Introduction: Sleep quality has become a public health concern due to serious impacts on individual’s health outcomes. Thus, this cross-sectional study aimed to determine the sleep quality and its associated factors among adults living in the province of Terengganu, Malaysia. Materials and Methods: Socio-demographic information was self-reported whilst anthropometric measurements were measured by trained researchers. Sleep quality was assessed using the validated Pittsburgh Sleep Quality Index (PSQI) whilst eating behavior was measured using the Dutch Eating Behavior Questionnaire (DEBQ). Descriptive statistics and multivariable linear regression models were employed using IBM SPSS version 25.0. Results: A total of 580 participants were enrolled (mean age = 29.1 ± 10.0 years; 51.2% female), of which 74.7% (n = 433) had poor sleep quality (PSQI global score > 5) with a total sleep duration per night of 6.2 ± 1.6 hours. Gender (p-value=0.044), educational level (p-value=0.001), emotional level (p-value=0.005) and external eating (p-value=0.026) were significantly associated with poorer sleep quality. Conclusion: This study underscored the high prevalence of poor sleep quality among adults living in Terengganu, Malaysia. The findings could serve as a basis for developing sleep education strategies that are tailored to improve sleep quality among adults.

Introduction: There are various methods used to repair lacerated tendons. The minimum requirement for the best results and lowest rupture rate is the four-strand repair technique. The cruciate type of repair is among the most popular methods available but is very technical and requires expertise. An easier two-double-loop method for tendon healing is suggested in this study. This study assessed the biomechanical properties of two well-known tendon repair techniques—the modified Kessler and cruciate approaches—and two lesser-known double-loop techniques for tensile strength, stiffness, and failure mode. Materials and methods: Twenty-four adult chickens' Achilles tendons were randomly divided into three groups and sutured with a four-strand core suture using the fourstrand modified Kessler technique, the four-strand cruciate technique, and the two-double-loop approach. Twenty-four more adult chicken Achilles tendons were acquired, and they were randomly assigned to the same three groups along with an extra running epitendinous repair. A synthetic, nonabsorbable monofilament polypropylene suture was used for all repairs. Results: The four-strand modified Kessler, and the fourstrand cruciate procedures had the lowest mean ultimate tensile strength, whereas the two double-loop techniques had the strongest. The results were dramatically impacted by using an epitendinous suture during test analysis. Conclusion: The strongest and comparatively less technically complex technique used in this investigation was the two-double-loop, four-strand core suture method. The significance of the extra strength that the epitendinous suture gave was clear. Using this in a clinical setting is recommended for hand flexor tendon injuries.

A series of comprehensive focus group discussions with active firefighters revealed that inconsistencies in incorporating a rigorous physical training program during work hours contributed significantly to the challenges of maintaining functional fitness, particularly strength. This article outlines a process for identifying the specific exercises required to enhance strength, drawing on the expertise and experience of physical trainers. Modified nominal group technique (mNGT) sessions were conducted to identify and rank exercises for five functional strengths (i.e., pushing, pulling, lifting, carrying, and dragging). A total of six physical trainers from the firefighter academy were interviewed to 1) identify the skeletal muscles involved in the functional movements using a visual aid; 2) generate ideas for exercises via brainstorming; 3) privately rank the displayed list of exercises for each muscle group involved in each functional movement; and 4) design a physical training programme for beginner, intermediate and advanced levels by manipulating loads. Males dominated the expert group (66.7%) and had a mean of 11.50 (SD 5.20) years of experience in physical training. The mNGTs yielded three top-ranking exercises for each functional strength: 1) Pushing: the push-up, sit-up, and jumping jack; 2) pulling: the push-up, jumping jack, and sit-up; 3) lifting: the jumping jack, push-up, and jumping squat; 4) carrying: the push-up, plank, and sit -up; and 5) dragging: the jumping jack, sit-up, and jumping squat. Then each exercise was designed for the beginner, intermediate, and advanced levels by manipulating loads (i.e. additional weight or number of repetitions). This study demonstrated that mNGT is an effective tool for identifying the three top-ranking exercises that address firefighter recruits’ functional strength. The experts chose multi-joint exercises targeting agonist and antagonist skeletal muscle groups and mimicking movements of daily work life. The exercises, corroborated by previous empirical evidence, provide opportunities for common skeletal muscle groupings to be targeted simultaneously to increase cardiovascular adaptations over a shorter period. The physical exercise is now ready to be implemented for piloting purposes among firefighter recruits.

