INTRODUCTION: In the clinical setting, erectile dysfunction (ED) is a significant issue that should not be neglected, as it can adversely impact the quality of life of patients and their partners, especially among overweight and obese populations. This study aims to determine the prevalence of ED and its associated factors among non-diabetic, overweight, and obese patients who attend a government health clinic in Kuantan, Pahang, Malaysia. MATERIALS AND METHODS: A six-month cross-sectional study was conducted from February 2024 to August 2024 at twelve health clinics in Kuantan, Pahang. The selected respondents were married men over 18 years old, and those with diabetes mellitus, cardiovascular disease, psychiatric illness, or illiteracy were excluded. Data were collected using the validated Malay version of the International Index of Erectile Function (IIEF-5). ED was defined as an IIEF-5 score of less than 22. Descriptive analysis and simple and multiple logistic regression were performed using SPSS. RESULTS: All 221 eligible patients in the study responded (100% response rate). The prevalence of ED was 66.1% (n=146). Multiple logistic regression showed that ED was significantly associated with dyslipidemia [AOR (95% CI): 2.42 (1.06–5.52); p-value=0.036], anxiety [AOR (95% CI): 3.99 (1.44–11.01); p-value=0.008] and older age [AOR (95% CI): 1.07 (1.02–1.12); p-value=0.009]. CONCLUSION: The study revealed a high prevalence of ED among non-diabetic overweight and obese patients, potentially linked to increasing age, dyslipidemia, and anxiety. Increasing awareness among the public and healthcare providers could improve detection rates in primary care.

Introduction: Early identification of patients at risk for severe multisystem inflammatory syndrome in children (MIS-C) is essential for favourable clinical outcomes. This study aims to identify the clinical characteristics, factors and outcomes associated with severe MIS-C. Materials and methods: In this retrospective cohort study involving 14 major hospitals in Malaysia, children <15 years who met the United States Centres for Disease Control and Prevention case definition for MIS-C were included. Severe MIS-C was defined as children who required inotropic support, ventilatory support (invasive or non-invasive ventilation), or left ventricular ejection fraction of <55%. The factors investigated for severe MIS-C were demographic characteristics, the presence of comorbidities, clinical characteristics, and laboratory measures. Multivariable logistic regression was used to compute the adjusted odds ratio (aORs) of factors associated with severe MIS-C. Results: Among the 155 patients, 91 (58.7%) presented with severe MIS-C. Severe MIS-C was more likely in patients aged ≥5 years old (aOR 2.13, 95% confidence interval [CI] 1.08-4.21), with dehydration (aOR 3.80, 95% CI 1.53-9.45), lethargy (aOR 2.02, 95% CI 0.97-4.18), tachycardia (aOR 8.33, 95% CI 3.27-21.22), albumin <30g/L (aOR 3.36, 95% CI 1.58-7.13), creatine kinase >200U/L (aOR 3.68, 95% CI 1.57-8.64), D-dimer >3.0µg/mL (aOR 2.11, 95% CI 1.08-4.13), ferritin >500ng/mL (aOR 3.77, 95% CI 1.88-7.55), prothrombin time >12.7 seconds (aOR 3.22, 95% CI 1.61-6.43), and urea >6mmol/L (aOR 5.09, 95% CI 2.04-12.71). Conclusion: Identification of these associated factors of severity in MIS-C could aid in early recognition and prompt escalation of care, leading to better outcomes.

Introduction: The disregard for hip flexion force when designing foot-operated equipment poses a potential threat to non-compliance with ergonomics principles, ultimately impacting occupational health. Nevertheless, there is a noticeable lack of studies focusing on the hip flexion strength of Malaysian adults in a standing position. This paper aimed to measure the maximum force of hip flexion strength and formulate a regression model for Malaysian young adults in a standing posture. Materials and methods: The experiment invited sixty Malaysian adults aged 20 to 26 years old. A digital force gauge (Mark-10, USA) was used to measure the hip flexion force. A regression model was developed to determine the influence of gender, body mass, body height, thigh length, and thigh circumference on the hip flexion force. Results: The results of this study found that the means of hip flexion force for the male and female participants were 192.8 N and 126.0 N, respectively. The regression model concluded that gender is the most significant factor influencing hip flexion force (p<0.01). The body mass, body height, thigh length, and thigh circumference positively correlate to hip flexion force. However, these correlations were not statistically significant (p>0.05). Conclusion: This study concluded that the relationship between anthropometric parameters and hip flexion force is not always straightforward and can be influenced by various factors. To gain a more comprehensive picture of hip flexion, it is essential to consider other potential factors such as muscle mass, neuromuscular control, and joint mechanics.

Introduction: The Theory of Planned Behavior (TPB) construct is recommended by the World Health Organization to assess intention for vaccination; however, there is yet a validated instrument in the context of booster dose Covid-19 vaccination in Malaysia. The purpose of the present study is to translate and investigate the factorial validity and internal reliability of the TPB construct for booster dose Covid-19 vaccination (TPB-BDV) questionnaire in Malaysia. Materials and methods: In the pre-testing of the study, five experts and 40 Malaysian adults respectively rated the content and validity index of all 11 items of the translated questionnaire in Malay version. Next, 160 Malaysian adults completed the Malay version of Theory of Planned Behavior- Booster Dose Vaccination (TPB-BDV) questionnaire via online. Results: In the pre-testing phase, Content Validity and Face Validity Index for 10 items in Malay version of TPB-BDV achieved cutoff mean score >3.0 for relevancy, clarity, ambiguity, and simplicity. Meanwhile, Item 8 scored low on relevancy. In the main study, exploratory factor analysis suggested three factors consisting of a final 10 items (without Item 8) which accounted for 74.0% of the total variance. The three factors were Attitude (5 items), Subjective Norms (3 items), and Perceived Behavioral Control (2 items). The internal reliability ranged from a = 0.83 to a = 0.93, with an overall value of a = 0.90. Conclusion: The findings suggest that the 10-items Malay version of TPB-BDV is valid and reliable to measure the individual decision in taking the Covid-19 booster-dose vaccine among Malaysian adult population.

