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Fulltext T-BACCO SCORE: A predictive scoring tool for tuberculosis (TB) loss to follow-up among TB smokers

Sharani ZZ, Ismail N, Yasin SM, Isa MR, Razali A, Sherzkawee MA, et al.

PLoS One, 2023;18(6):e0287374.
PMID: 37319310 DOI: 10.1371/journal.pone.0287374

INTRODUCTION: Loss to follow-up (LTFU) and smoking during TB treatment are major challenges for TB control programs. Smoking increases the severity and prolongs TB treatment duration, which lead to a higher rate of LTFU. We aim to develop a prognostic scoring tool to predict LTFU among TB patients who smoke to improve successful TB treatment outcomes.
MATERIALS AND METHODS: The development of the prognostic model utilized prospectively collected longitudinal data of adult TB patients who smoked in the state of Selangor between 2013 until 2017, which were obtained from the Malaysian Tuberculosis Information System (MyTB) database. Data were randomly split into development and internal validation cohorts. A simple prognostic score (T-BACCO SCORE) was constructed based on the regression coefficients of predictors in the final logistic model of the development cohort. Estimated missing data was 2.8% from the development cohort and was completely at random. Model discrimination was determined using c-statistics (AUCs), and calibration was based on the Hosmer and Lemeshow goodness of fit test and calibration plot.
RESULTS: The model highlights several variables with different T-BACCO SCORE values as predictors for LTFU among TB patients who smoke (e.g., age group, ethnicity, locality, nationality, educational level, monthly income level, employment status, TB case category, TB detection methods, X-ray categories, HIV status, and sputum status). The prognostic scores were categorized into three groups that predict the risk for LTFU: low-risk (<15 points), medium-risk (15 to 25 points) and high-risk (> 25 points). The model exhibited fair discrimination with a c-statistic of 0.681 (95% CI 0.627-0.710) and good calibration with a nonsignificant chi-square Hosmer‒Lemeshow's goodness of fit test χ2 = 4.893 and accompanying p value of 0.769.
CONCLUSION: Predicting LTFU among TB patients who smoke in the early phase of TB treatment is achievable using this simple T-BACCO SCORE. The applicability of the tool in clinical settings helps health care professionals manage TB smokers based on their risk scores. Further external validation should be carried out prior to use.
PAHs remediation from hazardous waste landfill leachate using fenton, photo - fenton and electro - fenton oxidation processes - performance evaluation under optimized conditions using RSM and ANN

Singa PK, Isa MH, Sivaprakash B, Ho YC, Lim JW, Rajamohan N

Environ Res, 2023 Aug 15;231(Pt 2):116191.
PMID: 37211185 DOI: 10.1016/j.envres.2023.116191

Polycyclic aromatic hydrocharbons (PAHs) are a class of highly toxic pollutants that are highly detrimental to the ecosystem. Landfill leechate emanated from municipal solid waste are reported to constitute significant PAHs. In the present investigation, three Fenton proceses, namely conventional Fenton, photo-fenton and electro-fenton methods have been employed to treat landfill leehcate for removing PAHs from a waste dumpig yard. Response surface methodology (RSM) and artificial neural network (ANN) methodologies were adopted to optimize and validate the conditions for optimum oxidative removal of COD and PAHs. The statistical analysis results showed that all independent variables chosen in the study are reported to have significant influence of the removal effects with P-values <0.05. Sensitivity analysis by the developed ANN model showed that the pH had the highest significance of 1.89 in PAH removal when compared to the other parameters. However for COD removal, H2O2 had the highest relative importance of 1.15, followed by Fe2+ and pH. Under optimal treatment conditions, the photo-fenton and electro-fenton processes showed better removal of COD and PAH compared to the Fenton process. The photo-fenton and electro-fenton treatment processes removed 85.32% and 74.64% of COD and 93.25% and 81.65% of PAHs, respectively. Also the investigations revelaed the presence of 16 distinct PAH compunds and the removal percentage of each of these PAHs are also reported. The PAH treatment research studies are generally limited to the assay of removal of PAH and COD levels. In the present investigation, in addition to the treatment of landfill leachate, particle size distribution analysis and elemental characterization of the resultant iron sludge by FESEM and EDX are reported. It was revealed that elemental oxygen is present in highest percentage, followed by iron, sulphur, sodium, chlorine, carbon and potassium. However, iron percentage can be reduced by treating the Fenton-treated sample with NaOH.
Fulltext CDK9 inhibitors define elongation checkpoints at both ends of RNA polymerase II-transcribed genes

