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Fulltext Knowledge, attitude, and practice regarding the risk of cardiovascular diseases in patients attending outpatient clinic in Kuantan, Malaysia

Mohammad NB, Rahman NAA, Haque M

J Pharm Bioallied Sci, 2018 4 17;10(1):7-14.
PMID: 29657502 DOI: 10.4103/jpbs.JPBS_227_17

Background: Cardiovascular disease (CVD) is a leading cause of death around the world including Malaysia. Ischemic heart disease (IHD) is the single largest cause of death in the developed countries and is one of the main contributors to the disease burden in developing countries.
Materials and Methods: This was a cross-sectional study conducted to determine knowledge, attitude, and practice (KAP) regarding the risk of CVD in patients attending an outpatient clinic in Kuantan, Malaysia. A total of 100 patients comprising 52 male and 48 female subjects were selected through convenient sampling method.
Results: Of the total subjects, 86% were Malays. The mean scores (standard deviation) for KAP were 60.75±4.823, 54.36±8.711, and 33.43±4.046, respectively, whereas the maximum scores obtained by the subjects for KAP were 71, 65, and 43, respectively. Regarding questions related to knowledge, 88% subjects knew irregular eating pattern can cause disease and the benefits of vegetable intake. Most subjects recognized that smoking and obesity were CVD risk factors. Regarding questions related to attitude, 96% agreed that exercise can prevent CVD. More than half of the subjects followed healthy lifestyle. There were statistically significant differences observed in knowledge level between sexes (P = 0.046) and races (P = 0.001). Nevertheless, there was no statistically significant difference observed in KAP across different education levels of the subjects regarding the risk of CVD (P-value = 0.332, 0.185, and 0.160, respectively).
Conclusion: This study revealed that patients had good knowledge and attitude regarding CVD risk factors. Yet, the number of smokers is still quite high. Development of better public information system is essential for the well-being of the society.
Fulltext Knowledge, Attitude, and Practice toward Food Poisoning among Food Handlers and Dietetic Students in a Public University in Malaysia

Mohd Yusof AM, Rahman NAA, Haque M

J Pharm Bioallied Sci, 2018 12 21;10(4):232-239.
PMID: 30568381 DOI: 10.4103/JPBS.JPBS_141_18

Background: Food poisoning (FP) commonly occurs because of consuming contaminated food, which can be fatal. Many people are not aware of the dangers of FP. Thus, the purpose of this study is to analyze the knowledge, attitude, and practice (KAP) of FP among dietetic students (DS) and food handlers (FH) in a public university in Malaysia.
Materials and Methods: A cross-sectional study was designed, and a self-administered questionnaire was distributed to 106 respondents. The survey comprised four sections including sociodemographic, knowledge, attitude, and practice.
Results: Total percentage scores for KAP for FH were 86.06%, 32.40%, and 19.91%, respectively, whereas the KAP scores for DS were 89.36%, 34.26%, and 19.94%, respectively. This study revealed that the respondents had good knowledge but poor attitude and practice toward FP. Total mean percentage of KAP scores for DS was higher than FH. Besides, no significant difference was observed in KAP toward FP across different genders, age, education, and income levels among FH. However, for DS, significant difference (p = 0.008) was observed in knowledge toward FP between genders. Significant association (p = 0.048) was also reported in practice toward FP with age among DS. This study also found a significant association between knowledge and attitude (p = 0.032) and knowledge and practice (p = 0.017) toward FP among FH.
Conclusion: Nevertheless, among DS, no significant association was observed between knowledge, attitude and practice toward FP. The findings may help them to plan effective methods to promote better understanding about FP and improving their knowledge and awareness.
Fulltext Unsupervised bivariate data clustering for damage assessment of carbon fiber composite laminates

