Background: The mortality of severe dengue infections is approximately 23%. In the management of dengue shock syndrome (DSS), aggressive fluid resuscitation is recommended. The primary objective of our study was to assess the factors associated with 30-day mortality in DSS patients. Methods: Adult patients >18 years old, who were admitted with DSS were included. DSS was diagnosed in patients who required vasopressors or had lactic acidosis >4 mmol/L. Patients were divided into three different groups based on cumulative fluid balance at death or extubation: group I (<3.5 L), group II (3.5–8.0 L), and group III (>8.0 L). Results: A total of 135 patients with DSS was included, with an overall 30-day mortality of 74.8%. The average Sequential Organ Failure Assessment (SOFA) score on intensive care unit admission was 12.2. Mechanical ventilation was required in 112 patients (83.0%), with 61 patients (45.2%) being intubated without a noninvasive ventilation trial. Respiratory failure was the most common reason for requiring intubation (65 patients, 48.2%). In survivors, the median cumulative fluid balance was 1,493 ml (interquartile range [IQR], 0–4,501 ml), whereas that in the mortality group was 7,797 ml (IQR, 3,700–13,600 ml). On multivariate analysis, SOFA score (odds ratio [OR], 1.220; 95% CI, 1.011–1.472; P=0.038) and having received >8.0 L cumulative fluid balance (OR, 6.682; 95% CI, 1.808–24.689; P=0.004) were associated with increased risk of mortality. Conclusions DSS patients have high mortality rates. High SOFA scores and >8.0 L cumulative fluid balance may indicate worse outcomes.

Multiple morphological abnormalities of the flagella (MMAF) represent a severe form of sperm defects leading to asthenozoospermia and male infertility. In this study, we identified a novel homozygous splicing mutation (c.871-4 ACA>A) in the adenylate kinase 7 (AK7) gene by whole-exome sequencing in infertile individuals. Spermatozoa from affected individuals exhibited typical MMAF characteristics, including coiled, bent, short, absent, and irregular flagella. Transmission electron microscopy analysis showed disorganized axonemal structure and abnormal mitochondrial sheets in sperm flagella. Immunofluorescence staining confirmed the absence of AK7 protein from the patients' spermatozoa, validating the pathogenic nature of the mutation. This study provides direct evidence linking the AK7 gene to MMAF-associated asthenozoospermia in humans, expanding the mutational spectrum of AK7 and enhancing our understanding of the genetic basis of male infertility.
Humans ; Male ; Sperm Tail/ultrastructure* ; Homozygote ; Consanguinity ; Asthenozoospermia/pathology* ; Infertility, Male/genetics* ; Mutation ; Pakistan ; Adenylate Kinase/genetics* ; Adult ; Pedigree ; RNA Splicing ; Exome Sequencing ; Spermatozoa

Pharmacovigilance and ADR Reporting in Perak Background: Healthcare professionals, particularly pharmacists, play a crucial role in adverse drug reaction (ADR) reporting and pharmacovigilance activities. Despite retail pharmacies being the most accessible point of care for the patients to report mild ADRs, ADR reporting by community pharmacists in Malaysia remains low. Hence, increasing reporting rate among community pharmacists is crucial to promote medication safety. Objective: This study aimed to assess the knowledge, attitudes, and barriers related to ADR reporting and pharmacovigilance among community pharmacists in Perak, Malaysia, and explore associations between their sociodemographic characteristics with their good knowledge, positive attitudes and high barriers level. Methods: A cross-sectional study design was employed through both physical and online survey, involving 179 community pharmacists in Perak. Data were collected using a 38-item self-administered online structured questionnaire. Statistical analyses were subsequently conducted. Results: This study revealed that community pharmacists exhibited good knowledge (82.1%), positive attitudes (68.7%) and low barriers (86.1%) towards ADR reporting and pharmacovigilance. However, several significant barriers hindered their reporting efforts, including the time-consuming nature of the reporting process (37.4%) and doubts about the causality of ADRs (29.7%). Remarkably, gender and CPD programmes participation were associated with good knowledge. While female gender, younger age and recent pharmacovigilance course exposure were associated with positive attitudes, higher education level was inversely associated with positive attitudes. Conclusion: Despite possessing good knowledge and positive attitudes, several barriers prevent community pharmacists in Perak from effectively reporting ADRs. Targeted interventions are necessary to address these barriers and improve ADR reporting rates among community pharmacists.

