This report describes an approach to recover SARS-CoV-2 RNA from rapid antigen test kit (RTK-antigen) cassettes for whole-genome sequencing (WGS). RNA samples were recovered from 33 RTK-antigen cassettes for WGS, with 18 samples achieving more than 80% genome coverage. This work provides a proof-of-concept that positive RTK-antigen cassettes can be safely transported, stored and subjected to WGS, enabling swift identification of circulating variants.

Objective: The COVID-19 pandemic disrupted disease surveillance systems globally, leading to reduced notifications of other infectious diseases. This study aims to estimate the impact of the COVID-19 pandemic on the infectious disease surveillance system in Klang district, Selangor state, Malaysia. Methods: Data on notifiable diseases from 2014 to 2022 were sourced from the Klang District Health Office. The 11 diseases with more than 100 notifications each were included in the study. For these 11 diseases, a negative binomial regression model was used to explore the effect of the pandemic on case notifications and registrations by year, and a quasi-Poisson regression model was used to explore the changes by week. Results: The results showed a reduction in the number of notifications and registrations for all 11 diseases combined during the pandemic compared with previous years. Changes between expected and observed notifications by week were heterogeneous across the diseases. Discussion: These findings suggest that restrictive public health and social measures in Klang district may have impacted the transmission of other infectious diseases during the COVID-19 pandemic. The differential impact of the pandemic on disease notifications and reporting highlights the large ancillary effects of restrictive public health and social measures and the importance of building resilience into infectious disease surveillance systems.

Background: Evidence indicates that central sensitization (CS) plays a role in subacromial impingement syndrome (SIS). Reduced treatment response has been associated with pretreatment pain sensitization features, such as CSrelated symptoms. Methods: Patients who received subacromial steroid injection were evaluated before the injection, at the first and third months. CS-related symptoms were investigated through the central sensitization inventory (CSI), and pain hypersensitivity was investigated by pressure pain threshold (PPT). Patients were evaluated using the visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand, Hospital Anxiety and Depression Scale, and Short Form-36. Results: With the injection, all participants had a significant reduction in shoulder pain (P < 0.05). In all follow-ups,VAS values did not differ significantly between the groups, and patients with CSI ≥ 40 had higher levels of disability,anxiety, depression, and worse quality of life before treatment (P < 0.05). Post-injection disability decreased significantly in the CS group and reached similar levels in both groups at the third month (P > 0.05). Although both groups' PPT values were comparable pre-treatment and at the third month, the CS group's affected shoulder showed a notable PPT decline at the first month (P < 0.05). Conclusions Pre-treatment CS-related symptoms had no effect on SIS patients' responsiveness to steroid injections.

Background: The co-occurrence of frailty, sarcopenia, and malnutrition was well studied in inpatient and nursing home settings, which was associated with higher risk of all-cause mortality. Multicentre data in community-dwelling outpatient setting were lacking. We aimed to find the prevalence of frailty, possible sarcopenia and malnutrition, their overlap and the associated factors in community-dwelling older outpatients. Methods: We collected data from community-dwelling outpatients aged ≥60 years in Indonesian geriatric care centres to conduct this cross-sectional study with bivariate and multivariable analyses. Frailty, possible sarcopenia, and malnutrition diagnoses were based on FRAIL scale, Asian Working Group for Sarcopenia 2019 consensus, and Mini Nutritional Assessment Short Form, respectively. Results: The prevalence of frailty, possible sarcopenia, and malnutrition in community-dwelling older outpatients were 13.6%, 45.5%, and 5.3%, respectively. The prevalence of co-occurrence of frailty, possible sarcopenia and malnutrition was 3.3%. It was associated with transient ischemic attack (TIA) and cerebrovascular accident (odds ratio [OR]=5.53, 95% confidence interval [CI] 1.48–20.61), cognitive impairment (OR=3.70, 95% CI 1.21–11.31), and dependent functional capacity (OR=11.62, 95% CI 3.38–39.99). Overlap of three evaluated syndromes was found in 24.1%, 7.2%, and 61.3% of subjects with frailty, possible sarcopenia, and malnutrition, respectively. It was characterized by a substantial proportion of female sex, older adults with low educational attainment, diabetes mellitus, hypertension, cognitive impairment, multimorbidity, and dependent functional status. Conclusion Approximately 1 in 30 community-dwelling older outpatients had overlapping frailty, possible sarcopenia, and malnutrition. The condition is associated with TIA and cerebrovascular accident, cognitive impairment, and dependent functional capacity. Standardized screening in community-dwelling older population is necessary.

