle boards as water equivalent materials.

Introduction: Trauma is a Global threat and the 5th highest cause of all-cause mortality in Malaysia caused predominantly due to road traffic accidents. Majority of trauma victims are young adults aged between 21-40 years old. In Malaysia, 24 out of 100,000 population die annually due to trauma, rating us amongst the highest in South East Asia. These alarming figures justify aggressive preventive and mitigation strategies. The aim of this paper is to promote the implementation of evidence-based interventions that will reduce the rate of preventable death because of trauma. Tranexamic acid is one of the few interventions in the early management of severe trauma with level-one evidence. Tranexamic acid has been proven to reduce all causes of mortality and mortality due to bleeding. Evidence proves that it is most effective when administered early, particularly within the 1st hour of trauma. This proposed guideline is formulated based upon quality evidence from multicentre studies, clinical practices in other countries and consideration of the local demographic factors with the intent of enabling an easy and simple pathway to administer tranexamic acid early in the care of the severely injured. Conclusion: The guideline highlights select pre-hospital criteria’s and the methods for drug administration. The authors recognise that some variants may be present amongst certain institutions necessitating minor adaptations, nevertheless the core principles of advocating tranexamic acid early in the course of pre-hospital trauma should be adhered to.