Laitem C, Zaborowska J, Isa NF, Kufs J, Dienstbier M, Murphy S

Nat Struct Mol Biol, 2015 May;22(5):396-403.
PMID: 25849141 DOI: 10.1038/nsmb.3000

Transcription through early-elongation checkpoints requires phosphorylation of negative transcription elongation factors (NTEFs) by the cyclin-dependent kinase (CDK) 9. Using CDK9 inhibitors and global run-on sequencing (GRO-seq), we have mapped CDK9 inhibitor-sensitive checkpoints genome wide in human cells. Our data indicate that early-elongation checkpoints are a general feature of RNA polymerase (pol) II-transcribed human genes and occur independently of polymerase stalling. Pol II that has negotiated the early-elongation checkpoint can elongate in the presence of inhibitors but, remarkably, terminates transcription prematurely close to the terminal polyadenylation (poly(A)) site. Our analysis has revealed an unexpected poly(A)-associated elongation checkpoint, which has major implications for the regulation of gene expression. Interestingly, the pattern of modification of the C-terminal domain of pol II terminated at this new checkpoint largely mirrors the pattern normally found downstream of the poly(A) site, thus suggesting common mechanisms of termination.
Fulltext The Unusual Cause of Cardiac Tamponade

Othman MK, Yusof Z, Hussin SA, Samsudin N, Muhd Besari AB, W Isa WYH

JACC Case Rep, 2022 Oct 05;4(19):1288-1291.
PMID: 36406916 DOI: 10.1016/j.jaccas.2022.07.016

We present a previously healthy young man with cardiac tamponade. He underwent emergency pericardiocentesis. The pericardial fluid was exudative, and Salmonella sp. was grown on both pericardial and blood cultures. Further investigations revealed that this patient had classical Hodgkin lymphoma, which explains his immunocompromised state predisposing him to this infection. (Level of Difficulty: Advanced.).
Fulltext Functional prediction of de novo uni-genes from chicken transcriptomic data following infectious bursal disease virus at 3-days post-infection

Azli B, Ravi S, Hair-Bejo M, Omar AR, Ideris A, Mat Isa N

BMC Genomics, 2021 Jun 19;22(1):461.
PMID: 34147086 DOI: 10.1186/s12864-021-07690-3

BACKGROUND: Infectious bursal disease (IBD) is an economically very important issue to the poultry industry and it is one of the major threats to the nation's food security. The pathogen, a highly pathogenic strain of a very virulent IBD virus causes high mortality and immunosuppression in chickens. The importance of understanding the underlying genes that could combat this disease is now of global interest in order to control future outbreaks. We had looked at identified novel genes that could elucidate the pathogenicity of the virus following infection and at possible disease resistance genes present in chickens.
RESULTS: A set of sequences retrieved from IBD virus-infected chickens that did not map to the chicken reference genome were de novo assembled, clustered and analysed. From six inbred chicken lines, we managed to assemble 10,828 uni-transcripts and screened 618 uni-transcripts which were the most significant sequences to known genes, as determined by BLASTX searches. Based on the differentially expressed genes (DEGs) analysis, 12 commonly upregulated and 18 downregulated uni-genes present in all six inbred lines were identified with false discovery rate of q-value
Fulltext Risk factors for tuberculosis-related death among adults with drug-sensitive pulmonary tuberculosis in Selangor, Malaysia from 2013 to 2019: a retrospective cohort study using surveillance data

