Introduction: Anaemia is a common medical condition among children worldwide, yet a commonly overlooked health problem if not life-threatening. This study aimed to determine the prevalence of anaemia in hospitalized children and identify its associated risk factors. Methods: A retrospective study was conducted from January to December 2021 on 792 patients aged 6 months to less than 12 years old with acute illnesses, who were admitted to the general paediatric ward in Hospital Universiti Sains Malaysia. We analysed socioeconomic and demographic data, and risk factors associated with anaemia. Result: The overall prevalence of anaemia among children aged 6 months to less than 12 years old was 16.4%. The age group of 6 to 59 months has a significant association with anaemia with 3.73 odds compared to the age group of 5 to 11 years (Adj OR 3.73, 95% CI 2.53-5.49). Birth weight of more than 2.5kg has a significant association with anaemia with 1.80 odds compared to weight less than 2.5kg (Adj OR 1.79, 95% CI 1.12-2.88). Conclusion: The prevalence of anaemia in the studied population was considered as a mild public health problem according to WHO severity classification. Children aged 6 to 59 months and those with birth weight more than or equivalent to 2.5kg were more likely to be anaemic. Early iron supplementation should be taken into consideration to reduce anaemia in this population.

Cancer-induced bone pain is currently facing inadequate pain management due to unwanted side effects and relative ineffectiveness. The search for alternative therapy to alleviate pain and target a few mechanism pathways might improve survival in metastatic patients. Vitamin E which has been promoted as anti-inflammatory, anti-cancer, and anti-metastatic were chosen in this study to potentiate its capability in a cancer-induced bone pain rat model. Rats were randomly grouped into five groups, and a breast cancer cell line was induced into the left femur of four groups: Negative Control (NC), Alpha Tocopherol (ATF), Tocotrienol Rich Fraction (TRF) and Zoledronic Acid (ZA), whereas Sham group as healthy subjects induced with supplementary media. Pain assessment tests were carried out at four days intervals. The animals were sacrificed after 21 days following SPECT/CT imaging. Bone specimens were analyzed for ELISA and gene expression studies. The results showed that the animal model was successfully validated via the presence of abnormal uptake of the skeletal system. Pain assessment tests demonstrated that vitamin E, specifically TRF significantly alleviate pain compared to the NC group. Biomarker activity illustrated that the TRF supplement group was able to regulate the bone turnover activity comparable to the ZA treatment group. Gene expression studies signify the role of TRF supplement comparable to the ZA group in the ability to regulate osteoclastogenesis, osteoclast activation, and regulating the secretion of metastatic cancer cytokine. This finding addressed the beneficial potency of TRF compared to ATF as a therapeutic option in the management of cancer-induced bone pain.

Teratomatous tumours of the head are rather uncommon. We report a 3-month-old child who presented with acute signs of raised intracranial pressure, needing craniectomy and subtotal tumour removal. The patient was diagnosed as intracranial immature teratoma grade 3, from the pathological study and elevated alpha-fetoprotein (AFP). Managing brain teratoma posed a challenge to the managing team due to the location of the tumour, the unavailability of standardized chemotherapy protocol and the dilemma of commencing adjuvant chemotherapy in a very young infant. The tumour was partially removed due to its critical location. And chemotherapy was delayed until the patient achieved 7 months of age. After four rounds of chemotherapy, the patient remained in remission for more than three years follow up.

Extragastrointestinal tumour of rectovaginal septum (rvGIST) is a rare malignancy that affects rectovaginal septum. We present a case of rvGIST that was initially managed as cervical eGIST based on clinical assessment. A 66-yearold woman presented with postmenopausal bleeding and constipation. Bimanual pelvic examination revealed an irregular mass occupying the vagina. CT thorax, abdomen and pelvis showed a 9.2 x 10.0 x 14.0 cm pelvic mass arising from cervix, extending superiorly to involve the uterus. The patient proceeded to undergo total abdominal hysterectomy, bilateral salpingo-oophorectomy, enucleation of rectovaginal septum mass, rectosigmoidectomy and permanent colostomy. Intraoperatively, there was a 9 x 7 cm mass arising from rectovaginal septum. Histopathological examination of surgical specimen revealed spindle cell tumour diffusely positive for CD34, CD117 and DOG1. The final diagnosis was rvGIST. In conclusion, the diagnosis of rvGIST require a combination of clinical assessment with intraoperative finding and histological assessment of the surgical specimen.

Introduction: Limited studies have been documented on the presence of pathogenic Leptospira in public markets serving the community in sub-districts of Selangor. The aim of this study was to detect the presence of pathogenic Leptospira in rats using a gene encoding an outer membrane lipoprotein LipL32. Methods: Polymerase chain reaction (PCR) was performed using LipL32 primers on sixty kidney samples of rats trapped at two locations of study; Pasar Borong Selangor in Seri Kembangan and Pasar Basah Bandar Baru Bangi in Bangi. Results: Out of 60 samples analysed, 36.7% were positive for the presence of LipL32. All positive samples highly matched (>94%) nucleotide sequence for LipL32 of pathogenic Leptospira and related to the pathogens through phylogenetic analysis. Conclusion: The detection of LipL32 indicates the potential presence of pathogenic Leptospira species at public markets. Although only 60 rats were successfully trapped, the rats are mobile and might further transmit the pathogenic organisms to other areas.

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.