The coronavirus disease (COVID-19) pandemic has led to an alarming increase in domestic violence against women owing to lockdown measures and limited access to support services. This article provides insights into the global prevalence of domestic violence, barriers to seeking help, its impact on women and children, and the best practices implemented worldwide. Domestic violence encompasses various forms of abuse; many young women experience partner violence. Barriers to seeking help include fear, financial constraints, lack of awareness of available services, and distrust among stakeholders. The consequences of domestic violence affect the mental health of both mothers and children. Countries have increased shelter funding and developed innovative protocols to reach survivors and address this issue. However, the healthcare sector’s involvement in addressing domestic violence has been limited. This review advocates collaboration among healthcare institutions and government bodies. Key recommendations include utilizing telehealth services, implementing comprehensive training programs, establishing effective referral systems, enhancing health education, developing a domestic violence registry, improving the responses of law enforcement and justice systems through healthcare integration, promoting data sharing, and conducting further research. Healthcare systems should recognize domestic violence as a public health concern and detect, prevent, and intervene in cases to support survivors.

Aims: This study was aimed to monitor the asymptomatic carriage of coagulase-positive staphylococcal bacteria among university male students and detect the prevalence of virulence marker genes that encode methicillin resistance (mecA) and Panton-Valentine leukocidin (PVL) toxin among the isolates. Methodology and results: Single nasal swaps were collected from 144 participating students who resided at four different locations within Al-Madinah city. A total of 112 Gram-positive staphylococcal isolates were recovered from the 144 participants (carriage rate of 77.8%). Coagulase-positive staphylococci were differentiated using duplex PCR amplification of the 16S rRNA and nuc genes and accounted for 30 isolates (carriage rate of 20.8%). These isolates were most prevalent in the northern and southern parts of Al-Madinah city, while the lowest numbers of isolates were detected in students of the eastern part. Coagulase-positive isolates were further phenotypically characterized for methicillin resistance by the disc diffusion method. Uniplex PCR assays were conducted to screen for mecA- and PVL toxin-encoding genes. The mecA gene was amplified from all 15 (50%) methicillin-resistant coagulase-positive isolates, while the PVL toxin-encoding gene was detected in 19 isolates (63.3%), 10 (33.3%) of which contained the mecA gene. Lastly, PCR amplification of the NRPS gene from coagulase-positive isolates revealed the absence of Staphylococcus argenteus, the recently discovered genetically divergent lineage of Staphylococcus aureus. Conclusion, significance and impact of study An elevated prevalence of coagulase-positive isolates harboring mecA and PVL virulence genes was observed compared with previous investigations. This poses a potential threat if they spread among the population, resulting in outbreaks of community-acquired infections.

