Objective To discuss the correlation TIMI risk score to plasma N terminal pro brain natriuretic peptide(NTpro-BNP)level and serum troponin Ⅰ(TNⅠ)in patients with acute coronary syndrome.Methods Totally 98 cases of acute coronary artery from May,2013 to September,2014 treated in our hospital with syndrome TIMI risk score were observed,According to the score,the patients were divided into low risk group(n=23),middle risk group(n=34)and high risk group(n=41),and NTpro-BNP and TNⅠ levels were detected by AQT rapid immunoassay.The correlation of TIMI and NTpro-BNP and TNⅠ were stud-ied..Results TIMI scores in single,double,triple disease have statistically significant differences(P <0.01).The adverse event in-cidence of the high risk group was higher than the middle risk group and the low risk group(P <0.01).TIMI risk score was effec-tive in predicting adverse cardiovascular events,patients in the 3 groups after 6 months of treatment all had higher incidence of ad-verse events than that of the 3 month and the treatment period,the incidence of adverse events in high risk group was significantly higher than that in low risk group and middle risk group(P <0.01).Low risk group,the middle group,the high risk group of pa-tients with the increase of TIMI risk score,NTpro-BNP and BNP levels were elevated,NTpro-BNP increases more significantly,can be used to identify high risk patients,(P <0.01).Spearman rank correlation analysis shows that NTpro-BNP was relation to TIMI (P <0.01),and NTpro-BNP had positive correlation with TNⅠ(P <0.05);TIMI no statistically significant correlation with TNⅠ(P >0.01).Conclusion TIMI risk score in patients with acute coronary syndromes has significant correlation with NTpro-BNP, but has no correlation with TNⅠ.

By the end of 2015, about 72,152 children with learning disabilities were registered under the Malaysian Welfare Service Department (JKM). Malnutrition has been found to be a common setback among children with learning disability (LD). This study presents available evidence on the prevalence and risk factors associated with malnutrition in children with LD. Methods: A framework suggested by Arksey & O`Male (2005) was used to carry out this scoping review. Published articles, reviews and reports were identified through a complete search. Inclusion criteria for the search were English articles related to LD, published from 2005 to 2016. Results: Seventeen international studies published from 2005 until 2015 with a total of 318,596 participants and one study involving 281 participants from Malaysia, were identified and included in this review (n=18). The target age range of the sample in these 18 studies was 2 - 20 years, with a mean age of 3.2 - 14.2 years. The prevalence of underweight among children with LD was 3.4 - 36%, overweight 7.6 - 37% and obesity 5.7 - 52%. Several studies reveal that malnutrition risk among children with LD is significantly associated with gender, age, genetic syndrome, type of disability, medication used, and country economic status. Conclusion: A number of studies show that children with LD have a higher prevalence of being overweight and obese than typically developing children and the risk associated with obesity significantly increases with age.

Objective To observe the adverse effects of two different high-dose methotrexate(MTX) in pediatric acute lymphoblastic leukemia.Methods Totally 25 cases acute lymphoblastic leukemia children were grouped according to the risk factor,the low-risk group(13 patients) received MTX 3 g/m2 continuous infusion and high-risk group(12 patients) received MTX 5 g/m2 continuous infusion.Using Calcium Folinate(CF) 36 h after first dose MTX (1/6 total dose) ,then compare the incidence rates and the severity of the MTX of adverse effects.Results Gastrointestinal syptoms, hver damage, mucosal damage were the most common adverse effects after high-dose MTX infusion, the two groups had no significant difference (P ＞ 0.05).Conclusion The incidence rates and the severity of adverse reactions of high dose MTX were related directly with the level and the persistencetime of the plasma concentration.

Autoregressive integrated moving average (ARIMA) was applied to make realtime predictions on the Aedes egg populations in three selected dengue hotspots of Penang, Malaysia. The weekly ovitrap collection was carried out to determine the abundance of Aedes eggs in field population in some selected areas. The ARIMA models were able to estimate actual egg abundance using two criteria. The first criteria is determine the reliability of statistics and the second is to measure the accuracy of forecasting ability of the model equation. The parsimonious model with a lowest order of AR or MA and RMSE value of the forecast for each data set was considered the best. ARIMA (1,0,0), ARIMA (2,0,0) and ARIMA (0,1,1) models were judged to be the best fit for the suburban, urban squatter and urban area data sets respectively. The models were able to forecast the number of eggs within a range of one to eleven weeks. The developed models were able to estimate the egg abundance adequately to permit their use in Aedes control programme in Penang Island. Thus, it can be a useful tool for health officials to improve the management of mosquito control and alert the public to reduce the possibility of dengue outbreaks.

The importance of non-technical skills among healthcare professionals is gaining a widespread recognition as critical elements complementing the technical skills used for improving patients’ safety. These skills are typically acquired through simulation training, which emerged as an effective way to complement clinical training. Non-technical skills frequently use high-fidelity simulation followed by a facilitated discussion known as debriefing. Debriefing by a skilled facilitator is thought to be essential for effective learning through reflective processes. Unfortunately, evidence to support the elements which contributes towards the effectiveness of debriefing remains sparse. We review the studies where elements of debriefing that have been manipulated and its effectiveness on the acquisition of non-technical skills among healthcare professionals through eight publications across four different databases. Non-technical skills performance improved after manipulated debriefing such as multimedia debrief, self-led debrief or no debrief. Besides, there was no added performance when video recording was added to facilitator-led debriefing. The application of learning theory on specific elements together with the application of selected debriefing models is highly encouraging for effective debriefing.

