Colorectal cancer (CRC) carries a significant burden in most world regions. However, its screening uptake remains low. This study aimed to explore awareness and perspectives on CRC screening program in a multiethnic population and their preference for CRC screening decision aid. In-depth interviews were conducted until data saturation was reached. All interviews were audiotaped, transcribed verbatim, translated to English and analysed thematically using hybrid inductive and deductive approaches. 17 informants from three main ethnic groups (Malay, Chinese and Indian) with various levels of risk for developing CRC were recruited. Awareness on CRC screening program was found to be low. Majority of informants never heard of CRC screening program. Among 11 eligible informants, only five experienced CRC screening uptake. Thematic analysis of the transcripts yielded six major themes; knowledge on CRC, screening process, authority’s role, curability, willingness to screening and preference for decision aid, and theywere mapped onto the Health Belief Model. Specific multiethnic perspectives found included preference for traditional medicine coming from all ethnics, and reliance in God coming from Malay informants. Majority preferred short videos as CRC screening decision aid, in the form of animation and live-action screenplay. Exploration of perspective of CRC screening helps in producing impactful decision aids. Future efforts should focus on developing short videos that incorporate population’s perspectives and can be disseminated through electronic media.

Alveolar Soft Part Sarcoma as a Great Masquerader of Unilateral Sinonasal Tumour in Child: A Case Report Alveolar soft part sarcoma (ASPS) is a rare mesenchymal neoplasm that accounts for less than 1% of all sarcoma and the most common site of tumour is found in the soft tissue of the extremity. The incidence of ASPS in paediatric age group is rare. It is extremely uncommon for the tumour arising from the sinonasal within the head and neck region. Most of the reported cases were in the orbit and tongue. Localised ASPS carries a good prognosis after complete total resection. Diagnosing ASPS can be challenging as it can be a masquerader to other sinonasal soft tissue malignancy which required the laborious process of histopathological examination, immunohistochemistry, and ultrastructural examination to solve the complexity. We encountered an 11-year-old girl who presented with sudden onset of left nasal obstruction and on examination noted a unilateral vascular mass in the left nasal cavity turned out to be ASPS. She underwent left nasal tumour debulking via endoscopic approach under general anaesthesia. Post-operative, she recovered well with regular endoscopic surveillance and was referred to the oncology team for post-operative radiotherapy.

DR, I CAN’T MOVE MY LEG! A CASE REPORT OF AORTIC DISSECTION Aortic dissection, a condition where the aorta tears, is the most frequently occurring life-threatening condition affecting the aorta, happening 2-3 times more often than the rupture of the abdominal aorta. If left untreated, 33% of patients die within 24 hours, and 50% die within 48 hours. As a result, early identification and management of the condition are critical in determining patient outcomes. We highlight a case of atypical presentation of aortic dissection in which the patient demonstrated bilateral lower limb weakness without any pain. We illustrate the vital role played by point-of-care ultrasound (POCUS) echocardiography in diagnosing the condition.

ANTIMICROBIAL EFFICACY OF 2-HYDROXYISOCAPROIC ACID (HICA) TOWARDS ENTEROCOCCUS FAECALIS AS ALTERNATIVE ENDODONTIC INTRACANAL MEDICAMENT Introduction: Antibiotics are used as intracanal medicaments in endodontic therapy. However, increasing antimicrobial resistance has led to research on alternative medications. 2-hydroxyisocaproic acid (HICA) is a derivative of leucine, a normal component of human plasma that shows potential as an intracanal medicament. Objective: To determine the antimicrobial efficacy of HICA against Enterococcus faecalis (E. faecalis). Methods: The antimicrobial activity was screened by measuring the Zone of Inhibition (ZOI) using the disk diffusion method, minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC). The positive control was a Triple Antibiotic Paste (TAP) containing minocycline, metronidazole, and ciprofloxacin. Sixty-six teeth were prepared, and the canals were filled with E. faecalis suspension before incubation for 21 days. Later, HICA at a concentration of 16 mg/mL, TAP at 1 mg/mL, and saline (negative control) were introduced and further incubated for seven days under anaerobic conditions at 37°C. Viable bacterial counts in the canals were used as indicators of bacterial growth. Results: At 256 mg/mL concentration, HICA exhibited a ZOI of 15.72 ± 1.60 mm, and MIC and MBC were 8 mg/mL and 16 mg/mL, respectively. TAP, at a concentration of 4 mg/mL, exhibited a ZOI of 30.74 ± 0.71 mm, and its MIC was equal to MBC at 0.25 mg/mL. The viable bacterial counts extracted from the canal were 4.33 ± 0.23log10 for saline, 4.03 ± 0.21log10 for HICA and 3.97 ± 0.34log10 for TAP. Compared with saline, both TAP and HICA exhibited a significant difference in bacterial counts (p < 0.01). Interestingly, the efficacies of TAP and HICA were similar, with p-values of 0.79. Discussion: The ZOI indicated that HICA exhibited an antimicrobial effect. E. faecalis growth was repressed at 8 mg/mL, and cell death was observed at 16 mg/mL. At 16 mg/mL, HICA showed antimicrobial efficacy comparable to 1 mg/mL of TAP. Conclusion: HICA shows potential as an alternative intracanal medicament to eradicate E. faecalis in endodontic treatment.

