Typhoid is an acute febrile illness primarily caused by Salmonella enterica serotype typhi (S. Typhi) which could be challenging to diagnose in children, owing to its non-specific clinical signs and symptoms which may resemble other febrile illnesses. Here, we present a case of typhoid which was atypically presented as fever of unknown origin (FUO) in a two-year-old boy with underlying glucose-6-phosphate dehydrogenase (G6PD) deficiency. This child was initially diagnosed and managed as acute tonsillopharyngitis, however remained febrile despite medications. A series of investigations were performed and S. Typhi was isolated from the bone marrow culture after almost a month of admission. The antibiotic was started based on antibiotic susceptibility testing and he recovered well. Our case underscores the challenges of diagnosis establishment and clinical management of typhoid in paediatric patients who has underlying disease and emphasizes the importance of having high index of clinical suspicion to ascertain timely and proper diagnosis.

Introduction: Corona Mortis (CMOR) is a term used to describe an anatomical vascular variant of retropubic anastomosis located posterior to superior pubic ramus. We aim to provide sufficient data on the incidence, morphology and mean location of ‘crown of death’ in Asian population. Other objectives include to assess the relationship between CMOR incidence with gender, race and age. Materials and methods: This is a cross-sectional cadaveric study involving 164 randomly selected fresh multiracial Asian hemipelves (82 cadavers). Hemipelves were dissected to expose and evaluate the vascular elements posterior to superior pubic rami. Data were analysed using Chi-Square, ttest and with the help of IBM SPSS Statistics v26 software. Results: CMOR was found in 117 hemipelves (71.3%). No new morphological subtype was found. The mean distance of CMOR to symphysis pubis was 54.72mm (SD 9.35). Based on the results, it is evident that precaution needed to be taken at least within 55mm from symphysis pubis during any surgical intervention. The lack of statistically significant correlation between CMOR occurrence and gender, race and age suggest that the incidence of CMOR could be sporadic in manner. Conclusion: We conclude that CMOR is not just aberrant vessel as the incidence is high and this finding is comparable to other studies. The mean location of CMOR obtained in this study will guide surgeons from various disciplines in Asia to manage traumatic vascular injury and to perform a safe surgical procedure involving the pelvis area.

The Relationship Between Quality of Life (QoL) and Academic Performance During E-Learning Among Students in Higher Learning Institution Introduction The level of education and academic performance at the Universiti Malaysia Pahang (UMP) depends on having a better understanding of the standard of living among students there. The study aims to acquire the relationship between psychological, social, and environmental conditions and academic performance during e-learning among students from Universiti Malaysia Pahang, Gambang. This study aims to ascertain the relationship between the variables affecting students' performances and their outcomes in UMP, Gambang. Methodology Data were collected from 326 students through a questionnaire survey. The data were analyzed using Statistical Package for the Social Sciences (SSPS) version 26 software. Results This study analyzed three aspects that influence students' academic performance toward psychological, social, and environmental. Conclusion The findings show that none of the hypotheses proposed are statistically significant for this study. The analysis result shows that psychological with a spearman-value of -0.043. Spearman-value of -0.097, and for social and environmental with spearman-value of -0.087. The results from this study reveal that all the listed factors have a weak contribution to the student’ academic performance.

THERAPEUTIC EFFECT OF NATURAL HERBS IN DENTISTRY: A NARRATIVE REVIEW Objectives: Natural herbs have increased attention due to their therapeutic and general health-improving qualities as reported in the literature. This review paper aims to explore the therapeutic effects of natural herbs in dentistry and to describe the various herbal sources, active compounds and its dental applications. Methodology: A literature search was conducted using WoS, Pubmed, and Scopus with the search terms ‘herbal’ AND ‘dentistry’ AND ‘alternative treatment’. Articles related to natural herbs and dental applications from the past 15 years until September 2023 were gathered. The inclusion criteria for this study were in-vitro experiments and clinical studies. Result: 512 articles were extracted from the search with 128 falling under the inclusion criteria (86 in-vitro experiments and 42 clinical studies). It was observed that 15 therapeutic properties were extensively examined, with antimicrobial studies being the most prevalent (50.0%), while the least explored properties were pulp-capping and obturation material (0.8%). Diseases such as denture stomatitis, oral candidiasis, and gingivitis were highly reported to have benefited from natural herbal medicine as an alternative treatment option. Herbals such as propolis, green tea, ginger, Zataria multiflora, chitosan, garlic, Artemisia, Schinus terebinthifolius Raddi, Uncaria tomentosa, Punica granatum, and Ricinus communis were found to be useful in the treatment of denture stomatitis. Rhizoma imperatae extract has been added to oral care products and has shown an excellent effect on reducing gingivitis. Pistacia atlantica extract mouthwash was reported to be effective against dental plaque bacteria and subgingival microorganisms. Conclusion: Numerous natural herbs have been extensively documented to have therapeutic effects in certain dental diseases as supported by laboratory and clinical studies. However, comprehensive guides such as the clinical indications, therapeutic doses and application methods were with minimal evidence that can be derived from the literature. More extensive clinical trials are to be conducted on the therapeutic efficacy of natural herbs in dentistry.

