Displaying publications 21 - 36 of 36 in total

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  1. Fulltext Enhanced memory in Wistar rats by virgin coconut oil is associated with increased antioxidative, cholinergic activities and reduced oxidative stress
    Rahim NS, Lim SM, Mani V, Abdul Majeed AB, Ramasamy K
    Pharm Biol, 2017 Dec;55(1):825-832.
    PMID: 28118770 DOI: 10.1080/13880209.2017.1280688
    CONTEXT: Virgin coconut oil (VCO) has been reported to possess antioxidative, anti-inflammatory and anti-stress properties.

    OBJECTIVE: Capitalizing on these therapeutic effects, this study investigated for the first time the potential of VCO on memory improvement in vivo.

    MATERIALS AND METHODS: Thirty male Wistar rats (7-8 weeks old) were randomly assigned to five groups (n = six per group). Treatment groups were administered with 1, 5 and 10 g/kg VCO for 31 days by oral gavages. The cognitive function of treated-rats were assessed using the Morris Water Maze Test. Brains were removed, homogenized and subjected to biochemical analyses of acetylcholine (ACh) and acetylcholinesterase (AChE), antioxidants [superoxide dismutase (SOD), catalase (CAT), glutathione (GSH), glutathione peroxidase (GPx) and glutathione reductase (GRx)], lipid peroxidase [malondialdehyde (MDA)] as well as nitric oxide (NO). α-Tocopherol (αT; 150 mg/kg) was also included for comparison purposes.

    RESULTS: VCO-fed Wistar rats exhibited significant (p  33%) and NO (≥ 34%). Overall, memory improvement by VCO was comparable to αT.

    DISCUSSION AND CONCLUSION: VCO has the potential to be used as a memory enhancer, the effect of which was mediated, at least in part, through enhanced cholinergic activity, increased antioxidants level and reduced oxidative stress.

