Extensive Palatal Necrosis Secondary to Chrysomya bezziana Myiasis: A Case Report Oral myiasis, a rare condition characterised by infestation of dipterous larvae in the oral cavity, poses unique diagnostic and therapeutic challenges. Herein, we present a case study of a 35-yearold quadriplegic man presenting with oral myiasis localised to the palatal region, likely attributable to malnutrition and suboptimal oral hygiene. Manifestations comprised oral bleeding, fever, and necrotic palatal ulcers infested with maggots. Initial diagnostic considerations encompassed mucormycosis and neoplastic lesions; however, further scrutiny revealed primary palatal myiasis caused by Chrysomya bezziana species. Therapeutic interventions entailed bedside maggot removal and meticulous wound care, with topical hyaluronic acid application and oral hygiene guidance. This case underscores the significance of uncommon conditions such as palatal myiasis, especially among patients with intricate medical backgrounds. A comprehensive diagnostic approach and optimal treatment ensure favourable outcomes.

A COMPARATIVE REVIEW OF CURRENT INTERNATIONAL ATRIAL FIBRILLATION GUIDELINES FROM A PRIMARY CARE PERSPECTIVE Atrial fibrillation (AF) is the most frequent sustained arrhythmia globally with significant morbidity and mortality. A local guideline has been created to help physicians in clinical decision-making by outlining various generally accepted approaches for the diagnosis, management and prevention of AF. This guideline was published 10 years ago, and it is imperative that new guidelines based on the latest consensus be renewed. Since then, various clinical guidelines have been issued in the past 5 years to standardise the management of AF, including the American College of Cardiology, European Society of Cardiology, National Institute for Health and Care Excellence and Asia Pacific Heart Rhythm Society guidelines. This review aims to provide a comprehensive comparison of these guidelines across multiple aspects of clinical management, including management frameworks, screening, anticoagulation, stroke and bleeding risk assessments, rate and rhythm control, follow-up, comorbidity management and technology usage.

UNMASKING THE CHIK SIGN: A CASE REPORT ON NASAL HYPERPIGMENTATION AS A DIAGNOSTIC CLUE FOR CHIKUNGUNYA FEVER Macular hyperpigmentation of the nasal region, often referred to as the ‘chik sign’, constitutes a distinctive physical manifestation associated with chikungunya fever. Chikungunya, a mosquitoborne viral illness, presents with acute febrile symptoms, intense arthralgia and cutaneous eruptions. The chik sign serves as a valuable clinical marker for discerning chikungunya from other febrile illnesses with analogous presentations, such as dengue fever and malaria. This differentiation is particularly crucial in endemic regions. Recognition of the chik sign underscores the significance of clinical acumen in diagnosing chikungunya. In conjunction with confirmatory laboratory testing, identification of this sign can augment diagnostic accuracy and guide appropriate therapeutic strategies. Herein, we present the case of a 44-year-old woman with chikungunya virus infection who exhibited acute febrile symptoms, severe polyarthralgia and hyperpigmentation of the nasal region. In conclusion, the chik sign is a crucial clinical marker for identifying chikungunya fever. Its identification can improve diagnostic precision and enable timely care, particularly in places with limited access to laboratory testing. Healthcare professionals should thus be vigilant for this skin pigmentation in patients who exhibit joint pain and feverish symptoms that are indicative of chikungunya virus infection. To further understand the clinical spectrum of chikungunya, more research into the presentation of this pigmentation would be helpful.

and Relevance: This review highlights the list of parasites infecting rodents in Malaysia, provides information on the molecular and pathological findings from previous studies, and identifies some of the limitations and knowledge gaps that suggest future research to address the issues, including the paucity of information on blood parasites, molecular, and histopathological studies of parasites in rodents.

and Relevance: This review highlights the list of parasites infecting rodents in Malaysia, provides information on the molecular and pathological findings from previous studies, and identifies some of the limitations and knowledge gaps that suggest future research to address the issues, including the paucity of information on blood parasites, molecular, and histopathological studies of parasites in rodents.

and Relevance: This review highlights the list of parasites infecting rodents in Malaysia, provides information on the molecular and pathological findings from previous studies, and identifies some of the limitations and knowledge gaps that suggest future research to address the issues, including the paucity of information on blood parasites, molecular, and histopathological studies of parasites in rodents.

and Relevance: This review highlights the list of parasites infecting rodents in Malaysia, provides information on the molecular and pathological findings from previous studies, and identifies some of the limitations and knowledge gaps that suggest future research to address the issues, including the paucity of information on blood parasites, molecular, and histopathological studies of parasites in rodents.