Introduction: Early studies have suggested the role of C-C chemokine receptor type 5 (CCR5) polymorphisms in influencing HIV pathogenesis and phenotypes, including the protection against HIV infection and delaying disease progression to AIDS. This study aimed to further determine the impact of CCR5 variants (CCR5-Δ32 and CCR5- R223Q) on HIV susceptibility, viral load suppression and CD4 recovery during highly active antiretroviral therapy (HAART) among Malaysian HIV patients. Methods: This cross-sectional study involved 182 HIV-infected who were recruited from three out-patient clinics, and 150 non-HIV subjects from Malay, Chinese and Indian ethnicities. CD4 count and viral load data at 4-6 months (t1) and 8-12 months (t2) after starting HAART were gathered from hospital records. Chi-square test was used to analyse the correlation between CCR5 variants with dependent variables. Results: Heterozygous CCR5-Δ32 and CCR5-R223Q occurred in a percentage of 0.5% (1/182) and 1.7% (3/182) among HIV patients respectively, while none of homozygous mutant for CCR5-Δ32 and CCR5-R223Q were found. CCR5-R223Q was found more frequently in non-HIV as compared to the HIV group (P=0.018). However, both polymorphisms were not found to be correlated with CD4 recovery to ≥500 cells/mm3 (P>0.05) and viral load suppression ≤50 copies/mL (P>0.05). Conclusion: CCR5-R223Q and CCR5-Δ32 alleles probably have no modifying effects on HIV susceptibility virological and immunological recoveries in the first 12 months of HAART, partially due to the low prevalence of these mutations in the studied population.

Aims: The aquaculture industry has been identified as one of the sources for the emergence of antimicrobial resistant bacteria. This study aimed to determine the level of bacterial contamination from selected catfish pond farming at Jasin, Melaka and its susceptibility to antimicrobial agents. The correlation between the sampling points’ Water Quality Index and the level of bacterial contamination was also determined. Methodology and results : Sampling was carried out at six sampling points of the river as well as selected catfish pond farming. Microbial counts were assessed using the membrane filtration and isolates were further identified by using the polymerase chain reaction (PCR) method. Antimicrobial susceptibility tests were carried out using the disk diffusion method. Results showed that the total bacterial count obtained was not significantly different (P>0.05) between sampling points with an average of 4.47 ± 0.41 log CFU/mL. A total of 27 different bacterial species were identified where 63% were identified as Gram-negative bacteria. A medium negative correlation (r=-6.16, P<0.01) was found between the sampling points’ Water Quality Index and the level of bacterial contamination. Among bacterial species identified, 18 species are pathogenic strains. Conclusion, significance and impact of study Antibiotic susceptibility test indicated that only 4 isolates showed resistance to antimicrobials tested and the study shows the potential cross contamination between fishponds and Kesang River, Melaka. Thus, public health concerns are tangible, and prevention of the cross contamination is crucial for the farm.

