Introduction: Tuberculosis (TB) patients default their treatment during the treatment course. Therefore, this study aims to analyze the demographic characteristics of the patient who missed follow-ups and identify the reasons for missed appointments or defaulted their treatment. Methods: The records of patients diagnosed with TB follow-up at the chest clinic from January to June 2023 were reviewed based on our inclusion and exclusion criteria. Results: The retrospective descriptive analysis was conducted based on the data collected. Based on the study sample (n=33), the result shows that the majority of the defaulted patients were male in gender (n=22). Most of the missed appointments patients and defaulters are of Malay (39.4%) ethnicity and Malaysian nationality (66.7%). Most patients gave the transport issues as the reason for missed appointments followed by financial issues and feeling healthy. The majority of them missed follow-up in the first month after starting anti-TB. Conclusions In conclusion, missed appointments, treatment compliance and defaulted cases in TB treatment remain as one of the main challenges in the effort to end TB epidemics. Further in-depth research is required to propose effective measures to solve this issue and improve the national TB control program.

Introduction: Acne is the most common skin disease among adolescents and has significant psychological distress. Our objective is to assess acne severity, functional disability, and its psychological distress among acne patients. Methods: A cross-sectional study was conducted from November 2021 to May 2022 among 163 acne patients attending Dermatology Clinics in the district of Kuantan, Pahang. The severity of acne was graded using the Comprehensive Acne Severity Scale (CASS). The functional disability index was measured using a Cardiff Acne Disability Index (CADI), while Depression, Anxiety and Stress Scale (DASS-21) questionnaires were used as a screening tool to detect the psychological distress of acne. Data were analysed using a Chi-square test, Fisher’s exact test and multiple logistic regression. Results: The mean age was 23 years, 60.1% were female, 94.5% were Malay, and 68.1% were unemployed. The severity of acne was more prominent in the mild (30.7%) and moderate (28.2%) categories. A total of 20.2%, 11.7%, and 4.9% of the respondents had anxiety, depression, and stress symptoms, respectively. Regarding the respondents’ functional disability, 40.5% had mild impairment, 38.0% had moderate impairment, and 13.5% had severe impairment. Acne severity was found to be significantly associated with the functional disability index (P<0.05). The functional disability index was also found to be significantly associated with depression (p=0.019) and anxiety symptoms (p=0.042). Conclusion: Clinical management of acne patients should include not only pharmacological treatment but also consideration of the disease’s functional disability status and psychological distress.

Introduction: This systematic review aimed to investigate the level of participation, obstacles, and facilitator factors that influence activities of daily living among persons with spinal cord injury (SCI). Methods: A comprehensive search was conducted in four online databases, namely Google Scholar, PubMed, OT Seeker, and Cochrane Library covering the ten-years period from January 2012 to December 2022. Inclusion criteria encompassed original published studies in English focusing on daily activities, work, participation, obstacles, and facilitators in persons with SCI. Non-peer review sources (e.g., abstracts, grey literature, preprints), and studies unrelated to occupational therapy were excluded. The selected studies were assessed for quality using McMaster University Occupational Therapy Evidence-Based Practice critical review form. Results: Out of the 678 articles identified, ten studies were included after the screening, exploring participation in daily living activities, employment, return to work, leisure activities, family tasks, and community mobility among persons with SCI. Obstacles and facilitators influencing participation in activities of daily living were classified using the International Classification of Functioning, Disability, and Health (ICF) framework. This review highlighted that long-term participation is challenging for persons with SCI, affected by obstacles such as body functions, pain, low self-esteem, and environmental and social factors. Conclusion: The findings underscore the importance of adopting a multidisciplinary rehabilitation approach to enhance participation in daily activities for persons with SCI. Occupational therapy plays a significant role in improving participation levels among persons with SCI.

