In Malaysia, dengue fever is a common vector-borne disease. Most cases of dengue fever are reported in residential areas. Children are at high risk to be infected because they spend a lot of time around their housing area for outdoor activities. Such areas may have a high number of Aedes mosquitoes. As schools are equipped with infrastructure and medium for effective educational purposes, school represent the most suitable facilities for learning and teaching process. A cross-sectional study was conducted to determine the level of knowledge among students in Hulu Langat on Aedes mosquitoes, dengue fever, and Zika virus. The study also reported on the demographic factors which affected the knowledge level. Based on sample size calculation using G*Power v3.1 software, a total of 171 respondents were needed from the two primary schools involved in the study. Data collection was conducted using a pre-tested questionnaire that consisted of two main sections on demography and knowledge about Aedes mosquitoes, dengue fever and Zika virus. From the total score of 55, the mean knowledge score is 34.2 ± 8.38. Based on the median value of 36.0, about 50.9% of respondents had satisfactory knowledge. From the study, it was found that students from School A, students who had been watching video related to Aedes mosquito, and those with history of dengue infection among family members had a significantly better knowledge score (p < 0.01). In conclusion, knowledge about Aedes mosquitoes and related illnesses need to be enhanced through a comprehensive module and effective educational materials that can serve as a reliable source of information for primary school students.

80mmHg in all patients at stimulating test. Selected septal branch angiography was taken. The methods of target septal branch selection included balloon occlusion test, angiography through the catheter lumen, and ultrasonic echocardiogram monitor. The 1st septal branch was ablated in 6 patients, and in 2nd branch in 2. The volume of alcohol injected was 1 75~7 0ml. The results showed that the successful rate of PTSMA operation was 100%, and the clinical symptoms for all patients improved significantly with mean LVOTPG decreased by 68 3%?13 0% at the end of the procedure. No severe ventricular arrhythmia occurred. One patient was followed-up clinically and angiographically half a year after the operation and his LVOTPG was 0 mmHg and the NYHA heart function was raised to Ⅱ grade from Ⅳ grades before operation. PTSMA is a promising interventional technique for HOCM therapy with satisfactory short-term clinical outcome.

Literature data on association between physical activity (PA) and health related quality of life (HRQoL) in non-clinical adults population are still limited. Thereby, the objective of this study was to evaluate the association between PA and HRQoL among the non-academic staff serving the Faculty of Health Sciences (FSK), Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur (KL). In this cross sectional study, 105 non-academic staffs aged between 18 to 60 years were recruited. Self-administered questionnaires (Malay version of the International Physical Activity Questionnaire and World Health Organisation Quality of Life-Brief Version) were administered among the participants. Mann Whitney test and Spearman’s rho correlation were employed for the statistical analysis using SPSS version 22.0 Majority of participants (72.4%) demonstrated high PA scores of ≥ 3000 MET-minutes/week. PA scores between genders was not statistically significant (p = 0.137). However, total PA score of support staffs (median = 9039.0, IQR = 15811.00) was significantly higher compared to staffs in management and professional group (median = 4329.0, IQR = 4189.00). The mean(SD) self-perceived HRQoL score was 3.4 (0.76). There were no significant correlation between PA and all domains of HRQoL such as physical health, psychological, social relationship and environmental domains (Correlation coefficient, ρ = -0.108, 0.003, -0.023, 0.026 respectively) with p = 0.273, 0.978, 0.818, 0.794 respectively. Majority of non-academic staffs of FSK, UKM engaged in high physical activity. The PA levels of support staffs were significantly higher than management and professional staffs. However, there was no statistically significant correlation observed between PA and domains of HRQoL.
Life Style

Toxoplasma gondii consists of three genotypes, namely genotype I, II and III. Based on its virulence, T. gondii can be divided into virulent and avirulent strains. This study intends to evaluate an alternative method for predicting T. gondii virulence using hierarchical cluster analysis based on complete coding sequences (CDS) of sag1, gra7 and rop18 genes. Dendrogram was constructed using UPGMA with a Kimura 80 nucleotide distance measurement. The results showed that the prediction errors of T. gondii virulence using sag1, gra7 and rop18 were 7.41%, 6.89% and 9.1%, respectively. Analysis based on CDS of gra7 and rop18 was able to differentiate avirulent strains into genotypes II and III, whereas sag1 failed to differentiate.

Infective endocarditis during breastfeeding is rare. To the best of the authors’ knowledge, this is the second recorded case of infective endocarditis in a lactating mother. It is known that women of child-bearing age are susceptible to infective endocarditis during pregnancy when the immune system is compromised.1 Nevertheless, past cases were also exposed to a systemic infection via milk infected by their infant’s oral commensal. Streptococcus mitis (S.Mitis) endocarditis in pregnancy has also been reported, whereby a lady delivered via caesarean section and underwent mitral valve reconstruction and annuloplasty.1 S. mitis is considered a pioneer streptococci commensal in human oral mucosa, appearing as early as 1-3 days after delivery.2 As a child grows, their oral mucosa will be colonized by more viridans streptococci, including the teeth, oropharynx and nasopharynx. In a mother who breastfeeds, a crack in the nipple and breast engorgement can be predisposing factors for systemic infection stemming from an infant’s oral commensal. Both cases of breastfeeding-related infective endocarditis caused by pioneer streptococcus viridans, S.mitis in our report and S.salivarius3 in the previous report, affected the left-sided valves