Suhairi MH, Mohamad M, Isa MR, Mohd Yusoff MAS, Ismail N

BMJ Open, 2024 Feb 26;14(2):e080144.
PMID: 38413152 DOI: 10.1136/bmjopen-2023-080144

OBJECTIVES: Due to the paucity of literature on risk factors for tuberculosis (TB)-related death, we determine the sociodemographic and clinical risk factors associated with TB-related deaths among adult pulmonary TB (PTB) patients on treatment in Selangor, Malaysia.
DESIGN: Retrospective cohort study.
SETTING: Routinely collected primary care data from all government TB clinics in Selangor.
PARTICIPANTS: Data of 24 570 eligible adult PTB patients from 2013 to 2019 were obtained from Selangor's State Health Department surveillance records. We included PTB patients aged at least 15 years old at the time of diagnosis with complete documentation of the dates of diagnosis, treatment initiation, end of treatment/follow-up and treatment outcomes. We excluded patients whose diagnoses were changed to non-TB, post-mortem TB diagnosis and multidrug-resistant TB (MDR-TB) patients.
PRIMARY AND SECONDARY OUTCOME MEASURES: TB-related death, determined from the recorded physicians' consensus during the TB mortality meeting.
RESULTS: TB-related death was significantly associated with far (adjusted HR (aHR) 9.98, 95% CI 4.28 to 23.28) and moderately advanced (aHR 3.23, 95% CI 1.43 to 7.31) radiological findings at diagnosis; concurrent TB meningitis (aHR 7.67, 95% CI 4.53 to 12.98) and miliary TB (aHR 6.32, 95% CI 4.10 to 9.74) involvement; HIV positive at diagnosis (aHR 2.81, 95% CI 2.21 to 3.57); Hulu Selangor (aHR 1.95, 95% CI 1.29 to 2.93), Klang (aHR 1.53, 95% CI 1.18 to 1.98) and Hulu Langat (aHR 1.31, 95% CI 1.03 to 1.68) residing districts; no formal education (aHR 1.70, 95% CI 1.23 to 2.35); unemployment (aHR 1.54, 95% CI 1.29 to 1.84), positive sputum smear acid-fast bacilli (AFB) at diagnosis (aHR 1.51, 95% CI 1.22 to 1.85); rural residency (aHR 1.39, 95% CI 1.13 to 1.72) and advancing age (aHR 1.03, 95% CI 1.02 to 1.03).
CONCLUSIONS: Far and moderately advanced radiological findings, concurrent TB meningitis and miliary TB involvement, HIV positive, Hulu Selangor, Klang and Hulu Langat residing districts, no formal education, unemployment, positive sputum smear AFB, rural residency and advancing age are risk factors of TB-related death. Our findings should assist in identifying high-risk patients requiring interventions against TB-related death.
Fulltext Nystagmus and Abducens Nerve Palsy as an Early Presentation of Non-alcoholic Wernicke Encephalopathy

Darussalam SH, Mohd Isa M, Md Saleh R, Mohmood A, Mohammad Razali A

Cureus, 2024 Jan;16(1):e52121.
PMID: 38344547 DOI: 10.7759/cureus.52121

Wernicke encephalopathy (WE) is a rare but life-threatening syndrome that is commonly associated with chronic alcoholism. It has also been found to be associated with malnutrition, prolonged parenteral nutrition, hemodialysis, hyperemesis gravidarum, gastroplasty, and AIDS. It usually presents as a clinical triad of confusion, ophthalmoplegia, and gait ataxia. Nystagmus is usually the most common and earliest ophthalmologic sign. We report a case of non-alcoholic WE in a patient who had prior bariatric surgery and was treated for malnutrition and sepsis, with nystagmus being the initial presentation. The MRI of the brain was normal. The diagnosis of WE was made clinically and was supported by the patient's symptomatic and clinical recovery following intravenous thiamine treatment. It is essential to highlight that a high level of suspicion is needed to diagnose non-alcoholic WE to allow the commencement of appropriate treatment and reduce morbidity and mortality rates related to this condition.
Fulltext Prevalence of test anxiety and its determinants among nursing students in Selangor, Malaysia