May Z, Alam MK, Mahmud MS, Rahman NAA

PLoS One, 2020;15(11):e0242022.
PMID: 33186372 DOI: 10.1371/journal.pone.0242022

Damage assessment is a key element in structural health monitoring of various industrial applications to understand well and predict the response of the material. The big uncertainty in carbon fiber composite materials response is because of variability in the initiation and propagation of damage. Developing advanced tools to design with composite materials, methods for characterizing several damage modes during operation are required. While there is a significant amount of work on the analysis of acoustic emission (AE) from different composite materials and many loading cases, this research focuses on applying an unsupervised clustering method for separating AE data into several groups with distinct evolution. In this paper, we develop an adaptive sampling and unsupervised bivariate data clustering techniques to characterize the several damage initiations of a composite structure in different lay-ups. An adaptive sampling technique pre-processes the AE features and eliminates redundant AE data samples. The reduction of unnecessary AE data depends on the requirements of the proposed bivariate data clustering technique. The bivariate data clustering technique groups the AE data (dependent variable) with respect to the mechanical data (independent variable) to assess the damage of the composite structure. Tensile experiments on carbon fiber reinforced composite laminates (CFRP) in different orientations are carried out to collect mechanical and AE data and demonstrate the damage modes. Based on the mechanical stress-strain data, the results show the dominant damage regions in different lay-ups of specimens and the definition of the different states of damage. In addition, the states of the damage are observed using Scanning Electron Microscope (SEM) analysis. Based on the AE data, the results show that the strong linear correlation between AE and mechanical energy, and the classification of various modes of damage in all lay-ups of specimens forming clusters of AE energy with respect to the mechanical energy. Furthermore, the validation of the cluster-based characterization and improvement of the sensitivity of the damage modes classification are observed by the combined knowledge of AE and mechanical energy and time-frequency spectrum analysis.
Fulltext Knowledge, attitude and practice regarding hypertension among residents in a housing area in Selangor, Malaysia

Buang NFB, Rahman NAA, Haque M

Med Pharm Rep, 2019 Apr;92(2):145-152.
PMID: 31086842 DOI: 10.15386/mpr-1227

Background and aims: Hypertension is becoming a global epidemic and threat to the world population. This cross-sectional study was carried out at a housing area in Selangor, Malaysia to study the knowledge, attitude and practice (KAP) regarding hypertension among the residents.
Methods: A total of 110 respondents aged 18 years old and above were selected by convenience sampling. Data was collected using a structured interviewer-guided questionnaire with Likert-scale choices of answers.
Results: All respondents were Malay with the mean age of 41 years [Standard Deviation (SD)=11.828]. The total mean and SD of knowledge, attitude and practice scores were 74.33 (SD=6.25), 44.22 (SD=5.05) and 27.55 (SD=2.86), respectively. There were significant positive correlations between knowledge with attitude (r=+0.393; p<0.001) and practice (r=+0.378; p<0.001). However, there was no significant correlation between attitude and practice (r=+0.120; p=0.212). There were significant fair positive correlations between age with knowledge (r=+0.402; p<0.001), attitude (r=+0.265; p=0.005) and practice (r=+0.337; p<0.001) regarding hypertension. Meanwhile, gender, educational level, employment status and family history had no significant association with knowledge, attitude and practice regarding hypertension.
Conclusion: This study revealed that KAP regarding hypertension were associated with age, but not with other socio-demographic characteristics studied. The awareness, prevention and control programs of hypertension in their community should be increased, so that the residents could enjoy and maintain the healthy lifestyle.
Implementing primary eye care in private practises in Malaysia: the challenges faced by optometrists

Yahaya NA, Musa A, Azemin MZC, Rahman NAA

Med J Malaysia, 2023 May;78(3):357-363.
PMID: 37271846

OBJECTIVE: In Malaysia, optometrists' role in the private sector is limited compared to their counterparts elsewhere. Primary eye care (PEC) is still not widely offered in private practises despite its demand to reduce the public's eye morbidity. This study aims to explore the challenges perceived by the private sector optometrists in implementing PEC in Malaysia.
MATERIALS AND METHODS: In-depth interview using semistructured open-ended questions were designed to explore the challenges of implementing PEC. Fifteen private optometrists across Malaysian were interviewed via purposive sampling until the data were saturated. The interviews were audio-recorded, transcribed and analysed.
RESULTS: Four major themes emerged: working environment, support and recognition, self-sufficiency and customer influence. The first major theme identified a lack of time and equipment in the workplace as a barrier to PEC implementation. The second major theme acknowledges the lack of support and recognition for PEC practise from financial bodies, the government, Malaysian Optical Council (MOC) and other eye professionals. Meanwhile, some practising optometrists faced significant challenges due to their lack of self-sufficiency regarding skills, knowledge and confidence. The final major theme, customer influence, reflects the customer's role in shaping eye care delivery through their perception and acceptance of PEC.
CONCLUSION: Each of the issues identified played a significant impact in impeding PEC implementation in Malaysia. This study is the first step toward developing tailored interventions to improve eye care delivery in Malaysia.
Fulltext Failure Severity Prediction for Protective-Coating Disbondment via the Classification of Acoustic Emission Signals