The aim of this review was to provide an update on the current status of digital occlusal force measurement devices, as well as clinical and research applications in complete arch maximum occlusal force measurement. SCOPUS, ScienceDirect, and PubMed databases were used to conduct a literature search from January 2001 to January 2021. Identification and screening of literature were done independently according to published guidelines and selection criteria. The electronic searches turned up 394 articles, 16 of which met the inclusion and exclusion criteria and were selected for study analysis. All of these studies used T-scan and Dental Prescale digital occlusal analysis system with pressure-sensitive foils as occlusal force measurement devices. The devices showed a promising potential for identifying and comprehending maximum occlusal forces objectively. According to the current review, maximum occlusal force measured with digital occlusal force devices can be used as a prosthodontic adjunct to address issues that arise during the treatment of occlusal disorders, temporomandibular disorders, and complete dentures. It is also useful in predicting cognitive and functional decline in the elderly.

Introduction: Epithelial-mesenchymal transition (EMT) is a process of epithelial transformation into mesenchymal cells. It is also a process that contributes to the progression of fibrosis and cancer metastasis. Transforming growth factor-beta (TGF-β), as a potent inducer of EMT, has therefore became a potential therapeutic target. However, clinical developments of TGF-β inhibitors have been un-successful due to safety risks. Hence, drug repurposing of existing safe-to-use drugs could over-come this issue. Methods: In this study, the TGF-β receptor type 1 (ALK5) was selected as the target protein. Molecular docking was performed using known ALK5 inhibitors as positive controls. Clinical drugs with similar binding affinity and amino acid interaction were selected for in vitro experimental validation. Results: ALK5 inhibitor demonstrated binding affinities ranging from -11.2 to -9.5 kcal/mol. Analysis of amino acid interaction revealed that Val219, Ala230, Lys232, and Leu340 amino acid residues are crucial for binding. Subsequent screening of clinically approved drugs against ALK5 showed top five potential drugs (ergotamine, telmisartan, saquinavir, indinavir, and nelfinavir). The selected drugs were tested in TGF-β1-induced normal human bronchial epithelial cell line, BEAS-2B. Western blot analysis showed that the drugs did not exhibit inhibitory effects on the downregulation of epithelial proteins (E-cadherin) and upregulation of mesenchymal proteins (vimentin and α-smooth muscle actin). Conclusion: Based on these experimental outcome, it is postulated that the results from molecular docking were false positives. The tested drugs in this study could serve as negative controls in future screening against ALK5 protein.

Introduction: Lean sustainability has gained prominence in the health sector for operational and business advantages. However, understanding the link between lean and healthcare sustainability, especially in social and environmental aspects, remains limited. This study introduces a preliminary framework for measuring lean healthcare sustainability in hospitals. The framework aligns Critical Success Factors (CSFs) with sustainability objectives and business strategies to ensure successful and enduring lean deployment. Methods: The study was conducted among 52 Lean Agile Hospitals in Malaysia using a cross-sectional approach. The validated questionnaire was employed for data collection. A reliability test and Exploratory Factor Analysis (EFA) were also performed to assess and validate the framework using Statistical Package for Social Sciences (SPSS) version 27. Results: The content validation was 0.9, which indicates that the instrument is sufficient to measure the research objective. The data screening test was performed to eliminate problem observation. The overall reliability value was over 0.830 which depicts data consistency and stability. The Kaiser-Meyer-Olkin exceeded 0.6, Bartlett’s test was under 0.001 and factor loading was between 0.507 to 0.948, thus indicating a significant correlation matrix among at least some of the variables. Therefore, the latent factors were significant to specific items of the research. Conclusion: It is concluded that important CSF is aligned with the strategic level influence of lean deployment in healthcare, which has a specific impact on certain sustainability performance. Thus, this paper proposed a generic preliminary framework to measure lean healthcare sustainability.