Khaira MK, Raja Gopal RL, Mohamed Saini S, Md Isa Z

Heliyon, 2024 Feb 29;10(4):e26236.
PMID: 38380008 DOI: 10.1016/j.heliyon.2024.e26236

The current education system significantly emphasizes tests and evaluations as crucial factors in determining a student's future career path. It has been shown that nursing students have moderate to high levels of Test Anxiety (TA), which results in decreased academic performance, low self-esteem, and an inability to complete the program and pursue a career in nursing successfully. This study aimed to determine nursing students' level of TA and its relationship with demographic characteristics. Four hundred twenty-one nursing students at seven private universities and colleges in Selangor participated in this cross-sectional study. The level of TA was measured using the TA Inventory (TAI). A total of 62.5% of the respondents had mild TA, 25.4% had moderate TA and 2.1% had severe TA. There were significant relationships between TA level and household income (χ2 = 6.70, p = 0.035) and ethnic groups (F (3,417) = 5.20, p = 0.002) where Chinese and Indians are protective from TA compared to the Malays and other ethnic groups and high anxiety was significant in the Ringgit Malaysia (RM 3000) and below group. The study's findings indicate that a significant percentage of nursing students involved in the research had mild to moderate levels of test anxiety (TA) and there is a significant association between TA and demographic characteristics. The results indicate the importance of early identification of TA and the need for interventions to overcome TA to ensure they are emotionally, physically, and academically successful.
Fulltext The Effects of Indoor Pollutants Exposure on Allergy and Lung Inflammation: An Activation State of Neutrophils and Eosinophils in Sputum

Mohd Isa KN, Hashim Z, Jalaludin J, Lung Than LT, Hashim JH

Int J Environ Res Public Health, 2020 07 28;17(15).
PMID: 32731346 DOI: 10.3390/ijerph17155413

BACKGROUND: To explore the inflammation phenotypes following indoor pollutants exposure based on marker expression on eosinophils and neutrophils with the application of chemometric analysis approaches.
METHODS: A cross-sectional study was undertaken among secondary school students in eight suburban and urban schools in the district of Hulu Langat, Selangor, Malaysia. The survey was completed by 96 students at the age of 14 by using the International Study of Asthma and Allergies in Children (ISAAC) and European Community Respiratory Health Survey (ECRHS) questionnaires. The fractional exhaled nitric oxide (FeNO) was measured, and an allergic skin prick test and sputum induction were performed for all students. Induced sputum samples were analysed for the expression of CD11b, CD35, CD63, and CD66b on eosinophils and neutrophils by flow cytometry. The particulate matter (PM2.5 and PM10), NO2, CO2, and formaldehyde were measured inside the classrooms.
RESULTS: Chemometric and regression results have clustered the expression of CD63 with PM2.5, CD11b with NO2, CD66b with FeNO levels, and CO2 with eosinophils, with the prediction accuracy of the models being 71.88%, 76.04%, and 76.04%, respectively. Meanwhile, for neutrophils, the CD63 and CD66b clustering with PM2.5 and CD11b with FeNO levels showed a model prediction accuracy of 72.92% and 71.88%, respectively.
CONCLUSION: The findings indicated that the exposure to PM2.5 and NO2 was likely associated with the degranulation of eosinophils and neutrophils, following the activation mechanisms that led to the inflammatory reactions.
Fulltext Model-based test case prioritization using selective and even-spread count-based methods with scrutinized ordering criterion

