Introduction: Perinatal depression and anxiety are prevalent, but professional mental health help-seeking remains low, resulting in a lack of utilization of mental health services. We aimed to determine the prevalence of positive mental health help-seeking behaviour (MHHSB) among pregnant women and its associated factors. Materials and methods: This cross-sectional study was conducted at an urban public maternal and child health clinic (MCHC) in Selangor, Klang Valley between August and November 2022. 296 pregnant women were recruited. The Malay version of Edinburgh Postnatal Depression Scale (EPDS), Self-Stigma of Seeking Psychological Help (SSOSH), Mental Health Literacy Scale (MHLS) and MHHSB questionnaires were used for data collection. Multivariate logistic regression was used to identify factors. Results: The mean age was 30.06 (±5.14) years and more than two-third (61%, n=181) were multiparous. More than half (57.4%, n=170) were in their second trimester, while 15.9% (n=47) and 21.3% (n=63) had probable depression and anxiety, respectively. The prevalence of positive MHHSB was 73.6% (95% CI: 0.68, 0.78), yet the prevalence of probable getting professional assistance was 22.6% (95% CI: 0.18, 0.28). Two factors were associated with positive MHHSB. These were probable anxiety [odds ratio (OR)3.86, 95% CI: 1.80, 9.15] and MHLS [OR 1.05, 95% CI: 1.03, 1.08]. Conclusion: Positive MHHSB was prevalent among pregnant women, yet the possibility of seeking professional assistance is low. Having anxiety was likely to influence MHHSB, hence efforts to improve mental health literacy and training staff to recognize symptoms and cultivating supportive environment for pregnant women will ensure timely interventions.

Dengue remains a public health threat that consumes a significant number of resources for its prevention and control. This systematic review aimed to solidify recent costing evidence in dengue management among South East Asian (SEA) countries. All studies conducted between 2010 and 2020 were retrieved using four international databases i.e. PubMed, Scopus, Web of Science, and Emerald Insight. The review was reported according to PRISMA guidelines. Quality assessments were done independently by two reviewers using a checklist adapted for the cost of illness studies. We identified 13 original articles representing several SEA countries. Among the common reported costing measure include total cost/ health expenditure; direct medical cost; direct non-medical cost; and indirect cost. The estimated total cost for dengue management varied between countries largely due to the difference in the total incidence of dengue cases. The estimated cost spent on dengue per capita GDP ranges from less than 0.001% to 0.1%, depending on the recorded number of dengue cases of the year. The majority of the articles focused on the economic burden from the perspective of treatment such as hospitalization and ambulatory care. In a nutshell, the economic burden of managing dengue infection is costly and the evidence suggests a steady increase in health expenditure with the growing number of dengue cases

Aims: LysM containing-protein is widely distributed in all domains of life and this kind of protein is essential for various biological activities in living organisms. Rv1288, a LysM containing-protein with esterase, was found in Mycobacterium tuberculosis. Biophysical studies revealed that the protein is responsible for modulating lipid metabolism that enables pathogens to survive under extreme conditions and decrease the permeability of the pathogen’s cell wall to drug therapeutic agents. However, recognition and interaction between the protein, lipid and carbohydrate moieties at the molecular level remains largely unknown and must be investigated. Therefore, a production of recombinant protein Rv1288 should be performed to aid the study. Methodology and results: In this study, we cloned the full-length cDNA of Rv1288 from M. tuberculosis strain H37Rv and expressed it in pET-24d- Escherichia coli BL21(DE3) cells. Affinity and size exclusion chromatography methods purified the protein, and its preliminary oligomerisation state was determined based on a calculated apparent molecular weight of the protein. Rv1288 was expressed as a soluble protein at 20 °C, induced with 1 mM of isopropyl β-D-1-thiogalactopyranoside (IPTG). The calculated apparent molecular weight suggested that the Rv1288 protein formed a hexamer in solution. Conclusion, significance and impact of study All the methods involved in this study to produce the recombinant Rv1288-pET24d and its soluble protein in E. coli cells have been described. Hence, it can be implemented for future studies.

Introduction: In circumstances where the ante mortem list is unknown, gender determination would exclude onehalf of the population, aid in a more precise search of the ante mortem records. This study aims to formulate gender prediction models in the Pakhtun Pakistani population using digital dental arch dimensions. Methods: Data collection and analysis of the dental casts were conducted on 128 subjects, 64 males and 64 females from the Pakistani population. The mean age of the subjects was 19.2 years old. Several linear dental arch dimensions were measured and recorded for both upper and lower arches. Results: It was found that gender differences in linear arch dimensions were statistically significant for both males and females (p<0.05); in which the arch dimensions for the males were larger than the arch dimensions for the females. Stepwise discriminant function analysis found that the highest discriminant power of the variables was present within the inter-second premolar width for the upper arch and inter-molar width for the lower arch. These variables significantly contributed to gender variance. Moreover, the prediction of 67.2% of original grouped cases for the upper arch and 66.4% of cross-validated group cases was correct. Similarly, the correct prediction was made on 64.8% of original grouped cases for the lower arch and 64.1% of cross-validated group cases. Conclusion: The dental arch dimensions were larger among the males compared to the females. Prediction models obtained in this study were moderately strong predictors which may be used as an adjunct to predict gender.

