Objective: To study risk factors, contributing factors of bacterial and fungal endophthalmitis in Upper Egypt, test the isolated species sensitive to some therapeutic agents, and to investigate the air-borne bacteria and fungi in opthalmology operating rooms. Methods: Thirty one cases of endophthalmitis were clinically diagnosed and microbiologically studied. Indoor air-borne bacteria and fungi inside four air-conditioned operating rooms in the Ophthalmology Department at Assiut University Hospitals were also investigated. The isolated microbes from endophthalmitis cases were tested for their ability to produce some extracellular enzymes including protease, lipase, urease, phosphatase and catalase. Also the ability of 5 fungal isolates from endophthalmitis origin to produce mycotoxins and their sensitivity to some therapeutic agents were studied. Results: Results showed that bacteria and fungi were responsihle for infection in 10 and 6 cases of endophthalmitis, respectively and only 2 cases produced a mixture of bacteria and fungi. Trauma was the most prevalent risk factor of endophthalmitis where 58.1% of the 31 cases were due to trauma. In ophthalmology operating rooms, different bacterial and fungal species were isolated. 8 bacterial and 5 fungal isolates showed their ability to produce enzymes while only 3 fungal isolates were able to produce mycotoxins. Terbinafine showed the highest effect against most isolates in vitro. Conclusions: The ability of bacterial and fungal isolates to produce extracellular enzymes and mycotoxins may be aid in the invasion and destruction of eye tissues. Microbial contamination of operating rooms with air-borne bacteria and fungi in the present work may be a source of postoperative endophthalmitis.

The incidence of unintended pregnancy and unsafe abortion are significantly high due to the lack of knowledge and negative attitude towards contraception and it can be prevented by effective and appropriate contraceptive knowledge and usage. Considering the future role of medical students as family planning educator as well as counsellors, it is not only important to determine their knowledge, attitude and perception towards contraception but also should be updated for improvement on the quality of future healthcare professionals on contraceptive knowledge which may lead to the reduction in the number of unintended pregnancy with improving maternal morbidity and mortality. This was a cross sectional study using self-reported questionnaires survey that consists of four sections as socio-demographic characteristics information, knowledge towards contraception, attitude towards contraception, and perception of education and training in sexual and reproductive health among medical student. Questions were, distributed among medical students in Faculty of Medicine and Health Sciences and analyzed. The response rate was 100%. and most of the respondents in this study were Malay (64·4%), female (68·3%), single (98·6%) and live in urban area (69·1%). Most of their parents had tertiary education level (father educational level, 63·3%; mother educational level, 50·0%). 56·1% of the respondents had poor level of knowledge and 59.2% of them had negative attitude towards contraception. Regarding the perception on contraception, most of the respondents thought that they did not have sufficient clinical practice (50·4%) though adequate training (57·6%) in counselling the patients for family planning service during their clinical posting. There was a significant association between gender, place of birth, ethnicity, marital status, father educational status and level of knowledge. There were a higher percentage of respondents who had poor knowledge and negative attitude towards contraception. Assessing the knowledge and attitude of medical students on contraception and their relationship with socio-demographic characteristics and socio-economic factors plays a leading role in public health projects which are aimed to combat maternal mortality through reducing unintended pregnancies. To change the attitude towards contraception and further increase the level of knowledge of contraception among medical students, collaborated health education and similar studies among health workers are highly recommended.

Neck pain presents as a symptom of dull pain or discomfort mainly along the trapezius muscle. Dry needling is an invasive procedure which uses acupuncture needle directed at myofascial trigger points. The aim of the study was to evaluate the effectiveness of dry needling in managing patients with neck pain. A pre-test-post-test interventional study design was used. Patient education package was provided to 32 respondents who fulfilled the inclusion criteria. A 13-item Pain Catastrophizing Scale (PCS) questionnaire was used to assess Rumination, Magnification and Helplessness. Subjective pain intensity was measured by Visual Analogue Scale (VAS). These questionnaires were given before and after the dry needling intervention. The findings reported that respondents scored high in pre-test total PCS score (27.41±13.652). Post-test result revealed a significant improvement in total PCS score (23.06±13.938) (p = 0.000). Post-test VAS score (4.78±1.237) was also significantly better than pre-test (6.47±1.414) (p = 0.000). There was no significant difference in pre-test PCS in terms of marital status (p > 0.05) whereas there was significant difference between marital status and rumination in post-test (Z = -2.303, p = 0.021). There was significant difference between pre-test magnification in terms of respondents’ occupation (p = 0.008) and race (p = 0.035) but no significant difference in post-test. Respondents’ age group showed no significant differences between pre-test and post-test PCS and VAS (p > 0.05). In conclusion, patients who received dry needling showed improvement in pain intensity and catastrophizing towards neck pain.
Neck Pain

