Introduction: Osteoporosis is a major health problem worldwide. In Asia, few studies have measured knowledge, attitude and practices (KAP) of osteoporosis. This study aimed to determine the KAP of osteoporosis, including the main factors influencing attitude towards osteoporosis, and the relationship between osteoporosis knowledge, attitude, and practices among adults in Kuala Lumpur, Malaysia. Methods: A cross-sectional study via a self-administrated KAP questionnaire was carried out among 232 respondents aged 21 to 50 years in Kuala Lumpur. Random sampling was applied to select five districts in Kuala Lumpur, while convenient sampling was used for recruitment of apparently healthy subjects from community and institutional settings. The data were analysed using Mann-Whitney, Kruskal-Wallis, Chi-Square, Spearman Correlation and multiple logistic regression tests. Results: The findings indicate a moderate level of knowledge and attitude towards osteoporosis prevention with median scores of 51.6% and 68.6%, respectively. Osteoporosis knowledge varied significantly with gender, educational level and household income (p<0.05). Furthermore, attitude was significantly different in relation to educational level and household income. Based on the multiple logistic regression test, relatives and friends appeared to be the most significant factor influencing attitude (R=0.319, p<0.0001). Poor dietary and lifestyles practices were indicated, and a significant relationship was found between practice of weight-bearing activities and educational level (p<0.05). A significant correlation was found (ρ=0.348, p<0.0001) between knowledge and attitude, while no relationship was noted between knowledge and practice of weight-bearing activities or attitude and practice of weight-bearing activities. Conclusion: Knowledge played a significant role in affecting attitudes towards osteoporosis. However, understanding of osteoporosis is still at a moderate level. Friends and family were the most influential factor.

Introduction: There is an emergent increase of ultra-processed food consumption in developing countries including Malaysia which carries a likelihood towards the increase of obesity. However, few studies have been done in relating between ultra-processed consumption and obesity, especially in Malaysia. Therefore, this study aims to determine the consumption of ultra-processed foods and its relationship with BMI and body fat percentage among university committee in Kuala Nerus, Terengganu. Methods: A cross-sectional study was performed among 167 individuals aged 18 to 59 years old in Kuala Nerus. Data were collected using a researcher-administered questionnaire which consisted of three different sections: socio-demographic profile, two days 24-hour dietary recall, and nutritional status assessment on BMI and body fat percentage. Consumption of ultra-processed foods were determined by classifying two days 24-hour dietary recall based on ultra-processed food classification. Data were analyzed using SPSS version 21.0 with p<0.05 to indicate significant. Results: The results showed Group 4 (ultra-processed foods) contributes 23% of overall daily energy consumption while Group 1+2 (unprocessed or minimally processed food + culinary ingredients) and Group 3 (processed foods) had contributed 75% and 2% respectively. Results showed that there was no relationship found between the ultra-processed food consumption and nutritional status through spearmen correlation at p<0.05. Conclusion: It is evidently clear from the findings that the consumption of ultra-processed foods is providentially still low among the respondents.

BACKGROUND: Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis and causes irreversible joint damage, unless detected early and treated with systemic drugs. OBJECTIVE: There is no reliable tool for screening PsA among Turkish psoriasis patients. Therefore, we aimed to validate the psoriatic arthritis screening and evaluation (PASE) questionnaire in the Turkish. METHODS: A 15-item Turkish PASE questionnaire was administered to 122 consecutive psoriasis patients who visited our dermatology clinic for routine evaluations. Then, the patients were evaluated for PsA by a rheumatologist who was blinded to the results of the questionnaire. RESULTS: Among the 113 patients who participated in the study, 11.5% (13 of 113) had a diagnosis of PsA. The Turkish PASE total scores ranged from 15 to 67 (possible range, 15~75). The median total score was 49 (25th and 75th percentile, 36 and 50) for the PsA group and 35 (25th and 75th percentile, 27 and 42) for the non-PsA group. The median total score of the PsA group was significantly higher than that of the non-PsA group (p=0.33). The Turkish PASE total score of 44 distinguished PsA from non-PsA participants, with 62% sensitivity and 76% specificity. For further analysis of each question, we counted the responses according to symptoms (positive for "agree" and "strongly agree" and negative for "disagree" and "strongly disagree"), and the sensitivity ranged from 23% (third question of the functions subscale) to 77% (second question of the symptoms subscale, first and fifth questions of the functions subscale) and the specificity ranged from 51% (second question of the symptoms subscale) to 87% (fourth question of the functions subscale). No relation was found between the PASI scores and the presence (p=0.899) or absence (p=0.941) of PsA, as well as between the PASI and PASE scores of each patient (p=0.961). CONCLUSION: Thirteen of the 15 items demonstrated significant test-retest reliability as assessed with the Spearman correlation coefficient (p<0.05). These results show that the Turkish version of the PASE questionnaire may be useful for identifying PsA patients for inclusion in trials; however, it is not a reliable tool for screening PSA patients in a dermatology clinic.
Arthritis ; Arthritis, Psoriatic* ; Dermatology ; Diagnosis ; Humans ; Joints ; Mass Screening* ; Psoriasis ; Surveys and Questionnaires

