Introduction: Tooth restoration is a common, routine procedure among dentists but still has its own difficulties especially for posterior teeth. As it is a straightforward procedure, some dentists are not aware of the difficulties that may contribute in reducing the longevity of the filling. The aim of the study is to determine the difficulties encountered during and after placement of restorative materials in deep cavities. Materials and methods: Standardized questionnaires were divided randomly among general private dental practitioners in Kuala Lumpur. Chi-square test was used to determine any significant factors associated with difficulties of material placement. Results: This study showed that the most frequent difficulties encountered among practitioners were to obtain good moisture control (39.0%). No significant association was found between obtaining good moisture control and year of clinical experience (p= 0.286) and also place of graduation with the manipulation of the materials (p= 0.542). Conclusion: Dental practitioners claimed that it was difficult to obtain good moisture control in placement of posterior restoration. Thus, it is an obligation of dental practitioners to practice proper isolation and good manipulation of materials on posterior restoration.

Presence of air in the kidney can be problematic as the location of the air in different parts of the kidney greatly affects the subsequent management and outcome of the patient. We present here a case of a patient who had emphysematous pyelitis, in which CT scan was able to display presence of air only in the collecting system, thus differentiating this condition from the more fulminant emphysematous pyelonephritis. This leads to a more favourable prognosis and outcome to the patient.

The objective s of the research are t o identify the noise sources and noise level exposure inside C130H aircraft ’s hangar ; to produce nois e mapp ing ; to identify hearing status of C 130H aircraft maintenance crews (MC) ; and suggesting the noise control measure that can be applied. A field survey on noise level by using a digital s ound level m eter and producin g noise mapping . A h earing test ing among 63 MC was carried out in Institute of Aviation Me dicine , Royal Malaysian Air Force ( RMAF ) . Reviewing the literature and a nalyzing some control measure s to be taken. Hearing test result shown 41.2% of the MC are having hearing impairment. The highest noise level at the central of the hanga r is 92.2 dB A ( day - time) and 94.2 dBA (night - time) when there is a C130H aircraft starting its engine at 50 meter s from the centr al of the hanga r, 95.3 dBA (day - time) and 97.3 dBA (night - time) when there is a C130H a ircraft Engine Ground Run at 150 meter s fr om the centra l of the hanga r. Besides, Auxiliary Power Unit is producing the highest nois e level which is 125.7 dBA (day - time) and 127.7 dBA (night - time) . The application of Personal Protective Equipment (PPE) is the very likely control measure to be taken while engin eering control is ve ry costly but can be considered. Since noise is recognized as a hazard, hearing protection as PPE will not be the ultimate solution as a control measure. Hence, the Engineering Control must be identified and studied to be implemented as an ultimate solution to control the noise hazard in long term duration.

The objectives of the research are to identify the noise sources and noise level exposure inside C130H aircraft’s hangar; to produce noise mapping; to identify hearing status of C130H aircraft maintenance crews (MC); and suggesting the noise control measure that can be applied. A field survey on noise level by using a digital sound level meter and producing noise mapping. A hearing testing among 63 MC was carried out in Institute of Aviation Medicine, Royal Malaysian Air Force (RMAF). Reviewing the literature and analyzing some control measures to be taken. Hearing test result shown 41.2% of the MC are having hearing impairment. The highest noise level at the central of the hangar is 92.2 dBA (day-time) and 94.2 dBA (night-time) when there is a C130H aircraft starting its engine at 50 meters from the central of the hangar, 95.3 dBA (day-time) and 97.3 dBA (night-time) when there is a C130H aircraft Engine Ground Run at 150 meters from the central of the hangar. Besides, Auxiliary Power Unit is producing the highest noise level which is 125.7 dBA (day-time) and 127.7 dBA (night-time). The application of Personal Protective Equipment (PPE) is the very likely control measure to be taken while engineering control is very costly but can be considered. Since noise is recognized as a hazard, hearing protection as PPE will not be the ultimate solution as a control measure. Hence, the Engineering Control must be identified and studied to be implemented as an ultimate solution to control the noise hazard in long term duration.
C130H aircraft ; maintenance crew ; noise exposure

