Introduction: Burnout is a growing trend among medical students worldwide. The aim of this study was to determine the prevalence and factors associated with burnout among medical students at a public university in Malaysia. Methods: A cross-sectional study was conducted among 1st through 5th year medical students at a public university using a simple random sampling method in recruiting participants. In this study, The Maslach Burnout Inventory-General Survey for Student (MBI-SS) was used and burnout is defined as severely emotionally exhausted and severely depersonalised. Results: A total of 328 medical students were recruited with a with response rate of 88.6%. The burnout prevalence was 10.1%. Based on multivariate logistic regression, presence of smartphone addiction with adjusted (odds ratio (OR) 7.37, 95% confidence interval (CI) = 1.67, 32.49), course choice not based on personal interest or due to family pressure (OR 2.72, 95% CI = 1.08, 6.85) and the presence of family relationship problems (OR = 3.58, 95% CI = 1.27, 10.04) are more likely to be associated with burnout among the medical students. Conclusion: Our study has shown that every tenth medical students suffers from burnout. Medical students who are addicted to smartphone, have chosen medical course against individual interest or because of family pressure and have family relationship problems are at risk of getting burnout. Intervention is required to address this issue for the future well-being of medical students.

OBJECTIVES: This study aimed to develop susceptible-exposed-infectious-recovered-vaccinated (SEIRV) models to examine the effects of vaccination on coronavirus disease 2019 (COVID-19) case trends in Malaysia during Phase 3 of the National COVID-19 Immunization Program amidst the Delta outbreak. METHODS: SEIRV models were developed and validated using COVID-19 case and vaccination data from the Ministry of Health, Malaysia, from June 21, 2021 to July 21, 2021 to generate forecasts of COVID-19 cases from July 22, 2021 to December 31, 2021. Three scenarios were examined to measure the effects of vaccination on COVID-19 case trends. Scenarios 1 and 2 represented the trends taking into account the earliest and latest possible times of achieving full vaccination for 80% of the adult population by October 31, 2021 and December 31, 2021, respectively. Scenario 3 described a scenario without vaccination for comparison. RESULTS: In scenario 1, forecasted cases peaked on August 28, 2021, which was close to the peak of observed cases on August 26, 2021. The observed peak was 20.27% higher than in scenario 1 and 10.37% lower than in scenario 2. The cumulative observed cases from July 22, 2021 to December 31, 2021 were 13.29% higher than in scenario 1 and 55.19% lower than in scenario 2. The daily COVID-19 case trends closely mirrored the forecast of COVID-19 cases in scenario 1 (best-case scenario). CONCLUSIONS Our study demonstrated that COVID-19 vaccination reduced COVID-19 case trends during the Delta outbreak. The compartmental models developed assisted in the management and control of the COVID-19 pandemic in Malaysia.

The emergence of a third wave of COVID-19 infection in Malaysia since September 2020 has led to imminent changes in public health prevention and control measures. As high as 96.2% of registered COVID-19 cases and 88.5% of confirmed deaths in Malaysia occurred during this third wave of infection. A phylogenomic study on 258 SARS-CoV-2 full genomes from February 2020-February 2021 has led to the discovery of a novel Malaysian lineage B.1.524. This lineage contains another spike mutation A701V that co-exists with the D614G spike mutation that was predominant in most of the third-wave clusters. The study provides vital genomic insights on the rapid spread of the SARS-CoV-2 variants in Malaysia in conjunction with the presence of a dominant SARS-CoV-2 lineage during the third wave of COVID-19 infection.

