Background: Healthcare workers (HCWs) are at increased risk of getting influenza than the general population, therefore putting patients at risk of nosocomial infection. Influenza vaccination coverage among HCWs is low despite the availability of a safe and effective vaccine. However, the reasons for such a poor uptake are not well reported in Malaysia. This study aimed at assessing the rate of influenza vaccination uptake, knowledge and attitude of healthcare workers regarding influenza, and employers’ policy on influenza vaccination. Methods: A cross-sectional questionnaire survey was conducted in three hospitals in the Klang Valley. Mann–Whitney test was used to assess possible differences in knowledge and attitude towards flu vaccination and the χ2 was used for categorical variables. Analyses were performed with SPSS 22.0. Results: A total of 690 questionnaires were distributed; 527 were returned (giving a response rate of 76.4%. The vaccine uptake was 51.4% with the majority (83.5%) of those believing they were vaccinated to protect themselves. Higher proportion of vaccinated HCWs (p <0.05) agreeing to the fact that influenza is a serious threat to their health, however, 10% were not sure of its safety. Eighty-three (15.7%) claimed their employers did not have a vaccination policy, while 43.3% were not sure if their employers have vaccination policy. Conclusion: This study has demonstrated more than half of the healthcare workers were vaccinated, with a significant proportion of the healthcare workers believed they were vaccinated to protect themselves, while most of those that were not vaccinated claimed they are worried about the safety of the vaccine. Most employers did not have a flu vaccination policy in place. Hence, the need for government to enforce such policy and make annual flu vaccination free and compulsory for all healthcare workers KEY WORDS:

A clinical descriptive study was done to determine the sociodemographic, laboratory and clinical characteristics of patients with congenital adrenal hyperplasia (CAH) referred to Hospital Putrajaya, a tertiary endocrine centre in Malaysia. Electronic laboratory data of 51 CAH patients were obtained. The demographics and clinical details of the study population were acquired from a questionnaire completed by parents of participants. There were 25 males (49%) and 26 females (51%), of which, 58.8% were Malays. Median age of participants was 4 years whilst median age at diagnosis of CAH was two years. Parental consanguinity was documented in three patients (5.9%). Patients originated from Johor (19.6%), Selangor (19.6%), Negeri Sembilan (17.6%) and Kedah (13.7%). Majority of patients were diagnosed after one week of life (80.4%) although more females were diagnosed under the age of one week compared to males (p=0.041). Most females presented with ambiguous genitalia (42.3%) [p=0.001] whereas 72% of males presented with salt wasting (p=0.003). No significant associations between race and all other variables, though interestingly three Malay patients presented with ambiguous genitalia and hypertension. Equal gender distribution noted as expected in an autosomal recessive condition, although not in keeping with other Asian countries. Early diagnosis in females attributed to obvious genital ambiguity at birth. Varied clinical presentation, although in minority, necessitates genetic studies for prompt diagnosis and treatment. Considering that majority of patients presented with salt wasting and the age at diagnosis was delayed, the introduction of a neonatal screening programme is essential in Malaysia.
Adrenal Hyperplasia, Congenital

INTRODUCTIONGestational hypertension (GH) is a common disorder during pregnancy that can progress to preeclampsia and cause various subsequent fatal complications. A cluster of enzymes, called matrix metalloproteinases (MMPs), and its specific inhibitors, tissue inhibitors of metalloproteinases (TIMPs), have been reported to be involved in the pathophysiology of GH. The purpose of this study was to examine circulating levels of MMP-9, TIMP-1 and TIMP-2 in pregnant women who had GH and those who were normotensive.

METHODSIn a case-control study, the total levels of MMP-9, TIMP-1 and TIMP-2 in the sera of 108 pregnant patients were evaluated using enzyme-linked immunosorbent assays. 54 patients with GH (test group) and 64 normotensive pregnant women (control group) were included in the study.

RESULTSWhile MMP-9 levels showed a high level of expression in the GH group (p = 0.085), TIMP-1 and TIMP-2 levels showed low levels of expression for the same. Weak positive correlations were found on correlation analysis between maternal age and TIMP-1 in the GH group (r = 0.278, p < 0.05), and between gestational age and TIMP-2 in the control group (r = 0.318, p < 0.05).

CONCLUSIONOur findings suggest that MMP-9 may be involved in the pathophysiology of GH. It may be of value to further evaluate MMP-9 as a potential biomarker for predicting preeclampsia in pregnant women.