Rahman NAA, May Z, Jaffari R, Hanif M

Sensors (Basel), 2023 Jul 31;23(15).
PMID: 37571616 DOI: 10.3390/s23156833

Structural health monitoring is a popular inspection method that utilizes acoustic emission (AE) signals for fault detection in engineering infrastructures. Diagnosis based on the propagation of AE signals along any surface material offers an attractive solution for fault identification. However, the classification of AE signals originating from failure events, especially coating failure (coating disbondment), is a challenging task given the AE signature of each material. Thus, different experimental settings and analyses of AE signals are required to classify the various types of coating failures, and they are time-consuming and expensive. Hence, to address these issues, we utilized machine learning (ML) classification models in this work to evaluate epoxy-based-protective-coating disbondment based on the AE principle. A coating disbondment experiment consisting of coated carbon steel test panels for the collection of AE signals was implemented. The obtained AE signals were then processed to construct the final dataset to train various state-of-the-art ML classification models to divide the failure severity of coating disbondment into three classes. Consequently, methods for the extraction of useful features, the handling of data imbalance, and a reduction in the bias of ML models were also effectively utilized in this study. Evaluations of state-of-the-art ML classification models on the AE signal dataset in terms of standard metrics revealed that the decision forest classification model outperformed the other state-of-the-art models, with accuracy, precision, recall, and F1 score values of 99.48%, 98.76%, 97.58%, and 98.17%, respectively. These results demonstrate the effectiveness of utilizing ML classification models for the failure severity prediction of protective-coating defects via AE signals.
Fulltext Comparative Study of CDST & Multiplex PCR to Detect MBL Producing Gram-Negative Bacilli among VAP Patients Admitted in a Public Medical College Hospital of Bangladesh

Nusrat T, Akter N, Haque M, Rahman NAA, Dewanjee AK, Ahmed S, et al.

Pathogens, 2019 Sep 12;8(3).
PMID: 31547453 DOI: 10.3390/pathogens8030151

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICU), which accounts for 25% of all ICU infection. Documenting carbapenem-resistant gram-negative bacilli is very important as these strains may often cause outbreaks in the ICU setting and are responsible for the increased mortality and morbidity or limiting therapeutic options. The classical phenotypic method cannot provide an efficient means of diagnosis of the metallo-β-lactamases (MBLs) producer. Polymerase chain reaction (PCR) assays have lessened the importance of the phenotypic approach by detecting metallo-β-lactamase resistance genes such as New Delhi metallo-β-lactamase (NDM), Imipenemase (IMP), Verona integron-encoded metallo-β-lactamase (VIM), Sao Paulo metallo-β-lactamase (SPM), Germany Imipenemase (GIM).
OBJECTIVE: To compare the results of the Combined Disc Synergy Test (CDST) with that of the multiplex PCR to detect MBL-producing gram-negative bacilli.
MATERIALS AND METHOD: A total of 105 endotracheal aspirates (ETA) samples were collected from the ICU of a public school in Bangladesh. This cross-sectional study was carried out in the Department of Microbiology, Chittagong for quantitative culture, CDST test, and multiplex PCR for blaIMP, blaVIM, blaNDM genes of MBL producers.
RESULTS: Among the 105 clinically suspected VAP cases, the quantitative culture was positive in 95 (90%) and among 95 g-negative bacilli isolated from VAP patients, 46 (48.42%) were imipenem resistant, 30 (65.22%) were MBL producers by CDST, 21 (45.65%) were identified as MBL producers by multiplex PCR.
CONCLUSION: PCR was highly sensitive and specific for the detection of MBL producers.
Fulltext A Case of Large Perianal Mucinous Adenocarcinoma Arising from Recurrent Abscess and Complex Fistulae

Azmi FP, Rahman NAA, Mazlan L, Basiron N, Imran FH

Case Rep Surg, 2020;2020:1798543.
PMID: 33381344 DOI: 10.1155/2020/1798543

Mucinous adenocarcinoma of the perianal region is an oncologic rarity posing a diagnostic and therapeutic dilemma for treating oncologists. This is due to the low number of reported cases, compounded by the lack of definitive therapeutic guidelines. It accounts for 2% to 3% of all gastrointestinal malignancies and is historically known to arise from chronic anal fistulas and ischiorectal or perianal abscesses. We hereby report an interesting case of perianal mucinous adenocarcinoma in a 66-year-old male initially treated for a horseshoe abscess with complex fistulae. He presented with a 6-month history of a discharging growth in perianal region and painful defecation associated with occasional blood mixed stools. An incisional biopsy from the ulcer revealed mucinous adenocarcinoma. Contrast-enhanced computed tomography (CT) scan and magnetic resonance imaging (MRI) scan showed a localized perianal growth which involves the internal and external sphincter as well as suspicious involvement in the posterior aspect of the levator ani/puborectalis sling, which was further confirmed with colonoscopy (see figures). With no preset treatment protocol for this rare entity, he was managed with an abdominoperineal resection (APR) and vertical rectus abdominis myocutaneous flap (VRAM) tissue reconstruction. He had a turbulent postoperative period including intestinal obstruction secondary to internal herniation of bowel resulting in flap failure. The subsequent perineal wound was managed conservatively with advanced wound care and has since completely healed.
Antibiotic resistance and sensitivity pattern of Metallo-β-Lactamase Producing Gram-Negative Bacilli in ventilator-associated pneumonia in the intensive care unit of a public medical school hospital in Bangladesh

