BACKGROUND/OBJECTIVES: Dietitians frequently use nutrition education tools to facilitate dietary counselling sessions. Nevertheless, these tools may require adaptation to keep pace with technological advancements. This study had a 2-fold purpose: first, to identify the types of nutrition education tools currently in use, identify their limitations, and explore dietitians’ perspectives on the importance of these tools; second, to investigate the features that dietitians prefer in digital nutrition education tools. SUBJECTS/METHODS: A semi-structured face-to-face interview was conducted among 15 dietitians from selected public hospitals, primary care clinics, and teaching hospitals in Malaysia.Inductive thematic analysis of the responses was conducted using NVivo version 12 software. RESULTS: Most dietitians used physical education tools including the healthy plate model, pamphlets, food models, and flip charts. These tools were perceived as important as they facilitate the nutrition assessment process, deliver nutrition intervention, and are time efficient. However, dietitians described the current educational tools as impersonal, outdated, limited in availability due to financial constraints, unhandy, and difficult to visualise. Alternatively, they strongly favoured digital education tools that provided instant feedback, utilised an automated system, included a local food database, were user-friendly, developed by experts in the field, and seamlessly integrated into the healthcare system. CONCLUSION Presently, although dietitians have a preference for digital educational tools, they heavily rely on physical nutrition education tools due to their availability despite the perception that these tools are outdated, impersonal, and inconvenient. Transitioning to digital dietary education tools could potentially address these issues.

We describe the case of a 72-year-old housewife who presented to a primary care specialist clinic for reassessment following multiple hospitalisations for heart failure within the past 9 months. She presented with decreased effort tolerance and tiredness for the past 1 year. Her symptoms had remained the same despite current treatment. During the initial history-taking, she did not report any medical illnesses or surgeries. She had been well and had not undergone any screening for almost 30 years before the first hospitalisation for heart failure. There was neither cough, constipation, dyspepsia, abdominal pain, stool changes, haematuria, per vaginal bleeding nor hoarse voice. The physical examination findings were remarkable for slow movement and speech. Her skin was dry with a markedly increased serum lipid profile. Further investigation and management confirmed the suspected diagnosis.
Heart Failure ; Geriatrics ; Primary Health Care

Introduction: Limited studies have been documented on the presence of pathogenic Leptospira in public markets serving the community in sub-districts of Selangor. The aim of this study was to detect the presence of pathogenic Leptospira in rats using a gene encoding an outer membrane lipoprotein LipL32. Methods: Polymerase chain reaction (PCR) was performed using LipL32 primers on sixty kidney samples of rats trapped at two locations of study; Pasar Borong Selangor in Seri Kembangan and Pasar Basah Bandar Baru Bangi in Bangi. Results: Out of 60 samples analysed, 36.7% were positive for the presence of LipL32. All positive samples highly matched (>94%) nucleotide sequence for LipL32 of pathogenic Leptospira and related to the pathogens through phylogenetic analysis. Conclusion: The detection of LipL32 indicates the potential presence of pathogenic Leptospira species at public markets. Although only 60 rats were successfully trapped, the rats are mobile and might further transmit the pathogenic organisms to other areas.

Introduction: This audit was performed to monitor the diagnosis and management of chronic kidney disease (CKD) according to the clinical practice guidelines (CPGs) of CKD 2018 in a primary care clinic. Methods: Patients who attended the clinic from April to June 2019 and fulfilled the diagnosis of CKD were included in this study, except for those diagnosed with a urinary tract infection, pregnant women and those on dialysis. These criteria were set based on the CPGs. The standards were set following discussions with the clinic team members with reference to local guidelines, the 2017 United Kingdom National CKD audit and other relevant studies. Results: A total of 384 medical records were included in this audit. Overall, 5 out of 20 criteria for processes and 3 of 8 clinical outcomes for CKD care did not meet the set standards. These included the following: documentation of CKD classification based on albumin category (43.8%); CKD advice (19.0%); dietitian referral (9.1%); nephrologist referral (45.5%); haemoglobin level monitoring (65.7%); overall blood pressure (BP) control (45.3%); BP readings for diabetic kidney disease (DKD) and non-DKD with > 1 g/day of proteinuria (≤ 130/80 mmHg, 37.0%); eGFR reduction of < 25% over the past year (77.2%). Identified problems included the absence of a CKD registry, eGFR and albuminuria reports, and a dedicated team, among other factors. Conclusions: Overall, 8 out of 28 criteria did not meet the standards of CKD care set for this audit. The problems identified in this audit have been addressed. Moreover, strategies have also been formulated to improve the diagnosis and management of CKD in this clinic.

