THE USE OF HYPNOSIS AS AN ADJUNCT TO NITROUS OXIDE/OXYGEN SEDATION: A CASE SERIES It is known that managing patients with dental fear and anxiety is challenging for clinicians and patients. This series of case reports highlights the importance and benefits of dental management under clinical hypnosis as an adjunct to nitrous oxide inhalation sedation for ages six to fifteen. These treatments range from pulp therapy, extraction and minor oral surgery. Customised hypnosis scripts were utilised for each patient, and the metaphors used were tailored to the patient’s interest and preference. The intended treatment was successfully carried out in all the patients. Five cases discussed in this case series were initially indicated for treatment under general anaesthesia, but treatment was successfully carried out using hypnosis and nitrous oxide/oxygen sedation. In the two surgical cases, nitrous oxide was tapered off once local anaesthesia was achieved, and the state of relaxation was maintained using a hypnotic trance, reducing the anaesthetic agent’s utilisation. Hypnosis successfully reduces patients’ anxiety, allowing them to feel more relaxed and confident about accepting future dental treatment without the need for pharmacological intervention.

INTERPRETATION OF EMOJI® IN MALAY LANGUAGE AMONG CHILDREN IN MALAYSIA The existing dental anxiety scales for paediatric patients tend to categorize and label children according to their level of cooperation. However, human emotions are more complex, and each child is unique. Hence, a more dynamic and interactive method should be introduced for a better understanding of the patient’s current state of emotion. The aim of this study was to investigate the interpretation and understanding of children towards frequently used emoji® for the development of an emoji® dental emotional spectrum. Both online and physical surveys were conducted among 147 Malay language-speaking children aged between 4-to-16 years in Malaysia. The children were asked to interpret 30 pre-selected emoji® images in their own words using the Malay Language. The pre-selected emoji® represent happiness, neutral, fear, sadness, and anger. The interpretations were subsequently based on their similar meaning, a process that was validated by two experts in the field of linguistics. The study involved participants with an average age of 9.2 years, with the majority of them being female (61.2%). Of the 30 pre-selected emoji® images used in this study, 13 had respondent agreement exceeding 60% which was the threshold set for suitability for use in evaluating dental emotion. The remaining 17 emoji® images have a remarkable variability in the interpretation which indicates potential misinterpretation by the respondents. The 13 emoji® images range from happiness, neutral, fear, dislike, unhappy, sad, anxious, and angry with the emoji® images which represent “excited” (94.0%), “loudly crying” (97.3%) and “angry” (91.8%) had the highest agreement. Meanwhile, the emoji® images represented “confounded” and “downcast” had the least agreement among respondents (1.3%). Despite the universal meaning imposed by emoji®, the interpretations may vary in different populations and age groups. Emoji® images hold the potential to serve as a valuable tool for identifying and managing children’s behaviour.

Introduction: General population across different countries have shown an overall support for anti-smoking measures that vary significantly by certain population parameters. However, characteristics of the public attitude in a community who has been exposed to prolonged awareness campaigns and smoke-free area legislation is unclear. Consequently, we investigate residents who reside next to Batu Buruk beach in Kuala Terengganu city which has been gazetted as a smoke-free area since 2017. Methods: The cross-sectional study involves self-administered validated questionnaires. Multiple linear regression with forward method was applied to identify significant factors associated with the attitude towards anti-smoking measures. Results: A total of 295 residents participated. Most of them were Malays (96.6%), married (64.4%), attained up to the secondary school level (45.4%) and employed (59.7%). The mean value of the total attitude scores was 181.86 (range: 70-200). Multivariate analyses revealed those having higher monthly income had a higher total attitude scores (adjusted b: 6.91, 95% CI: 2.15, 11.66), while current daily smokers had a lower total attitude scores towards anti-smoking measures than non-smokers (adjusted b: -23.30, 95% CI: -29.55, -17.05). These findings highlight comparatively stronger and more consistent support for anti-smoking measures that may vindicate high-stake investment and legislation against smoking. Conclusion: The novel evidence may also better-inform the strategy to expand the initiatives further through profiling the target population with heightened emphasis on the economic standing and prevalence of current daily smokers. Future research may adopt experimental design to establish causality relationship between predictors and outcomes revealed in this community.