Nusrat T, Akter N, Rahman NAA, Godman B, D Rozario DT, Haque M

Hosp Pract (1995), 2020 Aug;48(3):128-136.
PMID: 32271642 DOI: 10.1080/21548331.2020.1754687

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICU), accounting for 25% of all ICU infections. Antimicrobial resistance is increasing and becoming a significant health problem worldwide, increasing hospital length of stay, mortality and costs. Identifying antibiotic resistance patterns in VAP is important as this can cause outbreaks in ICUs. To date, there have been limited studies assessing this in Bangladesh. Consequently, the primary objective of this research was to study the species of bacterial growth and to determine the antibiotic resistance patterns of Metallo-β-Lactamase (MBL) producing gram-negative bacilli among ICU patients with VAP in a public medical school hospital, Bangladesh. In addition, identify the factors associated with a positive culture to provide future guidance.
METHOD: Cross-sectional study performed in the Chattogram Medical College Hospital, Bangladesh. Mueller Hinton agar plates were used for antibiotic sensitivity testing by the Kirby-Buer disc diffusion test.
RESULTS: Among 105 clinically suspected VAP cases, qualitative cultures were positive in 95 (90%) of them. The most common bacteria identified were Acinetobacter spp. (43.2%), Klebsiella spp. (20%) and Pseudomonas spp. (18.9%). A positive culture was not associated with patients' age or gender. Among 41 isolated Acinetobacter spp., 38 (92.7%) were resistant to gentamicin followed by 36 (87.8%) to ceftriaxone. Among 24 isolated Klebsiella spp., 22 (83.3%) were resistant to ceftriaxone. Among 18 isolated Pseudomonas spp., 16 (88.8%) were resistant to ciprofloxacin, and 13 (72.2%) were resistant to ceftriaxone. Among nine isolated E.coli, all were resistant to ceftriaxone and ciprofloxacin. All four Proteus spp. (100%) isolated were resistant to ciprofloxacin. Additionally, phenotype MBL producing was 65.22% and genotype was 45.65% among imipenem resistant pathogens. Imipenem resistant pathogens were sensitive to amoxyclav, amikacin¸ azithromycin, ceftazidime, ceftriaxone, colistin and gentamycin.
CONCLUSION: A positive culture was detected in 90% of VAP patients, but it was not associated with the patients' age and gender. The most common bacteria identified were Acinetobacter spp., Klebsiella spp. and Pseudomonas spp., where the majority of these were resistant to ceftriaxone. The results are being used to provide future guidance on the empiric management of VAP in this hospital.
Fulltext Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries

Haque M, Islam T, Rahman NAA, McKimm J, Abdullah A, Dhingra S

Risk Manag Healthc Policy, 2020;13:409-426.
PMID: 32547272 DOI: 10.2147/RMHP.S239074

The prevalence of long-term (chronic) non-communicable diseases (NCDs) is increasing globally due to an ageing global population, urbanization, changes in lifestyles, and inequitable access to healthcare. Although previously more common in high- and upper-middle-income countries, lower-middle-income countries (LMICs) are more affected, with NCDs in LMICs currently accounting for 85-90% of premature deaths among 30-69 years old. NCDs have both high morbidity and mortality and high treatment costs, not only for the diseases themselves but also for their complications. Primary health care (PHC) services are a vital component in the prevention and control of long-term NCDs, particularly in LMICs, where the health infrastructure and hospital services may be under strain. Drawing from published studies, this review analyses how PHC services can be utilized and strengthened to help prevent and control long-term NCDs in LMICs. The review finds that a PHC service approach, which deals with health in a comprehensive way, including the promotion, prevention, and control of diseases, can be useful in both high and low resource settings. Further, a PHC based approach also provides opportunities for communities to better access appropriate healthcare, which ensures more significant equity, efficiency, effectiveness, safety, and timeliness, empowers service users, and helps healthcare providers to achieve better health outcomes at lower costs.
Fulltext Bioprospecting microwave-alkaline hydrolysate cocktail of defatted soybean meal and jackfruit peel biomass as carrier additive of molasses-alginate-bead biofertilizer