Aims: The surplus use of herbicide Dalapon® contains 2,2-dichloropropionic acid (2,2-DCP) poses great danger to human and ecosystem due to its toxicity. Hence, this study focused on the isolation and characterization of a dehalogenase producing bacteria from Sungai Skudai, Johor, capable of utilizing 2,2-DCP as a carbon source and in silico analysis of its putative dehalogenase. Methodology and results: Isolation of the target bacteria was done by using 2,2-DCP-enriched culture as the sole carbon source that allows a bacterium to grow in 20 mM of 2,2-DCP at 30 °C with the corresponding doubling time of 8.89 ± 0.03 h. The isolated bacterium was then designated as Klebsiella pneumoniae strain YZ based on biochemical tests and basic morphological examination. The full genome of K. pneumoniae strain KLPN_25 (accession number: RRE04903) which obtained from NCBI database was screened for the presence of dehalogenase gene, assuming both strains YZ and KLPN_25 were the same organisms. A putative dehalogenase gene was then identified as type II dehalogenase from the genome sequence of strain KLPN_25. The protein structure of the type II dehalogenase of KLPN_25 strain was then pairwise aligned with the crystal structure of L-2-haloacid dehalogenase (L-DEX) Pseudomonas sp. strain YL as the template, revealing the existence of conserved amino acids residues, uniquely known to participate in the dehalogenation mechanism. The finding thus implies that the amino acid residues of type II dehalogenase possibly shares similar catalytic functions with the L-DEX. Conclusion, significance and impact of the study In conclusion, this study confirmed the presence of new dehalogenase from the genus Klebsiella with potential to degrade 2,2-DCP from the river water. The structural information of type II dehalogenase provides insights for future work in designing haloacid dehalogenases.
Klebsiella pneumoniae--isolation & ; purification ; Computer Simulation ; Molecular Dynamics Simulation

Introduction: Food is a necessity for students. Yet, students’ food expenditure is anticipated to be restrained by their financial status. This cross-sectional study aims to determine the prevalence of food insecurity and its determinants among university students attending public universities in Peninsular Malaysia. Methods: Multistage random sampling was used to select respondents from public universities in Peninsular Malaysia. A total of 427 undergraduate students completed a selfadministered questionnaire at four randomly selected universities (Universiti Utara Malaysia, Universiti Kebangsaan Malaysia, Universiti Malaysia Pahang and Universiti Teknologi Malaysia). The questionnaire consisted of information concerning demographic and socioeconomic backgrounds, food security status, eating behaviour, financial literacy, and financial problem among university students. Frequency, chi-square, and logistic regression were used to analyse the variables. Results: Mean age of the respondents was 21.6 years, and 60.9% were found to be food insecure. Gender (χ2=5.415), origin (χ2=3.871), number of siblings (χ2=4.521), financial problem (χ2=42.364), and regular breakfast intake (χ2=5.654) were associated with food security status (p<0.05). Male respondents had 1.5 times (AOR=1.547, 95% CI: 1.006-2.380) the risk of having low food security status. Those with higher financial problems (AOR=3.575, 95% CI: 2.332-5.481) were 3.5 times more likely to be food insecure. Conclusion: The prevalence of food insecurity among public university students in Peninsular Malaysia was significantly high. Thus, intervention studies should focus on students with financial problems. Moreover, establishing a better system for an on campus food pantry or food bank is needed to counter the high prevalence of food insecurity among university students.

Aims: Aquaculture has grown tremendously in Malaysia over the past decades. However, guaranteeing aquaculture sustainability is a big challenge in terms of maintaining continuous output with a safe environment. Furthermore, the cultured species should be free from antibiotic resistance bacterial and antibiotic residue. This study aimed to monitor the existence and prevalence of antibiotic resistant bacteria associated with aquaculture farms in Sarawak. Methodology and results: Samples of water, sediment and fish were collected from five aquaculture farms within Sarawak. The samples were plated on trypticase soy agar and incubated at 28 °C for 24 h. A total of 204 bacterial isolates were isolated and analysed by (GTG)5-fingerprinting to determine genetic similarity among the bacterial isolates, so that representatives could be selected from similar clonal isolates. Based on the (GTG)5 profiles, 50 representative isolates were chosen for species identification using 16S rRNA sequencing. The identified bacteria were tested against 25 antibiotics using standard disk diffusion method. The 16S rRNA analysis revealed that the isolates constitute of 14 genera of bacteria including Bacillus (38%), Exiguobacterium (16%), Enterobacter (14%), Aeromonas (6%), Acinetobacter (4%), Citrobacter (4%), Staphylococcus (4%), Achromobacter (2%), Chitinophaga (2%), Fictibacillus (2%), Plesiomonas (2%), Pseudomonas (2%), Pseudoxanthomonas (2%) and Stenotrophomonas (2%). The antibiotic resistance analysis revealed that the highest percentage of resistance was recorded against streptomycin (75.0%), followed by ampicillin (66.0%), ceftriaxone (50.0%), rifampin (43.3%), aztreonam (36.8%) and ceftazidime (31.6%). Resistance to more than two antibiotics was observed in 40.0% of isolates with an overall multiple antibiotic resistant (MAR) index ranging from 0 to 0.79. Conclusion, significant and impact of study The variability of antibiotic resistance patterns exhibited by different bacterial species suggests a dependence on selective pressures exhibited in different geographical locations. Our results show that the occurrence of MAR bacteria in an aquaculture environment with unknown history of antibiotics usage in the aquaculture system is possible, indicating a need to continuously monitor the presence of antibiotic resistant bacteria in the aquaculture system.
Drug Resistance, Microbial ; Aquaculture ; Malaysia

