Purpose: This study evaluated the sensitivity, specificity, and accuracy of computed tomographic angiography (CTA) versus handheld Doppler (HHD) in detecting perforators for anterolateral thigh (ALT) flap surgery. Methods: This study was conducted on 20 patients randomly assigned to two groups from April 2023 to November 2024: One group received CTA and HHD, while the other group received only HHD. Perforators were evaluated for their number, location, and source and compared with intraoperative findings. Results: The sensitivity and specificity of CTA were 86.0% and 98.0%, respectively, while those of HHD were 81.0% and 86.5%. CTA exhibited an accuracy of 92.0% for perforator identification, whereas that of HHD was 83.5%. Conclusion CTA offers higher sensitivity, specificity, and accuracy in identifying ALT flap perforators than HHD. Its superior imaging capabilities can enable improved surgical planning, minimizing intraoperative challenges, reducing the risk of complications, and potentially increasing flap survival rates. As such, CTA could be considered a valuable standard tool in preoperative planning for ALT flap surgery, particularly in cases where anatomical variation poses a challenge.

Purpose: This study evaluated the sensitivity, specificity, and accuracy of computed tomographic angiography (CTA) versus handheld Doppler (HHD) in detecting perforators for anterolateral thigh (ALT) flap surgery. Methods: This study was conducted on 20 patients randomly assigned to two groups from April 2023 to November 2024: One group received CTA and HHD, while the other group received only HHD. Perforators were evaluated for their number, location, and source and compared with intraoperative findings. Results: The sensitivity and specificity of CTA were 86.0% and 98.0%, respectively, while those of HHD were 81.0% and 86.5%. CTA exhibited an accuracy of 92.0% for perforator identification, whereas that of HHD was 83.5%. Conclusion CTA offers higher sensitivity, specificity, and accuracy in identifying ALT flap perforators than HHD. Its superior imaging capabilities can enable improved surgical planning, minimizing intraoperative challenges, reducing the risk of complications, and potentially increasing flap survival rates. As such, CTA could be considered a valuable standard tool in preoperative planning for ALT flap surgery, particularly in cases where anatomical variation poses a challenge.

Purpose: This study evaluated the sensitivity, specificity, and accuracy of computed tomographic angiography (CTA) versus handheld Doppler (HHD) in detecting perforators for anterolateral thigh (ALT) flap surgery. Methods: This study was conducted on 20 patients randomly assigned to two groups from April 2023 to November 2024: One group received CTA and HHD, while the other group received only HHD. Perforators were evaluated for their number, location, and source and compared with intraoperative findings. Results: The sensitivity and specificity of CTA were 86.0% and 98.0%, respectively, while those of HHD were 81.0% and 86.5%. CTA exhibited an accuracy of 92.0% for perforator identification, whereas that of HHD was 83.5%. Conclusion CTA offers higher sensitivity, specificity, and accuracy in identifying ALT flap perforators than HHD. Its superior imaging capabilities can enable improved surgical planning, minimizing intraoperative challenges, reducing the risk of complications, and potentially increasing flap survival rates. As such, CTA could be considered a valuable standard tool in preoperative planning for ALT flap surgery, particularly in cases where anatomical variation poses a challenge.

Introduction: The high prevalence of obesity in adults with type 2 diabetes (T2D) has become a major public health burden. This study explored the readiness to change for weight loss in adults with T2D with obesity, examining its association with sociodemographics, health status, dietary self-efficacy, and social support for physical activity and diet. Materials and methods: This cross-sectional study involved 381 adults with T2D with obesity in Kemaman, Terengganu. The stages of change were dichotomized into ‘not ready’ and ‘ready'. The self-efficacy was measured using the Weight Efficacy Lifestyle Questionnaire (WEL-Q), and the social support for physical activity was measured using the Social Support Scale for Diet and Physical Activity Questionnaire. Results: More than half of the participants (50.4%) were still not ready to change for weight loss. Multiple logistic regression showed patients who are not married (p = 0.011), obtained tertiary education (p = 0.018), have a higher score in self-efficacy for social pressure (p < 0.001) and received better family support for physical activity (p = 0.001) tend to be ready for weight loss efforts. Conclusion: This study identified marital status, academic background, self-efficacy for social pressure, and family support for physical activity as the determinants in influencing the readiness to change for weight loss in adults with T2D with obesity. The results highlight the importance of targeting the large proportion of adults with T2D who are not ready to lose weight, providing valuable insights to improve obesity interventions within this population.