Children with dyslexia are commonly associated with gross motor difficulties. However, this non-literacy symptom is often overlooked as an important feature of dyslexia. Therefore, the aims of this study were to determine gross motor skills status among children with dyslexia and to compare the gross motor skills between younger and older children. A cross-sectional study was conducted on children with dyslexia from government schools and Dyslexia Association Malaysia. The participants were divided into two groups, namely younger (4 to 10 years) and older children (11 to 17 years old), and were recruited randomly. The gross motor skills were measured using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) (subtests: Body Coordination, and, Strength and Agility) and the Movement Assessment Battery for Children, Second Edition (MABC-2) (subtest: Aiming and Catching). Standard scores and percentile rankings were used for statistical analysis. A total of 82 children with dyslexia were recruited for this study, consisted of younger (n = 57) and older groups of children (n = 25). The younger children were found to have a significantly lower performance in gross motor skills in Body Coordination (Mdn = 48, IQR = 26-63), compared to the older children, (Mdn = 54, IQR = 30-77), with a small effect size (r = -.25). There were no significant different for other findings. The older children were found to demonstrate the highest level of gross motor skills. This study may suggest the need for an early intervention program for young age children with dyslexia. Future studies that assess gross motor skills using longitudinal design are recommended to investigate the changes in gross motor performance over time.

Nurses’ job performance is defined as the effectiveness of a person in carrying out his or her duties related to patient care. Aim of this study is to measure job performance among nurses in a tertiary hospital and its associated factors. A cross-sectional study was conducted among nurses selected from four departments, which were Obstetrics & Gynecology (O&G), medical, surgical and Cardiac Care Unit (CCU)/High Dependency Unit (HDU). A Malay validated Six-Dimension Scale of Nursing Performance (6-DSNP) questionnaire was used to measure job performance. Nurses who have one child more compared to other nurses had significantly lower total mean score of job performance by -0.06 (95% CI 0.11, 0.01). Nurses working in medical department [adj.β=0.16 (95% CI 0.01, 0.30)] and CCU/HDU [adj.β= 0.33(95% CI: 0.17, 0.50)] had significantly higher total mean scores of jobs performance compared to O&G department. Effective strategies and re-examining work conditions are imperative for better job performance.
job performance ; associated factors ; nurses ; tertiary hospital

COVID-19 infection in pregnant mothers is associated with higher risk of intrauterine growth retardation and premature births. Very low birth weight infants are more susceptible to neurodevelopmental and chronic respiratory problems. An infant delivered at 33 weeks via caesarean section to a COVID-19 Stage 5A positive mother, weighing 1.43kg at birth. She was kept nil by mouth with parenteral nutrition (PN) support since day five of life until referred to dietitian on day 22 of life for enteral nutrition (EN) establishment. Feeding was administered intermittently via oro-gastric Ryles tube. She was kept under non-invasive ventilation (NIV) mode and had difficulty in weaning from ventilation, leading to slow feeding progress. Initially, enteral trophic feeding was administered using premature infant formula fortified with modular products. In the later stage of feeding, modular products were tapered off and the formula was concentrated. Frequency of bowel output when using fortified formula is lesser compared to when using concentrated and supplemented formula. There is no significant difference in renal profile observed in both stages of feeding. Increasing energy intake using easily digestible sources is preferable as opposed to concentrating feeds even further due to concerns about osmolality and excess administration of other solutes. Intermittent bolus feeding mode may have an effect on dependency on oxygen since intermittent feeds can decrease tidal volume, minute ventilation and dynamic compliance. Additional research is necessary to establish optimal caloric density and nutritional compositions of feedings, feeding mechanisms and its’ effect on feeding tolerance.

Performance of upper extremity function and movement sequence is influenced by postural control. Motor disorders lead to deficits in postural control, which subsequently may lead to postural instability of children with cerebral palsy (CWCP). This will limit their upper extremity activity performance. Management strategies help to support and enhance the CWCP’s upper extremity function so that they may engage with the activities of daily living. The purpose of this paper is to review previous literature on the influence of postural control towards upper extremity function. Literature searches were conducted in various electronic databases, including ProQuest, Science Direct, Springer Link, Sage, Wiley Online Library, and Google Scholar using specific key terms. Search terms included children with cerebral palsy; postural control; postural adjustments; upper extremity function; reaching and sitting and from references of retrieved articles. Nineteen journal articles published between 2000 and May 2015 were found. Most search results consisted of experimental studies, while others are reviews, case studies, and cross-sectional studies. Findings show that, postural control has a major influence on upper extremity function. In conclusion, it is necessary to highlight the importance of both factors to the CWCP parents or caregivers, as understanding and awareness on this matter is still inadequate in the community. Hence, a study is needed on the awareness of the postural control influence on upper extremity function among caregivers, as well as examining the implementation of management strategies in community settings.
Cerebral Palsy

We report a case of acute gonococcal conjunctivitis in a 36-year-old woman who presented with eye redness and a history of discharge for one month. Prior to presenting to us, she was treated for bacterial conjunctivitis with three courses of local antibiotics by three different clinics after brief assessments and without improvement. The final diagnosis of gonococcal conjunctivitis was made after a complete history was elicited and supported by the presence of Neisseria Gonorrhoeae in the eye swab culture test. She and her sexual partner were treated successfully with intramuscular Ceftriaxone and oral Azithromycin. This case highlights the importance of complete history taking, including sexual history, which translates into early recognition and treatment, thus preventing complications.