Abstract Introduction: Malaysian traffic police are always working on the public roads to alleviate traffic congestion and therefore exposed them to the polluted air every day. In particular, polluted air containing PM2.5 is dangerous to their respiratory health as they can penetrate deep into the lungs, leading to bronchitis, lung cancer and many more. Hence, this research examined the relationship of personal exposure level to PM2.5 with respiratory symptoms among traffic policemen in Kuala Lumpur and Johor Bahru. Methods: 134 participants among traffic policemen were agreed to participate in this study. They were requested to complete a questionnaire regarding the sociodemographic background and respiratory health information. The questionnaire was adopted from International Union Against Tuberculosis Lung Diseases (1986). Personal exposure level of PM2.5 was measured using an air pump with 5.0µm pore size PVC filter. Results: The mean exposure level of PM2.5 among traffic policemen was 28.69 µg/m3. It was found that some of them possess respiratory symptoms (Coughing 33.6%, Phlegm 25.4%, Wheezing 14.9% and Shortness of breath 32.1%). There was significant association detected at p-value < 0.05 in coughing. Despite, there was no significant association in other symptoms such as phlegm, wheezing and shortness of breath. Conclusions: Traffic police were exposed to a relatively high level of PM2.5 (12.4 µg/m3 to 55.3 µg/m3) and showed symptoms of respiratory effects. Therefore, recognition of the risks connected with occupational lung disease and exposure monitoring must be a high priority. This baseline data can serve as a reference to the top management of traffic police officers in order to develop an occupational safety and health guideline for police officers as required by Occupational Safety and Health Act (OSHA, Act 514 1994).

Abstract Discomfort measurement has usually been attempted by asking the participants to rate the scale of their discomfort which commonly termed as a subjective scale. Various studies had conducted the discomfort level on vehicle seat by using Visual Analogue Scale (VAS) and Likert scale. VAS is a tool that use to measure a discomfort or characteristics in range across a continuum of values. Meanwhile, Likert-scale is a tool consist of items that require respondents to rate their degrees of comfort or discomfort with various declarative statements. Thus, the purpose of this study is to review, discuss and compare between the VAS and Likert scale used on the development and assessment of sitting discomfort survey in seat vehicles. The literature on various topics related to questionnaire development on discomfort in seat vehicle were collected from electronic databases. Four high-quality studies were eligible and met the inclusion and exclusion criteria. Overall, there is no evidence and conclusion that neither visual analogue scale nor Likert scale are better to one another. Therefore, it can be concluded that either of this scale still applicable for the ergonomic research application as both of this scale have their own pros and cons.

Introduction: The refeeding programme in government hospitals is aimed at improving the nutritional status of malnourished children with weight-for-height z-score (WHZ) below -2.0, using special therapeutic food. However, there is a lack of data on the nutritional status of indigenous (Orang Asli) children when they return to the community after hospital discharge. Case Presentation: A 3-year-old Temiar boy residing in a tribal village in Hulu Perak was visited to determine his nutritional status following discharge from a refeeding programme in a government hospital. He was admitted to the hospital with a weight of 10.0 kg, height of 85.5 cm and WHZ of -2.09. The boy was later discharged weighing 11.0 kg, and with height unchanged at 85.5 cm and WHZ of -0.87. During our visit to the child’s home three months after discharge, his weight was 9.5 kg, height 86.0 cm, and WHZ –2.91. Discussion: The management of the case in the hospital was based on the Malnourished Orang Asli Protocols of the hospital. Household food insecurity, feeding and care practices, unhealthy household environment and the lack of communication between hospital and community health services were all identified as risk factors for malnutrition. Conclusion: The recurrence of malnutrition in this child, after successful improvement during hospital stay, highlights the importance of identifying factors that may affect nutritional status after hospital discharge. This knowledge will be beneficial in planning specific interventions, especially for Orang Asli children, living in remote villages