Pain, while salient, is highly subjective. A sensation perceived as painful by one person may be perceived as uncomfortable, not painful or even pleasant to others. Within the same person, pain may also be modulated according to its threat value and the context in which it is presented. Imaging techniques, such as functional magnetic resonance imaging and positron emission tomography, have identified a distributed network in the brain, the pain-relevant brain regions, that encode the sensory-discriminative aspect of pain, as well as its cognitive and affective/emotional factors. Current knowledge also implicates the prefrontal cortex as the modulatory area for pain, with its subdivisions forming the cortico-cortical pathway, an alternative pain modulatory pathway distinct from the descending modulatory pathway of pain. These findings from neuroimaging in human subjects have paved the way for the molecular mechanisms of pain modulation to be explored in animal studies.

Research in schizophrenia has advanced tremendously. One hundred and seventy five articles related to Schizophrenia were found from a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. This project aims to examine published research articles, in local and international journals in order to provide a glimpse of the research interest in Malaysia with regards to schizophrenia. Single case study, case series report, reviews and registry reports were not included in this review. Medication trial, unless it concerned a wider scope of psychopharmacology was also excluded from this review. A total of 105 articles were included in this review. Despite numerous genetics studies conducted and published, a definitive conclusion on the aetiology or mechanism underlying schizophrenia remains elusive. The National Mental Health - Schizophrenia Registry (NMHR) proved to be an important platform for many studies and publications. Studies stemmed from NMHR have provided significant insight into the baseline characteristic of patients with schizophrenia, pathway to care, and outcomes of the illness. International and regional collaborations have also encouraged important work involving stigma and discrimination in schizophrenia. Ministry of Health’s hospitals (MOH) are the main research sites in the country with regards to schizophrenia research. Numbers of schizophrenia research are still low in relation to the number of universities and hospitals in the country. Some of the weaknesses include duplication of studies, over-emphasising clinical trials and ignoring basic clinical research, and the lack of publications in international and regional journals.

Introduction: Embolisation has long been used as an adjunct to surgical resection in the treatment of brain arteriovenous malformation (bAVM). The most commonly used embolic material, n-butylcyanoacrylate glue, requires experience and skill to handle its quick and unpredictable flow and polymerisation. A new liquid embolic agent, ethylene vinyl alcohol copolymer (Onyx), is less adhesive and polymerises slowly, which provides better control for radiologists performing embolisation. Objective: To report our experience in embolisation using Onyx alone or in combination with histoacryl for bAVM embolisation in our tertiary referral centre. Methods: We retrospectively reviewed the anatomy, technical conditions, complications and clinical outcome of all bAVM patients embolised at our centre using Onyx alone or in combination with n-butylcyanoacrylate glue. Results: Between 2010 and 2013, 13 patients [6 (46.2%) male; 7 (53.8%) female; aged, 14– 57 years] were included, and a total of 31 embolisations were performed. Clinical presentation included hemorrhage [9 (69.2%)], seizures [2 (15.4%)], and headache [2 (15.4%)]. Most AVMs were located in the brain hemispheres [12 (92.3%)] and measured <3 cm [7 (53.8%]. Complete occlusion of the AVM was obtained in 2 (15.4%) patients; 11 (84.6%) patients had partial occlusion [6 (54.5%) had <50% nidus occlusion]. Complications occurred in four procedures involving 3 patients (morbidity, 23.1%). This resulted in the death of 1 patient (mortality, 7.7%) and complete recovery with no disability in 2 patients. Conclusion: The total nidal occlusion achieved herein is comparable to other similar studies. Our morbidity and mortality were higher compared to other studies which may be attributed to the small number of patients. More data is being collected which may better reflect on our experience.

