Objective: Parkinson’s disease (PD) affects approximately 2% of individuals over the age of 60. With more than two billion Muslims observing Ramadan, individuals with PD encounter specific challenges, such as deteriorating motor skills, sleep disturbances, and an increased risk of falls during fasting. Methods: Our study focused on 75 patients with idiopathic PD divided into two groups: the Ramadan Regime group, which consisted of 50 patients whose medication was adjusted to twice daily at Suhoor and Iftar, and the Nontreatment group, which included 25 patients who abstained from medication for religious reasons. Both groups were instructed to wear a Parkinson’s KinetiGraph (PKG) wrist device. Results: The study findings revealed that motor function worsened in the Nontreatment group (p<0.001) but improved in the Ramadan Regime group (p=0.007). Daytime sleepiness also significantly increased in the Nontreatment group (p<0.001). Conclusion Overall, the findings suggest that the Ramadan regime significantly enhances patient health and quality of life.

Objective: Lumbar foraminal stenosis can lead radiculopathy in a subset of patients. Imaging findings have a high false-positive rate. The Kemp test is a provocative maneuver that has traditionally been used for diagnosing facet joint disease. However, it has shown an increased likelihood of concomitant foraminal stenosis. Thus we evaluated the diagnostic accuracy of a modified version of Kemp test (the Singh-Hartl foraminal compression test) in the diagnosis of symptomatic foraminal stenosis. Methods: Fifty consecutive patients with radiculopathy were enrolled. Participants were asked to perform the Singh-Hartl foraminal compression test, with a positive result if there was reproduction of radicular symptoms. Selective nerve root block (SNRB) was then performed at the suspected level. Visual analogue scores (VAS) were collected before and 15-minutes postprocedure. VAS improvement was calculated as a percentage. Various statistical analyses were conducted considering 2 different threshold (75% or 80% improvement in VAS). Results: Twenty-eight participants (56%) were women, with an average age of 47.3 years. L4 was most commonly involved (n=20). Using 75% improvement as the VAS threshold, the test had a sensitivity of 0.72 (95% confidence interval [CI], 0.53–0.87), specificity of 0.57 (95% CI, 0.34–0.78), PPV of 0.70 (95% CI, 0.56–0.79), and NPV of 0.60 (95% CI, 0.43–0.75). When using 80% improvement as the VAS threshold, the test had a sensitivity of 0.64 (95% CI, 0.41–0.83), specificity of 0.43 (95% CI, 0.24–0.63), PPV of 0.47 (95% CI, 0.36–0.58), and NPV of 0.60 (95% CI, 0.43–0.75). Conclusion The Singh-Hartl maneuver exhibited moderate to strong ability to rule-in the diagnosis and a moderate ability to rule out the diagnosis of foraminal stenosis when using a threshold of 75% improvement in radicular symptoms post-SNRB. Further studies evaluating the result of this physical examination test in conjunction with severity of imaging findings are warranted.

Introduction: SABINA III assessed short-acting β2-agonist (SABA) prescription patterns and their association with asthma-related outcomes globally. Herein, we examined SABA prescription and clinical outcomes in the Malaysian cohort of SABINA III. Methods: In this observational, cross-sectional study, patients (≥12 years) were recruited between July and December 2019 from 15 primary and specialty care centres in Malaysia. Prescribed asthma treatments and severe exacerbation history within 12 months prior and asthma symptom control during the study visit were evaluated. Associations of SABA prescription with asthma control and severe exacerbation were analysed using multivariable regression models. Results: Seven hundred thirty-one patients (primary care, n=265 [36.3%]; specialty care, n=466 [63.7%]) were evaluated. The prevalence of SABA over-prescription (≥3 SABA prescriptions/year) was 47.4% (primary care, 47.1%; specialty care, 47.6%), 51.8% and 44.5% among all patients and patients with mild and moderate-to-severe asthma, respectively. Altogether 9.0% (n=66) purchased SABA without a prescription; among them, 43.9% (n=29) purchased ≥3 inhalers. The mean (standard deviation) number of severe asthma exacerbations was 1.38 (2.76), and 19.7% (n=144) and 25.7% (n=188) had uncontrolled and partly controlled symptoms, respectively. Prescriptions of ≥3 SABA inhalers (vs 1–2) were associated with lower odds of at least partly controlled asthma (odds ratio=0.42; 95% confidence interval [CI]=0.27–0.67) and higher odds of having severe exacerbation(s) (odds ratio=2.04; 95% CI=1.44–2.89). Conclusion The prevalence of SABA over-prescription in Malaysia is high, regardless of the prescriber type, emphasising the need for healthcare providers and policymakers to adopt latest evidence-based recommendations to address this public health concern.
Asthma ; Malaysia

OBJECTIVES: This study compared the amount of apically extruded bacteria during the glide-path preparation by using multi-file and single-file glide-path establishing nickel-titanium (NiTi) rotary systems. MATERIALS AND METHODS: Sixty mandibular first molar teeth were used to prepare the test apparatus. They were decoronated, blocked into glass vials, sterilized in ethylene oxide gas, infected with a pure culture of Enterococcus faecalis, randomly assigned to 5 experimental groups, and then prepared using manual stainless-steel files (group KF) and glide-path establishing NiTi rotary files (group PF with PathFiles, group GF with G-Files, group PG with ProGlider, and group OG with One G). At the end of canal preparation, 0.01 mL NaCl solution was taken from the experimental vials. The suspension was plated on brain heart infusion agar and colonies of bacteria were counted, and the results were given as number of colony-forming units (CFU). RESULTS: The manual instrumentation technique tested in group KF extruded the highest number of bacteria compared to the other 4 groups (p < 0.05). The 4 groups using rotary glide-path establishing instruments extruded similar amounts of bacteria. CONCLUSIONS: All glide-path establishment instrument systems tested caused a measurable apical extrusion of bacteria. The manual glide-path preparation showed the highest number of bacteria extruded compared to the other NiTi glide-path establishing instruments.
Agar ; Bacteria* ; Brain ; Enterococcus faecalis ; Ethylene Oxide ; Glass ; Heart ; In Vitro Techniques* ; Molar ; Stem Cells ; Tooth

Objective To establish a suitable method of diagnosis of visceral leishmaniasis (VL) using peripheral blood, spleen or bone marrow aspirates. Methods Peripheral blood, bone marrow and spleen aspirate samples were collected from clinically suspected VL patients (n = 26). A new PCR primer pair (MK1F/R) was designed targeting kinetoplast mini circle DNA sequences of Leishmania donovani, and Leishmania infantum, and was used to diagnose VL along with some other established primers for VL in polymerase chain reactions. Test was validated by comparing with several other diagnostic methods. Results The designed primer set showed 100% specificity and 98% sensitivity in detecting VL using blood samples, when compared with more invasive samples: bone marrow or spleen aspirates. Conclusions The newly designed primer MK1F/R could be a better alternative for PCR based diagnosis of VL using less invasive sample, peripheral blood instead of bone marrow or spleen aspirates.