Introduction: Emergency contraception (EC) is an important method for preventing unintended pregnancies. By being knowledgeable and readily available to dispense this medication, pharmacists play a crucial role in preventing unintended pregnancies, which can have significant social, economic, and health repercussions. This study aimed to assess the knowledge and perception of EC among undergraduate pharmacy students in Malaysia, examining the socio-demographic factors associated with these dependent variables. Materials and methods: A cross-sectional study was conducted among 355 pharmacy students from 20 institutions offering a Bachelor of Pharmacy (Hons.) program. The data was collected from April to June 2022. The questionnaire was formatted as a web-based questionnaire consisting of 33 questions divided into three sections. Independent t-test and one-way ANOVA was used to compare the means in student’s knowledge and perception. Chi-square test was used to identify the association between the demographic variables and the knowledge and perception. Results: Three hundred and fifty-five students participated in the survey. Participants' mean (SD) knowledge score was 5.31(2.94) of 10 items. Factors affecting the mean knowledge of participants include academic year (P<0.001), institution type (P<0.001), race (P<0.001), religion (P<0.001), residence area (P=0.013), and prior knowledge of EC (P<0.001). The mean (SD) score of perception was 36.8 (4.9) from 50. Most of the students had an average perception of EC. Conclusion: The findings indicate that the majority of students held average perceptions but lacked sufficient knowledge about EC, highlighting the need to address these knowledge gaps for the development of an effective educational program.

Problem: In September 2024, an illegal toxic waste dumping incident along the Tebrau River in Johor State, Malaysia, raised widespread health concerns in Johor Bahru and Kulai districts. The pollution released a strong, unpleasant odour, resulting in acute symptoms among exposed individuals, including sore throat, dizziness and coughing. Context: The Tebrau River is a vital waterway supporting urban populations in Johor. This was not the first chemical pollution event in the region, as previous incidents, including the Kim Kim River crisis in 2019, highlighted the region’s vulnerability to such events. The involvement of multiple districts and agencies during the response presented challenges in coordination and data sharing. Action: The Johor Bahru District Health Office promptly deployed a rapid assessment team to assess the affected areas and implement both active and passive case detection. Community engagement targeted vulnerable populations, such as schoolchildren, to minimize exposure risks. Additional dumping sites identified along the Tebrau River prompted expanded surveillance and a state-level response to coordinate efforts across districts and all health-care facilities. Outcome: A total of 484 individuals were exposed to the pollution, 334 of whom developed symptoms related to chemical exposure. Timely public health actions consisted of actions to mitigate the impact. Health facilities were placed on high alert and community trust was maintained through proactive engagement. However, gaps in cross-district coordination and challenges accessing environmental data underscored areas for improvement. Discussion: This incident highlighted the importance of rapid assessment, cross-sector collaboration, community engagement and integrated data systems. It also showed that effective public health action is possible despite environmental data limitations. The strengthening of communication, standardized protocols and real-time data sharing will be critical to improving future chemical pollution events.

Introduction: Haze imposes a substantial health burden especially in Southeast Asia where occurrences are frequent. Reduction in air quality levels has resulted in an increase in healthcare utilization, especially to the front door of healthcare, the emergency department (ED). Data on ED utilization during haze period is lacking. Methods: This is a retrospective study aimed to determine the association between haze and ED utilization of haze-related acute respiratory illnesses between April 2013 to September 2013. The study period was divided into haze/ non-haze period. Clinical data was collected from the registration book and patients’ case notes. Environmental data was obtained from Institute of Environment and Development Universiti Kebangsaan Malaysia. Results: Total number of patients presented to ED during the study was 32,661. Fifteen percent (n= 5177) presented with acute respiratory symptoms. Total Emergency Department visits during haze period reduced due to emergency declaration, hence reducing non-emergency visits. However, there was a significant increase in hospital admission (p=0.0015) and infective respiratory illnesses (p=0.001) during haze which correlates with increase air pollutant. Patients with chronic respiratory illnesses were more affected by haze (p = 0.001). PM10 and ozone were the main pollutant during the haze period. Conclusion Increasing pollutant levels from the haze significantly increases ED hospital admission. Evidence from this study can influence policymakers to prepare and allocate resources to hospitals in response to haze-related illnesses.