  2. Fulltext Recombinant Production and Characterization of an Extracellular Subtilisin-Like Serine Protease from Acinetobacter baumannii of Fermented Food Origin
    Muhammed NS, Hussin N, Lim AS, Jonet MA, Mohamad SE, Jamaluddin H
    Protein J, 2021 06;40(3):419-435.
    PMID: 33870461 DOI: 10.1007/s10930-021-09986-5
    Acinetobacter baumannii is a ubiquitous bacteria that is increasingly becoming a formidable nosocomial pathogen. Due to its clinical relevance, studies on the bacteria's secretory molecules especially extracellular proteases are of interest primarily in relation to the enzyme's role in virulence. Besides, favorable properties that extracellular proteases possess may be exploited for commercial use thus there is a need to investigate extracellular proteases from Acinetobacter baumannii to gain insights into their catalytic properties. In this study, an extracellular subtilisin-like serine protease from Acinetobacter baumannii designated as SPSFQ that was isolated from fermented food was recombinantly expressed and characterized. The mature catalytically active form of SPSFQ shared a high percentage sequence identity of 99% to extracellular proteases from clinical isolates of Acinetobacter baumannii and Klebsiella pneumoniae as well as a moderately high percentage identity to other bacterial proteases with known keratinolytic and collagenolytic activity. The homology model of mature SPSFQ revealed its structure is composed of 10 β-strands, 8 α-helices, and connecting loops resembling a typical architecture of subtilisin-like α/β motif. SPSFQ is catalytically active at an optimum temperature of 40 °C and pH 9. Its activity is stimulated in the presence of Ca2+ and severely inhibited in the presence of PMSF. SPSFQ also displayed the ability to degrade several tissue-associated protein substrates such as keratin, collagen, and fibrin. Accordingly, our study shed light on the catalytic properties of a previously uncharacterized extracellular serine protease from Acinetobacter baumannii that warrants further investigations into its potential role as a virulence factor in pathogenicity and commercial applications.
  3. Fulltext Draft Genome Sequence of Rhizoctonia solani Anastomosis Group 1 Subgroup 1A Strain 1802/KB Isolated from Rice
    Nadarajah K, Mat Razali N, Cheah BH, Sahruna NS, Ismail I, Tathode M, et al.
    Genome Announc, 2017 Oct 26;5(43).
    PMID: 29074665 DOI: 10.1128/genomeA.01188-17
    Sheath blight, caused by Rhizoctonia solani anastomosis group 1 subgroup 1A (AG1-1A), is one of the most devastating rice diseases worldwide. Here, we report the draft genome sequence of R. solani AG1-1A strain 1802/KB isolated from a popular Malaysian rice variety. To the best of our knowledge, this is the second reported representative genome from AG1-1A.
  4. Assessing the economic value of urban green spaces in Kuala Lumpur
    A Samad NS, Abdul-Rahim AS, Mohd Yusof MJ, Tanaka K
    Environ Sci Pollut Res Int, 2020 Apr;27(10):10367-10390.
    PMID: 31939016 DOI: 10.1007/s11356-019-07593-7
    This study assessed the economic value of public urban green spaces (UGSs) in Kuala Lumpur (KL) city by using the hedonic price method (HPM). It involves 1269 house units from eight sub-districts in KL city. Based on the hedonic price method, this study formulates a global and local model. The global model and local model are analyzed using ordinary least square (OLS) regression and geographically weighted regression (GWR). By using the hedonic price method, the house price serves as a proxy for public urban green spaces' economic value. The house price is regressed against the set of three variables which are structural characteristics, neighborhood attributes, and environmental attributes. Measurements of interest in this study are environmental characteristics, including distance to public UGSs and size of public UGSs. The results of the OLS regression illustrated that Taman Rimba Kiara and Taman Tasik Titiwangsa provide the maximum economic value. On average, reducing the distance of the house location to Taman Rimba Kiara by 10 m increased the house price by RM1700. Similarly, increasing the size of the Taman Tasik Titiwangsa by 1000 m2 increases the house price by RM60,000. The advantage of the GWR result is the economic value of public UGSs which can be analyzed by the specific location according to sub-district. From this study, the GWR result exposed that the economic values of Taman Rimba Bukit Kiara and Taman Tasik Titiwangsa were not significant in each of the sub-district within KL city. Taman Rimba Bukit Kiara was negatively significant at all sub-districts except Setapak and certain house locations located at the sub-district of KL. In contrast, Taman Tasik Titiwangsa was positively significant at all sub-districts except certain house locations at the sub-districts of Batu, KL, Setapak, and KL city center. In conclusion, results show that the house price is influenced by the environmental attribute. However, even though both of these public UGSs generate the highest economic value based on distance and size, its significant values with an expected sign are only obtained based on the specific house location as verified by the local model. In terms of model comparison, the local model was better compared with the global model.
  5. Fulltext Pediatric brain abscess with fatal outcome caused by hypervirulent Klebsiella pneumoniae, serotype K2-ST65
    En ETS, Ismail N, Nasir NSM, Ismadi YKM, Zuraina NMNN, Hassan SA
    J Infect Public Health, 2023 Jul;16(7):1089-1092.
    PMID: 37224619 DOI: 10.1016/j.jiph.2023.05.015
    Hypervirulent Klebsiella pneumoniae (hvKp) is an emerging pathotype in addition to classical Klebsiella pneumoniae, with its ability to cause life-threatening, community-acquired metastatic infections even in healthy individuals. We presented a case of cerebral abscess preceded by otitis media in a 10-year-old child caused by hvKp. The isolates from blood pus aspirate were later identified as K. pneumoniae capsular serotype K2 and closely related to sequence type (ST65), with multiple hypervirulent genes detected (rmpA, rmpA2, iucA and peg344). She succumbed to death despite surgical drainage and susceptible antibiotic therapy. Clinicians should be cognizant of the rising incidence of hvKp infections in pediatric populations.
  6. Fulltext Development and validation of parental knowledge, attitude and practice in eye problem among children questionnaire (PEPC-KAPQ)
    Ghani NDH, Abd Rahman MH, Mohamad Fadzil N, Mohammed Z, Mohd Rasdi HF, Shafie NS
    PLoS One, 2023;18(9):e0291062.
    PMID: 37682886 DOI: 10.1371/journal.pone.0291062
    BACKGROUND: Most eye problems among children can be detected and treated at an early age to reduce the prevalence of visual impairment. Understanding the knowledge, attitude, and practice (KAP) among parents about common children's eye problems is fundamental to encourage parents to seek early eye care services for their children. This study aims to develop a Parental Knowledge, Attitude, and Practice in Eye Problem among Children Questionnaire (PEPC-KAPQ) and evaluate its psychometric properties.

