MATERIALS/METHODS: Participants interested in a 12-week virtual training program completed a needs assessment survey via a data collection web application. The survey included demographics, practice characteristics, and interests in contouring and plan evaluation education and training. Herein we provide descriptive statistics of the reports from participant surveys.
RESULTS: Across Thailand, Myanmar, Malaysia, Indonesia, and Nepal, 116 participants (82 attendings, 33 residents, 1 other) responded from 23 participating medical institutions (20 public, 3 private). The average number of radiation oncologists per medical institution was 6.81 (range 1-30) and radiation oncology residents was 17.50 (range 2-56). In the 7 centers with residency programs, 0 (0%) indicated that residents were solely involved in contouring, 5 (71.4%) that residents were jointly involved in contouring with attendings, and 2 (28.6%) that attendings contour without residents. Commonly cited obstacles to providing radiotherapy included: patient financial barriers (61.4%), inadequate training (51.8%), too many patients (48.2%), lack of modern equipment (40.4%), shortage of staff (39.5%), and malfunctioning equipment (36.8%). The most common, top-rated obstacle was inadequate training (24.8%). The most seen disease sites were head and neck (38.2%) and breast (30.3%). Respondent time spent contouring the target was greatest for head and neck, pediatric, and lymphoma disease sites with 66 (56.9%), 59 (50.8%), and 46 (29.3%) indicating more than 1 hour, respectively. Respondent time spent contouring the normal tissues was greatest for head and neck, pediatric, and CNS disease sites with 51 (44%), 46 (39.7%), and 30 (26.1%) indicating more than 1 hour. For head and neck cases, 34 (29.3%) respondents typically contour 6-10 Organs at Risk (OARs), 47 (40.5%) contour 11-15 OARs, 18 (15.5%) contour 16-20 OARs, and 15 (12.9%) contour > 20 OARs. 85 (76.3%) respondents believe their practice would most benefit from head and neck contouring education, while 114 (98.3%) were interested in receiving contouring and plan evaluation training.
CONCLUSION: The biggest physician-reported obstacle to providing radiotherapy in Southeast Asian practices is inadequate training. There is both high need and interest for well-developed virtual training, particularly in head and neck contouring, which currently appears time-intensive and heterogeneous among practices.
RESULTS: The decline in breastfeeding in the Philippines in the mid-twentieth Century associated with intensive BMS marketing via health systems and consumer advertising. As regulations tightened, the industry more aggressively promoted CMFs for older infants and young children, thereby 'marketing around' the Milk Code. It established front groups to implement political strategies intended to weaken the country's breastfeeding policy framework while also fostering a favourable image. This included lobbying government officials and international organizations, emphasising its economic importance and threats to foreign investment and trade, direct litigation against the government, messaging that framed marketing in terms of women's choice and empowerment, and forging partnerships. A resurgence in breastfeeding from the mid-1980s onwards reflected strengthening political commitment for a national breastfeeding policy framework and Milk Code, resulting in-turn, from collective actions by breastfeeding coalitions, advocates and mothers.
CONCLUSION: The Philippines illustrates the continuing battle for worldwide Code implementation, and in particular, how the baby food industry uses and adapts its market and political practices to promote and sustain CMF markets. Our results demonstrate that this industry's political practices require much greater scrutiny. Furthermore, that mobilizing breastfeeding coalitions, advocacy groups and mothers is crucial to continually strengthen and protect national breastfeeding policy frameworks and Code implementation.
Methods: The designed anti-tuberculosis nanodelivery composite, MgLH-PAS, was prepared by a novel co-precipitation method using MgNO3 as well MgO as starting materials.
Results: The designed nano-formulation, PAS-MgLH, showed good antimycobacterial and antimicrobial activities with significant synergistic anti-inflammatory effects on the suppression of lipopolysaccharide (LPS) stimulated inflammatory mediators in RAW 264.7 macrophages. The designed nano-formulation was also found to be biocompatible with human normal lung cells (MRC-5) and 3T3 fibroblast cells. Furthermore, the in vitro release of PAS from PAS-MgLH was found to be sustained in human body simulated phosphate buffer saline (PBS) solutions of pH 7.4 and pH 4.8.