Background: Understanding the relationship between muscle mass, muscle strength, and bone density in older adults is crucial for addressing age-related conditions like osteoporosis and sarcopenia. This review aims to evaluate the relationship between muscle mass and muscle strength with bone density in older adults. Methods: This systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, involved a comprehensive search across seven databases from 2014 to April 2024. Included were observational studies in English and Indonesian on adults aged 60 and older. The Appraisal Tool for Cross-Sectional Studies (AXIS) tool assessed the risk of bias, and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework evaluated the evidence quality. Study selection was independently reviewed, and consensus was reached through discussion. Results: Ten studies were included. For muscle mass and bone density, five studies showed a significant association, while four did not. For muscle strength and bone density, four of seven studies reported a significant association. However, the evidence quality was low due to inconsistency. Conclusion The relationship between muscle mass, muscle strength, and bone density in older adults shows variability and inconsistent evidence.

1p36 deletion syndrome is characterized by a genetic deletion that frequently causes central nervous system, craniofacial, cardiac, and musculoskeletal anomalies. Perioperative management of patients with 1p36 deletion syndrome presents unique challenges due to multiple anomalies and potential complications. We present the successful anesthetic management of a 16-year-old patient diagnosed with 1p36 deletion syndrome who underwent general anesthesia for multiple dental procedures, including dental fillings, extractions, and tartar removal. The patient had micrognathia, hypotonia, flat eyebrows, a short neck, inability to sit without support, absence of speech and self-care skills, limited ability to follow simple commands, and poor cooperation. These factors increase the risk of difficult mask ventilation and intubation. To minimize aspiration risk, we successfully intubated the patient using rapid-sequence induction and intubation (RSII) method with cricoid pressure. A perioperative multidisciplinary team approach and comprehensive preoperative evaluation are crucial due to the existing anomalies, developmental and motor delays, and potential airway complications associated with this syndrome.

Background: Evidence indicates that central sensitization (CS) plays a role in subacromial impingement syndrome (SIS). Reduced treatment response has been associated with pretreatment pain sensitization features, such as CSrelated symptoms. Methods: Patients who received subacromial steroid injection were evaluated before the injection, at the first and third months. CS-related symptoms were investigated through the central sensitization inventory (CSI), and pain hypersensitivity was investigated by pressure pain threshold (PPT). Patients were evaluated using the visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand, Hospital Anxiety and Depression Scale, and Short Form-36. Results: With the injection, all participants had a significant reduction in shoulder pain (P < 0.05). In all follow-ups,VAS values did not differ significantly between the groups, and patients with CSI ≥ 40 had higher levels of disability,anxiety, depression, and worse quality of life before treatment (P < 0.05). Post-injection disability decreased significantly in the CS group and reached similar levels in both groups at the third month (P > 0.05). Although both groups' PPT values were comparable pre-treatment and at the third month, the CS group's affected shoulder showed a notable PPT decline at the first month (P < 0.05). Conclusions Pre-treatment CS-related symptoms had no effect on SIS patients' responsiveness to steroid injections.

PURPOSE: In surgical procedures commonly employed for the management of scaphoid and distal radial fractures, the incision and dissection of the pronator quadratus muscle play a pivotal role. Nevertheless, comprehensive investigations into the anatomical intricacies of the pronator quadratus muscle have been relatively scarce within the clinical community. In light of this, our study endeavors to make a substantive contribution to the medical literature by conducting a meticulous examination of the morphology and morphometry of this muscle. METHODS: This study is a cross-sectional observational study conducted on 22 cadaveric upper extremities (44 sides) preserved between January 2005 and December 2018 at Istanbul University. The study included specimens with intact dissection areas and no prior surgical intervention. Observations focused on the morphometry of the pronator quadratus muscle and related anatomical structures. Statistical analysis was performed using SPSS v23.0, employing Student's t-test and paired t-test, with significance set at p < 0.05. RESULTS: Significant differences were found in the morphometric measurements of the pronator quadratus muscle between the right and left upper extremities, particularly in the vertical distance between the proximal and distal attachment points of the pronator quadratus to the radius (p = 0.008). Additionally, significant differences were observed between male and female samples for radius length (p < 0.001), ulna length (p < 0.001), pronator quadratus width (p < 0.001), and the vertical distance between pronator quadratus attachment points on both the radius (p = 0.001) and ulna (p = 0.001). Furthermore, significant correlations were identified between radius length and parameters such as the vertical distance between pronator quadratus attachment points on both the radius (p = 0.002) and pronator quadratus width (p = 0.030), and between ulna length and parameters including the vertical distances on the radius (p = 0.001) and ulna (p = 0.024). CONCLUSION In light of our comprehensive analysis, which encompasses not only the anatomical features of the pronator quadratus muscle but also its vascular supply and the organization of its neurovascular structures, we posit that our study holds significant implications for the field of orthopedic surgery. We anticipate that this research will furnish valuable insights that can inform and enhance orthopedic procedures.
Humans ; Female ; Male ; Cross-Sectional Studies ; Muscle, Skeletal/anatomy & histology* ; Cadaver ; Aged ; Middle Aged

