Aims: The aquaculture industry has been identified as one of the sources for the emergence of antimicrobial resistant bacteria. This study aimed to determine the level of bacterial contamination from selected catfish pond farming at Jasin, Melaka and its susceptibility to antimicrobial agents. The correlation between the sampling points’ Water Quality Index and the level of bacterial contamination was also determined. Methodology and results : Sampling was carried out at six sampling points of the river as well as selected catfish pond farming. Microbial counts were assessed using the membrane filtration and isolates were further identified by using the polymerase chain reaction (PCR) method. Antimicrobial susceptibility tests were carried out using the disk diffusion method. Results showed that the total bacterial count obtained was not significantly different (P>0.05) between sampling points with an average of 4.47 ± 0.41 log CFU/mL. A total of 27 different bacterial species were identified where 63% were identified as Gram-negative bacteria. A medium negative correlation (r=-6.16, P<0.01) was found between the sampling points’ Water Quality Index and the level of bacterial contamination. Among bacterial species identified, 18 species are pathogenic strains. Conclusion, significance and impact of study Antibiotic susceptibility test indicated that only 4 isolates showed resistance to antimicrobials tested and the study shows the potential cross contamination between fishponds and Kesang River, Melaka. Thus, public health concerns are tangible, and prevention of the cross contamination is crucial for the farm.

Introduction: Daily use and improper management of plastic materials by the public contributes to the occurrence of microplastic pollution. It can be acknowledged that knowledge and attitudes are one of the keys to reducing the release of microplastic into the environment. Therefore, enhancing student’s understanding may play an important role in effective solution innovation and readiness to take specific actions for environmental protection. Method: This cross-sectional study was conducted among university students using an online questionnaire to assess their knowledge and attitudes about microplastic pollution. For data analysis, Pearson’s Chi-square was conducted using SPSS version 26. Results: Findings revealed that students have moderate knowledge (4.66) and attitudes (5.42) towards microplastic pollution. However, neither age, gender, CGPA, nor the course in which they studied had any significant association with their level of knowledge and attitudes (p>0.05). In fact, the level of knowledge and attitude reported by respondents indicate that it is necessary to address this deficiency by providing education through structured education and mass media, along with vigorous policy enforcement and replacement of conventional plastics. Conclusion: Education on microplastics among the younger generation is key to curbing the problem of microplastic pollution. As future consumers, the demand for alternative products that does not contribute to microplastic can help encourage brands and markets to come up with better solution that is critical to prevent this problem from worsening.

Introduction: C-reactive protein (CRP), urea, albumin, CRP/albumin ratio (CAR) and urea/albumin ratio (UAR) could be valuable biomarkers for determining the severity of illness in patients with COVID-19. This study aimed to determine the association between these markers and disease severity in COVID-19 patients on admission and days five to seven after admission. Methods: This retrospective study includes 153 adult COVID-19 patients admitted to Hospital Raja Perempuan Zainab II and Hospital Ampang from January 2021 to December 2021. Patients’ serum CRP, urea, albumin and creatinine levels were recorded on admission and on days five to seven after admission. The patients were categorised based on the Annex 2e guidelines published by the Ministry of Health, Malaysia and further classified as mild to moderate disease (stages 1-3) and severe to critical illness (stages 4-5). Results: On admission, urea, creatinine, CRP, UAR and CAR were significantly higher in the severe to critical group (p<0.001). The optimal cut-off value for the UAR was 0.16; the area under the curve (AUC) was 0.760, and sensitivity and specificity were 63.6% and 85.7%, respectively. The AUC of the CAR was 0.752, with 54.2% sensitivity and 91.4% specificity at an optimal cut-off value of 1.63. In severe to critical COVID-19 patients, albumin levels decreased significantly on days five to seven after admission, while urea levels remained significantly higher in this group (p<0.001, p<0.05, respectively). Conclusion: CRP, urea, albumin, CAR and UAR are promising biomarkers for predicting the severity of disease in COVID-19 patients.

Introduction: Rotator cuff pathology is commonly attributed to acromion morphology that is demonstrable in standard AP shoulder radiographs by measuring the critical shoulder angle (CSA), the lateral acromial angle (LAA), and the acromial index (AI). However, these parameters vary among races and countries. Therefore, our study aimed to get the local data on acromion morphology in patients with rotator cuff disease. Materials and methods: MRI shoulder reports between January 2012 and June 2018 were reviewed. The study group consisted of 47 patients with rotator cuff injury with a partial or complete tear, and a control group of 37 patients with tendinitis or osteoarthritis and intact rotator cuffs. The CSA, LAA, and AI of both groups were measured on the anteroposterior shoulder radiograph. The risk factors for both groups and the acromion morphology were recorded. Results: The CSA for the rotator cuff tear and the control group was 39.08° and 38.28°, LAA was 72.57 ° and 73.51°, and AI was 0.79 and 0.75. The acromion morphology differed in terms of gender, and only LAA was different among the different ethnic groups. There was a negative correlation between age and CSA, age and AI, LAA and CSA, LAA and AI, but a positive correlation between AI and CSA. Conclusion: The CSA for rotator cuff tear patients in our population was 39.08°, LAA was 72.57°, and AI was 0.79. The acromion morphology was significantly influenced by age and gender.

