Introduction: Cardiopulmonary resuscitation (CPR) is a life-saving emergency that must be addressed immediately in cases of cardiac arrest to increase survival rates. Bystander CPR is critical for maximising the chances of survival before qualified medical personnel arrive. This study aims to identify the community's knowledge, perception, and attitude towards cardiopulmonary resuscitation (CPR) in Ipoh, Perak, Malaysia. Materials and methods: : A cross-sectional quantitative survey was conducted among the population of Ipoh, Perak. This study included a non-medical background group of people aged 18 and above. Data were reported in frequency and percentage for descriptive analysis, and the inferential statistic was analysed using Chi-square and Mann-Whitney U tests. Results: A total of 380 people completed the survey. Most responders, 54.7% (n=208), have inadequate knowledge of CPR. Even though 63.4% of respondents were not confident in performing CPR, 88.7% consented to participate in CPR training. Most respondents (n=261, 69%) had no formal Basic life support (BLS) training, and 79.7% (n=208) needed help knowing where to get training in cardiopulmonary resuscitation (CPR). Worrying about being sued (n=333, 87.6%) and injuring the sufferer (n=313, 82.4%) are also barriers to commencing CPR. The majority of respondents (n=307, 208.8%) are willing to conduct CPR on members of their immediate relatives. With a P value of 0.05, only knowledge of CPR was related to demographic data (age). Conclusion: In this study, the population of Ipoh, Perak demonstrated insufficient awareness and a reasonable opinion and attitude towards CPR practice. Therefore, increasing BLS training should be considered in all organisations.

A series of comprehensive focus group discussions with active firefighters revealed that inconsistencies in incorporating a rigorous physical training program during work hours contributed significantly to the challenges of maintaining functional fitness, particularly strength. This article outlines a process for identifying the specific exercises required to enhance strength, drawing on the expertise and experience of physical trainers. Modified nominal group technique (mNGT) sessions were conducted to identify and rank exercises for five functional strengths (i.e., pushing, pulling, lifting, carrying, and dragging). A total of six physical trainers from the firefighter academy were interviewed to 1) identify the skeletal muscles involved in the functional movements using a visual aid; 2) generate ideas for exercises via brainstorming; 3) privately rank the displayed list of exercises for each muscle group involved in each functional movement; and 4) design a physical training programme for beginner, intermediate and advanced levels by manipulating loads. Males dominated the expert group (66.7%) and had a mean of 11.50 (SD 5.20) years of experience in physical training. The mNGTs yielded three top-ranking exercises for each functional strength: 1) Pushing: the push-up, sit-up, and jumping jack; 2) pulling: the push-up, jumping jack, and sit-up; 3) lifting: the jumping jack, push-up, and jumping squat; 4) carrying: the push-up, plank, and sit -up; and 5) dragging: the jumping jack, sit-up, and jumping squat. Then each exercise was designed for the beginner, intermediate, and advanced levels by manipulating loads (i.e. additional weight or number of repetitions). This study demonstrated that mNGT is an effective tool for identifying the three top-ranking exercises that address firefighter recruits’ functional strength. The experts chose multi-joint exercises targeting agonist and antagonist skeletal muscle groups and mimicking movements of daily work life. The exercises, corroborated by previous empirical evidence, provide opportunities for common skeletal muscle groupings to be targeted simultaneously to increase cardiovascular adaptations over a shorter period. The physical exercise is now ready to be implemented for piloting purposes among firefighter recruits.

Background: and Purpose There is increasing evidence that the anterior visual pathways are involved in neurodegenerative diseases including amyotrophic lateral sclerosis (ALS) and Parkinson’s disease (PD). This study investigated longitudinal changes in retinal nerve fiber layer (RNFL) thickness in patients with ALS and PD with the aim of better understanding their roles as biomarkers of disease progression. Methods: This study recruited 21 ALS patients, 19 age-matched PD patients, and 21 agematched healthy controls. Patient demographics and clinical scores relating to the respective diseases were documented. The RNFL thickness was measured using optical coherence tomography at baseline and after 6 months. Results: At baseline, the RNFL in the superior quadrant was significantly thinner in the patients with ALS than in healthy controls (109.90±22.41 µm vs. 127.81±17.05 µm [mean±standard deviation], p=0.008). The RNFL thickness did not differ significantly between the ALS and PD patients or between the PD patients and healthy controls. At 6 months, there was further significant RNFL thinning in patients with ALS, for both the overall thickness (baseline: median=94.5 µm, range=83.0–106.0 µm; follow-up: median=93.5 µm, range=82.5–104.5 µm, p=0.043) and the thickness in the inferior quadrant (median=126 µm, range=109.5–142.5 µm; and median=117.5 µm, range=98.5–136.5 µm; respectively, p=0.032). However, these changes were not correlated with the ALS functional scores. In contrast, the patients with PD did not demonstrate a significant change in RNFL thickness between the two time points. Conclusions The RNFL thickness is a promising biomarker of disease progression in patients with ALS but not in those with PD, which has a slower disease progression.

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.