    METHODS: This study involved developing a questionnaire and was conducted in Kuala Lumpur, Malaysia from July 2021 until June 2022. The questionnaire was developed based on a literature review and expert consultation. The first phase includes a systematic literature review to generate the items for the questionnaire. A group of five panels was then invited to perform content validity for the questionnaire. Face validity was conducted among ten parents to get feedback for the questionnaire. Construct validity and reliability of the questionnaire were measured by which the questionnaire was administered to a total of 134 parents and 64 parents for reliability test.

    RESULT: The final PEPC-KAPQ consists of four main sections: demographic, knowledge, attitude, and practice with 52 items. The content validity index was 0.85 for all domains of KAP. Modified kappa showed excellent value for most items for all domains. The Kaiser-Meyer-Olkin sampling adequacy showed acceptable scores of 0.84, and Bartlett's Test of Sphericity was significant (x2 = 3172.09, p<0.0001). Kuder-Richardson-2 of the domain knowledge was 0.95. Cronbach's α coefficient of domain attitude and practice were 0.92 and 0.88, respectively and the intraclass correlation of domain attitude and practice were 0.93 and 0.94 respectively. Bland and Altman's plots show that majority of the data fell within the limits of agreement.

    CONCLUSION: The findings of this validation and reliability study show that the developed questionnaire has a satisfactory psychometric property for measuring the KAP of parents regarding eye problems among children.