Delayed wound healing is one of the major complications of diabetes mellitus where it often leads to amputation. Virgin coconut oil (VCO) is a natural oil widely used to treat wounds and burns traditionally. It possesses potent antioxidant and antibacterial activities. This study aimed to determine the effect of VCO on the fibroblast population in diabetic wound healing. Full thickness cutaneous wound tissues were collected from non-treated, VCO-treated, and silver sulfadiazine (SS)-treated diabetic rats. The tissues were then subjected to Verhoeff eosin staining and immunohistology of fibroblast and myofibroblast. Histological analysis showed increased collagen deposition with intact epidermis in the VCO treated group compared to decreased collagen deposition with damaged epidermis in both non-treated and SS-treated groups. Interestingly, more fibroblasts and myofibroblasts were observed in the non-treated group compared to the VCO- and SS-treated groups. VCO significantly promoted wound healing process in diabetic rats via promoting re-epithelialization, and increasing collagen fibres deposition and wound contraction. The results suggested VCO can be used to treat diabetic wounds.

594Med J Malaysia Vol 75 No 5 September 2020SUMMARYMorel-Lavallee lesions (MLL) are post-traumatic, closedinternal degloving injuries that can result in severecomplications if not diagnosed early. It is conventionallyseen in cases of the high energy injuries of the pelvis andlower limb. The accumulation of extravasated blood,secondary to fracture and soft tissue damage may causeinternal degloving injury, skin necrosis, soft tissue damageand acute osteomyelitis. We report here the clinical andradiological features in a 32-year-old male referred from theemergency department of a tertiary hospital who hadsustained high energy motor vehicle accident. Onexamination, there was a fluctuant, mobile, non-tendersubcutaneous mass over the distal arm with suspicion ofinternal degloving injury. Plain radiographs showed nofractures. Ultrasound showed a fluid collection with thepresence of septations and echogenic debris within thecollection. Extravasation was noted between subcutaneoustissue layer and fascia at the posterolateral aspect of thearm. Wound debridement under general anaesthesia wascarried out. Intraoperative findings reported a significantamount of thick serous fluid with necrotic debris. Unhealthyskin and fat layers were debrided. Underlying muscles werefound to be healthy. The results of the intraoperative fluidculture and sensitivity showed no growth. Negative pressurevacuum dressing was carried out. After five cycles ofvacuum dressing, the wound showed signs of healing withan improved range of motion of the elbow. Orthopaedicsurgeons need to be vigilant of the possibility of MLL in theupper limb as a differential diagnosis in the management ofhigh energy trauma.

Introduction: Lean sustainability has gained prominence in the health sector for operational and business advantages. However, understanding the link between lean and healthcare sustainability, especially in social and environmental aspects, remains limited. This study introduces a preliminary framework for measuring lean healthcare sustainability in hospitals. The framework aligns Critical Success Factors (CSFs) with sustainability objectives and business strategies to ensure successful and enduring lean deployment. Methods: The study was conducted among 52 Lean Agile Hospitals in Malaysia using a cross-sectional approach. The validated questionnaire was employed for data collection. A reliability test and Exploratory Factor Analysis (EFA) were also performed to assess and validate the framework using Statistical Package for Social Sciences (SPSS) version 27. Results: The content validation was 0.9, which indicates that the instrument is sufficient to measure the research objective. The data screening test was performed to eliminate problem observation. The overall reliability value was over 0.830 which depicts data consistency and stability. The Kaiser-Meyer-Olkin exceeded 0.6, Bartlett’s test was under 0.001 and factor loading was between 0.507 to 0.948, thus indicating a significant correlation matrix among at least some of the variables. Therefore, the latent factors were significant to specific items of the research. Conclusion: It is concluded that important CSF is aligned with the strategic level influence of lean deployment in healthcare, which has a specific impact on certain sustainability performance. Thus, this paper proposed a generic preliminary framework to measure lean healthcare sustainability.