Introduction: There is limited evidence on dietary patterns and the risk of type 2 diabetes (T2D) in women with a history of gestational diabetes mellitus (GDM) compared to their non-GDM counterparts, especially in the Asian population. The pilot study investigated dietary patterns in women with a history of GDM (HGDM) and without a history of GDM (non-HGDM), and the association with T2D risk. Methods: This comparative cross-sectional study involved 64 women (32 HGDM, 32 non-HGDM). Food intake was assessed using a validated food frequency questionnaire. Principal component analysis derived the dietary patterns. T2D risk score was determined using the Finnish Diabetes Risk Score tool. Results: HGDM group had significantly higher proportion of first-degree family history of diabetes; higher risk of T2D and better diabetes knowledge; lower gestational weight gain and postpartum weight retention; and consumed more fast food than nonHGDM. ‘Rice-noodle-pasta-meat’ dietary pattern was significantly associated with increased T2D risk after adjusting for age (β=0.272, p=0.032). ‘Bread-cereals-fast food-meat’ dietary pattern was positively and significantly associated with T2D risk after adjusting for confounders, including age, education level, family history of diabetes, diabetes knowledge score, gestational weight gain, and postpartum weight retention (β=0.251, p=0.012). Conclusion: Dietary patterns high in bread, cereals and cereal products, fast food and meat, as well as rice, noodle, pasta and meat were associated with an elevated T2D risk. A more extensive study is warranted to establish the association between dietary patterns and risk of T2D, focusing on women with a history of GDM.

Mycoplasma pneumonia is an atypical bacterium that causes mild respiratory tract infections, especially in the upper respiratory system. Mycoplasma pneumoniae infection is infrequently associated with various CNS manifestations such as encephalitis, meningoencephalitis, myelitis, Guillain-Barre syndrome and acute disseminated encephalomyelitis (ADEM). Here we report a rare case of mycoplasma encephalitis in an adult who presented with a first episode of seizure following fever and neck stiffness for one week. Mycoplasma pneumoniae antibody titer was markedly elevated at >1:320 and MRI brain revealed encephalitic changes with a lesion in the splenium. Interestingly, there was no associated respiratory infection and his stay in the hospital was also complicated by SIADH. The patient improved after treatment with a macrolide antibiotic.

Pharmacotherapeutics are being repurposed and used as off-label at various stages of COVID-19 infection. Clinical trials are being initiated or are ongoing to investigate the effectiveness and safety of these pharmacotherapeutics. This review article outlines the current pharmacotherapeutics and the controversies surrounding their use. The pharmacotherapeutics that were discussed are hydroxychloroquine, favipiravir, lopinavir/ritonavir, remdesivir, interferons, tocilizumab, and steroids. We also discussed the special consideration for pharmacotherapeutics in COVID-19 infection. No pharmacotherapeutics have been found to be effective and approved for the treatment of COVID-19 infection. However, there are clinical trials that have eliminated the possibilities of use of some pharmacotherapeutics while others had shown promising preliminary results of its use

Introduction: Intravenous thrombolysis (IVT) is the gold standard for the treatment of patients with acute ischemic stroke (AIS) presenting within four and a half hours of onset. However, development of new thrombolytic agents and advanced imaging has led to extended time for thrombolysis based on advanced imaging. Here we describe four patients who presented in the extended hours; that benefitted from thrombolysis. Case series: We advocate magnetic resonance imaging (MRI) for AIS, that includes diffusion weighted imaging (DWI), apparent diffusion coefficient (ADC), fluid attenuated inversion recovery (FLAIR), susceptibility weighted imaging (SWI), and magnetic resonance angiography (MRA). We included four patients who were more than 18 years old, with National Institute of Health Stroke Scale (NIHSS) of six or more, presenting between four and a half to nine hours after stroke onset with no contraindications for intravenous thrombolysis. The imaging criteria used to determine eligibility for IVT is evidence of DWI-FLAIR mismatch on MRI. If FLAIR detects no signal change in the area of stroke on DWI, it is then termed DWIFLAIR mismatch, or FLAIR-negative – indicating high probability that the brain tissue is still viable, and that patients are good candidates for IVT. Conclusion: For patients with AIS who present within nine hours, DWI-FLAIR mismatch serves as an excellent surrogate marker of salvageable brain tissue, allowing a greater proportion of patients benefiting from this life-saving therapy. Our experience also shows that with careful patient selection, treatment with IVT can safely be given without an increased risk of bleeding or mortality.

Puncture injury from sea-urchin stings may lead to a local and systemic inflammatory reaction. We are reporting a case of longitudinal extensive transverse myelitis (LETM), which occurred ten days post-sea-urchin stings, where the patient presented with bilateral lower limb weakness. MRI showed multilevel segment spinal cord T2-weighted hyperintensity. Prompt intravenous methylprednisolone was administered, and the patient had a full recovery. To date, there is no case report of LETM associated with sea-urchin stings. Possible mechanism due to delayed immunological hypersensitivity to sea-urchin venom. This case demonstrates the potential serious neurological sequelae that may be associated with post-sea-urchin sting and the importance of prompt recognition and management in aiding recovery.