Discussion: The results of the present study are highly encouraging for further in vivo studies. This new nanodelivery system, MgLH, can be exploited in the delivery of other drugs and in numerous other biomedical applications as well.
Patients and Methods: This cross-sectional study used data collected during 2018-2020 from 1204 older adults aged 60 and older selected from Selangor state, Malaysia. A comprehensive face-to-face interview based on the Bahasa Malaysia version of the Japan Gerontological Evaluation Study (JAGES-BM) questionnaire was administered to gain information on unmet healthcare needs, socioeconomic factors, health-related factors, and measures of function (activities of daily living, depression, visual impairment, hearing impairment, memory impairment, and walking impairment). Multivariate logistic regression was used to analyze factors associated with their unmet healthcare needs.
Results: Overall, the percentage of older people respondents with unmet healthcare needs is 6.6%. The most reported reasons for forgoing or delaying healthcare were lack of knowledge about healthcare and financial barriers to care. The inability to travel alone (adjusted odds ratio [aOR] 2.51), being overweight (aOR 1.88), and having self-reported depression (aOR 2.23) were each associated with a higher likelihood of having unmet healthcare needs in their daily life.
Conclusion: The prevalence of unmet healthcare needs among older people in this part of Malaysia is lower than that reported in some other countries. However, it is possible to further reduce unmet healthcare needs by improving people's knowledge and attitudes about appropriate healthcare utilization, strengthening financial protection measures and providing support to people at high risk of having unmet healthcare needs.
Objectives: This study aims to determine the incidence of healthcare-associated infections in a military hospital in Alkharj and the adherence to the HAIs' prevention strategies.
Methods: This study included exporting data for all infected cases confirmed by the infection disease specialists in 2019. The data were collected from the reports that were written by infection control unit and infectious disease department.
Results: The rate of healthcare associated infections (HAIs) in 2019 was 0.43% of total patient admissions. The rate of central line associated bloodstream infections in 2019 was 1.15 per 1000 central line days. The rate of catheter associated urinary tract infections in 2019 was 1.00 per 1000 catheter days. The rate of ventilator associated pneumonia in 2019 was 2.11 per 1000 ventilator days and the rate of surgical site infections in 2019 was 0.41 %.
Conclusion: The rate of overall healthcare-associated infections (HAI) was low. The compliance rate of health care workers to preventive measures that control HAIs was generally high but there was a need for more awareness particularly regarding personal protective equipment and hand hygiene. So it is important to attend more awareness activities and workshops particularly regarding personal protective equipment and hand hygiene. Furthermore, infection control unit and infectious disease department in the hospital should support the robust HAI prevention programs.
Material and methods: One hundred and ten (110) women with unexplained RM were included in this study. Participants were subjected to diagnostic hysteroscopy for uterine cavity, and endometrium evaluation. The diagnosis of CE during hysteroscopic examination was based on CE-related hysteroscopic signs (micro-polyps, stromal edema, and/or hyperemia). At the end of hysteroscopy, an endometrial biopsy was taken from participants for culture, and immunohistochemical (IHC) staining. Collected data were analyzed to assess the relation between CE and RM and the accuracy of hysteroscopy in diagnosing CE.
Results: The prevalence of CE in women with RM was 31.8% using CE-related hysteroscopic signs, while it was 38.2% using IHC staining and endometrial cultures (p = 0.4). CE-related hysteroscopic signs had 64.1% sensitivity, 85.9% specificity, 71.4% positive predictive value (PPV), 81.3% negative predictive value (NPV), and 78.2% overall accuracy in diagnosing CE. Most cases of CE (> 81%) were caused by Mycoplasma and common pathogens.
Conclusions: The prevalence of CE in women with RM was 31.8% using CE-related hysteroscopic signs, while it was 38.2% using IHC staining and endometrial cultures. CE-related hysteroscopic signs had 64.1% sensitivity, 85.9% specificity, 71.4% PPV, 81.3% NPV, and 78.2% overall accuracy in diagnosing CE. Most cases of CE (> 81%) were caused by Mycoplasma and common pathogens.