Background: Pediatric malignant bone tumors constitute an important subgroup of solid tumors and need comprehensive multidisciplinary care for optimal management. We aimed to review our local practice of managing malignant bone tumors and identify gaps to improve service. Methods: We retrospectively reviewed disease characteristics and management of twenty-five pediatric patients with malignant bone tumors from Jan 2000 to Dec 2020. Results: Median age at diagnosis was 8.75 years, male to female ratio of 0.8:1, and median follow-up was 3.6 years. Pain and swelling were the predominant symptoms at presentation, while lung was the most common metastatic site in Osteosarcoma (OS) and Ewing’s Sarcoma Family Tumors (ESFT). Metastatic disease was not associated with developing an event in OS (P=0.26) but was significantly associated with developing an event in the ESFT subgroup (P=0.002). There was no association of tumor necrosis of ＜90% or positive histological margins with developing an event in the entire cohort. The relapsed disease was associated with a mortality risk in the OS group (P=0.01). At the same time, it did not return significant results for this association in ESFT; however, a trend was noted for poor outcomes (P=0.09). Event-free survival and overall survival in OS were 54% and 69%, while in the ESFT group, they were 50% and 66%, respectively. Conclusion Metastatic disease was associated with developing relapsed disease in the ESFT cohort, while relapsed disease was associated with mortality in the OS cohort.Positive histological margins and ＜90% necrosis on resected tumor specimens did not result in poor survival. Multicenter collaboration at the national level is needed to improve the outcome of this disease group, which needs specialized multidisciplinary management.

Background: Pediatric malignant bone tumors constitute an important subgroup of solid tumors and need comprehensive multidisciplinary care for optimal management. We aimed to review our local practice of managing malignant bone tumors and identify gaps to improve service. Methods: We retrospectively reviewed disease characteristics and management of twenty-five pediatric patients with malignant bone tumors from Jan 2000 to Dec 2020. Results: Median age at diagnosis was 8.75 years, male to female ratio of 0.8:1, and median follow-up was 3.6 years. Pain and swelling were the predominant symptoms at presentation, while lung was the most common metastatic site in Osteosarcoma (OS) and Ewing’s Sarcoma Family Tumors (ESFT). Metastatic disease was not associated with developing an event in OS (P=0.26) but was significantly associated with developing an event in the ESFT subgroup (P=0.002). There was no association of tumor necrosis of ＜90% or positive histological margins with developing an event in the entire cohort. The relapsed disease was associated with a mortality risk in the OS group (P=0.01). At the same time, it did not return significant results for this association in ESFT; however, a trend was noted for poor outcomes (P=0.09). Event-free survival and overall survival in OS were 54% and 69%, while in the ESFT group, they were 50% and 66%, respectively. Conclusion Metastatic disease was associated with developing relapsed disease in the ESFT cohort, while relapsed disease was associated with mortality in the OS cohort.Positive histological margins and ＜90% necrosis on resected tumor specimens did not result in poor survival. Multicenter collaboration at the national level is needed to improve the outcome of this disease group, which needs specialized multidisciplinary management.

Background: Pediatric malignant bone tumors constitute an important subgroup of solid tumors and need comprehensive multidisciplinary care for optimal management. We aimed to review our local practice of managing malignant bone tumors and identify gaps to improve service. Methods: We retrospectively reviewed disease characteristics and management of twenty-five pediatric patients with malignant bone tumors from Jan 2000 to Dec 2020. Results: Median age at diagnosis was 8.75 years, male to female ratio of 0.8:1, and median follow-up was 3.6 years. Pain and swelling were the predominant symptoms at presentation, while lung was the most common metastatic site in Osteosarcoma (OS) and Ewing’s Sarcoma Family Tumors (ESFT). Metastatic disease was not associated with developing an event in OS (P=0.26) but was significantly associated with developing an event in the ESFT subgroup (P=0.002). There was no association of tumor necrosis of ＜90% or positive histological margins with developing an event in the entire cohort. The relapsed disease was associated with a mortality risk in the OS group (P=0.01). At the same time, it did not return significant results for this association in ESFT; however, a trend was noted for poor outcomes (P=0.09). Event-free survival and overall survival in OS were 54% and 69%, while in the ESFT group, they were 50% and 66%, respectively. Conclusion Metastatic disease was associated with developing relapsed disease in the ESFT cohort, while relapsed disease was associated with mortality in the OS cohort.Positive histological margins and ＜90% necrosis on resected tumor specimens did not result in poor survival. Multicenter collaboration at the national level is needed to improve the outcome of this disease group, which needs specialized multidisciplinary management.