PURPOSE: Insulin pumps are widely used in diabetes. They are equipped with safety alarms to alert users. Pump manuals contain alarm codes and how to troubleshoot them. However, these manuals are lengthy and difficult to use, particularly in emergencies. We aim to assess the impact of targeted education on warnings and errors in improving competency to troubleshoot the alarms. METHODS: Twenty-one patients, with a median age of 13, were recruited over a 5-month period. Each patient had 2 study visits. The frequencies and types of alarms were recorded, and patients were given a summary sheet that outlined common alarms encountered and troubleshooting tips. In visit 2, the frequencies and types of alarms were compared to those of visit 1. The patients were asked to fill a questionnaire and to rate the education session given in visit 1, their level of competency in decrypting alarm codes, and their promptness in responding to alarms. RESULTS: Low cartridge (W1), low battery (W2), and bolus cancelled (W8) were the commonest warnings. The most noted errors were occlusion (E4), power interruption (E8), empty battery (E2), set not primed (E11), and cartridge empty (E1). The numbers of warning and error signals markedly decreased after targeted education (P < 0.05). The ability in decrypting warning signals significantly improved (P=0.02), and the frequency of response to pump alarms significantly increased (P=0.001). CONCLUSION: Certain warnings and errors are more common than others in insulin pumps. Targeted education is useful in improving competency and response of patients in managing pump alarms.
Adolescent* ; Child* ; Clinical Alarms ; Diabetes Mellitus, Type 1 ; Education* ; Emergencies ; Humans ; Insulin Infusion Systems ; Insulin* ; Medical Errors

PURPOSE: The specific targeting of interleukin-4 receptor α (IL4Rα) receptor offers a promising therapeutic approach for inhibition of tumor cell progression in breast cancer patients. In the current study, the in vitro efficacy of superparamagnetic iron oxide nanoparticles conjugated with anti-IL4Rα blocking antibodies (SPION-IL4Rα) via polyethylene glycol polymers was evaluated in 4T1 breast cancer cells. MATERIALS AND METHODS: Cell viability, reactive oxygen species generation, and apoptosis frequency were assessed in vitro in 4T1 cancer cell lines following exposure to SPION-IL4Rα alone or combined with doxorubicin. In addition, immunofluorescence assessments and fluorimetrywere performed to confirm the specific targeting and interaction of the developed nanocarriers with IL4Rα receptors in breast cancer cells. RESULTS: Blocking of IL4Rα receptors caused a significant decrease in cell viability and induced apoptosis in 4T1 cells. In addition, combined treatment with SPION-IL4Rα+doxorubicin caused significant increases in cell death, apoptosis, and oxidative stress compared to either SPION-IL4Rα or doxorubicin alone, indicating the enhanced therapeutic efficacy of this combination. The decrease in fluorescence intensity upon immunofluorescence and fluorimetry assays combined with increased viability and decreased apoptosis following the blocking of IL4Rα receptors confirmed the successful binding of the synthesized nanocarriers to the target sites on murine 4T1 breast cancerous cells. CONCLUSION: These results suggest that SPION-IL4Rα nanocarriers might be used for successfulreduction of tumor growth and inhibition of progression of metastasis in vivo.
Antibodies, Blocking ; Apoptosis ; Biomarkers ; Breast Neoplasms* ; Breast* ; Cell Death ; Cell Line ; Cell Proliferation* ; Cell Survival ; Doxorubicin ; Drug Delivery Systems ; Fluorescence ; Fluorescent Antibody Technique ; Fluorometry ; Humans ; In Vitro Techniques ; Interleukin-4* ; Iron* ; Nanoparticles ; Neoplasm Metastasis ; Oxidative Stress ; Polyethylene Glycols* ; Polyethylene* ; Polymers ; Reactive Oxygen Species

