Objective:To determine the prevalence of Anaplasma marginale (A.marginale) and Anaplasma ovis from sheep and goat in different highland pasture in west of lran.Methods:From July 2015 to October 2015,370 blood samples of sheep and goat were collected fiom different regions in Hamedan province,Iran.The DNA extracted fiom blood and subsequently,16S rRNA and MSP4 genes were analyzed by nested-PCR,semi nested-PCR and RFLP methods.Results:In the PCR assessment,overall 27.5％ (102/370) of sheep and goat were positive for Anaplasma ovis and A.margiule infection,which was lower than reports from tropical and subtropical regions of lran.Statistical analysis (the Chi-square test) did not show any significant relation between infection and variables such as location,tick infestation age and sex (P ＞ 0.05).No significant correlation between the altitude and the Anaplasma species infection was found (Mann-Whitney test:P ＞ 0.05).However,Anaplasma infection in goat significantly is more than the sheep (P =0.008).Conclusions:The ecological changes affect the frequency and distribution of Anaplasma species.Furthermore,our results indicate that sheep as potential reservoirs ofA.marginale.

BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian populations. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in Kuwait population. METHODS: This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook (unit B) from November 2014 to March 2016. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. RESULTS: A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modified Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specificity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specificity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modified Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased significantly, from 18.4% to 10.7% for the modified Alvarado, and to 2.2% for the RIPASA scoring system, which was a significant difference (P<0.001) for both scoring systems. CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specificity than the modified Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modified Alvarado scoring system for Kuwait population.

practice and care environments are important aspects ofnursing care. The use of a reliable and valid scale canmonitor the quality of handover and provide information forcontinuous improvement of practice. This study aims todescribe the perception of nurses, on the domains of qualityof information, efficiency, interaction and support andpatient involvement. Method: A cross-sectional descriptive study was conductedamong 450 nurses from 37 wards in Hospital Kuala Lumpur.Nurses on shift duty were recruited by conveniencesampling from the Medical, Surgery, Obstetrics &Gynaecology, Orthopaedic and Paediatric wards. Using avalidated questionnaire (Handover Evaluation Scale), nursesself-rated their perceptions using a 7-point scale andprovided open-ended responses to the strengths andchallenges that they faced. Descriptive and inferentialanalyses were done while open-ended questions weresummarised based on key themes. Results: A total of 414 nurses completed the survey (92.0%response rate). Nurses had an overall mean (SD) perceptionscore of 5.01 (SD 0.56). They perceived good interaction andsupport during handover and on the quality of informationthat they received, with mean scores of 5.54 (SD 0.79) and5.19 (SD 0.69), respectively. There was an associationbetween the departments where the nurses worked and theiroverall perceptions on nursing handover (p<0.001).Interruptions being the most common theme emerged fromthe open-ended section.Conclusion: Despite having substantial interaction andsupport amongst nurses, opportunities for improvementswere noted. Improvements in the quality of handoverinformation and reducing interruptions should be the mainemphases as these were perceived to be essential in thecurrent handover practices by nurses.

Objective To determine the prevalence of Anaplasma marginale (A. marginale) and Anaplasma ovis from sheep and goat in different highland pasture in west of Iran. Methods From July 2015 to October 2015, 370 blood samples of sheep and goat were collected from different regions in Hamedan province, Iran. The DNA extracted from blood and subsequently, 16S rRNA and MSP4 genes were analyzed by nested-PCR, semi nested-PCR and RFLP methods. Results In the PCR assessment, overall 27.5% (102/370) of sheep and goat were positive for Anaplasma ovis and A. marginale infection, which was lower than reports from tropical and subtropical regions of Iran. Statistical analysis (the Chi-square test) did not show any significant relation between infection and variables such as location, tick infestation age and sex (P > 0.05). No significant correlation between the altitude and the Anaplasma species infection was found (Mann–Whitney test: P > 0.05). However, Anaplasma infection in goat significantly is more than the sheep (P = 0.008). Conclusions The ecological changes affect the frequency and distribution of Anaplasma species. Furthermore, our results indicate that sheep as potential reservoirs of A. marginale.

