exposure during enamel formation. Increased and decreased in fluorosis prevalence may also reflect to the different ways of measuring the disease. The choice of measuring fluorosis is depends on the objective of the assessment such as assessing public health significant of fluorosis in the population or assessing the detailed of biological effects of fluoride. These differences in requirement have led to the adoption of many indices and assessment methods of enamel fluorosis, which subsequently led to evaluation of examiner agreement between them. Several indices were developed to measure dental fluorosis in the 20th century. These include fluorosis specific indices such as Dean’s Index; the Thylstrup and Fejerskov Index; the Total Tooth Surface Index; and the Fluorosis Risk Index. Non-specific descriptive indices such as the Developmental Defects of Enamel index have also been used to record fluorosis. Fluorosis has most commonly been recorded using clinical examinations and photographs. Recent developments have seen the use of a Visual Analog Scale and automated grading systems such as Quantitative Light Fluorescence emerge as possible enhancements to fluorosis scoring. This article aims to review existing indices and new methods in measuring dental fluorosis, together with examiner reliability across different methods and indices.
Fluorosis, Dental ; Fluorides

The study evaluated the function of median sensory nerve fibers, as well as determining the relationship between its function with the duration of Carpal Tunnel Syndrome (CTS) and body mass index (BMI) among CTS patients in Physiotherapy Unit, Universiti Kebangsaan Malaysia Hospital (HUKM). Thirty subjects (6 males and 24 females) with mean age 53.30 ± 9.20 years and duration of the CTS 51.17 ± 50.22 months participated in this study. The sensitivity of median sensory nerve was evaluated using Current Perception Threshold (CPT) Test with stimulation frequencies of 5 Hz, 250 Hz and 2000 Hz; which demonstrated the function of C, Aδ and Aβ nerve fiber respectively. Majority of the CTS patients had normal function in the 3 types of median sensory nerve fiber. Forty percents of the subjects had abnormality in the Aâ function, 7% had abnormality of the Aβ function and 27% demonstrated abnormality in the C fiber function. Spearman Correlation Test showed no significant relationship between the function of median sensory nerve and the duration of CTS and body mass index (BMI) (p > 0.05). In conclusion, although majority of the patients demonstrated normal median sensory nerve function, abnormality of the Aβ, Aδ and C fibers sensitivity in some patients requires attention to prevent worsening of the nerve function thus avoiding related complications. Physiotherapists in HUKM may intensify the use of nervestimulating modalities such as Transcutaneous Electrical Nerve Stimulation (TENS) to normalize the nerve functions of these patients.

Hepatitis A, an acute usually self limiting infection of the liver is one of the most common vaccine-preventable infectious disease in the world. Effective vaccines which provide long term immunity against hepatitis A have been available since 1992. They are of known good quality, well tolerated with no serious adverse events and have been successfully used to protect different populations from infection as well as interrupt outbreak in closed communities. Mathematical models estimate the long term persistence of antiHAV antibodies to be more than 25 years. Vaccination efforts should be supplemented by health education and improved sanitation. Planning for large scale immunization programmes against hepatitis A should take into consideration epidemiological and cost benefit studies.
Hepatitis A ; seconds ; Infection as complication of medical care ; Hepatitis A Vaccines ; Vaccines

Synchronous primary non-small cell lung cancers (NSCLC) are rare and may be discovered unexpectedly following lung resection. Discrimination from intrapulmonary metastases is important to guide treatment and prognosis but is difficult solely on clinical or radiological findings. Histopathological evaluation with immunohistochemistry (IHC) markers can prove decisive and should feature in the diagnostic algorithm of such patients. We report a rare case of two synchronous primary NSCLCs diagnosed post operatively following pathological examination of the resected lobe, highlighting the value of IHC and discuss the management of such patients.