The Effect of Brand, Thickness, and Abutment Substrate on the Masking Ability of Monolithic Zirconia Cera The goal of the present study was to determine the minimum thickness of monolithic zirconia required to achieve an acceptable masking ability and to examine how brand, thickness, and abutment substrate influenced that masking ability (∆E). Seventy-two A2-shade monolithic zirconia disc specimens in various thicknesses (1.0, 1.5, and 2.0 mm) were fabricated using three brands: Nacera® Pearl 1, DD cubeX2 and XTCERA TT. A spectrophotometer was used to determine the CIELab values of the specimens, which were placed on a D4-shade resin composite and white acrylic (control) substrates. The ∆E was calculated and compared with the acceptable (AT = 5.5) and perceptible (PT = 2.6) tolerance thresholds. Further investigation was conducted on 72-disc specimens from the monolithic zirconia brand with the best masking ability on D3-shade resin composite and semi-precious alloy. Using two-way ANOVA, the interaction of thickness, brand, and abutment substrate on ∆E was investigated. Nacera® Pearl 1 at 1.5 mm thickness was sufficient to achieve AT on a D4-shade resin composite substrate, whereas 2.0 mm of DD cubeX2 and XTCERA TT were required. Nacera® Pearl 1 further testing on two other substrates requires thicknesses of 1.5 mm and 1.0 mm, respectively. Only the Nacera® Pearl 1 group achieved PT on D3- and D4-shade resin composite (2.0 mm) and semi-precious alloy substrates (1.5 mm). Brand, thickness, and abutment substrate influenced the ∆E (p < 0.001). To achieve an acceptable masking ability, the minimum thickness of monolithic zirconia tested on D3- and D4-shade resin composite and semi-precious alloy should be around 1.5 mm to 2.0 mm.

Metformin-associated lactic acidosis (MALA) is a rare but potentially fatal complication that can occur in a patient on metformin, who had a sudden reduction in the renal function resulting in a raised serum metformin level. We describe a case of MALA who survived with prompt haemodialysis. An elderly female with diabetes on metformin presented with gastrointestinal losses, lethargy and confusion. She was in circulatory shock and despite an aggressive fluid regime, she remained acidotic with an increasing lactate level of > 15 mmol/L. After endotracheal intubation, she was referred to tertiary centre for haemodialysis. Her serum lactate level rapidly fell to a satisfactory range and a progressive recovery followed. We are highlighting this case for its rarity and to serve as a guidance on the early recognition of MALA for fellow clinicians. Despite the high mortality rate, MALA is reversible, and we urge clinicians to expedite haemodialysis as definitive treatment.

Sporotrichosis is a fungal infection caused by Sporothrix, a thermally dimorphic fungus that affects humans and animals. It is most commonly associated with cutaneous and subcutaneous tissue exposed to fungus-containing soil, moss, or organic material. Sporotrichosis is challenging to diagnose because it can mimic various other dermatological diseases. Thus, as demonstrated in this case, the importance of making a diagnosis based on history and a thorough physical examination, as misdiagnosis can delay proper treatment. A 53-year-old Malay woman presented with bilateral thumb swelling that had been treated with two courses of antibiotics but had failed, resulting in disease progression. Clinical suspicion of lymphocutaneous sporotrichosis was made based on history, physical examination, and investigations finding. The patient was started on an empirical course of Itraconazole 200mg twice daily, and the lesions responded well.

Aims: Prebiotics and probiotics profoundly enhance water quality and shrimp development to tackle infectious disease in shrimp farming. This study evaluated the impact of prebiotics and probiotics treatments in water by assessing the physicochemical properties and bacterial communities in local shrimp ponds. Methodology and results : Water was collected from shrimp pond 1 (SP1), treated with prebiotics and probiotics, and shrimp pond 2 (SP2), treated with only prebiotics. The physicochemical parameters of water from two shrimp ponds were measured, including pH, dissolved oxygen (DO), ammonia concentration and temperature. The total environmental DNA (eDNA) was extracted from the water samples and sequenced using amplicon sequencing targeting the full length of the 16S rRNA gene region via the Oxford Nanopore Technology Flongle. The water quality analysis indicated that SP1 had better water quality than SP2 for shrimp aquaculture. The dominant phyla in both shrimp ponds were Proteobacteria and Bacteroidota. SP1 samples had unique microbiota at the phylum level, including Bdellovibrionota, Firmicutes A, Patescibacteria and unclassified Rhizobiales, Saprospiraceae, Vulcanococcus and HIMB114 at the genus level. The alpha- and beta-diversity showed insignificant differences in microbiota composition between SP1 and SP2 (p-value>0.05). Conclusion, significance and impact of study Research findings demonstrated that the probiotic-treated shrimp pond (SP1) had better water quality and more diverse microbial communities than the shrimp pond that was not treated with probiotics (SP2).

