Background: The prevalence of confirmed cases of COVID-19 is high and tends to continue to increase in Indonesia. Based on data, the Province of South Kalimantan, Indonesia in early mid-2021 experienced a high spike in cases, resulting in a large number of deaths, especially in Banjar Regency. Active COVID-19 cases in South Kalimantan in July 2021 were recorded at 5,279 (12.41%) out of 42,527 positive cases. Data compiled from the COVID-19 Task Force (Satgas) showed that Banjar Regency was the third highest area of the cumulative number of deaths, with as many as 47 people dying in one day. The results of many research on risk factors for COVID-19 cases vary widely. People with comorbidities are a very vulnerable group. Objective: This study aims to identify the relationship between comorbid conditions and death based on data from COVID-19 admission in the Wetland Environment community in Banjar Regency, South Kalimantan, Indonesia in the years 2020-2021. Methods: This is a retrospective analytical observational study which used purposive sampling. The data were collected from the case form report (CFR). The dependent variable in this study was inpatients at Ratu Zaleha Hospital who died and were diagnosed as positive for COVID-19, while the independent variables were age (productive/non-productive), tuberculosis, hypertension, diabetes mellitus, asthma, pneumonia, heart disease, COPD (lung disease), HIV/AIDS, chronic kidney disease (CKD), and stroke (CVA). Data were analyzed by univariate, bivariate, and multivariate analyses with logistic regression method to obtain adjusted OR. Results: Out of 700 patients with confirmed COVID-19 infection, 273 (39%) had no comorbidity while 427 (61%) had at least one comorbid condition. There were 330 (47.1%) male patients and 370 (52.9%) female patients. There were 565 (80.7%) patients who belong in the productive age and 135 (19.35%) in the nonproductive age. Results showed that age (p=0.002), asthma (p=0.026), chronic kidney disease (p=0.000), and heart disease (p=0.002) are significant risk factors of COVID-19 death in Banjar Regency. Conclusion Based on our analysis of COVID-19-related deaths in Banjar Regency in Ratu Zaleha Hospital on the year 2020-2021, diabetes, pneumonia, kidney failure, and COPD were associated with increased mortality.
COVID-19 ; Comorbidity ; Mortality

In light of the increasing use of online learning platforms in medical education, there is a critical need to assess the current state of online learning environments. Despite the global emphasis on digital education, limited studies have systematically explored how medical students perceive the effectiveness and quality of these environments, particularly in Pakistan. This study aims to fill this gap by evaluating medical students’ experiences with their institution’s online learning environments and identifying key strengths and challenges that impact learning outcomes. A mixed-method, sequential exploratory design was used, starting with a quantitative assessment followed by qualitative inquiry. Data from 253 medical students were collected via a survey, and 30 focus group interviews were conducted to provide deeper insights into the challenges students face in navigating the online learning environment. The findings revealed critical areas in need of improvement, including digital infrastructure, student engagement, and the accessibility of online resources. Qualitative data highlighted the need for more interactive and student-centred approaches to online education. By focusing on the status of online learning in medical education, this research provides valuable insights for educators and policymakers aiming to enhance the quality of digital learning environments. The study contributes to ongoing efforts to develop more effective, engaging, and responsive online learning strategies for medical students in Pakistan.
Education, Distance ; Education, Medical, Undergraduate ; Perception

Introduction: Studies show that adolescents are more reward sensitive compared to other age groups. The nucleus accumbens (NAcc) has been identified as a key brain area involved in reward through its connectivity to other reward-related brain areas. Our study aimed to characterise the white matter structural connectivity of nucleus accumbens with brain areas that are most often associated with reward in female adolescents. Methods: Fifteen healthy female Malay adolescents were recruited and underwent diffusion-weighted brain scanning. Two behaviour scales were also given to verify typical reward responsiveness. Then, probabilistic tractography and NAcc segmentation were performed on the data using FMRIB Software Library (FSL). Probabilistic tractography was performed to determine the relative connection probability of nucleus accumbens (NAcc) to areas shown to be associated with reward, namely amygdala, anterior cingulate cortex (ACC), medial orbitofrontal cortex (mOFC), hippocampus, ventrolateral prefrontal cortex (vlPFC) and dorsolateral prefrontal cortex (dlPFC). Connectivity-based segmentation of NAcc was performed to determine the spatial distribution of its connectivity with the target brain areas according to the highest connection probability. Results: The highest relative connection probability was found between NAcc to mOFC, while the NAcc parcellation showed the widest distribution of connection to mOFC compared to the other five targets on both sides of the brain. Conclusion: Our findings demonstrated the strongest structural connectivity and widest distribution between NAcc and mOFC compared with other brain areas related to reward. This study’s findings could be used as baseline to compare with people with atypical reward circuit problems.

