The knowledge and beliefs on the presence of fluoride in drinking water, its purpose and the associated health risks aids in equate water fluoridation and effective prevention programs. Water fluoridation is a safe, effective, and necessary method where adequate doses of fluoride is added into drinking water supplies with the target of assisting in tooth restoration and preventing tooth decay and dental caries. Therefore, this study identifies the level of knowledge and perception of fluoride in drinking water among residents living in Precinct 9, Putrajaya Methods: A cross-sectional, self-administered online questionnaire was used to examine knowledge and perception of fluoride in drinking water of 240 Precinct 9 residents. Descriptive analysis was applied for socio-demographic data and Chi-square was used to compare discrete data. All data obtained were further analyzed using SPSS Version 23.0. Results: The highest frequency (percentage) of residents were 213 (88.8%), aged 18-64 years old, 141 (58.8%) female, 214 (89.2%) with tertiary education background and 125 (51.1%) of them lived in Precinct 9 for more than 10 years. Of all participants, 137 (57.1%) and 83 (34.6%) have poor knowledge and medium perception regarding fluoride in drinking water respectively. There was a significant association between those with higher education level with knowledge (p=0.02) and perception (p=0.005) where they were more likely to know about overall fluoride in drinking water. Conclusion: Most participants had limited knowledge and negative perception of fluoride beyond a general sense it was beneficial. It appears that in moving forward to receive the water fluoridation support will need to attend to the challenge of anti-fluoride sentiment influence.

Introduction: Elevated body fat percentage among elderly has resulted in a significant number of morbidity and mortality. Thus, this study aimed to determine the body fat percentage and its associated factors among hospitalized elderly in Klang Valley hospitals. Methods: A total of 57 subjects aged ≥ 60 years were recruited from the geriatric wards of three Klang Valley hospitals (Hospital Sungai Buloh, Hospital Tengku Ampuan Rahimah and Hospital Kuala Lumpur) using purposive and convenience sampling. A face-to-face interview and physical examination were conducted to obtain the data on socio-demographic characteristics, medical background, anthropometric measurements, total cholesterol levels, hand-grip strength, perception towards oral health, dietary assessment and malnutrition risk. The body fat percentage was assessed using a handheld bio-electrical impedance OMRON HBF-302 and compared with Gallagher’s classification of body fat percentage. A simple descriptive statistic and correlation analysis were used to analyze the body fat percentage and its associated factors. Results: Majority of hospitalized elderly (49%) had elevated body fat percentages. Weight (p≤0.0005), BMI (p≤0.0005), and malnutrition risk (p≤0.0005) were significantly associated with the body fat percentage. Meanwhile, other variables were not significantly associated with body fat percentage in hospitalized elderly. Conclusion: Weight, BMI, and malnutrition risk were found to be significantly associated with the body fat percentage. Other variables were not significantly associated. Thus, a better understanding of factors associated with body fat percentage is necessary in managing elevated body fat percentage to reduce the risk of morbidity and mortality among hospitalized elderly.

Introduction: Indonesia is one of the countries whose inhabitants use well water for drinking and cooking purposes. In East Java, 48.90% of the population uses well water for their daily needs. Well water contained heavy metals had bad effects on health such as cancer, damage of liver, kidneys, and others. The objective of this study was to evaluate the concentration of heavy metals in well water and relate them to a potential health outcomes. Methods: The method used in this study was analytical descriptive. Data used was secondary from East Java Environmental Office. A total of 101 samples were collected from 33 locations. There were 5 heavy metals analyzed, namely cadmium, chromium, lead, manganese, and zinc. Equipment using ICPMS and AAS. Data analyzed with descriptive statistics by SPSS. Data obtained were compared to the WHO Standard for Drinking Water Quality. Results: Concentration for cadmium was 0.002 mg/l, followed by manganese at 1.80 mg/l and zinc at 0.020 mg/l. Besides, all water samples had levels of chromium and lead below the detection limit. Conclusion: All heavy metals had concentrations below the maximum allowable standard, except for five water samples from three locations with levels of manganese which was above the maximum standard. Long term effects of manganese include neurological problems, intelligence, and low birth weight. Further studies need to be done to determine the source of manganese contamination. It is recommended that bottled water is used for drinking purposes in an area where heavy metal concentration is above the allowable limit.