Objective: High temperatures can trigger cellular oxidative stress and disrupt spermatogenesis, potentially leading to male infertility. We investigated the effects of retinoic acid (RA), chitosan nanoparticles (CHNPs), and retinoic acid loaded with chitosan nanoparticles (RACHNPs) on spermatogenesis in mice induced by scrotal hyperthermia (Hyp). Methods: Thirty mice (weighing 25 to 30 g) were divided into five experimental groups of six mice each. The groups were as follows: control, Hyp induced by a water bath (43 °C for 30 minutes/day for 5 weeks), Hyp+RA (2 mg/kg/day), Hyp+CHNPs (2 mg/kg/72 hours), and Hyp+RACHNPs (4 mg/kg/72 hours). The mice were treated for 35 days. After the experimental treatments, the animals were euthanized. Sperm samples were collected for analysis of sperm parameters, and blood serum was isolated for testosterone measurement. Testis samples were also collected for histopathology assessment, reactive oxygen species (ROS) evaluation, and RNA extraction, which was done to compare the expression levels of the bax, bcl2, p53, Fas, and FasL genes among groups. Additionally, immunohistochemical staining was performed. Results: Treatment with RACHNPs significantly increased stereological parameters such as testicular volume, seminiferous tubule length, and testicular cell count. Additionally, it increased testosterone concentration and improved sperm parameters. We observed significant decreases in ROS production and caspase-3 immunostaining in the RACHNP group. Moreover, the expression levels of bax, p53, Fas, and FasL significantly decreased in the groups treated with RACHNPs and RA. Conclusion RACHNPs can be considered a potent antioxidative and antiapoptotic agent for therapeutic strategies in reproductive and regenerative medicine.

OBJECTIVES: The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major challenge for the global control of tuberculosis (TB). The aim of this study was to determine the risk factors associated with MDR-TB in Sudan. METHODS: This case-control study was conducted from May 2017 to February 2019. Patients newly diagnosed with MDR-TB were selected as cases, and controls were selected from TB patients who responded to first-line anti-TB drugs. A questionnaire was designed and used to collect data from study participants. Logistic regression was used to evaluate associations between risk factors and MDR-TB infection. The best multivariate model was selected based on the likelihood ratio test. RESULTS: A total of 430 cases and 860 controls were selected for this study. A history of previous TB treatment (adjusted odds ratio [aOR], 54.85; 95% confidence interval [CI], 30.48 to 98.69) was strongly associated with MDR-TB infection. We identified interruption of TB treatment (aOR, 7.62; 95% CI, 3.16 to 18.34), contact with MDR-TB patients (aOR, 5.40; 95% CI, 2.69 to 10.74), lower body weight (aOR, 0.89; 95% CI, 0.87 to 0.91), and water pipe smoking (aOR, 3.23; 95% CI, 1.73 to 6.04) as factors associated with MDR-TB infection. CONCLUSIONS Previous TB treatment and interruption of TB treatment were found to be the main predictors of MDR-TB. Additionally, this study found that contact with MDR-TB patients and water pipe smoking were associated with MDR-TB infection in Sudan. More efforts are required to decrease the rate of treatment interruption, to strengthen patients' adherence to treatment, and to reduce contact with MDR-TB patients.