OBJECTIVES: This study aimed to develop susceptible-exposed-infectious-recovered-vaccinated (SEIRV) models to examine the effects of vaccination on coronavirus disease 2019 (COVID-19) case trends in Malaysia during Phase 3 of the National COVID-19 Immunization Program amidst the Delta outbreak. METHODS: SEIRV models were developed and validated using COVID-19 case and vaccination data from the Ministry of Health, Malaysia, from June 21, 2021 to July 21, 2021 to generate forecasts of COVID-19 cases from July 22, 2021 to December 31, 2021. Three scenarios were examined to measure the effects of vaccination on COVID-19 case trends. Scenarios 1 and 2 represented the trends taking into account the earliest and latest possible times of achieving full vaccination for 80% of the adult population by October 31, 2021 and December 31, 2021, respectively. Scenario 3 described a scenario without vaccination for comparison. RESULTS: In scenario 1, forecasted cases peaked on August 28, 2021, which was close to the peak of observed cases on August 26, 2021. The observed peak was 20.27% higher than in scenario 1 and 10.37% lower than in scenario 2. The cumulative observed cases from July 22, 2021 to December 31, 2021 were 13.29% higher than in scenario 1 and 55.19% lower than in scenario 2. The daily COVID-19 case trends closely mirrored the forecast of COVID-19 cases in scenario 1 (best-case scenario). CONCLUSIONS Our study demonstrated that COVID-19 vaccination reduced COVID-19 case trends during the Delta outbreak. The compartmental models developed assisted in the management and control of the COVID-19 pandemic in Malaysia.

Introduction: Thalassaemia is a common genetic blood disorder. Knowledge, awareness, attitude towards, and intention to screen for thalassaemia among Malaysians is poor. Screening for thalassaemia in unmarried individuals plays a key role in preventing thalassaemia major births. Methods: A cross-sectional study was conducted on unmarried individuals aged 18 years and older in Kota Bharu, Kelantan, Malaysia. A questionnaire was used to collect the general data of the participants, their knowledge of thalassaemia, attitude towards thalassaemia, and intention to screen for thalassaemia. Results: A total of 278 respondents were included in this study. The mean (SD) knowledge score was 8.8 (4.99) out of a possible score of 21, with higher scores indicating better knowledge. The factor associated with good knowledge of thalassaemia was being a professional. Most respondents agreed that unmarried individuals should be screened for thalassaemia before marriage. Conclusion In conclusion, knowledge of thalassaemia among unmarried individuals who were not professionals was low.
Thalassemia ; Knowledge ; Attitude ; Intention

Superior mesenteric artery (SMA) syndrome is rare with the common presentation of megaduodenum from entrapment of the third part of the duodenum (D3) by the SMA. We present a case report of a thin, fit 16-year-old boy, active smoker complaining of generalized colicky abdominal pain associated with persistent postprandial vomiting. Small bowel study demonstrated partial duodenal obstruction from compression of the third part of the duodenum by the SMA. Computed tomography of the abdomen shows an aorto-mesenteric angle of 13 degrees with aorto-mesenteric distance of 0.32 cm, indicating SMA syndrome. His symptoms resolved spontaneously with watchful waiting and nutritional care plan. The success was contributed to restoring the fat cushion around the SMA, hence, widening the aorto-mesenteric angle. In conclusion, watchful waiting with a nutritional care plan is a feasible initial strategy in the approach to SMA syndrome. However, should this strategy be unsuccessful, the choice of surgical treatment is duodenojejunostomy.