Introduction: Laboratory tests account for 66% of clinical decision making and reducing inappropriate test utilisation is a step towards optimising patients’ care and hospital cost savings. This study aims to identify the rate and cost of redundant test requests in our centre. Methods: A cross-sectional study comprising laboratory results of 14 analytes in renal function test (RFT) and liver function test (LFT) were made. Data involved blood results from adult patients admitted to Hospital Universiti Sains Malaysia from January to December 2018. The redundant test is defined as test results consecutively normal twice and requested within 26 hours for analytes in RFT and 50 hours for analytes in LFT. Cost contributions were estimated by multiplying cost-per-test with total redundant requests. The test redundancy in different wards and disease groups were also evaluated. Results: Equal distribution of RFT and LFT requests were observed in both genders (50% respectively), with the most requests seen in the 60 – 79 years age group. More than 20% redundancy rate was observed for seven analytes (ALT, total bilirubin, sodium, urea, potassium, AST, Chloride), and overall redundancy was 19.7%, equals to Malaysian Ringgit (MYR) 669,105.00. Oncology wards and genitourinary diseases contribute to the highest redundancy rate. Conclusion: This study estimated MYR 600 thousands of saving if test redundancy were to be eliminated. The finding is hoped to serve as a platform for future intervention and policymaking. Future planning to optimise the current laboratory request system and collaboration among physicians and laboratory professionals can minimise test inappropriateness.

Acute suppurative thyroiditis is a rare and potentially fatal condition. We present a case of an 18-year-old Malay female who presented with one-week history of painful right sided neck swelling, fever and odynophagia. Neck CT confirms ruptured multiloculated abscess with posterosuperior extension into prevertebral space. Pus and tissue cultured Streptococcus anginosus and Eikenella corrodens with positive TB PCR. She responded well to ampicillin/sulbactam and anti-tuberculosis treatment with no evidence of residual collection from ultrasound.
Thyroiditis, Suppurative

Eye socket contracture is a well-known late complication of enucleation surgery, and the additional insult of radiotherapy at an early age causes even further fibrosis and scarring of the socket. Management of the contracted socket is challenging, and several methods have been proposed. We report a case of eye socket contracture after enucleation and radiotherapy in which multiple reconstructive procedures failed. The recurrent contracture caused difficulty in housing and retaining the eye prosthesis. We reconstructed the lower eyelid with a facial artery myomucosal flap and nasolabial flap, and the upper eyelid with a Fricke flap following reconstruction of the orbital rims (supraorbital and infraorbital rims with a calvarial bone graft, and further augmentation of the infraorbital rim with a rib bone graft). Cosmesis post-reconstruction was acceptable and the prosthesis was retained very well.

Safety culture refers to how safety is addressed and communicated in the workplace. It encompasses the attitudes, beliefs, perceptions, and values of all employees in an organization about safety. A good safety culture can be promoted by management through a commitment to safety, realistic practices for handling hazards, continuous organizational learning and concern for hazards shared across the workforce. The objective of this paper is to reviews the safety culture in handling radioactive sources. The radioactive substances used should comply with the following characteristics where radiotoxicity must be as low as possible, short-living isotopes are preferred to long-living ones and the amounts used must be kept to a minimum. Therefore, the As Low As Reasonably Achievable (ALARA) principle was applied that based on the minimization of radiation doses and limiting the release of radioactive materials into the environment by employing all reasonable methods. Besides that, the ALARA principle is an integral part of all activities that involve the use of radiation or radioactive materials and can help prevent unnecessary exposure as well as overexposure. The three major ALARA principles to assist with maintaining doses are time, distance and shielding. It takes a whole team effort to successfully implement the ALARA in safety culture while doing routine elements of working in handling radioactive materials.

Objective: To determine the etiologies of tropical acute febrile illness (TAFI) in West Pahang, Malaysia and to investigate morbidity and mortality factors in relation to TAFI. Methods: A multicenter prospective cohort study was conducted between January and June 2016 in six district hospitals throughout the western part of Pahang State in Peninsular Malaysia. A total of 336 patients answered a standardized questionnaire and blood samples were collected for laboratory confirmation of infectious etiology. Descriptive analysis and logistic regression were performed to identify factors associated with TAFI. Results: A total of 336 patients were included. The patients were mainly Malays (70.2%), males (61.3%), aged (44.6±17.4) years, with more than half (58.9%) presenting with gastrointestinal symptoms. The majority were diagnosed with dengue (35.7%) while malaria (4.5%) was the least frequent. The in-hospital mortality due to TAFI was 9.2%. Patients with meliodosis had five times higher mortality [Adjusted OR: 5.002, 95% CI: (1.233, 20.286)]. Patients with comorbidities such as cardiovascular symptoms (P <0.001) and renal replacement therapy initiation (P <0.001) were significantly associated with in-hospital mortality in all TAFI. Conclusions: The etiology of TAFI in the western Pahang includes dengue, leptospirosis, malaria and melioidosis, which carry the highest risk of in-hospital mortality. The presence of cardiovascular symptoms may be used to assess the disease severity in TAFI, but more studies are needed in the future.

Introduction: To correlate the score obtained using a bilingual (Malay and English) 14 points questionnaire in the detection of hearing loss at the University of Malaya, Medical Centre (UMMC), Kuala Lumpur, Malaysia over a 9 month period. Methods: This is a prospective instrument correlation study done on 93 children aged 1-4 years of age with speech and language delay for at least 3 months. Hearing status was confirmed using otoacoustic emissions, pure tone audiometry and brainstem evoked response (BSER). Hearing status was then compared to the 14-point questionnaire final scores and is statistically correlated. Results: There were 26 patients, 15 males (58%) and 11(42%) females who were diagnosed to have hearing loss. The average age of presentation was 2.49 and conductive hearing loss accounted for about 74% of cases of hearing loss. The mean questionnaire score obtained through our patients was 3.83±1.987. Discriminant analysis suggests that a questionnaire score of above 4 was indicative that the child was suffering from hearing loss. Conclusion: Our study suggests that the low-cost bilingual (Malay and English) questionnaire can be used to detect hearing loss in the Malaysian population and could potentially be useful in rural health centres to help detect hearing loss and to determine the urgency of referral to a tertiary health centre.