Roslan MAM, Sobri ZM, Zuan ATK, Cheak SC, Rahman NAA

Sci Rep, 2022 01 07;12(1):254.
PMID: 34996897 DOI: 10.1038/s41598-021-02170-w

The extraction of soluble hydrolysate protein and sugar from a biomass cocktail of defatted soybean meal (DSM) and jackfruit peel (JP) was examined using microwave-alkaline hydrolysis by varying the NaOH concentrations (0.04-0.11 M) and residence times (2-11 min). Based on the central composite design, the optimized parameters were achieved at 0.084 M NaOH concentration (100 mL), for 8.7 min at 300 W microwave power level to obtain the highest protein (5.31 mg/mL) and sugar concentrations (8.07 mg/mL) with > 75% recovery. Both raw and detoxified hydrolysate (using activated carbon) were correspondingly biocompatible with Enterobacter hormaechei strain 40a (P > 0.05) resulting in maximal cell counts of > 10 log CFU/mL. The optimized hydrolysate was prepared as an additive in molasses-alginate bead encapsulation of strain 40a. Further evaluation on phosphate and potassium solubilization performance of the encapsulated strain 40a exhibited comparable results with those of free cell counterpart (P > 0.05). The DSM-JP hydrolysate cocktail holds potential as a carrier additive of encapsulated-cell bead biofertilizers in order to sustain bacterial cell quality and consequently improve crop growth and productivity.
Fulltext Acoustic emission corrosion feature extraction and severity prediction using hybrid wavelet packet transform and linear support vector classifier

May Z, Alam MK, Nayan NA, Rahman NAA, Mahmud MS

PLoS One, 2021;16(12):e0261040.
PMID: 34914761 DOI: 10.1371/journal.pone.0261040

Corrosion in carbon-steel pipelines leads to failure, which is a major cause of breakdown maintenance in the oil and gas industries. The acoustic emission (AE) signal is a reliable method for corrosion detection and classification in the modern Structural Health Monitoring (SHM) system. The efficiency of this system in detection and classification mainly depends on the suitable AE features. Therefore, many feature extraction and classification methods have been developed for corrosion detection and severity assessment. However, the extraction of appropriate AE features and classification of various levels of corrosion utilizing these extracted features are still challenging issues. To overcome these issues, this article proposes a hybrid machine learning approach that combines Wavelet Packet Transform (WPT) integrated with Fast Fourier Transform (FFT) for multiresolution feature extraction and Linear Support Vector Classifier (L-SVC) for predicting corrosion severity levels. A Laboratory-based Linear Polarization Resistance (LPR) test was performed on carbon-steel samples for AE data acquisition over a different time span. AE signals were collected at a high sampling rate with a sound well AE sensor using AEWin software. Simulation results show a linear relationship between the proposed approach-based extracted AE features and the corrosion process. For multi-class problems, three corrosion severity stages have been made based on the corrosion rate over time and AE activity. The ANOVA test results indicate the significance within and between the feature-groups where F-values (F-value>1) rejects the null hypothesis and P-values (P-value<0.05) are less than the significance level. The utilized L-SVC classifier achieves higher prediction accuracy of 99.0% than the accuracy of other benchmarked classifiers. Findings of our proposed machine learning approach confirm that it can be effectively utilized for corrosion detection and severity assessment in SHM applications.
Fulltext Microbial Resistance Movements: An Overview of Global Public Health Threats Posed by Antimicrobial Resistance, and How Best to Counter

Dhingra S, Rahman NAA, Peile E, Rahman M, Sartelli M, Hassali MA, et al.

Front Public Health, 2020;8:535668.
PMID: 33251170 DOI: 10.3389/fpubh.2020.535668

Antibiotics changed medical practice by significantly decreasing the morbidity and mortality associated with bacterial infection. However, infectious diseases remain the leading cause of death in the world. There is global concern about the rise in antimicrobial resistance (AMR), which affects both developed and developing countries. AMR is a public health challenge with extensive health, economic, and societal implications. This paper sets AMR in context, starting with the history of antibiotics, including the discovery of penicillin and the golden era of antibiotics, before exploring the problems and challenges we now face due to AMR. Among the factors discussed is the low level of development of new antimicrobials and the irrational prescribing of antibiotics in developed and developing countries. A fundamental problem is the knowledge, attitude, and practice (KAP) regarding antibiotics among medical practitioners, and we explore this aspect in some depth, including a discussion on the KAP among medical students. We conclude with suggestions on how to address this public health threat, including recommendations on training medical students about antibiotics, and strategies to overcome the problems of irrational antibiotic prescribing and AMR.
Fulltext The Protective Effect of Maternal Folic Acid Supplementation on Childhood Cancer: A Systematic Review and Meta-analysis of Case-control Studies

Wan Ismail WR, Abdul Rahman R, Rahman NAA, Atil A, Nawi AM

J Prev Med Public Health, 2019 Jul;52(4):205-213.
PMID: 31390683 DOI: 10.3961/jpmph.19.020