  7. Fulltext Investigation on three-dimensional printed prosthetics leg sockets coated with different reinforcement materials: analysis on mechanical strength and microstructural
    Ramlee MH, Ammarullah MI, Mohd Sukri NS, Faidzul Hassan NS, Baharuddin MH, Abdul Kadir MR
    Sci Rep, 2024 Mar 21;14(1):6842.
    PMID: 38514731 DOI: 10.1038/s41598-024-57454-8
    Previous research has primarily focused on pre-processing parameters such as design, material selection, and printing techniques to improve the strength of 3D-printed prosthetic leg sockets. However, these methods fail to address the major challenges that arise post-printing, namely failures at the distal end of the socket and susceptibility to shear failure. Addressing this gap, the study aims to enhance the mechanical properties of 3D-printed prosthetic leg sockets through post-processing techniques. Fifteen PLA + prosthetic leg sockets are fabricated and reinforced with four materials: carbon fiber, carbon-Kevlar fiber, fiberglass, and cement. Mechanical and microstructural properties of the sockets are evaluated through axial compression testing and scanning electron microscopy (SEM). Results highlight superior attributes of cement-reinforced sockets, exhibiting significantly higher yield strength (up to 89.57% more than counterparts) and higher Young's modulus (up to 76.15% greater). SEM reveals correlations between microstructural properties and socket strength. These findings deepen the comprehension of 3D-printed prosthetic leg socket post-processing, presenting optimization prospects. Future research can focus on refining fabrication techniques, exploring alternative reinforcement materials, and investigating the long-term durability and functionality of post-processed 3D-printed prosthetic leg sockets.
  8. Fulltext Preparation of Ethylene Glycol Dimethacrylate (EGDMA)-Based Terpolymer as Potential Sorbents for Pharmaceuticals Adsorption
    Shaipulizan NS, Md Jamil SNA, Kamaruzaman S, Subri NNS, Adeyi AA, Abdullah AH, et al.
    Polymers (Basel), 2020 Feb 12;12(2).
    PMID: 32059354 DOI: 10.3390/polym12020423
    Ethylene glycol dimethacrylate (EGDMA) is used as a crosslinker in poly(acrylonitrile (AN)-co-vinylbenzyl chloride (VBC)) to investigate the effect of long-chain crosslinker to the porosity of the terpolymer system. Poly(AN-co-EGDMA-co-VBC) is synthesized by using precipitation polymerization method and further hypercrosslinked by Friedel-Crafts reaction. FT-IR spectra of poly(AN-co-EGDMA-co-VBC) show that the absorption bands at ~1290 cm-1 that are assigned to the C-Cl vibrations are almost disappeared in hypercrosslinked (HXL) poly(AN-co-EGDMA-co-VBC) polymers, confirming that the hypercrosslinking reaction is successful. SEM images show that the morphologies of the polymers are retained through the hypercrosslinking reactions. Brunauer-Emmett-Teller (BET) analysis shows that hypercrosslinked polymers had a specific surface area up to 59 m2·g-1. The preliminary performance of the terpolymer adsorbent to capture polar analyte is evaluated by adsorbing salicylic acid and mefenamic acid from aqueous solution in a batch system. The maximum adsorption capacity of salicylic acid and mefenamic acid were up to 416.7 mg·g-1 and 625 mg·g-1, respectively, and the adsorption kinetic data obeyed pseudo-second-order rate equation.
  9. Glycoproteomics-based liquid biopsy: translational outlook for colorectal cancer clinical management in Southeast Asia
    Kumarasamy G, Mohd Salim NH, Mohd Afandi NS, Hazlami Habib MA, Mat Amin ND, Ismail MN, et al.
    Future Oncol, 2023 Nov;19(34):2313-2332.
    PMID: 37937446 DOI: 10.2217/fon-2023-0704
    Colorectal cancer (CRC) signifies a significant healthcare challenge in Southeast Asia. Despite advancements in screening approaches and treatment modalities, significant medical gaps remain, ranging from prevention and early diagnosis to determining targeted therapy and establishing personalized approaches to managing CRC. There is a need to expand more validated biomarkers in clinical practice. An advanced technique incorporating high-throughput mass spectrometry as a liquid biopsy to unravel a repertoire of glycoproteins and glycans would potentially drive the development of clinical tools for CRC screening, diagnosis and monitoring, and it can be further adapted to the existing standard-of-care procedure. Therefore this review offers a perspective on glycoproteomics-driven liquid biopsy and its potential integration into the clinical care of CRC in the southeast Asia region.
  10. Fulltext Production of Lipopeptide Biosurfactant by a Hydrocarbon-Degrading Antarctic Rhodococcus
    Habib S, Ahmad SA, Wan Johari WL, Abd Shukor MY, Alias SA, Smykla J, et al.
    Int J Mol Sci, 2020 Aug 26;21(17).
    PMID: 32858859 DOI: 10.3390/ijms21176138