CYP3A4 and CYP3A5 are metabolizing enzymes abundantly expressed in liver and involved in the metabolism of xenobiotics as well as clinically used drugs. Genetic polymorphisms in CYP3A4 and CYP3A5 may alter the metabolic ability of individuals. Thus, CYP3A4 and CYP3A5 might play an important role in the aetiology of chronic myeloid leukaemia (CML) and as modulators of cancer therapy response. In this study, the impact of two single nucleotide polymorphisms (SNPs) CYP3A4*18 (878T>C) and CYP3A5*3 (6986A>G) on CML susceptibility risk was investigated. This case-control study involved a total of 520 study subjects comprising 270 CML patients and 250 normal healthy controls. Genotyping of CYP3A4*18 and CYP3A5*3 was performed by polymerase chain reaction – restriction fragment length polymorphism (PCR-RFLP) technique. The association between allelic variants and CML susceptibility risk was assessed by logistic regression analysis, deriving odds ratio (OR) with 95% confident intervals. The results showed that heterozygous (*1/*1*8) genotype of CYP3A4*18 was significantly associated with CML susceptibility risk (OR 3.387; 95% CI: 1.433–8.007, p = 0.005). No homozygous variant (*18/*18) genotype was detected in this study. On the contrary, homozygous variant (*3/*3) and heterozygous (*1/*3) genotypes of CYP3A5*3 were associated with significantly lower risk for CML susceptibility (OR 0.140; 95% CI: 0.079–0.246’ p < 0.001 and OR 0.310; 95% CI: 0.180–0.535, p < 0.001, respectively). The results prompt us to conclude that genetic variation in CYP3A4*18 may contribute to a higher risk whereas CYP3A5*3 polymorphism confers a lower susceptibility risk in Malaysian CML patients.

Reported fatal accidents in Malaysia construction industry contributed the highest number among other industries since 2009 until 2018. These statistics are alarming and elucidate the need to conduct scientific research to find the solution to solve the problem. Safety and health issues remain critical to the construction industry due to its working environment and the complexity of working practices. To prevent an accident, hazard identification is essential to construction safety management because unidentified hazards present the most unmanageable risks. Therefore, this research is conducted to help in reducing occupational accidents in the construction industry, and it can be considered worthy. This study aims to understand the triggering events, and their factors leading to fatal accidents are of significant input. The obtained data were analyzed using a statistical analysis program. Data collections of 139 numbers of respondents have been conducted in six different construction sites in east Malaysia. The result showed that there is a correlation between worker's perspective on safety management in the construction site and accident that can lead to a more fatality rate compared to other sectors. The corresponding recommendations are ultimately put forward as fatal accident prevention in construction activities. The patterns found in this paper can contribute valuable direction for formulating accident prevention strategies. In future research, reporting of an accident and near misses are essential to be further explored.

The National Health Morbidity Survey in 2006 showed Breast Self Examination (BSE) is still low in Malaysian women even though many awareness programs have been carried out. This study was conducted from May to December 2000 to observe the changes on the level of knowledge, practice and attitude amongst nurses at the Kuala Krai Hospital, Kelantan on the practice of BSE after a health education intervention program was conducted. The objective of the study is to increase the practice of BSE among nurses in that hospital. The study was performed by pre and post intervention without comparison. Respondents consist of 43 nurses selected by random sampling. The instrument used in this study was by questionnaires through direct interview with the respondent. The health education intervention program includes talks, BSE demonstration, counseling and exhibition, was conducted to educate the nurses on the proper time, frequency and correct technique of BSE. The results of the study showed a significant change in the level of knowledge (p < 0.001) before and after intervention. Meanwhile, analysis on practice showed no significant change towards correct BSE practice (p = 0.083). Analysis on attitude showed that all 43 or 100% respondents had changed from negative to positive towards perceived susceptibility, perceived barrier and perceived benefit. No relationship between the socio-demographic factors and the BSE practice (p = 0.63) was observed. Even though practice changes before and after intervention is still low and not significant, but the introduction of the health intervention program caused some changes among the nurses from Hospital Kuala Krai, even though there was no overall change.