INTRODUCTION: Behavioural and psychological symptoms of dementia (BPSD) are considered integral parts of dementia. While pharmacotherapy is reserved for severe symptoms of BPSD, the associated adverse effects can be detrimental. Therefore, non-pharmacological intervention is recommended as the first line of treatment in the management of BPSD. This study aimed to explore the non-pharmacological approaches for the management of BPSD and the strategies and barriers to implementing them in secondary care facilities in Malaysia. METHODS: A qualitative study design was employed. Data were collected through observations and semi-structured interviews of 12 caregivers and 11 people with dementia (PWD) at seven secondary care facilities. Observations were written in the field notes, and interviews were audio-recorded and transcribed. All data were subjected to thematic analysis. RESULTS: Some personalised non-pharmacological interventions, such as physical exercise, music therapy, reminiscence therapy and pet therapy, were conducted in several nursing care centres. Collaborative care from the care providers and family members was found to be an important facilitating factor. The lack of family support led to care providers carrying additional workload beyond their job scope. Other barriers to non-pharmacological interventions were cultural and language differences between the care providers and PWD, inadequate staff numbers and training, and time constraints. CONCLUSION Although non-pharmacological approaches have been used to some extent in Malaysia, continuous education and training of healthcare providers and the family members of PWD is needed to overcome the challenges to their successful implementation.
Humans ; Dementia/diagnosis* ; Psychotherapy ; Qualitative Research ; Health Personnel ; Caregivers

Introduction: Caffeine is a psychoactive substance widely consumed over the past decades. The effect of caffeine can be either beneficial or harmful. It increases cognitive performances, including attention, alertness and concentration. However, high caffeine intake may also induce an anxiogenic effect, causing symptoms such as rapid heart rate, restlessness and nervousness. This study aimed to determine the association between caffeine intake and mental health disorders such as anxiety and depression among undergraduate pharmacy students at UiTM Puncak Alam. Methods: This was a cross-sectional study with stratified random convenience sampling. A total of 270 undergraduate pharmacy students in UiTM Puncak Alam, Selangor participated in this study. A set of questionnaires was distributed using the Google Form platform. Standard General Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) scoring were used to assess the level of anxiety and depression among the respondents, respectively. SPSS version 27.0 was used to analyse the data. Results: About 70.4% of the students consumed caffeine, while 29.6% of the students did not consume caffeine. No significant association was found between caffeine status and the mental health scoring of GAD-7 (χ2 =4.639, p=0.200) and PHQ-9 (χ2 =5.256, p=0.262). Conclusion: Non-daily consumption and a low dose of caffeine intake patterns are good practises to prevent the development of anxiety or depression conditions, although the associations were not significant. Public awareness on possible anxiogenic effect and mental related disorders due to caffeine consumption need to be initiated, as nowadays, the caffeine intake behaviour has become a trendy lifestyle among the young adults.

INTRODUCTION: Overweight and obesity are becoming a major health issue which contributes to increase in health morbidity and mortality. This study aimed to evaluate the effect of the mainly diet intervention and exercise for weight reduction among obese but healthy adults. METHODOLOGY: This was a quasi-experimental study using designed Structured Diet Program adapted from Malaysia Healthy Plate method (half-half quarter) for weight reduction that lasts for 10 weeks. The anthropometry and biochemistry parameters were monitored and collected pre and 10 weeks post program. The WHO BMI criteria for Asian population cut off points was used to define obesity in this study. RESULT: Thirty healthcare workers (HCWs) were recruited. However, only 27 HCWs completed the program. The pre and post program mean BMI was 32.90kg/m2 and 31.39kg/m2 and weight was 81.25 kg to 77.37kg. The total cholesterol reduced significantly with mean 5.65mmol/l to 5.34mmol/l. Other blood parameters showed some reduction but not statically significant with mean FBS 4.82mmol/l to 4.69mmol/l, mean HDL: 1.43mmol/l to 1.32mmol/l mean LDL: 3.54mmol/l to 3.42mmol/l and mean TG 1.52mmol/l to 1.31mmol/l. CONCLUSION Overall, the programme led to a considerable reduction in body weight, BMI, and Total Cholesterol. Even though other blood parameters do not show statistically significant reduction but they still showed some reduction post programme. This method is recommended to be implemented among Malaysians for longer duration to achieve significant reduction in blood parameters. However, the commitment and motivation of the HCWs are highly needed to ensure the effectiveness and adherence to the diet method.

