Introduction: Perinatal depression and anxiety are prevalent, but professional mental health help-seeking remains low, resulting in a lack of utilization of mental health services. We aimed to determine the prevalence of positive mental health help-seeking behaviour (MHHSB) among pregnant women and its associated factors. Materials and methods: This cross-sectional study was conducted at an urban public maternal and child health clinic (MCHC) in Selangor, Klang Valley between August and November 2022. 296 pregnant women were recruited. The Malay version of Edinburgh Postnatal Depression Scale (EPDS), Self-Stigma of Seeking Psychological Help (SSOSH), Mental Health Literacy Scale (MHLS) and MHHSB questionnaires were used for data collection. Multivariate logistic regression was used to identify factors. Results: The mean age was 30.06 (±5.14) years and more than two-third (61%, n=181) were multiparous. More than half (57.4%, n=170) were in their second trimester, while 15.9% (n=47) and 21.3% (n=63) had probable depression and anxiety, respectively. The prevalence of positive MHHSB was 73.6% (95% CI: 0.68, 0.78), yet the prevalence of probable getting professional assistance was 22.6% (95% CI: 0.18, 0.28). Two factors were associated with positive MHHSB. These were probable anxiety [odds ratio (OR)3.86, 95% CI: 1.80, 9.15] and MHLS [OR 1.05, 95% CI: 1.03, 1.08]. Conclusion: Positive MHHSB was prevalent among pregnant women, yet the possibility of seeking professional assistance is low. Having anxiety was likely to influence MHHSB, hence efforts to improve mental health literacy and training staff to recognize symptoms and cultivating supportive environment for pregnant women will ensure timely interventions.

Introduction: COVID-19 lockdown has been linked to alterations in eating behaviour and a sedentary lifestyle. As human-to-human transmission rapidly increased, the Movement Control Order (MCO) was put in place as an attempt to minimise the risk of the virus spreading in the community. This study aimed to determine whether eating behaviour was associated with sleep quality and physical activity among college students in Malaysia during MCO. Methods: This was a cross-sectional study among Malaysian students aged between 20 to 34 years old. A simple random sampling method was applied and the participants had to complete an online survey consisting of a validated Dutch Eating Behaviour Questionnaire (DEBQ), Pittsburgh Sleep Quality Index (PSQI), and International Physical Activity Questionnaire–Short Form (IPAQ-SF), distributed via an online platform. Results: A total of 370 students participated, with 22.4% emotional eaters, 58.6% external eaters, and 23.0% restrained eaters. In addition, 64.3% had poor sleep quality, while 57.6% claimed to be physically active. However, no correlations were found between all eating behaviour subscales with sleep quality and physical activity. Conclusion: More than half of college students presented with external eating behaviours. Early screening and further investigations should be done, especially with the high rate of poor sleepers, to promote and sustain a healthy lifestyle during and beyond COVID-19.

Period poverty is a global community health dilemma that has long been overlooked. This condition is described as having insufficient access to menstrual products, education, and sanitation facilities. Briefly, period poverty means that millions of women are subjected to injustice and inequity due to menstruation. This review aimed to explore the definition, challenges, and effects of period poverty on the community, especially among women at their productive ages. In addition, suggestions to minimize the impact of period poverty are discussed. A search strategy was applied using the keywords “period poverty,” “period equity,” “period poverty,” and “menstrual hygiene” in Google Scholar, ScienceDirect, SpringerLink, MEDLINE, and PubMed electronic databases, journals, and articles on relevant topics. Trained researchers conducted a keyword search from January 2021 to June 2022. Based on the reviewed studies, it has been proven that many countries are still affected by the period stigma and taboo, inadequate exposure to menstrual health and its management, lack of education about menstruation, and shortage of access to menstrual products and facilities. The next step is to reduce and slowly eliminate the period poverty issue by conducting more research to increase clinical evidence and future references. This narrative review could inform policymakers of the magnitude of the burden related to this issue and guide them to develop effective strategies to minimize the impact of poverty, especially during the challenging years of the post-coronavirus disease 2019 era.