Aims: Linezolid has become a decisive therapy in treating infections with vancomycin-resistant Enterococcus (VRE). Currently, the emergence of linezolid-resistant Enterococcus further complicates the therapeutic options and leads to global health threat not only in hospital setting but in the community. The study aimed at antimicrobial pattern of Enterococcus isolated from 6 poultry farms in Kelantan, Malaysia. Methodology and results: Between February and December 2019, 300 broiler cloacal swab sample (Gallus gallus domesticus) were collected and screened for linezolid-resistant enterococci (LRE) using a standard biochemical and antimicrobial susceptibility tests. Among all the samples, 32.3% (n=97/300) grew Enterococcus, 71.1% (n=69/97) of it were identified Enterococcus casseliflavus by molecular identification, whilst remaining isolates 28.9% (n=28/97) were further identified as Enterococcus gallinarum by 16S rRNA sequencing. None of the isolates were found to exhibit high-level resistance to vancomycin. However, 3/97 (3.1%) were exhibit resistance to high-level gentamicin based on Kirby-Bauer disk diffusion test. Whereas 48/97 (49.5%) of isolates were observed to be resistant to ampicillin, 28/97 (28.9%) were resistant to penicillin. Surprisingly, among the two strains isolated, 18.6% (n=18/97) of it were resistant to linezolid. Isolates showed resistance to linezolid by disk diffusion test were verified by VITEK-2 automated system (bioMérieux, USA) with MIC ≥8 µg/mL. All antimicrobial susceptibility test and minimal inhibitory concentration (MIC) results were interpreted according to Clinical and Laboratory Standard Institute (CLSI). Conclusion, significance and impact of study In conclusion, this study has reported the prevalence of linezolid resistant Enterococcus (LRE) in highly intrinsic antibiotic resistant of E. casseliflavus and E. gallinarum in Malaysia poultry farms, alongside with the truancy of vanA strains. The emergence of LRE strains is an alarming problem to the animal husbandry and healthcare setting worldwide. This could lead to potentially untreatable and life-threatening enterococcal infections. Even more worrying is the spread of LRE to geographical regions where these strains were previously unreported, which may pose a global health threat. Antimicrobial surveillance in poultry husbandry is thus, dimly necessary to prevent wide spread of multidrug-resistant bacteria.
Linezolid ; Enterococcus ; Farms

Work environment in dentistry benefits the right-handed dental practitioners. This situation requires the left-handers to work in an adjusted position causing them discomfort and inconvenience. The aim of this study was to explore the experiences of the identified left-handed undergraduate dental students in Faculty of Dentistry, Universiti Sains Islam Malaysia (USIM) in performing dental procedures. The first phase of the study was to determine handedness of the students using the Edinburgh Handedness Inventory Questionnaire that was distributed to all the dental students. This was followed by a qualitative study using the phenomenology approach. Semi-structured interviews were conducted on left-handed students to determine their perceptions on left-handedness in performing dental procedures. The number of students interviewed was based on attainment of the saturation point. The interview was recorded and transcribed verbatim. The transcripts were analysed through coding, categorising and grouping responses into themes. Prevalence of left-handedness in this faculty was 7%. The participants were not aware of the right-handed situation when they enrolled in the faculty. This situation gave rise to psychological impact such as anxiety and stress. Although some participants were able to use their right hand for certain procedures, the dominant hand continued to be their preference. The difficulties encountered when using the non-dominant hand were grip-strength, angulation and positioning of the instruments. Dental procedures in periodontology (such as scaling, root debridement) and oral surgery (tooth extraction, incision and suturing) were found to be very challenging. They experienced muscle fatigue, reduced precision and prolonged time to complete the dental procedures. They felt that they should be given more time to adapt using the right hand under the tutelage of left-handed faculty members. Left-handed dental students faced difficulties in adapting to the right-handed situation and affect their effectiveness and efficiency. Specific activities need to be designed for left-handers to adapt to the situation under the guidance of left-handed faculty members.

More studies are now focusing on vitamin E as an anticancer agent for its good effects in many in-vitro studies. Current studies proposed that vitamin E might be a suitable candidate as an alternative treatment for cancer due to its antioxidant properties. Vitamin E act as an antioxidant by their long-chain polyunsaturated fatty acids, and thus the integrity of membranes in the cells is maintained and consequently retain the bioactivity of the cells. This mini review will focus on the activity of vitamin E as an antioxidant to protect against cancer in in-vitro, in-vivo, and clinical studies. Although most studies reported great outcomes for the anticancer activity of vitamin E, there were some conflicting data. To date, studies on effects of vitamin E are still undergoing where researchers are still debating on the positive and negative effects of vitamin E as an anticancer therapeutic action.

Background: The choice of anaesthetic techniques is important for the outcome of traumatic brain injury (TBI) emergency surgery. The objective of this study was to compare patient outcomes for target-controlled infusion (TCI) of propofol and sevoflurane anaesthesia. Methods: A total of 110 severe TBI patients, aged 18–60, who underwent emergency brain surgery were randomised into Group T (TCI) (n = 55) and Group S (sevoflurane) (n = 55). Anaesthesia was maintained in Group T with propofol target plasma concentration of 3–6 μg/mL and in Group S with minimum alveolar concentration (MAC) of sevoflurane 1.0–1.5. Both groups received TCI remifentanil 2–8 ng/mL for analgesia. After the surgery, patients were managed in the intensive care unit and were followed up until discharge for the outcome parameters. Results: Demographic characteristics were comparable in both groups. Differences in Glasgow Outcome Scale (GOS) score at discharge were not significant between Group T and Group S (P = 0.25): the percentages of mortality (GOS 1) [27.3% versus 16.4%], vegetative and severe disability (GOS 2–3) [29.1% versus 41.8%] and good outcome (GOS 4–5) [43.6% versus 41.8%] were comparable in both groups. There were no significant differences in other outcome parameters. Conclusion: TCI propofol and sevoflurane anaesthesia were comparable in the outcomes of TBI patients after emergency surgery.