OBJECTIVES: The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major challenge for the global control of tuberculosis (TB). The aim of this study was to determine the risk factors associated with MDR-TB in Sudan.METHODS: This case-control study was conducted from May 2017 to February 2019. Patients newly diagnosed with MDR-TB were selected as cases, and controls were selected from TB patients who responded to first-line anti-TB drugs. A questionnaire was designed and used to collect data from study participants. Logistic regression was used to evaluate associations between risk factors and MDR-TB infection. The best multivariate model was selected based on the likelihood ratio test.RESULTS: A total of 430 cases and 860 controls were selected for this study. A history of previous TB treatment (adjusted odds ratio [aOR], 54.85; 95% confidence interval [CI], 30.48 to 98.69) was strongly associated with MDR-TB infection. We identified interruption of TB treatment (aOR, 7.62; 95% CI, 3.16 to 18.34), contact with MDR-TB patients (aOR, 5.40; 95% CI, 2.69 to 10.74), lower body weight (aOR, 0.89; 95% CI, 0.87 to 0.91), and water pipe smoking (aOR, 3.23; 95% CI, 1.73 to 6.04) as factors associated with MDR-TB infection.CONCLUSIONS: Previous TB treatment and interruption of TB treatment were found to be the main predictors of MDR-TB. Additionally, this study found that contact with MDR-TB patients and water pipe smoking were associated with MDR-TB infection in Sudan. More efforts are required to decrease the rate of treatment interruption, to strengthen patients' adherence to treatment, and to reduce contact with MDR-TB patients.
Body Weight ; Case-Control Studies ; Humans ; Logistic Models ; Odds Ratio ; Risk Factors ; Smoking ; Sudan ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Water

OBJECTIVES: The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major challenge for the global control of tuberculosis (TB). The aim of this study was to determine the risk factors associated with MDR-TB in Sudan. METHODS: This case-control study was conducted from May 2017 to February 2019. Patients newly diagnosed with MDR-TB were selected as cases, and controls were selected from TB patients who responded to first-line anti-TB drugs. A questionnaire was designed and used to collect data from study participants. Logistic regression was used to evaluate associations between risk factors and MDR-TB infection. The best multivariate model was selected based on the likelihood ratio test. RESULTS: A total of 430 cases and 860 controls were selected for this study. A history of previous TB treatment (adjusted odds ratio [aOR], 54.85; 95% confidence interval [CI], 30.48 to 98.69) was strongly associated with MDR-TB infection. We identified interruption of TB treatment (aOR, 7.62; 95% CI, 3.16 to 18.34), contact with MDR-TB patients (aOR, 5.40; 95% CI, 2.69 to 10.74), lower body weight (aOR, 0.89; 95% CI, 0.87 to 0.91), and water pipe smoking (aOR, 3.23; 95% CI, 1.73 to 6.04) as factors associated with MDR-TB infection. CONCLUSIONS: Previous TB treatment and interruption of TB treatment were found to be the main predictors of MDR-TB. Additionally, this study found that contact with MDR-TB patients and water pipe smoking were associated with MDR-TB infection in Sudan. More efforts are required to decrease the rate of treatment interruption, to strengthen patients’ adherence to treatment, and to reduce contact with MDR-TB patients.
Body Weight ; Case-Control Studies ; Humans ; Logistic Models ; Odds Ratio ; Risk Factors ; Smoking ; Sudan ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Water

This paper highlights the dietary intake of fishermen's children, their nutritional status and cognitive performance. It will help to have a reasonable perspective of their dietary intake and their relationship with nutritional status and how it inevitably influences cognitive performance. This is relevant as it can provide the government and health authorities with insights into the execution of an action plan to improve the nutritional status of fishing communities, especially in Malaysia, where possible. A systematic search of the English scholarly papers on this subject was undertaken between 1997 and 2020. A total of 20 studies have been systematically chosen and reviewed. Studies are divided into two groups, based on the type of research conducted. Ten of the retrieved studies looked at dietary intake and nutritional status in fisherman's children, while another ten studies looked at cognitive performance in children and adolescents and the factors that contributed to it. In terms of dietary intake, three studies reported low energy consumption and low carbohydrate intake, one study reported high carbohydrate intake, four studies reported high protein intake, one study reported low fat intake, five studies reported low micronutrient intake (calcium, iron, vitamin A and vitamin C) and two studies reported a high intake of niacin. As far as nutritional status is concerned, six studies recorded that children are stunted/underweight and three studies reported that children are obese/overweight. In comparison, one study recorded high cognitive performance, three studies reported average cognitive performance, and three studies reported poor cognitive performance. In the studies reviewed, it has been shown that there is a positive association between socio-economic status, dietary intake/nutritional status and cognitive performance among children in fishing communities in different regions. There is a need for nutrition education and intervention in these disadvantaged communities.