Introduction: Childhood anxiety is one of the common mental health problems in children. Untreated childhood anxiety will lead to a higher risk of developing mental health problems in adulthood. Thus, this study aimed to investigate the relationship between parental emotional styles and family values to anxiety level among primary school children. Methods: A cross-sectional study was conducted in a selected primary school in Kelantan, Malaysia. A set of questionnaires consisted of the Revised Child Anxiety and Depression Scale–Parents’ Report (RCADS-P 25), the Parental Emotional Style Questionnaire (PESQ), and the Asian Family Characteristics Scale (AFCS) was used for assessing anxiety, parental emotional styles, and family values, respectively. Data were collected via an online survey using Google Form, and were analysed using Multiple Linear Regression (MLR) to determine the factors associated with childhood anxiety. The significance value was set at p < 0.05. Results: A total of 150 parents of primary school children from the selected school was involved in this study. The majority of respondents were females (82.0%), married (94.7%), hold a degree (66.7%), and were working in the government sector (60.0%). Most of the respondents’ child were twelve years old (20.7%) and males (62%). Based on the MLR, emotional dismissing parental style (p = 0.025) and family values (p = 0.016) were significantly associated with anxiety in these children. Conclusion: Emotional dismissing parental style and family values were significant predictors of anxiety in primary school children. Future intervention research on childhood anxiety is needed.

Objective: To characterise a collection of pili-carrying and none pili-carrying pneumococcal isolates of clinical origin for serotypes, antibiotic resistance and genotype. Methods: In total, 42 clinical isolates were collected between October 2017 and December 2019. Those isolates were analysed for antimicrobial susceptibility, serotype distribution, detection of pneumococcal virulence and pilus genes. Multilocus sequence typing was performed only for piliated isolates, followed by phylogenetic analysis. Results: The common isolation sites among the pneumococcal isolates were tracheal aspirate (28.6%), blood (26.2%), and sputum (23.8%). Fifty percent isolates were resistant to erythromycin, tetracycline (50.0%) and trimethoprim-sulfamethoxazole (43.0%). The most frequent were serotypes 19F (28.6%), 6A/B (23.8%) and 19A (14.3%). Piliated isolates were detected in a small proportion (33.3%); 64.3% were multidrug-resistant. ST320 was the prevalent sequence type among the piliated isolates and genetically related to the Pneumococcal Molecular Epidemiology Network clones Taiwan 19F -14 (CC271). In the phylogenetic analysis, some piliated isolates showed a close association having similar ST320, carrying serotype 19A and both pilus genes indicating their clonal spread. Conclusions: Pneumococcal lineages of piliated isolates have been globally disseminated and pili could have played a role in the spread of antibiotic resistant clones.

Background: The spread of COVID-19 was inevitable and has not spared small and isolated communities, including the community of Perhentian Island in Besut District, Terengganu. Managing clusters in small islands can be difficult, given the limited resources. This study explores the characteristics of COVID-19 cases and the experience of outbreak containment at Perhentian Island. Methodology: A retrospective study involving record review of COVID-19 cases and at-risk individuals registered under Perhentian Cluster were retrieved from the Besut District Health Office COVID-19 online registry from the 16thAugust2021 until 6thOctober 2021. All notified cases and close contacts who fulfilled the inclusion criteria were extracted and analysed using descriptive statistics. Results: A total of 1,093 community members of Perhentian Island were screened of which 170 (15.5%) tested positive for COVID-19, while 923 (84.5%) tested negative. Among individuals who tested positive, the majority were adults (52.4%), male (51.8%), Malays (98.8%), and villagers (96.5%). Clinical characteristics were categorized into: asymptomatic (55.9%), had no known medical comorbidities (90.6%), low-risk groups (87.1%), vaccinated (57.6%), and admitted to PKRC (97.1%) for treatment. Multiple agencies were involved in the outbreak containment of the Perhentian Cluster, working collectively and in good coordination. Conclusion The outbreak was attributed to community gatherings and close interactions among villagers. Prompt actions, targeted planning, and inter-agency collaboration were the key factors in successful containment of further spread of COVID-19 in Perhentian Island.
COVID-19