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

Introduction: COVID-19 pandemic placed unprecedented strain on hospital resources and manpower. This study assesses the impact of Malaysia’s nationwide lockdown on the incidence, types, severity, and outcomes of emergency general surgery (EGS) cases at a tertiary care hospital. Methods: This retrospective cohort study analysed the data of patients who underwent EGS procedures for the period 2017 and 2021. Results: During the pandemic period, there was a 48.3% reduction in EGS cases (n=889) compared to the pre-pandemic period (n=1720). Significant reductions were observed in surgeries for appendicitis, soft tissue infection, colorectal, urology, peptic ulcer, and vascular disorders in the COVID period. Conversely, procedures for biliary disorders and hernia complications increased by 7.4% and 5.5%, respectively. Length of hospital stay increased by 57.8% for patients with small bowel disorders, while ICU/HDU admissions rose by 43.5% for colorectal cases (P < 0.05). There was no significant difference in mortality rates between the two periods. Conclusions The overall reduction in EGS procedures during the COVID-19 period was consistent with global trends. Despite the challenges posed by the pandemic, the outcomes related to duration of stay, ICU/HDU utilisation, and mortality remained comparable to the pre-pandemic period. These findings highlight the adaptability of healthcare professionals in maintaining continuity and quality of emergency surgical care during a crisis.
Acute Care Surgery ; COVID-19 ; Pandemics

Environmental Determinants in Sustaining the Transmission of Lymphatic Filariasis: A Systematic Review IntroductionSince mass drug administration continues in many of the endemic countries, it is vital to synthesise evidence to adapt the challenges contributed by the environments. As such, the aim of this review was to explore relationship between lymphatic filariasis prevalence and potential environmental determinants .MethodsWe searched the electronic databases PubMed, Web of Science, Cochrane, and Scopus between Jan 1, 2013, and Dec 31, 2022, for studies fulfilling the following criteria: it was an original article investigating the environmental determinants associated with transmission of lymphatic filariasis; and the study was published in English. The quality assessment tools for observational studies from the National Heart, Lung, and Blood Institute was used to assess the study quality. This systematic review was registered with the PROSPERO database (CRD42023393018).ResultsWe identified 409 potentially eligible published articles, of which 11 met our inclusion criteria. The main environmental determinants associated with lymphatic filariasis transmission were Normalised Difference Vegetation Index (NDVI), land cover, distance to waterbody, rainfall/precipitation, elevation, slope, day land surface temperature, average annual temperature, house type and distance to stable light. ConclusionsThis review is one of the steps towards understanding the associations between environmental determinantsand transmission of lymphatic filariasis. These results can be used in future evidence-based strategies to strengthen surveillance and control strategies.

Cabaran Dalam Pencegahan dan Kawalan Plasmodium Knowlesi Malaria Di Rantau Asia Tenggara – Ulasan Naratif PengenalanDi sebalik kejayaan program penghapusan malaria manusia, terdapat peningkatan yang membimbangkan berkenaan jangkitan malaria Plasmodium knowlesi (P. knowlesi) di rantau Asia Tenggara. Pemahaman menyeluruh tentang cabaran dalam mencegah dan mengawal malaria zoonosis ini mesti diutarakan, terutamanya apabila menentukan strategi paling berkesan untuk menyekat penularan penyakit.MetodologiDi sebalik kejayaan program penghapusan malaria manusia, terdapat peningkatan yang membimbangkan berkenaan jangkitan malaria Plasmodium knowlesi (P. knowlesi) di rantau Asia Tenggara. Pemahaman menyeluruh tentang cabaran dalam mencegah dan mengawal malaria zoonosis ini mesti diutarakan, terutamanya apabila menentukan strategi paling berkesan untuk menyekat penularan penyakit.Hasil KajianKepelbagaian manusia, seperti sosioekonomi dan sosiobudaya tempatan yang majmuk, persepsi yang rendah dan pematuhan optimum terhadap langkah-langkah pencegahan dan kawalan perlu ditangani. Isu dana nasional, pelaksanaan program, dan birokrasi mesti diselesaikan dalam memastikan keberkesanan peranan kerajaan dan kerjasama pelbagai sektor apabila melibatkan pengurusan penyakit malaria. Kejayaan sesuatu program akan terhalang sekiranya tiada sokongan daripada pemimpin masyarakat dan bertentangan dengan dinamik sosial. Kebolehsuaian nyamuk Anopheles bertanggungjawab terutamanya terhadap cabaran yang dihadapi dalam kawalan vektor. Kesan anjakan ekologi dan perubahan iklim, ditambah dengan aktiviti antropogenik mewujudkan limpahan zoonosis dan variasi penyesuaian yang mengubah landskap transmisi sylvian dan manusia.KesimpulanCabaran daripada pelbagai faktor mengurangkan keberkesanan dalam mencegah penularan penyakit ini. Pendekatan baharu mesti dibangunkan untuk mencapai kawasan terjejas dengan intervensi jangka panjang, komprehensif dan berkesan.

