Aims: This study was aimed to characterize laccase from a selected fungal strain and examine the enzyme’s ability to remove lignin from paper pulp. Methodology and results: Twelve fungal strains were screened for laccase production, resulting in the selection of Trichoderma sp. UBDFT12. The highest laccase activity (103 U/L) was observed from the culture filtrate on the fourth day of incubation. The optimum temperature and pH for the enzyme were 40 °C and pH 4, respectively. However, the enzyme stability was found to be reduced with time after 1 h incubation. At 1 mM, it was found that AgNO3, CaCO3, CuSO4, KCl, MgSO4, MnSO4 and ZnSO4 increased the laccase activity to 107, 107, 111, 112, 106, 105 and 107%, respectively, whereas FeSO4 and NH4Cl reduced the activity to 84 and 99%, respectively. The addition of 1% H2O2, 1% NaCl, 1% sodium dodecyl sulphate (SDS), 1 mM ethylenediaminetetraacetic acid (EDTA), 10 mM EDTA, 1 mM phenanthroline and 10 mM phenanthroline reduced the activity to 95, 73, 0, 79, 79, 73 and 37%, respectively. The culture filtrate was partially purified via ammonium sulphate precipitation and the recovered enzyme had a specific activity of 0.176 U/mg. Using sodium dodecyl-sulfate polyacrylamide gel electrophoresis (SDS-PAGE), the molecular weight of the enzyme was approximately 65 kDa and its activity was confirmed by zymography. The culture filtrate was also found to be able to remove lignin from different types of paper pulp. Conclusion, significance and impact of study Laccase produced by Trichoderma sp. UBDFT12 was found to have the ability to remove lignin from paper pulp.

Introduction: Social media and Internet use during disasters have been proven to be useful tools in helping public health agencies to respond to pandemics. However, this tool can also be the culprit in the spread of misinformation to the public. This study aims to identify the public health impact of misinformation during the COVID-19 pandemic using the socio-ecological model. Methods: A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was initially undertaken by searching relevant articles published from January to November 2020 in several electronic databases including Medline, PubMed, and Springer link. All publications produced in English regarding the impact of misinformation during the COVID-19 outbreak were included except review articles. Results: Eleven articles were identified from these databases. The public health impact of misinformation from these articles was analysed and discussed according to the domains of the socio-ecological model. It was found that various elements of misinformation on the COVID-19 pandemic caused a significant impact on the individual, interpersonal, organisational, community, and policy levels across various nations. Conclusion: This study concludes that addressing misinformation during a pandemic such as the COVID-19 phenomenon is an important measure to improve public health response in mitigating the spread of pandemics.

Introduction: During this pandemic, overcrowding in classroom caused by a lack of educational facilities and poor indoor air quality are the main causes of respiratory diseases among children and adolescents. Therefore, it is essential to measure and assess the indoor air quality where children spend extended periods of time such as school. Materials and methods: This study covered four schools with old buildings and four schools with new buildings in Bayanzurkh, Sukhbaatar, Khan-Uul, Chingeltei district of Ulaanbaatar. We collected PM10 and PM2.5, carbon dioxide, air temperature, humidity, and microbiological count from chosen classrooms and compared to the MNS4585:2016 standard. SPSS-24 was used to do statistical analysis on the information gathered during the evaluation. Results and Discussion: The 24-hour average PM2.5 concentration was 64.3 (95% CI: 64.1-64.5) mcg/m3, which was 4.3 times higher than the WHO guideline value and 1.3 times higher than the MNS4585:2016 standard. The 24-hour average PM10 concentration was 85.3 (95 % CI: 85.1-85.6) mcg/m3, which is 1.9 times higher than WHO guideline value. In older school buildings, the 24-hour average PM2.5 concentration was 5.6 times higher than the WHO guideline value and 1.7 times higher than the MNS4585:2016; the average PM10 concentration was 2.8 times higher than the WHO guideline value and 1.3 times higher than the MNS4585:2016. The air temperature and carbon dioxide concentration in classroom was met the MNS4585: 2016. The average relative humidity of all schools is 24.2±6.5%, which is 14-16% lower than the MNS4585: 2016. Conclusion The indoor air quality of the school in new and old buildings was similar poor, therefore a variety of steps are needed to improve it.