OBJECTIVES: Maternal folic acid supplementation is considered mandatory in almost every country in the world to prevent congenital malformations. However, little is known about the association of maternal folic acid intake with the occurrence of childhood cancer. Hence, this study aimed to determine the effects of maternal folic acid consumption on the risk of childhood cancer.
METHODS: A total of 158 related articles were obtained from PubMed, Google Scholar, Scopus, and ProQuest using standardized keywords, of which 17 were included in the final review.
RESULTS: Eleven of the 17 articles showed a significant protective association between maternal folic acid supplementation and childhood cancer. Using a random-effects model, pooled odds ratios (ORs) showed a protective association between maternal folic acid supplementation and childhood acute lymphoblastic leukaemia (OR, 0.75; 95% confidence interval [CI], 0.66 to 0.86). However, there was no significant association between maternal folic acid supplementation and acute myeloid leukaemia (OR, 0.70; 95% CI, 0.46 to 1.06) or childhood brain tumours (OR, 1.02; 95% CI, 0.88 to 1.19).
CONCLUSIONS: Maternal folic acid supplementation was found to have a protective effect against childhood acute lymphoblastic leukaemia. Thus, healthcare professionals are recommended to provide regular health education and health promotion to the community on the benefits of folic acid supplementation during pregnancy.
Fulltext The Proposed Future Infrastructure Model for Basic Occupational Health Services in Malaysia

Samsuddin N, Razali A, Rahman NAA, Yusof MZ, Mahmood NAKN, Hair AFA

Malays J Med Sci, 2019 Mar;26(2):131-137.
PMID: 31447616 MyJurnal DOI: 10.21315/mjms2019.26.2.14

The objectives of occupational health services (OHS) are to create a healthy and safe working environment, prevent work-related diseases, optimise employees' functional capacity and promote health. According to the literature, global accessibility to OHS has not shown much improvement and even worsened in certain countries. The main challenges come from the small and medium enterprises (SMEs). To respond to these global challenges, the basic occupational health services (BOHS) guideline was published under the purview of the World Health Organization and the International Labour Organization. The guideline describes BOHS as part of the infrastructure called the occupational safety and health system, an essential element that ensures the high service coverage and sustainability of the programme. The BOHS guideline was introduced in Malaysia by the Department of Occupational Safety and Health with a focus on SMEs, but its accessibility is low. A gap analysis was conducted between the current BOHS in Malaysia and the published international guideline. The important challenges identified that contributes to the low BOHS accessibility in Malaysia is the weakness in the BOHS infrastructure and OHS system provision. The proposed BOHS infrastructure model is meant to increase accessibility and to provide fair and equitable health services for Malaysians.
Fulltext Comparing the Outcomes of Early and Late Tracheostomy in Severe Traumatic Brain Injury Patient

Ismail MI, Idris Z, Abdullah JM, Rahman NAA, Nordin M

Malays J Med Sci, 2021 Aug;28(4):63-70.
PMID: 34512131 DOI: 10.21315/mjms2021.28.4.7

Background: Patients with severe traumatic brain injury (TBI) were expected to have poor Glasgow Coma Scale (GCS) recovery and prolonged intubation. Therefore, an early tracheostomy procedure was indicated for all severe TBI. In view of growing concern regarding the safety and outcome of early tracheostomy on these patients, it was deemed valid and needed to be addressed.
Methods: This study was conducted to compare the outcomes of early and late tracheostomies in severe TBI. Only severe TBI patients who were admitted to the Neurosurgery High Dependency Unit (NHDU), Hospital Sultanah Aminah (HSA), Johor Bahru, Johor, Malaysia and who had underwent a tracheostomy were recruited. Three main outcomes noted: duration on ventilation, length of NHDU stay and rate of ventilator associated pneumonia (VAP).
Results: Out of 155 patients, 72 (46.5%) were in early tracheostomy group (ETG) and 83 (53.5%) were in late tracheostomy group (LTG). The majority of the participants, 95 (61.3%) were ethnic Malays. The mean duration on ventilator use was 2.65 days (1.57) for ETG and 5.63 days (2.35) for LTG. While, mean NHDU stay was 4.75 days (1.98) for ETG and 9.77 days (2.70) for LTG. Upon independent t-test, early duration of tracheostomies had shown significant outcome in reducing length of NHDU stay, (P < 0.001) and had shortening participants' time on mechanical ventilator (P < 0.001). Then, based on forward multiple logistic regression test, there were significant association between comorbid (P = 0.003) and tracheostomy (P = 0.020) towards presence of VAP when adjusted for other variables.
Conclusion: In this study it was found that early tracheostomy was significant in shortening the duration on ventilator, reducing the length of NHDU stay and reducing the rate of VAP.
Fulltext Response Surface Optimization of Extraction Conditions and In Vitro Antioxidant and Antidiabetic Evaluation of an Under-Valued Medicinal Weed, Mimosa pudica

Baharuddin NS, Roslan MAM, Bawzer MAM, Mohamad Azzeme A, Rahman ZA, Khayat ME, et al.

