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.

Objective: Verbal autopsy (VA) through face-to-face interviews with caregivers is a way to determine cause of death without medical certification. In Malaysia, the use of VA has improved mortality statistics. However, during the coronavirus disease 2019 (COVID-19) pandemic, face-to-face interviews were delayed, reducing VA data collection and affecting data for mortality surveillance. This study aims to investigate the feasibility and acceptability of conducting VA interviews via telephone calls, and the quality of the data gathered. Methods: The study was conducted in Malaysia from September to October 2020 using a cross-sectional design. Participants were health-care workers from established VA teams across the country. They conducted VA interviews via telephone and provided feedback through a customized online form. Data collected from the form were used to assess the feasibility, acceptability and quality of the telephone interviews using IBM SPSS version 23. Results: Responses were received from 113 participants. There were 74 (65.5%) successful interviews, representing 91% of the 81 cases who were able to be contacted. More than two thirds of health-care workers provided positive feedback on the telephone interview method for themselves and the interviewees. Only 10.8% of causes of death were unusable. Discussion This study provides preliminary evidence that VA via telephone interview is feasible, acceptable and can be used as an alternative to face-to-face interviews without affecting data quality. During times when face-to-face interviews are not advisable, VA telephone interviews can be used for data collection for mortality surveillance.

Introduction: Human immunodeficiency virus (HIV)-related stigmatisation and discrimination adversely affect health outcomes in terms of timely diagnosis, treatment and care. Despite global efforts, they remain common among healthcare workers worldwide. In Malaysia, family medicine specialists are entrusted with the care of HIV patients at the primary care level. This study aimed to assess HIV-related knowledge, acts of discrimination, stigmatising attitudes and their associated factors among family medicine trainees in Malaysia. Methodology: This cross-sectional study was conducted among 397 family medicine trainees in Malaysia using a validated, self-administered questionnaire that assessed the participants’ sociodemographic information, HIV/AIDS knowledge, stigmatising attitudes (attitudes of blame, attitudes towards imposed measures, comfort in dealing with HIV patients) and acts of discrimination. Results: The most common stigmatisation was “attitudes of blame” (mean [SD] score: 3.0 (0.74); range score:1–5), and the most frequent discriminatory act was breaching patient confidentiality (54.9%). Around 82.1% had good knowledge of HIV/AIDS. Married participants and participants who had 7 years or less in service were more stigmatising in “attitudes of imposed measures” towards people living with HIV (p=0.006). Conclusion Family medicine trainees exhibited stigmatisation and discrimination towards HIV patients despite having good HIV knowledge. Hence, appropriate and concerted health education should be given to all family medicine trainees to eliminate stigmatisation and discrimination.
Discrimination, Psychological ; Social Discrimination ; HIV

Introduction: Bertolotti’s syndrome (BS) is defined as the presence of low back pain (LBP), radiculopathy or both with a dysplastic transverse process (TP) of the fifth lumbar vertebra that is articulated or fused with the sacral base or iliac crest. This study aimed to investigate the prevalence and severity of BS to promote awareness of this disease. Methods: A retrospective review of anteroposterior lumbosacral plain radiographs was conducted between 1 January and 31 December 2017. Patients were recruited via systematic randomised sampling and were then interviewed and examined. The severity of BS was measured objectively using the numerical pain rating scale (NPRS) and Oswestry disability questionnaire (ODQ). Data were analysed using IBM SPSS for Windows version 22. Results: The prevalence of BS was 9.6% (16/166). Age significantly affected the severity of BS. The older and younger groups had a mean ODQ score of 42.86% and 24.08%, respectively (P=0.006). There was no significant relationship found between the prevalence of BS and age (P=0.126). Only one patient was diagnosed with BS during medical consultation. The mean NPRS score was 5.5. The majority of the BS cases were of moderate severity (43.8%), followed by those of minimal severity (31.2%) and severe disability (25%). Conclusion Early diagnosis of BS and orthopaedic referral are crucial to halt its progression. BS should be considered in patients presenting with LBP during assessments of lumbosacral radiographs.
Low Back Pain