Introduction: Infected diabetic foot ulcers may lead to serious complications if not recognised in the early stage. Diagnosis of infection is particularly challenging at that stage; thus, a sensitive inflammatory biomarker may be helpful. We aimed to evaluate the role of procalcitonin (PCT) as an early biomarker for infected diabetic foot ulcers (IDFU). Materials and method: This cross-sectional study was conducted at Klinik Rawatan Keluarga (KRK), Orthopedic clinic and wards in Hospital Universiti Sains Malaysia (USM) from May 2020 to December 2020. A total of 264 participants were recruited and divided into three groups: 50 diabetic patients with no ulcers (control), 107 patients with non-infected diabetic foot ulcers (NIDFU), and 107 patients with infected diabetic foot ulcers (IDFU). The level of PCT was taken for all patients. Total white count (TWC) and Creactive protein (CRP) were taken only for IDFU patients. Diagnosis of infection was based on the Infectious Disease Society of America-International Working Group of Diabetic Foot (IDSA-IMWGDF), and the severity of infection was graded according to the Wagner Classification. Results: The level of PCT was higher in IDFU than in NIDFU and diabetic patient, with a median (IQR) of 0.355 (0.63) ng/mL, 0.077 (0.15) ng/mL and 0.028 (0.02) ng/mL, respectively. PCT and CRP showed moderate positive correlations in IDFU patients (p<0.001). The sensitivity and specificity were 63.6% and 83.2%, respectively, at the best cut-off at 0.25 ng/mL. Conclusion: PCT is a valuable biomarker for the diagnosis of infection; however, it adds little value in the early diagnosis of IDFU in view of its low sensitivity.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety. METHODS: A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR). RESULTS: We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR. CONCLUSION Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.
Humans ; Cross-Sectional Studies ; Pandemics ; COVID-19/epidemiology* ; Burnout, Psychological ; Health Personnel

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.

We present a case of cryptococcal meningitis initially misdiagnosed as stroke. Our patient is a young man on longterm corticosteroid due to gouty arthritis, who presented with acute onset of left-sided body weakness. Computed tomography of the brain revealed multifocal chronic lacunar infarcts with acute communicating hydrocephalus and cerebrospinal fluid culture isolated Cryptococcus neoformans. He was subsequently treated with amphotericin B and fluconazole but passed away due to multiorgan failure. This case report highlights the importance of considering chronic meningitis as a differential diagnosis when encountering stroke in young and immunocompromised patients.

Aims: Metarhizium anisopliae is an entomopathogenic fungus (EPF) that exists naturally in the environment and potentially be used as a biological control agent against many insect pests. This study aims to evaluate the effect of nutrient additives on the yield and viability of M. anisopliae spore and to determine the optimum incubation period for maximum spore production. Methodology and results: In this study, M. anisopliae was cultivated by solid-state fermentation using rice as a growth medium. Three different nutrient additives were examined which aimed to maximize the production of M. anisopliae spores. Among the three nutrient additives evaluated, yeast (1.84 ± 0.04 g) supported better growth and spore production than molasses (0.58 ± 0.04 g) and palm oil (0.47 ± 0.09 g). The incubation period between 2-6 weeks produced higher spore yield (0.97 ± 0.02 g spores) at week 4 with a better spore viability (86.30 ± 0.45%) at week 2. Conclusion, significance and impact of study Hence, it is suggested that the optimum incubation period is between 2 and 6 weeks after inoculation, and M. anisopliae could be mass produced in large quantities on rice substrate with the addition of yeast as the nutrient additives.
Biological Control Agents ; Microbial Viability ; Metarhizium

Objective: This study aimed to investigate the effect of micro-osteoperforations (MOPs) on external apical root resorption (EARR) during the initial orthodontic alignment phase of maxillary anterior crowding. Methods: Thirty patients (25 females, 5 males; mean age, 22.66 ± 3.27 years) who presented with moderate crowding of the upper labial segment and underwent extraction-based fixed appliance treatment were recruited. They were randomly allocated to receive adjunctive therapy with MOPs (n = 15) or treatment with fixed appliances only (control group; n = 15). EARR was measured from long-cone periapical radiographs taken at the start and the sixth month of treatment. A correction factor for the enlargement difference was used to calculate EARR. Data were analyzed with descriptive statistics and repeated-measures analysis of variance. Results: The mean root lengths of 168 teeth were measured and showed no statistically significant difference (p > 0.05) after six months of fixed appliance treatment in the MOP (mean difference [MD] = 0.13 mm; 95% confidence interval [CI] = −0.10–0.35) and control group (MD = 0.14 mm; 95% CI = −0.10–0.37). Most of the roots in the MOP and control groups (42.86% and 52.38%, respectively) showed only mild resorption. Less than 8% of the roots in both groups (7.14% in the MOP group and 4.76% in the control group) showed moderate resorption. Conclusions Acceleration of orthodontic tooth movement with adjunctive MOPs therapy during the alignment phase does not exacerbate EARR in patients with moderate crowding of the upper labial segment in comparison with controls.