Introduction: Paediatric asthma, a prevalent chronic disease among children in Malaysia, can have its morbidity reduced through effective education. This study aims to assess the knowledge and perceptions of childhood asthma in the Malaysian general population. Materials and methods: A prospective study was conducted among visitors attending paediatric wards and clinics at the Institute of Paediatric Hospital Kuala Lumpur. Participants, who gave their consent, completed validated questionnaires in written form that evaluated their knowledge of asthma symptoms, triggering factors, medication, prevention, and myth perception. A higher score indicated a deeper understanding of asthma. Results: The study included 200 participants, predominantly female (88%), with a median age of 35.5 years. Among them, 12% were asthmatics, and 36% had a family member with asthma. The primary source of asthma information was electronic media (82%). The average score for knowledge of asthma symptoms, triggering factors, medication prevention and myth was 62.13% (SD 17.6). 62.88% (SD 16.3), 56.7% (SD 16.5), 82% (SD 15.1) and 57.8% (SD 15.4) respectively. Asthma myth perception and source of asthma information from family members were strongly related (p-value of 0.042). Conclusion: The general population exhibits an average understanding of asthma, comparable to findings from previous studies in other countries. This highlights the need for targeted educational interventions to dispel myths and enhance asthma knowledge.

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.

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.

Aims: This study was aimed to investigate the effects of methanol extracts from various parts of the Pereskia bleo Kuhn plant on Acanthamoeba sp. The antioxidant levels of each extract from different plant parts were measured after the extraction process. These extracts were then exposed to Acanthamoeba sp. to assess dose-response, IC50 values, changes in cell morphology, internal cell activity and apoptosis based on alterations in phospholipids. Methodology and results: The total phenolic content, carotenoid estimation and antioxidant activity of the leaves, flowers and fruits of P. bleo were measured based on 1,1-diphenyl-2-picrylhydrazyl radicals (DPPH) assay. Its anti-amoebic properties were tested using 3-(4, 5-dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide (MTT) assay for the IC50 determination. The morphological and biochemical changes in the Acanthamoeba sp. were observed under light and fluorescence microscopy using the acridine orange and propidium iodide double staining (AO/PI). The IC50 values of P. bleo leaves, flowers and fruits methanolic extracts were 5.884%, 0.1646% and 20.69%, respectively. Morphological observation displayed shortened acanthapodia with darkened cytoplasms. AO/PI-stained Acanthamoeba sp. cells appear with orange-fluorescent organelles in their green cytoplasm, indicating autophagic cell deaths. Apoptotic and necrotic Acanthamoeba sp. cells were absent based on Annexin V labelling. Conclusion, significance and impact of study: This study confirmed that the methanolic crude extracts of P. bleo exhibit high cytotoxic potential towards Acanthamoeba sp. trophozoites by inducing an autophagic mode of cell death.

Introduction: Malaysian adults consume excessive amounts of salt daily, which could lead to hypertension. Understanding knowledge, attitudes, and practices (KAP) surrounding salt intake is crucial for designing effective interventions to reduce excessive consumption and its associated health risks. Therefore, this study aimed to adapt an existing salt intake-related KAP questionnaire that was previously employed in a local population-based survey and to validate and test its reliability. Methods: This cross-sectional study comprised two phases: (1) adaptation, content validation (CV), and face validation (FV); (2) pilot testing and reliability testing. CV and FV involved a total of seven experts and ten Malaysian adults from the Klang Valley, respectively. Pilot testing involved 139 Malaysian adults to determine the questionnaire’s reliability. Content validity index (CVI) and Face validity index (FVI) values were calculated to analyse CV and FV. Reliability of each domain was analysed by obtaining Cronbach’s alpha (α) values. Results: A self-administered questionnaire comprising six items each for knowledge, attitude, and practice was developed. The questionnaire demonstrated acceptable item-level CVI (I-CVI) and item-level FVI (I-FVI) values of at least 0.83, indicating that the items were relevant, clear, non-ambiguous, and simple. Reliability test showed acceptable α values of at least 0.70 for each domain, suggesting that the questionnaire was reliable. Conclusion: This tool could be considered valid and reliable for assessing the level of KAP towards salt intake among adults in Malaysia.

Dengue is a mosquito-transmitted infection endemic in tropical and subtropical locations of the world where nearly half of the world’s population resides. The disease may present as mild febrile illness to severe and can even be fatal if untreated. There are four genetically related but antigenically distinct dengue virus (DENV) serotypes. Immune responses to DENV infection are in general protective but under certain conditions, they can also aggravate the disease. The importance of the cellular immune responses and the antibody responses involving IgG and IgM has been well-studied. In contrast, not much has been described on the potential role of hypersensitivity reactions involving IgE in dengue. Several studies have shown elevated levels of IgE in patients with dengue fever, but its involvement in the immune response against the virus and disease is unknown. Activation of mast cells (MCs) and basophils mediated through dengue-specific IgE could result in the release of mediators affecting dengue virus infection. The present review explores the relationships between the induction of IgE in dengue virus infection, and the potential role of MCs and basophils, exploring both protective and pathogenic aspects, including antibody-dependent enhancement (ADE) of infection in dengue.