Background: Pediatric malignant bone tumors constitute an important subgroup of solid tumors and need comprehensive multidisciplinary care for optimal management. We aimed to review our local practice of managing malignant bone tumors and identify gaps to improve service. Methods: We retrospectively reviewed disease characteristics and management of twenty-five pediatric patients with malignant bone tumors from Jan 2000 to Dec 2020. Results: Median age at diagnosis was 8.75 years, male to female ratio of 0.8:1, and median follow-up was 3.6 years. Pain and swelling were the predominant symptoms at presentation, while lung was the most common metastatic site in Osteosarcoma (OS) and Ewing’s Sarcoma Family Tumors (ESFT). Metastatic disease was not associated with developing an event in OS (P=0.26) but was significantly associated with developing an event in the ESFT subgroup (P=0.002). There was no association of tumor necrosis of ＜90% or positive histological margins with developing an event in the entire cohort. The relapsed disease was associated with a mortality risk in the OS group (P=0.01). At the same time, it did not return significant results for this association in ESFT; however, a trend was noted for poor outcomes (P=0.09). Event-free survival and overall survival in OS were 54% and 69%, while in the ESFT group, they were 50% and 66%, respectively. Conclusion Metastatic disease was associated with developing relapsed disease in the ESFT cohort, while relapsed disease was associated with mortality in the OS cohort.Positive histological margins and ＜90% necrosis on resected tumor specimens did not result in poor survival. Multicenter collaboration at the national level is needed to improve the outcome of this disease group, which needs specialized multidisciplinary management.

OCCUPATIONAL STRESS, COPING STRATEGIES, AND QUALITY OF LIFE AMONG NURSES IN ABHA CITY Background: The nursing profession is inherently stressful, and nurses in Abha City face unique challenges due to rapid population growth and evolving healthcare needs. Objective: The purpose of the present study is to identify the correlation between “Occupational stress, coping strategies and quality of life” among nurses in Abha city. Method: The present study utilized a cross-sectional, descriptive survey, and correlational research design. A convenience sampling throughout an online questionnaire was used to recruit 411 nurses from three hospitals in Abha city, and data was collected using three validated instruments: The Expanded Nursing Stress Scale, the Brief Cope Scale, and the World Health Organization-Quality of Life Scale. SPSS version 26 was used for data analysis, including descriptive statistics, independent samples t-test, ANOVA, and Pearson’s correlation coefficient. Results: Findings revealed a moderate level of occupational stress (mean score 2.31 ± 0.56 on the ENSS-59 scale), with the main sources being dealing with patients and their families (2.35 ± 0.65), uncertainty concerning treatment (2.33 ± 0.66), and discrimination (2.32 ± 0.88). Nurses employed coping strategies such as planning (2.49 ± 0.75), religion (2.47 ± 0.72), and substance use (2.45 ± 0.77), while the least adopted strategies were self-blame (2.40 ± 0.71), self-distraction (2.37 ± 0.73), and behavioral disengagement (2.32 ± 0.73). Significant associations were found between sources of occupational stress and coping strategies, such as death and dying stress source correlating with self-distraction (r=0.202), use of instrumental support (r=0.111), positive reframing (r=0.154), humor (r=0.111), religion (r=0.142), and self-blame (r=0.141). Conflict with peers as a stress source was significantly correlated with self-distraction (r=0.157), denial (r=0.158), substance use (r=0.183), use of instrumental support (r=0.130), behavioral disengagement (r=0.106), venting (r=0.121), humor (r=0.203), religion (r=0.106), and self-blame (r=0.152). A significantly negative association between occupational stress and quality of life was also identified (r=-0.451). Conclusion: Significant correlation were found between sources of occupational stress and coping strategies. The study also demonstrated a significant negative association between occupational stress and quality of life, emphasizing the need for interventions to reduce occupational stress and enhance nurses’ well-being. ASEAN Journal of Psychiatry, Vol. 25 (2) February, 2024; 1-14.