Toxoplasma gondii consists of three genotypes, namely genotype I, II and III. Based on its virulence, T. gondii can be divided into virulent and avirulent strains. This study intends to evaluate an alternative method for predicting T. gondii virulence using hierarchical cluster analysis based on complete coding sequences (CDS) of sag1, gra7 and rop18 genes. Dendrogram was constructed using UPGMA with a Kimura 80 nucleotide distance measurement. The results showed that the prediction errors of T. gondii virulence using sag1, gra7 and rop18 were 7.41%, 6.89% and 9.1%, respectively. Analysis based on CDS of gra7 and rop18 was able to differentiate avirulent strains into genotypes II and III, whereas sag1 failed to differentiate.

Introduction: According to the predefined 2010 World Health Organisation criteria, serrated colonic polyps (SCP) are pathologically classified into hyperplastic polyp (HP), sessile serrated adenoma/polyp (SSA/P) with or without cytological dysplasia and traditional serrated adenoma (TSA). Sessile serrated adenoma/polyp is acknowledged as a precursor of colorectal carcinoma through the serrated neoplastic pathway. Hyperplastic polyps display similar histological features to SSA/P, in comparison to other types of SCP. It is noteworthy to discriminate between HP and SSA/P, since only the latter has a malignant potential. Method: A total of 198 cases of SCP were identified and the slides were reexamined and reclassified accordingly. Analysis on the proportion of SSA/P among SCP and underdiagnosed cases of SSA/P was performed. The association between SSA/P and non-SSA/P with demographic data and colonoscopic findings were also studied. Results: From the 198 cases of SCP, 164, 29 and five cases were reclassified as HP, SSA/P and TSA respectively. Sixteen cases of SSA/P were underdiagnosed as HP. From among 29 cases of SSA/P, the majority were ≥ 65 years old (17; 58.6%), male (21; 72.4 %) and Chinese (17; 58.6%). Most of the SSA/P (16; 55.2 %) were located in the right colon and measured ≥ 10mm (9; 31%) in size. Location (p=0.004) and size (p=0.013) of the colonoscopic findings were significantly associated with SSA/P. Conclusion: Underdiagnosed cases of SSA/P among HP were identified most likely because of the resemblance of their histological features. The location and size of SCP may suggest the probability of SSA/P.

Fellowship in Prehospital and Disaster Medicine (PDM) is a flagship program of the Emergency in Medical and Trauma Services offered by the Universiti Teknologi MARA in Malaysia. This program is designed to empower emergency physicians through academic courses, leadership training, and networking. One of the essential elements to advance in the program is being able to do a fellowship attachment in a foreign country. I specifically chose to have my fellowship attachment in Davao City, Philippines because it has been recognized as a peaceful and orderly city that is resilient to natural and anthropogenic disasters. I was also interested to learn about the proactive stances of its leaders towards empowering communities and strengthening disaster risk reduction and disaster management capabilities. My fellowship attachment took place between March 14, 2019, and June 24, 2019. I was the first fellow in the PDM program to have my attachment in Davao City. My purpose was to identify and learn from gaps between the prehospital care and emergency medical services of Philippines and Malaysia. I also wanted to expand my clinical experience and learn more about the Emergency Medical Services in the Southern Philippines Medical Center (SPMC). Their Department of Emergency Medicine has observership arrangements with partner institutions. In SPMC, my main rotation took place in the Emergency Room - Trauma Surgery Unit. I had a comprehensive learning experience while being part of medical standby services for significant events. First, I was part of the medical standby services for the Alveo Ironman 70.3 in Azuela Cove, Davao City. The event had a month-long training and simulation for the safest race, which involved a team from various agencies such as SPMC, Central 911, Bureau of Fire Protection, Philippine National Police, Philippine Red Cross, and Philippine Coast Guard. Second, I was also involved in the medical standby services during the 2019 Palarong Pambansa, an annual multi-sport event for student athletes from all over the Philippines. I was able to participate in the emergency medical service activities of the Davao City Central 911. I had quite a few day-time, and night-time ambulance runs during my rotation, not only in the main Central 911 office, but also in the three other satellite stations in the city–Panacan, Toril, and Cabantian. Most of the patients I responded to (woman in labour, head trauma patient, medical patient in shock, pre-arrest condition, etc.) needed immediate transfers. I also had the opportunity to teach the emergency medical technicians (EMTs) and Emergency Medicine residents who were doing rotation in Central 911. During my fellowship attachment, I was also able to participate as a trainer and evaluator in an audit activity on high-quality cardiopulmonary resuscitation (CPR) using the QCPR app and a mannequin. The audit involved 60 EMTs. The pretest results of the batch revealed that about 90% of the EMTs had poor-quality CPR performance, with compression fraction percentages falling between 10% and 50% (acceptable: 80%). After the pretest, we taught the EMTs how to perform high-quality CPR and to assess the quality of their CPR through the feedback sensor attached to the mannequin's chest and the QCPR app. All of the EMTs in the batch passed the high-quality CPR feedback posttest, making them competent in performing single-rescuer, high-quality CPR. During the last month of my fellowship attachment, the Chief of the Davao City Disaster Risk Reduction and Management Office gave me the opportunity to learn about the concept and practice of disaster risk reduction in Davao City. We reviewed the data on the catastrophic events in the city during the past decade, the progressive development of disaster risk reduction efforts, and the coping mechanisms of communities that experienced disasters. I was amazed at how hard the team worked through the challenges in responding to disasters and how it managed to produce outcomes that are worthy of recognition. SPMC also gave me the opportunity to participate in its medical missions in Surigao. The missions strengthened the collaboration of SPMC with other hospitals in Mindanao for the development of the telemedicine program based in SPMC Emergency Medicine and Surgery departments. During the missions, clinicians in rural areas underwent short trainings on point-of-care ultrasonography and real-time ultrasound image transfer to enable them to participate in the telemedicine program. I was also introduced to the SPMC Diving and Hyperbaric Medicine Unit, which is located near the Emergency Room - Trauma Surgery Unit of SPMC. I learned the process of how selected patients undergo hyperbaric therapy, and I was even allowed to get into the hyperbaric chamber. I look forward to bringing back new ideas, thoughts and connections from SPMC to my institution in Malaysia. What I have witnessed and experienced firsthand during my fellowship attachment inspired me to encourage people from outside Davao City to explore the excellent development and progress of the disaster risk reduction program in Davao City. Indeed, the Philippines has many great people with compassionate character and benevolent nature. Even before leaving for my home country, I know that I will miss the Philippines and its people very much.
Emergency Medicine