COVID-19 has spread rapidly worldwide. The role of fomites in facilitating onward transmission is plausible. This study aimed to determine the presence of viable virus and its persistence on the surfaces of fomites in wards treating COVID-19 patients in Malaysia. This study was conducted in two stages. First, environmental sampling was performed on random days in the intensive care unit (ICU) and general wards. Then, in the second stage, samples were collected serially on alternate days for 7 days in two selected general wards. In Stage 1, a total of 104 samples were collected from the surfaces of highly touched and used areas by patients and healthcare workers. Only three samples were tested positive for SARS-COV-2. In Stage 2, three surface samples were detected positive, but no persistence of the virus was observed. However, none of the SARS-CoV-2 RNA was viable through tissue culture. Overall, the environmental contamination of SARS-CoV-2 was low in this hospital setting. Hospitals’ strict infection control and the compliance of patients with wearing masks may have played a role in these findings, suggesting adherence to those measures to reduce occupational exposure of COVID-19 in hospital settings.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide, especially in the Western world and Asia-Pacific regions. This study was designed to determine the prevalence of NAFLD detected by sonographic assessment among the rural indigenous population in Peninsula Malaysia and its association with anthropometric and biochemical factors. Methods: A cross-sectional survey was carried out from January 2014-February 2016. Subjects were recruited among indigenous peninsula Malaysia population in rural villages, aged ≥18 years old. The survey was questionnaire-based followed by anthropometric and blood parameters measurements. All subjects underwent abdominal ultrasound assessment to screen for the presence of NAFLD. Semi-quantitative visual grading was performed to assess for mild, moderate or severe NAFLD. Results: A total of 270 subjects underwent the screening program (mean age 43.3 ±14.0 years). Approximately 53 subjects (19.6 %) were identified with NAFLD. Of those with NAFLD, approximately 83% had moderate grade of fatty liver and the remainder were diagnosed with mild grade. NAFLD was closely associated with age, body mass index (BMI), central obesity, hypertension, total cholesterol (TC), triglyceride/high density lipoprotein-cholesterol (TG/HDL-C) ratio. On multivariate logistic regression, a high BMI (≥23.0 kg/m2), central obesity, and raised TG/HDL-C ratio were independent risk factors for developing NAFLD. Conclusion: This pioneer study defines the prevalence of NAFLD among rural indigenous population in Peninsula Malaysia. Lifestyle-related diseases, such as NAFLD can affect both rural and urban communities with equal severity. High BMI, central obesity, and elevated TG/HDL-C ratio were independent risk factors for developing NAFLD.

Introduction: Autopsy is one of the most important approaches to identify clearly the exact cause of death, whether it was due to natural causes, sudden death, or traumatic. Various studies have been done in different countries regarding ways to improve the diagnosis during autopsy. The imaging approach is one of the methods that has been used to complement autopsy findings and to enhance the diagnosis for achieving the most accurate post-mortem diagnosis. The aim of this study is to identify the role of imaging modalities that complement routine autopsy and correlate the findings of diagnostic imaging that can help improve the accuracy of diagnosing the cause of death. Methods: We sourced articles from Scopus, Ovid and PubMed databases for journal publications related to post-mortem diagnostic imaging. We highlight the most relevant full articles in English that explain the type of modality that was utilised and the added value it provided for diagnosing the cause of death. Results: Minimally invasive autopsies assisted by imaging modalities added a great benefit to forensic medicine, and supported conventional autopsy. In particular the role of post mortem computed tomography (PMCT), post mortem computed tomography angiography (PMMR) and positron emission tomography computed tomography (PMCTA) that have incremental benefits in diagnosing traumatic death, fractures, tissue injuries, as well as the assessment of body height or weight for corpse identification. Conclusion: PMCT and PMMR, with particular emphasis on PMCTA, can provide higher accuracy than the other modalities. They can be regarded as indispensable methods that should be applied to the routine autopsy protocol, thus improving the findings and accuracy of diagnosing the cause of death.

Objective: To identify regions of the brain affected during cognitive working memory during tasks to assess attention, planning and decision making among military aviation personnel who have chronic intermittent exposure to high altitude environment. Method: A case-control study was conducted in the Universiti Putra Malaysia among eight military personnel, four of whom had chronic intermittent exposure to high altitude training. They were divided into two groups, chronic intermittent exposure group (CE) (n=4) and a control group (n=4). They underwent a task-based functional magnetic resonance imaging (fMRI) that utilised spatial working memory task to objectively evaluate the neural activation in response to the Tower of London paradigm. Each correct answer was given a score of one and the maximum achievable score was 100%. Results: A consecutive dichotomised group of CE (4/8) and control (4/8) of age-matched military aviation personnel with a mean age of 37.23±5.52 years; showed significant activation in the right middle frontal gyrus (MFG). This in turn was positively correlated with response accuracy. A significant difference in the response accuracy was noted among both the groups at p<0.05. Conclusion: At the minimum results of power analysis of this preliminary fMRI study, our group of aviation personnel who had chronic intermittent exposure to hypobaric hypoxic environment, did not have any significant decrease in cognitive function namely attention, decision-making and problem solving compared to controls during a working memory task