Plants (Basel), 2021 Aug 18;10(8).
PMID: 34451737 DOI: 10.3390/plants10081692

Mimosa pudica Linn is a well-known perennial herb and is traditionally used in ayurvedic medicine for the treatment of various illnesses. Despite its abundance in nature, the therapeutic potential of this invasive weed is deemed to be underappreciated in Malaysia. Previous studies have found an abundance of bioactive compounds associated with potent antioxidant properties in all parts of the plant. However, the optimum parameters required for the extraction of antioxidant compounds are still unknown. Therefore, the present study aimed to optimize the solvent extraction parameters of M. pudica using response surface methodology to enrich the accumulation of antioxidant compounds in the extracts. The effects of the optimized M. pudica extracts were then evaluated on the cell viability and glucose uptake ability in a 3T3-L1 adipocyte cell line. The highest total phenolic (91.98 mg of gallic acid equivalent per g of the dry extract) and total flavonoid content (606.31 mg of quercetin equivalent per g of the dry extract) were recorded when using 100% ethanol that was five-fold and three-fold higher, respectively, as compared to using 50% ethanol. The extract concentration required to achieve 50% of antioxidant activity (IC50 value) was 42.0 µg/mL using 100% ethanol as compared to 975.03 µg/mL using 50% ethanol. The results indicated that the use of 100% ethanol solvent had the greatest impact on the accumulation of antioxidant compounds in the extract (p < 0.05). Cell viability assay revealed that all extract concentration treatments recorded a viability level of above 50%. Glucose uptake assay using 2-NBDG analog showed that the cells treated with 50 µg/mL extract combined with insulin were five-fold higher than the control group. Given the high antioxidant and antidiabetic properties of this plant, M. pudica can be easily highlighted as a plant subject of interest, which warrants further investigation for nutraceutical prospects.
Fulltext Mitigating mutual coupling effects on circular polarization for improved bandwidth in MIMO systems: A novel approach

Ali A, Yasin MNM, Adam I, Ismail AM, Jack SP, Alghaihab A, et al.

Heliyon, 2024 Mar 30;10(6):e27782.
PMID: 38524620 DOI: 10.1016/j.heliyon.2024.e27782

An improved mutual coupling compensation in circularly polarized (CP) multi-input multi-output (MIMO) dielectric resonator antenna (DRA) is presented in this paper. Using trimming approach, the mutual coupling (MC) between closely spaced DRA units at 0.3λ has been significantly reduced while axial ratio performance has been maintained. Mutual coupling reduction is obtained by trimming the DRA to ensure low mutual coupling below -20dB. The exclusive features of the proposed MIMO DRA include wide impedance matching bandwidth (BW), triple band circular polarization, and suppressed MC between the radiating elements. The impedance bandwidth matches perfectly with a triple band's 3 dB axial ratio (AR). It is designed with characteristic mode analysis with good agreement of the measurement that has been obtained. Using the probe feed method, the DRA and patch strip are coupled together to allow bandwidth widening of the pro-posed DRA. An impedance bandwidth of 34% at a lower frequency to around 2% at a higher frequency was achieved in all resonance frequencies. Thus, we refer to our newly designed DRA as a proposed method for effectively reducing the mutual coupling between DRAs. Additionally, the 3 dB AR bandwidth matched at 3.3 GHz, 4.6 GHz, and 6.3 GHz with a percentage of 11.66%, 3.04%, and 2.22% obtained at the three different frequencies. Note that the proposed DRA exhibits low mutual coupling (below -20 dB) at the targeted frequencies, which is suitable for better signal reception for MIMO applications. By computing, the metrics envelop correlation coefficient, diversity gain, channel capacity loss, and total active reflection coefficient, the MIMO performance of the proposed antenna is verified. The experiments show a close result between simulated and computed validation of the proposed DRA.
Fulltext Chronic Anterior Pituitary Dysfunction Following Traumatic Head Injury: Prospective Study in Hospital Sultanah Aminah Johor Bahru, Malaysia

Mohd Salleh N, Theophilus SC, Rahman NAA, Ghani ARI, Abdullah JM, Idris Z, et al.

