Background: and Purpose Repetitive transcranial magnetic stimulation (rTMS) of the cerebellar hemisphere represents a new option in treating essential tremor (ET) patients. We aimed to determine the efficacy of cerebellar rTMS in treating ET using different protocols regarding the number of sessions, exposure duration, and follow-up duration. Methods: A randomized sham-controlled trial was conducted, in which 45 recruit patients were randomly allocated to 2 groups. The first (active group) comprised 23 patients who were exposed to 12 sessions of active rTMS with 900 pulses of 1-Hz rTMS at 90% of the resting motor threshold daily on each side of the cerebellar hemispheres over 4 weeks. The second group (sham group) comprised 22 patients who were exposed to 12 sessions of sham rTMS. Both groups were reassessed at baseline and after 1 day, 1 month, 2 months, and 3 months using the Fahn-Tolosa-Marin tremor-rating scale (FTM). Results: Demographic characteristics did no differ between the two groups. There were significant reductions both in FTM subscores A and B and in the FTM total score in the active-rTMS group during the period of assessment and after 3 months (p=0.031 and 0.011, respectively).However, subscore C did not change significantly from baseline when assessed at 2 and 3 months (p=0.073 and 0.236, respectively). Furthermore, the global assessment score was significantly higher in the active-rTMS group (p>0.001). Conclusions Low-frequency rTMS over the cerebellar cortex for 1 month showed relative safety and long-lasting efficacy in patients with ET. Further large-sample clinical trials are needed that include different sites of stimulation and longer follow-ups.

Introduction: Childhood anxiety is one of the common mental health problems in children. Untreated childhood anxiety will lead to a higher risk of developing mental health problems in adulthood. Thus, this study aimed to investigate the relationship between parental emotional styles and family values to anxiety level among primary school children. Methods: A cross-sectional study was conducted in a selected primary school in Kelantan, Malaysia. A set of questionnaires consisted of the Revised Child Anxiety and Depression Scale–Parents’ Report (RCADS-P 25), the Parental Emotional Style Questionnaire (PESQ), and the Asian Family Characteristics Scale (AFCS) was used for assessing anxiety, parental emotional styles, and family values, respectively. Data were collected via an online survey using Google Form, and were analysed using Multiple Linear Regression (MLR) to determine the factors associated with childhood anxiety. The significance value was set at p < 0.05. Results: A total of 150 parents of primary school children from the selected school was involved in this study. The majority of respondents were females (82.0%), married (94.7%), hold a degree (66.7%), and were working in the government sector (60.0%). Most of the respondents’ child were twelve years old (20.7%) and males (62%). Based on the MLR, emotional dismissing parental style (p = 0.025) and family values (p = 0.016) were significantly associated with anxiety in these children. Conclusion: Emotional dismissing parental style and family values were significant predictors of anxiety in primary school children. Future intervention research on childhood anxiety is needed.

Excessive salt intake has been linked to the development of hypertension and non-communicable diseases. This study aims to explore the different types of salt reduction intervention implemented among adults aged ≥18 years and to identify the suitable settings, duration and tools used for effective salt reduction interventions. This review adapted the established structured scoping review framework by Arksey and O’Malley. Related articles from the year 2008 to 2018 were retrieved based on the study objectives using keywords in electronic databases and through a bibliographic search of books, reports, conference proceedings, posters and summaries. Out of 130 potentially relevant full-text articles assessed, 14 articles were included in the review. Suitable salt reduction initiatives for the community who regularly consume home-cooked food are through cooking and usage of a tool such as a salt-restriction spoon, together with awareness on the benefits of salt reduction in their daily diet. Healthy catering initiative should be implemented in the workplace or institution-based settings. Policy development targeting the source of salts such as mandatory usage of salt-substitutes or Front-of-Pack labelling of salt content in all food products suitable for population-level intervention.

Purpose: Newcastle disease (ND) represents a major viral disease across the world which imposes high costs to poultry producers for vaccination. Hemagglutinin-neuraminidase (HN) and fusion (F) proteins are the major immunogenic epitopes of Newcastle disease virus and hence, have been the main targets for development of anti-ND vaccines. This paper reports transient expression of a synthetic gene composing of four tandem repeats of HN and three tandem repeats of F epitopes in maize leaves as initial step toward production of recombinant vaccine against ND. Materials and Methods: The synthetic gene was cloned in pBI121 plasmid to yield an expression vector. The vector was sophisticated by the addition of AUG codon, polyhistidine-tag, tobacco mosaic virus omega sequence, stop codon, and restriction sites. Leaf transformation was conducted by the agroinfiltration method. Molecular detection assays including polymerase chain reaction, reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay (ELISA) were carried out to evaluate transgene expression in infiltrated leaves of the corn plant. Results: The result obtained in this research revealed that the transgene was transcribed and translated in maize leaves only 48 hours after infiltration. In the second phase of the experiment, the expressed protein was injected into rabbits. The result of the ELISA assay indicated induction of immune response in the rabbits after injection with the heterologous protein. Conclusion These results confirm the feasibility of agroinfiltration for transient gene expression of viral epitopes in monocot plants which naturally resist stable transformation by Agrobacterium tumefaciens. Practical implications of this finding are discussed in detail and some recommendations for future studies are proposed.