Adolescent ; Adult ; Biomarkers ; blood ; Case-Control Studies ; Enzyme-Linked Immunosorbent Assay ; Female ; Gestational Age ; Humans ; Hypertension, Pregnancy-Induced ; blood ; diagnosis ; Matrix Metalloproteinase 9 ; blood ; Pregnancy ; Tissue Inhibitor of Metalloproteinase-1 ; blood ; Tissue Inhibitor of Metalloproteinase-2 ; blood ; Young Adult

Introduction: Endometrial carcinoma is the most common gynaecological malignancy in developed countries and the sixth most common cancer among women worldwide. Cancer staging is vital in treatment decisions and the prediction of prognoses, and is based on imaging studies, histological results and surgery. Therefore, a simple and fast preoperative tool to predict the precise cancer stage of patients is needed. CA 125, a cancer antigen, is used in assessing therapeutic response and cancer surveillance in endometrial carcinoma. However, this tumour marker is not routinely performed in the mentioned circumstances. Studies have shown that preoperative CA 125 was significantly high in patients in a higher stage of endometrial cancer. Thus, this study aims to assess the primary role of CA 125 in predicting the stage of endometrial carcinoma, by correlating preoperative serum CA 125 with clinicopathological parameters. Method: The retrospective data of endometrial carcinoma cases consisting of demographic and clinicopathological parameters as well as preoperative serum CA 125 levels were retrieved from Laboratories Information System (LIS) at Hospital Selayang, Selangor, Malaysia, from January 2000 until June 2016. Only 20 cases fulfilled the inclusion and exclusion criteria. Preoperative serum CA 125 was correlated with demographic and clinicopathological parameters, and was analysed using a Kruskal-Wallis test. Results: There was a significant association between elevated serum CA 125 with myometrial and cervical stroma invasion in endometrial carcinoma (p<0.05). Conclusion: Preoperative serum CA 125 is a useful marker in predicting early stages of endometrial carcinoma, and plays a role in pre-operative cancer staging in endometrial carcinoma.

Introduction: Malaria poses immerse public health challenges in the world as it is still causing significant morbidity and mortality especially in endemic regions such as Zambia. One of the effective tools in preventing malaria is the application of insecticide-treated bed nets (ITNs). This study aims to explored the socio-acceptability of malaria and ITNs among rural village community of Mazabuka, Zambia. Methods: A semi-structured questionnaire was administered to 177 respondents via two different approached methods; focus group discussions and one-to-one interviews to assess the level of KAP of the respondents about malaria and ITNs. Results: Most of the respondents (98.7%) possessed ITNs that were provided free of charge by the Ministry of Health Zambia. Overall, the knowledge and attitude of respondents on malaria and ITNs were at moderate levels of 68.1% and 71.8%, respectively. In contrast, the level of practice was poor with only 36.2% of positive response. Although 92.1% of the respondents answered correctly on the association between malaria and mosquito bites, myths and misconceptions were still common as some of them still attributed malaria to drinking dirty waters (32.8%), bad weather (15.8%), witchcraft (3.4%), and bathing dirty water (19.8%). The practice was significantly associated with knowledge (p=0.003), but not attitude (p=0.230). Logistic regression analysis revealed that respondents with high knowledge level and tertiary education were more likely to use ITNs correctly (OR=2.957; OR=21.739, respectively). Conclusion: The present study showed that the knowledge gaps were remained among the villagers as misconceptions and their believe of myths were still exist.

Introduction: The internalization process of group A streptococci (GAS) into human cells is one of the crucial steps in the pathogenesis of GAS infections, which could also affect their susceptibility responses toward several antibiotics. Currently, data on the distribution of internalization-associated genes and susceptibility patterns are still lacking in Malaysia. This study investigated the distribution of fibronectin-binding protein F1 (prtF1) and streptococcal pyrogenic exotoxin B (speB) genes in GAS isolates with their susceptibility profiles and source of samples. Methods: We used 43 GAS isolates from our previous stock culture and performed antibiotic susceptibility testing by Kirby-Bauer disk diffusion method and interpreted the results according to the established guidelines. We detected virulence (prtF1 and speB) and resistance (ermA, ermB, mefA, tetM and lnuA) genes by PCR method using established primers and protocols. Results: High resistance rates were observed against doxycycline (58.1%) and clindamycin (16.3%). In comparison, 100.0% and 46.5% of GAS isolates carried speB and prtF1 genes, respectively. tetM and lnuA genes were detected in all respective resistant isolates (100% for each). No macrolide resistance genes were detected. Interestingly, prtF1 gene was highly distributed in doxycycline-resistant than doxycycline-sensitive isolates (60.0% versus 27.8%). Conclusions: High resistance rate of GAS toward doxycycline in our study may potentially reflect the uncontrol dissemination of tetM gene among our isolates. The presence of prtF1 gene among this strain would enhance its ability to evade the intracellular action of antibiotics, which may affect the management of GAS diseases. Thus, close monitoring of GAS by molecular methods is required in the future.