    Rhodococci are renowned for their great metabolic repertoire partly because of their numerous putative pathways for large number of specialized metabolites such as biosurfactant. Screening and genome-based assessment for the capacity to produce surface-active molecules was conducted on Rhodococcus sp. ADL36, a diesel-degrading Antarctic bacterium. The strain showed a positive bacterial adhesion to hydrocarbon (BATH) assay, drop collapse test, oil displacement activity, microplate assay, maximal emulsification index at 45% and ability to reduce water surface tension to < 30 mN/m. The evaluation of the cell-free supernatant demonstrated its high stability across the temperature, pH and salinity gradient although no correlation was found between the surface and emulsification activity. Based on the positive relationship between the assessment of macromolecules content and infrared analysis, the extracted biosurfactant synthesized was classified as a lipopeptide. Prediction of the secondary metabolites in the non-ribosomal peptide synthetase (NRPS) clusters suggested the likelihood of the surface-active lipopeptide production in the strain's genomic data. This is the third report of surface-active lipopeptide producers from this phylotype and the first from the polar region. The lipopeptide synthesized by ADL36 has the prospect to be an Antarctic remediation tool while furnishing a distinctive natural product for biotechnological application and research.
  11. Fulltext Frequency, clinical characteristics and outcomes of Tropidolaemus species bite envenomations in Malaysia
    Ismail AK, Abd Hamid MNH, Ariff NA, Frederic Ng VER, Goh WC, Abdul Samat NS, et al.
    PLoS Negl Trop Dis, 2023 Jan;17(1):e0010983.
    PMID: 36598885 DOI: 10.1371/journal.pntd.0010983
    Pit vipers from the genus Tropidolaemus are identified as one of the common causes of snake bite from venomous species in Malaysia. All Tropidolaemus species bite cases referred to the Remote Envenomation Consultation Services (RECS) between 2015-2021 were included. A total of 4,718 snake-related injuries cases consulted to RECS with 310 (6.6%) involved Tropidolaemus species; of these 190 (61.3%) were T. subannulatus and 120 (38.7%) T. wagleri. All the T. subannulatus cases occurred in Sabah and Sarawak while all cases of T. wagleri occurred in Peninsular Malaysia. The majority of patients were male (74.8%) and adults between 18-59 years old (61.2%). The upper limb (56.6%) was the most frequent anatomical region involved. Most cases were non-occupationally related (75.4%). Bites from both species caused local pain (77.1%) and swelling (27.2%). Most patients complained of mild pain (48.0%). Paracetamol (40.0%) was the most common analgesic prescribed. Antivenom was not indicated in all cases. Two patients were given antivenom inappropriately before RECS consultation. Most patients (54.7%) needed hospital observation for less than 24 hours. No deaths occurred in the group studied.
  12. Enhanced binding interaction and antibacterial inhibition for nanometal oxide particles activated with Aloe Vulgarize through one-pot ultrasonication techniques
    Dzulkharnien NSF, Rohani R, Tan Kofli N, Mohd Kasim NA, Abd Muid S, Patrick M, et al.
    Bioorg Chem, 2024 Sep;150:107513.
    PMID: 38905888 DOI: 10.1016/j.bioorg.2024.107513
    The interaction of green zinc oxide nanoparticles (ZnO NPs) with bacterial strains are still scarcely reported. This work was conducted to study the green-one-pot-synthesized ZnO NPs from the Aloe Vulgarize (AV) leaf peel extract assisted with different sonication techniques followed by the physicochemical, biological activities and molecular docking studies. The NPs structure was analyzed using FTIR, UV-vis and EDX. The morphology, particle size and crystallinity of ZnO NPs were identified using FESEM and XRD. It was found that the formed flower-like structure with sharp edge and fine size of particulates in ZnO NPs/AV could enhance the bacterial inhibition. The minimum inhibitory concentration (MIC) for all the tested bacterial strains is at 3.125 µg/ml and the bacterial growth curve are dependent on the ZnO NPs dosage. The results of disc diffusion revealed that the ZnO NPs/AV possess better antibacterial effect with bigger ZOI due to the presence of AV active ingredient. The molecular docking between active ingredients of AV in the NPs with the protein of IFCM and 1MWU revealed that low binding energy (Ebind = -6.56 kcal/mol and -8.99 kcal/mol, respectively) attributes to the excessive hydrogen bond from AV that highly influenced their interaction with the amino acid of the selected proteins. Finally, the cytotoxicity test on the biosynthesized ZnO NPs with concentration below 20 µg/ml are found nontoxic on the HDF cell. Overall, ZnO NPs/20 % AV (probe sonication) is considered as the best synthesis option due to its efficient one-pot method, short sonication time but own the best antibacterial effect.
  13. Exposure of a Dengue Vector to Tea and Its Waste: Survival, Developmental Consequences, and Significance for Pest Management
    Dieng H, Tan Yusop NS, Kamal NN, Ahmad AH, Ghani IA, Abang F, et al.
    J Agric Food Chem, 2016 May 11;64(18):3485-91.
    PMID: 27115536 DOI: 10.1021/acs.jafc.6b01157
    Dengue mosquitoes are evolving into a broader global public health menace, with relentless outbreaks and the rise in number of Zika virus disease cases as reminders of the continued hazard associated with Aedes vectors. The use of chemical insecticides-the principal strategy against mosquito vectors-has been greatly impeded due to the development of insecticide resistance and the shrinking spectrum of effective agents. Therefore, there is a pressing need for new chemistries for vector control. Tea contains hundreds of chemicals, and its waste, which has become a growing global environmental problem, is almost as rich in toxicants as green leaves. This paper presents the toxic and sublethal effects of different crude extracts of tea on Aedes albopictus. The survival rates of larvae exposed to tea extracts, especially fresh tea extract (FTE), were markedly lower than those in the control treatment