Transcranial magnetic stimulation (TMS) is a non-invasive, non-pharmacological technique that is able to modulate cortical activity beyond the stimulation period. The residual aftereffects are akin to the plasticity mechanism of the brain and suggest the potential use of TMS for therapy. For years, TMS has been shown to transiently improve symptoms of neuropsychiatric disorders, but the underlying neural correlates remain elusive. Recently, there is evidence that altered connectivity of brain network dynamics is the mechanism underlying symptoms of various neuropsychiatric illnesses. By combining TMS and electroencephalography (EEG), the functional connectivity patterns among brain regions, and the causal link between function or behaviour and a specific brain region can be determined. Nonetheless, the brain network connectivity are highly complex and involve the dynamics interplay among multitude of brain regions. In this review article, we present previous TMS-EEG co-registration studies, which explore the functional connectivity patterns of human cerebral cortex. We argue the possibilities of neural correlates of long-term potentiation/ depression (LTP-/LTD)-like mechanisms of synaptic plasticity that drive the TMS aftereffects as shown by the dissociation between EEG and motor evoked potentials (MEP) cortical output. Here, we also explore alternative explanations that drive the EEG oscillatory modulations post TMS. The precise knowledge of the neurophysiological mechanisms underlying TMS will help characterise disturbances in oscillatory patterns, and the altered functional connectivity in neuropsychiatric illnesses.

Walking 10,000 steps daily is associated with beneficial health outcomes. Recent systematic reviews have suggested that pedometers may be an effective motivational tool to promote walking. The aim of this study was to study the effectiveness of a 10-week, pedometer-based walking intervention to improve physical activity, body composition and metabolic health indices in a sample of suburban community-dwelling adults not meeting current physical activity recommendations. After screening, 34 overweight/obese individuals (mean age: 46 ± 8 years, mean BMI: 28.3 ± 4.2 kg/m2 ) were accepted into the walking program conducted by the Health Promotion Community Centre, Bangi. Subjects were instructed to increase their steps by 3000 steps daily above their baseline values for 10 weeks. Daily step count, body weight, BMI, waist circumference, as well as blood pressure, fasting glucose and lipids were evaluated at baseline and following the 10-week intervention. Thirty-one participants completed the program with 100% adherence. The average daily steps recorded during the 10-week intervention was 9693 ± 2196 steps per day. Mean daily steps increased from 8679 ± 2567 steps in Week 1 to 10,766 ± 3200 steps in Week 10 (p=0.040). Overall, there were reductions in body weight (-1.13%, p=0.010), waist circumference (-3.5%, p=0.001) and BMI (-1.41%, p=0.008) as well as fasting blood glucose (-8.5%, p=0.003) and systolic blood pressure (-4.8%, p=0.007) following the intervention. The findings of this study demonstrated that a goal-driven, pedometer-based walking intervention for 10 weeks resulted in a modest reduction in body weight and improved metabolic health outcomes in overweight/obese, community-dwelling adults.

Evaluation of pre-qualifying interprofessional education (IPE) programmes is important in exploring its effectiveness. The University of the West of England Interprofessional Questionnaire (UWE IPQ) has been rigorously validated, yet few studies using this tool have been published. We aimed to explore the attitudes of final year allied health profession (AHP), midwifery and nursing students towards IPE in this study. Differences between students’ attitudes towards IPE according to gender, undergraduate programmes, academic background and experience were also explored. A total of 103 participants, AHP (n=10), midwifery (n=19) and nursing (n=74) students took part in the study. This study design used a cross-sectional questionnaire survey, and was conducted within the Faculty of Health Sciences, University of Southampton. The validated UWE IPQ was administered to a volunteer sample of final year AHP, nursing and midwifery students in June 2010. Findings revealed that majority of the students rated their communication and teamwork skills (76.7%), interprofessional learning (74.8%) and interprofessional relationships (92.2%) positively, but they held negative attitudes towards interprofessional interactions (69.9%). Significant differences were found between participants’ attitudes towards interprofessional learning in relation to undergraduate programmes (p=0.01) and prior working experience in health and social care (p=0.03). IPE has shaped the students’ views regarding their collaborative learning and teamwork. Therefore, introducing IPE initiative from the beginning of the pre-qualifying stage at universities would motivate them to become interprofessional collaborative-ready professionals.