Fellowship in Prehospital and Disaster Medicine (PDM) is a flagship program of the Emergency in Medical and Trauma Services offered by the Universiti Teknologi MARA in Malaysia. This program is designed to empower emergency physicians through academic courses, leadership training, and networking. One of the essential elements to advance in the program is being able to do a fellowship attachment in a foreign country. I specifically chose to have my fellowship attachment in Davao City, Philippines because it has been recognized as a peaceful and orderly city that is resilient to natural and anthropogenic disasters. I was also interested to learn about the proactive stances of its leaders towards empowering communities and strengthening disaster risk reduction and disaster management capabilities. My fellowship attachment took place between March 14, 2019, and June 24, 2019. I was the first fellow in the PDM program to have my attachment in Davao City. My purpose was to identify and learn from gaps between the prehospital care and emergency medical services of Philippines and Malaysia. I also wanted to expand my clinical experience and learn more about the Emergency Medical Services in the Southern Philippines Medical Center (SPMC). Their Department of Emergency Medicine has observership arrangements with partner institutions. In SPMC, my main rotation took place in the Emergency Room - Trauma Surgery Unit. I had a comprehensive learning experience while being part of medical standby services for significant events. First, I was part of the medical standby services for the Alveo Ironman 70.3 in Azuela Cove, Davao City. The event had a month-long training and simulation for the safest race, which involved a team from various agencies such as SPMC, Central 911, Bureau of Fire Protection, Philippine National Police, Philippine Red Cross, and Philippine Coast Guard. Second, I was also involved in the medical standby services during the 2019 Palarong Pambansa, an annual multi-sport event for student athletes from all over the Philippines. I was able to participate in the emergency medical service activities of the Davao City Central 911. I had quite a few day-time, and night-time ambulance runs during my rotation, not only in the main Central 911 office, but also in the three other satellite stations in the city–Panacan, Toril, and Cabantian. Most of the patients I responded to (woman in labour, head trauma patient, medical patient in shock, pre-arrest condition, etc.) needed immediate transfers. I also had the opportunity to teach the emergency medical technicians (EMTs) and Emergency Medicine residents who were doing rotation in Central 911. During my fellowship attachment, I was also able to participate as a trainer and evaluator in an audit activity on high-quality cardiopulmonary resuscitation (CPR) using the QCPR app and a mannequin. The audit involved 60 EMTs. The pretest results of the batch revealed that about 90% of the EMTs had poor-quality CPR performance, with compression fraction percentages falling between 10% and 50% (acceptable: 80%). After the pretest, we taught the EMTs how to perform high-quality CPR and to assess the quality of their CPR through the feedback sensor attached to the mannequin's chest and the QCPR app. All of the EMTs in the batch passed the high-quality CPR feedback posttest, making them competent in performing single-rescuer, high-quality CPR. During the last month of my fellowship attachment, the Chief of the Davao City Disaster Risk Reduction and Management Office gave me the opportunity to learn about the concept and practice of disaster risk reduction in Davao City. We reviewed the data on the catastrophic events in the city during the past decade, the progressive development of disaster risk reduction efforts, and the coping mechanisms of communities that experienced disasters. I was amazed at how hard the team worked through the challenges in responding to disasters and how it managed to produce outcomes that are worthy of recognition. SPMC also gave me the opportunity to participate in its medical missions in Surigao. The missions strengthened the collaboration of SPMC with other hospitals in Mindanao for the development of the telemedicine program based in SPMC Emergency Medicine and Surgery departments. During the missions, clinicians in rural areas underwent short trainings on point-of-care ultrasonography and real-time ultrasound image transfer to enable them to participate in the telemedicine program. I was also introduced to the SPMC Diving and Hyperbaric Medicine Unit, which is located near the Emergency Room - Trauma Surgery Unit of SPMC. I learned the process of how selected patients undergo hyperbaric therapy, and I was even allowed to get into the hyperbaric chamber. I look forward to bringing back new ideas, thoughts and connections from SPMC to my institution in Malaysia. What I have witnessed and experienced firsthand during my fellowship attachment inspired me to encourage people from outside Davao City to explore the excellent development and progress of the disaster risk reduction program in Davao City. Indeed, the Philippines has many great people with compassionate character and benevolent nature. Even before leaving for my home country, I know that I will miss the Philippines and its people very much.
Emergency Medicine

Introduction: Adulterated premixed coffees have turned into an issue in Malaysia lately and have caught the eye of the authorities due to death reports linked to these products. The major cause of this issue is reported that these premixed coffees have passed food inspection test and eventually released to the market for public consumption. These coffees were claimed to be spiked with several sexual enhancers like sildenafil, tadalafil, and vardenafill, which are common drugs used to treat erectile dysfunction. Methods: Chemometrics approach using UV-Vis spectroscopy was developed to detect the selected sexual enhancer drugs found in commercial coffees by employing SIMCA-P software for the multivariate statistical analysis. Seven brands of coffee samples were purchased from local stores, and 30 sachets each were tested, hence totalling to 210 samples. Each sample was named H, J, G, W, N, T, and K, respectively. Results: Three multivariate models were generated, namely principal component analysis (PCA), orthogonal partial least squares discriminant analysis (OPLS-DA), and partial least squares discriminant analysis (PLSDA). OPLS-DA was selected as the best model for the overall results as it displayed minimal discriminate. Sildenafil, tadalafil, and vardenafil were detected in sample H, while vardenafil in brand J, and none in samples G, W, N, T, and K. Conclusion: OPLS-DA analysis showed discrimination for the sexual enhancer drugs in two brands of premixed coffee. The UV-Vis spectroscopy-based chemometrics method proved to be reliable and efficient in determining the selected drugs, as well as in saving time and cost.
Chemometrics

Asthma is a chronic inflammatory disease of the airway which is often misdiagnosed and undertreated. Early diagnosis and vigilant asthma control are crucial to preventing permanent airway damage, improving quality of life and reducing healthcare burdens. The key approaches to asthma management should include patient empowerment through health education and selfmanagement and, an effective patient-healthcare provider partnership.