Socio-ecological Factors Associated with Tuberculosis Infection: A Systematic Review Introduction Tuberculosis (TB) is a major public health issue and poses a threat to the community with high incidence and mortality, especially in the endemic countries. Social and ecological factors have been known to cause TB transmission. Hence, it is vital to synthesis evidence to adapt to the challenges caused by these factors. As such, this review aims to explore the relationship between TB prevalence and potential social and environmental factors. Methods We searched the electronic databases PubMed, Web of Science (WoS) and Scopus between 1st January 2013 and 31st 2024, for studies that met the following requirements: 1) original article investigating the social and environmental determinants associated with transmission of TB and; 2) the study was published in English. The Mixed Method Appraisal Tool (MMAT) assessed the study quality. Results We identified 484 potentially eligible published articles, of which 27 met our inclusion criteria. Findings from this systematic review showed that environmental and socioeconomic factors, mainly housing and living conditions, poverty, air quality and pollution, climate and weather, and water and sanitation infrastructure, influence the dynamics of TB transmission. Conclusion These findings can guide policymakers in improving and strengthening the TB control program.

Gema Ekologi: Meneroka Interaksi Antara Persekitaran Hutan dan Vektor Malaria Pendahuluan Malaria kekal sebagai salah satu cabaran kesihatan awam yang penting di seluruh dunia, dengan kemajuan telah terbantut dalam kebelakangan ini. Memandangkan peningkatan kes malaria terutamanya di beberapa kawasan tropika, pemahaman yang lebih baik tentang hubungan ekologi yang mendasari penularan vektor malaria perlu diberikan fokus. Pendekatan pelbagai disiplin yang melibatkan ekologi, entomologi dan kesihatan awam adalah diperlukanuntuk memahami kaitan antara malaria dan habitat persekitaran. Ulasan ini bertujuan untuk mensintesis penyelidikan sedia ada tentang bagaimana ekosistem hutan mempengaruhi dinamik penularan malaria.MetodologiMenggunakan pangkalandata PubMed, Google Scholar dan Scopus, kajian literatur komprehensif telah dijalankan menggunakan kata kunci tertentu. Artikel yang berkaitan telah dinilai untuk aliran tematik. Secara keseluruhan, 42 artikel telah dipilih untuk naratif ini.Hasil Iklim mikro hutan mempengaruhi kecergasan, tingkah laku, corak aktiviti dan fisiologi organisma. Relung biologiberbeza yang disebabkanoleh suhu, kelembapan, pendedahan cahaya dan kerpasan boleh memberi kesan kepada populasi nyamuk. Ciri-ciri fiziko-biokimia badan air, termasuk suhu, pH, jumlah pepejal terlarut (TDS), kandungan nitrat, dan paras oksigen terlarut, mempunyai kesan yang ketara ke atas banyaknya larva nyamuk anopheline. Kelimpahan vektor mungkin dipengaruhi oleh kehadiran perumah dan pemangsa semulajadi. Interaksi rumit geografi, tumbuh-tumbuhan hutan, kepadatan vektor malaria, dan tingkah laku mempunyai pengaruh besar ke atas dinamik penularan malaria. Penebangan hutan mengubah landskap dan ekosistem serpihan, yang mempunyai kesan besar ke atas habitat larva vektor Plasmodium. Perubahan iklim menimbulkan ancaman besar kepada kelimpahan vektor malaria dan dinamik penghantaran.KesimpulanTerdapat banyak aspek kepada interaksi kompleks antara persekitaran hutan dan penyebaran malaria,memerlukan pengetahuan yang mendalam dan lebih banyak penyiasatan. Kerjasama antara ahli ekologi, entomologi dan pakar kesihatan awam adalah penting dalam menghasilkan model komprehensif yang meramalkan risiko malaria dengan tepat dalam persekitaran yang berubah-ubah