Introduction: The aim of the study is to determine the prevalence of burnout and correlation between burnout score and stressor domain score and to determine the association between sociodemographic and occupational related factors with overall burnout among nurses caring for children in Hospital Universiti Sains Malaysia (Hospital USM). Methods: This was a cross-sectional study using bilingual validated questionnaire; the General Stressor Questionnaire (GSQ) and Copenhagen Burnout Inventory (CBI) conducted among nurses providing medical service for children in Hospital USM particularly in wards and clinics. All 159 eligible nurses were recruited and 157 completed questionnaires were analysed. Pearson’s correlation analysis was applied to study the correlation while simple logistic regression and multiple logistic regressions were applied to study the association. Results: The prevalence of burnout among nurses caring for children in Hospital USM was 28.7% (95% CI = 21.6, 35.7) with the majority of them experienced personal burnout (49.7%, 95% CI = 41.9, 57.5). There was a significant moderate positive correlation between different stressor domain score with overall burnout score with p-value < 0.05. Work placement and bureaucratic constraints were identified as the main contributory factor leading to overall burnout. Conclusion: Burnout among nurses providing medical services for children in Hospital USM is of concern especially involving personal burnout. The main stressor related factors of burnout were work placement and bureaucratic constraints. Therefore, burnout among nurses providing care for children must be addressed in order to enhance their psychological well-being.

Introduction: The purpose of this research is to determine the factors associated with low-birthweight (LBW) infants in teenage pregnancy. Methods: A cross-sectional study was conducted in Terengganu, Malaysia, from January 1, 2020, to May 31, 2020. Records of teenage pregnancies in 2018 were retrieved from the Maternal Health Record Book and Pregnant Woman and Postnatal Book Registry. Simple logistic and multiple logistic regression analysis was used to analyse the factors associated with LBW infants in teenage pregnancy. Results: All 357 cases that fulfilled the study criteria were included. LBW infants were the most common perinatal outcome among teenage pregnancies (19.3%), followed by preterm birth (9.0%), and both low Apgar score and stillbirth (1.4% each). Factors associated with low-birth-weight infants in teenage pregnancy in Terengganu were a teenage husband (AOR 2.0; 95% CI: 1.01, 3.96; p=0.047) and a mother with a low level of education (AOR 3.07; 95% CI: 1.20, 7.85; p=0.019). Conclusion Teenage husband and low level of maternal education are significant factors that need to be addressed to improve teenage pregnancy outcomes. Interventions to improve these factors should continue to be encouraged.
Pregnancy in Adolescence ; Infant, Low Birth Weight

Introduction: Microalbuminuria presents significant health risks for the progression of endstage renal-failure (ESRF) among type 2 diabetes mellitus (T2DM) patients. This study aims to determine the proportion and associated factors of microalbuminuria among T2DM patients in Kuala Selangor district, Malaysia. Methods: A retrospective cross-sectional study was conducted from December 2020 to February 2021 using secondary data from the National Diabetic Registry (NDR), Malaysia, and reviewed patients’ diabetic records for the year 2020. All T2DM patients aged ≥18 years who were registered with the NDR in 2020 and fulfilled the inclusion and exclusion criteria were included in the study. Descriptive statistics and multiple logistic regression analysis were performed. Data were analysed using SPSS version 26.0. A total of 343 samples were included in this study for the determination of the proportion of microalbuminuria and its associated factors. Results: Of 343 respondents, 34.4% had microalbuminuria. HbA1c >7.0% (AdjOR 2.19, 95% CI: 1.35, 3.55, p=0.001), HDL <1.04 mmol/L (AdjOR 2.44, 95% CI: 1.323, 4.52, p=0.004), dyslipidaemia (AdjOR 1.90, 95% CI: 1.03, 3.48, p=0.039), and peripheral neuropathy (AdjOR 3.01, 95% CI: 1.02, 8.93, p=0.047) were significantly associated with microalbuminuria. Conclusion Microalbuminuria is a modifiable risk factor in preventing the progression of ESRF among T2DM patients. Therefore, identification of factors associated with microalbuminuria among this high-risk group is important to facilitate early screening and prompt treatment to prevent progression of diabetic kidney disease to ESRF.
Diabetes Mellitus, Type 2 ; Glycated Hemoglobin

Eye socket contracture is a well-known late complication of enucleation surgery, and the additional insult of radiotherapy at an early age causes even further fibrosis and scarring of the socket. Management of the contracted socket is challenging, and several methods have been proposed. We report a case of eye socket contracture after enucleation and radiotherapy in which multiple reconstructive procedures failed. The recurrent contracture caused difficulty in housing and retaining the eye prosthesis. We reconstructed the lower eyelid with a facial artery myomucosal flap and nasolabial flap, and the upper eyelid with a Fricke flap following reconstruction of the orbital rims (supraorbital and infraorbital rims with a calvarial bone graft, and further augmentation of the infraorbital rim with a rib bone graft). Cosmesis post-reconstruction was acceptable and the prosthesis was retained very well.