OBJECTIVES: To examine 5-year trends and variations in dual antiplatelet therapy (DAPT) prescription among multiethnic Malaysian patients aged 60 years and older. METHODS: Using the Malaysian National Cardiovascular Disease-Acute Coronary Syndrome (NCVD-ACS) registry, DAPT 5-year temporal trends prescribing patterns at discharge were examined. Multivariate logistic regression was used to calculate the adjusted odds ratio (aOR) of DAPT prescription. The 1-year all-cause mortality by Cox proportional hazard regression model (adjusted hazard ratio, aHR) using inverse proportional weighting covariates adjustment was performed to assess DAPT prognostic impacts. RESULTS: Data of patients aged 60 years and older were extracted from 2013 to 2017 (n = 3718, mean age: 68 ± 6.74 years, men: 72%, and Malay ethnicity: 43%). The majority of patients were diagnosed with non-ST-segment elevation acute coronary syndrome (63%), predisposed hypertension (76%) and were overweight (74%), while only 35% of patients underwent percutaneous coronary intervention. Over the five years, there was a significant increasing trend in DAPT prescriptions (P < 0.001), with the aspirin-clopidogrel combination being the most common. Aspirin-ticagrelor prescriptions have also increased over the years. Variations in DAPT prescriptions were observed based on patient characteristics. Patients who underwent percutaneous coronary intervention were more likely to be prescribed DAPT in general (aOR = 2.53, 95% CI: 1.95-3.28, P < 0.001) and aspirin-ticagrelor specifically (aOR = 7.76, 95% CI: 5.65-10.68, P < 0.001). Patients with chronic lung disease (aOR = 0.62, 95% CI: 0.42-0.92, P = 0.02) and a history of angina within two weeks (aOR = 0.69, 95% CI: 0.56-0.85, P < 0.001) were approximately 30% less likely to be prescribed DAPT. Approximately 15% of 1-year all-cause mortality were reported. Older patients prescribed DAPT showed significantly higher survival rates than those who were not (aHR < 1.0, P < 0.001). Aspirin-ticagrelor was associated with higher survival rates than aspirin-clopidogrel (aHR = 0.21, 95% CI: 0.11-0.40, P < 0.001). CONCLUSIONS Despite the optimal prescription rate and variation of DAPT in the older Malaysian population, there is room for investigation and improvement in the prescription of newer DAPT combinations that have been suggested to improve patient survival.

BACKGROUND: Acute decompensated heart failure (ADHF) is one of the leading causes of mortality, highlighting the importance of early identification of high-risk patients. The fibrosis-5 (FIB-5) index, traditionally used to evaluate hepatic fibrosis, may hold prognostic value in ADHF patients by reflecting systemic congestion, inflammation, and organ dysfunction. The hypothesis of this study is that the FIB-5 index is an independent predictor of 1-month mortality in patients with ADHF. METHODS: This retrospective study included 155 patients diagnosed with ADHF between 2020 and 2024. Patients were divided into two groups based on their left ventricular ejection fraction (LVEF ≤ 40% or LVEF > 50%). Survival was monitored for one month, and clinical, biochemical, and echocardiographic parameters were compared between survivors and death. Logistic regression and receiver operating characteristic curve analyses were performed to assess the prognostic value of the FIB-5 index. RESULTS: During the 1-month follow-up, 66 patients (42.6%) died. The mean FIB-5 index was significantly lower in non-survivors (-10.46 ± 6.93) compared to survivors (-8.10 ± 6.67) (P = 0.03). Multivariate regression analysis identified the FIB-5 index as an independent predictor of 1-month mortality (OR = 1.089, 95% CI: 1.022-1.160, P = 0.009). The receiver operating characteristic curve analysis demonstrated an area under the curve of 0.609 (95% CI: 0.51-0.699) with sensitivity of 59.6% and specificity of 63.4%. Kaplan-Meier survival analysis revealed significantly higher mortality rates among patients with lower FIB-5 values (log-rank: 7.887, P = 0.005). CONCLUSIONS The FIB-5 index is an independent predictor of 1-month mortality in ADHF patients. Its low cost, non-invasive nature, and ability to reflect systemic inflammation and congestion make it a promising tool for risk stratification. Prospective studies are needed to validate its utility in clinical practice and evaluate its role in guiding therapeutic decisions.