Background: s/Aims: The implementation of enhanced recovery after surgery (ERAS) protocols has demonstrated significant advantages for patients by mitigating surgical stress and expediting recovery across a spectrum of surgical procedures worldwide. This investigation seeks to assess the effectiveness of the ERAS protocol specifically in the context of major liver resections within our geographical region. Methods: Our department conducted retrospective analysis of prospectively collected data, gathered from consenting individuals who underwent liver resections from January 2018 to December 2023. The assessment encompassed baseline characteristics, preoperative indications, surgical outcomes, and postoperative complications among patients undergoing liver surgery. Results: Among the included 184 patients (73 standard care, 111 ERAS program), the baseline characteristics were similar. Median postoperative hospital stay differed significantly: 5 days (range: 3–13 days) in ERAS, and 11 days (range: 6–22 days) in standard care (p < 0.001). Prophylactic abdominal drainage was less in ERAS (54.9%) than in standard care (86.3%, p < 0.001). Notably, in ERAS, 88.2% initiated enteral feeding orally on postoperative day 1, significantly higher than in standard care (47.9%, p < 0.001). Early postoperative mobilization was more common in ERAS (84.6%) than in standard care (36.9%, p < 0.001). Overall complication rates were 21.9% in standard care, and 8.1% in ERAS (p = 0.004). Conclusions Our investigation highlights the merits of ERAS protocol; adherence to its diverse components results in significant reduction in hospital length of stay, and reduced occurrence of postoperative complications, improving short-term recovery post liver resection

Introduction: Coconut sap is a sweet, fragrant liquid obtained from the inflorescence of coconut tree. In this study, a literature search was conducted using the Scopus database to study the trends of coconut sap research. Methods: Data extracted from the Scopus database were analysed and visualised using VOSviewer to determine top authors, papers, countries, collaborations, and research areas. A total of 76 publications up to year 2021 were identified and refined using keywords of “coconut sap”, “coconut sugar”, “coconut inflorescence”, “coconut inflorescence sap”, “coconut neera”, and “Cocos nucifera”. Results: Based on the analysis, research on coconut sap started in 1984, with a total of 53 authors, nine countries, and 12 sources that had published more than two documents. The analysis of countries and sources revealed that India and IOP Conference Series: Earth and Environmental Science (EES) were the most prolific country and sources, respectively. The most influential document was on the chemical compositions and bacteriology of coconut sap. The results also showed that research on coconut sap was in the field of food processing during the early years, followed by fermentation, agriculture, and bacteriology of coconut sap. Research on coconut sap’s bacteriology started in 1986 and became a major interest, especially among high impact journals. Conclusion: Overall, coconut sap is a potential target for the development of nutraceutical products, especially in the food and beverage industry.

Background: and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

The purpose of this study was to identify the relationship between sleepiness and daily sleep amount, and its significant associated factors among shift workers of the electronics manufacturing industry in Malaysia. 300 shift workers were asked to respond to a survey on demographic information, sleepiness and daily sleep. Sleepiness was surveyed by using the Karolinska Sleepiness Scale and daily sleep was captured by using sleep diary. A total of 255 employees provided valid data for analysis. To test the hypothesis, statistical analysis was conducted using IBM SPSS program version 24. Sleepiness among shift workers found to be increased by the end of the shift. Around 30% of workers did not have an adequate amount of daily sleep. Sleepiness was found to have significant associations with age, marital status, level of education, time of shift, and working experience. Meanwhile, the amount of daily sleep obtained was only significantly associated with the age of the respondents. There is no significant relationship found between sleepiness and daily sleep of the shift workers. Shift workers in the electronics manufacturing industry in Malaysia were exposed to sleepiness at work and reduction in their daily sleep. This will increase the risk of an accident in the workplace. Appropriate intervention program should be implemented to curb this problem.

Introduction: The Patient Activation Measure (PAM) is one of the most extensively used, widely translated, and tested instruments worldwide in measuring patient activation levels in self-management. This study aimed to determine the validity and reliability of the PAM-13 Malay version among patients with Metabolic Syndrome (MetS) attending a primary care clinic.Methods: This work is a cross-sectional validation study among patients with MetS attending a university primary care clinic in Selangor. The PAM-13 Malay version underwent a validation process and field testing. Psychometric properties were examined using principal component analysis (PCA) with varimax rotation, scree plot, Monte Carlo simulation, internal consistency, and test-retest reliability analyses. Results: The content of the PAM-13 Malay version and the original version were conceptually equivalent. The questionnaire was refined after face validation by 10 patients with MetS. The refined version was then field-tested among 130 participants (response rate 89.7%). The Kaiser–Meyer– Olkin test was 0.767, and Bartlett’s test of sphericity was ≤0.001, indicating sampling adequacy. Two factors were identified and labeled as (1) Passive and Building Knowledge, and (2) Taking Action and Maintaining Behavior. These labels were chosen as they were conceptually consistent with the items representing the levels of activation in PAM-13. The validated PAM-13 Malay version consisted of 13 items, framed into two domains. The overall Cronbach’s α was 0.79, and the intraclass correlation coefficient was 0.45. Conclusions: The PAM-13 Malay version is valid, reliable, and fairly stable over time. This questionnaire can be used to evaluate the levels of activation among patients with MetS in primary care in Malaysia.

Introduction: A foreign body (FB) in the upper aerodigestive tract is a fairly common encounter.Fish bones are the commonest FB seen in adults. The commonest presentation is odynophagia.Usually, the patient will point at the level of FB on the neck to indicate the location.Methods: Clinical report.Results: This case report describes a large FB in an adult with underlying infantile cerebral palsy.Besides dysphagia, it was associated with drooling of saliva and pain in the throat region.Conclusion: FB ingestion with complete obstruction of the oesophagus is an emergency. It maycause total dysphagia as the passage of food is completely blocked.

Foreign body aspiration is commonly described in infants and children. However, recently, a newhigh-risk group was identified among young women, especially those from the Muslim populationwho wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between thelips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing thescarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present acase of scarf pin inhalation and the challenges encountered in managing this patient during thesuccessful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particularcase was technically challenging for us as the sharp tip of the needle was pointing upward andpiercing the bronchial mucosa.