Staphylococcus aureus is a common bacterial pathogen known to cause various kinds of infections due to its repertoire of virulence factors. This study aimed to investigate the distribution of 19 types of virulence genes among clinical isolates of methicillin-susceptible S. aureus (MSSA) using the polymerase chain reaction. A total of 109 MSSA isolates, i.e., 63 hospital-associated (HA) and 46 community-associated (CA) were collected from Hospital Sultanah Nur Zahirah, the main tertiary hospital in Terengganu, Malaysia, from July 2016 to June 2017. The most frequent virulence genes detected were hla (78.9%, n=86) and hld (78.0%, n=85) encoding hemolysins, lukED (56.9%, n=62) encoding leukotoxin ED, followed by seb (26.6%, n=29) and sea (24.8%, n=27) encoding enterotoxins. Among 34 (31.2%) isolates carrying six or more virulence genes, only five were multidrug resistant (MDR) while the remaining isolates were susceptible. Significant associations were discovered between the hld gene with CA-MSSA (p=0.016) and the seo gene with HA-MSSA (p=0.023). However, there is no significant association between virulence genes among the different types of infection. The clinical MSSA isolates in Terengganu showed high prevalence and high diversity of virulence gene carriage.

A three-year-old female with a history of recurrent tonsillitis was investigated for failure to thrive and global developmental delay. Clinically, she had a triangular face with low-set ears and intermittent tachycardia. She had growth failure with her weight under the third centile while her height was within normal limits. Other systemic examinations were unremarkable. The presence of an elevated free T4 (FT4) with an inappropriately high thyroid stimulating hormone (TSH) in this patient raised the clinical suspicion of Thyroid Hormone Resistance Syndrome. DNA sequencing confirmed the diagnosis, which showed R243W gene mutation in Thyroid Hormone Receptor-Beta1 (THRB1).
Receptors, Thyroid Hormone ; Thyroid Hormone Resistance Syndrome ; Goiter

Background: The effects of housing conditions on animal physiology, behavior or stress are still debated. The aim of this study was to investigate the effects of three different housing systems, individually ventilated cages (IVC), classical small cages with floor surface area of 500 cm2 (CC500) and classical large cages with floor surface area of 800 cm2 (CC800) on body weight, sensory-motor performances, depression-like behavior, plasma corticosterone and brain oxidative stress parameters in C57BL/6 mice. The mice housed in one of the cages from birth to 6 months of age. Hang wire and adhesive removal tests were performed to evaluate somatosensory and motor performances. The extent of depression was determined by the forced swim test. Blood corticosterone levels were measured. In addition, brain malondialdehyde (MDA), total antioxidant status (TAS) and total oxidant status (TOS) levels were analyzed. Results: The depression-like behavior of the groups was similar. Although there were no significant differences in hang wire test among groups, CC500 group required longer durations in adhesive removal test. The body weight and plasma corticosterone levels of CC800 group were significantly higher than other groups. The oxidative stress parameters were highest in CC500 cage. Conclusions Our study showed that the least stressful housing condition was IVC cage systems. Interestingly, the number of mice in the classical cages had a significant effect on stress levels and sensory-motor performance.

THE USE OF HYPNOSIS AS AN ADJUNCT TO NITROUS OXIDE/OXYGEN SEDATION: A CASE SERIES It is known that managing patients with dental fear and anxiety is challenging for clinicians and patients. This series of case reports highlights the importance and benefits of dental management under clinical hypnosis as an adjunct to nitrous oxide inhalation sedation for ages six to fifteen. These treatments range from pulp therapy, extraction and minor oral surgery. Customised hypnosis scripts were utilised for each patient, and the metaphors used were tailored to the patient’s interest and preference. The intended treatment was successfully carried out in all the patients. Five cases discussed in this case series were initially indicated for treatment under general anaesthesia, but treatment was successfully carried out using hypnosis and nitrous oxide/oxygen sedation. In the two surgical cases, nitrous oxide was tapered off once local anaesthesia was achieved, and the state of relaxation was maintained using a hypnotic trance, reducing the anaesthetic agent’s utilisation. Hypnosis successfully reduces patients’ anxiety, allowing them to feel more relaxed and confident about accepting future dental treatment without the need for pharmacological intervention.