Polyunsaturated fatty acids (PUFAs) intake may be beneficial in many aspects during the early phase of life. This scoping review aims to examine the beneficial outcomes and intakes of omega-3 and omega-6 PUFA among children. An electronic database search on academic journals published from 2017 to 2021 was conducted using Science Direct, PubMed, and Google Scholar. A total of 35 studies were identified and included in this scoping review. Majority of the findings found that PUFAs intake has a beneficial impact on the growth development, mental and cognitive health among children whether they are malnourished, sick or healthy individuals. Overall, this review may provide additional information on the benefits and recommended intake of supplementing PUFAs on children. More detailed research on this topic is needed to support these findings since it will contribute to the formation of the dietary intervention.

Introduction: Intervention approaches that integrate human coaching into technology are considered as a convenient, accessible and scalable method to reach a larger population at risk. The objective of this paper is to present the protocol for a randomised controlled trial that evaluates the efficacy of a lifestyle intervention programme via a mobile phone app (MyDiPP), which aims to prevent diabetes among adults at risk of developing diabetes. Methods: MyDiPP intervention is to be delivered for 12 months with multiple approaches (weight loss, dietary modification, physical activity, and quality of life). Eligible adults aged 18-65 years, overweight/obese (body mass index, BMI ≥ 23kg/m2), and at high risk of type 2 diabetes [American Diabetes Association (ADA) Diabetes Risk Score ≥5, or haemoglobin A1c (HbA1c) of 5.6-6.2%], will be randomly assigned to one of two study groups (intervention or usual care control groups) in a 1:1 ratio using simple randomisation. Results: Changes in weight and HbA1c level (primary outcomes), and changes in physical activity level, dietary intake, and quality of life (secondary outcomes) will be assessed at 6 and 12 months. Conclusion: This study protocol describes the first digital therapy for diabetes prevention in Malaysia, which will determine whether the effect of this intervention is larger than the effect of usual care in reducing body weight and HbA1c level, and improving dietary intake, physical activity, and quality of life of high-risk individuals. Results from this trial may be useful for preventing type 2 diabetes mellitus in Malaysia.

Introduction: The incidence and complications of hyperlipidemia associated co-morbidities and mortalities are grossly increasing globally. Intervention with natural products preparation has been identified as an alternative for the management of hyperlipidaemia and its related cardiovascular complications. This study investigated the anti-hyperlipidaemic activities of a mixture of Zinger officinale, Allium sativum, Citrus lemon, honey, and Malus domestica vinegar (ZACAH) extracts in in Sprague Dawley (SD) rats fed with high cholesterol diet. Methods: Thirty-six male SD rats were randomly distributed into 6 groups, including normal chow diet-fed (NC), high cholesterol diet (HCD), HCD+ Simvastatin (standard drug) while the remaining three groups were fed with HCD + ZACAH extracts at different doses (1, 3 and 5mg/kg body weight) for 18 weeks. Simvastatin at 10 mg/kg of bodyweight was used as control. High-performance liquid chromatography (HPLC) was used to determine phenolic compounds present in ZACAH extracts, elastase inhibitory assay was determined using spectrometric with a substrate (N-Succ-(Ala)3-pnitroanilide (SANA) while 2,2-diphenyl-1-picrylhydrazyl (DPPH) was performed based by the method described by Blois, 1958. Results: In vitro; ZACAH extracts had oxygen radical absorbance capacity (ORAC) value of 2000 µmol TE/100 mL, total phenolic content (TPC) of 7537 ± 54.5%, DPPH free radical scavenging activity of 27.34 ± 2.71%, elastase inhibitory assay of 29.29 ± 1.65% and lipoxygenase inhibitory assay of 98.58 ± 1.42%. In vivo, ZACAH extracts showed decreased bodyweight, adipose tissue, improved lipid profiles and hepatic biochemical enzymes. Conclusion: These results suggested that ZACAH extracts supplementation improved hyperlipidaemia in SD rats and might be a promising adjuvant for the treatment of hyperlipidaemia.

Introduction: This study explored stroke survivors’ understanding regarding stroke, the perceived facilitators and barriers of healthy lifestyle changes, and provision of secondary prevention education. Methods: Semi-structured interviews were conducted with 22 stroke patients (13 males and nine females; aged 34-80 years) who were attending rehabilitation clinics in three Malaysian hospitals. Each interview was audiotaped, transcribed, and analysed using the framework approach. Results: Six themes were reported: understanding of stroke; facilitators of healthy lifestyle changes; barriers of healthy lifestyle changes; food taboos; recovery; and provision of secondary stroke prevention. A third of them were uncertain about the cause of stroke and the perception towards risk of recurrent stroke varied widely. The lack of secondary prevention education was obvious although many had received general verbal advices. Several personal, social, and environmental factors were identified as the facilitators or barriers in healthy lifestyle participation. Food taboos were common and had become one of the barriers in practising healthy eating practices. Families had a strong influence on the patient’s belief and behaviour changes, both in positive and negative ways. Besides, patients tended to have a problem in information recall, while some faced confusion during the early stages of stroke recovery. Conclusion: More efforts to improve knowledge regarding cause of stroke and secondary prevention strategies are needed. Use of appropriate behavioural changes strategies, family-centred approach and continuous health education are necessary to facilitate patients’ efforts at making successful lifestyle modification after stroke event.