group. In addition to this immediate toxicity against different developmental stages, the extracts tested caused a broad range of sublethal effects. The developmental time was clearly longer in containers with tea, especially in those with young larvae (YL) and FTE. Among the survivors, pupation success was reduced in containers with tea, which also produced low adult emergence rates with increasing tea concentration. The production of eggs tended to be reduced in females derived from the tea treatment groups. These indirect effects of tea extracts on Ae. albopictus exhibited different patterns according to the exposed larval stage. Taken together, these findings indicate that tea and its waste affect most key components of Ae. albopictus vectorial capacity and may be useful for dengue control. Reusing tea waste in vector control could also be a practical solution to the problems associated with its pollution.
  14. Fulltext Vaginal Infections during Pregnancy Increase Breast Milk Microbiome Alpha Diversity and Alter Taxonomic Composition
    Nisaa AA, Oon CE, Sreenivasan S, Balakrishnan V, Rajendran D, Tan JJ, et al.
    Prev Nutr Food Sci, 2023 Mar 31;28(1):1-9.
    PMID: 37066035 DOI: 10.3746/pnf.2023.28.1.1
    We previously reported that breast milk from women with (W) or without (WO) vaginal yeast infection during pregnancy differs in its immunological and antimicrobial properties, especially against pathogenic vaginal Candida sp.. Here, we investigated the differences in microbiota profiles of breast milk from these groups. Seventy-two breast milk samples were collected from lactating mothers (W, n=37; WO, n=35). The DNA of bacteria was extracted from each breast milk sample for microbiota profiling by 16S rRNA gene sequencing. Breast milk from the W-group exhibited higher alpha diversity than that from the WO-group across different taxonomic levels of class (P=0.015), order (P=0.011), family (P=0.020), and genus (P=0.030). Compositional differences between groups as determined via beta diversity showed marginal differences at taxonomic levels of phylum (P=0.087), family (P=0.064), and genus (P=0.067). The W-group showed higher abundances of families Moraxellaceae (P=0.010) and Xanthomonadaceae (P=0.008), and their genera Acinetobacter (P=0.015), Enhydrobacter (P=0.015), and Stenotrophomonas (P=0.007). Meanwhile, the WO-group showed higher abundances of genus Staphylococcus (P=0.046) and species Streptococcus infantis (P=0.025). This study shows that, although breast milk composition is affected by vaginal infection during pregnancy, this may not pose a threat to infant growth and development.
  15. Fulltext The Toxicity of Mercury and Its Chemical Compounds: Molecular Mechanisms and Environmental and Human Health Implications: A Comprehensive Review
    Wu YS, Osman AI, Hosny M, Elgarahy AM, Eltaweil AS, Rooney DW, et al.
    ACS Omega, 2024 Feb 06;9(5):5100-5126.
    PMID: 38343989 DOI: 10.1021/acsomega.3c07047
    Mercury is a type of hazardous and toxic pollutant that can result in detrimental effects on the environment and human health. This review is aimed at discussing the state-of-the-art progress on the recent developments on the toxicity of mercury and its chemical compounds. More than 210 recent works of literature are covered in this review. It first delineates the types (covering elemental mercury, inorganic mercury compounds, organic mercury compounds), structures, and sources of mercury. It then discusses the pharmacokinetic profile of mercury, molecular mechanisms of mercury toxicity, and clinical manifestation of acute and chronic mercury toxicity to public health. It also elucidates the mercury toxicity to the environment and human health in detail, covering ecotoxicity, neurotoxicity diseases, neurological diseases, genotoxicity and gene regulation, immunogenicity, pregnancy and reproductive system damage, cancer promotion, cardiotoxicity, pulmonary diseases, and renal disease. In order to mitigate the adverse effects of mercury, strategies to overcome mercury toxicity are recommended. Finally, some future perspectives are provided in order to advance this field of research in the future.
  16. Fulltext Multicentre case-control study of pneumococcal infections among children with pneumonia in Peninsular Malaysia (MY-Pneumo): a study protocol
    Ramzi NH, Hoong ATC, Johari NA, Nathan AM, Teh CSJ, Sulaiman NA, et al.
    BMC Public Health, 2024 Aug 20;24(1):2255.
    PMID: 39164673 DOI: 10.1186/s12889-024-19789-9
    BACKGROUND: S. pneumoniae (SPN) is the most common cause of pneumonia. The disease can be effectively prevented through immunisation. Since December 2020, the Malaysian Government has included the 10-valent pneumococcal conjugate vaccine (PCV10) for all infants born on or after 1 January 2020 as part of the National Immunisation Programme (NIP). However, the epidemiology of pneumonia remains poorly understood. To fill the knowledge gap, we established a multicentre surveillance study to understand the burden of pneumococcal pneumonia among young children in Peninsular Malaysia.

    METHODS: MY-Pneumo is a multicentre prospective case-control study conducted in three sentinel sites located in three different states of Peninsular Malaysia - Kuala Lumpur, Pahang, and Kelantan. A cohort of at least 500 incident cases and 500 controls is enrolled beginning in October 2021 and matched for age. Cases are hospitalised children 

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