Introduction: Cardiovascular disease (CVD) remains the leading cause of death in Malaysia. Identification of asymptomatic at-risk individuals is often achieved by means of a risk prediction algorithm. Traditional CVD risk factors and their associated algorithms are, however, limited by residual CVD risk. High sensitivity C-reactive protein (hsCRP) has emerged as a novel CVD risk factor. This study aimed to evaluate hsCRP as an adjunct CVD risk marker among the adult Malaysian population by determining its correlation with the Framingham Risk Score (FRS). Comparison analyses were done according to sociodemographic, clinical and laboratory factors and between subjects with and without Metabolic Syndrome (MetS). Method: This cross-sectional study involved eighty-three (n=83) adults attending a health screening program at Universiti Putra Malaysia (UPM). Demographic data, anthropometric measurements and blood samples for fasting blood glucose (FBG), fasting lipid profile (FSL), glycated haemoglobin (HbA1c) and hsCRP were taken. Respondents were grouped according toFRSand the Joint Interim Statementinto 10-year CVD risk categories (low, intermediate and high) and MetS, respectively. Results: hsCRP was significantly increased in patients with high body mass index (BMI) (p=0.001), at-risk waist circumference (WC) (p=0.001) and MetS (p=0.009). Spearman’s correlation coefficient showed a significant positive correlation between hsCRP level and total FRS score (r=0.26, p<0.05) and HDL-C score (r=0.22, p<0.05). Conclusion: The significant difference of hsCRP levels across obesity levels and MetS with its modest correlation with FRS scores supported the adjunctive role of hsCRP in CVD risk prediction, most likely capturing the inflammatory pathological aspect and thus partly accounting for the residual CVD risk.

Background: The World Health Organization guidelines did not make a recommendation on use of remdesivir based on disease severity. Little is known regarding effectiveness of remdesivir in critically ill coronavirus disease 2019 (COVID-19) patients. This has led to a state of dilemma for doctors leaving them skeptical of whether they should continue to recommend the drug or not. Materials and Methods: A systematic search adhering to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was conducted from inception until February 20, 2020. Electronic bibliographic databases (PubMed, Cochrane database, Scopus, Embase) were included. Using dichotomous data for select values, the unadjusted odds ratios (ORs) were calculated applying Mantel Haenszel (M-H) using random-effects model. The primary outcome of interest was all-cause mortality in ventilated and nonventilated patients. Results: The Remdesivir arm was associated with similar rates of 28-day all-cause mortality (OR: 0.93, 95% confidence interval [CI]: 0.80 - 1.08; P = 0.33). Remdesivir was not found to be favorable for ventilated patients. Non ventilated COVID-19 patients showed a significant lower in-hospital mortality rate as compared with patients requiring mechanical ventilatory support (OR: 6.86, 95% CI: 5.39 - 268.74;P<0.0001). Conclusion Non-ventilated patients were associated with significant lower all-cause mortality rates. Prudent use of remdesivir is recommended in critically ill COVID-19 patients.

Background: The World Health Organization guidelines did not make a recommendation on use of remdesivir based on disease severity. Little is known regarding effectiveness of remdesivir in critically ill coronavirus disease 2019 (COVID-19) patients. This has led to a state of dilemma for doctors leaving them skeptical of whether they should continue to recommend the drug or not. Materials and Methods: A systematic search adhering to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was conducted from inception until February 20, 2020. Electronic bibliographic databases (PubMed, Cochrane database, Scopus, Embase) were included. Using dichotomous data for select values, the unadjusted odds ratios (ORs) were calculated applying Mantel Haenszel (M-H) using random-effects model. The primary outcome of interest was all-cause mortality in ventilated and nonventilated patients. Results: The Remdesivir arm was associated with similar rates of 28-day all-cause mortality (OR: 0.93, 95% confidence interval [CI]: 0.80 - 1.08; P = 0.33). Remdesivir was not found to be favorable for ventilated patients. Non ventilated COVID-19 patients showed a significant lower in-hospital mortality rate as compared with patients requiring mechanical ventilatory support (OR: 6.86, 95% CI: 5.39 - 268.74;P<0.0001). Conclusion Non-ventilated patients were associated with significant lower all-cause mortality rates. Prudent use of remdesivir is recommended in critically ill COVID-19 patients.

Introduction: Consistent condom use can reduce the rate of transmission of STD/HIV. Condom self-efficacy is an important determinant of consistent condom use. The Condom Use Self-Efficacy Scale (CUSES) assesses the individual's confidence and expectations to obtain, use, dispose and negotiate use of condom with their sexual partners. This study aimed to adapt, translate and determine the validity and reliability of CUSES Malay version among STD/ HIV patients in a primary care clinic. Methods: This was a cross sectional validation study conducted among STD/ HIV patients in a primary care clinic. The CUSES Malay version underwent content validation (calculation of I-CVI), forward and backward translation, face validation and field testing for psychometric analysis. Psychometric analysis used included Principal Axis Factoring with direct oblimin rotation, internal consistency reliability (Cronbach's α) and test-retest reliability analyses (Intraclass Correlation (ICC)). Results: A total of 168 participants were enrolled into this study (99% response rate). In content validation, all items were retained as the I-CVI were >1.00. Feedback from face validation resulted in simpler phrases of some items. One item (B2) was removed due to poor factor loading of <0.3. This resulted in 27 items framed within four factors. These factors were identified as Mechanics, Perceived Barriers, Assertiveness and Intoxicants. Reliability analysis achieved an overall Cronbach's α of 0.878 and ICC >0.4. Conclusion: The CUSES-M is a valid, reliable and stable tool to measure condom use self-efficacy among STD/HIV patients in primary care.