Involvement of informal carer in post-stroke care is important to prevent development of secondary complications particularly among stroke survivors with severe disability. However, to date, evidence on the benefit of stroke care training and involving carer to assist in the care for this group of stroke survivors is still limited. In this study, we evaluated the outcome of a carer-assisted care program for stroke survivors with severe disability who live at home. Sixteen stroke survivors with severe disability and 16 primary carers participated in this pre-test post-test intervention study. Carers were trained using a stroke care module which was developed by a group of multidisciplinary researchers from Universiti Kebangsaan Malaysia, prior to implementing the daily care for 8 weeks. Outcome of care on stroke survivors was assessed in term of change in disability level and quality of life using Modified Barthel Index (MBI) and EuroQol health-state measure (EQ-5D and EQ-VAS), respectively. While outcome of stroke care training on carer was determined using Modified Caregiver Strain Index (MCSI). Significant improvement is shown in the stroke survivors’ EQ-VAS component of EuroQol health state measure (average increase by 12%, t = 2.86, p = 0.01) following the care. Although not statistically significant (t = 0.97; p = 0.35), the mean score of MCSI reduced by 14%. No significant change was found in the MBI of the stroke survivors at completion of the program. Carer-assisted care is useful in improving quality of life of stroke survivors and can potentially reduce stress level among carers. Larger study may assist in establishing these preliminary findings.

Aims: Rice blast disease caused by Pyricularia oryzae is one of the major biotic diseases of rice in Sarawak, Malaysian Borneo. This study aims to isolate and characterize rice blast fungus obtained from infected leaf collected from four different divisions in Sarawak, viz, Miri, Serian, Sri Aman, and Kuching. Methodology and results: Twelve succeeded isolates were pre-identified as P. oryzae by morphological characteristics of spores, followed by verification through (internal transcribed spacer) ITS sequencing. The isolates were evaluated for morphological characteristics, growth rate and sporulation rate, which were grown on two types of media, (filtered oatmeal agar) FOMA and (potato dextrose agar) PDA. Morphological characterization showed that the colony surface of the different isolates varied from smooth and fluffy to rough and flattened mycelia; some were with the present of concentric rings, and some with aerial mycelia. The growth rate and sporulation rate of each isolate varied based on types of media used. Most of the isolates grew faster on PDA than on FOMA but produced higher number of spores on FOMA as compared to PDA. Conclusion, significance and impact of study: This preliminary study showed that there were variations observed based on morphological and physiological characterization for the different isolates collected in Sarawak, Malaysian Borneo. This study is the first step towards understanding variation in the population of P. oryzae from Sarawak.

Stress and anxiety are common among intensive care unit (ICU) patients especially those who are on mechanical ventilation. Non-pharmacological interventions such as music and prayer are recommended because they are opioid sparing, easy to provide, cheap and safe. There is a growing body of evidence on the effects of Holy Quran Recitation (HQR) in reducing stress and anxiety in critically ill Muslim patients. The aim of this review is to evaluate the physiological and psychological effects of HQR specifically in ICU setting. This review was performed on articles published between 2007 and 2018. Extensive search was done using PubMed, ISI Web of Knowledge, Scopus and Google Scholar. Systematic review articles are also assessed and relevant literatures are hand searched based on reference lists and citations made in key publications. Studies related to HQR which were done outside adult ICU setting were excluded. A total of nine articles are included in the final list for detail analysis. Findings of this review revealed six studies with significant results in improving stress responses, hemodynamic stability and conscious levels. HQR is a potential nonpharmacological tool to reduce stress and can also be used as auditory stimulus to improve conscious level in comatose patients. More studies in this area are recommended aiming for low risk of bias, appropriate calculation of sample size and adequately powered to detect significant outcomes.