Aims: Streptococcus pneumoniae is one the world’s foremost bacterial pathogens that cause massive global mortality and morbidity in young children and immunocompromised adults especially in developing countries. Biofilms have been increasingly recognized as an important prerequisite to disease. Individual S. pneumoniae strains differ markedly in their virulence phenotypes, but genetic heterogeneity has complicated attempts to identify any association between a given clonal lineage and propensity to cause a particular disease type. This study investigated serotype 19 S. pneumoniae from blood and ear isolates for biofilm formation capacity in relation to isolate source, pH and ferric oxide [Fe(III)] supplementation. Methodology and results: Viable count and density biofilm assays, microscopy and multi locus sequence typing (MLST) were applied to investigate biofilm formation capacity and genetic diversity of serotype 19 S. pneumoniae from blood and ear isolates. Generally, blood isolates were observed to produce more biofilms at both pH 7.4 and 6.8 compared to the ear isolates. The supplementation of Fe(III) was also found to support biofilm growth. Upon MLST typing of the isolates, marked differences in biofilm formation within the same sequence types (ST) of ST199 and ST177 was observed. This strongly indicated that strains within the same sequence type show differences in biofilm formation capacity. Conclusion, significance and impact of study This study showed that despite belonging to the same serotype, serotype 19, S. pneumoniae blood and ear isolates showed high diversity in biofilm formation ability in relation to pH and Fe(III) supplementation. Additionally, pneumococcal isolates from sequence types ST199 and ST177 also gave rise to differences in biofilm formation ability within the same sequence type (ST). The diversity of biofilm formation within serotype 19 seen in this study is significant to further inform of vaccination strategies against pneumococcal infections, in that due to variations in biofilm formation capacity within the same ST. It is possible that within serotype 19 may show variable vaccination or drug treatment responses. This also indicates that the current treatment strategy which employs specific serotype selection as for PCV14 and PCV7 pneumococcal vaccines may not produce the desired therapeutic results.
Streptococcus pneumoniae--immunology ; Biofilms--radiation effects

Introduction: Pursuing higher education has always been considered to be stressful as students need to adapt to new social and academic environment. Higher education in recent years has shifted from teacher centred authoritarian approach to student centred learning with amicable learning environment. In this changing scenario, this study aims to identify the indicators of stress and stress levels among 21st century university students and fathom the demographic factors influencing it. Method: A cross-sectional survey was conducted on students attending a private university in Malaysia using Stress Indicators Questionnaire. The data was analysed with descriptive and inferential statistical tests. Results: A total of 1050 university students aged between 18-30 years from different faculties voluntarily participated in the study. All respondents reported stress varying from very low to dangerous levels. Among the indicators of stress, sleep and emotional indicators were at dangerous levels, physical indicators and personal habits were at high level and behaviour indicators were perceived at medium level. A significant difference in total stress score between students of different age groups and ethnicity were observed, while no significant difference was noted with regards to gender. Conclusion: This study reveals that various indicators of stress are prevalent among the present-day university students. It may help guide policy makers and teachers in early identification of stress among their pupils and plan effective strategies aimed at balancing a good quality of life and academic achievement for the learners in institutions of higher learning.

A sixty-eight years old man was referred to the hospital for evaluation of lung adenocarcinoma treatment. Chest computed tomography (CT) imaging showed lung nodule, pleural plaques, ground-glass opacity, and parenchymal bands related to asbestosis. Pleural plaques are the proxy of asbestos exposure, and asbestosis is lung parenchymal fibrosis caused by asbestos. The interview revealed that the patient had worked as an owner of a construction firm for more than 37 years. Construction workers are at high risk of getting asbestos-related diseases because some building materials have asbestos. This case study aimed to describe chest CT findings of asbestosis and pleural plaques that suggest the presence of asbestos exposure in a lung cancer case. This case showed the pivotal role of chest CT to define asbestos-related lung diseases and a structured interview to obtain past asbestos exposure.
Lung Neoplasms ; Asbestos

African swine fever (ASF) is a transboundary haemorrhagic viral disease that affected domestic and wild pigs of all ages. The disease is caused by African swine fever virus (ASFV) and was introduced to China in 2018 before spreading rapidly to neighbouring Asian countries. As such, putting countries free from ASF like Malaysia at risk. ASF is highly lethal with no vaccine or treatment available. In February 2021, we confirmed backyard pigs from various locations in Sabah were infected with ASF using real time polymerase chain reaction (realtime PCR). Further characterization of the Sabah ASFVs indicated that they were of p72 genotype II with intergenic region (IGR) variant II that displayed an addition tandem repeat sequence (TRS) insertion, similar to ASFV from Indonesia, Vietnam and China. These results indicate and support the transboundary expansion of a homogenotypic ASFV (p72 genotype II and IGR variant II) in the Europe and Asia-Pacific, emphasizing the need for a holistic international collaboration in control and preventing further spreading of the current ASF pandemic. Importantly, our results informed the first detection and characterization of ASF, a disease previously not detected in Malaysia. This information is crucial for further mitigation and preventive measures.