Ocular trauma remains a significant cause of eye blindness. Disruption or violation of the globe's integrity can lead to an ocular emergency that usually jeopardises the vision. Early identification of this condition can fasten the management process to give the patients the best and most appropriate treatment. We described the role of point-of-care ultrasound (POCUS) in diagnosing globe rupture in the Emergency Department.
Emergency Service, Hospital

Introduction: The forward psychiatry practice in the combat field has proven effective in reducing the attrition rates due to combat and operational stress of the service members. The concept has evolved over the years with the same objective to conserve the fighting troops' strength and minimize the incident rates of post-traumatic stress disorder among the soldiers. The Combat and Operational Stress Reaction (COSR) team has been deployed to the conflict zone and applied the forward psychiatry principles to the troops on the battlefield. Case Series : Here, we presented 3 case series of service members that were attended by the COSR team during their deployment on the frontline. First, a serviceman presented with late recognition of acute stress symptoms following active combat duty with poor support from his unit. Second, a combat engineer presented with anxiety and somatic symptoms after combat duty; third, a combat radio operator with early detection of acute stress symptoms by his unit commander. Results: In the first case, the patient's psychological condition deteriorated, requiring frequent sedation and transfer to a military tertiary hospital. In the second and third cases, both patients improved and returned to their duties with individualized psychotherapy and relaxation techniques. Conclusion Early detection of the symptoms and intervention based on the principles of forward psychiatry in active combat zone facilitate service members' return to function and reduce complications and morbidity to their psychological health

Objectives: Soldiers can manifest a wide range of psychological symptoms that varies from anxiety, depression to somatic symptoms in combative and noncombative situations. This paper aims to discuss the issue related to the challenges of establishing the diagnosis of a soldier in a stressful non-battlefield condition. Methods: : We herein report a young soldier with no underlying medical condition who presented with initial abnormal behaviour associated with progressive mutism for two years. Physical examination was unremarkable. Relevant blood investigations and Magnetic Resonance Imaging (MRI) brain revealed no abnormalities. He was initially treated as brief psychotic disorder and was revised into Schizophrenia based on Diagnostic and Statistical Manuals of Mental Disorders (DSM-5) and was started on antipsychotics. However, he showed no improvement after two years on treatment. He was on the verge of being discharged from the service due to medical reasons. Therefore, he was readmitted to the ward for evaluation of the diagnosis while all of his medications were withheld. Different psychological approaches including supportive therapy and occupational therapy were employed. Results: Following series of individual supportive therapy sessions, we uncovered the unconscious psychological conflicts within him. He gradually started to communicate verbally and his psychosocial functions began to improve. Upon discharged, the soldier was diagnosed as Functional Neurological Symptom Disorder. Conclusion A thorough and careful evaluation was crucial in assessing patients with progressive mutism to ensure a correct diagnosis was made. In a patient who failed to improve after optimum treatments were given, a different approach may be utilized to explore the possible factors that hindered the patient’ recovery.

The modiolus of the face manifests the interesting landmark for facial muscles attachment. The strong connective tissue fibres play an important role in the clinical setting, especially in the aesthetic and dental surgeries. In the fourth week of intrauterine life, the development of the modiolus evolves in accordance with the growth of muscles of facial expression. Microscopically, a white, tendinous structure with the thick irregular collagenous connective tissue of collagen fibres predominance appeared to be the modiolus. Modiolus is morphologically a fibromuscular muscle situated on the lateral border of the mouth. The formation of the nasolabial fold is important and a well-developed modiolus provide a toned face. Several works of literature forementioned the number of facial muscles attached to the modiolus but no definitive similarity are identified. This review summarizes the updated morphological features and applied anatomy of the facial modiolus with its muscle attachment.

ed as outpatients. Ultrasonographyevidence of plasma leakage either pleural effusion,thickened gallbladder wall, ascites or pericardial effusionwere compared with clinical findings and laboratoryparameters for plasma leakage. Results: Of the 83 dengue patients, eventually 72.3% haddengue fever with warning signs and 6.0% had severedengue fever. There were 38 patients who had subclinicalplasma leakage at initial presentation, 84.2% and 7.9% ofthem then progressed to dengue fever with warning signsand severe dengue respectively. There was a minimalagreement between serial bedside ultrasound andhaematocrit level in the detection of plasma leakage(observed kappa 0.135). Conclusions: Serial bedside ultrasound is an adjunctprocedure to physical examination and may detect plasmaleakage earlier compared to haemoconcentration. The earlyusage of serial ultrasound is of paramount importance indetecting dengue patients who are at risk of progressing tosevere dengue.

Atrial ectopic rhythm is one of the most common fetal arrhythmias that can present during the prenatal period. Detection of fetal arrhythmia can be made by auscultating fetal heart rate and rhythm using a fetal handheld Doppler, and this can be done even in a resource-limited setting. Te fnding of an abnormal fetal heart rate and rhythm should prompt early referral to a pediatric cardiologist, as this may improve clinical outcomes. We present a case of atrial ectopic rhythm detected in utero using a handheld Doppler.