Introduction: Tuberculosis (TB) patients default their treatment during the treatment course. Therefore, this study aims to analyze the demographic characteristics of the patient who missed follow-ups and identify the reasons for missed appointments or defaulted their treatment. Methods: The records of patients diagnosed with TB follow-up at the chest clinic from January to June 2023 were reviewed based on our inclusion and exclusion criteria. Results: The retrospective descriptive analysis was conducted based on the data collected. Based on the study sample (n=33), the result shows that the majority of the defaulted patients were male in gender (n=22). Most of the missed appointments patients and defaulters are of Malay (39.4%) ethnicity and Malaysian nationality (66.7%). Most patients gave the transport issues as the reason for missed appointments followed by financial issues and feeling healthy. The majority of them missed follow-up in the first month after starting anti-TB. Conclusions In conclusion, missed appointments, treatment compliance and defaulted cases in TB treatment remain as one of the main challenges in the effort to end TB epidemics. Further in-depth research is required to propose effective measures to solve this issue and improve the national TB control program.

Introduction: Persistent exposure to stress can lead to a wide range of pathological effects, including reproductive dysfunctions. Tualang honey, renowned for its antioxidant properties has been utilised in traditional and modern medicine. This study aims to investigate the protective effects of Tualang honey against stress-induced testicular damage in male rats. Method: Twenty-four male rats were divided into control group, stress-exposed group, Tualang-honey-supplemented group and stress-exposed with Tualang-honey-supplemented group. Restraint stress test (RST) and Forced swimming test (FST) were imposed on the rats for 21 days. Serum testosterone and corticosterone concentration were measured using ELISA. Testes were harvested, weighed, processed and stained for spermatid counts and measuring seminiferous epithelial height and diameter. One-way analysis of variance (ANOVA) was used to compare the numerical data between groups. Results: The testosterone concentration, spermatid count, seminiferous epithelial height and diameter in stress group were significantly lower compared to control group (p < 0.05). Corticosterone concentration was significantly greater in the stress group than in the control group. The spermatid count and seminiferous epithelial height and diameter of honey-treated groups were significantly higher than the stress-only group (p < 0.05). The corticosterone concentration of honey-treated groups was significantly higher compared to the stress-only group. Meanwhile, the testosterone concentration of honey-treated groups was higher than the stress-only group although the results were insignificant. Conclusion: Tualang honey has the potential to ameliorate corticosterone concentration and induce morphological alterations by increasing spermatid counts and seminiferous epithelial thickness and diameter in rat testes exposed to prolonged stress.

Paragangliomas are rare neuroendocrine tumors that are usually benign in nature. They may be either familial or sporadic in their occurrence. Numerous neuroendocrine tumors are collectively included under the umbrella of paragangliomas. Among them, carotid body tumors and glomus jugulare tumors are extremely rare. Thus, we present a rare case of 29-year-old male who was admitted with hearing difficulties and tinnitus in the left ear, with swelling on the left side of the neck. Based on clinical and radiological findings, a diagnosis of left-sided glomus jugulare with carotid body tumor was made. The patient underwent a twostage surgery with an interval of approximately 2 months. Histopathology revealed a paraganglioma. Herein, we present the clinical features, imaging findings, management, and a brief review of literature on the classification, evaluation, and management of carotid body and glomus jugulare tumors. Paraganglioma is a slow-growing tumor. The synchronous occurrence of carotid body and glomus jugulare tumors is infrequent. Microsurgical resection remains the primary treatment modality. Therefore, our patient underwent two-stage surgery. The rarity of occurrence and the proximity and adherence to vital neurovascular structures have resulted in the treatment of paragangliomas remaining a challenge.