Mohd-Shafie ML, Wan-Kadir WMN, Khatibsyarbini M, Isa MA

PLoS One, 2020;15(2):e0229312.
PMID: 32084232 DOI: 10.1371/journal.pone.0229312

Regression testing is crucial in ensuring that modifications made did not introduce any adverse effect on the software being modified. However, regression testing suffers from execution cost and time consumption problems. Test case prioritization (TCP) is one of the techniques used to overcome these issues by re-ordering test cases based on their priorities. Model-based TCP (MB-TCP) is an approach in TCP where the software models are manipulated to perform prioritization. The issue with MB-TCP is that most of the existing approaches do not provide satisfactory faults detection capability. Besides, their granularity of test selection criteria is not very good and this can affect prioritization effectiveness. This study proposes an MB-TCP approach that can improve the faults detection performance of regression testing. It combines the implementation of two existing approaches from the literature while incorporating an additional ordering criterion to boost prioritization efficacy. A detailed empirical study is conducted with the aim to evaluate and compare the performance of the proposed approach with the selected existing approaches from the literature using the average of the percentage of faults detected (APFD) metric. Three web applications were used as the objects of study to obtain the required test suites that contained the tests to be prioritized. From the result obtained, the proposed approach yields the highest APFD values over other existing approaches which are 91%, 86% and 91% respectively for the three web applications. These higher APFD values signify that the proposed approach is very effective in revealing faults early during testing. They also show that the proposed approach can improve the faults detection performance of regression testing.
Fulltext E-Learning in Teaching Emergency Disaster Response Among Undergraduate Medical Students in Malaysia

Saiboon IM, Zahari F, Isa HM, Sabardin DM, Robertson CE

Front Public Health, 2021;9:628178.
PMID: 33996711 DOI: 10.3389/fpubh.2021.628178

Introduction: Teaching disaster response medicine (DRM) to medical students requires considerable resources. We evaluate the effectiveness of e-learning in teaching emergency disaster response (ELITE-DR), a novel initiative, in educating medical students of the cognitive aspect of DRM. Methods: A prospective cross-sectional study among pre-clinical year medical students was carried out to determine their knowledge on DRM and perception regarding the ELITE-DR initiative using a validated online questionnaire. A three-part self-learning video covering the principles and medical management of DRM were distributed before answering the questionnaire served as the training. Results: A total of 168 students participated in the study. Their overall knowledge showed a significant increase in between pre-and-post-interventions. Recall and simple decision-making knowledge aspects were better than complex decision-making knowledge. It appeared that participants assimilate knowledge better from visual rather than audio stimuli. Participants with high perception-scores demonstrated better knowledge-scores. However, e-learning was not preferred as a substitute for face-to-face (F2F) teaching. Conclusion: ELITE-DR shows promise in teaching DRM. Simple recall and comprehension levels of knowledge were well-served through this technique. However, for more complex decision-making knowledge, a different approach might be required. ELITE-DR offers flexibility, accessibility, and personalized learning. The content presentation is improved by using several different visual stimuli. This approach is useful for cognitive aspect learning, but it should not replace standard F2F teaching.
Fulltext Prevalence of chromosome anomalies in a deer farm with fertility decline in Malaysia

Yahaya MS, Salisi MS, Md Isa NM, Meng GY, Haron A

Future Sci OA, 2020 Jun 02;6(6):FSO580.
PMID: 32670608 DOI: 10.2144/fsoa-2020-0037

BACKGROUND: A number of factors are known to reduce fertility rate in animals and one of the important categories of such factors is chromosome anomalies. They can occur with or without causing phenotypic abnormalities on animals; in some cases, they may directly affect meiosis, gametogenesis and the viability of conceptus. In many instances, balanced structural rearrangements can be transmitted to offspring, affecting fertility in subsequent generations.
AIM: This work investigated the occurrence of chromosome aberrations in Rusa timorensis, Rusa unicolor and Axis axis raised in a nucleus deer farm in Malaysia with a history of declining fertility of unknown origin.
MATERIALS & METHODS: Blood samples were collected from 60 animals through venipuncture, cultured for 72 h and arrested at metaphase. SmartType® and Ideokar® software were used to karyotype the chromosomes.
RESULTS: We found 15 out of the 60 animals screened from both sexes harbor some form of chromosome aberration. Chromosomal aberrations exist at the rate of 25% and may not be unconnected with the observed reduced fertility on the farm. Further investigations should be carried out, especially on the offspring of the studied animals to transmission of these aberrations. The animals that are confirmed to transmit the chromosomal aberrations should be culled to arrest the propagation of their abnormalities.
Fulltext Exhaled Carbon Monoxide Level and Practices among Tobacco and Nicotine Adult Users in Klang Valley, Malaysia