Background: Regarding the long-term safety issues with the use of inhaled corticosteroids (ICS) and the clinical predominance of dual bronchodilators in enhancing treatment outcomes in chronic obstructive pulmonary disease (COPD), ICS is no longer a “preferred therapy” according to the Global Initiative for Chronic Obstructive Lung Disease except on top of a dual bronchodilator. This has necessitated a change in the current therapy for many COPD patients. Objective: To determine a standardised algorithm to reassess and personalise the treatment COPD patients based on the available evidence. Methods: A consensus statement was agreed upon by a panel of pulmonologists in from 11 institutes in Malaysia whose members formed this consensus group. Results: According to the consensus, which was unanimously adopted, all COPD patients who are currently receiving an ICS-based treatment should be reassessed based on the presence of co-existence of asthma or high eosinophil counts and frequency of moderate or severe exacerbations in the previous 12 months. When that the patients meet any of the aforementioned criteria, then the patient can continue taking ICS-based therapy. However, if the patients do not meet the criteria, then the treatment of patients need to be personalised based on whether the patient is currently receiving long-acting beta-agonists (LABA)/ICS or triple therapy. Conclusion: A flowchart of the consensus providing a guidance to Malaysian clinicians was elucidated based on evidences and international guidelines that identifies the right patients who should receive inhaled corticosteroids and enable to switch non ICS based therapies in patients less likely to benefit from such treatments.

Rapid detection of Burkholderia pseudomallei, the etiologic agent of melioidosis, allows for timely initiation of appropriate treatment and better clinical outcomes. In the current gold standard, the culture method is time consuming and suffers from low sensitivity. Meanwhile, previously reported molecular assays are fast and sensitive, but their performance on isolates from Malaysia, an endemic region of melioidosis is under reported. This study designed oligonucleotides targeting orf2 of Type III secretion system (TTSS) genes cluster for the detection of Malaysian B. pseudomallei isolates and evaluated the assay on 95 local B. pseudomallei strains, 58 other microorganisms and 71 clinical specimens from patients. The developed assay exclusively detected all tested B. pseudomallei isolates with a detection limit of 20 fg per reaction (equivalent to ~2.5 copies). Subsequent testing on clinical samples showed that the assay detected all confirmed specimens with the growth of B. pseudomallei (n = 10/10). None of the negative specimens had a detectable signal of our TTSS-orf2 assay (n = 0/61). In conclusion, the present study provides crucial preliminary data for a subsequent study and should be considered as a potential alternative to current time-consuming culture method for the detection of B. pseudomallei.

Introduction: The number of breast cancer survivors in developing Asian countries is still lacking compared to Western countries. Health-related quality of life (HRQoL) of cancer patients is one of the significant predictors of survival. Hence, this study was conducted to determine HRQoL status among breast cancer survivors of different diagnosis duration in East Coast of Peninsular Malaysia. Methods: Cross-sectional data were collected for 128 breast cancer survivors, aged 37 to 72 years who were recruited by using purposive sampling method at two main government hospitals in Kelantan (n=67) and Terengganu (n=61). The validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ–C30) and Breast Cancer Supplementary Measure (EORTC QLQ-BR23) which had been translated into the Malay language were used to measure HRQoL. Independent t-test was used to compare HRQoL status among short term (≤5 years duration since diagnosis) and long term (>5 years duration since diagnosis) breast cancer survivors. Results: Overall, our breast cancer survivors reported good HRQoL, with high scores for global health status, functional status and low symptoms scores. Long term breast cancer survivors had better social functioning compared to short term survivors (p=.038). Nevertheless, there was no significant difference found for other HRQoL status between short and long term breast cancer survivors. Conclusion: Breast cancer survivors in East Coast of Peninsular Malaysia generally experienced good HRQoL. The relatively similar HRQoL status between long-term and short-term survivors indicated a constant HRQoL profile among survivors throughout their survivorship.