Introduction: Soil-transmitted helminths (STHs) are considered one of the neglected parasitic diseases that cause major health problems and other related complications. The aim of this study was to determine the prevalence of STHs and anaemia among school children of little-known refugee communities in Malaysia. Methods: A cross-sectional study was conducted among 148 refugee school children in the Klang Valley, Malaysia, from 2017 to 2019. Data were collected using a questionnaire, in addition to haemoglobin testing while faecal samples were screened for STHs eggs using the formalin-ether concentration technique. Results: The result showed that the prevalence of STHs in this study was 37.2%. Trichuris trichiura infection was the most prevalent (46.4%) followed by Ascaris lumbricoides (44.9%) and hookworms (8.7%). About 37.8 % of the respondents were found to be anaemic. Binary logistic regression showed significant infection with STHs complicated with anaemia (AOR: 3.67, 95 % CI 1.595-8.5). Conclusion: The evidence from this study suggests proper and strategic interventions to reduce morbidity. An alternative and efficient system is needed to provide the schoolchildren with basic care for sanitation and health provision. It is recommended that voluntary clinics provided by non-government organisations focus on counselling and advice on personal hygiene of the children.

Introduction: Total calcium concentration is widely used to assess body calcium status although limited by many confounding factors. Thus, this study aimed to derive and internally validate an albumin-adjusted calcium equation for a selected Malaysian population. Method: This cross-sectional study involved 1011 adults at an emergency department of a tertiary hospital. Patients who had total calcium, ionised calcium and albumin measurements taken simultaneously were included. Derivation of the albumin-adjusted calcium equation was based on the adjustment equation obtained from the Association for Clinical Biochemistry and Laboratory Medicine 2015 position paper. Additionally, the equation was internally validated and compared with ionised calcium (gold standard) and the conventional Payne’s equation. Results: The newly derived equation = total calcium + 0.017 (41.35 – albumin). Internal validation exhibited the amount of shrinkage of 0.049. It tends to overestimate the adjusted calcium by a mean difference of 0.029 mmol/L compared to Payne’s equation. The comparison between Payne’s equation and the new equation with ionised calcium reclassified 402 and 486 patients, respectively into different calcium status. When both equations were compared, calcium status classification significantly differed in all and hypoalbuminaemic subjects by 90 and 16 patients, respectively. Conclusion: Locally derived albumin-adjusted calcium equation differed statistically in calcium status classification when compared to the Payne’s equation. However, to confirm this significance, the result must be compared to ionised calcium under strict, controlled preanalytical conditions. In terms of clinical significance, there was no difference in classification of calcium status between Payne’s and the new equation at medical decision limits.

Introduction: Eating out has always been associated with increasing cases of food poisoning. These problems can be minimized through mobile applications and technology development. A mobile application called MyWarung© was developed to provide an alternative, improved tool for improving food poisoning knowledge and preventive behaviour. Methods: This cross-sectional study aims to assess the feasibility and acceptance of the MyWarung© application for consumers in Terengganu. The 50 consumers were selected based on the inclusion and exclusion criteria using convenience non-probability sampling. The data were collected through a questionnaire that included three components: socio-demographic, feasible (6 components) and acceptable (7 components). The scoring above 80.0% indicates an acceptable, while lower than 80.0% show unacceptable for both feasibility and acceptability sections. SPSS 22.0 has analyzed the data. Results: The results showed excellent feasibility with a median score of 27.5 (IQR 6.0) out of 30.0, and acceptance with 32.0 (IQR 7.0) out of 35.0. Majority of the respondents agreed that the app is easy to use (94.0%), easy to understand (88.0%), attractive (84.0%), catchy (88.0%), provides more information (96.0%), efficient (96.0%), knowledge improvement (96.0%), beneficial (100.0%), useful application (88.0%), and recommend to the other people (84.0%). The overall result showed that most respondents agreed that MyWarung© application was feasible and acceptable with 90.0% and 86.0% feasibility and acceptability rate. Conclusion: The MyWarung© application among consumers can be highly feasible and acceptable in preventing food poisoning during dining out.