In Malaysia, dengue fever is a common vector-borne disease. Most cases of dengue fever are reported in residential areas. Children are at high risk to be infected because they spend a lot of time around their housing area for outdoor activities. Such areas may have a high number of Aedes mosquitoes. As schools are equipped with infrastructure and medium for effective educational purposes, school represent the most suitable facilities for learning and teaching process. A cross-sectional study was conducted to determine the level of knowledge among students in Hulu Langat on Aedes mosquitoes, dengue fever, and Zika virus. The study also reported on the demographic factors which affected the knowledge level. Based on sample size calculation using G*Power v3.1 software, a total of 171 respondents were needed from the two primary schools involved in the study. Data collection was conducted using a pre-tested questionnaire that consisted of two main sections on demography and knowledge about Aedes mosquitoes, dengue fever and Zika virus. From the total score of 55, the mean knowledge score is 34.2 ± 8.38. Based on the median value of 36.0, about 50.9% of respondents had satisfactory knowledge. From the study, it was found that students from School A, students who had been watching video related to Aedes mosquito, and those with history of dengue infection among family members had a significantly better knowledge score (p < 0.01). In conclusion, knowledge about Aedes mosquitoes and related illnesses need to be enhanced through a comprehensive module and effective educational materials that can serve as a reliable source of information for primary school students.

Infective endocarditis during breastfeeding is rare. To the best of the authors’ knowledge, this is the second recorded case of infective endocarditis in a lactating mother. It is known that women of child-bearing age are susceptible to infective endocarditis during pregnancy when the immune system is compromised.1 Nevertheless, past cases were also exposed to a systemic infection via milk infected by their infant’s oral commensal. Streptococcus mitis (S.Mitis) endocarditis in pregnancy has also been reported, whereby a lady delivered via caesarean section and underwent mitral valve reconstruction and annuloplasty.1 S. mitis is considered a pioneer streptococci commensal in human oral mucosa, appearing as early as 1-3 days after delivery.2 As a child grows, their oral mucosa will be colonized by more viridans streptococci, including the teeth, oropharynx and nasopharynx. In a mother who breastfeeds, a crack in the nipple and breast engorgement can be predisposing factors for systemic infection stemming from an infant’s oral commensal. Both cases of breastfeeding-related infective endocarditis caused by pioneer streptococcus viridans, S.mitis in our report and S.salivarius3 in the previous report, affected the left-sided valves