Introduction: Mental health-related problems are on the rise among medical doctors, with many house officers (HOs) have quitted training prematurely owing to work and life-related factors. However, the quality of work-life (QOWL) among Malaysian HOs remains unknown. Hence, we aimed to determine the mean score of QOWL and its predictors among HOs working at two tertiary hospitals. Methods: This is a cross-sectional study conducted at two tertiary hospitals in Selangor, between May and August 2019. A stratified random sampling was employed. The Malay version of work-related quality of life scale (M-WRQLS-2) and the patient health questionnaire (M-PHQ-9) were used for data collection. Statistical analysis was performed using the SPSS version 23.0 (IBM, Chicago, IL). Results: A total of 260 (72.9%) respondents completed the questionnaires. The overall score of QOWL was 3.05 ± 0.48 (95% CI: 2.99, 3.11). Depressed HOs had a significantly lower mean score across all subscales (p < 0.005) except for the stress at work (SAW) subscale. Two predictors were inversely associated with QOWL. These were the M-PHQ-9 score [β= -0.049,95% CI: -0.06, -0.04] and being female [β=-0.129,95% CI: -0.24, -0.02]. Conclusion: HOs who worked at the two hospitals in Selangor perceived their overall QOWL as average. However, being female and having depression were found to be associated with lower QOWL. Therefore, early interventions targeting female HOs and those with depressive symptoms are warranted. Further research and strategies aiming to improve the overall quality of work-life and its dimensions for HOs during housemanship training are vital.

Background: The long waiting time for Tetralogy of Fallot (TOF) operation may potentially increase the risk of hypoxic insult. Therefore, the objective of this study is to determine the frequency of acute neurological complications following primary TOF repair and to identify the peri-operative risk factors and predictors for the neurological sequelae. Methods: A retrospective review of the medical and surgical notes of 68 patients who underwent TOF repair in Hospital Serdang, from January 2013 to December 2017 was done. Univariate and multivariate analyses of demographics and perioperative clinical data were performed to determine the risk for the development of acute neurological complications (ANC) among these patients. Results: ANC was reported in 13 cases (19.1%) with delirium being the most common manifestation (10/68, 14.7%), followed by seizures in 4 (5.9%) and abnormal movements in two patients (2.9%). Univariate analyses showed that the presence of right ventricular (RV) dysfunction, prolonged duration of inotropic support (≥7 days), prolonged duration of mechanical ventilation (≥7 days), longer length of ICU stays (≥7 days), and longer length of hospital stay (≥14 days), were significantly associated with the presence of ANCs (p<0.05). However, multivariate analyses did not show any significant association between these variables and the development of ANC (p>0.05). The predictors for the development of postoperative delirium were pre-operative oxygen saturation less than 75% (Odds Ratio, OR=16.90, 95% Confidence Interval, 95%CI:1.36, 209.71) and duration of ventilation of more than 7 days (OR=13.20, 95%CI: 1.20, 144.98). Conclusion: ANC following TOF repair were significantly higher in patients with RV dysfunction, in those who required a longer duration of inotropic support, mechanical ventilation, ICU and hospital stay. Low pre-operative oxygen saturation and prolonged mechanical ventilation requirement were predictors for delirium which was the commonest neurological complications observed in this study. Hence, routine screening for delirium using an objective assessment tool should be performed on these high-risk patients to enable accurate diagnosis and early intervention to improve the overall outcome of TOF surgery in this country

Introduction: Data on water and sugar sweetened beverages (SSB) intake among young adults in Malaysia is sparse. This study aimed at measuring the intake of plain water and SSB among undergraduate students in a Malaysian university and examine its association with body mass index (BMI). Methods: A total of 376 undergraduate students aged 18-30 years were recruited. A selfadministered questionnaire was used to determine the SSB consumption pattern. The questionnaire consisted of five sections that included the background of the participants, knowledge about SSB, SSB preferences, frequency and portion size. Results: 23.9% of subjects in this study were overweight. Almost all of the subjects took outside food (93.1%) and drink (74.2%). The highest daily consumption was plain water (92.3%), with a majority drinking more than two cups at each intake. Caffeinated drinks (coffee or tea) were the most popular SSB among the students (18.4%). Most students (79.7%) did not consume SSB on a daily basis. A significant association was found between the proportion of plain water consumption and BMI (p<0.05). Those who were overweight consumed a greater amount of plain water as compared to those underweight. Conclusion: Our findings of low plain water intake among the underweight may be used to tailor intervention efforts to increase its intake and reduce that of SSB, especially among underweight young adults.