INTERPRETATION OF EMOJI® IN MALAY LANGUAGE AMONG CHILDREN IN MALAYSIA The existing dental anxiety scales for paediatric patients tend to categorize and label children according to their level of cooperation. However, human emotions are more complex, and each child is unique. Hence, a more dynamic and interactive method should be introduced for a better understanding of the patient’s current state of emotion. The aim of this study was to investigate the interpretation and understanding of children towards frequently used emoji® for the development of an emoji® dental emotional spectrum. Both online and physical surveys were conducted among 147 Malay language-speaking children aged between 4-to-16 years in Malaysia. The children were asked to interpret 30 pre-selected emoji® images in their own words using the Malay Language. The pre-selected emoji® represent happiness, neutral, fear, sadness, and anger. The interpretations were subsequently based on their similar meaning, a process that was validated by two experts in the field of linguistics. The study involved participants with an average age of 9.2 years, with the majority of them being female (61.2%). Of the 30 pre-selected emoji® images used in this study, 13 had respondent agreement exceeding 60% which was the threshold set for suitability for use in evaluating dental emotion. The remaining 17 emoji® images have a remarkable variability in the interpretation which indicates potential misinterpretation by the respondents. The 13 emoji® images range from happiness, neutral, fear, dislike, unhappy, sad, anxious, and angry with the emoji® images which represent “excited” (94.0%), “loudly crying” (97.3%) and “angry” (91.8%) had the highest agreement. Meanwhile, the emoji® images represented “confounded” and “downcast” had the least agreement among respondents (1.3%). Despite the universal meaning imposed by emoji®, the interpretations may vary in different populations and age groups. Emoji® images hold the potential to serve as a valuable tool for identifying and managing children’s behaviour.

Introduction: Exploring potential optimization strategies and developing evident practices is critical. Previous studies show that radiation dose can be reduced by increasing the source-image distance (SID). Although most studies use digital radiography, many hospitals in underdeveloped countries still use computed radiography (CR). Therefore, research will investigate the relationship between SID and Entrance surface dose (ESD) using the CR. Methods: This study involved the measurement of radiation dose and image quality of a radiological procedure performed at a reference SID; 100cm and the tested SIDs; 110cm, 120cm, and 130cm, using constant technical factors (70kVp, 25mAs, grid). A LiF; Mg Ti thermoluminescence dosimeter (TLD-100) chip was placed in the center of the radiation field of the OF10° skull radiography examination to measure ESD. Image quality was assessed using the European Commission guidelines and graded using relative visual assessment analysis (VGA). Results: Significant ESD reduction from 21% and 45% when SID was increased from 100cm to 130cm (p <0.001), where SID was negatively correlated with ESD (r= - 0.98). The VGA scores showed no statistical difference in the image quality of the OF10° skull radiography examination for the tested and reference images (p=0.21). VGA scores for 120cm images showed the highest image quality among the SIDs tested with a dose reduction of 37%. Conclusion: ESD was statically reduced when SID was increased from 100cm to 130cm, while image quality was diagnostically acceptable. The study suggests that 120cm is the optimal SID when both dose and image quality are considered.

Allopurinol is the well-known first-line treatment option for symptomatic hyperuricaemia and gout. It is cost-effective particularly for the management of chronic gout. The common early side effects of allopurinol are skin rashes, diarrhoea and nausea. Meanwhile, a dangerous concerning complication is Stevens–Johnson syndrome, which can cause severe morbidity and mortality. Delayed hypersensitivity to allopurinol is rare but should be one of the differential diagnoses if a patient with underlying gout on chronic allopurinol treatment presents with skin rashes. The present case highlights the importance of a high index of suspicion in at-risk patients with underlying gout along with skin rashes on long-term allopurinol treatment to avoid unnecessary patient management.
Hypersensitivity, Delayed ; Allopurinol ; Exanthema