Introduction: Cardiovascular disease is the leading cause of death worldwide. Despite the proven benefit of secondary prevention medications (SPMs), their utilisation remains suboptimal in many countries. This study aimed to assess the use of SPMs in a Malaysian primary care clinic and factors associated with it. Methods: A retrospective review of electronic medical records was conducted to assess the prescription of SPMs among patients with coronary artery disease who attended the clinic between 1st January 2018 and 31st December 2018. Prescriptions of SPMs were documented in numbers and percentages. Multiple logistic regressions were used to analyse factors associated with the prescription of SPMs. Results: Of the 662 patients included in the study, 99.1% were prescribed statins, 97% antiplatelets, 81.7% angiotensin-converting enzyme (ACE)-inhibitors or angiotensin Ⅱ receptor blockers (ARBs), and 78.7% beta-blockers. Male patients were more likely to be prescribed statins (OR = 8.584, 95% CI: 1.431 – 51.510) and antiplatelets (OR = 6.818, 95% CI: 2.294 – 20.257). Another significant factor for antiplatelets prescription was having diabetes (OR = 3.318, 95% CI: 1.148 – 9.590). Having hypertension was associated with ACE-inhibitors or ARBs prescription (OR = 4.008, 95% CI: 2.522 – 6.370). Conclusion: Although the majority of patients received SPMs, there were significant disparities for some SPMs prescriptions among female patients. As these medications are widely available in the Malaysian primary care setting, steps should be taken to ensure that these medications are prescribed equally for all eligible patients.

Background: COVID-19 was first detected in Malaysia on 25 January 2020. Multiple clusters were detected in Petaling District, with the first locally transmitted case reported on 8 February. Descriptive analyses of the epidemiology of the COVID-19 outbreak in Petaling are presented, from the first case to the end of the first wave. Methods: All laboratory-confirmed COVID-19 cases reported to the Petaling District Health Office between 1 February and 26 June 2020 were analysed. Socio-demographic characteristics, symptoms, date of onset, date of exposure, travel history and history of comorbidities were obtained by phone interviews using one of two investigation forms. The descriptive analysis was conducted according to time, place and person. Results: There were 437 COVID-19 cases, for an incidence rate of 24/100 000 population. Ten (2.3%) deaths and 427 recovered cases were recorded. Of the 437 cases, 35.5% remained asymptomatic and 64.5% were symptomatic. Common symptoms included fever (43.8%), cough (31.6%) and sore throat (16.2%); 67.3% had no comorbidities, 62.5% reported close contact with a confirmed case, and 76.7% were local infections. Transmission occurred in four main groups: religious gatherings (20.4%), corporations (15.1%), health facilities (10.3%) and a wholesale wet market (6.4%). In 31.9% of confirmed cases, an epidemiological link to an asymptomatic case was found. Conclusion: Transmission of the disease by asymptomatic cases should be emphasized to ensure continuous wearing of face masks, hand hygiene and social distancing. Further research should be conducted to better understand the transmission of SARS-CoV-2 from asymptomatic cases.

In higher education setting throughout the world, the practise of handwashing among staff is essential, particularly in the period of COVID-19 pandemic. Despite the overwhelming evidence on the effectiveness of proper handwashing, the knowledge, attitude and practice of handwashing among the staff of higher education have not been well investigated. Consequently, a cross-sectional study among staff in a university in Malaysia was conducted to identify the prevalence of proper handwashing and its associated factors. The data was collected using questionnaires in Google form from 18th June to 21st June 2020. Statistical analyses involved simple and multiple logistic regression with backward likelihood ratio method. Out of 349 participants, 31.8% (95% CI: 26.9,36.7) had proper handwashing practice. The results of the multivariable analysis revealed that the total knowledge scores (OR: 1.04, 95% CI: 1.001, 1.071) and the total attitude scores (OR: 1.23, 95% CI: 1.152, 1.321) were found to be significantly associated with proper handwashing practice among staff. Our study suggests that having the right knowledge and favourable attitudes are crucial towards achieving the proper handwashing practise. Additional supports for promoting a conducive ecosystem may also likely be needed to sustain a long-term practice of proper handwashing.