Introduction: Coronavirus disease-2019 (COVID-19) was declared a global pandemic in March 2020, with 15 million people have been infected worldwide, and this number is increasing. Our study sought to assess the knowledge and practice of healthcare workers (HCWs) in a teaching hospital in Malaysia. Methods: This cross-sectional study was undertaken using online Google form links among HCWs. Knowledge and practice were assessed using a validated questionnaire. The analysis was performed with SPSS version 26. Factors associated with poor knowledge were analysed using multivariate analysis. Results: A total of 193 HCW responded to our online survey. Majority of our HCWs were female (74.1%) with a mean age of 32.5 years. We found 53 (27.5%) and 134 (69.4%) of our HCWs had good knowledge and good practice on COVID-19, respectively. Knowledge gap was identified in the symptomatology, investigation methods and management. Based on multiple logistic regression, determinants of poor knowledge scores were those work as medical attendants (aOR = 3.626; 95% CI = 1.489, 8.834) and nurses (aOR = 4.107; 95% CI = 1.175, 14.358). Conclusion: Around one-third and 70% of our HCWs have good knowledge and practice of COVID-19 infection respectively. Continuous, specifically targeted and updated medical education, need to be carried out to improve the knowledge and practice among our HCWs in order to keep abreast of the fast-moving pace of COVID-19 knowledge development.

This paper proposes a conceptual model for establishing a new approach to improvise anti-smoking strategies. The Tobacco Control programme under the World Health Organization (WHO) has established MPOWER measures to be applied globally. Although numerous approaches have been implemented, there is a knowledge gap pertaining to the positive impact of these strategies. Therefore, analyzing current approaches and establishing new strategies will be beneficial for the tobacco control movement. The proposed model has been adapted from the Medical Research Council (MRC), United Kingdom framework for complex interventions which can be used as reference for researchers to develop a new initiative or strategy for tobacco control. This proposed model incorporates three phases, which are (i) Phase 1: To identify factors influencing stop smoking desires and their successfulness among “specific location” population, (ii) Phase 2: To analyse available smoking cessation strategies globally using systematic review, and (iii) Phase 3: To develop new potential tools/products/guidelines for anti-smoking promotions based on Phase 1 and 2. The novelty of this concept in developing anti-smoking strategies is the incorporation of local needs in Phase 1. This research may contribute significantly to stop or quit smoking behavior among Malaysians. At the end of this study, researchers will be able to recommend new and/or adapted tools/products/guidelines based on the framework discussed. Also, government regulations regarding cigarettes should be properly reviewed in order to achieve more significant results whilst minimizing expenses for anti-smoking campaigns.
Smoking Prevention

Blastocystis sp. is a common enteric protozoan parasite found in humans and various type of animal worldwide. Recently, genotypic distribution of Blastocystis sp. was revealed in insects, rodents, avian and mammals, which exposed its potential of transmiting the infections to human. However, very little information on current level of Blastocystis sp. infection were reported in cattle from Malaysia. Herein, a total of 120 stool samples of cattles were collected. While the potential risk of infection such as age, gender, body score, diarrheic condition of the cattle were noted, the management of the farms was also recorded. All stool sample were cultured, but 80 samples were selected for PCR sequencing analysis. The cultivation and microscopic examination revealed only 25% of the cattle (30/120) were infected with Blastocystis sp.. But, 43.8% of the cattle (35/80) were found positive upon PCR sequencing. The study also found that age, body score condition, diarrheic condition and certain farm were associated with the infection (p<0.05). Six subtypes (STs) that were discovered during the study were ST10 (21.3%;17/35), ST5 (8.8%;7/35), ST3 (7.5%;6/35), ST1 (2.5%;2/35), ST4 (2.5%;2/35) and ST14 (1.3%;1/35). Thus, moderate infections of Blastocystis sp. and variants in the genotypic distributions of the cattle suggest its potential for zoonotic transmission. Therefore, this findings could be helpful for further understanding the parasite, which assist studies of its pathogenicity.

Stroke care service in Malaysia is suboptimal despite the fact that it is one of the commonest cause of death. This is due to several limitations, including lack of resources and funding for the stroke care establishment and the management itself. Alternatively, other regions have come up with numerous ways to combat the difficulties in order to provide better stroke care services. We have identified the overwhelming benefits of creating stroke care units, thrombolysis services, and endovascular thrombectomy. For this reason, we designed a Regional Emergency Stroke Quick Response Network (RESQ) based on the needs of the current situation in Malaysia. With a standardised RESQ training, we hope to achieve close-knitted cooperation in between the emergency medical services, emergency department team and the RESQ, which subsequently will create an ideal improvised stroke care units.

Introduction: Consistent condom use can reduce the rate of transmission of STD/HIV. Condom self-efficacy is an important determinant of consistent condom use. The Condom Use Self-Efficacy Scale (CUSES) assesses the individual's confidence and expectations to obtain, use, dispose and negotiate use of condom with their sexual partners. This study aimed to adapt, translate and determine the validity and reliability of CUSES Malay version among STD/ HIV patients in a primary care clinic. Methods: This was a cross sectional validation study conducted among STD/ HIV patients in a primary care clinic. The CUSES Malay version underwent content validation (calculation of I-CVI), forward and backward translation, face validation and field testing for psychometric analysis. Psychometric analysis used included Principal Axis Factoring with direct oblimin rotation, internal consistency reliability (Cronbach's α) and test-retest reliability analyses (Intraclass Correlation (ICC)). Results: A total of 168 participants were enrolled into this study (99% response rate). In content validation, all items were retained as the I-CVI were >1.00. Feedback from face validation resulted in simpler phrases of some items. One item (B2) was removed due to poor factor loading of <0.3. This resulted in 27 items framed within four factors. These factors were identified as Mechanics, Perceived Barriers, Assertiveness and Intoxicants. Reliability analysis achieved an overall Cronbach's α of 0.878 and ICC >0.4. Conclusion: The CUSES-M is a valid, reliable and stable tool to measure condom use self-efficacy among STD/HIV patients in primary care.