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.

Introduction: Paediatric asthma, a prevalent chronic disease among children in Malaysia, can have its morbidity reduced through effective education. This study aims to assess the knowledge and perceptions of childhood asthma in the Malaysian general population. Materials and methods: A prospective study was conducted among visitors attending paediatric wards and clinics at the Institute of Paediatric Hospital Kuala Lumpur. Participants, who gave their consent, completed validated questionnaires in written form that evaluated their knowledge of asthma symptoms, triggering factors, medication, prevention, and myth perception. A higher score indicated a deeper understanding of asthma. Results: The study included 200 participants, predominantly female (88%), with a median age of 35.5 years. Among them, 12% were asthmatics, and 36% had a family member with asthma. The primary source of asthma information was electronic media (82%). The average score for knowledge of asthma symptoms, triggering factors, medication prevention and myth was 62.13% (SD 17.6). 62.88% (SD 16.3), 56.7% (SD 16.5), 82% (SD 15.1) and 57.8% (SD 15.4) respectively. Asthma myth perception and source of asthma information from family members were strongly related (p-value of 0.042). Conclusion: The general population exhibits an average understanding of asthma, comparable to findings from previous studies in other countries. This highlights the need for targeted educational interventions to dispel myths and enhance asthma knowledge.

Introduction: Acute Coronary Syndrome (ACS) is still a major cause of mortality and morbidity globally. One of the factors that cause a prehospital delay is the delay in early detection and inaccuracy of early treatment of ACS. The Internet of Things, which is supported by the high use of smartphones with the DETAK application, can be an opportunity to facilitate ACS education programs so that ACS can be detected early. Method: This study has used a quantitative research design with a quasi-experimental approach which pretest and posttest, in which both the experimental and control groups participate. The inclusion criteria of this study were age >45 years; obesity; smoker; Respondents with a history of: hypertension/diabetes mellitus/hyperlipidemia/hypercholesterolemia/CVD/families with cardiovascular disease. 252 respondents who met the inclusion criteria were randomly divided into control (n=126) and intervention groups (n=126). The intervention group was given education through the DETAK application and the control group was given leaflet about ACS. Results: The results of the study showed that there was an increased in early treatment ability was only found in the intervention group (p<.001). Mean differences of the ability of early detection (p<.001) and early treatment (p=.019)between intervention and control groups were both significance. Conclusion: There is potential for DETAK applications to improve the early detection and treatment capabilities of ACS.

In systemic lupus erythematosus (SLE), haematological abnormalities are frequent, although they are an uncommon cause of acquired von Willebrand syndrome (AVWS). AVWS is a rare condition that can cause a bleeding disorder. We presented a case of AVWS in the early diagnosis of SLE. One month before admission, the patient had a history of recurrent epistaxis. He presented to the hospital with symptomatic anaemia and was noted to have severe anaemia with iron deficiency. During hospitalisation, recurrent epistaxis recurred and was found to have prolonged activated partial thromboplastin time (aPTT), presence of lupus anticoagulant (LA), and lower von Willebrand factor (VWF), and factor 8 (VIII) levels. Simultaneously, he was diagnosed with SLE based on Systemic Lupus International Collaborating Clinics (SLICC) criteria. He underwent blood transfusions and was treated with immunosuppressive drugs such as steroids, mycophenolate mofetil, and an anti-fibrinolytic agent; he subsequently stopped bleeding and showed clinical improvement.

Introduction: The Asthma Knowledge Questionnaire developed by C. Rodriguez Martinez in 2005 was proved to be a valid instrument for asthma knowledge assessment for parents of children with asthma. 17 items were included in the questionnaire including their myths and beliefs, knowledge, and associated aspects. The objective of this study is to analyse the validity and reliability of the Malay version of the questionnaire. Methods: Forward-Backward translation method was used by language experts to obtain the Malay version of the questionnaire. The questionnaire was then given to twenty respondents at the Paediatric Institute Hospital Kuala Lumpur to ensure the clarity and relevance of the questionnaire as a pilot study. Subsequently, 60 respondents who fulfilled the inclusion and exclusion criteria were selected to proceed with the reliability test of the Malay version questionnaire. The results were analysed with SPSS version 26.0. The reliability and internal consistency were confirmed by intra-class correlation and Cronbach’s alpha coefficient. Results: There were 60 respondents to the questionnaire consisting of parents and caretaker who has child with asthma at the Institute of Paediatric Hospital Kuala Lumpur. The mean age of respondents was 34 ± 7.5year old. 91.7% of the respondents were female. The overall Cronbach’s alpha coefficient of the questionnaire was 0.84. Conclusion: The Malay version of the Asthma Knowledge Questionnaire has a good degree of validity, reliability and is culturally acceptable equivalent to the original version.