Pressure Ulcers (PUs) are a significant health problem for hospitalized patients associated with the leading cause of morbidity and mortality. Each year, more than 2.5 million patients suffer from PUs, and about 60,000 people died due to complications of PUs globally. Although PUs brings devastating consequences, fortunately, it can be prevented. The prevention of PUs represents a marker of quality of care and safety of a health-care organization. PUs prevention indeed needs multidisciplinary collaboration management; however, nurses' role is more significant as they are the frontline in providing patient care. This study aimed to assess knowledge, practice, and perceived barriers of PUs prevention among nurses in a Public Hospital in Selangor. A descriptive and cross-sectional study was used to obtain the data. A purposive sample of 220 nurses had been recruited from ICU, CCU, medical, surgical, and orthopedic wards at Public Hospital in Selangor. Data were obtained from self-administered questionnaires. The result was analyzed using the IBM Statistical Packages for Social Science (SPSS) Window Version 23. This study revealed that the respondents had adequate knowledge (95.0%) and good practice (96.8%) of PUs prevention. Heavy workload and inadequate staff were mostly cited as the barrier of PUs prevention. In overall, the respondents' knowledge and practice were good; however, deficits in a particular area of knowledge and practice of PUs prevention still exist. The hospital and nursing department should organize continuous education programs and in-house training in related field to optimized nurses’ knowledge and practice regarding pressure ulcer prevention and management.

Clival chordoma is a rare malignant tumor of the brain that typically occurs in older adults. It has a high local recurrence rate and is hence associated with poor prognosis. Here, we report a case of an adolescent who presented with a 1-month history of worsening headache and blurring of vision, as well as a 6-month history of left-sided facial and body numbness. Clinical findings were consistent with left upper motor neuron lesion of the seventh cranial nerve with involvement of the fifth cranial nerve. He was also found to have a sixth cranial nerve palsy demonstrated by diplopia upon lateral gaze with no evidence of papilledema. Magnetic resonance imaging of the brain suggested clival chordoma. He was subsequently referred to the neurosurgical team, and he successfully underwent an endoscopic trans-sphenoidal surgery to excise the lesion. He recovered well, continued his follow-ups with the neurosurgical team, and showed good progress. He also attended regular follow-ups with his primary care physician to ensure ongoing psychosocial support and monitoring of his overall health status. This case demonstrates the importance of prompt identification and treatment of clival chordoma in an adolescent. Long-term follow-ups and shared care between primary and secondary care physicians are essential to monitor recurrence of tumor and to provide psychosocial support.

Objective: To standardize the technique; evaluate resources requirements and analyze our early experience of total marrow and lymphoid irradiation (TMLI) as part of the conditioning regimen before allogenic bone marrow transplantation using helical tomotherapy. Methods: Computed tomography (CT) scanning and treatment were performed in head first supine (HFS) and feet first supine (FFS) orientations with an overlap at mid-thigh. Patients along with the immobilization device were manually rotated by 180° to change the orientation after the delivery of HFS plan. The dose at the junction was contributed by a complementary dose gradient from each of the plans. Plan was to deliver 95% of 12 Gy to 98% of clinical target volume with dose heterogeneity <10% and pre-specified organs-at-risk dose constraints. Megavoltage-CT was used for position verification before each fraction. Patient specific quality assurance and in vivo film dosimetry to verify junction dose were performed in all patients. Results: Treatment was delivered in two daily fractions of 2 Gy each for 3 days with at least 8-hour gap between each fraction. The target coverage goals were met in all the patients. The average person-hours per patient were 16.5, 21.5, and 25.75 for radiation oncologist, radiation therapist, and medical physicist, respectively. Average in-room time per patient was 9.25 hours with an average beam-on time of 3.32 hours for all the 6 fractions. Conclusion This report comprehensively describes technique and resource requirements for TMLI and would serve as a practical guide for departments keen to start this service. Despite being time and labor intensive, it can be implemented safely and robustly.