Helium gas inhalation for suicide is a relatively new technique and practically unheard of in Malaysia. The internet has helped spread this technique rapidly across the globe. We report a case of helium gas inhalation as a suicide attempt in Malaysia. Such a case offers a diagnostic challenge upon presentation. Simple techniques of ensuring adequate oxygenation can help in treatment of such cases

Cytomegalovirus (CMV) is frequently isolated from neonates. Symptomatic infection is only apparent in 10% of affected babies with particular predilection for the reticuloendothelial and central nervous system. Isolated respiratory system involvement is rarely encountered. We report a case of a premature 32 weeks infant who required prolonged oxygen dependency and treated for bronchopulmonary dysplasia. The diagnosis of CMV pneumonitis was only discovered after detection of CMV DNA in the bronchoalveolar lavage. A high level of clinical awareness is crucial as a definite diagnosis and treatment will significantly alter the morbidity and the cost of therapy.

Pesticides application is essential in protecting crops and increases their productivity. However, this causes the pesticide residues to contaminate the crops and their surrounding environment that will eventually lead to exposure to human being. There is very little understanding on the human health effects of pesticides, thus many studies are being carried out for this purpose. In conjunction to this, there are various analytical methods on multi-residue pesticides analysis that have been developed over the years in various samples. This review provides an overview of the reported concentration of pesticides, the extraction and determination techniques of pesticides in environmental samples and the potential health effects they imposed on human in Malaysia from 2007 to 2017.

Introduction: Diverse tools dedicated to the assessment of various NTS components during cardiopulmonary resuscitation have been published for medical professionals, nevertheless there are no precise measures for the assessment of emergency resuscitation relevant in the context of non-medical community. The aim of the study is to combine and develop a valid and reliable nontechnical skills (NTS) tool for basic life support emergency resuscitation training via simulation learning for flight attendant. Methods: (1) Selection and combination of relevant items into a draft instrument with a UKM specialist team. (2) Obtaining the expert’s review from various specialty for content validity. (3) Instrument testing through pilot study on five recorded simulated case scenarios involving four different elements of nontechnical skills (teamwork, communication, decision making & situation awareness) which were demonstrated in a medical emergency (acute myocardial infarction) (4) Obtaining the internal consistency & inter-rater reliability of the instrument. Results: Through expert review, selected items had been found to have an excellent total content validity index of 1.00. A single mean of both raters yielded a good internal consistency of 0.77. Strong correlations of both ratings from raters in each video ranging from 0.69 to 0.93 (p < .05). There was a good inter-rater reliability (ICC 0.68) and a good agreement (Kappa 0.62 – 0.81) among raters. Conclusion: The CETAM was found to be a reliable and valid instrument and should be beneficial for the measurement of NTS, nevertheless further evaluation is required to fully determined its properties before reaching definitive conclusion.
Basic life support

Introduction: In respond to the World Health Assembly global NCD target of 30% reduction in the prevalence of adult tobacco use by 2025, Malaysian government called for lowering its smoking prevalence to 15% by 2025. In addition, moving towards the endgame target of less than 5% smoking prevalence in 2045. Methods: Malaysia Abridged SimSmoke model, a simulation model uses specific policy parameters, the most recent smoking prevalence, and population size for Malaysia is developed to estimates and access the impact of MPOWER policies in achieving the targets. Results: The 15% prevalence rate in 2025 can be achieved if the Malaysian government increase tobacco excise tax to 72% of the retail price, implement and enforce comprehensive smoke-free air policies, ban all forms of advertising/promotions and run intensive mass media campaigns. Such approach would reduce the number of smokers by about 2.6 million, averting almost 1.3 million premature deaths in the long term. The tobacco endgame target of less than 5% smoking prevalence by 2045 is achievable if the excise tax is further increased to 86.5% of the retail price while all other tobacco control policies are kept at the enhanced level. Conclusions: Both the targeted smoking prevalence are a realistic proposition if the proposed measures are fully implemented. It requires a whole government approach with the MOH as a leading agency driving the process. It is important to monitor both the compliance with the new measures and smoking prevalence to make sure that Malaysia is on track in achieving its targets.
Tobacco

Introduction: Physical inactivity has been recognised as the fourth leading risk factor for mortality worldwide. Individuals who are physically inactive have an increased risk of 20% to 30% of dying prematurely. Individuals who fulfil the minimum recommendations of physical activity can reduce the development of Non-Communicable Diseases. In 2015, 33.5% of Malaysian adults were reported to be physically inactive. Various factors were found to be associated with physical activity participation and these factors need to be explored. Methods: A cross-sectional study using proportionate simple random sampling was conducted. A total of 310 health staff were sampled according to the proportion from five divisions and data were collected using a self-administered questionnaire. IBM SPSS version 22.0 were used to analyse the data. Predictors for physical activity were also determined. Results: The response rate was 97.7% (303 out of 310). The prevalence of physical inactivity among respondents was 37.6%. The predictors for physical inactivity were smoker/ex-smoker (aOR=2.308, p=0.027), certificate/diploma education (aOR=2.135, p=0.008), personal barrier (aOR=1.055, p=0.017) and social environment barrier (aOR=1.106, p =0.025). Conclusion: People that have a higher possibility of being physically inactive were those with certificate or diploma education and smokers or ex-smokers. Those with personal barriers and social environment barriers likewise have higher probability of being physically inactive. Thus, appropriate health interventions should be developed by taking these factors into consideration to promote physical activity among the health staff.
Physical inactivity