Introduction: Uncontrolled hypertension is a leading cause of death worldwide and self-care is one of the essential management strategies. However, data regarding the psychometric properties of self-care instruments in the Indonesian context is lacking. This study aims to validate the Hypertension Self-care Profile (HBP SCP) instrument in the Indonesia version. Methods: A forward-backward translation technique was used for the Hypertension (HBP SCP) questionnaire. This questionnaire had three domains namely motivation, self-efficacy, and behavior. It was completed by a total of 191 respondents and the survey was conducted from September to December 2021 in the Health Primary Care Bandung West Java, Indonesia. The Cronbach’s alpha was used to test the reliability scale, the content validity index was assessed by five experts, and item inter-correlation was analyzed to test the total items. Results: The results showed that the content validity index was in the excellent category with a value of 0.89. The Cronbach’s alpha coefficient was 0.875, indicating satisfactory internal consistency. Furthermore, the total items correlation had a significance value of 0.05 (df = N-2) for the three scales namely 0.353-0.742, 0.302- 0.642, and 0.237-0.649 for motivation, self-efficacy, and behavior, respectively. Conclusion: The Indonesian version of the Hypertension HBP SCP instrument is valid and reliable.

Aims: Marine bacteria have been reported to produce potential natural pigment with pharmaceutical properties and their growth can be manipulated in the laboratory to increase pigment production and their antimicrobial activity. Hence, this study aimed to enhance the prodigiosin production in Serratia marcescens IBRL USM84 by improving physical conditions. Methodology and results: The quantification of the pigment produced by S. marcescens IBRL USM84, bacterial cell growth, and its antibacterial activity in the broth medium were determined using a spectrophotometry method. Meanwhile, the antibacterial effect of red pigment on MRSA cells was observed under a scanning electron microscope (SEM). This marine isolate produced the highest yield of prodigiosin (6.95 μg/mL) when cultivated in marine broth with the addition of 0.2% of agar, 25 °C incubation temperature, initial medium pH of 7, 150 rpm of agitation speed for 48 h of cultivation time under light illumination. There was an increment of 151.81% in prodigiosin production after enhancement compared to before the enhancement of cultural conditions. SEM observations revealed that severe damage to the cell’s morphologies was exposed to red pigment as indicated by the formation of small dents, which led to completely collapse and eventually, cell death. Conclusion, significance and impact of study A positive correlation between pigment production and antibacterial activity was observed in the present study. The results supported the fact that marine bacteria are a reservoir of various pigments with antimicrobial properties. Also, the pigment production by S. marcescens and its antibacterial activity were significantly influenced by physical parameters.
Prodigiosin ; Serratia marcescens ; Marine Biology

Introduction: There is limited evidence on dietary patterns and the risk of type 2 diabetes (T2D) in women with a history of gestational diabetes mellitus (GDM) compared to their non-GDM counterparts, especially in the Asian population. The pilot study investigated dietary patterns in women with a history of GDM (HGDM) and without a history of GDM (non-HGDM), and the association with T2D risk. Methods: This comparative cross-sectional study involved 64 women (32 HGDM, 32 non-HGDM). Food intake was assessed using a validated food frequency questionnaire. Principal component analysis derived the dietary patterns. T2D risk score was determined using the Finnish Diabetes Risk Score tool. Results: HGDM group had significantly higher proportion of first-degree family history of diabetes; higher risk of T2D and better diabetes knowledge; lower gestational weight gain and postpartum weight retention; and consumed more fast food than nonHGDM. ‘Rice-noodle-pasta-meat’ dietary pattern was significantly associated with increased T2D risk after adjusting for age (β=0.272, p=0.032). ‘Bread-cereals-fast food-meat’ dietary pattern was positively and significantly associated with T2D risk after adjusting for confounders, including age, education level, family history of diabetes, diabetes knowledge score, gestational weight gain, and postpartum weight retention (β=0.251, p=0.012). Conclusion: Dietary patterns high in bread, cereals and cereal products, fast food and meat, as well as rice, noodle, pasta and meat were associated with an elevated T2D risk. A more extensive study is warranted to establish the association between dietary patterns and risk of T2D, focusing on women with a history of GDM.

Objective: Aged-care facilities are high-risk settings for coronavirus disease 2019 (COVID-19) outbreaks because residents have risk factors such as advanced age and multiple comorbidities. This report details a COVID-19 outbreak at an aged-care facility in Selangor, Malaysia during March–April 2020. Methods: Epidemiological and environmental data were gathered via telephone interviews and field investigations. Swab samples were taken from all residents and staff for laboratory investigation. Possible contributing factors to the outbreak were explored. Results: There were a total of 18 individuals at the institution: nine elderly residents and nine staff. The attack rate was 66.67% (6/9) among the elderly residents and 55.56% (5/9) among the staff. The most common symptoms reported were fever, cough, shortness of breath and diarrhoea. The fatality rate among COVID-19 cases was 18.18% (2/11). Both fatal cases occurred in people of advanced age (86 and 92 years old), who had comorbidities and had fever at presentation. The factors contributing to the outbreak included a delay in isolating symptomatic residents, the use of common facilities, caregivers providing support to more than one resident and a lack of natural ventilation. Discussion Prevention and control measures must be aggressively implemented in high-risk sites to significantly reduce the risk of morbidity and mortality during COVID-19 outbreaks. Specific guidelines should be developed detailing the management of outbreaks in institutions such as aged-care facilities.

Type 2 diabetes mellitus (Type 2 DM) is a chronic disease which rise is closely linked to the obesity epidemic and which requires long-term medical attention to limit the development of its wideranged complications. Many of these complications arise from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. The increasing evidence of its remission state has been discussed in the literature. Here we report on a patient with metabolic syndrome who underwent a structured therapeutic lifestyle changes (TLC) therapy which eventually led to remission of Type 2 DM.