Wan Puteh SE, Mohd Ismail N, Md Isa Z, Ban AY

Int J Environ Res Public Health, 2023 Mar 02;20(5).
PMID: 36901455 DOI: 10.3390/ijerph20054443

Tobacco and nicotine derivatives uses are multiple in nature. These include conventional cigarettes (CCs), heated tobacco products (HTPs), and electronic cigarettes (ECs). This study aims to determine the practices, nicotine dependency profile, association with exhaled carbon monoxide (eCO) level, and pulmonary function (PF) among adult product users and non-smokers. This cross-sectional study involved smokers, nicotine users, and non-smokers from two public health facilities in Kuala Lumpur from December 2021 to April 2022. Data on socio-demography, smoking profile, nicotine dependency level, anthropometry, eCO monitor, and spirometer measurements were recorded. Out of 657 respondents, 52.1% were non-smokers, 48.3% were CC only smokers, poly-users (PUs) (27.3%), EC-only users (20.9%), and HTP-only users (3.5%). EC use was prevalent among the younger aged, tertiary educated, and females; HTP use was prevalent among those of an older age and CC users was common among lower educated males. The highest median eCO (in ppm) seen were as follows: in CC users only (13.00), PUs (7.00), EC users (2.00), HTP users (2.00), and the least was observed among non-smokers (1.00), which is significantly different across the groups (p <0.001). Comparison of practice between the different product users showed significant differences in age of product initiation (p <0.001, youngest in CC users in PUs), duration of product use (p <0.001, longest in exclusive CC users), cost per month (p <0.001, highest in exclusive HTP users) and attempt to quit product (p <0.001, CC use in PUs had the highest attempt to quit), while there is no significant difference in Fagerström score across the groups. Among EC users, 68.2% successfully switched from smoking CCs to ECs. The findings suggest that EC and HTP users are exhaling less CO. The use of these products in a targeted approach may manage nicotine addiction. Switching practice was higher among current EC users (from using CCs), hence emphasizing the need of switching encouragement and total nicotine abstinence later on. Lower eCO levels in the PU group, (as compared to CC-only users) and high quit attempt rate among in CC use in PUs may indicate attempt of PUs in reducing CC use through alternative modalities such as ECs and HTPs.
Fulltext Clinical Pathology, Immunopathology and Advanced Vaccine Technology in Bovine Theileriosis: A Review

Agina OA, Shaari MR, Isa NMM, Ajat M, Zamri-Saad M, Hamzah H

Pathogens, 2020 Aug 25;9(9).
PMID: 32854179 DOI: 10.3390/pathogens9090697

Theileriosis is a blood piroplasmic disease that adversely affects the livestock industry, especially in tropical and sub-tropical countries. It is caused by haemoprotozoan of the Theileria genus, transmitted by hard ticks and which possesses a complex life cycle. The clinical course of the disease ranges from benign to lethal, but subclinical infections can occur depending on the infecting Theileria species. The main clinical and clinicopathological manifestations of acute disease include fever, lymphadenopathy, anorexia and severe loss of condition, conjunctivitis, and pale mucous membranes that are associated with Theileria-induced immune-mediated haemolytic anaemia and/or non-regenerative anaemia. Additionally, jaundice, increases in hepatic enzymes, and variable leukocyte count changes are seen. Theileria annulata and Theileria parva induce an incomplete transformation of lymphoid and myeloid cell lineages, and these cells possess certain phenotypes of cancer cells. Pathogenic genotypes of Theileria orientalis have been recently associated with severe production losses in Southeast Asia and some parts of Europe. The infection and treatment method (ITM) is currently used in the control and prevention of T. parva infection, and recombinant vaccines are still under evaluation. The use of gene gun immunization against T. parva infection has been recently evaluated. This review, therefore, provides an overview of the clinicopathological and immunopathological profiles of Theileria-infected cattle and focus on DNA vaccines consisting of plasmid DNA with genes of interest, molecular adjuvants, and chitosan as the most promising next-generation vaccine against bovine theileriosis.
Dizzy spells in pregnancy: successful antenatal removal of a huge left atrial myxoma with mitral valve obstruction