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

The aim of this study is to assess the knowledge, attitude and practices of breast cancer among health science students in Shahrekord city, Iran. A cross- sectional study was conducted in 2017-2018 academic year among 334 health science students in Shahrekord University of Medical Sciences. Data was collected using self-administered structured questionnaire. The total score for knowledge was 18. Any respondent who had more than 9 was considered as having good knowledge and below 9 as having poor knowledge. The total score for attitude was 7. Any score more than 4 was considered as good attitude and score less than 4 was considered as bad attitude. The mean age of the respondents was 21.21± 1.19 years. Most of the respondents aged 18 to 21 years. The knowledge level was significantly different by age group (P=0.002), department (P=0.000) and those who attended training course (P=0.000). Those who perform BSE (Breast Self-Examination) had higher knowledge score about breast cancer than those who do not perform BSE (P=0.000). The participants’ attitude was not significantly different by age group, department, family history of cancer and attending of training courses (p > 0.05). The breast self-examination practice was significantly different by age group (P=0.002), department (P=0.000) and those who attended training course (P=0.000). About half of the respondents had good knowledge on breast cancer. However, more than half of the participants had negative attitude towards breast cancer. For example, less than half of the respondents performed BSE and none of the respondents has performed CBE (Clinical Breast Examination) or mammogram before.

Canine Enteric Coronavirus (CCoV) is one of the major enteric pathogen affecting dogs. This study aims to investigate the molecular prevalence, phylogenetic analysis, associated risk factors, and haemato-biochemical alterations in Canine Coronavirus in dogs in district Lahore, Pakistan. 450 fecal samples were collected from symptomatic dogs originating from various pet-clinics and kennels during 2018-2019. Samples were initially analyzed by sandwich lateral flow immunochromatographic assay and then further processed by RT-PCR (reverse transcriptase polymerase chain reaction) targeting the M gene followed by sequencing. RT-PCR based positive (n=20) and negative (n=20) dogs were samples for their blood for the haemato-biochemical analysis. A questionnaire was used to collect data from pet owners, in order to analyze the data for risk factors analysis by chi square test on SPSS. The prevalence of CCoV was 35.1%, and 23.8 % through Sandwich lateral flow immunochromatographic and RT-PCR respectively. Various risk factors like breed, age, sex, vomiting, diarrhea, sample source, body size, cohabitation with other animals, living environment, food, deworming history, contact with other animals or birds feces, and season were significantly associated with CCoV. The CCoV identified in Pakistan were 98% similar with the isolates from China (KT 192675, 1), South Korea (HM 130573, 1), Brazil (GU 300134, 1), Colombia (MH 717721, 1), United Kingdom (JX 082356, 1) and Tunisia (KX156806). Haematobiochemical alterations in CCoV affected dogs revealed anaemia, leucopenia, lymphopenia, neutrophilia, and decreased packed cell volume, and a significant increase in alkaline phosphate and alanine transaminase. It is concluded that infection with canine coronavirus appears widespread among dog populations in district Lahore, Pakistan. This study is the first report regarding the molecular detection and sequence analysis of CCoV in Pakistan.

Introduction: The culture of eating out among Malaysians has substantially increased in recent years due to the urbanisation of the society. Frequent eating out has been linked with reduced quality of diet, reduced intake of micronutrients, and increased weight gain. This study aims to explore specific factors on the perceptions and behaviours related to eating out from the perspective of parents. Methods: A qualitative study was carried out among 27 informants from various ethnicities and locations in Peninsular Malaysia. All sessions were audio-recorded, fully transcribed and analysed using thematic content analysis. Results: The main overarching theme that surfaced from this study was the role of parents in shaping the practice of eating out. Time constraints due to parents’ work commitments, the availability of various food outlets, increase in family bonding time and food preferences were recurring themes revealed by informants as facilitating factors to eating out. Other emerging themes, such as hygiene of food premises and cost of food, posed as barriers to eating out. Conclusion: These findings offered a better understanding on the eating out practices of a family from the parents’ perspective. Information as such could be incorporated in strategies to enhance the promotion of healthy eating and nutrition interventions that aim to inculcate healthy food choices while eating out.

Introduction: Overweight and obesity among adolescents are not caused by a single factor, and evidence indicates that the food environment is one of the driving forces behind the current escalating obesity epidemic. Therefore, it is imperative to explore any perceived factors related to food choices and quality of food in the school food environment among adolescents. Methods: A qualitative study based on the Socio-Ecological Model (SEM) was conducted on a purposive, multi-ethnic sample of 51 adolescents from different localities. The semi-structured and in-depth interviews were fully transcribed and analyzed qualitatively using Atlas.Ti. The transcribed texts were coded into similar and related themes such as food choices, quality of food, social-peers’ influence, cost of food and self-awareness. Results: The findings revealed that there is a clustering of barriers to practising a healthy dietary intake within the school food environment. Accessibility to low cost snacks and fried foods, influence by parents and peers, as well as the autonomous character of informants in making their own purchases are the contributing factors to healthy eating practice among adolescents. Conclusions: The study highlights that the barriers to practicing healthy eating considerably outweighs the enabling factors. Therefore, the findings will help facilitate the construction of policy-driven environmental changes as well as strategies in designing effective and multilevel interventions that raise awareness in helping adolescents navigate healthy food in their school’s compound
Obesity