Medication review is an intervention with the potential to reduce drug-related problems (DRPs) in the elderly. This study aimed to determine the effect of pharmacists’ medication reviews on geriatric patients. This study accessed two online databases, MEDLINE Complete and Scopus, and examined all studies published in English between 2019 and 2023, except for reviews. The studies included (1) participants over 65 years of age and (2) medication reviews conducted by pharmacists. The titles, abstracts, and full texts were reviewed for data extraction to determine whether the studies satisfied the inclusion and exclusion criteria. Forty-four of the initial 709 articles were included in this study. The articles included discussions on the incidence rates of DRPs and potentially inappropriate medications (PIMs) (n=21), hospitalization (n=14), medication adherence (n=9), quality of life (QoL) (n=8), and falls (n=7). Pharmacist medication reviews were associated with a reduced incidence of DRPs and PIMs, and improved adherence to medications. Patients’ overall QoL is also increasing. However, pharmacist medication reviews were not strongly associated with decreased hospitalization or falls. A pharmacist’s medication review may be a feasible intervention for reducing the incidence rates of DRPs and PIMs, regardless of whether it is performed as a sole intervention or supplemented with other interventions. The intervention was also effective in increasing medication adherence and QoL.

Introduction: Hepatic diseases patients are especially prone to malnutrition, which is often underestimated. Screening tools were developed to detect the risk of malnutrition. However, screening tools for patients with liver disease were frequently underestimated. Fluid overload is the main issue to perform nutritional screening in liver disease patients. Therefore, this study aimed to validate the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) among patients and to evaluate association between RFH-NPT, Nutritional Risk Screening (NRS 2002) and Subjective Global Assessment (SGA). Methods: This cross sectional study was conducted in 3 phases; transcultural adaptation, criterion validity and reliability phases. Content validity was confirmed by interviewing eight liver disease professionals. Face validity was assessed by surveying forty nurses working in the liver disease ward. In addition, agreement between NRS 2002 and RFH-NPT assessment was assessed using the SGA tool. Results: Eighty patients with liver disease took part in this study. The SGA assessment found malnutrition in 75% of patients (95% CI, 60%–95%) while 80% (95% CI, 65%-80) were found as at risk of malnutrition using RFH- NPT. Moderate specificity and high sensitivity of RFHNPT were 97% and 74%, respectively, and 95% positive predictive value was measured. Conclusion: The RFH-NPT nutritional screening tool is the initial and most reliable in this population to assess the malnutrition risk. Thus, inclusion of the RFH-NPT with NRS 2002 demonstrated positive and a fair agreement between the SGA and RFH-NPT tool to be used as a routine nutrition screening protocol for identifying patients at risk of malnutrition.

Paint contains various complex chemical mixtures, such as aliphatic hydrocarbons, aromatic hydrocarbons (primarily toluene), ketones, and benzene as reported at previous studies. Toxicity from some chemicals can cause early DNA damage with various factors. A scoping review was conducted via literature review on relevant studies on the effect of paint exposure on paint workers and DNA damage. A systematic search was conducted in October 2021 via PubMed, Scopus, and Web of Science databases. The key terms used were paint, solvent-based paint, organic solvent, mixed organic solvent, occupational exposure and DNA damage, oxidative stress, genotoxicity on a painter, paint worker. From 561 articles, only 13 articles were finally selected based on the inclusion, exclusion criteria, and eligibility criteria. The literature showed that biomonitoring studies on painters were consistently reporting positive and significant DNA damage due to exposure to different types of compounds mixed in a paint. However, there were fewer studies on paint manufacturing factory workers compared to painters while paint manufacturing workers exposed various chemical everyday during the paint production which potentially susceptible to occupational toxicity. In conclusion, this review suggests that exposure to paints could induce early DNA damage among paint workers and further investigations on paint exposure among paint manufacturing factory workers and the DNA damage were needed in order to improve occupational health among paint workers in the future.

Introduction: As humans spend 90% of their time inside, indoor air quality (IAQ) is critical for occupant health. The primary concern associated with low IAQ is its impact on employees’ health, comfort, and productivity. In accordance with the Industry Code of Practice on Indoor Air Quality 2010 (ICOP IAQ 2010), a ten-parameter assessment was conducted in the office of the transformer manufacturing factory in Selangor, Malaysia. Methods: The measured parameters are temperature, air movement, relative humidity, carbon dioxide (CO2 ), carbon monoxide (CO), formaldehyde (CH2 O), particulate matter (PM10), total volatile organic compounds (TVOCs), total fungal count (TFC), and total bacterial count (TBC). This study employed both qualitative and quantitative approaches by distributing questionnaires (N = 42), and measuring the indoor air quality parameters with integrated equipment at selected stations and comparing them to the ICOP IAQ 2010 standard. Results: A majority of the measures, with the exception of air movement, CO2 , and TBC, complied with the ICOP IAQ 2010 standards. The one-way ANOVA test showed that there were significant differences (p < 0.05) for the parameters of temperature, PM10, and TVOCs. The ChiSquare test revealed that sleepiness was a symptom of the sick building syndrome, affecting both male and female employees the most frequently and significantly. Conclusion: Air movement, CO2 , and TBC values that did not meet ICOP IAQ 2010 requirements revealed poor IAQ at the study site, which could have a negative influence on the employees’ health. To cut down on air pollution, the improvement on the ventilation system should be done to reduce the risks to the employees’ health.