Rare but serious thrombotic incidents in relation to thrombocytopenia, termed vaccine-induced immune thrombotic thrombocytopenia (VITT), have been observed since the vaccine rollout, particularly among replication-defective adenoviral vector-based severe acute respiratory syndrome coronavirus 2 vaccine recipients. Herein, we comprehensively reviewed and summarized reported studies of VITT following the coronavirus disease 2019 (COVID-19) vaccination to determine its prevalence, clinical characteristics, as well as its management. A literature search up to October 1, 2021 using PubMed and SCOPUS identified a combined total of 720 articles. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline, after screening the titles and abstracts based on the eligibility criteria, the remaining 47 full-text articles were assessed for eligibility and 29 studies were included. Findings revealed that VITT cases are strongly related to viral vector-based vaccines, which are the AstraZeneca COVID-19 vaccine (95%) and the Janssen COVID-19 vaccine (4%), with much rarer reports involving messenger RNA-based vaccines such as the Moderna COVID-19 vaccine (0.2%) and the Pfizer COVID-19 vaccine (0.2%). The most severe manifestation of VITT is cerebral venous sinus thrombosis with 317 cases (70.4%) and the earliest primary symptom in the majority of cases is headache. Intravenous immunoglobulin and non-heparin anticoagulant are the main therapeutic options for managing immune responses and thrombosis, respectively. As there is emerging knowledge on and refinement of the published guidelines regarding VITT, this review may assist the medical communities in early VITT recognition, understanding the clinical presentations, diagnostic criteria as well as its management, offering a window of opportunity to VITT patients. Further larger sample size trials could further elucidate the link and safety profile.

Objectives: This study aimed to assess menopause symptoms, treatment-seeking behaviors, treatments received, and factors associated with seeking consultation from healthcare providers (HCPs). Methods: Using a self-administered Menopause Quick-6 in the Malay language (MQ6[M]) questionnaire, we surveyed 349 women aged 40–60 years attending primary healthcare clinics in four states in Malaysia for their menopause symptoms. Health-seeking behaviors for menopause symptoms were assessed using questions regarding HCPs consulted and treatments prescribed. Binary logistic regression was employed on factors associated with seeking consultation for menopause symptoms. Results: Using MQ6(M), we observed that 125 (31.3%) women reported at least one menopause symptom, with joint pains (42.8%), menstrual changes (39.5%), and hot flashes (29.3%) being the most frequent symptoms. Furthermore, 60% of the women were prescribed vitamins, and only 13% were administered Hormone Replacement Therapy (HRT). Medical comorbidities, the presence of at least one gynecological condition, menopause status, and MQ6(M) score were associated with seeking consultation with an HCP. For women with medical conditions, the odds of seeking consultation increased by a factor of 1.34 (adjusted odds ratio [AOR], 1.34; 95% confidence interval [CI], 1.11–1.76) for every additional comorbidity. The odds of seeking consultation from an HCP increased by a factor of 1.26 (AOR, 1.26; 95% CI, 1.04–1.47) with a unit increase in MQ6(M) score. Conclusions Most women had menopause symptoms but favored the use of complementary and alternative medicine over HRT. Screening and awareness of menopause treatments need to be improved at primary healthcare clinics.

Introduction: Family planning (FP) is a method to prevent unwanted pregnancies among couples. More than 200 million women in the developing nation do not want pregnancy but do not practically use modern methods of FP. Women’s knowledge, attitude, and practice (KAP) play a crucial role in using FP’s is a form of practice. This study explored the determinants of KAP towards FP among women in Raub, Pahang, Malaysia. Methods: A cross-sectional study was conducted among 249 women with a convenience sampling method. Data was collected using a pilot-tested self-administered questionnaire. Results: Age, ethnicity, religion, marital status, employment status, annual income, education level, and the number of children were significantly correlated (p = 0.001 – 0.019) with the KAP of FP. Conclusion: The study demonstrated a need for health education campaigns and utilise every interaction of women with healthcare providers to disseminate information on FP and dispel misconceptions. Interventional studies are recommended for further exploration.