THE USE OF HYPNOSIS AS AN ADJUNCT TO NITROUS OXIDE/OXYGEN SEDATION: A CASE SERIES It is known that managing patients with dental fear and anxiety is challenging for clinicians and patients. This series of case reports highlights the importance and benefits of dental management under clinical hypnosis as an adjunct to nitrous oxide inhalation sedation for ages six to fifteen. These treatments range from pulp therapy, extraction and minor oral surgery. Customised hypnosis scripts were utilised for each patient, and the metaphors used were tailored to the patient’s interest and preference. The intended treatment was successfully carried out in all the patients. Five cases discussed in this case series were initially indicated for treatment under general anaesthesia, but treatment was successfully carried out using hypnosis and nitrous oxide/oxygen sedation. In the two surgical cases, nitrous oxide was tapered off once local anaesthesia was achieved, and the state of relaxation was maintained using a hypnotic trance, reducing the anaesthetic agent’s utilisation. Hypnosis successfully reduces patients’ anxiety, allowing them to feel more relaxed and confident about accepting future dental treatment without the need for pharmacological intervention.

INTERPRETATION OF EMOJI® IN MALAY LANGUAGE AMONG CHILDREN IN MALAYSIA The existing dental anxiety scales for paediatric patients tend to categorize and label children according to their level of cooperation. However, human emotions are more complex, and each child is unique. Hence, a more dynamic and interactive method should be introduced for a better understanding of the patient’s current state of emotion. The aim of this study was to investigate the interpretation and understanding of children towards frequently used emoji® for the development of an emoji® dental emotional spectrum. Both online and physical surveys were conducted among 147 Malay language-speaking children aged between 4-to-16 years in Malaysia. The children were asked to interpret 30 pre-selected emoji® images in their own words using the Malay Language. The pre-selected emoji® represent happiness, neutral, fear, sadness, and anger. The interpretations were subsequently based on their similar meaning, a process that was validated by two experts in the field of linguistics. The study involved participants with an average age of 9.2 years, with the majority of them being female (61.2%). Of the 30 pre-selected emoji® images used in this study, 13 had respondent agreement exceeding 60% which was the threshold set for suitability for use in evaluating dental emotion. The remaining 17 emoji® images have a remarkable variability in the interpretation which indicates potential misinterpretation by the respondents. The 13 emoji® images range from happiness, neutral, fear, dislike, unhappy, sad, anxious, and angry with the emoji® images which represent “excited” (94.0%), “loudly crying” (97.3%) and “angry” (91.8%) had the highest agreement. Meanwhile, the emoji® images represented “confounded” and “downcast” had the least agreement among respondents (1.3%). Despite the universal meaning imposed by emoji®, the interpretations may vary in different populations and age groups. Emoji® images hold the potential to serve as a valuable tool for identifying and managing children’s behaviour.

Uterine leiomyosarcoma is a malignant smooth muscle tumour of the uterus. It is rare and accounting for less than 2% of cases in malignant gynaepathology. To date, only a few reported cases of leiomyosarcoma arising from leiomyoma documented in the literature. We shared an uncommon occurrence of leiomyosarcoma arising from leiomyoma. Presented herein is a case of a ‘rare epithelioid subtype’ of leiomyosarcoma arising from a leiomyoma in a postmenopausal woman. We highlighted the importance of recognizing the possibilities of this event to allow for a timely diagnosis of leiomyosarcoma and to provide insights on management of patients presented with clinically presumed fibroid.