Objective: Problematic smartphone use (PSU) is the development of pathological dependence at the expense of performing activities of daily living, thus having negative health and psychological impact on the users. Previous PSU studies focused on medical students and little is known regarding its effect on students undergoing other courses. The objective of this study is to identify the pattern of smartphone usage and determine the psychological factors affecting PSU among undergraduate students in Malaysia and compare the pattern among students from different fields of study. Method: A prospective cross-sectional study was conducted using the validated Smartphone Addiction Scale–Malay version (SAS-M) questionnaire. One-way ANOVA was used to determine the correlation between the PSU among the students categorised by their ethnicity, hand dominance and by their field of study. MLR analysis was applied to predict PSU based on socio-demographic data, usage patterns, psychological factors and fields of study. Results: A total of 1060 students completed the questionnaire. Most students had some degree of problematic usage of the smartphone. Students used smartphones predominantly to access SNAs, namely Instagram. Longer duration on the smartphone per day, younger age at first using a smartphone and underlying depression carried higher risk of developing PSU, whereas the field of study (science vs. humanities based) did not contribute to an increased risk of developing PSU. Conclusion: Findings from this study can help better inform university administrators about at- risk groups of undergraduate students who may benefit from targeted intervention designed to reduce their addictive behaviour patterns

Storage of dengue virus (DENV) culture stocks in -80°C is a common laboratory practice to maintain the viability of the virus for long-term usage. However, the efficiency of this method could still be hindered by multiple factors. In our laboratory, we observed a constant and substantial deterioration in the titer of DENV in Vero culture supernatant stored in -80°C. Such incident had badly hampered the laboratory work and prompted an investigation to determine the cause. DENV isolates representing all four serotypes were propagated and the culture supernatants were harvested and stored in aliquots of original stock and 10 fold dilutions (10-1 -10-4). DENV titer in these stocks was determined prior to storage and reassessed on the third and sixth month of storage by focus forming unit assay (FFUA). The result demonstrated a constant preservation of titer ranging from 104 ffu/ml to 105 ffu/ml in the diluted DENV virus culture stocks of 10-1, and 10-2 of DENV1-4, a minor reduction of titer from 103 ffu/ml to 102 ffu/ml at dilution 10-3 for DENV4 only and complete deterioration in undiluted culture stock and lower dilution (10-4) within 6 months of storage in -80°C for all serotypes. It is recommended that propagated DENV in Vero cells are stored in 10 fold dilutions as compared to the original form to preserve the titer for long-term usage.

Objectives: To determine the prevalence of osteopenia (OPe) and osteoporosis (OP) in an urban adult population in Malaysia, and to compare the change in the prevalence when using a Caucasian compared to an Asian reference range. Methods: A cross-sectional random sample of the population aged between 45 and 90 years from the state of Selangor, Malaysia, was invited to attend a bone health check-up. Participants with diseases known to affect bone metabolism or who were on treatment for OP were excluded. Bone mineral density was measured using dual energy X-ray absorptiometry. Based on the World Health Organization definitions, the prevalence of OPe and OP was calculated using the Asian and Caucasian T-scores. Results: A total of 342 subjects (222 females, 120 males), with a mean age of 59.68 (standard deviation: 8.89) years, who fulfilled the study criteria were assessed. Based on the Asian reference range, there were 140 (40.9%) subjects with OPe and 48 (14.0%) with OP. On applying the Caucasian reference range, there were 152 (44.4%) subjects with OPe and 79 (23.1%) with OP, with significant increases in males, females, and Chinese ethnic groups. Overall, 75 (21.9%) of subjects had a change in their diagnostic status. T-scores were consistently lower when the Caucasian reference range was used. Conclusions In a healthy urban Malaysian population, the prevalence of OP is 14.0% and OPe is 40.9%. Application of a Caucasian reference range significantly increased the number of subjects with OP and may potentially lead to over-treatment.