Medication review is an intervention with the potential to reduce drug-related problems (DRPs) in the elderly. This study aimed to determine the effect of pharmacists’ medication reviews on geriatric patients. This study accessed two online databases, MEDLINE Complete and Scopus, and examined all studies published in English between 2019 and 2023, except for reviews. The studies included (1) participants over 65 years of age and (2) medication reviews conducted by pharmacists. The titles, abstracts, and full texts were reviewed for data extraction to determine whether the studies satisfied the inclusion and exclusion criteria. Forty-four of the initial 709 articles were included in this study. The articles included discussions on the incidence rates of DRPs and potentially inappropriate medications (PIMs) (n=21), hospitalization (n=14), medication adherence (n=9), quality of life (QoL) (n=8), and falls (n=7). Pharmacist medication reviews were associated with a reduced incidence of DRPs and PIMs, and improved adherence to medications. Patients’ overall QoL is also increasing. However, pharmacist medication reviews were not strongly associated with decreased hospitalization or falls. A pharmacist’s medication review may be a feasible intervention for reducing the incidence rates of DRPs and PIMs, regardless of whether it is performed as a sole intervention or supplemented with other interventions. The intervention was also effective in increasing medication adherence and QoL.

Introduction: Hepatic diseases patients are especially prone to malnutrition, which is often underestimated. Screening tools were developed to detect the risk of malnutrition. However, screening tools for patients with liver disease were frequently underestimated. Fluid overload is the main issue to perform nutritional screening in liver disease patients. Therefore, this study aimed to validate the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) among patients and to evaluate association between RFH-NPT, Nutritional Risk Screening (NRS 2002) and Subjective Global Assessment (SGA). Methods: This cross sectional study was conducted in 3 phases; transcultural adaptation, criterion validity and reliability phases. Content validity was confirmed by interviewing eight liver disease professionals. Face validity was assessed by surveying forty nurses working in the liver disease ward. In addition, agreement between NRS 2002 and RFH-NPT assessment was assessed using the SGA tool. Results: Eighty patients with liver disease took part in this study. The SGA assessment found malnutrition in 75% of patients (95% CI, 60%–95%) while 80% (95% CI, 65%-80) were found as at risk of malnutrition using RFH- NPT. Moderate specificity and high sensitivity of RFHNPT were 97% and 74%, respectively, and 95% positive predictive value was measured. Conclusion: The RFH-NPT nutritional screening tool is the initial and most reliable in this population to assess the malnutrition risk. Thus, inclusion of the RFH-NPT with NRS 2002 demonstrated positive and a fair agreement between the SGA and RFH-NPT tool to be used as a routine nutrition screening protocol for identifying patients at risk of malnutrition.

Introduction: During the COVID-19 pandemic, healthcare providers have been in great fear due to the high risk of contracting COVID-19 infection at any time. This study aimed to determine the mediating role of resilience on the relationship between fear of COVID-19 and burnout in primary care healthcare providers in Malaysia. Methods: This was an online cross-sectional study involving 1280 healthcare providers aged 18 years and older from 30 government primary care clinics in Malaysia. We used the COVID-19 Fear Scale, the Copenhagen Burnout Inventory Scale, and the Short Brief Resilience Scale to collect data from the respondents. Smart-PLS was used to perform mediation analysis. Results: The mean age of the respondents was 36 years old and mean duration of working experience was 11 years. The majority of the respondents were female (82.4%) and Malays (82.3%). The study population consisted of nurses (47.4%), doctors (26%), medical assistants (11.9), healthcare assistant (7.1%), medical laboratory technicians (6.4%) and drivers(1.3).The results show that fear of COVID-19 positively predicts burnout. According to the results, resilience mediates the relationship between fear of COVID-19 and all the three burnout domains, namely personal burnout (β=0.175,p<0.001), work-related burnout (β=0.175,p<0.001) and client-related burnout (β=0.172,p<0.001). Additionally, resilience reduces the impact of COVID-19 fear on the three domains of burnout. Conclusion: Our study has reported a mediating effect of resilience on the relationship between fear of COVID-19 and burnout.