Aims: Insect pests are one of the major constraints of oil palm production in Malaysia. However, synthetic chemical insecticides are the most common method for its control, despite their negative effects on non-target organisms and the development of resistance. Therefore, the present study is aimed to identify novel indigenous isolates of entomopathogenic fungi (EPF) in oil palm soil as part of integrated pest management (IPM) of oil palm insect pests. Methodology and results: The potential of EPF were isolated from the soil collected from the oil palm plantation in UPM using a mealworm beetle larva (Tenebrio molitor) as an insect bait. Seven Metarhizium anisopliae and two Purpureocillium lilacinum isolates were identified by morphological characterization (macroscopic and microscopic observation) and molecular identification using internal transcribed spacer (ITS) region (ITS region amplification). Conclusion, significance and impact of study To our knowledge, this is the first time P. lilacinum has been found in the soil of an oil palm plantation or any other host in Malaysia. Furthermore, both of the isolates M. anisopliae and P. lilacinum may be potentially considered as biological control candidates for major insect pests in oil palm.
Entomophthorales--genetics ; Palm Oil ; Insecticides

Introduction: The prevalence of needle stick and sharp injuries (NSSIs) still high among healthcare workers and many of them, without reason had defaulted the post management follow up. Thus, the aim of the study was to determine factors associated with default follow up among healthcare workers sustained NSSIs in Kelantan. Method: A retrospective cohort study using secondary data from Sharp Injury Surveillance notification system within period of six years started from January 2010 was done. Data were collected using proforma and analysed using SPSS version 22.0. Two hundred and seventy cases were selected by using multistage random selection method. Binary logistic regression analysis was used to determine the factors. Result: Majority of reported NSSIs involved female, with the mean age of 33 years. Most of them were intern that had less than ten years’ experience. Most of the accident occurred during office hours at tertiary healthcare setting during venepuncture for blood or intravenous fluid management. The workers with age less than 40 years and those who work at hospital setting have higher possibility to default the follow up with (Adj. OR 2.80; 95% CI: 1.12,7.00; p = 0.027) and (Adj. OR 4.65; 95% CI: 1.77,12.33; p = 0.002) respectively. Conclusion: NSSIs can occur at all level of occupational setting particularly among those who has less experience and work at tertiary healthcare setting. Thus, an intensive precaution action should focus on them since they are also the group that has higher odd to default the post management follow up.

Introduction: Suboptimal vitamin D levels are commonly presented by systemic lupus erythemathosus (SLE) patients. This is likely due to protection measures from sunshine exposure adopted by SLE patients to reduce the likelihood of SLE flares onset. In this study, we investigated the vitamin D level among SLE patients and its association with SLE Disease Activity (SLEDAI) scores and among groups of steroid and non-steroid usage. Methods: We recruited 84 SLE patients who attended the Rheumatology Clinic of Hospital Universiti Sains Malaysia from June 2018 until October 2018. Their clinico-demographic data were retrieved and serum vitamin D immunoassay was conducted to measure the vitamin D levels of each patient Vitamin D levels were categorized as normal (≥75nmol/L), insufficient (50-74 nmol/L) or deficient (<50 nmol/L). Comparison between the clinico-demographic parameters with vitamin D levels were conducted using the Fisher’s exact test (for categorical variables) and unpaired t-test (for continuous variables). Results: The mean vitamin D level among the subjects was 40.79 ± 20.2 nmol/L. Fifty-eight (69%) patients were vitamin D deficient, while 20 (23.8%) patients were vitamin D insufficient, and only 6 (7.1%) patients had sufficient level of vitamin D. Vitamin D status was not significantly associated with SLEDAI score (p=0.185) as well as between steroids and non-steroids groups (p=0.255). Conclusion: Vitamin D deficiency occurred in majority of our SLE patients. SLE disease activities were not associated with the status of vitamin D or steroid usage.

Background: Regarding the long-term safety issues with the use of inhaled corticosteroids (ICS) and the clinical predominance of dual bronchodilators in enhancing treatment outcomes in chronic obstructive pulmonary disease (COPD), ICS is no longer a “preferred therapy” according to the Global Initiative for Chronic Obstructive Lung Disease except on top of a dual bronchodilator. This has necessitated a change in the current therapy for many COPD patients. Objective: To determine a standardised algorithm to reassess and personalise the treatment COPD patients based on the available evidence. Methods: A consensus statement was agreed upon by a panel of pulmonologists in from 11 institutes in Malaysia whose members formed this consensus group. Results: According to the consensus, which was unanimously adopted, all COPD patients who are currently receiving an ICS-based treatment should be reassessed based on the presence of co-existence of asthma or high eosinophil counts and frequency of moderate or severe exacerbations in the previous 12 months. When that the patients meet any of the aforementioned criteria, then the patient can continue taking ICS-based therapy. However, if the patients do not meet the criteria, then the treatment of patients need to be personalised based on whether the patient is currently receiving long-acting beta-agonists (LABA)/ICS or triple therapy. Conclusion: A flowchart of the consensus providing a guidance to Malaysian clinicians was elucidated based on evidences and international guidelines that identifies the right patients who should receive inhaled corticosteroids and enable to switch non ICS based therapies in patients less likely to benefit from such treatments.