Introduction: Positive professional practice environments are crucial to safeguard a healthy and safe working conditions for health workforce, including nurses; so as to ensure provision of quality healthcare and safety of patient. Methods: This was a cross-sectional study to assess nurses’ perceptions towards nursing practice environment and factors associated with their perceptions. A validated Practice Environment Scale of the Nursing Work Index (PESNWI) questionnaire was administered to nurses working in two Ministry of Health hospitals. The questionnaire comprises of five subscales: Participation, Foundation, Managers Support, Workforce Adequacy and Physician/Nurse Relations. Mean scores of >2.50 were considered as favourable, and ≤2.50 were considered as unfavourable. Simple linear and multiple linear regression analysis were employed to identify factors associated with their perceptions. Analysis was carried out using STATA version 14.0. Results: A total of 366 respondents took part in the study, with a response rate of 98.4%. Majority were working shift (89.6%) and working extended hours (62.3%). In general, the nursing practice environments were rated as favourable. Overall mean score was 2.90±0.03 and four out of five subscales’ mean scores were >2.50. Foundation for quality nursing care was perceived as the most favourable subscale, while workforce adequacy was perceived as the least favourable. There were statistically significant association between working extended hours, doing double shift and working during day off with perceived unfavourable workforce adequacy. Conclusion: Nursing practice environment was perceived as favourable in the studied hospitals. Policy makers, service providers, and hospital managers could explore further on human resource planning and management of nursing personnel to tackle the issue of nurse staffing in the country.

Introduction: The aim of this study was to compare the visual outcomes of phacoemulsification with intraocular lens implantation (IOL) surgery in patients with and without diabetes mellitus (DM) in Malaysia over a 12-year period and to identify factors that may contribute to poor visual outcome. Materials and Methods: Data was retrieved from the webbased Malaysian Cataract Surgery Registry (CSR). Perioperative data for cataract surgery performed from 2007- 2018 were analysed. Inclusion criteria were age ≥40 years, phacoemulsification and IOL and senile cataract. Combined surgeries, surgeries performed by trainees and ocular comorbidities were excluded. Post-operative Best-Corrected Visual Acuity (BCVA) were compared. Factors affecting poor visual outcomes among those with DM were analysed using multivariate logistic regression to produce adjusted odds ratio (OR) for variables of interest. Results: Total number of cases between 2007-2018 was 442,858, of whom 179,210 qualified for our analysis. DM group consisted of 72,087 cases (40.2%). There were 94.5% cases in DM group and 95.0% from non-DM group who achieved BCVA ≥6/12 (p<0.001). Among patients with DM, advanced age (70-79 years old, OR: 2.54, 95% Confidence Interva, 95%CI: 1.91, 3.40; 80-89 years old, OR: 5.50, 95%CI: 4.02, 7.51), ≥90 years, OR: 9.77, 95%CI: 4.18, 22.81), poor preoperative presenting visual acuity [<6/18–6/60] (OR: 2.40, 95%CI: 1.84, 3.14) and <6/60-3/60 (OR: 3.00, 95%CI: 2.24, 4.02), <3/60 (OR 3.63, 95%CI: 2.77, 4.74)], presence of intraoperative complication (OR 2.24, 95%CI: 1.86, 2.71) and presence of postoperative complication (OR 5.21, 95%CI: 2.97, 9.16) were significant factors for poor visual outcome. Conclusions: Visual outcomes following phacoemulsification with IOL implantation surgery among cases with DM were poorer compared to cases without DM. Risk factors for poor visual outcomes among cases with DM were identified.

Introduction: Fall is a health problem for older persons. This study investigates the potential factors of concern: the nutritional status of older persons and non-communicable disease association with incidence of falls. Methods: This study used data from NHMS 2018, and conducted a cross-sectional design by applying two-stage stratified cluster sampling. Descriptive statistics such as the percentage of each variable were done. Factors associated with falls were determined at both univariate and multivariable levels using simple logistic regression and multiple logistic regression. The data were presented as standard values for each analysis and adjusted odds ratios with 95% CI with p values (<0.05). Results: A total of 3,867 from 3,977 elderly (mean age 68.2+ 6.85) were recruited with the response rate of 97.2%. Factors associated with fall were 70 years old and above (AOR= 1.34, 95% CI: 1.09, 1.64), obesity (AOR=1.55, 95% CI: 1.21, 1.98), undernutrition (AOR=1.59, 95% CI: 1.30, 1.94), persons with 2 NCDs (AOR=1.49, 95% CI: 1.15, 1.92) and persons with 3 NCDs (AOR=1.63, 95% CI: 1.23, 2.16). Conclusions Advanced age, malnutrition, obesity, and having two or more NCDs are associated with falls in the NHMS 2018 study. In conclusion, falls are prevalent among older persons. There is an urgent need for public health strategies and programmes to decrease the incidence of modifiable risk factors and early identification of those at risk. Implementation of fall preventive programs which includes multifactorial interventions at hospitals and homes can also significantly reduce incidence of falls among older persons