COVID-19 infection or vaccination is rarely associated with arterial occlusive disease of the extremities. The surgical department of a hospital in Johor, Malaysia, recorded a significant increase in the number of COVID-19-related acute limb ischaemia when the rates of COVID-19 were high both locally and internationally. The clinical presentation and management of acute limb ischaemia associated with COVID-19 infection or vaccination are largely underreported in Johor. Herein, we report a case series of 12 patients managed with strategies ranging from purely anticoagulation to catheter-directed thrombolysis and surgical embolectomy. This case series describes the clinical presentation, risk profiles, treatment approaches and limb outcomes of the patients. The amputation rate was high in view of unfavourable factors, including delayed presentation, high-risk factors and severe COVID-19. Three cases of potential COVID-19 vaccine-related acute limb ischaemia were included. COVID-19-related acute limb ischaemia can be minimised with heightened alert, preemptive optimisation with proper hydration and consideration for early prophylactic anticoagulation in high-risk cases.
COVID-19 ; Arterial Occlusive Diseases ; Mechanical Thrombolysis

Adenosquamous carcinoma is a rare variant of squamous cell carcinoma of the nasal septum which is very aggressive and metastasise early with poor prognosis. We present a case of a gentleman who presented with left nasal septal swelling for 4 months. Examination showed a lesion at the left nasal septum extending to the dorsum of the nose and right upper lip region. Computed tomography scan of the paranasal sinuses and neck showed an enhancing lesion with ulceration at the left nasal septum, with regional metastasis to the neck. He underwent a subtotal rhinectomy, inferior maxillectomy, and bilateral modified radical neck dissection type III. Unfortunately, he succumbed to a cardiac arrest 5 days after surgery.

Food insecurity affects food intake, and it could prevent an individual from consuming enough nutritious food to support and maintain health. The aim of this paper is to determine the prevalence and factors influencing food insecurity among Malaysian households. In 2014, the Malaysian Adult Nutrition Survey (MANS) was carried out, and one of the components measured was food insecurity. Six out of sixteen questions from the food security core-module questionnaire were adopted and answered by 2962 adults. The results showed that about 25.0% adult experienced food quantity insufficiency, 25.5% had food variety insufficiency, 21.9% practised reduced size of the meal, and 15.2% skipped main meal due to lack of money to spend on. For the parents, 23.7% only rely on cheap food to feed children, and 20.8% could not afford to purchase various foods to feed their children. Location, strata, race, level of education, working status and household income shows significant difference while none of the nutritional status components found to be difference in all six parameters of food insecurity measured. Logistic regression with adjusted odds ratios discovered race, education level and household income were related to risk to all six parameters of food insecurity. In conclusion, food insecurity can be a serious problem in Malaysia. An effective and comprehensive effort by the government in terms of policy solution is required to increase education level and ensure an adequate income for every household. Therefore, future research should focus on some of those promising policy solutions and at the same time, study the other possible underlying factors that may lead to food insecurity.
Food Insecurity ; Malaysia ; Adult ; Nutrition Survey

Overweight and obesity are major health concerns in Malaysia, which are linked to other health consequences such as type 2 diabetes mellitus, cardiovascular diseases and several others. Among dietary factors, sugar-sweetened beverages (SSBs) are reported to be one of the leading factors of weight gain and a higher body mass index (BMI). Sugar-sweetened beverages are beverages with added sugar that only add calories to an individual’s normal diet and they represent the largest contributor to the added sugars intake. This study was aimed to determine the prevalence of SSB consumption among university students in Kuala Nerus, Terengganu, as well as to investigate the association between the students’ SSB consumption and their BMI. A cross-sectional study was conducted among 350 Universiti Sultan Zainal Abidin (UniSZA) Gong Badak Campus and Universiti Malaysia Terengganu (UMT) students by using the convenience sampling. Each participant was given a questionnaire consisting of socio-demographic details, anthropometric assessment and beverage intake. The results revealed that half of the students consumed 2 cups (500 mL) of SSBs on average days (49.4%), whereas 21.7% of them consumed at least 3 cups daily. It was found that sweetened tea was the students’ most preferred SSB and there was also an association between the SSB consumption and the BMI. In conclusion, university students in Kuala Nerus drink 2 cups of SSBs daily and sweetened tea is their preferred SSB. Since the students’ SSB consumption influences their BMI, these students must be aware on the contents of SSB and the related health consequences in order to reduce the consumption of these beverages and hence, reduce their BMI to a healthy level.