Case presentation: An elderly man presented to us with progressive onset of bilateral lower limb weakness which was associated with thoracic radiculopathy and urinary incontinence. An urgent magnetic resonance imaging (MRI) of the spine showed severe cord compression with enlarged prostate and superior mediastinal mass. A computed tomography (CT) guided biopsy of the mediastinal mass was suggestive of prostatic malignancy. An emergency posterior instrumentation and fusion (PSIF) in prone position was successfully done. Histopathological examination of the spine showed malignant glandular tissues, suggestive of prostate.
Discussion: A huge mediastinal mass can compromise the cardiorespiratory system and is very challenging for the anaesthetist to safely secure the airway for surgical procedures. Androgen deprivation therapy (ADT) for patients with metastatic prostatic carcinoma can be achieved either by medical castration or with bilateral orchidectomy.
Conclusion: It is extremely uncommon for a prostatic carcinoma to metastasize to the mediastinum. Patients with a huge mediastinal mass possess risks of cardiorespiratory collapse perioperatively. Chemoradiotherapy and androgen deprivation therapy (ADT) can be utilized for metastatic prostatic carcinoma with good outcomes.
Context: The survey is nationally representative and community based and is conducted by the Institute for Public Health, part of the National Institutes of Health, to generate health-related evidence and to support the Malaysian Ministry of Health in policy-making. Its planned scope for 2020 was the seroprevalence of communicable diseases such as hepatitis B and C.
Action: Additional components were added to the survey to increase its usefulness, including COVID-19 seroprevalence and facial anthropometric studies to ensure respirator fit. The survey's scale was reduced, and data collection was changed from including only face-to-face interviews to mainly self-administered and telephone interviews. The transmission risk to participants was reduced by screening data collectors before the survey and fortnightly thereafter, using standard droplet and contact precautions, ensuring proper training and monitoring of data collectors, and implementing other administrative infection prevention measures.
Outcome: Data were collected from 7 August to 11 October 2020, with 5957 participants recruited. Only 4 out of 12 components of the survey were conducted via face-to-face interview. No COVID-19 cases were reported among data collectors and participants. All participants were given their hepatitis and COVID-19 laboratory test results; 73 participants with hepatitis B and 14 with hepatitis C who had been previously undiagnosed were referred for further case management.
Discussion: Preparing and conducting the National Health and Morbidity Survey during the COVID-19 pandemic required careful consideration of the risks and benefits, multiple infection prevention measures, strong leadership and strong stakeholder support to ensure there were no adverse events.
Methods: Malaysian COVID-19 data was extracted from 16 March 2020 up to 31 May 2021. We estimated the following epidemiological indicators: 7-day incidence rates, 7-day mortality rates, case fatality rates, test positive ratios, testing rates and the time-varying reproduction number (Rt).
Findings: Between 16 March 2020 and 31 May 2021, Malaysia has reported 571,901 cases and 2,796 deaths. Malaysia's average 7-day incidence rate was 26•6 reported infections per 100,000 population (95% CI: 17•8, 38•1). The average test positive ratio and testing rate were 4•3% (95% CI: 1•6, 10•2) and 0•8 tests per 1,000 population (95% CI: <0•1, 3•7), respectively. The case fatality rates (CFR) was 0•6% (95% CI: <0•1, 3•7). Among the 2,796 cases who died, 87•3% were ≥ 50 years.
Interpretation: The public health response was successful in the suppression of COVID-19 transmission or the first half of 2020. However, a state election and outbreaks in institutionalised populations have been the catalyst for more significant community propagation. This rising community transmission has continued in 2021, leading to increased incidence and strained healthcare systems. Calibrating NPI based on epidemiological indicators remain critical for us to live with the virus. (243 words).
Funding: This study is part of the COVID-19 Epidemiological Analysis and Strategies (CEASe) Project with funding from the Ministry of Science, Technology and Innovation (UM.0000245/HGA.GV).