Introduction: Proper distribution of human resources is an important factor ensuring high-quality performance and sustained service quality. The aim of this study was determining the workload pressure among medical officers in health clinics (HCs) in Kelantan. Method: A record review survey was conducted between January and April 2019 using human resources data for 2018 involving HCs in Kelantan. It included all the HCs in Kelantan and excluded community clinics. Workload pressure was determined using a tool known as Workload Indicator of Staffing Needs, developed by World Health Organization. A high workload pressure was defined as a ratio between required and acquired medical officers of less than 1. The data were presented descriptively using as frequencies and percentages. Results: All 85 HCs in Kelantan were involved in the study; 90% (9/10) of the Kelantan districts recorded high workload pressure. Moreover, 68.2% (58/85) HCs had high workload pressure. Tanah Merah, Tumpat, Pasir Mas, and Kota Bharu had the most HCs with high workload pressure, and most such HCs were found in areas with a high-density population, requiring huge coverage. Conclusion: The Kelantan State Health Department should develop better human resource distribution strategies to ensure the sustainability of quality care in HCs.

Introduction: Initially, studies showed that graphic warning signs (GWSs) on cigarette packages encouraged smoking cessation. However, there have been recent concerns over the effectiveness of GWSs to change smoker perceptions and behavior over time. Our goals were to assess the latest perceptions of GWSs among smokers in Kelantan and to determine the factors associated with them. Methods: This cross-sectional study was conducted among respondents who attended outpatient clinics in a teaching hospital in Kelantan. Their perceptions were analyzed with a validated Malay questionnaire containing four domains: fear, influence, credibility, and picture content. Results: The average smoking age was 17 (3.04) years old. The mean smoking time was 11 (7.49) years. The average daily cigarettes smoked was 8 (6.26). Most respondents perceived low levels of fear (83%), poor picture content (65.5%), low influence (87.6%), and low levels of credibility (70.1%) in GWSs. Those with low levels of education were significantly associated with poor perceptions of GWSs. Conclusion: Despite vigorous efforts by the government to discourage smoking in Kelantan, smokers still poorly perceive GWSs. More effective health-promotion strategies are essential to influence smokers in this area.

Introduction: Primary health care plays an important role in healthcare systems. In Malaysia, One (1) Malaysia Clinic (now known as Community Clinic since 2018) was established in 2010 aims to increase healthcare services accessibility within the poor urban population. The aim was to look at the effectiveness of One (1) Malaysia Clinic as a new form of public primary health clinic by looking at expectations and perceptions of the quality of the provided services by the patients. Method: It applied a cross sectional study involving nine clinics in of the busiest district in Kelantan namely, Kota Bharu district. 386 respondents which were Malaysian citizen, 18 years old and above were involved in this study. The survey used Malay validated SERVQUAL questionnaire. The Service Quality (SQ) gap was calculated. Result: The empathy dimension obtained the highest expectation and perception score, while the tangible dimension has the lowest expectation and perception score. In all SERVQUAL dimension, the expectations and perceptions of the service provided was significantly different with P < 0.001. The most critical dimension identified was tangible dimension as it has the largest negative SQ gap score. Conclusion: Negative gaps for all SERVQUAL dimensions and individual items indicated that provided services at One (1) Malaysia Clinic still could not fulfilled the patient’s expectation. A continuous improvement program is needed especially on tangible dimension in delivering a quality healthcare services.