Introduction: Sun exposure is a risk for skin cancer but is beneficial for multiple other diseases. Recommendations for photoprotection are well defined, guidelines for optimal sun exposure is not clear. We determined sun exposure in healthy adults, considering their skin phototype and amount of skin exposed. Methods: A cross sectional study was performed involving healthy adults working in a tertiary health facility. Fitzpatrick skin phototype quiz was used to determine skin phototype. Sun exposure was quantified as an index (SEI); body surface area exposed times duration of exposure. Results: We recruited 167 volunteers, 110(66%) women and 56(34%) men. Mean age was 29.77±6.58 years, 124(74.7%) were Malay, 27(16.3%) Chinese, 14(8.4%) Indians and 1(0.6%) of other ethnicity. Fitzpatrick skin phototypes were 30(18.1%) type III, 109(65.7%) type IV and 27(16.3%) type V. Exposed body surface area was 13.96±8.33% in males and 14.55±9.58% in females. The duration of sun exposure per week in males was 11.52±6.11hours and 10.71±5.75 hours in females. Mean SEI was 160 ±144. The SEI in females was 158 ±151, 164 ±130 in males, p value =0.81. There were no significant differences in SEI between gender and skin phototypes. Conclusion: SEI was very low in our study population due to limited body surface area exposed and duration of sun exposure. SEI was higher in darker skin and males, however these were not statistically significant.
Sun exposure

Introduction: Leptospirosis is a preventable zoonosis of public health importance. Due to increasing incidence of leptospirosis and seasonal floods affecting Kuantan community, a study was conducted to identify the determinants of leptospirosis preventive practices. Methods: A cross-sectional study was carried out in Perkampungan Sungai Isap, Kuantan, Pahang, Malaysia, which obtained 568 respondents by stratified proportionate random sampling technique. Data was collected using a modified guided questionnaire and analysed using IBM SPSS version 22.0. Results: Majority of the respondents were females (52.6%), Malay ethnicity (98.8%), attended up to secondary school (57.2%), worked in low-risk occupational group (96.0%) and reside in moderate-risk stratum (55.6%). Overall, majority (68%) of the respondents had good knowledge. However, only 38% of the respondents had satisfactory attitude and 18% had satisfactory practice. There were significant associations between stratum and leptospirosis preventive practices (χ2=11.84, df=2, p=0.003), age group and leptospirosis preventive practices (χ2=7.41, df=2, p=0.03) and personal income and leptospirosis preventive practices (χ2=6.32, df=1, p=0.01). Multivariate logistic regression showed that the predictors of satisfactory leptospirosis preventive practices were high-risk stratum (aOR: 3.69, 95% CI: 1.71-8.00, p=0.001) and monthly personal income of less than RM1000 (aOR: 1.65, 95% CI: 1.05-2.59, p=0.03). Conclusions: Leptospirosis can be prevented by having adequate awareness regarding the disease through health promotional activities especially before, during and after flooding, targeting more on those in low to moderate risk areas and higher income group to prevent potential outbreaks.
Leptospirosis

Introduction: The formation of bacterial biofilms by opportunistic microorganisms on the surfaces of the implants is the leading etiopathogenetic factor of peri-implant mucositis and peri-implantitis. The purpose of this research was to study the adhesive and biofilm-forming properties of clinical strains of K. kristinae isolated from patients with peri-implant mucositis. Methods: 18 clinical strains of K. kristinae isolated from the patients were the object of the study. The adhesion of the microorganisms was determined by using formalized human red blood cells of the blood group O (1) Rh+ by the G. Brilis technique. The study of biofilm-forming properties of clinical isolates of K. kristinae was performed by using the spectrophotometric technique by G.D. Christensen (MtP microtiter plate test). Results: The representatives of genus Kocuria were isolated in 70% of patients. Total proportion of clinical isolates of Kocuria spp. among all isolated microorganisms reached 18.3%. The representatives of the species K. kristinae showed a high adhesion to red blood cells and high ability to form biofilms. The r-Pearson coefficient (+0.87) between adhesion and the ability to form biofilms by K. kristinae strains pointed out a direct correlation. Conclusions: Obviously, Kocuria spp. take part in peri-implant mucositis development. It is proved by their presence on the mucous membrane of peri-implant area of patients with complications after dental implant placement. The representatives of the species K. kristinae showed a high adhesion and high biofilmformation.
Biofilms

The application of ultrasound technology has been widely accepted in clinical settings, particularly in Obstetrics and Gynaecology. This is in light of its ability to detect early foetal malformations apart from enabling foetal monitoring throughout gestation. While ultrasonography is an imaging method that is regularly used in Obstetrics, it is questionable as to whether it is safe for foetuses. The purpose of this paper was to review the evidence regarding the thermal effects of ultrasound exposure on foetal development, particularly. It is hoped that the importance of prudent usage of prenatal ultrasonography will be impressed on clinicians and the public in order to avoid the unnecessary usage of ultrasonography when it is not medically indicated. This is so that the welfare of pregnant women will be looked after, besides contributing to the better health of the next generation by ensuring that the benefits outweigh the known risks or potential harms.
Prenatal