Malays J Med Sci, 2023 Feb;30(1):107-115.
PMID: 36875199 DOI: 10.21315/mjms2023.30.1.9

BACKGROUND: Hypopituitarism following traumatic brain injury (TBI) is not rare however most patients were left undiagnosed and untreated. Association of post TBI hypopituitarism causing neurobehavioural and quality of life impairment. The aim of the study is to determine the incidence of the chronic anterior pituitary deficiency in patients with traumatic brain injury. Subsequently determine the risk factor and the outcome of the patient with chronic anterior pituitary dysfunction.
METHODS: This is single centre cross-sectional study involved 105 traumatic head injury patients under the Neurosurgical Department Hospital Sultanah Aminah, Johor Bahru, Malaysia. The primary investigator will do an interview and the patients will be asked question to complete a questioner from SF-36 (36 questions). Subsequently, consent for participation will be taken and blood sampling will be done.
RESULTS: Thirty-three patients were noted to have anterior pituitary dysfunction. The mean age was 36.97 ± 12.96 years old. Twenty-seven patients (32.5%) were male and six patients were female (27.3%). Chronic anterior pituitary dysfunction in patients with a severe traumatic head injury around 47.1% (23 patients), as compared to a moderate head injury (8 patients, 38.1%) and 2 sustained mild head injury (5.6%). The mean duration after the onset of trauma was 10.3 ± 1.79 months. All patient with anterior pituitary dysfunction had positive CT brain findings with 22 had subarachnoid haemorrhage (SAH) at the basal cistern and 27 patients had a base of skull fracture, where 52.1% of the patient underwent surgical intervention, 84.8% involved one axis and another 5 patients had two axes involved. Severity of the head injury (P < 0.001), prolonged duration of hospital stay (P = 0.014), radiological findings of a base of skull fracture (P < 0.001) and presence of SAH at basal cistern (P < 0.001) was significantly associated with pituitary dysfunction. The patient with anterior pituitary dysfunction has the lower 36-item Short Form Survey (SF-36) marks 56.3 ± 10.3.
CONCLUSION: The prevalence of hypopituitarism was 31%. Indicators are increased TBI severity, prolonged hospitalisation and positive finding in radiological assessment. Post-traumatic chronic anterior pituitary dysfunction also related with poor quality of life as showed by low SF-36 marks.
Fulltext Genotypic to Phenotypic Resistance Discrepancies Identified Involving β-Lactamase Genes, blaKPC, blaIMP, blaNDM-1, and blaVIM in Uropathogenic Klebsiella pneumoniae

Urmi UL, Nahar S, Rana M, Sultana F, Jahan N, Hossain B, et al.

Infect Drug Resist, 2020;13:2863-2875.
PMID: 32903880 DOI: 10.2147/IDR.S262493

Introduction: Klebsiella pneumoniae carbapenemase (KPC) belongs to the Group-A β-lactamases that incorporate serine at their active site and hydrolyze various penicillins, cephalosporins, and carbapenems. Metallo-beta-lactamases (MBLs) are group-B enzymes that contain one or two essential zinc ions in the active sites and hydrolyze almost all clinically available β-lactam antibiotics. Klebsiella pneumoniae remains the pathogen with the most antimicrobial resistance to KPC and MBLs.
Methods: This research investigated the blaKPC, and MBL genes, namely, blaIMP, blaVIM, and blaNDM-1 and their phenotypic resistance to K. pneumoniae isolated from urinary tract infections (UTI) in Bangladesh. Isolated UTI K. pneumoniae were identified by API-20E and 16s rDNA gene analysis. Their phenotypic antimicrobial resistance was examined by the Kirby-Bauer disc diffusion method, followed by minimal inhibitory concentration (MIC) determination. blaKPC, blaIMP, blaNDM-1, and blaVIM genes were evaluated by polymerase chain reactions (PCR) and confirmed by sequencing.
Results: Fifty-eight K. pneumoniae were identified from 142 acute UTI cases. Their phenotypic resistance to amoxycillin-clavulanic acid, cephalexin, cefuroxime, ceftriaxone, and imipenem were 98.3%, 100%, 96.5%, 91.4%, 75.1%, respectively. Over half (31/58) of the isolates contained either blaKPC or one of the MBL genes. Individual prevalence of blaKPC, blaIMP, blaNDM-1, and blaVIM were 15.5% (9), 10.3% (6), 22.4% (13), and 19% (11), respectively. Of these, eight isolates (25.8%, 8/31) were found to have two genes in four different combinations. The co-existence of the ESBL genes generated more resistance than each one individually. Some isolates appeared phenotypically susceptible to imipenem in the presence of blaKPC, blaIMP, blaVIM, and blaNDM-1 genes, singly or in combination.
Conclusion: The discrepancy of genotype and phenotype resistance has significant consequences for clinical bacteriology, precision in diagnosis, the prudent selection of antimicrobials, and rational prescribing. Heterogeneous phenotypes of antimicrobial susceptibility testing should be taken seriously to avoid inappropriate diagnostic and therapeutic decisions.

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