Shahbuddin HMA, Hussin SA, W Isa WYH, Mamat AZ, Marzuki A, Yusof Z

BMJ Case Rep, 2024 Mar 07;17(3).
PMID: 38453227 DOI: 10.1136/bcr-2024-259675

Diagnosing atrial myxoma in pregnancy is challenging because patients may present with non-specific symptoms that might be overlooked. The timing of non-obstetric operation usually depends on the nature of the disease, after careful consideration of feto-maternal safety, including the use of cardiopulmonary bypass and placental transfer of anaesthetic drug. A woman in her 30s at 18 weeks of pregnancy presented with recurring dizziness. She underwent successful myxoma excision at 20 weeks under general anaesthesia and cardiopulmonary bypass. The 6×5 cm myxoma was histologically confirmed as myxoma. Early detection of atrial myxoma in pregnancy is crucial, and a clinician has to consider the diagnosis of left atrial myxoma with mitral valve obstruction as a cause of severe dizziness. Optimal outcomes require multidisciplinary management. In this case, surgery during the second trimester of pregnancy enabled a full-term pregnancy with the patient's and foetal well-being and normal postprocedural echocardiography.
Fulltext Adverse Cardiovascular Events Associated With Kopi Jantan

Othman MK, Yusof Z, Mohd Rossli NI, Mohd Fauzi MH, W Isa WYH

Cureus, 2024 Jan;16(1):e52344.
PMID: 38361715 DOI: 10.7759/cureus.52344

Energy drinks (EDs) are widely accessible worldwide. In Malaysia, it is common for EDs to be premixed with sexual stimulants. ED consumption has been shown to have an association with cardiac arrest, myocardial infarction, spontaneous coronary artery dissection, and coronary vasospasm. In addition to this, EDs are associated with arrhythmias, which significantly prolong the QTc interval. Myocardial infarction with no obstructive coronary artery disease (MINOCA) is defined as a patient presenting with myocardial infarction with no obstructive coronary artery disease or ≤50% stenosis. It is a challenging and complex pathophysiology compared to obstructive coronary artery disease. MINOCA is more frequently associated with younger patients and women. Here, we report two cases related to a Malaysian local energy drink Kopi Jantan, which presented with atrial flutter and MINOCA.
Fulltext Ocular syphilis: resurgence of an old disease in modern Malaysian society

Mustapha M, Abdollah Z, Ahem A, Mohd Isa H, Bastion MC, Din NM

Int J Ophthalmol, 2018;11(9):1573-1576.
PMID: 30225238 DOI: 10.18240/ijo.2018.09.25
Fulltext Are medical students confident in taking a sexual history? An assessment on attitude and skills from an upper middle income country

Ariffin F, Chin KL, Ng C, Miskan M, Lee VK, Isa MR

BMC Res Notes, 2015;8:248.
PMID: 26082003 DOI: 10.1186/s13104-015-1220-y

BACKGROUND: Sexual history training during undergraduate education is essential for preparing future doctors to handle patients' sexual health concerns. The purpose of this study was to assess the attitudes and perceptions of final-year medical students in Malaysia toward sexual history taking and the training they receive from their medical schools.
METHODS: The study used a cross-sectional survey of 379 final-year medical students from three medical schools in Malaysia. Students were asked to rate their attitudes and perceptions regarding training on taking sexual histories using a newly developed questionnaire with good internal consistency (Cronbach's alpha = 0.73). Ethics approval was obtained from the relevant medical schools, and the statistical analysis was conducted using SPSS, Version 20.0.
RESULTS: The mean age of participants was 23.58 ± 0.65 SD. Participants reported high interest in sexual health and felt it was important for doctors to know how to take a sexual history (95%). Among the participants, only half felt comfortable in taking sexual histories from patients. The participants identified cultural and religious differences between the doctor and the patient as a potential barrier for discussing sexual health. Participants were aware of their own practice and ability, as well as their limitations, in taking sexual histories. Less than half (46%) felt that the training they received adequately prepared them to take sexual histories.
CONCLUSIONS: This study identified gaps in sexual health training among medical schools in Malaysia. The delivery of sexual health education program should incorporate confidence building and to make students feel comfortable to take sexual histories from patients. The barrier caused by differences in culture or religion between a doctor and a patient may be overcome through cross cultural and cultural competency training. This is important for multi-faith, multi cultural societies such as Malaysia and other similar countries.
Fulltext Computer-aided segmentation system for breast MRI tumour using modified automatic seeded region growing (BMRI-MASRG)