Introduction: Hypercholesterolemia has been proven as a main pathogenic trigger for pathogenesis of atherosclerosis. Atherosclerosis characterised by chronic inflammatory process and increased expression of inflammatory markers. In this study; Trihoney (a combination of three types of natural honey namely: Trigona, mellifera, and Dorsata) was investigated for its anti-inflammatory effect in hypercholesterolemic atherosclerotic rabbits. Methods: Thirty male New Zealand white rabbits (NZW) were grouped into: normal diet (C), normal diet with 0.6g/kg/day of Trihoney (C+H), 1% cholesterol diet (HCD), 1% cholesterol diet with 0.6g/kg/day of Trihoney (HCD+H), and 1% cholesterol diet with 2mg/kg/day of atorvastatin (HCD+At.). After 12 weeks of starting the experiment, animals were sacrificed and serum analysed for homocysteine and pro-atherogenic inflammatory markers such as: interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumour necrosis factor-α (TNF-α). Fasting serum glucose was analysed to assess glycaemic status. Results: Trihoney treated group showed significantly lower (p<0.05) serum IL-1β and IL-6 compared to the HCD group. Trihoney supplementation resulted in significant (p<0.001) reduction of serum TNF-α compared to HCD group. Experimental group HCD had serum homocysteine level comparable to that of the control groups without any significant difference despite little increase in the mean value. Trihoney treated group had serum homocysteine comparable to the controls. All experimental groups showed fasting serum glucose comparable to the control. Conclusion: This study showed that Trihoney has an anti-inflammatory function and may be used as an adjuvant to statins for management of atherosclerotic cardiovascular diseases even in diabetic subjects.

Objective: To determine the morphological and molecular characterization of Acanthamoeba isolates from contact lens paraphernalia in Malaysia and to investigate their pathogenic potential based on the physiological tolerance. Methods: One hundred and eighty contact lens wearers donated their contact lens, lens storage cases and lens solutions between 2018 and 2019. The samples were inoculated onto 1.5% non-nutrient agar plates for 14 d. Polymerase chain reaction (PCR) was performed and the amplified PCR products were sequenced and compared with the published sequences in GenBank. The pathogenic potential of positive isolates was further tested using temperature-tolerance and osmo-tolerance assays. Acanthamoeba species were categorized into three distinct morphological groups established by Pussard and Pons. Results: Acanthamoeba was successfully isolated from 14 (7.8%) culture-positive samples in which 11 belong to morphological group II and 3 belong to morphological group III, respectively. The sequencing of 18S ribosomal RNA gene led to the identification of the T4 genotype in all the isolated strains. In vitro assays revealed that 9 (64.3%) Acanthamoeba isolates were able to grow at 42 °C and 1 M mannitol and were thus considered to be highly pathogenic. Conclusions: To the best of our knowledge, this is the first report identifying the Acanthamoeba genotype and their pathogenic potential among contact lens wearers in Malaysia. The potentially pathogenic T4 genotype isolated in this study is the most predominant genotype responsible for human ocular infection worldwide. Hence, increasing attention should be aimed at the prevention of contamination by Acanthamoeba and the disinfection of contact lens paraphernalia.

Aims: This study aimed to evaluate the antimicrobial activity of naturally derived phenylpropanoids from Alpinia conchigera (A. conchigera) Griff. and its synthetic analogues, as well as interactions between selected compounds with first-line tuberculosis (TB) drug, rifampicin, against Mycobacterium smegmatis, a potential opportunistic nontuberculous mycobacterium (NTM) and a surrogate organism for TB. Methodology and results: Twelve phenylpropanoids of A. conchigera were evaluated for antimicrobial activity against M. smegmatis (ATCC 14468). The phenylpropanoid compound from A. conchigera with the lowest minimum inhibitory concentration and bactericidal (MIC, MBC) values were selected for checkerboard tetrazolium microplate assay (TEMA) with rifampicin to determine drug interactions. A majority of the compounds had antimicrobial activity, however, purified natural compound 1'S-1'-acetoxychavicol acetate (ACA) showed the highest antimicrobial activity with an MIC value of 62.5 µg/mL against M. smegmatis. The combination of ACA and rifampicin produced indifferent interaction with fractional inhibition concentration (FIC) index of 1.5, while the combination of rifampicin and ACA synthetic analogue 4-allyl-2,6- methoxyphenyl isobutyrate produced a synergistic interaction effect with FIC index of 0.5. None of the compounds tested were bactericidal but appear to be bacteriostatic. Conclusion, significance and impact of study This study presents the first report on the antimicrobial potential of natural A. conchigera-derived ACA against M. smegmatis as well as the synergistic interaction of 4-allyl-2,6- methoxyphenyl isobutyrate with rifampicin which warrants further investigation.
Anti-Infective Agents ; Alpinia ; Mycobacterium smegmatis