Aims: This study was aimed to investigate the anti-inflammatory and anti-rheumatoid effects of the Bacillus amyloliquefaciens derived surfactin. Methodology and results: Crude and biosurfactant extracts were analyzed using thin-layer chromatography to determine the presence of biosurfactant. Both extracts were evaluated for their inhibitory effects against the acetylcholinesterase and 5-lipoxygenase enzymes. Human synovial cells were induced with TNF-α and IL-1β. The percentages of the cell viability for both normal and induced cells were determined with an MTT assay. Results showed that surfactin was detected in the biosurfactant extract and demonstrated higher inhibitory effects compared to the crude extract against both inhibitory enzymes acetylcholinesterse (IC50=30.60 μg/mL) and lipoxygenase (IC50=110.10 μg/mL). Both crudes showed no cytotoxic effects at the highest concentration used (50 μg/mL) against normal human synovial cells but showed active reactions against the induced cells. The anti-proliferative effects of biosurfactant and crude extracts were in dose-dependent manner. Conclusion, significance and impact of study Notably, surfactin obtained from B. amyloliquefaciens has shown an inhibitory effect against pro-inflammatory enzymes and cell viability of the induced rheumatoid arthritis cell line. These results highlighted the therapeutic potential of surfactin application as an anti-inflammatory agent for arthritis treatment. Further study is needed to elucidate the mechanisms underlying the anti-inflammatory effect of surfactin.
Bacillus amyloliquefaciens ; Surface-Active Agents ; Anti-Inflammatory Agents ; Rheumatoid Factor

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.

Introduction: Sampling of non-palpable thyroid nodule under ultrasound guidance has been widely used, however less studies done in comparing the efficacy of technique between fine needle aspiration cytology (FNAC) and fine needle capillary sampling (FNCS) under ultrasound guidance. Objectives: This study aimed to determine the cytologic adequacy rates and sample quality obtained by both techniques under ultrasound guidance. Methods: Ultrasound‐guided thyroid nodule samplings were performed on 88 patients, 44 of them had FNAC and another 44 FNCS technique. The slides obtained were scored using a predetermined scoring system comparing five parameters: background blood; amount of cellular material; appropriate architecture retention, degree of cellular degeneration and cellular trauma. The results were analysed using chi square and binary logistic regression test. Results: Patient who underwent FNCS technique was 0.61times (95%CI) less likely to have large amount of background blood sample; 0.39times less likely to have sample with excellent architecture retention; 2.31times and 1.13times more likely to have sample with minimal cellular degeneration and minimal cellular trauma respectively when compare to FNAC. These were however not statistically significant. FNCS was 0.23times less likely to obtain sample with abundant cellular material compared to FNAC and it was statistically significant. Diagnostic adequacy rate was similar in both techniques and it was statistically significant. Conclusions Ultrasound‐guided FNAC and FNCS yielded comparable diagnostic adequacy rates. Our study did not prove a clear superiority of FNCS over FNAC or vice versa. Both techniques could be use in tandem to achieve better diagnostic accuracy.

Background: The spread of COVID-19 was inevitable and has not spared small and isolated communities, including the community of Perhentian Island in Besut District, Terengganu. Managing clusters in small islands can be difficult, given the limited resources. This study explores the characteristics of COVID-19 cases and the experience of outbreak containment at Perhentian Island. Methodology: A retrospective study involving record review of COVID-19 cases and at-risk individuals registered under Perhentian Cluster were retrieved from the Besut District Health Office COVID-19 online registry from the 16thAugust2021 until 6thOctober 2021. All notified cases and close contacts who fulfilled the inclusion criteria were extracted and analysed using descriptive statistics. Results: A total of 1,093 community members of Perhentian Island were screened of which 170 (15.5%) tested positive for COVID-19, while 923 (84.5%) tested negative. Among individuals who tested positive, the majority were adults (52.4%), male (51.8%), Malays (98.8%), and villagers (96.5%). Clinical characteristics were categorized into: asymptomatic (55.9%), had no known medical comorbidities (90.6%), low-risk groups (87.1%), vaccinated (57.6%), and admitted to PKRC (97.1%) for treatment. Multiple agencies were involved in the outbreak containment of the Perhentian Cluster, working collectively and in good coordination. Conclusion The outbreak was attributed to community gatherings and close interactions among villagers. Prompt actions, targeted planning, and inter-agency collaboration were the key factors in successful containment of further spread of COVID-19 in Perhentian Island.
COVID-19

Trifocal fracture of a radius is a rare injury. Trifocal factures involving the shaft of a radius were previously mentioned in a few literature. This type of fractures, involving proximal, shaft, and distal radius with ulna shaft fracture, has also been reported once. However, to the best of our knowledge, our report is the first describing trifocal injuries affecting the shaft and proximal and distal intraarticular part of the radius with an intact ulna shaft. Thorough clinical and radiological assessments are necessary for diagnosis as these injuries are commonly missed. We would like to share the presentation of this rare case and the importance of the correct management to achieve a good outcome.
Radius