Al-Faris AQ, Ngah UK, Isa NA, Shuaib IL

J Digit Imaging, 2014 Feb;27(1):133-44.
PMID: 24100762 DOI: 10.1007/s10278-013-9640-5

In this paper, an automatic computer-aided detection system for breast magnetic resonance imaging (MRI) tumour segmentation will be presented. The study is focused on tumour segmentation using the modified automatic seeded region growing algorithm with a variation of the automated initial seed and threshold selection methodologies. Prior to that, some pre-processing methodologies are involved. Breast skin is detected and deleted using the integration of two algorithms, namely the level set active contour and morphological thinning. The system is applied and tested on 40 test images from the RIDER breast MRI dataset, the results are evaluated and presented in comparison to the ground truths of the dataset. The analysis of variance (ANOVA) test shows that there is a statistically significance in the performance compared to the previous segmentation approaches that have been tested on the same dataset where ANOVA p values for the evaluation measures' results are less than 0.05, such as: relative overlap (p = 0.0002), misclassification rate (p = 0.045), true negative fraction (p = 0.0001) and sum of true volume fraction (p = 0.0001).
Hidden bugs in a newly opened hospital: the distribution of skin microbiota among healthcare workers in a newly opened teaching hospital

Kamala Nathan M, Jasni AS, Zakariah SZ, Tengku Jamaluddin TZM, Mohd Isa M, Ibrahim R

J Med Microbiol, 2023 Jul;72(7).
PMID: 37432079 DOI: 10.1099/jmm.0.001732

Background. Skin is a reservoir for millions of micro-organisms, all of which make up the skin microbiota. Hospitals have been identified as a favourable environment for transmitting micro-organisms and thus, it is important to know the distribution of skin microbiota among healthcare workers (HCWs), as such findings may provide baseline information for the distribution of skin microbiota in hospitals.Hypothesis. There is no significant association between the factors (age, gender, type of skin microenvironment, hand hygiene practices, usage of skin care products, current healthcare practices and previous workplace) and the distribution of the skin microbiota among HCWs.Aim. The study aims to identify type of skin microbiota and associated factors (age, gender, type of skin microenvironment, hand hygiene practices, use of skincare products, current healthcare practice, and previous workplace) that influence the growth of skin microbiota.Method. About 102 bacterial isolates were obtained from the skin of 63 healthcare workers in a newly opened teaching hospital, namely Hospital Pengajar Universiti Putra Malaysia (HPUPM). All isolated bacteria were subjected to phenotypic identification according to standard microbiological procedures.Results. The most common isolated skin microbiota were Gram-positive bacteria (84.3%), followed by Gram-negative bacteria (15.7%). A Chi-square test of independence was used to analyse the above factors and there was a significant association between the type of skin microenvironment and the distribution of skin microbiota (P=0.03) (type of skin microenvironment influences the distribution of skin microbiota).Conclusion. Coagulase-negative Staphylococcus spp. was the most common bacteria isolated from the skin of the healthcare workers. Even though coagulase-negative staphylococci (CoNS) are low pathogenic bacteria, but it may cause serious infection in high risk group of patients. Therefore, it is important to emphasize on the good hand hygiene practices and implement strict infection control measures to minimize the risk of HAI in newly opened hospitals.

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